COVID-19 Coronavirus Containment Efforts

[mfb]

Turkmenistan misunderstands "containment efforts", apparently, and contains the discussion instead. It's official case count: zero.

 

[atyy]

This is where a serologic test becomes useful. A serologic test will detect if someone has antibodies against the virus, which is a sign that they were infected in the past. As others have mentioned, you can use the test to sample a population after the outbreak to estimate the real infection rate (which also tells you the fraction of undiagnosed mild/asymptotic cases).

Is it possible to use an antibody test as a step in testing the effectiveness of a vaccine? For example, before testing whether the vaccine reduces infections, would it make sense to first check that the vaccine is able to elicit antibody production?

 

[peanut]

Is it possible to use an antibody test as a step in testing the effectiveness of a vaccine? For example, before testing whether the vaccine reduces infections, would it make sense to first check that the vaccine is able to elicit antibody production?

I was told that:

1. The COVID-19 RDT can only be used in people who had onset of symptoms for at least 5 days (i.e. for IgM) and 21 days (i.e. for IgG). Most kits include both IgM and IgG, so they can be used by day 5.

2. Anyone who tests positive for IgM should be tested with an RT-PCR to confirm the positive test.

3. A negative IgM test DOES NOT rule out COVID-19 and the symptomatic patient should REMAIN ISOLATED, and swabbed using RT-PCR for confirmation.

4. IgG-only positive individuals without RT-PCR should be labeled as presumptive past COVID-19 and not be officially counted as confirmed unless there is a further validation test in the future, or if validated with a PRNT (Plaque reduction neutralization test) or viral culture by a third party. If a patient is symptomatic, an RT-PCR should be done, and the patient should be quarantined. If a patient is asymptomatic, there is no need to test using an RT-PCR.

5. The IgG antibody can be used as an adjunct test to clear quarantined patients who remain asymptomatic at 14 days post discharge. The presence of antibodies typically indicates viral clearance. If IgG is positive, the patient can be released from self-quarantine. If IgG is negative, a repeat RT-PCR should be performed

 

[atyy]

I was told that:

1. The COVID-19 RDT can only be used in people who had onset of symptoms for at least 5 days (i.e. for IgM) and 21 days (i.e. for IgG). Most kits include both IgM and IgG, so they can be used by day 5.

2. Anyone who tests positive for IgM should be tested with an RT-PCR to confirm the positive test.

3. A negative IgM test DOES NOT rule out COVID-19 and the symptomatic patient should REMAIN ISOLATED, and swabbed using RT-PCR for confirmation.

4. IgG-only positive individuals without RT-PCR should be labeled as presumptive past COVID-19 and not be officially counted as confirmed unless there is a further validation test in the future, or if validated with a PRNT (Plaque reduction neutralization test) or viral culture by a third party. If a patient is symptomatic, an RT-PCR should be done, and the patient should be quarantined. If a patient is asymptomatic, there is no need to test using an RT-PCR.

5. The IgG antibody can be used as an adjunct test to clear quarantined patients who remain asymptomatic at 14 days post discharge. The presence of antibodies typically indicates viral clearance. If IgG is positive, the patient can be released from self-quarantine. If IgG is negative, a repeat RT-PCR should be performed

Where did you read this? I'm asking because the protocol might be different in different countries.,

 

[peanut]

Where did you read this? I'm asking because the protocol might be different in different countries.,

I've learned that in our group chat from an infectious diseases physician. Yes protocol vary from country to country.

 

[atyy]

I've learned that in our group chat from an infectious diseases physician. Yes protocol vary from country to country.

Do you know which country he was referring to? I'm patricularly interested because of point 2 (Anyone who tests positive for IgM should be tested with an RT-PCR to confirm the positive test) - I think practice here varies the most. My guess from news articles is that Indonesia does something like this, but as @chemisttree and @mfb indicated in posts #1962 and #1963, the purpose of the PCR test may not be to confirm the result of the antibody test.

 

[DennisN]

On a more positive note:

Why I did the comparison was simply that I was interested in comparing countries to see which countries were doing well and what can possibly be learned from the countries that have been/are doing well.

In this spirit, I continued with the statistics from 31 March 2020¹.

This is a selection of 25 countries² (with number of cases larger than 716³) that have reported comparatively low case fatality rates (CFR), sorted from low to higher CFRs :

Source: Covid-19 CSSE dashboard (31 March 2020).

Notes:

1. The numbers may have changed since yesterday.
2. There are other countries with low CFRs (countries with numbers of cases smaller than 716³).
3. This is just an arbitrary selection criteria due to the fact that I restricted the list to 25 countries.

 

[DennisN]

@bhobba , @davenn :

Australia seems to have a comparatively low case fatality rate (ca 0,4%) judging from the statistics I posted above. Does anyone of you have any thoughts about why this could be the case?
Tell us your secrets...

EDIT:

Coincidentally, Sweden (where I am from) and Australia are currently just next to each other in the list with respect to numbers of confirmed cases (1 April 2020):

Sweden:
Cases: 4947
Deaths: 239
Case Fatality Rate (CFR) = 239/4947 = 0,048 = 4,8% (ca)

Australia:
Cases: 4862
Deaths: 20
Case Fatality Rate (CFR) = 20/4862 = 0,004 = 0,4% (ca)

So currently Australia has got a 10 times (ca) lower case fatality rate than Sweden.

 

[Ygggdrasil]

Is it possible to use an antibody test as a step in testing the effectiveness of a vaccine? For example, before testing whether the vaccine reduces infections, would it make sense to first check that the vaccine is able to elicit antibody production?

Yes, for example, this is one thing that Moderna will be monitoring during their phase I clinical trials of their mRNA vaccine:

This is a phase I, open-label, dose ranging clinical trial in males and non-pregnant females, 18 to 55 years of age, inclusive, who are in good health and meet all eligibility criteria. This clinical trial is designed to assess the safety, reactogenicity and immunogenicity of mRNA-1273 manufactured by ModernaTX, Inc. mRNA-1273 is a novel lipid nanoparticle (LNP)-encapsulated mRNA-based vaccine that encodes for a full-length, prefusion stabilized spike (S) protein of SARS-CoV-2. Enrollment will occur at one domestic site. Forty-five subjects will be enrolled into one of three cohorts (25 microgram [mcg], 100 mcg, 250 mcg). Subjects will receive an intramuscular (IM) injection (0.5 milliliter [mL]) of mRNA-1273 on Days 1 and 29 in the deltoid muscle and will be followed through 12 months post second vaccination (Day 394). Follow-up visits will occur 1, 2 and 4 weeks post each vaccination (Days 8, 15, 29, 36, 43, and 57), as well as 3, 6 and 12 months post second vaccination (Days 119, 209 and 394). The primary objective is to evaluate the safety and reactogenicity of a 2-dose vaccination schedule of mRNA-1273, given 28 days apart, across 3 dosages in healthy adults. The secondary objective is to evaluate the immunogenicity as measured by Immunoglobulin G (IgG) enzyme-linked immunosorbent assay ELISA to the SARS-CoV-2 S (spike) protein following a 2-dose vaccination schedule of mRNA-1273 at Day 57.

https://clinicaltrials.gov/ct2/show/NCT04283461

However, detecting antibodies against the virus doesn't necessarily guarantee that the vaccine will be effective. If the vaccine is not designed correctly, the antibodies could recognize the antigen from the vaccine very effectively but not the antigen in the actual virus. In some cases, antibodies can bind to the antigen, but instead of neutralizing the virus, they actually help the virus get into cells (a phenomenon known as antibody dependent enhancement). These are some of the reasons why a lot of clinical trials are necessary before vaccines can be made available to the general public.

 

[atyy]

@bhobba , @davenn :
Australia seems to have comparatively a low case fatality rate (ca 0,4%) judging from the statistics I posted above. Does anyone of you have any thoughts about why this could be the case?
Tell us your secrets...

It's a sports mad country, they spend all their time running and swimming at the beach so they are fit.

 

[DennisN]

It's a sports mad country, they spend all their time running and swimming at the beach so they are fit.

...and it's a big country with a lot of boomerangs they run around trying to take cover from.

 

[peanut]

Nothing to say that viruses that diluted over space can still cause an infection. Plus the absence of gravity allows them to be suspended in air (easier transmission? Especially in a closed environment - space shuttle etc)

 

[mfb]

Sweden stopped most tests, so cases are limited to some hospitalized patients. Forget their confirmed case count, it doesn't reflect reality at all.

Looks like Australia follows the path of Germany so far.

Daily new cases in the US now exceed 24,000, which means 1000 per hour or one every 3.6 seconds.

 

[DennisN]

Sweden stopped most tests, so cases are limited to some hospitalized patients. Forget their confirmed case count, it doesn't reflect reality at all.

Yes, I was aware of that. I wasn't aware of why, but according to this article which the wiki page referred to (Swedish only, sorry) the government epidemiologist Anders Tegnell said that they think there is community spread and they will focus to look more on severe than general cases:

We won't discuss anymore if we have 458 or 562 cases. Instead we'll look at how many regions are affected and how severely affected they are, says Tegnell.
(my translation to English from Swedish)

I guess time will tell if that was a wise decision or not...

 

[anorlunda]

I guess time will tell if that was a wise decision or not...

In the coming years, I'm sure that we'll hear a lot more about such decisions.

Should each continent/country/state/county/town/city/neighborhood/family/person be able to choose their own strategy independent of others? If yes, we have no containment. If no, we have a single world government with total authority. Freedom versus survival is not a nice choice to make. See #2979 about China.

 

[PeroK]

In the coming years, I'm sure that we'll hear a lot more about such decisions.

Should each continent/country/state/county/town/city/neighborhood/family/person be able to choose their own strategy independent of others? If yes, we have no containment. If no, we have a single world government with total authority. Freedom versus survival is not a nice choice to make. See #2979 about China.

This isn't about survival. This is about minimising deaths. What's the total world population doing at the moment? This virus, bad though it may be, will have a negligible effect on world population.

 

[Astronuc]

TALLAHASSEE, Fla. -- Governor Ron DeSantis announced Wednesday afternoon that the state of Florida is being shut down amid the Coronavirus pandemic. Stay-at-home declaration will take effect Thursday, April 2 at midnight (So technically Friday, April 3, 0000) and be in effect for 30 days.
https://weartv.com/news/local/gov-desantis-issues-stay-at-home-order-for-entire-state-of-florida

The numbers in NY state and city show that the state acted 7 to 10 days to mitigate the spread of the virus, and probably they should have started imposing restrictions during the first week of March.

As of Wednesday, April 1, this afternoon:

• 83,712 total cases in New York State
• 1,941 deaths from the Coronavirus in the state
• 47,439 cases in New York City, including 1,096 deaths
• 12,226 people with COVID-19 are hospitalized, including 3,022 in intensive care — 6,142 Coronavirus patients have been discharged
• 18,997 cases in New Jersey, with 267 deaths
• 3,128 cases in Connecticut, with 69 deaths

https://nymag.com/intelligencer/article/new-york-coronavirus-cases-updates.htmlWashington state Dept of Health has not reported numbers (cases and deaths) since March 28! They are approaching a 4-day lag. The number of positive cases should be greater than 5500 cases by today.

 

[bhobba]

Does anyone of you have any thoughts about why this could be the case?

No secrets. They have a team of 400 in Queensland alone tracing and testing all cases. Recently the criteria to test when traced has been relaxed so even asymptomatics are tested. It's too early yet to say anything for sure, but as of now it looks like the asypmtomatics are a small percentage - certainly not the 80% I have heard from some sources. I suspect it will rise, but the large percentages some are touting is looking doubtful - still one never knows. So it's simply the denominator here in Aus is greater. It must also be said Australia has an excellent medical system so those in intensive care are being really well looked after. BTW we are planning even more testing:
https://www1.racgp.org.au/newsgp/clinical/government-flags-expanding-coronavirus-testing

Thanks
Bill

 

[Point Conception]

Nothing to say that viruses that diluted over space can still cause an infection.

Yes, the exposure gradient, concentration,seems to be overlooked in the risk of infection from various exposures.

 

[BillTre]

Here is a link to a NY Times DIY article on making your own face mask.

The article also a link to a pdf for the sewing pattern.

 

[mfb]

Some discussion how reliable numbers from some countries are.

Italy:

 

[kyphysics]

https://www.nytimes.com/2020/04/01/nyregion/coronavirus-new-york-update.html

Other developments on Wednesday:

• Confirmed cases in New York State: 83,712, up from 75,795.
• Currently hospitalized in New York State: 12,226, up from 10,929.
• In intensive care in New York State: 3,022, up from 2,710.
• In New Jersey: There were 22,255 cases, up from 18,696, and 355 deaths, up from 267.
• In Connecticut: There were 3,557 cases, up from 3,218, and 85 deaths, up from 69. Among the newly dead, Gov. Ned Lamont said, was a 6-week-old infant.
• The latest projections for the state put the peak of the outbreak at the end of this month.

Some numbers of the U.S. Northeast as of 4/1/2020 (yesterday).

When the deaths get into the hundreds (let alone, thousands) range for a state, it just feels scary for me. My state has less than 100 at this point, but we'll probably get there.

 

[kadiot]

Sweden's no lockdown policy is based on the recommendation of the country's leading epidemiologist. The strategy is totally opposed to what the rest of the world is doing. Let's see how this experiment turns out.

 

[atyy]

[response to deleted post deleted]

We are not given enough detail to understand Deborah Birx's statement. It is not obviously correct, since what is going on in Italy or Spain is consistent with China's numbers.

Deborah Birx recently made another bizarre statement that Singapore followed Trump's guidelines.
https://mothership.sg/2020/03/singapore-took-trump-guidelines-covid-19/

 

[wukunlin]

Ah indeed. Sorry for the tunnel vision.

 

[atyy]

Sweden's no lockdown policy is based on the recommendation of the country's leading epidemiologist. The strategy is totally opposed to what the rest of the world is doing. Let's see how this experiment turns out.

Well, I believe South Korea also has no lockdown, and they've been successful so far. I think the two successful cases so far are China and South Korea. China's problem was bigger because the outbreak started there and they mishandled things initially. Nonetheless South Korea also handled a great challenge. So it seems that depending on how out of control things are, both countries show the range of potentially successful policies.

Hopefully Italy will become another example of success, but it's too early to say at the moment.

 

[atyy]

Ok, I know people in many countries will be thinking "child abuse", but here in Singapore it is still normal for parents to discipline their children by caning (and yes, I was caned by my parents). Anyway, just for laughs (which is how most Singaporeans will understand this article):

S’porean mum discovers canes sold out at 2 stores as side effect of work-from-home
Kids all over the country quaking in fear.
https://mothership.sg/2020/04/canes-sold-out-work-from-home/

 

[DrClaude]

Sweden's no lockdown policy is based on the recommendation of the country's leading epidemiologist. The strategy is totally opposed to what the rest of the world is doing. Let's see how this experiment turns out.

While there is no lockdown, there are many recommendations to limit contact and people are following them. Even if Sweden's approach succeeds, it won't necessarily mean that it would have worked everywhere. The overall low population density appears to be helpful here.

 

[bhobba]

Ok, I know people in many countries will be thinking "child abuse", but here in Singapore it is still normal for parents to discipline their children by caning (and yes, I was caned by my parents).
https://mothership.sg/2020/04/canes-sold-out-work-from-home/

So was I at school, not so much at home, although other forms of punishment were used such as the handle of a feather duster. It was considered normal in Australia. But for some reason it went by the wayside here, but obviously not in Singapore. The only thing my parents disliked about it (as a child I just thought it normal) was at school when someone in a class would not own up to something they would cane the whole class. My mother had a very 'strong' talk to the principle about that practice - my son did nothing and you punished him.

Thanks
Bill

 

[wukunlin]

Ok, I know people in many countries will be thinking "child abuse", but here in Singapore it is still normal for parents to discipline their children by caning (and yes, I was caned by my parents). Anyway, just for laughs (which is how most Singaporeans will understand this article):

S’porean mum discovers canes sold out at 2 stores as side effect of work-from-home
Kids all over the country quaking in fear.
https://mothership.sg/2020/04/canes-sold-out-work-from-home/

I'm more shocked that there are canes made specifically for that purpose. Most parent I know use whatever's at hand.