Coronavirus

[Norbert]

I hate to say it but as far as I can tell with the current death rate and trajectory in Italy a fatality rate in the range of 200-500 DPM in the relatively short term is a near certainty. It could even be higher with the hospitals completely overwhelmed in some areas. The only thing I can see that will stop that is some miraculous treatment breakthrough in the very short term, which seems highly unlikely. One crude model I posted recently estimated that deaths in Italy would be in the range of 25000-32000, which would put the DPM at the high end of your range, and it is not clear this model adequately factors in the added fatalities from an overwhelmed medical system. https://www.medrxiv.org/content/10.1101/2020.03.25.20041475v1.full.pdf

I would appreciate your thoughts about this as I have great respect for your modeling, and I'm basically spitballing here.

The reason I am interested in IFR and/or serological testing is to have some sense of where we will be in different parts of the world after social distancing and other policies have taken effect and the virus is under control at least temporarily. Will 50% of the population already be exposed and herd immunity in effect, or will we barely be scratching the surface with only 1-5% exposed? That's a critical question and we don't seem to have a clue.

One of the problems with deciding how to tackle this virus or plan for it is that almost all of the attention is focused on the short term (understandable in a crisis but still a problem). We lack the most basic information necessary to predict how things will play out in the medium to long term. If we tamp it down in the next couple months in the Northern hemisphere, is it going to come roaring back with equal or greater force after we lift restrictions, or next winter (assuming it is temperature sensitive -- IMO probably yes but another issue where the jury still seems to be out).

A problem with drawing conclusions from the US trajectory of tested cases, is that it is too much determined by testing capacity.

 

[Lessmog]

There are no proof right now. But one can logically deduce that initial viral load determines how fast this virus invade.Since it is very easy for this virus to latch on to cells, it also should multiply fast.

There were some speculation that n to tye symptoms from the infection route. As the ones from eyes are milder and less likely to fe threatening, the ingest cases causes diarrhea and the deep inhalation ones from aerosol gets pneumonia.

Excuse me, Alien, but I think you need to spray your keyboard with something else.

 

[Oil4AsphaultOnly]

But US Gov entities do not have a track record for being fair . . . They often have significant political motivations. They should not, I agree, but they do sometimes depending upon the party in power.

That's an excuse for keeping the existing broken system in place.

I agree. I think, and have thought for a long time, that the Sherman Antitrust Act should be enforced. It seems we just gloss of that these days.

THAT should be the sole job of government - to ensure and enforce that competition exists and the playing field is level.

The anti-trust act doesn't require the break-up of any monopolies. Only monopolies that abuse their position to maintain that monopoly. Insurance has a pretty high barrier of entry in needing a significant cash pile or an underwriter with one. So not government's job to break up this monopoly/oligopoly yet. See, single-payer would fix this too. But this is already off-topic.

Edit: Insurance having a high barrier of entry means that new competitors aren't being restricted by the insurance companies themselves, but by the task of providing insurance itself. So there isn't a clear-cut case of a monopoly abusing its power (like the way OPEC or Microsoft would).

 

[Doggydogworld]

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."

Far be it for a mere armchair epidemiologist to take on the great and powerful Wizard of Oxford, but "none of this group dies" may be the single dumbest thing ever written about this pandemic.

"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%."

And they do it again....

There are actual epidemiologists working to compute the true infection fatality rate. It's probably around 1% (assuming good medical care!).

I've long said 1%, but South Korea is making a case for 1.5-2.0%. And their cases supposedly skewed toward young and female.

 

[linux-works]

House passes the CARES act, sends to Trump for signing:
House passes historic $2 trillion stimulus despite objections from GOP lawmaker - CNNPolitics

wow, bay area tech workers are getting ripped off. I don't know of a single person in silicon valley who makes less than $100k. to those that think that sounds like a lot, rents here for a 2BR apartment (not even a house) are in the $3800/mo range, rougly. when you do the math, you find that $100k in the bay area doesn't even come close to being 'rich'. you are just barely middle class, given the host cost of living here.

wonder why they didn't make it scaled by geography?

for middle of the country, $100k/year really is rich man's income, but that's absolutely not true on the coasts, for example.

what a ripoff. as usual.

 

[dhanson865]

This one is . . . odd. In my experience anyone under 18 can get an emergency provision under Medi-Cal and / or CHIP by the US Gov. This one is a failure of the hospital to pursue proper coverage for an emergent patient. The family should seek legal counsel here, as I believe this might fall under malpractice.

There ARE safety nets in place, and a hospital social worker should have been able to assist the family, given the limited information presented in the article.

with all due respect, you might want to read the article before commenting, he wasn't turned away from a hospital.

If reading an article isn't your style maybe a youtube video is more your speed? Video is only 2:45 long and you'll get the point well before 2 minutes in.

 

[sixela]

actually, i'm with the 3rd option. Around Jan, i got deathly ill with the flu, and i was truly worried about it being C-19, but only had aches and chills. no fever, coughing, nor respitory issues. discussed it with others who said that there was a particularly nasty flu bug going around this year that the vaccine did NOT cover. so it's very likely that people with these suspected c-19 symptoms are just infected with an entirely different bug. anecdotal, i know, but it's there.

There has been sampling of the "untested " population over here in Belgium -- the people with symptoms that heir general practitioner tells them "they should treat as if it were COVD-19" but don't get tested.

Sampling reveals that an estimated 39% have the flu, 11% have SARS-CoV-2, and the rest test negative for both (and have other bugs).

Since the flu season is nearing its end, that's something in flux, but yes, not everyone with symptoms has COVID-19.

On the other hand, one hospital is now testing _all_ people entering the hospital for traces of COVID-19 using CT scans (regardless of whether they have symptoms), and out of 50 people, they found 5 people who turned out to have COVID-19, some completely asymptomatic. So there are also people without symptoms but who _are_ carrying (and transmitting) the virus too.

 

[deonb]

Another milestone just reached:

 

[Daniel in SD]

I've long said 1%, but South Korea is making a case for 1.5-2.0%. And their cases supposedly skewed toward young and female.

It's also my feeling that South Korea is close to the true value. The most rigorous analysis seems to be of China's data and they came up with 0.66% with a really wide confidence interval (0.39% - 1.33%).
https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1.full.pdf

 

[bkp_duke]

That's an excuse for keeping the existing broken system in place.

The anti-trust act doesn't require the break-up of any monopolies. Only monopolies that abuse their position to maintain that monopoly. Insurance has a pretty high barrier of entry in needing a significant cash pile or an underwriter with one. So not government's job to break up this monopoly/oligopoly yet. See, single-payer would fix this too. But this is already off-topic.

Don't put words into my mouth. Did I say I liked the current system? Did you forget to read the rest of this thread and see how much I LOATHE insurance companies?

Stop reading your personal preferences and prejudices into my post. If I want to say something, I'm always clear about it and don't mince words.


Single payer in this country would be a DISASTER for the following reasons:
1) you will see doctors retire in droves. This is not a guess on my part, this is well established given the insanely low reimbursement rates that Medicare currently pays for office visits.
2) you will see rationing of care because of #1 - Canada and the UK already have this and it's not called "rationing" it's called "extended wait times to see a specialist". Literally, costs are kept down because some of the sickest people in the system (that would use up the resources) cannot get the care they need in time before dying. This is evidenced by higher mortality rates in these countries for various diseases (see my post several pages back about cancers).
3) the US Government is HORRIBLY inefficient in everything it touches. So inefficient that the cost of care would probably go UP, instead of DOWN.
- When I was a medical student some of the WORST care I ever saw was in the VA medical system. That's 100% government run, and should be looked at CLOSELY as to how a bureaucratic system would run healthcare. I literally showed up for work one day at a VA facility and had a nurse look me square in the eyes and refuse to draw blood on a patient because she had "met her quota for the day".

 

[Causalien]

Excuse me, Alien, but I think you need to spray your keyboard with something else.

Lol. These auto corrects from swift keyboard is annoying AF.

 

[Daniel in SD]

On the other hand, one hospital is now testing _all_ people entering the hospital for traces of COVID-19 using CT scans (regardless of whether they have symptoms), and out of 50 people, they found 5 people who turned out to have COVID-19, some completely asymptomatic. So there are also people without symptoms but who _are_ carrying (and transmitting) the virus too.

CT scan? computerized tomography?
60% of the Diamond Princess positives were asymptomatic.

 

[AlanSubie4Life]

I've long said 1%, but South Korea is making a case for 1.5-2.0%. And their cases supposedly skewed toward young and female.

It's also my feeling that South Korea is close to the true value.

However, there likely are *some* uncounted asymptomatics - or family members of symptomatics who self-quarantined through their illness, etc.

But I very much doubt, with the data that I've seen, it is enough undercounting to drive the IFR below 1%. There are of course uncounted deaths as well, in all countries.

Eventually they'll be able to do population sampling and figure out the real answers, but with what we know now, the only reasonable course is to suppress the epidemic. If we can use that suppression time to get some population sampling with serological tests, etc., to figure out the "true" situation on the ground, great. It will inform us in a few weeks of what we need to do in order to lift the suppression measures. But the current actions are clear.

Of course, we're still not doing it. Hooray. So much winning. 100k!

 

[bkp_duke]

you might want to read the article before commenting, he wasn't turned away from a hospital.

If reading an article isn't your style maybe a youtube video is more your speed?

Actually, I did read it. The most important line in the article is this one:
"The medical staff then told the child to go to a local public hospital."

An urgent care is a private entity, and is not like an ER which has a mandate that they cannot turn anyone away until they are "stabilized".

The devil is in the details. Did he immediately go to the local public hospital? Did he go home for a period of time beforehand and his condition worsen? That's not in there, and it is critical information.

 

[Bigjet]

The CDC is reporting that Influenza A and B, collectively, have a 7.4% mortality rate in the US, this flu season. There have been 24,000 to 62,000 deaths attributed to the flu, not Covid-19. I wonder how many deaths that are being attributed to the novel virus were really due to Influenza A and/or B? In any case, it doesn't appear that Covid-19 is nearly as lethal as what we might consider "ordinary" flu.

 

[AlanSubie4Life]

now testing _all_ people entering the hospital for traces of COVID-19 using CT scans

You'd think people who had pathology severe enough to show up on a CT scan that they'd notice it. But I'm no doctor. I just figure if my lungs were jacked, I would feel a bit under the weather. One man's symptoms are another man's...asymptoms?

Doctors: Is it easy to distinguish pre-existing lung damage from recent lung damage, in a CT scan? I imagine some of the population has mild scarring from prior pneumonia, etc. - and probably even more likely in people presenting at a hospital ER with respiratory problems.

 

[bkp_duke]

The CDC is reporting that Influenza A and B, collectively, have a 7.4% mortality rate in the US, this flu season. There have been 24,000 to 62,000 deaths attributed to the flu, not Covid-19. I wonder how many deaths that are being attributed to the novel virus were really due to Influenza A and/or B? In any case, it doesn't appear that Covid-19 is nearly as lethal as what we might consider "ordinary" flu.

Link please. I can find nothing on the CDC website that shows a 7.4% mortality rate for Influenza in the current season.

And the COVID-19 specific deaths are not based upon some "guess". Literally, they require a PCR test either during diagnosis or post-mortem.



EDIT - according to this page:
Preliminary In-Season 2019-2020 Flu Burden Estimates

38 - 54 mil illnesses
18 - 26 mil medical visits
400 - 730 thous hospitalizations
24 - 62 thous deaths

That's a IFR (Infection Fatality Rate) of 0.06 - 0.11 percent
That's a CFR (Case Fatality Rate) of 0.13 - 0.24 percent

Your reported number doesn't add up.




You do, however, bring up a point which colleagues have been talking about. SARS-CoV-2 positive patients are being tested for Influenza A and B as well. It is possible to have more than one virus at the same time, and if someone is Flu + SARS-CoV-2 positive, you can treat the flu portion of their illness to reduce the mortality rate, but only in patients co-infected.

 

[Daniel in SD]

The CDC is reporting that Influenza A and B, collectively, have a 7.4% mortality rate in the US, this flu season. There have been 24,000 to 62,000 deaths attributed to the flu, not Covid-19. I wonder how many deaths that are being attributed to the novel virus were really due to Influenza A and/or B? In any case, it doesn't appear that Covid-19 is nearly as lethal as what we might consider "ordinary" flu.

I'm pretty sure every single death is tested to have COVID-19. It's certainly possible that some of them also had the flu.
I'm not saying it's a big enough sample size but does it intuitively make sense to you that 7.4% of people who get the flu die?
The current number of deaths is "fine" in a way. It's the future number of deaths that are the problem. A very small percentage of people have COVID-19 and none of us are immune (unlike the flu).

 

[Economite]

wow, bay area tech workers are getting ripped off. I don't know of a single person in silicon valley who makes less than $100k. to those that think that sounds like a lot, rents here for a 2BR apartment (not even a house) are in the $3800/mo range, rougly. when you do the math, you find that $100k in the bay area doesn't even come close to being 'rich'. you are just barely middle class, given the host cost of living here.

wonder why they didn't make it scaled by geography?

for middle of the country, $100k/year really is rich man's income, but that's absolutely not true on the coasts, for example.

what a ripoff. as usual.

If such a tech worker is laid off (which they probably won't be, since they can work from home and their employer is likely flush), then they are eligible for enhanced unemployment benefits. If they aren't laid off, then why do they need the assistance?

 

[Lessmog]

Lol. These auto corrects from swift keyboard is annoying AF.

Did you mean "annoying AD?"
Elon Musk on Twitter

I always call it autocorrupt. But we are off topic (sorry, Mods!) again.