Coronavirus

[AlanSubie4Life]

it's evidence that he's really lost his critical thinking (as the Stanford study was a disaster) or perhaps that he was somebody who was motivated to minimize covid-19 IFR for other reasons. 5% infected in USA looks realistic. 15% is nuts.

Yeah, I'm not sure how anyone looking at the data could ever have concluded such a thing. It's never been remotely possible, when looking at South Korea, and at all the serological studies from around the world, and weighting them according to their methodological flaws. Even the very first studies suggesting high prevalence were obviously suffering from issues.

The only place IFR was conceivably "low" where we had relatively early "complete" visibility was Iceland, and that had clear factors pushing it to the low side (population relatively young and healthy, those infected were mostly people traveling, so relatively healthy, etc.).

South Korea's result was the key for me, and the earliest example that made things very clear. They stopped their outbreak (temporarily), so it was very clear what a reasonable IFR was (the only question was how many asymptomatics/missed cases there were - but reasonably they HAD to be very low since the outbreak was contained, and it was unreasonable (not physically possible) to assume there was no asymptomatic spread). It seemed reasonable to say that no more than about a factor of ~2 cases beyond what was positively identified in SK - which brought the IFR to right around 1%. (Their CFR is currently around 2.3%.) A factor of 4 (what would be required for 0.5%) would have made no sense.

---

Meanwhile, we continue to miss the mark on strategy here in the US. Seems to me you have to keep increasing testing (etc.) until the number of cases you find goes into steep decline everywhere! Such a simple strategy.

Starting to become convinced that the "needle threading" approach (open up while simultaneously continuing to increase testing) is going to fail (mostly because we gave up on the testing part). We should be at well over a million tests a day now. Shortly, unless the virus inexplicably vanishes (no evidence of that happening!), nationwide infections are going to start to rise (if they haven't already), and then we're in danger of seriously outstripping test capacity. We've had this "nice" long case plateau, and we've done approximately nothing to increase our testing (we hit an all time high on the 7-day average of tests/day, but it's only around 500k!!!) .

AR, AZ, NC, SC, FL, TX continue to be the most problematic areas but there are "twinges" in other areas as well.

For example, a "twinge": Looks like OK is doing great! (They have approximately quadrupled their rate of positive results since Memorial Day).

 

[dfwatt]

Photo op at the White House with His Orangeness and a whole bunch of other people trying to get in on the photo op. Super spreader event? Certainly a large number of stupid white folks with no masks and no social distancing. One person of color worked into the photo op probably to achieve acceptability in some quarters since he was signing his 'executive order' on police reform

Is this yet another commercial opportunity for groundbreaking products like Moron Spray? If they're this careless now wait till the Tulsa rallies. Won't be enough ICU beds in all of Oklahoma to catch the Fallout from that klusterfuk.

 

[dfwatt]

Yeah, I'm not sure how anyone looking at the data could ever have concluded such a thing. It's never been remotely possible, when looking at South Korea, and at all the serological studies from around the world, and weighting them according to their methodological flaws. Even the very first studies suggesting high prevalence were obviously suffering from issues.

The only place IFR was conceivably "low" where we had relatively early "complete" visibility was Iceland, and that had clear factors pushing it to the low side (population relatively young and healthy, those infected were mostly people traveling, so relatively healthy, etc.).

South Korea's result was the key for me, and the earliest example that made things very clear. They stopped their outbreak (temporarily), so it was very clear what a reasonable IFR was (the only question was how many asymptomatics/missed cases there were - but reasonably they HAD to be very low since the outbreak was contained, and it was unreasonable (not physically possible) to assume there was no asymptomatic spread). It seemed reasonable to say that no more than about a factor of ~2 cases beyond what was positively identified in SK - which brought the IFR to right around 1%. (Their CFR is currently around 2.3%.) A factor of 4 (what would be required for 0.5%) would have made no sense.

---

Meanwhile, we continue to miss the mark on strategy here in the US. Seems to me you have to keep increasing testing (etc.) until the number of cases you find goes into steep decline everywhere! Such a simple strategy.

Starting to become convinced that the "needle threading" approach (open up while simultaneously continuing to increase testing) is going to fail (mostly because we gave up on the testing part). We should be at well over a million tests a day now. Shortly, unless the virus inexplicably vanishes (no evidence of that happening!), nationwide infections are going to start to rise (if they haven't already), and then we're in danger of seriously outstripping test capacity. We've had this "nice" long case plateau, and we've done approximately nothing to increase our testing (we hit an all time high on the 7-day average of tests/day, but it's only around 500k!!!) .

AR, AZ, NC, SC, FL, TX continue to be the most problematic areas but there are "twinges" in other areas as well.

For example, a "twinge": Looks like OK is doing great! (They have approximately quadrupled their rate of positive results since Memorial Day).

View attachment 552458

I think you have to assume from Trump's statements, from Mike Pence's recent editorial and from the Republican Governors most but fortunately not all of whom are in lockstep with all this nonsense that there really isn't any true strategy to speak of. It's more just that they're going to somehow paper over the disaster, lie as much as they possibly can, obfuscate, and claim that the media is against them, and hope that no one notices or if they notice that somehow the public becomes numb to the fatality numbers.

We're on pace for 200,000 deaths by sometime in October and perhaps three hundred thousand deaths if we keep going by the end of the year or early next year. Those numbers seem crazy, impossible, and yet that's what we're looking at. Unless we get competent leadership. And there's no chance of that with Trump and his collection of Stooges and sycophants running things.

I think at this point Trump and his team feel that Trump is virtually Teflon. Nothing sticks, the public forgets about the last disaster because of the new disaster, and his 35% base sticks through thick and thin with him. Perhaps with enough voter suppression and help from his Handler in Russia I think they figure they can still steal the election. Who needs a strategy to help anybody when you can just steal power? And then again if they lose the election they can always declare it's null and void due to 'voter fraud' and all the 'illegal voting' and steal it that way. Who knows what happens at that point. My bet is the Republican Senate rolls over at that point and only the Supreme Court prevents Donald Trump from being president. And that's assuming he doesn't win the election. Okay enough . . I'm on a a downer Jag!!

 

[Daniel in SD]

We're on pace for 200,000 deaths by sometime in October and perhaps three hundred thousand deaths if we keep going by the end of the year or early next year.

If we can keep the numbers that low with people behaving the way they are now I would actually consider that a successful implementation of the Swedish "learn to live with the virus" strategy.
Trump is speaking at an event in a 22,500 seat church in Arizona next week...

 

[dfwatt]

If we can keep the numbers that low with people behaving the way they are now I would actually consider that a successful implementation of the Swedish "learn to live with the virus" strategy.
Trump is speaking at an event in a 22,500 seat church in Arizona next week...

Yes that looks like it could be one of many super spreader events each one bigger than the last. It's literally possible that you could have thousands of infections emerging from Tulsa and Arizona. These are already hot spots with poorly contained and growing Community transmission. Trump's rallies are really going to accelerate this.

An interesting question is which will prove greater: the burden of illness from covid-19 on these rabid supporters or the Cult of the Personality for Donald Trump. I would like to think that reality testing in that context wins out but I'm not optimistic about that at this point. What do you think?

 

[Daniel in SD]

What do you think?

I think his supporters are right and Trump's election was God's will. We deserve this.

Seriously though the only way I can wrap my head around this insanity is that he's hoping for a miracle.

 

[PeterJA]

Damn, I wish I had all this impressive technical information before I started releasing my groundbreaking products (Idiot Spray and Moron Spray I/II)

That was my original point, which you seem to have now claimed as your idea. IT IS TOTALLY DIFFERENT TO GET SUGARS FROM FRUITS AND VEGETABLES VERSUS HIGH FRUCTOSE CORN SYRUP!!!!

@dfwatt and @bkp_duke sure do like to sneer at folks lacking their superior intellects, yet they exhibit an obvious cognitive dissonance.

They acknowledge (or even claim ownership of the idea!) that vitamin-rich fruits and vegetables can help prevent/treat modern metabolic diseases, yet they refuse to consider the abundant evidence that fruits and vegetables or their vitamins can help prevent/treat modern infectious diseases. For diabetes? Of course! For Covid19? Facepalm! Time for moron spray!

Maybe this cognitive dissonance could be addressed by more thinking and less sneering and blocking of posts that challenge them. I guess we'll never know.

Here's some evidence for vitamin C.
Medical Evidence – Frontline COVID-19 Critical Care Working Group

 

[TEG]

Coronavirus takes 'shocking' toll on health: patient survey - DutchNews.nl

 

[AZRI11]

I think you have to assume from Trump's statements, from Mike Pence's recent editorial and from the Republican Governors most but fortunately not all of whom are in lockstep with all this nonsense that there really isn't any true strategy to speak of. It's more just that they're going to somehow paper over the disaster, lie as much as they possibly can, obfuscate, and claim that the media is against them, and hope that no one notices or if they notice that somehow the public becomes numb to the fatality numbers.

We're on pace for 200,000 deaths by sometime in October and perhaps three hundred thousand deaths if we keep going by the end of the year or early next year. Those numbers seem crazy, impossible, and yet that's what we're looking at. Unless we get competent leadership. And there's no chance of that with Trump and his collection of Stooges and sycophants running things.

I think at this point Trump and his team feel that Trump is virtually Teflon. Nothing sticks, the public forgets about the last disaster because of the new disaster, and his 35% base sticks through thick and thin with him. Perhaps with enough voter suppression and help from his Handler in Russia I think they figure they can still steal the election. Who needs a strategy to help anybody when you can just steal power? And then again if they lose the election they can always declare it's null and void due to 'voter fraud' and all the 'illegal voting' and steal it that way. Who knows what happens at that point. My bet is the Republican Senate rolls over at that point and only the Supreme Court prevents Donald Trump from being president. And that's assuming he doesn't win the election. Okay enough . . I'm on a a downer Jag!!

Don't worry, trump loses this election (not even close) he'll spend the last two months of his presidency in Florida. Covid-19 vaccine from oxford university before xmas. 200k deaths are probable.

 

[Causalien]

Photo op at the White House with His Orangeness and a whole bunch of other people trying to get in on the photo op. Super spreader event? Certainly a large number of stupid white folks with no masks and no social distancing. One person of color worked into the photo op probably to achieve acceptability in some quarters since he was signing his 'executive order' on police reform

Is this yet another commercial opportunity for groundbreaking products like Moron Spray? If they're this careless now wait till the Tulsa rallies. Won't be enough ICU beds in all of Oklahoma to catch the Fallout from that klusterfuk.

View attachment 552457

Obese + old. 4x likely to die from covid19.

I am impressed that trump has not caught the virus so far. Maybe he already did and is already cured. That's why he is not wearing a mask.

 

[AlanSubie4Life]

Yes that looks like it could be one of many super spreader events each one bigger than the last. It's literally possible that you could have thousands of infections emerging from Tulsa and Arizona. These are already hot spots with poorly contained and growing Community transmission. Trump's rallies are really going to accelerate this.

I don't have any doubt that there will be coronavirus transmissions that will occur at these events, but I doubt they'll be all that much worse than the various church events that have occurred (choir, South Korea, Oregon La Grande Pentecostal church). So they'll spur the further growth of the existing outbreak but seems like won't accelerate it that much. If anything it will be watched closely enough that anything that happens might be fairly quickly contained.

I have no idea how many unlinked infections are occurring in Oklahoma and Arizona right now. It seems like in Arizona it must be a lot.

Looks like Tulsa has ~400 active infections known right now (1200 cases, 800 recoverd), so that might mean another 1600 people in Tulsa walking around with the virus undiagnosed. Certainly one of them will be eager to attend the rally - but it will depend on whether they are a superspreader, etc., as to how many sparks are generated. And even if it generates 100 new infections, it might well be swamped by everything else going on.

Downstream, it will certainly cause more deaths than would otherwise occur, so it's a deadly choice to have the rallies, but the advantage of doing nothing to stop the outbreak is that it also doesn't really matter much what any one person does. If the goal is to get to herd immunity, the rally actually helps!

In Arizona it's a non-issue. Their infections are already showing up at a 15-20% positive rate, so probably this is just a good way to mix the virus into some new populations. I'd guess something like 2-3% of the people in Maricopa County are running around with active infections (mostly young people based on their infection demographics). Maybe that's high. Anyway, probably already pretty hopeless; it's possible there is going to be no way to stop that anyway.

 

[AlanSubie4Life]

Maybe he already did and is already cured.

This is my main concern with him catching the virus and surviving. He would become completely insufferable (become?). Can you imagine? That's why I hope he stays virus free.

 

[Dr. J]

Looks like OK is doing great! (They have approximately quadrupled their rate of positive results since Memorial Day.)

You're doin' fine, Oklahoma!

 

[traxila]

COVID-19: Data Summary - NYC Health

According to this NYC had 13 new cases on June 15, a welcome collapse from a daily high near ten thousand.

Hoping for some insightful comments on how the second surge due to protests and lack of social distancing over the past 20 days has not appeared.

I am thinking masks and the beginning of some kind of herd immunity in specific susceptible populations that are most likely to spread it.

Thoughts?

 

[ZeApelido]

You obviously didn't listen / view even a single one of the videos that I linked. He doesn't say it's simple, but he lays out the evidence very well.

You are very much in a minority here, and are literally arguing against a trained endocrinologist (ya know, the people that TREAT diabetes). EVERY time I could get my patients to eliminate sugared or artificial sweetened drinks from their diets, they lost weight and their diabetes at minimum improved. EVERY, SINGLE, TIME.

I didn't say the liver "cannot handle" it. The liver is the only substantially regenerative organ in the body. No one goes into liver failure from fructose intake. They can from fat deposition, but even that is not that common. What I did say was Fructose is processed VERY differently from Glucose. Glucose is transported (via the GLUT4 transporter) into muscles for direct usage. Fructose transport is far lower in skeletal muscle, and instead is primarily transported into the liver and fat cells.

You can burn Glucose for fuel, directly. Fructose, your body has to make a lot of changes to it and most of those usually involve the liver processing it.

Fructose also doesn't promote the release of Ghrelin from the brain (the hormone that makes you feel full). Glucose does, and fats and proteins do much more. Literally, this is the definition of "empty calories" - Fructose doesn't fill you up at all, and makes you store the energy.

Literally I don't disagree with anything you've written.

My only point is the "blame" put on sugar by Lustig is "too" extreme (yes that is vague), and obesity and diabetes causes are multifactorial. I was triggered by past history of low-carb nuts (they definitely are on worse footing than anti-sugar folks) touting his stuff.

I'm too tired to argue more.

I'm gonna go do some intense running w/o sugar

 

[bkp_duke]

I still can't find a paper in a UK Journal that gives us any real data about this - have you got anything?. It would be really interesting to see SOFA scores and cytokine levels and other lab values in these patients that may have shown benefit vs in patients that showed no benefit. Would help folks parameterize when to use dexamethasone.

All I could find was a press release, and that the researchers haven't released the study yet:
Coronavirus breakthrough: dexamethasone is first drug shown to save lives

 

[bkp_duke]

Literally I don't disagree with anything you've written.

My only point is the "blame" put on sugar by Lustig is "too" extreme (yes that is vague), and obesity and diabetes causes are multifactorial. I was triggered by past history of low-carb nuts (they definitely are on worse footing than anti-sugar folks) touting his stuff.

I'm too tired to argue more.

I'm gonna go do some intense running w/o sugar

Alright, we'll agree that extremes on both sides don't serve any purpose.

 

[davepsilon]

COVID-19: Data Summary - NYC Health

According to this NYC had 13 new cases on June 15, a welcome collapse from a daily high near ten thousand.

Hoping for some insightful comments on how the second surge due to protests and lack of social distancing over the past 20 days has not appeared.

I am thinking masks and the beginning of some kind of herd immunity in specific susceptible populations that are most likely to spread it.

Thoughts?

It’s not unique to NY. The core of Europe has seen similar reductions since the peak. Certainly you can think about something more complex than viewing ‘the population’ as a single monolithic entity with uniform interconnections. You have people that are more susceptible than average and you have people with a high number of social connections. Once they are immune Rt is lower. Due to these variables the effect is likely even bigger than a straight reduction where 10% immune = 10% fewer transfers per infected person.

I wish we knew more about the transmission probabilities. We seem to still be shooting in the dark on the most effective protections. Masks seem like a good idea. But is it also self isolating when sick and general hygiene awareness that is having a bigger effect? If one doesn’t talk/cough does a mask matter? Is 6 ft separation useful or is the mask enough? Even if bad indoors is fresh air + separation good enough with no masks? So many questions. There are theories, but I don’t have confidence in these sorts of answers as facts

 

[davepsilon]

Texas +4.4k cases yesterday. Positive ratio over 10% (34k tests). Not a good trend.

 

[Doggydogworld]

COVID-19: Data Summary - NYC Health

According to this NYC had 13 new cases on June 15, a welcome collapse from a daily high near ten thousand.

Columns in this chart show date of diagnosis, not date reported. They say reporting delays can be as long as a week. So the vast majority of 6/15 diagnoses probably haven't been reported yet. That said, NYC's decline is very dramatic.

It's hard to guess at the impact of protests. NYC had unmitigated spread for ~6 weeks in Feb/March, with 8.4 million unmasked people of all ages congregating indoors multiple times per day at work/shops/restaurants/bars/coffee shops/etc. A few thousand mostly masked, mostly young people marching outdoors might show up in the numbers, but seems very unlikely to generate a 2nd wave.

Looks like Tulsa has ~400 active infections known right now (1200 cases, 800 recoverd), so that might mean another 1600 people in Tulsa walking around with the virus undiagnosed.

Covid Projections estimates 0.1% of Oklahomans are currently infected. That matches the 400 known infections in Tulsa's 400k people. But their death-driven method doesn't catch outbreaks early and OK shows a recent spike in cases. So 1600 undiagnosed (0.4%) might be possible. 0.4% means 80 infected out of 20k attendees, but people with symptoms will presumably stay home and not every infectee is highly contagious. So maybe 10-20 people each infect another 10-20 for a few hundred total infections. If half the attendees are local this would be visible in Tulsa's numbers, but not statewide. And it's not like Trumpers will trumpet that they got infected at a rally.