COVID-19 Thread

[JosephC]

Latest government failure-

 

https://www.governor.virginia.gov/media/governorvirginiagov/executive-actions/EO-63-and-Order-Of-Public-Health-Emergency-Five---Requirement-To-Wear-Face-Covering-While-Inside-Buildings.pdf

 

Early in the document-

Science shows us that face coverings can help stop the spread of the virus.

 

Later in the document-

All patrons in the Commonwealth aged ten and over shall when entering, exiting, traveling through, and spending time inside the settings listed below cover their mouth and nose with a face covering, as described and recommended by the CDC:

 

Even later in the document-

State or local government buildings when accessed for the purpose of securing public services, with the exception of students in daycare centers or participating in-person classes in K-12 education or institutions of higher education.

 

I guess science says that the virus cannot be transmitted by 9 year old's in grocery stores or 20-year old's sitting in a journalism class? Science! Science! Science! Equally as ridiculous as the stay-at-homes where staying at home means go to the grocery store, go to the hardware store, go get an oil filter at the auto parts store, go to the laundromat, go through the drive-through window at McDonalds and don't forget to stop at the dispensary to pick up some dope (where it is now legal).

 

https://www.richmond.com/special-report/coronavirus/northam-faces-criticism-for-virginia-beach-visit-without-a-mask-covid-19-cases-increase-by/article_cebace6b-e8f7-5810-b076-bb6bdbd02968.html

[igor67]

Good question, so the short version some quick skimming indicates that the observation of higher winter death rates exist goes back to early Western medicine, but the overall picture is still only modestly understood. Flu itself is only modestly responsible for the increase, with other respiratory infections causing some more, but cardiovascular disease being the single most identifiable factor.

 

https://www.demogr.mpg.de/books/drm/003/2.pdf

https://pubmed.ncbi.nlm.nih.gov/18959541/

[jerichoholicninja]

https://www.politico.com/news/magazine/2020/06/04/public-health-protests-301534?cid=apn

 

https://www.cnn.com/2020/06/05/health/health-care-open-letter-protests-coronavirus-trnd/index.html

 

 

And health officials and the medical community wonder why people have lost trust in them. Don't get to the beach, don't go visit your aunt and her kids, your haircut isn't more important than saving lives, stay inside stay safe, #flattenthecurve! But we encourage you to gather with hundreds or thousands of people and the government better not dare try and stop you because of health concerns.

 

I don't care if people protest about whatever they want to protest about but don't tell us all that we're being selfish and endangering lives for doing the same thing you are now encouraging people to do just because you agree with their cause.

[JosephC]

https://www.politico.com/news/magazine/2020/06/04/public-health-protests-301534?cid=apn

 

https://www.cnn.com/2020/06/05/health/health-care-open-letter-protests-coronavirus-trnd/index.html

 

 

And health officials and the medical community wonder why people have lost trust in them. Don't get to the beach, don't go visit your aunt and her kids, your haircut isn't more important than saving lives, stay inside stay safe, #flattenthecurve! But we encourage you to gather with hundreds or thousands of people and the government better not dare try and stop you because of health concerns.

 

I don't care if people protest about whatever they want to protest about but don't tell us all that we're being selfish and endangering lives for doing the same thing you are now encouraging people to do just because you agree with their cause.

 

I couldn't agree more.

 

I 100% support those who want to peacefully protest without restriction as long as it's done without destruction of property, obstructing traffic or physically beating up another human being. It is a constitutional right.

 

Practicing one's religion is also a constitutional right, and the media's double standard of "it's your right to protest" versus "if you go to church you are evil because you are putting other in peril" is pretty mind-boggling. What happened with some Jewish funerals in New York a few months ago looks like a complete disgrace now.

 

Personally, I don't care of it's FOX News, CNN, MSNBC. I wish there was a big enough toilet to flush all these "journalist" down the drain with one push of the handle.

[igor67]

So remember when I said multiple times that the simplified messaging was key to communicating. Perfect example here. You are complaining about a double standard, but as the quotes from the healthcare letters indicate they are motivated and arguing for this course of action based on public health needs of the black community (aka a single standard is being used). Were they saying do whatever you want? No. They were arguing for not using 1 public health crisis to prevent improvement on another. Looking at the Life expectancy data we can observe a 3.5 years difference between black and white Americans

https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf

 

This now becomes the challenge do you want to sort through and figure out how comparable that is to covid? The chronic vs. acute makes it tricky, but just looking at some numbers makes it clear that these are 2 public health issues of a similar enough magnitude to be comparable. To be clear I don't necessarily think it's the correct call, but it is close enough to recognize it is legitimately debatable. That is the real importance of the free speech right, reminding ourselves to do try and give folks a chance and hear them out.

[stoutdude04]

 

I couldn't agree more.

 

I 100% support those who want to peacefully protest without restriction as long as it's done without destruction of property, obstructing traffic or physically beating up another human being. It is a constitutional right.

 

Practicing one's religion is also a constitutional right, and the media's double standard of "it's your right to protest" versus "if you go to church you are evil because you are putting other in peril" is pretty mind-boggling. What happened with some Jewish funerals in New York a few months ago looks like a complete disgrace now.

 

Personally, I don't care of it's FOX News, CNN, MSNBC. I wish there was a big enough toilet to flush all these "journalist" down the drain with one push of the handle.

 

I dont disagree with what you said, but my only response would be that you dont need to be in church to practice your faith(funerals are different). In fact, I'm pretty sure the bible even says something similar. I may be misremembering.

[Machu Peach]

I dont disagree with what you said, but my only response would be that you dont need to be in church to practice your faith(funerals are different). In fact, I'm pretty sure the bible even says something similar. I may be misremembering.

 

The response to this is that it's not up to you (or anyone else) to determine what is needed for others practice their faith. Most religions don't use the bible, so what it says is irrelevant.

[Machu Peach]

So remember when I said multiple times that the simplified messaging was key to communicating. Perfect example here. You are complaining about a double standard, but as the quotes from the healthcare letters indicate they are motivated and arguing for this course of action based on public health needs of the black community (aka a single standard is being used). Were they saying do whatever you want? No. They were arguing for not using 1 public health crisis to prevent improvement on another. Looking at the Life expectancy data we can observe a 3.5 years difference between black and white Americans

https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf

 

This now becomes the challenge do you want to sort through and figure out how comparable that is to covid? The chronic vs. acute makes it tricky, but just looking at some numbers makes it clear that these are 2 public health issues of a similar enough magnitude to be comparable. To be clear I don't necessarily think it's the correct call, but it is close enough to recognize it is legitimately debatable. That is the real importance of the free speech right, reminding ourselves to do try and give folks a chance and hear them out.

 

Would you please prove what "numbers" you're looking through to determine that police brutality towards minorities and and COVID are of a similar magnitude from a public health point of view? I don't know how I would even begin to determine such a thing.

[Machu Peach]

One thing that has been bugging me is the definition of "public health". I can see two possible definitions. A more limited one would be hygiene, epidemiology, and disease prevention and their effects the health of a population. One can easily argue that this is too limited as it ignores many major things impacting health. A more expansive definition would be anything to do with the health of a population. One can easily argue that this definition is so broad that it covers literally everything in the world and thus is meaningless.

 

One big criticism of mine of the CDC is that mission creep has caused them to study things like gun violence and accidental pool deaths. Both are certainly important topics that deserve study, but really fall more into a societal structure category than a disease category. Thus by having the CDC study them you're losing expertise/focus on actual diseases. There are certainly many things in grey areas, such as alcoholism, which falls into both societal structure and disease categories.

 

I don't really have a good or simple answer for any of that, but they are things that I think need to be considered.

[igor67]

I'll go for bullet points

 

*police brutality is a central theme and catalyst to the protest, but many of the speakers broaden and speak towards systematic racism.

* From a training standpoint in education and from my wife's experience's in healthcare things are generally lumped into systematic racism with police brutality just 1 example, so as a matter of how they think about the the issues it is going to be influenced more by that perspective than just a singular focus on brutality.

* I used the life expectancy difference as an estimate for the cumulative impact of systematic factors, an approach I had seen used elsewhere particularly in noticing the decline in rural white America related to the trending economic decline since the 1970's.

*It was also they only way I could think of to try and mesh the numbers without a really sophisticated analysis. #overlyhonestmethods

* The most recent comparable for Covid I could find is from https://wellcomeopenresearch.org/articles/5-75 and would give you a 12 years lost on average per covid death. Those are not identical measurement types, but in a loose comparison I think it works ok.

*So the covid impact is noticeably higher in terms of years, but as an acute problem it is only a 1 time 'cost' whereas the systematic racism accumulates and will continue to accumulate damage over time.

* 42 million African Americans * the 3 year life expectancy gap = 126 million years of life lost, 12 years* the current highside estimate of 1% mortality and 2/3 population needed for herd immunity = 26.4 million years lost

*Thanks for pushing me to finish making the estimation, on my initial eyeballing I still thought worst case covid was going to come out modestly ahead, but the population size difference between all African Americans and only 1% or so dying from Covid really flips that estimation around.

* The initial core argument was only that the 2 would be close enough for a reasonable person in the field to act like they were similar scale problems without resorting to ascribing bias or tribalism as explanation.

[Machu Peach]

Thanks for the response! Obviously things change drastically if you're comparing all systemic racism as opposed to just police brutality.

 

You are making a few major assumptions.

1) That 100% of the difference in life expectancy is due to systemic racism. I don't think that's a safe assumption. Females in the US live about 7 years longer than males and I don't think anyone would blame 100% of that gap on systemic sexism. That's a bit of an apples to oranges comparison, but it does point out that there can be other factors that influence life expectancy.

2) That life expectancy is similar in all environments. Life expectancy varies greatly by state and urban/rural living and races are not evenly spread across locations. To avoid an apples to oranges comparison you'd need to normalize for both. I suspect this would have a major impact on the data.

3) That 66% immunity could achieve herd immunity. For a more easily spread disease like COVID 90% is a more realistic minimal value.

 

Finally, I am a reasonable person. Asking for clarification or explanation is not unreasonable. I never accused anyone of bias or tribalism. I don't see the need for your last bullet point.

[igor67]

I whole-heartedly agree that every step of the estimation is subject to significant swings. Sorry If my last point came off directed toward you I was just trying to concisely restate my original thesis, your request was entirely reasonable.

 

For the sake of discussion

1) Attributing 100% of the life expectancy gap to systematic racism is problematic, but a significant portion of the male female gap also has some clear biological causes like the lower genetic load from having two Xs vs. one, and at a crude level of explanation hormone differences. Trying to extend looking for biological explanations into race of course is fraught with difficulty, leaving only environmental explanations most of which would likely be grouped under systematic racism.

2) That level or granularity could make some significant changes

3) I'm curious how you arrived at 90%, I've tended to use 66% based on the early R0 number and equation. I know that Michael Osterholm has said it might get up to 70% to achieve natural herd immunity. I'm sure a formal immunization campaign would target a higher number than 70%, but that is a slightly different sort of end point.

[Machu Peach]

For vaccines we usually are aiming for well over 95% immunity because the goal is often eventual eradication. Measles was the target, but sadly due to the success of the anti-vax movement that no longer seems possible.

 

I came up with over 90% because most diseases that I'm aware of need coverage in the 70-95% range and this seems quite infectious.

 

I don't like modeling using R0 beyond very general estimations. I personally think R0 is a terrible concept and I wish the general population had never heard of it because it is so often misunderstood. It gives people the impression that it's something inherent to the virus, but really it's far more about the environment. An extreme example is malaria where R0 estimates have ranged up to 3000 in certain settings, but is effectively 0 in the Midwest due the lack of a vector. Thus an R0 is going to vary considerably and is not a constant.

 

There's also significant heterogeneity of spread between infected individuals, something that most basic modeling does not account for. That seems particularly important to consider with COVID due the seemingly high reliance on 'super-spreaders' (another term I hate because it implies that it's a binary category) for non-co-living spread. I know there have been multiple studies that quantify this, but I'm not sure if anything method has become standard.

 

My background is also viral pathogenesis not epidemiology so I probably have a bit of bias against modeling. I think comparisons to real world data from other diseases is probably more useful.

[igor67]

Super helpful perspective. And my wife was very much on the frontline during the last measles outbreak in MN, so I am very familiar with that frustration.

[LouisEly]

For vaccines we usually are aiming for well over 95% immunity because the goal is often eventual eradication. Measles was the target, but sadly due to the success of the anti-vax movement that no longer seems possible.

 

I came up with over 90% because most diseases that I'm aware of need coverage in the 70-95% range and this seems quite infectious.

What do you think is the minimum threshold for "good enough" to get through the next fall/winter with a death rate that is no higher than influenza, in order to have decent immunity while giving more time to develop/test a better vaccine?

 

The goal is to get an ideal vaccine, but given how quickly this has come on and the need to balance public health with economic strain, I'm not sure that we have enough time to wait until we have an ideal vaccine if someone can develop one that is "good enough".

[Machu Peach]

I'd be lying if I said I could do anything other than guess. I switched fields from vaccine development 5 years ago so I'm not directly working on anything COVID-related now, but I do have a lot of old friend and colleagues. They're optimistic they'll have a protective vaccine, but worried that the decreasing rates of infection won't give their current studies enough statistical power. SAR and MERS (two very similar viruses) vaccines induced immunological features that one would assume would be protective, but there was obviously no way to test them after the outbreaks ended.

 

If forced to guess (cannot stress enough that this is a guess), I would say that a vaccine that induces good protection will be out in some capacity sometime this winter. I think the duration of protection will largely be unknown (it could be just months or could be years) and that a a very sizable percentage of the population (in the 10-50% range) will not want to be vaccinated until it undergoes more testing.

 

I am reasonably confident that a good vaccine will eventually be developed. There's nothing particularly unique about COVID (at least that's known right now) that makes vaccine development more difficult like with flu or HIV.

 

I also don't really know what to expect as far as the "2nd wave". I think it's more likely than not to occur, but that's just my impression and I have no idea what it may look like if/when it does occur.

 

I don't really trust anyone who claims to have good predictions for either a 2nd wave or the short-term success of vaccine development at this point. There are just too many unknowns.

[adambr2]

I really appreciate the good information that Igor and Machu have been able to provide to these threads (others too!! but thought these two deserved some recognition)

 

I'll be the first to admit I don't know anything other than what I hear secondhand. It's frustrating these days to do research and find so much that just contradicts something else you find.

[igor67]

Thanks for the appreciation.

[Machu Peach]

Thanks. I've been lurking on the site forever but never felt I had anything to add because y'all know a lot more about baseball than I do.

[FVBrewerFan]

Thanks. I've been lurking on the site forever but never felt I had anything to add because y'all know a lot more about baseball than I do.

 

That's another assumption that may very well not be accurate. ; )

[Samurai Bucky]

 

I couldn't agree more.

 

I 100% support those who want to peacefully protest without restriction as long as it's done without destruction of property, obstructing traffic or physically beating up another human being. It is a constitutional right.

 

Practicing one's religion is also a constitutional right, and the media's double standard of "it's your right to protest" versus "if you go to church you are evil because you are putting other in peril" is pretty mind-boggling. What happened with some Jewish funerals in New York a few months ago looks like a complete disgrace now.

 

Personally, I don't care of it's FOX News, CNN, MSNBC. I wish there was a big enough toilet to flush all these "journalist" down the drain with one push of the handle.

 

I don't disagree with what you said, but my only response would be that you don't need to be in church to practice your faith(funerals are different). In fact, I'm pretty sure the bible even says something similar. I may be misremembering.

This is one thing the Elders of our church are wrestling with. In Hebrews 10:24-25, it says, "And let us consider how we may spur one another on toward love and good deeds, not giving up meeting together, as some are in the habit of doing, but encouraging one another—and all the more as you see the Day approaching." The context for this is a little bit different because Hebrews addresses how people were reacting to the validity of Christ -- and how to face persecution related to their faith. However, this is one thing that is quoted often.

 

Can you practice your faith without having to go to church? Sure. I see my older friends struggling with this because they either don't know how to use technology, or they really yearn for the face-to-face contact. Over the past few months, our staff put sermons and other videos on YouTube. I found encouragement in those messages.

Our church had a parking lot service this past Sunday. It is possible they will start meeting in the sanctuary, but masks will be required, social distancing will need to be observed and enforced. I know there are some churches that aren't using that amount of discernment. The food pantry has been open during the pandemic, though. An awesome way to meet the needs of the people, for sure.

[LouisEly]

In light of some of the discussion over the last few pages, I thought you might be interested in this. The UW Alumni Association hosts a weekly livestream session on COVID-19, and this week (tomorrow, Tuesday, 7pm) it is on COVID-19 misinformation:

 

https://www.allwaysforward.org/uwnow/confronting-misinformation/

 

The professor leading the session is an infectious disease epidemiologist and teaches a class called "Conspiracies in Public Health".

 

I think it's an open YouTube session available to anyone and don't have to be a member of the UW Alumni Association. If I remember and watch, I'll provide highlights.

[homer]

Arizona is going through a big spike right now. This is from the biggest healthcare system in the state:

 

 

[Machu Peach]

Looking at total ICU occupancy for Arizona as a whole.

May 15th: 1200

June 6th: 1192

 

Added:

Total ventilators in use for COVID+ or COVID suspected for Arizona as a whole.

May 15th: 210

June 6th: 249

 

Source: https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/covid-19/dashboards/index.php

[homer]

Looking at total ICU occupancy for Arizona as a whole.

May 15th: 1200

June 6th: 1192

 

Added:

Total ventilators in use for COVID+ or COVID suspected for Arizona as a whole.

May 15th: 210

June 6th: 249

 

Source: https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/covid-19/dashboards/index.php

 

re: ICU occupancy - look at the percentage occupied

May 15th 72%

June 6th 77%

 

I'm assuming there are fewer ICU beds now than before. May 11th it was 68%