PlagueWatch 2020-23 - Coronavirus

[CDu]

"At least two people who died in early and mid-February had contracted the novel coronavirus, health officials in California said Tuesday, signaling that the virus may have spread — and claimed lives — in the United States weeks earlier than previously thought."

https://www.washingtonpost.com/natio...st-california/

If this is correct (and seems very likely to be so), then maybe that Santa Clara study, though flawed, has quite a bit of truth in it.

Just to be clear again: it is almost certainly true that there are WAY more people who have been infected than we know about. Many researchers think that the case fatality rate is in the 0.5-1.5% range, which would imply that there have been 3-10 times as many cases as have been reported. It is also true that the Santa Clara study was crap science, and thus their “50- to 80-fold“ estimate is very likely crap.

[CDu]

https://www.usnews.com/news/health-n...treat-covid-19

TUESDAY, April 21, 2020 (HealthDay News) -- Preliminary data from two clinical trials using the antiviral drug remdesivir to treat COVID-19 patients is encouraging, researchers report.

And this is where we should probably be placing our hope: on a treatment reducing the severity of outcomes.

[aimo]

Here's an unreviewed, pre-print of a study looking at hydroxychloroquine, with and without azithromycin.

"In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs."

https://www.medrxiv.org/content/10.1...920v1.full.pdf

Maybe folks who need hydroxychloroquine for lupus will be able to fill their prescriptions.

This article mentions nothing of the patients' other comorbidities, which are highly prevalent in the VA population.

[CrazyNotCrazie]

New York is allowing for partial re-opening of upstate hospitals (away from NY City) for elective surgery with detailed guidelines. I assume "elective surgery" means procedures that have medical needs but just aren't critical, rather than cosmetic surgery, etc.?

https://www.bloomberg.com/news/artic...ective-surgery

[CDu]

This article mentions nothing of the patients' other comorbidities, which are highly prevalent in the VA population.

The other comorbidities are not really a concern, as everyone in the study (both arms) were from the VA. Also, they specifically control for comorbidities and other demographic and clinical characteristics. So that is a non-issue.

The bigger concern is that it was not a randomized study but rather a retrospective analysis. So they can’t easily control for physician’s decisions. If there was something systematic in the physician’s decision to treat with hydroxylchloroquine, and if that isn’t being captured in one of the other covariates, then the results could be biased. They do the best they can in controlling for lab results and comorbidities and other clinical factors, but it is unlikely that they have captured all of the variance associated with physician decision.

I will add, though, that they do control for severity, and they did find no difference in ventilator use as an outcome. So it is quite possible that the death result is somewhat real.

[Bostondevil]

New York is allowing for partial re-opening of upstate hospitals (away from NY City) for elective surgery with detailed guidelines. I assume "elective surgery" means procedures that have medical needs but just aren't critical, rather than cosmetic surgery, etc.?

https://www.bloomberg.com/news/artic...ective-surgery

Yes. Elective surgery is pretty much anything that isn't emergency surgery. It's anything that can wait until you and your surgeon think it's a good time to do it. Knee replacement, cataract surgery, CABG - all elective procedures, for example.

[Indoor66]

Yes. Elective surgery is pretty much anything that isn't emergency surgery. It's anything that can wait until you and your surgeon think it's a good time to do it. Knee replacement, cataract surgery, CABG - all elective procedures, for example.

It is a lot less elective if you are suffering the pain.

[Bostondevil]

It is a lot less elective if you are suffering the pain.

In medical parlance, elective is about scheduling, not necessity.

[MChambers]

Just to be clear again: it is almost certainly true that there are WAY more people who have been infected than we know about. Many researchers think that the case fatality rate is in the 0.5-1.5% range, which would imply that there have been 3-10 times as many cases as have been reported. It is also true that the Santa Clara study was crap science, and thus their “50- to 80-fold“ estimate is very likely crap.

No argument from me on the flaws of that study, but if the virus was spreading in early February (or even late January) in Santa Clara, it does explain why the infection rate there could have been quite high.

[CameronBornAndBred]

This will be one of hundreds of bands cancelling tours, but Dead & Company is one of the first big ones to shut their Summer down.


https://www.billboard.com/articles/c...20-summer-tour

[JasonEvans]

I posted something from a local Atlanta journalist last night that has some pretty scathing allegations in it. Because the author was a journalist, I gave it more credibility than it probably deserved. It has been pointed out that the claims this journalist made were clearly biased and partisan. As a result, I have deleted my post and the replies to it. Sorry about that.

[jv001]

I posted something from a local Atlanta journalist last night that has some pretty scathing allegations in it. Because the author was a journalist, I gave it more credibility than it probably deserved. It has been pointed out that the claims this journalist made were clearly biased and partisan. As a result, I have deleted my post and the replies to it. Sorry about that.

Jason, I respect you for doing that. I don't put much stock into facebook posts slanted toward either party. Way too many made up claims.

GoDuke!

[Troublemaker]

Re: Sweden's fascinating approach to Covid-19, would the below be accurate?

The problem is that at their projected peak (https://covid19.healthdata.org/sweden ), there will be bed, ICU, and maybe ventilator shortages. However, *if* it were the case that Sweden's health care system is never overwhelmed, they would end up with approximately the same number of deaths as if they had tried to flatten the curve? That is, they're just taking the hit upfront rather than spreading it out?

Now that I'm typing this out, I'm guessing there are (at least) three more factors in play:
(1) Knowledge of how to treat Covid-19 improves over time. It's not just about not overwhelming the medical system. Protocols for treatment in July will presumably be better than protocols for treatment in March/April, for example. The upfront load of patients will not get the benefit of knowledge gained.
(2) Likewise, therapeutic treatments can be developed over time. If, for example, remdesivir turns out to be a gamechanger, many of Sweden's cases won't receive the benefit of that.
(3) Second wave impacts. If, for example, it's true that Covid-19 will return in a major way in fall/winter and cause lots of problems since at the same time the flu will be spreading, Sweden could be in a much better place than other countries if they have already achieved or are much further along in achieving herd immunity.

[BD80]

I posted something from a local Atlanta journalist last night that has some pretty scathing allegations in it. Because the author was a journalist, I gave it more credibility than it probably deserved. It has been pointed out that the claims this journalist made were clearly biased and partisan. As a result, I have deleted my post and the replies to it. Sorry about that.

Kudos. It says a lot about this board that the rules are applied evenhandedly.


The post was very thought provoking, and prompted me to take a deeper look into the Georgia executive orders. Does anyone have a cite to the two orders, the stay at nome order that expires at the end of the month and the back to work order that goes into effect Friday that includes elective surgeries?


Hospitals in Michigan are adjusting their staffing plans daily, as covid patients are leaving and there is no other incoming "business." Hospitals in the northern metro area were never over-run, but accepted all covid patients that were available. Now, Detroit hospitals and the metro hospitals close by are not transferring any patients and even they are closing down whole floors.

[CDu]

Re: Sweden's fascinating approach to Covid-19, would the below be accurate?

The problem is that at their projected peak (https://covid19.healthdata.org/sweden ), there will be bed, ICU, and maybe ventilator shortages. However, *if* it were the case that Sweden's health care system is never overwhelmed, they would end up with approximately the same number of deaths as if they had tried to flatten the curve? That is, they're just taking the hit upfront rather than spreading it out?

Now that I'm typing this out, I'm guessing there are (at least) three more factors in play:
(1) Knowledge of how to treat Covid-19 improves over time. It's not just about not overwhelming the medical system. Protocols for treatment in July will presumably be better than protocols for treatment in March/April, for example. The upfront load of patients will not get the benefit of knowledge gained.
(2) Likewise, therapeutic treatments can be developed over time. If, for example, remdesivir turns out to be a gamechanger, many of Sweden's cases won't receive the benefit of that.
(3) Second wave impacts. If, for example, it's true that Covid-19 will return in a major way in fall/winter and cause lots of problems since at the same time the flu will be spreading, Sweden could be in a much better place than other countries if they have already achieved or are much further along in achieving herd immunity.

Absent other means of eradicating the disease (vaccine, much better case identification and isolation, etc), “flattening the curve” doesn’t necessarily prevent cases - it delays them and spreads them out. So if all you do is social distance you flatten the curve, you will likely end up somewhere near the same point in terms of cases.

That has several benefits: (1) buying time for testing and surveillance to improve, potentially allowing you to substantially reduce R (reproduction number) and help eradicate the disease and reduce cases; (2) buy time for treatments to improve so that more cases are less severe/fatal; (3) not overwhelm the healthcare system, which will help reduce the number of cases that are fatal.

It is possible that Sweden will see a less severe second wave. But that would only be true if they have a more severe first wave. If the second wave doesn’t hit until after the flattened curve countries have “caught up,” then both approaches would face a similar second wave. If the flattened curve folks haven’t caught up in cases by the start of the second wave, then by definition Sweden will have gotten a worse first wave. And as you note, that first wave will have likely have worse treatments available to them.

[bundabergdevil]

Kudos. It says a lot about this board that the rules are applied evenhandedly.


The post was very thought provoking, and prompted me to take a deeper look into the Georgia executive orders. Does anyone have a cite to the two orders, the stay at nome order that expires at the end of the month and the back to work order that goes into effect Friday that includes elective surgeries?


Hospitals in Michigan are adjusting their staffing plans daily, as covid patients are leaving and there is no other incoming "business." Hospitals in the northern metro area were never over-run, but accepted all covid patients that were available. Now, Detroit hospitals and the metro hospitals close by are not transferring any patients and even they are closing down whole floors.

I think it's safe to say that some people try to profit - be it financially or politically - from times of crisis. The current one is no different. You wish it wasn't the case but, well, humans. While I'm comfortable making that generalization, it's tough (and probably not fair) to label a specific act predatory without an awful lot of evidence.

That being said, Georgia's governor's orders are an outlier. As an example, in neighboring SC, the Governor is opening stuff up but still ceding decision to mayors with a better view of local circumstance, which makes sense and is something the GA governor specifically forbade.

[mph]

I posted something from a local Atlanta journalist last night that has some pretty scathing allegations in it. Because the author was a journalist, I gave it more credibility than it probably deserved. It has been pointed out that the claims this journalist made were clearly biased and partisan. As a result, I have deleted my post and the replies to it. Sorry about that.

Thank you Jason. And thank you for the difficult job you and the other moderators do on a daily basis, especially in threads like this.

[Bostondevil]

Absent other means of eradicating the disease (vaccine, much better case identification and isolation, etc), “flattening the curve” doesn’t necessarily prevent cases - it delays them and spreads them out. So if all you do is social distance you flatten the curve, you will likely end up somewhere near the same point in terms of cases.

That has several benefits: (1) buying time for testing and surveillance to improve, potentially allowing you to substantially reduce R (reproduction number) and help eradicate the disease and reduce cases; (2) buy time for treatments to improve so that more cases are less severe/fatal; (3) not overwhelm the healthcare system, which will help reduce the number of cases that are fatal.

It is possible that Sweden will see a less severe second wave. But that would only be true if they have a more severe first wave. If the second wave doesn’t hit until after the flattened curve countries have “caught up,” then both approaches would face a similar second wave. If the flattened curve folks haven’t caught up in cases by the start of the second wave, then by definition Sweden will have gotten a worse first wave. And as you note, that first wave will have likely have worse treatments available to them.

To add to CDu's response, an overwhelmed healthcare system leads to increased mortality from all causes. If the hospital is full of Covid patients, more people die from heart attacks and strokes and car accidents. And my big complaint with the UW models, is that they are looking at beds/equipment but not human resources. If a hospital is running at near capacity but 5-10% of their staff is home sick with Covid, then it's overwhelmed even if there are a few empty beds. I checked and here is what the UW modeling website says "The forecasts show demand for hospital services, including the availability of ventilators, general hospital beds, and ICU beds, as well as daily and cumulative deaths due to COVID-19." So no, they are not factoring in staffing with these models.

And even without factoring the human resources, the UW model is predicting that the Swedish healthcare system will be overwhelmed. Right now they are experiencing 3-6 times more deaths per 1m population than the other Scandinavian countries.

[JasonEvans]

The last huge cruise ship at sea docked on Tuesday. 1631 passengers and 900 crew members had been on board the Costa Deliziosa since January 5th. And while you may think cruising was insanely dangerous during this pandemic, the Deliziosa was actually the safest place to be on the planet. Not a single person on board contracted the coronavirus during the 115-day journey and the ship has not allowed anyone from land to come on board in many weeks.

Now all those passengers and crew have to get off and join the rest of us in our virus-laden world.

The ship's final port of call... the place where it let its passengers back into the world? Genoa, Italy.



https://www.thedailybeast.com/costa-...docks-in-italy

[AustinDevil]

The last huge cruise ship at sea docked on Tuesday. 1631 passengers and 900 crew members had been on board the Costa Deliziosa since January 5th. And while you may think cruising was insanely dangerous during this pandemic, the Deliziosa was actually the safest place to be on the planet. Not a single person on board contracted the coronavirus during the 115-day journey and the ship has not allowed anyone from land to come on board in many weeks.

Now all those passengers and crew have to get off and join the rest of us in our virus-laden world.

The ship's final port of call... the place where it let its passengers back into the world? Genoa, Italy.



https://www.thedailybeast.com/costa-...docks-in-italy

I'd be curious if any researchers look at how many times this ship must have taken on supplies from ports where the virus was present, and how that was accomplished. Despite studies showing how many days that COVID-19 RNA can be present on surfaces, it seems that there might (or might not, depending on how stringent their protocols were) be evidence here that human-to-surface-to-human transmission is vanishingly rare.