Coronavirus Sars-CoV-2/Covid-19 Megathread

[Josquius]

I like the way they show the graph on the newspaper, no distortion needed

[Sheilbh]

Early indication of UK-wide serology survey is that high single figures-low teens have had coronavirus.

[Caliga]

Roy from Siegfried and Roy died of COVID-19.

[Legbiter]

Early indication of UK-wide serology survey is that high single figures-low teens have had coronavirus.

We're still trying to cobble together a serological test with acceptable accuracy.

[Tamas]

Early indication of UK-wide serology survey is that high single figures-low teens have had coronavirus.

That's hopefully not accurate, is it? Would it mean we are like at best one-sixth way to herd immunity with 30k+ dead and thousands of new cases discovered per daily DURING lockdown?

[Legbiter]

That's hopefully not accurate, is it? Would it mean we are like at best one-sixth way to herd immunity with 30k+ dead and thousands of new cases discovered per daily DURING lockdown?

The UK isn't going for herd immunity. They're going for South Korea but it's just such agonizingly slow going watching it from the outside. The setting up of national contact tracing teams and the contact tracing app is 6 weeks to 2 months behind the countries that have crushed their curves. Sheilbh thinks it's because they're too centralized and bureaucratic. Plus the general population has too many oldsters and metabolically challenged people to make herd immunity viable as a strategy.

[celedhring]

Early indication of UK-wide serology survey is that high single figures-low teens have had coronavirus.

That's hopefully not accurate, is it? Would it mean we are like at best one-sixth way to herd immunity with 30k+ dead and thousands of new cases discovered per daily DURING lockdown?

Figures from small-scale tests in Spain point in the same direction tbf. We're still awaiting results from the nationwide one.

Herd immunity is just not a valid expectation unless we're willing to accept hundreds of thousands of dead in our countries.

[alfred russel]

Early indication of UK-wide serology survey is that high single figures-low teens have had coronavirus.

That's hopefully not accurate, is it? Would it mean we are like at best one-sixth way to herd immunity with 30k+ dead and thousands of new cases discovered per daily DURING lockdown?

I'm not sure how much better you could hope for. The death totals seem right(ish) -- there aren't massive numbers of unexplained deaths. If you assume 6 million have been infected (about 10% of the UK population), that points to about a 0.5% mortality, which is in line with expectations.

[Sheilbh]

Early indication of UK-wide serology survey is that high single figures-low teens have had coronavirus.

We're still trying to cobble together a serological test with acceptable accuracy.

My understanding is this isn't accurate enough to be used for individuals but is enough for a large-scale surveys which are now being run here. But it is one of the really extraordinary aspects of this disease that we are in this situation but noone, anywhere has any real idea how many people have had it. Obviously we're only four months in from the world's scientists knowing anything about it but it's that weird feeling of it's incredible how much we know and how little we know.

That's hopefully not accurate, is it? Would it mean we are like at best one-sixth way to herd immunity with 30k+ dead and thousands of new cases discovered per daily DURING lockdown?

It is higher than I expected to be honest - I thought we'd be around 5%, just based on I think celed saying initial studies in Barcelona were about 11% and I think Switzerland's survey had about 9% (interestingly Switzerland's sort of showed that shielding worked, the over 65s had about half the rate of the under 65s). I don't know if there'll be a regional breakdown but I assume London, the West Midlands and the North-West probably have a higher rate. And my understanding is it would mean the IFR is somewhere between .5-1% which is consistent with other serological studies elsewhere. And I think the latest UK figure is 43k excess deaths (but projected to be about 55k by now).

On the new cases this was the point the National Statistician was making in their evidence - the R is key, but it is only useful in the context of prevalence. If the disease is very prevalent then even an R below 1 could overwhelm the health service. And him and one of the modellers (from London School of Hygiene and Tropical Medicine) were both saying that while there is one R for the epidemic in the UK there are variations across the country. They think it's between 0.5-0.9 and it has ticked up in recent weeks, but the community transmission rate is at the lower end so they think London is around 0.5, the higher end which has increased in recent weeks are those closed environments - in the UK hospitals and care homes (though case numbers in hospitals have been falling for several weeks now). But all of that means that I think they'll want more evidence that the prevalence is lower before there's any big change on lockdown.

But also the big thing in the UK is the increase in testing. So I don't think our case numbers are at all useful until the last couple of weeks - because the capacity was so low it was focused on hospitals, care homes (though not enough) and prisons. We're now in the range of 75-100k a day which is a higher level than South Korea, but comparable with Germany and Italy. So there'll be a lot more positives because we've gone from 10-15k at the start of April to a far higher number. But given that we've gone from very focused testing because of low capacity to wider testing and are getting a similar number of positives, it suggest it's still fairly concentrated in those priority areas which bolsters the idea that the R is at the higher end in hospitals and care homes.

I understand there's something similar in the US (I don't know about the R there) but the recent outbreaks have all been in closed environments: care homes, prisons, naval ships, meat-packing factories.

[Sheilbh]

I'm not sure how much better you could hope for. The death totals seem right(ish) -- there aren't massive numbers of unexplained deaths. If you assume 6 million have been infected (about 10% of the UK population), that points to about a 0.5% mortality, which is in line with expectations.

I think about one third of UK excess deaths are not covid related (according to the death certificates/attending physician). But that will need untangling after this, some are no doubt covid-19 which hasn't been identified. Others are probably just the indirect deaths of the shutdown of the healthcare system for some ongoing conditions - there's been a huge drop in cancer diagnosis, but also chemo and radiology treatments - and people "mustn't grumble" if they're in an emergency/not wanting to catch covid in a hospital - so the number of 999 calls about heart attacks has halved and I am sure that the number of heart attack hasn't decreased that much.

Herd immunity is just not a valid expectation unless we're willing to accept hundreds of thousands of dead in our countries.

Unless we develop some treatments - then, yeah. We might get there by accident, but it'll be with a strong track-and-trace program going on to keep ther R below 1 and the spread contained.

[alfred russel]

The UK isn't going for herd immunity. They're going for South Korea but it's just such agonizingly slow going watching it from the outside. The setting up of national contact tracing teams and the contact tracing app is 6 weeks to 2 months behind the countries that have crushed their curves. Sheilbh thinks it's because they're too centralized and bureaucratic. Plus the general population has too many oldsters and metabolically challenged people to make herd immunity viable as a strategy.

South Korea--no open land border so effectively an island--Taiwan, Singapore, Japan, and Iceland can do this.

I'm really doubtful the US can. Our borders are massive and we have a zillion international airports. The developing world won't have the resources and we have a massive border with Mexico. Not to mention millions of undocumented immigrants fearful of authorities/deportation. That isn't even getting to distrust in minority communities and our 2nd amendment right wingers. The Trump administration is not exactly the ideal vehicle to overcome the fear and distrust.

It may be easier in Europe than the US but it will still be an epic challenge to seal it off from the developing world.

[DGuller]

What is the biggest unanswered question in my mind is to what extent all that was necessary was just increased knowledge and awareness of the virus.  If on February 15 you got up in the morning to go to work, and had a slight cough, you wouldn't think twice about it.  You would get on the subway, get to work, and power through it.  I bet a lot fewer people would do it on May 15, and would have a more understanding employer if they call in sick.  How much of an effect just that would have on the R number?

[viper37]

BB, I vigorously object to your willingness to confine people to their homes because you assess the risk for them to leave as excessive.

But let me put it another way. The German government projected that 70% of their population will be infected before this is over. Lets run with that. Out of a group of 10 of us, that means 7 will be infected. One of us volunteers to be among the 7. Will you really forbid this, knowing that:

-it increases the risk for the other 9,
-the volunteer has a risk of death of perhaps 1/500, while others in the group may be an order of magnitude higher, so it actually increases the projected death total of the full population,
-for many people who are high risk of dying after infection, they are put at increased risk of infection by the nature of their risk...for example, a dialysis patient has to regularly leave home for treatment.
-dragging the process out to get to the 7 is causing severe social and economic strain, and accelerating the process will reduce this.

is there a difference between 1000 cases in 1 day and 1000 in 1 month to you?

If the same percent of the population is going to get it and it doesn't overwhelm the medical system, going fast lessens the economic and social destruction, can reduce total deaths by allowing the lower risk to be disproportionately infected, and may reduce reinfections if antibodies aren't long lasting.

that is the problem, really.  In ordinary times, say, a big accident, an hospital may have 100 beds, with 10 already occuppied, and for the 90 others, once it reaches near-capacity, it will divert ambulances to other hospitals in the county.

Now, in times of pandemic, those same 100 beds become 50, because you need to split the hospital into hot zones and cold zones.

and if too many people get sick at the same time, those 50 beds for covi-19 will become 70 and 30 will be left for other emergencies.  And once it's at full capacity, it's done.  People die, who could have been saved.

This is what happenned in NY State, particularly NY City.  It also happenned in New Orleans.

The reality is, the virus is extremely contagious, and for a part of those affected, they will require hospital care.  And since it's infectious, you risk disease transmission to the healthcare staff.  And suddenly, that 70-30 split you had become a 60-20 because you don't have the required staff to take care of them and disinfect everything thorougly.  Keep going while doing nothing, and it's 50-10.  And then it's really critical.  And you plea the Feds for more equipments, maks, ventilators, etc, but they can't manage it.  And then people start dying in mass.  As in many places.

That is the problematic you keep ignoring by refusing early quarantine.

the longer you wait, the more deaths there are and then you either see the deaths spiking or you quarantine for even longer than before.

[Sheilbh]

South Korea--no open land border so effectively an island--Taiwan, Singapore, Japan, and Iceland can do this.

I'm really doubtful the US can. Our borders are massive and we have a zillion international airports. The developing world won't have the resources and we have a massive border with Mexico. Not to mention millions of undocumented immigrants fearful of authorities/deportation. That isn't even getting to distrust in minority communities and our 2nd amendment right wingers. The Trump administration is not exactly the ideal vehicle to overcome the fear and distrust.

It may be easier in Europe than the US but it will still be an epic challenge to seal it off from the developing world.

I don't think travel restrictions are a big part of South Korea's strategy. It's about testing and contact tracing - South Korea uses a lot more data than European countries are comfortable with for this. I don't see any reason in principle why the US could do that and it would probably best be done at a state level with coordination at the Federal level. The US now has the testing capacity, there are loads of track-and-trace apps being developed in the US. But the missing pieces seem to be training up contact tracers (the UK and Germany are both recruiting to about 5 tracers per 18,000 people) and coordination/a plan. Some of that depends on being competent at government which I'm not convinced is in place at a federal level but may happen in states or regional areas.

The UK isn't going for herd immunity. They're going for South Korea but it's just such agonizingly slow going watching it from the outside. The setting up of national contact tracing teams and the contact tracing app is 6 weeks to 2 months behind the countries that have crushed their curves. Sheilbh thinks it's because they're too centralized and bureaucratic. Plus the general population has too many oldsters and metabolically challenged people to make herd immunity viable as a strategy.

There's a very good recent thread by Anthony Costello on how centralised our approach was - it's still going on. It was only last week that Public Health England decided that care home testing prioritisation and strategy should be decided by local authority public health teams, not nationally - which is particularly striking because care homes are provided by local, not national authorities. As I say I don't know if that's the fault of the politicians, but it feels like over-centralisation and not just being transparent with the public but also with other bits of government are problems that recur in the British whichever party or leadership is in charge.

I mean for example those contact tracers that are being hired will be administered centrally - whereas I think that should be local - and Buzzfeed had an article where they'd asked for details on plans etc by the German Lander and the UK government. There was a decent amount of information being provided by German authorities and nothing by UK authorities. As I say I think there is an issue of the British state (I actually suspect this crisis will have strengthened Cummings' views on the British state) that the default position is: can we manage it from London and everything should be secret/highly confidential. The attitude is just still very mid-20th century.

Edit: And apparently we're "weeks" away from the physical contact tracers being in place.

[frunk]

Considering that the US has the most reported cases of the virus in the world I don't think protecting the borders is the primary concern for containment.