[OutsiderFan]

After reporting its number today, Italy has now achieved two consecutive days of lower confirmed case growth and deaths.

March 21: +6,557 - 793 Dead
March 22: +5,560 - 651 Dead
March 23: +4,790 - 602 Dead

Lockdown is finally starting to work! Now the question is how long must it stay in place to keep spread manageable. That's only possible with testing. Hopefully the antibody test from South Korea and others like it can be mass produced so those with immunity can go back into public life and those without it can stay distanced from others.

[OutsiderFan]

After reporting its number today, Italy has now achieved two consecutive days of lower confirmed case growth and deaths.

March 21: +6,557 - 793 Dead
March 22: +5,560 - 651 Dead
March 23: +4,790 - 602 Dead

Lockdown is finally starting to work! Now the question is how long must it stay in place to keep spread manageable. That's only possible with testing. Hopefully the antibody test from South Korea and others like it can be mass produced so those with immunity can go back into public life and those without it can stay distanced from others.

[Goose]

Lockdown is finally starting to work! Now the question is how long must it stay in place to keep spread manageable. That's only possible with testing. Hopefully the antibody test from South Korea and others like it can be mass produced so those with immunity can go back into public life and those without it can stay distanced from others.

The immunity test  will be useful, but unfortunately only marginally so. It will allow people who have had the disease and have immunity to remain in the mainstream and not get quarantined if the are re-exposed. However, that is a very small percentage of the population. Right now 0.1% of the Italian population has been confirmed to have the disease. Even if there are 10 times as many silent cases out there generating immunity, the vast majority of the public will not have had the disease and will test negative for the antibody. These people will still need to be quarantined if exposed. Distancing won't cut it when a nation is trying to return to normal, as even minimal non-compliance will re-inject the disease into the general non-immune public, and here we go again. Full on quarantine will be needed in Italy and the USA because people who have been exposed but are not sick (yet) simply will not reliably self-quarantine. In Korea, you can get away with trusting people, although that almost bit them too. In a few years, maybe the general herd immunity will be high enough the antibody test will be a real good tool, but right now, not so much.

[Goose]

Lockdown is finally starting to work! Now the question is how long must it stay in place to keep spread manageable. That's only possible with testing. Hopefully the antibody test from South Korea and others like it can be mass produced so those with immunity can go back into public life and those without it can stay distanced from others.

The immunity test  will be useful, but unfortunately only marginally so. It will allow people who have had the disease and have immunity to remain in the mainstream and not get quarantined if the are re-exposed. However, that is a very small percentage of the population. Right now 0.1% of the Italian population has been confirmed to have the disease. Even if there are 10 times as many silent cases out there generating immunity, the vast majority of the public will not have had the disease and will test negative for the antibody. These people will still need to be quarantined if exposed. Distancing won't cut it when a nation is trying to return to normal, as even minimal non-compliance will re-inject the disease into the general non-immune public, and here we go again. Full on quarantine will be needed in Italy and the USA because people who have been exposed but are not sick (yet) simply will not reliably self-quarantine. In Korea, you can get away with trusting people, although that almost bit them too. In a few years, maybe the general herd immunity will be high enough the antibody test will be a real good tool, but right now, not so much.

[OutsiderFan]

Yes, but we know there is a large population that carries the virus without developing the infection. The Chinese report as many as 1/3 of population tested for the virus were positive with no symptoms. That begs the question how many were virus carriers who were never tested. I agree it will take some time to get herd immunity/vaccine, but perhaps there is a way to develop a formula to assess how many who have never developed symptoms have been virus carriers?

The NBA is a great case study. There have been I believe 8 NBA players to test positive, and to my knowledge none have developed symptoms of consequence or at all. Rudy Gobert reports losing his sense of smell as part of his symptoms, but not sure that means anything worse is coming or not. Many of these guys would never know they were infected if not tested.  Probably goes for a large percentage of the population.

[OutsiderFan]

Yes, but we know there is a large population that carries the virus without developing the infection. The Chinese report as many as 1/3 of population tested for the virus were positive with no symptoms. That begs the question how many were virus carriers who were never tested. I agree it will take some time to get herd immunity/vaccine, but perhaps there is a way to develop a formula to assess how many who have never developed symptoms have been virus carriers?

The NBA is a great case study. There have been I believe 8 NBA players to test positive, and to my knowledge none have developed symptoms of consequence or at all. Rudy Gobert reports losing his sense of smell as part of his symptoms, but not sure that means anything worse is coming or not. Many of these guys would never know they were infected if not tested.  Probably goes for a large percentage of the population.

[BostonCard]

Eventually we will have serology testing and will be able to know whether someone has developed antibodies to SARS-CoV-2 and thus was exposed to the virus without developing symptoms.

I am hopeful that the data in Italy is the start of a trend.  Around now is when you might be hopeful that the curve has bent, but I'd like to see a few more days of data to be sure, as the numbers are noisy.  At last check the trailing 7-day average daily increase was hovering between 10 and 20%; I will believe.



BC

[BostonCard]

Eventually we will have serology testing and will be able to know whether someone has developed antibodies to SARS-CoV-2 and thus was exposed to the virus without developing symptoms.

I am hopeful that the data in Italy is the start of a trend.  Around now is when you might be hopeful that the curve has bent, but I'd like to see a few more days of data to be sure, as the numbers are noisy.  At last check the trailing 7-day average daily increase was hovering between 10 and 20%; I will believe.



BC

[Goose]

Yes, but we know there is a large population that carries the virus without developing the infection. The Chinese report as many as 1/3 of population tested for the virus were positive with no symptoms.
...
Probably goes for a large percentage of the population.

Maybe, but it seems improbable to me that say 1/3 of the general population of Italy has been exposed to the virus, carried it, expressed no symptoms, could pass it on, and only 0.1% of the population so far is actually "sick". If you said even 1% of the population was in that category, it is still hard to understand how only 0.1% of the population actually got sick and did so quickly. I suspect that in pockets of active disease it could be true that 1/3 of the population has actually carried the virus, but not in the general population.

[Goose]

Yes, but we know there is a large population that carries the virus without developing the infection. The Chinese report as many as 1/3 of population tested for the virus were positive with no symptoms.
...
Probably goes for a large percentage of the population.

Maybe, but it seems improbable to me that say 1/3 of the general population of Italy has been exposed to the virus, carried it, expressed no symptoms, could pass it on, and only 0.1% of the population so far is actually "sick". If you said even 1% of the population was in that category, it is still hard to understand how only 0.1% of the population actually got sick and did so quickly. I suspect that in pockets of active disease it could be true that 1/3 of the population has actually carried the virus, but not in the general population.

[JustAnotherFan]

Does anyone have any deeper insight into what's happening in Italy that the death rate is decreasing? Have less people been turned away from hospitals because of increased capacity (e.g., beds, ventilators, medical staff)? Or has quarantine and social distancing reduced the daily infection rate which is trickling down to people being admitted, put on ventilators, and dying? Or has the most vulnerable population quickly passed leaving a lower CFR for those who still need to be admitted and put on ventilators?

[JustAnotherFan]

Does anyone have any deeper insight into what's happening in Italy that the death rate is decreasing? Have less people been turned away from hospitals because of increased capacity (e.g., beds, ventilators, medical staff)? Or has quarantine and social distancing reduced the daily infection rate which is trickling down to people being admitted, put on ventilators, and dying? Or has the most vulnerable population quickly passed leaving a lower CFR for those who still need to be admitted and put on ventilators?

[OutsiderFan]

Apparently Italy issued its countrywide lockdown order on March 9. They were told it would take 2 weeks to start showing results. That seems to have been accurate. They had their peak CEA and death increase on 3/21. What we see is spread will stop when lockdown is preserved, but it takes 1-2 weeks for most infections to present symptoms. This means after three weeks there should be very few new infections. Then the issue becomes how do you slowly wind up distancing so another wave doesn’t occur.

[OutsiderFan]

Apparently Italy issued its countrywide lockdown order on March 9. They were told it would take 2 weeks to start showing results. That seems to have been accurate. They had their peak CEA and death increase on 3/21. What we see is spread will stop when lockdown is preserved, but it takes 1-2 weeks for most infections to present symptoms. This means after three weeks there should be very few new infections. Then the issue becomes how do you slowly wind up distancing so another wave doesn’t occur.

[BostonCard]

Worth noting that cases in France appeared to be flat for four days:
1834
1598
1821
1525

And then today they got 4035 cases.
I hope you are right but the data are noisy.

BC

[BostonCard]

Worth noting that cases in France appeared to be flat for four days:
1834
1598
1821
1525

And then today they got 4035 cases.
I hope you are right but the data are noisy.

BC

[magnus]

Alas,  all it takes is a metropolitan area to flare up.

[magnus]

Alas,  all it takes is a metropolitan area to flare up.

[OutsiderFan]

Italy numbers are in for March 24:

March 21: +6,557 - 793 Dead
March 22: +5,560 - 651 Dead
March 23: +4,790 -  602 Dead

March 24 +5,249 - 743 Dead

Hopefully the numbers decrease tomorrow so we can see that curve really start bending down. Of course, we have no idea where these numbers are coming from in the country.  Maybe North is decreasing because it took lockdown measures first, and South is increasing because it delayed locking down.  That's my guess, but don't have any data to confirm this.

Here's a quote from March 22:

"We expect to see the first [b]effects of the stringent lockdown measures[/b] adopted on March 11[b] after 2-3 weeks[/b], so the [b]coming week will be absolutely crucial [/b]in this sense: [b]we expect to finally see a  sign of trend reversal[/b]," said Franco Locatelli, President of the Health Council 

[OutsiderFan]

Italy numbers are in for March 24:

March 21: +6,557 - 793 Dead
March 22: +5,560 - 651 Dead
March 23: +4,790 -  602 Dead

March 24 +5,249 - 743 Dead

Hopefully the numbers decrease tomorrow so we can see that curve really start bending down. Of course, we have no idea where these numbers are coming from in the country.  Maybe North is decreasing because it took lockdown measures first, and South is increasing because it delayed locking down.  That's my guess, but don't have any data to confirm this.

Here's a quote from March 22:

"We expect to see the first [b]effects of the stringent lockdown measures[/b] adopted on March 11[b] after 2-3 weeks[/b], so the [b]coming week will be absolutely crucial [/b]in this sense: [b]we expect to finally see a  sign of trend reversal[/b]," said Franco Locatelli, President of the Health Council 

[chrisk]

Apparently Italy issued its countrywide lockdown order on March 9. They were told it would take 2 weeks to start showing results. That seems to have been accurate. They had their peak CEA and death increase on 3/21. What we see is spread will stop when lockdown is preserved, but it takes 1-2 weeks for most infections to present symptoms. This means after three weeks there should be very few new infections. Then the issue becomes how do you slowly wind up distancing so another wave doesn’t occur.

Heavy testing like South Korea so you can then do contact tracing

[chrisk]

Apparently Italy issued its countrywide lockdown order on March 9. They were told it would take 2 weeks to start showing results. That seems to have been accurate. They had their peak CEA and death increase on 3/21. What we see is spread will stop when lockdown is preserved, but it takes 1-2 weeks for most infections to present symptoms. This means after three weeks there should be very few new infections. Then the issue becomes how do you slowly wind up distancing so another wave doesn’t occur.

Heavy testing like South Korea so you can then do contact tracing

[magnus]

Make everyone wear masks.   Even cloth ones are better than nothing.   

Will assuredly reduce the chance of transmission which will go a long way towards bending the curve.

[magnus]

Make everyone wear masks.   Even cloth ones are better than nothing.   

Will assuredly reduce the chance of transmission which will go a long way towards bending the curve.

[OutsiderFan]

Make everyone wear masks.   Even cloth ones are better than nothing.   

Will assuredly reduce the chance of transmission which will go a long way towards bending the curve.

Masks are a good idea. I'm seeing more and more people wearing them around town. 

Disclaimer: I haven't set foot in a structure with someone other than with whom I live, since Friday, March 13. I've walked by stores and seen people driving with them on or even hanging on their rear view mirror, while walking my dog.

[OutsiderFan]

Make everyone wear masks.   Even cloth ones are better than nothing.   

Will assuredly reduce the chance of transmission which will go a long way towards bending the curve.

Masks are a good idea. I'm seeing more and more people wearing them around town. 

Disclaimer: I haven't set foot in a structure with someone other than with whom I live, since Friday, March 13. I've walked by stores and seen people driving with them on or even hanging on their rear view mirror, while walking my dog.

[2006alum]

One major problem is that a lot of people don't have masks. However, here's a PSA on how (relatively) effective other easily accessible materials can be at a MacGyver-esque substitute:

[tweet]https://twitter.com/michaelzlin/status/1241052444798279680?s=20[/tweet]

[2006alum]

One major problem is that a lot of people don't have masks. However, here's a PSA on how (relatively) effective other easily accessible materials can be at a MacGyver-esque substitute:

[tweet]https://twitter.com/michaelzlin/status/1241052444798279680?s=20[/tweet]

[magnus]

One major problem is that a lot of people don't have masks. However, here's a PSA on how (relatively) effective other easily accessible materials can be at a MacGyver-esque substitute:

[tweet]https://twitter.com/michaelzlin/status/1241052444798279680?s=20[/tweet]

Completely agree with the people don't have masks issue as a major problem.  The other major issue is that masks are seen as stigmatic in US (western?) culture.  So there's both a physical barrier and a psychological barrier that needs to be cleared.

But looking at the graph, one can see that even using a cotton shirt, you will get a 50% reduction in Covid particles which hopefully translates into 50% less likely to get it, but even if not that clear cut, at least the viral load will be reduced by 50% which hopefully means your symptoms will be lessened.

Oh and the third issue is our government telling us that we shouldn't wear masks to try to avoid Covid.

[magnus]

One major problem is that a lot of people don't have masks. However, here's a PSA on how (relatively) effective other easily accessible materials can be at a MacGyver-esque substitute:

[tweet]https://twitter.com/michaelzlin/status/1241052444798279680?s=20[/tweet]

Completely agree with the people don't have masks issue as a major problem.  The other major issue is that masks are seen as stigmatic in US (western?) culture.  So there's both a physical barrier and a psychological barrier that needs to be cleared.

But looking at the graph, one can see that even using a cotton shirt, you will get a 50% reduction in Covid particles which hopefully translates into 50% less likely to get it, but even if not that clear cut, at least the viral load will be reduced by 50% which hopefully means your symptoms will be lessened.

Oh and the third issue is our government telling us that we shouldn't wear masks to try to avoid Covid.

[BostonCard]

Best use for a mask is to prevent others from getting sick if you asymptomatically have the virus.  Masks are just one part of contact precautions that healthy people ought to use to prevent infection from others who are sick.  These also include gowns, gloves, face shields and hand-washing before and after patient contacts, and (this seems quaint now) changing PPE between patients.

BC

[BostonCard]

Best use for a mask is to prevent others from getting sick if you asymptomatically have the virus.  Masks are just one part of contact precautions that healthy people ought to use to prevent infection from others who are sick.  These also include gowns, gloves, face shields and hand-washing before and after patient contacts, and (this seems quaint now) changing PPE between patients.

BC

[magnus]

Best use for a mask is to prevent others from getting sick if you asymptomatically have the virus.  Masks are just one part of contact precautions that healthy people ought to use to prevent infection from others who are sick.  These also include gowns, gloves, face shields and hand-washing before and after patient contacts, and (this seems quaint now) changing PPE between patients.

BC

Sadly, some hospitals (I know of at least one) are still prohibiting their docs from wearing masks for routine clinic visits (they worry it will scare the patients).  This includes visits where the doc is sitting within an arms length of the patient's face.  Egad!

[magnus]

Best use for a mask is to prevent others from getting sick if you asymptomatically have the virus.  Masks are just one part of contact precautions that healthy people ought to use to prevent infection from others who are sick.  These also include gowns, gloves, face shields and hand-washing before and after patient contacts, and (this seems quaint now) changing PPE between patients.

BC

Sadly, some hospitals (I know of at least one) are still prohibiting their docs from wearing masks for routine clinic visits (they worry it will scare the patients).  This includes visits where the doc is sitting within an arms length of the patient's face.  Egad!

[akiddoc]

Best use for a mask is to prevent others from getting sick if you asymptomatically have the virus.  Masks are just one part of contact precautions that healthy people ought to use to prevent infection from others who are sick.  These also include gowns, gloves, face shields and hand-washing before and after patient contacts, and (this seems quaint now) changing PPE between patients.

BC

Sadly, some hospitals (I know of at least one) are still prohibiting their docs from wearing masks for routine clinic visits (they worry it will scare the patients).  This includes visits where the doc is sitting within an arms length of the patient's face.  Egad!

Both of my jobs require a mask for every patient contact. And gloves. And if there is any symptom suggesting infection, eye protection.

[akiddoc]

Best use for a mask is to prevent others from getting sick if you asymptomatically have the virus.  Masks are just one part of contact precautions that healthy people ought to use to prevent infection from others who are sick.  These also include gowns, gloves, face shields and hand-washing before and after patient contacts, and (this seems quaint now) changing PPE between patients.

BC

Sadly, some hospitals (I know of at least one) are still prohibiting their docs from wearing masks for routine clinic visits (they worry it will scare the patients).  This includes visits where the doc is sitting within an arms length of the patient's face.  Egad!

Both of my jobs require a mask for every patient contact. And gloves. And if there is any symptom suggesting infection, eye protection.

[BostonCard]

Both of my jobs require a mask for every patient contact. And gloves. And if there is any symptom suggesting infection, eye protection.

And to be clear, this is both for your protection and for the protection of your patients. (I know you know; it's for the benefit of others).

When I was a resident, we had a patient with lupus who was so horribly immunosuppressed who developed disseminated TB (basically, her physicians thought her symptoms were due to a lupus flare so they increased her immunosuppressives, when, in fact, they were due to tuberculosis).  She was hospitalized for over a month until she could finally get her TB cleared and was no longer infectious.  Throughout the entire time, she never developed any hospital acquired infections, because every one who went into her room was religious about using PPE and washing hands, etc.  Within a week of her being declared non-infectious and of contact/airborne precautions being lifted, she developed VRE (a resistant infection).

BC

[BostonCard]

Both of my jobs require a mask for every patient contact. And gloves. And if there is any symptom suggesting infection, eye protection.

And to be clear, this is both for your protection and for the protection of your patients. (I know you know; it's for the benefit of others).

When I was a resident, we had a patient with lupus who was so horribly immunosuppressed who developed disseminated TB (basically, her physicians thought her symptoms were due to a lupus flare so they increased her immunosuppressives, when, in fact, they were due to tuberculosis).  She was hospitalized for over a month until she could finally get her TB cleared and was no longer infectious.  Throughout the entire time, she never developed any hospital acquired infections, because every one who went into her room was religious about using PPE and washing hands, etc.  Within a week of her being declared non-infectious and of contact/airborne precautions being lifted, she developed VRE (a resistant infection).

BC

[magnus]

Both of my jobs require a mask for every patient contact. And gloves. And if there is any symptom suggesting infection, eye protection.

That is very good to hear.  Wish all hospitals were like that.

[magnus]

Both of my jobs require a mask for every patient contact. And gloves. And if there is any symptom suggesting infection, eye protection.

That is very good to hear.  Wish all hospitals were like that.