2019 - nCoV (novel coronavirus originating in Wuhan, China)

[Gator]

REPORT FROM MY STATE - THE "EPICENTER"

Florida DOH just reported its daily updated statistics. 

                                 Total Tests Since Start:   3,006,000
                                 Total Positive Cases:         346,602   (daily increase of 12,401, 2nd highest ever)
                                 Total Hospitalizations:         20,971   (daily increase of 339)
                                 Total Deaths:                       4,982   (daily increase of 77)


Case Fatality Rate (Accumulative Confirmed Deaths as Percentage of Accumulative Confirmed Cases)

                                1 May      3.8%
                                1 June     4.3%
                                1 July      2.3%
                                Today      1.4%


BC, Italy's CFR of 14% is more than twice Florida's hospitalization rate.   My point is that comparing Italy with the US is apples and oranges. 

Regardless, I am envious of "your" low number of daily new cases.   

[BC]

BC, Italy's CFR of 14% is more than twice Florida's hospitalization rate.   My point is that comparing Italy with the US is apples and oranges. 

Regardless, I am envious of "your" low number of daily new cases.

Gator,

CFR is one of those 'fuzzy' numbers.  We don't know the number of infections in the US or Italy or any other country for that matter, and even deaths are not absolute, but surely more 'firm' than cases.  Many other variables need to be addressed before it is of true comparative value.

A more 'absolute' 'apples and apples' measure is deaths per million as the population is generally known as well as the number of deaths.  With large numbers of each, the margin for error is less and thus comparitave value is increased.  It also takes into account different mitigation methods healthcare aspects etc.  The only major variable that I can think of that needs to be 'guessed in' are demographic differences, but even that would be small with the large numbers we have at hand today for analysis.

Italy currenly has 580 deaths per million and the US 432.  Now that might seem to be favorable for the US, but we have to remember this number grows.

Over the last couple weeks, daily deaths are around 15 per day, so if it continues at this rate, it takes 4 days to raise the death per million by one.  Daily deaths are getting lower though, today only 3

The US OTOH is experiencing around 700 deaths per day which equates to roughly two per million added each day, but unfortunately rising.  In 4 days that equals 10 per million, so deaths per million 10 times faster than Italy, and rising.  You can do the math. barring an explosion of infections and deaths here, it won't be long before the US overtakes Italy in this measure as well, even if deaths do not rise further which seems unlikely at this point.  If factors such an older population, overwhelmed healthcare system for a couple months and treatment that has improved over time is taken into account, the situation looks even worse on that side of the Atlantic as far as how effective overall management of the virus crisis goes.  This I believe is the bottom line number to watch.  Sometime in the future we may also be looking at longer term health impact of those that survived.  Although that is another topic in itself, I doubt the US will be better off 'flattening the curve' vs others that cut down the curve quickly.

Do let me know if you find any faults in logic.  I'm capable of learning from my mistakes.

[BillyB]

Florida has 2.5x more cases than New Jersey but 3x less deaths. NY has 40% more cases than Florida but 600% more deaths than Florida. NY, NJ, and Italy was caught off-guard. Florida and everybody else learned from their mistakes. The most vulnerable are better protected now. Case fatality rate will go way down as long as we protect the most vulnerable.

[krimster2]

"The most painful state of being is remembering the future, particularly the one you'll never have."

[Gator]

Do let me know if you find any faults in logic.  I'm capable of learning from my mistakes.

I agree deaths is a better measure than positive cases.  IMO an even better measure is "hospitalizations" as I would think the data have been verified by a doctor, there is nil double counting, and delay in reporting is minimal.   

This still has not solved the comparability issue.  BillyB gives a good, terse explanation of why Florida today is an orange, and Italy, NY and NJ were apples.   Italians are more compliant than Americans.

Regardless, I believe we both agree it is paramount to follow closely the surge of new positive cases with concern about hospitalization rates and deaths. 

Even more paramount is to wear masks, maintain distance from others, wash hands, avoid crowds.....all of which are decisions made by individuals.   

[BC]

Gator,

compliance of populations is, of course, a factor, but also included in deaths per million assessment.

Plenty of Americans comply with what is requested.  NY is a good example and with positive results.  Obviously the majority of the population in NY complied, along with the state complying with re-opening criteria.  If other states would have followed suit, we wouldn't be faced with near the problem we have today.  I don't agree to 'apples and oranges' arguments.  It is a matter of will and leadership and not something inherently different that cannot be influenced.

I agree hospitalizations are important, but then again there are no comparable standards as to when a patient is admitted or not.  In cases like Italy and NY, I believe a large portion of deaths were due to patients waiting too long to be admitted due to stresses on healthcare assets.  Both have very similar results.  Germany seemed to find that 'sweet spot' AND had the critical care capacity along with preventing infections by having folks not line up and fill ER's, instead being visited first at home by full fledged doctors who determined when and where patients should be admitted.

As for comparative analysis, deaths are about the best we have.  IIRC you were the first to bring up deaths first as the number to be watched along with hospitalization.  I admit being a bit sceptic that deaths were a good measure back then, trying to rationalize the high death rate in Italy with other factors such as age demographics, but I do see today that I was wrong and you were quite correct.

[Gator]

I agree hospitalizations are important, but then again there are no comparable standards as to when a patient is admitted or not. 

It is worse than that.  The reason HHS recently took over hospital data reporting is because CDC had limited capacity for timely, accurate reporting (e. g., some hospitals were literally faxing reports to CDC; the Administration wanted data on hospitalizations sorted by age and region, and CDC said it would take a month or more).   

To CDC's credit, for many years they have asked for funding of a new system, but went ignored.  Likewise, our intelligence community has for years warned that pandemics should be treated as a national risk on par with terrorism.  Our Federal agencies in many ways were not prepared for a pandemic.     Oddly, before COVID the US was ranked as best prepared, followed by UK. 

In cases like Italy and NY, I believe a large portion of deaths were due to patients waiting too long to be admitted due to stresses on healthcare assets.  Both have very similar results.

In March-April we thought NYC would be the next Italy.  The Feds quickly expanded hospital capacity, only to go unused, partly because Cuomo ordered nursing home cases of COVID to be returned to their nursing homes. And....     

Germany seemed to find that 'sweet spot' AND had the critical care capacity along with preventing infections by having folks not line up and fill ER's, instead being visited first at home by full fledged doctors who determined when and where patients should be admitted.

House calls!  I remember in my early youth a doctor coming to our home to diagnose my mother and give her medicine.   That was a long time ago.  The Germany approach seems a less efficient use of limited numbers of doctors, yet the results were superior. 

As for comparative analysis, deaths are about the best we have.  IIRC you were the first to bring up deaths first as the number to be watched along with hospitalization.  I admit being a bit sceptic that deaths were a good measure back then, trying to rationalize the high death rate in Italy with other factors such as age demographics, but I do see today that I was wrong and you were quite correct surprised.

As were us all on most aspects of this pandemic, including  the renown Dr. Fauci.  It caught the world flat-footed.     We still have much to learn. 

[Gator]

Interview with Dr. Scott Gottlieb

Six months into the pandemic, we still don’t have enough supplies, equipment or lab services.

Almost half of our testing is done at hospitals and point-of-care facilities, with quick turnaround of results.  Major commercial labs account for 50%, and reporting of results is taking as much as seven days, if not longer.  This raises questions about whether tested patients in the interim are heeding isolation recommendations. 

The major commercial labs need to scale up, yet are unwilling to make the huge investment because COVID testing will become unnecessary within a year if not sooner.    Another limitation is a shortage of lab technicians. 

Schools can open safely this fall. Staggered schedules and other precautions would help reduce children's low but real risk from Covid.

A study from South Korea cautions that children older than 10 yo are just as infectious as young adults.  The study was limited, yet suggests we could at least open elementary schools, something vitally needed to free the parents to work.

Tomorrow. Vaccines. Just saying.

Tweet yesterday by editor of Lancet about reporting the Phase 1 &2 trials for AstraZeneca-Oxford vaccine.   

[Gator]

Another tidbit - many are questioning whether the US has the manufacturing capacity to provide quickly the hundreds of millions of doses of vaccines passing their Phase 3 trials.   The US pharma companies have moved their manufacturing mostly off-shore.  Because of this limitation,  Trump's warp speed program is funding manufacturing of promising vaccines while undergoing Phase 3 trials.   

[BC]

It is worse than that.  The reason HHS recently took over hospital data reporting is because CDC had limited capacity for timely, accurate reporting (e. g., some hospitals were literally faxing reports to CDC; the Administration wanted data on hospitalizations sorted by age and region, and CDC said it would take a month or more).

Indeed, quick and accurate reporting is one of those very basic necessities.  If that is the result of sending data to HHS then fine. 

To CDC's credit, for many years they have asked for funding of a new system, but went ignored.  Likewise, our intelligence community has for years warned that pandemics should be treated as a national risk on par with terrorism.  Our Federal agencies in many ways were not prepared for a pandemic.     Oddly, before COVID the US was ranked as best prepared, followed by UK. 

The world wasn't ready for this very few countries are prepared for such, i.e. Germany who plans and has regular exercises for all types of major events.

In March-April we thought NYC would be the next Italy.  The Feds quickly expanded hospital capacity, only to go unused, partly because Cuomo ordered nursing home cases of COVID to be returned to their nursing homes. And.... 

   

In many ways, NY was our Italy.. very similar on many levels.  Field hospitals were opened here also and went unused or were dropped when they started to get a grasp on the situation and stabilize.  I was very surprised at the number of ventilators Cuomo ordered based on experience here where the numbers kept growing steadily but IIRC maxed out at around 2500 or so before starting to drop.  Had the number of infections not have dropped, I expect double would have been needed.

House calls!  I remember in my early youth a doctor coming to our home to diagnose my mother and give her medicine.   That was a long time ago.  The Germany approach seems a less efficient use of limited numbers of doctors, yet the results were superior.

Housecalls are very common here in Europe.  Our town of around 15000 inhabitants has 10 or 12 GP's that will make housecalls if necessary such as folks vomiting, high fevers and other stuff one doesn't want to have others in waiting rooms infected. The health system pays the GP's their salary and folks can pick the one they like to go to. They rotate with on-call night/holiday coverage.  IOW we can go or call in a doc 24/7/365.  If necessary even IV's are done at home, there are a couple of trained folks that do this if the doc orders.  If a shot or something is needed, pick it up at the pharmacy and give wifey target practice if she's comfortable. Everyone has syringes in their med cabinet at home and most grocery stores carry them. 

As were us all on most aspects of this pandemic, including the renown Dr Fauci.  It caught the world flat-footed.     We still have much to learn.

Fauci is a scientist that understands when new information is available a hypothesis will be revised.  Science is not static.  I heard him get beaten up about masks, but also remember much of the intent early on was to conserve masks for those on the front lines.

[BC]

Because of this limitation,  Trump's warp speed program is funding manufacturing of promising vaccines while undergoing Phase 3 trials.

As is being done here and in Germany, other places as well.  Interesting that production and packaging of the AZ/ Oxford vaccine is underway 300 miles from here so look for a 'Made in Italy' stamp on your vial   EU spent a billion bucks as well on the Oxford vaccine production alone.

[fathertime]

Florida has 2.5x more cases than New Jersey but 3x less deaths. NY has 40% more cases than Florida but 600% more deaths than Florida. NY, NJ, and Italy was caught off-guard. Florida and everybody else learned from their mistakes. The most vulnerable are better protected now. Case fatality rate will go way down as long as we protect the most vulnerable.

Currently, I'm not seeing enough death to warrant full shut downs.  Perhaps the shutdowns have kept the death rate low.   Had the situation been the same as it was in NY or Italy then I could see good reason to shut down.  At least for the moment the states are suffering hundreds of deaths per day which isn't good but not enough to close down. 

My own thought is we lost the ability to control the spread of the virus long ago, and I don't see the US populace ever showing the discipline to take the measures that would be necessary to contain it like other countries appear to have.  So if that is the case, lets just get back to living.  Unfortunately the most vulnerable will have to really change their lives to avoid this illness. 

Fathertime! 

[BC]

Currently, I'm not seeing enough death to warrant full shut downs.  Perhaps the shutdowns have kept the death rate low.   Had the situation been the same as it was in NY or Italy then I could see good reason to shut down.  At least for the moment the states are suffering hundreds of deaths per day which isn't good but not enough to close down. 

Problem is FT, you only know it is 'happening' when it hits you in the face. 'Currently' is pretty much a useless term in this context, already a month or more behind the curve.

[Gator]

As is being done here and in Germany, other places as well.  Interesting that production and packaging of the AZ/ Oxford vaccine is underway 300 miles from here so look for a 'Made in Italy' stamp on your vial   EU spent a billion bucks as well on the Oxford vaccine production alone.

And the Phase 1-2 trial, released in the past hour shows much promise in producing antibodies. 

In simple terms from BBC:

  Scientists did this by transferring the genetic instructions for the coronavirus's "spike protein" - the crucial tool it uses to invade our cells - to the vaccine they were developing.

This means the vaccine resembles the coronavirus and the immune system can learn how to attack it.

Oxford developed the vaccine from a "genetically engineered virus that causes the common cold in chimpanzees."  China is developing a vaccine very similar to the Oxford vaccine with one huge difference - instead of using a virus that attacks chimps, Chinese selected a virus that attacks humans.  It is felt that the China approach of starting with human viruses approach increases the probability of success. 

[BillyB]

Fauci is a scientist that understands when new information is available a hypothesis will be revised.  Science is not static.  I heard him get beaten up about masks, but also remember much of the intent early on was to conserve masks for those on the front lines.

Fauci, other medical experts, and governments around the world had to lie to save the masks for medical personnel otherwise we'd have what we had with toilet paper. It's amazing how many will believe a lie by educated people and governments when common sense should tell them masks are worn by healthy medical workers for protection so masks will work for everybody. There are still some people today believing masks are useless based on the education they got a few months ago. They believe the current about face on masks is the lie.

[BC]

Gator,

yes, promising.  Now we only need to know if it works.

I can imagine some places like China might put aside some of the ethical aspects and do a 'trial by fire' intentionally infecting folks to test their vaccine ISO vaccinating many thousands and waiting to see if any get infected over time in areas where the virus is abundant.  Much of Europe wouldn't work well because too few are infected nowadays, but the US would make for good proving grounds.

[Gator]

There are still some people today believing masks are useless based on the education they got a few months ago. They believe the current about face on masks is the lie.

[msmob]

Sorry,

Surely no-one is using bacterial transmission in comparison with viral ones  ?


"Bacteria are giants when compared to viruses. The smallest bacteria are about 0.4 micron (one millionth of a meter) in diameter while viruses range in size from 0.02 to 0.25 micron. This makes most viruses submicroscopic, unable to be seen in an ordinary light microscope."

[BC]

How many viruses are piggybacking on the surface of bacteria and in droplets carrying them Moby?  A gazillion, maybe two?

Yepper, I'm a believer in using masks.

[krimster2]

more on the Russian vaccine
http://www.foxnews.com/world/russias-elite-experimental-vaccine-months-report

oh yeah, they do bio war research there using cancer causing viruses as agents!
you don't believe me?

read for yourself

http://www.istc.int/en/project/EF4231F327C2E0CBC32570CF003340E3

half the stuff going on in this lab is biowar, and this is all public
imagine the part that isn't!

biopreparat

are the same people who:

In 1947 the Soviet Union established a smallpox weapons factory in the city of Zagorsk, 75 km to the northeast of Moscow. An outbreak of weaponized smallpox occurred during testing at a facility on an island in the Aral Sea in 1971. General Burgasov, former Chief Sanitary Physician of the Soviet Army and a senior researcher within the Soviet program of biological weapons, described the incident:

    On Vozrozhdeniya Island in the Aral Sea, the strongest recipes of smallpox were tested. Suddenly I was informed that there were mysterious cases of mortalities in Aralsk. A research ship of the Aral fleet came to within 15 km of the island (it was forbidden to come any closer than 40 km). The lab technician of this ship took samples of plankton twice a day from the top deck. The smallpox formulation – 400 gr. of which was exploded on the island – "got her" and she became infected. After returning home to Aralsk, she infected several people including children. All of them died. I suspected the reason for this and called the Chief of General Staff of Ministry of Defense and requested to forbid the stop of the Alma-Ata–Moscow train in Aralsk. As a result, the epidemic around the country was prevented. I called Andropov, who at that time was Chief of KGB, and informed him of the exclusive recipe of smallpox obtained on Vozrazhdenie Island

so what happened?
they were testing a 1 pound powdered smallpox bomb with an explosive burst charge and sampling how the virus spread
there weren't supposed to be any human beings within 50 miles of the test site, virus needs a host to spread...
but some of the virus reached a boat that suddenly appeared over the horizon and infected a crew member standing on the deck
from a single 1 pound virus bomb created with 50 year old technology
the cloud spread 7.5 miles....

THESE PEOPLE!!

[Gator]

Surely no-one is using bacterial transmission in comparison with viral ones  ?

Acknowledged in the text for all but you to see.  The mucous-saliva respiratory droplet transporting bacteria can just as easily transport viruses.    If you don't believe me, google multiphase fluid dynamics. 


The text also mentions aerosols (smaller than droplets) produced when coughing, etc.  Most are sufficiently large to carry viruses and they can travel farther than droplets.         

[calmissile]

Acknowledged in the text for all but you to see.  The mucous-saliva respiratory droplet transporting bacteria can just as easily transport viruses.    If you don't believe me, google multiphase fluid dynamics. 


The text also mentions aerosols (smaller than droplets) produced when coughing, etc.  Most are sufficiently large to carry viruses and they can travel farther than droplets.       

Please don't use any common sense here.  I don't think it is allowed. 
Before accepting your comments we should demand an independent controlled study and make sure all the scientific geniuses agree.

What is the big deal about requiring people to wear a face covering (in public) until the epidemic is under control?  I just don't get it.

[Confederate]

Fauci, other medical experts, and governments around the world had to lie to save the masks for medical personnel otherwise we'd have what we had with toilet paper. It's amazing how many will believe a lie by educated people and governments when common sense should tell them masks are worn by healthy medical workers for protection so masks will work for everybody. There are still some people today believing masks are useless based on the education they got a few months ago. They believe the current about face on masks is the lie.

BC said “Fauci is a scientist”.

 

He’s a big Pharma con-Artist pushing death cult propaganda and the sheep love it.

[BC]

What is the big deal about requiring people to wear a face covering (in public) until the epidemic is under control?  I just don't get it.

Masking has sadly been turned into a political statement instead of a way to show others you care about them.

[BC]

BC said “Fauci is a scientist”.

 

He’s a big Pharma con-Artist pushing death cult propaganda and the sheep love it.

Have anything constructive to add?  And tell me, what do sheep have to do with it?