Coronavirus

[Daniel in SD]

I focus on cases as cases show the spread. Death rate is dependent on various things and happens after infection. I'm looking at spread.

If you look at cases then COVID-19 has a 10%+ fatality rate in many countries. Hospitalizations are a much better indicator of the true rate of spread.

 

[bkp_duke]

This testing was organised by a local hotel chain which bought the quick-kits from Wuhan with an advertised 100% specificity...

Ahem, no such test exists. I would bet they come to that "100%" number because their validation pool size is like 15 people.

The only reason these tests exist is because they are able to be used under the Emergency Use Act from the FDA. In normal times, no Antibody test is ever going to claim 100% specificity. They would have been tested on a FAR larger population to get proper stats.

Basically, that 100% number should be on the label as 100% +/- 5 or 10%.

 

[bkp_duke]

"Mit den flächendeckenden Tests wurde am vergangenen Dienstag begonnen. Mittlerweile – Stand Freitagabend – wurden 456 St. Ulricher getestet, und fast die Hälfte weisen Antikörper auf. Über 2 Drittel der Getesteten sind zwischen 20 und 59 Jahre alt. Und wichtiges Detail am Rande: Fast ein Drittel gab an, keinerlei Symptome gehabt zu haben."

Flächendeckend =/= nationwide, it just means wide-area testing, in this case in one town.

The sample was entirely self-selected; the service was advertised, patients presented themselves at a clinic and paid €30 apiece for the 10-min thumb-prick test, presumably most of them because they suspected they'd already had it.

Almost a third = 30% asymptomatic amongst the confirmed infected, which sounds at upper end of ranges reported elsewhere (18..30%).

Are we forgetting that there is a LONG asymptomatic period for this disease? Just perhaps?

If you are testing an endemic area, which this is, and you are looking for people that are concerned about being exposed, which is by definition this group, and are are testing for a disease that has viral shedding for 2-10 days before symptoms . . . then YES you are going to pick up positives with no symptoms.

That DOES NOT mean these people are going to make it through the infection completely without symptoms. It ONLY means that at the time of testing, they are asymptomatic.

 

[OPRCE]

Ahem, no such test exists. I would bet they come to that "100%" number because their validation pool size is like 15 people.

The only reason these tests exist is because they are able to be used under the Emergency Use Act from the FDA. In normal times, no Antibody test is ever going to claim 100% specificity.

Agree 100% specificity is nigh impossible but in mountain villages in Austria they do not care a toss for the opinions of FDA one way or t'other. A local hotel owner wanting to get his staff back to work asap bought the batch of (probably cheap'n'cheerful) quick-tests straight from allegedly Wuhan with allegedly 100% specificity, probably neither of which proposition was tested, and the local GP administered them to whoever rolled up. Even the Austrian government seems not to have been involved.

 

[Daniel in SD]

Nice personal attack. I post mostly scientific studies, the occasional news article and data that I find interesting. If you find any of that "misleading" because it contradicts your strongly held views, that's your problem, not mine.

You are free to continue pointing out why the emerging data doesn't change your mind.

Almost 49 percent of the 456 St. Ulrichers tested have antibodies against Covid-19 .... That is almost 50 times the number in the official medical statistics.

How is that not misleading? It would only be true if it were a random sample which it was not.
Your defense seem to be that you're only quoting other people who are being misleading.

 

[bkp_duke]

Agree 100% specificity is nigh impossible but in mountain villages in Austria they do not care a toss for the opinions of FDA one way or t'other. A local hotel owner wanting to get his staff back to work asap bought the batch of (probably cheap'n'cheerful) quick-tests straight from allegedly Wuhan with allegedly 100% specificity, probably neither of which proposition was tested, and the local GP administered them to whoever rolled up. Even the Austrian government seems not to have been involved.

I'm not arguing that. I'm just saying you have people (ahem, on this forum) trying to armchair epidemiology and argue about IFR. You cannot make IFR calculations from a test like this because the statistics are just ugly.

 

[EinSV]

How is that not misleading? It would only be true if it were a random sample which it was not.
Your defense seem to be that you're only quoting other people who are being misleading.

LOL, I posted the article -- people can read it, do their own research, and draw their own conclusions. In any case, there has been little or random testing anywhere, so it would have been the exception if that were the case.

In a reddit thread on this article someone mentioned that this village has 4883 residents (I haven't fact checked that but you can if you want). According to the article, they have 2000 people lined up for testing, including the 600 tested already. Sounds like they may be trying to test the whole village or as many as possible -- sort of the antibody testing equivalent of Vo.

A serological antibody test on 600 persons in the mountain town of Ortisei (north of Italy near Austria) reveals 50% have antibodies against Covid-19. : Coronavirus

People should be happy to have more information to test their theories but for some strange reason some people find information upsetting.

 

[TEG]

https://www.nejm.org/doi/full/10.1056/NEJMoa2007016

Compassionate Use | Gilead

(From March 23):
Gilead Suspends Access to Remdesivir Due to 'Overwhelming Demand' for the Experimental COVID-19 Treatment | BioSpace

 

[Daniel in SD]

LOL, I posted the article

You posted the article and then only quoted the most misleading part of the article!
Anyway, it doesn't sound like you have any intention of doing a better job of curation or summarization in the future. I will continue to view your posts with extreme skepticism.

 

[Daniel in SD]

Some good news. South Korea reported only 8 new cases (5 were from overseas) yesterday and has begun to relax social distancing rules.
South Korea relaxes some social distancing rules as new virus cases fall

 

[SMAlset]

This has been reported in the pediatric physician circles. Note that it is really only consistent in children, and only on the soles of the feet, not over the entire body.

Sadly, that presentation is a lot like Hand Foot and Mouth, so it's NOT UNIQUE to SARS-CoV-2.

Any thoughts yet medically on what what might be triggering these reactions? I know the virus for chicken pox can lay dormant, right?, and emerge as shingles later in life. Could this be somehow reactivating things in the body or overstimulating other conditions in the body? I can see where infants and young children wouldn’t have built up their immune system yet (and maybe not had all their vaccinations yet). That lady in the video however doesn’t fall into that age category and her toes looked horrible. Can’t imagine touching them and having them bleed like that.

 

[dqd88]

Taking three European countries with similar populations (~10M) for comparison:

Country..........Confmd.....Dead.....Recovd.....Tests/Mpop......rawCFR......ResolvedCFR...CaseGrowth...DeathGrowth
Sweden...........13’822......1’511............550.............7'387..............10.93%.........73.31%.............4.59%..............7.93%
Austria............14’671.........443.......14'671...........19'902................3.02%...........4.16%..............0.52%..............2.78%
Switzerland....27’404.......1’368.......17'100...........25'566................4.99%...........7.41%.............1.20%..............3.09%

It seems clear that, due to considerably less testing, Swedish cases are being detected later, typically when the patient presents to hospital with severe pneumonia, at which point the death rate is a terrifying 73.3%. Coupled with the very lax social distancing to date, this would also mean undetected community spread is likely much more prevalent, thus a sharply increasing case-load and belated, more persistent lockdown can be expected.

By contrast the latter two countries are well over the hump, the major difference between them being that Austria closed its border to Italy 2..3 days before Switzerland, and did so tighter.

Overall it is looking like Sweden's experiment will prove to be a spectacular failure and false economy.

[data from COVID19INFO.live and Worldometer]

1) how did you get 73.31%? where's the denominator?

2) you have also consider that Sweden is looking long term. They know that countries that have clamped down, when they let off the brakes, they may have a resurgence. Then what? Put brakes back on? Stay shut down forever to prevent any resurgence?
What if there's another outbreak in the fall or winter? Sweden's approach is to gradually acclimate to the virus as they realize it's here to stay and they must learn to live with it long term.
It will be a while (maybe a couple years) before we can definitively assess the strategy of any country.

 

[Dutchie]

We should all realize that most likely net deaths will remain about the same. Everyone dies of something. Without Coronavirus they would die of a "thing". If they die of Coronavirus then they will not die of that thing. So they won't be counted as a death attributed to that thing, it will just move to the Covid column.
Death causes are a zero sum game; particularly with Covid which doesn't (ok, very rarely) kill people who are healthy.

I guess my point is that it's not like the plague or the spanish flu, which would show an increase in the yearly death total because it would kill a bunch of young and otherwise healthy people who wouldn't normally have died soon.

We should know that we're incurring trillions of cost, and potentially an economic depression, which will yield zero change in net annual deaths. Which just seem bonkers if you really think about it. I find it peculiar that no one cares to do a cost/benefit analysis.

The case load is at a low level outside of New York City.
Hospitals are cutting salaries and going into the red.
So, it is in their interest to open back up the economy. A busy economy creates ailments and harm (occupational accidents) that feeds the hospital systems.



I doubt life expectancy will change in any material way. The avg age of death of Covid is 80, which is above avg life expectancy. So even is we had "let it rip", it wouldn't have moved the needle much.

Sadly, you missed the point due to your emotional reaction, which blinds you to facts and reason.
It's important to view the problem in it's entirety, not just one part. I.e. no one wants to believe that the cost matters, but that would be disingenuous of you and everyone, because we make choices about cost and life/death all the time. It's just that it's become taboo to discuss in the fog of overly dramatic rhetoric which makes it hard to find a holistic approach to solving this problem. Very sad state of affairs.

Dr. Jay Bhattacharya puts it best - the decisions/policy we make depends on the death rate. E.g. If it's true that 1/1000 die we would not do a shut down, but if it's 3/100 then we would. Everyone assumed it's 3/100. But we don't have enough data. So he's trying to get it. His study is criticized, but he's not claiming it to be perfect, but it's something, it adds to insights that we did not have before.

If I follow you correctly you say that the cost benefit is out of whack. That we should accept a few more death in order to save the economy. People who die have mostly underlying conditions anyway, they will die of something soon and the total death rate would not change.

But which few percent of the people in the country did you have in mind?

Tell you what. There are about 600 billiionaires in the US. That is 0.00017% of the population. Their average age is about 60.
Why don't we choose them? Kill them all and use their combined wealth to kick start the economy and give everyone free healthcare. They are average over 60 and quite a few of the have probably an underlying condition. They had a good life and these 600 extra deaths won't change the mortality needle, and hack, you have to die from something. It just changes to another column. How about that for cost benefit??

 

[EV-lutioin]

Some good news. South Korea reported only 8 new cases (5 were from overseas) yesterday and has begun to relax social distancing rules.
South Korea relaxes some social distancing rules as new virus cases fall

South Korea's good news serves as one of the best examples for the world; they have extensive testing of symptomatic and asymptomatic individuals, they generally follow rules, diligently wear masks and consistently practice social distancing. Unfortunately, we have little of the above in the U.S., many Americans are skeptical of government, don't like following rules, think masks are for sissys and, we don't have near enough tests. Our road will be longer and harder than South Korea's.

 

[Daniel in SD]

1) how did you get 73.31%? where's the denominator?

73.31% = dead / resolved cases
resolved cases = dead + recovered.
You don't know if someone has survived until they no longer have the virus. I doubt this number is real. They're probably not keeping track of everyone who has recovered.

South Korea's good news serves as one of the best examples for the world; they have extensive testing of symptomatic and asymptomatic individuals, they generally follow rules, diligently wear masks and consistently practice social distancing. Unfortunately, we have little of the above in the U.S., many Americans are skeptical of government, don't like following rules, think masks are for sissys and, we don't have near enough tests. Our road will be longer and harder than South Korea's.

I agree. I'm actually not very optimistic at all. On the other hand, in my area, mask usage seems very high now, 100% at bagel shop this morning. It would be nice to have masks that meet some sort of performance standard.

 

[MXLRplus]

If I follow you correctly you say that the cost benefit is out of whack. That we should accept a few more death in order to save the economy. People who die have mostly underlying conditions anyway, they will die of something soon and the total death rate would not change.

But which few percent of the people in the country did you have in mind?

Tell you what. There are about 600 billiionaires in the US. That is 0.00017% of the population. Their average age is about 60.
Why don't we choose them? Kill them all and use their combined wealth to kick start the economy and give everyone free healthcare. They are average over 60 and quite a few of the have probably an underlying condition. They had a good life and these 600 extra deaths won't change the mortality needle, and hack, you have to die from something. It just changes to another column. How about that for cost benefit??

We should have protected the residents and staff of senior care facilities first. We still haven't. Why?
We decided other people were more worthy.

 

[N5329K]

Stanford study reviewed and analyzed here:

Robin

 

[OPRCE]

1) how did you get 73.31%? where's the denominator?

2) you have also consider that Sweden is looking long term. They know that countries that have clamped down, when they let off the brakes, they may have a resurgence. Then what? Put brakes back on? Stay shut down forever to prevent any resurgence?
What if there's another outbreak in the fall or winter? Sweden's approach is to gradually acclimate to the virus as they realize it's here to stay and they must learn to live with it long term.
It will be a while (maybe a couple years) before we can definitively assess the strategy of any country.

1. Resolved = dead + recovered = 1511+550 = 2061, of which 1511 died, gives resCFR = 73.3%

2. Yeah, all will be clear in several years, but from the data we have now, Sweden is trending in the wrong direction.

3. This policy of "acclimatisation" (a euphemism for "malign neglect") allows the live virus to spread relatively unchecked though the naive population (i.e. with no previous immunity) in hopes to build up a "herd immunity" which in theory may protect against a second wave. Problems are that A) no-one actually knows it will even work like that. If it mutates like flu, last year's antibodies may be of little use in fighting off a new infection and B) it leads to swamping of the health system, greatly exacerbating fatality rates.

4. I think once the let-them-eat-cake brigade starts having to worry about being personally dragged out of their cosy nests and lynched by mobs of the needlessly bereaved, a stringent policy will shortly be introduced.

 

[Doggydogworld]

So, how is Sweden doing?

Let's compare them to a handful of other countries - countries of Western Europe of similar size (Belgium, Netherlands, Switzerland, Austria, Portugal), as well as their Scadinavian neighbors (Denmark, Finland, Norway).

Total cases:

Belgium: 37,183
Netherlands: 31,589
Switzerland: 27,404
Portugal: 19,685
Austria: 14,671
Sweden: 13,822
Denmark: 7,242
Norway: 7,069
Finland: 3,681

Cases / million population:

Belgium: 3,208
Switzerland: 3,166
USA: 2,232 (for context)
Portugal: 1,931
Netherlands: 1,844
Austria: 1,629
Sweden: 1,369
Norway: 1,298
Denmark: 1,250
Finland: 664

We can see that Sweden, despite having somewhat relaxed measures, has not exploded in cases as some have predicted. Primary schools remain open. Shopping centers remain open. For now.

Are they doing great? Not exactly. Are they doing horribly? No
Somewhere in the middle. Which I would consider a success since they did not incur near the cost as most other countries.

Of course, the final chapter has not yet been written. They could still see numbers "take off". We will see.

Scandinavia is similar to the US midwest in one (and perhaps only one, ha) aspect - they were infected later and got a first-hand look at what happened in Italy, Spain, NYC, etc. where the virus spread unabated for many weeks. Sweden, Norway and Finland all took advantage of this "virus preview" and instituted restrictions. Of the three, Sweden is the least strict. They prohibited gatherings of more than 50, closed high school and university campuses, closed bars and instituted work from home. But primary schools are in session, table service is allowed and most small businesses can operate. Norway and Finland generally took a harder line, e.g. closing more schools and non-essential businesses. Results so far:

Deaths per million
Sweden - 152
Norway - 30
Finland - 17

At first glance this looks like total failure. But Sweden's restrictions have so far prevented runaway. Can they peak and start declining without stricter measures? The jury is still out.

 

[dqd88]

This sheds some light on Sweden's frame of mind. (easy read)
Bloomberg - Are you a robot?