Coronavirus pandemic

[jemacedo9]

The fact that Sweden has more deaths right now than their Nordic neighbors doesn't mean their strategy isn't working.  In the end of this pandemic, if Sweden has lower deaths per capita than Norway will it really matter if those deaths were front-loaded or back-loaded?  Similarly just because California has seen 1/10th the number of COVID deaths than New York (even though they are twice the population) doesn't mean they are going to end up with lower deaths at the end of this pandemic.  What does seem like a silly strategy is keeping everything shuttered even after you've gained herd immunity.  There is enough data to suggest that a high level of herd immunity has been achieved in the NYC area and perhaps they could rollout their reopening plans at a quicker pace.  I'd almost be more concerned opening up Buffalo at this point than NYC.

You're misusing the term herd immunity.  Herd immunity - the percentage of a population's immunity that reduces the spread of a pandemic...doesn't occur until at least 60% and that's the low end. The high end is 90%.  And it is gradual.

What you're looking for is the R0 factor - the number of new infections estimated to stem from a single case.  An R0 factor below 1.0 slows the spread, above 1.0 increases the spread.  The initial estimated R0 for COVID-19 was 2.5.  The more immune the population is, the lower the R0 becomes...that's what you're looking for.

New York...at 35% immunity...is only now halfway to where a R0 factor of < 1.0 is possible without vaccines and without physical distancing. 

[tradephoric]

We have a drug that reduces deaths by 1/3 for those who already have COVID-19. It's likely that this 1/3 will keep getting better as we find new drugs. A later peak means that we can take more advantage of this.

Are you referring to Gilead's drug Remdesivir?  I read a study where the mortality rate for the remdesivir group was 8% compared to 11.6% for the placebo group; but that the mortality difference was not statistically significant.  What drug is seeing a 1/3 reduction in deaths?

[hotdogPi]

We have a drug that reduces deaths by 1/3 for those who already have COVID-19. It's likely that this 1/3 will keep getting better as we find new drugs. A later peak means that we can take more advantage of this.

Are you referring to Gilead's drug Remdesivir?  I read a study where the mortality rate for the remdesivir group was 8% compared to 11.6% for the placebo group; but that the mortality difference was not statistically significant.  What drug is seeing a 1/3 reduction in deaths?

1 - 8%/11.6% ≈ 1/3. I didn't realize that it was statistically insignificant.

[tradephoric]

You're misusing the term herd immunity.  Herd immunity - the percentage of a population's immunity that reduces the spread of a pandemic...doesn't occur until at least 60% and that's the low end. The high end is 90%.  And it is gradual.

What you're looking for is the R0 factor - the number of new infections estimated to stem from a single case.  An R0 factor below 1.0 slows the spread, above 1.0 increases the spread.  The initial estimated R0 for COVID-19 was 2.5.  The more immune the population is, the lower the R0 becomes...that's what you're looking for.

New York...at 35% immunity...is only now halfway to where a R0 factor of < 1.0 is possible without vaccines and without physical distancing. 

The CDC just estimated that NYC has had around 25k COVID deaths.  On May 9th Governor Cuomo said that 19.9% of people tested for antibodies in New York City tested positive.  Also when Governor Cuomo was announcing the antibody results, he said the fatality rate in New York appeared to be 0.5%.  But these numbers don't add up.  Assuming the deaths and mortality are correct, than immunity would be 60%.  If deaths and immunity are correct, than mortality would be 1.5%.  If mortality and immunity are correct, then deaths would need to be revised down to 8,300.  What is going on here?

[tradephoric]

Johns Hopkins lists the mortality rate of the virus.  There are several countries with case mortality rates below 1%.  There are other countries with much higher case mortality rates, but that indicates more a lack of testing than the virus being more deadly there. 

https://coronavirus.jhu.edu/data/mortality

So bringing this discussion back to NYC, it's hard to believe the mortality rate would be 1.5% in NYC when other countries are seeing case mortality rates much lower than that (with some below 0.5%).  Also there has been a lot of talk to the actual number of COVID deaths, but it's relatively straight forward to estimate the number of deaths you would expect to see in a region during a given time period.  In a report released Monday the CDC found between March 11 and May 2, about 24,000 more people died in the city than researchers would ordinarily expect during that time period (which ends up being about 5,300 more deaths than were blamed on the coronavirus in official tallies).  So if anything, it appears that NYC is underreporting COVID deaths.  If it's safe to say there have been over 20k COVID deaths in NYC and the mortality rate is about 0.5%, than over half of NYC population should have antibodies (but officials are saying only about 20% of people in NYC have antibodies). 

[jemacedo9]

Tradephoric - good questions.  and if anything you're questioning the 34.7% you showed above when stating that NYS is close to herd immunity (if herd immunity is reached at 60% for COVID-19 and not 90%...that remains to be seen, since herd immunity is not a metric that is applicable at the same rate for all diseases), when NYS is not.  NYC might be.  Not NYS.  Which is good for NYC.  And maybe North Jersey and SE CT and Westchester County NY...and some others. 

[tradephoric]

^Yeah that 34.7% wasn't meant to suggest that New York State as a whole was gaining herd immunity.  Of the 3 main data points that New York State officials have shared (deaths, mortality rate, antibody results) two are relatively easy to verify (deaths & mortality rate).  That really puts the antibody testing into question.  If officials say that 20% of the population have antibodies when the other data points suggest that number has to be closer to 60%.  Am i missing something here?  This is my math.

(Deaths / Mortality) / Population = % antibodies

Where:
Deaths = 25,000 (https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e5.htm)
Mortality = 0.5% (https://www.livescience.com/covid-antibody-test-results-new-york-test.html)
Population = 8,400,000

(25,000 / 0.005) / 8,400,000 = 59.5% antibodies

[kphoger]

The fact that Sweden has more deaths right now than their Nordic neighbors doesn't mean their strategy isn't working.  In the end of this pandemic, if Sweden has lower deaths per capita than Norway will it really matter if those deaths were front-loaded or back-loaded?  Similarly just because California has seen 1/10th the number of COVID deaths than New York (even though they are twice the population) doesn't mean they are going to end up with lower deaths at the end of this pandemic.  What does seem like a silly strategy is keeping everything shuttered even after you've gained herd immunity.  There is enough data to suggest that a high level of herd immunity has been achieved in the NYC area and perhaps they could rollout their reopening plans at a quicker pace.  I'd almost be more concerned opening up Buffalo at this point than NYC.

You're misusing the term herd immunity.  Herd immunity - the percentage of a population's immunity that reduces the spread of a pandemic...doesn't occur until at least 60% and that's the low end. The high end is 90%.  And it is gradual.

What you're looking for is the R0 factor - the number of new infections estimated to stem from a single case.  An R0 factor below 1.0 slows the spread, above 1.0 increases the spread.  The initial estimated R0 for COVID-19 was 2.5.  The more immune the population is, the lower the R0 becomes...that's what you're looking for.

New York...at 35% immunity...is only now halfway to where a R0 factor of < 1.0 is possible without vaccines and without physical distancing. 

Allow me to also reiterate that we don't know how long the immune system hangs onto SARS-CoV-2 antibodies.  This means we don't know how long a person who has contracted the virus actually remains immune.  Even if 70% of the population contracts the virus, that does little good if that same 70% gradually lose their immunity before the epidemic dies down.  Our immune system hangs onto antibodies for some pathogens for years, but for others it's only months or even weeks.  So all this talk about herd immunity only goes so far, until we know how long a recovered person actually remains immune.

[jemacedo9]

The fact that Sweden has more deaths right now than their Nordic neighbors doesn't mean their strategy isn't working.  In the end of this pandemic, if Sweden has lower deaths per capita than Norway will it really matter if those deaths were front-loaded or back-loaded?  Similarly just because California has seen 1/10th the number of COVID deaths than New York (even though they are twice the population) doesn't mean they are going to end up with lower deaths at the end of this pandemic.  What does seem like a silly strategy is keeping everything shuttered even after you've gained herd immunity.  There is enough data to suggest that a high level of herd immunity has been achieved in the NYC area and perhaps they could rollout their reopening plans at a quicker pace.  I'd almost be more concerned opening up Buffalo at this point than NYC.

You're misusing the term herd immunity.  Herd immunity - the percentage of a population's immunity that reduces the spread of a pandemic...doesn't occur until at least 60% and that's the low end. The high end is 90%.  And it is gradual.

What you're looking for is the R0 factor - the number of new infections estimated to stem from a single case.  An R0 factor below 1.0 slows the spread, above 1.0 increases the spread.  The initial estimated R0 for COVID-19 was 2.5.  The more immune the population is, the lower the R0 becomes...that's what you're looking for.

New York...at 35% immunity...is only now halfway to where a R0 factor of < 1.0 is possible without vaccines and without physical distancing. 

Allow me to also reiterate that we don't know how long the immune system hangs onto SARS-CoV-2 antibodies.  This means we don't know how long a person who has contracted the virus actually remains immune.  Even if 70% of the population contracts the virus, that does little good if that same 70% gradually lose their immunity before the epidemic dies down.  Our immune system hangs onto antibodies for some pathogens for years, but for others it's only months or even weeks.  So all this talk about herd immunity only goes so far, until we know how long a recovered person actually remains immune.

CORRECT.

[kphoger]

I just wish we had taken Sweden's approach. It's not a "leave everything open" approach, but it's not a lockdown either.

The WHO now has some very good things to say about this method.

Sweden has a much higher death count than any of the other Scandinavian countries.

Compared to many places in Europe, it's pretty low.

Look per capita, or as a percentage of total cases.

OK, here's per capita, for all European nations with a population of more than 1 million:



Yes, Sweden is higher than its Nordic neighbors on both charts, but it's hardly out of the ballpark in Europe.  I note specifically that the total case rate per capita of Sweden is less than 50% larger than that of Denmark.  And it should be clear to anyone that several countries in Europe took more drastic shutdown measures than Sweden yet have higher case rates and death rates than Sweden.  So let's stop talking about Sweden's plan as if it's an obvious failure.

[kphoger]

Other than New York City, has there been any place where the health care system has been overwhelmed? None to my knowledge. The stated reason for all these government-mandated closures was to "flatten the curve" to prevent that from happening. In Kentucky, hospital capacity was never close to being reached. In fact, hospitals are having to furlough or lay off personnel and most of them are empty, so there's plenty of capacity. And two field hospitals were built, one in Lexington and one in Louisville, and neither has seen their first patient. It's not likely that we'll have a second wave (I believe this for a variety of reasons), but we could have a future outbreak 5 to 10 times worse than the current one and the health care system would still not be overburdened.

If you will, fact that containment is successful so far means that those measures work, and nothing else. NYC shows that going into catastrophic mode is very possible, and any further steps have to account for, and avoid as much as possible, that very scenario.

Empty hospital beds and furloughed doctors in Kentucky are proof of neither position.

How many of the empty beds are ICU beds?  A canceled hip replacement surgery leaves a hospital bed empty, but that has nothing to do with how close to capacity the ICU is.  Did a hospital postpone all hysterectomies?  If so, there are some more empty hospital beds that have nothing to do with COVID.  And I assume the furloughed doctors couldn't all be sent over to ICU to treat COVID patients, right?  Can you imagine that many doctors all crammed into one wing of the hospital?  And so a hospital could very well be at capacity for COVID patients while simultaneously having empty hospital beds and furloughed doctors.

My dad suffers from back pain due in part to Parkinson's disease.  He had been, until this past week, unable to get an injection to help with that because the procedure had been deemed "non-essential".  That empty seat in the waiting room, that PA not attending to him while waiting for the doctor, that doctor not seeing him–those are neither evidence of local shutdown measures working effectively nor of their being unnecessary.

About five weeks ago, Wesley Woodlawn Hospital suspended all in-patient services, which created a lot of empty hospital beds.  Such was not an indication that there were hardly any COVID cases in Wichita, because the reason they made that move was to send staff and other resources to a different hospital.  Was that move premature and unnecessary?  Without it, would the health care system in Wichita overrun capacity, or would it have handled the outbreak just fine?  Those are questions that simply cannot be answered by the mere presence of empty hospital beds and furloughed doctors in the city.

[Roadgeekteen]

Dentists are reopening in MA.

[Eth]

We have a drug that reduces deaths by 1/3 for those who already have COVID-19. It's likely that this 1/3 will keep getting better as we find new drugs. A later peak means that we can take more advantage of this.

Are you referring to Gilead's drug Remdesivir?  I read a study where the mortality rate for the remdesivir group was 8% compared to 11.6% for the placebo group; but that the mortality difference was not statistically significant.  What drug is seeing a 1/3 reduction in deaths?

1 - 8%/11.6% ≈ 1/3. I didn't realize that it was statistically insignificant.

From what I remember of that study, both the death rate and the recovery time for surviving patients were observed to be reduced by about 1/3, but only the recovery time metric was shown to be statistically significant.

What you're looking for is the R0 factor - the number of new infections estimated to stem from a single case.  An R0 factor below 1.0 slows the spread, above 1.0 increases the spread.  The initial estimated R0 for COVID-19 was 2.5.  The more immune the population is, the lower the R0 becomes...that's what you're looking for.

New York...at 35% immunity...is only now halfway to where a R0 factor of < 1.0 is possible without vaccines and without physical distancing. 

Slight nitpick: R₀ specifically refers to the initial value (in this case, ~2.5). R_t is the value at any other given point in time.

[bandit957]

I went out earlier and counted people in public spaces. Unmasked people outnumbered masked people 79 to 1.

[tradephoric]

We have a drug that reduces deaths by 1/3 for those who already have COVID-19. It's likely that this 1/3 will keep getting better as we find new drugs. A later peak means that we can take more advantage of this.

Are you referring to Gilead's drug Remdesivir?  I read a study where the mortality rate for the remdesivir group was 8% compared to 11.6% for the placebo group; but that the mortality difference was not statistically significant.  What drug is seeing a 1/3 reduction in deaths?

1 - 8%/11.6% ≈ 1/3. I didn't realize that it was statistically insignificant.

From what I remember of that study, both the death rate and the recovery time for surviving patients were observed to be reduced by about 1/3, but only the recovery time metric was shown to be statistically significant.

It almost feels like the media latched on to a negative study regarding Hydroxychloriquine for the sole person of proving Trump wrong.  Similarly they are now touting the drug Remdesivir even though a lot of questions remain regarding its effectiveness.  In the meantime, researchers from NYU Grossman School of Medicine looked at 900 Covid-19 patients and published their findings on Monday (to be clear the paper has not been peer reviewed).  Half were given zinc sulfate, hydroxychloroquine, and the antibiotic azithromycin.  The other half were given just hydroxychloroquine and azithromycin.  Those receiving the zinc sulfate were 44% less likely to die compared to those who weren't given the zinc in combination with hydroxychloroquine.  The theory is that the zinc is the primary substance that attacks the virus while the Hydroxychloroquine is the agent that transports the zinc into the cells.  It's possibly the combination of the two drugs that make them effective.

https://www.trtworld.com/americas/zinc-hydroxychloroquine-found-effective-in-some-covid-19-patients-study-36233

[jemacedo9]

We have a drug that reduces deaths by 1/3 for those who already have COVID-19. It's likely that this 1/3 will keep getting better as we find new drugs. A later peak means that we can take more advantage of this.

Are you referring to Gilead's drug Remdesivir?  I read a study where the mortality rate for the remdesivir group was 8% compared to 11.6% for the placebo group; but that the mortality difference was not statistically significant.  What drug is seeing a 1/3 reduction in deaths?

1 - 8%/11.6% ≈ 1/3. I didn't realize that it was statistically insignificant.

From what I remember of that study, both the death rate and the recovery time for surviving patients were observed to be reduced by about 1/3, but only the recovery time metric was shown to be statistically significant.

What you're looking for is the R0 factor - the number of new infections estimated to stem from a single case.  An R0 factor below 1.0 slows the spread, above 1.0 increases the spread.  The initial estimated R0 for COVID-19 was 2.5.  The more immune the population is, the lower the R0 becomes...that's what you're looking for.

New York...at 35% immunity...is only now halfway to where a R0 factor of < 1.0 is possible without vaccines and without physical distancing. 

Slight nitpick: R₀ specifically refers to the initial value (in this case, ~2.5). R_t is the value at any other given point in time.

CORRECT...I oversimplified a little bit.

[tradephoric]

Allow me to also reiterate that we don't know how long the immune system hangs onto SARS-CoV-2 antibodies.  This means we don't know how long a person who has contracted the virus actually remains immune.  Even if 70% of the population contracts the virus, that does little good if that same 70% gradually lose their immunity before the epidemic dies down.  Our immune system hangs onto antibodies for some pathogens for years, but for others it's only months or even weeks.  So all this talk about herd immunity only goes so far, until we know how long a recovered person actually remains immune.

"Given what we know about the recovery from virus' such as coronavirus' in general, or even any infectious disease with very few exceptions, that when you have antibodies present it very likely indicates a degree of protection." - Dr. Fauci

[vdeane]

New York shouldn't blanket reopen. The NYC area and upstate are completely different.

What should be the first thing to reopen? I'm imagining things like jewelry stores, antique shops, and other stores where you probably have only one or two customers in the store at a time and the single worker is behind a desk.

NY's plan is detailed online.  Phase 1 retail is curbside pickup only.
https://forward.ny.gov/
https://forward.ny.gov/industries-reopening-phase

Allow me to also reiterate that we don't know how long the immune system hangs onto SARS-CoV-2 antibodies.  This means we don't know how long a person who has contracted the virus actually remains immune.  Even if 70% of the population contracts the virus, that does little good if that same 70% gradually lose their immunity before the epidemic dies down.  Our immune system hangs onto antibodies for some pathogens for years, but for others it's only months or even weeks.  So all this talk about herd immunity only goes so far, until we know how long a recovered person actually remains immune.

"Given what we know about the recovery from virus' such as coronavirus' in general, or even any infectious disease with very few exceptions, that when you have antibodies present it very likely indicates a degree of protection." - Dr. Fauci

"very likely" is not the same as "guarantee" and "a degree" does not say to what specific degree.  About the only thing we know from antibody studies right now is high-level data about how far the virus has spread.  Everything else is still up in the air.

[GaryV]

I went out earlier and counted people in public spaces. Unmasked people outnumbered masked people 79 to 1.

Indoors or outdoors?

[kphoger]

I went out earlier and counted people in public spaces. Unmasked people outnumbered masked people 79 to 1.

Indoors or outdoors?

??   See bolded.   ??

[bandit957]

I went out earlier and counted people in public spaces. Unmasked people outnumbered masked people 79 to 1.

Indoors or outdoors?

Outdoors.

[GaryV]

I went out earlier and counted people in public spaces. Unmasked people outnumbered masked people 79 to 1.

Indoors or outdoors?

Outdoors.

And your point is?

[bandit957]

I went out earlier and counted people in public spaces. Unmasked people outnumbered masked people 79 to 1.

Indoors or outdoors?

Outdoors.

And your point is?

Pooing is cool.

[kphoger]

It sounds like his point is that most people aren't wearing masks outdoors.

Considering that I've been routinely seeing people wearing masks outdoors, that's something worth noting.

[kphoger]

Pooing is cool.

Is that because it bips?