This Overlooked Variable is the Key to the Pandemic

This Overlooked Variable is the Key to the Pandemic - Printable Version

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This Overlooked Variable is the Key to the Pandemic - DocSavage87 - 10-16-2020

Have been visiting sporadically so not sure if this article got posted elsewhere:
https://www.theatlantic.com/health/archive/2020/09/k-overlooked-variable-driving-pandemic/616548/

Some interesting stuff there, particularly the distinction between deterministic vs stochastic disease patterns. There's been some cool studies where they deduce how people get infected by viral genomic analysis. It allows them to determine the likelihood that people got it at a work site (e.g., a meat packing plant) versus getting it from the general community. In part, this works because there have been so many reintroductions of the SARS-CoV-2 from different origins and the prevalence is so high now in some communities. What a sad state we are in the US.

I also get tired of the constant pushing of Sweden as justification for reckless stupidity by a vast number of Americans. They ignore the large scale morbidity and mortality happening right here and describe some alternative reality as if we are Sweden. The article points out a lot of reasons why we are nothing like Sweden, not the least of which are limits on gathering sizes, social distancing, and differences in school reopenings. It doesn't talk about other differences like less poverty and universal sick leave that allows those who happen to be symptomatic to take 2-4 weeks off with pay.

Quote:Once we recognize super-spreading as a key lever, countries that look as if they were too relaxed in some aspects appear very different, and our usual polarized debates about the pandemic are scrambled, too. Take Sweden, an alleged example of the great success or the terrible failure of herd immunity without lockdowns, depending on whom you ask. In reality, although Sweden joins many other countries in failing to protect elderly populations in congregate-living facilities, its measures that target super-spreading have been stricter than many other European countries. Although it did not have a complete lockdown, as Kucharski pointed out to me, Sweden imposed a 50-person limit on indoor gatherings in March, and did not remove the cap even as many other European countries eased such restrictions after beating back the first wave. (Many are once again restricting gathering sizes after seeing a resurgence.) Plus, the country has a small household size and fewer multigenerational households compared with most of Europe, which further limits transmission and cluster possibilities. It kept schools fully open without distancing or masks, but only for children under 16, who are unlikely to be super-spreaders of this disease. Both transmission and illness risks go up with age, and Sweden went all online for higher-risk high-school and university students—the opposite of what we did in the United States. It also encouraged social-distancing, and closed down indoor places that failed to observe the rules. From an overdispersion and super-spreading point of view, Sweden would not necessarily be classified as among the most lax countries, but nor is it the most strict. It simply doesn’t deserve this oversize place in our debates assessing different strategies.

RE: This Overlooked Variable is the Key to the Pandemic - oregontim - 10-16-2020

Good post, thanks. That's a useful discussion. I like your summary too, because you seem to pick out a key nugget from a pretty dense article.

RE: This Overlooked Variable is the Key to the Pandemic - M T - 10-16-2020

(10-16-2020, 07:10 AM)DocSavage87 Wrote: Have been visiting sporadically so not sure if this article got posted elsewhere:

The CARDboard has a search feature. Next time, remember you can search for the URL.

It was previously brought up in two threads.
K versus R0 by JustAnotherFan
RE: lex24 by Hurlburt88

RE: This Overlooked Variable is the Key to the Pandemic - DocSavage87 - 10-16-2020

(10-16-2020, 12:04 PM)oregontim Wrote: Good post, thanks. That's a useful discussion. I like your summary too, because you seem to pick out a key nugget from a pretty dense article.

I just listened to a talk by Joe Derisi, the co-president of Chan Zuckerberg Biohub that's been doing a lot of the COVID-19 testing in the bay area. In the Q&A he emphasized a couple of points. One is the socioeconomic disparity in infection rates, particularly when they looked at particular areas of SF. The rich remote working inhabitants had very low infection rates compared to their Latin-X neighbors. So testing should be focused in those areas and made less burdensome (e.g., they shouldn't worry about their info being shared or used for non-medical reasons). But another point he made was the social net so they could take off work when they were symptomatic, because many of these people don't have the option of just calling in sick. That was one of the early things I saw in Sweden vs US -- the Swedes were quite progressive in forcing all employers to have paid sick leave and they even supplement that with government funds to cover the first day, which hadn't been covered before the pandemic began. It was also really surprising to me that they simply don't put elderly or morbidly obese people in ICUs regardless of their conditions. So the stats on ICU usage is very skewed.

RE: This Overlooked Variable is the Key to the Pandemic - oregontim - 10-16-2020

(10-16-2020, 12:30 PM)M T Wrote:
(10-16-2020, 07:10 AM)DocSavage87 Wrote: Have been visiting sporadically so not sure if this article got posted elsewhere:

The CARDboard has a search feature. Next time, remember you can search for the URL.

It was previously brought up in two threads.
K versus R0 by JustAnotherFan
RE: lex24 by Hurlburt88

Thanks MT ... I've wanted search before but didn't see it in the interface. Your post here prompted me to look harder, and I found it now, in the dropdown labeled "Forum Jump" at the right bottom ... good to know.

RE: This Overlooked Variable is the Key to the Pandemic - 82lsju - 10-16-2020

(10-16-2020, 12:34 PM)oregontim Wrote: Thanks MT ... I've wanted search before but didn't see it in the interface. Your post here prompted me to look harder, and I found it now, in the dropdown labeled "Forum Jump" at the right bottom ... good to know.

at least on a computer it is also at the top of the page along with "portal" "forum" "search" "member" "misc"

RE: This Overlooked Variable is the Key to the Pandemic - Goose - 10-16-2020

(10-16-2020, 12:34 PM)DocSavage87 Wrote: The rich remote working inhabitants had very low infection rates compared to their Latin-X neighbors. So testing should be focused in those areas and made less burdensome (e.g., they shouldn't worry about their info being shared or used for non-medical reasons). But another point he made was the social net so they could take off work when they were symptomatic, because many of these people don't have the option of just calling in sick.

While this is an issue, at least in San Mateo County a much larger issue is that often there are many other people in the household. It is impossible to isolate in that condition, even if you have sick pay. Further, the population doesn't trust the County (or government in general) enough to accept other accommodation if offered. Naturally the other people in the household are contacts and should quarantine. They also can not/do not, for the same reasons. This has been an ongoing problem all along.

RE: This Overlooked Variable is the Key to the Pandemic - DocSavage87 - 10-17-2020

Getting back to the deterministic vs stochastic / super-spreader characteristics of this pandemic, I wonder if gathering size is even more important for the US in particular. Most K-12 classes are less than 50. This is what Sweden has been limiting all gatherings to. The combo of larger gatherings / poor ventilation / indoor / close proximity with little mask wearing and longer duration -- these all are things that US does more of than other countries as far as I can tell. As the prevalence of infection increases, like happening in US now, the chances of one or more infectious people in a crowd increases. I'm pessimistic about what's going to happen this winter.

(10-16-2020, 08:58 PM)Goose Wrote:
(10-16-2020, 12:34 PM)DocSavage87 Wrote: The rich remote working inhabitants had very low infection rates compared to their Latin-X neighbors. So testing should be focused in those areas and made less burdensome (e.g., they shouldn't worry about their info being shared or used for non-medical reasons). But another point he made was the social net so they could take off work when they were symptomatic, because many of these people don't have the option of just calling in sick.
While this is an issue, at least in San Mateo County a much larger issue is that often there are many other people in the household. It is impossible to isolate in that condition, even if you have sick pay. Further, the population doesn't trust the County (or government in general) enough to accept other accommodation if offered. Naturally the other people in the household are contacts and should quarantine. They also can not/do not, for the same reasons. This has been an ongoing problem all along.

I think what you say makes a lot of sense for a deterministic spread pattern. However, I'm starting to wonder if families get it (aside from impact on elderly or susceptible members) how much this impacts the overall spread. If super-spreader events are much more significant, the biggest risk is an actively infectious person winds up in a location that's very bad -- poor ventilation, crowded, long duration, etc -- perhaps as a service worker. The worst scenario is someone who is working in nursing facilities or places like that. Kids aren't going to concerts and I would think they hang out in small groups of friends. Elderly aren't the active spreaders.

RE: This Overlooked Variable is the Key to the Pandemic - Goose - 10-17-2020

(10-17-2020, 06:17 AM)DocSavage87 Wrote:
(10-16-2020, 08:58 PM)Goose Wrote: While this is an issue, at least in San Mateo County a much larger issue is that often there are many other people in the household. It is impossible to isolate in that condition, even if you have sick pay. Further, the population doesn't trust the County (or government in general) enough to accept other accommodation if offered. Naturally the other people in the household are contacts and should quarantine. They also can not/do not, for the same reasons. This has been an ongoing problem all along.

I think what you say makes a lot of sense for a deterministic spread pattern. However, I'm starting to wonder if families get it (aside from impact on elderly or susceptible members) how much this impacts the overall spread. If super-spreader events are much more significant, the biggest risk is an actively infectious person winds up in a location that's very bad -- poor ventilation, crowded, long duration, etc -- perhaps as a service worker. The worst scenario is someone who is working in nursing facilities or places like that. Kids aren't going to concerts and I would think they hang out in small groups of friends. Elderly aren't the active spreaders.

It is beyond question that an infected person who has lots of contact with the public over a long period of time can spread the disease widely. However, at least in SMC the home setting for many infected people is poor poor ventilation, crowded, and long duration. The other people in the household often do get it under those circumstances, and many of them are the service workers you reference. Dr. Morrow is attributing 50% of the SMC county cases to this type of spread. How good a number that is I can't say, but if it is even close it is a big driver. Not "super spreader" in the sense that in a 10 person household maybe not all 10 get it, but if even 5 do, Reff is 5. That is really hard to overcome, and contact tracing won't help if people won't/can't cooperate.

RE: This Overlooked Variable is the Key to the Pandemic - Genuine Realist - 10-17-2020

(10-17-2020, 01:02 PM)Goose Wrote:
(10-17-2020, 06:17 AM)DocSavage87 Wrote:
(10-16-2020, 08:58 PM)Goose Wrote: While this is an issue, at least in San Mateo County a much larger issue is that often there are many other people in the household. It is impossible to isolate in that condition, even if you have sick pay. Further, the population doesn't trust the County (or government in general) enough to accept other accommodation if offered. Naturally the other people in the household are contacts and should quarantine. They also can not/do not, for the same reasons. This has been an ongoing problem all along.

I think what you say makes a lot of sense for a deterministic spread pattern. However, I'm starting to wonder if families get it (aside from impact on elderly or susceptible members) how much this impacts the overall spread. If super-spreader events are much more significant, the biggest risk is an actively infectious person winds up in a location that's very bad -- poor ventilation, crowded, long duration, etc -- perhaps as a service worker. The worst scenario is someone who is working in nursing facilities or places like that. Kids aren't going to concerts and I would think they hang out in small groups of friends. Elderly aren't the active spreaders.
It is beyond question that an infected person who has lots of contact with the public over a long period of time can spread the disease widely. However, at least in SMC the home setting for many infected people is poor poor ventilation, crowded, and long duration. The other people in the household often do get it under those circumstances, and many of them are the service workers you reference. Dr. Morrow is attributing 50% of the SMC county cases to this type of spread. How good a number that is I can't say, but if it is even close it is a big driver. Not "super spreader" in the sense that in a 10 person household maybe not all 10 get it, but if even 5 do, Reff is 5. That is really hard to overcome, and contact tracing won't help if people won't/can't cooperate.

It is a good article, but I could do without the reflexive US bashing. The notion that liberal sick leave policies had anything to do with this belies most of what we have been reading these past six months. So far from some Upton Sinclair notion that diseased workers were forced to stay on the assembly line while they spread contagion, my recollection was that whole businesses shut down if so much as a single worker tested positive. So I would look to the cause for discrepancies elsewhere than better unemployment insurance.

What Swedish policy, taken at its best, did do was go straight to the dynamics of social distancing that the US reached far more belatedly. What Swedish policy, taken at its worst, didn't do was make sufficient allowance for the truly vulnerable. Obviously, those two objectives are not irreconcilable. I think we are heading towards some balanced policy at this time, e.g., in distinguishing the reopening of schools for a portion of the population that badly needs the schooling and is relatively invulnerable to the worst consequences.

My own thought is that the drastic lockdown has actually impeded the march towards the best (i.e., best balanced) policy. It bred a cynicism in a fundamentally anti-authoritarian society that lingers on with regard to much more sane and sensible policy. The dreadful leadership of Trump (since early March) contributes to this, but Trump's personality is not the only factor.

Finally, the national obsession with race once again rears its ugly head in terms of distorting the inquiry. Class and labor categories matter a lot more here. I would dearly love to know what type of laborers kept our distribution systems going and what price they paid. It sure as hell wasn't computer programmers and lawyers. Joe Biden may pay tribute to the Black women who restocked the shelves, but around here they are union workers, largely Caucasian and Hispanic But race doesn't matter, or at least is distant second. I'd like to see infection rates, hospitalizations, and deaths broken down by labor and work category. I don't know if anyone has done or is doing this.

And I wonder who did this work in Sweden? And how that has worked out?

RE: This Overlooked Variable is the Key to the Pandemic - JustAnotherFan - 10-17-2020

(10-17-2020, 01:35 PM)Genuine Realist Wrote: It is a good article, but I could do without the reflexive US bashing. The notion that liberal sick leave policies had anything to do with this belies most of what we have been reading these past six months. So far from some Upton Sinclair notion that diseased workers were forced to stay on the assembly line while they spread contagion, my recollection was that whole businesses shut down if so much as a single worker tested positive.

If we ignore the super spreader sites called elder care facilities, prisons, and meat packing plants I guess you have a point.

RE: This Overlooked Variable is the Key to the Pandemic - Genuine Realist - 10-17-2020

(10-17-2020, 01:48 PM)JustAnotherFan Wrote:
(10-17-2020, 01:35 PM)Genuine Realist Wrote: It is a good article, but I could do without the reflexive US bashing. The notion that liberal sick leave policies had anything to do with this belies most of what we have been reading these past six months. So far from some Upton Sinclair notion that diseased workers were forced to stay on the assembly line while they spread contagion, my recollection was that whole businesses shut down if so much as a single worker tested positive.

If we ignore the super spreader sites called elder care facilities, prisons, and meat packing plants I guess you have a point.

Yes. The workers there would have raced away if only there had been paid worker's leave.

Do be serious. Infected persons caused whole plants to close.

RE: This Overlooked Variable is the Key to the Pandemic - magnus - 10-17-2020

(10-17-2020, 01:35 PM)Genuine Realist Wrote: My own thought is that the drastic lockdown has actually impeded the march towards the best (i.e., best balanced) policy. It bred a cynicism in a fundamentally anti-authoritarian society that lingers on with regard to much more sane and sensible policy. The dreadful leadership of Trump (since early March) contributes to this, but Trump's personality is not the only factor.

I think if we didn't have a drastic lockdown, we would have had much higher death tolls in the first wave. People would not have reacted as quickly, the virus would have had another few weeks to months to spread unencumbered which would have led to more NYCs (though perhaps not at the same extreme due to density differences). Telling people they need to social distance and wear masks is hard enough with the drastic lockdown step, but without it, a lot of the folks in the middle of the spectrum (especially those who don't pay attention to the news), would have not seen the urgency to change behavior. Closing schools and businesses is probably one of the most effective ways to reach everyone and show the serious nature rather than it being "just another flu".

If we would have had a higher initial death toll, perhaps that would have helped prevent/delay a second/nth wave, but not sure that's what we want.

RE: This Overlooked Variable is the Key to the Pandemic - DocSavage87 - 10-17-2020

(10-17-2020, 03:30 PM)Genuine Realist Wrote:
(10-17-2020, 01:48 PM)JustAnotherFan Wrote:
(10-17-2020, 01:35 PM)Genuine Realist Wrote: It is a good article, but I could do without the reflexive US bashing. The notion that liberal sick leave policies had anything to do with this belies most of what we have been reading these past six months. So far from some Upton Sinclair notion that diseased workers were forced to stay on the assembly line while they spread contagion, my recollection was that whole businesses shut down if so much as a single worker tested positive.

If we ignore the super spreader sites called elder care facilities, prisons, and meat packing plants I guess you have a point.
Yes. The workers there would have raced away if only there had been paid worker's leave.

Do be serious. Infected persons caused whole plants to close.

Do we have the same sources of information? In my world, meat plants were forced to stay open and they revised CDC recommendations to make many measures optional instead of mandatory before allowing reopening.

RE: This Overlooked Variable is the Key to the Pandemic - DocSavage87 - 10-17-2020

(10-17-2020, 01:35 PM)Genuine Realist Wrote: So I would look to the cause for discrepancies elsewhere than better unemployment insurance.

There doesn't have to be just one factor you know. It could be multi-factorial but still a significant contributor.

(10-17-2020, 01:35 PM)Genuine Realist Wrote:
What Swedish policy, taken at its best, did do was go straight to the dynamics of social distancing that the US reached far more belatedly.

*Cough*

[Image: 6ed4a6a8-25d2-44a4-b975-68bf7bb5c225.jpg]

(10-17-2020, 01:35 PM)Genuine Realist Wrote:
Finally, the national obsession with race once again rears its ugly head in terms of distorting the inquiry. Class and labor categories matter a lot more here.

RE: This Overlooked Variable is the Key to the Pandemic - Genuine Realist - 10-17-2020

(10-17-2020, 05:32 PM)DocSavage87 Wrote: [quote="Genuine Realist" pid='293675' dateline='1602966904']
So I would look to the cause for discrepancies elsewhere than better unemployment insurance.

There doesn't have to be just one factor you know. It could be multi-factorial but still a significant contributor.

(10-17-2020, 01:35 PM)Genuine Realist Wrote:
What Swedish policy, taken at its best, did do was go straight to the dynamics of social distancing that the US reached far more belatedly.

*Cough*

(10-17-2020, 01:35 PM)Genuine Realist Wrote:
Finally, the national obsession with race once again rears its ugly head in terms of distorting the inquiry. Class and labor categories matter a lot more here.

Don't disagree that more data is better and targeted testing by occupations and risk makes sense and is done (e.g., healthcare workers). However, you ignore there's a very strong overlap in many areas between race and class/labor categories. Example: the CZI Biohub surveys of particular areas of SF where even within the same neighborhood, infection rates of Latin-X are many multiples of white occupants of the same neighborhood. This could well be the "household spread" that Goose is hammering at. Single white techies don't have families where even if one of them is high tech, there's also another person in the household that has a riskier occupation.
[ please
I'm aware of the overlap, but that makes the descent (sic) even more exasperating. Are we talking about differential outcomes that are rooted in racial disparity, or ones in which race is only correlated, and class and occupational status far more important? I think the latter.

Meat packing plants responded for a time by sending workers away, as I recall. Then there was discussion of 'ordering' them to stay open. How such an order would be enforced on individual workers, I have no idea. I'm aware of no legal authority for such action, and I'm not aware that any such action was undertaken.

In any case, the situation in which Covid infected workers stayed on the job and infected others because of the unavailability of worker's leave is in my recollection non-existent. If you are aware of one, I'd be curious.

I don't know where the picture came from. I do know that Sweden instituted relatively strict social distancing measures. What it did not do was shut down the entire country. We shall see how it all works out. It is way too early to write history.

RE: This Overlooked Variable is the Key to the Pandemic - JustAnotherFan - 10-18-2020

(10-17-2020, 07:34 PM)Genuine Realist Wrote: Meat packing plants responded for a time by sending workers away, as I recall. Then there was discussion of 'ordering' them to stay open. How such an order would be enforced on individual workers, I have no idea. I'm aware of no legal authority for such action, and I'm not aware that any such action was undertaken.

In any case, the situation in which Covid infected workers stayed on the job and infected others because of the unavailability of worker's leave is in my recollection non-existent. If you are aware of one, I'd be curious.

Breaking news: undocumented workers don't get to take time off to heal up if they're sick in the midst of a pandemic.

See also low wage workers: elder care facility employees
See also low wage workers who think they're overseeing animals: corrections officers

RE: This Overlooked Variable is the Key to the Pandemic - Goose - 10-20-2020

(10-18-2020, 08:16 AM)JustAnotherFan Wrote:
(10-17-2020, 07:34 PM)Genuine Realist Wrote: Meat packing plants responded for a time by sending workers away, as I recall. Then there was discussion of 'ordering' them to stay open. How such an order would be enforced on individual workers, I have no idea. I'm aware of no legal authority for such action, and I'm not aware that any such action was undertaken.

In any case, the situation in which Covid infected workers stayed on the job and infected others because of the unavailability of worker's leave is in my recollection non-existent. If you are aware of one, I'd be curious.

Breaking news: undocumented workers don't get to take time off to heal up if they're sick in the midst of a pandemic.

Actually, some of them do. It may be without pay, because the entire business shuts down, but in any case there is often "time off". It generally doesn't matter however, because they have no place in their crowded household where the can isolate. They usually can't even quarantine because there are other people in the household who are not sick, have jobs, and therefore must go to work. The other working members of the household start shedding virus, spread the disease for a few days, become ill, get tested, and the cycle continues.
Even when the County offers a hotel room (which some do, some don't), undocumented workers (or workers who live with undocumented family members) are apparently unwilling to take it. This isn't me saying all this. this is Dr. Morrow.