COVID-19

[thrifty++]

@jacob. Wow they have done a lot. It shows how insidious this virus is that despite all that there is still in excess of 12,000 reported cases.

[ertyu]

people i know in china report temperature checks twice a day at work. Anyone above 37.3 taken to hospital for lung scan, blood test, pcr. No one leaves premises until ct scan + blood test comes back all clear -- i remember at one point someone was asking how the chinese are reopening: this is how they think it's necessary to reopen. they fully expect a second wave.

[Ego]

RE: Israel

https://www.timesofisrael.com/top-israe ... r-70-days/

A prominent Israeli mathematician, analyst and former general claims simple statistical analysis demonstrates that the spread of COVID-19 peaks after about 40 days and declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it.

Prof Isaac Ben-Israel, head of the Security Studies program in Tel Aviv University and the chairman of the National Council for Research and Development, told Israel’s Channel 12 (Hebrew) Monday night that research he conducted with a fellow professor, analyzing the growth and decline of new cases in countries around the world, showed repeatedly that “there’s a set pattern” and “the numbers speak for themselves.”

While he said he supports social distancing, the widespread shuttering of economies worldwide constitutes a demonstrable error in light of those statistics. In Israel’s case, he noted, about 140 people normally die every day. To have shuttered much of the economy because of a virus that is killing one or two a day is a radical error that is unnecessarily costing Israel 20% of its GDP, he charged.

[steveo73]

@Ego - that is extremely interesting. It's still another piece of data that we have to really careful with though. That is his analysis right now but in 2 months time that could change.

I also think that is the reason why you utilize social distancing. If you limit the impact and the outbreak is over in a couple of months then you are good to go with only a couple of months impact to the economy.

To me it backs up the approach of squashing the virus rather than flattening the curve.

[George the original one]

RE: Israel

https://www.timesofisrael.com/top-israe ... r-70-days/

I'm pretty certain he ignores the differences in penetration. NY vs. CA, for instance. NY has only about half the population of CA, yet NY is significantly more infected. NY's first confirmed case was Mar 1 where CA's first case was Jan 26.

[Ego]

So far the models have been spectacularly wrong and they have consistently erred on the side of pessimism. In short, they predicted this would be far worse than it has been. Even their best-case models have been wrong by many factors.

They will continue to be wrong in that direction because they never want to be wrong in the other direction. So they continue to use bad assumptions. Here is one that I find particularly interesting and may explain the phenomenon I linked to above....

https://marginalrevolution.com/marginal ... blems.html

One thing both economists and epidemiologists seem to be lacking is an awareness for the problems of aggregation. Most models in both fields see the population as one homogenous mass of individuals. But sometimes, individual variation makes a difference in the aggregate, even if the average is the same.

In the case of pandemics, it makes a big difference how that infection rate varies in the population. Most models assume that it is the same for everyone. But in reality, human interactions are not evenly distributed. Some people shake hands all day, while others spend their days mostly alone in front of a screen. This uneven distribution has an interesting effect: those who spread virus the most are also the most likely to get it. This means that the infection rate looks very higher in the beginning of a pandemic, but sinks once the super spreaders has the disease and got immunity. Also, it means herd immunity is reached much earlier: not after 70% of the population is immune, but after people who are involved in 70% of all human interactions are immune. At average, this is the same. But in practice, it can make a big difference.

I did a small simulation on this and came to the conclusion that with recursively applied Pareto-distribution where 1/3 of all people are responsible for 2/3 of all human interaction, herd immunity is already reached when 10% of the population had the virus. So individual variation in the infection rate can make an enormous difference that are be captured in aggregate models.

Github sim is linked from the source. I'm not saying his model is correct. Nor is he. But his assumptions seem reasonable to me. It also explains the crazy cultural difference we are seeing.

[Jin+Guice]

A prominent Israeli mathematician, analyst and former general claims simple statistical analysis demonstrates that the spread of COVID-19 peaks after about 40 days and declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it.

Didn't most western European countries have their first cases just over 70 days ago though?

It looks like Italy's new cases peaked March 21. I guess you could make the case that the infection rate was pretty small on Feb. 9th, so it really didn't start until then. I'd bet the prominent mathematician a QP that Italy's cases won't be at "nearly 0" by 4/20 though .

To have shuttered much of the economy because of a virus that is killing one or two a day is a radical error that is unnecessarily costing Israel 20% of its GDP, he charged.

O.K., um... but you shuttered the economy so that only 1 or 2 people a day die from the disease. Israel shutters early and has a peak daily death rate of 13. NY waits to shutter and has a peak daily death rate of 799. This is evidence that shuttering doesn't work*? From a mathematician?


*I'm not saying that shuttering was definitely the right move. I'm saying that this dude is either being misquoted or that my simple statistical analysis says he's a charlatan.




It'd be nice if we used this first wave of the quarantine to increase hospital capacity (mission, uh, semi-accomplished in a G.W.B. sort of way) and prepare a plan to quarantine those who are most at risk... whoops.

It looks like some European nations are starting to loosen the reigns a little on the quarantine, does anyone think this will workout well?

Also, is anyone watching Ecuador or Brazil (thinking of you @bigato)? Cause...fuck.


On the other side of the news, there's speculation that U.S. hospitals have a financial incentive to falsify patients as COVID-19 positive because they get paid more per patient (and also as @Ego mentioned, a financial incentive to put patients on ventilators). This would mean, at least in the U.S., that we're overcounting patients/ deaths (counterbalanced by the fact that home deaths and maybe nursing home deaths aren't being counted in the official data).

On the one hand, I find this hard to believe, because U.S. numbers (except for NY) are pretty consistent with Europe (unless the problem is their too?). On the other hand, it makes sense that hospitals would get some sort of relief for COVID patients and that this would encourage falsification.

[Jin+Guice]

@Ego: Damn! Now that's an interesting article. I have no idea if it's accurate or not, but so many COVID articles are easily refutable, it's almost refreshing to read one that I have no idea about. It does seem like we should be attempting to recreate an SK scenario in parts of the U.S. where the disease seems to be less widespread.

Have the

So far the models have been spectacularly wrong and they have consistently erred on the side of pessimism. In short, they predicted this would be far worse than it has been. Even their best-case models have been wrong by many factors.

Have the models been spectacularly wrong? I have no idea if they have or haven't, but are there examples of epidemological models that have been spectacularly wrong in best case scenarios (I spent all my time focusing on worst case scenarios)?

I still buy the argument that places where the virus is running wild need to be shutdown to stop hospitals from becoming overwhelmed. I still sight the fact that 1) hospitals became over run in several places and 2) it very strongly looks like quarantining prevented this from getting worse (no proof though). I'm open to the fact that I could be wrong.

I do think the more targeted approach could have worked as well, but I guess we'll never know (or maybe we will if there's a round 2).

[Ego]

@J&G, Yeah, I particularly liked the part about reaching herd immunity. To do so we don't need to have a 70% of the population immune, we need the people responsible for 70% of the interactions to be immune. Hah!

Your statement about hospital overwhelm begs the question.... what is hospital overwhelm and is avoiding it the underlying reason for the lockdowns? If we were sure that the hospitals would not be overwhelmed would we unlock the lockdown? We touched on it above when I mentioned the fact that some hospital protocols are moving away from using ventilator on most patients. Were ventilators the limiting factor? If not, then what? It seems other factors are more scalable.

[Tyler9000]

Yeah, I particularly liked the part about reaching herd immunity. To do so we don't need to have a 70% of the population immune, we need the people responsible for 70% of the interactions to be immune. Hah!

Fascinating. While I can't speak to its measurable real-world effect in this particular situation, it's such a simple concept and makes total sense. And knowing how most people depend on averages in order to make complex ideas simple enough to work with, I also see from a human-nature point of view how such an over-simplification makes it into the models.

[horsewoman]

@ego here in Germany we have been able to avoid overwhelmed hospitals for the most part, same in our neighboring country of Austria. Both countries had early and rather strict lock downs. Austria started to loosen the lock down yesterday and Germany will do so in 2 weeks - we are around 10 days behind Austria, since the uncontrolled spread started with people coming home to Germany from skiing in Austria.

I don't know if the lock down was the only viable option but I'm very glad that our health system got the time and the opportunity to gear up, as there most certainly will be a second wave in autumn. Real numbers will emerge only much later when enough data is collected. Right now everything is speculation. I don't envy the politicians their job, damned if they do, damned if they don't...

[ZAFCorrection]

The virus escaping from a Wuhan laboratory stopped being a racist, crackpot conspiracy as of today I guess.

The CDC changed its mind about wearing masks and apparently now the hipster grocery store I go to is taking a hard line on mask wearing.

Socially acceptable attitudes and behavior are changing by the minute depending on the last thing the authorities said.

[thrifty++]

NZ had 15 new cases reported today for a total of 1,401 confirmed and probable cases so far.

70,160 tests done (1.46% of total population).

9 people have died.

The number of deaths increased significantly in the past week. So fatality rate has gone up a lot (0.64%). All of them are in their 70s, 80s and 90s. I think youngest was 73. Also 6 of the 9 are from a cluster that hit one retirement village and I think they were all from the dementia ward. Very sad though.

770 recovered cases exceeds the active cases of 662.

The increase in new cases is the smallest daily increase in 4 weeks. Im really hoping this trend continues.

We are currently in level 4 alert lockdown until at least 22 April. We wont find out as to whether we go to level 3 alert until next week. Im hoping we have another week in full lockdown TBH. NZ is heading into winter. I think we need to be cautious.

Although the govt has just announced what level 3 alert looks like and it will still be much of a lockdown in any event. Takeaways will be able to operate again, provided there is no contact payment and collection or delivery. Construction can resume with strict hygiene procedures. People who can work from home are expected to continue to. E commerce can resume in full swing provided its completely contactless. All contact based businesses have to remain closed. Eg no hairdressers no gyms etc. Everyone has to stay in their bubble and not meet other people or leave their local region. Apparently we are allowed to swim in the ocean again. But who cares. Swimming in May here is like swimming in the ocean in November in the Northern Hemisphere. Wasnt worth exempting. But the big Achilles heel is that schools are reopening. Im disappointed with that one. The biggest cluster we have had here was at a school. So hopefully full lockdown carries on longer than until 22 April.

[steveo73]

@ego and that discussion on herd immunity. I always envisioned herd immunity as something that required more like 80% of people to be immune and more importantly a lot of deaths. I've always thought we can squash this virus however that explanation provides a good rationale why that is the case. I'm not stating it's true but if it is also means we can manage this situation differently.

I'm still a massive fan of squashing the virus but maybe we can do that relatively quickly via social distancing. Instead of this taking at least a year to develop a vaccine we might not even require one for normality to slowly resume.

I heard a good medical commentator today state that he was more confident in a cure compared to a vaccine and he thought that could come relatively quickly.

I'm getting more hopeful that we can get over this in less than a years time. I don't know what everyone else's expectations are though.

[J_]

We are all more or less blind and looking for ways to overcome this (for the naked eye) invisible virus. Models are (only) thinking instruments..

The (early) warnings about the coming virus here in this forum were/are a good guide for me.
And yes like @horsewoman wrote, Austria and Germany where she and I live, seem to have found a good way to delay the spread so that the deadly surge becomes "manageable", and have until now a very low death rate (ca 45 pM) compared to eg. Spain (ca 400 pM) altough we are about on the same time-path.

The virus still kills people with a weak or impaired health, and/or those who are trapped in community/homes/care/homes. Especially when the management of those homes are/were too late to take measures to curb the spread via carers and via the inhabitants themselves. It can be that those measures are not feasable/possible.

One of the ere goals is getting/maintaining a (perfect/optimal) health, and many of the wealth's illnesses are reversable. A long time ago I realised this and worked since then to reach and maintain such a health, and (yes @ 7W5) separate to that a good level of fitness.

Now it is here up all to our own behave, have we the means and the patience to stay isolated for another long time?

For the ones who are still depending on an income from work, the best solution is a: get/maintain optimal health, take measures to avoid as long as possible contamination, but in the end your health is the only weapon for all of us to survive.

[Bankai]

Quo Vadis UK?

Looking at the latest stats, both new cases and deaths are stabilizing in the UK and the number of people with COVID-19 in hospitals also dropped slightly. There are currently over 2000 free ICU beds specifically for COVID-19 patients and that number is stable for a good few days. It looks to me as if the worst is over and the system was not overstretched at any point. Obviously, it's still early days but the experience of other countries suggests the trend will continue.

With this in mind, why is the UK government building 7 new field hospitals with a potential capacity of over 10k beds and ordering tens of thousands of ventilators? It seems to me that either:

1) they overreacted big time and the problem is not as bad as it initially seemed, and they are now afraid to cancel the orders/halt the construction as to not look silly, or

2) they fully expect a second wave and are getting ready for vastly more patients than at the current peak (which looks to be around now). So the plan would be to let the virus run if (when) there's a second wave, without closing the economy down but still keeping some social distancing and shielding the vulnerable? That would explain all this extra capacity being build but would people not demand a second lockdown if things get even worse than now?

It doesn't help that the government is treating citizens like kids and not communicating clearly what the plan is, but instead just repeating the mantra to stay home and that it's too early to discuss the next steps.

[Ego]

@ego here in Germany we have been able to avoid overwhelmed hospitals for the most part, same in our neighboring country of Austria. Both countries had early and rather strict lock downs.

Understood. That is the narrative. Avoiding hospital overwhelm was the reason for the lockdowns and now we are hearing what you said, the hospitals were not overwhelmed because of the lockdown. Everyone seems to be repeating it without giving it much thought.

The question I have is... what is the limiting factor in a hospital that makes it overwhelmed? The original claim was ventilators. We now know that medical school textbooks from as far back as the 90s have said that ventilators should not be used in situations like Covid except for a minority of patients with certain heart emergencies. Yet we all bought into the ventilator frenzy. Some still talk about it. In fact, next weekend's cover of the NYTimes magazine shows a patient being intubated in preparation for being placed on a ventilator.

So, what is the next lowest point of failure? Some have said it is staff, but there are reports from all over the US that medical staff normally tasked with the more lucrative elective procedures are being laid-off. Others have said it is hospital beds. That seems to me to be an easy fix. Medications? Infrastructure?

[jacob]

@Ego - I've been trying to rack my brain to see if I'm gaslighting myself, but thinking about it, ventilators haven't been mentioned much at all in non-US media(!) The US excels in high-tech intensive care, so perhaps putting people on ventilators is a US CYA/standard procedure but not elsewhere? Different countries definitely have different treatment philosophies and different health approaches. If you look at the number of hospital beds or ICU per capita, different countries have very different numbers.

One thing that is being tracked everywhere is the number of hospitalizations as well as the number of people in critical (ICU). The second point of conversation is avoiding running out of healthy hospital staff (PPE) where other countries have "recalled" people from retirement or "drafted" people with medical experience from other jobs while cancelling other noncritical procedures. My impression (based on the media noise level) is that staff shortage is the most critical.

[Bankai]

Podcast with one of the leading statisticians in the UK:

https://riskytalk.libsyn.com/coronaviru ... he-numbers

[BeyondtheWrap]

Also, it means herd immunity is reached much earlier: not after 70% of the population is immune, but after people who are involved in 70% of all human interactions are immune.

Interesting. I would guess that this group heavily overlaps with the essential worker class, particularly those with public-facing service jobs. Arguably, most places are followed the “let the disease run its course” strategy for this group (excepting those whose workplaces are currently shut down, such as gyms, bars, barbershops, theaters, etc. depending on the locale).