For WHOm the Bell Tolls - Covid-19 #11

[williamjm]

11 hours ago, Paxter said:

Greenland is not a country though right? Just sayin’...having a cool/weird flag makes not a nation state.

Go Mauritania!

I was also going for the 'UN Member State' definition of country, and not trying to take anything away from Greenland's (more plausible) achievement.

1 hour ago, Hereward said:

Mauritania couldn't lock down their borders even if they wanted to, and the significant numbers of nomads (and jihadis) in their population wouldn't take any notice anyway. 

I was wondering whether borders in the Sahara desert might be more theoretical than practical.

They might have a temporary benefit for them due to their being more degrees of separation between them and the initial virus hotspots since I doubt many of those nomads and jihadis were skiing in the Alps or shopping in New York, but that's just going to delay the inevitable.

46 minutes ago, Werthead said:

I was wondering if they'd made a mistake and had meant to say Mauritius, which is at least semi-plausible (small island nation relatively easy to cut off from the rest of the world). But apparently not.

I would also guess that the Mauritanian government may not be a model of transparency.

Small island nations are probably the best bet for eliminating the virus in the short term if they've only had cases in travellers and they managed to quarantine them, the Worldometers stats don't tell us whether any of the nations with small case counts are in that situation. There are still a few countries claiming to have never had a case of the virus and I think the only plausible claims are from island nations like Samoa or Tonga.

[Zorral]

12 hours ago, Bonnot OG said:

Looks like that reopen bs going on in the US is some gigantic astroturf campaign going on. 
https://www.reddit.com/r/maryland/comments/g3niq3/i_simply_cannot_believe_that_people_are/fnstpyl/

 

How 100 death cultists take control of the entire news cycle.  They are doing exactly the same thing in Brasil, including pulling up trucks to block access to hospitals, which, of course, really does get everybody's attention.

[Isalie]

7 hours ago, Werthead said:

The situation in Sweden is bad, and now we know how the situation in care homes there is impacting the situation.

I was wondering if they'd made a mistake and had meant to say Mauritius, which is at least semi-plausible (small island nation relatively easy to cut off from the rest of the world). But apparently not.

The situation at the care homes is probably more down to general neoliberal policies than the corona response. But im sure a lot of people think that the elderly would magically be saved if we just closed the schools..

[Ran]

38 minutes ago, Mikael said:

The situation at the care homes is probably more down to general neoliberal policies than the corona response.

I don't know if I'd call them neoliberal policies, per se, since a lot of it just has to do with how elder care is generally structured; Sweden has extremely generous in-home assistance for the elderly, so for the most part what you get in these institutions are those so ill or frail that they can no longer live alone at their homes (20% of these die within the first couple of months of entering a home, just to show how frail we're talking) and those who have advanced Alzheimer's or dementia that leaves them relatively hale but not able to be taken care of at home any longer (my mother-in-law, sadly; we helped care for her as she deteriorated over a few years, but the point came that the family felt it was beyond us; and yes, we're worried about what will happen if this gets into her facility, but we know they're doing the best they can).

 

But yes, no one has denied that a major driver of mortality in Sweden, as it has been elsewhere (including Norway, Denmark, Finland, etc., simply at a smaller scale) are group homes for the elderly. I suppose the neoliberal part would be that in at least some of the Nordic countries, these have been increasingly privatized (in Sweden, it began to happen under the Moderate party) and that lax regulation combined with profit-seeking has led to various cost-cutting choices that are now coming home to roost.

The Guardian article doesn't mention the fact that many workers at elder care facilities are not well-trained and many of them come from lower economic backgrounds (especially immigrants, who have also been disproportionately affected in the Stockholm region by covid-19) which can mean that they are less likely to take the fairly generous sick leave (80% income while out ill) because their income is already tightly constrained and they can't afford to miss days. This likely did lead to some workers with early symptoms wavering over whether it was "just" a minor cold or not. Indeed, one of the arguments against wider adoption of masks in Sweden is that we don't want people with any symptoms being out and about, and there's a concern that people will trust a mask to be enough even if they "just" have a runny nose or occasional cough.

Personally, were I the government, I would have proposed some kind of increase in pay or 100% income coverage while out sick as a measure to help with some of this.

The other issues, re: PPE and so on, are an issue many other countries are dealing with as well. You can only work with the resources you have. Should Sweden have had more? Yes, and some years ago it did have more stocks of supplies for just such a crisis... but much of it has been sold off over time, and I suppose it's fair to say that that, too, is a bit of the fault of neoliberal policies. 

Finally, it should be noted that just as the majority of deaths are in Stockholm, the majority of elder care deaths are in Stockholm as well. The relevant agencies have been working hard to get ahead of this in areas like my own Västra Götaland and Skåne, where so far the rate of infection, hospitalization, and deaths are dramatically lower.

 

(A digression: this points to something I've mentioned earlier: the time when the various regions/nations had their winter sportlov seems to be a major determiner of when and where this thing blew up.  Oslo and Gothenburg are very comparable in terms of city sizes and overall populations -- 50 dead per million in Oslo, 47 dead per million in Västra Götaland (where Gothenburg is) -- and they had their winter holiday on week 8 and week 7 respectively. Then you look at Uppsala, next-door neighbor to Stockholm, and they had theirs on week 8 and are much less impacted. Same for Helsinki and Copenhagen -- week 7 or week 8 for their holidays. Stockholm's the only Nordic capital that had their vacation  week on week 9, right when the epidemic was becoming full blown in Northern Italy. 

Something like 10,000 to 15,000 Swedes were in Northern Italy during that period, and all of these came flooding back at about the same time. It's when the Stockholmers all came back that they had to give up contact tracing because it was no longer feasible. It's why Stockholm is so much worse off than any other city, including Gothenburg and Malmö, the third largest city.

Whether they should have tried a stricter lockdown on just Stockholm, I don't know. The Swedish constitution doesn't allow general freedom of movement to be constrained at all except under specific circumstances (pandemics not (yet) one of them), but certainly they could have tried to close down all restaurants, bars, etc. much earlier and maybe see if they could push R down hard from so many vectors. This in turn may well have saved many of the elderly. OTOH, it could have led to a flight of some of the more well-heeled Stockholmers who had been in Italy to other parts of Sweden, and the spread in those areas might even be greater... so, who knows?)

 

Quote

But im sure a lot of people think that the elderly would magically be saved if we just closed the schools..

Sadly, I've seen some of these. It's mostly because some fixate on the idea that the only substantial difference has been school closure, when it's not really it. Another thing I've learned about Norwegian elder care is that the institutions tend to have fewer people in them, so less of the eggs all in one basket, so to speak.

[Paxter]

Something similar happened in Canada @Ran. British Columbia had a later spring break and has far fewer cases than Quebec and Ontario. Luck of the draw really.

[RhaenysBee]

We are at 1916 cases, 250 recoveries and 187 deaths. 

This past week allegedly 30000 beds were freed nationwide in hospitals. The step proved rather controversial as there’s little explanation on how it was possible to free so many beds in so little time, what happened to the previous occupants of these beds and why are we preparing to have 60-70 thousand cases in the upcoming weeks (allegedly, 40% need hospital treatment). We are allegedly purchasing ventilators from... someone and there was allegedly a deal made with engineering universities to develop and produce even more ventilators here. Allegedly we are aiming to 15 thousand. Again, there’s no explanation that I have heard of why we are preparing for such drastic rise in cases. It was stated in a press conference that we are still on the upward side of the curve, but the number of new cases per day seems hardly exponential.

According to worldometer data our number of total case per million population is under regional average and our tests per million population is improving as well and slowly but surely climbing toward a regional average. of course I am aware that all countries have their own specific way of publishing their numbers so it’s difficult to make comparisons. Still it would be helpful to see statistics in the news or at least get a glimpse of the maths that makes the government expect such drastic rise in cases.

All this is my opinion, for the record, scraped together from potentially unreliable sources of information and thus holds no factual or scientific weight. 

which brings me to my next point. Some time this week, I have reached the conclusion that I have absolutely no idea what is going on in my country or in the world in terms of this pandemic. There are fifty versions of every pieces of news in the media and ten contradicting report on each of them. I have completely lost track of what’s true and what isn’t, I don’t know more about the virus than I did on week 1 and I don’t know more about the phase of the epidemic in my country (or any other country, or the world collectively) than I did on week 1. The lack of understanding and the amount of false, misleading, contradicting information have a worse effect on me than being stuck at home (or being out of a job, for that matter). Somehow, at this point,  this makes me feel angry rather than scared, helpless and vulnerable like it did previously. 

[Clueless Northman]

5 hours ago, Ran said:

for the most part what you get in these institutions are those so ill or frail that they can no longer live alone at their homes (20% of these die within the first couple of months of entering a home, just to show how frail we're talking) 

High mortality in the first months in nursing homes isn't just because people are frail. If I look at both my grandfather and my boss's mother, they weren't deadly ill when they went there, they were just well into their 90s, couldn't live alone anymore, and the burden of taking care of them was becoming too high for their children, who couldn't be with them as personal nurses but still had their lifes and their jobs. Having lived an independent life until then and not wanting to be put into such homes, they were morally, psychically, crushed beyond any hope and just let go of their will to live.

[Which Tyler]

5 hours ago, Clueless Northman said:

High mortality in the first months in nursing homes isn't just because people are frail. If I look at both my grandfather and my boss's mother, they weren't deadly ill when they went there, they were just well into their 90s, couldn't live alone anymore, and the burden of taking care of them was becoming too high for their children, who couldn't be with them as personal nurses but still had their lifes and their jobs. Having lived an independent life until then and not wanting to be put into such homes, they were morally, psychically, crushed beyond any hope and just let go of their will to live.

Common story I'm afraid.

[Free Northman Reborn]

Not sure if I’m looking at the latest statistics, but on worldometer it would appear that the death rate for people with no pre-existing conditions is about 0.9%. That would appear to be across all age ranges. I can’t see the same result just for people under the age of 60, but considering that the overall death rate below 60 is already below 1%, if you strip out pre-existing conditions it is likely around 0.1% or even less.

And that would be based on known cases, I guess. If prevalence is many times higher as some studies are now suggesting, these death rates could be an order of magnitude lower.

[A True Kaniggit]

25 minutes ago, Free Northman Reborn said:

Not sure if I’m looking at the latest statistics, but on worldometer it would appear that the death rate for people with no pre-existing conditions is about 0.9%. That would appear to be across all age ranges. I can’t see the same result just for people under the age of 60, but considering that the overall death rate below 60 is already below 1%, if you strip out pre-existing conditions it is likely around 0.1% or even less.

And that would be based on known cases, I guess. If prevalence is many times higher as some studies are now suggesting, these death rates could be an order of magnitude lower.

So in the U.S. (if we round down to a 300,000,000 population, I know it's a bit more) at 0.1% that would be 300,000 dead if everyone gets infected. And that's with no pre-existing conditions from what you are saying. Aren't we already at 40,000 dead? Best keep up measures to ensure as few people as possible get the virus.

[Free Northman Reborn]

2 minutes ago, A True Kaniggit said:

So in the U.S. (if we round down to a 300,000,000 population, I know it's a bit more) at 0.1% infection that would be 300,000 dead if everyone gets infected. And that's with no pre-existing conditions from what you are saying. Aren't we already at 40,000 dead? Best keep up measures to ensure as few people as possible get the virus.

So the Guardian has some UK figures from 2 days ago, saying 5% of hospital deaths are in people with no pre-existing conditions. They also say that the overall death rate is about 5%. So 5% of 5% would mean 0.25% of deaths are people with no pre-existing conditions. But that is across all age ranges. Take out people over 60 and I guess it would be ten times lower. So about 0.025%.
 

[A True Kaniggit]

21 minutes ago, Free Northman Reborn said:

So the Guardian has some UK figures from 2 days ago, saying 5% of hospital deaths are in people with no pre-existing conditions. They also say that the overall death rate is about 5%. So 5% of 5% would mean 0.25% of deaths are people with no pre-existing conditions. But that is across all age ranges. Take out people over 60 and I guess it would be ten times lower. So about 0.025%.
 

Why you gotta make me do math? Give me a sec.

Ok. Disclaimer, I'm drunk as shit. So my math could be super sideways.

But with a 0.025% fatalaty rate with a population of 300 million, calculator tells be that would be 75,000 dead if everyone in the country were all somehow magically infected. Considering we're already at 40,000 dead......

[Heartofice]

I think in the UK 91% of people dying with the virus had a pre existing health condition 

[Free Northman Reborn]

1 hour ago, Heartofice said:

I think in the UK 91% of people dying with the virus had a pre existing health condition 

Yeah, the Guardian article I referenced above seemed to distinguish between hospital deaths where 5% had no pre-existing conditions and all deaths where 91% had pre-existing conditions. These are rough figures anyway, as we don’t know the true infection rate to apply these to. But both of the above are across all age ranges. I would like to know the death rate for otherwise healthy people below 65. Which I suspect is very low.

[Old Zog]

1 hour ago, Free Northman Reborn said:

So the Guardian has some UK figures from 2 days ago, saying 5% of hospital deaths are in people with no pre-existing conditions. They also say that the overall death rate is about 5%. So 5% of 5% would mean 0.25% of deaths are people with no pre-existing conditions. But that is across all age ranges. Take out people over 60 and I guess it would be ten times lower. So about 0.025%.
 

Just knowing that 5% of hospital deaths are in people with no pre-existing conditions and that the overall death rate is about 5% (assuming these figures are correct) does not give us any information at all about the death rates in people with no pre-existing conditions.

[Free Northman Reborn]

2 minutes ago, Old Zog said:

Just knowing that 5% of hospital deaths are in people with no pre-existing conditions and that the overall death rate is about 5% (assuming these figures are correct) does not give us any information at all about the death rates in people with no pre-existing conditions.

Is your point that the hospital death rate is different to the overall death rate? Fair enough. Addressed by Hereward above and also in my response to him.

[Clueless Northman]

So what's the reasoning here? That it's fine because people have pre-conditions? There are tens of mio of people with pre-conditions in the US. In a normal year, they're not going to fall sick and die. Besides, in a normal flu year, hospitals don't break down everywhere and ICUs aren't overcrowded to the point most people are left to die - which is exactly what's happening in places where the virus runs unchecked, like the flu tends to do.

I mean, it would be a bit blunt and callous but I wouldn't be surprised if some people were thinking "Well, that's their problem" when people who could've got the flu shot didn't get it and died of the flu, but we're talking about something we have pretty much nothing to fight against, no vaccine, not even any proven drug so far.

[Old Zog]

10 minutes ago, Free Northman Reborn said:

Is your point that the hospital death rate is different to the overall death rate? Fair enough. Addressed by Hereward above and also in my response to him.

No, my point has nothing to do with the overall death rate outside of hospitals. My point is that percentages don't work the way you want them to. Consider the following two situations:

In Hospital A, 400 patients are admitted testing positive for CoViD-19. Of those 400, 20 die (5%). Of those 20, one (5%) has no pre-existing conditions. It just so happens that (s)he is the only one of the 400 admitted patients with no pre-existing conditions, so the observed death rate for admitted patients with CoViD-19 and no pre-existing conditions is 100%.

In Hospital B, 400 patients are admitted testing positive for CoViD-19. Of those 400, 20 die (5%). Of those 20, one (5%) has no pre-existing conditions. (Sounds pretty familiar, so far.) But in this hospital, all 380 of the patients who recover have no pre-existing conditions; the observed death rate for admitted patients with CoViD-19 and no pre-existing conditions is 0.26%.

There's nothing in any of the numbers you gave to tell us which hospital is closer to the truth.

[Free Northman Reborn]

12 minutes ago, Old Zog said:

No, my point has nothing to do with the overall death rate outside of hospitals. My point is that percentages don't work the way you want them to. Consider the following two situations:

In Hospital A, 400 patients are admitted testing positive for CoViD-19. Of those 400, 20 die (5%). Of those 20, one (5%) has no pre-existing conditions. It just so happens that (s)he is the only one of the 400 admitted patients with no pre-existing conditions, so the observed death rate for admitted patients with CoViD-19 and no pre-existing conditions is 100%.

In Hospital B, 400 patients are admitted testing positive for CoViD-19. Of those 400, 20 die (5%). Of those 20, one (5%) has no pre-existing conditions. (Sounds pretty familiar, so far.) But in this hospital, all 380 of the patients who recover have no pre-existing conditions; the observed death rate for admitted patients with CoViD-19 and no pre-existing conditions is 0.26%.

There's nothing in any of the numbers you gave to tell us which hospital is closer to the truth.

That’s not what the 5% was referencing. It said of all Covid19 hospital deaths, 5% had no pre-existing conditions. That’s averaged across all hospitals.

So that’s merely a sample of the entire population (but skewed towards those who were hospitalized). How skewed? Well as Hereward pointed out, the overall percentage of Covid19 deaths with pre-existing conditions is apparently 91% in the UK.

So only 9% had no pre-existing conditions. At the same time, the article states that the overall Covid-19 death rate is currently estimated to stabilize at about 5% in the UK. So if only 9% of those 5% have no pre-existing conditions, the death rate for otherwise healthy people is about ten times lower than the rest. So around 0.5%, roughly.

And that’s across all age groups. Exclude those over 60, and it probably drops ten fold again.

And if they are actually underestimating the actual infection rate by an order of magnitude as now seems possible, then the death rate drops a further ten fold.

What’s the point of all of this? Well, it is that we should rather focus on targeted measures to protect the vulnerable minority of the population, than locking down the entire economy, when the vast majority of the working age population is exposed to very low risk.

[Old Zog]

Free Northman Reborn,

I'll try again, because there's a basic mathematical point you're getting wrong. Maybe it'll be easier to follow if I strip away all of the real-world context.

We have a universe U of people which can be split into four mutually disjoint sets - call them A, B, C and D. We're given that A and B together make up 5% of U. We're also given that the size of A is 5% of the size of the union of A and B. (So, the size of set B is 19 times the size of set A.) It seems to me that you are then trying to conclude that the size of A is 0.25% (5% of 5%) of the size of the union of A and C. But that's false. We're given no information about the relative sizes of C and D, so there's no way to conclude anything about the relative sizes of A and C.

To re-connect this to the real-world context: U is the set of all people (in the hospital, overall, whatever qualifier you want) who have CoViD-19. The people in A are those who die despite having no pre-existing conditions. The people in B are those who die and have pre-existing conditions. The people in C are those who recover and have no pre-existing conditions. And the people in D are those who recover despite having pre-existing conditions.