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

[Oystein]

I was talking about locking down the entire nursing home before the virus got in, not quarantening infected patients, and I have heard of it happening in the UK, reasonably local to me.

If you avoided it whilst still changing shifts and having staff come in from outside you were lucky, but yes it can happen.

Same problem, we wouldn't have rooms for staff to live in.

 

[marting]

Sweden continues to be interesting.

Very high overall death count (.054%) but the daily death rates have been declining nearly continuously and are about 1/10th the peak in early Apr. This differs from the USA where the reduction from peak has only been about 1/4 and has reached a plateau with a very slight decline in deaths overall. Strong decline in areas hard hit early but above R=1 with plateaued deaths in some areas lightly hit like Florida.

The other notable thing about Sweden is that while new cases have increased much of this is from testing, not positive percentages. And new cases continue at a pretty constant rate. But the really big factor is that people 65 and over now account for a very small portion of new cases ( < 10%) . And this is what's causing the nice, and consistent, decline in daily deaths.

Could be their strategy to protect the elderly but let younger people get covid is now working though they have paid a significant price in the .054% of the population that's died, which includes about 1/3 from nursing homes.

 

[Samson]

Sweden continues to be interesting.

Very high overall death count (.054%) but the daily death rates have been declining nearly continuously and are about 1/10th the peak in early Apr. This differs from the USA where the reduction from peak has only been about 1/4 and has reached a plateau with a very slight decline in deaths overall. Strong decline in areas hard hit early but above R=1 with plateaued deaths in some areas lightly hit like Florida.

The other notable thing about Sweden is that while new cases have increased much of this is from testing, not positive percentages. And new cases continue at a pretty constant rate. But the really big factor is that people 65 and over now account for a very small portion of new cases ( < 10%) . And this is what's causing the nice, and consistent, decline in daily deaths.

Could be their strategy to protect the elderly but let younger people get covid is now working though they have paid a significant price in the .054% of the population that's died, which includes about 1/3 from nursing homes.

The freedoms for all ages to mix in a carefree manner in New Zealand afford a sense of national unity, and make Sweden look totally insane. Surprisingly it is fashionable to praise Sweden with right wing commentators.

 

[marting]

The freedoms for all ages to mix in a carefree manner in New Zealand afford a sense of national unity, and make Sweden look totally insane. Surprisingly it is fashionable to praise Sweden with right wing commentators.

New Zealand, like for instance S. Korea, was able to control Covid-19. Sweden, the UK, France, Spain, Italy, etc. were not and, with the exception of Sweden, implemented controls that, while not as strong as China were stronger than the lighter ones that Sweden did and produced more societal harm on top of more deaths.

I will start off saying I'm surprised Sweden has dropped its daily death rate so consistently given its policies. I did not expect this.

But it isn't true that Sweden didn't implement controls. Sweden implemented partial school closures, limits on group size, social distancing. Not to the degree in most other places and still resulted in a lot of deaths pretty typical of other locations like France, Spain, Italy, UK, etc.

However, the really large reduction in new cases of older people apparent in the last month is beyond what's seen in other countries. There is obviously a conscious effort to reduce exposure of vulnerable people in Sweden we do not see to the same degree most elsewhere. If they keep this up it's entirely possible they could reach herd immunity with under .1% of the population dying while just letting it rip w/o protecting the vulnerable might kill .4% to .6% of Sweden.

.1% is still a lot of people.

 

[Myriad]

Pathetic achievement.

With just a little effort USA can pass 100k infections a day, easy. Late August would be my guess for when that happens.

I don't think that's going to happen. Every time the virus has reached a point where it seemed nothing short of saturation was going to slow it down in some region, it's slowed down. I have no idea why. Not knowing why has been driving me crazy. But it's been a very consistent pattern.

I think the only challenger USA might have is India, and since they don't worry about things like testing or death certificates, you wouldn't know.

I agree with you about India.

 

[Trebuchet]

Pathetic achievement.



With just a little effort USA can pass 100k infections a day, easy. Late August would be my guess for when that happens.



I think the only challenger USA might have is India, and since they don't worry about things like testing or death certificates, you wouldn't know.

Late August? Late July seems more likely!

 

[Ulf Nereng]

Sweden continues to be interesting.

Very high overall death count (.054%) but the daily death rates have been declining nearly continuously and are about 1/10th the peak in early Apr. This differs from the USA where the reduction from peak has only been about 1/4 and has reached a plateau with a very slight decline in deaths overall. Strong decline in areas hard hit early but above R=1 with plateaued deaths in some areas lightly hit like Florida.

The other notable thing about Sweden is that while new cases have increased much of this is from testing, not positive percentages. And new cases continue at a pretty constant rate. But the really big factor is that people 65 and over now account for a very small portion of new cases ( < 10%) . And this is what's causing the nice, and consistent, decline in daily deaths.

Could be their strategy to protect the elderly but let younger people get covid is now working though they have paid a significant price in the .054% of the population that's died, which includes about 1/3 from nursing homes.

It would be good to hear from our Swedish members what, if anything new, has been done recently to get the deaths down. I assume that mistakes that were made early on wrt to care homes are not being repeated, at least. And perhaps the populace have become more conscious of the dangers so that they socially distance better or somesuch?

 

[marting]

It would be good to hear from our Swedish members what, if anything new, has been done recently to get the deaths down. I assume that mistakes that were made early on wrt to care homes are not being repeated, at least. And perhaps the populace have become more conscious of the dangers so that they socially distance better or somesuch?

Agreed. I don't claim to understand Sweden, but the USA's populace is highly fragmented. Even in California, there are some areas that take things seriously and other areas that are "What? me worry? Covid-19 is fake" And friends with connections tell me anecdotally that people in the regions spiking cases tend to think Covid-19 is either overblown or outright fake news. My hope is that older people are taking it more seriously. There is some evidence of this.

Quite amazing and our leadership as done squat to create consensus. Quite the opposite. Very frustrating from the POV of someone that just wishes to see the facts and skip the politics.

 

[The Atheist]

Here's another piece on the long-term effects of Covid: https://www.stuff.co.nz/national/he...ple-will-need-treatment-for-life-experts-warn

Early on in the crisis, researchers at King's College London developed a Covid-19 app for people to record their symptoms daily. They report one in 10 people has symptoms lasting for eight to 10 weeks and say symptoms can fade, only to come bouncing back.

10% of patients is a hell of a lot, although it will only symptomatic cases, so 1-2% of the overall number. That's still a lot of people and another very good reason for reducing the number of people infected.

 

[Myriad]

Here's another piece on the long-term effects of Covid: https://www.stuff.co.nz/national/he...ple-will-need-treatment-for-life-experts-warn

That matches my own experience of symptoms clearing and then coming back, any tissue or organ that gets stressed in any way seeming to become a target for the virus, and "wow, I'm finally back to normal... wait, I lifted something heavy and now I'm not so sure."

Unfortunately, I can't apply my own experience because I tested negative. Either it was a false negative, or I had something else that happens to have all the same symptoms, or it was all psychosomatic from spending too much time reading about the disease. None of those seem particularly likely, but one of them has to be true.

 

[Ulf Nereng]

Here's another piece on the long-term effects of Covid: https://www.stuff.co.nz/national/he...ple-will-need-treatment-for-life-experts-warn



10% of patients is a hell of a lot, although it will only symptomatic cases, so 1-2% of the overall number. That's still a lot of people and another very good reason for reducing the number of people infected.

It's a strong argument against the "herd immunity by infection" idea.

 

[dann]

The freedoms for all ages to mix in a carefree manner in New Zealand afford a sense of national unity, and make Sweden look totally insane. Surprisingly it is fashionable to praise Sweden with right wing commentators.

No reason to be surprised, really. Sweden has been doing all along what right-wingers prefer: Let the virus run its course and kill the people whose immune systems aren't up to the task of saving their lives.
Right-wing commentators in Denmark also advocate the Swedish strategy.
By the way, Sweden's right-wing party of anti-immigrants, Sverigedemokraterna, criticize the ruling Social Democrats and actually advocate wearing masks: Munskydd räddar liv = Masks save lives.
However, I don't think that wearing masks or declining to do so has turned into a political statement in Sweden yet.

 

[dann]

New Zealand, like for instance S. Korea, was able to control Covid-19. Sweden, the UK, France, Spain, Italy, etc. were not and, with the exception of Sweden, implemented controls that, while not as strong as China were stronger than the lighter ones that Sweden did and produced more societal harm on top of more deaths.

I will start off saying I'm surprised Sweden has dropped its daily death rate so consistently given its policies. I did not expect this.

Compare Sweden's total corona deaths and their deaths per million to the other Nordic countries - and it's still ongoing. Iceland hasn't had any for months. Denmark, Norway and Finland now have less than one Covid-19 death a day, and they have just a handful of serious/critical cases.

But it isn't true that Sweden didn't implement controls. Sweden implemented partial school closures, limits on group size, social distancing. Not to the degree in most other places and still resulted in a lot of deaths pretty typical of other locations like France, Spain, Italy, UK, etc.

Sweden overtook the death toll per million of France a couple of weeks ago and is gaining on Italy while Sweden's senior citizens are cowering in their homes.

However, the really large reduction in new cases of older people apparent in the last month is beyond what's seen in other countries. There is obviously a conscious effort to reduce exposure of vulnerable people in Sweden we do not see to the same degree most elsewhere.

Old people in Sweden have been left to their own devices, but some old people have more devices than others. You reduce the exposure of vulnerable people by reducing it in the general population.

If they keep this up it's entirely possible they could reach herd immunity with under .1% of the population dying while just letting it rip w/o protecting the vulnerable might kill .4% to .6% of Sweden.

There is no such thing as herd immunity reached in this way. And there are many other vulnerable segments of the population besides old people. Some are more vulnerable to the virus if the get it. Others are more likely to get exposed to it than others. Well-to-do senior citizens in Sweden are much better protected from getting it in the first place than poor people and/or immigrants, for instance:
Rich and poor
Poverty and bad health
And it's a pattern we see all over the world.

.1% is still a lot of people.

It is. And it doesn't include the people who are maimed for life.
A month ago or so, some Swedes came up with the slogan that what is needed isn't herd immunity, it's herd humanity.
It's sorely lacking in Sweden.

 

[dann]

It would be good to hear from our Swedish members what, if anything new, has been done recently to get the deaths down. I assume that mistakes that were made early on wrt to care homes are not being repeated, at least. And perhaps the populace have become more conscious of the dangers so that they socially distance better or somesuch?

At this point, Sweden has been attempting to do testing, contact tracing and self-isolation/quarantine for a couple of weeks, but some regions still aren't up to it. However, it should already be contributing to bringing down the number of new cases as well as hospitalizations and deaths.
I have no doubt that advocates of the Swedish strategy will contribute the decreasing numbers to the successful implementation of their insane ideas of herd immunity.

 

[Skeptic Ginger]

That matches my own experience of symptoms clearing and then coming back, any tissue or organ that gets stressed in any way seeming to become a target for the virus, and "wow, I'm finally back to normal... wait, I lifted something heavy and now I'm not so sure."

Unfortunately, I can't apply my own experience because I tested negative. Either it was a false negative, or I had something else that happens to have all the same symptoms, or it was all psychosomatic from spending too much time reading about the disease. None of those seem particularly likely, but one of them has to be true.

If I were seeing you as a nurse practitioner, test results are only one element I would consider. You give a good test a lot of weight, but even then it wouldn't rule out COVID 19 completely. If the symptoms are that distinct, and COVID 19 is in the area and I ruled out things like Rocky Mountain Spotted Fever (did you get any tick bites?) and brucellosis (drink any raw milk?)... I would diagnose it as COVID 19.

 

[dann]

With just a little effort USA can pass 100k infections a day, easy. Late August would be my guess for when that happens.

I don't think that's going to happen. Every time the virus has reached a point where it seemed nothing short of saturation was going to slow it down in some region, it's slowed down. I have no idea why. Not knowing why has been driving me crazy. But it's been a very consistent pattern.

There is no reason to assume that it didn't already happen. Consider that we aren't talking about the actual number of new infections. We are talking about the number of registered new infections, i.e. people who have been tested positive. There is no reason to assume that the number of actual new infections isn't already considerably higher than 100,000.
If they ramp up testing, they'll notice that they are already there. Trump knows that, which is why he would prefer that they don't.

 

[Myriad]

If I were seeing you as a nurse practitioner, test results are only one element I would consider. You give a good test a lot of weight, but even then it wouldn't rule out COVID 19 completely. If the symptoms are that distinct, and COVID 19 is in the area and I ruled out things like Rocky Mountain Spotted Fever (did you get any tick bites?) and brucellosis (drink any raw milk?)... I would diagnose it as COVID 19.

No raw milk, though brucellosis is a pretty good match for the symptoms otherwise. I'm not aware of any tick bites, but there are plenty of ticks around here so Lyme and RMSF are hypothetical possibilities. No rashes, though, and the cough doesn't fit. (I'll probably get tested for all the tick-bornes when I tell my PCP the history, in about a week.)

I'm in MA, which has a low new case rate right now, but five or six weeks ago they were still tapering off in my area. My wife had potential exposure through her retail job, and if she had an asymptomatic case (or nearly asymptomatic; she had some minor coughing, malaise, and an unexpected arthritis flare-up at around that time, but no fever) I'd be practically guaranteed to catch it from her.

That's all a rather ad hoc scenario, though. Overall, it's plausible but improbable. I doubt they'll even do an antibody test because at this point if they don't find something else, it wouldn't really make any difference. Doctors are understandably rather blasé about symptoms you had weeks ago.

 

[The Atheist]

That matches my own experience of symptoms clearing and then coming back, any tissue or organ that gets stressed in any way seeming to become a target for the virus, and "wow, I'm finally back to normal... wait, I lifted something heavy and now I'm not so sure."

Unfortunately, I can't apply my own experience because I tested negative. Either it was a false negative, or I had something else that happens to have all the same symptoms, or it was all psychosomatic from spending too much time reading about the disease. None of those seem particularly likely, but one of them has to be true.

I'd certainly put you in the "positive through symptoms" pile. In the middle of a pandemic, it's a hell of a lot more likely than any other infection.

It's a strong argument against the "herd immunity by infection" idea.

Not to mention we have no evidence of how long that alleged herd immunity might last.

 

[Myriad]

There is no reason to assume that it didn't already happen. Consider that we aren't talking about the actual number of new infections. We are talking about the number of registered new infections, i.e. people who have been tested positive. There is no reason to assume that the number of actual new infections isn't already considerably higher than 100,000.
If they ramp up testing, they'll notice that they are already there. Trump knows that, which is why he would prefer that they don't.

Well, sure. But at this point "new confirmed cases" under more or less the current testing system has become a de facto comparative measure. As crude as it is, it's what we're using to compare one country with another and one week with another (along with hospitalization, ICU, intubation, and death rates). I don't think that measure is going to double in the U.S. from where it is today.

Sure if you change the measure (e.g. to extrapolated total new cases, or to new confirmed cases under a regimen of much wider testing and test eligibility) the numbers will change.

 

[marting]

There is no reason to assume that it didn't already happen. Consider that we aren't talking about the actual number of new infections. We are talking about the number of registered new infections, i.e. people who have been tested positive. There is no reason to assume that the number of actual new infections isn't already considerably higher than 100,000.
If they ramp up testing, they'll notice that they are already there. Trump knows that, which is why he would prefer that they don't.

If the USA didn't have any Covid-19 testing at all there would be no Covid-19 deaths. There would just be excess deaths. Estimates of excess deaths from the Covid-19 pandemic vary from 15% to 50% from one state to another. What's for Trump not to like?

And of course there would have been no shutdown, social distancing, etc. so the actual deaths would have been much higher. But hey, at least no certified Covid-19 deaths.