COVID-19 Thread [V2.0]

[OldSchoolSnapper]

I'm still not following this. Are high COVID counts not the cause of the business failures? If COVID is contained then businesses can increase capacity. Restrictions are a result, not a cause.

I'm confused by "Restrictions are a result, not a cause." Are you arguing that restrictions are the result of business failures?

 

He's saying the restrictions are because of Covid explosions, not the cause of a failing business. Which I think is flawed because a) we started forcing things closed before there was an explosion and b) what I just posted above.

[owbc]

I'm still not following this. Are high COVID counts not the cause of the business failures? If COVID is contained then businesses can increase capacity. Restrictions are a result, not a cause.

I'm confused by "Restrictions are a result, not a cause." Are you arguing that restrictions are the result of business failures?

 

He's saying the restrictions are because of Covid explosions, not the cause of a failing business. Which I think is flawed because a) we started forcing things closed before there was an explosion and b) what I just posted above.

 

Ok I think we're on the same page with the source of our disagreement here. This is starting to make sense to me.

 

Well at this point in time, at least in the state and county that I live in, the restrictions are directly, quantitatively tied to COVID case counts and positive test rates. Hit a certain target, then more businesses can open and others can have higher capacity. So if we fail to hit the target and it hurts businesses, then you can:

(1) blame the people for allowing the virus to spread (lack of mask use/social distancing);

(2) blame the government for having too FEW restrictions and/or not enforcing restrictions, thus making the virus targets unreachable (or for not squashing the virus levels to zero);

(3) blame the government for having too MANY restrictions, thus preventing businesses from opening.

 

OldSchoolSnapper seems to be (3) and I'm a (1). Other people might be (2) or some combination of (1) and (2). The position might also be different depending on location and culture and the specifics of the government restrictions, since they are different everywhere.

[Machu Peach]

He's saying the restrictions are because of Covid explosions, not the cause of a failing business. Which I think is flawed because a) we started forcing things closed before there was an explosion and b) what I just posted above.

That makes sense. Usually I hear that phrase used when referring to how two subjects interact, not three.

 

...though, can't they be both? Can't the restrictions be the result of COVID and the cause of business failings?

[OldSchoolSnapper]

We can do option 1, and I think it is a fair option, but I think it is also the option that has no realistic alternative because I never expected enough people to comply with the rules in the first place.

[igor67]

Late to the party here I dove in to nate's article's a little more, and there some deeper warning flags and problems with them than what Peavey identified. For example

https://www.medrxiv.org/content/10.1101/2020.04.24.20078717v1 not only is the article somewhat old, it was submitted by a scientist way outside their field to what is called a pre-print server. Typically these articles will be posted with the expectation they are going to a journal for actual peer review. I haven't seen any sign that ever happened, along with a title that does not sound like a publication and it being a single author. Looking at the methods it reads as a math proof, not a statistical analysis of data.

 

The AIER is also incredibly problematic since again it provides no statistical analysis. Just a series of bar graphs. Followed by 1 off comparisons trying to look for correlations. Unsurprisingly for a complex problem when they make no attempt to control for these complications they can't find correlations of effectiveness of different policies (none of which were terribly well defined in the paper).

 

I had a brief look at the wallstreet journal articles before the paywall went up, but it was enough to track down link to one of there citations. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30208-X/fulltext

 

What was particular troubling was that it was clear the wall street journal article fixated on this sentence from the paper :Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. " Which sound really supporting of Nate's point until you read the full article.

The following is far more representative of the authors data and conclusions then the WSJ rather bad reading job.

"We built a country-level model, incorporating data from 50 different countries, to assess country-specific socioeconomic factors and healthcare capabilities on COVID-19-related outcomes such as new case burden, critical cases, and mortality. Our country-level model demonstrated that travel restrictions and containment measures put in place up till 01 May 2020 may have an impact on the total number of COVID-19 cases in a given country, but there was no observed association between public health policies and the number of critical cases or mortality. Importantly, low levels of national preparedness in early detection and reporting, limited health care capacity, and population characteristics such as advanced age, obesity and higher unemployment rates were key factors associated with increased viral spread and overall mortality." Of particular note is that all the data only goes up to May 1st, so I personally find it less than surprising that most mortality in that timeframe was driven more by pre-existing risk factors than the ability to decrease the infection rates (which did happen)

[Machu Peach]

For example

https://www.medrxiv.org/content/10.1101/2020.04.24.20078717v1 not only is the article somewhat old, it was submitted by a scientist way outside their field to what is called a pre-print server. Typically these articles will be posted with the expectation they are going to a journal for actual peer review. I haven't seen any sign that ever happened, along with a title that does not sound like a publication and it being a single author. Looking at the methods it reads as a math proof, not a statistical analysis of data.

You wouldn't see any sign until it is accepted/published, though one should be EXTREMELY skeptical (10x so for COVID related papers) of all preprints unless the authors are very well established. I don't have a major issue with the title, though if I were a reviewer I would ask that they phrase it "_____ analysis shows full lockdown policies...". The other criticisms are quite valid.

 

Of particular note is that all the data only goes up to May 1st, so I personally find it less than surprising that most mortality in that timeframe was driven more by pre-existing risk factors than the ability to decrease the infection rates (which did happen)

Why do you find that less than surprising?

[igor67]

First sorry the link got all messed up to the lancet paper

https://doi.org/10.1016/j.eclinm.2020.100464

 

I wasn't surprised there wasn't a linkage in a multiple regression analysis between lockdowns and the mortality numbers because it was so early. Countries initial responses and initial impacts certainly would be heavily impacted by already existing conditions. The paper also did not attempt to correct for any under counting of deaths in that critical early period which is a pretty big confounder in the data. Add into the mix the how much of a lagging indicator deaths are and I can certainly see how any number of other factors would have dominated the reasons for early deaths. I hope that clarifies.

[igor67]

Something else I thought of while driving. Since the Lancet paper was doing a regression analysis and only reported statistically significant effects, there is a huge sample size difference between number of cases and number of deaths. Which definitely is going to make it easier to show a significant impact on overall case numbers compared to death numbers.

[Machu Peach]

Assuming I understand your point correctly, I would argue that it's likely the oppose. Existing factors, such as obesity prevalence, don't change over a 12 month period (or even over years), so there isn't reason to assume they would have a larger impact early. Similarly, I would think the effects of a lockdown would be strongest early when disease prevalence is lowest and lockdown compliance is highest. Once the disease is ubiquitous and compliance wanes, lockdowns would likely be less effective.

 

The data reporting issue are likely an issue, but overall I don't have a major problem with the paper's methodology or conclusions. Given the data limitations at the time I think it's quite good overall.

 

 

...and just on the chance that someone is planning on to tell me that it 'seems like' I'm arguing against lockdowns, let me be clear that I'm not making any overall statements about lockdowns either way

[homer]

https://www.jsonline.com/story/money/business/health-care/2020/10/29/crush-covid-19-cases-continues-wisconsin-eyes-shortage-icu-beds-coronavirus/6058257002/

 

Wisconsin is on track to run out of ICU beds and, more importantly, the nurses to staff them, in as little as two weeks if the number of people testing positive for COVID-19 does not drop.

 

On Tuesday, when the state reported a record 5,200 people tested positive, only 187 of the state's 1,469 intensive care unit beds were available. Of the patients in ICUs, 319 were being treated for COVID-19.

 

Fewer than four out of 100 COVID-19 patients — roughly 3.5% — end up in the hospital. But about one in four of those patients require ICU care. This means that an estimated 36 of the more than 5,200 people who tested positive for the virus on Tuesday will end up in an ICU — and some of them may be in the units for weeks.

 

That’s just from one day.

 

Almost 28,000 people tested positive in a seven-day period. Thus, 200 of them could require ICU care in coming weeks. And there are no signs of the infection rate slowing.

[FVBrewerFan]

Or it could mean ICU beds are being used because they're available, and same is true of regular hospital beds. Maybe not all ICU patients actually need to be there. Not saying that's the case, but would not surprise me. Rule #1 is always follow the money. Hospitals are hurting, and if they have space why not fill it? We'll find out soon enough I guess.

[reillymcshane]

My wife's hospital system has seen COVID patient numbers triple in the last three weeks - and they expect them to at least double - or perhaps triple - by the end of November.

 

Their ICU beds are filling up - and only with people who need to be there.

 

A big problem is getting staff. ICU nurses and docs have specialized training required to do that job. And they are quitting and moving out of the ICU at a record pace due to the stress and fear and frustration of the situation.

 

Hospitals are routinely finding 10-20% of staff sidelined due to having COVID - or being forced to quarantine.

 

I hope I am wrong, but things appear like they will be getting quite a bit worse in the coming month or so.

[homer]

Or it could mean ICU beds are being used because they're available, and same is true of regular hospital beds. Maybe not all ICU patients actually need to be there. Not saying that's the case, but would not surprise me. Rule #1 is always follow the money. Hospitals are hurting, and if they have space why not fill it? We'll find out soon enough I guess.

 

Are you suggesting that they are putting people in ICU that don't require intensive care? And that this generates additional revenue for the hospital?

[jjfanec]

Or it could mean ICU beds are being used because they're available, and same is true of regular hospital beds. Maybe not all ICU patients actually need to be there. Not saying that's the case, but would not surprise me. Rule #1 is always follow the money. Hospitals are hurting, and if they have space why not fill it? We'll find out soon enough I guess.

 

As someone who has had numerous family members with covid who are older, and now have it myself, I would say there has been zero pressure to go to the hospital. In fact they are steering you away from the hospital unless you show warning signs of severe symptoms. To imply hospitals are putting people in the ICU and other rooms who dont need to be there - without any proof - does not seem fair to the hospitals and the doctors and nurses who are on the frontlines of this. I have been incredibly impressed with the professionalism of all the people i have interacted with who walked my parents and now me through everything.

[reillymcshane]

As someone who has had numerous family members with covid who are older, and now have it myself, I would say there has been zero pressure to go to the hospital. In fact they are steering you away from the hospital unless you show warning signs of severe symptoms. To imply hospitals are putting people in the ICU and other rooms who dont need to be there - without any proof - does not seem fair to the hospitals and the doctors and nurses who are on the frontlines of this. I have been incredibly impressed with the professionalism of all the people i have interacted with who walked my parents and now me through everything.

Well said. And take care. Hope all works out well.

[Ron Robinsons Beard]

Or it could mean ICU beds are being used because they're available, and same is true of regular hospital beds. Maybe not all ICU patients actually need to be there. Not saying that's the case, but would not surprise me. Rule #1 is always follow the money. Hospitals are hurting, and if they have space why not fill it? We'll find out soon enough I guess.

 

That's honestly the first time I've heard that one on the conspiracy train. I also don't think it is anywhere close to the truth. Why in the world would someone be admitted to the ICU if they didn't show the symptoms to warrant them being there? That theory makes absolutely no sense.

[Jimbo]

Congressman Grothmann on a TV ad and this morning on WPR said that Vitamin D needs more emphasis. He stated a study out of Spain. OK, I know sunlight contains Vitamin D, so why all the cases in GA, FL, TX and AZ during the summer?

 

Any of the knowledgeable people on this board have any insight on this?

[MrTPlush]

Vitamin D doesn’t help avoid it, it helps reduce chances of severe symptoms. Early on there was a connection to Vitamin D deficiency and severe cases. Of course the problem is such deficiency is really common in older people who have so many other risk factors it is hard to really confirm the connection as super meaningful. Vitamin D helps the immune system though, so it would help to some degree having your levels in check.

[tmwiese55]

Or it could mean ICU beds are being used because they're available, and same is true of regular hospital beds. Maybe not all ICU patients actually need to be there. Not saying that's the case, but would not surprise me. Rule #1 is always follow the money. Hospitals are hurting, and if they have space why not fill it? We'll find out soon enough I guess.

 

That's honestly the first time I've heard that one on the conspiracy train. I also don't think it is anywhere close to the truth. Why in the world would someone be admitted to the ICU if they didn't show the symptoms to warrant them being there? That theory makes absolutely no sense.

 

It goes along with how the doctors are making up the numbers because they get funding based on number of cases. I hope everyone who believes this says it to any hospital workers they know and see the result. Or of course if/when you get it or anything else of severity, please tell that doctor how they're dirty lying cheats trying to rip everyone off so just go home and not get treatment. Stuff like this is so frustrating to the workers. These are real people, not some nebulous 'they' in some grand conspiracy.

[igor67]

Vitamin D has some sophisticated interactions that put it on the short list of things where supplements may have some health benefits for 'normal' people. Which is a short way of saying most people with any kind of remotely normal food intake get plenty of what they need and supplements are a waste. That said I would be shocked if vitamin D was more than a footnote in terms of risk factors or strategies. That said the UW has made a ton of money over the years from drugs derived from vitamin D.

https://biochem.wisc.edu/highlights/2016/highlights-vitamin-d-21st-century

 

Proud Badger all the way.

[LouisEly]

Congressman Grothmann on a TV ad and this morning on WPR said that Vitamin D needs more emphasis. He stated a study out of Spain. OK, I know sunlight contains Vitamin D, so why all the cases in GA, FL, TX and AZ during the summer?

 

Any of the knowledgeable people on this board have any insight on this?

Even been in those states during the summer? Too hot to be outside.

 

A good friend of mine lives in Austin, TX. During August this year they had something like 25 days where the high temperature was over 100 degrees.

[LouisEly]

Which is a short way of saying most people with any kind of remotely normal food intake get plenty of what they need and supplements are a waste.

There is no vitamin D in a hamburger, fried perch, or french fries and a cup of cheddar cheese (132g) has 4% of the USRDA of Vitamin D.

[PeaveyFury]

Which is a short way of saying most people with any kind of remotely normal food intake get plenty of what they need and supplements are a waste.

There is no vitamin D in a hamburger, fried perch, or french fries and a cup of cheddar cheese (132g) has 4% of the USRDA of Vitamin D.

 

Hey, there's probably SOME in the tartar.

[Machu Peach]

Which is a short way of saying most people with any kind of remotely normal food intake get plenty of what they need and supplements are a waste.

50-90% of Vitamin D is produced from sunshine exposure on skin. The rest comes from diet. Something like 3 million people in the US suffer from clinical-level vitamin D deficiency. Subclinical vitamin D deficiency is estimated to be much higher, with some estimates up to 50% of people worldwide.

 

The main clinical symptoms of a vitamin D deficiency is bone density problems and muscle weakness. On a mechanistic level, vitamin D plays a role in several parts of the immune system, most notably immune tolerance.

 

Vitamin D deficiency could absolutely be playing a role in COVID severity. Whether it actually does and to what extent needs more research, but I'm certainly not comfortable writing it off.

[OldSchoolSnapper]

Fortunately, if you live in a cold-weather state or just don't get outside much, SunnyD is loaded with it and is best consumed by the pint.