Coronavirus - worldwide spread and control

Florida DoH reported 3,650 new cases today, and 176 deaths. For the last week we've been running over 100 deaths per day, and 2,699 new cases per day. This is not what I would call the end of the problem. Naturally, the state government has gone to court to stop local schools from releasing data on their own cases. I'm not sure how you control an outbreak if you don't tell the public. Here's where that data is going.

BTW: most of Florida will be reopening bars on Monday.

My own crude estimate of positive cases out of all those tested sits at 13%. I can't square that with state numbers.

 

I haven't heard this. But to be honest haven't kept up with all the news stuff for the last week or so. Is there really evidence for a difference in strain? Or is this just an inference based on the lower death rate (which could have other roots, for example, in the demographics of spread)?

 

I thought it was from a reliable source - can anyone confirm? It was certainly weeks rather than days ago.

 

There is a mutation that is prominent in Europe. But whether or not it is more contagious or less fatal has to be derived from the epidemiology, which is confounded by the shift in behaviour of vulnerable people, so I am not sure anyone really knows. You would have to infect two populations with the same dose of each mutation to tell.

 

Florida reported another 3,190 cases and *only* 98 deaths today. The positivity rate I'm using remains close to 13%, which is not an indication the pandemic is going away. I still don't know where the DoH gets their numbers. The value of Rt is again above 1.0 at 1.02. This is not what I would look for to reopen bars, even at half capacity. Then there is the question of football season.

We have an additional complication this weekend, a tropical depression passed over the tip of the state, and became a tropical storm right off the west coast. Lots of rain in South Florida, but so far little damage. (For those who noticed that it is unusual for tropical cyclones to form near land, I'll mention that there is little difference between that land and water. Sea surface temperatures have been about like a warm bath.)

 

Florida went through its usual weekend dip with 2,423 new cases and 8 reported deaths. My best guess at an R value for the entire state remains above 1.0, meaning case numbers are growing slowly.

For comparison I checked on the U.K.'s official R numbers. Most regions are most likely above 1.0, with case numbers growing at up to 4% per day. The U.K. epidemic appears to be tracking France, where there is a definite second wave, with a delay of about three weeks.

Here's where I run into problems comparing with Florida. On a per capita basis the U.K. would have over 7,000 new cases per day, if you were in the same shape we are on our best day. A 7-day average might even reach 10,000 cases per day. This would likely trigger a outcry, questions in Parliament, etc. Large regions of Florida have had very few cases, so there is still plenty of room for spread. So far, we have not seen significant numbers of flu cases. This is almost certain to change.

Florida hospitals are now down to only 2,685 beds filled with COVID-19 patients, with 1,343 adult beds available. This is relatively good, in terms of avoiding being overwhelmed. It does not mean the crisis is over. We are seeing cases pop up unpredictably, and most are not being traced to an explicit cause. This points to a great deal of community spread. Official rhetoric is off in some other reality.

 

Florida continued the weekend dip in reporting with 1,736 new cases and 34 deaths. This is being hailed as turning a corner on the pandemic.

For comparison, I'd like to point out that Victoria, Australia (pop. 6.5 million) had 41 new cases and zero deaths. That is what real epidemic control looks like. The numbers are small enough that you have no trouble treating/quarantining everyone infected, and tracing every case. Political leaders there generally retain public confidence, despite the tough measures they have imposed. If that entire continent had the numbers we see here in one state it would be considered a disaster.

Here I've talked to enough people to realize that even those who know they were near someone who tested positive are unlikely to get a telephone call from tracers. Likewise, they are generally on their own when it comes to being tested themselves. If they don't show symptoms, they are not being encouraged to get tests. Testing has become a voluntary thing with little urgency. We have a strong correlation between declining testing rates and declining new cases. If you don't look for cases you won't find many.

I can't actually prove that we are ignoring substantial numbers of cases because I don't have access to any data on which I could base such an opinion. Even so, we have had a total of 665,730 confirmed cases and 12,642 resident deaths in a population of 21.5 million. Every person in the state is only a few degrees of separation away from a person who has been infected. I estimate about one person in 4 is at increased risk of dying from COVID-19. (Seniors alone amount to 1 person in 5.)

 

Florida is back to typical pandemic numbers, 3,116 new cases and 145 deaths today.

 

Florida reported 2,355 new cases and 157 new deaths today. Because we have 162 non-resident deaths our total is already over 13,100 dead. If cases are really going down, we should be seeing fewer deaths two months after the peak in case numbers. One problem is that some deaths which took place two months ago are just now being reported. Such statistics are useless for controlling an epidemic.

To me it seems clear we are not catching many infections. Raw data on number of tests versus number of positives appears to show rising positivity now at 19%. The state somehow gets this down to 5.78%. I confess that I do not understand their derivation.

 

BMA speech.worth a read
https://www.bma.org.uk/armspeech?s=09

 

Wow, that speech is amazing and wide-ranging.

It not only covers COVID, the role and inequalities of ethnic minorities in the NHS, also issues relating to women and doctors who are disabled/have a long term condition. Also the future needs for the NHS which have been exposed by the pandemic.

What a guy!

 

Florida reported 3,255 new cases and 147 deaths today. I had to check carefully to be sure this was a new report, not a copy of an old one.

At some point I will have to stop these daily reports. What I feel I must say is that no one should consider thousands of daily cases and hundreds of deaths normal. We are running close to 20,000 new cases and over 830 deaths per week in one state.

Overall, news reports indicate that returning U.S. college students are causing outbreaks in schools with on-campus instruction. The pandemic is not close to under control.

 

This has been reported by media but not properly discussed by the scientific community ... I am unclear if its published or peer reviewed. However here is one of the papers they cite -

https://www.biorxiv.org/content/10.1101/2020.06.12.148726v1.full.pdf

PS This is research arising out of Florida.

 

It's interesting, but still speculative. Notably, however these authors do not claim the SG614 mutation leads to lower severity and I don't see why it would (mechanistically) either. The authors speculate as to why the mutation hasn't yet led to worse observed disease severity.

 

https://twitter.com/user/status/1306889919416225795

 

In other news, Australia is making progress on eliminating the virus.

Also notable, our economy has taken less of a hit to GDP than Sweden.

 

The WHO's Dr. Michael Ryan made a very blunt assessment of the COVID-19 crisis today. He is talking about 50,000 deaths per week worldwide, and close to 1,000 of these are happening here in Florida. We are also one of the places he mentions where testing is declining, even though the technical capability exists to increase testing.

Florida reported 3,204 cases and 139 deaths of residents today. Positivity in testing remains at 18.485% by numbers I believe, or 5.33% by numbers state officials prefer. If I treat this as a proxy for infection rates, it would mean that we have between 1.11 million and 3.844 million cases which would turn up if we tested everybody.

Please don't criticize that assumption too much, I am only making it to illustrate the extraordinary uncertainty this produces. We have another problem caused by delays in reporting and validating data. Here is a screenshot of two plots of deaths over time from the community dashboard. We had a peak back in early July, and we are still seeing deaths added to that peak two months later. If all of these were due to long illnesses, that might be understandable, but some are simply delays in reporting vital statistics.



The bottom line is that official statistics leave enormous uncertainty about the number of infections out there, and the number of deaths these cause. This is not at all useful in guiding policy unless you intend to throw up your hands, stop tracing contacts and hope for "herd immunity".

 

It seems we in Florida don't have a corner on the market for official incompetence. The U.K. is now rationing testing because nobody expected a surge in demand in September. Somebody must have believed their own propaganda about the pandemic fading away.

 

Well, of course, people coming back off holidays, students returning to university and children returning to school - but of course we all know children don't catch the virus or transfer it to anyone else, don't we, so why on earth should there be a second spike in September?

 

In very local news, we just had a second local school close because of an outbreak. Because the state has tried to restrict information about cases in schools, and I did not know anyone at that particular school, this came as a surprise. It appears that 2 out of 20 high schools in the district did not make it through the first month of the school year.

Note: Orange County has not been considered particularly hard-hit.

Added: a teacher told me there are 6 other schools with outbreaks which are struggling to stay open. Unfortunately, I can't reference a source. No question there is strong political pressure to pretend things are normal.