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Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away


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3 minutes ago, JBJ said:

My understanding of the data:

1) CDC is tracking both separately (tested and suspected deaths) and requested states/hospitals to report both as well.  The published numbers are a combination of both.

2) Attribution doesn't matter right now.  Years down the road someome will parse the coroner reports for causes and co-morbidities and do an attribution study.  Right now the qualifications are (1) testing positive or suspected and (2) dying.

3) Various places are reporting deaths differently than the CDC guidelines.  They aren't compelled to be standardized.

4) Dead people probably wouldn't test positive even if you tested them.  Viral shed would be low if it exists at all.  This also goes back to my previous post where viral shed has usually already peaked before you hit peak symptoms.  If you are on the tail end of the disease, you might not get an accurate result.  If you are discovered a day later, even more so.  Viruses aren't going to last long without a host.

5) The scarcity of tests or difficulty getting tested was vastly overstated.  You'd expect a surge in cases with equal drop in rates if this was an impactful problem.  It'd also show up in random population studies in the areas testing was reported to be a problem.

6) False positive rates are known and low.  This is easy to know by testing aged blood from blood banks. 

False negatives are less certain and may be high.  The most certain way to figure false negatives is testing against a different test.  This is where the three-prong test comes in.  Two of the prongs are specific to SARS-COV-2.  When these produce different results, the sample goes to CDC for deeper analysis and confirmation.  If they confirm, then you know one leg failed.  You do this enough and you can determine the rate both will fail.  I'm not sure where on the curve we currently are.  It would take longer to nail down numbers the smaller they are.

The bigger problem with false negatives is the sampling.  If you don't get a good sample you'll get a false negative regardless of the test.  This could be double-digit %s for the nasal swab method that has to go deep into your brain.

7) There's zero incentive for hospitals to lie about test results.  They aren't going to be turned down for a COVID treatment for a patient if it is uncertain exactly which ILI disease they have.  The tests are better at confirming a treatment than ruling it out.

I don't think anyone(i'm not) is saying hospitals would lie about actual test results. I believe the question is how does one get to be a maybe and why wouldn't the CDC just have maybe column if they are tracking it.

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38 minutes ago, Brisketexan said:

"except now they tied a financial incentive to it.  It both over inflates the true case count and creates a perverse incentive, leading to the stark possibility of moral hazard."

There is a financial incentive to a jillion codes.  There always has been.  And how does that "overinflate the true case count?"  Come on, there's no evidence that someone coming in for a hangnail is being reported as a COVID case.  There's ALWAYS a possibility of this "moral hazard."  And I am NOT arguing that there is zero instances of that happening - imagine any bad act, and someone has probably committed it.  The issue is whether the phenomenon that you FEAR is statistically meaningful.

" It's amazing the mental gymnastics for perverse incentives with CEOs, corporate boards, etc most here are so quick to sentence to the gallows"

Well, where we've seen the evidence of ACTIONS driven by those incentives (e.g, shitty long-term planning driven by quarterly reporting trumping all else), then yes.  The existence of the incentive alone....particularly in a complex mix of factors...doesn't give us the basis to conclude that there is some wrongful action.

And if you want to look into the medicare fraud issue, give it a look.  It's rather rare that a HOSPITAL is popped for any meaningful fraud.  Almost all of it is by individual doctors and practices (the direct providers).  I have plenty of issues with how hospitals are run, but what you are postulating is just not how they operate.  I know and have worked with several hospital CEOs, and that's just not in play.  Again, not saying there are no bad actors in the world, but it's not a systemic issue.

I agree with you in that I don't think that Covid-19 medicare reimbursement is going to move the needle for hospitals. And I don't think its happening here (at least no evidence of it). But, uh, I can think of at least one prominent example of fraud claims involving a hospital system (the largest one): HCA's ~ 2 billion dollar settlement in 2003. 

Edited by Dahobbs
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18 minutes ago, Brisketexan said:

"except now they tied a financial incentive to it.  It both over inflates the true case count and creates a perverse incentive, leading to the stark possibility of moral hazard."

There is a financial incentive to a jillion codes.  There always has been.  And how does that "overinflate the true case count?"  Come on, there's no evidence that someone coming in for a hangnail is being reported as a COVID case.  There's ALWAYS a possibility of this "moral hazard."  And I am NOT arguing that there is zero instances of that happening - imagine any bad act, and someone has probably committed it.  The issue is whether the phenomenon that you FEAR is statistically meaningful.

" It's amazing the mental gymnastics for perverse incentives with CEOs, corporate boards, etc most here are so quick to sentence to the gallows"

Well, where we've seen the evidence of ACTIONS driven by those incentives (e.g, shitty long-term planning driven by quarterly reporting trumping all else), then yes.  The existence of the incentive alone....particularly in a complex mix of factors...doesn't give us the basis to conclude that there is some wrongful action.

And if you want to look into the medicare fraud issue, give it a look.  It's rather rare that a HOSPITAL is popped for any meaningful fraud.  Almost all of it is by individual doctors and practices (the direct providers).  I have plenty of issues with how hospitals are run, but what you are postulating is just not how they operate.  I know and have worked with several hospital CEOs, and that's just not in play.  Again, not saying there are no bad actors in the world, but it's not a systemic issue.

You are now arguing that incentives don't matter because so far, nobody has been seen or caught abusing them?  Nobody knows the statistical significance because nobody has taken the time to investigate.  Again, the point of a thought experiment as pointed out early on.  What you are saying, to use your example of CEOs "being caught", was that at the time, before their malfeasance, because nobody had yet been caught, to question their incentive structure was a waste of time and not "statistically meaningful".  That;s not how it works.  

We have had numerous physicians come out and publicly admit they have been pressured to attribute COVID as the COD.  Whether you believe them or not, what is their incentive to lie about this and risk their reputations and careers?  

 

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7 minutes ago, BabaYaga said:

You are now arguing that incentives don't matter because so far, nobody has been seen or caught abusing them?  Nobody knows the statistical significance because nobody has taken the time to investigate.  Again, the point of a thought experiment as pointed out early on.  What you are saying, to use your example of CEOs "being caught", was that at the time, before their malfeasance, because nobody had yet been caught, to question their incentive structure was a waste of time and not "statistically meaningful".  That;s not how it works.  

We have had numerous physicians come out and publicly admit they have been pressured to attribute COVID as the COD.  Whether you believe them or not, what is their incentive to lie about this and risk their reputations and careers?  

 

I'm aware of one. And he was a politician (incentive implied). 

Questioning whether some perverse billing incentive exists isn't inherently wrong. Implying that something is actually happening when there is no real evidence to support that assertion is the problem. And, if the hospitals really wanted to fraudulently make money, it isn't covid-19 that they'd use to do it. 

Edited by Dahobbs
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4 minutes ago, dcar00 said:

I don't think anyone(i'm not) is saying hospitals would lie about actual test results. I believe the question is how does one get to be a maybe and why wouldn't the CDC just have maybe column if they are tracking it.

Dunno why CDC published data the way that they do.

Better explanation of how this works: You get to be a maybe if the coroner codes you as such.  There are two relevant codes.

A) Tested positive

B) Probably died from COVID (not standardized)

Either code gets you listed as a death.  Maybes would have one but not the other.

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Just now, elguapo said:

Hmm I wonder why some folks are pushing hard on the narrative that covid deaths are being over reported? Obviously it couldn't have anything to do with the P word because that is NOT allowed in this thread.

Mongo say cloak room Cold, brrrrr

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25 minutes ago, dcar00 said:

OK, I'm correcting myself here.  It was 66% of hospitalizations that were at home.  apparently this means they had not left their home at all but got it and were hospitalized.  It was called shocking by NY because it was said that these people did not take public transportation, and were sheltering at home, which surprised them that they got it.  I guess you have to go under the assumption these people are being truthful and truly did not leave home ever or have guests come to their home.

 

Overpopulation, unless you can board people inside their homes ala Wuhan, there is nothing you can do. City planners take note. More negative consequences of upzoning 

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Northwestern hospital in Chicago is losing 150,000,000 per month. 

At 39,000 per Covid death they need to fake 3800 deaths a month to get back to even. 

People really believe that shit happens? 

I had surgery and an overnight there last year. Total bill was 100,000.

Logic would dictate that if anything they would hide all Covid deaths so they can open up and get that hospital going 100% again. Thats the incentive. 

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Just now, bullzak said:

Northwestern hospital in Chicago is losing 150,000,000 per month. 

At 39,000 per Covid death they need to fake 3800 deaths a month to get back to even. 

People really believe that shit happens? 

I had surgery and an overnight there last year. Total bill was 100,000.

Logic would dictate that if anything they would hide all Covid deaths so they can open up and get that hospital going 100% again. Thats the incentive. 

Bingo.  It's the math, more than anything, that makes the hypothesized vast conspiracy so very unlikely.

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Just now, bullzak said:

Northwestern hospital in Chicago is losing 150,000,000 per month. 

At 39,000 per Covid death they need to fake 3800 deaths a month to get back to even. 

People really believe that shit happens? 

I had surgery and an overnight there last year. Total bill was 100,000.

Logic would dictate that if anything they would hide all Covid deaths so they can open up and get that hospital going 100% again. Thats the incentive. 

the openings really have nothing to do with the death count.  to take a phrase from stonks "its baked in"

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2 minutes ago, bullzak said:

Northwestern hospital in Chicago is losing 150,000,000 per month. 

At 39,000 per Covid death they need to fake 3800 deaths a month to get back to even. 

People really believe that shit happens? 

I had surgery and an overnight there last year. Total bill was 100,000.

Logic would dictate that if anything they would hide all Covid deaths so they can open up and get that hospital going 100% again. Thats the incentive. 

Not even 3,800 a month. It would have to be 3,800 medicare recipients a month (15% of the population). And each would need to be on a ventilator. And I'm pretty sure the $39,000 is pretty much for New York and that is it. 

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10 minutes ago, elguapo said:

Hmm I wonder why some folks are pushing hard on the narrative that covid deaths are being over reported? Obviously it couldn't have anything to do with the P word because that is NOT allowed in this thread.

Its hard to discuss testing without toeing the line either.  As long as policies or politicians are not brought up in a partisan manner it should be allowed; even if the motivation for the discussion could be political.

We are over reporting deaths because of how they've chosen to report.  I think it can be explained how without getting political.  I think it's also the best way right now to report. Trying to attribute all the uncertainies with a new disease can only make the problem more political. I would like the data parsed but that's years away. 

Edited by JBJ
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4 minutes ago, bullzak said:

Northwestern hospital in Chicago is losing 150,000,000 per month. 

At 39,000 per Covid death they need to fake 3800 deaths a month to get back to even. 

People really believe that shit happens? 

I had surgery and an overnight there last year. Total bill was 100,000.

Logic would dictate that if anything they would hide all Covid deaths so they can open up and get that hospital going 100% again. Thats the incentive. 

NY is taxing nurses dispatched to help them during the crisis with a multi billion dollar busted budget. It’s really not hard at all to “believe” this happens 

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2 minutes ago, ChickenSandwich said:

NY is taxing nurses dispatched to help them during the crisis with a multi billion dollar busted budget. It’s really not hard at all to “believe” this happens 

New York is taxing people working in New York, just like it as always done. It just hasn't (yet) made an exception for healthcare professionals. 

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I'm tempted to go to the CR version of this thread to check out some of the lunacy that gets thrown around there if these are the talking points on the non political thread.  It must be a fucking free-for-all.

Alas, I shall never give into that temptation.

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8 minutes ago, ChickenSandwich said:

NY is taxing nurses dispatched to help them during the crisis with a multi billion dollar busted budget. It’s really not hard at all to “believe” this happens 

It's hard not to believe that a jurisdiction [checks notes] follows the law regarding taxation of work done within the state as it has always done?  Ok then.  And yes, not this shit again.

It's all a damned conspiracy, from the halls of Albany right down to the billing department of every hospital!  They're just inflating the numbers!  It's not even as bad as the flu!  Jesus.  Fuck this shit, I'm out.

You're right, it's all a conspiracy, cooked up to make someone look bad, and to steal millions from medicare.  Just a super-scam, all the way around.  Check out my Youtube video for more of the HARD TRUTH!

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34 minutes ago, dcar00 said:

I don't think anyone(i'm not) is saying hospitals would lie about actual test results. I believe the question is how does one get to be a maybe and why wouldn't the CDC just have maybe column if they are tracking it.

So you are 1) not saying that hospitals are lying about test results, and 2) saying that hospitals are lying about their COVID cases for money? Ok, mongo.

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1 minute ago, Captainant said:

So you are 1) not saying that hospitals are lying about test results, and 2) saying that hospitals are lying about their COVID cases for money? Ok, mongo.

where did I say they are lying about covid cases for money?

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4 minutes ago, aggie08 said:

I'm tempted to go to the CR version of this thread to check out some of the lunacy that gets thrown around there if these are the talking points on the non political thread.  It must be a fucking free-for-all.

Alas, I shall never give into that temptation.

medical discussion thread is for you..

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Guest Lobo

You know what would be really fucking helpful?  A consensus list of talking points that are considered gospel on this thread.  there seems to be such a goddamn fascinating list of things that are scientific gospel on here that if you contradict it without any overtones or undertones of politics, you get banned.

So why don't some of you nut the fuck up and list exactly what is settled commentary about this virus outbreak and the response to it so we can either add to it respectfully or stay the fuck away.  This ambiguous bullshit where y'all act like scorned women is reaching a critical mass of bullshit.

Poster 1:  "Here's some settled science from experts about what's going on."

Poster 2:  "Oh that is political bullshit." 

Poster 1:  "Well, what exactly is your issue with it?"

Poster 2: "Oh yeah right, like you'd even understand."

Everybody on each side take the night off and decide what exactly can be discussed on here.  We're way beyond blaming parties on here.  I'm talking about why we can't even have sensible conversations about maths, stats, and the people that are you know...actually heading up the prevention/treatment/vaccination efforts on this thing worldwide.  

I am but a humble Yankee, but even where I'm from...being kind to people that are more vulnerable than you doesn't mean you're a pussy...it actually is a testament to your strength as a man.  That we're now debating the pussy-factor of wearing masks among people in Texas is beyond the ironic pale. 

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Isn’t someone comparing the spike in overall deaths in places to the reported covid deaths and finding decent correlation?  Are deaths from cancer, heart disease, and other common causes down or steady?  Motor vehicle accident deaths should be way down, though that’s not that big a deal in nyc presumably. 

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17 minutes ago, Lobo said:

You know what would be really fucking helpful?  A consensus list of talking points that are considered gospel on this thread.  there seems to be such a goddamn fascinating list of things that are scientific gospel on here that if you contradict it without any overtones or undertones of politics, you get banned.

So why don't some of you nut the fuck up and list exactly what is settled commentary about this virus outbreak and the response to it so we can either add to it respectfully or stay the fuck away.  This ambiguous bullshit where y'all act like scorned women is reaching a critical mass of bullshit.

Poster 1:  "Here's some settled science from experts about what's going on."

Poster 2:  "Oh that is political bullshit." 

Poster 1:  "Well, what exactly is your issue with it?"

Poster 2: "Oh yeah right, like you'd even understand."

Everybody on each side take the night off and decide what exactly can be discussed on here.  We're way beyond blaming parties on here.  I'm talking about why we can't even have sensible conversations about maths, stats, and the people that are you know...actually heading up the prevention/treatment/vaccination efforts on this thing worldwide.  

I am but a humble Yankee, but even where I'm from...being kind to people that are more vulnerable than you doesn't mean you're a pussy...it actually is a testament to your strength as a man.  That we're now debating the pussy-factor of wearing masks among people in Texas is beyond the ironic pale. 

mike jude GIF by Idiocracy

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32 minutes ago, Dahobbs said:

New York is taxing people working in New York, just like it as always done. It just hasn't (yet) made an exception for healthcare professionals. 

Whoa whoa, let's not go crazy and accurately represent data or anything like that. ChickenShit is going to feel bad and call the mods on you for being political.

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Guest Lobo

People that had something else terminally wrong with them that would have killed them anyway in a few months maybe aren't officially dying from Covid-19 according to these bizarre fucking metrics.  To me, somebody with brain cancer in chicago who gets shot to death on the street a month before they were gonna TIA-out anyway, to me that still counts as a gun death.  

But my point is part of the reason 20-25% of our GDP is down is healthcare, and it's not just elective surgeries being quelled.  It's because a lot of people dying from Covid-19 are not sticking around to be treated for end-of-life care.  Which is a huge portion of our system.  I should know, I watch a youtube scientist channel from Christina Khalil. 
I love how quickly our country got so confused by data.  One day, we're gonna have some moneyball level shit about Covid-19 and our solution will be to clam up and shoot bullets into the air.  

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2 hours ago, BabaYaga said:

It's not "fraud" to attribute if they do test positive for COVID.  More than 70% of the cases of asymptomatic, yet test positive.  This stat doesn't stop at the door of the hospital.  Pneumonia, cardia arrest, COPT issues, etc.  There were innumerable MEMEs about shark victims having a COD as "COVID" for this very reason.  It's not "fraud", it's examining critically the perverse incentive created by the stimulus bill and reconciling this with hospitals on the verge of insolvency.  

Economics is simply the study of how people make decisions.  It's not a complicated thought experiment.  We know, for a hard, cold fact the stimulus is keeping tens of thousands of people on the sidelines by paying them NOT to work.  This is not up for debate.  We know hospitals are floundering and furloughing thousands.  Now you have a way to receive up to $39,000 PER PERSON, that technically can, and probably does test positive, even though what is uncertain is the actual relationship to between the virus, the diagnosis, and the COD.  So you check the box, and you get what you can.  A perverse incentive creating a moral hazard.  We see them all them time.  This is no different.  To just wave you hands and dismiss this is being less than intellectually honest.  

First, this only applies to Medicare payments, not private insurance.  Second, its not a blanket $39k for a positive test.  To get that maximum payment, the patient would have to be positive for COVID pneumonia, and ventilated.  A positive test with pneumonia that doesn't get ventilated is a lesser payout ($13k avg) versus $5k for a non-Covid pneumonia patient.  They aren't paying $39k for everyone that walks in asymptomatic and tests positive.  Its possible to exploit, but its not as simple as you're describing.  Fraud would be pretty easy to figure out.  For example, a hospital cant claim they ventilated 50 patients in a month when they have 5 ventilators and patients ride them for 14+ days on average.  

https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

On its face though, you are correct, it is possible to exploit.  

 

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6 minutes ago, Pato del Muerto said:

Isn’t someone comparing the spike in overall deaths in places to the reported covid deaths and finding decent correlation?  Are deaths from cancer, heart disease, and other common causes down or steady?  Motor vehicle accident deaths should be way down, though that’s not that big a deal in nyc presumably. 

Yes, people are doing that. Unfortunately it takes an understanding of math and statistics beyond the 5th grade level, so it never occurs to the general public to ask "Hey, why is our death rate going up despite quarantine measures that would result in normal causes of (at least) accidental deaths plummeting?" They think it's smarter to just speculate on how many doctors must be lying about causes of death for some bizzaro-world reasons fed to them by the Alex Joneses of the world.

Edited by Brian Fantana
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15 minutes ago, Pato del Muerto said:

Isn’t someone comparing the spike in overall deaths in places to the reported covid deaths and finding decent correlation?  Are deaths from cancer, heart disease, and other common causes down or steady?  Motor vehicle accident deaths should be way down, though that’s not that big a deal in nyc presumably. 

They attribute an increase to the new variable.  They did this after the 1995 heat wave that killed an estimated 700+ if IL.  Anything north of "normal", despite the complicated interconnected correlations.  

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5 minutes ago, Deej said:

Are they testing the 66% who died at home? How many of those are people who didn't go to the hospital for some other live-threatening illness or disease and possibly died from that?

that was my mistake.  it was 66% at home who were eventually hospitalized not died at home.  they seemed surprised by that percentage because they were told that they did not go out of the house at all.  not sure what percentage of those evenually died.  I assumed it was deaths, which would be actually, shocking.

https://www.cnbc.com/2020/05/06/ny-gov-cuomo-says-its-shocking-most-new-coronavirus-hospitalizations-are-people-staying-home.html

 

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8 minutes ago, StruggleBus said:

I’m assuming “didn’t leave the house at all” means they only left the house to go to the grocery store, gas station, and McDonalds. Very few people in this country are completely locked down.

not sure it seemed like Cuomo was saying he was surprised they got it in that high a percentage.  It was 100 hospitals and 1000 patients.  I'm kind of wondering what point he was trying to make.

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Guest Lobo

Many of you remind me of the great Doctor Nolan (played by the fantastic M. Emmet Walsh) when diagnosing what people died from in this Covid-19 environment we find ourselves in.  

"Ah yes, shame about Ed.  He went so sudden."

"You kidding?  He was dying for years." 

"He was in Covid care for eight weeks." 

"but the end, when he actually died.  That was extremely sudden."  

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9 minutes ago, dcar00 said:

not sure it seemed like Cuomo was saying he was surprised they got it in that high a percentage.  It was 100 hospitals and 1000 patients.  I'm kind of wondering what point he was trying to make.

we were surprised but since day one people have been flooding the parks, open air gyms, running tracks, and I've even see a fair amount of street drinking in front of bars although the latter has been only in the last 3 or 4 days. Everyone I know has more or less stuck to the @StruggleBus list of places but even in late march and early april I saw small clusters of people outside individual homes while I was out walking the dog. Figured they were all related or lived together but who knows. I've missed the PCs since Thursday so maybe he had a point but I know my friends and I were also wondering how the hell more people kept getting infected. Did he ever say how?

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3 hours ago, bschoolprof said:

nah; Tu-TH "catch up" and revisions will butt secks us.  

I'm pretty sure lots of America likes butt secks.  They'll deny it front of others but behind closed doors....

 

 

 

Right Now This?

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https://www.dailywire.com/news/people-in-hong-kong-are-becoming-ill-with-rat-hepatitis-for-first-time-ever-no-one-knows-how-its-happening?utm_source=facebook&utm_medium=social&utm_campaign=benshapiro

 

"A new report this week outlined an increasing virus problem in Hong Kong, which is attached to mainland China, where rat hepatitis E is jumping from rats to humans for the first time in history, and no one seems to know how it’s happening.

The first case was reported in 2018 when infectious disease experts at the University of Hong Kong (HKU) examined a man who had just undergone a liver transplant and was having liver problems."

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Guest Lobo

Well the end of days not quite working out how the experts predicted, but here we are Bob.  Surely this means God is happy with our choices.  Let's go back down to the field.  

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3 hours ago, JBJ said:

Its hard to discuss testing without toeing the line either.  As long as policies or politicians are not brought up in a partisan manner it should be allowed; even if the motivation for the discussion could be political.

We are over reporting deaths because of how they've chosen to report.  I think it can be explained how without getting political.  I think it's also the best way right now to report. Trying to attribute all the uncertainies with a new disease can only make the problem more political. I would like the data parsed but that's years away. 

Explain again in plain english how exactly deaths are being over reported?  I hadn’t seen the he factual data behind that yet.  Or is there any?

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  • hayden_horn changed the title to Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away


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