COVID-19 Coronavirus Containment Efforts

[bob012345]

This has frustrated me. The beaches near me that I've grown up going to are never packed with people. There are hundreds of miles of rural coastline. Often when I would go to the beach, there would be nobody, or only one or two people. Social distance is usually something like 150 feet. The cool breeze also quickly diffuses particles into the air. It is one of the least transmissible environments.

This is what they look like in terms of crowds:

View attachment 264016

Anyway, these coastlines still have been closed. Recently they opened some up, but with the caveats that you must live within 50 miles, you can only go in the morning or evening, and parking anywhere is illegal. But these beaches are basically not safely accessible without driving. Unless you have someone to drop you off, or you happen to have beach front property, you really still can't go.

It's frustrating, along with the blanket closures of outdoor recreational area's, especially when we're all taking much larger risks regularly shopping for food and doing other things. And not really that much is shut down, the skate shop is open, car dealerships are open, department stores are open, hardware stores are open, cannabis shops are open, coffee shops are open, and liquor stores are open.

Still I understand the motivation to close these beaches down and ban other safe outdoor recreation. It's really to curb travel. They don't want people coming in from other areas and bringing the virus there.

I'm really wondering what's just beyond that dune...

 

[mathwonk]

@bob012345: "What rating do you think they have?" I'm not sure, but I was also worrying that if they are too interesting, they might attract curious people to come close and read them.

 

[mfb]

Here's another of the hated Sweden-Denmark comparisons. I added UK and Germany for fun.

View attachment 264000

This is the 7-day running average of fatalities, normalized to the peak and (this is new) plotted against the days since the peak.

My conclusions:

1. The curves are closer to each other than I guessed before making the plot.
2. Our pariah nation, Sweden, is presently doing better than Norway, Germany and the UK. It's getting harder and harder to say "Every life matters! We need to get off the blue curve!"
3. Our pariah nation, Sweden, is not doing hugely better than Norway, Germany and the UK. It sums to 4%. or 179 people. I'm willing to believe that this is a downward fluctuation, and maybe the true value is not -4% but really +1 or +2% but not much more than that.
4. The upward part of the curve has some interesting features.

If you align them by onset of the pandemic (let's say 0.2 of the peak) you get completely different conclusions. Now the path until half of the peak looks virtually identical between the four countries, but they deviate later. Suddenly Sweden dragged out the pandemic longer than Denmark and the UK (peak comes later) and it doesn't recover faster either. Funny how a different presentation can completely change the interpretation, isn't it? The day of the highest reported death count depends on details of the reporting and accounting, and a bit of randomness as well.
Normalizing to the peak could be interpreted as "here, your risk to die doesn't matter so much if many other people die around you". Don't normalize to the peak and suddenly the graph looks very different again.

The fraction protesting is about 10^-4. I estimate this from news reports that say "hundreds" for local protests and "tens of thousands" in total. The case fatality rate is a few 10^-4 for that age group (predominantly young), so we'll say 10^-8 in total (not all exposed become infected, and not all who are infected become cases). So if everyone protesting is infected -obviously an upper limit - that's 3 additional deaths: a 0.003% increase to the US total. Probably closer to 0.001%. (And less than the 9 killed directly in the rioting)

• That's assuming no one infected from demonstrations infects anyone else, which is quite an interesting assumption.
• The fatality rate looks too low as well. Reported case fatality rates for young people are ~10^-3 and higher.
• I count 13 protests described as "thousands of people", one "over 3000", one "more than 3000", one "at least 5000", and too many demonstrations with 1000-2000 people to count. And that's just the US, and only the ones I found by searching for "thousand" and "000". 10^-4 or 30,000 is too low.

Sure, NYC is out of control, but the vast majority of the country is not.

It is not out of control, but still at significantly higher rates than e.g. in continental Europe. Sure, it started later, so we can also expect it to go down later, and that's what we see.

Germany had 220 deaths in the last week in a population of 80 million, or ~3 per million per week.
France had 400 deaths in the last week in a population of 70 million, or ~6 million per week.
Italy had 560 deaths in the last week in a population of 60 million, or ~9 million per week.
Spain had 260 deaths in the last week in a population of 50 million, or ~5 per million per week.

Alabama had 70 deaths last week in a population of 5 million, or 14 per million per week.
Alaska didn't have deaths but also has a population of just 0.7 million in a giant area. 0 per million per week.
Arizona had 110 deaths last week in a population of 7 million, or 15 per million per week.
Arkansas had 16 deaths last week in a population of 3 million, or 5 per million per week.
California had 460 deaths last week in a population of 40 million, or 12 per million per week.
Colorado had 130 deaths last week in a population of 6 million, or 21 per million per week.
I didn't pick specific states, I just took the first few by alphabet. Apart from Colorado they are all below the US average: The US overall had 6500 deaths in a population of 330 million, or 20 per million per week.
The life expectancy in western countries is about 4000 weeks, so 250 deaths per million per week is the normal background rate. Which means 1 in 10 deaths in Colorado and the US overall is from COVID-19 at the moment.

 

[Vanadium 50]

If you align them by onset of the pandemic (let's say 0.2 of the peak) you get completely different conclusions.

Sure, but now you're talking about actions taken at the onset of the pandemic. That tells us something about the post-peak conditions, but not about the impact of post-peak policies. Personally, I'd think this tells us something more important: we should be looking at the leading edge and a possible second wave and not about the trailing edge.

You want to quibble that 10^-4 should be two or even three times that? Have at it.

 

[mfb]

I'm talking about actions taken over the whole period, affecting the whole period.

More infections means more people die and/or more regulations and/or a longer duration of these regulations. It's not about the few people who protest who might die (it's their own risk anyway), they might have a larger impact on the trend of infectious cases. That they are a small fraction of the population doesn't change their individual impact, which might be quite large. I don't say it has to be. I don't know. But I know it can be large. We had people who infected tens of other peoples in larger crowds.

 

[kadiot]

The pictures we see that anger people and the media and some politicians call a problem are like this one:

View attachment 264018
https://www.theguardian.com/us-news/2020/apr/27/california-beaches-coronavirus-orange-county

There could be a thousand people (guess) in this photo ( ). But a thousand people over a (guess) length of a quarter mile and width of 100 yds is roughly 400 square feet per person or an average of 20'x20' per person! If you consider that most pare probably family units or small groups of friends in 2s, 3s, 5s, etc., the spacing is multiplied. This isn't a photo of violating guidelines, it's a photo showing excellent social distancing.

...and then there's the wind.

Beach and Second Wave rhymes.

 

[kadiot]

.

Overheard: "Almost all COVID-19 patients are no longer contagious by the 11th day of illness. Korea and Singapore are changing their guidelines for clearing people from quarantine and are going for time-based clearance rather than test-based clearance. For context, RT-PCR can remain positive for up to 8 weeks, but people are no longer contagious by the 2nd week. This will allow us to record recoveries much faster (you used to have to have 2 negative RT-PCRs for clearance) and free up hospital and isolation beds.

Can you confirm this? Especially the highlighted bit.

 

[PeroK]

It is not out of control, but still at significantly higher rates than e.g. in continental Europe. Sure, it started later, so we can also expect it to go down later, and that's what we see.

I've organised the data taking population into account. Here are the average daily cases (per week) per 10 million people. I used 10 million in order to get India onto the scale.

Note: these are new cases per day averaged out over each week.

Cases per
10 million)	USA	UK	Spain	Italy	France	Germany	Russia	Brazil	India	Iran	Peru
07-Apr​	932​	633​	1,405​	704​	1,029​	611​	51​	56​	4​	306​	82​
14-Apr​	919​	813​	980​	635​	680​	418​	133​	76​	6​	209​	319​
21-Apr​	874​	740​	919​	507​	509​	277​	310​	120​	9​	169​	327​
28-Apr​	914​	675​	853​	438​	271​	195​	398​	201​	12​	133​	580​
05-May​	872​	712​	563​	272​	102​	121​	605​	281​	19​	126​	868​
12-May​	738​	662​	579​	194​	168​	105​	753​	423​	26​	184​	906​
19-May​	699​	470​	283​	129​	63​	79​	663​	634​	33​	236​	1,191​
26-May​	668​	345​	150​	91​	47​	59​	611​	810​	46​	254​	1,314​
02-Jun​	673​	268​	112​	70​	143​	48​	601​	1,105​	58​	307​	1,960​

 

[kyphysics]

0...

I mean the former. The claim was made by an Italian doctor but is still controversial.

https://www.dailymail.co.uk/news/article-8376105/Is-Covid-19-really-potent.html
https://orthospinenews.com/2020/05/...ations-may-be-weakening-this-is-virology-101/

It's a good topic to keep an eye on, but from the articles I've Googled, there is a lot of push back against these claims.

 

[kyphysics]

There is nothing to do about the riots as pertains to COVID-19.

I disagree, but will also avoid the topic, because of "social politics" involved.

I do think, as stated earlier, that allowing such mass gatherings (although, it's hard to control at this point) is dangerous during the time of coronavirus. I support the protests and their cause. I just think it's unwise and a public health hazard given what the entire world is experiencing right now with the virus. #end comments

 

[morrobay]

I'm really wondering what's just beyond that dune...

I would guess a long remote coastline as far as can be scene until the next point. I would like to know what country? New Zealand? @Jarvis323

 

[OmCheeto]

I've organised the data taking population into account. Here are the average daily cases (per week) per 10 million people. I used 10 million in order to get India onto the scale.

Note: these are new cases per day averaged out over each week.

Cases per
10 million)	USA	UK	Spain	Italy	France	Germany	Russia	Brazil	India	Iran	Peru
07-Apr​	932​	633​	1,405​	704​	1,029​	611​	51​	56​	4​	306​	82​
14-Apr​	919​	813​	980​	635​	680​	418​	133​	76​	6​	209​	319​
21-Apr​	874​	740​	919​	507​	509​	277​	310​	120​	9​	169​	327​
28-Apr​	914​	675​	853​	438​	271​	195​	398​	201​	12​	133​	580​
05-May​	872​	712​	563​	272​	102​	121​	605​	281​	19​	126​	868​
12-May​	738​	662​	579​	194​	168​	105​	753​	423​	26​	184​	906​
19-May​	699​	470​	283​	129​	63​	79​	663​	634​	33​	236​	1,191​
26-May​	668​	345​	150​	91​	47​	59​	611​	810​	46​	254​	1,314​
02-Jun​	673​	268​	112​	70​	143​	48​	601​	1,105​	58​	307​	1,960​

Someone may want to check my maths. This can't be correct:

PeroK
new cases per day per 10 million	USA	UK	Spain	Italy	France	Germany	Russia	Brazil	India	Iran	Peru
2-Jun​	673	268	112	70	143	48	601	1,105	58	307	1,960
OmCheeto
2-Jun actual count	22,209​	1,769​	526​	420​	958​	398​	8,775​	23,205​	7,830​	2,548​	6,272​
cases not counted yet	14,800,000​	5,900,000​	4,000,000​	5,000,000​	4,300,000​	1,200,000​	360,000​	4,300,000​	700,000​	1,100,000​	550,000​
% cases not counted	89.0%​	95.5%​	94.3%​	95.5%​	95.9%​	86.3%​	46.2%​	88.6%​	77.3%​	87.3%​	76.5%​
dead	106,000​	39,400​	27,100​	33,500​	28,900​	8,560​	5,000​	31,200​	5,800​	7,900​	4,600​
years to count cases @ 2-Jun rate	1.8​	9.1​	21​	33​	12​	8.2​	0.11​	0.51​	0.24​	1.2​	0.24​

This is based on an "Infection Fatality Rate" of 0.64%, which I found in a paper yesterday.

If my numbers turn out to be correct, the point I'm trying to make is that daily case counts for these countries are somewhat meaningless, given the extraordinary number of uncounted cases.

If my numbers are incorrect, please feel free to delete.

 

[bob012345]

I would guess a long remote coastline as far as can be scene until the next point. I would like to know what country? New Zealand? @Jarvis323

I'm really wondering what's just beyond that dune... I was thinking more of this;

 

[PeroK]

If my numbers turn out to be correct, the point I'm trying to make is that daily case counts for these countries are somewhat meaningless, given the extraordinary number of uncounted cases.

If my numbers are incorrect, please feel free to delete.

The data is from:

https://www.worldometers.info/coronavirus/

This represents the number of people who have tested positive and the number who have subsequently died. The official number of cases in the UK stands at 280,000, and the number of deaths at nearly 40,000. That, however, is only those who have died after testing positive. The ONS (Office for National Statistics) is also counting the additional number of death certificates where COVID-19 is mentioned. This is, I believe, close to a further 10,000. So, we have somewhere between 40,000 and 50,000 confirmed deaths in the UK.

If you use an overall fatality rate of 0.64% (*), then this implies a huge number of unrecorded cases in most countries. I cannot comment on this, other than to say that anyone who claims such a low fatality rate has a lot of apparently contradictory data to explain. This has been raised several times in the previous posts. To repeat the one example of South Korea, who recorded 11,600 cases and 273 deaths (2.3%). Which implies that S Korean identified only one case in four - and yet effectively stamped it out.

The latest figures I have seen (for the UK) is that an estimated 7% of the population has already contracted the virus - i.e. about 5 million people. That would equate to a death rate of about 1%. In any case, this data is a significant unknown in most countries I believe.

The number of positive cases above is relevant because that represents a large proportion of those who have become seriously ill with COVID-19, which itself must be a reasonable measure of the state of the containment efforts.

(*) PS a fatality rate of 0.27% has been quoted.

 

[bob012345]

It's a good topic to keep an eye on, but from the articles I've Googled, there is a lot of push back against these claims.

There always is. It's much too easy to criticize new work. New ideas and results can get tabled if there's a rush to judgement.

 

[OmCheeto]

...

If you use an overall fatality rate of 0.64% (*), then this implies a huge number of unrecorded cases in most countries. I cannot comment on this, other than to say that anyone who claims such a low fatality rate has a lot of apparently contradictory data to explain. This has been raised several times in the previous posts. To repeat the one example of South Korea, who recorded 11,600 cases and 273 deaths (2.3%). Which implies that S Korean identified only one case in four - and yet effectively stamped it out.

...

Some of us are of the opinion that simply wearing masks is the biggest factor in the spread of the disease.

If 80% of Americans Wore Masks, COVID-19 Infections Would Plummet, New Study Says [Vanity Fair, 8 May, 2020]​

As long as a population follows simple rules, the disease loses.

Here's some data I graphed about a week ago:

[ref: Singapore, Malaysia]

From the Vanity Fair article; “One reason is that nearly everyone there[Japan] is wearing a mask,”
I'm guessing South Koreans probably all wear masks.

It would be interesting to find data for other countries.
I saw a video last week from New York City where one unmasked customer was bullied out of the grocery store by the masked customers.

 

[OmCheeto]

...
I'm guessing South Koreans probably all wear masks.
...

Ha!
According to Statista, 19% of South Koreans were wearing masks BEFORE the outbreak.
70% wore them after the outbreak, and 11% didn't wear them ever.

 

[atyy]

Some of us are of the opinion that simply wearing masks is the biggest factor in the spread of the disease.

If 80% of Americans Wore Masks, COVID-19 Infections Would Plummet, New Study Says [Vanity Fair, 8 May, 2020]

It seems the Japanese also did social distancing and contact tracing, not just mask wearing.
https://www.ft.com/content/7a4ce8b5-20a3-40ab-abaf-1de213a66403

New Zealand has also had a successful response so far, and mask wearing in the community is not currently recommended for healthy people.
https://www.health.govt.nz/our-work...eral-public/covid-19-use-face-masks-community

 

[mfb]

Here is a larger metastudy:
Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis
Not surprisingly, they find that all three help.
Caveat: It's not a randomized study for obvious reasons, it's just from observations. The overall conclusion is probably right but the numbers could be quite different.

13 days without new case in New Zealand. Still one active case.

 

[Astronuc]

Anders Tegnell, Sweden's state epidemiologist, told Swedish radio station Sveriges Radio on Wednesday that while the country would have implemented tougher restrictions, they would still likely not have been as strict as in many countries.

"If we were to encounter the same illness with the same knowledge that we have today, I think our response would land somewhere in between what Sweden did and what the rest of the world has done," Tegnell said, according to Bloomberg.

"Clearly, there is potential for improvement in what we have done in Sweden," he added.

https://news.yahoo.com/architect-swedens-no-lockdown-plan-132103531.html

STOCKHOLM — The debate over Sweden’s controversial no-lockdown Coronavirus strategy flared again after its architect, state epidemiologist Anders Tegnell, appeared to suggest the country's approach had been flawed.

https://www.politico.eu/article/swedens-dr-no-lockdown-denies-tactical-retreat/

However, at his daily press briefing in Stockholm, Tegnell pushed back against the idea that he was changing tack and reiterated his view that Sweden’s overall strategy had been correct.

“We continue to believe the strategy is good but then there are always improvements we can make,” he told reporters.

In hindsight, there is always room for improvement, but ideally, it helps one develop some foresight.

 

[bob012345]

Sweden again. They're wailing and gnashing their teeth over this data but it amounts to a little worse than The Netherlands without the severe disruptions to economic and social life which itself may have led to hundreds of untimely deaths. Also the list of countries included are misleading. Why not include Belgium (824)? Or France (445)? Then, there is discussion that the deaths may be more to do with differences in the health care system and policy differences in treatment.

It seems to me a better metric is not deaths per million but cases per million. That measures the spread while deaths measures the way they handle the disease. Even though Sweden tops this list below, it is ranked #20 in the world.

Total cases per million goes as;

Sweden 4149
Holland 2740
Germany 2203
Denmark 2040
Finland 1247
Estonia 1425
Norway 1567
Poland 662
Iceland 5295
Lithuania 619
Latvia 573

 

[Ygggdrasil]

Overheard: "Almost all COVID-19 patients are no longer contagious by the 11th day of illness. Korea and Singapore are changing their guidelines for clearing people from quarantine and are going for time-based clearance rather than test-based clearance. For context, RT-PCR can remain positive for up to 8 weeks, but people are no longer contagious by the 2nd week. This will allow us to record recoveries much faster (you used to have to have 2 negative RT-PCRs for clearance) and free up hospital and isolation beds.

Can you confirm this? Especially the highlighted bit.

I don't know anything about the policies of Korea and Singapore, but the the scientific claim that COVID-19 patients are no longer contagious by the 11th day of illness despite still testing positive for the virus, these claims are supported by this non-peer reviewed study that studied the infectiousness of COVID-19 patients over time:

People who contract the novel coronavirus emit high amounts of virus very early on in their infection, according to a new study from Germany that helps to explain the rapid and efficient way in which the virus has spread around the world.

At the same time, the study suggests that while people with mild infections can still test positive by throat swabs for days and even weeks after their illness, those who are only mildly sick are likely not still infectious by about 10 days after they start to experience symptoms.

Link to the scientific paper: https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1
Link to a popular press summary: https://www.statnews.com/2020/03/09...-likely-not-infectious-after-recovery-begins/

 

[kyphysics]

https://www.theatlantic.com/health/...-coronavirus-longterm-symptoms-months/612679/
COVID-19 Can Last for Several Months
The disease’s “long-haulers” have endured relentless waves of debilitating symptoms—and disbelief from doctors and friends.

For vonny leclerc, day one was March 16.
Hours after British Prime Minister Boris Johnson instated stringent social-distancing measures to halt the SARS-CoV-2 coronavirus, LeClerc, a Glasgow-based journalist, arrived home feeling shivery and flushed. Over the next few days, she developed a cough, chest pain, aching joints, and a prickling sensation on her skin. After a week of bed rest, she started improving. But on day 12, every old symptom returned, amplified and with reinforcements: She spiked an intermittent fever, lost her sense of taste and smell, and struggled to breathe.

When I spoke with LeClerc on day 66, she was still experiencing waves of symptoms. “Before this, I was a fit, healthy 32-year-old,” she said. “Now I’ve been reduced to not being able to stand up in the shower without feeling fatigued. I’ve tried going to the supermarket and I’m in bed for days afterwards. It’s like nothing I’ve ever experienced before.” Despite her best efforts, LeClerc has not been able to get a test, but “every doctor I’ve spoken to says there’s no shadow of a doubt that this has been COVID,” she said. Today is day 80.

 

[mfb]

Also the list of countries included are misleading. Why not include Belgium (824)? Or France (445)?

Because it's a list of neighbors, with a bit of liberty in the definition for oceans, but Belgium and France are definitely not neighbors.

It seems to me a better metric is not deaths per million but cases per million.

I agree. But recorded cases per million is a really poor metric, especially if a country decides to stop large-scale testing, like Sweden did.

14 days without new case in New Zealand.

 

[bhobba]

14 days without new case in New Zealand.

Australia is lifting restrictions. Tons are screaming - lift them entirely - we have beaten it. Not so fast - we are in fact tetering as the growth factor (r0 is 1 right now) shows:
https://www.abc.net.au/news/2020-04...ustralia-growth-factor-covid-19/12132478?nw=0

We need to lift restrictions slowly and be prepared to clamp them on again. I try to explain this in forums out here, but to no avail. Personally I think we are lifting them too fast.

Thanks
Bill

 

[Bystander]

but Belgium and France are definitely not neighbors.

Say again?

 

[wukunlin]

Say again?

I think he means they are not neighbors of Sweden

 

[mfb]

Say again?

... of Sweden. It was a list of neighbors of Sweden, and Belgium and France don't belong in that list because they are not neighbors [of Sweden].

 

[atyy]

I don't know anything about the policies of Korea and Singapore, but the the scientific claim that COVID-19 patients are no longer contagious by the 11th day of illness despite still testing positive for the virus, these claims are supported by this non-peer reviewed study that studied the infectiousness of COVID-19 patients over time:

Link to the scientific paper: https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1
Link to a popular press summary: https://www.statnews.com/2020/03/09...-likely-not-infectious-after-recovery-begins/

It's since been published in Nature
https://www.nature.com/articles/s41586-020-2196-x

The current Singapore policy is to use 21 days and clinically well, even if the patient tests positive by PCR.
https://www.moh.gov.sg/news-highlights/details/revised-discharge-criteria-for-covid-19-patients
" ... This is corroborated by local research. The recent position statement on the period of infectivity by the National Centre for Infectious Diseases and the Chapter of Infectious Disease Physicians, Academy of Medicine, Singapore, noted that viable COVID-19 virus was not found after the second week of illness despite the persistence of PCR detection of RNA. Local and international clinical observations therefore support the discharge of well patients after Day 14 from the onset of illness. ..."

 

[Vanadium 50]

It seems to me a better metric is not deaths per million but cases per million.

That would be true if there were 100% testing. But without it, the number of cases is strongly dependent on the number of tests.

 

[Vanadium 50]

If you align them by onset of the pandemic (let's say 0.2 of the peak) you get completely different conclusions.

Not for Sweden and Norway. They are on the same upward trend.

Funny how Norway is the perfect comparison to Sweden, except when it isn't.

 

[Vanadium 50]

It's much too easy to criticize new work.

New York screwed up big time. They acted late (when the shelter-in-place order was given they had 20,000 cases) and they put policies in place to make the situation in nursing homes worse, not better. (By that time we had known the impact on the elderly for some time).

 

[bob012345]

That would be true if there were 100% testing. But without it, the number of cases is strongly dependent on the number of tests.

I suspect that the number of actual cases tracks the number of reported cases fairly consistently in European countries. If so, using reported cases is still a better benchmark than deaths.

 

[Vanadium 50]

Well, you'd be wrong. See https://ourworldindata.org/coronavi...testing-compared-to-the-scale-of-the-outbreak For example, croatia and Portugal are more than an order of magnitude apart.

 

[PeroK]

... of Sweden. It was a list of neighbors of Sweden, and Belgium and France don't belong in that list because they are not neighbors [of Sweden].

The European Union has a population of 445 million. You are only prepared to compare Sweden with three countries with a combined population of 16 million. Excluding 96% of the data is fundamentally unscientific and designed only to support an a priori conclusion.

If you really believe what you say you must be prepared to absolutely condemn Spain in comparison with its neighbor Portugal: 580 deaths per million against 144. That's appalling. What was the Spanish government doing to lose so many people?