Outside Topic Covid-19 considerations - Printable Version
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RE: Covid-19 considerations - burger - 02-28-2020
(02-28-2020, 11:07 AM)oldalum Wrote: the latest from the CDC and NIH on the case fatality rate, articles published today in the New England J of Medicine: free NEJM article
On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%. In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.
That is heartening but much lower than the estimates being produced elsewhere using more robust analytic methods (like this one: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-2019-nCoV-severity-10-02-2020.pdf ). The authors of the NEJM article include the head of CDC and the head of a major NIH division, and they have made clear that they are not permitted to interact with the public without approval from politicians. So, there is reason for major skepticism about that article (not saying they're lying, but they are cherry picking).
RE: Covid-19 considerations - cardcrimson - 02-28-2020
As pneumonia seems to be a big risk with Covid-19, a dumb question from someone who's had pneumonia twice. Will the pneumonia vaccine help the severity of Covid-19, not necessarily with the disease itself? In other words, since I've had the pneumonia vaccine, will it lessen the severity of Covid-19 should I catch it? My guess is that's it's a completely different bug. . . .
(02-28-2020, 11:20 AM)burger Wrote:(02-28-2020, 11:07 AM)oldalum Wrote: the latest from the CDC and NIH on the case fatality rate, articles published today in the New England J of Medicine: free NEJM article
On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%. In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.
That is heartening but much lower than the estimates being produced elsewhere using more robust analytic methods (like this one: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-2019-nCoV-severity-10-02-2020.pdf ). The authors of the NEJM article include the head of CDC and the head of a major NIH division, and they have made clear that they are not permitted to interact with the public without approval from politicians. So, there is reason for major skepticism about that article (not saying they're lying, but they are cherry picking).
And on the lighter side. The World's Shortest Horror Movie:
https://www.youtube.com/watch?v=0L9-POl_GFs
RE: Covid-19 considerations - Goose - 02-28-2020
(02-28-2020, 09:26 AM)OutsiderFan Wrote:(02-28-2020, 08:04 AM)Goose Wrote: OF, before you conclude that a "drive up" testing approach is a good idea, it might be wise to consider that a limited number of testing kits are currently available. If they get consumed by people who are "just being safe" but have a low probability of being positive we will really have a problem if this outbreak becomes widespread. The capacity to manufacture these kits is also limited. We can't just order a bunch of them and have them show up in a week. The CDC is certainly being cautious about using them up, but that may be because they know we don't have "enough" and can't get "enough" soon.
If it was hard to test, there is no way these other countries could be doing tests on the scale they are. I didn't say everyone should be tested. There should be some criteria. Moreover, the point of doing widespread testing is for surveillance, to get a picture for what is happening in terms of community spread. It is not to identify every virus carrier per se, but to understand what is happening for planning purposes. Without widespread testing we are blind.
I don't know that the "test" that is being done in other countries is the same test that the CDC specifies. The CDC test is described in https://www.cdc.gov/coronavirus/mers/lab/lab-testing.html. I agree that we need to get data, but it is EXTREMELY important that the data be "apples to apples" and be reliable. Drawing conclusions from inaccurate testing data is possibly worse that having no data. I don't know that the CDC test is any good, but the problems they had with multiplying up one of the fragments with PCR have caused them to drop it from the test. We also aren't in a real good place with negative controls on this test, as there could be other corona virus that has the same "signature" as Covid-19 with these three (now two) markers but does not cause the disease. Thus the comment about no FDA approved test in the above link.
RE: Covid-19 considerations - oldalum - 02-28-2020
(02-28-2020, 11:20 AM)burger Wrote: The authors of the NEJM article include the head of CDC and the head of a major NIH division, and they have made clear that they are not permitted to interact with the public without approval from politicians. So, there is reason for major skepticism about that article (not saying they're lying, but they are cherry picking).Fauci is probably the single most well-known/significant infectious disease person alive, he is 79 and at the end of his career, and I find it hard to believe he'd make any statements, as a result of political pressure, that he viewed as inaccurate, slanted, or misleading, even by omission. Due to production lead-time, this article was probably finalized before the administration allegedly acted this week to muzzle his public statements. (I only say allegedly because it has been denied by Fauci's Institute at NIH, but I certainly find the allegation believable.) Anyway, my point in quoting the article was simply to provide some support for what BC and I have been posting, which is that if the number of asymptomatic and mild cases is significant, the currently cited case fatality rates are too high. And the "more robust" analysis you cite says that "All CFR estimates should be viewed cautiously at the current time as the sensitivity of surveillance of both deaths and cases in mainland China is unclear." And their point estimates for CFR based on all infections are under 1%, albeit with wide confidence intervals.
RE: Covid-19 considerations - OutsiderFan - 02-28-2020
(02-28-2020, 12:00 PM)Goose Wrote:(02-28-2020, 09:26 AM)OutsiderFan Wrote:(02-28-2020, 08:04 AM)Goose Wrote: OF, before you conclude that a "drive up" testing approach is a good idea, it might be wise to consider that a limited number of testing kits are currently available. If they get consumed by people who are "just being safe" but have a low probability of being positive we will really have a problem if this outbreak becomes widespread. The capacity to manufacture these kits is also limited. We can't just order a bunch of them and have them show up in a week. The CDC is certainly being cautious about using them up, but that may be because they know we don't have "enough" and can't get "enough" soon.
If it was hard to test, there is no way these other countries could be doing tests on the scale they are. I didn't say everyone should be tested. There should be some criteria. Moreover, the point of doing widespread testing is for surveillance, to get a picture for what is happening in terms of community spread. It is not to identify every virus carrier per se, but to understand what is happening for planning purposes. Without widespread testing we are blind.
I don't know that the "test" that is being done in other countries is the same test that the CDC specifies. The CDC test is described in https://www.cdc.gov/coronavirus/mers/lab/lab-testing.html. I agree that we need to get data, but it is EXTREMELY important that the data be "apples to apples" and be reliable. Drawing conclusions from inaccurate testing data is possibly worse that having no data. I don't know that the CDC test is any good, but the problems they had with multiplying up one of the fragments with PCR have caused them to drop it from the test. We also aren't in a real good place with negative controls on this test, as there could be other corona virus that has the same "signature" as Covid-19 with these three (now two) markers but does not cause the disease. Thus the comment about no FDA approved test in the above link.
ANOTHER variable to consider is mutations or gene sequences of the virus. What it was in December might not be what it is in March. Perhaps this would provide some clues to re-infection. Then again, testing may not have been able to pick up trace levels of the virus in people who had it but were cleared. IOW, re-infection could be a misnomer, and the reality is it never really went away.
Sometimes the more you think you know, the more you realize how little you do. Seems to be the case with SARS-CoV-2.
RE: Covid-19 considerations - cardcrimson - 02-28-2020
Ruh-roh Scooby. . . .
https://www.cnbc.com/2020/02/28/a-dog-in-hong-kong-tests-positive-for-the-coronavirus-who-confirms.html
RE: Covid-19 considerations - OutsiderFan - 02-28-2020
(02-28-2020, 01:28 PM)cardcrimson Wrote: Ruh-roh Scooby. . . .
https://www.cnbc.com/2020/02/28/a-dog-in-hong-kong-tests-positive-for-the-coronavirus-who-confirms.html
On so many levels... @%#$!!!!
RE: Covid-19 considerations - Goose - 02-28-2020
(02-28-2020, 01:20 PM)OutsiderFan Wrote: ANOTHER variable to consider is mutations or gene sequences of the virus. What it was in December might not be what it is in March. Perhaps this would provide some clues to re-infection. Then again, testing may not have been able to pick up trace levels of the virus in people who had it but were cleared. IOW, re-infection could be a misnomer, and the reality is it never really went away.
Sometimes the more you think you know, the more you realize how little you do. Seems to be the case with SARS-CoV-2.
Totally agree. It is still very early days in the disease. That is why we need to err on the side of caution. It MAY turn out to be "just another flu", but it may turn out lots worse. Slowing it down while we figure it out is important, perhaps critical.
RE: Covid-19 considerations - Langdude - 02-28-2020
They closed the high school here (suburb of Seattle) both yesterday and today (though not the middle school where my oldest daughter attends) because the relative of a staffer recently returned from traveling abroad and is sick. The sickness has not been diagnosed as Covid-19, but both staffer and relative are quarantined. They are undertaking a deep clean of every surface in the school. Hopefully this will just amount to a snow day without the snow (great weather, actually).
-m.
RE: Covid-19 considerations - burger - 02-28-2020
(02-28-2020, 01:12 PM)oldalum Wrote: Fauci is probably the single most well-known/significant infectious disease person alive, he is 79 and at the end of his career, and I find it hard to believe he'd make any statements, as a result of political pressure, that he viewed as inaccurate, slanted, or misleading, even by omission. Due to production lead-time, this article was probably finalized before the administration allegedly acted this week to muzzle his public statements. (I only say allegedly because it has been denied by Fauci's Institute at NIH, but I certainly find the allegation believable.) Anyway, my point in quoting the article was simply to provide some support for what BC and I have been posting, which is that if the number of asymptomatic and mild cases is significant, the currently cited case fatality rates are too high. And the "more robust" analysis you cite says that "All CFR estimates should be viewed cautiously at the current time as the sensitivity of surveillance of both deaths and cases in mainland China is unclear." And their point estimates for CFR based on all infections are under 1%, albeit with wide confidence intervals.I'm actually with you and Fauci et al. in that I think the denominator is underestimated in all of the CFR analyses and that the "final" number, if ever calculated in a way that included all asymptomatic cases, will be on the lowish side of the current range of estimates.
That siad, you have to take any official pronouncements, like their NEJM commentary, with some skepticism because there is a concerted effort by the administration to downplay and obfuscate what is happening. Is it too political to say that some of the statements coming from the administration are divorced from reality? And the lack of testing by CDC implies a "see no evil" mindset. If CDC were acting like this is a serious issue, I would take their statements more seriously. Until then, I'm going to be skeptical of everything they say. Hopefully they will open up more, but I doubt it.
RE: Covid-19 considerations - martyup - 02-28-2020
Please keep politics out of this thread.
RE: Covid-19 considerations - M T - 02-28-2020
(02-28-2020, 01:20 PM)OutsiderFan Wrote: ANOTHER variable to consider is mutations or gene sequences of the virus. What it was in December might not be what it is in March. Perhaps this would provide some clues to re-infection. Then again, testing may not have been able to pick up trace levels of the virus in people who had it but were cleared. IOW, re-infection could be a misnomer, and the reality is it never really went away.
Sometimes the more you think you know, the more you realize how little you do. Seems to be the case with SARS-CoV-2.
The WHO-China joint mission investigated mutations to Feb 24.
Quote:The Joint Mission carried out whole gene sequencing in 104 new coronavirus strains isolated from different locations
and confirmed that the homology among these strains reached 99.9%. Accordingly, the Joint Mission believes that the virus has no obvious variation
As for some people's belief that there must be a large set of asymptomatic people with the disease (same source as just above):
Quote:Some asymptomatic patients have been found. However, whether such cases are patients with asymptomatic infections or carriers whose virus is still in the incubation period warrants further study. It is unclear whether the asymptomatic carriers can also spread the disease
From other accounts, the "some" appears to be 889 out of 72,000 (as of Feb 19).
A news article of Feb 15 says:
Quote:Zhang Hongxing, head of Wuhan's health commission, said last week the city tested about 6,000 to 8,000 people dailyThat's at least 42K that week (counting Wuhan only). The WHO-China Joint mission ended some 9 days later, which would suggest another 54K tested (in Wuhan). That's far more than the 47,000 confirmed cases in Wuhan at that date (Feb 24). If there were widespread asymptomatic cases, I would expect the number of confirmed cases would have climbed as that testing progressed, and the WHO-China joint mission would likely have noted that. Instead, the opposite seems to be suggested by WHO comment just above and by "the number of milder cases may not be great" I quoted in an earlier post.
From before, WHO's daily sitreps are here.
China's CDC daily sitreps are here. (not previously listed here)
US CDC page is here
RE: Covid-19 considerations - Goose - 02-28-2020
(02-28-2020, 03:00 PM)M T Wrote: A news article of Feb 15 says:Quote:Zhang Hongxing, head of Wuhan's health commission, said last week the city tested about 6,000 to 8,000 people daily
Do you know, or does anyone hear know, are the tests being done in Wuhan the same test as the CDC is using, and if not, what the test they are using actually is? I have no idea myself. Not to say one is "better" than another at this point, but if they are different, it may be an issue.
RE: Covid-19 considerations - Snorlax94 - 02-28-2020
Another case of unknown origin this time in Santa Clara County, so it’s here now.
From the Mercury News:
The El Camino nurse, who did not want to be identified, said staff were frustrated and worried about the lack of available tests from the U.S. Centers for Disease Control and Prevention, as well as protective gear such as n 95 respirator masks to protect health care workers treating the sick. The nurse said a doctor and several emergency room staff have been quarantined.
“We’re in Silicon Valley, the richest economy in the world and we don’t have enough N 95 masks,” “It’s insanity. Everybody is worried about it. I’m just worried about containment. It’s so contagious.”
https://www.mercurynews.com/2020/02/28/santa-clara-county-announces-new-coronavirus-case/
RE: Covid-19 considerations - martyup - 02-28-2020
Here is a Corona virus tracker dashboard by Johns Hopkins:
https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
RE: Covid-19 considerations - OutsiderFan - 02-28-2020
(02-28-2020, 05:21 PM)Snorlax94 Wrote: Another case of unknown origin this time in Santa Clara County, so it’s here now.
From the Mercury News:
The El Camino nurse, who did not want to be identified, said staff were frustrated and worried about the lack of available tests from the U.S. Centers for Disease Control and Prevention, as well as protective gear such as n 95 respirator masks to protect health care workers treating the sick. The nurse said a doctor and several emergency room staff have been quarantined.
“We’re in Silicon Valley, the richest economy in the world and we don’t have enough N 95 masks,” “It’s insanity. Everybody is worried about it. I’m just worried about containment. It’s so contagious.”
https://www.mercurynews.com/2020/02/28/santa-clara-county-announces-new-coronavirus-case/
Nice to see Santa Clara Valley has its own testing ability, but now what? Health officials of course want to do tests for community surveillance, but who wants to pay for them? Who’s gonna pay for them? It sounds like maybe Santa Clara County?
RE: Covid-19 considerations - cardcrimson - 02-28-2020
Per Newsom, the state, in conjunction with the CDC, has it covered.
“We are currently in deep partnership with CDC on one overriding protocol that drives our principal focus right now and that’s testing, and the importance to increase our testing protocols and to have point of contact diagnostic testing as our top priority not just in the state of California, but I imagine all across the United States."
— Gov. Gavin Newsom on Thursday
https://www.axios.com/california-monitor-8400-people-coronavirus-fb785e1c-8f38-4225-988b-11344fb7859e.html
(02-28-2020, 05:58 PM)OutsiderFan Wrote:(02-28-2020, 05:21 PM)Snorlax94 Wrote: Another case of unknown origin this time in Santa Clara County, so it’s here now.
From the Mercury News:
The El Camino nurse, who did not want to be identified, said staff were frustrated and worried about the lack of available tests from the U.S. Centers for Disease Control and Prevention, as well as protective gear such as n 95 respirator masks to protect health care workers treating the sick. The nurse said a doctor and several emergency room staff have been quarantined.
“We’re in Silicon Valley, the richest economy in the world and we don’t have enough N 95 masks,” “It’s insanity. Everybody is worried about it. I’m just worried about containment. It’s so contagious.”
https://www.mercurynews.com/2020/02/28/santa-clara-county-announces-new-coronavirus-case/
Nice to see Santa Clara Valley has its own testing ability, but now what? Health officials of course want to do tests for community surveillance, but who wants to pay for them? Who’s gonna pay for them? It sounds like maybe Santa Clara County?
RE: Covid-19 considerations - 82lsju - 02-28-2020
Quote:But the average American may be surprised to learn who holds the authority to order such public-health measures [e.g. quarantines]. Except at the nation’s borders, the federal government, with the expertise of the Centers for Disease Control and Prevention, is not in charge. America’s defense against epidemics is divided among 2,684 state, local, and tribal public-health departments. Each one is responsible for monitoring people within its jurisdiction, imposing isolation or quarantine as needed. CDC officials are “preparing as if [the new coronavirus] is the next pandemic,” but in reality, the laboring oar falls to state and local health departments.
https://www.theatlantic.com/ideas/archive/2020/02/coronavirus-quarantine-america-could-be-giant-legal-mess/606595/?utm_campaign=the-atlantic&utm_medium=social&utm_source=facebook
RE: Covid-19 considerations - magnus - 02-28-2020
(02-28-2020, 01:52 PM)Langdude Wrote: suburb of Seattle...
Speaking of Seattle, 2 new presumptive cases in King (50 year old lady linked to South Korea) and Snohomish (Everett high school student with unknown source) counties
https://www.kiro7.com/news/local/coronavirus-2-test-presumptive-positive-western-washington/5B2T22DXRVBJVABTSSJNRFYJ2Y/
And one in Lake Oswego, Oregon (employee of Forest Hills Elementary School with unknown source)
https://www.oregonlive.com/clackamascounty/2020/02/clackamas-county-school-employee-has-coronavirus-forest-hills-elementary-shut.html
What's with this west coast bias?
RE: Covid-19 considerations - oldalum - 02-29-2020
(02-28-2020, 10:24 PM)magnus Wrote: What's with this west coast bias?proximity to Asia