The Next Pandemic: SARS-CoV-2/COVID-19

[FireChans]

2 minutes ago, Kemp said:

Flattening a curve is merely the first step. It can still go up again and even if it flattens, if it doesn't go down, it's not mission accomplished. 

The number of flu cases go up every year. And we have flu vaccines. I’m curious what end goal you have in mind?

[Deranged Rhino]

Just now, FireChans said:

The number of flu cases go up every year. And we have flu vaccines. I’m curious what end goal you have in mind?

He will let you know that when MSNBC lets him know. 

[Kemp]

1 hour ago, Doc Brown said:

Huh?

 

 

 

If young people are hit hard and older people aren't, the most likely reason would be that older people probably already had antibodies from a previous infection. 

[Doc Brown]

12 minutes ago, Kemp said:

 

If young people are hit hard and older people aren't, the most likely reason would be that older people probably already had antibodies from a previous infection. 

Got ya.  Thanks for clarifying.

[Hapless Bills Fan]

5 hours ago, Magox said:

Let's just use common sense here for a second.  These are two examples and it's a pretty large sample size, we are talking about over 4000 positive test cases where on average 97% showed no symptoms.

 

That is an astounding figure.   How in the world are you going to contact trace people effectively if such a large portion of the infected population are not showing any symptoms?

 

What?  Someone who is showing no symptoms is expected to request a test?  That's not going to happen.

 

I don't intend to hang in here, but I wandered over because I was paged so I'll weigh in here. This seems like a misunderstanding of how contact tracing works.  BECAUSE there are so many asymptomatic people, contact tracing is ABSOLUTELY critical with this disease.

 

It doesn't depend upon someone who is showing no symptoms requesting a test.

 

I have symptoms.  I get a test.  It's positive.  I have covid-19.  I work in a plant where I have close contact with you and 200 other people on my shift.  I take a bus home.  All those people get tested.  Let's say you're one of them, you're positive, and you have no symptoms at this point.  Now we want to trace your contacts and test them.

 

In industries where people have to work shoulder to shoulder, yes, contact tracing is gonna be a bear.   A kodiak bear. This is where social distancing continues to be important - obviously, if someone can work from home, or works in a workspace where people are able to be spaced 6 feet apart, have good ventilation, and don't share common equipment, the infection rates may be lower and the contact tracing is only a crabby raccoon, not a kodiak bear.

 

Everyone "masking up" is also going to be critical, so that while contact tracing is ongoing, asymptomatic people aren't out bopping around don't unknowingly infect others

 

Peace out

 

32 minutes ago, FireChans said:

The number of flu cases go up every year. And we have flu vaccines. I’m curious what end goal you have in mind?

 

My end goal is getting to a basic reproduction number that doesn't overwhelm the healthcare system.  No bueno to HCW or to patients.

 

You?

 

 

53 minutes ago, Doc Brown said:

I just did and there seemed to be no follow up studies on any of them regarding possible incubation period.  Nevertheless, it's just more evidence it's highly contagious, asymptomatic to most people who contract it, and we're pry closer to herd immunity than we realize.  It should give policy makers more incentive to open things up as quickly as possible.

 

Except that in most areas where antibody tests are ongoing, the finding is 2-6% of the population has anti-covid-19 antibodies.

Herd immunity requires 50-60%.  So the "incentive to open things up" is a little opaque to me here.

[IDBillzFan]

4 hours ago, leh-nerd skin-erd said:

Thats pure horse-cockery!

 

I just want to note for the newer posters here that in spite of his language above, Mr. Skin-erd is not a Biden supporter.

[Magox]

13 minutes ago, Hapless Bills Fan said:

 

I don't intend to hang in here, but I wandered over because I was paged so I'll weigh in here. This seems like a misunderstanding of how contact tracing works.  BECAUSE there are so many asymptomatic people, contact tracing is ABSOLUTELY critical with this disease.

 

It doesn't depend upon someone who is showing no symptoms requesting a test.

 

I have symptoms.  I get a test.  It's positive.  I have covid-19.  I work in a plant where I have close contact with you and 200 other people on my shift.  I take a bus home.  All those people get tested.  Let's say you're one of them, you're positive, and you have no symptoms at this point.  Now we want to trace your contacts and test them.

 

In industries where people have to work shoulder to shoulder, yes, contact tracing is gonna be a bear.   A kodiak bear. This is where social distancing continues to be important - obviously, if someone can work from home, or works in a workspace where people are able to be spaced 6 feet apart, have good ventilation, and don't share common equipment, the infection rates may be lower and the contact tracing is only a crabby raccoon, not a kodiak bear.

 

Everyone "masking up" is also going to be critical, so that while contact tracing is ongoing, asymptomatic people aren't out bopping around don't unknowingly infect others

 

Peace out

 

 

You misunderstood what I said.  I said that contact tracing serves a purpose and that it should be used.
In a subsequent post:

 

————

 

3) That contact tracing will be used much more effectively on a targeted basis.  Areas that are deemed at higher risk and frontline “essential” workers.   

 

—————-

 

 

 But strategically for people at risk or front line “essential” workers.  The idea that we are going to be able to contact trace the majority of the infections is not realistic.  There are too many asymptomatic carriers to be able to do it effectively.  I stand by what I said and I’m fairly certain that we will still see confirmed infections above 10k come sometime in the following winter. No matter how much contact tracing they do.  It’s toothpaste out of the tube.

Edited May 7, 2020 by Magox

[Hapless Bills Fan]

6 hours ago, shoshin said:

 

Could be. I am not sure if there's been a study yet about the contagiousness of asymptomatic people. I know there have been studies of prespymptomatic people, but that may be a different thing. Maybe @Hapless Bills Fan has some insight on this: I could be nuts to think there would be a difference between asypmtomatic and presymptomatic carriers. 

 

Hi @shoshin, if you're talking widespread studies we followed 400 asymptomatic people and looked at all their contacts and how many got infected, hasn't been done.

 

But there have been a number of early contact tracing studies where a person who never developed any symptoms was the clear point of infection for a whole cluster of covid-19 infections, many  of whom did develop symptoms.  One of the first was being discussed in an email chain among US public health scientists and physicians at the end of January.  It may be this study which was eventually published in Critical Care March 27th. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100442/

 

So it's been very clear since at least towards the end of January: asymptomatic people can infect others.  Maybe not as efficiently as presymptomatic people (who haven't developed symptoms yet, but will) - don't know yet.

[Q-baby!]

44 minutes ago, Deranged Rhino said:

He will let you know that when MSNBC lets him know. 

? OK Twitter boy!! ?

[FireChans]

15 minutes ago, Hapless Bills Fan said:

 

 

 

My end goal is getting to a basic reproduction number that doesn't overwhelm the healthcare system.  No bueno to HCW or to patients.

That’s what flattening the curve is for. What is the next step?

[snafu]

1 hour ago, Doc Brown said:

I just did and there seemed to be no follow up studies on any of them regarding possible incubation period.  Nevertheless, it's just more evidence it's highly contagious, asymptomatic to most people who contract it, and we're pry closer to herd immunity than we realize.  It should give policy makers more incentive to open things up as quickly as possible.

 

It should.

It won’t.

 

[4merper4mer]

1 hour ago, FireChans said:

The number of flu cases go up every year. And we have flu vaccines. I’m curious what end goal you have in mind?

End goal you ask?

 

Communize.

[Hapless Bills Fan]

6 minutes ago, FireChans said:

That’s what flattening the curve is for. What is the next step?

 

No.  "Flattening the curve" is a hail-Mary desperation play when an epidemic has escaped containment and mitigation is the only option.

As society reopens, the next step SHOULD be to systematically #testtraceisolate to ring-fence infection clusters.  The point of "flattening the curve" initially is to lower the number of infections to the point where #testtraceisolate is possible

As well, take other reproduction-number lowering actions like requiring people to wear masks at work, on public transportation, and in stores, and asking them to so in public especially in situations where distance can't be maintained.  Ask people who can do so to continue to work at home and minimize business travel.

 

 

[3rdnlng]

24 minutes ago, IDBillzFan said:

 

I just want to note for the newer posters here that in spite of his language above, Mr. Skin-erd is not a Biden supporter.

That's no malarkey!

[Hapless Bills Fan]

14 minutes ago, snafu said:

It should.

 

Why should it, when outside a few hotspots like NYC, meat packing plants, prisons, cruise ships - most epidemiologists estimate 2-6% of the population has currently been infected and so far antibody studies bear this out?  Herd immunity 50-60% immune.

[Magox]

1 hour ago, Doc Brown said:

I just did and there seemed to be no follow up studies on any of them regarding possible incubation period.  Nevertheless, it's just more evidence it's highly contagious, asymptomatic to most people who contract it, and we're pry closer to herd immunity than we realize.  It should give policy makers more incentive to open things up as quickly as possible.

 

Hap is right in that we aren’t anywhere near reaching herd immunity with the exception of NY city which isn’t quite there yet either.   But we don’t know how long a vaccine will come about and until then we need to rely on the data, have some good therapeutics in place, strategically attempt to mitigate the virus and protect the most vulnerable all while gradually and eventually liberally reopening the economy.  The economic costs and all the residual effects on health will far outweigh the actual direct impacts of the virus.

Edited May 7, 2020 by Magox

[FireChans]

5 minutes ago, Hapless Bills Fan said:

 

No.  "Flattening the curve" is a hail-Mary desperation play when an epidemic has escaped containment and mitigation is the only option.

As society reopens, the next step SHOULD be to systematically #testtraceisolate to ring-fence infection clusters.  The point of "flattening the curve" initially is to lower the number of infections to the point where #testtraceisolate is possible

As well, take other reproduction-number lowering actions like requiring people to wear masks at work, on public transportation, and in stores, and asking them to so in public especially in situations where distance can't be maintained.  Ask people who can do so to continue to work at home and minimize business travel.

 

 

Sure, I’m all good with that. But as you said, we start to reopen. 

[Hapless Bills Fan]

20 minutes ago, Magox said:

 

You misunderstood what I said.  I said that contact tracing serves a purpose and that it should be used.
In a subsequent post:

 

————

 

3) That contact tracing will be used much more effectively on a targeted basis.  Areas that are deemed at higher risk and frontline “essential” workers.   

 

—————-

 

 

 But strategically for people at risk or front line “essential” workers.  The idea that we are going to be able to contact trace the majority of the infections is not realistic.  There are too many asymptomatic carriers to be able to do it effectively.  I stand by what I said and I’m fairly certain that we will still see confirmed infections above 10k come sometime in the following winter. No matter how much contact tracing they do.  It’s toothpaste out of the tube.

 

If we don't generally #testtraceisolate, then unless we achieve close to 100% public mask wearing, the chances of keeping the disease burden from overwhelming hospitals again seem slim.

 

Or what is your notion on how one achieves that latter?

 

I think the large number of asymptomatic infected people arise in specific circumstances - places where large numbers of people are regularly forced into close contact such as meat packing plants, prisons, cruise ships etc. 

 

The whole point of "flatten the curve" from an epidemiologist viewpoint (and I am not an epidemiologist though I have worked with same on occasion) is to buy time to increase testing and put together a contact-tracing mechanism, while lowering the # cases to the point where #testtraceisolate is feasible.  After Wuhan, China appears able to have done this.  Singapore seems to have done this - ID'd an outbreak and contained.  S. Korea seems to have done this with several surges. Several European nations will be giving their try.

 

It's the same disease here, are you saying we are somehow less capable, more deficient and more sociologically challenged than democracies such as S. Korea, Taiwan etc?

 

That may be a rhetorical question fair warning I'm not likely to hang here.

3 minutes ago, FireChans said:

Sure, I’m all good with that. But as you said, we start to reopen. 

 

From an epidemiological viewpoint, reopening should occur when the number of cases have subsided and testing/contact tracing capabilities have been built to the point where #testtraceisolate is possible.

[FireChans]

2 minutes ago, Hapless Bills Fan said:

 

If we don't generally #testtraceisolate, then unless we achieve close to 100% public mask wearing, the chances of keeping the disease burden from overwhelming hospitals again seem slim.

 

Or what is your notion on how one achieves that latter?

 

I think the large number of asymptomatic infected people arise in specific circumstances - places where large numbers of people are regularly forced into close contact such as meat packing plants, prisons, cruise ships etc. 

 

The whole point of "flatten the curve" from an epidemiologist viewpoint (and I am not an epidemiologist though I have worked with same on occasion) is to buy time to increase testing and put together a contact-tracing mechanism, while lowering the # cases to the point where #testtraceisolate is feasible.  After Wuhan, China appears able to have done this.  Singapore seems to have done this - ID'd an outbreak and contained.  S. Korea seems to have done this with several surges. Several European nations will be giving their try.

 

It's the same disease here, are you saying we are somehow less capable, more deficient and more sociologically challenged than democracies such as S. Korea, Taiwan etc?

 

That may be a rhetorical question fair warning I'm not likely to hang here.

 

From an epidemiological viewpoint, reopening should occur when the number of cases have subsided and testing/contact tracing capabilities have been built to the point where #testtraceisolate is possible.

I do not believe the first part. Didn’t this whole saga begin with everyone running around that hospitals were gonna overflow and we would be the next Italy? Hospitals across the country are effectively at half census or were at one point. The hospitals themselves are reopening elective surgeries. 

 

To your second, this is not an epidemiological experiment. A judgement call must be made between the economy/people’s livelihoods and 100% by the book disease control.

[snafu]

33 minutes ago, Hapless Bills Fan said:

 

Why should it, when outside a few hotspots like NYC, meat packing plants, prisons, cruise ships - most epidemiologists estimate 2-6% of the population has currently been infected and so far antibody studies bear this out?  Herd immunity 50-60% immune.

 

You’ve been a boon to this community, and I mean that. I’ve learned a helluva lot from you.

I was being pretty lazy in my response to Doc Brown. To answer your question, I’ve seen recent reports from Cuomo that say that up to 21% of NYC residents showed antibodies, and over 13% statewide. That was at least a week ago. The numbers must be a bit higher now, and it is my opinion (based on reports) that there’s a significant multiplier (7x, 10x, 15x, 20x ??) higher than those results which will push the number closer to herd immunity than the estimates you are stating.

 

Couple that with what Cuomo said today (yesterday) stating that up to 66% of hospitalized New Yorkers were infected at home, while not working, and I’ve got a problem believing that this policy should remain in place as is for much longer. The hardest hit part of the country so far (by far) has been NYC. Reports indicate that the hospitals are well below capacity.   If other parts of the country are now “hot” then deal with them S. Korea style. Isn’t it much easier to do that in less densely populated areas?

 

You can can go to any of my posts on this subject and see that I’ve advocated regional opening where possible, and more testing and tracing.  I believe that as long as people are diligent and honest, they will be able to self monitor and report their illness to their health care professionals and family and friends more quickly than government-appointed tracers, and the contacts can be tested and monitored as needed.  I believe that the development of quick and easy (saliva based) testing makes it much more possible to let people get back to work to a reasonable extent.   I believe (without any overt proof) that researchers every day are gaining a better understanding of treatment protocols.  I believe that PPE is being replenished so that the inevitable spike can be met with more preparedness than we had at the outset of this mess.

 

Maybe I’m the eternal optimist. I also balance my optimism with knowledge that people are going to continue to get sick and die whether we open or remain shut in. I just believe that the shutdown of our society (not just the economy) is only prolonging our necessary march toward true herd immunity.

 

I realize that my post may be thin on facts, charts, numbers and heavy on what I glean from news reports.  It is how I see things. Thanks for asking, I mean that.

 

 

Edited May 7, 2020 by snafu