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For WHOm the Bell Tolls - Covid-19 #11


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1 minute ago, BigFatCoward said:

That doesn't sound right. New york has 240000 cases so 2%ish of the population is confirmed. There must be a huge number of people with no/minor symptoms. 

Really hard to say anything definitively without major testing. We still don't know if antibodies provide immunity yet. 

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The idea of isolating only the most vulnerable members of society (to keep the economy running I guess) might seem attractive at a glance.

But the less vulnerable still fall sick. For about two weeks on average.

And this supposes that we know who is vulnerable and is not. What about people whose "comorbidities" have not been identified yet?

So I'd say... In a country with universal health care, perhaps you could offer a chance to everyone to test for comorbidities AND a three or four-week sick leave for the people who fall ill.

So the irony is, I think the plan could work. Just not in the US.

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Also, on the 'only 1% or less will die' remember that while that's true, the actual studies we have also have about 20% of the 20-45 crowd who have gotten it require hospitalization, and 2% of the 20-45 crowd with no pre-existing conditions require ICU treatment/ventilators.

2% of the 20-45 population is close to a million people. By itself. And that would more than overwhelm our hospitals. 

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11 minutes ago, Kalbear said:

Really hard to say anything definitively without major testing. We still don't know if antibodies provide immunity yet. 

Preliminary indications are that the people with no/very minor symptoms don't seem to be getting a level of antibodies to expect to be immune, but people who get moderately/very sick do.  Which would mean that the talk of herd immunity is still a really long way off, even in the hardest hit areas.

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21 minutes ago, Kalbear said:

We still don't know if antibodies provide immunity yet. 

I mean, decades of science say that the antibodies produced by the body exist for a reason, namely to protect against infection. I think WHO's point got a bit muddled, because what they're really saying is that people shouldn't trust antibody tests on the individual level to be 100% certain about level of immunity one may have. Which, at present, may be true. But I'm not going to buy the idea that antibodies versus a coronavirus are useless. Especially when there are already studies that are suggestive of the fact that, yes, antibodies still work, and the question now is simply how long they are effective for, and how well does the body become primed to deal with this when the immediate immune response wears off? 

To put this another way, just think -- if antibodies don't provide immunity, then we are fucked as a species because vaccination will not work, since it depends on getting us to create antibodies, and we sure as hell are not going to eradicate this so the only way to go is to get used to a lot more old people and overweight people dying from here to eternity.

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Just now, Ran said:

I mean, decades of science say that the antibodies produced by the body exist for a reason, namely to protect against infection. I think WHO's point got a bit muddled, because what they're really saying is that people shouldn't trust antibody tests on the individual level to be 100% certain about level of immunity one may have. Which, at present, may be true. But I'm not going to buy the idea that antibodies versus a coronavirus are useless. Especially when there are already studies that are suggestive of the fact that, yes, antibodies still work, and the question now is simply how long they are effective for, and how well does the body become primed to deal with this when the immediate immune response wears off? 

To put this another way, just think -- if antibodies don't provide immunity, then we are fucked as a species because vaccination will not work, since it depends on getting us to create antibodies, and we sure as hell are not going to eradicate this so the only way to go is to get used for a lot more old people and overweight dying from here to eternity.

That's fair and a more expansive point of what I was making.

Antibody tests only reveal that at some point the person had the virus. What it doesn't say:

  • How long the antibodies are effective
  • How much exposure does a body need before it produces antibodies
  • How long does the immediate response last
  • How many people cannot for whatever reason produce antibodies and will remain vulnerable

Really, the novel coronavirus is so new and interesting and different that we barely understand all the ways in which it actually kills or harms people. We still don't understand enough to make declarative statements about what will work. There are strategies we can put in place IF things are certain ways (frex: a larger population that is asymptomatic and immune than we think, a version where many people don't have a strong immunity response and can get reinfected), but we simply don't know enough right now to say anything.

What we do know is what we have from experimental evidence in places like South Korea which work:

  • Major testing and aggressive quarantining of anyone who is infected and who has contacted them
  • Public contact testing results allowing everyone to know what is going on
  • Major public health measures to allow for good social distancing and gathering
  • Strong unified messaging and methods

That is so far the only thing that has been reliable. Everything else is a gamble based on incomplete information.

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3 minutes ago, Ran said:

To put this another way, just think -- if antibodies don't provide immunity, then we are fucked as a species because vaccination will not work, since it depends on getting us to create antibodies,

Eeeh, Ran, hold on. I'm no doctor so I might be talking out of my ass but...
I don't think anybody said that antibodies don't work.
I think the question is whether you can develop antibodies if you're asymptomatic.
In other words, the question is whether a "healthy carrier" becomes immune to the virus or not.
But even if that's not the case, a vaccine could still be produced.
It's just that it would then be likely to cause extremely mild symptoms.

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Just now, Rippounet said:

Eeeh, Ran, hold on. I'm no doctor so I might be talking out of my ass but...
I don't think anybody said that antibodies don't work.

Kal has clarified his point, but what he said was literally that we didn't know if antibodies provide immunity, and that's what I was responding to.

Just now, Rippounet said:


I think the question is whether you can develop antibodies if you're asymptomatic.

Yes, but then there needs to be study into why people are asymptomatic and appear to fight off the virus without their immune system adapting itself to deal with it. Here is an article from yesterday that has some interesting things to say. Could it just that a lot of people (mostly younger) have great innate immunity? Could be! But if so, then that reduces R, and herd immunity is actually probably closer, not further away.

 

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1 hour ago, Ran said:

Kal has clarified his point, but what he said was literally that we didn't know if antibodies provide immunity, and that's what I was responding to.

Yes, but then there needs to be study into why people are asymptomatic and appear to fight off the virus without their immune system adapting itself to deal with it. Here is an article from yesterday that has some interesting things to say. Could it just that a lot of people (mostly younger) have great innate immunity? Could be! But if so, then that reduces R, and herd immunity is actually probably closer, not further away.

 

One reason for the large number of asymptotic people is tha the virus, having recently crossed over into humans, is not that good at infect g humans yet. As it adapts and evolves it will be more effective and will be more widespread. We can only hope that it does not evolve to be more lethal. 

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Speaking of antibodies, Karonlinska University Hospital in Stockholm released results  (Swedish, Google Translate it) that showed at least 11% of blood donors (test with 99.5% specificity and 70-80% sensitivity, which actually means the actual number could be as high as 15-16%) are positive for antibodies as of last week; a couple of weeks earlier, the test showed about 4%. 

Notably, blood donors are generally ruled out from donating if they indicate any recent illness, so if anything a true random sampling in Stockholm could show higher numbers.  Apparently they're estimating that 20-30% have had it in Stockholm as of today, based on this.

ETA: Also, while "have you had recent illness" queries for blood donors is self-reporting, the fact that a bunch of people said "no" while having antibodies for this virus does imply that they were asymptomatic or so mild they didn't really notice.

Also, a point I forgot to note, it takes a couple of weeks from infection for these antibodies to be detected, so this is more of a snapshot of where Stockholm was  two three weeks ago. Thinking 30%+ is indeed quite possible, and would explain the plateau we've had in the region for the last two weeks without any substantial changes in policy if it's helping to push R further down below 1.

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3 hours ago, Kalbear said:

Not left to the actual reader: how many people actually have pre-existing conditions. Remember, one of the pre-existing conditions is being overweight, which over 60% of the US population is. Fuck those guys, I guess. 

I do love how it's just glossed over, like oh well, if you have any pre-existing condition time to die. 

You speak from the bottom of my heart. The virus only affects elderly people and those with pre-existing conditions. Well, we have an aging population and lots of pre-existing conditions. 18% of the population is over 65, 25% smokes, 20% is obese, 38% is a regular heavy drinker. Barely more than half of the population considers themselves healthy, chronic stress and therefore hypertension, cardiovascular diseases, cancer rates are relatively high, many people live with diabetes. I don’t have numbers but to be honest, I would be surprised if most people above 45 didn’t have any pre-existing health conditions. Old and rusty healthcare system, sixth worst mortality rate in EU, life expectancy 5 years below average.   If I take all of this into account we aren’t talking about 15 or even 20% and sickly 70+ year olds. We are talking about, what.. 50% of people? One of the reason why the “our elderly are at threat” narrative makes me sad and angry. Many more are at threat and ALL should take extra special care. 

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1 hour ago, Ran said:

Kal has clarified his point, but what he said was literally that we didn't know if antibodies provide immunity, and that's what I was responding to.

Yes, but then there needs to be study into why people are asymptomatic and appear to fight off the virus without their immune system adapting itself to deal with it. Here is an article from yesterday that has some interesting things to say. Could it just that a lot of people (mostly younger) have great innate immunity? Could be! But if so, then that reduces R, and herd immunity is actually probably closer, not further away.

 

There's certainly a significant degree of undercounting, but I remain skeptical of the claims we are starting to see, based on early antibody studies, that there are massive numbers of asymptomatic people that we are undercounting.  I don't think any country is close to herd immunity yet. 

 

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Following Mauritania a couple of days ago we now have a second country claiming to have got to zero active cases, namely Burundi. The Worldometers site says they've done a whole 80 tests, which might explain why they haven't reported many cases.

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I just saw this: 

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1?fbclid=IwAR3yTQqS2GInnVVU_iikRQjrucsi1KYwWpV1UEEhiLTTXLvGnLfRc3tUy_g

The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases. 

 

not peered reviewed.

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3 minutes ago, Filippa Eilhart said:

I just saw this: 

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1?fbclid=IwAR3yTQqS2GInnVVU_iikRQjrucsi1KYwWpV1UEEhiLTTXLvGnLfRc3tUy_g

The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases. 

not peered reviewed.

Yup, the comments are quite interesting with doctors and scientists pointing out that there are flaws in their methodology. However, there does seem to be broader agreement that an argument for 1% of the population being infected can be more strongly made, which would still be significantly more than the number of confirmed cases.

Given the lack of testing in the US, they'd also then have to factor out those people who were at home with symptoms but never went to hospital or called a health care professional, so were never entered into the statistics.

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6 minutes ago, Ran said:

Speaking of antibodies, Karonlinska University Hospital in Stockholm released results  (Swedish, Google Translate it) that showed at least 11% of blood donors (test with 99.5% specificity and 70-80% sensitivity, which actually means the actual number could be as high as 15-16%) are positive for antibodies as of last week; a couple of weeks earlier, the test showed about 4%.

Notably, blood donors are generally ruled out from donating if they indicate any recent illness, so if anything a true random sampling in Stockholm could show higher numbers.  Apparently they're estimating that 20-30% have had it in Stockholm as of today, based on this.

ETA: Also, while "have you had recent illness" queries for blood donors is self-reporting, the fact that a bunch of people said "no" while having antibodies for this virus does imply that they were asymptomatic or so mild they didn't really notice.

If true, Stockholm should be at herd immunity levels within about a month, and there should be a drastic drop in the number of new cases over the following weeks.  

NYC had similar results, with about 15% of mothers delivering babies at the hospital testing positive.  

It would be great news if these numbers were true and representative of the at large population, but I would like to see random testing of the general population with a well validated antibody assay (preferably with more than one test) before I'm convinced.

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1 hour ago, Ran said:

Speaking of antibodies, Karonlinska University Hospital in Stockholm released results  (Swedish, Google Translate it) that showed at least 11% of blood donors (test with 99.5% specificity and 70-80% sensitivity, which actually means the actual number could be as high as 15-16%) are positive for antibodies as of last week; a couple of weeks earlier, the test showed about 4%. 

Notably, blood donors are generally ruled out from donating if they indicate any recent illness, so if anything a true random sampling in Stockholm could show higher numbers.  Apparently they're estimating that 20-30% have had it in Stockholm as of today, based on this.

ETA: Also, while "have you had recent illness" queries for blood donors is self-reporting, the fact that a bunch of people said "no" while having antibodies for this virus does imply that they were asymptomatic or so mild they didn't really notice.

Also, a point I forgot to note, it takes a couple of weeks from infection for these antibodies to be detected, so this is more of a snapshot of where Stockholm was  two three weeks ago. Thinking 30%+ is indeed quite possible, and would explain the plateau we've had in the region for the last two weeks without any substantial changes in policy if it's helping to push R further down below 1.

According to Worldometers there have been ~1600 deaths in Sweden. You mentioned previously Stockholm is by far the most infected city in Sweden. My rule of thumb that the true infection rate is more likely to be between 100 and 200x the official death rate (CFR between 0.5% and 1%) than the reported official confirmed infection rate means infection in Sweden is somewhere around 160,000 and 320,000. With Stockholm population being 1 million-ish that 20%-30% estimate tracks. Though even if 11% is an accurate estimate of the total current and past infections it's still closer to 100x CFR than is the current official confirmed cases.

In local news, our govt has decided to extend lvl4 lock down until the 11:59PM next Monday. Not coincidentally next Monday is ANZAC day holiday (ANZAC - a WW I commemoration for Aus and NZ -  day is 25 April and when it falls on a weekend the holiday is Monday-ised). So clearly the govt didn't want to drop to lvl3 and give people a sense that they can congregate in larger groups to commemorate this day, which I'm fine with. Also interestingly an online poll conducted on a news website asking if people felt the country was ready to drop out of lvl 4 had 61% of people saying no we are not ready to drop out of lvl 4.

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41 minutes ago, Werthead said:

Yup, the comments are quite interesting with doctors and scientists pointing out that there are flaws in their methodology. However, there does seem to be broader agreement that an argument for 1% of the population being infected can be more strongly made, which would still be significantly more than the number of confirmed cases.

Given the lack of testing in the US, they'd also then have to factor out those people who were at home with symptoms but never went to hospital or called a health care professional, so were never entered into the statistics.

Yeah, I saw this study when it came out, and I decided against mentioning it here because the study was so flawed.  I don't think you can say anything with confidence based on this study.  The selection bias from recruiting subjects through Facebook ads instead of randomly selecting subjects is a major problem, as well as the limited testing of the specificity of the assay.  If the false positive rate is actually just one percent lower than claimed (98.5% v. 99.5%), false positives could account for the bulk of the positive cases they found.

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10 minutes ago, The Anti-Targ said:

According to Worldometers there have been ~1600 deaths in Sweden. You mentioned previously Stockholm is by far the most infected city in Sweden. My rule of thumb that the true infection rate is more likely to be between 100 and 200x the official death rate (CFR between 0.5% and 1%) than the reported official confirmed infection rate means infection in Sweden is somewhere around 160,000 and 320,000. With Stockholm population being 1 million-ish that 20%-30% estimate tracks. Though even if 11% is an accurate estimate of the total current and past infections it's still closer to 100x CFR than is the current official confirmed cases.

Oh, yes, CFR is terribly high here because we only test serious cases of the illness as far as reported case figures. 

I should add that a separate test of 2000 health care workers in Stockholm, reported on yesterday, showed about a third having antibodies, but I don't know the specificity or sensitivity of the test used. They are of course much likelier to have been exposed than the general population, so not too many conclusions can be drawn, other than possible supporting evidence of a low IFR.

 

Quote

In local news, our govt has decided to extend lvl4 lock down until the 11:59PM next Monday. Not coincidentally next Monday is ANZAC day holiday (ANZAC - a WW I commemoration for Aus and NZ -  day is 25 April and when it falls on a weekend the holiday is Monday-ised).

Makes sense. Norway and Denmark held off on school reopenings until after Easter, as well.

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