totm april 2020 Coronavirus

[YNM]

27 minutes ago, sevenperforce said:

The problem is that the variance in case severity is ridiculously high. Some people are contagious and asymptomatic. Some people are contagious but their symptoms are so mild that they think it’s just allergies and they’re spreading it like crazy. Some people are dead in under a week with no pre-existing conditions.

Yeah, honestly this is my problem as well, I mean if it's a russian roulette just on getting it it's fine, but this is like a two-tier russian roulette. Does case severity variance signals that there're actually a lot of types and strains of the virus or not ? Would a lot of variants means that innate immune response might not be enough to stop the other variants ? Why haven't one strain overruled the others ? Or is the winning strain highly mutable ? Does it mean it'll be the new influenza ? Etc etc.

 

14 minutes ago, Boyster said:

I am not against vaccines i am just extra scared of these fast track ones and all the mixed signals we get from various countries.

I mean, the only other alternative is you having to catch it in the first place to even hope to be immune at all...

[Serenity]

35 minutes ago, YNM said:

I mean, the only other alternative is you having to catch it in the first place to even hope to be immune at all...

If someone who has fresh anti bodies of the virus gets vaccinated does he get double the immunity or it doesn't make a difference with someone that hasn't?

[sevenperforce]

13 hours ago, Boyster said:

If someone who has fresh anti bodies of the virus gets vaccinated does he get double the immunity or it doesn't make a difference with someone that hasn't?

We don't know yet what sort of natural immunity is conferred by infection. We also don't know the dependency of mutagenic rate on immunity.

There are certain things like strep that most people will never be immune to. Strep is a very hardy bacteria that must be beaten down with antibiotics before the immune system can really deal with it. As a result, even if you have strep antibodies, your immune system cannot defeat it faster than it duplicates and so you can be reinfected. Before the invention of antibiotics, strep throat could be fatal or could progress to scarlet fever. My ex actually ignored her strep throat (at age 26!!) long enough that it became scarlet fever...one of the first scarlet fever cases her doctor had ever seen in an adult. If you beat scarlet fever without antibiotics, you are immune to strep for life. You're probably also scarred for life, but that's another matter.

Flu antibodies last a lifetime. However, flu mutates so fast (and each flu season contains multiple flu strains) that immunity does not last longer than a single flu season, because your antibodies are only useful against a single strain. The flu vaccine is effective because it stimulates antibody production for a wide variety of strains at once, although it is still not 100% effective.

So what about COVID? A SARS-CoV-2 infection certainly produces antibodies, but will the antibodies for one strain work against other strains? SARS-CoV-2 mutates fairly quickly but none of the mutations have been shown to be very significant, so it's possible that the antibodies protect you against other strains. Alternately, they may provide partial protection...meaning you will still contract a new strain, but your symptoms will be minor, just like how the flu vaccine can reduce the severity of influenza even if you catch it. Unfortunately, with something as virulent as this virus, an asymptomatic or mild-symptom case increases your risk of spreading it to other people.

One of my early theories (which I still think seems probable) is that people with past exposure to mild coronaviruses (like the common cold) had partial protection against SARS-CoV-2. As a result, they had mild symptoms or no symptoms, and recovered quickly but spread the virus rapidly. This explains the huge variance in symptomaticity and why resistance seemed to be "clustered" in certain groups.

An effective vaccine would confer broad protection against all known strains, so you should still get the vaccine even if you have recently had COVID and recovered.

[Serenity]

16 minutes ago, sevenperforce said:

SARS-CoV-2 mutates fairly quickly but none of the mutations have been shown to be very significant, so it's possible that the antibodies protect you against other strains. 

But isn't that too soon to tell? In the time scale of mutating viruses don't we need way more time to actually tell how different the mutations will be?

I am afraid by the time we know most of the vaccines will be produced and be ready for consumption and whatever the result is we might actually do a vaccine that does almost nothing.

[sevenperforce]

3 minutes ago, Boyster said:

But isn't that too soon to tell? In the time scale of mutating viruses don't we need way more time to actually tell how different the mutations will be?

I am afraid by the time we know most of the vaccines will be produced and be ready for consumption and whatever the result is we might actually do a vaccine that does almost nothing.

Research to date shows that the mutation rate of SARS-CoV-2 does not adversely impact vaccine efficacy.

https://www.newswise.com/coronavirus/potential-covid-19-vaccines-not-affected-by-dominant-g-strain

There are two major strains, D-strain and G-strain. The initial vaccines were developed on D-strain but are still effective against G-strain. The cluster-5 variant could be a problem, though.

[Souptime]

the w h a t

[AHHans]

1 hour ago, sevenperforce said:

One of my early theories (which I still think seems probable) is that people with past exposure to mild coronaviruses (like the common cold) had partial protection against SARS-CoV-2. As a result, they had mild symptoms or no symptoms, and recovered quickly but spread the virus rapidly.

Which could mean that parents could be protected against COVID-19 by their kids. By having endured lots of infections in the previous years that their kids "brought home" from day care or school.  (As I mentioned earlier in this thread.)

P.S. Yes, I'm aware, it's a theory. And it could also be the other way around. But I like the idea that parents may have a benefit from being sick all the time.

[sevenperforce]

1 hour ago, Souptime said:

the w h a t

LOL!

Some minks in Denmark caught it, and it mutated, and now the minks are giving it back to people. No indication that it's any different (in terms of virulence or transmissibility) than the D-Strain or G-strain, but it seems to be vaccine-resistant, so that sucks. They are working hard to keep it contained.

The biggest risk right now would be a zoonotic mutation that increases the deadliness of the virus without reducing how rapidly it spreads. MERS, for example, is fatal in 35% of diagnosed cases.

The good news is that the relatively low CFR in most of the population is probably part of why COVID-19 spreads so rapidly. It is contagious in carriers who are asymptomatic, presymptomatic, or mild-symptomatic, which encourages transmission. But if people got sicker, then there would be fewer asymptomatic/presymptomatic transmission events. The scary scenario would be a mutation that increases the lethality of serious infections without decreasing the percentage of asymptomatic/mild-symptomatic cases.

59 minutes ago, AHHans said:

2 hours ago, sevenperforce said:

One of my early theories (which I still think seems probable) is that people with past exposure to mild coronaviruses (like the common cold) had partial protection against SARS-CoV-2. As a result, they had mild symptoms or no symptoms, and recovered quickly but spread the virus rapidly. This explains the huge variance in symptomaticity and why resistance seemed to be "clustered" in certain groups.

Which could mean that parents could be protected against COVID-19 by their kids. By having endured lots of infections in the previous years that their kids "brought home" from day care or school.  (As I mentioned earlier in this thread.)

P.S. Yes, I'm aware, it's a theory. And it could also be the other way around. But I like the idea that parents may have a benefit from being sick all the time.

I mean it certainly fits that data. Children trade common colds all year long and their parents are exposed as well, so children can be carriers but typically have good disease outcomes.

[DDE]

9 minutes ago, sevenperforce said:

Some minks in Denmark caught it, and it mutated, and now the minks are giving it back to people.

@Souptime, surely you've heard of the Danish government's campaign to exterminate its entire population of millions of minks?

[sevenperforce]

The virulence, spread, transmission characteristics, and mortality of SARS-CoV-2 can be pretty well-modeled by a couple of hypotheses which account for a handful of variables.

• The high-affinity (S) spike glycoprotein. The spike protein on the SARS-CoV-2 has an extremely high affinity for the human ACES2 receptor. Its affinity is 10-20 times higher than that of SARS-CoV-1, the coronavirus which caused SARS. So the necessary viral load for COVID-19 is very low. It doesn't take many virions to infect someone, so they can be infected readily by indirect transmission. 
• Common human coronaviruses. 229E, NL63, OC43, and HKU1 are all prevalent coronaviruses which produce mild cold symptoms.  While HKU1 and OC43 bind to the Neu5Ac receptor and 229E binds to the APN receptor, NL63 binds to ACES2 just like SARS-CoV-1 and SARS-CoV-2. NL63 is a recombinant virus which evolved from 229E about 1,000 years ago. Serological surveys in 2007 and 2008 found that depending on age, between 43% and 75% of children under age 4 had antibodies related to one of these four coronaviruses, with the highest number (75%) being NL63. In one study of older people with obstructive pulmonary disease, 98% had antibodies for NL63.
• Human neutralizing antibodies. The dependence of coronaviruses on their spike proteins to invade human endothelial cells means that the human immune system is quite good at dealing with them. Human neutralizing antibodies bind to one of the four domains on S1 subunit of coronavirus spike proteins, inhibiting their ability to interact with hACES2 or other receptor proteins. This doesn't directly reduce the viral population, but it reduces the ability of the virions to reproduce. Additional studies show that human neutralizing antibodies for NL63 convey short-term protective immunity against 229E despite their different spike proteins, and that SARS patients had a rise in antibodies to both 229E and NL63.

Our hypothesis, then, is pretty simple. Prior infection by hCoV-229E conveys some degree of protection against SARS-CoV-2, while prior infection by hCoV-NL63 conveys a different but also-important degree of protection against SARS-CoV-2. Antibodies derived from 229E infection probably allow the human immune system to directly attack and suppress the SARS-CoV-2 population, while antibodies derived from NL63 infection probably reduce the severity of symptoms by blocking the spike proteins and inhibiting viral spread. The longer it has been since you were infected with NL63, the less available those antibodies are and thus the more serious your symptoms can be.

Because SARS-CoV-2 has such a high hACES2 affinity, your chances of becoming infected is pretty high as long as you were initially exposed to a sufficient viral load. However, once you are infected, your resistance and the course of the illness depends on how recently you were exposed to NL63 and 229E. Those with high levels of 229E antibodies are not as contagious but can suffer from COVID-19 for a long time and have numerous other complications. Those with high levels of NL63 antibodies remain very contagious but have very few symptoms. If you have both antibodies, you're likely to be asymptomatic and not very contagious at all; you'll recover quickly, but you may not build up enough SARS-CoV-2 antibodies to be fully immune. Healthy people without significant antibodies from NL63 or 229E can quickly succumb because they have no natural resistance, just like people with pre-existing conditions.

That hypothesis would explain the high variance in contagiousness and morbidity, as well as reports of reinfection.

[Souptime]

4 hours ago, sevenperforce said:

Some minks in Denmark caught it, and it mutated, and now the minks are giving it back to people.

oh no

4 hours ago, sevenperforce said:

No indication that it's any different (in terms of virulence or transmissibility) than the D-Strain or G-strain, but it seems to be vaccine-resistant, so that sucks.

OH NOO

4 hours ago, DDE said:

surely you've heard of the Danish government's campaign to exterminate its entire population of millions of minks?

oh no

[Serenity]

Not only Denmark is horrified about Mink but other countries too,

i hope we learn more about this but they will probably keep it hush hush until the second wave of vaccinations so people

don't loose even more trust.

[YNM]

12 hours ago, sevenperforce said:

The cluster-5 variant could be a problem, though.

Great... a century and a half of disease control gone with a new influenza... XD

[sevenperforce]

This is mildly horrifying.

https://covid19-projections.com/

Here's Nate Silver's discussion of it:

Using statistical methods to estimate actual infections seems pretty smart.

[tater]

On 11/15/2020 at 4:47 PM, sevenperforce said:

This may be where we are going to disagree strongly. I have seen no evidence beyond speculation that tests at Ct > 32 constitute a majority of positive tests, let alone a vast majority.

They don't report Ct with "positives." Decent data should do so, since it matters critically. You can't even get an answer if you ask the heath department here. There is simply no reason to test higher than 35 unless the goal is to detect old infections, literally the only positive tests that matter as screening for intervention are people who are actually infectious, treatment is symptomatic.

On 11/15/2020 at 4:47 PM, sevenperforce said:

Are you in NM then?

Sweden’s mortality has skyrocketed in comparison to most of Europe.

No it hasn't.

http://91-divoc.com/pages/covid-visualization/?chart=countries-normalized&highlight=Sweden&show=25-lg&y=both&scale=linear&data=deaths&data-source=jhu&xaxis=right&extra=Netherlands%2CLuxembourg%2CUnited Kingdom%2CFrance%2CBelgium%2CItaly#countries-normalized

If mitigations actually mattered, Sweden would have far worse mortality. They don't.

 

 

On 11/15/2020 at 4:47 PM, sevenperforce said:

I agree that the United States did a terrible job. Blue states had restrictive lockdowns that didn’t do much good because red states refused to follow suit and conservatives in blue states kept protesting. There was no national leadership and so we have had draconian restrictions for little or no reason. If we had done the right thing and gone to a national lockdown early, we could have brought transmission low enough at the beginning. 

"Early" would have had to have been last year. A recent Italian paper looked at a national cancer screening blood test they did last year, and reexamined the samples. A large % from September 2019 in northern Italy have IgG or IgM antibodies for SARS-CoV2. September! Previous (retroactive, obviously) PCR testing of sewage samples showed November 2019 in the same region. Brazil had a similar result (last fall it was in community spread).

A handful of "conservatives" protesting is deeply concerning, but millions of "not conservatives" doing so in June was not? Because magic? Pretty sure the difference in such protest attendance is orders of magnitude. Meanwhile FL/TX/etc have substantially lower death rates per capita than NY/NJ/MA, etc.

http://91-divoc.com/pages/covid-visualization/?chart=states-normalized&highlight=New York&show=us-states&y=both&scale=linear&data=deaths&data-source=jhu&xaxis=right&extra=New Jersey%2CMassachusetts%2CConnecticut%2CRhode Island%2CTexas%2CFlorida#states-normalized

The NE didn't have a high death toll because of protests in red states (and those states are fighting it out for worst mortality on Earth until Belgium passed them).

 Lockdown is not associated with reduced mortality. It's just not. You can find scatter plots of countries with mortality vs lockdown/social interaction score. The only mild correlation is the lower the SIS score, the higher the mortality (weak).  Peru has been in full military enforced lockdown since March. Worst mortality on Earth. Since this was certainly circulating earlier than was first assumed, the number of crypo infections was likely pretty high—makes sense since it is not very likely to kill people, many (most) have few/no symptoms, and you only start seeing clusters when you finally get enough vulnerable people really sick in 1 place. It's likely some places closer to the origin had the mortality conflated with flu last fall and not counted. Regardless, this was in full community spread by the time it was known to be in the US. It was very likely in full community spread in the US well before the Chinese announced it at all (it certainly was in Europe).

This virus is not terribly concerning to people under 65, it just isn't.

WHO said in early Oct that they estimated ~10% of the world had been infected. At that time, 1.03 M deaths had been attributed to COVID-19. That's an IFR of 0.136% (world). The number of US infections is likely 10X the number tested. IFR of course varies with population, and all that really matters is age distribution, and maybe how severe the last few flu seasons were. Places that had mild flu the last 2 years have worse mortality from COVID (from elderly people who dodged a bullet for a couple years being "dry brush" that this lightning hit). Younger populations have lower mortality since this doesn't often kill young people compared to other infectious disease.

Being twice as concerned as you were last year is entirely rational, heck, be 3 or 4X more concerned! What is a "lockdown" compared to last year in concern level? If last year's flu response was a "1" what is any shutdown at all in concern level? 1000? 1,000,000? Certainly far more than 2X, 3X, or 4X.

All to save people who were going to die soon anyway. That's a harsh statement, but true.

Average nursing home stay is 13.7 months in the US. Discharge is via death. ~50%+ of COVID-19 deaths are in nursing homes (more in many states/countries). Nursing homes are hospice for the elderly, they are "supposed to die," that's pretty much why they are there. I never want to be in assisted living or a nursing home. Not ever. My firend who runs a LTC facility says that their mortality has been up 50% from last year since March—not counting COVID-19. So the lockdowns to protect nursing homes have still resulted in most deaths being in nursing homes, AND more deaths unrelated to the SARS-CoV2 virus, but possibly related to lockdown-induced despair (she's convinced they feel imprisoned, and are "giving up" on life, and she's been doing this for like 15 years).

I've gone through the numbers, and MY chance of death (average for my age bracket) is in the up to 2X flu range (and that's with an annual flu vaccine). Scary! Except that my flu risk is vanishingly small, so 2 times ~0 is still ~0.  Give N95s to the elderly, help them get food delivered, etc, and the rest of us should behave normally, get a cold, take some daquil, and recover. The solution is herd immunity, which is achieved through infection (which confers like 99.99% immunity (what's the reinfection rate, some small fraction of 1%?), or via vaccination (90-95% effective apparently!). Whatever the actual threshold is that % of the pop needs to have gotten sick, or get vaccinated (weighted for efficacy). Lockdown until a vaccine was never a thing that should have been considered.

 

1 hour ago, sevenperforce said:

Using statistical methods to estimate actual infections seems pretty smart.

That last total infected seems pretty low, frankly.

Goes back to my initial complaints about R₀ vs infections.

R₀ > 2 implies rapid doubling. HIT is a function of R₀ so if it is way more infectious, considerably more people must have already been infected than get flu each year. Flu R₀ is ~1.3, and that's with a vaccine after all, and typical flu infections are 30-70M people annually.

If HIT is higher than the 20-something % of flu, then many 10s of millions, possibly over 100M have already been infected since the implied R₀ is higher.

It's one or the other. If this is grossly more infectious than flu, more people must have been infected than would get flu. There were zero mitigations until March, and this was certainly in community spread in late 2019 in the US. Early March is 64 days into the year... What's the doubling period?

 

[tater]

My wife is home today doing some phone visits. She had to delay a cancer patient's surgery for 2 weeks because they guy tested + after admission. She'd normally have taken him in pretty much immediately (the guy delayed care out of fear of COVID, then got it at home).

I asked her, and the docs literally just see a + test result. No Ct value. All positives are the same for the people treating patients. If the guy had a test that took way more than 35 cycles to come +, he could get his surgery without risking the surgery team—but they are not given this information, so he has to live with his cancer longer.

She's forced to balance patient care with risk to the staff, and not given the proper tools to make a really good decision.

Edited November 19, 2020 by tater

[tater]

https://www.frontiersin.org/articles/10.3389/fpubh.2020.604339/full

This is fascinating.

[sevenperforce]

1 hour ago, tater said:

They don't report Ct with "positives." Decent data should do so, since it matters critically. You can't even get an answer if you ask the heath department here. There is simply no reason to test higher than 35 unless the goal is to detect old infections, literally the only positive tests that matter as screening for intervention are people who are actually infectious

I agree that Ct data should be reported -- in fact, reporting Ct data along with positives could help to determine overall infection rate. Of course, Ct is not directly comparable between different manufacturers, so maybe that's why they don't. But it's simply not true that testing higher than 35 will only detect old infections.

You can have positives at Ct = 38 or even higher when you are first infected and presymptomatic. If your PCR test trips positive at a Ct of 38 or 39, they shouldn't tell you you're negative. They should tell you that your test came back with a "marginal positive" and you should quarantine and retest in 2 days. If your Ct on the second test remains high, then you know it's a past infection. If your Ct has come down, then you know you caught it early and you were smart to quarantine right away.

Elon's initial positive PCR test had a Ct in the mid-to-high 30s and he threw a big fit, but after Michael Mina calmed him down he admitted that subsequent PCRs had come back with Ct<20. If you stopped at 35 you would miss early infections.

1 hour ago, tater said:

On 11/15/2020 at 6:47 PM, sevenperforce said:

Are you in NM then?

Sweden’s mortality has skyrocketed in comparison to most of Europe.

No it hasn't.

http://91-divoc.com/pages/covid-visualization/?chart=countries-normalized&highlight=Sweden&show=25-lg&y=both&scale=linear&data=deaths&data-source=jhu&xaxis=right&extra=Netherlands%2CLuxembourg%2CUnited Kingdom%2CFrance%2CBelgium%2CItaly#countries-normalized

If mitigations actually mattered, Sweden would have far worse mortality. They don't.

These are cumulative deaths per capita, not deaths per day. So you have to look at the slope of the curve.

210 days ago, the death rate per capita (slope of the curve) in Sweden was approximately the same as the rates in France, Italy, and the Netherlands. It was higher than the death rate in Luxembourg. Luxembourg, France, Italy, and the Netherlands all successfully lowered the slope of their curves after that point, but Sweden didn't. Sweden's curve doesn't get close to flattening until 119 days ago. That's significantly later than Luxembourg, the Netherlands, Italy, France, or even the UK. (Belgium counts its cases differently, so the absolute number is off, but even it flattened its curve much earlier.)

2 hours ago, tater said:

A recent Italian paper looked at a national cancer screening blood test they did last year, and reexamined the samples. A large % from September 2019 in northern Italy have IgG or IgM antibodies for SARS-CoV2. September! Previous (retroactive, obviously) PCR testing of sewage samples showed November 2019 in the same region. Brazil had a similar result (last fall it was in community spread).

Immunoglobulin G and M tests are not reliable for differentiating between coronaviruses. The earliest positive PCR tests I've seen from Italian wastewater were in mid-December 2019, unless you have a different source.

We know from genetic sequencing that the pandemic onset spread in China to Europe and then to the rest of the world in December and January.

2 hours ago, tater said:

Quote

I agree that the United States did a terrible job. Blue states had restrictive lockdowns that didn’t do much good because red states refused to follow suit and conservatives in blue states kept protesting.

A handful of "conservatives" protesting is deeply concerning, but millions of "not conservatives" doing so in June was not? Because magic? Pretty sure the difference in such protest attendance is orders of magnitude.

I didn't mean physically protesting; I meant that conservatives in blue states refused to follow the lockdown restrictions and thus continued to endanger everyone. Neither the anti-mask protests nor the anti-police protests were associated with any significant rise in cases, because the anti-mask protests weren't big enough and the anti-police protests typically involved masks and took place outside. 

2 hours ago, tater said:

Meanwhile FL/TX/etc have substantially lower death rates per capita than NY/NJ/MA, etc.

Again, you have to look at the curvature of the slope. Northeastern states have much higher population density and had the earliest onset of spread, so of course they have had higher cumulative per capita deaths. But Florida, Texas, Mississippi, and other southern states have nearly monotonically-increasing rates because they're not actually mitigating.

2 hours ago, tater said:

This virus is not terribly concerning to people under 65, it just isn't.

The average CFR for people under 65 is not the problem. The variance in the CFR for people under 65 is the problem. Along with the ease of transmissibility, rate of presymptomatic/asymptomatic transmission, and all the people who actually do have pre-existing conditions. 

Say what you will about people in nursing homes, but there are a lot of people over 65 who are NOT in nursing homes. And a lot of people with pre-existing conditions. And a lot of COVID-related complications with permanency, even in populations with low CFR.

2 hours ago, tater said:

The solution is herd immunity, which is achieved through infection (which confers like 99.99% immunity (what's the reinfection rate, some small fraction of 1%?), or via vaccination (90-95% effective apparently!).

We do not have any data to suggest infection confers immunity anywhere close to what vaccination confers.

2 hours ago, tater said:

Lockdown until a vaccine was never a thing that should have been considered.

Lockdown until a vaccine was never the plan. What we should have done was a serious, well-enforced, nationwide lockdown (with significant emergency federal assistance) for 3-4 weeks, to starve out the virus, then maintained reasonable containment measures (distancing, telework, N95s in public, no large-capacity events) until a vaccine. Instead we've been clawing our way forward against the wind.

2 hours ago, tater said:

I asked her, and the docs literally just see a + test result. No Ct value. All positives are the same for the people treating patients. If the guy had a test that took way more than 35 cycles to come +, he could get his surgery without risking the surgery team—but they are not given this information, so he has to live with his cancer longer.

 No, he should have been retested after a couple of days to find out whether it was an old infection that wouldn't risk the surgery team or a new infection that would.

[tater]

1 hour ago, sevenperforce said:

210 days ago, the death rate per capita (slope of the curve) in Sweden was approximately the same as the rates in France, Italy, and the Netherlands. It was higher than the death rate in Luxembourg. Luxembourg, France, Italy, and the Netherlands all successfully lowered the slope of their curves after that point, but Sweden didn't. Sweden's curve doesn't get close to flattening until 119 days ago. That's significantly later than Luxembourg, the Netherlands, Italy, France, or even the UK. (Belgium counts its cases differently, so the absolute number is off, but even it flattened its curve much earlier.)

They were not trying to. They explicitly said they expected more mortality, but were trying to push infections into younger populations.

All that matters is total mortality.

 

 

[tater]

1 hour ago, sevenperforce said:

Lockdown until a vaccine was never the plan. What we should have done was a serious, well-enforced, nationwide lockdown (with significant emergency federal assistance) for 3-4 weeks, to starve out the virus, then maintained reasonable containment measures (distancing, telework, N95s in public, no large-capacity events) until a vaccine. Instead we've been clawing our way forward against the wind.

Nope. It was already too late by the time that would even have been considered.

That was never the CDC pandemic plan before. It never should be. Quite frankly, I'm willing to accept far higher mortality than COVID to avoid that sort of assault on personal freedom. Tell people facts, let them make up their own minds. Anyone terrified to go outside can hide at home. The 1968 flu was per capita pretty much identical to this, I lived through it, and my parents never even mentioned it (asked my dad about it today on the phone, he didn't lock down in the late 50s for a similarly bad flu pandemic (per capita deaths), either.

We're doing the same as everyone else. Places that were hit hard are effectively done. Places that were not hit hard are having some deaths. Small bumps? That will be normal, it's an endemic disease, if "COVID" is going around, people will die of COVID in a given year, if the flu dominates, it will be the flu.

http://91-divoc.com/pages/covid-visualization/?chart=countries-normalized&highlight=Sweden&show=highlight-only&y=both&scale=linear&data=deaths-daily-7&data-source=jhu&xaxis=right&extra=United States%2CUnited Kingdom%2CFrance%2CGermany#countries-normalized

You're suggesting that somehow the US should have done better, and acted in a quicker, and more immediately draconian way than Europe? We would have had to immediately ban all travel into the country. We would have to certainly make sure ZERO people entered without quarantine, etc. The hardest hit places in the summer in this region were in fact border counties (as right now). How does the virus know where the border is? Oh, wait, sick people have legs, and there's a lot of open space. Pretty sure harsh border restrictions would have been attacked back before March by anyone in favor of them for the pandemic retroactively (look at the contemporaneous reaction to stopping incoming China flights). The horse was out of the barn by the time China told anyone.

From the paper linked above:

Quote

This is consistent with the hypothesis of an optimal human development niche, that has aggregated favorable health, demographic, environment, and economic parameters (1). However, though previously positive, they now expose populations to higher vulnerabilities to both infectious (Covid-19) or physical constraints (heat waves). Regarding government's actions (i.e., containment and stringency index), no association was found with the outcome, suggesting that the other studied factors were more important in the Covid-19 mortality than political measures implemented to fight the virus, except for the economic support index.

My bold.

 

This is interesting:

https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30114-2/fulltext?s=09

 

[Guest]

I have noticed that we are getting closer and closer to a vaccine. So it's a good idea to start preparing and if you are of younger age to wait for people who need it more to get it first. teens should get the vaccine last. Here is a good video for anyone who want's a in a nutshell of why:

 

[AHHans]

19 hours ago, tater said:

No it hasn't.

http://91-divoc.com/pages/covid-visualization/?chart=countries-normalized&highlight=Sweden&show=25-lg&y=both&scale=linear&data=deaths&data-source=jhu&xaxis=right&extra=Netherlands%2CLuxembourg%2CUnited Kingdom%2CFrance%2CBelgium%2CItaly#countries-normalized

If mitigations actually mattered, Sweden would have far worse mortality. They don't.

Well, comparing COVID numbers of Sweden with those from Italy or France is a bit ridiculous. There is a  joke that the Swedish are sick and tired of this "2m social distancing" stuff and that they want to get back to their normal distance of 5m. Nobody is going to make this joke about France or Italy! So if you want to evaluate the effect of mitigation strategies then you should compare Sweden with Norway, Finland, and Denmark. That also not 100% fair, but much better. (Just from cultural and geographical considerations I would espect Sweden to fall between Denmark and Norway/Finland.)

[tater]

1 hour ago, AHHans said:

Well, comparing COVID numbers of Sweden with those from Italy or France is a bit ridiculous. There is a  joke that the Swedish are sick and tired of this "2m social distancing" stuff and that they want to get back to their normal distance of 5m. Nobody is going to make this joke about France or Italy! So if you want to evaluate the effect of mitigation strategies then you should compare Sweden with Norway, Finland, and Denmark. That also not 100% fair, but much better. (Just from cultural and geographical considerations I would espect Sweden to fall between Denmark and Norway/Finland.)

What's the masking/lockdown/distancing situation in the rest of Scandinavia? Transit? Outbreak severity heat maps in NYC basically drew a subway map if you look at it, minus Manhattan—where the heat map drew a picture of people who use "summer" as a verb (the rich people left the city for their beach houses).

Regardless, it's entirely rational to look at Sweden as a control when we have so few, and most responses are overly complex. I have no idea how tightly people stand together to chat in France, but here in the US, "6 feet" seems pretty much like the distance I usually stand from people voluntarily (obviously some lines, and events, etc crowd more than that). You're suggesting that Swedes don't stand closer than that in pubs, etc?

The use of all variables in response is what really bugs me. Not just because targeted interventions are more sensible and sustainable, but because if any NPI happened to work, we will have pretty much no idea.

Take your example about distancing as an NPI. If that is normal for Sweden, do they have lower levels of seasonal flu or Rhinovirus? If 2m nominal social distancing (all the time, culturally) is the driver, then why add in masking? What happens when we see an actually dangerous pandemic in the future? Lock down forever, until a vaccine (apparently the current strategy), or simply do the few mitigations within that lockdown constellation that actually did the heavy lifting?

I'd prefer to know what mitigations worked, and to what level they worked. There is no substantial evidence that any mitigations have had a profound impact at all (hard to tease out with all variables changed at once).

[Entropian]

6 minutes ago, tater said:

I'd prefer to know what mitigations worked, and to what level they worked. There is no substantial evidence that any mitigations have had a profound impact at all (hard to tease out with all variables changed at once).

Early lockdowns and border closures to starve out the virus and then continued border closure, end of lockdowns, and widespread testing.  Look at New Zealand and South Korea.

[tater]

1 minute ago, Entropian said:

Early lockdowns and border closures to starve out the virus and then continued border closure, end of lockdowns, and widespread testing.  Look at New Zealand and South Korea.

Both are effectively small islands (SK has a nearly 100% impermeable northern border). Both are in Asia, and there is increasing evidence of preexisting immunity at some level (T-Cell immunity, etc). It is also now certain that this was in full circulation months before anyone knew it was a thing. SK did not lock down, BTW.

Can you imagine the US completely locking the border? How would that be done, a wall? Many of the cases in my State right now are transfers from El Paso, and many cases in El Paso are from Ciudad Juarez.

Testing gives you more cases. We are now testing 1.6 million people per day. We test 75,000 people for flu—per year.

Testing should stop, frankly, unless needed for a rule out in treatment in a hospital setting. The only thing that matters is ILI (now CLI) that requires care. "Cases" that require dayquil are not concerning.

US IFR is under 0.3%—deaths/detected_cases divided by 11 (the number of actual infections is 11X tested per CDC website). Anyone more than 3X concerned as they were last year about flu is not being rational. My concern about flu was enough to get a free flu shot. We are financially secure, so I would have paid whatever for a flu shot. At some dollar value had it cost something I likely would have just skipped it. How much would you pay for a flu shot? How much would you pay for a COVID shot?

I could afford $1000 fr a COVID shot, but I'd not pay that, I'd skip it if it was that expensive, I'd bump up the SSD size on my next computer, instead. That is actually an interesting way to gauge real concern levels, how much would you pay out of pocket to be vaccinated for COVID-19?