Coronavirus

[Read the Footnotes]

https://www.wired.com/story/covid-19-cases-were-already-rising-before-the-george-floyd-protests/

[rb]

Here's the guy behind Sweden's CV strategy doing his "...Ummm we fucked up" moment.

 

https://www.bloomberg.com/news/articles/2020-06-03/man-behind-sweden-s-virus-strategy-says-he-got-some-things-wrong?sref=qzusa8bC

[Spekulatius]

 

A fascinating aspect may be that the concept of herd immunity has been mishandled when discussed. It appears that a large part of the population, even if significantly exposed, will not develop the disease or will not be sick if they seroconvert. For that reason, the "true" level of herd immunity may be much lower than the typical 60-70% mentioned at large, if you consider the susceptible subpopulation as the relevant group. There are areas with partial lockdowns where the community spread has been controlled with antibody levels in less than 10% of the population.

 

In terms of likelihood, a second (or more) wave is likely but the genetic drift of the virus is unlikely to be detrimental (but the risk is not zero). This will make it difficult to obtain an effective vaccine and preparation of the host (medical and economic) for the future makes sense.

 

From the healthcare standpoint, the virus and associated measures have resulted in a huge (and still mostly unrecognized) cost: delayed and or forgone care (stroke, heart disease, cancer screening and treatments, vaccination etc). Alcohol and cigarette tax increased in proportion to the federal response and history shows that some trends are hard to reverse. The cynic in me says that the 30-50% of US care that is waste or detrimental will not be missed but, in reality, the net loss to health has been very significant.

 

From an economic standpoint, many poor and uncoordinated decisions have been taken and a lower level of measures (gross amount) has been linked to higher mortality numbers but, in terms of sunk costs and their significance, a second wave or any source of economic malaise would occur in a period very heavily mortgaged with future liabilities. Maybe the answer lies in partial lock-downs and better management of spread control.

 

If ~10% exposure is enough to cause herd immunity, the how do you explain the extremely high positive test rate (>30%) for antibody  in Chelsea (the hardest hit community in MA)? If 10% exposure were enough, the 30% exposure should have never occurred.

https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

 

I haven’t seen much updates lately on antibody test results. Some other communities have been evaluated in our neck of woods, but the Chelsea study was never repeated. This study was from mid April, so the positive test rate should be even higher now and close to the herd immunity threshold.

 

On many other points you made, especially deferring medical care, I very much agree with you. I while ago for example, I went through a CC transcript from TMDX, a company that works in the field, of improving organ transplants. They pretty much stated that all organ transplants came to a screeching halt in March 2020, which means  that many organs went to waste (got buried) because there was literally chaos and nobody knew how to deal with hospital capacity (mostly reserved for covid) as well as how to ensure that organs weren’t from infected donors (since there wasn’t sufficient testing ). While this is addressed by now (hopefully) it means that many organ transplants didn’t get done and since there is a shortage of donor organs, some will not get transplants don’t just get deferred, they simply will not get done for people that might have otherwise gotten them.

[Investor20]

I wanted to post as separate post as it is a different argument.

 

Remedesivir is very expensive.  HCQ is cheap. 

 

Shouldn't governments and WHO leave Remedesivir where profit can be made to pharmaceutical companies and focus on HCQ which is cheap and no profit can be made?

 

Yes, and that is why the WHO should Continue to perform a study (or at least finish it) even when the odds are long Remdesevir  is not just expensive, but also a drug that needs to be Intravenously in 5 or ten rounds applied, which makes it unlikely a game changer even if it works. HCQ is cheap and even if it is only modestly effective might have a significant value especially for the many poorer countries, which are really the main focus of the WHO anyways.

 

 

Why not add an arm with Zinc in the Solidarity study. I would prefer exactly same dosage regimen as done by NYU grossman study.

 

Many doctors believe in this Zinc addition. I earlier cited a NY doctor and LA doctor. Here is another article, this from India.

 

......

Along with HCQ, zinc is also normally administered to Covid patients. Doctors said, “The virus is inside the cell and zinc cannot get inside the cell for biochemical reasons. HCQ opens the door and lets zinc in. That’s all it does in this context,” said Dr Praveen Kumar, a physician at a private hospital.

 

"The antibiotic azithromycin protects the patient from secondary infections.” Meanwhile, another renowned cardiac surgeon said, “In Karnataka, the drug has cured many. Cardiac arrests have happened due to various other comorbidities and can’t be linked with this drug alone.” Doctors and medical researchers suspect that several drug companies in the US want to push new drugs that almost do the same work as HCQ and are lobbying for its ban. “But the central government being very firm on the usage of this drug, it’s highly unlikely that its usage will be stopped to treat Covid patients,” a senior doctor said.

https://www.newindianexpress.com/cities/bengaluru/2020/may/27/karnataka-doctors-to-continue-hcq-for-treatment-2148433.html

.......

 

When doctors from NY, LA and India saying Zinc helps with HCQ and HCQ and Zinc are very cheap and can be easily provided to a lot of people and HCQ at these doses is already approved for long term use for Lupus, isnt it proper to test that first?

 

Note: Not a medical advise.  These are prescription medicines.  Consult your doctor. For discussion only.

[Spekulatius]

I wanted to post as separate post as it is a different argument.

 

Remedesivir is very expensive.  HCQ is cheap. 

 

Shouldn't governments and WHO leave Remedesivir where profit can be made to pharmaceutical companies and focus on HCQ which is cheap and no profit can be made?

 

Yes, and that is why the WHO should Continue to perform a study (or at least finish it) even when the odds are long Remdesevir  is not just expensive, but also a drug that needs to be Intravenously in 5 or ten rounds applied, which makes it unlikely a game changer even if it works. HCQ is cheap and even if it is only modestly effective might have a significant value especially for the many poorer countries, which are really the main focus of the WHO anyways.

 

 

Why not add an arm with Zinc in the Solidarity study. I would prefer exactly same dosage regimen as done by NYU grossman study.

 

Many doctors believe in this Zinc addition. I earlier cited a NY doctor and LA doctor. Here is another article, this from India.

 

......

Along with HCQ, zinc is also normally administered to Covid patients. Doctors said, “The virus is inside the cell and zinc cannot get inside the cell for biochemical reasons. HCQ opens the door and lets zinc in. That’s all it does in this context,” said Dr Praveen Kumar, a physician at a private hospital.

 

"The antibiotic azithromycin protects the patient from secondary infections.” Meanwhile, another renowned cardiac surgeon said, “In Karnataka, the drug has cured many. Cardiac arrests have happened due to various other comorbidities and can’t be linked with this drug alone.” Doctors and medical researchers suspect that several drug companies in the US want to push new drugs that almost do the same work as HCQ and are lobbying for its ban. “But the central government being very firm on the usage of this drug, it’s highly unlikely that its usage will be stopped to treat Covid patients,” a senior doctor said.

https://www.newindianexpress.com/cities/bengaluru/2020/may/27/karnataka-doctors-to-continue-hcq-for-treatment-2148433.html

.......

 

When doctors from NY, LA and India saying Zinc helps with HCQ and HCQ and Zinc are very cheap and can be easily provided to a lot of people and HCQ at these doses is already approved for long term use for Lupus, isnt it proper to test that first?

 

Note: Not a medical advise.  These are prescription medicines.  Consult your doctor. For discussion only.

 

I take zinc supplements myself. They supposedly help against common cold and may help against COVID-19 as well. There is minimal downside so I don’t see why not.

Taking antibiotics as a prophylactic is generally not a good idea, I think. It increases the chance of Having to deal with antibiotic resistant strains later. I would think it is better to take it as needed generally.

[Cigarbutt]

 

...the concept of herd immunity...There are areas with partial lockdowns where the community spread has been controlled with antibody levels in less than 10% of the population.

...

From the healthcare standpoint, the virus and associated measures have resulted in a huge (and still mostly unrecognized) cost: delayed and or forgone care (stroke, heart disease, cancer screening and treatments, vaccination etc). Alcohol and cigarette tax increased in proportion to the federal response and history shows that some trends are hard to reverse. The cynic in me says that the 30-50% of US care that is waste or detrimental will not be missed but, in reality, the net loss to health has been very significant.

...

If ~10% exposure is enough to cause herd immunity, the how do you explain the extremely high positive test rate (>30%) for antibody  in Chelsea (the hardest hit community in MA)? If 10% exposure were enough, the 30% exposure should have never occurred.

https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

 

I haven’t seen much updates lately on antibody test results. Some other communities have been evaluated in our neck of woods, but the Chelsea study was never repeated. This study was from mid April, so the positive test rate should be even higher now and close to the herd immunity threshold.

 

On many other points you made, especially deferring medical care, I very much agree with you. I while ago for example, I went through a CC transcript from TMDX, a company that works in the field, of improving organ transplants. They pretty much stated that all organ transplants came to a screeching halt in March 2020, which means  that many organs went to waste (got buried) because there was literally chaos and nobody knew how to deal with hospital capacity (mostly reserved for covid) as well as how to ensure that organs weren’t from infected donors (since there wasn’t sufficient testing ). While this is addressed by now (hopefully) it means that many organ transplants didn’t get done and since there is a shortage of donor organs, some will not get transplants don’t just get deferred, they simply will not get done for people that might have otherwise gotten them.

It's been reported that organ transplant activity in the US declined by 85% for some time and is slowly picking up (similar story in Canada, see link if interested). Transplant patients don't tend to make noise in the public sphere but organ transplant activity is resource intensive and rely on a delicate balance as far as supply is concerned. Of note is that some people die while waiting and the typical transplant patient will get a large number of useful and good quality life-years after the procedure (typically "life-changing"). If you think like an actuary reporting to a decision maker, you may want to calculate the equivalent to the typical patient succumbing in nursing homes. Tough question, i know...

https://profedu.blood.ca/en/organs-and-tissues/covid-19-update/national-covid-19-impact-data

 

You're correct in pointing out the flaw when using a 'modified' herd immunity concept. The R0 and herd immunity numbers assume an unhindered transmission across a homogeneous population. With CV, under these assumptions, the effective herd immunity may be equivalent or similar to the theoretical herd immunity. But many factors need to be considered including the impact of social measures (from simple distancing, washing hands etc to strict and extensive lock-downs) and the possibility that seroconversion numbers may not give an appropriate approximation of exposure. The point i was trying to make (in terms of sustainability, resurgence activity with opening, other waves etc) is that a + or - 10% prevalence of antibodies may be another criteria to allow or maintain some kind of partial or limited lock-down. i think Sweden did not necessarily "aim" for full herd immunity but it had to be a considered feature of their plans. It looks like they were surprised by the price to pay (mortality in nursing homes, morbidity and mortality in some immigrant subgroups and hospital resources allocation) per unit of herd immunity acquired. Their plan (outcome of some parameters) looks wrong now in retrospect but their process was based on a lower price-to-pay premise. Some say that it's easier to fail conventionally. It's great to succeed unconventionally but the risk is to look bad. However, they may have helped define a way to go forward if we are early in the game. In May 2003, Toronto (relatively hard hit area, US had 0 mortality from this high case fatality outbreak) declared victory (and many leading officials left the country to lecture others) only to find out later that the spread process was, in fact, not over.

 

Personal anecdote: Today, i went for a bike ride and, on the cycling path, there were two ladies (who had met by chance presumably) who decided to talk together. They decided to keep a safe distance (one on each side of the path) and had to somewhat shout to each other, aerosolizing their droplets on the numerous riders and walkers passing by. Sometimes the challenge is between the design and the application. So, i wonder now if i should take zinc as post-exposure prophylaxis but, for some reason, there is cognitive resistance. :)

 

 

[mattee2264]

Controlling the spread is not the same as herd immunity. I think the argument these scientists are making is that there may now exist some level of immunity in the population that will allow containment of the virus even as we re-open economies and societies. This level of immunity may vary by community due to factors such as demographics, general health of the population, climate, patterns of social behaviour etc.

 

Of course the hard evidence is not really there as mass antibody testing hasn't been done and the tests have their limitations. But compliance with lockdowns has been far from perfect and even those following the rules have still had some exposure to the virus as a lot of interpretations of lockdown still allow people to leave their houses so I think the theory that quite a lot of people have already had exposure/developed immunity has some merit. Also helping matters is the biggest rule breakers tend to be healthy young people who are among the least vulnerable and therefore best suited to a de facto partial herd immunity type approach. They are also probably the least likely to volunteer for antibody tests which might lead to some sampling error in the test data.

 

There has been an increase in cases/deaths in some of the countries as they have eased lockdowns. But this is to be expected in the same way that there are going to be more car accidents now that more people are taking to the roads. So long as the case rates/death rates stabilize at a low level and then resume a natural decline rate then re-openings can still be considered to be successful. That is still compatible with containment.

[Cigarbutt]

Controlling the spread is not the same as herd immunity. I think the argument these scientists are making is that there may now exist some level of immunity in the population that will allow containment of the virus even as we re-open economies and societies. This level of immunity may vary by community due to factors such as demographics, general health of the population, climate, patterns of social behaviour etc.

Of course the hard evidence is not really there as mass antibody testing hasn't been done and the tests have their limitations. But compliance with lockdowns has been far from perfect and even those following the rules have still had some exposure to the virus as a lot of interpretations of lockdown still allow people to leave their houses so I think the theory that quite a lot of people have already had exposure/developed immunity has some merit. Also helping matters is the biggest rule breakers tend to be healthy young people who are among the least vulnerable and therefore best suited to a de facto partial herd immunity type approach. They are also probably the least likely to volunteer for antibody tests which might lead to some sampling error in the test data.

There has been an increase in cases/deaths in some of the countries as they have eased lockdowns. But this is to be expected in the same way that there are going to be more car accidents now that more people are taking to the roads. So long as the case rates/death rates stabilize at a low level and then resume a natural decline rate then re-openings can still be considered to be successful. That is still compatible with containment.

In my area, elementary schools (ages 5 to 12) have been re-opened outside of the metropolitan areas (with some social distancing-type rules) for about one month (natural experiment going on) and there have been small and localized outbreaks affecting mostly children and some adults. So far, this appears manageable.

[Spekulatius]

Anyone noticed that trends in a lot of states are ticking up. AL, AR, AZ, CO, CA, TX, FL and others. Some of it can be explained by the number of tests going up, but when number of tests go up and % of positives go up and hospitalization rates, it most likely a real trend. We will see how much of a trend this becomes - I guess it is expected when opening up the economy.

 

The NE states still show downward trends, but of course we haven’t opened much yet.

[mattee2264]

 

https://www.theguardian.com/commentisfree/2020/may/28/coronavirus-infection-rate-too-high-second-wave

 

Beautiful quote from Harvard epidemiology professor Bill Hanage “A fire burns fast at first but the embers take a long time to die down.”

 

I think that is a real risk of re-opening economies too soon. An uptick of cases is to be expected but will probably stabilize at a fairly low level that governments may see as an acceptable trade-off vs the economic cost of lockdown. But that stabilization means that the virus will continue to circulate throughout the population ready to flare up in the winter. Maybe the hot weather and some degree of social distancing and build up of immunity will be enough to kill it off over the summer so this risk does not materialize. But the scary thing is that people and governments could get lulled into a false sense of security in the meantime-socializing more freely, going back to work, taking holidays, losing the masks etc-increasing the likelihood of a second wave.

 

 

 

[Liberty]

NZ:

[Jurgis]

Let's all go to Vegas:

 

[rb]

Let's all go to Vegas:

 

USA! USA! USA!

[Jurgis]

Let's all go to Vegas:

 

USA! USA! USA!

 

Make Covid Great Again!

[Cigarbutt]

Let's all go to Vegas:

USA! USA! USA!

Make Covid Great Again!

i was part of an interactive online session today dealing with risk management and COVID-19 (how to establish protocols, guidelines when the sky falls etc) and there was a relevant part.

One of the participants showed a risk-consequence matrix:

 

                                  low risk          high risk

low consequence              #1                #2

high consequence            #3                #4

 

For many scenarios, CV exposure often ends up in section #3. This is, in a way, similar to driving above the speed limit or investing in an overvalued market. The #3 area often gives rise to controversies in the application of collective measures imposed on individuals. A disconcerting aspect is that individuals seem to go through a two-step process: a) risk perception and b) risk tolerance. How does that work in Las Vegas?

[Spekulatius]

Let's all go to Vegas:

USA! USA! USA!

Make Covid Great Again!

i was part of an interactive online session today dealing with risk management and COVID-19 (how to establish protocols, guidelines when the sky falls etc) and there was a relevant part.

One of the participants showed a risk-consequence matrix:

 

                                  low risk          high risk

low consequence              #1                #2

high consequence            #3                #4

 

For many scenarios, CV exposure often ends up in section #3. This is, in a way, similar to driving above the speed limit or investing in an overvalued market. The #3 area often gives rise to controversies in the application of collective measures imposed on individuals. A disconcerting aspect is that individuals seem to go through a two-step process: a) risk perception and b) risk tolerance. How does that work in Las Vegas?

 

Well, the crowd going to Las Vegas is probably not that strong in risk assessment and statistics to begin with. Same with the protests in a sense, although I think the risking catching the Virus at a protest is lower than at the casino.

Are the buffets open? Might as well go all in.

 

A while ago the major of LV gave an interview. It was something to watch....

 

Edit - I checked for some sort of recent visitor experience and this sounded a whole lot for subdued then the Twitter walkthrough above:

 

I found the lack of staffing quite interesting.

[Spekulatius]

Trump has a point (imo) pointing out the protests On one hand and the resistance to allowing campaign rallies on the other :

https://www.cnbc.com/2020/06/08/trump-to-resume-campaign-rallies-this-month-as-states-loosen-coronavirus-limits.html

 

However, the protesters skewed young and mostly wear masks and the protests were outdoors, while Campaign rallies would be indoors and the audience as well as the headliners (including himself) skew older. Will they wear masks?

 

This will be an interesting experiment.

[Liberty]

https://medium.com/@tomaspueyo/coronavirus-should-we-aim-for-herd-immunity-like-sweden-b1de3348e88b

 

"Coronavirus: Should We Aim for Herd Immunity Like Sweden?

And What Can Countries like the US or Netherlands Learn from It?"

 

By Tomas Pueyo, from "The Hammer and the Dance" and other smart writings about COVID.

[Pauly]

Trump has a point (imo) pointing out the protests On one hand and the resistance to allowing campaign rallies on the other :

https://www.cnbc.com/2020/06/08/trump-to-resume-campaign-rallies-this-month-as-states-loosen-coronavirus-limits.html

 

However, the protesters skewed young and mostly wear masks and the protests were outdoors, while Campaign rallies would be indoors and the audience as well as the headliners (including himself) skew older. Will they wear masks?

 

This will be an interesting experiment.

 

For the mask question I would put my money on 'No'.

 

The best way to encourage these rallies to be safe would be to ask the President if he really wants to kill off a good number of his guaranteed votes.

[Spekulatius]

Anyone noticed that trends in a lot of states are ticking up. AL, AR, AZ, CO, CA, TX, FL and others. Some of it can be explained by the number of tests going up, but when number of tests go up and % of positives go up and hospitalization rates, it most likely a real trend. We will see how much of a trend this becomes - I guess it is expected when opening up the economy.

 

The NE states still show downward trends, but of course we haven’t opened much yet.

 

AZ not looking good at all. While the higher number of positive cases can be explained by higher testing numbers either, the higher % positive definitely points into the wrong direction, as does in the increasing number of hospitalizations. The number of death is still small. TX and a few other states in that neck of woods show similar trends.

[Liberty]

https://www.reuters.com/article/us-health-coronavirus-masks-study-idUSKBN23G37V

[Spekulatius]

Anyone noticed that trends in a lot of states are ticking up. AL, AR, AZ, CO, CA, TX, FL and others. Some of it can be explained by the number of tests going up, but when number of tests go up and % of positives go up and hospitalization rates, it most likely a real trend. We will see how much of a trend this becomes - I guess it is expected when opening up the economy.

 

The NE states still show downward trends, but of course we haven’t opened much yet.

 

AZ not looking good at all. While the higher number of positive cases can be explained by higher testing numbers either, the higher % positive definitely points into the wrong direction, as does in the increasing number of hospitalizations. The number of death is still small. TX and a few other states in that neck of woods show similar trends.

 

That didn’t take long:

https://www.reuters.com/article/us-health-coronavirus-usa-arizona/arizona-calls-for-emergency-plan-as-covid-19-spikes-after-reopening-idUSKBN23H03K

[LongHaul]

Let's all go to Vegas:

 

Covid Roulette!

[LongHaul]

I am in the Houston area where cases are up here and in Texas (see link) and my sense is that:

 

1.  People are taking more risk as the see others they know going out, etc.  (Social proof, overconfidence)

2.  On the plus side a lot of people are wearing masks.

3.  But - Houston is hot and humid - so cases are up even with higher temperatures, more sun and high humidity

 

https://www.houstonchronicle.com/coronavirus/article/covid-interactive-map-houston-texas-us-case-virus-15142609.php

 

I personally think that Covid 19 goes way up in many parts of the US - especially when it cools down. 

 

The secondary effect of people going out and taking more chances is that many more people could get Covid-19 and it is not a zero chance

that it gets so bad the hospital beds become full. When people see that on the news then they will get REALLY scared again. 

That would really tank the economy again.  Hard to predict though.

 

The more confident people are the more dangerous the virus danger is. 

 

 

 

 

 

[Spekulatius]

I am in the Houston area where cases are up here and in Texas (see link) and my sense is that:

 

1.  People are taking more risk as the see others they know going out, etc.  (Social proof, overconfidence)

2.  On the plus side a lot of people are wearing masks.

3.  But - Houston is hot and humid - so cases are up even with higher temperatures, more sun and high humidity

 

https://www.houstonchronicle.com/coronavirus/article/covid-interactive-map-houston-texas-us-case-virus-15142609.php

 

I personally think that Covid 19 goes way up in many parts of the US - especially when it cools down. 

 

The secondary effect of people going out and taking more chances is that many more people could get Covid-19 and it is not a zero chance

that it gets so bad the hospital beds become full. When people see that on the news then they will get REALLY scared again. 

That would really tank the economy again.  Hard to predict though.

 

The more confident people are the more dangerous the virus danger is.

 

I wrote this before, but when people see other people  doing “risky” things, they intuitively think it is safe (social proof food concept). Ironically it is just the opposite - going to an empty restaurant is way less risky than going to a full one for example.

 

I am not sure how much of a cofactor colder weather is. People are mostly indoors and most infections occur indoors as well. it might increase the susceptibility of the respiratory system but then on the other hand, the epidemic has been raging pretty well in warmer climates as well (Italy, Spain, Brazil etc).