Coronavirus

[rolling]

https://www.marketwatch.com/story/wheels-are-in-motion-for-widespread-coronavirus-antibody-testing-in-new-york-2020-04-15?mod=mw_latestnews

 

Antibody testing will be key to getting economies around the country moving again.

 

“We have these estimates that it could be millions of people” in the U.S. who will qualify to go back to work once an antibody test is deployed, said Joshua M. Epstein, a professor of epidemiology at the New York University School of Global Public Health.

 

"Until the tests are available, there’s no way of knowing just how many New Yorkers have had the virus, Racaniello said. He estimates it could be 10 times more than the official tally, due to lack of early testing and the potentially large number of asymptomatic carriers. "

 

And no one hit me with that its been spreading since you said millions of people 5-6 weeks ago so thats why I could be that high now. If Dalal can say the curve was flattened and disaster was averted because of the lock down, then you cant in same breath said it has been spreading rapidly. Cant have it both ways.

Dear orthopa, not taking sides, but Exponencial growth makes it possible. numbers were growing over 30% a day in most places prior to lockdown, which means healthcare capacity would be overwhelmed in those places were it not for the lockdowns: lockdowns earn you time by reducing  case growth from over 30 to sub 10% (over here after a few weeks we are now on a 3-4% case growth per day). with that time you can plan, prioritize, buy supplies, organize campaign hospitals, etc. at over 30 % a day (in some places maybe over 50% a day) everybody gets sick before you can do anything.

However, millions of cases is not something strange in a country as big as the us. And with a double in less than 3 days you very quickly reach the millions. The lockdowns however might have turned many millions into a few millions, which means this thing will last longer, but should not kill so many

 

I agree, and believe probably millions. Spreading rapidly and what that means is highly up for debate and probably useless to discuss right. Throw a number and situation out there and it seems plausible.

 

My point was if the lock down slowed the spread and people stayed in their house, wore masks etc then the growth should have slowed exponentially. NY has been on a "pause" for a month. New cases caused by community spread should have hit rock bottom and in reality only now be from spread within families/close contacts etc. Once the pre lockdown infections progressed to recovered or death where else would the infection be coming from? So if NY is at 2 million cases after a complete lock down taking into account the slowest possible spread from the most extreme measures contemplated, that number of infected now is coming from a higher then expected initial base before the lock down.

 

Whether or the lock downs actually worked or not maybe up for debate around the country. Different states locked down at different times. Different restrictions in each state. Some have only essential services, some don't. All seem to be working. Its likely the social distancing, standard precautions, hand washing, masks, etc that is having the most effect since that is probably the most consistent measure practiced across the entire US.

There is, by definition, a delay between infection and diagnosis, which would be about 10-14 days in an unadvised population. In adition, taking into account new york crowding, subways, etc, instead of the 2-3 days duplication rate seen in most countries (which include scattered populations), it is highly likely duplication rate was higher than once a day (or over 100% daily growth rate, just think how many people a subway user infects in just a day, and then imagine how many people those infected subway users infect). That would conservatively mean infected people in NYC would be 2^10 higher (or 1024x higher) than known by the time they implemented the lockdown, and that does not include prior cases (which were certainly present, but nor necessarily by that much) not diagnosed by various motives. If you take into account that base, millions will not be that far away, even if the lockdowns slowed everything to 5% a day immediately (which is doubtful: close contacts from yet not contagious people would still have to be infected, so you can count on at least 1-2 weeks more of a reasonably higher growth rate).

[Dalal.Holdings]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).

 

Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths.  3% of 17 million is 500K.  So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.

 

So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard.  On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).

This is interesting. Netherlands used policies more or less intermediate compared to places like Austria on one side and Italy on the other with, as expected, more or less intermediate results. Netherlands has also produced interesting work on influenza vaccine effectiveness and is a good relative European student in terms of historical flu vaccinate rates.

It looks like (picture developing) that the CV does behave (intrinsic features) similarly to the influenza virus, with the main difference being that the population tends to have a much lower natural immunity to it and there is no vaccine, not even a partially effective one. Reasonable extrapolation of data in the Netherlands suggests that the eventual death rate from CV (with some social distancing and other basic measures) will look like (compare to a reasonable degree) the typical death rate for influenza, had there been a 0% rate of vaccination.

What society is doing is basically trying to adapt (with various levels of 'success') to this new and evolving reality.

 

@LC

Thank you for supplying the link for the European monitoring of mortality with seasonal variations.

 

Apologies. To my own embarassment upon re-reading this I made a primary school calculation error here (my only defence: it was early).  3100 out of 500 000 obviously isn't 0.06%, but 0.6%, which makes quite a bit of difference here, Still not quite the 3% some are saying, but definitely not flu percentages either.

 

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7

 

See Table 1. Estimated CFR 1.38%, >10x deadlier than the Flu. The best CFR from published studies is in the vicinity of 1% which is 10x deadlier than Flu.

 

The 3% antibodies is not good news for feasibility of herd immunity as you note. British government backed off of that strategy quickly...

[Gregmal]

 

In my 53 years of seeing dumb things, defunding the WHO in the middle of a global pandemic is the winner.

 

Sure, on the surface it sounds like it, but removing political biases on the part of those trumpeting this "horrible decision", is it not credible to at least question these people?

 

They've been horribly wrong about things directly related to the purpose of their existence and continuously seem to have a pro China position, even down to the OK being given to re-open wet markets...

[minten]

is it not credible to at least question these people?

 

There's definitely a time and place for questioning (and even for fund cutting if need be), I totally agree; But surely we can also all agree that time is not now.

[Guest cherzeca]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).

 

Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths.  3% of 17 million is 500K.  So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.

 

So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard.  On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).

This is interesting. Netherlands used policies more or less intermediate compared to places like Austria on one side and Italy on the other with, as expected, more or less intermediate results. Netherlands has also produced interesting work on influenza vaccine effectiveness and is a good relative European student in terms of historical flu vaccinate rates.

It looks like (picture developing) that the CV does behave (intrinsic features) similarly to the influenza virus, with the main difference being that the population tends to have a much lower natural immunity to it and there is no vaccine, not even a partially effective one. Reasonable extrapolation of data in the Netherlands suggests that the eventual death rate from CV (with some social distancing and other basic measures) will look like (compare to a reasonable degree) the typical death rate for influenza, had there been a 0% rate of vaccination.

What society is doing is basically trying to adapt (with various levels of 'success') to this new and evolving reality.

 

@LC

Thank you for supplying the link for the European monitoring of mortality with seasonal variations.

 

Apologies. To my own embarassment upon re-reading this I made a primary school calculation error here (my only defence: it was early).  3100 out of 500 000 obviously isn't 0.06%, but 0.6%, which makes quite a bit of difference here, Still not quite the 3% some are saying, but definitely not flu percentages either.

 

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7

 

See Table 1. Estimated CFR 1.38%, >10x deadlier than the Flu. The best CFR from published studies is in the vicinity of 1% which is 10x deadlier than Flu.

 

The 3% antibodies is not good news for feasibility of herd immunity as you note. British government backed off of that strategy quickly...

 

"However, after further adjusting for demography and under-ascertainment..."

 

what does this mean?  oh, that the so-called scientists fudged their data to get the results they wanted, is what this means.  garbage in, garbage out.  good enough for Dalal though.

[Dalal.Holdings]

"However, after further adjusting for demography and under-ascertainment..."

 

what does this mean?  oh, that the so-called scientists fudged their data to get the results they wanted, is what this means.  garbage in, garbage out.  good enough for Dalal though.

 

You're right, this Lancet study is good enough for me for the time being. And so are you! You treasure, you!

[Guest cherzeca]

"However, after further adjusting for demography and under-ascertainment..."

 

what does this mean?  oh, that the so-called scientists fudged their data to get the results they wanted, is what this means.  garbage in, garbage out.  good enough for Dalal though.

 

You're right, this Lancet study is good enough for me for the time being. And so are you! You treasure, you!

 

first figure out how to spell my user name dipstick.  then I will engage you, though I will likely debase myself in the process.

[Cigarbutt]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).

Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths.  3% of 17 million is 500K.  So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.

So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard.  On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).

This is interesting. Netherlands used policies more or less intermediate compared to places like Austria on one side and Italy on the other with, as expected, more or less intermediate results. Netherlands has also produced interesting work on influenza vaccine effectiveness and is a good relative European student in terms of historical flu vaccinate rates.

It looks like (picture developing) that the CV does behave (intrinsic features) similarly to the influenza virus, with the main difference being that the population tends to have a much lower natural immunity to it and there is no vaccine, not even a partially effective one. Reasonable extrapolation of data in the Netherlands suggests that the eventual death rate from CV (with some social distancing and other basic measures) will look like (compare to a reasonable degree) the typical death rate for influenza, had there been a 0% rate of vaccination.

What society is doing is basically trying to adapt (with various levels of 'success') to this new and evolving reality.

@LC

Thank you for supplying the link for the European monitoring of mortality with seasonal variations.

Apologies. To my own embarassment upon re-reading this I made a primary school calculation error here (my only defence: it was early).  3100 out of 500 000 obviously isn't 0.06%, but 0.6%, which makes quite a bit of difference here, Still not quite the 3% some are saying, but definitely not flu percentages either.

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7

See Table 1. Estimated CFR 1.38%, >10x deadlier than the Flu. The best CFR from published studies is in the vicinity of 1% which is 10x deadlier than Flu.

The 3% antibodies is not good news for feasibility of herd immunity as you note. British government backed off of that strategy quickly...

"However, after further adjusting for demography and under-ascertainment..."

what does this mean?  oh, that the so-called scientists fudged their data to get the results they wanted, is what this means.  garbage in, garbage out.  good enough for Dalal though.

FWIW, i find the study to be relatively strong: using framework and tools that deal with uncertainty, explaining limitations, written in a way to allow to make up one's own mind. It seems to me that the authors would be ready to change their conclusions with evolving appreciation of data, which can be a useful attribute.

Given this article, other data and some personal 'adjustments', it appears likely that the final CFR value will be going down from here. i don't want to sound like the commander-in- chief but the virus is bright in a way and somehow preferentially finds its way to susceptible individuals with the potential risk to overestimate CFR in the early stages.

 

@minten

No problem for the calculation issue. One should always check the initial source for quality before commenting, so the responsibility is on me. BTW, it's not clear what the true results are and we'll know more as we go along.

https://www.dutchnews.nl/news/2020/04/half-a-million-people-may-have-developed-coronavirus-antibodies-rivm/

Netherlands has an excellent reputation (well deserved IMO) for various health policy management initiatives.

https://www.rivm.nl/en

[LC]

"However, after further adjusting for demography and under-ascertainment..."

 

what does this mean?  oh, that the so-called scientists fudged their data to get the results they wanted, is what this means.  garbage in, garbage out.  good enough for Dalal though.

 

It means that COVID attempts to infect all age groups, not just one particular demographic group.

 

Obviously different groups are more or less susceptible to infection, but the virus is not specifically targeting one group vs. another.

[Jurgis]

I'm trying to ask this uncontroversially mostly medical professionals here: assuming a gradual relaxation of the lockdown with no vaccine, no treatment, and no (or minimal) testing/tracking. Would you say going out is acceptable or too risky? Let's assume a medium-high risk state like MA. Let's assume not super vulnerable person.

If we want to talk concrete "going out" categories, let's say going to parks, general shopping, meeting friends/family, going to office/work, going to a restaurant (I tried to order this from least risk to most risk).

Outcome of "severe" infection sounds very scary. That has to be balanced with infection risks though.

I know this is a bit theoretical and uncertain, but since there's a talk of "relaxation" even in NY state, maybe this could be useful.

I could open a new topic... but probably not worth it.

Thanks

Complement to Cobafdek, in the middle of the (tribal) fight.

Your question is difficult to answer (it feels like: What's the risk of shorting Tesla stock?) and it includes the evaluation of tail risk.

Since my background has some relevance and since i need to address this question now, here's a tentative answer.

 

It seems that the opening will be gradual and the rate of opening will be inversely proportional to virus resurgence. So you'll need to adjust your risk management for your area and with the evolving picture. I work with a scenario of localized and limited resurgence activity during the opening with no second or third wave although this could become low-grade seasonal. I'd say testing will be useful for certain areas of concern but it's hard to see how testing at large will be useful for local decisions. I would also add that herd immunity is not a black or white concept. Relative herd immunity may be much lower than the often 60-70% quoted.

 

1st risk: risk that you become a spreader without being sick

This is a population-level risk but also an individual risk as you may bring the disease to loved ones who may be susceptible (known risk factors or even rarely idiosyncratic).

Then, your cumulative (i share DocSnowball's realism about molecules and timeline) individual risk is likely lowish (and will evolve over a fairly long time), especially if you take basic precautions (basic distance, washing hands, and avoiding social contacts with older (or frail) friends or family members). The concept of position sizing (extent of your social participation along the activity risk spectrum you describe) could be applied as a degree of conviction that your area is safe (from publicly announced statistics, hospital activity level etc).

 

2nd risk: risk that you become significantly sick

Apart from idiosyncratic risk, which is very low, your risk will be proportional to risk factors (age, lung disease, obesity, diabetes etc) with individual risk factors being likely more than additive and serious event risk going up exponentially with the overall level of frailty. Assuming not super vulnerable means no major risk factors, it seems that your risk of becoming significantly sick is very low (do your own work  :) ).

 

What you do as an individual is also tied to your risk personality. If you used to go for the flu vaccine every year versus not even worrying about becoming sick will have an influence on future behavior vs CV. It's possible CV becomes old news very rapidly especially if other events take eyeballs off the bug (and its consequences).

 

@Jurgis: personally I wait for one incubation period to start to trust the data - cases in your state have gone down and stayed down for 14 days; and for two incubation periods for giving the all clear - cases are in single digits or zero in your state for 28 days. Try to phase your return back towards activities in that way. The most essential activities come first, and the lowest risk will be where you're not within 3-6 feet of others and are outdoors. The highest risk will be going to healthcare facilities and crowded indoor gatherings. One thing I've learned is this virus is 2 SD beyond what I've expected of it in spreading, so better to be safe than sorry. The fact that it spreads so easily in healthcare facilities (10k healthcare workers infected in the US!!! cities with public transport really hit hard) tells me there is effective transmission beyond droplets, perhaps it lives well on surfaces + asymptomatic/presymptomatic people spread it early on...(you fill in your thoughts)

 

Maybe a smart idea to build a checklist of do's and don't to follow before, during and after going out and test-drive/refine it when you start going out. I'll try to get it started.

 

Is this activity essential?

What is the risk in this activity? How can it be substituted or minimized?

Hand sanitizer - check. Wipes - check. Mask - check.

Keeping social distance, minimizing touches, minimizing time spent/risk incurred in the activity

Sanitize when done, dispose mask and take footwear off safely on return

Hand washing when home

Dispose clothes for washing later, hand washing again

 

These are good suggestions. Thanks.

[Liberty]

It's starting to happen, finally:

 

 

You MUST wear a face covering or mask:

 

-On public transportation

-In for-hire vehicles

 

If you are a bus/train operator or a driver of a for-hire vehicle, you must also wear a face covering or mask.

 

These rules go into effect on Friday at 8PM.

[rb]

 

In my 53 years of seeing dumb things, defunding the WHO in the middle of a global pandemic is the winner.

 

I now support Donald Trump's decision to defund the WHO.

 

https://www.cnbc.com/2020/04/15/drinking-alcohol-can-make-the-coronavirus-worse-the-who-says-in-recommending-restricting-access.html?__source=twitter%7Cmain

 

[Investor20]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).

 

Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths.  3% of 17 million is 500K.  So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.

 

So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard.  On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).

This is interesting. Netherlands used policies more or less intermediate compared to places like Austria on one side and Italy on the other with, as expected, more or less intermediate results. Netherlands has also produced interesting work on influenza vaccine effectiveness and is a good relative European student in terms of historical flu vaccinate rates.

It looks like (picture developing) that the CV does behave (intrinsic features) similarly to the influenza virus, with the main difference being that the population tends to have a much lower natural immunity to it and there is no vaccine, not even a partially effective one. Reasonable extrapolation of data in the Netherlands suggests that the eventual death rate from CV (with some social distancing and other basic measures) will look like (compare to a reasonable degree) the typical death rate for influenza, had there been a 0% rate of vaccination.

What society is doing is basically trying to adapt (with various levels of 'success') to this new and evolving reality.

 

@LC

Thank you for supplying the link for the European monitoring of mortality with seasonal variations.

 

Apologies. To my own embarassment upon re-reading this I made a primary school calculation error here (my only defence: it was early).  3100 out of 500 000 obviously isn't 0.06%, but 0.6%, which makes quite a bit of difference here, Still not quite the 3% some are saying, but definitely not flu percentages either.

 

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7

 

See Table 1. Estimated CFR 1.38%, >10x deadlier than the Flu. The best CFR from published studies is in the vicinity of 1% which is 10x deadlier than Flu.

 

The 3% antibodies is not good news for feasibility of herd immunity as you note. British government backed off of that strategy quickly...

 

"However, after further adjusting for demography and under-ascertainment..."

 

what does this mean?  oh, that the so-called scientists fudged their data to get the results they wanted, is what this means.  garbage in, garbage out.  good enough for Dalal though.

 

Dalal, first of all from Lancet study the number to be used is

 

" Our estimated overall infection fatality ratio for China was 0·66% (0·39–1·33), with an increasing profile with age."

 

Their case fatality ratio is 1.38 & Infection fatality ratio is 0.66 indicates they are assuming 1.38/0.66 =2 infected for each case that came to testing level.

 

However all the four studies now published in last two days (NYC pregnant women, Boston homeless, China asymptomatic study and Netherlands blood donors) indicates that it is more than 1 asymptomatic for each symptomatic.  The 1.38 case fatality ratio has to be adjusted for the new asymptomatic vs symptomatic ratio.

[patience_and_focus]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).

 

Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths.  3% of 17 million is 500K.  So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.

 

So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard.  On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).

This is interesting. Netherlands used policies more or less intermediate compared to places like Austria on one side and Italy on the other with, as expected, more or less intermediate results. Netherlands has also produced interesting work on influenza vaccine effectiveness and is a good relative European student in terms of historical flu vaccinate rates.

It looks like (picture developing) that the CV does behave (intrinsic features) similarly to the influenza virus, with the main difference being that the population tends to have a much lower natural immunity to it and there is no vaccine, not even a partially effective one. Reasonable extrapolation of data in the Netherlands suggests that the eventual death rate from CV (with some social distancing and other basic measures) will look like (compare to a reasonable degree) the typical death rate for influenza, had there been a 0% rate of vaccination.

What society is doing is basically trying to adapt (with various levels of 'success') to this new and evolving reality.

 

@LC

Thank you for supplying the link for the European monitoring of mortality with seasonal variations.

 

Apologies. To my own embarassment upon re-reading this I made a primary school calculation error here (my only defence: it was early).  3100 out of 500 000 obviously isn't 0.06%, but 0.6%, which makes quite a bit of difference here, Still not quite the 3% some are saying, but definitely not flu percentages either.

 

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7

 

See Table 1. Estimated CFR 1.38%, >10x deadlier than the Flu. The best CFR from published studies is in the vicinity of 1% which is 10x deadlier than Flu.

 

The 3% antibodies is not good news for feasibility of herd immunity as you note. British government backed off of that strategy quickly...

 

"However, after further adjusting for demography and under-ascertainment..."

 

what does this mean?  oh, that the so-called scientists fudged their data to get the results they wanted, is what this means.  garbage in, garbage out.  good enough for Dalal though.

 

Dalal, first of all from Lancet study the number to be used is

 

" Our estimated overall infection fatality ratio for China was 0·66% (0·39–1·33), with an increasing profile with age."

 

Their case fatality ratio is 1.38 & Infection fatality ratio is 0.66 indicates they are assuming 1.38/0.66 =2 infected for each case that came to testing level.

 

However all the four studies now published in last two days (NYC pregnant women, Boston homeless, China asymptomatic study and Netherlands blood donors) indicates that it is more than 1 asymptomatic for each symptomatic.  The 1.38 case fatality ratio has to be adjusted for the new asymptomatic vs symptomatic ratio.

 

That is fine. But seems like comparing this to flu numbers to confirm pre-existing biases is quite prevalent. So in order to keep comparisons apples to apples we should be adjusting flu numbers as well for the asymptomatic vs symptomatic ratio. The reported flu numbers do not do that. This will reduce corresponding flu numbers significantly. See below

 

UK flu study: Many are infected, few are sick

https://www.cidrap.umn.edu/news-perspective/2014/03/uk-flu-study-many-are-infected-few-are-sick

 

Original study in the Lancet:

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70034-7/fulltext

 

[RichardGibbons]

Country      Deaths/1M population    Tests/1M population

Spain                  402                          13,908

Italy                    358                          18,481

France                263                            5,114

UK                      190                            5,876

Switzerland        143                          22,993

USA                      86                            9,845     

Germany              45                          20,629

S.Korea                  9                          10,509

Japan                    1                                745

Taiwan                    0.3                          2,129

 

 

Still no trend.  Taiwan doesnt follow.  Taiwan has one of the lowest testing rates and lowest death rates. 

Next is Japan with lowest testing rates in list above and deaths only above Taiwan.

Richard, please do check my data on Worldometer.

 

It is very difficult to rely on testing when vast majority of infected have no symptoms. 

You have to test most of 340 million in US. Thats not an easy job.

The highest in the list above is Switzerland which tested 2.3% of its population.

 

So, that's the testing half of the numbers. What about the tracing part? Is there some way to quantify the tracing?  I've been thinking about it, and have found nothing but anecdotes.

 

One of the challenges is that effectively it's a system with feedback.  Like, if you do good tracing, then the virus doesn't spread, which means that there are fewer "high risk" people to test, which means your per capita test rate can be low.

 

This is an interesting discussion, because pretty well everyone accepts after the first explosion of cases, South Korea got the pandemic under control with test and track.  So it would be interesting to have something quantitative that supports or contradicts the "track" part of the thesis.

 

I guess one of the other things to keep in mind--which is obvious but tends to be ignored because people are too busy creating things like the 10 Commandments--is that multiple different strategies might work. Like, maybe "masks + handwashing + a culture that does these things when told to" is as effective at stopping the virus as "test + track + lock up people who were exposed".

[cwericb]

Here are some interesting statistics:

 

The US has had 654,000 cases less 56,000 recovered. So about 600,000 active cases

 

Canada has 29,000 cases less 9000 recovered. So about 20,000 active cases

 

Deaths show the same ratio.

 

So the US has 30 times the active cases and deaths that Canada has but (roughly) only 10 times the population.

 

It would seem Canada has - so far - handled the situation considerably better.

 

Three weeks ago Trump wanted troops on the Canada US border.

 

Only Mr. Trump knew why.

 

Now Trump wants to open the border. But Canada is not ready for this yet which puts Trudeau in an awkward position as he doesn't want to piss off Trump any more than necessary and he has already done this when Trump unsuccessfully tried to hijack Canada's masks.

 

I am guessing that individual provinces will declare or extend States of Emergency which I believe gives them power to control provincial borders. This takes the authority away from Trudeau so he does not have to make a decision that would irritate Trump.

 

It is somewhat similar to the Trump vs states individual authority.

[LC]

But the US has 30 times the active cases and deaths that Canada has but (roughly) only 10 times the population.

 

It would seem Canada has - so far - handled the situation considerably better.

 

There are other factors: population density and volume of international travel being two that come to mind.

 

Realistically my guess is a combination of all these factors.

 

[Dalal.Holdings]

 

That is fine. But seems like comparing this to flu numbers to confirm pre-existing biases is quite prevalent. So in order to keep comparisons apples to apples we should be adjusting flu numbers as well for the asymptomatic vs symptomatic ratio. The reported flu numbers do not do that. This will reduce corresponding flu numbers significantly. See below

 

UK flu study: Many are infected, few are sick

https://www.cidrap.umn.edu/news-perspective/2014/03/uk-flu-study-many-are-infected-few-are-sick

 

Original study in the Lancet:

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70034-7/fulltext

 

Nice job.

[cwericb]

"There are other factors: population density and volume of international travel being two that come to mind.

 

Realistically my guess is a combination of all these factors. "

 

Well Toronto is the same size as Chicago or larger and I would suggest that per capita Canadians travel as much as Americans or more. Plus 90% of Canadians are clustered within 100 miles of the US border.

[dwy000]

But the US has 30 times the active cases and deaths that Canada has but (roughly) only 10 times the population.

 

It would seem Canada has - so far - handled the situation considerably better.

 

There are other factors: population density and volume of international travel being two that come to mind.

 

Realistically my guess is a combination of all these factors.

 

I don't think you can trust the "active" number.  The tracking of recoveries is sketchy at best.  If someone tests positive but they have a very mild case at home they're unlikely to go back into the system as recovered. 

[Spekulatius]

Anyone has an opinion to use an Ozone generator for desinfection? I felt it’s worth a shot and bought a~$100 unit and put it in the garage. My wife leaves her scrub, shoes there and The car doors open and we let this run for half an hour. I do the same coming home.

Likewise we keep everything going in he house ( grocery, mail ) and expose it for 1/2  hour plus risk time.

 

Subjectively the ozone smell is pretty strong and lingers for a couple hours when the unit is done.

 

I have read some Chinese papers that seem indicate that ozone disinfection works well viruses ( small particles = large surface to volume ratio) but nothing definitive.

 

You definitely want to be careful running this in the house because ozone can create respiratory issues, but running in the garage should be ok.

 

Any input welcome. I looked at UV desinfection but determined that what obenan buy noncommercially most likely doesn’t have enough power to do much.

[Peregrine]

Still mind-boggling how off some of these models were.

 

[Liberty]

I've read a few things about proning over the past month.. Seems to be helpful in many cases:

 

https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus.html

 

At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said.

[Dalal.Holdings]

I've read a few things about proning over the past month.. Seems to be helpful in many cases:

 

https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus.html

 

At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said.

 

Most lung tissue is actually in the back (posterior region of thorax). When a patient lies in bed for a long time, these airway sacs (alveoli) collapse (atelactasis) which means they no longer participate in gas exchange. Because these regions are located below in a supine patient, they also get more blood flow due to gravity. So now you have most of your lung that’s getting more blood flow not participating in gas exchange (what’s called V-Q mismatch) and this worsens hypoxia.

 

There are docs who think spending prone time may be worthwhile for non intubated Covid patients as well—covid patients with shortness of breath should consider it...

[Liberty]

I've read a few things about proning over the past month.. Seems to be helpful in many cases:

 

https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus.html

 

At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said.

 

Most lung tissue is actually in the back (posterior region of thorax). When a patient lies in bed for a long time, these airway sacs (alveoli) collapse (atelactasis) which means they no longer participate in gas exchange. Because these regions are located below in a supine patient, they also get more blood flow due to gravity. So now you have most of your lung that’s getting more blood flow not participating in gas exchange (what’s called V-Q mismatch) and this worsens hypoxia.

 

There are docs who think spending prone time may be worthwhile for non intubated Covid patients as well—covid patients with shortness of breath should consider it...

 

A little more here:

 

https://emcrit.org/pulmcrit/proning-nonintubated/

 

https://www.intelligentliving.co/postural-drainage-clear-fluid-lungs/