Coronavirus

[NicoV]

Its a tragedy that healthcare workers have died in other countries, but lets be crystal clear, to date the evidence in my country is that young healthy people are completely absent from covid19 fatality statistics.

I dont know how to divide by zero. But currently there are zero covid19 fatalities for age groups 1-49 in australia and that includes people with comorbidities like cancer, asthma, COPD, diabetes. That may change, but right now its an established trend. covid19 is a barely fatal disease.

View attachment 531553

You probably don’t have enough deaths yet. The following article contains a graph with the age distribution of death in Belgim: De nieuwe coronacijfers op een rijtje

Belgium is probably the hardest hit country that didn’t have their health care system overwhelmed.

BTW: Many people are scared to go to the doctor or hospital. Belgium has set up separate triage centra in each community so that suspect Corona cases don’t have to go to their regular doctor. I went to my doctor yesterday and he says he barely sees any patients anymore (for the normal pre-corona illnesses). He has a friend who is cardiologist and he also barely sees urgent patients anymore. So they suspect a very big collateral damage with people who should have gone to the doctor for some illness, but didn’t out of fear.

 

[davepsilon]

Well, we know that genetically Australians tend to be quite British, and that SarsCorinavirus 2019 has not had much time to mutate yet (so it not genetics, either human or virus)

so the question remains, why are there zero fatalities in the 0-49 age group here (and a sole victum 50-59).

Over 50% of our Covid19 cases are now classified as recovered. Why.

For whatever reason, Covid19 is a barely fatal disease. And i doubt it is because of vegemite or cold beer.View attachment 531584

These stats are consistent with covid 19 stats globally. Closing 50% of the cases does not mean 50% of serious cases have recovered. The CFR for under 40 is estimated around 0.2%. You might expect a handful of deaths in the younger age ranges in the coming weeks. Though with small expected numbers even if it stays zero it is not inconsistent with global stats.

 

[alloverx]

I note that in AUS after some overseas arrivals were naughty and did not go straight home; subsequent arrivals were not trusted and they had police/military escorts to hotels for 14 day quarantine.

 

[AlanSubie4Life]

Well, we know that genetically Australians tend to be quite British, and that SarsCorinavirus 2019 has not had much time to mutate yet (so it not genetics, either human or virus)

so the question remains, why are there zero fatalities in the 0-49 age group here (and a sole victum 50-59).

Over 50% of our Covid19 cases are now classified as recovered. Why.

For whatever reason, Covid19 is a barely fatal disease. And i doubt it is because of vegemite or cold beer.View attachment 531584

As others have said, the fatality rate in the 40-49 bracket is at most about 0.4% and it is probably closer to 0.2%.

So you might expect 3 deaths maximum though obviously expected values could have a range.

And only half of your cases have recovered. The ones that have not are likely the ones that are the worst off.

I’d be surprised if you did not have one or two people who do not surprise in this age bracket, but obviously I hope I am wrong and it ends up being 0.

 

[PACEMD]

The positive test rate is still an indicator of infection prevalence.

It is true that Montana has tested less than 1%. They have tested about 0.8% of the population. More would be better. It puts them at #24 (as I said originally, not that awesome). North Dakota is at #10 in that regard (well over 1%) and has an even lower positivity.

These numbers are at best rough estimates. We don't have true numbers for the total SARS-CoV-2 tests performed in Montana, only those sent to the Montana state lab. Many were also sent to out-of-state and private labs. More importantly, the number of positives as a percentage of the estimated total tests performed tells us nothing about the prevalence of a disease. It only tells us what percentage of tests were positive. Those numbers are biased by the sampling methods. Meaning if you only test people likely to have a disease you can't say anything about the disease prevalence in the general population. Here in Montana, and nationally, we know what we need to do. Having the resources to do that is another matter entirely. Until last week anyone with symptoms but not sick enough to be hospitalized was sent home from emergency to self-quarantine, without testing. Why? Because of the lack of available testing. Meaning we are not even sampling the majority of symptomatic patients. And this, of course, makes the invalid assumption that only symptomatic patients would test positive. In our New York emergency departments, we are seeing close to 90%-100% positive testing rates, regardless of the cause of presentation. Involved in a motor vehicle collision and present to emergency in New York? Odds are you are positive for SARS-CoV-2. Twist an ankle and present to emergency, odds are you are SARS-CoV-2 positive. COVID-19 is a disease process with many unique features. We are learning and assimilating information at a rapid rate. It is, however, early in the process. Analyzing and applying that information and knowledge is a fluid and ongoing endeavor. Any attempts to be overly precise at this point will likely fail.

 

[Lasairfion]

COVID19 is particularly virulent compared to other coronaviruses like SARS or MERS, or even compared with the regular flu, and we have no immune response or vaccinated people to slow its spread either. It's not massively deadly in comparison. However that's what makes it a numbers game.

Flu might kill more of the infected, but it's not going to spread so rapidly. COVID19 doesn't kill as many but it can infect the whole population rapidly. If Flu kills 5 in 100 and spreads to 2 people at a time (and stops sometimes because of vaccines or immunity from prior infection), but COVID19 kills 2 in 100 but spreads to 10 people at a time (all numbers exaggerated) then it becomes a race to prevent the spread.

I'm going to guess that the spread out nature of Australia and its cities, and the distance of travel, plus the low population comparative to space is all helping out with the figures in Oz, especially as it has started isolation procedures too. There may also be cultural differences between younger Aussies and other countries in how they interact with each-other (no US style 'spring break') and other members of society (perhaps a lower rate of younger people living with older family members compared to other places?) Hard to say which complex factors are at play here.

 

[jerry33]

There is no way we can expect a compliant population - and we have the added problem of presidential elections this year. So, everything will be viewed through this lens.

Unless the emergency is used as an excuse to call off the elections--likely on a permanent basis. I would not put it past those currently in power.

 

[EinSV]

Looks like IHME is sticking to its guns.

Its updated model currently predicts peak deaths today in the US, with total deaths estimated to increase to 61,545 from 60,415. IHME | COVID-19 Projections

US deaths dropped from 2035 on Friday to 1830 yesterday per worldometer, so IHME's prediction for deaths to peak Friday has not been invalidated so far. But it's only one day so can't rule out @jhm's "dumb-ass" model yet.

 

[HG Wells]

Unless the emergency is used as an excuse to call off the elections--likely on a permanent basis. I would not put it past those currently in power.

If elections are called off the presidency goes to Nancy.
Trump can't cancel the 2020 election, even in a coronavirus pandemic

 

[EinSV]

There has been a lot of discussion in this forum about the pros and cons of hydroxychloroquine use, so what do doctors who are treating patients think? An American Thoracic Society‐led International Task Force recently issued "Interim Guidance on Management Pending Empirical Evidence" on treatments such as hydroxychloroquine and remdesivir.

Wrestling with the question of whether to recommend covid-19 treatments with imperfect evidence, they "suggest" use of hydroxychloroquine in hospitalized patients who have evidence of pnemonia on a case-by-case basis, but don't recommend routine use for covid-19 patients.

The recommendations were based on a survey of members who were working on the frontlines treating covid-19.

73% were in favor of intervention, 11% against, and 16% no suggestion.

"For hospitalized patients with COVID‐19 who have evidence of pneumonia, we suggest hydroxychloroquine (or chloroquine) on a case‐by‐case basis. Requirements include all of the following: a) shared decision‐making in which the patient is informed about the possible benefits and potential side effects, b) collection of data in a manner that enables studies that use valid methods for causal inference and control of confounders for the purpose of interim assessment, c) the patient’s clinical condition is sufficiently severe to warrant investigational therapy, and d) there is not a shortage of drug supply."​

Interestingly, the Task Force did not "suggest" use of remdesivir even in hospitalized patients with evidence of pneumonia. Support for that option fell slightly below its somewhat arbitrary 70% cut-off needed for a "suggestion." I suspect this will change after the results of the most recent remesdivir data are factored in.

https://www.thoracic.org/profession...sease-related-resources/covid-19-guidance.pdf

 

[SageBrush]

The US is just getting started, and has 1000x the disease mortality burden per capita of the successful countries.

When you hear that sociopath self-congratulating himself on the handling of the epidemic, remember that number (although it will rise.)

Correction:

The US disease mortality burden is not 1000x fold (yet, anyway), it is 50x - 250x per capita of the successful countries.

 

[SageBrush]

b) collection of data in a manner that enables studies that use valid methods for causal inference and control of confounders for the purpose of interim assessment,

This means limit use to academic institutions, with intent to enroll patients into a research study.
On a scale of 'we think this drug has merit', it is under 10 on a scale of 100.

 

[EinSV]

This means limit use to academic institutions, with intent to enroll patients into a research study.
On a scale of 'we think this drug has merit', it is under 10 on a scale of 100.

This is a treatment recommendation for doctors treating patients. It is not limited to academic institutions.

Elsewhere in the document they make clear that the information gathering is distinct from clinical trials, but designed to allow for real-time adjustments to interim treatment recommendations as new data comes in:

1.The International Task Force suggests that data be collected from COVID‐19 patients who receive one or more of the interventions suggested in this document, in a manner that enables studies that use valid methods for causal inference and control of confounders. The data should be assessed periodically so that patients who received the intervention can be compared those who did not receive the intervention. Management should be modified as‐needed based upon the comparisons. Rationale. There is an immediate need to determine which interventions against COVID‐19 are effective and safe. Ideally, this would be done through randomized trials and there are many such trials in progress. In the meantime, unproven therapies are being administered off‐label or on a compassionate use basis. When data are not collected in such situations, it is a missed opportunity. The International Task Force recommends that data be collected from COVID‐19 patients who receive one or more of the interventions suggested in this document. Ideally, data collection will include detailed information about interventions, outcomes, and patient characteristics to enable analysis using appropriate methods of causal inference and to control for confounding. Important outcomes include mortality, ICU length of stay, hospital length of stay, intubation rate, length of mechanical ventilation, need for long‐term oxygen therapy, and adverse events. The data should be assessed periodically so that patients who received the intervention can be compared those who did not receive the intervention. This can be done at the institutional, local, national, or international level. Such data will provide interim guidance until superseded by randomized trial results when available.​

In their discussion of survey results, most of the doctors emphasized that treatment was reasonable based on the severity of the disease, potential benefits of HCQ/CQ, and that side effects were well characterized.

"Results. The task force was roughly divided into two perspectives. Some members concluded that neither hydroxychloroquine nor chloroquine should be administered without proven benefit in COVID‐19; rather, clinicians should wait until the results of randomized trials are known, otherwise there is a possibility that an ineffective and potentially harmful medication may be inappropriately administered on a large scale, potentially leading to shortages of these medications that are needed for other legitimate purposes. Other members extrapolated from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework for making recommendations in the context of low or very‐low quality evidence and concluded that treatment is reasonable because severe COVID‐19 pneumonia is a potentially lethal disease, hydroxychloroquine or chloroquine might be beneficial, and the chance of harm is low. The latter group emphasized that the adverse effects profile of hydroxychloroquine and chloroquine are well established ...."
​

Notably, they did not make a similar suggestion (for now) for remdesivir or lopinavir‐ritonavir.

 

[AlanSubie4Life]

More importantly, the number of positives as a percentage of the estimated total tests performed tells us nothing about the prevalence of a disease. It only tells us what percentage of tests were positive. Those numbers are biased by the sampling methods.

Of course, but it does not tell us “nothing.”

Any attempts to be overly precise at this point will likely fail.

Of course. That’s why I said the positivity rate was simply correlated.

However. Dr. Birx has specifically mentioned this positivity rate as one of the things they look at when monitoring disease prevalence.

About 3/4 of the way down after Pence speaks, she goes into a long discussion about this. It’s a metric:

Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing | The White House

If you look at my prior posts you’ll see I’ve been very pro “test a lot more.”

We need to be doing hundreds of millions of tests in this country at least, per year. In combination with other approaches, it’s the only way to get back to a near normal. Everyone who wants a test or has any doubt about their status needs immediate access to a test that provides accurate results in 15 minutes.

Do ND and MT need more testing? Sure. Are they catching more than half their cases? Probably not. But the capture rate is likely much better than NY’s. If only 4% of your tests are positive, you’re likely administering tests to a significant number of people who don’t really present with symptoms that are consistent with COVID-19.

 

[SageBrush]

NYC supplies perhaps the most useful Covid-19 data available since it is normalized by age group, per capita, and hospitalizations.
It is generally true that 1/4 hospitalizations end up in the ICU, and ~ 0.3 ICU Covid-19 cases survive.

The apparent linearity of relative risk is striking, but it has to be corrected for age distribution in the population.

 

[SageBrush]

This is a treatment recommendation for doctors treating patients and is not limited to academic institutions.

I am telling you how the text will be parsed by ICU physicians. The agency is saying that it does not know whether to recommend the drug, and use outside of a research context has no value.

 

[mikevbf]

Here is a summary of NewYork-Presbyterian Hospital's update from yesterday:

"Nationally things are improving but there are some hotspots.
social distancing is working but it doesn't mean we can stop it right now.
In china there is a hold on equipment and supplies because of counterfeits, NYP is in good shape for the time being.
Slow down in terms of cases.
2,479 inpatients
Ventilators: 739 on ventilators (30%)
Capacity: the ICU capacity needs to continue.
We started testing this week of our healthcare workers-- this week we tested 500 healthcare workers.
We have not started the blood test yet. Plan to start it later this week for employees.
Staff is coming to us from across the country to our aid."

 

[VirusResearch]

View attachment 504898

You can check new data for covid-19 chart and map

 

[lascavarian]

This morning on “Face the Nation” Dr Scott Gotleib (sp?) stated that he expects the percentage exposure to the virus in the general population in the US is in the single digits. Some occupations with great public exposure will be higher.

 

[EinSV]

I am telling you how the text will be parsed by ICU physicians. The agency is saying that it does not know whether to recommend the drug, and use outside of a research context has no value.

The International Task Force and 73% of doctors on the front lines think the benefits of HCQ/CQ outweigh the risks for hospitalized patients with pneumonia (on a case-by-case basis), only 11% of doctors oppose, but doctors will ignore the Task Force's treatment suggestion. Got it.