Cont: The One Covid-19 Science and Medicine Thread Part 2

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Aridas said:
Generally speaking, I would call it the first wave. Some places in the US are at risk for a second wave - New York City, for example, but for most of the US, it's first wave. For there to be a second wave, it's pretty much necessary for the first wave to have significantly gone down, and plateaus don't really count.
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Expanding on this, if you look at individual states (from sites like covidactnow.org, rt.live, or aatishb.com ), many states appear to be in or starting a second wave, while many are still in the trailing end of a first, and some appear to have already finished the second. By looking at the USA as a whole, it blends those all together to a fuzzy, indistinct curve that's difficult to draw conclusions from. Many states are really too far apart to lump together as a single national number; physically, emotionally, and politically.
 
No evidence that taking vitamin D prevents coronavirus

A rapid review of evidence into claims that the so-called sunshine vitamin could reduce the risk of coronavirus was launched amid concerns about the disproportionate number of black, Asian and minority ethnic people contracting and dying from the disease. Higher levels of melanin in the skin lead to less absorption of vitamin D from sunlight.

However, on Monday, the National Institute for Health and Care Excellence (Nice) said that, having examined five studies, it had not found evidence to support any benefit from vitamin D with respect to Covid-19.

“While there are health benefits associated with vitamin D, our rapid evidence summary did not identify sufficient evidence to support the use of vitamin D supplements for the treatment or prevention of Covid-19,” said Paul Chrisp, the director of the centre for guidelines at Nice. “We know that the research on this subject is ongoing, and Nice is continuing to monitor new published evidence.”

At the same time, the Scientific Advisory Committee on Nutrition (SACN) reached similar conclusions, stating that the evidence did not support recommending vitamin D supplementation to prevent acute respiratory tract infections (ARTIs).
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Disappointing.
 
arthwollipot said:
Mostly in Melbourne. The rest of the country is doing pretty well.
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And within a few suburbs of Melbourne.

Health authorities in Victoria are literally door knocking these entire suburbs where spikes have been identified and getting people to test on the spot, symptomatic or not. The hope is that 50% of the population per suburb will test. This will be around 100,000 tests in 10 days.

Apparently on Sunday (on the ABC or the TV news - sorry, can't find a report), the positive test rate from this blitz was 0.2. So, yes it is bad when compared to the rest of Australia, but they are actively seeking positives, and not unnaturally, in a spike area, finding them. But not too many.

I still have hope that this can be contained.


Norm
 
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Twice again ...

The Atheist said:
I don't think that's too hard, actually and I've tried so hard to be objective that some people accused me of wanting a pandemic at the start.

There's enough evidence now that we can be fairly sure that age, morbid obesity and hypertension are the big dangers.

We can be fairly sure the IFR will be within margin of error of 0.5%.

We are very sure that 90% of cases are never counted, which means that it's not 80% of disease that's mild, it's 98% are asymptomatic or very mildly symptomatic. Given that 98% of Americans are obese, it shows that it's not that deadly, because they're holding to the 0.5%.

Within that 25 of severe illness, an unknown - but very small - number of younger people end up with a debilitating and long-lasting disease, for reasons also unknown. Or die.

All those numbers are small, but the problem is that when everyone gets it at the same time, it screws health systems big time, leading to the unenviable situation of triaging for death. We can increase the size of ICUs all we like, but ya gotta have people to staff them.

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My hilite.

"that 25 of severe illness" - huh? :confused:

Missing "%" (e.g. "25%")? or decimal point (e.g. "2.5")? Both?

Where are Shannon Warnest or John Kirkpatrick when you need them? :D :p
 
The Atheist said:
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JeanTate said:
Nonsense
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Except it's not nonsense at all, but established by various studies.

USA - the CDC estimates ten times more infections than positive tests.

Germany - Bonn University conducted a rigorous study and found the same.
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My hilite.

"The assessment comes from looking at blood samples across the country for the presence of antibodies to the virus. For every confirmed case of COVID-19, 10 more people had antibodies, Redfield said" - first source.

"The study, [...] found that about 15% of Gangelt residents had been infected with covid-19, compared with the official infection rate at the time of only 3%." - second source.

Of course, the media headlines are based, ultimately, on models. In the second of your sources, that's made clear and easy enough to find what they are; not so much for the first (I'm still digging).

There are other studies going right back to February, so let me know if you need more convincing.

The rest is simple maths - if 20% of x = y, then 2% of 10x = y as well.

Take Iceland:
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Nope. Iceland, NZ, Taiwan & a few other islands are outliers and don't conform.

You accuse me of posting nonsense, then try to use an example making up 0.001% of total infections when we have the other 99.999% to work with.

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Then I guess using a sample that's far smaller (I estimate ~0.0004%) would be even worse, right? ;)
 
JeanTate said:
<snip>

Of course, the media headlines are based, ultimately, on models. In the second of your sources, that's made clear and easy enough to find what they are; not so much for the first (I'm still digging).

<snip>
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Here's what I've found so far:

From this transcript (bold in original): Transcript for the CDC Telebriefing Update on COVID-19 (Press Briefing Transcript Thursday, June 25, 2020)

"Maggie Fox: Thanks. Dr. Redfield, I was very intrigued by something you said, that for every case that’s tested positive, there might be ten that weren’t detected. Can you expand on that? And I think you probably know, the Wall Street Journal has said that the CDC estimates many millions more cases than has been diagnosed. Thanks.

Robert Redfield: Yeah. Thank you for the question. I mean. We have one of the realities, because this virus causes so much asymptomatic infection. And again, we don’t know the exact number. There’s ranges between 20%, as high as 80% in different groups. But clearly, it causes significant asymptomatic infection. The traditional approach of looking for symptomatic illness and diagnosing it obviously underestimated the total amount of infections. So, now, with the availability of serology, the ability to test for antibodies, CDC has established surveillance throughout the united states using a variety of different mechanisms for serology, and that information now is coming in and will continue as we look at the range, for example, where you have a different range of percent infections, say on the west coast, where it may be limited, say 1% or so, and then you have the northeast, where it may be much more common. The estimates that we have right now, that I mentioned — and again, this will continue with more and more surveillance — is that it’s about ten times more people have antibody in these jurisdictions that had documented infection. So that gives you an idea. What the ultimate number is going to be — is it 5-1, is it 10-1, is it 12-1? But I think a good rough estimate right now is 10-1. And I just wanted to highlight that, because at the beginning, we were seeing diagnosis in cases of individuals that presented in hospitals and emergency rooms and nursing homes. And we were selecting for symptomatic or higher-risk groups. There wasn’t a lot of testing that was done of younger-age symptomatic individuals. So, I think it’s important for us to realize that, that we probably recognized about 10% of the outbreak by the methods that were used to diagnose it between March, April, and May. And I think we are continuing to try to enhance surveillance systems for individuals that are asymptomatic to be able to start detecting that asymptomatic infection more in real time."

How consistent would you say this is, TA, with what you wrote ("We are very sure that 90% of cases are never counted, which means that it's not 80% of disease that's mild, it's 98% are asymptomatic or very mildly symptomatic.")?

Also, from the "Germany" source you cited (my bold):

"In other findings, the study found that 22% of those infected in Gangelt were asymptomatic" :jaw-dropp
 
arthwollipot said:
Mostly in Melbourne. The rest of the country is doing pretty well.
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Yeah, I see that, and it's quite odd that Melbourne is alone in it.

Still, the numbers are small enough to get on top of with any luck.

Steve said:
Conversely, those posting here that are optimistic about the development of a vaccine seem to be relying solely on optimistic statements from the vaccine developers, and not on any actual evidence.
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Wrong. I haven't quoted a single manufacturer and have only quoted vaccine and viral specialists.

Interestingly, China is using one of its virus candidates to vaccinate the army.

https://www.reuters.com/article/us-...roved-for-military-use-in-china-idUSKBN2400DZ

Pixel42 said:
No evidence that taking vitamin D prevents coronavirus

Disappointing.
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No!!! There goes my Nobel Prize...

Still more work needed, though.
 
The Atheist said:
<snip>

We are very sure that 90% of cases are never counted, which means that it's not 80% of disease that's mild, it's 98% are asymptomatic or very mildly symptomatic. Given that 98% of Americans are obese, it shows that it's not that deadly, because they're holding to the 0.5%.

<snip>
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The Atheist said:
<snip>

I'm not sure whether you're hopeless at arithmetic, or what the problem is, but there's no weakness of logic in what I'm saying - it's backed by a large and growing weight of evidence.

Can you not even understand the simple equations I gave you?

20% (0.2) of x is identical to 2% (0.02) of 10x. Even my 10 year old understands that.

Feel free to show some actual numbers - not from Iceland, Taiwan or Singapore, because cherry-picking countries is absurd.

I could equally point to San Marino, which with 17% of the entire population tested, is showing an IFR of 6%. Everyone panic!

<snip>
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My hilite.

How about those in The COVID Tracking Project?

Specifically, the reported numbers for Connecticut, New Jersey, and New York (the state)? Add in what Redfield said at the 25 July Press Briefing. If necessary we could get some estimates of each state's population (WP, say).

I'll let you go first, if you wish.

From those sources, what do you estimate the COVID-19 IFR is, over the last few months, for those three states (combined or individually)? With or without confidence intervals/error bars/uncertainties.

What do you estimate the incidence of serious/severe (or worse) cases is, among all those who have (and have had) COVID-19 (in those states, over the last few months)?

What do you estimate the incidence of "asymptomatic or very mildly symptomatic" cases is, among all those who have (and have had) COVID-19 (in those states, over the last few months)? Please show your working.
 
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Steve said:
My sole point is that I am pessimistic that an effective and practical vaccine will be developed in a timely manner. My opinion is based on two things:
- a successful vaccine has not been developed for any other coronavirus.
- recent evidence that antibodies developed by those infected fade in a time frame of months.
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This is valid.

Conversely, those posting here that are optimistic about the development of a vaccine seem to be relying solely on optimistic statements from the vaccine developers, and not on any actual evidence.

Yes, I am speculating. The vast majority of posts in ISF are speculation. If everyone here stopped speculating and offering opinions based on inconclusive information the Forum would quickly die from lack of interest.
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I agree.

I will say the evidence of waning antibodies makes for a good news story but don't put too much stock in that for the moment. Until we see people getting reinfected, the finding of waning antibody might not be as significant as you think, at least not in the 6 month revaccination range. The immune system has a tendency to be reactivated with new exposures to the same virus.

For example, antibodies to the hepatitis B vaccine wane with time but immunity does not correlate with detectable circulating antibody. As long as there was documented immunity from the vaccine at some point, undetectable antibody, even at the time of an exposure, does not require a booster. The virus will stimulate the immune response.

The news media loves fear mongering.


I have already conceded that my comparison to functional medical aspects of flu vaccines likely wrong so you do not need to keep harping on that. I was looking at how the flu vaccine is an annual event and thinking how practical a vaccine that needs to be repeated every 6 months or so would really be.
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This is a valid observation.

If we have a short lived vaccine there will be a number of variables at play.

First, if we eliminate the burden of the pathogen in large areas, it gives time for revaccinating, especially if rapid recognition of outbreaks and contact tracing is in place (ah the good old days when we had a functioning public health agency).

The drawback is there won't be a lot of natural boosting when a vaccinated person is exposed to the virus in the wild, naturally boosting the person's immunity. There is a bit of work going on now looking to see if lack of natural boosting to chicken pox (whether the initial immunity is from vaccine or natural disease) might contribute to an increase in shingles. You don't catch a new case of chicken pox if your immunity wanes, rather the latent virus in the person is reactivated.


Right now, the biggest problem we are facing was reiterated by the WHO today. Only a small fraction of the world's population has been infected so far. The pool of susceptible hosts is HUGE!

People who think this is over are really being misled by Trump and his fantasyland munchkins.
 
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GodMark2 said:
Expanding on this, if you look at individual states (from sites like covidactnow.org, rt.live, or aatishb.com ), many states appear to be in or starting a second wave, while many are still in the trailing end of a first, and some appear to have already finished the second. By looking at the USA as a whole, it blends those all together to a fuzzy, indistinct curve that's difficult to draw conclusions from. Many states are really too far apart to lump together as a single national number; physically, emotionally, and politically.
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Not that it matters much but you can't have a second wave when the first one has yet to end.
 
The Atheist said:
The 0.2 - 1% is the consensus opinion, and it happens the 0.5% (which I've mentioned many times previously) is right in that range...

I could equally point to San Marino, which with 17% of the entire population tested, is showing an IFR of 6%. Everyone panic!
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Why the emphasis on IFR anyway? It's just the tip of the iceberg. Deaths aren't really that important - it's the people who don't die but go on to develop long term health issues that are the real problem.

My brother is very fit and healthy except for one thing - about a year ago he developed rheumatoid arthritis. After a few months it went into remission, but... This morning we went to the hardware store, and on the way his left foot became so sore that he could hardly walk (we didn't make it to the store). I asked him what could have caused the arthritis to flare up again. Then he told me that about 2 weeks ago he had a sore throat and persistent cough for 3 days. He assured me that it wasn't Covid-19, even though he didn't get tested!

Whether my bother had Covid-19 or some other virus, the effect was the same. Luckily he is on leave right now so it hasn't affected his work output, but this is the kind of thing you don't hear about that will have long-term economic effects - people with symptoms so mild they don't even think they have the virus suffering ongoing related health issues.

2.63 million are known to have contracted Covid-19 in the US so far, and only 1/3 of them have recovered. 128 thousand have died which is tragic, by they are no longer a drag on the economy. Now the virus is infecting more younger people now so the death rate is slowing, but that won't significantly improve the long term medical and economic impact. When everything is tallied up I bet we will find that the death rate was the least of our problems. But of course it gets the most attention because people are scared of dying.
 
Roger Ramjets said:
Why the emphasis on IFR anyway? It's just the tip of the iceberg. Deaths aren't really that important - it's the people who don't die but go on to develop long term health issues that are the real problem.
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I did mention that very point.

The only reason I got into IFR was an early estimate - it's not something I'd be betting on, and as you say, dead is dead, the living might be a much bigger issue.

Skeptic Ginger said:
Right now, the biggest problem we are facing was reiterated by the WHO today. Only a small fraction of the world's population has been infected so far. The pool of susceptible hosts is HUGE!

People who think this is over are really being misled by Trump and his fantasyland munchkins.
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I've been trying to emphasise that everywhere the past couple of weeks - we are at most 10% of the way through, and Covid does have a very long tail.

Skeptic Ginger said:
Do we have a 'told you so' emoji? [Not you specifically]
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I'm not conceding that entirely just yet - it's one study says no, others seem to indicate the opposite.

Like a lot of things, needs more work.
 
Ulf Nereng said:
Well, you did tell us so, but:

"Nice said the five studies it had examined all had very low quality of evidence, noting that none had adjusted for confounding factors..."

You may have to tell us so again! :p
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OK, let me tell you again: :)

Vitamin D deficiency impacts the immune system in a large way.

Extra vitamin D will not boost the immune system.

Vitamin D deficiency is not all that widespread. So don't expect a huge impact.
 
Skeptic Ginger said:
Vitamin D deficiency is not all that widespread.
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Think again.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018438/

Vitamin D deficiency is a major public health problem worldwide in all age groups.

Low vitamin D status is a problem even in countries with sun exposure all year round.

This problem is particularly high in the Middle East, specially among girls and women.
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__________________________

Meanwhile, if one pandemic isn't enough for people, take a look at the (potential) next one!

https://www.bbc.com/news/health-53218704
 
The Atheist said:
Think again.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018438/
__________________________

Meanwhile, if one pandemic isn't enough for people, take a look at the (potential) next one!

https://www.bbc.com/news/health-53218704
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Given all the deficiency in babies and kids, one has to ask why these groups aren't suffering high rates from COVID 19?

And if a significant vit D deficiency was as widespread as the article makes it seem, why isn't everyone sick?

RE the emerging flu pandemic, we've been on the verge of the next 1918 flu pandemic for decades. Not that it won't happen. One day it most certainly will.
 
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