Coronavirus

[NicoV]

Look at how artificially low Frances numbers were, then a giant spike and 3 days of larger numbers.

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if any of those look like smooth curve to you we must live in a different universe.

That’s just a reporting issue. Most of the historical numbers in France are confirmed hospital deaths only, and they now are adding ((suspected) covid related) deaths from nursing homes too, but on the reporting day, not on the day of death, which may have been much earlier. We have the same reporting issue in Belgium. Other countries don’t include nursing home deaths at all, so it’s difficult to compare death numbers.

 

[dhanson865]

That’s just a reporting issue. Most of the historical numbers in France are confirmed hospital deaths only, and they now are adding ((suspected) covid related) deaths from nursing homes too, but on the reporting day, not on the day of death, which may have been much earlier. We have the same reporting issue in Belgium. Other countries don’t include nursing home deaths at all, so it’s difficult to compare death numbers.

as I said in post 8877

for those 3 days all 3 days have nursing home data added. So the question is will future days include that data or is this just a temporary backlog of records they are trying to catch up on? It needs to be added in, but knowing if it is or isn't changes the way you interpret the graph.

 

[dhanson865]

OK, another visual from r/dataisbeautiful The State of COVID-19 in US by State

warning: The colors on the map are continuous interpolations of a single-hue color. However, the colors of the legend (bars) is discrete schemes of the same color. So bounding the bars with the numbers wouldn't make much sense (the start and end of the bar has exactly same color). But one can use a continuous interpolation for the legend and put the numbers as you described.

So reading it might be counter intuitive if you expect the color of the state fill and the bar section to match exactly.

 

[NicoV]

as I said in post 8877

for those 3 days all 3 days have nursing home data added. So the question is will future days include that data or is this just a temporary backlog of records they are trying to catch up on? It needs to be added in, but knowing if it is or isn't changes the way you interpret the graph.

They are included now. On Coronavirus : suivez la propagation de la pandémie en France et dans le monde you can see a graph where they split up cases, hospital deaths and nursing home deaths.
Although I do suspect that there may be some delay in the reporting of nursing home deaths.

 

[nwdiver]

So incase anyone has lost track of 'Mercas slip from '1st world' status here's where we are....

• Our nurses and doctors are using hand-made protective gear
• Posing with a dead teenager like a hunting trophy that was possibly murdered is 'ok', while working to protect the sailors under your command from COVID-19 is 'inappropriate'.

And to think this only took 3 years.....

 

[cwerdna]

So incase anyone has lost track of 'Mercas slip from '1st world' status here's where we are....

• Our nurses and doctors are using hand-made protective gear
• Posing with a dead teenager like a hunting trophy that was possibly murdered is ok, while working to protect the sailors under your command from COVID-19 is 'inappropriate'.

And to think this only took 3 years.....

Yeah, it's nuts. I saw the letter posted somewhere else at work and Exclusive: Captain of aircraft carrier with growing coronavirus outbreak pleads for help from Navy has it. Seemed like a well thought out letter to me.

Trump says Navy captain letter asking for help on coronavirus-stricken ship 'was terrible' says

“I thought it was terrible what he did, to write a letter. This isn’t a class on literature. This is a captain of a massive ship that’s nuclear-powered,” Trump said at a news briefing Saturday evening. “The letter was a five-page letter from a captain, and the letter was all over the place. That’s not appropriate. I don’t think that’s appropriate.”

Way to go with the usual projection coming from the orange draft dodger.

From the videos I'd seen of send-off that Captain Crozier's crew gave him, he was loved by his crew.

 

[Norbert]

Healthdata.org (the IHME model) removed the "next update April 4" notice. The latest update remains the one from April 1.

 

[cwerdna]

The hard part is gauging whether states are actually doing enough testing in the first place. We've heard anecodotes of states under-testing due to lack of PPE, reagents, cotton swabs, etc.

Plus, you want to know how effectively they are backtracing. Assuming there is a point where people are supposed to go back to work.

Indeed, there are backlogs per Coronavirus Testing Backlogs Continue As Laboratories Struggle To Keep Up With Demand from April 3rd. I listened to Swab Manufacturer Works To Meet 'Overwhelming' Demand (from April 1) the other day.

We already saw a notice from earlier in the thread (https://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/2020/covid-19-03202020.pdf) which in part says

To preserve PPE for HCW providing medically necessary care for hospitalized patients, the NYC Health Department is directing healthcare facilities toIMMEDIATELY STOP TESTING NON-HOSPITALIZED PATIENTS FOR COVID-19 unless test results will impact the clinical management of the patient. In addition, do not test asymptomatic people, including HCWs or first responders. COVID-19 testing is only indicated for HOSPITALIZED PATIENTS.

unless the above has been superseded, which I'd doubt at this point given how hard NYC is being hit.

As for backtracing, what backtracing? I doubt California and any states which have a large # of infected people are doing any contact tracing at this point.

 

[Norbert]

There are clearly 2 "camps" now. One thinks the IFR is very low and a lot more than we know are infected.

Michael Mina on Twitter

Could the US have >2 million #COVID19 cases by now?
I'll be astounded if not! We simply don't test.
The ratio of who gets a test vs who should, likely worse than 1 in 10.
So given 220K cases reported ->
>2.2 million COVID cases in US already?
>4 million? Perhaps...

Last note - and *speculative* – given very limited testing and relatively short windows of time to capture virus in a nasal swab, I really won't be surprised if even 50x more people have acquired the virus than cases confirmed If so ~11 million in US could have acquired #COVID19​

And those who think IFR is actually > 1% and not that many are infected. I'm using the following reply to the above tweet by a Harvard epidemiologist because it was retweeted by Marc Lipsitch. I think this is the mainstream epidemiologist view.

Pierre Andurand on Twitter

We have way enough data to know that it is not 0.1%, but more than 1%... already 0.024% of both the Spanish population and Italian population died from it officially, with reports that death rates are actually 3-4 times higher in many places.​

Regions in Italy and Spain have more than 1% of their population that died from it. SKorea with extensive testing and contact tracing have a 1.7% CFR. It obviously cannot be a 0.1% IFR. Way enough evidence now​

In so far as that is representative, it seems even the pro's are still quite in the dark. Which is what I thought. Kind of. Some of our discussions here seem to be not that bad in comparison.

Some more thoughts about South Korea:

If we assume that testing & tracing was done very well, then we can assume that a very high percentage mild and asymptomatic cases were tested as well, for the following reason:

The contact lists of asymptomatic and symptomatic cases are overlapping. If you start with symptomatic cases, and test all contacts you can find, those will include asymptomatic cases, possibly including the direction back to patient(s) zero. Now you can continue with all positive tested cases (not just the symptomatic ones), and you will also follow along the paths of asymptomatic cases that have infected other asymptomatic cases, and back. So if that works well enough, I think the tested cases will be a very high percentage of all infected cases.

Or in simpler words: you will find asymptomatic cases because they infect symptomatic cases, or were infected by symptomatic cases, directly or indirectly.

 

[wdolson]

I was thinking about haircuts the other day, and what they tell us about our nation's C19 quarantine response.
Nobody on TV has a hair out of place, nor do any politicians. And none wear masks.
All the barbers and hair salons are supposed to be closed in Hollywood, New York, and DC.
I guess rules are for fools?

The news people are all looking spiffy, but a lot of other TV people aren't. There seems to be a trend among late night men to let their facial hair grow. Most of the entertainers still doing shows are making content at home with makeshift arrangements. Stephen Colbert's son has become his producer and his daughter his makeup artist.

I hate facial hair so I always shave. The only time in my adult life I didn't shave was when I had chicken pox (when I was 28). But I have wavy hair that is difficult to cut right. If it isn't done right I end up with cowlicks sticking out all over the place. The trickiest is one on top of my head, if the hair there isn't left long, it pops up and I look like Alfalfa from the Our Gang shorts. I'm not sure what I'm going to do, it needs to be cut by someone who knows what they're doing.

Chances are good I am immune at this point, though I can't prove it and there are no exceptions to the lock down order for people who have had it and are no longer contagious.

 

[NicoV]

The epidemic in Belgium seems to have peaked. Yesterday, the outflow in hospitals was bigger than de inflow, for the first time. That is after a week of stable new hospital admissions (between 500 and 600/day). Also the number of new confirmed cases is going down, despite a growing test capacity.

 

[SMAlset]

I see from this Bloomberg report that India has banned all exports of the malaria drug Trump was touting. Wonder if this is a partial response to the WH not wanting to “share” with other nations (ban on 3M masks exports in recent news).

“India Bans All Exports of Trump’s ‘Game Changer’ Virus Drug”
By Rajesh Kumar Singh, 3/5/20, 12:42am PDT

Bloomberg - Are you a robot?

 

[RobStark]

Parents Name Newborn Twins 'Covid' and 'Corona'

 

[Sean Wagner]

I was including all hospitalizations in my definition of medical care.
I imagine that twice as many people would die without medical care but that is pure guesstimate.

I may not be following. But, why do they bother to take up beds for people in serious condition, then, if them not being hospitalized (something like 15% of people are in serious but not critical condition) is not necessary?

The FT just ran a very interesting article concerning the two adjacent northern Italian regions of Lombardy and Veneto, with the latter doing markedly better seemingly because they tried to keep as many people tested positive at home rather than infecting the hospital staff.

Quotes:
...
As of Wednesday Lombardy, which has a population of 10m people, accounts for 7,593, or 57.7 per cent, of Italy’s total declared deaths from the virus of 13,155. Meanwhile Veneto, which has a population of 4.9m, has suffered 499 official deaths out of 9,625 diagnosed cases.

Higher levels of testing and tracing in Veneto is the most widely cited explanation for why the region has managed to control its outbreak more effectively than its neighbours.
...
Professor Palù said the hospitalisation rate in Lombardy, meaning the number of diagnosed patients who are taken in for clinical treatment, at the start of the outbreak was about 65 per cent.

This compares with 20 per cent in Veneto, where the majority were told to stay at home unless urgent care was required.
...
Subscribe to read | Financial Times

Walmart will be limiting customers in the stores based on the square footage of the store.

Excellent, this was mandated about two weeks ago in Switzerland together with hand sanitizer at the entrance and is much appreciated by lil' ole me. Next up masks for all shoppers and staff please.

Dog clippers work well for Dogs and Dougs.

Well done! Will Dougette now step forward. Rrrr rrrr...

I ordered a barberbot right at the outset but am still waiting for the order to be fulfilled. At least the electric trimmer arrived and my self-styling attempt came out better than expected. The one glitch will soon be obscured.


@aubreymcfato

Going back to the FT Alphaville section's habitual hatchet piece, I now broke my silence and added a brief riposte in the comments. Waiting a day or two is important to me - I think it's beneficial not to get sucked in and rather choose to support the problem-solvers. Many years down the line, a very few people may hopefully reflect on the smarter course they might have charted.

https://ftalphaville.ft.com/2020/04...omised-ventilators--These-are-BPAP-machines-/

 

[MD70]

Randi Mayem Singer on Twitter

This is why I think the pandemic will take longer to deal with In the USA. (A lady put a message on Facebook saying not to take the virus seriously and it’s all a ploy to undermine Trump etc. Then she died due to complications from the virus)

 

[dfwatt]

That's a great list, and for a moment I thought you are going to lift this discussion to a scientific level. Like when kids are having a pillow fight in the living room and then the parents come home.

And then you are talking about a CFR below 1%, and only in the case of busting our healthcare system, you talk about "way more than 1%". Possibly 5%.

Most of the countries we look at for comparison have a CFR higher than 1%, many much higher. Italy has a CFR above 10% country-wide.

The CFR is even more dependent on variable numbers than the IFR. Which number isn't?

The number of deaths? That's the number when everything is literally too late.

Now I see what you are getting at. Here's what I have to say and I hope you understand this post in the spirit in which it is being offered. If you create somewhat low ball CFR or IFR numbers a subgroup posting here challenges you. If you go the other way with higher case-fatality or IFR numbers, another subgroup challenges you.

It's safe to say we don't know. We don't know the true denominator or the true numerator, and lots of people on this thread have already enumerated the many factors that distort those numbers or make them incomplete or unreliable so I won't belabor the point. I could say somewhat flippantly that it doesn't matter but of course it does. But it's not the most important thing and we already know enough to know absolutely for certain that this virus is staggeringly dangerous particularly for the older patients, those with comorbidities and for an unknown vulnerable subset of younger people where we appear to have virtually no biomarkers that would flag their vulnerability or let them and the medical system know that this is extremely dangerous for them as well.

Most importantly - we know enough to know that we're not doing what we should have done and we're not doing even now what we could be doing. In view of those undeniable realities on the ground, I feel like the intensity of the debate about case-fatality is missing the forest for the trees on that point. With all due respect to all parties on both sides of this debate.

 

[Norbert]

Now I see what you are getting at. Here's what I have to say and I hope you understand this post in the spirit in which it is being offered. If you create somewhat low ball CFR or IFR numbers a subgroup posting here challenges you. If you go the other way with higher case-fatality or IFR numbers, another subgroup challenges you.

It's safe to say we don't know. We don't know the true denominator or the true numerator. I could say somewhat flippantly that it doesn't matter but of course it does. But it's not the most important thing and we already know enough to know absolutely for certain that this virus is staggeringly dangerous particularly for the older patients, those with comorbidities and for an unknown vulnerable subset of younger people where we appear to have virtually no biomarkers that would flag their vulnerability or let them and the medical system know that this is extremely dangerous for them as well.

Most importantly - we know enough to know that we're not doing what we should have done and we're not doing even now what we could be doing. In view of those undeniable realities on the ground, I feel like the intensity of the debate about case-fatality is missing the forest for the trees on that point. With all due respect.

I think none of these thoughts are new to me, if I didn't miss anything. It is basically what more or less everyone here agrees on. (EDIT: Other than your conclusion about the CFR/IFR discussion.)

As I can tell from the twitter discussion that we were commenting on, there are still disappointingly many voices talking about herd immunity. Low estimates of the IFR support hopes in that direction. All the CFRs that have been quoted in support of low IFR estimates have moved upwards, yet IFR estimates haven't. Only the voices quoting them have become more silent. The flirting with herd immunity continues in a lower but still scary amount.

And in general, I believe the problem is still being underestimated, which is dangerous, in my opinion.

You claim to oppose the discussion of CFR and IFR, but then in the same post you have thrown CFR quotes into the discussion that are provocatively outdated.

 

[dfwatt]

I think none of these thoughts are new to me, if I didn't miss anything. It is basically what more or less everyone here agrees on.

As I can tell from the twitter discussion that we were commenting on, there are still disappointingly many voices talking about herd immunity. Low estimates of the IFR support hopes in that direction. All the CFRs that have been quoted in support of low IFR estimates have moved upwards, yet IFR estimates haven't. Only the voices quoting them have become more silent. The flirting with herd immunity continues in a lower but still scary amount.

And in general, I believe the problem is still being underestimated, which is dangerous, in my opinion.

You claim to oppose the discussion of CFR and IFR, but then in the same post you have thrown CFR quotes into the discussion that are provocatively outdated.

Wow. I have to say I'm terribly disappointed in terms of your interpretation of my post. To suggest that I am opposed to the discussion of any relevant variable is really a total misreading of what I'm saying. I'm saying that it's a mis-emphasis to put as much energy as we have put into this discussion and debate about case fatality when we know enough to know how incredibly dangerous this virus is. Could I be any clearer about that Norbert? If so please advise how I might be clearer because I really don't know.

As for the notion that herd immunity will eventually provide some kind of protection, that's laughable, at least from the standpoint of the millions of individuals and millions of families that will be affected by loss due to this virus. Herd immunity Concepts offer little consolation to them. Additionally I hold out hope that a vaccine will render the notion of gradual herd immunity a moot point. But we have an incredibly difficult stretch between now and the appearance of any reasonably effective vaccine.

 

[davepsilon]

Now I see what you are getting at. Here's what I have to say and I hope you understand this post in the spirit in which it is being offered. If you create somewhat low ball CFR or IFR numbers a subgroup posting here challenges you. If you go the other way with higher case-fatality or IFR numbers, another subgroup challenges you.

It's safe to say we don't know. We don't know the true denominator or the true numerator, and lots of people on this thread have already enumerated the many factors that distort those numbers or make them incomplete or unreliable so I won't belabor the point. I could say somewhat flippantly that it doesn't matter but of course it does. But it's not the most important thing and we already know enough to know absolutely for certain that this virus is staggeringly dangerous particularly for the older patients, those with comorbidities and for an unknown vulnerable subset of younger people where we appear to have virtually no biomarkers that would flag their vulnerability or let them and the medical system know that this is extremely dangerous for them as well.

Most importantly - we know enough to know that we're not doing what we should have done and we're not doing even now what we could be doing. In view of those undeniable realities on the ground, I feel like the intensity of the debate about case-fatality is missing the forest for the trees on that point. With all due respect to all parties on both sides of this debate.

The case fatality rate is ‘easy.’ It is directly measured. Until you start to forecast it while cases numbers are ramping up, then you realize there is a debate about how much to lag the data to get the ‘true rate’

The infection fatality rate. Everyone agrees it is lower than the CFR no one agrees by how much. Data is available that pushes you in both directions. That’s the reality in the search for truth in crisis. You can never make sense of 100% of reports that reach you. So many data points out there. Diamond princess testing, South Korea containment, Iceland self-selected broad testing, Italian village broad testing, differing death rates between Germany vs. Italy.

But it doesn’t really matter to me. Nothing I’ve seen suggests we are close to herd immunity. A large number of asymptomatic carriers is fought the same way as carriers that have a long pre-symptomatic infectious period.

 

[Norbert]

Wow. I have to say I'm terribly disappointed in terms of your interpretation of my post. To suggest that I am opposed to the discussion of any relevant variable is really a total misreading of what I'm saying. I'm saying that it's a mis-emphasis to put as much energy as we have put into this discussion and debate about case fatality when we know enough to know how incredibly dangerous this virus is. Could I be any clearer about that Norbert? If so please advise how I might be clearer because I really don't know.

A mis-emphasis? We don't know exactly how dangerous the situation is. And how soon the "peak" will be there. But that is an important question. For example, I think some states are still not in stay-at-home mode, or make exceptions for large group gatherings. It is to a large degree the discussion of CFR and IFR that has allowed some of us to see that the situation will get worse than others were hoping. That turned out to be correct. And it continues to be relevant to understanding the significance of the situation.

I still believe that underestimating the problem continues to be the larger danger.

As for the notion that herd immunity will eventually provide some kind of protection, that's laughable, at least from the standpoint of the millions of individuals and millions of families that will be affected by loss due to this virus. Herd immunity Concepts offer little consolation to them. Additionally I hold out hope that a vaccine will render the notion of gradual herd immunity a moot point. But we have an incredibly difficult stretch between now and the appearance of any reasonably effective vaccine.

Good that we appear to agree on this.