Sandbox (4)

Sometimes very active discussions about peripheral issues overwhelm a thread, so this is a permanent home for those conversations.

I’ve opened a new “Sandbox” thread as a post as the new “ignore commenter” plug-in only works on threads started as posts.

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2,921 thoughts on “Sandbox (4)

  1. I should add that while testing gives data useful for determining the prevalence of the disease, it is pretty useless for diagnosing individuals.

    CDC has recently advised that anyone who tests positive should be considered recovered after 10 days. There is no all clear test.

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  2. The number and magnitude of unknowns about this virus is really discouraging. I’ve been trying to follow the science, but as far as I can tell what we don’t know is:
    1) Whether asymptomatic infected people are always contagious
    2) Whether outwardly asymptomatic people are actually being injured internally
    3) How many people have actually been infected, or died. Both have been estimated at up to ten times the Johns Hopkins counts.
    4) Whether an effective treatment is even possible
    5) Whether an effective vaccine is even possible
    6) Whether recovered people have immunity, and if so for how long
    7) What causes the wide range of symptoms, from none all the way to death
    8) Whether anyone has contracted the virus from touching surfaces, and how long the virus can remain active on different surfaces. Do we need to disinfect all doorknobs, groceries, shoes, clothing?
    9) Whether this virus will become endemic, making masks and social distancing part of our lives from now on. (Nations that got it under control and re-opened are seeing resurgences. Can we EVER re-open?)

    I’m sure this is just a partial list, but this much ignorance has us living in Sagan’s demon haunted world for the indefinite future.

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  3. Flint:
    The number and magnitude of unknowns about this virus is really discouraging. I’ve been trying to follow the science, but as far as I can tell what we don’t know is:
    1) Whether asymptomatic infected people are always contagious
    2) Whether outwardly asymptomatic people are actually being injured internally
    3) How many people have actually been infected, or died. Both have been estimated at up to ten times the Johns Hopkins counts.
    4) Whether an effective treatment is even possible
    5) Whether an effective vaccine is even possible
    6) Whether recovered people have immunity, and if so for how long
    7) What causes the wide range of symptoms, from none all the way to death
    8) Whether anyone has contracted the virus from touching surfaces, and how long the virus can remain active on different surfaces. Do we need to disinfect all doorknobs, groceries, shoes, clothing?
    9) Whether this virus will become endemic, making masks and social distancing part of our lives from now on. (Nations that got it under control and re-opened are seeing resurgences. Can we EVER re-open?)

    I’m sure this is just a partial list, but this much ignorance has us living in Sagan’s demon haunted world for the indefinite future.

    I think the mistake is thinking you van get it under control. Aside from vaccination and herd immunity.

    I’ve heard nothing to suggest anyone can get it twice. As for lasting immunity, people have immune responses to covid-2 seventeen years later. Vaccine trials are encouraging.

    If it were not so lethal to old people and people with certain health conditions, it would be a nothingburger. Below the noise level of seasonal flu.

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  4. New York has a cumulative case mortality rate of seven percent. Florida has about the same population, approximately the same number of old people, and approximately the same number of cases.

    But it has a cumulative case mortality rate of 1.25 percent.

    Something happened between NY’s surge and Florida’s.

    Could be improvements in treatment.
    Could be cases in florida are younger and healthier.
    Could be Florida did a better job of protecting people in nursing homes.

    Texas’ case mortality rate is better than Florida’s.

    Regardless, it makes no sense to make policy based on number of cases.

    More sense to look at deaths and hospital utilization, even though the reporting is not consistent from place to place.

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  5. petrushka:

    I’ve heard nothing to suggest anyone can get it twice. As for lasting immunity, people have immune responses to covid-2 seventeen years later. Vaccine trials are encouraging.

    If it were not so lethal to old people and people with certain health conditions, it would be a nothingburger.Below the noise level of seasonal flu.

    Clearly, we are looking at different sources for our information. I have read of multiple cases of “recovered” people getting re-infected. In these cases, it’s unknown whether they had fully recovered, or contracted a different strain, or had simply failed to develop immunity for some reason. But it has happened.

    I have seen also a couple of studies suggesting that variations of certain genes are at least partly responsible for the severity of the symptoms in different people. As for lasting immunity, while there hasn’t yet been time to determine this, several studies suggest that antibody counts diminish rapidly, and are below a helpful level within a few months. NOT like several other coronaviruses.

    New York has a cumulative case mortality rate of seven percent. Florida has about the same population, approximately the same number of old people, and approximately the same number of cases.

    But it has a cumulative case mortality rate of 1.25 percent.

    Something happened between NY’s surge and Florida’s.

    Could be improvements in treatment.
    Could be cases in florida are younger and healthier.
    Could be Florida did a better job of protecting people in nursing homes.

    Texas’ case mortality rate is better than Florida’s.

    Regardless, it makes no sense to make policy based on number of cases.

    More sense to look at deaths and hospital utilization, even though the reporting is not consistent from place to place.

    Lot’s of possible variables here. But just for starters, there simply IS NO USEFUL TREATMENT yet. Maybe remdesivir will prove out, and some medications seem to postpone or even prevent deaths in people on ventilators. But as for a general treatment, nothing yet.
    One thing that changed between New York and Florida was extensive testing, enabling cases to be identified earlier. Also, Florida’s victims are much younger on average. I think also PPE availability changed, so nurses weren’t so likely to spread the virus a couple months down the road.

    I agree that deaths and hospitalization rates are more solid data, though I’m a bit dubious since the administration took the CDC out of the reporting chain, so actual numbers are now unknowable. A cynic might suspect this was done so that false numbers, much more positive, couldn’t be fact-checked.

    As far as I have been able to determine, the fatality rate for confirmed cases is approximating 1%, which is an order of magnitude higher than the 0.1% for flu. I can’t agree without about “old people and people with certain health conditions.” Do you really think prisoners and met-packers are that old, or that being a prisoner or meat packer is a “certain health condition”? The dangerous conditions are tight quarters without protection.

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  6. I think you may have misread or misunderstood my intended meaning on several points.

    Meat packers may have spread the disease to each other, but I’m not aware that many died.

    As for comparisons with flu, I’m not aware that any attempt has ever been made to test for flu in every sick individual. I think the data are mostly estimates and pretty sketchy.

    I’ll be happy to admit I’m wrong if you can find a recently sourced well grounded case of someone getting covid-19 twice. I’m not even sure we have the technology to confirm that kind of claim. I know half a dozen people who had suspicious symptoms and tested negative. And there are people who test positive months after recovery, but not when studied closely.

    CDC was taken out of the reporting chain because they were including antibody positives as new cases. Quite frankly, the data are crap.

    I’ve been watching every day for a couple of months. I haven’t seen any reason to doubt the big trends, but the daily stuff is meaningless. It looks more plausible when you look at seven day averages. Better yet if you look at months.

    Again, deaths and hospitalizations are more difficult to politicize, especially the seven day averages.

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  7. Roughly 450 South Koreans tested positive for the virus again after meeting the criteria for recovery and being discharged from isolation. The Korea Centers for Disease Control and Prevention re-tested more than half of those people and found no evidence of the live virus circulating.

    Peer-reviewed research studies have shown that viral fragments can circulate even after an individual is symptom-free. That doesn’t mean that people are still sick or infectious.

    https://www.wsj.com/articles/can-you-get-covid-19-twice-11589388593

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  8. petrushka:
    Antibodies might be transient, but the immune response isn’t. There’s lots of evidence that no one gets 19 twice.
    There’s recent evidence that tests are reporting false positives due to picking up dead virus material circulating months after recovery,.

    Let’s hope it stays that way, this virus is less than a year old, there is lots of unknowns.

    I’m in Connecticut. My kids live in NYC. Things have been open for six weeks here without a surge. We keep our distance and wear masks, but we can eat in restaurants. There’s no second wave.

    Not yet, the 1918 virus, had a Spring, a lager wave in the Fall and another in the following Spring. I think caution is warranted. Since so far the US response has not been impressive. At the Federal level, our response has been at a “ person, woman ,man , camera, TV” level.

    The naughtyfour — Florida, California, Arizona, and Texas — are having their first wave, and have pretty much peaked.

    California is locked down , all the others have reversed course. Trump campaign already has thrown the Governors under the bus for opening too soon, based on the belief that voters suffer from amnesia .There will be more pressure to declare victory and reopen. Wash ,rinse ,repeat.

    Deaths haven’t peaked, because they lag cases by three or four weeks.

    I agree, three weeks ago about 450 Americans died ever day ,about the lowest since March , we are now at eleven hundred a day and rising still.

    Apparently a lot has been learned about treatment, because case mortality is down about 80 percent from April.

    True, they understand how to use ventilators better, other drug therapies. And despite that knowledge the number of deaths has almost tripled in three weeks.

    That, or the median age of cases has dropped 20 years. There are virtually no deaths among otherwise healthy people under 60. Almost no deaths among school age children.

    Yes ,lack of testing cost many lives in March and April. Now the virus has established itself in a larger geographical area. Lots more people over 60 and lots of unhealthy.

    Middle and upper middle class kids are doing well with remote schooling. Not so much with poor kids. They will be a year behind.

    Then we should come up with a good plan and fund it ,to do our best to insure we do not have to close the schools back down. A bit of caution seems warranted, unless the motivation is re-election .

    A number of European countries reopened schools without problems.

    Sure, they did the work to lower the spread, we argued about masks. The US lacks any cohesive National will to do the hard work.

    Obviously, kids and teachers having medical problems need exemptions, as do teachers. That would include people living with a vulnerable person.

    Good idea, now how many kids to a class, who is paying for the additional cleaning, should we give teacher premium pay like the medical folks for putting their lives in an exposed situation? These questions and more need to be answered ,before opening.

    Hopefullythe vaccine will be ready before December, and we can put this thing to rest .

    Maybe, as long as you don’t throughly test it. And come December at the rate we are going, we could be pushing 250.000 dead. And Trump will still be playing golf.

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  9. Kantian Naturalist: It wouldn’t be the first day of school without a socially distanced active shooter drill.

    This generation is facing some big challenges.

    It’s a “killing two birds with one stone” victory for the Trump administration: forcing schools to re-open enables parents to go back to work, which makes “the economy” look better, and doing so without adequate precautions means that more teachers will get sick and die.

    People are attached to their children, who in their right mind would think Trump cares about what happens to anybody but Trump? Maybe he will dispatch his armed government employees to act as truant officers, they have some experience with that along the border.

    But the Trump administration is probably assuming that the coronavirus won’t be too serious for the children themselves. I don’t know what the data are on that.

    That is the general consensus. Barron’s school feels that caution is a good idea.

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  10. petrushka:
    I should add that while testing gives data useful for determining the prevalence of the disease, it is pretty useless for diagnosing individuals.

    My wife is at risk, she ran a fever And her blood pressure dropped , we took to the ER. That did a quick test and eliminated COVID , that seemed like useful knowledge to have. The doctors eliminated several things by testing.

    CDC has recently advised that anyone who tests positive should be considered recovered after 10 days. There is no all clear test.

    Heard that.

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  11. petrushka: If it were not so lethal to old people and people with certain health conditions, it would be a nothingburger. Below the noise level of seasonal flu.

    “ Apart from that Mrs. Lincoln ,how was the play?”

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    Alan Fox
  12. Concerns on immunity are not eliminated by vaccine – if real-disease antibodies are ineffective, artificially-stimulated ones will be no better.

    I’m more optimistic. We aren’t still in the grip of any prior pandemics, and I can’t see this being the first-ever perpetual one. This is not the immune system’s first rodeo. The disease may become endemic, but even so it is also likely that severity will diminish – partly through natural selection, partly through a possibly imperfect but still-there immune response. The colds that give us the sniffles annually were fatal to remote tribes that had never seen them. At origin, presumably they were fatal to our ancestors too. Something changed.

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  13. Allan Miller:
    Concerns on immunity are not eliminated by vaccine – if real-disease antibodies are ineffective, artificially-stimulated ones will be no better.

    I’m more optimistic. We aren’t still in the grip of any prior pandemics, and I can’t see this being the first-ever perpetual one. This is not the immune system’s first rodeo. The disease may become endemic, but even so it is also likely that severity will diminish – partly through natural selection, partly through a possibly imperfect but still-there immune response. The colds that give us the sniffles annually were fatal to remote tribes that had never seen them. At origin, presumably they were fatal to our ancestors too. Something changed.

    Elimination of a certain segment of the population?

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  14. Some of you are treating the current situation as a second wave, but it isn’t.

    Some regions just started later than others. As some countries did.

    As for how things have been managed, you need to look at case mortality rates.

    The Northeast was hit first. Its case mortality rate is at least six times that of Texas.

    Either Texas is six times better than New York at treating the disease, or the demographics are different. Or some of both.

    I ask myself, what happened in early June that didn’t happen in May, when lots of states opened for business. Why is the current surge mostly in people below age thirty? Why did so many old people get infected in the northeast, but not so many in Florida, Texas, California, and the rest of the country? Actual questions; not rhetorical.

    There are two conjectures that need confirmation, but seem likely to me.

    One is that the majority of people — maybe as high as 80 percent — have partial immunity due to exposure to other coronaviruses. That would explain the likely ten to one ratio of infections to reported cases. That ratio is the second conjecture.

    Together they make a plausible hypothesis as to why regions have developed something like herd immunity when only two percent of the population is known to have been infected. Two percent is actually twenty, and another eighty percent will never have severe symptoms.

    Regardless, we can observe that everywhere in the world, the epidemic fades over three months or so. And until a vaccine arrives, every region will eventually have a surge. High density populations will be hardest hit. Demographics will determine death rate.

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  15. petrushka: Some of you are treating the current situation as a second wave, but it isn’t.

    It’s still the first wave. Over 90% of the use of the phrase “2nd wave” that I have seen has been people attributing it to someone else, as you do here.

    Some regions just started later than others. As some countries did.

    The most important factor, by far. And the later geographies had the opportunity to learn from the experience of the earlier geographies, regarding both epidemiology of transmission and effective treatment paradigms.
    The debate surrounds when and where this opportunity was squandered.

    As for how things have been managed, you need to look at case mortality rates.

    That is one metric, of many. But we will have to wait until the pandemic is over before we can do that, death being a lagging indicator. We will have to wait even longer to assess long-term morbidity associated with CoVid-19. If you really want to measure something as vague as “how things have been managed”, you ought to look at excess per capita mortality.

    The Northeast was hit first. Its case mortality rate is at least six times that of Texas.

    Either Texas is six times better than New York at treating the disease, or the demographics are different. Or some of both.

    Medical staff in Texas knew far more about treating CoVid-19 than their counterparts in NY did, and they had remdesivir and dexamethasone. As to whether Texas’s resources will be overloaded the way that NY’s were, that remains to be seen.

    I ask myself, what happened in early June that didn’t happen in May, when lots of states opened for business. Why is the current surge mostly in people below age thirty? Why did so many old people get infected in the northeast, but not so many in Florida, Texas, California, and the rest of the country? Actual questions; not rhetorical.

    You might want to find a less biased source for your data on when states re-opened, and HOW. And again, understand that the demographics we are seeing today are not comforting at all. Here’s a random thought: surges in FL, TX, AZ and parts of CA were due to young morons going out and partying. (Also, note the lack of any effect of BLM protests: masks work) The wave of young adults will be followed by a wave of their parents. Just as a reminder, on June 12th, you wrote this:

    Outbreaks defined how? Do you have some magic way of distinguishing increases in actual cases from the increased numbers recorded by increased testing?

    New US case rates recorded by worldometers have been steadily declining if you look at the seven day rolling average. Despite increases in testing.

    Deaths have been declining at a more rapid rate.

    Neither of these trends have changed in the last two weeks.

    The charts below highlight June12 to illustrate just how spectacularly wrong you were. Also, to answer your “magic way” taunt: yes we do, test positivity rate.

    There are two conjectures that need confirmation, but seem likely to me.

    One is that the majority of people — maybe as high as 80 percent — have partial immunity due to exposure to other coronaviruses. That would explain the likely ten to one ratio of infections to reported cases. That ratio is the second conjecture.

    Together they make a plausible hypothesis as to why regions have developed something like herd immunity when only two percent of the population is known to have been infected. Two percent is actually twenty, and another eighty percent will never have severe symptoms.

    This is incoherent. First thing to sort out: you are using the phrase “partial immunity” when you mean something else. I think you mean “have a mild course of disease”. That’s a completely different thing, especially since those patients transmit the disease to others. Pre-symptomatic patients transmit the disease, unlike the flu. Now, in fairness, there is a suggestion that some patients may never show any symptoms, and it is unclear if such patients are ever infectious. The whole ratio of infections to reported cases question affects the ‘how long til herd immunity kicks in’ question, and to date there is no sign that anywhere (except Wuhan, perhaps?) is reaching that point.

    Regardless, we can observe that everywhere in the world, the epidemic fades over three months or so. And until a vaccine arrives, every region will eventually have a surge. High density populations will be hardest hit. Demographics will determine death rate.

    [Spit-take]
    The only regions where it has ‘faded’ are Europe and the Western Pacific, which includes New Zealand. Would you like me to explain why? (that’s rhetorical).

    It is unclear how long-lasting and effective immunity will turn out to be, whether achieved through infection or via one of the vaccines. I will agree that the cases of apparent re-infection that I have read about look (to me) more like a zoster-like flare up, rather than a new infection. That is hardly reassuring. But saying, as you did, “people have immune responses to covid-2 seventeen years later” is highly irresponsible. Please be more precise, and less misleading, in your use of language.

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  16. Here’s the graphic, call-outs refer to the date certain people claimed “look how well we are doing!”.

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  17. newton: Elimination of a certain segment of the population?

    Yes, that’s the ‘natural selection’ part, though it also applies to the virus. Not the segment one might immediately think of though – differential elimination of the elderly or circumstantially infirm wouldn’t be NS, since there isn’t a genetic component to being a particular age.

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  18. I had a pet theory that the virus would exhibit seasonality, but the rampaging through the southern states rather argues against that (perhaps air conditioning is a counteracting factor, as well as behaviour). Australia’s resurgence and S. America favour the hypothesis.

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  19. Allan Miller:
    I had a pet theory that the virus would exhibit seasonality, but the rampaging through the southern states rather argues against that (perhaps air conditioning is a counteracting factor, as well as behaviour). Australia’s resurgence and S. America favour the hypothesis.

    The main contributing factor of the spread seems the inevitable need of young people to congregate.

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  20. I never asserted a second wave happened. I havent seen any region have more than one peak.

    What seems to happen is that different countries and different states and different population centers start their wave at different times.

    Texas, Florida, and California combined have four times the population of New York, and combined, have half the deaths.

    I can think of three possible causes.

    The greatest cause is that recent surges have mostly been among young people.

    Second cause is that most states did not send sick people into nursing homes. That maneuver probably doubled the death toll in April.

    Third probable cause is that treatment has gotten better. That’s neither political nor managerial. Medicine gets better with experience.

    Georgia, Florida, Texas, and Arizona have all entered an easily visible decline in new cases. Their deaths will be undeniably down by the middle of August. In five or six weeks, covid19 will no longer meet the definition of pandemic.

    There’s lots of discussion as to why it declines before reaching the 60 percent point.

    One possibility is that lots of people had partial immunity.

    Another possibility is that the disease is mostly transmitted by superspreaders — people who are unusually socially active. Once these people recover, the spread is considerably slowed. The hypothesis is that herd immunity can be reached at ten or twenty percent.

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  21. petrushka:
    I never asserted a second wave happened. I havent seen any region have more than one peak.

    For what it’s worth, the news this morning reported that after nearly eliminating new cases, we now have serious resurgence in Japan, Hong Kong, and Australia. Australia was down to only a few cases a day, and suddenly they’re back up to hundreds, and over 7000 cases in the last month. Hong Kong went like 19 days without a single new confirmed case, and they are now back to several hundred a day. One of these nations (I forget which) is now experiencing the most daily cases they have ever had. Does this count as a second wave?

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  22. petrushka: I havent seen any region have more than one peak.

    Louisiana and Maryland.
    and Japan and Australia, [h/t Flint.]

    petrushka: Texas, Florida, and California combined have four times the population of New York, and combined, have half the deaths.

    Well, that hasn’t been true for over a week now. Try to keep up.

    petrushka: Georgia, Florida, Texas, and Arizona have all entered an easily visible decline in new cases.

    That’s a relief. And death rates have plateaued in Arizona, but they continue to rise in the other three states. It’s almost as if death were a lagging indicator…

    petrushka: Their deaths will be undeniably down by the middle of August.

    I hope so too, but…

    petrushka: There’s lots of discussion as to why it declines before reaching the 60 percent point.

    One possibility is that lots of people had partial immunity.

    Another possibility is that the disease is mostly transmitted by superspreaders — people who are unusually socially active. Once these people recover, the spread is considerably slowed. The hypothesis is that herd immunity can be reached at ten or twenty percent.

    …all you seem to have is some incoherent wishful thinking.
    There’s tons of data correlating the decline in infection rates with avoiding high risk activities.
    Furthermore, you failed to clarify what you mean by “partial immunity”. Do you really mean to claim that a majority of the population is (thanks to previous exposure to other coronaviruses) largely immune to infection, requiring, say, a far larger initial exposure for a productive SARS-CoV2 infection?
    I would advise anyone reading this blog to rely on medical experts, such as Dr. Fauci and the doctors at the CDC, and not the magical thinking of internet pundits with political axes to grind (of any persuasion, irony intended).

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  23. petrushka:
    I never asserted a second wave happened. I havent seen any region have more than one peak.

    I think the issue was you attributed the usage of a second wave to some other people here.

    What seems to happen is that different countries and different states and different population centers start their wave at different times.

    I think that is exactly right, and those in the initial outbreak generally faired worse due to higher density and makeup of the population and the the surprising quickness of the spread.

    Texas, Florida, and California combined have four times the population of New York, and combined, have half the deaths.

    So far. Though that is a bit apples and oranges. ,

    I can think of three possible causes.

    The greatest cause is that recent surges have mostly been among young people.

    True, locking down the State before the virus was widespread in the population slowed the rate of infection. Testing allowed some control over the spread. In the case
    of New York, the density of the area allowed it to spread quickly and the ability to test was pathetically low. Generally a more at risk population, plus nursing homes became death traps.

    Second cause is that most states did not send sick people into nursing homes. That maneuver probably doubled the death toll in April.

    More testing of health worker and residents.

    Third probable cause is that treatment has gotten better. That’s neither political nor managerial. Medicine gets better with experience.

    There was much to do about about treatments at the political levels, and pressure to administer certain drugs with still unknown side effects. The effectiveness of the present therapy might be attributed to science triumphing over politics The first cause you cited is directly managerial and political, the speed of the opening was a political consideration.

    You have yet to list testing or lack of it a cause. Certainly that was and is a managerial and political issue, latest White House plan calls for reduction of funding for CDC and testing. Accurate reporting of cases and outcomes also seems to be under fire. Cutting CDC out and hospitals directly report to HHS, if one chose to gild the lily that would be a way.

    Or the use of masks. The lack of masks for the doctors and nurses and understanding the spreading mechanism caused the medical authorities misinform the public about use of masks. Political, it has become.

    Georgia, Florida, Texas, and Arizona have all entered an easily visible decline in new cases.

    A decline from record high is not anything to get too happy about, remember ,these states are back to where they were in May shutdown wise. It seems obvious that the political pressure to reopen caused this surge. A surge of young and old, and the deaths many still going on,

    “Doctors at a Texas hospital along the US-Mexico border may decide to send coronavirus patients “home to die by their loved ones” due to limited resources, officials say.

    Government and health officials in Starr County announced this week they are creating committees to review patients’ cases at the Starr County Memorial Hospital in Rio Grande City.
    At least 50% of the patients admitted in the hospital’s emergency room have tested positive for Covid-19, Dr. Jose Vasquez, the county’s health authority, said in a news conference earlier this week.
    “The situation is desperate,” he said.

    Texas Covid-19 hot spot is facing a ‘tsunami’ of patients, overwhelming hospitals
    This rural South Texas county began seeing an increase in positive cases about a month ago, Vasquez said, and the hospital admitted its first Covid-19 patient at that time.“

    https://www.cnn.com/2020/07/24/us/texas-starr-county-hospital-coronavirus/index.html

    Their deaths will be undeniably down by the middle of August. In five or six weeks, covid19 will no longer meet the definition of pandemic.

    Are you nuts? The University of Texas plans to put 50,000 people , young and old, in a football stadium drinking beer in the hot sun.How many people are going to leave a mask on? People cheering on their team. Just like all the other big time Universities. Look what happened just opening bars,

    The stuff is out there, right now it’s dropping cause things are still closed.

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  24. My reading of lots of the state graphs is the pattern of rapid rise, slow decline, and then another slow rise (or in some cases the second rise is higher than the first). This pattern is clearly the case for the US as a whole – just take a look at the Johns Hopkins graphs.

    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

    Select US in left column, then daily cases in lower right. Sure enough, rapid rise, gradual decline, then another rise, MUCH higher than initially. Yes, this reflects New York initially, and other states later. We used to be a single country, back when we had a federal government that knew how to govern.

    What happened in Japan, Hong Kong, and Australia was a firm full-tilt national lockdown until the spread subsided and new cases were quite rare. Only then did they slowly start to re-open, and apparently the rapid resurgence of the virus spreads from certain flash points, like church services, bars, movie theaters, and apparently people visiting (or returning) from other countries, like the US.

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  25. 91-divoc.com has a lot of interactive features.

    One of the things you can spot is changes in diagnostic and testing criteria.

    If you look at deaths, the curves are less glitchy.

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  26. petrushka:
    This is just silly.

    There is no second wave. Just first waves starting at different times.
    https://91-divoc.com/pages/covid-visualization/?chart=states-normalized&highlight=(None)&show=us-states&y=both&scale=linear&data=cases-daily-7&data-source=jhu&xaxis=right#states-normalized

    Perhaps this is a matter of confusing terminology. What LOOKS like a possible second wave in Japan, Australia, Hong Kong might simply be significant outbreaks in locations where there was no previous problem. If we look at the US as a whole, or Australia, or Japan, we see what could easily be described as a second wave. But if we drill down to actual states, cities, even neighborhoods, we don’t see the same pattern. So if we are going to define a “second wave” in highly granular terms, where actual city blocks must have an outbreak, have it diminish to nearly nothing and then return, then no, there’s no second wave. The appearance of “second waves”, then, is simply a matter of our regions being too large to see the actual pattern. There is a forest-level second wave at national levels, but no tree-level instances.

    But if we dig down far enough, the only “second wave” possible is if distinct individuals recover and then get re-infected. I’m not sure this has been happening – those people could reflect a false diagnosis of recovery.

    Bottom line: whether a second wave has happened anywhere depends entirely on how we define such a wave, and how we measure what we have defined. I haven’t seen a definition I regard as particularly informative or useful.

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  27. The possibility of people getting reinfected has been studied in some detail, and it doesn’t seem to happen.

    Most of the cases happen in dense populations, and whatever their size, they seem to reach herd immunity. At any rate, deaths decline to very low levels and don’t rise again.

    I’m optimistic that deaths will decline drastically in the next two months, and that vaccines will be available by the end of the year. This involves some wishful thinking, but it is based on statements made by vaccine makers and on reading graphs that look very regular.

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  28. petrushka:
    The possibility of people getting reinfected has been studied in some detail, and it doesn’t seem to happen.

    I hope this is the case, and remains the case. I’m not sure that half a year at most is long enough to be a reliable baseline.

    Most of the cases happen in dense populations, and whatever their size, they seem to reach herd immunity. At any rate, deaths decline to very low levels and don’t rise again.

    I haven’t read of herd immunity being reached anywhere. I note that Sweden tried (and maybe some red states), with resounding lack of success. I’d be willing to bet more on changes in public caution where case rates have been very high. Data from Europe suggest that universal mask wearing is the most effective tactic, followed by social distancing, enabled by partial economic opening. This seems to be working in New York. An effective vaccine would be much better.

    I’m optimistic that deaths will decline drastically in the next two months, and that vaccines will be available by the end of the year. This involves some wishful thinking, but it is based on statements made by vaccine makers and on reading graphs that look very regular.

    Well, clearly the winner of the vaccine race is in for Big Money, so vaccine producers might be, uh, pushing it a bit. I’m convinced that deaths are to a large degree a function of cases, but trailing them by a few weeks. For deaths to decline drastically in the next two months, cases would need to start drastically declining right now. I see some leveling off, but still at high levels.

    Not to be excessively pessimistic, but I’m starting to read about permanent ravages to heart, lungs, kidney, liver, pancreas in those who “recovered” from serious cases and now test negative. One recovered baseball pitcher (for the Red Sox, I think) tests negative, but can no longer play because of heart damage. When a vaccine is widely available, we may still have millions of cases of permanent vascular issues.

    Like everyone else, I’m itching to get out and do things – attend sporting events, eat in restaurants, and all that. But meanwhile, here in Alabama I see we’re now the new hot spot. It threatens to be a long winter…

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  29. petrushka: I’m optimistic that deaths will decline drastically in the next two months, and that vaccines will be available by the end of the year. This involves some wishful thinking, but it is based on statements made by vaccine makers and on reading graphs that look very regular

    Depends when they open up bars again. They opened the bars in middle of May in Texas ,it took about a month to cause hospitalization to rise and another three weeks for deaths. Closed them at end of June and we are seeing a drop about a month later.

    Unless human behavior drastically changes in next month, the reopening of universities in the fall the cases and hospitalization will rise.And those inflected will spread it to groups . And some of those inflected die unless you think there are only 150,000 Americans at risk.

    Vaccines are moving ahead, they are recruiting volunteers for the next phase, to see if it actually works. Four months sounds like a pretty short time to do that, what side effects occur,. You then have to manufacture the stuff. I believe Bill Gates is working on that aspect .

    I agree with Flint , I would love to have my life back. If history is a guide, the Fall looks to be unpleasant.

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  30. Flint: Not to be excessively pessimistic, but I’m starting to read about permanent ravages to heart, lungs, kidney, liver, pancreas in those who “recovered” from serious cases and now test negative. One recovered baseball pitcher (for the Red Sox, I think) tests negative, but can no longer play because of heart damage. When a vaccine is widely available, we may still have millions of cases of permanent vascular issues.

    That is the problem with just focusing on deaths, if there are long term issues some of the people who recover , the equation that the young are at little risk changes.

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  31. If you are just starting to read about long term effects, you are a bit behind. They have been in the news since April.

    The interesting questions are how many people are affected, and are improved treatments improving outcomes.

    I’m not reading much about this recently.

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  32. Here’s a July article:

    “ For many who contract the novel coronavirus, the manifestations of the disease tend to the mild and moderate, with improvement in a couple of weeks. But for those who survive COVID-19 after intubation and a long hospital stay, the health ramifications may last long after they are discharged. ”

    https://news.umiamihealth.org/en/what-are-the-long-term-effects-of-covid-19/

    Might be worth pointing out that after the initial NY surge, ventilator usage declined, and survival rates for those on ventilators improved dramatically.

    I could be reading these articles incorrectly, but this is my takeaway:

    90 percent of infections go unreported. Of the remaining ten percent, one in five will be hospitalized. That’s two percent.

    Also of that ten percent, one in 20 will require intubation. That’s 0.5 percent of all cases. Of those on ventilators, one in three will die. That’s about 0.16 percent.

    So of all infected people, about 0.34 percent are in the class which might have long term effects. Of course it’s possible that some milder cases might have milder long term effects. On the whole, being well is better than being sick. But for the most part, intubation itself causes lung damage, and requiring it is a sign of desperate illness.

    Again, I’m not an expert in statistics, but it appears in the early days, most of the people who died were on ventilators. It seems likely that better techniques and reduction in ventilator usage might account for much of the reduction in case mortality.

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  33. petrushka: 90 percent of infections go unreported. Of the remaining ten percent, one in five will be hospitalized. That’s two percent.

    Also of that ten percent, one in 20 will require intubation. That’s 0.5 percent of all cases. Of those on ventilators, one in three will die. That’s about 0.16 percent.

    So of all infected people, about 0.34 percent are in the class which might have long term effects. Of course it’s possible that some milder cases might have milder long term effects. On the whole, being well is better than being sick. But for the most part, intubation itself causes lung damage, and requiring it is a sign of desperate illness.

    There is a suspicion that Covid is a vascular disease rather than respiratory. In which case assuming long term effects will only apply to those who have been on vents is unjustified. At this point , any infection of Covid has a level of unknown risk not matter age or health.

    There are indications of cardiac, liver ,kidneys, and brain function being affected. These could be transitory effects , or like some drugs ,a permanent damage . That is why, in my opinion ,using mortality as the sole statistical indicator because it is less quirky may be underestimating the actual damage being done by the virus.

    Just as only counting the soldiers who die does not truly encompass the damage done to human bodies.

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  34. I just looked at recent case mortality rates for the country. It’s a bit lower than two percent.

    Assuming 90 percent of infections are unreported, that makes case mortality 0.2 percent, which is close to the 0.16 percent I calculated from the article on lingering effects of intubation.

    An aside: if medicine had been as good in April as it is now, the national death toll would be 50,000-80,000 instead of 150,000.

    The national case mortality rate in April was 6.5 percent. Now 2.0 percent.

    It will be difficult to tease out the effects of differences in testing and reporting, but the decline in case mortality is pretty much the same in all large states.

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  35. petrushka,

    I’m not sure there is much point in engaging with this magical thinking, but your comment about “recent” case fatality rates (CFR) needs correction.
    The CFR for a specified time period is calculated as the number of deaths divided by the number of diagnoses in that time period
    So long as there are unresolved, active cases, the CFR is inaccurate. 91-divoc, for instance, calculates the ‘weekly’ CFR as the number of CoViD deaths in the past week, divided by the number of New Cases in the past week.
    Since death is a lagging indicator, this CFR will bounce around in funky ways that have nothing to do with medical care. CFR only has meaning to the extent that the “Steady State Assumption” holds true.
    By way of illustration, below is a plot of Arizona’s ‘weekly’ data from 91-divoc: it shows new cases (divided by fifty to be roughly comparable with the death numbers), deaths, and the CFR.
    Notice how CFR is noisy in April, bouncing above 7.5% briefly. Then, at the end of May, New Cases start showing up [I wonder why], and this drives the CFR down. By June 23, Arizona has achieved an impressive (but meaningless) 1% CFR. Wow! Moving into July, New Cases plateau and start to come back down [why?], but the deaths start the inexorable climb that sane people knew was coming; and the CFR triples. Not terribly informative about the actual risk of death.

    1+

  36. petrushka: An aside: if medicine had been as good in April as it is now, the national death toll would be 50,000-80,000 instead of 150,000.

    Yes. And thanks to the ineptitude of the White House in ‘flattening the curve’, those 100,000 (and counting) deaths can be laid at Trump’s door.

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  37. petrushka:
    I just looked at recent case mortality rates for the country. It’s a bit lower than two percent.

    Assuming 90 percent of infections are unreported, that makes case mortality 0.2 percent, which is close to the 0.16 percent I calculated from the article on lingering effects of intubation.

    Why do you assume 90% of cases are unreported, but NONE of the deaths are unreported. After all, if you look at some particular jurisdiction, look at the historical baseline mortality rate, the current mortality rate, subtract the baseline from the current, you find a Very Large Number of deaths left over. Why do you suppose this is?

    Unfortunately for your statistics, excess (compared to normal) corpses taken from homes are NOT tested for covid. Why bother, they’re dead anyway, right? Conversely, I don’t know if we would be more accurate to attribute ALL deaths above the baseline rate to covid. But even if it’s most of them, your statistics are useless.

    Now, using your technique, I could count all those excess deaths, ignore ALL unreported infections, and derive a huge death rate. Why would my cherry-picking be less accurate than yours?

    ETA: Here is further discussion of this issue:
    https://ourworldindata.org/excess-mortality-covid

    https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2767980

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  38. I don’t really assume the data are perfect, but I assume they show trends.

    The 90 percent number come from a number of studies. Prison testing, cruise ships. 90 is low.

    Prison testing indicates that 96 percent of infections are asymptomatic.

    There are opposing complaints. That dying with covid is recorded as dying of.

    There are strong financial incentives for hospitals to record patients as covid.

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  39. DNA_Jock: Yes. And thanks to the ineptitude of the White House in ‘flattening the curve’, those 100,000 (and counting) deaths can be laid at Trump’s door.

    USA per capita deaths are lower than most European countries. At whose door are they laid?

    Belgium, France, Spain, UK.

    Germany is the standout exception.

    The American states that had huge death numbers are, by coincidence, the same states that sent covid patients into nursing homes. Nine out of ten states didn’t.

    Perhaps you can cite the statutory authority by which a president can flatten the curve.

    I believe that authority belongs to the states. The responsibility for monitoring diseases and advising states belongs to the Public Health Service, the Surgeon General, and the CDC.

    I could be wrong. Perhaps someone could enlighten me by explaining how SARS and H1N1 were handled.

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  40. petrushka: Prison testing indicates that 96 percent of infections are asymptomatic.

    That is helpful in prisons, not sure it translates to the general population, might need to see the demographics of the population.

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  41. petrushka: There are opposing complaints. That dying with covid is recorded as dying of.

    Depends ,I expect they do not test dead people with gunshot wounds for Covid. I expect there are general rules about how to classify deaths.

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  42. petrushka: There are strong financial incentives for hospitals to record patients as covid.

    Please elaborate strong financial incentives

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  43. I smell a hint of politics here. Trump sees it to his political advantage to claim that covid is being exaggerated, that the actual virus problem is much less dangerous than the fake news media have painted it. This is achieved in numerous ways.
    Count even wild estimates of unidentified cases as actual cases (this artificially lowers the mortality rate).
    Ignore even the possibility of people dying of covid at home (this artificially lowers mortality rate also).
    Focus on death rates falling as cases are rising, then when deaths catch up, change the subject.
    Claim that deaths from other causes are being counted as covid deaths (but provide no evidence).
    Claim hospital incentives to fabricate covid deaths (but provide no evidence).
    Predict, ad nauseum, that the virus is rapidly going away and will be gone soon.
    Redirect actual reporting from the field to political offices motivated to support Trump’s political requirements.
    Take actual scientists out of the loop, and away from any TV camera.
    Do everything possible to force organizations to pretend (or provide photo ops) things are normal (For example, threaten to deport foreign students taking college classes online. This hurts their home country, hurts the students, hurts the colleges, hurts the US balance of trade. Helps NOBODY, so Trump can pretend all is normal. Until colleges become hotspots. Then blame someone else.)

    And now, here we have the claim that even if Trump had recognized the threat when other nations did, and taken prompt and appropriate actions, there’s actually nothing he could have done because he lacks the authority! And how about nations that DID take quick and necessary steps, and now enjoy very low cases of new infections? Coincidence? How to explain why new cases are rising only in nations whose leaders are in denial (US, Brazil). Bad luck?

    I admit I wasn’t aware that any states had a policy or practice of identifying covid patients and sending them to nursing homes rather than hospitals. What is the source of this claim? I was also under the impression that the President had emergency authority to require manufacture of urgently needed supplies. When did he lose this power?

    I guess we should never underestimate the power of Trump TV to spin or fabricate whatever Trumpies want to hear.

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  44. petrushka: USA per capita deaths are lower than most European countries. At whose door are they laid?

    Get your facts straight. The USA, at mortality of 449 /mil, ranks 8th out of 50 European countries. Last time I checked, 43 is greater than 7. If I give you the benefit of the doubt, and restrict the ranking to EU-27, the USA is number 5; 22 is still greater than 4, FFS!

    Belgium, France, Spain, UK.

    Well the good old USA just overtook France, kid. Spain and Italy got hit significantly earlier than the US did (that’s where the US infections came from, btw) hence all the talk of the squandered opportunity. The UK and Sweden are the other two poster children for how NOT to deal with a pandemic. Belgium counts any death that might conceivably be corona as CoVid; they are the one country that might conceivably be over-counting CoVid deaths, whereas in the USA, for every two “CoVid” deaths there is approximately one additional excess death.
    So Boris and Stefan join Donald in the Hall of Shame.

    Germany is the standout exception.

    Well, along with Denmark, Austria, Hungary, Finland, Poland, Greece, etc, etc.

    The American states that had huge death numbers are, by coincidence, the same states that sent covid patients into nursing homes. Nine out of ten states didn’t.

    Huh? NY, NJ, and CA made this mistake, but you are claiming that it happened in the top five states (in terms of # dead) — Massachusetts did not. You tell me about Illinois.

    Perhaps you can cite the statutory authority by which a president can flatten the curve.

    ROFLMAO! Donald claimed he had the power to deploy the Army along the Southern Border to defend us against a Guatemalan caravan, because it was a National Emergency. He thinks he can order the Governors to re-open their states for business. So, it’s safe to say he could have issued a National Face Mask Mandate; there’s a million things he could have done. Are you really retreating to the position that “he’s only the President, he can’t do anything” in defense of this President? That’s deranged!

    I believe that authority belongs to the states. The responsibility for monitoring diseases and advising states belongs to the Public Health Service, the Surgeon General, and the CDC.

    I could be wrong. Perhaps someone could enlighten me by explaining how SARS and H1N1 were handled.

    A lot better than this clusterfuck. For example, they conducted a thorough after-action review and laid out exactly how to respond to the next epidemic in a Playbook. But you already knew about that, right?

    I don’t mind your defense of Trump — it’s entertaining. But please cease making statements about CoVid-19 that are misleading or outright false.

    1+
    Corneel
  45. petrushka: USA per capita deaths are lower than most European countries. At whose door are they laid?

    Belgium, France, Spain, UK.

    Germany is the standout exception

    Demographics ,geography and timing, and the UK has a Trump wannabe.

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  46. DNA_Jock: Get your facts straight.

    Whilst folks recommend John Hopkins, I find Worldometer easier to use. I hope the figures are reasonably accurate. With the country comparison chart, you can easily get a ranking on any parameter shown. US is shown today as 11th in deaths per head of population, just behind France. But, looking at the trends, I doubt US is going to remain at 11th for long. Of course these tables are only as good as the data they are based on.

    The Guardian on John Hopkins.

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  47. I happened to hear this morning that there was a “one day only” free covid test in the local town so I went along (Mrs F is away), queued for three hours and got both a nasal swab and blood test for antibodies. Results on line in a couple of days and no charge (did need to prove I had medical cover). I think it might be a way to gather reliable statistics on prevalence in the general population.

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