https://mobile.twitter.com/UNMC_DrKhan/status/12574400820191...
Unless, the antibody test gave a false positive, and he did not get the virus. Then, how the hell did an American politician get the virus, before China even noticed it on their radar, and reported it to the W.H.O. in December 2019?
This timeline also seems to coincide with CDC warnings of strange flu and pneumonia patterns late last year, with people having more difficult symptoms than normal.
If you recall getting very sick late last year in 2019, then you should consider taking a coronavirus antibody test, to confirm whether you got the virus or not.
[1] https://www.nj.com/coronavirus/2020/04/nj-mayor-thinks-he-ha...
There could very well be a less infectious, less severe strain circulating out there.
Maybe I was patient 0 for both california and new york :|
I think the bigger question is, let's say it did arrive much earlier that we think, does that mean the virus grows at a much smaller rate than current models?
CDC estimates the basic reproduction number to be 6, German Robert-Koch-Institut IIRC around 3. Maybe the presence of earlier, undetected cases have lead to an overestimation of R0.
The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.)
This absolutely makes sense to me and would explain a lot of weirdness in the statistics. Less infectious, with a longer incubation period and circulating among the population for longer.
I think that local data, mortality in just one care center, does not seem to fit with slow spread. Many people have died in a short period of time in just one care center. But, as any small sample of data, could be just an anomaly and not a trend.
I guess that right now all options are open and as data gets cleared and accumulated we will know more. With more testing it would be easier to be sure who is infected, who has been infected and how the pandemic is behaving.
Oh and also from KC.
The problem is not whether this is more or less scary than the flu (or anything else), it is both. With no solutions aimed at buffering nursing homes/elderly.
Am I just insane? This narrative seems completely absent in all of the coverage.
There is of course some trade off between number of deaths avoided and amount of money we should be prepared to throw at the problem. Where on this spectrum are you?
My specific point is that people need to stop looking at a single IFR/CFR stat. It does no good. We look to be getting safer numbers there by simply increasing testing. (Of note, NYC has a strict lower bound on its numbers with how many in its population has died. But, do note they have more people over sixty than most cities do people. Such that most places will not be comparable.)
And that is the problem. The virus has not gotten safer as we get more data. Our understanding is just not focusing on helping the elderly. We seem to be taking a crap shot that everyone can stay home and we can out sit the virus.
I would wager we could have setup hotels and strict access controls on supplies into and out of at risk communities cheaper than what we have done. Certainly if you count on all of the job loss.
This is the narrative we keep getting fed over and over again, but it doesn't seem to be working out. There are a lot of people who were afraid to go to doctors for minor issues, a lot of important surgeries canceled for being elective, etc. On top of that, 80% of people who need a ventilator who are older or have other health issues, will die on them[0]. For the younger patients, it's almost a coin toss.
Some hospital systems are overwhelmed, but some are totally empty. Treating a region as large as the US as one unified geographical region, even with our unrestricted travel, didn't seem sound.
The devastation to peoples jobs, lives, savings, homes .. everything ... we keep saying Lives > Economy, but unless our leaders address how to deal with reconstruction (no one seems to be talking about this), there could be a lot of consequences worse than covid down the line.
0: https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
We all acknowledge that it is deadly. Because it is. And you are right that this is in all the data. But the narrative is still holistic. We are locking down everyone to try and kill the virus.
Yes, it could work. But so could strict access to most nursing homes. Wouldn't be cheap, but could have even been more effective. Reasoning that we could reach herd immunity style buffer between the populations.
(Note that I flat reject just letting people die. I am not saying to abandon the older at risk crowd. I'm saying take pointed measures to explicitly protect them.)
Now, it says the cases are 33% above sixty, and the deaths are 91% above sixty. So that would be a CFR of 758/5011, 15%.
Contrast with below sixty. Which comes to a CFR of about .7%.
If I go with just under twenty, the paper doesn't give me enough data to calculate. They are 4% of the cases, but don't even get listed in the deaths breakdown.
Under forty, the rate is about 1.5%.
And note that more testing can drive down these numbers. But it's unlikely to do so for the elderly.
We know from the high rate of corona infection in SF with low mortality that corona stats are being improperly analyzed.
The numbers show that this is <1% fatal and probably <0.1% but all it takes is one story of some 30 year old dying on the news and everybody loses their minds.
Granted, I was very scared myself before we had numbers, but I don’t know how many people are willing to actually take a look at them now that this has become sort of political. It’s like how a school shooting will get a lot of coverage, but nobody talks about how way more people are shooting themselves in the head. Emotions over facts.
In New York City about 0.15% of the entire population of the city have already died from the virus, putting a lower limit on the IFR.
Estimates of the IFR have been consistently between about 0.5% to 1% by most authorities I have confidence in.
I think you're confusing Covid with pneumonic plague: https://www.nytimes.com/2019/11/13/world/asia/plague-china-p.... There's apparently evidence based on mutation rates that COVID-19 can't be older than late October, and it wouldn't have been detected until mid-late November, which matches official timelines.
FWIW, in MA the average age of hospitalized C19 patients is 69, average age of positive tested is 53 -- Interestingly over the last 2 weeks the average ages for deaths and hospitalizations has been creeping up and the average age for a positive test creeping down. In all, 1% of the MA population has tested positive (out of 4.67% the total pop. tested).
[0] https://www.mass.gov/doc/covid-19-dashboard-may-4-2020/downl...
[1] Graphs of today's MA numbers (courtesy of /u/oldgrimalkin on reddit) https://i.redd.it/bpb0884w7tw41.png
Because nursing home patients don't travel, so they lag in catching it, then die.
And calculate that IFR per age band. Running WA numbers in https://news.ycombinator.com/item?id=23080035 shows that the IFR here ranges from .7% to 15%(!) if you do that.
There's other weird effects going on -- some countries that look really really similar have vastly different experiences with the virus. (Canonical example is DR and Haiti, although the situation is dynamic enough no-one knows if that'll last.)
My takeaway from the difficulty in measuring this thing is that there is pretty high variance in transmission. Some carriers spread it REALLY well. Some carriers spread it poorly. With a lot of variance it matters a ton to figure out what is the deal with high-transmission situations. My take so far is we have some clues but no certainty. (Seems to spread in public transit and healthcare environments more rapidly, but slower than you'd expect in schools and prisons.)
It'd clearly be a gigantic win in terms of intervention policy to understand this better, and we simply cannot do that without extensive contact tracing so we know what's going on. They're doing a pretty good job of this in China, HK, Taiwan, South Korea. As nearly as I can tell we're doing a dismally poor job in the US and Europe.
You read papers that have diagrams of restaurant tables and bus seating charts from China. In the US it's hard to get stats on aggregate nursing home vs non-nursing home fatality rates. Maybe it takes some time for these papers to come out, but I don't see evidence that high-quality pre-pub contact tracing data is being relied on to develop policy responses.
There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
Note that I am still proposing an expensive solution. But asking if the barrier between the populations could be setup stronger. Such that the death and hospitalization load would have been what we have had, minus most of the elder population.
Edit: you edited on me. Yes, I am proposing that offering strict access to this crowd could have been done cheaper and more effective than what we have done.
The problem with isolating high risk populations is that you have to go round them all up and temporarily house them in quarantined facilities. And since the elderly are sometimes infamous for their unwillingness to be rounded up and forced to leave their homes, you have to either force them anyway or just abandon them to their fate. And that’s without touching the massive logistics of such an effort. (Not rounding them up would be even harder.)
Honestly, if you were gonna try and do that, I think geographical isolation would be a better option. Compartmentalize your state/region/country into separate zones, block all non-essential travel between zones, regularly test essential travelers, and change the lockdown status of each zone based on local conditions.
What will end up happening is occasional breaches between zones where a zone might go from green to red. But it gets us in a position where most people are mostly unrestricted most of the time. It also makes it possible to eradicate the virus without actually infecting most of the population, which is nice. Logistically you’d, at most, just set up checkpoints on roadways and inside airports and train stations to enforce the travel restrictions.
Over time you could even allow travel between green zones.
It has been disastrous (comparatively). We had a couple of asymptomatic carriers infect some aged care facilities and now nearly 20% of the deaths country wide are from those incidents. And that's with the second best testing regime in the world though March/April (after South Korea).
We'd have been better closing the aged care faculties and moving people in with relatives. That's not very practical, but the COVID deaths would almost certainly have been less.
Then the use of ventilators was shown to be ineffective, so they can re update the models and bring back the original plan.
(See recent articles. In summary none of the patients who are put on ventilators survive.)
That's simply not true. A very high percentage of them die (because you only put very sick people on ventilators), but to suggest that they all die is just absurd.
Biggest problem: determining if someone dies because or despite of ventilators.
There are also millions of people in low risk groups who care for people in nursing homes and other high risk populations. How do you propose keeping them from infecting those they are caring for?
The thread is also predicated on a very high base reproduction number. A high R0 means a very large percentage of the population needs to be immunity before "herd immunity" is a thing (on the order of 80-90%). Even with a very low IFR, that is hundreds of thousands dead.
I'll note some of the first cases in WA included a high school student that had not been traveling. I cannot square that, how contagious this is, and the idea that it wasn't widely in that school.
I think herd immunity is silly at the holistic level. At a cohort level, though, it could work reasonable. Consider, at this point we could start rotations of health workers that have the antibodies.
I have said it before, but I will stress again I am just a random internet poster. Much of why I am posting this is to get challenged on it.
What are you talking about?
That was never the goal in the US.
Of course, the more data we get, the less control we see that it was ever in. Such that right now,I don't think we have a coherent plan.
This is absolutely insane. My ex was telling me today, "well we could have a vaccine in 18 months" and I am so getting sick of this bullshit big-pharma narrative.
Safe vaccines take 5~10 years to develop. A vaccine in <2 years seems like a disaster waiting to happen. Vaccines for SARS1 were very difficult to make and some caused reinfections worse or incomplete protection[0].
We still don't have safe vaccines for HIV or Herpes. I feel like people talking about vaccines in 18 months are being totally unrealistic and irresponsible.
I think you could have gotten pretty good volunteer isolation. As simple as getting grocery stores to deliver to elderly. As expensive as renting the Ritz for a month. Still expensive, but cheap compared to what we have landed in.
Here there has been very limited community transmission, and aged care facilities have turned out to be transmission clusters (not just death clusters). I guess shared facilities, lots of people in limited space etc.
And it's proved very hard to keep it out of facilities despite the best testing in the world. So here in Australia, (with different transmission dynamics to most places) they have been more likely to be exposed in aged care homes than elsewhere. This observation is made with the benefit of hindsight though.
Counter-factuals are hard, but in the proposed model where all old people are quarantined and the rest of the population is left to be infected the Australian experience indicates that the quarantine for aged care facilities wouldn't have been effective enough.
Note, I explicitly don't think this would be cheap. Such that I am not sure it is tenable without hindsight.
That said, I can see your point. With my firework shop metaphor, you are basically proposing to disperse the inventory such that one misfire will not ignite all of them.
I think I just have a hard time believing we will contain this with all of the other data we have seen. My gut is it is as likely that there is some yet unknown factor for the places that have seen better numbers.
So, unless they have something protecting them, just reopening slowly didn't really have a mechanism to protect them.
Now, they could go for herd immunity in care workers. Rotate in those with antibodies, and you are simulations how we protect the elderly from the flu.
But just slowly reopening? What is the mechanism that is expecting a change?
This is like watching for a spark in a firework store, while you start letting active smokers back in...
https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
E.g. https://blogs.sciencemag.org/pipeline/archives/2020/04/23/a-...
Human trials have already begun, so they seem reasonably confident that it's safe and works.
I think a lot of the time taken to develop vaccines historically is due to lack of resources. That's not a problem in the current climate.
Note I am not happy about a race to a vaccine. Just feels like that is what our grand plan is.
But there's no telling if or when one of those drugs will pan out (and it would certainly be before a vaccine). There is no talk of reconstruction now, which really needs to happen.
About half of Sweden’s deaths have been in nursing homes, which prohibit visitors. Tegnell said health officials had thought it would be easier to keep the disease away from them..... "“We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been,” he told Noah."
https://www.businessinsider.com.au/coronavirus-sweden-lockdo...
Also I've just discovered Australia publishes deaths in aged care facilities vs subsidised care at home. The home death rate is much lower.
https://www.health.gov.au/news/health-alerts/novel-coronavir...
Note. Not cheap. At all.
For the at home rate, we need the question of would that have simply shifted if we sent them home?
Edit. Realized I didn't say it directly. I do find these interesting. Thanks!
That is, we do not have data showing this is deadly for pretty much why identifiable group, other than elderly. Such that no matter where a flare up is, we need to isolate the elderly.
My fireworks quip was that if a spark gets in there, the whole thing blows. But, large parts of the city could likely take a flare up and not notice. That is, the whole city is not a firework store. Right?
Evil dictator idea. App on peoples smartphones that collects the number of unique close contacts and rebroadcasts that. So then people get warned that someones a risk.
Studies like this and I'm sure the many to come make me really wish we had better contact tracing from the get go and hopefully in years to come there can be some better implementations
Since smoking is allowed in most casinos, they have extremely powerful ventilation and air filtration systems, so that their non-smoking customers aren't excessively bothered. If you've been in a Vegas casino and seen someone smoking, you notice that the smoke almost instantly gets sucked into the ceiling. This may dramatically reduce transmission in casinos or other venues that allow smoking.
This was often cited as a reason why everyone on a flight won't catch it, just those in nearby rows.
Vegas also doesn't have a subway system, which was cited as why it spread so rapidly in NY.
Then again, they can't even give health care workers PPEs.
I believe micro-droplets being evaporated by the notorious South Asian heat is playing a part.
The story I heard is that Vegas hotels/casinos mix in small amount of certain gas/chemical in the circulating air that makes people not want to sleep, which makes people gamble more and spend more money.
Some crazy theories people have...
So I can see (as a non-expert) that the well ventilated casinos is the reason for low infection rate in Vegas.
NYC on the other hand has had the extremely highly infection rate because EVERYONE has to take subway and pretty sure there's not much air circulation in the subway cars...
Either way, I think not spending too much time indoors is the key to avoid covid-19. Unfortunately most all indoor space has recirculated, air-conditioned, stale air.
Edit: I personally think businesses that can leave windows open for fresh air will have lower chance of spreading Covid-19 than ones with barely functioning AC system with little air circulation.
Sure no masks and what may appear crowded is not really that, high ceilings, powerful HVAC heat exchange systems which bring air from the outside and overall low population density in the urban areas make Vegas seem actually a pretty safe place compared to say packed motels during Gra or Spring Break.
P.S. on an anecdotal note about 6-7 years ago after BH USA I’ve personally witnessed a person that was all sweaty and coughing like they are about to die being escorted by security of the floor after about 15-20min of being around the tables.
While I don’t have any sources on to confirm this policy, it really wouldn’t surprise me if casino security monitors people who seem to be ill if nothing else than to avoid the optics of having medics on the casino floor.
It's behind only New York and Miami in the US, and has more international arrivals than LA, Berlin, Moscow, or Athens.
https://en.wikipedia.org/wiki/List_of_cities_by_internationa...
However, fuel your brain with these bits: if lots of transmissions happened in Vegas then they likely counted against another states numbers when those folks went home.
I guess what happens in Vegas doesn't stay in Vegas.
It's really very unlikely that any of you had covid 19 in Las Vegas in late December.
Perhaps a lot of those visitors left the area before symptoms developed.
But, if it became endemic in Vegas it would start to infect locals. The blackjack dealer and the waitress and the floor manager are still there after you come home.
My flight was delayed, so I was in the airpot for about 8 hours. I decided to walk a lot during my time at the airport (I do that when I have long flights), so I walked about 20,000 steps in total back and forth in the waiting hall.
About one week later (beginning of March), I started with symptoms and since then it has been a nightmare from which I still haven't completely recovered.
Some viruses, like flu, prefer dry air. That's actually the reason flu spreads better in winter -- because colder air is less humid.
https://news.yale.edu/2019/05/13/flu-virus-best-friend-low-h...
Also, there's a chance your stats are being thrown off by the fact that Las Vegas the city doesn't have very many world-class casinos. All the popular areas are actually in unincorporated Clark county, in an unincorporated community known as Paradise, NV. Make sure you include those.
1. Visitors who are vulnerable went home and took Covid with them. They contributed to their home city counts.
2. Vegas natives who work on the strip are protected via second hand smoke inhalation. Source: https://www.economist.com/science-and-technology/2020/05/02/...
/crazy
Most people who work in customer facing roles in Vegas are already extremely paranoid and careful about hygiene. Gloves, constant cleaning of commonly touched surfaces, etc. Being a low level casino/hotel employee teaches you very quickly that humans are just sentient germ dispersal machines.
https://www.lvcva.com/stats-and-facts/visitor-statistics/faq...
I play a lot of table games, and casino chips are pretty disgusting in the best of time. I Immediately washed my hands every time I left the table.
I really want to do a serological test for Covid just to see if we might have gone through it in January, when 0 cases were reported in our vicinity (Slovenia, which is next to Italy).
It appears that by late November, the government first took a notice of the outbreak, and by early December it was already a complete freak out.
How the government knew? China has built a nationwide electronic infectious disease reporting system after the first SARS outbreak with specific intent of spotting SARS recurrence. Hospitals in China are required by law to report anything with a remote semblance of SARS into the system. China also holds nationwide drills for infectious disease specialists annually with SARS comeback in mind.
Any claim that China was caught unprepared are hard to believe.
Given that first reliably confirmed info on Beijing dispatching orders to provincial governments on handling a "disaster" also comes onto first days of December, it seems very, very likely to me that they already knew of it being SARS in December.
I also heard of what I have no ability to confirm, like the talk of huge pileups at HK border crossings in first days of December, and a spike of private jet departures.
Also this is not the first hospital to do that in France, IHU Méditerannée Infection, from Raoult and Chloroquine fame did that at the beginning of the epidemic in China, they tested 2500 samples from several month ago and found absolutely nothing.
That said, I do agree that a seismological test of the patient would be more definitive, but sometimes you cannot contact the patient due to privacy concerns/ IRB rules. I don't know how French hospitals deal with patient data, but if it's anything like America, you are highly unlikely to be able to do those sort of things without additional approval.
The only reason I'm confused about stories like the one above or the few about Covid-19 in California in January is that wouldn't we see such data inevitably?
A lot of people have stories about getting the worst sickness of their life in February which I understand but am also skeptical of (with bias probably 10% of the population gets a self-described worst flu of their life every year and Bayesian thinking would suggest almost none of these were Covid). However, it seems like nursing home data would be concrete.
http://publichealth.lacounty.gov/media/Coronavirus/locations...
[1] https://nextstrain.org/ncov/global?branchLabel=aa&dmax=2020-...
Of 14 samples, from 124 patients in Dec/Jan, one tested positive for COV by PCR. How well can we bound our uncertainty about false positive in such circumstances?
"taken from a 42 years old. ... One of his child presented with ILI prior to the onset of his symptoms. His medical history consisted in asthma, type II diabetes mellitus. He presented to the emergency ward on December 27 2019 with hemoptysis, cough, headache and fever, evolving for 4 days" ... "evolution was favorable until discharge on December 29,2019."
---
ILI == Influenza-like illness
Hemoptysis == coughing up of blood
0. http://virological.org/t/early-phylodynamics-analysis-of-the...
> Clearly they wanted the result as well.
Based on what? If anything, I'd say it's clear you don't want the result.
“ He presented to the emergency ward on December 27 2019 with hemoptysis, cough, headache and fever, evolving for 4 days. Initial examination was unremarkable and the performed CT scan revealed bilateral ground glass opacity in inferior lobes”
Actually many in China suspect that maybe a weak version has been around in SE Asia and China for years (remember that Malay pangolin?).
Sure? No. But taking their statement at face value, it does seem unlikely.
- Airborne
- 8+ daily flights between Paris and Algiers on one company (8 others)
- It's a matter of days if it's not already in Algiers.
Went back to Algiers. I canceled meetings in Paris for February. Algeria had its first confirmed case on 25 February 2020 - an Italian national coming back from Italy, and no airport measures whatsoever at the time -.
We established work from home for some teammates - who take public transportation - a few days later while we learn more about this as the risk/reward of not doing it was high and we transitioned to exclusively remote for everyone when it hit 17 confirmed cases in the country 4 March.
Is there a another opinion on this? It's where the virus originated (Lab created or from eating a bat or even US military doing it - whatever you are opting to believe) in November 2019 and it took them until late Jan 2020 to say that there's human to human transmission despite their own doctors warning and telling the world earlier than that (and they were silenced)
I looked at putative drug-related adverse event case reports submitted to the US FDA. Interestingly, there are 61 case reports that mention drugs used to treat "corona virus infection." 52 of those cases were filed in 2020.
Oddly, 6 cases involved drugs used to treat "corona virus infection" in 2019 (all submitted in the US). My speculation was that those 6 cases were unrelated to SARS-CoV-2, but you never know.
Here is the most relevant chart: https://2.bp.blogspot.com/-hrhtVnswxPI/Xq_7-HsE97I/AAAAAAABv...
Dec 2017 - 700k cases - http://www.xinhuanet.com/english/2018-01/29/c_136933793.htm
Dec 2018 - 712k cases - http://www.xinhuanet.com/english/2019-01/27/c_137778435.htm
Dec 2019 - 1.71m cases - http://www.xinhuanet.com/english/2020-02/01/c_138748020.htm
Dec 2017 - 93% of class C cases were infectious diarrhea, influenza, foot and mouth disease.
Dec 2018 - 93% of class C cases were infectious diarrhea, influenza, foot and mouth disease.
Dec 2019 - 98% of class C cases were infectious diarrhea, influenza, foot and mouth disease.
Dec 2017 - 10 deaths were class C
Dec 2018 - 16 deaths were class C
Dec 2019 - 18 deaths were class C
We know that most countries have made this mistake, even if their intentions are good.
We know that every authoritarian nation has intentionally misrepresented Covid cases in extreme ways. Russia for example was aggressively lying about their cases, claiming hospitalizations were pneumonia early on and not Covid. Eventually Russia was unable to maintain the lies, which is what happened in China's case as well (the lie gets overwhelmed).
Back in early January The Wall Street Journal caught China lying about Covid deaths, they were putting pneumonia on the death certificates when they knew it was Covid.
First that's where CDG airport is. This is the second largest airport in Europe by passenger traffic and the main gateway into Paris for tourists (not least Chinese tourists).
Second, that's where Paris' Gare du Nord is. This is the largest train station in Europe by traffic, where trains from CDG airport arrive, and the start of high speed trains to London, Brussels, Amsterdam.
So to me it's not surprising that this virus arrived there early.
But it also means that the area should be monitored closely, not only by French authorities, but by British ones, etc. as well because any highly contagious disease that shows up there will be around Europe in no time.
With a doubling time of 3 days and a morality rate of 1% a single person had it December 31st it would have infected a million people by around the end of February, killed approximately 10,000 and 150,000 would have been hospitalized by it.
I've seen a lot of articles about how it may have been spreading earlier but none seem to account for the exponential growth.
[1] counting Kent county and all adjacent counties.
Same in UK, people were sick a lot of the time, October through December 2019. But that wasn't the COVID-19. It was just a bad colds and flu season.
I had the normal story of being sick in January in London with the "worst flu ever" and suspected it might have been COVID. But I recently had a lab-based IgG antibody test and it came back negative.
Everyone else in my family was also negative. Also, friends who have family members who work in the NHS with similar stories of being sick were also negative. No one I know directly has tested positive yet.
I can't speak to the overall accuracy of the test, but the one I took was the private IgG antibody offered through the company 'Qured'.
People want to believe that covid-19 has already worked its way through the entire community because they want to believe that this is almost over.
The data does not support that position.
Being sick today, still likely means you have something OTHER than covid-19
What seems to indicate that it wasn't Covid was that at the same time as all of us had that monster flu in january, the hospitals weren't filling up with people who couldn't breathe.
Maybe there is a second actor there teaming with it
Presumably Chinese government holds such events regularly to test preparedness as well. They could be easily confused with prescience if there is not enough transparency about such things.
The term for "Novel Coronavirus" started trending on Dec 11th
So that suggests they noticed people getting sick around the 1st and had identified the virus by the 11th.
Say case zero was on Nov 1 and it doubled every 3 days then there I guess there would be about 1000 infected by Dec 1st and maybe 5 or 10 seriously ill. (guessing it takes 12 days to get seriously ill and maybe 5% of those infected). I think epidemiologists actually estimated it started about Nov 10th.
Link to paper https://www.medrxiv.org/content/10.1101/2020.02.24.20026682v...
Google doesn't give me any result if I search "武汉 肺炎" (Wuhan Pneumonia) prior to December 30. December 30 was definitively the first time it appeared on the news, and when it did, it quickly became the top news in about a week.
SCMP is itself source refer to a third party source. Caixin had a deleted report with about the same message. A few other apparently refer to the same blurry pics with a document saying something about SARS that were going around in Wechat groups in first week of January.
The first "something is going on" signal I remember was an article on aboluowang in the last week of December, where they cite a report of major mobilisation in provincial governments, and preparation for "medical emergency" starting first days of December.
And yet it appears manifestly to be the case, no?
I'm no fan of China, but I give credit where credit is due.
Even with antibody testing, it would still be possible that the sample from December was a false positive, and the patient later contracted CoVID-19 and developed antibodies, but it would increase the certainty a great deal. If the person has antibodies and does not report having had an additional bout of CoVID-19-like symptoms after the initial disease, then this would be much more certain.
See also this analysis of a few articles based on the genome of the virus : https://www.lemonde.fr/blog/realitesbiomedicales/2020/04/30/...
They support the COVID-19 diagnosis by looking at the patient's lung CT scan, which "revealed bilateral ground glass opacity in inferior lobes."
A decent explanation of PCR amplification can be found here: https://www.promega.ca/resources/guides/nucleic-acid-analysi...
"Each cycle of PCR includes steps for template denaturation, primer annealing and primer extension. The initial step denatures the target DNA by heating it to 94°C or higher for 15 seconds to 2 minutes. In the denaturation process, the two intertwined strands of DNA separate from one another, producing the necessary single-stranded DNA template for replication by the thermostable DNA polymerase. In the next step of a cycle, the temperature is reduced to approximately 40–60°C. At this temperature, the oligonucleotide primers can form stable associations (anneal) with the denatured target DNA and serve as primers for the DNA polymerase. This step lasts approximately 15–60 seconds. Finally, the synthesis of new DNA begins as the reaction temperature is raised to the optimum for the DNA polymerase. For most thermostable DNA polymerases, this temperature is in the range of 70–74°C. The extension step lasts approximately 1–2 minutes. The next cycle begins with a return to 94°C for denaturation."
Can't find the exact quote I read earlier but this link says basically the same.
https://www.heart.co.uk/news/coronavirus/french-covid-case-d...
0. https://www.wolframalpha.com/input/?i=binomial+distribution+...
The problem lies with the test itself, which might have an unknown false positive rate. Although in this case we're basically looking at what I understand to be the gold standard in RNA/DNA evidence, combined with matching symptoms.
Also apparently they had 2 separate teams testing the samples using different methodology, so we've got at least a decent amount of confidence that something is going on with that sample, although it doesn't rule out systematic bias.
Then again had some light respiratory stuff in early March. I live alone, isolation was already starting in some places, and I'm fortunate enough to work somewhere that WFH is easy.
I had plenty of "I might have already had it!" type conversations.
So I got my antibody test last week at my primary care physician. Negative. Was just a bad flu, I guess.
""" [Elitza Theel's] team has found that it's mostly the sickest patients — those who've been hospitalized — who produce IgG antibodies. And it appears that a small percentage of patients with milder cases of the disease aren't making the robust IgG antibodies.
"This is very preliminary," Theel warned. "But there might be a differential immune response between very sick individuals and individuals who have a more mild course of disease." """
https://www.nbcnews.com/health/health-news/antibody-tests-ca...
Their definition of "mild" means that you didn't require hospital care. So if you're under ~30 and otherwise healthy, you may be one of the people who beat the infection by some other mechanism. Or you just had influenza. It's impossible to know for sure right now.
As someone who really hopes there will be a long-lasting immunity, I really, really hope you had a bad flu.
Coincidentally, I got sick after several of my coworkers/close friends returned from trips to China.
Then a month later, after my roommate returned from a trip to Vancouver, BC, we both became ill. This time it lasted about a week.
Next, about a month and a half later I was feeling unwell for weeks with very different symptoms. I went to urgent care. This turned out to be an episode of diabetic ketoacidosis, and I was diagnosed with adult onset type 1 diabetes.
No clue if it was COVID-19, but it was strange. And we're ground zero for it (I work in Manhattan and used to commute every day on public transit).
or another seasonal infection that is normally benign is going around.
Sars-Cov-2 debilitates linings of the lungs and other organs and the immune system and blood cell oxygen transport efficiency all at once
But if nothing takes advantage of that then nothing happens, and you heal before something does happen.
With HIV we studied it in reverse: we saw people were dying of benign illnesses and then discovered they had been infected with this other virus for a decade. This first exposure to HIV presents itself as a flu/fever until it is sufficiently surpressed by the immune system and takes a decade of iterative mutations to bypass the immune system.
With COVID19 a similar result happens within a week, but we aren't really looking at which bacteria or viruses could have been benign that may also be present.
Not that complicated, just no bandwidth to figure it out yet.
But if you follow this rabbit hole, it could easily suggest that in late fall 2019 there were just few people that had Sars-Cov-2 and they either statistically were not getting exposed to the opportunistic infections, or a seasonal benign opportunistic infection was not running in conjunction that season.
This notion has been vehemently rejected by people over the past month, but it looks like people might be a little more open to it. Maybe the right people will begin to entertain the hypothesis.
There were a spike in bacterial pneumonia cases in regional Australian hospitals in the middle of summer prior to the known outbreak. I know of 1/2 dozen people (including myself) who caught some highly contagious non-flu virus and had varying symptoms. One person developed pneumonia but tested negative for both the flu and SARS-CoV-2 at the time - which was how I heard about the spike in hospitalisations.
My pet theory is that someone infected with the milder version was co-infected with the bat originated virus in Wuhan resulting in a highly contagious version that can cause COVID-19.
Whether they worked in the lab or got it from the market is a matter of debate. I'm thinking lab as the market didn't have bats and patient zero didn't go to the market, while the lab did have bats at some point. There was a serious effort to hide the evidence which makes it all the more suspicious.
There was evidence of a human-specific immune response mutation which could indicate it was neither manufactured or required an intermediary host.
What I think we have to be careful of is that the milder version doesn't provide immunity for the more dangerous one.
A lot of people in this thread an to be clutching at the assumption it couldn't possibly have been anywhere else before it was detected. One case in France not spreading is fairly lucky if it's true.
https://www.reuters.com/article/us-health-coronavirus-italy-...
October 2019 is even earlier than the earliest known cases.
Still I suspect the extreme differences between countries and even regions between countries will be studied for many years to come.
edit: Also, I misssss you. Hope you're well. <3
https://ars.els-cdn.com/content/image/1-s2.0-S09248579203016...
Sorry, all governments are to blame here, for sure (these deaths cant be justified) but China and to a large extent WHO are in the blame here too. Majorly.
PCR tests have high false negative rates, but low false positive.
The case from November was not recognized as a novel virus at the time.
This take has held up pretty well. Look at how much more mid-range NYC is humidity-wise than the others:
That is more possible, both because of timing and symptoms. It's not certain (or even most likely) to be COVID-19, but is worth checking out.
Given things like this:
https://www.bbc.co.uk/news/world-us-canada-52385558
if someone _died_ on 6 Feb, they were infected in mid-late January.
I'll try to explain my reasoning:
- there are lots of ILI
- COVID-19 is a more severe ILI
- more severe ILI requires more hospital resources
- COVID-19 is an infectious disease, more disease, more infections
- depending on how much more severe COVID-19 is set to be, a conclusion can be drawn whether it was more or less likely that you had COVID-19 versus any other ILI based on increased hospital resource usage.
The important thing here is removing the perceived illness severity (i.e. worst flu ever, etc.) from the calculation, because it's highly subjective, as well of being a sample size of one.
The thing that usually happens is that someone writes that they had the worst flu ever, and soon somebody responds with something that they feel is relevant to the post, e.g. "I also had the worst flu ever", these comments often imply the possibility that their "worst flu" was their "COVID-19", which is exponentially less likely the closer to the start of the pandemic you go.
I'll call this phenomenon COVID-19+1 unless there's already a better name for it. And I won't claim immunity to it.
For there to be a discernible difference here, you need a "critical mass" of cases. How many such cases are necessary depends on the incidence of severe cases vs non-severe cases, but we do not know the amount of non-severe cases, because we did not test everyone.
Antibody studies suggest that there are 10x as many cases as reported. If that is true, then there could have been hundreds of thousands of cases that went undetected along with some more severe cases that were labeled as "viral pneumonia".
The different rates of infection in different countries may well have more to do with the amount of testing than the actual infection rate.
Xi Jinping had no problem locking down cities after he learned the severity of it. It's ludicrous to think he knew it in December but somehow decided it was a good idea to wait till it spread to the whole country to do it.
- He had no problems locking down cities after the severity became known. Is fairly Reasonable to think that in the beginning they thought it was something they could keep quiet and it would go away
- people in China don’t report things that might be negative for fear of consequences, he is creating a situation where he doesn’t get to know things before it’s too late this way
In fact, I am suspicious of anyone who knows anything about this and claims otherwise.
In the US Midwest it was very harsh for flu, conjunctivitis, strep, etc. My children both had coughs, fever, ruptured right ear and one had chicken pox style rash (late December). Doctors never tested my son, my daughter tested negative for flu with multi-day symptoms and then positive for flu A (same test) ~10 days later. So there is/was a definite lack of data. Unfortunately, we do not have the samples to go back in time and apply newer tests. Luckily, France had the foresight to preserve some of the samples.
They are being offered inexpensively at least here in NYC by commercial urgent care facilities.
I expect the mail-in Labs will get geared up pretty quickly also.
[1] https://www.google.com/covid19/mobility/ (Look for Nevada under the US)
This makes me think that either
1. nobody else in France was infected by the spread that they now found to have happened in December, the strain died
2. the findings are wrong
1 seems pretty unlikely. We’ll know once they hopefully sequence and publish the genome of the virus they found.
Ball is in your court. Keen to hear a response.
No universal healthcare so billing data is available, local and state governments are do not answer to the federal government on most matters.
Press is free and for the most part anyone is free to tweet what ever is going on without the fear of diving out of window.
In many universal healthcare systems there is still clear divison between healthcare providers (doctors and hospitals) and payers (public health insurance), so billing data are also available.
People who were sick in December (I mean, be real: a lot of people were sick in December!) are overwhelmingly more likely to have had the flu than a disease that even in Wuhan was at just a few thousand cases at most.
That's what they said in France too before this new study
Which makes this one bad as it's infectious for a long time before there are symptoms or it kills the host - hence the panic.
One of the techniques of trying to make vaccines is to attenuate it by exposing to to different hosts; so that it will mutate into a form that's less harmful to humans; kinda the opposite of what probably happened here, where a virus that was not deadly to either bats or pangolins but caused havoc when it got to us.
I think this needs to be repeated more often. Everyone who had a sniffle in the last 6 months thinks they had COVID-19. There are always a lot of different diseases going around in the winter.
But beyond that, this trend I've seen of people thinking they had it because they had the sniffles is dangerous if it makes them think they're now somehow safe.
If we learn that people who've had it have resistance then we should all get tested, capacity allowing.
Having had a cold at some point is almost irrelevant, because it seems that most carriers are asymptomatic, and that most people with mild covid19-like symptoms don't actually have it. The predictive value really isn't that high.
When my doctor arrived, he was all cool. Then he asked me a bunch of questions and went to see the x-ray and blood work result in the labs. After taking some time, when he came back, he had a face mask and a can of Lysol. He said he had been delayed filling an epidemiological report.
That's the moment when I knew it was bad haha.
- response to a power tool injury
This isn't a knock against their skill or their competence. Sometimes shit just happens. Certainly if this is true, I'd be very interested in how this changes the nature of our models of the virus.
Rather than pointing fingers at China we should point at our own governments and ask how with months of warning watching this unfold in China, we were caught completely unprepared and on the back foot? Every single country. It's a truly shameful performance that has cost us big time in deaths and lost economic output.
https://www.reuters.com/article/us-china-health-who/who-chie...
In the end, western countries are indeed responsible for their own well being, but China did everything they can to block information from going out.
To know the true severity of the virus, you had to rely on leaked information. Doctors were silenced and journalists arrested, and social media censored.
Taiwan sent their own researchers in December, when only rumors were out. This is what western countries should have done.
China had first hand memory of SARS as a scary illness.
The west mostly thought of SARS as "that thing that mostly stayed in China".
So I guess if there's any good news, it's that for the next one, many more of us will have some frame of reference for how bad it can get.
Although it has been bad, parts of Europe has not been that bad. Germany, Norway, Denmark and maybe others have had very low numbers of deaths with much less impact on the population than China. Also of course New Zealand have done very well.
Sure we should ask our governments to do more, but this issue is because of China. They create the conditions for Coronaviruses and they are extremely unhelpful in fighting them.
Some examples https://www.youtube.com/watch?v=1nC_VN2SgzU https://www.youtube.com/watch?v=amr-rLpD3lw
My wife presented with symptoms quite similar to covid-19 to A&E (UK: A&E ~= ER) after a cruise we went on in late November. She has never smoked but she did get quite breathless and shook it off after about a week. As you say, there are a lot of anecdotes.
A decent antibody test would be nice but at the moment we don't know enough about how the bloody thing works. Even if you have detectable antibodies after an infection, does that mean you have any immunity to another infection and if so, for how long?
My money is on this thing turning into another 'flu after about five years. It will stop killing large numbers of people and evolve into a sort of status quo, just like the seasonal 'flus. It will still be a killer but not quite so aggressive as it is now. It is not as aggressive a killer as Ebola but it spreads far easier. Evolution will ensure that it will find a "happy" medium where it can carry on spreading but we don't still feel the need to eradicate it because we can live with the consequences of the adjusted version.
My language in the above para is a bit off but the sentiment is the same. We happily jump into cars every day (not so much now) and kill ourselves and others in pretty large numbers across the world but that is judged an acceptable risk. covid-19 will simply become another one eventually. For now, it is a right old shit show and we do not understand the enemy at all well. We do not know how to live with it.
We will.
it is very simple to remember: the one named after the disease is the virus, the one named after the virus is the disease.
/facepalm.
[1]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/ [2]. https://www.ncbi.nlm.nih.gov/pubmed/28525597
As far as I'm aware, this does not tell us that it'll be the same for SARS-CoV-2. Maybe it makes it more likely, but that's not the same as knowing for sure.
I didn't mean we will evolve. The virus will be doing the evolving. We live for years, this virus "lives" for days.
Because the WHO does not generally condone travel restrictions. Based on research on influenza pandemics, the WHO (and much of the epidemiology community) believe that travel restrictions are largely ineffective at stopping highly contagious, airborne diseases like influenza (and now CoVID-19).
Beyond that, the entire framework of international health cooperation is set up to discourage travel restrictions. The International Health Regulations of 2005 state that any travel restrictions must be explicitly justified with scientific evidence, and periodically reviewed, and should be negotiated with the country that is on the receiving end of the restrictions.
> China did everything they can to block information from going out.
Except for issuing an official alert within days of discovering the first cases, releasing the genome, and stating that person-to-person transmission was a possibility. Even if one missed all that, shutting down a province of over 50 million people should have been a massive giveaway.
I'm not trying to resort to hyperbole to make my point, but how is this not considered Biological Warfare by the CCP?
I'm being sincere, whether deliberate or by accident they ended up using their citizens as a (possible) vector of infection in Hong Kong--a country they have had ongoing political strife and used overt violence against--while maintaining and withholding information of its infectious nature to the rest of the World, and censoring or outright disappear'ing Citizen journalists or Physicians on the mainland who tried to share that information in the process. Which then overwhelmed Hong Kong's medical system by keeping the borders open, despite local opposition from the medical professionals as well as the Citizenry for reasons only Lam's administration could rationalize, one that risked the lives of the over worked medical professionals who were just trying to cope [4] with the influx of patients.
All while censoring the Internet for possible related incidents for those who tried to research the topic on their own
Even now Xi/CCP are trying to stonewall the investigation [1] and even threatening Australia with a boycott [2] for their calls for the probe.
And now with the findings of the Five Eyes dossier [3], which has to be approached and treated with a healthy level of skepticism, it is coinciding with the events the CCP took and has taken in the past to curtail anything it deems undesirable.
If anything this underscores why a Free Internet, uncesonrable by any Nation-State(s) is a matter of Life or Death and should be taken as serious as any other critical form of infrastructure and move away form its current monetized Panopticon model at all costs. And I'm not just referring to the one behind the Great Firewall, either.
1: https://www.msn.com/en-gb/news/uknews/china-bristles-at-aust...
2: https://www.thehour.com/news/article/China-threatened-Austra...
3: https://www.msn.com/en-us/news/coronavirus/bombshell-five-ey...
4: https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Hong_Kong
Plus the China numbers match Italy and elsewhere. I doubt their real numbers are that much off from their official released numbers. If they were, we'd see it around the world by now.
The only way to know would have been to perform tests, which we did not do.
All the antibody studies so far suggested infection numbers that were massively higher than confirmed cases.
Furthermore the PCR tests used for initial diagnosis have high false negative rates and most people with only mild or no symptoms never got tested in the first place.
They're still higher than usual, and so any 'even at the peak' appeal to curves acknowledges that epidemiologists were probably correct and numbers of cases rose very rapidly from near-negligible levels, before slowing due to social distancing measures. If the disease was widespread much earlier, excess hospitalisations and deaths during that period ought to be much higher than they are now with aggressive social distancing having been place for nearly two months. It's not like France has limited access to healthcare or was more likely to chalk a surge of hospital inpatients with severe respiratory symptoms off as something else in late Feb or early March than in late April, when despite lockdown they were much higher...
Viral pneumonia is among the most common cases of death among the elderly.
Influenza cases vary significantly between years.
There is a lag of infection to death of two to three weeks.
It would have been invisible for a long time, spreading uncontrolled.
BTW, that 50% is for national level and with a shutdown in place.
Regions hardly hit by the virus have a much higher excess mortality (Bergamo province 450%, NYC 390%, Madrid 250%, Manaus 250%) [1]
[1] https://twitter.com/jburnmurdoch/status/1256312094334619648
It simply would not have registered among the usual deaths from viral pneumonia, which has a year over year variance of a similar magnitude.
The actual death numbers are also highly dependent on the age groups affected, in Germany for instance there is no discernible excess mortality because most of the infected are below the age of 65.
Disease spread tends to always show a pretty standard shape. It was that observation (Farr's law) that led to epidemiology being born as a field. It grows, it peaks, it enters immediate decline. Importantly the peak doesn't last long - epidemics don't spend 6 months with a stable number of people getting sick at the peak. Look at graphs of COVID deaths and cases and you'll see the standard pattern.
We know now that this virus has left hospitals virtually everywhere without overload, even in places like Sweden. A few other places were hit much harder. But the response in New York (with mobile morgues) wasn't reported anywhere else. It's apparently some kind of invention of New York policymakers during a brief peak rather than a worldwide phenomenon.
A virus can be spreading and growing for a long time before it attracts attention. The evidence keeps mounting that the first reports in Wuhan were not in fact the first cases after COVID had mutated or crossed from animals but merely the first where doctors decided to search for a novel virus after coming under pressure and noticing some novel symptoms. What you saw in New York was a mix of:
1. Conditions at the absolute peak of infection, not at the start.
2. Media hype and fake news.
For (2) I present https://nypost.com/2020/04/01/cbs-admits-to-using-footage-fr... as evidence. CNBC spliced video from an ICU in Italy into reports about New York without telling anyone. Outright deliberate deception is also the tip of an iceberg: there's far more selective reporting, exaggerated anecdotes and so on. On April 6th Vox reported the entire USA was running out of sedatives needed for ventilation:
https://www.vox.com/2020/4/6/21209589/coronavirus-medicine-v...
On the same day Gov Cuomo was saying they had enough ventilators with some in reserve. A few days later he was sending them to other parts of the USA.
Whatever you think you know about the situation in New York you really only have a tiny fragment of the whole picture (and the same for me and everyone else posting here). Our understand of reality lies shattered in pieces on the floor, smashed by speed, poor quality data, poor use of data, and extremely poor journalism. All we can do is work to piece together a narrative of what really happened by examining all the evidence we can get. Repeated anecdotes from many different people about having had a COVID-like illness before it was being discussed much are interesting for that reason.
So I am capable of personally falsifying your statement:
>But the response in New York (with mobile morgues) wasn't reported anywhere else.
I lack a citation but I'm not really trying to prove anything either. I don't think New York is isolated. Lombardy seems to be stricken pretty hard, and it's hard for us to know what it was truly like in Wuhan.
Also nursing care homes make up a significant part of the deaths: some infected patients from elsewhere were put there under the "promise" of keeping them separate from the others, and you can imagine what happened later.
What's interesting is that many US states have shown virtually linear growth for more than a month, which is an extended "peak", assuming it's a peak. That depends on if enough of the population is exposed before the interventions are relaxed, or else it will just revert to its natural progression and the media will have something exciting to report on again.
The US data is tricky to interpret because the nation's testing rate has been growing relatively slowly. Over the past week (Covid tracking project data), the US has reported about 242k tests/day; for the week ending April 7 (so 4 weeks ago), that number was 144k tests/day.
In the meantime, an extended peak is consistent with the idea that policy measures in place have reduced the R0, but only to a value close to 1. Suppose stay-at-home orders reduce the number of daily contacts by about 70%, taking the R0 from 2.5 to about 0.8. With an infection period of two weeks, that would only reduce the number of new infections per day by 35% after a month.
The UK, France, Spain, and Italy are all countries that have temporary morgues because of covid-19.
> On April 6th Vox reported the entire USA was running out of sedatives needed for ventilation:
They link to this document. Are you saying this document is incorrect? How do you know it's wrong?
https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-S...
Aside due to the fact that there were high number of cases and the skewed death rate towards the elderly, couldn't also this be due to the fact that (at least in Italy) tests are done only if a patient is hospitalized?
I mean, the evidence is so far scant and anecdotal, but the timeline for treatment (I'm aware only remedisivir has been proven to be effective, but protocols also use other drugs, even if the efficacy is unknown) suggests that the earlier the treatment, the more effective it will be.
If only admitted patients are tested, that usually means a lag from symptom onset, which may ultimately be detrimental.
Only without intervention. With social change, the disease's R0 (with respect to a given society) will differ, altering the shape of the epidemic curve.
We can have great confidence that COVID has not gone through a full, "status quo" epidemic curve anywhere.
Take Italy as an example. That nation has conducted (as of May 2, Wikipedia data) 2.11 million tests to find 210k positive cases. That 10% test positivity rate forms a loose upper bound on the prevalence of nCoV in the entire population -- even if we assume that policymakers erred and many infections are asymptomatic, test-selection criteria should not have caused a worse than average chance of detecting a positive case.
In the meantime, Italy documented 28,710 COVID-related deaths as of that date. If we again make the generous assumption that all COVID-related deaths were detected but the true population prevalence was about 10%, that would give the disease an 0.48% IFR. That's far too high for a rapidly-spreading disease to remain hidden for long.
Simultaneously, we can't say that the supposed 10% infection rate is sufficient for herd immunity. If 10% of the population is infected now when the virus was introduced at the end of December, the R0 of the disease must be well above 2 (with a generously short two-week period between infection and recovery -- shorter than many observations -- we've only had 8 generations.) Herd immunity would then require > 50% immunity in the population.
Instead, the much simpler conclusion is that policy responses have worked, with lockdowns and distancing reducing Italy's R number to somewhere around 0.75 (based on a rough look at the number of new cases per day, divided by the number from two weeks ago).
> All we can do is work to piece together a narrative of what really happened by examining all the evidence we can get.
Yes, but we must examine all that evidence in light of what we know of epidemiology. It's far too easy to cherry-pick data that is comforting or aligns with our political predispositions.
> Repeated anecdotes from many different people about having had a COVID-like illness before it was being discussed much are interesting for that reason.
... but the plural of anecdote is not data. Especially for a disease such as COVID, where the range of attributed symptoms is so wide that just about any commonly-circulating cold or flu could -- by symptoms alone -- be attributed to nCoV.
Italy will slowly get out of lock down soon (while still preventing travel across regions). We will see how it goes.
This is not a message that any politician can ever espouse. It is sadly the way of things.
I suspect that the next novel coronavirus will meet with quite a lot of resistance. It seems we screwed the pooch/jumped the shark/fucked up ... with SARS which was our last warning apart from Bird flu (H5N1) and the other horrendous epidemics and pandemics across the years.
It's a bit embarrassing to have several world class virus killer orgs here in the UK and yet we are only deploying them properly fairly recently. You Yanks can stop sniggering at the back - you've screwed up in the same way we have. It is of course not that simple and we are all unprepared for this. It will be different next time and there will be a next time. All countries are changing visibly with their response to this thing. It is remarkable and quite humbling. Keep your eyes peeled and your brain on point and observe. We will never see the like again in our lifetimes (I hope)
My take away is that we need to get all our govts onboard with real risk assessment.
That's a bullshit line by incompetent politicians who deliberately dismantled the very systems that were put in place to deal with this.
As for warnings: By end of December, the epi community knew something was up. By mid January, there was a pretty loud clamor that we need to address this.By end of January, Covid was a regular occurrence in the intelligence briefing for the president, and the warnings weren't exactly ambiguous. By mid February, anybody who was paying actual attention was preparing one way or another.
As for warning the general public: Bill Gates did a whole song and dance on a TED stage. We had SARS, and Mers, and swine flu.
So, no, we are not "all unprepared". Many closed their eyes and pretended wishing extra-hard makes science go away.
And yes, there's a good chance we'll see another one in our lifetime. As we encroach more and more on animal habitats, it's pretty inevitable. (That, too, is a thing people have been warning about for decades)
In the US, the Trump administration’s bungling incompetence handling of the outbreak is truly staggering. Wildly contradictory statements from moment to the next, no coordinated pandemic plan, “hijacking” PPE shipments enroute from China and Malaysia to the countries that had bought, and paid for, them...this is rogue/failed state level stuff.
Other western countries also messed up big time. In Canada, France, the UK and Spain people in longterm care homes were abandoned and left wallowing in their own filth as COVID-19 burned through these facilities like wildfire, killing scores of elderly inpatients, many of whom were left to suffer and die alone.
It’s striking how some of the most “advanced” countries utterly failed to prepare for and manage a very foreseeable pandemic.
Then again, is it really that surprising that this happened in places where health care systems have been chronically underfunded for decades as permanent homeless camps have become normalized and the middle-class economy replaced by low-wage precarity and easy credit?
It’s like after four decades of “there is no such thing as society” governance the health and well-being of people, of the public, in these places has become an afterthought.
The scramble to blame other countries or pretend that “there is nothing we could have done to prepare for this” is theatre designed to deflect attention from the fact that dictatorships, like China, and places with authoritarian governments, like Singapore and South Korea, care more for the health of their citizens than many of the western liberal democracies, where austerity and massive neglect of public services and infrastructure have become the norm.
Like the market crash of 2008, the coronavirus outbreak of 2020 is showing that the social and economic system underpinning the west is seriously broken and can’t handle even the slightest amount of stress.
It needs to be replaced with an arrangement that reins in the ability of the avaricious banker and CEO class to dictate how the economy should be run. The health and well-being of all people in society needs to come first or these places will degrade even further.
We (humans) are trying to impose evolutionary pressure by isolating potential carriers. Maybe that will help.
The Influenza causing the Spanish flu became deadlier in the second wave, it then evolved to be milder in the third wave, however, still more dangerous than in the first wave.
The evolutionary pressure is for reproduction, and if other factors facilitate reproduction, like a large window during which the infected are asymptomatic but contagious, or maybe airborne transmission, then the virus can very well be deadly.
It appears SARS-Cov-2 is very well adapted given how contagious it is. Personally I fear a more dangerous second wave in autumn or next year.
My understanding is that viruses typically cause symptoms because they cause the virus to spread, things like coughing spread the virus. If a virus induces too strong of a reaction then the host dies or can't function while they have it and it doesn't spread.
It's probably unlikely for a virus to develop an infectious period where the symptoms are mild but strong enough to spread and then shift phases to become lethal, as a virus has no coordination between itself.
I think typically viruses are either in an asymptomatic phase, where they're less likely to spread and don't cause symptoms (because they haven't replicated much), and a symptomatic phase where spreading is more likely but obvious the person has it.
As a last bit, my understanding is that "novel" viruses, such as this novel coronavirus, are particularly concerning when they cross over from a non human host and become infectious because they haven't developed to have mild symptoms that are amenable to spreading well, and so can be more deadly than viruses that evolved alongside or within the human population.
Except that if it really was 'spreading uncontrolled' and giving everyone 'the worst flu', as opposed to a handful of isolated cases which became more than a handful shortly after people started to panic about it, there wouldn't still be more vastly people being hospitalised for respiratory symptoms weeks after measures were taken to halt the spread than in late February. There might not have been much community testing going on then, but hospitals were certainly keeping records of who was coming in with respiratory problems; the well-established fact that comparatively few people were is strong evidence against the hypothesis it had already become widespread by then.
You're also more likely to develop pneumonia from Influenza than from COVID-19, especially if you're young. If you presented to a doctor oblivious of COVID-19 (or SARS), they would assume it is Influenza.
It does highlight that highly individualistic societies struggle more than places that put a higher value on collective wellbeing.
There's no real evidence to support the thesis that the MTA was a primary vector of spread in NYC. Granular data of infection rate by neighborhood is spotty, but the data that does exist doesn't show any clear trends towards increased infection rates nearer subway lines. And the borough with the highest infection rate is the borough with the least transit ridership, and the borough with the lowest infection rate is that with the highest transit ridership...
(Source cite: https://pedestrianobservations.com/2020/04/15/the-subway-is-...).
The subway is a shared space with poor air quality and many hard surfaces that are touched by many people every hour.
The blog post you are "citing" tries to draw conclusions by zip code in a map that is not granular enough to support the claims. You yourself acknowledge this so I'm not sure why you use that blog post as evidence.
Also, Jeff Harris (the MIT professor who wrote the paper with which the blogger disagrees) is a doctor as well as being an economist. That doesn't mean he is infallible, but I wouldn't be so quick to dismiss his thoughts.
I use an inner city transit system every day on my usual commute, but the transit system hub I access it from is about 15 miles away from where I live. I use a bus and then a regional train network to get to it, then go into the underground.
Yes, subways are crowded, but so is everything else in NYC. As for why NYC is doing much worse than other comparably dense cities worldwide, my thesis is that it's a failure at all levels of civic participation (federal, state, local, and even residential and commercial proprietors) to be proactive in counteracting the spread of coronavirus.
Rush hour on a subway is about as close as your going to get (no pun intended) to a clear cut ‘yep, this is how it spread’.
So if people got contaminated there, in a couple of days they probably were somewhere else already.
As a similar example, a lot of people in NJ work in NY but a case on a NJ resident would be counted as NJ.
Some countries are still trying to avoid testing. Many Japanese hospitals are turning people away from testing unless they have severe symptoms lasting several days, so naturally, numbers look tiny. And let's be frank, China's numbers just shouldn't be believed.
https://www.theguardian.com/uk-news/2016/sep/29/tube-chat-ca...
You get the impression that a lot of people in Western society would rather risk infection than be seen wearing a mask - defies logic.
This is why I believe it's just a bad flu after all - the spread pattern matches the usual seasonal flu/cold; and we would have noticed an elevated mortality.
If we adjust for years of life lost, as opposed to just lives lost, COVID-19 may be less severe than seasonal H1N1 Influenza, which kills a lot of young people. On the other hand, COVID-19 also seems to be far more infectious.
https://www.euromomo.eu/graphs-and-maps/
Outside of NY/NJ, the excess mortality in the US is within 20% of the normal rate, no different than the variance expected from a bad/mild flu season.
If you were to transpose those cases back to February, what would you have seen in the death statistics? Nothing suspicious at all. There could have been hundreds of thousands of cases that have gone unnoticed, because there wasn't any testing - and that's assuming a mortality rate of over 2%. If the mortality rate is lower than 0.4%, as some studies suggest, it could've been millions of cases.
https://www.cnn.com/2020/04/30/opinions/eye-opening-south-ko...
The case study covers infections in a 19-story mixed commercial-residential building. First case was reported on March 9, 2020. The office seating diagram provided in the article shows extended (10 min or 1hr not sure), very close proximity spacing physically is the main reason for the spread.
Note that this was a call center so people were sitting and talking without masks on for extended periods.
* On March 9, one day after the first cases were reported, the entire building was closed. Testing was performed almost immediately on 1,143 people (workers, residents and a few visitors) with rapid results available to those affected and the team working to control the situation. The testing showed that 97 people (8.5% of those occupying the building) were infected. Most of the cases were women in their 30s and almost all (94 of the 97) worked on the 11th floor of the building, in the call center.*
I counted colored seats in the diagram and found 84 people in the call center got infected.
I think NYC got hit particularly hard because of subway cars. Enclosed in nearly airtight space for 10 - 30 minutes at a time.
I agree that everything is more crowded in NYC, but the only thing I can think of more crowded than a subway car is a nightclub. Estimating from ridership numbers, the average New Yorker rides the subway 15-30 minutes per day. The ceilings aren't even that high, just the number of people per unit volume is incredible.
One of the case studies I saw showed it spreading on a long distance bus between people sitting four rows away from each other.
That’s rush hour. Let’s not kid ourselves.
(I'll also point out that you picked literally the busiest station on the entire system to use as an example.)
The thing about the subway is that we all try to hold onto a pole or bar, total vectors for the spread. It’s not just an obvious case of being near each other, we’re forced to touch the same surfaces so we don’t collide every 30 seconds.
The US doesn't have high quality national excess death data, apparently. That's surprising. Part of the distorted response to this outbreak is because most countries only seem to publish relatively recent excess death data - often only a few years. But when longer term data is examined it shows that there have been plenty of flu seasons with similar death rates. That's why people keep comparing it to the flu.
At a national level the peak in the USA was at 20,000 excess deaths. In 2017 the peak was at about 7,000
(https://talkingpointsmemo.com/news/cdc-releases-detailed-nat...)
So it must be much worse, right?
Well, not really. If you look at the longer term data for a hard-hit country like the UK, where there are a lot of lockdown-created excess deaths due to excessively underloading the hospitals:
http://inproportion2.talkigy.com/
You can see that this outbreak had at the end of April an almost identical number of excess deaths so far this year to 2017, 1999 (which was worse), 1998, 1996 and 1995.
It seems flu care might have got better over time, or perhaps vaccinations had the impact. But so far the impact on COVID on the UK is not much different to disease outbreaks throughout the 1990s.
The UK stats will go up and it'll be worse than any other outbreak for sure, because at this point the population is in a state of fear and avoiding hospitals - even if they don't want to, critical treatments for other diseases have been cancelled to free up space for a surge that never came.
https://www.telegraph.co.uk/news/2020/04/27/care-homes-see-r...
"UK's biggest provider says deaths among residents at three times last year's rate, but only half of additional deaths linked to virus"
And this is with almost any death being ascribed to COVID, without requiring tests or evidence. The lockdown will claim more lives than COVID will.
What a rubbish site. Its first argument is that deaths are not worse than 2018, so its not bad. Even though you can see that number of deaths quickly surpasses 2018 in 2-3 weeks and rises a lot higher faster, while it started a lot lower.
It's third argument is even more ridiculous. "Look at this graph showing a strong correlation between lockdown stringency and infection cases, stringent lockdowns increase infections!" is akin to saying people should stop using umbrellas because they increase rain.
(Also that graph is useless because the number of cases is not normalized inhabitants per inhabitants, so its x axis is bad)
talk about ridiculous claims.
However this is only really in over 60s
The explanations would be
1) more covid deaths than have been mentioned on death certificate 2) more deaths from other reasons
I haven’t seen any detailed breakdown of cause of death other than “covid mentioned” (and thus not mentioned)
Edit: actual calc i did is 13k confirmed deaths in nyc / 70% herd immunity magic number of 8.4 mil
Let's look at Germany from that EUROMOMO map. Despite all the measures, they have had over 150k cases and over 6k deaths (a death rate of over 2%), but it doesn't show up on the graph.
All the deaths that have happened in Germany in the past weeks could've happened months earlier and it wouldn't have shown up either.
This disproves the idea that there couldn't have been any mass infections earlier, because we would've seen that from excess deaths. That's the point I am making. The only way to know would've been through testing, but there wasn't any testing then.
You can't really disprove the idea that "without measures excess mortality will always happen".
This is because there are lags in the data. You need to wait a few more weeks (and for some countries it'll be months) for the data to come in and be reported.
In the case of Germany, there would be 12,000 weekly deaths on average, versus about 2000 weekly deaths due to COVID-19 at the peak - that is within the variance caused by the seasonal flu. It would not have been a suspicious rise.
It's very easy to search for this information. Here's one link: https://blog.ons.gov.uk/2020/03/31/counting-deaths-involving...
> In the case of Germany, there would be 12,000 weekly deaths on average, versus about 2000 weekly deaths due to COVID-19 at the peak - that is within the variance caused by the seasonal flu. It would not have been a suspicious rise.
If you're comparing covid-19 to flu you must count them using the same method, and you're not doing that here. Here, for covid-19 you're using "deaths after confirmed positive" but for flu you're using "all cause mortality". When you use the same method to count covid-19 and flu deaths you see much higher rates of death for covid-19.
Your claim is that the lack in excess mortality is solely due to lag. Your link doesn't say anything about the extent of the delay regarding countries like Germany.
> If you're comparing covid-19 to flu you must count them using the same method, and you're not doing that here. Here, for covid-19 you're using "deaths after confirmed positive" but for flu you're using "all cause mortality".
The hypothesis is "If there had been mass spread back then, we would've seen it from excess deaths", which implies all-cause mortality. Of course I'm mentioning Influenza because it causes some of the seasonal variance and some of the same symptoms.
> When you use the same method to count covid-19 and flu deaths you see much higher rates of death for covid-19.
Yes, but that's in hindsight. That's not the way you would have looked at the cases at the time.
There are about 20,000 pneumonia deaths per year in Germany where the cause is never determined[1]. That's over 300 per week average, more in the winter years. Now suppose an old person comes in and dies of pneumonia. There's nothing suspicious about this. Suppose a few more come in this year than the last year. Again, nothing suspicious, some flu seasons are worse than others.
I'm not saying there have been 2000 undetected cases of COVID-19 deaths per week in Germany back in January/February, but there could have easily been 100-200.
[1] http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/dbo...
Let me reiterate:
Hypothesis: "If there had been mass spread outside of Asia as soon as January or February, we would have been able to tell because of unusually high excess deaths"
Contradicted by: "There are known cases of mass spread that didn't result in unusually high excess deaths"
Therefore, excess death is an insufficient metric to reveal a mass spread of COVID-19 - it could have been spreading undetected.
Whether there have been any measures to limit the spread is irrelevant to that conclusion.
You used Germany as an example.
Here's the situation in Germany:
Since 13 March, the pandemic has been managed in the protection stage as per the RKI plan, with German states mandating school and kindergarten closures, postponing academic semesters and prohibiting visits to nursing homes to protect the elderly. Two days later, borders to five neighbouring countries were closed. By 22 March, all regional governments had announced curfews or restrictions in public spaces. Throughout Germany, domestic travelling is only authorised in groups not exceeding two people unless they are from the same household. Some German states imposed further restrictions authorising people to leave their homes only for certain activities including commuting to workplaces, exercising or purchasing groceries.[10]
https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Germany
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Tell me, please, how does this support the idea that mass spread without extreme protective measures (as was the case in January or February) can result in no excess death?
I'm not saying it can result in "no excess death", I'm saying if there had been mass spread back then, even on the order of hundreds of thousands of cases, it could've gone unnoticed, because the excess death would've been within the seasonal variance.
If there are really 10x as many actual cases as reported - which is what antibody studies suggest - then the virus has either been spreading much faster than we assumed, or has been spreading for longer than we assumed.
The fact that somebody who died in France in December appears to have been infected with COVID-19 strongly suggests that there has been community spread far earlier than we assumed.
