COVID-19

[Bo Deadly]

https://twitter.com/nbcnews/status/1235786467420581888?s=21

Wow. I never really read twitter comments before. What a horrible site.

 

[fazer]

What a horrible site.

Anger equals participation on social media. 

I’ve been avoiding twitter.    These  sites needs a 12 step program.  It’s impossible to resist once you participate.

 

[JohnRoberts]

Case study published in New England Journal f Medicine of 1099 Chinese cases said time from symptoms to death was average ~12 days if I recall.

only for the people who died.... many cases especially in younger people are mild and perhaps undiagnosed. These undiagnosed cases skew the mortality rate.

For S Korea numbers you should use the numbers from 4-12 days ago and see what the death rate is. I agree that because of their testing they are establishing a likely lower bound to the figure.

S. Korea is a fair comparison as a wealthy nation that should have decent access to healthcare. I do not know how we compare demographically.

Italy looks brutal. 10% of their current cases are severe / requiring ICU.

Italy has an older population that is a risk factor for severity (just like with influenza).

If the local epidemic isn’t controlled there’s a real risk of hospital overload. That starts having knock-on effects to base load / typical patients as well as increasing mortality due to drop in care.

It seems we need to focus on at risk populations (i.e. old people). An outbreak in the US getting a lot of news attention is a nursing home in Washington state. While the breathless reportage glosses over the (should be obvious) age factor.

But I don’t think mortality is the real story here to be honest. Economic disruption is going to be crazy. Here’s hoping for a v shaped recovery.

I have already been accused of pooh-poohing this, but I expect this to continue it's spread, and probably continue killing older people, and those with weakened immune systems.

The stock market was past due for a correction so this is as good an excuse as any. There are, and will be real economic consequences of this. Air travel is down, and numerous conventions have cancelled out of a preponderance of caution (like Musik Messe). Probably not a good year to sell senior citizen ocean cruises.

I would suggest looking at this in the context of short term effects and long term. In the short term more at risk patients can die but they might have died from the flu du jour.  Longer term supply chains will be rethought, who realized how much medicine we source from China?

I see many opportunities in the stock market, and fear pushed bond yields even lower.... The treasury broke below 1%... that is nuts, and evidence of another economic distortion. Perhaps a little too early to buy bargain stocks (hard to catch a falling knife).

I still worry about the coordinated easing of central bankers... This too easy money has been distorting economic behavior for over a decade. At some point the tide will go out, but the corona virus is just the latest excuse for a market correction and flight to safety, not a new economic crisis (we are still dealing with the last one).

This too will pass..

JR

PS; Yesterday while refilling my thyroid prescription at Walmart I saw them selling cheap dust face masks in the pharmacy...  If anything those cheesy face masks probably count as unhealthy face touching.  :

 

[dogears]

I've seen some reports there are two varieties of covid-19 now, a severe and mild version. Maybe this is just conjecture that Italy has a severe version and SK has a mild version...

That paper has also been recommended for retraction based on peer review.

http://virological.org/t/response-to-on-the-origin-and-continuing-evolution-of-sars-cov-2/418

It is, however, important to appreciate that finding a majority of samples with a particular mutation is not evidence that viruses with that mutation transmit more readily. To make this claim would, at very minimum, require a comparison to be made to expectations under a null distribution assuming equal transmission rates. As this has not been performed by the authors, we believe there is insufficient evidence to make this suggestion, and that it is incorrect (and irresponsible) to state that there is any difference in transmission rates. Differences in the observed numbers of samples with and without this mutation are far more likely to be due to stochastic epidemiological effects.
-snip-
Evidence from the widespread media uptake (35 articles at last count), and many comments on social media in response to this article, suggests that the unsupported claims made by Tang et al. have already spread undue fear.

When interpreting their results, Tang et al. do not consider that sequencing error could be a driver of a relative excess of singleton nonsynonymous mutations. This possibility is important because sequencing errors will be at low frequency as they are rare and cannot be transmitted, but real mutations observed mutations can be at any frequency because they can be transmitted. Additionally, purifying selection can only act on real mutations, and not sequencing errors. Therefore it is very possible that sequencing error will have a higher nonsynonymous to synonymous ratio, and these mutations will be at low frequency, which will mimic the action of purifying selection suppressing the frequency of nonsynonymous mutations.

Given these flaws, we believe that Tang et al. should retract their paper, as the claims made in it are clearly unfounded and risk spreading dangerous misinformation at a crucial time in the outbreak

 

[dogears]

Agreed on all counts John.

Here's a nice table from the NEJM article.

If we're trying to guesstimate at total mortality, us CDC now saying 0.1-1%.

Just as a thought exercise we can think of the two parts of the statistical analysis: those who present for medical attention vs those who don't, and the outcomes of those who present.

The CDC says in the US about 50% of flu cases wind up seeing a doc. So we're saying that the mortality figures of ~0.1% are inclusive of all known cases and these are half of the estimated total.

We have no idea what the number of silent cases for COVID19 are. It may very well be more, even orders of magnitude more, than influenza. But, we can only measure what we see, which is somewhere between 0.6% and 3.4%. If the mortality figure of 1% of known cases (i.e., those presenting for medical attention) is going to wind up being comparable to the flu rate of total cases, that means the proportion of total vs known cases has to be similarly proportionate. Meaning that nCov virus would have a much broader spectrum of response it causes (10x as many minor cases). Which may be true.

I'd guess, however, that seeing as the flu infrequently requires 10-12 days to recover and COVID19 seems to, that the ratios of minor to severe cases are probably comparable (if not worse for COVID19).

 

[cyrano]

Spme insights about what the CDC is doing: lying and faking. Coming from a nurse who volunteered to help one of the first US infections.

According to the CDC, she doesn't need to be tested, because she can't be infected, as all the proper precautions were in place...

https://act.nationalnursesunited.org/page/-/files/graphics/NU-Quarantine-RN-press-conf-statement.pdf

It seems idiots are infectious too, these days in the US of A.

 

[boji]

Don't have yall's math superpowers, so things like this help me:

https://www.youtube.com/watch?v=Kas0tIxDvrg

 

[JohnRoberts]

Don't have yall's math superpowers, so things like this help me:

https://www.youtube.com/watch?v=Kas0tIxDvrg

Thank you... I rarely click on videos but that was a good one and I watched the entire math lesson.

The good news is that we are living in 2020 so can alter the opportunities for this to spread into new communities lacking immunity. This is probably a delaying tactic until we get better targeted treatments, and eventually a vaccine.

JR

PS: It looks like China already passed the inflection point there, Italy is in the steep part of the growth curve and shutting down large public gatherings to reduce spread. Iran is probably a poster boy for how not to handle this, and South Korea the better example. Shutting down SXSW and St Patrick's day parades here is probably prudent to reduce exposure. Cancelling the Musik Messe in Frankfurt was a no brainer.

 

[dogears]

Lessons to learn here.

China stopped it by brute force.
S Korea seems to have it contained by tracing contacts and aggressive individual quarantine. Same with Singapore.

Iran may be in a worst case scenario
https://www.theatlantic.com/ideas/archive/2020/03/irans-coronavirus-problem-lot-worse-it-seems/607663/

Italy missed their window and is in the mess now.

The next interesting thing is going to be to watch how it plays out in China once they relax the quarantine measures. What they're doing is not sustainable. Same with S Korea.

 

[dmp]

The next interesting thing is going to be to watch how it plays out in China once they relax the quarantine measures.

The catch-22 of government response is picking between isolation and the hit on the economy.
The USA is going to be really interesting over the next few weeks. Doubling every 3 days and at 1000 cases today (but probably severely undercounted due to the restrictions on testing).

 

[JohnRoberts]

The catch-22 of government response is picking between isolation and the hit on the economy.

The reflexive response of most governments is to stay in power...  China made the problem worse by lying about the situation, and suppressing honest news reports. The Chinese leadership appears to be secure for now, the leader actually made a public PR appearance in Wuhan this week, no doubt to calm his scared and distrustful public.
-----
The outcome for Iran's leadership seems to literally include risk of physical survival, let alone just staying in power. It would be funny if it wasn't so tragic but a couple weeks ago there was a video clip of Iran's top health official in obvious physical distress on camera during a press conference. In the short term covid-19 risk will reduce large public anti-government demonstrations, but as soon as the immediate risk of public assembly subsides, the public's displeasure will likely be expressed as this is another failure of that government.

The USA is going to be really interesting over the next few weeks. Doubling every 3 days and at 1000 cases today (but probably severely undercounted due to the restrictions on testing).

The original distribution of test kits by CDC was mishandled... Sadly this is not that rare with government agencies. I am more inclined to blame incompetence before any dark conspiracy. 

The original shortage of test kits has been remedied and I now expect a surge of reported cases, as these test kits get put into wider use around the country. Media will blow this up as they often do to scare viewers into watching more.

President Trump remains overly focussed on the stock market and is talking about new spending, like a democrat to create short term economic stimulus (he is turning into a politician faster than I expected).     

The US economy has another risk as Russia and Saudi Arabia are in a pissing contest over OPEC oil output reductions.  Cheaper oil is a double edged sword, it helps consumers with cheaper gas prices, but hurts employment in the US energy industry that profits from exporting oil. Oil prices were already seeing downward price pressure due to slowing international economies due to Covid-19. Russia and the Saudis are harming themselves more than everybody else with cheap oil prices, so I expect them to sort this out sooner rather than later.

Russia is angrier than usual because of sanctions last month imposed on Rosneft (russian state owned oil company) for their support of Venezuela oil industry, helping Maduro remain in power. Not that Putin needs excuses to stir the pot, and appear to punch above his weight in world politics.

JR

 

[Bo Deadly]

Doubling every 3 days and at 1000 cases today (but probably severely undercounted due to the restrictions on testing).

The numbers pretty much doubled in a day yesterday. I think that is a function of the testing ramping up. So it will start to flatten out as the numbers approach reality. My feeling is that it will be more like a 2x / week rate.

I don't think China has reached an inflection point. You can't live in lock-down forever. Yeah, it's an impressive demonstration of single-party government control but it cannot be sustained.

I wouldn't be shocked if young people start to have coronavirus parties and get it on purpose so that they can cross over to the other side and go on cheap vacay. It might sound like a horrible strategy but it's actually not completely insane. As long as they don't tax the system, they'd actually be doing us all a favor by taking away carriers.

 

[dogears]

http://www.cidrap.umn.edu/news-perspective/2020/03/study-highlights-ease-spread-covid-19-viruses

New study, not peer-reviewed, so take with a grain of salt.

However, important bit I think:

The findings contrasted starkly with those from the 2003 outbreak of SARS in terms of viral load. "In SARS, it took 7 to 10 days after onset until peak RNA concentrations (of up to 5x105 copies per swab) were reached," the researchers wrote. "In the present study, peak concentrations were reached before day 5, and were more than 1,000 times higher."
...
The findings confirm that COVID-19 is spread simply through breathing, even without coughing, he said. They also challenge the idea that contact with contaminated surfaces is a primary means of spread, Osterholm said.

"Don't forget about hand washing, but at the same time we've got to get people to understand that if you don't want to get infected, you can't be in crowds," he said. "Social distancing is the most effective tool we have right now."

Wash your hands, keep a 6' rule. May save some lives.

 

[JohnRoberts]

http://www.cidrap.umn.edu/news-perspective/2020/03/study-highlights-ease-spread-covid-19-viruses

New study, not peer-reviewed, so take with a grain of salt.

However, important bit I think:
Wash your hands, keep a 6' rule. May save some lives.

That is interesting... suggests that masks may help prevent spread?

JR

 

[john12ax7]

From what I've read,  masks can help stop infected people from transmitting the disease.  But don't do much to prevent people from getting infected.  For that you need a proper respirator.

 

[cyrano]

Somehow, that doesn't sound logical, John...

But I more or less get what you're aiming for. I saw numbers that read like a 1:6 reduction in the chance of catching Corona by wearing a mask (best case). Of course that's hardly worth mentioning. Especially as it seems to travel twice as far as the flu...

What's puzzling, is the infection rate. Much higher in Iran and Italy than fi Taiwan or Korea.

People getting billed 10k for not being tested, as they weren't in the target group seems suicide. But that's what's happening in the US. Imagine quarantining the US, as has been done in Italy.

 

[dogears]

People getting billed 10k for not being tested, as they weren't in the target group seems suicide. But that's what's happening in the US. Imagine quarantining the US, as has been done in Italy.

It's unlikely to happen for several reasons.

1) The reason it got so bad in Italy was lack of response. It got completely out of control because they weren't aggressively tracing contacts, they weren't self-isolating.

2) The biggest issue in Italy right now is they didn't "flatten the curve".

3) This exacerbated by their older population

4) They have about 1/4 the ICU bed capacity of the US, and the ICU capacity they have is not on par. We have more beds, more ECMO machines, more ventilators, etc. per capita than they do. This is in part because our healthcare system is not socialized. The rest of the explanation is that the United States is simply a wealthier nation (this is also what drives our healthcare spending). Even if the US had exactly the same outbreak, it is unlikely the outcome would be as severe because of this.

I'd be much more worried if I lived in a European nation. The Italian doctors are literally writing the ethical manual on how to decide who lives and who dies in a situation where there is insufficient healthcare capacity for the patients.

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

Make no mistake, this outcome is entirely possible in the US as well. It wouldn't surprise me if we have something similar a large US city... NYC or Seattle. But all things being equal it won't be as bad here.

 

[JohnRoberts]

Somehow, that doesn't sound logical, John...

I'm shocked you don't agree... :

If the virus is transmitted by breathing, a mask sounds logical to me... Perhaps not a dust mask like walmart was pushing last week, I am just sharing my first impression about comments here.

But I more or less get what you're aiming for. I saw numbers that read like a 1:6 reduction in the chance of catching Corona by wearing a mask (best case). Of course that's hardly worth mentioning. Especially as it seems to travel twice as far as the flu...

I didn't know this was all documented that quantitatively and precisely.

What's puzzling, is the infection rate. Much higher in Iran and Italy than fi Taiwan or Korea.

I heard reports about Iran government trying to shut down the religious site that was implicated in spread of covid-19, and religious leaders ignored the official government advice.  While this may be fake news, but reportedly religious pilgrims were literally kissing some religious icons, how could that possibly end badly?  : :

People getting billed 10k for not being tested, as they weren't in the target group seems suicide. But that's what's happening in the US. Imagine quarantining the US, as has been done in Italy.

Please share your reference for that...

There are reports of insurance companies waiving co-pays for COVID-19 testing (or being told to)...

Amazon is reportedly stepping up to ship self-test kits to consumers in the seattle area, in a joint venture with gates foundation, to be tested by U of Wash.  This could relieve the pressure on emergency rooms from people who worry they may be sick.

We'll figure this out... This is not like 1917 when the Spanish  flu infected tens of millions worldwide.

This is not nothing, but smart people are already engaged. I remain optimistic...

but please don't breath on me..

JR

[edit- for another outside the box idea... how about re-purposing the idled tourist ocean liners into temporary quarantine housing... In fact a slow boat might be good for repatriating large groups of people from some distance. /edit]

 

[john12ax7]

The issue is the typical surgical mask does not stop the virus,  as the particles are too small and pass through. But it's can mitigate things in the case of someone sneezing,  as a certain percentage could get trapped.

 

[sodderboy]

I'm totally fine with giving everybody free health care and education, simply because I don't want to live in a country full of diseased idiots.

How ironic that you live in Libertyville. . . , when you wish to continue the erosion of your liberty, along with that of everyone else in the US.

How sad to see that you think that free college will solve idiocy.  Free high school has done the opposite over the past decades.  Maybe some free HVAC or plumbing training, but sod free English or History BA's.  What rubbish!

Mike