COVID COVID-19 Coronavirus Containment Efforts

[atyy]

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.

If some countries manage to get it back to the stage of being manageable by contact tracing and some degree of social distancing that still allows many businesses to operate, then it may be ok to test only symptomatics and those highly at risk (eg. very close contacts of positives). Testing the general population also has a false positive risk. Maybe something like the South Korean testing strategy.

 

[kyphysics]

Perhaps that is from increased testing in the dorms (for construction workers). I think that has been difficult to manage as there hasn't been enough space for social distancing there. Hopefully it will get better as they find at least temporary living space for them in which social distancing is possible.

The health ministry has recently been plotting a new statistic called "community cases". The numbers are much higher than before the school holidays, but the number of new community cases per day has been pretty constant over the last two weeks. Take a look at the last column of the first table (Fig 1.1) in each of these reports, or the orange bar graph in the figure (Fig 1.2) after the table.
https://www.moh.gov.sg/docs/librari...ion-report/situation-report---15-apr-2020.pdf
https://www.moh.gov.sg/docs/librari...port/situation-report---13-apr-2020-2354h.pdf

Yikes.

200's to 400's to now 700's today.
Hoping you stay safe out there!

eta: The reason this is of such interest to me is that Singapore was obviously the world's model nation and there have been questions about what happens if a country relaxes shelter-in-place, social distancing, etc. measures? Will there be a second wave (although, in Singapore, maybe one can argue it's your "first wave," given how you clamped down on the growth curve successfully)?

If this is happening as a "second wave" in Singapore, then I worry about the U.S. and other countries.

 

[Astronuc]

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

This is true. However, the idea of widespread testing is to identify those with exposure or asymptomatic/presymptomatic COVID-19 cases and take steps to prevent exposure of others.

There are numerous institutions developing rapid testing. For example,
https://www.raybiotech.com/covid-19-igm-igg-rapid-test-kit/
https://www.confirmbiosciences.com/covid19-instant-coronavirus-test-kit/
https://www.abbott.com/corpnewsroom...etect-covid-19-in-as-little-as-5-minutes.html

I've heard of rapid testing from nasal swabs as well.

If people go back to work in public, folks may need to wear protective masks (and use hand washing and hand sanitizer) to preclude either infecting others or receiving an infection. Physical distancing would probably still apply.

Then it looks like there may be at least one effective anti-viral treatment, and others are being developed.

The long term goal is the development of a vaccine - perhaps a year out, or longer.

With respect to tracking the existing cases, one bit of data that would be useful, primarily in NY City would be the positive cases of folks who use elevators in their dwellings and at work. An elevator is an enclosed space and all it takes is for one infected person to exposure many others. A relative who is a doctor mentioned the longevity of Coronavirus in elevators. Apparently, it's a long time time, as in days. Elevators in high rise office buildings could expose hundreds or thousands of people depending on the number of stories, and there are many high rise buildings around Grand Central Station in NY City.

 

[mfb]

The mean time from infection or onset of symptoms to death for a given person (the ~20 days) is not the mean time of the infection to death for deaths at a given time in a country where cases grow rapidly. If we have 10,000 cases that are 10 days old and 2,000 cases that are 20 days old then the former group can easily lead to more deaths even if a death after 10 days is less likely for each person. If we look at "deaths at day x" then many of them will come from infections that happened more recently.

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?

If everyone who could potentially be tested is negative then the pandemic wouldn't exist. It keeps spreading mainly from people who don't know they have it, and probably some people who know and don't care. People get infectious before they have symptoms and staying at home 24/7 isn't feasible for many. If you stay at home the whole time, get food delivered and so on you are probably the least concern for widespread testing - but think of the people who deliver that food and do other essential activities outside their home.
Testing will focus on high risk groups and people who had contact to someone infected. The more infected people we can isolate quickly the less likely they can infect others.

Smallpox wasn't eradicated by vaccinating everyone - that approach was viable in developed countries but not elsewhere. It was eradicated by quick reporting of cases and then vaccination of only people close to that case. We don't have a vaccine yet, so we have to rely on tests and isolation instead. If the case count is low enough to test everyone at risk that can work.

 

[atyy]

Yikes.

Yikes indeed!

200's to 400's to now 700's today.
Hoping you stay safe out there!

Thanks!

eta: The reason this is of such interest to me is that Singapore was obviously the world's model nation and there have been questions about what happens if a country relaxes shelter-in-place, social distancing, etc. measures? Will there be a second wave (although, in Singapore, maybe one can argue it's your "first wave," given how you clamped down on the growth curve successfully)?

We haven't had anything like shelter-in-place until last week, and primary and secondary schools were all still running with physical classes, because things seemed to be under control. So I think the Singapore data is still consistent with the idea from South Korea, and the currently good signs from China, that it is possible to manage things well without shutting everything down. The reason I've always cited South Korea (not Singapore) as the model, is that Singapore had not had any spike until now, so Singapore doesn't show what to do after you have a spike. On the other hand, South Korea had a huge spike, and they dealt with it successfully.

The current spike in Singapore is still atypical (at least with respect to Europe and North America), because it is mainly among construction workers living in dorms where social distancing is hard, so the government has had to find new temporary housing for a very large number of people (about 20,000 people) in a short time. I think this has been mostly done now, so hopefully there won't be new infections, we'll find out in a few days. The other thing that has to be done is to take care of the welfare of all the people who suddenly have to live in temporary housing (these are foreign workers, so they don't have family here).

Edit: it seems more temporary housing for the workers in dorms in still being set up.

 

[BillTre]

As things go on, it seems that some kinds of businesses could be set-up to be conducted with a minimal chance of infection.

For example, I just heard of someone who had a load of gravel dumped in her driveway.
No close contact is needed for this to happen. The order could be placed on line and a truck comes and dumps the load in the driveway without any close contact.

This seems fine to me and could happen with a lot of other businesses.
However, making guidelines for things like this would be complex due to the many different kinds of businesses and is probably too complex for some simple minded government regulation.
In addition, there will always be people or businesses that will try to cut corners which can lead to new infections. Some kind of public shaming might work in many cases, but then some of those shamed would probably want to sue those doing the shaming.

 

[atyy]

Interesting positive case with negative nasal swab.

Typical takotsubo syndrome triggered by SARS-CoV-2 infection
Philippe Meyer, Sophie Degrauwe, Christian Van Delden, Jelena-Rima Ghadri, Christian Templin
European Heart Journal, ehaa306, https://doi.org/10.1093/eurheartj/ehaa306

"An 83-year-old lady treated for chronic hypertension was hospitalized for acute chest pain on 18 March 2020, 21 days after the COVID-19 outbreak started in Geneva, Switzerland.
...
At day 3, the patient started developing fever, showing increasing biological signs of inflammation, and clear bilateral lung X-ray opacities (Panel D). Nasopharyngeal swab was negative for SARS-CoV-2, but the initial positive immunoglobin A and negative immunoglobulin G serology pattern proved acute infection."

 

[kadiot]

This is interesting. The Philippines's Department of Health considered the entire Sitio Zapatera, Barangay Luz, Cebu City in the Philippines as infected. The estimated total population of said Sitio is at 10,000. Does this mean they are adding 10k to the official count for COVID-19 positive cases in the Philippines? Because, really, that’s the implication of this decision.

Cebu City will be the country’s New York City, the epicenter of epicenters, dislodging every city in the Capital with over “10k” cases.

https://www.sunstar.com.ph/article/...kiwmX8NJID9kvzjH0jcE2Ao9LtTC7bPvslNgi-MRBiOPI

 

[chirhone]

1. I want to see studies of people with mild symptoms who got well and then immersed themselves as frontlines in hospitals. Can they be reinfected and would it progressed into serious complications or would they continue to have no or mild symptoms? If so, then these immuned people can become invulnerable frontlines?

2. The fatality is 2% and some young people are affected. I want to see studies if the younger victims have insomnia. This is because lack of sleep can make one weak. So do these young people succumbed to Covid because of lack of sleep (even in hospitals)?

 

[kadiot]

1. I want to see studies of people with mild symptoms who got well and then immersed themselves as frontlines in hospitals. Can they be reinfected and would it progressed into serious complications or would they continue to have no or mild symptoms? If so, then these immuned people can become invulnerable frontlines?

I'm not sure if such studies exist because practically we test asymptomatic patients who are contacts of known case.

Have you read the Cebu news report I posted earlier? Amazingly 51 out of 53 tested are asymptomatic meaning their immune system is able to manage the virus. Notably the human body is host to many types of viruses and bacteria with no apparent impact to ones health. It crosses my mind with only 352 official deaths attributed to COVID-19 from January 25 to April 16 or 80 days in a country with more than 108,000,000, we may be reacting disproportionately to this selective pandemic. Bangladesh and many third world populations are not recording the anticipated mortality rates. In the case of the Philippines, were more than 6 weeks past due on the projected surge date... Hopefully it never happens.

 

[kadiot]

Is there a study already of collating criteria based on history and PE that could help determine it is a clinically Covid-19 case over using diagnostic kits?

 

[chirhone]

https://www.washingtonpost.com/heal...f71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html

Are there other bacteria or viruses that can damage other organs like kidneys or the heart? I know syphilis can. The Covid-19 virus has indications it can.

 

[WWGD]

What should we make of the recent report of 1,290 deaths in China after more than some 3 months when we had a trickle of 3-4 deaths every other day?

 

[TeethWhitener]

What should we make of the recent report of 1,290 deaths in China after more than some 3 months when we had a trickle of 3-4 deaths every other day?

Upward revisions of death tolls are pretty common in pandemics. The initial US death toll from the 2009 swine flu epidemic was around 3,000, later revised upward to around 12,000 as authorities started including people who had died at home, etc.

 

[kadiot]

This is interesting. The Philippines's Department of Health considered the entire Sitio Zapatera, Barangay Luz, Cebu City in the Philippines as infected. The estimated total population of said Sitio is at 10,000. Does this mean they are adding 10k to the official count for COVID-19 positive cases in the Philippines? Because, really, that’s the implication of this decision.

Cebu City will be the country’s New York City, the epicenter of epicenters, dislodging every city in the Capital with over “10k” cases.

https://www.sunstar.com.ph/article/...kiwmX8NJID9kvzjH0jcE2Ao9LtTC7bPvslNgi-MRBiOPI

This is a good case study for herd immunity...lock down that place and let's see who survives...I'm beginning to favor herd immunity, if we can have the old, very young, immunocompromised people protected or secured.

 

[WWGD]

This is a good case study for herd immunity...lock down that place and let's see who survives...I'm beginning to favor herd immunity, if we can have the old, very young, immunocompromised people protected or secured.

I understand the Netherlands have been implementing it yet they are not doing so well; maybe one can claim they would be doing worse without it. They are doing better than neighbor Belgium but the two may not be independent. I don't know how ethical it is to have people subjected to such test, specially without their consent.

 

[Ygggdrasil]

If some countries manage to get it back to the stage of being manageable by contact tracing and some degree of social distancing that still allows many businesses to operate, then it may be ok to test only symptomatics and those highly at risk (eg. very close contacts of positives). Testing the general population also has a false positive risk. Maybe something like the South Korean testing strategy.

A new paper estimates that people with COVID-19 are most infectious before the onset of symptoms and that infections from pre-symptomatic individuals accounts for a fairly large proportion of infections, when analyzing a population of patients from a hospital in China:

we inferred that infectiousness started from 2.3 days (95% CI, 0.8–3.0 days) before symptom onset and peaked at 0.7 days (95% CI, −0.2–2.0 days) before symptom onset. The estimated proportion of presymptomatic transmission (area under the curve) was 44% (95% CI, 25–69%).

He et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. Published online 15 Apr 2020. doi:10.1038/s41591-020-0869-5
https://www.nature.com/articles/s41591-020-0869-5

This work would seem to challenge the effectiveness of a strategy that only tests symptomatic individuals.

https://www.washingtonpost.com/heal...f71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html

Are there other bacteria or viruses that can damage other organs like kidneys or the heart? I know syphilis can. The Covid-19 virus has indications it can.

Influenza increases the risk of heart attacks:
https://www.npr.org/sections/health...iously-the-flu-can-trigger-a-heart-attack-too
https://www.cdc.gov/flu/highrisk/heartdisease.htm

What should we make of the recent report of 1,290 deaths in China after more than some 3 months when we had a trickle of 3-4 deaths every other day?

From CNN:

Officials explained that the deaths had initially gone uncounted because in the early stages of the pandemic some people died at home, overwhelmed medics were focused on treating cases rather than reporting deaths and due to a delay in collecting figures from various government and private organizations.

https://amp.cnn.com/cnn/2020/04/17/asia/china-wuhan-coronavirus-death-toll-intl-hnk/index.html

Reporting in the US suggests similar undercounting may be occurring here as well, for example:

Medical professionals around the US told BuzzFeed News that the official numbers of people who have died of COVID-19 are not consistent with the number of deaths they’re seeing on the front lines.

In some cases, it’s a lag in reporting, caused by delays and possible breakdowns in logging positive tests and making them public. In other, more troubling, cases, medical experts told BuzzFeed News they think it’s because people are not being tested before or after they die.

https://www.buzzfeednews.com/article/nidhiprakash/coronavirus-update-dead-covid19-doctors-hospitals

Other news articles suggest potential underreporting of deaths in France and Germany as well.

 

[WWGD]

A new paper estimates that people with COVID-19 are most infectious before the onset of symptoms and that infections from pre-symptomatic individuals accounts for a fairly large proportion of infections, when analyzing a population of patients from a hospital in Chinae et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. Published online 15 Apr 2020. doi:10.1038/s41591-020-0869-5
https://www.nature.com/articles/s41591-020-0869-5

This work would seem to challenge the effectiveness of a strategy that only tests symptomatic individuals.
Influenza increases the risk of heart attacks:
https://www.npr.org/sections/health...iously-the-flu-can-trigger-a-heart-attack-too
https://www.cdc.gov/flu/highrisk/heartdisease.htm
From CNN:https://amp.cnn.com/cnn/2020/04/17/asia/china-wuhan-coronavirus-death-toll-intl-hnk/index.html

Reporting in the US suggests similar undercounting may be occurring here as well, for example:

https://www.buzzfeednews.com/article/nidhiprakash/coronavirus-update-dead-covid19-doctors-hospitals

Other news articles suggest potential underreporting of deaths in France and Germany as well.

Is it safe to assume a similar rate of under-reporting in different countries; along the lines of 30-40%?

 

[kadiot]

Is it safe to assume a similar rate of under-reporting in different countries; along the lines of 30-40%?

I think so. The truth is no one knows the true numbers. But they are much larger than what official stats show.

The numbers the Health Department releases are just the tiny tip of a huge iceberg of deaths, recoveries and cases that the government has not counted or cannot count.

How about all the Covid deaths of people who were not “confirmed cases?” Not counted.

The thousands of people who recovered from Covid but did not have to be hospitalized? Not counted.

And the possible millions of infected people but who have not been tested? Not counted.

 

[Ygggdrasil]

Is it safe to assume a similar rate of under-reporting in different countries; along the lines of 30-40%?

No. The under-reporting rate would depend a lot on the availability of testing and the policies about testing/investigating unconfirmed probable cases, which likely differ a lot between locales (e.g. even between different states in the US).

A major challenge with the outbreak is that "all the Coronavirus statistics are flawed:"

Confirmed cases are a function of confirmed tests. After a tragically late start, U.S. testing capacity has doubled in the past week. Is the U.S. currently experiencing rapid growth in Coronavirus cases, or rapid growth in Coronavirus testing, or both? The answer should sound familiar: We don’t know yet, and it will be a while before we do.

Other metrics used to gauge the scale of the outbreak, such as hospitalizations and deaths, have their own limitations. Not all states are reporting hospitalizations, and once hospitals are full, additional cases might not show up in reported figures. Death statistics are also a function of case-by-case diagnosis and cause-of-death methodology. Many deaths due to COVID-19 may have been—and many more may continue to be—misdiagnosed as the result of pneumonia or another respiratory ailment.

With time and increased testing, the state of this outbreak will come into focus. But leaders should be humble, and citizens must be patient, about the fact that no single metric is gospel right now. Even many health statistics taken together can offer at best an incomplete picture of the scope of the crisis.

(note the article is from late March, but it explains many of the limitations to the various measures used to track the spread and deadliness of the virus)

 

[phinds]

No. The under-reporting rate would depend a lot on the availability of testing and the policies about testing/investigating unconfirmed probable cases, which likely differ a lot between locales (e.g. even between different states in the US).

And in some cases a major factor can be the political environment. Witness the widespread and numerous reports that China deliberately has unreported even the cases and deaths that it knows about because their administration wanted things to appear rosier than reality.

 

[BillTre]

And in some cases a major factor can be the political environment. Witness the widespread and numerous reports that China deliberately has unreported even the cases and deaths that it knows about because their administration wanted things to appear rosier than reality.

The same has been going on in the US, only not in such a well controlled centralized manner.

 

[phinds]

The same has been going on in the US, only not in such a well controlled centralized manner.

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

 

[Ygggdrasil]

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

While I agree that we should avoid making the discussion here too political, I do have to ask: why is it political to make claims like this against the US government but not political to make similar claims against the Chinese government?

 

[BillTre]

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

From my point of view, politics in one country is the same as politics in any other country.
This is why I find the application of these rules somewhat confusing.

 

[hmmm27]

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

Pretty scary how everything stopped cold for a bit when a member from another culture inquired what we thought of them. Took a few days to formulate a neutrally-worded response, and by then the conversation had moved on. Haven't seen them past that bit, which is a shame.

 

[BillTre]

I also think that issues of competence are important to discuss but get entangled with politics.
This allows some politically minded people (or those they support) to hide behind these kind of rules in order to avoid legitimate criticism of their completely incompetent management.

 

[hmmm27]

From my point of view, politics in one country is the same as politics in any other country.
This is why I find the application of these rules somewhat confusing.

Partial rampant political-correctness, partially not to scare them away, partially because there are homegrown idiots who take jest as seriousness.

Mostly because not all societies have the same casual attitude (and "ours" is not necessarily "better").

 

[phinds]

While I agree that we should avoid making the discussion here too political, I do have to ask: why is it political to make claims like this against the US government but not political to make similar claims against the Chinese government?

From my point of view, politics in one country is the same as politics in any other country.
This is why I find the application of these rules somewhat confusing.

I also think that issues of competence are important to discuss but get entangled with politics.
This allows some politically minded people (or those they support) to hide behind these kind of rules in order to avoid legitimate criticism of their completely incompetent management.

Partial rampant political-correctness, partially not to scare them away, partially because there are homegrown idiots who take jest as seriousness.

Mostly because not all societies have the same casual attitude (and "ours" is not necessarily "better").

I think you all are overlooking or not considering how totally vicious political partisanship has become in America in the last several years. We have always had partisan divides but not as widespread or a vehement as we have now.

Any discussion of them is likely to quickly devolve into bickering.

 

[BillTre]

I'm not overlooking it, but I see no reason to consent to it without it being made clear why its an issue.

Also, I think it is better to try countering it rather than rolling over and playing intellectually and ethically dead.
Things won't get better without some dose of realism.

This issues are costing lives (as well as screwing up the economy)!