COVID-19 Coronavirus Containment Efforts

[DennisN]

Reuters reports today that UK and Italy researchers are investigating some suspicious symptoms in children:

French and Swedish news are reporting that the same suspicious symptoms in children are being seen in France:

CNN has now reported that similar cases have been seen in the US:

15 children are hospitalized in New York City with an inflammatory syndrome that could be linked to Coronavirus (CNN, May 5, 2020)

Fifteen children in New York City have been hospitalized with symptoms compatible with a multi-system inflammatory syndrome possibly linked to the coronavirus, according to a health alert issued by the New York City Health Department on Monday.

The patients, ages 2 to 15 years, were hospitalized from April 17 to May 1, according to the alert.
Several tested positive for Covid-19 or had positive antibody tests.

Some of the patients experienced persistent fever and features similar to Kawasaki disease or features of toxic shock syndrome, the alert said.

Another article: What is Kawasaki disease? (CNN, May 1, 2020)

Here is the NYC Health Department alert (pdf):
2020 Health Alert #13:Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19 (NYC Health Department, May 4, 2020)

 

[Vanadium 50]

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?

Comment 1: Why do you think this would be temporary? Look at all the post-9/11 responses that were supposed to be temporary and are with us today. The threat level spent a decade never getting to green or even blue before they dispensed with colors entirely.

Comment 2: Why do you think this should be temporary? If it's worth sparing a life from Covid, why isn't it worth sparing a life from influenza? Or AIDS?

Comment 3: If it's so good as a tool to save lives from disease, why shouldn't it be used to save lives from criminal behavior? Restraining orders would never be violated. Missing children on milk cartons would be a thing of the past (well, assuming milk shortages end). What a fabulous tool for law enforcement!

Who could be opposed to this...unless they had something to hide.

 

[mfb]

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.

Thinking without action isn't better than just waiting. You can keep thinking forever, but if that doesn't translate to actions it's all for nothing. Actions that need to come before "thinking is done" - you'll never be done with that anyway. The pandemic doesn't wait.

If you strongly disagreed with the paper discussed around here, suggesting no quick action if the full consequences of an action are not clear, then I missed that.
But at least it's clear now why the base case was not chosen. I was curious even back then why you discussed it at all.

Yes, I don't find any post where you said "the policy should be X", but no matter how hard I try, I can't read your earlier messages as favoring quick and strong government efforts (of any kind).

How many more deaths and trillions of dollars does it have to cost before we even ask if we're on the right path?

But... that is asked all the time.

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.

Why do you keep discussing "social distancing" in particular? You keep bringing this up over and over again.
Anyway: If you pool everything that reduces the risk of infection under "social distancing" then there isn't much else you can do.

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.

The better method is to call your "upper estimate" a lower estimate. If someone needs a ventilator and doesn't get one they'll die with ~100% chance, otherwise they didn't need a ventilator. Without hospital care deaths will go up by at least 25% based on your earlier estimate. Or 50% using the data from UK, or ~80% if we take China's earlier data. The best upper limit we can set so far is "everyone admitted to a hospital". In Italy that is 16% of the current cases - although that is biased as more severe cases take longer to resolve. But still: If these people wouldn't have somewhat problematic cases they wouldn't be in a hospital.

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?

I don't find the post now but somewhere in this thread I compared deaths to hospitalizations and ICU admissions, a bit similar to what we do now, and the result was the same. It will increase the death toll a lot, potentially by several hundred percent. Is this a gamble you want to take? Do you want to keep studying this for months, possibly to end up with the result that yes, doing more would have saved two million people?

But I'm confused why this is now being discussed again. You want the government to take actions to limit the spread, right? So why do we discuss the do-nothing, just collect dead bodies from the streets scenario again?

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.

Clearly a shorter shutdown is preferable. The initial rise in cases was roughly twice as fast as the subsequent drop, so every day of earlier action means the restrictions can be shorter by two days (ending three days earlier) if everything else stays the same. You end up with fewer overall deaths, too. Ramping up the testing capability won't be sped up from that, okay.

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.

Even the Korean border, probably the most well-watched land border in the world, isn't 100% without contact. But that's clearly not a typical border.
Borders in the Schengen area are largely like borders between US states: On major roads there is a sign that you are now in a different country, and probably another sign informing you about speed limits in that country. That's it. On smaller roads there isn't even a sign. Tens of thousands cross each of these borders every day because they live on one side and work on the other, or simply because the nearest supermarket is across the border. Can you imagine closing the border between New Jersey and New York? For a year? Me neither. Sure, Schengen borders are the other extreme here, but they are clearly of interest in Europe. Most borders will be somewhere between these.
Islands have it much easier. Very few international commuters, generally fewer people crossing the border normally, and people enter the country in a very limited set of places.

any, even temporary, loss of privacy?

When was the last time a government stopped recording private data it got access to?

----

Australia's new cases per day went up a bit the last days. From ~5-20 in late April to ~25 the last three days. Do we see an effect of loosened restrictions, or something else?
New Zealand's new cases are quickly approaching zero. 2, 3, 6, 2, 0, -1, 2 cases the last seven days. -1 was a false positive I guess. Iceland is at one case every few days, every case could be the last one now.

 

[kadiot]

More 'transmissible' strain of SARSCoV2? This is based on a pre-print on computational analysis of virus sequences. The team found a mutation that became dominant over time – this mutation at position 614 in the SPIKE protein changed aspartic acid (D) to glycine (G). The pre-print title is very misleading. "Spike mutation pipeline reveals the emergence of a more transmissible form of SARS-CoV-2" Really? That was NOT what the study showed. The study only showed emergence of a substitution of aspartic acid for glycine at position 614. Did the team do studies to actually show its functional significance in transmission (the ability to significantly infect cells / be more transmissible)? NO. Correlation is NOT causation..

 

[russ_watters]

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

For many, hypertension isn't a big deal right up until the moment it kills them via stroke, heart attack, aneurysm...etc.

At the same time, the Big Bad C-word isn't a singular/dire risk either. There are many forms of cancer with many potential outcomes for different people, depending on the stage. Some are so minor compared to other risks that we don't even bother treating them (colon cancer). Others have pretty easy, near-guaranteed cure rates (breast cancer). On the other side of the coin, some are a near-certain death sentence (pancreatic cancer).

Unfortunately, I've had the "I have cancer" with several people and knowing which type and at what stage they are in is critical to knowing how dire a situation they are in.

COVID-19 + hypertension would = having comorbidities

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

Right.

https://www.verywellmind.com/what-is-comorbidity-3024480

 

[russ_watters]

Comment 1: Why do you think this would be temporary?
[snip]Why do you think this should be temporary?

The framework has to be permanent in order to be maximize the benefit for the next pandemic. That's how South Korea was able to implement digital contact tracing so fast. But the information we're talking about - COVID-19 infection status - is temporary by its very nature. When the next pandemic hits, we apply the pre-determined criteria to decide whether to initiate the action again.

Comment 2: [snip] If it's worth sparing a life from Covid, why isn't it worth sparing a life from influenza? Or AIDS?

Note: I re-arranged your comments since they didn't quite align with what I was after, and they really are different questions based on the approach.

Maybe it is. We should have a rational discussion about lives saved vs costs and set goals and thresholds. For whatever reason many people don't seem to want to even discuss it, preferring instead to put their head down and charge. For just one of the comparisons; COVID-19 to flu, COVID-19 has so far been about as bad as a bad flu in terms of deaths, but at a vastly higher financial cost. By the time it is over it will likely be much higher in deaths as well.

So I'll set the following thresholds as a starting point for the discussion:
1. 150,000 deaths in a single disease event/season.
2. Digital contact tracing is prioritized ahead of mandatory social distancing/shutdown. Note: this supersedes the cost question. Alternately, perhaps, we could say the threshold cost of mandatory social mitigation is $2 Trillion. From a practical standpoint, I think we've found that they are the same criteria, but one formulation focuses on rights and the other on money.

Comment 3: If it's so good as a tool to save lives from disease, why shouldn't it be used to save lives from criminal behavior? Restraining orders would never be violated. Missing children on milk cartons would be a thing of the past (well, assuming milk shortages end). What a fabulous tool for law enforcement!

That's already a thing for some purposes (sex offenders, kidnappers, house arrest). Yes, it's a fabulous tool [/notsarcastic], and we should always be considering options for expansion as technology improves.

I'd love to talk through the nuts-and-bolts of this, but so far nobody has seemed interested. As social distancing and the economy fail while the death toll, cost and loss of freedom rises, I guess I'll find out if the level of interest starts to rise.

Who could be opposed to this...unless they had something to hide.

For this issue, sarcasm does not work on someone who actually believes privacy is relatively unimportant.

Part of the problem here in my opinion is that people are staking positions on rights without recognizing those positions contradict each other. You may not like it, but you have to make choices:

• Do you value privacy more than freedom?
• Do you value privacy more than your life?
• Do you value freedom more than your life?

For me, privacy ranks 3rd. We'd need a matrix to add money to that mix, but we've largely discussed the money issue already...

 

[bob012345]

I'm not in favor of trashing the Constitution for safety against future pandemics. If we cede power over our lives to politicians, technocrats and health officials because we are scared and think they will keep us totally safe we deserve to live in a hellish Huxleyan* future.

https://expressiveegg.org/2017/01/03/four-kinds-dystopia/

 

[Dullard]

For me, this debate shares some features with the 'gun control' argument. As with many popular gun control measures, there is a lot of (unjustified?) confidence that digital tracing will address the specific problem in a meaningful way. 'Do Nothing' can (and often is) a better choice than 'do something that accomplishes nothing.' The prevalence of the virus, the fact that everyone doesn't have a smart-phone, and the near-impossibility of deciding if a 'contact' actually occurred make it extremely unlikely that there will be a useful result. In our litigious society, it seems likely that everyone would just get a warning every day. It is certain that the location information will (eventually) be blatantly abused. It's likely that it will be used in other-than-intended (by the public) ways immediately. If you're active on Facebook, you may not even understand the problem with that. Were I Christian (I'm not), I'd probably avoid taking the MAC address of the beast.

 

[russ_watters]

I'm not in favor of trashing the Constitution for safety against future pandemics.

What about the current pandemic? For the current pandemic, we've already made choices that restrict rights and created a hierarchy of rights to use as a basis for deciding which to restrict and by how much. Presumably we would make such choices in the future as well. I'm only suggesting we should consider different choices based on which freedoms/rights I value, and suggest people put more thought into the ones they are making.

What I find a bit mind boggling (and it certainly isn't just you) is that people are acting like the right to privacy is completely untouchable seemingly without even realizing it:

• Right to privacy totally supersedes right to life
• Right to privacy totally supersedes many basic freedoms (movement/assembly, speech, religion, etc)
• Right to privacy totally supersedes economic freedoms

Is the right to privacy really by a wide margin our most fundamental/important right?

 

[Vanadium 50]

Do you value freedom more than your life?

Clearly people have different answers to this - under totalitarian regimes, for example, some react by accepting the situation and others risk their very lives to change things. If you take your 150,000 per year number and apply it to the Covid age distribution, my probability of dying is about 3 x 10^-5. That's 100x less likely than dying in a car crash, where I am willing to accept that I need to blow in a breathalyzer for any reason or no reason at all, but not that my position is known at all times.

Because people have different values, this is an inherently political question, which is why a state of emergency shutting down the political process is not a good way to make these decisions.

 

[bob012345]

What about the current pandemic? For the current pandemic, we've already made choices that restrict rights and created a hierarchy of rights to use as a basis for deciding which to restrict and by how much. Presumably we would make such choices in the future as well. I'm only suggesting we should consider different choices based on which freedoms/rights I value, and suggest people put more thought into the ones they are making.

What I find a bit mind boggling (and it certainly isn't just you) is that people are acting like the right to privacy is completely untouchable seemingly without even realizing it:

• Right to privacy totally supersedes right to life
• Right to privacy totally supersedes many basic freedoms (movement/assembly, speech, religion, etc)
• Right to privacy totally supersedes economic freedoms

Is the right to privacy really by a wide margin our most fundamental/important right?

In regards to the current crisis, I consider certain government actions to have been unnecessarily oppressive however the Constitutionality will have to be tested. I do not advocate civil disobedience to those measures now but I hope the actions taken be tested up to the Supreme Court. Then we shall know. If the Court strikes down certain measures, there is time for relevant authorities to find alternative strategies for the next pandemic or a possible second wave of this one.

I do not own a smartphone. Could the government eventually require me to have one so they can track my movements?

 

[ChemAir]

Because people have different values, this is an inherently political question, which is why a state of emergency shutting down the political process is not a good way to make these decisions.

And, since the US public has largely decided to make this a black and white issue along party lines, we are here. Some politicians, online media, and news outlets aren't helping (anyone but themselves), as usual. Outside this forum, it is very difficult to point out good statistics or bad statistics on this situation without being labeled as partisan, depending on what you point out. It is nice to see some civil discussion here.

In this age of information, where we have the ability to identify a new virus, fully transcribe its genome and develop knowledge pretty darn quickly, it is sad to see how much bad information is being distributed, how much good information is being re-framed incorrectly, and how many individuals are more interested in self promotion than actually fixing the issue.

I guess that's about the same as any other political problem.

 

[WWGD]

And, since the US public has largely decided to make this a black and white issue along party lines, we are here. Some politicians, online media, and news outlets aren't helping (anyone but themselves), as usual. Outside this forum, it is very difficult to point out good statistics or bad statistics on this situation without being labeled as partisan, depending on what you point out. It is nice to see some civil discussion here.

In this age of information, where we have the ability to identify a new virus, fully transcribe its genome and develop knowledge pretty darn quickly, it is sad to see how much bad information is being distributed, how much good information is being re-framed incorrectly, and how many individuals are more interested in self promotion than actually fixing the issue.

I guess that's about the same as any other political problem.

Plus the blaming of politicians ( which is sometimes warranted) and calling them liars. Because your average person is 100% honest and never petty. If politicians are low quality, then it reflects poorly on the communities they come from. They're not from Mars or Pluto, they come from the schools, churches and other institutions in their communities. They are us.

 

[bob012345]

Plus the blaming of politicians ( which is sometimes warranted) and calling them liars. Because your average person is 100% honest and never petty. If politicians are low quality, then it reflects poorly on the communities they come from. They're not from Mars or Pluto, they come from the schools, churches and other institutions in their communities. They are us.

Yes, and while I think people in public life sometimes react in a petty manner or say stupid things... I have felt from the beginning that everyone is trying to do the best they can to solve this crisis. Which is why I have been carrying on a civil dialog with my Congressman, who seems to be an advocate of near infinite testing before we even think about relaxing any restrictions, trying to explain my position of not having to wait forever for the never quite defined 'more testing' before society can open up slowly. But, I could be wrong...

 

[Vanadium 50]

And, since the US public has largely decided to make this a black and white issue along party lines

I don't think the public has made this black and white. The Press certainly has. The technocracy has. Fundamentally, the issue is that not everyone receives the same benefit from the present policies and not everyone pays the same price. The closest thing to party lines is that this axis is close to the previous axis - what led us to Brexit, the gilets jaunes, and yes, the Bad Orange Man.

I think the American people would be willing to stand for a much longer and more severe lockdown, provided they were part of the discussion. But what the reaction of the elite class (and I feel these are my peeps) is appears to be "shut up and let us decide how much you will suffer". Where the political parties get involved is in egging on one side or the other.

In Illinois, the governor has dissolved the legislature (well, technically the legislature still exists - they're just not allowed to meet and vote) and ruled by fiat for longer than the 30 days the law gives him the authority for. His position is that this doesn't matter and he will continue until he feels good and ready to end it. Maybe this is the correct decision, but it's not a good way to get everybody on board. If this happened south of the border, we would be tossing words like "banana republic" around.

Why should Joe's Pizza in Paris Illinois, (pop. 6105) where you have to literally drive for miles to find a Covid case shut down? Why should it be illegal to sell vegetable seeds in Copper Harbor, Michigan, where you need again to drive for miles to find a case. Why is Beaver Island - an island, for heaven's sake - under lockdown? While there may well be good answers to these questions "do as you're told" is not one, nor is "if you don't, millions will die". Worst of all is "it's complex, but if we explained it to you, we don't think you're going to understand."

 

[BillTre]

Back to technical issues:

Several groups are looking for antibodies that can be used to treat coronavirus, as opposed to looking for antibodies to determine if one was infected.

Preliminary antibody explanation for understanding the article:
Consider the surface of the virus as a limited number of proteins which are exposed so that antibodies could interact with them.
Each protein of a particular kind (such as the spike protein) will have a particular pattern of amino acids and/or protein modifications to which antibodies can bind. The binding site of an antibody is called an epitope.

Antibodies are produced by immune cells. Each cell produces many copies of a single kind of antibody that binds to a particular binding site on the exposed surface of the protein it binds to. During an immune response cells producing antibodies that effectively bind target divide and make more of the cells making the same antibody (sometimes with refining minor mutations). This is called clonal selection. As a result, overall, the body produces the same antibody in greater numbers (this can take weeks).
(for this figure like of the pathogenic bacterial cell as the virus)

An antibody can bind to its target strongly, weakly, or in between. Strong binding antibodies will stay bound longer and generally have stronger effects (binding is stochastic, the antibodies can come and go depending on their binding properties).
Since the immune system has millions (or more) cells doing this, a normal immune response can have lots of different antibodies that bind to different distinct places on a virus surface protein.
More antibodies binding to a single target will generally have a stronger immune response.
Antibodies can either directly block their targets function by blocking or occupying its binding site (or enzymatic site, depending on the function of the target molecule), or they can just label the virus (or whatever else they might be binding) for follow up by the immune system which could result in eating the virus, killing an infected cell or an invading bacteria.

This Science news article reviews the efforts of several (but not all) of these groups (see below).
They are looking for antibodies that will prevent the Coronavirus from binding and entering cells.
This approach is similar to one that was previously posted about using the protein that is bound by the virus's spike protein and flooding a person's blood with this protein which would bind all (or enough to be effective) of the proteins spike protein's binding sites to prevent them from binding their cellular targets, and thus preventing them from getting into cells.

Several approaches described.
They are focused on making/identifying monoclonal antibodies (antibodies that are all molecularly the same and bind the same part of the target protein), but to produce a more effective response want to have more than one kind of antibody so more of the spike protein is bound by antibody. Therefore they want to combine different monoclonals into a cocktail (mix of two or three different antibodies) that can be used to treat patients.

This approach seems to have worked OK with the Ebola virus.

The technical issues of producting the antibodies are not immense but intricate and involve a lot of work.
They are using clever strategies to target antibodies that are more likely to be useful.
The scale-up may present challenges.

 

[BillTre]

https://www.nytimes.com/2020/05/05/health/https://www.physicsforums.com/insights/dont-fear-crispr-new-gene-editing-technologies-wont-lead-designer-babies/-coronavirus-covid-test.html?campaign_id=2&emc=edit_th_200506&instance_id=18224&nl=todaysheadlines&regi_id=38810697&segment_id=26690&user_id=5e9e0d67b7b00aecd626a3f1ac4f0f14 (by Carl Zimmer) about a Crispr based test being developed by Dr. Feng Zhang, a researcher at the Broad Institute in Cambridge, Mass., and one of the pioneers of Crispr technology to rapidly determine if someone is infected with coronavirus. They want it to be as easy as a pregnancy test.

Its promise is that the test will be cheap, fast and simple, once worked out.
A good test for people who are infected is the basis of many strategies for controlling the pandemic.

Not yet published, but promising and they have made a website with information for other researchers to try it out.

 

[atyy]

https://www.medrxiv.org/content/10.1101/2020.04.30.20085613v1
Humoral immune response and prolonged PCR positivity in a cohort of 1343 SARS-CoV 2 patients in the New York City region
Ania Wajnberg, Mayce Mansour, Emily Leven, Nicole M Bouvier, Gopi Patel, Adolfo Firpo, Rao Mendu, Jeffrey Jhang, Suzanne Arinsburg, Melissa Gitman, Jane Houldsworth, Ian Baine, Viviana Simon, Judith Aberg, Florian Krammer, David Reich, Carlos Cordon-Cardo
doi: https://doi.org/10.1101/2020.04.30.20085613

"Six hundred and twenty-four participants had confirmed SARS-CoV-2 disease by PCR prior to coming for testing ... At first test, five hundred and eleven (82%) were strongly antibody positive ...

Of the 113 participants with PCR confirmed SARS-CoV-2 and weakly positive or negative titers on their first serum antibody test, 64 have returned for follow up antibody titers at the time of submission. Of these, 57 (89%) displayed increased titers between the two tests, a median of 13 days (5-25) later (Figure 1B). Four remained weakly positive, and three remained negative. The three that remained negative all self-reported positive PCR testing (none were documented in our EMR). ...

Although we do not yet know what, if any, immunity is conferred by IgG or the duration of the IgG response, at this time it seems likely that IgG to SARS-CoV-2 may confer some level of immunity based on what is known about viral immunity to other pathogens. ...

In contrast to some of the prior literature on formation of antibodies, over 99% of the patients who self-reported or had laboratory documented SARS-CoV-2 infection developed IgG antibodies using our assay. ...

All participants had mild disease, and thus these data 213 may not reflect PCR or Ab findings in a moderately or severely ill population. ..."

My comment: Depending on how one analyzes the data, the percentage may be lower than 99%, but this data set suggests that most (more than 90%) COVID-19 patients develop antibodies, a contrast to some earlier studies. This may be because it takes time for the antibodies to develop, so testing patients earlier might give lower numbers.

 

[Ygggdrasil]

https://www.nytimes.com/2020/05/05/health/https://www.physicsforums.com/insights/dont-fear-crispr-new-gene-editing-technologies-wont-lead-designer-babies/-coronavirus-covid-test.html?campaign_id=2&emc=edit_th_200506&instance_id=18224&nl=todaysheadlines&regi_id=38810697&segment_id=26690&user_id=5e9e0d67b7b00aecd626a3f1ac4f0f14 (by Carl Zimmer) about a Crispr based test being developed by Dr. Feng Zhang, a researcher at the Broad Institute in Cambridge, Mass., and one of the pioneers of Crispr technology to rapidly determine if someone is infected with coronavirus. They want it to be as easy as a pregnancy test.

Its promise is that the test will be cheap, fast and simple, once worked out.
A good test for people who are infected is the basis of many strategies for controlling the pandemic.

Not yet published, but promising and they have made a website with information for other researchers to try it out.

Here's a paper published by a competing group describing a CRISPR-based diagnostic test for detecting SARS-CoV-2 RNA: https://www.nature.com/articles/s41587-020-0513-4

 

[kyphysics]

Questions re: blood clots and COVID-19:

i.) First, I've been reading more stories about this recently. Some figures have 10% of hospitalized COVID-19 patients getting clots.
https://www.businessinsider.com/blo...ns-are-showing-up-in-covid-19-patients-2020-5

Clotting complications appear to pop up in about 10% of all hospitalized COVID-19 cases, according to data seen by Dr. Mark Crowther, the chair of the department of medicine at McMaster University in Ontario, Canada and the treasurer of the American Society of Hematology.

10% is significant. One reason listed for clots is a lack of movement by a lot of patients (often sedated on ventilators).

Is that the only reason you'd get a clot? Anyone know why else a COVID-19 patient would have blood clots? I'm not seeing the WHY part (other than immobility).

ii.) Would a person know they have a blood clot?

The other question is whether blood clots are causing problems after COVID-19 patients leave the hospital, leading to sudden deaths. Spyropolous said he's concerned about complications arising after patients are discharged.

In early autopsy data from Northwell, there appear to be major clotting events like a massive heart attack or lung clots in 40% of patients who have died after leaving the hospital, Business Insider previously reported.

Michael Reagan, a 49-year-old COVID-19 patient, told Business Insider he was recovering from the illness when doctors found blood clots in his lungs. After an overnight stay, Reagan was sent home with a prescription for a blood thinner.

"It feels like a toxin is in my body," Reagan told Business Insider in April.

iii.) Not really a blood clot question per se, but does anyone have numbers for how many patients with COVID-19 die after leaving the hospital (something referenced in the quote above)? This is disturbing to me. As in, why are patients dying after leaving? Are they being let go too soon?

 

[Vanadium 50]

The framework has to be permanent in order to be maximize the benefit for the next pandemic. That's how South Korea was able to implement digital contact tracing so fast. But the information we're talking about - COVID-19 infection status - is temporary by its very nature. When the next pandemic hits, we apply the pre-determined criteria to decide whether to initiate the action again.

I don't think that will do what you want. When you have your first case, you want to look back and see who that person had contact with, and who they had contact with, and so on. Then you can "crush the curve" when you are dealing with many fewer people.

So you need to be running this system all the time, although after a few weeks oir a month you could probably throw it (the data) away. But the data needs to be created. And that means that it has to be protected. And we don't have a very good track record of this.

 

[Dullard]

"So you need to be running this system all the time, ..."
This is another similarity to the gun control argument. A virus tracking system implies a 'look-back' capability; you need to start it about 3 weeks before you know that you need it; it must always be running to have any utility. Enforcement of many of the 'simple' gun control proposals (regarding transfers) imply (but never claim) a complete list of who owns what guns. In both cases, the implications are unpalatable to many.

 

[ChemAir]

And we don't have a very good track record of this.

We also don't have a good track record for ending costly (whether in dollars or convenience) policies initiated in situations like this. Once the infrastructure has been allowed to be installed, the temptation to use the system would be strong.

 

[bob012345]

https://www.nytimes.com/2020/05/05/health/https://www.physicsforums.com/insights/dont-fear-crispr-new-gene-editing-technologies-wont-lead-designer-babies/-coronavirus-covid-test.html?campaign_id=2&emc=edit_th_200506&instance_id=18224&nl=todaysheadlines&regi_id=38810697&segment_id=26690&user_id=5e9e0d67b7b00aecd626a3f1ac4f0f14 (by Carl Zimmer) about a Crispr based test being developed by Dr. Feng Zhang, a researcher at the Broad Institute in Cambridge, Mass., and one of the pioneers of Crispr technology to rapidly determine if someone is infected with coronavirus. They want it to be as easy as a pregnancy test.

Its promise is that the test will be cheap, fast and simple, once worked out.
A good test for people who are infected is the basis of many strategies for controlling the pandemic.

Not yet published, but promising and they have made a website with information for other researchers to try it out.

It's quite astounding how non-technical people such as politicians and journalists continually gripe about the "lack of testing" as if by magic these complex processes and procedures can just be invented, designed, deployed and competently run from scratch by the millions every day. There is no appreciation for the technical and logistical difficulties involved and how far we have come in such a short time. They seem to think there should have been hundreds of millions of daily tests conveniently deployed out of thin air on day one and since that was impossible, we failed.

 

[Vanadium 50]

We also don't have a good track record for ending costly (whether in dollars or convenience) policies initiated in situations like this

This is not just a feature of government, although there are examples - my favorite is the Rural Electrification Administration, left over from the 1930's. They're still around, although there has been essentially 100% electrification for 40 or 50 years. (And oddly, the REA is not part of the Department of Energy.) My favorite non-governmental example is the March of Dimes. They were created to end polio. This was a success, but they didn't go away.

 

[hmmm27]

Don't forget income tax : have we paid for World War I yet ?

 

[OCR]

my favorite is the Rural Electrification Administration

Now known as the United States Rural Utilities Service . . .
.

 

[mfb]

It's quite astounding how non-technical people such as politicians and journalists continually gripe about the "lack of testing" as if by magic these complex processes and procedures can just be invented, designed, deployed and competently run from scratch by the millions every day. There is no appreciation for the technical and logistical difficulties involved and how far we have come in such a short time. They seem to think there should have been hundreds of millions of daily tests conveniently deployed out of thin air on day one and since that was impossible, we failed.

Look beyond the borders. If one country can test 5% of its population, why does another one with a similar economic situation struggle testing 1%?

 

[anorlunda]

Now known as the United States Rural Utilities Service . . .

I visited their offices in Washington DC once. I did not detect any sign of life.

 

[vela]

It's quite astounding how non-technical people such as politicians and journalists continually gripe about the "lack of testing" as if by magic these complex processes and procedures can just be invented, designed, deployed and competently run from scratch by the millions every day. There is no appreciation for the technical and logistical difficulties involved and how far we have come in such a short time. They seem to think there should have been hundreds of millions of daily tests conveniently deployed out of thin air on day one and since that was impossible, we failed.

It's not a lack of appreciation for the complexity of the problem. It's the lack of will of the federal government to implement such a process.

 

[anorlunda]

It's the lack of will of the federal government to implement such a process.

I'm an engineer. I want to see requirements before design and design before implementation. I've been watching and listening, and I've yet to hear a straight answer to the question, "How much testing is enough?"

Globally, the upper limit is of the order of 7 billion tests per day. Is that too much? Then state the requirement. How much is enough? Any answer needs to be accepted nearly everywhere to be useful.

I am most frustrated with journalists who fail to ask "How much is enough?" in press conferences where testing is discussed.

 

[bob012345]

I'm an engineer. I want to see requirements before design and design before implementation. I've been watching and listening, and I've yet to hear a straight answer to the question, "How much testing is enough?"

Globally, the upper limit is of the order of 7 billion tests per day. Is that too much? Then state the requirement. How much is enough? Any answer needs to be accepted nearly everywhere to be useful.

I am most frustrated with journalists who fail to ask "How much is enough?" in press conferences where testing is discussed.

Journalists don't care about that question. They care about making political statements and the testing issue has become a hammer to make political statements. What Dr. Birx said was reasonable. Enough testing is what is needed to handle any major local outbreak as the economy slowly opens up which she and Fauci expressed confidence that we have that capability now.

 

[Vanadium 50]

I'm an engineer. I want to see requirements before design and design before implementation

That's adorable! "I'll know it when I see it" is a more typical spec for me.

The reason you don't see a spec on testing is that the goals of testing are unclear. One thing you might want to do is have wide testing to statistically monitor the spread of the disease. Another is that you might want to use it for diagnostic purposes. A third is you might want to use it for is to identify and monitor individuals who may be exposed. (And there's also the "brickbat one can use against one's opponents" mentioned before)

These all have different requirements. For example, if I am using it to test individuals, I want the false positive/negative rate to be small. If I am using it statistically, I want the false positive/negative rate to be well-known (small is nice too). If I am testing millions, it needs to be quick, cheap and easy in a way that it doesn't if I am testing thousands. And so on.

 

[bob012345]

Look beyond the borders. If one country can test 5% of its population, why does another one with a similar economic situation struggle testing 1%?

Define similar. Similar size? Similar GDP but different population? Is the metric per capita? What tests are being used and how much do they cost? Are they vastly different in complexity? 1% of 330 million is a lot harder than 5% of 3 million. Even the number of tests can be defined differently in different countries.

https://ourworldindata.org/coronavirus-testing

As I understand, the in the U.S., the C.D.C. developed our test. The test was complex and cumbersome, and they only allowed certain state labs to use it despite requests from hundreds of private labs to help until the feds encouraged cooperation . But now, the cumulative tests in the U.S. per 1000 is 24.5 on par with many European nations and ahead of some. Our rolling three day average of new tests is about 1 per 1000 which also is on par with most of the world.

 

[bob012345]

It's not a lack of appreciation for the complexity of the problem. It's the lack of will of the federal government to implement such a process.

If you mean the slow response of the C.D.C. and their refusing to allow private labs to help develop and administer tests, yes.