COVID-19 Megathread 3: Third time's a charm

[GoTfan]

Forgive me for circling back, but I'm a bit confused about the projection model on this site posted earlier: https://covid19.healthdata.org/projections.

If my math is right, with total American deaths coming in at around 81,000, a death rate of 1% means we will only see ~8 million Americans get infected with this virus. How is that possible in a country as populous as the United States? Either the death rate is wrong and there is a ridiculous proportion of asymptomatic cases, or the virus will come back with just as much force as before... right?

You're corrrect.

Any model showing less than 250,000 deaths need to explain why the following isn't true:

- AT LEAST 0.5% of infected Americans will die (probably more)
- AT LEAST 25% of all Americans will eventually get COVID-19 (probably more)
- If herd immunity doesn't materialize, simply containing the virus is a stopgap

All three are true... no?

Punch in the US population on a calculator, multiplied by 0.25 infected, multiplied by 0.005 death rate, and keep in mind I'm using conservative numbers here. I'd be glad to be wrong about this, but nobody has shown me why I'm wrong as of yet. I'm open-minded to changing my mind here.

You can contact them. They have their details at the bottom of the page.

[💥💥 brandon bro (he/him/his)]

We are going into a recession and car sales are plummeting. Getting DPAed is probably the best thing that could have happened for GM, because now they can at least make something and have a sure buyer for it. Even if they end up not being needed, then we will have them on hand.

One would think these ventilators would be new and state of the art models. If they can't be sold internationally surely either the fed could purchase them to replenish decade-old ventilators in the stockpile or, if they have enough money, privately run hospitals could do the same.

[Obama-Biden Democrat]

Trump is such a disgusting obese f#ck that i wouldnt be surprised if he needed one ventilator for each lung

Uncle Joe is going to be running circles around Trump at the debates.

[TJ in Oregon]

Forgive me for circling back, but I'm a bit confused about the projection model on this site posted earlier: https://covid19.healthdata.org/projections.

If my math is right, with total American deaths coming in at around 81,000, a death rate of 1% means we will only see ~8 million Americans get infected with this virus. How is that possible in a country as populous as the United States? Either the death rate is wrong and there is a ridiculous proportion of asymptomatic cases, or the virus will come back with just as much force as before... right?

You're corrrect.

Any model showing less than 250,000 deaths need to explain why the following isn't true:

- AT LEAST 0.5% of infected Americans will die (probably more)
- AT LEAST 25% of all Americans will eventually get COVID-19 (probably more)
- If herd immunity doesn't materialize, simply containing the virus is a stopgap

All three are true... no?

Punch in the US population on a calculator, multiplied by 0.25 infected, multiplied by 0.005 death rate, and keep in mind I'm using conservative numbers here. I'd be glad to be wrong about this, but nobody has shown me why I'm wrong as of yet. I'm open-minded to changing my mind here.

You can contact them. They have their details at the bottom of the page.

I'm also curious at the very wide disparities in when they project the peak will occur for each state: doesn't have any obvious correlation with when containment policies were implemented, how early the virus got there, or really any obvious parameter.

[GoTfan]

Forgive me for circling back, but I'm a bit confused about the projection model on this site posted earlier: https://covid19.healthdata.org/projections.

If my math is right, with total American deaths coming in at around 81,000, a death rate of 1% means we will only see ~8 million Americans get infected with this virus. How is that possible in a country as populous as the United States? Either the death rate is wrong and there is a ridiculous proportion of asymptomatic cases, or the virus will come back with just as much force as before... right?

You're corrrect.

Any model showing less than 250,000 deaths need to explain why the following isn't true:

- AT LEAST 0.5% of infected Americans will die (probably more)
- AT LEAST 25% of all Americans will eventually get COVID-19 (probably more)
- If herd immunity doesn't materialize, simply containing the virus is a stopgap

All three are true... no?

Punch in the US population on a calculator, multiplied by 0.25 infected, multiplied by 0.005 death rate, and keep in mind I'm using conservative numbers here. I'd be glad to be wrong about this, but nobody has shown me why I'm wrong as of yet. I'm open-minded to changing my mind here.

You can contact them. They have their details at the bottom of the page.

I'm also curious at the very wide disparities in when they project the peak will occur for each state: doesn't have any obvious correlation with when containment policies were implemented, how early the virus got there, or really any obvious parameter.

Like I said, they have an email address at the bottom of the page if you want to contact them for anything.

[Pulaski]

Very cautiously optimistic about things here in Australia. We haven't seen a peak in new infections for 5 days, and new infections have remained steady or slightly dropped for the past 3 (https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers)

Given most state governments have introduced new restrictions within that period, I'm hoping the number of new infections to remain steady for the next week or so, between 300 and 400 a day. That would be really encouraging and a sign that we've begun to flatten our curve.

[Tender Branson]

Intensive Care Unit beds in selected OECD countries per capita:

https://twitter.com/krone_at/status/1243787403850121221
The high number of beds in Austria and Germany has often been criticized and there were political calls to reduce it, but now our welfare states are turning out to help us ...

[Penn_Quaker_Girl]

Lower population density is all well and good, as is basing this model on trends we have seen elsewhere, but I guess I am having a hard time reconciling this model with logic. Unless every last stitch of this virus is cut off from the potential to spread and then dies out, it is going to linger. 8 million infections by the end of that curve in the model is nowhere near enough to achieve herd immunity. So isn't it, like... extremely likely it will return?

And when it does, and we start to open things back up, are we really going to be able to do enough tracking, contact tracing, and quarantining of resurgent cases/exposures to put a lid on things before  we get another curve? I'm very pessimistic, sorry.

It's definitely a possibility.  

Dr. Bruce Aylward (Senior Adv. to the Director-General of the WHO) -- I've heard him speak; he's absolutely fantastic -- says that it's unlikely that the virus will simply disappear on its own.  

And the question then is: What’s going to happen? Is this going to disappear completely? Are we going to get into a period of cyclical waves? Or are we going to end up with low level endemic disease that we have to deal with? Most people believe that that first scenario where this might disappear completely is very, very unlikely, it just transmits too easily in the human population

And he stresses the importance of testing:

Now what we’ve done is, we’ve gained time again by putting in place these big shutdowns. All they do is they buy time, they don’t actually stop the virus, they suppress it, they slow it. What you want to do now is use that time well to get the testing in place, to get the systems in place, so that you can actually manage the individual level cases that are going to be fundamental to stopping this.

Obviously, there's no way to detect every infected person in America.  But as the number of cases declines, it's imperative to keep up the pressure.  Being able to manage newly-infected individuals and keep them from spawning new clusters is crucial.  

Also, Aylward was asked about the buzz around a second wave already taking hold in China:

Absolutely, and China is concerned. As we traveled around China, one of the most striking things that I found, especially in contrast to the West, as I spoke to governors, mayors, and their cases were plummeting—in some of the places they were down to single digit cases already—as I spoke to them and I said, “So what are you doing now?” They said, “We’re building beds, we’re buying ventilators, we’re preparing.” They said, “We do not expect this virus to disappear, but we do expect to be able to run our society, run our economy, run our health system. We cannot end up in this situation again.”

So as cases were plummeting, the response was ramping up.  Of course, Aylward and these Chinese officials are much much more in-tune with the present situation than myself, but just from my novice epi point of view: this is something that concerns me about the potential for a second wave here in the States.  As of right now, I'm not completely confident that American officials (especially those who think that the present actions are overkill) will understand the need to keep up the pressure as the numbers fall.  

But that's still a ways away.  

SOURCE:  https://time.com/5805368/will-coronavirus-go-away-world-health-organization/

[Torrain]

https://twitter.com/ScottGottliebMD/status/1243696001958981632

How can it take longer to get a negative result than a positive one?  If after 5 minutes, you don’t have a positive result, what else could the result be?

Because it's easy to detect the presence of a highly concentrated antigen/antibody.
Ensuring that it's absent is much harder.

Think of it like looking for ants in your house. If you've got an ant infestation, then you'd know about it. Going looking for ants to confirm their absence is a lot harder...

[Vaccinated Russian Bear]

A projection meter for COVID-19 in the US.

https://covid19.healthdata.org/projections.

Listen to Scientists, folks!

According to these, US will need 20,000 ventilators at the peak, so may be 15,000 additional ventilators (most states has unused capacity). Cuomo requested ADDITIONAL 40,000. Now, obviously, their projection isn't the worst case scenario, but as for now Trump's claim are backed by SCIENCE, not Cuomo's.

[GoTfan]

A projection meter for COVID-19 in the US.

https://covid19.healthdata.org/projections.

Listen to Scientists, folks!

According to these, US will need 20,000 ventilators at the peak, so may be 15,000 additional ventilators (most states has unused capacity). Cuomo requested ADDITIONAL 40,000. Now, obviously, their projection isn't the worst case scenario, but as for now Trump's claim are backed by SCIENCE, not Cuomo's.

I will say that this is a projection based on strictly maintained social distancing and lockdown measures. The issue is that projections are inherently unrelaiable by nature.

Do not take this one as the gospel truth.

[Vaccinated Russian Bear]

Forgive me for circling back, but I'm a bit confused about the projection model on this site posted earlier: https://covid19.healthdata.org/projections.

If my math is right, with total American deaths coming in at around 81,000, a death rate of 1% means we will only see ~8 million Americans get infected with this virus. How is that possible in a country as populous as the United States? Either the death rate is wrong and there is a ridiculous proportion of asymptomatic cases, or the virus will come back with just as much force as before... right?

The death rate is not that wrong (but likely lower than 1%). I think that the key is herd immunity.

Here is an example with fictional numbers:
Among 90% of healthiest ones it is 0,1%.
The rest it's 10%.

The tricky part is to isolate the rest until healthy ones get immunity. It is a difficult task when no one is immune and you have an exponential growth with doubling rate of 2 days...

[Vaccinated Russian Bear]

A projection meter for COVID-19 in the US.

https://covid19.healthdata.org/projections.

Listen to Scientists, folks!

According to these, US will need 20,000 ventilators at the peak, so may be 15,000 additional ventilators (most states has unused capacity). Cuomo requested ADDITIONAL 40,000. Now, obviously, their projection isn't the worst case scenario, but as for now Trump's claim are backed by SCIENCE, not Cuomo's.

I will say that this is a projection based on strictly maintained social distancing and lockdown measures. The issue is that projections are inherently unrelaiable by nature.

Do not take this one as the gospel truth.

I don't. Obviously, we are in very early phase, and all the projections are super uncertain. In 2-3 weeks we have much more data, the projections will be better I suppose.


Important note: 18,000 I mentioned is an average. The projection for US is 8,000-40,000 ventilators.
For NY the projection of ventilators needed is 3,000 (1,000-10,000).


# of deaths projection for US is 80,000 (40,000 - 160,000).

Compared to licensed capacity and average annual occupancy rates, excess demand from COVID-19 at the peak of the pandemic in the second week of April is predicted to be 64,175 (95% UI 7,977 to 251,059) total beds and 17,309 (95% UI 2,432 to 57,584) ICU beds. At the peak of the pandemic, ventilator use is predicted to be 19,481 (95% UI 9,767 to 39,674). The date of peak excess demand by state varies from the second week of April through May. We estimate that there will be a total of 81,114 deaths (95% UI 38,242 to 162,106) from COVID-19 over the next 4 months in the US. Deaths from COVID-19 are estimated to drop below 10 deaths per day between May 31 and June 6.

In addition to a large number of deaths from COVID-19, the epidemic in the US will place a load well beyond the current capacity of hospitals to manage, especially for ICU care. These estimates can help inform the development and implementation of strategies to mitigate this gap, including reducing non-COVID-19 demand for services and temporarily increasing system capacity. These are urgently needed given that peak volumes are estimated to be only three weeks away. The estimated excess demand on hospital systems is predicated on the enactment of social distancing measures in all states that have not done so already within the next week and maintenance of these measures throughout the epidemic, emphasizing the importance of implementing, enforcing, and maintaining these measures to mitigate hospital system overload and prevent deaths.

[Meclazine for Israel]

Forgive me for circling back, but I'm a bit confused about the projection model on this site posted earlier: https://covid19.healthdata.org/projections.

If my math is right, with total American deaths coming in at around 81,000, a death rate of 1% means we will only see ~8 million Americans get infected with this virus. How is that possible in a country as populous as the United States? Either the death rate is wrong and there is a ridiculous proportion of asymptomatic cases, or the virus will come back with just as much force as before... right?

The death rate is not that wrong (but likely lower than 1%). I think that the key is herd immunity.

Here is an example with fictional numbers:
Among 90% of healthiest ones it is 0,1%.
The rest it's 10%.

The tricky part is to isolate the rest until healthy ones get immunity. It is a difficult task when no one is immune and you have an exponential growth with doubling rate of 2 days...

Herd immunity is a term used more commonly to describe a biological situation where a large portion of a population has already gained immunity through previous infection or vaccination.

Thus protecting the remainder of the population from the virus by removing any effective pathway or access to the more vulnerable.

It is how vaccinating chidren from Measles works.

But given the experience of The Netherlands, it is not effective against Corona-virus.

[Penn_Quaker_Girl]

Forgive me for circling back, but I'm a bit confused about the projection model on this site posted earlier: https://covid19.healthdata.org/projections.

If my math is right, with total American deaths coming in at around 81,000, a death rate of 1% means we will only see ~8 million Americans get infected with this virus. How is that possible in a country as populous as the United States? Either the death rate is wrong and there is a ridiculous proportion of asymptomatic cases, or the virus will come back with just as much force as before... right?

The death rate is not that wrong (but likely lower than 1%). I think that the key is herd immunity.

Here is an example with fictional numbers:
Among 90% of healthiest ones it is 0,1%.
The rest it's 10%.

The tricky part is to isolate the rest until healthy ones get immunity. It is a difficult task when no one is immune and you have an exponential growth with doubling rate of 2 days...

Herd immunity is a term used more commonly to describe a biological situation where a large portion of a population has already gained immunity through previous infection or vaccination.

Thus protecting the remainder of the population from the virus by removing any effective pathway or access to the more vulnerable.

It is how vaccinating children from Measles works.

But given the experience of The Netherlands, it is not effective against Corona-virus.

Thank you for clarifying that, Meclazine.  Herd immunity is one of those terms that gets thrown around in too broad a sense. 

[Vaccinated Russian Bear]

But given the experience of The Netherlands, it is not effective against Corona-virus.

Isn't it though what Western World is doing? Nobody says we can't stop it (without going full authoritarian mode), but only slow it down. The questions is what herd immunity is enough. 20%? 40%? 70%?

[Penn_Quaker_Girl]

But given the experience of The Netherlands, it is not effective against Corona-virus.

Isn't it though what Western World is doing? Nobody says we can't stop it (without going full authoritarian mode), but only slow it down. The questions is what herd immunity is enough. 20%? 40%? 70%?

Estimates seem to center around 60-70%:

https://www.aljazeera.com/news/2020/03/herd-immunity-slow-coronavirus-pandemic-200320092928984.html

"When about 70 percent of the population have been infected and recovered, the chances of outbreaks of the disease become much less because most people are resistant to infection," said Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene & Tropical Medicine.

https://www.foxnews.com/health/will-heard-immunity-work-against-coronavirus

"Herd immunity is protection in a community from an infectious disease when a large percentage – typically at least 60 percent – become immune," John Whyte, M.D., chief medical officer of WebMD, told Fox News. "They become immune either by getting the infection and getting better – surviving – or by getting vaccinated. Since the majority of people in a community are then immune, there are fewer people who can become infected."

On a side note and from what I remember in my ID classes, measles requires around 90-95% vaccination to maintain herd immunity.  

[GeorgiaModerate]

But given the experience of The Netherlands, it is not effective against Corona-virus.

Isn't it though what Western World is doing? Nobody says we can't stop it (without going full authoritarian mode), but only slow it down. The questions is what herd immunity is enough. 20%? 40%? 70%?

Estimates seem to center around 60-70%:

https://www.aljazeera.com/news/2020/03/herd-immunity-slow-coronavirus-pandemic-200320092928984.html

"When about 70 percent of the population have been infected and recovered, the chances of outbreaks of the disease become much less because most people are resistant to infection," said Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene & Tropical Medicine.

https://www.foxnews.com/health/will-heard-immunity-work-against-coronavirus

"Herd immunity is protection in a community from an infectious disease when a large percentage – typically at least 60 percent – become immune," John Whyte, M.D., chief medical officer of WebMD, told Fox News. "They become immune either by getting the infection and getting better – surviving – or by getting vaccinated. Since the majority of people in a community are then immune, there are fewer people who can become infected."

From what I remember in my ID classes, measles has around a 90-95% HI level.  

IIRC, measles is incredibly contagious (R0 of 12 to 18) so it makes sense that it would require a higher percentage of the population to reach herd immunity.

[The Dowager Mod]

I guess i need to apologize to you guys, I didn't immediately infract a post because i got weak and went to sleep.
How fu***ng dare i sleep when there are reports to be moderated here!

[Vaccinated Russian Bear]

But given the experience of The Netherlands, it is not effective against Corona-virus.

Isn't it though what Western World is doing? Nobody says we can't stop it (without going full authoritarian mode), but only slow it down. The questions is what herd immunity is enough. 20%? 40%? 70%?

Estimates seem to center around 60-70%:

https://www.aljazeera.com/news/2020/03/herd-immunity-slow-coronavirus-pandemic-200320092928984.html

"When about 70 percent of the population have been infected and recovered, the chances of outbreaks of the disease become much less because most people are resistant to infection," said Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene & Tropical Medicine.

https://www.foxnews.com/health/will-heard-immunity-work-against-coronavirus

"Herd immunity is protection in a community from an infectious disease when a large percentage – typically at least 60 percent – become immune," John Whyte, M.D., chief medical officer of WebMD, told Fox News. "They become immune either by getting the infection and getting better – surviving – or by getting vaccinated. Since the majority of people in a community are then immune, there are fewer people who can become infected."

On a side note and from what I remember in my ID classes, measles requires around 90-95% vaccination to maintain herd immunity.  

60-70% is for "no measures" scenario according to Al Jazeera's article.

With the new coronavirus outbreak, current evidence suggests that one infected person on average infects between two and three others. This means that, if no other measures are taken, herd immunity would kick in when between 50 to 70 percent of a population is immune.

"But it doesn't have to be - and it won't be - this way," Matthew Baylis, a professor at the Institute of Infection, Veterinary and Ecological Sciences at Liverpool University, said.

By reducing the number of people that one person infects - with social distancing measures such as closing schools, working from home, avoiding large gatherings and frequent hand washing - the point at which herd immunity kicks in can be lowered.

"From an epidemiological point of view, the trick is to reduce the number of people we are in contact with ... so that we can drive down the number of contacts we infect, and herd immunity starts earlier," Baylis said.

Also, you'll need a lot of testing. I think I've read somewhere that Germany thinks they'll need ~200,000 a day to be able to uphold a well-targeted quarantine. So let's say 1,000,000 a day for US?

[Thomas D]

https://twitter.com/DrMattMcCarthy/status/1243891663162019841


Not sure why they'd wait 10 days

[Vaccinated Russian Bear]

https://twitter.com/DrMattMcCarthy/status/1243891663162019841

Not sure why they'd wait 10 days

A shortage, I guess?

[Penn_Quaker_Girl]

But given the experience of The Netherlands, it is not effective against Corona-virus.

Isn't it though what Western World is doing? Nobody says we can't stop it (without going full authoritarian mode), but only slow it down. The questions is what herd immunity is enough. 20%? 40%? 70%?

Estimates seem to center around 60-70%:

https://www.aljazeera.com/news/2020/03/herd-immunity-slow-coronavirus-pandemic-200320092928984.html

"When about 70 percent of the population have been infected and recovered, the chances of outbreaks of the disease become much less because most people are resistant to infection," said Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene & Tropical Medicine.

https://www.foxnews.com/health/will-heard-immunity-work-against-coronavirus

"Herd immunity is protection in a community from an infectious disease when a large percentage – typically at least 60 percent – become immune," John Whyte, M.D., chief medical officer of WebMD, told Fox News. "They become immune either by getting the infection and getting better – surviving – or by getting vaccinated. Since the majority of people in a community are then immune, there are fewer people who can become infected."

From what I remember in my ID classes, measles requires around 90-95% vaccination to maintain herd immunity. 

IIRC, measles is incredibly contagious (R0 of 12 to 18) so it makes sense that it would require a higher percentage of the population to reach herd immunity.

It's definitely one of the more infectious viruses.  We were taught that measles patients should be treated with "airborne precautions" (a whole list of preventative items and actions) for around four days past the presentation of the trademark rash (which itself presents around 2-5 days after initial symptoms).  

[politicallefty]

https://twitter.com/DrMattMcCarthy/status/1243891663162019841

Not sure why they'd wait 10 days

A shortage, I guess?

I'd been wondering about that as well. I know what I'd said before, but there does seem to be a clear difference between countries that use masks regularly versus those that don't. As long as they are plentiful and not resulting in shortages for healthcare professionals, it seems clear that the benefits far outweigh any potential risks. I think it's been vastly underestimated how contagious this virus really is. And on top of that, wearing a mask simply prevents you from touching your own face with your potentially infected hands or vice versa. I actually already heeded that advice when I went out earlier this week. No one in this country is really going to bat an eye now seeing someone wearing a mask in public, which is a complete switch from a month or two ago.

[ilikeverin]

...where do we get them? I have no idea where to buy a mask.