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

[Gordo]

2 hours ago, Mike41 said:

What’s this got to do with this thread??

It wouldn’t be any fun if I had to connect all the dots 🙂 but yes, I do think the riots are at least partially linked to the state of unrest produced by the lockdowns. There is no way to prove that of course.  In other news, check out these fun pics as restaurants reopen!

Edited May 28, 2020 by Gordo

[Saul]

Yum!

[Gordo]

Another good data point for random testing this time in San Francisco. Only 2% were infected (and none of those were Caucasian) and 53% of the infected were asymptomatic.

Since you guys seem to like making predictions- what odds do you give to a “second wave”?  Just based on what seems like mediocre compliance on prevention, no evidence of a serious tracking and contact tracing capability, the continuing steady daily new cases, and the presumably very low total infections as a percentage of the population, it seems like better than 50/50 odds of a second wave to me. It may be even worse if there is a Summer lull and people just start acting like it’s all over. It doesn’t seem likely that it will just burn out like SARS-CoV-1 did. A vaccine being ready and effective is another big wildcard with its own set of odds 😉

 

Edited May 29, 2020 by Gordo

[Todd Allen]

13 minutes ago, Gordo said:

it seems like better than 50/50 odds of a second wave to me

I don't see much evidence of the first wave ending any time soon.  Although new cases and death rates are down in places that have been hard hit such as Italy, France and Spain none of these places have achieved the very low rates of places that acted quickly for containment through tracking, tracing and quarantining the infected.  Here in the US some hot spots such as New York and New Jersey have made progress similar to European hot spots.  But other states are seeing increases such as here in Illinois.  I expect a long game of whac-a-mole.  As places hard hit react strongly to suppress the spread others will be relaxing and some of those will become new hot spots.  The rapid recent growth of cases and deaths in Mexico suggests to me that while summer may slow the virus in the US I don't expect dropping to minimal case rates without a focused containment effort which seems unlikely.  I have seen headlines stating far more younger people are dying in Mexico although the stories were on sites requiring subscription or not allowing ad blockers so I don't yet have further details and maybe there is something special going on there that doesn't affect the US similarly and we'll get a lucky summer reprieve.

I'm not predicting anything, there's too much uncertainty, just sharing my thoughts.

[Dean Pomerleau]

I agree with Todd that the first wave isn't going away but is likely to persist throughout the summer. The model that has been most accurate is predicting that the US daily death toll will hover around 1000 throughout the summer, with a total US deaths by Sept 1st of about double what it is now (202K, 95% CI 125-346K). Here is the graph:

It seems more likely than not that daily new cases and deaths will go up from there during the fall and winter months as schools reopen and people spend more time indoors, barring the discovery of effective prophylactics and/or treatments.

--Dean

[Dean Pomerleau]

A while back we discussed the true rate of completely asymptomatic infections. It looks like my estimate of ~30% was a little low. A new (rather small) study from China published as a letter in JAMA found it to be around 42%. Those people whose complete course of infection was asymptomatic shed virus and hence were infectious for 8 days, compared with 19 days for symptomatic people.

ASYMPTOMATIC SARS-CoV-2 INFECTION A Research Letter published in JAMA Network Open describes the characteristics of asymptomatic SARS-CoV-2 infections identified in Wuhan, China. The study compiled clinical data from 78 patients, representing 26 COVID-19 clusters—identified between December 24, 2019, and February 24, 2020—with known epidemiological links to known cases or exposure at the Hunan Seafood Market in Wuhan. Among these patients, 33 (42.3%) were asymptomatic throughout their infection. The asymptomatic individuals tended to be younger than symptomatic individuals—median age of 37 years, compared to 57 years—and a higher proportion of asymptomatic infections were in females—66.7% of asymptomatic infections, compared to 31% of symptomatic cases. Additionally, asymptomatic individuals exhibited a shorter duration of viral shedding than symptomatic cases—median of 8 days in asymptomatic individuals, compared to 19 days in symptomatic cases.

--Dean

[Ron Put]

3 hours ago, Dean Pomerleau said:

A while back we discussed the true rate of completely asymptomatic infections. It looks like my estimate of ~30% was a little low. A new (rather small) study from China published as a letter in JAMA found it to be around 42%. ...

Yeah, well....

More than 80% of coronavirus patients on a cruise ship did not have any symptoms, new study says

"More than 80% of infected passengers and crew on an expedition cruise ship did not show any symptoms, raising questions about the true prevalence of “silent” coronavirus infections, according to a new study."

---


And here is something on Sweden, where Covid-19 deaths just passed the 4000 mark, which is the upper end for their estimated flu season deaths:
 

Sweden’s Economy Grew In Q1 In Absence Of Lockdown

Edited May 30, 2020 by Ron Put

[Ron Put]

Hah, here is another (non-reviewed) extrapolation which puts the number of Covid-19 infected in NY at the end of March was over 2 million.  So much for the reasons and usefulness of the lockdown.

Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York:

"Results: Among 15,101 adults with suitable DBS specimens, 1,887 (12.5%) were reactive using a validated SARS-CoV-2 IgG microsphere immunoassay (sensitivity 87.9%, specificity 99.75%). Following post-stratification weighting on region, sex, age, and race and ethnicity and adjustment for assay characteristics, estimated cumulative incidence through March 29 was 14.0% (95% CI: 13.3-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was higher among Hispanic/Latino (29.2%, 95% CI: 27.2-31.2%), non-Hispanic black/African American (20.2% 95% CI, 18.1-22.3%), and non-Hispanic Asian (12.4%, 95% CI: 9.4-15.4%) adults than non-Hispanic white adults (8.1%, 95% CI: 7.4-8.7%, p<.0001). Cumulative incidence was highest in New York City (NYC) 22.7% (95% CI: 21.5%-24.0). Dividing diagnoses reported to NYS by estimated infection-experienced adults, an estimated 8.9% (95% CI: 8.4-9.3%) of infections were diagnosed, with those ≥55 years most likely to be diagnosed (11.3%, 95% CI: 10.4-12.2%). Conclusions and Relevance: Over 2 million adults were infected through late March 2020, with substantial variations by subpopulations. As this remains below herd immunity thresholds, monitoring, testing, and contact tracing remain essential public health strategies."

Given the number of infections, the "contact tracing" bit at the end sounds like a required nod to the prevailing "correct" thinking of the day.

Edited May 30, 2020 by Ron Put

[Todd Allen]

10 hours ago, Ron Put said:

Hah, here is another (non-reviewed) extrapolation which puts the number of Covid-19 infected in NY at the end of March was over 2 million. 

One possible issue with that study is it was not a random sampling of population.  Sampling at grocery stores would bias it towards sampling people who are shopping more frequently and with grocery stores a likely point of exposure those who shop more frequently may have a greater exposure rate than the population as a whole.

[mccoy]

I just came across this section ot Britannica. It's interesting because it supports my previous reasoning that, if no alternatives are provided to a strong association, then the hypothesis of causation has a high degree of probability. This refers to previous discussions on excess mortality and its association with Covid-19, where there is a lack of alternative explanations.

 

Quote

Inferring Causality

Perhaps the greatest danger with all measures of association is the temptation to infer causality. Whenever one variable causes changes in another variable, an association will exist. But whenever an association exists, it does not always follow that causation exists. In epidemiology, the ability to infer causation from an association is often weak because many studies are observational and subject to various alternative explanations for their results. Even when randomization has been applied, as in clinical trials, inference of causation is often limited.

 

[mccoy]

Another more complete definition. the three criteria of causality hold for Excess mortality and Covid-19, since:

1. There is a covariation, or statistical association between the numbers of excess mortality and the numbers of infected people
2. The independent variable, # of infected people, has temporal precedence
3. There are no reasonable alternative explanation for the observed relationship.

 

 

Quote

 

What are the three criteria for causality?

There are three conditions for causality: covariation, temporal precedence, and control for “third variables.” The latter comprise alternative explanations for the observed causal relationship.Dec 15, 2010

 

Concept of Causality and Conditions for Causality - Oppewal - 2010

 

 

[Gordo]

Massive hydroxychloroquine study raising health concerns about the drug under scrutiny from scientists

At the world level, daily new infections just surged to an all time high although that hasn’t really been reflected yet in deaths:

Unrelated but I’ve been watching live coverage at night of the protests as they’ve been spreading and tonight these riots are expected in even more cities. 
Protests, some violent, spread in wake of George Floyd death
Cities brace for increasing unrest, call in National Guard
I believe with the economy imploding and frustration over being cooped up for so long it didn’t take much of an excuse to go out and create some mayhem.

https://youtu.be/iFBP0zpTj-o

 

Edited May 31, 2020 by Gordo

[Dean Pomerleau]

The Washington Post has an interesting article with a graphic showing changes in foot traffic to various types of businesses since early March both by state and as a national average.

Here is the data from Georgia, which was one of the earliest states to reopen (late April) compared with the US average (dashed line):

It looks like several types of Georgia businesses are seeing a slightly greater rebound in foot traffic than the national average. But everything except grocery stores, fast-food restaurants and barbers/salons are still way down both in Georgia and across the US.

The recovery looks to be progressing rather slowly so far.

--Dean

[Dean Pomerleau]

1 hour ago, Gordo said:

At the world level, daily new infections just surged to an all time high although that hasn’t really been reflected yet in deaths:

A while back I expressed concerned about the developing world getting hit hard by the virus. It appears to be happening, especially in South America with Brazil, Peru and Chile. New daily cases in Brazil are rapidly approaching the peak we saw in the US, which was just under 40K cases:

Perhaps not surprisingly given their limited medical infrastructure, the number of deaths relatively to number of diagnosed cases is already nearly identical to that of the US (5.8%). This may be due to more diagnosed patients dying as a result of less-effective medical care or fewer cases being diagnosed due to limited testing.

India and Bangladesh are also seeing a consistent rise in new cases:

Fortunately the reported covid-19 deaths in both countries are relatively low.

--Dean

[Todd Allen]

2 hours ago, Gordo said:

At the world level, daily new infections just surged to an all time high although that hasn’t really been reflected yet in deaths:

I've been watching this too.  I think comparing this to the death rate curve in a week or two will suggest to what degree this is an increase in new cases or newly discovered cases due to increases in testing.

Edited May 31, 2020 by Todd Allen

[Gordo]

Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis

Harvey A Risch

Abstract

More than 1.6 million Americans have been infected with SARS-CoV-2 and >10 times that number carry antibodies to it. High-risk patients presenting with progressing symptomatic disease have only hospitalization treatment with its high mortality. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir, and hydroxychloroquine+azithromycin. Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients. Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe.

[drewab]

Dr. Greger has a pretty extensive writeup in the DailyMail UK - great to see since that news outlet reaches millions. 

https://www.dailymail.co.uk/news/article-8370969/The-apocalyptic-killer-virus-coming-home-roost.html

 

[Todd Allen]

The cure may be worse than the disease at least for penny pinchers:

https://www.thedenverchannel.com/news/local-news/covid-survivor-receives-840-000-statement-for-treatment-with-more-on-the-way

[Gordo]

New coronavirus losing potency, top Italian doctor says

[Saul]

Hi Gordo!

Hope that's the case.

  -- Saul

[Sibiriak]

FWIW:

Virus still potent says WHO, after claim by Italian doctor

Quote

 

The World Health Organization stressed Monday that the new coronavirus has not suddenly become less pathogenic, following claims by a leading Italian doctor that Covid-19 had lost some of its potency.

“That is not the case at all,” WHO emergencies director Michael Ryan told a virtual press briefing.

The claims by Alberto Zangrillo sparked a furore on Monday, with the Italian government urging caution.

“In reality, the virus clinically no longer exists in Italy,” said Zangrillo, head of the San Raffaele Hospital in Milan, the capital of the northern Lombardy region, which has been the worst-hit by the pandemic.

“The swabs performed over the past 10 days have showed a viral load that is absolutely infinitesimal in quantitative terms compared to those carried out a month or two months ago,” he told RAI television on Sunday.

That prompted cries of disbelief from other experts, who said Zangrillo may have mistaken a higher detection rate of asymptomatic cases for diminished potency of the virus.

 

 

[Sibiriak]

Lockdown restrictions unsustainable:

Pakistanis urged to ‘live with the virus’

Quote

Pakistanis are being urged to “live with the virus” as the country’s prime minister Imran Khan pushes ahead with a plan to lift lockdown restrictions despite rising infections and deaths, citing the economic losses being suffered.

Pakistan has rolled back almost all measures, primarily to avert an economic meltdown. The country will open to tourism but cinemas, theatres and schools remain closed.The nation of 220 million has reported 72,160 cases and 1,543 deaths, which jumped lately to as high as 80 a day.

The country cannot afford to match the losses incurred as many other countries have done, Khan said. He cited 50 million people who live below the poverty line and 25 million daily wagers. He said his government has given cash handouts to the poor, which wasn’t possible to continue on such a large scale, adding around 130 million to 150 million people were adversely affected by the shutdowns.

    "Our conditions don’t allow that we keep feeding money to them, how long we can give them money."

He urged people to act responsibly but more infections and deaths were inevitable.

   "This virus will spread more. I have to say it with regret that there will be more deaths. If people do take care they can live with the virus."

 

 

In the US,  views are highly polarized and politicized,  thanks to the bane of "liberal democracy" known as "populism"  (and, of course,  Russian ops to "sow division and discord.")

Quote

Nearly 6 in 10 Americans say the coronavirus outbreak has exacted a severe economic toll on their communities, but a majority of a divided country still says controlling the virus’s spread is more important than trying to restart the economy, according to a Washington Post-ABC News poll.

The nationwide survey finds that despite the shared disruption of their daily lives since stay-at-home orders began, partisans differ sharply on how the country should move forward.

In the starkest split, 57 percent of Americans overall and 81 percent of Democrats say trying to control the spread of the coronavirus is most important right now, even if it hurts the economy. A far smaller 27 percent of Republicans agree, while 66 percent of them say restarting the economy is more important, even if it hurts efforts to control the virus. Nearly 6 in 10 independents say their priority is trying to control the virus’s spread.

 

Edited June 2, 2020 by Sibiriak

[mccoy]

6 hours ago, Sibiriak said:

That prompted cries of disbelief from other experts, who said Zangrillo may have mistaken a higher detection rate of asymptomatic cases for diminished potency of the virus.

He's the head of anesthesiology and says he's recounting the empirical evidence in his hospital. Truth is that, the Covid-19 sections are emptying now, he says, and he's speaking up as an opponent of the strong government line, together with others. He cites SARS and MERS which suddenly disappeared and SARS-CVO2 might follow suit. It will be interesting to see the developments, if the infections and deaths will steadily decline in Italy or if they'll peak out again after the release of the lockdown. The danger is that the 'mass response time' to the infection is slow and that this decline is the effect of the draconian lockdown itself. Then we should see a steady increasing trend in one or two months. At this juncture, clairvoyance should be needed but the fear is that the words of the professor might trigger a false sense of assurance int the population. Especially young people, as we know,  tend to be foolhardy.

The declining infections might be interpreted as a higher number of asymptomatic detected, but the decline in deaths is probably underestimated since it has been shown that at the beginning deaths were grossly underestimated in the main outbreak areas whereas now the death counts appear to be more accurate.

Put together, the two following graphs are pretty eloquent.

Edited June 2, 2020 by mccoy

[Ron Put]

7 hours ago, mccoy said:

He's the head of anesthesiology and says he's recounting the empirical evidence in his hospital.

If I recall, there was a woman from the same hospital which a couple of months ago came out saying that the Italian government is over-reacting, but she was savaged in the Italian and the British press, called incompetent and there were calls for her to be fired.

Yet now, with the lock  down for which others will pay, we have 33000 dead in Italy, which is likely higher than the real number, since not all the "probables" died from Covid-19. 

To place it in perspective, the 2017-2018 flu season death toll in Italy was at 25000+, with barely a mention.  

[Ron Put]

China withheld data on coronavirus from WHO, recordings reveal

The World Health Organization struggled to get needed information from China during critical early days of the coronavirus pandemic, according to recordings of internal meetings that contradict the organisation’s public praise of Beijing’s response to the outbreak.

The recordings, obtained by the Associated Press (AP), show officials complaining in meetings during the week of 6 January that Beijing was not sharing data needed to evaluate the risk of the virus to the rest of the world. It was not until 20 January that China confirmed coronavirus was contagious and 30 January that the WHO declared a global emergency.

“We’re going on very minimal information,” said Maria Van Kerkhove, an epidemiologist and the WHO technical lead for Covid-19, according to the AP. “It’s clearly not enough for you to do proper planning.”

The WHO’s top official in China, Gauden Galea, said in one of the recordings: “We’re currently at the stage where yes, they’re giving it to us 15 minutes before it appears on CCTV [Chinese state TV].”

The report comes amid growing international scrutiny of China’s handling of the outbreak and moves to establish an independent investigation into the origins of the virus, which has infected more than 6 million and killed more than 375,000 people around the world.

...