COVID COVID-19 Coronavirus Containment Efforts

[jedishrfu]

Amid Covid19 crisis, US insurance cos. warn tens of millions of Americans do not have health cover. I would understand this in PH but in America? What will happen to them past this crisis if they need treatment? Incomprehensible...

The US has been in turmoil over healthcare for decades so this is nothing new. It will change when we catch up to the rest of the world with healthcare for all.

However, until that time let's focus on COVID-19 specific stuff in this thread rather than the political theater of the US Healthcare system.

 

[jim mcnamara]

@kadiot Let's not go down that road. All it will do is derail this thread. (veiled hint ).
Okay?

 

[atyy]

It's a few days behind now, but this presentation from UT Austin pointed to an interesting graph put together by Stephanie Jolly: https://www.wave3.com/2020/03/24/graph-comparing-ky-tenn-coronavirus-responses-goes-viral/

Up to March 22, the growth of cases in Kentucky is less than in Tennessee. This may be because Kentucky implemented social distancing measures earlier.

 

[atyy]

Kentucky is putting ankle monitors on Coronavirus patients who ignore self-isolation order
https://fox59.com/news/kentucky-is-...rus-patients-who-ignore-self-isolation-order/

 

[OCR]

Kentucky is putting ankle monitors on Coronavirus patients who ignore self-isolation order

Ankle monitors?. . . Ankle monitors?? . We don't need no stinkin' ankle monitors!

I really don't have a strong desire to go outside, anyway. . . .

.

 

[mfb]

"Enough time" and "enough data" are highly uncertain things. The data is thin and vague in some ways, overwhelmingly large and unwieldy in others, so it is perfectly reasonable and completely unsurprising that different countries/entities reacted very differently from each other. Yes, South Korea shows that it was *possible* to use a catch-and-contain strategy, but in order to accomplish that they reacted much faster and more aggressively than any other country I'm aware of.

History may judge South Korea's reaction "right" and everyone else's "wrong", but when an awful lot of people independently come to the "wrong" conclusion, I think you have to accept that reality at face value: under most systems of logic, political philosophy, risk tolerance, institutional inertia, etc. the data did not support an aggressive response. Being "right" makes South Korea the outlier - the one who's reaction doesn't make sense - not the rest of the world.

South Korea is a country that listened closely to experts.
Too many other governments were more concerned about their public image, about their re-election chances, about selling their private stocks before taking public action, and similar things, while too many people in these countries were more worried about their holidays than about the pandemic.
The reaction of South Korea made perfectly sense. It's just rare to see governments and most people listening to experts.

Researchers from the University of Nebraska Medical Centre and the National Strategic Research Institute at the University of Nebraska took air samples from 11 rooms where 13 confirmed cases were being treated.

As well as finding genetic material from the Coronavirus on lavatories and on everyday items, 63.2 per cent of air samples taken inside the rooms and 66.7 per cent of those taken outside also showed traces.

Note that "genetic material" doesn't mean virions (i.e. infection risk). Just some genetic material on its own isn't infectious.

 

[kadiot]

The Philippine government is planning to start the "mass testing" of COVID-19 Person Under Investigation (PUI) and Person Under Monitoring (PUM) on April 14, 2020.

1. Mass testing is not testing everyone. It is “risk-based” testing. Basically, you test people in increasing circles of risk: test the PUI, then the close contacts, then the community. It is not a shotgun approach because no country can test every single citizen for COVID-19. So we need to figure out our priorities for testing, and WHAT TEST to use. You CAN’T test 100M people, but you can test the MOST AT RISK.

2. Understand the limitations of testing. No TEST is 100% accurate. There are trade-offs. The probability that a test is positive when the disease is REALLY present is called the SENSITIVITY. The probability that a negative test actually means the disease is REALLY NOT there is called the SPECIFICITY.

3. A good sensitivity means that a test is able to detect disease MOST of the time if it is PRESENT in a patient. Having a negative test when the disease is PRESENT is called a FALSE NEGATIVE. In other words, the test failed to detect a sick person.

4. A good specificity means that a test is NEGATIVE MOST of the time if there is NO DISEASE in a patient. Having a positive test when the disease is ABSENT is called a FALSE POSITIVE.

5. FALSE NEGATIVES are harmful because you say that someone is COVID-19-free when he actually has COVID-19 so that patient will be free to spread the disease.

6. FALSE POSITIVES are harmful because you will put a patient WITHOUT COVID-19 in the hospital, possibly with REAL COVID-19 patients such that the patient can get COVID, or be isolated needlessly.

7. So how good are the tests? There are two tests we can use for COVID-19 – RT-PCR and antibody tests.

8. RT-PCR is considered the best test for diagnosing ONGOING COVID-19 infection. PCR itself is very sensitive and specific, >90% for both. HOWEVER, the TYPE of specimen and the stage of disease (how many days with symptoms) can affect how often a test is positive. So for RT-PCR, using a nasopharyngeal swab in a patient WITH disease, the probability of getting a positive test is only 63%. So you will actually MISS 37% of cases. This is why we can do a REPEAT test after 48 hours in a patient who is getting sicker of what looks like COVID, but was NEGATIVE on the first test. The DANGER of RT-PCR is a FALSE NEGATIVE and you can end up clearing someone who actually has COVID-19. This can happen in UP TO 1/3 OF PATIENTS so its not a perfect test.

9. RT-PCR is also a highly technical process that not only involves having the right machine and kits, BUT also the proper SAFETY INFRASTRUCTURE like a BSL2 laboratory. Many labs and hospitals HAVE RT-PCR machines but they do not have the biosafety infrastructure.

10. Antibody tests include PRNT (Plaque reduction neutralization test, the gold standard), ELISA (enzyme linked immunosorbent assay) and lateral flow IgM/IgG. The first two are LABORATORY based assays and the last is a point of care rapid diagnostic test (POC-RDT).

11. As much as we would like to use rapid lateral flow assays (IgM/IgG) because of convenience, NONE of the lateral flow assays have used the industry standard PRNT assay as a gold standard. In other words, we have NO IDEA how good they are despite their claimed sensitivity and specificity. The biggest danger is that because it takes 5 to 10 days to make IgM antibody, the test has a high FALSE NEGATIVE rate in those who just started having symptoms. And so you will get a FALSE SENSE OF SECURITY and end up passing the virus to other people and your family members.

12. The OTHER problem with the lateral flow IgM/IgG is that there are other HUMAN CORONAVIRUSES that cause the common cold, and some antibodies against these viruses may CROSS-REACT with the test, giving you a FALSE POSITIVE, which is bad for the reasons stated.

The BOTTOM LINE is NONE OF THESE TESTS ARE PERFECT. FAR from it. Tests INFORM your response, but they still need to be INTERPRETED in the right context.

To some lay persons like myself, we think that a positive is a positive, and a negative is a negative. To clinicians and scientists, they come with HUGE caveats in management. There are times they WILL NOT believe a test result because it is NOT CONSISTENT with the patient’s clinical picture. If we let ourselves be mislead by a test result without USING OUR BRAIN, people will DIE. And this also holds for doing public health strategies and mass testing.

 

[DennisN]

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.

Well, I believe South Korea also has no lockdown, and they've been successful so far.

Yes. It seems we are quite compliant in Sweden, both judging from the news and from my own experience. At my place in Malmö, I noticed early that the number of people being outside was getting less. Now there are very few people going outside. And those who are out are generally more careful with keeping distance. And the fact that so few people are outside has of course had a great impact on business, e.g. restaurants.

Another thing I have personally noticed is a new kind of unusual silence. I much more seldom hear the noise of human activity like cars driving, and the usual background noise has been replaced with the sound of birds singing and chatting, which is quite pleasant.

 

[chemisttree]

Researchers from the University of Nebraska Medical Centre and the National Strategic Research Institute at the University of Nebraska took air samples from 11 rooms where 13 confirmed cases were being treated.

As well as finding genetic material from the Coronavirus on lavatories and on everyday items, 63.2 per cent of air samples taken inside the rooms and 66.7 per cent of those taken outside also showed traces.

That’s because it’s airborne. Something we have known for some time but which our “experts” still refuse to publicly admit. We don’t have enough of the “spacesuits” for all healthcare workers dealing with this so the response is to refuse to admit it’s airborne. Problem solved.

We are all going to get this thing eventually. Let’s hope the system can deal with it when we do.

 

[zoki85]

We are all going to get this thing eventually. Let’s hope the system can deal with it when we do.

I hope not...

 

[kadiot]

There's bound to be huge recession; many will be poorer than when this pandemic began; 2008 recession will look like peanuts.

 

[bhobba]

I hope not...

Your hope is justified. Managed correctly until we get a vaccine, while very hard, is not impossible. Over here in Aus they often publish a graph of those infected, those who got over it, and those who never get it. Do nothing - we all get it. Take simple measures eg hand washing etc, and the number at any time that have it is flattened and we have about 20% or so that never get it. Add in social distancing and it flattens more plus more never get it. Lockdown - better again. A vaccine - well that's pretty obvious - just a trickle get it and most never do.

If I remember correctly in China only 1% actually ever got it.

Thanks
Bill

 

[chemisttree]

How are the multistory apartment buildings in NYC different than the cruise ships being refused dockage in Florida?

The passengers of those land-bound ships can freely come and go.

https://www.bloomberg.com/graphics/2020-united-states-coronavirus-outbreak/

 

[atyy]

The Philippine government is planning to start the "mass testing" of COVID-19 Person Under Investigation (PUI) and Person Under Monitoring (PUM) on April 14, 2020.

1. Mass testing is not testing everyone. It is “risk-based” testing. Basically, you test people in increasing circles of risk: test the PUI, then the close contacts, then the community. It is not a shotgun approach because no country can test every single citizen for COVID-19. So we need to figure out our priorities for testing, and WHAT TEST to use. You CAN’T test 100M people, but you can test the MOST AT RISK.

2. Understand the limitations of testing. No TEST is 100% accurate. There are trade-offs. The probability that a test is positive when the disease is REALLY present is called the SENSITIVITY. The probability that a negative test actually means the disease is REALLY NOT there is called the SPECIFICITY.

3. A good sensitivity means that a test is able to detect disease MOST of the time if it is PRESENT in a patient. Having a negative test when the disease is PRESENT is called a FALSE NEGATIVE. In other words, the test failed to detect a sick person.

4. A good specificity means that a test is NEGATIVE MOST of the time if there is NO DISEASE in a patient. Having a positive test when the disease is ABSENT is called a FALSE POSITIVE.

5. FALSE NEGATIVES are harmful because you say that someone is COVID-19-free when he actually has COVID-19 so that patient will be free to spread the disease.

6. FALSE POSITIVES are harmful because you will put a patient WITHOUT COVID-19 in the hospital, possibly with REAL COVID-19 patients such that the patient can get COVID, or be isolated needlessly.

7. So how good are the tests? There are two tests we can use for COVID-19 – RT-PCR and antibody tests.

8. RT-PCR is considered the best test for diagnosing ONGOING COVID-19 infection. PCR itself is very sensitive and specific, >90% for both. HOWEVER, the TYPE of specimen and the stage of disease (how many days with symptoms) can affect how often a test is positive. So for RT-PCR, using a nasopharyngeal swab in a patient WITH disease, the probability of getting a positive test is only 63%. So you will actually MISS 37% of cases. This is why we can do a REPEAT test after 48 hours in a patient who is getting sicker of what looks like COVID, but was NEGATIVE on the first test. The DANGER of RT-PCR is a FALSE NEGATIVE and you can end up clearing someone who actually has COVID-19. This can happen in UP TO 1/3 OF PATIENTS so its not a perfect test.

9. RT-PCR is also a highly technical process that not only involves having the right machine and kits, BUT also the proper SAFETY INFRASTRUCTURE like a BSL2 laboratory. Many labs and hospitals HAVE RT-PCR machines but they do not have the biosafety infrastructure.

10. Antibody tests include PRNT (Plaque reduction neutralization test, the gold standard), ELISA (enzyme linked immunosorbent assay) and lateral flow IgM/IgG. The first two are LABORATORY based assays and the last is a point of care rapid diagnostic test (POC-RDT).

11. As much as we would like to use rapid lateral flow assays (IgM/IgG) because of convenience, NONE of the lateral flow assays have used the industry standard PRNT assay as a gold standard. In other words, we have NO IDEA how good they are despite their claimed sensitivity and specificity. The biggest danger is that because it takes 5 to 10 days to make IgM antibody, the test has a high FALSE NEGATIVE rate in those who just started having symptoms. And so you will get a FALSE SENSE OF SECURITY and end up passing the virus to other people and your family members.

12. The OTHER problem with the lateral flow IgM/IgG is that there are other HUMAN CORONAVIRUSES that cause the common cold, and some antibodies against these viruses may CROSS-REACT with the test, giving you a FALSE POSITIVE, which is bad for the reasons stated.

The BOTTOM LINE is NONE OF THESE TESTS ARE PERFECT. FAR from it. Tests INFORM your response, but they still need to be INTERPRETED in the right context.

To some lay persons like myself, we think that a positive is a positive, and a negative is a negative. To clinicians and scientists, they come with HUGE caveats in management. There are times they WILL NOT believe a test result because it is NOT CONSISTENT with the patient’s clinical picture. If we let ourselves be mislead by a test result without USING OUR BRAIN, people will DIE. And this also holds for doing public health strategies and mass testing.

Where did you get this from? It looked correct when I gave it a quick read.

 

[chemisttree]

If I remember correctly in China only 1% actually ever got it.

That story is far from finished.

“Some venues that had reopened were told by the government to close yet again.”

 

[atyy]

If I remember correctly in China only 1% actually ever got it.

That's not correct. The current status is that in Wuhan, the city where the outbreak began, approximately 1% got but it was still less than 1%. In Hubei, the province in which Wuhan is located, about 0.15% have had it. In China as a whole, the percentage is about 0.01%. The percentages may be about 20% higher if you include cases that are totally asymptomatic, but that does not change the qualitative picture.

 

[wukunlin]

That story is far from finished.

“Some venues that had reopened were told by the government to close yet again.”

Looks like asymptomatic cases will be wreaking havoc
https://www.scmp.com/news/china/soc...s-coronavirus-lockdown-country-tries-get-back

 

[DennisN]

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.

Well, I believe South Korea also has no lockdown, and they've been successful so far.

Yes. It seems we are quite compliant in Sweden, both judging from the news and from my own experience.

I just looked at the Reuters news site and there was a brand new article about Sweden's liberal strategy which is being questioned domestically:

Sweden's liberal pandemic strategy questioned as Stockholm death toll mounts (Reuters, April 3 2020)

Some quotes:

But Sweden’s liberal approach, which aims to minimise disruption to social and economic life, is coming under fire as the epidemic spreads in the capital.

“We don’t have a choice, we have to close Stockholm right now,” Cecilia Soderberg-Naucler, Professor of Microbial Pathogenesis at the Karolinska Institute, told Reuters.

She is one of around 2,300 academics who signed an open letter to the government at the end of last month calling for tougher measures to protect the healthcare system.

“We must establish control over the situation, we cannot head into a situation where we get complete chaos. No one has tried this route, so why should we test it first in Sweden, without informed consent?” she said.

...

The public face of Sweden’s pandemic fight, Health Agency Chief Epidemiologist Anders Tegnell, only months ago a little known civil servant but now rivalling the prime minister for publicity, has questioned how effectively lockdowns can be enforced over time.

“It is important to have a policy that can be sustained over a longer period, meaning staying home if you are sick, which is our message,” said Tegnell, who has received both threats and fan mail over the country’s handling of the crisis.

“Locking people up at home won’t work in the longer term,” he said. “Sooner or later people are going to go out anyway.”

 

[DrClaude]

I just looked at the Reuters news site and there was a brand new article about Sweden's liberal strategy which is being questioned domestically:

Sweden's liberal pandemic strategy questioned as Stockholm death toll mounts (Reuters, April 3 2020)

I wouldn't be surprised if Stockholm was put under lockdown in the coming days. Maybe even Malmö and Göteborg, looking at the current map of known cases:
https://en.m.wikipedia.org/wiki/202...eak_Cases_in_Sweden_by_Number_with_Legend.svg

I just hope the government doesn't go for a one-size-fits-all solution.

 

[kadiot]

Where did you get this from? It looked correct when I gave it a quick read.

Working draft from the inter-agency task force on emerging infectious diseases in the Philippines. I'll post here the final and official paper once it's done,

 

[peanut]

Saw this University of Cambridge published diagram and eventually found the original paper.

https://arxiv.org/pdf/2003.12055.pd...UYSdIpSgzc2V9bkYueivMv5Q9h7G2Nm9Y2VVCEMNcn_5E

 

[DrClaude]

There is a very interesting trend plotter: https://aatishb.com/covidtrends/

More explanation can be found in this video:

 

[russ_watters]

Researchers from the University of Nebraska Medical Centre and the National Strategic Research Institute at the University of Nebraska took air samples from 11 rooms where 13 confirmed cases were being treated.

As well as finding genetic material from the Coronavirus on lavatories and on everyday items, 63.2 per cent of air samples taken inside the rooms and 66.7 per cent of those taken outside also showed traces.

My take on this and the broader issue...

There are three layers to the "airborne" description:
1. Transmission by suspension in water droplets from coughing or aggressive singing is confirmed.
2. True "airborne transmission" is what happens after those droplets dry-out and the virus particles remain suspended in the air because they are small. This isn't confirmed.
3. The quote above is referring to likely inert virus debris being detected. That's an obvious thing that doesn't imply anything about airborne transmission.

From a policy perspective, we've been receiving conflicting guidance on wearing masks. This is based in part on changing or differing risk/risk analysis and in part on logistics: there aren't enough masks (of any type) to go around. Framing the risk, I see three categories:
1. People who are sick need to wear masks to reduce the emission of virus-carrying droplets of saliva.
2. Not everyone who is sick knows it. Hence, potentially anyone could be sick and everyone should wear masks.
3. The value of wearing a mask if you are not sick is debatable, but it's not zero. Hence, again, everyone should wear masks.

Initial guidance was based on #1. Now people are changing to #2 and #3. But the logistic issue is still a problem.

So my personal opinion - not a doctor or policymaker - is that if you want a wear a mask, go ahead. But only if you aren't taking one from a first-responder/caregiver/sick person. I literally just found a new-in-package N95 mask on a shelf in my closet by my attic access. I have several masks of various types I use if I'm doing something dusty like working in my attic, and this happens to have gone unused. I'll keep it in the package for now.

 

[kith]

History may judge South Korea's reaction "right" and everyone else's "wrong", but when an awful lot of people independently come to the "wrong" conclusion, I think you have to accept that reality at face value: under most systems of logic, political philosophy, risk tolerance, institutional inertia, etc. the data did not support an aggressive response.

In his books "The Black Swan" and "Antifragile", Nassim Nicholas Taleb argues that the usual measures of risk are increasingly inadequate in the modern world. They deal only with a certain class of risks but not with events like the financial crisis in 2008 or the current Coronavirus crisis which are arguably much more influencial. He suggests a different approach to risk management based on identifying a specific class of big risks ("systemic" and "fat-tailed") and being more cautious towards them. In line with this, he co-authored a call to action regarding the current crisis in late January. I find his line of thinking quite interesting.

 

[Vanadium 50]

Saw this University of Cambridge published diagram and eventually found the original paper.

Their forecast doesn't seem to match the data.

 

[kith]

Do we have good data about the number of tests in individual countries (ideally over time)?
/edit: Here's our world in data on it: https://ourworldindata.org/covid-testing

 

[russ_watters]

How are the multistory apartment buildings in NYC different than the cruise ships being refused dockage in Florida?

The passengers of those land-bound ships can freely come and go.

https://www.bloomberg.com/graphics/2020-united-states-coronavirus-outbreak/

They have kitchens. Also, the building staff don't all live together in tiny quarters.

By the way, the 2 main problem cruise ships were granted permission to dock. The plan is in good agreement with what I was hoping for when I wrote my complaint post yesterday. The very-sick people went to hospitals, the kinda sick people stayed onboard and the apparently healthy people are getting charter flights back to their home countries.

https://www.usatoday.com/story/trav...merica-ships-dock-fort-lauderdale/5110778002/

 

[atyy]

In his books "The Black Swan" and "Antifragile", Nassim Nicholas Taleb argues that the usual measures of risk are increasingly inadequate in the modern world. They deal only with a certain class of risks but not with events like the financial crisis in 2008 or the current Coronavirus crisis which are arguably much more influencial. He suggests a different approach to risk management based on identifying a specific class of big risks ("systemic" and "fat-tailed") and being more cautious towards them. In line with this, he co-authored a call to action regarding the current crisis in late January. I find his line of thinking quite interesting.

Some interesting recent Tweets from him.

 

[PeroK]

In his books "The Black Swan" and "Antifragile", Nassim Nicholas Taleb argues that the usual measures of risk are increasingly inadequate in the modern world. They deal only with a certain class of risks but not with events like the financial crisis in 2008 or the current Coronavirus crisis which are arguably much more influencial. He suggests a different approach to risk management based on identifying a specific class of big risks ("systemic" and "fat-tailed") and being more cautious towards them. In line with this, he co-authored a call to action regarding the current crisis in late January. I find his line of thinking quite interesting.

I re-read Fooled by Randomness recently, but to be honest it just depressed me. One example was a market analyst who advocated avoiding over-exposure in certain stocks. Then, when those stocks went up the TV presenters declared that you would have lost money by following his advice!

Human beings generally seem to be ill-equipped to think like he advocates. For example, in UK politics something was a risk only when things go wrong!

 

[Stephen Tashi]

In his books "The Black Swan" and "Antifragile", Nassim Nicholas Taleb argues that the usual measures of risk are increasingly inadequate in the modern world.

What makes the situation different than in the pre-modern world? - whenever that was.

One thought is that epidemics can spread faster. Medical technology can also respond faster.

Another thought is that organizations with authority to do risk-management didn't exist in the pre-modern world. That would be a historical debate.

Given the large number of great but improbable catastrophies ( giant asteroid impacts, supervolcano erruption at Yellowstone etc. ) are there sufficient resources to be "adequately prepared" to meet all of them?