PlagueWatch 2020-23 - Coronavirus

[freshmanjs]

So, if freshmanjs' estimate is correct -- with most of us doing nothing to stop the spread of influenza, we end up with roughly the same number of hospitalizations (but not nearly the same number of deaths) as where we are right now on Covid. That is despite a large percentage of the nation observing social distancing and mask wearing on an order of magnitude unlike anything in our history. Even with those this unprecedented effort to control it, the disease is running rampant and spreading faster and faster every day.

I shudder to think of what hospitalizations and deaths would be like if we were to ease off even a little bit. I want to thank freshmanjs for providing such a convincing argument for us being even more vigilant!

- We have a significant vaccine program for influenza. That's hardly doing nothing.
- I agree we should be vigilant! Mask up!

[PackMan97]

Agree, hospitalizations is a good metric to assess severity.

According to the CDC, there were 410,000-740,000 influenza hospitalizations in the USA during the 2019-20 flu season (about 6 months).

It is very difficult to find cumulative hospitalization data on Covid-19, but based on my research, it does not appear to be significantly higher than that and may still be lower (although it is 4 months vs. 6 and the seasonality / sustained transmission within a region are unknown for Covid-19).

I guess we are back to comparing COVID-19 and the Flu.

/facepalm

[freshmanjs]

I guess we are back to comparing COVID-19 and the Flu.

/facepalm

There is nothing at all wrong with a fact based comparison of Covid-19 and flu. The dismissal of Covid-19, saying "it's just a flu" without any basis is obviously stupid and a lot of people were doing it. That is completely different from comparing hospitalization rates and societal cost of various diseases using large scale data. No one would be upset with me for saying that Covid-19 has caused more deaths than flu in that time period. People only get upset when the data doesn't say what they want it to say.

[CameronBornAndBred]

I read today that for the first time in seemingly forever, NYC went 24 hours without a death.

[Bostondevil]

We are doomed...

So, I was signing up this morning to be a volunteer in the large Phase 3 vaccine study Moderna is doing. They are running it out of Emory University and seeking volunteers in the Atlanta area. I doubt I will be chosen. The questionnaire was asking lots of stuff about your workplace and how many people you interact with. They obviously want people who are somewhat likely to be exposed because that is the best way to test the efficacy of the vaccine. Sadly for them, and good for me, I am working from home and not likely to be exposed.

Anyway, I came to a question that made me scratch my head. See if you can figure out an answer that makes sense for this. The person who designed this questionnaire is just not very smart.



So, if I answer "Yes" then I am saying I do know if someone I have been close to contracted Covid. I am not saying if they have it, I am merely saying I know if they have or have not tested positive. If I say "no" then I am saying I have no idea if people I have been close to have tested for the disease. I cannot begin to figure out what "I don't know" means as "no" and "I don't know" are the same thing here.

I know that people close to me have not tested positive for Covid. Do I check "yes" because I know the results of their Covid status or do I check "no" because they tested negative (even though "no" technically means I don't know how they tested)?

What a terribly worded question. I fear for us if these are the people trying to solve this crisis.

One of my strengths as a statistician is survey design. I can write questions that ask for the actual data the investigator wants. It is a real skill and I have it. I sometimes have to beat people (figuratively) over the head to be given permission to actually use that skill, but, when necessary, I will deliver a beating. Part of my ability involves getting the investigators to pin down exactly what it is they really want to know. If you go into a survey with only a vague idea, you will get vague answers.

[Bostondevil]

Not directly Covid related, but this is not great publicity for our alma mater:https://www.washingtonpost.com/inves...s/?arc404=true


Some very harsh words for our student health center...

I was misdiagnosed as a freshman. Luckily it was only mononucleosis but I had a particularly bad case that took them months to diagnose properly (and more months for me to recover). The Washington Post loves to pick on Duke, but Duke is hardly alone with the student health center stuff.

[budwom]

I was misdiagnosed as a freshman. Luckily it was only mononucleosis but I had a particularly bad case that took them months to diagnose properly (and more months for me to recover). The Washington Post loves to pick on Duke, but Duke is hardly alone with the student health center stuff.

Yes, they spread the blame around...what was concerning was the assertion from the young woman with cancer that Duke student health is widely viewed as being "awful." I wonder if that's true, I have no way of knowing.

[swood1000]

We are doomed...

So, I was signing up this morning to be a volunteer in the large Phase 3 vaccine study Moderna is doing. They are running it out of Emory University and seeking volunteers in the Atlanta area. I doubt I will be chosen. The questionnaire was asking lots of stuff about your workplace and how many people you interact with. They obviously want people who are somewhat likely to be exposed because that is the best way to test the efficacy of the vaccine. Sadly for them, and good for me, I am working from home and not likely to be exposed.

Anyway, I came to a question that made me scratch my head. See if you can figure out an answer that makes sense for this. The person who designed this questionnaire is just not very smart.



So, if I answer "Yes" then I am saying I do know if someone I have been close to contracted Covid. I am not saying if they have it, I am merely saying I know if they have or have not tested positive. If I say "no" then I am saying I have no idea if people I have been close to have tested for the disease. I cannot begin to figure out what "I don't know" means as "no" and "I don't know" are the same thing here.

I know that people close to me have not tested positive for Covid. Do I check "yes" because I know the results of their Covid status or do I check "no" because they tested negative (even though "no" technically means I don't know how they tested)?

What a terribly worded question. I fear for us if these are the people trying to solve this crisis.

This is really an argument against those who disparage formal rules for conventional English, claiming that languages evolve and so there should not be so much stress placed on the currently accepted technical rules, including in schools. The result is confusion and worse. Replacing “if” with “that” produces the meaning that I assume was intended.

[MarkD83]

There is nothing at all wrong with a fact based comparison of Covid-19 and flu. The dismissal of Covid-19, saying "it's just a flu" without any basis is obviously stupid and a lot of people were doing it. That is completely different from comparing hospitalization rates and societal cost of various diseases using large scale data. No one would be upset with me for saying that Covid-19 has caused more deaths than flu in that time period. People only get upset when the data doesn't say what they want it to say.

freshmanjs...the comparison of the two is very useful and appreciated.

We do need to take this several steps forward to point out the contrasts (some of which have already been pointed out numerous times in this thread).

Scientists develop yearly flu vaccines and there are therapeutics that exist to fit the flu. The flu therapeutics can be used at home and allow some percent of those that are infected from going to the hospital in order to recover.

Covid-19 has neither a vaccine or a therapeutic that can be used (at this time). Lots of promising research but I can't go into a pharmacy and ask for either a Covid-19 vaccine or medicine. The medicines that are showing promise for Covid-19 require a visit to the hospital to be administered.

In terms of prevention of Covid -19 vs the flu the sociological difference is critical.

I do not need to depend upon anyone else to feel safe from the flu. I can get a vaccine if I wish. I can also get the medicine at the pharmacy if I wish.
To feel safe from Covid-19 I need to depend upon everyone around me to....(you've heard this already).

So how much trust do we have in one another (Covid-19 issue) vs I don't need to trust other people (flu).

[swood1000]

Barbaric is a strong word, but it may not be a great decision. The study you cite looks entirely at the risk of death, and as folks have repeatedly pointed out in this thread, death is not the only bad outcome to COVID-19. Significant hospital stays and potentially long-term effects to the disease are not especially uncommon. Or, to quote another article posted up-thread:


I don't know about your school, but my kids' high school is absolutely loaded with people in the 50s age range, including many of the very best teachers in the district. Personally, I'm not happy to subject them to that. Also, I'm not terribly willing to run the experiment with my high-schoolers, given that, according to retrospective studies in France, China, and Iceland, the secondary infection rate for households of high-school-age children is 10%-15%. I'm really not all that happy to subject myself to that substantial of a chance to contract this kind of infection.

Things are quite different at the elementary level, where transmission among children 11 and under seems to be quite uncommon. One size does not fit all, even when it comes to schools.

Yes but the question was whether the offer should be made, with people deciding whether to accept it or not, with the offer increasing until staffing for the school is complete.

[CameronBlue]

Two Headlines running concurrently on CNN

California Rolls Back Reopening as Coronavirus Cases Surge

and Yahoo:

Trump identifies another hoax: The coronavirus

It's hard to fathom how we arrived at this level of dysfunction. Tomorrow should be a fun day on Wall Street.

[freshmanjs]

freshmanjs...the comparison of the two is very useful and appreciated.

We do need to take this several steps forward to point out the contrasts (some of which have already been pointed out numerous times in this thread).

Scientists develop yearly flu vaccines and there are therapeutics that exist to fit the flu. The flu therapeutics can be used at home and allow some percent of those that are infected from going to the hospital in order to recover.

Covid-19 has neither a vaccine or a therapeutic that can be used (at this time). Lots of promising research but I can't go into a pharmacy and ask for either a Covid-19 vaccine or medicine. The medicines that are showing promise for Covid-19 require a visit to the hospital to be administered.

In terms of prevention of Covid -19 vs the flu the sociological difference is critical.

I do not need to depend upon anyone else to feel safe from the flu. I can get a vaccine if I wish. I can also get the medicine at the pharmacy if I wish.
To feel safe from Covid-19 I need to depend upon everyone around me to...(you've heard this already).

So how much trust do we have in one another (Covid-19 issue) vs I don't need to trust other people (flu).

I Agree with all of these points. If we could just get almost everyone wearing masks almost all of the time, we would be in a much better position. And it's a very low cost thing to do.

[CDu]

Based on that, I conclude that it doesn't seem likely that there are significantly more C-19 hospitalizations than flu hospitalizations so far.

I am not claiming this is just the flu or anything like that. Just think it is good to have some grounding facts. The # of deaths from C-19 has definitely been higher than from flu in the same time period, with the bulk of those C-19 deaths happening in Spring.

For those who believe there have been more C-19 hospitalizations than influenza hospitalizations since October of 2019, what is the evidence for that belief?

The CDC estimated ~35.5 million flu cases last year, with 490,000 hospitalizations and 34,000 deaths. For this year's flu season (preliminary data), they estimate 39-56 million cases, 410-740K hospitalizations, and 24-62K deaths. That's an average of about 1.2-1.3% hospitalization rate and 0.09-0.1% mortality rate:
https://www.cdc.gov/flu/about/burden/2018-2019.html
https://www.cdc.gov/flu/about/burden...-estimates.htm

Also worth noting that their 2019-20 flu estimates are likely overestimates, because some of the suspected flu cases late in the flu season may actually be COVID cases. But for now we'll take those as gospel.

For COVID, they estimated a hospitalization rate of ~14% and a mortality rate of 5.4% using data from January through May 30:
https://www.cdc.gov/mmwr/volumes/69/...e2.htm#T1_down

A couple of points to keep in mind:
1. Hospitalization and death data are still undercounted in those data as they didn't, at that time, have complete information on all the cases (and probably never will)
2. Deaths are further undercounted in that not all cases were resolved as of that MMWR report.
3. The total number of cases is undoubtedly an underestimate as asymptomatic cases are certainly underreported. I'd venture that the true total case count is now somewhere between 5 and 10 times the confirmed number, with the proportional difference coming down as our testing increases.
4. Similarly, information on cases in the early stages of the pandemic (cases, hospitalizations, deaths) are likely underestimated due to lack of availability of testing.

Now, what this suggests is that COVID is more severe than the flu. The proportion of deaths relative to hospitalizations is much higher than that of the flu, indicating that COVID hospitalizations are likely to be more severe on average than flu hospitalizations. Furthermore, the raw rates suggest that even if the case counts are underestimated by a factor of 10, that would still be a slightly higher hospitalization rate and much higher case fatality rate.

As for total hospitalizations due to COVID so far, the CDC estimates approximately 350,000 have occurred as of July 4 (~35,000 hospitalizations from a sample of approximately 10% of the US population):
https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html

Note though that this is through only part of the year and likely undercounts at the beginning and probably over the past week, as data early on are underestimates due to lack of tests available and the most recent data are still trickling in.

Now, that number is likely to rise, both prospectively (as new cases are coming in) and retrospectively (as they back-collect data; same thing they have had to do with flu historically). It's almost certainly an underestimate, for example, of the early stages of the disease. Researchers at several prominent universities estimate that the mean number of new hospitalizations will be between 2,000 and 10,000 per day for the next month (with confidence intervals ranging from 2,000 up to 20,000):
https://www.cdc.gov/coronavirus/2019...forecasts.html

So, to summarize:
1. I would not say that we've had more COVID hospitalizations this year than we had flu hospitalizations this past flu season (at least not yet). But we do have 2 more months from which to estimate data for COVID to match a typical flu season and the projections suggest we're going to add a LOT more hospitalizations.
2. Note that the flu season hit the entire country. So far, COVID is still making its way into most of the country. California, Arizona, Texas, and Florida are just now starting to see the disease take off. As COVID reaches the rest of the states, especially now that it is hitting the 3 most populous states in the US, there's reason for concern that it's going to blow past the hospitalization total for a flu season.
3. From the case data that we have for flu and for COVID, hospitalizations and deaths do appear to be more common among COVID patients than flu patients.

Now, that's not to say with certainty that COVID will have a larger hospitalization burden. But from the data we've seen, I think that it's pretty likely that it will.

[Phredd3]

Yes but the question was whether the offer should be made, with people deciding whether to accept it or not, with the offer increasing until staffing for the school is complete.

So does that mean teachers who don't accept the lower offer are laid off? Otherwise, where does the money for the ever-increasing salary offers come from? Oh, and who teaches the kids whose parents don't want to take that risk? Or are they out of luck, too?

Perhaps I just don't understand what you are proposing.

[Skydog]

I was misdiagnosed as a freshman. Luckily it was only mononucleosis but I had a particularly bad case that took them months to diagnose properly (and more months for me to recover). The Washington Post loves to pick on Duke, but Duke is hardly alone with the student health center stuff.

Anecdotally this was common. When I was an undergraduate in the 70’s the student health centers at both Princeton and Yale had bad reputations, at least among my friends. The latter incorrectly diagnosed me with viral hepatitis, sending dozens of students I had interacted with into a panic. I remember being puzzled by their poor reps - I thought such clinics would attract the best and brightest (kind of cushy job) and be held to a higher standard given their “precious cargo” (in the minds of their tuition paying parents.) That being said my interactions with Duke student health in the 80’s were uniformly excellent, as was their rep with my fellow grad students.

[freshmanjs]

Who is upset with you? Personally, I am simply trying to understand the point you are making.

If you are arguing that the number of Covid-19 hospitalizations is no greater than the average number of flu hospitalizations in a given year, then I am skeptical of that argument. I do not recall hospitals running out of ICU beds in so many states from any flu season. The evidence suggests that this new virus is straining out medical system in a way that no other has since the Spanish Flu.

I interpreted Packman97's facepalm as being upset.

I don't think we know yet how Covid-19 hospitalizations will look for a full year, especially since behaviors are inconsistent and changing. We also don't know how year 2 will look vs. year 1, etc. We have a very good idea how flu will look for a given year.

The ICU bed situation is an interesting topic. We do clearly have an ICU capacity problem in some places right now, and certainly had a big problem in NY/NJ in the Spring. However, there are also misleading news reports that say things like "Crisis: only 19% of ICU beds available" in a particular county, when that county typically has 80+% utilization of ICU beds. I've seen quite a bit of this type of reporting, which seems intended to scare rather than to inform. It makes it hard to tell where the problems really are with ICU capacity. Every year, there are some hospitals and regions that have ICU capacity overruns. I have not seen a good comparison of ICU overflow this year vs. other years, so have a hard time assessing how severe that particular problem has been overall.

I am raising the question: What does it mean if the death rate per new case continues to be low compared to what we saw in the Spring? Does that have any implications for policy and path forward? One of the (reasonable) responses to that is that it's not all about deaths, there are other serious complications. I agreed that there are, but said that the evidence is anecdotal so far. Someone suggested that hospitalizations would be a good way to estimate other serious complications. So, I looked at the hospitalization data, actually expecting that Covid-19 hospitalizations were higher than flu for 2019-20. I think I assumed that since the Covid-19 death toll is higher, the hospitalization number would also be higher. I was surprised to learn that, so far, flu hospitalizations for 2019-20 appear to be higher. I agree with CDu that Covid-19 will likely surpass flu for that time period, but it's not certain to happen and may not be by a large amount. Jason is also correct that we are not comparing apples to apples. Flu has a vaccine, but no social interventions. Covid-19 has inconsistent lockdown + distancing / masks and evolving / improving treatment protocols. It's hard to know what the comparison will look like over time.

It's too early to say what the Florida and Texas "experiments" will tell us, but I do think we should evaluate the morbidity and mortality statistics for Covid-19 (like any disease) as we determine what policies and behaviors to implement. We need to do this with open minds about what is changing and what the changes mean. We can't be afraid to discuss changes for fear that people will adopt wrong behaviors. In the case of non-death Covid-19 complications, it is important that we get real data about the prevalence and severity of these complications quickly to inform decisions (and sorry, Packman97, but we should compare to flu and other diseases that we deal with). We can't let scary anecdotal articles drive the decision making, when identical or very similar scary anecdotal articles can be (and have been) written about other diseases.

[CrazyNotCrazie]

Anecdotally this was common. When I was an undergraduate in the 70’s the student health centers at both Princeton and Yale had bad reputations, at least among my friends. The latter incorrectly diagnosed me with viral hepatitis, sending dozens of students I had interacted with into a panic. I remember being puzzled by their poor reps - I thought such clinics would attract the best and brightest (kind of cushy job) and be held to a higher standard given their “precious cargo” (in the minds of their tuition paying parents.) That being said my interactions with Duke student health in the 80’s were uniformly excellent, as was their rep with my fellow grad students.

My interactions with student health were fine - not great, not horrible - generally somewhat underwhelming given the overall strength of the medical center. It was also frustrating that one had to trek over to Erwin to get checked - I believe it has been relocated across from the Cameron lot on west campus, which is great.

There was the widely circulated urban legend about the young woman who went in thinking that she had a sprained ankle, only to be told that she was pregnant, which was not possible unless her name was Mary.

[CDu]

I should add that there is a nonzero chance we already have surpassed flu hospitalizations. If, for example, we had 50,000 hospitalizations this past week (the week after the last data dump), and if 50,000 of the estimated flu hospitalizations were really COVID, then we would be at around 450,000 COVID hospitalizations and 360-660,000 flu hospitalizations.

I would still say “we probably have had more flu hospitalizations than COVID ones so far,“ but I am definitely not 100% sure of that. I am probably more sure that we will pass flu totals by end of August than I am sure that we haven’t already passed flu totals.

[Bostondevil]

Yes, they spread the blame around...what was concerning was the assertion from the young woman with cancer that Duke student health is widely viewed as being "awful." I wonder if that's true, I have no way of knowing.

It was true when I was there. And my experience with it only confirmed the notion. I had an icky experience there as a senior too. I'll defend Duke about a lot of things, but their student health center, not so much. That said, it's a problem with student health centers in general. I get the feeling that they all believe every student is coming in either because they are drunk or trying to get out of exams. And let's face it, they probably see a lot that kind of thing. Although they ought to be better at recognizing mono. They probably see a lot of that too.

To be completely fair though, they did a decent job taking care of me when I broke 3 toes my junior year.

[cato]

I interpreted Packman97's facepalm as being upset.

I don't think we know yet how Covid-19 hospitalizations will look for a full year, especially since behaviors are inconsistent and changing. We also don't know how year 2 will look vs. year 1, etc. We have a very good idea how flu will look for a given year.

The ICU bed situation is an interesting topic. We do clearly have an ICU capacity problem in some places right now, and certainly had a big problem in NY/NJ in the Spring. However, there are also misleading news reports that say things like "Crisis: only 19% of ICU beds available" in a particular county, when that county typically has 80+% utilization of ICU beds. I've seen quite a bit of this type of reporting, which seems intended to scare rather than to inform. It makes it hard to tell where the problems really are with ICU capacity. Every year, there are some hospitals and regions that have ICU capacity overruns. I have not seen a good comparison of ICU overflow this year vs. other years, so have a hard time assessing how severe that particular problem has been overall.

I am raising the question: What does it mean if the death rate per new case continues to be low compared to what we saw in the Spring? Does that have any implications for policy and path forward? One of the (reasonable) responses to that is that it's not all about deaths, there are other serious complications. I agreed that there are, but said that the evidence is anecdotal so far. Someone suggested that hospitalizations would be a good way to estimate other serious complications. So, I looked at the hospitalization data, actually expecting that Covid-19 hospitalizations were higher than flu for 2019-20. I think I assumed that since the Covid-19 death toll is higher, the hospitalization number would also be higher. I was surprised to learn that, so far, flu hospitalizations for 2019-20 appear to be higher. I agree with CDu that Covid-19 will likely surpass flu for that time period, but it's not certain to happen and may not be by a large amount. Jason is also correct that we are not comparing apples to apples. Flu has a vaccine, but no social interventions. Covid-19 has inconsistent lockdown + distancing / masks and evolving / improving treatment protocols. It's hard to know what the comparison will look like over time.

It's too early to say what the Florida and Texas "experiments" will tell us, but I do think we should evaluate the morbidity and mortality statistics for Covid-19 (like any disease) as we determine what policies and behaviors to implement. We need to do this with open minds about what is changing and what the changes mean. We can't be afraid to discuss changes for fear that people will adopt wrong behaviors. In the case of non-death Covid-19 complications, it is important that we get real data about the prevalence and severity of these complications quickly to inform decisions (and sorry, Packman97, but we should compare to flu and other diseases that we deal with). We can't let scary anecdotal articles drive the decision making, when identical or very similar scary anecdotal articles can be (and have been) written about other diseases.

I am in favor of using information to guide decisions and revising past decisions as new information becomes available. I doubt you’ll get much argument with that position, for what it’s worth.

But, of course, decisions have to be made.

Based on your research, if you were making a decision today, and that decision require you to assume a hospitalization rate for Covid-19 compared to flu, would you assume that rate is higher than, equal to or below?