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

[mccoy]

16 hours ago, Ron Put said:

I already linked above some of the reasons why the NY numbers are likely considerably inflated, so I'd say data speak for themselves, but especially preliminary data speaks depending on how it's collected, edited and presented.  I and many others find plenty of issues how this is done in NY, and I would expect anyone reasonably intelligent to at least question the huge and largely poorly explained differences with most other locales.

I'm missing more here.... Usually, the number of all-cause mortality cannot be inflated, unless you start not to count dead people, or to consider dead people who are not really so. Which, in the western society, fortunately, is still not happening. Every single confirmed death is accounted for. The way COVID19 deaths are counted or ignored is totally irrelevant to the parameter called all-cause death mortality .

[Gordo]

16 hours ago, Ron Put said:

If Covid-19 turns out to be such "major" event, and it is not certain, as currently its worldwide death toll is still less than a third of even the 2018 flu season (1,200,000 deaths), it should most certainly be compared to other "major" pandemics, not to relatively mild seasons in between.  Thus the comparison with past major events such as the 1957 and 1968pandemics is not just relevant, but necessary, to properly formulate and evaluate policies.  Which is something none of the "real leaders" did.

Why American life went on as normal during the killer pandemic of 1969

”The idea that a pandemic could be controlled with social distancing and public lockdowns is a relatively new one, said Tucker. It was first suggested in a 2006 study by New Mexico scientist Robert J. Glass, who got the idea from his 14-year-old daughter’s science project.”

I guess over the last 50 years society has changed a lot, without the internet and cell phones, it’s much harder for fear, hysteria or panic to spread. 

Edited May 17, 2020 by Gordo

[Gordo]

Moderna reports positive data on early-stage coronavirus vaccine trial, shares surge

• Moderna’s closely watched early-stage human trial for a coronavirus vaccine produced Covid-19 antibodies in all 45 participants.
• Each participant received a 25, 100 or 250 microgram dose, with 15 people in each dose group.
• At day 43, or two weeks following the second dose, levels of binding antibodies in the 25 microgram group were at the levels generally seen in blood samples from people who recovered from the disease.

“These interim Phase 1 data, while early, demonstrate that vaccination with mRNA-1273 elicits an immune response of the magnitude caused by natural infection starting with a dose as low as 25 [micrograms],” Moderna chief medical officer Dr. Tal Zaks said in a statement.

“When combined with the success in preventing viral replication in the lungs of a pre-clinical challenge model at a dose that elicited similar levels of neutralizing antibodies, these data substantiate our belief that mRNA-1273 has the potential to prevent COVID-19 disease and advance our ability to select a dose for pivotal trials,” Zaks added.

 

 

[KHashmi316]

Wuhan lab(s) --  complicit or not in COVID-19?

 Potholer54 investigates with reasonable analysis, rationality, facts, and research:

 

[Dean Pomerleau]

On 5/17/2020 at 9:41 AM, Gordo said:

”The idea that a pandemic could be controlled with social distancing and public lockdowns is a relatively new one, said Tucker. It was first suggested in a 2006 study by New Mexico scientist Robert J. Glass, who got the idea from his 14-year-old daughter’s science project.”

In case this wasn't obvious, the NY Post probably isn't the most reliable source for information. Non-pharmaceutical interventions including social distancing and closures has been employed to slow the spread of infectious diseases for hundreds of years. 

For example, businesses and markets were closed both by government decree and proprietor judgment during the Plague years in England in the 16th and 17th century. From [1]:

The ultimate cause of these [economic] difficulties was failure of local commerce, a topic
of great importance. The commonest single symptom of this damage was the suspension of fairs and markets, a detail easy to pass over without full appreciation of
its significance. Towns relied on their markets as their chief source of food, raw
materials and customers for their shops and stalls, while fairs were vital for the
organization of inter-regional trade. Once an epidemic was established both these
commercial gatherings quickly petered out, through both official closure, due to the
risk of spreading infection, and the natural reluctance of countryfolk to attend at
the risk of their lives. These closures could last for up to six or nine months in
many cases, and the resultant lack of both raw materials and buyers quickly closed
down local businesses, even if they could survive the flight of their owners. Temporary markets were set up in suburban fields (many towns retain traditions of their
location) but they were always very inadequate substitutes, since attendance at them
demanded either desperation or eccentricity.

A variety of mandatory non-pharmaceutical interventions including mask-wearing, school closures, business closures and prohibition of gathering in public were instituted in various US cities to slow the spread of the 1917 flu pandemic, as we've discussed before. Here is an example from Des Moines Iowa:

On Oct. 10, 1918, for instance, Des Moines, Iowa, Mayor Thomas P. Fairweather announced that “in order to prevent the spread of Spanish Influenza and to protect the public health and safety,” he was directing “all public places of amusement, including theaters, moving pictures houses, dance halls and public dancing places, pool and billiard halls, skating rinks, outdoor athletic events, all public congregating places subject to unusual congestion, be closed.”

So most of the interventions people are chaffing against, most notably closing of non-essential businesses, have a long history in the face of infectious disease epidemics.

--Dean

----------

[1] Medical History Volume 22, Issue 3July 1978 , pp. 308-326
The influence of bubonic plaque in England 1500-1667
Alan D. Dyer
DOI: https://doi.org/10.1017/S0025727300032932

Published online by Cambridge University Press: 16 August 2012

[Dean Pomerleau]

The model with the best accuracy track record is now projecting just shy of 200k as the most likely death toll in the US by August 4th, with a range of 121k to 339k:

This model is now estimating there is a 77% chance of >150k deaths in the US by August 4th. So it looks like my prediction from April 1st:

On 4/1/2020 at 5:54 PM, Dean Pomerleau said:

I'll stick my neck out and say I think it will be higher than 100k, but I'm hoping not dramatically so in this first wave.

may prove to be too optimistic, although I did included the qualification that all bets are off if states start relaxing their restrictions soon, which they obviously have.

Unfortunately it is looking more like my pessimistic projections from a month ago, on April 17th and April 19th of ~200k and ~200-275k US deaths respectively by August may end up being closer to the actual death toll in the first wave. Time will tell.

I anticipate accusations of that old refrain "garbage in, garbage out", an increasingly vacuous criticism as the official covid-19 US death count and commensurate stats for excess all-cause mortality far surpass the impact of the worst seasonal flus and continue to climb towards my projections. 

--Dean

[Gordo]

1 hour ago, Dean Pomerleau said:

In case this wasn't obvious, the NY Post probably isn't the most reliable source for information. Non-pharmaceutical interventions including social distancing and closures has been employed to slow the spread of infectious diseases for hundreds of years. 

Maybe it was the public lockdowns (stay at home orders) that the author thought was new? Not sure, quick google turned up:

1918 or 2020? This public health order from the flu pandemic sounds a lot like today

It’s an interesting comparison but we actually do seem to be more strict officially now vs then, and there were no stay at home orders (lockdowns).

 

[Dean Pomerleau]

50 minutes ago, Gordo said:

Maybe it was the public lockdowns (stay at home orders) that the author thought was new?

Stay at home orders may not have been tried before, but they appear to have been pretty effective at slowing the spread of the virus in the US, according to new research published in Health Affairs [1].

Researchers from the University of Kentucky and the University of Louisville studied the effects of four different social distancing policies — school closures, closing restaurants and bars, bans on large gatherings, and shelter-in-place orders (SIPOs) — to tease out both their individual and cumulative effects in flattening the curve. They studied the period from March 1, before any of these policies had been put into effect, to April 27, when Georgia became the first state to start relaxing its social distancing measures.

The bottom line, according to their modeling: These government interventions have worked to reduce the spread of the coronavirus. From the text of [1]:

Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1–5 days, 6.8 after 6–10 days, 8.2 after 11–15 days, and 9.1 after 16–20 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million).

Here is the graph from the paper (note the log scale):

 

So rather than the observed 1M infections by April 27th in the US, they estimate there would have been 10M without SIPOs (but with the other interventions) and 25M if none of the social distancing interventions has been instituted, instead relying solely on voluntary distancing. 

The author's analysis of the data suggests SIPOs significantly slowed the spread beyond the slowing resulting from the other interventions:

Relative to the reference category of 0–4 days before implementation, SIPOs lead to statistically significant (p < 0:01) reductions in the COVID-19 case growth rate of 3.0 percentage points after 6–10 days, 4.5 after 11–15 days, 5.9 after 16–20 days, and 8.6 from day 21 onward. Because the model held constant the other types of policies, these estimates should be interpreted as the additional effect of SIPOs beyond shutting down schools, large gatherings, and entertainment-related businesses.

An argument can be made that SIPOs (i.e. lockdowns) were too draconian and had too great a negative impact on people's lives to be justified, but the evidence suggests they weren't entirely superfluous or in vain - i.e. they appear to have had the desired effect of taming the exponential growth of the covid infections in the US.

Using a 0.5-1% infection mortality rate, 9M more infections without SIPOs would have resulted in 45k-95k more deaths. Relying solely on voluntary social distancing, the author's estimated 24M more infections would have resulted in 120K-240K more deaths.

--Dean

-------

[1] HEALTH AFFAIRS 39, NO. 7 (2020)
https://doi.org/10.1377/hlthaff.2020.00608

Strong Social Distancing Measures In The United States Reduced The COVID-19 Growth Rate

Charles Courtemanche, Joseph Garuccio, Anh Le, Joshua Pinkston, and Aaron Yelowitz

ABSTRACT State and local governments imposed social distancing
measures in March and April of 2020 to contain the spread of novel
coronavirus disease 2019 (COVID-19). These included large event bans,
school closures, closures of entertainment venues, gyms, bars, and
restaurant dining areas, and shelter-in-place orders (SIPOs). We evaluated
the impact of these measures on the growth rate of confirmed COVID-19
cases across US counties between March 1, 2020 and April 27, 2020. An
event-study design allowed each policy’s impact on COVID-19 case growth
to evolve over time. Adoption of government-imposed social distancing
measures reduced the daily growth rate by 5.4 percentage points after
1–5 days, 6.8 after 6–10 days, 8.2 after 11–15 days, and 9.1 after 16–20
days. Holding the amount of voluntary social distancing constant,
these results imply 10 times greater spread by April 27 without SIPOs
(10 million cases) and more than 35 times greater spread without any of
the four measures (35 million). Our paper illustrates the potential danger
of exponential spread in the absence of interventions, providing relevant
information to strategies for restarting economic activ

[TomBAvoider]

It really is a crapshoot as to whether you'll have a severe reaction to COVID-19 or a mild one. There are so many factors, it's very difficult to predict. For example, when I saw reports of a lot of strokes and coagulation caused by COVID-19, I wondered if my particular situation might have some bearing. For most of my life, I've had mild thrombocytopenia - the lower level of the platelet count for normal is 150,000, and I often had in the range of 130K - 140K, although the lowest was when I was fasting for 8 days, and it was 94K. But often I'm at the lower end of normal, f.ex. this year (a week ago), I had exactly 150K, and one year I had 175K. So basically, very mild thrombocytopenia - I have never experienced any negative symptoms, bleeding and the like.

So, it occured to me, that if my blood is less prone to coagulation, and the virus causes coagulation, then I might be slightly protected from this aspect of the illness.

I went looking for info, and guess what - it transpires that having thrombocytopenia drastically escalates the odds of a severe reaction to COVID-19, and dramatically elevates (by multiple times) the odds of death:

Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis.

Thrombocytopenia and its association with mortality in patients with COVID‐19

Yikes. That looks pretty bad. Far from being protected, I have substantially elevated risk. 

As a result, I am even more concerned about getting this virus - I might not do well, even though I don't suffer from hypertension, obesity, diabetes, pulmonary, cardiac or nephropathic disorders.

Who knows what other combo of features your physiology has might make you extra vulnerable to this virus and the outcome of getting sick.

All in all, it's a lottery. You might do well. Or you might not.

[mccoy]

1 hour ago, TomBAvoider said:

Who knows what other combo of features your physiology has might make you extra vulnerable to this virus and the outcome of getting sick.

All in all, it's a lottery. You might do well. Or you might not.

Yeah, the temptation for us might be to ignore all safety measures and try to get infected and most probably without symptoms, with the advantage of consequent immunity.

But that, as you say, might be a dangerous gamble...

As usual, the middle way is likely the best: adopt all reasonable safety measures without getting obsessed about it.

[Mike41]

 

Hi Tom B, I just checked my lab results online based on your concerns and my last result showed platelet count low at 135 k. I looked at all the others going back 4 years and there were 4 and all of them were over 150k. So why the last Was below 150 who knows? but the highest was only 168 so I guess Im in the lowball camp. So I looked up ways to raise platelets and the research is sketchy at best. A study on dengue fever showed good results using papaya extract. A few sites mention alcohol and milk as potentially raising levels. Also papaya fruit also lowerinG but no serious research. Also mentioned vitamin C, b12. 
 

https://www.ncbi.nlm.nih.gov/pubmed/31601215

https://www.pdsa.org/treatments/complementary/vitamins-and-supplements.html

alcoholism may be what we are looking at. They are very likely to have low platelet levels. That could explain the assocIation

Edited May 18, 2020 by Mike41

[corybroo]

https://amp.ft.com/content/97dc7de6-940b-11ea-abcd-371e24b679ed?__twitter_impression=true

"For the time being, Trump has been persuaded to cease his daily briefings.  White House internal polling shows that his once double-digit lead over Biden among Americans over 65 has been wiped out. It turns out retirees are no fans of herd immunity."

😉   Cory

[Saul]

2 hours ago, TomBAvoider said:

It really is a crapshoot as to whether you'll have a severe reaction to COVID-19 or a mild one. There are so many factors, it's very difficult to predict. For example, when I saw reports of a lot of strokes and coagulation caused by COVID-19, I wondered if my particular situation might have some bearing. For most of my life, I've had mild thrombocytopenia - the lower level of the platelet count for normal is 150,000, and I often had in the range of 130K - 140K, although the lowest was when I was fasting for 8 days, and it was 94K. But often I'm at the lower end of normal, f.ex. this year (a week ago), I had exactly 150K, and one year I had 175K. So basically, very mild thrombocytopenia - I have never experienced any negative symptoms, bleeding and the like.

So, it occured to me, that if my blood is less prone to coagulation, and the virus causes coagulation, then I might be slightly protected from this aspect of the illness.

I went looking for info, and guess what - it transpires that having thrombocytopenia drastically escalates the odds of a severe reaction to COVID-19, and dramatically elevates (by multiple times) the odds of death:

Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis.

Thrombocytopenia and its association with mortality in patients with COVID‐19

Yikes. That looks pretty bad. Far from being protected, I have substantially elevated risk. 

As a result, I am even more concerned about getting this virus - I might not do well, even though I don't suffer from hypertension, obesity, diabetes, pulmonary, cardiac or nephropathic disorders.

Who knows what other combo of features your physiology has might make you extra vulnerable to this virus and the outcome of getting sick.

All in all, it's a lottery. You might do well. Or you might not.

Hi Tom!

CRONnies usually have low platelet count.  My gut feeling is that not all low-platelet people will have the same reaction to the virus -- and that the low  platelets of CRONnies is far from a problem.

  --  Saul

[Ron Put]

On 5/17/2020 at 6:11 AM, mccoy said:

Ron, now I'm probably missing something... The excess mortality curves have been plotted for all months, but the relevant months are March to May since March was the inception of the outbreak in Europe. And again, I'm perhaps missing your point, but even during the flu season, the effects of the flue are normalized, since we divide, for example, the all-cause mortality in June, 2020 by the average all-cause mortality of latest 5 years....

 

On 5/17/2020 at 6:26 AM, mccoy said:

I beg to dissent to the above. You cannot compare the social, political, economical , technological aspects in 2020 to those of 50+years ago. A political decision must be taken on the basis of the present conditions, which are probably different for every single state or region.

mccoy, my point was that significant pandemics occur relatively rarely in one's lifetime, usually once every one or two decade.  Which is why Covid-19 must be placed in proper perspective, not compared to relatively mild flu seasons, or periods of generally low excess mortality.  Without such perspective, Dean's graphs grossly exaggerate the mortality and the danger of Covid-19.  But so does most of the media, just like they did back when WMDs were in fashion.

Gross exaggerations and by-the-hour body counting are what created the hysteria, and what ultimately led to the lock-downs.  The only relevant differences between now and 1969 are the significantly better technology and treatments we have today, and the information technology tsunami which feeds on eyeballs and clicks.  And since in most of the Western World the decentralized  The intent of the Singapore graphs was to show a decades long timeline and illustrate how comparing adjacent periods can create scary visuals, without the benefit of a longer-term perspective.

--------

12 hours ago, Dean Pomerleau said:

In case this wasn't obvious, the NY Post probably isn't the most reliable source for information. Non-pharmaceutical interventions including social distancing and closures has been employed to slow the spread of infectious diseases for hundreds of years....

"Social distancing" has been employed previously, but generally to isolate carriers, not shut down the whole society and economy.  Typhoid Mary is an example of forcibly enforced "social distancing."

As to the snarky comment about the NYPost, what exactly in the article do you find less reliable than the "million death" predicting charts you've been posting?

-------

11 hours ago, Dean Pomerleau said:

The model with the best accuracy track record is now projecting just shy of 200k as the most likely death toll in the US by August 4th...

...

Ah, so this one is better than the ones predicting 750,000 dead in the UK and 2,000,000 dead in the US?  Those were not the "best?!"

Oops!  "Cause they were the reason for the shutting down of the Western world's economies....

But, again, it's much easier to fool someone than to convince them that they've been fooled.

 

10 hours ago, TomBAvoider said:

It really is a crapshoot as to whether you'll have a severe reaction to COVID-19 or a mild one. There are so many factors, it's very difficult to predict....

I fully agree with Saul on this one. It's good to keep things in perspective: for 98-99% Covid-19 is a mild illness (see, for instance, the video below).  I've posted examples before, but the past coronaviruses have had very similar and just as rare complications.  And the regular flu appears to be deadlier among those younger than 65.
 

 

Edited May 19, 2020 by Ron Put

[Ron Put]

This is an informative interview with Dr. Jay Bhattacharaya, who ran the MLB Covid-19 serological study:

 

 

Edited May 19, 2020 by Ron Put

[corybroo]

Perhaps a ray of hope.

Scientists in China believe new drug can stop pandemic 'without vaccine'

https://medicalxpress.com/news/2020-05-scientists-china-drug-pandemic-vaccine.html

A drug being tested by scientists at China's prestigious Peking University could not only shorten the recovery time for those infected, but even offer short-term immunity from the virus, researchers say

Sunney Xie, director of the university's Beijing Advanced Innovation Center for Genomics, told AFP that the drug has been successful at the animal testing stage.

"When we injected neutralising antibodies into infected mice, after five days the viral load was reduced by a factor of 2,500," said Xie.

"That means this potential drug has (a) therapeutic effect."

The drug uses neutralising antibodies—produced by the human immune system to prevent the virus infecting cells—which Xie's team isolated from the blood of 60 recovered patients.

He added that the drug should be ready for use later this year and in time for any potential winter outbreak of the virus, which has infected 4.8 million people around the world and killed more than 315,000.

The new drug could even offer short-term protection against the virus.

The study showed that if the neutralising antibody was injected before the mice were infected with the virus, the mice stayed free of infection and no virus was detected.

This may offer temporary protection for medical workers for a few weeks, which Xie said they are hoping to "extend to a few months".

Cory

[corybroo]

What if no treatment (other than injecting disinfectants) are developed this year, it could be grim

COVID-19: Study reports 'staggering' death rate in US among those infected who show symptoms

https://medicalxpress.com/news/2020-05-covid-staggering-death-infected-symptoms.html

Is COVID-19 more deadly than the flu?

It's a lot more deadly, concludes a new study by the University of Washington published May 7 in the journal Health Affairs. The study's results also project a grim future if the U.S. doesn't put up a strong fight against the spread of the virus.

[Sometimes grim extrapolations are published to motivate people to take evasive action.   CB]

The national rate of death among people infected with the novel coronavirus—SARS-CoV-2—that causes COVID-19 and who show symptoms is 1.3%, the study found. The comparable rate of death for the seasonal flu is 0.1%.

The School of Pharmacy and Basu have developed a website that explores the infection and fatality rates by U.S. counties for people with symptoms. 

Basu stresses that this website is not a forecasting tool—it does not predict what will happen in the future. Rather, it uses the estimated death rate among symptomatic COVID-19 cases to project what is happening currently in these communities, such as what are the likely numbers for total infections and symptomatic cases.

The COVID-19 death rate, the study adds, means that if the same number of people in the U.S. are infected by the end of the year as were infected with the influenza virus—roughly 35.5 million in 2018-2019—then nearly 500,000 people will die of COVID-19.

However, the novel coronavirus is more infectious than the influenza virus, Basu noted. So, a conservative estimate of 20% of the U.S. population becoming infected by the end of the year—with the current trends in social distancing and health care supply continuing, while accounting for those infected who will recover asymptomatically—could result in the number of deaths climbing to between 350,000 and 1.2 million.

[Gordo]

corybroo looks like another math fail to me.   Lets check that:

"So, a conservative estimate of 20% of the U.S. population becoming infected by the end of the year"

US population = 328,239,523 * 20% =65,647,904.6

80% of the infected show no or only mild symptoms and don't seek medical treatment, so lets just look at the 20% that remain:

65647904.6 * 20%=13,129,580.92

We'll go with the death rate you cite of 1.3% (for people seeking treatment), that gives us 13,129,580.92 * 0.013 = 170,685 dead

This is around 2x a recent bad flu year in terms of deaths.  It's bad, but not catastrophic as far as pandemics go.

In the meantime, empty hospitals are resulting in more and more layoffs, just saw this one today:

UW Medicine furloughs 1,500 staffers, with more possible

I guess we just hole up until the vaccine comes out and we hope for that happening before end of year?  Its going to be a long 7 months!  😉 In the meantime I hear the treasury is now issuing "stimulus debit cards"! Haha.  You have to wonder about longer term unintended consequences...

Edited May 19, 2020 by Gordo

[Dean Pomerleau]

1 hour ago, Gordo said:

corybroo looks like another math fail to me.   ...

that gives us... 170,685 dead.

This is around 2x a recent bad flu year in terms of deaths. 

Gordo,

I think the error is on your part, in one of your assumptions. Namely:

1 hour ago, Gordo said:

80% of the infected show no or only mild symptoms and don't seek medical treatment, so lets just look at the 20% that remain:

First of all, "mild symptoms" would be included in the symptomatic population that this study uses, and upon which Cory's study's 1.3% symptomatic mortality rate is based. In other words, the 1.3% mortality is not among people who seek medical attention as you seem to be suggesting, but among all people who develop symptoms. So your exclusion of mildly symptomatic people is mistaken.

But more directly (and partly as a result of you clumping asymptomatic and mildly symptomatic people together), your 80% figure is wildly off base.

For example, study [1] in the most closely study covid-19 population, the people on the Diamond Princess cruise ship, found only 17.9% of covid-positive patients were asymptomatic throughout the course of their infection. Here is another data point from Washington state nursing homes:

Of the 76 [nursing home] residents who participated in the surveys, 48 (63%) tested positive. Twenty-seven (56%) of the 48 had no symptoms when tested, and 24 of them later had symptoms within a median of 4 days.

So in this case, only 3 of 48 (6.25%) got through their infection without any symptoms.

So the actual percent of asymptomatic people appears to be far lower than you seem to be suggesting. The problem with many single-point-in-time estimates of asymptomatic percentages is that they fail to account for people who are pre-symptomatic, i.e. who will eventually go on to develop symptoms.

So getting back to corybroo's paper. If rather than 6.25% or 17.9% we use a more generous 25% estimate for people who remain completely asymptomatic throughout infection (rather than the 80% you speculated) then the 1.3% fatality rate on symptomatic people among 65M (20% of US) would result in 65M * 0.75 * 0.013 = 633,000 deaths, which is in the middle of the 350K to 1.2M that the study estimates, and very close to the total US death toll from the 1918 flu pandemic (although lower on a per-capita basis since the population was 1/3 what it is today).

The upper end of the scale (1.2M) is meant to account for the fact that with its higher infectiousness, the coronavirus could infect many more than 20% of the population. If instead of 20%, we assume herd-immunity level infection rates (~65%) in the US, the death count would be estimated at 330M * 0.65 * 0.75 * 0.013 = 2.1M.

--Dean

--------

[1] Euro Surveill. 2020 Mar;25(10). doi: 10.2807/1560-7917.ES.2020.25.10.2000180.

Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19)
cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020.

Mizumoto K(1)(2)(3), Kagaya K(4)(2), Zarebski A(5), Chowell G(1).

Author information: 
(1)Department of Population Health Sciences, School of Public Health, Georgia
State University, Atlanta, Georgia, United States.
(2)Hakubi Center for Advanced Research, Kyoto University, Yoshidahonmachi,
Sakyo-ku, Kyoto, Japan.
(3)Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto
University Yoshida-Nakaadachi-cho, Sakyo-ku, Kyoto, Japan.
(4)Seto Marine Biological Laboratory, Field Science, Education and Reseach
Center, Kyoto University, Shirahama-cho, Nishimuro-gun, Wakayama, Japan.
(5)Department of Zoology, University of Oxford, Oxford, United Kingdom.

On 5 February 2020, in Yokohama, Japan, a cruise ship hosting 3,711 people
underwent a 2-week quarantine after a former passenger was found with COVID-19
post-disembarking. As at 20 February, 634 persons on board tested positive for
the causative virus. We conducted statistical modelling to derive the
delay-adjusted asymptomatic proportion of infections, along with the infections' 
timeline. The estimated asymptomatic proportion was 17.9% (95% credible interval 
(CrI): 15.5-20.2%). Most infections occurred before the quarantine start.

DOI: 10.2807/1560-7917.ES.2020.25.10.2000180 
PMCID: PMC7078829
PMID: 32183930  [Indexed for MEDLINE]
 

[Gordo]

Do you think its a good idea though to base your assumptions about asymptomatic or mild symptom rates on cruise ship and nursing home populations and then apply that at a national level?  Also note that such calculations are worthless for projecting deaths because they don't take into account protections for the most vulnerable (including nursing homes) which undoubtedly will strengthen.  A new analysis shows that the percentage of national COVID-19 deaths that occurred in nursing homes and assisted living facilities is at least 40%.  In my (our) state its even higher than that.  We are also seeing many effective new treatments that will help the most vulnerable:

Johns Hopkins to launch trials of blood plasma treatment for COVID-19

Coronavirus Treatment: Blood from Recovered Patients Is Safe to Use, Comprehensive Study Reveals

Takeda says coronavirus treatment trial using recovered patients' blood could start in July

 

Edited May 19, 2020 by Gordo

[Dean Pomerleau]

25 minutes ago, Gordo said:

Do you think its a good idea though to base your assumptions about asymptomatic or mild symptom rates on cruise ship and nursing home populations and then apply that at a national level? 

That's why I used a more generous 25% asymptomatic rate rather than 18% or 6.25% from the cruise ship and nursing home populations. Here is another study [1] of 36 children from China diagnosed with covid-19. Only 28% of them never developed symptoms. Given how mildly covid-19 hits kids relative to adults, I think a 25% rate of completely asymptomatic cases population wide is pretty generous.

On your other point, I think you overestimate our ability to effectively shield vulnerable populations.

--Dean

--------

[1] Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study.
PMID: 32220650PMC7158906Mar 30, 2020 
Qiu, Haiyan; Wu, Junhua; Hong, Liang; Luo, Yunling; Song, Qifa; Chen, Dong  Lancet Infect Dis
Full TextTransmissionMechanismDiagnosis
BACKGROUND: Since December, 2019, an outbreak of coronavirus disease 2019 (COVID-19) has spread globally. Little is known about the epidemiological and clinical features of paediatric patients with COVID-19. METHODS: We retrospectively retrieved data for paediatric patients (aged 0-16 years) with confirmed COVID-19 from electronic medical records in three hospitals in Zhejiang, China. We recorded patients' epidemiological and clinical features. FINDINGS: From Jan 17 to March 1, 2020, 36 children (mean age 8.3 [SD 3.5] years) were identified to be infected with severe acute respiratory syndrome coronavirus 2. The route of transmission was by close contact with family members (32 [89%]) or a history of exposure to the epidemic area (12 [33%]); eight (22%) patients had both exposures. 19 (53%) patients had moderate clinical type with pneumonia; 17 (47%) had mild clinical type and either were asymptomatic (ten [28%]) or had acute upper respiratory symptoms (seven [19%]). Common symptoms on admission were fever (13 [36%]) and dry cough (seven [19%]). Of those with fever, four (11%) had a body temperature of 38.5 degrees C or higher, and nine (25%) had a body temperature of 37.5-38.5 degrees C. Typical abnormal laboratory findings were elevated creatine kinase MB (11 [31%]), decreased lymphocytes (11 [31%]), leucopenia (seven [19%]), and elevated procalcitonin (six [17%]). Besides radiographic presentations, variables that were associated significantly with severity of COVID-19 were decreased lymphocytes, elevated body temperature, and high levels of procalcitonin, D-dimer, and creatine kinase MB. All children received interferon alfa by aerosolisation twice a day, 14 (39%) received lopinavir-ritonavir syrup twice a day, and six (17%) needed oxygen inhalation. Mean time in hospital was 14 (SD 3) days. By Feb 28, 2020, all patients were cured. INTERPRETATION: Although all paediatric patients in our cohort had mild or moderate type of COVID-19, the large proportion of asymptomatic children indicates the difficulty in identifying paediatric patients who do not have clear epidemiological information, leading to a dangerous situation in community-acquired infections. FUNDING: Ningbo Clinical Research Center for Children's Health and Diseases, Ningbo Reproductive Medicine Centre, and Key Scientific and Technological Innovation Projects of Wenzhou.

[Gordo]

1 hour ago, Dean Pomerleau said:

I think you overestimate our ability to effectively shield vulnerable populations

Other countries hit hard and ahead of us seem to have found a way to do this:

[Sibiriak]

9 minutes ago, Gordo said:

[Dean P: I think you overestimate our ability to effectively shield vulnerable populations]

Other countries hit hard and ahead of us seem to have found a way to do this: 

What way? What exactly are you claiming  they did to shield the vulnerable?

[Ron Put]

2 hours ago, Dean Pomerleau said:

That's why I used a more generous 25% asymptomatic rate rather than 18% or 6.25% from the cruise ship and nursing home populations....

And you are still wrong, just as you have been with all of the other nonsensical "models" you have been posting, predicting hundreds of thousands to over a million dead in the US.  Enough already.

The Iceland study shows 50% asymptomatic and Sweden shows that well over 90% have mild enough symptoms not seek medical help.

Iceland’s testing suggests 50% of COVID-19 cases are asymptomatic

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53 minutes ago, Sibiriak said:

What way? What exactly are you claiming  they did to shield the vulnerable?

You mean, other than not forcing nursing homes to accept Covid-19 patients?

Coronavirus spreads in a New York nursing home forced to take recovering patients
Three states hit hard by the pandemic — New York, New Jersey and California — have ordered nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals. The policy, intended to help clear in-demand hospital beds for sicker patients, has prompted sharp criticism from the nursing home industry, staff members and concerned families, as well as some leading public health experts.

“Nursing homes are working so hard to keep the virus out, and now we’re going to be introducing new COVID-positive patients?” asked David Grabowski, a professor of health policy at Harvard Medical School.

Edited May 19, 2020 by Ron Put

[Sibiriak]

7 minutes ago, Ron Put said:

You mean, other than not forcing nursing homes to accept Covid-19 patients?

Yes.