Coronavirus

[Fobble]

Anyone with an IQ in the set of positive integers will not stop social distancing until a vaccine is developed and has been deployed.

Can be done even before anti virus vaccine is developed. One is fast test, ie, get results within 5 mins or less and tests are readily available to deploy around airports and malls, office lobbies etc. Second is to have anti-body tests to test everyone's ability to resist the virus. This is to increase self-confidence.
Of course anti virus vaccine is the ultimate solution, but it can be a while.

 

[jbcarioca]

...
80% of those on a vent die.

Everyone who is familiar with morbidity from any pulmonary disease is quite well aware that the crucial distinction is exactly that one SageBrush so sagely stated;

~80% of people put on ventilators die. Nobody every goes on a ventilator (apart from a handful of surgical cases) has a good prognosis for survival. As much effort as needs to be placed on adequacy of ventilator access, that is for the most critically ill patients.

For the others in the world. Masks, PPE, more masks, more PPE. Further, all medical persons who are involved in intubation need very, very excellent PPE. In Spain, Italy, New York, Wuhan and everywhere else, people involved with ventilator recipients are at vastly higher risk. For some reason this receives less attention than it should.

 

[SageBrush]

Everyone who is familiar with morbidity from any pulmonary disease is quite well aware that the crucial distinction is exactly that one SageBrush so sagely stated;

~80% of people put on ventilators die. Nobody every goes on a ventilator (apart from a handful of surgical cases) has a good prognosis for survival.

The 80% mortality I quoted is specifically Covid-19 patients on ventilators. You are quite right though, elderly people placed on vents with primary respiratory failure from any cause have a poor prognosis.

 

[Daniel in SD]

If it's all the same to everyone else, I'd like to avoid this nonsense logic as we unpack all the data. Freaking out and going into mediocre ineffective lockdown did not push the death toll down from 2.2M to 70k.

I would wait until we have large scale antibody testing to make that determination. Unless you have another theory how only a small fraction of the population might be infected?
Also, worst case scenario is definitely still in the cards...

 

[Daniel in SD]

Think we should be grateful that this virus isn’t slightly more lethal, because our response would not have been any different.

I had been thinking about this. If SARS-CoV-2 were as deadly as SARS classic or MERS would there be more deaths or fewer deaths? I feel like people would be way more scared and the initial response would have been far more extreme and effective than it was.

 

[jhm]

With some degree of irony, I'd like to present a chart I put together this morning. It is a scatter plot of naïve CFR vs tests per confirmed case. The idea is to help us understand a little better what role higher frequency testing plays in uncovering lower mortality cases.

Can you really get to a lower nCFR simply by testing more. Maybe there is some latitude for this. The regression curve tries to capture the trend. But what is abundantly clear is that there is substantial variation in deaths per case that cannot be explained by testing frequency alone. Indeed some of the highest variability in nCFR exists where there are more than 20 tests per confirmed case.

Not also the cluster of states where tests per case are the lowest. These are really problematic states. Few than 5 tests per case may not be adequate to manage outbreaks. In states like NY, it could be that growth in infections is simply outrunning the availability of tests. If I were in control of national resources I would want to focus available testing resources on states with fewer than 10 tests per case.

 

[dhanson865]

Snapshot for Apr 5 numbers

Italy ~12.3% (no change)
Spain ~9.6 (up from 9.5 the prior day)
USA ~2.9 (up from 2.7% the prior day)
France ~8.7 (up from 8.4% the prior day), no longer has note about nursing home deaths on daily update
UK ~10.3% (no change)
Iran ~6.2% (no change)
China ~4.1% (no change)

note this is not a relative change, these are total deaths/total cases so for France or USA to jump up multiple tenths requires a significant surge in daily deaths.

 

[deonb]

I had been thinking about this. If SARS-CoV-2 were as deadly as SARS classic or MERS would there be more deaths or fewer deaths? I feel like people would be way more scared and the initial response would have been far more extreme and effective than it was.

I think even if this virus was just called "SARS" or even "SARS-2" at the start instead of "Coronavirus", you wouldn't have had world leaders so dramatically under-react with their "This is just a Flu" nonsense.

That could have given the US another 6 weeks extra in response time which would have made a massive difference. People would have also been much more likely to obey lockdown orders as well - even if the R0 and IFR was the same as it is now.

 

[bkp_duke]

Your high horse keeps getting higher. Careful. I suspect you don’t bounce as well as you once did.

Unlike many here, I come with the game to back up my high horse.

Thanks for playing.

 

[bkp_duke]

My understanding is that we will be able to relax social distancing by:
4) After reduction to manageable number of infections, implementation of massive testing, quarantining and contact tracing. (Although I haven’t seen any plans from US leadership along these lines).

Likely we will see an oscillating effect as social distancing is relaxed, and that will result in fresh waves of new cases.

Of course, we will never know if no one is actually doing enough testing.

 

[bkp_duke]

@bkp_duke posted something earlier today that there is some evidence at least some of the people who are getting sickest with COVID-19 have multiple infections. If true, it's possible that hydroxychloroquine may help with some of the secondary infections and thus help overall. I'm just speculating here.

Sadly, this is likely not true. While tests with HCQ are ongoing for COVID-19, we have a lot of data of HCQ with other viruses.

I'm not kidding when I said we've known about the in vitro (test tube) properties of HCQ since the 1960/70s. Unfortunately not in a single instance did that ever translate to helping in vivo (in a person). In fact, in one report I was reading there was decent data that it made influenza worse.

 

[MXLRplus]

My understanding is that we will be able to relax social distancing by:
4) After reduction to manageable number of infections, implementation of massive testing, quarantining and contact tracing. (Although I haven’t seen any plans from US leadership along these lines).

Wouldn't contact tracing at this point where there is far less than 1% national infection actually be more of a new vector and less than prophylactic? We don't have 200 million (2018) networked cameras with facial recognition like they do in China, it would have to done with humans.

It would be nice if there was a card for people who were positive for C19, and now test negative.

I'm not the only American who fears that this plague is going to be the excuse needed to begin the process to repeal the Bill of Rights. We have eroded it, but not came out and directly said it's threat to national interests.

Just read the BoR right now, and look at how many are affected by situation today. Even the 2nd Amendment, which has little to do with the outbreak, was nerfed in California, and perhaps other places.

 

[bkp_duke]

This is a quote from the NYTimes article ( Official Counts Understate the U.S. Coronavirus Death Toll — The New York Times )

“I kept trying to get him tested from the beginning,” Ms. Murillo said. “They told me no.”

Frustrated, Ms. Murillo enlisted friends to call the C.D.C. on her behalf, urging a post-mortem test. Then she hired a private company to conduct an autopsy; the owner pleaded for a coronavirus test from local and federal authorities.

On Saturday afternoon, 19 days after the death, Ms. Murillo received a call from the Los Angeles County Department of Public Health, she said. The health department had gone to the funeral home where her husband’s body was resting and taken a sample for a coronavirus test. He tested positive.”

How long does the CV19 last on/in a body? Do we know?

Cellular decomposition, especially in a refrigerated setting like a morgue or funeral home, would be very slow and would preserve the tissue properly for a test like this. I don't have numbers for Coronavirus, but when I worked with Adenoviruses we could keep them viable for months at 4 C, and decades at -40 C. I'm sure my old mentor still has the viruses I worked on in cold storage somewhere.

 

[EinSV]

Potentially promising sign for California that Governor Newsom is comfortable joining the states that have given ventilators to other states more in need ....

 

[SageBrush]

I've been following Covid-19 in my NM county of ~ 650k population. Peak daily cases occurred 10 days after SAH was instituted, which matches up well with two incubation periods. The corollary is that locales with peaks later than 10 days after SAH is started implies less than complete compliance with the order, or infection during shopping.

I wrote earlier that Gov should mandate mask use for all customer facing retail workers, but a smarter move would be to mandate mask use for everybody entering a store. We already have stores placing a worker at the doors to ration number of people in the store at a time so it would easy to use that person to police masking.

 

[bkp_duke]

18% drop in world deaths last 24 hours after 3 days of stable deaths. Looks like the April slow down is here

Strongly caution people to not put a lot of faith in single day numbers, especially over the weekends. Hospitals and labs run lower staff numbers on the weekends. You could see a surge in cases on Monday / Tuesday as the labs catch up on reporting.

 

[traxila]

I had been thinking about this. If SARS-CoV-2 were as deadly as SARS classic or MERS would there be more deaths or fewer deaths? I feel like people would be way more scared and the initial response would have been far more extreme and effective than it was.

That is why I said slightly more lethal. For example a five to seven percent death rate, instead of a two to four (I know we are still not sure...). The response probably would have been the same. But as we all know here, the difference would be catastrophic in lives.

 

[bkp_duke]

That is why I said slightly more lethal. For example a five to seven percent death rate, instead of a two to four (I know we are still not sure...). The response probably would have been the same. But as we all know here, the difference would be catastrophic in lives.

So, SARS and MERS have significantly different infection profiles:
1) The data we have on them show they do not have viral shedding till symptoms occur. This makes containment far easier since you don't have the "silent spreaders"
2) Both viruses have a substantially higher mortality rate. It's high enough that there is a significant degree of the virus "burning itself out" before it can spread further.

 

[powertoold]

Strongly caution people to not put a lot of faith in single day numbers, especially over the weekends. Hospitals and labs run lower staff numbers on the weekends. You could see a surge in cases on Monday / Tuesday as the labs catch up on reporting.

I didn't, that's why I said after 3 days of stable deaths, the deaths dropped 18% on 4th day. 4 days is almost one incubation period, which is a good sample.

 

[deonb]

Some musings on how Italy would need to contain this after lock down is lifted:

How Italy is Preparing for Phase 2 - Leaders League