On Twitter, I keep reading people slamming Florida for the rise in Covid cases. The cases have been rising for a month now. We know very little about this disease, but it was hitting the same vulnerable demographic and we haven’t figured out how to cure or save people consistently, I’d have expected deaths to have risen already. They haven’t.
That doesn’t mean they won’t, but here’s the comparison.
(Oddity, the github data only goes through 6/28. I think it used to update more more quickly?)
Update, July 8
I think it’s possible to interpret a slight uptick in deaths this week. It still might just be “noise”; we need to see it continue to be sure. If this is an uptick, this particular uptick, lag the confirmed uptick in cases by 5 weeks.
Ohio has shifted positive results from date of test to onset date recently. This is causing new lags in reporting as most don’t get tested until after onset. Also Yesterday they reported no new tests, where they have been reporting 15k+ a day. Positives are running flat at 5%. Like Florida, our hospitalizations and deaths are running flat from May but our spike really didn’t kick off until June 15.
Lucia,
The only thing you can be certain of when it comes to covid 19 is that any increase in cases will be trumpeted in the MSM as huge catastrophe and entirely blamed on evil Republican governors…. plus Trump, of course.
.
The facts that Florida has 10% of the death rates of states like NY and NJ, far fewer deaths per documented case, and that the demographics of the cases in Florida have changed dramatically (to a much lower average risk for confirmed cases) is almost NEVER reported, or if reported, contorted through idiotic rational to suggest things are ‘even worse than the numbers suggest’. The MSM is simply dishonest, motivated by the politics of their denizens rather than a desire to accurately report factual reality.
New study, 50% reduction in mortality. Best one to date.
https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
My comment didn’t take or something. New study on HCQ – 50% reduction in mortality rate. Very large study and seems very well done.
https://www.ijidonline.com/article/S1201-9712(20)30534-8/abstract
This is very mysterious, I would have expected to see an increase by now. It’s possible that people are getting tested earlier, and getting results earlier so the death lag is longer. There is no doubt that the positive test / age demographic has changed significantly which is a part of the anomaly. Another may be that old folks home are being protected better. The bar / gym / office demographic which is vulnerable to re-opening is not the death demographic with preexisting conditions. However they are the vector to this death demographic, perhaps we will see a delayed lag for this chain of events.
.
I find it almost impossible to believe that we would be seeing 10x the cases with little change in the death counts unless the virus itself changed. This once again shows how little we know and how hard this is to predict.
.
The MSM is embarrassing themselves, it is difficult to even read their stories. After treating Cuomo like a hero they ask DeSantis questions like “Do you feel personal responsibility for the people dying?â€. They don’t broadcast his briefings live in their entirety, but will pepper him with gotcha questions. BAU.
Jeff,
Wow. That’s huge!
Matches in-vitro and french results. Wife found it on the original site.
Also, only includes people already in trouble. Every proper study said treat it sooner and better results.
Very very big.
https://noconsensus.wordpress.com/2020/07/03/good-quality-paper-demonstrates-strong-efficacy-of-hydroxychloroquine-mortality-rate-cut-in-half/
Hello Jeff,
There are a couple of obvious weaknesses in that study:
1) It is retrospective, not prospective.
2) There is no description that I can find about patient selection other than that the patients with the worst symptoms were assigned the joint hydroxychloroquine/azithromycin protocol. It appears the therapies were not at all randomly assigned.
3) The uncertainty ranges for treatment and no-treatment overlap, so the power of the study (even if the treatments were assigned randomly) is not great. With non-random assignments (eg based on symptoms), the results may be meaningless.
.
Could be that the authors have accounted for everything, but if so, I don’t get that from the description.
Tom– Yeah, 10x the increase in cases with no increase in deaths is huge. Because the file I pulled from github was “stuck” ending jun 18, I’m trying to pull another one. It downloads more slowly because it contains more data. But it means I might conveniently do some addional demographic processing I was too lazy to do before.
.
Or not…. Depends how motivated I get.
Tom Scharf,
““Do you feel personal responsibility for the people dying?â€. They don’t broadcast his briefings live in their entirety, but will pepper him with gotcha questions. BAU.”
.
Yes brutally unfair and politically motivated. Of all the governors in the country, DeSantis has arguably done the most to save lives among the elderly, yet the MSM paints a false portrait of him as an uncaring monster, while treating a real monster like Cuomo, who killed many thousands of elderly with his PC-driven idiotic decisions, like some kind of hero. The MSM are unprincipled and evil.
California cases have been rising steadily since mid April, and now appear to be in the same kind of rapid growth as in Florida… with the same flat-ish death rate history. Yet Newsom gets a free pass, while DeSantis gets a daily beating from the MSM. They are evil.
stevef
It is not double blind Which cannot be reasonably achieved for covid, but they do a very good job in the middle of it matching up 190 equal patients with equal symptomatic conditions and amazing results. all the sickest folk too so treatment for those infected But not hospitalized will do nothing but improve outcomes. yes I know they recommend only in hospital settings bit hcq has been given out like chicklets for decades.
It is not ony patients with worst symptoms being treated as last resort, which would bias the study against the drug, not for it. That was kind of the point. It also shows a very clear separation of treatment groups to a very high significance so Im not sure what portion of the stats didn’t impress you.
Jeff,
“It is not double blind Which cannot be reasonably achieved for covid”
.
Why not? (real question)
Tom, it could be the deaths haven’t appeared yet. There is a time lag of a few weeks.
Also, it could be there is more testing available, so the increase is due to more testing of people that before would not have been tested, and have no symptoms or are mildly affected.
It could also be the numbers are coming from the same positive people being tested multiple times. They test inpatients at a hospital daily, and someone hospitalized for a week gets counted 7 times while they entered for something else.
Just hit Fox news
https://www.foxnews.com/politics/hydroxychloroquine-helped-save-coronavirus-study
Steve
Were someone emperor we would have achieved double blind in the first weeks, for the good of all. But since the entire study was based on hospitalized patients, giving fake medicine is insanely unethical. The french doc said the same.
This study matches condition level of different patients, which statistically is good enough to determine works or don’t. Turns out that it works.
Sorry if my spelling and grammar is even worse than it normally is, working on a cell phone.
At least in Texas, a cough and contact with a current case is enough to be classified as probable.
The contact only needs to be with a probable case.
https://eagenda.collincountytx.gov/docs/2020/CC/20200518_2481/48410%5FExplanation%2Epdf
Jeff,
“But since the entire study was based on hospitalized patients, giving fake medicine is insanely unethical. ”
.
Only unethical if you are sure the treatment is better than the placebo. Before you know that, it is not unethical, and is done all the time. Could be that the treatment is actually worse for patients than the placebo, but that unexpected negative result is never known before the study starts. In cases like this, the results are often monitored by an independent person (or group) who disclose nothing until the end of the study, unless the results during the study are so clear that the study is ended and all subjects are either switched to the active treatment or the active treatment is ended…. continuing placebo dosing when the treatment is saving lives, or continuing active treatment when it is injuring (or killing) patients would in fact be unethical.
MikeN,
It looks like the situation for testing in Illinois is “it depends”. Some test locations require a doctors referral. Some require some level of cause. Some let anyone take a test. Some have a caveat like “until supplies run out”.
MikeN,
I should add that the list of Covid symptoms means almost anyone who has anything could be ‘presumed covid’.
Vomiting or diarrhea? Could be food poisoning. But on the list. Go get a test.
Cough sneezing due to allergies? On list!
Aching muscles? On list
Tired? On list!
Hungover! Well, that’s probably nausea and headache. So on list!
Most people ordinarily have the good sense to know when their headache is due to staring at a poorly placed computer screen looking through the wrong part of their bifocals…. (Let me see… who does that? I pretty much figure if it goes away 30 minutes after looking at the screen it was the screen. Don’t even ask why I haven’t fixed this whole screen too high issue or I’ll give a long story about trying to get an adjustable desk.)
.
But it seriously makes it hard to notice symptoms of an infection early when the list of items contains things lots of symptoms people routinely have to some mild degree for other reasons. Let’s hope “heartburn” and “rash” don’t end up added to the list. Because if they do, then everyone buying calamine lotion or tums will be advised to go get a covid test too!
Jeff,
I re-read the paper. The results for the matched (selected) populations with and without HCQ is far more convincing than the other results; I think their conclusion of a substantial benefit is pretty solid.
.
But don’t worry, the paper will get near-zero air time in the MSM. What it does get will be crowded with reports of conflicting studies to cast maximum doubt, and no reference will be made to Trump taking HCQ. There probably will also be plenty of comments about fishtank cleaners and how terribly dangerous HCQ is. Which is utterly false… hundreds of thousands of people (including my wife) take it continuously for years for autoimmune illnesses, with no bad effects.
Happy Independence Day!
CDC numbers updated today: 52K cases, 271 deaths. We’ll see what it looks like after the weekend and holiday.
This article is from June, saying the virus is pretty much gone.
https://archive.is/8rLzi
Some points in that article matches some anomalous results so far. NYC, where between the Gov and Mayor did everything wrong, never made it past 20% infected. If anywhere in the US was getting to herd immunity it should have been NYC and you would have expected a 60%+ infected rate. If you tack a 34% non covid immune response onto that 20% antibody (somewhat specific to covid) you get pretty close.
The latest uptick is in the areas where summer inside hibernation, kind of the reverse of winter in the north, occurs. Areas where they hit 200+ cases per million in the spring, mostly the North East, seem to be immune to this uptick. Opening up where people stay indoors with heavy HVAC cycling seems to be a perfect environment for spreading. Locally, OH, we were fully closed down by the end of March and our new cases, and Hospitalizations/Deaths, ran flat through the end of May. But the end of May we were mostly fully open. The numbers get funny then. All three metrics dropped till the middle of June before rebounding into the current spike which is just in new cases so far. The other metrics just rebounded to May’s values. https://imgur.com/a/P1y9688 We had decent weather for being outside the end of May and the first week in June. Every since we’ve been in the 90s and muggy.
The papers on this over the next few years should be interesting.
Andrew P,
“If anywhere in the US was getting to herd immunity it should have been NYC and you would have expected a 60%+ infected rate. If you tack a 34% non covid immune response onto that 20% antibody (somewhat specific to covid) you get pretty close.”
.
There is overwhelming evidence a large fraction of the population has active T-cell mediated immune response, even though they lack measurable covid 19 serum antibody levels. The best data say about twice as many “T-cell positives” as people with antibodies. So in a place like NYC with 22% antibody positive back in April, the total population with previous exposure is much higher… on the order of 60% back when the 22% antibody positives were measured in mid April. That was a long time ago, and by now the NYC region has for certain long since passed the herd immunity threshold, as the trend in deaths clearly shows: 97% drop in daily deaths since the peak of 598 on April 7. There is just not much fuel left for the fire. The crazy part is people in NYC are still acting as if herd immunity doesn’t exist.
Medical ethics are a bit bizarre and religiously stringent. You can’t intentionally expose people to the virus to gather useful scientific data (place 10 people in a room with an infected person for 5 minutes, 10 minutes, an hours etc., etc.).
.
There would be a line a mile long if those test subjects were paid $1,000 each.
.
Instead we have literally millions of infected people and only loosely compiled information on what is risky, what isn’t, and what might be effective (run office HVAC 100% with no recycling of air?).
.
How many people are indirectly killed because of medical ethics here?
Andrew P,
For a completely novel infectious agent where the population has zero immunity and are all equally likely to infect others with an Ro of 3, 67% infected is when the infection rate peaks. The total infected when new infections cease will be over 80%. However, SARS-CoV-2 is not completely novel, the population clearly has some immunity and spread rate is not uniform in the population. In those circumstances, herd immunity is reached at a much lower fraction of the population infected. There was a link to an article about that in one of the other threads here. I should probably look for it, but not right now.
Another problem is that if Stadler is correct about the serum antibody test not being specific to SARS-CoV-2, we once again have no idea of the IFR because we again have no confidence in the number of infected. Also, perhaps the reason why Qatar, for one, has had a low death rate for COVID-19 is partial immunity from exposure to MERS. While Japan, South Korea and Singapore have increased immunity from exposure to SARS-CoV-1 rather than from wearing masks.
DeWitt Payne (Comment #187387): “Also, perhaps the reason why Qatar, for one, has had a low death rate for COVID-19 is partial immunity from exposure to MERS. While Japan, South Korea and Singapore have increased immunity from exposure to SARS-CoV-1 rather than from wearing masks.”
.
But very few people have been infected by either SARS or MERS. At least that is the conventional wisdom. As I recall, the former requires high exposure levels for transmission and the latter is barely transmitted from person to person.
MikeM,
Yes, but wasn’t MERs transmitted by camels? Qatar has lots of camels…. and they spit. 😉
Jeff Id (Comment #187269)
July 3rd, 2020 at 9:28 am
My comment didn’t take or something. New study on HCQ – 50% reduction in mortality rate. Very large study and seems very well done.
https://www.ijidonline.com/article/S1201-9712(20)30534-8/abstract
As noted, this study was not random assignment or double bind. See Table 1, third line: median age of patients not getting either drug, 68.1. median age in treatment groups, 63.3. P-value for difference <0.001. The older patients were less likely to get HCQ.
Table 1, next to last line: Given steroid?: No HCQ groups 35.7% and 38.8%. Given HCQ groups: 78.9% and 74.3%. As many are aware, dexamethasone was recently shown to reduce mortality by about 1/3 in large blinded, RCT. P = 0.001
IMO, these difference cast serious doubt upon the study's conclusions.
There are many other differences between the various treatment groups that statistically significant. Patients getting HCQ had higher BMI. Some doctors appear to have been selecting treatment for some patients base on what they thought would work best for that patient.
They have some kind of model that attempts to correct for these difference between treatment groups that I didn't try to fully understand.
SteveF – thanks for reading that part of the paper. I think some other folks have really missed the point. We can’t really do a double blind study when there is so much sensationalism for this virus. Table 4 is really the critical bit because the rest of the study uses MV analysis to try and do the same thing but that becomes fuzzy Mannian math really quickly.
Frank,
“Further, a total of 190 hydroxychloroquine patients exactly matched up with 190 corresponding non-hydroxychloroquine treated patients based on the exact underlying propensity score. ”
There is your answer. Table 3 and the attached paragraph. You cannot do better right now unless you are willing to not treat critical patients. Can you imagine giving a fake vaccine for this to prove the real vaccine works?
In an opinion piece in today’s WSJ, Allysia Finley suggests that some studies indicate that antibody tests underestimate infections because people with mild cases may not develop antibodies, or at least sufficient antibodies to test positive. Also, the virus seems to have mutated to become more virulent leading to the major breakouts in March.
I found this article very interesting:
https://archive.is/8rLzi#selection-203.0-203.35
“Coronavirus: Why everyone was wrong”
“The author, Beda M Stadler is the former director of the Institute for Immunology at the University of Bern, a biologist and professor emeritus. Stadler is an important medical professional in Switzerland, he also likes to use provoking language, which should not deter you from the extremely important points he makes.”
I found Dr. Stadler’s opinion very much agreeing with my, far less educated, opinion. While his observations are about the situation in Switzerland, they appear, IMHO, to be applicable across the world.
pauligon59,
MikeN already posted a link to that article a few posts above yours.
http://rankexploits.com/musings/2020/fl-cases-death-disconnect/#comment-187358
Another 46,000 cases reported today, with the death number at 322. This is a number only seen on weekends recently, and is a drop of almost 90%, and we are now at two weeks of more than 30,000 cases per day. Previously this would have meant at least 1500 deaths per day.
What is needed to be classified as a recovery?
Under the theory that the new cases are because of more testing and getting people who are less affected, I would expect the daily recovery numbers to be much higher:
https://docs.google.com/spreadsheets/u/2/d/e/2PACX-1vRwAqp96T9sYYq2-i7Tj0pvTf6XVHjDSMIKBdZHXiCGGdNC0ypEU9NbngS8mxea55JuCFuua1MUeOj5/pubhtml#
MikeN (Comment #187422): “What is needed to be classified as a recovery?”
.
I think it is two successive tests that show no virus. Most people who are not hospitalized don’t bother and so never get counted as recovered.
In OH it’s presumed recovered and it’s six weeks after positive test.
MikeN (Comment #187418)
July 7th, 2020 at 3:30 pm
First you fill the hospitals, then you fill the morgues. If the hospitals are not filling up, then the new reported cases are predominantly in the younger demographic (who are much less likely to die from the virus)… so the death count won’t follow the case count.
From what I’ve read, hospitals in Florida and Texas are starting to fill up now… so I would expect to see higher death counts in those states by the end of the month.
skeptikal (Comment #187442): “From what I’ve read, hospitals in Florida and Texas are starting to fill up now”
.
Do you have a source for that? Because that is not what I have heard.
This shows <10% hospital bed use in Florida
https://covid19.healthdata.org/united-states-of-america/florida
ICU beds are more like 25%. I am pretty sure that surge capacity is not included.
And here is Texas:
https://covid19.healthdata.org/united-states-of-america/texas
Similar story.
.
Sounds like you have been consuming fake news.
MikeM,
That site is garbage, and has been making crazy-wrong projections from the beginning.
.
One small example: They project (yet again) catastrophic death rates in Florida unless mask wearing is universal. Catastrophic death rate projections seem tightly correlated with having a Republican Governor, of course. Trouble is, that looks like 100% speculation. I have never seen a single scientific publication showing the efficiency of cloth face coverings…. yet somehow cloth face coverings become the difference between terrible projected death rates and catastrophic rates. It’s nutty, and clearly designed only to frighten.
.
Florida is not going to have 400 deaths per day, and even that, were it to ever happen, would be only 35% of New York’s peak rate back in April.
.
Younger people in Florida, Texas, California, and other states with relatively low death rates are going to catch the virus, but very few will become very sick, and even fewer will die. Let’s hope all those states have put in place sensible policies to reduce exposure risk in elderly care facilities….. where nearly half of all deaths in high death rate states happened. Hummm… very high death rates seem correlated with having Democrat governors. Maybe just a coincidence, maybe not.
skeptical,
“From what I’ve read, hospitals in Florida and Texas are starting to fill up now.”
.
Read where? There is no evidence I have seen for hospitals in Florida starting to “fill up”; hospital use rate remains very low.
SteveF (Comment #187445): “That site is garbage, and has been making crazy-wrong projections from the beginning.”
.
I know that. Their projections are useless and I ignore them. But previously, they have used *data* for the past and so far as I can tell they are still doing so. So the site should be OK for *data*. Do you have information to the contrary?
NBC news said this morning that CA hospitals in southern CA are filling up and have been transferring patients to hospitals in northern CA. However, the CDC data only shows AZ and TX with more than 20% of hospital beds used for coronavirus patients. But that’s statewide data.
OK, I see that the numbers for “beds” and “ICU” are indicated as projections, even for the past. So maybe not reliable.
Sweden update:
Worldometers.info now has death data for Sweden through July 7. The seven day moving average for July 1 is 9. That’s rather a far cry from 20 and pretty close to what I expected a week ago. It’s still not ten days later, though, so we’ll see.
DeWitt,
The CDC shows Texas has 15.5% (estimated) beds occupied by covid patients.
I’ve been under the weather so I haven’t gotten around to pulling in data from a file with more detail. OTOH, this particular github file stopped being “stuck” and is (mostly” fresh though july 7).
Florida deaths may have an uptick. It’s big enough I’d tend to say they probably do. But it may turn out to be noise. So, the disconnect between the dramatic rise in cases and deaths appears to continue.
On the divergence of science and policy:
https://arcdigital.media/how-science-best-serves-society-493e3bfad0b4
My area’s hospitals have more patients according to the local paper. They had started allowing elective surgeries again a while back so that is part of the fill up. The deaths may be rising, but not nearly as fast as the case counts so far. The case counts look to have stopped expanding at the moment. None of the hospitals have started their expansion protocols to handle more people if necessary.
.
https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429
My wife’s hospital is much fuller than it was during the lockdown, both because of the return of elective surgeries and less fear of going to the hospital. Some of the patients that come to the hospital for other reasons turn out to have Covid. Just as it would be useful to count/report people who died of covid along with died with covid, it would be useful to count/report people who are hospitalized because of covid as well as hospitalized with covid.
The NYT, unable to determine whether the protests had any effect on the outbreak because there wasn’t any definitive proof, has magically determined religion is the culprit.
.
Churches Were Eager to Reopen. Now They Are a Major Source of Coronavirus Cases.
https://www.nytimes.com/2020/07/08/us/coronavirus-churches-outbreaks.html
.
“The virus has infiltrated Sunday services, church meetings and youth camps. More than 650 cases have been linked to reopened religious facilities.”
.
More than 50K cases a day are being reported nationwide, not sure what the NYT time frame is, but 650 is not a major source of anything. It’s the usual biased framing, list a bunch of anecdotal cases and infer much greater exposure, when asking about protests they require much more rigor and proof to make any statement at all.
Lucia,
covid?
Mike M,
Very good article. I expect the author will be shunned by the enlightened on the left.
Nope. Had a test. But not covid.
.
I was wiped out though. Vomit, runs, headache. No appetite. Extrapolating from hangovers I have had, I’d say it was like the worst possible hangover while still being drunk. Then having that last 2 days.
.
No fever. No cough. No sore throat. No shortness of breath. Still all the GI stuff is on the list and evidently something like 10% of covid have GI only symptoms. So when I was vomiting, I figured I’d call in for a test. I did have a test July 2. Heard back July 5.
.
Now (after hearing back about tests) I have an itchy rash on the side of my face (which is getting better.)
.
I’ve been sleeping a lot.
.
I told my sister that it actually cannot be a hangover because…. in anticipation of being tempted to drink too much when my brothers-in-law came for a small birthday celebration on Friday, I had prepared a quart of mint tea to sip. That would put off drinking on my part. THEN on top of it, Robert brought a bottle of wine, but between the four of us, we didn’t even finish it. Robert definitely drank some and there is a 1/3rd of a bottle left. So there is no way I downed enough to be vomiting and hung over for two straight days. (Plus, the “hangover” started Monday afternoon– not morning.)
My sister’s theory is it was the mint tea. (Honestly, it’s the only thing I ate that Robert, David and Jim did not eat!) But really, we have no theory.
BTW: I rarely get severely sick and almost never go to the doctor. Jim nags me to even get my annual physical. I hadn’t gone to the doctor for any actual symptoms in a decade. About a decade ago, I went for poison ivy. So to calibrate level of sickness: I need to be pretty bowled over to report myself as sick.
.
So… pretty sick.
Sounds like viral gastroenteritis, like from a common norovirus infection.
Hospitals run in the 60% utilization range most of the time. Adding 20% on top tends to get you in to the nervous range. Especially with longer stays and increasing positive counts.
Lucia that sounds like what people are saying when they think they had coronavirus in December/November.
SteveF,
Googled. Reads similar. Maybe it was the mint. I cut it from the garden. I rinsed it, but maybe it was contaminated somehow, and not boiling a long time resulted in…. bleh some how.
.
Otherwise, I don’t know where I would encounter something like contaminate water. If it was from eating anything else either Jim, Robert or David should have gotten it.
Hospitals are filling up with non coronavirus patients. The number of hospitalized for covid is up about 50% but still 30% below the peak.
The hospitals were closed for many treatments before. Now they are open. Also before there were many who were too scared to go the hospital, and are now coming in sicker.
The daily deaths is at 900 today.
Lucia,
Could always be something you ate, but norovirus is remarkably infectious (air droplets, surface contact, food). Symptoms are said to normally start 24 to 48 hours after infection.
MikeN,
Did you look at the CDC hospital usage DeWitt linked to above?
SteveF,
I was looking at the color coded map for Texas, which apparently didn’t agree with the data tables. Or I’m becoming colorblind.
Andrew P (Comment #187467): “Hospitals run in the 60% utilization range most of the time. Adding 20% on top tends to get you in to the nervous range. Especially with longer stays and increasing positive counts.”
.
OK. There are just under 800K community hospital beds in the U.S.
https://www.aha.org/statistics/fast-facts-us-hospitals
So that means that the difference between average occupancy and nervous is 160K.
Peak number of hospitalizations for Wuhan were 62K and current is 21K.
https://covid19.healthdata.org/united-states-of-america
Those are “projections”, which I assume means some sort of fit for past days. SteveF implied that actual numbers are available from CDC, but did not provide a link.
So it looks like areas running 5-10 times above the national average might be getting stressed. It looks like Texas has about 1/6 of new cases with about 1/12 the population, so they should be OK. But the surge seems heavily concentrated in the Houston area, so maybe they are having trouble there.
——
Edit: DeWitt Payne (Comment #187452) provided a link:
https://www.cdc.gov/nhsn/covid19/report-patient-impact.html
SteveF,
Jim has zero symptoms. That’s what makes it seem unlikely it’s something infectious. I ate with Jim, Robert and David on Sunday and got sick Monday afternoon. Owing to social distancing, the last I was near other people was Friday at 6 pm. That would have been my dance teacher Vlad.
.
I want to get back to dancing!!!! But I’ve been paranoid about the face rash. Not really worried it’s contagious or how I look. I just really don’t want to see someone who then wants to discuss health and who might subsequently worry about exposure to someone with a rash!
SteveF, I used the COVID-19 daily tracker site. I’m not sure what it’s source is, but I think it is CDC.
It is in line with what is at DeWitt’s link, though that site is a bit daunting.
Lucia,
Norovirus is a bit funny: some people seem completely immune, while others catch it very easily. My production manager’s family (wife, two daughters) became violently sick (your symptoms) within three days of each other about 6 months ago, while he never got sick at all. I have read that resistance may have to do with earlier exposure to the same virus family. My least favorite kind of illness is when you don’t know which end to put to the toilet…. just terrible.
Re: Lucia, very infrequent doctor visits.
……
Based on my experience, I would strongly suggest that you get a colonoscopy. I went 10 years without one until last year. When colonoscopy was done they found a large polyp that contained a cancerous growth. Luckily, it hadn’t spread at all beyond the polyp, but undoubtedly the colonoscopy saved my life. Also, helped that I have exercised 7 days a week for 4 years. (Exercise and abstinence from alcohol greatly reduce incidence of colon cancer.)
……
Colon cancer is the 2d or 3rd most deadly cancer in the US. Would add that the colonoscopy, itself, is nothing. However, the 2 days before the colonoscopy where you first have to restrict your food and the day before when you induce cr*pping are moderately annoying.
Mike M. (Comment #187444)
July 8th, 2020 at 6:32 am
https://time.com/5863564/hospitals-capacity-coronavirus-surge/
.
I can find a lot more stories saying similar things, but I don’t know if lucia has set a limit on the amount of links I can put in a comment so I’ll just leave it at that one. With google you can easily find other stories like “56 Florida ICU Beds Are Full With Dozens More Over 90 Percent Capacity” (no link provided).
Yeah, maybe… but it’s easier to just accept the fake news than to try to find all the hospital data and piece together the real story.
lucia (Comment #187457)
July 8th, 2020 at 8:57 am
.
I haven’t looked at Florida data, but I have looked at Texas data and I’m seeing the same thing for Texas.
Skeptikal
I meant to insert the image
JD
I am due for a colonoscopy next year. I have to admit I’m not going to move it up in time. Jim’s going to defer his which is due. We both read that the doctors are trying to make sure they have Covid protocols in place. (Like everything Covid, it may or may not be able to transmit by GI tract. So….)
JD,
I should have added: I did have a colonoscopy. So I do do screenings. But few are every year sort of things.
OTOH I have a friend from high school who is pretty constantly seeing the doctor for one thing or another. (I honestly sometimes think she might have Munnchausen. Her issues are so frequent! But of course, some people might just be unlucky enough to have bad health.)
lucia (Comment #187487)
July 8th, 2020 at 6:47 pm
Lucia, you already had inserted the image. I think I worded it poorly when I said that “I haven’t looked at Florida data”. I saw the image you posted about the Florida data… what I meant was that I haven’t downloaded Florida data to look at the raw numbers and make my own graphs. Sorry to cause the confusion.
Lucia, glad to hear you are keeping up with colonoscopy. Will add that I had my yearly follow-up about 1 month ago. (Colon fine) Found a cyst in Pancreas. Upon closer look on more specific follow-up, cyst was side branch and nothing dangerous now. However, it will have to be monitored to make sure it doesn’t grow into pancreatic cancer.
Pancreatic cancer is really bad in that the Pancreas is hard to get to and tumors can attach to main blood vessels. If my cyst starts getting worrisome, docs can get to it before it would require a huge surgery. So, I had a really good secondary benefit from colon surgery and follow up colon ct scan.
FL set a new record in its daily death count and hospitalizations today, approx. the same as its peak a couple months ago. The question is how high this will go with a 10x increase in active cases.
.
Ultimately it will depend on how well the older demographic is isolated and protected. The younger demographic seems to have given up on lock downs. Corona fatigue is real. My guess is there will also be resurgences up north in winter once everyone starts staying inside again.
.
There was a change in behavior about a week or so ago (mandatory mask orders, etc.) so the deaths may peak for a while and climb down a little. The case counts seem to still be leveling off around 9K a day for now.
.
Younger people getting herd immunity isn’t such a bad thing. If this was a simulation or strategy game the preferred path might be to infect the young as efficiently and as fast as possible.
Jeff wrote Jeff Id (Comment #187403) July 7th, 2020 at 7:12 am
“Further, a total of 190 hydroxychloroquine patients exactly matched up with 190 corresponding non-hydroxychloroquine treated patients based on the exact underlying propensity score. â€
There is your answer. Table 3 and the attached paragraph. You cannot do better right now unless you are willing to not treat critical patients. Can you imagine giving a fake vaccine for this to prove the real vaccine works?
______________________
Look at Table 2, the regression data used to select the matched controls. This data indicates that patients given steroid didn’t quite show a statistically significant benefit (p = 0.08) from being given steroid, with the 95% ci for the hazards ratio ranging from 0.63 to 1.03 and a central estimate of 0.8. However, the most important discovery so far from definitive clinical trials (double blind random assignment placebo controlled) is that dexamethasone reduces mortality by 30%. However, in this trial patients were not randomly assigned to treatments, the uncertainty associated with running a 20 parameter multiple linear regression made it difficult to see what should have been a 30% reduction in mortality from using steroids. It looks like the use of steroids was NOT part of the criteria for selecting a group of 190 matched controls.
Now let’s look at age. The regression in Table 2 used a single indicator (1 or 0?) for age greater than or less than 65. We know that the risk of death increases dramatically from the 60s, to 70’s, to 80’s and a few 90’s. Reducing this continuous relationship to a single discrete variable seems absurd. As I noted above, the average patient who didn’t get any drug was 5 years older than those who did. 13% fewer of the HCQ alone group were over 65. Age greater 65 was associated 2.0- to 3.3-fold increase in risk of death – a large amount of uncertainty in this relationship.
The authors say: “The combination of hydroxychloroquine + azithromycin was reserved for selected patients with severe COVID-19 and with minimal cardiac risk factors. An electrocardiogram (ECK) based algorithm was utilized for hydroxychloroquine use. QTc>500 ms was considered an elevated cardiac risk and consequently hydroxychloroquine was reserved for patients with severe disease with telemetry monitoring and serial QTc checks.” So ECK data was used to select which patients got and didn’t get HCQ, meaning that some patients who didn’t get HCQ likely had more serious cardiac problems than those that did.
If I were looking for 190 matched controls, I might start with matched ages (say +/- 2 years) and matched steroid use, no ECK liabilities, and then look for the closest match by other criteria. How sensitive is the conclusion to choices in how the data was analyzed? Who knows. Did conscious or unconscious bias influence the choices that were made? Who knows. Given the opportunity to design the criteria for selecting only 190 matched controls from groups of about 1000, I suspect I could produce any answer I wanted. (This is exactly why the FDA insists on a clinical trials using predetermined patient population treated with a standard protocol and predetermined end-points and side effects analyzed by predetermined statistical tests when approving new drugs.)
Poorly controlled clinical studies like this one don’t provide reliable answers, but they are useful in deciding whether or not to invest in a properly controlled clinical trial. In this case, however, it is my understanding that such trials have been done and that some show “no benefit”. Even that statement is complicated. How much benefit was needed to reach statistical significance? “No benefit” when used in a preventative mode, as Trump used it? “No benefit” when used for hospitalized patients? What subpopulation of hospitalized patients – those whose ECK shows minimal risk of sudden death? (That is what “torsades de pointes” and QTc are concerned with). The paper lists ten other studies. We shouldn’t be jumping on one clearly problematic study that agrees or disagrees with our biases. (FWIW, my bias was that HCQ needed to be at least an order of magnitude more potent in cell culture to have a chance of being useful and that there were cardiac and immunosuppressive liabilities. Remdesivir is at least an order of magnitude more potent in cell culture, has good pharmacokinetics and has very marginal benefits). Somewhere experts are reviewing the sum total of the evidence, and I will trust their conclusions.
Frank,
If you read the comments of physicians who claim to have successfully used HCQ to treat early COVID-19, the mode of action for HCQ is as an ionophore to increase intracellular zinc level. It’s zinc that interferes with RNA replication, not HCQ itself. I have not seen any mention of monitoring and maintaining serum zinc levels in any of these studies. That means they are all flawed and appear to be designed for failure.
DeWItt: After spending years looking for drug candidates that bind with high affinity and selectivity to a particular enzyme or receptor, I find drugs like HCQ – which don’t bind to anything specifically – frustrating to understand. The drug has a half-life of about 40 days and an enormous volume of distribution. (If you think of a person as a 70 L beaker and you give that person a 700 mg dose, you don’t find 10 mg/L = 10 ug/mL in the plasma. You find something like 10 ng/mL, because the 99+% of drug has been sucked from the blood stream into some poorly understood compartment where it does who knows what.
One compartment where HCQ builds up is the lysosome, the compartment that forms when cells engulf something, often when something binds to a receptor (say a steroid receptor) and that receptor is internalized so the steroid-receptor complex can be delivered to the nucleus to regulate gene expression. And to prevent viruses from hitching a ride on internalized receptors, lysosomes are acidified. And some viruses have evolved to make use of acidification by having coat proteins undergo a conformation change in acidic solution that allows them to disrupt the lysosome and escape into the cell. We know that HCQ is concentrated about a 1000 fold in lysosomes and its basic nitrogens prevent acidification. Apparently HCQ also binds to zinc and raises zinc concentration there. Messing with fundamental host cell lysosomal machinery is an inherently toxic mechanism of action, but there is a decent therapeutic window between host toxicity and toxicity in the lysosomes of malaria parasites. For the same reason, HCQ appears to have weak activity in cell culture against many many viruses in cell culture and kills the host cells at modestly higher concentrations. If you need a worthless publication, you can put HCQ into almost any cell culture assay and see some activity.
Azithromycin is another drug with a huge volume of distribution that is concentrated in lysosomes (of white blood cells). We know beyond any doubt from ribosomal mutations that produce resistance that azithromycin acts by binding one specific site on bacterial ribosomes (like other macrolide antibiotics that aren’t concentrated in the lysosome). However, because azithromycin is cleared from the body slowly, you can advertise that you only need to take it for 5 days instead of the usual 10.
So when a viral pandemic comes along, and you are a desperate doctor hoping to find something that works, you decide to double your chances of success using a combination of two approved drugs that concentrate in lysosomes. And you don’t use a proper placebo control group or pre-defined endpoint, which enables you to later select a metric that defines the success of your treatment.
And when that combination start to look shaky, you add zinc to the mix. The predominant intracellular divalent cation is magnesium. Some textbooks list ATP-Mg complex as the substrate for all kinases and magnesium complexes with ribo- and deoxyribonucleotides as the substrates of all nucleic acid polymerases. When you throw a competing divalent ion into those enzyme assays, you are certain to find inhibition and another worthless publication. And since you are again messing around with fundamental processes of your host cells, adding zinc to compete with magnesium is likely to be toxic at some concentration (unless active transport carefully regulates zinc levels). Nevertheless, there is some chance of interfering with viral replication with doses that are slightly lower than doses that are toxic.
When that isn’t good enough you can always add Vitamin C (appalling, I know) or get an orange clown to promote it for you (also appalling).
After medicinal chemists slave for years to find high affinity, high selectivity drugs like Sustiva or Tamiflu or Ledipasvir that specifically interfere with a viral process and not host cell processes, it is a TRAVESTY that a toxic molecule like HCQ that doesn’t bind to anything is useful for treating malaria, lupus and maybe COVID. And lithium salts are actually useful for treating depression (they have some selectivity for one kinase). And a simple, slightly reactive, molecule like aspirin is still useful for inhibiting cyclo-oxygenase. You’d probably never get these drugs approved for sale today, because their non-specificity means they have significant side effects. Nevertheless, it is always possible that HCQ (possibly combined with azithromycin or zinc or both) is active against COVID and that its toxicity can be tolerated for a week or two. Just don’t ask me to believe it without a proper random-assignment placebo-controlled double-blind study.
Tom Scharf
Yep. If it was a board game where players lost the same number of “points” for any death, and the disease has the features this one does, you’d encourage younger people to get out into bars and parties and circulate until you reached herd immunity. Heck, you might force them to have mild exposures (hoping perhaps that initial mild exposure often leads to milder disease.)
.
If the board game rules were something else… like lose more points for less economically viable people… you’d schedule regular exposures in old folks homes.
.
This isn’t a board game. But the way policy people are acting is to minimize cases right now. Although that wasn’t always everyone’s strategy when they knew getting infected was nearly inevitable and they believed the disease was less deadly at some particular age. Parents used to have chicken pox and measles parties. Most now get their kids vaccinated (though I understand some still have the parties, which is ridiculous given that we have a vaccine.)
lucia (Comment #187663): “But the way policy people are acting is to minimize cases right now.”
.
Indeed. That policy made sense back in March, when almost nothing was known and buying time was valuable. But since they abandoned “flatten the curve”, I have not seen any explanation of what the big picture strategy now is.
Does anyone here know what the big picture strategy has actually morphed into? Other than OMB? Real question.
My impression is that it is like a stampede. All the other cattle are running this way, therefore I must run this way. Even if it is toward a cliff.
MikeM,
Generally speaking, I think there is no true “big picture” policy in the US. Each state is kinda-sorta doing its own thing. “the press” likes current number to be low. I’m not sure that’s really a policy so much is what you get with daily reports.
.
There is some sense to the idea that fewer deaths and cases right now is a good thing. After all: a vaccine or treatment may be found and people who are not yet ill or dead will have that available. I know it’s a motivation for me to avoid getting sick now! People are working on these– and certainly, they’ve figured out they should likely avoid intubation!
If there was no hope for vaccine or better treatments in the time frame of… oh… two years. I might be avidly reading to discover whether there was some way to maximize getting a lighter case that might give me immunity. Afterwards, I could resume a normal life!
.
If I were younger, the window for decided to get it now and get it over with might be even shorter. Think back to college age: If you could really expect something that’s just the flu, you’d live but feel bad for two weeks, lots of people would pick getting it in summer. Then you don’t come down with the illness during midterms or finals! No matter how much slack your prof give you, that’s just a much worse inconvenience then.
lucia (Comment #187667): “Generally speaking, I think there is no true “big picture†policy in the US. Each state is kinda-sorta doing its own thing.”
.
Those are two different things. The lack of a national policy does not mean that states can not be acting in accord with a big picture policy. It just means that states might differ as to both their big pictures and details of implementation. The more restrictive states, which is most of them, do not seem to be guided by any big picture as to what they are trying to accomplish.
——
lucia: “There is some sense to the idea that fewer deaths and cases right now is a good thing.”
.
Well, yes. But that has to be weighed against the massive cost of trying to achieve that. That is not just about money; the existing policies have a huge cost in lives.
——-
lucia: “If there was no hope for vaccine or better treatments in the time frame of… oh… two years.”
.
I find that time frame to be unreasonable. What we are doing is costing trillions of dollars and probably in excess of 100K lives per year. It can not be maintained for anything close to two years. And there is no guarantee of a vaccine in two years.
——–
lucia: I might be avidly reading to discover whether there was some way to maximize getting a lighter case that might give me immunity. Afterwards, I could resume a normal life!
.
No you could not resume a normal life. All of the restrictions would still apply to you.
I have no objection to your being willing to modify your behavior for two years in the hope that you will be vaccinated before catching the virus. I object to people insisting that everyone else be required to do the same.
MikeM
Sure. I agree the lack of a national policy doesn’t mean the states cannot be acting in accord with some big picture policy. What I’m saying is that as an empirical matter, the are not acting in accord with some “big picture policy”. I think the more restrictive states have just as much or little a “big picture” for their individual state as the less restrictive ones. Theirs might not be the one you like but that doesn’t mean its existence is less than in other states whose policies better match your preferences.
.
Of course death and disease need to be weighed against other things. That, among other things, is one of the reasons I said my time window for my choices would be different if I were younger and in college. I’m semi retired. The cost to me of “quarantine” is not very great. In college or grad-school it would be greater. Same for someone who needs to work to pay the mortgage.
.
I’m in Illinois. Which restrictions do you think apply to me? Restaurants are open– at lower seating capacity. But I would feel comfortable going. Some places are open for Friday night social dancing. I would feel comfortable going. I’d feel more comfortable shopping and doing lots of things. So, if I were immune, as far as I can tell, I’d have quite a bit of flexibility in my choices.
.
I’m not immune (as far as I am aware.) So my behavior is restrained by my own desire to protect myself.
.
I haven’t so insisted. And Illinois is largely dropping restrictions.
Mike M,
“My impression is that it is like a stampede. All the other cattle are running this way, therefore I must run this way. Even if it is toward a cliff.”
.
I think it is more like a herd of politicians terrified that even discussion of realistic policies will lead to them being voted out of office. Every time the case rate (never mind the death rate!) increases, the MSM goes absolutely bonkers, and suggests the politician in charge, if a Republican, is personally responsible for all cases (and all deaths). (Democarts get a free pass, no matter the number of cases or deaths, of course.) No politician I am aware of is willing to even directly address the impracticality of locking down the economy for 18 or 24 months… or more… and that heard immunity is the only practical route to normalcy.
Daily deaths at CDC is now 900. Has come close to but not passed 1000 several days now. However, for weekend numbers this is a large increase, triple the recent numbers.
MikeN, SteveF and Lucia:
You seem to think we have only two choices: 1) severe, punishing restrictions for two or more years or 2) a pandemic that rages until herd immunity or a vaccine. Why isn’t the goal to effectively end the pandemic and suppress local outbreaks. China did. Cases in Europe are down to 10% peak levels and falling. A few other countries managed to keep peak case loads far below the rest of the world. Why is it acceptable that our country isn’t winning too?
Until fear and policy changed behavior, worldwide experience was that every person with COVID passed it on to an average of about 4 other people while they were infectious. When cases began to fall in the US during the lockdown in April, each infected person was infecting an average of slightly less than 1 new person. If we had gotten that number down to 0.5 or even 0.7 new people, our pandemic would be over today. Mandatory masks might have been enough, mandatory temperature checks might have been enough, more and faster testing might have been enough, better contact tracing and more effective quarantine of exposed people might have been enough. More likely, all or most of these measures would have been needed. Others have shown it is possible. Unfortunately, most of these measures needed to be implemented by local governments, which are starved for money and can’t afford to hire any of the millions of laid off people (collecting unemployment) to combat COVID. Merely redirecting a minuscule fraction of money the feds are spending to combat the economic damage from the pandemic would have ended the pandemic by now. If these measures were in place today, the current surge in cases wouldn’t have occurred when we tried to re-open our economy.
The fundamental question is: Why do some think measures this intrusive are required to combat COVID, but not seasonal influenza or other problems? DESPITE our efforts, today we are experiencing about the same number of deaths every month from COVID as we experience in an average year from seasonal influenza, but that toll is only 10-15% of the people who die from all causes. However, COVID is threatening to overrun our hospitals and bring “civilized heath care” to an end – something no leader (democrat or authoritarian) can tolerate. Like it or not, our leaders WILL use the police powers they have been granted in pandemics to ensure that hospitals can meet the demand of those who are sick. IF you accept that political reality, then you logically should insist that leaders use their power to bring the pandemic to an effective halt – and not let it drag on indefinitely. It takes only modestly more effort to win than to maintain today’s unstable state and will cost far less in the long run. And significant sectors of our economy won’t recovery until people feel safer.
Frank,
I am reminded a bit by your comments of people who argue that there is no reason not to eliminate nuclear weapons…. everyone just has to agree to stop producing those weapons and destroy all those that exist. Sorry neither genies nor viruses go back in the bottle so easily.
.
The pandemic is not going to drag on indefinitely; look a Sweden if you doubt that. Herd immunity, perhaps in combination with some care in social interactions, especially (I hope) by those most at risk of death, will reduce the scale of the pandemic until it is no longer a major issue. Look at the states where the pandemic really was not addressed in any significant way until already widely spread (NY, MA, NJ, etc). All of the new case rates in those places, and more importantly death rates, have dropped by factors of greater than 20. The heath care system in those places is at zero risk of being overwhelmed, no matter the specific policies in place. The number of exposed individuals in those places with active resistance is high enough that spread of the virus is greatly inhibited compared to March. For certain there are pockets within those states were the number of resistant individuals remains low enough for local “flare-ups†(many places in up state NY, for example), but the more populated regions are done with the pandemic.
.
Many states where the virus was effectively suppressed via ‘lockdowns’ and social distancing (like FL, TX, CA) are now seeing a big rise in cases, but a much lesser rise in deaths, because the demographics of the cases has changed. In FL, I believe current median age for a verified case is now near 25 years old… very few of those younger people are going to die from coronavirus. California has (unwisely IMO) started to return to lockdown like rules. These will only prolong the economic and social disruption.
.
It is neither economically not politically possible in the States to end the pandemic as you suggest, but those steps, if adopted, will cause almost endless economic and social disruption.
Frank,
Please consider this comparison for two places, both very near the end of the pandemic:
.
……………….Sweden…………… Massachusetts
Population……10.6 million……….6.9 million
Median age…..41.1 years…………39.1 years
Schools……… Closed colleges……Closed all
Day care……. Open………………. Closed
Restaurants… Open………………. Closed
Stores………. Open……………….Most closed
Masks……….. No………………… Yes
Travel restr…. No………………….Yes
Automatic
Quarantines… No………………….Yes
Economic
Disruption….. Little……………… Extensive
Peak deaths… April 12…………… April 17
Deaths
per million…..~520…………….. ~1,203
.
A reasonable person might ask two questions: 1) How effective were all the rules and regulations in Massachusetts compared to their costs, and 2) What did Sweden do right to have 42% of the fatalities of Massachusetts?
.
My answers to those questions are: 1) All the rules in Massachusetts did little, but cost a huge amount, and 2) Sweden recognized early on that children and adults below 60 are not at high risk, while much older people are, and did a better job protecting those most at risk.
.
Sweden is less densely populated, and this certainly helped to reduce deaths among the elderly, but on balance, states like Florida, Texas, and California resemble the population density pattern of Sweden more than Massachusetts, and would be best served to focus on protecting the elderly and very elderly…. and forget most of the disruptive covid rules that do nothing to save lives. I hope Florida continues to focus on elderly care facilities and on ways to minimize risks to the elderly who live on their own. Based on the age profile of people who die from covid, there is no reason I can see that effective policies, focused on those truly at risk, could not cut the fatality rate in half or less compared to Sweden.
This is not an epidemic. It is hundreds of epidemics. Just in New Mexico, a relatively small state, there have been many: one in the urban center of the state, seeded from New York, that eventually got into nursing homes; one in the Navajo Nation in the northwest and in Arizona; several in southern New Mexico, especially Dona Ana county, seeded from out of state, especially from Mexico; and now a new one in Albuquerque, details as to where from and who among are not clear.
.
Case loads in an epidemic rise and then fall; the latter creates the impression of success even if policy had nothing to do with it. But when there are hundreds of epidemics, there is no overall pattern, creating the impression of failure.
MikeM,
I don’t think I understand your comment. There is a clear pattern everywhere that case rates (and unfortunately, deaths) were high (many individual states and many countries). Places were the virus was never widely spread remain vulnerable to local spread (‘flare-ups’), of course. Is that what you mean by ‘the impression of failure’?
SteveF (Comment #187716): “Places were the virus was never widely spread remain vulnerable to local spread (‘flare-ups’), of course. Is that what you mean by ‘the impression of failure’?”
.
Yes. The overall pattern for the U.S. looks nothing like New York City. That is routinely cited as evidence of a massive policy failure by the U.S., although the cause of the failure never seems to be specified beyond federalism or OMB. But it is inevitable that there will be flareups unless you have reached herd immunity or live somewhere that can only be practically reached by air travel.
Mike M.,
How is the rest of the US not looking like NYC a failure? NYC and the surrounding counties in NY, particularly Rockland and Westchester counties in NY, and NJ have some of the highest COVID-19 infection and death rates in the world. At worldometers.info, only San Marino is even close. Over 0.2% of the entire populations of the boroughs of Queens and the Bronx have died. That’s over 7% of the confirmed cases.
I would say that not looking like NY, NJ, CT and MA is a huge policy success for the rest of the country.
DeWitt Payne (Comment #187720): “I would say that not looking like NY, NJ, CT and MA is a huge policy success for the rest of the country.”
I agree. But one sees those places, as well as countries with similar results, described as successes while places that don’t look like them are called failures. Especially if those places are red states.
When discussing herd immunity, should the 20% of the population 14 and younger be included?
MikeN,
That is a very good question. All of the available data say that the chance of serious illness is very close to zero for that age group. The chance of raising antibodies after exposure appears much lower than in older groups as well (less than half)… again suggesting very low viral loads. Most research suggests that even among children who do get the virus, the chance of passing to one another or to adults is low….. probably because of much lower virus load in very mild cases.
.
So my guess is that 20% represents somewhere reasonably close to a 20% contribution to herd immunity (15%?), but there are probably people who won’t accept that conclusion. The is strong resistance in many places to opening schools in September, due to fear youngsters will become a source of rapid spread to older people. In light of the experience in Sweden (no, the kids did not spread the virus because they went to school) I think the resistance to schools opening is mostly due to fear, not reason. Sort of like most covid-19 policies.
MikeN,
We don’t know for sure because we don’t know for sure that they literally don’t get it and are not contagieous. It seems plausible they don’t get it at all and are not carriers. But we don’t know for absolute sure
If elementary schools do resume in person meetings, we’ll know. . .
If you run an SEIR type model, you can just start with “N_susceptible_0” be the group the number that is susceptable. Then the herd immunity is reached at a fraction of “N_affected/”N_susceptible_0” which depends on the initial R based on progress through the susceptible fraction of the population.
If a subpopulation is not susceptible for some reason (e.g. they are robots, young people or others who for some reason who cant get it), you just don’t include them in the N_susceptible_0, and the % works out the same.
There are other ways of doing the math. (There are also extension to the model that would allow young people to age into the population that becomes susceptible and so on.)
MikeM,
“But one sees those places, as well as countries with similar results, described as successes while places that don’t look like them are called failures. Especially if those places are red states.”
.
Sure. It is a politically motivated description of ‘success’ and ‘failure’. That Georgia has 285 deaths per million and New Jersey 1,760 per million is not even related to that political evaluation of policy. ‘Success’ for progressive politicians and their MSM hacks has nothing to do with death rates, but rather how effectively state and local governments adopted onerous policies, (which might in someone’s fevered dreams possibly reduce death rates) and then forced the population to comply. It’s forcing the population to comply with onerous policies that is the definition of ‘success’, no matter the issue. “Do exactly as I say” is the default position of the left on every public policy question, and covid-19 is no different.
.
Covid-19 death rates are simply orthogonal to the fundamental political question: Should the public, through elected politicians, control all personal activities? The progressive answer is always “yes”. The rest, including all the howls about OMB, is window dressing. The left wants power over individuals, and nothing else, even much higher death rates from covid-19 due to stupid lefty policies, matters a whit.
lucia (Comment #187727): “If elementary schools do resume in person meetings, we’ll know.”
.
They have resumed in many places. There have been no problems.
Back in May, the Wisconsin Supreme Court told progressive Gov. Evers that his covid related orders were in violation of the law and blocked all enforcement. Evers had refused to compromise with the Republican controlled legislature as required by law, and STILL refuses to. The result of lifting Ever’s many covid rules: Nothing. No surge, no overwhelming of the hospitals, no dramatic rise in deaths. Wisconsin has had an average of 3 deaths per day for the last three weeks, and remains among the lowest of the states in deaths per million population.
.
Will the MSM ever revisit the issue and admit that Ever’s onerous and economically damaging policies were not needed? Hell no!
SteveF compared Massachusetts and Sweden: SteveF (Comment #187713) July 14th, 2020 at 6:16 am
Massachusetts new cases peaked in late April at about 2,500 case/day (with one day at 5,000). New cases have been below about 500 since Jun 1 and 250 since July 1. I would say Massachusetts measures were very effective in suppressing the pandemic in that state. And this progress has been maintained despite re-opening of the state’s economy beginning on June 1, after a solid month of progress when the new case load had fallen by a factor of three. Today, the state is on “Phase 3, step 1” of re-opening, which means that hair salons and indoor restaurants are at least partially re-opened, but not amusement parks or bars or indoor gyms. The situation is evolving, not static.
https://coronavirus.jhu.edu/data/state-timeline/new-confirmed-cases/massachusetts
https://www.mass.gov/info-details/reopening-when-can-my-business-reopen
The pandemic in Massachusetts exploded in March with the number of cases doubling every few days until it reached 1,000/day. It had already reached 1,000 cases/day by April 1, the earliest date restrictions could have had an impact. Massachusetts’s measures did not appear to be particularly effective in early April as the number of cases rose to 2,500. Actually, that is a mis-impression created by thinking in linear terms. In early April the doubling time had increase to something like 10 days more than a month by the end of April.
Sweden (according to Nic’s post at Judy’s) had about 4,000 cases/day when Massachusetts was reaching its peak at 2,500 and today that number is up to 8,000/day because of a surge in June similar to that seen in some US state. Nic notes that the number of tests run in Sweden doubled after June 1, but the number of tests run in Massachusetts has tripled since its peak.
I won’t discuss hospitalization or death rates, because these are highly dependent on the age of the people being infected. Dead and hospitalized patients aren’t contributing to the spread of the pandemic, while newly infected younger people can infect the vulnerable in the future. An older person in Massachusetts is roughly 30-fold safer today in Massachusetts today than in Sweden.
One was vastly freer in Sweden to do what you wanted and keep your business open, but the economic impact of the pandemic is just as bad in Sweden as it’s Nordic neighbors that imposed mandatory restrictions and are now much safer. I looked for an article from a conservative publication that discusses Sweden’s current economic state, but for some reason such publications haven’t written about this subject lately. So, I’m stuck offering this evidence:
https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html
IMO, whether or not there are mandatory restrictions, many customers aren’t going to patronize businesses where they don’t feel safe. You may be able to avoid some economic damage in the short term by avoiding lockdowns, but still lose in the long run.
Finally on Jun 3, “Sweden’s top epidemiologist has admitted his strategy to fight Covid-19 resulted in too many deaths, after persuading his country to avoid a strict lockdown. 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,†Anders Tegnell said in an interview with Swedish Radio.”
https://www.bloomberg.com/news/articles/2020-06-03/man-behind-sweden-s-virus-strategy-says-he-got-some-things-wrong
And that was BEFORE the number of cases per day doubled in June!
I’m surprised that you aren’t aware of these highly publicized aspects of Sweden’s policy. However, confirmation bias does make it difficult for all of us to retain information that contradicts our deepest beliefs. So please rub my nose in any new facts I have omitted – I need them.
Frank,
“An older person in Massachusetts is roughly 30-fold safer today in Massachusetts today than in Sweden.”
.
Absolute rubbish. Almost nobody is dying of covid 19 in either place.
.
Your comment is exactly the kind of avoidance of the substantive issues that I expected from you. I laid out an item by item comparison, and all you want to comment on is how wonderful Massachusetts policies are that lead to 2.4 times more deaths! It is almost like a joke, save for the fact that lots of people died in Massachusetts who didn’t need to. Do you think Massachusetts did a really good job… say, much better than Georgia, Florida, Texas, and others? (real question) It seems you won’t ever address data which refutes your pre-conceived notions about a need for draconian measures. Do you not care at all about those people who died for no good reason?
.
Sweden could have done better, especially if they had been more careful to avoid spread among the most elderly (and that is one thing all the Swedish authorities agree on). New York and NJ could have done a hell of a lot better if they hadn’t send elderly patients with covid 19 from hospitals back to the nursing homes to infect others. But nobody (and certainly not you) will address that triumph of idiocy over reason.
.
Massachusetts is long past herd immunity, save for a few regions that are much less populated and never suffered the very high infection rates of the more populated regions. Do you believe otherwise? (real question) The restrictive policies that remain in place are doing nothing of consequence except continuing economic damage.
.
Sweden is long past herd immunity too. Their Nordic neighbors are not. We will see how it turns out for the other Nordic countries in the long term (maybe a vaccine will save them), but Sweden is just about done with the virus, vaccine or not.
Frank,
You should get your facts straight: Massachusetts new cases are averaging about 200 per day over the last 10 days, and deaths are averaging about 20 per day over the last 10 days. Sweden is averaging about 500 cases per day over the last 10 days, but rapidly declining, and deaths continue to decline, reaching about 20 per day as of June 30 (there are reporting delays on deaths in Sweden, but the trend is even steeper in decline than Massachusetts. Keep in mind that Sweden has more people (10 million vs 6.7 million), so if anything, Sweden is doing better than Massachusetts in deaths, not worse.
Frank,
Deaths per million people:
Massachusetts 1,210
Sweden 549
Sweden is the clear winner even though they did a lousy job of protecting older citizens.
Massachusetts is reopening its schools with 3 feet social distancing. The virus must work differently there.
MikeN,
“The virus must work differently there.”
.
I guess the theory is: “smaller people, less distance needed”. 😉 You got to love such idiocy, if only for its humor value. Note to Massachusetts: Germany (and Sweden, of course) discovered kids don’t spread the virus at all when they attend school, so no social distancing is needed for school kids.
SteveF wrote:
“Frank,You should get your facts straight: Massachusetts new cases are averaging about 200 per day over the last 10 days, and deaths are averaging about 20 per day over the last 10 days. Sweden is averaging about 500 cases per day over the last 10 days, but rapidly declining, and deaths continue to decline, reaching about 20 per day as of June 30 (there are reporting delays on deaths in Sweden, but the trend is even steeper in decline than Massachusetts. Keep in mind that Sweden has more people (10 million vs 6.7 million), so if anything, Sweden is doing better than Massachusetts in deaths, not worse.”
You are right. I got my facts about Sweden from Figure 1 in this Nic Lewis post:
https://judithcurry.com/2020/06/28/the-progress-of-the-covid-19-epidemic-in-sweden-an-analysis/
Note that deaths and infections are plotted on the same graph with infections divided by 10, but I didn’t notice the units were per week, not per day. So the current rate of new infections is about 1000+/day (and rising). 4-5 times riskier than Massachusetts. Sorry for my mistake.
BTW, Wisconsin’s new cases have double since the court ruling. If the factors that caused the rise haven’t changed, the logical expectation is another doubling in the following month – and the next.
I have a 90+ year old mother-in-law. If she were living in Sweden with 1,000 cases per day, there would be roughly 10,000 people capable of infecting her, about one out of every thousand. If she went out every day for 100 days and encountered 10 people per day, one of them would be capable of infecting her. So it doesn’t make sense for her to go out much. My wife sees her every day, but she can be asymptomatic and infect her mom. So the same safety considerations that apply to my mother-in-law apply to my wife and me. We also live with a son who, before COVID, commuted to work on the Metro, a 30 min standing room only trip at rush hour. Fortunately, he is working from home, possibly because his employer is generous and possibly because the city won’t let his employer’s non-essential business open yet.
The take home lesson is that really vulnerable people in our society can’t effectively isolate themselves from the sea of people around them. The difference in risk between Massachusetts’s peak rate of 2500 new cases/day and the 250 cases/day after lockdown is a non-trivial difference in real risk. I focus on new infections as a metric (rather than deaths) because the vulnerable are at risk from those who are infected. While treatment is improving, many of those who barely survive COVID will never be the same.
I do NOT think politicians should be keeping other people from working and doing what they want because of my personal circumstances. I don’t claim to know whether the costs of fighting this pandemic are worth the benefits. Our leaders don’t know either, nor do they care. Politicians are acting because voters won’t tolerate watching fellow citizens die waiting in line to get into a hospital. You and I can join protests for our rights if we like, but most of us will head home when there is a line waiting to get into the hospital. Since politicians are going to act, I think the goal should have been to end the pandemic and suppress localized outbreaks, not get by with 0.1% of the population in many areas being infectious at any given time – and then crack down when that surges to about 0.5% of people. (NYC experienced 5000 new cases/day in April, multiplied by a 10 day infectious period divided by 10 million people). The difference between stability (1 new infection from each existing infection) and winning (0.8 new infections from each existing infection, 90% reduction in about 10 weeks) seems worth the effort to me.
You may forget how much liberty we are already sacrificing for public health and safety. A century or more ago, we stopped dumping raw sewage and horse dung in the streets, and about a half-century ago we stopped driving cars without catalytic converters and burning trash in our backyards. And created Medicare. Restaurant owners are inspected, as are most suppliers from farm to table. These changes occurred because people wanted more safety. Unfortunately, a crowded restaurant with 0.1% of the customers infected with COVID isn’t a safe place to routinely go anymore – whether your goal is to protect a vulnerable family member or avoid overcrowded hospitals. With more space between tables, better air filtration and circulation, and screening customers at the door for fever, the risk of COVID being transmitted from one person to another could be 10-fold or more smaller. The state was ALREADY regulating the number of tables in the restaurant and probably ventilation. More speculatively, maybe it’s time our society evolved so that everyone stayed home with a fever, because they aren’t welcome in schools, offices, stores, and other public facilities – with temperature scanners monitoring the doors. (No more seasonal flu and common colds?) We must get people back to work – safely.
Frank,
Will you please look at the actual data? https://www.worldometers.info/coronavirus/country/sweden/
.
The last day with 1000+ cases in Sweden was June 26, and the cases have dropped dramatically since then. The seven day rolling average shows the drop even more clearly. The rate of Death in Sweden is presently under 20 and dropping, while Massachusetts has a relatively steady 20 or so deaths per day. Those are all nearly all elderly people. If the risk to a very elderly person were 10 times higher in Sweden, then certainly there would be that many more deaths; there aren’t. I don’t know how to discuss this with you when you ignore to actual data.
.
There are no States where hospitals are going to be overwhelmed by covid patients. Your continued claims they will be if your preferred policies are not followed are divorced from reality, and seem to me only to reflect an irrational fear. You might recall that even the grotesque policy incompetence in NY and NJ, leading to the highest death rates in the world was not enough to overwhelm the hospitals…. the Navy hospital ship in the harbor and the special emergency clinic set up at the Javits center went unused. The lack of ventilators never materialized. It was all a waste.
.
I note that your personal level of fear of spread of the virus strikes me as way beyond reasonable. That is just an opinion, as are your policy preferences. You and your wife should do as you wish, of course, but keep in mind that there are lots of people who do not share your worries, and will continue to resist keeping the draconian policies you favor in place. I rather suspect that there are very few public policies on which we would even remotely agree; covid 19 is but one of them. It is a question of values and priorities, and on those it is clear we fundamentally disagree. Support candidates who agree with your priorities and values, but please don’t misrepresent factually reality in the process.
Frank (Comment #187778): “I got my facts about Sweden from Figure 1 in this Nic Lewis post”
.
For crying out loud, that post is nearly a month old.
Here is a factor in increasing “new” cases and positive test rate. You have mild symptoms, go get tested, and get a positive result. A few days later you are feeling fine, so you get tested again just to be sure, but the test comes back positive. Next day, you are still feeling fine so you get tested again, with the same result. That goes on for two weeks before you finally get a negative test. 15 “new” cases, from a single person.
.
That is happening, but I don’t know to what extent is it messing up the data. It may be that some states don’t double count tests from the same individual. I don’t know what fraction of people get retested or what fraction of those get a new positive. But people do continue to shed virus fragments for a long time, so it could easily be a big effect.
MikeM
That is happening,
Seriously? Link to show this is happening at any significant rate.
Idiots exist. And perhaps some idiot somewhere *might* do what you described. But getting tested is a hassle. I think practically no one who tested positive is going to be retested a “few” days later just to confirm their initial positive was not one of the rare false positives. Even fewer are going to go get tested a freakin’ third time to see if the first two positives might not have been false positives.
In the first place, they will surely have read that many people have mild or no symptoms. If they haven’t, their doctor will remind them!
I wouldn’t doubt you could find someone who did this. But it’s impossible to believe that is the cause of positive/new cases rising significantly.
In Illinois positives/new tests have flatlined. Death’s are still dropping. We may be approaching the effective false positive rate.
lucia,
Yes, that is happening. As I said, I don’t know the extent. If I find a link, I will post it.
lucia: “Idiots exist. And perhaps some idiot somewhere *might* do what you described. But getting tested is a hassle. I think practically no one who tested positive is going to be retested a “few†days later just to confirm their initial positive was not one of the rare false positives.”
.
I don’t see why that is hard to believe. Being in quarantine is a bigger hassle than getting tested, especially if you are quarantining yourself away from family members. It seems to me that getting tested to see if you have cleared the virus would make more sense than getting tested because of a stomach bug.
So what would you do if you had a positive test and no symptoms? Real question. Would you and Jim really never leave your house for two or three weeks, without getting tested to see if you can leave?
lucia (Comment #187791): “We may be approaching the effective false positive rate.”
.
The positive rate is down below 1%?
Some folks are getting tested repeatedly. Everyone involved the the recently restarted Formula One season is tested every five days.
Everything I see is saying that many, if not most, of the testing facilities in the US are currently overwhelmed. Turnaround time seems to frequently exceed one week. That’s unacceptable and makes the test nearly pointless as well as making contact tracing impossible.
In FL they only count a positive test for a person’s name once, but they do count their negative tests every time, ha ha. This was revealed this week. I doubt this distorts numbers very much, but it falsely lowers positivity rate by some amount that nobody could figure out.
.
The death toll continues to climb in FL. Median age for positive test is 40. What hasn’t changed much is the average age of deaths, 70 and 81 from counties in my area yesterday. The death rate is now about 2x, active cases about 12x. One would expect the death rate to continue to climb for at least another week or so.
Tom Scharf (Comment #187795): “In FL they only count a positive test for a person’s name once,”
.
Good. But surely they need more information than just the name.
——-
lucia,
When you got tested, did they ask if you had been tested before?
Mike M.
I don’t recall them asking me that. But they asked me a lot of things related to why I was there. I had a referral from my primary care physician and they had access to those records. So they would be able to know that without asking me.
.
I don’t think them not asking me is particularly important. Them not asking doesn’t motivate me to go out and get test after test after test after test. I could understand wanting to get a second test if I had a *negative* outcome but thought I’d been exposed later.
But I honestly can’t see any reason their not asking me if I had been tested would motivate me to get another test after having a *positive* outcome. I’m a bit mystified why you would think why that sort of behavior could possibly be frequent enough to significantly affect the statistics.
.
I read a CDC warning that one of the tests “out there” has a false positive rate of 3%. We’re below that. But I don’t know what fraction of tests use that method, and I don’t know the false posistive for the other tests. Most articles just say “very low”.
Some parts of the state are above 3%, so I doubt we are at the false positive rate. But we might be getting near enough that we won’t see the %positive rate fall quickly. At some point it has to flatline. I just don’t know that number.
MikeM
The technicians did have more information that my name. They had my phone number and date of birth. It was my provider, so they had my medical file!
.
They do want to be able to report the results to the person who took the test. So I think they’ll have everyone’s phone number.
.
Tom Scharf,
“One would expect the death rate to continue to climb for at least another week or so.”
.
I guess a little longer than that, maybe two weeks. The maximum rate is the bigger question. My swag: It might reach ~150 per day before dropping.
MIkeM
If you are literally placed in quarantine, they aren’t going to let you out in a “few days” just because you take a 2nd test that comes out negative. If the authorities really literally took you out of quarantine, they aren’t going to let you out if you get 2 positive tests followed by a negative one! It could be a false negative. They are going to make you wait until a defined time after symptoms clear. So this strategy wouldn’t get you out of quarantine!
.
That sort of reduces the motive to give it a try.
.
Most states aren’t literally putting anyone in quarantine. They don’t have the resources to monitor people! So you don’t need the 2nd test to step out. You could just chose to not believe your test!
.
Yep. I’d do two weeks of self quarantine. I’d order food in or I’d ask neighbors to get it. I’m sure I could find people to do it. This wouldn’t be THAT hard.
.
Later on, I’d get an antibody test to verify I had antibodies. If I had them, I’d thank my lucky stars and feel much freer going about my daily business.
lucia (Comment #187797): “Them not asking doesn’t motivate me to go out and get test after test after test after test.”
.
Of course it wouldn’t. But it might indicate that they are not concerned about duplicate results. Since it was your provider, there might be no need as long as you gave them your ID number.
I was thinking in terms of drive-up testing, pharmacies, etc.
.
I suppose a critical question is what people are told to do if they test positive. If they are told to isolate for two weeks or until they get a negative test, then people might get retested often. Or you might be anxious for a negative test if your elderly mom lives alone and depends on you for grocery shopping and some routine household task.
Most people probably think the test is for the virus, rather than for virus fragments. So they might equate “positive test” with “contagious”.
SteveF
My guess is deaths could increase for 3 or 4 weeks. The doubling rate of cases seems to have slowed, but new cases may not have peaked. So if the lag stays roughly constant, the peak in death’s could be 4 weeks away. (Could be longer.)
.
Your swag of ~150/day deaths might end up close. Dunno. . .Could end up lower though. It sort of depends on whether the case fatality rate is different because it’s younger people (or any other reason.)
.
So many uncertainties.
Lucia,
“So many uncertainties.”
.
Sure, the only certainties are death, taxes… and herd immunity. 😉
.
I hope Florida gets there with a lot fewer deaths per million than Sweden… matching Sweden would be ~12,000 to ~13,000 total. Maybe Florida can keep total deaths to under 7,000 – 8,000 if they can keep the virus out of most elderly care facilities. We’ll see.
MikeM
If I was really worried about my elderly mom, I wouldn’t want risk getting a false negative after having a true positive so I could then risk her life by exposing her to my covid.
Unless my brain had fallen out of my cranium, I’d phone neighbors, post on Nextdoor or Facebook, call the church, or perhaps the mayor or do something if I came out positive. I’d do any and all of these things before I’d self-assign myself the task of becoming the riskiest possible choice of care giver to go visit my mom!
.
I’m not big on asking other people more help. But if I got a positive Covid test, asking them to help would be one hell of a lot more sane than going out every two days and being retested, decreeing myself “well” on the basis of a possible false negative after two positives and then risk infecting her!
.
Sure. What positive tests means is “more likely to be contagious than if you had a negative test.” Yes. Perhaps you are over the contagious period and can no longer infect people.
.
Also if you took the test while *asymptomatic*, it’s much more likely you are still contagious. After all: the main motive for getting tested when you are not yet sick is you were in contact with someone who got sick. Since you have no symptoms, it would be much more more likely you are in the *early* stage than the late state.
.
It makes a lot more sense to wait more than a “few days” to get retested.
One of the big pushes by the state is to do contact tracing. Even if it were not, those testing need to provide you your results. These people are going to get your phone number at least. The state is also collecting demographic information including age, sex and race. So these places must be collecting that information. Otherwise, the States wouldn’t have it!
Anyway: as far as I can tell, your basis for thinking this happens is you dreamed up the possibility. And on that basis– and absolutely no other you are now suggesting it’s realistic to think it IS happening at some significant rate. I seriously doubt this is happening at any significant rate.
lucia (Comment #187805): “your basis for thinking this happens is you dreamed up the possibility. And on that basis– and absolutely no other you are now suggesting it’s realistic to think it IS happening at some significant rate. I seriously doubt this is happening at any significant rate.”
.
It is happening. It might or might not be significant; as I said earlier, I don’t know. Neither do you. Perhaps that will get sorted now that it is getting some attention.
Frank,
“I have a 90+ year old mother-in-law. If she were living in Sweden with 1,000 cases per day, there would be roughly 10,000 people capable of infecting her, about one out of every thousand. If she went out every day for 100 days and encountered 10 people per day, one of them would be capable of infecting her. So it doesn’t make sense for her to go out much.”
You have a very active MIL, going out every day and encountering 10 people per day with sufficient proximity to become infected if they are sick. The 90+ I’ve known in my family rarely left their houses at all, even in the complete absence of a pandemic.
.
I’ve left the house most days, before lockdowns, during lockdowns, and after. If one stranger in 1,000 were actually a COVID carrier, it’s exceedingly likely I’ve been within six feet of several of them over this period. But the number I’ve been within six feet of for at least ten minutes — a handful at most, perhaps none since March. If I were a high-risk individual and taking precautions to avoid that situation, it would have been zero *including* March. I hope your mother-in-law is taking precautions, including *not going out* unless she needs to.
.
Non-strangers are a different story, I certainly could have contracted covid from any of my family members if they were infected. My wife is a hospital nurse and has repeatedly dealt with seriously ill covid patients. There have also been social contacts with friends that could serve as a vector — some friends of ours are current self-quarantined because they tested positive (she thought it was hay fever, he noticed no symptoms), and I’ve played games with them several times in March and once or twice since then. But I’ve no reason to believe that if I got it, it would be any more serious for me than it was for them. I don’t have anyone vulnerable living in my home, or reliant on me to get the necessity of life. My brother is in that category, living across the street from my parents, and he’s had to make sure he can get what they need *without* coming into close contact with them, for months now.
So what does this have to do with the lockdown? Not much, as far as I can tell. The intention of the lockdown was to spread the cases out, not to eliminate the disease — the “success” of the Northeast appears to be failure to contain causing effective herd immunity. Spreading the cases out means that the risk is spread *indefinitely*. My father has dementia and has already been cut off by his mind from everything he used to care about. My mother has been cut off from personal contact with all the people she cares about. But the only way to avoid that outcome is if the virus had been contained in *China* and never became a pandemic in the first place. And the contrast between New York and Sweden’s curve shows that the road to herd immunity doesn’t lie in lack of governement control, it lies in failure to contain the epidemic.
MikeM
Well… that’s a claim.
As I said: I doubt it’s remotely significant.
Black Lives Matter protests may have slowed overall spread of coronavirus in Denver and other cities, new study finds
https://coloradosun.com/2020/06/30/police-protests-coronavirus-spread/
.
Enjoy, ha ha. As the world struggles to determine the vectors and probabilities of covid spread, there is at least one thing the media and public health experts know for certain, it wasn’t the protests.
.
If asked earlier what an outbreak from protests might look like, they might have said a sharp uptick in numbers especially among young people. I can accept it is hard to untangle the transmission numbers, but I can’t accept that they figured all this out in record time and still don’t know much about other forms of transmission. It’s idiocy of the highest order.
The study does pick up on an unintended consequence — the consequence of large numbers of people gathering together to potentially riot is that a much larger number of people stay home for fear of getting caught up in a riot.
.
However, the conclusions don’t follow from the findings, at least from the information in the article. The opening paragraph says “The protests may have slowed the overall spread of the coronavirus in cities with large demonstrations”. So what metric was used for this? Two things are mentioned:
—
“As the protests built, Friedson said he and his colleagues took note of the rising concerns about virus’ spread. He said they also realized they had the ability to answer that question — using official coronavirus case counts and the anonymous, aggregated cell phone data that has become the gold standard for tracking societal shifts in movement.”
.
Case counts trail infection, of course, and the article notes that infections among young people have risen, reversing an overall declining trend — at a minimum, that would seem to *support* the premise that protests could increase spread. So what evidence for the decrease is there? Cell phone data.
.
“The researchers found that protests correlated with a net increase in overall stay-at-home behavior in cities where they occurred — and the increase was larger in cities that saw more sustained protests or reports of violence.”
.
Sensible. What’s *not* sensible is the conclusion that stay-at-home behavior increasing automatically translates into an increase in “social distancing”, especially when the protests involved large numbers of people not social distancing. Scaring the people who *were* moving about but not getting infected (declining case rate) into staying home completely won’t materially change things — large gatherings where an infector can affect many more people than usual could. And yet the co-author says in the first paragraph “The overall effect for the entire city is more social distancing because people are avoiding the protests.” No, that wasn’t shown. Cellphone mobility can show whether people are staying home more often, but it does not show that they are not socially distancing when away from home — or that they are using proper precautions when staying at home.
.
Sadly, the idea of unintended consequences wasn’t followed through for other possible protest-related effects. We have this revealing quote from a CO DOH spokesperson:
—
“On Monday, a spokesman for the Colorado Department of Public Health and Environment said that, while the state has now seen rising numbers of new cases for two consecutive weeks, “we have not seen any clear association between the protests and an increase in cases.â€
The spokesman, Ian Dickson, said the uptick in infections “may be partly due to some Coloradans changing their behavior — especially socializing in larger groups, sometimes without proper distancing or mask wearing.â€
—
There’s photograph proof that protesters sometimes did not wear masks and consistently didn’t have proper distancing, and I don’t know of any sense in which a protest should not be considered “socializing in larger groups”. But let’s suppose for a moment that the protestors are just a small subset of the “Coloradans changing their behavior.” Do you suppose there’s any chance that they might have done so *because* they saw protestors flouting the rules on gathering and distancing? Is there any chance that the utter absence of protest criticism from media/government officials on *health* grounds might have made them think that social distancing wasn’t so important anymore?
.
I’ll grant the last possibility isn’t the fault of Floyd protestors, who certainly didn’t force the media to abandon the hyperventilation they had previously employed on far less numerous lockdown protestors. But if you want to grant the protestors some civic virtue points for scaring normal people into staying home, you should also ding them some points for convincing normal people that social distancing was less important than virtue signalling, and therefore not important at all.
DeWitt Payne wrote (Comment #187761). July 15th, 2020 at 8:27 am
Frank,
Deaths per million people:
Massachusetts 1,210
Sweden 549
Sweden is the clear winner even though they did a lousy job of protecting older citizens.
DeWitt: Fate dealt Massachusetts and Sweden different hands in this pandemic. If I had a choice, it would be safer to have lived in Sweden. If I lived in Massachusetts, from a safety perspective, I vastly prefer Massachusetts’s response (a 10-fold reduction in cases from peak) to Sweden’s response. Deaths track with infections, so Massachusetts’s death rate has probably dropped a similar amount. As I have said elsewhere, I don’t know what would be “best” for either location, but I’m sure both will act to prevent their hospitals from being overrun with COVID patients (regardless of what is “best”).
Besides, Massachusetts is a cherry-picked state. The death rate in Virginia (230/million) is 1/5 of that of Massachusetts (which is the fourth worst in the US. Sweden is 20-fold bigger than MA. The death rate in the US as a whole is lower and most comparable EU countries are far lower than in Sweden. That is why the Swedish epidemiologist who was most responsible of the decision has expressed public regret.
Massachusetts had 1000 cases a day by April 1, about the earliest time the state’s policies could BEGIN make any difference and Sweden less than half that number. Massachusetts kept imposing stricter regulations until new cases peaked near the end of the month at 2500. Sweden saw only a modest rise in April.
I took a quick look at amount of time it took total cases in Sweden to double in March – roughly a measure of how many Swedes on the average were infected by the average infected Swede before behavior was modified by fear. For the US, I had posted a very robust 2.5 day doubling time for the US as a whole in March (and it may have been worse in hard-hit Massachusetts). The log plot for accumulated Swedish cases vs time didn’t fit a linear relationship nearly as well as the US data did, but the doubling time was 3.8 days for the entire month of March and 5.4 days starting after a 4-fold increase over two days from March 5-7. In other words, R_0 for Swedes under normal March conditions appears to be about half of R_0 for the US. The Swedes may have better public hygiene or less crowded public facilities. (It would be interesting to know if seasonal influenza is less severe in Sweden.)
This information may explain why the Swedish epidemiologists didn’t share the same sense of panic as March unfolded as other epidemiologists. They probably thought they had plenty of time before facing the possibility that their hospitals would be overrun.
In the US, there was a dramatic change in doubling time in early April as our restrictions began to become effective. New cases were falling slightly by mid-April. Since no government restrictions were imposed in late March, no sharp transition occurred in Sweden in early April and the doubling time slowly lengthened until late May. At that point, the data goes crazy, even with seven day averaging. New cases rose to about 1000/day for six week and returned to 500/day over the last two weeks. Those weeks weren’t on Nic’s plot, so I didn’t know until I got the latest data. With this new data, Sweden looks like it is only twice as dangerous today as Massachusetts right now.
Massachusetts suffered badly from limited testing for COVID.
Frank,
“Fate dealt Massachusetts and Sweden different hands in this pandemic.”
.
If we are appealing to fate to explain differences between MA and Sweden, then fate could equally explain differences between Sweden and other places.
.
“Sweden is 20-fold bigger than MA”
.
This is a reference to land area, I presume, since MA has over half the population of Sweden. If persons were evenly spread in both location this would certainly make the population less dense, but in both cases most of the population is located in urban areas (as are the covid hotspots). I’ve only been to Massachusetts once and never been to Sweden so I can’t compare actual density *in* urban areas (includes suburbs), but in general my understanding is that the US is far more spread-out in metropolitan areas than Europe.
.
“Besides, Massachusetts is a cherry-picked state.”
.
Yes, it is. Most US states had less deaths/million than Sweden. But lockdowns were a state-level thing, and the severity of lockdowns was not the same from state to state. The lockdowns were instituted as a way to “flatten the curve”, but in a few NE states the results were exactly the shape we were trying to avoid. Why are we congratulating those states for the results of the lockdown, or assuming that the curve would be dramatically different absent mandatory lockdown?
.
“Massachusetts had 1000 cases a day by April 1, about the earliest time the state’s policies could BEGIN make any difference and Sweden less than half that number. Massachusetts kept imposing stricter regulations until new cases peaked near the end of the month at 2500.”
.
Looking at the timeline in wikipedia, large gatherings were closed at the state level on March 13th, and on the 15th schools were closed along with eating at restaurants and gatherings of 25+. The lockdown (state-level) didn’t happen until the 24th, but why wouldn’t the earlier policies — or voluntarily social distancing, *begin* to make a difference in cases until April 1st? Why were the earliest measures originally slated to end April 7th, if the expectation that it wouldn’t even *begin* to work on new cases until April 1st?
.
And of course, the peak appears to be later than April 1st. Is it only because of “stricter regulations” that the peak was finally reached in late April? Here’s the state’s new restrictions after the stay-at-home order on the 24th important enough to make the wikipedia timeline:
Mar 25th — regulations on groceries and pharmacies, like providing a senior hour and banning reusable bags
Apr 10th — closed some parkways to vehicle traffic and limited parking at some state parks.
May 1st — required facemasks if you can’t be 6 feet apart in public.
.
That’s it. I doubt the role of additional state regulations in reaching a peak, and suspect reaching effective herd immunity was a larger factor. One interesting point on the timeline was this:
.
“On April 9, the Massachusetts Institute of Technology published a preliminary study of sewage samples taken in the Boston area on March 25, in an effort to determine the extent of COVID-19 infections. Based on concentrations of the virus found in the samples, the study suggested that approximately 115,000 of the Boston region’s 2.3 million people were infected. At the time of sampling, Massachusetts had only 646 confirmed cases in the area”
.
So on the date of the lockdown the Boston region was estimated at 5% of the population, yet hospitalizations peaked a *month* later. If there’s anything to their method, it’s hard for me to believe that it was the state-mandated lockdown that made the difference.
.
“I took a quick look at amount of time it took total cases in Sweden to double in March – roughly a measure of how many Swedes on the average were infected by the average infected Swede before behavior was modified by fear.”
.
Are you assuming that an inflection in Sweden’s doubling is solely the result of “behavior was modified by fear”, rather than the natural inflection caused by increasing immunity? Where I live behavior was modified by fear long before the shelter-in-place order. I saw a marginal improvement in social distancing at places still allowed to be open before/after, the massive *behavioral* change came in March.
.
“Massachusetts suffered badly from limited testing for COVID.”
.
I agree, if there had been sufficient testing to know the actual infection rate and the actual death rate from this disease way back in March, the public fear and government policies might have caused less damage to the economy, and more practical protection of those most at risk. But since you’ve been defending lockdowns, I’m guessing that’s not what your thinking. If extended lockdowns were actually the best policy, then limited testing increasing over time would probably give the best chance of producing that.
.
I think the world has suffered badly from not discerning *quickly* exactly how the virus is likely to spread, exactly the best way to avoid transmitting it, and exactly the best way to treat it. The information on this, months later, is still annoyingly vague.
Dale S,
“The information on this, months later, is still annoyingly vague.â€
.
Indeed. And absent that solid information, public policy development in many places has resembled the behavior seen in a disturbed anthill. The guiding principle seems to have often been: “Don’t think, just do something!â€, no matter how stupid.
.
But there is a bit of humor in all the madness: Many of the same public officials who insisted everyone MUST use re-usable grocery bags to save the environment (and more importantly, to virtue signal about those public official’s environmental correctness), suddenly forbade the use of those same environmentally responsible shopping bags. Brings a smile to my face to see one mindless inanity suddenly replaced by another, with justification for neither.
I fail to understand if there has been all this contact tracing going on why there has been no relevant information released from that. Things such as home vs community spread, office spread, etc. could all be gathered.
.
I still maintain “science” and “public health experts” are dropping the ball here. Color me unimpressed, they think they are heroes. What I see is a bunch of moralizing bureaucrats making over confident assertions. 9 months into a global pandemic we have “wear a mask and wash your hands”. The only thing that made “outdoor activities are lower risk” an official statement was to cut out an exception for approved protests.
Tom Scharf,
There may be people who are doing what looks like contact tracing, but I doubt that it’s effective. As I said elsewhere, if the test turnaround time is a week or more, which AFAIK is true most everywhere, you can’t really do effective contact tracing.
What happens in NYC is going to be interesting. I find it unconvincing that NYC has done something special to prevent a second phase of covid hitting, they are way too exposed. If NYC does not see a second wave then there is probably something different going on now compared to previously. Most likely some sort of effective herd immunity. So far NYC and much of the NE is still declining.
.
FL isn’t really doing much to prevent transmission (no lock downs) and seems to be heading toward a peak of 1% to 2% of population verified cases. It’s at about 1% now. That would show a similar path as NY where using a 10x/20x hidden case multiplier would show this virus burning out at 10% to 20%.
Even if you only rooted out 5% to 10% of confirmed transmission paths in contact tracing (both people testing positive) then a lot of useful information could be determined from that. AFAICT nobody is even interested in this question.
Tom wrote: “Most likely some sort of effective herd immunity. So far NYC and much of the NE is still declining.”
.
I am under the impression that a proper second wave supposes some kind of mutation that renders people susceptible again. There is no evidence of this that I am aware of. All we are seeing right now is the results of lock-down: A delayed first wave. Ironically, the only space in the ICU here is in the covid section. They’re getting inundated by all the people who were strangely absent during the main scare.
Tom Scharf (Comment #187829): “I fail to understand if there has been all this contact tracing going on why there has been no relevant information released from that.”
.
Spot on. With widespread infection, the importance of contact tracing is to provide information on how the virus spreads so as to inform policy. The behavior of the powers that be (yes, that includes Fauci) has been shameful.
.
The explanation is that the enacted policies actually have little or nothing to do with stopping or slowing the spread of the Wuhan virus. That has been obvious to me for a long time, but two things ought to prove that to anyone who is not willfully blind: official approval of approved protests and keeping schools closed in total defiance of the science.
Tom Scharf (Comment #187832): “FL isn’t really doing much to prevent transmission (no lock downs) and seems to be heading toward a peak of 1% to 2% of population verified cases. It’s at about 1% now. That would show a similar path as NY where using a 10x/20x hidden case multiplier would show this virus burning out at 10% to 20%.”
.
States in the NE that peaked early had maximum daily new cases with total confirmed cases between 0.5% and 1% of population. Florida is still climbing with total cases approaching 1.5% of population. Louisiana is just under 1.9% and new cases are still climbing. So they really are not on the same path as New York.
.
It may be that the ratio of infected to confirmed cases has dropped with more testing and less colds and allergies.
NYC had its subways open throughout, and people were not wearing masks initially.
Along the lines of a lack of updated information, does anyone know whether a lot of the things we “know” have actually been confirmed?
.
Is the estimate of 2-14 day incubation period still based on the Chinese reports from February?
.
Can the virus live up to three days on surfaces (which has led to people quarantining their mail)?
.
Are there actual scientific studies that quantify the benefits of maintaining a distance or 1 meter (WHO) or 6 foot (CDC) from people, and why do these organizations have different guidelines?
.
And along those lines, CDC defines “close exposure” for emergency personnel as being withing six feet of a person for 15 minutes or greater. Where does that come from?
.
All real questions about things we “know.”
DaveJR,
I don’t know that there is any distinction between a proper 2nd wave and an improper one. As far as I am aware, a 2nd wave is merely going through one pulse of peak/trough and then having things increase to a second peak/trough. These should typically be in the same region.
.
I don’t think we need a mutation to get this. It can be the consequence of having cut the effective R to less than 1 through behavior and subsequently resuming activity before herd immunity was reached. If we don’t get a vaccine the only ways to avoid 2nd waves are either
(1) The whole world getting the virus quenched (which isn’t going to happen.
(2) perpetual vigilance (to keep R 1) in countries that did quench their first wave. (NZ is in this situation until a vaccine arrives. They may be able to succeed.)
(3) Getting to herd immunity associated with behavior is “normal” level for a particular society. This will involve lots of people getting infected at some point– either in a long slow process or in big waves.
We can change “normal” to some degree through things like masks, working remotely and so on. But to some extent, that’s a variation on “perpetual vigilance.”
.
The one way in which what we see in the US is not a second wave is that the US is spread out. So, NY can be said to have gone through one wave. Chicago seems to have done so. But I don’t think we can really say the US as a whole has even passed a first wave.
.
There is some good news on vaccine front. Fingers crossed.
It does not appear we can reopen and keep R < 1. This sucks, and leaves the solution set to bad and worse.
.
Vaccines or virus burn out are the prevailing options right now. We might end up with vaccines available when they are no longer needed.
You don’t have to look very far for stories like this anymore, this is just a sign post for how absurd this has become today.
https://www.kqed.org/arts/13883305/sfmoma-senior-curator-gary-garrels-resigns-after-reverse-discrimination-comments
.
Museum curator rejects call to ban white male artists with the predictable outcome from Team Equity and Tolerance.
Tom Scharf (Comment #187840): “It does not appear we can reopen and keep R < 1."
.
There is really no evidence that we can keep R < 1 by closing down.
The Swedes got it right. The virus will do what the virus will do, so take just the least damaging measures needed to keep it from getting out of hand.
———
John M (Comment #187838),
There seems to be no really sound basis for the things claimed to be known.
Tom Scharf,
“We might end up with vaccines available when they are no longer needed.”
.
In many places that will likely be true. Of course, a vaccine would still be helpful for the elderly who have not contracted the virus, even if that is only a smallish fraction of the population by the time a vaccine is broadly available. They will also be useful in countries like New Zealand with populations that have not been exposed to the virus.
Tom/Steve
It depends on how you define “need”. Currently, we need it to avoid uncontrolled growth in places. NY was bad. FL is not as bad (yet) but still, we would want a vaccine to prevent that. But even if the disease is just endemic, I don’t want to get the disease. I would certainly want to get the vaccine myself.
.
I imagine a fair number of people will want it. We might not need to try to get “everyone” vaccinated. But if 20% of people get the vaccine that would cut nicely into possible outbreaks.
.
Honestly, as a society we “need” it for school teachers whether or not transmission in school is realistic. I read the /teacher thread on reddit, and newspapers. Teachers all going to yap about risking their lives until they can get a vaccine. Heck, even the subset of teachers who will ultimately refuse the vaccinne will yap– until the vaccinne is available. 🙂 (Honestly, I sympathize given the general uncertainty of everything. )
.
College students need it too. Getting sick during the semester is dang inconvenient.
lucia (Comment #187845): “Teachers all going to yap about risking their lives until they can get a vaccine.”
.
A lot of that is politically motivated. And probably a lot is motivated by wanting to get paid without doing any work.
.
Are any essential workers allowed to opt out of working and still get paid? Real question. Because as essential workers go, teachers are at really low risk. At least compared to police, EMTs, doctors, nurses, bus drivers, checkout clerks and no doubt many more.
.
LA teachers have really given away the game by saying they won’t go back to work until the police are defunded, there is a national single payer health system, and so on.
Dale S: Thanks for the reply. Some people seem to think we can effectively isolate the vulnerable people in our society while the epidemic rages among people who are unlikely to die until we reach herd immunity. I was trying to explain why this isn’t really practical (though risk can be minimized). Where communities are struggling with COVID (like Sweden and MA), on the order of 0.1% of the people are infectious at any time. (100 new cases/day/million * 10 day infectious period.) Anyone who goes out into the pandemic – not just my MIL – for 100 days and has 10 risky contacts/day will have an average of one risky contact with an infected person. Many people have such contacts which is why the pandemic is still raging, but we aren’t building up herd immunity very fast when only 0.1% are becoming immune at any time. My MIL, wife, and I can and have minimized our contacts, but when my son needs to return to work (rather than work from home), he will be out in that environment, and a far worse environment if he rides the Metro. When everyone returns to work, driving will be impractical. He can asymptomatically bring COVID home to us and then to his Grandmother. The same problem exists for the people who work in nursing homes – the rest of their family is living in the midst of the pandemic. With a total of about one staff member per resident, it will take near daily testing of staff to ensure complete safety. That is what the NFL player’s association is demanding to return to work.)
I dream about sending all college students and other young unemployed people who will volunteer to isolated resort islands with free crowded room and board for the summer to party. They could return mostly immune in the fall with little risk, quarantine for two weeks, and have decent chance of not increasing the risk to staff and their families, and then the local community (which may shut them down).
The 1918 pandemic occurred in three waves in most locations. Victims of the second wave were immune to the third wave, so the second wave wasn’t ended by herd immunity. (IIRC, the first wave wasn’t as deadly and may not have proved immunity to later waves.) These papers studied the effect of government interventions in that pandemic (which appears less easily transmitted than COVID and therefore easier to contain).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226987/
https://www.pnas.org/content/104/18/7582/tab-figures-data
The paper below considers the cost benefit of government interventions and explains how fear alone can modify pandemics. (The 1918 pandemic killed an unusually large number of healthy people from 20-45 years old, presumably because of cytokine storms, and possibly some immunity in those over 45 who had been exposed to similar strain when younger.
https://link.springer.com/article/10.1186/1471-2458-12-679
“Depending on the characteristics of the epidemic and on the relative economic importance of making contacts versus avoiding infection, the optimal control is one of two extremes: either to adopt a highly cautious [effective] control, thereby suppressing the epidemic quickly by drastically reducing contacts as soon as disease is detected; or else to forego control and allow the epidemic to run its course. The worst outcome arises when control is attempted, but not cautiously [stringently] enough to cause the epidemic to be suppressed. The next main result comes from comparing the size of the neighbourhood of which individuals are aware [fear] to that of the neighbourhood within which transmission can occur. The control works best when these sizes match and is particularly ineffective when the awareness neighbourhood is smaller than the infection neighbourhood. The results are robust with respect to inclusion of long-range, small-world links which destroy the spatial structure, regardless of whether individuals can or cannot control them. However, addition of many non-local links eventually makes control ineffective.â€
Unfortunately, suppressing pandemics just enough to prevent overcrowded hospitals probably produces a worst-case scenario.
Frank,
“Some people seem to think we can effectively isolate the vulnerable people in our society while the epidemic rages among people who are unlikely to die until we reach herd immunity. I was trying to explain why this isn’t really practical (though risk can be minimized). Where communities are struggling with COVID (like Sweden and MA), on the order of 0.1% of the people are infectious at any time. (100 new cases/day/million * 10 day infectious period.) Anyone who goes out into the pandemic – not just my MIL – for 100 days and has 10 risky contacts/day will have an average of one risky contact with an infected person.”
.
Effectively isolating the vulnerable people in our society will certainly not be easy. It’s a hard problem, and likely an expensive one. But it’s not impossible, and it has to start with the idea that the vulnerable (like your MIL) should not be included *at all* in “anyone who goes out into the pandemic”. We don’t know nearly enough about the virus, despite the months we’ve had to study it, but we’ve known from the very beginning that the risk of death is wildly unbalanced. Any calculations based on the idea that a 90+ person is having ten random contacts per day in circumstances that present actual risk of infection imply a radically reckless strategy.
.
But what happens when you, or your wife, or your son — not part of a vulnerable group — becomes infected? Couldn’t you infect your MIL without even knowing it? Of course! YOU are the likely infection vector, not some random asymptomic person who is within six feet of your MIL for seconds out in public. You have two choices if you want to keep your MIL safe:
1) Assume that you *are* infected and never put yourself in a situation where you as an infected person could infect your MIL.
2) Treat yourself as one of the vulnerable and *completely* isolate from the wider world for the duration, so you can do for her what she can’t do for herself.
.
What’s needed for either strategy is the *best possible* information about how the virus *actually* spreads, and this has been notoriously lacking. It doesn’t really matter if the proportion of General Public that has it is 0.1% (your estimate based on 100 cases new day, as if the *reported* new cases per day actually ever was a good estimate of the *actual* new cases per day) or 10%, either way the genie is out of the bottle and you have to supress transmission paths. Not “minimize contacts” with people who *think* they haven’t been affected. Eliminate them. It’s *not* possible to do a hard lockdown of everybody, but it should be possible to do a hard lockdown of a fraction of the population. Where Sweden — and New York — failed isn’t so much in what happened to general population but on how well they protected the nursing homes.
.
My mother wasn’t having ten risky contacts per day during the lockdown. She was having *zero*. Her son and several grandkids lived right across the street and she wasn’t coming in personal contact with *any* of them. For months. Of course, she’s still capable enough to care for herself and my Dad, and that’s not true of a lot of elderly. What happens when you can’t isolate them completely?
.
1) You do the best you can to reduce the risk. This *requires* both vigilance about caregivers, *and* the best possible information about how to make contacts *with* infected people as safe as possible.
2) People will die. This isn’t avoidable; policies have to be based on trying to achieve the best possible outcome of the unpleasant range available, a public goal of preventing the epidemic completely requires a sealed population, which most nations and communities cannot achieve.
.
I’m surprised that your MIL is having ten contacts per day, but if your goal is to protect her I’m even more surprised at this:
.
“My MIL, wife, and I can and have minimized our contacts, but when my son needs to return to work (rather than work from home), he will be out in that environment, and a far worse environment if he rides the Metro. When everyone returns to work, driving will be impractical. He can asymptomatically bring COVID home to us and then to his Grandmother.”
.
Impractical? Good lord man, if it’s *necessary* that there be a transmission path between your son and your MIL, who cares if it’s “impractical” to drive? If it’s *possible* to drive and reduce infection risk that way, that should be the strategy, let those who don’t have contacts with vulnerable population expose themselves to additional contacts.
.
But there’s additional questions that arise — if your son can work from home *now*, why would he *have* to work in an office environment later? As a caregiver for a vulnerable member, why can’t he work remotely indefinitely? Where does he work that Metro is “far worse” as an infection risk? In NYC, transit workers had a *lower* disease rate than those sheltering at home. And if it’s necessary that you make potentially infectious contacts with your MIL, can’t you stop making potentially infectious contacts with your son? This is where *detailed* information about transmission risks would be especially useful.
.
“The same problem exists for the people who work in nursing homes – the rest of their family is living in the midst of the pandemic. With a total of about one staff member per resident, it will take near daily testing of staff to ensure complete safety.”
.
1:1 seems unusually high, though the ratio is heavily dependent on the level of care needed/provided. Not all staff have equal contact, of course; a nurse is much more likely to transmit than an administrator.
.
If it takes “near daily testing” to ensure complete safety, do it — but I don’t think near daily testing does ensure *complete* safety, unless the tests have no false negatives during infectious stage and can be processed immediately. I do think that testing nursing home personnel may be a better use of limited testing capacity than testing 20-something hospital admissions who have no symptoms, just in case.
.
Checking for fever daily can be done cheaply and easily. But if you can spread without fever, if you have external staff in close contact with patients, you have to assume staff *will* be infected and act accordingly. You also have to assume residents can get it and do what you can to minimize transmissions between patients.
.
You can also do what you can to break the chain between close-contact workers and the outside world. Pay a premium to get workers who can stay on-site for the duration of the crisis. This would be very expensive, but arguably much much cheaper than paying *everyone* to shelter at home. This would certainly result in a lower staff: patient ratio which has its own health risks, but that’s true of *any* anti-epidemic measures — they all have costs as well as benefits, and the policy has to be based on the *total* net cost, not just deaths specifically from (or with) Covid.
.
“Unfortunately, suppressing pandemics just enough to prevent overcrowded hospitals probably produces a worst-case scenario.”
.
This was the *actual goal* of the mandatory shelter-in-place orders when recommended in March, remember? I thought you were a fan of those.
Given the discussion of herd immunity, I decided to make plots of new cases vs, cumulative cases. With a simple SIR model, the maximum would occur when cumulative cases are at the herd immunity level. I posted them on IMGUR, if anyone is interested.
https://imgur.com/gallery/SBLakve
There are 17 graphs with three states shown on each, sorted in order of percentage of cumulative cases. They ended up in reverse order, so Hawaii is on the first one and New York on the last.
It looks to me like the states that got to 0.5-1.0% early have had strong decreases, although a few (IL, MD) have started to climb again. But states reaching 1% and up more recently are still climbing, as are most states that are still below 1% cumulative cases. That includes some states (ID, MT, OR, WA) that had been doing really well.
No conclusion; I don’t know what it means.
Frank, There are creative solutions for these problems. Nursing homes could pay for staff to live at the home for a month at a time. They might have to pay extra but it is feasible. In schools pay college students to proctor classrooms while older teachers Skype in to do the teaching. Multi-generation households are more difficult, but creative people can come up with measures that would work I think. Eat dinner in shifts rather than everyone at the same table.
But the bottom line is that nothing we do will prevent all deaths or stamp out this virus. What we can hope for is fatalities that are less than 10% of expected mortality on an annual basis. That’s 300K fatalities in the first year, but most of those will be people with limited life expectancy.
Countries in East Asia have had good success in controlling the Wuhan virus compared with countries in Europe and the Americas. It turns out that the Italian strain of the virus, that came here via New York City, is much more infectious than the original Wuhan strain.
https://www.biospace.com/article/mutated-covid-19-viral-strain-in-us-and-europe-much-more-contagious/
So it might not be public health policy that has made the difference.
Mike M,
Interesting article. The part about surface protein receptors for the virus in the testicles makes me cringe a bit. 😉
.
With regard to your plots: I think there are too many factors which confuse the trends and make matching with a simple model impossible: changes in testing frequency over time, changes in Reff due to social behaviors, changes in the age profile of cases over time, a range of susceptibility in the population, and maybe other factors.
MikeM,
I’d read that before. Might be a factor; might not be.
.
It’s plausible a more infective strain would overtake a less infective strain. It would be subject to positive selection pressure and fairly quickly. Whether it happened…. dunno.
.
Mike M,
I think given the increase in testing capacity (and the changes in directives on how to count cases), we can safely assume that cases reported early are a smaller fraction of the real case rate than cases reported late.
SteveF (Comment #187854): ” I think there are too many factors which confuse the trends and make matching with a simple model impossible”.
.
For sure. But *if* the declines in places like NY were due to herd immunity, then it should not be possible for other states to get much beyond that level without having declines. So maybe it was not herd immunity and NY etc. are still vulnerable to a second wave. Or, as Dale S (Comment #187857) suggests, maybe we are now detecting a significantly increased fraction of infections. If the experts were on the ball, we would have the serology results to assess that.
———-
lucia (Comment #187856): “I’d read that before.”
.
I think the study linked in Comment #187852 is a new result. It has been known that the Italian strain has become dominant and it has been speculated that was because it is more infectious. But now there is evidence that it is in fact more infectious.
Dale S (Comment #187857): “I think given the increase in testing capacity (and the changes in directives on how to count cases), we can safely assume that cases reported early are a smaller fraction of the real case rate than cases reported late.”
.
Testing capacity makes it possible to detect a larger fraction of cases, but it does not ensure that. If the increase were only due to increased capacity, then the positive rate should be dropping, or at least steady. But the positive rate is going up. So something else must be going on.
.
Distinctive symptoms would produce both a high positive test rate and a high efficiency in detecting infections. So maybe the symptoms have become more distinctive. The symptoms for the Wuhan virus are basically cold/flu/allergy symptoms. Those are more distinctive in June and July than in April and May.
Mike M. (Comment #187859)
July 18th, 2020 at 7:53 am
“But the positive rate is going up. So something else must be going on.”
Early on, because of the lack of testing available, the standard instructions for people with symptoms was to stay home and quarantine unless they experienced severe symptoms (e.g. difficulty breathing.) At least in some cases, the increased positives testing rates are because more and more people with mild or even no symptoms are testing positive.
As the sport leagues ramp up, we’re seeing this. I recall something like 30 LSU players tested positive as the team did routine testing. I doubt any of them were seriously ill.
.
Also, in NASCAR, Jimmy Johnson tested positive and was asymptomatic. In less that a week, he had two negative tests.
.
No doubt the same is happening in the rest of society. Hospitals are doing routine testing of anyone being admitted for “elective” procedures. It seems a reasonable assumption that any of these testing positive are also asymptomatic or with very mild symptoms. Who would show up for an elective procedure with severe flu-like symptoms? (OK, rhetorical question.).
.
Without better data on severity of illness in those testing positive, I would hesitate to conclude that it’s the disease that has changed.
The % positive rate went down this week in FL. Keep your fingers crossed this continues:
Mike M,
“Testing capacity makes it possible to detect a larger fraction of cases, but it does not ensure that. If the increase were only due to increased capacity, then the positive rate should be dropping, or at least steady. But the positive rate is going up. So something else must be going on.”
.
Agree completely — a positive rate increasing must mean that the epidemic is getting worse, as long as the tests themselves and definitions remain the same. It’s highly unlikely to me that expanding testing would bring in a group of testees that are more likely to be positive than the smaller group tested earlier.
.
However, if we’re not just looking at the trend of positive rates but using the number of “cumulative cases” as a percentage of population, I don’t think 1% in New York in April is remotely comparable to 1% in Texas or Florida now. Hospitalizations or Deaths per million would be a comp much more likely to be comparable, though even there the with-covid and for-covid rears its head — elective surgeries are going to result in a substantial bump of with-covid hospitalization patients.
.
I don’t know why it would’ve been so difficult to try to track *both* with-covid and of-covid. Both numbers would be of interest.
DaleS
I doubt it. People who get a positive on their covid test will not be scheduled for their elective surgery. It will be postponed.
.
That’s the whole purpose of the covid test.
.
Non elective things won’t be rescheduled. You really can’t tell a woman in labor to wait two weeks until after she’s recovered from Covid. But my mom’s having a covid test on Tuesday in anticipation of cataract surgery. If she comes out positive, they’ll defer the cataract surgery. This is a no brainer.
So if masks prevent transmission, how come Japan is showing a ‘second’ wave? If any country should demonstrate the effectiveness of masks, I would have thought it would have been Japan. Israel is also not looking so good. The death rates in Japan and Israel so far are lower than in the first peak. I suspect a substantial part of that is improved treatment. Statins, for example, seem to reduce severe lung infections.
Our county executive has mandated mask wearing and I’m seeing a lot more masks on people. It will be interesting to see if that actually has an effect on the rate of new infections. I’m thinking it won’t, but we’ll see.
Dale S (Comment #187864): “Hospitalizations or Deaths per million would be a comp much more likely to be comparable”.
.
We only have actual hospitalization numbers for a small, non-random portion of hospitals. So I doubt they would be much good. You can find hospitalization numbers for states at both the IHME and CDC web sites, but they are wildly different and appear to be from models.
.
There are two big problems with deaths. Deaths are essentially a measure of how poorly a state has done at keeping the virus out of nursing homes. Also, treatment appears to have improved quite a bit.
MikeM
That doesn’t make it a poor measure of quantifying the severity of the outbreak in a state! Sure: NY was really bad because Cuomo screwed the pooch and put Covid carriers in nursing homes. That sadly ill advised decision caused the outbreak to be worse in NY and is reflected in the death data. IOW: The death data correctly reflects the severity of the outbreak in NY. Other information might be required to understand why it was so bad. But that doesn’t make the death rate flawed.
Good. That makes me happy to semi-isolate, stay out of indoor restaurant and bars and wear a mask even if it only means I get Covid in December rather than last March when I would have died. 🙂
Lucia,
“Non elective things won’t be rescheduled. You really can’t tell a woman in labor to wait two weeks until after she’s recovered from Covid. But my mom’s having a covid test on Tuesday in anticipation of cataract surgery. If she comes out positive, they’ll defer the cataract surgery. This is a no brainer.”
.
Fair enough. And yet, I believe every Covid patient my wife has cared for in the last two months has been hospitalized for elective surgery. My view is distorted by my window on the medical world just being through cardiac nurse rantings. My wife specifically is on intermediate care for cardiac patients, which is typically pre-operative patients for those who can/will receive operations. Here’s how the typical sequence of events goes:
.
1) Patient has distress that sends them to hospital. This can be an obvious emergency, like a heart attack that is immediately life-threatening. But it can also been something like chest pains or shortness of breath that causes the patient to go to their physician, urgent care, or ER, and eventually they get diagnosed with a heart problem that causes them to need an operation.
.
2) These operations form two types, “elective” and “non-elective” (for the purpose of Covid laws) — non elective ones that have to be done NOW, or the patients will die in the immediate future. These are non-elective surgeries, and under the lockdown still occurred — though at a *noticeably* lower rate, because people experiencing non-dramatic symptoms were avoiding the presumably covid-infested hospital. My wife’s seen a number of them come in since the lockdown ended, in some cases not pre-operative, but pre-hospice. Their problems are no longer fixable because of the delay.
.
“Non-elective” are surgeries to try to improve their odds of surviving the next time bad thing X happened. Since there’s no guarantee that bad thing X will happen in (say) the next two months, these sort of surgeries did not happen during the lockdown, but they do have a non-zero chance of causing the patient to die before its down. But these are also the sort of surgeries that the walk-in-to-ER cardiac types have. Under normal conditions, they get hospitalized right away and their surgery scheduled. Under *current* conditions, they get hospitalized right away, tested, and then get upset when they can’t have surgery because they unknowingly had covid. These *are* hospitalizations with covid, but not because of covid, and during lockdown would not have been hospitalized at all.
.
Now that’s just cardiac, and I have no idea how common this sort of thing is for other specialties. For quality-of-life operations or childbirth, probably not at all. Cancer biopsies are an obvious example of something that can be both non-elective and yet time sensitive, but I have no idea how fuzzy the line is for them or how often they hospitalize immediately for something that *could* be done later. In truth, it’s quite possible that even for cardiac my wife’s hospital is not typical of other hospitals nationwide; cardiac is their profit center, so they have the facilities and personnel availability to get “elective” surgeries done very quickly.
Dale S (Comment #187873)” ” Their problems are no longer fixable because of the delay.”
Indeed. My local paper has reported that two Albuquerque area hospitals now have full ICUs and are into surge capacity. But the main cause is not coronavirus patients; it is people who did not get timely care and are now in really bad shape.
lucia (Comment #187872): “That doesn’t make it a poor measure of quantifying the severity of the outbreak in a state!”
.
Yes, but it does make it a poor measure for quantifying the spread of the virus.
Mike M. (Comment #187852) July 17th, 2020 at 9:37 pm “Countries in East Asia have had good success in controlling the Wuhan virus compared with countries in Europe and the Americas. It turns out that the Italian strain of the virus, that came here via New York City, is much more infectious than the original Wuhan strain.”
That depends on how you define “much more infectious”. Assuming 1 week between a person being infected and passing the virus on to a second person, there have been about 25 transmission chains since these strains diverged. If the new strain were 10% more transmissible than the old, there would be 11-fold more cases of the new strain. If the new strain were 3% more transmissible than the old strain, the new strain would dominate by 2:1. I don’t know the exact numbers today, but the differences in transmissibility are small.
If the new strain were twice as transmissible, there would be, in theory, 33 million times as many cases from the new strain as the old by now. Survival of the fittest at work.
MikeM,
No. It’s not perfect, but it’s still a pretty good measure.
.
We have no perfect single measure especially if we want to compare number taken many months apart. With work and more detailed data, we can adjust death’s by age bins or other factors. But “number of cases detected” detected in March when tests were barely available vs. “number of cases ” now when tests are widely available doesn’t work. Hospitalization doesn’t work. ICU might not be too bad.
.
We haven’t made sufficient in roads on treatment for death’s to be worse than other metrics. Other than perhaps adjusting for age, deaths is likely still the best single metric.
Lucia,
“Other than perhaps adjusting for age, deaths is likely still the best single metric.“
.
Deaths versus age is probably the single best measure of how different states (and countries) are doing. I mean, the same number of deaths in two places, with the average age in one place substantially lower than the other means that the place with the lower average age at death is doing better isolating the most vulnerable, and almost certainly is far closer to reaching effective herd immunity. A state that does ‘the Cuomo pooch thing’ has much higher average age at death.
It is well-known that viral RNA can be detected by PCR amplification in some patients long after they are no longer infectious. For a positive PCR result, one needs only a fragment of intact RNA (probably about several hundred bases long). Infection requires that millions copies of the entire 30,000 base RNA genome be intact and exhaled by a patient.
South Korea has identified a number of recovered and presumably immune individuals with newly-positive PCR tests, but reported zero chains of transmission beginning with such individuals. If I understand correctly, they are apparently convinced that such patients are non-infectious and immune to COVID (but possibly suffering from some other illness). So the detection of viral RNA does not equate to “infectious”.
The CDC finds it preferable for “essential health care workers” to return to work after COVID without being tested by PCR if it has been 10 days since symptoms first appeared, one day without fever (without fever lowing meds), and no symptoms. (Similar criteria are applied to people who quarantine, except an additional four days are added for the time it normally takes symptoms to appear.)
“A test-based strategy is no longer recommended (except as noted below) because, in the majority of cases, it results in excluding from work HCP who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.”
https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
For this reason, the stories that NY dumped infectious patients into nursing homes and started outbreaks could be wrong if those stories are based on PCR tests or coincidental timing. There could be sequencing data that proves whether an outbreak started with a particular transferred patient or not. Without such data, the evidence is ambiguous (IMO). Nursing home operators seeking to avoid lawsuits want to blame the state, the state wants to blame the operators, and ambulance-chasers and politicians want to inflame the problem for their personal benefit. It could make sense to withhold judgment until a trial, and conclude that it was all hot air if a trial is never held.
Where I live, every place that does COVID testing for individuals requires that you have symptoms recognized by the CDC, but there are two groups: “high priority” and “higher priority”. Symptoms alone don’t make one high priority. On June 14, the CDC expanded the list of symptoms that qualified you for testing, but it isn’t clear that testers are paying any attention to the additional ways to meet the CDC criteria. The CDC is perfectly happy with people with obvious symptoms of COVID and no other serious health problems remaining at home and not getting tested. So as the number of tests has slowly risen (perhaps 20% per month recently), I assume there are still plenty of people who would like to get tested or have good reasons for being tested.
Frank,
“For this reason, the stories that NY dumped infectious patients into nursing homes and started outbreaks could be wrong if those stories are based on PCR tests or coincidental timing. There could be sequencing data that proves whether an outbreak started with a particular transferred patient or not. Without such data, the evidence is ambiguous (IMO). Nursing home operators seeking to avoid lawsuits want to blame the state, the state wants to blame the operators, and ambulance-chasers and politicians want to inflame the problem for their personal benefit. It could make sense to withhold judgment until a trial, and conclude that it was all hot air if a trial is never held.”
.
Alternately, we could recognize that because of sovereign immunity, no one associated with the State of New York will *ever* go on trial for the nursing home order, no matter how badly it worked out.
.
Of course, they have produced a report absolving themselves of blame, though I’m not seeing a link from the NY Department of Health to the gory details. Here’s some interesting points:
.
“A causal link between the admission policy and infections/fatalities would be supported through a direct link in timing between the two, meaning that if admission of patients into nursing homes caused infection — and by extension mortality — the time interval between the admission and mortality curves would be consistent with the expected interval between infection and death. However, the peak date COVID-positive residents entered nursing homes occurred on April 14, 2020, a weekafterpeak mortality in New York’s nursing homes occurred on April 8, 2020. If admissions were driving fatalities, the order of the peak fatalities and peak admissions would have been reversed.”
.
That’s bulletproof logic if we expect mortality to be a linear effect of positive admissions. Why would we expect that in an epidemic? Once a closed population has been exposed and ravaged by a population, introducing new infectious patients will have the *least* effect — that’s what herd immunity is all about. If you want to disprove known-positive admissions as an infection route, you have to look at the *earliest* admissions, not the peak admissions.
.
“NYSDOH further analyzed the period of time patients stayed in hospitals prior to admission to nursing home facilities. Preliminary data show that residents were admitted to nursing homes a median of 9 days after hospital admission. Health experts believe that individuals infected with the virus are most infectious 2 days before symptoms appear and that they are likely no longer infectious 9 days after symptom onset – thus, by the time these patients were admitted to a nursing home after their hospital stay, they were no longer contagious.[3]”
.
So health experts say that patients are *likely* no longer infectious 9 days after onset, and that’s sufficient to say that because the *median* stay was 9 days, “they” were no longer contagious? What about the half of patients on the shorter side of the median stay? And exactly how “likely” is that “likely”? I was curious about the length of stay normally and found a lower figure for ICU patients at 12 NY hospitals:
.
“Length of stay was a median of 4 days, though 2.2% of patients were readmitted during the study period, with a median time to readmission of 3 days. The authors noted that readmission rates for patients discharged to a facility, such as a nursing home or rehabilitation center, increased for progressively older age groups versus patients discharged home.”
.
Here’s the part of the report that shifts blame to the healthcare workers:
.
“According to data submitted by nursing homes, in many cases under the penalty of perjury, approximately 37,500 nursing home staff members — one in four of the state’s approximately 158,000 nursing home workers — were infected with COVID-19 between March and early June 2020. Of the 37,500 nursing home staff infected, nearly 7,000 of them were working in facilities in the month of March; during the same period, more than a third of the state’s nursing home facilities had residents ill with the virus. Roughly 20,000 infected nursing home workers were known to be COVID-positive by the end of the month of April. These workforce infections are reflective of the larger geographic impact of the virus’s presence across the state.”
.
“NYSDOH further analyzed the timing of the COVID-positive staff infections and the timing of nursing home deaths. Based on published data, the average length of time between COVID-19 infections to death is between 18-25 days.[1] Therefore, the link between the timing of staff infection and nursing home mortality is supported by the fact that the peak number of nursing home staff reported COVID-19 symptoms on March 16, 2020 — 23 days prior to the date of the peak nursing home fatalities, which occurred on April 8, 2020. It is likely that thousands of employees who were infected in mid-March transmitted the virus unknowingly — through no fault of their own — while working, which then led to resident infection.”
.
Case closed! But I’m curious — we’re told that *7000* infected workers were in homes in March, *20000* were known to be infected by end of April, and *37500* through early June. That means 7000 in March and 13000 in April, then another 17500 in May through early June. Yet the peak of “nursing home staff reporting symptoms” is on *March 16th*? How is that possible, given the numbers involved?
.
The scale is also interesting. One in four of the nursing home workers is diagnosed as having it, and not because they caught it in nursing homes — they are unknowing carriers infected outside in bringing it in, there’s no reason to suppose their rate would be higher than general population, and given their field you’d think they’d be much *less* likely to catch something circulating in the wild than general population. But 25% in the state — not just NYC, the whole state — are believed to have it. What does that say about actual rates in NYC? And does general population symptoms really peak anywhere near March 16th?
.
A look at the full report clears that question up, at least. March 16th is the peak for nursing homes reporting their *first* symptomatic staff number — and if symptomatic, that staff worker should not be working. Using the 18-25 range from infection to death, noting the 23 day range between the *first* worker being symptom and the peak of death, obviously the peak number of nursing home deaths were infected by that first worker while still asymptomatic. And it’s all the CDC’s fault for not telling us that asymptomatic people could be contagious or giving us the means to test workers to see if they’re asymptomatic.
.
That last sentence isn’t my summation, it’s paraphrasing the actual report. They’re less interested in shifting blame to nursing home workers than they are in blaming the administration. Certainly the CDC *did* have a hand in mucking up the initial testing and deserves to be blamed for it. But to my knowledge, no nation *anywhere* can test workers instantly for asymptomatic covid, so that seems an unreasonable expectation for the Feds to provide. And the idea that learning asymptomatic could transmit as some sort of revelation that the CDC should have warned them about seems unreasonable to me — that was *widely* publicized and was supposed to be the very thing that required quarantining healthy people! There were — and are — questions about *how* dangerous asymptomatic people are, but that they could spread it was never in question. I think they’re also framing the CDC guidance unfairly. See if I’m being unfair:
.
“Moreover, CDC also issued guidance on March 7, 2020 that stated certain asymptomatic healthcare personnel exposed to others with the virus were “not restricted from work.â€13 This early, and ultimately erroneous, understanding of viral spread allowed many nursing home COVID-positive employees to continue working. It was not until much later, as the true number of asymptomatic cases became clear, that evidence based upon contact tracing established definitively that asymptomatic people were in fact capable of spreading the virus.”
.
Footnote 13 is “Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)”. This is not about “asymptomatic health workers”, it’s specifically about health workers who had been *exposed* to *patients* known to be covid-19 positive. Since the DOH is intent on pinning the covid deaths on health workers *importing* covid unknowingly, having had health workers who didn’t know they were sick catch it from general population who didn’t know they were sick, I don’t see *any* relevance to guidance that would only apply if the workers in question were dealing with *nursing home residents who were infected*.
Frank,
You can definitely get tested without symptoms in Illinois. There’s a ballroom dance studios giving group lessons. The students taking it lessons are required to have taken a Covid test, and the owner or the studio is telling them sites where you can have the test even if you have no symptoms.
.
I don’t know where you live and I’m perfectly willing to believe your reports on the conditions there. We can get tested every day if we feel like it.
Lucia,
Sounds like some people are dying to dance. 😉
SteveF,
I’m sure hat some people are willing to risk death to dance. The same probably goes for all hobbies. Pretty obviously, ballroom dance socials have potential for being super-spreader events in a way golf with your foursome is not.
.
I would love to be able to go out dancing at socials. I absolutely know it would be a terrible decision. All those lovely social people who like to dance every night at every possible bar, social and so on…. oh…. no… not going to go.
Lucia,
“ I’m sure hat some people are willing to risk death to dance. The same probably goes for all hobbies.â€
.
The same goes for everybody and every activity, social or commercial: Even getting it the car has risk of death. Walking along the street, flying in an airplane, etc. all risk death… heck being 20 lbs overweight, or drinking wine do too. The question is always the perception of risk and tolerance of risk. What I think the covid pandemic shows is that the tolerance for risk in most developed countries is very low on average… far lower than 50 years ago. I suspect that is at least in part due to a dearth of accurate information about the true risk of covid, especially early in the pandemic, and the willful exaggeration of risk by much of the MSM, which continues.
SteveF,
I’m also sure some of the people who will risk death to dance don’t understand the elevated risk of dancing. Also: some people just align their perception of risk to their personal (or sometimes policy) preferences.
.
Like some dancers who underestimate the risk of dancing, there are likely are others who over estimate which things are elevated risk. So for example: I bet lots of people see golfing in a foursome as equally risky as social dancing! Lots of people are focusing on the cleanliness of bathrooms, or thinking we could keep things safe by passing people through a disinfecting sprayer at the front of a store when the real danger lurks inside not outside the infected.
Sacrilege! Golf reduces covid cases, an avid golfer has a theory somewhere, not peer reviewed yet.
.
For golf people are no longer allowed to share carts, the ball washers are disabled, no rakes in sand traps, you don’t remove the pin for putting, no public water containers, and a few other minor things. You can get close together, especially on the tees waiting for the fairway to clear if you are talking which is common. Putting on the greens are also a gathering area but not so much as tees. Everything else is spread apart and outdoors.
.
I stay fairly far away from people on the tees, and I also pretty religiously note the wind direction and keep my position accordingly (noting wind you do in golf anyway).
.
This is just lowering risk, not eliminating it. People do have to assess the risk/reward here. I see some groups getting very close (all of them > 60 years old) and also see some of these groups hanging out after golf for drinks in what I consider a risky situation. The highest risk situation is actually going into the pro shop and paying (why do they make me touch that credit card machine?). It’s mandatory masks indoors now in my area.
.
Contactless dancing outside would perhaps be viable with low risk, but I’m not sure if that defeats the purpose of the whole endeavor.
Anthony Fauci on the correct way to handle the Wuhan virus:
https://www.foxnews.com/politics/anthony-fauci-praises-new-york-coronavirus-response
Idiot.
And in other news, two women have been arrested for dumping paint on DeBlasio’s BML mural.
Racists.
Oh, wait a minute:
https://a57.foxnews.com/static.foxnews.com/foxnews.com/content/uploads/2020/07/1862/1048/blm-mural-nyc2.jpg?ve=1&tl=1
Tom Scharf,
I wouldn’t worry about touching the credit card machine. You can always carry your hand sanitizer and use that after touching it. It’s the air in the pro shop or the cashier’s breath you potentially need to worry about.
.
Sounds like the cashier is wearing a mask. I bet the traffic in the pro-shop is pretty light now. But yes, that’s probably the highest risk aspect you are experiencing in golf. People who go to the bar after… the risk is being in the bar.
.
There are people doing contactless dance lessons. You can get some benefit from some exercises dancing on your own. We achieved a fair amount of that benefit with zoom lessons. But there is a limit. The ballroom dance is pair dancing, and the best technique requires connection between the dancers. Ideally, you feel push or pull for the lead to communicate steps to the follow.
.
There are some moves that simply require a pair and can’t entirely be mimicked contactless.
.
My lessons have contact. I don’t know if all students are doing that.
Mike M,
“Anthony Fauci on the correct way to handle the Wuhan virus:”
.
I think Fauci is just a very typical liberal New Yorker. I don’t think he is an idiot. I do think he is unwilling to publicly discuss data which would lead to public policies which conflict with his political inclinations. He appears to have concluded that neither New York City nor any of the other places with very low infection rates are anywhere near effective herd immunity. I think Sweden clearly shows he is mistaken, but political inclinations do strange things to rational thinking. Fauci wants the stringent restrictions on public behavior to continue indefinitely; I do not expect that will ever change.
.
Of course, it is possible Fauci fully understands that New York City, Sweden, and many other places have reached effective herd immunity (at different costs in lives!), but he believes that reduced rate of transmission is mostly due to behavioral changes, not due to a large fraction of the population having immunity to the virus. So he may think the minute some place like New York City stops restricting public behavior there will be a renewed pandemic. I think the available data say that is the purest of horse $hit, but the most generous interpretation of Fauci’s public statements is that he actually believes the horse $shit.
SteveF
I lean toward this view. But that view can be tested by slowly reducing restrictions. Illinois’s plan forward is supposedly based on cases /death data. As it is observed to go down, restrictions are reduced.
.
It may be we could go out faster with few ill effects, or it may not. The amount of risk of increase in contagion vs. risk to economy from restrictions is a policy decision. It’s not a purely medical decision.
.
Fauci’s view is a mostly medical view– which can be fine to an extent. He probably does believe cases will be higher if restrictions are reduced ratehr than otherwise. In some sense that’s true.
.
But not everyone needs to agree with his prioritization.
Illinois is allowing buffets, but they announced it at a very late date, when some of the places had gone through a month of changing operations to get rid of the buffet.
MikeN,
That’s got to be frustrating for restaurant owners. For now, I’m not eating at an indoor restaurant even with the low capacity limits put in place. I don’t think I’ve ever seen an outdoor buffet in a restaurant. ( Group picnics… yeah. I’m probably not going to any of those either!)
I have a question about why some people have such a strong negative reaction to wearing a mask. The benefits of masks may not be known, but it seems like a very small “cost” to wear one — it can get a little uncomfortable under the mask. [Perhaps others suffer more than I do.] So why such an aversion — is it a feeling that this is the camel’s nose in the tent? Or something else? Perhaps someone here who is a strong objector can speak to this.
And in a related question, why does GA’s governor claim that he can countermand the Atlanta mayor’s local rules? [Real question — more precisely, what statutory power does the governor assert in the court case.] I thought the FL governor was wise to avoid state-wide regulation (well, for a while), leaving it to the more heavily-hit counties to impose such rules as they saw fit, while other areas chose not to shut down businesses etc. Unless a local rule violates some federal or state constitutional principle, it seems to me that it’s the prerogative of the local authorities [mayor/aldermen/councilors/etc.] to issue local ordinances.
Dale S (Comment #187881) July 18th, 2020 at 4:25 pm
Thanks for the information about the pandemic in NY nursing homes, which several commenters above seem to blame on Cuomo. You said:
“Alternately, we could recognize that because of sovereign immunity, no one associated with the State of New York will *ever* go on trial for the nursing home order, no matter how badly it worked out.”
I was thinking of a civil lawsuit over deaths in a nursing home. An elderly patient can require a week of recovery in a nursing home with rehabilitation facilities to be able to take care of themselves at home. Based on my experience, hospitals normally don’t discharge elderly patients who can’t take care of themselves at home until they have identified a suitable nursing home for rehab. It wouldn’t be surprising if nursing homes were reluctant to take patients who had recovered from COVID. I assume Governor Cuomo or some other state official ordered nursing homes to accept COVID patients ready for discharge over their objections to free up hospital beds in over-capacity hospitals. If sequencing shows that one of those discharged patients infected at least one resident of a nursing home, then those who died or suffered permanent harm from the presence of that patient could sue the state for damages and state officials could be found liable – whether or not there were dozens of other paths that might have infected any patient in that facility.
I simply wanted others to understand that PCR positive doesn’t mean infectious and that the CDC is no longer recommending that a health care workers have two negative PCR tests before returning to work. The absence of symptoms is evidence of non-infectiousness if it has been 10 days since symptoms first appeared, as is a 14 day quarantine after exposure without symptoms.
You cited this section of a report on NY nursing homes. “Moreover, CDC also issued guidance on March 7, 2020 that stated certain asymptomatic healthcare personnel exposed to others with the virus were “not restricted from work.â€13 This early, and ultimately erroneous, understanding of viral spread allowed many nursing home COVID-positive employees to continue working.”
To a certain extent, all health care workers – like all Americans – are exposed to COVID. Some health care workers work daily with COVID patients and their highly effective personal protective equipment and hygiene failed to protect everyone, though they have gotten more skilled at protecting themselves with time. Those who deal with people potentially infected with COVID in nursing homes may not have the same level of protection or skill. However, by early March every health care worker should have known that asymptomatic people (including pre-symptomatic individuals, those with minor, trivial or absolutely no symptoms) could be infectious: This paper from Germany was first published online on January 31.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120970/
Nobody would have been treating COVID patients in hospitals if “exposure” disqualified a health care worker from working. And no one would be working in nursing homes either once the first resident was suspected of having COVID. The only safety is relative and arises from PPE, skill and hygiene.
Asymptomatic infection shouldn’t have been a surprise, there are publications on asymptomatic transmission of influenza.
https://www.clinicaladvisor.com/home/web-exclusives/most-flu-cases-asymptomatic/
Unfortunately, that knowledge didn’t leave us prepared for a new respiratory virus that is more easily transmitted and deadly and deadly than flu (initially killing 6.5% and currently 3.8% of those who have tested positive if I understand correctly).
HaroldW (Comment #187901): “I have a question about why some people have such a strong negative reaction to wearing a mask.”
.
I sometimes feel like the mask is suffocating me, but that is my problem.
I object to the mask mandate on principle. I have no problem with a business owner saying “no mask, no entry” and would have no problem with the government backing the business owner on that. I have no problem with the city requiring masks on buses or in city buildings. But I object to the governor saying that consenting adults can’t do away with the masks, especially in areas where there is no epidemic. Even more, I object to the governor claiming to have that power. Even more, I object to masks being required outdoors, even when there is plenty of social distance or when it could be unsafe, such as a bicyclist who wears glasses. Such nonsense tells me that the mask requirement is about power, not public health.
.
It is not the nose of the camel in the tent, it is getting darn near the tail.
.
Masks are socially damaging. I think that is part of their attraction to the left.
———–
HaroldW: “And in a related question, why does GA’s governor claim that he can countermand the Atlanta mayor’s local rules?”
.
I suppose they depends on the law in Georgia, Certainly, my governor and about 40 others claim exactly the same power. It seems to me that the guy in Georgia is on much better grounds than most, since he is acting to defend people’s rights. Why should a local mayor be allowed to destroy the work of someone’s lifetime?
——
HaroldW: “I thought the FL governor was wise to avoid state-wide regulation (well, for a while), leaving it to the more heavily-hit counties to impose such rules as they saw fit”
.
I think that is a good idea, up to a point. Did DeSantis not place any constraints on what localities could do?
.
HaroldW: “Unless a local rule violates some federal or state constitutional principle, it seems to me that it’s the prerogative of the local authorities”
.
Sure. But Gov. Kemp says that is what he is doing.
lucia (Comment #187882) July 18th, 2020 at 4:40 pm
“You can definitely get tested without symptoms in Illinois. There’s a ballroom dance studios giving group lessons. The students taking it lessons are required to have taken a Covid test, and the owner or the studio is telling them sites where you can have the test even if you have no symptoms.”
We had family members who flew across the country to shelter in place with us and quarantined for 14 days on a separate floor before joining us. I tried to find a way for them to get tested here (VA) at a facility that treats patients without a local doctor. The first thing they demanded before scheduling were symptoms, and not the CDC’s newly unexpanded list of symptoms. Every other nearby facility on the web listed “CDC symptoms” on their information. We didn’t try very hard, but “if you want a test, you can get a test” didn’t seem to apply in our situation.
Getting a COVID PCR test to participate ballroom dancing is insanely stupid since people can get infected at any time and 0.1% of people are infected in hard-hit areas. The only meaningful test for dance lessons would be a positive antibody test than proves you are likely to be immune and likely to remain immune for many months to years.
I also have two other family members who were very sick in late January, with one need an inhaler and the other lost their sense of smell. Their doctor was reluctant to recommend an antibody test and they were concern about the application of Bayes theorem to possibility of a false positive results, not recognizing that this mathematics applies to an average person in their low-risk community, not to two people who had experienced significant symptoms in their community. It took me awhile to realize that risk in this pandemic was an emotional, not mathematical, subject.
Mike M.–
First, thanks for your response.
“Did DeSantis not place any constraints on what localities could do?”
Other FL denizens can correct me on this, but I don’t think so. Dade/Broward counties closed county beaches & parks before any state-wide closures. I think at least one of them issued a mask mandate, at least for indoors when there wouldn’t necessarily be adequate physical spacing — e.g. supermarkets.
“Why should a local mayor be allowed to destroy the work of someone’s lifetime?” One might just as well ask that of a governor or president — in declared emergencies, the authorities can exercise additional powers, such as curfews. I don’t see why it matters at what level those powers are used.
Frank,
Participants are required to test every two weeks. The groups are also something called ‘static groups’. So it’s a specific set of 10 or fewer people in a lesson and only people in that group of 10 can be in the lesson.
https://files.constantcontact.com/fe25d767001/fe30bc73-43dc-4031-852c-ce88df0423e3.pdf?fbclid=IwAR0wfE7O2Alfz7uibW4Y1H6pPeq-jYyN9US9DE1GQj_8VEhJu25HdgVC0W4
I don’t think this is necessarily stupid. It does increase the likelyhood an infection by a person in the group will be caught. There are other steps being taken.
Frank,
Of course Bayes theorem applies to all situations. But the appropriate prior for a person with symptom are different from the prior for a random person picked from the population.
.
I also don’t quite understand why the doctor would be concerned someone might have a false positive. Sure…. they might. But they are already sick. But I can’t imagine what bad consequence the doctor would worry about happening if the test said they were positive when they weren’t. I get that would be a false positive… but it’s not like someone was going to chop off their leg if they got a false positive.
.
A positive test would suggest it’s more likely their symptoms are Covid than something else. A negative would suggest the opposite. I would think a doctor would want to have a test result that helps him diagnose even if that test result isn’t perfect.
lucia,
I did see somewhere, probably the WSJ, that some places are indeed counting a death as caused by COVID-19 if the person who died had ever had a positive test for SARS-CoV-2. That included getting run over by a bus three months later. But I still agree with you that of all the numbers we have, deaths are still the best measure we have of the extent of COVID-19.
I’m looking at the data (worldometers.info) to see what other countries are showing what looks to my uncalibrated eyeballs like at least two peak case load with a significant dip in new cases before the second surge. There are quite a few countries that show a relatively small dip that I’m not counting. Many other countries, like Brazil, haven’t had their first peak yet.
Israel
Romania
Japan
Costa Rica (very small first peak)
Uzbekistan
Azerbaijan
Palestine (very small first peak)
Serbia
Madagascar (possibly three peaks)
Canada (maybe)
Morocco
Belgium (maybe)
Bosnia and Herzegovina
North Macedonia
Germany (small second peak and wouldn’t bet against a third)
Australia
Bulgaria
Zambia
Austria
Netherlands (maybe)
Switzerland
France
DeWitt,
There is one important difference between state level authority and both federal and local authority. The states were originally sovereign, and while they surrendered certain powers to the federal government, they retained everything they didn’t surrender. The tenth amendment states “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the States respectively, or to the people.” We’ve seen the states repeatedly stomp over the rights of the people during the emergency, but cities aren’t in the list at all. Unless a state government specifically delegates its power to cities, mayors are never going to outrank governors.
.
Now that doesn’t mean that Kemp’s orders *have* to be one-size-fits-all, he very well could have delegated decisions on whether or not facemasks are mandatory to lower levels. But since his executive order *explicitly* states that more restrictive orders are superceded by his executive order, the mayor of Atlanta making facemasks mandatory is in *conflict* with the executive order, and mayors can’t overrule governors. This isn’t a new development, the statewide shelter-in-place also superceded local orders. Gwinnett county (where I live) had already closed, and the statewide order was actually slightly more lenient than the county order had been (specifically on outdoor restrictions, where I think Kemp’s judgement has been vindicated).
.
A case could certainly be made that the state is large/diverse enough to justify different responses in Atlanta and small rural towns hundreds of miles away. OTOH, the Atlanta metro area involves a lot of different counties, so the governor is the only executive responsible for all of it; differing policies within the metro area will cause confusion and/or negative economic impact.
I believe states can override city regulations as they see fit. It is common for it to go either way, state mandates or leaving it to the localities. In FL the localities are pretty much making up the rules for covid, with a lot of guidance from the state. It’s a hodgepodge of who has what power at the moment. Masks are local, I think a full lockdown is state though.
Tom,
My impression is that generally, states can override cities. Whether a governor’s order means much depends on state law though. Sometimes they have power to order; sometimes they don’t.
.
But the flip side is a governor might not have resources to enforce an order. In that case, the locals fail to enforce and pffffttttt…. to the order. In the end, to some extent, the lesser order holds.
HaroldW,
“I have a question about why some people have such a strong negative reaction to wearing a mask. The benefits of masks may not be known, but it seems like a very small “cost†to wear one — it can get a little uncomfortable under the mask.”
.
If exerting yourself, it can become hard to breathe, depending on how good the mask is. My cloth mask is thin enough that I haven’t had much problem breathing freely, though it does fog up my glasses, which is annoying.
.
What annoys me is being told *now* that it’s the most important thing we must do and that it should be mandatory for everyone, when a few months ago we were told it was worthless and healthy people shouldn’t be wearing them. They gave some reasonable reasons back then too for not wearing cloth masks if you’re not going to be coughing or sneezing — it gets dirty and you can get sick from it, you can infect yourself by adjusting your mask and/or touching your face (more likely with a mask), it might make you think you’re “safer” and so you neglect social distancing.
.
Which of those reasons is now untrue? Now we’re told that masks serve as a reminder of the importance of social distancing, the reverse of what was before. I saw a reference to research in Italy showing that people stayed further away from you when you were wearing a mask, and that certainly makes sense in an environment where all healthy people aren’t wearing a mask — ordinarily, I’d assume that someone is wearing a mask *because they might cough or sneeze* and giving them extra space is only good sense. But if *everybody* is wearing it, does that still apply? I’ve noticed mask-wearing has gone up, but I certainly have not noticed a difference in social distancing in general, or people staying further apart in Costo (masks required) than stores that don’t require it.
.
I’ve also noticed *lots* of people wearing their masks so they don’t cover the nose. Honestly…. I suppose that isn’t quite as stupid as wearing a crocheted mask. But I think some of the time spent on mask-shaming in the media could be spent more productively on mask-wearing tips…
HaroldW (Comment #187907): “One might just as well ask that of a governor or president — in declared emergencies, the authorities can exercise additional powers, such as curfews. I don’t see why it matters at what level those powers are used.”
.
There may or may not be a priori reasons for this level or that level. But we do have constitutions and laws that specify where powers lie. Those matter.
What matters very much is that emergency powers *must* be limited in scope and duration. Otherwise, democracy is over. So I will always favor the governor who, like Kemp, uses his powers to protect rights over the governor who, like most, uses his powers to trample rights.
——–
While I am at it, I very much agree with Dale S about the wild swings from don’t wear masks to must wear masks. Maybe they help a little, maybe they don’t; I don’t know. But I am sure that the authorities are not being straight with us.
.
OTOH, I don’t see the problem with leaving the nose uncovered, at least if the purpose of the mask it to protect others.
Mike M,
My understanding is that the main benefit (only benefit?) of masks is preventing large covid-carrying droplets from infecting others. When you sneeze, you get some of those out of your nose.
“What annoys me is being told *now* that it’s the most important thing we must do and that it should be mandatory for everyone, when a few months ago we were told it was worthless and healthy people shouldn’t be wearing them.”
.
Count me in. It wasn’t a nuanced speech back then, it was the same over confident lecture to the rubes who don’t know science. How do you know when they are over stating things? Well one clue was that they followed up that speech with a statement of how effective it apparently was for health care providers. It never made sense and the 4th estate never even seriously questioned the obvious contradiction.
.
I think people should wear masks now because they * might * be effective and they are available. I will once again state how disappointing it is that they seem to not really know how effective they are. The mask tut-tutters out there need to reign in their condescension though.
Frank,
I remain skeptical that NY state could be successfully sued over nursing home deaths, in fact I believe even the nursing homes have been protected from lawsuit by the state budget. However, if you are correct that all needed for big money is “sequencing” showing that *an* admission of a Covid-positive patient happened before someone else died, NY is toast. These admissions *peaked* in late April, but they started right away. In the DOH’s own report they point out that 252 of the 310 nursing homes already had a known or suspected Covid case before the first admission — which shows that 58 nursing homes *didn’t* have a known or suspected Covid case before the first admission. If all 58 of those homes had no deaths, they would have said so. They show death/admission graphs for four sample facilities in the report, two of which had no admissions. Cobble Hill had *most* of its deaths before the singular admission of a covid patient; Affinity Skilled Living and Rehabilitation Center had *all* of its deaths after it got its first admission, on March 30th.
.
It’s a good reminder that testing positive doesn’t mean you’re necessarily contagious, but by the same token it doesn’t mean you’re *not* contagious at all. CDC’s current guidelines for health care personnel returning to work have 10 days since onset of symptoms *and* 24 hours since last fever (without fever medicine) *and* symptoms getting better. But those guidelines are specifically for those with mild to moderate cases. Those with severe/critical illnesses (which I think would cover anyone *hospitalized*) have to wait *20* days. Does that inspire confidence in the idea that a *median* 9 day hospital stay means that *none of them* were infectious? The footnote says:
—
an estimated 95% of severely or critically ill patients, including some with severe immunocompromise, no longer had replication-competent virus 15 days after onset of symptoms; no patient had replication-competent virus more than 20 days after onset of symptoms.
—
They go on to say the *majority* of severe/critical patients appear not to be contagious 10-15 days after symptoms. Now, we don’t know how much time elapsed between symptoms and hospitalizations. The DOH report lists “average 8-12 days” between symptoms and hospitalization, but the CDC report it links to are all based on numbers from Wuhan, *not* nursing home patients in NYC. The fact that five different reports shows a range of 8-12 for the median (not average) time also shows that we’re not talking about lengths set in stone. I note that those same Wuhan studies had a range of 10 to 13 days for survivor hospital lengths, all more than NYC’s 9-day median of survivors who needed assisted living facilities.
Dale S,
As I understand it, a mask increases the effective dead volume of your lungs, the volume that isn’t replaced with a normal breath. The more effective the mask, the greater the increase. A higher dead volume means higher blood CO2, which generally makes you breathe faster, at least until you acclimate. IIRC, acclimation time is usually longer than you would normally wear a mask.
Our biochemistry is designed to quickly react to changes in blood CO2 rather than blood oxygen. Which is why hypoxia can be so dangerous.
You can get anti-fog stuff for your glasses. IIRC, they’re wetting agents so the condensed water spreads out and doesn’t bead up.
Tom,
I agree with you. When I read people confidently explaining why mask not only don’t work but make things worse I absolutely could not believe what they were claiming. There explanations contained a small fraction of things that were at least a little believable and a whole bunch of junk that was clearly just bunk.
.
I mean…. masks evidently were going to make wearers “over confident”, neglect washing their hands, go places they otherwise wouldn’t go touch their faces more and on and on and on.
.
I actually could help laughing at the idea that the mask would somehome become a virus laden trove that is now a sourch of infections. But all of these things artfully avoided discussing the process in which it acquires bacteria. I mean…. yeah. Scenario 1: If I have covid, when the mask blocks the cough, it collects the bacteria which otherwise would have been coughed onto someone. So the bacteria laden mask protected them during the cough. Meanwhile, although the mask has bacteria on it, it’s essentially trapped. The virus isn’t like a puppy able or mosquito. It really needs something else to move it around.
Scenario 2: I touch a surface with some bacteria on it. I touch my face. Oh– but there’s a mask on my face. So I haven’t touched my nose or mouth! But, yes, the mask has bacteria on it– where it is mostly adhered to fibers. I’m still exposed less.
Obviously, I should wash the mask– I wash mine after every wearing. I’d say they are generally washed after less than 1 hours worth of use. My dance instructor changes his mask for every lesson. He wears disposables, but if they were washable he could just wash how every many he needs every day.
It’s really not that hard to advise people to dunk your mask in a bowl of hot sudsy water and wash them for two minutes and then allow to dry. Masks aren’t going to be perfect, but it’s pretty easy to see they reduce the distance breath, coughs and sneeze travel. The intercept some spit. Even if you touch your face, they keep you from directly touching your nose and mouth. That’s generally going to help slow down transmission of respiratory illness.
.
I made makes pretty much as soon as the experts pivoted and started telling us to wear them. Because masks may help makes sense. Masks don’t help never made any sense.
.
(BTW: Yes. Masks do make my nose itch a little. I’ve gotten used to it.)
Dale S (Comment #187914): why is it strange that as we have learnt more about how the virus is spread (as we have a lot more data now than a few months ago) that the advice on prevention has changed?
Andrew,
It’s certainly not strange to change advice on prevention as more is learned, if that impacts certain strategies. So what exactly have we learned that means we need mandatory masks *now*, that wasn’t already known in March? It’s not that asymptomatic people can spread the virus — that was known back in Februrary. It’s not that droplets from an infected person can infect you — that was also known back in Februrary and should be assumed true for any respiratory virus. It’s not that cloth masks can block (some) respiratory droplets — that was also known prior to the epidemic. AFAICT, there’s nothing about the *disease* that has changed when it has come to the stated reasoning behind masks. The big disconnect I see is behavior — back in March it was confidently stated that masks would cause people to be less stringent about social distancing, and now it is confidently stated that masks will cause people to more stringent about social distancing. And I’ll admit that even those reasons aren’t *necessarily* wrong, because behavior changes. Recommend some new behavior for the common good (such as social distancing back in March) and adherence will be high, but as it stretches on indefinitely people will relax. Introducing new restrictions can try to recapture the magic, though when it’s the *opposite* of prior advice, a forseeable consequence will be people thinking the Powers That Be don’t know what the heck they’re doing and will cause them to question guidance they’ve previously been following.
.
I think it’s likely that cloth masks are a mild net positive, and it’s unfortunate that they weren’t recommended *along with social distancing* back in March, instead of telling us not to bother and closing down fabric stores. I can see discouraging people from buying medical masks due to needs elsewhere, but given the low utility of cloth masks in a medical setting and a vastly larger supply of materials for home-made cloth masks than for the existing masks being hoarded, I think that was a strategic mistake.
.
Overselling the benefits of cloth masks *now* in the service of promoting mask wearing is also a strategic mistake IMO. And efforts to get rid of contrary arguments make my spider senses tingle–trying to supress contrary arguments rather than refuting them tells me you have a weak case, and you know it. There’s an interesting we-don’t-recommend-masks-for-everyone article from April here that’s been updated on July 16th:
https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data
The update is in responses to request to remove the original article from the website. Why? “Reasons have included: (1) we don’t truly know that cloth masks (face coverings) are not effective, since the data are so limited, (2) wearing a cloth mask or face covering is better than doing nothing, (3) the article is being used by individuals and groups to support non-mask wearing where mandated and (4) there are now many modeling studies suggesting that cloth masks or face coverings could be effective at flattening the curve and preventing many cases of infection.”
.
The authors address these in their update, pushing back on #1, #2, and #4. For #3 they say they support mask wearing by general public, but are concerned about the messaging. Conclusion of the update:
—
In summary, though we support mask wearing by the general public, we continue to conclude that cloth masks and face coverings are likely to have limited impact on lowering COVID-19 transmission, because they have minimal ability to prevent the emission of small particles, offer limited personal protection with respect to small particle inhalation, and should not be recommended as a replacement for physical distancing or reducing time in enclosed spaces with many potentially infectious people. We are very concerned about messaging that suggests cloth masks or face coverings can replace physical distancing. We also worry that the public doesn’t understand the limitations of cloth masks and face coverings when we observe how many people wear their mask under their nose or even under their mouth, remove their masks when talking to someone nearby, or fail to practice physical distancing when wearing a mask.
—
Lucia (#187921),
I agree getting covid from the inside of your cloth mask never made sense, it’s a virus and my understanding is that it only multiplies *inside* the body, not in your mask. Bacteria is a different story, you could breath out bacteria into your mask and have it multiply in a warm, moist environment until you’re breathing in a much higher concentration of bacteria than was in your body. This news article from Canada:
https://www.cbc.ca/news/canada/new-brunswick/nb-wearing-masks-1.5560578
attributes to an epidemiologist that “a study in a U.K. medical journal showed health-care workers who wore cloth masks all day while working were 13 times more likely to get a respiratory illness when compared to the standard practice of only wearing a mask when necessary.” In the article he says he wears masks only for a two hour stretch, then boils them, and he never wears them outside or in the car.
.
Interestingly, I’ve read elsewhere that boiling isn’t the right way to clean them. I’ve seen a recommendation onlin for 20 seconds in sudsy water, but the CDC washing instructions are only washing machine (highest temperature for the kind of cloth) and 5 minutes in a bleach solution. I’ve seen elsewhere criticism of using a bleach solution, which if not adequately rinsed can expose you to bleach. And I had to go looking for these things because even though I’m constantly hearing about the importance of wearing masks, I rarely hear about the importance of *washing* masks or how to best do it. Mine gets washed in the laundry about once per week and is generally left in the car between washings (at least the sunlight does some good — CDC recommends direct sunlight when air drying if possible). So I suspect I’m much more likely to get sick (not of covid) from my mask than you are.
Bacteria have a cell wall, which makes them more resistant to things which viruses are not, soap and water being a prime example.
.
I think you’d have to rinse your mask very badly to be exposed to bleach. Just because you can smell bleach doesn’t mean it’s at any significant concentration to do you damage.
.
If you ran it through the wash with a bleach step, I think you’d be pretty well covered against everything except the toughest pathogens, which tend to come in spore form.
Andrew,
It’s not strange at all that science changes it’s mind under uncertainty. The point here is that the communicators for science were not initially expressing uncertainty and there was little dissent in the scientific community evident to most people. Then they ALL changed their minds seemingly simultaneously based on … I’m not even sure what. There was no landmark study released or some piece of evidence they all agree changed everything that I am aware of. It all seems so arbitrary.
.
This was a minor deal in the grand scheme, but when combined with the “mass protests with screaming and singing are OK now!” arbitrary reversal one loses confidence in the enterprise of science communication. It’s unclear how much the fault is with the media or with science groups that have become too activist.
.
It appears this was misinformation using appeal to scientific authority to hoard resources for healthcare workers. The end goal made sense (and was not obtained through the attempted misinformation), but the credibility hit is justified IMO.
I think that mask wearing has largely become another form of virtue signalling. I have seen people wearing a mask while driving, alone in the car. That is not even virtue signaling; it is treating the mask as a sort of lucky rabbit’s foot.
.
The big thing that changed from four months ago is that they were lying about masks because they wanted them reserved for health care workers. That resulted in the unintended, but entirely predictable, consequence that people now have reduced trust in the experts.
.
The thing that supposedly changed was an increased appreciation of asymptomatic transmission. But we now know that was largely mistaken and mask mandates have only increased.
.
Cloth masks do nothing to protect the wearer. Unless handled properly (unlikely), they increase risk to the wearer. They probably are of marginal advantage to protect others if the wearer is shedding the virus.
.
Here is another unintended, but entirely predictable, consequence of people wearing masks. Some individuals who are sick will feel free to go out in public because the mask makes it OK. If even a small fraction of sick people do that, any advantage will be more than wiped out.
“We are very concerned about messaging that suggests cloth masks or face coverings can replace physical distancing.”
.
I have never seen this messaging, in fact it is exactly the opposite. It is always stressed that other forms of risk reduction need to be kept in place.
.
The media treats this like it is the first ever respiratory illness. Nobody has ever done studies on face masks until last week? The CDC gets a billion dollars a year, maybe they have looked into it before, ha ha. Obviously the contagiousness of this specific virus may be unique, but the ways to prevent the spread of a respiratory virus are not unique.
.
At least we will know a lot more after this one has run its course. I have a feeling we will be treated to endless “if only we would have done X a zillion lives would have been saved” studies over the next decade.
.
Face Masks Really Do Matter. The Scientific Evidence Is Growing.
https://www.wsj.com/articles/face-masks-really-do-matter-the-scientific-evidence-is-growing-11595083298
“Yet if 95% of the U.S. population began wearing masks, the expected death toll would drop by more than 40,000 cases to about 183,000 people, according to IHME.”
.
NYT March:
“Seriously people — STOP BUYING MASKS!†the surgeon general, Jerome M. Adams, said in a tweet on Saturday morning. “They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!â€
DaleS
Yep. I’m willing to believe it’s a problem if worn all day. I wear my mask at the grocery store and when dancing. I also clean it every time I wear it.
WRT to people who might be advised to wear it all day: I’m really glad my grocery store now has plexiglass shields up for the cashier. If I were a cashier, I’d make myself at least 10 masks and change my mask every hour. But at least the plexiglass gives me further protection from customers breathing in my face and accumulating virus on the mask.
For cleaning: I do the 2 minutes in sudsy water. Jim follows that with getting it heated to steaming in the microwave. (This makes the elastic wear out. . . ) I figure if 2o seconds washing my hands is enough to destroy the outer layer of the virus, 2 minutes in sudsy water is enough to destroy it otherwise.
The CDC recommendations of machine washing and bleach may be all well and good. But if that was necessary to reduce Covid, then hand washing wouldn’t be enough to reduce spread either. I am not going to escalate my goal up to getting the mask sterilized for use in the operating theater.
Tom Scharf,
” according to IHME.â€
.
If there is any organization that should be ignored it is that nutty group.
Lucia,
I’m far less worried about catching Covid from a dirty mask than some bacteria-driven disease. But obviously, I’m not worried enough to make sure my mask is regularly cleaned! I do only wear it for the duration of a trip inside the store, so I’m at least never wearing it for very long at a stretch. Having multiple masks to wear during the day for a mask-requiring job is a good, simple idea.
.
I like the plexiglass shields that stores have put up, but most around here have breaks for the credit card pad, which is where customers usually stand.
DaleS,
They have a break for the credit card pad at my grocery store. But that’s shifted at least 3 ft from the cash register where the cashier stands ringing up the groceries. So the plexiglass is in front of the cashier. Often customers stand across from the cashier while the cashier rings up. Without the plexiglass, they would ordinarily have their faces at most 2 feet apart, on the same level and facing each other. This would persist during the duration of time the cashier is ringing up.
The customers do have to move down to the pay pad to pay. The cashier generally remains by the cash register. So when customers are paying, they are not facing the cashier, and the cashier and customers are easily 6 ft apart. So I think it’s a big improvement.
Everyone is still wearing masks. But I still feel much better for the cashier’s sake.
The media are oversellling masks now. One person on some NBC or CBS show over the weekend claimed that if everyone wore a mask, the problem would be over in six weeks. They also had a doctor on the Today show this morning that claimed that masks had no effect on CO2 levels. I don’t believe that to be true. Now if he had said that the effect was small and the trade-off was worth it, I could accept that. But there doesn’t seem to be a middle ground. Masks are either useless or a panacea.
I wear a mask and see how they can help, but have a problem with condescending finger-waggers.
.
Because I have a daughter in AZ, I’ve been following the cases out there. Happily, case numbers and hospitalizations are both falling. Based on my daughter’s complaints, I was pretty sure the state didn’t impose a mask mandate, so I went looking, and found confirmation from a surprising source…
.
https://www.newsweek.com/arizona-most-anti-mask-state-sees-coronavirus-cases-fall-1519129
.
It looks like the governor has sensibly left it to local authorities to decide on mask mandates, but more importantly, has put limits on bars and nightclubs.
.
While I will continue to wear a mask, it looks like allowing folks to jam themselves into drinking establishments may be the bigger issue.
I think there is a big potential market for Darth Vader-like suits… with a self contained battery powered breathing system supplying ISO Class 1 clean-room quality filtered air (<0.1 micron), positive internal air pressure, and whole body coverage… with nothing exposed. Plus a life sized color image of your face on the front of the suit….. smiling or not. The suit wouldn't have to be black…. a selection of color schemes could be selected from.
.
An add-on would be an UV-light decontamination chamber for the outside of the suit when you get home. Fry those little covids right on the surfaces of the suit, then enter your house without a care.
John M,
It’s really hot in Arizona, even without a mask.
.
“While I will continue to wear a mask, it looks like allowing folks to jam themselves into drinking establishments may be the bigger issue.”
.
Gives a whole new meaning to the words ‘drink responsibly’. 😉
.
But yes, a bunch of people crowding into a bar is going to lead to a lot of virus transmission. Scaled to Florida’s population, the peak case rate in Arizona corresponds to ~11,000 cases per day in Florida. The peak in deaths per day in Arizona is probably still a week or so away.
John M,
A comment to your linked article claims that there is a test backlog in AZ of 100,000. If that is indeed true, then we don’t actually know whether cases are falling.
By the way, according to this article, the at least one member of the extended Ochs family of New York Times fame, owned slaves.
DeWitt,
It is not about slavery, or civil rights, or even racism. It is about who has the power to force compliance. The people who work for the NYT’s want power for the left. Nothing else matters much to them. The effort to destroy historical accuracy and de-legitimize people long dead is standard practice for the left, and has always been.
SteveF, stated by Orwell as “he who controls the past, controls the future. He who controls the present, controls the past”.
DeWitt Payne (Comment #187958)
July 20th, 2020 at 3:26 pm
.
Whether there’s a backlog or not, it’s clear hospitalizations are down. AZ has one of the better dashboards I’ve seen.
.
https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/covid-19/dashboards/index.php
.
From Covid-related bed and ICU usage to reports of “flu like” symptoms, all numbers are down. I’ve been following the data for several weeks.
.
It looks like their max testing is a little more than 20k per day, so 100,000 backlog is 4-5 days worth. Seven day moving average seems to have peaked about two weeks ago.
It seems that Arizona really does have a huge testing backlog”
https://www.msn.com/en-us/news/us/arizona-is-awash-in-covid-19-and-testing-is-a-shitshow/ar-BB16tiXb
DaveJR,
Orwell missed the date by nearly 4 decades, but 2020 is as close to his vision of dystopia as I have seen in my 69+ years. ‘Progressive’ culture has descended into near madness, as all connections to history, law, and even factual reality are slowly eroded by the unknowing mob of the ‘woke’. It does mot bode well for the future of liberty.
.
Multiple studies published have shown clearly that kids under 16 simply are not significant vectors for covid 19, yet the ‘progressive’ mob will not even entertain having those kids return to school in the fall. It is a triumph of idiocy and fear over reason and responsibility.
Mike M,
There is for sure a backlog of tests in Arizona. But consider the source of the story (Daily Beast) before taking everything in the story at face value. Sending tests to other labs outside Arizona seems like a simple and quick way to catch up.
Mike M. (Comment #187963)
July 20th, 2020 at 5:59 pm
Yes, I found that article when I looked for corroboration of the 100,000 backlog number. Unfortunately, it’s almost two weeks old and mostly anecdotal.
Wegman’s has changed procedures several times. They wipe the belt and credit card pad clean after each customer. Customer stands at the end of the aisle while items are scanned, and only approaches when ready to pay. At one point, a chain was placed across and they took the cart and handled everything.
I wonder if it might be a selling point to continue doing that even without fear of coronavirus.
MikeN,
It might be a selling point provided they have enough cashiers to do that without resulting in long waits for customers getting their items checked. I personally don’t mind unloading my cart and putting things on the belt. In normal no-plexiglass barrier times, when there is no 2nd person to bag while the cashier is ringing up, I usually bag my own stuff while the cashier is ringing. It takes less time than just standing their and waiting for the cashier to do it.
.
Mostly, I’d much rather the fairly easy unstrenuous process took less time rather than wait for someone to do it for me.
.
I often do self-check out at Walmart. The only thing that discourages me is I find that it has glitches. So I do scan to make sure there is a helper to code in the store number before I start using it. If I don’t see a helper, I go to the regular check out.
lucia,
I just watched Lori Lightfoot being interviewed on the Today Show. What a maroon! She seems to think that she has the authority to ban DHS agents from Chicago and that they are some sort of secret police that arrest and detain people in secret.
I tend to avoid self checkout also. It has become somewhat better over time.
Lucia,
My wife does most grocery shopping, and has started to use the order-and-pay-online service. The first time or two it is kind of slow, but once you have an account history, your commonly purchased items are all pre-listed, and need only a check/uncheck to choose or not. So at that point is is very much faster than shopping, although there is a $5 service fee. At a specified time you drive up and they load the groceries in your car. The only problematic issue is selection of fresh produce, where it is impossible to tell if it is worth buying (not ripe, over-ripe, wilted, etc). With covid it has become very popular.
Last comment snagged in moderation… no links and no bad words. Strange.
I released it. I also have no idea why it’s moderated. (I’ll go check moderation word *I’ve* put in. Maybe pay-online? )
It was “-online”. It’s very suspicious in emails strings… not so much in a comment. But the auto-moderation list doesn’t let me distinguish. I took it out of the list.
A grandson of mine and of whom I am a guardian lives in a group home for autistic young boys/men. There are other homes and a school (that my grandson attends) in the local area managed by the same organization. That organization in my view has been scrupulous in enforcing rules to avoid Covid infections in the residence and school populations. While my grandson’s residence has to date avoided any infections of residents and staff, a residence managed by the same organization in the same city had a staff member test positive for Covid about a week ago. The plan in place for this infection occurrence was for 4 volunteer staff members (with pay incentives) to live at the residence. Several days later 6 of the 8 residents tested positive for Covid and all were asymptomatic. At the same time 6 of 18 staff members tested positive for Covid with mild to moderate symptoms. The 4 staff members who are living in the residence tested negative for Covid. The organization has been very transparent about these issues and is attempting to find the weak link that resulted in these infections.
Unfortunately there well may be further ramifications that have not yet played out in this occurrence, but it will be interesting to see where and if the weak link is found. In the meantime it appears the game plan is to put additional rules into effect and have more complete isolation even in the residences that have not been affected.
We had an earlier discussion as to whether states are taking care to identify individuals tested in such a way that people with multiple tests are not reported as if they were multiple people. Some states are surely doing that right, but at least some are not. It appears that Florida is one of the latter.
.
People in Florida have been getting positive test results even though they were never tested. It happens if they get in line for a test, then leave before getting tested. Then they apparently get the result for the next person in line. It can be inferred that everybody after that gets somebody else’s result.
https://www.mysuncoast.com/2020/07/19/concerns-arise-some-receive-positive-covid-results-never-got-tested/
Portland is using the interesting argument that the presence of the Feds to protect their courthouse from ongoing vandalism is the source of the violence (oops, I mean “mostly peacefulness”). I suppose this is worth trying if you are a politician. The local people refuse to protect the courthouse, but demand the Feds pay up to repair the damage.
.
The throwing of commercial grade fireworks at the police should be met with force IMO. However, what is happening is many protesters are trying to get the police to overreact to overt provocations. The media has been overly compliant with this ploy and beyond Fox there appears to be a complete ban on showing protesters behaving badly. Obviously peaceful protesters are just being beaten down for fun, or something.
.
Given the media dynamics, I would just completely abandon the courthouse, allow it to be burned down in a media spectacle, and move it to a small city in the region.
Tom Scharf,
The CDC’s 10X multiplier is very conservative. Based on the same data for Florida, I got 16 as the multiplier. Add those people with T-cell mediated resistance, and the multiplier for confirmed cases could easily reach 25. With 369,000 cases so far, the resistant population could already be as high as 9 – 10 million. If we assume ~20% of the population are kids (unlikely to spread the virus), then the potentially infected population in Florida was about 18 million at the start of the pandemic. Assuming ~80% resistant to be well into herd immunity, that means 14.4 million resistant adult individuals. With cases running ~10,000 per day, it will not be long before the pandemic starts running out of susceptible people in most places in Florida.
Tom Scharf,
There is no question in my mind that the two and three inch mortar launch tube fireworks, which are available to the general public in my area, are deadly weapons if intentionally pointed at someone. Their use as weapons should be met with equally deadly force. We’re not talking about M-80’s or cherry bombs here. It’s more like a white phosphorus grenade shot from a grenade launcher.
Tom Scharf (Comment #187985)
I agree that the Feds should keep their distant in matters like Portland. Portland like other progressively run cities does not have the mindset or clues as how to deal with these matters, but the matters are in the realm of city government and it is those governments that should alone face the responsibility and blame. The Feds being involved locally can do no more than provide a temporary show of force and in the meantime get blamed by progressive politicians and their MSM supporters for the problem.
There are a lot of failures in large cities in the US and yet the same and mostly progressive governments remain in power. If there is a police problem these progressive politicians appear to answer by disassociating themselves from the police force – and the current intelligentsia allows them to get away with this irresponsible approach. These politicians make a big show out of their emotional reaction to the killing of Floyd and either ignore the murders of Black people in these cities or wring their hands and give the problem lip service.
Trump and his administration should be talking about these issues – but from a distance and with facts in hand and not with some emotional diatribe. The problem is that Trump’s narcissism is always getting in the way of a rational approach. He talks about fixing these problems seemingly single handed if given the opportunity and almost instantaneously. This is a dumb approach in both the political and real worlds. Instead of being an honest score keeper in the Covid crisis and allowing the governors and mayors to take responsibility Trump wants to pretend that he alone can be the conqueror of the disease. He does not seem to know that most people want to be informed of the status of a situation be it good or bad and not given daily doses of some spur of the moment thought up exaggerations.
That Trump is failing badly in the polls, I believe is the result of the prospective non always-Trumpers voters who are not progressives getting tired of Trump’s exaggerations and obvious narcissism and particularly in times of crises like we currently are enduring.
Unfortunately, it appears we are heading for at least four years of a progressive congress with a Joe Biden presidency guided by a progressive intelligentsia in the government and the MSM with no small share of the blame going to Trump.
Tom Scharf (Comment #187985): Given the media dynamics, I would just completely abandon the courthouse, allow it to be burned down in a media spectacle, and move it to a small city in the region.”
.
Nah. They should tell the city that if they want the feds out, then the city can buy up the federal property so that federal law enforcement will no longer be obligated to defend it.
Half of that is serious. Under no circumstances should the federal government abandon federal property to the mob.
Arctic and global sea ice are not looking good. The Arctic ice is 0.62Mm2, about 9%, less than the previous low in 2011 and global sea ice is at a record low for the day of the year, continuing the trend. If Arctic Sea ice doesn’t set a record low in 2020, I will be pleasantly surprised. OTOH, it’s unlikely to be zero, as the catastrophists were predicting for 2013.
Latest update on covid death rate:
https://www.wsj.com/articles/how-deadly-is-covid-19-researchers-are-getting-closer-to-an-answer-11595323801
.
“The CDC is now using the report as the basis for its own best-estimate for the infection-fatality rate in its pandemic planning scenarios. The agency’s estimate is 0.65% as of July 10, higher than its previous estimates.”
“An infection-fatality rate of roughly 0.6% is six times greater than the 0.1% estimate for seasonal influenza, which is based on CDC data. Though researchers point out the estimates are calculated in different ways and the flu estimate doesn’t take asymptomatic cases into account.”
Tom Scharf,
The entire idea of IFR without any reference to age distribution of cases is inherently misleading… even meaningless.
.
But just using their own 10X estimate for the number of actual infections compared to confirmed cases, the CDC value of 0.64% of infections puts total deaths in Florida by the time the pandemic is over at somewhere over 30,000. That is just not credible. The CDC needs to get its act together.
DeWitt,
“OTOH, it’s unlikely to be zero, as the catastrophists were predicting for 2013.”
.
Don’t worry, there will be a bunch of new catastrophic projections for complete loss of arctic sea ice if a new low is set in September. Those will also be very wrong.
SteveF, with increased testing, perhaps the 10x or 16x multiplier cannot be considered a constant.
MikeN,
Maybe the ratio will change a bit, but I think it is likely to remain a pretty big number. Most of the people getting tested (for virus, not for antibodies) are being tested because they have symptoms. The ratio of negative tests to positive tests, which has dropped substantially in Florida, is an indication mainly of the ratio of number of people with other illnesses that cause similar symptoms to number of people with covid. Asymptomatic people remain unlikely to be tested. Very early in the pandemic, when there were not enough tests available, asymptomatic people certainly were not tested. With plenty of tests available, some asymptomatic people may be tested based on contact with a known carrier, or just personal fear, but if that is true, I have not seen any data supporting it.
SteveF (Comment #188008): “The ratio of negative tests to positive tests, which has dropped substantially in Florida, is an indication mainly of the ratio of number of people with other illnesses that cause similar symptoms to number of people with covid.”
.
Indeed. But at least part of that is fewer people with other respiratory infections this time of year. The flip side is that people with symptoms are less likely to think that it is just cold and thus more likely to get tested. So the increase in positive tests is probably in part more people with the Wuhan virus and in part a larger fraction of those people being tested. Without continuing serology tests, we don’t know the relative importance of those two factors.
Mike M,
“Without continuing serology tests, we don’t know the relative importance of those two factors.”
.
Yes, but it is even more complicated. There is likely a significant fraction of exposed people who test negative for antibodies, but have T-cell mediated resistance. Antibody testing probably does catch anyone who had significant illness, but may miss a lot of those who had asymptomatic or very mild cases (based on a recent study by a Swedish group who measured T-cell sensitivity to covid 19). I suspect only seeing how the pandemic ends in different places, combined with both antibody and T-cell screening tests, will make clear the fraction of people who got the virus, whether they knew it or not.
It may also be that the serology antibody tests only catch people who recovered very recently. The antibodies die down, but the T-cell immunity remains. Or not. We don’t know.
.
There’s a lot we don’t know. So… I still just take death trajectories most seriously. I look at cases… but bear in mind other things two when interpreting that. The new case rate in FL looks like it’s close to peaking with testing rate increasing. Positivity ratio flat or down. (Statistical noise is big enough that some days the weekly average value is down relative to week before… the next day flat. ). Fingers crossed.
.
There’s some good news on the vaccine front. That’s still going to take time though.
MikeM
Well… we can estimate.
.
ΔΖ(χ,y) ~~ ∂Z/∂x),y* Δx + ∂Z/∂y),x Δx.
.
We know: Z = {Ntotal tests} * (N+ results/Ntotal test )
Set
Z= N+ results
x = {Ntotal tests} ,
y = (N+ results/Ntotal test ).
Do the estimate based on current values.
.
∂Z/∂x),y* Δx is the estimate of the increase due to increased testing. The other term is the estimate of the increase due to increase in the underlying rate of positive results. (If the test has 0 false positive and negative rate, that’s the increase in the underlying infections. Otherwise, you adjust for those errors. But we really can’t do that because we don’t know those rates very well.)
SteveF: BTW, in Illinois, we are having increase in testing due to some mandates for activity. I know you need to be tested to take group ballroom lessons in Chicago. That’s not a huge number, but I would guess there are other activities going on. We also have people getting tests to do elective surgery. My mother is having a test tomorrow. She’s going in for cataract surgery which she put off.
Lucia,
“The antibodies die down, but the T-cell immunity remains. Or not. We don’t know.”
.
We can’t know for certain, but long term T-cell based immunity is the rule, not the exception. We do at least know that T-cell mediated resistance for the original SARS coronavirus from more than decade ago remain active today in survivors.
Perhaps asymptomatic and minimally symptomatic infections are due to T cell resistance in the absence of antibodies. With no antibodies, the virus gets a foothold, then gets crushed before you get really sick.
.
I am not just thinking about coronavirus. We are told that something like half of influenza infections are asymptomatic and only about 20% produce THE FLU. We are told that the average adult gets 3+ colds a year, which seems unreasonable until you realize they are including asymptomatic and minimally symptomatic infections.
FL tested over 600K people last week, at least the testing process has been vastly improved from where it was several months ago. FL does look to be leveling out, history says the downside of that curve is long and slow, but there have been surprises all along this experience.
.
There is still an interesting latitude correlation going on here with the Sun Belt now the hot zone where NY/WA/Europe was previously. This is probably just a coincidence and it has exceptions, but still striking. Summer causing a decline is a non reality, ha ha. Climate driving people indoors is likely a better forcing.
.
India is still rising slowly and exponentially and looks dismal, Brazil looks to have peaked if you can trust their numbers. The pondering of why certain poor countries weren’t exploding is no longer a mystery, it just took longer. Those left seemingly untouched are probably just randomly lucky.
.
I think the US has a very high “contact rate” between citizens and more importantly a much higher dispersion rate of contacts, or perhaps a much higher contact rate with people outside of their local circle because of all the travel and high business level activity. It’s an interesting issue if one can get past the knee jerk moralizing.
So I’m hearing on the news that we’re still a long way from herd immunity everywhere in the US. Considering that 4% of the population of Westchester County in NY have been confirmed as infected, that statement does not appear to be true. It’s looking like the states with recent increases in COVID-19 are peaking, maybe even CA where up til now, they never had a decrease in their case rate.
My guess would be that the people claiming that we are far from herd immunity still believe that won’t happen until 80% of the population has been infected, i.e. the homogeneous, zero immunity, Ro = 3 case.
Tom Scharf (Comment #188023): “history says the downside of that curve is long and slow, but there have been surprises all along this experience.”
.
I suppose that depends on what you mean by long and slow.
Louisiana went from 340/day on 4/4 to 70/day on 4/27.
New York went from 470/day on 4/12 to 110/day on 5/12.
New Jersey went from 400/day on 4/20 to 130/day on 5/13.
.
I think those are comparable to the recent rates of increase. And the decreases were probably somewhat offset by increased testing.
.
But predictions are hard, especially about the future.
FYI: FL has free, no symptom, no wait, drive through testing in my area.