[Digitalis]

I'll be right over.....Umm... have Sth Aust closed the border??

The border is closed, but our airspace isn't. How do you feel about jumping out of an airplane with only a parachute to save you from gravity's wrath?

---------- Post added 2020-03-25 at 11:26 PM ----------

To those who are chafing at the rules that are in place, there are a few things to remember.

here is a TL/DR version

---

Last edited by Digitalis; 03-25-2020 at 05:33 PM.

[BigMackCam]

Folks - given the essential function of governments in this crisis, we've tried to cut everyone a little more slack than usual regarding comments that border on political. However, I'd like to remind everyone that political comments, opinions etc. are specifically precluded by our forum rules and will be subject to moderating action. Please take care not to stray into politics.

Thank you

[Wheatfield]

I think that may have been true last week, but we are moving in a different direction. If we hit a million people tested by the middle of next week, surely not all of them are rich and powerful?

I do think people in government have been tested pretty early, but they are people who have a need to meet together and hopefully not spread it among a group of really old politicians. Regardless, testing isn't available for "anyone who wants it," but it should be coming on line. To meet Korea's level of testing we need to test 1/200 Americans, which would be about 1.5 million tests. We are about 1/3 of the way there right now.

The thing is, it's a moving target. You could get tested this morning, come into contact and be infected this afternoon and get your negative test results tomorrow.
Or get infected next week after being cleared this week.
Consider that about all the test will do is confirm what you probably already suspect if you are symptomatic.

[Digitalis]

all the test will do is confirm what you probably already suspect if you are symptomatic.

IF you are symptomatic, and this virus has a rather long latent period where the infection is able to spread without the host being aware.

[photoptimist]

I posted earlier in the thread that the flu kills, in Spain, 400-1000 people per year (directly). That's over a period of about 6 months (same as the us). Covid-19 is at 2500 deaths in a month. The US is gonna be on a worse progression.

Seriously, how many times have hospitals in NYC come close to collapsing because of the flu? Everyone I know in healthcare is scared because it's really, really not "just a flu".

Indeed! And the death toll is still doubling in Spain. It will kill ANOTHER 2500 in the next 3 days. The totals for Spain will probably be above 10,000 in about a week.

The doubling rate of new cases seems to be slowing in Spain (and Italy) but it's still going up. As a rough guess, COVID-19 will kill at least 20,000 in Spain even with immediate and perfect social distances practices.

People who watch the death toll numbers and think "it's not so bad" don't understand that the death toll tells you how bad it was 2-3 weeks ago because that's the lag between being exposed and dying. For something that can double in magnitude every 2-3 days, that means the current death toll under-estimates the problem by a factor of between 30X and 1000X.

[photoptimist]

I think that may have been true last week, but we are moving in a different direction. If we hit a million people tested by the middle of next week, surely not all of them are rich and powerful?

I do think people in government have been tested pretty early, but they are people who have a need to meet together and hopefully not spread it among a group of really old politicians. Regardless, testing isn't available for "anyone who wants it," but it should be coming on line. To meet Korea's level of testing we need to test 1/200 Americans, which would be about 1.5 million tests. We are about 1/3 of the way there right now.

The required intensity of testing depends on how long we let this spread in the population. The US is already past the rate of spread where Korea-level testing is adequate (and we don't even have Korea-level testing yet!)

Based on the current death toll in the US, the likely fatality rate (for people with good access to hospitals), and the doubling rate, the US probably has 2 million infected people currently (about half of whom picked up the disease in the past 3 days and don't know it yet).

We needed Korea-level testing last week and now we need 2X Korea-level testing. And the "coming on line" volume will probably have to be 8X Korea-level testing to replicate the Korea model of containment.

Testing is not a one-and-done process. Anyone in a position that can't practice social distancing and who interacts with the public (e.g., healthcare, retail, food service, and politicians) probably needs frequent fast-turn-around testing to prevent them from infecting a lot of people in the pre-symptomatic and asymptomatic phases of the disease.

[Rondec]

The required intensity of testing depends on how long we let this spread in the population. The US is already past the rate of spread where Korea-level testing is adequate (and we don't even have Korea-level testing yet!)

Based on the current death toll in the US, the likely fatality rate (for people with good access to hospitals), and the doubling rate, the US probably has 2 million infected people currently (about half of whom picked up the disease in the past 3 days and don't know it yet).

We needed Korea-level testing last week and now we need 2X Korea-level testing. And the "coming on line" volume will probably have to be 8X Korea-level testing to replicate the Korea model of containment.

Testing is not a one-and-done process. Anyone in a position that can't practice social distancing and who interacts with the public (e.g., healthcare, retail, food service, and politicians) probably needs frequent fast-turn-around testing to prevent them from infecting a lot of people in the pre-symptomatic and asymptomatic phases of the disease.

Let's be clear that there are hot spots and not so hot spots. Intensive testing in hot spot areas is crucial. But the level of testing needed in, say, North Dakota or Wyoming is probably not as high. But clearly the way to make the target stop moving is with pretty vigorous social isolation and even then, it takes at least ten days to kick in.

States that had more aggressive measures early have not seen the same spike in cases that states that were less aggressive.

[swanlefitte]

I just saw somewhere that NYC density is greater than a half full cruise ship. San Fran is the second densist city in the US by nearly half.

[beholder3]

It is worthwile understanding that the exponetial curve of all those graphs is going to be flattened simply by the fact that testing capacities will not grow exponerially.

If you test 100 people a day constantly the growth of the graph but not the reality is going to be limited to linear at some point.

So you first have a cap on newly identified cases. What is not going to be flattened as much is the number of deaths. So we can expect the visible fatality rate to grow after some weeks.

---------- Post added 25th Mar 2020 at 16:48 ----------

Let's be clear that there are hot spots and not so hot spots. Intensive testing in hot spot areas is crucial. But the level of testing needed in, say, North Dakota or Wyoming is probably not as high. But clearly the way to make the target stop moving is with pretty vigorous social isolation and even then, it takes at least ten days to kick in.

States that had more aggressive measures early have not seen the same spike in cases that states that were less aggressive.

You could argue that testing expansion in the cold or warm spots will save more lives than where its already out of control.

[photoptimist]

Let's be clear that there are hot spots and not so hot spots. Intensive testing in hot spot areas is crucial. But the level of testing needed in, say, North Dakota or Wyoming is probably not as high. But clearly the way to make the target stop moving is with pretty vigorous social isolation and even then, it takes at least ten days to kick in.

States that had more aggressive measures early have not seen the same spike in cases that states that were less aggressive.

That's a very good point. Per capita testing can be much lower in places with KNOWN low rates of infection and must be higher only in places with high-rates of infection.

However, the math for averages for exponential things is very cruel. Let's say we have three cities each with the same population: one hot-spot requiring 3X the testing rate, one medium spot needing 1X the testing rate, and one cold-spot needing only 1/3 the testing rate. The average testing rate will need to be 1.44X.

But the math gets crueler than that. If the hot-spot is hot because it has 3X the population and the cold-spot is cold because it has 1/3 the population, then the required average testing rate is 2.33X. (Note that the current known per-capita case rate is 34X higher in New York state than in North Dakota and New York has 39X the population suggesting New York needs 1300X the test rate of North Dakota.)

The math ensures that the required average testing rate will be heavily biased toward the hot-spot test rate.

For example, New York State probably has on the order of 400,000 infected people right now (most of whom are still in the incubation phase). To find most of these people and then check most of their social contacts will probably requires 2 to 4 million tests. That's the "test right now" figure which only grows further if New York state can't test millions of people right now.

[sbh]

My Dad and I have both had what seemed like the start of a common cold, with sniffles - and, in my case, two days of a very mild, dry cough that wasn't by any means "persistant". No other symptoms, normal temperature, felt absolutely fine throughout - so I'm convinced it was just the weakest of common colds or a similar minor bug. Still, on the morning I woke up with the slight dry cough, I was unusually apprehensive...

I take hydroxychloroquine as a disease modifier for rheumatoid arthritis. Given recent mention of it as a potential COVID-19 treatment, I wonder if I'm less likely to get the virus?

Two thoughts here:
First, we are now much more sensitive to regognising a cough which we otherwise wouldn't waste a thought for.

Second: It is still possible that you got it and are lucky to have only mild symptoms. It can spread in the underground due to the lead time of two weeks (and in rare cases up to 27 days).

You can't just divide 114/20,875 to get the death rate because you are assuming that none of the most recently found cases will die. Those 114 deaths reflect that true case load (not the "tested case count') of about 2-3 weeks ago because that's the delay between getting infected and dying. The only way that the death rate can be just 1% and have 114 deaths right now is if 114,000 had this virus 2-3 weeks ago.

It's not fair to compare the end-of-the-season numbers for flu with the beginning-of-the-season numbers for COVID-19. And if you do compare beginning-of-the-season numbers for both diseases that's where you'll see that COVID-19 spreads faster, generates more hospitalizations, and kills more people that does the flu.

Worse, if you then extrapolate those numbers, you get a scenario where hospitalizations vastly exceeds hospital capacity and then you get a 3-8X increased death rate because the sick don't get the treatment they need (see Italy for what that looks like).

I wonder how the death rate is calculated correctly. I am not a statistics nerd and I would think like this: Those who get infected either survive or not. It is the number of deceased in relation to all. The formula for this would be:
Number of deceased people divided by deceased+survived.
But this would show a death rate of 6820 / (6820 + 8326) = 45%
Perhaps anyone here knows how to calculate it correctly.

I have those for my county: population density 1 person per 40 acres, tested positive 1 person, she was out of state and was fully recovered by the time she came home, deaths etc. obviously zero. Yet still the schools are shut down. Very frustrating for everyone. Kids have extra time off school, but they are not allowed to go out. Old farts with motorhomes (like me) have diesel down to $2.08 a gallon, but most camp grounds are closed down and we are being told to stay at home.

Don't be fooled by some early low numbers. Highly likely it will sweep through our county as well. Perhaps it is there already. It takes two weeks to show symptoms. The last thing you should do is go out.

IF you are symptomatic, and this virus has a rather long latent period where the infection is able to spread without the host being aware.

That's what many underestimate.
What happened around here (a town in the German countryside) where the 8-year old of my girlfriend goes to school.
Two weeks ago, school was closed.
12 days after closing, all parents were notified that all school children are ordered to be under quarantine because 1 child from that school showed symptoms shortly after closing and was tested positive.
Duration of quarantine: 2 days from the day of notificaion (calucation: last possible infection was the last day of school 12 days ago + 2 = 14 days)
So ALL the school children (approx. 300) were not under quarantine although they should have been due to lagging symptoms and test results.

How long has that child been infected already? How many did infect themselves from that one child? How many of them did pass it on in that time? Nobody knows.

I have been homeschooling her son since the school was closed. He doesn't show any symptoms but children often don't show any so he could have easily infected me. Either way, I know that I have not infected anyone else (at least since school closure) because I did not go out since then. Staying away from others is the only effective measure until vaccination or treatment is available.

Indeed!
...
People who watch the death toll numbers and think "it's not so bad" don't understand that the death toll tells you how bad it was 2-3 weeks ago because that's the lag between being exposed and dying. For something that can double in magnitude every 2-3 days, that means the current death toll under-estimates the problem by a factor of between 30X and 1000X.

Yup, it will come from the past. Take care now to be safe later.

Additionaly: From the news today I learned that the statistics in Germany lag behind because there isn't enough staff to aggregate all the numbers of newly infected and deceased cases. Also, from France I heard that the number of deceased is probably higher because they only count the cases in hospitals but not those else where like old-peoples-homes.

[gofour3]

In Canada we haven't had a lot of deaths, but they've almost all been over 65. If it got all of us, it still wouldn't be more than 15% of the Canadian population, so that would be a hard cap right there. But even among that population the death rate is only about 15%, so, 15% of 15% = 2% of the population might die.

Yeah it's the senior care buildings that are getting hit the hardest here in Vancouver. I work in a hospital in a Vancouver suburb and while we do have a COVID-19 ward and drive up testing, no one has died of the virus in the hospital that I know of. One of the nearby senior care homes has had all the deaths, 10 that I know of, which accounts for most of the deaths here in BC. Numerous other residents and staff have also tested positive for COVID-19 in that care home.

Phil.

[swanlefitte]

I have been homeschooling her son since the school was closed. He doesn't show any symptoms but children often don't show any so he could have easily infected me.

I was discussing this with a phd student. There is a distinction glossed over. Asymptomatic and presymptomatic. True asymptomatic spread is figured to be quite rare, not even certain.

Then again with the well studied influenza, we are not even certain of how many people are asymptomatic. Around 16%, 4-28%, meta studies show a range of 0-100%. This shows 2 things. 1. It is not known. 2. It is not important enough to study.
The fraction of influenza virus infections that are asymptomatic: a systematic review and meta-analysis

[Dartmoor Dave]

My sister who lives in New York, whose daughter tested positive late last week, has now developed the classic symptoms herself but can't get tested because they've run out of tests. And her symptoms are already worse than her daughter's, which seems to show the age factor again.

To be clear: I'm not posting this in search of sympathy. I'm posting it to remind everyone that this is not an abstract theoretical discussion. Sooner or later it's going to hit someone you know and love.

[sbh]

I was discussing this with a phd student. There is a distinction glossed over. Asymptomatic and presymptomatic. True asymptomatic spread is figured to be quite rare, not even certain.

Then again with the well studied influenza, we are not even certain of how many people are asymptomatic. Around 16%, 4-28%, meta studies show a range of 0-100%. This shows 2 things. 1. It is not known. 2. It is not important enough to study.
The fraction of influenza virus infections that are asymptomatic: a systematic review and meta-analysis

If I'm not mistaken it's different than the normal flu, with COVID-19 there is a higher rate of people seen without symptoms – more with younger people than with older ones.