PlagueWatch 2020-23 - Coronavirus

[MChambers]

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.

And (I think) not factoring shortages of PPE, which is still a big problem, from what I read.

[sagegrouse]

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

"[DBR] Will Always Do the Right Thing — After Exhausting All the Alternatives." -- Falsely attributed to Winston Churchill, although something similar was said by Israeli UN Ambassador Abba Eban

[MChambers]

Here's a scary story from the South China Morning Post:

"A new study by one of China’s top scientists has found the ability of the new coronavirus to mutate has been vastly underestimated and different strains may account for different impacts of the disease in various parts of the world."

https://www.scmp.com/news/china/scie...-chinese-study

I don't know enough to judge the study or its implications, except to know that this isn't good. How bad I can't say.

[Kdogg]

Here's a scary story from the South China Morning Post:

"A new study by one of China’s top scientists has found the ability of the new coronavirus to mutate has been vastly underestimated and different strains may account for different impacts of the disease in various parts of the world."

https://www.scmp.com/news/china/scie...-chinese-study

I don't know enough to judge the study or its implications, except to know that this isn't good. How bad I can't say.

That door swings both ways. Some tentative reports that a weakened strain is popping up in the US. Not must hard data yet.

[JasonEvans]

A poster who had been banned from this thread posted something interesting this morning. He was given a serious infraction and his post was deleted because those are the consequences for repeatedly flaunting the rules laid out by the moderators, but I still wanted folks to see his otherwise informative post.

We are now at full capacity production of Covid-19 Tests. We are producing millions of these test kits each week. We already had emergency authorization to use these tests in the US, but have now been granted similar concessions in almost every country across the globe.

We also have several vaccine candidates that are already in the human trial testing faze. We provided a purification solution for one of the most promising vaccine candidates which is an mRNA vaccine. It is undergoing human trials at the U.S. National Institutes of Health, and we are also providing the clinical trials for that effort. For those that don't know, here is some info on what mRNA vaccines are, and why they are important in the fight against infectious disease, and what they could mean for the future for diseases such as cancer. https://www.phgfoundation.org/briefing/rna-vaccines

Also, in partnership with Gilead Sciences, we have almost reached full capacity production of the antiviral drug Remdesivir, which has shown promise for treatment of patients with Covid-19 in small sample sizes.

Help is on the way.

[MChambers]

Interesting article from Reuters about people who recover yet still test positive, weeks or months later. https://www.reuters.com/article/us-h...-idUSKCN2240HI

[Bostondevil]

Does anybody really believe we will be at only 60,000 deaths in the US by August anymore?

[CDu]

Does anybody really believe we will be at only 60,000 deaths in the US by August anymore?

Yeah, the UW model is getting a ton of pub. But so far it has generally been underestimating things over the past few weeks. Italy, Spain, and France have all now already exceeded the death tolls that the UW model had previously projected as of a week ago, and are still going strong. So while the model appears to do a decent job of identifying when peaks will arise, it doesn’t appear to handle the “after peak is reached” very well. So it is hard to take the 66,000 projected deaths by August as very likely.

Also worth noting that the estimates assume full social distancing through May 31, which simply isn’t going to happen. Just want to be fair to those researchers as they fully acknowledge that assumption’s limitation.

Also worth noting that it doesn’t consider the second wave problem at all (again, a noted limitation from the authors).

[sagegrouse]

A poster who had been banned from this thread posted something interesting this morning. He was given a serious infraction and his post was deleted because those are the consequences for repeatedly flaunting the rules laid out by the moderators, but I still wanted folks to see his otherwise informative post.

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See, DBR is good! -- Even those who can't make the cut produce better-informed material than found anywhere else.

[MChambers]

Does anybody really believe we will be at only 60,000 deaths in the US by August anymore?

I'll take the over.

[Bostondevil]

I'll take the over.

Yeah. That's the smart but sad bet.

[Troublemaker]

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.

That's to be expected given their divergent and highly-criticized strategy. The question is what their per-capita death rate will be compared to their neighbors by the time a vaccine is widely available in 2021. From what I am reading...

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.

... and I thank everyone who has responded, Sweden is a huge underdog but there is a narrow pathway for them to come out ahead of their neighbors.

Essentially:
(1) Sweden's health care system must not be overwhelmed (yes, including staff) during the first wave.
(2) Sweden attains herd immunity before the second wave while their neighbors lag far behind in attaining herd immunity.
(3) Their neighbors' health care system *is* overwhelmed during the second wave of Covid-19 in combination with the flu while Sweden enjoys the benefits of herd immunity and isn't overwhelmed.

As far as I can tell.

[CDu]

That's to be expected given their divergent and highly-criticized strategy. The question is what their per-capita death rate will be compared to their neighbors by the time a vaccine is widely available in 2021. From what I am reading...



... and I thank everyone who has responded, Sweden is a huge underdog but there is a narrow pathway for them to come out ahead of their neighbors.

Essentially:
(1) Sweden's health care system must not be overwhelmed (yes, including staff) during the first wave.
(2) Sweden attains herd immunity before the second wave while their neighbors lag far behind in attaining herd immunity.
(3) Their neighbors' health care system *is* overwhelmed during the second wave of Covid-19 in combination with the flu while Sweden enjoys the benefits of herd immunity and isn't overwhelmed.

As far as I can tell.

I think it is an even bigger underdog scenario than you lay out, actually. Even in that scenario, it's hard to see how they come out ahead.

In order to achieve herd immunity, they'd essentially have to max out on cases in the first wave. That would mean that in order to catch up, their neighbors would have to max out in the second wave. In which case, they'd end up with about the same case load (per capita). Only in those who experience their "maxing out" during the second wave will have the advantage of better prep. Also, the second wave would probably be less impactful because those other countries would be starting from a nonzero point in partial immunity, whereas Sweden is starting from scratch right now.

Basically, it's hard to see how a scenario exists where Sweden would be not overwhelmed by reaching herd immunity during the first wave (in which we don't have good knowledge of the disease nor a good treatment and no prior immunity) but their neighbors would be overwhelmed in the second wave (in which we start with some prior immunity and hopefully are better prepared and hopefully have a treatment).

[DU82]

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

There were two other ships that docked this week. The Pacific Princess (not the same ship that was the Love Boat) finally docked in LA after ending its around the world tour early. (Most of its passengers got off in Australia, the remainder couldn’t fly home because of other medical reasons.). The MSC Magnifica, which started out from Genoa in January, also on a long tour, finally docked in France.

[sagegrouse]

That's to be expected given their divergent and highly-criticized strategy. The question is what their per-capita death rate will be compared to their neighbors by the time a vaccine is widely available in 2021. From what I am reading...



... and I thank everyone who has responded, Sweden is a huge underdog but there is a narrow pathway for them to come out ahead of their neighbors.

Essentially:
(1) Sweden's health care system must not be overwhelmed (yes, including staff) during the first wave.
(2) Sweden attains herd immunity before the second wave while their neighbors lag far behind in attaining herd immunity.
(3) Their neighbors' health care system *is* overwhelmed during the second wave of Covid-19 in combination with the flu while Sweden enjoys the benefits of herd immunity and isn't overwhelmed.

As far as I can tell.

The other benefit of delay is the potential for better means of treatment, possibly even effective therapies, resulting in fewer serious cases and a much lower death rate. I suppose this argues against the approach taken by Sweden.

[Indoor66]

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

I understand that but the pain issue is the same and the denial of all elective surgery has its negative consequenses well.

[OldPhiKap]

I hope this has not impacted the schedule of the Swedish Bikini Team. We need sports back on television, pronto.

[JasonEvans]

BD80, please re-post your now deleted comment without the obvious political references. Your point about contact tracing and privacy can be made without politics. Thanks!

[budwom]

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.

There was a really good article by a Harvard professor of exposure and assessment science who made the point that many of the articles about (for example) how the virus can remain on surfaces for days is very misleading...it was linked here and discussed I believe... There is a huge difference between the virus being detectable and transmissible. By and large he made the case that it takes some pretty direct sneezing or coughing on your UPS package to pose much of a threat.

There's a lot of advice now (which we've been following) that a lot of stuff you bring home, or get delivered, can just be set aside for a day or two doing its own quarantine thing...the point being that this can explain why taking in supplies for that ship didn't result in a virus outbreak...in fact, here's the article from WaPo...https://www.washingtonpost.com/opini...ting-packages/

[YmoBeThere]

A question for the crowd. I know it has been emphasized again and again that testing is a key element to managing the impact of Covid-19. In an ideal scenario, what does that look like? Who gets tested? What type of test? How many people tested? How often is there follow-up if any?

I ask as I've heard continuous announcements of such and such a company developing a new test that does X, Y, and Z. But it isn't clear to me when these things can actually get to scale to be useful. I am not belittling an entities efforts to get to 1 million test kits produced per month etc., I just have no idea if that is meaningful or inadequate based on the testing regimen. Any thoughts are appreciated!

If it has been answered already, please let me know.