OT: Corona virus

[geofflambert]

Looks like the Diamond Princess has been sent there to evacuate the place

[obvert]

ORIGINAL: Chickenboy

ORIGINAL: Sammy5IsAlive
I would not be surprised if a combination of travel restrictions, proactive testing and contact tracing and the simple dispersion of rural populations leads to some US states having very different, much more positive, outcomes and experiences than what has been seen elsewhere in the world.

I agree. Our country is quite heterogenous in its population distribution. Big cities on the East coast, West coast and a few in the Midwest and South. With lots of smaller communities in between. New York City's epidemiologic curve will likely wind up looking very different than Ames, Iowa or Houston, Texas.

I mentioned earlier that the differences in this big sprawling country could cause both difficulties and advantages at local levels depending on how the State and county leadership deal with this.

The difficult factor to deal with is movement of people. As the virus hits hard someplace it could lead to an exodus, bringing it elsewhere in force as has occurred in Iran, Italy and other locations.

[obvert]

London report: lockdown (almost)

We watched the PM deliver more advice and assurances last night, as well as warnings. This came as no surprise, as many of the young, the irresponsible and the downright rebellious have decided not to take isolation advice so far.

One of the twenty-somethings we know admitted going to barbecues in London Fields over the weekend and then blithely said with the new restrictions it was probably time to head home to the country. My wife, his employer, had to remind him his mother has had cancer, and is in a vulnerable category, and he'd have to self-isolate on arrival at their country house for up to 7-10 days. He was shocked. This had never occurred to him.

Youth is wonderful and terrible. I had meetings with my students through virtual conference software Zoom (great for meeting multiple people online if you want to connect with family and friends). They seemed much less exuberant, more serious, and definitely not in the rebellious crowd. Good to see them.

The new measures will still allow us to go out as a family for a bike ride to the large forest parks around us for a walk in the woods or a visit to the duck ponds. This is good. I hope these also help the rest of the city shut down more. The FT has been doing a great job of showing economic indicators from around the world, and London is obviously not closing quite enough. I still hear a constant stream of cars on the A-12 near our home. See traffic indicators from around the world.

[obvert]

Another visual I've not seen before which shows regional comparison. Looks like Ny is on a bad trajectory right now, and Madrid looking a lot like Lombardy. Some other positives though. Other Italian regions, California and Washington flattening.

[obvert]

This is the cases chart with the relatively new multi-country charts below. Very interesting comparisons, and some countries that are starting to have worrying trajectories, like Turkey, Pakistan and Ecuador.

[ITAKLinus]

ORIGINAL: Chickenboy

ORIGINAL: ITAKLinus

ORIGINAL: Chickenboy




Mortality is a lagging indicator of the leading edge of the infection 'wave'. Those that die from this virus and its complications were infected some weeks ago. I too want to see the mortality drop off, but I'm more interested in the waning of 'new cases' to track the progression of the virus through a given population.

Also, I've been following Japan more closely. They've got one of the oldest populations on the planet and they've had comparatively few cases to date, in spite of widespread testing. As far as I'm concerned, they're the champs at social distancing and 'flattening the curve'-a model for others. I'd like to hear more about how they've successfully stemmed the tide so far.

Of course, they're an island. Relatively xenophobic culture. Social distancing is their normative behavior anyways. No PDAs or touchy-feely in public. Perhaps that's the key to all this.

There is a major flaw in this reasoning. It relies on a number, the new infections, that is not really reliable.
Deaths are much easier to count and are "certain" by definition (unless the population starts to massively hide dead bodies, something I find quite... unlikely).

Now, it's probable that the number of infected people is grossly underestimated and that it reflects more the capability of a system (region/city/country) to test its citizens. Basically, if I have 10.000 positive people per-day and I can do 3.000 tests, I will never ever be able to track/test all of the 10.000.

On the other side, deaths are very easy to track even if the information we receive is delayed.


I suppose another important indicator is the number of people who got accepted in intensive care units. Still, also there, there can be under-tracking due to the fact that some people don't reach the hospital etcetc. Also, since the number of ICUs is finite, we can have that the number represents more the capacity of the hospitals, rather than information about the spreading of the virus.



I'm a strong proponent of deaths as the most reliable information. Secondarily, people admitted to ICUs and hospitalized.

You raise some good points. But if you want to use deaths (post awareness) as the most reliable indicator of successful implementation of an interventional strategy then you again need to look at Japan as a best-case scenario.

Their first case was identified on January 21. Their total deaths attributed to COVID-19 stands, as of today, at 41, with 235 recovered. Granted, their histogram of new confirmed cases has increased over the last 30 days, but its still less than 100/day. I understand that their testing is not as widespread as, say, South Korea. So maybe the 'other shoe has yet to drop', but it's worth looking at their (intrinsic?) social distancing as a means of preventing BOTH initial cases as well as the inherent mortality associated with those cases. Could the much ballyhooed South Korean response have benefited similarly? It bears more discovery.

I also assume from your comments that you mean people admitted to ICUs and hospitalized that *also happened to have COVID-19* (read: confirmed cases of COVID-19)? Tracking raw seasonal ICU visits / hospitalizations without the rationale for why they were hospitalized assumes too much causality to COVID-19. You will also be left with data confounders such as other respiratory diseases, age of the population at large and accessibility of hospital beds / ICU visits.

It is tempting to follow mortality from COVID-19 cases as a tracking measure. It's always been harder to 'hide the bodies' than it is to hide/ignore/understate/not find/not look for confirmed disease cases. But I'm old enough to remember the stigma associated with the AIDS epidemic in the 1980s. Death certificates ('cause of death') were routinely restated to avoid the social stigma of having a loved one associated with dying from AIDS. As a result, 'official' causes of death of Pneumocyctis carinii or Kaposi's Sarcoma or Cryptosporidiosis or other atypical diseases common in terminally immunosuppressed AIDS patients dramatically increased.

My father died from idiopathic chronic interstitial pulmonary fibrosis in 2017. He had a gradual decrease over about 5 years in his ability to breathe and oxygenate. His lungs effectively were scar tissue with insufficient lung function. "Idiopathic" means 'uncertain etiology/cause'. We worried a lot about him during a typical seasonal flu for the years he was sick, as any little respiratory ailment would have thrown him over the edge. He died from a massive heart attack. Had he instead picked up a fatal pneumococcus bacterial pneumonia or seasonal influenza or COVID-19, what should his death certificate had read? I believe that, in spite of his history of his disease (that disease is incurable and only goes 'one way') had he died in hospital today and be tested positive for COVID-19, that that's what would be on his death certificate. Unless there was a social stigma associated with it, in which cause of death verity may have come through.

I was reading about a man in Thailand that died in hospital with COVID-19. He was only in his 50s. Of course, he was originally in the hospital for Dengue. But I guess that got subsumed in the mortality reporting. We'd have never heard about his death unless he tested positive for COVID-19. And, by its mere presence, it became the presumptive cause of death.

So I believe that too many cases of co-morbidity are being wrapped into "COVID-19 mortality". Parsing out the details and sticking to some global system for ascribing official causality is far too cumbersome to already overworked hospital staff. At least with an RT-PCR test result, you have >95% chance of a "real" test result (positives are positives and negatives are negative). I don't think the same verity in the details is in the reported mortality for COVID-19.

I was making precisely the example of Kaposi's sarcoma and HIV/AIDS a couple of evenings ago. I agree with your point. Indeed, I'm quite into the way of counting Italy has adopted: counting deaths WITH coronavirus. Compared with the average death ratios for a given period, it tells roughly the delta due to cov-19, net of statistical variance.
In a situation where you cannot credibly track the infected people because of a lack of capacity in testing, I suspect that the indicator of "people died WITH coronavirus" compared with the historical death ratios is a good estimate of the additional deaths coming from the virus.

In some countries there are weird ways of assessing the death cause (your Kaposi's sarcoma example and mine regarding lung cancer in Ukraine) and Germany is definitely counting the people died OF coronavirus, instead of died WITH it as we do in Italy.
As I was mentioning in a post earlier, even if we take into consideration the differences in the lifestyle between Italy/Spain and Germany, it's still quite a huge difference.
Counting the deaths OF coronavirus, I think Italy still has to reach the number of 20. It's quite a big difference with the hundreds of daily casualties we have.


Given that, as you say, "hiding the bodies" isn't practical (or logical...), I see the deaths WITH cov-19 as the only reliable data together with infected people in ICUs. The total amount of cases, albeit potentially a much better indicator, is simply not even remotely accurate. For example: who tells you that the increase we experienced yesterday in Italy is the true increase and not just reflecting some kind of bottlenecks in the testing capacity?

When I started seeing the guys managing the emergency in Italy saying that the infected people can be maybe 20.000 or 30.000 more, I decided it wasn't reliable at all: even if we take the lower estimate of 20.000 untraced cases, it's quite a big difference over a confirmed amount of infected totalling at roughly 50.0000.




Dengue example touched my heart, though. I'm still recovering from the little friend called dengue I experienced 10 days ago.[:(]




PS. I'm fairly sure that Spanish healthcare system is doing the bodycount precisely as we are doing in Italy, while Germany (and for what it matters Czech Republic), have gone in the opposite direction. Spain is looking very, very bad currently.

[ITAKLinus]

I was just reading an article of the boss of Protezione Civile, the entity managing the emergency and the guy who does the 1800 daily upadte.

He was saying that we have no idea at all of the number of infected people and that it is credible the report stating that there are 10 (ten) positive untracked for every positive tracked.
It implies that the amount of infected people is incredibly higher and also that mortality, a part from the entire problem of "died OF Cov-19" or "died WITH Cov-19", is much lower than it looks like.


He also stated that they keep communicating the daily numbers of infected people for a matter of transparency but they do that just because they don't want the public opinion to think they are hiding something. He stated that those numbers are meaningless and he would have stopped publishing them many days ago if it weren't for the possible impacts it would have had on public opinion.


https://www.huffingtonpost.it/entry/ang ... t-homepage

The article is in Italian but it's short and google translate is your friend [:)][:)] I'm sorry but now I dont' have the time to fully translate it.

[Ian R]

Back in Oz, we now have 8 deaths and just over 2000 cases.

Interestingly, the majority of the increase is straight from a series of returning cruise ships including the Ruby Princess.

[Ian R]

Switching focus to our northern neighbor, Indonesia's apparent "luck" seems to simply be a case of non testing, non reporting, and non treatment.

Coronavirus COVID-19 death rate in Indonesia is the highest in the world. Experts say it's because reported case numbers are too low

[Ian R]

But perhaps Niall should stick to history, and not dabble in mathematics.

Professor Niall Ferguson from Imperial College in London agrees that one death corresponds to at least 1,000 cases in the community, assuming a death rate of about 1 per cent.

In above link.

[Ian R]

And here is what is happening in India:

Situation in Inda

A fundamental difference between India and Australia, according to experts, is that many Asian countries have experience in dealing with the threat of a disease epidemic.

"Asian countries have been primed for some time now," Professor K Shrinath Reddy from the Public Health Foundation of India told the ABC.

"You [Australia] have lost a bit of touch with infectious diseases."

[obvert]

A very interesting article, and something I mentioned very early on, when those first two cases showed up. No testing, who knows how many cases, and odd isn't that people leaving Indonesia seem to have contracted it there?

ORIGINAL: Ian R

But perhaps Niall should stick to history, and not dabble in mathematics.

Professor Niall Ferguson from Imperial College in London agrees that one death corresponds to at least 1,000 cases in the community, assuming a death rate of about 1 per cent.

In above link.

Ahhh, the joys of choosing soundbites out of context. I'm pretty sure basic maths is in his sphere of knowledge. [:D]

[/font][font="Trebuchet MS"]Professor Niall Ferguson from Imperial College in London agrees that one death corresponds to at least 1,000 cases in the community, assuming a death rate of about 1 per cent.

But he believes the spread of coronavirus may be doubling even more quickly.

"We think epidemics in the absence of control measures … probably double every five days or so. And only about one in 100 people infected die," Professor Ferguson said.

"The deaths we see today take 20 days or so from when you develop symptoms to when they die. So the deaths we see today correspond to the epidemic 20 days ago.

"And that gives you … the epidemic must have been about 10 times smaller then. You multiply that by a factor of 100 in cases to death. And you get about a 1,000-fold multiplier."

In fact, a lower death rate — of say 0.5, which some scientists support — would indicate an even higher number of cases in the community, because statistically it would mean one death per 200 cases instead of one in every 100.[/font]

And adding on fro the article on India (thanks Ian R, very interesting read).

[font="Trebuchet MS"]Over the past two decades, Professor Reddy listed a range of diseases as having "knocked at the door" of India, including H1N1 (swine flu), H5N1 (bird flu) and SARS.

Swine flu in particular has been difficult to eradicate, and so far at least 28 people have died from the infection this year, compared to only three confirmed deaths from COVID-19.

The experience has reinforced the view in India that harsh responses might come at an economic cost, but they're worth it.

"The economic cost of letting it run through the country like a blazing fire is much higher," Professor Reddy said.[/font]

So we may see two countries with similar demographics battle this in very different ways. The last sentence makes me fear the impact of Indonesia's response so far.

[MakeeLearn]

The 2009 H1N1 Pandemic: A New Flu Virus Emerges

https://www.cdc.gov/flu/pandemic-resour ... demic.html

"Tn the spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in the United States and spread quickly across the United States and the world. This new H1N1 virus contained a unique combination of influenza genes not previously identified in animals or people."



"From April 12, 2009 to April 10, 2010, CDC estimated there were

60.8 million cases (range: 43.3-89.3 million),
274,304 hospitalizations (range: 195,086-402,719),
and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus."



"Additionally, CDC estimated that:
151,700-575,400 people worldwide died from (H1N1)pdm09 virus infection during the first year the virus circulated,
globally, 80 percent of (H1N1)pdm09 virus-related deaths were estimated to have occurred in people younger than 65 years of age.

This differs greatly from typical seasonal influenza epidemics, during which about 70 percent to 90 percent of deaths are estimated to occur in people 65 years and older."

[Wuffer]

No! Please not - we have already three (3) birdies atm afaik, Phillipines, Indiana and the usual culprit (starts with C ). 😂

)

[MakeeLearn]

Dan Patrick says he is willing to risk his own life to allow economy to resume

https://www.msn.com/en-us/news/politics ... li=BBnb7Kz


"... Texas Lt. Gov Dan Patrick said on Fox News he agrees with the president and would be willing to risk his own life to return to normal conditions."

[MakeeLearn]

Last updated: March 24, 2020, 14:45 GMT
https://www.worldometers.info/coronavir ... try/italy/

Coronavirus Cases:
63,927

Deaths:
6,077

Recovered:
7,432

[Canoerebel]

That chart of Italy's daily deaths, with two days of encouraging decline, is as of 3/23. Today's update should come around 1 p.m. eastern (US) time. Everybody with their finger on the pulse of this thing is awaiting those numbers.

[Lokasenna]

ORIGINAL: obvert

A very interesting article, and something I mentioned very early on, when those first two cases showed up. No testing, who knows how many cases, and odd isn't that people leaving Indonesia seem to have contracted it there?

ORIGINAL: Ian R

But perhaps Niall should stick to history, and not dabble in mathematics.

Professor Niall Ferguson from Imperial College in London agrees that one death corresponds to at least 1,000 cases in the community, assuming a death rate of about 1 per cent.

In above link.

Ahhh, the joys of choosing soundbites out of context. I'm pretty sure basic maths is in his sphere of knowledge. [:D]

[/font][font="Trebuchet MS"]Professor Niall Ferguson from Imperial College in London agrees that one death corresponds to at least 1,000 cases in the community, assuming a death rate of about 1 per cent.

But he believes the spread of coronavirus may be doubling even more quickly.

"We think epidemics in the absence of control measures … probably double every five days or so. And only about one in 100 people infected die," Professor Ferguson said.

"The deaths we see today take 20 days or so from when you develop symptoms to when they die. So the deaths we see today correspond to the epidemic 20 days ago.

"And that gives you … the epidemic must have been about 10 times smaller then. You multiply that by a factor of 100 in cases to death. And you get about a 1,000-fold multiplier."

In fact, a lower death rate — of say 0.5, which some scientists support — would indicate an even higher number of cases in the community, because statistically it would mean one death per 200 cases instead of one in every 100.[/font]

And adding on fro the article on India (thanks Ian R, very interesting read).

[font="Trebuchet MS"]Over the past two decades, Professor Reddy listed a range of diseases as having "knocked at the door" of India, including H1N1 (swine flu), H5N1 (bird flu) and SARS.

Swine flu in particular has been difficult to eradicate, and so far at least 28 people have died from the infection this year, compared to only three confirmed deaths from COVID-19.

The experience has reinforced the view in India that harsh responses might come at an economic cost, but they're worth it.

"The economic cost of letting it run through the country like a blazing fire is much higher," Professor Reddy said.[/font]

So we may see two countries with similar demographics battle this in very different ways. The last sentence makes me fear the impact of Indonesia's response so far.

But he still flubbed the basic math! If it doubles every ~5 days, then 20 days is a factor of 2^4, which is 16, not 10! (What is the rate of doubling, anyway?)

I'll agree that Niall is a credentialed historian, but this isn't really his area of expertise.

[Canoerebel]

The Daily Mail posted this startling, misleading graph. It tells the truth but not the whole truth. A percentage of the population (certainly Forumites) understand the utility and weaknesses of this graph, but the media presents it without context (without "the whole truth" so often key to comprehension). The casual reader - the layman - doesn't have context, takes a look, and shudders. He knows that Italy has been ground zero for weeks and concludes that the US is in far worse shape. He doesn't have time to do the quick calculation needed to understand this is raw numbers rather than per capita, that the graph has a seriously distorted y axis, etc.

[Kull]

ORIGINAL: Canoerebel

That chart of Italy's daily deaths, with two days of encouraging decline, is as of 3/23. Today's update should come around 1 p.m. eastern (US) time. Everybody with their finger on the pulse of this thing is awaiting those numbers.

No need to wait - the Italian numbers are looking very good. The decreases are too large to be seen as statistical noise and are mirrored (to one degree or another) in almost every province. After peaking on the 19th (red), the rate of increase held steady for two more days (yellow) and has been dropping noticeably since (green). It's particularly noticeable in the north, where the rate of increase has been cut in half (red circles).

Looking just at Lombardy (which has been driving the numbers from the start), the number of new cases was "only" 1500, a number last seen on the 18th. This is real.

Also, RFalvo69 can take heart from the numbers in Calabria. The rate of increase is at 7% (well below the new national average), but more importantly, at least one patient has come back to life! (salmon colored cells)

Pertinent links:

1) Daily Italian Stats by province here

2) Original post with regional map of Italy here

3) The last post on this topic here