Coronavirus: How dangerous a threat?

[djpbaltimore]

This was the article that got Dr. Oz in trouble a little while back. The data about the effectiveness of closures was not well supported by the modeling.

They concluded that school closure as an isolated measure was predicted to reduce total deaths by around 2–4% during a COVID-19 outbreak in the UK, whereas single measures such as case isolation would be more effective, and a combination of measures would be the most effective. The authors concluded that school closure is predicted to be insufficient to mitigate (never mind suppress) the COVID-19 pandemic in isolation, which is in contrast to seasonal influenza epidemics where children are the key drivers of transmission.

Or by SARs data which was a vastly different outbreak despite a similar virus.

One study concluded that school closures made very little difference to the prevention of SARS in Beijing, given the very low attack rate in schools before the closure and the low prevalence of disease in children. A second study estimated the effective R for each day of the Beijing SARS outbreak, noting that school closures occurred after the R had dropped below 1 and that school closures in this case added little to control of the outbreak.

Then you have this chicken or the egg type scenario.

One way that school closures are effective during outbreaks might be through forcing parents to work at home and thus reducing work-related contacts.

Sweden still has younger kids in school. They are doing worse in relative terms, but there are other differences besides the school variable.

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30095-X/fulltext

 

[jmdirt]

I will again start with the disclaimer that I am not statistician, but similar to the model(s) that Merckx shared a while back questioning the effectiveness of stay at home orders, its impossible to model when THE factor didn't happen (ie: kids staying in school, people staying at work...). If schools are shuttered, there really is no way to accurately determine what would have happened if they were not. I understand that modelling is using known factors to predict unknown factors, but when THE factor is unknown, and the solution is the known total (deaths) there is no model. IMO the only way to really 'know' is if you have a control group: 'These kids stayed in school, these kids didn't, and here is the difference in the overall numbers...' (I realize that's not modeling though).

Also disclaimer: I'm not discounting the use of models because they are an important research tool for many things.

 

[Kaptain Kool]

I will again start with the disclaimer that I am not statistician, but similar to the model(s) that Merckx shared a while back questioning the effectiveness of stay at home orders, its impossible to model when THE factor didn't happen (ie: kids staying in school, people staying at work...). If schools are shuttered, there really is no way to accurately determine what would have happened if they were not. I understand that modelling is using known factors to predict unknown factors, but when THE factor is unknown, and the solution is the known total (deaths) there is no model. IMO the only way to really 'know' is if you have a control group: 'These kids stayed in school, these kids didn't, and here is the difference in the overall numbers...' (I realize that's not modeling though).

Also disclaimer: I'm not discounting the use of models because they are an important research tool for many things.

Obviously you can't do a true experience and randomly assign nations or large communities to various levels of lockdown, but that article did specifically state what data was being compared and what measure specifically defined a "lockdown." For example, IIRC school closings did not constitute a lockdown and he said data supports school closings.

 

[Koronin]

Maybe we should look at the numbers by percentage in different states in the US as we've had wide ranging lock down orders from the strictest in the north east to some states that never closed anything at all.

I do think population density does play a role in infection rates.

 

[jmdirt]

Maybe we should look at the numbers by percentage in different states in the US as we've had wide ranging lock down orders from the strictest in the north east to some states that never closed anything at all.

I do think population density does play a role in infection rates.

Absolutely. NY being a glaring example.

 

[Koronin]

Absolutely. NY being a glaring example.

Yep and compare NYC about 8 million people to LA County about 13 million people. The big different is population density.

 

[Merckx index]

In NYC, 0.15% of the population has died from C19. If we assume the Ab study is valid, and that about 25% of New Yorkers are or have been infected with the virus, the mortality rate is about 0.6%. Again, this is within the range of the 0.5-1.0% rate of other estimates. Actually, the rate should be higher, because deaths/cases is an underestimate, given that nearly 75% of the (known) cases are still active.

So the one Ab study where false positives might be ruled out as a major factor (because upstate the rate of positives was only 3.2%, which should be a maximum possible for false positives), still indicates a mortality rate much higher than the 0.1% claimed by some on the basis of the CA Ab tests. And the NYC results can still be criticized on the grounds of selection bias.

Now let’s take the NYC data, and consider mortality rates by age. If we divide deaths by confirmed cases, we get these rates:

18-44: 0.81%
45-64: 4.56%
65-74: 14.7%
75-: 32.2%
Overall: 7.5%

https://www1.nyc.gov/site/doh/covid/covid-19-data.page#download

But this is based on confirmed cases only, giving really high overall rates. If we assume, from the antibody study, that the overall rate is really 0.6%, and we adjust each age group accordingly, we get this:

18-44: 0.065%
45-64: 0.365%
65-74: 1.18%
75-: 2.58%

The 18-44 age group has a very low rate, lower than what is commonly described as the mortality rate for the seasonal flu. But what these comparisons ignore is that the seasonal flu mortality rate also varies by age. For 2017-18, one of the worst recent seasons, with 61,000 total deaths in the U.S., the mortality rate for age 18-49 was 0.02%, or about one-third for what I’ve calculated for C19 for 18-44. For age 50-65, it was 0.05%, or less than one-seventh for C19 45-64. For > 65, it was 0.86%, or less than half of the 1.92% value for C19 > 65.

https://www.cdc.gov/flu/about/burden/2017-2018.htm

So using the mortality rates for NYC, based on the antibody data, C19 is clearly worse than the seasonal flu. Overall, the mortality rate is about five times higher. The difference is greatest for the youngest, while less so for the elderly.

 

[Merckx index]

Continuing the analysis of the NY antibody tests to estimate mortality rates:

Long Island (assume Nassau + Suffolk counties only): 0.68%
Westchester/Rockland: 0.74%
Rest of NY state: 0.87%

The values are a little inexact, because i didn't always use the death data on the dates of the antibody tests (April 20-27). Using more current data would overestimate the number of deaths. OTOH, recent studies suggest, by using excess deaths from comparison of previous year's rates, that the C19 deaths may be seriously undercounted. According to recent studies, the deaths in NYC should be increased by about 16%, and those in L.I. by a whopping 47%. So no point in trying to be too precise at this stage.

https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-toll-total.html

https://www.newsday.com/news/health/coronavirus/death-certificate-covid-1.44229887

 

[Unchained]

I think that models about the spread of disease..any disease could be useful if the factors are done post epidemic..As Dirt points out..lots of things happened but just as many didn't.
One model we already have for children..lice, mumps,measles,TB..loads of other ailments..to go way fringe peanuts, other nuts animals, the dander associated with them..
when things are introduced to groups of children it can be devastating..for many reasons but often from immature immune systems.
people..children included should be screened \ checked before entering schools..
Same w group care facilities where residents \ patients cannot reasonably be expected to discern risk..
These are just a few sub groups that currently need zero studies..it should be assumed that a zero exposure..zero failure rate be the objective..
Similarly air travel..at a very minimum a ticket holder w an elevated temperature be required to wear a mask and be subject to seat reassignment at a minimum..I for one would like to see people who have an elevated temperature and are coughing and vomiting be denied access to the aircraft.
A study could be done later to show..lost revenue but the health data is conclusive that people experiencing Covid-19 at the outward expression of symptoms are highly infectious..
Turns out the outward signs may be far far less harmful to us all than the @60% of us that are or were asymptomatic..but outward signs of sickness may need to be what we use for now until testing and some kind of biological passport is available..
The NYC numbers do show that a death totals doubling at the front edge of curve,7-10 days of a government mandated behavior change would certainly have saved lives or will save lives in the future. Rapid response appears to be part of the best medicine available.

 

[Unchained]

Coronavirus kills nearly 70 veterans at Massachusetts elder care facility

Nearly 70 veterans have died of the coronavirus in a Massachusetts veterans care home — the deadliest known outbreak at a long-term care facility in the US. So far 68 of the aging residents w…

nypost.com

 

[aphronesis]

The toxic chemicals in our homes could increase Covid-19 threat | Leonardo Trasande and Akhgar Ghassabian

Everyday hormone-disrupting chemicals could affect our immune system’s defenses against infections

www.theguardian.com

It’s not the density of NY that’s the problem. It’s the fact that it’s a failed city propped up on finance and ancient infrastructure with no functional civic coordination. Which can be seen in the way its leadership is now casting around for blame, mystified that the majority of the world doesn't actually function according to what the Dow says or that common media wouldn't say anything different.

Critical study of Gilead's Covid-19 drug shows patients are responding to treatment, NIH says

A government-run study of Gilead’s remdesivir, perhaps the most closely watched experimental drug to treat the novel coronavirus, showed that the medicine is effective against Covid-19, the disease caused by the virus.

www.statnews.com

 

[djpbaltimore]

A clinical trial for a new vaccine is starting up now at my institution. I am going to try to get enrolled. It offers a good participation fee, but I would do it for free, so the compensation is a secondary consideration. I think it will be popular, so it might be challenging to get a spot.

After quite a bit of back and forth over the past week, it looks like Remdesivir is marginally effective against COVID-19.

Preliminary results indicate that patients who received remdesivir had a 31% faster time to recovery than those who received placebo (p<0.001). Specifically, the median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who received placebo. Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059).

That is not a great P value.

https://www.niaid.nih.gov/news-even...esivir-accelerates-recovery-advanced-covid-19

 

[Koronin]

Well Remdesivir being marginally effective is better than nothing and it's sounding like the FDA is looking into giving it emergency approval. Yesterday in his press briefing, Governor Newsom made a comment about the Remdesivir advanced trials and that these trials are giving a lot of great information about how the virus reacts and what is and what is not working to help patients. One other piece of information about Remdesivir appears to be that there is no additional benefit to giving it for more than 5 days and the sooner it can be started the better off the patient is.

 

[djpbaltimore]

Agreed, the sooner it is used during the infection course, the better it seems to do. The delayed timing is the explanation offered for why the China clinical trial was much less optimistic on its effectiveness. I saw it noted that if these results for remdesivir are consistent, it would be more effective for treating COVID-19 than Tamiflu is for treating Flu. And the latter is a staple therapy despite its marginal benefits. This is a good start, but definitely not a cure.

I thought this was interesting and addressed questions I have had about viral colonization by age.

https://twitter.com/x/status/1255555995671150597

View: https://twitter.com/c_drosten/status/1255555995671150597

 

[Koronin]

Agreed, the sooner it is used during the infection course, the better it seems to do. The delayed timing is the explanation offered for why the China clinical trial was much less optimistic on its effectiveness. I saw it noted that if these results for remdesivir are consistent, it would be more effective for treating COVID-19 than Tamiflu is for treating Flu. And the latter is a staple therapy despite its marginal benefits. This is a good start, but definitely not a cure.

I thought this was interesting and addressed questions I have had about viral colonization by age.

https://twitter.com/x/status/1255555995671150597

View: https://twitter.com/c_drosten/status/1255555995671150597

That makes sense on why the difference between the China trial and the trials over here. Interesting that it may be more effective for Covid-19 than Tamiflu is for treating the Flu. I'll take whatever we can get right now. I think even something that is helping a little will allow certain things in the economy to start opening back up. Not everything, obviously, but some things. Plus it definitely gives a good starting point for possibly better treatments as well.

 

[Merckx index]

I was able to get somewhat better estimates of mortality rates in NY state, by using data taken from the period of Ab testing. I also present the % of total cases that seem to be asymptomatic: 1 - (confirmed cases/Ab positives). However, this calculation does not take into account that some recently infected individuals would be Ab negative. So it should actually be an underestimate, high as it is already,

As far as symptomatic positives go, this isn't a big correction. E.g., about 75% of NYC's cases are active, representing about 1.5% of the population. Even if all of them were seronegative, which surely would not be the case, that would not much affect the 24.7% Ab positive value. But if there really are a very high proportion of asymptomatics, that figure could be much higher.

In any case (mortality rate/nominal % asymptomatic):

NYC: .59%/92.3%
L.I.: .60%/84.6%
R/W: .71%/80.7%

Notice that the mortality rates are in pretty good agreement with each other. I'll repeat what i mentioned in an earlier post, these rates could be much higher if deaths have been undercounted, which has been strongly suggested for NY by studies of excess deaths over the previous year. The % asymptomatics are very high, but not that much higher than some estimates from virus testing. Keep in mind, too, that there is likely to be some selection bias--the subjects were chosen from people out and about--which would inflate the number of Ab positives, and hence, the estimate of asymptomatics.

i couldn't get reliable figures for upstate, because i have to subtract the sum of the above three from NY state total, and since the figures for the above three are not exactly on the same day, too much error is introduced. However, using the latest figures, we get

Upstate: .36%/90.0%

The .36% is actually an overestimate, since it's based on current deaths divided by Ab % several days earlier. OTOH, if there is a significant rate of false positives, it will affect (decrease) the Upstate mortality rate estimate the most, since a larger fraction of the true positives will be false. E.g., if the false positive rate were 1.0%, the estimated mortality rate would be .52%, much closer to the values for the other three areas. I doubt very much that the antibody test they employed has no false positives at all, so overall, the estimated mortality rates for the four different areas of NY are probably in pretty good agreement.

Word is that the Stanford-MLB Ab testing of 10,000 subjects is done, the results are in, and an announcement is expected soon. The researchers are in the process of writing the paper.

 

[yaco]

Well Remdesivir being marginally effective is better than nothing and it's sounding like the FDA is looking into giving it emergency approval. Yesterday in his press briefing, Governor Newsom made a comment about the Remdesivir advanced trials and that these trials are giving a lot of great information about how the virus reacts and what is and what is not working to help patients. One other piece of information about Remdesivir appears to be that there is no additional benefit to giving it for more than 5 days and the sooner it can be started the better off the patient is.

I suggest this is old news - A number of Asian countries have been using a cocktail of drugs used for SARS/Ebola/HiV including Remdesivir in treating COVID19 patients - Death rates for most of Asia are low, so it must be having an effect - My understanding is aggressive use of these drugs can cause long term side effects - Some others can provide more information about the type of drugs.

 

[Unchained]

Silver lining or semi silver. My introduction to cycling was a front control arm and ball joint failing and folding in on my Volkswagen. Because of this personal catastrophe..and a borrowed Schwinn Le Tour..I found myself riding bicycles to get places. Including to,work,tennis,golf,the beach.
I found that I performed better,everywhere..Riding a bike made me a better golfer..and way better tennis.player.
I never shook it..and when I discovered racing nothing could get me off the bike.
Covid19 is opening up so much to so many from this involuntary life pause. Reading,cooking,parenting,music,gardening,writing,animal husbandry..walking..the list is endless.
seeing the store shelves empty of baking supplies and sewing machines..
No matter what something good will come of it.
Sleeping..how many people will live better and longer for being virus forced to sleep more and or better.
Nutrition?
Profound that people are revisiting food..cooking and eating it from raw ingredients..and if nothing else..eating slower.
For those who can explore these things..there may be a benefit.
And I do know that my attitude and resources are not available to all..

 

[Koronin]

A clinical trial for a new vaccine is starting up now at my institution. I am going to try to get enrolled. It offers a good participation fee, but I would do it for free, so the compensation is a secondary consideration. I think it will be popular, so it might be challenging to get a spot.

After quite a bit of back and forth over the past week, it looks like Remdesivir is marginally effective against COVID-19.

That is not a great P value.

https://www.niaid.nih.gov/news-even...esivir-accelerates-recovery-advanced-covid-19

Good luck with the vaccine trial. I suspect a lot of people are willing to get in on any of these vaccine trials. Hope all goes well for the trial.

 

[Mayomaniac]

I suspect the higher mortality rate among men has to do with the fact that in the +65 age group you have more male than female smokers.
It's interesting that many of the hotspot areas with the highest body count are also those known for high are pollution, but it could be that the deciding factor is just population density and that high air pollution isn't the actual cause of the higher death rates.

 

[movingtarget]

I suspect the higher mortality rate among men has to do with the fact that in the +65 age group you have more male than female smokers.
It's interesting that many of the hotspot areas with the highest body count are also those known for high are pollution, but it could be that the deciding factor is just population density and that high air pollution isn't the actual cause of the higher death rates.

Men are also less likely to go to the doctors especially middle aged men and and women tend to live longer than men so in old age they might have the superior immune system. Genetics plays it's part. Interesting that some of the worst affected regions in the world are also the worst for air pollution but I guess most large modern cities with lots of traffic and industry fall into that category and the smaller heavy industry cities also .

 

[Merckx index]

Riding a bike made me a better golfer..and way better tennis.player.

I tried doing that, but kept getting kicked off the golf course. The problem with tennis was I couldn't reverse direction fast enough.

A manifesto from a couple who own an art gallery in Napa, CA, and plan to open it, regardless. Two statements caught my eye:

We’ve risked everything; we’ve worked too hard and fought too long to bring our business to life, to keep it alive, and to grow it over the past 24 years to sit passively and watch it die for the unwillingness of some in the community to permit others to live and work on their own terms, to accept and deal with any marginal risk at their own judgment and discretion.

I appreciate that they've suffered. But this is all too typical, assuming that you are willingly taking on the risk, without taking into account that you're also increasing the risk for others. Too many people still don't get this.

We’re going back to work. We hope to see you in the gallery soonest, hopefully to enjoy the art. If not, know that we’re prepared to defend our right to live, work, and interact freely, and that we will indeed defend our right to do so, if and as necessary.

Do they mean defend only in a legal sense, which they mention earlier, or also in a physical sense? Are we going to see fighting in the streets over this?

https://napavalleyregister.com/opin...cle_ea43dd12-a53a-5639-945a-f56ffb08308c.html

 

[GVFTA]

MI, you've provided a ton of great info and it is appreciated very much, but how do you get "fighting in the streets" out of that? That's a bit extreme. I hope.

 

[djpbaltimore]

This goes back to my original assertion that the more effective the precautions taken, the more people will think they were overrated and/or unnecessary. The reason they have low case numbers in Napa is largely due to the public health decisions taken locally. Now museum owners think they know better than the people who are in charge of those decisions. Throw in the threat of litigation and that is America in a nutshell.

There is pretty good analysis that the precautions as currently being practiced have put R to about 0.9. There is not much wiggle room to ease restrictions if the goal is to limit death. Maybe the warmer weather will help, but there still needs to be a lot more work done on testing, tracing, and quarantining. The latter seems to be the most essential thing China did to limit the outbreak and there is very little even mentioned about that here.

Good non-biased sampling of Danish blood donors. Gives a good estimate of the fatality rate for people under 70.

https://twitter.com/x/status/1255759911570386944

View: https://twitter.com/CT_Bergstrom/status/1255759911570386944

 

[GVFTA]

In Maryland:

At least 4,011 confirmed cases – about 19 percent of the total infections in the state – were linked to nursing homes or long-term care facilities. At least 471 coronavirus-related deaths – about 48 percent of all fatalities in the state – were also tied to nursing homes.