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Hot Topic in Science: 2019-nCoV: Coronavirus Outbreak 2020

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What happened to the word about plasma and immunity tests? Cuomo has said nothing on them the last few days...

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16 minutes ago, USCG RS said:

Medical professionals asked them to give this consent?


Yes. ICU doctors in both cases asking if they should resuscitate in the event they crash.

 

 

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17 minutes ago, wxmd529 said:

Italy 6153 New cases and 662 deaths today. Not ideal. You really want that case count to start coming down...

 

At least deaths are remaining stable. It's hard to say how reliable the Italian case numbers are when they're clearly undercounting. 

 

EDIT: I can't find a source for this but people are saying that Italy conducted 37,000 tests today as opposed to 26,000 yesterday. We've seen new cases fluctuate closely with numbers of tests there for some time.

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4 hours ago, WxInTheBronx said:

Back to the drawing board...

 

 

Hey man, just got this and thought this might help you a bit.

 

 

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23 hours ago, ru848789 said:

From Cuomo's press conference today. Some better news than Monday and yesterday, but still a long way to go...

  • Their model is showing 140,000 hospitalizations (at 15% hosp rate, this is 920,000 cases) vs. 53,000 beds and 40,000 ICU cases vs. 4000 beds with the apex peak in 21 days for hospitalization.
  • I haven't seen their model, but I assume it's a worst case model with little social distancing and I think these numbers are high, but can't be sure without seeing the model - if NY is at 30K now and seeing 5-10K per day new cases for 21 days, that would be ~200K not ~900K.  Even 20K new per day would only get to ~450K - would need much more significant accleration than we're seeing now.  
  • As of Sunday, the hospitalization rate was doubling every 2 days, on Monday, the hospitalization rate was doubling every 3.4 days and yesterday the doubling was every 4.7 days. Clearly this is good news and hopefully reflects social distancing is working (and recall it takes 8-9 days to get to hospitalization, so this would reflect SD from 6-7 days ago. It also dovetails with what I said above that maybe the model projections are high.
  • Plans in place to get from 53K beds to 120K beds (vs. 140K beds needed); this includes 50-100% increase in beds in hospitals by efficiencies (30K more), using dorms (29K more), FEMA (4K more)
  • 103K tested so far/44K in NYC (12K on 3/23) which is 28% of US testing – hunting positives to isolate and reduce spread
  • 30K positive cases in NY State now with 5K new on 3/23 and 3/24; 17K cases in NYC and about 4200 cases in Westchester where there has been a significant slowdown in new cases, again reflecting some success for social distancing (especially in the New Rochelle hotspot)
  • Of those 30K positive cases, 12% (3800) are hospitalized and 3% are in ICU (888)
  • More on flattening the curve: no close contact sports, closing some streets to cars to provide room outside for people without being so close, monitoring parks/playgrounds for social distancing.
  • Hospital PPE: ok for now, still needs for peak
  • Ventilators: need 40K total, have 4K, purchased 7K, Feds sending 4K, will look into splitting, but need more production; Feds being more helpful and praised POTUS for sending the 4K ventilators (very different tone from yesterday).
  • Also said he discussed with Trump that NY is first to get hit very hard and others will likely follow and that they could address needs of rolling influx of patients with rolling deployment of 20K Fed stock of ventilators in NY first and Cuomo then promised NY will then help other areas that follow with redeploying ventilators/equip/personnel - not agreed yet, but considering
  • Surge healthcare force – 40K responses so far from retirees (2300 docs/37K nurses/assistants); also mental health hotline (6K providers)
  • $2T stimulus is $3.8B for NYS/$1.3B for NYC and NY needs $15B; hopes House restores some to NY (was $17B in their plan)
  • Says NY is not going to relax restrictions in the middle of a major outbreak, but is working on plans on how they will reduce restrictions once this is hopefully under more control.
  • Commented again on really needing antibody tests to send people back to work with confidence they won't get infected and won't infect people (since a sizable % of people who get the virus have mild to no symptoms, but don't even know they had it and are now immune for awhile.

Notes from today's presser by Cuomo...

  • 40K max projection on ventilators (not sure they'll get to that, but that's what the worst case models show); have 15K now (30K with splitting)
  • Expects peak in hospitals in 14-21 days (and remember, some of that is cumulative as it takes a long time for many to recover (or die - 3-5 weeks from symptoms to death)
  • approved ventilator tech for splitting – could double capacity (not ideal); converting a few thousand anesthesia machines to ventilators
  • 11-21 days on vent for CV2 vs. 3-4 days typically; some on 20-30 days – increases bad outcomes
  • Enough PPE for the next week or so – isolated issues are due to distribution in NYC
  • NY gets $5BB from $2T package and only for CV expenses (nothing for lost revenue) vs. $15BB need – he’s very disappointed, but is moving ahead as best he can
  • 18K tests done in NY on 3/25/7K in NYC, 122K to date/51K in NYC – 1 test per 160 people – 25% of all testing in the US.  
  • Says NY not limited in testing currently & will continue to test as much as they can (despite CDC guidance to only test severe cases) to help ID positives to isolate them/contacts.
  • Deaths increasing: 385 total from 285 on Tuesday (100 in one day)
  • 37K total cases in NY/21K in NYC (6K in Westchester); 6448 new cases in NY/3537 new in NYC/1253 new in WC
  • Daily NY new cases only increased from about 4K to 6K over past 4 days (less than before); Looking most at rate of increase in cases leveling off/decreasing, not number of cases
  • Of 37K positives, 5327 currently hospitalized/1280 in ICU (w/ventilators)/1500 discharged
  • 4400 in NJ, 3100 in CA, 2500 in WA, Louisiana growing fast (1700)
  • Talked about how important it is to stick to the facts and that deception is the worst thing
  • He always does some philosophizing at the end of these and he said he truly believes people will be better people and citizens for having gone through this (especially young people), even if they don't recognize it now and he feels strongly that we'll get through this together, despite the loss and pain. It's nice to hear his reassurances and empathy, but also his optimism despite it all.  
  • Thanked Fauci, as he calls him regularly and Fauci is always helpful.  For those who don't know, Fauci convinced Chris Cuomo (CNN - gov's brother) to stop going home and taking care of their mom, since he's at too high of a risk (was a touching moment on CNN). 

 

https://www.governor.ny.gov/keywords/health

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44 minutes ago, USCG RS said:

Unfortunately urgent care has this right as they tend to be privately run and they cannot be forced to treat a patient like the ER can. Secondly, I find it interesting how officials within the US are still doing everything in their power to lower the death and case counts of SARS-CoV-2

 

Agreed , the parents needed to take him to the ER 5 minutes later.

 

Can't be turned away.

There's healthcare for all there.

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33 minutes ago, Gravity Wave said:

 

At least deaths are remaining stable. It's hard to say how reliable the Italian case numbers are when they're clearly undercounting. 

 

EDIT: I can't find a source for this but people are saying that Italy conducted 37,000 tests today as opposed to 26,000 yesterday. We've seen new cases fluctuate closely with numbers of tests there for some time.

https://github.com/pcm-dpc/COVID-19/blob/master/dati-andamento-nazionale/dpc-covid19-ita-andamento-nazionale.csv

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NJ Update.

 

 

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Here is an interactive COVID-19 map showing deaths by county. Currently 1000+.  Data from John Hopkins. Multiple GIS overlays you can turn on/off/restack.

 

Want legend? Need help?  Please read the “Map tips” - link in upper left corner.

 

If you take a moment to read the “Map tips” then you can learn (1) how to make your own custom map links, (2) how to make any overlay clickable and (3) learn more about the data the map can display.

 

https://mappingsupport.com/p2/gissurfer.php?center=37.157050,-96.328125&zoom=4&basemap=USA_basemap&overlay=County_boundaries,COVID-19_deaths_by_county&txtfile=https://mappingsupport.com/p2/disaster/coronavirus/john_hopkins.txt

 

 

hopkins_2020_03_26_deaths.jpg

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Italy revision.

 

 

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42 minutes ago, wxmd529 said:

Excellent piece. 

 

Two questions - First, if this is indeed based on viral load, would masks in public not indeed help individuals? While they still may be exposed (and I am talking about n95+ masks), would it not be less of an exposure than without one? Especially as this has been found to be aerosolized. 

 

Two - Could this potentially explain why reinfection seems a distinct possibility? Perhaps the person obtains a small viral load and in turn has a mild disease, and then the second exposure is much higher in regard to viral load and this overwhelms whatever small immunity may have been developed by the person with the initial mild disease? In fact, could this explain the subsequent cytokine storm as the immunity is just enough to set off a serious immune response, but not enough to protect the individual? 

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Just now, WxInTheBronx said:

Anybody with any good news today?

I got a good lift in using my reusable shopping bags and gallons of water placed in it. 😊

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My revised best guess credible scenario with caveats and uncertainties - this is nowhere near the 2-3MM deaths in the US scenarios some have produced, but it's not "just the flu" either. Take this with a large grain of salt, as I'm certainly not an epidemiologist. I did take a grad class in it and my PhD did combine chem eng'g env law and public policy/health and I have been involved tangentially in infectious disease research for ~30 years, managing projects aimed at developing the processes to make several new antibiotics (and did a bit of work on vaccines).  I'd be curious on feedback...

Anyway Wuhan had a 0.5% infection rate according to the Chinese with maybe 50K cases, but I don't think anyone trusts the Chinese numbers, which I think are 10X greater as there's no way only 0.5% were infected. On the other hand, I've also never felt that the 50-70% infection rates for the population were realistic (those feed the 2-3MM deaths per year numbers).

However, I do think we need to at least consider the possibility that what was observed on the Diamond Princess could be a credible worst case, especially for densely populated areas that do not do a good job of testing, tracking, quarantining (of positives and their contacts), which can let the infection take off exponentially, as we've seen almost everywhere, at least for awhile, overwhelming health care systems, as we saw in Northern Italy and which we're at risk of in NYC.

The DP was a perfect "floating virus transmission laboratory" with 3711 people, who were exposed to the virus for 14 days (before the quarantine) in a location as densely populated as NYC with conditions ripe for transmission, given communal activities and meals and close quarters. About 712 people tested positive (19%) and of those about half had symptoms and half did not and we have no idea how many of the rest were infected but tested negative, due to low virus levels not detectable by the test - we'd need to test all of them via the serological antibody assay to know for sure (can't believe that hasn't been done yet). And of those 705, 9 died for a case fatality rate of 1.3%, while 37 (5.2%) required intensive care.

To me the 19% infection rate is the absolute worst case scenario, practically speaking, for larger populations (there could always be more for isolated case, like we might be seeing in nursing homes and individual families), assuming we did no interventions. So, for example if 20% of the US were infected and 1.3% died, we'd have about 830K deaths (vs 35K flu deaths/year in the US). Of course, 20% of the US is pretty unlikely due to much lower overall density but it's possible infection rates could reach 5-10% in some cities, like NYC and especially Manhattan with the highest population density in the US and heavy reliance on mass transit, plus a very high rate of people going in and out of the area.  


Even at just 5% infected (and we're at 0.3% in NYC now, but projected to reach at least 300K infections or more which would be 3.3% vs 9MM in NYC and that's with some social distancing) and if we had a 1.3% mortality rate, that's 5900 deaths and at 5.2% in the ICU that's 23,600 ICU cases. And if we extrapolated those numbers over the ~80% of the US that's considered urban, then 5% would be 13MM infections and at a 1.3% mortality rate that would be 170K deaths and 680K ICU cases, assuming no interventions.

Having said that, all of the people who died on the DP were over 65 and the cruise was older than the US on average, so some have done calculations suggesting the "true" DP death rate would be more like 0.7% which is about half of the 1.3% from the DP (see the 2nd link, which was published when only 6 had died, but that eventually became 9, so their 0.5% adjusted mortality becomes 0.7%). Even at half the numbers I just calculated above (using a 0.7% mortality rate), that would be 85K deaths and 340K ICU cases in the 80% of the US which is urban if we implemented few interventions, both of which are far in excess of an annual flu year.

 

We'd need a case rate of about 1-2% to bring the CV2 deaths down near the annual flu and that simply doesn't seem possible to achieve in densely populated areas (and hotspots outside of urban areas) without significant interventions (testing, tracing/quarantining, social distancing, no crowds, closures, etc.), like we're seeing now.  Also, keep in mind that the numbers in this scenario are totals for a year or so, comparing to the flu - the other issue with this virus is the very sharp peaks we've seen almost everywhere, which can potentially overwhelm anyone's health care system, which is another reason for "flattening the curve" via interventions.  

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm6912e3_w

https://www.sciencenews.org/article/coronavirus-outbreak-diamond-princess-cruise-ship-death-rate

And that's why most experts feel we need to intervene with testing, tracking, quarantining, social distancing, no crowds, closures, etc., especially in our cities, to keep the infection case rate down to 1-2% or less (1-2% would be in the range of 25-45K deaths, like the flu's 35K deaths/year) as we don't want to "hope" for spring reducing transmissions (which I think it will, but we don't know or by how much) or "hope" that transmission rates are even lower than my estimates.  How long we have to do this for is obviously the big question. My guess is 6 more weeks, since we got such a horribly late start on our interventions, especially on testing - we could have easily followed South Korea's model and peaked at maybe at 60-75K infections (they're at 9000 now and have 1/6 our population) and be close to the decline right now, but we didn't follow their playbook. The other wild card is if any of the clinical trials with repurposed older drugs help us, which is unlikely, from everything I've read (HCQ did not work in China much).

And the last, but best wild card was just announced yesterday, as NY got FDA approval in record time (one place Trump/Hahn deserve full credit for temporarily suspending many regs on new treatments) to start testing antibody-laden blood plasma collected from recovered infected patients with antibodies to the virus in very sick patients and eventually as possible preventative for elderly/high risk people and health care workers. It's low tech and cheap, but it should work to at least some extent and we should know in a few weeks (see the link).

 

3:45 pm edit: So, it appears that the eminent UK epidemiologist has been reading my posts, too, lol. He went from 500K potential deaths in the UK to 20K, as per reports today in the link below - he's basing this on the effectiveness of interventions seen worldwide to date. 20K deaths in the UK would roughly translate to 100K in the US, purely based on population 325MM in US vs. 66K in the UK), assuming the same death rate. My scenario guess in this post (and the past few days, posted elsewhere) if we do little intervention was 85K deaths/340K serious hospitalizations in the US, which is why we absolutely still need intervention and 25-45K deaths with strong interventions (vs. 35K deaths from the flu), but I've never been on board with the 500K UK deaths or the ~2-3MM deaths in the US (although early on we all had to recognize that was possible). This doesn't mean we reopen everything on Easter, though, lol - but it will likely embolden Trump.

https://www.newscientist.com/.../2238578-uk-has-enough.../

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5 minutes ago, ru848789 said:

My revised best guess credible scenario with caveats and uncertainties - this is nowhere near the 2-3MM deaths in the US scenarios some have produced, but it's not "just the flu" either. Take this with a large grain of salt, as I'm certainly not an epidemiologist. I did take a grad class in it and my PhD did combine chem eng'g env law and public policy/health and I have been involved tangentially in infectious disease research for ~30 years, managing projects aimed at developing several new antibiotics (and did a bit of work on vaccines).  I'd be curious on feedback...

Anyway Wuhan had a 0.5% infection rate according to the Chinese with maybe 50K cases, but I don't think anyone trusts the Chinese numbers, which I think are 10X greater as there's no way only 0.5% were infected. On the other hand, I've also never felt that the 50-70% infection rates for the population were realistic (those feed the 2-3MM deaths per year numbers).

However, I do think we need to at least consider the possibility that what was observed on the Diamond Princess could be a credible worst case, especially for densely populated areas that do not do a good job of testing, tracking, quarantining (of positives and their contacts), which can let the infection take off exponentially, as we've seen almost everywhere, at least for awhile, overwhelming health care systems, as we saw in Northern Italy and which we're at risk of in NYC.

The DP was a perfect "floating virus transmission laboratory" with 3711 people, who were exposed to the virus for 14 days (before the quarantine) in a location as densely populated as NYC with conditions ripe for transmission, given communal activities and meals and close quarters. About 712 people tested positive (19%) and of those about half had symptoms and half did not and we have no idea how many of the rest were infected but tested negative, due to low virus levels not detectable by the test - we'd need to test all of them via the serological antibody assay to know for sure (can't believe that hasn't been done yet). And of those 705, 9 died for a case fatality rate of 1.3%, while 37 (5.2%) required intensive care.

To me this is the absolute worst case scenario, assuming we did no interventions. So, for example if 20% of the US were infected and 1.3% died, we'd have about 830K deaths (vs 35K flu deaths/year in the US). Of course, 20% of the US is pretty unlikely due to much lower overall density but it's possible infection rates could reach 5-10% in some cities, like NYC and especially Manhattan with the highest population density in the US and heavy reliance on mass transit, plus a very high rate of people going in and out of the area.  


Even at just 5% infected (and we're at 0.3% in NYC now, but projected to reach at least 300K infections or more which would be 3.3% vs 9MM in NYC and that's with some social distancing) and if we had a 1.3% mortality rate, that's 5900 deaths and at 5.2% in the ICU that's 23,600 ICU cases. And if we extrapolated those numbers over the ~80% of the US that's considered urban, then 5% would be 13MM infections and at a 1.3% mortality rate that would be 170K deaths and 680K ICU cases, assuming no interventions.

Having said that, all of the people who died on the DP were over 65 and the cruise was older than the US on average, so some have done calculations suggesting the "true" DP death rate would be more like 0.7% which is about half of the 1.3% from the DP (see the 2nd link, which was published when only 6 had died, but that eventually became 9, so their 0.5% adjusted mortality becomes 0.7%). Even at half the numbers I just calculated above (using a 0.7% mortality rate), that would be 85K deaths and 340K ICU cases in the 80% of the US which is urban if we implemented few interventions, both of which are far in excess of an annual flu year.

 

We'd need a case rate of about 1-2% to bring the CV2 deaths down near the annual flu and that simply doesn't seem possible to achieve in densely populated areas (and hotspots outside of urban areas) without significant interventions (testing, tracing/quarantining, social distancing, no crowds, closures, etc.), like we're seeing now.  Also, keep in mind that the numbers in this scenario are totals for a year or so, comparing to the flu - the other issue with this virus is the very sharp peaks we've seen almost everywhere, which can potentially overwhelm anyone's health care system, which is another reason for "flattening the curve" via interventions.  

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm6912e3_w

https://www.sciencenews.org/article/coronavirus-outbreak-diamond-princess-cruise-ship-death-rate

And that's why most experts feel we need to intervene with testing, tracking, quarantining, social distancing, no crowds, closures, etc., especially in our cities, as we don't want to "hope" for spring reducing transmissions (which I think it will, but we don't know or by how much) or "hope" that transmission rates are even lower than my estimates.  How long we have to do this for is obviously the big question. My guess is 6 more weeks, since we got such a horribly late start on our interventions, especially on testing - we could have easily followed South Korea's model and peaked at maybe at 60-75K infections (they're at 9000 now and have 1/6 our population) and be close to the decline right now, but we didn't follow their playbook. The other wild card is if any of the clinical trials with repurposed older drugs help us, which is unlikely, from everything I've read (HCQ did not work in China much).

And the last, but best wild card was just announced yesterday, as NY got FDA approval in record time (one place Trump/Hahn deserve full credit for temporarily suspending many regs on new treatments) to start testing antibody-laden blood plasma collected from recovered infected patients with antibodies to the virus in very sick patients and eventually as possible preventative for elderly/high risk people and health care workers. It's low tech and cheap, but it should work to at least some extent and we should know in a few weeks (see the link).
 

Appreciate the work you've put into this, but the Diamond is only one example, and perhaps not a good one at all that you are using to model.

 

There have been new reports (Ct/NJ nursing homes/etc) of MUCH more than the 17 to 19 percent you are quoting. 

 

I come into much more contact with people in the NYC subways when I'm there for work than I EVER did with people on a cruise ship. They are also focused on sanitizing now because of recent norovirus outbreaks.

 

If your 19 cap was correct than the NJ nursing home wouldnt be 100 percent exposed.

 

Just saying, your theory is good work but using the Diamond to model how it will affect the rest of the populous is flawed.

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21 minutes ago, SnowWolf87 said:

Appreciate the work you've put into this, but the Diamond is only one example, and perhaps not a good one at all that you are using to model.

 

There have been new reports (Ct/NJ nursing homes/etc) of MUCH more than the 17 to 19 percent you are quoting. 

 

I come into much more contact with people in the NYC subways when I'm there for work than I EVER did with people on a cruise ship. They are also focused on sanitizing now because of recent norovirus outbreaks.

 

If your 19 cap was correct than the NJ nursing home wouldnt be 100 percent exposed.

 

Just saying, your theory is good work but using the Diamond to model how it will affect the rest of the populous is flawed.

Fair point.  I didn't mean it as an absolute 20% cap, but more of a practical 20% cap in larger populations.  Yes, there will always be exceptions and probably in susceptible populations - the real truth could be that there is a 50% infection rate for the elderly and maybe only a 10% infection rate for young people in a Diamond Princess scenario or elsewhere.  But the fact that no countries on Earth has yet even reached 0.2% infection rate overall (Italy is the highest with 0.12%, although NYC is at 0.3% and climbing, which is why I used 5% as my worst case) is at least somewhat reassuring - as well as the Asian countries keeping the rate below 0.05% of the population with significant interventions.  I edited my original to incorporate your comment and what the 19% meant to me - thanks!

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Just now, ru848789 said:

Fair point.  I didn't mean it as an absolute 20% cap, but more of a practical 20% cap in larger populations.  Yes, there will always be exceptions and probably in susceptible populations - the real truth could be that there is a 50% infection rate for the elderly and maybe only a 10% infection rate for young people in a Diamond Princess scenario or elsewhere.  But the fact that no countries on Earth has yet even reached 0.2% infection rate overall (Italy is the highest with 0.12%, although NYC is at 0.3% and climbing, which is why I used 5% as my worst case) is at least somewhat reassuring - as well as the Asian countries keeping the rate below 0.05% of the population with significant interventions.  

This I agree with, appreciate your response.

 

Yes I think as a populous on a whole perhaps we wont see the 50 plus infection percentage (at least not in the short term), but rather localized populations could have a much higher infection rate.

 

God, we still have SOOO much to learn about this thing it's scary. 

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