For WHOm the Bell Tolls - Covid-19 #11

[The Anti-Targ]

3 minutes ago, Ran said:

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.

 

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

Only testing serious cases is consistent with a policy of not really wanting to control or limit spread to any significant extent and intending for herd immunity by infection rather than waiting for vaccination. Is it still Sweden's formal policy to let herd immunity develop by trying to have moderate community spread?

[Ran]

Just now, The Anti-Targ said:

Only testing serious cases is consistent with a policy of not really wanting to control or limit spread to any significant extent and intending for herd immunity by infection rather than waiting for vaccination. Is it still Sweden's formal policy to let herd immunity develop by trying to have moderate community spread?

The stated position of FHM is that herd immunity is and never has been a goal, but it is a by product of the strategy of simply focusing at keeping the hospitals from being overwhelmed. The reason testing was so limited was simply lack of resources and capacity at the time, and wanting to focus on putting effort to building out ICU, acquiring more PPE, etc. They're working to ramp up to 100,000 a week, and are now handling over 20,000 tests a week.

All that said, I guess some of this may just be a semantic distinction. Their view, as expressed by Tegnell and Giesecke, is that "herd immunity" is the ultimate end state of this for everyone, whether it's achieved by vaccination or by natural exposure through the population. It seems pretty clear that if herd immunity's downward pressure on R is why things are plateauing, and the IFR is as low as .1 to .3 as some estimate, that there's not going to be a change of policy any time soon. In fact, Anders Tegnell (chief epidemiologist and spokesperson for FHM) said that today at the daily press conference, that the longer things go as they are, the less and less likely we're going to end up introducing more stringent measures.

BTW, here's something I wonder about:

Who holds the daily press conferences in everyone's respective countries? I know that in the US governors and the White House (and in some cases mayors) are holding these press conferences, with some experts sometimes on hand and sometimes not. In Sweden, it's representatives of the three or four agencies primarily involved in dealing with this, with nary a politician in sight (the ministers tend to do a press conference once a week, usually to announce some new measure -- the latest was reiterating that Sweden was going to extend the ban on most travellers from outside the EEA  that the EU had decided on).

 

[Impmk2]

So interesting modeling in a Science paper:

https://science.sciencemag.org/content/early/2020/04/14/science.abb5793

Take aways: If the sars-cov-2 gives a similar protective immunity to other related corona viruses which cause the common cold (median protective antibody duration ~45 weeks), we're looking at annual outbreaks and spikes in mortality (much like the flu). So would be back and killing again early next year assuming a large portion of the population get it now.

If immunity is more like SARS (protective immunity lasts a couple years) the outbreaks shift to a 2 yearly cycle. Hopefully a vaccine would be ready by then.

If its permenent immunity you get a single large peak then it's done.

 

So if we are getting a large portion of extremely mild / asymptomatic cases which simply aren't generating a decent immune response, it looks likely we enter a situation where it becomes a yearly cycle.

 

[Toth]

I must say a good indicator whether a country is able to just quarantine the vulnerable population is the experience I made today because it is just... too strange.

So two weeks ago I already mentioned how my principal asked everybody who belongs to the risk group to turn in certificates that they are so that they wouldn't be counted on with their presence at school. Note that already here there is no mention of people in the risk group belonging to your household that you could easily infect and kill, screw those people.

Today I phoned my lung specialist to ask her whether she would judge my Asthma in its current lack of severity as a risk. First thing to note is that it took me hours to get through, it appeared to me that there had been a constant onslaught the entire morning. I guess I should have seen that coming, what with the end of the Easter holidays.

In any case, the aid taking up the receiver was frustratingly pissed and hostile when I asked her whether it is possible for the doctor to make a judgement of whether I fall into the risk group. She said that I can pay 5 Euro to get a certificate that I have Asthma, but the doctor won't make any recommendation to either choice, I have to decide myself whether I'm in the risk group by looking up what the Robert Koch Institute says.

That... that certainly wasn't helpful at all. -.-

My mother's take on this is that the doctor wants to avoid any kind of responsibility by refusing to give a clear answer... which leaves me horrified at the prospect of other people with more severe preconditions not getting a clear reply either whether they could risk go to work or not.

[Fragile Bird]

5 minutes ago, Toth said:

I must say a good indicator whether a country is able to just quarantine the vulnerable population is the experience I made today because it is just... too strange.

So two weeks ago I already mentioned how my principal asked everybody who belongs to the risk group to turn in certificates that they are so that they wouldn't be counted on with their presence at school. Note that already here there is no mention of people in the risk group belonging to your household that you could easily infect and kill, screw those people.

Today I phoned my lung specialist to ask her whether she would judge my Asthma in its current lack of severity as a risk. First thing to note is that it took me hours to get through, it appeared to me that there had been a constant onslaught the entire morning. I guess I should have seen that coming, what with the end of the Easter holidays.

In any case, the aid taking up the receiver was frustratingly pissed and hostile when I asked her whether it is possible for the doctor to make a judgement of whether I fall into the risk group. She said that I can pay 5 Euro to get a certificate that I have Asthma, but the doctor won't make any recommendation to either choice, I have to decide myself whether I'm in the risk group by looking up what the Robert Koch Institute says.

That... that certainly wasn't helpful at all. -.-

My mother's take on this is that the doctor wants to avoid any kind of responsibility by refusing to give a clear answer... which leaves me horrified at the prospect of other people with more severe preconditions not getting a clear reply either whether they could risk go to work or not.

Toth, if it gives you any comfort, doctors are very surprised to see how few people with asthma end up in hospital. The four big underlying factors appear to be diabetes, obesity, hyper tension and of course I can’t remember the 4th, I think it’s heart disease, but I will look it up once I get home. It is not asthma.

[Mudguard]

Apparently Los Angeles county also did a study using the same antibody test used in the Santa Clara study.

 

Quote

Hundreds of thousands of Los Angeles County residents may have been infected with the coronavirus by early April, far outpacing the number of officially confirmed cases, according to a report released Monday.

The initial results from the first large-scale study tracking the spread of the coronavirus in the county found that 2.8% to 5.6% of adults have antibodies to the virus in their blood, an indication of past exposure.

That translates to roughly 221,000 to 442,000 adults who have recovered from an infection, according to the researchers conducting the study, even though the county had reported fewer than 8,000 cases at that time.

...

The early results from L.A. County come three days after Stanford researchers reported that the coronavirus appears to have circulated much more widely in Santa Clara County than previously thought.

The Stanford team estimated that 2.5% to 4.2% of Santa Clara County residents had antibodies to the coronavirus in their blood by early April.

...

Both counties used rapid antibody tests supplied from Premier Biotech, a Minneapolis-based company. The test has not yet been approved by the FDA, although the federal government does allow for such tests to be used for public health surveillance.

Someone needs to do a thorough validation of Premier Biotech's antibody test.  Are these results real?  Or just the result of false positives?  Can't tell yet.  Unfortunately, there are now around a hundred different antibody tests on the market, some of which are crap.  That said, even a relatively good test with 97-98% specificity would have trouble detecting low levels of infection.

[Zorral]

56 minutes ago, Bonnot OG said:

Get ready for strong Spikes of corona virus in red states thanks to daft shit republicans. 

Hey this is war and a good general expects to lose his troops, a lot of them, good troops all who loyally no matter what ride into that valley of death, all for the sake of their leader.

Besides, if they die, it's the fault of New York.

Their dearest infants can die with pink froth blooming out of their chests, but still they will follow their leader and blame someone else.

 

[Toth]

3 minutes ago, Fragile Bird said:

Toth, if it gives you any comfort, doctors are very surprised to see how few people with asthma end up in hospital. The four big underlying factors appear to be diabetes, obesity, hyper tension and of course I can’t remember the 4th, I think it’s heart disease, but I will look it up once I get home. It is not asthma.

Well, thanks, but I had already looked all of that up two weeks ago as well. It's stated that only those Asthmatics are in the risk group who have it so severe they have to take steroid pills instead of sprays. I still would have preferred an attempt to confirm or deny stuff I read on the internet by a professional.

[Bonnot OG]

‪Media legitimizing those asinine astroturfed “protests” at the moment. ‬Currently on cbs or what ever is currently on here are completely doing a facile look at this shit

[The Anti-Targ]

14 minutes ago, Ran said:

The stated position of FHM is that herd immunity is and never has been a goal, but it is a by product of the strategy of simply focusing at keeping the hospitals from being overwhelmed. The reason testing was so limited was simply lack of resources and capacity at the time, and wanting to focus on putting effort to building out ICU, acquiring more PPE, etc. They're working to ramp up to 100,000 a week, and are now handling over 20,000 tests a week.

All that said, I guess some of this may just be a semantic distinction. Their view, as expressed by Tegnell and Giesecke, is that "herd immunity" is the ultimate end state of this for everyone, whether it's achieved by vaccination or by natural exposure through the population. It seems pretty clear that if herd immunity's downward pressure on R is why things are plateauing, and the IFR is as low as .1 to .3 as some estimate, that there's not going to be a change of policy any time soon. In fact, Anders Tegnell (chief epidemiologist and spokesperson for FHM) said that today at the daily press conference, that the longer things go as they are, the less and less likely we're going to end up introducing more stringent measures.

BTW, here's something I wonder about:

Who holds the daily press conferences in everyone's respective countries? I know that in the US governors and the White House (and in some cases mayors) are holding these press conferences, with some experts sometimes on hand and sometimes not. In Sweden, it's representatives of the three or four agencies primarily involved in dealing with this, with nary a politician in sight (the ministers tend to do a press conference once a week, usually to announce some new measure -- the latest was reiterating that Sweden was going to extend the ban on most travellers from outside the EEA  that the EU had decided on).

 

Herd immunity is always the end goal. But given you are only looking at getting to a herd immunity situation via infection in Stockholm over the next few months there's still a lot of people outside Stockholm still to get infected to get the whole country up to 6 million people infected, and with protective antibody levels. 0.5-1% CFR is still approximately what we should be expecting, so getting 6 million people to herd immunity status via infection is paying a high price in human life. Is the public generally OK with the idea that 30,000 (or more) Swedish residents will likely die by the time herd immunity is achieved via infection. Just avoiding having the health system overwhelmed is quite a transactional and fatalistic goal if it is really the only metric for successful management of the disease.

The epidemiologist is right that the longer the disease is left to propagate with current controls the less effective it would be to put stricter controls in place. But that's a bit like saying there's no point in putting fire alarms in a burnt out building that killed a bunch of people when it burned. It's a tacit confirmation that stricter measures earlier would have been effective at keeping numbers down in the long term. When you hit a disease hard early on it does limit suffering and death over the longer term, because you train the population to think and behave in ways that continues to limit spread after enforced restrictions are lifted but while public messaging continues to be about doing things to stay safe. The first part of herd immunity before most people have antibodies is most people not behaving in a way that spreads the disease through their actions, which means educations and training in safe behaviour.

As to the question, our daily briefings are the PM and the chief of the health ministry.

[Ran]

 

Quote

Is the public generally OK with the idea that 30,000 (or more) Swedish residents will likely die by the time herd immunity is achieved via infection.

If IFR is .1, it'd be about 6,000 dead. If .3, 18,000 dead. The better they protect elder care homes, the lower the CFR will be as well. 

Are people all right with these numbers? Well, Giesecke was pretty blunt and pointed out that many of these dead would have died within a year anyways (note that he says this as a 70 year old man, well within the risk zone), and one has to think about total social health -- the most good for the most people -- and not be focused just on body counts.

 

Quote

Just avoiding having the health system overwhelmed is quite a transactional and fatalistic goal if it is really the only metric for successful management of the disease.

The metric of success is finding the balance of what does the least harm to the nation at large, balancing all sorts of factors -- the impact of school closures on health of students, the impact of long-term isolation on the psyches of young people, rates of domestic violence, the health impact of economic downturns, and so on and so forth. FHM as a health ministry has its mandate to be one of considering all of these aspects of public health and to consider them in determinign the best course.

Quote

The epidemiologist is right that the longer the disease is left to propagate with current controls the less effective it would be to put stricter controls in place.

Well, his actual meaning was that so long as it progresses as it does, it is better for Sweden to continue this course than to be more restrictive because the public health impact is judged to be worse than this pace of infection. Restrictions will come if the hospitals can't handle the work load.

Quote

The first part of herd immunity before most people have antibodies is most people not behaving in a way that spreads the disease through their actions, which means educations and training in safe behaviour.

We have R under 1 in Stockholm and probably most of Sweden. People have been trained and educated. They don't require orders or police intervention as of yet.

 

[Rippounet]

10 minutes ago, Ran said:

Well, Giesecke was pretty blunt and pointed out that many of these dead would have died within a year anyways (note that he says this as a 70 year old man, well within the risk zone), and one has to think about total social health -- the most good for the most people -- and not be focused just on body counts.

I want to be humble in the face of the unknown, and I don't think anyone of us should be in a position where they have to defend or explain their nation's choices. Also, it's obviously too soon to know what's the right thing to do.

But damn, I'm really glad this is not the policy that was chosen in my country. This seems like a pretty callous real-life application of utilitarianism.

Just for the lols, this is copy-pasted from the essay I'm grading in another window:

Quote

 

What comes first, humanity or the economy ?

Restarting the economy is for sure going to be beneficial for our society, but to what lengths are we willing to go and what lines are we willing to cross to make it happen ?

 

I think this student has their heart in the right place.

[Ran]

44 minutes ago, Rippounet said:

But damn, I'm really glad this is not the policy that was chosen in my country. This seems like a pretty callous real-life application of utilitarianism.

I mean.... but this is how countries decide things. They look at things like Quality-Adjusted Life Years to decide what interventions make sense at what time for individuals, and a similar process has to be used to try and weigh larger social interventons and impacts. Does giving a 90 year old an average change of an extra year of life merit spending some given amount of money? What if they are blind, deaf, and partially paralyzed? etc., etc. Now scale that up to society -- does it make sense to spend X to reduce the chance that people in risk groups have a 1% smaller chance to get infected? How about Y? How about Z? And so on, although while knowing that "spending X" has its own potential health impacts on other parts of the population..

But obviously, a lot of it depends not just on the forecast of what happens in Sweden, but on their view of the forecast of most every place else, namely that we're all going to be seeing IFRs like this, and the only thing that makes it worse is taking an approach with exacerbates the peak or leads to other bad health impacts. We'll see where things are when retrospective studies look at excess mortality above baselines a year or two in the future.

 

 

[williamjm]

1 hour ago, Ran said:

BTW, here's something I wonder about:

Who holds the daily press conferences in everyone's respective countries? I know that in the US governors and the White House (and in some cases mayors) are holding these press conferences, with some experts sometimes on hand and sometimes not. In Sweden, it's representatives of the three or four agencies primarily involved in dealing with this, with nary a politician in sight (the ministers tend to do a press conference once a week, usually to announce some new measure -- the latest was reiterating that Sweden was going to extend the ban on most travellers from outside the EEA  that the EU had decided on).

In the UK they've been lead by a government minister (originally Boris was going to do most of them, but that changed for obvious reasons) usually with a couple of experts to do the technical stuff. In Scotland they've usually been lead by Nicola Sturgeon, again with experts.

1 hour ago, Impmk2 said:

So interesting modeling in a Science paper:

https://science.sciencemag.org/content/early/2020/04/14/science.abb5793

Take aways: If the sars-cov-2 gives a similar protective immunity to other related corona viruses which cause the common cold (median protective antibody duration ~45 weeks), we're looking at annual outbreaks and spikes in mortality (much like the flu). So would be back and killing again early next year assuming a large portion of the population get it now.

If immunity is more like SARS (protective immunity lasts a couple years) the outbreaks shift to a 2 yearly cycle. Hopefully a vaccine would be ready by then.

If its permenent immunity you get a single large peak then it's done.

That was an interesting summary of the various possibilities, there does seem to be a lot of variation. I guess it will take quite a while to figure out which of the possible combinations of variables are true.

The weirdest scenario was probably the permanent immunity one that also kills off the common cold-causing coronviruses as a side-effect. It doesn't sound like one of the likelier scenarios.

[Mr. Chatywin et al.]

1 hour ago, Zorral said:

Hey this is war and a good general expects to lose his troops, a lot of them, good troops all who loyally no matter what ride into that valley of death, all for the sake of their leader.

Besides, if they die, it's the fault of New York.

Their dearest infants can die with pink froth blooming out of their chests, but still they will follow their leader and blame someone else.

 

Gallows alert:

 

[Kalbear]

I know I'm going to hell already, but god damn inject this into my veins

 

 

[Mr. Chatywin et al.]

Jokes aside, that happened quicker than I thought. First day back from partial pay furlough and we already had the meeting that most of us are getting furloughed without pay effective Sunday. Assuming I get half pay plus $600 each week, that would actually be a small net increase for me. If the $600 is biweekly, I'll still be fine, and we should be backed to work before it would matter at all for me.

Still, I'm surprised I felt the anxiety that I did. It's a lot easier to hear news like this when they also have a plan, but now it's just "we'll call you when we call you." But their 3% pay cut is such a shame. 

Also, I know this is a stupid question, but when they say "cough," how open or narrow is that? Like coughing fits? Or is even just something mild cause for concern? Have to ask because I've been coughing a bit for a few hours, it's just small ones, one or two at a time, but they seem to be happening every 10-15 minutes.

[Rippounet]

5 minutes ago, Tywin et al. said:

Also, I know this is a stupid question, but when they say "cough," how open or narrow is that? Like coughing fits? Or is even just something mild cause for concern? Have to ask because I've been coughing a bit for a few hours, it's just small ones, one or two at a time, but they seem to be happening every 10-15 minutes.

Coughing is a possible symptom, but should only be worrying if you have chest tightness (or chest pain), shortness of breath, or any kind of respiratory discomfort. IIRC you're rather young (younger than me ^^) and you smoke, so coughing fits are to be expected with Covid-19. You might also get bronchitis even after you're rid of Covid-19.
This being said do not hesitate to rush to the ER if you do have the other symptoms and think it's not anxiety.

As someone said on twitter: "A fun game to play with yourself is panic attack or coronavirus"

'cause yeah, panic attacks and Covid-19 symptoms are pretty damn close. And not mutually exclusive either.

Fucking virus, man. Anyway, take care, you keep this board funny.

[Fragile Bird]

14 minutes ago, Tywin et al. said:

Also, I know this is a stupid question, but when they say "cough," how open or narrow is that? Like coughing fits? Or is even just something mild cause for concern? Have to ask because I've been coughing a bit for a few hours, it's just small ones, one or two at a time, but they seem to be happening every 10-15 minutes.

Oh hell, Ty.

I have done a lot of reading on the topic, lots of people have posted stories. The coughs range from nothing at all to real constant hacking, even coughing up blood. From a tickle in the throat to a non-stop cough. But typically a dry cough.

I understand Reddit has lots of threads about Covid-19 including one where people have posted their symptoms.

And look after yourself, you damn fool. Look after yourself. Tylenol.

[The Anti-Targ]

The thing is a lot of the negative economic effects of this pandemic are simply choices about how much govts will spend in adherence to neoliberal ideology. 

A govt can choose to spend little to get the economy through and thus cause major recession and unemployment. A govt can spend a lot to get the economy through, all but prevent any significant unemployment and ensure no business goes under solely because they can't pay their bills while they have no or significantly reduced income. An economy with almost all businesses remaining viable through the period of reduced / no income will recover extremely quickly after restrictions are lifted. Enterprises going out of business and people losing jobs is a choice that govts make, not an inevitable consequence of a lock-down. So I fundamentally disagree that there is a significant compromise that must be made on life/health vs economy.

It's also BS to say that most of the dead would be dead within a year anyway so why bother trying to keep them alive through the pandemic? People and the health care system spend $10s of thousands to keep an individual alive for 6 months to a year when they are terminal. And most of the people dying from C-19 weren't terminal when they got the disease. So the spending to have a person die later this year instead of now would be seen to be worth it on an individual level, but somehow not at a collective level.

 

2 hours ago, Ran said:

If IFR is .1, it'd be about 6,000 dead. If .3, 18,000 dead. The better they protect elder care homes, the lower the CFR will be as well. 

 

If you think you're only looking at 6000 dead when Sweden's own data suggest 1600 dead with probably not more than 350K infected then I don't think people are interpreting the data correctly for the body count for reaching herd immunity. Without significant therapeutic improvements it's wishful thinking to assume that the next 5.6 million infected will only lead to 4.5k deaths. CFR among healthy under 60s might be 0.1% but there are a helluva lot of people that don't fit that description. In some countries the proportions will differ, but in all countries it's a significant proportion of people. And in the USA it's 1/3 of people solely on the basis of obesity being a significant risk factor.

Also, if you wait for the hospital system to become overburdened before implementing stricter measures it's too late.