COVID COVID-19 Coronavirus Containment Efforts

[Tendex]

Some of that decrease comes from improved treatment.

Very little if anything, there is no actual improved treatment in the full sense of the word, just a better use of corticoids and little more.

 

[Astronuc]

The ICU at Tampa General Hospital in Tampa, Fla., was 99% full this week, according to an internal report produced by the federal government. It's among numerous hospitals the report highlighted with ICUs filled to over 90% capacity.

https://www.npr.org/sections/health...hospitalization-data-the-government-keeps-hid

Last week University of Utah hospital's ICU was at 99% capacity with Covid patients. The hospital has warned health districts in surrounding states that out-of-state transfers may be suspended.


https://healthcare.utah.edu/coronavirus/
https://healthcare.utah.edu/coronavirus/#maskingfacts

The US reported 88,452 positive confirmed and probable cases on Thursday, according to https://covidtracking.com/data/national/cases
with 46,095 hospitalizations
https://covidtracking.com/data/national/hospitalization

https://www.forbes.com/sites/alison...tudy-finds-tennessee-vanderbilt/#669731b9623e

Covid-19 hospitalizations in Tennessee have risen at a far lower rate in areas that have mask-wearing mandates than those that don’t, a new analysis from Vanderbilt University researchers found, reinforcing evidence showing that face masks play a significant role in slowing Coronavirus transmission.

 

[PeroK]

The US reported 88,452 positive confirmed and probable cases on Thursday, according to https://covidtracking.com/data/national/cases

It's interesting to note that the number of cases per capita is now higher in Europe. The US figures represent about 270 people per million testing postive per day. Much of Europe is higher than that now. Belgium has the highest rate of 24,000 new cases yesterday from a population of 11.6 million. That's over 2000 people per million in one day.

The UK has reached more than 20,000 cases per day, which is about 300 cases per million - slightly higher than the US.

 

[atyy]

https://www.forbes.com/sites/alison...tudy-finds-tennessee-vanderbilt/#669731b9623e

"The researchers note that areas that have mask requirements also have “greater changes in other community behavior” that could reduce Covid-19 transmission, so the lower hospitalization rates may not be attributable to masks alone."

It's good that the news item indicates that because the study is correlational, we don't know how much of the effect is due to mask wearing.

 

[Vanadium 50]

Last week University of Utah hospital's ICU was at 99% capacity with Covid patients.

I'm trying to wrap my head around this, since they say they have a 12 bed Covid ICU. What does 99% mean? Eleven? Usually 12 but sometimes 11?

There are 338 total Covid hospitalizations in the entire state.

 

[PeroK]

I'm trying to wrap my head around this, since they say they have a 12 bed Covid ICU. What does 99% mean? Eleven? Usually 12 but sometimes 11?

My guess is it's how many hours the units are occupied - that might be only 20 hours per week (out of 12 x 168) that any unit was free.

 

[StevieTNZ]

The Hon Donald J Trump says:

More Testing equals more Cases. We have best testing.

Wouldn't it be nice if more testing equals less cases, ie more negative results?

 

[Vanadium 50]

My guess is it's how many hours the units are occupied

That makes sense, but when you look more closely, there is an issue. Treat this as a classic Poisson process. How many person-hours of need are there such that 1% of the hours of a 12 bed ICU are free? About 21.5 persons times 168 hours.

So if one wants an alarming statistic, why pick 99%? Why not compare 21.5 to 12?

 

[Astronuc]

I'm trying to wrap my head around this, since they say they have a 12 bed Covid ICU. What does 99% mean? Eleven? Usually 12 but sometimes 11?

There are 338 total Covid hospitalizations in the entire state.

I was puzzled by the 99%, and I thought a better statement would be "near capacity". However, I looked into the situation and found the following:

The hospital normally has room for 111 ICU patients, Vinik said. With the makeshift ICU, there is room for 134 patients — but with 115 patients admitted as of Friday, there was room for only 19 more, he said. The hospital had been adding three or four ICU patients each week — but with 1,496 new cases Friday, Utah saw its weekly rate of new cases reach unprecedented levels this week, and that means even more new ICU patients are likely on the way.

October 25 - https://www.sltrib.com/news/2020/10/16/utah-has-more/
Earlier the article it states

University of Utah Hospital was bringing in doctors and nurses for overtime shifts Friday to staff new beds after its ICU reached “more than 100% capacity,” said hospital spokeswoman Suzanne Winchester.

Back on October 16/17 - https://www.sltrib.com/news/2020/10/16/utah-has-more/ - they reached 100% capacity, so it seems they added capacity, and that became full, so it seems they added more capacity again.

There is a surgical ICU that has a capacity of 12, and a cardiovascular ICU with a capacity of 20, but the Covid ICU is a separate facility apparently.
https://medicine.utah.edu/anesthesiology/critical-care/

 

[mfb]

That makes sense, but when you look more closely, there is an issue. Treat this as a classic Poisson process. How many person-hours of need are there such that 1% of the hours of a 12 bed ICU are free? About 21.5 persons times 168 hours.

So if one wants an alarming statistic, why pick 99%? Why not compare 21.5 to 12?

It's not a Poisson statistics. The turnaround time is long, so you can't expect a long-term statistics to be relevant. Maybe they had three beds free three weeks ago but that's not what the current capacity is. People who arrive at the hospital when there is no ICU bed will be put in a regular bed and moved to ICU as soon as there is a bed free. The list of people who would profit from an ICU bed (but don't die immediately outside) could be long, too.

 

[StevieTNZ]

Surely that many beds aren't needed (for so long) if they are young, healthy people filling them. My inductive logic indicates they should over come Covid-19 in 15 or so mins. Barron Trump did, according to Trump.

 

[Keith_McClary]

Physicist Sabine Hossenfelder interviews astrophysicist Niayesh Afshordi about his new pandemic model.

http://backreaction.blogspot.com/2020/10/a-new-model-for-covid-pandemic.html

 

[mfb]

U.S. reports record 99,321 new Coronavirus cases as scientists warn latest surge just beginning

“We’re at a point where the epidemic is accelerating across the country. We’re right at the beginning of the steep part of the epidemic curve,”
[...]
As of Friday, 18 states reached record-high hospitalizations based on a seven-day average, particularly in the West and Midwest — Iowa, Idaho, Indiana, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Utah, Wisconsin and Wyoming all hit records, according to the Covid Tracking Project.

Meanwhile Europe's second wave has also ramped up in Scandinavia. Norway, Sweden, Finland.

Peru reports losing over 0.1% of its population, Belgium will cross that ratio very soon, Spain and several South American countries are close to 0.08%. Mexico, the US, the UK and Argentina are at 0.07%, Italy and Sweden report 0.06%.

 

[Vanadium 50]

There is a surgical ICU that has a capacity of 12, and a cardiovascular ICU with a capacity of 20, but the Covid ICU is a separate facility apparently.

Apparently also with 12.

The 134 number makes more sense with the "99%". As I understand it they have 20 ICU beds, 12 surgical beds, 12 Covid beds and 90 "general" or "other" beds. Where there are statistics, they seem to want to be at around 75% full. Applying that across the board, that means they would like to keep 30-35 beds free.

The sources of patients are a) non-Covid, b) local Covid, and c) Covid imports.

UofU has about 1/8 of the state's beds, so its fair share of patients is about 40. That's the problem - they can take a, and most of b (probably all of b with the elimination of "non-essential" surguries) but none of c). (And in fact, they have stopped taking in c)

I can see the problem, but it is not at all well-captured by the 99% number.

 

[Astronuc]

Skynews - Prime Minister Boris Johnson has announced a month-long 'lockdown' across England at a Downing Street news conference with chief medical officer Professor Chris Whitty and chief scientific adviser Sir Patrick Vallance.

 

[Ygggdrasil]

Very little if anything, there is no actual improved treatment in the full sense of the word, just a better use of corticoids and little more.

There have been published reports from hospital systems showing that the mortality patients hospitalized with COVID-19 has decreased since the start of the pandemic. For example:

The study, which was of a single health system, finds that mortality has dropped among hospitalized patients by 18 percentage points since the pandemic began. Patients in the study had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance.

(source)

Part of the decrease comes from the changing demographics of the hospitalized patients as patients later in the pandemic have tended to be younger and have fewer underlying health problems. However, the death rates appear to be decreasing even when correcting for these factors:

Horwitz and her colleagues looked at more than 5,000 hospitalizations in the NYU Langone Health system between March and August. They adjusted for factors including age and other diseases, such as diabetes, to rule out the possibility that the numbers had dropped only because younger, healthier people were getting diagnosed. They found that death rates dropped for all groups, even older patients by 18 percentage points on average.

The research, an earlier version of which was shared online as a preprint in August, appears in the Journal of Hospital Medicine.

Doctors interviewed in the article attribute the decreased mortality to better clinical practices:

Doctors have gotten better at quickly recognizing when COVID-19 patients are at risk of experiencing blood clots or debilitating "cytokine storms," where the body's immune system turns on itself, says Amesh Adalja, an infectious disease, critical care and emergency medicine physician who works at the Johns Hopkins Center for Health Security.

He says that doctors have developed standardized treatments that have been promulgated by groups such as the Infectious Diseases Society of America.

"We know that when people are getting standardized treatment, it makes it much easier to deal with the complications that occur because you already have protocols in place," Adalja says. "And that's definitely what's happened in many hospitals around the country."

Another good example has been adoption of the practice of proning patients -- placing patients on supplemental oxygen in a face-down, prone position -- which has been shown to reduce the need for intubation and mechanical ventilation. So, while only one pharmaceutical treatment has been shown to reduce COVID-19 mortality (the corticosteroid dexamethosone), it does not take a magic pill to reduce mortality from a new disease, just better practices and protocols.

Doctors also speculate that other factors could be reducing mortality, such as greater mask wearing by the public:

But Horwitz and Mateen say that factors outside of doctors' control are also playing a role in driving down mortality. Horwitz believes that mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients.

 

[Astronuc]

AP News, Nov 2 -

The seven-day rolling average of the positivity rate in Iowa has risen over the past two weeks from 25.5% on Oct. 18 to 36.4% on Sunday, according to researchers at Johns Hopkins University. Iowa’s rate is now third in the nation behind South Dakota and Wyoming. All 99 Iowa counties have a positivity rate above 7.5% and 46 are above 15%, an indication that the virus is aggressively spreading statewide.

https://apnews.com/article/virus-outbreak-public-health-health-iowa-edaa01995141c434d19fb8f4b2ba542c

Kansas had a rolling average of 1,507 new confirmed and probable cases a day for the seven days ending Monday, based on state Department of Health and Environment data. That’s nearly 18% higher than the previous high of 1,279 cases a day for the seven days ending Friday. The agency added more than 4,000 confirmed and probable cases to the state’s count since only Friday.

https://apnews.com/article/virus-outbreak-kansas-topeka-92816431aa5bcc3cc7b29da39576ed21

The Illinois Department of Public Health on Sunday reported 6,890 new confirmed cases of COVID-19, with 35 additional deaths.
https://apnews.com/article/virus-ou...lth-illinois-869884e2bed9784002adc835dc10b165

Dr. James Lawler, a director at the University of Nebraska Medical Center’s Global Center for Health Security in Omaha, said Friday that the state could have more than 2,500 COVID-19-related deaths by January if current trends continue without more stringent public health measures or better compliance with the measures already in place. The state has so far reported 652 deaths linked to the virus.

https://apnews.com/article/virus-ou...aha-nebraska-6968f5489c4de612512e91b035132cfd
We'll see in two months.

BOSTON (AP) — Here is a look at pandemic-related developments around New England
https://apnews.com/article/virus-ou...usetts-maine-f0df09812fa0b65b268c2e03c197a76a

An eighth grade Missouri boy died over the weekend of Covid-19 complications, becoming the state's, and one of the nation's, youngest deaths from the coronavirus.

In a statement, Dr. Lori VanLeer, superintendent of Missouri's Washington School District, said that the Baumgarth family confirmed their 13-year-old son Peyton had passed away from complications of the virus.

https://www.nbcnews.com/news/us-news/13-year-old-missouri-boy-dies-covid-19-complications-n1245739
The Missouri teen is the first person under the age of 18 to die of COVID-19 in the state.

 

[StevieTNZ]

Donald Trump's Chief of Staff has tested positive for, what he calls it, Chinese Virus.

 

[Astronuc]

https://www.npr.org/sections/health...records-this-week-and-hospitalizations-surged
From https://covidtracking.com/data
[CODE title="US COVID-19 cases, Nov 4-7, 2020"]
Date Cumulative New Cases New Hospit. New Fatal.
Nov 7, 2020 9,761,481 128,396 2,304 1,097
Nov 6, 2020 9,633,085 125,252 3,054 1,186
Nov 5, 2020 9,507,833 116,153 3,735 1,124
Nov 4, 2020 9,391,680 103,067 2,802 1,116[/CODE]
At the current rate, the US would experience more than 50,000 fatalities before the end of the year.

In the nuclear industry, we would say this indicates a lack of containment.

Update:

North Dakota reported that 309 people died from COVID-19 in the past 30 days, more than all other periods combined. The state shot to the top of the nation in deaths per capita in the last 30 days, with roughly 41 deaths per 100,000 people, according to data from Johns Hopkins. On Saturday, North Dakota reported 15 additional deaths and 1,615 new cases across the state.

South Dakota reported 252 deaths, a 98% increase in the last 30 days. It had a death rate of roughly 29 people per 100,000 over the last 30 days, according to the Johns Hopkins data. The state on Saturday recorded thirteen more deaths in addition to 1,337 new cases of COVID-19.

https://www.yahoo.com/news/doctors-fear-more-death-dakotas-175126618.html

 

[mfb]

Hospitalizations in the US peaked at almost 60,000 both in April and July. The latest update is 55800 and growing at over 1000/day, that's closely mimicking the July curve. The April curve was rising much faster.

Something is wrong with their "Currently on ventilator/Now on ventilator" data. The number exceeds the total!

 

[OmCheeto]

...
Something is wrong with their "Currently on ventilator/Now on ventilator" data. The number exceeds the total!

They should probably leave those blank for the nation.
I went through all 56 states and territories, and only 4 list numbers for "ventilator" "ever", and 29 for "now".

Actually, only one number is valid for the national "Hospitalization" section: "hospitalized now" is missing data from only 3 of the territories: AS, MP, and VI.
Everything else is filled with holes.

Only Kansas lists data for all 6 categories.
American Samoa and the US Virgin Islands list no data.

	state or	hospitalized​	hospitalized​	ICU​	ICU	ventilator	ventilator
	territory	ever​	now​	ever​	now​	ever​	now​
	…
	IN	18,273​	2,036​	3,527​	559​		195​
	IA		901​		194​		72​
	KS	4,067​	693​	1,122​	183​	337​	62​
	KY	7,844​	1,153​	1,989​	299​
	LA		644​				81​
	…
COUNT	56​	37​	53​	12​	39​	4​	29​
SUM	n/a	492,773​	55,817​	25,721​	11,078​	2,898​	2,943​

 

[mfb]

Okay, so only the current hospitalizations are meaningful in that table. Well, that's bad.

 

[Astronuc]

Nursing home COVID-19 cases rise four-fold in surge states
https://apnews.com/article/virus-ou...ursing-homes-596ef4bfe18313ae72368e2c86e85f27

An analysis of federal data from 20 states for The Associated Press finds that new weekly cases among residents rose nearly four-fold from the end of May to late October, from 1,083 to 4,274. Resident deaths more than doubled, from 318 a week to 699, according to the study by University of Chicago health researchers Rebecca Gorges and Tamara Konetzka.

Equally concerning, weekly cases among nursing home staff in surge states more than quadrupled, from 855 the week ending May 31, to 4,050 the week ending Oct. 25.

“Trying to protect nursing home residents without controlling community spread is a losing battle,” said Konetzka, a nationally recognized expert on long-term care. “Someone has to care for vulnerable nursing home residents, and those caregivers move in and out of the nursing home daily, providing an easy pathway for the virus to enter.”

The 20 states analyzed in the study were Alaska, Arkansas, Iowa, Idaho, Indiana, Kansas, Kentucky, Minnesota, Missouri, Montana, Nebraska, New Mexico, North Dakota, Ohio, Oklahoma, South Dakota, Utah, Wisconsin, West Virginia, and Wyoming. They were selected because they’re now seeing their highest hospitalization rates for COVID-19.

Update: A mutated Coronavirus strain causes most new COVID-19 infections in Europe and was spread within the continent by tourists, scientists say (I haven't verified)
https://www.yahoo.com/news/mutated-strain-covid-19-causes-104602982.html

• The Coronavirus variant was first identified in northeastern Spain in June and was carried abroad by tourists and other travelers, the scientists said.
• There isn't enough data to suggest this variant, known as 20A.EU1, is more deadly, the team from the University of Basel, ETH Zürich in Basel, and SeqCOVID in Spain said.
• The variant has been identified in 12 countries across the continent, as well as Hong Kong and New Zealand.

It gets around.

 

[mfb]

WHO: https://www.who.int/csr/don/06-november-2020-mink-associated-sars-cov2-denmark/en/

Most humans infected from minks just got the usual virus again, but a "cluster 5" variant seems to have a "moderately decreased" sensitivity to antibodies - which might make vaccines less effective.

Denmark is culling all of its minks in farms while trying to contain the spread of the cluster 5 variant (12 confirmed cases so far).

 

[OmCheeto]

It appears we have two counties that are in the "herd immunity" range.
Gove county Kansas reported 7 deaths in the last 7 days, pushing their interpolated infection rate to over 70%.
Normally, it would have taken 3½ months for that many people to have perished.

The video in the following article makes it sound like nearly everyone in town had it. Which, if I did my maths correctly, they did.
Small town spike: Gove County, KS hit hard by Coronavirus cases

 

[mfb]

Covid-19 vaccine candidate is 90% effective, says Pfizer
This is "only" a press release for now, but given the high profile of the news I expect that we get a detailed analysis soon.

Demonstrating the safety based on the defined thresholds will take until the third week of November. As far as I understand there has been no serious side effect in their trials. By early December they expect to reach 164 cases in total, the planned end of the study. The recent upwards trend in cases in the US sped up data-taking. It is possible that the vaccine gets approved before the end of the year. Pfizer&co expect to have 50 million doses by the end of the year and 1.3 billion in mid-2021. Everyone needs two doses three weeks apart so the number of vaccinated people will be half of that. It needs extremely cold temperatures to be stored, so wider distribution might be limited to highly developed countries for a while.

90% will make it easy to reach herd immunity with vaccinations even if many people are skeptical and don't get it. It is still unknown for how long the vaccine protects people, of course.

https://en.wikipedia.org/wiki/BNT162

 

[mfb]

More discussion of the press release

Some key points of the article:
It demonstrates that COVID-19 vaccines can work. The question is no longer "if", the question is when, how many, and which method in particular. It's not surprising, but it's good to finally have an experimental confirmation. And of course 90% is an excellent number. All the relevant vaccine candidates target the spike protein and all of them produced antibodies in phase I trials: If one of them works, it's likely they all work.
It looks like the immunity will last at least a year, which is great news as well.

 

[Keith_McClary]

Infectious-Disease Expert Urges For Caution Over Pfizer's Vaccine. Here's Why

 

[Astronuc]

Infectious-Disease Expert Urges For Caution Over Pfizer's Vaccine. Here's Why

I heard another caveat last night. Pfizer's vaccine requires cryogenic storage to remain viable. It deteriorates (becomes denatured) at ambient (room) temperature. That seems to be confirmed by other sources.

According to one Fierce Pharma article, the vaccines proposed by Moderna and by the Pfizer/BioNTech partnership will need subzero storage and shipping conditions, possibly as low at -70°C (roughly the lower limit for using dry ice as a source of cold). These vaccines are based on messenger-RNA (mRNA) technology—essentially a free-floating snippet of RNA that can elicit an immune response in the body. Other vaccine candidates, including those from Johnson & Johnson, Sanofi/Novavax and others, use a viral vector (adenovirus) to carry a “protein subunit” into the body; that subunit then confers the immune response. The virus-based vaccines (which is also typically the method used to deliver flu vaccine), generally speaking, are stored and shipped at 2-8°C.

https://www.pharmaceuticalcommerce.com/clinical-operations/covid-19-vaccines-chilled-frozen-or-cryogenic/

https://www.fiercepharma.com/manufacturing/pfizer-moderna-s-covid-19-shot-rollouts-could-be-ice-as-analysts-question-cold

https://www.wsj.com/articles/covid-...eep-freezers-into-a-hot-commodity-11599217201

https://www.marketwatch.com/story/m...estions-about-storage-distribution-2020-08-27

I haven't verified the independence sources of the articles.

One of the most advanced US Coronavirus vaccines, created by Pfizer in partnership with BioNTech, has to be stored at -70° Celsius (-94° Fahrenheit), or around 30°C colder than the North Pole in winter.

https://qz.com/1904638/covid-19-vaccine-states-are-hunting-for-medical-deep-freezers/

 

[mfb]

Infectious-Disease Expert Urges For Caution Over Pfizer's Vaccine. Here's Why

"We need to see the data". Sure, we do - but does anyone expect the upcoming data release to not back the 90% result? Of course not.

That may mean vaccinated people could still become asymptomatic carriers and unknowingly spread the virus to others.

Possible, but we know people are at least 10 times less likely to show symptoms. That means less coughing, and it almost certainly means lower viral loads in general. It will certainly help.

Haseltine also raised the question of if the vaccine reduces serious disease and ultimately affects the number of hospitalizations and deaths.

Is it really plausible that people are at least 10 times less likely to feel sick - but still need to be hospitalized at the same rate? A vaccine that only avoids infections that would have ended up mild but has no impact otherwise?

Finally, Pfizer's news release made no mention of if the vaccine appeared as effective in different subgroups, such as older people, who are more susceptible to the worst outcomes of the virus.

It couldn't achieve 90% reduction if it wouldn't work in older people, but 96 infected people in total lead to low statistics once you split this into subgroups. It makes sense to not give numbers for subgroups at this point.