COVID-19 Megathread 5: The Trumps catch COVID-19

[Fmr. Gov. NickG]

If the goal of “flatten the curve” were to control the pacing of cases as we move toward herd immunity, we wouldn’t be trying to reduce cases everywhere.  We would be trying to maintain a certain equilibrium number of infections across geography and time such that the health care system is never overwhelmed, but we are steadily increasing the proportion of the population who is infected, and eventually recovered and immune.

This would mean adopting a sort of Keynesian economic approach where the government would enforce restrictions in areas where the outbreak of cases was particularly high to discourage infection, but would also adopt policies to encourage infection where the outbreak was low and the healthcare system is below capacity.

We did a OK job of the first half of this in NYC, where we implemented strong restrictions just in time to avoid a complete health care collapse.  And now we are seeing steadily decreasing cases in NYC as the city clearly moves toward herd immunity.

But we aren’t doing the second half of this at all.  In areas with few infections, we are still trying to reduce them, not increase them.  This is just prolonging the lockdowns and delaying the infection surge that is going to happen in these places regardless.  They are mostly on a pace where there aren’t enough infections to get us to herd immunity within the next year, but also too many infections to declare the virus eradicated.

An additional advantage to encouraging infections in low-prevalence areas is that we could better engineer who gets infected.  The death rate of the virus will end up being much, much lower if we encourage infection among the young and health while quarantining the vulnerable than if we just equally expose everyone to the virus as we are doing now.

If a random 70% of the population ends up infected, probably over a million Americans die of the virus.  But if only the healthiest 70% are infected, this could drop as low as 100,000 deaths.

[Lief 🗽]

If a random 70% of the population ends up infected, probably over a million Americans die of the virus.  But if only the healthiest 70% are infected, this could drop as low as 100,000 deaths.

No one is going to sign off on a plan to intentionally kill 100,000 Americans though. So we'll muddle on and unintentionally kill twice or thrice as many.

[Bandit3 the Worker]

Remdesivir when?

Japan is about to approve it. Why won't the U.S.?

[emailking]

I keep reading here that flattening the curve was not about reducing the number of cases/deaths, just spreading them out over time. But as far as I remember, all of the models showed *many* fewer cases and deaths (like multiples) with a flattened curve than in a business as usual scenario.

[Dr. Arch]

I keep reading here that flattening the curve was not about reducing the number of cases/deaths, just spreading them out over time. But as far as I remember, all of the models showed *many* fewer cases and deaths (like multiples) with a flattened curve than in a business as usual scenario.

The reduced cases/deaths are a result of a normalized bell curve under the healthcare system encumbrance line. Once a health system collapses, the numbers of cases/deaths also skyrocket because that support structure is now gone.

The loss of life and out of control spread that happens once that scenario takes place is a result of the system collapsing more than the projected COVID-19 cases in a vacuum. In other words, those higher numbers also included lives that would have otherwise been saved from COVID-19 and other diseases/conditions as well.

Those nuanced stats are not discussed in public because that kind of detail is usually not necessary to get the point across, but it does generate confusion if people start scrutinizing the model against totals.

[Meclazine for Israel]

What the virus actually looks like at 100 nanometers across.



Great animated slide presentation for your PC or phone on the first isolated images of the Corona-virus.

https://mobile.abc.net.au/news/2020-04-28/putting-the-coronavirus-under-the-microscope/12158048

[Fmr. Gov. NickG]

I keep reading here that flattening the curve was not about reducing the number of cases/deaths, just spreading them out over time. But as far as I remember, all of the models showed *many* fewer cases and deaths (like multiples) with a flattened curve than in a business as usual scenario.

The reduced cases/deaths are a result of a normalized bell curve under the healthcare system encumbrance line. Once a health system collapses, the numbers of cases/deaths also skyrocket because that support structure is now gone.

The loss of life and out of control spread that happens once that scenario takes place is a result of the system collapsing more than the projected COVID-19 cases in a vacuum. In other words, those higher numbers also included lives that would have otherwise been saved from COVID-19 and other diseases/conditions as well.

Those nuanced stats are not discussed in public because that kind of detail is usually not necessary to get the point across, but it does generate confusion if people start scrutinizing the model against totals.

So how many people do you estimate will die from the virus if 200 million people are infected, but they are spread out in such a way that the health care system does not collapse?

[Dr. Arch]

I keep reading here that flattening the curve was not about reducing the number of cases/deaths, just spreading them out over time. But as far as I remember, all of the models showed *many* fewer cases and deaths (like multiples) with a flattened curve than in a business as usual scenario.

The reduced cases/deaths are a result of a normalized bell curve under the healthcare system encumbrance line. Once a health system collapses, the numbers of cases/deaths also skyrocket because that support structure is now gone.

The loss of life and out of control spread that happens once that scenario takes place is a result of the system collapsing more than the projected COVID-19 cases in a vacuum. In other words, those higher numbers also included lives that would have otherwise been saved from COVID-19 and other diseases/conditions as well.

Those nuanced stats are not discussed in public because that kind of detail is usually not necessary to get the point across, but it does generate confusion if people start scrutinizing the model against totals.

So how many people do you estimate will die from the virus if 200 million people are infected, but they are spread out in such a way that the health care system does not collapse?

I neither have the access to the necessary data nor the experience to make those estimates. I can tell you that they would vary greatly with the state of the healthcare system, who's infected, where, and how many at the same time.

[Fmr. Gov. NickG]

I keep reading here that flattening the curve was not about reducing the number of cases/deaths, just spreading them out over time. But as far as I remember, all of the models showed *many* fewer cases and deaths (like multiples) with a flattened curve than in a business as usual scenario.

The reduced cases/deaths are a result of a normalized bell curve under the healthcare system encumbrance line. Once a health system collapses, the numbers of cases/deaths also skyrocket because that support structure is now gone.

The loss of life and out of control spread that happens once that scenario takes place is a result of the system collapsing more than the projected COVID-19 cases in a vacuum. In other words, those higher numbers also included lives that would have otherwise been saved from COVID-19 and other diseases/conditions as well.

Those nuanced stats are not discussed in public because that kind of detail is usually not necessary to get the point across, but it does generate confusion if people start scrutinizing the model against totals.

So how many people do you estimate will die from the virus if 200 million people are infected, but they are spread out in such a way that the health care system does not collapse?

I neither have the access to the necessary data nor the experience to make those estimates. I can tell you that they would vary greatly with the state of the healthcare system, who's infected, where, and how many at the same time.

I’m stipulating that the state of healthcare systems is good.  Assume no shortage of necessary medical care or equipment.  As for where, if we’re talking about herd immunity, you’d have to assume the infected are pretty evenly spread out around the county.  You can make any assumption you wish about who gets infected and when under our current stay-at-home regime.

For reference, the current IMHE model is estimating that 74,000 will die.

[Dr. Arch]

I keep reading here that flattening the curve was not about reducing the number of cases/deaths, just spreading them out over time. But as far as I remember, all of the models showed *many* fewer cases and deaths (like multiples) with a flattened curve than in a business as usual scenario.

The reduced cases/deaths are a result of a normalized bell curve under the healthcare system encumbrance line. Once a health system collapses, the numbers of cases/deaths also skyrocket because that support structure is now gone.

The loss of life and out of control spread that happens once that scenario takes place is a result of the system collapsing more than the projected COVID-19 cases in a vacuum. In other words, those higher numbers also included lives that would have otherwise been saved from COVID-19 and other diseases/conditions as well.

Those nuanced stats are not discussed in public because that kind of detail is usually not necessary to get the point across, but it does generate confusion if people start scrutinizing the model against totals.

So how many people do you estimate will die from the virus if 200 million people are infected, but they are spread out in such a way that the health care system does not collapse?

I neither have the access to the necessary data nor the experience to make those estimates. I can tell you that they would vary greatly with the state of the healthcare system, who's infected, where, and how many at the same time.

I’m stipulating that the state of healthcare systems is good.  Assume no shortage of necessary medical care or equipment.  As for where, if we’re talking about herd immunity, you’d have to assume the infected are pretty evenly spread out around the county.  You can make any assumption you wish about who gets infected and when under our current stay-at-home regime.

For reference, the current IMHE model is estimating that 74,000 will die.

I don't know why you keep talking about herd immunity when we're still not even certain about whether or not someone who's had COVID-19 can be reinfected.

[Fmr. Gov. NickG]

I keep reading here that flattening the curve was not about reducing the number of cases/deaths, just spreading them out over time. But as far as I remember, all of the models showed *many* fewer cases and deaths (like multiples) with a flattened curve than in a business as usual scenario.

The reduced cases/deaths are a result of a normalized bell curve under the healthcare system encumbrance line. Once a health system collapses, the numbers of cases/deaths also skyrocket because that support structure is now gone.

The loss of life and out of control spread that happens once that scenario takes place is a result of the system collapsing more than the projected COVID-19 cases in a vacuum. In other words, those higher numbers also included lives that would have otherwise been saved from COVID-19 and other diseases/conditions as well.

Those nuanced stats are not discussed in public because that kind of detail is usually not necessary to get the point across, but it does generate confusion if people start scrutinizing the model against totals.

So how many people do you estimate will die from the virus if 200 million people are infected, but they are spread out in such a way that the health care system does not collapse?

I neither have the access to the necessary data nor the experience to make those estimates. I can tell you that they would vary greatly with the state of the healthcare system, who's infected, where, and how many at the same time.

I’m stipulating that the state of healthcare systems is good.  Assume no shortage of necessary medical care or equipment.  As for where, if we’re talking about herd immunity, you’d have to assume the infected are pretty evenly spread out around the county.  You can make any assumption you wish about who gets infected and when under our current stay-at-home regime.

For reference, the current IMHE model is estimating that 74,000 will die.

I don't know why you keep talking about herd immunity when we're still not even certain about whether or not someone who's had COVID-19 can be reinfected.

The “flatten the curve” model assumes that people have immunity once they recover as well.  Otherwise, how do you explain either of the curves in the “flatten the curve” figure ever declining?

[GoTfan]

https://twitter.com/meslackman/status/1254838397031464960

From the article:

That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.

The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.

Fun-Fact: Debates about animal testing aside (I'm not a big fan, but reluctantly understand the reasoning), Rhesus Monkeys share about ninety-five percent of genetic material with humans - hence why they're so often used in testing. 

I see this as wishful thinking at best. They're going to test it for five months then rush it out and damn the consequences?

[emailking]

It's likely most people get immunity after infection. Yes we don't know that for sure but it's pretty likely.

[Bandit3 the Worker]

I'm also wondering when the FDA is going to approve plasma treatment for broad use. Right now they only allow it on a case-by-case basis.

[Badger]

https://twitter.com/JesseFFerguson/status/1254886896376872960?s=20

If Obama or Hillary did this, Chapter 3497

[Penn_Quaker_Girl]

Morning, y'all!

Went to the doctor yesterday and have been given a clean bill of health! Also volunteered to have some blood drawn that Penn will use for antibody research.  

[Omega21]

Morning, y'all!

Went to the doctor yesterday and have been given a clean bill of health! Also volunteered to have some blood drawn that Penn will use for antibody research.  

Good to hear!

Btw. Do you just need to be the same/or other but compatible blood type as the receiver for someone to receive your blood, or is it like with organ transplants and more things come into play?

[Penn_Quaker_Girl]

Morning, y'all!

Went to the doctor yesterday and have been given a clean bill of health! Also volunteered to have some blood drawn that Penn will use for antibody research.  

Good to hear!

Btw. Do you just need to be the same/or other but compatible blood type as the receiver for someone to receive your blood, or is it like with organ transplants and more things come into play?

Blood transfusions are less complex than organ transplants.  With blood transfusions, the main considerations are the presence/lack of A/B antigens, A/B antibodies, and Rhesus proteins (rh-positive vs. rh-negative).  The different permutations with these factors produce the various blood types.  It's important to try and get these factors as close as possible to the donor. 

With organ transplant, not only does ABO-compatability and rh compatability need to be considered, but also the HLA testing (human leukocyte antigen) -- how compatible the actual tissues are between donor and recipient -- as well as blood tests that are part of something called serum crossmatching. 

As I said, this is super basic and doesn't even begin to scratch the surface of the actual mechanisms behind blood transfusions vs. organ transplants. 

[FrancoAgo]

Morning, y'all!

Went to the doctor yesterday and have been given a clean bill of health! Also volunteered to have some blood drawn that Penn will use for antibody research.  

do you did two consecutives negative test? or just clinically recovered?

[Penn_Quaker_Girl]

Morning, y'all!

Went to the doctor yesterday and have been given a clean bill of health! Also volunteered to have some blood drawn that Penn will use for antibody research.  

do you did two consecutives negative test? or just clinically recovered?

Clinically recovered for now, awaiting the results of a second test. 

[GeorgiaModerate]

State and federal public health agencies plan to screen people in parts of Fulton and DeKalb counties over the next seven days for antibodies to the novel coronavirus to pinpoint who might have had COVID-19 and estimate how widely the virus has traveled.

The Atlanta-based Centers for Disease Control and Prevention and state and local health boards in both counties will visit 420 randomly selected households through May 4 seeking volunteers to give blood samples.

https://www.ajc.com/news/local/where-testing-learn-how-many-have-had-virus-begins/4NKAdP7IEWCEqPX00iUz3H/

Fulton and DeKalb counties are the core of metro Atlanta.

[Meclazine for Israel]

Morning, y'all!

Went to the doctor yesterday and have been given a clean bill of health! Also volunteered to have some blood drawn that Penn will use for antibody research.  

Congratulations.

They don't mind that you've had malaria? I don't think i can donate blood in Australia because of either my previous malaria or working in Africa. Maybe there is a time limit.

[💥💥 brandon bro (he/him/his)]

These results are all preliminary tests on small samples (<100 patients) but several studies are finding early signs of longer-lasting lung damage to severe COVID patients that's consistent with but likely more damaging than other SARS and MERS infections.

link (Science News)

Some patients who survive COVID-19 may suffer lasting lung damage

[...]

The tissue lesions can be a sign of chronic lung disease. Similar damage has been documented in survivors of SARS and MERS, respiratory diseases caused by coronaviruses similar to the SARS-CoV-2 virus behind COVID-19. Long-term studies of SARS patients have shown that roughly a third of people who recovered from severe bouts were left with permanent lung damage. In the case of MERS, one study found about a third of people who recovered from a serious infection still had signs of lung damage about seven months later.

But while initial lung images indicate that SARS and MARS typically set into just one lung, COVID-19 appears to be more likely to afflict both lungs right away. In 75 of the 90 patients admitted to Huazhong University Hospital with COVID-19 pneumonia from January 16 to February 17, damage was seen across both lungs, Wang and colleagues report. CT scans taken before hospital discharge revealed that 42 out of 70 patients displayed the type of lesions around the alveoli that are more likely to develop into scars.

[...]

Some lung damage seen in the Wuhan study cases are likely to gradually heal or disappear, Wang and colleagues suspect. However, in some patients, lung abnormalities will harden into layers of scar tissue known as pulmonary fibrosis. That scarring stiffens the lungs, making it hard to get enough oxygen. People with pulmonary fibrosis typically suffer shortness of breath, limiting their ability to be physically active.

[...]

Article suggests a lot of this is due to the cytokine storm. There's some other interesting stuff in here like about how ventilators use is associated with longer-term damage (causation seems hard to determine here).

Here's one of the studies quoted in the article. 60% of patients featured still featured lung scarring upon discharge and all but four patients had "mild to substantial" lung abnormalities upon discharge. It looks like the scarring improved for some patients over the course of infection, though, so there's still some potential for recovery after discharge. Mean age in the study was 45.

[Penn_Quaker_Girl]

Morning, y'all!

Went to the doctor yesterday and have been given a clean bill of health! Also volunteered to have some blood drawn that Penn will use for antibody research.  

Congratulations.

They don't mind that you've had malaria? I don't think i can donate blood in Australia because of either my previous malaria or working in Africa. Maybe there is a time limit.

It's for lab purposes, not donation. 

[JA]

Howard Stern suggests Trump supporters take disinfectants and drop dead

Howard Stern, the famed radio personality, suggested Monday that President Trump's supporters should “take disinfectant” and “drop dead.”

“I would love it if Donald would get on TV and take an injection of Clorox and let’s see if his theory works,” Stern said on Monday. “Hold a big rally, say f—k this coronavirus, with all of his followers, and let them hug each other and kiss each other and have a big rally.”

“A big cocktail of disinfectant,“ Robin Quivers, his longtime sidekick suggested, according to the New York Daily News.

“Yeah,” Stern concurred. “And all take disinfectant and all drop dead.”