Coronavirus pandemic

[tradephoric]

Yeah.  100,000 dead.   Positive testing has gone UP after weeks of decreasing.  (And decreasing substantially in Europe.)  Hospitalizations rising in a number of areas.

In the UK there has been 43,414 reported COVID deaths.  If the same mortality per capita was applied to the US there would be 215,000 deaths here (luckily the US deaths aren't that high).  According to the European Center for Disease Prevention and Control, as of June 27th there has been 1,542,621 confirmed cases and 176,383 deaths in the EU/EEA and the UK  (compare that to 2,553,771 confirmed cases and 127,649 deaths in the US).  They are reporting a million fewer cases yet 48,734 more deaths than America.  That's crazy.  https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea

But it's just the media "fear mongering." Seriously some people just don't get it.

I watched a 15 minute segment on CNN with the lower thirds showing "DAILY NEW CASES HIGHER THAN AT ANY POINT DURING THIS PANDEMIC".  But at no point did they attempt to explain how the record new cases can be largely attributed to the dramatic increase in testing.  By not putting the data into context viewers may fear that today's situation is worse than it was back in April, and that's simply not the case.

But anyway, my point is lack of proper controls is increasing cases across the country - which will mean both hospitalizations and deaths eventually - yet the economy still stinks.

Failure of leadership. 

Your initial point was that more people were being tested today because the virus is more widespread.  The data doesn't support this and if you are only looking at daily new cases you aren't seeing the full picture.  As mentioned before if daily tests were at the same level today as it was back in April, you would be seeing about 10k daily new cases as opposed to the 40k being reported.

[jeffandnicole]

When I've had family members in the ICU, the above quotes match my observations. It's not unusual in my local hospital for, out of ICU 12 beds, that 10 or so are normally in use.  Obviously that can vary...I would go in the next day, and 11 or 9 beds would be in use.  And that was during normal times.  If 11 people were in there for historic illness reasons, and 1 person went in for Covid-related reasons, the "news" would claim the ICU beds were maxed out and relate it to Covid, even though only 1 bed may be in use due to that.  One morning I stopped in to visit a relative: Only 7 of 12 beds were in use, and they were commenting how slow it was that day.

That said...

Clearly the illnesses are on the rise.  And there should be by now a very clear relationship to wearing masks and social distancing does help dampen the spread, especially in public, group setting.  Warm/Hot weather, which was at first assumed to help diminish the virus, appears to have no effect on it.

And one last story...

I had a doctor's appointment yesterday.  After you walk in they quickly scan your head for your temp, and mine was well over 2 degrees off from normal...in the 95 degree range!  The girl looked a bit surprised, then asked if I was running my air conditioning.  In the car, yes, I keep it quite chilly, so it was probably that.  However, the week before I took my temperature at home and it was in the 95 and 96 degree range here too, and I'm not a foot away from an air conditioning vent. So I guess I just have a lower than normal body temp! :-)

[kalvado]

When I've had family members in the ICU, the above quotes match my observations. It's not unusual in my local hospital for, out of ICU 12 beds, that 10 or so are normally in use.  Obviously that can vary...I would go in the next day, and 11 or 9 beds would be in use.  And that was during normal times.  If 11 people were in there for historic illness reasons, and 1 person went in for Covid-related reasons, the "news" would claim the ICU beds were maxed out and relate it to Covid, even though only 1 bed may be in use due to that.  One morning I stopped in to visit a relative: Only 7 of 12 beds were in use, and they were commenting how slow it was that day.

Hospitals are for-profit organisations in US, it doesn't make sense for them to setup assets that would go unused. Some spare capacity, maybe.
ICU are used after major surgeries, though, so baseline use can be lower than normal. 

[kalvado]

Yeah.  100,000 dead.   Positive testing has gone UP after weeks of decreasing.  (And decreasing substantially in Europe.)  Hospitalizations rising in a number of areas.

In the UK there has been 43,414 reported COVID deaths.  If the same mortality per capita was applied to the US there would be 215,000 deaths here (luckily the US deaths aren't that high).  According to the European Center for Disease Prevention and Control, as of June 27th there has been 1,542,621 confirmed cases and 176,383 deaths in the EU/EEA and the UK  (compare that to 2,553,771 confirmed cases and 127,649 deaths in the US).  They are reporting a million fewer cases yet 48,734 more deaths than America.  That's crazy.  https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea

But it's just the media "fear mongering." Seriously some people just don't get it.

I watched a 15 minute segment on CNN with the lower thirds showing "DAILY NEW CASES HIGHER THAN AT ANY POINT DURING THIS PANDEMIC".  But at no point did they attempt to explain how the record new cases can be largely attributed to the dramatic increase in testing.  By not putting the data into context viewers may fear that today's situation is worse than it was back in April, and that's simply not the case.

But anyway, my point is lack of proper controls is increasing cases across the country - which will mean both hospitalizations and deaths eventually - yet the economy still stinks.

Failure of leadership. 

Your initial point was that more people were being tested today because the virus is more widespread.  The data doesn't support this and if you are only looking at daily new cases you aren't seeing the full picture.  As mentioned before if daily tests were at the same level today as it was back in April, you would be seeing about 10k daily new cases as opposed to the 40k being reported.

The best figure of merit could be hospital admissions - and even that may be skewed.
Number of deaths may strongly depend on the treatment approach - for example, I hear that ventilators were used in a way that didn't quite work. Now there is more understanding of how to deal with the disease, including less damaging use of ventilators.
The number of diagnosed infections may or may not include asymptomatic and cold-grade symptoms which are just disregarded as non-event near the peak.
Even the number of hospital admissions is not bullet proof, as admissions threshold can change quite a bit. During the peak, those capable of breathing and sustaining heartbeat without external help  may just be quarantined at home as there isn't much what could be done for them anyway. off-peak, it may be wise to keep them under constant monitoring.

[Roadgeekteen]

When I've had family members in the ICU, the above quotes match my observations. It's not unusual in my local hospital for, out of ICU 12 beds, that 10 or so are normally in use.  Obviously that can vary...I would go in the next day, and 11 or 9 beds would be in use.  And that was during normal times.  If 11 people were in there for historic illness reasons, and 1 person went in for Covid-related reasons, the "news" would claim the ICU beds were maxed out and relate it to Covid, even though only 1 bed may be in use due to that.  One morning I stopped in to visit a relative: Only 7 of 12 beds were in use, and they were commenting how slow it was that day.

Hospitals are for-profit organisations in US,

And that's a problem.

[J N Winkler]

But the ICUs aren't actually all that full.

100 percent of regular ICU beds in Texas Medical Center occupied, but hospitals have space for surge

Yes--when that link was posted earlier in this thread (by Roadgeekteen), I clicked through and discovered it was largely about hospital system CEOs trying to reel back an earlier communication about ICUs filling up that caused alarm to a degree they didn't intend.

This said, the underlying problem--the potential for cases to grow exponentially while ICU capacity can be increased arithmetically at best--doesn't go away.

I did a small back-of-the-envelope calculation based on TMC's quoted numbers:  ~400 beds in the ICU, ~25% covid-19 patients, ~350 additional beds available through reallocation, 500 beds available through opening up an ICU that is currently shuttered.  This means that available new capacity for covid-19 patients is about 8.5 times what is currently being utilized (ignoring the possibility, mentioned by Wxfree above, that there will be patients incoming from areas with higher load factors).  This added capacity can fill up in about three times the doubling period for cases plus some lag time for incubation.

So what is the doubling period?  For Texas my current back-of-the-envelope estimate is two weeks (based on ~5% growth in confirmed cases over the past couple of days), which gives about two months before things really hit the buffers, but this assumes the doubling period doesn't shorten.

So it doesn't surprise me that the governor has ordered bars closed and counties are now enforcing mask wearing more aggressively.

[Eth]

Your initial point was that more people were being tested today because the virus is more widespread.  The data doesn't support this and if you are only looking at daily new cases you aren't seeing the full picture.  As mentioned before if daily tests were at the same level today as it was back in April, you would be seeing about 10k daily new cases as opposed to the 40k being reported.

That might be true at the national level, but not at the state level. If case numbers are rising faster than test numbers are, if indeed test numbers are rising at all (looking at you, Florida), you can't just blame it on more tests.

As for death rates still going down: people generally aren't dying immediately upon testing positive. Don't be surprised if that trend changes in the next couple weeks.

[webny99]

Warm/Hot weather, which was at first assumed to help diminish the virus, appears to have no effect on it.

It does, to the extent that it affects whether you spend time indoors or outdoors. It's just that warm/hot weather has different meanings and implications in different parts of the country.

In the Northeast/Upper Midwest, warm/hot weather means summer! Time to get outside!
In the Deep South and Southwest, warm/hot weather means the "nice" season is over, time to crank up the AC and stay inside!
And the spread is greatly reduced outdoors, so that's why we're now seeing the significant north/south divide largely opposite to what we saw in March/April.



I went to a local ice cream shop last weekend, which was very busy now that it's summer and this area has reopened. There was probably several hundred people there, and quite long lines - certainly the largest "gathering" I had seen since the pandemic began. Probably about 2/3 of people were wearing masks, and social distancing was being observed in a loose and general sense (keep an arm's length away from other parties, but don't worry about taking 6 feet too literally). But no one seem bothered at all about the virus spreading because the lines and order points are outside. If it had been indoors, there would have been close to 100% mask wearing, and stricter social distancing. This just goes to show that indoors vs. outdoors is one of the most important factors in the spread of the virus.

[bandit957]

I don't understand why they don't test everyone. I'd gladly take the test.

[tradephoric]

Your initial point was that more people were being tested today because the virus is more widespread.  The data doesn't support this and if you are only looking at daily new cases you aren't seeing the full picture.  As mentioned before if daily tests were at the same level today as it was back in April, you would be seeing about 10k daily new cases as opposed to the 40k being reported.

That might be true at the national level, but not at the state level. If case numbers are rising faster than test numbers are, if indeed test numbers are rising at all (looking at you, Florida), you can't just blame it on more tests.

As for death rates still going down: people generally aren't dying immediately upon testing positive. Don't be surprised if that trend changes in the next couple weeks.

Percentage positive tests in Arizona have been rising since mid-May going from a 7-day rolling average of 6.5% to 23.2% today.  Even with that big rise there hasn't been a big increase in deaths.  I know deaths lag cases but this rise has been going on in Arizona for over a month now.  To put things in perspective Arizona would have to average 358 deaths a day to compare with what has happening in NY back in April.  Today Arizona is averaging 32 deaths a day which is only 18% higher than the 27 deaths they were averaging on May 8th.  What is going on in Arizona?

[J N Winkler]

I don't understand why they don't test everyone. I'd gladly take the test.

I wouldn't if it meant calling and then waiting for a callback that might not arrive for a week, if at all, which is the situation here for people who aren't reporting symptoms.  Test take-up would likely be much better if it did not need to be booked in advance and reliable results were available within fifteen minutes.

[SEWIGuy]

I don't understand why they don't test everyone. I'd gladly take the test.

Waste of resources. All that will do is tell you that you don't have it at that one point in time. You could catch it five minutes later.

[ftballfan]

In Michigan, I would say 80-90% of people are wearing masks inside at grocery stores (even in my home county, which had 12 COVID cases [11 of whom have recovered] as of earlier this week).

Whitmer is alarmed with the rise of cases this week (most of them found via contact tracing and known exposure locations), but there have been around 2,500 new cases in the last week (which is much lower than TX, AZ, FL, and CA, all of whom are averaging over 2,500 per DAY). ICU capacity is very good in Michigan (under 400 hospitalized COVID cases statewide last week, when there were nearly 4,000 hospitalized COVID cases statewide in mid-April).

[kalvado]

I don't understand why they don't test everyone. I'd gladly take the test.

There are two types of tests, and before you do testing - just think what would you do differently once you have the result.

1. Antibody blood test. I am flirting with the idea of getting one; over here it is $100 at urgent care (+$130 visit fee), should be mostly covered by insurance. It generally tells if you got a lucky ticket and already recovered (maybe without noticing it). Still not too reliable, still rare.  If positive, you may take a deep breath - pandemic is over for you personally.
2. Nasal swab PCR test. It tells only if you're actually having infection here and now. You could get infected 2 days before the test and it will not show up; you could get infected 5 minutes after the test, or possibly you're recovered. As such, it is IMHO meaningless to those who don't have a reason to be tested as it doesn't really change anythig. That is, those sick - to plan treatment and isolation options; those who got in close contact with sick may benefit - but quarantine is still required; and those who may feasibly infect lots of others - say nurses at nursing home, preferably before each shift. Otherwise, it tells you only that much.

[wxfree]

I don't understand why they don't test everyone. I'd gladly take the test.

There are two types of tests, and before you do testing - just think what would you do differently once you have the result.

1. Antibody blood test. I am flirting with the idea of getting one; over here it is $100 at urgent care (+$130 visit fee), should be mostly covered by insurance. It generally tells if you got a lucky ticket and already recovered (maybe without noticing it). Still not too reliable, still rare.  If positive, you may take a deep breath - pandemic is over for you personally.
2. Nasal swab PCR test. It tells only if you're actually having infection here and now. You could get infected 2 days before the test and it will not show up; you could get infected 5 minutes after the test, or possibly you're recovered. As such, it is IMHO meaningless to those who don't have a reason to be tested as it doesn't really change anythig. That is, those sick - to plan treatment and isolation options; those who got in close contact with sick may benefit - but quarantine is still required; and those who may feasibly infect lots of others - say nurses at nursing home, preferably before each shift. Otherwise, it tells you only that much.

Increased testing would help scientists understand more about how widely spread it is.  It would also catch some people who are spreading it around sooner.  I heard a doctor on television give an estimate that 1 in 200 Americans are currently infected (about 1.65 million).  That's just his professional opinion.  It would be nice if there were more data.  One thing I've been wondering about, that I've finally seen discussed, is pooled testing.  You can combine samples from several people and test all of them in the same specimen, using the same amount of  chemicals.  If the overall result is negative, then each individual is negative.  That could greatly increase the capacity.  If the overall result is positive, then the rest of each sample, which would have been saved, would be tested individually.  Until we get the much more efficient antigen testing, this could help us squeeze more tests out of our capacity.

[kalvado]

I don't understand why they don't test everyone. I'd gladly take the test.

There are two types of tests, and before you do testing - just think what would you do differently once you have the result.

1. Antibody blood test. I am flirting with the idea of getting one; over here it is $100 at urgent care (+$130 visit fee), should be mostly covered by insurance. It generally tells if you got a lucky ticket and already recovered (maybe without noticing it). Still not too reliable, still rare.  If positive, you may take a deep breath - pandemic is over for you personally.
2. Nasal swab PCR test. It tells only if you're actually having infection here and now. You could get infected 2 days before the test and it will not show up; you could get infected 5 minutes after the test, or possibly you're recovered. As such, it is IMHO meaningless to those who don't have a reason to be tested as it doesn't really change anythig. That is, those sick - to plan treatment and isolation options; those who got in close contact with sick may benefit - but quarantine is still required; and those who may feasibly infect lots of others - say nurses at nursing home, preferably before each shift. Otherwise, it tells you only that much.

Increased testing would help scientists understand more about how widely spread it is.  It would also catch some people who are spreading it around sooner.  I heard a doctor on television give an estimate that 1 in 200 Americans are currently infected (about 1.65 million).  That's just his professional opinion.  It would be nice if there were more data.  One thing I've been wondering about, that I've finally seen discussed, is pooled testing.  You can combine samples from several people and test all of them in the same specimen, using the same amount of  chemicals.  If the overall result is negative, then each individual is negative.  That could greatly increase the capacity.  If the overall result is positive, then the rest of each sample, which would have been saved, would be tested individually.  Until we get the much more efficient antigen testing, this could help us squeeze more tests out of our capacity.

"more data" is a great argument - until you realize it gives very little reason for you personally to seek the test.
Signing up potential plasma donors for IgM loaded plasma is another possible reason - assuming those symptomless patients have enough IgM to bother.

As for combined - PCR test is sensitive, but amount of virus in upper respiration tract is limited. My understanding is that poor test responce is already due to that limitation.

[hbelkins]

I am in southern Utah right now. Mask-wearing here isn't as consistent as it should be, but it seems similar to New Mexico and what little I saw of Colorado. And it's much better than the pathetic levels (with the striking exception, aside from the elderly, of black people) I saw in all the states between Virginia (mask requrement) and New Mexico I passed through on my way out west.

Which states? And is any distinct type of urban vs. rural divide noticeable?

I hope the situation improves on the return trip, which will take a more northerly route (TBD).

Fortunately, all current signs point to the bolded pairs going hand-in-hand with one another, while heading south is associated with things getting worse.

Part of the reason for that inversion is thought to be the weather, and not necessarily a refutation of the theory that heat would kill the virus. When the outbreak first started, it was cool in the north and people weren't out and about as much. They stayed indoors more. Now, it's mostly pleasant in the north, but it's time for summer heat in the south, and people are staying inside where it's air-conditioned. And since transmission is said to be more common inside than outside...

If this is still happening when winter comes, you're likely to see another inversion unless having the virus really does give you immunity. A rise in cases up north, and a decline down south.

[kalvado]

I am in southern Utah right now. Mask-wearing here isn't as consistent as it should be, but it seems similar to New Mexico and what little I saw of Colorado. And it's much better than the pathetic levels (with the striking exception, aside from the elderly, of black people) I saw in all the states between Virginia (mask requrement) and New Mexico I passed through on my way out west.

Which states? And is any distinct type of urban vs. rural divide noticeable?

I hope the situation improves on the return trip, which will take a more northerly route (TBD).

Fortunately, all current signs point to the bolded pairs going hand-in-hand with one another, while heading south is associated with things getting worse.

Part of the reason for that inversion is thought to be the weather, and not necessarily a refutation of the theory that heat would kill the virus. When the outbreak first started, it was cool in the north and people weren't out and about as much. They stayed indoors more. Now, it's mostly pleasant in the north, but it's time for summer heat in the south, and people are staying inside where it's air-conditioned. And since transmission is said to be more common inside than outside...

If this is still happening when winter comes, you're likely to see another inversion unless having the virus really does give you immunity. A rise in cases up north, and a decline down south.

While any explanation is plausible at this point, flu and common cold seasonality can be a good comparison. As far as I understand, relation of cold weather to rhinovirus infection is fairly straightforward. Flu, however, is more complicated. Interestingly enough, seasonality of flu can vary even within single country. This is for India, more northern Srinagar (top) and New Dehli (bottom):

[CoreySamson]

It turns out Houston's hospitals are not in a panic, echoing what Brandon said earlier in the thread:

http://www.memorialhermann.org/news/joint-statement-from-st--luke's-health,-houston-methodist,-memorial-hermann-health-system---texas-children's-hospital-regarding-houston-hospital-capacity-and-executive-order/

[Roadgeekteen]

It turns out Houston's hospitals are not in a panic, echoing what Brandon said earlier in the thread:

http://www.memorialhermann.org/news/joint-statement-from-st--luke's-health,-houston-methodist,-memorial-hermann-health-system---texas-children's-hospital-regarding-houston-hospital-capacity-and-executive-order/

Well that's good. Hopefully cases don't increase.

[wxfree]

But it's just the media "fear mongering." Seriously some people just don't get it.

I watched a 15 minute segment on CNN with the lower thirds showing "DAILY NEW CASES HIGHER THAN AT ANY POINT DURING THIS PANDEMIC".  But at no point did they attempt to explain how the record new cases can be largely attributed to the dramatic increase in testing.  By not putting the data into context viewers may fear that today's situation is worse than it was back in April, and that's simply not the case.

If the increase in diagnoses were a result of more testing, the positivity rate would be going down.  The positivity rate is going up rapidly, meaning that whatever portion of the cases we're catching is smaller than it was before, meaning that the actual spread is much faster than what's being measured, and by a higher multiple than it was a month ago.  I don't know if it's worse than April, but it's bad.  The spread today won't be measured for another week, and the resulting hospitalizations and deaths will continue for another three weeks after that.  The first thing to slow down will probably be the positivity rate, then the confirmed case rate.  The other numbers will keep going up for a while.  For right now, everything is headed in the wrong direction very fast.  Hopefully what we've learned from other places will help keep the death rate down.

[Duke87]

Part of the reason for that inversion is thought to be the weather, and not necessarily a refutation of the theory that heat would kill the virus. When the outbreak first started, it was cool in the north and people weren't out and about as much. They stayed indoors more. Now, it's mostly pleasant in the north, but it's time for summer heat in the south, and people are staying inside where it's air-conditioned. And since transmission is said to be more common inside than outside...

There is probably some truth to this.

Still, this is an explanation, not an excuse. If it's too hot to comfortably socialize outside... too bad. Build up some heat tolerance or abstain from socializing with people. Socializing indoors gets us the case surges we're now seeing and this should not be surrendered to as acceptable.

[RobbieL2415]

In Michigan, I would say 80-90% of people are wearing masks inside at grocery stores (even in my home county, which had 12 COVID cases [11 of whom have recovered] as of earlier this week).

Whitmer is alarmed with the rise of cases this week (most of them found via contact tracing and known exposure locations), but there have been around 2,500 new cases in the last week (which is much lower than TX, AZ, FL, and CA, all of whom are averaging over 2,500 per DAY). ICU capacity is very good in Michigan (under 400 hospitalized COVID cases statewide last week, when there were nearly 4,000 hospitalized COVID cases statewide in mid-April).

I have yet to see someone not wearing a mask. Everyone seems to have just accepted it as a part of life for now.

[oscar]

Hospitals are for-profit organisations in US, it doesn't make sense for them to setup assets that would go unused.

Only a small percentage are for-profit. Many more are private non-profit.

Of course, the private non-profits pay attention to the bottom line, too. As famously said by the nun who led one of the largest Catholic hospital systems, "no margin, no mission".

[Scott5114]

In Michigan, I would say 80-90% of people are wearing masks inside at grocery stores (even in my home county, which had 12 COVID cases [11 of whom have recovered] as of earlier this week).

Whitmer is alarmed with the rise of cases this week (most of them found via contact tracing and known exposure locations), but there have been around 2,500 new cases in the last week (which is much lower than TX, AZ, FL, and CA, all of whom are averaging over 2,500 per DAY). ICU capacity is very good in Michigan (under 400 hospitalized COVID cases statewide last week, when there were nearly 4,000 hospitalized COVID cases statewide in mid-April).

I have yet to see someone not wearing a mask. Everyone seems to have just accepted it as a part of life for now.

I went to Lowe's the other day, and I was the only non-employee in the building wearing a mask.