Coronavirus

[Beltsbear]

Of course and that seems like the most likely explanation for why daily deaths have fallen while daily case numbers have remained constant over the last couple months. What's disturbing about what's happening right now is that the number of cases is increasing in many states without a corresponding increase in testing. The positive test percentage is the metric that the COVID data sites track and that has been going up even as testing has increased.
It's possible that the people being infected right now are younger and healthier but I haven't seen that being tracked. I did hear the Florida governor talking about how there are a lot of cases right now among agricultural workers and that they should have a much lower chance of being hospitalized (younger and lots of vitamin D ).

Disagree. The death rate is not proven to be falling, but if it is the dominant factor will be improvements to care. Turning patients over (prone) before going to the step of a ventilator. Understanding what Covid does to the blood and taking that into account in treatment. Remdesivir and other drugs may be helping too.

 

[Daniel in SD]

I'm always open to other ideas, so this is another option for bringing our cases to zero:
View attachment 551839

Smart.

https://twitter.com/PeterAlexander/status/1272604861809463298

Fact check: True!

Business Insider has a story today 6/15 "Fauci: Mask advice was because of doctors' shortages from the start". Like we here didn't know that (sarcasm) but guess some people in the country thought it meant people shouldn't need to wear them at all, period. No the public's safety was second to medical and emergency workers. Really not hard to understand. BI's story (on Apple News) originated from a Fauci video interview with The Street, as linked to here: https://www.thestreet.com/video/dr-fauci-masks-changing-directive-coronavirus

Will actively publicizing the reason as to why the advice was initially given to the public result in more people wearing masks now that masks are available? I think it will take a lot more hospitalizations and deaths to sink in with some, probably more so if it hits their home/family, but I still believe others simply won't care. Today there was a story I saw about a woman in NYC at a bagel shop who wasn't wearing a mask assault another woman and those around her by intentionally going up to them and coughing several times at her/them exclaiming well I already have antibodies! and calling her names (Maskless woman at NYC bagel shop intentionally coughs on patron who calls her out: 'Horrific behavior'). Just appalling and certainly not the only case like this we've seen in the news. I can't help but think the mistake made initially which caused some of this mask uncertainty was in not suggesting people at least wear home made masks or scarves like we saw in other countries. Instead it lead people to not wearing anything and spreading the virus during that time and confusing some people as to why wear them at all.

They shouldn't have lied to people.
The biggest simple mistakes so far IMHO:
1. CDC not approving existing COVID-19 PCR tests.
2. Lying about masks (even if they felt it was for the greater good).
3. Downplaying/denying asymptomatic/presymptomatic spread.

Disagree. The death rate is not proven to be falling, but if it is the dominant factor will be improvements to care. Turning patients over (prone) before going to the step of a ventilator. Understanding what Covid does to the blood and taking that into account in treatment. Remdesivir and other drugs may be helping too.

I agree that improved treatment is very likely a factor. I bet nursing homes and assisted living facilities are getting better at protecting residents too. Longer term I think it will be very hard to hold back the tide if there are huge infections rates though.

 

[PeterJA]

Nobody thinks that there will be a fixed CFR at all. That's obviously not true.

I was referring not to experts like you, but to the public. I see young healthy people wearing masks on the beach because they've been told to fear for their lives until a vaccine is available and new cases disappear.

Furthermore, people also realize that IFR will likely go down with time, if we can do a good job of keeping it out of vulnerable populations (obviously there are other factors too). But as has been pointed out by me before, that's like having a peeing section in a swimming pool. If a lot of people start peeing, the water starts to get pretty yellow eventually (especially if everyone's been taking those vitamins you keep on harping on about).

Not exactly. With time, more people get infected, develop immunity, and stop shedding virus, so they can visit the grandparents eventually. The swimming pool doesn't stay yellow.

Edit: Vitamins C and D don't turn your pee yellow, as good doctors will tell you.

 

[AlanSubie4Life]

they can visit the grandparents eventually.

At the current pace...checks calculator...that will be in about 27 months (currently ~5% immunity, ~50% herd immunity, generously assuming R0 = 2, and we've been ballsing this up for 3 months so far).

 

[PeterJA]

What's disturbing about what's happening right now is that the number of cases is increasing in many states without a corresponding increase in testing.

That's disturbing if the health status of the tested people hasn't changed. But Alan said...

I've been specifically looking at AZ, TX, SC, and NC, and those states are definitely skewing towards younger people being infected.

I'm not defending the lying moron in the White House either, just trying to figure out the truth.

 

[PeterJA]

At the current pace...checks calculator...that will be in about 27 months (currently ~5% immunity, ~50% herd immunity, generously assuming R0 = 2, and we've been ballsing this up for 3 months so far).

So maybe the craven Republican plan is accidentally reasonable: Protect the vulnerable and infect everyone else as fast as possible within the limits of medical resources (which should include those vitamins I keep harping about, but Republicans and Democrats both ignore those).

But don't call it the Swedish plan. Republicans hate those socialists (except as immigrants; politics is so confusing).

 

[AlanSubie4Life]

That's disturbing if the health status of the tested people hasn't changed. But Alan said...

Not sure exactly what you mean by this, but to be clear, the number of cases is also increasing in many states without an increase in testing. When the data is available, it appears to be generally younger crowd of people than earlier in the outbreak (though admittedly I don't have the data from early in the outbreak so I could be wrong about the trends), so hospitalizations are a weaker function of the infection rate than earlier.

Here's TX, for example. 4% to over 6%. Not the worse of the states currently showing warning signs. But it's a large & populous state so this statewide number can conceal local trends driven by a specific city.

You can mostly ignore the early "10%" - don't look at the trend as downwards because of that - early in the outbreak you can see from the testing slope that they were testing at about half the rate, or less.

 

[AlanSubie4Life]

So maybe the craven Republican plan is accidentally reasonable: Protect the vulnerable and infect everyone else as fast as possible within the limits of medical resources

It's a great plan, except for all the deaths, and the likely long-term medical costs. And the (unproven) theory (which I tend to believe) that if you accelerate the infection rate that much, it likely will not be possible to keep it out of vulnerable populations. Catch-22.

 

[PeterJA]

Not sure exactly what you mean by this, but to be clear, the number of cases is also increasing in many states without an increase in testing. When the data is available, it appears to be generally younger crowd of people than earlier in the outbreak (though admittedly I don't have the data from early in the outbreak so I could be wrong about the trends), so hospitalizations are a weaker function of the infection rate than earlier.

So translated to lay language...

1) More new cases are appearing. (bad)
2) But more of them are younger, hopefully healthier, people. (good)
3) Therefore, more of them won't require hospitalization or die. (good)

Sounds good enough to not panic about Tesla's prospects. Thanks.

It's a great plan, except for all the deaths, and the likely long-term medical costs. And the (unproven) theory (which I tend to believe) that if you accelerate the infection rate that much, it likely will not be possible to keep it out of vulnerable populations. Catch-22.

Is that what happened in Sweden?

 

[AlanSubie4Life]

Sounds good enough to not panic about Tesla's prospects. Thanks.

I don't think there's reason to panic about Tesla's prospects, but the short term picture is a bit murky (I'd keep an eye on the local situation there to inform your decisions - all of these outbreaks & the control measures are local, not national, in nature).

Is that what happened in Sweden?

Well, Sweden has death panels for the elderly, from what I understand. And I think they're only at 6.1% or something infected on average nationwide (as of early May - so maybe they're at 8-10% now?).

So they haven't really had an opportunity to test any theory with a high disease burden, either. Sweden Study Summary

Looks like about 0.6% of their population is currently infected and a little over 8% infected in total thus far, based on estimates/models (which agrees pretty well with serology - predicts 6.1% on May 3rd):

COVID-19 Projections | Sweden

 

[jerry33]

Will actively publicizing the reason as to why the advice was initially given to the public result in more people wearing masks now that masks are available?

Umm. Where are they available? So far all the ones that offer real protection aren't available except for hospitals and such. The available masks only work if everyone wears them and the HVAC is properly filtered.

 

[Daniel in SD]

I was referring not to experts like you, but to the public. I see young healthy people wearing masks on the beach because they've been told to fear for their lives until a vaccine is available and new cases disappear.

Maybe they care about other people and not just themselves?
I'm a little bit of a hypocrite though. I wear a (probably fake) KN95 in lower risk situations and a full face respirator in higher risk situations (it has an exhaust valve so it's probably not very protective of others).

So maybe the craven Republican plan is accidentally reasonable: Protect the vulnerable and infect everyone else as fast as possible within the limits of medical resources (which should include those vitamins I keep harping about, but Republicans and Democrats both ignore those).

But don't call it the Swedish plan. Republicans hate those socialists (except as immigrants; politics is so confusing).

That is the Swedish plan. It even looks like they've been somewhat successful at it with 6.5% of 18-64 years old having antibodies and only 2.9% of people 65+. I think all their neighbors have closed the borders to them because of how diseased they are. They seem to have greatly increased testing recently so it looks like they have decided to change their plan.

 

[dfwatt]

They were prior quotes from Ioannidis.

https://www.washingtonpost.com/opin...61e178-7a9b-11ea-a130-df573469f094_story.html

In the coronavirus pandemic, we're making decisions without reliable data

I'm happy to say that I lol'ed at that first article at the time it came out. It was absurd.

I guess increasingly I think that the problem is that Ioannidis has spent so much time in his career in statistical calculation models that he's completely forgotten how to be a biologist or a clinician, or worse that he believes that somehow biological knowledge can be meaningfully supplanted by statistical epidemiologic analyses.

Anyone paying attention to the on-the-ground reports from Physicians working in ICU and ERs would have told anybody who is listening to the front line staff that this was different from a typical influenza. Different in several regards including 1) the fact that a high percentage of people were dying from clotting disorders (CVAs/MIs, along with more recently clarified microangiopathy in the lung due to pathological clotting) and that unlike influenza, mechanical ventilation often times made little difference in terms of increasing people's chances of survival, possibly because of that microangiopathy; 2) that renal failure was common (possibly indexing viral pathology in the endothelial system in the kidney); 3) that a higher incidence of lethal cytokine release syndrome or 'cytokine storm' as it is called colloquially was being seen in these covid-19 patients compared to influenza.

Collectively that's a lot of functional biological differences between this disease and the flu. So the idea that somehow it's going to have the same kind of epidemiologic footprint as the flu which appears to have taken over in Ioannidis's brain as a conviction should have been reality checked by these pieces of biological knowledge. Even more troubling, after his extremely poorly conceived Santa Clara Antibody study was blown up by the check on his unvetted Chinese serology with the gold standard Elisa showed a >50% false positive ratio, he doubled down on his original mistake. So instead of admitting that he was off track he appears to have redoubled his efforts to prove that covid-19 is a hoax (dressing up that discrediting of course in fancy statistics and scientific language).

I've rarely seen a scientist with a good reputation behave this badly in relationship to the science, although his entire scientific reputation has been based on statistically bashing conventional wisdom so perhaps he just can't resist being a contrarian. My prior high respect for him in fact was based on his ability to statistically demonstrate that mainline antidepressant drugs (SSRIs/SNRIs) really don't exceed Placebo in mild to moderate depression only in moderate to severe depression. I suspect picking on Psychiatry however was a much easier set of targets. As there's a whole lot more bull**** going on in psychiatric research at least in my opinion . I wonder if he will survive at Stanford.

 

[renim]

Maybe they care about other people and not just themselves?
I'm a little bit of a hypocrite though. I wear a (probably fake) KN95 in lower risk situations and a full face respirator in higher risk situations (it has an exhaust valve so it's probably not very protective of others).....

Full face respirator? I suppose that helps with maintaining social distancing. Just what is a higher risk situation?

 

[PeterJA]

1) the fact that a high percentage of people were dying from clotting disorders (CVAs/MIs, along with more recently clarified microangiopathy in the lung due to pathological clotting) and that unlike influenza, mechanical ventilation often times made little difference in terms of increasing people's chances of survival, possibly because of that microangiopathy; 2) that renal failure was common (possibly indexing viral pathology in the endothelial system in the kidney); 3) that a higher incidence of lethal cytokine release syndrome or 'cytokine storm' as it is called colloquially was being seen in these covid-19 patients compared to influenza.

That's why the lifesaving Frontline Critical Care Group hospital protocol includes the anticoagulant heparin to stop the clotting, and the antioxidant vitamin C to stop the oxidative damage from the cytokine storm.

Whoops, I harped again.

 

[Daniel in SD]

Full face respirator? I suppose that helps with maintaining social distancing. Just what is a higher risk situation?

Grocery store or hardware store. Basically any indoor space with a bunch of people.
Honestly I haven't even noticed people giving me funny looks. Indoor mask compliance had been very high here until they opened the restaurants.

 

[AlanSubie4Life]

I thought this summary of the CDC report from Tom Frieden (former director of the CDC) was helpful as a summary. You can also read the CDC report; though the report itself is a bit more in depth, it helps explain the subtleties of what NOT to conclude yet from the data.

Latest in COVIDView: Deaths decline, test positivity increases, concerning trends emerge in states

Looks like the list of problem states is similar to what I flagged last week on June 10th (though the trends have become more clear as of late) post...

AZ, TX, NC, FL, followed by SC, AK are the current problematic states. AZ is really concerning right now. I hope that somehow positivity drops this week, but doesn't look great so far.

 

[Dr. J]

Another possibility is that he just has no idea what is going on, or has inadvertently started believing his own spin. (The spin is the current talking point that cases are increasing due to increased testing - which certainly has an element of truth overall, but there are clearly states that are currently experiencing undesirable "blips" which are not due to increased testing (AZ, NC, SC, AR, TX).) While we'll probably never have another New York (I hope!), these blips have the potential to become quite problematic.

View attachment 551688


https://twitter.com/realDonaldTrump/status/1272532925460905984?s=20

"Testing is a double edged sword. Makes us look bad, but good to have!!!"

Because: appearance is the same as, or as important as, reality. No, testing is not a double-edged sword.

 

[Dr. J]

Business Insider has a story today 6/15 "Fauci: Mask advice was because of doctors' shortages from the start". Like we here didn't know that (sarcasm) but guess some people in the country thought it meant people shouldn't need to wear them at all, period. No the public's safety was second to medical and emergency workers. Really not hard to understand. BI's story (on Apple News) originated from a Fauci video interview with The Street, as linked to here: https://www.thestreet.com/video/dr-fauci-masks-changing-directive-coronavirus

Will actively publicizing the reason as to why the advice was initially given to the public result in more people wearing masks now that masks are available? I think it will take a lot more hospitalizations and deaths to sink in with some, probably more so if it hits their home/family, but I still believe others simply won't care. Today there was a story I saw about a woman in NYC at a bagel shop who wasn't wearing a mask assault another woman and those around her by intentionally going up to them and coughing several times at her/them exclaiming well I already have antibodies! and calling her names (Maskless woman at NYC bagel shop intentionally coughs on patron who calls her out: 'Horrific behavior'). Just appalling and certainly not the only case like this we've seen in the news. I can't help but think the mistake made initially which caused some of this mask uncertainty was in not suggesting people at least wear home made masks or scarves like we saw in other countries. Instead it lead people to not wearing anything and spreading the virus during that time and confusing some people as to why wear them at all.

They lied (esp. the Surgeon General) and destroyed their credibility. Now what they say is met with skepticism or disbelief. That is the price paid for expediency. They should have treated us like adults, told us the truth and asked us to donate our masks to healthcare workers. Instead they lied, and then couldn't come up with enough PPE for months. Worst possible outcome, especially in credibility.

 

[madodel]

Umm. Where are they available? So far all the ones that offer real protection aren't available except for hospitals and such. The available masks only work if everyone wears them and the HVAC is properly filtered.

I bought 100 face masks at Staples today to keep in the office for if someone shows up without one. Target also sells masks, though not in large boxes like Staples. Then there are all these KN95 masks that have popped up all over. What is the difference between these and real N95 masks. The KN95 are selling for like $5 a piece. Are they of any real use?