COVID-19 Coronavirus Containment Efforts

[bob012345]

You know what makes me angry? Why is it worth trillions of dollars to mitigate Covid and not 0.1% as much to end malaria (which kills a million or two people a year)? I'll tell you why. People who get malaria are poor, black and brown and live far away. Important people get Covid. Rich people. White people. New Yorkers and others living in the rich part of the US.

The rich countries have developed a simple, cheap and available treatment for malaria. The bigger question in my mind is why those in power in the endemic regions are not concerned enough to overcome their differences in order to prevent millions of their own people, mainly children, from dying from an easily treatable disease? It is not rich, white New Yorkers who are preventing poor African children from getting the care they need.

 

[bhobba]

The rich countries have developed a simple, cheap and available treatment for malaria. The bigger question in my mind is why those in power in the endemic regions are not concerned enough to overcome their differences in order to prevent millions of their own people, mainly children, from dying from an easily treatable disease? It is not rich, white New Yorkers who are preventing poor African children from getting the care they need.

Well when times are economically not so good, like here in Aus, the farmers, decimated by drought and fires, complain why are you spending money overseas and not helping them? Of course you can do both, but there is a limit to the tax you can impose before people vote you out - even the fear you will increase their cost of living is enough to generate a voter backlash. That's how the current government in Aus remained in power. The opposition were a shoe in according to polls. But close to the election it became obvious they had not fully costed many of their policies. Fear their wallets would be arbitrarily hit caused the average Australian to change their mind, and the Government had a surprise victory. Also it must be mentioned the bulk of a countries money comes from the middle and upper middle class - not the rich. There are many avenues open they take advantage of to reduce the tax they pay. I remember they had an inquiry into it and one of our richest citizens, Kerry Packer, was 'scolded' by a parliamentary committee for not paying what they thought was his fair share of tax. He was straight to the point - anyone that doesn't use any legal means to reduce his/her tax as much as possible is a 'mug', because to be blunt you (meaning the government) are not spending it wisely at all. He was applauded by the majority of Australians.

On a positive note Bill Gates is working hard to eliminate Malaria.

Added Later:
Of course it's not the rich in developed countries that is the problem, it's simple economics. That means, despite how terrible they feel about the blight of Malaria etc in the poor countries (and generally they do) you can't rely on those countries to help you out - they have their own issues.

Thanks
Bill

 

[atyy]

Death or undefined privacy risk?

It's not clear the apps work without traditional contact tracing and quarantine of confirmed cases and close contacts. If traditional contact tracing is in place, then it may be possible that the app need not be compulsory. Thus for example, it appears that the contact tracing for some of the early cases in the US was very well done. Another approach is to scale that up considerably (which one may need to anyway, even if there is an app).

 

[bhobba]

From our local newspaper

ADELAIDE VACCINE TO TARGET HOT SPOTS

Residents living in Coronavirus hot spots in Melbourne may be targeted for human trials of an Australian vaccine in a plan being drawn up by an Adelaide scientist.

A COVID-19 vaccine developed by Flinders University professor Nikolai Petrovsky is the first Australian candidate to enter phase 1 human trials, The Australian reports.

Professor Petrovsky wants to conduct the next phase of human trials in Victorian outbreak hot spots.

“What we’re proposing is that if a vaccine is available that has passed initial safety and immunogenicity preliminary testing criteria in humans, that vaccine could be used in the context of a localised outbreak to see whether that breaks the cycle of virus transmission and actually brings the outbreak to a stop,” Professor Petrovsky, the founder of the South Australian biotech Vaccine, said.

“As soon as the phase 1 safety data is available there is no reason that our vaccine could not be used in an experimental setting by Victoria in just such a manner.”'

The UQ vaccine has also entered phase 1 trials. It may also be deployed when that is finished.

My dinner is getting cold, but IMHO this is really important. Will be able to discuss it a bit later.

Thanks
Bill

 

[bhobba]

It's not clear the apps work without traditional contact tracing and quarantine of confirmed cases and close contacts.

I read where in the outbreak in Melbourne our app, called COVIDSafe, resulted in just one person traced. Why is not known at this stage eg most phones may have been turned off.

Thanks
Bill

 

[Rive]

https://www.jstor.org/stable/30082047?seq=8#metadata_info_tab_contents

Spoiler: hint

Check the date of the study

 

[bhobba]

https://www.jstor.org/stable/30082047?seq=8#metadata_info_tab_contents

Spoiler: hint

Check the date of the study

Good one.

Thanks
Bill

 

[Vanadium 50]

I've said this before, but the combination of "dying of Covid is even worse than dying of something else" and "all vaccines are perfectly safe - who are you anyway? Jenny McCarthy?" is leading us towards some real risks once there is a putative vaccine.

I'm going to take Victoria as an example. It has 6M people (a little more) and 24 deaths from Covid. Assuming you vaccinate everyone, and want the vaccine to kill fewer people than the disease, it needs to kill fewer than 4 x 10^-6 of the people who receive it. To know that requires testing around a million people. (And few per million serious adverse effects is in the ballpark of common vaccines)

This is well above the size of any previous trial.

You can make the same argument for other vaccines, but this history in most cases was that there were years between development and widespread use and tests went from the few, to the few thousands, to monitored widespread use, to widespread use. The world wants to skip all that.

 

[bhobba]

Yes - all true.

Those vaccinated to try and bring second wave outbreaks under control will be as part of the stage two trials (after stage 1 safety trials completed), and I highly doubt it will be anything but voluntary.

But it is a valid point - there is risk here without doubt - is the risk of deploying a vaccine whose medium/long term safety (short term safety is checked in stage 1) is unknown greater than the death rate of not deploying it? It's a very difficult ethical question. I have my view - if ever we want to get back to normal that, or something similar (ie an effective treatment), is virtually the only way. We could do something like have rather nice, distanced, and carefully protected communities for those at greater risk and let the rest go for it, achieve heard immunity and be done with it. But remember that heard immunity will have to be rather high because of how contagious it is, with an r0 about 2.3 or maybe even as high as 3. We can also have various mixtures of this.

That sets the scene - how should we proceed. Or is there another choice I have not considered.

Thanks
Bill

 

[Ygggdrasil]

I've said this before, but the combination of "dying of Covid is even worse than dying of something else" and "all vaccines are perfectly safe - who are you anyway? Jenny McCarthy?" is leading us towards some real risks once there is a putative vaccine.

I'm going to take Victoria as an example. It has 6M people (a little more) and 24 deaths from Covid. Assuming you vaccinate everyone, and want the vaccine to kill fewer people than the disease, it needs to kill fewer than 4 x 10^-6 of the people who receive it. To know that requires testing around a million people. (And few per million serious adverse effects is in the ballpark of common vaccines)

This is well above the size of any previous trial.

You can make the same argument for other vaccines, but this history in most cases was that there were years between development and widespread use and tests went from the few, to the few thousands, to monitored widespread use, to widespread use. The world wants to skip all that.

The logic here is laughably bad. Do you expect 24 deaths to be the final death toll from COVID-19 in Victoria? Given estimates of the IFR ~ 0.5-1% and a herd immunity threshold of 50-80%, the vaccine would potentially be preventing 15,000-48,000 deaths in the 6M population, so it would need to kill fewer than 2.5x10^-3 of those who receive it (to cause fewer deaths than an unchecked COVID-19 outbreak), an estimate three orders of magnitude smaller than your estimate.

Furthermore, your cost benefit analysis does not take into account the costs of keeping the death toll to only 24 deaths (lockdowns and serious suppression of economic activity and personal freedom). An effective vaccine would enable lifting of lockdowns and returns to more normal levels of economic activity and personal freedoms.

I agree with the general point that we need to be careful in testing and evaluating a COVID-19 vaccine (especially to avoid political pressure causing a pre-mature release of the vaccine), but your argument here is very flawed.

 

[bhobba]

Hey guys, this is very interesting. But remember what is being looked at is part of normal phase 2 testing using it to break hotspots so they are bought under control. At this stage Australia is not looking at mass vaccinations of the entire population, although I think it will eventually come.

Interesting as well the person responsible for the Adelaide vaccine thinks vaccines like the Oxford one they are looking at 2 billion doses by September will likely not end up the answer:
https://www.hospitalhealth.com.au/c...id-19-says-professor-1538816326#axzz6RzyX3U5F

If it's weak enough not to cause side effects it's effectiveness may be of value, but not enough for things to return to normal.

Thanks
Bill

 

[Vanadium 50]

It's a very difficult ethical question.

One rational path forward is to let individuals decide based on their own risk.

I estimate my own risk of dying at around 10^-5. I am substantially younger than the highest risk group, I am in an area that has below-average infections, and I am better able to isolate than others. So rationally, I should get vaccinated when ~10⁵ others have demonstrated its safety. Some would even argue that I should "wait my turn."

Yggdrasil's argument that the numbers might change is in fact covered by this. If I moved to Victoria, the 10^-5 goes down, and it is in my interest to go farther back in line. If I moved to Sao Paolo, the 10^-5 goes up, and it is in my interest to go farther up in line. If there is a breakout a city or two over, the10^-5 again goes up, and it is in my interest to go farther up in line.

The real problem is "who wants to be in the first few thousand?" If the answer is "nobody" (which could be entirely rational) something must be done. Most likely the answer will be "test it out on the poor". Nobody will say, that, of course, but if we said a barely-tested vaccine were a requirement to resume work for the "inessentials", well, we know who our guinea pigs pioneers will be. The fact that this is a group that is poorer, less politically powerful and frankly, less white than the population as a whole is just a sad side effect. Jonathan Swift would be proud.

The next problem is one we see today with other vaccines, like MMR, and that's freeloading. An effective vaccine reduces risk, and that in turn moves the rational equilibrium point further back. It is rational for each individual to let the others take on the risk, but if everyone does that, there is no risk reduction. This is an example of the Tragedy of the Commons. The freeloaders in the US are more educated, more urban, have higher incomes and are whiter than the population as a whole. A related issue is that the inevitably opens up the question "if I can choose for myself for Covid, why can't I with MMR?"

 

[bhobba]

One rational path forward is to let individuals decide based on their own risk.

In a democracy that is exactly how it is done. The use of the vaccine will be voluntary. But it's easy to guess what the average person will do. They will take it to avoid possibly spending longer in lockdown. Thats exactly what's happening with Covid tests. We can't force anyone to take them (there is a caveat if the biosecurity act is invoked - but the government, correctly IMHO, will only do that in a dire emergency) but if you refuse it, its off to quarantine at your own expense. When that rule was bought in not too many refused anymore.

I have chatted with anti-vaccer's about this. They were really worried about being forced to be vaccinated. I explained it is possible that will happen in a dire emergency, but is not likely. They were still worried - but the bottom line is, sometimes doctors must make decisions to save many lives that violate individual freedoms. It's a terrible decision, but laws are correctly on the books for an emergency. Of course they too are subject to the democratic process.

Interestingly here in Brisbane the phase 1 volunteers for the UQ vaccine had many many more people wanting to participate than required. Other factors than your rational self interest come into it such as can you live with yourself knowing you could help many others by taking some risk. There are, and have always been, people like that. Why I leave to philosophers, psychologists and sociologists. I would do it because that's how I was raised - that mateship is central to our culture - you can't let your mates down.

Thanks
Bill

 

[atyy]

A related issue is that the inevitably opens up the question "if I can choose for myself for Covid, why can't I with MMR?"

The strength of evidence supporting mandatory vaccination is different for COVID-19 and for MMR. I hope we are get lucky, but it might already be optimistic to think the first COVID-19 vaccines will be as effective for COVID-19 as flu vaccines are for flu. For the flu vaccine, there seems to be debate about making it mandatory for various groups of people.

https://www.bmj.com/bmj/section-pdf/749788?path=/bmj/347/7933/Head_to_Head.full.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468130/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468124/
https://www.cdc.gov/flu/professionals/healthcareworkers.htm

 

[mfb]

The real problem is "who wants to be in the first few thousand?"

This is a solved problem. They have found thousands of volunteers for trials, and globally we are probably looking at tens of thousands participating in trials.
It shouldn't be surprising. They get thousands of volunteers for other vaccine trials that are much less urgent. Imagine how much easier it is for a current pandemic.

 

[Point Conception]

June 11, 2020 - The D614G mutation in the SARS-CoV-2 spike protein reduces S1 shedding and increases infectivity
https://www.scripps.edu/news-and-ev...611-choe-farzan-sars-cov-2-spike-protein.html

Yes increased infectivity but are there any data/studies showing whether the D614G mutation is more or less lethal?

 

[atyy]

Yes increased infectivity but are there any data/studies showing whether the D614G mutation is more or less lethal?

The infectivity refers to cell culture data, and may not apply to transmissibility (though it is consistent with the variant becoming more common). One of the papers looking at the variants was not able to find any difference in severity between them: https://www.cell.com/cell/pdf/S0092-8674(20)30820-5.pdf

 

[bhobba]

For the flu vaccine, there seems to be debate about making it mandatory for various groups of people.

No debate for me. I do not know if being on the cocktail of drugs I am on it is a requirement I have it, but when I see my doctor it's where do you want it.

Thanks
Bill

 

[vela]

California's locking down again.

https://www.latimes.com/california/...ifornia-county-rollback-reopening-coronavirus

 

[Buzz Bloom]

I found some interesting stuff on the Internet (which I have cited below) regarding dogs trained to detect covid-19.

https://www.bbc.com/news/uk-england-beds-bucks-herts-53254200​

https://news.sky.com/story/covid-do...o-250-people-an-hour-for-coronavirus-11989180​

https://podcasts.apple.com/gb/podca...t-us-out-lockdown/id951048357?i=1000472322269​

https://canvethospital.com/news/disease-detecting-dogs-even-covid-19​

I have not been able to find any peer review articles about the details of the training. I hope someone can help me find some.

I also have an mp4 file which I think may be from facebook. I have not included it in this post because I am not sure about the relevant PFs' rules.

 

[bob012345]

Has the definition of what constitutes a new case recently changed? Are they including 'probable' cases as new cases now? Are they also including people who test positive for antibodies but never were tested for the virus as 'new' cases too?

 

[Astronuc]

Has the definition of what constitutes a new case recently changed? Are they including 'probable' cases as new cases now? Are they also including people who test positive for antibodies but never were tested for the virus as 'new' cases too?

That's hard to say, and it probably depends on who is doing the reporting. I believe 'probable' cases are treated separately, but it's not clear how uniform and consistent the reporting is across 50 states and the 3000+ counties.

See different ways of reporting
Alabama - https://alpublichealth.maps.arcgis..../index.html#/6d2771faa9da4a2786a509d82c8cf0f7
Arizona - https://www.azdhs.gov/preparedness/...se-epidemiology/covid-19/dashboards/index.php
California - https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx#
Florida - https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429
New York - https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Map
Texas - https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/0d8bdf9be927459d9cb11b9eaef6101f
Washington - https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020COVID19/DataDashboard

Compare to https://ncov2019.live/data/unitedstates and https://covidtracking.com/data
ncov2019.live has greater numbers than reported by the states, so I believe they may count some 'probable' positive cases and deaths in their numbers. However, the discrepancies are not clear to me.

Meanwhile, CNN reports that Governor Kevin Stitt of Oklahoma has tested positive for COVID-19
https://www.cnn.com/2020/07/15/politics/kevin-stitt-oklahoma-governor-coronavirus/index.html

The health department reports that it is not clear how he was exposed. "Dr. Lance Frye, the commissioner of the Oklahoma State Department of Health, said they don't know exactly when Stitt was infected, but that it would've been within the last couple of weeks."

Update: NY Times reported on how states report deaths - probable and confirmed
https://www.nytimes.com/interactive/2020/06/19/us/us-coronavirus-covid-death-toll.html

 

[Jarvis323]

Incomplete classification, but still an interesting observation.

https://www.google.com/amp/s/hbr.or...pandemic-reshape-notions-of-female-leadership

 

[StevieTNZ]

I like New Zealand's response. Real competent leadership.

 

[PeroK]

Incomplete classification, but still an interesting observation. View attachment 266419

One of the things a lot of journalists have struggled with re the COVID-19 pandemic is the concept that different countries have different populations and the total numbers are not comparable. Only numbers adjusted for population are comparable. And also that countries are geographically very different.

If, for example, you compare Iceland with the less populated and more remote US states, there's a general correlation:

				Per	Million
	Pop	Cases	Deaths	Cases	Deaths
Iceland	340,000​	1,900​	10​	5,600​	29​
Wyoming	580,000​	2,000​	22​	3,400​	38​
Alaska	730,000​	1,600​	17​	2,200​	23​
Hawaii	1,400,000​	1,300​	22​	900​	16​

Therefore, if we compare Iceland with comparable US states, then the picture is very different.

 

[Jarvis323]

One of the things a lot of journalists have struggled with re the COVID-19 pandemic is the concept that different countries have different populations and the total numbers are not comparable. Only numbers adjusted for population are comparable. And also that countries are geographically very different.

If, for example, you compare Iceland with the less populated and more remote US states, there's a general correlation:

				Per	Million
	Pop	Cases	Deaths	Cases	Deaths
Iceland	340,000​	1,900​	10​	5,600​	29​
Wyoming	580,000​	2,000​	22​	3,400​	38​
Alaska	730,000​	1,600​	17​	2,200​	23​
Hawaii	1,400,000​	1,300​	22​	900​	16​

Therefore, if we compare Iceland with comparable US states, then the picture is very different.

That's true; but it's worth considering that Iceland has done more than twice as much testing per capita as the US.

 

[PeroK]

That's true; it's still not clear though because we can't fairly compare the numbers directly. Iceland has done more than twice as much testing per capita than the US. Who knows how much testing Alaska has done, or how accurate the death counts are. And then there is chance. With deaths in the 10-20 range, chance can be a pretty big factor. And what strain showed up, when is an important factor.

Comparing an island country of 300,000 with a country of 300,000,000 is fundamentally problematic. You want to say that Iceland vs the USA is a logical and valid comparison; but Iceland vs Alaska is not?

 

[Jarvis323]

Comparing an island country of 300,000 with a country of 300,000,000 is fundamentally problematic. You want to say that Iceland vs the USA is a logical and valid comparison; but Iceland vs Alaska is not?

I'm just pointing out that even your adjustment doesn't cut it. Just an estimate, after looking here and some other places, (https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/), I would say that Alaska, Hawaii, and Wyoming have likely undercounted compared with Iceland by about a factor of 4 or more.

But the numbers are low enough to just observe Iceland did good. You can compare one state to Iceland, but the leader of the US is in charge of the whole country. So that comparison is not a comparison of national leadership.

You can't be asking for too much more performance from Iceland, but there is a lot more to ask of the US. Of course there are differences due to population density and so forth. So, maybe you can say the US leadership has a different problem (maybe a harder one), but you can't say they did a good job.

So one leader had a better outcome than the other, but one may have had an advantage. The next thing to do is compare actions. I think the articles in the topic are looking at that as well, and it's those comparisons which really highlight leadership quality differences in my opinion.

 

[PeroK]

I'm just pointing out that even your adjustment doesn't cut it.

I wasn't trying to make a definitive case. I simply highlighted the absurdity of the data analysis I was presented with.

 

[Jarvis323]

I wasn't trying to make a definitive case. I simply highlighted the absurdity of the data analysis I was presented with.

What are you talking about, the testing rate I mentioned? It seams Iceland has tested a much larger percentage of it's population, which you didn't account for. That's all the data analysis I did.