COVID-19 Coronavirus Containment Efforts

[OmCheeto]

That has a question mark at the end, but is worded as a statement. Can you say where you heard of it, what the criteria is for being a "hot spot" and if that's really a question, what the question is? I've never heard of Chattahoochee, Ga., so I googled it, and I see that it isn't where the Master's Tournament is being held.

I'm guessing I mentally inserted the commas and inflections differently, and interpreted what mfb said as 'why is it still a hot spot?'. Having also never heard of Chattahoochee, Georgia, US, I spent several hours yesterday analyzing their numbers.
Results:

1. They were #2 in the world for "Cases/Million/Day" for the week averaged from 3/28 thru 4/4. Guessing this is where "hot spot" came from.

2. They were also #2 in the world for "% Case total" as of April 4th.

3. Since I almost never look at cases, this kind of surprised me, and I looked at their "% death total", which showed a number 3 times too low. I thought that was very strange until I looked them up in wikipedia and found:

4.

a. "As of September 23, 2020, during the COVID-19 pandemic in the United States, the county had the highest infection rate of any county in the US, with 14,908 cases per 100,000 residents."

b. "The median age was 24.0 years."

c. "Although its population has declined, the county was notable in 2016 for having the highest proportion of millennials (persons 15–34 years old) of any county within the United States: 59.7%"
​

4.b. kind of answered my question as to why their case fatality rate was so far off, as their median age was lower than even the lowest of our territories.

------
Edit:
As usual, the Center for Systems Science and Engineering at Johns Hopkins University was my data source.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

 

[Ygggdrasil]

That has a question mark at the end, but is worded as a statement. Can you say where you heard of it, what the criteria is for being a "hot spot" and if that's really a question, what the question is? I've never heard of Chattahoochee, Ga., so I googled it, and I see that it isn't where the Master's Tournament is being held.

Looks like the data are from the NY Times link posted by @Astronuc in the post directly preceding the post you quoted:

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

 

[russ_watters]

Looks like the data are from the NY Times link posted by @Astronuc in the post directly preceding the post you quoted:

I'm guessing I mentally inserted the commas and inflections differently, and interpreted what mfb said as 'why is it still a hot spot?'. Having also never heard of Chattahoochee, Georgia, US, I spent several hours yesterday analyzing their numbers...

b. "The median age was 24.0 years."

c. "Although its population has declined, the county was notable in 2016 for having the highest proportion of millennials (persons 15–34 years old) of any county within the United States: 59.7%"

Thanks. This media fascination with identifying teeny-tiny outliers is bizarre to me, and while I've no interest in spending hours on their "case", I did see that the county is underfoot of Fort Benning, which is an Army base 10 times the population of the county itself. It's huge, a training center, populated by younger people, houses them in close quarters, and then sends them traveling throughout the country and world. So that would explain the weird demographics and high case load. But Crozby, TX, stand by because we're coming for you next!

 

[mfb]

I did see that the county is underfoot of Fort Benning, which is an Army base 10 times the population of the county itself.

That probably answers the question how the county can maintain so many nominal cases per capita: The population number in the denominator is not the number of people there.

 

[russ_watters]

That probably answers the question how the county can maintain so many nominal cases per capita: The population number in the denominator is not the number of people there.

Well, I don't think the soldiers get counted in either - that would be a big mismatch if they did. I did see a link where the Army said they weren't going to report their caseload anymore. So I do think their numbers are really townspeople - it's just that they have a lot of interactions with soldiers and their families.

 

[mfb]

I don't see how that would lead to a maintained high per capita rate. What's the scenario here?
Soldiers have a lower capita rate? Why would they preferably infect the civilians?
Soldiers have a similar or higher per capita rate? Why didn't they run out of infectious people already?

If that base doesn't enter the statistics directly, how would that base differ from a random other high population county nearby with a similar demographics?

 

[russ_watters]

I don't see how that would lead to a maintained high per capita rate. What's the scenario here?
Soldiers have a lower capita rate? Why would they preferably infect the civilians?
Soldiers have a similar or higher per capita rate? Why didn't they run out of infectious people already?

If that base doesn't enter the statistics directly, how would that base differ from a random other high population county nearby with a similar demographics?

I don't know either. I was guessing it is because soldiers have a high per capita rate and high "churn". Being somewhat of a training facility, they continuously circulate new infected people through the base and town. But there could also be a numerator/denominator issue. Even a tiny fraction of families (girlfriends?) living off-base, and turning-over every 2-3 years (for the long-term population) or more often could add significantly to the pool of "infectables". 1/3 reported infected is a really high number that is hard to achieve given the large number of missed infections in the early days of the pandemic. Regardless, the base demographics themselves are going to be weird and it is impossible for us to know for sure what they are or what their infection profile looks like.

 

[russ_watters]

Updates to my projections in this March 18 post:

• The Biden administration's current goal is to produce enough vaccines for every adult by the end of May. That's a touch vague, as current guidance is for the vaccine to be administered to at-risk teenagers 16+. If it includes everyone 16+, that's 260 million people. Figure 4 weeks for the emptying of the distribution pipeline and we could have every adult vaccinated by the end of June.

On track, but people declining the vaccine will of course prevent that from being achieved.

• The J&J vaccine is not currently ramping-up. There was an initial stockpile of 4M doses starting to ship on 3/1, but only 1.9 M have been administered so far, and over the past week the vaccination rate has actually dropped a bit. So I modeled that based on the assumption of a smooth ramp-up until J&J's projection of 95M doses shipped by the end of May is administered two weeks later (same link).

We're a bit behind what I was predicting overall, mostly due to the J&J vaccine continuing to not ramp up. It just started to ramp at the beginning of April, from about 100,000 doses administered per day, to 350,000 as of a few days ago. If it continues that ramp rate, it won't meet the 95M goal.

• 2nd doses of the Moderna & Pfizer vaccines are also not ramping-up. It's been fluctuating between 0.5 and 0.9 million per day for more than a month.

Now starting to ramp-up: currently about 1.2M per day.

• I have the total administered (1st + 2nd + J&J) continuing its current ramp rate. By the 2nd week in June it would reach 6 million per day if we don't run out of people to vaccinate. Currently it's about 2.5 million per day.

As I said, we're trending a little below my projections mostly due to the J&J vaccine, by about a week. But again, 6 million doses/day won't happen because we'll run out of people to vaccinate first. We could reach 5 million/day by the end of May, but that probably won't even happen. We're at 3 million/day now.

• There's 30 million doses of the AZ vaccine stockpiled. AZ has not applied for emergency use authorization yet, so there's a decent chance these doses don't factor into the USA's vaccination picture until we're well into the "everyone else" group if at all (more on that in the projections...).

The AZ vaccine will almost certainly not factor into the first wave USA vaccination picture.

Projections:

• By April 10, 131M will have received at least a first dose and 75M will be fully vaccinated.
• When the vaccine is opened up to "everyone else", that will include me. I'll be aggressive about scheduling, so I'll expect I can get at least the first dose (if a 2-dose vaccine) by April 10.
• By April 20, 155M will have received at least a first dose and 114M will be fully vaccinated. We will need to have transitioned to the "everyone else (>16)" eligibility by then or we'll start running out of people to vaccinate.

Actual April 10 numbers are 121M at least one dose, 74M fully vaccinated. These will go up by a couple million, as the CDC lists totals by date reported on their dashboard, but updates by date administered in a spreadsheet. Despite the 72hr required reporting time, the numbers for a particular date continue going up for weeks.

Biden wants everyone eligible by April 19. My state just announced they are opening-up eligibility to every adult tomorrow (so I was off by 3 days on that). I've seen in my graph of the running totals that the distribution pipeline is starting to lengthen, which may be a result of starting to "run out of people to vaccinate" in Phase 1.

• By May 10, even at 90% uptake we'll start running out of adults to vaccinate (everyone who wants one will have at least a first dose), and the rates will start to flatten or drop. I haven't modeled how that will look.
• By May 30, every adult who wants to be vaccinated will have been fully vaccinated (234 M) if everyone lines-right up for them (so the rates don't drop).

These are looking a week or so behind, but again we'll run out of people to vaccinate anyway before we get to them. We'll start to find out in a few weeks just how much vaccine hesitancy there is.

Side note: My area has been re-opening, too quickly. Case rates are too high, and they've been flat for the past few weeks even as restrictions are easing. As close as we are to the finish line, I think that's dumb and I'm not easing up on my protocols. I won't be doing any indoor dining, traveling, going to the gym or permanently returning to my office, etc. until I'm fully vaccinated or the case rates drop another order of magnitude. What's another month after 12? I believe tomorrow's my 1-year anniversary of work from home.

That remains my opinion. But I did go out to dinner for my dad's 78th birthday on Saturday.

 

[Astronuc]

Reuters - Majority of Brazil COVID-19 ICU patients aged 40 years or younger - report
https://www.reuters.com/article/us-...aged-40-years-or-younger-report-idUSKBN2C02UB

RIO DE JANEIRO (Reuters) - The surging COVID-19 outbreak in Brazil is increasingly affecting younger people, with hospital data showing that last month the majority of those in intensive care were aged 40 or younger, according to a new report.

The report, released by the Brazilian Association of Intensive Medicine (AMIB) over the weekend, is based on data from over a third of all the country’s intensive care wards. It found a significant increase in younger people being admitted to beds in Intensive Care Units (ICUs).

For the first time since the outbreak reached Brazil last year, 52% of ICU beds were filled by patients aged 40 or younger. That is a jump of 16.5% compared to the occupancy of that age group between December and February.

I have a friend who still believes SARS-Cov-2 (and Covid-19) is not a serious threat. He believes he is young enough (late 50s), and he states that many acquaintances have had Covid-19 and survived. He believes the vaccine and precautions are unnecessary, so he takes chances. We still don't know who is and who is not vulnerable, but age and comorbidities are factors. I won't take a chance.

 

[mfb]

It's a relative statement. Vaccinate older people first and the fraction of younger people in ICU increases, without anything negative happening. Without absolute numbers this isn't telling us much.

 

[Wrichik Basu]

In my country, the situation is worsening every day. Six days back, we were having ~ 145k new patients every day. Since yesterday, it has grown to > 215k. Higher deaths as well. People are not wearing masks anywhere. Neither does the Govt. have any plans for lockdown because of ongoing elections in many states (including mine). Essentially, no containment efforts.

A graph on the daily new number of COVID-19 patients (from a Bengali newspaper) is available here.

 

[WWGD]

In my country, the situation is worsening every day. Six days back, we were having ~ 145k new patients every day. Since yesterday, it has grown to > 215k. Higher deaths as well. People are not wearing masks anywhere. Neither does the Govt. have any plans for lockdown because of ongoing elections in many states (including mine). Essentially, no containment efforts.

A graph on the daily new number of COVID-19 patients (from a Bengali newspaper) is available here.

View attachment 281603

Ouch! Sorry to hear that. Worldwide, we hit the 3 million deaths milestone today, and stuck at 500,000+ cases, 10,000+ deaths daily.

 

[dlgoff]

I have a friend who still believes SARS-Cov-2 (and Covid-19) is not a serious threat. He believes he is young enough (late 50s), and he states that many acquaintances have had Covid-19 and survived. He believes the vaccine and precautions are unnecessary, so he takes chances. We still don't know who is and who is not vulnerable, but age and comorbidities are factors. I won't take a chance.

Do you still consider him a friend?

 

[WWGD]

Do you still consider him a friend?

Valid concern, but ostracizing someone for their ( absurd, nonsensical) beliefs is rarely if ever the way of bringing them around.

 

[StevieTNZ]

https://www.channelnewsasia.com/news/world/australia-death-blood-clots-linked-astrazeneca-covid-19-vaccine-14635410

Australia on Friday (Apr 16) reported its first death from blood clots linked to the AstraZeneca COVID-19 vaccine after the country's regulator said a 48-year-old woman's fatality was "likely" linked to the shot.

Australia's Vaccine Safety Investigation Group (VSIG), which held a late meeting on Friday, concluded the New South Wales woman's death was likely linked to the vaccination, the Therapeutic Goods Administration said in a statement.

 

[dlgoff]

Valid concern, but ostracizing someone for their ( absurd, nonsensical) beliefs is rarely if ever the way of bringing them around.

Agreed. Hopefully He will come around.

 

[WWGD]

Agreed. Hopefully He will come around.

I don't mean to preach to you; I can be a hot head and just blurt things in anger that I most likely should not.

 

[Vanadium 50]

I have a friend who still believes SARS-Cov-2 (and Covid-19) is not a serious threat. He believes he is young enough (late 50s), and he states that many acquaintances have had Covid-19 and survived. He believes the vaccine and precautions are unnecessary, so he takes chances. We still don't know who is and who is not vulnerable, but age and comorbidities are factors. I won't take a chance.

I wouldn't either, but, despite the comments on this thread, your friend is not being completely irrational. Being in the 40-49 age group reduces the probability of dying to about the same level as being vaccinated, just from being younger.

"I'm not going to get vaccinated" and "I'm going to get vaccinated and then run out and indulge in all the risky behaviors I've missed" have (in that age bracket) comparable risks. Yet one is less accepted than the other. Why is that?

 

[mfb]

"I'm not going to get vaccinated" and "I'm going to get vaccinated and then run out and indulge in all the risky behaviors I've missed" have (in that age bracket) comparable risks.

I don't think it's useful to compare COVID-19 to skydiving, drunk driving or whatever you have to do to get a comparable risk.

 

[Vanadium 50]

There is a paper out, "The lockdown effect: A counterfactual for Sweden". It claims that had Sweden locked down, they would have reduced infections by 75% and fatalities by 38%. That would have moved Sweden from the middle of the pack of European countries to the top quintile.

This has gotten some press, mostly along the lines of "Ha ha Sweden. We told you so."

I find the methodology very interesting. They weight the statistics of the other countries pre-lockdown until it matches Sweden, and then look at the post lockdown numbers for those countries. However, I did not think the paper itself was very good. I have two main objections:

(1) There is nothing magic about Sweden. They could and should have done this for every country, showing that the technique has predictive power. Apart from validating the technique, it would have allowed them to quantify the uncertainty in the method. is it good to 1%? 10%? A factor of two?

Furthermore, there's nothing magic about now. They should be able to calculate infections vs. time and deaths vs. time and compare.with what actually happened.

(2) If a lockdown reduces infections by 75% and fatalities only by 38%, somehow it means it increases the severity of the disease. Hmmm...

Of course, one could argue maybe this is just a demographic effect - that a lockdown preferentially protects a less vulnerable population. Fair enough, but I'd expect the paper to detail this.

I think a really good paper could be written along these lines. This paper, though, IMO isn't it.

 

[Vanadium 50]

Which numbers do you compare here?

Deaths per unit population by age and vaccine effectiveness.

We can argue about exactly where the lines cross, but cross they do.

 

[Vanadium 50]

I don't think it's useful to compare COVID-19 to skydiving, drunk driving or whatever you have to do to get a comparable risk.

I don't think I am comparing that to drunk driving. I think I am comparing it to going to a party without a mask.

 

[PeroK]

Deaths per unit population by age and vaccine effectiveness.

We can argue about exactly where the lines cross, but cross they do.

The lines cross, if at all, in children. For example, in January 2021 in the UK there were 39 deaths from COVID recorded for the age group 20-29. That's out of about 8 million people. That's just one month. With a bit of calculation I would say that without a vaccine about 200 people in the 20-29 age group would die before the pandemic naturally runs its course. That's one in 40,000.

The risk from the vaccine is about 25 times less, although both numbers are small - which ties in with the publicity that younger people need to be vaccinated only a little for themselves and mostly to protect others.

PS there are almost no deaths in people under 20.

 

[.Scott]

I just read another article about whether some counties with low vaccination interest will ever reach COVID-19 herd immunity.

This is a mis-placed concern. Communities with low interest in the vaccine commonly have low interest in other COVID precautions - and so they will certainly reach herd immunity. They're just choosing sick over stick.

 

[hmmm27]

If various gov'ts could find their collective balls, borders - country/province/city/etc - would be closed to people/shipments from places with worse stat's.

 

[Wrichik Basu]

We are seeing a great shortage of oxygen supply in our country. The central Govt. has prohibited use of O₂ for industrial and educational purposes, so that the supply can be diverted to hospitals only. The railways have arranged for special trains known as "Oxygen Express" for delivering cylinders very fast via green corridors. There is a shortage of remdesivir too; I read in the news some days back that people are buying the drug from the black market for 7 to 12 times the list price.

Most of the political parties (except one) have cut down their election campaigns to help curb the spread of the virus.

In the last 24 hours, 273,810 more people contracted the virus countrywide, with 1,619 deaths. The total number of active patients is 1,929,329.

 

[StevieTNZ]

NZ has banned all flights originating or transiting through India, as many in MIQ having arrived from that country were returning positive Covid results.

 

[mfb]

I don't think I am comparing that to drunk driving. I think I am comparing it to going to a party without a mask.

Do we have a COVID-19 death from someone vaccinated now? The vaccine reduces deaths to essentially zero, going to a party can't beat that.

 

[Vanadium 50]

Do we have a COVID-19 death from someone vaccinated now?

74. (In the US)

An interesting outcome is that the question of dying with Covid and dying from Covid is back. But many people have switched sides.

The vaccine reduces deaths to essentially zero,

That's not what the CDC statistics show. Their numbers are 5800 post-vaccination cases, 400 hospitalizations, and 74 deaths. If you took 5800 random unvaccinated cases, you would expect just over 100 deaths.

Sol, does the vaccine reduce the severity? Taking the numbers at face value, a little. However, you would expect deaths/case to be lower post-vaccination even if severity were unchanged, because the denominator has been redefined. Pre-vaccination, someone with antibodies is a "case", even if asymptomatic. Post-vaccination, someone with antibodies and no symptoms is not a "case" - it's "just the vaccine doing its job".

 

[Ygggdrasil]

That's not what the CDC statistics show. Their numbers are 5800 post-vaccination cases, 400 hospitalizations, and 74 deaths. If you took 5800 random unvaccinated cases, you would expect just over 100 deaths.

Sol, does the vaccine reduce the severity? Taking the numbers at face value, a little. However, you would expect deaths/case to be lower post-vaccination even if severity were unchanged, because the denominator has been redefined. Pre-vaccination, someone with antibodies is a "case", even if asymptomatic. Post-vaccination, someone with antibodies and no symptoms is not a "case" - it's "just the vaccine doing its job".

While I don't question the numbers (they are the numbers that the https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html), they don't seem consistent with other reports that the vaccine does reduce severity of disease. For example, in real world data from Israel published in the NEJM, they saw 9 deaths among 4460 infections among vaccinated individuals (0.2%) but 32 deaths among 6100 matched unvaccinated control individuals (0.5%).

Similar reductions can be seen in the clinical trial data for the various vaccines. I wonder why the data from the US seem to show less efficacy at preventing infection to progressing to death.

 

[russ_watters]

I wouldn't either, but, despite the comments on this thread, your friend is not being completely irrational. Being in the 40-49 age group reduces the probability of dying to about the same level as being vaccinated, just from being younger.

"I'm not going to get vaccinated" and "I'm going to get vaccinated and then run out and indulge in all the risky behaviors I've missed" have (in that age bracket) comparable risks. Yet one is less accepted than the other. Why is that?

Speaking of riskier behaviors than skydiving, I just sent my manager an email saying I'm willing to go back to the office full time after being fully vaccinated (in about 6 wks). Surely being in the office is more than 20x more dangerous than being at home. 95% effective sounds (is) awesome and while I previously expressed that once I'm vaccinated I would no longer need to care about my COVID risk or the choices of others, now that it's closer to reality 95% doesn't sound like that big a number anymore. For example...

The new case rate criteria for starting to re-open, which we never achieved, was 3.5 per 100k per 2 weeks. The lowest in my area was 4, in late June. Right now we are at about 40 and rising. So by those numbers, doing something risky like eating near other people while vaccinated would only be about twice as safe as while unvaccinated last June, unless we can quantify the severity decrease on top of the 95% efficacy. Twice as safe does not sound like a big improvement...it's a lot smaller than 20x safer.

This is something I'll need to weigh unless the case rates start dropping again.

 

[Vanadium 50]

I wonder why the data from the US seem to show less efficacy at preventing infection to progressing to death.

The tyranny of mathematics. We have two firm numbers, a squsihy number, and a desire for a particular outcome from a public policy perspective.

Numbers vaccinated and number dead are pretty firm. The number of cases is not so firm, and it depends on the definition of a case, which has some flexibility and human judgement. What the public health officials want to tell the populace is that cases/vaccinated and deaths/cases are as low as possible.

Obviously, there's no definition of "cases" that minimizes both ratios. Different countries, different choices.

Also, different countries use different vaccines. While we are told that all three varieties have exactly the same protection, and exactly the same small risk of side effects (well, until one was pulled, anyway), maybe this isn't true.

 

[Vanadium 50]

Surely being in the office is more than 20x more dangerous than being at home.

Why do you think that? Only one person is allowed in my office (one on one meetings are held with me in my office and the other person in a chair outside my door) My office gets cleaned and disinfected daily. People who are in more often than me (I am slowly ramping up to weekly) get tested. At home you have to worry about whatever germs your spouse and kids drag in.

I'd be prepared to say it's riskier - but a factor 20 riskier?

 

[russ_watters]

Why do you think that? Only one person is allowed in my office (one on one meetings are held with me in my office and the other person in a chair outside my door) My office gets cleaned and disinfected daily. People who are in more often than me (I am slowly ramping up to weekly) get tested. At home you have to worry about whatever germs your spouse and kids drag in.

I'd be prepared to say it's riskier - but a factor 20 riskier?

I'm looking into acquiring one of those "spouse" things. Right now I have "girlfriend", which I don't keep in my house. This provides a buffer/enables quarantine in case of exposure.

My office today has very low occupancy, maybe 20 people in 30,000 Sq ft. Normally I'm in a cubicle with low walls and right now a checkerboard occupancy pattern. I'm speculating that by the time I get back it will be half occupied; maybe 100 people. I'm not sure when the checkerboard pattern will be discontinued. We don't do any testing, but we have exposure/quarantine protocols and internal social distancing.

Still, and I do mean this 90% seriously; my risk of exposure from my coworkers is exactly zero if I stay home and some non-zero number if I go into the office. I really don't know how to quantify the difference without a divide by zero error.

 

[russ_watters]

Also, different countries use different vaccines. While we are told that all three varieties have exactly the same protection, and exactly the same small risk of side effects (well, until one was pulled, anyway), maybe this isn't true.

We're told to get the first vaccine we can get, without considering the efficacy. I was already having mixed thoughts on that, but then the J&J vaccine got halted and the decision was re-made for me (my J&J vaccine appointment was for the day after the halt). The J&J vaccine is said to have between 66% and 75% efficacy. That's better than most flu vaccines but way, way worse than the 95% of the Pfizer/Moderna vaccines. To make it even more complicated, it takes 2 weeks to achieve full efficacy with the J&J vaccine vs 5 weeks for Pfizer/Moderna. I'd rather just stay home and wait 3 more weeks for the 95% than assume I'm good to go back to work/restaurants/parties after 2 weeks at 66-75%.

It's almost certainly better for policy to tell people to get the first available dose, but it's probably better for me to get the more effective one. Fortunately the J&J vaccine is going to end up as a small fraction of our first wave of vaccinations so "we" don't have to consider the ethics of that guidance if we don't want to...though it will matter for other countries, particularly less developed ones.

https://www.healthline.com/health-n...first-covid-19-vaccine-thats-available-to-you