COVID-19 Coronavirus Containment Efforts

[BillTre]

I like The Who:
However, this Who prediction ("we won't get fooled again") does not seem to have worked (Bad Track Record).
Also, I don't recall them being Peer Reviewed (by other bands?).
They are Influenced By Politics.
However, I don't know that they tend to Contradict The Scientific Community.

 

[gmax137]

I like The Who:

@BillTre you beat me to it, I was thinking of exactly this song as I read down through the thread :)

 

[mfb]

Do you have any more specific criticism, or do you just dismiss it because you don't like the WHO?

They have a bad track record, not peer reviewed, tend to contradict the scientific community, influenced by politics, and have been criticized by their own employees as being unreasonably hard headed.

I would try to carefully review their work if you can before taking anything they say seriously.

Okay, so it's just because you don't like the WHO in general, not because you would have any criticism of this estimate here.

 

[Astronuc]

COVID-19 cases at Appalachian State University, part of North Carolina’s state university system, spiked sharply last week. The school’s dashboard shows more than 700 confirmed COVID-19 cases at the 20,000-student campus since early June. However,

Aside from athletes, who must be tested under NCAA rules, Appalachian State has not conducted the kind of costly, widespread mandatory testing and tracing of people with and without symptoms that has helped control the virus at some campuses. Rather, the school has offered voluntary testing at its student health center and at “pop-up” test sites where students can walk up and be tested twice weekly.

https://news.yahoo.com/student-dies-campus-gets-serious-184001668.html

A 19-year-old student Chad Dorrill, with no apparent underlying or pre-existing medical conditions, died from COVID-19. He apparently had a severe neurological reaction to the virus.
https://www.wsoctv.com/news/local/1...-19-complications/X4AAXZ7JQBBRLFICKM3QIE3BZI/

The university (ASU in NCSU system) reported a new high of 159 current COVID-19 cases among students on Tuesday. Nearly 550 students have tested positive for the virus since in-person classes resumed last month. Appalachian State remains open for in-person instruction.

Three North Carolina colleges, including UNC-Chapel Hill, North Carolina State University and East Carolina University, have halted physical classes for undergraduate students, after reporting a series of Coronavirus outbreaks shortly after students returned to campus. Nearly 1,000 UNC students have tested positive for COVID-19 since classes resumed in August. ECU surpassed 1,000 cases earlier this month, followed shortly thereafter by NC State.

https://www.cbsnews.com/news/appalachian-state-student-chad-dorrill-dies-covid-19/Side topic: Dexamethasone

Among mountaineers, dex is often taken preventatively—and controversially, since it raises ethical questions as a performance enhancer—to reduce brain swelling and improve one’s summit chances. National Park Service rescuers on Denali, in Alaska, use it to circumvent the slow process of acclimatization, and guides often wear doses of it around their neck or keep an injectable syringe full of it in their pocket in case a client stops moving due to cerebral edema.

https://www.outsideonline.com/2415005/coronavirus-treatment-mountaineering-dexamethasone

 

[Astronuc]

Aruba only is oddly specific,

Aruba, Jamaica, . . . . you know.

 

[morrobay]

It is suspected that Appalachian State Univ. student Chad Dorrill had undetected Guillain Barr Syndrome. This undiagnosed disorder results in an immune system response that attacks the nerves.

 

[StevieTNZ]

The issue , I guess, is this president's denial of the ease of spread of the virus, against all medical advice, so I guess that will be a good thing.

One would hope, but - https://www.stuff.co.nz/world/ameri...post-calling-covid19-less-lethal-than-the-flu

 

[mfb]

New Zealand: No active cases in community; 3 new cases at the border
They beat it a second time.

Iceland has an outbreak at the moment

 

[BillTre]

I was thinking how could they have cases at the border, since they are an island.
It sounds like they are people coming in kept in isolation though.

 

[StevieTNZ]

It sounds like they are people coming in kept in isolation though.

That's correct. They are tested at day 3 and day 13 of their stay in managed isolation.

 

[StevieTNZ]

New Zealand: No active cases in community; 3 new cases at the border
They beat it a second time.

So much for these statements about NZ from Trump: https://www.theguardian.com/world/2...-big-surge-on-day-it-records-nine-covid-cases

 

[nsaspook]

I think the NZ elimination strategy is a good one for its fairly unique position of a wealthy, low population, geographically isolated nation but they are essentially a submerged submarine now in a world filled with stealthy destroyers that know the subs location on the bottom.

 

[Ygggdrasil]

The growth in COVID-19 cases in Wisconsin is putting strain on health systems in the state as hospitals near capacity:

MADISON, Wis. (AP) — Wisconsin health officials announced Wednesday that a field hospital will open next week at the state fairgrounds near Milwaukee as a surge in COVID-19 cases threatens to overwhelm hospitals.

Wisconsin has become a hot spot for the disease over the last month, ranking third nationwide this week in new cases per capita over the last two weeks. Health experts have attributed the spike to the reopening of colleges and K-12 schools as well as general fatigue over wearing masks and socially distancing.

[...]

Only 16% of the state’s 11,452 hospital beds were available as of Tuesday afternoon, according to the DHS. The number of hospitalized COVID-19 patients had grown to 853, it’s highest during the pandemic according to the COVID Tracking Project, with 216 in intensive care.

https://apnews.com/article/virus-ou...nsin-archive-61856a69ec6e9e6f032bb121b6d58a5d

Here are the metrics for testing, hospitalizations and deaths from Wisconsin:

North Dakota and South Dakota are the two states with a higher rate of new cases per capita over the past week than Wisconsin:

 

[russ_watters]

The growth in COVID-19 cases in Wisconsin is putting strain on health systems in the state as hospitals near capacity:

https://apnews.com/article/virus-ou...nsin-archive-61856a69ec6e9e6f032bb121b6d58a5d

MADISON, Wis. (AP) — Wisconsin health officials announced Wednesday that a field hospital will open next week at the state fairgrounds near Milwaukee as a surge in COVID-19 cases threatens to overwhelm hospitals...

Only 16% of the state’s 11,452 hospital beds were available as of Tuesday afternoon, according to the DHS. The number of hospitalized COVID-19 patients had grown to 853, it’s highest during the pandemic according to the COVID Tracking Project, with 216 in intensive care.

This article is a good example of why media/political characterizations annoy me so much. If there's a hospital capacity problem or projected problem in WI, they haven't told us what it is. What their data says to me is that COVID patients are taking up a third of the available hospital beds in the state and they'll need to triple in order to fill it completely (if evenly spread). That doesn't sound like either a "strain" or "near capacity" or "overwhelmed" to me.

 

[hutchphd]

The statewide average may be far different from what is happening in, say, Milwaukee. Also there are fluctuations in time. Are you familiar with the classic "telephone" problem (how many long distance line do you need yada yada...;) I know you really don't want to get a busy signal when requesting an ER.

 

[russ_watters]

The statewide average may be far different from what is happening in, say, Milwaukee. Also there are fluctuations in time.

Yes, that's a possibility. Like I said, if there's a problem, they haven't said what it is.

 

[nsaspook]

Florida is an interesting case that seems to confound the expectations of cases and deaths since the beginning of the pandemic.

It seems states like Wisconsin that didn't have a localized Gompertz’s wave for deaths at some point in the pandemic are getting one now.

https://arxiv.org/pdf/2008.02475.pdf

Our main finding is that the epidemic curves for COVID-19 related deaths for most countries with a reliable reporting system are surprisingly well described by the so-called Gompertz growth model [7].

 

[Ygggdrasil]

This article is a good example of why media/political characterizations annoy me so much. If there's a hospital capacity problem or projected problem in WI, they haven't told us what it is. What their data says to me is that COVID patients are taking up a third of the available hospital beds in the state and they'll need to triple in order to fill it completely (if evenly spread). That doesn't sound like either a "strain" or "near capacity" or "overwhelmed" to me.

Here's a piece from the Milwaukee Journal Sentinel with more details on the situation in Wisconsin (excerpting /cherry-picking a few quotes here, but I encourage you to read the full piece): https://www.jsonline.com/story/news...s-what-know-rise-hospitalizations/3591616001/

ThedaCare President and CEO Imran Andrabi said last week that 95% of beds at the system's Fox Valley facilities were full, and 250 workers were unable to come to work.

Tight on space at ThedaCare's Appleton hospital, leaders have begun sending patients to Neenah and critical access hospitals in Berlin, Shawano and Waupaca.

Last week, some patients with non-COVID diagnoses waited on gurneys in hallways at Bellin Hospital in Green Bay, and Aspirus Health Care in Wausau had to put some patients on a wait list. Many hospitals report being at 90% capacity or more.

It doesn't sound like that many people are hospitalized with the coronavirus. Why is it a big deal?
When hospitals are full with Coronavirus patients, it affects health care workers' ability to treat patients of all kinds.

"A big influx of (coronavirus) patients would have a serious effect on our ability to care for others," Nathan Bubenzer, the emergency preparedness manager at Meriter Hospital in Madison, said last week.

[...]

In the spring, hospital administrators developed plans to free up bed space in case of an outbreak. But the health care system can only be stretched so far, experts say.

"None of those plans is infinite. At some point, they all have an end-point," Jeff Pothof, chief quality officer at University of Wisconsin Health, said last week. "And if you get to those end-points, that's when bad things start to happen to patients."

On Monday, Wausau-based Aspirus hospital administrators said they were discussing the possibility they'd have to delay elective and nonessential surgeries to make space for the new Coronavirus patients. But they know that delaying those procedures is detrimental to patients.

So, yes, as @hutchphd said, the problem is localized to some of the hotspots in Northeast and Central Wisconsin.

 

[mfb]

This article is a good example of why media/political characterizations annoy me so much. If there's a hospital capacity problem or projected problem in WI, they haven't told us what it is. What their data says to me is that COVID patients are taking up a third of the available hospital beds in the state and they'll need to triple in order to fill it completely (if evenly spread). That doesn't sound like either a "strain" or "near capacity" or "overwhelmed" to me.

84% capacity would be a bad state even if it would be evenly distributed. The unequal distribution only makes it worse. But it's also a look into the future: Wisconsin now has 27,000 active cases, up from 16000 two weeks ago, and by eye the growth looks exponential. What if the cases keep going up for a while? Do you start setting up another hospital when the literal last bed is filled?

 

[Vanadium 50]

The State of Wisconsin has a lot of data available: https://www.dhs.wisconsin.gov/covid-19/county.htm

They are very good about describing the exact methodology they use, and the data is all downloadable into CSV, so you can look at it any way you like.

While there is a recent uptick, it is not as sudden or as severe as shown in the Atlantic's pages. I expect a lot of guff from the forum community about this, and all I can say is "look for yourselves". The Wisconsin State web page shows a gradual uptick starting around September 1st, but the Atlantic has a more sudden jump a month later. The Atlantic reports 27 deaths on 9/30, where the State says their worst days were in April with 18. They haven't had a day with even half the 27 since June.

Wisconsin is, like many other states, driven by it's population centers. Half the deaths occur in just three counties: Milwaukee, Brown (Green Bay) and Dane (Madison). These three counties have about a third of the state's population and about 38% of the cases.

The time evolution of cases in those three counties is different.

There are rural counties that show a very large case per population. Forest County, for example, has the second highest case rate and the largest fatality rate (2%). It really stands out. But it also has only 9000 people.

Milwaukee County has a very high fatality rate: 1.6%. The population-weighted average is 1%, excluding Milwaukee it's 0.8%. The unweighted county average is also 0.8%.

 

[russ_watters]

84% capacity would be a bad state even if it would be evenly distributed.

Why would 84% be a bad state if 76% is normal? Or, given that a large number of elective surgeries have been delayed, the gap is probably actually a lot smaller. I don't know those numbers, but if for example it is usually 84% full and elective surgeries take up 8% (percentage points), then the current state would still be a normal patient load. But also, hospitals are re-arranging internally to increase the number of beds -- is that included here? At the same time their staffing levels may be harder to change. So they may not be overwhelmed in terms of physical capacity but could be in terms of staffing. Unless there was a pre-COVID shortage I could see perhaps a 50% surge in hours being possible for a month (60hrs/wk instead of 40hrs/wk) before staff starts getting significantly taxed.

These are the sort of thing that would need to be measured/quantified in order to properly characterize the level of strain on the medical system. Which then would provide direct support (or not) for hospital system strain causing an impact on death rates.

But it's also a look into the future: Wisconsin now has 27,000 active cases, up from 16000 two weeks ago, and by eye the growth looks exponential. What if the cases keep going up for a while? Do you start setting up another hospital when the literal last bed is filled?

I'm not suggesting they wait. In my opinion it is definitely worth it to spend a few billion dollars to set up field hospitals even if the odds are very low/very uncertain that they will be needed. That's not why I'm objecting to the hyperbole.

Here's a piece from the Milwaukee Journal Sentinel with more details on the situation in Wisconsin...

That's helpful/better, thanks. One thing that will come from the analysis is identification of the specific weaknesses/limiting factors: ICU beds? Staff? PPE? Equipment? Transportation?

 

[mfb]

Why would 84% be a bad state if 76% is normal?

The US had an average hospital occupancy of 64% in 2019 based on OECD data. I don't have more local data. 64% -> 84% is 30% more patient to care for than normal. If hospitals arranged more beds that increase is even larger. I'm quite sure they didn't reduce the number of beds recently.
The higher occupancy also means significantly less wiggle room to move patients around as needed. Some stations will need to put patients to other stations because not everything fills up uniformly.

These are the sort of thing that would need to be measured/quantified in order to properly characterize the level of strain on the medical system. Which then would provide direct support (or not) for hospital system strain causing an impact on death rates.

And I'm sure they are measured. This is a news article, not a report to the health ministry (or whoever is responsible).

------

Here are some animations about cases and deaths per US state as function of time.

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Cost-effectiveness and return on investment of protecting health workers [HCWs] in low- and middle-income countries [LMICs] during the COVID-19 pandemic

An investment of $9.6 billion USD would adequately protect HCWs in all LMICs. This intervention would save 2,299,543 lives across LMICs, costing $59 USD per HCW case averted and $4,309 USD per HCW life saved. The societal ROI would be $755.3 billion USD, the equivalent of a 7,932% return. Regional and national estimates are also presented.

The numbers depend critically on how the pandemic progresses, of course.

 

[Vanadium 50]

if there's a problem, they haven't said what it is.

The argument seems to be "The US health care system is overwhelmed, because Wisconsin is overwhelmed, because Green Bay is overwhelmed, because the number of beds in use is up by 20% and if it keeps going some people in Shawano may have to go to a hospital in Appleton rather than Green Bay".

First, this is a statement about what might happen, and not what has happened. Second, if one keeps going, eventually one gets to a single bed, which once occupied, is now "overwhelmed". Or at least "whelmed".

My definition would be that the system is overwhelmed when a patient cannot get care. That is not fully captured by statistics involving beds. If a hospital has 1000 beds but only the resources to handle 800 patients, the right number to use is not 1000.

 

[Ygggdrasil]

The State of Wisconsin has a lot of data available: https://www.dhs.wisconsin.gov/covid-19/county.htm

They are very good about describing the exact methodology they use, and the data is all downloadable into CSV, so you can look at it any way you like.

While there is a recent uptick, it is not as sudden or as severe as shown in the Atlantic's pages. I expect a lot of guff from the forum community about this, and all I can say is "look for yourselves". The Wisconsin State web page shows a gradual uptick starting around September 1st, but the Atlantic has a more sudden jump a month later.

Here's a comparison of the number of new cases per day in Wisconsin from the Atlantic's COVID Tracking project in black (https://covidtracking.com/data/#state-wi) versus the data from the State of Wisconsin in red (https://www.dhs.wisconsin.gov/covid-19/county.htm):

While there are differences, they show roughly the same trend, both showing a sharp increase in cases from Sept 1 onward.

The Atlantic reports 27 deaths on 9/30, where the State says their worst days were in April with 18. They haven't had a day with even half the 27 since June.

According to the State of Wisconsin website, data from 9/25 onward are still marked as preliminary. The Atlantic dataset does not show deaths increasing until after that point, so maybe we may have to wait until the State of Wisconsin data gets fully updated in the next few weeks.

The argument seems to be "The US health care system is overwhelmed, because Wisconsin is overwhelmed, because Green Bay is overwhelmed, because the number of beds in use is up by 20% and if it keeps going some people in Shawano may have to go to a hospital in Appleton rather than Green Bay".

I don't think anyone is arguing that the US healthcare system is currently overwhelmed. Can you cite something that someone in this thread has posted that makes that argument?

My original post on the subject admittedly makes the error of saying that hospitals in Wisconsin are nearing capacity, but as @russ_watters and others have correctly noted, the problem is more localized to specific regions in Wisconsin and not the entire state.

Your comment is too dismissive of the problem as doctors and officials of hospitals from those regions have been sounding alarms about problems to come if the rise in hospitalizations continue (such as the cancellation of elective and non-essential procedures, which would entail people not being able to seek care).

 

[Vanadium 50]

Your comment is too dismissive of the problem as doctors and officials of hospitals from those regions

I would actually argue that
a) There is a problem with hospitalization in rural areas of the US period. This predates Covid.
b) The problem with cancellation of procedures is extremely serious. It's also personal - I have a close friend who needs non-Covid treatment and is having difficulty getting it.

My original post on the subject admittedly makes the error of saying that hospitals in Wisconsin are nearing capacity

Thank you. Yes, that was part of my motivation.

 

[Ygggdrasil]

I would actually argue that
a) There is a problem with hospitalization in rural areas of the US period. This predates Covid.
b) The problem with cancellation of procedures is extremely serious. It's also personal - I have a close friend who needs non-Covid treatment and is having difficulty getting it.

I agree with both of these points, and hope your friend is able to access care soon.

 

[OmCheeto]

While there are differences, ...

I'm not seeing much of a difference in the two databases regarding deaths.

The Wisconsin database is peculiar in that I get different timespans, and the data is out of chronological order, when I download information. Not sure if it's me or them.

 

[Astronuc]

My definition would be that the system is overwhelmed when a patient cannot get care. That is not fully captured by statistics involving beds. If a hospital has 1000 beds but only the resources to handle 800 patients, the right number to use is not 1000.

This is a critical point. As I recall, once a patient with an infectious disease is admitted to a ward, it would preclude other patients from being admitted. I've seen infectious disease wards in hospitals, and I assume they are some small fraction of the total number of beds. Once that ward fills, another ward would have to be converted. Also, in the case of SARS-COV-2, one would not mix patients with other communicable diseases (e.g., influenza, measles, . . . ) in the same ward. I imagine that some hospitals are overwhelmed and have had to convert some regular wards to SARS-Cov-2 wards.

An example of the complication - https://www.health.state.mn.us/communities/ep/surge/infectious/airbornenegative.pdf (see Figure 19 on page 16 in brochure, or 19 of 41 in pdf).

I understand that the level of care is much greater for COVID-19 patients, especially when oxygen levels fluctuate or drop precipitously. And staff caring for COVID patients cannot just leave and take care of others.

Here is an article that states "Of the 54 wards, 12 (22%) were overcrowded, as indicated by bed occupancy of more than 85% during the study month."
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1105845

 

[bob012345]

In the metro area I live in there currently are less than 20,000 active cases out of a population of 7.6 million. I am 'technically' in a higher risk group but I am healthy. Am I being overcautious not going out except to grocery shop? All my groups and associations and friends have started meeting again. Of course, I would follow CDC precautions if I did go.

 

[StevieTNZ]

Probability a world first here: https://www.stuff.co.nz/world/ameri...-that-hes-immune-to-coronavirus-as-misleading

"That means I can't get it (immune), and can't give it. Very nice to know!"

- Trump.

Didn't know he was a MD or scientist.

Don't know how others caught it multiple times, after getting the all clear.

 

[mfb]

Don't know how others caught it multiple times, after getting the all clear.

That's a handful of cases worldwide. It is extremely rare, at least within a few months. We don't know how it will look over longer timescales.

 

[nsaspook]

The odds of him or anyone else catching it again are very low judging from the very low number of possible cases in millions of infections.

https://www.theatlantic.com/health/archive/2020/09/can-i-get-covid19-again/615940/

A flood of headlines over the past few weeks stoked many of our worst fears, warning about instances of people getting infected twice. But despite the way much of the coverage has been framed, so far what we’ve learned about reinfection has been largely reassuring. Globally, more than 25 million people have tested positive for the coronavirus, and we know of very few people who have gotten infected twice. In those that have, the immune system seems to be functioning as we would hope: Antibodies and other protective immune mechanisms are apparently identifying the virus and clearing it before it causes serious illness.
...
Many news reports were scarier than they needed to be, because they implied that people had been sick and then gotten sick again. The cases were occasionally referred to, inaccurately, as proof that you can “catch COVID twice.” But testing positive for the Coronavirus doesn’t mean you have COVID-19. Though the terms are often used interchangeably, the difference between getting infected by the virus twice and getting a severe disease twice is massively consequential.

 

[StevieTNZ]

He seems to imply he can't get it again, EVER. Even if (the correct way of looking at things) the possibility of reinfection is low.

 

[atyy]

Didn't know he was a MD or scientist.

That's a fallacious argument. Doctors and scientists do not have monopolies on truth or falsehood.

https://en.wikipedia.org/wiki/Ad_hominem

 

[mfb]

He seems to imply he can't get it again, EVER.

I don't interpret it that way.

That's a fallacious argument. Doctors and scientists do not have monopolies on truth or falsehood.

They are certainly more knowledgeable, but of course that doesn't mean everything someone else says must be false. StevieTNZ is not an MD either.