COVID-19 #13 or: How I Learned to Stop Worrying and Love the Disease

[The Anti-Targ]

1 hour ago, ljkeane said:

Er what? The UK isn't reporting recoveries so there isn't really a publicly available measure of 'active cases'.

I assume it's probably a bit of a guesstimate but apparently the team trying to model the UK's R value at Imperial College, presumably with better access to data, currently have it at 0.7.

Yes, you are right. I wasn't paying attention to the lack of recovered cases number for the UK on Worldometer. The confirmed cases - deaths almost equals Worldometer's active cases number.

@rotting sea cow

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Why in the seven hells the number of cases in Spain and Italy is going down so slowly despite strong quarantine measures??? Germany and Austria with far fewer restrictions reported a decrease of cases at the expected scale. 

Where do these cases in Italy coming from?

Another element to it is time to recovery if the disease is substantially in groups that are older, immune compromised or with comorbidities then recovery will take longer so the active case numbers won't drop as quickly. Spain's active cases is dropping at a reasonable rate, but it only just started dropping so it's a wee bit early to say it's a sustained pattern.

[A wilding]

1 hour ago, rotting sea cow said:

Why in the seven hells the number of cases in Spain and Italy is going down so slowly despite strong quarantine measures??? Germany and Austria with far fewer restrictions reported a decrease of cases at the expected scale. 

Where do these cases in Italy coming from?

At a guess. a major factor may be more aggressive contact tracing and testing in Germany/Austria, made easier by there being fewer cases overall.

[LynnS]

Interesting study on modes of transmission.

https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/

[Paxter]

1 hour ago, rotting sea cow said:

Why in the seven hells the number of cases in Spain and Italy is going down so slowly despite strong quarantine measures??? Germany and Austria with far fewer restrictions reported a decrease of cases at the expected scale. 

Where do these cases in Italy coming from?

I think these were very different types of outbreaks. Germany had a low-ish concentration of cases throughout the country, whereas Italy and Spain had some clear "hot spots" (Lombardia, Madrid) where the virus is even now very difficult to contain. 

Despite speculation from some boarders in previous threads that the Italian South was going to get hit hard, the highest risk zones are still all in the North (Lombardia, Trento, Liguria and Piemonte). Granted, there is time yet for the Mezzogiorno to be decimated...particularly as restrictions are relaxed and the usual South-North travel route is restored. 

I don't know much about the Austria example - certainly they have fared a lot better than comparable countries like Belgium or the Netherlands. Perhaps the lowland countries suffered from their centrality, while Austria's mountain holdfasts functioned in an almost Arryn/Eyrie-like manner :P. Luz might be able to enlighten us. 

ETA: Germany's de-centralized health care model and resultant greater testing ability have also been cited as key factors in some reports. But I still think the concentration of risk in particular (older) Italian towns and cities was the main determinant. 

[The Anti-Targ]

Speaking of reporting of recovery numbers, has Sweden stopped reporting recoveries or something? Sweden's death:recovery ratio is very high which doesn't seem right. and also Sweden's total resolved cases (deaths+recoveries) is also very low. The vast majority of Sweden's cases have come during April, so perhaps the recoveries are just not coming through yet. The recovery number should rise dramatically fairly soon unless they have stopped reporting.

[Paxter]

9 minutes ago, The Anti-Targ said:

Speaking of reporting of recovery numbers, has Sweden stopped reporting recoveries or something? Sweden's death:recovery ratio is very high which doesn't seem right. and also Sweden's total resolved cases (deaths+recoveries) is also very low. The vast majority of Sweden's cases have come during April, so perhaps the recoveries are just not coming through yet. The recovery number should rise dramatically fairly soon unless they have stopped reporting.

Sweden doesn't collect recoveries on a national level as far as I'm aware.

[The Anti-Targ]

1 minute ago, Paxter said:

Sweden doesn't collect recoveries on a national level as far as I'm aware.

Worldometer should put a N/A in the recovery column like it has for the UK.

[rotting sea cow]

2 hours ago, Jeor said:

I also scratch my head thinking that Italy and Spain should have been coming down quicker than this. My only thought is that demographics might be playing a role. Not just that Italy and Spain might have older populations, but I get the impression that perhaps they have populations with generally higher risk factors (smoking, high blood pressure?) or greater household size or population density? Just guesses.

 

1 hour ago, LynnS said:

Interesting study on modes of transmission.

https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/

Well, according to this article, speaking louder might play a role. In my experience, Italians and Spaniards do speak louder. But population density is probably a greater factor.

 

1 hour ago, The Anti-Targ said:

Another element to it is time to recovery if the disease is substantially in groups that are older, immune compromised or with comorbidities then recovery will take longer so the active case numbers won't drop as quickly. Spain's active cases is dropping at a reasonable rate, but it only just started dropping so it's a wee bit early to say it's a sustained pattern.

Ok. But this affect the number of active cases, not the number of new cases. Where do these new cases are coming from? People have been in strict lockdown for weeks!  Even children were not allowed outside, a measure I consider inhumane. Despite this, the number of new cases didn't drop to a low level plateau like in Germany and Austria, but to a long extended downward curve.

 

43 minutes ago, Paxter said:

I think these were very different types of outbreaks. Germany had a low-ish concentration of cases throughout the country, whereas Italy and Spain had some clear "hot spots" (Lombardia, Madrid) where the virus is even now very difficult to contain.

Yeah, the virus there might be so widespread that the chance of getting it even in restricted activities is quite high. It might be worth to look at the prevalence of the virus in staircases, supermarkets, water supplies, etc. Now that I think about it. I remember some Italian streets (also some in Spain) that are very narrow and each flat has a air conditioning system. Might be a contributing factor?

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Despite speculation from some boarders in previous threads that the Italian South was going to get hit hard, the highest risk zones are still all in the North (Lombardia, Trento, Liguria and Piemonte). Granted, there is time yet for the Mezzogiorno to be decimated...particularly as restrictions are relaxed and the usual South-North travel route is restored.

Well, this is also somewhat strange. There was clearly plenty of time to reach the south of Italy. Similarly the south of Spain is not as critically affected like the north.

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I don't know much about the Austria example - certainly they have fared a lot better than comparable countries like Belgium or the Netherlands. Perhaps the lowland countries suffered from their centrality, while Austria's mountain holdfasts functioned in an almost Arryn/Eyrie-like manner :P. Luz might be able to enlighten us. 

From what I know, Austria got that hotspot in the Tirol area where ski-goers from all around the world went, met and got infected. It is unlikely that there were no Austrians.

 

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ETA: Germany's de-centralized health care model and resultant greater testing ability have also been cited as key factors in some reports. But I still think the concentration of risk in particular (older) Italian towns and cities was the main determinant. 

Yes, I think it might have to do with structure of the cities, assuming that there are no other underlying variables hiding somewhere.

 

ETA: Thank you all for the replies

[Paxter]

1 hour ago, Triskele said:

John Oliver or someone needs to do a mashup of people on TV unable to pronounce Remdesivir.  It's seriously not that hard, or so I'd have thought.  

I must admit to having no idea how to pronounce it.

Phonetically I'm guessing it's something like: "This-drug-sucked-at-treating-Ebola-and-won't-work-this-time-either". 

[Raja]

28 minutes ago, Paxter said:

I must admit to having no idea how to pronounce it.

Phonetically I'm guessing it's something like: "This-drug-sucked-at-treating-Ebola-and-won't-work-this-time-either". 

Wait till you try pronouncing Tamiflu's generic name ( Oseltamivir), the last drug we had high hopes for that ended up providing marginal benefits which governments around the world breathlessly stockpiled anyway because Big Pharma gonna Big Pharma.

[Prue]

6 hours ago, Paxter said:

I think these were very different types of outbreaks. Germany had a low-ish concentration of cases throughout the country, whereas Italy and Spain had some clear "hot spots" (Lombardia, Madrid) where the virus is even now very difficult to contain.  ...

I don't know much about the Austria example - certainly they have fared a lot better than comparable countries like Belgium or the Netherlands. Perhaps the lowland countries suffered from their centrality, while Austria's mountain holdfasts functioned in an almost Arryn/Eyrie-like manner :P. Luz might be able to enlighten us. 

ETA: Germany's de-centralized health care model and resultant greater testing ability have also been cited as key factors in some reports. But I still think the concentration of risk in particular (older) Italian towns and cities was the main determinant. 

I think that Northern Italy simply may have had many undetected cases very early. I read somewhere that there were many Chinese tourist groups e.g. going to Venice, Florence etc. in December/January. If only a few locals who work in the tourist industry got infected by Chinese tourists, without developing many symptoms, they probably brought the disease to their home villages where old people live in close contact with younger people. And they are at a higher risk to develop severe symptoms.

Germany was merely extremely lucky that so many of the first infected were younger people who went skiing in Austria or Italy. Every time the disease now spreads in a nursery home here, the fatality rates are much higher, too. But the health care system fortunately didn't get overwhelmed as there is a very high concentration of intensive care units here. To be honest, that's mainly because ICUs happen to be lucrative for a hospital to have, not because of visionary planning for a possible pandemic...

 

[Paxter]

18 minutes ago, Prue said:

I think that Northern Italy simply may have had many undetected cases very early. I read somewhere that there were many Chinese tourist groups e.g. going to Venice, Florence etc. in December/January. If only a few locals who work in the tourist industry got infected by Chinese tourists, without developing many symptoms, they probably brought the disease to their home villages where old people live in close contact with younger people. And they are at a higher risk to develop severe symptoms.

That's possible...though it doesn't quite jive with the fact that Venice and Florence have not been among the particularly hard-hit cities. I guess it's plausible that someone working in Florence goes to Bergamo to visit family and passes the virus on - who knows. 

Veneto (the region of which Venice is the capital), has actually had a pretty "good" pandemic, with 30 fatalities / 100,000 people. There is some speculation that health authorities may have contributed to this by encouraging people with mild symptoms to stay home and not present at hospitals. Lombardia, Piemonte and Emilia-Romagna have a far worse record (e.g. 137 fatalities / 100,000 people in Lombardia). Tuscany has also fared reasonably well. And of course, many southern regions have had (according to the data) only small outbreaks so far. 

Hope things are good where you are AP!

[Prue]

I'm fine (again), thanks.  Had to start working again, though, which increases the risk of infection. But I guess all the people who don't have a high risk to become seriously ill will have to be sent back to work eventually, to contribute to herd immunity. Not a nice feeling to belong to the group that is consciously endangered, but unless there's a vaccine really soon, many people will have to get the disease. *shrugs* I just hope that I will get a mild case. Maybe I already had it, but tests are far harder to get in Germany than you would assume. If you didn't have contact to a confirmed case, you can only get a test if you have severe symptoms or if you belong to a high-risk-group. They want to be more generous now, because only half of the test capacity is used at the moment, but that's too late for me as my suspicious flu-like symptoms are long gone.

Concerning Northern Italy: I remember there was also a super-spreader detected at the end of February.  A young man who didn't have symptoms for two weeks, but who was a dedicated skiing fan who visited lots of skiing competitions in Northern Italy and Austria, as a spectator. He may have been responsible for many of the cases detected in March.

 

[rotting sea cow]

A bit related to the topic of the slow cases reduction in Italy and Spain.

Full lockdown policies in Western Europe countries have no evident impacts on the COVID-19 epidemic.

https://www.medrxiv.org/content/10.1101/2020.04.24.20078717v1

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This phenomenological study assesses the impacts of full lockdown strategies applied in Italy, France, Spain and United Kingdom, on the slowdown of the 2020 COVID-19 outbreak. Comparing the trajectory of the epidemic before and after the lockdown, we find no evidence of any discontinuity in the growth rate, doubling time, and reproduction number trends. Extrapolating pre-lockdown growth rate trends, we provide estimates of the death toll in the absence of any lockdown policies, and show that these strategies might not have saved any life in western Europe. We also show that neighboring countries applying less restrictive social distancing measures (as opposed to police-enforced home containment) experience a very similar time evolution of the epidemic.

I cannot judge how solid this analysis is, but it strict lockdowns are no better than more relaxed measures (paper doesn't argue for no mesaures), then Spain and Italy made a serious mistake.

[williamjm]

15 minutes ago, rotting sea cow said:

A bit related to the topic of the slow cases reduction in Italy and Spain.

Full lockdown policies in Western Europe countries have no evident impacts on the COVID-19 epidemic.

https://www.medrxiv.org/content/10.1101/2020.04.24.20078717v1

I cannot judge how solid this analysis is, but it strict lockdowns are no better than more relaxed measures (paper doesn't argue for no mesaures), then Spain and Italy made a serious mistake.

Some of the statements in it seem weird. It states several times that Sweden had implemented no social distancing measures, which I don't think is accurate since they had done things like banning large gatherings.

[Impmk2]

23 minutes ago, rotting sea cow said:

A bit related to the topic of the slow cases reduction in Italy and Spain.

Full lockdown policies in Western Europe countries have no evident impacts on the COVID-19 epidemic.

https://www.medrxiv.org/content/10.1101/2020.04.24.20078717v1

I cannot judge how solid this analysis is, but it strict lockdowns are no better than more relaxed measures (paper doesn't argue for no mesaures), then Spain and Italy made a serious mistake.

That's a non peer reviewed article from a single author who seems to be an oceanographer. I wouldn't put too much weight on it.

[Impmk2]

As to why Spain & Italy are taking so long to get their death rates under control? I'd say it's that they let it get to the point where their healthcare system was so overwhelmed, and the disease was so out of control, that just the tail on that curve continues to overwhelm their healthcare system and cause massive problems.

It takes up to a month for severe cases to clear post infection so this isn't a quick process. It's why not letting it get to that stage is very important.

 

[Paxter]

31 minutes ago, Impmk2 said:

As to why Spain & Italy are taking so long to get their death rates under control? I'd say it's that they let it get to the point where their healthcare system was so overwhelmed, and the disease was so out of control, that just the tail on that curve continues to overwhelm their healthcare system and cause massive problems.

It takes up to a month for severe cases to clear post infection so this isn't a quick process. It's why not letting it get to that stage is very important.

I think it's too early to judge their performance.

We have seen only one country (China) successfully navigate from triple-digit fatalities / day to a low number. Most other large countries are struggling to get off their peaks quickly. Germany, for example, has had a 7-day rolling average of around 200 fatalities / day for the last 20 days, with some positive movement recently but not a huge amount.

Italy's is now a bit below 500 / day after being closer to 1,000 a month ago (though they reported under 300 today). 

I'm not a fan of allegations that Spain and Italy have "let" things get to this stage. It feeds into some intellectually lazy stereotypes about Southern Europe. I also believe that, when all is said and done, countries like the UK and Belgium will have had as bad (or worse) experiences in this pandemic than their southern neighbours, particularly when you control for factors like median age. 

[Impmk2]

17 minutes ago, Paxter said:

I think it's too early to judge their performance.

We have seen only one country (China) successfully navigate from triple-digit fatalities / day to a low number. Most other large countries are struggling to get off their peaks quickly. Germany, for example, has had a 7-day rolling average of around 200 fatalities / day for the last 20 days, with some positive movement recently but not a huge amount.

Italy's is now a bit below 500 / day after being closer to 1,000 a month ago (though they reported under 300 today). 

I'm not a fan of allegations that Spain and Italy have "let" things get to this stage. It feeds into some intellectually lazy stereotypes about Southern Europe. I also believe that, when all is said and done, countries like the UK and Belgium will have had as bad (or worse) experiences in this pandemic than their southern neighbours, particularly when you control for factors like median age. 

If my language came across as judgemental I apologise, that really wasn't the intent of the post. Spain and Italy were hit very hard before any other western countries were taking this seriously.

My post was largely meant to push back on the premise that lock downs are ineffective based on the situation in those countries. It takes a long time to get this disease under control even with relatively harsh measures, it doesn't just vanish when you push R0<1, and the higher the baseline the longer it takes.

[A True Kaniggit]

Great news! 65,000+ people have not died in the United States from the virus. It's all a government conspiracy! The deaths have been faked to make President Trump look bad! At least, that's what this guy told me tonight.

 

What the hell is wrong with other human beings? 

Edit: That last question was rhetorical. I know what is wrong with them. It just pisses me off.