Covid-19 #14 - Are We Done Yet?

[Ormond]

2 minutes ago, Tywin et al. said:

I honestly just wanted to go to Como (the public zoo) to put some money in their donation banks, but the place is closed for the summer as far I can tell, which is horrific for their economics. 

Don't they have a way for you to donate online?

The Omaha Zoo has an online page where one can donate to an Emergency Support Fund:

http://www.omahazoo.com/emergency-support-fund

[Mr. Chatywin et al.]

1 minute ago, Ormond said:

Don't they have a way for you to donate online?

The Omaha Zoo has an online page where one can donate to an Emergency Support Fund:

http://www.omahazoo.com/emergency-support-fund

The government should just cover the cost and tax the populace, offer the standard free entry, hope for donations and expect patrons to buy overpriced ice cream for their kids.

[Kalbear]

SHOCKING

 

 

[williamjm]

There have been more reports that COVID-19 was already present in Europe in December, analysis of wastewater samples shows traces in Milan and Turin on December 18th (but not in earlier samples):

https://www.bbc.co.uk/news/world-europe-53106444

15 hours ago, Tywin et al. said:

I honestly just wanted to go to Como (the public zoo) to put some money in their donation banks, but the place is closed for the summer as far I can tell, which is horrific for their economics. 

Are zoos allowed to open where you are yet? There was a campaign earlier this month in the UK from zoos pointing out they risked running out of money because most of the expenses don't stop during lockdown and questioning why people were allowed to pack onto beaches but allowed in controlled number to outdoor areas in zoos. Their date when they were permitted to reopen (with conditions) was then brought forward to the same day as non-essential shops reopening. I suspect they may still struggle since they'll probably have fewer visitors than usual and probably some extra expenses.

[BigFatCoward]

1 minute ago, williamjm said:

There have been more reports that COVID-19 was already present in Europe in December, analysis of wastewater samples shows traces in Milan and Turin on December 18th (but not in earlier samples):

https://www.bbc.co.uk/news/world-europe-53106444

Are zoos allowed to open where you are yet? There was a campaign earlier this month in the UK from zoos pointing out they risked running out of money because most of the expenses don't stop during lockdown and questioning why people were allowed to pack onto beaches but allowed in controlled number to outdoor areas in zoos. Their date when they were permitted to reopen (with conditions) was then brought forward to the same day as non-essential shops reopening. I suspect they may still struggle since they'll probably have fewer visitors than usual and probably some extra expenses.

My local safari park is limiting numbers to 30% of capacity, but I don't know if this is any less than their average occupancy rate pre closure. 

[Fragile Bird]

The zoo in Toronto, which moved out of small quarters decades ago and onto a huge space in the suburbs, 287 hectares, about 710 acres, has many service roads behind the scenes, connecting 7 geographic zones. A couple of weeks ago they opened up by creating a 45 minute route using the back roads, selling tickets on-line only. As far as I know they've been selling out on most days. They will also need government money. 

[Mr. Chatywin et al.]

2 hours ago, williamjm said:

Are zoos allowed to open where you are yet? There was a campaign earlier this month in the UK from zoos pointing out they risked running out of money because most of the expenses don't stop during lockdown and questioning why people were allowed to pack onto beaches but allowed in controlled number to outdoor areas in zoos. Their date when they were permitted to reopen (with conditions) was then brought forward to the same day as non-essential shops reopening. I suspect they may still struggle since they'll probably have fewer visitors than usual and probably some extra expenses.

There are two major zoos here, and both seem to be closed with no planned date to open. One is public, there is no price of entry, but you're a jackass if you don't put at least a few bucks in the coffers when you enter. The state zoo is a bit pricey, but they have a solid setup so it's worth it. But like I said, both seem to be closed as far as their calendars' extend. The Twin Cities is getting hit with a double dose of problems with the virus and the nexus of the protests steaming from George Floyd's murder happening just a few miles down Lake St. from where I am. 

It's so weird biking around the area and seeing so many streets just closed.  

[Hereward]

On 6/18/2020 at 9:31 PM, williamjm said:

 It feels like the Scottish approach of doing more or less the same revisions to lockdown but waiting a couple of weeks longer to do them is starting to show real benefits given that new cases there are averaging about 20 a day now while England still has about 1000 a day.

Surely the fact that the Scottish outbreak was estimated as being at roughly two weeks behind that of England has more to do with it? 

[BigFatCoward]

I wish I could write conciliatory posts like that, instead of my normal 'fuck off, you wanker' style.

[Pebble thats Stubby]

10 minutes ago, BigFatCoward said:

I wish I could write conciliatory posts like that, instead of my normal 'fuck off, you wanker' style.

It's called deescilstion.  It's something a lot of police seem to have problems with.  ;p

[BigFatCoward]

Fuck you as well. 

[williamjm]

15 hours ago, Hereward said:

Surely the fact that the Scottish outbreak was estimated as being at roughly two weeks behind that of England has more to do with it? 

That could be important as well. Since lockdown was imposed more or less simultaneously across the UK if that meant the outbreak was never quite as severe in Scotland (although Scotland was definitely still very badly hit by it) it might be expected that the latter stages of the initial outbreak improve faster even without other changes.

[Zorral]

A really good source of information for those of us who aren't virologists / biologists / chemists / epidemiologists is Mike Davis's updated just now and about to be republished, The Monster Enters: Covid-19, Avian Flu and the Plagues of Capitalism. 

https://www.orbooks.com/catalog/the-monster-enters/

We just got an reading copy, and it is pretty riveting, no matter how much one already knows or how little one still doesn't know about these matters.

https://en.wikipedia.org/wiki/Mike_Davis_(scholar)

https://www.newyorker.com/news/california-chronicles/mike-davis-in-the-age-of-catastrophe

http://bostonreview.net/class-inequality/troy-vettese-last-man-know-everything

https://www.penguinrandomhouse.com/authors/6574/mike-davis

 

I'm also watching a multi-episode lecture from 2016 on the history of the 14th C bubonic plagues, The Black Death: The World's Most Devastating Plague. covering a variety of aspects.  It's streaming on amazon prime until the end of June.

I am struck by how differently this pandemic is playing out from that of the 14th C Great Mortality and the Great Influenza.  Most particularly one is struck how many of the ruling establishment, excluding monarchs and their royal families, died in these pandemics.  But not this time -- no members of Parliament, no members of the Church, no members of governing oligarchies -- no members of the Senate, etc. So many died particularly in the 14th century that in many situations it created a vast social mobility, of younger, less wealthy, less well born, etc. moving into these positions of power because they were empty.  The entire ruling council of Barcelona died with a single exception, for instance.

Whereas now, this pandemic is only tightening the strictures inequality in power and opportunity and poverty across the globe.

Also nobody now sees the dead, the dying and the sick.

[Fragile Bird]

2 hours ago, Triskele said:

Peter Attia's blog has a cool post on "how does this thing end" with a matrix of four scenarios that I found helpful for thinking it all through.

The matrix is:

 

 

Well #3 sure looks delightful...

[The Anti-Targ]

8 hours ago, Triskele said:

Peter Attia's blog has a cool post on "how does this thing end" with a matrix of four scenarios that I found helpful for thinking it all through.

The matrix is:

8 hours ago, Triskele said:

Case I: Long-standing immunity to viral infection, but ineffective vaccines

Case II: Long-standing immunity to viral infection, and very effective vaccines

Case III: No long-standing immunity to viral infection, and ineffective vaccines

Case IV: No long-standing immunity to viral infection, but very effective vaccines

 

That seems a but simplistic (the titles of the cases that is, I haven't read the detail). In particular the binary ineffective vaccine vs "very effective" vaccine is not right. There are also the very useful "somewhat effective" and "fairly effective" vaccine possibilities. If a vaccine confers 1 year of effective immunity in ~80% of people who receive the vaccine then that can be a useful tool to protect vulnerable populations by giving annual booster shots. There would be an argument to say there is little point deploying such a vaccine across the whole population, but such a vaccine should still be made available to anyone who wants to get an annual booster shot. And if they can combine it with the 'flu vaccine (MMR is a multi-pathogen vaccine, so combo vaccines are doable) then there's no reason people who are already getting the annual 'flu jab should not opt for a combo jab.

Not sure if the mink thing has done the rounds here yet. I just got this as part of a biosecurity report, which comes to us monthly:

Quote

3. Several new cases of COVID-19 infection in domestic cats, dogs and mink have emerged in this reporting period.
    a. On mink farms in the Netherlands, there have been two likely cases of mink infecting people. These are the first reports of animal-to-human transmission that we have seen. Dutch authorities are culling all mink on affected farms as a precautionary measure, but say these farms pose negligible risk to surrounding communities. They are continuing to investigate how many farms have become infected, how the virus may be introduced to mink farms, and how it propagates within and between farms.
    b. Mink have also tested positive on a farm in Denmark. Mink on the affected farm will be culled, and Danish authorities are planning to test other mink farms.

I was quite surprised when I found out that mink farming was still a thing about a month ago, when the mink connection was first mentioned.

[The Anti-Targ]

4 minutes ago, Triskele said:

Sounds like your point is that there were only two vaccine choices in the matrix which were 100% glorious vaccine and worthless vaccine in which case I take you point.  So perhaps we say there's a middle "somewhat or fairly" effective vaccine but still that would I think not massively disrupt the thought-experiment.

Maybe we'd say that the "somewhat effective" vaccine is like the status quo for influenza?  Is the other side of the matrix also overly-simplistic?  Should we have three rows or columns on the antibody / protection side of things too?  Starting to think yes.  Are there not some ID's where getting exposed gets you virtually lifetime immunity, some where it gets you jack shit, and some where it gets you a solid but fading effect?  Maybe the author's approach was cool but could have been improved as 3 x 3 instead of a 2 x 2.  

There is also the natural attenuation aspect too. Does the virus attenuate over time to become less deadly? If yes, then the implications of all the various permutations change. Some people are claiming that attenuation is already starting to appear. Not entirely sure I buy it just yet, but it is a phenomenon that can happen.

Phase 2 trials are already happening for vaccines. The expense of moving from phase 1 to phase 2 means there must be some confidence that vaccines will be at least somewhat effective and potentially depoyable for public health protection. Respiratory coronaviruses in animals have been shown to be amendable to vaccination (gastro vaccines not so much), but in the more somewhat / fairly effective category rather than 1  or 2 jabs = life long immunity.

I am still optimistic that a vaccine is in our reasonably near future. Which is why I am still happy with our current approach of fortress NZ when it comes to staying closed to all but essential overseas arrivals (who knew the Avatar 2 and 3 film crew are essential? But that's a different discussion). But in 6 - 12 months I may well support a fundamentally different policy if it turns out all efforts at vaccine development are proving fruitless.

[rotting sea cow]

12 hours ago, Triskele said:

Peter Attia's blog has a cool post on "how does this thing end" with a matrix of four scenarios that I found helpful for thinking it all through.

The matrix is:

 

I agree with the @The Anti-Targ  There are other alternatives to "only an effective vaccine can get out of this". I tend to think that people aren't thinking creatively.  For example there was a lot of noise about the BCG vaccine some months ago that might offer some general protection (apparently the optimism was unfounded), some with MMR vaccine or the Polio's. These things need to be investigated and translated into public policy.  What about Vitamin D?  Or other immunological boosters? They might make a huge difference in the rate of critical cases and ultimately death.

At the same time treatments are evolving and improving, despite the messy science sometimes (see the HCQ polemics).

Together they might reduce the IFR to let's say 0.1% making it not worse than the flu.

But you might ask, but the disease is still far more contagious than the flu. Well, but some proper non pharmaceutical measures can make huge impact in the transmission rates. Masks anyone? Be careful with places that can lead to superspreading events. Create incentives and support for infected people to stay at home. Etc.

 

 

[The Anti-Targ]

6 hours ago, Triskele said:

Shit, that's an important point.  While we don't know that this will happen like SARS I suppose there's hope that it will.

But Trump's "the heat will kill it" is looking like a weak claim.  

For what it's worth working with some ID doctors (not a scientist myself I hasten to add) I've heard something like "this one will be with us for some time."  The upshot to me is that they fear it'll settle into being like influenza but deadlier.  Something that we can't eradicate and sends a few tens of thousands of people to the ICU per year with pneumonia-like symptoms.  That seems to be where we are now except that we think we're almost done and we may be nowhere near almost done.  And if we weren't distancing it'd maybe hundreds of thousands per year.  

I will be very surprised if it is ever eradicated, too many countries are too far gone to pull it back, but I expect (hope) vaccination to control it at least to an adequate degree to allow life to operate normally and not have ongoing cycles of major outbreaks and deaths in many countries. Long term I expect it to continue to appear in the annual death stats. But I don't expect it to be the biggest cause of death from infectious disease in almost every developed country.

I did say that respiratory coronavirus diseases in animals have vaccines, but they have been around in countries where they are endemic for a long time and they don't look to be disappearing any time soon. So that kind of suggests a trajectory for COVID-19.

Given a very cheap drug, dexamethasone, has been legit proven to reduce death rates in patients needing O₂ therapy by 25%. It shouldn't be too long (maybe still a year or more, but that's not long in the grand scheme of things) before some other supportive therapies are developed (in combination with dex most likely) that will significantly reduce death even in very vulnerable populations to negligible levels. I kind of feel a bit dumb for not thinking of dex much sooner. It is a very well known course of therapy in any viral disease that causes severe inflamation in the respiratory system as a leading cause of death. It is effective are reducing fluid on the lungs, and some people might recognise it as a drug that is given to prem babies to help with post-partum lung development (and premature calves too). It's completely bloody useless in non-severe respiratory disease, and as an immune suppressor could be detrimental. But when your immune system is freaking out and actually the thing likely to kill you, the exact thing that makes dex risky in mild disease becomes a life saver in severe disease.  It's not the game changer that people are looking for, but it's a good tool to start with and refinement of the treatment regime could increase its effectiveness.

Dex also makes you high, but not in a way that makes it something junkies would be interested in, because you stop reacting to it that way after a fairly short duration of use.

[Zorral]

11 hours ago, Triskele said:

they fear it'll settle into being like influenza but deadlier. 

At this time, this is pretty much the consensus and has been for quite some time.

[Guest]

Why do I keep seeing articles from Italian or UK (for example) infectious disease experts saying that it seems like the virus is becoming less deadly based on what seems to be nothing more than anecdotal evidence?

Here is the latest example I've seen. 

Quote

 

"The clinical impression I have is that the virus is changing in severity," he said.

"In March and early April, the patterns were completely different. People were coming to the emergency department with a very difficult-to-manage illness, and they needed oxygen and ventilation; some developed pneumonia.

"Now, in the past four weeks, the picture has completely changed in terms of patterns. There could be a lower viral load in the respiratory tract, probably due to a genetic mutation in the virus which has not yet been demonstrated scientifically. Also, we are now more aware of the disease and able to manage it," he said.

"It was like an aggressive tiger in March and April, but now it's like a wild cat. Even elderly patients, aged 80 or 90, are now sitting up in bed, and they are breathing without help. The same patients would have died in two or three days before," Bassetti said.

"I think the virus has mutated because our immune system reacts to the virus, and we have a lower viral load now due to the lockdown, mask-wearing [and] social distancing. We still have to demonstrate why it's different now," he said.

"Yes, probably it could go away completely without a vaccine. We have fewer and fewer people infected and it could end up with the virus dying out."

I've seen at least 4 or 5 articles like this in the past week. I honestly haven't paid enough attention until now to say if it is the same experts talking to different news outlets or not.

But isn't the most likely explanation that the virus took the low-hanging fruit when we were unprepared, and that rising caseloads and rising hospitalizations in the U.S. belie this hypothesis? And even if that's not the most likely explanation, shouldn't we be operating as if it is, until we know more? This just seems to be incredibly irresponsible behavior on the part of these doctors.