I'm sorry for being unclear.

Let's say there are 10 cases each with 10 contacts. 100 total contacts to trace. The paper says with R0 of 1.5 and 0 asymptomatic transmission you need to get 50% tracing to ensure it dies out. That means you need to isolate 50 people or more. If we have confirmed only 4 cases it is impossible to trace and isolate the 50 people we need to even at 100% trace. To "even things back out" we'd need to test 5 and trace 100%.

I don't think we are doing sufficient testing. I have serious doubts that we're tracing 50% of total actual contacts. How well we're tracing contacts on confirmed cases is irrelevant if we're not seeing enough of the total.

CDub06 said:

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CDub06 said:

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Anyone know the story with Germany? They've announced 1151 confirmed cases, but no deaths.

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What have I done...

https://www.n-tv.de/panorama/Zwei-Coronavirus-Todesfaelle-in-Deutschland-article21629404.html

First two confirmed deaths in Germany. In Heinsberg and Essen.

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YOU KILLED 'EM!!

Nosmo said:

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AgsMyDude said:

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If a person has no symptoms, how is testing going to help?

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Many people are asymptomatic carriers. You can easily spread the disease and not show any symptoms. If you test positive without symptoms you still need to be isolated to avoid giving it to others who may be effected.

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Then why didn't they test Cruz?

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That's the million-dollar question. Our testing is significantly lower than any other major country with cases.

https://www.vox.com/science-and-health/2020/3/6/21168087/cdc-coronavirus-test-kits-covid-19

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Mar 6, 2020

But it starts with testing. To date, per an investigation in the Atlantic, fewer than 2,000 people have been tested for Covid-19 in the US a number far behind other developed countries. South Korea, for example, has tested more than 140,000 people and has even set up drive-though testing stations for people to access.

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you have to assume the R0 will decrease significantly as 1) the epidemic progresses and 2) social distancing and paranoia take over

contract tracing works on top of that

dragmagpuff said:

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FbgTxAg said:

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Good Grief we are all going to suffer from this insanity.

Has this thing killed ONE person under 70 that wasn't immunodeficient or had a preexisting lung issue?

I'll hang up and listen.

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Again, why are people thinking that deaths are the only negative outcome of getting this virus? 10% of Italians that tested positive needed critical care. The Italian hospital system is getting overwhelmed. They had to institute a quarantine to slow the spread.

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Death is the only metric most people care about, no matter what you think. Also, if 200 people are overwhelming the Italian healthcare system then they have other problems.

AgsMyDude said:

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Nosmo said:

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AgsMyDude said:

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Quote:

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If a person has no symptoms, how is testing going to help?

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Many people are asymptomatic carriers. You can easily spread the disease and not show any symptoms. If you test positive without symptoms you still need to be isolated to avoid giving it to others who may be effected.

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Then why didn't they test Cruz?

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That's the million-dollar question. Our testing is significantly lower than any other major country with cases.

https://www.vox.com/science-and-health/2020/3/6/21168087/cdc-coronavirus-test-kits-covid-19

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Mar 6, 2020

But it starts with testing. To date, per an investigation in the Atlantic, fewer than 2,000 people have been tested for Covid-19 in the US a number far behind other developed countries. South Korea, for example, has tested more than 140,000 people and has even set up drive-though testing stations for people to access.

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So you are saying the quote from the Cruz story saying testing before symptoms is ineffective, is not accurate?

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He also said his situation does not meet the CDC criteria to self-quarantine, and he cannot be tested since testing is not effective before symptoms manifest.

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lead said:

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dragmagpuff said:

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FbgTxAg said:

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Good Grief we are all going to suffer from this insanity.

Has this thing killed ONE person under 70 that wasn't immunodeficient or had a preexisting lung issue?

I'll hang up and listen.

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Again, why are people thinking that deaths are the only negative outcome of getting this virus? 10% of Italians that tested positive needed critical care. The Italian hospital system is getting overwhelmed. They had to institute a quarantine to slow the spread.

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Death is the only metric most people care about, no matter what you think. Also, if 200 people are overwhelming the Italian healthcare system then they have other problems.

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200 ICU cases at one time, on top of all the other ICU cases, requiring breathing assistance and possible isolation would be catostrophic to pretty much all of Texas.

Italy has around 12.5 ICU beds per 100,000 people (source), which means Italy has around 2,600 ICU beds. But this isn't happening spread over the entire country - most of the cases are in Lombardy, which has 10 million people. Assuming the ICU beds are similar per capita all over, that means that region has 1,250 beds. In most countries ICU beds run at >65% capacity. That means at any time in a general way they have around 2600 free beds in all of Italy, and about 435 free in Lombardy.

Italy has 650 serious/critical cases, mostly in Lombardy. It is unsurprising that this is straining their infrastructure.

For reference, the US has around 35 critical care beds per 100,000 (2015), Germany has around 30 (2012), Italy has around 12 (2012). UK has only 6.

The US is the best able to handle a large number of critical care cases, but it's hard to know what each country's incremental capacity for new cases are.

k2aggie07 said:

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Italy has around 12.5 ICU beds per 100,000 people (source), which means Italy has around 2,600 ICU beds. But this isn't happening spread over the entire country - most of the cases are in Lombardy, which has 10 million people. Assuming the ICU beds are similar per capita all over, that means that region has 1,250 beds. In most countries ICU beds run at >65% capacity. That means at any time in a general way they have around 2600 free beds in all of Italy, and about 435 free in Lombardy.

Italy has 650 serious/critical cases, mostly in Lombardy. It is unsurprising that this is straining their infrastructure.

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Wow, we both looked at the exact same plot.

dragmagpuff said:

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k2aggie07 said:

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Italy has around 12.5 ICU beds per 100,000 people (source), which means Italy has around 2,600 ICU beds. But this isn't happening spread over the entire country - most of the cases are in Lombardy, which has 10 million people. Assuming the ICU beds are similar per capita all over, that means that region has 1,250 beds. In most countries ICU beds run at >65% capacity. That means at any time in a general way they have around 2600 free beds in all of Italy, and about 435 free in Lombardy.

Italy has 650 serious/critical cases, mostly in Lombardy. It is unsurprising that this is straining their infrastructure.

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Wow, we both looked at the exact same plot.

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Another TexAgs hookup.

k2aggie07 said:

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I'm sorry for being unclear.

Let's say there are 10 cases each with 10 contacts. 100 total contacts to trace. The paper says with R0 of 1.5 and 0 asymptomatic transmission you need to get 50% tracing to ensure it dies out. That means you need to isolate 50 people or more. If we have confirmed only 4 cases it is impossible to trace and isolate the 50 people we need to even at 100% trace. To "even things back out" we'd need to test 5 and trace 100%.

I don't think we are doing sufficient testing. I have serious doubts that we're tracing 50% of total actual contacts. How well we're tracing contacts on confirmed cases is irrelevant if we're not seeing enough of the total.

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Thank you for clarifying. I understand your point and have many of the same doubts.

I just don't think how well we're tracing contacts on confirmed cases is irrelevant in the grand scheme. Don't get me wrong, I'm disappointed we are doing a poor job at testing. I still think it's better that we have traced what we know than if we didn't. I would think it still helps to hold number down. The question is how much.

But my point to your reaction to the article is that just because we aren't seeing enough of the total doesn't mean we'll have that R0 the article suggests or maybe even close to it. I do think the actions we have taken are helping, even if not the best actions we should be taking. I also posed my question about the hand washing because those actions COULD help balance out the poor job we've done at testing.

So yes, maybe we shouldn't feel as good about things in the US as what's happened in SK, but I don't think we should feel the exact opposite. I don't know exactly how I feel about the potential R0 value in the States because there are too many damn factors in determining it.

Hopefully we actually will ramp up testing now and at least start to get some real, reliable hard data.

DTP02 said:

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gonemaroon said:

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He really needs his twitter taken away

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I would say he's playing that part of his role pretty well.

The panic is outpacing the current risk by a good margin right now. He should be trying to calm the panic. This is absolutely part of the comprehensive approach to dealing with a pandemic that is necessary from our govt officials, a balancing of the risks of the panic caused by the virus with the risks of the virus itself.

Now, what I would like to see from his twitter account and public comments is some educational stuff about hand washing and the like.

That would be a prudent, balanced approach.

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He did that at the beginning and the MSM was attacking him for saying to wash your hands and social distance.

I Have Spoken said:

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A couple of 80 degree days here in the metroplex expected to start the week. Unfortunately, it does not look like it is going to hold.

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Singapore tested various temp and humidity combos.

Gotta be over 85* and humidity lower than 20% for that to matter.

KidDoc said:

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I've been pretty much correct on this whole course. My next prediction is widespread school closures & work from home in the next month and more stock market nuttiness. I hope to buy in some more stocks in about a month.

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If they send my kids home for school and tell me to work for home we are going to take a vacation somewhere!

But the referenced post indicated the ITALIAN healthcare system was overwhelmed. I remain skeptical based on the numbers. I also see this as a relatively small issue when compared to deaths.

Quote:

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But my point to your reaction to the article is that just because we aren't seeing enough of the total doesn't mean we'll have that R0 the article suggests or maybe even close to it. I do think the actions we have taken are helping, even if not the best actions we should be taking. I also posed my question about the hand washing because those actions COULD help balance out the poor job we've done at testing.

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The R0 value is based on the disease's biological characteristics as well as human behavior.

The spread went through phases in China. An article was published in Nature (wowza that impact factor for these docs!!) in late Feb about it.

https://www.nature.com/articles/s41421-020-0148-0

They said it went in three phases - uncontrolled in Jan at R0 of 3.1, followed by public transportation lockdown and mass gatherings being banned, which reduced it to 2.6. In the third phase they ratched up the quarantine and isolation which dropped it to 1.9. Then the full effect of the public health measures hit around Feb 16 and result in their model dropping down below 1 and proceeding toward containment.

As long as the disease is spreading by definition the R0 is greater than 1.

They note that "the curve continued to go up throughout February without any indication of dropping, indicating the need for further enhancement of public health measures for containment of the current outbreak." Considering what was necessary to control this in Wuhan once it hit a kind of critical mass, I think we should be paying very, very close attention.

In the beginning you have a narrow window to trace. If the model in that Nature paper is accurate and without any containment measures you have it around 3, you have to be hitting an extremely high percentage of actual contacts (not observed!) to prevent an epidemic.

Looking at the stats in Singapore and Australia, I don't see how summer doesn't have a big impact on this virus. It is spreading very slow in those.

Even if this wasn't localized to Lombardy, if they have ~2600 ICU beds in all of Italy, that means on any given day they probably have around 900 free. 650 new critical cases hitting all at once would absolutely represent a pretty big load to their system.

fooz said:

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Great

A few of us posted the scientific article about how soap works and regular bar soap works best on viruses. Yet every store has plenty of bar soap stacked to the ceilings and no Purell.

Unrolled thread for easier reading:

https://threadreaderapp.com/thread/1236680328875474944.html

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Wow, we both looked at the exact same plot.

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So you are both surrendering to the Corona Virus and think it will kill you, thus the need to pick out a plot?

Big Al 1992 said:

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A few of us posted the scientific article about how soap works and regular bar soap works best on viruses. Yet every store has plenty of bar soap stacked to the ceilings and no Purell.

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Because with soap you need access to a sink and running water to wash it off - With hand sanitizer you don't.

It would make a pretty big mess if everyone walked around in public with a thick coating of soap on their hands 24/7.

fooz said:

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Oh boy. Here comes the panic. I'm buying some frozen meat on the way home.

FriscoKid said:

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fooz said:

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Oh boy. Here comes the panic. I'm buying some frozen meat on the way home.

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We live literally a block away from an albertsons here in Ft Worth, so I doubt we will be doing a lot of stocking up on stuff, but i can see costco getting absolutely raided in the next few days.

FriscoKid said:

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fooz said:

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Oh boy. Here comes the panic. I'm buying some frozen meat on the way home.

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I was hoping I would have been patient zero in DFW so I could infect all you people.

PJYoung said:

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Unrolled thread for easier reading:

https://threadreaderapp.com/thread/1236680328875474944.html

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The thread unroll and the NY Times interview is a must read.

Snips from the NYT interview

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Wait "whip you through a CT scan"?

Each machine did maybe 200 a day. Five, 10 minutes a scan. Maybe even partial scans. A typical hospital in the West does one or two an hour. And not X-rays; they could come up normal, but a CT would show the "ground-glass opacities" they were looking for.

What were mild, severe and critical? We think of "mild" as like a minor cold.
No. "Mild" was a positive test, fever, cough maybe even pneumonia, but not needing oxygen. "Severe" was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator. "Critical" was respiratory failure or multi-organ failure.

So saying 80 percent of all cases are mild doesn't mean what we thought.
I'm Canadian. This is the Wayne Gretzky of viruses people didn't think it was big enough or fast enough to have the impact it does.

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KidDoc said:

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I've been pretty much correct on this whole course. My next prediction is widespread school closures & work from home in the next month and more stock market nuttiness. I hope to buy in some more stocks in about a month.

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If the schools close, your nieces may come for a visit. It's been a crazy few weeks.

dragmagpuff said:

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For reference, the US has around 35 critical care beds per 100,000 (2015), Germany has around 30 (2012), Italy has around 12 (2012). UK has only 6.

The US is the best able to handle a large number of critical care cases, but it's hard to know what each country's incremental capacity for new cases are.

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it'll take less than two sequential Democrat Presidential admins for America to be begging for just 6 IC beds per 100k

PJYoung said:

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Unrolled thread for easier reading:

https://threadreaderapp.com/thread/1236680328875474944.html

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I find this pretty interesting and would like to hear more about these kinds of evaluation. It's not the first story I've seen that suggests that China is much more prepared for this sort of thing than we are here, which would make sense with the SARS and Flu outbreaks over the last 20+ years. My natural bias is to assume that medical management in China is more backwards than here, but I have no basis for that. I'd venture to guess that's true for most of us.

Interesting thought, but it's probably too close to irrational panic to be allowed these days.

Very depressing read. Not good.

Big Al 1992 said:

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A few of us posted the scientific article about how soap works and regular bar soap works best on viruses. Yet every store has plenty of bar soap stacked to the ceilings and no Purell.

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It's a very good point. I remember talking to a doctor back in the '90s about this (don't remember the reason) and he said Zest and Irish Spring were the two best at the time.

I worked with a guy right out of college in the mid 2000's that had contracted a staph infection at his apartment gym. He said he had never used anything but liquid soap to bathe with his entire life and his doctor told him to switch to bar soap because the liquid stuff isn't effective.

I don't know the difference but I prefer bar soap myself.