COVID-19

[living sounds]

My feeling on Germany's numbers, in all seriousness.

1. There are differences in reporting country to country. China listed cause of death as the existing comorbidity, not COVID-19. I don't think that's necessarily sinister. It was widely reported. That's just how they do it.  Country to country will have different methods of confirmed /official cases (lab test, centralized / confirm lab test, clinical diagnosis have all been used at various points) and classification of serious / critical cases, as well as testing or reporting regimes for fatalities.

2. Germany is testing very widely. This means over time they'll "see the whole field" much better - catch more cases, which inevitably increases the denominator -> lowers the rate. Over time their rate will rise to similar to everyone else's, much like S Korea's. This is because you'd expect them to catch all the serious cases but the more minor ones are harder to see (ascertainment bias) .

3. Unlike other countries (including Italy and the US) Germany is not performing post-mortem tests (reported here and here). Several of the cases that have been reported in the US were determined after the fact.  This can reduce numbers significantly, most especially in the early stages of an epidemic when one or two numbers make a significant impact to percentages.

This is a long game. It's not going to be over in a week.

I recommend reading this.

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

You are moving the goalposts now. You explicitly stated Germany were "taking the Chinese route and not attributing comorbidities to covid19 deaths".

Now you present different arguments why the German numbers are lower than other country's.

The official German count peformed by the Robert-Koch-Institut includes every death with a connection to Corona infection. It means that every case for which a cause other than Covid-19 could not be definitively assertained counts as a death by Covid-19.

https://www.br.de/nachrichten/deutschland-welt/faktenfuchs-wie-werden-corona-todesfaelle-gezaehlt,RtnpYVL

The same link (one of Germans public media outlets, in this case from Bavaria, a known and trustworthy source) also states that in cases where Covid-19 was not tested for before the patients death, post-mortems can be performed.

As for your sources, the first link is behind a paywal, the second one isn't there at all.

Everybody please ramp up your diligence. It's important.

 

[JohnRoberts]

this whole plan actually makes a good opening for a disaster movie! i would copyright it!

I described it as bad science fiction...it has probably been done. 

I guess the attractiveness of this could be influenced by which  group you are in.  :  It was a very long time ago but I was young once, and haven't completely forgotten.  8)

===

We all want more, faster, safer, easier (cheaper?) testing. The responsible agencies are pedaling as fast as they can, and private industry is working on alternative (testing and even self testing) options. Unfortunately this takes time and we are in the critical stage of trying to control the rate of spread (flatten the proverbial curve). Increased testing is generally accompanied by scary increases in confirmed cases but this is a positive feedback deal as more cases precipitate more testing and more cases.

I was disappointed , but not surprised to hear that several of the infected old age facilities in the northwest shared some of the same workers who helped spread the infection rapidly across the vulnerable community. This is not good practice even without covid19. Those same older residents routinely suffer disproportionately from normal influenza.
====

Lies, damn lies, and statistics...  Indeed different countries count cases differently and some are decidedly less reliable than others even factoring for how they count. One way to partially normalize for reporting differences is to look at statistics for all deaths  before and after covid19 spread, any uptick in all morbidity can be at least partially attributed to covid19 directly or indirectly. Overwhelmed hospital services can kill people even without them having covid19.

This data is of limited value to the public in the short term other than perhaps as a way to scare them into following health professionals advice. Media hypes up scary data to generate viewership fear and ratings.

Be safe and well.... I remain optimistic.

JR

 

[Bo Deadly]

I guess the attractiveness of this could be influenced by which  group you are in.  :

True. If you're in the vulnerable category you should be a strong advocate for it.

Clearly I'm describing this in a horrible way like Spock with zero emotion and pure logic. A little marketing spin would go a long way. Let me spin it like this:

Monday, Wednesday and Friday are "Safety Days". If you want to go out on those days you might need proof of a recent Coronavirus test with a negative result to get admitted. The Dentist for example might require you to show them the lab result which might have one of those square bar codes that they can scan with their phone and confirm that you have a recent negative test. Police could order someone to go home or even detain detail them if they do not comply with the Safety Days protocol. The other days OTOH would be wide-open. If you are simply not as concerned about getting Coronavirus, you can go out to restaurants, bars, the beach or whatever you want to do. The catch of course is that everyone who goes out on non-Safety Days are just assumed to be infected. But, believe it or not, more and more people will start to loose fear of the virus as time goes on. Many younger people are already simply not that fearful. And in truth, they honestly should not be. So perhaps we should just make it official and let them go about their business and reserve Monday, Wednesday and Friday for vulnerable individuals. Over time, as people are documented to have had Coronavirus and recover, they can be employed to work on Safety Days and further reduce the risk to the most vulnerable people.

 

[ruairioflaherty]

Many younger people are already simply not that fearful. And in truth, they honestly should not be.

This is wrong.  100% wrong.  Young people should be afraid.  I'll admit up to maybe 10 days ago I was pretty agnostic about whether I (in my 40s) or my family got this disease, I have updated that opinion.

Look at the data from the CDC on this first wave of hospitalizations

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

Also, anecdotal information coming from the frontlines in hospitals via channels I trust (The Peter Attia link above) is showing that younger people (20 to 64) who are hospitalized but survive this are seeing significant injury to their heart and lungs.  Only time will tell how this looks but right now I do not like the odds. 

 

[dogears]

RC

You are moving the goalposts now. You explicitly stated Germany were "taking the Chinese route and not attributing comorbidities to covid19 deaths".

Now you present different arguments why the German numbers are lower than other country's.

The official German count peformed by the Robert-Koch-Institut includes every death with a connection to Corona infection. It means that every case for which a cause other than Covid-19 could not be definitively assertained counts as a death by Covid-19.

https://www.br.de/nachrichten/deutschland-welt/faktenfuchs-wie-werden-corona-todesfaelle-gezaehlt,RtnpYVL

The same link (one of Germans public media outlets, in this case from Bavaria, a known and trustworthy source) also states that in cases where Covid-19 was not tested for before the patients death, post-mortems can be performed.

As for your sources, the first link is behind a paywal, the second one isn't there at all.

Everybody please ramp up your diligence. It's important.

Sorry you can’t see the paywall. Google, it’s widely reported they’re not doing post-mortem tests. A significant number of the US total were post-mortem.

The original article I read about Germany not reporting co-morbidities was speculation and after I looked carefully I couldn’t find a reliable source. I was also making a bit of a joke, which was in poor taste but mostly trying to keep some levity. I’m sorry for posting unsourced info, I’ll do better.

Which is why I prefaced the post with - in seriousness.

Germany and the US have the largest number of ICU beds per capita in the world, something like ~3-4x that of Italy and 6-8x that of the UK.

Doctors that I know who work in Texas are starting to see this show up. These are ER physicians who were not taking this seriously a few weeks ago are now a aying they were way off. The next month is going to be ugly.

 

[dogears]

Good article

https://www.caltech.edu/about/news/tip-iceberg-virologist-david-ho-bs-74-speaks-about-covid-19

 

[living sounds]

Germany and the US have the largest number of ICU beds per capita in the world, something like ~3-4x that of Italy and 6-8x that of the UK.

It was reported (on MSNBC - TV) that doctors are hacking respirators to supply 4 patients instead of one. I really hope it works.

 

[Bo Deadly]

This is wrong.  100% wrong.  Young people should be afraid.

Look at the data from the CDC on this first wave of hospitalizations

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

Clearly you did not even read this because it absolutely confirms what I have been saying:

"As of March 16, a total of 4,226 COVID-19 cases had been reported in the United States...<snip>... Among 121 patients known to have been admitted to an ICU, 7% of cases were reported among adults ≥85 years, 46% among adults aged 65–84 years, 36% among adults aged 45–64 years, and 12% among adults aged 20–44 years (Figure 2). No ICU admissions were reported among persons aged ≤19 years. Percentages of ICU admissions were lowest among adults aged 20–44 years (2%–4%)"

So if you pick age 44 for example, that's 12% of 121 of the 4,226. Meaning 121/4226 =  2.9% * 0.12 = 0.3%. Meaning if you're 44 or younger, your chances of even making it to the ICU is 0.3%.

But because the data is incomplete it looks like they made some kind of adjusted estimate to come up with the 2%-4% in the following sentence. But even if it is 4%, it's not a leap to assume that many or even most of those individuals have underlying health conditions and therefore would not be in the 99.9 percentile category I have been using.

And consider two things. One is that young people are by nature more sociable. Older people are already more socially isolated. So it follows that there will be a high incidence among young people in the beginning just because they're not isolating. The second thing is that there will always be you people who participate in behavior that is complicating. For example, there was a report [1] about a young woman from NOLA who was found dead in her kitchen. If you skip to the bottom, her boyfriend said:  "she drank "medicinal whiskey" to try to feel better". The report cites Coronavirus but does not even state if is tested positive or not. Ooookay.

I think it's a great idea that people include citations. But it is particularly misleading when your claims about what you're citing are 100% incorrect.

[1] https://www.katc.com/news/covering-louisiana/new-orleans-woman-tested-for-covid-19-dies-before-getting-results

 

[JohnRoberts]

It was reported (on MSNBC - TV) that doctors are hacking respirators to supply 4 patients instead of one. I really hope it works.

Sweet if it works, doesn't sound trivial.

I don't generally watch MSNBC because I don't find them very unbiased regarding information presentations.
===
Indeed there is a massive US effort to source more respirators as a critical resource for compromised individuals. Multiple car companied have volunteered to manufacture respirators from scratch (I do not know how quickly they can get up to speed, but during WWII they responded impressively).

Also I understand there are a number of respirators in use for other applications that can be fairly easily modified for use with infectious patients.  With more respirators we could turn those empty cruise ships into relocatable ICUs.

Of course this is a huge concern if we fail to bend the curve and exceed our ICU capacity.

JR

PS: For more unproved optimism, there is speculation that the old anti-malarial drugs now in clinical trials, can also be used prophylactically to reduce susceptibility of contracting virus.  That could be big. Fingers crossed.

 

[Tubetec]

I heard of one workplace at the forefront of testing and co-ordinating the response to the virus ,
What they have done to try an ensure continuity of service is , divided their staff into two completely seperate teams , 3 days on 2 days off alternating between the two teams , shorter hours means less stress and of course in the event of someone becoming ill less chance the whole place has to be closed down , simple and effective hopefully.

 

[kambo]

sorry to disappoint some,
FDA approved 45 min test , start shipping on monday  ;D

 

[living sounds]

https://www.theguardian.com/world/2020/mar/22/germany-low-coronavirus-mortality-rate-puzzles-experts

 

[JohnRoberts]

I heard of one workplace at the forefront of testing and co-ordinating the response to the virus ,
What they have done to try an ensure continuity of service is , divided their staff into two completely seperate teams , 3 days on 2 days off alternating between the two teams , shorter hours means less stress and of course in the event of someone becoming ill less chance the whole place has to be closed down , simple and effective hopefully.

Smart, yes, this is going on already in several industries, if they can't tele commute... With the whole team working together, one confirmed virus means the whole crew must be quarantined (2 weeks?), by platooning you can reduce the loss to a fraction of the whole team.  Of course they need to clean well between alternate teams.  And a positive test may shut down the facility for an even more thorough cleaning.

JR

 

[pucho812]

coronavirus vent

the big thing I saw on the news this morning  is kris Jenner took a corona virus test and Harvey Weinstein tested positive for coronavirus.
WTF. HTH, WTH. Why are these do idiots who have nothing to offer society as a whole getting tested?
kris was at a party and was with a billionaire who tested positive for coronavirus so she got tested even though she was not showing symptoms.  So basically she did not follow  shelter in place/social distancing rules asked of us in the times and gets rewarded by taking a test away from someone who actually could have ,would have, needed it.

Weinstein, why does that POS  rapist get tested? Based on the reporting so far, it appears a common theme of compromised immune systems in those  that they are reporting died. If that is the case, Weinstein is going to die. They have been reporting off and on that his health has not been so good since he went into jail for being a rapist.

Sorry don't mean to vent but this is f**king ridiculous news  I saw this morning.  I also don't want to sound callus and uncaring, and I especially do not want anyone to be sick, but come on, those two get it?

Back to our regularly scheduled discussion. be safe and be well.

 

[Whoops]

What they have done to try an ensure continuity of service is , divided their staff into two completely seperate teams , 3 days on 2 days off alternating between the two teams , shorter hours means less stress and of course in the event of someone becoming ill less chance the whole place has to be closed down , simple and effective hopefully.

They are applying that here in Portugal also,
it's the right thing to do

 

[ruairioflaherty]

Clearly you did not even read this because it absolutely confirms what I have been saying:

Of course I read the link before posting, I'm just not interpreting the data the way you are.

From your own post earlier pitching your solution

"Group A: Everyone who's ok with getting Coronavirus (like me) and just going about their business knowing that there's a 99.9% chance that they'll breeze through it like a bad date. Yeah, there's a 0.1% chance they might have a bad reaction and not be able to get an ICU bed / ventilator but personally I like those odds.

Group B: Anyone who is concerned because of their age or a health condition or they're just not on board and want to isolate."

Re Group A, at least as you have defined it, I do not like those odds.  My personal odds of 0.3% as you calculated, even less so.  Those odds with the likelihood of no functioning ICU care?  No thanks.

And Re Group B as you have defined it, it would need to be a very large group indeed not to include people over the age of 44 - 89% of ICU admissions were people over that age.  If we pick 44 years old as an acceptable cutoff (and I don't find that acceptable) the over 44s account for 136 million adults in the U.S. population.

I have moderate faith in this population data
https://www.statista.com/statistics/241488/population-of-the-us-by-sex-and-age/

This leaves approx 108 million working age adults for your group A.

With the virus living 3 days on plastic and some metal surfaces the idea of share public spaces with twice weekly changeovers seems unappealing.

Can you point to any experts in the field who are proposing this? Or supporting even elements of the idea?

The U.K. seems to have been trounced by experts for their toe in the water of "Herd Immunity", they have walked it back now.

I recognize that the current economic shutdown is unsustainable, the pain is enormous has very real personal implications for me.  I'm just not seeing anyone of note out there who believes we can roll the dice on our ability to provide healthcare as you have suggested.

 

[Whoops]

You explicitly stated Germany were "taking the Chinese route and not attributing comorbidities to covid19 deaths".

The original article I read about Germany not reporting co-morbidities was speculation and after I looked carefully I couldn’t find a reliable source.

So it's not only Trump that just says Bullshit

 

[ruairioflaherty]

So it's not only Trump that just says Bullsh*t

It's everywhere, the quality of information I am seeing is pretty shocking.

We can be part of the solution here, by sharing reliable info from vetted sources and not engaging in wild speculation.

I get that we come here and love to riff and shoot the shit, but now is a time for more care and rigor.

I'm going to repost the link Dogears shared on the previous page - it's an excellent and readable summary of where we are at and possible solutions - https://www.caltech.edu/about/news/tip-iceberg-virologist-david-ho-bs-74-speaks-about-covid-19

 

[Bo Deadly]

My personal odds of 0.3% as you calculated, even less so.  Those odds with the likelihood of no functioning ICU care?  No thanks.

Those are not your odds. I just picked age 44 because that was the upper end of that group in the CDC data. The 0.3% was a very vague average probability for everyone 44 or below. In practice your "odds" are almost entirely dependent on your health.

But numbers like this are borderline meaningless. That CDC analysis is really quite misleading because the numbers are not suitable for a real analysis. The main problem with all of the numbers that we have been referencing is that they are based on confirmed cases but we're not even testing people if they don't already have a temp and cough. So the denominator is far too low which means the probabilities of bad outcomes are actually much much lower. That 0.3% could easily be 0.003%.

The bottom line is that you have to be a particularly unhealthy individual or have a compromised immune system to be permanently affected by Coronavirus. I'm not going to try to attach numbers and come up with probabilities anymore other than to keep pointing out that all of the numbers are way off because we're not testing everyone equally.

People are going to figure this out in the coming weeks and the limits on gatherings and business closures are going to be lifted. Then, if you really are one of the particularly unhealthy individuals, you will wish there were "Safety Days". And no, I do not have any support for the whole "Safety Days" thing. That is entirely my only science fiction.

 

[ruairioflaherty]

Those are not your odds. I just picked age 44 because that was the upper end of that group in the CDC data. The 0.3% was a very vague average probability for everyone 44 or below. In practice your "odds" are almost entirely dependent on your health.

But numbers like this are borderline meaningless. That CDC analysis is really quite misleading because the numbers are not suitable for a real analysis. The main problem with all of the numbers that we have been referencing is that they are based on confirmed cases but we're not even testing people if they don't already have a temp and cough. So the denominator is far too low which means the probabilities of bad outcomes are actually much much lower. That 0.3% could easily be 0.003%.

The bottom line is that you have to be a particularly unhealthy individual or have a compromised immune system to be permanently affected by Coronavirus. I'm not going to try to attach numbers and come up with probabilities anymore other than to keep pointing out that all of the numbers are way off because we're not testing everyone equally.

People are going to figure this out in the coming weeks and the limits on gatherings and business closures are going to be lifted. Then, if you really are one of the particularly unhealthy individuals, you will wish there were "Safety Days". And no, I do not have any support for the whole "Safety Days" thing. That is entirely my only science fiction.

On this we can agree 100%.  The data is just not in yet, there are too many unknowns.  And I should have mentioned that the data set in my CDC link was tiny, not the level of rigor that I am advocating.

Re I think Italy will scare people somewhat straight in the short and medium term. latent othering means that we were not quite prepared to learn from the Chinese experience. 

For the record I have come close to dying from a lung condition previously. Although I am generally healthy now I am not looking to stress test my respiratory system.