Coronavirus - worldwide spread and control

I think the important point is that the approach described, not testing asymptomatic people who may be carriers, does not identify the routes by which the infection spreads. This is classic "community spread" which defeats contact tracing. In Florida we went through a previous dispute about testing asymptomatic workers in long-term care facilities. Nationally, the cost of testing twice a week was estimated at $25 billion. This was rejected as too expensive. We ultimately found many thousands of workers in long-term care who were infected.

The reason for testing so often is to catch carriers before they can infect others. A friend who is sending a daughter to an exclusive university this year found that they promised to test two or three times a week to prevent spread among healthy students. Cost was not a barrier for them. They also have plans to isolate infected students.

Our governor had previously modified an executive order about workers in restaurants to say they could return to work without testing if they were asymptomatic. Prior to this it required two negative tests. This was aimed at reducing the cost burden on restaurants. It completely ignored the possibility those with mild symptoms would lie in order to keep working for financial reasons. This state is not offering a great deal of financial support for workers who self-isolate, and our unemployment system has been a disaster.

What is central to this idea of encouraging community spread is that many cases will not be identified and will not appear in statistics. I've tried to model the epidemic and run into discrepancies that just don't make sense. What I can say with confidence is that there is a strong correlation between the decline in testing and the decline in the number of cases. This serves political purposes, even if unmistakable consequences show up after the election.

About 1 in 5 Florida residents is counted as senior. Large numbers of Floridians have risk factors like heart disease, diabetes, COPD or obesity. I have not been able to untangle these statistics to get accurate totals, but I estimate that about 1 person in 4 is at increased risk. From our current totals I get a mortality rate of 1.6% for the general population. People at risk may have higher mortality rates. If all 5 million I consider at higher risk are infected, we could see 100,000 deaths in this state alone. A more realistic number could be 50,000. This is still appalling as a politically acceptable toll.

 

https://twitter.com/user/status/1300722163247439873

 

New York decided to treat some excess deaths as COVID-19 caused, and now looks worse in statistics as a result. Florida has fought to deny or delay damaging numbers. We had a dispute between the state DoH and various county medical examiners over which deaths were due to COVID-19. We have a group run by the administration that is checking reports of infections and deaths to make sure they meet strict criteria for COVID-19 deaths. The process takes up to two months.

I can't even tell you what our situation is w.r.t. excess deaths, and I live here and read at least two daily newspapers in the state and two outside. I've literally got people telling me to ignore what the CDC says. We have a similar problem with FDA advice on treatments. National COVID-19 statistics have been taken out of the control of the CDC and handed over to HHS, where political appointees have more influence, and medical professionals less.

We are currently trying to reopen schools, and are currently short of data on infections resulting from this. With official sources unreliable, I am falling back on a volunteer group called The COVID Monitor. I've been using a community site displaying official data for months, after state officials fired the person who created the state dashboard.

I don't know that the horrific numbers mentioned in my above post will happen. Without reliable data I can't tell what is going on. I don't know exactly why the numbers departed from various models, but I'd feel better if the case numbers and testing numbers had not started trending down together right after leaders said we were seeing too many cases because we were testing too much. What I can show is what the limits of risk of this policy decision are, and for this state they are huge.

 

The Public Health Agency of Sweden (FHM) published a report on covid-19 today, about their suggestions and recommendations for the next 12 months.

What I found particularly interesting is that they are now finally starting to open up to the idea of maybe recommending face masks (but only in case of difficult-to-control local or regional outbreaks). Tegnell says that such a recommendation, if they were to introduce it in the future, would be "primarily of symbolic value".

Up until now FHM's main reasons for not recommending face masks have been 1) that there is no strong scientific evidence that shows face masks are effective in controlling the spread, and 2) it would give people a false sense of security, which would lead to people not following other recommendations such as social distancing etc.

Today, however, Tegnell did a one-eighty and has apparently changed his mind completely. He said:

I was also happy to read that they are considering changing the recommendations for people who are living in the same househould as someone who has covid-19. Current recommendations say that you can go to school or your job as usual (even if you work among vulnerable people, for example in a care home ), as long as you don't have any symptoms. But maybe they will change this in the future so that household members too will have to stay at home for a while, and avoid close contact with people other than the household members.

I believe these two potential changes could make a big difference for the better. Fingers crossed..!

 

Why the United States is having a coronavirus data crisis
https://www.nature.com/articles/d41586-020-02478-z

 

Florida has two new stories today: 1) the governor is opening long-term care facilities to visitors; 2) the state is breaking off use of Quest laboratories because of delayed test results. The first item indicates those visitors will be checked for symptoms, and will have to wear masks, but will not need a negative test result. I'm well aware of the problems caused by not allowing visitors, but I'm at a loss to say what has changed. This policy could have been implemented months ago. Why was it implemented now?

Item two is more complicated. Those results have been delayed for up to several months, and produced a blip of 7,569 new cases today, which angered the governor. There is also an increase to 190 deaths reported today, which is not Quest's fault. Quest is about the largest private laboratory in this state, and has run more than 1 million tests. I've previously tried to get data on how many results were pending, and failed. It appears the DoH didn't have any better idea. Individuals tested did get results, but some were not passed to the DoH in a timely manner.

Added: my own concerns have now been echoed by others. State statistics may well be a serious underestimate if they didn't even notice this problem.

Problems with coronavirus data linked in Andy's post above are on full display in Florida, and as a result, I'm afraid we are flying blind. We are heading into a new school year and a new flu season. If the kind of disaster my pessimism anticipates shows up, undeniable evidence may not be available until after the election.

 

Herd immunity would imply on the order of two million dead in the US to get there, presuming the hospitals are not overwhelmed. If they were overwhelmed then the death toll might rise to approach 10 million. I do not personally see this as a viable strategy, especially since that might also mean maybe 200 million in some level of medical debt, some more than a million dollars in debt, and as yet unknown number, maybe up to 160 million, with long term health issues, the long haulers. Its too soon to be sure of the full cost, but I think a vaccine is a much, much safer way to get herd immunity, and its not that many months till the first candidates may be approved if the trials work out.

PS My best guess range is that herd immunity will cost the US people between ten and a hundred trillion dollars, depending on how long haulers work out, and the real cost of medical treatment per capita. That is no minor cost. That is just dollars, not factoring in suffering or loss of life. I would like to see a Treasury or other accounting estimate.

 

Just feel despairing and hopeless at what’s happening around the world with coronavirus. China showed us what to do. Yes they did lots of things wrong but a strict lockdown and strict border control and contact tracing is all it takes! Other Asian countries also showed us what to do - by having an amazing contact tracing system and being careful about who comes in. Also New Zealand. It’s not something undoable. It just requires funding and quickly setting up infrastructure and people wanting to do best for others. I do not get it. Even the U.K., opening up schools & forcing people back to work when we have over 1000 new cases a day, don’t know unofficially how many.. many fold more.. what’s the point? Where do they think this is leading?

 

'Delaying Herd Immunity Is Costing Lives', American Institute for Economic Research. 31st August 2020
https://www.aier.org/article/delaying-herd-immunity-is-costing-lives/

 

Climate change deniers, anti-vaxers, anti-herders ...

I think I can see what he's doing there.

 

To survivors, and society, and an additional issue is the extreme cost of the medical bills, in some cases over a million dollars. If a large percentage of the work force are incapable of working productively, what happens to a society?

Yet next year we will most likely have a vaccine, and we can push that to stabilise the situation.

 

Health insurance, business insurance, life insurance - there's a lot of insurance products in all this, especially in the US. It's not an area I know much about, but I expect to see insurance companies increasingly acting to deny claims and lobby politicians.

 

I also expect that anyone who loses their insurance, unless pre-existing conditions are not allowed to be considered by law, will not be able to re-insure if they are long haulers. Best case scenario is they face massive premium increases. Further, insurance companies are going to face massive costs, so everybody will have premiums increased.

 

If you have good data, pandemic spread can be accurately predicted. Here's an example from Ohio. I don't believe Ohio has quite the degree of controversy over data we see in Florida, where cooperation between various people with access to data has broken down.

Of course, my cynical old mind thinks some don't want to know how bad things are. What do the stories I linked above tell you about the benefits of not testing asymptomatic people in schools and at long-term care? For one thing, testing costs money, and these people are always looking to cut expenses, but that is not the major long-term benefit. You see, testing creates a paper trail, showing the cause of infections among school children and/or seniors in long-term care. Without that trail, and with aggressive attorneys, those with money to pay lawyers can stand off lawsuits over negligence. They would have preferred blanket liability protection, but that couldn't make it through Congress. The current ability to manipulate the legal system until litigants run out of money allows another approach.

 

7 signs you may have had COVID-19 without realising it, according to doctors

http://www.msn.com/en-gb/health/med...to-doctors/ar-BB18Af9O?li=AAnZ9Ug&ocid=ASUDHP

US-oriented, but again suggesting that Covid was spreading rather earlier than we had thought.

 

One problem for our community in particular is many of these symptoms are common ME symptoms. We might not even notice if the Covid was mild enough. Exhaustion, sore throat, cough, dear me, I must have got Covid twenty five years ago! (sarcasm)

 

Somebody, and I can't always be sure who, has been trying to argue that the mortality rate for COVID-19 in the U.S. is a fraction of the official numbers. Reuters does a fact check on the claim. I'm sure this has been used in some other countries to minimize the problem.

 

Sadly, one of the people who claimed that COVID-19 numbers are inaccurate is a US Senator, Iowa senator Joni Ernst:

https://www.nytimes.com/2020/09/02/us/politics/joni-ernst-coronavirus.html

The article says that she has "walked back" her comments since then. But to have said this in the first place, especially since it is based on some baseless conspiracy theory, is irresponsible.

She also said this:

It has been debunked by fact checking sites (couldn't find a newer link, this is from April 2020)

https://www.factcheck.org/2020/04/hospital-payments-and-the-covid-19-death-count/