Coronavirus: How dangerous a threat?

[Jagartrott]

A bit anecdotal perhaps, but interesting nevertheless. In a care home near Antwerp, all the inhabitants were tested: 68 were found to be negative, 98 positive. Of those 98, only 26 showed symptoms. The median age of people in such care homes in Belgium is 87, if I remember correctly. The government will now test all c. 210.000 inhabitants and staff of care homes in Belgium over the course of the next 3 weeks (this is c 2% of the total Belgian population). I think that will be very informative.

Here's a Guardian piece on the relevance of care homes. Also note that Belgium records all of these, but most other countries, including the UK , don't add these deaths to their total covid-19 mortality:

Half of coronavirus deaths happen in care homes, data from EU suggests

Figures from Italy, Spain, France, Ireland and Belgium suggest UK may be underestimating care sector deaths

www.theguardian.com

 

[jmdirt]

RE: Moving toward pre C19 life: As has been already stated it can't just be "GO!", but gradual has its issues as well. If one state or town (or even country) is more "open" than its neighbors they will be inundated and maybe become the next hot spot.

I shared an article maybe last week about a North Idaho sheriff who wanted his county open because they (at the time) didn't have any cases. OK, let's open Bonner County. The first problem is no economy stands on its own, especially a depressed logging county that relies heavily on tourism. Certainly people from neighboring counties/towns will be coming in to eat, drink, shop, recreate..., but so will people from Washington ,Oregon, Montana, and maybe Canada (Spokane is less than an hour, Seattle is 5 hours, Missoula is 3.5, Canada is 2.5 hours). HOPEFULLY, a lot of carefully planning goes into our move to the new normal.

 

[djpbaltimore]

A bit anecdotal perhaps, but interesting nevertheless. In a care home near Antwerp, all the inhabitants were tested: 68 were found to be negative, 98 positive. Of those 98, only 26 showed symptoms. The median age of people in such care homes in Belgium is 87, if I remember correctly. The government will now test all c. 210.000 inhabitants and staff of care homes in Belgium over the course of the next 3 weeks (this is c 2% of the total Belgian population). I think that will be very informative.

Here's a Guardian piece on the relevance of care homes. Also note that Belgium records all of these, but most other countries, including the UK , don't add these deaths to their total covid-19 mortality:

Half of coronavirus deaths happen in care homes, data from EU suggests

Figures from Italy, Spain, France, Ireland and Belgium suggest UK may be underestimating care sector deaths

www.theguardian.com

Does the 98 total include staff or was that just residents? Very curious about transmission in these places. Resident to resident or staff to resident.

 

[Koronin]

RE: Moving toward pre C19 life: As has been already stated it can't just be "GO!", but gradual has its issues as well. If one state or town (or even country) is more "open" than its neighbors they will be inundated and maybe become the next hot spot.

I shared an article maybe last week about a North Idaho sheriff who wanted his county open because they (at the time) didn't have any cases. OK, let's open Bonner County. The first problem is no economy stands on its own, especially a depressed logging county that relies heavily on tourism. Certainly people from neighboring counties/towns will be coming in to eat, drink, shop, recreate..., but so will people from Washington ,Oregon, Montana, and maybe Canada (Spokane is less than an hour, Seattle is 5 hours, Missoula is 3.5, Canada is 2.5 hours). HOPEFULLY, a lot of carefully planning goes into our move to the new normal.

California is releasing their detailed plan tomorrow for reopening.

This is likely why you have Governors talking to each other about reopening plans as well.

 

[del1962]

one side effect of the lock down is that the death rate from other causes is down, like traffic accidents and violence associated with nights out

 

[Merckx index]

After I went to bed last night, I realized that the whole issue over false positives with Ab tests is incoherent. How can you even determine a false positive rate? To do that, you have to have a group of subjects that you know never tested positive to the virus, but the whole idea of the study is that we can't say that for sure about anyone. Asymptomatics might have been positive to the virus at one time, and therefore have Abs, but we can't distinguish them from people who were always negative.

The problem is that when positives recover, they no longer test positive for the virus. This is in contrast to, e.g., HIV, where once infected, a person always, or almost always, carries the virus for life. You can determine the false positive rate for an HIV Ab test, because anyone with no virus should have no Abs, and therefore if the person tests positive, that has to be a false positive. You can't do this with the coronavirus.

With regard to California, SF mayor London Breed is being hailed for keeping the rate way down in that city. She was one of the first mayors in the country to order social distancing measures, way back when other cities weren't taking the pandemic seriously. E.g., the Warriors were no longer allowed to play in their home court--this was before an NBA player tested positive, and the entire league was shut down. She took a tremendous amount of heat for that decision, but it proved to be the correct one.

A former colleague of mine, a Chinese-American, sent me this video of a guy strongly criticizing the NYT for alleged anti-Chinese coverage. This could be considered political--I'll leave that up to the mods--but he challenges a lot of currently accepted facts. E.g., he says "everyone has known for months" that the outbreak didn't begin in the wet market. That's news to me. There have been other theories, for sure, but he states this as though it's certain. He also says the first clear case, on Dec. 1, was not associated with the market. Every source I've seen up to now says the man was, but now I see that has been revised. It does make me suspicious. How could the man have been originally reported to have been to the market, then later, not? He also gives a date for the first announcement of human-human transmission, Jan.15, which is almost certainly wrong.

In the second half of this eighteen minute video, he talks about China's lockdown policy, and people being allowed to leave the country. Here I'm more inclined to agree with him.

View: https://www.youtube.com/watch?v=I-19Q1tyhhw&feature=youtu.be

 

[hrotha]

RE: Moving toward pre C19 life: As has been already stated it can't just be "GO!", but gradual has its issues as well. If one state or town (or even country) is more "open" than its neighbors they will be inundated and maybe become the next hot spot.

I shared an article maybe last week about a North Idaho sheriff who wanted his county open because they (at the time) didn't have any cases. OK, let's open Bonner County. The first problem is no economy stands on its own, especially a depressed logging county that relies heavily on tourism. Certainly people from neighboring counties/towns will be coming in to eat, drink, shop, recreate..., but so will people from Washington ,Oregon, Montana, and maybe Canada (Spokane is less than an hour, Seattle is 5 hours, Missoula is 3.5, Canada is 2.5 hours). HOPEFULLY, a lot of carefully planning goes into our move to the new normal.

I don't know about regions as small as a county, but I can definitely picture countries returning to normality, except with closed borders. Or, well, with strict controls and testing at the borders/airports, if not with actual quarantines, at the very least.

 

[djpbaltimore]

After I went to bed last night, I realized that the whole issue over false positives with Ab tests is incoherent. How can you even determine a false positive rate? To do that, you have to have a group of subjects that you know never tested positive to the virus, but the whole idea of the study is that we can't say that for sure about anyone. Asymptomatics might have been positive to the virus at one time, and therefore have Abs, but we can't distinguish them from people who were always negative.

The problem is that when positives recover, they no longer test positive for the virus. This is in contrast to, e.g., HIV, where once infected, a person always, or almost always, carries the virus for life. You can determine the false positive rate for an HIV Ab test, because anyone with no virus should have no Abs, and therefore if the person tests positive, that has to be a false positive. You can't do this with the coronavirus.

With regard to California, SF mayor London Breed is being hailed for keeping the rate way down in that city. She was one of the first mayors in the country to order social distancing measures, way back when other cities weren't taking the pandemic seriously. E.g., the Warriors were no longer allowed to play in their home court--this was before an NBA player tested positive, and the entire league was shut down. She took a tremendous amount of heat for that decision, but it proved to be the correct one.

A former colleague of mine, a Chinese-American, sent me this video of a guy strongly criticizing the NYT for alleged anti-Chinese coverage. This could be considered political--I'll leave that up to the mods--but he challenges a lot of currently accepted facts. E.g., he says "everyone has known for months" that the outbreak didn't begin in the wet market. That's news to me. There have been other theories, for sure, but he states this as though it's certain. He also says the first clear case, on Dec. 1, was not associated with the market. Every source I've seen up to now says the man was, but now I see that has been revised. It does make me suspicious. How could the man have been originally reported to have been to the market, then later, not? He also gives a date for the first announcement of human-human transmission, Jan.15, which is almost certainly wrong.

In the second half of this eighteen minute video, he talks about China's lockdown policy, and people being allowed to leave the country. Here I'm more inclined to agree with him.

View: https://www.youtube.com/watch?v=I-19Q1tyhhw&feature=youtu.be

That is an interesting thought. I don't know what would be required by the FDA, but I would use samples from before the outbreak.

Just looked at the Cellex product insert and they used blood samples from Sept 2019.

 

[Merckx index]

That is an interesting thought. I don't know what would be required by the FDA, but I would use samples from before the outbreak.

Just looked at the Cellex product insert and they used blood samples from Sept 2019.

Good point. But there are apparently four strains of coronavirus that cause relatively harmless colds, and I don't know how prevalent Abs to these strains might be in the general population.--nor, of course, how strongly Abs to these viruses might react to the antigen used in the German test.

 

[Koronin]

Good point. But there are apparently four strains of coronavirus that cause relatively harmless colds, and I don't know how prevalent Abs to these strains might be in the general population.--nor, of course, how strongly Abs to these viruses might react to the antigen used in the German test.

It sounds like California has just started a test on antibody testing. This is through at least 2 different Universities working together. It'll be interesting to see if this one has similar results to the German test.

 

[jmdirt]

I don't know about regions as small as a county, but I can definitely picture countries returning to normality, except with closed borders. Or, well, with strict controls and testing at the borders/airports, if not with actual quarantines, at the very least.

I agree. With that being said though, I still wonder about people from a hot spot city/state going to an area that isn't (yet) even within countries.

 

[Merckx index]

Here's a hot off the press study on coronavirus Abs. They used several different domains of the spike protein (S1, S1A, RBD), and the nucleocapsid protein (N) for antigens. The S1 antigen seemed to be the most specific for SARS-CoV-2. They tested this against the four mild coronavirus strains, as well as against SARS-CoV, the 2003 virus, and MERS. There was some cross-reactivity with SARS-CoV, but they cite other studies indicating that after 17 years, Abs to that virus have mostly disappeared from the population. So they believe false positives to that are unlikely to be an issue.

They also reported that sero-conversion, i.e., development of Abs, did not occur until at least 13 days after infection in three patients examined, though this is obviously a very small sample size.

https://wwwnc.cdc.gov/eid/article/26/7/20-0841_article

 

[movingtarget]

A happy story for a change.........

'I didn't have my belly anymore': Mum gives birth while in a coronavirus coma

Angela Primachenko still hasn't been able to hold her baby girl.

au.lifestyle.yahoo.com

 

[Jagartrott]

Does the 98 total include staff or was that just residents? Very curious about transmission in these places. Resident to resident or staff to resident.

Just residents.
Transmission is probably very high in these places because the care the inhabitants require means a lot of physical contact and proximity.

 

[search]

Just residents.
Transmission is probably very high in these places because the care the inhabitants require means a lot of physical contact and proximity.

there was a kinda similar case in Germany a couple of days ago, where both residents (37 of 70 positive) and staff (38 positive) were affected.

Nach Corona-Ausbruch: Pflegeheim in Sankt Augustin teilweise evakuiert

• Corona-Ausbruch in Pflegeheim in Sankt Augustin • Infizierte Bewohner in Krankenhäuser verlegt • Großteil der Pflegekräfte erkrankt oder in Quarantäne

www1.wdr.de

 

[djpbaltimore]

Here's a hot off the press study on coronavirus Abs. They used several different domains of the spike protein (S1, S1A, RBD), and the nucleocapsid protein (N) for antigens. The S1 antigen seemed to be the most specific for SARS-CoV-2. They tested this against the four mild coronavirus strains, as well as against SARS-CoV, the 2003 virus, and MERS. There was some cross-reactivity with SARS-CoV, but they cite other studies indicating that after 17 years, Abs to that virus have mostly disappeared from the population. So they believe false positives to that are unlikely to be an issue.

They also reported that sero-conversion, i.e., development of Abs, did not occur until at least 13 days after infection in three patients examined, though this is obviously a very small sample size.

https://wwwnc.cdc.gov/eid/article/26/7/20-0841_article

That is not too surprising based on phylogeny. COVID-19 is closely related to SARs and bat coronaviruses, but not terribly close to the human strains.

The Cellex antibody test used a human coronavirus panel and a HBV patient sample to validate their assay and also saw no cross-reactivity with either. Antibodies by their nature are designed to bind macromolecules. I worry that these quick assays don't disrupt enough of the low affinity interactions and that is where false positives come from. How other unregulated assays are validated is up for conjecture, especially those from academia.

there was a kinda similar case in Germany a couple of days ago, where both residents (37 of 70 positive) and staff (38 positive) were affected.

Nach Corona-Ausbruch: Pflegeheim in Sankt Augustin teilweise evakuiert

• Corona-Ausbruch in Pflegeheim in Sankt Augustin • Infizierte Bewohner in Krankenhäuser verlegt • Großteil der Pflegekräfte erkrankt oder in Quarantäne

www1.wdr.de

Another potentially vulnerable population, albeit at the other end of the age spectrum. I think the R0 in these populations is much higher than the general population. Or that the prevalence in NYC is much higher than anticipated.

https://twitter.com/x/status/1249902973334872065

View: https://twitter.com/KateGrabowski/status/1249902973334872065

 

[Keram]

Just residents.
Transmission is probably very high in these places because the care the inhabitants require means a lot of physical contact and proximity.

In Slovakia there is 43 residents and 5 staff member from aproximatelly 22 staff members and 130 residents in one care home were is outbreak. I was surprised by your post that there is many asymptomatic in elderly people in that place. But unfotunetely I suppose lot of them will develop some symptoms.

 

[yaco]

I find it disturbing that health workers in age centres are not regularly tested two or three times a week for COVID 19, especially when older people are vulnerable.

 

[djpbaltimore]

The capacity to test all the people we should be testing is not there currently. The other problem is the backlog of testing in some places. It may take a week to even get a result, so what is the value of that test if you don't self-quarantine in the meantime. The only medical screening I have heard is temperature testing and we know that is woefully inadequate.

 

[Keram]

I find it disturbing that health workers in age centres are not regularly tested two or three times a week for COVID 19, especially when older people are vulnerable.

Well our minister of health get similar question and if we would testing these workers every second week we basically could not testing nobody but these people.

 

[Mayomaniac]

I find it disturbing that health workers in age centres are not regularly tested two or three times a week for COVID 19, especially when older people are vulnerable.

Same here in South Tyrol, most of the new infections are actually just happening because they are finally testing more people in age centres, both workers and residents. How else would you still have a linear growth after a few weeks of lockdown?

 

[Jagartrott]

A former colleague of mine, a Chinese-American, sent me this video of a guy strongly criticizing the NYT for alleged anti-Chinese coverage. This could be considered political--I'll leave that up to the mods--but he challenges a lot of currently accepted facts. E.g., he says "everyone has known for months" that the outbreak didn't begin in the wet market. That's news to me. There have been other theories, for sure, but he states this as though it's certain. He also says the first clear case, on Dec. 1, was not associated with the market. Every source I've seen up to now says the man was, but now I see that has been revised. It does make me suspicious. How could the man have been originally reported to have been to the market, then later, not? He also gives a date for the first announcement of human-human transmission, Jan.15, which is almost certainly wrong.

In the second half of this eighteen minute video, he talks about China's lockdown policy, and people being allowed to leave the country. Here I'm more inclined to agree with him.

View: https://www.youtube.com/watch?v=I-19Q1tyhhw&feature=youtu.be

I do not like such videos. A brief look in the comments section demonstrates what this does: polarising, playing on nationalism. Often, these videos are made to generate clicks and likes, and the poster has a financial incentive to appease to a certain public. The irony here is of course that Youtube isn't even allowed in China - although obviously plenty of Chinese circumvent that with VPNs.

Anyway, I've seen that claim about 'the first corona case' having no clear link to the wet market, but it misses the point. It's the first detected case, not the first case. Of the first 50 or so cases, most had links to that market - that is the most important, not the first case (while the second was recorded the next day). Plenty of Chinese officials have been floating round the idea that the American military brought it into Wuhan, but that's ridiculous. If some soldier or officer had picked it up (how?), it surely would've created an outbreak in the base and/or region where the personnel came from. The wet market is the obvious source, the conditions there are like a laboratory for new diseases - so it makes sense.

Finally, there's a good saying about people appearing to be 'certain', but I'll just refer to Dunning-Kruger.

 

[Koronin]

The capacity to test all the people we should be testing is not there currently. The other problem is the backlog of testing in some places. It may take a week to even get a result, so what is the value of that test if you don't self-quarantine in the meantime. The only medical screening I have heard is temperature testing and we know that is woefully inadequate.

The time between taking test and getting results in some areas is really bad. In NJ it's about 2 full weeks. In California is still over 1 week. I've heard in NC it's also just over a week. Some areas it's much better. I suspect in other countries there are also variances.

 

[del1962]

Looking at ways out of lockdown, when new cases get lower

I think the vast majority will need a phone app which will trace contacts, adding your own health symptons daily and tracing will be allowed.

Add to this testing of suspected cases and contacts and self isolation where appropriate.

I think people will have a measure of social distancing under these circumstances.

 

[jmdirt]

I find it disturbing that health workers in age centres are not regularly tested two or three times a week for COVID 19, especially when older people are vulnerable.

I caught the end of an interview with the directer of the Henry Ford Clinics and he said that a huge advantage that they had was the developed their own test early on that tested employees daily and had same day results so sick employees didn't work with patients.

EDIT: 3:15 of the video:
https://www.pbs.org/newshour/show/some-encouraging-signs-emerge-in-detroits-coronavirus-fight

EDIT: If you can't get the video:
I think we have to put it in context. So, Henry Ford Health System has about 34,000 employees. And about 800 of them tested positive. And we did this because, again, we were very, very proactive at the beginning of this challenge to say, if you are part of, you know, dealing with patients in any way, if you are coming into our centers, we want to know.

And so, thankfully, we developed an in-house test early on that gave same-day results. And this allowed, I think, for a very robust testing effort.

We're thrilled that we did, because that allowed us to identify health care workers and employees who were positive, so that we could immediately remove them from the work force, thereby preventing the infections of thousands and thousands of other patients. We feel, had we not done that early on, it would have been a lot worse.