COVID COVID-19 Coronavirus Containment Efforts

[mfb]

Of the 397 people tested, 146 people tested positive. Not a single one had any symptoms.

... at the time of the test. Maybe nearly all got infected shortly before the tests? From the article I infer that many (most?) now show symptoms:

According to O’Connell, only one of those patients needed hospital care, and many continue to show no symptoms.

“If we did universal testing among the general population, would these numbers be similar?”

We know the answer is "no" in all places that did testing among the general population.Germany's new case reports keep large fluctuations, but they clearly go down. They do fewer tests during the weekends... that explains parts of the fluctuations.
Daily recoveries now exceed new reported cases. Tests stabilized at >=50,000 per day. About 8% of them were positive last week, this week will be quite a bit lower.

They also asked confirmed patients about their onset of symptoms and did modeling based on it (German): The peak of patients becoming symptomatic was March 16-18, a month ago. From then to April 9 new cases went down by ~40% (Figure 6).

Germany prepares for the time after the first wave (also German). It's planned to partially open schools early May. All small businesses and a few larger ones will be allowed to open again early May (if they aren't allowed now -> supermarkets and other essential stuff is open anyway), with some regulations how to reduce the risk of infections.

 

[kadiot]

The dorms outbreak in Singapore is among construction workers, not college students. These dorms are not like college dorms in the U.S. They are more like army barracks, where there are 10 people in a room.

Singapore has college dorms too. There were students in these up till about April 3, after which students who were Singaporeans mostly went home. But there were no outbreaks in college dorms up till April 3, whereas there were already several small clusters in the worker dorms.

I think Philippines’ 9th circle of hell is more challenging than Singapore's dorms outbreak.

 

[DennisN]

I learned something interesting recently. The word "quarantine" comes from "quarantena" which means "forty days":

Quote from http://en.wikipedia.org/wiki/Quarantine#Etymology_and_terminology :

The word quarantine comes from quarantena, meaning "forty days", used in the 14th-15th-century Venetian language and designating the period that all ships were required to be isolated before passengers and crew could go ashore during the Black Death plague epidemic;

and from the quarantine entry on Merriam-Webster:

Definition of quarantine

(Entry 1 of 2)
1 : a period of 40 days
2a : a term during which a ship arriving in port and suspected of carrying contagious disease is held in isolation from the shore
...

The world is using medieval* tactics at the moment.

(* or maybe even older )

 

[chirhone]

Most countries with most fatalities are rich (USA, France, UK, Italy, China). I don't see this occurring in slums or very poor people living so close together. Is it possible the virus can smell money or something like it?

Or maybe the rich can be distinguished by some chemistry in the body compared to the very poor. Is it more sugar? or carbohydrates? What chemical profile distinguishes the physical bodies of very rich vs very poor? While both of them can be infected. In the poor it seems the symptoms are mild or nonexistence.

Do you know a very poor person who got infected and die? If many, maybe the virus can smell the national treasury instead?

 

[Ygggdrasil]

Most countries with most fatalities are rich (USA, France, UK, Italy, China). I don't see this occurring in slums or very poor people living so close together. Is it possible the virus can smell money or something like it?

Or maybe the rich can be distinguished by some chemistry in the body compared to the very poor. Is it more sugar? or carbohydrates? What chemical profile distinguishes the physical bodies of very rich vs very poor? While both of them can be infected. In the poor it seems the symptoms are mild or nonexistence.

Do you know a very poor person who got infected and die? If many, maybe the virus can smell the national treasury instead?

1) Rich/powerful people are more likely to travel internationally (for business or pleasure) and meet a large number of people, putting them at a greater risk of being exposed (especially early in the epidemic). These travelers will then expose others in the rich countries.

2) Rich nations have greater capacity for testing, so it will be easier for them identify those dying from coronavirus.

3) Many poorer nations are in the Southern hemisphere where warmer temperatures may be slowing the spread of the virus. Things may get bad in the Southern hemisphere in the next few months as they move into winter.

 

[Vanadium 50]

Is it possible the virus can smell money or something like it?

I can't tell if you are serious or not.

First, China is not rich. It's #72 according to the World Bank in GDP per capita. It does slightly worse in PPP.

Second, your message (sadly, like many of yours) is poorly thought out and would have been vastly improved by a few seconds of research. Had you Googled "Covid Poor" you would have received almost a billion hits, pointing out that in the US the poor are being hit disproportionately hard by this.

A fair point that you could have made, but did not, is that the world economy is taking a $10T or so hit for a disease that will likely kill fewer people this year than malaria (and many fewer over a decade than malaria). Yet we are spending 2000x more on Covid than malaria. Why is that?

 

[kyphysics]

Positivity rate as a metric?
https://www.theatlantic.com/technol...reak-out-control-test-positivity-rate/610132/

The test-positivity rate, then, is a decent (if unusual) proxy for the severity of an outbreak in an area. And it shows clearly that the U.S. still lags far behind other countries in the course of fighting its outbreak. South Korea—which discovered its first Coronavirus case on the same day as the U.S.—has tested more than half a million people, or about 1 percent of its population, and discovered about 10,500 cases. The U.S. has now tested 3.2 million people, which is also about 1 percent of its population, but it has found more than 630,000 cases. So while the U.S. has a 20 percent positivity rate, South Korea’s is only about 2 percent—a full order of magnitude smaller.

South Korea is not alone in bringing its positivity rate down: America’s figure dwarfs that of almost every other developed country. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html, Germany and Denmark have positivity rates from 6 to 8 percent. https://www1.health.gov.au/internet/main/publishing.nsf/Content/1D03BCB527F40C8BCA258503000302EB/%24File/covid_19_australia_epidemiology_report_10__reporting_week_ending_23_59_aest_5_april_2020.pdf and New Zealand have 2 percent positivity rates. Even Italy—which faced one of the world’s most ravaging outbreaks—has a 15 percent rate. It has found nearly 160,000 cases and conducted more than a million tests. Virtually the only wealthy country with a larger positivity rate than the U.S. is the United Kingdom, where more than 30 percent of people tested for the virus have been positive.

It seems any number (ratio or rate) is problematic at this point if testing protocols are inconsistent.

In South Korea, is it random testing?

In the U.S., even people with COVID-19/flu-like symptoms could not get tested early on (even now maybe?), unless they answered "yes" to a bunch of screening questions. I had some possible symptoms early on:

--fatigue
--shortness of breath
--cough
--burning sensation in my chest/stomache/throat

When I called, they said I could not get tested if I hadn't had known contact with another person who has tested positive for COVID-19 or been outside of the U.S. Okay, so I didn't travel outside of the U.S., but how the heck would I known someone who has tested positive for COVID-19 when really they weren't testing people that much early on anyways? Medical workers on the frontline themselves have said THEY COULDN'T get tested, despite literally treating COVID-19 patients all day long, until recently (thank God they can get tested now...w/o symptoms that is!).

If the U.S. is not randomly testing people and tests are only reserved for those with obvious COVID-19 symptoms and people who've had contact with another known positive COVID-19 case or they've been outside the U.S., then that leaves a lot of people out of the testing sample.

Two vastly different sampling techniques = non-comparable results (would be my fear).

 

[mfb]

Most countries with most fatalities are rich (USA, France, UK, Italy, China).

Most countries with most reported fatalities are rich. Poor countries often don't count or don't report them.

This is Ecuador. Its official case and death counts are low, simply because the testing capability is essentially zero.
This is Brazil. Its official case and death counts are relatively low because the president thinks they don't need to do anything.

 

[kyphysics]

@Astronuc - after reading the article, I think I agree with this toward the end:

Not every epidemiologist feels as comfortable drawing conclusions from the test-positivity rate as Andrews. “If you want to interpret [the positivity rate] as a hint to prevalence in a particular location, you have to assume lots of other things stay constant,” Daniel Westreich, an epidemiology professor at the University of North Carolina, told us. He warned that too little was still known about who exactly is getting tested, and how reliable the tests are, to draw large conclusions from the positivity rate alone.

“We just haven’t tested enough people yet,” he said. “If you were doing random screening of the whole population, we just don’t know what you’d see. We don’t know how many asymptomatic viral shedders are out there.” As such, he advised extreme caution in using the rate—but being cautious about data, he added, “is my job.”

I thought the authors of the piece did a poor job. The flow of logic in their writing wasn't the best and had me constantly scratching my head at how they came to certain conclusions.

 

[chirhone]

I have been reading this the past few days at cnn. If it's true that "WHO says no evidence antibody tests can determine immunity". Does this mean herd immunity doesn't work in covid? What other virus or bacteria where herd immunity doesn't apply (I know HIV doesn't apply).

https://edition.cnn.com/world/live-...18-20-intl/h_e0d2a136beef210445661ea9cce09f53

"The World Health Organization has warned there is no evidence to suggest the presence of antibodies in blood can determine whether someone has immunity to the coronavirus.

Dr. Mike Ryan, the WHO’s executive director for health emergencies, said Friday there was no indication so far that a large proportion of the population had developed immunity. "

 

[mfb]

If it's true that "WHO says no evidence antibody tests can determine immunity". Does this mean herd immunity doesn't work in covid?

Read that again.
The WHO statement is purely about the antibody test and whether it can detect if someone is immune. And "no evidence" doesn't mean it doesn't work. It just means we don't know.

HIV is a very special case.

 

[hutchphd]

A fair point that you could have made, but did not is that the world economy is taking a $10T or so hit for a disease that will likely kill fewer people this year than malaria (and many fewer over a decade than malaria). Yet we are spending 2000x more on Covid than malaria. Why is that

I can only speak for myself but when my old, fat, lily-white, arse is in the line of fire I am suddenly motivated to move it into armor plate..

Also don't expect the population of the USA to maintain the present posture much longer. I feel quite certain the status quo ante mongers will soon get their way. Unless accompanied by very specific safeguards for those over age 50 this will result in significant added mortality
To those "live free and let them die" advocates I would propose the following middle of the road program to minimize almost certain excess mortality:

Anyone over age 50 who desires to maintain social isolation should be given, at his/her request, the financial wherewithal (pension, social services, job remote access where possible., etc...) to enable such isolation. This should be federally mandated and funded. ​

That's it. No more general quarantine. This will cost far less than present efforts (about 50 million total folks in the 50 to 65 bracket ) For younger people the resultant total death rate could be as high as 1% but maybe 0.1% so 30 kilohumans maybe. And the economy comes right back

A Swiftian bargain, but better than throwing the old people off the cliff by the million (so says the old guy).

 

[chirhone]

Read that again.
The WHO statement is purely about the antibody test and whether it can detect if someone is immune. And "no evidence" doesn't mean it doesn't work. It just means we don't know.

HIV is a very special case.

If it doesn't work (not just no evidence) , then it means herd immunity doesn't work too?

Following the paragraph, it says that "“There’s been an expectation, maybe, that herd immunity may have been achieved and that the majority of people in society may already have developed antibodies. I think the general evidence is pointing against that... so it may not solve the problem the governments are trying to solve.”

What would happen to infections when there are no herd immunity?

In NK, they will kill all Covid positive, herd immunity not required. But elsewhere it is a valid concern.

 

[DennisN]

When I called, they said I could not get tested if I hadn't had known contact with another person who has tested positive for COVID-19 or been outside of the U.S. Okay, so I didn't travel outside of the U.S.

Replace U.S. with Sweden and the story would be the same in my case (though the underlying reasons for testing/not testing may have been different, who knows? )...

but how the heck would I known someone who has tested positive for COVID-19 when really they weren't testing people that much early on anyways?

... and I thought exactly the same.
In fact, I also said so to the nurse I spoke to (in a nice way).

Edit: I should add that the nurse I spoke to told me that there was no indication of community spread in our region at that time (Scania County, Sweden).

 

[BillTre]

means herd immunity doesn't work too?

By definition, if the herd (a group of individuals) is immune (that is the individuals in the population are immune), there is herd immunity (enough immune individuals in the herd to prevent or greatly reduce the ability of the pathogen (coronavirus in this case)).
Herd immunity is not going to not work.

Perhaps some of your issues are:

• does exposure to the disease cause immunity in an individual in all cases, or in enough cases for the herd to develop effective immunity (maybe not, but really not known yet)
• what do differences in level, type, or specificity of antibody mean for having immunity to Covid-19 (different antibodies can bind different parts of a pathogen molecule and have different effects, different kinds of antibodies (IgG or IgM for example) are used differently by the immune system, different levels of antibody concentrationin the blood can be effective against a pathogen or not)? (these things are probably not known yet)
• can the virus go dormant and then return (perhaps like chicken pox; not known yet)

 

[Mary Conrads Sanburn]

Coronavirus Pandemic Brings Hundreds Of U.S. Clinical Trials To A Halt
April 11, 20207:02 AM ET

https://www.npr.org/sections/health...ngs-hundreds-of-u-s-clinical-trials-to-a-halt

You have to read the article! Honestly, I wish for every person to be healthy.

 

[bhobba]

Brisbane where I live starting vaccine human trials:
https://9now.nine.com.au/today/coro...ustralia/3b9d3cac-697d-4ccc-b824-cd6af72bde8c

Lancet article on the British vaccine:
https://www.thelancet.com/action/showPdf?pii=S0140-6736(20)30796-0

Real heroes all.

Thanks
Bill

 

[DennisN]

More about Sweden's numbers and the domestic debate about the more relaxed policy:

Anger in Sweden as elderly pay price for Coronavirus strategy (The Guardian, 19 april 2020)

Since then pressure has mounted on the government to explain how, despite a stated aim of protecting the elderly from the risks of Covid-19, a third of fatalities have been people living in care homes.

...

“This is our big problem area,” said Tegnell, the brains behind the government’s relatively light-touch strategy, which has seen it ask, rather than order, people to avoid non-essential travel, work from home and stay indoors if they are over 70 or are feeling ill.

...

Lena Einhorn, a virologist who has been one of the leading domestic critics of Sweden’s Coronavirus policy, told the Observer that the government and the health agency were still resisting the most obvious explanations.

“They have to admit that it’s a huge failure, since they have said the whole time that their main aim has been to protect the elderly,” she said. “But what is really strange is that they still do not acknowledge the likely route. They say it’s very unfortunate, that they are investigating, and that it’s a matter of the training personnel, but they will not acknowledge that presymptomatic or asymptomatic spread is a factor.”

...

“Where I’m working we don’t have face masks at all, and we are working with the most vulnerable people of all,” said one care home worker, who wanted to remain anonymous. “We don’t have hand sanitiser, just soap. That’s it. Everybody’s concerned about it. We are all worried.”

...

“The worst thing is that it is us, the staff, who are taking the infection into the elderly,” complained one nurse to Swedish public broadcaster SVT. “It’s unbelievable that more of them haven’t been infected. It’s a scandal.”

...

“It’s not like it goes from one old age home to another. It comes in separately to all of these old age homes, so there’s no way it can be all be attributed to the personnel going in and working when they are sick. There’s a basic system fault in their recommendations. There’s no other explanation for it.”

I just quoted some parts above that I thought might be interesting for others.
Please read the entire article to get a better picture of the debate.

And about the "third of fatalities have been people living in care homes":

I don't know if this is for Sweden as a whole or only Stockholm County.
I will check the Swedish news and come back with info if I find any.

EDIT:

It took a while, but I finally found the info.
According to the Public Health Agency of Sweden (Folkhälsomyndigheten):

In Sweden 1 333 people have died from covid-19.
About a third of these were people in nursing homes (eldercare).
This was stated by the Public Health Agency today.
In Stockholm about half of all deaths were in nursing homes.
- A lot of the other things are working reasonably well, but the infections in nursing homes is a big problem, says Anders Tegnell, chief epidemiologist.
...
– It is definitely an environment we need to be better at protecting, says Anders Tegnell.

(my translation to English)

Source: En tredjedel av alla dödsfall från äldreboenden i Sverige (SVT, 16 april 2020, Swedish only)

 

[chirhone]

The thread was created on January 30. By now. We know the COVID-19 Coronavirus Containment Efforts have failed. Not many could have forseen over 40,000 deaths in the US alone. You could have warned WHO or CDC.

But I read someone (or two) amongst you projecting 70% of US population would be infected and over 1 million deaths.

With the Lockdowns going to be eased up just when the peaks are not yet reached. This is priming for the possibility it would create a sustained chain reaction or community transmissions that can infect 70% of US population.

For the person who projected it. Do you have data about it? Maybe before this happens in November, You really need to contact WHO or CDC and share them.. before it's too late and the containment efforts have totally failed.

 

[Vanadium 50]

Maybe Trump would have been fine with an estimated 200,000 young children dying.

Will you stop with the goddamn Trumpitty Trump Trump?

If you want to criticize him for things he has done, fine., (But not here - you know the rules, even if you think they don't apply to you) He has plenty to answer for. But criticizing him for actions taken only in your imagination?

 

[chirhone]

The thread was created on January 30. By now. We know the COVID-19 Coronavirus Containment Efforts have failed. Not many could have forseen over 40,000 deaths in the US alone. You could have warned WHO or CDC.

But I read someone (or two) amongst you projecting 70% of US population would be infected and over 1 million deaths.

With the Lockdowns going to be eased up just when the peaks are not yet reached. This is priming for the possibility it would create a sustained chain reaction or community transmissions that can infect 70% of US population.

For the person who projected it. Do you have data about it? Maybe before this happens in November, You really need to contact WHO or CDC and share them.. before it's too late and the containment efforts have totally failed.

Also based on the above summary I think no other countries can reach 1 million cases like the United States, isn't it.

And if 70% of Americans would be infected. 70% of 331 million population is 231.7 million and if fatality is 2% then 4.6 million would be the casualities.

But then millions of americans die per year from the flu (this is true?). Then it's like a 4 or 5 year fatality from illnesses. Since they are used to it. Maybe 4.6 million death would just be just common illnesses fatality statistics?

 

[Vanadium 50]

<sigh>

This is as ill-considered as your "China is a rich country" post.

If the numbers you posted were correct, Hubei province alone would already have had 800,000 deaths. In all of China, fewer than 5000 deaths have been reported.

 

[Vanadium 50]

There seems to be this idea that sometime soon someone will blow a whistle, and all restrictions will immediately end throughout the US (or maybe the world) and we'll all rush into the streets, busily infecting each other. I can't imagine where people are getting this from - I know of no authorities calling for this.

First, the fact that Detroit has been particularly hard-hit is not a very good reason to ban the sale of vegetable seeds in Copper Harbor (population 100), which is separated from Detroit by 500 miles and two Great Lakes. When lifting restrictions, it's hard to argue that these should be the very last ones to be lifted.

Next, there is the assumption that people will immediately go back to the status quo. I don't think people will be going back to restaurants, amusements, sporting events, etc. until they feel safe to do so. Just because it's legal again will not make things mandatory.

Finally, many restaurants (e.g.) have already gone under. Eventually new ones will take their place, but it will take time. This will also tend to make lifting restrictions a more gradual return to the status quo ante.

 

[Astronuc]

In the U.S., even people with COVID-19/flu-like symptoms could not get tested early on (even now maybe?), unless they answered "yes" to a bunch of screening questions. I had some possible symptoms early on:

--fatigue
--shortness of breath
--cough
--burning sensation in my chest/stomach/throat

When I called, they said I could not get tested if I hadn't had known contact with another person who has tested positive for COVID-19 or been outside of the U.S. Okay, so I didn't travel outside of the U.S., but how the heck would I known someone who has tested positive for COVID-19 when really they weren't testing people that much early on anyways? Medical workers on the frontline themselves have said THEY COULDN'T get tested, despite literally treating COVID-19 patients all day long, until recently (thank God they can get tested now...w/o symptoms that is!).

From reports, news and anecdotal evidence, testing is inconsistent. Some with symptoms are not tested, while others without symptoms are tested.

Apparently, residents if Fisher Island, Florida, were able to purchase COVID-19 test kits for all residents.
https://www.miamiherald.com/opinion/editorials/article242001586.html

I know some folks who were potentially exposed to coronavirus, and who were tested because they are healthcare workers treating COVID-19 cases (and in one case, the healthcare management did not want to test one person because they would have to test everyone, and it would cost, i.e., reduce profits). On the other hand, I've read of cases where some healthcare workers are exposed, and may have symptoms, but they are not able to get tests!

Availability of test kits is one key issue, and another is the willingness of those who decide who gets tested to authorize a test.

I thought the authors of the piece did a poor job. The flow of logic in their writing wasn't the best and had me constantly scratching my head at how they came to certain conclusions.

Yes, but they are journalists/science writers, not scientists. I find such reporting frustrating.With regard to testing in the US, Covidtracking reports 724,926 positive tests and 2,998,708 negative tests. What the numbers don't tell is the number of those with symptoms and those without symptoms in either group. I would hope health departments are tracking that for later, but I somehow doubt it. Some counties, e.g., those in NY City are overwhelmed.

 

[Ygggdrasil]

The thread was created on January 30. By now. We know the COVID-19 Coronavirus Containment Efforts have failed. Not many could have forseen over 40,000 deaths in the US alone. You could have warned WHO or CDC.

There is plenty of documented evidence that high level advisors within the US government were warning of the potential for death tolls this high as early as late January:

A top White House adviser starkly warned Trump administration officials in late January that the coronavirus crisis could cost the United States trillions of dollars and put millions of Americans at risk of illness or death.

The warning, written in a memo by Peter Navarro, President Trump’s trade adviser, is the highest-level alert known to have circulated inside the West Wing as the administration was taking its first substantive steps to confront a crisis that had already consumed China’s leaders and would go on to upend life in Europe and the United States.

“The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown Coronavirus outbreak on U.S. soil,” Mr. Navarro’s memo said. “This lack of protection elevates the risk of the Coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”

https://www.nytimes.com/2020/04/06/us/politics/navarro-warning-trump-coronavirus.html

In addition, the piece cites a second memo from late Feb:

A second memo that Mr. Navarro wrote, dated Feb. 23, warned of an “increasing probability of a full-blown COVID-19 pandemic that could infect as many as 100 million Americans, with a loss of life of as many as 1-2 million souls.”

Similarly, other news outlets have reported of reports from the intelligence community in Jan and Feb also warning of significant health risks to the US.

It does not seem like a lack of warning was the major issue.

 

[atyy]

South Korea relaxes some social distancing rules as new Coronavirus cases fall
https://www.channelnewsasia.com/news/asia/covid-19-coronavirus-south-korea-social-distancing-cases-12656516

Ahead of the curve: South Korea's evolving strategy to prevent a COVID-19 resurgence
https://www.channelnewsasia.com/news/asia/covid19-south-korea-evolving-strategy-prevent-resurgence-12643774

 

[Ygggdrasil]

If the numbers you posted were correct, Hubei province alone would already have had 800,000 deaths. In all of China, fewer than 5000 deaths have been reported.

This statement hugely misinterprets @chirhone's post. The claim was that, in the absence of protective measures, up to 70% of the population could be infected (this number is on the higher end of figures offered by experts). Scientifically, these numbers are based on the fraction of the population that would need to be infected for the population to achieve herd immunity, which is the scenario in which the outbreak would end without interventions to stop the spread of the disease.

Of course, China imposed quite severe interventions to stop the spread of the disease, so it is completely inappropriate to question the validity of these estimates based on the number of death observed after the imposition of very strict quarantines. There are a number of scientifically valid and intelligent reasons to question the estimates in @chirhone's post, but this is not one of them.

 

[peanut]

A lesson on exponential function

https://centerforinquiry.org/blog/i...-vuGmtoe_W-DYwuAZmK6W10XBDGyrijcgPA5wZQLHiFDE

 

[bhobba]

A lesson on exponential function

I have said it before, and will say it again, I think when the true denominator is known it will be found to have a death rate about the same as the flu without a vaccine (the death rate being lowered if you do get it and are vaccinated). The real issue is the R0 - about 2.3 compared to the flu's 1.3 or so. That means by comparison cases literally explode. To me this is its main issue. BTW we don't have to wait until no cases for two weeks - simply have an effective R0 significantly below 1 for a reasonable amount of time - it will die out. Of course with a higher R0 than the flu it's going to be harder to get it well below 1.

As an aside, the new measurement they are using here in Aus to decide when to start lifting, slowly, restrictions is R0 - its about .5 at the moment in most states.

Thanks
Bill

 

[Vanadium 50]

I think when the true denominator is known it will be found to have a death rate not much worse than the flu without a vaccine.

Which denominator? There are at least three probabilities being bandied about:

1. The probability of death once exposed
2. The probability of death once infected
3. The probability of death once symptomatic

The working assumption is that 1 and 2 are nearly equal, and 3 is smaller. That may or may not prove to be the case.