Coronavirus

[jerry33]

All of these things point to a broken education system that has failed to prepare our young people for the moral, ethical, and civic responsibilities that will face them as adults. Until we stop under-funding our education system — until we pay teachers enough that good teachers won't flock to other careers over education so that they can pay the bills — we're going to continue having a populace that lacks the breadth of education required to make good decisions, and lacks the drive to learn things on their own that will enable them to get that education outside of the system, which means that their only source of knowledge will be the people who feed it to them; unfortunately, those people don't always have their best interests at heart.

The problem is that the politicians don't want an educated populace, they want a populace that is easily manipulated. So education bills are almost always denied or altered in a way that harms education.

 

[Silicon Desert]

My wife tells me she has patients who still tell her this is all a hoax, who are seeing her because of COVID19 issues. Yeah they didn’t die but now they have cardiac problems. But they still think it is all nothing.

I guess that belief will go on for decades. There are people 50 years later thinking the moon landing never occurred.

 

[AlanSubie4Life]

The problem is that it is nowhere near 100%. The rapid tests only catch about 84% of cases, i.e. about one in six sick people will still be out there walking around. That's nowhere near good enough for a school environment, where dozens of people are sharing air all day every day, because in that environment, it doesn't matter if one person is sick or six; they're all getting it.

Did you read the Time article? Dr. Mina believes that the tests are sensitive enough. And additionally he believes only 50% of the population would have to participate to be effective. These are numbers coming out of their epi model, I would guess, so they are not based on nothing.

In fact, the tests are probably about as sensitive as PCR in the infectious period, when it is most important. They may even be more useful than PCR, since they are less likely to give a positive result when you are no longer infectious.

I think it is worth reading through the article and his associated web page. At the very least it seems like it would be an improvement on what we have. It’s not a substitute for what we are doing anyway - it is another layer. All the other stuff we are doing can and should go on and we can even try other strategies too.

The problem with your plan (which we can, and probably should, try, AS WELL) is that you’d probably only get 50% of people to do it. And that would not be good enough. You need something that works with 50% compliance.

 

[TheTalkingMule]

Lol.....Pfizer has a 90.5% effective vaccine.....until someone else shows 95%. Wait! We revised our study and ours is now 95% effective too! Corporate America.

 

[AlanSubie4Life]

Lol.....Pfizer has a 90.5% effective vaccine.....until someone else shows 95%. Wait! We revised our study and ours is now 95% effective too! Corporate America.

You realize they said greater than 90% originally, right? From a preliminary readout? And that due to limited sample sizes there are not insignificant confidence intervals on all of these numbers?

Not everything is a conspiracy (most things are not in fact!) and for very similar vaccine types (both mRNA) you would expect similar effectiveness if they picked the right proteins to target.

 

[Daniel in SD]

Lol.....Pfizer has a 90.5% effective vaccine.....until someone else shows 95%. Wait! We revised our study and ours is now 95% effective too! Corporate America.

The first report was clearly the lower end of the confidence interval (as I speculated a week ago). This report is the center.
People are really getting COVID fast, they went from 94 cases to 170 in a week!

I do have a question for a statistician. When they say at least 90% effective presumably they mean that more than 90% of the people infected were in the placebo group and that 90% is the lower bound of the interval (say 97.5% chance that it is more than 90% effective if they're using a standard 95% confidence interval). So the question is 94 people infected, 22k placebo, 22k vaccine, if the lower bound of the 95% confidence interval is 90% what was the actual percentage?

 

[Doggydogworld]

People are really getting COVID fast, they went from 94 cases to 170 in a week!

Third wave renders "1 Day Sooner" moot...

In other news, Sweden's "herd immunity" isn't proving to be very effective. They and Finland/Norway are all getting hit with a second wave, but once again Swedes are dying at 5-10x the rate of their next door neighbors.

 

[AlanSubie4Life]

Sweden was wrong.

https://twitter.com/zorinaq/status/1329133636851953665?s=20

once again Swedes are dying at 5-10x the rate of their next door neighbors.

It's amazing what keeping the number of infections down will do. Shocking. There was no way to know.

 

[dgatwood]

Did you read the Time article? Dr. Mina believes that the tests are sensitive enough. And additionally he believes only 50% of the population would have to participate to be effective. These are numbers coming out of their epi model, I would guess, so they are not based on nothing.

In fact, the tests are probably about as sensitive as PCR in the infectious period, when it is most important. They may even be more useful than PCR, since they are less likely to give a positive result when you are no longer infectious.

On the other hand, they're less likely to give a positive result when you are still infectious, so that's problematic. Yes, from a purely "let's bring R0 below 1" perspective, 50% participation might be enough to eventually make it die out, even if it only stops 84% of the spreaders. But the problem is, right now, there are so many active cases that at that level of participation, it would probably take a year to die out. (I haven't done the math, mind you.)

 

[AlanSubie4Life]

On the other hand, they're less likely to give a positive result when you are still infectious, so that's problematic

I'm not sure whether that's really true - though it would probably depend on the antigen test. PCR is not 100% sensitive either (surprisingly, to me).

Dr. Mina seems pretty optimistic about the tests, and you also have to weight the speed, reduced risk, and convenience of an at-home test, even if the sensitivity is not as high. Getting an instant result will reduce your risk of spreading to family (I know of a situation where a COVID positive individual traveled in a car with a family member who was COVID negative to get a COVID test, for example). It also reduces the risk of spreading to others - remember it often takes 2 days to get a PCR result back - by which time you may not be nearly as infectious!

As far as specificity is concerned:
As Dr. Mina says, the counterfactual to antigen tests being less specific - say that they have a 1% false positive rate, which depending on the use scenario might mean as high as 30-50% of positive results are false positives (could be much lower though) (note that Dr. Mina also proposes confirmatory at-home instant LAMP molecular testing) - is the prospect of lockdown/quarantining, where ~99% of the people locked down can be viewed as "false positives" since they are behaving as though they are positive.

https://twitter.com/zorinaq/status/1329133636851953665?s=20

BTW these Sweden predictions are expected to hold, even if cases drop to zero tomorrow and stay at zero all the way through December.

 

[Doggydogworld]

Sweden was wrong.

View attachment 609572
View attachment 609573
https://twitter.com/zorinaq/status/1329133636851953665?s=20

That's a terrific thread. Ugh. They were stable around ~2 deaths per day all summer. 100/day will be a 50x increase! They still aren't locking down, but have recently tightened restrictions.

100/day in Sweden scales to 3300/day in the US. Our 7 day average is about 1200 now. Our ramp started a bit after theirs, but from a much higher level.

 

[AlanSubie4Life]

100/day in Sweden scales to 3300/day in the US.

Yeah, that 3300/day is about what I expect. Could go as high as 4000 per day by the end of the year, but that high would depend on how cases go for the next couple weeks. We'll see if Marc Bevand's prediction is as good for Sweden as it was for Florida. He has a little bit less exact data in Sweden, so I think he should be less confident, but I definitely think the 100/day is a reasonable guess.

 

[dgatwood]

Dr. Mina seems pretty optimistic about the tests, and you also have to weight the speed, reduced risk, and convenience of an at-home test, even if the sensitivity is not as high. Getting an instant result will reduce your risk of spreading to family (I know of a situation where a COVID positive individual traveled in a car with a family member who was COVID negative to get a COVID test, for example). It also reduces the risk of spreading to others - remember it often takes 2 days to get a PCR result back - by which time you may not be nearly as infectious!

Oh, absolutely. They're extremely useful. They're just not quite good enough for me to say that we should test everybody and then send them back to class. We really need to close schools that are still open and then beat the numbers down a LOT before reopening. Otherwise, schools are a perfect vector for spreading it to the rest of the population.

As far as specificity is concerned:

FYI, I was talking about sensitivity, not specificity. The rapid tests generally have pretty good specificity.

As Dr. Mina says, the counterfactual to antigen tests being less specific - say that they have a 1% false positive rate, which depending on the use scenario might mean as high as 30-50% of positive results are false positives (could be much lower though) (note that Dr. Mina also proposes confirmatory at-home instant LAMP molecular testing) - is the prospect of lockdown/quarantining, where ~99% of the people locked down can be viewed as "false positives" since they are behaving as though they are positive.

The better tests have a specificity of 100% (relative to the PCR test as a baseline). However, the worst tests currently approved in the U.S. have specificity as low as 95% (I think). So if you're doing mass testing of everybody, then if the specificity of the test that you're using is significantly less than 100%, it is probably a good idea to do a PCR test as a follow-up for anybody who tests positive, just so that they can stop quarantining themselves after three days instead of two weeks.

 

[renim]

'Once again this highlights the need for an effective COVID-19 vaccine that could be used to ring fence and help control such outbreaks, rather than have to lock down an entire city. Vaxine’s Covax-19 vaccine was shown to prevent nasal virus shedding in the ferret infection model (manuscript in preparation), suggesting it could be beneficial in stopping virus transmission as well as preventing clinical disease. Transmission blocking vaccines are what is urgently needed to curtail such outbreaks and ultimately end this pandemic. Unfortunately not all COVID vaccines are equal in this regard with neither of CSL’s government-funded vaccines from University of Queensland or Oxford demonstrating an ability to block nasal virus replication in their published animal data"


'Declared conflicts of interest:
Nikolai Petrovsky is Research Director of Vaxine Pty Ltd, which is currently undertaking clinical trials of a COVID-19 vaccine.'

 

[renim]

So, at first glance, we should not expect the first rush vaccines to significantly protect against transmission (if it does, that's a bonus).

But the next generation should provide transmission protection.

 

[AlanSubie4Life]

So, at first glance, we should not expect the first rush vaccines to significantly protect against transmission (if it does, that's a bonus).

But the next generation should provide transmission protection.

It’s an open question for the mRNA vaccines. My guess is that based on the robust immune response (seems to be stronger and more robust than is obtained via a natural infection, which is normal for vaccines I guess) those vaccines substantially reduce transmission. But it’s a guess and it might require rollout of the vaccines before we know.

 

[cwerdna]

Seems like many of the people involved in the below would be good candidates for idiot spray.
More than a third of 83 people who attended Ohio wedding test positive for Covid-19

A recent Ohio wedding attended by 83 people has become the latest super-spreader event amid a nationwide surge in Covid-19 after nearly half of them tested positive for coronavirus, the newlywed couple said.

Among the 32 people to contract the virus were the couple, Anthony and Mikayla Bishop, and three of their grandparents, two of whom visited the emergency room, the Bishops said in an interview with NBC affiliate WLWT of Cincinnati.

“I didn't think that almost half of our wedding guests were gonna’ get sick,” Mikayla Bishop told the station. “You're in the moment. You're having fun. You don't think about COVID anymore."
...
But aside from the couple’s grandparents, few people appeared to wear masks, even while they let loose during the reception and were close to one another on the dance floor.

From https://www.washingtonpost.com/nation/2020/11/18/ohio-wedding-covid-coronavirus/ :

A photo of their wedding posted to the venue’s Facebook page shows a basketful of hand sanitizer bottles for guests beside a container holding disposable white masks. A sign in between read: “Spread Love Not Germs.” But another picture shows the white-and-gold chairs for guests did not appear to be at least six feet apart, as recommended by the Centers for Disease Control and Prevention.

Although the couple both quickly noticed most guests hadn’t picked up masks, they told WLWT they didn’t feel they could change anything at that point.

“When I saw everyone not wearing masks I was just like, ‘Oh, well I guess we’re just gonna kinda go with it I guess,’” Anthony Bishop told the station.

Photos currently still up at Cooper Creek Event Center and Cooper Creek Event Center. Cooper Creek Event Center has pics from the wedding’s setup.

Indoors, people not spaced apart properly and almost nobody wearing masks during a pandemic? Good going!

 

[AlanSubie4Life]

They're just not quite good enough for me to say that we should test everybody and then send them back to class. We really need to close schools that are still open

I disagree with this. Schools (especially elementary) are the highest priority, and should be the last thing to close. There is some evidence suggesting that with mitigation in place, schools do not drive outbreaks. They don’t seem to result in superspreading events.

If we have easy, cheap and numerous antigen tests, it would be even easier to keep them open, until the last workable moment. I suspect daily "instant" antigen tests for every student & staff member in elementary school would work pretty well, as long as they maintain all the other layers.

 

[AlanSubie4Life]

Seems like many of the people involved in the below would be good candidates for idiot spray.
More than a third of 83 people who attended Ohio wedding test positive for Covid-19

From https://www.washingtonpost.com/nation/2020/11/18/ohio-wedding-covid-coronavirus/ :

Photos currently still up at Cooper Creek Event Center and Cooper Creek Event Center. Cooper Creek Event Center has pics from the wedding’s setup.

Indoors, people not spaced apart properly and almost nobody wearing masks during a pandemic? Good going!

At least it was a "political free" zone, if not a COVID-free one.

 

[Norbert]

My wife tells me she has patients who still tell her this is all a hoax, who are seeing her because of COVID19 issues. Yeah they didn’t die but now they have cardiac problems. But they still think it is all nothing.

This isn't just plain denial anymore. The US appears to be developing a much more serious problem dealing with reality.