COVID-19

[thrifty++]

New Zealand has now had 100 days with no community transmission.

There are 23 active cases currently but those are all in quarantine and are returning NZ citizens/permanent residents who have recently returned from overseas. They are under strict quarantine and not allowed out. There have also been 0 new covid cases in the last 3 days.

Im feeling lucky to be in NZ at the moment as things seem very unexposed here. Like in a safe little bubble in the middle of nowhere. Things have been very normal here for months. With everything functioning as per normal. The economy seems to be far less impacted than expected. Unemployment stats are recently out and its only 4%. This is actually a reduction from the March quarter of 4.2%. NZ dollar is actually at its highest in the last year. Unfortunately, property prices are also increasing and reaching new record highs.

The govt has recently been telling everyone to not be complacent and to stock up on masks. This made people sceptical as to whether the govt has not told people something about an outbreak. But that turns out not to have been the case. It is probably more likely because of the recent rapid outbreak that occurred in the state of Victoria, Australia, and wanting to manage any similar outbreak here really swiftly to avoid it getting out of hand as it has done in Victoria. Stangely, for the first time in a month, I saw people wearing masks in the supermarket today. A lot of N95 masks have been manufactured in NZ now. I ordered 10 of them before they end up getting sold out following the govt mask announcements.

It is difficult to be sure the virus can be kept out of NZ though. The quarantine measures are getting increasingly strict. But its seems the rest of the world is now saturated in the virus and so many NZ citizens are trying to come back. So a lot more people coming back now bring it with them. I think that NZ govt is trying to manage and restrict the amount that can come back at any one time so that the quarantine is more manageable.

[classical_Liberal]

@nomadscientist
I had the exact same thought. These are tests people just don't normally get after being ill. The trop's and BNP's are at yawn levels for someone used to working in an acute cardiac unit, but that's my brains bias. Also of note, the CRP was higher in the COVID cohort P <.001, so maybe their bodies weren't quite done with the fight yet and permanence should not be implied. Anyway, at least this is a good study. A big step up from others posted, thanks @jacob.

[CS]

https://www.nytimes.com/2020/07/29/heal ... cines.html

I'm being blocked from the article on my computer (to grab quotes) but read it on the phone last night. Apparently, analysis shows reduced risk with recent pneumonia (28% ish I think) shot and a reduction in the 40's for recent Polio shots. Maybe that is why kids are doing better. I looked at my records and had five (five!) polio shots as a child. They really didn't want kids to get polio.

They recommend pneumonia shots when you hit fifty so those with better insurance, better care are going to be more like to get those.

[Solvent]

I'm still following news for Australia even though I'm not there and it looks like I won't be able to visit family for quite some time. A few things are really interesting to me in that some of the restrictions I find fairly unexpected.

Maybe of interest to those in the USA - of course, although our federations are very different, Australian states have closed borders with each other. This is something I didn't even realise they would have the power to do, and it causes some quite unfortunate events: https://www.theguardian.com/australia-n ... ansit-deal

As thrifty pointed out, there is a serious outbreak in Victoria. Australia as a whole seemed to be handling the crisis remarkably well, but these slip ups in Victoria have now potentially put the whole country in serious danger. I wouldn't rule out that it can be brought under control, Australia's government is generally fairly competent and I'd like to think the populace can be serious-minded about this, but the situation is definitely looking quite bad for now.

The Australian government has also disallowed Australians fromleaving the country. Legally, I'm unsure of what the basis is for them doing this but it has passed without comment from any lawyers so I guess there's a law, precedent or something written down somewhere that allows this. Practically, the government has remarked that this is because they need to control the inflow of people (since incoming passengers are being quarantined), and allowing people to leave just means for the most part they'll try to come back after a short holiday and then be in distress and potentially need consular help after they realise flights are being cancelled, are too expensive, or can't afford quarantine on return. They've also said it's to prevent ongoing spread of COVID to other countries, which sure, that's something you can say but it doesn't really line up with any realpolitik.

[ajcoleman22]

Hawaii seems to have minimal cases, unsurprisingly. (I thought Rhode Island should then I realised most of it isn't actually an island)

I looked this up today and Hawaii seems to be having an uptick in cases which is really surprising because they have locked down harder than any state.

[George the original one]

Texas, Florida, & California account for roughly half of the current weekly USA COVID-19 death rate. 47.8% of 7373 deaths, if you want more precision. They also account for 39.7% of weekly new cases as their new cases have tapered off from last month's peak.

[Frita]

One thing that I think is very important issue with school openings is the fact that the current number of school nurses is very low and this job has largely been taken on by school clerical staff with virtually no training. Even in a normal situation, in an elementary school with a few hundred students there will be a near constant stream of sick or “playing sick” kids into the office throughout the day. Who is going to take responsibility for determining whether third grader likely has Covid, strep throat, just allergies, or just wants to go home and play video games? I can’t imagine the situation as being anything but a logistical nightmare.

Yep, our state requires a BSN, approximately 1 per 400 students, but it’s still challenging under normal circumstances. High needs special ed. kids, asthma, vision/hearing/dental screening, sex ed., lots of duties before COVID.

[RealPerson]

New Zealand has its first case of community transmission in 102 days. Auckland is being locked down.

https://www.theguardian.com/world/2020/ ... n-102-days

The source of the infection is a mystery since none of the infected people had an overseas trip. The same thing happened in Vietnam recently. COVID 19 has a lot of tricks up its sleeve. I am sorry that New Zealand is facing this, and it reminds me of the Swedish approach. With virtually no herd immunity building, NZ is 100% betting on an effective vaccine, or closing its borders for years to come. COVID 19 may be inevitable, and it could be better to let natural immunity develop at an RO rate that is manageable for the health care system. Like Sweden did on purpose and the US did by accident. It is possible that COVID 19 will die out naturally before we even get a vaccine.

[thrifty++]

Yes, NZ has turned to shit really fast.

Auckland is being locked down on half a days notice. The rest of the country not locked down - yet- but subject to prohibitions on large gatherings.

If NZ hasnt been able to get rid of it the world is fucked. The virus is everywhere.

[Riggerjack]

COVID 19 may be inevitable, and it could be better to let natural immunity develop at an RO rate that is manageable for the health care system.

Better for who? The stockholders? By comparison to what? I'm a stockholder, I am willing to be convinced.

Myself, I have no spare heart, and lots of anticipated need for the one I am using. C19 and heart health seem to have limited compatability.

So what wonderful benefits to widespread C19 am I missing that will make it better to let c19 run wild at a rate that is "manageable" for the healthcare system?

Because from the way it looks C19 expenditures go up with infection rate, controlling infection rate controls expenditures. Up to a point.

But expenditures for C19 (per case) are still so much cheaper than for heart problems (per case), that my economic concerns for C19 are as much follow up costs as these temporary business closures and refitting we worry about today.

No end in sight, no lights ahead, and the tracks go downhill. Maybe this isn't a tunnel...

[RealPerson]

No end in sight, no lights ahead, and the tracks go downhill. Maybe this isn't a tunnel...

I am not suggesting that we should go out and try to get infected. A covid-19 party is one of the dumbest things I have heard. I propose that, within the envelope of personal responsibility, we should all do what we can to stay uninfected. I am saying that we cannot perennially shut down our economy to bring down disease transmission as low as possible. I wear a mask everywhere, wash my hands all the time, carry a CO2 monitor to make an educated guess of aerosol presence in a public indoor place and avoid unnecessary contact with people, especially indoors. These things alone can immensely reduce our personal risk, the community exposure and keep our economy going. There are very real costs associated with drastic economic shutdowns, for all stakeholders in the economy.

New Zealand, while being admirably successful in containing Covid-19 up to now, backed itself into a corner. Unless a very effective vaccine, available and administered on an unprecedented scale happens in short order, NZ will be faced with the choice of keeping their border closed for years to come, ban their own citizens from leaving and enforce draconian shutdowns like the one now implemented in Auckland, or face the reality of a COVID 19 epidemic going through the country. If NZ persists on the current path, it will provide hugely valuable data in the future for biostatisticians and economists. There will be many strategies to compare in retrospective studies.

And I hear you on the heart concerns. The same applies to the lungs, kidneys, brain and some other viral structures (like testes ). I am just acknowledging the reality of an extremely contagious virus and wonder how we can deal with that reality. By manageable, I mean that the health care system is able to provide appropriate care to those who need it. If we exceed that capacity, mortality rates will rise very quickly.

[jacob]

Like other coronaviruses (SARS1, MERS, ...) SARS2 (COVID) might only create immunity for 6-12 months from either having been infected or from having been temporarily vaccinated. If this is so then given the [slow] rate it's spreading, "herd immunity"(*) will not be possible unless society is permanently behaviorally rewired. If not, the virus will present itself it recurring breakouts around the planet.

(*) Whatever the number percentage follows from however people behave. We now know what kind of behavior will take R0 below 1 given the current infection rates. Insofar that behavior becomes the new normal, then herd immunity will be achieved.

Various countries are already going down different tunnels^H^H^H^Hholes.

We keep talking about health vs economy as if we can choose which aspect of normality we can sacrifice for the other. Some propose that they're intertwined (for example, Sweden with its open policy still suffered as much or more economic/GDP damage as the other Scandinavian countries because people stayed at home on their own anyway) and that there's a way to thread the needle. However, it may also be that we have to accept that SARS2 will become endemic and add to the disease burden in a material way.

This is not all that different than how e.g. malaria kills millions of people in areas/countries which for reasons of government, population density, environment, and overall behavior can't control it. For example, Malaria used to be endemic in North America until a mass effort installed window screens and systematically eliminated standing water (drained swamps).

It's similarly conceivable that COVID will become endemic in areas where people can't figure out masks, different behavioral habits, and new business practices. Some existing practices are no longer possible because the world (procreation, living, eating and travel habits) will eventually literally kill the incompatible behavior. While the average human tends to have a fairly narrow and short-sighted outlook ("it hasn't happened to me and anyone I know, so it's not going to happen to me"), it will eventually happen to everybody who didn't protect themselves (whether as a country or an individual) and so lives will change eventually. Either they'll change behaviorally now, or they'll be cut short (die) later because of not having changed behavior. This goes for both humans and businesses.

In that regard, it's really no different than other lifestyle diseases. It's random, but it's not that random. And it kills a significant number of people. Currently, in the US, the COVID kill rate is approximately half of what cancer kills. Figure about a quarter million per year forever in recurring outbreaks here and there as immunity wears out in previously burned out areas.

Change in behavior will influence this a lot. (Like staying home from work when sick. A culture of wearing masks in public. Getting the stink eye if coughing in public.)

Change in behavior could influence the cancer rate too but it hasn't because people enjoy their freedom to live a carcinogenic lifestyle more than they enjoy an additional 5+ years of lifespan. IOW, it's hard to know how acceptable adding this disease will be to Americans (cf. e.g. Europeans, Asians, or Africans) and how willing and/or capable people are to change to avoid it. We won't know until most people have yet to be personally exposed/laid down by it. People often have an epiphany after being personally exposed to a major health scare but not before.

I expect the world to do significant amounts of Kuebler-Ross exercises navigating denial, anger, bargaining, depression, and ultimately acceptance of the "new normal" as their navigate their own emotions, values, and habits to make the transition. It's basically a process.

[AnalyticalEngine]

Interesting analysis, @Jacob. I pretty much agree with everything you wrote. It's really not unlike influenza, which never really goes away. However, CV-19 is much more deadly than influenza. Long, long term, there will probably be a yearly vaccine to get in order to ensure herd immunity. The vaccines they are working on now don't provide "sterilizing" immunity. That is, they don't prevent covid. The current criteria is to merely reduce the severity of illness in 50% of cases. That might help save lives, but it's going to require sterilizing immunity to stop the spread.

Humanity and disease (infectious or otherwise) have a long and interesting history. There's any number of diseases that can be prevented through behavior (washing hands, not eating sugar, draining standing water, etc), and yet, there's a profound history of humans not changing our behavior and instead merely accepting the disease burden.

I do think the perception of CV-19 being an "old person disease" is materially influencing the response. For example, malaria largely kills children, but CV-19 largely kills the 50+ older crowd.

I do think we're in for a long and strange period of readjustment as the world figures this out.

[tonyedgecombe]

The Spanish flu mutated to become less lethal, by 1920 it was all but gone. We already have evidence CV-19 is mutating, perhaps it's only a matter of time before it becomes less lethal.

[AnalyticalEngine]

I wouldn't put too much stock in covid mutating. While it is an RNA virus, it has special error checking proteins that make it less prone to mutation than other RNA viruses. Also, when exposed to a large population of completely susceptible and densely packed hosts, many diseases can evolve to become more virulent, not less. The 1918 flu also evolved to be more deadly before it went away (the first wave was minor; the second wave was extremely deadly.) Many diseases have existed for millions of years, yet never evolved lower virulence (smallpox, diphtheria). This isn't to say that covid will or will not mutate. It's just that "the virus will mutate" is more a science fiction movie plot point than it is something that is guaranteed to happen.

[J_]

@Jacob thanks for your analysis.
It is up to each of us to maintain/develop (or not) a way of life to avoid contamination and/or to be or to become more robust if we are hit by this virus.
It requires some more attention in our daily life: e.g.what will I avoid when shopping, if it is too busy in the shop I come again later. Shall I go by plane or take the car for my visit to my other home and so on.
And for people who have a job it requires even more daily considerations.

[jacob]

SARS1 faded away as well. While virulence tends to decrease as infectious agents evolve, I'm not sure its a rule or an expression of survivor bias. For example, social distancing might favor more virulent or resilient strains in order to survive. I'm not aware of any detailed models(*) for virulence although surely it's co-evolving according to the various environments, we (humans) are setting it up for.

(*) My paygrade for this is pretty low though.

As it is it's certainly occupying the Goldilocks zone of infectious agents in terms of lethality, reach, force, ... and primarily messing with the ACE2 receptors, which are found in very many human cell types (hence all the "COVID19 could damage X-organ"-papers) and regulate important systems like blood pressure, it's also more "creatively destructive" (H/T Schumpeter) than H?N?-type flues (hooking up to other cell receptors) which mainly get into the lungs and kills via secondary pneumonia in the weak as the damaged lung tissues get infected by bacteria which then go on into the blood stream and eventually terminate some critical organs.

In some bizarre sense, that is, from its own perspective, it's a brilliant disease. Because Goldilocks, I'm not sure, we (humanity as a whole) can defeat it, so hopefully it will defeat itself.

[AnalyticalEngine]

Do Pathogens Gain Virulence as Hosts Become More Resistant?

Traditional selective breeding, genetic engineering, and immunization can all be used to make animals more resistant to infections. If pathogens in nature respond to increases in host resistance by evolving greater virulence, however, is it possible that such efforts will unintentionally select for the same response in pathogens infecting farm animals?

Nothing will happen if hosts are made completely resistant: stop onward transmission, and evolution will cease as well. But artificially enhanced resistance is often imperfect. Many vaccines used on farms do not render hosts impervious to infection, and animal breeders have yet to produce animals completely resistant to a number of different infections. In those situations, pathogens will evolve in newly resistant hosts, just as MYXV, RHDV, WNV, and MG did. Given what we now know about pathogen-host arms races, we think we have to take seriously the possibility that by creating resistant hosts, humans might trigger the evolution of more-virulent animal pathogens.

In fact, this may have already happened. Marek’s disease virus (MDV) is a highly contagious cancer-causing herpesvirus of poultry. Fenner-style common garden experiments clearly show that MDV has become more virulent over the last 50 years.10 When the poultry industry began to ramp up in the 1950s, MDV caused mild disease and had little economic impact. Currently, MDV strains that kill all unvaccinated birds in just 10 days are common in the US and Europe. Birds have to be vaccinated or the losses are devastating. Critically, and for reasons not fully understood, MDV vaccines protect against disease but they do not generate so-called sterilizing immunity: vaccinated hosts can become infected and transmit viruses to other chickens.

The critical thing to understand here is that under what conditions viruses evolve more virulence is not always well understood. With 8 billion humans on the planet, and CV-19 circulating widely, it's entirely possible for it to infect a particularly susceptible population, evolve to be more virulent, then emerge to infect everyone else with the more deadly version, as has happened in many animal populations.

Viruses can also paradoxically evolve higher virulence in immuno-compromised hosts. Because higher virulence often translates to higher viral loads faster, infecting hosts who are likely to die anyway (immuno-compromised) can put selective pressures on spreading the virus ASAP into the infection, which favors faster reproduction of the virus, which favors higher virulence. It's always been a concern about novel pandemic diseases that they will get into a high HIV+ population, evolve higher virulence there, then go on to infect everyone else with the now more virulent strain.

Is any of this stuff guaranteed to happen? Definitely not. There's a lot of uncertainty about the direction this disease will evolve in. But whether the disease evolves more or less virulence is basically a crapshoot at this point.

(My entirely armchair guess is it will stay about the same level of virulence, as this disease is pretty well suited to spread in a lot of conditions. That's just speculation on my part though.)

[nomadscientist]

It's similarly conceivable that COVID will become endemic in areas where people can't figure out masks, different behavioral habits, and new business practices. Some existing practices are no longer possible because the world (procreation, living, eating and travel habits) will eventually literally kill the incompatible behavior. While the average human tends to have a fairly narrow and short-sighted outlook ("it hasn't happened to me and anyone I know, so it's not going to happen to me"), it will eventually happen to everybody who didn't protect themselves (whether as a country or an individual) and so lives will change eventually. Either they'll change behaviorally now, or they'll be cut short (die) later because of not having changed behavior. This goes for both humans and businesses.

It's not Ebola, it doesn't kill healthy fertile age people in any significant numbers, we've lived with endemic diseases much more deadly than this; really society (or at least some societies) are just freaking out at returning to the distant normality of all settled human life before the 1960s, where cancer (as one example) isn't the only improbable but not-vanishingly-improbable cause of death before general systems collapse from age.

Speaking from strictly species level functional view, the current social restrictions must be suppressing birth rates far more than the virus would by killing 25-35yos without restrictions. Already some large number of women will never have children who otherwise would have done because corona restrictions killed their social options as their fertility window was closing, almost certainly more women than people who have died (so far) of the disease.

[Riggerjack]

https://advances.sciencemag.org/content ... dv.abd3083

Basically, they used a laser and a cell phone camera to track numbers of droplets released during speach, through various masks.

Surprise, some masks are worse by this measure than no mask. But please remember masks work both ways, and this is not the personally important direction. And most masks are an improvement on no mask.