Coronavirus

[Doggydogworld]

After looking at this and continuing to observe the steady case count, with no significant gov't countermeasures, I don't think there's much chance that ND and SD won't exceed 3k deaths per million now. They just need 2 more months of this death rate, and they'll be there, and there's no example that I'm aware of where the projected death curve would suggest a different outcome. And they're going to easily exceed NYC in terms of % of population infected, so not really any reason to think their deaths would be lower, in spite of treatment advances and small age differences.

Will likely be the worst in the US, with the notable exception of the Navajo Nation, which is at ~3600 deaths per million, and increasing steadily (a horrible outcome for them - probably 30-35% of the population has been infected).

I'm confident they won't hold steady at 25 deaths/day for another 10 weeks. It'll probably rise a bit higher then decline.

Until a community gets their first big wave they think it won't happen to them. When it finally hits it dominates the local conversation and people change their behavior regardless of government action. Especially older/at-risk people. SD faces a tough seasonal headwind and they won't change behavior as much as NY did, so deaths won't drop to near-zero. But there's no real COVID fatigue there, and it's not that hard to hang on a couple months until vaccines arrive for the most at-risk. I'm pretty sure they'll exceed 2000/million, but 3000 is less likely. Cases/day peaked almost two weeks ago.

Where did you get the Navajo data?

That's never been the threshold for ANYTHING. Not AIDS, not opioid deaths, not highway fatalities.

It was the goal for smallpox and is still the goal for polio. Plus some others. SARS-COV-2 is probably too prevalent and contagious, though. It depends on factors we don't know, such as mutation rate and persistence of immunity.

 

[AlanSubie4Life]

Where did you get the Navajo data?

Navajo Nation Data

Official population is 173k. 638 have died. (Probably will exceed 1000 before this is over; 0.6% of the population.) Worse case DETECTED infection rate in a service area is 12% of the population (Chinle)! So most likely over 30% infected, easily.

Unfortunately I think they will basically have herd immunity by the time the vaccine arrives.

I'm confident they won't hold steady at 25 deaths/day for another 10 weeks. It'll probably rise a bit higher then decline.

We’ll see. I think 3000 is within reach. Just take the 7-day avg peak, multiply by 75 days, and divide by 2 (rough triangle approximation).

I think SD will peak around 30-35. So in two and a half months they’ll be at zero deaths (approx) so add 1300 to their total, just for this surge. That takes them to 2100 deaths, 2400 deaths/million pretty easily.

North Dakota is the more likely case probably. They are already quite high. Ends up closer to 3000 deaths/million. On the other hand, they actually have had some gov't intervention recently, and that may help.

I will say that for these higher estimates I am counting on some pretty terrible things happening as a result of Thanksgiving, and continued government inaction. That will probably be needed, to extend the high case peak for a bit longer and end up with more mortality. They may not hit a new peak, but would not be surprised with a second sub peak in the first couple weeks of December. Inaction will also extend the decay of cases and enable a high floor of cases in three months (though by then the vaccine will start to reduce mortality).

Even if they don’t quite make it, pretty clearly an awful performance. They will certainly end up at the top of all states per capita (assuming no more explosions in already hard-hit states like New York).

 

[EVCollies]

Is there a reason you think their EUA they’ll probably submit this month will not be approved before the end of December?

Pfizer is the only vaccine submitted to the FDA at this time. I predict one submission per month.

 

[AlanSubie4Life]

Pfizer is the only vaccine submitted to the FDA at this time. I predict one submission per month.

I see. Moderna is expected to submit their data for the EUA by the end of this month, so they'll be about 10 days behind Pfizer, but we'll see what happens.

 

[madodel]

Latest I saw was that the general public isn't expected to get vaccines until April or so. So you probably have to avoid COVID until summer, but even then I expect it to be around in low numbers until we get enough of the population vaccinated and unfortunately, I am worried about all the anti-vaxxers out there or the people who simply don't trust a free vaccine.

Some worrisome data about COVID in San Diego:

https://twitter.com/K_G_Andersen/status/1331077909012836353

Unfortunately, it looks like COVID is starting to hit vulnerable age groups. One reason, besides better therapeutics, that the COVID death rate has been dropping is that mostly young and healthy people had been getting infected after the initial surge. But with high numbers of people 60+ picking it up, I would expect to see hospitalizations and deaths climb higher than it has been on a per-case basis.

The assisted living place where my Mother In Law resides managed for almost 8 months to have no more than one employee test positive for COVID19 and that was in the very beginning. Then 2 weeks ago they notified us that there was one employee and one resident testing positive. Then 4 residents and 2 employees a few days later. Then 8 residents end of last week including my M-I-L. Then 21 residents and 8 employees. Now another 21 patients this week on the memory floor of the facility which they had maintained separate staff for. It just amazes me how fast it spread after being so successful at keeping it out for 7 months.

 

[AlanSubie4Life]

Then 8 residents end of last week including my M-I-L. T

That is terrible news. I hope she is doing ok, and recovers quickly.

It just amazes me how fast it spread after being so successful at keeping it out for 7 months.

It's really contagious. One of these days after the dust and virus settles, we'll finally be told that the recommendations from the CDC were flawed and that airborne spread is common (perhaps not airborne in the classical "technical" sense, like measles or whatever, but in the practical sense). You really can't mess around with the precautions. And if 10% of the workers think it's no big deal, it's game over.

 

[madodel]

That is terrible news. I hope she is doing ok, and recovers quickly.

Thanks. She's now hospice care. She has no pneumonia symptoms. No respiratory problems, she's just shutting down. We aren't allowed to see her, which is tough, but that's the new norm. The nurse there said that all the patients have different symptoms. Some nothing, others violently sick and sent to the hospital. The most bizarre thing I've seen since HIV. My mother died in March in a nursing home in NJ. They listed immediate cause of death as AHD on the death certificate, but she never had documented cardiac problems. Might have been COVID, but there were no tests back then for non-hospital patients and she was a DNR/DNH as she had Alzheimers.

 

[Norbert]

Keeping track:
7-day average of US new cases, compared to Sept 27th:

Oct 11th: + 20%
Oct 15th: + 30%
Oct 20th: + 46%
Oct 26th: + 70%
Nov 2nd: + 107%
Nov 7th: + 156%
Nov 12th: + 224% This is 3.24x the Sept 27th value. (Testing has increased less than 50% approx)
Nov 25th: + 330% (today). This is 4.3x the Sept 27th value. (While testing has increased less than 80% approx)

The number of new cases per day is not only super high, but also still increasing, though in the last few days not quite as quickly as before. However if Thanksgiving will become a mega-super-spreader event, this might allow us to see if the effect is large enough to become visible in the national graph. Reports are that quite a few people are traveling, so that might become the case. Obviously we are so very far away from herd immunity that this will not be useful at all, even if that was a valid thought process in the first place.

The death rate is (so far) following the rise of cases with a delay of a few weeks.
The 7 day average of daily deaths, now above 1,700, compared to Oct 11th: (about 6 weeks ago)

Nov 12th: + 49%
Nov 18th: + 74%
Nov 25th: + 135% (today). This is 2.35x the Oct 11th value.

The rate at which deaths per day increase, itself, has become even steeper since Nov 18th. So I think one can now say based on the death graph itself that we will most likely have more than 320,000 deaths by the end of the year (even as counted by John Hopkins U.). Possibly quite a few more.

These numbers are from worldometers.info.

"Currently Hospitalized" is now 46 short of 90,000. This is 50% higher than the original peak of 60,000 in April/May.
Quite a few hospitals and areas are running out of ICU beds.
This number is from @covid19tracking.

 

[heltok]

What is the current explaination for why half dose + full dose > 2x full dose in the AZ/Oxford vaccine early results?

Imo it seems to indicate that something is not right in the data, not that they have found a more efficient dosage .

 

[wdolson]

Thanks. She's now hospice care. She has no pneumonia symptoms. No respiratory problems, she's just shutting down. We aren't allowed to see her, which is tough, but that's the new norm. The nurse there said that all the patients have different symptoms. Some nothing, others violently sick and sent to the hospital. The most bizarre thing I've seen since HIV. My mother died in March in a nursing home in NJ. They listed immediate cause of death as AHD on the death certificate, but she never had documented cardiac problems. Might have been COVID, but there were no tests back then for non-hospital patients and she was a DNR/DNH as she had Alzheimers.

Sounds a lot like how my father went. The town he lived in (Morro Bay, CA) has been spared from cases throughout this pandemic and I don't believe there was a single case in the assisted living place he was in at the end. He was in multiple organ failure for a couple of years and things just wore out. At the end my sister was able to be there as they let immediate family in when in hospice.

The funeral was outdoors at the graveside with a fairly stiff wind, so little risk of spread, though my step-niece showed up with no mask and wanted to hug me. I did an awkward half hug while holding my breath.

 

[AlanSubie4Life]

What is the current explaination for why half dose + full dose > 2x full dose in the AZ/Oxford vaccine early results?

Imo it seems to indicate that something is not right in the data, not that they have found a more efficient dosage .

The two groups are not properly randomized vs. the control group, as this was a mistake by AZ, and apparently the half dose group skewed younger.

So it’s probably best to take the effectiveness in aggregate, though of course that is not right either, because the doses are not the same. But at least it will be a proper comparison of the vaccinated participants vs. the control group, even though not everyone got the vaccine.

It’s a mess! It’s going to be really difficult to determine what is the right dosing to use. Probably need more trials, or at least wait for more events to reduce uncertainty.

So it looks like it’s only 70% effective maybe, and this will likely slow down the EUA.

 

[heltok]

The two groups are not properly randomized vs. the control group, as this was a mistake by AZ, and apparently the half dose group skewed younger.

So it’s probably best to take the effectiveness in aggregate, though of course that is not right either, because the doses are not the same. But at least it will be a proper comparison of the vaccinated participants vs. the control group, even though not everyone got the vaccine.

It’s a mess! It’s going to be really difficult to determine what is the right dosing to use. Probably need more trials, or at least wait for more events to reduce uncertainty.

So it looks like it’s only 70% effective maybe, and this will likely slow down the EUA.

Makes sense. Then Medcram is not only bad at basic math(1+1 vs 0.5+1 -> 3B vs 4B not 4.5 as his math says and doubles down on in comments), he is drawing some very incorrect conclusions:

 

[AlanSubie4Life]

I think in the next few days we’ll hit a local maximum nationwide case peak. Though the reporting of it may get delayed a few days more by the Thanksgiving holiday, and there may be some enormous case number days middle of next week (due to backlog reporting).

This peak is going to result in a 7-day average of deaths of a little under 3000 deaths per day (2800?), a few days before Christmas. And we should see some peak single-day death total days mid-December of around 3500.

This does not rule out a second peak a few weeks later due to Thanksgiving. We’ll see.

 

[KG M3]

Thanks. She's now hospice care. She has no pneumonia symptoms. No respiratory problems, she's just shutting down. We aren't allowed to see her, which is tough, but that's the new norm. The nurse there said that all the patients have different symptoms. Some nothing, others violently sick and sent to the hospital. The most bizarre thing I've seen since HIV. My mother died in March in a nursing home in NJ. They listed immediate cause of death as AHD on the death certificate, but she never had documented cardiac problems. Might have been COVID, but there were no tests back then for non-hospital patients and she was a DNR/DNH as she had Alzheimers.

Wow, so sorry to hear about your mother and mother-in-law. I hope she finds a way to arrest the slide. Positive energy coming her way. . .

 

[AlanSubie4Life]

Then Medcram is not only bad at basic math(1+1 vs 0.5+1 -> 3B vs 4B not 4.5 as his math says and doubles down on in comments)

Video was from the 24th, possibly before the details of the different issues was widely known.

 

[Jeff N]

What is the current explaination for why half dose + full dose > 2x full dose in the AZ/Oxford vaccine early results?

Imo it seems to indicate that something is not right in the data, not that they have found a more efficient dosage .

Apparently the half dose was a mistake made by the folks conducting the Brazilian part of the multi-country phase 3 test. The vaccine is shipped in condensed form and is diluted before injection.

One possible explanation for the better results is that this is a “virus vector vaccine” that is a modified monkey cold virus with the reproductive parts (of the viral dna) scooped out and replaced with the genetic code for the new Coronavirus spike protein.

So, it’s like catching a cold virus which then infects your cells but can’t actually reproduce & multiply but makes the targetted part of the virus that causes COVID-19 which then triggers the immune system to make antibodies to the spike. Unfortunately, with this kind of vaccine the body can also make antibodies to the modified monkey virus that is being used to deliver the vaccination. The half-dose theory is that using a smaller amount causes the body to make a weaker immune response to the monkey virus so when you get the 2nd booster shot 3-4 weeks later you don’t have as many antibodies primed to block the monkey virus and thus interfere with the vaccination boost.

Some other vector-based vaccine efforts are using different vector virus for the -st and 2nd shots but AZ is using the same monkey Andenovirus probably for simplicity and lower time-to-market risk.

The Moderna and Pfizer vaccines don’t use vector viruses as their vaccine delivery mechanism and so don’t have this issue.

 

[wdolson]

I think in the next few days we’ll hit a local maximum nationwide case peak. Though the reporting of it may get delayed a few days more by the Thanksgiving holiday, and there may be some enormous case number days middle of next week (due to backlog reporting).

This peak is going to result in a 7-day average of deaths of a little under 3000 deaths per day (2800?), a few days before Christmas. And we should see some peak single-day death total days mid-December of around 3500.

This does not rule out a second peak a few weeks later due to Thanksgiving. We’ll see.

This year it's:
"Merry Christmas! Gramps is dead..."

On CNN's website today they have a before and after picture of a 28 year old nurse. She looks 50 now. We're heading into the worst surge of the pandemic to date with the front line workers completely worn out and spent. We're going to have an entire generation of health care workers who have pretty severe PTSD.

 

[wycolo]

Was a fan of the ZPG (zero population growth) concept way back when, now as good as completely forgotten though. But sensing possibilities here; ND anyone for a 12 mo period?
--

 

[EVCollies]

What is the current explaination for why half dose + full dose > 2x full dose in the AZ/Oxford vaccine early results?

Imo it seems to indicate that something is not right in the data, not that they have found a more efficient dosage .

Such a small group of patients treated differently without randomization, could be just statistical error.
I hope the UK starts a randomized trial of these two dosing regimens. Ethically, the study would need to stop after the vaccine is available in the UK, but I bet it would accrue quickly for volunteers hoping to get the vaccine earlier.

 

[Slipstream]

Such a small group of patients treated differently without randomization, could be just statistical error.
I hope the UK starts a randomized trial of these two dosing regimens. Ethically, the study would need to stop after the vaccine is available in the UK, but I bet it would accrue quickly for volunteers hoping to get the vaccine earlier.

I think the 2 different dosing regimens are planned for the US study arm. So we may have more of an idea of efficacy between the two dosages then.