It's been 2 weeks off and on since end of May and grown slowly. It's worth watching but it seems actually are better than the model.
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Last: 2 yr ago by AggieUSMC
I have no idea if this is possible, but in a pinch couldn't you shut down elective surgeries and clear out the icus?
I'd be surprised if the population of "needing icu for recovery " and "elective" surgery overlap any if at all.
Gotcha. I have no idea, was just a thought.
They do a ton. There is a broad definition of elective. My Dad just had some cancer surgery that was put off due to COVID and was monitored ICU. He developed an infection and what was supposed to be 12 hr stay turned into 2 days. All good now, but it's a portion for sure.
There is actually some overlap. (1) negative pressure rooms - for a sterile post-surgery environment and for keeping infectious disease patients best contained within the hospital (2) rooms with gasses in the head walls, can run ventilators, big enough for equipment and staff access, etc (3) trained icu nurses capable of taking great care of really sick patients, including those most likely to code
CowtownAg06 said:
It's been 2 weeks off and on since end of May and grown slowly. It's worth watching but it seems actually are better than the model.
An entire week in a row suggesting less than 2 weeks of capacity is very different then a few days here and there. We've clearly entered sn accelerated phase of spread.
Klinker,
That's what the assumption basis is for max capacity. Normal capacity is based on not doing that.
I don't know how you can look at those and not conclude that something is happening in Houston that is worth paying attention to.
That's what the assumption basis is for max capacity. Normal capacity is based on not doing that.
I don't know how you can look at those and not conclude that something is happening in Houston that is worth paying attention to.
ahhh I see it.
Thank you for clearing that up
Thank you for clearing that up
CowtownAg06 said:
They do a ton. There is a broad definition of elective. My Dad just had some cancer surgery that was put off due to COVID and was monitored ICU. He developed an infection and what was supposed to be 12 hr stay turned into 2 days. All good now, but it's a portion for sure.
Interesting. Color me surprised
Also think people should realize we are not at tests per day peak. That is not the reason why cases are going up. The reason why the spike in comfirmed cases has been the doubling in the positivity rate moreso than the test count. The fact that 10% of tests are positive and climbing is scary.
We're spreading this virus very quickly despite not having the population density of New York, having still semi-restricted social mobility, by having at least some adherence to mask wearing/social distancing practices all in the middle of the summer. If you have any doubts about the seasonal spread of the virus South America is showing how bad it can get. This does not bode well for October-vaccine. It's bad now, but people need to be appropriately concerned so that we have the social will power to mitigate this as best as we can. Without acknowledgement of the bad potential outcomes, we increase the odds of a worse outcome.
We're spreading this virus very quickly despite not having the population density of New York, having still semi-restricted social mobility, by having at least some adherence to mask wearing/social distancing practices all in the middle of the summer. If you have any doubts about the seasonal spread of the virus South America is showing how bad it can get. This does not bode well for October-vaccine. It's bad now, but people need to be appropriately concerned so that we have the social will power to mitigate this as best as we can. Without acknowledgement of the bad potential outcomes, we increase the odds of a worse outcome.
The question is why has the positive rate climbed? The easy answer is the virus is simply spreading. This is undoubtedly true. However, could part of the positive rate increase be due to flu and allergies declining during the summer months? This would cause a change in the testing population, which could be a factor in positive rate increase. Further, it could be people who had some symptoms were less likely to go get tested in March/April out of fear of catching it if they didn't think they had it. Additionally, there were a lot of people turned away early on from testing because they hadn't traveled or been in direct contact with a positive case. All of this can change the population currently being tested, which could be leading to an increase in positive rate. So, the question I have is: is the virus spreading faster than before or could it actually be at the same rate, but the testing population has changed and we're finding more people than before?Gordo14 said:
Also think people should realize we are not at tests per day peak. That is not the reason why cases are going up. The reason why the spike in comfirmed cases has been the doubling in the positivity rate moreso than the test count. The fact that 10% of tests are positive and climbing is scary.
We're spreading this virus very quickly despite not having the population density of New York, having still semi-restricted social mobility, by having at least some adherence to mask wearing/social distancing practices all in the middle of the summer. If you have any doubts about the seasonal spread of the virus South America is showing how bad it can get. This does not bode well for October-vaccine. It's bad now, but people need to be appropriately concerned so that we have the social will power to mitigate this as best as we can. Without acknowledgement of the bad potential outcomes, we increase the odds of a worse outcome.
Question: what do you mean by social will power?
To the part I've bolded - what's your confidence we have a vaccine for this?
The testing population has undoubtedly changed.
Asymptomatic exposures know they can get a test. They're going to get tested even though they're asymptomatics, and learning they're positive. Job sites are blanket testing after exposures are exhibiting this phenomenon. As are smaller groups like families.
The value of a "case" today is very different from what it was a month ago, and bears little resemblance to one from two months ago.
Asymptomatic exposures know they can get a test. They're going to get tested even though they're asymptomatics, and learning they're positive. Job sites are blanket testing after exposures are exhibiting this phenomenon. As are smaller groups like families.
The value of a "case" today is very different from what it was a month ago, and bears little resemblance to one from two months ago.
I've just unilaterally called my Doc and asked for an order to get an antibody test.
I know the odds are against my having had it...but it sure would be handy to find out if I was one of the lucky asymptomatic.
On the other hand....watch me actually catch it in the waiting room at LabCorp.
I know the odds are against my having had it...but it sure would be handy to find out if I was one of the lucky asymptomatic.
On the other hand....watch me actually catch it in the waiting room at LabCorp.
They are not doing enough to explain the statistics, what makes up the hospitalized. What makes up the positive cases, symptomatic vs. not.
Give blood and it's free.
OlSarge92 said:
They are not doing enough to explain the statistics, what makes up the hospitalized. What makes up the positive cases, symptomatic vs. not.
That could be just as misleading. If somebody tests positive, but has no symptoms are they "asymptomatic" or "presymptomatic"? Are they "not hospitalized" or prehospitalized? It's an evolving picture... Honestly providing that kind of data would be more misleading than the data they are showing now.
Most people that are testing positive likely have symptoms or recently interacted with someone who is positive (more than likely presymptomatic than asymptomatic).
Nobody gets this test for fun. By all accounts the swab pushed up your nose feels terrible.
Beat40 said:The question is why has the positive rate climbed? The easy answer is the virus is simply spreading. This is undoubtedly true. However, could part of the positive rate increase be due to flu and allergies declining during the summer months? This would cause a change in the testing population, which could be a factor in positive rate increase. Further, it could be people who had some symptoms were less likely to go get tested in March/April out of fear of catching it if they didn't think they had it. Additionally, there were a lot of people turned away early on from testing because they hadn't traveled or been in direct contact with a positive case. All of this can change the population currently being tested, which could be leading to an increase in positive rate. So, the question I have is: is the virus spreading faster than before or could it actually be at the same rate, but the testing population has changed and we're finding more people than before?Gordo14 said:
Also think people should realize we are not at tests per day peak. That is not the reason why cases are going up. The reason why the spike in comfirmed cases has been the doubling in the positivity rate moreso than the test count. The fact that 10% of tests are positive and climbing is scary.
We're spreading this virus very quickly despite not having the population density of New York, having still semi-restricted social mobility, by having at least some adherence to mask wearing/social distancing practices all in the middle of the summer. If you have any doubts about the seasonal spread of the virus South America is showing how bad it can get. This does not bode well for October-vaccine. It's bad now, but people need to be appropriately concerned so that we have the social will power to mitigate this as best as we can. Without acknowledgement of the bad potential outcomes, we increase the odds of a worse outcome.
Question: what do you mean by social will power?
To the part I've bolded - what's your confidence we have a vaccine for this?
I mean that we need the social will power to social distance, stay away from crowds, wear masks, etc. Part of the reason this spike is happening is despite that.
Honestly, not an epidemiologist, I'm very confident in a vaccine. We have more resources dedicated to this than any vaccine in history. We have many promising candidates that are moving faster through the approvals process than they ever have before. We've got multiple different approaches to a vaccine going simultaneously (mRNA, weakenes/inactive virus, viral vector, protein vaccines). I think the question is more when will the vaccine be accessible to the mass market, and how frequently should you get the shot.
This sounds plausible on the surface, but isn't necessarily true.Keegan99 said:
The testing population has undoubtedly changed.
Asymptomatic exposures know they can get a test. They're going to get tested even though they're asymptomatics, and learning they're positive. Job sites are blanket testing after exposures are exhibiting this phenomenon. As are smaller groups like families.
The value of a "case" today is very different from what it was a month ago, and bears little resemblance to one from two months ago.
I can speak directly to Houston area testing. Two months ago is almost exactly when we first began blanket testing congregate sites (nursing homes, long-term care facilities, food bank, homeless shelters, etc...).
In all of the initial blanket testing, positives at those congregate sites were very rare. We were seeing 0-2 positives at most sites, with one that stuck out early on because it had 12 positives out of around 80 total staff/residents. We were testing 2-3 sites per day, 6 days a week.
Based on my lab's results, there was an obvious and pretty dramatic shift in the proportion of positives from both congregate sites as well as drive-up sites first starting around 10-12 days ago (and based on the TMC numbers, other local labs have seen the same). Over the past week we've had three congregate sites with significant positives, one had 54 positives out of ~115 staff/residents tested.
All that said, the proportion of all tests made up by "blanket" testing of at-risk populations compared to the number of people seeking tests (either due to illness or due to possible exposure) is very small.
Regardless, the percentage of positives is going up because more people are infected. The probability of someone being infected with SARS-CoV-2 is much higher if they're symptomatic than if they're not. So blanket testing after potential exposure of asymptomatic (or pre-symptomatic) people would be expected to drop the percentage of positive tests, not increase it.
The value of a case today is what it has always been: It's a person that's infected at the time the test is taken.
Just watched Sylvester Turners pc here in Houston. Says in the last two days have had over 1700 positive cases. Then says testing on these cases was done between June 9th -17th. Can somebody remind me what was happening before and during that time?
You're talking blanket testing of closed, at-risk populations two months ago.
I'm talking blanket testing of job sites and families today.
The latter dwarfs the former by orders of magnitude. Texas ran 225k tests in the last week. Two months ago? We had run 225k tests total. From the start of the outbreak.
An example:
https://www.kbtx.com/2020/06/16/55-construction-workers-on-texas-am-campus-test-positive-for-covid-19/
One job site at A&M. 153 tests. 55 positives. But only six symptomatic cases. One brief hospitalization.
Correct. But it creates non-random samples that boost positives.
And as I said, there is the larger issue of "potential exposures" seeking out tests now because they know they are available vs two months ago when they wouldn't even bother unless they were sick. Plenty of asymptomatic or paucisymptomatic cases.
If you had 50 cases in April, it generally meant you had 50 sick people showing up at a hospital.
But today, 50 cases could just mean a job site was tested.
The value of a case has changed.
I'm talking blanket testing of job sites and families today.
The latter dwarfs the former by orders of magnitude. Texas ran 225k tests in the last week. Two months ago? We had run 225k tests total. From the start of the outbreak.
An example:
https://www.kbtx.com/2020/06/16/55-construction-workers-on-texas-am-campus-test-positive-for-covid-19/
One job site at A&M. 153 tests. 55 positives. But only six symptomatic cases. One brief hospitalization.
Quote:
All that said, the proportion of all tests made up by "blanket" testing of at-risk populations compared to the number of people seeking tests (either due to illness or due to possible exposure) is very small.
Correct. But it creates non-random samples that boost positives.
And as I said, there is the larger issue of "potential exposures" seeking out tests now because they know they are available vs two months ago when they wouldn't even bother unless they were sick. Plenty of asymptomatic or paucisymptomatic cases.
If you had 50 cases in April, it generally meant you had 50 sick people showing up at a hospital.
But today, 50 cases could just mean a job site was tested.
The value of a case has changed.
There isn't a clean dividing line in time between different populations seeking tests. There is more testing going on today, but it's more of all groups, not a replacement of one group by another. But you're right, there is definitely a much greater percentage of tests running through my lab for which the response at the time of testing is "no symptoms".Keegan99 said:
You're talking blanket testing of closed, at-risk populations two months ago.
I'm talking blanket testing of job sites and families today.
The latter dwarfs the former by orders of magnitude. Texas ran 225k tests in the last week. Two months ago? We had run 225k tests total. From the start of the outbreak.
An example:
https://www.kbtx.com/2020/06/16/55-construction-workers-on-texas-am-campus-test-positive-for-covid-19/
One job site at A&M. 153 tests. 55 positives. But only six symptomatic cases. One brief hospitalization.Quote:
All that said, the proportion of all tests made up by "blanket" testing of at-risk populations compared to the number of people seeking tests (either due to illness or due to possible exposure) is very small.
Correct. But it creates non-random samples that boost positives.
And as I said, there is the larger issue of "potential exposures" seeking out tests now because they know they are available vs two months ago when they wouldn't even bother unless they were sick. Plenty of asymptomatic or paucisymptomatic cases.
If you had 50 cases in April, it generally meant you had 50 sick people showing up at a hospital.
But today, 50 cases could just mean a job site was tested.
The value of a case has changed.
The blanket testing of closed, at-risk populations started two months ago but has continued throughout, ramped up throughout, and continues to increase. Those populations also include staff, which typically are not considered "at risk" from the perspective of who's most likely to end up in the hospital.
Totally agree with your last example. The point I was trying to make is that extrapolation to the wider population of the 50 tests then vs 50 tests now scenario would be expected to lower the positive test percentage. But we're seeing the opposite. That suggests the rate of infection in the population is outpacing the "dilution" of the testing pool with blanket testing.
oglaw said:
Just watched Sylvester Turners pc here in Houston. Says in the last two days have had over 1700 positive cases. Then says testing on these cases was done between June 9th -17th. Can somebody remind me what was happening before and during that time?
Hospitalization capacity is the focus now.
How many are now in the hospital non COVID because they delayed doctor
PJYoung said:
Hospitalization capacity is the focus now.
Sort of.
The problem is there are too many variables and data is not comparable over extended periods of time.
First we tracked cases, but with increased testing and a greater population tested (i.e., not the sickest), that's not comparable.
Then we focus on deaths, but we find out the impact is greatly shifted towards those in LTC and higher age. One outbreak doesn't reflect the impact to society.
So now we've arrived at hospitalizations. However, we've introduced elective procedures into the mix and there are anecdotes of those already admitted testing positive. Further, length of stay is also extending - is this because we are treating earlier, know how to better treat, incentivized in other efforts?
The problem is we've been so focused on letting metrics make our decision rather than analyzing the risk profiles of age groups. We could have 10,000 cases tomorrow with an average age of 32 and that would be less impactful than a 200 person outbreak in a LTC facility. And until we face clear data (as allowed by HIPPA), all this is theoretical conjecturing.
Some humans are good at evaluating risk.
The majority are not and are fearful animals.
The majority are not and are fearful animals.
yukmonkey said:
Some humans are good at evaluating risk.
The majority are not and are fearful animals.
Really. In my experience humans are extremely overconfident and almost always underprice risk. The housing crisis being an absolutely perfect example. Or what's happening to unconventional E&Ps right now. I mean, I could go on for days on risk management, because that's a big part of my job.
But I'm sure you're brilliant at evaluating risk and not a fearful animal
You started a thread for an article claiming we may lose immunity in 2-3 months despite zero confirmed instances of someone getting the virus twice. Perhaps you're not so good at the risk management thing.
Your extreme pessimism is so tiring. It oozes out of every novel you post. Please take a break, dude.Gordo14 said:yukmonkey said:
Some humans are good at evaluating risk.
The majority are not and are fearful animals.
Really. In my experience humans are extremely overconfident and almost always underprice risk. The housing crisis being an absolutely perfect example. Or what's happening to unconventional E&Ps right now. I mean, I could go on for days on risk management, because that's a big part of my job.
But I'm sure you're brilliant at evaluating risk and not a fearful animal
oglaw said:
Just watched Sylvester Turners pc here in Houston. Says in the last two days have had over 1700 positive cases. Then says testing on these cases was done between June 9th -17th. Can somebody remind me what was happening before and during that time?
I really want to understand the impact of the protests on the spike. This is key data as the spike appears to correlate exactly to the mass gatherings. If we can determine that the mass gatherings were a main driver (or not) it would be very informative for future risk mitigation decisions.
Agreed... and I feel like we should know in the next week or so if cases start to come off again. Also, seems like if deaths don't start to move up soon, then we can say we've entered a new paradigm in terms of deaths lagging cases for younger people. The next week or so should be really interesting.
There seems very minimal evidence the protests caused anything. Mask usage and outdoor events together make it very hard to spread this thing (which was already known). Indoor vs. outdoor settings unmasked has 20x less spread out of a few studies now. With effective mask usage at 80% and outdoors it's entirely possible there is nearly no spread whatsoever. In this way the protests could really be used to drive policy to some extent (like football games and other sporting events outdoors could happen)kag00 said:oglaw said:
Just watched Sylvester Turners pc here in Houston. Says in the last two days have had over 1700 positive cases. Then says testing on these cases was done between June 9th -17th. Can somebody remind me what was happening before and during that time?
I really want to understand the impact of the protests on the spike. This is key data as the spike appears to correlate exactly to the mass gatherings. If we can determine that the mass gatherings were a main driver (or not) it would be very informative for future risk mitigation decisions.
Here's an interesting study on impact of masking.
If we later find that the protests show no case load (likely) and bars/nightclubs/gyms have risk then you have some policy.
https://www.researchgate.net/publication/342198360_Association_of_country-wide_coronavirus_mortality_with_demographics_testing_lockdowns_and_public_wearing_of_masks_Update_June_15_2020
If we later find that the protests show no case load (likely) and bars/nightclubs/gyms have risk then you have some policy.
https://www.researchgate.net/publication/342198360_Association_of_country-wide_coronavirus_mortality_with_demographics_testing_lockdowns_and_public_wearing_of_masks_Update_June_15_2020
Cases, positive test rate, ER visits, hospitalizations, ICU occupancy and deaths are rising in Houston. Cases and hospitalizations have started on an exponential path, not on the same growth rate as early-stages NYC, but still >9% average daily growth. You can see from all the graphs that Houston could be on a path to fill up their ICUs in the short term if the growth rate continues. The problem is that there is no will in this city do anything to reverse the trend.Old Buffalo said:PJYoung said:
Hospitalization capacity is the focus now.
Sort of.
The problem is there are too many variables and data is not comparable over extended periods of time.
First we tracked cases, but with increased testing and a greater population tested (i.e., not the sickest), that's not comparable.
Then we focus on deaths, but we find out the impact is greatly shifted towards those in LTC and higher age. One outbreak doesn't reflect the impact to society.
So now we've arrived at hospitalizations. However, we've introduced elective procedures into the mix and there are anecdotes of those already admitted testing positive. Further, length of stay is also extending - is this because we are treating earlier, know how to better treat, incentivized in other efforts?
The problem is we've been so focused on letting metrics make our decision rather than analyzing the risk profiles of age groups. We could have 10,000 cases tomorrow with an average age of 32 and that would be less impactful than a 200 person outbreak in a LTC facility. And until we face clear data (as allowed by HIPPA), all this is theoretical conjecturing.
The other problem is that ALL of these statistics are backwards-looking. Getting a reported positive test case is the first sign we have of infection, but in reality that infection happened 1-4 weeks before that time due o the time to show symptoms, time to get a test, time for that test to be procesed, then time for that test to be reported. And that's just cases! Hospitalizations and Deaths are even further lagging reported. Every day the Houston Health department releases the age, sex, and date of death for all the people reported dead on that day. The day of death goes back a month in many cases.
So, if you're waiting for deaths to go up to a certain point before you make a change, you've already missed the moment where things got out of control. Even if you're waiting for hospitalizations to get to the point where things are unsustainable, you've missed the moment.
Again, accepting that NYC had a higher rate of transmission when they ultimately shut things down, they do have the best data I have found in terms of backdating all reported deaths back to the day of death. So even with the lag of reporting deaths taken out, there was a few weeks between when they shut down and deaths peaked. Consider how few deaths per day NYC had when they shut down versus their ultimate peak.
I am not advocating for a shut down, but I do wish people would do sensible things like wearing masks. I've been going into work 2 days a week and I would say less than half the people are wearing masks, even when they come to talk to me from 2 feet away or in meeting rooms when we can't maintain social distancing for 1-2 hours. It bothers me, not because I am worried about dying if I get CV, but because it shows lack of consideration and a thoughtlessness.
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