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

[A True Kaniggit]

3 minutes ago, HelenaExMachina said:

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

Imagine being beat by a bat that had a bat.

Pain = Bat²

[HexMachina]

Just now, A True Kaniggit said:

Imagine being beat by a bat that had a bat.

A bat batting me around the head with a bat? But which bat is doing the batting?

 

 

[Mudguard]

9 hours ago, Raja said:

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.

That a tweet is from an alleged MD (or PhD, JD, etc.) doesn't mean much to me.  I've never heard of Nitin Arora, so as far as I'm concerned, he's just a random internet guy like the rest of us.  It's a pain to have to try and confirm the credentials or lack thereof of a tweeter.  I agree though that if citations are provided in the tweet to reliable sources of information, that is much more useful.

Even assuming that he is an MD, I still don't place that much stock in what is said in tweets, due to the presumed lack of fact-checking or review process that takes place before some random person posts a tweet.  How much time did this guy spend reading and thinking about that report before tweeting?  Did he post this during his 15 minute break?  Who knows.  MDs make mistakes all the time just like other people.  And because I've seen way too much junk in tweets, I feel compelled to fact check everything, which is exhausting.  Much easier to just rely on more reliable sources.

Looking at one of the first posts in the thread, he states that:

Quote

As you can see here, we have seen more patients with #COVID19 admitted to ICUs nationally, than the total number of viral pneumonias (mainly flu) in 3 years.

For support he circles a Table in the ICNARC report that breaks down the demographics of 6720 critically ill patients with confirmed COVID-19 and compares it with the demographics of a cohort of 5782 critically ill patients with viral pneumonia from 2017-2019.  I have a couple issues/questions with this tweet. 

Is that 6720 (updated to 7542 in the May 1st report) number really the national total as suggested by the tweet when the UK has recorded over 28000 deaths?  Reading the ICNARC report, it states that the numbers are compiled from critical care units participating in the Case Mix Programme (the national clinical audit covering all NHS adult, general intensive care and combined intensive care/high dependency units in England, Wales and Northern Ireland, plus some additional specialist and non-NHS critical care units).  Would this capture ALL critical care admissions in the UK?  Or just a sampling to perform the audit?

Second issue is with the 5782 number which is claimed to be the total number of viral pneumonias in 3 years, presumably also the national total.  That just seems low to be a national number for critical care influenza cases in the UK over a three year period.  The report itself just states that the 5782 number is an historic cohort of patients critically ill with viral pneumonia (non-COVID-19) admitted between 1 January 2017 and 31 December 2019.  It doesn't state that the 5782 number is a national total, or anything else really.  It's not clear from the report how this cohort was selected.  Was it from the same set of hospitals that reported the COVID-19 data?  Or a different set of hospitals?

Maybe he is right with everything.  Or maybe his conclusion is sound even though statements about the numbers were a bit off.  Or maybe he's just wrong.  It's not immediately obvious where he falls in this spectrum without a lot of work.

Do I want to go through this exercise with all the other tweets in the thread?  No, so I'd prefer to just get my information from other sources.

[A True Kaniggit]

Just now, HelenaExMachina said:

A bat batting me around the head with a bat? But which bat is doing the batting?

 

 

The bat.

[Impmk2]

24 minutes ago, Meera of Tarth said:

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.

Sure. People have been pushing the theory since like, January. There was some random guy in one of the early covid threads on this board who was big into it.

But it wasn't getting much traction in any kind of mainstream way until Trump jumped on board and started promoting it.

[Meera of Tarth]

17 minutes ago, Impmk2 said:

Sure. People have been pushing the theory since like, January. There was some random guy in one of the early covid threads on this board who was big into it.

But it wasn't getting much traction in any kind of mainstream way until Trump jumped on board and started promoting it.

Exactly

[Meera of Tarth]

53 minutes ago, A True Kaniggit said:

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

It's this one apparently:

news source: https://www.marca.com/tiramillas/2020/04/23/5ea18bcb46163fd4248b45b0.html

Translation:

http://translate.google.com/translate?sl=es&tl=en&u=https%3A%2F%2Fwww.marca.com%2Ftiramillas%2F2020%2F04%2F23%2F5ea18bcb46163fd4248b45b0.html

YouTube, original source (Spanish): 

 

 

[Raja]

48 minutes ago, Mudguard said:

  MDs make mistakes all the time just like other people. 

Totally. I think it is a mistake to read things, especially during these times without at least having a little bit of curiosity or skepticism about the things one is reading. Taking threads or news articles, as gospel is not something I'm advocating.

48 minutes ago, Mudguard said:

Would this capture ALL critical care admissions in the UK?  Or just a sampling to perform the audit?

I think when you're approaching a number that is 7000 in their latest report, it is enough to make inferences based on that data given - at the moment I haven't looked up if that covers ALL ICU cases in the NHS, but it covers enough that I feel comfortable looking at the data and making *some* inferences whilst being cognizant of limitations. Again, I think it is practical to not take *everything* at face value all the time.

Regarding their data - 99% of all adult, general, critical care units (ICU and ICU/HDU) in England, Wales and Northern Ireland participate in the CMP program, which is why I am comfortable looking at their data, in addition, they are part of the National clinical audits that the NHS runs. I have yet to see a more detailed report on ICU admissions from anywhere else, I tried looking at Sweden's reports, but twas all in Swedish. I'm sure there is a NYC or US one somewhere, but I haven't come across it. There *was* a paper in JAMA about ICU admissions in NYC, but it was a cross sectional study that wasn't being updated weekly.

48 minutes ago, Mudguard said:

 That just seems low to be a national number for critical care influenza cases in the UK over a three year period. 

Do you have a source for that?

48 minutes ago, Mudguard said:

Do I want to go through this exercise with all the other tweets in the thread?  No, so I'd prefer to just get my information from other sources.

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.

[Ran]

Seems like the Australian intelligence service is batting back Pompeo's claims of "enormous" intelligence information pointing to a lab-related situation, noting that the document the US has been circulating among the Five Eyes intelligence sharing group is mostly just rehashed news stories with no actual new intelligence work.

In other news, Slovenia will be releasing full official results tomorrow, but they've publicized that their first national test for antibodies -- some 1300 participants -- found between 2% and 4% had antibodies at a 95% confidence interval. The samples were taken from April 20 "and onwards", but not sure what the median date is. 

[mcbigski]

18 hours ago, Fragile Bird said:

Did I have Covid-19? Or some mutation? I actually suspect that in early April I caught Covid-19, because of dry cough, shortness of breathe, weird aches and pains, and strange and aweful paranoia at night (which I have heard people with confirmed cases report).

Whatever was going around in December/January was something weird.

What's the availability of anitbody tests in Ontario?  To be sure, that's another politicized topic these days, but if I had that many symptoms, I would like to know if I had much less to worry about as far as catching the virus and spreading it.

16 hours ago, Werthead said:

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.

Unless prayer for vaccine is guaranteed effective, we're going to end up with roughly the same amount of long term medical damage in either case, as long as the number of cases are kept below treatment capacity.   We can't pretend that only one side of the wager has a cost in lives.  I'm on the side of the argument that in areas where medical resources are being underutilized, the optimal choice is the heighten the curve a bit and take it on the chin.  While the alternative isn't quite "we all stay home and starve to death" there are significant costs either way.  Keep an eye on Sweden, compare Georgia to Virginia over the next month or so, and we'll have more data.

14 hours ago, Mudguard said:

  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.  

That was a rumor going around a month or so ago, haven't seen much follow up on it, and thought at the time, that if there's something to that, it would be straightforward enough to see. 

[Luzifer's right hand]

8 minutes ago, mcbigski said:

Unless prayer for vaccine is guaranteed effective, we're going to end up with roughly the same amount of long term medical damage in either case, as long as the number of cases are kept below treatment capacity.   We can't pretend that only one side of the wager has a cost in lives.  I'm on the side of the argument that in areas where medical resources are being underutilized, the optimal choice is the heighten the curve a bit and take it on the chin.  While the alternative isn't quite "we all stay home and starve to death" there are significant costs either way.  Keep an eye on Sweden, compare Georgia to Virginia over the next month or so, and we'll have more data.

Swedes don't have to fear life destroying personal debts caused by a massively overpriced for profit system though. The damage to personal finances caused by a few months of reduced or no income are nothing compared to the financial damage medical treatment can cause in the US. Lives will be destroyed even if people manage to recover fully from a health point of view.

[Loge]

On the herd immunity thing: I don't want to enter a controversy over the right use of the word, but if you look at a Kermack-Mc Kendrick SIR model, the point where 26 % of the population are immune is actually very close to where the number of active cases / infected persons peaks. So if that estimate is correct, Sweden can indeed expect the number of cases to fall. 

https://de.wikipedia.org/wiki/SIR-Modell#/media/Datei:SIR-Modell.svg

[DireWolfSpirit]

Wtf, the covid is now making Russian Dr's fall out windows?

Three Russian doctors fall from hospital windows, raising questions amid coronavirus pandemic

https://www.cnn.com/2020/05/04/europe/russia-medical-workers-windows-intl/index.html

Authoritarian governments in action, the story sounds like a Sopranos scene.

[Ran]

2 hours ago, Luzifer's right hand said:

Swedes don't have to fear life destroying personal debts caused by a massively overpriced for profit system though.

 

Yep. Social safety nets need to be very high to get people to behave properly. In Sweden, you get sick leave payments (80% of regular salary) from day 1, without any need for a doctor's note for at least two weeks -- we simply trust people who say they have any kind of symptoms associated with SARS-CoV-2 (e.g. even just a minor cough or sneezes) are being honest, and are doing the right thing by taking time off work.

Most of the US isn't in that position. You can't do everything in Sweden's approach because conditions in the US are not very like Sweden's in terms of healthcare.

Reopening primary and elementary schools is about the only thing I'd recommend for the US. There is no evidence of schools in Stockholm, our hardest-hit city, causing clusters of infection. In all this time with open schools, we've only had an issue at one school, in the small city of Skellefteå. There a teacher died and 18 of the staff were found to have or have had infection, but from the examinations and interviews they've taken it was the teachers passing it among themselves from  their interactions in meetings, the teacher's lounge, and in the offices. Obviously, reopening schools would require some efforts to change conditions for teachers and staff, re: where they hold meetings, how many adults in a room, etc. Care needs to be taken.

Regular schooling is very important developmentally, and for many children in the US it is an important part of their food security (through subsidized breakfast and lunch) and in some cases their personal safety (re: domestic violence and child abuse). Epidemiological estimates from Sweden and Norway's health authorities believe that only 2-4% less spread would happen from school closures, and so far this appears to be born out, which is why Denmark and Norway were reopening schools.

 

[Kalbear]

36 minutes ago, Ran said:

Reopening primary and elementary schools is about the only thing I'd recommend for the US. There is no evidence of schools in Stockholm, our hardest-hit city, causing clusters of infection. In all this time with open schools, we've only had an issue at one school, in the small city of Skellefteå. There a teacher died and 18 of the staff were found to have or have had infection, but from the examinations and interviews they've taken it was the teachers passing it among themselves from  their interactions in meetings, the teacher's lounge, and in the offices. Obviously, reopening schools would require some efforts to change conditions for teachers and staff, re: where they hold meetings, how many adults in a room, etc. Care needs to be taken.

Regular schooling is very important developmentally, and for many children in the US it is an important part of their food security (through subsidized breakfast and lunch) and in some cases their personal safety (re: domestic violence and child abuse). Epidemiological estimates from Sweden and Norway's health authorities believe that only 2-4% less spread would happen from school closures, and so far this appears to be born out, which is why Denmark and Norway were reopening schools.

It's cool that the data from Sweden is good, but in the US we had several early outbreaks in schools specifically. Because so much of the US's safety net is in schools - free breakfast and lunch, afterschool day care, sick kids having to go to school because there's no one at home to care for them - the spread here is a lot more. 

In my district school has already been closed for the school year and we've only got a month left. 

[Ran]

8 minutes ago, Kalbear said:

It's cool that the data from Sweden is good, but in the US we had several early outbreaks in schools specifically.

 

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.

[Kalbear]

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/

[Guest]

LA Times reporting "mutant" dominant strain of SARS-CoV-2 is more infectious, is causing most current infections.

Quote

The new strain appeared in February in Europe, migrated quickly to the East Coast of the United States and has been the dominant strain across the world since mid-March, the scientists wrote.

In addition to spreading faster, it may make people vulnerable to a second infection after a first bout with the disease, the report warned.

If this is true, that means the immunity ID thing is already moot on its face, right?

Also, would provide some explanatory weight to why we're seeing new infections going back to December, for example.

ETA 2: Link to study.

[Kalbear]

And again, why this possibly isn't a big deal.

 

[Guest]

16 minutes ago, Kalbear said:

And again, why this possibly isn't a big deal.

 

Reading through that thread, I see the argument against the reporting on this. However, all it seems that she's saying is that the results haven't yet been replicated in a laboratory setting, and she concedes that the strain "mutation" may "increase viral fitness or infectivity", but cautions against extrapolating changes in the R0.

I completely agree from a scientific standpoint. I'm also not a scientist, so if anyone wants to put me on blast for talking out my ass, be gentle.

However, it seems like this information could have time-sensitive policy implications if the mutation does indeed turn out to be more transmissible, especially since the earliest hit nations, like China and South Korea, are opening up and, presumably, have not yet had to deal with this new strain. 

From a decision-making perspective, I'd want this information asap, in order to prepare accordingly, even if it turns out to be a false alarm.