COVID-19 Coronavirus Containment Efforts

[bhobba]

Just a note on the latest from Australia's CSIRO including a video about their testing of vaccines:
https://www.csiro.au/en/News/News-releases/2020/Covid19-expert-commentary

They still seem to think end of this year, beginning of next year - or maybe I misinterpreted what they were saying.

Thanks
Bill

 

[mfb]

Ivermectin is an inhibitor of the COVID19 Coronavirus SARSCoV2 IN VITRO. A single treatment is able to effect ∼5000-fold reduction of the virus at 48H in cell culture.

Strong acids, bases, and a gun can get a more than 5000 fold reduction in seconds - in cell culture.
Ivermectin has been tested in humans but it's unclear if you can get it to the right place in the right dose.

 

[peanut]

Strong acids, bases, and a gun can get a more than 5000 fold reduction in seconds - in cell culture.
Ivermectin has been tested in humans but it's unclear if you can get it to the right place in the right dose.

There are no approved treatments so repurposing of any approved drug is promising. Especially of an old drug with a well-known safety profile. This is even more widely available than chloroquine / hydroxychloroquine or ribavirin or teicoplanin and cheaper than Azithromycin. The other potential options such as the mAbs & plasma-derived therapies are complicated logistically & expensive. Dosing will be a different issue & that’s why more studies are needed.

 

[Astronuc]

I know the quarantine is helping slow the spread of the virus, but my question is why are the cases still rising? Where are all these people getting sick from?

The virus may spread from those who are asymptomatic or have mild symptoms, and who do not get tested, so they and the authorities do not know they are contagious. The obvious positive cases get tested. The isolation/stay-at-home is not consistently practiced or enforced. In the US, only 21 of 50 states implemented stay-at-home before March 25, and there were already thousands of cases. States that implemented stay-at-home did so only after it because obvious to authorities that infections were going up, but by then, infections were widespread and new cases began to appear at a higher rate. There is some thought that for every 1 confirmed case, there are 4 to 5 unconfirmed cases.

We also see various 'super-spreading' events where groups of 40 - 200+ gather for a party, or funeral, or whatever either in a confined area or closely packed, and one or more persons are infected, then others who are infected return to from wherever they came and spread the virus in those locations.

Search this thread for 'super-spreading'.

 

[Vanadium 50]

It is possible that cases of influenza are under-reported, but then again, in the beginning, some COVID-19 cases were initially thought to be cases of influenza.

Here is what the document that says 91 cases says about that:

Note that influenza deaths are likely under-reported. The reasons for this under-reporting vary. Influenza may not be listed as a cause of death, influenza testing may not have occurred in a timely fashion to identify the virus, or may not have been performed at all, and lab-confirmed influenza deaths may not have been appropriately reported to public health.

I'm willing to take them at their word that 91 is too low.

 

[Astronuc]

I'm willing to take them at their word that 91 is too low.

But by how much? By a factor of 2 or 3? Even with a factor of 2 or 3, it would still be less than COVID-19 over the last 5 weeks (or since Feb 27) in Washington state. From January 15 - February, Washington state had a small number of positive cases and fewer deaths, and an unknown number of infections.

One could argue that such numbers (deaths to influenza, or cases of influenza in general) have always been under-reported for the same reasons given. I don't know if my case was ever reported since I wasn't tested (and I was not hospitalized, nor did I die), but just treated and sent home. The same would apply to COVID-19 deaths, for the same reasons.

In the two counties where I lived during the last month, there are cases where folks died, but tests for COVID-19 were not performed. Many who die also have underlying causes.

In one case, where a woman died from COVID-19 (positive test + symptoms), the husband died the same weekend from a heart attack, but apparently, he wasn't tested. Given that he lived in close proximity, with his wife, he likely had COVID-19 as well, which may have contributed to a heart attack.

On the last reason for under-reporting, "lab-confirmed influenza deaths may not have been appropriately reported to public health," that is disturbing, since it indicates that the public health system is not functioning properly - if it ever was. Hell of time to find out!

Anecdotally, my wife had a conversation this evening with a fried who is a physician's assistant locally. The PA indicated that tests for COVID-19 are taking up to 6 days for results. The numbers reported by the county health department are lagging actual cases. The number hospitalized is apparently significantly under-reported, and one hospital is described as a 'mess', which I take to mean overwhelmed, but that's not quantified.

 

[peanut]

The virus may spread from those who are asymptomatic or have mild symptoms, and who do not get tested, so they and the authorities do not know they are contagious.

Yes. Though there is very LITTLE data on any kind of ASYMPTOMATIC transmission precisely because these people are hard to identify. PRESYMPTOMATIC transmission does seem to occur and may be responsible for probably up to 10% of transmission. The MAJORITY (about 90%) of transmission STILL seems to occur from symptomatic individuals.

 

[Astronuc]

Yes. Though there is very LITTLE data on any kind of ASYMPTOMATIC transmission precisely because these people are hard to identify. PRESYMPTOMATIC transmission does seem to occur and may be responsible for probably up to 10% of transmission.

Unless asymptomatics are associated with someone who is a confirmed case, they are impossible to identify, because they are not tested, at least not in the US. It would seem that Presymptomatics are Asymptomatics who later develop symptoms.

The MAJORITY (about 90%) of transmission STILL seems to occur from symptomatic individuals.

What study or studies? For example, a study on transmission by presymptomatic individuals, https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm

 

[mfb]

Unless asymptomatics are associated with someone who is a confirmed case, they are impossible to identify, because they are not tested, at least not in the US. It would seem that Presymptomatics are Asymptomatics who later develop symptoms.

Some countries do (somewhat) random tests.

I learned why Germany has such an odd pattern of daily new cases: The individual states group their reports differently and don't necessarily make exactly one update per day. See e.g. NRW, BY, BW (second plot in each case).
Ignoring the day to day fluctuations, its new case count looks more stable now. Same for Spain, while France seems to report falling new cases (but with large fluctuations).
The US is earlier in its outbreak, it's still rising quickly.Something I haven't seen discussed explicitly so far, although some numbers take it into account: If 10% of the population got it then the spread doesn't decrease by 10%, it should decrease by much more. These 10% are not randomly sampled from the population, they are heavily biased towards people with more contacts. All the potential superspreaders are among the 10% who got it.

 

[bhobba]

Regarding comparing Covid to influenza it is true some think Covid has a similar death rate etc to influenza if we had no vaccine. The big difference isn't that - its the R0 - that is much higher and why it spreads with such ease. The R0 of flu is about 1.3 and 2.3 for Covid. Of course these are averages, the true number depends on setting eg if you are doing regular hand washing, social distancing, in lockdown etc. If R0 is less than 1 it dies out or rumbles on at a low level. You obviously have to do much less to get the flu below 1 than Covid, and not only that the exponential rate of growth is higher so when it strikes it strikes with greater ferocity in numbers infected.

Thanks
Bill

 

[OCR]

There are no approved treatments...

However, I did read a brief discussion concerning the fact, that how, due to our

ability to adapt, could very well be leading to. . . an attainable form of pathogenic

resistance !
.

 

[Rive]

Regarding comparing Covid to influenza it is true some think Covid has a similar death rate etc to influenza if we had no vaccine.

Unfortunately, no. Usually flu comes with much lower death rate and in this vaccianation actually makes no difference: that effects only the R0 value.
Novel flu can do something similar, at least we know a case when it did.

Another difference is, that flu often kills those who are already weakened by some serious illness. Covid19 however, might cause a pneumonia which is severe just by itself.

 

[mfb]

https://www.vetmed.ucdavis.edu/news/can-pets-contract-coronavirus-humans-or-vice-versa

This was posted in February. A new study finds different results for cats:
Susceptibility of ferrets, cats, dogs, and different domestic animals to SARS-coronavirus-2
Cats can infect each other with coronavirus, Chinese study finds
This is only humans -> cats and cats -> cats, they didn't find cats -> humans transmission but it won't be impossible.
The virus doesn't replicate well in dogs, pigs, chickens, and ducks.

----

Spanish Government Aims to Roll Out Basic Income ‘Soon’
For a long time this has been discussed in many places but never made it beyond small tests. This will be interesting to watch.

----

Italy starts to look ahead to 'phase two' as COVID-19 death toll slows

They will keep the current restrictions for a while to reduce the new cases more, but then they will explore which measures are needed to keep R<=1. Unlike the first outbreak, they have several advantages, lowering R:
* The population is well aware of the threat
* Vastly improved testing capacity
* Better contact tracing
* Increased production of face masks and similar protective equipment
* Better treatment, including dedicated hospitals

I hope the rest of the world watches this closely.

 

[DrClaude]

This was posted in February. A new study find different results for cats:
Susceptibility of ferrets, cats, dogs, and different domestic animals to SARS-coronavirus-2
Cats can infect each other with coronavirus, Chinese study finds
This is only humans -> cats and cats -> cats, they didn't find cats -> humans transmission but it won't be impossible.
The virus doesn't replicate well in dogs, pigs, chickens, and ducks.

There seems to be something about felines:
https://www.theguardian.com/world/2020/apr/06/bronx-zoo-tiger-tests-positive-for-coronavirus

 

[Vanadium 50]

But by how much?

That would be a guess. If you want my guess, fine, but it shouldn't carry the authority of an official number. (And I would argue that the best way to express the official number, given what they have written, is "more than 91".

 

[anorlunda]

Something I haven't seen discussed explicitly so far, although some numbers take it into account: If 10% of the population got it then the spread doesn't decrease by 10%, it should decrease by much more. These 10% are not randomly sampled from the population, they are heavily biased towards people with more contacts. All the potential superspreaders are among the 10% who got it.

I had to read that 3 times to understand. That is an excellent point.

At some point, we need to pay attention to people recovered from COVID-19. They should be among the first to be released from lockdown to get things restarted. Unfortunately they won't have any documentary proof that they had it and recovered.

 

[Astronuc]

At some point, we need to pay attention to people recovered from COVID-19. They should be among the first to be released from lockdown to get things restarted. Unfortunately they won't ave any documentary proof that they had it and recovered.

I thought some nations would give those who recovered a certificate that they had been treated and recovered. I don't know if that's the case in the US. I suppose one could request a note from a doctor, or health department.

 

[mfb]

Unfortunately they won't have any documentary proof that they had it and recovered.

At least in Germany they should.
https://www.businessinsider.com/cor...tes-testing-social-distancing-lockdown-2020-3
https://www.theguardian.com/world/2...-could-speed-up-return-to-work-after-covid-19

As far as I know other countries consider something similar.

 

[Astronuc]

That would be a guess. If you want my guess, fine, but it shouldn't carry the authority of an official number. (And I would argue that the best way to express the official number, given what they have written, is "more than 91".

But 91 is the official number. However, it should be reported with the caveat, "Note that influenza deaths are likely under-reported. The reasons for this under-reporting vary. Influenza may not be listed as a cause of death, influenza testing may not have occurred in a timely fashion to identify the virus, or may not have been performed at all, and lab-confirmed influenza deaths may not have been appropriately reported to public health."

Re-reading the pdf report, that caveat applies to historical data as well. It is buried on page 10 under "Past season summaries are available"! It shows up in the 2014-2015 report and since then, but not in earlier reports on the page with the set of reports. The systematic error in reporting is not mentioned, and probably not known, it would seem, and it may vary by county.

 

[nsaspook]

https://qz.com/1832988/covid-19-results-in-new-jersey-desperately-needing-cobol-coders/

In New Jersey, experts are now needed to fix COBOL-based unemployment insurance systems—more than four decades old—that are overwhelmed due to pandemic-related job losses. At a press conference yesterday, governor Phil Murphy asked for the help of volunteer coders who still knew how to work in COBOL.

Of course, as cyber-security expert Joseph Steinberg noted on his blog, such volunteers are likely well over 60 years old, making them especially vulnerable to Covid-19. Whether they would risk venturing out (or work on a volunteer basis, for that matter) to fix creaky systems that should have been updated decades ago is an open question.

 

[Vanadium 50]

But 91 is the official number.

Yes it is. However, I wouldn't use it in any calculation because a) it implies that there is something special about the State of Washington that causes their flu death rates to be a factor of ~3ish to ~10ish smaller than in the rest of the country and b) the people who say "91" also say it is an underestimate.

 

[Astronuc]

Yes it is. However, I wouldn't use it in any calculation because a) it implies that there is something special about the State of Washington that causes their flu death rates to be a factor of ~3ish to ~10ish smaller than in the rest of the country and b) the people who say "91" also say it is an underestimate.

The only way to use the number is comparatively with previous years numbers from Washington state, and even then one cannot draw a definitive conclusion without knowing how under-reported this year is compared to previous years. One would also have to dig deeper into variables like access to health-care and what fraction of the population is vaccinated. And one would have to sample data from the 39 counties to see how reporting of cases and fatalities compares within each county and historically. Reporting in the Seattle metropolitan area may be different than counties in the SW (Vancouver), NE (Spokane) and SE (Yakima, Tri-Cities, Walla Walla) of the state.

It would be interesting to map influenza cases and fatalities against population density in the state.
https://commons.wikimedia.org/wiki/File:Washington_population_map.png

 

[Mary Conrads Sanburn]

GLOBAL COVID – 19 LOCKDOWN TRACKER

Last updated 06 April 2020

https://auravision.ai/covid19-lockdown-tracker/

 

[peanut]

Does anyone knows what the doctors gave him? Any treatment?

https://www.straitstimes.com/world/...merican-is-worlds-oldest-coronavirus-survivor

 

[Astronuc]

Does anyone knows what the doctors gave him? Any treatment?

https://www.straitstimes.com/world/...merican-is-worlds-oldest-coronavirus-survivor

According to the article, He had a 'moderate' case of Coronavirus according to Dr Rob Richardson, his physician. However, he did not develop any serious breathing problems.

And - Two nurses in contact with Mr Lapchies and the other resident who was first infected and later died had shown the same symptoms. Both nurses were told to get tested by the home, but were turned away with 'mild' symptoms and continued to work for a week before they both tested positive.

There are a few cases of elderly surviving, but perhaps many more who do not. We don't know yet who is or is not susceptible to the virus in terms of severity of symptoms.

 

[PeroK]

I thought some nations would give those who recovered a certificate that they had been treated and recovered. I don't know if that's the case in the US. I suppose one could request a note from a doctor, or health department.

There won't be very many of them. If we believe the figures and stop this phase at around 70,000 recovered in the UK, say, that's only 0.1% of the population. That leaves 999 people out of every 1000 still in lockdown - or, not in the clear.

 

[Astronuc]

Various news sources are reporting UK Prime Minister Boris Johnson was moved to the intensive care unit at St. Thomas's Hospital, according to a Downing Street. Two sources indicate the move to ICU came after his condition (COVID-19) worsened.

BBC - https://www.bbc.com/news/uk-52192604

 

[DennisN]

As one of many famous people getting Covid-19, the UK prime minister Boris Johnson has recently been taken into intensive care. He is 55 years old.

Source: Coronavirus: Boris Johnson taken into intensive care (The Guardian, 6 april 2020)

EDIT: I saw @Astronuc was faster than me.

 

[atyy]

Aiyoh ...

 

[mfb]

There won't be very many of them. If we believe the figures and stop this phase at around 70,000 recovered in the UK, say, that's only 0.1% of the population. That leaves 999 people out of every 1000 still in lockdown - or, not in the clear.

It includes a significant share of the healthcare workers - probably even more than the confirmed cases among them.

Folding@Home has COVID-19 packages. If you have a computer that isn't 100% busy with other tasks you can contribute some CPU cycles to searches for vaccines or cures: Folding@Home
You can't select COVID-19 in particular, but if you keep it set to "any disease" the chance to get one of these is probably quite high. My computer is working on one right now.

 

[WWGD]

Unfortunately, in the third world countries, where everyone is crammed into a tight space, some people seriously think the kids won't bring the virus home, or if they get it from their home, bring it to school? And who brings a lot of kids to school? Adults! Plus the teachers. And you know what? Grandma and grandpa live with these kids! If they contract the virus it may kill them. And I think the reason why testing of kids isn't done much: (two words) nasopharyngeal swab. Try sticking that baby down your 7-year old's nose. No. Schools should stay closed. .

Think of those crammed in slums with 60,000+ per square mile.

 

[WWGD]

Boris Johnson moved to ICU. Sorry, I have a phone and don't know how to cut and paste for sourcing.

 

[Vanadium 50]

A few points. One is that Nate Silver (former bookie and now runs Five Thirty Eight) has a pretty good write up Corona Case Counts are Meaningless. His point is that number is sampled and calculated differently in different places, and is not a very good indicator of what is going on.

Second, @Astronuc seems to have taken issue with my claims that the Washington flu numbers are underestimated (although they are probably underestimated by the same factor year to year). So here's my comparison between flu and Covid.

1. Europe:

Thanks to @Stephen Tashi , we have total death statistics from Europe from all causes. Europe has been both harder hit and is in a later stage of the epidemiology than the US.

That uptick in 65+ and Total at the very end is Covid. The downtick in the other age groups is hypothesized by @russ_watters to be a side effect of lockdowns. You can see the spikes (which look like lumps) in the last three winters. The CDC US death estimates for flu for those years was, starting with 2018-9 and working backward, 34K, 61K (in two phases) and 28K, these are all fairly high years. Low years are more like 20K, sometimes as low as 12K.

Comparing the relative heights of the Covid spike with the Flu "spikes" tells you something about the relative number of fatalities without needing to correctly account for any individual death.

2. Greater New York City:

I am going to start with the Diamond Princess data. Since everyone was tested, we have a fairly good dataset. Furthermore, the population density is about the same as Manhattan: 68000 per square mile. It's also the density of greater NYC, defined as the five boroughs and nearby cities in New Jersey, but not counting Long Island, Connecticut etc.

On the Diamond Princess, they had everyone interacting in close quarters until the first symptoms showed (about two weeks), and then they locked everything down. Not too different than NY. So we have a pretty good, but not perfect, proxy.

18% of the passengers and crew tested positive, and the fatality rate is 1.8%. However, cruise demographics skews elderly. The median age of cruise passengers is 65. The US as a whole has 14% of its population 65+. Since the disease affects primarily the elderly, there should be a correction of 14/50 to the 1.8%, making it 0.5%. That doesn't count the crew (none of whom died), so 0.7% is probably closer.

If you say 15M people in the NYC area, 2.7M of them will be infected if you treat it as a giant cruise ship. About 20K will die. Time will tell how accurate this model is. If you just take the NYC numbers and place them over the Hubei graph, extrapolate, and correct for the inner suburbs, you get 22K.

How many died of the flu in the same window? Assuming 34,000 deaths in the country, like last year, that would correspond to about 1600. A bad year would be twice that, and a good year half that. How many die in a year from all causes? About 130,000.

How does this extrapolate to the rest of the country? No idea. The 18% number will come down, but I have no idea how much. I'd need at least one more data point.

 

[Keith_McClary]

I know the quarantine is helping slow the spread of the virus, but my question is why are the cases still rising? Where are all these people getting sick from?

There are still groceries, pharmacies and supply chain workers (trucking, warehouse, gas stations, ...).

 

[Jarvis323]

An interesting active research topic:

In conclusion, although there is no conclusion regarding the association of COVID-19 with RAS inhibitors, RAS inhibitors can affect the expression of ACE2 mRNA and the activity of ACE2 in tissues; theoretically, it is possible that ACE2 could promote the proliferation of COVID-19 and enhance its capability for infection. Therefore, large-scale clinical studies are urgently needed to explore COVID-19 susceptibility and corresponding treatment strategies in patients with hypertension treated with RAS inhibitors.

https://www.nature.com/articles/s41440-020-0433-1