What's the point of a Covid-19 test that takes 19 days for results?
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The complete lack of leadership and resulting power vacuum resulted in valuable time lost bickering, blaming and thumb twiddling that could have gone towards preventing the second wave. This is a community spread at this stage and another hundred thousand people are all but guaranteed to die. It‘s mindblowing.
Here in Germany, I‘m getting my test results within 3 days via SMS (usually same-day for positive results) and can enter it into an app to warn others.
Everybody wears a mask indoors and nobody but a very small minority complains. Social distancing is enforced by usually friendly police which the people mostly trusts to do its job.
It‘s just so sad to see how personal „freedom to choose“ turned into the achilles heel of one of the formerly greatest nations on Earth.
This is true in supermarkets at least.
> Social distancing is enforced by usually friendly police which the people mostly trusts to do its job.
Sorry, hardly anyone still practices distancing outside. At a lake people were on a crowded beach 20cm apart.
And the risks at these places are apparently pretty low, even with more lax physical distancing; 20cm does seem a bit close though.
- After the April lock down it is clear, that we cannot repeat this economically again.
- Population becomes tired of maintaining the hygiene regiment. Improperly worn masks are on the rise. Dining out is increasing / bars/gyms/pools are reopening and are starting to get crowded.
- Decision making is pushed down from Federal to State and local levels (at least in Germany) causing a lack of cohesion of plans and making it impossible for the public to understand what policy is enforced where and why. One good example of this is that the general mask wearing mandate is still in place but many states have allowed for employees (e.g. in stores) to forego masks.
- Schools closed for summer have paused a likely source of many transmission routes.
After going below 2000 infection per week, we are set to hit 4000 per week after the weekend in Germany.
It may not be a choice. Then what?
https://www.destatis.de/EN/Themes/Cross-Section/Corona/Socie...
That's not a dangerous virus. At least not in Germany. And it's the same virus everywhere, so questions must be asked about why so many countries have seen no real change in excess deaths and others did (but even when they did, it's not high relative to the reaction).
You still can’t get in as a foreigner, so it’s not like they aren’t locked down.
It's possible, but I would not be surprised to see community acquired cases pop up in Taiwan at some point. Testing is currently extremely limited.
For example Taiwan performed 94 tests yesterday[1]. This is for a population of around 24 million. Since June 18, the average number of daily tests was 153 [1][2], which are almost entirely nationals returning from overseas.
Compare this to ~700k/day in the US for a population of ~330 million.
The ubiquitous wearing of masks and attention to hand hygiene etc. in Taiwan makes it more likely that any community transmission will be a lot slower (and thus slower to lead to a serious case that is more likely to be detected), but could easily still be a greater than zero.
[1] https://www.cdc.gov.tw/en/Disease/SubIndex/
[2] https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Taiwan
Idunno man, here in Canada the testing woes are about the middle of the pack, when compared with each of the states, the case fatality rates are higher than in Texas. The overall death rates are still much higher in the UK than either the U.S. or Canada.
I think you're being extremely lopsided in your analysis of this, which I don't blame you entirely for, given how much American-made anti-American propaganda there is out there.
> It‘s just so sad to see how personal „freedom to choose“ turned into the achilles heel of one of the formerly greatest nations on Earth.
It didn't, it's a spectacular country and will continue to be for a long time still. The places in the U.S. where there was more choice and personal freedom did better on almost every metric so far, and we haven't even tallied the totals yet (we'll know for real in a couple years, when we correct our death records, and look at real overall mortality over the whole event, rather than rates on a given date).
You can not simultaneously warn about a second wave and dismiss the Swedish model out of hand. In reality, we won't know who was right until much later.
https://ourworldindata.org/coronavirus/country/canada?countr...
Which, yup, Canada and the US aren't that far apart, and the UK has a higher CFR.
And Canada…it's worth noting that Canada is a bunch of city-states bound loosely together by Tim Horton's, and the responses varied quite a bit by province. British Columbia bent their curve early, and made some really key decisions in regards to nursing homes and other long-term care facilities that made a big difference versus Ontario and Quebec. (Last I checked 81% of COVID deaths here were in such facilities. If we'd managed to secure nursing homes and figure out protections for farm workers, there'd be far fewer deaths. ICUs never, ever hit anywhere near capacity, at least in Toronto.)
And pure off-topic anecdote: testing has gone very well for me. My local hospital here on the east side of Toronto was on top of this early, and my tests have all come back in less than 24 hours. (Though I live with a front-line healthcare worker, which makes me think they're giving me just a little extra speed.)
Yeah, it was sad to watch. It seems like it was a mistake made by a lot of places up here in the north. The States and Provinces which had more time got to see it working out poorly ahead of time seem to have been able to change course.
> My local hospital here on the east side of Toronto was on top of this early, and my tests have all come back in less than 24 hours.
I've heard good things about that area, yes. A lot of places were having long delays earlier on because they were overflowing to the regional labs, or somesuch.
> Though I live with a front-line healthcare worker, which makes me think they're giving me just a little extra speed
The answer to that is understandably yes
It has been mercifully mild here in Hamilton, most of the patients in the hospitals are still elderly people from LTC facilities, as far as I'm aware. The panic has been minimal.
One thing here in Hamilton is the handful of people who don't care much about anything in life (Hamilton has a high concentration of such people, being a hub for social services), who will gladly pretend to cough indoors near you just to make you uncomfortable.
Spent some time in British Colombia. I’d say 10% are wearing masks (there is no mandate). Went to the lake and the beaches are packed. Recent outbreak in town because the bars are packed.
And Americans say “man! we’re so stupid to not wear masks. why can’t we be like other countries?”
Look at our respective stock markets for a more accurate view of the situation. They’re tracking very close, even adjusting for currency float. The USA is nowhere near falling apart.
We didn't really flatten the curve except briefly in a few places like CA; the supposed national curve flattening is an artifact of the fact that the New York epidemic peaked a declined as the rest of the country was (and largely still is) on the upswing.
This is just the first wave hitting more places with no effective mitigation, not a second wave.
> as long as hospitals aren’t overwhelmed, our response is successful.
Hospitals are overwhelmed in a growing number of parts of the country, out response is not successful.
> Look at our respective stock markets for a more accurate view of the situation.
Not really, the big firms on most stock markets are international conglomerates, and the major indexes don't really have much to do with national conditions.
I'm sure our president and his sycophants also completely believe this.
Maaaaybe, but it sure has 'flattened' at a very high number of cases and the death curve seems to be rising still
https://www.washingtonpost.com/graphics/2020/national/corona...
Never discount a European's willingness to poo-poo the united states. It's like a pass time.
As for data.
Peer Reviewed Antivirus\Seriological studies show a mortality rate of .9-1.1% when hospitals\ICU's are not overloaded. When they are overloaded, the observational data shows that rate jumps up to double digits. Something like 30% of patients require hospitalization. There's also a body of observational evidence this virus also reinfects people; GISAid shows 6 distict strains at this point.
So your enemy looks like it can infect and reinfect and every round, if your healthcare system isn't built up, it kills double digits.
India has an exponential breakout they will not be stopping any time soon, Brazil is following suite it seems as well. It doesn't require a lot of scientific infrastructure to count body bags and the fundemental reason the numbers are so f'd up is due to the fact once body bags begin piling up people freak out and try something new.
If you are smart you'll take this thing seriously, wear a respirator or CBRN Gas mask, and work at getting yourself healthy.
Total cases are less than half. Daily new cases yesterday were 8K vs US’s 65K+. Deaths yesterday were 150 vs US’s 900+.
What numbers were you referring to? Did you think the numbers are similar, but they aren’t now and haven’t been for months?
Georgia is currently tracing just 7% of contacts. They were in the 7-9% range from mid May to early June, then fell slowly to about 4%, then briefly in late June got up to 19%, and then immediately went into decline back down to 7%.
Texas is doing 6%. They were at 19% in mid May, rising to 42% near the end of May, fell to 25% in early to mid June, jumped to 33% by June 11, and then have been on a decline down to the current 6%.
Experts say this needs to be 90% withing 48 hours of infection.
California peaked at 39% in mid May and has followed roughly a declining sawtooth since then, currently at 22%.
Florida is just 3%. They peaked at 40% at the start of June and went steadily down hill since then. They curve looks like a capacitor discharge curve.
The only states that currently either have enough contact tracers or have planned expansions that will get them enough are: Alaska, Hawaii, South Dakota, and everything north or east of Pennsylvania except for Rhode Island, .
Of those, all but New Jersey, Massachusetts, Alaska, and Hawaii currently have sufficient contact tracers on hand.
The remaining ~40 states do not have enough and do not plan to get enough.
A state needs 5-15 tracers per daily positive test. Georgia has 0.33, Texas 0.31, California 1.07, and Florida 0.15. Compare to New York at 13.75. (Missouri and Alabama are tied for the worst here, at a paltry 0.08).
Reading between the lines, I think that several states hired enough to handle the load near the end of lockdown, with perhaps some room to spare for a minor raise as they reopened. When the rise was faster than they anticipated, they failed to slow down reopening or to boost their budget for contract tracing.
Above data from https://testandtrace.com/ and https://covidactnow.org/
It is unclear to me why this wasn't doable in more countries but this has been one of the very few winning strategies. (not trying to be malicious here, I admit that I don't know the logistics of large scale testing and why it wasn't applicable to more countries).
Honestly, my imagination fails to come up with a remotely plausible math model of containment, say in CA, of further spread from the current 400K (4M after the CDC 10x multiplier with the most being unaware of being a carrier) cases in 40M population.
This is particularly important for metro areas that span multiple local jurisdictions: a single authority can’t do significantly better (or worse) than its neighbors, so they have to act in concert with each other. Ruling by committee is inevitably slower than by fiat, which makes it harder to handle highly dynamic situations.
The CDC was specifically created because diseases need a nationwide response, the US simply failed.
Right now it would take an atomic mushroom cloud and/or the military in the streets to keep people at home for an extended period of time. And even then we would see 3-6 weeks of exponential rise in case numbers because testing is just so far behind and you will have tons of follow-up cases.
The United States is well on track to becoming the most tested large country in the world, and its testing rate is already the highest among large countries: https://ourworldindata.org/grapher/daily-tests-per-thousand-...
This is why the press is not trustworthy.
We sit just between Nigeria and India, but well ahead of Brazil and Mexico.
More concretely, 0.5% of the tests in Germany, the UK, and Italy are positive. For us, between 8 and 9% are positive. So to do the same level of testing per-case, we need to do 15x as many tests as we have been.
https://ourworldindata.org/grapher/covid-19-daily-tests-vs-d...
The point is that as a nation we don't get brownie points for handling the outbreak so badly that we need to do things that other nations do not.
No one but the US (or Brazil or India, perhaps) has any business having the most tests per day, and few other nations have the need for a significant number of tests per capita, because cases per capita are so low that it's not worth it.
That's why I have to qualify my sarcasm with /s on this site, including my post above: the population density is too high. /s Trump sarcastically suggested it, but there never was such a "plan". Nor could there be one: the president of the United States does not have the authority to shut down (mostly private) testing.
Anecdote. An acquaintance is a disease export working for NIH near DC who also does contract tracing in the field. Sometimes their contact with the public includes death threats, refusals to cooperate, and even been spit on. They are good people trying to prevent more illness. Some of the public has been coached that the doctors are taking their jobs, closing employers, etc.
Leadership needs to get everyone behind the same spear so we can snuff this out quickly.
Source needed. It is, for example, what we used successfully to stop SARS from doing what COVID-19 has done.
But you have to get levels low enough first.
The US response is the worst of all worlds. We do enough to trash our economy but not enough to keep the disease from its inevitable march.
Also, if the things that worked successfully to stop SARS from doing what COVID-19 has done worked for it as well, then it would have been stopped just like SARS. All the western countries like the US, UK, Italy (I think), etc did SARS-style contact tracing starting really early on. It just didn't work this time around. There's not a huge amount of media coverage of this because it doesn't fit the narrative, but you should be able to find some.
Not that I disagree that the US response has been among the worst .. and the bar is pretty low with only a handful of countries (like south korea and Taiwan) having been able to promptly adopt effective strategies.
Government being government, I understand why this doesn't work, but states literally have a list of people without jobs and their occupations that they're already paying. If the health department could/would just talk to the unemployment department...
The only reason for it was because offering spam blocking service was a cash cow for phone companies, so hey lobbied against any effective governance to stop it (finally some was passed in late 2019). If people have an interest in something, the government is barely responsive, it took years and years. Special interests that can pay to lobby for it get their way right away unless there is pretty huge backlash.
Northeast states like NY, NJ, CT, Mass were able to mobilize after the initial crisis and rapidly hired and got systems in place to do contact tracing.
In the south, you have the conflict between municipal and county authorities managing the crisis on the ground while the obsequious governors are busy sucking up.
It’s depressing that the tragedy of what happened in April didn’t result in more intelligent actions in other places based in the lessons learned.
My parents who are about to retire do not want this.
Statements like this always bother me. Which experts? What happens if the value isn’t reached? How did they even arrive at these numbers? The statement makes it seem totally made up on the spot, which isn’t helpful in a time when so much of the “expert advice” is already disregarded (often for good reason! Remember when “experts said” that masks were ineffective at reducing transmission of this disease that has very few asymptomatic carriers?)
I recall it was more about not buying up masks so that healthcare workers had enough. And that masks may not help stop contracting it oneself.
Edit: maybe for clarity I should add that I don’t remember anyone saying it was ineffective, just unnecessary. I witnessed several physicians wearing their own masks be told by higher ups to stop though. I’ll have to look through old emails, things have changed on a weekly basis.
I definitely had a good share of discussions revolving around "scientists are saying different things every week" in the last few months. My closer connections seem to understand now.
Somewhere I read that among the reasons for ordinary people not to wear N95 masks is that the valve lets air out freely, while filtering incoming air. This would make you more likely to infect others if you are infected, than some other kind of mask.
It's not that you increase your own risk per se, but you increase the risk of your class, of civilians, by wearing it.
N-95 masks can be with or without valves.
With the valve they are pointless if the werarer is positive/transmits the illness.
The valveless ones are fine, but both with valve and valveless are not as useful as they promise (filtering 95% or so) because the wearer must be trained to use them AND the masks need to be suitable to the wearer, after a proper "fit test" AND the wearer must be medically tested to be able to breath with reduced flow.
The exact method the fit test (and the medical check) is performed varies by country/norm, but check this:
https://www.osha.gov/video/respiratory_protection/fittesting...
https://www.youtube.com/watch?time_continue=559&v=D38BjgUdL5...
Basically you choose among 10-12 different models the one that seemingly fits better your face, then you put the mask on, a sort of transparent plastic hood is put over your head and a small quantity of substance is sprayed (usually vanilla or similar highly penetrating odour) under the hood, if you can smell it, the mask is not the proper fit or has not been put on properly and you start again.
Then, the particular model of mask with which you passed the test is "your" mask (and you won't use another model).
And of course you need to be cleanly shaved.
A "surgical mask" has a much lower filtering potential, but unlike the N-95 masks (FFP-2 in Europe) anyone can reach it without issues.
I didn't say they necessarily have valves, but all the ones I've seen do. I had one intended for painting, gave it to a local hospital.
And it was probably the right call based on the information we had then (the real question is what the US government was doing for the many months notice it had and why it did not use its powers to deploy companies to manufacture masks or as in the case of GM agree to pay the at cost rates they were offering the US government for manufacturing PPE and ventilators).
Once it became clear that asymptomatic carriers and spreaders existed, and that the majority of spread was through water droplets emitted during actions like speaking and singing (unlike most other viruses where it’s usually sneezing and coughing), the advice was changed rapidly since regular cloth masks could be effective for this purpose.
This wasn’t a failure of expertise but was the natural consequence of facing a novel threat that was moving faster than we were learning about it.
He could have told everyone to wear bandanas or other homebrew mouth coverings but he did not.
I was not speculating in my comment, this is Fauci's own admission.
Source: https://www.thestreet.com/video/dr-fauci-masks-changing-dire...
I'm exaggerating but not by much...
Contrast with the current messaging. They work but are in short supply. If you have a stash of new surgical or N-95 masks, please donate it. If you have a used mask, please continue wearing it. You're encouraged to make, wear, and sell/give to anyone non-medical-grade reusable masks. Anything is better than nothing.
Randomly searched YT of what I'm referring to: https://www.youtube.com/watch?v=5gYAka7qSnM
The incubation period is usually five days or more, while patients can already be infectious two days before symptoms show. That means there is a window of opportunity of 2-3 days to find contacts of the current case and put them into quarantine before they start infecting even more people.
Where the percentage comes from, I do not know but I would assume that it is meant to push the number of new infections per case (R = reproduction number) to 1 or even better well below it (R < 1 means it would eventually fizzle out). Super sketchy math: if the reproduction number is ~2.5 and you trace and quarantine 90% of the contacts (1 - 0.9) * 2.5 ~= 0.25 new cases will slip through. They might be aiming at such a high number to compensate for other cases where no tracing is done (e.g. because it was not known that the patient was Covid-19 positive) to keep the overall reproduction number low.
Once again - I am not a professional and just offering some thoughts about the problem (and happy to be corrected / to learn more).
[1] I'm putting this firmly in the "all models are wrong, but some models are useful" camp
Why don’t we do this? It’s a jobs program, not an entitlement, so, theoretically, Republicans should eat it up. And, I don’t see Democrats opposing it, either. Instead, we’re pointing fingers, calling it the “China flu,” or the “Trump virus,” while over 130k have died, and many more get infected by superspreaders who could easily have been identified and isolated were there enough contact tracing in place. Even California, which I thought was handling the crisis well at first, has faltered by prematurely reopening sectors of the economy.
I’d like to say it’s a lack of leadership, but I think it’s more that our leaders are serving interests that are not ours. This is a nonpartisan statement — Trump is to blame for a lot of it, but Democratic governors and mayors, by and large, haven’t stepped up, either. It’s time to ask cui bono? It’s time to really drain the swamp, instead of continuing to vote for the mosquitoes who suck the life out of the American people.
That is no longer true: https://www.federalreserve.gov/monetarypolicy/muni.htm
On April 8, 2020, the Board of Governors of the Federal Reserve System
(the Board), by the unanimous vote of its five members and with the approval of
the Secretary of the Treasury, authorized the establishment and operation of the
Municipal Liquidity Facility (MLF) under section 13(3) of the Federal Reserve
Act (12 U.S.C. § 343(3)). The MLF is intended to support lending to state, city,
and county governments.
Under the MLF, the Federal Reserve Bank of New York (Reserve Bank)
will commit to lend on a recourse basis to a special purpose vehicle (SPV). The
SPV will purchase eligible notes directly from eligible issuers at the time of
issuance.
[...]
The Department of the Treasury, using funds appropriated to the Exchange
Stabilization Fund under section 4027 of the Coronavirus Aid, Relief, and
Economic Security Act (CARES Act), will make a $35 billion equity investment
in the SPV in connection with the MLF.
https://www.ncsl.org/research/fiscal-policy/state-balanced-b...
I don’t think the other ones exist in significantly large amounts to be meaningful and even then, keep in mind that furloughed people are not getting paid. The money has to come from somewhere to start paying them for whatever again, and states and cities have limited funding resources even before COVID blew a hole in most tax revenues.
The only entity capable of nationwide deficit spending is the federal government, which seems unwilling to step up to the plate.
The feds have decided to prioritize the economy in an election year, for some short-sighted definition of a good economy. And the party in power has never liked a strong federal government anyways.
They can issue bonds to raise capital and, last I heard, the Fed is buying.
But at the same time, there were health officials being given PUBLIC DEATH THREATS by people who insisted that wearing a mask was dangerous to their health.
Ultimately, I suppose you have to give into politics and public pressure. A mandate that nobody respects and can't really be enforced has no value at all. It's plausible that responding to political pressure and trying to reopen, or give dates and phases, would result in better adherence than just telling the whole state "sorry, stay home indefinitely".
A mandate is essentially unenforceable, yes, but it's valuable regardless. It's about setting social norms and expectations. If public figures had put forward a consistent message regarding masks from the beginning, we'd have seen better compliance and fewer people would be dead now.
True, and that was impossible once CDC decided to lie to the public in an attempt to preserve supplies for hospitals.
I was recently (a year and a half ago, time flies) out of work, and I did get a solicitation about a contact tracing job since the epidemic started. I didn't think my experience was applicable, nor am I free, but somehow they found me. Maybe they have indeed been trying to recruit pretty widely?
Paying to millions of unemployed people to do contact tracing - does not mean effective contact tracing.
Why does the roll need to be performed by boots on the ground (exclusively?).
I could just be ill-informed here. We have one active case in hospital quarantine here is Tasmania who is a resident returning from Victoria, and I’m not really paying much attention so.
https://www.microbe.tv/twiv/twiv-640/ [TWiV 640: Test often, fast turnaround, with Michael Mina]
The way to beat the pandemic is to have cheap, disposable instant tests that anybody can take in their homes, everyday, to see if they have a large amount of virus in their system. These instant tests will not have the sensitivity or specificity of the PCR style test, but it doesn't matter. The PCR style test can test for levels of virus that are billions or trillions times smaller than necessary, yet we disqualify other types of tests because they aren't as accurate as the PCR tests. So we set an impossible standard that all other tests, no matter how practically useful they could be, fail to reach.
We all could have cheap, accurate enough instant tests, but do not because they aren't as accurate as a test that is ridiculously accurate but takes so long to get results at scale it becomes completely ineffective. It's complete madness.
Yes, accuracy is a nice thing to have, but if you aren't tested at all you are worse off. You can still follow precautions if you are negative on an inaccurate test, but we can't afford to have everyone take the precautions that those with positive tests should.
If the test is highly sensitive but biased toward false positives, that would also be a useful form of test.
The Abbott ID NOW COVID-19 rapid result machine that the white house uses has the same properties:
> Based on our findings we could argue that the Abbott ID NOW detects samples with high viral load or possibly viable virus that could be of importance for transmission. But, the fact that it misses positive samples on patients being admitted to the hospital with clinical picture of COVID-19 makes this technology unacceptable in our clinical setting [1]
So they will have very few false positives, but a lot of false negatives. However... being negative for having a lot of virus is actually meaningful, whether you have the virus or not, because the best assumption is that contagiousness is related to amount of virus in your system.
So basically, the tests aren't perfectly accurate, but they do provide useful information, and they are instant. That is the key. A PCR test that is perfectly accurately is useless for contact tracing/isolation and peace of mind if it takes 14+ days to get the results.
Think of a pregnancy test. If it comes back positive, you are very likely pregnant but should get it confirmed by a doctor. If it comes back negative, you likely aren't pregnant, but maybe it's too early to tell. Pregnancy tests are widely used even though they have these characteristics because people understand the quirks and the information they provide is useful and of course, comes instantly.
1: https://www.biorxiv.org/content/10.1101/2020.05.11.089896v1....
I'm not sure why you're not seeing any problems with this.
If a billion sounds like a lot, it’s not. The virus goes from undetectable to rampant within hours. The cheap test will miss out the very early stage of infection. But we are talking hours.
Such a cheap test could allow kids to go to school or adults to go to work. It would be revolutionary.
We can have a functional economy without the average person getting in planes and moving around the world. It is enough for essential staff and cargo to move around the world. No reason why that shouldn't work and we can't all make money. We will just be making money doing different things in different ways with different norms.
Mother's day? Restaurant? Nah. What should we order from uber eats? Who delivers flowers. Etc. Gap year? Let's travel in the same country / same state, and go deeper rather than wider.
It feels like the entire media is always trying to highlight the next systemic failure. "This is wrong." "This failed." "We don't have enough ventilators." "New York cases are surging." "California cases are surging." "We don't have enough PPE." "We don't have hand sanitizer." "We don't have masks." "We don't have enough tests."
Are things actually this consistently bad, or does the media magnify the negative and ignore the positive developments (of which there are plenty)?
It's like the difference between acute inflammation (which is good for the body when it's fighting an infection) and chronic inflammation (which causes a lot of problems).
Well, yeah, it's not fucking working well. We're cranking out tests and running analyses at an unprecedented level. And we're doing a decent job of ramping up, actually, but not perfectly evenly across the board.
My healthcare center is not particularly large or particularly well-connected. We've been getting our tests back in 3 days. At one point our partner started getting too heavily inundated, things were lagging to 5 days, so we switched to another that didn't require shipping to Houston for processing. We're back to 3 days.
But we're lucky - we're small enough that we don't have to partner with a Houston-based center. Others aren't.
The media crafts its daily narrative with an eye on objectivity and plays right down the middle. Just the facts, always. To suggest otherwise is quite dangerous.
fact is the news needs their audience to feel that news is essential to their daily life, and if it was just good news I could make the choice to watch something a little more interesting, but by choosing stories that feel urgent and dramatic, they create the urgency to stay tuned to 'stay informed'
No one needs to stay informed of the good news, although I do miss when the late night shows would make fun of light hearted news that was a once daily reminder that there's a lot going on in the world that's not american politics
And now, a few months later, we're seeing the affects of the lockdown. Businesses are closing everywhere.
It's incredibly sad.
The vulnerable should have stayed isolated - cleansed everything from the outside. That ensures their safety. The healthy should have been able to go forward.
Responsibility without control is cruel. Financial debt accumulates, but hey, stay inside, don't go to work.
What was the reporting like and how has it changed?
It's an excellent (sad) example of history repeating itself.
On the other hand, things aren't all that comparable. Consider the distances people travel, the amount of people that use the same space, but also the amount of single-use things we have now that we didn't have (at scale) back then (even simple things like spoons, napkins, cups).
People love to make comparisons, but it's not always as useful or helpful as one might think (even if we went all the way down the rabbit hole and tried to find all the variables between now and then).
Firstly, the medical technologies of 1918 were nothing like what we have today.
For example, even though it would have been no help fighting Spanish Flu, wide spread use of penicillin was still some 20 years, showing just how far behind the medical system of that time really was.
That difference also shows up in things like life expectancy which back then was in the low 50s where as today it is in the 70s.
Finally the two virus are very different.
One factor that made the Spanish Flu virus so deadly was it killed both young and old.
If COVID-19 had the same death profile I suspect we would be seeing those same 750,000 totals.
And this deathcount was for an event that extended for 16 months between 2918 and 1920. We are in the eight month of covid-19 still
1918
Give it a couple days.
Also of interest: Germany has almost as many ECMO-equipped hospitals as the US does, despite having 1/4 the population and a tiny fraction of the land area.
This is very different from the narrative the American and British press have been pushing, probably for political reasons - in that narrative Italy was just unlucky, and it was the other countries that didn't learn from them and stop themselves following in Italy's footsteps that failed. That doesn't seem to match reality. As best I can tell, Italy screwed up so badly that they doomed not only themselves, but any hope of containing Covid-19 in Europe and America. Everywhere else seems to have done a reasonably good job of stopping it coming from China, and it was the unexpected, undetected cases from Italy when they claimed to be completely clean that caused the outbreaks.
Was that a crisis? Based on numbers alone, I’d say yes. But it sure didn’t seem like it.
The current hysteria is not disproportionate.
That is only the case because we shut down so much of the economy & society.
In this context, negative headlines are hardly surprising.
They’ve had fewer deaths per capita than Italy, UK, France, Sweden and plenty others... not doing great but also in plenty good company.
https://www.history.com/news/1918-pandemic-public-health-cam...
If you can centralise test assignment enough to eliminate that, you can do something smarter, like prioritising health workers, at-risk demographics and those who are already asymptomatic. Assign any remaining capacity quasi-randomly to get the best possible statistical data for your epidemiologists: if your systems are that overwhelmed it's far too late for contact tracing to be useful, but the data scientists may learn something.
Having inefficient assignment of test resources is a problem inherent to privatised distributed healthcare that doesn't just go away if you solve the financial side with Obamacare or the like.
I’m not sure that you can have a test that’s 50% accurate and errs equally in both directions. At least, I’m not sure what it would mean.
https://news.ycombinator.com/item?id=23881080
"Apparently even the "less sensitive" tests are in fact sensitive enough to catch these who produce a lot of virus. Those who produce a lot of virus have many orders of magnitude more virus RNA present in their samples than those who are in the phase of infection where they aren't so dangerously infective."
Thinking more about it, the most important point I'd add now is:
We should learn not to think about "the test" but about (at least) two different kinds of tests for different purposes:
1) fast tests to reduce the chance of virus spreading. Anybody isolated before managing to spread the virus is better than not testing, so it doesn't have to be too precise. We just have to understand its limits.
2) more reliable tests for clinical purposes, whenever they are needed. Interestingly, even in such scenarios antibody tests could find their use and allow cheaper or faster results, something like this:
https://www.clinisciences.com/en/read/newsletter-26/sars-cov...
E.g. if somebody has symptoms and IgM (or IgM and IgG), that could be good enough of information to decide how somebody is to be treated. One more example where I'd guess nobody needs to wait for a PCR result.
1) Why are you getting tested so often?
2) Where/how are are you getting tested and getting quick results?
Often being: once a week. Not considered often compared to physical contact workers, but considered often compared to work-from-home workers. Heck, even considered often compared to the entire continent of North America.
Quickly being: drive-in test or walk-in test that is done in 5 minutes, results within 3 days, usually within 24h, either by SMS text message or phone call (depending on the test center).
Test center appointments are generally divided based on proximity, there are 4 test centers nearby for me (4 kilometres to max 30 kilometres -- sadly the one closest is usually queued up full for 1 or 2 days). So far my experience has been that they are very efficient; a lot of open space, about 6 people physically there at the most, testing room is about the size of a shipping container, one person doing the tests, one person observing/checking/entering data. The most efficient one was actually in a parking lot next to the hospital that also has a lab where they do mass testing. There is space for about 30 cars, but they regulate the appointments in a way that even when some people come early only 4 cars are there. Half the spaces are blocked/crossed out, entry and exit are made using ramps and zigzags (if that makes sense) so they are very accessible but also naturally prompt people to keep their distance (aside from the stickers/billboards all over the place). Because it's a single-direction flow for both cars and people and the people flow exit ends where the car parking flow starts you never run in to anyone getting in or out.
For test and trace to suppress the epidemic you'd want to have results before people become infectious to chase the infection chain quicker than it spreads. That means contact identification and test results in the order of 1-2 days (the faster the better but with peak about 3-8 days after infection you want to be on the lower end). Right now this strategy is not feasible since there are just too many cases coming in. Therefore this calls for a hard lockdown until the case rate is manageable again. Since the lockdown is not going to happen it will continue to spread till the hot zones burn out. Getting to herd immunity without overloading the hospitals is unlikely and would probably take years. Therefore overloading the hospitals is inevitable now. The difference between hospitals overloaded by a factor 3, 10, 100 does not seem so very big since you can't care for most patients anyways. Overloading heavily on the other hand has the advantage that it might be over soon and you are done with it (or maybe not, we don't know how long lasting immunity is and how many people will have serious health problems afterwards). So in summary: We are probably beyond the point of no return and whatever happens will happen. I wish you all and your loved ones good health and good luck.
I believe positive “antibody” test could hint to some chance of faring better “next time”.
But even that is still not clear.
It’s a form of bufferbloat.
I sometimes wonder how many fewer USians would have died in this pandemic had it occurred outside of an election year.
(Indeed, the economy is the only issue/criteria in which Biden still trails Trump in polls, but even that margin has been decreasing.)
This relentless push to reopen things has resulted in many, many more deaths.
Unless you want to get really cynical and say there was a political motive in Democrat governors for sending positive patients into nursing homes and causing most of those deaths...
But the incompetent response was incompetent because it was incompetent, not because a sensible electoral strategy was pursued ahead of pandemic control.
As things play out, responding incompetently and saying nice things about the economy looks like a really bad strategy through the electoral lens.
I don’t think this is an either/or situation. If incompetence and corruption is on the menu this administration seems to always take two scoops, one of each.
There also seem to be some utilization problems. Some folks I know got tested after 1 person had enough symptoms. The person with symptoms got sampled several days before 3 other people and got their result last, probably because of which lab was used.
The time to judge the different strategies has not come yet. At the least, we need to wait until the pandemic is over and the counts are in. I don't trust any count until somebody takes a good look at the excess mortality. Right now it's just way too easy to manipulate the numbers in any direction until your hospitals overflow (and even then, the press might not report it). The real case numbers may be off by a factor of below 2 or over 10 and immunity in the population may already exist due to other corona viruses or maybe not, we don't know yet. Other counties which seem to be doing very well until now may still fail horribly. The economic impact may play out in vastly different ways. Currently it seems that hard containment is the best strategy but it requires coordination in a large area and high compliance in the population. In a few months, the vaccine could be available any day and it might work perfectly or very poorly.
Sweden was an example of this, but Australia is looking a bit sketchy now and us next door in New Zealand are feeling a little uncomfortable.
OZ has a problem.
NZ is in a similar situation as VN where a local transmission appeared today without known infection chain. It only takes one error and you're back to square 1.
Could you clarify this? I wasn't aware of any local transmission for months but I suspect an 'if' is missing from your sentence.
I think that a full breakout takes a lot more than one error and it requires a whole chain of them and a lot of systems to fail. We have had errors like this.
The battle now seems to be keeping those quarantine contained. There are near daily escape attempts and some are going to public places or covering significant distances.
(https://www.who.int/emergencies/diseases/novel-coronavirus-2...)
The case here https://ncov.moh.gov.vn/ on "11:00 25/07/2020" seems to be a local transmission if the google translation is correct. The infection must have happened two weeks ago and they are currently contact tracing. Taking an average of 4 days, we are now on generation 2-3 of follow-up cases (or even more if the infection source/chain is older and has been spreading for a longer time). Let's hope that nobody else got infected and there are no asymptomatic patients running around by now, unaware that they are spreading it all over the country.
Taking an R0 of 3 (since they don't have any hard measures right now), we are currently expect 3 * 3 * 3 cases if this person somehow got it from out of country. Finding those cases could take a bit of time and then we would look at 3 times more cases to find every 4 days. Assuming that some youngster got it and this older person is the first one to go to the doctor we could easily have 3 * 3 * 3 * 3 * 3 * 3 = 729 cases by now and that would probably already be out of control without instating a hard lockdown on all possibly affected regions and testing the whole population like China did.
The death rate has been declining pretty much linearly since April. Restrictions were lighter than pretty much everywhere else in Europe, and have been successively loosened since they were implemented in March.
But your comment implies that Sweden is "doing something" recently, and that there haven't been any results until recently either.
And neither of that is true.
> we will see in a few months when the people get tired and want to return to normal life
Uh, it already is pretty much normal. There are signs everywhere reminding people to keep distance, restaurants have fewer tables than usual, and large gatherings are still banned, same as everywhere else. There never was a "reopen" debate in Sweden, because there wasn't really anything to reopen.
But the media image of Sweden is incredibly distorted right now, it's pretty fascinating to watch what happens when a country goes against a major news narrative.
Can you comment on what measures have brought down the infection numbers? Why were they so high in the beginning and why are they falling so quickly now?
After implementing measures it can take a few weeks to show results since detected cases can lag a lot behind actual infection events and there's local transmission chains (inside families/communities) that need to burn out before case numbers fall.
Also speaking of measures, to my knowledge, the government did not take hard measures but rather suggested a lot of the same things that other countries put into law and the Swedish population is very compliant. So it is hard to make an apples-to-apples comparison.
Working from home, banning large gatherings, remote education for universities and secondary schools, reminders to keep the distance, table service only at restaurants and more space between tables.
> the infection numbers?
Sweden, like pretty much every other country, has no idea how large the number of unknown infections were back in March and April. The only certain numbers we have are ICU patients and deaths, and those have been declining constantly since mid-April. Presumably, actual cases follow the same curve.
> Why were they so high in the beginning
Exponential growth before any measures were taken.
> why are they falling so quickly now?
They're not falling quickly now, deaths and ICU patients have been falling linearly since mid-April. Death curve here: https://adamaltmejd.se/covid/
As to why, my best guess is that this virus simply wasn't much different from any other flu virus. A bit more deadly, but whatever measures people in Sweden took was enough to curb it. Also, herd immunity is probably much easier to achieve than earlier models suggest.
Also, note that the death curves for Sweden and the UK are pretty much identical despite wildly different amount of restrictions implemented: https://ourworldindata.org/grapher/daily-covid-deaths-per-mi...
> After implementing measures it can take a few weeks to show results
Yes, and actual analysis of mobility shows that people voluntarily took a lot of measures before actual recommendations were put into place. Same as everywhere else. Most EU countries implemented their lockdowns weeks after the peak.
> Also speaking of measures, to my knowledge, the government did not take hard measures but rather suggested a lot of the same things that other countries put into law and the Swedish population is very compliant.
Yes. That said, mobility dropped less in Sweden compared to neighbour countries who had stronger recommendations and rules in place. You can compare the mobility curves between countries at the bottom of this page: https://covid19.healthdata.org/sweden
> I'm not IN Sweden, so I only have the media image.
I'm sorry, the media image is absolutely bananas. I have never seen such blatant bias to skew everything to make Sweden look like a zombie apocalypse to drum up support for lockdowns. But it looks like lockdowns are much less effective than people think. And it looks like a small amount of meaningful measures pushed the effects of this down to less than a regular flu season.
Unmitigated, it would have been worse, but it's been mitigated everywhere, and here we are.
Most countries experience excess deaths during flu season, and some flu seasons are worse than others. Sweden absolutely had excess deaths for a couple of months this year, but you have to look at the bigger picture.
So here are graphs of total deaths per million per month for the past 40 years in Germany, Sweden, France, and Belgium: https://medium.com/@FrankfurtZack/unprecedented-overall-mort...
Now, 2020 isn't over yet, there might be a second wave of covid-19 in the winter, but given how the virus has died out with the small amount of measures taken, I don't think that's very likely. So far, 2020 in Sweden is tracking below average total deaths, even if you include all the covid-19 deaths.
If this year was "devastating", then what would you call the flu season of 1988, 1993, or 1999? Those flu seasons saw higher excess deaths than 2020 in Sweden, and no-one noticed or cared. No news articles, no reports, no lockdowns, no face masks, no travel closures, nothing. We did nothing out of the ordinary.
Now, covid-19 is more lethal than the viruses of those flu seasons, and we have no vaccine for this one, so some response is warranted. But the current worldwide hysteria is unprecedented, we have never before cared this much for this few deaths.
If you want to compare COVID-19 with the flu I think that the data so far suggests that letality rate is about 10 times higher and the number of infections is also about 10 times higher due to lack of immunity from previous infections.
I don't say that the "normal flu" is harmless, either. Nor that COVID-19 is like the plague or "harmless" like the flu. Nor that we should simply do nothing when the next infection wave comes.
It's not a flu virus and I'm not aware of anyone who thinks it is. Is this a language issue, or what do you mean?
No, it's not a flu virus, but it's definitely comparable. This thing looks nothing like ebola or measles or herpes, for example.
https://jamanetwork.com/journals/jamainternalmedicine/fullar...
Ok, it's 20 times as deadly if you count in this weird fashion.
The reason the influenza attributions are estimated higher than actual counts is because we know we're systematically underreporting influenza deaths. It also doesn't look like the US is underreporting covid-19 deaths to the same degree, so saying that the reported numbers are equally true for both diseases doesn't make sense when we know one of them is more underreported than the other, right?
Cause of death is also not an exact science, did a patient die from something or with something? Which something actually killed the patient? All of it? Some of it?
The only 100% true statistic we have is total all-cause deaths. I posted a link above that graphs total deaths per million per month going back 40 years for a couple of countries, and 2020 does not stick out in any way, shape, or form. The excess death spikes from covid-19 looks very similar to excess death spikes during regular flu seasons.
If it's 20 times as deadly, why isn't that reflected in the all-cause deaths?
Check the stats for yourself: https://medium.com/@FrankfurtZack/unprecedented-overall-mort...
How many people already had it in Sweden? About 5%? And how many will get it until herd immunity is reached? About 70%? Then it seems that it will probably come back next winter and probably with force. What we've seen this spring and summer may only be a tenth of what's about to come.
Those numbers are only some estimates and we don't know for sure but time will tell.
> What we've seen this spring and summer may only be a tenth of what's about to come.
How?
We've gotten better at treating covid-19 as the months passed, we figured out that ventilators was a pretty crap treatment, and instead figured out that oxygen, steroids and blood-thinners worked much better.
A large part of the population has already had it and built up immunity to it, and because of how a virus spreads through a population, the best spreaders are usually hit first.
The population that died from it were mostly the old and frail and at-risk, and we've gotten better at protecting them with time as well.
When we were unprepared, this thing killed less people than a regular flu season does. Why would it suddenly kill ten times as many people, now that we are prepared, and now that a significant part of the population is immune? What possible chain of events could lead to that outcome? Magic?
Granted, the 70% number is based on an R0 of 3.5 and homogeneous transmission. It's probably lower than that in many cases. In some cases it like prisons or close contact workplaces or other close contact activities it's going to be even higher as some incidents show.
The T-cell immunity is something we don't understand very well yet.
I hope that only 20% of the population will be enough to stop it, i really do, but right now i don't think it's very likely. We may have the first solid data points after the winter.
Yes, we get better at treatment and protective measures. As long as the hospitals are not overrun this may lower the fatalities a great deal. In Sweden it's looking quite good right now. In some areas in the US not so much for the coming weeks. When the hospitals are overrun, you can't help much and the fatalities will increase a lot.
Until next summer I will not judge which strategy works best. But I'd rather err on the safe side health wise and advocate for stronger protective measures even if it may mean a higher economic cost (that won't crash the economy completely). If we err on the wrong side, we could lose both, health and economy at the same time. After the numbers are in, we can say with hindsight what would have been the best course of action.
That's the problem with the NZ model of draconian lockdowns. Of course it can work, but only temporarily, and you can't stay locked down forever. I doubt the people of New Zealand are prepared to lock down over and over again every time the virus re-emerges.
The Swedish model is one that people can live with for long periods of time.
Citation? I'm not seeing it on any of the usual NZ news sites, and I rather suspect it would be big news.
edit: oh, i see, I've misparsed your sentence. VN is where the local transmission occurred, not NZ. nevermind.
I'm betting there's a good answer, like maybe the amount of test availability Oregon has is dependent on the rest of the nation. Like, if our epidemic goes down 90%, maybe our test availability will go down 90% anyway because other states will get further prioritized.
But anyway, it seems like that should be the basic standard nationwide. Lock it down until you can get test results within 24 hours, and then only slowly open it up while proving you can keep that test availability - if you can't, freeze or go back.
Recently I had some minor symptoms and wanted to get a test. By going through my employer’s employee testing process I
A) got a test scheduled for the same day I called
B) got my negative result under 12 hours later
I truly believe the future historical narrative of this moment will cast our elected leaders as the orchestrators of mass genocide. It’s hard to consider living, breathing, contemporary people who hold esteemed positions to be on the level of evil as historical Nazis. But as time passes and we consider the impact their choices are having, it will both become easier to cast them in such a light, and to question the passivity of a population that accepts their decisions. It has never been more clear to me how such atrocities can happen and at the same time become normalized.
i am not a fan of this administration and feel there is plenty of blame to go around but i would love for more insight on why you think there is some intentional malice happening...
From the CDC article which they link right there, "[q]uarantine helps prevent spread of disease that can occur before a person knows they are sick or if they are infected with the virus without feeling symptoms."
Testing isn't the goal, it's data to use for an informed response. If the response isn't going to come it's just a morbid and useless statistic.
Why when i am already paying like 500$/mo for insurance and making one physical in a year at most. Also during this physical i asked about help with my panic attacks and was told "well we don't have capacity at all for this, you will wait for ~month for your visit and it won't be useful since they are not going to have enough time to look at you". And this visit would be paid.
May be AHA shouldn't limit number of doctors educated to make it available to public? Money is clearly not an issue.
None of that is going to medical professionals, infrastructure, or research. We pay considerably more than anyone else per-capita but that’s waste: as far as outcomes go we rank much lower than our peers.
This is also interesting when you compare tax rates: Americans pay taxes + insurance at a combined rate around “expensive” countries like Denmark but we don’t get anywhere near as much for our money.
Do you realize that to become a doctor requires years of medical residency working with a team of experienced doctors.
the limit isn't simply bureaucratic... it's a limit on the number of available mentors.
For example, I understand that (and please correct me if I’m wrong) that all foreign-trained and foreign-qualified doctors regardless of age, experience, and position (and country of origin, country of education, etc) have to go through the same rigorous process as a fresh-faced med-school grad in the US - even though most US doctors would fail the same process if they were also 5+ years out of med-school.
Personal anecdote: my sister is a GP in London. I asked her if she’d ever consider working here in the US and she said she considered it but she didn’t want to spend a full year or more having to re-qualify from scratch, despite her professional qualifications and experience (she has her medical masters from LSHTM and is a published researcher with her papers in the US’ PubMed).
We have international portability of licensing for drivers licenses - and many places allow for portability of professional engineering licenses too - it seems arbitrary (if not outright protectionist) to not have some degree of medical license portability in the US.
I don't see any benefit from being tested at this time.
I definitely don't want to spread the virus if I'm positive or be around people who are positive and can spread it to me but the time frame and false +/- results, testing doesn't seem viable to provide any actionable knowledge.
I think we'll see the limits of what testing can do to prevent the spread of the virus with the start of NFL training camp/season.
“Roche’s SARS-CoV2 antibody test, which has a specificity greater than 99.8% and 100% sensitivity3 (14 Days post-PCR confirmation), can help assess patients’ immune response to the virus.”
What is the latest death rate of confirmed cases?
Mission accomplished.
Given people are already so predisposed to their theories not sure how many people actually will listen without a full lockdown. Also it’s highly unlikely the red states will lockdown ahead of the election and go against trump. We are in a real mess. The pessimist in me is thinking we will probably have to really solve it after the election it if trump wins probably never until we get a vaccine.
The case that's somewhat interesting is the one in article where someone might have gotten people sick at a party.
1) Testing of corpses and blood samples thereof. The CDC recently changed its guidelines for cause of death determination to be "if it looks like COVID, just mark it down as COVID." Being able to test corpses, who are in no rush, could help more accurately pin down mortality rates.
2) Knowing that you are not likely to catch it again, or, alternately, are still at risk. Yes, I know there's some debate as to whether or not you can catch it again due to declining antibodies. I am not believing that at current.
3) Being able to use antibodies cultivated from patients who have recovered in those who are currently quite ill. That's a common enough concept, cheaper than cultivating monoclonal antibodies.
Boom, three right there. How hard was that?