COVID-19 Thread

[igor67]

Luckily we have the complete viral genome sequence to verify it contains no signs of genetic engineering. The wide array of genetic engineering techniques all leave little pieces of extra or distinctive sequence behind. So we don't need to worry about the man made angle at all.

Joseph-

I think the difference here is very much a kinetic vs. thermodynamic control issue. The R value being measured for the virus under uncontrolled conditions has not changed much. So the 'thermodynamic' aka herd immunity limit is still the same 60-70% of the population. Every other model has been all about kinetics, which is a lot more sensitive to any number of changing parameters. That doesn't make the models garbage. I mean we could do the same thing in baseball and start with a nice set of predictions on the season, and then start changing the rules of the game as the season went on.

[MrTPlush]

A quick google search and you will find a lot of articles on why these things tend to pop up in China/Asia. Personally I am surprised it doesn’t happen more often.

[igor67]

Entertainingly though PBS was showing Wednesday Nite at the lab this weekend and they were showing one on flu from a couple of years ago. Apparently the first documented zoonotic (animal to people) transmission of a flu virus was in Broadhead, WI.

[LouisEly]

Over the past week the news has been showing pictures of victims of the virus who were relatively young. Small sample, but every person I saw under 40 was obese. We know about age and comorbidities, but have they done any correlation between obesity and morbidity/mortality with this?

 

Many of the comorbidities (hypertension, diabetes) are direct functions of poor diet/exercise habits, which also leads to obesity. l've hypothesized before that smoking would be the #1 commonality between cases. Is it that people who live a healthy lifestyle and don't smoke are the ones who aren't at risk?

[nodakfan17]

Michigan is not allowing its own citizens to travel to their vacation homes within the state. Much like Wisconsin, these aren’t all wealthy individuals, but rather a lot of middle class folks with a cabin ‘up north.’ I’m a big libertarian who has accepted that government may need to play a larger role in our lives for a while, but restricting people from accessing their personal property indefinitely? C’mon - just be smart, people.

[igor67]

Ugh, so I finally got around to tracking down some info on these chloroquinie studies with 'positive' results. I shouldn't be surprised at how bad they were, and yet I had imagined they were small scale limited studies done in good faith. I'll post a link to someone else's analysis below, but they are reputable. In this case I do not routinely analyze clinical studies, so it is easy for me to miss some of the limitations. But the short version is that the studies weren't just small sample size, they patients appear to have been cherry picked in a few different ways. The most significant is that the treatment was primarily tested on patients with mild symptoms. It is not a stretch to say I wouldn't have accepted that design from my high school students. My initial skepticism was driven by a pretty simple thing to be on the lookout for namely, how would such a drug work? The fact that the treatment involved an antibiotic for a virus was a key reason to be suspicious.

https://sciencebasedmedicine.org/hydroxychloroquine-and-azithromycin-versus-covid-19/

 

As I posted way up thread the communication piece is hard for a lot of reasons, one is trying to find the balance between simplifying and explaining all the details. You can kind of compare my quick summary to the more robust take down in the link. Another issue, one I really focus on is appropriate skepticism. New research should always be greeted with SOME skepticism. It is the nature of research that we working on things we don't understand yet, so the conclusions from any study in any field are often incomplete or wrong. Over time though we make progress. We are stuck with limited time however and can't minutely dissect every piece of information. Situations like this and the way it is presented often turn into confirming evidence then for extreme skeptical stances against science. The antidote for that is not science cheerleading and mindless positivity. No one has actually found a good way to counteract these modern pulls in attitude.

[et bbal]

Over the past week the news has been showing pictures of victims of the virus who were relatively young. Small sample, but every person I saw under 40 was obese. We know about age and comorbidities, but have they done any correlation between obesity and morbidity/mortality with this?

 

Many of the comorbidities (hypertension, diabetes) are direct functions of poor diet/exercise habits, which also leads to obesity. l've hypothesized before that smoking would be the #1 commonality between cases. Is it that people who live a healthy lifestyle and don't smoke are the ones who aren't at risk?

 

Read a story on JSonline yesterday about a 34 (I believe) year old who was originally from Brookfield. The young man was a runner, had even done ultra-marathons, so I am guessing he was not overweight and he was in very good shape. Anyway, he was working in New York caught and succumbed the the covid virus. If a person like that can't fight this virus who can.

[Fear The Chorizo]

Over the past week the news has been showing pictures of victims of the virus who were relatively young. Small sample, but every person I saw under 40 was obese. We know about age and comorbidities, but have they done any correlation between obesity and morbidity/mortality with this?

 

Many of the comorbidities (hypertension, diabetes) are direct functions of poor diet/exercise habits, which also leads to obesity. l've hypothesized before that smoking would be the #1 commonality between cases. Is it that people who live a healthy lifestyle and don't smoke are the ones who aren't at risk?

 

Read a story on JSonline yesterday about a 34 (I believe) year old who was originally from Brookfield. The young man was a runner, had even done ultra-marathons, so I am guessing he was not overweight and he was in very good shape. Anyway, he was working in New York caught and succumbed the the covid virus. If a person like that can't fight this virus who can.

 

That may be the case, but there are handfuls of very healthy people under 50 who die every year from very random diseases one would never expect them to - genetics and specific target organ health can be a very random thing. Overwhelming evidence that Covid-19 is hardest on elderly - specifically elderly with weakened immune systems or comorbidities. I'm pretty certain just about any able-bodied person under 50 who dies or even gets hospitalized becomes newsworthy, at least on a local scale. The fact that those stories aren't everywhere means the lethality of Covid-19 on younger people isn't close to the main concerns surrounding who gets it.

[homer]

Michigan is not allowing its own citizens to travel to their vacation homes within the state. Much like Wisconsin, these aren’t all wealthy individuals, but rather a lot of middle class folks with a cabin ‘up north.’ I’m a big libertarian who has accepted that government may need to play a larger role in our lives for a while, but restricting people from accessing their personal property indefinitely? C’mon - just be smart, people.

 

I read something that the people that live in the vacation towns year round are really worried the vacationers are going to bring the disease with them. Michigan has 4th highest death rate per capita. Tough situation to deal with....not sure what I would do if I was the governor.

[nodakfan17]

Michigan is not allowing its own citizens to travel to their vacation homes within the state. Much like Wisconsin, these aren’t all wealthy individuals, but rather a lot of middle class folks with a cabin ‘up north.’ I’m a big libertarian who has accepted that government may need to play a larger role in our lives for a while, but restricting people from accessing their personal property indefinitely? C’mon - just be smart, people.

 

I read something that the people that live in the vacation towns year round are really worried the vacationers are going to bring the disease with them. Michigan has 4th highest death rate per capita. Tough situation to deal with....not sure what I would do if I was the governor.

 

It’s one thing to ban vacationers, but property owners? I think I’d want a refund on my property taxes.

[homer]

Michigan is not allowing its own citizens to travel to their vacation homes within the state. Much like Wisconsin, these aren’t all wealthy individuals, but rather a lot of middle class folks with a cabin ‘up north.’ I’m a big libertarian who has accepted that government may need to play a larger role in our lives for a while, but restricting people from accessing their personal property indefinitely? C’mon - just be smart, people.

 

I read something that the people that live in the vacation towns year round are really worried the vacationers are going to bring the disease with them. Michigan has 4th highest death rate per capita. Tough situation to deal with....not sure what I would do if I was the governor.

 

It’s one thing to ban vacationers, but property owners? I think I’d want a refund on my property taxes.

 

I think that'd be a fair compromise.

[adambr2]

Over the past week the news has been showing pictures of victims of the virus who were relatively young. Small sample, but every person I saw under 40 was obese. We know about age and comorbidities, but have they done any correlation between obesity and morbidity/mortality with this?

 

Many of the comorbidities (hypertension, diabetes) are direct functions of poor diet/exercise habits, which also leads to obesity. l've hypothesized before that smoking would be the #1 commonality between cases. Is it that people who live a healthy lifestyle and don't smoke are the ones who aren't at risk?

 

Read a story on JSonline yesterday about a 34 (I believe) year old who was originally from Brookfield. The young man was a runner, had even done ultra-marathons, so I am guessing he was not overweight and he was in very good shape. Anyway, he was working in New York caught and succumbed the the covid virus. If a person like that can't fight this virus who can.

 

You're always going to have exceptions. Always. Many people can and have fought off this virus.

 

Somewhere out there last year I'm sure there is a perfectly healthy 20 something who died from pneumonia while there is a 70 year old smoker with COPD who got pneumonia and is still around to talk about it now. There will always be statistical anomalies but it doesn't change the overall rates.

[igor67]

Organ recipients (immune compromised), asthma, and a big chunk of cancer patients have no diet/ exercise/ moral issues. I should know since I don't even have to go outside my teaching department to hit people in each category none of whom are anywhere close to 50. And while that is factoid status as I posted above those categories do make up a sizeable fraction of the population. Asthma alone hits 25 million people which is still quite a bit more than the unemployment number. In fact if you count just the adults with asthma you get 19.5 million which still is bigger than current unemployment. So at least for the time being it would actually do more economic damage.

[A Swing and A Drive]

Testing is the key to everything.

 

Testing for the virus, and testing for the antibodies. Mass testing will answer so many questions. All the stats we have tell us nothing if we don't have testing. The number of infected and dead in Wisconsin tells us almost nothing. If you have symptoms, and you get told you can't get tested because you don't need hospitalization and you just need to go home and rest for 2 weeks and call if you get worse, we need to do better. Imagine how many infected have no symptoms at all, and in many cases we can't get the midly symptomatic tested.

 

If we could test everyone for the virus and antibodies, this thing would be over soon. I heard in March about a 5 minute test that was going to start being produced at the rate of 50K per day on April 1st, but I haven't heard much since.

 

I 100% agree with the post. Why is it that out of 328 million Americans, only 2.5 million have been tested so far? This is absurd. The federal Task Force needs to be focusing a plan to impliment tests on a massive scale in order to open the country back up safely.

 

It's either that or wait for a vaccine and the earliest I've heard one would possibly be ready by would be September.

 

My fear is that we will do neither and decide to trade human lives for economic stability.

[Fear The Chorizo]

Testing is the key to everything.

 

Testing for the virus, and testing for the antibodies. Mass testing will answer so many questions. All the stats we have tell us nothing if we don't have testing. The number of infected and dead in Wisconsin tells us almost nothing. If you have symptoms, and you get told you can't get tested because you don't need hospitalization and you just need to go home and rest for 2 weeks and call if you get worse, we need to do better. Imagine how many infected have no symptoms at all, and in many cases we can't get the midly symptomatic tested.

 

If we could test everyone for the virus and antibodies, this thing would be over soon. I heard in March about a 5 minute test that was going to start being produced at the rate of 50K per day on April 1st, but I haven't heard much since.

 

I 100% agree with the post. Why is it that out of 328 million Americans, only 2.5 million have been tested so far? This is absurd. The federal Task Force needs to be focusing a plan to impliment tests on a massive scale in order to open the country back up safely.

 

It's either that or wait for a vaccine and the earliest I've heard one would possibly be ready by would be September.

 

My fear is that we will do neither and decide to trade human lives for economic stability.

 

2.5 million tested based on the testing method they've used is actually a decent amount - sure they could have done better, but this isn't like taking someone's temperature. Nobody else in the world has come close to that total in terms of total testing - Germany is probably the current gold standard in per capita testing, and they've started some antibody population studies as well. Plus, a test for Covid-19 is a snapshot in time for the individual tested. A vast majority of those tests have come back negative - that's great for the person at the time of the test that they didn't have coroavirus, but it tells us nothing about whether they picked up the virus the next day. I'd also guess a decent chunk of the total testing done has been on medical personnel who have been tested more than once simply because they are treating patients or are working among high risk populations/patients. There just isn't the capacity to do wide scale Covid-19 testing on hundreds of millions of people repeatedly - they need to reduce active infective cases back down to isolated clusters and rebuild a testing program from there.

 

The only population-wide testing that has value at this point after this extended period of sheltering in place would be antibody testing - doing that on a nationwide scale for even 5% of the population would make a huge difference in determining how many millions of people likely haven't yet come in contact with the virus, which would drastically improve modeling parameters for the 2nd/3rd waves of infection this virus will bring starting this summer. It's very important to understand that social distancing/shelter in place doesn't end the risk of the virus to people who haven't been infected yet, nor has it led to any of the modeled death toll reductions aside from giving the system time to have what they deem sufficient ICU capacities - it's bought time to prevent this initial surge from overwhelming the hospital system that would have led to unnecessary deaths, and has given many areas time to increase ICU bed capacity to better manage peak infection rates later this year. The reductions in modeled death rate over the last week or two have come solely from virus parameter adjustments as more becomes known about coronavirus. It's Ro (infection rate) is higher, avg hospital length stay is actually lower, asymptomatic infection rate is higher, and vulnerabale populations/cormorbidity risks are more well known than the initial models guestimated - those are actually all good things that will lead to fewer deaths from this virus.

 

And waiting to reopen the world until a vaccine is available isn't an option - pushing too fast to distribute an uncertain vaccine could lead to even more problems. The MN dept of health provided some specifics on their modeling, and this recent round of forecasts essentially point to reaching diminishing returns across the entire pandemic arc (12-18 months depending who you ask) of strict shelter in place measures by early May. Their most recent decision point was whether to try and keep vulnerable populations sheltered in place for an extended period and letting everything else back open this weekend, or extending the shelter in place order the next 4 weeks. The modeled death toll actually was very similar with those two options, however they opted to keep the order on everyone the rest of this month because it extended when the peak ICU need will be out into mid July instead of early June, buying the medical system more time to prepare. From May forward, their current modeling projects little to no positive impact on estimated deaths by continuing shelter in place policies into the summer/indefinitely - it would just drag the timing on when those occur out further. These timeframes may differ for different countries or different states in the US' instance, which is why I really hope the next phase of this isn't a one-sized fits all approach. Large swaths of the country shouldn't have to wait to reopen until New York is in a better place to do so, nor should New York or other initial hot spot areas have to reopen before they are ready.

 

Once the calendar rolls into May and assuming things start opening back up then, antibody testing plus the current Covid-19 testing to try and isolate infection clusters will be the key to preventing the need to do another nationwide shelter in place order and keeping future waves of infection manageable. We are going to need to live with this for a good amount of time before a magic bullet presents itself - might sound scary at the moment, but there will likely be a combination of treatment therapies, testing, and slowly increasing herd immunity that will prevent things from spiraling out of control again for this particular virus.

[PeaveyFury]

And waiting to reopen the world until a vaccine is available isn't an option - pushing too fast to distribute an uncertain vaccine could lead to even more problems. The MN dept of health provided some specifics on their modeling, and this recent round of forecasts essentially point to reaching diminishing returns across the entire pandemic arc (12-18 months depending who you ask) of strict shelter in place measures by early May.

 

Sounds like a very interesting study- do you have a link?

[LouisEly]

Over the past week the news has been showing pictures of victims of the virus who were relatively young. Small sample, but every person I saw under 40 was obese. We know about age and comorbidities, but have they done any correlation between obesity and morbidity/mortality with this?

 

Many of the comorbidities (hypertension, diabetes) are direct functions of poor diet/exercise habits, which also leads to obesity. l've hypothesized before that smoking would be the #1 commonality between cases. Is it that people who live a healthy lifestyle and don't smoke are the ones who aren't at risk?

 

Read a story on JSonline yesterday about a 34 (I believe) year old who was originally from Brookfield. The young man was a runner, had even done ultra-marathons, so I am guessing he was not overweight and he was in very good shape. Anyway, he was working in New York caught and succumbed the the covid virus. If a person like that can't fight this virus who can.

I've manned a cheer station around mile 22 of the Chicago Marathon the last three years and have watched every single "runner" from beginning to end. People who "run" marathons come in all shapes and sizes.

 

I know two people who do ultras, and if you saw either of them you would think that they couldn't run 5 miles much less 50. Marathons and ultras are more about mental toughness, good knees, and being able to metabolize lactic acid than being in good shape. Highly likely that they don't smoke, but doesn't mean that they don't have underlying health conditions from poor diet habits.

[igor67]

I believe this is the link Chorizo was discussing

https://www.kare11.com/article/news/health/coronavirus/minnesota-department-of-health-releases-covid-19-modeling/89-09e965f6-9b4c-4307-8e36-743f084fbcea

 

I share the concern about risks of pushing a vaccine too fast. The vaccine freedom/ I don't want too/ fill-in adjective of your choice crowd have already killed people and a rushed vaccine runs the risk of giving them more 'doubt' to sow among people. If one looks at the pre-vaccine rates of these diseases on the CDC website and compares that to the modern developed world death rates from these diseases you collectively still get around 200,000 people saved per year at the US current size. And that doesn't get into the huge other costs. I have an older relative for example who spent his/her entire life on disability as a result of the brain damage caused by the high measles fever. Regrettably even folks of the generation to have a better understanding of the toll often forget about these sorts of things, because those students were sent to special schools not more integrated like they are today.

[superfly]

I believe this is the link Chorizo was discussing

https://www.kare11.com/article/news/health/coronavirus/minnesota-department-of-health-releases-covid-19-modeling/89-09e965f6-9b4c-4307-8e36-743f084fbcea

 

I share the concern about risks of pushing a vaccine too fast. The vaccine freedom/ I don't want too/ fill-in adjective of your choice crowd have already killed people and a rushed vaccine runs the risk of giving them more 'doubt' to sow among people. If one looks at the pre-vaccine rates of these diseases on the CDC website and compares that to the modern developed world death rates from these diseases you collectively still get around 200,000 people saved per year at the US current size. And that doesn't get into the huge other costs. I have an older relative for example who spent his/her entire life on disability as a result of the brain damage caused by the high measles fever. Regrettably even folks of the generation to have a better understanding of the toll often forget about these sorts of things, because those students were sent to special schools not more integrated like they are today.

 

It’s not so much that even. I think there’s a difference between significant risk diseases and something like a coronavirus. Say whatever you would like, this is a version of flu/pneumonia/etc. If it wasn’t it wouldn’t be classified in a family of coronavirus. At what is appearing to be a 0.3-1% fatality rate, and infinitely less if you’re under the age of 80, it should not be a requirement to take a rushed vaccine. Humans will build up an immunity to this virus.

 

If we’re talking 50% fatality rates with REAL data backing it up, not models and weakly supported data then yes I agree we should consider it being part of the vaccine regimen.

[PeaveyFury]

I believe this is the link Chorizo was discussing

https://www.kare11.com/article/news/health/coronavirus/minnesota-department-of-health-releases-covid-19-modeling/89-09e965f6-9b4c-4307-8e36-743f084fbcea

 

This data is a bit concerning, as in addition to the extension of the full quarantine through May 8, it further advocates for a 50% quaranitine into July or August to achieve the mitigation that they're hoping to achieve, which could include an extended closure of bars and restaurants. It also predicts, as noted 2-3 waves of this over the next 12-18 months. And am I reading it correctly that they're assuming 22,000 deaths JUST in Minnesota?

[Fear The Chorizo]

I believe this is the link Chorizo was discussing

https://www.kare11.com/article/news/health/coronavirus/minnesota-department-of-health-releases-covid-19-modeling/89-09e965f6-9b4c-4307-8e36-743f084fbcea

 

This data is a bit concerning, as in addition to the extension of the full quarantine through May 8, it further advocates for a 50% quaranitine into July or August to achieve the mitigation that they're hoping to achieve, which could include an extended closure of bars and restaurants. It also predicts, as noted 2-3 waves of this over the next 12-18 months. And am I reading it correctly that they're assuming 22,000 deaths JUST in Minnesota?

 

Yes, but that's over the course of the full pandemic, which is a very long time because it is based on 100 percent of the population becoming infected at some point, and based on no progress with treating the systems that lead to deaths/hospitalizations during that whole time - neither if which will be the case. The combination of a medical system that can handle the spikes, social distancing measures that can be done without shuttering everything, evolving treatments/therapies, and IMO further evidence that this virus isnt as nasty as originally feared will keep actual deaths well below modeled deaths. I think even their revised model still overestimates what the ICU need will be during future peak infections, and the asymptomatic/minor symptoms rate still used in the modeling is still lower than what it will actually prove to be.

 

And given the fact MN is still well under 100 deaths and its average age of death is now 88, I dont see 20k more deaths happening by the time coronavirus is a societal afterthought. These models were developed based on limited available testing during initial outbreaks, so hopefully the second, third, and however many other spikes can be managed much more gradually using testing to isolate clusters before needing to shut everything down.

[igor67]

A few things, most of the diseases we have vaccines for have mortality rates within the plausible range of covid-19 at least under current levels of treatment. A few of them are definitely higher. There are costs outside of death, most of the old diseases we have a pretty good idea of the additional costs. Though just a few years ago they realized by looking at historical data that measles biggest effect was probably that is suppressed the immune system for most people often for a year or more (sorry I don't have the citation handy). We are far from having a good idea what the level of long term cost for survivors of covid-19, but there are some signs it could involve some level of long-term lung damage.

 

Viruses classification is based on structure, not relative threat level. It is the same in bacteria which is why you both need E.coli in your gut, and different strains are pathogenic. There is no particular biological relationship between covid and flu viruses. Hence folks looking to earlier work on other covid viruses like MERS and Sars to jump start vaccine efforts and not any of the 30-40 years worth of flu vaccines.

 

All scientific math is modelling, especially things like gravity the normal universal law of gravitation doesn't even work well enough to support GPS. You have to adjust the model to account for relativity. Generally however you do not have to adjust the model for variations in the Earth's density to get GPS to work, but other high precision work might have to. Modelling is one of the key innovations of the entire Scientific Revolution because it forces us to turn all of fuzzy verbal logic into something that generates numerical predictions. Another key innovation is the experimental idea itself. Namely the entire notion that you could set-up a carefully controlled lab experiment with only a single variable being altered. These tools are ridiculously good, but in many scientific fields we can't do that type of lab experiment. This tends to as we are seeing in public make things messier.

[logan82]

Just to clarify the vaccine pessimism. A primary reason there is no common cold vaccine is that, the common cold is a dump category of symptoms caused by a bunch of different viruses, the majority of which are not coronaviruses. Second both SARS and MERS were coronaviruses that there has been prior success developing vaccines for. It also lacks the genetic characteristics of the flu, which allow it to change so rapidly we have to develop a new vaccine every year. Betting on a single vaccine candidate to make it all the way through would be silly, but folks have really identified a pretty large number of candidates with different methods already, so there is pretty good reason for optimism.

The Flu is a collection of viruses too that the vaccine only guesses at the dominant 2-3 strains each year.

 

Michigan is not allowing its own citizens to travel to their vacation homes within the state. Much like Wisconsin, these aren’t all wealthy individuals, but rather a lot of middle class folks with a cabin ‘up north.’ I’m a big libertarian who has accepted that government may need to play a larger role in our lives for a while, but restricting people from accessing their personal property indefinitely? C’mon - just be smart, people.

 

I read something that the people that live in the vacation towns year round are really worried the vacationers are going to bring the disease with them. Michigan has 4th highest death rate per capita. Tough situation to deal with....not sure what I would do if I was the governor.

 

It’s one thing to ban vacationers, but property owners? I think I’d want a refund on my property taxes.

I agree keeping people from their property is wrong if it is their primary residence. We 100% should be keeping people in their primary residence and away from their vacation homes in areas with an older population and less capacity to treat severe cases.

 

We really don't have enough testing to have any clear idea how many people are infected. That completely undercuts any possible usefulness of any stats so far.

[Fear The Chorizo]

To piggyback on the previous post, MN dept of health officials are suggesting that as many as 100x as many people have been infected by coronavirus in the state as what their current 1600 total confirmed cases based on testing total. That would be roughly 30 percent of the state's population, which would actually be incredibly good news provided most of that discrepancy is asymptomatic or minor symptom cases considering the low death and hospitalization rate thus far.

 

Honestly nobody really knows just how many people have already come in contact with coronavirus. Only way to better quantify that is with antibody testing, which needs to happen on a reasonably large percentage of the population over the next 1-2 months.

[DuWayne Steurer]

Not to be nitpicky, but 1600 X 100 / 5 million would be 3 percent, not 30 percent of Minnesota's population.

 

Ok, I guess that was nitpicky.