COVID COVID-19 Coronavirus Containment Efforts

[kyphysics]

Whatever China reports, I'd compare it with China Beige Book: https://www.chinabeigebook.com/

They are the largest and most trusted non-Chinese government sponsored source of economic data from China.

 

[kadiot]

This is an interesting comparison among ASEAN COVID-19 cases. Do you agree with this presentation?

 

[anorlunda]

Sweden is called an outlier because it has refused lockdown.

https://www.msn.com/en-us/news/world/swedish-virus-deaths-top-1000-fueling-criticism-over-strategy/ar-BB12C1xU

 

[Ygggdrasil]

This is an interesting comparison among ASEAN COVID-19 cases. Do you agree with this presentation?
View attachment 260743View attachment 260743

The number of total confirmed cases depends a lot on how much testing has been done. It would be more informative if presented along with the number of individuals tested.

 

[kadiot]

Postmortem is now on.

https://www.theatlantic.com/politic...ganization-blame-pandemic-coronavirus/609820/

 

[kadiot]

Sweden is called an outlier because it has refused lockdown.

https://www.msn.com/en-us/news/world/swedish-virus-deaths-top-1000-fueling-criticism-over-strategy/ar-BB12C1xU

View attachment 260744

EU has called on Sweden to revise their anti-Covid measures. I bet that if they don't change them, people coming into the EU from Sweden might be banned from entering EU or at the very least, asked to self-quarantine.

 

[Vanadium 50]

Sweden is called an outlier because it has refused lockdown.

I'm afraid that plot is innumerate nonsense.

You don't take 100 deaths/million and 50 deaths/million and add them to get 150 deaths/million. You just don't.

Second, those plots are cumulative. They, by construction, integrate out day-to-day effects. Sweden has a high death rate today, but it has since the beginning - since before anyone locked anything down.

Further, Sweden has a very high case fatality ratio, and has since the beginning. Picking "deaths" instead of "cases" to plot emphasizes this. One can argue the reasons this might be, but it emphasizes Sweden was an outlier since before anyone locked anything down.

So, what should they have used? I would suggests the fraction of deaths in the last 15 days compared to the total. If the whole point of a lockdown is to save lives, we should be seeing it save lives, no?

I picked 15 because it's easy to get off Wikipedia. But that's not a crazy number: 2-3 weeks since shutdoiwns began, and the disease has on average a 5-6 day incubation period, and a couple days for the disease to progress. That leaves time for one or two cycles. So what does the data say? Sweden is at 63%, Denmark 61%, Norway it's impossible to tell, and Germany (for comparison) is 71%.

Based on this data, it's hard to say lockdowns are doing anything at all. If you want to make a big deal of 61% vs 63%, that says a Swedish lockdown would have saved 24 people.

At this point, a lot of people are invested in the lockdown and see a Swedish failure as validation of their preferred policies. (And indeed, the ultimate source of that graph was from a news source whose owner has political ambitions) But if we want to to call ourselves scientists, we have to look at the evidence.

Oh, and did I say that plot is innumerate nonsense?

 

[anorlunda]

There's a lot of talk on the news about widespread testing as a prerequisite to ending the lockdown. But how is "widespread testing" defined? Dr. Fauci was asked about that yesterday, and his answer sounded evasive.

I also see a lack of specifics about scaling up testing capacity. How many kits in the USA, 10 million, 100 million, 330 million? Back end lab processing tests/day? Turnaround time? What criteria for who gets tested? Once someone tests negative, how long until a second test? Effciency of the testing program?

I would define efficiency as the ratio of $\frac{\text{infected people tested}}{\text{infected people}}$

Without answers to those questions, how could anyone predict when widespread testing will be ready or has been achieved?

 

[kadiot]

how could anyone predict when widespread testing will be ready or has been achieved?

Good question. And also, how effective were they in reality.

 

[kadiot]

Handguns, rifles? Perhaps they think they can kill Covid19 virus in a shoot out? They would be better off carrying disinfectant pistols/spray!

https://www.msn.com/en-gb/news/world/michigan-residents-armed-with-rifles-and-handguns-defy-stay-at-home-order/ar-BB12HeNs

 

[mfb]

You don't take 100 deaths/million and 50 deaths/million and add them to get 150 deaths/million. You just don't.

And no one does. So what's the point of this remark?

Second, those plots are cumulative. They, by construction, integrate out day-to-day effects.

Which is a good thing as the reports have large day-to-day fluctuations no one is interested in.

Norway started its lockdown March 12, Denmark started it the day afterwards, that's at the very beginning of the graph. Nearly the whole graph is impacted by the lockdowns. If you want to take ratios you have to start them March 20 or so. And ideally you also shift the curves to take different starting dates of the outbreak into account, otherwise these ratios will vary a lot simply from the different relative time of the cutoff.

I don't think I'm telling you anything new here. So why do you make such a misleading analysis?

Sweden's reported case count is not helpful since they effectively stopped testing.

 

[atyy]

Also, construction workers tend to be fit (but there is one worrying case from much earlier, a 39 years old construction worker who was (is?) in critical care for months now - his wife in Bangladesh gave birth while he was (is?) still under sedation - all of us really hope he gets to see his baby boy and makes a full recovery).

Some good news - this worker has now been moved out of intensive care

COVID-19: Bangladeshi worker, whose wife gave birth while he was in critical state, moves out of ICU
https://www.channelnewsasia.com/new...19-bangladesh-worker-case-42-recover-12649648

 

[Ygggdrasil]

I picked 15 because it's easy to get off Wikipedia. But that's not a crazy number: 2-3 weeks since shutdoiwns began, and the disease has on average a 5-6 day incubation period, and a couple days for the disease to progress. That leaves time for one or two cycles. So what does the data say? Sweden is at 63%, Denmark 61%, Norway it's impossible to tell, and Germany (for comparison) is 71%.

Scientific publications suggest that the mean time from onset of symptoms to death is 20 days, so combined with a ~5 day delay from infection to onset of symptoms, this gives a figure closer to 4 weeks between infection to death.

In Italy, initial lockdowns began around 21 Feb in the hardest hit regions and expanded to a national lockdown on 9 Mar. The number of deaths per day in Italy don't begin to level off until ~ Mar 28, 5 weeks after the initial lockdowns and 3 weeks after the national lockdown, consistent with a ~4 week delay between infection and death:

https://www.worldometers.info/coronavirus/country/italy/

It is likely still too early to judge the success/failure of Sweden's policy by looking at death data. Data over the next few weeks, however, will likely be informative.

Let's also flip the question on its head. Is there evidence that Sweden's policies have resulted in better economic outlook for that country versus other surrounding countries? Here's what an article from the Guardian says:

Although the longer-term impact is obviously unknown, Sweden’s strategy is not expected to preserve the country’s economy this year any more than those of countries imposing stricter lockdowns: Magdalena Andersson, the finance minister, said on Wednesday GDP could shrink by 10% this year and unemployment rise to 13.5%.

https://www.theguardian.com/world/2020/apr/15/sweden-coronavirus-death-toll-reaches-1000

By comparison, the https://www.imf.org/en/Publications/WEO/Issues/2020/04/14/weo-april-2020a -7.5% annual percent change for real GDP for the Euro area (though I don't know if this figure is directly comparable to the figure cited by the Guardian).

 

[Vanadium 50]

You don't take 100 deaths/million and 50 deaths/million and add them to get 150 deaths/million. You just don't.

And no one does.

It says so right in the top right corner of anorlunda's plot.

So why do you make such a misleading analysis?

That comment is beneath you, beneath the Mentorship and beneath PF. You can argue that I am wrong and provide better numbers that make your point without claiming dishonesty on my part.

 

[anorlunda]

You don't take 100 deaths/million and 50 deaths/million and add them to get 150 deaths/million. You just don't.

It says so right in the top right corner of anorlunda's plot.

Aha, now I understand. You misread the plot. The 150 is not a sum, it is the scale, 0, 50, 100, 150 are the tic marks on the scale.

 

[atyy]

This is an interesting comparison among ASEAN COVID-19 cases. Do you agree with this presentation?

The number of total confirmed cases depends a lot on how much testing has been done. It would be more informative if presented along with the number of individuals tested.

Singapore's place at the top with most cases per population is (unfortunately for us) probably right, we've had a huge outbreak among about 20,000 construction workers living in dorms in which social distancing is very hard (total number of workers living in dorms is about 300,000). The government has been increasing testing among these workers and finding temporary housing in military camps and "floating hotels" etc to deal with this.
https://www.reuters.com/article/us-...-workers-as-coronavirus-spreads-idUSKCN21V0FN

I attended a webinar in which one speaker (Dale Fisher) was asked whether Vietnam's apparent success was an artifact of to little testing, and he said no - they had done lots of tests. https://www.worldometers.info/coronavirus/ says 268 cases detected in 135938 tests to date. Also it seems they have very good contact tracing with four layers of contacts under various degrees of quarantine and monitoring. I found a couple of interesting articles by googling:
https://www.npr.org/sections/corona...an-300-covid-19-cases-and-no-deaths-heres-why
https://www.dw.com/en/how-vietnam-is-winning-its-war-on-coronavirus/a-52929967

 

[Keith_McClary]

Postmortem is now on.

Putting aside the politics, how can we scientifically prove human-to-human transmission? Experiments, even with volunteers, would be unacceptable. If you have only a few dozen cases and your testing methods are new and experimental, can you prove it to scientific standards?

 

[mfb]

Hospital staff getting it is quite an obvious sign. Work colleagues who didn't eat the same food? Other people who only visited the same place?

 

[Vanadium 50]

Scientific publications suggest that the mean time from onset of symptoms to death is 20 days,

I see 18.5 days in that study. Mean incubation is 5-6 days, so that's 24 days from infection to death, so we should be seeing effects starting a week ago, perhaps a bit sooner because these are median times.

Also, that seems to be longer than other estimates: https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1 says infection (not onset)to death is 17.8 days./

The Louisiana governor says it's 11 days. He should know. He's a governor.

But I take your point. "Starting the clock" later gives better data, but there's less of it, so you're more prone to fluctuations. If one goes to the last 7 days (which makes the fluctuations 40% larger - N=74 for Denmark), one gets 24% for Sweden, 24% for Denmark, and 31% for Germany. We will surely get more and better data with time.

All that said, though, the "it's too soon" argument cuts both ways. If it is too soon to tell that Sweden's strategy is no worse than Denmark or Germany's, it's too soon to tell it's worse, which is what the plot that started this discussion was saying.

The "economy is already damaged" is a fair point. Clearly any action should calculate the projected impact taking what has already happened into account. It also needs to take into account what "do nothing" means. "Do nothing" in Sweden means, as far as I can tell, strong encouragement for beneficial behaviors without shutting everything down. But it's not like they are holding handshaking contests. So what we are really seeing is the differential between encouragement and lockdown, not the difference between lockdown and the status quo ante.

 

[Keith_McClary]

Hospital staff getting it is quite an obvious sign. Work colleagues who didn't eat the same food? Other people who only visited the same place?

I mean, suppose you are the district medical officer advising the government, and they are considering mass lockdowns and quarantines. Would you say "There is some anecdotal evidence" or "strong anecdotal evidence", or ... five-sigma confidence?

 

[Ygggdrasil]

Also, that seems to be longer than other estimates: https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1 says infection (not onset)to death is 17.8 days./

The abstract of that pre-print says "We estimate the mean duration from onset-of-symptoms to death to be 17.8 days (95% credible interval, crI 16.9,19.2 days)" which is consistent with the paper that I cited (18·5 days, CI: 15·0–22·0) (which makes sense because the teams were likely working from similar datasets).

Otherwise, I largely agree with this post. Although we have ~1 week of data, it's probably still too early to judge whether Sweden's policy has led to worse outcomes. Data from Sweden could inform the next steps the US takes in the next few months (e.g. relaxation to Sweden-like rules in some areas of the country).

 

[DennisN]

A bit of fun in all seriousness...
There's a lot of talk of the consequences for millions of people around the world due to disease and lockdowns, but we must remember that there are consequences for animals too:

 

[gmax137]

Here's something I don't understand: The call for widespread testing. All of us who have been seriously staying home, and haven't been sick, we probably have not been infected, right? If we tested everyone who has been staying home, nearly all would be negative, right? What new information do we get from that testing? So, how do the results factor into deciding when to leave the house?

 

[BillTre]

If we tested everyone who has been staying home, nearly all would be negative, right?

Not necessarily.
Since a portion of people can be infected, but show no symptoms, people in a home could spread covid19 from a single infected person in a house (with no symptoms) to others in the home who might also show no symptoms. These secondarily infected people could pop out of their house and infect many others.
There will also always be those who flaunt guidelines and could have picked up or spead an infection.

What new information do we get from that testing?

1. If social distancing guidelines are loosened, then it is expected than incidents of infection will increase. being able to efficiently test people (as has been promised, low these many weeks ago) will allow more rapidly identifying the newly sick and therefore require less re-quarantining of people (which will be politically unacceptable to some.
2. Better understanding of where a particular population is WRT amount of covid19 going around. the appropriate time to loosen things up will be optimized by better information (which is now not so good, IMHO).
3. Effective testing of the effects of different methods of loosening social distancing guidelines will require test results to determine what works. They should have a quick turnaround to limit unintended damage.

Making medical (life and death) decisions in a vacuum of relevant information is not a well thought out approach.
Leadership should realize this and plan for these things BEFORE they are needed.

 

[gmax137]

If social distancing guidelines are loosened, then it is expected than incidents of infection will increase. being able to efficiently test people (as has been promised, low these many weeks ago) will allow more rapidly identifying the newly sick and therefore require less re-quarantining of people (which will be politically unacceptable to some.

yes, but I can test negative today and get infected tomorrow. So is the idea everyone gets tested periodically? Like, every couple of days?

 

[BillTre]

yes, but I can test negative today and get infected tomorrow. So is the idea everyone gets tested periodically? Like, every couple of days?

Could be.
To be determined. More info needed.

 

[DennisN]

About Sweden...

Sweden is called an outlier because it has refused lockdown.
https://www.msn.com/en-us/news/world/swedish-virus-deaths-top-1000-fueling-criticism-over-strategy/ar-BB12C1xU

EU has called on Sweden to revise their anti-Covid measures

Regarding EU: I haven't heard of this. Do you have a source for this`? As far as I know, EU has pretty little to say about (read: enforce) how different member countries handle this.

Further, Sweden has a very high case fatality ratio

Yes, and also few tests being made. And the tests are focused on healthcare workers and incoming patients which could be an explanation for the larger case fatality ratio. But I don't know.

Sweden's reported case count is not helpful since they effectively stopped testing.

I agree with that.

It is likely still too early to judge the success/failure of Sweden's policy by looking at death data.

I think so too. But I am concerned about our policy, more concerned than before.

The major corona hotspot in Sweden is the capital Stockholm and the region associated with it (Stockholm County). Here in South Sweden (Scania) we have been comparatively pretty lucky so far:

(Note: Numbers per 100k population, Date: 16 april 2020)

Stockholm County:
Cases: 219¹
Deaths: 33.4¹

Scania County:
Cases: 36¹
Deaths: 2.7<sup>1

1</sup> per 100k population.

Source: http://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden#Statistics

Furthermore, recently there has been concern and debate about the high death ratio due to Covid-19 in the eldercare in Sweden (compared to the other Scandinavian countries Denmark and Norway).

Edit:

I should also say that most of the major political parties in Sweden has joined together to help out during this crisis, and recently there was a decision made which gave the government extended abilities to take countermeasures e.g. for local lockdowns if needed.

Edit 2:

Even though it is anecdotal, I also want to add that I have just recently heard from a couple of Swedish friends concerns about experienced diminishing discipline regarding social distancing. And a couple of days ago, while going out late for supplies, I happened to pass by a nightclub in the city which was absolutely packed with people, inside and outside. I did not like seeing that, and I changed my path to keep a good distance from the crowd. So I am a bit concerned about the Swedish policy...

 

[Astronuc]

Data on Gilead Coronavirus drug (remdesivir) suggests patients are responding to treatment
https://www.statnews.com/2020/04/16...uggests-patients-are-responding-to-treatment/

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

. . .
“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

There is another trial in Pennsylvania.

More on different trials from Gilead.
https://www.gilead.com/purpose/advancing-global-health/covid-19/remdesivir-clinical-trials

 

[kyphysics]

Even though it is anecdotal, I also want to add that I have just recently heard from a couple of Swedish friends concerns about experienced diminishing discipline regarding social distancing. And a couple of days ago, while going out late for supplies, I happened to pass by a nightclub in the city which was absolutely packed with people, inside and outside. I did not like seeing that, and I changed my path to keep a good distance from the crowd. So I am a bit concerned about the Swedish policy...

I'm guessing the non-social distancers were young?

I'm annoyed as hell. We have an executive order in my state to social distance. The kids in my neighborhood don't obey at all. They come from all different households to play sports (contact involved).

*tempted to call the police*

 

[DennisN]

I'm guessing the non-social distancers were young?

Hmm... I'd say between 18 and 30 years old circa. And it has a consequence for those who work at the club also of course. I was a bit shocked to see it actually, since I have experienced quite a lot of carefulness among people those times I venture out. My worries about growing complacency/overconfidence which I have mentioned before in the thread remains.