I like in KC, KS, USA. So back in early late November early December, I had something that was exactly like Covid19 symptoms: lasted 2.5 weeks, mild fever, fatigue, persistent cough, upper respiratory problems. The doctor said it was likely viral and they couldn't give me anything. Unfortunately, I don't know if there's a way to test how old my antibodies are IF this was in fact was Sars-Cov-2.
I think the bigger question is, let's say it did arrive much earlier that we think, does that mean the virus grows at a much smaller rate than current models?
It could also be a different strain that was spreading before it mutated into the more deadly and viral version. The virus spread is weird we can get a super spreader that can spread to 60-70 people like the church in Korea. At the same time I know personally of a family of 8 where 1 person got it had it for almost a week before getting tested positive and then sent to quarantine none of the other family members was infected.
Given the correlation between cases and deaths, isn't one of the big arguments against the early community spread theory that we would have seen death rates increase earlier on than they actually did?
No, because the mortality rate is very, very low outside nursing homes. And cause of death in the early days won't be listed as corona, since it was an unknown disease.
The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.)
I have been beating this drum for a while. I feel like I'm shouting aliens. The CFR for sixty plus is staggering. Below sixty? Still crappy, but not shut down the world. Below twenty? We wouldn't even notice.
The problem is not whether this is more or less scary than the flu (or anything else), it is both. With no solutions aimed at buffering nursing homes/elderly.
Am I just insane? This narrative seems completely absent in all of the coverage.
What narrative... that COVID-19 is most deadly for those over 60? That's literally the only fact that most people know about it. If you think that has been absent in all the coverage, I have no idea what coverage you have been paying attention to.
It is and it isn't. This thread is predicated on an IFR that is a flat 5 or so percent on the population.
We all acknowledge that it is deadly. Because it is. And you are right that this is in all the data. But the narrative is still holistic. We are locking down everyone to try and kill the virus.
Yes, it could work. But so could strict access to most nursing homes. Wouldn't be cheap, but could have even been more effective. Reasoning that we could reach herd immunity style buffer between the populations.
(Note that I flat reject just letting people die. I am not saying to abandon the older at risk crowd. I'm saying take pointed measures to explicitly protect them.)
This was more or less the original UK strategy: isolate the elderly and go full-bore for herd immunity. They scrapped that plan after they updated the model to account for ventilator shortages.
There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
That was reported as full on no shut down. Just crap reporting?
Note that I am still proposing an expensive solution. But asking if the barrier between the populations could be setup stronger. Such that the death and hospitalization load would have been what we have had, minus most of the elder population.
Edit: you edited on me. Yes, I am proposing that offering strict access to this crowd could have been done cheaper and more effective than what we have done.
The problem with isolating high risk populations is that you have to go round them all up and temporarily house them in quarantined facilities. And since the elderly are sometimes infamous for their unwillingness to be rounded up and forced to leave their homes, you have to either force them anyway or just abandon them to their fate. And that’s without touching the massive logistics of such an effort. (Not rounding them up would be even harder.)
Honestly, if you were gonna try and do that, I think geographical isolation would be a better option. Compartmentalize your state/region/country into separate zones, block all non-essential travel between zones, regularly test essential travelers, and change the lockdown status of each zone based on local conditions.
What will end up happening is occasional breaches between zones where a zone might go from green to red. But it gets us in a position where most people are mostly unrestricted most of the time. It also makes it possible to eradicate the virus without actually infecting most of the population, which is nice. Logistically you’d, at most, just set up checkpoints on roadways and inside airports and train stations to enforce the travel restrictions.
Over time you could even allow travel between green zones.
No worries on the edit. Meant that more to explain if I seemed to ignore party of your post.
I think you could have gotten pretty good volunteer isolation. As simple as getting grocery stores to deliver to elderly. As expensive as renting the Ritz for a month. Still expensive, but cheap compared to what we have landed in.
In Australia we basically did both: shutdown everything, and shutdown all access to nursing homes.
It has been disastrous (comparatively). We had a couple of asymptomatic carriers infect some aged care facilities and now nearly 20% of the deaths country wide are from those incidents. And that's with the second best testing regime in the world though March/April (after South Korea).
We'd have been better closing the aged care faculties and moving people in with relatives. That's not very practical, but the COVID deaths would almost certainly have been less.
I'm not sure how that would have been better. You are basically calling to mix them in with the whole population, do you would expect them to get more exposure, right? Why do you think it would have been less?
In Australia (where we have been lucky and controlled the virus) there would almost certainly have been less deaths if they were in the general population.
Here there has been very limited community transmission, and aged care facilities have turned out to be transmission clusters (not just death clusters). I guess shared facilities, lots of people in limited space etc.
And it's proved very hard to keep it out of facilities despite the best testing in the world. So here in Australia, (with different transmission dynamics to most places) they have been more likely to be exposed in aged care homes than elsewhere. This observation is made with the benefit of hindsight though.
Counter-factuals are hard, but in the proposed model where all old people are quarantined and the rest of the population is left to be infected the Australian experience indicates that the quarantine for aged care facilities wouldn't have been effective enough.
I can see how they may become transmission corridors. My thought is they could also be treatment clusters. Don't just quarantine them in place, per se. Take over nearby hotels and spread them out, if needed. On contamination, have all supplies ready and onsite.
Note, I explicitly don't think this would be cheap. Such that I am not sure it is tenable without hindsight.
That said, I can see your point. With my firework shop metaphor, you are basically proposing to disperse the inventory such that one misfire will not ignite all of them.
I think I just have a hard time believing we will contain this with all of the other data we have seen. My gut is it is as likely that there is some yet unknown factor for the places that have seen better numbers.
You might find this article (on Sweden) interesting:
About half of Sweden’s deaths have been in nursing homes, which prohibit visitors. Tegnell said health officials had thought it would be easier to keep the disease away from them..... "“We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been,” he told Noah."
But my suggestion isn't just to prohibit visitors. It is to basically isolate all living staff. Cleaners, caretakers, all. If need, rent out hotels nearby to spread them out.
Note. Not cheap. At all.
For the at home rate, we need the question of would that have simply shifted if we sent them home?
Edit. Realized I didn't say it directly. I do find these interesting. Thanks!
> In summary none of the patients who are put on ventilators survive.
That's simply not true. A very high percentage of them die (because you only put very sick people on ventilators), but to suggest that they all die is just absurd.
There are millions of people in high risk groups outside of nursing homes. How do you propose protecting them?
There are also millions of people in low risk groups who care for people in nursing homes and other high risk populations. How do you propose keeping them from infecting those they are caring for?
The thread is also predicated on a very high base reproduction number. A high R0 means a very large percentage of the population needs to be immunity before "herd immunity" is a thing (on the order of 80-90%). Even with a very low IFR, that is hundreds of thousands dead.
We haven't dodged that bullet in our current strategy. And the more data we get, the more it looks like we haven't protected them, honestly.
I'll note some of the first cases in WA included a high school student that had not been traveling. I cannot square that, how contagious this is, and the idea that it wasn't widely in that school.
I think herd immunity is silly at the holistic level. At a cohort level, though, it could work reasonable. Consider, at this point we could start rotations of health workers that have the antibodies.
I have said it before, but I will stress again I am just a random internet poster. Much of why I am posting this is to get challenged on it.
New York seems to have a reasonable plan. Hospitalization rate is under control, careful planning is going into how to reopen the state in a tiered way, etc.
What are they doing to keep it out of the rest of their long term care facilities? Note that they have over a million people over sixty. And if you redo their numbers assuming the CFR is roughly known in the different age brackets, things could get much much worse. (That is, the CFR in WA is in very low numbers holistically. For the sixty plus? It is over 15%!!)
So, unless they have something protecting them, just reopening slowly didn't really have a mechanism to protect them.
Now, they could go for herd immunity in care workers. Rotate in those with antibodies, and you are simulations how we protect the elderly from the flu.
But just slowly reopening? What is the mechanism that is expecting a change?
It's going to be interesting to see how the mix of competence and luck plays out over the next nine months.
Evil dictator idea. App on peoples smartphones that collects the number of unique close contacts and rebroadcasts that. So then people get warned that someones a risk.
But how are we going to effectively isolate people? More, if it is in a young community, do we care?
That is, we do not have data showing this is deadly for pretty much why identifiable group, other than elderly. Such that no matter where a flare up is, we need to isolate the elderly.
My fireworks quip was that if a spark gets in there, the whole thing blows. But, large parts of the city could likely take a flare up and not notice. That is, the whole city is not a firework store. Right?
This is absolutely insane. My ex was telling me today, "well we could have a vaccine in 18 months" and I am so getting sick of this bullshit big-pharma narrative.
Safe vaccines take 5~10 years to develop. A vaccine in <2 years seems like a disaster waiting to happen. Vaccines for SARS1 were very difficult to make and some caused reinfections worse or incomplete protection[0].
We still don't have safe vaccines for HIV or Herpes. I feel like people talking about vaccines in 18 months are being totally unrealistic and irresponsible.
Yes, pretty much. It's more likely we'll find a drug or surgery to prevent people from dying (if feels like we're literally throwing every compound that's already FDA approved at it in the massive amounts of emergency clinical trials).
But there's no telling if or when one of those drugs will pan out (and it would certainly be before a vaccine). There is no talk of reconstruction now, which really needs to happen.
To provide some context: the Oxford people have been testing their viral vector (a non-human adeno-associated virus which expresses, in this case, the spike protein of SARS-CoV-2) for malaria in the past (which failed) and for MERS (which was being trialed), so they're building on previous experience.
You're not insane, but you need to take into account that the CFR would be higher if the healthcare system were overwhelmed with patients. Also reducing death is not the only target, we are reasonably sure that many patients will have long-lasting damage to their lungs.
There is of course some trade off between number of deaths avoided and amount of money we should be prepared to throw at the problem. Where on this spectrum are you?
My specific point is that people need to stop looking at a single IFR/CFR stat. It does no good. We look to be getting safer numbers there by simply increasing testing. (Of note, NYC has a strict lower bound on its numbers with how many in its population has died. But, do note they have more people over sixty than most cities do people. Such that most places will not be comparable.)
And that is the problem. The virus has not gotten safer as we get more data. Our understanding is just not focusing on helping the elderly. We seem to be taking a crap shot that everyone can stay home and we can out sit the virus.
I would wager we could have setup hotels and strict access controls on supplies into and out of at risk communities cheaper than what we have done. Certainly if you count on all of the job loss.
> you need to take into account that the CFR would be higher if the healthcare system were overwhelmed with patients
This is the narrative we keep getting fed over and over again, but it doesn't seem to be working out. There are a lot of people who were afraid to go to doctors for minor issues, a lot of important surgeries canceled for being elective, etc. On top of that, 80% of people who need a ventilator who are older or have other health issues, will die on them[0]. For the younger patients, it's almost a coin toss.
Some hospital systems are overwhelmed, but some are totally empty. Treating a region as large as the US as one unified geographical region, even with our unrestricted travel, didn't seem sound.
The devastation to peoples jobs, lives, savings, homes .. everything ... we keep saying Lives > Economy, but unless our leaders address how to deal with reconstruction (no one seems to be talking about this), there could be a lot of consequences worse than covid down the line.
The numbers show that this is <1% fatal and probably <0.1% but all it takes is one story of some 30 year old dying on the news and everybody loses their minds.
Granted, I was very scared myself before we had numbers, but I don’t know how many people are willing to actually take a look at them now that this has become sort of political. It’s like how a school shooting will get a lot of coverage, but nobody talks about how way more people are shooting themselves in the head. Emotions over facts.
That is a lower limit on the IFR in NYC. They also have more people over sixty two than city of Seattle has people. So, much more dense, with about 13% of the population an at risk group.
Sure. Per yesterday's paper, there have been 15185 cases and 834 deaths in WA. That would be a CFR of about 5%.
Now, it says the cases are 33% above sixty, and the deaths are 91% above sixty. So that would be a CFR of 758/5011, 15%.
Contrast with below sixty. Which comes to a CFR of about .7%.
If I go with just under twenty, the paper doesn't give me enough data to calculate. They are 4% of the cases, but don't even get listed in the deaths breakdown.
Under forty, the rate is about 1.5%.
And note that more testing can drive down these numbers. But it's unlikely to do so for the elderly.
That doesn't address the the question. We have seen a significant increase in deaths that correlates with our best understanding of when widespread community spread started. If it was "actually" circulating earlier than that, why did the deaths lag significantly?
I think the theory is "there are few enough we didn't notice."
There's other weird effects going on -- some countries that look really really similar have vastly different experiences with the virus. (Canonical example is DR and Haiti, although the situation is dynamic enough no-one knows if that'll last.)
My takeaway from the difficulty in measuring this thing is that there is pretty high variance in transmission. Some carriers spread it REALLY well. Some carriers spread it poorly. With a lot of variance it matters a ton to figure out what is the deal with high-transmission situations. My take so far is we have some clues but no certainty. (Seems to spread in public transit and healthcare environments more rapidly, but slower than you'd expect in schools and prisons.)
It'd clearly be a gigantic win in terms of intervention policy to understand this better, and we simply cannot do that without extensive contact tracing so we know what's going on. They're doing a pretty good job of this in China, HK, Taiwan, South Korea. As nearly as I can tell we're doing a dismally poor job in the US and Europe.
You read papers that have diagrams of restaurant tables and bus seating charts from China. In the US it's hard to get stats on aggregate nursing home vs non-nursing home fatality rates. Maybe it takes some time for these papers to come out, but I don't see evidence that high-quality pre-pub contact tracing data is being relied on to develop policy responses.
> The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.)
I think you're confusing Covid with pneumonic plague: https://www.nytimes.com/2019/11/13/world/asia/plague-china-p.... There's apparently evidence based on mutation rates that COVID-19 can't be older than late October, and it wouldn't have been detected until mid-late November, which matches official timelines.
In the US, Massachusetts, with 6.5M total population has been hit fairly hard (outside of NY/NJ). Today's MA DoH numbers [0] show that of the 4090 deaths to date, the average age of the dead is 82 and just about 60% of them were in long term care homes. If you look towards the end of the report, it lists LTC facility after LTC facility with >30% residents infected, it's quite tragic really.
FWIW, in MA the average age of hospitalized C19 patients is 69, average age of positive tested is 53 -- Interestingly over the last 2 weeks the average ages for deaths and hospitalizations has been creeping up and the average age for a positive test creeping down. In all, 1% of the MA population has tested positive (out of 4.67% the total pop. tested).
Are the spikes in prior year Q4 from the flu? And if so was this year’s flu much more mild? It seems prior to coronavirus the number of excess deaths was quite low compared to past years.
Yes and no. At the start of an epidemic the excess mortality is not yet measurable, its within the variation of normal deaths, and the "official" numbers of corona deaths (people who die after having been tested positive) are not yet observed because there is no testing.
CDC estimates the basic reproduction number to be 6, German Robert-Koch-Institut IIRC around 3. Maybe the presence of earlier, undetected cases have lead to an overestimation of R0.
I've run into a number of southern KC suburbanites who are all convinced they had it. One had attended a thing in Vegas in Jan and came back with bad con-crud. Two houses down the whole family is certain they all had it. I'm super skeptical, because the pattern we've seen in "real" hotspots like NY just don't play out the same. It is feasible that it's really only truly devastating to dense populations, but until we have any kind of reliable testing on the infection and recovered side, the only # we can use is the death rate over normal. And that view seems to point in the direction of people not actually having it until after Feb. But here we are, having exhausted 2 months of our collective patience and not demonstrably further along in our ability to measure this thing.
The other reason to be skeptical is simply by looking at the positive test rate of jurisdictions with high levels of testing. I was also ill in February and then again in March, but the rate of positive tests for COVID-19 in my area has never made it above low single-digits, so just by the numbers, it's pretty unlikely I had it.
My wife and I were just talking about this the other day. We both got really sick in January. We had a few of the symptoms that could be just a regular flu. My wife had one symptom that stood out the most was while she was sick, she lost her sense of taste. Not just lessened, but gone.
> I think the bigger question is, let's say it did arrive much earlier that we think, does that mean the virus grows at a much smaller rate than current models?
This absolutely makes sense to me and would explain a lot of weirdness in the statistics. Less infectious, with a longer incubation period and circulating among the population for longer.
> grows at a much smaller rate than current models?
I think that local data, mortality in just one care center, does not seem to fit with slow spread. Many people have died in a short period of time in just one care center. But, as any small sample of data, could be just an anomaly and not a trend.
I guess that right now all options are open and as data gets cleared and accumulated we will know more. With more testing it would be easier to be sure who is infected, who has been infected and how the pandemic is behaving.
I have a friend in Philly who swears he had it around the holidays in December. Said he had a flu that wiped him out for a few days - said he had never had anything like it. After SARS-CoV-2 blew up and symptoms were being discovered, he swears that it's what he had.
FWIW SARS-CoV-1 specific antibodies last approximately 3 years or so [1]. The antibody test all have a very high specificity (all I've seen have been 98%+, but I'm going off of memory and not any specific cited information), so you'll for sure know you had it.
I think the bigger question is, let's say it did arrive much earlier that we think, does that mean the virus grows at a much smaller rate than current models?
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