Covid-19 #14 - Are We Done Yet?

[Guest]

3 minutes ago, Ran said:

I suspect a lot of people answering this are taking into the account the idea of being essentially guinea pigs for rushed-through-trials novel vaccine for a novel virus. I'd expect similar numbers in Sweden, or perhaps even worse numbers, because of the swine flu vaccine that caused incurable narcolepsy in hundreds of young people has left a great deal of skepticism towards the idea of trying new vaccines before they have been thoroughly proven safe.

 

 

This captures my hesitation in taking a COVID-19 vaccine perfectly. I'm normally all in on vaccines, but there is too much pressure being put on manufacturers to create a new vaccine, too many steps being jumped, and too strong of a financial incentive to bury potentially disqualifying side effects.

[Ran]

4 minutes ago, The Great Unwashed said:

This captures my hesitation in taking a COVID-19 vaccine perfectly. I'm normally all in on vaccines, but there is too much pressure being put on manufacturers to create a new vaccine, too many steps being jumped, and too strong of a financial incentive to bury potentially disqualifying side effects.

I think it's a very reasonable attitude to have. And it's not like Sweden is some sort of hotbed of anti-vaxxers or anything -- we have one of the highest voluntary immunization rates in the world (97%+

45 minutes ago, Kalbear said:

Scientist behind Sweden's response says that if he had a do-over, he'd do things a bit more strict:

 

 

At today's press conference he said he felt that the interview was being taken a bit out of context in the press, drawing conclusions about his meaning that he hadn't intended. In fact, one of the few concrete changes he thought Sweden might have made in this counterfactual world where they had more information initially than they had was that they are increasingly convinced that closing high schools wasn't a useful step in fighting the pandemic, so in some senses restrictions could have lightened rather than become stronger.

 

 

[williamjm]

5 hours ago, Kalbear said:

Science moving too quickly - the data around hydrochloroquinine was almost certainly false and did not indicate more deaths. 

https://amp.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine?__twitter_impression=true

On a similar topic there are also results from a (hopefully more reputable) randomised control study which find no significant benefit or harm from HCQ.

https://www.theguardian.com/world/2020/jun/03/hydroxychloroquine-no-better-than-placebo-study-finds

I don't have the link now but I saw a story about a different drug which has also had some wild swings in reputation recently saying that scientists in the UK have started a trial to investigate whether ibuprofen could be beneficial in treating the symptoms of covid-19.

[Guest]

I'm looking at the reported case numbers in several of the southern states that have begun reopening early, and it's already looking like things are on their way to getting out of control.

Florida, Arizona, Texas, Georgia, and Arkansas have all reported record increases in cases over the past few days. Each state's trendline is obviously increasing. Things might not be out of control yet, but they could very well be on the edge of getting out of hand.

If that happens, I'm worried that there will be too little political will left to force businesses to close, at least not until the after infection has started raging, which will be too late at that point to quickly reduce the number of new infections, hospital admissions, and death. These governors are literally gambling with the lives and health of their citizens.

[Filippa Eilhart]

12 hours ago, williamjm said:

I don't have the link now but I saw a story about a different drug which has also had some wild swings in reputation recently saying that scientists in the UK have started a trial to investigate whether ibuprofen could be beneficial in treating the symptoms of covid-19.

yeah, I read that too. Funny

[Relic]

According to the latest update (yesterday June 3) from the chief statistician and doctor at the Center for Evidence Based Medicine (arguably these guys are the world’s leading experts for estimating a global IFR (Infection Fatality Rate) .

“Taking account of historical experience, trends in the data, increased number of infections in the population at largest, and potential impact of misclassification of deaths gives a presumed estimate for the COVID-19 IFR somewhere between 0.1% and 0.41%.*

Data from COVID deaths in Gangelt, Germany, suggests an IFR of 0.37%. A random sample of 1,000 residents of Gangelt found that 14% were carrying antibodies (2% were detected cases), which led to the lowering of the IFR estimates

*Demographic changes in the population will vary the IFR significantly. If younger populations are infected more the IFR will be lower. Comorbidities will have a significant impact to increase the IFR: the elderly and those with ≥ 3 comorbidities are at much higher risk.

 

https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/

[Ormond]

19 hours ago, Fragile Bird said:

How many people in the US would take a vaccine?

Survey says...

38% say yes they would definitely

16% say maybe

21% say definitely not.

11% say maybe not.

Where are you getting those figures?

They are a bit more pessimistic than this ABC/Washington Post poll, which found 15% saying "definitely" they would not get the vaccine and another 12% "probably not."

https://abcnews.go.com/Politics/27-vaccinated-coronavirus-republicans-conservatives-poll/story?id=70962377

It would also be nice to know the exact wording of these questions. The ABC/WAPO poll's question was: "If a vaccine that protected you from coronavirus was available for free, would you get it?" That wording might make those who would be concerned about taking an "experimental" vaccine less likely to say no, as one that "protected you" might be assumed to be beyond the experimental stage. And I would assume that a question that didn't include the "for free" would also get a higher % of "no's".

[Fragile Bird]

24 minutes ago, Ormond said:

Where are you getting those figures?

They are a bit more pessimistic than this ABC/Washington Post poll, which found 15% saying "definitely" they would not get the vaccine and another 12% "probably not."

https://abcnews.go.com/Politics/27-vaccinated-coronavirus-republicans-conservatives-poll/story?id=70962377

It would also be nice to know the exact wording of these questions. The ABC/WAPO poll's question was: "If a vaccine that protected you from coronavirus was available for free, would you get it?" That wording might make those who would be concerned about taking an "experimental" vaccine less likely to say no, as one that "protected you" might be assumed to be beyond the experimental stage. And I would assume that a question that didn't include the "for free" would also get a higher % of "no's".

I should have paid more attention when the story started regarding who's survey it was. You're right, the numbers are different from the WaPo one. I think I saw it on CNBC, 19 hours ago so roughly 3:30 yesterday afternoon, because I typed that post while the pie chart with the numbers were up on the tv screen. I just searched the CNBC site and could not find a clip. I'll try again and add it here if I find it. They were discussing herd immunity and how many people had to be vaccinated before folks could feel pretty safe again.

eta: no luck, they only have clips from the last few hours up

[Frey family reunion]

7 hours ago, Ormond said:

"If a vaccine that protected you from coronavirus was available for free, would you get it?"

Do you think that would instill more warm and fuzzy confidence than: "if we can get a vaccine rushed out by the end of the year, sidestepping many of the safety precautions that we normally take before we approve a vaccine, for a virus that depending on your age and health condition, you may have no significant adverse affects if you get infected would you take it?"  Because I think that's what may be going through a lot of people's minds when they decide whether getting a vaccine injected into them is worth it.

Personally, I think it's going to largely depend on hospitalization rates.  If they keep going down when a vaccine finally comes about, you may not see a mad rush for vaccination.  If we get hit by a second wave of increased hospitalizations in the Fall, than it's going to be a different story.

[Raja]

No Clinical Benefit from use of HCQ in hospitalized patients with covid-19 ( Here's results from the Recovery trial - One of the big covid therapeutic trial from the UK) Pretty sure this is the end for HCQ as a possible treatment for hospitalized patients, hopefully full results are out soon

Quote

‘On Thursday 4 June, in response to a request from the UK Medicines and Healthcare Products Regulatory Agency (MHRA), the independent Data Monitoring Committee conducted a further review of the data. Last night, the Committee recommended the chief investigators review the unblinded data on the hydroxychloroquine arm of the trial.

‘We have concluded that there is no beneficial effect of hydroxychloroquine in patients hospitalised with COVID-19. We have therefore decided to stop enrolling participants to the hydroxychloroquine arm of the RECOVERY trial with immediate effect. We are now releasing the preliminary results as they have important implications for patient care and public health. 

‘A total of 1542 patients were randomised to hydroxychloroquine and compared with 3132 patients randomised to usual care alone. There was no significant difference in the primary endpoint of 28-day mortality (25.7% hydroxychloroquine vs. 23.5% usual care; hazard ratio 1.11 [95% confidence interval 0.98-1.26]; p=0.10). There was also no evidence of beneficial effects on hospital stay duration or other outcomes. 

‘These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19. Full results will be made available as soon as possible. 

Peter Horby, Professor of Emerging Infectious Diseases and Global Health in the Nuffield Department of Medicine, University of Oxford, and Chief Investigator for the trial, said:

‘Hydroxychloroquine and chloroquine have received a lot of attention and have been used very widely to treat COVID patients despite the absence of any good evidence. The RECOVERY trial has shown that hydroxychloroquine is not an effective treatment in patients hospitalised with COVID-19. Although it is disappointing that this treatment has been shown to be ineffective, it does allow us to focus care and research on more promising drugs.’

 

[Fragile Bird]

I have been looking at some of the stranger numbers being reported around the world. Russia has almost 450,000 cases and "only" 5,528 deaths, a couple of thousand less than Canada has, 7,703. Brazil has 646,000 cases and 35,000 deaths, for example. Similarly, Peru has 187,000 cases and only 5,162 deaths. Right.

And I keep forgetting Pakistan has so many people. A voice in my head says the population is about 80 M, but actually their population is 220 M.

[Rane]

2 hours ago, Fragile Bird said:

I have been looking at some of the stranger numbers being reported around the world. Russia has almost 450,000 cases and "only" 5,528 deaths, a couple of thousand less than Canada has, 7,703. Brazil has 646,000 cases and 35,000 deaths, for example. Similarly, Peru has 187,000 cases and only 5,162 deaths. Right.

And I keep forgetting Pakistan has so many people. A voice in my head says the population is about 80 M, but actually their population is 220 M.

To be fair, Brazil is only testing serious cases. And if worldometers stats are accurate, Russia tested 12 times more than Brazil. So it's reasonable that they have a lower mortality rate.

 

[Loge]

The Worldometer table has changed a lot over the last couple of weeks. The virus is now spreading fast in Latin America, Russia and Southern Asia. Figures from Africa are still low, except Egypt and South Africa. Iran has growing figures again after a they had been going down in April. Not sure what happened there. I guess Ramadan.

As for the number of deaths, each country has its own way of reporting them, and of course some are cheating. The Guardian has a look at the Russian figures: https://www.theguardian.com/world/2020/jun/04/st-petersburg-death-tally-casts-doubt-on-russian-coronavirus-figures. 

 

[williamjm]

8 hours ago, Fragile Bird said:

I have been looking at some of the stranger numbers being reported around the world. Russia has almost 450,000 cases and "only" 5,528 deaths, a couple of thousand less than Canada has, 7,703. Brazil has 646,000 cases and 35,000 deaths, for example. Similarly, Peru has 187,000 cases and only 5,162 deaths. Right.

There are some more extreme examples as well, Qatar has 67000 cases but only 51 deaths, Singapore has 37000 cases but only 24 deaths which are tiny death rates compared to the number of cases. It might be that they're better at detecting cases because they have the wealth to test large portions of their population. Another possibility could be that if they're largely cases in migrant workers (which we know is the case in Singapore and wouldn't be at all surprising in the Gulf states) there might be relatively few high-risk elderly people infected.

And I keep forgetting Pakistan has so many people. A voice in my head says the population is about 80 M, but actually their population is 220 M.

Similarly I tend to think of Bangladesh as being small compared to India/Pakistan, which is true, but it still has 160 million people.

5 hours ago, Loge said:

The Worldometer table has changed a lot over the last couple of weeks. The virus is now spreading fast in Latin America, Russia and Southern Asia. Figures from Africa are still low, except Egypt and South Africa. Iran has growing figures again after a they had been going down in April. Not sure what happened there. I guess Ramadan.

I think Iran had been loosening their lockdown restrictions as well.

In some better news elsewhere, after all the Fijian cases recovered the South Pacific is now down to 3 active cases, 1 in New Zealand and 2 in New Caledonia. Australia still has over 400 cases but the numbers of new cases have consistently been low recently.

[Mr. Chatywin et al.]

8 hours ago, Rane said:

To be fair, Brazil is only testing serious cases. And if worldometers stats are accurate, Russia tested 12 times more than Brazil. So it's reasonable that they have a lower mortality rate.

 

I would have no faith in the numbers coming out of developing countries with large slums.

Frankly I am skeptical of most developed countries too. Including my own. 

[Clueless Northman]

Gulf States and Singapore cases are most probably in migrant workers, so no elderly. Explains the low death rate. That said, I'm also a bit suspicious and wouldn't be surprised if they don't test as much as they should and underreport their deaths. Though Singapore should be a bit closer to the truth, but then, if it's limited to migrant and migrant deaths, they might be sloppy because they don't give much of a shit about it.

Russia tests 300K people every day allegedly. If true, then they basically have a bit less than 3% of tested people who turn out to be infected. That seems reasonable. It would also mean that they test way more than the rest of Europe and therefore find most of the cases - only New Zealand would come close to that among Western countries. Since the average death ratio seems to lie between 1 and 1.5% (depending on the population), Russian numbers are loosely credible. Still, deaths are definitely undercounted - even a country like Belgium, who tries to be as open and honest as possible, has official numbers that are still a tad lower than the actual excess deaths. So I'd still assume their real deaths are at least 50% higher, without even taking into account political motivations to tamper with the numbers.

From what I've seen of death ratios, reported deaths and reported new cases, I'd say most Western countries were underreporting cases by a factor 5 in April, and are still only reporting a third of the new cases - after all half the unreported would be genuinely asymptomatic. Singapore, Taiwan, NZ or Korea might be far closer to the real situation, considering their level of testing and usually few cases. For Russia, whatever they say, I would suspect they have at the very least double the official cases, and possibly triple - at least similar ratios for the deaths. Though they probably have lower deaths per capita than the US or Brazil, since Moscow seems to have a better control over the situation and how people behave - though that's nowhere near the Chinese level of control.

[Fragile Bird]

42 minutes ago, Clueless Northman said:

Gulf States and Singapore cases are most probably in migrant workers, so no elderly. Explains the low death rate. That said, I'm also a bit suspicious and wouldn't be surprised if they don't test as much as they should and underreport their deaths. Though Singapore should be a bit closer to the truth, but then, if it's limited to migrant and migrant deaths, they might be sloppy because they don't give much of a shit about it.

Russia tests 300K people every day allegedly. If true, then they basically have a bit less than 3% of tested people who turn out to be infected. That seems reasonable. It would also mean that they test way more than the rest of Europe and therefore find most of the cases - only New Zealand would come close to that among Western countries. Since the average death ratio seems to lie between 1 and 1.5% (depending on the population), Russian numbers are loosely credible. Still, deaths are definitely undercounted - even a country like Belgium, who tries to be as open and honest as possible, has official numbers that are still a tad lower than the actual excess deaths. So I'd still assume their real deaths are at least 50% higher, without even taking into account political motivations to tamper with the numbers.

From what I've seen of death ratios, reported deaths and reported new cases, I'd say most Western countries were underreporting cases by a factor 5 in April, and are still only reporting a third of the new cases - after all half the unreported would be genuinely asymptomatic. Singapore, Taiwan, NZ or Korea might be far closer to the real situation, considering their level of testing and usually few cases. For Russia, whatever they say, I would suspect they have at the very least double the official cases, and possibly triple - at least similar ratios for the deaths. Though they probably have lower deaths per capita than the US or Brazil, since Moscow seems to have a better control over the situation and how people behave - though that's nowhere near the Chinese level of control.

I have mentioned this before - weeks ago the Soviet media were warning people to be prepared for "Italy like" numbers of deaths. This has not happened, so excuse me me if I totally disbelieve their reported deaths. My assumption is that the government decided that reporting the true story would cause social unrest. They were already having food riots.

[Clueless Northman]

Food riots? It's 2020 Russia, not the 1930s USSR, not 1788 France, not some starving African country.

[Guest]

1 hour ago, Fragile Bird said:

I have mentioned this before - weeks ago the Soviet media were warning people to be prepared for "Italy like" numbers of deaths. This has not happened, so excuse me me if I totally disbelieve their reported deaths. My assumption is that the government decided that reporting the true story would cause social unrest. They were already having food riots.

So much this.

Russia is deliberately underreporting deaths by making the criteria to be counted so stringent that it's nearly farcical. For a death to be counted as from COVID-19, a full autopsy has to be performed, even with a positive diagnosis. Deaths from pneumonia there are through the roof. Even if one assumes total transparency from the Russians (which you shouldn't), they're going to be performing autopsies and reporting COVID-19 deaths long after the pandemic is over.

This is so uncontroversial that I'm not even going to bother linking an article.

ETA: I'm honestly surprised at the amount of pushback against allegations that deliberate underreporting is occurring. The entire planet watched the world's last remaining "superpower" fuck up its response to the novel coronavirus precisely because of political motivations. Why is it so controversial to assert that this is not only happening in states in the U.S., but also dictatorial, repressive regimes around the world?

[Hereward]

It’s part of my job to monitor Russian sources and its response to what’s going on in the West. They went full on Covid 19 being a Western plot, which Russians were immune to because of proper preparations and a lack of degenerate pervisity. They can’t back down on that now.