Cont: 2019-nCoV / Corona virus Pt 3

[marting]

I keep seeing that, but there appears to be a huge conflict of opinion.

Surely, it must be one or the other?

Of course, but it takes a lot of data to even get some estimate as to which is most likely the case. Sometimes the docs just have to go by instinct and whether it's the best option won't be known for some time. If ever. That such a higher percentage of COVID patients on ventilators die was unexpected so it's pretty natural to start thinking of alternatives. But it's also really hard to know if an alternative is better.

 

[smartcooky]

Wrong thread

 

[The Atheist]

Some observations:

Brazil, Sweden & Russia look to be in trouble, with some very ugly increases in the past couple of days.

India are missing or deliberately not counting thousands of cases and at least hundreds of deaths. They are in deep trouble, but possibly delays due to their pathetic infrastructure might be an issue, too.

Chile might be about to rain on my praise, too.

NZ and Australia have it beaten. Both countries have solid downward trends and current new cases are 80 & 90% off their highs respectively.

But if you want to come and join us, you'll need to be happy with spending the first 14 days in quarantine.

 

[The Atheist]

Sometimes the docs just have to go by instinct and whether it's the best option won't be known for some time. If ever. That such a higher percentage of COVID patients on ventilators die was unexpected so it's pretty natural to start thinking of alternatives. But it's also really hard to know if an alternative is better.

I've seen claims that the pressure in ventilators is causing damage, but I've also seen claims that without pressure, the lungs wouldn't inflate, so they'd die anyway.

Seems to me the ideal plan is to not get to that stage. Or, even better, don't catch it at all.

 

[marting]

Interesting comment at Worldometers implying USA may be underreporting due to resource limits.

An estimated additional 180 - 195 deaths per day occurring at home in New York City due to COVID-19 are not being counted in the official figures. "Early on in this crisis we were able to swab people who died at home, and thus got a coronavirus reading. But those days are long gone. We simply don't have the testing capacity for the large numbers dying at home.

 

[marting]

I've seen claims that the pressure in ventilators is causing damage, but I've also seen claims that without pressure, the lungs wouldn't inflate, so they'd die anyway.

Seems to me the ideal plan is to not get to that stage. Or, even better, don't catch it at all.

Pick your poison.

 

[Dr.Sid]

SNZ and Australia have it beaten. Both countries have solid downward trends and current new cases are 80 & 90% off their highs respectively.

Beaten is quite a strong word. They avoided the worst scenarios. Now the question is - how long can they hold the countermeasures, and what will happen, when they start returning back to normal.

Even if you assume 10 times more people were not caught by testing, there is no hope for crowd immunity. And some suggest it's way less, models here in Czech Republic show it's only 10% more compared to confirmed cases. That's insane. All hope for low mortality are based on the hope that much more people is actually infected. But what if they simply are not ?
You cannot let something with real 2-5% CFR long enough to get crowd immunity. We will have to suffer the lockdown until the vaccine is ready.

I think any lockdown slackening should be based on decent antibody study on big enough random groups.

 

[TellyKNeasuss]

It is. I've read that 80% of COVID-19 cases that go on the ventilator die, and worse, they spend many more days on it than pneumonia cases. There's some question as to whether ventilators may even do more harm that good for COVID. Some places are experimenting with adding N2O to O2 as an alternative. No data on the results but an interesting alternative.

According to an article posted by a DC radio station, 80% is almost twice the percentage of people who die after being place on ventilators due to other causes of respiratory distress.

https://wtop.com/national/2020/04/s...XY40A2l1QSB1yAoe7sjroPfaQdC_pnTmoQOalcT-aehy4

 

[EHocking]

It is. I've read that 80% of COVID-19 cases that go on the ventilator die, and worse, they spend many more days on it than pneumonia cases. There's some question as to whether ventilators may even do more harm that good for COVID. Some places are experimenting with adding N2O to O2 as an alternative. No data on the results but an interesting alternative.

Most of the papers I've read on ventilator mortality seem to indicate that older patients, e.g. into their 80s and have preexisting/underlying medical conditions.
That's also pretty much what we're seeing with COVID-19, the more severe cases that require ICU care are elderly and/or have underlying medical conditions.
It is not at all surprising then that the "usual" mortality rate for the old or medically compromised on ventilators correlates with a similar mortality rate for the old or medically compromised on ventilators due to COVID-19.

e.g., in Lancet

This is a highly invasive technique and is known for it to possibly cause damage to the lungs. The procedure for ventilators is to stop the patient breathing by administering a parylytic. The elderly are always a risk group for administering anesthesia too.
Also, during this time, no antibiotics (usually) are administered during the initial few days attempting to stabilise a patientso the possibility of other lung infections is also quite high.

The antibiotics are probably treating other infections such as pneumonia anyway - as there is no cure for COVID-19 at present.

 

[TellyKNeasuss]

My 2 stupid questions for the day are:

1) The Chinese have allowed "wet markets", including the one that has been a target of suspicion that SARS-COV-2 emerged there, to resume operations. Does this imply that the Chinese know more than they are revealing about the origin of the virus and that it did not emerge at a "wet market"?

2) According to an ABC News report, American military intelligence began warning about a lethal virus with the potential to cause an international crisis at the end of November. Based on the numbers that the Chinese have released, there should have only been 12-15 people who were known to have contracted the virus by the end of November. Was the military able to make a forecast based on such limited numbers or does this imply that the number infected during the first few weeks of the outbreak was significantly more than what the Chinese have stated? Or that the ABC News report cannot be correct?

 

[angrysoba]

My 2 stupid questions for the day are:

1) The Chinese have allowed "wet markets", including the one that has been a target of suspicion that SARS-COV-2 emerged there, to resume operations. Does this imply that the Chinese know more than they are revealing about the origin of the virus and that it did not emerge at a "wet market"?

2) According to an ABC News report, American military intelligence began warning about a lethal virus with the potential to cause an international crisis at the end of November. Based on the numbers that the Chinese have released, there should have only been 12-15 people who were known to have contracted the virus by the end of November. Was the military able to make a forecast based on such limited numbers or does this imply that the number infected during the first few weeks of the outbreak was significantly more than what the Chinese have stated? Or that the ABC News report cannot be correct?

On the question of wet markets, my understanding is that it is still not clear if this was how the virus originated.

BUT even if it is apparently there are fears that underground wet markets or black wet markets are harder to regulate, so closing them is not as simple a solution as it sounds.

Disclaimer: I am not an epidemiologist and done even play one on TV.

 

[EHocking]

nvmd

 

[The Atheist]

Interesting comment at Worldometers implying USA may be underreporting due to resource limits.

I've seen a few suggestions that people dying at home aren't being counted. Whether that's awaiting autopsy, I don't know, but I suspect every place with high death counts is sturggling to keep the paperwork up to date.

Beaten is quite a strong word. They avoided the worst scenarios. Now the question is - how long can they hold the countermeasures, and what will happen, when they start returning back to normal.

NZ's plan is to ease the lockdown when daily cases are either zero, or people known to have been in isolation/quarantine.

Even then, the initial easing will be a small step with schools closed for at least 2-3 weeks after that to see if it springs up again.

Even if you assume 10 times more people were not caught by testing, there is no hope for crowd immunity. And some suggest it's way less, models here in Czech Republic show it's only 10% more compared to confirmed cases. That's insane. All hope for low mortality are based on the hope that much more people is actually infected. But what if they simply are not ?

The best information I've seen said 50% of cases asmyptomatic, but Dann posted info from a Danish scientist that reckoned 30 - 90 times as many cases happened as shown.

You cannot let something with real 2-5% CFR long enough to get crowd immunity. We will have to suffer the lockdown until the vaccine is ready.

I think any lockdown slackening should be based on decent antibody study on big enough random groups.

Well, there's no chance of that, so it's wait & see.

Was the military able to make a forecast based on such limited numbers or does this imply that the number infected during the first few weeks of the outbreak was significantly more than what the Chinese have stated? Or that the ABC News report cannot be correct?

I wouldn't read anything sinister in it - the potential for a pandemic was well known and forecast by everyone from Bill Gates to Fauci, plus we'd already had the experience of SARS & MERS, so saying there was a danger with the new virus was no great leap of logic. The key was human - human transmission, and the first-known cluster fitted that scenario.

 

[Belz...]

It can infect cats.

Are we 100% sure about that?

 

[Squeegee Beckenheim]

Current projections are that UK deaths will exceed those in the USA. IHME is projecting 66k deaths, about 10% more and peaking 3 days later than the USA. This is consistent with the UK distancing being done several days later. It's also much higher a percentage of the population than the USA which probably also benefits from lower population density.

https://covid19.healthdata.org/united-kingdom

That link is way off, though. Projected deaths per day for yesterday was 1,433. In reality it was 938. So the projected figure is an overestimation of about 50%.

Total deaths isn't off by as much, but it's saying 8,867, whereas the real figure was 7,097. So still an overestimation by close to 30%.

If the model can't predict the present with a reasonable degree of accuracy, I don't think we should put too much stock in how well it can predict 4 months in the future.

 

[The Atheist]

Brazil, Sweden & Russia look to be in trouble, with some very ugly increases in the past couple of days.

And you can add in Mexico, Indonesia & Malaysia as places where the numbers are going in a dangerous direction.

Looks to me like it's developing nations about to take off. That will not be funny.

 

[Planigale]

Current projections are that UK deaths will exceed those in the USA. IHME is projecting 66k deaths, about 10% more and peaking 3 days later than the USA. This is consistent with the UK distancing being done several days later. It's also much higher a percentage of the population than the USA which probably also benefits from lower population density.

https://covid19.healthdata.org/united-kingdom

This is a better site to look at trajectory.
https://aatishb.com/covidtrends/
The interesting things are all countries start on the same trajectory. As infection control procedures kick in they fall off the line (China and S. Korea), Spain and Italy are clearly falling off the trajectory, France not so much. Germany and the UK are possibly falling off the trajectory. Looking at this plot there seems to be little difference in the fatality rates between countries initially; Germany is earlier in the outbreak than the UK not intrinsically different. The US seems to accelerating away with no sign of falling off the trajectory. The UK seems to be sitting between Italy and Spain on its current trajectory; my prediction is mortality will be similar to Spain or Italy.

 

[JesseCuster]

This is a better site to look at trajectory.
https://aatishb.com/covidtrends/
The interesting things are all countries start on the same trajectory. As infection control procedures kick in they fall off the line (China and S. Korea), Spain and Italy are clearly falling off the trajectory, France not so much. Germany and the UK are possibly falling off the trajectory. Looking at this plot there seems to be little difference in the fatality rates between countries initially; Germany is earlier in the outbreak than the UK not intrinsically different. The US seems to accelerating away with no sign of falling off the trajectory. The UK seems to be sitting between Italy and Spain on its current trajectory; my prediction is mortality will be similar to Spain or Italy.

My completely unscientific made-up opinion is that too many people don't realise this and are looking at different countries with very different daily death tolls, failing to realise that they're simply earlier in their course of the outbreak, and people are falling over themselves to come up with reasons why country X is doing so much better than country Y. Not that there aren't obviously other factors to take into consideration, but I think this important factor is too often being overlooked.

 

[JesseCuster]

Here's a linear graph of reported weekly and total deaths for a handful of countries, for what it's worth.

 

[sphenisc]

Beaten is quite a strong word. They avoided the worst scenarios. Now the question is - how long can they hold the countermeasures, and what will happen, when they start returning back to normal.

Even if you assume 10 times more people were not caught by testing, there is no hope for crowd immunity. And some suggest it's way less, models here in Czech Republic show it's only 10% more compared to confirmed cases. That's insane. All hope for low mortality are based on the hope that much more people is actually infected. But what if they simply are not ?
You cannot let something with real 2-5% CFR long enough to get crowd immunity. We will have to suffer the lockdown until the vaccine is ready.

I think any lockdown slackening should be based on decent antibody study on big enough random groups.

There seems to be wide variation in CFR between demographics. If lockdown was removed for the least vulnerable ones would that allow something approaching herd immunity levels without placing unnecessary risks on the most vulnerable groups?