COVID COVID-19 Coronavirus Containment Efforts

[DennisN]

An article and a blog post about the reported lingering/prolonged symptoms of Covid-19:

'Weird as hell’: the Covid-19 patients who have symptoms for months (The Guardian, 15 May 2020)

In mid-March Paul Garner developed what he thought was a “bit of a cough”. A professor of infectious diseases, Garner was discussing the new Coronavirus with David Nabarro, the UK’s special envoy on the pandemic. At the end of the Zoom call, Nabarro advised Garner to go home immediately and to self-isolate. Garner did. He felt no more than a “little bit off”.

Days later, he found himself fighting a raging infection. It’s one he likens to being “abused by somebody” or clubbed over the head with a cricket bat. “The symptoms were weird as hell,” he says. They included loss of smell, heaviness, malaise, tight chest and racing heart. At one point Garner thought he was about to die. He tried to Google “fulminating myocarditis” but was too unwell to navigate the screen.

[...]

Paul Garner: For 7 weeks I have been through a roller coaster of ill health, extreme emotions, and utter exhaustion (BMJ, 5 May 2020)

Paul Garner, professor of infectious diseases at Liverpool School of Tropical Medicine, discusses his experience of having covid-19

In mid March I developed covid-19. For almost seven weeks I have been through a roller coaster of ill health, extreme emotions, and utter exhaustion. Although not hospitalised, it has been frightening and long. The illness ebbs and flows, but never goes away. Health professionals, employers, partners, and people with the disease need to know that this illness can last for weeks, and the long tail is not some “post-viral fatigue syndrome”—it is the disease. People who have a more protracted illness need help to understand and cope with the constantly shifting, bizarre symptoms, and their unpredictable course.

[...]

 

[bhobba]

In Singapore we've also had one outbreak in a nursing home, with 2 deaths (I think) so far from that.

It's not just Singapore:
https://www.abc.net.au/news/2020-05-17/coronavirus-rockhampton-nurse-covid-19-test/12256038

It's a very interesting thing. India has had a lower death rate than other places. I do not think anybody knows why for sure, but one theory is older people tend to still stay with their family and not concentrated in nursing homes. When it gets in a elderly care facility it can spread like wildfire and they have a higher death rate.

Thanks
Bill

 

[Vanadium 50]

I do not think anybody knows why for sure, but one theory is older people tend to still stay with their family and not concentrated in nursing homes

This is the same theory as to why Italy had a higher rate. (And Spain higher and Japan lower) I'm willing to believe it makes the rate either higher or lower, but not both.

 

[Vanadium 50]

I don't like the possible implicit reading of your posts that lockdown policies are mistaken

But if the data says that they are, shouldn't that change your mind? Are we scientists or not?

The data show that the post-peak peformence of Sweden is not hugely better or worse than other countries. It is true that Sweden has a 30% high overall death rate than the EU as a whole (and it would be smaller if the UK were still in), but as PeroK points out other countries with harsher lockdown policies have higher rates (up to a factor of 2 more). Further, it's impossible for post-peak policies to influence the size of the peak. In short, if you want to argue Sweden's past policies were mistaken, go ahead, but it is a completely separate issue from how well the present policies are performing.

I will admit the question of "what works" is tangled with the question "who decides". If democracies are going to temporarily cede control to the Experts to make decisions, it is not unreasonable to ask how well these Experts are doing. The insistence that we need to lock down tighter than Sweden seems not to be supported by the facts. The moving of Covid patients into nursing homes in New York seems not to have been a good idea.

 

[mfb]

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

100 deaths per million in Germany.
Scandinavian countries are best compared to other Scandinavian countries as they are the most similar.

I looked again how the isolated islands do (treating Australia as island here):
Iceland is at nearly zero - one case last week, two cases the week before that. 6 active cases. They might have a few asymptomatic cases left that they only find if these infect others or if they show up in random testing.
New Zealand found two cases last week and 10 the week before. So far they follow the path of Iceland with a week delay or so.

Australia limited the spread quickly after the peak, but in the last weeks new cases have been roughly constant:



By state, this seems to come mainly from a smaller outbreak in Victoria, but it's not gone elsewhere either. If the goal is regional extinction they'll probably need to do more.

Hawaii has 1-2 cases per day. The trend still seems to go downwards, slowly. They have a mandatory 2 week quarantine for people entering, but no travel restrictions otherwise as far as I understand. I'm still skeptical if they can keep that up, without tourism a main income source is gone.

 

[atyy]

But if the data says that they are, shouldn't that change your mind? Are we scientists or not?

We are both scientists and citizens. The data already shows that lockdown-like policies can work superbly. How well they and other policies work in each context will depend on the past and continuing actions of citizens.

 

[bhobba]

Is Nobel Laureate Peter Doherty being overly optimistic:


Maybe it's because he is not a MD but a vet .

Seriously he and his institute is on the frontlines of this battle.

Thanks
Bill

 

[PAllen]

Is Nobel Laureate Peter Doherty being overly optimistic:


Maybe it because he is not a MD but a vet .

Seriously he and his institute is on the frontlines of this battle.

Thanks
Bill

Interesting - your link complains that one must disable tracking protection in firefox to see the embedded link. Foul behavior, IMO. I found the content anyway, but I despise such behavior by websites. What I see as the text of your tweet link is "Cannot load tweet. Disable your adblocker and tracking protection. " I have no adblocker, but I do accept firefox default tracking blocking. This is the very first time a site has complained about tracking protection in the year since firefox introduced it.

 

[atyy]

It's a very interesting thing. India has had a lower death rate than other places. I do not think anybody knows why for sure, but one theory is older people tend to still stay with their family and not concentrated in nursing homes. When it gets in a elderly care facility it can spread like wildfire and they have a higher death rate.

Various reports on the quite varied situation in India

https://www.npr.org/sections/corona...india-sees-a-drop-in-mortality-under-lockdown

https://www.theguardian.com/world/2...-health-minister-helped-save-it-from-covid-19

https://www.channelnewsasia.com/news/asia/covid-19-packed-morgues-beds-mumbai-hospitals-12738752

 

[PeroK]

Scandinavian countries are best compared to other Scandinavian countries as they are the most similar.

Why? What's the scientific reason for this? Are you sure you don't have a moral objection to what Sweden did, hence are only prepared to compare them to countries with fewer deaths?

Several newspaper articles I've read have done the same: emphasised the deaths in Sweden, with never a mention that there are countries that locked down very hard are have many more deaths.

If we compare Sweden only with countries with fewer deaths, then Sweden is the worst place for COVID-19. If we compare Sweden with all other countries, then it isn't the worst place.

 

[Vanadium 50]

he data already shows that lockdown-like policies can work superbly.

What do you think is the best data for it? I ask only that:

• Sweden is not in the list of countries with "lockdown-like" policies (otherwise why complain about my posts?)
• It be causal - i.e. post-peak policies can't influence an earlier statistic
• It be data - not comparing to a counterfactual model

 

[mfb]

Why? What's the scientific reason for this?

See my previous post.
Why don't we compare Sweden to North Korea with zero reported deaths? Syria with 3 reported deaths? You know why: Because that wouldn't make sense. We need countries that are as similar as possible for a meaningful comparison. Countries with a similar demographics, structure, style of life, overall government policies and so on.

Are you sure you don't have a moral objection to what Sweden did, hence are only prepared to compare them to countries with fewer deaths?

What an odd question. Yes, I am sure.

If we compare Sweden with all other countries, then it isn't the worst place.

No one questioned that, but is that really the best measure? Should we stop trying to get the best result we can because it is worse somewhere in the world?

Is Nobel Laureate Peter Doherty being overly optimistic:

If they start mass production in October we can get something early 2021. A record speed for a record demand, but in line with optimistic predictions we have seen before.

 

[PeroK]

We need countries that are as similar as possible for a meaningful comparison. Countries with a similar demographics, structure, style of life, overall government policies and so on.

We're not talking about N Korea, we're talking about Western Europe. The virus is widespread across all of western Europe. You're comparing Sweden with three small countries with a combined population of less than 20 million. There needs to be a good reason to say that Sweden is fundamentally (or at least significantly) different from the Netherlands, say. And why the rest of western Europe is not a relevant comparison to Sweden.

There's no issue excluding Africa, Asia or N Korea. The problem is excluding the rest of western Europe.

There is no scientific basis I can see for this.

 

[DennisN]

About Sweden and comparing countries...

I wrote previously in this thread briefly about that I think it is difficult to compare countries.
When it comes to Sweden I was thinking that I don't really see the point comparing such a small country with US. I personally wouldn't even try to; just thinking about it gives me a headache.
Maybe one could compare Sweden to a state in the US perhaps, but still I personally wouldn't, because I know too little about US. To me it would seem more straightforward to compare the individual US states with each other, rather than Sweden.

I also wrote that I think it is best to compare Sweden with Denmark, Norway and Finland, because these countries have been, and are often compared to each other in various ways; they are close, with comparable populations and area etc (though Denmark is pretty small). But maybe there are other countries in the EU that would be useful to compare the Nordic countries with, I really don't know. Belgium and Netherlands perhaps?

I understand the desire of and interest in comparing countries, I really do. I did it myself in this thread
before, when I did a couple of graphs and tables. But after I realized that the testing policies in different countries were different, I started to question the validity of the numbers and thus the usefulness in comparing cases (confirmed cases).

After that I started to think about different circumstances for different countries, and soon it gave me headaches . For instance, when it comes to the Nordic countries, I don't know if these countries count the deaths in a similar way. Another thing is that Sweden has a large number of deaths in nursing homes. Now, add the fact that the nursing homes in Sweden have more people in them (they are more dense) than in Norway, and you may understand that comparisons can get quite tricky. Furthermore, if I am not misinformed, Finland was not hit as hard initially with the virus as the other Nordic countries.

My point here is that there seems to be significant difficulties in comparisons even between the Nordic countries.

Personally, I temporarily have given up making comparisons. I see so many variables that may have an influence on the numbers that it gives me headaches, e.g. population, population density, age distribution, initial cases (spreaders), number of hotspots, policies, regulations, testing, population movement, information to the public etc etc. And I realize I know very little about these things in other countries, so I leave it to others to do comparisons if they like to.

Also, I would repeat what Dr Osterholm and others I have quoted in this thread before has said, this pandemic may last for quite a while. But hopefully it will be over sooner than later.

Nevertheless I am pretty certain that this pandemic and the various policies will be heavily researched in the near future. I am also certain I won't do any of that research.

Edit: I could also add that the Swedish policy and the high number of deaths in nursing homes are being debated domestically, but I'm not up to date about it. And I am of the opinion that we have failed with regards to the nursing homes, and I share our chief epidemiologists thoughts that this is likely in part due to inherent/previous problems with our nursing homes (e.g. bad routines, lack of info). This will likely be heavily debated and discussed in Sweden.

 

[mfb]

We're not talking about N Korea, we're talking about Western Europe. The virus is widespread across all of western Europe. You're comparing Sweden with three small countries with a combined population of less than 20 million. There needs to be a good reason to say that Sweden is fundamentally (or at least significantly) different from the Netherlands, say. And why the rest of western Europe is not a relevant comparison to Sweden.

Sweden has a population of 10 million. Norway has 5 million, Finland has 6 million, Denmark has has 6 million. I don't know why you brought up total population, but clearly these countries are closer in population than e.g. Germany with 80 million or France with 70 million?
If you think Scandinavian countries are so similar to Western Europe (and no matter where you look, they are not) you would have to explain why they all had death tolls so much lower than most of Western Europe. Well, all except Sweden.

 

[bob012345]

Sweden has a population of 10 million. Norway has 5 million, Finland has 6 million, Denmark has has 6 million. I don't know why you brought up total population, but clearly these countries are closer in population than e.g. Germany with 80 million or France with 70 million?
If you think Scandinavian countries are so similar to Western Europe (and no matter where you look, they are not) you would have to explain why they all had death tolls so much lower than most of Western Europe. Well, all except Sweden.

Sweden hasn't done so bad and it's a false comparison to assume the Scandinavian countries must be compared as a unit. The WHO now says Sweden is a model for reopening economies.

 

[mfb]

I don't say Sweden has done bad, but its deaths were much higher than for all its neighbors. All the neighbors kept the disease at a much lower level.

 

[PAllen]

Sweden has a population of 10 million. Norway has 5 million, Finland has 6 million, Denmark has has 6 million. I don't know why you brought up total population, but clearly these countries are closer in population than e.g. Germany with 80 million or France with 70 million?
If you think Scandinavian countries are so similar to Western Europe (and no matter where you look, they are not) you would have to explain why they all had death tolls so much lower than most of Western Europe. Well, all except Sweden.

Also, as I noted earlier, Denmark has six times higher population density than Sweden (with similar population) and has a land connection to Western Europe, all of which would suggest much worse results than Sweden. Instead, they have done much better.

 

[OmCheeto]

Anyone have a guess how Denmark ended up with a worse deaths/million (X/M) ratio than Hubei?

Belgium thru Denmark are the top 15 X/M nations, minus San Marino(1214), Andorra(636), and Luxembourg(168), as their populations strike me more as town/cityish.

 

[wukunlin]

Anyone have a guess how Denmark ended up with a worse deaths/million (X/M) ratio than Hubei?

View attachment 263028
Belgium thru Denmark are the top 15 X/M nations, minus San Marino(1214), Andorra(636), and Luxembourg(168), as their populations strike me more as town/cityish.

Just a wild guess. I took a quick look and saw around 40% of Hubei's population are registered in rural areas. The only contacts they have with people outside their local clusters of villages are either people who come into buy their fresh produce, or their children who work in cities. The former were on holiday during the outbreak because it was near spring break, the latter couldn't come home due to the lock down.

 

[Rive]

...ended up...

What bothers me the most regarding the/an ongoing pandemic is the usage of 'ended'.
I would reserve that word for later use - it is just not fair and not useful to apply it now.

 

[PeroK]

Sweden has a population of 10 million. Norway has 5 million, Finland has 6 million, Denmark has has 6 million. I don't know why you brought up total population, but clearly these countries are closer in population than e.g. Germany with 80 million or France with 70 million?
If you think Scandinavian countries are so similar to Western Europe (and no matter where you look, they are not) you would have to explain why they all had death tolls so much lower than most of Western Europe. Well, all except Sweden.

In some ways all these countries have too low a population to be statistically significant. The virus breaks out exponentially in certain areas. A country the size of Denmark can get "lucky" and practically avoid the virus, whereas another small country like Belgium can get "unlucky" and be disproportionately hit. In the larger countries like Italy, Spain and France the data tends to even out. You'll find regions in these countries as badly hit as Belgium and other regions who, like Denmark, have low numbers.

That would be, IMO, a significant part of the reason why Denmark has 95 deaths per million and Belgium 784. If there had been an early major outbreak in Copenhagen rather than Brussels it could have been the other way round.

The virus is not evenly spread across western Europe. There are other countries with low death rates:

Portugal (adjacent to Spain) has 121 per million; Spain has 593.
Austria only 70 per million; whereas Switzerland has 218.

There is a massive spread in numbers, especially across the smaller countries and that points to the randomness of uncontrolled outbreaks.

 

[atyy]

The Trinity of COVID-19: Immunity, Inflammation and Intervention | Assoc Prof Paul MacAry (Part 2)

Lecture by Paul MacAry, an immunologist at the National University of Singapore. The part from 6:15 to the end gives an introduction to vaccines in general, and an overview of current vaccine efforts. He says it may be possible for a vaccine will become available in early 2021 for emergency use or similar protocols, given the number of ongoing efforts and coordination among governments and the WHO.

 

[Vanadium 50]

A country the size of Denmark can get "lucky" and practically avoid the virus, whereas another small country like Belgium can get "unlucky" and be disproportionately hit.

Look at Liechtenstein and the neighboring Swiss canton of Graubunden. Things are an order of magnitude worse in Graubunden. The difference used to be even more evident, but then Liechtenstein got a case.

 

[russ_watters]

In some ways all these countries have too low a population to be statistically significant. The virus breaks out exponentially in certain areas. A country the size of Denmark can get "lucky" and practically avoid the virus, whereas another small country like Belgium can get "unlucky" and be disproportionately hit. In the larger countries like Italy, Spain and France the data tends to even out.

I'd say the first bit slightly differently or even amplify: it's the larger sample sizes that show the smoothest exponential curves. But for "certain areas" the starting point is often one of explosive clusters. At that choir practice in Washington, one person infected a probable 52 others in a single event. If the average reproduction rate is 2.2 and the average time is 5 days, that's 3.5 weeks (5 generations) of growth from a single event. Or put another way, instead of starting with 1 case and 3.5 weeks later having 53, you now have 1,200. That kind of explosive growth early in the pandemic in some places likely had a huge impact on the outcome for smaller areas that happened to be unlucky enough to have them; especially to have them early.

 

[david2]

some hopeful news

Moderna Announces Positive Interim Phase 1 Data for its mRNA Vaccine

https://modernatx.gcs-web.com/news-...ositive-interim-phase-1-data-its-mrna-vaccine

 

[Astronuc]

Coronavirus: Baby develops life-threatening inflammatory condition 'while her twin escapes unscathed'
https://www.yahoo.com/lifestyle/coronavirus-covid1-kawasaki-disease-inflammation-092538403.html

A mother of identical twins has revealed how one suffered a life-threatening illness after overcoming the coronavirus, while the other is thought to have escaped unscathed.

Hannah Godwin, 35, noticed her five-month-old daughter Leia had a rash and fever while lying next to her “healthy and happy” sister Thea.

NHS doctors have been told to look out for signs of “multi-system inflammation” after intensive care units in London saw eight children with unusual symptoms, some of whom tested positive for the coronavirus.

Leia has spent the past three weeks in hospital, . . . . Although Leia is no longer in critical care, doctors have warned she has a long road to recovery.

Even without COVID-19 respiratory distress, the inflammation presents yet another challenge.

 

[bob012345]

Is it just me or is anyone else alarmed by so called gain-of-function research on dangerous viruses? This is the practice of taking a virus, such as the bird flu and making it more transmittable to humans for the purpose of researching cures and vaccines in the event that virus ever naturally mutates and gets into the human population. I mentioned bird flu because that was debated and defended by prominent scientists a decade ago with references below.

https://osp.od.nih.gov/biotechnology/gain-of-function-research/

https://www.washingtonpost.com/opin...worth-taking/2011/12/30/gIQAM9sNRP_story.html

https://www.bbc.com/news/world-us-canada-16279365

https://www.sciencemag.org/news/201...iments-make-bird-flu-more-risky-poised-resume

Relevant to the current crisis is the fact that NIH funded and NIAID administered gain-of-function research at the Wuhan Institute of Virology and elsewhere using SARS-CoV-2. Basically, we paid them to make it much easier to transmit to humans for research purposes. Here is the NIH funding for EcoHealth Alliance, the organization that funnels NIH money to labs around the world.

https://projectreporter.nih.gov/reporter_SearchResults.cfm?icde=50081038

Notice this statement from the sixth project title down;

2

R01

AI110964

06

Speaking of SARSr-CoVs,;

"We will use S protein sequence data, infectious clone technology, in vitro and in vivo infection experiments and analysis of receptor binding to test the hypothesis that % divergence thresholds in S protein sequences predict spillover potential."

Note that I made no claims that this research was the cause of the pandemic. But representatives of 122 nations just demanded that the actual source of the virus be vigorously investigated.

 

[mfb]

Note that I made no claims that this research was the cause of the pandemic.

Good, because that claim would be foolish.

But representatives of 122 nations just demanded that the actual source of the virus be vigorously investigated.

Why put this completely unrelated point next to the other one?

 

[atyy]

Moderna Announces Positive Interim Phase 1 Data for its mRNA Vaccine

Interesting. I hadn't been very hopeful for the RNA/DNA vaccines as they need the body to produce the antigen from the RNA, whereas other vaccine contain the antigen. Also, none to date have been approved for any other use in people, although they have veterinary use. However, these are generally thought to be very likely to be safe.