wuhan - coronavirus

[Arcadia]

9 minutes ago, Pen said:

 

Trying to improve link.   ?

https://www.nbcbayarea.com/news/coronavirus/team-of-ucsf-medical-workers-heads-to-navajo-nation-to-help-population-overwhelmed-by-virus/2277815/

https://www.ucsf.edu/news/2020/04/417236/ucsf-health-care-workers-serve-navajo-nation

ETA: think it is a tinyurl issue. Sometimes it doesn’t work for NBC and ABC

Edited April 23, 2020 by Arcadia

[TravelingChris]

14 hours ago, Ausmumof3 said:

https://www.9news.com.au/world/coronavirus-causing-stroke-in-young-people-doctors-report/7890c285-fee7-4296-bec1-2ded051cd535
 

COVID 19 appears to be affecting the way blood clots and causing small strokes in younger patients

this could also be possibly related to the language thing the professor was asking about 

“Our report shows a seven-fold increase in incidence of sudden stroke in young patients during the past two weeks. Most of these patients have no past medical history and were at home with either mild symptoms (or in two cases, no symptoms) of COVID-19," he added.

And just to add to the info, when I had my gigantic blood clot in 2010, I was put on blood thinners but after a few months, I had to go to a hemotologist and get testing as to why I clotted.  Back in 2010, they took something like 22 vials of blood from me for all the possible reasons (and some tests were able to be used with the same vial).  From my understanding, our knowledge of genetic and autoimmune clotting issues has just risen from then.  I doubt anyone is doing any sort of genetic testing on these patients who are getting the blood clots.  The primary one I have is Factor V Leiden---- that is a genetic factor in approx 9-10% of European ancestry people------ and the vast majority have no idea that they have it.  And we haven't found all the factors yet, most likely.  I know that Hilary Clinton had her testing done at least five years after mine and they hadn't figured out why she was getting clots.  Many people have had the 23andme test that tells them they have Factor V Leiden but only one copy so don't worry---- that is completely false.  It puts you at high risk with pregnancies, with leg breaks, with airplane and car travel, etc.  I only have one copy and started having non diagnosed blood clotting issues by the time I was 30 and that was one I knew about.  

IF you or any family member has ever gotten a clot after an IV----please get tested.  The nurses dismissed it with me but of course, it was part of my clotting issues.

[Pen]

28 minutes ago, TracyP said:

Argh, I wish I could break up quotes on my phone...

 

I break them up on my phone by putting my cursor in the quote and tapping return several times. 

Quote

My guess on the death rates - 70% of our deaths are coming from nursing homes. That's that. 🙁

 

Maybe in HI it did not get loose in nursing homes.    

 

Quote

Yes, we did social distance and that's my point. That showed success; taking further steps does not seem to be showing even more success. Those first steps seem like they might have been enough.

 

Do you know dates of Social Distance  and lockdowns?  I’d like to look at your state graphs with that in mind.  

And won’t MN be an early state to loosen restrictions?  It’s low on the worldometer list of states, that is, in very good shape with CV19. 

I think my state is doing way worse than MN, though way better that NY and NJ. 

 

Quote

Will that vary by area? For sure. We have had pretty good compliance from what I understand. 

NYC is going to have a somewhat unique problem. The high population and subway system are issues that I don't have an answer for.

I am musing right now more than suggesting what should be. I would like to see more evidence based ideas

 

How will you (people) get the evidence prior to doing the experiments?

This is a novel situation.

 

Eta: we do know certain things—generally because some place or some people essentially already did an experiment.  But we don’t have any good way to do controlled experiments.  

Or maybe we do.  Maybe Minneapolis could be divided into 4 or 5 comparable cohorts that would have 1 stay closed longer and the others open each with a different experimental protocol. And see which do best.    Trouble is, no way to know which had benefits from protocols, versus luck of no asymptomatic “super spreader”

 

I don’t think, for example, that there was a way to know for certain in advance that a choir group with no known sick member and everyone practicing Distancing would end up with lots of sicknesses and some deaths before it happened.  So now we know that choir singing, even with Physical Distancing is risky.  

There’s a lot of debate about masks, but I think we know from places like [Austria,     ] that used properly by everyone they do help. 

 

Edited April 23, 2020 by Pen
Added thoughts

[Arcadia]

29 minutes ago, TracyP said:

 

I am musing right now more than suggesting what should be. I would like to see more evidence based ideas being put into the reopening of states. A shop being too small, for example, might carry a risk. But if it is not a statistically significant risk, then maybe that should be left up to the owner and customers.

We have quite a lot of small minimarts and liquor stores. They kept the doors open like what the retail stores did. It helps air circulation, “stale air” tends to affect my asthma (I feel like my oxygen level is dropping). Many buses I was on in February/March opened their windows instead of relying on air con. My DS15’s community college classes also have doors opened and they were moved to bigger classrooms if any were available. Weather here is mild though. 

My local Red Robin has a table with staff outside their main door for customers to pick up their takeout orders. I think that’s a good idea, rather than the customer walk in to an enclosed area. 

[TracyP]

14 minutes ago, Pen said:

 

I break them up on my phone by putting my cursor in the quote and tapping return several times. 

Yay, that worked. Thank you!!!

14 minutes ago, Pen said:

 

Do you know dates of Social Distance  and lockdowns?  I’d like to look at your state graphs with that in mind.  

Schools closed on the 18th of March, though the 13th (a a Friday) ended up being the last day in most districts. Bars and restaurants were shut around the same time, iirc. The stay at home order began on March 27.

14 minutes ago, Pen said:

And won’t MN be an early state to loosen restrictions?  It’s low on the worldometer list of states, that is, in very good shape with CV19. 

Yes, we already are slooowly starting the process.

14 minutes ago, Pen said:

 

How will you (people) get the evidence prior to doing the experiments?

This is a novel situation.

 

Eta: we do know certain things—generally because some place or some people essentially already did an experiment.  But we don’t have any good way to do controlled experiments.  

Or maybe we do.  Maybe Minneapolis could be divided into 4 or 5 comparable cohorts that would have 1 stay closed longer and the others open each with a different experimental protocol. And see which do best.    (Trouble is no way to know which had benefits from protocols versus luck of no asymptomatic “super spreader”

 

I don’t think, for example, that there was a way to know for certain in advance that a choir group with no known sick member and everyone practicing Distancing would end up with lots of sicknesses and some deaths before it happened.  So now we know that choir singing, even with Physical Distancing is risky. 

There’s a lot of debate about masks, but I think we know from places like [Austria,     ] that used properly by everyone they do help. 

 

No, we don't have a lot of evidence. But when MN enacted stricter measures, I expected that to be reflected by a drop in cases. That hasn't happened.

[Arcadia]

4 minutes ago, TracyP said:

 

No, we don't have a lot of evidence. But when MN enacted stricter measures, I expected that to be reflected by a drop in cases. That hasn't happened.

The frustration I have “heard” (through online chatting) is that testing locally is still not widespread so we have to rely on hospitalization numbers to guess the potential positive cases. 

I have seen a lot more people out and about after shelter in place was extended. People have kind of gave up staying home.  UCSD’s announcement that Fall classes might be online and CSU Fullerton’s announcement that Fall classes would be online are also making people think the shelter in place would be so long term that they might as well go out for walks and car rides and go as often to supermarkets as they want to. My neighboring cities (other than San Jose which is a big city) have low case numbers. 

[TracyP]

2 minutes ago, Arcadia said:

The frustration I have “heard” (through online chatting) is that testing locally is still not widespread so we have to rely on hospitalization numbers to guess the potential positive cases. 

I have seen a lot more people out and about after shelter in place was extended. People have kind of gave up staying home.  UCSD’s announcement that Fall classes might be online and CSU Fullerton’s announcement that Fall classes would be online are also making people think the shelter in place would be so long term that they might as well go out for walks and car rides and go as often to supermarkets as they want to. My neighboring cities (other than San Jose which is a big city) have low case numbers. 

Something similar seems to be happening here. Everybody was very compliant during the initial 2 week stay at home order. Since it got extended, a lot of people seem to be taking it less seriously.

[Pen]

Re long term effects:

 

https://www.jpost.com/health-science/coronavirus-may-cause-lasting-damage-throughout-body-doctors-fear-625099

 

[Pen]

8 minutes ago, Ordinary Shoes said:

I apologize up front that this is a stupid question and has probably already been discussed on this thread. I don't have any education in epidemiology. 

Dr. Google tells me that the seasonal flu has an IFR of 0.1%. An IFR of 0.5% seems significantly higher. Am I understanding that correctly? 

 

 

Yes. You understand that correctly. 0.5 is 5x 0.1. 

 

But is seasonal flu actually even 0.1% IFR  in typical flu years?   (Not pandemic unusually deadly flu years) 

 

And is the CV19 IFR 0.5%?

 

I could not find a good source for either figure.  

A site called TheConversation had this:

“One estimate of the IFR for COVID-19 puts this figure at 1%, and some new data suggests this is credible.

As testing becomes more rigorous, the discrepancy between the two measures (CFR and IFR) gets smaller. This may be happening in South Korea, where exhaustive testing has detected many mild infections and pushed the estimated death rate down to 0.65%.

Similarly, the stricken cruise ship Diamond Princess is illuminating because the rigorous quarantine meant nearly all COVID-19 cases (even asymptomatic ones) were identified. There were 7 deaths among more than 600 infections, giving an IFR of about 1.2%. This is higher than in South Korea, but perhaps expectedly so, given that one-third of the ship’s passengers were aged over 70.”

 

Both South Korea and Diamond Princess passengers  had care from medical systems that were advanced and functional.  I expect death rate when system isn’t good in first place (Ecuador, India) or is excellent but gets overwhelmed (Italy) would be higher. 

Edited April 23, 2020 by Pen

[mathnerd]

12 hours ago, Arcadia said:

@square_25@mathnerd

Someone said this on Facebook for my county and since my husband and neighbors work in tech, I have heard the same thing during that time period.

“Many large tech companies put in place strict rules on quarantine during January saying that if an employee or anyone in the employees family had been to anywhere in China or interacted with anyone from China within 14 days then they had to report in and had to self isolate for 14 days no matter symptoms or not.”

This is true. This is also true for all the huge private high schools in the area.

Edited April 23, 2020 by mathnerd

[The Governess]

50 minutes ago, square_25 said:

About 14 percent of NY state has antibodies:

https://www.google.com/amp/s/www.cnbc.com/amp/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html
 

Looks like the pregnant woman sample wasn’t bad!

And that gets us an IFR of about 0.5%, probably a bit more due to lag in deaths compared to cases and undercounting.

Everyone but the California group is getting this kind of IFR. Everyone.

 

That’s really interesting.  It does make me wonder about the CA studies (well, I was already wondering...)

I’m still very curious about LA county (CA’s hardest hit county that is still nowhere near as bad as NY) and how it escaped the high infection rate. I did some research on the timeline of events there and here is what I found: 

Jan 26 - first case of Coronavirus in LA County - someone traveling from Wuhan

March 4 - six new travel-related cases (Europe based, at least a portion from Italy) in LA county - local state of emergency announced

March 5 - four new travel related cases

March 6 - two new travel related cases 

March 7 - one new travel related case

March 9 - first known case of community spread, residents are warned to prepare for social distancing and stock up on essentials

March 11 - first death

March 13 - first social distancing guidelines

March 14 - 53 total cases, 8 community transmission

March 17 - 144 total cases

March 19 - Safer at Home guidelines announced for state of CA

March 20 -292 total cases

I was in LA County for an event the weekend of Feb 22, and by then Coronavirus was already a hot topic. In fact, an acquaintance at the event had gone to a Chinese restaurant in the area for dinner, and they were taking customers’ temperatures before allowing them in. This was before there was any known community spread, and only one known case in the entire county (a traveler from Wuhan nearly a month prior). 

It makes me wonder if the Chinese community and their precautions are responsible for the lack of spread early on in CA? It wasn’t until travel-related cases from European vacationers started showing up there that the numbers started increasing exponentially. I’m sure there are many, many factors, but this stands out to me.

[mathnerd]

12 hours ago, Arcadia said:

It’s an opt in test by Facebook users. 

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf
“This study had several limitations. First, our sampling strategy selected for members of Santa Clara County with access to Facebook and a car to attend drive-through testing sites. This resulted in an over- representation of white women between the ages of 19 and 64, and an under-representation of Hispanic and Asian populations, relative to our community. Those imbalances were partly addressed by weighting our sample population by zip code, race, and sex to match the county. We did not account for age imbalance in our sample, and could not ascertain representativeness of SARS-CoV-2 antibodies in homeless populations. Other biases, such as bias favoring individuals in good health capable of attending our testing sites, or bias favoring those with prior COVID-like illnesses seeking antibody confirmation are also possible. The overall effect of such biases is hard to ascertain.”

“Study Participants and Sample Recruitment

We recruited participants by placing targeted advertisements on Facebook aimed at residents of Santa Clara County. We used Facebook to quickly reach a large number of county residents and because it allows for granular targeting by zip code and sociodemographic characteristics. We used a combination of two targeting strategies: ads aimed at a representative population of the county by zip code, and specially targeted ads to balance our sample for under-represented zip codes. In addition, we capped registrations from overrepresented areas.

Individuals who clicked on the advertisement were directed to a survey hosted by the Stanford REDcap platform, which provided information about the study. The survey asked for six data elements: zip code of residence, age, sex, race/ethnicity, underlying co-morbidities, and prior clinical symptoms. Over 24 hours, we registered 3,285 adults, and each adult was allowed to bring one child from the same household with them (889 children registered).”

@Arcadia thank you for linking that.  Race and class are a huge issue that affects the results of antibody testing. What I am hearing about the stanford research paper from locals: I am told that their targeted ads for recruiting volunteers reached a very narrow segment of local society that has chances of least exposure to COVID19, mostly women who stay at home and their kids - apparently, some of them learned about the testing and recruited their friends and families to drive to the testing site because they heard that Stanford was looking for volunteers for antibody testing in their neighborhood. The downside to this is that the Hispanics and Asians comprise more than 60% of the county's population. The service industry and the essential services sectors are comprised of a large swathe of these populations where social distancing is not easy. So, their findings of ~2% infection rate is being questioned by medical professionals as well as other academic institutions. A truly representative testing for antibodies in SC county would be if they set up testing tents in downtown areas, outside walmart and costco and in working class neighborhoods where chances of previously infected people participating would be higher.

[mathnerd]

1 minute ago, square_25 said:

Yes, I'm sure that's true. However, they were also likely to get people who had either had a cold in February or had been exposed. Either way, the sampling is flawed and the study is problematic. 

NYC just came back with about a fifth of the antibody tests (in the city itself) as positive. There's NO WAY California has a higher rate. Just no way.

Do you mean that NYC came back with 20% of people testing positive for antibodies? 

[ElizabethB]

2 hours ago, Arcadia said:

“A team of 21 doctors and nurses from UCSF are headed to the Navajo Nation to help a population that has seen one of the highest rates of coronavirus infection in the country.”
 

ETA:

https://www.nbcbayarea.com/news/coronavirus/team-of-ucsf-medical-workers-heads-to-navajo-nation-to-help-population-overwhelmed-by-virus/2277815/

https://www.ucsf.edu/news/2020/04/417236/ucsf-health-care-workers-serve-navajo-nation

We have relatives that are Navaho Nation.  A lot of the activities they normally do are activities listed in the very interesting Quillette super spreader article.  I wonder if the percent infected is much higher there?  Also, our relatives are outside a lot and hike a lot, but they are also high SES and have left the reservation, going back to visit a few times a year.  Navajo Nation may also have unique genes not as protective against flu even if they are outside and vitamin D protected as a group.

Edited April 23, 2020 by ElizabethB

[ElizabethB]

1 hour ago, TravelingChris said:

And just to add to the info, when I had my gigantic blood clot in 2010, I was put on blood thinners but after a few months, I had to go to a hemotologist and get testing as to why I clotted.  Back in 2010, they took something like 22 vials of blood from me for all the possible reasons (and some tests were able to be used with the same vial).  From my understanding, our knowledge of genetic and autoimmune clotting issues has just risen from then.  I doubt anyone is doing any sort of genetic testing on these patients who are getting the blood clots.  The primary one I have is Factor V Leiden---- that is a genetic factor in approx 9-10% of European ancestry people------ and the vast majority have no idea that they have it.  And we haven't found all the factors yet, most likely.  I know that Hilary Clinton had her testing done at least five years after mine and they hadn't figured out why she was getting clots.  Many people have had the 23andme test that tells them they have Factor V Leiden but only one copy so don't worry---- that is completely false.  It puts you at high risk with pregnancies, with leg breaks, with airplane and car travel, etc.  I only have one copy and started having non diagnosed blood clotting issues by the time I was 30 and that was one I knew about.  

IF you or any family member has ever gotten a clot after an IV----please get tested.  The nurses dismissed it with me but of course, it was part of my clotting issues.

One copy can be the same in reverse.  For example, mild hemophiliac female carriers have factor levels around 70%, low end of normal, usually not a problem, but can cause minor issues like stomach micro bleeding with aspirin and Motrin.  Severe hemophiliac female carriers can have factor levels much lower, 30% or 40%, and need to be watched carefully for surgery or childbirth, may need factor or blood products for surgery or childbirth.

[ElizabethB]

1 hour ago, Arcadia said:

We have quite a lot of small minimarts and liquor stores. They kept the doors open like what the retail stores did. It helps air circulation, “stale air” tends to affect my asthma (I feel like my oxygen level is dropping). Many buses I was on in February/March opened their windows instead of relying on air con. My DS15’s community college classes also have doors opened and they were moved to bigger classrooms if any were available. Weather here is mild though. 

My local Red Robin has a table with staff outside their main door for customers to pick up their takeout orders. I think that’s a good idea, rather than the customer walk in to an enclosed area. 

That could account for low levels in Hawaii, too, many good air flow areas even when inside.

[Matryoshka]

11 minutes ago, mathnerd said:

@Arcadia thank you for linking that.  Race and class are a huge issue that affects the results of antibody testing. What I am hearing about the stanford research paper from locals: I am told that their targeted ads for recruiting volunteers reached a very narrow segment of local society that has chances of least exposure to COVID19, mostly women who stay at home and their kids - apparently, some of them learned about the testing and recruited their friends and families to drive to the testing site because they heard that Stanford was looking for volunteers for antibody testing in their neighborhood. The downside to this is that the Hispanics and Asians comprise more than 60% of the county's population. The service industry and the essential services sectors are comprised of a large swathe of these populations where social distancing is not easy. So, their findings of ~2% infection rate is being questioned by medical professionals as well as other academic institutions. A truly representative testing for antibodies in SC county would be if they set up testing tents in downtown areas, outside walmart and costco and in working class neighborhoods where chances of previously infected people participating would be higher.

Well, that certainly would skew the numbers.  The Chelsea study was done as you suggest - out in public in a working-class community with a high minority population (about 66% Latino, 5% AA, 29% white - no data for Asians, must be low...) where most (80%) of the workers could not stay home because they were 'essential' - so a vastly different population than a bunch of white stay-at-home moms who took a road trip to Stanford.

[Arcadia]

6 minutes ago, square_25 said:

No, that wouldn't be representative, because that would be an oversampling of people who are likely to be positive!! Sampling in grocery stores, like they did in NY, seems like a good idea. Almost everyone goes to the grocery.

And even that probably wound up with some self-selection, because some reporter at yesterday's briefings noted that she had thought about going and getting tested at one of these grocery stores ;-). If you know they are doing antibody testing and you're wondering if you've had it... well, you may very well go and seek it out. 

Here, many could afford grocery deliveries and some get their produce deliveries from smaller family run businesses where it is by word of mouth or local Facebook group. I go to the grocers weekly because its good for my emotional health (and physical health, less incentive to walk for at least 30 minutes daily at home under doctor's orders). My family could afford to pay the family run grocers for delivery. My next door neighbor has two young adults who would be happy to be paid to do a grocery run for me at the supermarket that is literally down the road.

5 minutes ago, mathnerd said:

Do you mean that NYC came back with 20% of people testing positive for antibodies? 

https://apnews.com/01e148acd7226332d14e9ce350d8de16

"A state survey of around 3,000 people found that 13.9% had antibodies suggesting they had been exposed to the virus, Gov. Andrew Cuomo said at his daily news briefing in Albany.

In New York City, 21% of the people tested had antibodies.

Cuomo cautioned that the data was preliminary. The sample of people tested was small and people were recruited for the study at shopping centers and grocery stores, which meant they were healthy enough to be out in public"

[Matryoshka]

5 minutes ago, square_25 said:

They did scale up to try to get a representative answer. That's how they wound up with 3% and not 1.5%. (I think re-weighting this heavily is a big problem, to be honest.) 

Just seems like a deeply flawed study.  They should do it again out in community with the newer test.

[kbutton]

1 hour ago, TravelingChris said:

And just to add to the info, when I had my gigantic blood clot in 2010, I was put on blood thinners but after a few months, I had to go to a hemotologist and get testing as to why I clotted.  Back in 2010, they took something like 22 vials of blood from me for all the possible reasons (and some tests were able to be used with the same vial).  From my understanding, our knowledge of genetic and autoimmune clotting issues has just risen from then.  I doubt anyone is doing any sort of genetic testing on these patients who are getting the blood clots.  The primary one I have is Factor V Leiden---- that is a genetic factor in approx 9-10% of European ancestry people------ and the vast majority have no idea that they have it.  And we haven't found all the factors yet, most likely.  I know that Hilary Clinton had her testing done at least five years after mine and they hadn't figured out why she was getting clots.  Many people have had the 23andme test that tells them they have Factor V Leiden but only one copy so don't worry---- that is completely false.  It puts you at high risk with pregnancies, with leg breaks, with airplane and car travel, etc.  I only have one copy and started having non diagnosed blood clotting issues by the time I was 30 and that was one I knew about.  

IF you or any family member has ever gotten a clot after an IV----please get tested.  The nurses dismissed it with me but of course, it was part of my clotting issues.

I think everyone should be curious about their clot risk, but doctors don't seem to agree, other than ones that realize how prevalent clotting disorders are. 

And not all clot risk comes from bleeding factors or are inherited in a straightforward way or confer the same risks for everyone who has them. There are multiple types of antibodies, and you can have all, none, or a combo deal. Anti-phospholipid antibody syndrome (Hughes Syndrome, Sticky Blood) seems to run in families, but they can't explain how. Some people have the antibodies and never have symptoms or clots (clots are just one thing they cause). Some people have transiently high levels of antibodies vs. persistently high. It's widely/incorrectly thought to be something that only affects pregnant women (miscarriage), people who have strokes under age 50 (also often women), and people with lupus (large percentage of people with lupus have it). Some experts believe it's responsible for up to 20% of ALL blood clots. I think the diagnostic criteria has been revised several times. There are some other very rare conditions that have been associated with it--Sheehan Syndrome, Boerhave Syndrome (rupture of the esophagus), small bowel ruptures, and stomach ulcers leading to gangrene. Three of those very rare things have been present in my family in women (one of whom had leg ulcers, which are skin manifestations of APS), along with blood clots in men, and so far, only one of those people has managed to be identified and tested for APS. 

http://www.humberside-rheumatology.uk/assets/antiphospholipid-syndrome---diagnosis-and-classification-j-autoimmunity-2014.pdf  for anyone that might want to see if they have symptoms or are in a category to get testing. 

1 hour ago, Arcadia said:

We have quite a lot of small minimarts and liquor stores. They kept the doors open like what the retail stores did. It helps air circulation, “stale air” tends to affect my asthma (I feel like my oxygen level is dropping). 

I have trouble with stale air as well, but everyone always thinks I'm weird when I mention it. It seems to happen a lot around here in the winter when big groups are meeting at church or other venues where people aren't coming and going like they would be in a store, or the largest group room has doors separate from outside that are kept closed (like the sanctuary at church) to be less chaotic. Thanks for making me feel more normal, lol! 

[Arcadia]

16 minutes ago, kbutton said:

I have trouble with stale air as well, but everyone always thinks I'm weird when I mention it. It seems to happen a lot around here in the winter when big groups are meeting at church or other venues where people aren't coming and going like they would be in a store, or the largest group room has doors separate from outside that are kept closed (like the sanctuary at church) to be less chaotic. Thanks for making me feel more normal, lol! 

The “social distancing” required in exam halls were very helpful. My ex-classmates are wonderful but a big exam hall with high ceilings and nicely spaced tables and chairs are great. 
For winter, heaters are on at the libraries and some retail stores, and it does get that “stuffy” feeling. For libraries, I just take a walk out to feel better and then walk back in (because my teens were at the library with their tutor). 
When I can get another oximeter at a cheaper price, I would take one out with me just for curiosity. 
 

My local light rail trains are above ground for all stations and I find that helpful since they usually stop at all stations and open all doors. 

[Arcadia]

12 minutes ago, square_25 said:

Is your local light rail Caltrain? Or am I blanking on a different Bay Area train system?

I do take the Caltrain but the light rail is this one https://www.vta.org/sites/default/files/2020-01/LR-Map-2020.pdf

VTA (Valley Transportation Authority) runs the buses in my county as well as the light rail train system.  

https://www.vta.org/blog/using-teamwork-stop-spread

"To meet social distancing health requirements, aside from the two passengers allowed in the reserved seating area, bus capacity is now limited to:

• 60-foot bus (the extra-long one) – 9 individuals*
• 40-foot bus (used on most routes) – 6 individuals*
• 35-foot bus – 5 individuals*

*When passengers are traveling together in family groups (such as couples or parents with children) or from the same household, they can sit next to each other, meaning coaches can support more passengers per vehicle, up to 18, 12 or 11 respectively.

Unfortunately, it is possible that operators may need to pass up customers at bus stops if these limits are reached.

Light rail trains are running with two cars coupled together to ensure there is plenty of space between passengers. Seats are marked off for social distancing on both buses and trains."

[mathnerd]

56 minutes ago, kdsuomi said:

All of the first confirmed cases have to be travel related because at the time they were only testing people who had recently traveled from China. The newly found COVID related deaths in the Bay Area show there was extremely likely community spread in early January or late December, so it likely would have been the case throughout CA. We just weren't testing those people. My area had a person a month before our first confirmed case who likely had it and had recently come back from China, but he needed medical attention just outside of two week window. Thus, they said his travel wasn't recent enough to be tested. 

We went down to Orange County in late February for a hockey game, and it certainly was on my mind. 

There was a lot of surprise in the Bay Area when Seattle had the first Covid related cases and death as we had been bracing ourselves for the impact of the epidemic since January. Now, it seems that the fears were not unfounded:

The county’s Feb. 6 death was more than three weeks before the first known death in the U.S. on Feb. 29. Cody said the new deaths reveal “iceberg tips” showing a far larger degree of community spread of COVID-19. “When you have an outcome like death or ICU, that means that there’s some iceberg of cases of unknown size that underlie those iceberg tips,” Cody said. “With three of them, that tells us that there must have been a somewhat significant degree of community transmission.” https://www.sfgate.com/bayarea/article/Santa-Clara-coronavirus-deaths-antibody-earlier-15218794.php

A seemingly healthy woman's sudden death is now the first known US coronavirus-related fatality: https://www.cnn.com/2020/04/23/us/california-woman-first-coronavirus-death/index.html

 

[mathnerd]

1 hour ago, Matryoshka said:

Just seems like a deeply flawed study.  They should do it again out in community with the newer test.

I think that the Stanford researchers were pressed for time while at the same time there were many biases that weighed on the results. There is a new study in San Francisco (lead by the UCSF medical school) where they are testing every single person in a sparsely populated hamlet north of the city and also in the very densely populated Mission District in downtown. That would give us a better idea of how this virus has spread across different strata of the population.

[mathnerd]

Just now, square_25 said:

Hmmmm. That’ll give very regional numbers, but it’d be good to see.

The Mission is harder hit than a lot of places, right? It’s a denser and poorer and more immigrant area.

Yes. That is the reason that they chose a couple of spots with vastly different populations to study the spread.

https://www.latimes.com/opinion/story/2020-04-23/editorial-wealthy-towns-testing-program-is-a-favor-to-the-rest-of-us

 

[mathnerd]

Just now, square_25 said:

Yeah, but only using two places seems suboptimal. However, I look forward to seeing the results :-).

There are not many FDA approved tests right now that claim to be highly accurate. And this study is not being funded by the government, which ideally they should. Too many factors that make it suboptimal 🙂

 

[73349]

2 hours ago, square_25 said:

No, that wouldn't be representative, because that would be an oversampling of people who are likely to be positive!! Sampling in grocery stores, like they did in NY, seems like a good idea. Almost everyone goes to the grocery.

I would hope grocery store sampling would exclude people with very recent symptoms, who are not supposed to go out until they've been better for a while.

Some day, I'm going to go back into a grocery store! 🤩

[73349]

The problem with opening various areas under different circumstances as an experiment is that participants can't consent. 😕

[mathnerd]

16 minutes ago, square_25 said:

It’s not controversial. It’s just not supported by any data. 

I would have personally guessed that California has a higher rate of spread than what is currently being reported. But then I took a look at

a) percentages positive tests in CA out of all tests being done

b) numbers of deaths in CA

c) the antibody test results in CA

and I revised my estimate, because all of those things point to a rate in the single digits. 

I try to be flexible with my assumptions until I get enough data. That’s how science is supposed to work. 

Testing numbers are so low: 20,000 tested in a county with over 2 million population ... the people who are being tested are those that go to a hospital with bad symptoms. We are all told to stay home if our symptoms are manageable, so, there will not be any positive tests for the majority of infected people. The usability of data coming out is low and the information being put out can be confusing.

Edited April 23, 2020 by mathnerd

[mathnerd]

2 minutes ago, kdsuomi said:

And, if it started sooner when people weren't testing, of course the positive tests now would be lower. The issue here is that at least one of these "new" deaths shows that it must have been here earlier because that person had to have gotten it from community spread. Given the lag between infection and death, we had to have had community spread in at least mid-January. Again, this is not just what we random people on the internet are saying but what experts who have looked at this are saying. 

To add to this, with reports of re-infections from South Korea and Japan, it is possible that the antibodies produced by the initial infection are either temporary or insignificantly low, in which case, there may be unreliable results from antibody tests assuming that the infection spread in Jan (which is when many people in my community had a strange respiratory illness which was difficult for some to fight off) and we are testing in April. This would have a potential impact on how the vaccine should be designed to work and how often it needs to be administered.

[Pen]

59 minutes ago, whitehawk said:

The problem with opening various areas under different circumstances as an experiment is that participants can't consent. 😕

 

Opening areas under any conditions whether the same or different across a region, do participants give consent? 

I have been writing my Governor more about CV19 issues  than anything prior to this all together for my life.  But she does what she wants whether I consent or not. 

Even if different rules or guidelines were given for different similar areas in one municipality , the people might not go with that.  So one might find differences following guidelines, but that might not reflect actual behavior. 

Like for example, allowing small shops or restaurants to open up even if good Distancing isn’t possible in them,  does not necessarily mean that customers will flock to those establishments—Especially if alternative places that are larger and more open exist.   And I don’t think people could be restricted from going to what they want to in another part of a city if it were open either. 

 

I think problem is less likely to be lack of consent as that statistics coming out might still be meaningless. 

Edited April 23, 2020 by Pen

[Arcadia]

10 minutes ago, square_25 said:

California has had about 35,000 positive tests out of the 465,000 tests it has run. That is less than 10% of the tests turning up positive, even given that the sample is highly biased towards the people who are positive, because only the sickest people get tests. 

LA County has a high number for California. Could not find how many tests were run. 

"Novel Coronavirus in Los Angeles County*

16,435 Cases**

729 Deaths

As of 12pm 4/22"

detailed breakdown by age, gender, race, city in link http://publichealth.lacounty.gov/media/Coronavirus/locations.htm

 

[73349]

@Pen I'm thinking about employees and students who have to go when workplaces/schools are opened, not voluntary customers. If there's reason to doubt that it's safe, and not everyone has a meaningful choice whether or not to participate, I think it's unethical to open.

[Pen]

4 minutes ago, whitehawk said:

@Pen I'm thinking about employees and students who have to go when workplaces/schools are opened, not voluntary customers. If there's reason to doubt that it's safe, and not everyone has a meaningful choice whether or not to participate, I think it's unethical to open.

 

I don’t think anything that is guessed to be unsafe should be done.

But if there’s debate about safe way to do something, different areas could maybe, possibly, try the different variants.  

For example is it better to have stores set up so everyone has to go up and down every aisle in a pattern from door to exits, at a minimum of 6 feet  from one another, or is it better to let people follow their own paths to what they want possibly not going to many aisles at all—but less orderly progression... 

[EmseB]

35 minutes ago, square_25 said:

I have seen no credible public health expert say that California has an outbreak of a similar kind of severity as New York. It's not like I want NY to be the hardest hit area!! What would be the motivation for that? I just call 'em as I see 'em. 

I think it's pretty obvious that NYC is the hardest hit area. I don't think people are arguing that it isn't. I think people are wondering, if it was here in CA that early, *why* isn't it worse here? And why did NYC get so bad? Sure we had measures in place earlier, but I don't think that accounts for all of it. I think people are trying to figure that out. On the other hand, even in NYC it wasn't as bad as predicted.

But way back 2 whole months ago (which feels like a year ago in covid time) I got a sense of impending dread when the Wuhan travel ban was announced here in the states. It was pretty obvious to me at that time, knowing what I know about CA demographics and flights and such, that it was already here and probably not in small numbers. It seems like you're assuming that if it was spreading here that early then we should have had an outbreak as bad as NYC. I think that's the wrong assumption maybe? Since we know it was here and things have not gotten that bad (yet?) there seem to be some other factors at play and we should fish to try to figure those out.

[Selkie]

Not sure if this has been posted yet, but our governor here in Illinois just extended our shelter in place through the end of May.

Anyone over 2 years old must wear a mask when in a public place and unable to maintain a distance of six feet from others. Same goes for employees at essential businesses.

There are several other measures that essential businesses must follow, including occupancy limits, shift staggering, and operating essential lines only for manufacturers.

Greenhouses and garden centers will be allowed to reopen.

Non-essential retail stores may reopen for curbside pickup and delivery.

Some elective surgeries will be allowed beginning May 1.

 

[Jean in Newcastle]

48 minutes ago, whitehawk said:

@Pen I'm thinking about employees and students who have to go when workplaces/schools are opened, not voluntary customers. If there's reason to doubt that it's safe, and not everyone has a meaningful choice whether or not to participate, I think it's unethical to open.

That's why some small businesses in Georgia are deciding not to open.  They discussed it with the employees and decided that it was not safe. 

[BeachGal]

A recent preprint is out showing that a strain of the virus in Arizona was found to have a large deletion in a gene called ORF7a which protects the virus from the host cell's defenses. The deletion might mean that the virus would have a more difficult time replicating in the host. That would be good but it's not known yet. It also doesn't mean that all of the strains are like this. It's been observed in this one strain. It does show that the virus is starting to delete some of its genetic material which could make it less virulent eventually.

https://www.medrxiv.org/content/10.1101/2020.04.17.20069641v1

 

[Arcadia]

14 minutes ago, EmseB said:

But way back 2 whole months ago (which feels like a year ago in covid time) I got a sense of impending dread when the Wuhan travel ban was announced here in the states. It was pretty obvious to me at that time, knowing what I know about CA demographics and flights and such, that it was already here and probably not in small numbers. It seems like you're assuming that if it was spreading here that early then we should have had an outbreak as bad as NYC. I think that's the wrong assumption maybe? Since we know it was here and things have not gotten that bad (yet?) there seem to be some other factors at play and we should fish to try to figure those out.

@square_25

I think that was what @mathnerd and I were thinking about. The impending dread was already palpable in January in areas with high Asian populations.  My county with 33% Asian by population kind of resembles the news articles on Prato, Tuscany, Italy e.g. https://www.scmp.com/news/world/united-states-canada/article/3077880/coronavirus-why-prato-home-italys-biggest-single 

Also this (I bolded) https://abc7news.com/san-francisco-coronavirus-map-in-chinatown-by-zipcode/6117707/

"Five San Francisco zip codes had fewer than 10 known cases of COVID-19: 94104 (small part of the Financial District), 94108 (Union Square and Chinatown), 94111 (near The Embarcadero), 94129 (the Presidio) and 94130 (Treasure Island). Of those five areas with very few infections, the most densely populated by far is the Union Square/Chinatown area."

[BeachGal]

Some of the people who are experiencing the long infections have compromised immune systems. They are able to tackle the infection somewhat but not entirely so the infection comes back or the viral shedding continues for long periods.

[mathnerd]

1 hour ago, kdsuomi said:

Maybe NY also had earlier community spread of grew Chinese strain of the virus, too. It's possible that both areas did, that it's less deadly, and that NY just got hit harder with the European strain (that might be a "worse" strain) after.

That is the popular theory at the moment to explain the vast difference in deaths between LA and NYC which are both extremely crowded and large cities.

Researchers found that COVID-19 in New York City "predominately arose through untracked transmission between the United States and Europe, with limited evidence supporting direct introductions from China, where the virus originated, or other locations in Asia."

https://abcnews.go.com/Health/york-coronavirus-outbreak-originated-europe-study-finds/story?id=70062642

[mlktwins]

Someone my DH knows was near death on a vent for many days before he was given a clinical trial drug call tocilizumab.  He was not part of the clinical trial, but was given the drug out of compassion (he really was likely going to die).  Within 24 hours his condition markedly improved and within 3 days he was off the vent.  He is still in the hospital, but is doing really well.

Has anyone heard of this drug in relation to COVID-19?  Please forgive me if it has already been mentioned.

 

[Arcadia]

China report https://www.medrxiv.org/content/10.1101/2020.04.14.20060160v2

"Here we report functional characterizations of 11 patient-derived viral isolates, all of which have at least one mutation. Importantly, these viral isolates show significant variation in cytopathic effects and viral load, up to 270-fold differences, when infecting Vero-E6 cells. We observed intrapersonal variation and 6 different mutations in the spike glycoprotein (S protein), including 2 different SNVs that led to the same missense mutation. Therefore, we provide direct evidence that the SARS-CoV-2 has acquired mutations capable of substantially changing its pathogenicity."

[Arcadia]

6 minutes ago, mlktwins said:

Someone my DH knows was near death on a vent for many days before he was given a clinical trial drug call tocilizumab.  He was not part of the clinical trial, but was given the drug out of compassion (he really was likely going to die).  Within 24 hours his condition markedly improved and within 3 days he was off the vent.  He is still in the hospital, but is doing really well.

Has anyone heard of this drug in relation to COVID-19?  Please forgive me if it has already been mentioned.

March 23rd https://www.nydailynews.com/coronavirus/ny-coronavirus-fda-approves-trial-for-drug-to-treat-coronavirus-20200323-cuwac5zw7vguddbj6nhoexuw3a-story.html

"The FDA has given fast-track approval to a clinical trial involving a rheumatoid arthritis drug thought to help patients with COVID-19 pneumonia, Genentech announced Monday.

The drug, Tocilizumab (Actemra), already is showing promising results in Italy, the ANSA news agency reported earlier this month."

Edited April 23, 2020 by Arcadia

[Ausmumof3]

6 hours ago, Ordinary Shoes said:

I apologize up front that this is a stupid question and has probably already been discussed on this thread. I don't have any education in epidemiology. 

Dr. Google tells me that the seasonal flu has an IFR of 0.1%. An IFR of 0.5% seems significantly higher. Am I understanding that correctly? 

 

Yes I think so.  I have seen people more knowledgeable than me say they same thing.

[RootAnn]

What is the role of the IL-6 inhibitor tocilizumab (Actemra) in the treatment of coronavirus disease 2019 (COVID-19)? @mlktwins

https://www.medscape.com/answers/2500114-197457/what-is-the-role-of-the-il-6-inhibitor-tocilizumab-actemra-in-the-treatment-of-coronavirus-disease-2019-covid-19

Genentech, maker of another IL-6 inhibitor, tocilizumab (Actemra), is working with the FDA to initiate a randomized, double-blind, placebo-controlled phase III clinical trial in collaboration with BARDA to evaluate the safety and efficacy of tocilizumab plus standard of care in hospitalized adult patients with severe COVID-19 pneumonia compared to placebo plus standard of care.

[Ausmumof3]

Someone asked how many eggs we will need to produce a vaccine and this was ABC s answer.  I’m using this to justify my chicken food bill right now 😆

“Professor de Courten said while he foresees a staggered rollout, exactly how the eventual candidate is produced will have to be solved in the coming months and years.

"Some of them, the influenza vaccine for instance, is produced using eggs," he said.

"For COVID-19, there wouldn't be enough eggs in the world.

"The production question is a very serious one. So there is one thing of finding an effective vaccine, then not being able to produce it, so you need to solve those problems."

[Arcadia]

Think someone already posted this study link https://jamanetwork.com/journals/jama/fullarticle/2765184

News link https://abc7news.com/health/two-thirds-of-seriously-ill-covid-19-patients-didnt-have-fever-study-finds/6123325/

“Coronavirus Update: Two-thirds of seriously ill COVID-19 patients didn't have fever, study finds

57% of patients had high blood pressure, 41% were obese and 34% had type 2 diabetes, the study found

... "The most surprising finding to me was that two-thirds of the patients who were seriously ill with an active infection did not have a fever," said senior researcher Karina Davidson, PhD.

Fever is the first symptom doctors look for, but Davidson said the sickest patients didn't present with a fever.

... Davidson and her colleagues from Northwell Health's Feinstein Institutes for Medical Research looked at the records of 5,700 hospitalized COVID-19 patients between March 1 and April 4.

Fifty-seven percent had hypertension (high blood pressure), 41% were obese and 34% had type 2 diabetes. The results reveal COVID-19 is much more than just a lung disease.

"It is going to have not just short-term effects that are deleterious on many target organs, but we may be looking at an infection that has long-term consequences," Davidson said.”

[Ausmumof3]

10 minutes ago, StellaM said:

Sorry - another question - because I trust the combined brains of the Hive more than I do the CMO in my state:

Is the following true, so far as you're aware? Particularly on the spread?

All the data from Australia and internationally, suggests it is uncommon for children <15 yrs to get or spread Covid

The issue with data from Australia would be that almost all testing so far up until the last couple of weeks has been focussed on symptomatic people.  So I don’t see how we have any data on whether children can spread asymptomatically or not.  I’m not sure on international data.  

[73349]

11 minutes ago, StellaM said:

Sorry - another question - because I trust the combined brains of the Hive more than I do the CMO in my state:

Is the following true, so far as you're aware? Particularly on the spread?

All the data from Australia and internationally, suggests it is uncommon for children <15 yrs to get or spread Covid

It is uncommon for children to test positive in the areas where they are not testing them, because their symptoms tend to look like a mere cold. 🙂 It is uncommon for children to get a case severe enough to require hospitalization. It is extremely rare for children to die.

I don't know of any information that suggests that they can't spread it--why wouldn't they?