Coronavirus: How dangerous a threat?

[djpbaltimore]

Spain changed the way it reports new cases and deaths a week ago and now basically the daily data is useless. Maybe the system will catch up eventually, but as of right now you can't trust those figures.

That is a good point to consider. I did check their stats before I posted and they look positive even if the stat is not indicative of complete success. I could've used Greece too as an example. I keep hearing how we can't replicate So. Korea or New Zealand for...reasons. Not sure what the excuses will be about Spain or Greece or Slovakia.

https://www.nytimes.com/interactive/2020/world/europe/spain-coronavirus-cases.html

According to these numbers one could argue that the US has done quite well compared to many countries.

Are you the one making that argument?

 

[GVFTA]

Are you the one making that argument?

I'm on the fence about the overall response here in the US. There are so many factors that make the US stand apart from other countries, such as 50 separate governments, non closable State borders. I could go on and on. Anyways, comparison is difficult.

I see more negative in the individual response, people not taking it seriously, than the collective, authorities trying to manage it side, when grading the situation.

 

[Jagartrott]

According to these numbers one could argue that the US has done quite well compared to many countries.

Country	Confirmed	Deaths	Case-Fatality	Deaths/100k pop.
US	1,790,172	104,381	5.8%	31.90
United Kingdom	276,156	38,571	14.0%	58.01
Italy	232,997	33,415	14.3%	55.29
Brazil	514,849	29,314	5.7%	13.99
France	189,009	28,805	15.2%	43.00
Spain	239,479	27,127	11.3%	58.06
Mexico	90,664	9,930	11.0%	7.87
Belgium	58,381	9,467	16.2%	82.88
Germany	183,410	8,540	4.7%	10.30

I think it should be clear by now that the reported mortality is pretty useless. No-one believes the numbers coming out of Mexico, Brazil, Russia. Even in western countries, there are huge differences in what is counted as covid-death. The Netherlands reporting half the number of dead than Belgium, but overall mortality (from all sources) is the same in both countries, meaning The Netherlands are under-reporting. Moreover, it is difficult to compare countries that differ so much in size and population density. I think the problem in the US is that there is no clear national strategy, and that the infection is in different stages in different states, which makes renewed spread from 'later' states to 'earlier' states possible.

 

[GVFTA]

I think the problem in the US is that there is no clear national strategy, and that the infection is in different stages in different states, which makes renewed spread from 'later' states to 'earlier' states possible.

I don't disagree, but a Federally mandated, nationalized response would have sent people, especially some Governors into histeria over State Sovereignty being violated.

 

[djpbaltimore]

I think the problem in the US is that there is no clear national strategy, and that the infection is in different stages in different states, which makes renewed spread from 'later' states to 'earlier' states possible.

I think that is the crux of it. Tactics are everywhere but strategy is in short supply. There are a surplus of 4 step plans from states and businesses moving forward. My employer is rolling out a tracking app to monitor symptoms and implementing new PPE protocols. But it all seems like everybody is whistling past the graveyard. No one can speak about the larger plan because the larger plan involves hundreds, if not thousands, of people dying every day and we are just expected to live with it. The public normalization of this status quo boggles my mind. As bad as that is, what could happen in the fall is getting scant attention. I think an underlying faith in things 'working out in the end' must be at the root of this complacency, but I think this faith is highly misplaced.

 

[Jagartrott]

Story about the spread of the virus being earlier than most thought. I wonder how much 'silent spread' there has been. Once we get a clearer picture about true infections and the manner of spread (with super-spreaders), sure models could back-track and make it clearer how early the pandemic really started?

Could Covid-19 have reached the UK earlier than thought?

WHO is urging countries to investigate any suspicious deaths so virus can be better understood

www.theguardian.com

 

[Keram]

Spain changed the way it reports new cases and deaths a week ago and now basically the daily data is useless. Maybe the system will catch up eventually, but as of right now you can't trust those figures.

What they changed? I thought that newest death count is suspicious but I liked the idea that Spain Italy and Germany today had about 200 new cases each. Would be huge if it is true.

 

[King Boonen]

I think that the viral load in the saliva on your lips is really small compared to the load emitted when you cough or sneeze.

If KB sneezes into his hand (he thinks its just his allergies acting up, but is asymptomatic and just emitted C19 droplets in his hand and sprayed around), picks up the can, decides not to get that flavor, puts the can back, and moves on, then the next person who touches that can probably just grabbed a pretty heavy load of C19. Obviously their behavior dictates what happens after that, but KB has increased their risk.

That scenario is less likely to infect someone than walking through a cloud of droplets loaded with C19 right?

While I may absentmindedly rub my face with my hand, I wouldn’t sneeze into my hand and touch produce in a shop, Coronavirus or not, because im not an absolute scumbag.

 

[Koronin]

Even companies can't figure out how or what direction to go in trying to help employees stay safe. I'm a vendor and thus work for several companies. I have 2 companies telling us that we need to get our masks, whatever type we want to wear and wear those when working. I have one that sent us a cloth mask but no way to actually secure it to your face and cloth gloves. A fourth that sent us surgical masks and latex (blue) gloves). They want us to wear both, however, I'd love to know how I'm supposed to wear the gloves when putting what amounts to stickers on the floors and many of the coupons we put on products have sticky stuff on the back so they adhere to the boxes. You can't wear those type of gloves when doing that.

 

[Merckx index]

Either I've been giving people more credit than they deserve, or you are giving them less.

For me, this is the key statement in the whole discussion of aerosols vs. surfaces. Much of what KB says makes sense to me IF many/most people don't wear masks and sanitize their hands regularly. My assumption--and I've been lucky enough not to have to test it yet--is that people in food markets will be extra cautious, because this is the one place where everyone is touching things, the same things everyone else is touching, things that will go into your mouth. I can't imagine people would pick up anything w/o either wearing disposable gloves, or sanitizing their hands immediately after, but maybe this is not the case.

According to these numbers one could argue that the US has done quite well compared to many countries.

The U.S. looks good when you compare it to the small handful of countries that have the highest mortality rates in the world. It has the eighth highest mortality rate of countries with a population of > 10 million (there are more than 80 of them, which puts the U.S. in the 90th percentile), and has the second highest case rate in this group. Sure, you can argue that some countries are under-reporting, but this doesn't change the general conclusion.

No, the U.S. has not done well.

I think the problem in the US is that there is no clear national strategy, and that the infection is in different stages in different states, which makes renewed spread from 'later' states to 'earlier' states possible.

Sure, but why is there no clear national strategy? And why are the highest case and death rates in Western countries, while SE Asia, Taiwan, S. Korea, and "socialist" Norway are doing so well? A lot of America's problem is that pandemics are best handled by people with a strong sense of the collective. Individualism has its strengths, but it doesn't help much when a non-discriminating virus is sweeping the land. The most successful countries locked down early, did lots of testing, and were aggressive in contact tracing. The U.S. has basically taken a half-assed approach to these.

This head of IC, has said some strange things on RAI (Italy):

Coronavirus, Zangrillo: "Il Covid non esiste più, qualcuno terrorizza il paese". Richeldi: "No, il virus circola"

Il primario del San Raffaele di Milano, direttore della terapia intensiva: "Sono tre mesi che sciorinano una serie di numeri che hanno evidenza zero"…

www.repubblica.it

Basically, he says that the virus has changed, that the viral loads in new patients are much lower than before. But, it's unclear why he claims that and what proof he has.

It frankly reads as someone citing flimsy evidence to push a political view (end lockdowns). The way to determine if the virus has become less lethal or infective is sequence analysis, not the amount of load in recent cases.

 

[hrotha]

What they changed? I thought that newest death count is suspicious but I liked the idea that Spain Italy and Germany today had about 200 new cases each. Would be huge if it is true.

No one is quite sure of what they've changed. Ostensibly they want to report weekly rather than daily figures, and when they speak of daily deaths they are referring to deaths that happened AND were notified in the last 24 hours (whereas previously it didn't matter when those deaths actually happened). The result seems to be new deaths are underreported in any given day. For example, while Spain as a whole reported 0 new deaths today, apparently the Madrid region alone reported 7 new deaths.

But the whole system is so byzantine and has undergone so many changes and had so many footnotes attached to it that nobody is quite sure this is actually what's happening or that the figures add up anymore.

Make no mistake, last time we were getting reliable numbers that could be compared to previous data it certainly looked like things were going very well, and it is unlikely that they have changed much since then. Still, there have been important changes to the lockdown restrictions over the last few weeks, and it's bewildering that we have lost this invaluable statistical tool to keep an eye on the evolution of the pandemic.

 

[movingtarget]

According to these numbers one could argue that the US has done quite well compared to many countries.

Country	Confirmed	Deaths	Case-Fatality	Deaths/100k pop.
US	1,790,172	104,381	5.8%	31.90
United Kingdom	276,156	38,571	14.0%	58.01
Italy	232,997	33,415	14.3%	55.29
Brazil	514,849	29,314	5.7%	13.99
France	189,009	28,805	15.2%	43.00
Spain	239,479	27,127	11.3%	58.06
Mexico	90,664	9,930	11.0%	7.87
Belgium	58,381	9,467	16.2%	82.88
Germany	183,410	8,540	4.7%	10.30

The 104,381 figure stands out above everything else. Not sure how that can be seen as a positive even in such a large country. I guess the funeral industry is doing well..........

 

[dusty red roads]

Russia rolling out their modified version of Japanese drug:
"After fast-tracking Japanese COVID-19 drug, Russia to roll out 'game changer' next week
Clinical trials of the drug reportedly showed success in most cases within four days:"

After fast-tracking Japanese COVID-19 drug, Russia to roll out 'game changer' next week

Russia will start administering its first approved antiviral drug to treat coronavirus patients next week, its state financial backer told Reuters, a move it described as 'a game changer' that should speed a return to normal economic life.

www.japantimes.co.jp

 

[jmdirt]

While I may absentmindedly rub my face with my hand, I wouldn’t sneeze into my hand and touch produce in a shop, Coronavirus or not, because im not an absolute scumbag.

I shouldn't have used KB as my character, I was talking about Joe average. I think that way more people don't wash their hands after sneezing...or #1/#2.

 

[Unchained]

I have sneezed in one way for decades and the behavior modifications to use my elbow joint as the backstop has been less than success. As a boy a handshake was the preferred greeting. In the last decades in the US,often handshake and to embrace is the norm among many..older people don't often shake hands and hug..but I feel that is a minority reaction.
Try to imagine American culture not touching door knobs, each other,deep cleaning and sanitation in public spaces,like bathrooms,post office,cash register areas of markets..
I just don't see anything being effective..used the ATM at Chase and Wells Fargo banks..so the recent updates that Covid 19 remaining on surfaces for less time than was previously thought..kind of a non issue unless there is cleaning after each use..the line at the grocery store is pretty representative..@5-6 people in line we all use the same pivot point..the cashier and or the credit card terminal..
maybe other countries have different behaviors but in the US our daily designs will certainly infect each other from acting normal.

 

[djpbaltimore]

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysisSummary
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.

Methods
We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047.

Findings
Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.

Interpretation
The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.

From the Lancet yesterday.

https://www.sciencedirect.com/science/article/pii/S0140673620311429?via=ihub

ETA. I just completed the mandatory safety training for our institute. The interesting thing is that they specifically ask that people do not wear surgical masks, only cloth ones. Nothing mentioned about eye protection at all. BTW, we are a School of Medicine and this is the best we can do? Seriously? I repeat an earlier suggestion, people need to inform and protect themselves.

 

[GVFTA]

ETA. I just completed the mandatory safety training for our institute. The interesting thing is that they specifically ask that people do not wear surgical masks, only cloth ones. Nothing mentioned about eye protection at all. BTW, we are a School of Medicine and this is the best we can do? Seriously? I repeat an earlier suggestion, people need to inform and protect themselves.

I sure hope that you voiced your concerns at the training.

 

[djpbaltimore]

The automated powerpoint presentation was rather unresponsive to my concerns.

Lots more sequences of bat coronaviruses released, but no real good lead about the origin. I did find this interesting.

There is plenty of evidence that some of these viruses are spilling over to humans all the time in southern China, Daszak says. In an earlier paper, Daszak and co-workers found SARS-related antibodies to coronaviruses in about 3% of people they sampled in China living near bat caves, suggesting they had been infected by some of these viruses.

It supports my feeling that the species gap is too far to bridge. Once they make the abortive jump, they die out without the ability to transmit within human populations. Much like MERS. Still think the intermediate host is needed.

https://www.sciencemag.org/news/202...nveils-its-massive-analysis-bat-coronaviruses

 

[Jagartrott]

 

[jmdirt]

From the Lancet yesterday.

https://www.sciencedirect.com/science/article/pii/S0140673620311429?via=ihub

ETA. I just completed the mandatory safety training for our institute. The interesting thing is that they specifically ask that people do not wear surgical masks, only cloth ones. Nothing mentioned about eye protection at all. BTW, we are a School of Medicine and this is the best we can do? Seriously? I repeat an earlier suggestion, people need to inform and protect themselves.

Which brings me back to my question about when the stockpile of N95 will be full for professional use so that the rest of us can buy them (we can buy them now, but I won't feel OK about doing that until we know that first responders and medical people have plenty).

 

[movingtarget]

I think it should be clear by now that the reported mortality is pretty useless. No-one believes the numbers coming out of Mexico, Brazil, Russia. Even in western countries, there are huge differences in what is counted as covid-death. The Netherlands reporting half the number of dead than Belgium, but overall mortality (from all sources) is the same in both countries, meaning The Netherlands are under-reporting. Moreover, it is difficult to compare countries that differ so much in size and population density. I think the problem in the US is that there is no clear national strategy, and that the infection is in different stages in different states, which makes renewed spread from 'later' states to 'earlier' states possible.

Some countries are not counting pneumonia related deaths even though the pneumonia related death rate has skyrocketed in the elderly in many countries. Nor are they doing autopsies to see if it was Covid related..........

 

[Merckx index]

Regarding the face mask study. It's generally thought that air-borne virus, at least, enters the body predominantly through the nose. i wonder if people plugged their noses, and breathed only through their mouths--with or without a face mask--if this would reduce the risk. Once enough virus gets into the nose, infection seems virtually certain. I'm not sure that's the case with the mouth.

Regarding the study of bats, the estimate of 10-15,000 coronaviruses is mind-boggling. It's a shame that they sequenced only the polymerase, as sequence data on the RBD would be especially critical now. You would certainly want to know if there was a virus with an RBD sequence more similar to that of SARS-CoV-2 than that of RaTG13, the coronavirus most similar overall to SARS-CoV-2. The article mentioned that they also collected and analyzed bat guano. It would be of great interest to know whether any infectious virus was found in the guano, as that would probably be the most likely way that a bat would infect a human.

 

[Koronin]

Regarding the face mask study. It's generally thought that air-borne virus, at least, enters the body predominantly through the nose. i wonder if people plugged their noses, and breathed only through their mouths--with or without a face mask--if this would reduce the risk. Once enough virus gets into the nose, infection seems virtually certain. I'm not sure that's the case with the mouth.

Interesting question. Why would it make that big of a difference if it enters through the mouth vs the nose?

 

[Merckx index]

Interesting question. Why would it make that big of a difference if it enters through the mouth vs the nose?

Well, I guess scotch that idea. There seem to be plenty of ACE2 receptors in the mouth, including on the tongue:

https://www.nature.com/articles/s41368-020-0074-x

The general idea is that the longer the virus lingers inside the body, but outside of individual cells, the greater the chance it will be degraded. So it needs to be someplace where there are a lot of these ACE2 receptors. Still, the worst symptoms from the virus result from lower respiratory tract infections, and it's possible that if the initial infection is in the mouth, rather than in the nose, it will not be able to move lower as quickly and easily. I'm just speculating here, but we don't know why the virus moves on to the lungs in some people, while remaining in the upper respiratory tract in others. There are probably multiple factors, but original site of infection could be one of them.

 

[Koronin]

Well, I guess scotch that idea. There seem to be plenty of ACE2 receptors in the mouth, including on the tongue:

https://www.nature.com/articles/s41368-020-0074-x

The general idea is that the longer the virus lingers inside the body, but outside of individual cells, the greater the chance it will be degraded. So it needs to be someplace where there are a lot of these ACE2 receptors. Still, the worst symptoms from the virus result from lower respiratory tract infections, and it's possible that if the initial infection is in the mouth, rather than in the nose, it will not be able to move lower as quickly and easily. I'm just speculating here, but we don't know why the virus moves on to the lungs in some people, while remaining in the upper respiratory tract in others. There are probably multiple factors, but original site of infection could be one of them.

Ok. It is an interesting question anyway. I'm hoping it might be the case anyway since when I'm wearing a mask I'm typically breathing through my mouth instead of my nose anyway. I'm hoping there might some truth to this.