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Fragile Bird

Taking it to the Streets - Covid-19 #12

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Posted (edited)

Rise in numbers. After about two weeks of pretty steady inpatient numbers, we're seeing a rise again at my health system. Not over-capacity surge but about 20% rise at the downtowns. I blame Easter/Passover and people getting stir crazy.

We're also seeing increased hypertension and rising diuretic prescriptions with outpatients in non-COVID news. Can't pretend there aren't health side effects to stay-at-home. But I'd prefer steadily decreasing numbers before reopening.

Edited by AverageGuy

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Posted (edited)

So I did a quick analysis of the state level data on https://covidtracking.com/data/us-daily

Here's a few conclusions, based on 5 day averages:

1.  New Cases peaked for the US in the 4/06 to 4/10 range, and have been declining (slowly) since then. 

2.  Most of the states that didn't lock down have not seen a similar peak.  The holdouts are Arkansas, South Dakota, North Dakota, Wyoming, Iowa, and Nebraska.  Of those, IA, SD, ND, and NE are still getting worse (in some cases, much worse).  WY and AR are a bit less clear, their numbers are muddy.  Are these states going to start shutting down soon, when other states are starting to reopen?  Who knows. 

3. There are a few states that have declined significantly from their peak.  This includes both hard hit states like Michigan, Louisiana, and Washington (all down 59% or more since their peak) and states that acted quickly with relatively few cases like Idaho, Montana, and Vermont (all down more than 65%). 

4. Some of the states that are talking about reopening are NOT in group #3 above.  Georgia and Texas show little sign of declining cases.  Mississippi is still increasing.  It gives the impression these governors are putting political concerns ahead of public health. 

 

Given #2 and #4, I think that the second wave in the US is virtually inevitable.  And when that happens, there will be fewer govt tools to throw at the problem, and far more popular opposition to another month long lockdown.  There's a lot of potential for disaster here. 

 

Edited by Maithanet

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7 minutes ago, Maithanet said:

Given #2 and #4, I think that the second wave in the US is virtually inevitable.  And when that happens, there will be fewer govt tools to throw at the problem, and far more popular support for another month long lockdown.  There's a lot of potential for disaster here.

I think a second wave in the USA is inevitable, given that they're opening too soon. But it will probably take two weeks before the effects are seen in another spike in cases, given the long incubation time of this virus. I just hope that people don't see the reopenings going well for a week and decide that suddenly means everyone else should open too.

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Posted (edited)
4 minutes ago, Jeor said:

I think a second wave in the USA is inevitable, given that they're opening too soon. But it will probably take two weeks before the effects are seen in another spike in cases, given the long incubation time of this virus. I just hope that people don't see the reopenings going well for a week and decide that suddenly means everyone else should open too.

Yes, I worry about this too.  I think the "thaw" will happen more gradually in most states with a Democratic governor.  But if GA and TX reopen and after a week cases are still flat/declining, there's going to be a lot of pressure on governors to "think of the economy".

Edited by Maithanet

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4 minutes ago, Maithanet said:

Yes, I worry about this too.  I think the "thaw" will happen more gradually in most states with a Democratic governor.  But if GA and TX reopen and after a week cases are still flat/declining, there's going to be a lot of pressure on governors to "think of the economy".

It's also a time when interstate travel might become fraught - states that catch a second wave versus states that stayed closed and are getting the numbers down. We already saw a bit of this with people coming out of New York.

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Completely forgot to mention this, and to be fair it might be bogus... But a number of French doctors were reporting something really odd with tobacco. They said that contrary to what you'd expect, few smokers had to go into ICU. One of them even joked that nicotine seemed to protect people from Covid-19. OTOH though, smokers who did end up in ICU had a greater chance of dying because their lungs were too damaged to recover.

I wouldn't necessarily believe that this is anything else than a statistical oddity that can be explained in various ways (for example, smokers are used to being short of breath and don't rush to the ER as easily as others). But you know... "fun fact of the day" I guess.

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There are monsters who have been driving their fast cars into NYC to 'own the libs', howling their racing engines up and down our streets, trying to breathe on NYers and all the rest.  They call themselves smart and cool for not believing in the virus, you betcha -- safe as they are within their vehicles.  Except it seems sometimes there are several of them in there.  Cops are running those guys down.  Also motorcyclists are doing this too.  There's a great charm for these sorts to be disobeying speed limits and driving top speed on our streets.  Accidents happen too.  Which always seem to shock them.

 

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some more anecdotical evidence regarding face masks:

Our city decided that the use of  (home-made) face mask is mandatory for public transport and shops some two weeks ago. It was the first county in Germany to do so.

Until then we had a not too bad - but decidedly above average number of infection /100.000 people /Germany.

For the last 12 days we now had NO new infections.

Starting this week, some more cities and also some states are deciding in favor of face masks. It seem that this is overdue.

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And in "more news from the dirtiest country" ...

So in answer to Ran's earlier question, in France it's mostly the "general director for health" who communicates on Covid-19. It's a sub-division of the Ministry for health that deals with "health threats" on the national level.

So Covid-19 has now killed more than 20,000 of us dirty frogs, thus making it deadlier than any seasonal flu. About 30,000 people are still hospitalized and 5,683 in ICU.
Confinement brought R from 3,3 to 0,5 apparently, and the curve is flattening, but it's estimated that only 5,7% of the population has been infected and is now immune.
Schools will re-open progressively after the 12th of May, with only "half-groups" of 10 to 15 students so the kids can respect social distancing (how on earth will that work... it seems completely stupid if you ask me).
It was considered to keep the elderly confined after the 11th, but public outrage led to it being a mere recommendation.

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So I got a call from my dad's nursery:

Hello, it's about the spread of Covid.

*gulp* Ok...

Yes, two of our staffers have tested positive. They are of course sent home for now. However, we'd like to get your permission to have your father tested.

So you are just asking for my consent for a test, that's all? *sigh of relief* Ok, considered it hereby given.

[I am my dad's legal guardian, so they presumably had to call me, even if this is a non-invasive procedure].

 

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33 minutes ago, Which Tyler said:

 

Thats really bad isnt it? It also seems to be a problem with underreporting (or is this the  "we count only the dead in hospital"). It seems that the UK outbreak may be worse already in absolute cases than in any other European country (but in relation to inhabitants it may still be Belgium?) . Worse than Italy or Spain. And the health services were not overwhelmed as they were in Italy. so this is the real covid-19 fatality?

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Posted (edited)

Speaking of excess deaths, the New York Times has an article on the subject, finding many countries have an excess amount of deaths that are not being reported in their covid-19 results just yet. This isn't really due to trying to hide things, but simply some combination of bureaucracy, lack of resources, and so on. There's a handy chart at the top comparing the excess deaths above normal and their seeming undercount (with one exception) for Spain, England and Wales, France, NYC, the Netherlands, Istanbul, Jakarta, Belgium, Switzerland, and Sweden.

Most of the studied locations have significant undercounts from March to April -- Spain with 7,300 deaths above normal through April 5th, England and Wale with 6,300 through April 10th, France with 5,100, NYC with 4,000, and so on. Belgium and Switzerland have smaller undercounts in total, but as percentages they're still missing an accurate report by 25-33%.

And then there's Sweden. There has been much criticism in Sweden about the daily updates on deaths including adding a lot of retrospective deaths on occasion, and part of the defense from the health ministry is that while there are several different bureaucratic systems involved that are interfacing and this can take time, they have promised that we'll likely have one of the best and most accurate pictures of deaths during this pandemic of any affected country. NYT's early results appears to bear that out, because unlike everyone else that they looked at, Sweden has "overcounted" (compared to an artificial baseline, so probably not actually done so) by seemingly claiming 100 more deaths were Covid-19 than when comparing to the baseline, or about a 5% "overcount".

Also, through April 15th, Sweden is more or less at the baseline for deaths compared to the last 5 years. This will no doubt change going forward, because in general deaths trend down as you get deeper into spring and summer. Most of the reason for this, though, is that we had an extremely mild flu season this time around, compared to at least two of the past five years which were pretty hard.

Edited by Ran

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28 minutes ago, Ran said:

Speaking of excess deaths, the New York Times has an article on the subject, finding many countries have an excess amount of deaths that are not being reported in their covid-19 results just yet. This isn't really due to trying to hide things, but simply some combination of bureaucracy, lack of resources, and so on. There's a handy chart at the top comparing the excess deaths above normal and their seeming undercount (with one exception) for Spain, England and Wales, France, NYC, the Netherlands, Istanbul, Jakarta, Belgium, Switzerland, and Sweden.

Most of the studied locations have significant undercounts from March to April -- Spain with 7,300 deaths above normal through April 5th, England and Wale with 6,300 through April 10th, France with 5,100, NYC with 4,000, and so on. Belgium and Switzerland have smaller undercounts in total, but as percentages they're still missing an accurate report by 25-33%.

And then there's Sweden. There has been much criticism in Sweden about the daily updates on deaths including adding a lot of retrospective deaths on occasion, and part of the defense from the health ministry is that while there are several different bureaucratic systems involved that are interfacing and this can take time, they have promised that we'll likely have one of the best and most accurate pictures of deaths during this pandemic of any affected country. NYT's early results appears to bear that out, because unlike everyone else that they looked at, Sweden has "overcounted" (compared to an artificial baseline, so probably not actually done so) by seemingly claiming 100 more deaths were Covid-19 than when comparing to the baseline, or about a 5% "overcount".

Also, through April 15th, Sweden is more or less at the baseline for deaths compared to the last 5 years. This will no doubt change going forward, because in general deaths trend down as you get deeper into spring and summer. Most of the reason for this, though, is that we had an extremely mild flu season this time around, compared to at least two of the past five years which were pretty hard.

We are getting excess death numbers in Austria too now(burecracy is slow here) and there are more excess deaths than known covid-19 deaths. They started increasing around March 15.

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4 hours ago, Jeor said:

It's also a time when interstate travel might become fraught - states that catch a second wave versus states that stayed closed and are getting the numbers down. We already saw a bit of this with people coming out of New York.

I think it's time to plan for several waves. There could be a second wave starting in a few weeks, another in the fall, and then we'll maybe have mini-regional waves that don't occur with the previous three. Hopefully the gangbusters push for supplies will mitigate the loss of life in those waves, though, at least in a lot of places.

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4 hours ago, Rippounet said:

Completely forgot to mention this, and to be fair it might be bogus... But a number of French doctors were reporting something really odd with tobacco. They said that contrary to what you'd expect, few smokers had to go into ICU. One of them even joked that nicotine seemed to protect people from Covid-19. OTOH though, smokers who did end up in ICU had a greater chance of dying because their lungs were too damaged to recover.

I wouldn't necessarily believe that this is anything else than a statistical oddity that can be explained in various ways (for example, smokers are used to being short of breath and don't rush to the ER as easily as others). But you know... "fun fact of the day" I guess.

Data coming from China has been showing the same for a while. This is the first time I read that coming from a Western country. Do you have a link? Speculation was that nicotine blocks the ACE2 receptors in lungs. But who knows really.

btw: hopefully you are fully recovered from COVID

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BTW. I think there should be more focus on investigating those who are asymptomatic or with very light symptoms. It seems to me that lots of effort is being spent on those who get really sick, when the key to fight the disease might be found in those who do not get sick.

Also, since countries are reopening. We need better information about what can we do to - eventually - get better outcomes if we get sick and what we should do in case we do get sick.

 

 

 

 

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In an hour we are having a zoom meeting of my coworkers, my boss is a board member of the o lot real professional organization for my industry and they sent out a letter to the health dept and state legislators trying to reopen shit explaining why they think we can reopen safely (which I think is theoretically mostly true, but not actually true with PPE shortages- if we CAN order n95 masks we probably ethically shouldn’t be using supply front line healthcare workers need, also we are only trained about blood borne pathogens and not air and droplet borne pathogens). Before we were shut down my boss was betting that by four weeks in we wouldn’t even be hearing about it anymore and it’s just a flu and that this happens every election. So I don’t have a ton of confidence in getting on the same page about when and how to reopen. 

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4 minutes ago, rotting sea cow said:

BTW. I think there should be more focus on investigating those who are asymptomatic or with very light symptoms. It seems to me that lots of effort is being spent on those who get really sick, when the key to fight the disease might be found in those who do not get sick.

Also, since countries are reopening. We need better information about what can we do to - eventually - get better outcomes if we get sick and what we should do in case we do get sick.

 

 

 

 

I think the reason we haven’t focused on this and can’t yet is the testing shortage. We can only spare the tests in most places to test people who require hospitalization and you can’t focus on what you do t have the tools to identify yet.

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