Coronavirus - worldwide spread and control

The assumption that results of covid-19 infection are binary, recover or die, has bothered me from day one. A recent blip in the news illustrates how politics, financial interests and possible liability complicate discussion and research on the subject of covid-19 sequelae.

CNN aired an interview with a doctor at Penn. State over possible myocarditis in infected athletes. This provoked a strong reaction to walk back the report. The evidence for this possibility was clearly inadequate, but I have to admit the university was probably motivated by alumni donors, loss of revenue and potential lawsuits to provide assurances they cannot yet back up.

Many of us have been told that we don't have the kind of inflammation pathologists can see in specimens, so our problems must be psychological. We now have multiple research papers showing signs of inflammation not apparent to eyeballs, following a presumed viral infection.

This is a reasonable question to ask concerning infection by SARS-CoV-2, but so far it has not been answered. Here's one example of the problems in research on the subject. If definitive answers require pathologist's samples from dead patients, or cardiac biopsies, it will be impossible to find such results in patients with mild infections. This is a catch-22 about obtaining solid data, not an assurance no such damage takes place.

We need better research.

 

I was concerned enough about yesterday's UK Covid infection numbers having gone up quite substantially, but today's announcement of nearly 3000 people testing positive in the past 24 hours compared with about half that a few days ago is really worrying. I hope there's some reasonable explanation, but am not at all sure that there will be one.

http://www.msn.com/en-gb/news/uknew...rease-in-three-months/ar-BB18LonK?ocid=ASUDHP

 

You need to quantify that by population. Florida is bragging about getting new cases below 3,000 per day, with less than 1/3 your population. Sunday we had 2,564 new cases, and *only* 38 deaths of residents. (You need to keep in mind that statistics all over the world show a dip on weekends because of reporting, not illness.)

What is going on here is fairly predictable. Schools reopened in late August, and we are already seeing campus closures due to new outbreaks. Even if students are at low risk (not zero), schools can't operate without staff. Here in the U.S. this is Labor Day weekend, which will probably produce more spreading events.

So far, we don't have to worry about cold weather and flu. I'm slightly stir-crazy because of temperatures above 90F and high humidity. It cooled off this evening, due to thunderstorms. That was another problem with going out.

 

http://occupyme.net/2020/09/07/how-pandemic-response-measures-harm-people-with-disabilities/

 

"
A further 2,988 cases of coronavirus have been reported in the UK in the past 24 hours, government data showed.

It is the highest number reported on a single day since 22 May and a rise of 1,175 on Saturday, according to the UK government's coronavirus dashboard."

https://www.bbc.co.uk/news/uk-54050342

if my experience today is anything to go by, I'm not surprised.

I had to go to my nearest large town by bus today (first time since February).
The driver was not wearing a mask. The only seats that had crosses on them (ie not to be sat on) were the few single ones at the front of the bus.
There were no restrictions/instructions as to where to sit on the rest of the bus.
People where handling multiple grab rails/poles regularly when they sat down and when they got up to leave.
In the town, the bank was well organised re social distancing but they were encouraging people to use the machines as there was only one cashier.
In the pedestrianised high street there was no social distancing long cues into certain shops (eg Greggs) not much mask wearing and someone was going round trying to sell packs of masks for £10.
The only shop I went into (and couldn't get out of fast enough) there were a number of young mums without masks, with small kids and buggies filling up the aisles, no social distancing, and none of the staff throughout the store wore masks or face shields.

 

Although partly due to the "weekend effect", Australia reported only 43 new cases on Monday. Total active cases is below 2000 and dropping by ~100 per day.

Testing remains high with 437,637 tests in the last week.

 

These were the w/e ones: I hope to God they don't get higher during the week ...

 

The drivers don't have to wear masks: they're sufficiently well isolated from everyone else now that the risk is deemed minimal - or at least that's how it is in London. The crossed seats are to keep passengers at a safe distance from the driver. You can't really block off the other seats because you don't know who's going to be sitting where: a 3-person household could perfectly well occupy a 4-seat section which might otherwise require 3 seats to be blocked off. You have to allow people to use their common sense as to where to sit. Unfortunately, common sense sometimes seems to be in short supply ...

 

Didn't we see a modelling study a few months back that suggests much of the predicted decline in death rates as as infection rates increase is due to the fact that the most vulnerable have already died?

That seems more like survival of the fittest than herd immunity.

 

In Spain and France new infections are almost as high as in late winter/early spring, if I was not blind.

But there is not anymore a high death rate.

Another question is of course on long term outcomes, but if this would be a massive problem there would be data, I guess.


Taken together, although some precaution may be good advice, there is no principle reason to bother more than about other diseases.

 

I've been looking for material on the decline in testing which is not overtly political. This is hard because everything has become political this year.

I've said I found inconsistency in official numbers, but I'm not ready to make detailed criticisms. I can point to Florida businesses and local governments that are happy to hide or delay news that would impact them. Even Disney, which has typically had a good reputation on public health, is now accused of attempts to downplay the problems they are facing. I suspect they are simply the most public of many businesses hiding cases.

While many correlations in official numbers have not panned out, the correlation between the decline in cases and the decline in testing is very strong. Testing has dropped by 40%. Here's a somewhat dated reference by NPR to the problem in some states which don't want to acknowledge the problem. Florida is clearly one of these. The drop in testing just happened to take place after announcements at high levels that we were seeing too many cases because we were testing too much.

I will remind everyone that reported deaths are generally delayed a month or more from the infections that cause them. Current efforts to validate causes are introducing more delays.

 

In the U.S. COVID-19 is currently the 3rd most common cause of death after heart disease and cancer. This is a very large public health problem.

As for data on long-term outcomes, that is largely lacking, medical professionals are way too busy coping with acute disease. Those I have corresponded with locally are worried about burn-out if this goes on.

 

But you must be able to distinguish. Excess mortalitiy is still high, as of two weeks ago, but has gone significantly down. So a death with covid-19 does not equal a death because of covid-19. It could already be that other causes of the deaths have risen high. I see though that the US most likely have mistreated the problem, as the Uk most likely has. It should have been a mistake not to pay any attention to it when the virus got around. Is there, btw, any comparision between the different states, which would shed light on the effects of the different measures (high in democratic sates, lower ones in republican ones)? My last - short - glance I did got not that a clear relationship.

Yes, the question is why.

Probabaly not because of mutations, which may/do not have already occured.

It could be, that a background immunity already has arisen.

Also that people who have been vulnerable, now would have died, might account.

And it could be - as you say - that the shape of our behaviour accounts.


Late autumn might pay out bad enough again.

 

Is it not also because, in Europe at least, the strain which currently appears to be circulating is the extremely-contagious-but-less-severe one, rather than the less-contagious-but-more-devastating one?

 

I'm going to try to link this article in the Washington Post about covid-19 cases in Florida schools, because it showed up in the coronavirus section, which should be free. I'm seeing a pattern here, of the initial official response being to suppress information. I've already heard about some local examples.

For that matter, people in the U.K. have had trouble getting tested because local labs are overwhelmed. A health minister blames the problem on people without symptoms asking for tests.

When did we get a scientific finding that people without symptoms can't transmit the infection? Last I read the estimate was that 48% of those infected do not exhibit typical clinical symptoms, and substantial numbers of these have plenty of active virions to spread. Ignore a substantial subpopulation of vectors and you will certainly fail to control an epidemic.

In cases where epidemiological models stop working, but the correlation between case numbers and test numbers remains very strong, I believe it is because reduced testing is not catching many infections. This is particularly true when testing numbers fall before case numbers.

Another news article has to do with a study by economists on the costs of the Sturgis motorcycle rally. Strangely, epidemiologists say their medical conclusions are plausible. What is wrong is the estimate of economic costs per case.

I'm not interested in weighing Republicans versus Democrats in this matter. I'm not a member of either party, and certainly not a member of any U.K. political party.

What I can get a handle on is the way leaders have dealt with essential facts in the epidemic. Some had denied there was human to human spread or a pandemic. That didn't last long, only long enough for infection to become established. Many have said there was no community spread in their state or country. Some have denied that people without symptoms could transmit the disease. If the same people, after a period of admitting there might be some such transmission, are now acting as if there is none, by denying a need to test people without symptoms, I suspect they are making a political calculation quite separate from public health concerns.

This seems to apply to leaders in Florida and Texas, states which have had huge case loads affecting national statistics. These are also states where decline in testing seems to correlate particularly well with decline in case numbers. I can't prove the drop in testing preceded the drop in cases, but I certainly can't prove it was the other way round.

When the number of people inconvenienced or financially impacted outweighs the number who will fall ill, and possibly die, a leader who simply counts votes may easily decide that the best political course is to ignore the vulnerable, treating this as a PR problem.

 

If someone could show that these data are wrong, I would be curious.

Ivor Cummings, 9.8.

Spoiler

https://www.youtube.com/watch?v=8UvFhIFzaac

about US at 22:00, about south america right before

some prediction for the rest of the year at 33:00

 

Central Florida now has a glimpse of the problem of containing the virus in schools. While relatively few students have been infected, enough have been exposed to force closing a few schools. At this point community spread is so common that I don't expect the path by which these students were infected to be traced. Stopping the spread within schools requires quarantining far more people than tested positive.

I would note that none of the schools I've heard about have been in areas considered hard hit by the virus. Olympia High School is actually in an area I would describe as affluent.

The State of Florida is coming out of the weekend dip in numbers, with 2,056 new cases and 200 deaths. If my crude estimate of undercounting due to not testing those without symptoms is close to correct, we would have over 3,000 infections per day. This would bring the mortality rate down, but would not indicate the pandemic is going away here any time soon.

I'm bracing for a long period of isolation this autumn.

 

I was looking for a reference to gastrointestinal infection separate from respiratory infection. By chance I found one which also says those infected may not exhibit symptoms. Some patients show the virus in stool samples after the respiratory infection is cleared. I wouldn't discount such infections in those showing "dead" virions in respiratory samples if you don't test stool samples.

 

Coronavirus: Scotland's Covid-19 contact tracing app goes live

https://www.bbc.co.uk/news/uk-scotland-54098960