COVID-19 Coronavirus Containment Efforts

[anorlunda]

I know we are way past it now, but what would have an optimal US response looked like?

That's difficult to answer. An important ingredient is our form of government with a national (federal) government with limited powers, plus state governments with their own powers.

In the context of this question, it would be better to compare the USA with the EU. In the COVID-19 crisis, EU member states mostly acted independently, and the EU did very little centrally. In the USA the media focuses on the national news and national action in a crisis, but most of the authority remains with the states. People see news from their own state, but less news from other states. People outside the USA see USA national news via satellite but relatively little news from the 50 different US states. If you want to report on the COVID-19 policies in Sweden, would you go to Stockholm or Brussels?

So the answer to your question depends as much on the media as it does on the government. Instead of comparing the USA with Singapore, compare it with Asia.

 

[Vanadium 50]

Sean Trende, who is a reporter who often reports on polling, has an article titled: https://www.realclearpolitics.com/articles/2020/05/03/policy_and_punditry_need_to_adapt_to_new_virus_data_143102.html.

In it he makes a number of points also made in this thread:

1. "Flatten the curve" is morphing to something else. Maybe it's better, but it's different.
2. Hospital capacity in the US is far from being overwhelmed.
3. The fatality rate is lower than we thought it was when decisions on lockdown were being made.
4. There is no consensus on when and how to reopen and nobody has a crystal ball.
5. "This seems to reflect a wider phenomenon of people being driven into “teams” regarding the shutdown."

Besides all that, he also posts a very, very state-by-state plot. It pretty clearly shows that Montana and Minnesota are in very different stages. The Utah double bump is also very interesting. It's hard to tell what it is, but it appears to be geographic: SLC and near Bluff.

 

[russ_watters]

https://www.bbc.com/news/health-52473523

I feel like flatten the curve was a rallying cry to:

i.) at minimum, try to prevent a overwhelming of the healthcare system (via a slower transmission rate)
ii.) on the more optimistic side, try to give the virus nowhere to spread

Yes, if the true goal was to cut the curve, then I would agree that it was a good idea. And that's what I thought the true goal was*, but it isn't looking that way now.

*For the US and most Western countries anyway. China successfully chopped-off the back side of the curve and drove the outbreak to near extinction (if they aren't lying to us), at an average of <100 cases per day since early March.

 

[russ_watters]

What made you change your mind? A month ago you seemed skeptical of all the proposed and actual measures to "do better", citing their not well-known impact on the economy. Attempts to keep everything running as normal was exactly what prevented people from doing better.

You misunderstand my position because of an incorrect/excessive focus on "flattening the curve", and improperly equating "social distancing" with "flattening the curve". I still maintain that the options were ill considered, and that there were additional options that have even today not been put on the table. Specifically, I'm talking about cumpulsory digital contact tracing, plus testing. South Korea did it, and never implemented mandatory social distancing.

It's a multi-part failure, and while you're looking back and saying "social distancing" was a good approach that should have been implemented sooner, I'm looking back further and saying it was a bad approach that should never have been needed to begin with. And I think looking at where we are today and where we are going validates that it is a bad approach.

To me, social distancing is trying to bail water out of the Titanic. We shouldn't judge it to be a good idea when we never should have hit the iceberg to begin with. And quibbling over when it was implemented is arguing deck chair arrangement.

You assume that everyone who doesn't get a ventilator in a hospital would survive fine at home. I would like to see something backing that assumption.

I'm sure there's no stat for that, but it is a basic/logical assumption. The treatment follows a relatively linear path that ends with a respirator as a final step for most (there is also an external artificial lung, but I hadn't heard of it until I googled it).

I would also like to see where this 80% number comes from. In China it was ~50%, and 1/3 of people admitted to ICU.

Actually, an update since last I checked is 88% in NYC on ventilators died:
https://www.washingtonpost.com/health/2020/04/22/coronavirus-ventilators-survival/

In the UK only 1/5 of people requiring "basic respiratory support" died. In the subset requiring mechanical ventilation it was 2/3.

There's multiple levels of "mechanical ventilation", and I can't access the article to see what they are referring to.

If everyone requiring basic respiratory support dies without a hospital your deaths increase by 400%, not 25%. I don't say that is true, but for an upper estimate that's certainly something to consider. And that's assuming a hospital does nothing but providing respiratory support, which is clearly not correct.

"Basic respiratory support" is just an oxygen mask; It doesn't require a hospital, nor does it prevent an imminent death, so I don't think your conclusion is logical/accurate. But fair enough, my upper-bound scenario may have been extreme; that was on purpose for the purpose of simplicity/clarity. We would of course never leave *everyone* at home, but there are other options that would enable closing that gap without significant impact on the non-COVID patients. I think it is also worth noting that the bigger the COVID impact, the smaller the impact of non-COVID patients on the totals.

But again, my main point here is we're arguing percentages when we should be talking about orders of magnitude. But that discussion isn't being held to a significant extent in the West.
[edit]
Here's where my head's at overall: Four weeks ago, Dr. Fauci reduced the US government's official projection from 80,000 to 60,000 deaths. I saw a refinement of that just two weeks ago, at the same level. In order for that to have come true, we would have needed to see a rapid drop-off in infections/deaths following the peak; an extinction scenario, not a "flattening the curve" scenario. That seemed ok to me. And in my opinion it is relatively useless to argue over whether implementing social distancing a week or three earlier could have saved half or even 3/4 of those lives. It doesn't matter if you have no exit strategy: they are going to die anyway.

That 60,000 total and extinction hasn't happened, and today we're at 70,000 deaths/1,000 per day, and I haven't seen an updated projection. That tells me that social distancing hasn't worked anywhere near as well as was predicted. And moving forward, things look far more bleak. We've fired that bullet and it missed, and we can't easily fire it again. Now what? People don't seem to be saying it, but it sounds to me like we're preparing to enter some half-open-half-closed steady-state, with 1,000 deaths per day, for the next 18 months or so, until a vaccine is produced. I'm really, really not ok with that.

 

[russ_watters]

Right, as I understood it, the idea was that, while the number of infections would be the same (area under the curve), the number of deaths would be lower since at any time, fewer people would be hospitalized. If too many enter the hospital at once, they don't get the care they need to survive.

This makes sense, since without a vaccine, eventually everyone will be infected.

But it stops making sense if it is true that 80% of the hospitalized die anyway. I don't know if that number is right, I have heard (TV news reports) even higher numbers.

Not 80% of hospitalizations, 80% of those on ventilators -- but you get my point, and yes, it's apparently higher than that based on the report I linked above.

 

[gmax137]

Not 80% of hospitalizations, 80% of those on ventilators

Oops, my mistake. But I wonder what the right value would be for percent of hospitalizations resulting in recovery. The TV news has run stories of the ICU staff lined up and cheering as a patient is released; this feel-good story seems to imply, darkly, that recovery and release is unusual.

 

[russ_watters]

Oops, my mistake. But I wonder what the right value would be for percent of hospitalizations resulting in recovery. The TV news has run stories of the ICU staff lined up and cheering as a patient is released; this feel-good story seems to imply, darkly, that recovery and release is unusual.

I wouldn't conclude that; the patients getting the most care for the longest are the ones who have the most impact on hospital staff. Someone who is just there for a night or two but had no significant risk of dying isn't getting a sendoff.

 

[Vanadium 50]

eople don't seem to be saying it, but it sounds to me like we're preparing to enter some half-open-half-closed steady-state, with 1,000 deaths per day, for the next 18 months or so, until a vaccine is produced. I'm really, really not ok with that.

I think it's both better than that and worse than that. You're going to see reductions in fatalities in places like Massachusetts and New Jersey because they are approaching 100% infected in nursing homes. Sad to say, everyone who would die is already dead or dying. On the other hand, there has never been a successful Coronavirus vaccine, so it may be longer than 18 months. Maybe never.

Let's assume that continued lockdown saves your 1000 lives/day. All of them. I think that's way too big (it would make Covid the third leading cause of death) , but let's take that for the sake of argument. I'm also going to assume that lockdown is a 20% effect on the economy. I think it's larger than that (after all, unemployment is at 30%) but we need some number, so let me pick that one out of thin air. That's $13B/day. Why save these 1000 people? Why not use this $13B to save other people? That's roughly what it would cost to make free flu vaccine available to everyone - after just one day - and flu kills 20.000-60,000 people are year. Why let 20-60,000 people die of flu if it saves 1000 lives? Why are these people more important than those people. Annual breast cancer screening for all women over 40 could be done for an additional $7B. That kills 40-50,000 people per year. If it saves10% of them, why not save 4000 women over 500 Covid patients?

Once you go down the path "it hurts the economy, but that's OK because it saves lives", you immediately run into the question of how much you will hurt the economy and how many and which lives you save.

 

[russ_watters]

I think it's both better than that and worse than that. You're going to see reductions in fatalities in places like Massachusetts and New Jersey because they are approaching 100% infected in nursing homes. Sad to say, everyone who would die is already dead or dying. On the other hand, there has never been a successful Coronavirus vaccine, so it may be longer than 18 months. Maybe never.

Understood. And it's really anybody's guess. But just FYI, new predictions are coming out and they are grim. Here's an organization that was predicting 60,000 deaths by August two weeks ago and is now predicting 135,000, and 3,000 per day in June. The prior prediction appeared to include effective extinction by the end of June (new 1 case per million people per day).
https://www.nytimes.com/2020/05/04/us/coronavirus-live-updates.html

Let's assume that continued lockdown saves your 1000 lives/day. All of them. I think that's way too big (it would make Covid the third leading cause of death) , but let's take that for the sake of argument. I'm also going to assume that lockdown is a 20% effect on the economy. I think it's larger than that (after all, unemployment is at 30%) but we need some number, so let me pick that one out of thin air. That's $13B/day. Why save these 1000 people? Why not use this $13B to save other people?

Well I know its just an example, but that's $13M per life saved, and while as we've discussed how hard it is to put a value on a human life, that sounds like an entirely unreasonable sum to me. Forget healthcare; that's double what the average person spends on everything for their entire life.

How about we treat it as a bribe? I know people don't want mandatory tracking, but what if I offered you $5,000 for 2 years of mandatory location tracking and COVID-19 status sharing (the cost of 4 months of shutdown, per American)? The instant return-to-normal-life comes free with that.

 

[mfb]

You misunderstand my position because of an incorrect/excessive focus on "flattening the curve", and improperly equating "social distancing" with "flattening the curve". I still maintain that the options were ill considered, and that there were additional options that have even today not been put on the table. Specifically, I'm talking about cumpulsory digital contact tracing, plus testing. South Korea did it, and never implemented mandatory social distancing.

I didn't focus on anything in particular. I compared "we don't know how restrictions will affect the economy, it might be worse than acting, we should wait with actions" (paraphrased, that's how I understood your comments) with your more recent comment.

I'm looking back further and saying it was a bad approach that should never have been needed to begin with.

Yes, in an ideal world everyone who is sick doesn't get in contact with others and none of that is needed. We don't live in such a world. Scenarios need to be realistic to be relevant.

https://www.washingtonpost.com/health/2020/04/22/coronavirus-ventilators-survival/

Paywall :(
NYC is an example of a hospital system that can't treat patients well because there are so many of them, that can easily skew statistics.

"Basic respiratory support" is just an oxygen mask; It doesn't require a hospital, nor does it prevent an imminent death, so I don't think your conclusion is logical/accurate. But fair enough, my upper-bound scenario may have been extreme; that was on purpose for the purpose of simplicity/clarity. We would of course never leave *everyone* at home, but there are other options that would enable closing that gap without significant impact on the non-COVID patients. I think it is also worth noting that the bigger the COVID impact, the smaller the impact of non-COVID patients on the totals.

I don't have an oxygen mask at home. Do you?
Sure, patients with a higher risk are more likely to have an oxygen system somewhere, and there are portable systems, and you can visit the patients at home and whatever, but in all these cases we are back to the original problem: We need some resources for COVID-19 patients, resources that are now missing elsewhere. You can't have the full healthcare system capacity for all other diseases and oxygen masks for every COVID-19 patient who might need one at the same time. In your scenario "what if we let all patients handle that on their own" people who need an oxygen mask might die because they don't get one.

I have mentioned this several times in this thread (at least from March on). The death rate of the disease is bad. But what is worse is the large number of people who need to go to a hospital and/or need an ICU bed. People are sent to a hospital or ICU for good reasons.

It doesn't matter if you have no exit strategy: they are going to die anyway.

Not if they just died because hospitals were overwhelmed.

People don't seem to be saying it, but it sounds to me like we're preparing to enter some half-open-half-closed steady-state, with 1,000 deaths per day, for the next 18 months or so, until a vaccine is produced. I'm really, really not ok with that.

Well, the 1000 deaths per day could easily be 500, or 200, or 50, or even lower. That depends on (a) when actions were taken and (b) how they evolve over time.
Plenty of people say we'll probably look at a half-open-half-closed state for a while. How open, and what exactly are the least impactful things to keep closed? Time will tell. Extinction might work for islands, but closing land borders completely (or requiring quarantine for everyone crossing) is unrealistic.

 

[anorlunda]

Every country has prisons, and every prison is a microcosm of COVID-19 risks, and mitigation policies. Many of the claims and counter-claims in this thread could be tested against prison data.

Once the virus gets inside undetected it would spread very fast. Marion Correctional Institution in Ohio reports 80% of their 2000+ inmates tested positive with 17 dead so far. That is analogous to cruise ship reports. On the other hand, look at the data from Florida in the table below.

51 of 59 institutions report few or no positives, but in the other 8, the virus spread much more. Interestingly, the data for all 59 has been nearly constant for the 6 weeks I've been watching. I surmise that in the 8 of 59, once things were properly locked down, further spread has been halted.

Prisoners can be locked down much more strictly than the public. They can be kept in their cells 24x7, with no visitors, and with meals delivered. Their exposure is carried by the small number of guards who go in and out of the prison daily, but those guards can be screened daily before entry. Ironically, despite fear of inadequate medical treatment behind bars, these inmates appear to be safer inside than if they were released. Their mental health is a separate issue and not reported in this data.

COVID-19 Statistics, May 5, 2020 10:00, 176000 inmates, 7 inmate deaths so far

Institution	Medical Quarantine	Medical Isolation	Pending Tests	Negative Tests	Positive Tests	Positive Staff
Apalachee CI	69	1	1	9	6	9
Avon Park CI	0	0	0	5	0	0
Baker CI	0	0	0	1	0	0
Bay CF	0	0	0	2	0	0
Blackwater CF	170	0	0	16	48	11
Calhoun CI	0	0	0	0	0	0
Century CI	0	0	0	1	0	1
CFRC	0	0	0	2	0	1
Charlotte CI	0	0	0	0	0	3
Columbia CI	0	0	0	49	25	1
Cross City CI	0	0	0	3	0	1
Dade CI	5	1	1	3	0	2
Desoto Annex	0	0	0	0	0	2
Everglades CI	0	0	0	2	0	1
Florida State Prison	0	0	0	3	0	1
FWRC	0	0	0	1	0	2
Franklin CI	0	0	0	0	0	0
Gadsden CF	327	0	0	1	8	14
Gadsden	0	0	0	0	0	0
Graceville CF	0	1	1	0	0	2
Gulf CI	0	0	0	1	0	0
Hamilton CI	0	0	0	6	0	2
Hardee CI	0	0	0	2	0	0
Hernando CI	0	0	0	2	0	2
Holmes CI	0	0	0	0	0	0
Homestead CI	0	0	0	2	0	1
Jackson CI	0	0	0	0	0	4
Jefferson CI	0	0	0	1	0	0
Lake CI	0	0	0	3	0	0
Lake City CF	0	0	0	1	0	1
Lancaster CI	0	0	0	2	0	0
Lawtey CI	0	0	0	5	0	0
Liberty CI	351	1	1	29	66	2
Lowell CI	0	0	0	11	0	1
Madison CI	0	0	0	1	0	0
Marion CI	0	0	0	5	0	1
Martin CI	0	0	0	10	1	0
http://www.dc.state.fl.us/comm/223	0	0	0	3	0	0
Moore Haven CF	161	0	0	0	0	1
New River CI	0	0	0	3	0	1
NWFRC	0	0	0	2	0	0
Okaloosa CI	0	0	0	0	0	1
Okeechobee CI	0	0	0	3	0	1
Polk CI	0	0	0	1	0	1
Putnam CI	0	0	0	2	0	0
RMC	0	0	0	3	0	0
Santa Rosa CI	0	0	0	5	0	2
SFRC	0	1	1	19	2	6
South Bay CF	927	0	0	8	14	44
Sumter CI	913	4	4	52	92	13
Suwannee CI	0	0	0	1	0	0
Taylor CI	0	0	0	5	0	0
Tomoka CI	1162	2	2	83	128	19
Union CI	0	0	0	5	0	0
Wakulla CI	3	0	0	2	0	5
Walton CI	0	0	0	1	0	0
Zephyrhills CI	0	0	0	12	0	4
Totals	4088	11	11	389	390	174

Source:
http://www.dc.state.fl.us/comm/covid-19.html#stats

 

[anorlunda]

NYC is an example of a hospital system that can't treat patients well because there are so many of them, that can easily skew statistics.

I'm not sure that's true.

That's what the news reports implied, but NY Governor Cuomo said that even during the peak, no patient that needed a ventilator was denied a ventilator. So their claim is that they were never overwhelmed.

https://www.usatoday.com/story/news...-shortage-curve-new-york-flattens/3036008001/

 

[mfb]

Maybe they were creative with the definition of "needed a ventilator". Or something else made the people getting a ventilator die more often than elsewhere.

 

[russ_watters]

I didn't focus on anything in particular. I compared "we don't know how restrictions will affect the economy, it might be worse than acting, we should wait with actions" (paraphrased, that's how I understood your comments) with your more recent comment.

No, I'm pretty sure I never suggested waiting as a general strategy before taking action of any kind -- perhaps case-by-case basis action, though, which could be earlier or later. Thinking-through your options isn't "waiting", especially if you should have already done it. Deciding not to do social distancing isn't choosing a less aggressive path that favors the economy over human lives if you're doing electronic contact tracing instead (see: Korea). The reality for us, here, is that most of the optionality passed us by before the choices were made.

While I held out hope - and bought stock - late in February, by the second week in March it was spreading-through my county and I had no illusions about a shutdown not being necessary at that point. But I always think you need a plan.

My concern about not considering health-vs-economy is still a big concern. It gets worse the longer the shutdown lasts, and worse as the death estimates go up. We're seeing predictions of more deaths and higher economic cost over time. And we're still not having a serious discussion of it in the general public. Not having the discussion before doing anything was bad, and another 6 weeks have gone by and we're still not addressing it. How many more deaths and trillions of dollars does it have to cost before we even ask if we're on the right path?

Yes, in an ideal world everyone who is sick doesn't get in contact with others and none of that is needed. We don't live in such a world. Scenarios need to be realistic to be relevant.

I've certainly never suggested any such thing. I can't fathom where you got that from except to speculate that you have "social distancing" blinders on and aren't considering the other options. If true, don't feel bad: that's where the West's head is at right now in general. And that's basically my entire complaint that we're discussing here.

Paywall :(

Huh - they went free for COVID-19 coverage, but I guess it's just in the US. No need for the frowney face; when I do this to someone else, I provide quotes as needed. Key quote:

Now five weeks into the crisis, a paper published in the journal JAMA about New York state’s largest health system suggests a reality that, like so much else about the novel coronavirus, confounds our early expectations.
Researchers found that 20 percent of all those hospitalized died — a finding that’s similar to the percentage who perish in normal times among those who are admitted for respiratory distress.

But the numbers diverge more for the critically ill put on ventilators.
A total of 1,151 patients required mechanical ventilators. Of the 320 for whom final outcomes are known (either death or discharge), 88 percent died. That compares with about 80 percent of patients who died on ventilators before the pandemic, according to previous studies — and with the death rate of about 50 percent that some critical-care doctors had optimistically hoped for when the first cases were diagnosed.

NYC is an example of a hospital system that can't treat patients well because there are so many of them, that can easily skew statistics.

I'm not sure that's true. Yes, I know we've seen the videos and photos of hospitals with patients in the hallways, but field hospitals went unfilled by a wide margin. But regardless, note in particular the stat that even in normal times, an 80% death rate is typical.

I don't have an oxygen mask at home. Do you?

Sure, patients with a higher risk are more likely to have an oxygen system somewhere, and there are portable systems, and you can visit the patients at home and whatever

No, but I'm reasonably certain if shipped one I could figure out how to wear it. And yes, I have a couple of relatives with COPD who wear masks or tubes most of the time.

...but in all these cases we are back to the original problem: We need some resources for COVID-19 patients, resources that are now missing elsewhere. You can't have the full healthcare system capacity for all other diseases and oxygen masks for every COVID-19 patient who might need one at the same time. In your scenario "what if we let all patients handle that on their own" people who need an oxygen mask might die because they don't get one.

Of course. Again, I'm not suggesting we actually do this, I'm suggesting it as a logic exercise to predict the upper bound of additional deaths from hospital overcrowding. If you've got a better method or better yet a source that's actually attempted to model it, I'm all ears.

Remember, this is not my claim we're discussing: "Flattening the curve" was predicated on preventing deaths from hospital overcrowding. In order to evaluate that choice, we need to know how many deaths it prevents. In a perfect world, the people proposing the actions would be backing their proposals with models, but instead we have replaced that with the infinite value of human life assumption. I don't think I've ever seen any effort by proponents of flattening the curve to show how many lives it could save via avoiding hospital overcrowding.

I have mentioned this several times in this thread (at least from March on).

I note that while in that post you put some numbers to hospital bed requirements, you vaguely alluded to but made no attempt to quantify the additional deaths of overwhelming them.

Not if they just died because hospitals were overwhelmed.

As you showed, you made this claim at least as early as March 1, without attempting to quantify it. How can you claim it is important to not overwhelm the healthcare system if you can't or won't put a number on the death toll that will result?

Well, the 1000 deaths per day could easily be 500, or 200, or 50, or even lower. That depends on (a) when actions were taken and (b) how they evolve over time.

It doesn't depend much on when the actions were originally taken, because we're "resetting" when we re-open. It just impacts the duration of the shutdown until re-opening is possible. In general the goal is to get the case rate down to where contact-tracing will successfully hold down the number of new cases. In my area, that criteria is 50 cases per day per 100,000 people, and the effect is that different places will open at different times versus the start, which happened in the entire state pretty much at once.

But 50 cases per day per 100,000 people if applied nationwide is 165,000 cases per day, or ~3,800 deaths per day. V50 is right that some places like NYC won't be able to support that rate indefinitely, but there are still some prime targets available. And that's if contact tracing works, which I don't think it will. And again, to my earlier point; today's models are predicting that it won't work and we're going to re-open anyway.

Plenty of people say we'll probably look at a half-open-half-closed state for a while. How open, and what exactly are the least impactful things to keep closed? Time will tell.

So, as before: we should be weighing the options and making decisions based on cost/benefit.

Extinction might work for islands, but closing land borders completely (or requiring quarantine for everyone crossing) is unrealistic.

Don't tell China or Korea that. But seriously, there's nothing special about a land border in most of the world. They are controlled and can be closed.

 

[Ygggdrasil]

Regarding mortality on ventilators, here's what I posted ~1 month ago based mostly on observations from China, which are roughly consistent with the numbers @russ_watters has cited:

Based on published data from China, it's not actually clear to me how much ventilators are helping at this point. Here are statistics from two studies in China that look at critically ill cases of COVID-19:

32 patients required invasive mechanical ventilation, of whom 31 (97%) died.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext

29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext

Of course, other studies have shown ventilators can more generally be helpful against acute respiratory distress syndrome (a study of 178 H1N1 cases from 2009, which shows a 46% mortality of patients on mechanical ventilation, and a wider meta-analysis of treatments for ARDS finds a 34.6% mortality of patients with severe ARDS treated with mechanical ventilation or ECMO). However, there is reason to think that COVID-19 is different: 1) Ventilators treat the symptoms but not the cause of the problems. If the virus is still active in the body, ventilators ultimately won't solve that problem. 2) It has been reported that the virus could infect other organs of the body, so while ventilation could solve issues with lung function, the virus may cause death due to damage to other organs such as the heart, liver or kidneys.

In both cases, it seems like the best candidates for ventilators would be those whose bodies seem to be getting the infection under control, whereas ventilation may not be so helpful to those whose immune systems have not been able to control the virus. This would suggest that better triage of cases rather than sharing ventilators would be a better strategy (though I don't know if it's possible to assess how well patients' immune systems are fighting the virus).

Ventilators would likely have higher effectiveness once good antiviral therapies that can control the infection are identified, so there is still good reason for the country to mass produce ventilators for treating COVID-19 patients.

 

[russ_watters]

Every country has prisons, and every prison is a microcosm of COVID-19 risks, and mitigation policies. Many of the claims and counter-claims in this thread could be tested against prison data.

Once the virus gets inside undetected it would spread very fast. Marion Correctional Institution in Ohio reports 80% of their 2000+ inmates tested positive with 17 dead so far. That is analogous to cruise ship reports. On the other hand, look at the data from Florida in the table below.

51 of 59 institutions report few or no positives, but in the other 8, the virus spread much more. Interestingly, the data for all 59 has been nearly constant for the 6 weeks I've been watching. I surmise that in the 8 of 59, once things were properly locked down, further spread has been halted.

Prisoners can be locked down much more strictly than the public. They can be kept in their cells 24x7, with no visitors, and with meals delivered. Their exposure is carried by the small number of guards who go in and out of the prison daily, but those guards can be screened daily before entry. Ironically, despite fear of inadequate medical treatment behind bars, these inmates appear to be safer inside than if they were released.

Yes, the prison system outbreak is pretty nuts. It should be easy to strictly quarantine, but apparently it wasn't done. And the stats indicate that efforts to test have been even more sporadic than the rest of the population. My county's worst day of recorded tests was just last week; because that's the day the county got back the tests for the prison population it just took. All of the prisoners in the county were tested, but it didn't happen until the last week of April.

 

[kyphysics]

Scientists Create Antibody That Defeats Coronavirus in Lab
By
Tim Loh

Scientists created a monoclonal antibody that can defeat the new Coronavirus in the lab, an early but promising step in efforts to find treatments and curb the pandemic’s spread.

The experimental antibody has neutralized the virus in cell cultures. While that’s early in the drug development process -- before animal research and human trials -- the antibody may help prevent or treat Covid-19 and related diseases in the future, either alone or in a drug combination, according to a study published Monday in the journal Nature Communications.

More research is needed to see whether the findings are confirmed in a clinical setting and how precisely the antibody defeats the virus, Berend-Jan Bosch of Utrecht University in the Netherlands and colleagues wrote in the paper.

The antibody known as 47D11 targets the spike protein that gives the new Coronavirus a crown-like shape and let's it enter human cells. In the Utrecht experiments, it didn’t just defeat the virus responsible for Covid-19 but also a cousin equipped with similar spike proteins, which causes Severe Acute Respiratory Syndrome, or SARS.

Monoclonal antibodies are lab-created proteins that resemble naturally occurring versions the body raises to fight off bacteria and viruses. Highly potent, they target exactly one site on a virus. In this case, the scientists used genetically modified mice to produce different antibodies to the spike proteins of coronaviruses. After a subsequent screening process, 47D11 emerged as showing neutralizing activity. Researchers then reformatted that antibody to create a fully human version, according to the paper.

article: https://www.bloomberg.com/news/arti...eate-antibody-that-defeats-coronavirus-in-lab

Any thoughts from the Physics Forums brain trust here? I see lots of "hopeful" news about "possible" treatments and vaccines, but it's too early to tell with them.

This one seems interesting in that seems "different" in nature.

 

[atyy]

Sean Trende, who is a reporter who often reports on polling, has an article titled: https://www.realclearpolitics.com/articles/2020/05/03/policy_and_punditry_need_to_adapt_to_new_virus_data_143102.html.

In it he makes a number of points also made in this thread:

1. "Flatten the curve" is morphing to something else. Maybe it's better, but it's different.
2. Hospital capacity in the US is far from being overwhelmed.
3. The fatality rate is lower than we thought it was when decisions on lockdown were being made.
4. There is no consensus on when and how to reopen and nobody has a crystal ball.
5. "This seems to reflect a wider phenomenon of people being driven into “teams” regarding the shutdown."

Interesting article. I think it is reasonable to expect a variety of views on how low one would like new cases to be before opening up. South Korea brought its spike down without closing non-essential businesses, but then tightened measures and closed non-essential businesses to bring their rate down to single digits per day. The US has tremendous resources and a large domestic economy, so it could in principle try to (or have tried to) bring its new cases down to the level of China or South Korea. The difficulty of course is whether it makes sense for say California to try that, if other states don't want to.

 

[russ_watters]

Sean Trende, who is a reporter who often reports on polling, has an article titled: https://www.realclearpolitics.com/articles/2020/05/03/policy_and_punditry_need_to_adapt_to_new_virus_data_143102.html.

In it he makes a number of points also made in this thread:

1. "Flatten the curve" is morphing to something else. Maybe it's better, but it's different.
2. Hospital capacity in the US is far from being overwhelmed.
3. The fatality rate is lower than we thought it was when decisions on lockdown were being made.
4. There is no consensus on when and how to reopen and nobody has a crystal ball.
5. "This seems to reflect a wider phenomenon of people being driven into “teams” regarding the shutdown."

Good article, so I'll bump it. I like his "Crush the Curve" vs my "Cleave" or "Cut" the Curve slogan. To align his point with mine, I think that's a worthy goal and we should be considering it and what it will take to accomplish it, vs the human and financial costs of not doing it.

 

[nsaspook]

This thread is both interesting and depressing at the same time. We better hope the 2003 SARS end-game is in our future as it seems most of our human actions at elimination are ineffective other than some combination of physical (island or political) isolation that can't last forever.

https://medicalxpress.com/news/2020-05-scientific-team-unique-mutation-coronavirus.html

"One of the reasons why this mutation is of interest is because it mirrors a large deletion that arose in the 2003 SARS outbreak," said Lim, an assistant professor at ASU's Biodesign Institute. During the middle and late phases of the SARS epidemic, SARS-CoV accumulated mutations that attenuated the virus. Scientists believe that a weakened virus that causes less severe disease may have a selective advantage if it is able to spread efficiently through populations by people who are infected unknowingly.

My limited understanding is that vaccines are targeting the spike protein which doesn't change.

 

[Astronuc]

Sad to say, everyone who would die is already dead or dying.

In a nursing home, yes; most, if not all, are waiting to die. In the public at large, I don't believe so.

In the population of NY State, there are 3 deaths in the 0-9 year group, and only one with a comorbidity (of the top 10, so perhaps there was another infrequent). The two who were unfortunate to be exposed, were simply unfortunate? No telling what they might have achieved had they lived beyond their current age. There are 8 deaths in the age group 10-19, but only one comorbidity from the top 10. Again, they were unfortunately exposed. In the 20-29 age group, of the 68 deaths, there are 33 with comorbidities in the top 10 of causes, but 35 who may have been otherwise healthy.

I had an interesting conversation with my father (age 90) two days ago. He indicated that if he is infected and develops Coivd-19, he does not want to be intubated, and he doesn't want heroic efforts. I respect that, and I would honor his wish. As for me, I'd want the same, but if it is my children or wife, I'd want to give them a chance to continue living.

I have no idea if I've been exposed, or if I have had the n-cov, but were asymptomatic. My concern is not myself, but those whom I love and about whom I care. By the time I return to work (physically onsite), they are supposed to have testing available.

On another topic, New York City is an example of hospital systems that were overwhelmed such that too many were turned away. We still don't know the number of fatalities due to COVID-19, because too many died at home. Only yesterday, NY State indicated 1700 folks in nursing homes and adult care facilities who are considered to have died from COVID-19 (retrospectively to March 1). Officially, as of yesterday, NY State confirms 19645 deaths due to COVID-19, but some statistics indicate the number is more than 25k, a difference of over 5k. The discrepancy includes presumed deaths.

 

[TeethWhitener]

Scientists Create Antibody That Defeats Coronavirus in Lab
By
Tim Loh
article: https://www.bloomberg.com/news/arti...eate-antibody-that-defeats-coronavirus-in-lab

Any thoughts from the Physics Forums brain trust here? I see lots of "hopeful" news about "possible" treatments and vaccines, but it's too early to tell with them.

This one seems interesting in that seems "different" in nature.

Nat. Commun. is open access. Here's the article:
https://www.nature.com/articles/s41467-020-16256-y

 

[kyphysics]

re: comorbidities

When people use this term:

1.) Are they including COVID-19 as one of the comorbidities?

In other words, if we say Person X dies of COVID-19 and had comorbidities present, does that mean the person had two different pre-existing medical conditions OTHER THAN COVID-19 or that they had one pre-existing condition and COVID-19 was the second?

2.) Are comorbidities very severe pre-existing conditions (such as HIV, cancer, etc.)? Can they be more "mild" conditions - and, if so, what would be an example?

Thanks!

 

[Vanadium 50]

And we're still not having a serious discussion of it in the general public.

I don't see that coming. The idea that seems to be ascendant is "The experts are in charge, and if we let the populace decide, they may decide to do the wrong thing."

In a nursing home, yes; most, if not all, are waiting to die. In the public at large, I don't believe so.

Not even nursing homes in other states, like SC.

 

[russ_watters]

I don't see that coming. The idea that seems to be ascendant is "The experts are in charge, and if we let the populace decide, they may decide to do the wrong thing."

Which expert(s) can I blame for us not having a compulsory tracking app tied to testing data? Tim Cook?

Maybe "general public" was the wrong term for what I meant. I mean an open/"out there" discussion of the issue overall. Be it in government, among experts in a public-access forum, even scientific and media pundits. But I agree; there's a lot of 'follow-the-leader' going on here and not a lot of big-picture thought among ordinary citizens, or the leaders/experts.

https://www.sciencenews.org/article/covid-19-coronavirus-u-s-contact-tracing-end-social-distancing

 

[atyy]

Which expert(s) can I blame for us not having a compulsory tracking app tied to testing data? Tim Cook?

I know you are thinking of South Korea.

There seems to be uncertainty about how well other apps work, especially if traditional contact tracing is not ongoing as well:
https://www.vox.com/recode/2020/4/1...contact-tracing-app-coronavirus-covid-privacy
https://www.zdnet.com/article/austr...g-story-is-full-of-holes-and-we-should-worry/

Maybe suppose that supports your point that the South Korean method is the way to go. Though I would guess they also have very good traditional contact tracing.

 

[russ_watters]

I know you are thinking of South Korea.

There seems to be uncertainty about how well other apps work, especially if traditional contact tracing is not ongoing as well:
https://www.vox.com/recode/2020/4/1...contact-tracing-app-coronavirus-covid-privacy
https://www.zdnet.com/article/austr...g-story-is-full-of-holes-and-we-should-worry/

Maybe suppose that supports your point that the South Korean method is the way to go. Though I would guess they also have very good traditional contact tracing.

Admittedly I didn't read the articles, I only searched for the word "traditional", but didn't see it. All I see is more of the same problem I've been harping on: virtually all of the discussion is about privacy and none of it about efficacy. Is there discussion of the efficacy of "traditional contact tracing" vs the app in either article?

I guess we should save a life at all financial costs, but no number of lives saved is worth any, even temporary, loss of privacy?

 

[russ_watters]

re: comorbidities

When people use this term:

1.) Are they including COVID-19 as one of the comorbidities?

Co = prefix meaning in addition to or in conjunction with
morbidity = diseased

Comorbidity is therefore the other diseases/conditions you have besides the main issue.

2.) Are comorbidities very severe pre-existing conditions (such as HIV, cancer, etc.)? Can they be more "mild" conditions - and, if so, what would be an example?

Hypertension.

 

[Astronuc]

During the 157th Annual Meeting of the National Academy of Sciences, Dr. Anthony Fauci discussed the progression of the COVID-19 pandemic in the United States, the state of testing, and therapeutics that are currently in development. Content reflects information available as of April 25th.

View the full video here:
http://ow.ly/ujAg50zs1AN

Fauci mentioned 5 types of approaches (and institutions) to a vaccine in the US, and indicated others outside the US.
Genetic immunization (DNA and RNA vaccines)
NIAID/Moderna, CureVac/NIAID, Inovio/Beijing Advaccine

Viral vector (ex: adenovirus)
Johnson & Johnson, Jenner NIAID

Live attenuated
Codagenix

Recombinant protein
Baylor and collaborators

Nanoparticle (viral protein on particle)
Novavax

 

[russ_watters]

Digital contact tracing won't work in the West because it won't be compulsory:
https://www.fastcompany.com/90496839/contact-tracing-has-a-ux-problem
https://www.cnet.com/health/contact...problem-even-if-they-do-protect-your-privacy/

And manual contact tracing won't work either:
https://nypost.com/2020/04/22/sorry-contact-tracing-isnt-the-answer-to-ending-lockdowns/

 

[atyy]

I guess we should save a life at all financial costs, but no number of lives saved is worth any, even temporary, loss of privacy?

I'm not a believer in the first (it doesn't even begin to make sense, though I absolute appreciate and respect the sentiment behind it). The second is fine, but it depends on the trust between the public and the government. I'm very curious to know how useful the TraceTogether app in Singapore is turning out to be, it will take time to find out. So far about 25% of the population has downloaded the app, that's been a slow but steady increase. But we have also greatly increased traditional contact tracing capability.

Singapore also has other methods. For places that tend to be crowded, there is a capacity limit (they post someone at the entrance to make sure people queue up), and people have to register when they enter. Earlier this year, the registration was done by pen and paper, but now there is a scanner that will scan the bar code on one's identity card (everyone has one), which has one's name, address, date of birth and blood group. I'm not sure off the top of my head how long the law requires this information to be kept and whether it requires it to be discarded.

 

[atyy]

UK epidemiologist Neil Ferguson resigns as a government adviser after admitting he broke Coronavirus lockdown to meet his married lover
https://www.insider.com/neil-ferguson-resigns-broke-lockdown-to-see-married-lover-2020-5

 

[kyphysics]

Co = prefix meaning in addition to or in conjunction with
morbidity = diseased

Comorbidity is therefore the other diseases/conditions you have besides the main issue.

Hypertension.

Hypertension doesn't sound that bad. I guess the word "comorbidity" makes me think of something very dire - like cancer.

Since I have a low IQ, let me confirm:

COVID-19 + hypertension would = having comorbidities

Is that right? It would NOT require COVID-19 + hypertension + something like cancer?

 

[Vanadium 50]

UK epidemiologist Neil Ferguson resigns as a government adviser after admitting he broke Coronavirus lockdown to meet his married lover

Lockdown for me but not for thee.

 

[Vanadium 50]

Hypertension doesn't sound that bad.

Kills half a million people a year in the US.