COVID COVID-19 Coronavirus Containment Efforts

[DennisN]

Various:

'This virus may never go away,' WHO says (Reuters, May 13, 2020)

GENEVA (Reuters) - The Coronavirus that causes COVID-19 could become endemic like HIV, the World Health Organization said on Wednesday, warning against any attempt to predict how long it would keep circulating and calling for a “massive effort” to counter it.

“It is important to put this on the table: this virus may become just another endemic virus in our communities, and this virus may never go away,” WHO emergencies expert Mike Ryan told an online briefing.

“I think it is important we are realistic and I don’t think anyone can predict when this disease will disappear,” he added. “I think there are no promises in this and there are no dates. This disease may settle into a long problem, or it may not be.”

However, he said the world had some control over how it coped with the disease, although this would take a “massive effort” even if a vaccine was found — a prospect he described as a “massive moonshot”.

[...]

echoing the words of Dr Richard Hatchett in this video I posted 6 March, where Hatchett also thought it could become endemic. Those who watched the video at that time may remember that Hatchett also was very worried how the virus could impact the US, and sadly he was pretty much correct in his worries.

China's Wuhan kicks off mass testing campaign for new coronavirus (Reuters, May 13, 2020)

BEIJING (Reuters) - Authorities in the Chinese city where the novel Coronavirus emerged launched an ambitious campaign on Wednesday to test all of its 11 million residents, after a cluster of new cases raised fears of a second wave of infections.

[...]

And a summary article from Reuters:

Factbox: Latest on the worldwide spread of the new coronavirus (Reuters, May 7, 2020)

 

[OmCheeto]

Sorry, the 1.6 % figure is from another web:

https://f7td5.app.goo.gl/77uJX7

You can get the full report clicking there. I attached the paragraph where it is written as a screenshot.
...

The only thing I can extract from your link is;

"Covid-19: Serological study says that only 5% of Spaniards have antibodies
Soria has the highest percentage of immunized potentials: 14%.
The study, which consists of three phases in which it is expected to reach around 60,000 participants, calculates the immunity of the Spanish population against the virus."

Perhaps as it says at the top, it only works for Samsung telephones.

Also, you might want to learn the difference, and report deaths as either "mortality rates" or "Case Fatality Rates(CFR)".

This will save a lot of confusion.

According to my latest data, Spain has a mortality rate of 0.057% and a CFR, based on this 5% serological study, of 1.13%.

Obligatory graph:

 

[PAllen]

Actually, what you would really like to know is IFR (infection fatality rate), factored by risks. The difference between CFR and IFR can by quite large due to not testing people who never seek medical treatment. However, the Spanish sampling approach using antibody tests, can potentially lead to more accurate IFR. A figure of 1.13%, if true, is devastating in its implications. However, I don't know how well the Spanish study adjusted for Bayesian statistics: a 90% accurate antibody test with a true infection rate of a few percent will have 70% of its positive test results be false.

 

[atyy]

Actually, what you would really like to know is IFR (infection fatality rate), factored by risks. The difference between CFR and IFR can by quite large due to not testing people who never seek medical treatment. However, the Spanish sampling approach using antibody tests, can potentially lead to more accurate IFR. A figure of 1.13%, if true, is devastating in its implications. However, I don't know how well the Spanish study adjusted for Bayesian statistics: a 90% accurate antibody test with a true infection rate of a few percent will have 70% of its positive test results be false.

If false positives were not accounted for, then the IFR would be higher than 1.13%.

If you take the NYC serological estimates (uncorrected for false positives) around 27 April.
https://www.360dx.com/infectious-di...ly-estimates-covid-19-prevalence#.Xrydx8BS_IU : 21% infected
https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-deaths-new-york-city.html: 27000 deaths
NYC population: 8.5 million
IFR ~ 100% * 27000/(0.21 * 8,500,000) = 1.5% (seems high to me, last time I did it I got 0.8%)

Anyway, an estimate of 1% IFR seems in the right ball park, and taking estimates from different countries and trying to adjust for different sources of error, reasonable estimates give an IFR as low as ~ 0.3%. However, depending on what phase of the epidemic in the US one is trying to devise policy for, the accuracy of that number is not so critical, because other data was also available. For example, in the early stages, the need to react quickly was already known because the infection had already been shown to overwhelm the healthcare systems in Wuhan and Northern Italy.

 

[mfb]

Iceland found one more case.
They plan to open the country to visitors again starting June 15, but under the following conditions: Go into 2 weeks quarantine, get tested in Iceland, or get tested in the country of origin. In addition visitors need a tracking app.

 

[morrobay]

80% of this 3rd string seaside resorts business depends on tourism. and tourism is down here 80% as well for the country. (Thailand) The government is not letting any foreign tourists into the country until end of year. Except for the chinese who they are going to let in this July. Like a few other countries in S.E.Asia the chinese are boss. The chinese will be welcomed by the military government. The chinese who brought this misery to the world and drove out many of the Western tourism demographics to this area. They keep on going with this act and tumbleweeds blowing across the road next.

 

[Tendex]

If false positives were not accounted for, then the IFR would be higher than 1.13%.

If you take the NYC serological estimates (uncorrected for false positives) around 27 April.
https://www.360dx.com/infectious-di...ly-estimates-covid-19-prevalence#.Xrydx8BS_IU : 21% infected
https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-deaths-new-york-city.html: 27000 deaths
NYC population: 8.5 million
IFR ~ 100% * 27000/(0.21 * 8,500,000) = 1.5% (seems high to me, last time I did it I got 0.8%)

Anyway, an estimate of 1% IFR seems in the right ball park, and taking estimates from different countries and trying to adjust for different sources of error, reasonable estimates give an IFR as low as ~ 0.3%. However, depending on what phase of the epidemic in the US one is trying to devise policy for, the accuracy of that number is not so critical, because other data was also available. For example, in the early stages, the need to react quickly was already known because the infection had already been shown to overwhelm the healthcare systems in Wuhan and Northern Italy.

I wonder if the serological study was well designed and one can take seriously only a 5% of the population infected for more than 27000 deaths. If true, then the mortality of the virus must certainly be over 1% and yet there is evidence from elsewhere that this is way above the real IFR. In any case if the higher mortality is true it is a really tough dilemma to ponder over as to what should really be the goals and strategies. If the goal really is to gain herd immunity, that is 60-70% of the population having passed the infection either with or without symptoms, in the absence of a vaccine or effective treatment ,with this IFR higher that 1% one should be ready to accept in the vecinity of three hundred thousands deaths in Spain for a population of 47.5 million people, and several millions in the USA for instance if that IFR is not restricted to Spain.

 

[Tendex]

Actually, what you would really like to know is IFR (infection fatality rate), factored by risks. The difference between CFR and IFR can by quite large due to not testing people who never seek medical treatment. However, the Spanish sampling approach using antibody tests, can potentially lead to more accurate IFR. A figure of 1.13%, if true, is devastating in its implications. However, I don't know how well the Spanish study adjusted for Bayesian statistics: a 90% accurate antibody test with a true infection rate of a few percent will have 70% of its positive test results be false.

I would hope it is the false negatives that are really high with the serological tests, that would imply less devastating implications with a lower IFR for the general population.

 

[Klystron]

View attachment 262756
View attachment 262755
80% of this 3rd string seaside resorts business depends on tourism. and tourism is down here 80% as well for the country. (Thailand) The government is not letting any foreign tourists into the country until end of year. Except for the chinese who they are going to let in this July. Like a few other countries in S.E.Asia the chinese are boss. The chinese will be welcomed by the military government. The chinese who brought this misery to the world and drove out many of the Western tourism demographics to this area. They keep on going with this act and tumbleweeds blowing across the road next.

Your post brings up important issues not all restricted to Thailand. My current city relies on international tourism to fill hotels and casinos that drive large segments of the service economy. Competent leaders strive to introduce diversity in the economy but with many obstacles including education and tradition.

Talk about tumbleweeds. Before casinos, my state government encouraged and subsidized ranching -- raising herds of cattle and sheep to transport to distant markets -- in a desert ecology. Talk about unsustainable economic endeavors.

Thailand has always had to balance its fierce love of freedom and independence with close proximity to its large northern neighbor. Thais have learned to be sage diplomats in order to avoid colonization and massive economic subjugation witnessed in nearby countries such as Myanmar, Vietnam, Laos and China, itself, in recent centuries.

Though wrenching, perhaps the collapse of the tourist industry due to this pandemic will indicate paths to economic independence beyond agricultural exports.

 

[bob012345]

View attachment 262756
View attachment 262755
80% of this 3rd string seaside resorts business depends on tourism. and tourism is down here 80% as well for the country. (Thailand) The government is not letting any foreign tourists into the country until end of year. Except for the chinese who they are going to let in this July. Like a few other countries in S.E.Asia the chinese are boss. The chinese will be welcomed by the military government. The chinese who brought this misery to the world and drove out many of the Western tourism demographics to this area. They keep on going with this act and tumbleweeds blowing across the road next.

In spite of grandiose rhetoric, all nations act in their self interest and China will certainly try to position itself during this crisis to come out on top as far as possible. It is especially disturbing to learn that certain countries are actively waging cyber war against researchers in the West attempting to develop vaccines.

 

[anorlunda]

This post touches on government authority to act. I tried to make it non-partisan, but it may be borderline.

Spoiler: Borderline political.

Wisconsin's Supreme Court struck down the entire state governor's COVID guidelines, and said it can not be enforced.

This is a bit unusual, the case where government did not give the executive branch sufficient emergency powers in advance. The legislature could rush to pass new laws, but they aren't nearly as fast as bars and restaurants which reopened within minutes of the court decision.

Wisconsin Bars Welcome Crowds After Court Strikes Down 'Safer At Home' Bans

Authority is also an issue in the USA. Today, a whistleblower is demanding a single central plan for the whole country. But in reality, state governments that have that authority. The federal government does not have the authority to impose a national plan. It is similar to Europe where the member states have the authority and the EU does not.

Of course the virus knows nothing about political borders. At what scale should COVID plans be made, city? region? nation? continent? global? That's a pointless question because rational planning is not the issue, authority to act is the issue.

 

[Dale]

It may not matter what the government says for the most part. People started staying home on their own well before the state issued stay at home orders. People have information and generally reacted appropriately without waiting for orders from government. I similarly suspect many people will not put themselves at risk simply because a governor says so.

https://fivethirtyeight.com/feature...o-tell-them-to-stay-home-because-of-covid-19/

 

[PAllen]

I would hope it is the false negatives that are really high with the serological tests, that would imply less devastating implications with a lower IFR for the general population.

To make the true IFR significantly lower than the raw measured one for the Spanish data, using an antibody test on sampled total population, you would have to assume a very high false negative rate and a near zero false positive. I don’t know whether that is plausible for an antibody test. For something symmetric, e.g. 3% false negative, 3% false positive, and 5% measured infection rate, you would expect that the true infection rate is around 2.1%, leading to IFR of 2.7%! So I sure hope they considered this in the analysis. I mean it is elementary statistics.

 

[atyy]

It may not matter what the government says for the most part. People started staying home on their own well before the state issued stay at home orders. People have information and generally reacted appropriately without waiting for orders from government. I similarly suspect many people will not put themselves at risk simply because a governor says so.

https://fivethirtyeight.com/feature...o-tell-them-to-stay-home-because-of-covid-19/

But in this case the lack of central (federal) coordination has meant a very suboptimal response, despite the efforts of individuals and corporations. As Trevor Bedford has commented, "However, the main point of the report was that given IFR, we should be pursuing suppression rather than mitigation. This implies a strict lockdown for suppression followed by #TestTraceIsolate to keep epidemic suppressed. Notably, this is exactly what countries like South Korea and New Zealand have been able to achieve. The US was not able to reach suppression with our lockdown and so we're left with agonizing decisions about how to keep society functioning while holding the virus in check. "

Of course it doesn't mean that federal coordination (which is apparent legally impossible) would have been enough (even if it had been legally possible), since there isn't enough police manpower to enforce the stay-at-home if many people simply disregard the law. So an optimal response (eg. South Korea, NZ) needs both central coordination, and trust of the people in their government.

 

[atyy]

To make the true IFR significantly lower than the raw measured one for the Spanish data, using an antibody test on sampled total population, you would have to assume a very high false negative rate and a near zero false positive. I don’t know whether that is plausible for an antibody test. For something symmetric, e.g. 3% false negative, 3% false positive, and 5% measured infection rate, you would expect that the true infection rate is around 2.1%, leading to IFR of 2.7%! So I sure hope they considered this in the analysis. I mean it is elementary statistics.

One possibility for quite a high "false negative" rate is that it takes time for antibodies to develop to a detectable level. I believe some early studies did not find antibodies in about 30% of cases, while later studies are consistent with more of than 90% of cases developing antibodies. https://www.medrxiv.org/content/10.1101/2020.04.30.20085613v1 (see their discussion for the earlier papers with lower estimates)

Another possibility is that the IFR depends on whether the health care system is overwhelmed (which it may have been in some parts of Spain). So if capacity has been built up (eg. hypoxemic people get detected and put on oxygen early to reduce the risk of deterioration), so that might lead to a lower IFR depending on available health care.

 

[mfb]

An overestimated infection fatality rate can come from an overestimated false positive rate: You subtract the fraction of people you expect to be false negative positive, you subtract too many, leaving too few people counted as infected.

 

[PAllen]

An overestimated infection fatality rate can come from an overestimated false positive rate: You subtract the fraction of people you expect to be false negative, you subtract too many, leaving too few people counted as infected.

True, but I think you accidentally used false negative above (second use) when you meant false positive.

 

[mattt]

A little more information about the seroprevalence study in Spain.

https://english.elpais.com/society/...paniards-have-contracted-the-coronavirus.html

 

[BWV]

So much for warm humid weather hindering the virus

https://www.cnn.com/2020/05/07/americas/amazon-manaus-coronavirus-intl/index.html

 

[Tendex]

To make the true IFR significantly lower than the raw measured one for the Spanish data, using an antibody test on sampled total population, you would have to assume a very high false negative rate and a near zero false positive. I don’t know whether that is plausible for an antibody test. For something symmetric, e.g. 3% false negative, 3% false positive, and 5% measured infection rate, you would expect that the true infection rate is around 2.1%, leading to IFR of 2.7%! So I sure hope they considered this in the analysis. I mean it is elementary statistics.

There are diagnostic tests that are not symmetric at all for those rates(they are call either very specific-little sensitive or viceversa) but I would think they have taken this into account. So if the 5% figure is correct maybe it is not as straightforward to obtain a globally valid IFR from the simple proportion of dead from immune. Maybe the strategy to keep healthy people mostly unaffected through confinement while the most susceptible to die like those in nursery homes comparatively less protected is giving a misleadingly high IFR in these first periods of the pandemic?

 

[nsaspook]

Worth watching as an overview of current efforts. And it steers clear of politics.

https://www.pbs.org/video/decoding-covid-19-hrfhb2/

Decoding COVID-19

 

[atyy]

https://www.nbcnews.com/health/health-news/coronavirus-vaccine-week-s-updates-oxford-nih-n1207141
Coronavirus vaccine: This week's updates from Oxford and the NIH

https://www.biorxiv.org/content/10.1101/2020.05.13.093195v1
ChAdOx1 nCoV-19 vaccination prevents SARS-CoV-2 pneumonia in rhesus macaques
Neeltje van Doremalen, Teresa Lambe, Alex Spencer, Sandra Belij-Rammerstorfer, Jyothi Purushotham, Julia Port, Victoria Avanzato, Trenton Bushmaker, Amy Flaxman, Marta Ulaszewska, Friederike Feldmann, Elizabeth Allen, Hannah Sharpe, Jonathan Schulz, Myndi Holbrook, Atsushi Okumura, Kimberly Meade-White, Lizzette Perez-Perez, Cameron Bissett, Ciaran Gilbride, Brandi Williamson, Rebecca Rosenke, Dan Long, Alka Ishwarbhai, Reshma Kailath, Louisa Rose, Susan Morris, Claire Powers, Jamie Lovaglio, Patrick Hanley, Dana Scott, Greg Saturday, Emmie de Wit, Sarah C Gilbert, Vincent Munster

 

[PAllen]

There are diagnostic tests that are not symmetric at all for those rates(they are call either very specific-little sensitive or viceversa) but I would think they have taken this into account. So if the 5% figure is correct maybe it is not as straightforward to obtain a globally valid IFR from the simple proportion of dead from immune. Maybe the strategy to keep healthy people mostly unaffected through confinement while the most susceptible to die like those in nursery homes comparatively less protected is giving a misleadingly high IFR in these first periods of the pandemic?

Yes, I think differing demographics of who is infected in different regions likely plays a role in different apparent IFRs. Also, differences in treatment protocols, and whether healthcare systems are overwhelmed must play a role.

 

[Vanadium 50]

A fast Sweden/Denmark comparison.

Looking at death rates and seeing where the 7-day moving average peaked, it was April 6 for Denmark and April 22 for Sweden. The doubling time before the peak (i.e. the time to get from half the peak to the peak) was 6-8 days for Denmark and 8-10 for Sweden. Error range comes from picking a peak day +/- 1 or 2 days from the dates above.

The time for an additional 50% deaths to come in is ~8 days for both countries.

The time to double the number of deaths is ~15 days for Denmark and ~23 days for Sweden (at which time Denmark is at 2.3x)

My conclusion: the incremental lockdown difference between the two countries buys you very little. If anything, Sweden's curve is a little flatter. I'm willing to believe that -15% (Comparing 2.3x with 2,.0x) is really +10%, but not that's a factor of 10, 20 or even 60 as various decision-makers and thought leaders have claimed. I don't think it's even a factor of 2.

 

[Vanadium 50]

Atty, you often just say "skeptical". Of what? The procedure? Say what you don't like, don't just stick a frowny face on it. The data? It is what it is, and it's out there for everyone.

Or do you just dislike the conclusion?

 

[mfb]

90 deaths per million in Denmark
40 deaths per million in Norway
50 deaths per million in Finland
350 deaths per million in Sweden.
Is there any evidence against the idea that Sweden simply did worse the whole time? You focus on the time of the lockdown, but the countries did way more than just that.

 

[atyy]

Atty, you often just say "skeptical". Of what? The procedure? Say what you don't like, don't just stick a frowny face on it. The data? It is what it is, and it's out there for everyone.

Or do you just dislike the conclusion?

I worry about the combative tone of many of your posts on this topic. Just as I'm not fond of the exaggerated criticisms by some about Sweden's policy, I don't like the possible implicit reading of your posts that lockdown policies are mistaken - both policies could be reasonable, depending on the situation in each country.

I actually think Sweden had a reasonable policy, riskier in some respects, but if people did follow the government's recommendations even though there was no law punishing non-compliance, it is reasonable to think it could work. Part of the reason I think Sweden's policy was reasonable is that Singapore in the early phase (first 1.5 months after onset of community transmission) had a similar policy with no stay-at-home and things were under control (I am pretty sure there were not a lot of undetected cases in the community; we have since had a huge spike in cases needing stay-at-home orders, but that was due a different cause that is maybe quite unique to Singapore).

Although Sweden overall has more COVID-19 deaths per capita than Denmark, that may not be because of the lack of a lockdown-like policy. Some of their officials have attributed it to an implementation failure in other policies meant to protect people in nursing homes (though I haven't seen the numbers), and I recall reading that they have since taken steps to address that (not sure precisely what they've done, will have to look).

 

[PAllen]

One point is that the least damaging policy depends on features of the country, e.g. population density, demographics, culture including trust of government, etc. As a simple point, Denmark has over 6 times the population density of Sweden, so there is no reason to expect the same optimal policy for both. Similarly, Wyoming is rather different from NYC.

 

[PeroK]

90 deaths per million in Denmark
40 deaths per million in Norway
50 deaths per million in Finland
350 deaths per million in Sweden.

420 deaths per million in France.
508 deaths per million in the UK.
525 deaths per million in Italy
590 deaths per million in Spain
770 deaths per million in Belgium

 

[atyy]

As I mentioned above, the higher per capita deaths in Sweden may not be related to a lack of a lockdown-like policy, but may be due to an implementation failure in policy to protect nursing homes, as one of the reports below says "The country said early on that shielding those 70 and older was its top priority."

https://www.thelocal.se/20200504/swedish-health-authorities-examine-high-coronavirus-death-toll
Sweden has been hit much harder by the Coronavirus than the rest of Scandinavia. The country's health authorities are now looking at why the infection swept through elderly care homes so fast.

https://www.france24.com/en/20200510-sweden-admits-failure-to-protect-elderly-in-care-homes
Sweden admits failure to protect elderly in care homes

In Singapore we've also had one outbreak in a nursing home, with 2 deaths (I think) so far from that. Though we did have good news that a 102 year-old female nursing home resident made a good recovery. A rather draconian measure the Singapore government has now taken is that all nursing home workers must be tested and not return home, but stay in either at work or hotels (paid for by the government) for a few weeks, to avoid the workers acquiring the infection at home then bringing it to work. It's supposed to be temporary (a couple of weeks), while they figure out a more sustainable policy, but we don't know what that is yet. Chatting with a friend of mine whose wife works at a nursing home, and he said she was enjoying a vacation at a hotel while he's left with the kids at home (obviously his point of view, not hers ).