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RE: COVID-19 start of a new era
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BarkellWH
Posts: 3458
Joined: Jul. 12 2009
From: Washington, DC
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 RE: COVID-19 start of a new era (in reply to RobF)
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quote:
quote:
...people will vary widely in their responses and attitudes. I am reluctant to criticize anyone who expresses concern, but please guard against both over- and under-reaction based on scanty or unreliable information. Time for a glass of cognac.
The voice of reason. Hear, hear (and cheers).
Perhaps, unbeknownst to science and medicine, the key to immunity from the Coronavirus lies in a nightly glass of cognac. Or, as I would prefer, in an amontillado, medium dry sherry aperitif or a postprandial glass of port.
Bill
_____________________________
And the end of the fight is a tombstone white,
With the name of the late deceased,
And the epitaph drear, "A fool lies here,
Who tried to hustle the East."
--Rudyard Kipling
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Date Feb. 25 2020 15:30:47
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Ricardo
Posts: 14801
Joined: Dec. 14 2004
From: Washington DC
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RE: COVID-19 start of a new era (in reply to sartorius)
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From a Doctor friend of mine:
<Quite a few people have asked me for an update to my previously posted thoughts about the Covid19 outbreaks. A few hours ago something happened that is worth an update:
Today, the first community-acquired case of Covid19 was confirmed inside the United States. In this context, "community-acquired" means that the affected patient had not travelled outside the US and had no identifiable contact with any known potential foreign source of infection.
That means Covid19 is now loose in the US, and has very likely already spread into communities all across the country. The same situation now exists in several European countries as well.
In my opinion this is now a pandemic, and I believe the CDC and WHO will soon make an announcement to that effect.
There is no longer any possibility of containment, and despite all the messaging by public authorities, there is no known effective way to avoid eventual exposure to this virus.
Masks and other personal protective equipment (PPE) are effective when used properly to avoid transmission from a small number of known and contained cases. Unfortunately, even trained professionals often are infected due to brief or unrecognized violations of PPE protocol.
Now we are no longer dealing with a small number of quarantined cases: we are facing a pandemic. Masks and other protective gear have never been effective to prevent ultimate exposure in a pandemic respiratory illness. During the 1918-1919 flu pandemic, for example, virtually everybody in the world was eventually exposed regardless of how careful people tried to be.
Vaccine development is underway, but there is no existing mechanism by which a vaccine for the general population could be developed, manufactured, and distributed in quantity during this season of the pandemic. Once infected, there is no proven effective treatment. We are going to have to cope with this as best we can.
How bad will it be? Nobody has a definitive answer for that question. We don't know the true death rate because there is one big piece of data missing: we have absolutely no idea how many people have been infected and had only minimal or mild symptoms. We have never systematically tested exposed but asymptomatic patients, or those with mild symptoms but no fever at the time of presentation. There aren't enough tests available to do so, and the tests have too many false positives and false negatives to be used for screening of asymptomatic people. We've learned that it's possible to test negative for several weeks (possibly up to 4 weeks) before becoming symptomatic and testing positive. We have quite a bit of data but we still don't know the true mortality rate.
My personal guess is that the true mortality rate will be on the order of 0.1% - 0.5%. This estimate is based on public and private reports from China and elsewhere, and on published data from the "natural experiment" that occurred on the cruise ship Diamond Princess.
This estimate makes sense to me in the context of my general knowledge as a physician and a biophysicist, and of the special knowledge I gained while working for a time in the area of preparedness for bioterrorism and emerging diseases. Estimates released by public officials may be based on different assumptions or may reflect different scenarios. This is just my own best guess based on what I know at this time. To understand my estimate, consider the Diamond Princess cruise ship experience:
The ship carried roughly 3700 passengers and crew. There is evidence to support a belief that 100% of these were exposed during their time aboard. Roughly 700 people have become noticeably sick and have tested positive, and thus far 5 of those have died. No doubt more will become ill and more will die, but we are many weeks from the initial exposures and the current numbers are at least a starting point. What we see is that about 20% of those exposed have become significantly sick and a little less than 1% of the sick ones have already died. The overall death rate among those exposed is currently 5/3700 (0.14%, or roughly 1 in 740). If another 5 to 10 people die (this would match the China experience in which 2% to 3% of the identifiably sick patients died) the *overall* mortality rate would be something on the order of 0.4%, or roughly 1 in 250.
This is significantly worse than the seasonal flu but it's not as bad as the initial estimates of 2% - 3% mortality and nowhere near the 1918 flu pandemic, in which 1 out of 6 people died, often within a few hours of symptom onset.
To reiterate, I think the 2% mortality estimates we've been hearing are high because they are based on counts of people with test-proven disease, and nobody got the test unless they were significantly sick. All mild cases and asymptomatic patients were excluded from the denominator. The Diamond Princess gives us our best estimate because we know the total number of people who were placed at risk.
It's worth noting that at any mortality rate, disruption to our social and economic order could potentially do as much harm as the virus itself. For example, many people live paycheck to paycheck, so if their work is shut down they'll have no money to buy food or medicine, or pay rent. If schools are closed, as they surely will be, many households will be financially strained. And for anybody who ends up in the ICU with Covid19, the medical bills could be crippling. A public health problem of this magnitude that affects us all certainly puts "Healthcare for all" into a different perspective.
In some epidemics the supply chain is disrupted and critical infrastructure may collapse. This pandemic likely will not be severe enough to cause such a collapse in and of itself, but public mismanagement, antisocial behavior, and panic could combine to make things much worse.
We will need to pull together to get through this. We need to keep the system working. We can't afford to treat each other badly. Nobody is going to be able to hide long enough to avoid exposure, especially since a doorknob or a perfectly healthy-seeming person may be a vector.
Now is also the time to make contingency plans. The vast majority of us will survive, but now would still be a good time to write or update wills, and to make sure children won't be left without a designated guardian in the event of unexpected death of a parent.
Of course all of this may change as new data becomes available. Things should get better as we get past the traditional flu season. Next year we will likely have a vaccine and possibly even a proven therapy.
Under normal circumstances we expect a virus of this general type to circle the globe for a year or two, until the number of susceptible hosts becomes too low to sustain it. At that point the original virus typically dies away or mutates to behave quite differently. Sometimes a virus mutates significantly once it begins propagating outside its population of origin. If that happens, everything could change fairly quickly.
Wishing the best for everybody.>
_____________________________
CD's and transcriptions available here:
www.ricardomarlow.com
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Date Feb. 27 2020 11:31:44
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Richard Jernigan
Posts: 3430
Joined: Jan. 20 2004
From: Austin, Texas USA
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RE: COVID-19 start of a new era (in reply to Ricardo)
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The U.S. Center for Disease Control has daily updated info on the coronavirus, and advice for individual and institutional response.
https://www.cdc.gov/coronavirus/2019-ncov/index.html
Although it is estimated that somewhere around 2% of cases are fatal, there is a sizable uncertainty in the number. Deaths due to the disease are counted better than the possible number of cases.
Furthermore, the death rate increases with the age of the patient. While very few young children have died of the disease, there is a sizable increase in the mortality rate by age 65, and the estimated mortality for people over the age of 80 is 14-15%.
The immune system inevitably weakens with age.It took Larisa (age 41, in excellent health) about a week to get over a fairly bad bout of viral bronchitis. I am in pretty good health for an 82-year old, but it took me several weeks. It resolved into a very minor case of bacterial pneumonia--when I was a kid, they called it "walking pneumonia"--which was knocked out in about 3 days by an antibiotic.
The CDC says today that the risk for people to contract the coronavirus in the USA is very low, but wil probably increase. For China and South Korea of course, the risk is assessed as high, and for Italy, moderate.
I wish the best of health for all of my friends here.
RNJ
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Date Feb. 28 2020 21:45:54
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kitarist
Posts: 1715
Joined: Dec. 4 2012
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RE: COVID-19 start of a new era (in reply to Richard Jernigan)
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The best Covid-19 map and user interface I've found is by the University of Washington, at https://hgis.uw.edu/virus/
Everyone probably knows about the Johns Hopkins map, but that map does not show time series. The UW map does - I can choose a particular region or country and see a time series of active, recovered, deaths and aggregate confirmed cases - so this is my go-to map.
It is very useful for two reasons: I can see the exponential growth and how similar it is in all regions where no effective measures have been taken so far, and I can also see a few locations where the measures are having the desired effect.
Using the similarities, one can get an idea of the timelines for continued growth and/or of getting the disease under control.
With exponential growth when no effective measures are in place: the number of confirmed cases doubles every 3 days or so. The only difference in the current absolute totals is the offset/lag that different regions have. But as long you start from the day D of about 100 cases or so (so that the numbers are large enough not to be skewed by data artifacts), you will get roughly:
100 cases on day D
200 cases by D+3
400 cases by D+6
800 cases by D+9
...
3200 cases by D+15 (half a month later)
...
~100,000 cases by D+30 (a month after day D)
because in 30 days there would have been 10 doublings (2^10 = 1024)
We can also see, from the few places where a peak was reached and the total confirmed cases have levelled off, how long it takes to resolve the disease.
Hubei province in China, is farthest along. We can see that social isolation measures do work. The peak of active cases was on Feb 19; now 4 weeks later there have been almost no new cases, and the active cases have dropped to less than a a fifth of what they were at the peak.
South Korea is also past the peak infection point which was reached on Mar 12, with a peak of about 7,500 cases. Based on the Hubei timeline, we can say that 4 weeks after Mar 12, so by Apr 9 or so, the active cases should decline to less than 1,500 (less than a fifth).
The numbers shown are the total + the new daily change. The way to read them is as additions and subtractions from the active cases (yellow): The new infections (as aggregate confirmed change) are additions, and the new recoveries and deaths are subtractions from the active cases.
So, For South Korea, for example, the net change of -231 (reduction) of active cases is comprised of 74 new cases - 303 recoveries - 2 deaths.
Things are getting under control when the number of recoveries gets (much) larger than the number of new cases.
For almost all other regions outside china's' provinces, this is still not the case, unfortunately.
Italy's situation still looks horrible, with new cases more than 10 times the number of recoveries, and an exponential growth. They do have the right measures now, so this is likely still the inertia of previously undiagnosed transmissions from the time the disease was propagating unconstrained; within a week we should start seeing a change though.
It is a bit tricky, but possible, to choose the whole of Canada or the USA (rather than states/provinces within) - you just have to find the sweet spot by hovering over the border on the great lakes, for examples, till you see the whole country being picked up. For the USA, things are still on an exponential growth path with doubling of cases every 3 days or so:
I keep checking the Hubei and South Korea timelines. All we have to do is stay away from others for up to 1 month (up to 2 weeks inertia + 2 weeks till resolution of any active cases), and this whole thing will go away.
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Konstantin
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Date Mar. 16 2020 19:37:08
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flyeogh
Posts: 729
Joined: Oct. 13 2004
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RE: COVID-19 start of a new era (in reply to kitarist)
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quote:
All we have to do is stay away from others for up to 1 month (up to 2 weeks inertia + 2 weeks till resolution of any active cases), and this whole thing will go away.
Could well be the case but I find it very difficult to draw conclusions regarding the behaviour. One can look at countries that should be similar only to find that they are not.
For example one could expect France, Germany and the UK to be similar. Yet the UK has 22 cases per million, Germany 87, and France 101. The UK has not been as limiting on its population as many European countries. Even a half marathon was run in Bath on Sunday!!! And it has the stronger China links.
And one can look at Singapore, Malaysia, Taiwan, etc. And then the countries you illustrated kitarist. There seems little logic.
Of course the situation is clouded as many countries have very poor health services so numbers from these cannot be taken seriously.
But I can only conclude that the largest number of cases are simply undetectable (bit like dark matter  ). Which sounds like great news if, and it is a big if, resistance is not very short-term. But I'm quietly optimistic. Thanks for the link Kitarist. It confirms that most sources are similar with just slight variation which is good.
ps. See first vaccine is already under test in Seattle. Won't be weeks but it does show what can be done when we all pull together. As a Doctor at Imperial college said "Yes, this is very fast - but it is a race against the virus, not against each other as scientists, and it's being done for the benefit of humanity." Maybe some real good will come of this 
_____________________________
nigel (el raton de Watford - now Puerto de Santa Maria, Cadiz)
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Date Mar. 17 2020 6:13:33
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kitarist
Posts: 1715
Joined: Dec. 4 2012
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RE: COVID-19 start of a new era (in reply to flyeogh)
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quote:
One can look at countries that should be similar only to find that they are not. For example one could expect France, Germany and the UK to be similar. Yet the UK has 22 cases per million, Germany 87, and France 101.
This is explained by the difference in timing of when the infections started spreading in different countries. The rate is still about a doubling every 3 days, when not constrained in any way. You can see the similarity when you account for this time shift and align starting from a day with about the same number of cases in two countries.
This below is a bit old (data filled up to Mar 13) but gives you an idea of what I mean: a comparison between USA and Italy where the start is USA's Mar 5 data is aligned with Italy's Feb 23 as they had similar number of cases on those days:
Additionally, when you look at cases/million, you are implicitly incorporating the number of people within some territory. Neither the snapshot number of cases on a particular day, not the total number of people within a country, have relevance to how the infection spreads, however (within reason; if you stuff 100,000 people in some stadium and let them stay there for a week, you will probably get doubling of infections faster than once every 3 days; but over statistically normal interaction density, the rate of spread is about the same).
Images are resized automatically to a maximum width of 800px
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_____________________________
Konstantin
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Date Mar. 17 2020 16:32:29
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RobF
Posts: 1611
Joined: Aug. 24 2017
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RE: COVID-19 start of a new era (in reply to kitarist)
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quote:
Looks like I failed.
You didn’t fail, we need this to keep us occupied, IMO. I find some comfort in it, in a strange way.
This is probably way over-simplified, but, what I *think* you’re showing in the climbing curves is either an open-loop system entering into an explosive phase, or a closed loop system with latency responding to an initial excitation (in other words, it has yet to show the damping effects of the elements in the closed loop at its output). The gain/filtering of the closed loop would be, in part, the effectiveness or scope of the distancing and isolation measures put into effect, and the latency would be due to the incubation period + the time to become ill enough to be measured as part of the data set. I suppose the feedback portion of the loop would be the testing and health care data. It’s probably a lot more complicated than that, but it probably could be modelled, to some degree, and most likely has been.
So, part of what is needed is to control the gain to allow for critical damping until something like an anti-viral or vaccine comes along to act as an off switch. By that I mean we need to balance the need for the system to function (supply lines kept open, hospitals and essential services to continue, etc...) against some level of contagion that could be considered acceptable or controllable. The danger of overdamping is it could lead to a collapse which takes the structure down, instead of the virus, then the loop would reopen and the system be free to enter into a new explosive phase. Or, even if taking down the structure takes down the virus with it, the consequences would probably be far worse than the disease itself.
So, if we can get the damping right, people will eat, we all won’t go bankrupt, but we’ll have to learn to live with a controlled amount of this virus in the community for some time, at a level that doesn’t overwhelm our system’s ability to cope. Not sure if “controlled amount” is the most politic way of putting it, but it is the gist of what “flattening the curve” is all about.
I hope we can find an OFF switch, instead.
But, as I said, this is probably way over-simplified...
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Date Mar. 17 2020 17:06:54
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Richard Jernigan
Posts: 3430
Joined: Jan. 20 2004
From: Austin, Texas USA
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RE: COVID-19 start of a new era (in reply to kitarist)
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This article
https://www.washingtonpost.com/graphics/2020/world/corona-simulator/?fbclid=IwAR2hC8DXtddmohRgJijWfAuq9Xzh7XTo30FNspZ69Rv-3oTKbeodrsJ7lYY
in the Washington Post shows via computer simulation why quarantine alone, without social distancing, does not alter the shape of the curves, it merely moves them forward in time.
No quarantine can be perfect, in fact none is ever intended to be, since essential supplies must be allowed to arrive, and essential services must continue to function. When the virus inevitably escapes the quarantine with no social distancing the curve of case numbers ascends with the same exponential acceleration as it would have with no quarantine, only it starts going up at later time.
To effectively flatten the curve, social distancing is absolutely essential, the more the better.
The city of Austin is giving it a shot. After closing schools and prohibiting large gatherings, now bars and restaurants are closed, and planned or commercial gatherings of more than 10 people are prohibited. Ten is a low enough number that there will have to be a lot of exceptions to provide essential services, and there will be a significant number of deliberate or uninformed violations, but it's encouraging to see the city take social distancing seriously.
My lawyer appointments are now done over the telephone, with documents transmitted electronically. To mail documents I'm using ordinary mail and outdoor mailboxes, rather than standing in line at the post office to register or certify things I'm sending.
The big financial service companies say they are on the verge of chaos. I'm not worried about immediate personal effects of the stock market crash. I haven't owned a single share of publicly traded stock since I saw housing prices flatten in 2007.
Talking to friends and experts I had concluded that the mortgage bubble and its derivatives would bust, but even the Secretary of the Treasury and the Chairman of the Fed couldn't know it would bring the entire credit market to a halt, and destroy major banks and trading houses, and with them tank the whole economy.
I could have made some money during the recovery by going in near the bottom, but the equity and derivatives side of the financial business has looked pretty flaky to me ever since 2008. The banks and the Republicans demonstrated the ease with which the Consumer Finance Protection Act could be castrated, and banking regulations could be dictated by the banks themselves.
I'm still planning to use the curbside pickup service of Texas's biggest grocery chain tomorrow. I'll see whether the panic buying has begun to die down.
On the Austin Reddit there's a crowdsourced subreddit telling what crowd conditions and empty shelves are like at many of the local supermarkets. One interesting pattern that has emerged involves two very big pan-Asian supermarkets, under different ownership. They have stuff. Their clientele haven't been panicking--or if they have the stores' rationing policies have prevented stuff being completely cleaned out.
Other supermarket chains implemented rationing, but too late to prevent the disappearance of toilet paper, paper towels, fresh produce, laundry detergent, hand sanitizer, rubbing alcohol, etc. etc.
I'm pretty well set for another couple of weeks. Maybe by then all the supermarket looters will have filled up their garages. Will there be an uptick in private dwelling toilet paper burglaries?
Be well, friends.
RNJ
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Date Mar. 18 2020 4:19:41
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BarkellWH
Posts: 3458
Joined: Jul. 12 2009
From: Washington, DC
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RE: COVID-19 start of a new era (in reply to RobF)
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Yesterday, Marta and I flew from Phoenix, Arizona to Washington, DC as scheduled, and there were no more than 25 passengers on the aircraft. I expect to see drastic cancellations of flight schedules soon, as everyone shelters in place.
As our tennis and squash club is closed indefinitely, we will not be engaging in sports, and we certainly will not be out socializing. We plan to just stay in "lock-down" mode and have laid in some books to read.
The books I plan to read are listed below.
I have currently begun to re-read "At Dawn We Slept," by Professor Gordon Prange, who was the chief historian on MacArthur's staff in Japan. Published in 1982, Prange's book is probably the most detailed effort to describe the decisions and actions on both the Japanese and American sides in the planning, lead-up, and execution of the attack on Pearl Harbor. I am re-reading it with as much interest as I did on the first go-round. It is really a classic.
I have also laid in the following three just-published books.
"Operation Chastise," by the British military historian Max Hastings. It details the planning and execution of the most audacious Royal Air Force raid of World War II, the extremely low-level bombings and breaching of the Moene and Eder dams in order to flood and cripple the German Ruhr industrial area. The development of the special bomb required for the operation is as interesting as the actual raid.
"Eight Days at Yalta," by Diana Preston is, as noted in the title, the story of the Yalta Conference with the Big Three--Churchill, Roosevelt, and Stalin--and their staffs. It promises to be very interesting, as much of it is gleaned from diaries, notes, and recently opened archives in Russia.
"The Mirror and the Light," by Hilary Mantel, is historical fiction at its best. It is the third in a trilogy (the first two were "Wolf Hall" and "Bringing Up the Bodies") about the life of Thomas Cromwell, King Henry VIII's Chief Minister, who was involved in Henry's annulment of marriage to Catherine of Aragon, his subsequent marriage to Anne Boleyn, and many other events with a cast including Sir Thomas More and others. In the end, Cromwell falls victim to Henry's impetuous personality and is himself executed. In any case, Mantel brings them all to life.
I'm thinking of upping my evening pre-dinner aperitif quota of medium dry amontillado sherry to two copitas instead of one, in the hope that therein lies the key to immunity from Coronavirus.
Stay hunkered down, safe, and healthy.
Bill
_____________________________
And the end of the fight is a tombstone white,
With the name of the late deceased,
And the epitaph drear, "A fool lies here,
Who tried to hustle the East."
--Rudyard Kipling
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Date Mar. 19 2020 22:16:56
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