PlagueWatch 2020-23 - Coronavirus

[DST Fan]

Hadnt heard this, but it certainly jives with what I am seeing here with our ED and UC cases. I get notified of every positive test, since I am running occ health for my company.

Overall numbers for Virginia have been relatively stable, but our local numbers are definitely drifting up.

I would guess that the increase is driven by visitors and crowds in Virginia Beach.

[Wheat/"/"/"]

Newer study reported today that patients who got hydroxychloroquine had a better survival rate than those who did not. I suspect this is going to get a lot of press over the next little while, and we might as well throw another log on the fire that is mistrust of science, get it up to a nice roar.

I haven't been able to actually see the data or how they were collected. The authors say it is not particularly surprising that they reached a different conclusion from that of other studies; they base this on the fact that they started hydroxychloroquine early in the process, rather than waiting until the patients were on death's door. They believe that hydroxychloroquine is likely helpful if started in the earlier stages. They also said that they very carefully selected patients for the drug to minimize heart side effects, and that they followed them for cardiac side effects very closely.

Look for a lot of "I told you so" from Trump in the near future...

Good news, but not likely to get much press.

[richardjackson199]

Newer study reported today that patients who got hydroxychloroquine had a better survival rate than those who did not. I suspect this is going to get a lot of press over the next little while, and we might as well throw another log on the fire that is mistrust of science, get it up to a nice roar.

I haven't been able to actually see the data or how they were collected. The authors say it is not particularly surprising that they reached a different conclusion from that of other studies; they base this on the fact that they started hydroxychloroquine early in the process, rather than waiting until the patients were on death's door. They believe that hydroxychloroquine is likely helpful if started in the earlier stages. They also said that they very carefully selected patients for the drug to minimize heart side effects, and that they followed them for cardiac side effects very closely.

Look for a lot of "I told you so" from Trump in the near future...

He got a feeling...

https://www.youtube.com/watch?v=BVWICpzU3fE

[budwom]

When you're adding 50,000 cases per day, news on hydroxychloroquine is not exactly worth celebrating...

[Bob Green]

I would guess that the increase is driven by visitors and crowds in Virginia Beach.

I’m certain that is a factor. An additional factor is the ship repair industry ramping back up to normal level after a couple months working with reduced manpower.

[duke79]

When you're adding 50,000 cases per day, news on hydroxychloroquine is not exactly worth celebrating...

Maybe this is a question for rsvman, but are we really "adding" 50,000 new cases per day (i.e., new infections) or are we simple "discovering" 50,000 new cases (through greater testing) per day?

[CDu]

Maybe this is a question for rsvman, but are we really "adding" 50,000 new cases per day (i.e., new infections) or are we simple "discovering" 50,000 new cases (through greater testing) per day?

Well, it is six of one, half dozen of the other. We are discovering cases each day. They are relatively new cases (infected any time within the past two weeks).

The greater testing means that we are catching a greater percentage of these new cases than before. But they are still new cases. And we are almost certainly still not capturing all of the new cases.

[Mtn.Devil.91.92.01.10.15]

Maybe this is a question for rsvman, but are we really "adding" 50,000 new cases per day (i.e., new infections) or are we simple "discovering" 50,000 new cases (through greater testing) per day?

If these were antibody tests, I might say we were still "catching up," but if you test positive, you actively have the virus.

When antibody tests are widespread, we might have truly mind boggling numbers.

[MChambers]

Maybe this is a question for rsvman, but are we really "adding" 50,000 new cases per day (i.e., new infections) or are we simple "discovering" 50,000 new cases (through greater testing) per day?

CDC says the actual number of cases may be 10 times higher than reported. https://www.washingtonpost.com/healt...-times-larger/

Let that sink in.

[duke79]

Well, it is six of one, half dozen of the other. We are discovering cases each day. They are relatively new cases (infected any time within the past two weeks).

The greater testing means that we are catching a greater percentage of these new cases than before. But they are still new cases. And we are almost certainly still not capturing all of the new cases.

If these were antibody tests, I might say we were still "catching up," but if you test positive, you actively have the virus.

When antibody tests are widespread, we might have truly mind boggling numbers.

CDC says the actual number of cases may be 10 times higher than reported. https://www.washingtonpost.com/healt...-times-larger/

Let that sink in.

So, the bottom line is we have (almost) no clue how many people are currently infected with Covid-19 AND how fast it is spreading to new individuals? Will we ever know the answers to these questions?

[Bostondevil]

Maybe this is a question for rsvman, but are we really "adding" 50,000 new cases per day (i.e., new infections) or are we simple "discovering" 50,000 new cases (through greater testing) per day?

It is my understanding that positivity rates are also going up, so, it's more cases at the same time that we're doing a better job of testing. 50,000 cases can not be explained away by better testing alone.

[throatybeard]

CDC says the actual number of cases may be 10 times higher than reported. https://www.washingtonpost.com/health/2020/06/25/coronavirus-cases-10-times-larger/

Let that sink in.

In theory, you could work backwards from deaths.

But then you'd have to have states that weren't scrambling to misrepresent the deaths low, and you'd have to have a reasonably sound mortality percentage.

My wife can't believe how low the case count for Saint Louis City is. I forget the numbers now, but showed how much more sense the caseload number would make if we built estimates from the known deaths, at 0.5, 1, and 2% mortality. Any of which seems more plausible than the absurdly low case reported case count.

[camion]

So, the bottom line is we have (almost) no clue how many people are currently infected with Covid-19 AND how fast it is spreading to new individuals? Will we ever know the answers to these questions?

Check the hospitals in a few weeks and the morgues in a another month. That should give numbers for an estimate.

In the meantime we really don't know how big the problem is. I have peanut butter to last 6 weeks and I just got a Costco delivery of canned goods. I hope I'm overreacting. But then I live in SC where I can go from my home in the upstate to Charleston and remain in a red risk zone for the entire 3 hour drive.

SC-NC-risk-20200703.jpg

[throatybeard]

Check the hospitals in a a few weeks and the morgues in a another month. That should give numbers for an estimate.

In the meantime we really don't know how big the problem is. I have peanut butter to last 6 weeks and I just got a Costco delivery of canned goods. I hope I'm overreacting. But then I live in SC where I can drive from my home in the upstate to Charleston and remain completely in a red risk zone.

SC-NC-risk-20200703.jpg

You're not overreacting. We've got staples (rice, lentils, beans, chickpeas, peanut butter, grits &c) in the house into 2021, we estimate.

[House P]

Maybe this is a question for rsvman, but are we really "adding" 50,000 new cases per day (i.e., new infections) or are we simple "discovering" 50,000 new cases (through greater testing) per day?

The number of people hospitalized with COVID in the South and West has doubled since mid June and shows no signs of letting up. So, it is pretty likely that the virus is more widespread in the South and West today than it was in May.

Here is a plot of new cases and current hospitalizations among the 16 Southern and Western states which are responsible for ~80% of new cases in the US.

Cases and Hosp - 3 July.jpg



The hospitalization curve seems to match the curve of new cases. The only difference is that the rise in hospitalizations seems to lag the rise in cases by ~10 days.

Here is what you get if you shift the hospitalization curve by 11 days.

Cases and Hosp 11 day offset - 3 July.jpg

The increase in hospitalizations between June 15 and July 2 is almost an exact match of the increase in cases between June 4 and June 21. If you consider that the number of new cases in these states has more than doubled since June 21, it seems reasonable to predict that the number of hospitalizations will continue to increase, even if the 1:1 relationship with a 10 day offset doesn't continue.


EDIT: I just realized that these graphs are misleading because Florida reports new cases but not hospitalizations. If you remove Florida from the "new cases" curve you still see a relationship between increase in cases and increase in hospitalizations. However, the shift is closer to 2 weeks than 11 days.

[throatybeard]

The number of people hospitalized with COVID in the South and West has doubled since mid June and shows no signs of letting up. So, it is pretty likely that the virus is more widespread in the South and West today than it was in May.

Here is a plot of new cases and current hospitalizations among the 16 Southern and Western states which are responsible for ~80% of new cases in the US.

Cases and Hosp - 3 July.jpg



The hospitalization curve seems to match the curve of new cases. The only difference is that the rise in hospitalizations seems to lag the rise in cases by ~10 days.

Here is what you get if you shift the hospitalization curve by 11 days.

Cases and Hosp 11 day offset - 3 July.jpg

The increase in hospitalizations between June 15 and July 2 is almost an exact match of the increase in cases between June 4 and June 21. If you consider that the number of new cases in these states has more than doubled since June 21, it seems reasonable to predict that the number of hospitalizations will continue to increase, even if the 1:1 relationship with a 10 day offset doesn't continue.


EDIT: I just realized that these graphs are misleading because Florida reports new cases but not hospitalizations. If you remove Florida from the "new cases" curve you still see a relationship between increase in cases and increase in hospitalizations. However, the shift is closer to 2 weeks than 11 days.

So, how bad are things by 31 July?

[tbyers11]

From what I've read, this study is another retrospective study, so is of limited value. And, because they "very carefully selected patients", it may be that they simply picked patients who were more likely to survive (especially since they were concerned about heart side effects). But you're right, will spark another bad debate.

Agree that this is of limited value since it was a retrospective study. Earlier administration of HCQ could help but there are too many confounding variables to know if the difference was due to HCQ. They also pre-selected their patients without known heart issues to receive the HCQ. In the other studies, that caused the FDA to remove emergency use status, the increased risk of cardiac events was the big issue.

Here is a CNN link raising many of the issues and a link to the paper itself.

I don't think should get much press going forward because it is not a sound, controlled study. The fact that they administered early and found benefit could be of use to warrant a further study.

[Bob Green]

So, how bad are things by 31 July?

After Memorial Day Weekend, I asked how bad are things by July 4? Pretty darn bad.

[rsvman]

Agree that this is of limited value since it was a retrospective study. Earlier administration of HCQ could help but there are too many confounding variables to know if the difference was due to HCQ. They also pre-selected their patients without known heart issues to receive the HCQ. In the other studies, that caused the FDA to remove emergency use status, the increased risk of cardiac events was the big issue.

Here is a CNN link raising many of the issues and a link to the paper itself.

I don't think should get much press going forward because it is not a sound, controlled study. The fact that they administered early and found benefit could be of use to warrant a further study.

I wasn't suggesting it was a good study. I was only suggesting that, because it supported what Trump had been saying early on, I expect it to appear in one of his tweets in the very near future, if only as a 'I told you so' sort of fashion.

[MChambers]

I wasn't suggesting it was a good study. I was only suggesting that, because it supported what Trump had been saying early on, I expect it to appear in one of his tweets in the very near future, if only as a 'I told you so' sort of fashion.

Exactly. And it will be picked up with enthusiasm by some of the media (you know who).