Coronavirus

[madodel]

Deaths were under-reported over Thanksgiving, on top of the normal weekend under-reporting. We'd need almost 4000 today and another 4000 tomorrow to fully catch up. If it takes until Friday to catch up we'll see more like 3000/day. I don't see a good way to isolate the catch-up effect. We'll have to wait for next week to get clean numbers.

My mother in law died this past Saturday. I was wondering if her death was included in the daily counts since she didn't die in a hospital or nursing home, but died in an assisted living facility. I asked our Coroner how the death is reported. At least in Pennsylvania all nursing homes and assisted living facilities have to report deaths and cases to both our state Department of Health and to the County Coroner/Medical Examiner. He said it is a crosscheck to make sure both the county and the state have the same information.

Edit: Just received the latest COVID numbers from the assisted living place where my M-I-L resided. They are now up to 59 residents testing positive with COVID and 7 employees. Nothing about deaths. This place only has a capacity of 96 residents.

 

[AlanSubie4Life]

Any guesses on the number tomorrow? I'm putting the over/under at 2400 deaths.

Seems totally reasonable, but would prefer not to wager. Data this week is all messed up due to delays. In any case, we'll see single-day totals of ~3500, probably on Wednesday the 9th or Wednesday the 16th, which will not be disturbed by the long weekend. Bad times.

 

[byeLT4]

Update on my county since we crossed a 'milestone'....

Just over 90k people total, 2 more people passed away yesterday bringing us to 101 deaths total. Currently 269 active cases (34 new), with 4766 'recovered'.

To be honest I thought we would be doing a lot worse in this wave. I know there is still time so maybe I should just keep my masked mouth shut....

 

[AlanSubie4Life]

So why the delay till the 10 th of December. Are they awaiting more data or is it a scheduling thing.

Follow up on this. Basically other countries (UK in particular, MHRA is their agency) have been reviewing data in advance. Not so in the US! Operation Warp Speed?

Really was impossible to predict this problem.

 

[30seconds]

Follow up on this. Basically other countries (UK in particular, MHRA is their agency) have been reviewing data in advance. Not so in the US! Operation Warp Speed?

Really was impossible to predict this problem.

View attachment 613712

Rolling review is an option in US as well. This would be Pfizer's choice to submit it this way.

The Advisory Committee is not a requirement, but it is an option by the FDA. I suspect that they are using it to supplement the shortened review time.

For reference an "accelerated review" by the FDA is a six month review. Typical review time is closer to 1 year. Europe is usually close or slightly longer than these times.

I don't know of any therapeutic that has been reviewed and approved in a matter of weeks by either the FDA or the EMA (European equivalent)

 

[AlanSubie4Life]

Any guesses on the number tomorrow? I'm putting the over/under at 2400 deaths.

The over would have been the clear bet here, with the overhang. Second highest deaths reported on a single day ever. Next week, or possibly even this week, we'll see record numbers. I expect deaths to peak about 75% higher than current numbers, so somewhere around 2800 for the 7-day average, with a single-day peak of 3500-4000 (the amplitude of the single-day peak has a lot of uncertainty, as it depends on which states the deaths are coming from and how the reporting is done in those states). That's assuming there's not a larger second surge from Thanksgiving of course. All pretty brutal.

For those concerned about mutations escaping the vaccine, it sounds like low probability, given the number of antibodies that are generated by the body to bind to the spike protein which is expressed via the vaccine. A good thread:

https://twitter.com/jbloom_lab/status/1334175652463800324?s=20

Sounds like it's possible that we might need new vaccines occasionally, but it's not a certainty. If we can vaccinate the entire world fast enough, we might be able to eradicate the virus. Lots of animal reservoirs though. We'll see. In any case, sounds like this is likely more of a long-term (several years) problem than a short-term problem.

 

[Jeff N]

This has also been shot down by Prof. Shane Crotty, who studies immunology. In serious academic circles, after initial study, the cross-reactivity was thought to most likely just result in a lower IFR than COVID would otherwise have had, had the cross-reactivity not existed in the population. There was never any evidence that cross-reactivity prevented infection or lowered the HIT - and in fact there were plenty of counterexamples (massive cities (Manaus), prisons, boats, small towns, etc.) showing that cross-reactivity likely did not prevent infection. So not sure why any rational person would cling to the idea that it does. But clearly Dr. Atlas clung to that!

I don’t think it’s really been shown yet that this cross-reactivity actually has much effect in reducing disease or the IFR yet. Prof. Crotty and others have warned against assuming that they provide significant protection without more evidence.

 

[AlanSubie4Life]

Prof. Crotty and others have warned against assuming that they provide significant protection without more evidence.

That's correct, they aren't sure about that aspect of things, I'm just saying that's as far as they'll go with what is possible - there's a tweet from him to that effect. It's something that would require further investigation to prove one way or another. In any case it doesn't matter much in the short term practical sense - the IFR is what it is; it's not like we're going to go infect people randomly with other coronaviruses in the hope it provides some protection. On the science front, it does matter for understanding immune function and what might affect disease trajectories in different individuals.

 

[heltok]

https://www.lamayor.org/sites/g/fil...2 Mayor Public Order Targeted SAH Order_1.pdf
Subject only to the exceptions outlined in this Order, all persons living within the City of Los Angeles are hereby ordered to remain in their homes.

 

[AlanSubie4Life]

https://www.lamayor.org/sites/g/files/wph446/f/page/file/20201202 Mayor Public Order Targeted SAH Order_1.pdf
Subject only to the exceptions outlined in this Order, all persons living within the City of Los Angeles are hereby ordered to remain in their homes.

No really substantial changes here unless you're in one of the affected businesses. More or less seems like life as normal, as it has been in SoCal for the last 8 months. Only thing I see is that for some reason K-6 is not being allowed to go back to school in-person, which should be driven by the data (I don't know what the data say, but I repeatedly see reputable people say it is probably an acceptable risk/reward tradeoff). For some reason playgrounds are closed too, which I am also not sure is supported by data. If it is, so be it.

I'm not sure why we didn't just do this same thing for longer nationwide, and just get cases to basically zero, roll out all the fast antigen tests, do tens of millions of tests a day, and go back to a near normal life. Back in May. Oh well.

If you're one of the many lucky people who aren't directly affected by this stuff, life can go on pretty much as normal. Just can't hang out with anyone or go anywhere inside. It's not bad at all really, and life goes on. Unless you have an essential job and are exposed, or you have no choice in the matter in some other way.

 

[dhanson865]

"All Knox County benchmarks are now red, including hospital capacity. Only 8 ICU beds are available in East Tennessee--that's 97.2% ICU capacity. Overall hospital capacity is at 93.2%. "

Think about it, an area of over 2.3 million people has 8 ICU beds open.

"It comes as the hospital systems and @ KnoxCoHealthTN have re-evaluated the number of hospital beds available and removed ones for labor and delivery, for example."

One month ago (November 2)

• Number of Confirmed Cases: 13299
• Number of Inactive Cases: 12535
• Number of Active Cases: 1332
• Probable Cases: 675
• Hospitalizations: 471
• Currently Hospitalized: 62
• Deaths: 107

Today (December 2)

• Number of Confirmed Cases: 19315
• Number of Inactive Cases: 17645
• Number of Active Cases: 2597
• Probable Cases: 1106
• Hospitalizations: 609
• Currently Hospitalized: 130
• Deaths: 179

 

[dhanson865]

hospitalizations going up at a quicker pace that positive cases.

 

[AlanSubie4Life]

hospitalizations going up at a quicker pace that positive cases.


View attachment 614021

If you have access to infections by age for this jurisdiction, you could see whether this is because the infections are moving into the older population (this is one possibility for why this is happening). Also that dip appears to be Thanksgiving related on the case front, so is somewhat artificial.

 

[alloverx]

COVID patient with sepsis makes 'remarkable' recovery following megadose of vitamin C

 

[ZeApelido]

Have we really improved treatment of hospitalized patients with COVID? My data does not show any clear reduction in death rate / hospitalized rate in the last 6 months.

 

[EVCollies]

At our weekly Team meeting our system showed a decrease in hospitalized mortality from 25% with the first wave down to 10% with current wave. I can imagine the mortality of the second wave could increase with time though as patients progress through their illness.

 

[AlanSubie4Life]

Have we really improved treatment of hospitalized patients with COVID?

At our weekly Team meeting our system showed a decrease in hospitalized mortality from 25% with the first wave down to 10% with current wave. I can imagine the mortality of the second wave could increase with time though as patients progress through their illness.

Not knowing anything about how/whether treatment has really improved a lot (I suspect it is slightly improved (better ventilator settings, better understanding of when to use anti-clotting drugs, etc.) but no idea), the issue with these stats is that the sample of patients hospitalized is changing with time. Early in the pandemic, it was likely that only the sickest patients would show up at the hospital, and (importantly) they were more likely further along in the course of the disease (worse for prognosis from what I understand). These changes in patient composition are probably due to availability of testing (only the sickest patients got tested early on) and also patient awareness that this is a serious disease. (Early on, a lot of people may have chosen to stay at home and tough it out, or in a few cases, just die at home.)

I don't know. It seems like something a hospitalist (you, as I understand it?) would have a better gauge of - again, I'm not saying that treatment hasn't improved. I'm just a guy on the internet who knows nothing about medicine. But reducing mortality by more than a factor of 2? I'm not so sure. Certainly the "80% reduced mortality" that people talk about is a load of nonsense. Yes, CFR has dropped by that amount, but I'm not sure why anyone thinks of that is due to reduced mortality or due to better treatment - it's primarily due to better testing!

CFR these days is fairly stable at about 1.5-1.7%, FWIW. Obviously it does change a little bit with time as waves move from younger to older populations, with slightly different age distributions over time. But it's remarkably stable, and when you look at the aggregate national CFR, these wave variations in CFR tend to get smoothed out, since all states have somewhat different surge phases.

That's why we're headed to nearly 3000 deaths per day (7-day moving average) over the next two weeks or so. (To be clear, we're probably losing that many people this week and next week - but it will be another week or two before that is reported.)

 

[ABCTG]

Governor Newsom of California will give updates on latest response to Covid

12PM Pacific Time

 

[madodel]

Former Presidents Obama, Bush and Clinton volunteer to get coronavirus vaccine publicly to prove it's safe - CNNPolitics

Former Presidents Barack Obama, George W. Bush and Bill Clinton are volunteering to get their Covid-19 vaccines on camera to promote public confidence in the vaccine's safety once the US Food and Drug Administration authorizes one.

 

[wdolson]

Have we really improved treatment of hospitalized patients with COVID? My data does not show any clear reduction in death rate / hospitalized rate in the last 6 months.

Others have weighed in with their data and I agree with them. Another way to look at it is the infection rate and hospitalization rate with the current wave is way higher than the two previous spikes in cases, but the death rate is smaller proportionally to the same point in the wave as the previous two. The total death rate is the highest yet, but the infection rate but that is due to the extremely high infection rate.