COVID-19 Talk

[OSUmetstud]

3 minutes ago, 40westwx said:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291398/

"fatality rates were >2.5%, compared to <0.1% in other influenza pandemics. Total deaths were estimated at ≈50 million (5–7) and were arguably as high as 100 million"
We debated it greatly.. but we are probably looking at 0.25% - 0.5% rate with COVID-19

We might be, but from what I've seen the scientific consensus seems higher, more like 0.5-1% IFR. The NY data from yesterday is pretty scary and more like 1% or even perhaps slightly higher if you account for the excessive mortality stats. You cannot compare the IFR of COVID to the CFR of influenza. We only have the CFR of the 1918 flu, we weren't doing antibody testing then, only looking at symptomatic infections. 

[PhineasC]

2 hours ago, PrinceFrederickWx said:

In my opinion I think most of these at home deaths are simply people too afraid to go to the ER for fear of catching the virus. They’ll probably ignore that lingering chest pain rather than get it checked out in normal circumstances.

Though I’ve read more and more anecdotal reports from ER Doctors saying ventilators don’t help, it seems like more of a blood disorder rather than a respiratory one, etc. I wouldn’t be surprised if we get another about-face from public health officials on that, just like we did with masks and many other things.

It would be interesting if we started seeing excess deaths from home in December through February, months before the panic- if so, it may be a clue as when the virus really arrived here. I don’t know if that data exists though.

There is a story out of Ontario of dozens of heart attack deaths that are from people too scared to seek medical care. It’s definitely happening here too and with other diseases as well. 

[PhineasC]

1 hour ago, ErinInTheSky said:

You know I hope it's clear to the "open now" people that a lot of us are not against opening, we just want to do it smartly. I don't think any of us want to stay isolated in quarantine for 2 years, but we also want to come out of this measured and calculated. All of the countries that have thrived in a coronavirus world have done so. It's why I'm so happy with Hogan's procuring of the 500k tests, and Maryland's decision to go forward sticking to the rules rather than trying to shortcut the process... and if things spike, well it will suck but at least we're following an evidence based process.

 

Test, contact trace, isolate. I hope that the bill passes this next week to fund a 120,000 person contact tracing army. It seems to be getting support.

When does Hogan plan to even use those tests that he has armed soldiers guarding (LOL)? Last I heard he was still “considering his options” with them. 

[PhineasC]

4 minutes ago, OSUmetstud said:

We might be, but from what I've seen the scientific consensus seems higher, more like 0.5-1% IFR. The NY data from yesterday is pretty scary and more like 1% or even perhaps slightly higher if you account for the excessive mortality stats. You cannot compare the IFR of COVID to the CFR of influenza. We only have the CFR of the 1918 flu, we weren't doing antibody testing then, only looking at symptomatic infections. 

The IFR is highly age stratified. People under 40 or perhaps 50 have a death rate much lower than those 70, and especially those with underlying conditions. We need to start looking at risk that way too. 

[OSUmetstud]

Just now, PhineasC said:

The IFR is highly age stratified. People under 40 or perhaps 50 have a death rate much lower than those 70, and especially those with underlying conditions. We need to start looking at risk that way too. 

Yes, I felt like that was known without me having to say it. 

[SomeguyfromTakomaPark]

Just now, PhineasC said:

The IFR is highly age stratified. People under 40 or perhaps 50 have a death rate much lower than those 70, and especially those with underlying conditions. We need to start looking at risk that way too. 

Correct.  Hey we actually agree on something!

[PrinceFrederickWx]

8 minutes ago, wxtrix said:

what were you referring to?

There’s a LOT of ICU docs talking about this, but this NY Times video is a good start: 

Dr. Cameron Kyle-Sidell’s videos are all worth watching as he’s an ICU Doc in NYC.

I didn’t care for the video of the two CA Docs that went viral FYI

[ErinInTheSky]

17 minutes ago, 40westwx said:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291398/

"fatality rates were >2.5%, compared to <0.1% in other influenza pandemics. Total deaths were estimated at ≈50 million (5–7) and were arguably as high as 100 million"
We debated it greatly.. but we are probably looking at 0.25% - 0.5% rate with COVID-19

Right now most IFRs are 0.5-1%, not 0.25-0.5%. 

And the Spanish Flu fatality rate is a CFR, not an IFR, as far as I can tell, and lack of testing in 1918 means estimates are probably fairly poor.

[PhineasC]

20 minutes ago, OSUmetstud said:

Yes, I felt like that was known without me having to say it. 

LOL no, it’s not. People read 1% IFR and readily assume it kills 20 year olds at that rate. Also, NYC was an outlier in the US based on what we are seeing elsewhere. We can’t set the nationwide bar based on just them.  

[OSUmetstud]

Just now, PhineasC said:

LOL no, it’s not. People read 1% IFR and readily assume it kills 20 year olds at that rate. 

lol no. Literally everyone in this ****ing thread knows the risk increases with age. 

[PhineasC]

Just now, OSUmetstud said:

lol no. Literally everyone in this ****ing thread knows the risk increases with age. 

That’s different than what I said, and I wouldn’t be so sure about that. My two cents. 

[OSUmetstud]

3 minutes ago, PhineasC said:

LOL no, it’s not. People read 1% IFR and readily assume it kills 20 year olds at that rate. Also, NYC was an outlier in the US based on what we are seeing elsewhere. We can’t set the nationwide bar based on just them.  

An outlier in terms of level of disease, not necessarily IFR. I was discussing the NY state in general. 

[Yeoman]

Good news on the reinfection threat.. https://www.independent.co.uk/news/world/asia/coronavirus-south-korea-patients-infected-twice-test-a9491986.html

[PhineasC]

2 minutes ago, OSUmetstud said:

An outlier in terms of level of disease, not necessarily IFR. I was discussing the NY state in general. 

It would seem to me that the IFR is higher among 10,000 NY residents than it is among 10,000 CA residents, for example. There has to be an explanation for that.

If you take a random slice of people, the IFR can look wildly different. Iran says their IFR is near 0.1% for some cohorts, but that's probably because they have a very young population, 8 years younger than the US and 15(!) years younger than Italy. Explains some of that situation.

[PhineasC]

3 minutes ago, Yeoman said:

Good news on the reinfection threat.. https://www.independent.co.uk/news/world/asia/coronavirus-south-korea-patients-infected-twice-test-a9491986.html

Were they tested with some of the tests Hogan rushed out to buy from South Korea?

I have a feeling he is sitting on the tests now because (1) they are not needed, and (2) they are not reliable. Another boondoggle like the ventilators and field hospitals.

Hopefully these findings calm the "we might not have immunity" crowd.

[PhineasC]

French doctors saying they have evidence of a case there from late December. 

Adds another log on the fire for those who believe this thing was already very widespread before any mitigation steps were taken (like me).

Case coount numbers are totally useless and this also calls the death stats into question even more too.

[OSUmetstud]

1 minute ago, PhineasC said:

It would seem to me that the IFR is higher among 10,000 NY residents than it is among 10,000 CA residents, for example. There has to be an explanation for that.

If you take a random slice of people, the IFR can look wildly different. Iran says their IFR is near 0.1% for some cohorts, but that's probably because they have a very young population, 8 years younger than the US and 15(!) years younger than Italy. Explains some of that situation.

That Iran study used people from the same household (why?) and had a very small percentage infected, which is more prone to error than larger numbers. 

I also think it was pretty clear that was a lot of misrepresentation of the fatalities in Iran (mass graves) and that way more have died than is reported. 

I haven't seen any large study coming out of California yet in terms of IFR. We've only seen the Santa Clara and Los Angles County testing which also had very small percentages and the test didn't pass scrutiny in terms of specificity. 

[SomeguyfromTakomaPark]

8 minutes ago, PhineasC said:

It would seem to me that the IFR is higher among 10,000 NY residents than it is among 10,000 CA residents, for example. There has to be an explanation for that.

If you take a random slice of people, the IFR can look wildly different. Iran says their IFR is near 0.1% for some cohorts, but that's probably because they have a very young population, 8 years younger than the US and 15(!) years younger than Italy. Explains some of that situation.

It’s also possible the strain on NY’s healthcare system explains some of the difference as compared to CA.  Since NY’s hospitals we near or over capacity it’s possible the care, on average, wasn’t as good.  

[psuhoffman]

1 hour ago, 40westwx said:

I agree that social distancing is fine.. but to what extent.. this is the real question at play.

What if social distancing was as simple as a few common sense suggestions:

• If you are immunocompromised or have significant risk factors, self isolate. 
• No visitors in nursing homes and certain units in hospitals. 
• Extensive testing and monitoring for employees working in nursing homes and with the elderly.
• If you think your sick, don't go to work.  Don't go to the baseball game.  Don't go to the club.

Suggestions like these of course spur on the expected response - 

• What about incubation periods? You can be infectious and not be sick.  Simply staying home from work is not good enough.
• What if you are immunocompromised and you live with a some millennial who insists they continue to go to the bar 3 nights a week.

The truth is that we really do not know the true relationship between mitigation efforts and communal spread.  Who on earth can tell you definitively that an increase in mitigation efforts would have a proportional decrease in communal spread.  Of course you have the cookie cutter answer of.. "Every expert in the world agrees that this works" This is @psuhoffman favorite.  But if you really think about it.. group consensus doesn't equal fact. The world's control groups suggest that the impact of mitigation efforts on communal spread is more or less unknown and sort of chaotic.  What we do know for sure is that there are hotspots.

The only way we will ever know the answer to this question is through years of studies, statistical analysis and peer review of such studies.   Maybe postmortem (no pun intended) will supply these answers.  I hope so.

 Expert consensus isn’t always perfect but it’s got a much higher success rate than going with “some random contrarian said what I want to hear”. The effects of social distancing on viral spread has been documented for hundreds of years. This isn’t new. How effective depends on various factors and is a valid discussion. Acting like “it just doesn’t work” is nonsense. 

Some variables in effect here...

1. We never really truly locked down. There were so many exceptions that allowed many people to still go to work and activities and other people took advantage of those exceptions to be doing things they technically shouldn’t have been in a “lockdown”. 

2.  GPS data shows people are relaxing their guard and traveling around more the last couple weeks. We see the evidence of that anecdotally as well with rises in traffic and crowds at places. I had to pick up some prescriptions from CVS the other day and there was a line of cars to get through the light in town as if it was almost a normal morning rush hour!  My neighbor had a birthday party yesterday complete with a blow up bounce house and about 12 cars in their driveway.  There was a town in OK that had to rescind their order to wear masks because some businesses were getting threats of violence when they attended to enforce it.  (Btw I can’t believe they buckled to that kind of intimidation. The last thing you should do is reward bad behavior.  That’s behavior modification 101!  Every parent knows that. It only encourages it. If they had thrown a few of those assclowns in jail I’m pretty sure it would have stopped).  Last time I went to the grocery store I waited in line to get in and the person in front of me had a mask on. Then after we got in I watched him take it off!  Yes I know that’s all anecdotal but gps tracking data supports what we are seeing.  Too many people are not taking the measures seriously!  

3. There was some evidence covid can transmit airborn up to 10 feet but when that study came out we never adapted the guidelines. One reason was it’s just not practical unless you really go on true lockdown.   Take the local Walmart here.  They are only allowing 200 in at a time. The other day when I went to CVS the line to get in was ~150 yards through the parking lot. What would it look like if the standard was 10 feet and they could only let 120 in at a time?  How would that work in the store?  Checkout lines would be unmanageable. Lines to get into an aisle would be impossible to manage.  I get all that. But if we choose to implement a less effective policy because the more effective one is inconvenient then we will get a less effective result. 

So discussions about these factors and the practicality of implementing effective measures is a legit discussion to have. And if the majority of people agree the measures needed to prevent transmission just aren’t worth it that’s acceptable so long as that decision is based on the facts. 

What’s not acceptable is trying to achieve a policy goal by telling people that “we can’t stop this no matter what we do so just let nature take its course”. That’s BS. It’s dishonest.  And the decision shouldn’t be influenced by the handful of tin foil hat lunatics whose logic and reality are so warped they thing this is all part of some global deep state conspiracy to subjugate the world.  And if the majority of society does decide we want to take serious mitigation measures than there should be some enforcement when the 30% of contrarians and libertarians who don’t like to let anyone tell them what to do threaten to render those efforts ineffective by their refusal to follow the law. 

If people want to examine all the facts and decide they don’t want to mitigate this I can accept that.  And the facts might suggest there are ways to effectively fight this without a full lockdown. But there are too many people trying to trick people into that determination with nonsense. 

[OSUmetstud]

1 minute ago, DCTeacherman said:

It’s also possible the strain on NY’s healthcare system explains some of the diferente as compared to CA.  Since NY’s hospitals we near or over capacity it’s possible the care, on average, wasn’t as good.  

We don't have any good data on California's fatality rate. We only know it didn't take off there so far like was feared. 

[PhineasC]

1 minute ago, DCTeacherman said:

It’s also possible the strain on NY’s healthcare system explains some of the diferente as compared to CA.  Since NY’s hospitals we near or over capacity it’s possible the care, on average, wasn’t as good.  

And the handful of hospitals at the epicenter in NYC had poor ratings even before the pandemic. That may have contributed. There were also reports of early ventilator usage as a means to reduce spread in the hospital, which we now know was a mistake with this virus. 

[PhineasC]

1 minute ago, OSUmetstud said:

We don't have any good data on California's fatality rate. We only know it didn't take off there so far like was feared. 

It didn’t really take off anywhere to the level that was “feared.” Florida and Georgia were supposed to be awash in deaths by now. But wait “2 more weeks” I guess...

[PhineasC]

7 minutes ago, OSUmetstud said:

That Iran study used people from the same household (why?) and had a very small percentage infected, which is more prone to error than larger numbers. 

I also think it was pretty clear that was a lot of misrepresentation of the fatalities in Iran (mass graves) and that way more have died than is reported. 

I haven't seen any large study coming out of California yet in terms of IFR. We've only seen the Santa Clara and Los Angles County testing which also had very small percentages and the test didn't pass scrutiny in terms of specificity. 

Yeah I don’t really believe Iranian or Chinese numbers verbatim. It’s just another data point to throw in. 

[OSUmetstud]

Just now, PhineasC said:

It didn’t really take off anywhere to the level that was “feared.” Florida and Georgia were supposed to be awash in deaths by now. But wait “2 more weeks” I guess...

I mean you do know what the incubation period is? It would actually take time to see an uptick. 

I am not completely convinced either that we will see a big surge in the state's opening up. Idk. We'll see how important personal risk aversion compared to government measures. We also might be just on the tail end of this disease wave as there could at least be a partial seasonality component. 

[PhineasC]

7 minutes ago, OSUmetstud said:

I mean you do know what the incubation period is? It would actually take time to see an uptick. 

I am not completely convinced either that we will see a big surge in the state's opening up. Idk. We'll see how important personal risk aversion compared to government measures. We also might be just on the tail end of this disease wave as there could at least be a partial seasonality component. 

This thing has been spreading steadily here since January, possibly December. We’ve had plenty of time to see the surge hypothetical play out. NYC was as close as we came and even there we never really outpaced local hospital capacity. 

[OSUmetstud]

Just now, PhineasC said:

This thing has been spreading steadily here since January, possibly December. We’ve had plenty of time to see the surge hypothetical play out. NYC was as close as we came and even there we never really outpaced local hospital capacity. 

What do you attribute that to? Do you think the disease just isn't that bad? It's not that infectious? Randomness? 

[PhineasC]

3 minutes ago, OSUmetstud said:

What do you attribute that to? Do you think the disease just isn't that bad? It's not that infectious? Randomness? 

Not as deadly but widespread with 50% having no symptoms and a further 25% having a very mild experience. The disease also got into the hospices and nursing homes which really pumped up the death numbers and gave a skewed picture of risk for the general population. 

[OSUmetstud]

Just now, PhineasC said:

Not as deadly but widespread with 50% having no symptoms and a further 25% having a very mild experience. The disease also got into the hospices and nursing homes which really pumped up the death numbers and gave a skewed picture of risk for the general population. 

Well I think I've seen 50 percent asymptomatic reported in the literature, the princess cruise ship also had that. Certain areas have been very hard hit (northern Italy, NYC) mainly because they've had significant number of people get infected. I just don't think the infection is really widespread across many areas (>5%) due to randomness and the government measures implemented.

[PhineasC]

Just now, OSUmetstud said:

Well I think I've seen 50 percent asymptomatic reported in the literature, the princess cruise ship also had that. Certain areas have been very hard hit (northern Italy, NYC) mainly because they've had significant number of people get infected. I just don't think the infection is really widespread across many areas (>5%) due to randomness and the government measures implemented.

To me, the fact that nearly 50% of the deaths are in nursing care facilities is kind of screwing up our assessment of risk for the general population. COVID for them is like herding a bunch of Boy Scouts into a cave and tossing a stick of dynamite in before sealing the entrance. Doesn’t mean kids everywhere are suddenly at much higher risk of being blown up. 

[psuhoffman]

1 hour ago, wxtrix said:

what were you referring to?

I do think there is some evidence that this could possibly be handled in a less restrictive way. Some version of common sense social distancing and a plan to accommodate the high risk populations combined with testing/tracing and a plan to quickly mitigate hot spots that flare up. 

However...that isn’t the conversation happening here or what the people showing up at state houses with guns are advocating for.  In some cases they are going out of their way to say no to some reasonable less restrictive measures for no logical reason. They are a combination of “you can’t tell me what to do” libertarians and “this is a hoax” conspiracy nuts. 

There are rational moderates on both sides that should be having a legit discussion about adapting our strategy as evidence comes in and adjusting over time. We probably can create an effective least restrictive policy if our government wasn’t the mess that it is right now.  But I think most of those people have checked out of these debates frustrated by the way the two extreme polar opposites are dominating the narrative.