Coronavirus

[dfwatt]

Something like 2,500 uniformed police have tested positive. Another 2k are out sick. Not sure how many cops have been tested in total, but that's one of the only well-tested groups in NYC and it indicates a massive infection rate.

In the least social distancing occupation on Earth? That's your data point? And you don't even have a firm infection rate number to boot?

 

[SageBrush]

It's believable that several really really hot hot spots in Europe particularly Italy but also Germany saw something on the order of 15% exposure. Indeed we have to assume I believe that Italy has many more cases than their actual case number in order to get to their death toll. It's possible that a high percentage of folks smoking also bumps that up and there's some evidence that overuse of antibiotics in Italy may contribute as well but still even with those shadings so to speak, I think you have to believe that Italy has the highest level of exposure along with Spain perhaps. But that's still an enormous distance from any version of 70%. So you have to say that even the places with the greatest penetration of covid-19 have a long way to go to get to any concept of herd immunity.

This is true but a perhaps intuitive corollary is not: herd immunity > 15 - 20% in fact DOES flatten the curve in a significant way. If you play with a decent SIR model and view fractional immunity as a proportional reduction in infectivity you can visualize the effect.

 

[Norbert]

If corona has a ~0.37% IFR like the Iceland and German studies seem to suggest, with ~7,300 dead that means that 2-3 weeks ago ~2 million people in NYC already had Coronavirus... That's 1/4 of NYC. By now it could nearly be half of the city that has or had it.

Iceland has only 8 deaths now, but 9 in ICU, 40 hospitalized and 770 still in isolation. So it is far too early to use just the number 8 for calculating a general IFR. Aside from that, with such a small number, much depends on coincidences. For example, Iceland was testing very early and very much, and may have succeeded in protecting nursing homes. Even so, that number could easily double or triple before things are over. Iceland is not exactly typical in the first place.

 

[SageBrush]

S. Korea has a general election tomorrow. That sounds like one hell of a test for the country

Spoiler: Infection Prevention Measures

○ KCDC asked voters to carefully follow the infection prevention guidelines when casting their votes for the general election tomorrow (15 April).

- Voters should wash their hands thoroughly before and after going to polling places, wear a facemask at polling stations, and keep a distance of at least 1 meter from other voters.

- At the entrance to the polling station, voters will undergo temperature checks, disinfect their hands with hand sanitizer, and put on disposable gloves. Voters should comply with the instructions of poll workers.

- Marking one’s hand or finger inside the polling booth with the stamp used to fill out the ballot (something many Korean voters have been doing in recent elections to casually display their pride in exercising their right to vote) is not recommended for this election due to infection prevention reasons.

 

[Norbert]

It's believable that several really really hot hot spots in Europe particularly Italy but also Germany saw something on the order of 15% exposure.

I don't doubt that there are specific places with an infection rate that high. I have more reservations about the other conclusions without seeing the data.

Indeed we have to assume I believe that Italy has many more cases than their actual case number in order to get to their death toll. It's possible that a high percentage of folks smoking also bumps that up and there's some evidence that overuse of antibiotics in Italy may contribute as well but still even with those shadings so to speak, I think you have to believe that Italy has the highest level of exposure along with Spain perhaps. But that's still an enormous distance from any version of 70%. So you have to say that even the places with the greatest penetration of covid-19 have a long way to go to get to any concept of herd immunity.

Yes, even so still a long way.

 

[TheTalkingMule]

In the least social distancing occupation on Earth? That's your data point? And you don't even have a firm infection rate number to boot?

We were discussing NYC teachers, one of the few groups even closer to the frontline of infection than cops.

I don't know how many of the 18k cops they tested and I don't know how many of those home sick are infected, so no I don't have an infection rate.

 

[jerry33]

Now, there's talk of it airborne up to 13 ft. Waiting for mandatory helmets soon, esp for the military (storm troopers).

If you are outside, won't that depend on the wind? Could be much further if you are downwind. Inside it's going to depend on the HVAC and which way it's blowing.

 

[mikevbf]

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

"The curve is flattening, there is a lot of discussion about when we will get back to business as usual. But so many things will continue to be different.

Total NYP: 2,512--762 on ventilators, ICU: 746

22 new admissions netted across the enterprise.

Testing: we are testing all patients coming into the hospital, all those having procedures, and outpatient testing for those that need it.

Testing for healthcare workers: available if you are sick.

Blood test: not so straightforward. More information coming.

Our supply of N95 is substantial. You can use one whenever you are in direct care. Please conserve them, but if you need more than one please use more.

Ventilators: we do not anticipate a shortage of ventilators.

New Issue: many ill patients have low blood pressure due to shock, this begins to impact internal organs, especially the kidneys. There is a critical shortage of dialysis medication. Asking vendors to prioritize hot spots like us.

Field hospitals are ready and accepting patients starting tomorrow.

Staffing: we have had outpouring of support from across the country. Nurses from all over joining us."

 

[TheTalkingMule]

More news from NY Presbyterian and a very interesting data point....

https://nypost.com/2020/04/14/pregnant-women-without-symptoms-are-getting-coronavirus-study/

NewYork-Presbyterian and Columbia University Medical Center screened more than 200 women for the illness upon admission between March 22 and April 4, according to the study.

Among the 33 patients who tested positive, 29 of them had no symptoms.

One patient with a swab that was negative for SARS-CoV-2 on admission became symptomatic after giving birth, and was tested again 3 days after the initial test.

 

[EinSV]

More news from NY Presbyterian and a very intceresting data point....

https://nypost.com/2020/04/14/pregnant-women-without-symptoms-are-getting-coronavirus-study/

As mentioned in my post yesterday, that study represents test results collected through April 4, and used PCR, which multiple studies have found has a significant number of false negatives for covid-19.

15.4% positive, likely a minimum of 25% false negatives, and 10 days of growth since April 4 suggests an overall infection rate of 30-50% of the population would not be at all surprising.

The main question in my mind is whether this population (pregnant women about to give birth), in this hospital, is representative of the total New York City population.

 

[EinSV]

As a quick follow-up, a new Johns Hopkins study finds PCR false negatives for covid-19 are very high (consistent with other reports). In this study, they found that the rate of false negatives varies depending on the time of testing relative to exposure but on the best day (3 days after symptom onset) was still about 26%.

https://www.medrxiv.org/content/10.1101/2020.04.07.20051474v1.full.pdf

From the authors:

Probability of a False Negative Result Among SARS-CoV-2 Positive Patients, by Day Since Exposure

Over the four days of infection prior to the typical time of symptom onset (day 5) the probability of a false negative test in an infected individual falls from 100% on day one (95% CI 69-100%) to 61% on day four (95% CI 18-98%), though there is considerable uncertainty in these numbers.

Probability of a False Negative Result by Time Since Symptom Onset

On the day of symptom onset, the median false negative rate was 39% (95% CI 16-77%) (Figure 1, upper panel). This decreased to 26% (95% CI 18-34%) on day 8 (3 days after symptom onset), then began to rise again, from 27% (95% CI 20-34%) on day 9 to 61% (95% CI 54-67%) on day 21.​

 

[Curt Renz]

Piper Sandler (formerly Piper Jaffray) managing director and chief technical analyst Craig Johnson was a regular guest of mine on my old TV show. I still get his newsletters. In early 2013 he recommended TSLA and I bought my initial shares. Below is the summary of his market opinion today. He also recommended a number of stocks today. I'm posting the two that I actually own, including TSLA.

EDIT: Craig's Piper Sandler colleague Alexander Potter currently has a BUY rating on TSLA and an $820 price target.
____________________________________

In summary, based on the +20% advance off the recent March lows, the bear market for stocks has concluded, and we believe the low of the cycle has been set. Fundamental expectations have been reset, and the bar should be low for the upcoming earnings season. From our perspective, bad news is most likely old news at this juncture. The technical backdrop for the broader market also continues to improve. The recent recovery rally has reversed a downtrend on the SPX, while momentum and breadth move in the right direction. We continue to recommend investors increase equity exposure and reiterate our year-end price objective on the SPX of 3,600.

• Tesla Inc (TSLA - $650.95); Indicated higher this AM; shares have confirmed support off a prior breakout level and reversed a ST downtrend; back above the 10-/30-week WMAs; RS is confirming the bullish price action; notable TechniGrade ranking; add to positions, the next levels of overhead resistance set up near $805 and $901.

• Amazon.com, Inc. (AMZN - $2168.87); Shares have broken above the upper end of a LT ascending triangle; back above the 10-/30-week WMAs; RS and volume are confirming the breakout; impressive TechniGrade ranking and recent insider buying activity; add to positions, as we suspect more upside lies ahead.

 

[EinSV]

Marc Lipsitch has written a pretty balanced high level summary of many of the issues we are discussing: Opinion | Who Is Immune to the Coronavirus?

 

[TheTalkingMule]

As mentioned in my post yesterday, that study represents test results collected through April 4, and used PCR, which multiple studies have found has a significant number of false negatives for covid-19.

15.4% positive, likely a minimum of 25% false negatives, and 10 days of growth since April 4 suggests an overall infection rate of 30-50% of the population would not be at all surprising.

The main question in my mind is whether this population (pregnant women about to give birth), in this hospital, is representative of the total New York City population.

These are the kinds of conclusions I'm drawing as well, for NYC anyway. Most evidence is pointing to spread being closer to 60% than 10%. I don't think it's a stretch to say nearly half of New Yorkers have been in contact with the virus and have developed some degree of antibodies.

If anything the situation in Philadelphia almost dictates there must be such a wide spread in NYC. Plenty of people have it in Philly, but we're still under 200 deaths so spread must have been dramatically slowed here(or the weather is a huge factor).

Smells to me like repeated heavy exposure is what's really doing the damage. Hard to get that kind of exposure when 97% of Philadelphia is terrified to go near anyone. Hopefully this means the spread is nearly as wide(geographically) in Philadelphia, but the behavior and weather are limiting heavy exposure. A lot of our early cases were grocery and convenience store folks. And now we're seeing cops and bus drivers dying. Then we contrast that to my 75 year old mother living nextdoor to an 87 year old woman who tested positive and both are now fine.

A slow drip might let us build antibodies while experiencing almost exclusively asymptomatic cases. Just a WILD guess on that obviously, but there has to be some similar answer to the dramatically different reaction in very similar populations. One thing I thought we knew for certain was that this thing spreads like crazy.

 

[blckdmp]

We were discussing NYC teachers, one of the few groups even closer to the frontline of infection than cops.

I don't know how many of the 18k cops they tested and I don't know how many of those home sick are infected, so no I don't have an infection rate.

LMGTFY 38k+ NYPD members.

 

[EVNow]

As a quick follow-up, a new Johns Hopkins study finds PCR false negatives for covid-19 are very high (consistent with other reports). In this study, they found that the rate of false negatives varies depending on the time of testing relative to exposure but on the best day (3 days after symptom onset) was still about 26%.

https://www.medrxiv.org/content/10.1101/2020.04.07.20051474v1.full.pdf

View attachment 532227

From the authors:

Probability of a False Negative Result Among SARS-CoV-2 Positive Patients, by Day Since Exposure

Over the four days of infection prior to the typical time of symptom onset (day 5) the probability of a false negative test in an infected individual falls from 100% on day one (95% CI 69-100%) to 61% on day four (95% CI 18-98%), though there is considerable uncertainty in these numbers.

Probability of a False Negative Result by Time Since Symptom Onset

On the day of symptom onset, the median false negative rate was 39% (95% CI 16-77%) (Figure 1, upper panel). This decreased to 26% (95% CI 18-34%) on day 8 (3 days after symptom onset), then began to rise again, from 27% (95% CI 20-34%) on day 9 to 61% (95% CI 54-67%) on day 21.​

Note that for our purposes the lower graph should be used i.e. what is the likelihood of the person being infected, when tested negative on PCR. On day 21, for eg. (my case), it is only 7%.

The main take away from the study is ...

As RT-PCR-based tests for SARS-CoV-2 are becoming more available, these are increasingly being used to
“rule out” infection to conserve scarce PPE and preserve the workforce. When an exposed healthcare
worker tests negative they may be cleared to return to work; similarly when an exposed patient tests
negative, airborne/droplet precautions may be removed. If negative tests performed during the window
period are treated as strong evidence that an exposed individual is negative, preventable transmission
could occur.​

 

[Artful Dodger]

"How the world could change after the coronavirus pandemic | Fareed Zakaria" | TED

 

[deonb]

Positive new cases in Italy today (2972) is the lowest it's been in 30 days.

Looks like it is the first European nation to cross that threshold.

 

[EVNow]

S. Korea has a general election tomorrow. That sounds like one hell of a test for the country

Spoiler: Infection Prevention Measures

○ KCDC asked voters to carefully follow the infection prevention guidelines when casting their votes for the general election tomorrow (15 April).

- Voters should wash their hands thoroughly before and after going to polling places, wear a facemask at polling stations, and keep a distance of at least 1 meter from other voters.

- At the entrance to the polling station, voters will undergo temperature checks, disinfect their hands with hand sanitizer, and put on disposable gloves. Voters should comply with the instructions of poll workers.

- Marking one’s hand or finger inside the polling booth with the stamp used to fill out the ballot (something many Korean voters have been doing in recent elections to casually display their pride in exercising their right to vote) is not recommended for this election due to infection prevention reasons.

Why don't they do mail in ballots ?!

 

[EVNow]

If corona has a ~0.37% IFR like the Iceland and German studies seem to suggest, with ~7,300 dead that means that 2-3 weeks ago ~2 million people in NYC already had Coronavirus... That's 1/4 of NYC. By now it could nearly be half of the city that has or had it.

In South Korea, based on widespread testing we were thinking CFR was about 0.5% - but the death rate steadily rose and it is now 2%.

In Germany - when comparing to France, all of us were surprised at very low death count. Now Germany will surpass China in a day or two.

BTW, CFR and IFR are NOT immutable numbers. A lot depends on demographics, socio-economic conditions, cultural practices, living conditions, healthcare system etc etc. You simply can't take speculative IFR from one country / city to derive infection rates in a different country.

Its like trying to figure out Tesla sales in India by looking at the rates in San Jose.