[Griffins78]

Just saw this article by Reuter’s and am wondering if anyone has seen any other indicator this might be true?

Statistically it appears that fewer people hospitalized as percentage of people tested positive and when they are, fewer seem to be dying. People seem to be recovering more. Yes, we’re testing & counting more, especially more that are less severe, but also earlier and treating people earlier.

Could the virus be becoming less potent? Or does this not make sense?


“The new coronavirus is losing its potency and has become much less lethal, a senior Italian doctor said on Sunday.“

Read in Reuters: https://apple.news/AUvgpYKHcQ2WzDd0c6qd2eg

[Griffins78]

Just saw this article by Reuter’s and am wondering if anyone has seen any other indicator this might be true?

Statistically it appears that fewer people hospitalized as percentage of people tested positive and when they are, fewer seem to be dying. People seem to be recovering more. Yes, we’re testing & counting more, especially more that are less severe, but also earlier and treating people earlier.

Could the virus be becoming less potent? Or does this not make sense?


“The new coronavirus is losing its potency and has become much less lethal, a senior Italian doctor said on Sunday.“

Read in Reuters: https://apple.news/AUvgpYKHcQ2WzDd0c6qd2eg

[dabigv13]

Read that article, seemed like a strange story based purely on anecdote, with no numbers. Biologically, it's hard to envision the virus becoming significantly less lethal via mutation this rapidly. To drive selection, a virus would have to kill its hosts off too quickly so less lethal strains can spread more quickly and outnumber the more lethal ones. With the number of mild and asymptomatic cases this thing has, that seems unlikely to me.

[dabigv13]

Read that article, seemed like a strange story based purely on anecdote, with no numbers. Biologically, it's hard to envision the virus becoming significantly less lethal via mutation this rapidly. To drive selection, a virus would have to kill its hosts off too quickly so less lethal strains can spread more quickly and outnumber the more lethal ones. With the number of mild and asymptomatic cases this thing has, that seems unlikely to me.

[OutsiderFan]

Is the virus different or have the most vulnerable to it already been impacted? Also, if the reported data is correct, one could argue Italy’s lockdown measures worked well enough to really send the virus into a much weaker state. It stands to reason that fewer infections would lead to less viral load.

But we also have evidence countries that do a great job with mitigation all see similar sharply declining curves. In contrast, look at Sweden and the U.S. Both have similar daily case number development. They plateaued, but certainly aren’t going down at the rate Italy has, and the slowing death rates may be because the most vulnerable have already been exposed and already died.

Brazil is just getting absolutely obliterated right now. I don’t think any Brazilian doctors are thinking Italy was overzealous with what it did to stop spread.

[OutsiderFan]

Is the virus different or have the most vulnerable to it already been impacted? Also, if the reported data is correct, one could argue Italy’s lockdown measures worked well enough to really send the virus into a much weaker state. It stands to reason that fewer infections would lead to less viral load.

But we also have evidence countries that do a great job with mitigation all see similar sharply declining curves. In contrast, look at Sweden and the U.S. Both have similar daily case number development. They plateaued, but certainly aren’t going down at the rate Italy has, and the slowing death rates may be because the most vulnerable have already been exposed and already died.

Brazil is just getting absolutely obliterated right now. I don’t think any Brazilian doctors are thinking Italy was overzealous with what it did to stop spread.

[Griffins78]

dabigv13 - That’s been my assumption as well. This was the first time I saw anyone saying this so it peaked my interest.

[Griffins78]

dabigv13 - That’s been my assumption as well. This was the first time I saw anyone saying this so it peaked my interest.

[dabigv13]

It is plausible that certain very hard hit parts of Italy could have had clusters of the most vulnerable who got hit hard and overran hospitals early in the outbreak, but now mostly younger, healthier, and less likely to have a bad clinical course type patients are getting it. That could explain the type of experience of a single Italian doctor at one hospital. 

I will say, here in LA, the county has been posting some big case numbers, while our hospitals are doing as well as they have been since March. I think we have just been testing more broadly. Will be looking to see what it looks like in a few weeks after relaxation has been in place.

[dabigv13]

It is plausible that certain very hard hit parts of Italy could have had clusters of the most vulnerable who got hit hard and overran hospitals early in the outbreak, but now mostly younger, healthier, and less likely to have a bad clinical course type patients are getting it. That could explain the type of experience of a single Italian doctor at one hospital. 

I will say, here in LA, the county has been posting some big case numbers, while our hospitals are doing as well as they have been since March. I think we have just been testing more broadly. Will be looking to see what it looks like in a few weeks after relaxation has been in place.

[Goose]

I will say, here in LA, the county has been posting some big case numbers, while our hospitals are doing as well as they have been since March. I think we have just been testing more broadly. Will be looking to see what it looks like in a few weeks after relaxation has been in place.

I really hope that is true. The theory there is, I assume, that we really have the same number of  actual cases (or possibly fewer) but are detecting a larger percentage of them due to increased testing.

[Goose]

I will say, here in LA, the county has been posting some big case numbers, while our hospitals are doing as well as they have been since March. I think we have just been testing more broadly. Will be looking to see what it looks like in a few weeks after relaxation has been in place.

I really hope that is true. The theory there is, I assume, that we really have the same number of  actual cases (or possibly fewer) but are detecting a larger percentage of them due to increased testing.

[BostonCard]

If you look at the weekly naive CFR (weekly deaths divided by weekly cases), it peaked at 6% in early April, but has been falling since then, and has been hovering around 3% the last couple weeks.  My guess is you are right, more testing is finding minimally symptomatic and (a few) asymptomatic patients who are at low risk for death.

BC

[BostonCard]

If you look at the weekly naive CFR (weekly deaths divided by weekly cases), it peaked at 6% in early April, but has been falling since then, and has been hovering around 3% the last couple weeks.  My guess is you are right, more testing is finding minimally symptomatic and (a few) asymptomatic patients who are at low risk for death.

BC

[Goose]

If you look at the weekly naive CFR (weekly deaths divided by weekly cases), it peaked at 6% in early April, but has been falling since then, and has been hovering around 3% the last couple weeks.  My guess is you are right, more testing is finding minimally symptomatic and (a few) asymptomatic patients who are at low risk for death.

BC

That mostly works for me. However, I am greatly bothered that San Mateo County seems to have so many more "residual" cases than Santa Clara County, which is a significantly larger county that it is right next to. Can't be testing availability, as both use Stanford as the processing center. Also, the Northern California counties seem to be somewhat "stuck" at levels of illness higher than we see in Germany or Italy. Even New York seems to have behaved in a more "classical" manner. Once again, why? Whenever I see something that doesn't seem to fit what we have been led to expect, I worry that there is an undetected level of pathology hidden in the weeds.

[Goose]

If you look at the weekly naive CFR (weekly deaths divided by weekly cases), it peaked at 6% in early April, but has been falling since then, and has been hovering around 3% the last couple weeks.  My guess is you are right, more testing is finding minimally symptomatic and (a few) asymptomatic patients who are at low risk for death.

BC

That mostly works for me. However, I am greatly bothered that San Mateo County seems to have so many more "residual" cases than Santa Clara County, which is a significantly larger county that it is right next to. Can't be testing availability, as both use Stanford as the processing center. Also, the Northern California counties seem to be somewhat "stuck" at levels of illness higher than we see in Germany or Italy. Even New York seems to have behaved in a more "classical" manner. Once again, why? Whenever I see something that doesn't seem to fit what we have been led to expect, I worry that there is an undetected level of pathology hidden in the weeds.

[2006alum]

One would have to expect the naive CFR to decline in developed countries as testing becomes more widespread, the virus spreads among less vulnerable communities than nursing homes and hospitals (which were very often the first to be hit), and especially as knowledge of effective treatments and techniques improves. My impression is that one reason why we never had the ventilator demand issues that were forecasted is that physicians realized that prone positioning - rather than intubation - is a more effective technique. 

Now that we're well past the "flattening the curve" phase it's easy to forget that one thing that flattening the curve bought us was time to discover effective medical treatment techniques, not just "miracle cures" pushed by our Snakeoil Salesman President. Those kinds of best practices are not on their own game changers, but every single improvement adds up and whittles away the naive CFR.

[2006alum]

One would have to expect the naive CFR to decline in developed countries as testing becomes more widespread, the virus spreads among less vulnerable communities than nursing homes and hospitals (which were very often the first to be hit), and especially as knowledge of effective treatments and techniques improves. My impression is that one reason why we never had the ventilator demand issues that were forecasted is that physicians realized that prone positioning - rather than intubation - is a more effective technique. 

Now that we're well past the "flattening the curve" phase it's easy to forget that one thing that flattening the curve bought us was time to discover effective medical treatment techniques, not just "miracle cures" pushed by our Snakeoil Salesman President. Those kinds of best practices are not on their own game changers, but every single improvement adds up and whittles away the naive CFR.

[M T]

It is interesting to see both this effect and the surprise at it.  Wuhan noted this after they knocked down the local infections and opened up a bit. They started getting infections being introduced from other parts of China and reported it as less severe (fewer severe cases, shorter hospitalizations).

I think people need to separate (1) getting infected, (2) an infected individual having a severe/fatal case, and (3) communities having severe/fatal cases.

As far as I can tell, there is no dramatic age difference for testing positive for the infection FOR ADULTS. (See SCC case demographics and age demographics)  However, that might be affected by different practices of avoiding exposure by different ages, as well as the consequence of mild cases not being detected.  At-risk-of-infection is less a function of your health characteristics and more a function of your social characteristics (congregate housing, exposures to large number of people, etc.)   For instance, firemen would be at-risk-of-infection.

It has long been known that individual outcomes are worse for classes of individuals, associated with various factors: age, gender, comorbidities, race, blood type, etc.  For the disease to be milder, these risk numbers would need to change.  At-risk-of-severe-outcome is more a function of your health characteristics and less of your social characteristics.  For instance, an 80yo person living at home would be at risk-of-severe-outcome.

Severe/fatal cases for a community SHOULD be dropping everywhere as a result of general prophylactic measures, and for measures applied to each of the at-risk-of-infection and at-risk-of-severe-outcome groups.  For instance, at the SCC dashboard page, you can see that the number of infections at long-term care facilities (LTCF) spiked early but presumably even tighter controls were applied there to keep cases way down after that initial gut punch.  Compare the temporal distribution of cases at the LTCF (bottom of page) with the general population (top of page).   The effect of the tighter controls at those facilities reduced the infections in a at-risk-of-infection community, and simultaneously reduced the infections in a at-risk-of-severe-outcome community.   As a result, I suspect that if you looked at the historical demographics of SCC age distribution of COVID-19 infections, you will see reductions in average age (or, at least, older age), and probably reductions in percent for many of the at-risk comorbidities.   As a result, the "average" current case now should be less likely to have severe outcome and be hospitalized less.

-----

I agree there is no selection basis for the virus to spread better without a severe outcome for the patient.  By the time a severe outcome happens (or doesn't happen), the viral load levels have dropped.

-------

If there truly would be a less severe outcome for an identical twin with the same comorbidities on June 1 than there was for the twin on April 1, maybe it isn't the virus that has changed.  I could conceive that as even 0.5% of the population gets the disease, that there are little bits of the viral RNA, perhaps inactivated virus, in the environment where healthy people get exposed to small doses.   Maybe our bodies are reacting to it in small ways, perhaps becoming sensitized (to kill it off faster) or desensitized (avoiding the massive immune reaction that does the real damage) or both.

I'm not a physician so I may be way off base.  But, perhaps naively, I'd believe people's immune systems have changed as more likely than the virus has changed.

[M T]

It is interesting to see both this effect and the surprise at it.  Wuhan noted this after they knocked down the local infections and opened up a bit. They started getting infections being introduced from other parts of China and reported it as less severe (fewer severe cases, shorter hospitalizations).

I think people need to separate (1) getting infected, (2) an infected individual having a severe/fatal case, and (3) communities having severe/fatal cases.

As far as I can tell, there is no dramatic age difference for testing positive for the infection FOR ADULTS. (See SCC case demographics and age demographics)  However, that might be affected by different practices of avoiding exposure by different ages, as well as the consequence of mild cases not being detected.  At-risk-of-infection is less a function of your health characteristics and more a function of your social characteristics (congregate housing, exposures to large number of people, etc.)   For instance, firemen would be at-risk-of-infection.

It has long been known that individual outcomes are worse for classes of individuals, associated with various factors: age, gender, comorbidities, race, blood type, etc.  For the disease to be milder, these risk numbers would need to change.  At-risk-of-severe-outcome is more a function of your health characteristics and less of your social characteristics.  For instance, an 80yo person living at home would be at risk-of-severe-outcome.

Severe/fatal cases for a community SHOULD be dropping everywhere as a result of general prophylactic measures, and for measures applied to each of the at-risk-of-infection and at-risk-of-severe-outcome groups.  For instance, at the SCC dashboard page, you can see that the number of infections at long-term care facilities (LTCF) spiked early but presumably even tighter controls were applied there to keep cases way down after that initial gut punch.  Compare the temporal distribution of cases at the LTCF (bottom of page) with the general population (top of page).   The effect of the tighter controls at those facilities reduced the infections in a at-risk-of-infection community, and simultaneously reduced the infections in a at-risk-of-severe-outcome community.   As a result, I suspect that if you looked at the historical demographics of SCC age distribution of COVID-19 infections, you will see reductions in average age (or, at least, older age), and probably reductions in percent for many of the at-risk comorbidities.   As a result, the "average" current case now should be less likely to have severe outcome and be hospitalized less.

-----

I agree there is no selection basis for the virus to spread better without a severe outcome for the patient.  By the time a severe outcome happens (or doesn't happen), the viral load levels have dropped.

-------

If there truly would be a less severe outcome for an identical twin with the same comorbidities on June 1 than there was for the twin on April 1, maybe it isn't the virus that has changed.  I could conceive that as even 0.5% of the population gets the disease, that there are little bits of the viral RNA, perhaps inactivated virus, in the environment where healthy people get exposed to small doses.   Maybe our bodies are reacting to it in small ways, perhaps becoming sensitized (to kill it off faster) or desensitized (avoiding the massive immune reaction that does the real damage) or both.

I'm not a physician so I may be way off base.  But, perhaps naively, I'd believe people's immune systems have changed as more likely than the virus has changed.

[Snorlax94]

That mostly works for me. However, I am greatly bothered that San Mateo County seems to have so many more "residual" cases than Santa Clara County, which is a significantly larger county that it is right next to. Can't be testing availability, as both use Stanford as the processing center. Also, the Northern California counties seem to be somewhat "stuck" at levels of illness higher than we see in Germany or Italy. Even New York seems to have behaved in a more "classical" manner. Once again, why? Whenever I see something that doesn't seem to fit what we have been led to expect, I worry that there is an undetected level of pathology hidden in the weeds.

I have been a little frustrated at the lack of information and the inconsistency (for example, each county's dashboard, while appearing to use similar software, provides different bits of information in different ways), so it's sometimes hard to know what's going on.

I generally find the California DPH Dataset website to provide the most useful and consistent information. The SCC website warns there could be inaccuracies day-to-day from double-counting, but because the state dataset shows you historical data, you can better see historical trends.

https://data.chhs.ca.gov/dataset/califor...d656e1176e

Generally, the State data set has been showing *extremely positive hospitalization data* in SCC. From May 1, SCC went from 97 hospitalizations and 38 in the ICU, to 25 hospitalizations and 9 in the ICU (though with 31 fatalities). The hospitalizations have decreased even though restrictions have been loosened in many ways -- construction and more recreational activities were permitted several weeks ago.

So, I am still optimistic that the large increase in confirmed cases is due to catching more asymptomatic or mild cases, which we always knew were greatly under-counted. However, the state dataset shows 3 more fatalities today that have not yet been reflected on the SCC dashboard, social activities have been increasing lately, and it's still a little early to see any effect from hospitalizations from the least loosening, so, I'm anxious to see how the next 2 weeks play out. 

But this Friday is 2 weeks since the last loosening, and if hospitalizations continue to decrease, I am hopeful there will be another round of loosening announced soon. In order to enjoy the relatively-safe outdoors during the summer, there needs to be some summer left to enjoy.

[Snorlax94]

That mostly works for me. However, I am greatly bothered that San Mateo County seems to have so many more "residual" cases than Santa Clara County, which is a significantly larger county that it is right next to. Can't be testing availability, as both use Stanford as the processing center. Also, the Northern California counties seem to be somewhat "stuck" at levels of illness higher than we see in Germany or Italy. Even New York seems to have behaved in a more "classical" manner. Once again, why? Whenever I see something that doesn't seem to fit what we have been led to expect, I worry that there is an undetected level of pathology hidden in the weeds.

I have been a little frustrated at the lack of information and the inconsistency (for example, each county's dashboard, while appearing to use similar software, provides different bits of information in different ways), so it's sometimes hard to know what's going on.

I generally find the California DPH Dataset website to provide the most useful and consistent information. The SCC website warns there could be inaccuracies day-to-day from double-counting, but because the state dataset shows you historical data, you can better see historical trends.

https://data.chhs.ca.gov/dataset/califor...d656e1176e

Generally, the State data set has been showing *extremely positive hospitalization data* in SCC. From May 1, SCC went from 97 hospitalizations and 38 in the ICU, to 25 hospitalizations and 9 in the ICU (though with 31 fatalities). The hospitalizations have decreased even though restrictions have been loosened in many ways -- construction and more recreational activities were permitted several weeks ago.

So, I am still optimistic that the large increase in confirmed cases is due to catching more asymptomatic or mild cases, which we always knew were greatly under-counted. However, the state dataset shows 3 more fatalities today that have not yet been reflected on the SCC dashboard, social activities have been increasing lately, and it's still a little early to see any effect from hospitalizations from the least loosening, so, I'm anxious to see how the next 2 weeks play out. 

But this Friday is 2 weeks since the last loosening, and if hospitalizations continue to decrease, I am hopeful there will be another round of loosening announced soon. In order to enjoy the relatively-safe outdoors during the summer, there needs to be some summer left to enjoy.

[BostonCard]

The WHO is pushing back against this:

https://www.cnbc.com/2020/06/01/who-says...virus.html


[*]

“We need to be exceptionally careful that we are not creating a sense that all of a sudden the virus has decided to be less pathogenic. That is not the case at all,” said Dr. Mike Ryan, executive director of the WHO’s emergencies program.

I know we are all of a sudden not supposed to like or believe the WHO, but I trust their assessment over a random doctor in Italy's (says a random doctor in the US).

BC

[BostonCard]

The WHO is pushing back against this:

https://www.cnbc.com/2020/06/01/who-says...virus.html


[*]

“We need to be exceptionally careful that we are not creating a sense that all of a sudden the virus has decided to be less pathogenic. That is not the case at all,” said Dr. Mike Ryan, executive director of the WHO’s emergencies program.

I know we are all of a sudden not supposed to like or believe the WHO, but I trust their assessment over a random doctor in Italy's (says a random doctor in the US).

BC

[akiddoc]

I really doubt that it is less lethal. We are testing far more people with far fewer symptoms. ICU's, and hospitals, are almost certainly getting better at treatment, knowing how to avoid using a ventilator, etc.

[akiddoc]

I really doubt that it is less lethal. We are testing far more people with far fewer symptoms. ICU's, and hospitals, are almost certainly getting better at treatment, knowing how to avoid using a ventilator, etc.

[2006alum]

https://www.reuters.com/article/us-healt...SKBN2370OQ

This guy is no quack. What's going on? Not just whether he's right or wrong, but how he could come to such a bold statement.

Merged your inquiry with this thread, which has been dissecting that statement and its associated implications.

[2006alum]

https://www.reuters.com/article/us-healt...SKBN2370OQ

This guy is no quack. What's going on? Not just whether he's right or wrong, but how he could come to such a bold statement.

Merged your inquiry with this thread, which has been dissecting that statement and its associated implications.

[Genuine Realist]

The WHO is pushing back against this:

https://www.cnbc.com/2020/06/01/who-says...virus.html


[*]

“We need to be exceptionally careful that we are not creating a sense that all of a sudden the virus has decided to be less pathogenic. That is not the case at all,” said Dr. Mike Ryan, executive director of the WHO’s emergencies program.

I know we are all of a sudden not supposed to like or believe the WHO, but I trust their assessment over a random doctor in Italy's (says a random doctor in the US).

BC

It seems too good to be true, but the guy is not random, the head of the San Raffaele hospital in Milan, which (says the article) has borne the brunt of the pandemic. He's talking about the pattern of testing in the hospital and region.

[Genuine Realist]

The WHO is pushing back against this:

https://www.cnbc.com/2020/06/01/who-says...virus.html


[*]

“We need to be exceptionally careful that we are not creating a sense that all of a sudden the virus has decided to be less pathogenic. That is not the case at all,” said Dr. Mike Ryan, executive director of the WHO’s emergencies program.

I know we are all of a sudden not supposed to like or believe the WHO, but I trust their assessment over a random doctor in Italy's (says a random doctor in the US).

BC

It seems too good to be true, but the guy is not random, the head of the San Raffaele hospital in Milan, which (says the article) has borne the brunt of the pandemic. He's talking about the pattern of testing in the hospital and region.

[fullmetal]

Well, if Mr. Italian Senior Doctor wants to explain which new strain of coronavirus he's talking about correlating with lower mortality rates, then I'll listen.  Otherwise, this would be a very unsubstantiated and highly unlikely event that will probably have no impact on the disease impact in the USA.

[fullmetal]

Well, if Mr. Italian Senior Doctor wants to explain which new strain of coronavirus he's talking about correlating with lower mortality rates, then I'll listen.  Otherwise, this would be a very unsubstantiated and highly unlikely event that will probably have no impact on the disease impact in the USA.