Coronavirus

[Dr. J]

How Does Economic Recession Affect Substance Use? A Reality Check With Clients of Drug Treatment Centres - PubMed

Income and wealth inequality also just took a massive leap forward. Poverty obviously kills more than anything.

As your volunteer fact checker, I would point out the study cited is of a subset of illegal drug users, who probably are not representative of the general population:

Aims: The aim of the present study was to undertake a survey on behaviour and perspectives related to the latest European economic crisis among illegal drug users attending substance treatment services.

Also, I think it's too early to tell whether income and wealth inequality will have dramatically increased when this is over. I think the result depends on the policy response and on currently unknowable future economic conditions. Granted, I'm not optimistic on those fronts, and history would indicate what you say will come to pass. But we as citizens can determine whether that is our fate.

 

[Sancho]

Because this is a new threat, we are combatting it more aggressively than we do all existing threats of a similar morbidity. We don’t lock down the country for the flu, we don’t restrict alcohol more, even though it is directly responsible for so many deaths, etc

What would a policy look like if our goal was just to keep the morbidity in line with other causes?

Rather than lock down whole states, we might lock down only cities where there are fast spreading cases. And put reasonable travel restrictions between places. For sure, this less aggressive policy would mean that the virus would spread to a lot more places, and the overall death rate would be much higher, but not higher than other causes.

The economic and social toll of a less aggressive policy would be massively less destructive than what we are heading towards with state-wide shelter-in-place orders.

In the end, a society needs to balance harm vs cost of cure. In this case we’ve decided to solve for minimum deaths, but that is contrary to the way we solve for every other threat to human life.

We claim we are taking the more aggressive policies to “flatten the curve”, but locking down huge swaths of regions where there are few cases goes beyond flattening the curve. It is really a policy to minimize total deaths from this one cause of death, at whatever the cost to the economy and the human condition generally.

 

[JRP3]

Kind of makes you wonder if this virus hasn't been among us for a long time. How many times have we been sick with the "flu" when really it wasn't? How many of the 70,000 flu deaths this year in the U.S. weren't actually flu deaths? How about last year, the year before, etc... if news had never made it out of Wuhan about the outbreak there, would we even have noticed the < 300 U.S. deaths?

The rate of transmission and the symptoms of illness show that what you propose is simply not possible.

 

[dl003]

Getting a bit OT for this thread, so I'll try to be brief: Iceland has a company named deCODE Genetics, which was designed around doing whole-population genetic studies for disease modeling, so the company has been repurposed into doing randomized sampling of the population to look for COVID-19 in people who are not suspect cases - just the general public. They found the disease in around 1% of the general population over a period of a couple weeks (reported 1 week ago) - an implied per-capita rate twentyfold that of the country's official diagnoses at the time of reporting (which in turn has involved one of the most aggressive testing regimes in the world). Over half had no symptoms whatsoever, and the rest, generally just a minor cold.

In an experiment which started several weeks ago, Italy tested the entire town of Vò in a series of rounds and successfully eradicated the disease from the town. Again, this is one of the few cases of experiments of testing of the general population rather than suspect cases. 3% of the population was determined as infected during the first round. 50-75% of them were entirely asymptomatic. Most of the rest had only minor cold symptoms and did not suspect that they had the disease. During the study, asymptomatic cases usually remained asymptomatic, and most minor cases remained minor.

The net picture is that the disease was already widespread even several weeks ago; that people with no symptoms whatsoever are the majority; and of those with symptoms, symptoms so minor that people don't get tested are by far the most common. To match with the death rate (as severe cases almost always get tested), a widespread disease in the population implies a low IFR (infection fatality rate), and implies that places with overloaded medical systems are overloaded not because the disease sends a large percent of its victims to the hospital, but because a large percent of the population has already gotten infected. This implies that the disease will tend to play itself out sooner.

As mentioned, the other study I mentioned (still preliminary) estimated that Wuhan hit a 19% infection rate at its peak, and that the disease had a non-time-delay IFR of 0,04% and a time-delay IFR of 0,12%. They also found (as others have) that the disease is highly prone to nosocomical transmission (spread inside hospitals and clinics, generally by staff) - that is to say, prone to spread to the most vulnerable of patients. I.e. that stamping out nosocomical transmission is one of the most important steps that can be done. Both Wuhan and Lombardy had extensive problems with nosocomical transmission before the severity of the situation was realized.

ED: Well, so much for trying to be brief...

Thanks Karen. My little town in Central Texas just reported 10 cases out of the blue. 9 of them was asymptomatic/minor that they got sent home. The 10th one was in ICU but mainly for isolation purpose. They got sent home pretty quickly. Where do you think the inflection point is going to be? Do we just wait for new cases to drop? Do we wait a while for hospitals to report they're still functioning as normal? Do we have to both of these and drastic social changes like in China? Something else?

 

[Bobfitz1]

Getting as many RNA based tests available asap is surely the highest testing priority for now.

The article about new antibody tests explains why their results when available will also be very important.

There is a third type of test that can be done in labs that can fill in a remaining gap. The sample is cultured to see
if the virus that is or was in the patient is live and can still replicate. As the quote below states someone who has been infected
and recovers quickly (or was asymptomatic) can still test positive for days or weeks. This third test can show whether they are or are not infectious when tested. I don't know how easy, time consuming this culturing is or if labs need any special equipment.
But it seems like it would be a gold standard that can show when it is safe for the infected and recovered to go back to work safely.
Especially important for doctors and nurses who get infected and recover.

One downside of RNA tests: People 'shed' coronavirus early, but most likely not infectious after recovery

"People who contract the novel coronavirus emit high amounts of virus very early on in their infection, according to a new study from Germany that helps to explain the rapid and efficient way in which the virus has spread around the world.
At the same time, the study suggests that while people with mild infections can still test positive by throat swabs for days and even weeks after their illness, those who are only mildly sick are likely not still infectious by about 10 days after they start to experience symptoms.

The study, by scientists in Berlin and Munich, is one of the first outside China to look at clinical data from patients who have been diagnosed with Covid-19, the disease caused by the coronavirus, and one of the first to try to map when people infected with the virus can infect others."

 

[uselesslogin]

Because this is a new threat, we are combatting it more aggressively than we do all existing threats of a similar morbidity. We don’t lock down the country for the flu, we don’t restrict alcohol more, even though it is directly responsible for so many deaths, etc

What would a policy look like if our goal was just to keep the morbidity in line with other causes?

Rather than lock down whole states, we might lock down only cities where there are fast spreading cases. And put reasonable travel restrictions between places. For sure, this less aggressive policy would mean that the virus would spread to a lot more places, and the overall death rate would be much higher, but not higher than other causes.

The economic and social toll of a less aggressive policy would be massively less destructive than what we are heading towards with state-wide shelter-in-place orders.

In the end, a society needs to balance harm vs cost of cure. In this case we’ve decided to solve for minimum deaths, but that is contrary to the way we solve for every other threat to human life.

We claim we are taking the more aggressive policies to “flatten the curve”, but locking down huge swaths of regions where there are few cases goes beyond flattening the curve. It is really a policy to minimize total deaths from this one cause of death, at whatever the cost to the economy and the human condition generally.

Ventilators and PPE can be moved or prioritized to places that need them if other places in lockdown have spare resources. This can’t happen if we let it spread everywhere.

 

[bpjod]

Getting a bit OT for this thread, so I'll try to be brief: Iceland has a company named deCODE Genetics, which was designed around doing whole-population genetic studies for disease modeling, so the company has been repurposed into doing randomized sampling of the population to look for COVID-19 in people who are not suspect cases - just the general public. They found the disease in around 1% of the general population over a period of a couple weeks (reported 1 week ago) - an implied per-capita rate twentyfold that of the country's official diagnoses at the time of reporting (which in turn has involved one of the most aggressive testing regimes in the world). Over half had no symptoms whatsoever, and the rest, generally just a minor cold.

In an experiment which started several weeks ago, Italy tested the entire town of Vò in a series of rounds and successfully eradicated the disease from the town. Again, this is one of the few cases of experiments of testing of the general population rather than suspect cases. 3% of the population was determined as infected during the first round. 50-75% of them were entirely asymptomatic. Most of the rest had only minor cold symptoms and did not suspect that they had the disease. During the study, asymptomatic cases usually remained asymptomatic, and most minor cases remained minor.

The net picture is that the disease was already widespread even several weeks ago; that people with no symptoms whatsoever are the majority; and of those with symptoms, symptoms so minor that people don't get tested are by far the most common. To match with the death rate (as severe cases almost always get tested), a widespread disease in the population implies a low IFR (infection fatality rate), and implies that places with overloaded medical systems are overloaded not because the disease sends a large percent of its victims to the hospital, but because a large percent of the population has already gotten infected. This implies that the disease will tend to play itself out sooner.

As mentioned, the other study I mentioned (still preliminary) estimated that Wuhan hit a 19% infection rate at its peak, and that the disease had a non-time-delay IFR of 0,04% and a time-delay IFR of 0,12%. They also found (as others have) that the disease is highly prone to nosocomical transmission (spread inside hospitals and clinics, generally by staff) - that is to say, prone to spread to the most vulnerable of patients. I.e. that stamping out nosocomical transmission is one of the most important steps that can be done. Both Wuhan and Lombardy had extensive problems with nosocomical transmission before the severity of the situation was realized.

ED: Well, so much for trying to be brief...

I want to believe this. However, if this is true, can you explain to me how in Alberta we’ve performed 20,360 tests with 20,165 negative results and 195 positive results for a less than 1% rate of positive tests. Keep in mind that so far we’re testing those with a degree of suspicion for being positive due to risk factors and/or symptoms rather than the general population. In my mind the rate for positive in the group being tested should have at least the same infection rate as the general population if not greater, but in fact it is far less than the numbers you’re proposing. Please help me understand this discrepancy.

 

[ccdisce]

You have to come out sometime, an the virus will still be there.

Hopefully the virus will be dead after 3 days, but the back-up virus will have infected someone else and fine tuned itself to be deadlier and in larger numbers in a larger area.

 

[KarenRei]

I want to believe this. However, if this is true, can you explain to me how in Alberta we’ve performed 20,360 tests with 20,165 negative results and 195 positive results for a less than 1% rate of positive tests. Keep in mind that so far we’re testing those with a degree of suspicion for being positive due to risk factors and/or symptoms rather than the general population. In my mind the rate for positive in the group being tested should have at least the same infection rate as the general population if not greater, but in fact it is far less than the numbers you’re proposing. Please help me understand this discrepancy.

The rate of infection will not be the same everywhere in the world at the same point in time. The small number of deaths (these days, I would expect most people who die in western countries with flu-like symptoms to be tested) would suggest that Alberta lags behind many other places in terms of incidence rates.

As for criteria for testing, I have no clue on what criteria Alberta decides who to test.

The key question is not where any individual place in the world stands at this moment in time. The question is what the IFR is. Because that determines how low you need to keep the incidence rate from overloading medical systems, and how quickly the threat passes.

Are there any indicators at all? Tight chest? occasional coughing?

Asymptomatic means no symptoms.

 

[Buckminster]

50-75% of them were entirely asymptomatic

Are there any indicators at all? Tight chest? occasional coughing?

 

[SageBrush]

I went to our local Walmart today with my wife.
Other than the two of us, one other person wore a mask or mouth/nose cover

In the vegetable section I started to pick tomatoes and a worker who was restocking picked up a tomato that had fallen on the floor and put it into stock. Remarkably stupid and primitive behavior but it does sort of point out just how hard it is to improve public health and hygiene on a wide scale.

 

[KarenRei]

Thanks Karen. My little town in Central Texas just reported 10 cases out of the blue. 9 of them was asymptomatic/minor that they got sent home. The 10th one was in ICU but mainly for isolation purpose. They got sent home pretty quickly. Where do you think the inflection point is going to be? Do we just wait for new cases to drop? Do we wait a while for hospitals to report they're still functioning as normal? Do we have to both of these and drastic social changes like in China? Something else?

Even the experts are debating the IFR right now, and the exact details matter a lot, so I hesitate to speculate. All that can be said is... the more common the disease is in the general population relative to the number of hospitalizations and deaths, the sooner this ends and the lower the casualties.

And yes, changes clearly are required. Clearly the disease, if left to its own devices, can overwhelm medical systems. The question is how common it has to be in the population for that to happen.

 

[aubreymcfato]

These 2 charts are both scary:
the logarithmic scale allegedly shows how the rate of the spread is increasing/stable in US and slowing in Italy.
Still, I don't really trust Italian data, so take with a grain of salt.
On the other hand, if data from US are reliable they are worrying.

Source: A Different Way to Chart the Spread of Coronavirus

 

[SageBrush]

I've gotten the distinct impression that people have a gross ignorance when it comes to infection via direct contact. Following is a primer:

Covid-19 DOES NOT infect a person via intact skin like the hands. Infection is via the nose and mouth, and to a minor extent (if at all), the eyes. The importance of keeping hands clean is to avoid introducing the virus into the mouth via the hands or food that has come into contact with contaminated hands or other surfaces.

I see people wearing gloves, but they do not seem to realize that the gloves are more much likely to be contaminated than the hands of a person who simply washes them often, before eating, and after touching surfaces that are high risk for contamination. And of course people typically do not wash gloves so the the net effect of glove use is I suspect about as bad as personal non-hygiene

 

[sparcs]

I went to our local Walmart today with my wife.
Other than the two of us, one other person wore a mask or mouth/nose cover

I don't think masks are generally available enough compared to the demand. Probably mostly going to hospitals at this point. If I were China, I would be trying to come up with a way to send a few billion masks to the USA and Europe before the economic ripple effects get pretty bad.

 

[X Fan]

This article highlights the necessity of both the United States and Europe to designate some products/industries as nationally important and thereby designate specific homegrown companies to produce those key products (and protect/prohibit from Chinese exporters).

The article states that the global shortage of N95, gowns, etc are a by-product of China instructing their companies to only allocate to China:

https://nypost.com/2020/03/21/coron...age-traced-to-sudden-drop-in-chinese-imports/

 

[SageBrush]

I don't think masks are generally available.

How hard have you looked ?
Given a choice, N95 is preferred but a simple surgical mask is a massive improvement over wearing nothing

 

[sparcs]

How hard have you looked ?

Didn't look too hard at some of the bigger stores. I'm focusing on reducing visits to stores and avoiding situations where there are too many people. Like shopping in odd hours. Last time i went, the store said they hadn't got them in two months.

If store employees don't have them, how widely available can they be? Pretty much every public facing worker in the USA should be wearing a mask. Are you seeing the employees wearing them at stores?

 

[SageBrush]

If store employees don't have them, how widely available can they be?

Why are you presuming that store employees are clued in ?

Get a mask, and use it if you want to be serious about avoiding infection. Mask use is integral to effective social distancing, particularly in the US where the herd is in moron (aka trump) mode. You may not be able to buy in large multiples, so get in the habit of disinfecting with heat and sunlight.

 

[Cosmacelf]

Elon Musk: Should Have 1000 Ventilators Next Week, + 250,000 N95 Masks For Hospitals Tomorrow — CleanTechnica Exclusive | CleanTechnica

A thousand ventilators next week? I think Elon's forgotten the underpromise, overdeliver thing again.

That's a lot of masks to just have lying around, isn't it?

Like Karen, I think the only way Elon can have 250,000 masks tomorrow night is by importing them from China. Which is still useful since no one else seems to have the pull to do so according to this article.

https://nypost.com/2020/03/21/coron...age-traced-to-sudden-drop-in-chinese-imports/