Honest question: yesterday the US saw the most cases in a day since this started. If that doesnt constitute a spike then what does? Or is the planning more about anticipated levels 6 weeks from now as compared to now.
However, I think it's pretty clear that those regions have it under control only because they've shut almost everything down. The second schools begin reopening and pupils start criss crossing the country, it'll bring the "second wave."
There are small hints that it MIGHT not be possible. The antibody tests measured the infection rate around April 15 or so, the number should be higher now. Second, there is some evidence that a percentage of people don't develop antibodies (only T cells) but are immune. Finally, we don't really know what is required for herd immunity.
None of this is to say you are wrong, just why it MIGHT be possible that NYC cannot have a second spike.
(herd immunity question): https://www.quantamagazine.org/the-tricky-math-of-covid-19-h...
(T cells and immunity) https://www.biorxiv.org/content/10.1101/2020.06.29.174888v1
(peer reviewed article on NYC antibody testing). https://www.sciencedirect.com/science/article/pii/S104727972...
How much more is up for debate. A competent government would be regularly conducting these surveys and publishing the results.
We have been more open, with many protests, streets full of open air bars, etc. for months.
I would bet $100 that NYC, if we could do a full antibody and t-cell assay, would show the majority of the population was infected.
Furthermore, I would submit that R0 as a crude instrument ignores network effects. I'd wager anyone who is a "super spreader" in NYC has been infected at this point.
Some papers have suggested a 20% herd immunity threshold taking into account the network effects. I doubt it's that low, but it is an important factor to consider.
NYC had a 20% antibody rate in a sample of people who were out shopping and consented to giving their blood for the study. That is enough potential sources of bias that assuming the general population had a 20% antibody rate strains credibility.
Sadly, I don't have a link. Hopefully my memory is accurate.
[1] https://www.latimes.com/california/story/2020-07-02/error-le...
Instead, people are simply starting with a foregone conclusion of "We must re-open!" and fishing for any nugget that might justify this pre-ordained decision. So far in this thread we've already seen:
1. The cases are not uniformly distributed, therefore it's OK to re-open in areas that currently seem good! [many variants of this one]
2. Cases are spiking but deaths are not up, we should ignore the non-fatal consequences of the disease and re-open!
3. Cases only look like they are up because testing is up, therefore the numbers are in question, so re-open!
4. Governments are conspiring to inflate case numbers, therefore the numbers are in question, so re-open!
We are already starting to see the disastrous effects of prematurely re-opening, but the public just won't accept any story that doesn't end with "...and we re-opened everything as soon as we could!"
There has certainly been community spread. But the average age of a confirmed case has also dropped enormously.
A spike would be an isolated short-term jump, this is just continuous increase in cases.
Of course, from a “should we open things” perspective, that’s worse than a spike, not better.
The positive test result rate continues to decrease across the United States, albeit more slowly as of late.
I really do mean this as an honest question.
(1) It's important to make sure the numbers you're using are directly comparable -- e.g., if #confirmed is the count of unique individuals who are confirmed to have the virus and #tested is the number of tests administered rather than the number of people who have been tested then you won't get the expected results.
(2) There can be confounding variables like choosing to test people with milder symptoms.
(3) False positive/negative rates can be a factor (though they shouldn't be in a halfway decent test). If your false negative rate is x and your false positive rate is greater than 1-x then your positive test result rate will fall as your true positive rate rises.
(4) Etc. The problem is that the numbers you're measuring (reported test results) aren't the numbers you care about (true infection rates). They might align, and they will mostly align with good tests and unbiased data that are correctly and honestly reported, but they don't have to.
Caveat: I haven't been closely following covid news and have no idea how much any of those potential discrepancies might apply IRL.
Initially, only the sickest patients, most obviously suffering from COVID-19, were eligible for testing. We would of course expect positive test rates to be sky-high during this time, as we were only testing those whom we were pretty certain were infected and were suffering life-threatening symptoms.
Now, tests are more widely available. Testing is no longer tightly constrained to the most obvious suspected cases. So, with a wider swatch of the population being eligible for testing, we would probably expect the % of positive test rates to fall even as the number of infected goes up.
Looking at only the US numbers hides some of the picture. For example, there's this chart from about a month ago showing that only looking at US numbers without breaking them down can be misleading: https://www.axios.com/us-coronavirus-new-cases-second-wave-n...
Remember "flatten the curve"? It's not "eliminate the curve". We're pretty much all going to be exposed to it at some point. Lots of people testing positive without ever having had to go to the hospital or even having been aware they had it is a good thing, not a reason to go shutting everything down again. It means the crisis is nearly over, not the worst it's ever been.
After all, consider what that would imply; for all infectious diseases, the level of crisis starts low, then monotonically goes up and never goes back down? Clearly that does not describe the real world we see, which is not still in crisis over the Spanish Flu, Black Death, and every other plague ever. The level of crisis can't be solely a function of the number of people testing as positive.
Hospitalizations and deaths are the bad numbers, not number of positives.
Except for high-risk activities such as nightclubs, life has mostly returned to normal. In the US, however, retail sales (as just one indicator) are stagnant at 50% of previous levels. Economic activity will be far from normal until people feel safe again.
As to hospitalisations and deaths: hospitals in Arizona, Nevada, Florida, and Texas are quickly filling up and/or full already.
On a per capita basis the only large European country with a lower death rate than the US is Germany. Italy, France, Spain and the UK are all higher. Comparing US and Europe, all of whom messed up badly, to the competent governments that ignored the WHO is absurd. Asia did much, much better than the USA and Europe, which are basically comparable.
https://www.tmc.edu/coronavirus-updates/tmc-daily-new-covid-...
I was just reading, about Houston I think, that hospitals were continuing to have elective surgeries to avoid sending a message that people should panic. And to make money, because they may not be able to keep the lights on with only COVID-19 patients.
There are quite a few countries with minimal reported cases, and it makes me think about the study that found "the state-specific introduction of birth certificates is associated with a 69-82% fall in the number of supercentenarian records."
South Africa has by far the most reported cases in Africa; is it possible that has some relation to how well they track them compared to other countries, and not just the underlying numbers?
But, I've spent the last 4 years living there (came back to the US for work at the end of January). I'm in tons of Vietnam related facebook groups and I have friends there.
Whole country is open internally, nobody is wearing a mask, plane flights are full. If there was a single infection, it would be all over the news and my friends would be notifying me.
I'm pretty confident, that at this point, the govt isn't lying. They admit when they import new cases (repatriation flights) and they quarantine everyone with multiple rounds of testing. If anyone 'escapes' quarantine... it is a full on manhunt. They aren't playing games.
Hands down, Vietnam won this war.
One reason I'm more confident of statistics in some countries is not just general prejudice, but that these countries have various levels of government, and statistics are reported by the lower level divisions independently, and third parties who are not the central government can and do compile them.
So, for instance, when you read about US statistics, they may have distortions or issues, but you're not (at least my sources are not) getting them filtered through the very top of the hierarchy.
This could in principle apply to Vietnam as well, but I notice you didn't make this sort of argument, that information flows out independently from centralized control.
I also notice you say you came back in January, and yet living there for four years means you know what the situation is. That sounds odd. I used to live in Virginia, and have a relative there but that doesn't mean I have particular insight into the epidemic there.
So if there was somebody independent doing that in Vietnam, or wherever, then I would take claims of no cases more seriously.
One thing about Vietnam culture is that they gossip like no other. Everything is in the open. As soon as one 'bad' thing happens, everyone knows about it. When one girl came back from Europe and infected a bunch of people, the govt got right on it and quarantined everyone who could have potentially came in contact. Someone turned in a UK friend of mine because they heard him coughing.
After 80+ days, I haven't heard a peep from anyone to suggest that the news isn't exactly what they say it is. My friends are flying around the country like nothing is happening. People are going out and socializing. Look in the news... you see parties and clubs going off. Look at restaurants and night club facebook pages... everyone is out.
If covid was affecting Vietnam, we'd all know, immediately.
I can't speak for Asian countries, but as far as Central Europe, e.g. in Slovenia, cases are spiking again (most positives since April - the point about low deaths from GP still stands but deaths used to follow positives with a delay)... probably precipitated by tourism & economy-driven reopening of borders and relaxation of most counter-measures (opening restaurants, etc. as well as unofficial parties & gatherings).
I strongly encourage everyone everywhere to evaluate our response when we are done with this. It was deeply suboptimal. However, in the current position we are in, there is no chance the virus is going to be eliminated in the US. With that, the best possible news is that everyone's already gotten it.
Please remember that we still know little about this virus, about long term effects, about how long immunity lasts, about the risk of auto-immune responses etc.
It's never, ever a good idea to let a new disease spread along the population of you can help it at all.
If the long term effects put a lot of people in the hospital, than that would not be the ideal outcome. You can't just drop clauses out of my definition of "ideal" then turn around and tell me about how that's not ideal. I agree, actually! Something other than the ideal I described would in fact be less than ideal!
The point remains; on its own merits, the ideal would be that it turns out everybody's already had it, because that would prove that the currently-known negative impact is also the total final negative impact. Since the total known negative impact is basically a given and can't go down and is thus a minimum, finding out that's also a maximum would be good news. On the whole, more people having been exposed without hospitalization or even awareness is good news. Maybe earlier in the cycle that wouldn't be the case, but with where we are now, it is.
At least, for this pandemic, for a disease that happens to affect a small set of people badly but, to all evidence, most people not at all. In terms of weathering a pandemic in which it was actually bad news for a majority of people, this has been a rather disheartening experience. That's a problem for another day, though.
(Which is not a synonym for "not a problem at all". But it's a problem for another day. Trying to solve COVID-19 with measures appropriate for EvenMoreBubonic-2022 is not a win.)
Sort of, but the fact that "deaths are lower" is likely a cohort problem.
Let's say I am looking at the bread in my cupboard and trying to figure out what percent goes moldy. I've got one moldy loaf, and I buy 9 fresh new ones. Boom, current moldy-rate is 10% what a relief, looks like mold is less of a problem than I thought--only 10% of bread goes moldy! Looks like the previous estimates of mold-rate were misleading.
If a vaccine is forthcoming, it is not at all inevitable that we will all be exposed to it.
It’s harder to fudge death numbers compared to case numbers.
The cohort I'm talking about is the number of days since a positive test result. When you have many new cases (loaves of fresh bread) and you use simple math, bread/moldy you get the wrong idea about death rate. Click-baity articles, and those with motivated reasoning for "it's just a flu" get breathlessly excited about this as if it were some sort of useful data. See ops assertion that the level of crisis "is independent of the number of people who test positive" for an example of what I mean.
People testing positive is a leading indicator for the size of the crisis.
In NYC, there were 358 hospitalizations and rising on 3/17, and 8 deaths. On 3/31, there were 383 daily deaths and rising. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
Deaths in Texas have been trending upwards since June. https://www.us-covid-tracker.com/?field=newDeaths&state=Texa...
Of course, there's no guarantee that the course of the epidemic in Texas will look like New York City's. But a sharp rise in hospitalizations does seem to presage a lot of deaths.
That's literally the worst case endgame, where everyone vulnerable has received the full brunt of the disease lessened only by medical care.
The ideal outcome is that the spread is minimized by a mix of general and targeted social distancing and containment measures until a vaccine, effective treatment, or both are deployed widely enough to eradicate the disease.
Approval of quarantine until vaccine was released =/= approval of social distancing in any form.
The poster claimed that most people are not in support of quarantine until vaccine, not that they oppose any quarantine.
The poll you linked did not ask about quarantining until the vaccine was available. In fact, 50% of the poll respondents expected social distancing to last no longer than 2 months. Note the poll was taken in March.
The big protests were about two weeks ago. Hence the spoke. The holiday just passed. So two weeks from now you’ll see a big wave of deaths and increasing caseloads.
If we are fortunate, the hospitals in the south will keep up with the surges in caseload and limited beds. If not, you’ll have the freezer trailers with stacked corpses like you saw in Queens.
Do you/we have any good reason to believe that outdoor gatherings are much of a problem? The impression I've gotten is that indoors is where most instances of large amounts of people getting infected at once happens.
This is correct. People are expecting a step function of deaths exactly 4 weeks from the peak of cases? This is not statistical. Peak of deaths lag peak of cases closer to 1-5 days. If case growth is a matter of true rise of infections we would see modest increase of deaths about 2-3 weeks ago (cases started growing 4 weeks ago). We’ve only seen deaths drop on a exponential decay trend.
https://91-divoc.com/pages/covid-visualization/?chart=states...
Presumably students coming from high-prevalence areas will be forced to quarantine for the first two weeks, and high-frequency testing and contact tracing will be mandatory. It might be manageable.
Actual deaths are down and have been trending down for months.
https://i.imgur.com/83sw5pd.png
https://www.worldometers.info/coronavirus/country/us/
I have no idea why this isn't front page news.
This is an example of Simpson's paradox. You're looking at the sum of two different timelines, the virus in the Northeast (deaths declining) and the South (rising, but slow).
https://en.wikipedia.org/wiki/Simpson's_paradox#/media/File:...
https://www.nytimes.com/interactive/2020/us/arizona-coronavi...
https://www.nytimes.com/interactive/2020/us/florida-coronavi...
https://www.nytimes.com/interactive/2020/us/texas-coronaviru...
1) Avg age of infected is 36-37 now instead of 60+ as in April, so there is a lower death rate (plus, infections today will only translate into deaths in three weeks or so)
2) Test positivity rate is UP, so testing has gone up "a little" while cases have gone up a lot.
It was impossible to get tested unless you were high-risk in April because there were so few tests. High-risk for Covid-19 means old.
Now we have more tests than we know what to do with -- so the average age is of course going to trend lower.
Also, test positivity is not up -- it's down:
https://pbs.twimg.com/media/Eb7_BMOU4AEdrLm?format=jpg&name=...
If your hypothesis is correct, and infection rate is going up just because of more testing, then we should be pacing with other countries that are also testing more. We're seeing positivity rates of almost 25% in Arizona and 19% in Florida and Texas; which way out strips countries that have this more under control. At that rate of 15% or more, how many people are being missed (or are you also assuming we're catching 100% of all cases)? The more likely interpretation of the data is that not only are we testing more, but there are more cases; which fits with the overall data trend of BOTH more tests AND more infections.
I'm going to nip your goalpost moving in the bud here - since I'm sure you'll come back with "yeah, but deaths are going down."
Just because mortality has been going down doesn't mean that it isn't affecting the younger group and they're just magically recovering back to baseline. There's good evidence that there are lasting lung and immune response issues post "recovery" if it doesn't kill you. Further, deaths are a lagging indicator, and unfortunately what timeframe on that is unknown now because the age group is skewing younger and a large portion of our dataset is skewed towards the 65+ group due to how the initial wave of the disease spread.
It’s pretty easy to compute normalized infection rates for populations based on samples of data, which haven’t changed materially with the testing ramp up.
Additionally, antibody testing allows for an assessment of past infection rates at a community level.
> Now we have more tests than we know what to do with
A coworker related about a month ago that when his wife, who works in a hospital and showed some symptoms of covid-19, asked to be tested, she was told that the nearest place with available tests was a 2.5 hour drive away.
And it has been news. https://www.nytimes.com/2020/07/03/health/coronavirus-mortal...
People have been saying this for months now, and it hasn't been true at any point. Daily deaths have been falling as cases rise.
The fact is we don’t know a lot about how this virus operates or why it does what it does. What we do know is that there are fates much worse than death that come from this disease (reduced lung/heart/organ function, long hospital stays with very expensive bills at the end, etc). We know it spreads quickly and we know it’s spreading uncontrolled right now. We know at least 130,000 people in the US have died and many more will be permanently injured. We know the countries who handled the response right, because they are opening back up. We know the countries who handled it poorly because their cases are still going up.
All of the things we don’t know are problems and we need to keep learning. All the things we DO know tell us this is bad and it’s going to get worse before it gets better unless people start taking it seriously. Unfortunately many people are taking the opposite approach and claiming victory based on the unknown factors we still don’t know answers to.
The claim was that deaths having been going down. They have for 90 days. We know that deaths lag diagnosis by 7-14 days.
The out of control growth "side" has lost it's credibility.
>All the things we DO know tell us this is bad and it’s going to get worse before it gets better unless people start taking it seriously.
Deaths is the most accurate data we have and it shows us things have been continuously getting better for 90 days. Of course we are not out of the woods, and should continue to implement reasonable controls.
I'm glad that death rates are down, but unless universities completely waive all attendance policies (and adjust grading systems accordingly) infections can't be ignored. Additionally, not dying doesn't mean a quick infection: there are long-term effects.
Initially the lockdown was enabled to flatten a curve of a disease we had little information about. Months later, we have lots more info about it. Treatments are better. Flattening the curve won’t change the area under the curve, and the majority of the US did not sign up to lockdown until a vaccine was released.
And deaths are a lagging indicator. It takes up to two weeks, median around one week to show symptoms, and then another two weeks, median a week and a half or so, to become seriously ill.
The outcome after that depends on predisposition and quality of care. But one developer I know spent forty days on a ventilator.
So if lockdown isn't being observed and masks aren't being worn, it's going to take 4-6 weeks for that to start significantly increasing deaths.
There are rumours in the UK of another national lockdown in September/October, but I suspect local lockdowns will become a thing long before then.
False dichotomy. Responsible mask-wearing allows many (admittedly not all) areas of society and the economy to function without a full lockdown.
Also, make sure to split out the data per state/region. The decline from NYC for example made up a huge amount of the decline. Otherwise you run into Simpson's Paradox.
Miles Beckett did a decent Twitter thread on the topic: https://twitter.com/mbeckett/status/1278750652160634880
Deaths have declined for various reasons, including improved treatment (rolling patients and avoiding ventilators). Also we have not had the overwhelming of hospitals that took place in NYC and Italy repeat yet. Between the protests and people cutting loose over the holidays, I certainly hope we don’t see a repeat of that.
Please for the love of god stop repeating this extremely misleading claim. The increase in new cases cannot simply be explained by the increase in testing.
https://www.washingtonpost.com/outlook/2020/06/22/no-more-te...
>> Deaths, which happen regardless of how many tests you run, are down and have been trending down for months.
Deaths are a lagging indicator. Cases started to spike recently. Deaths will start to increase soon, especially when ICUs fill up and non-covid patients can no longer be treated in intensive care either.
More positive tested cases.
They also tested more people yesterday alone than they did in any given week in April(the previous spike) while seeing a similar number of cases. The truth that no one wanted to talk about 2 months ago is that we can't reopen fully until we get a vaccine or natural herd immunity. a vaccine is likely still 6-10 months off from mass production, so if we wanna open up normally in anyway we need to go for natural herd immunity.
Or we can just stay 50% open, that works for countries where people respect the government (like most of the EU) but here in the US everyone thinks they know better, so there's no way to to enforce something like that.
1. See figure 2 in this paper for a graph of the relationship between R0 and herd immunity thresholds: https://academic.oup.com/cid/article-pdf/52/7/911/847338/cir...
Doesn't this also assume that those people remain inoculated to further viral infections after being infected the first time? From my limited understanding, that is not a given for SARS-CoV-2.
What vaccine?