COVID-19

[George the original one]

You seem to think that I want 1% to die and bodies lying on the streets, while all I'm thinking about is why the rest of the world doesn't do Sweden.

Why Sweden? Why not the better examples of South Korea (no shutdown at all) or Vietnam (hardly a blip of a shutdown)? Even with shutdowns, Australia & New Zealand are doing well.

Sweden is NOT doing well and their new case rate continues to climb, albeit slowly. Eventually, Sweden's new case rate or death rate will go beyond what the population is willing to tolerate.

[George the original one]

It's possible that NYC is closer to being 100% exposed by now, because the metro was still running during lockdown, and they REDUCED the train frequency, keeping people packed in. 0.2% of NYC population dead at 60% herd immunity = 0.33% mortality rate.

I wonder what the demographics are of NYC versus Italy. Much younger?

At 14% infection per the recent antibody sample of over 3,000 people (shoppers) and the current tally of 11,000 deaths, NYC's mortality rate is 0.93%. I think therefore, it's safe to say that 1% mortality is still a reasonable figure to use because even if NYC has no more new infections today, the deaths will still be coming in for another week or more.

Edit: I should have looked at Johns Hopkins for deaths, where they currently show 15,000 for NYC, rather than a google search. The 14% infection rate came from https://www.msn.com/en-us/news/us/new-y ... r-BB136bZG. Using the 15,000 deaths, mortality rate rises to 1.3%. I'm using 8.4 million for NYC population.

[ZAFCorrection]

Someone linked an announcement from the WHO earlier indicating they don't believe people necessarily get antibodies from being exposed/infected. Their conclusion was people can possibly get reinfected pretty easily. My interpretation is that also possibly indicates the current antibody testing could have significantly undercounted the number of people already exposed. I would think that would be a good thing on balance.

The more people exposed for a given amount of hospital utilization, the better this is.

[BeyondtheWrap]

@Augustus: It’s really not 21% of NYC that’s immune. They only tested people at grocery stores. So it’s really just 21% of the people that are still going outside.

From the virus’s perspective, the lockdown has reduced the effective size of the city’s population. People who stay home are mostly invisible for this purpose since the virus has little chance of reaching these people. So the city is no longer eight million people, now it’s more like the number of essential workers plus people grocery shopping times some discount rate because they’re only out for a short time. I have no idea how big this group is, maybe like 1 million. Only this population will have herd immunity soon.

Upon lifting the lockdown, the size of the city’s effective population will increase, thus introducing the virus to a new population that is not yet immune.

[thrifty++]

My question was: Why do you think the lockdown is causing R0 to go below 1?

I do not believe we possess the ability to stop the disease, or to prevent reinfection from abroad, even with a lock down. The lock downs aren't strict enough, and look at China, they just had to shut down another city. I'm just parroting Osterholm, he said all this in that video waaaaay up thread.

There is a significant correlation between lockdowns and RO reduction. See here. https://www.nzherald.co.nz/nz/news/arti ... d=12326697

The above item shows the RO levels across various countries and parts of countries. NZ RO got down to 0.5 and is probably lower than that by now.

[Bankai]

Why Sweden? Why not the better examples of South Korea (no shutdown at all) or Vietnam (hardly a blip of a shutdown)? Even with shutdowns, Australia & New Zealand are doing well.

Sweden is NOT doing well and their new case rate continues to climb, albeit slowly. Eventually, Sweden's new case rate or death rate will go beyond what the population is willing to tolerate.

That would be ideal but it's a bit late for that now. Having said that, once we start getting out of the lockdown (and it's going to be a long and gradual process), contact tracing on a mass scale similar to what Korea is doing will be in place in the UK.

Re: Sweden - why do you think it's not doing well? It's well below the worst affected Western countries in deaths per capita (https://www.statista.com/statistics/110 ... habitants/) while also not killing its economy completely.

[Ego]

+1 @Augustus

If 21% of New Yorkers have antibodies then how many people in addition to that fought the virus with their innate immune system alone and never produced antibodies?

Remember that study from the Fudan University where they did serological antibody tests on those who had been hospitalized for Covid and previously tested positive for the virus. They found that 30% produced very few antibodies and some hospitalized patients produced no antibodies! Now imagine how many young people never even realized they were infected, never produced antibodies and recovered because their innate immune system killed it.

The researchers found that the antibody level in around a third of the patients may be too low to provide protection. "About 30 percent of patients failed to develop high titers [concentrations] of neutralizing antibodies after COVID-19 infection. However, the disease duration of these patients compared to others was similar," the researchers said.

This is the major flaw in the belief that we can control the virus. We have no idea and no way to know how many people got it, fought it and did not produce antibodies. This is why it will get everywhere.

[JL13]

@Ego and @Augustus

That's my take. This thing is so freaking contagious that it's not containable. I mean there have been reports that it is spreading through the wastewater pipes in apartment buildings! As in, someone who lives 8 stories below you flushes the toilet and it aerosolizes your bathroom with virus.

I would not be surprised if we found out that nearly every New Yorker has been exposed by now, and it's close to being finished up there.

If you add the 'excess deaths' along with the confirmed deaths from Covid in NYC, you get about .2% of the population dead. The German and NY antibody studies both showed a fatality rate around .4% - .5%. If herd immunity is 60%, then we're looking at 60% * 0.5% = 0.3% dead in NYC. That means they are 2/3 of the way through the storm.

[BeyondtheWrap]

OK, so it seems you guys are arguing that, while containment may be possible at the beginning, once community transmission is reached and a lockdown becomes necessary, the numbers will never go down to the level where a containment strategy becomes viable (unless herd immunity is reached first). Do I have that right?

[Peanut]

Can anyone who is arguing for suppression name a single epidemiologist who says it's possible? Osterholm and Giesecke have both said the opposite. The vaccine will simply take too long. And from what I can tell people have very different levels of fear towards this virus. In democratic countries there will be enough who want to see a staggered opening up of the shutdown to make any dream of suppression impossible.

@Riggerjack: Viruses have lifelong consequences for health? What are you thinking of? SARS 1 was uniquely fatal, 1-50% fatality rate depending on age. Things that nobody even thinks about like the plastic in our lives (DH recently told me he read that every person ingests the equivalent of a credit card a week?!) seem more scary.

[JL13]

OK, so it seems you guys are arguing that, while containment may be possible at the beginning, once community transmission is reached and a lockdown becomes necessary, the numbers will never go down to the level where a containment strategy becomes viable (unless herd immunity is reached first). Do I have that right?

I'm personally saying that you can't contain a respiratory virus. Well, not me, but this epidemiologist:

https://www.youtube.com/watch?v=lGC5sGdz4kg

Herd immunity just means we don't have to worry about overwhelming the hospitals anymore, only a small amount of people will pick it up after that, and they can be treated with existing infrastructure.

[Riggerjack]

The lockdown already has saved lives. And will continue to do so, for a while yet. Your simple models don't show it. That doesn't change anything.

The only lives a lockdown saves are ones from an overloaded hospital system. All other deaths are postponed, unless you find a cure or vaccine.

And this is what I mean by simple model. You seem to have decided that infection to herd immunity is the only way forward. That somehow nobody is going to change behavior to reflect a threat, and the only factor worth considering is how long we hit the pause button before adopting the behavior you are familiar/comfortable with.

Maybe you are right.

But I tend to think that when masks are cheap, plentiful, and expected in public, SK style, we can operate in a similar fashion. Masking and contact tracing. Masks suck, but the full range of options suck, and masks seem like the most easily adopted option, as long as this goes on.

It's a virus, not magic. If a significant portion of the population removes itself from the viral feedlot with masking/social distancing/WFH, the situation is much more manageable.

The lockdown functions to remove a significant portion of the population from the viral feedlot until PPE is cheap and plentiful.

This doesn't seem complicated...

[George the original one]

Re: Sweden - why do you think it's not doing well? It's well below the worst affected Western countries in deaths per capita (https://www.statista.com/statistics/110 ... habitants/) while also not killing its economy completely.

Infection rate and death rate both continue to rise in Sweden. Since April 1, they have gone from 3,000 cases/week to 4,000 cases/week and the death rate has gone from 200/week to 700/week. That's not a sign that they've contained the virus.

[JL13]

@bigato

Yeah. I would imagine if it got extremely deadly, while remaining as contagious, then you'd see a massive outflow of people from dense cities into the country. You would see states/cities attempting border closures. We'd want to crate a lot of little New Zealands in the USA. Except without the natural ocean borders you'd need an incredible militarization of borders.

It would probably happen. Not quickly though.

[jacob]

From the positive human interest section of the news.

https://www.washingtonpost.com/nation/2 ... virus-ppe/

43 workers volunteered to stay isolated for 28 days at manufacturing plant to create critical PPE supplies. They just got out and a second team is about to go in. I recall some European power plants using the same strategy with workers staying on site. Maybe this will be the new way for critical businesses. Gated company towns.

[jennypenny]

Study of CT scans of Diamond Princess passengers

Over half of the positive/asymptomatic patients showed ground glass opacities in their lungs. The average age of the cruisers is higher than the normal population, but as I said upthread, asymptomatic cases of COVID aren't necessarily benign. I hope that NY follows up on some of those who tested positive but were asymptomatic to see how many show lung damage. If it shows that a significant percentage of asymptomatic people sustain lung damage, it's an important consideration for non-high-risk people who think it's safe to resume normal interactions, even with precautions.

[steveo73]

Keep them a month more or so and the virus would be gone from the city. Since it will keep coming back from the outside, if the goal is try to build herd immunity, the restrictions to movement should be lifted gradually starting now, so as to keep R0 > 1 and as high as the health system allows without overload.

This to me is the point that refutes the anti lock down argument. I think you can squash the virus and release lock downs slowly. I think this may result in the least possible impact to society.

[steveo73]

Sweden is NOT doing well and their new case rate continues to climb, albeit slowly. Eventually, Sweden's new case rate or death rate will go beyond what the population is willing to tolerate.

Sweden are an example currently of what not to do. The whole point about Sweden is that there is a theory that herd immunity is being created and everything will be good really soon whereas success stories like Australia and New Zealand are doomed in the long run. There is no proof of this. It might be true but we don't this.

[jacob]

The Swedish model is not completely open season with people running around licking door knobs and sneezing at each other pretending it's not a big deal. Some people and businesses are taking things into their own hands and isolating/closing on their own. Almost half the kids are kept home from school. It's similar to the situation in the US before the governors started acting. This does have some effect on the economy.

Still, discounting small islands with borked fractions, Sweden is now #7 and moving rapidly on the leaderboard with 20.0/100k dead or 1 in 5000.

[Ego]

French study found 25.9% have produced Covid-19 antibodies.
https://www.medrxiv.org/content/10.1101 ... 20071134v1