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16 minutes ago, square_25 said:

Nope, I was just going off your comment. I’ll read when my kiddo gives me my computer back.

But you said that it was people who had had a cold. That is not representative. Am I misunderstanding?

Sorry, I didn't mean that to come across as snarky, I just honestly thought we were both reading the same paper.

Yes to misunderstanding. I'm saying that according to the authors they recruited via FB and then adjusted for population demographics, but it isn't clear to me that they adjusted based on possible symptoms in Feb/March.

In any case, we *all* agree that there are way more cases out there than are being reported, right? And there are a lot of asymptomatic carriers of sars2? The disagreement is on how many and what that means for IFR?

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14 minutes ago, Garga said:

I’ve been saddened, too.  Like, I feel like if it was WWII and we were told to give up our stockings, we all would, and we’d feel patriotic for doing so. 

On some various FB groups I belong to, people are flipping out about their rights being infringed and they Will Not wear a mask. Meanwhile, on other groups people are encouraging each other to wear masks and sharing sewing patterns.

One group believes X (overblown hype and power grabs) about this pandemic and the other believes Y (a world-wide crisis that requires extreme action), often based on what news media they watch.  And each group believes the other is filled with unthinking lemmings.  

And that’s painful.  We’re sooo divided in what we believe about this thing, based on what news source we listen to.  And the news sources are based on what side politically they fall.  

So it’s all political and I have no idea how we can unite.

I looked into it briefly, because the nostalgic tale of cheerful patriotism and sacrifice during WWII seemed a bit rose-coloured.

This (quite long!) article seems to get into the things you are thinking of -- whether people questioned or resisted rationing, whether they accused political opponents of exaggeration, whether they expressed anger when their rights were infringed upon, etc.

https://www.politico.com/magazine/story/2019/06/06/how-world-war-ii-almost-broke-american-politics-227090

A relevant quote from about half way through is, "The administration's desire for unity did not, of course, erase deep-seated racial, ethnic and religious tensions—tensions that flared up as Americans came to chafe at the imposition of greater government control and taxation in the war years." The article carries on to give examples of people accusing and blaming minorities (that they already hated) for the hardships based on the belief that "someone" must be benefiting from the economic hardships. So, at least you aren't seeing the tension expressing itself as bigotry and violence. Maybe that's a comfort.

The article does substantiate that there was a very high level of "popular dissatisfaction with sacrifices imposed by the wartime state" -- not the rosy-cheeked happy patriots one might see grinning about going without ordinary things for the sake of the war.

Political partisanship and conflict was also at very high levels. FDR was widely attacked for being an outright 'communist' by conservative American news sources. An election for his fourth term was, "a filthy fight, and all the more so with so many soldiers and sailors fighting abroad. The president won comfortably, but with a smaller margin than in any of his previous elections."

"[T]he spirit of unity and camaraderie that we remember may over-sentimentalize a more complicated story."

"This spirit of triumphalism masked a darker reality: In 1940 and 1941, the Roosevelt administration faced widespread resistance, particularly from auto companies, to switch from civilian to war production."

"It should not surprise us that people could act both for the greater good and out of personal motivation."

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7 minutes ago, bolt. said:

I looked into it briefly, because the nostalgic tale of cheerful patriotism and sacrifice during WWII seemed a bit rose-coloured.

My parents were born in Asia during WWII and their older siblings as well as my grandparents said everyone was going on the basis of self preservation. Nobody (except maybe the wealthy) was cheerful. People were more of outwardly complying and going underground on “illegal” behavior. 

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3 hours ago, EmseB said:

Did anyone post this already? (Pre-print study) https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1

Thank you for posting this. I've been watching for the preliminary results of this study for the last few days.

2 hours ago, EmseB said:

I don't know enough about antibody tests to know if serology(?) tests are reliable or not

"We also adjust for test performance characteristics using 3 different estimates: (i) the test manufacturer's data, (ii) a sample of 37 positive and 30 negative controls tested at Stanford, and (iii) a combination of both."

It looks like the specificity was 99.5% or higher and the sensitivity was between 67.6-91.8%. I think that means their serology test almost always gives back a true negative but sometimes misses the true positives (giving a false negative). They checked their kits vs. Pre-COVID19 samples to see if the test would pick up other coronaviruses and 369 out of 371 tested negative (I think that was the 99.5% number).

"In medical diagnosis, test sensitivity is the ability of a test to correctly identify those with the disease (true positive rate), whereas test specificity is the ability of the test to correctly identify those without the disease (true negative rate)."

So, their results might be low for true positives, right?

I think this is a great study and if this were repeated across the nation, would give a better idea of the true spread in each area. I don't think you can extrapolate to the country as a whole, but certainly you can for the zip codes they included in their study. What it tells me is there isn't much herd immunity there. Only 1.5% of their sample tested positive (but their sample didn't match the county so they had to adjust it).

Still, that scales up to a lot more positives in their area than what the current tested cases in their area indicate. That's what the study was trying to find - the infection rate, right? Anyway, since their test probably missed some positives, that's the low end.

... Also, sorry, I'm behind on reading posts. They did NOT select for respiratory symptoms. But some of the recruited people might have signed up because they thought they had already had Covid-19 and wanted to know (self-selection bias?).

Edited by RootAnn
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7 hours ago, square_25 said:

Yeah, I think there are vast undercounts on the numbers of cases. Practically no one is testing anyone but the sickest people. 

I think Iceland and New Zealand would be the ones to watch for accurate CFRs. 

We are currently at 11 deaths for 1400 positives. But those 11 deaths are not randomly distributed.  6 of the deaths were in the special care part of a bigger nursing home, and these residents were 85+ years old and very frail.  

 

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2 minutes ago, square_25 said:

Yeah, I do not think anyone is getting randomly distributed deaths. 

So the question then is how do we use a CFR?  Is it useful at all?  How does it inform policy? 

For example, with 11 deaths, that would mean that we would have may 50 in the hospital based on overseas numbers?  But we don't, we only have ever had 15 at the max because of this group in a single nursing home.  They are close to 100% death rate, so deaths=hospital beds. So we can't use the CFR to inform the number of bed we need.  

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1 minute ago, square_25 said:

Any idea what your cumulative hospitalization rate is, by the way? 

Ah, we were writing at the same time and thinking the same thing.

We have had somewhere between 13-15 people in hospital for 3 weeks.  And a lot of those are the same people.  My guess is maybe 50-75 in total out of 1400 cases. 

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I thought this was an interesting article that reports on what I commented on anecdoctally about how the Asian communities in the US responded to this way ahead of the rest of the country.

https://www.sfgate.com/news/article/How-San-Francisco-s-Chinatown-Got-Ahead-of-the-15207797.php?fbclid=IwAR0VvlolNDrnrCJQFwle9U2FeD_XKkY53rLAzXsLPSS6iJ2ar7-dpFFz9jg

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4 hours ago, Matryoshka said:

Welp, apparently it's not auto deaths leading the decline... just watching a spot on CBS This Morning. .. rather than going down, auto deaths are actually spiking now in spite of lower traffic, due to increased speeding. Traffic speeds are up 30% in CA; in Minnesota,  traffic deaths have doubled

I know around here people seem to be driving worse than usual (and the usual isn't that great).   They are being less careful when needing to pass on the wrong side of the road, driving faster, ignoring stop signs, etc.  I think less cars being on the road makes them feel like they don't need to be so careful.   I don't know about speeding because I haven't been on a highway in ages. 

1 hour ago, Garga said:

I’ve been saddened, too.  Like, I feel like if it was WWII and we were told to give up our stockings, we all would, and we’d feel patriotic for doing so. 

On some various FB groups I belong to, people are flipping out about their rights being infringed and they Will Not wear a mask. Meanwhile, on other groups people are encouraging each other to wear masks and sharing sewing patterns.  (My state, PA, and the one next to me, MD, have some sort of rulings in place that you can’t enter businesses without a mask or you face fines and jail.)

One group believes X (overblown hype and power grabs) about this pandemic and the other believes Y (a world-wide crisis that requires extreme action), often based on what news media they watch.  And each group believes the other is filled with unthinking lemmings.  

And that’s painful.  We’re sooo divided in what we believe about this thing, based on what news source we listen to.  And the news sources are based on what side politically they fall.  

So it’s all political and I have no idea how we can unite.

I'm not seeing too much of this locally.  Most people on the general area groups seem to be in group Y - encouraging mask use, staying home, telling people not to be idiots.  But again, I'm in an area that this all feels very very real so that may be the difference.  Almost everyone seems to know someone who had/has it, and most know someone who knows someone who died.  

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10 minutes ago, square_25 said:

Perhaps the next such study needs to ASK participants whether they had a cold in February?

Do you believe that people are likely to be able to answer that accurately? I would think most healthy people who get a cold in winter and are not sick enough to see a doctor wouldn't have taken note of it, or people might vaguely remember having been sick, but it was actually in January rather than February... I would  have no idea how long I've been sick now except that I noted it on the calendar because C19 was already in my area.

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Also, we have only had 1 death that was someone who died *of* rather than *with* covid.  He was 70 years old and the father of the groom for our biggest cluster which was a wedding. 😞 All the others, were either in hospice already, or over 90, or with major underlying conditions. 

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18 minutes ago, RootAnn said:

 I've been watching for the preliminary results of this study for the last few days.

Page 13 & 14 does not make sense to me. I am in Santa Clara County, near to San Jose which has a high number of cases and seems undersampled. Stanford hospital is in Palo Alto, cases are low in that city so it seems oversampled. I have an active Facebook account  (and Facebook knows which city I live in) and did not see the recruitment ad for this study. 

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf

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13 minutes ago, square_25 said:

I'd be a lot less skeptical if this lined up with other estimates. I'm glad their test seems good, although I would definitely like it tested specifically on people who've had other respiratory infections and not on some random sample. 

Did you really mean to type that you want the test to be on people who had respiratory infections ? That seems like it would end up meaning a higher positive rate? Or are you wondering if the test kit is catching other respiratory infections and calling them Covid-19 positive?

11 minutes ago, square_25 said:

By the way, is there any particular reason they didn't subtract off their expected false positive rate? During their testing, it did seem to be about 0.5%. Even at that extremely low rate of false negatives, that still seems like it's a third of their cases... and that's assuming it really is 0.5% false positive and no more. 

I'm not following your math (0.5% does not equal 1/3 of positives?). They seem to have more of a false negative rate -- 8%-33% of their negatives could have been positive. 

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9 minutes ago, square_25 said:

Yeah, it's way oversampled from Palo Alto. But then they attempted to adjust for that, which is again where it's easy enough to monkey about with numbers if you so choose, because there are so many possible ways you could adjust parameters, but at the end of the day you really mostly sampled from Palo Alto near Stanford... 

 

I thought there was a Stanford study where the participants are their healthcare staff. 

Below is my county’s most recent data but the trend is similar day on day.

Campbell Cupertino Gilroy Los Altos Los Altos Hills Los Gatos Milpitas Monte Sereno
28 21 35 21 <10 23 59 <10
 
Morgan Hill Mountain View Palo Alto San Jose Santa Clara Saratoga Sunnyvale Other/Unknown
31 40 63 1202 83 10 99 106
Edited by Arcadia
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9 minutes ago, Arcadia said:

. I have an active Facebook account  (and Facebook knows which city I live in) and did not see the recruitment ad for this study.

From what I remember reading at the time of the study, the ad was up very briefly. They were actually hoping for 800 (?) participants and were watching the registration page in real time. When they realized they already had almost 3,000, they quickly called to get the ad removed and shut down the registration site. There is great demand for serology testing--that's what I got out of it.

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1 minute ago, RootAnn said:

From what I remember reading at the time of the study, the ad was up very briefly. They were actually hoping for 800 (?) participants and were watching the registration page in real time. When they realized they already had almost 3,000, they quickly called to get the ad removed and shut down the registration site. There is great demand for serology testing--that's what I got out of it.

What I meant was this recruitment method is going to end up with a bias sample. 

An easy way to get a less bias sample would be to mass email all the people who uses Stanford Healthcare as their PCP and stay in Santa Clara County to ask for participants. At least the sample population of each city could be proportional to the city’s population by doing the registration cutoff at each city’s level. 

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5 minutes ago, square_25 said:

I think their positive rate was 1.5%, so 0.5% would be a third of that, yes. And it's not that 8% to 33% of their negatives could have been positive: where are you seeing that? It's more that the actual number of positives may have been 8% to 33% greater than reported, which is VERY different from the calculation you just did.

I don't read their numbers like you are reading their numbers. It certainly isn't how I understand sensitivity vs. specificity. Either way, they say they adjusted for both in their calculations.

I'm hoping for more studies like this. This is the first of its kind to release results in the US, I believe, although there are others being conducted.

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47 minutes ago, square_25 said:

I think cumulatively four times as many hospitalizations as deaths sound about right for here, too, actually. You do have to look at cumulative for both. 

So 11 deaths, 60 hospitalizations, 1400 cases, 70,000 tests, 4.8 million population. 

Yesterday's positive testing rate was 8 in 4200 symptomatic people (but all in known clusters)

Yesterday, 0 in 300 asymptomatic people from 'hot spots' (areas where the most cases have been identified). 

Do these numbers line up with other countries?

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Question for you guys (well, many questions).  I simply can't make sense of studies saying 80% of people are asymptomatic and the data we have here.

NZ has only been testing *symptomatic* people, but has used a low bar of *any* respiratory symptoms, so like a sniff.  There must have been asymptomatic carriers here in NZ and they would have infected others. We have a 2% community spread number so 30 cases in 1400 that are not linked to our known 16 clusters. So if we weren't identifying asymptomatic people and they could be as high as 80% of all cases, then why did we not have more spread? 

Is it because we did a strict lockdown when we had only 70 cases or so?  At that time we actually had 350 cases (if 80% of people were asymptomatic but unknown), but the lockdown kept them from spreading?  I can't see how if that were true, that we wouldn't have more clusters.  Where did these 80% of asymptomatic people go?  How did they not infect more people?  Could it be that when other countries say that only symptomatic people are tested that they have a much higher bar, like a fever.  So perhaps 'asymptomatic' people in other countries have a sniff, but here we call that symptomatic?  I just can't make sense of this. 

ETA: I guess our 70 known cases ballooned into 1400 over the period of 3 weeks, and that was under the strictest lockdown in the world based on Oxford Stringency Index. 

Edited by lewelma
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14 minutes ago, lewelma said:

Question for you guys (well, many questions).  I simply can't make sense of studies saying 80% of people are asymptomatic and the data we have here.

NZ has only been testing *symptomatic* people, but has used a low bar of *any* respiratory symptoms, so like a sniff.  There must have been asymptomatic carriers here in NZ and they would have infected others. We have a 2% community spread number so 30 cases in 1400 that are not linked to our known 16 clusters. So if we weren't identifying asymptomatic people and they could be as high as 80% of all cases, then why did we not have more spread? 

Is it because we did a strict lockdown when we had only 70 cases or so?  At that time we actually had 350 cases (if 80% of people were asymptomatic but unknown), but the lockdown kept them from spreading?  I can't see how if that were true, that we wouldn't have more clusters.  Where did these 80% of asymptomatic people go?  How did they not infect more people?  Could it be that when other countries say that only symptomatic people are tested that they have a much higher bar, like a fever.  So perhaps 'asymptomatic' people in other countries have a sniff, but here we call that symptomatic?  I just can't make sense of this. 

ETA: I guess our 70 known cases ballooned into 1400 over the period of 3 weeks, and that was under the strictest lockdown in the world based on Oxford Stringency Index. 

I'm thinking because you did quarantine and contact tracing of people coming in?  Before it had time to spread in secret??

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Warning- I found this video depressing, even though I am not especially depressed currently. I think anyone already struggling with depression should not watch it.  

 

https://youtu.be/Y4E90SCSqS0   

https://youtu.be/Y4E90SCSqS0

 

I don’t know if anyone shared this or the underlying paper he refers to—.  It is particularly concerning to me with regard to hopes for a Successful CV19 vaccine.  But also generally as to things humans do. 

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@TravelingChris, I’m sorry; I don’t have time atm to read everything that has been posted here since I posted, but I wanted to answer your question of “what whitewashing”. The whitewashing I’m talking about is current, not the whitewashing from Feb and early March (which was a bad bungle, for sure). For example: “most of our states are in great shape...” No, they are NOT. “We’re doing many more tests...” in most places, testing is still extremely insufficient. “Anyone who needs a test can get tested...” that is patently false. A bunch of people I know IRL *think* Trump is saying the economy is going to be fully open any minute now. They hear his pep-talks full of false information meant to be cheery (if I’m being generous) and then they are completely mystified when, like today, the school opening date gets pushed further away. People are being misled by the rah-rah open-the-economy-any-second-now stuff they hear from Trump. 

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6 hours ago, square_25 said:

The US has an intelligence service for a reason and there's plenty of evidence that people had raised alarm. If you want another side, I was fine with the travel restriction to China and would have been fine with travel restrictions to Europe. And I've been saying I don't trust Chinese numbers for the whole darn length of this thread. So how do I get any fairer here? What do I say so that we can engage on the facts instead of on partisanship? If the only non-partisan thing to say is not to blame the administration, then we can't have a conversation. 

As for what they are doing now, there still seems to be less testing than desirable and there is a very loose and confusing management structure in which it's not clear whether the experts will get enough say. However, I'm glad there's now more testing, since it makes it more plausible than some things can be opened up sooner, assuming otherwise reasonable organization. 

I thought this link was interesting- it shows the testing numbers for each nation.  The US has actually done more testing than any other nation, by almost double.  I think the size of our country and population maybe makes it feel like not much has been done.  It’s certainly easier to ramp up a smaller country. And I don’t think testing issues are necessarily a federal issue.  They contract for them but don’t make them and don’t own the labs.  And even the pharmaceuticals that made the first tests that didn’t work well, it was probably the best at that time. They keep improving the tests they develop.

There’s a lot of ifs. Maybe if WHO declared a pandemic earlier and China shared more, then countries could have had a better ramp up.   Maybe if states were prepared for a pandemic with supplies, as they should have been for years, things might have seemed better. As it is, I think everyone involved is working hard and doing the best they can, even if that means changing things as new data comes in.  I see America coming together and all the goodness coming out. I love our country 🙂

https://en.m.wikipedia.org/wiki/COVID-19_testing

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2 hours ago, RootAnn said:

"We also adjust for test performance characteristics using 3 different estimates: (i) the test manufacturer's data, (ii) a sample of 37 positive and 30 negative controls tested at Stanford, and (iii) a combination of both."

It looks like the specificity was 99.5% or higher and the sensitivity was between 67.6-91.8%. I think that means their serology test almost always gives back a true negative but sometimes misses the true positives (giving a false negative). They checked their kits vs. Pre-COVID19 samples to see if the test would pick up other coronaviruses and 369 out of 371 tested negative (I think that was the 99.5% number).

 

They tested 30 blood samples they knew were negative for CV19, and their test results were also negative for those, but with such a tiny sample it seems like the odds that any of those 30 people happened to have one of the other coronaviruses that these antibody tests sometimes pick up seems incredibly small. And then they found 2 out of 371 samples that tested positive even though those people could not have had CV19, so presumably they had some other coronavirus the test picked up.  Then they used a sample that was entirely self-selected, and therefore likely to include a large number of people who had recent viral infections, and 1.5% of those tests came back positive. Given that 0.5% of the pre-CV19 blood tested positive, which presumably came from a sample with no selection bias, the fact that 1.5% of a potentially very biased sample tested positive, does not seem that surprising. The selection bias alone could account for 1.5% of true positives, and then you add the possibility of false positives attributable to other coronaviruses.

So basically they have a test that returns a false positive in 0.5% of controls, and a self-selected sample that is likely to return a much higher percentage of both true and false positives compared to the population at large, and then they double those numbers, apply the results to the entire population, and claim CV19 is much more widespread and much less dangerous than nearly every other virologist and epidemiologist believes. I'd love to believe that's true, but I'm... skeptical.

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6 hours ago, OH_Homeschooler said:

This is something that I've found particularly distressing. A town in Iowa-Columbus Junction. 2010 census said it had 1,899 residents. It's home to a Tyson pork plant, which of course is the town's largest employer. A week ago 24 workers tested positive. Two have died. Last I heard, 186 workers have tested positive: https://www.desmoinesregister.com/story/news/2020/04/14/testing-rural-iowa-covid-19-coronavirus-tyson-food-pork-processing/2989203001/

That doesn't even include the family members, and the town has a 10% infection rate. 

Now I am hearing on FB/underground sources that out-of-work employees from that plant are being sent to another local plant. It's just mind-boggling. That small, rural town is not going to survive this. How is that plant going to replace all the workers that die? How are the families going to survive? How is THIS better for the economy than if things had just been shut down in the first place?

Why isn't this getting more attention? 

I think even in lockdown though food processing has to keep running unless we have a stockpile otherwise people will go hungry.  But if other areas of work locked down harder and faster maybe it wouldn’t have got to the meat plant.

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5 hours ago, Pam in CT said:

re NY Columbia Presbyterian maternity ward data (to be clear, the doctors are definitely *not* presenting this as a full-scale peer-reviewed study; only as raw data that they've collected)...

... and how extrapolate-able it might be:

 

So (as noted above) the rate of COVID-positve, but asymptomatic, people in that all-female, all-young, all-pregnant, sample of 215 who showed up because they were in labor (and not because of extreme, or any, flu-like symptoms)... First: of the 215 women who showed up in labor, 33 ((or 15.3%) were COVID positive.  Second: of the 33 who were positive, 29 (87.9%) showed no symptoms at the time of admission.

Reasons why that 15.3% incidence might be higher than elsewhere:

  • The data was from a cohort in New York City in late March, where the disease was already spreading, so their baseline population was higher than the nation's
  • That cohort likely went to more pre-natal appointments in late Feb-early March than the typical NYC person, in medical offices or hospitals where the disease may (?) have already been spreading; or with medical personnel who may (?) have inadvertently been carrying, so they may (?) have been exposed at higher rates than the general NYC population
  • That cohort includes second- and third-time mothers, who may (?) have been exposed at rates higher than the general NYC population  through their asymptomatic toddlers and schoolchildren
  • That cohort includes women/morthers, who may (?) have sallied out to get groceries/other essentials at higher rates than the general NYC population
  • That cohort was all pregnant, which is generally associated with immune suppression, so they may (?) have contracted at higher rates than the general NYC population

Reasons why that 15.3% incidence might be lower than elsewhere:

  • Pregnant women may (?) be more conscious/cautious about both germs and unnecessary risk, and thus more avoidant of potentially infectious places and conditions in the run-up to March 22 (during which time New Yorkers, if not other places, were *very conscious* that COVID was coming) than the general NYC population

Reasons why that 87.9% asymptomatic rate might be higher among pregnant women than among other cohorts:

  • Pregnant women may (?) eat better, take more vitamins, and thus be in comparatively better baseline health than the general NYC population;
  • There may (?) be something about hormone or other factors associated with pregnancy that inhibits COVID's expression.

 

All of which to say -- as the obstetric doctors themselves do say -- that the takeaway here is not so much the particular percentages down to the decimal, but rather the Big Picture insight about the invisibility of transmission.  This is an enemy we cannot see.  

Until we have *ubiquitous and repeated* testing we simply will not know where the enemy is lurking. That is neither a political, nor a scaremongering, nor a scapegoating statement: it's just how the virus transmits. Through carriers who genuinely have no idea they're carrying.

The hormone thing seems possible given the disparity in outcomes for men and women 

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4 minutes ago, kdsuomi said:

Sorry, but it's not his fault that people can't understand what he says. He has very clearly said these last few days that governors will decide when to re-open and what that's based off. If the media is lying and saying something different and that's what the people are going off, that's the media's fault. If they don't have tests, that's on the state. Not everything is Trump's fault. 

Media that is supportive of Trump excepts the stuff his supporters want to hear and does not say what this actually means. And then Trump himself puts together you-didn’t-hear-what-you-thought-you-heard montages like his recent one meant to totally erase the fact that all through February he made numerous statements that Coronavirus was “going to disappear,” was “contained,” was “about to reach zero,” and would be “like a miracle.” 

I live in a state with a Republican governor, who pushes back against Trump’s blathering on a regular basis, though he rarely names him. People who love Trump (people I actually know) are hating on Gov. Hogan and calling him “Lockdown Larry” because he isn’t just blithely opening everything back up. They believe Trump wants to open everything up (of course they believe this because Trump makes statements about this over and over before walking them back and saying, “oh, that’s right, it’s up to the governors) right now and it’s just a bunch of Democratic governors and one political traitor, Hogan, who won’t open everything back up like Trump says. 

Do I think everything is Trump’s fault. No, I don’t. I was in favor of the ban on flights from China and think the European flight ban should have been sooner (even though it would have affected me and my kid.) I’m sure there have been other good things he has done. But personally, for me, the saying applies: “What you do speaks so loudly I can’t hear what you say.” 

In my darker moments, I think withholding testing in the early phase was intentional because Trump’s administration knew it would reveal a lot of sick people and would eff up his narrative about how it was going to miraculously not hurt Americans. 

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3 hours ago, lewelma said:

Ah, we were writing at the same time and thinking the same thing.

We have had somewhere between 13-15 people in hospital for 3 weeks.  And a lot of those are the same people.  My guess is maybe 50-75 in total out of 1400 cases. 

 

3 hours ago, lewelma said:

So the question then is how do we use a CFR?  Is it useful at all?  How does it inform policy? 

For example, with 11 deaths, that would mean that we would have may 50 in the hospital based on overseas numbers?  But we don't, we only have ever had 15 at the max because of this group in a single nursing home.  They are close to 100% death rate, so deaths=hospital beds. So we can't use the CFR to inform the number of bed we need.  

I can’t find it now but yes basically cfr is less useful than IFR.  I guess it might be useful on a medical setting because it tells you what percentage of diagnosed people will need extra support and may die.  
 

also when we compare with say Spanish Flu we maybe are comparing to their CFR because I don’t know if they had widespread antibody testing back then to determine how many asymptomatic people they are.  
 

it may also be that cfr is usually useful but isn’t for this specific disease because it has a much higher number of asymptomatic carriers than most.

 

Edited by Ausmumof3
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20 minutes ago, sassenach said:

That’s the one we are debating/complaining about upthread 🙂

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2 hours ago, RootAnn said:

They admit to possible self-selection bias. I think any opt-in study will have that, though. The only way to get around that is going door to door to collect samples from a randomly picked population. 

Yes I had the same thought with the German study.  But given we don’t forcibly test people I don’t know how you get away from that.  Healthcare worker stats won’t be representative because they have more exposure to higher viral loads etc.

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9 minutes ago, Quill said:

 

In my darker moments, I think withholding testing in the early phase was intentional because Trump’s administration knew it would reveal a lot of sick people and would eff up his narrative about how it was going to miraculously not hurt Americans. 

My country of origin under tested and while no one dare to say it out loud, it was because they were afraid of the economy tanking and losing the coming election (not South Korea). People were finding hard getting tested even though there was no shortage of test kits. So the cases have been skyrocketing this month as “expected” by the public. The govt basically look good until they can’t 😛

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quoting a Twitter comment on the Santa Clara study that seems relevant 
“Estimate based on their data that IFR is between .12% and .2% If so, NYC has 8.4m people, so at 100% prevalence, that'd be 10,000 deaths at IFR of .12% and 16,700 deaths at IFT of .2%. NYC has already reported well over 11,000 deaths.”

I don’t have the brain power to analyse it properly right now.  I’m feeling tired of numbers that say whatever people want.

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(Reuters) - The World Health Organization is not sure whether the presence of antibodies in blood gives full protection against reinfection with the new coronavirus, Mike Ryan, the WHO's top emergencies expert, told a briefing on Friday.

Ryan also said that even if antibodies were effective there was little sign that large numbers of people had developed them and were beginning to offer so-called "herd immunity" to the broader population.

"A lot of preliminary information coming to us right now would suggest quite a low percentage of population have seroconverted (to produce antibodies)," he said.

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32 minutes ago, Ausmumof3 said:

I can’t find it now but yes basically cfr is less useful than IFR.  I guess it might be useful on a medical setting because it tells you what percentage of diagnosed people will need extra support and may die.  

So for us the CFR = IFR, or at least pretty close.  

I'm wondering about the nonrandom distribution of the disease caused by chance.  It is probably a low sample size problem for us, but 6 out of 11 of our deaths are because 1 subset of a single nursing home got it by chance, and by chance they were the most frail and oldest.  So our death rate is inflated by 2x due to nonrandom distribution. 

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31 minutes ago, Ausmumof3 said:

Yes I had the same thought with the German study.  But given we don’t forcibly test people I don’t know how you get away from that.  Healthcare worker stats won’t be representative because they have more exposure to higher viral loads etc.

Our sentinel testing is purposely non-random.  We are testing in the hot spot regions where there are the most cases, and we are testing grocery store workers and customers in those regions because that is where most of the exposure is happening. 

The government is searching out the worst case scenario rather than just going for random testing. 

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1 minute ago, lewelma said:

So for us the CFR = IFR, or at least pretty close.  

I'm wondering about the nonrandom distribution of the disease caused by chance.  It is probably a low sample size problem for us, but 6 out of 11 of our deaths are because 1 subset of a single nursing home got it by chance, and by chance they were the most frail and oldest.  So our death rate is inflated by 2x due to nonrandom distribution. 

I think this is a huge problem because we are dealing with small amounts of data.  Australia’s apparent cfr is going all over the place.  It was high due to deaths in a nursing home outbreak then lower due to an influx of cases from overseas travel and is climbing again to just over 1pc.  We’re doing a fair bit of testing so it’s probably somewhat accurate.

theoretically this problem should go away where the epidemic has really got going and we have much larger sample sizes but then you run in to trouble with testing shortages and overwhelm.

in other words even when this is all over its probably going to keep epidemiologists busy sifting through it all.

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Just now, lewelma said:

Our sentinel testing is purposely non-random.  We are testing in the hot spot regions where there are the most cases, and we are testing grocery store workers and customers in those regions because that is where most of the exposure is happening. 

The government is searching out the worst case scenario rather than just going for random testing. 

Here on my state anyone who wants a test and has symptoms can get one for the next two weeks.  That won’t help with detecting asymptomatic cases though.

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2 minutes ago, square_25 said:

Except we're all having this issue -- places like nursing homes can't control the spread.

True, but we are at 91% of deaths were people who lived in nursing homes, which is way higher than in the USA. I think it is a small sample size problem, but it just means that NZ's numbers aren't going to inform anyone. 

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5 minutes ago, Ausmumof3 said:

Here on my state anyone who wants a test and has symptoms can get one for the next two weeks.  That won’t help with detecting asymptomatic cases though.

Same here.  For the past 2 weeks and for the foreseeable future, anyone with *any* respiratory symptoms can get a test. 

The sentinel testing is different.  This is the grocery store testing and it is supposed to detect asymptomatic cases. 

Edited by lewelma
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Just now, square_25 said:

Hmmmm, yes, I see your point. And of course, you had the oversampling of healthy people at the front, although that's probably worn out by now. 

I think they have said 40% of cases are from overseas travellers, but it might have been 40% *linked* to overseas travel. I can't remember. 

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1 hour ago, kdsuomi said:

Sorry, but it's not his fault that people can't understand what he says. He has very clearly said these last few days that governors will decide when to re-open and what that's based off. If the media is lying and saying something different and that's what the people are going off, that's the media's fault. If they don't have tests, that's on the state. Not everything is Trump's fault. 

First he says he has absolute authority (no mistake, just go back to the briefing to hear it).  Then he says it's up to the governors. Then he tweets today "Liberate Michigan, Liberate Minnesota, Liberate Virginia and save your great 2nd amendment. It is under siege".  How is the media lying about this when it is on his own briefing and his own twitter feed? This is actively undermining governors and fomenting protests.  

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16 minutes ago, SanDiegoMom in VA said:

First he says he has absolute authority (no mistake, just go back to the briefing to hear it).  Then he says it's up to the governors. Then he tweets today "Liberate Michigan, Liberate Minnesota, Liberate Virginia and save your great 2nd amendment. It is under siege".  How is the media lying about this when it is on his own briefing and his own twitter feed? This is actively undermining governors and fomenting protests.  

Yes. When my governor (MN) was asked about this today he said he spent 2 hours trying to get the president or VP on the phone after that tweet. He likes the president's reopening plan and is already implementing it. (It's the plan we've been on for the last 10 days, but same difference.) Governor Walz wanted to ask what exactly MN should be doing differently since apparently following the plan that the president laid out upsets the president?!?!?

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2 hours ago, kdsuomi said:

Sorry, but it's not his fault that people can't understand what he says. He has very clearly said these last few days that governors will decide when to re-open and what that's based off. If the media is lying and saying something different and that's what the people are going off, that's the media's fault. If they don't have tests, that's on the state. Not everything is Trump's fault. 

I'm sorry, that's just patently false. You can see what HE said in HIS press conferences and on HIS twitter. No media, no spin, no out of context. You can't blame the media when his words stand for themselves. I even cut and pasted directly from the transcript so there could be no accusations of bias. My IQ went down 40 points reading it. The transcript is from the press conference on the 13th. Honestly I am much more concerned that people can "hear" him say these things over and over and pretend he's not saying them and it's media spin. 
 

Quote

Speaker 24: (01:00:39)
Mr. President, thank you, sir. In regards to some of your tweets earlier today, and I think it was Steve’s question, my question to you is what provision in the Constitution gives the president the power to open or close state economies? And then-

Donald Trump: (01:00:54)
Numerous provisions. We’ll give you a legal brief if you want.

Speaker 24: (01:00:58)
We’ll be looking forward to that, sir. But following up, what happens if you say, for instance, we want states to reopen, but California or New York do not open, what would you do then?

Donald Trump: (01:01:08)
Well, I think everybody wants to open. I mean, I guess-

Speaker 24: (01:01:09)
[crosstalk 01:01:10].

Speaker 28: (01:01:11)
Sorry, could I just ask one other thing on the-

Donald Trump: (01:01:12)
I guess that could happen, but I don’t think that would happen.

Speaker 29: (01:01:13)
Mr. President [crosstalk 01:01:14].

Speaker 30: (01:01:13)
The states that have closed, ordered schools closed, it’s been states that have ordered businesses like restaurants and bars and place-

Donald Trump: (01:01:21)
That’s because I let that happen, because I would’ve preferred that. I let that happen. But if I wanted to, I could have closed it up. But I let that happen. I like the way they’ve done it.

Donald Trump: (01:01:29)
The seven that remained, really, in sort of a semi-lockdown, if you look at those states, they’ve really done a very good job. They’re very much different from a New York or from other places where they’ve been hit very hard. Go ahead, please.

Speaker 31: (01:01:39)
So you’re prepared then to [crosstalk 01:01:40] states and say, “I order you to open your schools. I order you to force kids to be able to go.”?

Donald Trump: (01:01:44)
Go ahead, please.

Speaker 32: (01:01:45)
Yeah. Yes, Mr. President. Following up on that, there are two consortiums of states today, California, Oregon, Washington on the West Coast, Northeastern states, totally representing about a hundred million people, who said they’re going to cooperate and decide when to reopen those states.

Donald Trump: (01:02:00)
Well they can decide, but-

Speaker 32: (01:02:01)
Does that undermine what you’re trying to do?

Donald Trump: (01:02:03)
No, not at all. Let me just tell you very simple. I’m going to put it very simply. The president of the United States has the authority to do what the president has the authority to do, which is very powerful. The president of the United States calls the shots. If we weren’t here for the states, you would have had a problem in this country like you’ve never seen before. We were here to back them up, and we’ve more than backed them up. We did a job that nobody ever thought was possible. It’s a decision for the president of the United States.

Donald Trump: (01:02:31)
Now, with that being said, we’re going to work with the states, because it’s very important. You have local governments. They’re pinpointed. It’s really, you talk about… It’s like a microchip. They’re pinpointed. We have local government that hopefully will do a good job. If they don’t do a good job, I’d step in so fast. But no, they can’t do anything without the approval of the president of the United States.

-----------LATER

Speaker 29: (01:27:01)
A quick question on something you just said. You said when someone is President of the United States, their authority is total. That is not true. Who told you that?

Donald Trump: (01:27:10)
You know what we’re going to do? We’re going to write up papers on this. It’s not going to be necessary because the governors need us one way or the other, because ultimately, it comes with the federal government. That being said, we’re getting along very well with the governors and I feel very certain that there won’t be a problem. Yeah please, go ahead.

Speaker 29: (01:27:28)
Has any governor agreed that you have the authority to decide when their states [crosstalk 01:27:32]?

Donald Trump: (01:27:32)
I haven’t asked anybody because-

Speaker 29: (01:27:34)
That no one is [crosstalk 01:27:34]-

Donald Trump: (01:27:36)
You know why? Because I don’t have to. Go ahead please.

Speaker 29: (01:27:36)
But who told you the president has the total authority?

Donald Trump: (01:27:36)
Enough. Please.

--------Later

John: (01:47:42)
One last thing on this question on this question of constitutionality. I’m just wondering what changed your view because-

Donald Trump: (01:47:46)
Nothing changed it. I know exactly what you’re going to say. Nothing changed it. The fact that I want to rely on states, or maybe will or have, and the fact that we’ve gotten on, that’s one thing. The fact that I don’t want to use the power is another thing. Look-

John: (01:47:59)
But you said from the standpoint of the constitution.

Donald Trump: (01:48:02)
Yes, the constitution.

John: (01:48:03)
You thought it should be up to the governors.

Donald Trump: (01:48:05)
You can look at it constitutionally, you could look at federalism. You can look at it any different way. John, the fact that I don’t want to exert my power is much different. We have the power. You asked does the federal government has the power? The federal government has absolute power. It has the power as to whether or not I’ll use that power. We’ll see.

John: (01:48:23)
[crosstalk 00:12:24].

Donald Trump: (01:48:24)
John, I would rather work with the states, because I like going down to a local government. That’s why, with I guess it’s now seven states, not eight, because South Carolina did. They went away from what we discussed the last time, so that’s why I looked at the individual states. They’re doing a very good job. They’re really doing a very good job. I’d rather have them make the decision. Now, the fact that I’d rather have, that’s fine, but I have the absolute right to do if I want to. I may not want to. We have a very good relationship now. We’ll see what happens. If you notice the few states you’re talking about, they’re all with democrat governors, but if governors are doing a good job and they control it better, because you don’t have somebody in Washington saying, “Set up a testing site in the parking lot of a Walmart.” We’re in Washington, and they’re in a state that’s very far away.

 

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