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Coronavirus (COVID-19) Thread

19 May 2021 15:51

PBS Frontline had an excellent episode last night about how the American healthcare system is ill-equipped to handle public health crises like pandemics.  But we knew this even before this happened.....yet another mark against the for profit health "care" system.
 
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Coronavirus (COVID-19) Thread

20 May 2021 00:25

Watsisname wrote:
Source of the post The excess deaths in Peru are now 503 per 100,000 people, suggesting an infection mortality rate greater than 0.5%.

Maybe, as in suggesting that covid in countries with negative excess deaths makes people healthier.  Mortality rates need to be divided into population groups like age to become meaningful.

Vaccination of the 75+ age groups is now complete over here, and just now they made the recommendation that very frail people (i.e. basically dying people) not be vaccinated, as it was concluded that amongst people who died shortly after getting the vaccine, the vaccine had sped up the death process in 10% of the cases.  A recommendation a bit too late.  But it doesn't seem to have influenced the excess death statistics.  Still negative.
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Coronavirus (COVID-19) Thread

20 May 2021 04:18

midtskogen wrote:
Source of the post Maybe, as in suggesting that covid in countries with negative excess deaths makes people healthier.


There is very little flu this year thanks to the travel and pandemic restrictions. So it's not hard for a country to have negative excess deaths even despite some COVID-19 deaths. (Some have also pointed out the reduced traffic during lockdowns, implying fewer traffic deaths, though this has actually been roughly balanced out by riskier driving behavior leading to more deadly accidents, at least in the US and Canada.)

I also talked about this a few posts ago, and it's an important factor in pandemic death estimates that use death above normal data.


midtskogen wrote:
Source of the post Mortality rates need to be divided into population groups like age to become meaningful.

Sure, if we are interested in one person or age group's specific risk, or want to understand effect of a different population pyramid like we did for Italy. Otherwise, if we want to know how severe the virus is in terms of how many deaths we might expect if a whole country is hard-hit, where in practice no particular age group can be well protected, then the weighted average over all ages is a useful measure. You likewise pointed out early on that the IFR matters in this sense:

What are your thoughts about the mortality rate?  I think this is a big issue.  If it's low, towards that of regular flu, it seems clear that what the world is really facing is a panic epidemic spread by media.  If the mortality is above 5% as some data might suggest, then clearly the world must not simply flatten the curve, but stop it.


Since the pandemic began I worked with the assumption that it is about 1% (or with some fuzziness depending on uncertainties and social factors: 0.5 to 2%), based on the reported CFRs in specific outbreaks and knowing roughly the fraction of asymptomatic cases. Then the antibody studies in New York supported that (not less than 0.5%). Now we can simply do excess deaths / total population, which is necessarily an underestimate because of incompleteness and because not everyone has been infected. So I didn't need to wait until now to believe this figure, but my confidence in it has only grown stronger as we have more data and lines of evidence.
 
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Coronavirus (COVID-19) Thread

20 May 2021 14:29

Watsisname wrote:
Source of the post Since the pandemic began I worked with the assumption that it is about 1% (or with some fuzziness depending on uncertainties and social factors: 0.5 to 2%), based on the reported CFRs in specific outbreaks and knowing roughly the fraction of asymptomatic cases. Then the antibody studies in New York supported that (not less than 0.5%).

That figure varies significantly between countries.  The differences could be real (due to healthcare, lifestyles, genes, population distribution, etc), or the methods for estimating could differ, or a combination.  The Norwegian Institute of Public Health has published a risk assessment with the following mortality rates by age:
All ages: 0.12%
0-19: 0.0022%
20-39: 0.020%
40-59: 0.040%
60-69: 0.18%
70-79: 0.91%
80+: 4.0 %

That easily explains the negative excess deaths.  In the 80+ group there are likely a few percent very frail people near death anyway, and without the flu threat many have lived an extra year.
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Coronavirus (COVID-19) Thread

25 May 2021 02:01

midtskogen wrote:
Watsisname wrote:
Source of the post The excess deaths in Peru are now 503 per 100,000 people, suggesting an infection mortality rate greater than 0.5%.

Maybe, as in suggesting that covid in countries with negative excess deaths makes people healthier.  Mortality rates need to be divided into population groups like age to become meaningful.

Vaccination of the 75+ age groups is now complete over here, and just now they made the recommendation that very frail people (i.e. basically dying people) not be vaccinated, as it was concluded that amongst people who died shortly after getting the vaccine, the vaccine had sped up the death process in 10% of the cases.  A recommendation a bit too late.  But it doesn't seem to have influenced the excess death statistics.  Still negative.

it seems to me that everything is situational. There must be a sensible approach to vaccination. If a person is extremely weak, then how can one additionally load his body with the introduction of a vaccine?
 
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20 Jul 2021 11:59

An estimate (by three different methods using excess mortality data) suggests the actual death toll from COVID-19 in India is between 3 and 5 million (versus the official figure of 400,000). Many deaths occurred in a spread out fashion last year due to the pandemic restrictions (which indeed flattened the curve but at an extremely high level). The second wave this spring was also far more deadly than the official figures indicated, and was much more visible. 

https://www.cgdev.org/publication/three-new-estimates-indias-all-cause-excess-mortality-during-covid-19-pandemic

Meanwhile in the US we're now seeing the same trajectory as so many other countries with delta. The delta variant is so infectious that it continues to spread -- easily and rapidly -- across the unvaccinated. With the relaxed measures, we observe an effective R value higher than at any time since spring 2020 before the lockdowns. The R0 value is likely between 5 and 8, which is insane. A more infectious disease also pushes the target for herd immunity higher. The original R0 of about 3 meant herd immunity would happen at around 66%. If R0 is 5, then we need 80%. If R0 is 8, then we need 87%. All of these numbers also don't account for how variants may evade prior immune response. If the virus develops enough ability to evade in a short enough time, then a true herd immunity never exists.

The way I see it, either we're going to take some much more dramatic action, or this is going to overwhelm our hospitals once again (in some places it's already happening), and result in many more preventable deaths and who knows what more variants. Allowing about a quarter of the population to be infected within a few months is not an acceptable strategy.
 
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Coronavirus (COVID-19) Thread

21 Jul 2021 08:55

A powerful and well-researched piece by Tanner Greer on Palladium:

The Myth of Panic
 
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Coronavirus (COVID-19) Thread

22 Jul 2021 01:39

Watsisname wrote:
Source of the post A powerful and well-researched piece by Tanner Greer on Palladium:

I don't think what delays action is so much fear of panic, but lack of data.  The aid of hindsight makes this kind of criticism somewhat unfair.  And how most governments have dealt with this pandemic doesn't really strike me as secrecy and inaction.  Have they misled people?  Possibly, but themselves as well, and no less in a way in order to rally by incorrectly saying that we will strike down the viruses rather than saying that we have to live with them and this is how.

From a scientific point of view many actions came too early (which doesn't imply that they were wrong).  Scientific consensus is built by waiting for data sufficient to conclude beyond doubt, analyse, debate, and do it all over.  In a pandemic there isn't time for that.  And vaccines got pushed through a fast track.  This can be acceptable, but were people really told?  It appears to me that there has been no less secrecy of fear that people wouldn't be scared enough than secrecy of fear that people would be too scared.

Since viruses have come to stay and are not all extremely dangerous, we can't slam the panic button every time a new virus shows up.  New mutations are expected and normal.  And then sometimes the button will be hit late.
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Coronavirus (COVID-19) Thread

22 Jul 2021 05:07

midtskogen wrote:
Source of the post I don't think what delays action is so much fear of panic, but lack of data.

I do think a delay in action out of fear of causing panic played a role. There are numerous examples of this being a part of decision making directly from leaders at multiple levels of government. It even played a role in the hesitancy to educate or even accept the role of airborne transmission (more on that in a moment.) It is also believed so widely by both leadership and media that I feel it's an important topic to think very critically about. But to blame a lack of data, the important question then is which data were lacking? 

I think we had plenty of data, but a lack of preparedness and will to act on it, particularly because it has been several generations since western nations have suffered a pandemic of this quality and magnitude. Decision makers lacked the understanding of how during that exponential phase of a pandemic, the reality of the number of infections and their rate of change is far higher than what case rates show (something the Act Today or People Will Die article described clearly.) That is, if we act based on what our cases and hospitalization curves show, then we act too late, because those data lag infections. This problem is not a lack of data, but a lack of understanding that lag, even though the lesson was right there from the original outbreak. (Or we could just look at the incubation period which had also been measured fairly accurately.)

By March 2020 we had seen what had happened in China, how it was being replicated in Italy, and the same trends were beginning in the US and many other countries. We had data on the infection rate, mortality rate by age, the percentage of cases that would require hospitalization, and so forth. We knew before this was declared a pandemic that the closest analogue to the situation was the 1918 pandemic. I think the only thing that was particularly lacking besides understanding the lag between infections and cases was the understanding of the role of transmission through the air vs. contact with contaminated objects. 

Actually, there's a long and interesting history of that misunderstanding in the medical field, which came to light when atmospheric scientists approached the problem of how far droplets of various sizes can be carried through the air. SARS-CoV-2 transmits so well through the air not because it is carried more by smaller droplets, but because the larger droplets can go further. That is, the concept of what droplet size should be considered an aerosol according to the medical field, was wrong. This realization (which took quite some debate between the scientists and leaders at the CDC and WHO) played a major part in issuing the mask mandate.

https://eos.org/articles/aerosol-scientists-try-to-clear-the-air-about-covid-19-transmission
https://www.wired.com/story/the-teeny-tiny-scientific-screwup-that-helped-covid-kill/
 
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Coronavirus (COVID-19) Thread

22 Jul 2021 06:36

Watsisname wrote:
An estimate (by three different methods using excess mortality data) suggests the actual death toll from COVID-19 in India is between 3 and 5 million (versus the official figure of 400,000). Many deaths occurred in a spread out fashion last year due to the pandemic restrictions (which indeed flattened the curve but at an extremely high level). The second wave this spring was also far more deadly than the official figures indicated, and was much more visible. 

https://www.cgdev.org/publication/three-new-estimates-indias-all-cause-excess-mortality-during-covid-19-pandemic

Meanwhile in the US we're now seeing the same trajectory as so many other countries with delta. The delta variant is so infectious that it continues to spread -- easily and rapidly -- across the unvaccinated. With the relaxed measures, we observe an effective R value higher than at any time since spring 2020 before the lockdowns. The R0 value is likely between 5 and 8, which is insane. A more infectious disease also pushes the target for herd immunity higher. The original R0 of about 3 meant herd immunity would happen at around 66%. If R0 is 5, then we need 80%. If R0 is 8, then we need 87%. All of these numbers also don't account for how variants may evade prior immune response. If the virus develops enough ability to evade in a short enough time, then a true herd immunity never exists.

The way I see it, either we're going to take some much more dramatic action, or this is going to overwhelm our hospitals once again (in some places it's already happening), and result in many more preventable deaths and who knows what more variants. Allowing about a quarter of the population to be infected within a few months is not an acceptable strategy.

Wat, how did the 1918 flu pandemic end?  Was that with vaccinations or was some other method employed?

Thanks for the info on aerosol transmission, I've always wondered why a big distinction is made between small droplets and airborne transmission, to me they are equally as bad.

And why are the Tokyo Olympics being held?  That's a huge mistake.
 
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Coronavirus (COVID-19) Thread

22 Jul 2021 07:11

A-L-E-X wrote:
Source of the post Wat, how did the 1918 flu pandemic end?  Was that with vaccinations or was some other method employed?

No, there was no vaccine developed for it. They instead used many of the same measures we still use today: social distancing, limits on gatherings, and in some places wearing masks. These measures did not stop the pandemic, but slowed it down considerably and broke it up into waves -- much like with COVID-19. The worst of that pandemic lasted for about about two years and hit in four distinct waves (though at different times in different regions, again much like with COVID-19). The second wave was the most deadly.

How did it end? In about the same way as most pandemics in history. Once enough of the population has been infected (or recovered), the virus has a harder time jumping to new hosts, so the rate of new infections declines exponentially. How many must be infected before that happens depends on how easily the virus spreads (the R number), and the measures taken to slow it down. With Spanish Flu, that seems to have happened after about 1/3 of the population was infected (according to most estimates, though perhaps more had truly been infected, maybe even half or two thirds.)
 
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Coronavirus (COVID-19) Thread

22 Jul 2021 07:45

Watsisname wrote:
A-L-E-X wrote:
Source of the post Wat, how did the 1918 flu pandemic end?  Was that with vaccinations or was some other method employed?

No, there was no vaccine developed for it. They instead used many of the same measures we still use today: social distancing, limits on gatherings, and in some places wearing masks. These measures did not stop the pandemic, but slowed it down considerably and broke it up into waves -- much like with COVID-19. The worst of that pandemic lasted for about about two years and hit in four distinct waves (though at different times in different regions, again much like with COVID-19). The second wave was the most deadly.

How did it end? In about the same way as most pandemics in history. Once enough of the population has been infected (or recovered), the virus has a harder time jumping to new hosts, so the rate of new infections declines exponentially. How many must be infected before that happens depends on how easily the virus spreads (the R number), and the measures taken to slow it down. With Spanish Flu, that seems to have happened after about 1/3 of the population was infected (according to most estimates, though perhaps more had truly been infected, maybe even half or two thirds.)

Thanks Wat- something else I wondered about- when children are born do they inherit antibodies/immunity from their parents who had gotten sick from it?  Because as the older population is being replaced by the younger, there has to be a mechanism to protect those people who had never been exposed to it?  I wonder what kind of secrets lie within our genome to protect us from what our ancestors had to experience, it seems it would be as intriguing as analyzing a fossil record to see the history of geological events the earth has experienced......
 
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Coronavirus (COVID-19) Thread

22 Jul 2021 13:22

Watsisname wrote:
Source of the post But to blame a lack of data, the important question then is which data were lacking? 

Like, how long various restrictions would be required (i.e. the effect on the spread and how exactly the pandemic would play out unchecked), and how much harm the restrictions would cause, for the economy and people's health (mental, reallocated resources, long term effects). These things were not well known in March 2020.  I'm looking forward to unpolitical research on this topic.  One interesting case study could be Norway vs Sweden whose demographic differences aren't greater than what can be corrected for. Pretty different strategies were chosen.

When people suggest that we weren't nearly afraid enough in March 2020, does it mean that they now reject the "flatten the curve" idea of that time?  It seems to me that the "flatten the curve" gets replaced by a "strike it down" policy with increased fear.  The stock market, however, was in panic in March 2020, but that fear was all gone less than half a year later.
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Coronavirus (COVID-19) Thread

22 Jul 2021 13:36

A-L-E-X wrote:
Source of the post when children are born do they inherit antibodies/immunity from their parents who had gotten sick from it?

I'm not an expert but my understanding is that newborns have some protection due to antibodies shared through the placenta and then the breast milk.  So this protection is quite limited, lasting only for the most critical time.  The baby needs to build its own immune system through exposure to germs and viruses, which takes time.  This is the main reason why child mortality is nearly 50% in undeveloped societies.  No protection is inherited from the father apart from genetic risk factors.
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Coronavirus (COVID-19) Thread

22 Jul 2021 20:55

midtskogen wrote:
Source of the post When people suggest that we weren't nearly afraid enough in March 2020, does it mean that they now reject the "flatten the curve" idea of that time?


Yes and no. It's more complicated.

"Flatten the curve" can make sense very early in the pandemic, when society is contemplating slowing the exponential growth in order to buy time, and don't yet know what R value they might be able to achieve under a certain set of actions. But if the actions they take don't push R below 1, then it's not sustainable in the long run. I would say that India and California reflect this kind of path. Both pushed R to something slightly higher than 1 for several months, which dramatically delayed and broadened the peak for their summer.

If the rate of new cases is already significant and growing rapidly, then it's better to take a short period of more dramatic action to drop the curve down and relieve the system. The most sensible strategy is to take more action than needed to push R below 1, and then relax measures carefully and evaluate the change in R, aiming to keep it very close to 1. New York is a striking example of this kind of path. I think most would also agree they chose to take this action too late. A rate of death 650% greater than normal is terrible. It could have been mitigated if they had taken actions (whether a full lockdown or something like flatten the curve), earlier.

Squashing the curve and keeping it down is also not realistic for most countries. But if it is (because they prepped for it and know how to deal with the post-lockdown phase), then it does less economic harm than dealing with more than a year of semi-lockdown and repeated waves. Most countries followed a strategy that is in between flattening the curve and squashing it. I think it's not hard to see why it's what most countries do, both practically and by understanding human nature.

Imagine trying to keep the curve for new cases flat at a sustainable level over an extended time. In practice this is almost impossible to do, because of how exponentials behave. Small fluctuations in R above and below 1 causes episodic waves of exponential growth and decay. Every time the rate of new cases gets too high, people get more concerned and authorities take action, ultimately bringing it back below 1 and dropping the rates back to manageable levels, at least until society gets tired and relaxes again. So we end up with waves. The waves are governed mostly by what we do, and we change our behavior based on what the waves do.

China is one of very few countries that adopted what I would call a true "strike the curve down and keep it down" policy, in the sense that they were not content with having to deal with repeated waves.

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