Coronavirus

[CLK350]

Trying to keep an open mind here. What to make of this piece a well-meaning friend sent me, basically saying we're still ignoring science and listening to politicians instead.

A New World Health Organization Report Once Again Proves Sweden Right

Even The WHO has to acknowledge reality

ianmsc.substack.com

 

[AlanSubie4Life]

fwiw the moving average for deaths in the US is now lower than at any time on the chart since the March 2020 (when the first wave hadn't even ramped up yet). Now lower than the minimum in Summer 2021 which used to be the low point.

It’s now up to 275 or so on May 17th rather than ~215 on May 17th when this was posted, and the deaths on May 17th will continue to increase, as expected.

So March 2020 remains the low as expected, for now.

These are rough numbers. Overall trajectory may still be slightly down.

 

[JRP3]

Trying to keep an open mind here. What to make of this piece a well-meaning friend sent me, basically saying we're still ignoring science and listening to politicians instead.

A New World Health Organization Report Once Again Proves Sweden Right

Even The WHO has to acknowledge reality

ianmsc.substack.com

Simply comparing Sweden to Norway and Finland says it all, Sweden did much worse over all.

 

[dhanson865]

It’s now up to 275 or so on May 17th rather than ~215 on May 17th when this was posted, and the deaths on May 17th will continue to increase, as expected.

So March 2020 remains the low as expected, for now.

These are rough numbers. Overall trajectory may still be slightly down.

I've been hesitant to comment on trends as they happen because when you zoom out those can be hidden by scale.

Now I have to be doubly patient and make sure not only does the min or max show when zoomed out, but I have to add an additional delay to see if it changes.

Anyway thanks for pointing it out to me, I might not have noticed they had switched to the new method as the revisions are very subtle.

 

[Daniel in SD]

Trying to keep an open mind here. What to make of this piece a well-meaning friend sent me, basically saying we're still ignoring science and listening to politicians instead.

A New World Health Organization Report Once Again Proves Sweden Right

Even The WHO has to acknowledge reality

ianmsc.substack.com

I'd like to see the excess mortality rate comparing US states with lockdowns and those without. That seems like a much better natural experiment.

Can someone please do a challenge trial with masks?
Are we really going to have 5 billion+ people get COVID without quantifying exactly how well they work?
I'm tempted to go over to my COVID positive friends house to test for myself. haha.

 

[bkp_duke]

I'd like to see the excess mortality rate comparing US states with lockdowns and those without. That seems like a much better natural experiment.

Can someone please do a challenge trial with masks?
Are we really going to have 5 billion+ people get COVID without quantifying exactly how well they work?
I'm tempted to go over to my COVID positive friends house to test for myself. haha.

Study was done long before COVID about mask effectiveness with respiratory pathogens. I posted it here multiple times.

 

[jerry33]

Can someone please do a challenge trial with masks?
Are we really going to have 5 billion+ people get COVID without quantifying exactly how well they work?

The problem is all masks are not equal. From what I’ve seen, most wear cloth masks which aren’t much better than no mask. Of those that wear masks a good number of them leave the nose uncovered or wear the masks on their chin. And mask use without frequent hand washing pretty much nullifies mask use. So unless you can get results for all the mask plus hand washing variables, the results won’t have a great deal of meaning.

 

[AlanSubie4Life]

Study was done long before COVID about mask effectiveness with respiratory pathogens. I posted it here multiple times.

I haven’t seen a single challenge trial posted here actually testing whether masks work. Would be relatively easy and could do sequencing too to verify the source of transmission. Obviously what was being suggested would also check different types of mask.

It’s all very well taking a study that tests whether intermittent mask usage (N95 or not?) works against respiratory pathogens and drawing conclusions willy nilly that confirm your priors - but that’s just garbage in garbage out.

 

[bkp_duke]

The problem is all masks are not equal. From what I’ve seen, most wear cloth masks which aren’t much better than no mask. Of those that wear masks a good number of them leave the nose uncovered or wear the masks on their chin. And mask use without frequent hand washing pretty much nullifies mask use. So unless you can get results for all the mask plus hand washing variables, the results won’t have a great deal of meaning.

BINGO! And this is exactly what the study showed. You want N95 or better, VERY tight against the face, and you MUST swap them out frequently. Cloth masks, neck gators, etc. were practically useless at ~20% effectiveness or less.

 

[ohmman]

Kid stayed home today. Logged into school via her chromebook, finished her reading "diagnostic test", reading assignments, math, and everything else in 2.5 hours. Made me wonder how much time the public education system is wasting annually for my children and how much more work could have been completed. . .

School is significantly more than just the academics.

 

[bkp_duke]

School is significantly more than just the academics.

My kids have far more than adequate socialization. Even during COVID and school from home we made sure they had plenty of peer interactions and play opportunities.

 

[scottf200]

U.S. COVID update: New cases continue to rise, up 22% from last week
- New cases: 145,962
- Average: 109,818 (+3,770)
- States reporting: 32/50
- In hospital: 24,068 (+18)
- In ICU: 2,661 (-1)
- New deaths: 502
- Average: 318 (+14)
More data: https://charts.medriva.com/us

https://twitter.com/x/status/1527832046596505604

 

[AlanSubie4Life]

BINGO! And this is exactly what the study showed. You want N95 or better, VERY tight against the face, and you MUST swap them out frequently. Cloth masks, neck gators, etc. were practically useless at ~20% effectiveness or less.

The cloth mask bit certainly isn’t surprising for personal protection (maybe source control is a bit different? - another study needed for that - may be completely ineffective now with Omicron, no idea). It certainly doesn’t seem like cloth masks would ever work, both due to their fit and how they are typically worn (much easier to wear improperly than N95). I’m surprised they show any efficacy at all.

I’m curious about the reuse part, and it would be good to see that tested. I don’t see why re-use within reason would be a problem (the masks do loosen up over time, and can sustain damage - that’s a different issue). Obviously need some care with contamination on the outside of the mask, but there simply doesn’t seem to be much evidence at this point of fomite transmission being common. It’s certainly very clear that the vast majority of transmission occurs through the air. Also would be good to do a controlled tests for fomite transmission!

We’re never going to know though. It’s better to stay confused and uncertain, that way we can spend money on a bunch of other unnecessary stuff!

Anyway, plenty of studies during COVID demonstrating that mask use (especially N95) is associated with lower rates of transmission. Posted here earlier. But none of these are remotely definitive either, which is why the challenge trials backed by sequencing would be nice.

1 in ~4540 children below 5 died of COVID, cumulatively, vs. 1 in 9600 for all other children (teenagers are also at higher risk, so if you compare very young children to the 5-11 group the 0-4 group is actually closer to 3x higher risk). These are CFRs of course, not IFRs. And obviously these stats are progressively getting skewed by the availability of vaccinations for older groups - but I've posted this data before vaccines were widely available for the 5-11 group, and this vulnerability difference is still apparent in that data (you can look up the posts - for example, but I have posted earlier as well ). For Omicron the situation could be different, but generally young children have floppy airways and can be more vulnerable to respiratory diseases, as you are well aware, as you are a pediatrician. It's speculative, but I assume that's the reason for these stats looking the way they do, and it's not just a ascertainment bias issue (possible, but I think given the degree of difference, unlikely to be the only explanation).

View attachment 771079



The doses they used are very small it seems (7ug instead of 100ug) and maybe they went too conservative. We'll hope that the response is strong enough for the three dose data. I suspect it will be. But we'll know in a few weeks.




My data above is cumulative, but I've posted this before, prior to Omicron really pushing through, so it's possible to look at deltas and see how risk has changed for each group over time specifically for the Omicron period - though CDC death data lags so much that it's too early to. make that assessment. Not going to do that here as a result.

Incremental CFRs (since last post) and (Overall) CFRs for children, which would be primarily Omicron:

Age Incremental (overall)
0-4: 1 in 10238 (1 in 5069)
5-11: 1 in 11462 (1 in 13800)
12-15: 1 in 8600 (1 in 9227)
16-17: N/A (negative) (1 in 6663)

Mixed bag. Omicron death rates apparently not much different, except much lower in young children, and in children 16 and over. Note the numbers are adjusted/adjudicated, which explains negative deltas. Impact of vaccination is surprisingly low, but of course ascertainment rate is probably way down and these are CFRs, so hard to say. Vaccination rates in 5-11 group are particularly low of course. And periodic CDC adjudication adjustments could be messing up the numbers a bit. Another possibility is that many/most of the deaths in children are in immunocompromised, so impact of vaccination may be lower, or make things look worse if vaccinated healthy children never test positive at all (I've heard ~30% of deaths in children are of children who have no pre-existing conditions, but the data are hard to come by).

 

[bkp_duke]

I’m curious about the reuse part, and it would be good to see that tested. I don’t see why re-use within reason would be a problem (the masks do loosen up over time, and can sustain damage - that’s a different issue). Obviously need some care with contamination on the outside of the mask, but there simply doesn’t seem to be much evidence at this point of fomite transmission being common. It’s certainly very clear that the vast majority of transmission occurs through the air. Also would be good to do a controlled tests for fomite transmission!

Well known phenomenon to medical workers. Pre-pandemic, even N95s, we ALWAYS trashed them after one use (in the waste that goes to an incinerator). It's been known for decades that viruses and bacteria can last for hours to days on these surfaces.

 

[Daniel in SD]

Well known phenomenon to medical workers. Pre-pandemic, even N95s, we ALWAYS trashed them after one use (in the waste that goes to an incinerator). It's been known for decades that viruses and bacteria can last for hours to days on these surfaces.

This is something I would test in my challenge trial. Sars-CoV-2 lasts days on all sorts of surfaces but we have no idea how likely it is to spread that way. And of course you can just rotate N95s, which health care workers did when they were in short supply.

 

[bkp_duke]

This is something I would test in my challenge trial. Sars-CoV-2 lasts days on all sorts of surfaces but we have no idea how likely it is to spread that way. And of course you can just rotate N95s, which health care workers did when they were in short supply.

Rotated N95s were almost always exposed to UV for hours or some other non-destructive cleaning method. I know of no hospital/health group that just pull the N95s off and let them sit.

 

[madodel]

Rotated N95s were almost always exposed to UV for hours or some other non-destructive cleaning method. I know of no hospital/health group that just pull the N95s off and let them sit.

In hospitals, but I recall articles suggesting people at home put masks in paper bags and let them sit a couple days before reuse because of the then scarcity of mass and the cost. Now of course you can buy counterfeit KN95 and surgical type masks on Amazon dirt cheap so you can also find them blowing all over parking lots everywhere.

As I've stated before in Germany, when masks were required, much of the masks used by people in the US would be unacceptable. No cloth masks, no surgical masks, only N95, KN95 and whatever the EU standard is. Of course now the EU just stopped requiring masks on transportation so anything goes I guess, Though when we were in Germany a few weeks ago my wife was refused entry into the Apothecary museum because she just had a surgical mask on, so some places are still requiring masks and only the N95 caliber ones.

 

[AlanSubie4Life]

It's been known for decades that viruses and bacteria can last for hours to days on these surfaces.

Yep, I don’t doubt it. The question is whether in general use cases with lower levels of contamination and some basic care taken to not touch the outside of the mask and then touch face, etc., whether there will be enough for an infectious dose. Would be really nice to know - obviously if you have access to ample N95s, you just use a new one every time, since the dogma requires it, and it wouldn’t look great for hospitals to be conserving their N95s for cost reasons if supply were not an issue. But, would be nice to know how things actually work (for COVID specifically, in a normal environment - in a hospital there are other pathogens and splash contamination to worry about and concern about transmission to vulnerable patients, so considerations are quite different and not just driven by fomite transmission of C19).

I don’t think fomite transmission drives transmission of COVID-19 (would be nice to know though!), but I still do take basic hand sanitation precautions and treat the outside of my mask as dirty. And I routinely reuse my N95s (I do cycle a couple, but not super rigorously). One of these days the defenses will be breached I suppose, but not yet.

 

[AlanSubie4Life]

It’s definitely a little premature to make the call, though wastewater signals do confirm it in some areas (e.g. Massachusetts), but good news is that things appear to have largely peaked in the Northeast and the upper Upper Midwest. Maybe there will be a secondary surge or a Memorial Day celebratory surge, but for now appears to be easing off.

Plenty of room to run in the South and West though.

Locally here in San Diego it looks like we may have peaked, based on the wastewater signal. Could be temporary of course - just a little too soon to confirm the trend. The data is a lot less noisy than it has been (settled down, starting in November/December 2021) though, so I am optimistic this could be a local maximum; I just hope it isn't broken through, like Tesla has done miraculously with FSD Beta.

 

[heltok]

Good news, it’s getting easier to travel to China:

China relaxes Covid-19 testing rules for travellers from Singapore

Travellers from Singapore to China will need to do fewer pre-departure tests for Covid-19, but quarantine remains. Read more at straitstimes.com.

www.straitstimes.com

BEIJING - Travellers from Singapore to China will need to do fewer pre-departure tests for Covid-19 following changes announced by the Chinese embassy in Singapore on Friday (May 20), even as another district in Beijing went into a semi-lockdown on Saturday.

They will no longer need to do a polymerase chain reaction (PCR) test seven days before flying, nor antibody tests, which used to be required.

The changes will take effect immediately, the embassy added in the notice on its public WeChat account.

But travellers from Singapore will still be required to isolate themselves for seven days - which can be done at home - before departure, and undergo two PCR tests two days before and within 24 hours of departure.

They will need to upload their test results and a letter stating their commitment to self-isolate for seven days to an Internet portal before they can attain a health code, which is necessary for entry into China.

Travellers will also need to do an antigen rapid test (ART) within six hours before boarding, on the day of check-in.


No changes were announced regarding quarantine upon arrival, which is at least two weeks depending on the city travelled to.