COVID-19 Coronavirus Containment Efforts

[WWGD]

This is a good case study for herd immunity...lock down that place and let's see who survives...I'm beginning to favor herd immunity, if we can have the old, very young, immunocompromised people protected or secured.

I understand the Netherlands have been implementing it yet they are not doing so well; maybe one can claim they would be doing worse without it. They are doing better than neighbor Belgium but the two may not be independent. I don't know how ethical it is to have people subjected to such test, specially without their consent.

 

[Ygggdrasil]

If some countries manage to get it back to the stage of being manageable by contact tracing and some degree of social distancing that still allows many businesses to operate, then it may be ok to test only symptomatics and those highly at risk (eg. very close contacts of positives). Testing the general population also has a false positive risk. Maybe something like the South Korean testing strategy.

A new paper estimates that people with COVID-19 are most infectious before the onset of symptoms and that infections from pre-symptomatic individuals accounts for a fairly large proportion of infections, when analyzing a population of patients from a hospital in China:

we inferred that infectiousness started from 2.3 days (95% CI, 0.8–3.0 days) before symptom onset and peaked at 0.7 days (95% CI, −0.2–2.0 days) before symptom onset. The estimated proportion of presymptomatic transmission (area under the curve) was 44% (95% CI, 25–69%).

He et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. Published online 15 Apr 2020. doi:10.1038/s41591-020-0869-5
https://www.nature.com/articles/s41591-020-0869-5

This work would seem to challenge the effectiveness of a strategy that only tests symptomatic individuals.

https://www.washingtonpost.com/heal...f71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html

Are there other bacteria or viruses that can damage other organs like kidneys or the heart? I know syphilis can. The Covid-19 virus has indications it can.

Influenza increases the risk of heart attacks:
https://www.npr.org/sections/health...iously-the-flu-can-trigger-a-heart-attack-too
https://www.cdc.gov/flu/highrisk/heartdisease.htm

What should we make of the recent report of 1,290 deaths in China after more than some 3 months when we had a trickle of 3-4 deaths every other day?

From CNN:

Officials explained that the deaths had initially gone uncounted because in the early stages of the pandemic some people died at home, overwhelmed medics were focused on treating cases rather than reporting deaths and due to a delay in collecting figures from various government and private organizations.

https://amp.cnn.com/cnn/2020/04/17/asia/china-wuhan-coronavirus-death-toll-intl-hnk/index.html

Reporting in the US suggests similar undercounting may be occurring here as well, for example:

Medical professionals around the US told BuzzFeed News that the official numbers of people who have died of COVID-19 are not consistent with the number of deaths they’re seeing on the front lines.

In some cases, it’s a lag in reporting, caused by delays and possible breakdowns in logging positive tests and making them public. In other, more troubling, cases, medical experts told BuzzFeed News they think it’s because people are not being tested before or after they die.

https://www.buzzfeednews.com/article/nidhiprakash/coronavirus-update-dead-covid19-doctors-hospitals

Other news articles suggest potential underreporting of deaths in France and Germany as well.

 

[WWGD]

A new paper estimates that people with COVID-19 are most infectious before the onset of symptoms and that infections from pre-symptomatic individuals accounts for a fairly large proportion of infections, when analyzing a population of patients from a hospital in Chinae et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. Published online 15 Apr 2020. doi:10.1038/s41591-020-0869-5
https://www.nature.com/articles/s41591-020-0869-5

This work would seem to challenge the effectiveness of a strategy that only tests symptomatic individuals.
Influenza increases the risk of heart attacks:
https://www.npr.org/sections/health...iously-the-flu-can-trigger-a-heart-attack-too
https://www.cdc.gov/flu/highrisk/heartdisease.htm
From CNN:https://amp.cnn.com/cnn/2020/04/17/asia/china-wuhan-coronavirus-death-toll-intl-hnk/index.html

Reporting in the US suggests similar undercounting may be occurring here as well, for example:

https://www.buzzfeednews.com/article/nidhiprakash/coronavirus-update-dead-covid19-doctors-hospitals

Other news articles suggest potential underreporting of deaths in France and Germany as well.

Is it safe to assume a similar rate of under-reporting in different countries; along the lines of 30-40%?

 

[kadiot]

Is it safe to assume a similar rate of under-reporting in different countries; along the lines of 30-40%?

I think so. The truth is no one knows the true numbers. But they are much larger than what official stats show.

The numbers the Health Department releases are just the tiny tip of a huge iceberg of deaths, recoveries and cases that the government has not counted or cannot count.

How about all the Covid deaths of people who were not “confirmed cases?” Not counted.

The thousands of people who recovered from Covid but did not have to be hospitalized? Not counted.

And the possible millions of infected people but who have not been tested? Not counted.

 

[Ygggdrasil]

Is it safe to assume a similar rate of under-reporting in different countries; along the lines of 30-40%?

No. The under-reporting rate would depend a lot on the availability of testing and the policies about testing/investigating unconfirmed probable cases, which likely differ a lot between locales (e.g. even between different states in the US).

A major challenge with the outbreak is that "all the Coronavirus statistics are flawed:"

Confirmed cases are a function of confirmed tests. After a tragically late start, U.S. testing capacity has doubled in the past week. Is the U.S. currently experiencing rapid growth in Coronavirus cases, or rapid growth in Coronavirus testing, or both? The answer should sound familiar: We don’t know yet, and it will be a while before we do.

Other metrics used to gauge the scale of the outbreak, such as hospitalizations and deaths, have their own limitations. Not all states are reporting hospitalizations, and once hospitals are full, additional cases might not show up in reported figures. Death statistics are also a function of case-by-case diagnosis and cause-of-death methodology. Many deaths due to COVID-19 may have been—and many more may continue to be—misdiagnosed as the result of pneumonia or another respiratory ailment.

With time and increased testing, the state of this outbreak will come into focus. But leaders should be humble, and citizens must be patient, about the fact that no single metric is gospel right now. Even many health statistics taken together can offer at best an incomplete picture of the scope of the crisis.

(note the article is from late March, but it explains many of the limitations to the various measures used to track the spread and deadliness of the virus)

 

[phinds]

No. The under-reporting rate would depend a lot on the availability of testing and the policies about testing/investigating unconfirmed probable cases, which likely differ a lot between locales (e.g. even between different states in the US).

And in some cases a major factor can be the political environment. Witness the widespread and numerous reports that China deliberately has unreported even the cases and deaths that it knows about because their administration wanted things to appear rosier than reality.

 

[BillTre]

And in some cases a major factor can be the political environment. Witness the widespread and numerous reports that China deliberately has unreported even the cases and deaths that it knows about because their administration wanted things to appear rosier than reality.

The same has been going on in the US, only not in such a well controlled centralized manner.

 

[phinds]

The same has been going on in the US, only not in such a well controlled centralized manner.

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

 

[Ygggdrasil]

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

While I agree that we should avoid making the discussion here too political, I do have to ask: why is it political to make claims like this against the US government but not political to make similar claims against the Chinese government?

 

[BillTre]

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

From my point of view, politics in one country is the same as politics in any other country.
This is why I find the application of these rules somewhat confusing.

 

[hmmm27]

Yes, but I don't even want to get started on American politics because that would very quickly go against forum rules.

Pretty scary how everything stopped cold for a bit when a member from another culture inquired what we thought of them. Took a few days to formulate a neutrally-worded response, and by then the conversation had moved on. Haven't seen them past that bit, which is a shame.

 

[BillTre]

I also think that issues of competence are important to discuss but get entangled with politics.
This allows some politically minded people (or those they support) to hide behind these kind of rules in order to avoid legitimate criticism of their completely incompetent management.

 

[hmmm27]

From my point of view, politics in one country is the same as politics in any other country.
This is why I find the application of these rules somewhat confusing.

Partial rampant political-correctness, partially not to scare them away, partially because there are homegrown idiots who take jest as seriousness.

Mostly because not all societies have the same casual attitude (and "ours" is not necessarily "better").

 

[phinds]

While I agree that we should avoid making the discussion here too political, I do have to ask: why is it political to make claims like this against the US government but not political to make similar claims against the Chinese government?

From my point of view, politics in one country is the same as politics in any other country.
This is why I find the application of these rules somewhat confusing.

I also think that issues of competence are important to discuss but get entangled with politics.
This allows some politically minded people (or those they support) to hide behind these kind of rules in order to avoid legitimate criticism of their completely incompetent management.

Partial rampant political-correctness, partially not to scare them away, partially because there are homegrown idiots who take jest as seriousness.

Mostly because not all societies have the same casual attitude (and "ours" is not necessarily "better").

I think you all are overlooking or not considering how totally vicious political partisanship has become in America in the last several years. We have always had partisan divides but not as widespread or a vehement as we have now.

Any discussion of them is likely to quickly devolve into bickering.

 

[BillTre]

I'm not overlooking it, but I see no reason to consent to it without it being made clear why its an issue.

Also, I think it is better to try countering it rather than rolling over and playing intellectually and ethically dead.
Things won't get better without some dose of realism.

This issues are costing lives (as well as screwing up the economy)!

 

[WWGD]

I think you all are overlooking or not considering how totally vicious political partisanship has become in America in the last several years. We have always had partisan divides but not as widespread or a vehement as we have now.

Any discussion of them is likely to quickly devolve into bickering.

Every time I visit a site that deals with or even allows political debate, I put on a helmet and camo. Divisions across all lines: right/left , men/women, millennials/boomers,...And now those blue-eyed bastards want to take over...er, sorry.

 

[vela]

I'm not overlooking it, but I see no reason to consent to it without it being made clear why it's an issue.

Also, I think it is better to try countering it rather than rolling over and playing intellectually and ethically dead.
Things won't get better without some dose of realism.

The reason is that Greg and the mentors have tried allowing these types of discussions in the past, and while one might hope that the people here could cut through the partisan BS and discuss issues dispassionately, past experience suggests this is not the case.

 

[phinds]

The reason is that Greg and the mentors have tried allowing these types of discussions in the past, and while one might hope that the people here could cut through the partisan BS and discuss issues dispassionately, past experience suggests this is not the case.

Exactly

 

[Ygggdrasil]

I think you all are overlooking or not considering how totally vicious political partisanship has become in America in the last several years. We have always had partisan divides but not as widespread or a vehement as we have now.

Any discussion of them is likely to quickly devolve into bickering.

Sure, and anti-Asian racism has become quite dangerous as well in recent times.

Overall, I agree with the rationale for avoiding partisan discussions on these forums for the reasons you cite. At the same time, I also lament that fact-based discussions can be muddled and/or shut down through partisan bickering.

It's also important to note that this thread, as it discusses policy issues surrounding how to best proceed with efforts to contain the Coronavirus outbreak will be inherently political as it involves balancing issues such as public health, economics, and personal freedoms (all concerns that various participants in this thread have raised at various points). Though political, these discussions here have largely remained fact-based, respectful and non-partisan, which is a credit to the forum members and its moderation team.

However, it is also important to point out that discussion of seemingly non-partisan issues can be proxies for partisan fights. For example, there seemed to be a pretty clear partisan subtext in the discussion of the effectiveness of Sweden's policies in this thread. Right-leaning media organizations in the US discuss Sweden as a piece of evidence supporting the case on the right for relaxing social distancing constraints. Similarly, one could point to discussions of the early success of South Korea as another topic with some partisan undertones; many left-leaning media organizations contrast the US and South Korea as how the Trump administration failed at containing the outbreak (I am certainly guilty of inserting partisan undertones into such discussions). So, it is almost impossible to completely avoid touching upon partisan issues in this thread without eliminating a lot of useful discussion (it is also important to note that the posted rules don't explicitly ban political or partisan discussions but rather set some reasonable guidelines for these types of discussion). The US government response should be able to be criticized as with any country's government's response so long as the criticism is based on fact and supported by citation to reputable sources (something that can be lacking in the discussions here at times).

These are all important observations to keep in mind, but again I will repeat that the moderation team has been doing a good job at keeping the discussions here respectful and based in facts . I trust that we will be able to continue having productive discussions of these issues here.

 

[BillTre]

So the reason it doesn't apply to politics in other countries is because what?

"those people" are not so fragile or easily provoked?

 

[chemisttree]

The same has been going on in the US, only not in such a well controlled centralized manner.

What evidence do you have for this?

 

[kadiot]

Re politics... I wonder if the following comentary is allowed: (If not, feel free to delete)

I watched Japan’s Prime Minister Shinzo Abe on NHK World channel...

My observation:

1. He explained in simple words why the original ¥300,000 was reduced to ¥100,000;

2. He urged everyone to cooperate with the national lockdown until May 5;

3. The questions of the journalists as well as the PM’s answers are marked by respect, deference and no hostility at all;

4. Can’t help comparing it with another daily press conference across from the Pacific Ocean, which leaves me so tired and depressed , many times..

 

[Ygggdrasil]

Data on Gilead Coronavirus drug (remdesivir) suggests patients are responding to treatment
https://www.statnews.com/2020/04/16...uggests-patients-are-responding-to-treatment/

There is another trial in Pennsylvania.

More on different trials from Gilead.
https://www.gilead.com/purpose/advancing-global-health/covid-19/remdesivir-clinical-trials

It's worth noting that the results are difficult to interpret because there the study was not blinded and there was no control arm to the trial. Randomized controlled trials (the gold standard for such studies) are on the way, so it would be prudent to wait for those before getting too excited about the data.

Here's an informative piece on the leaked info from the trial:

we have to wait for controlled trials in order to say anything definite. Such trials are underway, with actual comparisons to standard of care, but they take longer. Fast trials are generally not very interpretable, interpretable trials are generally not fast. I will be glad to see these numbers when they appear, but don’t believe anyone who runs with a “Cure for Covid!” headline, because it’s extremely unlikely that remdesivir (a single agent with a broad mechanisms that’s not optimized for this virus) is any such thing. Remember, there are as yet no single-small-molecule antiviral cures for anything, Coronavirus or not. My hope for the drug is that it is effective enough to get people out of the hospitals more quickly and to keep more of them off ventilators than if they were not taking it. For that hope to be realized, we need that comparison to the people who are not taking it. This trial doesn’t have it.

https://blogs.sciencemag.org/pipeline/archives/2020/04/17/whats-happening-with-remdesivir

 

[chemisttree]

<Mentor note: quoted text removed for being too political>
OK, thanks for clearing that up. You responded to a comment about under reporting #cases to make the response appear rosier with the “same thing is happening here.” I thought you were actually talking about the inaccuracy about reported cases/death rates and were alleging that it was being done to make the situation appear rosier.

The discussion began with Ygg’s post:

No. The under-reporting rate would depend a lot on the availability of testing and the policies about testing/investigating unconfirmed probable cases, which likely differ a lot between locales (e.g. even between different states in the US).

An then Phinds posted:

And in some cases a major factor can be the political environment. Witness the widespread and numerous reports that China deliberately has unreported even the cases and deaths that it knows about because their administration wanted things to appear rosier than reality.

You didn’t actually comment about whether numbers in the US were being manipulated for political reasons.

<comment removed>

 

[chemisttree]

My observation:
3. The questions of the journalists as well as the PM’s answers are marked by respect, deference and no hostility at all;

Yeah, there are big differences...

 

[kyphysics]

We haven't had anything like shelter-in-place until last week, and primary and secondary schools were all still running with physical classes, because things seemed to be under control. So I think the Singapore data is still consistent with the idea from South Korea, and the currently good signs from China, that it is possible to manage things well without shutting everything down. The reason I've always cited South Korea (not Singapore) as the model, is that Singapore had not had any spike until now, so Singapore doesn't show what to do after you have a spike. On the other hand, South Korea had a huge spike, and they dealt with it successfully.

The current spike in Singapore is still atypical (at least with respect to Europe and North America), because it is mainly among construction workers living in dorms where social distancing is hard, so the government has had to find new temporary housing for a very large number of people (about 20,000 people) in a short time. I think this has been mostly done now, so hopefully there won't be new infections, we'll find out in a few days. The other thing that has to be done is to take care of the welfare of all the people who suddenly have to live in temporary housing (these are foreign workers, so they don't have family here).

Edit: it seems more temporary housing for the workers in dorms in still being set up.

Thanks for the insight. I will also track S. Korea more now.

Although, the dorms outbreak in Singapore makes me wonder about colleges in the U.S. Those have tight living quarters. And, it's also hard to see how college students can just sit out another full year. They are too old to be under their parents' homes and too young/unqualified for earning their own income (to fully support themselves).

It's not just college dorms, but also:

-cruise lines
-casinos
-concert venues
-amusement parks
-airplanes, buses, trains, and subways

Anywhere there is close physical cramming of people, I'm concerned about if we get "business as usual."

Do you know if S. Korea has relaxed their restrictions to the point of having people "back to normal" in their everyday activities now? And, if so, have they STILL kept the case rates down?

 

[WWGD]

Thanks for the insight. I will also track S. Korea more now.

Although, the dorms outbreak in Singapore makes me wonder about colleges in the U.S. Those have tight living quarters. And, it's also hard to see how college students can just sit out another full year. They are too old to be under their parents' homes and too young/unqualified for earning their own income (to fully support themselves).

It's not just college dorms, but also:

-cruise lines
-casinos
-concert venues
-amusement parks
-airplanes, buses, trains, and subways

Anywhere there is close physical cramming of people, I'm concerned about if we get "business as usual."

Do you know if S. Korea has relaxed their restrictions to the point of having people "back to normal" in their everyday activities now? And, if so, have they STILL kept the case rates down?

Tokyo, Dhaka in Bangladesh and many citirs in India are some of tge most densely-packed places in the world yet have a low incidence ( at least thus far). So being drnsely-packed may be necessary or highly-correlated but not sufficient. Though I believe the converse has not happenef.

 

[mattt]

What do you think of this paper

 

[kyphysics]

Tokyo, Dhaka in Bangladesh and many citirs in India are some of tge most densely-packed places in the world yet have a low incidence ( at least thus far). So being drnsely-packed may be necessary or highly-correlated but not sufficient. Though I believe the converse has not happenef.

Two big factors in mortality (not necessarily case positive) are:

a.) age
b.) obesity

A lot of Asian countries (India a major one) have younger populations + less obese people.

India, specifically, has the world's best population dynamic in ratio of young-to-old.

Wondering if that (and maybe weather?) could play a role in the difference?

The negative side is that it is also very dense in population, poor, and lacks modern top-notch healthcare.

 

[atyy]

Although, the dorms outbreak in Singapore makes me wonder about colleges in the U.S. Those have tight living quarters. And, it's also hard to see how college students can just sit out another full year. They are too old to be under their parents' homes and too young/unqualified for earning their own income (to fully support themselves).

The dorms outbreak in Singapore is among construction workers, not college students. These dorms are not like college dorms in the U.S. They are more like army barracks, where there are 10 people in a room.

Singapore has college dorms too. There were students in these up till about April 3, after which students who were Singaporeans mostly went home. But there were no outbreaks in college dorms up till April 3, whereas there were already several small clusters in the worker dorms.

Do you know if S. Korea has relaxed their restrictions to the point of having people "back to normal" in their everyday activities now? And, if so, have they STILL kept the case rates down?

No, they are still not "back to normal". Many schools are online, and I believe (not sure) large gatherings are still banned.
https://www.forbes.com/sites/stevep...ut-normal-is-still-some-way-off/#4da20329760e
https://www.aljazeera.com/news/2020...-classrooms-remain-empty-200415094228841.html

 

[atyy]

Tokyo, Dhaka in Bangladesh and many citirs in India are some of tge most densely-packed places in the world yet have a low incidence ( at least thus far). So being drnsely-packed may be necessary or highly-correlated but not sufficient. Though I believe the converse has not happenef.

Two big factors in mortality (not necessarily case positive) are:

a.) age
b.) obesity

A lot of Asian countries (India a major one) have younger populations + less obese people.

India, specifically, has the world's best population dynamic in ratio of young-to-old.

Wondering if that (and maybe weather?) could play a role in the difference?

The negative side is that it is also very dense in population, poor, and lacks modern top-notch healthcare.

Here is an article about what Kerala has done.
https://www.technologyreview.com/2020/04/13/999313/kerala-fight-covid-19-india-coronavirus/

 

[OmCheeto]

Sweden is called an outlier because it has refused lockdown.

https://www.msn.com/en-us/news/world/swedish-virus-deaths-top-1000-fueling-criticism-over-strategy/ar-BB12C1xU

View attachment 260744

Ah! Hahahaha!

Lofven’s hands-off model has drawn criticism from across the globe, including from U.S. President Donald Trump.​

People should really look at more than one graph before pointing fingers.

About the only difference in the two plots that I can discern, is that the Swedes don't count their dead on weekends.

 

[hmmm27]

I think you all are overlooking or not considering how totally vicious political partisanship has become in America in the last several years. We have always had partisan divides but not as widespread or a vehement as we have now.

Ditto, up here north of the 49th : partially because they don't know what to do about global warming (that, unlike the nuclear threat of the 1950's, cannot be wished away by simple posturing)

Tying into the actual thread, it's a bit disconcerting to see the divide growing between government and populace. Today(ish) I read where the some levels of government are considering lifting/loosening some of the emergency restrictions.

According to the news report, the general reaction of "the people" is "What are you, nuts ?".

 

[Ygggdrasil]

View attachment 260864

About the only difference in the two plots that I can discern, is that the Swedes don't count their dead on weekends.

It's worth noting that US stay at home orders did not begin until slightly under 4 weeks ago (e.g. New York state, which is driving a large fraction of deaths in the US, imposed its stay at home order on 3/22), so the dynamics of the deaths curve largely reflects the spread of the disease in the absence of social distancing measures. In the next couple of weeks (when we expect to see the effects of stay at home orders imposed in states like NY, CA and IL), if we see Sweden's numbers continue to grow while the US's numbers begin to level off, this would be a sign that Sweden's more lax distancing policies likely do not work. However, if the two curves continue to look similar, this could be a sign that Sweden's more lax policies are similarly effective as distancing policies in the US.

 

[chirhone]

We have been discussing since January about containment efforts. Has anyone seen it coming that by April it would result in more than 34,000 American deaths and the event in Wuhan repeated almost everywhere in the world with far more deaths than in Wuhan?

If you have foreseen it. Have you not made any efforts to get in touch with CDC in Atlanta, etc.?