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

[williamjm]

4 minutes ago, Raja said:

Just to put a little context behind this as I'm seeing a lot of 'Look, Singapore strategy of contact tracing etc isn't working either so we have no options' (Not saying you are saying this specifically, but it's defo a take away going around).

I lived in Singapore for a decade and their abhorrent treatment of migrant workers ( mostly from South Asia) is the reason why they have had such a spike of cases, I don't think it is necessarily a reflection of the drawbacks of their overall strategy, but not having the foresight to recognize an at risk group.

These migrants live in dorms, and *very* cramped dorms with bunk beds, they are overcrowded, full of men, don't have adequate cleaning supplies. Rooms can have 30 men, with 80 men sharing one toilet which isn't clean. They are shunned to the outskirts of the city so they are out of the way and out of mind of the citizens of the country.

This cluster has exploded the way it has because of neglect, acceptance that brown & black people can live like this, and general ignorance and hostility towards migrant workers.

It does feel like a crisis like this can really expose the existing weaknesses in societies. Sadly, I fear plenty of other countries have similar blind spots although maybe they can learn something from Singapore's mistake.

[Raja]

14 minutes ago, williamjm said:

It does feel like a crisis like this can really expose the existing weaknesses in societies. Sadly, I fear plenty of other countries have similar blind spots although maybe they can learn something from Singapore's mistake.

Totally agree. It is weird, yet utterly predictable, that the Singapore government didn't heed the warnings by rights groups given that these concerns were raised in Feb and March.

It isn't a small number, Singapore employs roughly a million migrant workers, which is 1/5 of their total population and 300,000 living in places like the one I described. And access to healthcare is an even bigger issue.

 

[Kalbear]

In general, this has revealed that most governments have a lot of blind spots, there are a lot of failures and this will expose them well, and in general (but specifically in the US) governments are perfectly fine ignoring pain and death as long as most people don't experience it. 

[Werthead]

Interesting thread here on how the cytokine storm works, particularly the note on how one young person needed eight blood transfusions in one morning because their body could not produce enough to keep up with what it was being put through.

There's also another reiteration of how many people are coming off ventilators and then needing dialysis because their kidneys have taken a pounding from the virus as well. This thread doesn't even mention the number of people (of all ages) who are emerging with probably permanent lung damage, which may eventually kill them a few years down the line (and long before their time otherwise).

The "we're just going to have to take it on the chin" people do need to explain how society is going to handle the colossal amount of long-term medical damage that the virus does even to some of the people who survive.

[Conflicting Thought]

6 minutes ago, Werthead said:

and colds are caused by other-but-related coronaviruses, so it's most likely a conflated reading from that.

I think colds are caused by rhinoviruses, right? 

[Impmk2]

11 minutes ago, Conflicting Thought said:

I think colds are caused by rhinoviruses, right? 

Colds are caused by a variety of largely upper respiratory viruses. Corona virus strains account for approx 15%

[Zoë Sumra]

12 minutes ago, Conflicting Thought said:

I think colds are caused by rhinoviruses, right? 

A stack of rhinoviruses and two coronaviruses. There's been speculation that so few children are getting COVID because they spend all their time passing other coronaviruses around.

[Ormond]

19 minutes ago, Conflicting Thought said:

I think colds are caused by rhinoviruses, right? 

Here is a link to a Scientific American article which says in the first paragraph that about 20% of common colds are caused by four milder types of coronavirus:

https://www.scientificamerican.com/article/how-coronaviruses-cause-infection-from-colds-to-deadly-pneumonia1/

[BigFatCoward]

1 hour ago, Werthead said:

Based on what we know of the speed and spread of the virus, it seems highly improbable. If there were cases in France in December, it would have been in the full swing of the pandemic a good six to eight weeks before actually was the case, unless the initial people infected didn't spread it to anyone else for some reason.

We did have a bad cold season at the end of last year and the start of this, and colds are caused by other-but-related coronaviruses, so it's most likely a conflated reading from that.

It is interesting seeing health care professionals in several countries preparing to go on strike because of inadequate supplies of PPE. If economies reopen and we simply let the cases flow in and bodies be piled high on the streets outside, I can see doctors and nurses simply refusing to work because what's the point? If the government has committed to a policy of letting the virus sweep through the population and kill millions, then all the doctors and nurses can do is save a relatively small number against the overwhelming risk of themselves being killed because they have no protective gear.

Because that's why we sign up. 

That being said, in the month after the riots I worked nonstop and eventually my body just crashed,  that is the most worrying issue, there is no sign of any let up with this. 

[The Anti-Targ]

7 hours ago, Ran said:

26% reduces R from 1 to R .74. It reduces R 2 to R 1.48. And so on.

 

 

 

Like I said, not even close to herd immunity.

[Ran]

22 minutes ago, The Anti-Targ said:

Like I said, not even close to herd immunity.

That's not actually what you said.

What you said is this:

Quote

There is no meaningful herd immunity at 26% infection rate in a virus that has a R0 of 2+ without infection control measures being taken.

Emphasis mine.

Which was in response to my noting that the reduction of deaths, ICU usage, and hospital bed usage in Stockholm was likely evidence of the effect of ~26% being infected since our strategy has been unchanged since March and yet the trend is downward.

The "without infection control measures" thing was a non sequitor since no one has claimed Sweden has not taken control measures.

 

[Impmk2]

Decent 538 (of all places) article on the likely origins of sars-cov-2:

https://fivethirtyeight.com/features/why-scientists-think-the-novel-coronavirus-developed-naturally-not-in-a-chinese-lab/

Main points:

a) The shift in the spike protein are unlike anything that have been characterised before, and unlike any pathogen the Wuhan lab is known to be working on.
b) The Wuhan lab has be remarkably forthcoming with information about the virus and its work on it. This is completely against the MO of the Chinese Communist Party if it suspected the lab was the source for it. They'd clamp down on the lab hard and they wouldn't be speaking to anyone.
c) Around 3% of the bats in the region have antibodies for corona viruses closely related to SARS. They're completely uncontrolled so that's a far, far more likely source.

I think people are confusing what's possible and what's likely. Yes it's possible for something to escape a lab. But there is a far, far more likely explanations. And tbh the only reason this is getting play is because it suits the political interests of Trump who's looking for someone to shift the blame to. Frankly I think it'd be far more useful from a public health perspective to encourage China in its efforts to police the wildlife trade.

[Mudguard]

1 hour ago, Werthead said:

Interesting thread here on how the cytokine storm works, particularly the note on how one young person needed eight blood transfusions in one morning because their body could not produce enough to keep up with what it was being put through.

There's also another reiteration of how many people are coming off ventilators and then needing dialysis because their kidneys have taken a pounding from the virus as well. This thread doesn't even mention the number of people (of all ages) who are emerging with probably permanent lung damage, which may eventually kill them a few years down the line (and long before their time otherwise).

The "we're just going to have to take it on the chin" people do need to explain how society is going to handle the colossal amount of long-term medical damage that the virus does even to some of the people who survive.

I'm going to have to echo Scott in my hate of twitter, particularly the growing citation of twitter posts or twitter threads in a discussion.  In general, I assume that all twitter posts have zero vetting or fact-checking behind them, and many times I have no idea who the author is.  The twitter poster here, who I am not familiar with, claims to be a tv and screenwriter and best-selling author whose dad is a doctor.  Apparently she writes for Jimmy Kimmel Live.  Not sure why I would want to read anything she has to say about cytokine storms. 

From perusing the tweet thread, I barely see any mention of cytokine storms.  She suggests that it's something that hits young people just as they are getting better after getting off a ventilator, and then boom, the cytokine storms hits and destroys your lungs.  Other tweets talk about how the coronavirus can just eat up a person's red blood cells.  Severe anemia/low red blood cell counts aren't really something I've heard about with respect to COVID-19.  No citation is provided for anything in the thread.  

[Raja]

I'm fine with twitter threads - most of the information posted by me in thecovid thread have been by physicians who make clear links to academic literature or primary sources. For me, as long as I can read that, then I'm okay with that, but as Mudguard says above, it's hard to really draw any sort of conclusions on that specific thread given 1. We don't have specifics 2. The person doesn't really seem qualified to talk the subject. I am curious about this though so I'm going to do some digging and see what I can find.

As an aside, if people want really good, reliable data (especially if you're in the UK ) about COVID 19 patients in the ICU, ICNARC is the place to go - it's the the Intensive Care National Audit and Research ( ICNARC) center in the UK that has been putting out weekly reports since this all began, currently the report covers 7000 COVID 19 patients that ICUs in the NHS have treated. These can be found here

Here's an intensivist in the NHS summarizing parts of the report that came out in late April - IMO, this is the value of twitter & twitter threads, where experts can summarize primary source information that is either too granular or beyond the expertise of people not in the field.

 

[The Anti-Targ]

4 hours ago, Ran said:

That's not actually what you said.

What you said is this:

Emphasis mine.

Which was in response to my noting that the reduction of deaths, ICU usage, and hospital bed usage in Stockholm was likely evidence of the effect of ~26% being infected since our strategy has been unchanged since March and yet the trend is downward.

The "without infection control measures" thing was a non sequitor since no one has claimed Sweden has not taken control measures.

 

Since you are playing semantics "like I said" means similar to what I said previously not the same as. "No meaningful herd immunity" is like "not even close to herd immunity" in that they are both statements affirming that herd immunity effect of a 26% infection rate is not substantial and unlikely to explain a significant decrease in disease stats.

There are potential reasons for the decrease that have nothing at all to do with the 26% infection rate. Including that despite no change in govt policy or guidelines people may have been watching infection numbers and death rates go up and are choosing to be more diligent in social distancing. And in terms of hospitalisation and death it could be that aged care facilities are finally getting things under control which will decrease hospitalisation and deaths even if infection in the wider population remains constant. Observing an estimate of 26% infection and a decrease in hospitalisation and death and claiming one is causing the other is definitely oversimplifying and probably overstating.

The interesting thing about the infection rate estimated by the IgG testing is that it actually correlates well with the estimate that CFR ~0.37. On current deaths in Sweden, assuming the recorded deaths is reasonably close to the actual deaths the total country infection rate is estimated to be about 750K, and with the proportion of confirmed cases in Stockholm being about 37% of all confirmed cases this works out to about 23% infection rate in Stockholm. So this provides some pretty good supporting evidence of the expected CFR in populations with good healthcare systems that have not been overwhelmed.

But if that is generally true of such populations then the official case numbers for Aussie and NZ are less than half the actual number of infected people. So the fact that we appear to be firmly on the road to eradication (2 days running with 0 new cases with still a reasonable rate of daily testing) seems like quite good luck that over 1500 people got infected that nobody knows about but did not contribute to any community spread.

Less good news form here, there seems to still be reports of racist behaviour towards ethnically Asian people. Hopefully that's the media overblowing small numbers of badly behaved people.

[A True Kaniggit]

https://www.bbc.com/news/world-us-canada-52540266

Someone actually got murdered for trying to enforce the rule on wearing masks in Michigan. 

WTF?! 

[Which Tyler]

UK's excess deaths figures - updated today, and as of 10 days ago. Also included is FT's comparison to the same figures for other countries - last updated on 01/05/20
 

 

[Meera of Tarth]

12 hours ago, Impmk2 said:

I think people are confusing what's possible and what's likely. Yes it's possible for something to escape a lab. But there is a far, far more likely explanations. And tbh the only reason this is getting play is because it suits the political interests of Trump who's looking for someone to shift the blame to. Frankly I think it'd be far more useful from a public health perspective to encourage China in its efforts to police the wildlife trade.

Not going on Trump's defense, but I've read about that hypothesis by some journalists in Spain a month ago, beforeTrump said anything. Apparently some bats beat some investigators.

[A True Kaniggit]

1 minute ago, Meera of Tarth said:

Not going on Trump's defense, but I've read about that hypothesis by some journalist in Spain while back Trump said anything. Apparently some bats beat some investigators.

Well yeah. You ever been hit by a bat?  It hurts.

[HexMachina]

2 minutes ago, A True Kaniggit said:

Well yeah. You ever been hit by a bat?  It hurts.

I'm picturing both kinds of bats here and both seem like they would be painful...