PlagueWatch 2020-23 - Coronavirus

[moonpie23]

i guess we're gonna need some tweaks to that facial recognition software, huh?

[swood1000]

My, um, understanding, um, from a friend … is that the issue there is taxation. It wasn't illegal to purchase as a non-resident, it was illegal to import into another state without paying taxes.

I mean, I think I heard my friend say something like that. And certain quantities were allowed, up to 5 fifths or gallons. It's been a long time since I, um, heard my friend talk about this.

A friend of my father once had his car confiscated for driving from Ohio across to Kentucky to buy liquor and back. Don't know if they still do that but I think that "civil forfeiture" is still a thing.

[left_hook_lacey]

Golf courses still open here in Virginia, too. Played nine holes yesterday.

I walk pushing a cart, so no contact with the carts. The holes have been raised up out of the ground about 3 inches, so there is a ring (looks like duct tape) where the hole used to be. When the ball hits the ring it is considered holed. Therefore, nobody touches the flagstick. The ball washers are all covered with plastic bags. No drinking water on the course (I bring a big container of water that fits perfectly into a cupholder on my push cart, so no problem for me).

It's in the open air. I touch only my own golf clubs, golf balls, and tees. I see the risk as EXTREMELY low. And, it's good for the soul (except that I missed an 8-foot putt for birdie on the fourth hole; that one stung a bit).

Same here. My course has cylinder foam wrappings around the flag stick that fill the hole about 2/3 of the way up. This way you can get the sensation of it going in, without having to stick your hand in the hole or run on the stick.

I use a cart, but I bring wipes and hand sanitizer. Wipe the seat and steering wheel before we play.

[Tripping William]

Golf courses still open here in Virginia, too. Played nine holes yesterday.

I walk pushing a cart, so no contact with the carts. The holes have been raised up out of the ground about 3 inches, so there is a ring (looks like duct tape) where the hole used to be. When the ball hits the ring it is considered holed. Therefore, nobody touches the flagstick. The ball washers are all covered with plastic bags. No drinking water on the course (I bring a big container of water that fits perfectly into a cupholder on my push cart, so no problem for me).

It's in the open air. I touch only my own golf clubs, golf balls, and tees. I see the risk as EXTREMELY low. And, it's good for the soul (except that I missed an 8-foot putt for birdie on the fourth hole; that one stung a bit).

Courses remain open here in NC as well. Our governor's stay-at-home order expressly lists "golfing" as a permitted "outdoor activity." Similar restrictions, although many courses have put either some PVC pipe or a part of a pool noodle in the cup, so you can still hole-out but not have to put your hand clear down in the cup. At our home course, we don't even have to go into the pro shop; we just walk to the 1st or 10th tee to walk our nine. Other courses are taking payment over the phone, so you just have to yell into the shop and tell them you're there and ready to tee off. It has been a godsend; "good for the soul" is an understatement.

[Kdogg]

Golf courses still open here in Virginia, too. Played nine holes yesterday.

I walk pushing a cart, so no contact with the carts. The holes have been raised up out of the ground about 3 inches, so there is a ring (looks like duct tape) where the hole used to be. When the ball hits the ring it is considered holed. Therefore, nobody touches the flagstick. The ball washers are all covered with plastic bags. No drinking water on the course (I bring a big container of water that fits perfectly into a cupholder on my push cart, so no problem for me).

It's in the open air. I touch only my own golf clubs, golf balls, and tees. I see the risk as EXTREMELY low. And, it's good for the soul (except that I missed an 8-foot putt for birdie on the fourth hole; that one stung a bit).

Glad they are taking precautions but the courses in my area have only done some of those things. They have eliminated most of the common touched surfaces like your courses except the flag sticks. Most only serve bagged lunches too. The majority of our golfers this time of year are tourists though. They give one cart per person now but those golfers still pile out together on each tee box instead of waiting in the cart until it’s their turn. Plus although hotels, rental houses and condos are all closed we have a lot of out of state golfers going through. Apparently they all are “visiting relatives.”

[BD80]

Golf courses still open here in Virginia, too. Played nine holes yesterday.

I walk pushing a cart, so no contact with the carts. The holes have been raised up out of the ground about 3 inches, so there is a ring (looks like duct tape) where the hole used to be. When the ball hits the ring it is considered holed. Therefore, nobody touches the flagstick. The ball washers are all covered with plastic bags. No drinking water on the course (I bring a big container of water that fits perfectly into a cupholder on my push cart, so no problem for me).

It's in the open air. I touch only my own golf clubs, golf balls, and tees. I see the risk as EXTREMELY low. And, it's good for the soul (except that I missed an 8-foot putt for birdie on the fourth hole; that one stung a bit).

Same here. My course has cylinder foam wrappings around the flag stick that fill the hole about 2/3 of the way up. This way you can get the sensation of it going in, without having to stick your hand in the hole or run on the stick.

I use a cart, but I bring wipes and hand sanitizer. Wipe the seat and steering wheel before we play.

Courses remain open here in NC as well. Our governor's stay-at-home order expressly lists "golfing" as a permitted "outdoor activity." Similar restrictions, although many courses have put either some PVC pipe or a part of a pool noodle in the cup, so you can still hole-out but not have to put your hand clear down in the cup. At our home course, we don't even have to go into the pro shop; we just walk to the 1st or 10th tee to walk our nine. Other courses are taking payment over the phone, so you just have to yell into the shop and tell them you're there and ready to tee off. It has been a godsend; "good for the soul" is an understatement.

You want to see "social distancing?" Watch me play golf.

I'll go into the woods, into streams, opposing fairways, and sandtraps. I'm more likely to encounter a rabid squirrel than the corona virus. Problem is, my putter and wedge are particularly dedicated to social distancing.

[devildeac]

Golf courses still open here in Virginia, too. Played nine holes yesterday.

I walk pushing a cart, so no contact with the carts. The holes have been raised up out of the ground about 3 inches, so there is a ring (looks like duct tape) where the hole used to be. When the ball hits the ring it is considered holed. Therefore, nobody touches the flagstick. The ball washers are all covered with plastic bags. No drinking water on the course (I bring a big container of water that fits perfectly into a cupholder on my push cart, so no problem for me).

It's in the open air. I touch only my own golf clubs, golf balls, and tees. I see the risk as EXTREMELY low. And, it's good for the soul (except that I missed an 8-foot putt for birdie on the fourth hole; that one stung a bit).

If folks are "riders," they can be limited to one per cart with pre/post round wipe-downs of the vehicle. I see no problem with golf (my own ineptitude does not enter into this discussion ) unless your group congregates and/or agonizes over that 18 inch putt for eagle (or, in my case, triple bogey, at best).

[swood1000]

To be more clear: partial herd immunity helps slow the rate of growth. It is not a containment strategy though, which was my point. That, and that it's not the partial herd immunity that is deciding when it is safe to relax restrictions. It's the amount of circulating disease and surveillance capabilities.

Don’t you agree that one of the primary considerations as to when to relax restrictions concerns the likelihood of a resurgence, and that a resurgence would have less force or would be considered more manageable when 40% of the population is immune than if none of the population is immune, even if 60% immunity would constitute the herd immunity threshold? If not, then why do studies say things like:
 

• “The “partial” herd-immunity generated by past history of invasions on the host population can have a huge impact on the quantitative dynamics of the “flu” at the population level.”
• “Vaccination reduces the size of the epidemic through both direct protection of 15% of the population and indirect protection of others through partial herd immunity.”

Furthermore, here are the conditions for the relaxation of restrictions with which you said you “mostly” agree:
 

• There is a sustained reduction in cases for at least 14 days,
• Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care,
• The state is able to test all people with COVID-19 symptoms, and
• The state is able to conduct active monitoring of confirmed cases and their contacts.

If partial herd immunity helps slow the rate of growth, as you agreed, then it will be easier for the authorities to stay within hospital capacity, test all people with symptoms, and monitor all confirmed cases and their contacts, which are three of the four above conditions. Consequently, partial herd immunity is helping policymakers to decide when it is safe to relax restrictions.

You have made SEVERAL references to coronavirus relative to the flu in this thread. That is why I keep bringing it up. If you are no longer making that argument and have accepted that it is much deadlier than the flu, I'll happily stop bringing it up.

I have not discussed the flu in this topic, which has related to antibody testing and herd immunity. In this thread I have quoted statements and analysis by experts questioning whether Covid-12 is as virulent as some have proposed. In every instance they have said that the problem is the lack of data sufficient to enable us to answer the question. That remains my position as well, and will until we do antibody testing. How can “deadlier” be assessed without knowing how many people have been infected?

1. Yes, that 86% estimate is just one estimate. But it is also the highest anyone has published.

So you’re comfortable estimating the extent of asymptomatic or minor infection in a population by the largest guess that has been published to date? Then what about the two Stanford medical school professors, infectious disease and population health specialists, who proposed that if we assume that there was an epidemic seed in the U.S. on Jan. 1, then by March 9 about six million people in the U.S. would have been infected, doubling roughly every three days. What about the Oxford study modeling suggesting that in Britain there might have been a 68% infection rate by March 19? Wouldn’t both of these greatly exceed the 86% estimate? We just don’t have the data.

2. That article is a misrepresentation of the "50% of Britain" analysis. The modelers presented a series of scenarios varying key parameters, and found that in the best case scenario more than 50% of the UK has been infected. That isn't them saying "we think 50% or more have been infected," just that it is possible that over 50% have been infected if certain parameters have certain values - basically a "what if" scenario. The authors at Intelligencer have taken much more of a leap in conclusion than the modelers did.

You’re right. The study didn’t say that over 50% of Britain had been infected. It said that their modeling indicated that over 50% of Britain had been infected. Actually, the study in question said:

“Running the same model with R₀ =2.25 and the proportion of the population at risk of severe disease being distributed around 0.1%, places the start of transmission at 4 days prior to first case detection and 38 days before the first confirmed death and suggests that 68% would have been infected by 19/03/2020.”

Do you think that their assumptions were unwarranted?

3. That WSJ article by the Stanford folks that you linked is over two weeks old. At that time, less than 1,000 in the US had died of coronavirus.
In the two weeks sense then, roughly 9,000 have died. So if the disease had been sitting around in the US since January 1, then we must have an extremely lagged death rate.

Or that there are a lot more people who are asymptomatic or have only minor symptoms than many have been proposing.

Also worth noting that one of the two authors has since apparently backed off the stance of that article, per his latest Instagram post.

Of course I have no objection to accepting your characterization but could you provide a reference?

4. We do have a pretty good idea of the death rate the last few days. We don't know the case fatality rate, but we do know the death rate (deaths/day) which is what I was talking about. Over the last week, we've averaged over 1,000 dead from coronavirus per day. That is the death rate. The case fatality rate remains unknown.

Here is your statement:
 

Given the death rates the last few days, it seems safe to assume we’ll at least double our death rate among currently-active cases.

This is not a reference to deaths per day. It is a reference to deaths per currently-active cases, and we don’t know how many currently-active cases there are. We only know how many currently-active cases have come to the attention of the authorities. Excluded are the asymptomatic and minor cases.

Where have I suggested that partial herd immunity doesn't slow the spread? That is either a misunderstanding of what I said or a misrepresentation of it. It does slow the rate of increase in disease. But as I said above, it is not a means of containment, just delay.

Well, partial herd immunity helps us by slowing the spread, whereas you said that we are not helped by partial herd immunity but only if the death rate reaches the herd immunity threshold:

The only way herd immunity would help us is if the case identification rate is more like 1% (I.e., that 99% are going undiagnosed). Otherwise, the death rate is just too high to make waiting for infection-based herd immunity to save us a realistic option.

Partial herd immunity inhibits the spread of the virus, whether or not we call that containment (does containment refer only to geographic limits or can it refer to actions that slow numerical expansion). And if it spreads more slowly, then it is easier for the authorities to stay within hospital capacity, test all people with symptoms, and monitor all confirmed cases and their contacts.

[Tripping William]

You want to see "social distancing?" Watch me play golf.

I'll go into the woods, into streams, opposing fairways, and sandtraps. I'm more likely to encounter a rabid squirrel than the corona virus. Problem is, my putter and wedge are particularly dedicated to social distancing.

E9AC1D50-5E24-4241-B33F-02194EE3A90F.jpg

[AustinDevil]

Curious what the medical experts around here think of reports that plasma from those who have recovered already may be helpful:

https://www.theguardian.com/world/20...y-ill-patients

[LasVegas]

Some of y’all have a lot of time on your hands!

Doing ok here in Vegas. I’m an RN that works in the EHR department. After we made all the covid changes, I left my job to get back to the floor so I could help my fellow coworkers. Eventually I’ll return but I’m needed at the bedside now more than ever. It’s interesting how you can be gone for 5 years and hit the ground running on day one like you never left!

[Dr. Rosenrosen]

Some of y’all have a lot of time on your hands!

Doing ok here in Vegas. I’m an RN that works in the EHR department. After we made all the covid changes, I left my job to get back to the floor so I could help my fellow coworkers. Eventually I’ll return but I’m needed at the bedside now more than ever. It’s interesting how you can be gone for 5 years and hit the ground running on day one like you never left!

You are a warrior. Good luck to you!

[budwom]

Golf courses still open here in Virginia, too. Played nine holes yesterday.

I walk pushing a cart, so no contact with the carts. The holes have been raised up out of the ground about 3 inches, so there is a ring (looks like duct tape) where the hole used to be. When the ball hits the ring it is considered holed. Therefore, nobody touches the flagstick. The ball washers are all covered with plastic bags. No drinking water on the course (I bring a big container of water that fits perfectly into a cupholder on my push cart, so no problem for me).

It's in the open air. I touch only my own golf clubs, golf balls, and tees. I see the risk as EXTREMELY low. And, it's good for the soul (except that I missed an 8-foot putt for birdie on the fourth hole; that one stung a bit).

Is it true that lime green pants can ward off the virus?

[Kdogg]

Is it true that lime green pants can ward off the virus?

Is so I'm raiding John Daly's closet.

[camion]

Is it true that lime green pants can ward off the virus?

They do aid in social distancing.

Particularly if paired with a Hawaiian shirt.

[CDu]

Sigh.

Don’t you agree that one of the primary considerations as to when to relax restrictions concerns the likelihood of a resurgence, and that a resurgence would have less force or would be considered more manageable when 40% of the population is immune than if none of the population is immune, even if 60% immunity would constitute the herd immunity threshold? If not, then why do studies say things like:
 

Just to be clear, if 40% of the population has been infected, that would be quite helpful. But I don't think we're anywhere close to that number. If that were the case, we would be seeing this sustained reduction in new cases, and we'd be seeing a much higher % of positive tests than we are seeing (it's still very low nationally, despite it only being administered to symptomatic people). I think it's entirely unreasonable to suggest we are anywhere remotely near there nationwide.

I don't even think we're near that number in NYC. Even if we assume the disease is no more deadly than the flu (which, see below, seems a bad assumption), that would suggest we are only at around maybe 5% of the total US population infected. I don't even think we are at that level. But even if we are at 5%, you'd be needing this thing to be A LOT less deadly than the flu in order for the infection rate to reach 40% of the population without it killing a TON of people.

For reference, the flu hits less than 15% of the US population annually on average, and kills on average around 35,000 annually. You do NOT want 40% of the population to get infected COVID, even if it has the same case fatality rate as the flu. That would mean a death toll of more than 100K, and that's assuming the disease then stopped spreading beyond that 40% infection rate.

As for your quote above, it needs context due to the differences from the flu. Again, I'm talking about things in terms of a containment strategy, not a delay strategy. Flu herd immunity comes from a few different things:
1. Prior exposure providing partial immunity
2. Additional partial immunity from vaccination
3. A low R_0

Flu-based herd immunity benefits are much easier to achieve because of the combination of the above. Some people are inherently not going to get the flu because they had it last year or the year before and have maintained some immunity to the current strain. Some people are not going to get it because they got vaccinated. And because it has a pretty low R_0 to begin with, it doesn't take much partial immunity for the virus to be contained.

For COVID, we don't have prior exposure to it, we don't have a vaccination, and it doesn't have a low R_0. So, none of the factors that help lower the bar to reaching the flu HIT are applicable here. As a result, partial herd immunity in the case of COVID just slows down the time to reaching herd immunity (~60-70% infected, based on current estimates of R_0) at the population level. That is by definition not a containment strategy - it still has everyone who could get it actually getting it, just over a longer time frame. Will partial immunity slow down the rate at which we get to full spread of the disease? Absolutely. Never any disagreement there. But if the goal is to avoid hundreds of thousands of deaths, relying on partial herd immunity is not the way to do it.

Furthermore, here are the conditions for the relaxation of restrictions with which you said you “mostly” agree:
 

• There is a sustained reduction in cases for at least 14 days,
• Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care,
• The state is able to test all people with COVID-19 symptoms, and
• The state is able to conduct active monitoring of confirmed cases and their contacts.

If partial herd immunity helps slow the rate of growth, as you agreed, then it will be easier for the authorities to stay within hospital capacity, test all people with symptoms, and monitor all confirmed cases and their contacts, which are three of the four above conditions. Consequently, partial herd immunity is helping policymakers to decide when it is safe to relax restrictions.

Partial immunity doesn't slow it down THAT much, unless you are already close to the HIT (which we almost assuredly are not). And again, it's not partial herd immunity that is helping policymakers decide when it is safe to relax restrictions. It is clear evidence of containment: 14 straight days of declining incidence; sufficient testing to be able to trust that declining incidence; sufficient healthcare resources; sufficient surveillance. The first and third bullets are pretty crucial in concert, and neither has to do with partial immunity. They are all about containment. Because if we see 14 days of declining case loads, the disease will pretty clearly be in the containment phase (pretty much all the models suggest that the dropoff during containment is pretty quick).

I have not discussed the flu in this topic, which has related to antibody testing and herd immunity. In this thread I have quoted statements and analysis by experts questioning whether Covid-12 is as virulent as some have proposed. In every instance they have said that the problem is the lack of data sufficient to enable us to answer the question. That remains my position as well, and will until we do antibody testing. How can “deadlier” be assessed without knowing how many people have been infected?

I didn't say you discussed in this topic. My point was that you have repeatedly in this THREAD compared COVID with the flu. My sense is that this is just a continuation of that belief, even though you have not explicitly said so. That's why I brought it up. If you've chosen to back off the characterization that COVID is no more deadly than the flu, I'll stop bringing it up.

But as for the data, the most complete picture we have in terms of the case fatality rate is from that cruise ship. They tested ~80% of the 3700 people on the ship for infection, and based on their data they found a case fatality rate of about 1.5%. We also have data from Germany, which has probably the most extensive testing of any country, and so far has a case fatality rate of about 1.5%. Even if we assume those are overestimates, I sincerely doubt they are overestimates by a factor of 10. Well, the cruise ship inherently cannot be an overestimate by more than ~20%, though it is a small sample size.

But, frankly, they are MUCH better estimates than any evidence that suggests the contrary (which is virtually nonexistent). We also have seen the health care systems in very well-established places get wrecked by the virus, something that doesn't happen with the flu, further suggesting it is more deadly. So why exactly have you been holding out on the idea that the case fatality rate is indeed higher than for the flu? Because of a couple of contrarian thought-pieces from 2-3 weeks ago (including one from an author who appears to have backed off that stance)?

So you’re comfortable estimating the extent of asymptomatic or minor infection in a population by the largest guess that has been published to date?

Then what about the two Stanford medical school professors, infectious disease and population health specialists, who proposed that if we assume that there was an epidemic seed in the U.S. on Jan. 1, then by March 9 about six million people in the U.S. would have been infected, doubling roughly every three days. What about the Oxford study modeling suggesting that in Britain there might have been a 68% infection rate by March 19? Wouldn’t both of these greatly exceed the 86% estimate? We just don’t have the data.

The [UK] study didn’t say that over 50% of Britain had been infected. It said that their modeling indicated that over 50% of Britain had been infected. Actually, the study in question said:

Do you think that their assumptions were unwarranted?

As I can't read all of their assumptions, I can't comment more definitively - only suspicions. I have no idea if either set of researchers have varied R with increases in cases or not (remember: as you noted above, R goes down with more infections) in their "what if" scenarios. I can say that, in the case of the UK, holding R at 2.25 and risk rate at 0.1% would eventually be incorrect. Especially so after you hit around 30% of the population infected.

I can't say with certainty that they didn't vary R and the risk rate. But I suspect that they didn't, as they were "what if" analyses. And if so, then yeah, I think those analyses are wildly overestimating the number of cases present.

Or that there are a lot more people who are asymptomatic or have only minor symptoms than many have been proposing.

No, the spiking death rate (per day, to be 100% clear) disagrees with the theory that we have had a ton of cases going back to December/January. It just doesn't add up mathematically. The deaths would have to have been happening much sooner. Unless you conveniently assume that only the asymptomatic people were getting it first, which defies common sense.

Just to be clear: I absolutely do not think the death rate is 3%, which is roughly what our death/case data would suggest. But I sincerely doubt that the actual cases are an order of magnitude greater.

Here is your statement: [my quote]

This is not a reference to deaths per day. It is a reference to deaths per currently-active cases, and we don’t know how many currently-active cases there are. We only know how many currently-active cases have come to the attention of the authorities. Excluded are the asymptomatic and minor cases.

Yes, it most certainly WAS a reference to deaths per day. Please don't attempt to correct me on what I was saying: I know what I was saying, you are only inferring what I was saying. I was saying we know the death rate per day has been increasing over the last week (it has). And that since death is a lagging statistic for cases, we know that many more deaths are coming given the number of newly-identified cases in recent days. So if you are estimating a case fatality rate on the data today, it's going to underestimate because many of the cases haven't resolved (meaning there will be more deaths added to that calculation

I'm sorry that you didn't understand what I was saying. But you clearly didn't understand what I was saying.

Well, partial herd immunity helps us by slowing the spread, whereas you said that we are not helped by partial herd immunity but only if the death rate reaches the herd immunity threshold:

Allow me to finish that thought, since you have misinterpreted my point. Partial immunity slows things down some, but it doesn't help us to reduce the case count and death count. It just spreads out the case count and death count. It is not a containment strategy once outbreak has occurred. Absent a vaccine or incredibly thorough testing and surveillance, it just delays the point at which we reach full herd immunity.

By comparison, the goal of full social distancing is to reduce R to under 1. Keep R below 1 long enough and the disease essentially runs out of circulation. THAT is containment, and in the absence of a vaccine or an effective treatment for a virus with this R_0, that is really the only strategy for containment. Anything else is just delaying the time until we get to the HIT (in COVID's case, 60-70% of the population infected).

[swood1000]

This definitely isn’t how they do it in the US. The CDC website lays out how they do it for flu. It is a series of calculations based off of flu hospitalizations (to estimate hospitalized deaths due to the flu) and death certificates (to estimate nonhospitalized flu deaths). So the death counts you are seeing now for the US are almost certainly underestimates (because we probably don’t have all the nonhospitalized deaths) and not overestimates.

The CDC, on the web page How CDC Estimates the Burden of Seasonal Influenza in the U.S., says

The methods used to calculate the burden of influenza have been described previously (1-2).

They give two footnotes. One of them is a reference to Annual estimates of the burden of seasonal influenza in the United States: A tool for strengthening influenza surveillance and preparedness which says:

Estimates of the burden of seasonal influenza in the United States have evolved over time. …Changes were also made to the methods used to generate estimate of influenza burden. Statistical models were initially used to estimate excess deaths and hospitalizations, those that occur above what is predicted based on historical trends.1, 5, 6 During the 2009 H1N1 pandemic, there was a move toward using a multiplier that could extrapolate rates of hospitalization to rates of less severe disease.

Key here is the notion of “excess deaths” which refers to “those that occur above what is predicted based on historical trends.” Later in the article they explain further:

Estimates of excess deaths related to influenza were based on a statistical model of the weekly number of deaths obtained from the National Center for Health Statistics.16 The model accounts for seasonal trends in mortality and weekly circulation of influenza and respiratory syncytial virus, obtained from national virologic surveillance.16, 17

For a further definition of “excess mortality” see Interpreting and using mortality data in humanitarian emergencies - A primer for non-epidemiologists which refers to mortality rate (MR):

MRs describe the frequency with which deaths are occurring in a given population over a given time. If these are higher than the expected (baseline) MR in non-crisis conditions in that population, we can say that the difference between observed crisis and expected non-crisis MRs represents excess mortality, i.e. the mortality attributable to the crisis, above and beyond deaths that would have occurred in normal conditions.

So, this definitely is how they do it in the U.S. Yes, one of the problems they are trying to overcome is the inaccuracy of testing and reporting but that inaccuracy does not always skew toward underreporting. The number “predicted based on historical trends” includes those who died of old age. When they calculate “excess” deaths they are finding the number of deaths in excess of a number that includes those dying of old age. After all, the probability that an eighty year old will die during the year is over 4%.

So if they used this approach to estimate annual flu deaths, there would be by definition years in which the flu kills a negative number of people.

No, it is one component of a complex statistical calculation. It’s not a simple actual minus expected. I think I made that clear.

[JasonEvans]

The Secretary of the Navy has resigned after being blasted on all sides for his dressing down of Captain Crozier.

https://www.cnn.com/2020/04/07/polit...ump/index.html

-Jason "the lesson here is clearly, 'Don't mess with a guy who commands a nuclear powered floating airport'" Evans

[CDu]

The CDC, on the web page How CDC Estimates the Burden of Seasonal Influenza in the U.S., says



They give two footnotes. One of them is a reference to Annual estimates of the burden of seasonal influenza in the United States: A tool for strengthening influenza surveillance and preparedness

It's funny that you have identified the right articles... but come to the wrong conclusions from them. One of the quotes you reference is an incomplete thought from the article:

Estimates of excess deaths related to influenza were based on a statistical model of the weekly number of deaths obtained from the National Center for Health Statistics.16 The model accounts for seasonal trends in mortality and weekly circulation of influenza and respiratory syncytial virus, obtained from national virologic surveillance.16, 17

The quote here misses the target. Here is the rest of that paragraph:

Estimates of excess deaths related to influenza were based on a statistical model of the weekly number of deaths obtained from the National Center for Health Statistics.16 The model accounts for seasonal trends in mortality and weekly circulation of influenza and respiratory syncytial virus, obtained from national virologic surveillance.16, 17 The model was fitted using Markov chain Monte Carlo methods, yielding “point estimates” (mean or median of the empirical posterior distribution) and “confidence intervals” (95% credible intervals) for the number of deaths attributable to influenza. Data on deaths with pneumonia or influenza listed as a cause of death were used in the statistical model because they are available in near real time. However, most influenza‐related deaths are likely not due directly to influenza virus infection but may be due to secondary bacterial infection or worsening of underlying chronic health conditions, such as chronic heart or lung disease. Even when influenza likely contributed to the events leading to a death, it may not be recognized and is rarely listed on the death certificate. From prior analyses, the number of deaths associated with influenza may be two to four times higher than the number of deaths related to influenza that have pneumonia or influenza listed on the death certificate.7, 18 Deaths with any respiratory or circulatory causes listed on the death certificate are likely more inclusive of deaths related to influenza than deaths with pneumonia or influenza causes; therefore, additional statistical models were created using death from respiratory or circulatory causes. Data on respiratory and circulatory deaths were available with a 3 year lag; therefore, in 2016, data were available and summarized for the 2010‐2011 season through the 2013‐2014 season only.

The modeling is done to account for missed deaths. From the Reed article sited by the article you're quoting:

The under-detection of influenza hospitalizations and deaths has traditionally been accounted for using statistical methods to model excess morbidity and mortality attributable to influenza using data from death certificates and medical encounters such as hospital discharge records. These methods have been widely used over the past few decades in the United States (U.S.) and many other countries, but the data necessary to make estimates are often not available for 2–3 years following an influenza season.

The models aren't doing what you think they are doing. They are taking the data that is given and adjusting UPwards to account for data that are missed simply by looking at hospital records and death certificates. So while the current data may be wrong, they are going to be HIGHER than what is currently being reported once folks model it out in 2-3 years.

Side note: the total number of cases will also be much higher once they model it out, of course. But don't expect to see the data get decreased. The modeling is done to address UNDERreporting, not overestimates.

Here's the full quote from the CDC site:

The methods to estimate the annual number of influenza-associated deaths have been described in detail elsewhere (1-2). The model uses a ratio of deaths-to-hospitalizations in order to estimate the total influenza-associated deaths from the estimated number of influenza-associated hospitalizations.

We first look at how many in-hospital deaths were observed in FluSurv-NET. The in-hospital deaths are adjusted for under-detection of influenza using methods similar to those described above for hospitalizations using data on the frequency and sensitivity of influenza testing. Second, because not all deaths related to influenza occur in the hospital, we use death certificate data to estimate how likely deaths are to occur outside the hospital. We look at death certificates that have pneumonia or influenza causes (P&I), other respiratory and circulatory causes (R&C), or other non-respiratory, non-circulatory causes of death, because deaths related to influenza may not have influenza listed as a cause of death. We use information on the causes of death from FluSurv-NET to determine the mixture of P&I, R&C, and other coded deaths to include in our investigation of death certificate data. Finally, once we estimate the proportion of influenza-associated deaths that occurred outside of the hospital, we can estimate the deaths-to-hospitalization ratio.

Data needed to estimate influenza-associated deaths may lag for up to two years after the season ends. When this is not yet available for the season being estimated, we adjust based on values observed in prior seasons (e.g., the 2010-2011 season through the 2016-2017 season) and update the estimates when more current data become available.

There are the estimated deaths (which is what the CDC reports) and then there are excess deaths (which are an estimate of how much worse a particular year is - like the H1N1 year). The latter is useful when dealing with a particularly bad year of a virus. But the "deaths" that you see from the CDC (which average around 35,000 annually over the past decade) are deaths, not "excess deaths". And the death data that you'll see in 2-3 years for COVID are only likely to be higher than what is currently reported.

[Devilwin]

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They have closed most of the beaches to surf fishing, and all of the piers. So you can play golf, and not surf fish? Somebody explain that to me. Inland fishing is still ok.