COVID-19 Coronavirus Containment Efforts

[StevieTNZ]

Are NZ people brutally honest like AM Show Interview from self-isolation in NZ (4:32 -4:50)

I would hope so!

 

[mfb]

Reuters - Coronavirus emerged in Italy earlier than thought, Italian study shows
https://www.reuters.com/article/us-...han-thought-italian-study-shows-idUSKBN27V0KF

They claim to find antibodies in 10% of the samples from 2019. That's of the scale of the March/April wave in many places. It can't have been the same virus, that would have flooded hospitals and we didn't see that. Whatever formed these antibodies - it was something else. As long as they don't identify that "something else" it's unclear what we can learn from that study.Sweden stages Coronavirus U-turn, banning public events with more than eight people

 

[russ_watters]

I have not heard that, but if the premise is correct, your conclusions follow.

It's hard to argue that the lockdown rules are completely science-based. For example, the prohibition of cover charges in NYC bars. As we all know, cover charges kill.

From Friday's paper:

While it may seem counterintuitive that state officials aren’t turning back to stay-at-home orders and business closures as daily cases top 5,000, public health experts who spoke to Spotlight PA said widespread lockdowns aren’t the answer...

In Pennsylvania, there’s enough contact tracing data to show that infections are spreading because of small, private gatherings, where people let their guard down among family and friends.

https://www.inquirer.com/health/cor...-tracing-masks-small-gatherings-20201113.html

But now:

Philadelphia will close indoor restaurant dining, gyms, and museums starting on Friday and will require office workers to work remotely in an effort to slow the spread of the Coronavirus as new cases surge.

The new restrictions will last through Jan. 1, and include limits on outdoor gatherings and a ban on public and private indoor gatherings — making it a violation of city regulations for residents to hold holiday gatherings with anyone outside their own households...

They also require high schools and colleges to hold classes virtually. Day cares, elementary schools, and middle schools will be permitted to continue in-person instruction.

https://www.inquirer.com/health/cor...ng-hospital-news-20201116.html#card-996471612

Restrictions on private indoor gatherings are largely meaningless because as far as I can tell there is no way to enforce such things (but I'll let you know if I'm wrong about that...I'm dating someone who lives in Philly and that would complicate things...). But closing schools and forcing businesses to close is something the government can easily do, so they are doing it.

 

[Borg]

I just watched an evening newscast where a hospital nurse reported that she has had people on their deathbed who still think that the virus is a hoax. Wow.

https://abc.com/shows/world-news-tonight/episode-guide/2020-11/16-monday-november-16-2020 - seven minutes into the video.

 

[russ_watters]

Who is "we"? Because a great many areas of the nation barely closed this spring, if at all. Many places had their shelter or closure orders overturned. Many areas had orders with no teeth, providing no incentive to abide by them (except of course the prospect of controlling the pandemic).

Well I guess "success" depends on the thresholds you set. We have cell phone location data that says in counties with stay-at-home orders, the average drop in mobility was 83% a few weeks in:
https://www.nytimes.com/interactive/2020/04/02/us/coronavirus-social-distancing.html

But in any case, questioning the efficacy of the restrictions on COVID mitigation wasn't what you were talking about; economic impact was. So you seem to not be following your own point.

The arguements you tote out regarding our supposed kowledge of the possible effects of "lockdown" based on previous events are similarly shaky. You essentially blame 100% of the economic downturn early in the pandemic on lockdowns without considering even obvious additional contributions to that effect. What sort of other things might have taken a toll on the economy, you might ask? How about global uncertainty in the face of an emerging pandemic? How about a gross failure of the highest authority in the land to manage a remotely coherent or even logical strategy in the face of an emerging pandemic? How about the fears that were present relating to a largely unknown and unpredictable disease, do you think they even had the slightest of impact on decisions that tend to drive the market?

Your prior point was that when people die, they leave the market. That's true, and it is quantifiable. Also, the impact of staying home sick is quantifiable. But those numbers are tiny compared with the economic downturn, so they were not a large fraction of it.

Fear and uncertainty is hard to quantify except in the stock market, and it isn't reflecting fear and uncertainty.
The effects of the shutdowns show in how the GDP dropped in Q2 when the shutdowns were implemented and then rose in Q3 when they were lifted (and vice versa for unemployment).

...even though large areas of the country more or less stayed the course through the rise of the pandemic, the economic damage and other things like shortages were felt fairly broadly and almost immediately.

Supply shortages are caused by the production in one place effecting supply everywhere, so they aren't indicative of regional effects. And most economic data are presented nationally. But the impact of shutdowns can be seen in unemployment data at the state level:
https://www.bls.gov/opub/ted/2020/4...nemployment-rates-in-april-2020.htm?view_full

One example: the highest unemployment was in Nevada, almost certainly because their economy is heavily dependent on tourism.

Also: You need to watch your tone and stop with the insults. We require civility on this forum.

 

[StevieTNZ]

I just watched an evening newscast where a hospital nurse reported that she has had people on their deathbed who still think that the virus is a hoax. Wow.

Sounds like some ex-Harold Camping followers.

 

[Vanadium 50]

Russ,

A study on quarantined Marine recruits (DOI: 10.1056/NEJMoa2029717) seems to support The Philadelphia Story. (sorry...couldn't resist). Quarantine or not made little difference (and what difference there was goes the wrong way) but sharing a bedroom or a bathroom does.

Also, a few months ago, I commented that geography alters ones perceptions: in places like New Jersey, the rate is such that most people know at least one person who died of Covid, but in places like Vermont, few do. Well, I know - rather, knew - two casualties of the lockdown - one accidental death and one suicide.

 

[russ_watters]

The proposal is not to repeat what was done before:
[Osterholm: the government could borrow enough money to pay for a package that would cover lost income for individuals and governments during a shutdown. ]

If that was referenced in this conversation, I missed it. But regardless, that's a hypothetical from a member of an administration that won't exist for two more months, so it can have no impact on shutdown plans that are being enacted as we speak. Also, it's a stretch to even call it a "proposal", since it is one guy's idea, which at that point he hadn't even shared with his new boss, who doesn't agree with it:
https://www.cnbc.com/2020/11/11/bid...ould-control-pandemic-and-revive-economy.html

This is purely a hypothetical scenario, but I don't think a repetition (that no one plans!) would be worse. The first time everything was chaotic and unexpected. It's still somewhat chaotic but way less than in April.
[snip] You can't assign all of the economic downturn to a specific set of government measures.

I don't think chaos was the primary driver of the damage. I'm not even really sure what you mean by that -- I didn't see much of what I'd consider "chaos". Shutting businesses and laying off workers was the damage. Yes, I'm speculating, but it is a pretty logical speculation: in order to survive a downturn in business, a business needs a war chest of money. Businesses that had their war chests depleted have not had time to replenish them. This isn't a matter of the weak businesses dying off and the strong that survived are fine now. They're not; lots are damaged and in more danger because of the damage.

And as I'm typing this, I heard this on the news, from a business owner in Philadelphia, where new restrictions were announced today:
"We believe we are going to see a worse wave of business closures this time than we saw thus far, because we used all of our resources to get through this summer."

And of course the economic downturn started before the government measures and went way beyond their impact.

What data are you looking at to support that? Here's the weekly new unemployment claims for the US:
https://www.dol.gov/ui/data.pdf
Most of the jump happened in the 3rd week in March: the week the shutdowns started, and the peak was in mid-April. Then they started dropping as businesses gradually re-opened.

GDP in the US dropped 5% in Q1, the quarter that ended just as the restrictions were being put in place, and was down 31% in Q2. It's pretty close to an exact match of 2 weeks of shutdown following 10 of normalcy in Q1, to the Q2 drop. Then things mostly re-opened in Q3 and the GDP went back up.

The only indicator I know of that showed anything before the shutdowns started was the stock market, which is a leading indicator, not an indicator of at-the-time damage.

Closing a specific set of businesses is not a lockdown (@nsaspook). A true lockdown - what we had in Italy for example - would ban the gatherings of people not living in the same household.

Granted -- the media throws around that term wantonly and I need be more careful about how I use it. We primarily have had shutdowns, not lockdowns. But still, a ban on gatherings not in the same household - which Philly just re-implemented, isn't a lockdown either, it's just a stay-at-home order. It only becomes a lockdown if it is enforced. I don't know if Italy enforced theirs, but the USA did not. As a practical matter, Western countries are unable and as a philosophical matter are unwilling to enforce them.

They are not completely stupid and they didn't start doing this yesterday. They see an increase in traced contacts from small gatherings relative to what happened before.

I don't think they are stupid. What they are is woefully under-manned, and incapable of tracing the majority of infections.
https://www.inquirer.com/news/coron...lly-contact-tracing-pa-nj-cases-20201027.html
https://www.inquirer.com/health/cor...ng-hospital-news-20201116.html#card-996471612

Half of people don't cooperate. Half of those who do don't know who infected them. And as of this past week, less than a third get traced at all (the article is almost 3 weeks old). So that's just 8% of cases being successfully traced. I don't know if they are prioritizing the tracing, but again, logic tells me that a small social gathering where the participants all know each other (and later share COVID status with each other) would be the easiest to trace. It's an awfully big margin for error and potential systemic bias.

 

[Astronuc]

How bad could it get?

A nurse at a strained El Paso hospital says the sickest COVID-19 patients are put in a doctor-less room called 'the pit' where they are given 3 chances to be revived before workers let them die
https://www.businessinsider.com/coronavirus-el-paso-hospital-nurse-lawanna-rivers-video-2020-11

What is happening in El Paso is similar to what happened in parts of NY City during late March into April where hospitals got overwhelmed and morgues and funeral homes backed up, or overflowing. Some bodies were not claimed so they were placed in mass graves.
https://www.washingtonpost.com/history/2020/04/27/hart-island-mass-grave-coronavirus-burials/
https://www.cbsnews.com/news/corona...-island-cemetery-shorter-deadline-claim-dead/


https://www.fox5ny.com/news/hart-island-burials-soar-during-coronavirus-pandemic
From March 3 to June 4, crews buried 725 people on Hart Island.

The peak came the week of April 6, when 138 adults were buried, according to data from the Department of Correction. (The Office of the Chief Medical Examiner does not provide the cause of death of whoever is sent to Hart, so it isn't clear if these were all COVID-19 victims.)

 

[mfb]

I don't think chaos was the primary driver of the damage. I'm not even really sure what you mean by that -- I didn't see much of what I'd consider "chaos".

Uncertainty about the future, often even uncertainty about the current state - what is allowed, what is not, will that change again tomorrow? Can our business stay open, and if yes how do we need to modify it?

What data are you looking at to support that? Here's the weekly new unemployment claims for the US:
https://www.dol.gov/ui/data.pdf

The economic downturn didn't start with unemployment filings. It started when people bought less stuff, which started before any public measures were implemented (and pretty much in parallel everywhere independent of when exactly the government acted). We had this discussion months ago when it was new, I don't think we need to repeat it.
You can also look at Sweden if you like. No businesses were forced to close - but their economy still went down dramatically.

GDP in the US dropped 5% in Q1, the quarter that ended just as the restrictions were being put in place, and was down 31% in Q2. It's pretty close to an exact match of 2 weeks of shutdown following 10 of normalcy in Q1, to the Q2 drop.

You can't see that in quarterly data and the hand-waving isn't helping.

I don't think they are stupid. What they are is woefully under-manned, and incapable of tracing the majority of infections.

So why do you accuse them of drawing stupid conclusions?
You don't need much statistics to notice that more and more infections can be traced to family/friends gatherings. The statement was about a change. Earlier more infections were traced to other sources, recently more infections were traced to family/friends gatherings.

A nurse at a strained El Paso hospital says the sickest COVID-19 patients are put in a doctor-less room called 'the pit' where they are given 3 chances to be revived before workers let them die
[...]
What is happening in El Paso is similar to what happened in parts of NY City during late March into April where hospitals got overwhelmed and morgues and funeral homes backed up, or overflowing. Some bodies were not claimed so they were placed in mass graves.

Total COVID-19 hospitalizations in the US reached new records - this is not surprising.

@Vanadium 50: Looking back at your earlier comment, would you agree that the system in El Paso is overwhelmed? If not, how much worse does it need to get?

 

[nsaspook]

From Friday's paper:

https://www.inquirer.com/health/cor...-tracing-masks-small-gatherings-20201113.html

But now:

https://www.inquirer.com/health/cor...ng-hospital-news-20201116.html#card-996471612

Restrictions on private indoor gatherings are largely meaningless because as far as I can tell there is no way to enforce such things (but I'll let you know if I'm wrong about that...I'm dating someone who lives in Philly and that would complicate things...). But closing schools and forcing businesses to close is something the government can easily do, so they are doing it.

In Oregon at least it seems they just have no idea where people are getting infected so the only effective method is a shotgun approach to control because is works but the cost is horrendous vs targeted restrictions.

https://apkmetro.com/as-covid-19-surges-the-big-unknown-is-where-people-are-getting-infected/

Western nations face an enormous problem in combating the Covid-19 pandemic: Ten months into the well being disaster, they nonetheless know little about where people are catching the virus.

The issue is turning into extra acute as new cases are breaking records within the U.S. and Europe and strain grows on authorities to impose focused restrictions on locations which are spreading the virus, somewhat than broad confinement measures which are wreaking havoc on the economic system.
...
With no good understanding of the settings through which the virus is probably to be transmitted, a number of European countries have been forced to reintroduce indiscriminate lockdowns this autumn.

France, Germany, the United Kingdom. and different nations in latest weeks once more shut all eating places and bars, cinemas, theaters and in some situations nonessential outlets to stop well being techniques from collapsing beneath a flood of sufferers. U.S. states from New York to Utah additionally imposed new restrictions as each day new infections within the U.S. are hitting data.

Plenty of places that are high risk are still open but they are deemed essential like grocery stores or at least in Oregon, hair & massage parlors and tattoo shops while gyms are closed without much actual science of spreading the virus with current protections.

https://www.kptv.com/gyms-martial-art-schools-concerned-about-surviving-new-covid-19-restrictions/video_4c529f23-2014-51ec-a0ff-ba1d36428083.html
https://www.kgw.com/article/news/he...gain/283-4f6eb673-785e-4c29-9685-505f125bd254

https://www.bbc.com/news/newsbeat-54540188

Prof Ball says a lot of that risk can be dramatically lowered through things like effective air-conditioning, regular cleaning, social distancing and hand sanitising.
"From the data that I've seen from Public Health England, I'm not aware that there is a significant hotspot for infections in the gym environment.
"We know where the major risks are but after that we know there are other activities where people mix and where people mix, there is a chance of transmission occurring."

 

[Vanadium 50]

@Vanadium 50: Looking back at your earlier comment, would you agree that the system in El Paso is overwhelmed? If not, how much worse does it need to get?

Hmmm...wasn't flagged.

El Paso has 1120 present hospitalizations out of 6894 total. In April they had 1001 hospital beds with a surge capacity of 200. So you can see the problem.

However, if they had the nationwide average number of beds per capita, they would have 2200. I would argue (and have argued upthread) that this is a problem with under-hospitalization in general and is only exposed by Covid.

One other peculiar thing is that the deaths per hospitalization is about half of the national average. I do not understand that. It does match the late summer peak in hospitalizations (in Texas), again half the national average. This is consistent with admissions of people who are less sick on average, but it certainly doesn't prove it.

 

[nsaspook]

https://www.nature.com/articles/s41586-020-2923-3

We use data from SafeGraph, a company that aggregates anonymized location data from mobile applications, to study mobility patterns from March 1–May 2, 2020.

https://apnews.com/article/public-h...rus-pandemic-b984084e57c55b4ddc55fc420e757a46

This week, researchers from Stanford and Northwestern universities touted the benefits of occupancy caps after they used cellphone tracking of 98 million people to report that most infections happened at “super-spreader” sites including restaurants and fitness centers, because patrons are close together for longer periods.

Several San Francisco Bay Area counties decided to follow the city of San Francisco and banned indoor dining even though their case levels allow them to keep them open under the state’s rules.

Marin County’s health officer, Dr. Matt Willis, said restaurants have been the source of super-spreader events because families tend to linger and they can’t keep masks on while eating.

But not even all public health officials in the Bay Area see things similarly. Solano County public health officer Dr. Bela Matyas said the vast majority of cases have been traced back to casual gatherings.

“We’ve had no clusters we can attribute to restaurants, to gyms, to retail shopping, to any of those facilities,” Matyas said. “Because they have licensure on the line, they do a good job of enforcing social distancing.”

The study seems to be very much a rear-view mirror approach. They used data from March and May to say restaurants and fitness centers are “super-spreader” sites NOW? Hopefully updated data will show new insights as to how to approach this all in the coming months...

The world has changed since the spring. There is very little evidence today that restaurants and fitness centers are spreaders because they have been models of prevention under direct threat of government closure during the reopening phase unlike the packed pot shops and Baskin-Robbins near here.

https://www.statnews.com/2020/11/10...-sites-occupancy-limits-could-control-spread/

Analyzing what happened in the spring limits its applicability to the fall, said Adalja, who is also an infectious disease physician. There are many more mitigation measures in place now in public places, from face coverings to temperature checks to occupancy limits. “If you went to a restaurant in early March, it’s a very different experience than going to a restaurant in early November.”

There are also limits to what mobility data can tell us now, he said.

“We’ve seen in the epidemiology that now it’s not restaurants or even large gatherings that are driving spread, but small gatherings,” he said, although the summer surge in Sun Belt states was partly driven by people crowding into bars. Heading into winter, spread has happened more in people’s homes than in public places. That means “people wouldn’t be captured by mobility data because they’re at home, right there in their neighborhood.”

 

[mfb]

BioNTech/Pfizer have data for the full study now. 95% effective and safe, final analysis shows
170 cases, 162 in the placebo group, 8 in the equally sized vaccine group. Out of these 10 cases were severe, 9 in the placebo group one in the vaccine group.

We can expect more details "within days" - that will be the information necessary to get official approval in the US and the EU and probably elsewhere as well.

No serious side effects, 2% report headaches and fatigue, which is really nice.
The 95% number is based on infections at least a week after the second dose, but they also see an effect from the first dose alone.

We could see first vaccinations in December already, but wider distribution will only happen over the course of 2021. We'll need more than just two companies to get most people vaccinated.

 

[vela]

The study seems to be very much a rear-view mirror approach. They used data from March and May to say restaurants and fitness centers are “super-spreader” sites NOW? Hopefully updated data will show new insights as to how to approach this all in the coming months...

All studies only give you a backward looking view as you have to collect data before you can draw conclusions. The data from March and May suggest that restaurants and fitness centers can be super-spreader sites. The data doesn't say that these establishments now with some safeguards in place are still super-spreader sites, but they still could be if the measures taken are for some reason ineffective despite the owners' best intentions. The study did say that occupancy limits would likely cut down greatly on the spread that can occur.

The world has changed since the spring. There is very little evidence today that restaurants and fitness centers are spreaders because they have been models of prevention under direct threat of government closure during the reopening phase unlike the packed pot shops and Baskin-Robbins near here.

By the same token, is there good evidence today that they're in fact not still spreader sites despite the measures that have been put in place? We can make an educated guess based on what we've learned about how the virus spreads about the effectiveness any measures taken, to inform decisions on reopening these businesses, but this best guess still could turn out to be wrong.

Personally, I think businesses that have a good plan to deal with the virus should be allowed to operate and only closed if subsequent data show that the plan isn't working. The sledgehammer approach being used now in California seems to be based more on fear than reason and is only leading to frustration.

 

[Ygggdrasil]

BioNTech/Pfizer have data for the full study now. 95% effective and safe, final analysis shows
170 cases, 162 in the placebo group, 8 in the equally sized vaccine group. Out of these 10 cases were severe, 9 in the placebo group one in the vaccine group.

We can expect more details "within days" - that will be the information necessary to get official approval in the US and the EU and probably elsewhere as well.

Key information was not reported on that would be useful to know: 1) whether the vaccine just prevent symptomatic disease or whether it also prevents infection (which would halt transmission). 2) How effective is the disease at protecting older individuals (who often have weaker immune systems and usually don't respond as well to vaccination as other age groups).

No serious side effects, 2% report headaches and fatigue, which is really nice.

This figure is somewhat misleading and is not reported well in the news article you cite. The relevant statistic from Pfizer's press release is "Data demonstrate vaccine was well tolerated across all populations with over 43,000 participants enrolled; no serious safety concerns observed; the only Grade 3 adverse event greater than 2% in frequency was fatigue at 3.8% and headache at 2.0%."

Note that Grade 3 adverse events are defined as those that are severe or medically significant enough to require hospitalization or prevent normal daily activities but are not life-threatening.

So while severe fatigue and headache occur in ~4% and 2%, respectively, (non negligible rates given the vaccine will be administered to millions) these figures leave out reports of mild or moderate fatigue and headache. Based on the published results of the Phase I/II trial for BNT162b1 (not the exact version used for the Phase II/III trial, but very similar), ~100% of participants reported mild or moderate headache within 7 days of the second vaccination (vs 0% in placebo), and ~80-90% reported mild or moderate fatigue (vs ~ 10-20% in placebo) (based on a n=12, however, see Fig 3b from the paper linked above).

 

[nsaspook]

By the same token, is there good evidence today that they're in fact not still spreader sites despite the measures that have been put in place? We can make an educated guess based on what we've learned about how the virus spreads about the effectiveness any measures taken, to inform decisions on reopening these businesses, but this best guess still could turn out to be wrong.

Personally, I think businesses that have a good plan to deal with the virus should be allowed to operate and only closed if subsequent data show that the plan isn't working. The sledgehammer approach being used now in California seems to be based more on fear than reason and is only leading to frustration.

I agree completely. It's very hard to get local up to data data on where spread is happening.
https://www.washingtonpost.com/health/2020/11/12/covid-social-gatherings/

A record-breaking surge in U.S. coronavirus cases is being driven to a significant degree by casual occasions that may feel deceptively safe, officials and scientists warn — dinner parties, game nights, sleepovers and carpools.

Many earlier Coronavirus clusters were linked to nursing homes and crowded nightclubs. But public health officials nationwide say case investigations are increasingly leading them to small, private social gatherings. This behind-doors transmission trend reflects pandemic fatigue and widening social bubbles, experts say — and is particularly insidious because it is so difficult to police and likely to increase as temperatures drop and holidays approach.

https://www.clarkcountytoday.com/ne...ounty-small-private-gatherings-a-key-culprit/

Here’s the full list of sources of exposure for the 235 cases between Sept. 1-21 for whom there was data available:

• 41% – household member (97 cases)
• 20% – private social gathering, 1-10 ppl (48)
• 7% – health care setting (17)
• 5% – long-term care facility (12)
• 4% – office (10)
• 3% – manufacturing/warehouse (8)
• 3% – travel, out of state (8)
• 3% – private social gathering, 11-49 ppl (7)
• 3% – store – grocery (7)
• 2% – food establishment/restaurant (4)
• 2% – place of worship (4)
• 1% – public social gathering, 11-49 ppl (3)
• 1% – private social gathering, 50+ ppl (3)
• 1% – public social gathering, 50+ (2)
• <1% – public social gathering, 1-10 ppl (1)
• <1% – flight (1)
• <1% – store – general retail (1)
• <1% – preschool/childcare (1)
• <1% – travel, out of county (1)

https://www.oregon.gov/oha/PH/DISEA...nfections/Epidemic-Trends-and-Projections.pdf

Scenario Projections With the fitted model, we can explore outcomes under future scenarios. Predicting future trends in COVID-19 is extremely challenging. As illustrated in Figure 1, the estimated Re has fluctuated above and below 1 since reopening began in May. Indeed, the spread of this virus appears very sensitive to changes in how people are interacting with each other (e.g., wearing masks, physically distancing, being indoors with large groups). Unfortunately, we do not have measures of risk and protective behaviors over time, nor can we accurately predict them. Hence, we modeled two future scenarios with different assumptions about the Re value after November 6. 5 Figure 4 illustrates what could happen over the next month: • If Re were to be maintained at the estimated November 1 level (1.47): We would continue to see an exponential increase in new diagnosed cases. In a month, the projected number of new diagnosed cases would reach 500 per 100,000 people over a two week period. This rate translates to an average of 1,500 new diagnosed cases per day. • If behavior changes lowered the Re to the level of mid-October (0.91): New diagnosed cases would remain at historically high levels but would start decreasing again. These results highlight how the level of COVID activity depends strongly on the collective success of mitigation efforts in the coming months.

 

[bhobba]

One thing I have noticed, at least here in Aus, is first the total inability of bureaucrats to understand how contagious this thing is in the context of hotel quarantine, and way over the top desire for total lockdown when the first fails. The latest outbreak is just 37 at this stage, and was caused by a cleaner in the hotel moonlighting in a, get this, Pizza restaurant. It should be obvious you test all cleaners every day and they are to go straight home - no moonlighting - indeed after you get tested you are supposed to isolate anyway. It was in Adelaide, which is in the state of SA. So what they did is lockdown the whole of SA. There are only a few roads into Adelaide - why not just lockdown Adelaide. Beats me. Even then - why a total lockdown for 34 cases? I know the advice with this virus is to go early, hard and fast - but methinks - overkill.

Thanks
Bill

 

[PeroK]

One thing I have noticed, at least here in Aus, is first the total inability of bureaucrats to understand how contagious this thing is in the context of hotel quarantine, and way over the top desire for total lockdown when the first fails. The latest outbreak is just 37 at this stage, and was caused by a cleaner in the hotel moonlighting in a, get this, Pizza restaurant. It should be obvious you test all cleaners every day and they are to go straight home - no moonlighting - indeed after you get tested you are supposed to isolate anyway. It was in Adelaide, which is in the state of SA. So what they did is lockdown the whole of SA. There are only a few roads into Adelaide - why not just lockdown Adelaide. Beats me. Even then - why a total lockdown for 34 cases? I know the advice with this virus is to go early, hard and fast - but methinks - overkill.

Thanks
Bill

You can't have it both ways. You posted recently criticising the Australian government for allowing 800 deaths. Now, when the government comes down hard on any outbreak it's overkill. You have to decide which it is. You can't have a light touch on lockdown and no deaths. You can argue which is better, but you can't have both. Here's a thought for today:

The UK has twice as many deaths as Australia has confirmed cases.

 

[mfb]

Even then - why a total lockdown for 34 cases?

Because you don't want to wait until you have 300 cases. Or 3000. The earlier you take actions the fewer cases you get.

Key information was not reported on that would be useful to know: 1) whether the vaccine just prevent symptomatic disease or whether it also prevents infection (which would halt transmission). 2) How effective is the disease at protecting older individuals (who often have weaker immune systems and usually don't respond as well to vaccination as other age groups).

As far as I understand they don't have data on (1) because they didn't do regular COVID-19 tests. People only got tested if they felt sick (or if they were tested for other reasons - probably not enough to matter). For (2) they say in the press release that "Efficacy was consistent across age, gender, race and ethnicity demographics; observed efficacy in adults over 65 years of age was over 94%".

no serious safety concerns observed; the only Grade 3 adverse event greater than 2% in frequency was fatigue at 3.8% and headache at 2.0%."

Okay, that is worse than the news made it sound. I assume not many people go to a hospital because they feel tired or because of a headache, so we are probably looking at people who didn't go to work because of side effects.
Close to 100% mild side effects will scare some people, hopefully not too many.

I wonder how good the vaccine would be after the first dose. Toy scenario: You have N/5 doses for N people, do you get a larger benefit from giving two doses to N/10 people or one dose to N/5 people?
Sure, that's not what they want to get approved, so we'll never see this scenario, but nevertheless I think it's an interesting question.

 

[bhobba]

You can't have it both ways.

Fair enough. Overkill is better than it getting out of control. Anyway, the good news is it is working - no new cases today and the 37 cases included some suspected cases that have now been cleared - it is now only 22. Plus this particular strain has a short incubation period - usually less than 24 hours. And now it will not be allowed for those involved in hotel quarantine work to, in future, have second jobs while doing that work. And they will be tested weekly.

Thanks
Bill

 

[nsaspook]

https://www.nytimes.com/2020/11/17/health/coronavirus-immunity.html

How long might immunity to the Coronavirus last? Years, maybe even decades, according to a new study — the most hopeful answer yet to a question that has shadowed plans for widespread vaccination.
Eight months after infection, most people who have recovered still have enough immune cells to fend off the virus and prevent illness, the new data show. A slow rate of decline in the short term suggests, happily, that these cells may persist in the body for a very, very long time to come.
The research, published online, has not been peer-reviewed nor published in a scientific journal. But it is the most comprehensive and long-ranging study of immune memory to the Coronavirus to date.
“That amount of memory would likely prevent the vast majority of people from getting hospitalized disease, severe disease, for many years,” said Shane Crotty, a virologist at the La Jolla Institute of Immunology who co-led the new study.

https://www.biorxiv.org/content/10.1101/2020.11.15.383323v1.full.pdf

Notably, memory B cells specific for spike or RBD were detected in almost all COVID-19 cases,
with no apparent half-life at 5+ months post-infection. B cell memory to some other infections has been observed to be long-lived, including 60+ years after smallpox vaccination (58), or 90+ years after infection with influenza (59), another respiratory virus like SARS-CoV-2.

It looks like the only good news about the current infections rates is they are One and Done.

 

[BillTre]

I like the idea of a finer granularity to the way that anti-Covid actions are taken.
Especially for measures that are disruptive to economic functioning.
For this reason I would not favor a one size fits all global or national shutdown.

In my state, Oregon, these measures have sometimes been done county by county, such that the disruptions have their effects only where most needed. I am guessing that this will also lead to greater acceptance of the measures.
For example, there is a big difference between Covid rates in the Portland area (Oregon's largest city, in Multinoma and neighboring counties) and the southern coast, around Coos Bay (Coos and Curry counties), a low population density, relatively isolated area on the coast about 2 or 3 hundred miles form Portland.

I think that is what @bhobba was getting at.
However, granularity can have its drawbacks.
Too much fine granularity would lead to confusion about what one is supposed to do and its enforcement (if any).
There is a tradeoff there. Finding the proper balance it might not be easy.
Favoring more stringent measures would be favored from a health concern point of view.

The sledge hammer approach makes sense in some cases, such as where there is the less knowledge about what is going on.
If the new outbreak in Australia is a mutant Covid version that is more transmissible, more stringent measures may be appropriate.

Another factor to consider, as we get more experience dealing with Covid, the counter effects taken should evolve to be more effective and less economically intrusive.
However, recent history shows that such policy changes such can become fodder for poorly motivated politicians to rant on about, making preventive measures more contentious and damping their effect.

 

[Vanadium 50]

I like the idea of a finer granularity to the way that anti-Covid actions are taken.

I made this comment in the past - Copper Harbor Michigan and Detroit are as far apart as New York City and Nova Scotia. The problem is that political boundaries are not well matched to sensible sizes for measuring the severity of outbreaks (which seems to be larger than cities and smaller than states).

 

[Rive]

Already seven countries with 'mink' variant present

I _hope_ that it's not a big deal, but maybe it would be better to take this seriously.

 

[mfb]

Most of these "mink variants" seem to be no different than the others, we just know the virus was in minks in between.

North Dakota is racing towards 10% of the population as confirmed cases: 7% on Nov 6, 8% on Nov 12, 9% on Nov 18.
0.1% of its population has died from COVID-19, including David Andahl who won the election for the North Dakota Legislature after his death.
No sign of slow-down so far.

I found a bar chart of confirmed cases per US state (Nov 15) and removed the (political) original color:

 

[russ_watters]

North Dakota is racing towards 10% of the population as confirmed cases: 7% on Nov 6, 8% on Nov 12, 9% on Nov 18...
0.1% of its population has died from COVID-19...
I found a bar chart of confirmed cases per US state (Nov 15) and removed the (political) original color:

New Yorkers should be heartened to learn they were spared significant testing while the virus ravaged the state. North Dakotans should be dismayed that they missed the first wave. My county is lucky not to be a teeny tiny state (but larger than North Dakota), otherwise we might be listed here.

 

[Vanadium 50]

Interesting thing about North Dakota. They have the highest testing fraction in the country (one of four states where the number of tests exceeds the population at the 2010 census) at about twice the national average. People are getting sick, but the hospitalization per case and the deaths per case are both half the national average.

Clearly testing causes Covid.

 

[mfb]

With more tests we get a more realistic estimate how widely it is distributed.

but the hospitalization per case and the deaths per case are both half the national average.

Cases are 2.5 times the national average (currently at 3.5%), so overall North Dakota has above average hospitalizations and deaths per capita.

New Yorkers should be heartened to learn they were spared significant testing while the virus ravaged the state. North Dakotans should be dismayed that they missed the first wave.

Did I miss a particular reason to make fun of the situation?
North Dakota's deaths per capita are close to the value of New York already, and with the rapid rise they will probably exceed NY's rate soon.

 

[OmCheeto]

North Dakota's deaths per capita are close to the value of New York already, and with the rapid rise they will probably exceed NY's rate soon.

New Jersey is currently in the lead of deaths per capita, just slightly ahead of New York.
Plotted logarithmically, North Dakota should be #1 in the nation in about 2 weeks.

 

[Astronuc]

North Dakota population 762,062 (2019)

People tested = 331,169 PCR tests (on unique people); 11,378 antibody tests. Total PCR tests = 995,870, so some people are tested more than once. Perhaps one is tested daily while testing positive until one or two negative tests? https://covidtracking.com/data/#state-nd
https://www.health.nd.gov/diseases-conditions/coronavirus/north-dakota-coronavirus-cases

 

[mfb]

Testing an infected person daily would be overkill. I assume it's done for some high profile people (or generally people who want to pay for it), but doing that for every random positive case would be a waste of resources.

Plotted logarithmically, North Dakota should be #1 in the nation in about 2 weeks.

Deaths in the next two weeks are largely from people already infected, so it's almost guaranteed to happen independent of what they might do in the future to slow the spread.

 

[OmCheeto]

Testing an infected person daily would be overkill. I assume it's done for some high profile people (or generally people who want to pay for it), but doing that for every random positive case would be a waste of resources.

My guess is the opposite, that they are testing non-infected, but high risk persons, frequently.According to UC Davis

Currently, COVID-19 tests are prioritized for the following groups:​

• Hospitalized and symptomatic individuals (or people about to be hospitalized for a procedure)
• Health care workers and people in group living facilities
• First responders and other social service employees
• People exposed to infected individuals in places where COVID-19 risk is high

Doh! I just found a post that agrees with you.

[edit: HCP stands for "Health Care Provider"]

Testing to determine when HCP with SARS-CoV-2 infection are no longer infectious
A test-based strategy, which requires serial tests and improvement in symptoms, could be considered to allow HCP with SARS-CoV-2 to return to work earlier than the symptom-based strategy. However, in most cases, the test-based strategy results in prolonged work exclusion of HCP who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious. A test-based strategy could also be considered for some HCP (e.g., severely immunocompromised) in consultation with local infectious diseases experts if concerns exist for the HCP being infectious for more than 20 days. In all other circumstances, the symptom-based strategy should be used to determine when HCP may return to work.

ref: U.S. CDC

Makes sense to me.

 

[stefan r]

It was wise of the NZ government to constitute their country on an island (well, two major islands). The Federated States of Micronesia must have the best government in the world - zero cases.

New Jersey is effectively an island. All of the bridges already have toll booths where it would be simple to set up checkpoints. The entire east coast has a chain of barrier islands.

 

[mfb]

My guess is the opposite, that they are testing non-infected, but high risk persons, frequently.

That they do for sure. That's how they found the infections in the White House so quickly, for example.

New Jersey is effectively an island. All of the bridges already have toll booths where it would be simple to set up checkpoints. The entire east coast has a chain of barrier islands.

Can you imagine the consequences of closing all these bridges? Closing the land border north of NYC? How many commuters do you cut off?
Compare this to the number of commuters affected when you stop international flights to New Zealand.