Coronavirus

[Jurgis]

Spain not looking good..

 

 

I don't know details about Spain, but IMO a bunch of Europe reopened too much with no checks. In particular, there is a lot of vacation travel, which was pushed by vacation destination countries for their economy, but which was IMO foolhardy. Plus there was quite a lot of de-mask-ization and social distancing reduction going on - maybe not in all countries, but in some.

 

IMO even in Massachusetts people have relaxed the attitudes way too much.

 

But hey, I'm probably the only person who still pretty much has not met my friends or traveled anywhere.  ::)

 

 

[KCLarkin]

Sweden remained open throughout this crisis. The most likely explanation is herd immunity.

 

Cases in Sweden plummeted at the end of June. The most likely explanation is school closures and summer vacation.

[Spekulatius]

Spain not looking good..

 

 

I don't know details about Spain, but IMO a bunch of Europe reopened too much with no checks. In particular, there is a lot of vacation travel, which was pushed by vacation destination countries for their economy, but which was IMO foolhardy. Plus there was quite a lot of de-mask-ization and social distancing reduction going on - maybe not in all countries, but in some.

 

IMO even in Massachusetts people have relaxed the attitudes way too much.

 

But hey, I'm probably the only person who still pretty much has not met my friends or traveled anywhere.  ::)

 

Yes, the recent outbreak in France, Germany and Spain is certainly travel related.

 

It is understandable that young folks like enjoy night live where it’s warm and close to a beach ( been there , done it) but this just doesn’t work in the current conditions.

 

FWIW, the Spek family has traveled  and will travel again locally in New England. We keep an eye on the local COVID-19 conditions like we do with the weather and will bail out of any restaurant when we don’t like the setting and it seems crowded etc.

 

It is what it is and not what we like it to be.

[Castanza]

Has anyone looked at healthcare worker deaths due to Covid? Best numbers I could find...(if anyone has better sources feel free to share)

 

- 900 Covid-19 related deaths in the US according to (https://www.theguardian.com/us-news/2020/aug/11/covid-19-healthcare-workers-nearly-900-have-died)

- Covid-19 cases among healthcare workers is estimated at 200kish

- 5.54m total US cases

-173k total deaths

 

Comparison with SARS (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371777/)

"According to the World Health Organization, 8,098 cases occurred during the outbreak, and 774 (9.6%) persons died."

- 8k number is total healthcare worker cases.

- 102k total US cases 3.2k total US deaths

 

 

 

[Casey]

Sweden remained open throughout this crisis. The most likely explanation is herd immunity.

 

Cases in Sweden plummeted at the end of June. The most likely explanation is school closures and summer vacation.

 

Yep. Everyone in Sweden does lengthy vacations in summer often with lots of time in the outdoors / at a cabin somewhere. It's not exactly the conditions for spreading a virus.

 

https://www.thelocal.se/20180605/so-why-do-the-swedes-take-such-long-summer-holidays

[Gregmal]

COVID looks rough even if you're young and apparently healthy.. Dave Portnoy:

 

 

Looks like he made a bad trade. Hopefully he will be alright.

 

 

All better! This guy is certainly entertaining.

[cubsfan]

What do the great minds on the board make of this claim:

 

 

Bullshit?  Or Has merit?

[Read the Footnotes]

 

All better!

Not so fast. I'd give it a few days.

 

SARS 2.0 is famous for people going up and down at about this point in the recovery. There are some pretty crazy stories about people claiming that it's a hoax, then getting sicker begging for help, then getting better claiming it's a hoax and they always new it, then getting sicker and packing their hospital go bag begging to get tested, then getting better and they start talking about how it's a hoax again.

 

I hope it will go well for him, but feeling better for a few hours unfortunately means nothing.

[Read the Footnotes]

What do the great minds on the board make of this claim:

 

 

Bullshit?  Or Has merit?

Two addenda (edits)

1. I'm not a fan of trigger warnings, but if you're a hypochondriac, you might not want to read some of my thoughts below.

2. Cubs only gave two choices to choose from, but if I had chosen my own words, I probably would have rated the previous conversation as a) complicated, and b) not the best use of your time, which is more generous and potentially more accurate than simply calling it BS.

 

On to the original unedited post:

 

 

Unfortunately, basically a big pile of BS built upon the back of statements that needed to be incredibly carefully worded about an extremely complex subject in order to prevent misunderstanding by journalists or to open the door to intentionally misleading interpretations. This was from 6-10 weeks ago? There's plenty of contemporaneous analysis of the specifics of this past episode if you want to go looking for it.

 

I'll try a brief, simple and concise description of my own which maybe other can build upon or comment upon. I think it would be more constructive to attempt to provide good information than to argue about bad information.

 

First, it's important to understand that there is a good bit of evidence that there may not actually be such a thing as asymptomatic cases. Cases where the patient does not report symptoms are classified as asymptomatic. That does not mean the patient does not have symptoms.

 

What we actually have is symptoms that are below the level of consciousness of the patient. Many patients who never were conscious of the infection have evidence of the infection including what may be permanent damage to their lungs, so just because they were not aware of the symptoms and did not report symptoms, does not mean the virus was not present, that their immune system was not responding, or that they were not infectious. This may actually be more common among children than adults. There are probably many contributing factors such as the health of the patient, the self-awareness of the patient, the level of positive affect, and the severity of infection, in addition to the specific symptoms generated by the infection. You don't have pain nerve endings in your lungs so its possible to suffer permanent damage their without sensing that, and other signs are likely just being ignored by some of the infected.

 

In some ways it might be more understandable to the general public to call them "subconsciously symptomatic" (my own terminology) cases than asymptomatic cases.

 

On the other hand on average someone who is asymptomatic is less likely to be infectious because their viral load is likely not that high even though it may be doing damage to them subconsciously and unless they are incredibly clueless, they probably aren't coughing and sneezing a lot. The problem is that since these people are kind of clueless, they are more likely to be highly mobile and even though they may not be highly infectious, they can contribute significantly to spread. Someone who is highly symptomatic is much less likely to be going about in crowds and is much more likely to have other people notice their symptoms and avoid them due to their obvious symptoms.

 

Compare that to the most infectious, for example the very sick who are coughing and sneezing (coughs and sneezes spread diseases), and also those who have the virus growing within them but have not yet staged an immune response, or the presymptomatic infectious period. Most people are thought to actually be most infectious several days after inoculation and before the combination of the viral load and the immune response are great enough to generate self-reported symptoms in most patients. So the presymptomatic period is the most infectious period of most cases, whether the symptoms are ultimately consciously noted by the patient or not.

 

Unfortunately, the only ways to prevent the presymptomatic and "subconsciously symptomatic" spread of SARS 2.0, you need to good testing and contact tracing (which the USA and some other areas are incapable of at the moment) or you can use face masks, social distancing, etc. Yes, it sucks. We got lucky with the virus in some ways, but this part really sucks. That last part was highly technical, but hopefully you can follow that.  ;)

 

Unfortunately, that's about as brief as I think you can be on this subject. If anything is not completely up to date or goes astray in this attempted summary, then please feel free to add to the discussion.

[DocSnowball]

https://www.cidrap.umn.edu/news-perspective/2020/08/covid-19-cases-climb-higher-european-countries

1700 in Germany

3715 in Spain

 

And the most depressing map of the week award goes to this one from Dr. Anthony Fauci...

https://gizmodo.com/look-at-this-horrible-horrible-map-1844780399

 

 

[Cigarbutt]

What do the great googlers on the board make of this claim:    (modified to reflect the quality of this post)

Bullshit?  Or Has merit?

Post delivered in 3 parts.

Part 1

The Who did rectify the information after (it was some kind of misunderstanding). The simple answer is that 'we' don't really know the extent of asymptomatic transmission at this point. It appears that 20% of spreaders may be responsible for 80% of the cases and asymptomatic is probably less than symptomatic transmission. In the meantime, you have to deal with incomplete information unless you possess magical thinking abilities.

https://globalnews.ca/news/7043306/coronavirus-asymptomatic-spread-who/

Part 2

If you want to go fundamental, i would read the following. TL;DR: It appears that asymptomatic carriers develop similar viral loads and so, in theory and potentially, could spread the virus but asymptomatic people, by definition, don't sneeze or cough. But they can sing, yell, shake hands, ride the subway etc. If interested, in my area, asymptomatic (or minimally symptomatic) transmission was likely a significant killer of older and institutionalized people.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769235

Part 3

It seems to me the best way to deal with those questions (bullshit or Nobel Prize idea) is to do a fundamental analysis first and then to look at the sources (the driving force). i couldn't resist doing some limited digging. It looks like the interviewee is a prostate specialist spreading some controversial theories whose main claim (shame) to fame has been an unusual ability in creative billing. Not that it's relevant to you, at some point in my life, in order to self-regulate and to efficiently but fairly maximize profit potential, i was responsible, within my organization to periodically team up with the main payer with the goal to identify aberrant payments. The payer had great AI-type tools but a very rewarding area to look at involved the "high flyers" (it looks like your referenced urologist was one of those). In that group, one would find extremely hard-working or very well organized and productive individuals. But investigations sometimes revealed individuals billing in a way that could not be reconciled with human abilities (ie doing procedures simultaneously in various locations etc; it looks like your referenced urologist may have been one of those). i always wonder about opinions formulated by super-humans, they simply know too much.

Edit:

@Castanza: i suspect i finally made it to your ignore list which is fine. Just in case though, if you formulate a more precise question about frontline healthcare workers' exposure, i may potentially be of limited help.

[Castanza]

What do the great googlers on the board make of this claim:    (modified to reflect the quality of this post)

Bullshit?  Or Has merit?

Post delivered in 3 parts.

Part 1

The Who did rectify the information after (it was some kind of misunderstanding). The simple answer is that 'we' don't really know the extent of asymptomatic transmission at this point. It appears that 20% of spreaders may be responsible for 80% of the cases and asymptomatic is probably less than symptomatic transmission. In the meantime, you have to deal with incomplete information unless you possess magical thinking abilities.

https://globalnews.ca/news/7043306/coronavirus-asymptomatic-spread-who/

Part 2

If you want to go fundamental, i would read the following. TL;DR: It appears that asymptomatic carriers develop similar viral loads and so, in theory and potentially, could spread the virus but asymptomatic people, by definition, don't sneeze or cough. But they can sing, yell, shake hands, ride the subway etc. If interested, in my area, asymptomatic (or minimally symptomatic) transmission was likely a significant killer of older and institutionalized people.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769235

Part 3

It seems to me the best way to deal with those questions (bullshit or Nobel Prize idea) is to do a fundamental analysis first and then to look at the sources (the driving force). i couldn't resist doing some limited digging. It looks like the interviewee is a prostate specialist spreading some controversial theories whose main claim (shame) to fame has been an unusual ability in creative billing. Not that it's relevant to you, at some point in my life, in order to self-regulate and to efficiently but fairly maximize profit potential, i was responsible, within my organization to periodically team up with the main payer with the goal to identify aberrant payments. The payer had great AI-type tools but a very rewarding area to look at involved the "high flyers" (it looks like your referenced urologist was one of those). In that group, one would find extremely hard-working or very well organized and productive individuals. But investigations sometimes revealed individuals billing in a way that could not be reconciled with human abilities (ie doing procedures simultaneously in various locations etc; it looks like your referenced urologist may have been one of those). i always wonder about opinions formulated by super-humans, they simply know too much.

Edit:

@Castanza: i suspect i finally made it to your ignore list which is fine. Just in case though, if you formulate a more precise question about frontline healthcare workers' exposure, i may potentially be of limited help.

 

What? I don’t put anyone on my ignore list, and I certainly wouldn’t put you on it. I’d say your posts are  always high quality and challenging. I don’t always agree with your opinions but I respect them. This “area” seems to be in your level of competence judging by what little I know of your public health background. I didn’t see a response to the healthcare workers post. Sorry if I missed it.

 

I guess my question would be, shouldn’t we expect more deaths on the front lines if Covid is truly as bad as we are hearing? It’s probably a good mix of age, ethnicity, and underlying conditions to pull data from. Plus we can assume they are almost in constant contact or at a higher level of risk of catching it. Makes more sense to use data from this group than from elderly homes where we know it’s not a good outcome.

 

Just a quick look at the numbers I posted it seems like SARs was 3x as bad as Covid. But we also really have no idea on the total number of infected in the US. 5.5m still seems low with the length of time that’s gone by. I am not an expert on this and make no claim to be. Also not a professional “googler”. I just don’t remember seeing anyone post about healthcare workers.

[Cigarbutt]

Has anyone looked at healthcare worker deaths due to Covid? Best numbers I could find...(if anyone has better sources feel free to share)

- 900 Covid-19 related deaths in the US according to (https://www.theguardian.com/us-news/2020/aug/11/covid-19-healthcare-workers-nearly-900-have-died)

- Covid-19 cases among healthcare workers is estimated at 200kish

- 5.54m total US cases

-173k total deaths

Comparison with SARS (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371777/)

"According to the World Health Organization, 8,098 cases occurred during the outbreak, and 774 (9.6%) persons died."

- 8k number is total healthcare worker cases.

- 102k total US cases 3.2k total US deaths

...

I guess my question would be, shouldn’t we expect more deaths on the front lines if Covid is truly as bad as we are hearing? It’s probably a good mix of age, ethnicity, and underlying conditions to pull data from. Plus we can assume they are almost in constant contact or at a higher level of risk of catching it. Makes more sense to use data from this group than from elderly homes where we know it’s not a good outcome.

Just a quick look at the numbers I posted it seems like SARs was 3x as bad as Covid. But we also really have no idea on the total number of infected in the US. 5.5m still seems low with the length of time that’s gone by. I am not an expert on this and make no claim to be. Also not a professional “googler”. I just don’t remember seeing anyone post about healthcare workers.

Then, let me start with a related challenging question: In the US, if one lets the virus spread and not encourage or adopt appropriate population protection measures, "shouldn’t we expect more deaths" compared to other countries where such measures are applied? Answer: yes, a lot more  :(

Back to your specific question, the short answer AFAIK is 'we' don't know. There have been cases and deaths in healthcare workers having direct contact with patients but testing is said to be high and, at this point, it's hard to be precise. Eyeballing it (and using reference below), it seems that working directly with patients (even with precautions, protocols and equipment) means higher risk to catch the disease. In your country and various jurisdictions, criteria have been relaxed to accept the link between a Covid diagnosis and the job status as a healthcare worker (workers comp) which, it seems to me, is the reasonable thing to do at this point. It seems that mortality profile adjusted for risk factors is similar to the population in general except for the unusual cases early on (people not aware or accepting the risk anyways) and when protective equipment has been insufficient.

i think your wife works in a neonatal ICU so this was not (per se) a high risk area but maybe she heard how people tend to avoid "red" zones in certain hospitals even if they say that it's no big deal when writing posts on the internet.

There is no doubt that the viral loads involved in high-risk and repeated exposures without protection would have resulted in a healthcare workers' hecatomb in high risk areas. The key was the rapid (although disorganized and confused at first) definition of risk stratification and application of protocols (with appropriate level of equipment). Low risk required simple adjustments and high risk required complicated and often cumbersome requirements. Aerosol management has been a key aspect. Here's a video from China (they describe the protocol to put a tube down one's throat) that looks like it's coming from a bad movie but is quite representative of what has happened in various global emergency rooms, operating rooms and ICUs.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30164-X/fulltext

This virus is not equipped with a shotgun. It uses a musket but it's awfully good at replicating and getting close to you (or your threshold), if you let it.

 

 

[DocSnowball]

CDC data on seropositivity rates from 10 cities (taken from lab samples drawn for other reasons, so a more representative sample)

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-lab-surveys.html

 

Connecticut for example shows 4.9% --> 5.2% --> 6.3% in April, May and June specimens. Most under 10% barring NYC.

[StubbleJumper]

Has anyone looked at healthcare worker deaths due to Covid? Best numbers I could find...(if anyone has better sources feel free to share)

- 900 Covid-19 related deaths in the US according to (https://www.theguardian.com/us-news/2020/aug/11/covid-19-healthcare-workers-nearly-900-have-died)

- Covid-19 cases among healthcare workers is estimated at 200kish

- 5.54m total US cases

-173k total deaths

Comparison with SARS (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371777/)

"According to the World Health Organization, 8,098 cases occurred during the outbreak, and 774 (9.6%) persons died."

- 8k number is total healthcare worker cases.

- 102k total US cases 3.2k total US deaths

...

I guess my question would be, shouldn’t we expect more deaths on the front lines if Covid is truly as bad as we are hearing? It’s probably a good mix of age, ethnicity, and underlying conditions to pull data from. Plus we can assume they are almost in constant contact or at a higher level of risk of catching it. Makes more sense to use data from this group than from elderly homes where we know it’s not a good outcome.

Just a quick look at the numbers I posted it seems like SARs was 3x as bad as Covid. But we also really have no idea on the total number of infected in the US. 5.5m still seems low with the length of time that’s gone by. I am not an expert on this and make no claim to be. Also not a professional “googler”. I just don’t remember seeing anyone post about healthcare workers.

Then, let me start with a related challenging question: In the US, if one lets the virus spread and not encourage or adopt appropriate population protection measures, "shouldn’t we expect more deaths" compared to other countries where such measures are applied? Answer: yes, a lot more  :(

Back to your specific question, the short answer AFAIK is 'we' don't know. There have been cases and deaths in healthcare workers having direct contact with patients but testing is said to be high and, at this point, it's hard to be precise. Eyeballing it (and using reference below), it seems that working directly with patients (even with precautions, protocols and equipment) means higher risk to catch the disease. In your country and various jurisdictions, criteria have been relaxed to accept the link between a Covid diagnosis and the job status as a healthcare worker (workers comp) which, it seems to me, is the reasonable thing to do at this point. It seems that mortality profile adjusted for risk factors is similar to the population in general except for the unusual cases early on (people not aware or accepting the risk anyways) and when protective equipment has been insufficient.

i think your wife works in a neonatal ICU so this was not (per se) a high risk area but maybe she heard how people tend to avoid "red" zones in certain hospitals even if they say that it's no big deal when writing posts on the internet.

There is no doubt that the viral loads involved in high-risk and repeated exposures without protection would have resulted in a healthcare workers' hecatomb in high risk areas. The key was the rapid (although disorganized and confused at first) definition of risk stratification and application of protocols (with appropriate level of equipment). Low risk required simple adjustments and high risk required complicated and often cumbersome requirements. Aerosol management has been a key aspect. Here's a video from China (they describe the protocol to put a tube down one's throat) that looks like it's coming from a bad movie but is quite representative of what has happened in various global emergency rooms, operating rooms and ICUs.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30164-X/fulltext

This virus is not equipped with a shotgun. It uses a musket but it's awfully good at replicating and getting close to you (or your threshold), if you let it.

 

 

The data for Ontario health care workers is found in Table 2 of this document: https://www.publichealthontario.ca/-/media/documents/ncov/epi/2020/covid-19-daily-epi-summary-report.pdf?la=en

 

So, 2,600 infections and 8 deaths among health care workers, or an IFR of about 0.3%.  Making all of the normal disclaimers about SSS, the IFR seems pretty consistent with a weighted average IFR for a group of people with ages evenly distributed from, say, age 25 to 60 (ie the likely age range of nursing home employees).

 

 

SJ

[Cigarbutt]

...

The data for Ontario health care workers is found in Table 2 of this document: https://www.publichealthontario.ca/-/media/documents/ncov/epi/2020/covid-19-daily-epi-summary-report.pdf?la=en

So, 2,600 infections and 8 deaths among health care workers, or an IFR of about 0.3%.  Making all of the normal disclaimers about SSS, the IFR seems pretty consistent with a weighted average IFR for a group of people with ages evenly distributed from, say, age 25 to 60 (ie the likely age range of nursing home employees).

SJ

i think i see what you're getting at but i may have some trouble if you mean to imply that the risk is much ado about nothing.

It's been widely recognized (Ontario also) that, due to testing 'strategy' and other various reasons, significant bias can be introduced when analyzing the healthcare worker risk. The main bias risk is the "healthy worker effect". Because testing is typically used proportionally more in frontline workers (mostly for evidence-based reasons and the spreader issue), there is a tendency to report higher absolute numbers of 'detected' cases and to underestimate (vs if that bias were not there, at least temporarily, compared to other population groups) the CFR. When the proportion of testing in the healthcare population vs total population is high, this can introduce bias at the population level CFR also.

Having said that, given the use of PPE and procedure adjustments, it appears that most CV+ cases in the healthcare workers result from acquisition in the community but not all. i guess 'we' will find out more precisely over time. In terms of cost effective measures and keeping the precautionary principle in mind, it's probably a good idea for high risk workers to undress in the garage and take a shower before hugging family members even if community transfer in that setting has not been well documented.

Interestingly, during the SARS episode (SARS didn't kill so softly so it was more obvious), there were clear and direct links between healthcare workers becoming sick and dying and taking care of SARS-infected patients. An interesting lesson from the SARS episode though was that it was possible to bring the risk of the frontline worker to the same level of the general population, given appropriate measures. From a recent report coming out of the great Alberta province: "It is important to note that evidence from 2003 SARS demonstrated that risk to HCWs could be mitigated by diligent hand hygiene and use of personal protective equipment (PPE)". Not everybody 'believed' that then, in the heat of the action. And some still say it was a hoax.

[StubbleJumper]

...

The data for Ontario health care workers is found in Table 2 of this document: https://www.publichealthontario.ca/-/media/documents/ncov/epi/2020/covid-19-daily-epi-summary-report.pdf?la=en

So, 2,600 infections and 8 deaths among health care workers, or an IFR of about 0.3%.  Making all of the normal disclaimers about SSS, the IFR seems pretty consistent with a weighted average IFR for a group of people with ages evenly distributed from, say, age 25 to 60 (ie the likely age range of nursing home employees).

SJ

i think i see what you're getting at but i may have some trouble if you mean to imply that the risk is much ado about nothing.

It's been widely recognized (Ontario also) that, due to testing 'strategy' and other various reasons, significant bias can be introduced when analyzing the healthcare worker risk. The main bias risk is the "healthy worker effect". Because testing is typically used proportionally more in frontline workers (mostly for evidence-based reasons and the spreader issue), there is a tendency to report higher absolute numbers of 'detected' cases and to underestimate (vs if that bias were not there, at least temporarily, compared to other population groups) the CFR. When the proportion of testing in the healthcare population vs total population is high, this can introduce bias at the population level CFR also.

Having said that, given the use of PPE and procedure adjustments, it appears that most CV+ cases in the healthcare workers result from acquisition in the community but not all. i guess 'we' will find out more precisely over time. In terms of cost effective measures and keeping the precautionary principle in mind, it's probably a good idea for high risk workers to undress in the garage and take a shower before hugging family members even if community transfer in that setting has not been well documented.

Interestingly, during the SARS episode (SARS didn't kill so softly so it was more obvious), there were clear and direct links between healthcare workers becoming sick and dying and taking care of SARS-infected patients. An interesting lesson from the SARS episode though was that it was possible to bring the risk of the frontline worker to the same level of the general population, given appropriate measures. From a recent report coming out of the great Alberta province: "It is important to note that evidence from 2003 SARS demonstrated that risk to HCWs could be mitigated by diligent hand hygiene and use of personal protective equipment (PPE)". Not everybody 'believed' that then, in the heat of the action. And some still say it was a hoax.

 

 

No, I was not at all attempting to suggest that it was much ado about nothing.  Just sharing one jurisdiction's actual numbers.  Every jurisdiction seems to be good at capturing some data series, but are often terrible at capturing other series.  And, for Ontario, the healthcare worker data is actually published.

 

My point about the calculated infection fatality rate is that, setting aside the risks associated with small sample size, the fatality rate of those infected does not appear to be much different for healthcare workers than for the broader population in the age groups that would be typically employed in a health care setting.  The implication is that the calculated IFR would not provide evidence of an assertion that health care workers are healthier than the average population, nor would it provide evidence of favourable treatment in the healthcare system (queue jumping), nor would it provide evidence that the work environment delivers a heavier viral load resulting in an elevated fatality rate (all of those things are possible, but this data does not provide much in the way of evidentiary support for any of them).

 

With respect to the heavier testing of healthcare workers, you are undoubtedly correct.  I quite confidently took Ontario's nursing home worker deaths and divided by the officially diagnosed healthcare worker cases to calculate an IFR.  I did that because almost all infections amongst nursing home employees were officially diagnosed due to a heavy testing program (ie, CFR=IFR for that group).  But, you are correct that for the general population, the IFR estimate involves a bit of guesswork as a considerable portion of infections do not show up in the official statistics and need to be separately estimated (ie, CFR much higher than IFR for general population).

 

As to the source of the health care worker infections, I'd say we'll probably never know.  But, the logical and compelling assumption would be that they were mostly caught in the workplace due to unavailability of PPE early in the pandemic, failures of PPE or inconsistent usage of PPE.  I doubt that we'll ever truly know for sure.

 

 

SJ

[Cigarbutt]

...

The data...

As to the source of the health care worker infections, I'd say we'll probably never know... 

SJ

Thanks, i appreciated this exchange.

It must be tough for people taking decisions with such wide uncertainty and that perhaps militates for a larger margin of safety. This process is somehow related to contrarian value investing. In the face of uncertainty, coming up with a contrarian opinion is most likely to be wrong and one has to cherish the rare episodes when the 'true' odds are, indeed, favorable.

To link back to this thread, these days with all the attention to the virus, many people mention the name Ignaz Semmelweis.

https://en.wikipedia.org/wiki/Ignaz_Semmelweis#:~:text=Puerperal%20fever%20was%20common%20in,the%20mortality%20of%20midwives%27%20wards.

Based to some degree on intuition, he suggested hand washing in a contrarian way, met unusual resistance, was mocked along the way and did not survive well through the ordeal. But, in his case, he was right.

Here's to you, hoping that you find your occasional opportunities to benefit from unique opinions,

CF

[KCLarkin]

...

 

covid one-third death rate of flu in Texas.  so hard to understand?

 

Saw that Texas has tragically passed 11,000 covid deaths. Reminded me of this b.s. that you and Abby were spreading a month ago.

[Dalal.Holdings]

...

 

covid one-third death rate of flu in Texas.  so hard to understand?

 

Saw that Texas has tragically passed 11,000 covid deaths. Reminded me of this b.s. that you and Abby were spreading a month ago.

 

TX deaths now about 2% of confirmed cases with widespread testing. Abby’s “analysis” had glaring flaws that are apparent after taking a 2 second look (derp dividing by #tests tells you nothing), but that won’t filter it out from being posted on CoBF!

[clutch]

No spike in deaths relative to the number of cases in the US.

 

[Cigarbutt]

No spike in deaths relative to the number of cases in the US.

...

Why use worse-case scenarios when trying to define a gold standard?

...

covid one-third death rate of flu in Texas.  so hard to understand?

Saw that Texas has tragically passed 11,000 covid deaths. Reminded me of this b.s. that you and Abby were spreading a month ago.

As the 'story' is evolving, the Texas data is interesting if, for instance, one tries to compare the coronavirus toll to a normalized flu toll.

Reminder: most would agree that whatever population immunity concept one adheres to, the Texas population had much lower natural immunity potential to CV compared to the flu and the gap hasn't likely been bridged in a way that would apply under old normal circumstances.

Flu mortality trends in Texas, much like the US generally, have been moving down. In some quarters, this is called progress.

https://www.livestories.com/statistics/texas/influenza-flu-pneumonia-deaths-mortality

The 2017-8 year came with much higher numbers (about 11k deaths, with significant impacts on various population subgroups) but this seems to be an outlier season as it appears that the 2018-9 came back to previous trends. When comparing excess mortality patterns (including the excess in 2017-8 and the slowly crystallizing picture for Covid) for Texas (CDC link mentioned several times above) and integrating a multitude of credible sources of data and analysis, Texas is likely a state that has been, so far, reporting the highest gap between deaths attributed to Covid and total excess deaths. At this point, the evidence points to a 'severity score' of Covid to normalized flu in Texas of about 4 to 8. While it is true that it could have been worse, it's hard to consider these results as a great 'success'.

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This morning, we listened to the official virtual announcement of our school with our 13-year old. We took notes and i thought about the cost-benefit equation. On the negative side, because of grouping strategies, most enriched classes have been curtailed and the school has suddenly become much less productive. Another negative aspect was the realization that zoom meetings (with other parents) with "chat rooms" for questions have not reduced the number of irrelevant or even stupid questions, in fact quite to the contrary..

For those interested into the question of ongoing community spread when younger cohorts go back towards normal activities:

https://www.cdc.gov/mmwr/volumes/69/wr/mm6934e2.htm?s_cid=mm6934e2_x

[beerbaron]

No spike in deaths relative to the number of cases in the US.

 

 

Well, I would argue that it actually did,you are comparing vastly different numbers in a linear scale. Also, you need to average it out a bit.

 

Bottom was ~21K cases. Top was ~69K Cases.

Bottom was ~400 deaths. Top is about 1K.

 

So yes there was a spike, but not proportional to the case increase yet. Better treatments and a more testing could be the reason.

 

BeerBaron

[clutch]

^ definitely more testing

 

[Dalal.Holdings]

Now compare USA to other countries and look at normalized deaths...