We're #1 !!! - Printable Version

We're #1 !!! - Printable Version

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RE: We're #1 !!! - BostonCard - 10-30-2020

(10-29-2020, 11:45 PM)teejers1 Wrote:
(10-29-2020, 04:55 PM)BostonCard Wrote: [tweet]https://twitter.com/axios/status/1321955121761189888?s=20[/tweet]

The 88,000 number is bad, but the real concerning aspect is that hospitals are starting to become strained. Over/under on breaking 100,000 cases by election day?

BC

You know hospital capacity is my bugaboo, so I took interest in your descriptor "starting to become strained" and what that means. Nothing in the link you posted, which I think was just a tweet.

But the Utah reports were bad on that front, as is El Paso. We may see other locales with similar capacity issues, though it's possible we will not. In all events, that should be the driver, and I agree that as you approach real capacity constraints (not theoretical ones), then it's time to pull back/tighten the restrictions.

Meanwhile, SCC remains ridiculously well positioned on the hospital front, as it has throughout all the "surges" and case "explosions."

https://www.sccgov.org/sites/covid19/Pages/dashboard-hospitals.aspx#capacity

(And I say ridiculous because our "Dear Bureaucrat" seems to think those numbers are meaningless).

The good news nationally is that unlike the spring where the pandemic was confined to a small region (New York), now it is widespread and thus less likely to overwhelm one region's healthcare resources. On the other hand, outside of Boston, New York City has one of the highest hospital capacities in the country. Smaller towns and rural areas are less well-covered, and in fact, we've seen a lot of hospitals in rural areas close recently.

BC

(10-29-2020, 07:26 PM)BostonCard Wrote:
(10-29-2020, 06:00 PM)lex24 Wrote: Not interested in the prediction game. Good news in Ca. Deaths hit low last week. And the dire prediction on hospitization rates soaring in October did not come to pass.

Course, no one wants to hear good news on this board. Not at least till Biden wins. Which I find interesting - cause I doubt there is one person that reads (or at least posts) on this site that will be voting for Trump. .

Here's some good news:

https://www.fiercebiotech.com/biotech/regeneron-s-covid-19-antibody-cuts-medical-visits-phase-2-3-trial

Quote:Regeneron’s anti-SARS-CoV-2 antibody cocktail has significantly reduced medical visits in ambulatory COVID-19 patients. The phase 2/3 clinical trial linked REGN-COV2 to a 57% decline in medical visits associated with COVID-19 in the 29 days after treatment.

The downside is that this is an IV antibody cocktail, but you could imagine a case where high risk patients who have been exposed get the cocktail as prophylaxis. Cutting the hospitalization rate by over half is real progress.

BC

And now the bad news.

https://investor.regeneron.com/news-releases/news-release-details/regn-cov2-independent-data-monitoring-committee-recommends

The independent data safety monitoring board found a potential safety signal in the sicker patients.

Quote:based on a potential safety signal and an unfavorable risk/benefit profile at this time, the IDMC recommends further enrollment of patients requiring high-flow oxygen or mechanical ventilation be placed on hold pending collection and analysis of further data on patients already enrolled.

This is on the back of Eli Lilly stopping its treatment in hospitalized patients.

It looks like if antibody cocktails are going to be used, they would be used for high-risk outpatients, where they reduce the risk of subsequent hospitalization by over 50%. But once patients are already sick enough to require high flow oxygen or be intubated, they run the risk of making patients worse.

Interesting that this was the therapy given to Donald Trump. I'm not sure how sick he was when he got the cocktail, but this is why you generally don't give investigational drugs before they are cleared by the FDA. Imagine if he had a safety event.

BC

RE: We're #1 !!! - Farm93 - 10-30-2020

(10-30-2020, 11:03 AM)BostonCard Wrote: Interesting that this was the therapy given to Donald Trump. I'm not sure how sick he was when he got the cocktail, but this is why you generally don't give investigational drugs before they are cleared by the FDA. Imagine if he had a safety event.

BC

I am sure the Walter Reed crew would have done almost anything to reverse any adverse effects. Still I did see the Regeneron news and think that Donald Trump, the Walter Reed MDs, and all of the USA were lucky his untested cocktail of investigational drugs didn't spiral the other way.

The Lincoln Project's edits for President Trump pushing Regeneron now takes on a very different perspective.

Maybe with the latest news POTUS45 will push masks and testing instead of expensive, investigational drugs???

RE: We're #1 !!! - BostonCard - 10-30-2020

(10-29-2020, 06:00 PM)Farm93 Wrote:
(10-29-2020, 04:55 PM)BostonCard Wrote: The 88,000 number is bad, but the real concerning aspect is that hospitals are starting to become strained. Over/under on breaking 100,000 cases by election day?

BC

88,000 places the USA above "Original" Stanford Stadium's one time capacity of ~86,000. So that passing that is noteworthy to me.

100,000 is a big round number, but we are also close to exceeding the 107,601 of the Big House in Michigan. So that would mean something in the BigTen country.

To your odds -

Friday is likely the last potential day BEFORE election day.

Saturday, Sunday and Monday each have a weekend effect for different reasons.

Tuesday seems to serve as a catch-up day.

Friday is too soon for 100K.

Given Tuesday likely will have some cases from multiple prior days it is possible, but if that happens it will not be covered on that night.

Really wish it didn't seem inevitable, but Europe was on this path already. The cases exploded and then when it was really clear cases were out of control and hospitals were filling up the governments decided to take more decisive steps. We have a bigger base set of cases, we have fewer citizens trying to reduce the spread, and we have a national government that is not exactly working diligently to reinforce best practices for pandemic mitigation.

Even if decisive steps in the USA were taken tomorrow by citizens and the government the new cases we will see next week are already in the incubation phase. So we will hit 100,000 new cases and my guess is we will hit that number late NEXT week on Worldometers.

Well, today was 97,000

[tweet]https://twitter.com/COVID19Tracking/status/1322315688116019200?s=20[/tweet]

Note that the tally last Saturday was similar to last Friday's, so it is possible, if unlikely, that we will break 100,000 tomorrow. More likely, based on weekly patterns, it will be next Thursday.

BC

RE: We're #1 !!! - 82 Card - 10-30-2020

Worldometer has slightly higher numbers for today's new cases. They are currently showing 99,336. Nebraska hasn't been posted yet. If Nebraska cmes in with at least half of their number yesterday, it will put the total over 100K. Nebraska usually gets posted just before 6 pm pacific time.
_______________________
Update: The final numbers for the day posted by worldometers.info are 101,461 new cases and 988 deaths. I'm not sure exactly why their numbers are higher than some of the others. When we hit the record last Friday, worldometers.info was a couple thousand lower than many of the other sites. I suspect the difference has something to do with cutoff times and allocation between days. Regardless of whether the number is slightly above or slightly below 100K, that's a lot of cases, roughly 30/100K.The criteria for the purple ties in California is 10/100K.

RE: We're #1 !!! - BostonCard - 10-30-2020

(10-29-2020, 11:45 PM)teejers1 Wrote: You know hospital capacity is my bugaboo, so I took interest in your descriptor "starting to become strained" and what that means. Nothing in the link you posted, which I think was just a tweet.

But the Utah reports were bad on that front, as is El Paso. We may see other locales with similar capacity issues, though it's possible we will not. In all events, that should be the driver, and I agree that as you approach real capacity constraints (not theoretical ones), then it's time to pull back/tighten the restrictions.

Meanwhile, SCC remains ridiculously well positioned on the hospital front, as it has throughout all the "surges" and case "explosions."

https://www.sccgov.org/sites/covid19/Pages/dashboard-hospitals.aspx#capacity

(And I say ridiculous because our "Dear Bureaucrat" seems to think those numbers are meaningless).

https://www.kron4.com/news/bay-area/sf-to-pause-reopening-plans-amid-uptick-in-covid-19/

Lots of capacity left (even 37 is a drop in the bucket compared to the number of hospital beds at just UCSF), but still not a good trend.

BC

(10-30-2020, 05:11 PM)82 Card Wrote: Worldometer has slightly higher numbers for today's new cases. They are currently showing 99,336. Nebraska hasn't been posted yet. If Nebraska cmes in with at least half of their number yesterday, it will put the total over 100K. Nebraska usually gets posted just before 6 pm pacific time.

It did, in fact, cross 100,000 in Worldometer.

BC

RE: We're #1 !!! - dabigv13 - 10-30-2020

SoCal ICU usage is steeply rising though still pretty low. Doesn't seem there are any social or governmental changes happening widely at this point that would slow it. Perhaps increased news coverage will change people's decisions enough to blunt it again before more drastic measures are needed.

RE: We're #1 !!! - Farm93 - 10-30-2020

(10-30-2020, 06:04 PM)dabigv13 Wrote: SoCal ICU usage is steeply rising though still pretty low. Doesn't seem there are any social or governmental changes happening widely at this point that would slow it. Perhaps increased news coverage will change people's decisions enough to blunt it again before more drastic measures are needed.

No changes to the trend should be expected with the nation's #1 superspreader tour at full speed ahead for the next 72 hours complete with denials about the severity of the rate of spread and the disease. Per POTUS45 - Those darn MDs are lying about COVID to get a few extra bucks in reimbursement, so just ignore those numbers coming from his administration.

Even any message in any part of change will need to wait at least 72 hours. Any governor that announces a change over the weekend would rightfully be accused of making COVID-19 political. So I would anticipate we will see the first set of changes in the states with Governors using science or following European trends late next week. Even that will be too little and too late, but IIWII.

Really can't believe we got over 100,000 on worldometers today. Wow, that's scary.

RE: We're #1 !!! - OutsiderFan - 10-30-2020

I heard the Mayor of West Hartford did a robocall saying the town was now at orange level and if virus spread trends don't improve, they will be forced to close even limited indoor dining and gyms again.

People can gripe about Dr. Cody, but history is going to show very well on her. SCC has just 1.6% positive tests over last week. EVERYONE I see around here is masked.

RE: We're #1 !!! - DocSavage87 - 10-31-2020

With the Trump two-headed disinformation campaign about (1) doctors misclassifying COVID-19 cases to make money and (2) more tests = more cases, the people who need to be convinced will be completely unmoved by increasing cases. Some % of them might be moved if they see significant increases in hospitalization and deaths, which will happen after the election, but I wonder even then how many would simply claim "fake news" due to misclassification by the deep state and/or money-hungry doctors.

This is going to be a long, crappy winter. BC, not sure I'd view as a positive the wide-spread uptick so it's not localized. From my viewpoint, that just means you could get many mini-NYC overloads (especially due to worse healthcare infrastructure in those areas) and less ability for migration of resources. When NYC surged, there was an inflow of highly-qualified docs from SF and other locales to supplement the local critical care staff. That's already happening in South Dakota. If there are too many of these overloads, especially with lack of fed coordination (which certainly won't change until next calendar year), we could wind up seeing Italy-like overloads and subsequent increases in death rates from the better current baseline.

RE: We're #1 !!! - dabigv13 - 10-31-2020

Agree with the above. Look, all of Europe is instituting some sort of national lockdown. We're only a couple weeks behind them in our stage of the pandemic. This being everywhere will really strain our already nonexistent federal response. This will be a bad and chaotic winter.

RE: We're #1 !!! - BostonCard - 10-31-2020

This one is for Teejers...

https://www.npr.org/sections/health-shots/2020/10/30/929239481/internal-documents-reveal-covid-19-hospitalization-data-the-government-keeps-hid

Quote: For instance, the most recent report obtained by NPR, dated Oct 27, lists cities where hospitals are filling up, including the metro areas of Atlanta, Minneapolis and Baltimore, where in-patient hospital beds are over 80% full. It also lists specific hospitals reaching max capacity, including facilities in Tampa, Birmingham and New York that are at over 95% ICU capacity and at risk of running out of intensive care beds.

Indeed it would be useful for policy making purposes at a local level if this data were widely available.

(It would also be useful to know how this compares to typical utilization rates for this time of year; maybe because I did my residency in a facility that was chronically at capacity, 80% is not shocking, but I also know that the old UCLA medical center was the exception and not the rule.)

BC

RE: We're #1 !!! - DocSavage87 - 10-31-2020

(10-31-2020, 12:46 PM)BostonCard Wrote: This one is for Teejers...

https://www.npr.org/sections/health-shots/2020/10/30/929239481/internal-documents-reveal-covid-19-hospitalization-data-the-government-keeps-hid

Quote: For instance, the most recent report obtained by NPR, dated Oct 27, lists cities where hospitals are filling up, including the metro areas of Atlanta, Minneapolis and Baltimore, where in-patient hospital beds are over 80% full. It also lists specific hospitals reaching max capacity, including facilities in Tampa, Birmingham and New York that are at over 95% ICU capacity and at risk of running out of intensive care beds.

Indeed it would be useful for policy making purposes at a local level if this data were widely available.

(It would also be useful to know how this compares to typical utilization rates for this time of year; maybe because I did my residency in a facility that was chronically at capacity, 80% is not shocking, but I also know that the old UCLA medical center was the exception and not the rule.)

BC

I also wonder how capacity is defined with respect to beds vs staffing for that bed, particularly in ICU units where patient load and severity can impact the staffing requirements. I’ve heard of some politicians playing games with those figures to show they aren’t in trouble when if you factor in illness severity, possible workers being lost due to infection, etc, they are playing a dangerous game.

RE: We're #1 !!! - oldalum - 10-31-2020

(10-30-2020, 07:17 PM)OutsiderFan Wrote: People can gripe about Dr. Cody, but history is going to show very well on her. SCC has just 1.6% positive tests over last week.

The balance between NPI restrictions and economic and social activity is in part a value judgment on which people can differ, but it is also an epidemiological/public health judgment about the risk of the infection rate getting out of control and then having to increase the level of restrictions to combat it. As Cody has said she has learned, the infection rate can rocket upward quickly, and when it does it takes a long time to bring it back down. I had been on the side of thinking she was being too conservative in opening up SCC, but now that I'm seeing what's going on in Europe and much of the rest of the U.S., I'm rethinking that. Hospital and especially ICU capacity is an absolute limit that we must avoid hitting, but I am realizing that it is not the only factor to consider. It should be kept in mind that the NPI levers are very crude, blunt, slow tools; it takes weeks to start discerning the effects of moving them, and even then the data are difficult to tie to specific restrictions.

RE: We're #1 !!! - Goose - 10-31-2020

(10-31-2020, 01:21 PM)oldalum Wrote: It should be kept in mind that the NPI levers are very crude, blunt, slow tools; it takes weeks to start discerning the effects of moving them, and even then the data are difficult to tie to specific restrictions.

Indeed this is true. It is also true that the ANNOUNCEMENT of a change in restrictions will often create a change in behavior in the populace that is not directly tied to the restrictions. Scare people a bit and they stay home. Say things are "getting better" and they go to the disco.

RE: We're #1 !!! - Farm93 - 10-31-2020

Finally, my alma mater has something more definitive on COVID than offering the USA Dr. Atlas.

When POTUS45 said he could kill someone on 5th avenue, everyone in that audience chuckled.

Imagine if he updated that and said, I could kill 700 of YOU and those of you that survive will still love me.
Ahahaha, wait??? what?!!?

https://www.sfgate.com/politics/article/Stanford-study-Trump-rallies-deaths-super-spreader-15691006.php?IPID=SFGate-HP-CP-Spotlight

RE: We're #1 !!! - BostonCard - 10-31-2020

(10-31-2020, 02:52 PM)Goose Wrote:
(10-31-2020, 01:21 PM)oldalum Wrote: It should be kept in mind that the NPI levers are very crude, blunt, slow tools; it takes weeks to start discerning the effects of moving them, and even then the data are difficult to tie to specific restrictions.
Indeed this is true. It is also true that the ANNOUNCEMENT of a change in restrictions will often create a change in behavior in the populace that is not directly tied to the restrictions. Scare people a bit and they stay home. Say things are "getting better" and they go to the disco.

Right. One other thing to consider is that policy doesn't affect the level of infections, it affects the level of growth. Unfortunately, policies seem anchored on infection levels. The problem, of course, is that you can have low levels of infection, but if infections are growing exponentially, you will eventually get an outbreak. And because of the delay between exposure and infections, one can put in draconian restrictions (as the UK just did) and not see an effect for one to two weeks.

BC

RE: We're #1 !!! - M T - 10-31-2020

Regarding where things break down, this article (behind SJ MercuryNews paywall, but probably also on NY Times or other sites)
"How Are Americans Catching the Virus? Increasingly, ‘They Have No Idea’"
brings home the point that once the virus and outbreaks get beyond a point, there is little point in contact warning (almost always misrepresented as "contact tracing"). Some communities have given up even trying.

To me, one mention early in the article is telling and worrisome:

Quote:“I was so careful,” said Denny Taylor, 45, who said he had taken exacting precautions — wearing a mask, getting groceries delivered — before he became the first in his family and among his co-workers to test positive for the virus.
Lying in a hospital bed in Omaha, Nebraska, this past week, he said he still had no idea where he caught it.

Personally, I believe that the public policies may reduce R, but they aren't stringent enough to keep you from getting the disease. Your individual risk is dependent on the level of infection in the community, and not just on your specific behavior. If the infection is 10x in the community A vs community B, your risk is 10x.

RE: We're #1 !!! - BostonCard - 11-04-2020

Meanwhile, the virus doesn't care that we had an election.

[tweet]https://twitter.com/COVID19Tracking/status/1324143873191370752?s=20[/tweet]

100,000+ new diagnoses. Hospitalizations and deaths are trailing infections, but hospitalizations are rising quickly and if trends continue (always a big if), they will surpass this summer's peak by late next week. Deaths are starting to rise, but as usual, trail new diagnoses and hospitalizations.

BC

RE: We're #1 !!! - 82 Card - 11-04-2020

Once again, worldometers.info is coming in higher at 108,389 new cases. They report 1,201 deaths.

The difference between the worldometers.info numbers and the Covid Tracking Project announcements appears to be the sum of cases that are not allocated to states of DC (i.e. US territories. US prisons, VA, DOJ, Navajo Nation) and very late updating states. Theoretically, the daily cutoff is Midnight GMT (4 pm PST). However, worldometers continues to update numbers til almost 6 pm PST. It looks like taking these numbers out gives a number close to the Covid Tracking Project post. I haven't tried this for enough days to be able to say with confidence that this is the cause of the difference. However, that's my hypothesis right now.

RE: We're #1 !!! - BostonCard - 11-05-2020

New updates and the numbers are grim.

[tweet]https://twitter.com/COVID19Tracking/status/1324504054400053248?s=20[/tweet]

We've exceeded 110,000 new cases.
Hospitalizations are rapidly approaching the summer peak.
Deaths are starting to rise.

It is easy, in the context of the election, to forget about the pandemic. It is also to become numb to the numbers. But things are deteriorating quickly, and I don't see anything to suggest we are near the peak of this wave. Based on where Europe has been headed, and the fact that we are running about two weeks behind, I could easily see us start topping 200,000 new cases daily and 2,000 deaths a day. I really truly hope that in retrospect I look back at this post and chastise myself for my doom, but to be honest, I have not felt this pessimistic about where the pandemic was headed (and all that entails, including the economic hit) since March.

BC

BC