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Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - Printable Version

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Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - Snorlax94 - 04-17-2020

With the results of the Stanford COVID-19 Antibody Seroprevalence study being released, and with a NYC Study on Universal Screening for SARS-CoV-2 in Women Admitted for Delivery adding some support to a much higher rate of infection than the confirmed cases, what does this mean for life? 

This is new information, and, if more studies support these findings, this should result in different actions.

The ease of transmission will make it even more challenging to protect the vulnerable. How are we going to protect grandparents in the same households, and seniors in assisted living centers with such a high rate of transmission? Previous studies showed swabs from Jan 1 - Feb 28 largely came up negative, so all of this happened incredibly quickly.

I think we already had the capability to protect the vulnerable as one of the conditions for lifting a Shelter-In-Place, and this means we'll have even more work to do to ensure this.

With so many asymptomatic cases, this places an even greater emphasis on mass testing. If so many cases are asymptomatic, relying on tracing people with symptoms may mean things spread widely before you realize it.

I think the positive news is that the fatality rate should be much lower than feared, and even if we take things very carefully, we'll reach herd immunity sooner.

I could see states like CA still taking things even slower for a while -- let's figure out which treatments work, let's get more testing up so more people can be tested and get proven treatments early. Plus the bar to protect the vulnerable just got a lot higher.

But on the flipside, I do see the chance of more things opening up later this year. Maybe kids on campuses and kids in school is more likely this fall or next January. We may hit herd immunity before the general population can be vaccinated, with fewer deaths than previously feared.

RE: Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - 2006alum - 04-17-2020

I would not start taking social action based on the Stanford test. As I stated elsewhere, their estimated IFR was .12% to .2%, which would imply that with a 100% prevalence among NYC's 8.39m people, you'd expect between 10,000 and 16,700 deaths if every single person was infected. NYC already has reported nearly 12,000 deaths, so unless you think NYC's prevalence rate is near 75%, something is off with that estimate, and the low end of the range has already been proven to contradict reality. Let alone Italy, Spain, etc. 

Given that they are extrapolating from 50 positive tests out of 3,330 total tested, and do not attempt to account for bias in who would seek out a free test, I am skeptical that this is worth the attention it is getting. Here's another helpful skeptical thread on that study that show hows the math in their estimates literally defies reality:

[tweet]https://twitter.com/foxjust/status/1251202203597111298?s=20[/tweet]

RE: Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - oldalum - 04-17-2020

Seems like a lost opportunity: they could have spent more time and resources, such as with the help of the County, and obtained a more representative random sample of the population that would have had more generalizability and usefulness. But maybe they really just wanted to see how the test would perform in the field, and then they tried to do some statistical gymnastics to do an extrapolation.

RE: Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - 2006alum - 04-17-2020

One of the co-authors had also previously and very publicly staked his reputation on COVID-19 being no more virulent than the flu, so one also wonders what precisely they were hoping to find...

RE: Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - burger - 04-17-2020

I'm away from my computer and can't verify this now, but if true, this is a fatal critique of the paper:

[tweet]https://twitter.com/spence_jeffrey_/status/1251217544288931840?s=19[/tweet]

(Stanford postdoc, too, per the Twitter bio)

RE: Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - BostonCard - 04-17-2020

Another thing that doesn’t make sense... the rate of antibody positive people in Santa Clara is on par with that of Wuhan.

https://www.wsj.com/articles/wuhan-starts-testing-to-determine-level-of-immunity-from-coronavirus-11587039175?emailToken=9f6bdb66cc96aabb0d89f341916097e971FzuLpEX7i2YOU92CbRHooD3WvCIjcvvJMcktdlTZMODxbrGEyItyK/1gRKqg0urFmvifmKK6Rll6lxqalGnI7+MT6CoVisIaZXoFNSYbRlZyVglfMw5c+MMiw79MTcSSgqylZ1mok3CN6jJa4a0g%3D%3D&reflink=article_copyURL_share

(Sorry if paywalled)

Quote:Wuhan’s Zhongnan Hospital found that 2.4% of its employees and 2% to 3% of recent patients and other visitors, including people tested before returning to work, had developed antibodies, according to senior doctors there.


Note I haven’t looked at the methodology.

BC

RE: Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - JustAnotherFan - 04-18-2020

(04-17-2020, 02:48 PM)Snorlax94 Wrote:  With the results of the Stanford COVID-19 Antibody Seroprevalence study being released, and with a NYC Study on Universal Screening for SARS-CoV-2 in Women Admitted for Delivery adding some support to a much higher rate of infection than the confirmed cases, what does this mean for life? 

This is new information, and, if more studies support these findings, this should result in different actions.

The ease of transmission will make it even more challenging to protect the vulnerable. How are we going to protect grandparents in the same households, and seniors in assisted living centers with such a high rate of transmission? Previous studies showed swabs from Jan 1 - Feb 28 largely came up negative, so all of this happened incredibly quickly.

I think we already had the capability to protect the vulnerable as one of the conditions for lifting a Shelter-In-Place, and this means we'll have even more work to do to ensure this.

With so many asymptomatic cases, this places an even greater emphasis on mass testing. If so many cases are asymptomatic, relying on tracing people with symptoms may mean things spread widely before you realize it.

I think the positive news is that the fatality rate should be much lower than feared, and even if we take things very carefully, we'll reach herd immunity sooner.

I could see states like CA still taking things even slower for a while -- let's figure out which treatments work, let's get more testing up so more people can be tested and get proven treatments early. Plus the bar to protect the vulnerable just got a lot higher.

But on the flipside, I do see the chance of more things opening up later this year. Maybe kids on campuses and kids in school is more likely this fall or next January. We may hit herd immunity before the general population can be vaccinated, with fewer deaths than previously feared.

If true this will have the very unfortunate effect of people saying, "yeah, we were right, the fatality rate is so low that we need to stop worrying about it -- it's just like the flu! We can't let it ruin our economy!"

Of course it is not just like the flu. The consequences of getting it are horrible for certain segments of the population and going back to work without all the testing, tracing, isolation, especially with such a high spread among people who are asymptomatic, is going to lead to many more deaths. But when you divide by 360 million people you can turn all those deaths into a statistic.

"The death of one man: that is a catastrophe. One hundred thousand deaths: that is a statistic!"
(04-17-2020, 03:16 PM)2006alum Wrote:  I would not start taking social action based on the Stanford test. As I stated elsewhere, their estimated IFR was .12% to .2%, which would imply that with a 100% prevalence among NYC's 8.39m people, you'd expect between 10,000 and 16,700 deaths if every single person was infected. NYC already has reported nearly 12,000 deaths, so unless you think NYC's prevalence rate is near 75%, something is off with that estimate, and the low end of the range has already been proven to contradict reality. Let alone Italy, Spain, etc. 

Given that they are extrapolating from 50 positive tests out of 3,330 total tested, and do not attempt to account for bias in who would seek out a free test, I am skeptical that this is worth the attention it is getting. Here's another helpful skeptical thread on that study that show hows the math in their estimates literally defies reality:

[tweet]https://twitter.com/foxjust/status/1251202203597111298?s=20[/tweet]

Stanford as an adjective is becoming problematic these days. The Stanford study. The Stanford Prison Experiment. The Stanford band. The Stanford rapist. 

Can we do anything to reverse this trend of associating Stanford with negative perception? (Of course I think the band is great -- but grandpa in Iowa doesn't agree).

RE: Is it time to discuss: What does a much higher transmissibility, lower IFR mean? - Snorlax94 - 04-18-2020

I’ve been reading many criticisms about the massaging of the data and selection bias in the Seroprevalence Study.

So let’s say due to the flaws the multiplier is not 40-80x.  Let’s say it’s more in the neighborhood of 15-25x.

I am not advocating re-opening. If NYC now has significant immunity (15%? 20%). I don’t think they want to go through what they went through 3 or 4 more times.

But there are significant implications. A 15-25x is still a lot higher than I thought it would be. If say 2% of the local Santa Clara County population is immune, you can conceive of say, shifting immune healthcare workers to work at senior assisted living facilities in a way that would have been less practical if only .1% of the population had immunity (if in fact antibodies confer immunity).