Coronavirus

[SageBrush]

I believe Dr. Birx & Dr. Fauci are extremely talented professionals and are apolitical.

Fauci -- yes.
Birx -- best case, selection bias

 

[Cherry Wine]

I'm all for the President encouraging companies to increase ventilator production, but essentially rage tweeting? Unreal. If I'm not mistaken, isn't he the head of the administration that just backed out of a $1B procurement of 80,000 ventilators?

Donald J. Trump on Twitter

Donald J. Trump
@realDonaldTrump

General Motors MUST immediately open their stupidly abandoned Lordstown plant in Ohio, or some other plant, and START MAKING VENTILATORS, NOW!!!!!! FORD, GET GOING ON VENTILATORS, FAST!!!!!!

 

[zedtava]

A couple of hundred posts ago, I mentioned that my brother-in-law is a nurse in Seattle. It happens that he works at the VA hospital.

Almost two weeks ago he had mild, generic flu symptoms. His tests for influenza and COVID both came back negative (although he was told there was a 5% rate of false negatives). He was asked to return to work, since the tests were negative and the need for workers was dire.

A few days ago, his symptoms (including fever) got MUCH worse. His wife (who had similar symptoms, but much milder) wasn't sure he was going to make it through yesterday. But he seemed to turn a corner last night, and was able to speak to my wife today. He noted that it felt worse than anything he had experienced in his life.

He didn't get a second test. He's worked with patients with COVID, and his symptoms seemed to match exactly...but without the test, we aren't sure. Maybe he doesn't have COVID? Regardless, he's not counted in the stats.

Did he receive PCR or Serologic testing for COVID-19. I am working on a serologic test for IgG antibodies right now, and unfortunately IgM do not show up until symptoms start and IgG about 7 days later. The rapid tests kits that are coming out only look at IgM/IgG.

 

[X Fan]

Fauci -- yes.
Birx -- best case, selection bias

From the Guardian...not exactly a Conservative publication: She's a legend in the fight against HIV. Now Dr Deborah Birx is taking on Covid-19

 

[UnknownSoldier]

I'm all for the President encouraging companies to increase ventilator production, but essentially rage tweeting? Unreal. If I'm not mistaken, isn't he the head of the administration that just backed out of a $1B procurement of 80,000 ventilators?

Donald J. Trump on Twitter

You must not be familiar with the current President

Rage tweeting is almost his entire Presidential communications apparatus

 

[Lessmog]

Marc Lipsitch is one of the most prominent epidemiologists in US.

Good news is the Covid task force asked Marc's team to model certain scenarios.

Bad news is that the administration decided to ignore what the model predicted. Instead Dr Birx (who is not an epidemiologist) decided to go with what Trump wanted to hear, apparently, that it is ok to end the lockdown quickly and everything will be ok.

So, if Trump was before a Birther, he is now a Birxer?

 

[SageBrush]

Worldwide data through Mar 26



Spain, France, Switzerland and Italy are bending the curve, although the second derivative is still unfortunately quite modest

 

[ggr]

Interestingly enough, I would like to know how Germany treated you for free. According to this, you are supposed to come with insurance that covers medical problems if you enter Germany:

Countries Which Won't Let You In Without Health Insurance

"The Schengen Area is a zone in Europe where 26 countries have acknowledged the abolishment of their internal borders. Anyone who needs to apply for the Schengen visa to enter Europe must have international health insurance.

The 26 countries in the zone are Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, and Switzerland."

Well, at the time I was traveling on an Australian passport and didn't seem to require a visa... and I didn't have international insurance.

The one time I had experience with international insurance and health care was when I had to go to an ER in the US, after having severely blocked Eustachian tubes and getting off a plane, basically in agony. They charged me over $1000, and our office admin in Sydney had to fight for over 6 months to get the insurance company to pay up.

 

[jbcarioca]

We also know a fair amount about the shape of the variation curve. 4 - 7 days works for modeling.

By the way, gestation is for pregnancy. You mean incubation

FWIW, I knew that but way trying ineptly to lighten the otherwise dour tone.
Also, certainly for most modeling purposes we can use the mean incubation period, which usually need not even be very precise though it should be accurate, However, to reliably estimate probable Rnaught it can make a large difference. For that we need really to know differences between case characteristics (demographics plus) to estimate reliability probable spread.

We already know that a number of patient zero cases infected a large multiple of typical spreads. The less contagious the virus is the more important this sort of data becomes. Once we understand the demographic distribution of asymptomatic cases we can establish expected value of more generalized testing, for example.

Already it seems anecdotally that more healthy people are more likely to be asymptomatic. Generally people talk about older people as more symptomatic, but I doubt that is true. I hypothesize that the primary difference is actually absence of any other disease. That seems to be generally valid for nearly all disease. However, these same people are also likely to acquire the SARS-CoV-2 virus and successfully defeat COVID-19. Such might also help explain why children tend to be asymptomatic or not acquire the virus at all. Unless these populations are tested soon in a statistically valid way we cannot know whether large scale transmission might be happening.

Some of the data from China and South Korea suggest that this might be a minor factor. If it were significant the passage would tend to produce continuing spread over a longer period. From the standpoint of reopening factories and distribution facilities of anything, including Tesla products we really need the answers to these questions.

Frankly my suspicion is that such passage is probably only for brief periods, if at all. Making policy based on suspicion is guaranteed to produce bad results.

 

[EinSV]

A) When that article was first posted I pointed out how strange it was they calculated IFR from Germany alone, with no rationalization and then arbitrarily cut it in half. Do you have an explanation why this is a good method?

B They’ve since updated IFR:
“Our current best assumption, as of the 22nd March, is the IFR is approximate 0.29% (95% CI, 0.25 to 0.33).*”

A. Their explanation for cutting the number in half in the German studies is: "Early IFR rates are subject to selection bias as more severe cases are tested – generally those in the hospital settings or those with more severe symptoms. Mortality in children seems to be near zero (unlike flu) which will drive down the IFR significantly. In Swine flu, the IFR was fivefold less than the lowest estimate in the 1st ten weeks (0.1%). Therefore, to estimate the IFR, we used the estimate from Germany’s current data 22nd March (93 deaths 23129) cases); CFR 0.57% (95% CI, 0.50% to 0.65%) and halved this for the IFR of 0.29% (95% CI, 0.25% to 0.33%) based on the assumption that half the cases go undetected by testing and none of this group dies."

As you note they have been criticized for basing the analysis on German data. They don't explain why they did that but I suspect it is because the Germans had tested more broadly than other European countries and therefore the CFR data was less susceptible to selection bias.

B. March 22 (the date of the German analysis) is not the latest update -- on March 26 they added the Icelandic analysis with an IFR estimate of 0.05-0.14%. They said the Icelandic data will likely provide an accurate estimate of CFR and IFR:

"Iceland’s higher rates of testing, the smaller population, and their ability to ascertain all those with Sars-CoV-2 means they will likely provide an accurate estimate of the CFR and the IFR. Current data from Iceland suggests the IFR is somewhere between 0.05% and 0.14%."

They could be right, could be wrong -- I'd like to see more info to make sure there are no confounding variables/country-specific effects -- but certainly think this is an interesting data point.

 

[jbcarioca]

This is a fine example of inoculum.

Everybody should read this and think only one thing: MASKS

There is a small but growing understanding in the public that masks will decrease R naught, but almost nil understanding that masks will reduce disease severity (all else being equal.)

If it were anything other than an anecdote I would agree with you. They might well have been outliers. Right now nobody seems to know. I think you have a good hypothesis, which should be tested.

Historically roughly 30% of my hypotheses survive the first examination. About half of those go on to become legitimate theory. I'm happy to be correct 15% on such guesses.

Most people I know think their guesses are theories and live their lives like gamblers. I don't gamble, although I would not mind being the house, I suppose.

 

[SageBrush]

However, to reliably estimate probable Rnaught it can make a large difference

Indeed. I was saying that using 4 -7 days gives a reasonable sensitivity analysis. That still gives R naught values that differ almost 2 fold but I didn't want people to think 42x based on an incubation range of 18 hours to 21 days.

I was thinking about Lombardy again as an CFR outlier. I'm tempted to label them 'wedding mode.'

 

[Daniel in SD]

B They’ve since updated IFR:
“Our current best assumption, as of the 22nd March, is the IFR is approximate 0.29% (95% CI, 0.25 to 0.33).*”

What was their CI (confidence interval) on their first estimate? Their page is completely ridiculous and I have no idea why anyone takes them seriously. They're putting confidence intervals on dividing the total cumulative deaths by the cumulative number of positive test results for individual countries? WTF does that even mean?
Anyway, for an actual analysis of the IFR here's the paper that Ferguson et al. used: https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1.full.pdf
Has not been peer reviewed yet. I have no idea why we haven't seen an analysis of the South Korea data since it seems the most complete.

 

[bkp_duke]

Well, at the time I was traveling on an Australian passport and didn't seem to require a visa... and I didn't have international insurance.

The one time I had experience with international insurance and health care was when I had to go to an ER in the US, after having severely blocked Eustachian tubes and getting off a plane, basically in agony. They charged me over $1000, and our office admin in Sydney had to fight for over 6 months to get the insurance company to pay up.

My reply is not to advocate for insurance companies. And I am sure your experience was a miserable one.

I have literally wasted years of my life on the phone arguing the medical necessity of a procedure or test for a patient . . . with a bean counter with no medical training on the other end reading from a script. I am no fan of insurance companies, nor the owners of hospital systems. I think the US healthcare system can be FAR better. But I am a HUGE skeptic of putting that kind of power in the government's hands to determine for us (i.e. socialized medicine). Just look how far the current pandemic here has been screwed up by our government (Trump aside, there are multiple layers of screw-ups, from the CDC on down).

I fully expect to get disagreed on this post, but those that have read my posts in the market politics thread know that I am an advocate for removing the small, individual, regional monopolies that plague the US healthcare system. Specifically, stop letting one or a few insurance providers sell in just a single state (i.e. allow anyone in the US to buy any policy, from any company, in any state). Additionally, hospitals, providers, etc. should be FORCED to publish their prices. Right now, there is nearly ZERO price transparency for anything in the healthcare system here. That lack of transparency lets prices run amok and increase with no counterbalance (i.e. competition). If prices were published, and hospitals had to compete for services, not only would prices decrease, but the quality of care would increase.

It's only when companies and systems are allowed to become monopolies that we have serious issues with cost and quality.

My 0.02. Feel free to disagree.

 

[SageBrush]

Right now nobody seems to know. I think you have a good hypothesis, which should be tested.

That is a fair take, but it should be kept in mind that I am just extrapolating from a 100 years of scientific medicine. Covid-19 is not from Mars.

 

[SDRick]

I put this out there for those with a better understanding of this pandemic.

Would the most efficient way to reduce the overall death rate be to rigorously quarantine those most at risk? Probably the highest risk case would be an elderly male smoker with a compromised immune system. While difficult, a quarantine of the elderly, and those with compromised health issues and risk factors could significantly lower the death rate.

 

[bkp_duke]

I put this out there for those with a better understanding of this pandemic.

Would the most efficient way to reduce the overall death rate be to rigorously quarantine those most at risk? Probably the highest risk case would be an elderly male smoker with a compromised immune system. While difficult, a quarantine of the elderly, and those with compromised health issues and risk factors could significantly lower the death rate.

The problem with this approach is the caregivers. Because the virus has a latent period where someone can be infectious but without symptoms, they can spread the virus to this vulnerable population without know it. This is what we saw in the Kirkland retirement acute care facility in the Seattle area.

 

[Daniel in SD]

A. Their explanation for cutting the number in half in the German studies is: "Early IFR rates are subject to selection bias as more severe cases are tested – generally those in the hospital settings or those with more severe symptoms. Mortality in children seems to be near zero (unlike flu) which will drive down the IFR significantly. In Swine flu, the IFR was fivefold less than the lowest estimate in the 1st ten weeks (0.1%). Therefore, to estimate the IFR, we used the estimate from Germany’s current data 22nd March (93 deaths 23129) cases); CFR 0.57% (95% CI, 0.50% to 0.65%) and halved this for the IFR of 0.29% (95% CI, 0.25% to 0.33%) based on the assumption that half the cases go undetected by testing and none of this group dies."

This makes absolutely zero sense. How are they accounting for the people who are currently in the hospital who WILL die? I can 100% guarantee that if they use this same methodology in 1 week in Germany they will be outside their CI!

 

[Florafauna]

Politcal discussion for the market politics thread, but the cost of Medicare-4-All dwarfs the annual cost for wars, etc. And the "corporate bailouts" is a great catch phrase (click bait), but if you go back to the records for 2008 - most of those had to be repaid, and the companies that got them did repay them.

Love the contribution, you and the other qualified people make on this thread, it really makes you think so thanks.

But... (of course there is a but)...

Here in the UK we have a treatment for all, universal healthcare system, loved by the entire nation (Think similar ratings to soldiers - is that the same in the USA?) which costs less than half what the US pays for partial coverage.

Morally there is no excuse (IMHO) for any decent (read wealthy) nation to simply let anyone die because of lack of healthcare.

On the subject at hand, my small contribution to the virus situation is that Ive seen very little official statement on what is going to happen in the next phase of the outbreak - where widespread testing and contact tracing will be critical in keeping infection levels falling. Any failure there will simply lead to a new serious outbreak.

For the UK - it may not be true (don't believe all you hear in the press!) but I read that after our glorious and supreme leaders infection the government ministers (specifically the Chancellor) were not going to bother with self isolation - if our leaders can't do what they are told, what hope the rest of us?

Stay Safe All

 

[SageBrush]

Would the most efficient way to reduce the overall death rate be to rigorously quarantine those most at risk?

You also have to tightly control those that come in contact with those most at risk.

Or get them to wear masks and wash hands with diligence.