Coronavirus - worldwide spread and control

[Esther12]

Excess death rate in the US has gone quite negative, after it had been quite high (obviously due to corona):

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm#dashboard

I guess it will stay negative for some time, regardless of any corona tests.

If you put your mouse pointer over the end of the graph it says that data on recent weeks will be incomplete and only 60% of deaths are reported within ten days of death.

 

[Webdog]

NIH Director Francis Collins (Dr Fauci's boss) supports Dr Fauci, and discusses other COVID issues.

Collins mentions upcoming trials of monoclonal antibodies at 7:15 in the video.

 

[Hutan]

If you put your mouse pointer over the end of the graph it says that data on recent weeks will be incomplete and only 60% of deaths are reported within ten days of death.

Yes, and the orange line that you would expect is the historic average death rate is actually the 'upper bound' of the historic death rate. See the data point indicated with an orange dot below for Dec 15 2018. That's on the 60,000 line, indicating about 60,000 deaths per week from all causes. But, if you hover over that date, the historic average number of deaths was 57,279.

The effect is to make the actual death numbers look lower, relative to past death rates, than they actually are.

 

[Cheshire]

Older Children Spread the Coronavirus Just as Much as Adults, Large Study Finds

The study of nearly 65,000 people in South Korea suggests that school reopenings will trigger more outbreaks.

In the heated debate over reopening schools, one burning question has been whether and how efficiently children can spread the virus to others.

A large new study from South Korea offers an answer: Children younger than 10 transmit to others much less often than adults do, but the risk is not zero. And those between the ages of 10 and 19 can spread the virus at least as well as adults do.

https://www.nytimes.com/2020/07/18/health/coronavirus-children-schools.html?action=click&module=Top Stories&pgtype=Homepage

This study contradicts previous others. Who's right? It's really difficult to get a picture of how COVID spreads, and who transmits it.

Study: https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article

 

[FMMM1]

Why are they even at the hospital getting scans if they aren't sick. There have been several "asymptomatic" cases discussed recently. The first is an individual had shortness of breath but no fever, but was considered "asymptomatic" as the doctors claimed the shortness of breath and mild cough was due to an underlying illness (but why did the patient go to the hospital?). The second was an Australian woman who dismissed her symptoms as "allergies". In both cases they did have symptoms, but they were ignored for one reason or another. I consider this a reporting bias.



More scientists who are bad at arithmetic...



Cytokine storms are rare and not the cause of mortality in most COVID cases, inflammation in tissues directly related to a strong infection is not a "storm".

I think in Germany they test you before you go into hospital; haven't checked though. Maybe it's just admissions rather than appointments.

Maybe the problem is it takes hours to do a test; not a terribly good reason for not testing though - more an argument for doing the testing as quickly as possible.

 

[FMMM1]

A purely anecdotal report:

Orange County, Florida is still trying to reopen schools with face-to-face classes and no masks.
(Why? Because no money has been allocated for anything else. This also applies to Jonathan Edward's proposal to build new hospitals. )

There was a contentious school board meeting Tuesday which failed to settle the matter. Another meeting is scheduled Friday. After the last meeting a teacher I know decided to retire rather than risk her health. She went to file her retirement papers on-line, but found this down. She needed to arrange an in-person meeting with county school officials. It turned out the virus had run through that floor of the office building, and many people were in isolation or quarantine.

She is still trying to file her retirement papers.

Knowing this person the way I do, I don't think those officials realize the hornet's nest they have blundered into.

Yea every country has it's myths. Coronavirus may result in the re-examination of some of those --- I've heard someone in the US saying that possibly it may mean the health system is changed - so that it's universally available I guess.

 

[rvallee]

Older Children Spread the Coronavirus Just as Much as Adults, Large Study Finds



https://www.nytimes.com/2020/07/18/health/coronavirus-children-schools.html?action=click&module=Top Stories&pgtype=Homepage

This study contradicts previous others. Who's right? It's really difficult to get a picture of how COVID spreads, and who transmits it.

Study: https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article

I have no idea what got people believing this nonsense. How was it even supposed to work? What was supposed to be the cutoff? 14 years-old? No problem, perfectly safe. 15? Sure. 16? Yup, virus won't touch. 17? Still safe. 18? Now the virus knows it's permitted and begins invading.

Seriously how does so much nonsense ever gain traction in the first place, including among medical professionals. Many have warned about how absurd the proposition was to begin with but far too many propagated it. We don't actually HAVE to commit all the damn mistakes at every turn just to be sure. We can actually apply reason and such to problems.

Ugh.

 

[Mij]

The study explained that older kids are more likely to spread the coronavirus at a greater rate partly because of their height. Younger children are more likely to exhale less air and exhale closer to the ground where there are fewer people to infect, according to the study.

Conclusion- beware of tall people.

 

[Wonko]

Makes no sense to me.

Fair enough small people may have smaller lungs, so breathe out less air, but they also run around a lot more than larger people, so presumably need more lung fulls of air to do so - so that aspect would probably balance.

Add to that that in all the running around they probably travel more distance, thus, depending on the required concentration of the virus needed to transmit between one person and another, have the potential to infect more people in their travels.

My point is that this an be looked at several ways.

It's probable that the only way of knowing for certain is to imprison a few million children, and a few million adults, on an island, let them act naturally, within differing rulesets, and see how many catch it.

Sort of what the UK is doing now.

 

[JemPD]

They also often speak at full volume as the norm, shout and scream... a lot!

 

[anciendaze]

Here's what one expert in military planning for pandemics thinks about the current situation in Texas. Having been in the U.S. Army, I doubt the word he originally used was "trouble".

Vox's German Lopez has an account of what Florida did to end up with more COVID-19 cases than any other state. Considering the previous disasters this really took some doing. BTW: Florida added 12,478 cases today, and reported 79 more deaths.

From skimming the article, I don't see an account of the mess with nursing homes and statistics concerning them. In the first surge we didn't get information about such cases. When they resulted in deaths, these were not attributed to particular facilities. It took reporters tracking stories and lawsuits to discover that these facilities were experiencing waves of infections, and possibly infecting the community. We still can't pin down the role these played.

Failure to identify and isolate possible superspreaders was a major lapse in epidemiology. Aggregate numbers tend to hide hot spots.

We just saw this error repeated in the current surge. It appears that infections among patients in nursing homes, and even more, among workers there, have been surging for weeks before the public found out. People who are bedbound are not out spreading infections, but those who work there could be. In total, 6,388 workers there have been infected, nearly 4,000 in a few weeks. This is quite enough to seed a big outbreak. It also represents a substantial temporary loss of workers.

For the last week we (the state) have averaged 100 deaths per day, and we still have not seen many deaths of those infected recently. As of this morning our case mortality rate is 1.48%. If this continues, this will be catastrophic -- assuming it is not already.

Unfortunately, questions about how close we are to disaster have become political questions. Georgia has transferred patients hundreds of miles to reach available ICU beds, and is looking into moving some to other states. For much of Florida, moving patients to adjacent states is not an option. The state still has 13% of ICU beds available, but many are hundreds of miles from where they are needed. Locally, we still have 22% of ICU beds available, which is fairly good. Unfortunately, that comes to 81 beds, which is not a lot considering the rate at which patients are being admitted. Data on the rate at which they are being discharged is harder to get, and I'm afraid most need treatment for weeks, if they don't die. The total number of admissions minus deaths is close to the number still in hospitals.

My rule of thumb for detected infections to emergency visits stands at about 18:1. Half of those will be admitted to hospital. It is hard to compute the number that go on to ICU, and I'm afraid this is because about half of those die, which is not something people want to advertise. We're doing better than those who faced the earliest big patient loads because some things have been learned, but serious cases remain very dangerous.

My estimate, based on today's modest local numbers alone, is that this will later require 20 more hospital beds, 4 of which are in ICU. This stead drip of cases erodes our margin for handling later surges.

Something needs to change.

 

[anciendaze]

I don't think anyone on this forum will have trouble understanding this opinion piece from Fiona Lowenstein. One might hope there will be wider understanding of our predicament as a result. One might despair if reading those unimpressed by her story.

Incidentally, what I said to Snow Leopard about "asymptomatic" cases did not argue that there was no impairment, only that patients and doctors did not initially think this was a serious case of anything. This kind of error makes control of an epidemic and of the sequelae of illness much harder to accomplish.

For comparison with what I've said about Florida, consider the response in New South Wales and Victoria, in Australia. Yesterday, Orange County (FL) alone had 741 new cases, over twice what all of Australia had. We don't report on individual cases in ICU. Our 375 adult ICU beds are 78% full, but I can't say how many contain COVID-19 patients. (People are still having serious traffic accidents, gunshot wounds and heart attacks.) We have a county mask order in place, but not a lockdown. The state has no such order. Random observation shows the mask order is not always obeyed or enforced.

Central Florida is in better shape than South Florida.

This being the U.S. the question of reopening schools is being discussed via lawsuits.

 

[mango]

The Swedish Public Health Agency are moving contact tracing responsibilities from healthcare professionals to patients...

https://tt.omni.se/fhm-covidsjuka-ska-sjalva-fa-smittspara/a/Ad6vGM

FHM: People with covid are to do infection tracing themselves

The Swedish Public Health Agency [FMH] has made this possible by repealing the old rules.

Now a person who is tested positive for covid-19 can without problems be given the responsibility to call around to people who are suspected of having been infected. The same applies to other infectious diseases such as chlamydia.

- It is much better for you and I to do it ourselves than for someone to sit on an infection tracking unit and do it, says Bitte Bråstad [chief legal officer at the Swedish Public Health Agency].

Each clinic must decide for itself whether it is up to the staff or the patient to trace the infection. At the same time, the healthcare system must also have routines to ensure that the patient has really traced the infection.

- Obviously there are patients who can ignore it and then you must have a system for it, that you, for example, notify the clinic when you have traced the infection.

 

[Jonathan Edwards]

Something bothers me about the continuing figures for the UK, an indeed for all countries.

It seems reasonably certain that overall death rate from symptomatic Covid-19 infection is some where around 1%, or would be if all age groups were affected equally. I am being very approximate here.

Yet the proportion of recorded cases in the UK that die appears to be 15%. It is quite similar in some other European countries but in Portugal, for instance, is much much lower. I wonder why.

One thing might be that a high proportion of UK cases were in care homes, with high mortality. Another might be that case recording rates have been low. But one might expect by now for the high proportion of aged infirm cases to have dropped considerably and for case tracking to get within an order of magnitude of reality. If it isn't then case tracking is going to be useless.

But at the peak of the epidemic so far the proportion of deaths was 18% and it is still 11%. That is a major drop but even if the proportion of aged infirm cases had fallen to a half, which hopefully it has, that would account for it in toto. There seems to be little reason to think we are anywhere near recording the majority of symptomatic cases. Hopefully we are still only recording about one in ten, otherwise the death rate looks a lot more worrying than we have been led to believe.

And why is the proportion of deaths to recorded cases so much lower in certain other countries? Presumably it is 1.5% in New Zealand because pretty much all cases got recorded and old people did not get the brunt of it. Why isn't the ration in the UK now somewhere near that?

 

[BurnA]

Why isn't the ration in the UK now somewhere near that?

Could this account for some of the ratio discrepancy?

BBC News - Hancock calls for urgent review into coronavirus death data in England
https://www.bbc.co.uk/news/health-53443724

 

[Wonko]

From the above link

"By this PHE definition, no one with Covid in England is allowed to ever recover from their illness," Prof Heneghan says.

This is obvious and shouldn't require a Professor to point out.

https://www.worldometers.info/coronavirus/country/uk/

Looking at the figures the 'Recovered' figure has been zero and has now shifted to N/A - so he is correct, officially no one in the UK has recovered from covid-19.

No one, ever, not even the Prime Minister, has recovered from covid-19 in the UK, government figures state this categorically, in big green letters.

Recovery is not something which, in the UK, is applicable to people who catch covid-19.

Recovery is not allowed/applicable.

Which is.....odd, as people who catch it in other countries do recover.

 

[Jonathan Edwards]

Could this account for some of the ratio discrepancy?

BBC News - Hancock calls for urgent review into coronavirus death data in England
https://www.bbc.co.uk/news/health-53443724

I think it very unlikely that the method of attributing deaths will make a substantial difference. The proportion of people who die within a three month period (in general) is very small - maybe 0.3%. So just conceivably the figures might be 30% overestimates but that would not account for the sort of discrepancy we are seeing.

 

[alex3619]

This kind of error makes control of an epidemic and of the sequelae of illness much harder to accomplish.

I recently saw an interview with someone on YouTube who mentioned two obvious things. First, the longer the incubation period the harder it is to control an epidemic. Second, the more people who are asymptomatic the harder it is to control a pandemic. The reason is obvious to many of us, if you don't know who is infected, and do nothing to stop it, they may infect many others. This is a major point behind rapid and exhaustive testing, contact tracing, and quarantine.

I do not think many are aware of the long term risks here. There may never be an effective vaccine, its not guaranteed at this point, though many groups are working on it. Second, vaccination immunity might be very short lived. Third, rapid loss of immunity might mean the same people could be infected again and again, with more and more damage each time.

These are downside risks, but there are upsides as well. We have many groups working on a vaccine, and vaccines often create better immunity than the infection itself. Current data on antibody loss (ignoring T cell immunity) is from actual infections, not vaccinations. Second, short lived vaccination effectiveness can be countered with repeat vaccinations. Everyone may need their yearly or twice yearly booster shot. Third, while there are rare cases where people seem to be infected for a second time, its not clear this is a common problem. We lack any evidence of that at this point.

 

[anciendaze]

I'm still not convinced those were actually multiple infections. Way too many viruses can hide out in physiological compartments which are hard to test. The classic example is chickenpox and shingles. That is a DNA virus which survives for years, but an RNA virus could last for months, as we see with "long-haul patients" who still have changing fevers indicating active infection.

It would be handy if you could provide a better reference than "someone on YouTube". YouTube even has flat-earthers and weirder people.

 

[anciendaze]

Something bothers me about the continuing figures for the UK, an indeed for all countries....
One thing might be that a high proportion of UK cases were in care homes, with high mortality. Another might be that case recording rates have been low. But one might expect by now for the high proportion of aged infirm cases to have dropped considerably and for case tracking to get within an order of magnitude of reality. If it isn't then case tracking is going to be useless.
...

Sweden also had a high mortality rate for a first-world country, and this was definitely because of outbreaks in care homes. Florida has had close to half its deaths in long-term care facilities, and officials didn't want to admit it was running wild in places with inadequate testing and PPE.

The explanation I've heard for the U.K. is that hospitals discharged patients to long-term care to avoid overload at hospitals. Unfortunately, some of these were infectious, and those facilities were short on testing, isolation and protection. Here in Florida, I still can't get the data needed, but I suspect that is what happened. With 20% of our population considered at risk, we are in danger of the kind of mess that hit Italy.