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For WHOm the Bell Tolls - Covid-19 #11

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It really wouldn't surprise me if someone somewhere was deliberately letting it run wild through an enclosed population. Just to ascertain the true level of people who are not symptomatic.

Death row inmates in america should watch out.  

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1 hour ago, Tywin et al. said:

Chicago, from my experiences living a bit there part time as a kid, is more like L.A. than NYC. There's still lots of public transportation, but a lot of people still have their own ride. @Iskaral Pust, I haven't lived there in a long time though. Is that still true?

The L-train system in Chicago generally feels almost as heavily trafficked as the NYC subway, in terms of crowding in the cars/carriages and on platforms.  But the overall capacity and ridership is much lower, even scaling to population size.  Same applies to suburban rail systems. 

Lots of Chicagoans don’t own cars, especially Millenials in the good neighborhoods.  But the car ownership rate is probably still much higher than NYC.

Also Chicago has wider sidewalks, and the stores and restaurants are less cramped than NYC.  And very few people are out walking in Chicago in February and March.  These things will probably affect transmission rates. 

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24 minutes ago, Iskaral Pust said:

The L-train system in Chicago generally feels almost as heavily trafficked as the NYC subway, in terms of crowding in the cars/carriages and on platforms.  But the overall capacity and ridership is much lower, even scaling to population size.  Same applies to suburban rail systems. 

Lots of Chicagoans don’t own cars, especially Millenials in the good neighborhoods.  But the car ownership rate is probably still much higher than NYC.

Also Chicago has wider sidewalks, and the stores and restaurants are less cramped than NYC.  And very few people are out walking in Chicago in February and March.  These things will probably affect transmission rates. 

Not sure the weather is much better in NYC than in Chicago, but I had never stopped and considered the width of the sidewalks.

And for a point of reference, most of my time with my dad there was during the second Jordan's threepeat in the mid to late 90's, when I was like 8-10. Things understandably have changed.

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Ah, here we go - here's that map I mentioned.

https://abcnews.go.com/Health/nyc-map-shows-neighborhoods-hit-hardest-coronavirus/story?id=69918823

"Some of the hardest-hit neighborhoods include Elmhurst and Kew Gardens Hills in Queens, the South Bronx, and East New York in Brooklyn."

That is emphatically NOT about subway ridership. 

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What do I hear about a congressman who said that China should pay for the respirators? Have no idea who he is, but I do hope there will be some serious investigation into Chinese possibly hiding valuable information during epidemic in Wuhan in December and January.

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NYC subway system indeed is crowded, wagons are packed, and the stations are usually tiny and easily crowded as well - they're a century old and never were designed to deal with so many people.

 

5 hours ago, Jeor said:

I think we all expect that there would be a high number of asymptomatic cases out there that we don't know about, but those numbers are crazy. Herd immunity might be a lot closer than we think.

That being said, I don't think we can reach too many conclusions until there's an easy, cheap antibody test that everyone can take pretty easily that will give us a much better indication of the population spread.

Besides what Werthead said, there's also the problem that we don't know how immune asymptomatic people would truly be. Even among people with some degree of illness, antibodies can be found in low levels. Basically, too early to tell, so better be safe and don't plan on getting a natural herd immunity.

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11 minutes ago, Risto said:

What do I hear about a congressman who said that China should pay for the respirators? Have no idea who he is, but I do hope there will be some serious investigation into Chinese possibly hiding valuable information during epidemic in Wuhan in December and January.

Good luck with that. 

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The effect of some of the Euro lockdown is interesting. They seem to have done a great job at moving from rapid growth to stabilization, but nothing is really happening beyond stabilization. Italy's 7-day rolling average of daily fatalities is pretty much flat for the past two weeks. 

I'd still call that (qualified) success, but it's obviously not what we saw in China, with fatalities falling sharply around 30-40 days after the general outbreak. 

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3 hours ago, Kalbear said:

Ah, here we go - here's that map I mentioned.

https://abcnews.go.com/Health/nyc-map-shows-neighborhoods-hit-hardest-coronavirus/story?id=69918823

"Some of the hardest-hit neighborhoods include Elmhurst and Kew Gardens Hills in Queens, the South Bronx, and East New York in Brooklyn."

That is emphatically NOT about subway ridership. 

How do you think poor people get to work in NYC? Granted, in some of those areas it's more about buses than subways, but there is little difference between a crowded bus and a crowded train car. In fact, the buses are now somewhat worse because the area near the driver is cordoned off so there is even less space to spread out (but on the bright side, they're temporarily free to use).

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14 minutes ago, Paxter said:

The effect of some of the Euro lockdown is interesting. They seem to have done a great job at moving from rapid growth to stabilization, but nothing is really happening beyond stabilization. Italy's 7-day rolling average of daily fatalities is pretty much flat for the past two weeks. 

I'd still call that (qualified) success, but it's obviously not what we saw in China, with fatalities falling sharply around 30-40 days after the general outbreak. 

I think its clear we shouldn't be looking at China's data at all. The revision of a 50% increase in Wuhan's death total announced today is the only the start of the changes that would be needed before its remotely trustworthy.

I mean, they still claim that not a single member of the military became infected, despite them having a frontline role in Wuhan. It's laughable.

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6 hours ago, JoannaL said:

so all over the world, remdesivir is tested. but now first results are public by a chicago hospital. They look very promising. (Unfortunately again just a prepublication, and so on ... so not 100% sure results)

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

It's always difficult to know whether to pay any attention to this sort of unofficial report, but it sounds like the official results should be coming in later this month, hopefully they'll show some improvement.

While at that website I saw another story criticising the site we were discussing in one of the earlier threads that was estimating death tolls. I remember last week it was predicting abrupt declines in the Italian and Spanish numbers but the decline seems to be much more gradual.

https://www.statnews.com/2020/04/17/influential-covid-19-model-uses-flawed-methods-shouldnt-guide-policies-critics-say/

6 hours ago, Fragile Bird said:

Argh, yes of course! I was thinking of Taiwan, population 23.8 M.

Speaking of Taiwan, they've reported no new cases for two days in a row.

6 hours ago, Tywin et al. said:

Perhaps, but they're also testing at higher rates compared to other places. I still remain in the camp that places all over the country, and the world. are vastly under-reporting. I keep going back to the places I've traveled to in the developing world and wonder how their numbers are not exploding.

I read a story earlier about a city in Ecuador where the official death count from coronavirus was 400+ but the number of extra deaths compared to the same period last year was about 6000. There have been stories for a while now that there was a particularly bad problem in Ecuador so it may be worse than other South American countries but it does show how the official figures can be massive underestimates.

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The WHO is concerned about the antibody levels in people who've had the virus, which are not universally, conclusively high enough to suggest that building herd immunity is even possible.

Still early days but that is a concerning conclusion.

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2 minutes ago, Fez said:

I think its clear we shouldn't be looking at China's data at all. The revision of a 50% increase in Wuhan's death total announced today is the only the start of the changes that would be needed before its remotely trustworthy.

I mean, they still claim that not a single member of the military became infected, despite them having a frontline role in Wuhan. It's laughable.

Fair point. I guess I was proceeding on the basis that, even if China's figures are severely under-counted in aggregate, there may be some truth to the downward trend we saw in fatalities/day.

I'm also not really bothering to look at Brazil or Russia's stats so far. (Or Iran's, obviously). 

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3 minutes ago, Werthead said:

The WHO is concerned about the antibody levels in people who've had the virus, which are not universally, conclusively high enough to suggest that building herd immunity is even possible.

Still early days but that is a concerning conclusion.

This reminds me of that joke-y NEJM article from years ago pointing out that there was no evidence that parachutes save the lives of skydivers; because there'd never been a peer-reviewed study of it.

I think its incredibly reckless of the WHO to say there's this when there's also no evidence yet that antibodies aren't high enough to confer immunity. And it is important for states and countries to be getting ready for the future; eventually things are going to be reopening to some degree. 

Even the preliminary study I linked to a few days ago was that only a percentage of people seemingly had antibody levels too low for immunity (interestingly it was generally the asymptomatic people who had that issue), for the vast majority of people the antibodies were in line with what would be expected to confer immunity. Now we don't know for sure that it does yet, but consider that in nearly all cases viral antibodies do give immunity for at least a couple years, I'd be pretty surprised if there was no protection now.

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China was selling military equipment to Ecuador, although their biggest partners are Brazil, Chile, Venezuela, Argentina and Mexico.

I woud think any country that gets a lot of aid from China must be seeing outbreaks. Peru, Chile and Ecuador are the three countries with the most cases after Brazil.

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3 minutes ago, Fez said:

I think its incredibly reckless of the WHO to say there's this when there's also no evidence yet that antibodies aren't high enough to confer immunity. And it is important for states and countries to be getting ready for the future; eventually things are going to be reopening to some degree. 

Even the preliminary study I linked to a few days ago was that only a percentage of people seemingly had antibody levels too low for immunity (interestingly it was generally the asymptomatic people who had that issue), for the vast majority of people the antibodies were in line with what would be expected to confer immunity. Now we don't know for sure that it does yet, but consider that in nearly all cases viral antibodies do give immunity for at least a couple years, I'd be pretty surprised if there was no protection now.

There has been a strong narrative in the last couple of days from the "let's reopen everything now" brigade that asymptomatic people would also be immune to the virus and thus would already be building towards herd immunity (they're the same people who've been seizing on these dubious reports that up to 78% of patients are asymptomatic). The WHO report I think was mostly in response to this assumption, which seems to be incredibly dangerous.

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Posted (edited)
13 minutes ago, Fez said:

This reminds me of that joke-y NEJM article from years ago pointing out that there was no evidence that parachutes save the lives of skydivers; because there'd never been a peer-reviewed study of it.

I think its incredibly reckless of the WHO to say there's this when there's also no evidence yet that antibodies aren't high enough to confer immunity. And it is important for states and countries to be getting ready for the future; eventually things are going to be reopening to some degree. 

Even the preliminary study I linked to a few days ago was that only a percentage of people seemingly had antibody levels too low for immunity (interestingly it was generally the asymptomatic people who had that issue), for the vast majority of people the antibodies were in line with what would be expected to confer immunity. Now we don't know for sure that it does yet, but consider that in nearly all cases viral antibodies do give immunity for at least a couple years, I'd be pretty surprised if there was no protection now.

I'm curious what the original comments were in full because journalists have a tendency to summarise things poorly. I couldn't find the source with a quick search (I didn't try too hard), but I did find some more detailed comments from the same WHO doctor from earlier this week.

(The last paragraph in the quote below was meant to be my comment on it but I think the eccentricities of the board's quoting system have struck again and I can't move it out of there)

https://www.npr.org/sections/coronavirus-live-updates/2020/04/13/833534116/who-says-covid-19-immunity-is-an-unknown-disease-10-times-deadlier-than-2009-flu?t=1587156319318

Quote

While noting that the study out of Shanghai has not been peer-reviewed, Van Kerkhove said the findings suggest different immunity levels for different patients.

The study "found some individual had strong antibody response," Van Herkhove said, adding, "Whether that antibody response actually means immunity is a separate question."

Researchers in that project, she added, "found some patients who had no detectable antibody response. And they found some individuals who had a very high response."

"Right now, we don't have a full picture of what immunity looks like," Van Herkhove said. "And until we do, we can't give a complete answer."

It sounds like at that time she was basing the comments on what seems to be the same study you linked to in the previous thread. The statement in the quote on BBC News that "She said initial evidence did not suggest large numbers of people were developing antibodies after having the virus" seems more negative, I don't know whether new information has come in in the last couple of days.

Edited by williamjm

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29 minutes ago, Altherion said:

How do you think poor people get to work in NYC? Granted, in some of those areas it's more about buses than subways, but there is little difference between a crowded bus and a crowded train car. In fact, the buses are now somewhat worse because the area near the driver is cordoned off so there is even less space to spread out (but on the bright side, they're temporarily free to use).

I think a lot of them go to work by bus, but the more important thing is that they have to go to work, period. Manhattan - which is significantly more dense and has lots of rapid transit - benefitted greatly because most people could either work from home or could afford to not work. 

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48 minutes ago, Paxter said:

The effect of some of the Euro lockdown is interesting. They seem to have done a great job at moving from rapid growth to stabilization, but nothing is really happening beyond stabilization. Italy's 7-day rolling average of daily fatalities is pretty much flat for the past two weeks. 

I'd still call that (qualified) success, but it's obviously not what we saw in China, with fatalities falling sharply around 30-40 days after the general outbreak. 

I think we are seeing something similar in the NYC area, where it's more of a plateau than any type of significant drop, at least so far, and counter to the prediction of the models, which have shown themselves to be largely unreliable.

This shouldn't be too surprising since the rest of the world for the most part isn't imposing all the measures that China did during it's lockdown.  Our mask usage, although it's changing, is still very much a work in progress.  I think the WHO is still recommending that there is no need if you are healthy to wear a mask in public, even though there is overwhelming evidence to support wearing masks (i.e., large percentage of asymptomatic or pre-symptomatic people combined with droplet transmission).  Our lockdowns are much looser, in general.  For example, I think only one person per household was allowed to leave to get food and supplies in China.  Measuring peoples temperature before entry into supermarkets is also something that is rarely done in the US, at least where I live.  Placing infected into camps to isolate the sick from the healthy.  Massive amounts of contact tracing.  

We have been implementing some these things on a rolling basis, and you'll only see an effect after 3-4 weeks, so that's part of the reason why we are just seeing a plateau instead of a drop.  We have many people more concerned with privacy issues rather than supporting the development and usage of improved contact tracing tools.  This disease is clearly extremely infectious and will require extraordinary measures to stamp it out, or at least reduce it to very low levels.  If you are unwilling to tolerate these extraordinary measures, you have to accepting living with the presence of the disease in your community, at least until an effective vaccine is developed.  Like it or not, we may be more like Sweden than we think in our approach, where we are going to have to manage a steady number of cases.

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1 hour ago, williamjm said:

I read a story earlier about a city in Ecuador where the official death count from coronavirus was 400+ but the number of extra deaths compared to the same period last year was about 6000. There have been stories for a while now that there was a particularly bad problem in Ecuador so it may be worse than other South American countries but it does show how the official figures can be massive underestimates.

Ecuador is a SA country I admittedly know nothing about. But I still keep wondering how they could get accurate numbers from the slums, and my understanding is what I saw in Argentina, Paraguay and Uruguay is pretty common throughout the continent. 

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