[2006alum]

And here's one comparing the death rate across countries as of today, and noting how it's not a biological constant and depends on a variety of factors. Nonetheless, in all but a few countries with very good healthcare systems and very prepared governments, it is alarmingly high:

[tweet]https://twitter.com/Vaccinologist/status/1237017138184978433?s=20[/tweet]

[2006alum]

And here's one comparing the death rate across countries as of today, and noting how it's not a biological constant and depends on a variety of factors. Nonetheless, in all but a few countries with very good healthcare systems and very prepared governments, it is alarmingly high:

[tweet]https://twitter.com/Vaccinologist/status/1237017138184978433?s=20[/tweet]

[BostonCard]

And here's one comparing the death rate across countries as of today, and noting how it's not a biological constant and depends on a variety of factors. Nonetheless, in all but a few countries with very good healthcare systems and very prepared governments, it is alarmingly high:

[tweet]https://twitter.com/Vaccinologist/status/1237017138184978433?s=20[/tweet]

I agree, but one additional consideration is the degree to which the total cases are accurate.  You have confidence in South Korea's death rate given the number of tests they have sent out.  I'm less confident of the US's numbers given the general lack of testing.

BC

[BostonCard]

And here's one comparing the death rate across countries as of today, and noting how it's not a biological constant and depends on a variety of factors. Nonetheless, in all but a few countries with very good healthcare systems and very prepared governments, it is alarmingly high:

[tweet]https://twitter.com/Vaccinologist/status/1237017138184978433?s=20[/tweet]

I agree, but one additional consideration is the degree to which the total cases are accurate.  You have confidence in South Korea's death rate given the number of tests they have sent out.  I'm less confident of the US's numbers given the general lack of testing.

BC

[burger]

Italy death rates so far.  The usual caveats about limitations of testing apply (as in: these are probably correct only up to some multiplicative constant.), but these seem consistent with what China has reported.

[burger]

Italy death rates so far.  The usual caveats about limitations of testing apply (as in: these are probably correct only up to some multiplicative constant.), but these seem consistent with what China has reported.

[2006alum]

I agree, but one additional consideration is the degree to which the total cases are accurate.  You have confidence in South Korea's death rate given the number of tests they have sent out.  I'm less confident of the US's numbers given the general lack of testing.

BC

Per this spreadsheet, Italy has tested over 53,000 and had just over 9,000 positives, so 80% of tests come back negative. That makes me think Italy is doing a fairly good job of testing widely. Is there another reason to think we should lack confidence in Italy's death rate? 

[tweet]https://twitter.com/Dr_FarrisD/status/1237098779456819201?s=20[/tweet]

[2006alum]

I agree, but one additional consideration is the degree to which the total cases are accurate.  You have confidence in South Korea's death rate given the number of tests they have sent out.  I'm less confident of the US's numbers given the general lack of testing.

BC

Per this spreadsheet, Italy has tested over 53,000 and had just over 9,000 positives, so 80% of tests come back negative. That makes me think Italy is doing a fairly good job of testing widely. Is there another reason to think we should lack confidence in Italy's death rate? 

[tweet]https://twitter.com/Dr_FarrisD/status/1237098779456819201?s=20[/tweet]

[cardcrimson]

Watching the White House press briefing.  All they have to offer is tax cuts.

I don't even know what to say.  I work from home.  My wife works in a health care-adjacent field and sees a lot of people each day.  I'm going to suggest she quit, and we'll try to ride it out at home.  Good luck, everyone.  We'll need it.

Did I watch the same conference? One million test kits available today; four million by the end of the week. Specific community guidelines being published today, covering schools, places of employment etc. Average age of those that have perished thus far: 80 years old. Thus far, kids are more likely to die from the flu (very low rate) than the virus. There was more, but that's all I remember. Even the CNN talking head said he had confidence in the team assembled on stage.

As for tax cuts, yes there will be a payroll tax cut. But importantly, guaranteed sick leave pay to allow those that are sick to stay home and not worry about missing a paycheck. Other items as well, that I can't remember, but all to be released tomorrow.

Also, allegedly, the team had a conference call with 47 Governors today to discuss the plans for the outbreak, and to seek assistance in implementing the plans. Also, conversations with tons of stakeholders, including nursing home orgs, hospitals, travel industries, pharm cos, etc. have taken place. Seems a logical step as well.

Do I have confidence our government can save us from potential disaster? No. I've not had a lot of faith that our government can do much at all for 30 years. After the presser, I walked the dog at the local park, and headed to Safeway to stock up on non-perishable food, just in case.

[cardcrimson]

Watching the White House press briefing.  All they have to offer is tax cuts.

I don't even know what to say.  I work from home.  My wife works in a health care-adjacent field and sees a lot of people each day.  I'm going to suggest she quit, and we'll try to ride it out at home.  Good luck, everyone.  We'll need it.

Did I watch the same conference? One million test kits available today; four million by the end of the week. Specific community guidelines being published today, covering schools, places of employment etc. Average age of those that have perished thus far: 80 years old. Thus far, kids are more likely to die from the flu (very low rate) than the virus. There was more, but that's all I remember. Even the CNN talking head said he had confidence in the team assembled on stage.

As for tax cuts, yes there will be a payroll tax cut. But importantly, guaranteed sick leave pay to allow those that are sick to stay home and not worry about missing a paycheck. Other items as well, that I can't remember, but all to be released tomorrow.

Also, allegedly, the team had a conference call with 47 Governors today to discuss the plans for the outbreak, and to seek assistance in implementing the plans. Also, conversations with tons of stakeholders, including nursing home orgs, hospitals, travel industries, pharm cos, etc. have taken place. Seems a logical step as well.

Do I have confidence our government can save us from potential disaster? No. I've not had a lot of faith that our government can do much at all for 30 years. After the presser, I walked the dog at the local park, and headed to Safeway to stock up on non-perishable food, just in case.

[BostonCard]

The 10:1 ratio of hospitalized patients to deaths is about what you would expect, and doesn't suggest that Italy is inadequately set up to care for all hospitalized patients (though there are anecdotal reports of running out of ventilators).  However, pretty much everywhere else I've seen a 20% hospitalization rate, so 47% of patients being admitted to the hospital strikes me as an undercount of milder (non-hospitalized) patients, by at least a factor of 2.

By way of comparison, South Korea has tested 200,000 people and found 7500 positive; they have had 53 deaths.

Based on the strong age gradient, I can believe the death rate would be higher in Italy than in South Korea, but I'd be surprised if it was an order of magnitude higher.The median age in Italy is 45.5, compared to 41.8 in South Korea.

BC

---

Did I watch the same conference? One million test kits available today; four million by the end of the week.

I'd have a little more faith if they hadn't promised a million test kits available last week.

https://www.theatlantic.com/health/archi...us/607597/

On Monday, Stephen Hahn, the commissioner of the Food and Drug Administration, estimated that “by the end of this week, close to a million tests will be able to be performed” in the United States. On Wednesday, Vice President Mike Pence promised that “roughly 1.5 million tests” would be available this week.

The article is dated as of Friday.  It states:

California claims the highest testing capacity of any state, and has tested the most individuals so far. As of yesterday afternoon, it had tested 516 people, with 53 positive cases, a spokesperson for the Department of Health told us. The department now has the capacity to test 6,000 people every day, and it expects that capacity to expand to 7,400 people a day starting today, the spokesperson said.

Even at 10,000 tests per day in California, and extrapolating it to the whole of the US, I only get to 80,000 tests per day.  Not sure how you go from that to 4 million tests.  And even within California, there appears to be a chasm between the number of people tested (a shade over 500) and the capacity to test, which makes me wonder if the availability of test kits is only a small part of the story.

I would be shocked if by the end of the week we have even a fraction of the 1 million tests "available" translated into people tested.

BC

[BostonCard]

The 10:1 ratio of hospitalized patients to deaths is about what you would expect, and doesn't suggest that Italy is inadequately set up to care for all hospitalized patients (though there are anecdotal reports of running out of ventilators).  However, pretty much everywhere else I've seen a 20% hospitalization rate, so 47% of patients being admitted to the hospital strikes me as an undercount of milder (non-hospitalized) patients, by at least a factor of 2.

By way of comparison, South Korea has tested 200,000 people and found 7500 positive; they have had 53 deaths.

Based on the strong age gradient, I can believe the death rate would be higher in Italy than in South Korea, but I'd be surprised if it was an order of magnitude higher.The median age in Italy is 45.5, compared to 41.8 in South Korea.

BC

---

Did I watch the same conference? One million test kits available today; four million by the end of the week.

I'd have a little more faith if they hadn't promised a million test kits available last week.

https://www.theatlantic.com/health/archi...us/607597/

On Monday, Stephen Hahn, the commissioner of the Food and Drug Administration, estimated that “by the end of this week, close to a million tests will be able to be performed” in the United States. On Wednesday, Vice President Mike Pence promised that “roughly 1.5 million tests” would be available this week.

The article is dated as of Friday.  It states:

California claims the highest testing capacity of any state, and has tested the most individuals so far. As of yesterday afternoon, it had tested 516 people, with 53 positive cases, a spokesperson for the Department of Health told us. The department now has the capacity to test 6,000 people every day, and it expects that capacity to expand to 7,400 people a day starting today, the spokesperson said.

Even at 10,000 tests per day in California, and extrapolating it to the whole of the US, I only get to 80,000 tests per day.  Not sure how you go from that to 4 million tests.  And even within California, there appears to be a chasm between the number of people tested (a shade over 500) and the capacity to test, which makes me wonder if the availability of test kits is only a small part of the story.

I would be shocked if by the end of the week we have even a fraction of the 1 million tests "available" translated into people tested.

BC

[Goose]

I believe I recall somebody on this thread complaining that the US didn't use the "WHO test" for COVID-19. I can't find that post now, but in any case I think it is real interesting to look at https://www.who.int/emergencies/diseases...y-guidance. It shows what many, but not all (no Korea and no Italy) are using for testing. As expected, while there are common elements, all the tests are different. This is an example of the old saying that if you give a problem to N experts you will get 2 ** N solutions. The WHO suggests that countries that are not sure of themselves send the first 5 positive tests to the WHO for validation, but they don't disclose their own test, at least on this web page.

All these testing protocols have their strengths and weaknesses for sure. As the WHO points out, none of them are "validated". It is clear the CDC was worried about false positives and wanted a smaller target than the entire N gene. That may have been a wise decision, but they messed up the execution. I would imagine that each nation took into account what primers it could obtain quickly in adequate quantity that were clinical grade etc. That could lead to different approaches all by itself. This list doesn't include the different protocols developed at Stanford and other such institutions.

Some have called for "listening to the scientists". However, as the varied test show, science speaks with many sometimes disparate voices. Further, the CDC problem was more bio-engineering than science. The test may have been fine, the execution was not.

[Goose]

I believe I recall somebody on this thread complaining that the US didn't use the "WHO test" for COVID-19. I can't find that post now, but in any case I think it is real interesting to look at https://www.who.int/emergencies/diseases...y-guidance. It shows what many, but not all (no Korea and no Italy) are using for testing. As expected, while there are common elements, all the tests are different. This is an example of the old saying that if you give a problem to N experts you will get 2 ** N solutions. The WHO suggests that countries that are not sure of themselves send the first 5 positive tests to the WHO for validation, but they don't disclose their own test, at least on this web page.

All these testing protocols have their strengths and weaknesses for sure. As the WHO points out, none of them are "validated". It is clear the CDC was worried about false positives and wanted a smaller target than the entire N gene. That may have been a wise decision, but they messed up the execution. I would imagine that each nation took into account what primers it could obtain quickly in adequate quantity that were clinical grade etc. That could lead to different approaches all by itself. This list doesn't include the different protocols developed at Stanford and other such institutions.

Some have called for "listening to the scientists". However, as the varied test show, science speaks with many sometimes disparate voices. Further, the CDC problem was more bio-engineering than science. The test may have been fine, the execution was not.

[UltimateCard]

We can see what’s coming...and it’s not good (basically the U.S. is 11.5 days behind Italy. Only Japan has managed to flatten the curve)
[tweet]https://twitter.com/MarkJHandley/status/1237144386569416712[/tweet]
(Argh! can’t figure out to show tweet)

[UltimateCard]

We can see what’s coming...and it’s not good (basically the U.S. is 11.5 days behind Italy. Only Japan has managed to flatten the curve)
[tweet]https://twitter.com/MarkJHandley/status/1237144386569416712[/tweet]
(Argh! can’t figure out to show tweet)

[Goose]

One might wonder why not just test everybody (assuming that was possible) ? The problem is that these tests have limited sensitivity. Someone could have the virus but not at a high enough level for the test to detect it. They aren't sick now but will be later. That is also why immediately testing everybody right after they are exposed to the virus somehow will miss lots of people who will actually get sick. It is just a waste of effort. Since these are new tests, we really don't know what the sensitivity is and how soon after exposure the test will pick up active disease. We probably know more than we did before, but since we use a different test than China used, YMMV. Deciding who to test and when to test is not a simple as it may first appear.

[Goose]

One might wonder why not just test everybody (assuming that was possible) ? The problem is that these tests have limited sensitivity. Someone could have the virus but not at a high enough level for the test to detect it. They aren't sick now but will be later. That is also why immediately testing everybody right after they are exposed to the virus somehow will miss lots of people who will actually get sick. It is just a waste of effort. Since these are new tests, we really don't know what the sensitivity is and how soon after exposure the test will pick up active disease. We probably know more than we did before, but since we use a different test than China used, YMMV. Deciding who to test and when to test is not a simple as it may first appear.

[OutsiderFan]

We can see what’s coming...and it’s not good (basically the U.S. is 11.5 days behind Italy. Only Japan has managed to flatten the curve)
https://mobile.twitter.com/MarkJHandley/...6569416712
(Argh! can’t figure out to show tweet)

South Korea flattened the curve by mass testing and texting people with x distance of a confirmed case every time it happened. Japan is FOS. They aren’t testing hardly at all and trying to keep its numbers down because it doesn’t want the Olympics cancelled. 

Singapore, Hong Kong, and Taiwan have done very well to stop spread in part because of complete transparency about data and also based on being prepared by learning from SARS outbreak.

[OutsiderFan]

We can see what’s coming...and it’s not good (basically the U.S. is 11.5 days behind Italy. Only Japan has managed to flatten the curve)
https://mobile.twitter.com/MarkJHandley/...6569416712
(Argh! can’t figure out to show tweet)

South Korea flattened the curve by mass testing and texting people with x distance of a confirmed case every time it happened. Japan is FOS. They aren’t testing hardly at all and trying to keep its numbers down because it doesn’t want the Olympics cancelled. 

Singapore, Hong Kong, and Taiwan have done very well to stop spread in part because of complete transparency about data and also based on being prepared by learning from SARS outbreak.

[M T]

[tweet]https://twitter.com/Vaccinologist/status/1237017138184978433?s=20[/tweet]

Sorry, but those numbers are BS, (bad science, if you must).  They are including those that showed up with the disease yesterday.  Well, duh, they haven't had time to die or survive and shouldn't be in the denominator.

For instance, the numbers say 3K dead out of 80K in China.
On Mar 9, China reports
"As of 24:00 on March 8, the National Health Commission had received 80,735 reports of confirmed cases and 3,119 deaths in 31 provincial-level regions on the Chinese mainland and the Xinjiang Production and Construction Corps, and in all 58,600 patients had been cured and discharged from hospital. There still remained 19,016 confirmed cases (including 5,111 in serious condition) and 421 suspected cases."

The correct calculation for outcome (as someone else on the board reminded us a few days ago):  deaths/(deaths + survived),
which for China for that date is 3119/(3119+58600) = 3119/61719 (5.1%)  Not 3120/80739.

For South Korea, using the numbers from GISAID, there have been 53 deaths, 118 cured, 7478 cases.  The death rate is 53/(53+118) = 31%, not 53/7478.

Yes, the numbers calculated this way seem (and probably are) high.  When you don't catch the disease early, you're going to have a bunch of deaths early.  But it is bad science to say that CFR should be calculated as if all the active cases will recover.   If you want to talk about the 1918 flu, then, sure, deaths/cases = deaths/(deaths + cured).  But not in an active outbreak, unless your CFR is near 0.

That person's numbers are more a reflection of the (lack of) maturity of the disease (and its detection) in the various regions.

[M T]

[tweet]https://twitter.com/Vaccinologist/status/1237017138184978433?s=20[/tweet]

Sorry, but those numbers are BS, (bad science, if you must).  They are including those that showed up with the disease yesterday.  Well, duh, they haven't had time to die or survive and shouldn't be in the denominator.

For instance, the numbers say 3K dead out of 80K in China.
On Mar 9, China reports
"As of 24:00 on March 8, the National Health Commission had received 80,735 reports of confirmed cases and 3,119 deaths in 31 provincial-level regions on the Chinese mainland and the Xinjiang Production and Construction Corps, and in all 58,600 patients had been cured and discharged from hospital. There still remained 19,016 confirmed cases (including 5,111 in serious condition) and 421 suspected cases."

The correct calculation for outcome (as someone else on the board reminded us a few days ago):  deaths/(deaths + survived),
which for China for that date is 3119/(3119+58600) = 3119/61719 (5.1%)  Not 3120/80739.

For South Korea, using the numbers from GISAID, there have been 53 deaths, 118 cured, 7478 cases.  The death rate is 53/(53+118) = 31%, not 53/7478.

Yes, the numbers calculated this way seem (and probably are) high.  When you don't catch the disease early, you're going to have a bunch of deaths early.  But it is bad science to say that CFR should be calculated as if all the active cases will recover.   If you want to talk about the 1918 flu, then, sure, deaths/cases = deaths/(deaths + cured).  But not in an active outbreak, unless your CFR is near 0.

That person's numbers are more a reflection of the (lack of) maturity of the disease (and its detection) in the various regions.

[burger]

Any claims by the white House/CDC about a million tests are a complete fabrication: https://www.theatlantic.com/health/archi...rs/607714/

Heck, they haven't even tested all of those poor people in the WA nursing home yet.  Testing has been an epic fail so far.

[burger]

Any claims by the white House/CDC about a million tests are a complete fabrication: https://www.theatlantic.com/health/archi...rs/607714/

Heck, they haven't even tested all of those poor people in the WA nursing home yet.  Testing has been an epic fail so far.

[82 Card]

Well, if we make the NCAA tourney, I just hope we don't get a first round game against Siena...

NIT invitation might be a problem too. Madison Square Garden is not far from Westchester County.

[82 Card]

Well, if we make the NCAA tourney, I just hope we don't get a first round game against Siena...

NIT invitation might be a problem too. Madison Square Garden is not far from Westchester County.

[BostonCard]

And this note that a patient who was positive with coronavirus went to a BYU basketball game:

https://www.sltrib.com/news/education/20...ronavirus/

It seems a bit cavalier to assume only the 10 or so people next to him were at risk.  Like, the person scanning his ticket couldn't have gotten it?  He didn't use the concession stand and hand someone a credit card?

Agree these are all fairly low risk individually, but if you have bunch of low risk events, cummulatively chances are you might see an infection.

BC

[BostonCard]

And this note that a patient who was positive with coronavirus went to a BYU basketball game:

https://www.sltrib.com/news/education/20...ronavirus/

It seems a bit cavalier to assume only the 10 or so people next to him were at risk.  Like, the person scanning his ticket couldn't have gotten it?  He didn't use the concession stand and hand someone a credit card?

Agree these are all fairly low risk individually, but if you have bunch of low risk events, cummulatively chances are you might see an infection.

BC

[Erika]

No wonder this spreads so fast. Sorry if this has been stated elsewhere.

https://www.journalofhospitalinfection.c...3/abstract

Conclusion:
Human coronaviruses can remain infectious on inanimate surfaces for up to 9 days. Surface disinfection with 0.1% sodium hypochlorite or 62e71% ethanol significantly reduces coronavirus infectivity on surfaces within 1 min exposure time. We expect a similar effect against the SARS-CoV-2.

[Erika]

No wonder this spreads so fast. Sorry if this has been stated elsewhere.

https://www.journalofhospitalinfection.c...3/abstract

Conclusion:
Human coronaviruses can remain infectious on inanimate surfaces for up to 9 days. Surface disinfection with 0.1% sodium hypochlorite or 62e71% ethanol significantly reduces coronavirus infectivity on surfaces within 1 min exposure time. We expect a similar effect against the SARS-CoV-2.

[M T]

ubject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic.


3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.

I will suggest you use your non-primary hand (left, if you are right handed) to open a door, or if you have to touch any surface.  You are less likely (IMO) to touch your face with that one.  I carry a pocket full of tissues for when I have to touch something.

In private email here, another member indicated he uses only a non-contact pay system (Apple Pay or Google Pay).  Avoid handing your credit card to anyone as it may be contaminated when you take it back, and then you stick it in your wallet.

---

Per this spreadsheet, Italy has tested over 53,000 and had just over 9,000 positives, so 80% of tests come back negative. That makes me think Italy is doing a fairly good job of testing widely. Is there another reason to think we should lack confidence in Italy's death rate?

See BostonCard's reply (#133) when I quoted that in one province in China, they tested 320,000 and 99.5% came back negative.

[M T]

ubject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic.


3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.

I will suggest you use your non-primary hand (left, if you are right handed) to open a door, or if you have to touch any surface.  You are less likely (IMO) to touch your face with that one.  I carry a pocket full of tissues for when I have to touch something.

In private email here, another member indicated he uses only a non-contact pay system (Apple Pay or Google Pay).  Avoid handing your credit card to anyone as it may be contaminated when you take it back, and then you stick it in your wallet.

---

Per this spreadsheet, Italy has tested over 53,000 and had just over 9,000 positives, so 80% of tests come back negative. That makes me think Italy is doing a fairly good job of testing widely. Is there another reason to think we should lack confidence in Italy's death rate?

See BostonCard's reply (#133) when I quoted that in one province in China, they tested 320,000 and 99.5% came back negative.

[2006alum]

To that end, [the County of] Santa Clara is banning events with more than 1,000 attendants through early April. As this ESPN story notes, that makes it unclear whether the Sharks' home games will be played in an empty arena when they return from a three-game road trip late next week. Is it just me, or does that concern suddenly seem like someone playing a pretty dang freakin' tiny violin?

[2006alum]

To that end, [the County of] Santa Clara is banning events with more than 1,000 attendants through early April. As this ESPN story notes, that makes it unclear whether the Sharks' home games will be played in an empty arena when they return from a three-game road trip late next week. Is it just me, or does that concern suddenly seem like someone playing a pretty dang freakin' tiny violin?

[magnus]

The issue isn't the 1 million tests.  We could have 10 million.  We just don't have the system in place to distribute and use them. 

UW has the capacity to do 1000+ tests a day.  Yet, they did under 500 yesterday and the Life Care Center (just a short drive away) hasn't tested all their residents and don't plan to test their asymptomatic staff.

[magnus]

The issue isn't the 1 million tests.  We could have 10 million.  We just don't have the system in place to distribute and use them. 

UW has the capacity to do 1000+ tests a day.  Yet, they did under 500 yesterday and the Life Care Center (just a short drive away) hasn't tested all their residents and don't plan to test their asymptomatic staff.

[akiddoc]

I'm waiting to see what Stanford is going to do with their new test. Not sure what their testing capacity is going to be. I'm going to be texting my personal physician tomorrow to see what he can do to get me tested at Stanford if I get sick. Kind of important to know what I have in that situation due to the nature of my work.

[akiddoc]

I'm waiting to see what Stanford is going to do with their new test. Not sure what their testing capacity is going to be. I'm going to be texting my personal physician tomorrow to see what he can do to get me tested at Stanford if I get sick. Kind of important to know what I have in that situation due to the nature of my work.

[akiddoc]

UC Berkeley, Princeton, Columbia, Ohio State, and many others going to online classes only.

[akiddoc]

UC Berkeley, Princeton, Columbia, Ohio State, and many others going to online classes only.