Coronavirus

[jhm]

Interesting, so it might still serve as an indicator of the current trend.



So how will it respond if known cases grow partially because of increased testing? Will it adapt? Could testing be another "leading indicator", or is the data too limited to derive an improvement from that?



Because of many states reopening to various levels, there may be/will be another sub-wave soon. Wave 1.5. So we will see. (Probably.)

I was reluctant to model cases in the first case because of the differences in test levels between states. Now we've got testing going on in all the states. So perhaps the differences wash out. It is just an indicator of the intensity of the epidemic. So are deaths. What I try to keep an eye on is the consistency between different types of measurements. The rolling 28-day regression will keep adjusting to changes in the quality of the data as well as the correlations. Abrupt revisions are a bit hard to take, but gradual changes are fine.

You can play around with testing data. An increase can make a small increase in cases, but in most places the mostly likely cases are given priority for testing. So increases in testing can have "diminishing returns" as the marginal test has lower chances of being a positive.

The problem in using test in a forecast is that you also would want to forecast the tests too. It's questionable whether ones attempt to forecast future test availability really adds much to the forecast of endpoints you care about. So you can try it, but may find that it is not so helpful.

As a statistician I'm always happy to work with lousy data. People are always dreaming about the data they wish they had. But good statistical practice makes the most of the crappy data that you do have. Bringing cases and deaths together is good because there is a common underlying process generating both and the correlations between them.

 

[jhm]

No definite upper bound in so far as I can't imagine that people will go along with (much) more than 500K deaths. At some point, people will ask to turn around again with mitigation. Also, Trump wouldn't get re-elected with that kind of death count.

Then there's the boiled frog reality. People went along with 60k and got used to it. People then think 130k is not so bad and get used to it. Then people go along with 350k. After a while, 2 or 3 million seems like no big deal.

 

[renim]

'It is estimated up to 800 plasma donations will be required to produce sufficient COVID-19 Immunoglobulin to treat 50-100 seriously ill people under the clinical trial.'

20200506 CSL Behring Australia Commences Development of Treatment for Serious Cases of COVID-19

Wave 1 in Oz will be about 100 fatalies, so this is serious ammo for fighting wave 2 when it eventuates.

 

[AlanSubie4Life]

. So increases in testing can have "diminishing returns" as the marginal test has lower chances of being a positive.

Remember we are only finding 10-20% of actual cases right now. Definitely there are diminishing returns, but there are a lot of cases to find and in fact it is the only way we can have our cake and eat it too (economy good and quick end to mortality).
I think you will need to look at positivity if you want this model to hold together in the coming weeks (assuming we don’t just give up on the whole problem and say it is too hard - even though places like Uganda seem to be handling it fine).


Trump, on the other hand, actually believes we have more cases than other countries because we test more. So I guess he plans to test less going forward to help solve the problem?

Aaron Rupar on Twitter

He also lied about closing the border, lied that travelers were tested, lied that they were quarantined. But none of that matters, I guess, because it was all too late.

 

[lascavarian]

and because news of a nontoxic, non-drug treatment

Could you flesh out your thinking with some examples of different non-drugs specifically, that are administered intravenously? These would be as treatments for pathogens?

And what is bowl tolerance as relates to toxicity or side effects?

 

[SMAlset]

Thought worth mentioning that the Santa Clara County Health dashboard for long-term nursing/assisted care facilities statistics as of May 5 can now display a detailed list of facilities (see arrow). Broken out by resident and staff.

 

[Alfred]

To be fair, they aren't really going back to normal, and they are still increasing test & trace capacity.



I am not so sure. Obviously there's going to be an increase in cases, but if testing and tracing is scaled up in parallel, it's possible this will result in an optimal outcome (not optimal for the additional people who will die, however) - commerce opened on a limited basis, while public health catches up.

I think there's likely to be a few screw-ups in some states, but in general I'm optimistic about the prospects as long as testing & tracing continues to scale up. Definitely lives will be lost as a result.

I'm not sure it's quite as grim a picture as the media is painting it to be. Time will tell. In spite of the focus on people not wearing masks, etc., a lot of people are being more careful. That will help.

People are also staying home (the economy won't be coming back any time soon regardless of reopening). So combination of:

1) Reduced mobility
2) Improved sanitation
3) Improved containment by public health
4) Possible increase in heat very slightly reducing transmissibility

Combined, may still result in a slow steady decline.

The continued underperformance of the economy is going to place huge value on testing & tracing. (Think of the major sporting leagues, etc. - many tens of billions of dollars there, likely hundreds of billions.) They can't do anything until the virus is gone, so there's going to be massive, widespread testing, sooner rather than later (don't think there's really any other way out of it - temperature checks and such don't work).

I'm not saying it's as good as it would have been if we'd had some leadership, but I think we'll stumble along and survive. Still hoping we manage to keep deaths below about 160k by August.

Well - Switzerland has just reached the point where switching to tracing has again become possible. Some cantons had started the procedures already earlier. The lockdown was relatively soft. Personal mobility remained nationally mostly unrestricted (stay at home "recommended") and many construction sites and industries remained operational. Details can be read in the "Policy Brief" here (choose your language at top right). There you can also see a timeline of the "lockdown" measures taken.

Remember that the Swiss constitution is broadly a "copy" of the American constitution. The individual Cantons (states) have a lot of autonomy, so nationwide not much was rigorously coordinated. The Canton Ticino, bordering Italy and the Cantons Vaud and Geneva, bordering France were much more severely affected than those bordering Germany and Austria. From Austria just the diffusion from the Ski resorts turned out to be a problem.

Now comes the more difficult part: Reopening the right businesses, mostly in the tertiary sector, without having really much solid information about causes and effects during lockdown. An English language report about measures to take is linked in the "Policy Brief" above as well.
Logically also a large antibody test program has been started. The plan is to test across all regions about 20'000 people.

As to the questions surrounding immunities: Experts mostly agree that there remains much to be clarified. Political pressure on scientists to produce immediately help to allow termination of lockdowns leads to waves of poorly documented "knowledge" spread around the internet (see Drosten here e.g. in German, sorry). As an interesting aside: Also the new highly specific antibody tests may leave a few more puzzles to keep scientists busy. There is e.g. a suspicion that the many very mild or asymptomatic cases could be at least partly due to cross immunities from older similar viral infections.

 

[byeLT4]

Then there's the boiled frog reality. People went along with 60k and got used to it. People then think 130k is not so bad and get used to it. Then people go along with 350k. After a while, 2 or 3 million seems like no big deal.

And we get used to the deaths per day "well, we are still at 2k".

For a while my county had no deaths, then 'just one', 'just 2' etc. Now we are up to 5 and some locals are touting it as a percentage of total population- 'it is only .005%'.

County update-
2 new
145 total
5 deaths

We used to have press briefings every day, a few weeks ago they switched it to M,W,F. This week they changed it to Tuesday and Thursday. We are reopening faster than I'd like. Restaurants currently 25% capacity. I have also heard next week barbers and salon places will be able to open. Going to be an interesting month....

 

[AlanSubie4Life]

Going to be an interesting month....

For sure, keep us up to date. On the positive side, Texas has really gotten serious about ramping up testing from what I understand, so there may be hope for you folks. That plus tracing is the way out of this nightmare.

 

[AlanSubie4Life]

Looks like Elon has qualified for his first tranche of options, worth $700 million or so at current prices. (Last six months average valuation exceeds $100 billion.)

Maybe this means the insanity will end? I wonder if he will do something like postpone the grant or give a bunch of it to employees instead or something, etc?

Seems like from a perception standpoint, now would be a bad time to accept the award, with so many employees at potential risk if he wants to reopen the factory.

 

[Doggydogworld]

Does anybody have the quest diagnostic test number for the new IgG test that has a 99.9% specificity? (They did a study of 1000 samples that pre-date SARS-Cov-2 from last year, and found 1 false positive).

I think it's the one from Abbott.

I think it has a 100% sensitivity after 17 days or something. Can remember the post well, but not even Google can make sense out of this forum thread...

Abbott's press release doesn't show a number that I see, but might have info that helps you find it. It runs on their ARCHITECT machines.

Why has the CDC been so behind on this the entire time? They had several months to prepare. Not enough tests the entire time until just recently. It's shocking to me.

It was a combination of arrogance and incompetence. CDC wanted to create the gold standard of tests, so they developed one with three reagents instead of two. This test took longer to develop, then when they sent it to labs in early February it failed. CDC and FDA prohibited labs from using other tests throughout February, saying the CDC test would be fixed "any day now". At the end of February they finally OK'd two reagent testing, but by then we had 80-90k contagious people walking around, the vast majority without symptoms.

Testing ramped from there, but the virus ramped faster.

His spokeswoman?

The attorney who filed his whistleblower case. Or maybe a press contact person who works for her.

 

[MXLRplus]

...
The attorney who filed his whistleblower case. Or maybe a press contact person who works for her.

He has "attorneys" according to AP. An attorney is seldom reported as a spokesperson since that would be part of the news much like the names of those "cronies". But it could have been the assigned media coordinator or someone from the social networking dept of his organization. Not saying DNC, but DNC has already directly used COVID funds that Congress allocated them on non-bid contracts under the title of data collection. The funds were used for voter enrollment staff.

Remember that Ms. Ford had more than a dozen staff members.

The minute this became political, lives were lost, and trillions with a T were wasted.

 

[EVNow]

And we get used to the deaths per day "well, we are still at 2k".

For a while my county had no deaths, then 'just one', 'just 2' etc. Now we are up to 5 and some locals are touting it as a percentage of total population- 'it is only .005%'.

Yes - people get numb to the facts - even as facts change.

We had a huge run on Costco etc when one death was reported in WA on Feb 29th. Now we just raise an eyebrow if daily deaths go above 20.

Everyone was freaking out as US passed China death total (at that time of ~3,200). Now 2k+ deaths a day is taken for granted.

Infact I still remember just last week people dismissing Covid while comparing it to huge death count of annual flu (40k to 60k). No longer.

 

[MXLRplus]

Yes - people get numb to the facts - even as facts change.

We had a huge run on Costco etc when one death was reported in WA on Feb 29th. Now we just raise an eyebrow if daily deaths go above 20.

Everyone was freaking out as US passed China death total (at that time of ~3,200). Now 2k+ deaths a day is taken for granted.

Infact I still remember just last week people dismissing Covid while comparing it to huge death count of annual flu (40k to 60k). No longer.

The toilet paper hoarding was caused by social media reports that Europe ran out of TP due to C19. We had zero deaths and zero cases when the shelves were emptied here.

 

[EVNow]

The toilet paper hoarding was caused by social media reports that Europe ran out of TP due to C19.

Link ?

Media was still obsessed about Dem primary when we had the Costco run on Feb 30th.

ps : Its not just Trump administration that was caught napping at the wheel. Every governor and every media outlet in the US too ignored Covid until bodies started piling up.

 

[Alfred]

The following two updates on the evolution in Sweden are revealing. Death rates are very high, particularly in residences for the elderly and in the poorer outskirts of Stockholm. The question why such homes and disadvantaged districts could not be better protected is being raised. Also The Guardian has a recent commentary worth looking at.

 

[MXLRplus]

Link ?

Media was still obsessed about Dem primary when we had the Costco run on Feb 30th.

ps : Its not just Trump administration that was caught napping at the wheel. Every governor and every media outlet in the US too ignored Covid until bodies started piling up.

Observation. Our Costco lines started late Feb. By the first week of March no food or TP was readily avail. Our first case was Mar 8, our first death Mar 16. Population 2,500,000.

The most tragic part is that while everybody was arguing, the nursing home facilities spread C19 like a wildfire through their communities. And not much was said about it the very high rates in black and Hispanic neighborhoods, which also spread it very quickly.

 

[Doggydogworld]

I was reluctant to model cases in the first case because of the differences in test levels between states.

I'd be very reluctant to base a time series model on case data. Case counts jump due to increased testing even without a jump in infections. CA cases jumped from ~1100/day to ~1600/day around April 20th. If real that should show up in deaths/day by now, but it hasn't.

The roller coaster of US deaths. Trending down but not much slope there. A 5 or 7 day moving average would probably present this better.

The new narrative is "declining in NY but growing in the rest of the country". I don't agree. The major states are pretty flat. Texas and Virginia are growing from low levels. Pennsylvania had a big one-time adjustment yesterday, besides that it seems to be growing slowly. But Michigan and Louisiana have shown declines. Covid Projections predicts flat or declining deaths/day the next couple weeks in almost every state. That looks a little optimistic to me, but I don't see any problem areas that are big enough to move the national needle. It'd be good to see NJ and CT follow NY down the back side of the slope.

 

[PeterJA]

Could you flesh out your thinking with some examples of different non-drugs specifically, that are administered intravenously? These would be as treatments for pathogens?

Dr. Cheng writes:

1. Vitamin C has potent antiviral effects through virucidal and immune modulating effects. [4-13]
2. Vitamin C is a prototypical potent antioxidant that plays a critical role in the prevention and treatment of the marked inflammatory response to viruses and other pathogens. Clinically, vitamin C is effective in preventing and treating pneumonia [12], multi-organ failure [14], and acute respiratory distress syndrome (ARDS). [14-18] Another related antioxidant that has shown promise for acute cases of pneumonia is glutathione. [19]
3. Preliminary clinical evidence from China and elsewhere seems to show high-dose IV vitamin C is effective in treating Covid-19 patients. [20,21]
4. Out of the few treatments being tried for Covid-19, high-dose intravenous vitamin C (HDIVC) shows very promising results in treating critical cases of Covid-19 with reduced fatalities, reduced ICU or hospital stays [22-25] and is very safe, without significant side effects (caveat, G6PD deficiency). [22,26] HDIVC's effectiveness in treating infectious (including viral) diseases and its high safety profile is based on solid science with decades of basic and clinical research reflected in tens of thousands of research papers in the world's largest biomedical library, the United States National Library of Medicine, hosted at the NIH (pubmed.gov).
5. Given the lack of proven and widely accepted effective treatments of Covid-19, the high safety profile of HDIVC and promising effectiveness of HDIVC makes the compassionate use of HDIVC very reasonable. In my opinion, not to give HDIVC to critically ill Covid-19 patients seems unthinkable, even unethical.

Protected Group Immunity, Not a Vaccine, is the Way to Stop the COVID-19 Pandemic​

And what is bowl tolerance as relates to toxicity or side effects?

1.1. Safety of Oral Vitamin C
Oral supplementation of vitamin C is safe and well tolerated when not taken beyond bowel tolerance. Bowel tolerance is indicated by mild gastrointestinal symptoms such as: flatulence, belching, mild rumbling from the gastrointestinal tract, increased bowel movement and loose stools. Bowel tolerance is not indicated by severe gastrointestinal issues like diarrhea, abdominal pain, cramping and bloating and nausea. That's taking vitamin C past bowel tolerance, and it's not recommended unless the goal is to cleanse the gastrointestinal tract.

When taking very large and frequent (many times per day) oral dosages of vitamin C it could be potentially dangerous not to follow Dr. Robert F. Cathcart's advice on the symptoms of bowel tolerance and titrating vitamin C to bowel tolerance [1].

The original 1981 research paper by Cathcart discussed titrating to bowel tolerance with l-ascorbic acid (AA) - this was Cathcart's preferred variant of vitamin C. Cathcart said AA was the only form of oral vitamin C that could achieve a "clinical ascorbate effect".

According to Cathcart the usual bowel tolerance dosage depends on the severity of the disease. The dosage required to hit this level could be anything from 15g/day to +200g/day [1]. The severity of the disease is measured as the amount of inflammation and oxidation caused by reactive oxygen and nitrogen species (ROS/RNS). A 2007 literature review titled "Vitamin C may affect lung infections" reported this about the high bowel tolerance vitamin C dosages Cathcart had observed in his clinical practice [71]:

"Furthermore, it has been stated that patients with pneumonia can take up to 100 g/day of vitamin C without developing diarrhoea, possibly because of the changes in vitamin C metabolism caused by the severe infection."

Vitamin C Evidence for Treating Complications of COVID-19 and other Viral Infections​

 

[Feathermerchan]

Re post 14186
I think Cases of patients in nursing homes/ care facilities should be ignored when considering re-opening. They are by definition not in the public. Some of the stats show that 20 to 50% of all cases are in those care facilities which is really tragic and needs immediate attention.

So about Covid testing, it's only a snapshot if you are testing general public with no symptoms and not already in hospital.
If walk up testing, people may be infecting passers by before or after testing (or in the parking lot) so I'd think it may be pretty meaningless.

Regarding antibody testing, WHO last time I saw is still saying no evidence that presence of antibodys means immunity. So if you believe the scientists, there is no value to antibody testing. We have to believe the scientists right?