Coronavirus

[Gregmal]

Killing people passively is far easier to take than killing them aggressively. People were going to die here, regardless. Which is why everyone was in between a rock and a hard place. Its why many countries delayed, because the choice was not easy. But it seems many took the gutless approach...passively via economic suicide, akin to tossing a living person off a boat without a life raft in the middle of the ocean and driving away while they are still alive, vs, dealing with the repercussions of "you didn't lock down the economy and a bunch of old people died as a result of getting the virus"... we are continuing to see that the elder and at risk will die regardless, but now the economy is hitting hard all people, from infant to elder in its effects.

[Guest cherzeca]

'Up to half' of Europe deaths in care homes, WHO warns

 

https://www.bbc.com/news/live/world-52391597

 

"The state concedes that 3,448 residents of nursing homes or adult-care facilities are known to have died from the coronavirus, or nearly 25 percent of all deaths in New York. More than 2,000 of the total are in the five boroughs, and officials acknowledge that the real numbers are almost certainly higher."

 

https://nypost.com/2020/04/21/cuomo-coronavirus-nursing-home-policy-proves-tragic-goodwin/

 

sitting ducks for a failed public policy

 

[KJP]

Have there been any studies on the virus's ability to spread via HVAC systems in office/multi-family buildings? 

[Liberty]

https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/

 

 

 

 

[Liberty]

 

https://www.thenewatlantis.com/publications/not-like-the-flu-not-like-car-crashes-not-like

[Liberty]

Bill Gates memo:

 

https://www.seattletimes.com/nation-world/it-is-impossible-to-overstate-the-pain-fight-against-coronavirus-will-define-our-era-bill-gates-says/

 

“This is like a world war, except in this case, we’re all on the same side,” he writes. [...]

 

In the coming months, the drop-off in new infections will be precipitous in places where social distancing has slashed the rate of transmission, he says.

 

“A lot of people will be stunned that in many places we will go from hospitals being overloaded in April to having lots of empty beds in July,” Gates writes. “The whiplash will be confusing, but it is inevitable from the exponential nature of infection.”

[minten]

A humanitarian reason for opening up the economies around the world:

 

"Coronavirus pandemic will cause global famines of 'biblical proportions,' UN warns"\

 

"While dealing with a Covid-19 pandemic, we are also on the brink of a hunger pandemic," David Beasley told the UN's security council. "There is also a real danger that more people could potentially die from the economic impact of Covid-19 than from the virus itself."

 

https://www.cnn.com/2020/04/22/africa/coronavirus-famine-un-warning-intl/index.html

 

Yes, it is from CNN, not Fox.

 

We all know we won't care because it won't be us. It's a point i've been trying to make since the start.

[minten]

Preliminary NY sttudy says 21.2% of NYC has antibodies.

[Cigarbutt]

Have there been any studies on the virus's ability to spread via HVAC systems in office/multi-family buildings?

This is no time for definitive answers and there is potential airborne transmission over long distances. The critical variables are virus load, proximity and one's susceptibility. Unlike other infections (example: Legionella bacteria, Legionnaires' disease) which thrives in ventilation systems and transmits this way), CV does not appear to transmit through ventilation systems.

But do you own work. References below. Don't hesitate to ask more questions even if answers cannot be provided. :)

https://www.nature.com/articles/d41586-020-00974-w

https://msystems.asm.org/content/msys/5/2/e00245-20.full.pdf

Personal note: spending time on this will invariably cause you to focus on your environment and to the realization that microbes are terribly ubiquitous.

Killing people passively is far easier to take than killing them aggressively. People were going to die here, regardless. Which is why everyone was in between a rock and a hard place. Its why many countries delayed, because the choice was not easy. But it seems many took the gutless approach...passively via economic suicide, akin to tossing a living person off a boat without a life raft in the middle of the ocean and driving away while they are still alive, vs, dealing with the repercussions of "you didn't lock down the economy and a bunch of old people died as a result of getting the virus"... we are continuing to see that the elder and at risk will die regardless, but now the economy is hitting hard all people, from infant to elder in its effects.

Why do you limit your choices to only two extreme outcomes? Isn't it possible to get the boat going while simultaneously devising rescue units. As a society, we take these decisions all the time. What's different here is the suddenness, uncertainty and complexity of the issue but aren't there a lot of intelligent people on this boat?

In general, i think a high value belongs to individualism and would normally rather live in the US versus Singapore but wonder if the balance may require temporary adjustments to deal with abnormal transitions. Take a look (if short on time 10:16 to 10:26):

"Therefore, it is critical that we go into this eyes open,with strong leadership and good government, united and determined, to see this through."

[Guest Schwab711]

Gottlieb said 10x - 20x undercounting

https://seekingalpha.com/news/3562760-coronavirus-cases-10x-20x-higher-reported-former-fda-commish

 

In 2009, undercounting was found to be 17x.

 

 

Cuomo says 14% of NYC residents have had COVID

https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html

 

 

Given the ~140k NYC confirmed cases, this again supports 10x - 20x undercounting.

 

 

A lot of data supports closer to 20x (or potentially a little above it) in places with less testing and closer to 10x in NYC (which seems like where it is right now). That helps a lot to hone in on what we are dealing with!

 

 

The obvious question is true hospitalization rate/CFR:

https://www1.nyc.gov/site/doh/covid/covid-19-data.page

 

This implies a hospitalization rate of 1.2% - 2.5%

CFR of 0.5% - 1.0% (probably closer to middle or bottom of the range here since we have estimates of uncounted deaths not confirmed - there's some overcounting and early deaths are unlikely to fully offset any overcounting given the more accurate estimate of unconfirmed COVID deaths in NYC [versus other areas]).

 

 

This fits with what data looked like early. 0.5% - 1.0% CFR and highly contagious. If anyone has hospitalization/CFR by age bracket in NYC, please post! I'm not sure using the national age brackets makes sense yet. That's too much extrapolation imo, but a 15x - 20x scalar will probably give a reasonable range.

[Liberty]

"BREAKING: Gilead's drug Remdesivir has "flopped" in its first trial, according to the Financial Times"

[orthopa]

Let me repost my 5 things that people don't understand.

[*]Exponential growth

[*]It takes weeks between infection and hospitalization and death

[*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources

[*]If you're in the ICU with this, you are likely in there for weeks

[*]That without ventilators, the death rate increases dramatically

 

Maybe #5 not true

 

 

Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died.

https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily

 

Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women.

 

What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate.

 

Actually, this mortality rate is an indication that the health care system in NYC was overloaded. A lot of patients admitted to hospitals went straight on the respirator. They probably had already organ damage from oxygen deficiency at that point. Earlier admission with oxygen supplementation (which is what Boris Johnson got) might saved many. The high mortality rate in NYC also indicates such.

 

Overloaded based on what metric? Beds needed were over estimated by 6x, ventilators x 10 times, etc.

 

 

 

 

[clutch]

Hindsight is 20-20, but my thoughts on what as happened:

 

- Experts were looking at what was happening in Italy and updated their model parameters with the metrics from Italy (e.g., lethality)  for the "worst-case" scenario.

- Experts advised the governments to prepare the hospitals and resources according to the worst-case scenario.

- It turns out, while COVID-19 is highly contagious (due to its ability to spread via asymptomatic people), the number of fatal cases was not as high as expected. Health care systems in many places were rarely under a strain.

- Meanwhile, the obvious fact that COVID-19's lethality rate was disproportionately higher among older people was largely overlooked. Most governments did not take enough preemptive measures to protect those in long-term care homes (and sometimes counter-productive actions as in NY). In Europe and Canada, half of the number of COVID-19's death have come from long-term care facilities.

[Cigarbutt]

...

This fits with what data looked like early. 0.5% - 1.0% CFR and highly contagious. If anyone has hospitalization/CFR by age bracket in NYC, please post! I'm not sure using the national age brackets makes sense yet. That's too much extrapolation imo, but a 15x - 20x scalar will probably give a reasonable range.

i'm not sure what you're looking for exactly and cannot guarantee the validity of data (and there is a small date discrepancy) but it is possible to derive a range of outcomes for CFR which is in the same ballpark. In NYC, about 10 to 15% of people admitted go to ICU and about 20% of people who get admitted don't leave through the front door.

https://www.statista.com/statistics/1109831/coronavirus-cases-rates-by-age-new-york-city/

https://www.statista.com/statistics/1109867/coronavirus-death-rates-by-age-new-york-city/

[KJP]

https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/

 

 

Thanks for the link.  I read the Quillette article and the journal article from which the diagram was pulled.  I understand the theory about how the AC could have pushed droplets from Table A to Table B.  But I don't understand how Table C was infected by Table A, given that Table C was upstream from Table A with respect to the airflow from the AC unit.  The other diagram in the journal article shows an exhaust fan adjacent to Table B and a dashed line running in the opposite direction of the airflow from the air conditioner.  Are they saying that the exhaust fan recirculated contaminated droplets back into the AC system, rather than ventilating them to the outside?

 

[orthopa]

Dont think this was posted before but this does put some trade offs within perspective.

 

Avg length of stay once in a nursing home before death was 5 months.

 

https://www.geripal.org/2010/08/length-of-stay-in-nursing-homes-at-end.html

 

End of life was pulled forward ~5 months for the vast majority of COVID19 deaths it seems. The economic vs life cost discussion can get ugly but.....

 

 

[KJP]

Have there been any studies on the virus's ability to spread via HVAC systems in office/multi-family buildings?

This is no time for definitive answers and there is potential airborne transmission over long distances. The critical variables are virus load, proximity and one's susceptibility. Unlike other infections (example: Legionella bacteria, Legionnaires' disease) which thrives in ventilation systems and transmits this way), CV does not appear to transmit through ventilation systems.

But do you own work. References below. Don't hesitate to ask more questions even if answers cannot be provided. :)

https://www.nature.com/articles/d41586-020-00974-w

https://msystems.asm.org/content/msys/5/2/e00245-20.full.pdf

Personal note: spending time on this will invariably cause you to focus on your environment and to the realization that microbes are terribly ubiquitous.

 

 

Thanks for the links.

[orthopa]

https://www.nytimes.com/2020/04/23/us/coronavirus-early-outbreaks-cities.html

 

"Hidden outbreaks were also spreading almost completely undetected in Boston, San Francisco, Chicago and Seattle, long before testing showed that each city had a major problem, according to a model of the spread of the disease by researchers at Northeastern University who shared their results with The New York Times.

 

Even in early February — while the world focused on China — the virus was not only likely to be spreading in multiple American cities, but also seeding blooms of infection elsewhere in the United States, the researchers found."

 

"Unseen carriers of the disease, many of them with mild symptoms or none at all, can still spread the virus. For that reason, by the time leaders in many cities and states took action, it was already too late to slow the initial spread."

 

"The virus moved under the radar swiftly in February and March, doctors and researchers said, because few cities or states had adequate surveillance systems in place. And testing, if it was being done at all, was haphazard. Emergency rooms were busy preparing for the predicted onslaught and likely missed some of early virus-related deaths, and didn’t have time or tools to verify infections on the fly, experts said."

 

"In New York, for example, the model shows that the first 10 infected people could have been walking the streets of the city as early as the last week in January, or as late as the middle of February. From there, the infections in the centers of the outbreak grew exponentially."

 

 

I am biased but this does fit the spread for weeks/months theory I purposed back in the middle of March. No? The virus very well could have been spreading exponentially (I know you guys like that word) for 6 weeks by the middle of March all across the county. That meshes with the antibody testing from Cuomo today too.

 

As noted above back in early March I contributed to you guys that we were seeing a lot of negative flus in Feb/March in our urgent care network(which spans NY). Nice to see what we were seeing was very likely Covid as suspected and that our flu swabs were not defective etc. Testing would have helped but tx was all the same. Go home and self quarantine.

 

My bolded emphasis above was my rational for not running around testing everyone based on what we were seeing in the clinic/ER. It was too late, sad but true. It will serve more utility going back and hopefully some reasonable method goes into effect to track and trace.

 

My original hope/thought was that we were way further up the curve then we thought back in the middle of March. Im glad for everyones /USAs sake evidence continues to come out that this is the case.

 

I also thinks this makes for an interesting exercise why we didnt see massive healthcare overload across the country esp California at any time in March/April and why NYC, Italy, Spain were the exceptions.

 

The Gov of California is also going back to Dec to test the deceased for antibodies. This is smart IMO and may lead some credence to the discussion cubsfan/Liberty were having about the "bad flu season" California had.

 

Very interesting all of this.

 

[StubbleJumper]

https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/

 

 

Thanks for the link.  I read the Quillette article and the journal article from which the diagram was pulled.  I understand the theory about how the AC could have pushed droplets from Table A to Table B.  But I don't understand how Table C was infected by Table A, given that Table C was upstream from Table A with respect to the airflow from the AC unit.  The other diagram in the journal article shows an exhaust fan adjacent to Table B and a dashed line running in the opposite direction of the airflow from the air conditioner.  Are they saying that the exhaust fan recirculated contaminated droplets back into the AC system, rather than ventilating them to the outside?

 

 

I don't particularly buy the notion that most of the spread to the other tables was from breathing.  Usually when you go to a meeting, party, banquet or whatever in a hotel conference room consisting of 6 or 8 round tables of 8 people each, you introduce yourself and shake hands with the people at your table before having supper.  And then, if you know another 5 or 6 people from different tables at the same event, you'll probably end up shaking hands with them and exchanging a few words.  It's possible that it was the breathing that affected the people immediately beside A1, but it's also quite likely that the shaking of hands transmitted virus to some of the people in that room.

 

The author also made reference to the super-spreader event that occurred at the medical practioners' curling bonspiel in Alberta, and suggested that it could be curlers breathing heavily while sweeping rocks that caused the virus to spread.  I don't much buy that because when you sweep, you normally only have a couple of different sweeping partners.  However, everybody who has curled knows that you always shake hands before the game to wish each of your four opponents a good game, and then when it's over you once again shake hands with each of your four opponents and thank them for having played a good game.  And then all eight of you go to the bar, sit at one of those round tables for eight people, and the four winning players walk to the bar to buy a pint for the four losing players, and if there's enough time, the four losing players return the favour by buying a pint for the four winning players.  So, did the curlers mostly catch Covid from breathing on each other, or did they mostly catch it from shaking hands and transferring pint glasses?

 

The quillette article was interesting, but I still remain unconvinced about how the virus was transmitted at some of those events.

 

SJ

[Liberty]

https://www.ft.com/content/0a4872d1-4cac-4040-846f-ce32daa09d99

 

A potential antiviral drug for the coronavirus has flopped in its first randomised clinical trial, disappointing scientists and investors who had high hopes for remdesivir, according to draft documents published accidentally by the World Health Organization and seen by the Financial Times.

 

The Chinese trial showed remdesivir — developed by California-based Gilead Sciences — did not improve patients’ condition or reduce the pathogen’s presence in the bloodstream. Researchers studied 237 patients, giving the drug to 158 and comparing their progress with the remaining 79. The drug also showed significant side effects in some, which meant 18 patients were taken off it.

[Liberty]

https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/

 

 

Thanks for the link.  I read the Quillette article and the journal article from which the diagram was pulled.  I understand the theory about how the AC could have pushed droplets from Table A to Table B.  But I don't understand how Table C was infected by Table A, given that Table C was upstream from Table A with respect to the airflow from the AC unit.  The other diagram in the journal article shows an exhaust fan adjacent to Table B and a dashed line running in the opposite direction of the airflow from the air conditioner.  Are they saying that the exhaust fan recirculated contaminated droplets back into the AC system, rather than ventilating them to the outside?

 

Fluid dynamics is complex, air doesn't move in straight lines or predictable patterns, would be my guess.

[Liberty]

 

On the NY serology tests..

[clutch]

 

On the NY serology tests..

 

Great. This is how scientific experts should be critiquing each other. At least this testing method was transparent, but how come prediction models are never shared with the public so that others could review and critique them?

[RichardGibbons]

I am biased but this does fit the spread for weeks/months theory I purposed back in the middle of March. No? The virus very well could have been spreading exponentially (I know you guys like that word) for 6 weeks by the middle of March all across the county. That meshes with the antibody testing from Cuomo today too.

 

My original hope/thought was that we were way further up the curve then we thought back in the middle of March. Im glad for everyones /USAs sake evidence continues to come out that this is the case.

 

This is quite a clever way of moving the goalposts.  Nobody was disputing that the virus was spreading in the USA in March--or even in February. The thing everyone disagreed with was that there hundreds of thousands or millions of cases in March.

 

So I guess this is admission you were wrong while trying to rewrite what you said and what the actual disagreement was about?

 

(Like, good grief--why is it so hard for you to say that your speculation was wrong? It was a speculation, and speculations are often wrong. Why the heck would you allow a random speculation to bias you in such a huge way for everything that came afterward, rather than say, "Hey that speculation was wrong, but this is my view on what's happening now"?  So brutal!)

[RichardGibbons]

Bill Gates' State of the Pandemic essay.

 

https://www.gatesnotes.com/Health/Pandemic-Innovation?WT.mc_id=20200423060000_Pandemic-Innovation_BG-EM_&WT.tsrc=BGEM

 

Other than the obvious (the content), there are a couple things  I find interesting. First, the language is simple to the extent that I find it distracting. Maybe it's written at something like a 3rd-4th grade reading level? I think he wants this to be accessible to everyone possible, even those with poor English skills.

 

Second, the reference to opening churches isn't consistent with the rest of the essay, since there's negligible economic value to opening churches, and therefore it's pretty obvious that they should be among the last things open. Rather, I think he threw that in there so that the religious people have a better chance of supporting the approach he proposes.