Coronavirus

[Liberty]

I've read a few things about proning over the past month.. Seems to be helpful in many cases:

 

https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus.html

 

At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said.

 

Most lung tissue is actually in the back (posterior region of thorax). When a patient lies in bed for a long time, these airway sacs (alveoli) collapse (atelactasis) which means they no longer participate in gas exchange. Because these regions are located below in a supine patient, they also get more blood flow due to gravity. So now you have most of your lung that’s getting more blood flow not participating in gas exchange (what’s called V-Q mismatch) and this worsens hypoxia.

 

There are docs who think spending prone time may be worthwhile for non intubated Covid patients as well—covid patients with shortness of breath should consider it...

 

A little more here:

 

https://emcrit.org/pulmcrit/proning-nonintubated/

 

https://www.intelligentliving.co/postural-drainage-clear-fluid-lungs/

[Liberty]

https://www.businessinsider.com/fema-paid-bankrupt-company-no-employees-55-million-n95-masks-2020-4

 

Also: https://extra.ie/2020/04/16/news/irish-news/quadruples-irelands-who-budget

[sys]

3100 out of 500 000 obviously isn't 0.06%, but 0.6%, which makes quite a bit of difference here, Still not quite the 3% some are saying, but definitely not flu percentages either.

 

per the data on worldometers, the majority of cases in the netherlands have been reported in the last three weeks.  assuming that this is not an artifact of testing, it is likely that the number of deaths will climb a fair bit still.

 

this would follow the pattern observed in the diamond princess and south korean data, where initial cfr's appeared low, but lagging deaths eventually forced them higher.

 

[sys]

Country      Deaths/1M population    Tests/1M population

Spain                  402                          13,908

Italy                    358                          18,481

France                263                            5,114

UK                      190                            5,876

Switzerland        143                          22,993

USA                      86                            9,845     

Germany              45                          20,629

S.Korea                  9                          10,509

Japan                    1                                745

Taiwan                    0.3                          2,129

 

 

Still no trend.  Taiwan doesnt follow.  Taiwan has one of the lowest testing rates and lowest death rates. 

Next is Japan with lowest testing rates in list above and deaths only above Taiwan.

Richard, please do check my data on Worldometer.

 

It is very difficult to rely on testing when vast majority of infected have no symptoms. 

You have to test most of 340 million in US. Thats not an easy job.

The highest in the list above is Switzerland which tested 2.3% of its population.

 

So, that's the testing half of the numbers. What about the tracing part? Is there some way to quantify the tracing?  I've been thinking about it, and have found nothing but anecdotes.

 

One of the challenges is that effectively it's a system with feedback.  Like, if you do good tracing, then the virus doesn't spread, which means that there are fewer "high risk" people to test, which means your per capita test rate can be low.

 

This is an interesting discussion, because pretty well everyone accepts after the first explosion of cases, South Korea got the pandemic under control with test and track.  So it would be interesting to have something quantitative that supports or contradicts the "track" part of the thesis.

 

I guess one of the other things to keep in mind--which is obvious but tends to be ignored because people are too busy creating things like the 10 Commandments--is that multiple different strategies might work. Like, maybe "masks + handwashing + a culture that does these things when told to" is as effective at stopping the virus as "test + track + lock up people who were exposed".

 

the raw testing numbers per capita are not particularly meaningful, imo.  the ability to effectively test and trace is more related to the number of tests compared to the infected population.

 

another important variable is the speed with which test results are available.  slow tests are much less effective.  this thread is useful in illustrating.

 

[cwericb]

"I don't think you can trust the "active" number.  The tracking of recoveries is sketchy at best.  If someone tests positive but they have a very mild case at home they're unlikely to go back into the system as recovered. "

 

The number of active cases, the number of recovered and the number of deaths each correspond to the same ratio between Canada and the US - 30:1. When the difference in population is factored in the US has approximately 3 times that of Canada. This could change. I now see Manitoba has closed its borders like several other provinces.

 

I think this is probably going to mean that the US/Canadian border can't be opened no matter what Trump or Trudeau want until the provinces agree. Sure like to see it reopened, but it is a little early yet.

[Liberty]

Here's what the council of elders has been working on:

 

 

" Images of the plan for reopening America, as shared with Governors"

 

 

 

So this says.. not much

[StubbleJumper]

Here's what the council of elders has been working on:

 

 

" Images of the plan for reopening America, as shared with Governors"

 

 

So this says.. not much

 

 

I'm sure that the state governors will give it all of the consideration that it merits....

 

 

SJ

[Gregmal]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

[Liberty]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

Of course we have to re-open at some point. You're creating a false choice/strawman.

 

The idea is to do it well to minimize the chances of this thing getting out of control again, to minimize death and suffering, and to minimize eventual economic impact.

 

Just like if the US had done the early containment well, the problem would've been smaller and the economic impact would've been smaller. Now that ship has sailed, but it looks like the next phases aren't being handled much better than the early ones, with the daughter and son-in-law and some ex-TV hosts in charge.

[rranjan]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

The top 20% is the least impacted by lockdown and vast majority can work from home as well.

 

The bottom 20% is the most impacted by lockdown and vast majority can't work from home.

 

Just going by data published by labor department. Policymakers have to balance the economic damage vs health crisis. Bottom 20% is not the loudest voice here even though they may be most at risk of catching the virus. Top 20% may be a lot more comfortable with a longer lockdown.

 

Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike.

 

Good thing is that bottom 20% may be getting good money for the next 4 months, but it's also bad news if you want to open up. Some of them may be making more by not taking the job. Anyway, all jobs are not comng back so quickly. Slowly, but surely steps should be there to open economy. Longer it stays in shutdown , larger damage will be done and many job for bottom 20% may not exist for years if we keep economy shut for very long.

 

Debate sholdn't be taken as life vs economy to be honest. It's life vs life. Hospitals have started firing employees becasue we have shut down everything except virus cases. It's simply not sustainble even if Fed keeps prinintg money.

 

I also think using terms like stimulus or bail out takes the focus away from what's happening. Businesses are simply told to shut down by governemnt for a greater good. If goverment is giving them money to not fire emplyees then it's hardly a normal bailout situation.

 

[orthopa]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

Of course we have to re-open at some point. You're creating a false choice/strawman.

 

The idea is to do it well to minimize the chances of this thing getting out of control again, to minimize death and suffering, and to minimize eventual economic impact.

 

Just like if the US had done the early containment well, the problem would've been smaller and the economic impact would've been smaller. Now that ship has sailed, but it looks like the next phases aren't being handled much better than the early ones, with the daughter and son-in-law and some ex-TV hosts in charge.

 

I think its great and as good as an outline your going to get to control a population 328 million. If you think a more directed approach is needed we need way,way,way more man power then what is available as well as instant testing and tracing capabilities that likely dont exist yet or are not feasible.

 

We will continue to have a surge of cases over and over again until we reach herd immunity or get a good vaccine.

 

The way to minimize the most death and suffering is to do what we are doing, which is not possible, so yes there will likely be a good deal of death and suffering. Until a good vaccine comes out or treatments not much we can do about that if we plan to open the economy.

[orthopa]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

 

 

Debate sholdn't be taken as life vs economy to be honest. It's life vs life. Hospitals have started firing employees becasue we have shut down everything except virus cases. It's simply not sustainble even if Fed keeps prinintg money.

 

 

 

I agree I believe you have to assume the eventual goal is herd immunity with the brunt of infections taken on by the younger lower risk crowd. Looking at the studies if we are able to keep those 65 and older protected as much as possible you remove the highest risk population and the projected CFR and projected medical need drops to a much more palatable level. The older group is more likely to be on SSN, have a pension, etc and if needed much easier to keep this group above water with new money if needed.

 

 

[orthopa]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/?mod=article_inline

 

Promising results so far. This would surely make opening easier.

[samwise]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate.

 

Is 3% much above the false positive rate for these anti-body tests?

 

Someone posted above that the rate of false positives might be 5-10%. lets assume it is down to 3% now. If thats true, you would see 3% positive results in absolutely clean samples with no infections. Thats noise, not signal. Bottomline is: When you have an inaccurate test, the numbers need to be much higher than the test's accuracy to have much significance.

 

This is a known issue in disease tests, which I remember reading about as an undergrad. See the example below, which can seem uninutitive until you go through it. They actually use known disease incidence as an input, but unfortunately thats what we are trying to figure out here.

 

http://sphweb.bumc.bu.edu/otlt/MPH-Modules/BS/BS704_Probability/BS704_Probability6.html

 

"A patient goes to see a doctor. The doctor performs a test with 99 percent reliability--that is, 99 percent of people who are sick test positive and 99 percent of the healthy people test negative. The doctor knows that only 1 percent of the people in the country are sick. Now the question is: if the patient tests positive, what are the chances the patient is sick?"

 

 

 

The intuitive answer is 99 percent, but the correct answer is 50 percent...."

 

Because the 1 person who is sick will test positive.

1 out of the other 99 will also test positive (false positive).

Of those 2 who test positive, only 1 has the disease. So 50% chance.

[Dalal.Holdings]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

 

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

 

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

 

The lack of a control arm in the study could make interpreting the results more challenging.

 

Looks promising. No control arm in the study is a caveat.

[mcliu]

Coronavirus clue? Most cases aboard U.S. aircraft carrier are symptom-free

https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt/coronavirus-clue-most-cases-aboard-u-s-aircraft-carrier-are-symptom-free-idUSKCN21Y2GB

 

The Navy’s testing of the entire 4,800-member crew of the aircraft carrier - which is about 94% complete - was an extraordinary move in a headline-grabbing case that has already led to the firing of the carrier’s captain and the resignation of the Navy’s top civilian official.

 

Roughly 60 percent of the over 600 sailors who tested positive so far have not shown symptoms of COVID-19, the potentially lethal respiratory disease caused by the coronavirus, the Navy says. The service did not speculate about how many might later develop symptoms or remain asymptomatic.

 

 

[Liberty]

[Gregmal]

 

Why is it, that, regardless of content, the majority of the Twitter links you post are filled with losers who's posting history, 90%+ revolves around a Trump obsession?

[RichardGibbons]

Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike.

 

I think that this is an extremely good point that has gotten lost over the past month or two. The goal is to avoid overwhelming the healthcare system, not to eliminate every potential death from the virus by remaining shut for a year. (Based on Canadian polling, it's pretty clear that Canadians in aggregate don't get it.)

 

On the "how to reopen" list, it shocks me that they aren't bothering to require masks, since it seems to be a cheap and easy solution to reduce transmission (and deaths and medical costs). I wonder if there was some reasoning behind that, or if they were just writing down stuff on autopilot, and not really thinking. If they decided not to include it for cultural reasons, that puts the US at a competitive disadvantage relative to other countries that are more open-minded about such things.

[Casey]

 

Why is it, that, regardless of content, the majority of the Twitter links you post are filled with losers who's posting history, 90%+ revolves around a Trump obsession?

 

Speaking of obsessed  ::) It's a nice day Gregmal, take a walk!

[buffetteer1984]

I agree I think alot of people think we need to get cases to zero before we open the economy again.  That wasn't the point of this lockdown.  It was to limit the deaths (but not prevent it entirely) by not overwhelming hospitals. 

 

In terms of mask, Dr Fauci originally stated masks weren't required but I believe he came around to suggesting it as an effective way of preventing transmission.  Originally I think the shortage of supplies for front line workers was the agenda behind the message of the masks effectiveness.  That may still be the case which is why they suggest most to wear scarfs, or some form of clothing around your mouth area instead of directly suggesting masks for the general public.

 

Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike.

 

I think that this is an extremely good point that has gotten lost over the past month or two. The goal is to avoid overwhelming the healthcare system, not to eliminate every potential death from the virus by remaining shut for a year. (Based on Canadian polling, it's pretty clear that Canadians in aggregate don't get it.)

 

On the "how to reopen" list, it shocks me that they aren't bothering to require masks, since it seems to be a cheap and easy solution to reduce transmission (and deaths and medical costs). I wonder if there was some reasoning behind that, or if they were just writing down stuff on autopilot, and not really thinking. If they decided not to include it for cultural reasons, that puts the US at a competitive disadvantage relative to other countries that are more open-minded about such things.

[minten]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate.

 

Is 3% much above the false positive rate for these anti-body tests?

 

The researchers claim the anti-body test is not accurate enough to tell a certain person on an individual basis whether or not they have antibodies because of the false positives, but by looking at an entire group the results are reliable for that group. I can only assume that means they are correcting for the false positive rate. This is a study by a research institute. We'd have to wait for the final results what they did exactly, but doesn't sound like this was a study done by some group of overenthusiastic amateurs who were not aware of this.

 

 

 

 

[Guest cherzeca]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate.

 

Is 3% much above the false positive rate for these anti-body tests?

 

The researchers claim the anti-body test is not accurate enough to tell a certain person on an individual basis whether or not they have antibodies because of the false positives, but by looking at an entire group the results are reliable for that group. I can only assume that means they are correcting for the false positive rate. This is a study by a research institute. We'd have to wait for the final results what they did exactly, but doesn't sound like this was a study done by some group of overenthusiastic amateurs who were not aware of this.

 

so this raises the question I have about how effective a covid antibody test can be...what it really means to say you have covid antibodies.  if you have had a lyme's disease test, what you have reported is not the presence of the bacteria, but the presence of antibodies combatting the bacteria...and then you get a doxycycline scrip if there are elevated antibodies...which of course implies that the body's generation of antibodies is not sufficient to insulate you from lyme's. I am wondering if this will be the same situation with corona.

[minten]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

 

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

 

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

 

The lack of a control arm in the study could make interpreting the results more challenging.

 

Looks promising. No control arm in the study is a caveat.

 

Market seems to absolutely love this. GILD up 15% in after hours, SPY up 3.5%. Wow.

[Guest cherzeca]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

 

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

 

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

 

The lack of a control arm in the study could make interpreting the results more challenging.

 

Looks promising. No control arm in the study is a caveat.

 

Market seems to absolutely love this. GILD up 15% in after hours, SPY up 3.5%. Wow.

 

isn't a control group re a life threatening disease (at least with respect to this severely ill cohort) an ethical issue?