Corona Horse, Corona Rider - Covid #9

[lessthanluke]

16 minutes ago, Tywin et al. said:

True, but how long will this be sustainable? People will reach a breaking point.

They already are.

I don't see how this lockdown can last any real length of time before people lose their shit. Myself included. At least I can still go lift so I'm in a better position than most of my social circle.

[Mudguard]

Just now, Maithanet said:

And we get testing way up.  I feel like I'm beating a dead horse here, but without widespead, easy to access, relatively quick testing, any containment strategy is more or less doomed to fail.  If people don't know they have it, they aren't staying home.  And even if they suspect they might have it and do self-quarantine, they aren't contacting everyone they interacted with in the previous week to make sure they self-quarantine as well without being sure that they indeed positive. 

I actually think that our current capacity, if roughly 100k tests/day is accurate, is enough if we can get caseloads way down like they did in China.  100k tests/day would have been enough if we prepared, got to this level early on, and started mass testing as soon as we detected our first cases.  

Right now, because the numbers of new cases is increasing so fast, it's essentially impossible to increase our test capacity to keep up.  There is a limit to how many new machines can be built, installed, and be run by trained people, especially when the whole world is clamoring for the same testing resources.  Worldwide, the number of new cases per day is approaching 100k new cases a day.  In the US, yesterday we had 25k new cases (which could have meant over 100k tested samples to identify those 25k new cases).  We just can't increase testing capacity that quickly.  This problem isn't going away anytime soon unfortunately.  

[Mr. Chatywin et al.]

15 minutes ago, Paxter said:

There’s also the argument that a rapid ramp up in health care capacity will let us deal somewhat better with a spike - so a delayed spike is better than no change at at all.

A ramp up is a good thing, but I thing we're way further behind than we understand. We this post from the US thread, bolded will be my emphasis:

 

 

3 hours ago, Paladin of Ice said:

As a proud lifetime New Yorker born and bred in Brooklyn, .

In good fun.

Hey, thanks for asking. I’m lucky in several different ways there: I’m in the lab, so I’m only interacting with patient specimens rather than directly with patients, (most of the time, anyway) which puts me in less danger, I work for a large private medical group rather than a hospital so we’ve actually been slow lately. We’re still taking extra precautions and such, but we’re probably doing less than 40% of our usual business. (We’re actually about to start furloughs as a result, with half the staff working one week, then off the next while the other half works.) Lastly, I’m in the suburbs rather than in NYC, so conditions aren’t quite as bad.

I’m planning on signing up for the NYS site where they’re recruiting medical personnel on an emergency basis. We’ll see if they even want me considering that I haven’t gotten my state certification for running lab tests yet. (Studying for that is something I’ve been doing a lot at work lately because we’re so slow.) They might be more relaxed about that in an emergency, or they might be willing to stick me a rung down the ladder in a position that doesn’t require a certification, like I’m doing now.

Regarding the state of the hospitals, I keep hearing disquieting things through the grapevine. What gets said officially and makes the news is bad enough, but there are rumors about people being told not to talk to the press about how low they really are on PPE and supplies, or how unprepared they are for things to get worse. A lot of hospitals and doctors offices (including my company) are sending Covid tests out to labs that are either hopelessly backlogged or under equipped, last Friday I had to try to help a nurse get an answer to why an elderly patient’s swab for Covid didn’t have a result from Quest Diagnostics 11 days after it was sent out, and that is by no means the only such example I’ve dealt with. We’ve practically given up on testing compared to the numbers we were doing two weeks ago because it takes too long to hear back and in all but the worst cases they’re going to be told the same thing about staying at home and what precautions to take. Only in cases where “it’ll make a difference in treatment” (read: where we expect the patient to need to go to the hospital and get special lung treatment to help with severe pneumonia like symptoms) do we really try to get a definite diagnosis. Well that, staff, and people who’ve had contact with someone who was confirmed to have it.

Stories in the news have talked a lot about hospitals having contracts with small labs that are out of all their supplies, they don’t even have test reagents to run tests or even, in extreme cases, to properly calibrate their machines.

In short I’m personally lucky so far, but shit is bad, and getting worse. I privately laugh and then cry when I see people not in the field talking about how testing is ramping up or we’re getting a handle on things. I’m just doing everything I can to make sure I don’t bring it home to my asthmatic wife, who’s already suffering from the early spring blooming.

As for those fuckheads who compare this to seasonal flu... I don’t even have the strength or mental resources to go into it.

PoI is very trustworthy and in a position in which he can see what's happening. The rumors around here are somewhat similar, but Minnesota is nothing like New York right now.

[Maithanet]

2 minutes ago, Mudguard said:

I actually think that our current capacity, if roughly 100k tests/day is accurate, is enough if we can get caseloads way down like they did in China.  100k tests/day would have been enough if we prepared, got to this level early on, and started mass testing as soon as we detected our first cases.  

Right now, because the numbers of new cases is increasing so fast, it's essentially impossible to increase our test capacity to keep up.  There is a limit to how many new machines can be built, installed, and be run by trained people, especially when the whole world is clamoring for the same testing resources.  Worldwide, the number of new cases per day is approaching 100k new cases a day.  In the US, yesterday we had 25k new cases (which could have meant over 100k tested samples to identify those 25k new cases).  We just can't increase testing capacity that quickly.  This problem isn't going away anytime soon unfortunately.  

Both need to be done, but I disagree that 100k is sufficient or even close to sufficient for a country the size of the US.  The Governors of Michigan and Illinois both made statements that their testing goal is 10k/day for the state, and those states have 10 and 12 million people respectively.  That would work out to needing at least 250k-300k to cover the entire country at that level.

[Kalbear]

2 minutes ago, Mudguard said:

I actually think that our current capacity, if roughly 100k tests/day is accurate, is enough if we can get caseloads way down like they did in China.  100k tests/day would have been enough if we prepared, got to this level early on, and started mass testing as soon as we detected our first cases.  

It really isn't, now that it's widespread. In addition, the turnaround on those tests is up to a week. That cannot remotely work. We need to be able to test essentially multiple metropolitan areas in under a day if we want to have reasonable contact tracing. 

That would have worked when it was just in Washington or California. But now that it's in all 50 states? Oh no, 100k isn't going to be enough. 

2 minutes ago, Mudguard said:

Right now, because the numbers of new cases is increasing so fast, it's essentially impossible to increase our test capacity to keep up.  There is a limit to how many new machines can be built, installed, and be run by trained people, especially when the whole world is clamoring for the same testing resources.  Worldwide, the number of new cases per day is approaching 100k new cases a day.  In the US, yesterday we had 25k new cases (which could have meant over 100k tested samples to identify those 25k new cases).  We just can't increase testing capacity that quickly.  This problem isn't going away anytime soon unfortunately.  

There are a lot of ways to handle this, but the US has done basically the worst thing possible in each case, and it isn't getting any better. Labs are uncoordinated, information is out of date, processes are slow-going, new testing methodologies are being ignored in favor of homegrown stuff, no one is  talking to each other and when they do it doesn't work with the systems we have. 

[Mudguard]

4 minutes ago, Maithanet said:

Both need to be done, but I disagree that 100k is sufficient or even close to sufficient for a country the size of the US.  The Governors of Michigan and Illinois both made statements that their testing goal is 10k/day for the state, and those states have 10 and 12 million people respectively.  That would work out to needing at least 250k-300k to cover the entire country at that level.

 

3 minutes ago, Kalbear said:

It really isn't, now that it's widespread. In addition, the turnaround on those tests is up to a week. That cannot remotely work. We need to be able to test essentially multiple metropolitan areas in under a day if we want to have reasonable contact tracing. 

That would have worked when it was just in Washington or California. But now that it's in all 50 states? Oh no, 100k isn't going to be enough. 

There are a lot of ways to handle this, but the US has done basically the worst thing possible in each case, and it isn't getting any better. Labs are uncoordinated, information is out of date, processes are slow-going, new testing methodologies are being ignored in favor of homegrown stuff, no one is  talking to each other and when they do it doesn't work with the systems we have. 

As I stated, we need to get numbers way down, like in China where the numbers of new cases each day is less than a hundred, in order for containment measures to be even considered.  When you have 50 cases per day, you can do the contact tracing and testing with 100k tests/day.  That is just a pipe dream right now in the US, and personally, I don't think we can get there, certainly not with how things are being done here right now.  Honestly, at least in the US, we may default to the herd immunity strategy because of a complete failure in our strategy.  

The backlog of testing isn't going away until the numbers of new cases goes way down, which isn't happening for at least a month, if not more.  If the numbers of new cases go way down, hypothetically, we would be able to quickly eliminate the backlog.  Again, not happening for a month if not more.  That is our reality.

[Arakan]

South Korea is down to roughly 100 cases per day and roughly testing 12-15k/day. The reason it’s only 100 cases is due to this amount of testing. 
But then, SK never led it escalate to such levels we see in Europe and the US. Their biggest spike was sth like 850 cases. So much less widespread than what we see now in the aforementioned regions. 
 

So, the fundamental question right now is: to which level can each country suppress the number of new cases per day realistically? For Germany the aim should be sth. like 1000 cases at max. It’s a delicate business. Basically trying to control a chain reaction.  Delicate business. 

[Fragile Bird]

27 minutes ago, Mudguard said:

 The backlog of testing isn't going away until the numbers of new cases goes way down, which isn't happening for at least a month, if not more.  If the numbers of new cases go way down, hypothetically, we would be able to quickly eliminate the backlog.  Again, not happening for a month if not more.  That is our reality.

How does the new 15 minute test work? Labs are saying they are running out of the chemicals they need. Abbott is going to produce 50 k a day, what are they using?

[Arakan]

https://www.wsj.com/articles/italys-coronavirus-death-toll-is-far-higher-than-reported-11585767179

As could be expected. Bottom-up counting only leads so far. It is estimated that the „real“ death toll in Italy is at least double the current figure. No malice, simply no time and resources. 

[Mudguard]

Just now, Fragile Bird said:

How does the new 15 minute test work? Labs are saying they are running out of the chemicals they need. Abbott is going to produce 50 k a day, what are they using?

The new Abbott test is very quick (it's similar to the traditional PCR test, but there is a twist in how's it's done that allows the test to be performed much more quickly), but my understanding is that the machine it runs on, which is the size of a toaster, has a relatively low throughput because it can't process a bunch of samples simultaneously.  There are supposedly 18000 of these machines in the US, so this should give our testing capacity a sizeable boost.  It's great as a point of care test that let's the hospital immediately identify whether their highest priority cases, which the nurses and doctors themselves are now, are infected.  However, as a general surveillance tool, if the numbers of cases continues to double within a week, it's not going to be enough.  At least in the US, the numbers of new samples that need to be tested each day has long outstripped the rate of increase in our testing capacity.  

My guess is that all assays, including Abbotts, rely on at least some of the same basic chemicals and reagents, such as those used for the initial sample preparation steps like isolating the RNA from the virus.  These chemicals may still be a bottleneck now and in the future for all or many of the assays.  I'm not sure whether manufacturing of these basic chemicals and reagents has ramped up enough to meet current and future demand.  

[Cridefea]

Quote

I admit I don't have a full track of what every European country has said about its decisions. All I know for sure is that the health authorities of Denmark and Norway have indicated that some of the decisions made by their respective governments were made by the politicians and not by them. Even now the Norwegian health authorities wanted to start reopening schools and were again overriden by the political side of the government.

I do see that Foreign Policy magazine's reporting kind of strongly implies that Italy's problems are caused by a political failure rather than a governmental failure, per se. The New York Times, as well. I haven't read these in detail and don't know how well they match up to reporting in Italy.

Sorry @Ran I'm late and the other thread is closed, so I'm gonna answer here.

In the beginning politics and governament didn't take the scientists' warning seriously, so they acted too late. (so it's the opposite of what you say happened in Denmark or Norway). I'm talking about the first days. That was the moment when the virus spread a lot, probably with many people asymptomatic, that was the main problem and still is. Here you can find an Harvard analysis: Harvard business review

I have to add that also iternational media didn't take it seriously during first week or so, I remember that I was surprise that outside Italy journalists were talking about our cases like if they wasn't local transmissions and so not so dangerous. Probably this is the reason why you don't know so much about the first days. A sequence of miscommunications.

 

As for the numbers I see a lot of posts here about it, but don't trust the number so much! they are probably only partially right,. Probably the most trusworthy ones are the recovered.

[Zorral]

This may be of interest to us:

https://www.theatlantic.com/health/archive/2020/04/coronavirus-pandemic-airborne-go-outside-masks/609235/

It runs down all the confusions we still have because of lack of real proven knowledge about this virus gets to us.  Particularly via the airborne droplets -- which they are -- and masks.

 

[Meera of Tarth]

30 minutes ago, Cridefea said:

Sorry @Ran I'm late and the other thread is closed, so I'm gonna answer here.

In the beginning politics and governament didn't take the scientists' warning seriously, so they acted too late. (so it's the opposite of what you say happened in Denmark or Norway). I'm talking about the first days. That was the moment when the virus spread a lot, probably with many people asymptomatic, that was the main problem and still is. Here you can find an Harvard analysis: Harvard business review

I have to add that also iternational media didn't take it seriously during first week or so, I remember that I was surprise that outside Italy journalists were talking about our cases like if they wasn't local transmissions and so not so dangerous. Probably this is the reason why you don't know so much about the first days. A sequence of miscommunications.

 

As for the numbers I see a lot of posts here about it, but don't trust the number so much! they are probably only partially right,. Probably the most trusworthy ones are the recovered.

Indeeed. I remember they were talking about the first cases in Italy and an epidemiologist was asked whether or not that would "come" To Spain. He said it was likely and everyine was surprised. 

As for the numbers the recovered are only partitually true as well, in the sense they are recovered because they were tested befire and after. But there have been many more cases, recovered and having dead all of them not counted.

[AncalagonTheBlack]

39 minutes ago, Zorral said:

This may be of interest to us:

https://www.theatlantic.com/health/archive/2020/04/coronavirus-pandemic-airborne-go-outside-masks/609235/

It runs down all the confusions we still have because of lack of real proven knowledge about this virus gets to us.  Particularly via the airborne droplets -- which they are -- and masks.

 

fuck, but that's scary.

[Fez]

New York's electrical grid control operators have entirely self-isolated to ensure they can keep the system up and running. https://www.nbcnews.com/tech/security/prepared-worst-electrical-grid-workers-isolate-coronavirus-spreads-n1173171

Quote

 

New York has been the state hit hardest by the coronavirus, and so it is fully sequestering the employees at its main and backup control centers. Each is staffed with 14 operators, plus support staffing for food and cleaning, all of whom tested negative for COVID-19, the disease caused by the coronavirus.

They’ve lived without other human contact since March 24, and don’t have an end date in sight.

“They can actually talk on the phone with their family, Facetime, but they don’t have contact with anybody in the outside world,” Dewey said.

 

I'm glad these kinds of emergency plans have been getting activated; especially for something as crucial as the power grid. But damn does that sound like a rough go of it. I'm self-isolated too, but at least its from the comfort of my 1-bedroom apartment. Hopefully they're all pulling down hazard pay for this, or will get it retroactively.

[Meera of Tarth]

Now the new protocols kinda encourage not to hospitalise the elders from care homes.

Well basically what was on the media today explicitly sai that the last word is for the doctor, but people who could not live "benefitting from good health" Should not be prioritised but be accompanied with treatment to stop the pain. 

They also permit some minutes to see how is their breath if it's bad it's another gyide to not be prioritised and just well..let die.

Two weeks ago it was not the case generally speaking. They didn't have to create ethical guides.

They also said it doesn't depend on age bc a person can be very healthy at 80, but generally speaking that's the guide.

It's all very sad this has generalised and now they don't have the chance bc countries were too late to respond.

[Zorral]

The first death from covid-19 in our intersecting circles.  A former model (still young and beautiful), in Paris.

[Meera of Tarth]

Roughly two weeks ago we were astonished to hear the MP talking about the chances of reaching 10.000 cases when we had reached the thousand something that week. Now at 100.000 with a population of around 45 milion10.000 per day it's just "normal".

Reality is that there must be around a million actually. Otherwise the death rate counting the official numbers would be 10%. But probably it's more. 

[Which Tyler]

2 hours ago, Mudguard said:

I actually think that our current capacity, if roughly 100k tests/day is accurate, is enough if we can get caseloads way down like they did in China.  100k tests/day would have been enough if we prepared, got to this level early on, and started mass testing as soon as we detected our first cases.  

Right now, because the numbers of new cases is increasing so fast, it's essentially impossible to increase our test capacity to keep up.  There is a limit to how many new machines can be built, installed, and be run by trained people, especially when the whole world is clamoring for the same testing resources.  Worldwide, the number of new cases per day is approaching 100k new cases a day.  In the US, yesterday we had 25k new cases (which could have meant over 100k tested samples to identify those 25k new cases).  We just can't increase testing capacity that quickly.  This problem isn't going away anytime soon unfortunately.  

Apparently, the way the Germans are getting so many more people tested, is really clever.
They take a double sample from everyone, and pool the tests.
So 1 sample goes into storage, and the other is mixed with 10 other people. That batch is tested together, and if it's negative, all 10 people are negative. If it's positive, then the 10 samples are taken out of storage and tested individually.

Using up 1 test for 10 if negative (the vast majority), or 11 tests for 10 if positive.
Really smart. Really obvious. No-one else seems to have thought of it.

[Kalbear]

Fuck this man SOOOOO much