Just curious, anyone have a plan, or preps for global pandemic?

[KHashmi317]

On 4/8/2020 at 12:55 PM, Dean Pomerleau said:

A fascinating article in Nature about analyzing sewage to get a better handle on how widespread coronavirus is, especially given the lack of widespread community testing.

--Dean

"Studies have also shown that SARS-CoV-2 can appear in faeces within three days of infection, which is much sooner than the time taken for people to develop symptoms severe enough for them to seek hospital care — up to two weeks — and get an official diagnosis, says Tamar Kohn, an environmental virologist at the Swiss Federal Institute of Technology in Lausanne."

QUESTION:  Why isn’t fecal testing used to diagnose COVID-19—If this is the earliest detection possible?

[KHashmi317]

On the topic of epidemic/pandemic films/tv and novels...

Film/Novel: The Andromeda Strain (1971, film based on novel by Michael Crichton) ... both novel and film are very good.

Outbreak (1995)  movie based on Richard Preston's  1994 non-fiction thriller The Hot Zone.  I prefer the book, but the movie is decent. There was 2019 miniseries, The Hot Zone, on Nat. Geo Channel, too, but I have not see it.

Richard Preston's novels and non-fiction thrillers (avail. as audiobooks, too):

The Cobra Event (fiction, 1998); The Demon in the Freezer (non-fiction 2002)

 Earth Abides (1949, novel) by George R. Stewart. A personal favorite; the audiobook is well-performed, too. The now-classic title often appears on top 100 Sci-Fi lists. Wiki notes: "According to WorldCat.org, there have been 28 editions of Earth Abides published in English. The book has been in print in every decade from 1949 to 2008."

Contagion (2011 film)... noted earlier in this thread. A good effort! Too bad more folks (especially those running wet markets) did not heed the film's warning.

Edited April 10, 2020 by KHashmi317

[Ron Put]

6 hours ago, Dean Pomerleau said:

... First of all, the hospitals in some parts of the country besides NY are under serious stress, including in parts of Louisiana, Chicago and Detroit. Gordo, our own state (Pennsylvania) is seeing the third highest rate of new infections (after NY and NJ). In short, many parts of the US aren't out of the woods yet.

... This illustrates that what counts when it comes to controlling the outbreak in a region is the date of the lockdown relative to how widespread the virus is circulating at the time in that area. Lombardy, New York City and Philadelphia didn't lockdown early enough relative to their case load to stop the spread before it got out of hand and are suffering the consequences.

Note - this is total orthogonal to whether the benefit of a prolonged and ongoing lockdown is worth the cost in terms of social and economic impact.

It is simply to say that lockdowns do work to bring the effective R below 1, stopping the exponential spread of the virus, which now appears to has a very high R₀ (CDC estimated R₀ > 5). ...

Dean, the fact is that every year there are emergency rooms which get overwhelmed, somewhere in the country. It was true during the 2018 flu wave in both NY and Milan -- I won't pollute this thread with links, but a search will find plenty. In fact, in NY 2018 was bad enough that the medical community formally approached the state about infrastructure improvements in case of a repeat, but the requests were denied by the Cuomo Administration. There is plenty of blame on all sides, if we look for it.

Covid-19 was politicised from the start and many noted it, although I don't believe anyone foresaw the impact it would eventually have. Anyone who paid attention knew that over the last decade there has been a major push by China to gain influence over international organizations -- the election of Tedros to head the WHO raised a lot of red flags at the time, which is probably the only reason for the unity which stopped China stacking the WIPO this past March. 

What troubles me most is the militant political orthodoxy which drove the wave of lock-downs: Not only was it based on clearly bad data and bad models, but it openly attacked and denigrated all  opposing opinions, to the point where major social media channels were pressured to block accounts which presented an alternative view. When you don't have open discussion, major mistakes can be made and I believe this is what happened in the case of the Covid-19 response. It's telling that both BBC and NPR have opened war of words on Brazil and even Sweden, airing stories which are pure FUD.

There will be a rush to spin the numbers to justify the lock-downs. But the fact is, Covid-19 was not much worse than the other four corona viruses which spread over the last two decades and which are no part of the annual "flu" season. It is very contagious (I am not sure where you got R0 5, I've seen mostly R02.3 and it's being revised down, closer to the R0 1.7 seen for influenza), which is why many questioned WHO's urging that the world acts in the manner of Chinese-style "containment," instead of Sweden-style "mitigation.".

This is also telling of the political storm to come:

Minnesota doctor blasts 'ridiculous' CDC coronavirus death count guidelines
"In cases where a definite diagnosis of COVID cannot be made but is suspected or likely (e.g. the circumstances are compelling with a reasonable degree of certainty) it is acceptable to report COVID-19 on a death certificate as 'probable' or 'presumed.'"

In response, Jensen told Ingraham the CDC's death certificate manual tells physicians to focus on "precision and specificity," but the coronavirus death certification guidance runs completely counter to that axiom.
"I’ve never been encouraged to [notate 'influenza']," he said. "I would probably write 'respiratory arrest' to be the top line, and the underlying cause of this disease would be pneumonia ... I might well put emphysema or congestive heart failure, but I would never put influenza down as the underlying cause of death and yet that’s what we are being asked to do here."

Contrast this with the swine flu epidemic in 2009, when despite urging, the honeymooning Obama Administration refused to even count infections and deaths. And contrast it with the regular flu, which kills far more people, but which many states refuse to track -- New Your doesn't to the best of my knowledge, and California tracks only deaths among those over 65.

------

3 hours ago, Dean Pomerleau said:

He's not even accurate. South Carolina wasn't early. It didn't lock down until two days ago (April 7th).

I just did a quick search about South Carolina and it appears that robust social distancing measures were already well in place by March 25th. As comparison, California shut down all non-essential businesses on March 20th.

I have not seen any empirical evidence that Covid-19 can be contained, and as WHO stated, a virus with R0 of 1.3-1.7 cannot be contained (which is why they do nothing about the flu). Why would it make any sense that a virus with R0 of 2.3 (or R05, as you claim) can be contained?! And "containment" is the sole reason for the lock-downs.

Edited April 10, 2020 by Ron Put

[Ron Put]

Here is something else to ponder:

With ventilators running out, doctors say the machines are overused for Covid-19

[Gordo]

I am wondering now if the mass destruction of food due to supply chain disruptions could potentially lead to food scarcity or do we just have such an abundance that it won’t matter?

Coronavirus claims an unexpected victim: Florida vegetables

...
Farmers Dump Milk, Break Eggs as Coronavirus Restaurant Closings Destroy Demand

 

[Sibiriak]

3 hours ago, Ron Put said:

"containment" is the sole reason for the lock-downs.

No,  the temporary "lockdowns" are now aimed at mitigation, not containment, i.e.,  slowing the spread,  "flattening the curve"  to prevent hospitals from being overwhelmed and buying time for the development of vaccines and treatments.  With an R₀ of 2.3 -5.7,  significantly above that of the normal flu , containment  quickly becomes impossible after a certain number of people have become infected.   At this point  some top epidemiologists are arguing that the  only way the  outbreak will be completely resolved is   1) we get a vaccine, or 2) it burns through the entire population.

I'm in sync with Dean's position:

"I'm all for making plans to intelligently relax the stay-at-home orders "

"...there are definitely cogent arguments that can be made regarding the tradeoff between saving lives and saving the economy, and the best strategy to optimize both."

For large numbers of people  outside of wealthy, developed countries (not to mention the precariat et al. within wealthy countries),  severe lockdowns are a disaster.  India has already been discussed.  Here's another case in point:
 

Quote

Lebanon has long been a country that neither war nor crisis could defeat. But with a bankrupt economy, rampant poverty, a political class offering few solutions - and now coronavirus, the resilience of its people is being tested like never before.

Before the pandemic, Lebanon was in economic freefall, unable to pay its debts, or keep a lid on spiralling prices of food and medicine, and to stop a financial meltdown that threatens bank deposits.

Last November before the threat of Covid-19 materialised, the World Bank predicted that the portion of Lebanon’s population below the poverty line would rise from 30% to 50% in 2020.

The lockdown imposed on 15 March has compounded an already dire situation and there are grave fears that the large numbers who have lost their incomes since – the majority of the country’s workforce – can no longer meet daily needs.

On Wednesday, the Lebanese government announced a relief plan to reach those already impoverished. But Human Rights Watch says the plan raises more questions than it answers.

“The lockdown to slow the spread of Covid-19 has compounded the poverty and economic hardship rampant in Lebanon before the virus arrived,” said Lena Simet, senior researcher on poverty and inequality at the organisation. “Many people who had an income have lost it, and if the government does not step in, more than half the population may not be able to afford food and basic necessities.”

 

Edited April 10, 2020 by Sibiriak

[Dean Pomerleau]

On undercounting the death toll, this from today's New York Times:

In the first five days of April, 1,125 people were pronounced dead in their homes or on the street in New York City, more than eight times the deaths recorded during the same period in 2019, according to the Fire Department.

Many of those deaths were probably caused by Covid-19, but were not accounted for in the coronavirus tallies given by Gov. Andrew M. Cuomo during his widely watched daily news conferences — statistics that are viewed as key measures of the impact of the outbreak.

On Thursday, Mr. Cuomo said 799 people in New York had died from coronavirus in a single 24-hour period — more than 33 an hour — bringing the state’s total to 7,067.

But epidemiologists, city officials and medical personnel say those numbers are likely to be far below the city’s actual death toll... 

A huge number of people are dying at home with presumed cases of coronavirus, and it does not appear that the state has a clear mechanism for factoring those victims into official death tallies.

In the last three days, 766 people were found dead in their homes, bringing the total for the first eight days of April to 1,891, according to the city’s medical examiner’s office. It’s likely that many have not been counted in the current tally.

Mr. Cuomo said on Wednesday that the official death count numbers presented each day by the state are based on hospital data. Our most conservative understanding right now is that patients who have tested positive for the virus and die in hospitals are reflected in the state’s official death count.

The city has a different measure: Any patient who has had a positive coronavirus test and then later dies — whether at home or in a hospital — is being counted as a coronavirus death, said Dr. Oxiris Barbot, the commissioner of the city’s Department of Health.

“To date, we have only been recording on people who have had the test,” she said on Thursday morning.

Paramedics are not performing coronavirus tests on those they pronounce dead. Recent Fire Department policy says that death determinations on emergency calls should be made on scene rather than having paramedics take patients to nearby hospitals, where, in theory, health care workers could conduct post-mortem testing. 

About 120 morgue workers and soldiers from the U.S. Army, the National Guard and the Air National Guard are working in shifts around the clock, driving rented vans around the city to pick up the bodies of as many as 280 people a day who have died at home and have probably not been part of the official death count.

--Dean 

[Sibiriak]

The COVID-19 vaccine development landscape [Nature, April 9]

Lots of details in the article. Two excerpts:

Quote

As of 8 April 2020, the global COVID-19 vaccine R&D landscape includes 115 vaccine candidates (Fig. 1), of which 78 are confirmed as active and 37 are unconfirmed (development status cannot be determined from publicly available or proprietary information sources). Of the 78 confirmed active projects, 73 are currently at exploratory or preclinical stages. The most advanced candidates have recently moved into clinical development, including mRNA-1273 from Moderna, Ad5-nCoV from CanSino Biologicals, INO-4800 from Inovio, LV-SMENP-DC and pathogen-specific aAPC from Shenzhen Geno-Immune Medical Institute (Table 1). Numerous other vaccine developers have indicated plans to initiate human testing in 2020.

 

Quote

[...] vaccine could be available under emergency use or similar protocols by early 2021. This would represent a fundamental step change from the traditional vaccine development pathway, which takes on average over 10 years, even compared with the accelerated 5-year timescale for development of the first Ebola vaccine, and will necessitate novel vaccine development paradigms involving parallel and adaptive development phases, innovative regulatory processes and scaling manufacturing capacity.

[...]n order to assess vaccine efficacy, COVID-19 specific animal models are being developed, including ACE2-transgenic mice, hamsters, ferrets and non-human primates. Biosafety-level 3 containment measures are needed for animal studies involving live-virus challenges...

[...]Finally, strong international coordination and cooperation between vaccine developers, regulators, policymakers, funders, public health bodies and governments will be needed to ensure that promising late-stage vaccine candidates can be manufactured in sufficient quantities and equitably supplied to all affected areas, particularly low-resource regions.

How does COVID-19 kill? Uncertainty is hampering doctors’ ability to choose treatments [Nature, April 9]

Quote

Clinical data suggest that the immune system plays a part in the decline and death of people infected with the new coronavirus, and this has spurred a push for treatments such as steroids that rein in that immune response.

But some of these treatments act broadly to suppress the immune system, stoking fears that they could actually hamper the body’s ability to keep the viral infection in check. [etc.]

Edited April 10, 2020 by Sibiriak

[Ron Put]

5 hours ago, Dean Pomerleau said:

On undercounting the death toll, this from today's New York Times:

In the first five days of April, 1,125 people were pronounced dead in their homes or on the street in New York City, more than eight times the deaths recorded during the same period in 2019, according to the Fire Department....

Dean, this number doesn't make any sense. Between 750 and 800 people die in NY City every five days on average, so either "1125" and "more than eight times the deaths " is wrong, or the period is an aberration and chosen to create a false impression.

NY City doesn't track flu death, to the best of my knowledge. But the flu season is effectively over for the year, and it appears to be average for the US, probably resulting in about 35000 to 40000 flu -related deaths. The majority of flu deaths occur within a period of 4-6 weeks early in the year and during such time this would likely result in five-day tolls considerably higher than 800 deaths per five days.

----

10 hours ago, Sibiriak said:

No,  the temporary "lockdowns" are now aimed at mitigation, not containment

Really, how did you arrive at this conclusion?! You seem to either misunderstand, or misrepresent, the difference between "containment" and "mitigation," and the measures involved in achieving each, according to official WHO guidance.

WHO has clearly stated that the lock-downs (China model) are needed for "containment" and that "mitigation" (Swedish model) is dangerous.Are you arguing that WHO is wrong when he is issuing dire warnings against going to "mitigation," which does not include lock-downs and according to WHO is "wrong and dangerous."

Coronavirus is ‘controllable’ says WHO head:

“The idea that countries should shift from containment to mitigation is wrong and dangerous. On the contrary, we have to double down.

This is a controllable pandemic. Countries that decide to give up on fundamental public health measures may end up with a larger problem, and a heavier burden on the health system that requires more severe measures to control.”

He warned, however, that despite frequent warnings, the WHO is deeply concerned that some countries “are not approaching this threat with the level of political commitment needed to control it". He did not name any country."

The last admonition above is what has given political opponents of all shades the ammunition to attack leaders who did not implement lock-downs, with sloganeering like "Lives over money!" As I said, this is not a medical crisis, it's a political one and the divisions along party lines should give you an inkling. But, I have the feeling you already know this.

[Sibiriak]

1 hour ago, Ron Put said:

according to official WHO guidance

I'm not talking about some WHO guidance given back in early March.   The WHO is not directing the policies of individual states.  That's the basic fallacy in your ideology-driven polemic. 

I'm talking about the actual  temporary "lockdown" policies put in place now in the U.S., UK,  etc., whether good or bad,  with the aim of  "flattening the curve"  to prevent hospitals from being overwhelmed and buying time for the development of vaccines and treatments.

Those varied policies are being determined by the decisions of individual governments (on national and local levels) drawing on data and advice from their own experts and research institutions, such as the  Imperial College London (Neil Ferguson) , the London School of Hygiene and Tropical Medicine, The Institute for Health Metrics and Evaluation (IHME) , The University of Washington,    The Robert Koch Institute's (Germany),  The Pierre Louis Institute of Epidemiology and Public Health etc. etc. 

They are NOT being determined by those  the out-of-date/obviously wrong statements by Tedros Adhanom Ghebreyesus   which you  keep quoting over and over to create straw man arguments.

Have you not seen the "flattening the curve" charts  used all over the place to explain these policies?   "Flattening the curve" is about mitigation, not containment.

Of course,  in a particular country both containment and mitigation can be used at different times and in different places-- it's not completely either/or.   New York, though,  for example,   had to give up any hope of containment and shift to mitigation.  (Containment measures--  testing, contact tracing,  individual isolation etc.--will likely come back into play when the strict social distancing measures are relaxed.)

Quote

Cuomo: We are flattening the curve

Throughout this [April 10] conference Cuomo has stressed caution in moving forward even as New York sees incremental progress.

[..]“So where do we go from here? First keep doing what we’re doing. Stay home because that works. We are flattening the curve. We must continue flattening the curve,” Cuomo said. “We need both diagnostic testing and anti-biotic testing and we need millions and millions of them and we need them in a matter of weeks, not months.”

 

Regarding terminology:

What It Means to Contain and Mitigate the Coronavirus

Quote

At the community level, epidemiologists tend to speak of two different paradigms to limit both the extent and the rate of infection. The first, known as containment, is used at the start of an outbreak. It involves tracking the dissemination of a disease within a community, and then using isolation and individual quarantines to keep people who have been infected by or exposed to the disease from spreading it.

Quote

In communities where a local outbreak gets out of control, Rivers says, “there comes a tipping point in epidemics where you’re finding a lot more people who are unlinked” to known cases. “That’s a sign that contact tracing is not scaling appropriately.”

Though public-health authorities may continue to trace contacts after community spread has begun—in order, for instance, to better understand the particular features of how a disease spreads—epidemiologists generally recommend incorporating the mitigation paradigm.

In practical terms, this means redeploying public-health workers away from contact tracing and disease surveillance and towards efforts with a broader reach....

[...]Mitigation starts with the idea that we will probably not drive transmission to zero,” Rivers said. “So then we start thinking about what we can do to prepare our hospitals and communities to reduce transmission.”

 

Edited April 10, 2020 by Sibiriak

[Gordo]

3 hours ago, Ron Put said:

9 hours ago, Dean Pomerleau said:

In the first five days of April, 1,125 people were pronounced dead in their homes or on the street in New York City, more than eight times the deaths recorded during the same period in 2019, according to the Fire Department....

Dean, this number doesn't make any sense. Between 750 and 800 people die in NY City every five days on average, so either "1125" and "more than eight times the deaths " is wrong, or the period is an aberration and chosen to create a false impression.

But did you check with the authority on New York City deaths, the Fire Department?  😉

Kidding aside though, the number of deaths at home could be bumping up due to everyone avoiding hospitals (see more details in my post that follows this one). This theory can be at least partially validated by comparing total deaths now vs. last year.

Some pretty good podcasts out of Freakonomics including one yesterday about food:

 

EPISODE		DATE	LENGTH
412	What Happens When Everyone Stays Home to Eat? Covid-19 has shocked our food-supply system like nothing in modern history. We examine the winners, the losers, the unintended consequences — and just how much toilet paper one household really needs.	4/8/20	48:35
411	Is $2 Trillion the Right Medicine for a Sick Economy? Congress just passed the biggest aid package in modern history. We ask six former White House economic advisors and one U.S. Senator: Will it actually work? What are its best and worst features? Where does $2 trillion come from, and what are the long-term effects of all that government spending?	4/1/20	54:55
410	What Does COVID-19 Mean for Cities (and Marriages)? There are a lot of upsides to urban density — but viral contagion is not one of them. Also: a nationwide lockdown will show if familiarity really breeds contempt. And: how to help your neighbor.	3/25/20	42:23
409	The Side Effects of Social Distancing In just a few weeks, the novel coronavirus has undone a century’s worth of our economic and social habits. What consequences will this have on our future — and is there a silver lining in this very black pandemic cloud?	3/18/20	49:27

Edited April 10, 2020 by Gordo

[Gordo]

Here's another unintended consequence - governors in some states have ordered all elective and non-urgent medical procedures be canceled or rescheduled, this is resulting in mostly empty hospitals around the country, and unprecedented declines in hospital revenues which is forcing staff layoffs: 

https://www.modernhealthcare.com/hospitals/oregon-rural-hospitals-see-huge-revenue-losses-laying-workers

This is even happening in New York: Instead of coronavirus patients, Syracuse hospitals swamped with empty beds

Similar reports from California, Texas, really all over, but it gets even more interesting, people are no longer showing up even to emergency rooms (obviously not elective): Unexpected consequence of COVID-19 crisis: empty emergency rooms

Quote

 

 

“This doesn’t seem to be talked about at all… People are losing their shifts and paychecks and jobs,” the L.A. nurse wrote. “We only had 5 people in the whole ER when they sent me home. My agency sent out an email blast basically saying that there are a lot of people struggling to find shifts.

“So, I’m curious if any other nurses are experiencing this?”

The response to her post was overwhelming.

More than 140 responses from across the country were posted on the Facebook private group page “All-ER nurses.” Most were concerned about diminished hours — or having no work at all — and the economic distress that would follow.

“I work in a free-standing ER and a surgery hospital ER. Both places are sending people home,” wrote a Texas nurse. “It is really stressful and I am tempted to search for another job.”

News of nearly-empty emergency rooms may come as a surprise to most Americans amid media reports of a national health care system pushed to the brink. The reason, as counterintuitive as it may seem, is the coronavirus itself.

First, COVID-19 cases are immediately secured elsewhere in the hospital without entering the ER, segregating the infected patients from the hospital population. At the same time, fears of the virus are discouraging some people who might otherwise go to the ER for a relatively minor medical issue to stay home. Studies show that many Americans, including more than half of Millennials, use ERs or emergency care facilities for non-emergency care.

The majority of comments acknowledged their ERs were empty and they were concerned about their futures. The only nurses that seemed to feel “safe” were those who work in high-impact COVID-19 areas such as New York, New Jersey and California — but the majority of those also said they were worried about the future.

And apparently those hardest hit are ERs in rural and smaller hospitals, according to the L.A. nurse who said that though her hospital could hardly be considered in a small area, she was aware that many smaller “facilities are struggling to stay afloat.”

“Yes, nurses in central NH small hospitals being called off. They can call in each morning and see if they are needed,” wrote a New Hampshire nurse. “They have to use PTO [paid time off]. It’s very unfair.”

A recent New Hampshire Union Leader article cited empty ERs in two hospitals in Manchester — the Granite State’s largest city — the Catholic Medical Center (CMC) and the Elliot Hospital.

There was no wait at the CMC emergency department on March 31, said hospital spokesman Lauren Collins-Cline. “There are fewer people admitted to the hospital right now, so we’re able to move people out of the emergency department and into a bed very quickly if needed,” Collins-Cline wrote in an email.

And it’s not just ER nurses that are suffering the consequences of empty emergency rooms.

A doctor, who described himself as a physician in a western state on lockdown, posted the following on Reddit: “Make of this what you will, but I think this crisis is making people think twice about whether an ED visit is really necessary.”

In Boston, emergency room doctors at Beth Israel Deaconess Medical Center have been told some of their accrued pay is being held back, according to The Boston Globe. More than 1,100 Atrius Health physicians and staffers — who operate in conjunction with hospitals in eastern Massachusetts — are facing reduced paychecks or unpaid furloughs.

These financial cutbacks have generated an uproar from doctors and nurses who are already working exhausting shifts in demanding working conditions because of COVID-19.

An ER nurse who works in Northern Virginia and asked not to be identified, told InsideSources that his emergency room has been like a ghost town for weeks. He called his shifts the easiest of his career.

“The only thing there is more of in the ERs right now is free food,” he said, referring to the food and other gifts community members are dropping off in support of hospital staff.

“Yes, we are dealing with some COVID-19 patients,” he said. “It’s just not nearly the war zone the media is making it out to be.

“As far as the amount of actual people in the ER, I don’t know if I’ve ever had a census this low three weeks in a row. Every shift is half empty.”

 

 

Happening in other countries as well, Austrailia: WA hospital staff stood down, beds empty in unexpected COVID-19 lull

Canada: https://www.msn.com/en-ca/news/canada/covid-19-1862-lower-mainland-hospital-beds-empty-and-ready-for-pandemic-patients/ar-BB129cgz

Quote

the 20 largest hospitals have an occupancy rate of 60.2 per cent, leaving 4,273 free beds. Normally, at this time of year, the occupancy rate would be more than 100 per cent.

Even in New York City the overflow hospitals are empty

Everyone just doing an amazing job at social distancing and other mitigation and avoiding all injuries?  No more sports injuries.  Fewer people shooting/stabbing other people.  The end of car accidents?  This might be the world's healthiest year in decades.  

Edited April 10, 2020 by Gordo

[Dean Pomerleau]

1 hour ago, Ron Put said:

Dean, this number doesn't make any sense. Between 750 and 800 people die in NY City every five days on average, so either "1125" and "more than eight times the deaths " is wrong, or the period is an aberration and chosen to create a false impression.

Ron,

The numbers do make sense and you seem to have missed the point once again. Your number of of 750-800 deaths per five days on average is total deaths in New York City. The 1125 deaths over the last five days quoted in the New York Times was deaths occurring at home. Most deaths occur at hospitals or at least the deceased is brought to the hospital or morgue where cause of death is determined. As the NYT's article I quoted says, these procedures aren't being followed due to the huge surge of deaths occurring at home.

This "1125 deaths at home over 5 days which is 8x normal" is consistent with the report I discussed previously from the NYC Health Committee chairman, who said first responders were seeing around 200-215 deaths at home per day, compared with 20-25 deaths at home per day in normal times.

1 hour ago, Ron Put said:

it appears to be average for the US, probably resulting in about 35000 to 40000 flu -related deaths. The majority of flu deaths occur within a period of 4-6 weeks early in the year and during such time this would likely result in five-day tolls considerably higher than 800 deaths per five days.

Once again you're comparing apples and oranges. We're talking ~1000 excess deaths at home in NYC likely attributable to the virus plus ~3500 documented deaths from the virus in NYC Hospitals over the past five days. That's ~4500 deaths from coronavirus in single five day period in a single US city which has approximately 1/38th the population of the entire country. Your "it is not as bad as the flu" argument is getting really tiresome. Not even Trump is making that lame analogy anymore.

Once again I'll point out that you can argue the damage associated with blanket lockdowns across the country aren't worth the lives saved. But to be intellectually honest you need to acknowledge that the number of lives that have been saved as a result of the lockdowns is far higher than those that occur in the average flu season, since even with the lockdowns effectively slowing the spread of the virus (i.e. mitigation) we are on track to see a final death toll higher than an average (or even a bad) flu season.

Finally, earlier you questioned the idea that the R₀ for covid-19 is as high as 5.7 and wondered where that came from. Both Siberiak and I pointed to a new paper from the CDC which estimates the R₀ for the virus at 5.7. If you remain skeptical, please point out the error in the data or methodology used by the CDC epidemiologists as described in that paper.

--Dean

 

[Sibiriak]

A  pessimistic view of prospects for Covid-19 vaccines --John Hopkins epidemiologist Jennifer Nuzzo:

Quote

I think vaccines are not going to be a realistic solution for years. The 12-to-18 month timeline that you’ve likely heard assumes that the science works in our favor. But it will take years to get the quantities that we need. I don’t see vaccines being a viable solution for a long time.

I think what’s going to happen now is that we will, through these crippling social distancing measures, eventually slow our incidents to a more manageable point. [mitigation]

And then we’ll have to think about relaxing the social distancing measures very slowly. But in order to be able to do that, so that we don’t wind up back where we started, we’re going to have to do what Singapore and South Korea did.

We have to test widely in order to very rapidly identify cases, and then we will have to isolate those cases as soon as we find them, so they can’t transmit their disease to others. We have to identify their contacts, so that we can figure out if those people too have been infected. And we will have to monitor cases of transmission for a period of time—test and isolate so they don’t transmit. [containment]

We’re just going to have to keep doing that and doing that and doing that, until either the pandemic has peaked—and hopefully we’ve spared the health system from crashing—or until we have other tools, like maybe therapeutics that could treat people who become infected, so that they don’t require intensive care or ventilators.

 

FWIW,  a comment by  Dr. Michael Osterholm  (Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP), and an adjunct professor in the Medical School, all at the University of Minnesota):

Quote

The economy has come to a complete standstill. If we say to those under 55, “Go to work, wear a mask and stay away from those over that age or with a compromised immune system”, would that work?

First of all, that would work. The one challenge that does come to play here, if you look at New York City right now, we're seeing more and more young people that are getting critically ill. The primary risk factor is obesity. We're leading the world in that 45% of our citizens over the age of 50 are obese. This is very well documented in the literature for influenza. This means that we'll have more people in the younger age cohort who will get sick and die, but still not on the level of the older population.

 

[Gordo]

14 minutes ago, Sibiriak said:

The economy has come to a complete standstill. If we say to those under 55, “Go to work, wear a mask and stay away from those over that age, anyone obese, or with a compromised immune system”, would that work?

That would work.

Fixed it.  But it will be weird when a huge percentage of the population goes on disability because they can't work due to being obese.  I'm sure government can fix that though, like starving them down to a working weight (ration cards?)

[Dean Pomerleau]

Sadly, Singapore was doing well with containment without lockdown via contact tracing and quarantines. But recently they are seeing a spike in new cases:

As a result they have ordered what they are calling a "partial lockdown" to slow the spread:

Everyone is prohibited from leaving their homes except for essential activities and exercise, with fines of up to S$10,000 ($7,000; £5,600) or six months in prison.

If Singapore (a notoriously hard-ass country when it comes to public hygiene and social control) is having trouble containing the spread, it shows it won't be easy for less strict countries to lift social distancing measures and shift to containment via testing, individual quarantining and contact tracing. 

--Dean 

[TomBAvoider]

Just for the sake of the numbers, as a kind of modelling or gedanke-experiment, what would happen if countries elected to "just let 'er rip", i.e. took zero abatement measures? We know that the Spanish Flu killed some 100 million. There was an economic impact - and it killed young people in the prime of their lives. But the economic impact was, say "X" - and we survived without civilization collapsing.

If we now compare two economic (and social/political) models - one with abatement, obviously along a spectrum (as we're currently attempting to do) and the model of "let 'er rip" - what is the respective damage? Is it possible that ultimately "let 'er rip", while politically and socially (and morally) highly questionable, might be economically less damaging?

The Swedes (in an interview with the guy in charge of this) claim that the death outcome IN THE LONGER TERM will be the same regardless of measures taken or not taken. As long as we don't have a vaccine, what are we waiting for while locked down (flattening the curve aside) - I know there's a lot of optimism wrt. to a vaccine in 12-18 months, but you'll forgive me if I believe it when I see it.

Edited April 10, 2020 by TomBAvoider

[Dean Pomerleau]

45 minutes ago, TomBAvoider said:

Just for the sake of the numbers, as a kind of modelling or gedanke-experiment, what would happen if countries elected to "just let 'er rip", i.e. took zero abatement measures? We know that the Spanish Flu killed some 100 million. There was an economic impact - and it killed young people in the prime of their lives. But the economic impact was, say "X" - and we survived without civilization collapsing.

Tom,

Economists from the Fed analyzed the impact of the Spanish Flu comparing different US cities to see how the onset and duration of NPIs (non-pharmaceutical interventions - i.e. social distancing) impacted their economic growth following the pandemic. Here is their conclusion:

Cities that implemented early and extensive non-pharmaceutical interventions (like physical distancing and forbidding large gatherings) suffered no adverse economic effects over the medium term. On the contrary, cities that intervened earlier and more aggressively experienced a relative increase in real economic activity after the pandemic subsided.

In other words, "just let 'er rip" was not only bad health policy, but bad economic policy. Here is the graph that supports this conclusion:

The blue dot cities instituted longer NPIs and in general saw less mortality and more economic growth. Red dot cities (including my poor home town of Pittsburgh) saw the opposite - shorter institution of NPIs resulted in more deaths and less economic growth post pandemic.

The correlation is far from perfect, but these results would seem to support the idea that "let 'er rip" is bad health and economic policy.

--Dean

 

[Mike41]

47 minutes ago, TomBAvoider said:

Just for the sake of the numbers, as a kind of modelling or gedanke-experiment, what would happen if countries elected to "just let 'er rip", i.e. took zero abatement measures? We know that the Spanish Flu killed some 100 million. There was an economic impact - and it killed young people in the prime of their lives. But the economic impact was, say "X" - and we survived without civilization collapsing.

If we now compare two economic (and social/political) models - one with abatement, obviously along a spectrum (as we're currently attempting to do) and the model of "let 'er rip" - what is the respective damage? Is it possible that ultimately "let 'er rip", while politically and socially (and morally) highly questionable, might be economically less damaging?

The Swedes (in an interview with the guy in charge of this) claim that the death outcome IN THE LONGER TERM will be the same regardless of measures taken or not taken. As long as we don't have a vaccine, what are we waiting for while locked down (flattening the curve aside) - I know there's a lot of optimism wrt. to a vaccine in 12-18 months, but you'll forgive me if I believe it when I see it.

The Swedes say death outcomes would be the same? For covid 19 maybe, but overall well that’s very debatable considering the burden on the health care system . If we just let it rip would not many die who cannot get proper treatment? So overall the death rate might surge to include many who might have lived and are not covid patients. At least that’s what authorities are saying.

[Mike41]

Considering covid 19s main cause of death is inflammation of the respiratory system and that glucosamine is associated with anti inflammatory properties as well as lower death rates from respiratory illness It may be reasonable to take glucosamine as a supplement at this point in time based on the below citation posted by Sibirak

   On 4/9/2020 at 8:37 AM,  Sibiriak said: 

From Al's Papers' Citations:

Associations of regular glucosamine use with all-cause and cause-specific mortality: a large prospective cohort study.

Li ZH, Gao X, Chung VC, Zhong WF, Fu Q, Lv YB, Wang ZH, Shen D, Zhang XR, Zhang PD, Li FR, Huang QM, Chen Q, Song WQ, Wu XB, Shi XM, Kraus VB, Yang X, Mao C.

Ann Rheum Dis. 2020 Apr 6. pii: annrheumdis-2020-217176. doi: 10.1136/annrheumdis-2020-217176. [Epub ahead of print]
PMID: 32253185 

Edited April 10, 2020 by Mike41

[Dean Pomerleau]

Here is a rather discouraging article discussing three different concrete proposals for reopening the country.

 All of them feature a period of national lockdown — in which extreme social distancing is deployed to “flatten the curve” and health and testing capacity is surged to “raise the line.” 

All of them then imagine a phase two, which relaxes — but does not end — social distancing while implementing testing and surveillance on a mass scale.

The first of the three plans has a phase two where everyone who wants to go out needs to be download an app that tracks their movement for later contact tracing. Google and Apple have already partnered to develop such a (voluntary) app. Here is the idea:

The second plan has a phase two where everyone in the country is tested for the virus every two weeks (22 million tests per day!) to catch and isolate cases and their contacts quickly.

The third plan involves some of each, with more testing and contact tracing than is possible now, but not as extreme as either of the other two plans. It adds a component of having to do localized lockdowns if/when cases start to spike, which presumably would also be necessary in the first two plans as well.

Here is what the article's author concludes:

I don’t want anyone to mistake this as an argument for surrendering to the disease. As unlikely as these futures may be, I think the do-nothing argument is even less plausible: It imagines that we simply let a highly lethal virus kill perhaps millions of Americans, hospitalize tens of millions more, and crush the health system, while the rest of us go about our daily economic and social business. That is, in my view, far less likely than the construction of a huge digital surveillance state. I care about my privacy, but not nearly so much as I care about my mother.

My point isn’t to criticize these plans when I have nothing better to offer. Indeed, my point isn’t to criticize them at all. It’s simply to note that these aren’t plans for returning to anything even approaching normal. They either envision life under a surveillance and testing state of dystopian (but perhaps necessary!) proportions, or they envision a long period of economic and public health pain, as we wrestle the disease down only to see it roar back, as seems to be happening in Singapore.

--Dean

[Gordo]

On a personal note, I just learned today that my wife's great aunt in Philadelphia died from covid-19 related complications according to her family.  She was in her 90's (I believe 93 or 94).

Researchers have started doing some random antibody testing to see how far this bad boy has really spread in the population, doesn't look like we are even close to out of the woods as far as herd immunity, but I don't think that's a surprise:

COVID antibody test in German town shows 15 percent infection rate

Quote

Two weeks ago, [Oxford] published modeling claiming that up to half the UK population might already have been infected with the virus — a level of infection which would mean that lockdown may be the wrong approach, as we would already have achieved a state of herd immunity, preventing the further spread of the disease.

The Gangelt study does not provide support for the idea that half of the population of Britain, or any other country, has been infected with the virus. But for a town to have an infection rate of 15 percent suggests that the virus had spread a lot further than many believed.

...  they do raise the question: is there a ceiling on the number of people who are prone to be infected with the disease? Do many of us have some kind of natural protection against infection? Would it ever spread among more than about one in six of us?

 

 

[TomBAvoider]

Gordo, I'm sorry about your losing someone in your family. So far, I have not experienced that, but it's inevitable that we'll all probably know someone in our friends and family circles who passed away due to this virus. 

If Sweden is the least locked down country, does that mean that possibly the virus has achieved a greater than 15% penetration there? I wonder how that will be reflected in mortality statistics.

Presumably all epidemiologists in all countries have access to roughly the same information, so it's fascinating to see how different the various approaches are to dealing with this pandemic. F.ex. why aren't the Swedes persuaded by the kinds of stats from the 1918 Flu that Dean cited? Very strange.

Of course it is also true that apparently while the Spanis Flu hit young people disproportionately, it appears the old are being hit with the CV. This is the context in which I think about that joke I wrote about some time ago - how social security / pension organizations were offering all-expenses paid vacations to northern Italy to their retirees :).

Anecdote time - back in the early 90's just when the former Eastern Block countries were switching over to capitalism, due to my work, I had occassion to live in Prague the Czech Republic (Czechoslovakia back then) for a few months. As they were transitioning their economy, so too they had to write completely new regulations in all spheres of life, including health. Of course, various Western industries were looking to gain advantage, while the Czechs were looking to Western countries regulations for inspiration.

One of the big fights was between the tobacco industry which was being taken over by Western companies, and they definitely did not want any kind of regulations that might impinge on their sales - advertising etc. So naturally, they bought space in the various newspapers, including the English language papers, and had opinion columns written with the aim of influencing public opinion. I remember one column in particular, written by a Western economist - he pointed out, that smokers were much cheaper for a government, because they died on average 10 years sooner, which resulted in much smaller payouts from social security and medical care, so the idea being that smoking should even be encouraged.

Anyhow, that column caused all sorts of anger, even if the numbers cited were not the focus of the discussion. Similarly, I've seen - very cautious - mentions here and there in the press here in the states, that if the virus wipes out a lot of elderly people, far from being an economic disaster, it might even be a net positive in the long run when it came to governmental finances.

Of course, the virus doesn't discriminate. Look at Boris Johnson - a hardnosed Tory, who is more than willing to sacrifice the masses to various policies that emphasize economic gains at the cost of compassion for the poor and more vulnerable in society. And then he got the virus - fortunately for him, not fatal it seems, at least as of this writing.

 

Edited April 11, 2020 by TomBAvoider

[Ron Put]

5 hours ago, Dean Pomerleau said:

...The numbers do make sense and you seem to have missed the point once again. Your number of of 750-800 deaths per five days on average is total deaths in New York City. The 1125 deaths over the last five days quoted in the New York Times was deaths occurring at home.... Your "it is not as bad as the flu" argument is getting really tiresome. Not even Trump is making that lame analogy anymore....

What's getting tiresome are the hysterics about "half a million US deaths," collapsing healthcare system and "if you don't lock down you ain't no leader!"

Face it, the lock-downs were driven by fear, bad data and political calculations by various opportunists. The choice was never one between "doing nothing" and a "lock-down," the choice was between reasonable social distancing (like Sweden) and a lock-down (like New York and California). And Cuomo and Newsom made the wrong choice, and based on the way it was done, it was a political strategy, not a public health one. Once it snowballed, "lock-down" was the only safe choice for many politicians and they took it, like dominoes, reason be damned.

Now that Covid-19 seems to be looking more like a mild flu season, those who pushed us into this are desperately scrambling to pad the number of dead and to assure us that it was their "leadership" which saved us from the apocalypse. Never mind that the states and countries which did not lock down appear to have generally as many infections and deaths.

Dean, if your Chinese study is correct about Covid-19 having R0 of 5, then the argument for mitigation, not lock-down, is that much stronger: "People should try to protect themselves individually from flu strains, said Mike Ryan, the head of the WHO’s emergencies program, but at a societal and global level, “we don’t necessarily attempt to contain or stop them because we fundamentally believe they will spread unabated.”"

OK, we all know that more people die during the flu season, some at home and some at the hospital. So, why is de Blasio's administration comparing the death toll of the deadliest week of the Covid-19 epidemic to a time when there was no epidemic? While it tells us that some may have died of Covid-19 complications, it doesn't tell us how Covid-19 compares to the flu. For that, we need to compare to the deadliest five days of the flu season to the deadliest five days of Covid-19.

Ah, but NY doesn't even bother tracking flu deaths, because nothing can be done about the flu. Yet, they locked down the state for a virus which appears to be just like the flu, and probably milder?!! Now we'll all pay for it.
 

[Ron Put]

This is a post from Africa someone sent to me and I found interesting. Here are some excerpts, with emphasis added by me:

Could Covid-19 be the biggest evidence fiasco of the century?

If so, the alarmists must be held to account.

I’m going out on a limb here. There’s something terribly wrong with the reported numbers of deaths from Covid-19. Let’s just call it the virus, since it’s the only one being talked about.

My social media is ringing non-stop with dire forebodings of the holocaust that is about to befall us. Then there are those who say this is mass insanity.

This is vitally important because the country’s economy has been shut down and will take years to recover. Just looking at the restaurants and hotels, most of the 270,000 people who work in this sector have lost their incomes and don’t know if they will have a job when the crisis is over. People are in a panic, fearing for their lives, their children, their parents and their jobs. We better make sure we are making the right decisions based on unimpeachable data. ...

Prof Walter Ricciardi, scientific adviser to Italy’s minister of health, puts it this way: “The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.”

In fact, just 12% of reported Covid-19 deaths in Italy had coronavirus listed as the cause of death. Eighty percent had at least two other diseases. Only 1.4% had no other diseases. This is according to the Italian government’s own report.

In other words, those dying who test positive for coronavirus are assumed to have died from coronavirus, ignoring other pre-existing illnesses. Which means Italy’s Covid-19 fatality rate could be a massive over-count. Adjust for this – as some have suggested should be done – and Italy falls into line with fatality rates elsewhere in the world. ...

The University of Oxford’s Our World in Data group has stopped using data from the World Health Organisation (WHO) because its figures cannot be trusted. “The lack of good data available during the coronavirus outbreak has been a major source of frustration for economists, statisticians, scientists, and public policy professionals.

“A Stanford University epidemiologist and professor of medicine, in a widely circulated Stat article, recently said the COVID-19 pandemic could end up being “a once-in-a-century evidence fiasco.”

Author of the Stat article, Professor John Ioannidis, says data on how many people are infected and how the epidemic is evolving are utterly unreliable. “We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.”

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from WHO, cause horror — and are meaningless, adds Ioannidis. ...

A population-wide case fatality rate of 0.05% is lower than seasonal influenza. German physician and member of the Bundestag, Dr. Wolfgang Wodarg, points to a Glasgow study showing coronavirus (of which there are many strains) accounting for nearly one-in-five common cases in of flu. Ioannidis adds that these “mild” coronaviruses may be implicated in several thousands of deaths every year worldwide, though the vast majority of them are not documented with precise testing. “Instead, they are lost as noise among 60 million deaths from various causes every year.”

UK epidemiologist Neil Ferguson, who has Covid-19 himself, recently slashed his original projections of 500,000 UK Covid-19 deaths to less than 20,000 and expects the crisis to peak in 2-3 weeks. This reduction in estimates is based on evidence that the virus moves much quicker than was originally thought. Oxford University researchers have suggested potentially half the UK population may have been infected, in which case the fatality rate is far, far lower than reported.

If so, the much-maligned “herd immunity” (when enough people get the virus and build immunity) has already taken effect. As with previous epidemics such as Swine flu, the early prognostications of fatalities turn out to be wildly over-stated.

We better demand our government acts on correct data. Because when this blows over and South Africans survey the wreckage, they will look for someone to blame.

Even before the latest fatality stats, ETM Analytics economist Russell Lamberti questions whether the lockdown is proportionate to the threat from the virus. Nicolaas van Wyk, CEO of the SA Institute of Business Accountants (Saiba) says we must make absolutely sure we are making such critical decisions – such as lockdown – based on correct data. The damage to the business sector will not be easily repaired: “We really need to be sure government is making the right decisions based on the right data. What comes after the virus is what is most worrying, because people will be hungry and many businesses will have folded.”