Almost one-third of Florida children tested are positive for the coronavirus
thehill.com
thehill.com
a) are better at catching it (but not better at spreading it) than adults
b) have a larger window in which they "test positive" or
c) parents are the ones infecting children - that is to say that parents and children both test positive for the same duration of time, but parents get it and get over it first.
If you test positive, why make your kid go through that? If you test positive and you are both sick, you can presume you've caught the same thing.
In any case, I would expect kids to be tested after adults in most cases during the shelter in place
From what I understand, the overwhelming majority of kids with covid do not require any treatment whatsoever, with only a small handful of anecdotes of kids having bad symptoms.
Just don't let junior visit grandma.
if the kid turns out to be that small percentage that do need intensive care - you would be kicking yourself.
kids have died from covid complications, they are not immune.
Why is this so hard to grasp? Being a disease carrier is a problem even if the kid doesn't show symptoms, especially it's been established that covid is transmissible with no symptoms.
Most kids have no symptoms. If a kid has symptoms, they have a risk of them progressing, and COVID symptoms tend to progress fairly suddenly (or, at least, fairly silently, if you aren't continuously tracking O2 says, which results in a sudden-seeming transition from “mild symptoms”, or even no noticeable symptoms, to catastrophic symptoms.) While kids are far more likely to be completely asymptomatic, testing if they are exposed to determine need for monitoring, especially if they are already noticeably ill (and, thus, if you presumed they are infected, equally ought to be presumed to have missed the high probability in their age group of getting by completely asymptomatic.)
Some of this research is rather worrisome. But it's important to not overstate what it says: we find evidence of lung damage in imagery of a small proportion of asymptomatic adults. (I'm not aware of any imaging study of asymptomatic children).
How significant these imagery findings are, what proportion is from COVID-19 (because if you image a bunch of people without COVID-19 you're going to find some weird things in imagery, too), and what proportion of adults infected would have this are unknown (even the asymptomatic adults who manage to get a positive test result and enroll in an imaging study are not typical). Let alone knowing how common this would be in children.
The only way to get this outcome is if negative kids are less likely to be PCR tested than negative adults, or if positive kids are more likely to be PCR tested than positive adults, or both.
Most likely, you'd only get the kid(s) tested in that case if you were seeking medical care because it was pretty bad, or the tests were encouraged by a contact tracing regime. The first part would lead towards higher positivity results, and the second towards lower. With no details on who go tests / what their motive for testing was, we just don't know.
That, in a nutshell, is the reason positivity rate matters.
If a positivity rate is too high, that may indicate that the state is only testing the sickest patients who seek medical attention, and is not casting a wide enough net to know how much of the virus is spreading within its communities. A low rate of positivity in testing data can be seen as a sign that a state has sufficient testing capacity for the size of their outbreak and is testing enough of its population to make informed decisions about reopening. https://coronavirus.jhu.edu/testing/testing-positivity
if you know you are sick with covid, would you let your kid potentially die from the disease as well?
The ONLY reason we test is to control community spread. Covid doesn't really have any specific treatments, it gets managed the same way you manage a flu patient. There's near zero value in the individual information about an infection.
In an idea situation (i.e. where the pandemic hasn't outstripped test bandwidth, which is true now in almost all of asia, most of europe, and some areas of the US like NYC) you test everyone who gets sick with covid-like symptoms, and for every positive you then go and test everyone who had meaningful contact with them.
You absolutely don't skip tests because you can reasonably assume a positive. That's missing the point entirely.
At present. There are lots of reports about lingering effects. And large portions of asymptomatics studied have penumonia.
You don’t feel tis pneumonia as a symptoms, and if covid damages vascular or brain tissue, you won’t feel that directly either. But it could well be an issue down the road, and knowing if you or your kid had coronavirus could help future treatments.
Interestingly enough, my daughter got sick and we thought it was strep. She ended up getting tested for strep and covid in one day.
It is broken down by age group.
Also it could point to less exposure to common cold antibodies, this is the south. Common cold antibodies are believed to be the cause for the low IFR percentages worldwide.
The reason people track the "positive test rate" isn't to make deductions about the population directly, it's to provide data on how well testing and tracing is working. In NYC right now, positive tests are coming back at about 1%. That is, almost everyone who they think "might" have covid actually doesn't (they have the flu, or if they're a contact they didn't get infected). That's good, because it means the test and trace control is working and the probability of a person who does not get tested being infected is very low.
In FL, things are out of control. Getting back a 30% positive rate means that you're really only catching the cases that come in the door. It means that there are probably a ton that you aren't catching, because you can't test enough to keep up.
Which health experts? Why do they fear this?
"Alina Alonso, the health department director of Palm Beach County, reportedly told county commissioners on Tuesday that the long-term consequences of coronavirus in children are unknown."
That doesn't sound like fear to me, and in some respects the article comes off on me as though the author is attempting to elicit fear where there should be none. I am not a parent myself, but if there's one thing I know about them it's that they tend to be VERY fearful when it comes to their children's safety. If the author is deliberately toying with that then the ought to be ashamed.
Modern medicine had seen before severe cardiovascular accidents and is aware of what a damage in young arteries or heart can produce. Some tissues can self-repair better than other.
The origin is new, but the consequences of damage on any main organ are well studied.
COVID-19 is very obviously shaping up to be the defining issue of this election cycle. Mexico is very relieved. But as we are all aware - as the election goes, so goes the media.
Basically, this means that they don't have enough testing capacity and are testing only when they must.
[1] https://www.usatoday.com/story/news/health/2020/07/15/florid...
There's no "goalseeking" going on here. If you think the numbers are clearly wrong, what's your source on better ones, or what's your analysis showing what the proper infection rate is among tested children?
They are also doing good pulse oximeter tests at the finger, and temperature tests, which is at least something, but only when it's too late already. PCR tests find infections 2 days earlier.
My guess is the whole CDC procedures are flawed countrywide. The written CDC guidelines favor NP over OP (mouth) over Anterior nares. International guidelines only recommend NP swabs, nothing else. Maybe they don't dare to hurt the US snowflakes with the NP swabs, so that testing is at least somewhat accepted.
Edit: Sorry. I misintepreted parent comment.
That's far smaller than a third of the ~4 million children in Florida. Few of those are showing symptoms and thus don't get tested. At least, for another month or so, when the schools reopen and every student (and teacher) gets exposed.
Florida has averaged an 18% positive test rate over the last week. You can get a chart of the moving 1 week average positive rate here [1]. This was with a testing rate of 3000 tests/day per 1 million people.
Compare to 30 days ago, when they were getting a 7% positive rate on testing of 1400 tests/day per 1 million people.
Edit: might as well add deaths. 4.4 deaths/day per 1 million now (7 day average). 30 days ago it was 1.5.
In other words if you jurisdiction has a high positive test rate, you may want to bring that % down for optics and the way to do that would be to use contact tracing (tracking tools) to solicit people who have properly been isolating and their exposure would have been minimized.
Indeed that measure is unattainable in a growing epidemic, but shrinking it should have been the first target. That some states are moving away from a 5% positivity target is just the symptom that those (mostly Republican) states have failed at achieving the purpose of the lockdown and are still months away from being able to implement contact tracing.
Or an NBA player.
To be fair, the league is paying for these and sending them to a private lab, so I'm not sure if they're actually coming out of the test pool available to the general public.
Central Florida as driventhru testing, no reservation or symptoms required. They recently opened a diy swab line for people with symptoms.
https://www.wftv.com/news/local/coronavirus-where-testing-is...
Do you think The Hill should have attempted to apologize for the data with hearsay about the numbers? Or should they just report the facts as they are given and leave it up to the state of Florida to clean up their mess?
> FORT MYERS, Fla. – The Florida Department of Health in its daily COVID-19 report lists multiple laboratories throughout the state – many of them small testing sites – with 100% positivity rates, but Southwest Florida's dominant hospital system said Wednesday it is incorrect to say 100% of their labs are positive.
> The Lee Health hospital system is reporting that its laboratory testing of potential COVID-19 cases has shown an overall positivity rate of about 18%, despite the state report showing that all people coming in for testing at some of its labs have the novel coronavirus.
Why should the state's numbers be privileged when we know the state is being flatly Politburo about them?
All it takes is ~500 tests in each state per week to get a significant sample size. And, it would definitively answer what the population infection rate is, and how it’s trending.
You can blame ignorance or anti-science beliefs for the problems in some states, but the California state government clearly takes the virus seriously, is following expert advice, and still can't meet testing and tracing goals. Something else is going on here. Dysfunction of government is the answer.
The Federal government is pushing responsibility onto states, and states are pushing responsibility onto county governments. Most county governments are not equipped to deal with pandemics. There is just no way this is going to go well. The countries that did a good job testing and tracing had a central coordinated effort from the top.
Failure to execute is why I will not support another lockdown. We squandered the time we bought with the first lockdown, and I don't see a reason to believe it would go differently the second time. Not with the government we have.
They already have enough actionable data to identify where the outbreaks are, how fast they're spreading, etc. but local governments will make decisions however they want anyway.
If our federal government wants to push us to re-open, the best thing they could do is provide a substantial amount of federal funding so that tests are available, for free, to anyone who wants one.
> https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-...
"Only" is quite cruel btw considering that those kids will never grow up to have a life and how many other people sick kids infect and probably kill.
That the death rate for children is incredibly low.
Just as a for-instance, I had the Chickenpox, like most people my age. No biggie. Then I later developed Shingles, because the Chickenpox virus can be dormant in your body for decades. Shingles can be debilitating.
I highly doubt that Covid-19 will have long-term health impacts like that for children. But we absolutely don't know for sure, yet.
Covid “hangs out” in your body? I have not heard this, is there any source you can link?
The issue isn't the virus lingering, it's apparently blood clots throughout various organs, which can cause problems years after they come to be. A friend of my family died from unexpected bleeding/brain crushing after a small blood vessel in his brain popped. This was many months after the issue was first noticed, and a few months after one of to-be-two operations was done to prevent that clogged blood vessel from bursting due to over-pressure.
Even SARS-1, which is way more serious than SARS-2 (the virus that causes COVID-19), doesn’t cause long term damage (lungs, etc) in actual adults.
What we should be concerned about is the long term impacts of poor socialization, weakened immune systems due to suppression of natural pathogen exchange, an environment of fear and hysteria, widened educational attainment gaps due to non-scientifically-grounded refusal to allow in-person instruction etc. Virtually all the uncertainty is on the “pro lockdown” side IMO.
BTW I recognize you weren’t saying that long term damage does happen but rather that we just don’t know. But I reject that entire argument. We have no evidence it happens and plenty of evidence it doesn’t happen with more serious viruses.
https://www.theatlantic.com/health/archive/2020/06/covid-19-...
SARS-1 is much more deadly and much more symptomatic. But structurally they resemble each other; they share the characteristic spike protein and a bunch of other features.
Immunity to SARS-1 confers immunity to SARS-2.
Now, SARS-1 being a more severe version of SARS-2, serves as a great model of what severe COVID-19 might look like.
And we know that in SARS-1, there are not these supposed long-term effects. You can get lung damage that lasts for a few months, but is undetectable at the 1 year mark. That's not long-term damage.
I also want to mention that the "long-hauler" narrative does not have real evidence behind it, except for those who are immunocompromised and therefore would be a "long-hauler" for literally any virus they got infected with.
Unfortunately, and I am worried that saying this will trigger reflexive downvotes, almost all US mainstream media has an incredible leftist bias (see: recent events in the NYT, WaPo etc). Therefore anything coming from the atlantic, vox, CNN, is very transparently trying to perpetuate the "doom" narrative. That's why they don't report on any of the incredibly positive/surprising facts, such as the widespread T-cell cross-reactivity in those who have never been exposed to either SARS-1 or SARS-2, or the fact that children surprisingly don't seem to spread it to adults in any real numbers, or the logical conclusion of the fact that SARS-2 kills the very old but not the very young, which is that recurring deaths (deaths in subsequent years) from COVID-19 will be virtually nonexistent.
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Back to the long-term effects. The article you linked is not scientific at all and just rattles off a serious of anecdotes. So I don't really know what there is for me to argue against.
There was a great study of SARS-1 lung imaging that I love to cite, and yet I can't find where my notes on it are. So take this random one I just came across:
https://onlinelibrary.wiley.com/doi/full/10.1046/j.1440-1843...
> Lung function studies carried out on 258 patients from Xiaotangshan Hospital in Beijing 2 months after discharge showed that 21% patients (54 of 258 patients) had evidence of impaired diffusion (DLCO < 80%pred) while 6% (16 of 258 patients) had restrictive ventilatory defect (VC < 80%pred).18 Fifty‐one of 54 patients had lung function tests repeated one month later. DLCO was found to improve in 80.4% patients (41 of 51 patients), and FVC in 81.3% patients (13 of 16 patients) (Table 3). These findings suggest that lung function abnormality caused by SARS might improve spontaneously over time.
(BTW, long-term damage and the "long-hauler" meme are technically referring to two different things)
As a counter-point to myself, the following study identified abnormalities (although keep in mind abnormality doesn't mean it's necessarily a massive problem) at the 6 month mark:
https://thorax.bmj.com/content/59/10/889.abstract
The study I'm looking for but can't find showed abnormalities at the 3 month mark but no abnormalities at the 1 year mark, so that study I just linked doesn't actually contradict my own expectations.
Finally remember that we're using SARS-1 here as a model of what really bad SARS-2 looks like. For anyone who doesn't have invasive-ventilation-level COVID-19, the expectation that they might experience long term damage is completely unfounded.
But please consider:
At the one extreme, someone says "31 confirmed death by Covid19 on children under 14 years." As though death is the only possible negative consequence, and since 31 is a very small number, that should put to rest any concerns.
At the other extreme end, we're worried about the teachers, the staff, and the families of the students. We're worried about children who get sick, don't die, and develop chronic conditions.
The real danger level is probably in-between those two extremes, is it not?
[COVID-19 Transmission and Children: The Child Is Not to Blame](https://pediatrics.aappublications.org/content/early/2020/07...) - July 2020
--
As far as negative consequences, there is no theoretical basis for long-term consequences of COVID-19. There is basis for medium-term lung abnormalities which happens in general with pneumonia, but that doesn't apply to children except the incredibly small fraction that actually have bad outcomes, which is so rare that we should literally treat it as a rounding error.
Even pediatric multi-inflammatory syndrome is incredibly rare.
No, most people are dramatically overestimating COVID-19 risk and dramatically underestimating risk of lockdown, universal masking, etc
"Coronavirus disease (COVID-19) presents arguably the greatest public health crisis in living memory."
In other comments, you've claimed there's no long-term risk to children, while the article you cite says,
"emerging reports of a novel Kawasaki disease–like multisystem inflammatory syndrome necessitate continued surveillance in pediatric patients"
Then you just plain went to far, when you said "there is no theoretical basis for long-term consequences of COVID-19." Sorry, but "there is no theoretical basis" is an over-statement. If you had said, "The evidence indicates there are no long-term consequences," you would have maintained your aura of authority. But "there is no theoretical basis" is too far, especially since you cited an article that specifically mentions novel Kawasaki disease–like multisystem inflammatory syndrome. That's not just a theoretical basis, that's an example of a concrete basis. "There is no theoretical basis" doesn't mean, "the theory is incorrect," it means, "it's impossible for the theory to be correct," and that's a statement the evidence YOU CITED shows is not true.
I think you're more informed on the subject than average, but I am no longer convinced you have a good grasp of even the evidence you cite, let alone the body of available research. You Google well, but you don't really understand.
(2) Given your only argument against my statement of there being no theoretical basis is what I addressed in (1), there's not much for me to address here. So I'll throw it back at you: What long-term pathology has been observed in SARS-1?
It may be that we are using "long-term" in different senses. I don't consider 3 months to be "long-term". AFAIK most people raising alarm about (unfounded) long-term damage are implying either lifelong or at least years+, right?
(3)
> In the same comment you say "most people are dramatically overestimating COVID-19 risk," and then cite an article which says,
>> "Coronavirus disease (COVID-19) presents arguably the greatest public health crisis in living memory."
I don't see how these statements are mutually incompatible. It's possible for COVID-19 to be the most serious pandemic in over a century - which it is - and for people to still be overestimating the risk.
There is a study that surveyed people for their estimated COVID-19 risk which supports my claim; people in the 20-29 age group estimated their risk of death if infected at 2%. Think about that. That's at minimum a 50x overestimate.
Humorously, the older someone was the less they estimated their risk in absolute terms; young people reported higher chance of death than older people.
Seems like there's evidence to the contrary:
Older children, 10-19, spread the Coronavirus just as much as adults, large study finds.
People will get all upset over a report of a squirrel with bubonic plague, even though they never come anywhere near squirrels. Or they will hide because a raccoon walks through their yard in the daytime and they are afraid of rabies (even if they live in western Washington, where there has never been a known case of rabies in raccoons...). (The reason the raccoon is out in daytime is most likely that she has babies at home and needs to gather more food than she can with just her usual nocturnal foraging).
But children...which we actually allow to get close to us, even going so far as letting them into our buildings and vehicles? Meh.
This conflation between individual risk and aggregate risk is just pathological at this point. It won't stop.
I expected children to be virtually incapable of dying from it, but learning the truth about spread was quite surprising to me.
I don't know what you're citing. There are a few papers out there showing effects like this, there's certainly no "overwhelming" evidence of anything in a pandemic that's barely seven months old, be real.
> but learning the truth about spread was quite surprising to me
That phrasing freaks me out a bit. What, exactly, are you reading? This is science, that kind of certainty is a design smell.
As far as the overwhelming body of evidence, let's start with some weaker but still reasonable evidence:
https://www.folkhalsomyndigheten.se/contentassets/c1b78bffbf...
> In conclusion, closure or not of schools had no measurable direct impact on the number of laboratory confirmed cases in school-aged children in Finland orSweden. The negative effects of closing schools must be weighed against the positive indirect effects it might have on the mitigation of the covid-19 pandemic.
https://www.eurosurveillance.org/content/10.2807/1560-7917.E...
Title: No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020 separator commenting unavailable
> Children are thought to be vectors for transmission of many respiratory diseases including influenza [2]. It was assumed that this would be true for COVID-19 also. To date however, evidence of widespread paediatric transmission has failed to emerge
> Among 1,001 child contacts of these six cases there were no confirmed cases of COVID-19. In the school setting, among 924 child contacts and 101 adult contacts identified, there were no confirmed cases of COVID-19.
> In summary, examination of all Irish paediatric cases of COVID-19 attending school during the pre-symptomatic and symptomatic periods of infection (n = 3) identified no cases of onward transmission to other children or adults within the school and a variety of other settings. These included music lessons (woodwind instruments) and choir practice, both of which are high-risk activities for transmission. Furthermore, no onward transmission from the three identified adult cases to children was identified.
> The only documented transmission that occurred from this cohort was between adults in a working environment outside school. Among 1,025 child and adult contacts of these six cases in the school setting there were no confirmed cases of COVID-19 during the follow-up period. Follow-up period was at least one incubation period (14 days) from last contact with a case.
https://wwwnc.cdc.gov/eid/article/26/10/20-2403_article
> Children are underrepresented in coronavirus disease (COVID-19) case numbers (1,2). Severity in most children is limited, and children do not seem to be major drivers of transmission (3,4). However, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects children of all ages (1,3). Despite the high proportion of mild or asymptomatic infections (5), they should be considered as transmitters unless proven otherwise.
^ Note I included the "they should be considered as transmitters until included otherwise" to ward off accusations of cherry-picking
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Now, even if children did spread normally, I would still be against school closures, indeed I am against the policy of containment entirely because I view it as an infantile and ineffective policy that just leads to worsened all-cause mortality and likely worsened COVID-19 mortality over the medium-term.
There is one last study that I am having trouble finding which was much stronger/more conclusive than the ones I linked above, but I'm having trouble finding it. Really need to organize these studies better. (I have a master list of studies w/ relevant tidbits but haven't done that for the children studies since it doesn't interest me as much, given we already know that children don't personally die from COVID-19 in any real numbers)
But you don't play games here. This age dependency is just barely measured, not understood well AT ALL (it actually runs counter to the way almost all other respiratory viruses work!), and based on measurements that at best are a few months old. Most of the papers in this space are preprints, peer review is just now catching up.
Just stop. A few links doesn't make for proof in this space. People will die if we get it wrong.
That's your problem. You and everyone in your camp acts as if all the uncertainty exists in the "herd immunity" side. It doesn't. The risks of SARS-2 infection are much better bounded than the risks of unprecedented lockdown and economic destabilization. Full stop.
Not dying does not mean 100% OK.
SARS-2 is not the scary virus it’s made out to be. It’s just not. It’s a poor killer and a great spreader. Exactly the type of virus we in the general population need to let pass through us.
"Hundreds of health-care workers lost their lives battling the coronavirus"
https://www.washingtonpost.com/graphics/2020/health/healthca...
"The nation’s largest nurses union, National Nurses United, puts the total much higher: 939 fatalities among health-care workers, based on reports from its chapters around the country, social media and obituaries."
Isn't that a lot?
https://www.washingtonpost.com/investigations/2020/05/02/exc...
"Excess U.S. deaths hit estimated 37,100 in pandemic’s early days, far more than previously known"
Isn't the fact that you can visibly SEE excess deaths, greater than previous years' trends, concerning?
> It’s a poor killer and a great spreader.
It's such a great spreader, that even though it's a poor killer, it's killed 140,000 in the US.
Isn't that, you know, a lot?
You should know that the way we classify deaths is highly suspect, but my argument doesn't hinge on that so assume all the deaths are legit.
> Isn't the fact that you can visibly SEE excess deaths, greater than previous years' trends, concerning?
As for excess deaths, assuming those are COVID-19 deaths is foolish. More people die every year from cardiac events than have died thus far from COVID-19 (and likely that will still hold by the end of this year for an apples-to-apples comparison); it stands to reason that many of those deaths are from cardiovascular disease, amplified by the unprecedented suspension of elective surgeries and preventative care, not to mention how afraid of going to the hospital people are.
BTW, go look at 2019 all-cause mortality compared to 2020 all-cause mortality. They're almost identical. So no, statistically this is not something super crazy.
^ Seriously, go actually look at that data. You will probably be shocked. I was.
Likewise, hundreds of health-care workers losing their lives isn't very surprising. Although in general I don't like to 'rebut' news articles because they don't give much that's actually rebuttable.
---
BTW, I've said this elsewhere but probably not on this thread yet:
Given COVID-19 kills the very old and spares the very young, once it has passed through the population, deaths in subsequent years will be nearly non-existent. Why? Because the set of COVID-19-naive individuals (of those who can actually get infected, since many cannot due to cross reactivity) becomes dominated by new entrants to the world, e.g. babies/toddlers. The same individuals who are virtually incapable of dying from COVID-19. Therefore unlike Flu, which apart from its ability to mutate is responsible for significant recurring death, COVID-19 will not have significant recurring death. Thus amortized over many years, the numbers look even better than they do now. And I know this sounds hard to believe, but the numbers to me look really good.
I believe our policy of lockdown has certainly increased all-cause mortality - I consider that inarguable - but furthermore, I think it is very likely that our policies have put our bodies into a state where we suffer worse outcomes from COVID-19. This is due to people staying inside and therefore not getting sun exposure, with vitamin d and to a much lesser extent nitric oxide playing INCREDIBLE roles in the outcomes of respiratory diseases (the magnitude of effect size shocked me w/ vitamin D), lack of exercise due to gym closures etc, social isolation which has been shown to increase death apart from the feeling of emotional loneliness (i.e. even if you take away peoples' emotional loneliness they still die more), lack of sleep and general life disruption attributable to unemployment and the "new normal", etc. I could go on, but really I should step away now before I spend hours in this thread...
Sorry, this seems to be completely wrong.
"5,250 workers died on the job in 2018." If 939 health-care workers died from Covid-19... That's a really big percentage.
> You should know that the way we classify deaths is highly suspect,
That's why looking at excess deaths makes a ton of sense to me.
> it stands to reason that many of those deaths are from cardiovascular disease
Sorry, that seems like an extraordinary claim.
It sounds like you're standing on your head to not blame the novel disease. And intentionally standing on your head to say that when the conclusion of the cause of death is Coronavirus, it's wrong. Both at the same time.
Wouldn't we see autopsies saying "the cause of death is a cardiac event" close to 140,000 cases more than normal, for your claim to be remotely true? We're not seeing that.
> BTW, go look at 2019 all-cause mortality compared to 2020 all-cause mortality.
Can you provide the references that you found? It's not clear to me how to find this exact data.
How many people who would have lived from a cardiac event are having trouble finding an ICU bed?
We hear 50+ hospitals in Florida have their ICUs completely full?
[1]:https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
This is just a flat-out lie.
According the the CDC [1] the all-cause mortality in 2020 is currently 155,446 higher than the equivalent date range in 2019. This despite the fact that recent weeks for 2020 are definitely undercounts as it takes time for all the data to come in.
[1]:https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
Too lazy to google, but has anyone done any research on how the recovered are doing, say in Wuhan 6 months after they got infected?
https://www.centerforhealthjournalism.org/2020/06/06/what-s-...
There is an uncontrolled covid outbreak in Florida that has killed thousands and at this rate, will get much worse. This is after state leadership had the opportunity to see the exact same thing play out in Hubei province, northern Italy, and the NYC metro area. This is no surprise, the means of preventing it are well know, and it happened anyway.
However, most testing sites that you can just sign up for on your own only test 18+, so getting her tested would be a PITA. Most likely we'd have to take them to the doctor and maybe they would order a test, but more likely, they'd just say go home and get some rest, call us if it gets worse. And even if I got my child tested, what would I gain from it? At best it would tell me what I already know.
Given that most cases in children are mild (I wouldn't have suspected COVID nor bothered to have taken my child's temp if I hadn't tested positive myself), I imagine it's only the children who doctors suspect have it that are getting tested in Florida, for the most part. And among that group, the positive rate is gonna be high.
Every nurse & Dr I know is getting massive bonuses (200-400 a DAY + hazard pay) to pick up 1-2 extra shifts. Recruiters are offering contract jobs at smaller hospitals north of $100 an hour for 12 weeks, with housing. We are weeks away from Doctors & Nurses working 48+ hours a week. (Do you really want to be treated by someone on their last 12 hour shift on overtime?)
There is not much staff left to deploy to help with the rising case load. Florida hospitals will soon be overwhelmed.
I hope we peak here soon and learn a valuable lesson going into winter, where we will have to deal with both corona virus and influenza.
I'm aware it sounds crazy, but food for thought.
Neither Zika not Ebola outbreaks were, nor were pushed by the media as, pandemics (also, the 2012 Ebola outbreaks, depsite being in a Presidential election year, received minor news coverage consistent with their magnitude; the major media coverage of a recent set of Ebola outbreaks was of the 2014 set, which were not in a Presidential election year.)
The media is reporting a pandemic in 2020 because one exists, just as they did with the flu pandemic in 2009, which you will note was not an (US federal, even midterm) election year.
Also, if you've ever been treated by a resident, they were almost certainly over worked, they move to cap their hours at 80 per week received pushback from docs saying that residents needed 80-100hrs/wk for training.
Higher more people, overlap shifts, problem solved.
Sure, sometimes the solution is to just throw more money at the problem. However that doesn't mean the money is available to dedicate to that solution.
Also US healthcare is so grossly inefficient it doesn't make sense to look at one cost center in isolation from a policy perspective, only from a the perspective of private sector actors I think shouldn't exist.
Hospitals initially cancelled most elective procedures (which is what pays the hospital's bills), which helps explain why hospitals are more likely to flag a death as "covid-related", so they can collect federal covid money to make up lost revenue.
Also, picking up extra shifts isn't the same thing as a "massive bonus"....and "travel nursing" (where they pay for housing) has always paid a lot of money, even before the pandemic.
This is the key takeaway here. You're taking the "reports" fed to you at face-value when you don't have all the relevant information. If 10% of beds in a given hospital are listed as "available for use", and all 10% are accounted for, a hospital can claim they are at 100% capacity.
This statistic-manipulation is not only being done with hospital capacity numbers, but also with covid test numbers, and covid death numbers. Statistics have been messed with like this throughout history. Wake up people.
https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
I am concerned for the US economy long term. The pandemic will kill 100k more at least, current projected deaths in just a couple months is up to 150k, which doesn't count the winter ahead.
But considering how damaged our collective productivity is going to be from 3/20 to 3/21, we are in for unemployment above 10% for a very long time as shutdowns and closures continue.
Will all the musicians, music venues, sports venues, museums, bars, restaurants, parades, weddings, etc still be the same after mass vaccination? I think they will all be hollowed out industries, we will not achieve that level of culture for a few years...sigh.
Anyone else feel depressed to be American?
What’s insane is how much more under control this could be with federal leadership, and a more compliant public.
Yes, especially since getting the virus load down to a level that can be effectively managed with testing and contact tracing isn't rocket science. We were doing okay through April then just gave up (at least that's what it seems like in Texas).
There was a period where some states were working together, but I don't know what happened to that -- maybe we just stopped hearing about it, maybe the relative success in New England caused that to fall off my radar?
Of course, the federal government is also actively working against state-level leadership on Coronavirus, which is worse than doing nothing.
https://coronavirus.jhu.edu/testing/individual-states/florid...
It might have something to do with less transitions being safer: https://www.advisory.com/daily-briefing/2017/02/14/transitio...
or hospital control of the labor market:
https://www.theatlantic.com/business/archive/2017/02/doctors...
Personally, I don't see how it's good for anybody, but supposedly it doesn't affect patient safety: https://consumer.healthday.com/general-health-information-16...
Well, yeah, because 16 shifts is already way too long.
We are so screwed.
We will be lucky to end up with less than 750k dead and/or end up locked in our houses for 8-12 weeks straight.
https://directorsblog.nih.gov/2020/07/14/study-in-primates-f...
No, you can't say that, because this isn't a random sampling.
Here is one possible interpretation of the story:
The authors tested 100 kids in a COVID ward. Only, 33% had the disease, so the hospital is drastically over reporting COVID cases. This means actual death rates could be 3x higher than thought.
Here’s another:
We randomly tested all kids in Flordia, and 1/3 had coronavirus. This implies there are over 10x more coronavirus cases in Florida than previously thought, so the hospitalization rate and death rates in Florida are less than 10% was previously thought.
As written, the story tells us almost nothing. The most likely explanation is that the underlying study was studying some unrelated aspect of Coronavirus, and that this story is a mixture of sloppy reporting and clickbait. Without knowing how they sampled the population, you can’t infer anything about Coronavirus infection rates from the provided data.
However, if you demand hard proof before taking any significant action, that's the same thing as demanding that no significant action be taken.
That's a very difficult position to sustain. Not to mention, doing nothing in the face of a huge and deadly pandemic is a very significant action, which you'd be taking without hard evidence.
The reality is, we have to take action and don't have the luxury of time to ensure our decisions are absolutely correct. We need to marshal the evidence we have, have our best experts extrapolate what we don't know and take our best guess as to the most effective course of actions. Of course, one set of actions we can take is to initiate research to gather more evidence and change course in response -- prioritizing things based on level of impact and time/resources it takes to gather the information.
> You're better than this HN.
Making decent decisions in the face of imperfect information is something everyone should try to learn, though it is hard to do well.
We do have enough hard evidence of many things to take action. And we have seen those actions result in positive outcomes.
My gripe is about the many hot takes presented in this thread about what action we should take based on way more guessing than is needed and then presented as almost fact.
It sounds like we both agree we "need to marshal the evidence we have, have our best experts extrapolate what we don't know and take our best guess as to the most effective course of actions".
> They're younger patients. [Their] age, last time, was probably around 65. Now, our average age is between 25 to 35, 45 years old. That's one big change. Much younger patients, pretty much healthy. Not really major past medical history.
> We are not seeing that much obesity. I know there are some reports about obesity, but at least in the ICU, I would guess maybe 20% of patients are obese. Most of them are pretty young and healthy patients.
> And also they get sicker than the previous [wave]. Mortality has not been a major issue because they are younger patients. But I think as the days go on, we might also see a change in mortality.
> The delivery of oxygen is much higher, that's one. Second is the blood pressure has been low. So we have to use a lot of medications to actually bring the blood pressure to a normal level. So it's one, the use of medications to keep the blood pressure high, and second, the amount of oxygen these patients are required, which is more than last time.
https://www.npr.org/sections/coronavirus-live-updates/2020/0...
To be blunt, I don't think this is anything new or surprising. Kids are staying home more this summer than ever before, and with limited social interaction they're less exposed to other respiratory illnesses that are circulating in the general population. Hence, those that are coming down ill right now are more likely to have covid than not.
[1] http://ww11.doh.state.fl.us/comm/_partners/covid19_report_ar... [2] http://ww11.doh.state.fl.us/comm/_partners/covid19_report_ar...
Random testing would give a much better idea of how common Covid is at the moment.
You can't get a kid under 12 tested where I live except for these situations.
Florida's positivity rate is flawed because many labs were reporting only positive results to the state database.
"Lab24 in Miami is listed as reporting 457 results — all positive."
"Lee Memorial, a large health system in Fort Myers, is listed as having three of its sites reporting only positive results."
https://www.sun-sentinel.com/coronavirus/fl-ne-lab-results-2...
/s
People getting herd immunity involves people, you know, actually contracting the disease.
This seems like the most logical way to combat issue, as opposed to hiding and hoping it goes away. Of course proposing it publicly means to be smeared by the media and politicians and twitter blue checks, who always have our best interests in mind.
Does this solution cause no pain and death? Of course not! It’s about causing the least amount of pain long term, including the externalities of our actions.
https://www.cnbc.com/2020/07/14/immunity-to-covid-19-uk-stud...
Logical if all that matters to you is numbers and money.
Lets not hide behind words. This logic mean death. You are conducting a blood sacrifice to ensure people don't have to alter their behavior.
If you're so gung-ho to get to herd immunity, how about you volunteer to be on the front lines?
From alcohol & substance abuse, from increased suicides, from domestic violence, and so on. Extended period of being prevented from running your business (or out of employment) without steady income, and bottled up at home is a major stresor and silent killer. The hospitals already reported significantly elevated suicides.
There is no magical strategy to stave off all the problems; balancing the risks and managing precautions as our knowledge expands is the correct, if hard to politically sell, way to go.
The new estimates of HIT factoring in widespread t-cell cross-reactivity in humans that have NEVER been exposed to a SARS-like virus nor anyone who was themselves infected with one, implies that the true HIT is somewhere around 25%.
Do the math on the US with an IFR of .3% and an HIT of 25%. That’s what a likely scenario looks like. It means a few hundred thousand dead.
As an upper bound do the same math with .9% IFR and 25% HIT.
BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment.
IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak. Population immunity is the stable and logical solution. Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war. Vaccine-attributable herd immunity only works if a bunch of people get vaccinated. Granted the t-cell reactivity findings alter the calculus there, but we would need to vaccinate people who do not demonstrate cross reactivity in order for that fact to change the number of required vaccines.
Let’s be precise. That’s a quarter of a million dead Americans. I’d consider that number to be deep in the “catastrophic failure” territory.
I also find the idea that the IFR would stay at 0.3% to be absurdly optimistic. We know that fatality rates scale with hospital load, any minor change to IFR could result in tens or hundreds of thousands of unnecessary deaths.
> BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment.
Prove it.
> IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak.
It’s worked elsewhere.
> Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war.
This level of nihilism is genuinely baffling to me. What course of action are you recommending? Just ignore it?
Hospitals being overwhelmed is not a serious concern at this point in time. Even at NY at the peak, one hospital would be past capacity while a nearby one would be nearly empty. Shuffling is not ideal but it works.
> This level of nihilism is genuinely baffling to me. What course of action are you recommending? Just ignore it?
It's not nihilism. I don't believe that practicing containment actually avoids mortality, except in the most optimistic scenario where lockdown-associated deaths are unreasonably low and a safe/effective vaccine is developed and deployed unreasonably fast.
My recommendation is not to employ any measures to slow the spread of SARS-2 in the general population, but instead to let the virus naturally pass through the general population. We can practice containment for elderly care facilities, although those individuals should be permitted to leave the facility and stay at home if they abject to the prison-like conditions required to avoid pre-symptomatic spread.
> Let’s be precise. That’s a quarter of a million dead Americans. I’d consider that number to be deep in the “catastrophic failure” territory.
Well, we already have 130,000 deaths, so that's about double where we're at now. So, we're talking about a delta of +120,000 if you want to be hyper-precise (I was not to account for uncertainty).
That's not a catastrophic failure at all; early (unrealistic, but that didn't stop our policy leaders from using them) estimates were forecasting 2.2 million dead, that's Ferguson's paper with a .9% IFR and 82% of pop. getting infected.
Please don't twist these words to portray me as callous, as you seem apt to do, but are you aware that ~500k americans die from cardiac disease every year? Smoking?
> Prove it.
You know that there will never be a RCT, so you must rely on good mental models and experimental results, such as ones showing the incredible role of vitamin D in the pathology of respiratory illness, the fact that nitric oxide lowers blood pressure and is currently being studied as a possible COVID-19 treatment, the obvious result that closing gyms = less exercise, the fact that unemployment is disruptive to one's life and tends to lead to a disregulation of sleep schedules, emotional states, etc.
> It’s worked elsewhere.
Where, exactly? Be specific.
New Zealand is the classic example held up here, and now New Zealand, which is a tourist economy, cannot allow any foreign entrants into their country without a 2+ week quarantine. I think that's a bad and unstable solution. BTW this is less of a concern but it makes them vulnerable to bioterrorism (intentionally spreading SARS-2).
OTOH Sweden followed a herd immunity strategy and has gotten there. Findings of t-cell cross-reactivity in the absence of having ever been exposed to a SARS-type virus indicates that a large swath of the population is not susceptible to COVID-19, period. Of those that are, the vast majority will either be asymptomatic, paucisymptomatic, or experience symptoms consistent with a mild cold. A small fraction will develop severe COVID-19 (which is dramatically worsened by vitamin d deficiency), culminating in the need for invasive ventilation and possible death.
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In general, the risks of COVID-19 itself have been overblown, and somehow we never have enough information despite very well-defined risk categories and good bounds on what bad COVID-19 looks like (it looks like SARS-1, the original SARS). Whereas what we do not have bounds on are the results of an unprecedented global economic destabilization and lockdown, nor the socioemotional costs we're inflicting upon our children as well as ourselves.
Honestly we might as well stop the conversation here. A quarter of a million extra dead isn't a failure? Wow. You and I just don't have anywhere close to the same values.
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You have used the classic rhetorical technique of those on the "doom" faction: take a well-reasoned rebuttal, and reply with a single sentence implying I am callous for openly discussing mortality.
No, the callous ones are those that are imposing a dangerous and unprecedented regime of lockdown, and using fear and hysteria to do so.
--
Also your math is just wrong. An extra quarter million? We already hit 130k dead, that leaves 120k left "to go" with your number.
Even in the SF Bay Area, fewer than half the people I see outside actually wear masks. It's crazy how little people seem to care.
Someone on Reddit gave the analogy of people peeing themselves with or without clothes on. If you're clothed and someone else pees in your direction, you're gonna get at least a little wet. If they're clothed, you don't get wet at all.
If someone developed a comfortable mask that gave the wearer near-100% protection and was widely available, I wouldn't worry about what others do.
Keeping the vulnerable protected sounds good and all, but in the case of, say, children, the vulnerable is the teaching staff.
We also have no idea if herd immunity will work, or for how long. Lots of coronaviruses confer either no immunity or a short term one; remember that a lot of common cold cases are coronaviruses too, and you can catch those repeatedly. Also, pursuing herd immunity involves infecting basically 20-50% of the population, a strategy that might kill 500k to 1.5mil Americans (assuming CFR stays at 1%, an optimistic assumption in this scenario)
We also have no idea what the health impacts for non-fatal cases are. Lots of patients are surviving with heart & lung damage; long term impacts TBD. Crippling an entire generation from the get go would both be tragic, and would put lie to the idea that not opening schools is “letting them fall behind”.
I'm in a low risk population but just because I'm not likely to die from it doesn't mean it's completely harmless to me.
The US seems to be using the worst off all possible options. However, several countries have succeeded and demonstrate it’s possible to succeed.
Stockholm burnt itself out with 20% of the population getting immunity (determined via antibody testing).
So (328,000,000 - 37,000,000) / 770,000 = 378 days until herd immunity, considering the existing cases.
What is more likely is that the case numbers will ramp up significantly though, to over 100,000 per day at some point. In that case the USA will have herd immunity within the year.
This is nothing new. Influenza hits about 20% of the population (60 million people) as well and then burns out for the season. We struggle yearly with keeping influenza out of nursing homes and with the surge of hospitalization that it creates.
The good news is that right now there are no excess deaths in the USA and that hospitals all over the country are handling the virus and not running out of space (more beds can be always be converted to ICU, ICU capacity is not infexible, same as is done for influenza).
You seem to be playing match the numbers up where they fit and celebrate.
If true, what do you make of the following reports?
7/16 - "Manatee County's hospitals hit capacity as COVID-19 cases continue to surge" https://www.msn.com/en-us/health/medical/manatee-countys-hos...
7/16 - "ICU fills up at St. Luke's Nampa hospital, meaning patients must be diverted to Boise" https://www.msn.com/en-us/health/medical/icu-fills-up-at-st-...
7/6 - "Four Tampa-area hospitals at maximum ICU capacity" https://www.msn.com/en-us/news/us/four-tampa-area-hospitals-...
7/6 - "Hospitals in Florida, Texas and Arizona Are Almost at Capacity as Coronavirus Cases Surge" https://time.com/5863564/hospitals-capacity-coronavirus-surg...
In New York, the hospitals are so far under capacity that they're running TV ads begging people to start coming back in for elective procedures.
Do you think 20% exposure (at a cost of 17.5k lives) buys you herd immunity?
Even in hotspots like New York City that have been hit hardest by the pandemic, initial studies suggest that perhaps 15-21%6,7 of people have been exposed so far. In getting to that level of exposure, more than 17,500 of the 8.4 million people in New York City (about 1 in every 500 New Yorkers) have died [...] To reach herd immunity for COVID-19, likely 70% or more of the population would need to be immune. https://coronavirus.jhu.edu/from-our-experts/early-herd-immu...
The hope is that its more like 20% gets you herd immunity while practicing moderate social distancing. It's not too unreasonable. Japan has been able to avoid lockdowns and mass testing by mostly just using masks and avoiding very close conversations.
Now we see new waves popping up elsewhere and surprise, their hospitals are filling. Hospitals are having a great time in places where they took the virus seriously. New York did not take it seriously at first and they suffered. Now Texas and Florida are not taking it seriously and they are suffering as well. And you're suggesting that we can just let the virus run rampant and we won't see our healthcare system buckle?
That's great if you need something done at a hospital that is not super time sensitive; it's not great if you're in the area where hospitals are overful and you have an urgent need.
Epidemic response needs to be done at a regional level in response to what's going on in that region, taking note of what's happening nearby as it might spill over, and learning from other areas within the country and worldwide to try to figure out what works best. It's totally reasonable, if the numbers support it, for some regions to be increasing restrictions and others to be decreasing restrictions. Clear communication from all levels of response would certainly help.
It’s probably better to think of immunity as regional and also not binary (herd vs not herd).
States like MA and NY have a significant benefit from their population immunity levels, versus FL and TX less so. That is to say they have to do less (if not nothing) to keep their R0 below 1 and whatever cases do show up are less likely to spread widely.
Immunity benefits are cumulative to any policy measures put in place. You can try to slow down the rate (flatten the curve) which might not change the ultimate case count in the end, but can lower deaths through greater availability of care. At some point immunity and mitigation measures combined will get you below R0 of 1.
If you’re an island nation with enough testing for effective contact tracing and constant vigilance and willing to lockdown repeatedly, then the other option is trying to actually prevent any spread even without any immunity, but you have to be able to continue this process indefinitely until a vaccine is widely available.
PS: Influenza vaccines are common with 68% of people over 65 getting vaccinated in the US. Further at least half of all cases are asymptotic which ends up contributing significantly to herd immunity.
To achieve herd immunity for measles at least 90-95% of the population need to be vaccinated. A disease like polio is less contagious, and 80-85% of the population would need to be vaccinated for herd immunity to work. https://www.ovg.ox.ac.uk/news/herd-immunity-how-does-it-work
It suggests our immunity to SARS-CoV-2 does not last very long at all — as little as two months for some people. If this is the case, it means a potential vaccine might require regular boosters, and herd immunity might not be viable at all. https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v...
Can't get 80% people to wear a mask, much less seasonal vaccinations.
From what it appears we know about the virus so far, a vaccine is the only sane way to possibly hope to reach herd immunity.
Even a modest degree of immunity can significantly lower spread. In France, Spain, Germany, you still have hundreds of cases every day, but they don't grow to thousands of cases anymore.
The disease hasn’t been around long enough to make this claim.
> Even a modest degree of immunity can significantly lower spread. In France, Spain, Germany, you still have hundreds of cases every day, but they don't grow to thousands of cases anymore.
This is true, but depends on the duration of immunity and a more uniform global response (or very tight border and quarantine adherence). Ongoing, sporadic COVID crises would still be pretty disruptive unless we have highly effective therapeutics.
So where are they? Are you claiming that these hundreds of confirmed reinfections simply haven't been reported? Note that the number of actual reinfections would be orders of magnitude higher; the calculation above already assumes underascertainment by a factor of ~100x. You can redo this math in any moderately hard-hit region, though I chose Sweden here because their rate of infections vs. time has been more constant (eliminating the possibility that all the infections happened in a brief early peak, after which everyone acted more carefully so there's no longer any opportunity for reinfection). I'm not saying that reinfection is impossible, just that so far, if it exists, it's very rare.
And please don't cite the Vox article. In normal times, it would be criticized as "science by press release" or worse, a single anecdotal case written up as definitive for the popular press, with no case history and no publication to review. Maybe the author's patient really did get reinfected and it's common (but that seems vanishingly unlikely to me per above), or maybe the patient was reinfected but it's rare like getting chickenpox twice, or maybe the patient just had one long infection and tested false-negative (which is very common generally) in the middle. But since the author has disclosed nothing but the shocking headline result, we can't know.
So I believe you are sowing public panic without evidence. While it is impossible to directly demonstrate that immunity for a disease discovered X months ago lasts longer than X months, it is reasonable to expect that in this case. Maybe you think that at worst, if you're wrong, then you're telling a noble lie--but the public health authorities who said masks don't work (remember that?) did too, and look how that ended up. I can easily imagine Trump on television a year from now explaining that because people got reinfected, the vaccine is obviously a scam.
Abandoning the truth in favor of a perceived noble goal has unpredictable but generally bad effects, and I wish people would stop. Or if you actually believe what you're writing, I'm not sure what to say--please read the scientific literature (and not the popular media, which has been horrible in all directions), dust off your high school biology, and make your best assessment based on that. I think you'll find that while the coronavirus is a very serious problem, it's not the near-apocalyptic one that your comments seem to imply.
https://www.sfchronicle.com/health/article/With-coronavirus-...
https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v...
Likewise, asymptomatic cases appear to have limited immune duration and development:
https://www.jci.org/articles/view/138759#ABS
And meaningful immunity might depend on how much of the virus one is exposed to:
https://www.nature.com/articles/s41591-020-0965-6
I linked to the Vox article because it covers a lot of bases in disputing the spurious narratives that have circulated in places like the US, where the disease is out of control, pandemic response is poor, and various forms of denialism are used to excuse all of this. I don't think its an apocalyptic scenario for humanity writ large, but certainly a dangerous one for many countries, especially if an ongoing, effective public health response is required.
>While it is impossible to directly demonstrate that immunity for a disease discovered X months ago lasts longer than X months, it is reasonable to expect that in this case.
Instead of attributing motives to other people, perhaps interrogate your own need to insist on statements like this, absent any evidence, as well as the tone of your broader rebuttal. I have no intention of sowing panic or engaging in "noble lies," but nor will I embrace evidence-free narratives to soothe myself or others.
If the US intervened early or effectively with measures like those in Taiwan or South Korea, we would likely have the situation under control. It's still possible that we could do this and I hope that we do.
I also agree that whatever immunity patients get after a mild or asymptomatic case is likely to be weaker than after a severe case. That's one case where my calculation above could be wrong--if there are many reinfections but the first or second case is always very mild, we might be much more likely to miss those. That would still be good news for the patients, though bad news for the overall population if they're still comparably infectious.
Finally, even if a patient's immunity degrades to the point they no longer exhibit sterilizing immunity (i.e., the virus still replicates a little at first), in most diseases they won't get as sick as the first time. So even if the coronavirus becomes endemic (which seems relatively likely, since many countries will lack the resources to eradicate it even with a vaccine), I expect the cost in mortality from whatever reinfections do occur to be far lower than what we're seeing now. The opposite of that (antibody-dependent enhancement) does occur, and was a specific concern here because vaccine studies for the original SARS showed evidence of that. So far vaccine studies for SARS-CoV-2 do not, though.
I actually thought the SF Chronicle article wasn't terrible, more pessimistic in its conclusions and tone than I would be given the same evidence but with many of the points above. Their headline seems irresponsible to me though; even if durable sterilizing immunity were impossible, a vaccine that cut the IFR by a factor of ten would be tremendously valuable to the elderly. All that nuance is lost when people just say "reinfection is possible". I was probably too strong to say "sowing public panic", but I do believe your comments paint a falsely pessimistic picture of the current science, and that this false pessimism can be harmful later (e.g., by causing people not to seek a vaccine because of something they half-understood about immunity). Specifically, I also believe the absence of confirmed reinfections out of places like Sweden is strong evidence that immunity usually lasts >3 months. If you were claiming that reinfection might be common after a year, then I'd be much less sure (though I'd still guess probably not based on the original SARS).
In any case, I certainly agree that younger people shouldn't get themselves deliberately infected in search of whatever immunity that affords (though the death rate among young people is low enough that I doubt reinfection would change the calculus for anyone considering that either way). I also agree that the USA response has been terrible, and resulted in a lot of avoidable death--I'm not sure, but it seems possible to me that just with universal mask use and good hygiene (like in Japan), we could live otherwise normal life with negligible spread.
ETA: And here's a paper showing neutralizing antibodies for at least three months (the limit of the study, which they're continuing) in New York. It seems beyond any reasonable doubt to me that immunity lasts three months, and I believe you're simply wrong to question that. Longer gets more speculative, but I think it's quite likely.
https://www.medrxiv.org/content/10.1101/2020.07.14.20151126v...
Also, if I understand correctly, it has recently been shown that people who were infected with SARS 17 years ago still have memory T cells for SARS. (And, I think SARS is one of the viruses most closely related to Covid-19, and therefore there's reason to expect a long immunity period for it too).
"Memory T cells induced by previous pathogens can shape the susceptibility to, and clinical severity of, subsequent infections. <snip> We then showed that SARS-recovered patients (n=23) still possess long-lasting memory T cells reactive to SARS-NP 17 years after the 2003 outbreak." - from https://www.nature.com/articles/s41586-020-2550-z
https://www.vox.com/2020/7/12/21321653/getting-covid-19-twic...
https://www.theguardian.com/world/2020/jul/12/immunity-to-co...
The idea of reinfection contradicts decades of well established immunological principles. It also ignores the fact that we have a close relative of SARS-2 to study. That relative is SARS-1 and we have detected strong t cell activation after 17+ years. Therefore immunity is enduring and long lasting.
SARS-2 is substantially structurally similar to SARS-1.
Alternatively, take a statistical argument. There have been millions of cases around the world. SARS-2 is highly infectious for those who are susceptible. Therefore we would have thousands if not more well-documented, inarguable cases of reinfection. We don’t have those. All we have is a bunch of articles from heavily biased sources like Vox that have a vested interest in pushing the “doomer” narrative.
Why haven’t we seen widespread reinfection if it is truly possible?
https://www.sfchronicle.com/health/article/With-coronavirus-...
https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v....
Likewise, asymptomatic cases appear to have limited immune duration and development:
https://www.jci.org/articles/view/138759#ABS
And meaningful immunity might depend on how much of the virus one is exposed to:
https://www.nature.com/articles/s41591-020-0965-6
If this research holds up, we'll have your well documented cases in probably 3-6 months. Frontline doctors, outside the one cited in the Vox article, are already insisting its true.
Even though they wane, memory b cells persist, meaning subsequent infection is milder and theoretically less transmissible.
Additionally that reinfection potential only exists if you ignore t-cells. When you factor in t-cells, it simply does not happen.
We're in July 2020. SARS-2 existed since some point in 2019, probably midway through. Granted we couldn't detect reinfection until the whole globe had been freaking out about it, so let's start our clock from January 2020.
It's been 6 months and we don't have dozens of well-documented, credible reinfections?
No, such one-off supposed reinfections are much more explainable from a bayesian perspective of either false positives or false negatives of PCR.
Find me someone who is not immunocompromised, who is PCR-positive for SARS-2 and from whom viable SARS-2 is successfully cultured, then show them fighting off the infection and being PCR-negative and symptom-free for weeks, then show me them being PCR-positive again with viable SARS-2 cultured from their body. That's the standard.
20 examples of that and reinfection definitely happens. Until then, our priors are that we should assume it does not.
Such fears are just used to argue against herd immunity, which has been made into a "dirty word" (phrase). Herd immunity is a natural phenomenom, arguing "against" it is like arguing against natural selection in my book. (The analogy is not perfect but I hope you see the point. I'm tired of being called callous for saying "hey let's not fuck with the normal population immunity dynamics that we've used for every other highly infectious virus in existence")
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BTW, I can't find the study but they have tested reinfection in primates and showed them unable to get reinfected
>Sustained IgG levels were maintained for more than 2 years after SARS-CoV infection. Antibody responses in individuals with laboratory-confirmed MERS-CoV infection lasted for at least 34 months after the outbreak. Recently, several studies characterizing adaptive immune responses to SARS-CoV-2 infection have reported that most COVID-19 convalescent individuals have detectable neutralizing antibodies, which correlate with the numbers of virus-specific T cells. In this study, we observed that IgG levels and neutralizing antibodies in a high proportion of individuals who recovered from SARS-CoV-2 infection start to decrease within 2–3 months after infection. In another analysis of the dynamics of neutralizing antibody titers in eight convalescent patients with COVID-19, four patients showed decreased neutralizing antibodies approximately 6–7 weeks after illness onset. One mathematical model also suggests a short duration of immunity after SARS-CoV-2 infection. Together, these data might indicate the risks of using COVID-19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups and widespread testing.
So the rate of decrease is already greater than SARS and MERS under this initial investigation. I agree that we don't know the rate or duration of immunity, but nothing so far seems to point in the direction you keep emphasizing or justifies your confidence. I actually do hope immunity ends up being longer lasting, but what I "hope" is irrelevant.
I don't know that herd immunity is a dirty word, but might, for COVID, be being deployed dangerously and pseudo-scientifically. The "natural phenomenon" you refer to does not occur in all cases for all diseases. It's not callousness unless you're explicitly denying that reality and justifying excess death and illness on a dynamic which may not even be in play.
What's an example of an infectious disease that the body can fight off that does not result in herd immunity? (so, herpes and aids don't count because the body doesn't fight them off whereas we KNOW that the body fights off SARS-like diseases)
As far as reinfection is concerned, T-cells are more relevant. I am aware that antibody response fades sooner for SARS-CoV-2.
("SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls")[https://www.nature.com/articles/s41586-020-2550-z] - Published: 15 July 2020
* Here, we first studied T cell responses to structural (nucleocapsid protein, NP) and non-structural (NSP-7 and NSP13 of ORF1) regions of SARS-CoV-2 in COVID-19 convalescents (n=36). In all of them we demonstrated the presence of CD4 and CD8 T cells recognizing multiple regions of the NP protein. We then showed that SARS-recovered patients (n=23) still possess long-lasting memory T cells reactive to SARS-NP 17 years after the 2003 outbreak, which displayed robust cross-reactivity to SARS-CoV-2 NP.
* Surprisingly, we also frequently detected SARS-CoV-2 specific T cells in individuals with no history of SARS, COVID-19 or contact with SARS/COVID-19 patients (n=37)
> It's not callousness unless you're explicitly denying that reality and justifying excess death and illness on a dynamic which may not even be in play.
Again, the excess death is the deaths caused by lockdown, not the deaths caused by a highly infectious respiratory virus. All highly infectious respiratory viruses are dealt with the same way: acquiring population immunity. Vaccines are just a way to achieve that more cheaply, but because we do not currently have a vaccine it does not make sense to try to "stop, drop and roll" until we have one. Especially because, speaking for the US, we are on track to hit population immunity before we ever get one.
At the point that you're making blatantly counterfactual statements like this, it's hard to take anything else you say seriously. Some estimates put excess deaths from things besides COVID during lockdowns at about 35% to the total, but they in no way exceed the excess COVID deaths themselves, especially given the likelihood of COVID death undercounts.
You also obviously don't understand how the thresholds for herd immunity work are dependent on duration of immunity and social dynamics of populations. All of humanity doesn't just get together and say "let's get together, right now, and see which of us dies," as much as you would seemingly like to argue that they should. We don't have herd immunity to any number of diseases (e.g. cholera) because we quash their spread through other means, like sanitation, quarantines, using masks. I don’t know why you cite SARS over and over again without acknowledging that we don’t have herd immunity or a vaccine for it.
I wasn’t talking about “excess deaths” ie the extra deaths not explainable by known covid deaths. Sorry for the confusion. (Although I think more of those deaths are non-covid, likely cardiac disease etc due to fear of hospital)
(2) I talk about sars-1 because covid is caused by sars-2. You understand that right?
We don’t have herd immunity to sars-1 because it burned itself out. Sars-2 will not do that because it is not nearly as lethal and exhibits presymptomatic spread. It is here to stay.
Also by pointing out we don’t have a vaccine for sars-1 that only strengthens my argument that banking on a vaccine for sars-2 is foolish
As far as coronaviruses go, there are four mild human coronaviruses that are responsible for about 15% of common colds and for which humans do not develop any long lasting immunity.
There are also the three severe human coronaviruses: MERS, SARS-CoV, and SARS-CoV-2. AFAIU, long-lasting immunity to these is not well understood.
I do not understand how you can make such an authoritative statement about re-infection risk based on the limited data we have about SARS-CoV-2. Here's what immunologists have to say:
> In summary, progress since January 2020 has been impressive, but there is still so much more to learn. Are T cells protective and if so which are the key antigens and and cytokine effector programs to focus on? Are all T cell responses beneficial, or are some contributory to immunopathology and to be avoided? If it is indeed the case that antibodies are transient and T cell memory is more durable (though, how durable?), what can we learn about anomalies of T follicular helper-B cell interactions in germinal centers? In the short to medium term, we need to ensure that all of this T cell toolkit and knowledge is brought to bear on robust, comparative evaluation of the different vaccine platforms, their immunogenicity, efficacy and safety. Entering the next part of the battle, there are many thousands of people suffering the chronic aftermath of infection posed by chronic, so-called ‘long-COVID’ cases, characterized by diverse symptoms including fatigue, joint pain and dyspnea (19). A more detailed understanding of the T cell immunology will be valuable in deciphering this pathogenesis.
https://immunology.sciencemag.org/content/5/49/eabd6160.full
What I read there is a lot of "we're not sure yet."
At a minimum, we can agree that in the event of re-infection, the subsequent infection will hit a lower peak viral load and therefore theoretically a much milder outcome with reduced transmissibility, right? This is called immunological memory and arises due to memory b cells and memory t cells which persist across decades.
Anyway, please see https://www.nature.com/articles/s41586-020-2550-z
It establishes that those exposed to SARS-1, which structurally and functionally is incredibly similar to SARS-2 and thus is our best model of how to think about SARS-2, have long-lasting immunity. Their t-cells not only react to SARS-1 after 17 years, they also have immunity to SARS-2, which is a testament to how similar they are structurally speaking.
Additionally exposure to those common cold human coronaviruses you mentioned almost certainly confers immunity to SARS-2 based off that same paper. We're still hashing out the details, of course.
Immunology is incredibly complex and there is still plenty to learn about as far as the exact specifics of what unfolds here, yes. But we should assume reinfection isn't possible, because:
- It doesn't happen in SARS-1 which is by far the best model we have
- If it did happen, given the MILLIONS of cases of COVID-19 worldwide, we would have seen THOUSANDS of rigorously documented examples of the phenomenom happening
- Those arguing for reinfection tend to not make any mention of immunological memory
- Those arguing for reinfection do so to in an attempt to scare us into staying locked down until "the vaccine", which I am opposed to because I am opposed to any public health policy that banks on a future technological innovation that does not yet exist, particularly when I fear that the environment of irrational fear and anxiety and outright hysteria is going to be used to mandate vaccines, which is highly unethical under my moral framework
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As far as me sounding over-certain, frankly it's cognitive draining to be arguing against a horde of people whose priors have been completely screwed up by programming from a media that takes delight in knowingly lying to citizens, and even our trusted public health officials like Fauci don't have the courage or perhaps the desire to break out of the collective mass delusion we are all trapped in.
So yes, if I had infinite time and energy I agree, I could do a way better job of capturing uncertainty. I've written an 8000+ word writeup on COVID that does a much better job capturing the uncertainty, but it's very difficult to do without...writing 8000 words.
Also this doesn't justify it but I do feel the need to point out that those arguing for the "doom" scenario are even more egregiously overstating certainty, and tend to not be called out on their ridiculous statements. So that's why I tend to come into these threads guns blazing, with the predictable result of getting hammered by downvotes. C'est la vie.
In a risk-benefit analysis, it leaves future (speculative) advances in treatment VS acquiring herd immunity as quickly as possible and with minimal actual damage, for this it makes sense to maximize exposure for the less at risk.
Also, the summer is a better season to get infected, at least because of generally better immune system function (because of better vitamin d status).
Anyway to state your excellent point in a different way: “contain until vaccine” is a strategy based around a temporally unbounded future event. When has it ever made sense to bet the farm on a highly uncertain future event?
This world would be so much better off if we never knew that SARS-2 existed and therefore did not engage in any artificial suppression of natural transmission.
Generally speaking:
But then you have to keep containing it right?
There's not a magical end of containing unless the virus just goes away / a vaccine is available ... that doesn't seem to be a thing yet.
I'm not all for just letting the chips fall where they may, but success at preventing exposure to your population vs heard immunity means the folks who haven't been exposed have to keep avoiding it.
If you don't have herd immunity, then you need to be continually surveilling for it, and when it's present, switch to containment.
Containment is easier when the number of cases is small though. If you get a handful of cases, contact trace and make general advisory news releases. If you get more than 20 cases, ask people to wear masks. If it gets worse, then you have to take bigger steps.
America's strategy (or lack thereof) is simply negligence.
Memory T-Cell reactivity to SARS-1 has been shown to persist across decades. The latest study showed strong activity after 17+ years.
SARS-2 is incredibly structurally similar to SARS-1.
Even if we pretend t-cells don’t exist, immunological memory is a thing. Once circulating antibodies have completely faded after months, there still remain memory b cells which persist across decades and will ramp up antibody production all over again when exposed to SARS-CoV-2. Therefore the subsequent infection is addressed more quickly and more powerfully, leading to lower peak viral load and therefore theoretically lowered transmissibility and vastly improved individual outcomes.
So if we pretend half the immune system doesn’t exist, then you can get reinfected months later but you will spread way less and not be at any significant personal risk of bad outcome.
Herd immunity works. It’s a natural phenomenon that has been unjustifiably demonized.
What you are referring to is eradication, which has only ever been performed twice. SARS-2 is functionally impossible to eradicate due to its zoonotic origin and incredible spread.
Even with herd immunity SARS-2 is here to stay. That’s not a problem though, even if we could so something about it. Why? Because SARS-2 kills the very old but spares the very young. Therefore once it has passed through the current population, the set of SARS-CoV-2-naive individuals becomes dominated by new entrants to the world, meaning babies/toddlers, the same group that does not die to COVID-19 in any real numbers. Therefore unlike Influenza, recurring deaths from COVID-19 will be incredibly low in subsequent years.
Why would you willfully ignore the enormous research literature showing enduring immunity developing from SARS-1? Oh, right, because either you haven't read it or you don't like that it doesn't support your conclusions.
It's like, imagine we're discussing H1N1 reinfection, and we have a highly similar H1N0 which varies very slightly, and we know that doesn't lead to reinfection. But instead you look at a number of Influenza viruses in the same family but not nearly as similar.
Don't you see how ridiculous that is?
We obviously should use SARS-1 as a model for SARS-2.
Basing an entire countries policies around a supposition that herd immunity is practical is, in my opinion, negligence. It's only practical for diseases that don't kill 0.5-1% of the infected population.
It's been proven that lockdowns and slow reopenings work to limit spread, followed by contact tracing clusters to prevent reemergence until community vaccination programs.
Americans are just bitter that their governments are totally inept.
What is it about SARS-2 that makes it so that a few hundred thousand dead is impractical and negligent?
(BTW, the hidden argument of yours here is that we can successfully avoid that mortality by practicing containment which I dispute)
Practicing containment is like leaving a forest full of extremely dry brush. It works great until the fire starts.
We should be assuming that immunity doens't last long and basing all policies on that assumption until proven otherwise.
I wasn't encouraging infecting everyone intentionally.
I was noting the ongoing scale of effort required to protect everyone you keep a large % of the population unexposed.
>We should be assuming that immunity doens't last long and basing all policies on that assumption until proven otherwise.
I don't think that assumption makes sense at all with modern medical science.
No, they don't, or they wouldn't have new cases, even without even somewhat looser mandatory controls than other places. What they have is some degree of immunity in the population (not herd immunity) plus (in some subset of those places) some degree of contact tracing backed by targeted mandatory, or at least voluntary, quarantines/isolation of the exposed, and (in large part because of the intense impacts each has had) voluntary general distancing.
That's not what herd immunity means.
The Herd immunity threshold is attained when the R factor drops below 1, assuming otherwise uninhibited spread. The threshold for herd immunity for COVID-19 has been estimated at 50-80%, but that is assuming an R0 that is likely overestimated.
Given that spread is still mitigated by certain interventions, and since we don't know the impact of those interventions on R, nor do we know R0, we don't know if we have herd immunity. However, we do have R below one in many European countries.
https://www.medrxiv.org/content/10.1101/2020.07.15.20154294v...
And for real some people have many more contacts than others (nurses, police, etc.). They get infected first, with disproportionate harm, but then become immune first with disproportionate benefit. That heterogeneity means 1 - 1/R0 is potentially a significant overestimate of the share of the population that needs to get infected for herd immunity, but there have been very limited efforts to quantify that so far.
It seems like some people believe natural herd immunity (from recovered patients) could work like vaccination does, to effectively eradicate the disease? That's probably false--the most likely natural endgame would be that the coronavirus becomes endemic, always present with some low incidence, with continuing mortality that's very low (because the incidence is low, and because older people probably benefit from immunity from when they were younger and the IFR for young people is <1/100 of older people's) but nonzero.
Finally, herd immunity and interventions (social distancing, masks, etc.) work together. It's possible (and likely I believe) that in hard-hit areas that now show R ~ 1, this is due to the product of both factors, and that either relaxing to their previous lifestyle or applying the same interventions in a naive (100% susceptible) population would show R > 1.
But in any case, the immunity level of the population reduces the need for other measures in order to stay below an R0 of 1.
There’s a massive spectrum of efficacy in the dozens of different suppression or containment policies that can be applied, combined with demographics and geography of the location being studied.
But in any case, the immunity level of the population is a downward force on R0 that, for example, will naturally keep daily cases lower in New York vs. Florida regardless of policy.
The case rate has dropped faster as the restrictions have eased.
https://www.vox.com/2020/7/12/21321653/getting-covid-19-twic...
To avoid that, you basically have to limit the number of beds COVID patients are using and modulate the infection rate to keep the beds in use close to the limit without going over. Of course, modulating the rate is difficult, because people's behavior is hard to modulate. Also the demand for new beds shows up about 2 weeks after infection, so you have to modulate today based on what your bed capacity looks like then.
The meme around hospital overrun is just that, a meme. Especially given everywhere having at least a small percentage of positive serology tests. I doubt anywhere in the US would get truly overrun with uninhibited spread at this point.
[1] https://www.vox.com/2020/7/12/21321653/getting-covid-19-twic...
Everybody HAS to have antibodies for this eventually. There is no way around that at this point.
If Florida truly has 30% infection among children, that is FANTASTIC news.
To those who think they can wait it out until a vaccine, how long will you wait?
All of the measures we are taking: masks, distancing, WFH, these are meant to slow down the rate of infection, not end it.
If this statistic can be extrapolated to the entire population: GREAT. We need to study what Florida is doing and replicate it.
That's just not true. There are safety measures than can absolutely stop the spread of infection and given the chronology of a vaccine or treatment, even a slowdown of infections will save lives and prevent more infections. This is much is glaringly obvious.
Also, "what Florida is doing" is literally nothing. That's the problem.
They are meant to slow down the rate of infection for two reasons:
1. A certain portion of the infected population will need treatment in order to recover. The health care system will be unable to provide that treatment if they have to deal with a large number of cases in a short period of time.
2. To buy time until a vaccine is available. Even with better treatments and a manageable rate of infection, the mortality rate is relatively high. Vaccination is the only effective way to reduce that.
Also consider this: even if the virus is permitted to run wild, the infection rate will eventually slow (assuming that people retain immunity and the virus does not mutate). It will be a prolonged problem no matter how you look at it.