PlagueWatch 2020-23 - Coronavirus

[rsvman]

Hydrox cookies are at least 45% hydroxychloroquine, and are available over the counter! (Oreos have no measurable HCQ in them, but taste pretty good, especially dunked in milk.)

[YmoBeThere]

Okay, can I ask you, rsv, and everyone else here a practical question?

So we are going through reopening plans for my school district here in NJ.

Right now we are at the point where we are saying that windows must remain closed, because we want to minimize the possibility of breezes moving the sickness across the room. We are going to rely on univents, which bring in up to 20 percent fresh air, and air conditioners aimed up.

This seem... foolish to me.

Any docs here have any input here? This feels very important, and I feel like we are not on the right path with this.

My wife is on the reopening committee for our NYC public elementary school - building was built in the early 60s so not ancient but not state of the art either. She told me yesterday that I believe the plan is no air conditioning but windows will always be open - even in the winter - as they feel that is the safest. I don't know if that decision was made at the school level, district level, or NYC DOE level. Like many older buildings in NY, the building tends to run warm in the winter. The air conditioners tend to be somewhat loud and distracting so even under normal circumstances I think the teachers try to minimize usage. I believe one parent brought up a district in Bergen County that is getting filtration systems or something like that and the principal made it clear that that was not in the budget.

That being said, I am also curious to hear what the experts here say - I appreciate their input.

Feel free to PM me and I am happy to give you some more info - we don't open until after Labor Day (probably similar to you) so though they are very focused, decisions are still rapidly evolving as we have a little time.

Looking at the data, this is a tiny data set that a single death could cause movement. One week in that chart contained exactly zero deaths. Hint: it was in June. Sadly, this data would hardly be conclusive in any real world context, IMHO. There were two spikes, given the underlying dataset, I would look first to reporting anamolies(reclassification of deaths, delayed reportig, etc.) than anything having to do with a drug intervention.

Here is the underlying dataset:

Swiss Covid 19 Cases.jpg

[budwom]

Hydrox cookies are at least 45% hydroxychloroquine, and are available over the counter! (Oreos have no measurable HCQ in them, but taste pretty good, especially dunked in milk.)

Just moved my life savings into Leaf Brands stock, made a few posts on Facebook about America's Favorite Medical Cookie (Covid Buster!) ....I am going to be SO rich..rsvman gets a free ride on my new Gulfstream

https://leafbrands.com/hydrox/

[Bostondevil]

I think I just heard Bostondevil scream

I used to do a bit of suicide prevention research. I had to give it up to preserve my own sanity.

[Bluedog]

Earlier in the thread, there was some skepticism to the idea that people will choose to leave the labor force because of schools not re-opening, given they've already had to deal with that for six months or so. A GS analysis suggests that they'd expect an uptick in parents choosing to leave the labor market should school/daycare closures continue:

Single parents, parents with young children and parents who can't work from home are the groups most at risk to stop working entirely because they have no child care, said Goldman Sachs (GS) economists David Choi and Joseph Briggs in a note to clients on Tuesday. Nearly a third of the pre-pandemic US labor force has kids at home, and about 15% of the work force falls into at least two of those three risk categories above, Choi and Briggs said. That totals about 24 million people. Since May, some 7 million people per week have not worked because they didn't have access to childcare, according to data from the Census Household Pulse Survey, a number that accounts for about 14% of virus-related reasons for missing working.

https://www.cnn.com/2020/08/04/econo...obs/index.html

[budwom]

Earlier in the thread, there was some skepticism to the idea that people will choose to leave the labor force because of schools not re-opening, given they've already had to deal with that for six months or so. A GS analysis suggests that they'd expect an uptick in parents choosing to leave the labor market should school/daycare closures continue:


https://www.cnn.com/2020/08/04/econo...obs/index.html

I think that's a fair take. Given the confusion and uncertainty about schools, a LOT of families here are opting for home schooling...hardly optimal for them, but the Two Days In, Two Days Out model we have still requires a lot of parental presence, might as well go all the way...

[Bluedog]

I think that's a fair take. Given the confusion and uncertainty about schools, a LOT of families here are opting for home schooling...hardly optimal for them, but the Two Days In, Two Days Out model we have still requires a lot of parental presence, might as well go all the way...

Yes, the other thing I've seen -- for those families that can afford it -- is to hire a full-time nanny who is there to facilitate the remote learning with the school. I expect nanny demand has been skyrocketing. For this summer, supply has also been extremely high with college students not able to find other jobs anyways. We'll see if that shifts in the fall...

[cato]

Yes, the other thing I've seen -- for those families that can afford it -- is to hire a full-time nanny who is there to facilitate the remote learning with the school. I expect nanny demand has been skyrocketing. For this summer, supply has also been extremely high with college students not able to find other jobs anyways. We'll see if that shifts in the fall...

It was very difficult to find a nanny who could also “coach” kids in learning (our district now refers to us parents as our kids’ education coaches) before any of this happened. And I am not sure how many college kids are either skilled enough for the job or responsible enough for families to invite them into their homes five days a week, several hours a day.

[Bluedog]

It was very difficult to find a nanny who could also “coach” kids in learning (our district now refers to us parents as our kids’ education coaches) before any of this happened. And I am not sure how many college kids are either skilled enough for the job or responsible enough for families to invite them into their homes five days a week, several hours a day.

Right, people have been okay having a caregiver for their children without that skillset for the summer, but I agree that's not necessarily a long-term thing and perspectives may change. However, having SOMEBODY is better than NOBODY. People are getting desperate...Or recent college grads who perhaps have some relevant studies whose jobs fell through. Definitely tricky and all parents have different perspectives and decision-making.

[camion]

Can any of our medical experts tell me if there's any hydroxychloroquine in Hydrox cookies? You'd think so by the name...asking for a friend!

I'll be happy to start rumors online that this is true.*




*Right after I make a coincidental stock purchase.**



**Dang it. Too late.

[swood1000]

Maybe this has already been answered in this thread, but what is the explanation for the graph on the left? During April insufficient testing kept the blue line down? But what keeps the red line down in July?

[CrazyNotCrazie]

Right, people have been okay having a caregiver for their children without that skillset for the summer, but I agree that's not necessarily a long-term thing and perspectives may change. However, having SOMEBODY is better than NOBODY. People are getting desperate...Or recent college grads who perhaps have some relevant studies whose jobs fell through. Definitely tricky and all parents have different perspectives and decision-making.

We have a college student who takes care of our kids part time after school. We have been unable to have her work but are now bringing her back. Her main role was usually to take the kids to activities and supervise meals, baths, etc. She has supervised homework a bit in the past, but not much. We are going to be on a 2/3 days a week school model. Since there likely aren't activities for the kids to go to, we have asked her to help with school work. She is studying psychology, not teaching, but we are assuming that particularly for our younger one (first grade) she should be able to help. As you said, something is better than nothing, and with both my wife and I working full time, probably from home, there is only so much we can do. Since the nanny couldn't come to us in the spring, we had to manage the whole process for the last few months of school and it was not ideal.

I have said before that for all of the college students who are thinking of doing a gap year, this is a good way to fill there time - there is definitely demand.

[cato]

Right, people have been okay having a caregiver for their children without that skillset for the summer, but I agree that's not necessarily a long-term thing and perspectives may change. However, having SOMEBODY is better than NOBODY. People are getting desperate...Or recent college grads who perhaps have some relevant studies whose jobs fell through. Definitely tricky and all parents have different perspectives and decision-making.

Indeed. And I think that quite a few people will not be able to find anybody (or anybody that they feel safe with) and will ultimately leave the workforce. And most of those parents leaving the workforce will be women, wiping out decades of gains in the workforce in less than a year.

[rsvman]

Maybe this has already been answered in this thread, but what is the explanation for the graph on the left? During April insufficient testing kept the blue line down? But what keeps the red line down in July?

A lot of possible answers but the most probable is that later in the pandemic the burden of illness shifted toward younger, healthier persons with fewer comorbidities, as high-risk people continued to exercise caution (maybe even more so than they did in the beginning) and low-risk people got sick of the entire thing, decided on selfishness over altruism (surprise!) and began doing whatever they wanted to do.

[rsvman]

Best article I have ever seen about droplet versus aerosol transmission and what that even means. Written by an aerosol physicist, it challenges pretty much everything that physicians (even virologists and ID docs) have ever been taught.

I hope the link works. It's a long read, but well worth it. It explains transmission, transmission risks, N95 versus surgical masks, the occurrence of "super-spreaders," etc. Worth the time investment to read the entire thing.


https://www.medscape.com/viewarticle/934837#vp_1

[budwom]

It was very difficult to find a nanny who could also “coach” kids in learning (our district now refers to us parents as our kids’ education coaches) before any of this happened. And I am not sure how many college kids are either skilled enough for the job or responsible enough for families to invite them into their homes five days a week, several hours a day.

that's the truth...a lot of nannies that I'm aware of come from places like Europe (they've been more like high end babysitters than tutors)...not many of them coming in these days...very tough proposition for most people...

[CDu]

Maybe this has already been answered in this thread, but what is the explanation for the graph on the left? During April insufficient testing kept the blue line down? But what keeps the red line down in July?

I posted this a couple of times earlier in this thread, but am too lazy to go back and find the post. Here is an image of the observed (confirmed) cases, observed deaths, and a potential estimate of the "actual" cases (those confirmed + those missed due to insufficient testing and/or people just not trying to get tested). These are based on data obtained from the IHME website for full disclosure.

COVID1.jpg

As you can see, the "actual" cases in March and early April dwarf the confirmed cases. In that time, our case load was under by about a factor of up to 10 (which, coincidentally, was the estimate early on of how much we were underestimating cases). But as our testing improved in late-April, we started to catch more of the cases, and the increment between confirmed cases and "actual" cases decreased.

Now, let's assume the infection fatality rate is 1%. If we thus divide the "actual" cases (the gray line from the first graph) by 100 and plot it against the deaths, we get this:

COVID2.jpg

As you can see, through late June, the deaths are almost perfectly lagging the cases by about 3 weeks.

Now, that's a hypothetical, obviously, as we don't know for sure how many cases we missed back in March and early April. But it's in line with what people were suspecting back then, so it's probably not wildly off.

If for example, the "actual" case rate was only short of the confirmed case rate by 5 times, then the death rate early on would be in excess of what we're seeing now, but not wildly so. The explanation in that scenario could be one of a few things:
- We're testing more and catching more cases in healthier (and perhaps younger) subjects, which inherently reduces the case fatality rate
- Younger people are actually getting infected more now than were early on [note: the average age of infection IS decreasing, which lends itself to one or both of the above being true]
- We haven't reached the capacity constraints that we ran into in late-March/early-April. The disease is more widespread, but not as prevalent in specific places as it was early on. This is in part because we've started social distancing and wearing masks, whereas in early March (when the disease was rapidly spreading undetected) we were not. Capacity constraints will tend to result in more deaths.
- It is possible that we are getting better at treating patients too. Dexamethasone and remdesivir, for example, have shown promise in trials, and are getting used in emergency situations. And it's not unreasonable to assume that we're getting a bit better at figuring out how to care for these patients with more that we learn about it.

Honestly, I think it is a combination of the woefully insufficient testing in March and April (this is the #1 driver in my opinion) as well as a combination of the first 3 bullets, with a smaller contribution of the fourth (I don't think treatments are good enough or widespread enough to really be driving the difference).

[Jeffrey]

I posted this a couple of times earlier in this thread, but am too lazy to go back and find the post. Here is an image of the observed (confirmed) cases, observed deaths, and a potential estimate of the "actual" cases (those confirmed + those missed due to insufficient testing and/or people just not trying to get tested). These are based on data obtained from the IHME website for full disclosure.

COVID1.jpg

As you can see, the "actual" cases in March and early April dwarf the confirmed cases. In that time, our case load was under by about a factor of up to 10 (which, coincidentally, was the estimate early on of how much we were underestimating cases). But as our testing improved in late-April, we started to catch more of the cases, and the increment between confirmed cases and "actual" cases decreased.

Now, let's assume the infection fatality rate is 1%. If we thus divide the "actual" cases (the gray line from the first graph) by 100 and plot it against the deaths, we get this:

COVID2.jpg

As you can see, through late June, the deaths are almost perfectly lagging the cases by about 3 weeks.

Now, that's a hypothetical, obviously, as we don't know for sure how many cases we missed back in March and early April. But it's in line with what people were suspecting back then, so it's probably not wildly off.

If for example, the "actual" case rate was only short of the confirmed case rate by 5 times, then the death rate early on would be in excess of what we're seeing now, but not wildly so. The explanation in that scenario could be one of a few things:
- We're testing more and catching more cases in healthier (and perhaps younger) subjects, which inherently reduces the case fatality rate
- Younger people are actually getting infected more now than were early on [note: the average age of infection IS decreasing, which lends itself to one or both of the above being true]
- We haven't reached the capacity constraints that we ran into in late-March/early-April. The disease is more widespread, but not as prevalent in specific places as it was early on. This is in part because we've started social distancing and wearing masks, whereas in early March (when the disease was rapidly spreading undetected) we were not. Capacity constraints will tend to result in more deaths.
- It is possible that we are getting better at treating patients too. Dexamethasone and remdesivir, for example, have shown promise in trials, and are getting used in emergency situations. And it's not unreasonable to assume that we're getting a bit better at figuring out how to care for these patients with more that we learn about it.

Honestly, I think it is a combination of the woefully insufficient testing in March and April (this is the #1 driver in my opinion) as well as a combination of the first 3 bullets, with a smaller contribution of the fourth (I don't think treatments are good enough or widespread enough to really be driving the difference).

Another very informative and insightful post. Thanks, again, CDu!

[wavedukefan70s]

Highly highly recommended article, long, excellent overview of “How the Pandemic Defeated America.”

https://www.theatlantic.com/magazine...ailure/614191/

First line is: “How did it come to this?” Punchline is: “Pandemic. Pan and demos. All people.”

Every line in between is worth your time.

A very copious amount of politics in that.but thanks anyway.

[MarkD83]

Best article I have ever seen about droplet versus aerosol transmission and what that even means. Written by an aerosol physicist, it challenges pretty much everything that physicians (even virologists and ID docs) have ever been taught.

I hope the link works. It's a long read, but well worth it. It explains transmission, transmission risks, N95 versus surgical masks, the occurrence of "super-spreaders," etc. Worth the time investment to read the entire thing.


https://www.medscape.com/viewarticle/934837#vp_1

I did enjoy the article.

Here are also some interesting videos of aerosol transmission. The first is a 12 min news report with the physics studies in the first 4 minutes. After 4 minutes interviews with professionals so not as interesting in terms of seeing the actual movement of aerosols.

The second video is shorter and hard to see the aerosols but you can definitely see the effectiveness of masks.

https://video.search.yahoo.com/searc...3&action=click

https://video.search.yahoo.com/searc...9d&action=view