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Tywin et al.

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

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3 hours ago, Kalbear said:

There's some of it here - the Puyallup schools closed and Bothell schools closed for a bit after staff and a kid tested positive. This was super early in though, and we closed shortly afterwards. 

https://www.kiro7.com/news/local/coronavirus-washington-state-timeline-outbreak/IM65JK66N5BYTIAPZ3FUZSKMUE/

Thanks. The reports of these basically seem to be of the "some person tested positive, maybe" (the Bothell one was "a relative of someone who works here is maybe positive") and I can't find any further reporting providing evidence of any kind of clusters at these schools. Bothell's also a high school, and for Science Reasons that I am only vaguely familiar with it's primary and elementary schools that are recommended to be open, not high schools.

1 hour ago, rotting sea cow said:

This is weird. Unless a large fraction of the children are somehow immune,  I would have expected that COVID19 had already burned its way through Swedish schools and kindergartens and the families and teachers of these children. Who is then getting infected in Sweden? Which segment of the populace has more social contact than children to get infected faster?

People who work with others, people who use public transport, etc. 

Besides the fact that children's immune systems may be just very good at tackling this, children also are less likely to transmit it because they displace less air with their coughs, and with less force, so droplet transmission would be reduced.  There's this whole thing in pediatrics about how children don't necessarily cough in situations that would make adults cough, as well, and so far most kids who have been tested as having it seem to not cough or barely cough and so on.

 

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8 hours ago, Raja said:

Do you have a source for that?

That's totally fine, but in my experience, you have to do work with anything you read, weather that is something published in JAMA, NEJM, The Lancet etc - I don't think that is something unique to twitter or twitter threads. In my opinion, it is intellectually lazy not to look critically analyze the things you read, no matter the source. Going back to your point about physicians making mistakes, I totally agree, and that's why a healthy dose of skepticism is warranted when reading *anything*, including the aforementioned journals given the countless examples of completely bogus peer reviewed things that are published. I just think blanket statements regarding twitter threads don't really capture the nuance. To me, and maybe it's the way I use it, it is not a replacement for primary source information, but a very useful addition to it.

Well, initially, it was just a gut feeling which is why I stated that the number "seemed" low, but here's what I've found.  From page 24 of the "Surveillance of influenza and other respiratory viruses in the UK Winter 2018 to 2019" published by Public Health England:

Quote

Through the USISS mandatory scheme, a total of 3,157 ICU/HDU admissions of confirmed influenza were reported across the UK from week 40 2018 to week 15 2019, including 312 deaths, based on combined data from England, Scotland and Northern Ireland.

From page 21 of the "Surveillance of influenza and other respiratory viruses in the  UK Winter 2017 to 2018":

Quote

Through the USISS mandatory scheme, a total of 3,454 ICU/HDU admissions of confirmed influenza were reported across the UK from week 40 2017 to week 15 2018, including 372 deaths, based on combined data from England, Scotland and Northern Ireland.

These two winters already add up to greater than the 5782 cohort.  To complete the number, we would need part of the 2016-17 winter numbers (Week 1-15 2017) and part of the 2019-2020 winter numbers (Week 40-52 2019).  Conservatively, you can probably add at least a thousand to the total from the 2017-2018 and 2018-2019 reports to get to the 2017-2019 number.  Which brings me back to my original question.  How was the 5782 cohort selected?  The two sets of numbers don't match up.

I'm a skeptic by nature, so I tend to read everything with a grain of salt.  As you note, even peer reviewed papers can be wrong (for a variety of reasons from outright fraud, to poor experimental design, to poor interpretation of the results, to bad luck), and mainstream publications from reputable organizations, like the New York Times, can also be wrong.  That said, the peer review process and the fact-checking process make it less likely that junk gets through.  No one who reads a lot has time to fact check everything.  For me to fact check everything in that thread was frankly a waste of my time, but since I'm participating in this thread, I went through with it.  Imagine trying to fact check a long New York Times investigative piece.  Not going to try.  If something sticks out to me funny, maybe I'll do a little digging, but that's about it, but a lot of the time I'll just think "I don't know about that..." and move on.

Kalbear cited another twitter thread, from another tweeter that I'm not familiar with.  Her tweets seemed generally reasonable, so I'm not going to bother fact checking everything.  The problem with this though is it risks confirmation bias if I only fact check things I disagree with or think might be wrong.

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https://www.nytimes.com/2020/05/05/us/coronavirus-deaths-cases-united-states.html?

But nevermind let us lie all over the place, including the gov of Nebraska + other rethug govs writing in the WaPo about what a great job they've done in keeping the bug away, unlike those states with Dem govs.

Shutting down the joke they called a pandemic taskforce because, you know folks, just like the deathcultists promised, it's all over with.  Translate these things and what is really being said is that all of us should be taking a chance of dying or life diminishment forever so he can tickle the stock market and get re-elected.  That's the only value for Them -- we all die, all we useless people of color, poor, elderly, disabled in any way, etc.  Just no point in us other than to help Them get richer.  If that isn't what THEY are saying -- what are They saying because everything They say out loud and in public is a lie.  Except this time they aren't even bothering to pretend.

 

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Posted (edited)
3 hours ago, Mudguard said:

Well, initially, it was just a gut feeling which is why I stated that the number "seemed" low, but here's what I've found.  From page 24 of the "Surveillance of influenza and other respiratory viruses in the UK Winter 2018 to 2019" published by Public Health England:

From page 21 of the "Surveillance of influenza and other respiratory viruses in the  UK Winter 2017 to 2018":

These two winters already add up to greater than the 5782 cohort.  To complete the number, we would need part of the 2016-17 winter numbers (Week 1-15 2017) and part of the 2019-2020 winter numbers (Week 40-52 2019).  Conservatively, you can probably add at least a thousand to the total from the 2017-2018 and 2018-2019 reports to get to the 2017-2019 number.  Which brings me back to my original question.  How was the 5782 cohort selected?  The two sets of numbers don't match up.

Two points to note here - Firstly, I also had a look at the papers that you have linked above - the data there includes Scotland whereas the ICNARC does not ( It includes England, Wales & Northern Ireland but excludes Scotland).

We could probably figure that one out if we really wanted to, but I think his broader point re: increasing ICU capacity because COVID 19 has caused a surge in ICU admissions that is equivalent to a couple of winters worth of flu cases stands. As I said, it's the best national level ICU data ( at least the English speaking ones) I have seen so far, which in turn allows us to compare the two diseases whilst being cognizant of the fact that there are limitations ( Just like we would for articles appearing in peer reviewed work) and why I think the ICNARC data is quite useful.

The argument from me is not that twitter or twitter thread replace peer reviewed work, but that it's a platform that when used correctly is a useful adjunct. As I stated in  my original comment, twitter is good when you have experts distilling information down to a level that someone outside their profession can understand because lets face it, a lot of people have very little experience with good methodology when it comes to medical research ( It is less good when you have threads regarding 8 units of blood without much else to go off of - amplifying those leaves me uneasy)

( I also think familiarity with a person means little, at least for me, but ymmv on that)

Edited by Raja

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This is an excellent set of tools and education on how the whole modeling system works and what things like R0 and R and why we care about this means - as well as what certain plans do to impact the models:

https://ncase.me/covid-19/?fbclid=IwAR011ciQjOM6Sl2ev370_MN09b20iC8rue5SQA6u2cEb9TlGt-HioH0DsSc

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9 hours ago, Ran said:

First I've heard of this. Any thing I can Google on it? I'd be curious about primary and elementary school cases, specifically. And day cares, I suppose. I've tried searching and am coming up with nothing along those lines, except for very early cases of "We closed because one person was/maybe was sick" and no real evidence of clusters of infections associated with these situations.

Australia seems to have had a similar experience to Sweden, FWIW.

True, but New Zealand's second largest cluster was in a school.  

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9 hours ago, Ran said:

Besides the fact that children's immune systems may be just very good at tackling this, children also are less likely to transmit it because they displace less air with their coughs, and with less force, so droplet transmission would be reduced.  There's this whole thing in pediatrics about how children don't necessarily cough in situations that would make adults cough, as well, and so far most kids who have been tested as having it seem to not cough or barely cough and so on.

What I'd seen on this front is that things which impact the lungs in adults can attack the digestive tract in children instead, and that this is being seen in cases of covid amongst kids. Unfortunately I don't still have the link handy but it also talked about something like "covid toes" with kids having toes turn bright red or purple due to... Some other effect I'm forgetting.

Also I'd be wary of drawing any conclusions from the lack of spread in Australian schools, we have had only a little sustained community spread and over 50% of parents pulled their kids out of school before the formal shut down. You need to bear in mind that a big chunk of our cases, particularly the big spike, was due to cases from the Ruby Princess cruise ship, along with a couple of others, and the first wave of infections from those on the cruise ship that were allowed back into the community.

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Posted (edited)
5 hours ago, ants said:

True, but New Zealand's second largest cluster was in a school.  

Marist College, a high school, yes. My understanding is there's an associated elementary school where there have been cases, but these seem to be household transmission (older siblings passing it to parents and younger siblings). 

 

@karaddin

Sure, but this is the experience in other places. Not just Sweden, France as well for certain, and countries in Europe that shut down schools are reopening them because the incidence in serious illness in children is so rare.

Edited by Ran

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It's definitely a claim I've seen made in a number of places, including in the media here as well - I'm just saying our experience isn't really data towards either side in this.

There's also cross cultural confusion caused by some of the ways it's talked about, we only have 2 levels of school in Aus so when someone is talking in the American context and says "primary and elementary" that sounds like you're talking about all of school, and there is data showing the risk at 16 the risk is more aligned with regular adults so there is more push back on that. In reality the two schools you were talking about when you used that phrase earlier excludes those 16+ because those are in "high school" in that context. 

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Posted (edited)
11 hours ago, DaveSumm said:

Is there any convincing explanation yet for why the non-Covid death rate is so high? I hoped that there might be a silver lining here, surely vehicle accidents must be down? Maybe work place related accidents? It seems strange that it’s pushing up the figure up so much, unless of course they later transpire to be Covid after all.

Undiagnosed / misdiagnosed COVID cases

Patients being unwilling to "burden" the NHS with their problems leading to delayed diagnosis & treatment

Patients being scared to go out, or request repeat prescriptions, so are reducing their dose without consultation

Patients requiring urgent care, but there's no capacity to take them, or care arrives too late

Patients seeing ANOther therapist, who might pick up on a warning sign for something that the patient would otherwise ignore / not know about

Rise in domestic violence and suicide due to lockdown

 

All of which are still related to Covid-19 - which is why I feel they're the most useful statistic of the lot - not to mention that the total excess deaths is the one thing we can be pretty sure of (though the excess is likely higher, as they'd been lower for the year before covid arrived, and other causes of death SHOULD be reduced).

Edited by Which Tyler

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11 hours ago, Ran said:

 

Besides the fact that children's immune systems may be just very good at tackling this, children also are less likely to transmit it because they displace less air with their coughs, and with less force, so droplet transmission would be reduced.  There's this whole thing in pediatrics about how children don't necessarily cough in situations that would make adults cough, as well, and so far most kids who have been tested as having it seem to not cough or barely cough and so on.

 

 

In the Heinsberg/Gangelt study

(https://www.ukbonn.de/C12582D3002FD21D/vwLookupDownloads/Streeck_et_al_Infection_fatality_rate_of_SARS_CoV_2_infection2.pdf/%24FILE/Streeck_et_al_Infection_fatality_rate_of_SARS_CoV_2_infection2.pdf)

they found that household transmission was low and related to household size:

"A significant association between household cluster size and the per-person infection risk was found (Fig. 5B, p<0.001). In a two-person householdcluster, the estimated risk for the second infection increasedfrom 15.53%to43.59% [25.26%; 64.60%]; in a three-person householdclustertheestimatedrisk for the second and third personsincreasedfrom 15.53%to35.71% [19.57%; 55.60%] each, and in a four-person household cluster the estimated risk for the second, third and fourth personsincreasedfrom 15.53%to18.33% [9.67%; 28.74%]each."

 

why is not everyone infected in a household if it is so infectious? Why were less people infected if the household size was bigger (that could be related to infection risk of children)?

There was this other interesting study about background immunity, showing that antibodies for other coronaviruses react similar.

Perhaps children are more likely to have had the common cold more often in the past 1 or 2 years and are a little bit protected (this is only my reasoning no source )

 

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3 hours ago, JoannaL said:

why is not everyone infected in a household if it is so infectious?

This is something I'd really like to know. I've heard anecdotes of whole households infected (down to the cat and the dog) and others that one or two family members are infected, sometimes even skipping the grandmother, but more often the children.  Is there someone really looking at this? It might be the key to fight the disease.

3 hours ago, JoannaL said:

There was this other interesting study about background immunity, showing that antibodies for other coronaviruses react similar.

Well, this is very interesting. Maybe all what we need is to get a cold a few times a year. ;-)

3 hours ago, JoannaL said:

Perhaps children are more likely to have had the common cold more often in the past 1 or 2 years and are a little bit protected (this is only my reasoning no source )

 

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While we are throwing studies/theories around, I thought this one was pretty interesting. 

If you can't be bothered reading, the nutshell is: older people are more susceptible to SARS-CoV-2/COVID-19 because their bodies learned an "incorrect" response to the virus at an earlier stage of life. 

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so Merkel met the state governors today and she is just presenting the results:

more or less : this is it ! in the next few weeks we will slowly end the lock-down (small differences between states)

then we will have a management similar to Sweden (social distancing, no big events) but with face masks

and a regional county -wide new lock-down mechanism:

if a county has more than 50 new cases/100.000 people (avarage over 7 days, so about 7 a day) it goes automatically in lock-down again

 

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16 hours ago, Ran said:

People who work with others, people who use public transport, etc. 

Besides the fact that children's immune systems may be just very good at tackling this, children also are less likely to transmit it because they displace less air with their coughs, and with less force, so droplet transmission would be reduced.  There's this whole thing in pediatrics about how children don't necessarily cough in situations that would make adults cough, as well, and so far most kids who have been tested as having it seem to not cough or barely cough and so on.

Ok fine. Children are less susceptible, we still need to find out why.  But what about high schoolers? What about university students? Are they really social distancing in their classes, accommodations, parties, etc? Where are the outbreaks? Who are those 20% of infected in Sweden? Random people or some particular segments of the society?

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Posted (edited)

I’ll throw in another theory here.

Covid-19 creates inflammation in the body, particularly attacking blood cells. I don’t have a science background, excuse me if I use the wrong terminology here. As a result, we are seeing blood clots and strokes and damage to many organs. I have repeatedly seen doctors comment that we are still missing vital information about the mechanics of the way it attacks the body and blood cells in particular.

eta: I was struck by an interview with a surgeon who was operating on a patient (with Covid-19) who had a blood clot in his brain, who said as he removed the blood clot he watched more clots form before his eyes, something he had never seen before.

Your body deteriorates with age, the walls of blood vessels weaken. Children have strong, yes, young, blood cells, so the virus doesn’t get in. As we age our blood cells get weaker and the virus has greater and greater success, and so the deaths rise with age.
 

I am going to be fascinated with the reports on how the virus works that are going to come rolling out over the next few years, if, by God’s grace, I manage to survive that long. As someone who has battled with weight problems for years (fortunately almost entirely with being overweight and avoiding becoming obese) I have constantly read about issues with inflammation, and the links to sugar and carbs. It will be interesting to see if there’s a link made between obesity and inflammation and the virus, since obesity seems to be an important risk factor.

Edited by Fragile Bird

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My locality had a nice couple-week stretch where more and more people were wearing masks to the stores, coming together with online faith stuff on Sunday mornings, E-Proms and all that. The first few weeks of shutdown had stunning weather, which may have helped distract people. Then it was cold and rainy for awhile, so it was easier in a way to stay in and safe. 

Now it's really nice again, and my town seems to have wholly discarded any adherence to world-recommended responses. Our town's facebook group is generally a very polite place full of lost-dog posts, links to new businesses, reunions, that sort of thing. There are a handful of useful posts shared there daily, like local statistics and town hall reports. By exponential numbers, any post mentioning "We need to get back" is overwhelmingly flooded with support. Today one came up literally mocking mask-wearers, and like forty people had commented on it before it an admin removed it. 

Someone I know in the restaurant world put a joke up on their wall about opening their joint for a private party, and a good eight or ten people I consider friends all responded positively. One said "Just no pictures guys". 

I think that if vomit-spewing, pus-leaking zombies were shuffling down the streets due to a virus, millions of Muricans would still not wear a simple goddamn mask to buy their White Claws and frozen pizzas. 

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5 hours ago, Fragile Bird said:

I’ll throw in another theory here.

Covid-19 creates inflammation in the body, particularly attacking blood cells. I don’t have a science background, excuse me if I use the wrong terminology here. As a result, we are seeing blood clots and strokes and damage to many organs. I have repeatedly seen doctors comment that we are still missing vital information about the mechanics of the way it attacks the body and blood cells in particular.

eta: I was struck by an interview with a surgeon who was operating on a patient (with Covid-19) who had a blood clot in his brain, who said as he removed the blood clot he watched more clots form before his eyes, something he had never seen before.

Your body deteriorates with age, the walls of blood vessels weaken. Children have strong, yes, young, blood cells, so the virus doesn’t get in. As we age our blood cells get weaker and the virus has greater and greater success, and so the deaths rise with age.
 

I am going to be fascinated with the reports on how the virus works that are going to come rolling out over the next few years, if, by God’s grace, I manage to survive that long. As someone who has battled with weight problems for years (fortunately almost entirely with being overweight and avoiding becoming obese) I have constantly read about issues with inflammation, and the links to sugar and carbs. It will be interesting to see if there’s a link made between obesity and inflammation and the virus, since obesity seems to be an important risk factor.

We don’t fully understand why inflammation disorders lead to blood clots. It’s common with lupus (a major issue with me, I get small blood clots that burst in my legs so I always have a few bruises and I have to measure my legs to check for dvts). It was explained to me as having proteins in the blood that cause more clotting, not anything attacking blood vessels themselves or blood cells. I would imagine the Covid 19 problems to be similar or the same. I also think that’s why you have the stupid Dr Oz anecdotal people with lupus don’t get it thing, because a lot of what is described are already things lupus patients experience every day. Also with our shitty immune systems, we are much more careful.

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615 deaths in Brazil. Only surprise is how long it took to get to the higher end of the daily deaths totals with that fuckwit in charge. 

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