COVID impacts

[ChloeTzang]

It's not panic. It's science-based, common sense determination. The "panic" term is being used to try to defuse the stupidity and direct cause of tens of thousands of unnecessary deaths with which the threat was ignored and mocked for six weeks. This goes with those who keep saying the issue isn't political. Damn straight it's political. The "It's a Democratic Party hoax" and the initial and continued failed response by national leadership to it made it political from the getgo.

I think for once we more or less agree, taking out or reversing the political parties. Failures all round. On the good side, it could have been a lot worse. I was reading up on the plagues in medieval Europe where 30-50% of the population died, and that was bad. Puts it into perspective a little. We ain’t done so bad. Remains to be seen what effect all these current crowds will have on spread.

 

[KeithD]

Nope, won't grant "failures all around." The failure is quite specific and direct. No sliding away from that.

 

[Enchantment_of_Nyx]

Doesn’t really matter does it. No vaccine, it’s going to spread. The whole point of these lockdowns was to flatten the curve and spread out the impact on the medical system. So far there’s no overwhelmed, not even NYC. My take on it is, open up until the health systems are stressing, and only then do you need to alleviate the pressure. All this panic doesn’t do anyone any good. Looks like the Swedes more or less have the right idea. This virus isn’t going to disappear on us.

Well, about Sweden. That didn't go so well. They've now admitted they messed up. Their model was based on gaining herd immunity quickly. They're nowhere near herd immunity and they have one of the highest, if not the highest (I can't remember which) Covid death rates per capita. Their economy took a huge hit. Sweden's economy is expected to shrink by 7 percent, and many predictions show them on track for the worst recession wince World War II.

The arguments you make about flattening the curve are quite correct, or they would be, if it weren't for the fact that that treatments and vaccines are advancing. We expect to have a vaccine within a year. We are already developing more effective treatments for the virus. If we can keep the curve flattened until the vaccine is ready, there are many people who do not have to die. Even if all we did with more time was to produce more ventllators and develop faster test kits and better testing practices, we would be saving lives.

Another thing I'm not sure people are paying attention to is that when we exhaust our healthcare workers, we are pulling them away from providing the best care possible to non-covid patients. Mortality is also being affected by the fact that people are not going to the hospital because they're being advised not to, and because it's realisticlly not a safe place to be right now. There was a review done of ambulance calls in New York that illustrated this very clearly. Unfortunately, I can't remember where it was published, but it's pretty easy to see why it would happen that way.

This isn't a simple issue, and it's hard to stay apprised of the facts that allow informed opinions. For that reason, I think that we should either make a diligent effort to educate ourselves, or we should rely on the advice of professionals. I'm the last person to accept what is told me by some sort of authority, but I do believe that rejecting the advice of public health officials obligates one to do the research for themselves.

 

[Bramblethorn]

Well, about Sweden. That didn't go so well. They've now admitted they messed up. Their model was based on gaining herd immunity quickly. They're nowhere near herd immunity and they have one of the highest, if not the highest (I can't remember which) Covid death rates per capita. Their economy took a huge hit. Sweden's economy is expected to shrink by 7 percent, and many predictions show them on track for the worst recession wince World War II.

Yep. The guy who designed Sweden's strategy has acknowledged that they did a bad job.

People love to frame this as a trade-off between deaths from virus and economic damage, but what economic research I've seen suggests that it's nothing of the sort. Under the Spanish flu, cities that applied the strictest infection controls had the best economic recovery. The USA isn't at the "recovery" stage yet - and it doesn't help that the country was entering recession even before COVID-19 hit - but I saw some interesting economic research using things like job listings and bank payments data which showed that the economic damage this time around preceded lockdowns.

...meanwhile, New Zealand now has no known active cases. Here in Australia we're down to about ten new cases a day; we've started cautiously easing restrictions so I'll be interested to see how those numbers behave over the next few weeks.

"Herd immunity" vs. lockdown is also a false dichotomy. The more contagious a disease is, the higher a percentage of immunity you need to achieve herd immunity. At a rough approximation, you need (R0-1)/R0 * 100% of your population to be immune before you reach the point where the infection is no longer growing exponentially, where R0 is the basic reproduction number for the virus.

Current estimates for coronavirus R0 are about 4-9, so achieving herd immunity requires about 75%-90% of the population to be immune. If you don't have a vaccine, that means you need to infect at least 75% of the population (assuming that everybody who's been infected develops lasting immunity - last I saw, research on that front was hopeful but not conclusive).

Even if you can keep the case-fatality rate down to 1%, which is optimistic, that still means killing more than two million people in America.

But R0 isn't a universal constant. It can be lowered by hygiene and distancing measures. If you can halve the rate at which infected people pass it on, the herd immunity threshold drops from 75% to 50%, which saves around six hundred thousand lives.

[edit: I screwed up here - that estimate of 1% was for symptomatic cases, but I should've used a rate that includes undetected infections. That will probably lower the numbers a bit, but we're still talking hundreds of thousands.]

Gotta say though, it's fascinating seeing the folk who were screaming about "death panels" a few years back now explaining why a few hundred thousand people is an acceptable sacrifice to Mammon.

 

[JamesMiehoff]

I tend to think in terms of the most pessimistic so that (hopefully) I can be pleasantly surprised. The current track record on creating vaccines for Corona type viruses is 100% -- Failure. SARS, MERS, I forgot the other acronym, no vaccines. AIDS, no vaccines. Bird Flu, no vaccine. Herpes, no vaccine. If I was sure of my memory, I could go on and on.

I do not see a vaccine in the near future. Or if there is one, it will be an annual one, just like the current flu vaccines.

So get used to it folks, COVID is here to stay and the jury is still out as to what the best remedy is.

The South Korean and Taiwanese method of shut every thing down so tight you might as well roll up the streets, seems pretty harsh, but it has been effective.

The Spanish and Italian method of let's not do anything until all the at risk people have overwhelmed the health care and then let the strongest survive. Also pretty harsh, but we will see if they get the second bump next fall.

The American system of benign neglect until forced to act, then wave your magic schwantz and proclaim that it is a hoax, that it will be over soon, that it could have been worse and thanks Minneapolis, glad that's over with.

James

 

[Enchantment_of_Nyx]

I tend to think in terms of the most pessimistic so that (hopefully) I can be pleasantly surprised. The current track record on creating vaccines for Corona type viruses is 100% -- Failure. SARS, MERS, I forgot the other acronym, no vaccines. AIDS, no vaccines. Bird Flu, no vaccine. Herpes, no vaccine. If I was sure of my memory, I could go on and on.

I do not see a vaccine in the near future. Or if there is one, it will be an annual one, just like the current flu vaccines.

So get used to it folks, COVID is here to stay and the jury is still out as to what the best remedy is.

The South Korean and Taiwanese method of shut every thing down so tight you might as well roll up the streets, seems pretty harsh, but it has been effective.

The Spanish and Italian method of let's not do anything until all the at risk people have overwhelmed the health care and then let the strongest survive. Also pretty harsh, but we will see if they get the second bump next fall

The American system of benign neglect until forced to act, then wave your magic schwantz and proclaim that it is a hoax, that it will be over soon, that it could have been worse and thanks Minneapolis, glad that's over with.

James

Of that list, only SARS and MERS were coronaviruses. Development of the SARS vaccine was halted when SARS I just disappeared. They had a vaccine, but it was causing immune failures during animal testing. They didn't work further on it because, poof, no more SARS all of a sudden. They still haven't even figured out for sure why it disappeared. Strict quarantines helped, but that doesn't really explain the complete disappearance. It may have mutated itself out of existence. Nobody seems to know.

Last year, clinical trials of a MERS vaccine were successful in monkeys. As far as I know, it hasn't been tested in people, but it's expected to work. The MERS vaccine was not exactly front burner because MERS has been well-controlled. The MERS vaccine used a new RNA delivery platform that targets a piece of the RNA that's common to the coronavirus family.

There's at least one South Korean firm and one US firm using the same proven-successful RNA delivery platform in the vaccine they're testing for covid-19. The problem that they ran into with the SARS vaccine is that it's a protein-based. Protein-based vaccines have a tendency to cause immune problems because all those little bits of protein are the same things our body uses. They solved the problem with a new adjuvant (e.g., a secondary agent that increases the effectiveness of the vaccine) and stabilizer that doesn't have the same protein problem. Being able to use that same delivery system means more than half the work is already done. The delivery system is often the hardest part to get right.

A South Korean firm has also mapped the covid-19 genome already. There's a protein with a funny shape that all the coronaviruses seem to have in common. I wish I could remember more details about it, but because that shape is though to be unique to coronaviruses, it offers an ideal place to "attach" the vaccine.

Ten covid-19 vaccine candidates have already begun clinical trials. These are only the first stage of trials. They're far from primate trials. But the point is, they've got the information they need to develop these approaches. It's quite probable that none of these first ten are the one we ultimately land on, but their existence so soon after the virus came into existence is grounds for optimism.

Science marches on. They are finding ways around the impediments. I don't want to be falsely optimistic, but the fact that there is a MERS vaccine found safe and effective in primates should give everyone cause for hope, given how closely MERS and covid-19 are related. Pessimism is understandable, but we should try for realism. Pessimism can cause us to make poor policy decisions as easily as false optimism can.

A fatalistic outlook on a vaccine or treatment can lead us to balance competing factors differently. If we think there's no hope of a vaccine, we may not give adequate weight to the benefit of trying to spare as many people as possible until a vaccine arrives.

I'm not saying it's time to break out the champagne, but there's sound reason to expect a vaccine far soon than we are accustomed to seeing them develop.

 

[BelleCanzuto]

I tend to think in terms of the most pessimistic so that (hopefully) I can be pleasantly surprised. The current track record on creating vaccines for Corona type viruses is 100% -- Failure. SARS, MERS, I forgot the other acronym, no vaccines. AIDS, no vaccines. Bird Flu, no vaccine. Herpes, no vaccine. If I was sure of my memory, I could go on and on.

James

Everything you wrote about coronavirus vaccines is true, but I think it's worth putting in a little context. The regular coronaviruses that cause colds haven't been studied much for vaccines because they don't cause much harm. Hardly anyone dies of a "common cold" even though they're pretty contagious. Conversely, the SARS and MERS viruses weren't studied for vaccines because they didn't kill many people either, though for very different reasons. Apparently SARS mutated somehow and basically faded away (though there are still occasional cases). MERS was *so* deadly that it didn't get to spread very far. None of the other coronaviruses have both the impact and the longevity to try to find a vaccine for them.

The COVID-19 virus is the first coronavirus that's caused enough damage (death and very serious illness) over a widespread enough area and long enough period of time to make it worth making a vaccine for. And the Oxford group, that had been working on vaccines for the 'cold' viruses, reports some good preliminary results, based on strategies they learned from their previous work.

You may be right, in that no vaccine can be developed. I think it's likely that it'll wind up being an annual vaccine like the flu shot. But it's very early days, still.

HIV is a very different disease than the coronaviruses, but they are making headway on a vaccine.
Bird flu is 'influenza A' and some strains of it are included in annual flu shots.

eta: I didn't see Nyx's post when I wrote this. Theirs has more good detail.

~~~~
As an aside, when I got home from work today, there was a care package from my local public health department. Two big bottles of hand sanitizer made at a local distillery (80% alcohol), and two fabric masks. There was also a flyer reminding to wash hands and wipe down surfaces. My public health area only has a couple of hundred cases and less than two dozen deaths.

 

[SimonDoom]

A study that came out today suggested that lockdown measures in the US have prevented 60 million people from becoming infected with the virus.

The CDC today came out and said the mortality rate for the virus is around .26%. That's much less than was previously believed, but if you multiple 60 million times .26% that's over 150,000 people. Add that to the people who've already died and that's more Americans than died in all of World War 2, in just a few months.

So this isn't a hoax, and it isn't seasonal flu, and it's not a little deal.

Reasonable debates can be had about what we do about this, and how we balance the need to keep the economy and people's jobs intact against the need to save lives. But whatever our political biases we should try to stay open to the science and the evidence, because this is serious and lives are at stake.

 

[Enchantment_of_Nyx]

...I think it's likely that it'll wind up being an annual vaccine like the flu shot...

I agree. I suspect it's going to be something that works on a bunch of coronaviruses and is constantly updated as they emerge and mutate. As you said, like flu shots. Pneumonia shots, too.

 

[NotWise]

For what it's worth...

I went to my state Department of Health web site to check on today's stats. They have a link there for "Where to get tested." For reasons I can't possibly imagine, I read "Where to get fisted." I had to shake my head and check again.

 

[Rustyoznail]

For what it's worth...

I went to my state Department of Health web site to check on today's stats. They have a link there for "Where to get tested." For reasons I can't possibly imagine, I read "Where to get fisted." I had to shake my head and check again.

I was tested a few weeks ago, and it's not a whole lot of fun. But it's way better than the thought of having my arse fisted.

 

[Bramblethorn]

Of that list, only SARS and MERS were coronaviruses. Development of the SARS vaccine was halted when SARS I just disappeared. They had a vaccine, but it was causing immune failures during animal testing. They didn't work further on it because, poof, no more SARS all of a sudden. They still haven't even figured out for sure why it disappeared. Strict quarantines helped, but that doesn't really explain the complete disappearance. It may have mutated itself out of existence. Nobody seems to know.

Last year, clinical trials of a MERS vaccine were successful in monkeys. As far as I know, it hasn't been tested in people, but it's expected to work. The MERS vaccine was not exactly front burner because MERS has been well-controlled. The MERS vaccine used a new RNA delivery platform that targets a piece of the RNA that's common to the coronavirus family.

Also, while I'm not aware of any proven vaccine against human coronavirus strains yet, we do have a vaccine for canine coronavirus. Different mammal species and different strain, but it's still a good sign.

A study that came out today suggested that lockdown measures in the US have prevented 60 million people from becoming infected with the virus.

The CDC today came out and said the mortality rate for the virus is around .26%. That's much less than was previously believed, but if you multiple 60 million times .26% that's over 150,000 people. Add that to the people who've already died and that's more Americans than died in all of World War 2, in just a few months.

Terminology nitpick - "mortality rate" generally means deaths from a given cause as a % of the entire population. I think you and the CDC are talking about the case fatality rate, deaths as % of cases.

Per discussion at https://www.usatoday.com/story/news...stimates-covid-19-death-rate-0-26/5269331002/ the figure of 0.26% is CDC's current best estimate, but that depends on some assumptions about what percentage of cases are actually detected. It could be quite a bit lower, or higher, depending on that percentage. Still, looks like it's lower than the 1% I suggested above - I think I made the mistake of going on the death rate among detected cases, apologies for that.

One of my concerns is the lasting health damage on those who survive it. Viral infection can do some nasty long-term things to organs, nervous system, and immune system, and while it's obviously impossible to get long-term information yet, I've seen worrisome reports of things like chronic fatigue and memory loss. Another reason to avoid "let 'er rip".

 

[BelleCanzuto]

One of my concerns is the lasting health damage on those who survive it. Viral infection can do some nasty long-term things to organs, nervous system, and immune system, and while it's obviously impossible to get long-term information yet, I've seen worrisome reports of things like chronic fatigue and memory loss. Another reason to avoid "let 'er rip".

Granted, there's not a whole lot of science in this article; it's mostly snippets of interviews with people who've had COVID, but there does seem to be a growing body of evidence that even for people with "mild" cases, there are some significant long term effects.

Putting that together with the case fatality rate, and the apparent damage to multiple organ systems (either from the virus itself, or the immune response to it), this is definitely a disease to take seriously, and to try to mitigate.

COIVD-19 can last for months. Article in The Atlantic by Ed Yong

~~~~
Re the study Simon referenced about the mitigation factors saving millions of infections. I saw an interview this evening with Solomon Hsiang, who is one of the authors of the study. He asserted that the mitigation collectively saved more lives than any other action in human history (that's not verbatim, but true to the sentiment). Then he said "the roof was falling in, and collectively, we caught it. And, we're still, basically, holding it up."

So, yeah, not a time for panic. But definitely not a time to act like the virus has completely gone away, or was a hoax all along, or is part of some conspiracy promulgated by hospitals just to get extra funding.

Link to an article about the study: Shutdowns Prevented 60 Million Coronavirus Infections.

 

[Rustyoznail]

One of my concerns is the lasting health damage on those who survive it. Viral infection can do some nasty long-term things to organs, nervous system, and immune system, and while it's obviously impossible to get long-term information yet, I've seen worrisome reports of things like chronic fatigue and memory loss. Another reason to avoid "let 'er rip".

For reference

https://www.theage.com.au/national/research-points-to-virus-having-impact-on-brain-and-nervous-system-20200608-p550k9.html

 

[Enchantment_of_Nyx]

Granted, there's not a whole lot of science in this article; it's mostly snippets of interviews with people who've had COVID, but there does seem to be a growing body of evidence that even for people with "mild" cases, there are some significant long term effects...

I think you're right. Heart damage has already been well-documented. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/can-coronavirus-cause-heart-damage The researchers in a different article I read found that covid-related heart attacks weren't being diagnosed as covid-related (understandably), so that is another factor aggravating our ability to fully report covid-19 fatalities.

Anything that provokes such a severe inflammatory response probably causes wide-spread organ damage. That's absolutely going to be the case in patients who fell victim to cytokine storms. They're lucky to be alive. The memory loss you mentioned is also consistent with inflammatory damage, of course. The symptoms in young children, who were not initially being diagnosed, were almost exclusively inflammatory, so their organs were likely damaged to some degree. Hopefully they can still repair themselves.

 

[ElectricBlue]

I was tested a few weeks ago, and it's not a whole lot of fun. But it's way better than the thought of having my arse fisted.

I thought the test was done with a small probe in the nose and throat.

You sure your "Doc" is legit, there, Rusty? That inter-anal approach sounds... unusual.

 

[Bramblethorn]

NYC Health: use gloryholes to protect yourself from infection

Make it a little kinky. Be creative with sexual positions and physical barriers, like walls, that allow sexual contact while preventing close face to face contact.

 

[SolarRay]

NYC Health: use gloryholes to protect yourself from infection

Make it a little kinky. Be creative with sexual positions and physical barriers, like walls, that allow sexual contact while preventing close face to face contact.

Boy has this been making the rounds... Excuse me while I enjoy a brief moment of pride.

From an article about it:

"To be absolutely sure this wasn’t a failure of imagination on my part, I did my due diligence and reached out to the city health department for clarification. When asked if the above passage was a tacit endorsement of glory holes, Dr. Demetre Daskalakis, Deputy Commissioner for Disease Control and Incident Commander for the Health Department’s COVID-19 response, told Gizmodo (emphasis, again, ours):

'We trust our audience and New Yorkers are creative enough to know what this means.'"

 

[Enchantment_of_Nyx]

Also, while I'm not aware of any proven vaccine against human coronavirus strains yet, we do have a vaccine for canine coronavirus. Different mammal species and different strain, but it's still a good sign.

They've just submitted one for cats for human trials. They've been using it to vaccinate against feline peritonitis (a coronavirus that affects felines but not people) for some time. In laboratory settings, it prevented reproduction by covid-19. Since covid-19 also infects cats, there's some optimism that the feline vaccine will be effective in people. A lot of animal vaccines are. The rabies vaccine, for example, is identical.

 

[SolarRay]

Any thoughts about the impact (or lack thereof) of protests on infection rates? Where I am, we've had two weeks of heavy activity, with most participants wearing masks but no ability to social distance, of course. It appears the meter has not budged at all on new cases and I'd expect to see that by now if there was going to be a rise in cases from this. Positive sign? Or speaking too soon?

 

[KeithD]

Any thoughts about the impact (or lack thereof) of protests on infection rates? Where I am, we've had two weeks of heavy activity, with most participants wearing masks but no ability to social distance, of course. It appears the meter has not budged at all on new cases and I'd expect to see that by now if there was going to be a rise in cases from this. Positive sign? Or speaking too soon?

That remains to be seen as there is a delay involved. That said, the rates are going up all over the USA, not down, and this was happening even without everyone taking to the streets. Americans seem to have had enough of the virus--but the virus doesn't seem to have had enough of Americans.

 

[SolarRay]

That remains to be seen as there is a delay involved. That said, the rates are going up all over the USA, not down, and this was happening even without everyone taking to the streets. Americans seem to have had enough of the virus--but the virus doesn't seem to have had enough of Americans.

From what I've seen it varies by state, although the average for the country is going up. I've been watching the New York Times charts daily here, they break it out by upward, downward, and stable trends: https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

Here's what I've found regarding the delay of symptoms:

Currently, according to the Centers for Disease Control and Prevention (CDC)Trusted Source, the incubation period for the novel coronavirus is somewhere between 2 to 14 days after exposure.

According to a recent reportTrusted Source, more than 97 percent of people who contract SARS-CoV-2 show symptoms within 11.5 days of exposure. The average incubation period seems to be around 5 days. However, this estimate may change as we learn more about the virus.

 

[Enchantment_of_Nyx]

Any thoughts about the impact (or lack thereof) of protests on infection rates? Where I am, we've had two weeks of heavy activity, with most participants wearing masks but no ability to social distance, of course. It appears the meter has not budged at all on new cases and I'd expect to see that by now if there was going to be a rise in cases from this. Positive sign? Or speaking too soon?

There was a report that some National Guardsman stationed at protests have been infected. I have no idea why they weren't wearing masks, but most of them were not. CDC says the onset of symptoms averages around 5-6 days, but could be as early as 3 or as late as 14.

Anytime you get a large group together, there's gong to be a jump. The impacts may be less than feared because most people in most places have been wearing masks. Everyone agrees non-medical masks aren't completely effective, but I think they're more effective than people in the US have been led to believe. The U.S. Administration, including the freaking Surgeon General, said at first that masks were unnecessary or ineffective. That made no sense. It's an airborne respiratory illness for Pete's sake. Then it came out that the the Administration had been okaying the sale of masks from the US to China after the outbreak started. And of course, we were running out. So, there was a whole lot of political motivation for downplaying masks, plus the Administration's feelings about the "optics" of acknowledging the threat with such a visible symbol as a mask.

The effectiveness of the mask depends on the mask itself and how it's worn. It was hot, and there were people with their masks pulled down off of their nose and only covering their mouths. You might as well not wear one if you're going to do that.

BUT, and this is a big but, we don't know for sure that respiratory transmission is the only possible method. Infectious disease experts confirm that catching it through your eyes is plausible. That danger would have been increased by irritation from tear gassing. If the eyes are a vector, masks would only afford protection to the extent that infected people were wearing the masks.

New infection rates should already be accounting for some people exposed at protests, but of course the real impact will be the exponential effect if/when those people don't self-quarantine. Since very, very little contact-tracing is being done in the U.S. it's pretty difficult to attribute the source of infections.

 

[SolarRay]

Thanks for the great summary, Nyx!
Yes, I had heard about the national guardsmen. Of course, most of the guardsmen and police are not wearing masks whereas most of the protesters are. I was expecting to see some spread due to the protestors by now precisely because of that 3-14 day incubation period and found it interesting and encouraging that there was none. However, you're right that it might take more time to see what happens if they don't self-quarantine.

 

[Bramblethorn]

BUT, and this is a big but, we don't know for sure that respiratory transmission is the only possible method. Infectious disease experts confirm that catching it through your eyes is plausible. That danger would have been increased by irritation from tear gassing. If the eyes are a vector, masks would only afford protection to the extent that infected people were wearing the masks.

And tear gas is also a respiratory irritant - a couple of protestors have died just from gas exposure - so it may well increase vulnerability to infection via respiratory pathways.