1504 replies to this topic

[gamesguru]

citizens are now being told masks are not useless, and are resisting the advice en masse

 

the evidence from Japan can't suggest there's no benefit to lockdowns because they didn't try it, according to you, they only serve as a data point relative to their non-locked down selves.  Maybe the measures are extreme, but the rising numbers are also extreme so my point that Dan censored out about Japan having favorable cultural factors and not needing more aggressive intervention still seems reasonable

[Florin]

Any cultural factors can be suppressed by strictly enforced orders and mandates. We got stay-at-home orders but no mask mandates. Most of the blame for that failure resides with politicians and experts.

 

Japan was lot less strict than anything California did with the biggest difference being mask wearing compliance. There's plenty of evidence to suggest that people in Japan were a lot worse at obeying stay-at-home requests than people in California and that a lot less businesses closed. The results speak for themselves.

Edited by Florin, 20 July 2020 - 11:11 PM.

[gamesguru]

Japan did not require masks by law, they merely recommended it.  Just as CDC did to Americans.  The difference is mainly cultural, you cannot ask, force, or otherwise easily importune your way into mask compliance with Americans.

 

This only shows the contradictory nature of mandates.  They are resisted by bad cultures, and never needed in good ones.

[Florin]

Force worked for lockdowns, so force might also work to encourage mask wearing. If you don't try, you don't succeed.

 

[gamesguru]

Did it really work for lockdowns tho? Seems Americans took the virus serious for all of 2 months. Then they started throwing secret parties and stuff because they were losing their mind. I live in a state where masks were just mandated in the past few weeks. Already no one wants to enforce it, dems and reps alike. Probly 95% of people wear one in public, but obviously the employees can be seen oftener with it around their chin and neck than their nose and mouth. And combine that poor adoption rate with single ply tea cloth masks, and mitigation fatigue and tons of regressions with social togetherness, and I feel confident standing by my initial feeling that masks alone in America won't keep our numbers a joy through the Fall.

[Florin]

In California, the lockdown was enforced, even though Newsom didn't want to be heavy-handed about it. When the order to not use a beach wasn't being obeyed, the authorities closed all nearby parking so there was no way for crowds to gather at the beach. A gym refused to close and the cops had to come in and enforce its closure. Eventually, people got the message, and California became a huge ghost town.

 

The lockdowns did start to have a lot of public support though, while masks might not be quite as popular yet even in California, but you just have to start enforcing the mask mandate and hope that more people will start to comply just like they started to do with the lockdown. There's no alternative.

Edited by Florin, 21 July 2020 - 05:55 PM.

[mikeinnaples]

Here is some graphical context, comparing COVID to the Spanish Flu of 1918.

 

In every country, including the U.S. the story remains the same. This respiratory virus affects mainly the elderly. In the U.S. deaths from the Spanish Flu were 667 per 100,000. For COVID (through June 27th, 2020), it is 39 per 100,000. This thread was started, in order to provide data about this novel(?) respiratory virus. So many other recent disease outbreaks were accompanied by unwarranted fear and panic. This time around there is actually good data, and the data shows the overall population mortality rate is a fraction of one percent. Does this mortality rate justify the economic destruction, the fear, the panic, and all of the other ill-effects? I don't think so, but obviously some people disagree.

 

How many Spanish Flu deaths would have been prevented with access to 2020 medicine? How many additional people would be dying from SARS-Cov-2 with 1918 medicine?

 

If you want to even begin to compare the two, you need to normalize the 102 year technology gap in medicine.

[mikeinnaples]

Not at all reflected in death numbers

 

As I replied 3 weeks ago, deaths lag behind infections and that 'we shall see'. Indeed, we shall see and see we did.

 

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The announcement date of deaths is what is partially transparent in the background in case it wasn't clear by looking at the graph.

 

Hospitalization data is still being obfuscated on a state level as the DoH does not release the information. They do however release daily counts in their reports to the media and some locations are pulling data directly from that. I do know that the report showed new hospitalizations today hit a record daily number for the entire pandemic. Sadly, hospitalization information now is being obfuscated on a national level as the White House ordered that data be sent to them directly, bypassing the CDC. Nothing to be scared of if the data isn't available.......

Edited by mikeinnaples, 21 July 2020 - 08:06 PM.

[mikeinnaples]

FWIW I can tell you this in regards to Covid-19 Hospitalizations in Florida:

 

21 June: 13,325 total

21 July: 21,780 total

 

You do the math. Clear as day that the hospitalizations have gone drastically up in the past month.

Edited by mikeinnaples, 21 July 2020 - 08:06 PM.

[Florin]

Hospitalization data can be found at Covid Act Now. It's data sources are listed here.

Edited by Florin, 21 July 2020 - 08:18 PM.

[mikeinnaples]

Hospitalization data can be found at Covid Act Now. It's data sources are listed here.

 

Thanks for the link. I do wish they showed the daily new patient hospitalizations there though. That is the hard information to find in a graph unless you plot it out yourself and it is absolutely is relevant to the current state of the pandemic.

 

Its nice they show the 'current hospitalization' count on a daily graph to account for the differential between new admissions and discharges, even though the scale misrepresents the situation. Not many place do.

 

I say misrepresent because it shows a minor increase in current hospitalizations visually but the data shows it is far worse. I understand why in light of what the graph is trying to show but still..... Case in point with the current counts:

 

21 June: 5719

21 July: 9722

 

That is a huge increase over a month of those currently in the hospital but the graph in no way represents that visually.

Edited by mikeinnaples, 21 July 2020 - 08:33 PM.

[gamesguru]

seems like there was some good data with the vaccine phase I trials^[1].  Being potentially ready to vaccinate teachers, healthcare workers and other high risk groups by September it becomes a lot harder to make the highly sociopathic argument against shutting down the economy.  Pandemics are only to become likelier from now on.  Something which cannot sustain a few months of inactivity is not worth keeping anyways.  We need to change the economy to be more flexible and save some lives, rather than rigidly sticking to the idea the old economy needs to get back while needlessly sacrificing valuable lives.

 

Seems there is no extent to which some will not go to resist improvement and uphold the status quo.

[Florin]

Increasing mask wearing + telecommuting + vaccines = no lockdowns needed

Edited by Florin, 22 July 2020 - 02:33 AM.

[gamesguru]

Combine the masks with the fact that these are Americans, that most who are able to telecommute are already, and that the vaccine is not today ready.. and you see quite obviously the utility of using other draconian measures in the West.

 

I mean sure you can be naive and hopeful and just say the easy way will work, or you can be realistic and all seeing and recognize the need for an arbitrage of approaches.

 

The criticality threshold for mask compliance is somewhere on the order of 80-95%.  And the previous author had so admirably stipulated Americans are quite unlikely to reach as high as 60%, so enough of these "masks will do in the West" shenanigans do we all say

[Florin]

Americans are supposedly already at 60% compliance and sometimes up to 80%. Even without enforced mask mandates and if compliance is below the right threshold, the virus is simply going to give people a good beating until most do the right thing from peer pressure if from nothing else. Mandates and enforcement are just ways to get there with less beatings.

[gamesguru]

Proof that masks might not cut it in the great land of America.

 

A list of states with mask requirements: https://www.cnn.com/...trnd/index.html

 

Notice how New Jersey, Pennsylvania, New Mexico and California were all early adopters of mask requirements despite their continuing upward surge in cases (see: worldometers).

 

[Florin]

New Jersey, Pennsylvania, and New Mexico are doing just fine. California not so much, but compliance is below 80% in a lot of areas.

 

Even with high compliance, there will be ups and downs in cases and compliance itself. Just look at Japan. The key is to keep the damage at an acceptable level.

[gamesguru]

The irony kills

 

Sen. Jason Rapert ®, who has referred to the virus as a "hoax", called face mask measures as "draconian" is now hospitalized with COVID-19

 

[hype_wagon]

Blood vessel injury may spur disease's fatal second phase

    Catherine Matacic

Hide authors and affiliations
Science  05 Jun 2020:
Vol. 368, Issue 6495, pp. 1039-1040
DOI: 10.1126/science.368.6495.1039

    Science's COVID-19 coverage is supported by the Pulitzer Center.

Frank Ruschitzka told his pathologist to be ready before the first COVID-19 patient died. In early March, Ruschitzka, who leads the cardiology department at University Hospital Zürich, noticed that patients with the disease had strange symptoms for what was then thought to be chiefly a respiratory infection. Many patients had acute kidney failure, organ damage, and mysterious blood clots. Several weeks later, the first body was autopsied: Tiny clots and dead cells littered the capillaries of the lungs, and inflammation had distended blood vessels supplying every organ in the body.

The pathologist had never seen anything like it. But the results showed Ruschitzka why his patients were suffering so much: The virus had targeted their blood vessels.

Since the Zürich team's findings were published in mid-April, dozens of studies have revealed similar patterns of vascular damage in people who died of COVID-19. For example, a 21 May paper in The New England Journal of Medicine showed that the lungs of COVID-19 victims had nine times as many clots as those who died of the H1N1 flu. Other studies have noted inflammatory symptoms in children (Science, 29 May, p. 923) and strokes in otherwise healthy young adults. Now, researchers have woven these findings into a new hypothesis explaining why some patients slip into a fatal “second phase” of COVID-19, 1 week or so after hospitalization.

The key is direct and indirect damage to the endothelial cells that line the blood vessels, particularly in the lungs, explains Peter Carmeliet, a vascular biologist at the Belgian research institute VIB and co-author of a 21 May paper in Nature Reviews Immunology. By attacking those cells, COVID-19 infection causes vessels to leak and blood to clot. Those changes in turn spark inflammation throughout the body and fuel the acute respiratory distress syndrome (ARDS) responsible for most patient deaths.

“It's a vicious cycle,” says Nilam Mangalmurti, a pulmonary intensivist at the Hospital of the University of Pennsylvania, who was not involved in the new research.

This mechanism could explain why the disease pummels some patients who have obesity, diabetes, and cardiovascular conditions: The cells lining their blood vessels are already compromised. If so, drugs used to treat these conditions might help prevent other COVID-19 patients from sliding into serious disease. “[A vaccine] would be terrific,” says Richard Becker, a cardiologist at the University of Cincinnati College of Medicine who outlined a similar cardiovascular cascade in a 15 May review in the Journal of Thrombosis and Thrombolytis. But until a safe, effective vaccine is available, he says, such therapeutics might be “a good start.”

In healthy individuals, endothelial cells help regulate blood pressure, prevent inflammation, and inhibit clotting, in part through the continual production of nitric oxide (NO); they also serve as gatekeepers for molecules passing in and out of the bloodstream. When injured, they send out a complex array of signals to immune cells and clotting factors, which rush to repair the site. And they warn their fellow endothelial cells to be on alert for invaders.

Based on autopsy reports like those from the Zürich hospital, the epidemiology of the disease, and how the new coronavirus behaves in cells in the lab, Carmeliet and colleagues believe the virus can send that system spinning out of control.

When SARS-CoV-2 enters the lungs, it invades cells in the air sacs that transfer oxygen to the blood. Surrounding those sacs are capillaries lined like bricks with endothelial cells. The virus directly invades some of those cells; others become “activated,” likely in response to signals from the invading virus and other damaged cells. Some infected cells likely commit suicide. “It's not a quiet death where the cell just dies,” Mangalmurti says. “All the contents leak out.”

Carmeliet and colleagues suggest damage and other changes in the activated cells trigger vascular leakage, flooding the air sacs with fluid, a hallmark of ARDS. White blood cells swarm to the lungs and NO production likely plummets. Together with the activated endothelial cells, the immune cells release a host of signaling molecules, including interleukins, which raise local blood pressure and weaken cell junctions. Damage to the endothelial cells also exposes the membrane underneath them.

That exposed membrane in turn triggers uncontrolled clotting. The endothelial and immune cells add fuel to the fire, recruiting additional clotting factors and platelets, which help form clots. Those clots degrade into the key biomarker D-dimer, creating the sky-high levels that alert clinicians to patients in trouble (see graphic, below). Eventually, such clotting spreads throughout the body and blocks the blood supply within vital organs.



"GRAPHIC: TEUWEN ET AL., NAT. REV. IMMUNOL. (2020), ADAPTED BY V. ALTOUNIAN/SCIENCE"

These chain reactions culminate in a final, destructive phase of inflammation. Like clotting, inflammation is an essential defense, sending a diverse army of cells and messenger molecules called cytokines to fight invaders and mop up the debris of battle. But in COVID-19, this reaction spirals out of control in a deadly cytokine storm and plunges patients' bodies into shock.

Ruschitzka says the three-step hypothesis “makes perfect sense” of what he saw in his patients; he's already sending the Carmeliet paper to colleagues. He says the array of pathways may also explain why some young people without known risk factors for COVID-19 become seriously ill: They might have undiagnosed clotting or autoimmune disorders, such as rheumatoid arthritis, that amplify the effects of SARS-CoV-2 infection.

This emerging view of the key role of endothelial cells suggests that a number of existing drugs might dampen or even arrest the fatal second phase of the disease, Becker says. Already, evidence that inflammation and clotting play a role in COVID-19 has inspired dozens of trials in the United States and Europe of anticlotting, anti-inflammatory, and antiplatelet drugs.

Ruschitzka thinks another commonly prescribed drug might help: statins. Typically taken to lower cholesterol, they also reduce inflammation and improve endothelial cell function.

Mangalmurti welcomes such trials, but cautions that patients may respond differently depending on how healthy their endothelial cells are to start. “One size does not fit all.”

[hype_wagon]

Models demonstrating how inflammation is usually elevated in H1N1 fatalities.

Published online 2015 Apr 3. doi: 10.1016/j.jtbi.2015.03.017
The inflammatory response to influenza A virus (H1N1): an experimental and mathematical study

Abstract

Mortality from influenza infections continues as a global public health issue, with the host inflammatory response contributing to fatalities related to the primary infection. Based on Ordinary Differential Equation (ODE) formalism, a computational model was developed for the in-host response to influenza A virus, merging inflammatory, innate, adaptive and humoral responses to virus and linking severity of infection, the inflammatory response, and mortality. The model was calibrated using dense cytokine and cell data from adult BALB/c mice infected with the H1N1 influenza strain A/PR/8/34 in sublethal and lethal doses. Uncertainty in model parameters and disease mechanisms was quantified using Bayesian inference and ensemble model methodology that generates probabilistic predictions of survival, defined as viral clearance and recovery of the respiratory epithelium. The ensemble recovers the expected relationship between magnitude of viral exposure and the duration of survival, and suggests mechanisms primarily responsible for survival, which could guide the development of immunomodulatory interventions as adjuncts to current anti-viral treatments. The model is employed to extrapolate from available data survival curves for the population and their dependence on initial viral aliquot. In addition, the model allows us to illustrate the positive effect of controlled inflammation on influenza survival.

[gamesguru]

Population density (which is associated with greater per capita infection and death) and mask adoption rate maps.

 

 

[Florin]

COVID-19 deaths per 100,000 in the US by State/Territory
https://www.cdc.gov/...d-data-tracker/

[Daniel Cooper]

COVID-19 deaths per 100,000 in the US by State/Territory
https://www.cdc.gov/...d-data-tracker/

 

That map is interesting, and it says something about the quality of the underlying data or more accurately it says something about which states got hit early vs. late which has a bearing on the quality of the data.

 

Case in point - Look at New York City vs Georgia.

 

                               NYC                     Georgia

Total Cases        226,167                    178,323

Cases/100k           2,693                         1,695

Deaths/100k             280                              35

 

That's rather remarkable. The total cases are "confirmed + probable".  But surely NYC must have had many cases that that were not counted.  Otherwise, how do they get to a deaths/100k of 280 vs Georgia's 35?

 

It would seem there's two likely explanations - NYC had a lot of uncounted cases because the testing capacity was very low early in the pandemic when they had a great many of their cases, and the standard of care for covid treatment must be improving and Georgia has benefited from this more by having their cases later when the mortality rate is lower versus NYCs early cases when they were still learning how to treat.

 

As usual, the "Total Cases" view is the least informative since it obviously doesn't take population into account.  I would suggest that "Cases/100k" and "Deaths/100k" are the most informative.

 

Good find.

Edited by Daniel Cooper, 30 July 2020 - 07:57 PM.

[Daniel Cooper]

Another thing that jumps out at you about that map ..... Why the hell does West Virginia still look so damn good? 6 deaths/100k.

 

It's not just population density.  At 77 people/sq mile WV has a slightly denser population than Minnesota which has 29 deaths/100k and it's 11 times more dense than Montana which has virtually the same number - 5 deaths/100k.

 

It's hard to image that West Virginians have been especially vigilant at masking, lock downs, social distancing, etc. compared to the surrounding states.  

 

It's one of those unanswered things.  Same thing with Germany.  Were the Germans really so vastly better at these things than France and Italy? Maybe so.  

 

I expect there will be PhD thesis written about these things within the next couple of years.

[Hebbeh]

https://www.theatlan...failure/614191/

[pamojja]

The Fat Emperor:

Ep91 Emeritus Professor of Immunology – Reveals Crucial Viral Immunity Reality

Now THIS is a special one – a full debrief on everything important in this Covid19 issue – with one of the world’s top immunologists explaining the real situation, including “Herd Immunity” realities, and much, much more.

Dr. Stadler’s credentials in brief here – top of the heap, and named “The Vaccine Pope” by his colleagues:  https://expertinova..../cv-bedastadler

We discuss and reveal every important aspect of this pandemic, in terms of what is scientifically correct. In contrast to the bizarre, unscientific torrent coming from politicians and media alike. 1hr 24 min interview:

 

[pamojja]

Dr. Malcom Kendricks:

How bad is COVID really? (A Swedish doctor’s perspective)

207 Replies

7th August 2020

 

A doctor working in Sweden as an emergency care physician contacted me to discuss all things COVID-19. He has also written a blog, which can be seen here.

 

I asked if I could reproduce it on my blog as I felt it was a fascinating persepctive on what was happening in Sweden. It is also incredibly well written, in English, for someone who is Swedish. Most humbled. I hope you enjoy it.

 

Ok, I want to preface this article by stating that it is entirely anecdotal and based on my experience working as a doctor in the emergency room of one of the big hospitals in Stockholm, Sweden, and of living as a citizen in Sweden.

 

As many people know, Sweden is perhaps the country that has taken the most relaxed attitude of any towards the COVID pandemic. Unlike other countries, Sweden never went in to complete lockdown. Non-essential businesses have remained open, people have continues to go to cafés and restaurants, children have remained in school, and very few people have bothered with face masks in public.

 

COVID hit Stockholm like a storm in mid-March. One day I was seeing people with appendicitis and kidney stones, the usual things you see in the emergency room. The next day all those patients were gone and the only thing coming in to the hospital was COVID. Practically everyone who was tested had COVID, regardless of what the presenting symptom was. People came in with a nose bleed and they had COVID. They came in with stomach pain and they had COVID.

 

Then, after a few months, all the COVID patients disappeared. It is now four months since the start of the pandemic, and I haven’t seen a single COVID patient in over a month. When I do test someone because they have a cough or a fever, the test invariably comes back negative.

 

At the peak three months back, a hundred people were dying a day of COVID in Sweden, a country with a population of ten million. We are now down to around five people dying per day in the whole country, and that number continues to drop. Since people generally die around three weeks after infection, that means virtually no-one is getting infected any more.

 

If we assume around 0.5 percent of those infected die (which I think is very generous, more on that later), then that means that three weeks back 1,000 people were getting infected per day in the whole country, which works out to a daily risk per person of getting infected of 1 in 10,000, which is miniscule. And remember, the risk of dying is at the very most 1 in 200 if you actually do get infected. And that was three weeks ago. Basically,COVID is in all practical senses over and done with in Sweden.

 

After four months. In total COVID has killed under 6,000 people in a country of ten million. A country with an annual death rate of around 100,000 people. Considering that 70% of those who have died of COVID are over 80 years old, quite a few of those 6,000 would have died this year anyway. That makes covid a mere blip in terms of its effect on mortality.

 

That is why it is nonsensical to compare covid to other major pandemics, like the 1918 pandemic that killed tens of millions of people. COVID will never even come close to those numbers. And yet many countries have shut down their entire economies, stopped children going to school, and made large portions of their population unemployed in order to deal with this disease.

 

The media have been proclaiming that only a small percentage of the population have antibodies, and therefore it is impossible that herd immunity has developed. Well, if herd immunity hasn’t developed, where are all the sick people? Why has the rate of infection dropped so precipitously? Considering that most people in Sweden are leading their lives normally now, not socially distancing, not wearing masks, there should still be high rates of infection.

 

The reason we test for antibodies is because it is easy and cheap. Antibodies are in fact not the body’s main defence against virus infections. T-cells are. But T-cells are harder to measure than antibodies, so we don’t really do it clinically. It is quite possible to have T-cells that are specific for covid and thereby make you immune to the disease, without having any antibodies.

 

Personally, I think this is what has happened. Everybody who works in the emergency room where I work has had the antibody test. Very few actually have antibodies. This is in spite of being exposed to huge numbers of infected people, including at the beginning of the pandemic, before we realized how widespread COVID was, when no-one was wearing protective equipment.

 

I am not denying that COVID is awful for the people who do get really sick or for the families of the people who die, just as it is awful for the families of people who die of cancer, or influenza, or an opioid overdose. But the size of the response in most of the world (not including Sweden) has been totally disproportionate to the size of the threat.

 

Sweden ripped the metaphorical band-aid off quickly and got the epidemic over and done with in a short amount of time, while the rest of the world has chosen to try to peel the band-aid off slowly. At present that means Sweden has one of the highest total death rates in the world. But COVID is over in Sweden. People have gone back to their normal lives and barely anyone is getting infected any more.

 

I am willing to bet that the countries that have shut down completely will see rates spike when they open up. If that is the case, then there won’t have been any point in shutting down in the first place, because all those countries are going to end up with the same number of dead at the end of the day anyway. Shutting down completely in order to decrease the total number of deaths only makes sense if you are willing to stay shut down until a vaccine is available. That could take years. No country is willing to wait that long.

 

COVID has at present killed less than 6000 in Sweden. It is very unlikely that the number of dead will go above 7,000. An average influenza year in Sweden, 700 people die of influenza. Does that mean COVID is ten times worse than influenza? No, because influenza has been around for centuries while COVID is completely new.

 

In an average influenza year most people already have some level of immunity because they’ve been infected with a similar strain previously, or because they’re vaccinated. So it is quite possible, in fact likely, that the case fatality rate for COVID is the same as for influenza, or only slightly higher, and the entire difference we have seen is due to the complete lack of any immunity in the population at the start of this pandemic.

 

This conclusion makes sense of the Swedish fatality numbers – if we’ve reached a point where there is hardly any active infection going on any more in Sweden, in spite of the fact that there is barely any social distancing happening, then that means at least 50% of the population has been infected already and have developed immunity, which is five million people.

 

This number is perfectly reasonable if we assume a reproductive number for the virus of two: If each person infects two new, with a five day period between being infected and infecting others, and you start out with just one infected person in the country, then you will reach a point where several million are infected in just four months. If only 6000 are dead out of five million infected, that works out to a case fatality rate of 0.12 percent, roughly the same as regular old influenza, which no-one is the least bit frightened of, and which we don’t shut down our societies for.

[Mind]

As pamojja has highlighted prolifically and I have theorized as well, the "excess deaths" people keep referring to are probably not due entirely to the coronavirus.

 

Denver hospital finds heart attacks "at home" almost doubled during the lockdown - causing more deaths than COVID in the city of Denver. (imagine how many of these were mis-classified as dying "from COVID").

 

 Governments that keep promoting panic are just causing a lot more "excess deaths" through the psychological stress of fear, loneliness, and depression.

[Florin]

The idea that lockdowns have generally caused more deaths than COVID or that excess deaths are not mostly COVID-caused is unlikely to be true. For instance, there were excess deaths in Sweden which had no lockdown but none in Norway and Finland which did have lockdowns.

Edited by Florin, 22 August 2020 - 04:35 PM.

[Daniel Cooper]

The idea that lockdowns have generally caused more deaths than COVID or that excess deaths are not mostly COVID-caused is unlikely to be true. For instance, there were excess deaths in Sweden which had no lockdown but none in Norway and Finland which did have lockdowns.

 

I'm fairly sure you're right.  But we need to be aware that there are deaths on both sides of the ledger.

 

There are people that have avoided healthcare and treatments.  Rates of drug and domestic abuse have increased and suicides are up.  But I'm not going to allege that there have been more of these than covid deaths.  I don't know the numbers and it seems unlikely.  But, let's not image that lock downs are without costs.

 

Humans are social animals.  They don't do well in isolation.