Did you catch it ?

pmanton said:
We're 82 and 80. My wife is a heart patient. We DON'T want to catch this. Luckily we live on an airpark in rural AZ, so we're isolated.

Dimwits here are still doing buggy rides, happy hour, fly-outs for breakfast etc.
My fear is that they won't go home for the Summer. (We're full time residents)
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Not everyone has the same risk level or risk tolerance. Just stay away from other people and your risk should be close to zero.
 
PeterNSteinmetz said:
Not everyone has the same risk level or risk tolerance. Just stay away from other people and your risk should be close to zero.
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Even though my wife was an extremely successful and popular veterinarian, she is also an extreme extrovert. It was a real effort for her to have to converse with people all day and still provide top quality medical skills and advice.

She is 80% retired now (she works one day a week, except for this month when she isn't working at all) and she is loving this social distancing thing. She may not go back to work when this is over.
 
JOhnH said:
Even though my wife was an extremely successful and popular veterinarian, she is also an extreme extrovert. It was a real effort for her to have to converse with people all day and still provide top quality medical skills and advice.

She is 80% retired now (she works one day a week, except for this month when she isn't working at all) and she is loving this social distancing thing. She may not go back to work when this is over.
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Extrovert? Sounds like the opposite.
 
JOhnH said:
You are right. I meant introvert. Thanks for catching that.
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I'll never forget what my grandfather used to tell me,..

"Son, if you remember only one thing, remember this;...ALWAYS...no, wait a sec...NEVER......."...
 
RyanShort1 said:
Yeah, but there are finances involved, too. I know we were getting taxed for everything that sat on our shelves and they decided that even though it was cheaper to order in bulk, we needed to pay higher prices for less stock in order to keep that down.
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Some things shouldn't be taxed. I'd put any property, personal or business, under that umbrella. Especially hospital supplies.
 
IK04 said:
It appears many of us had it before it was popular:

Early Antibody Testing In Chicago: 30-50% Of Those Tested For COVID-19 Already Have Antibodies, Report Says

https://1clickurls.com/1HKdhLX
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Nice, I've said it from the start but I was betting this virus has been around. Its just now getting attention. People get sick and get tested for the flu and negative, then they just classify it as the crud. Probably Corona.
 
Half Fast said:
Massive prednisone, I presume?

Interesting. Makes me wonder if the immunosuppressant I'm taking might actually be a good thing.
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There are also reports of the use of IL-6 inhibitors, like tocilzumab, to blunt the cytokine storm in severely ill COVID-19 patients. I think this is a little more refined method than corticosteriods. At any rate, this treatment is not useful until you have said cytokine storm. Apparently, for some individuals, they start to clear the virus after 4-10 days, then the cytokine storm builds and causes massive damage as the immune system gets out of control. The mechanistic causes for this is not well understood at this time.

What we really need is a good RNA-dependent RNA polymerase inhibitor for SARS-CoV-2. Or maybe a specific protease inhibitor to mess with viral packaging. The trouble is that all the stuff we have on hand now is not specific for SARS-CoV-2--it was designed to target molecules important for other viral diseases, and we are hoping there is some weak cross-effectiveness. Ultimately, many antivirals just aren't that effective. At best, they blunt, but do not eliminate viral replication. Not like antibiotics, which are typically lethal to targeted bacteria and have relatively few side effects.
 
IK04 said:
It appears many of us had it before it was popular:

Early Antibody Testing In Chicago: 30-50% Of Those Tested For COVID-19 Already Have Antibodies, Report Says

https://1clickurls.com/1HKdhLX
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This is why serologic testing is important. It lets us look back in time, rather than just taking a snapshot of the current moment. We know from three good studies already (Diamond Princess Cruise Ship; the village of Vo, Italy; and the Iceland study) that about 50% of those infected by covid-19 will be asymptomatic or not have symptoms obvious enough to seek diagnoses. The first two studies were relatively closed populations of 3000+ who were nearly all tested. The latter study testing approximately 10% of the population of an entire country.

So many of us who had bouts of crud in late winter may have already been exposed and cleared the virus, and no longer need to isolate. The bad news is that covid-19 may be more contagious than originally suspected, so population "herd" immunity may require upwards of 90% exposure to stanch widespread transmission more or less permanently.
 
A bit more detail in the original report - https://chicagocitywire.com/stories...-30-of-those-tested-have-coronavirus-antibody

30% of those tested would be roughly consistent with the 15% from the random sample in Germany.

I will be very interested to see what this would imply in terms of policy using the models such as Kissler et al’s. Is social distancing going to turn out to have been at all a wise strategy given this level of spread and asymptomatic infections?
 
PeterNSteinmetz said:
A bit more detail in the original report - https://chicagocitywire.com/stories...-30-of-those-tested-have-coronavirus-antibody

30% of those tested would be roughly consistent with the 15% from the random sample in Germany.

I will be very interested to see what this would imply in terms of policy using the models such as Kissler et al’s. Is social distancing going to turn out to have been at all a wise strategy given this level of spread and asymptomatic infections?
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Social distancing is especially important if you don't know who is spreading the virus. It's pretty much the only tool without testing. With testing isolation can be more targeted, and immune individuals turned loose.
 
chemgeek said:
Social distancing is especially important if you don't know who is spreading the virus. It's pretty much the only tool without testing. With testing isolation can be more targeted, and immune individuals turned loose.
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Well, the serious models and preprints say basically that social distancing is unlikely to be sufficient in the US and may make things worse in the fall, if SARS Cov-2 is mildly seasonal.

I don’t know of any serious cost-benefit analyses used by our government in Arizona to justify the coercive measures they have put in place, either in terms of total deaths or lives that can be saved with the money that has effectively been spent on this by shutting down 1/4 of the economy.

Given what we now know about the likely characteristics of this virus - 0.3% fatality rate, R0 of 1.5-4, 50-80% of cases asymptomatic, and 15% of the population with anti-bodies, I don’t think one can rely simply on intuition. It requires more serious modeling and study to have even a rough idea, which probably isn’t very accurate, of what might work.

And yes, more testing will be key.
 
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simtech said:
Nice, I've said it from the start but I was betting this virus has been around. Its just now getting attention. People get sick and get tested for the flu and negative, then they just classify it as the crud. Probably Corona.
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A conona doesn't mean THE corona; many cold viruses are coronaviruses.
PeterNSteinmetz said:
Well, the serious models and preprints say basically that social distancing is unlikely to be sufficient in the US and may make things worse in the fall, if SARS Cov-2 is mildly seasonal.

I don’t know of any serious cost-benefit analyses used by our government in Arizona to justify the coercive measures they have put in place, either in terms of total deaths or lives that can be saved with the money that has effectively been spent on this by shutting down 1/4 of the economy.

Given what we now know about the likely characteristics of this virus - 0.3% fatality rate, R0 of 1.5-4, 50-80% of cases asymptomatic, and 15% of the population with anti-bodies, I don’t think one can rely simply on intuition. It requires more serious modeling and study to have even a rough idea, which probably isn’t very accurate, of what might work.

And yes, more testing will be key.
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Of those with confirmed cases of COVID-19 in the USA, nearly 4% are dying. I find that to be a harrowing number. And, since not 100% of the population has been tested, we don't know how many have been exposed. (I would love to see 100% of the population tested, eventually.) I would be quite happy if 15% of the population had been exposed, not gotten sick, and thus were out of the system.
Should sheltering in place / isolation / quarantine been strictly voluntary? I have my opinion on that, but I also have knowledge of what humans will actually do.
 
Kenny Phillips said:
A conona doesn't mean THE corona; many cold viruses are coronaviruses.

Of those with confirmed cases of COVID-19 in the USA, nearly 4% are dying. I find that to be a harrowing number. And, since not 100% of the population has been tested, we don't know how many have been exposed. (I would love to see 100% of the population tested, eventually.) I would be quite happy if 15% of the population had been exposed, not gotten sick, and thus were out of the system.
Should sheltering in place / isolation / quarantine been strictly voluntary? I have my opinion on that, but I also have knowledge of what humans will actually do.
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The 0.3% lethality rate comes from the study in Germany where they tested a random sample of households and 1000 people. That is the best estimate of the actual lethality rate of those infected, versus confirmed cases, for the general population which we presently have. It is likely much more lethal for the elderly and those with pre-existing conditions. That study also found 15% of the population with antibodies.

Could it be different here in the US? Theoretically possible; however, that study is the best data we have so far and the report from Chicago is roughly consistent with those numbers.

Clearly more studies needed.
 
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PeterNSteinmetz said:
The 0.3% lethality rate comes from the study in Germany where they tested a random sample of households and 1000 people. That is the best estimate of the actual lethality rate of those infected, versus confirmed cases, for the general population which we presently have. It is likely much more lethal for the elderly and those with pre-existing conditions. That study also found 15% of the population with antibodies.

Could it be different here in the US? Theoretically possible; however, that study is the best data we have so far and the report from Chicago is roughly consistent with those numbers.

Clearly more studies needed.
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If they tested a million people I'd like the numbers. At 1K, not so much. As I mentioned, I'll get tested if/when available, and I'd urge everyone else to do so. Finding out the actual spread is extremely useful information. I rarely leave the house, but my S/O saw people face-to-face for a living (and will again, once this is over), so I haven't a clue as to whether I've been exposed.
 
PeterNSteinmetz said:
The 0.3% lethality rate comes from the study in Germany where they tested a random sample of households and 1000 people. That is the best estimate of the actual lethality rate of those infected, versus confirmed cases, for the general population which we presently have. It is likely much more lethal for the elderly and those with pre-existing conditions. That study also found 15% of the population with antibodies.

Could it be different here in the US? Theoretically possible; however, that study is the best data we have so far and the report from Chicago is roughly consistent with those numbers.

Clearly more studies needed.
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The 0.3% infection lethality rate, if it gets confirmed by other researchers, is reassuring, but the high contagiousness of the disease leads me to wonder how much higher that rate would be if the health-care system gets overloaded by the sheer number of cases, as has reportedly happened in some locations.
 
PeterNSteinmetz said:
The 0.3% lethality rate comes from the study in Germany where they tested a random sample of households and 1000 people. That is the best estimate of the actual lethality rate of those infected, versus confirmed cases, for the general population which we presently have. It is likely much more lethal for the elderly and those with pre-existing conditions. That study also found 15% of the population with antibodies.

Could it be different here in the US? Theoretically possible; however, that study is the best data we have so far and the report from Chicago is roughly consistent with those numbers.

Clearly more studies needed.
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IIRC, the estimated infection fatality rate (IFR) from the German study was 0.37%, which is closer to 0.4% than 0.3%. I haven't yet been able to review a preprint or peer-reviewed publication of that study to understand what assumptions they made to arrive at that number from their serological testing.

We already have three published studies that have provided estimates of case and infection fatality rates from comprehensive testing of relatively closed populations of individuals: the Diamond Princess passengers (3000+), the village of Vo, Italy (about 3600), and a study in Iceland that tested approximately 10% of their population. They are in good agreement that the case fatality rate is about double the infection fatality rate. That is, approximately 50% of infected individuals are essentially asymptomatic and do not seek diagnosis. The infection fatality rate is, based on this data, somewhere in the neighborhood of 1%. This could change a bit as we do more widespread serological testing for antibodies, but the IFR is still likely going to be several times higher than seasonal flu. When making comparisons, it is important to compare the same numbers (CFR or IFR). The estimated IFR for seasonal flu is about 0.1%, although it varies a bit from year to year. One of the underappreciated factors of COVID-19 is that is is much more transmissible than infuenza. The R0 for influenza is around 1.3, whereas COVID-19 is around 2.3-2.6, which means it spreads much more explosively than the flu. This is what is causing the virus to overwhelm our health care system when transmission is not controlled. We have maybe 30 million flu cases worldwide each year, but they don't all show up in the hospital at the same time in the same locale.
 
chemgeek said:
We already have three published studies that have provided estimates of case and infection fatality rates from comprehensive testing of relatively closed populations of individuals: the Diamond Princess passengers (3000+), the village of Vo, Italy (about 3600), and a study in Iceland that tested approximately 10% of their population.
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Can you provide a citation for the Iceland publication you are referring to? I found the recent article by Stock et al (http://www.igmchicago.org/wp-content/uploads/2020/04/Covid_Iceland_v10.pdf) but that estimated an 90% of cases asymptomatic, so I assume that is not what you are referring to.

The daily updated data for Iceland are here: https://www.covid.is/data . They are interesting. They report 8 deaths thus far and 35,488 samples. If each sample is from an individual, and there are 1711 confirmed infections, that suggests an infection fatality rate of 0.47%. This would be close to the 0.37% (which as you note should be rounded to 0.4%, not truncated).

So compared to seasonal influenza, that corresponds to perhaps 3-5 times higher infection fatality rate (I agree "several" is a good qualitative descriptor there). Not 80X higher which is what some in the media were speculating about previously.

The R0 for influenza is around 1.3, whereas COVID-19 is around 2.3-2.6, which means it spreads much more explosively than the flu.
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I agree these seem to be the best estimates about now. I would not describe that as "much more explosively" from a qualitative perspective. The measles, which is highly contagious, has an R0 of about 16. But the numbers are really the most informative.

These estimates of the numbers, as I have stated before, strike me as being in a range where intuition is not going to tell us which policies are beneficial or harmful and whether social distancing as a strategy makes sense in terms of minimizing harm overall. Perhaps have a look at Kissler et al. 2020 https://doi.org/10.1101/2020.03.22.20041079 to see what modeling with these type of numbers says. Their conclusion is that a single period of social distancing will not be sufficient in the US and may make things worse in the fall if SARS COV-2 is moderately seasonal.
 
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chemgeek said:
I haven't yet been able to review a preprint or peer-reviewed publication of that study to understand what assumptions they made to arrive at that number from their serological testing.
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The preprint is in German here https://www.land.nrw/sites/default/...chenergebnis_covid19_case_study_gangelt_0.pdf .

My quite limited ability to read medical German suggests it was a random sampling of households with 1000 individuals enrolled. Also about 0.06% was the mortality rate in the total population. The same fraction in the US would suggest 198000 deaths in the US overall, about 3-4 times higher than the latest estimates reported by Dr. Fauci.

By way of comparison, there are about 2.8 million deaths in the US each year. So the upper estimate would represent about 7% of the total deaths due to all causes in the US in one year.
 
Keep in mind the R0 is an exponential factor. So going from 1.3 to 2.6 is a really big deal. Among other things it changes the herd immunity percentage requirements significantly.

There is no question that once we are past the first wave, we will have to aggressively control future local outbreaks to avoid getting back to where we are now. Until we have a widely deployed vaccine.
 
Mason said:
Extrovert? Sounds like the opposite.
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We keep hearing these comparisons to the fatality rate for influenza, without recognizing that many influenza infections and deaths are prevented by fairly widespread use of the flu vaccines, particularly among the most vulnerable populations. If you remove the effect of flu vaccine use from the analysis I think the COVID-19 fatality rate would look much more comparable.
 
Jeff Oslick said:
We keep hearing these comparisons to the fatality rate for influenza, without recognizing that many influenza infections and deaths are prevented by fairly widespread use of the flu vaccines, particularly among the most vulnerable populations. If you remove the effect of flu vaccine use from the analysis I think the COVID-19 fatality rate would look much more comparable.
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I think in terms of the sort of parameters being discussed here, a vaccine affects the R0 value, which is not a fixed item for a particular virus. As you immunize more of the population, fewer additional cases are infected for each case, thus reducing R0.

I do not know an historical value of R0 prior to flu vaccines. Clearly a vaccine would help with SARS Cov-2, though we don’t know if and when one might be available. Technology has advanced a lot since the 60s, but back then it took 6 years to produce the first mumps vaccine.
 
PeterNSteinmetz said:
a vaccine affects the R0 value
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FYI: a vaccine affects more than the R0 value. The CDC has been tracking influenza illnesses, medical visits, hospitalizations, and deaths averted by vaccines for years. I'll bet a nickel this method will include SARS tracking once a vaccine is developed. What will be interesting is if when a SARS vaccine is developed whether more people will take a SARS shot than the current 47% of the population who take a flu shot.
 
I suspect more people would take it if the efficacy is similar. Because the apparent lethality rate of SARS Cov-2 is perhaps 2-3X higher. But if that drops due to better treatments, one might see the same low rate of vaccination. The seasonal flu vaccines are not so high efficacy typically.
 
PeterNSteinmetz said:
I think in terms of the sort of parameters being discussed here, a vaccine affects the R0 value, which is not a fixed item for a particular virus. As you immunize more of the population, fewer additional cases are infected for each case, thus reducing R0.

I do not know an historical value of R0 prior to flu vaccines. Clearly a vaccine would help with SARS Cov-2, though we don’t know if and when one might be available. Technology has advanced a lot since the 60s, but back then it took 6 years to produce the first mumps vaccine.
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Interventions affect the "effective" R0. The intrinsic R0 for influenza is about 1.3, which is much lower than the estimated intrinsic R0 for SARS-CoV-2. These are the comparable numbers for transmissibility. It is more difficult to constrain SARS-CoV-2 than influenza, be it herd immunity, vaccination rates, or distancing. Unfortunately, not even a majority of Americans are vaccinated for the flu, and the vaccines are not 100% effective, so seasonal flu is not that well controlled. Many people get it each year.
 
PeterNSteinmetz said:
I suspect more people would take it if the efficacy is similar. Because the apparent lethality rate of SARS Cov-2 is perhaps 2-3X higher. But if that drops due to better treatments, one might see the same low rate of vaccination. The seasonal flu vaccines are not so high efficacy typically.
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If a COVID-19 vaccine is effective, even partially, it will be vastly superior to antiviral treatments, which are generally fairly poor therapeutics, and must be taken very early after exposure to have good effect. Tamiflu, for example, which is used to treat influenza, essentially ineffective more than 48 hours after appearance of first symptoms. Same thing applies to most every other antiviral for acute viral illnesses. (Anti-HIV drugs fare a little better, but the magic combos took years and years to hone.) Anyone relying on ativiral therapeutics is likely to be very disappointed in their outcome.
 
Jeff Oslick said:
We keep hearing these comparisons to the fatality rate for influenza, without recognizing that many influenza infections and deaths are prevented by fairly widespread use of the flu vaccines, particularly among the most vulnerable populations. If you remove the effect of flu vaccine use from the analysis I think the COVID-19 fatality rate would look much more comparable.
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They would be closer for sure. But the flu vaccines are not very effective as vaccines go, and not enough people get them to rely on herd immunity.
 
I want to see the numbers for NON-COVID-19 deaths. Probably some shocking numbers for everyone except the vultures who are hyping the relative comparison to normal flu and miscellaneous virus deaths. Those numbers are a whole lot bigger than the average dumass knows..
 
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chemgeek said:
The intrinsic R0 for influenza is about 1.3, which is much lower than the estimated intrinsic R0 for SARS-CoV-2..
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Likely better to state a number, rather than qualitative descriptions, which can be misleading. The estimated R0 for SARS-Cov-2 is about 2X that for the seasonal flu.

Personally, I wouldn’t call that “much lower”, just as I wouldn’t characterize it as “much more explosively”. Measles, widely considered a “highly contagious” disease, has an R0 of about 16.

As a short general summary of a comparison to seasonal flu, I like “it is about 2-3 times more deadly and twice as contagious”.
 
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It is "much lower" because the R0 is an exponential factor, as in e^(r0*t). If you double the R0, you halve the doubling time. That's a very big deal for exponential growth. (5 doublings is 32x initial; 10 doublings in the same time period is 1024x initial. Huge difference in growth of raw numbers.) Measles is one of the most contagious diseases known, undoubtedly. Covid-19 has an R0 about double that of seasonal flu, based on current knowledge.
 
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