Coronavirus

[Lindamon]

For those who were posting about the lack of recoveries in FL, I can’t go through this morass to see if this has already been posted, but the DOH here is not tracking recovery data. Why don't we know how many people have recovered from COVID-19 in Florida? An explanation

 

[Oil4AsphaultOnly]

Datagraver has a new interactive tool for generating Covid19 charts. I've shared many of their charts but now you can set the assumptions. For example, to predict when the US will cross 100 DPM, I can select just the countries I wish to compare with and start at days since 10 DPM or 29 DPM to align it most closely to my prediction problem. It also shows the death growth rate comparisons so I note that Netherlands and Switzerland are actually the two closest comps in terms of recent death growth rates. Following Netherlands, the US still looks on track to cross 100 DPM on April 14, but following Switzerland this could be a day or two later. So play with it yourself.

Covid-19.

wicked tool! But interestingly (and probably due to this weekend's lack of reported deaths), it _looks_ like the US fatalities curve is bending! We might be following more closely to switzerland's curve, giving us more than a few days lag to reaching 100DPM.

Now that we're a week after my predictions for April 27th, I re-did my chart using current numbers, and I was SHOCKED to find everything pointing towards your estimate of April 14th! But the datagraver chart showing Growth Rate Fatalities continue to trend down, gives me hope that there's still a chance to not reach 100DPM until later than April 17th.

 

[Oil4AsphaultOnly]

For those who were posting about the lack of recoveries in FL, I can’t go through this morass to see if this has already been posted, but the DOH here is not tracking recovery data. Why don't we know how many people have recovered from COVID-19 in Florida? An explanation

They don't need to track it. I merely calculated it based on the number of total cases of known infections minus the number of known deaths and the number of active cases (still sick). Until 2 days ago, the difference was zero.

 

[kbM3]

It's not really possible for a new virus to have all these same traits AND be highly lethal. SARS2 spreads super easily and incubates for up to 13 days. Combine that with a modern day mortality rate over 2% and you're describing something that would have ended human civilization long ago. Unless of course you want to believe this is some new type of virus that don't play by the rules.

I posted a video by Arvin Ash explaining exactly why this virus is different. Did you not watch it?

Basically it lodges in the upper respiratory tract first, where it is very contagious, but not yet that dangerous. After a few days, it works it’s way down to the lower respiratory tract, where it becomes far more lethal.

Search my previous posts, or Google Arvin Ash, watch the video and come back if you have questions, or don’t understand it.

 

[wdolson]

You know, pretty much all medical "science" is crap. Humans make lousy test subjects. The docs are clueless about statistics, and have little to no experience (i.e. even a lifetime of practice is next to nothing). Everybody concerned is constrained to do their best for the patients, not for science.

Give me any day a clinical group that has found a protocol which leads to better outcomes, no matter what their process. I'll go for what they say even if it has nothing to back it up beyond that. I am very much anticipating the advent of AI that can integrate data from all over the world over many decades. The diagnostics and treatments that will come out of that will revolutionize medicine. Current approaches are almost useless for producing good data or good analysis.

It will be the AI guys, not the medical guys, that help people most in the end. You'll no doubt enjoy being told to stuff your opinion because you're only a doctor and what would you possibly have to contribute.

Computer models can only be as good as the data going into them. We understand some phenomenon very well and we can make excellent computer models. But some things are very difficult to model.

How exactly the various human systems work together is a vastly complex problem that we have not fully figured out yet. We are learning more everyday, but we still have a lot to learn. How one person reacts to some substance can be very different than how another person reacts. That's why finding the right medication and right dosage can be trail and error much of the time.

We may be able to make AIs that become an aid to diagnostics, and computer modeling will help us advance medicine, but I doubt they are going to replace humans in the loop any time soon.

Now medicine isn't perfect either. There are people trying to game the system to make money like the guy who got famous for buying the rights to a drug that was used to treat a rare condition and only that condition and then jacking the price into the stratosphere. He got famous for it because he was the most extreme case, but there are many other similar stories that didn't make the headlines.

There are other ways people play games with the medical world to make money. I'm pretty sure some bad actors are playing games with the world medical supply system to make as much money as they can off this pandemic.

But back in the day things like blood letting and blowing tobacco smoke up someone's backside (it was a common practice) turned out to be nowhere near as effective as penicillin and other advances science based medicine brought us.

 

[Lindamon]

They don't need to track it. I merely calculated it based on the number of total cases of known infections minus the number of known deaths and the number of active cases (still sick). Until 2 days ago, the difference was zero.[/QUOTE

They don't need to track it. I merely calculated it based on the number of total cases of known infections minus the number of known deaths and the number of active cases (still sick). Until 2 days ago, the difference was zero.

Then you are making the assumption that taking down active cases means they have recovered, when the article states quite clearly the DOH has no good definition of recovery. You are just having fun with math.

 

[kbM3]

Can probably roughly extrapolate that 16 / 26 % ratio.

That would give (at time of publication), "end point" patients (discharge or death) as:
38% dischared
62% death

Not very favorable odds.

‘That rough approximation only works if the ICU influx is relatively constant. Assuming the influx has been increasing, there would be a larger percentage of patients with a shorter duration in the ICU, and therefore the data would be skewed towards survival. I.e. > 62% death rate.

Edit: Assuming days to recover is shorter than days to death.

 

[traxila]

Staggering Surge Of NYers Dying In Their Homes Suggests City Is Undercounting Coronavirus Fatalities

Nothing to see here folks. Move along move along.

 

[kbM3]

I think Fauci is sometimes making remarks in this direction.

I think it is too early to talk about dates for lifting stay-at-home. After all there are still states and places (for example churches) that should do SAH but don't.

However, if that time comes sooner than a vaccine, there will have to be a balance between mitigation and test&trace. Some seem to still think or talk as if there will be herd immunity. But actually we will be in the same position as when it started. And we will have to wait not only until the death rate goes down, but also until we will have a sufficient stockpile of masks, PPE, testing kits, recovered medical team, and so on. And so on.

Even then, unless test & trace helps, we will need to continue high levels of mitigation until there is a vaccine. Because herd immunity really is not an option.

I do find this a bit mysterious, but there was good news, as has been mentioned (the Bill Ackman tweet is ridiculous, of course - but if the market is making decisions based on that....). For what it is worth, the models were adjusted to predict fewer deaths and a slightly shorter tail. And New York expressed optimism. At least, it appears that all this social distancing is helping, rather than doing nothing.

That being said, I do think that the market is starting to think restrictions will be lifted at the end of April (consistent with the agreed timeline). I don't think there is any way that this will happen, though. At least, I don't think it would be a good idea at all, and would lead to a massive second wave. It is entirely possible that Trump will go down that path, though. It's just going to take too much time for infections to die down in all parts of the country, and there is too much infrastructure (temperature, test, trace, & track, etc.) to put in place to allow re-opening - can't all be done in just three weeks.

In any case, it seemed to me that today the market was pricing in a bit more optimism than warranted. Fauci, after all, said "we may never go back to normal" <without a vaccine>. It's going to be an "80% economy" or so until there's either a broadly effective therapy, a spectacular real-time test, trace, and track infrastructure, or a vaccine. A large number of people won't want to fly, in-person sporting events won't happen, etc. They simply can't. For sure everyone will need to wear masks (probably mandatory in enclosed spaces and crowds is my guess), but I don't think that's going to be a magic bullet to prevent super spreading events.

I just feel like the market can't possibly be pricing in that 80% economy. There is some chance of a miraculous treatment, or a pre-existing proven vaccine being truly effective (like the BCG), and that does have to be priced in conditionally, but it seems like that's being given too much weight.

Of course, it's also possible that the market expects Trump to simply build up a massive infrastructure of ventilators (10x or 100x what we currently have) and temporary hospitals, and a massive pipeline of PPE which effectively protects medical workers (full hazmat suits for everyone?), and then just let things rip (with the ensuing 2 million deaths).

All quite mysterious. The market is very mysterious though. I guess it's possible these are bargain prices and the best thing to do is to just go all in (rather than 20% or whatever). Just having a hard time justifying making that move.

I find it very disturbing the U.S. seems to have no plan for 2020 H2. This article does a great job in describing my worries. Please, please can someone tell me that behind the scenes, the Federal government has plans in place and we will be ready to roll in June?
There Is No Plan for the End of the Coronavirus Crisis

 

[Cosmacelf]

This article strikes the right tone for what to do after this crisis regarding China. Time to put China on lockdown for its dishonesty amid coronavirus crisis

 

[Oil4AsphaultOnly]

Then you are making the assumption that taking down active cases means they have recovered, when the article states quite clearly the DOH has no good definition of recovery. You are just having fun with math.

Ummm, what?!?! I think you've misunderstood the data.
Facts:
- We have the numbers for total cases (as tabulated each day)
- We have the numbers for total deaths (as tabulated each day)
- We have the numbers or active cases (as tabulated each day)

If a person is counted as infected (at some point in time before today), is NOT dead, and is NOT an active case, then is she not recovered? Or is she a zombie?

Now, it could be that many FL patients had recovered long ago but their cases remained active for observation, that would explain why there weren't any recoveries in the data for so long. But don't diss my math or logic, that's just insulting.

 

[bkp_duke]

And so humble too. That’s got to hurt.

Never claimed to be humble. Ever.

It's over-rated when you are dealing with rampant stupidity.

 

[jbcarioca]

@jbcarioca ...
I believe we're in a bit of a "perfect is the enemy of good" situation right now with no "perfect" studies to draw upon and yet a fair amount of data that is less than perfect and people RIGHT NOW having to make life or death decisions about whether to use the drug. While it may be dangerous to use a drug with known side effects it is also dangerous to not use that drug if it offers sufficient promise when the patient is facing a 10-27% chance of death if the decision is made to not use the drug.

Thanks for your comments. I do have one substantive reason why any use of HCQ in this context is fraught. Because of the role this drug and similar ones have in malaria prophylaxis it has been studied extensively. It is cheap and readily found almost everywhere so it is frequently imagined as a possibility for treatment of other diseases. In anti-malarial use the doses are very small, usually for limited periods and typically prescribed to people who are in good health, who travel within malaria-infected areas.

The problems come in two areas. Dosage itself and toxicity that itself increases with higher dosage and /or longer use.
I am not quoting any of the copious numbers of clinical trials and other testing that have been done over the years. Anybody who wants to can find dozens and dozens such evidence.

Summarizing typical conclusions, the present of co-morbidities (with whatever was the topic) invariably tends to increase negative side effects. Among the diseases that, if present, tend to stop prescribing almost any quinine-based medication are diabetes, hypertension, coronanary or pulmonary diseases, among others. Those categories tend to be the most common co-morbidities with CIVID-19, according to the anecdotal reports thus far.

In a couple of the most often cited favorable results it seems probable that successful results might well have been due to low risk of severe symptoms anyway. Nothing anyone has cited provide solid evidence to presume that prescribing this stuff is worth the risk, unless some controlled testing can show that the results are worth the risk of the damage caused.

I am quite intentionally not quoting any of the studies, exactly because none of them have been on point.

One of the most common errors non-statisticians is to say something like"I know this is not statistically valid, but it certainly is directionally correct" (that is in quotes because it is a verbatim quotation from a highly educated colleague of mine on another subject entirely.) Sadly, anecdotal observations are, by definition NEVER justification for trying something with known toxic reactions in search for treatment for something which has low mortality risk. If the patient is near death and a physician has no known treatment, clinical trials and even experimentation might be justified. Otherwise such use is unwise and might be illegal.

I hasten to add that off-label use of many drugs is common and warranted which the known risks are well documented and considered. That is NOT what this one is.

This one is getting clinical trials because politicians are promoting it in several countries. The politicians know nothing at all about their subject and less about potential death that might result from rushing this stuff to common use. They want a panacea and this ain't a panacea!

Right now there are many hundreds of serious professional efforts to develop treatments, cures, vaccines all using data that considers the genetic structure and composition of SARS-CoV-2 as well as the full character of COVID-19. These are not off-the-cuff guesses by a GP somewhere nor have they much political support. Some of these things are already undergoing trials. Some positive developments are happening, we'll hear about them as they yield results, probably long before there are actual applicable tools.

In the meantime uninformed speculation is exciting and hopeful, but really is depressing because the hope is false. Worldwide people are pushing things that are close to 'snake oil'. We desperately want these to be true.

So why have so many been pushing these quinine versions? That answer is too painful. Those who began to push it were those who had it on hand, they have been desperate too, so they used what they had. If they used it on people who would have recovered anyway it rarely would cause too much harm. Then, it would seem to be the cause of success when it really was something that was applied to someone who was going to recover anyway. So, maybe this paragraph is wrong. We cannot know because there were no controlled tests.

There is no shortcut to exhaustive testing. Remember thalidomide? That one is an excellent drug that is invaluable in treatment of several cancers, for example, but it should NEVER be given to a pregnant woman. Only careful and exhaustive testing can establish whether a given drug will have invaluable benefits or catastrophic side effects. If it is like thalidomide the same drug has both of those, depending on how it is applied.

So, if a politician says, "what do you have to lose?", there is an answer: your life.

 

[dhanson865]

I haven't read the article yet. Is the table saying more virus particles on the outside of the mask than the inside ?

That is hard to believe.

Not just the table, the article plainly says so.

>Of note, we found greater contamination on the outer than the inner mask surfaces. Although it is possible that virus particles may cross from the inner to the outer surface because of the physical pressure of swabbing, we swabbed the outer surface before the inner surface. The consistent finding of virus on the outer mask surface is unlikely to have been caused by experimental error or artifact. The mask's aerodynamic features may explain this finding. A turbulent jet due to air leakage around the mask edge could contaminate the outer surface. Alternatively, the small aerosols of SARS–CoV-2 generated during a high-velocity cough might penetrate the masks. However, this hypothesis may only be valid if the coughing patients did not exhale any large-sized particles, which would be expected to be deposited on the inner surface despite high velocity. These observations support the importance of hand hygiene after touching the outer surface of masks.

 

[ggr]

Here are the top 20 states in terms of Positives/Million as of today:

View attachment 529940
Of this grouping, NY and NJ are outliers on the high side while WA is on the low side. Most states are in the channel in the center. The Log2 plot makes it easy to see the doubling times.

Data from covidtracking.com, pop data from census.gov.

Strange to say "Washington is on the low side" when there are 30 other states not shown, including CA.

 

[bkp_duke]

You know, pretty much all medical "science" is crap. Humans make lousy test subjects. The docs are clueless about statistics, and have little to no experience (i.e. even a lifetime of practice is next to nothing). Everybody concerned is constrained to do their best for the patients, not for science.

Give me any day a clinical group that has found a protocol which leads to better outcomes, no matter what their process. I'll go for what they say even if it has nothing to back it up beyond that. I am very much anticipating the advent of AI that can integrate data from all over the world over many decades. The diagnostics and treatments that will come out of that will revolutionize medicine. Current approaches are almost useless for producing good data or good analysis.

It will be the AI guys, not the medical guys, that help people most in the end. You'll no doubt enjoy being told to stuff your opinion because you're only a doctor and what would you possibly have to contribute.

Be VERY careful with overly-broad and absolute statements like this one.

There are varying degrees of evidence for different medical recommendations, but some things are simply extremely well-proven by medical science. We even have a medical evidence grading scale to help weed out what is solid evidence for something, and what is poor evidence.

Smoke - you will increase your risk for many diseases.
Get fat - same, increased risk for many diseases.
Get infected by bacterium X, we have a very good antibiotic Y for that

I agree it is complicated, but I don't think a statement like this helps.

AI is only as good as who/what programs it. And in my experience, most programmers are too "binary" in their thinking to appreciated and understand the shades of grey.

 

[bkp_duke]

‘That rough approximation only works if the ICU influx is relatively constant. Assuming the influx has been increasing, there would be a larger percentage of patients with a shorter duration in the ICU, and therefore the data would be skewed towards survival. I.e. > 62% death rate.

Edit: Assuming days to recover is shorter than days to death.

Sure, but at this point we are splitting hairs on incomplete data. Some here say 80%, this calculations says . . . 62%. The general take home should be if you are put on a ventilator in the ICU, your odds of surviving for discharge are less than 50/50.

 

[dfwatt]

This article strikes the right tone for what to do after this crisis regarding China. Time to put China on lockdown for its dishonesty amid coronavirus crisis

I would respectfully suggest that the right tone is actually here. Better yet . . . . buy two copies of your favorite stable genius and fly them over your house!

More seriously don't you think we should clean up our own act first?

1) completely botched failure of testing
2) completely botched messaging and minimization of risk leading to sluggish and ambivalent rollout of mitigation and social distancing - often times too late
3) completely botched federal preparation despite many warnings from many epidemiologists and ID Specialists about risk of major pandemic
4) current federal klusterf-- around managing and administering PPE, ventilators, Etc
5) failure to prioritize and develop antibody test to see who is immune

I could go on but the point should be obvious namely that our failures are simply staggering

 

[FoverM]

Strange to say "Washington is on the low side" when there are 30 other states not shown, including CA.

I was describing those shown on the graph.

 

[mikevbf]

Sorry to have missed the last couple updates. My friend who I copy and paste these from took a short break from digital devices. Here is a summary of NewYork-Presbyterian Hospital's update from yesterday:

"New suggestion by the CDC for everyone to wear masks out and about.

We are contemplating moving patients to other hospitals that are not in NYC (think: upstate or less hard hit areas)

2,056 patients: yesterday we were about 2,100 and some when some. 585 of the 2,086 are on ventilators. Once they are on vents they typically stay on them for a while. We received some vents last week. We are not out of ventilators but the situation is grave. We are looking for invasive vents only.

We continue to receive adequate amounts of PPE.

Baker’s field: retired medical professionals will be joining us. We are adding lots of volunteers to our ranks.

Please be careful about online scams. Phishing attempts have gone way up.

We are now at the point where this week we will be standing up testing centers for our healthcare workers.

We have more testing available and swab kits which will allow us to identify if you have it. It will be only for symptomatic healthcare workers. The next tests (blood tests) that will come online will tell us if you have immunity and if you have mounted antibodies."