I practiced all kinds of anesthesia from total intravenous, to narcotic based, high potency volatile anesthetics +- N2O to weird stuff like pentothal/lidocaine/N2O/02. Even done some cases using heliox. The thing about general anesthesia except of the narcotics based anesthetics is they are second order control loops. You have to dump in a big dose into an empty tank and eventually the tank fills up enough that you gain control over a second order equation. Dosing is not linear but exponential. The devices we use like vaporizers make it feel like its linear but if you do an actual closed loop anesthetic where the mv uptake of O2 is static and the CO2 is absorbed the dosing if the anesthetic is over an increasingly longer time sequences say 1 2 4 8 16 32 minute intervals. If the anesthetic was dosed in cc what you would find as you got about half an hour into the case , your 16 minute does would be a relative overdose at the beginning of the period followed by a relative under dose beginning half way through the period. I would split my doses into 1/4 doses and give them along the interval to smooth out the relative peaks and troughs. I generally ran these kinds of anesthetics under spontaneous ventilation since the nature of the ventilation was a exquisite measure of anesthetic depth in a closed system better than HR or BP. If you had your hand on the bag and your ear piece on the chest you could feel and hear changes in anesthetic depth. Closed circuit anesthesia was total dog lab and I learned a ton about normal physiology and pathophysiology from it.
I’ve been following the virus on the Johns Hopkins site and the growth curves. The virus initially is like dumping anesthetic into an empty tank as the tank fills you start to apply measures meant to quell not the spread but the rate of spread in an attempt to reduce spread. That’s what shutting everything down is all about. It’s a means to normalize rate of spread. Spread is inevitable but rate of spread is controllable, and it works just like a closed circuit anesthetic.
Yesterday the US new case plot looked like this
See that little bar at the end is a bit lower than the previous bar. The other bars have been virtually relentlessly up BUT the log of the growth curve looks like this
See how the graph by the arrow seems like it’s starting to curve down slightly? Exponential growth would look like a straight line.
This is Italy. Note how the growth curve is almost horizontal, This means Italy is almost linear in it’s growth. This means R0 in Italy under its present quarantine regimen is approaching 1. Here is Italy’s new cases graph
If yesterday represents our first down day in 18 days we may be where Italy is today which is approaching an R0 of 1. I don’t want to overstate the data, we are in a hell of a mess. But the first sign of resolution is the change in sign from + to -.
Notice Italy is still under severe quarantine but the back of the virus seems to be approaching broke. If they just quit the quarantine exponential growth would resume, but by judicious relaxation of quarantine and spot case tracking and re-quarantine of local outbreaks things could well be looking up in Italy and we might be 18 days behind, at least that’s how I read the data. If you let off the controls too fast you will simply go exponential again.
This to me is good news since it seems a sign we have a modicum of control now, but it doesn’t jibe at all with media expectations. It exactly jibes with what I hear underlying Fauci ‘s expectation. To me this is very good news and I consider it a green shoot. We face a long and terrible recovery but the first step to recovery is the door step. You have to cross the door step to get out of hell.
So what does that mean to markets? What I see is a very slow and choppy restart to living. You may open up the Wendy’s or the Denny’s and COVID may reappear and contacts must be traced and quarantined until declared all clear. Those with immunity will be immune and will be able to resume economic activity and the nation in fits and starts will begin to recover economically. What that kind of time frame means to levered companies may be another story. What that means to company outputs, may mean companies are working at 50% or some other number. I would expect recovery growth to take a long time to become exponential and then normalize to some new normal steady state. How long does that take? Who knows but it certainly seems to me it will be many months to years.
I have no idea what all the screwing around with money velocity and money supply will produce except I don’t think it’s going to be anything good. I decided to buy some GLD at the present price as a hedge because I feel entirely naked being in cash. At least GLD will pay 0% interest because the 3 month treasury has been going negative. I’m not sure what it means to own government bonds that you have to pay to own, instead of having them pay you. I hear arguments like “well you pay a nickle to get your money back” Screw it I’ll just keep my money. and pay myself the nickle. I’m also thinking about getting back into BRK.B. Apparently it’s at book value around $167. I’m also looking at KOL which is taking a permanent option on energy and steel, and has a 17% yield. Buying this is a bit like buying a penny stock so unless you understand penny stocks be careful.
The whole world us up today so I’ll probably buy some SPY on a day trade and set a stop loss as it moves up. I much prefer buy and hold and don’t like this trading stuff but since trades are free and I can go short and long if I can make a few hundred a day, I pay for my hamburgers at very low risk, till things become clearer.
“Today I didn’t even have to use my AK
I gotta say, it was a good day”