You might be interested in this piece by Helen Branswell at STAT:
The good news: The United States has a window of opportunity to beat back Covid-19 before things get much, much worse.
The bad news: That window is rapidly closing. And the country seems unwilling or unable to seize the moment.
Maybe I haven’t been playing close enough attention but I have yet to hear any workable strategy proposed by anybody that would “beat back Covid-19”. What I have heard is wear facemasks, social distancing, testing, and contact tracing. The missing step in that strategy is contact tracing to what end? I presume it is quarantine. That voluntary quarantines are ineffective should be obvious at this point, cf. Melbourne. Or New Zealand for that matter. If they do not work in Australia or New Zealand, how in the heck could they ever work in the U. S.? Can anyone imagine an involuntary quarantine at the scale required being maintained in the U. S.? I can’t. All you need to do is picture the list of prospective quarantinees in Chicago, largely consisting of blacks and Hispanics, to recognize that it would never work.
An additional complexity I have yet to see being addressed is how anyone could anticipate any national plan to “beat back Covid-19” without getting control over our southern border. Cross-border contagion will stymie any such plan. First, Mexicans contracted SARS-CoV-2 in the U. S. and brought it home. Increasingly and as the case mortality rate continues to rise in Mexico, it will be from Mexico to the United States. Lather, rinse, repeat.
I’m hoping that the official infection rate is way off, @5M, we’re a long way from herd immunity. The real number could be much higher.
Schools opening should drive it way up and hopefully not deaths in tandem. (Schools are not nursing homes). But I do see the risk, I just think we have to take it.
The IFR was estimated at 1% back in April; due to better treatments and a younger population catching it, the IFR is currently trending to 0.5%.
Given an official death toll of 160k; and more realistic death tolls at ~200k. The lower bound on the true infection case count in the US is 16 million and the upper bound is 40 million.
“Pandemic” is a misnomer. It’s from the Greek pan meaning “all” and demos meaning “people” but in pandemics all of the people rarely are infected.
What historical precedent should we use? In the pandemic of 2009, roughly 25% of Americans got sick. Prevalence has been estimated at 40% in 1968; the prevalence in the 1918 pandemic has been estimated at 30%.
I wish those submitting plans would present their assumptions along with them with the evidence supporting them. I think that many policymakers are assuming a prevalence of 100% which I suspect is rather unlikely.
” Or New Zealand for that matter.”
I thought I heard last night they had 3 cases. That is a failure? Anyway, it is clear that the lockdowns worked well, but we were never going to have indefinite quarantine. We have wasted the effort in some parts of the country by ignoring minimal actions needed to keep the spread lower, like masks, distancing and large indoor groups. And maybe we shouldn’t care too much about the places doing that. They can determine their own level of risk. However, they are chewing up supplies that the rest of us need. We can hardly test anyone anymore. Still difficult to come by more N 95s and other gear.
All that said, few people are interested in data driven or science based arguments so I guess we just wait to see what happens in the fall. If there is serious seasonality associated with Covid we could get hit hard in the fall/winter.
OT- Nice Wired piece criticizing Covid research efforts. I dont think that they really understand how expensive it is to run RCTs and also dont realize that hospitals are organized to compete with each other. Also the places that had the most Covid pts and the best opportunities for research were hit pretty hard so staff didnt have lots of extra time. Still, we should have better research now. I think we are starting to see better stuff now, like the nursing home paper, but we are nowhere near where we could and should be.
Steve
I don’t believe it is possible to assess the success or failure of a strategy without knowing its objective. If the objective is zero new contagions, it was a failure. If the objective was to minimize new contagions, that’s no objective. Minimize relative to what? It’s easy to claim success using counter-factuals.
The case is similar with lockdowns. What was their objective? If it was time-shifting contagion and mortality, they were a success. I don’t think those were the stated objectives. Was their objective to prevent the health care system from being overwhelmed? Then they succeeded but, at least at this point, so has lifting lockdowns.
Pretty easy to claim failure if you just make up your own goals also. I would say that the lockdowns have resulted in reducing mortality, time shifting and also gave us, if we had chosen to do so, time to prepare for the fall. The lockdowns did all of those. For me that is a pretty significant success. You are arguing that even though we achieved those things it doesnt matter because they were not the stated goals in every paper or article you read. In fact all of these were seen as goals, at least by those of us in the trade.
Conservatives dont believe that respiratory infections have second waves. The only reason to believe that is because you want Trump to lose. In reality we have many examples of respiratory viruses having a second wave. If Covid is new, then the combination of flu and Covid will really be new. The flu also affects a slightly different population so no idea how bad this gets. I have 15 ICU physicians. None of them talk about elections with me. They do talk about flu + Covid.
At this point the national plan appears to be denial. It wont happen. I really, really hope they are correct. It just sucks wearing PPE gear all day and it is harder to do everything. We are all afraid someone will die because we cant work fast enough and accurately enough in full PPE. Plus, at this point testing material and PPE should be dropping like mana from heaven. It sent. Still hard to find PPE, why we are making our own, and we cant find much in the way of testing reagents.
So when that 6 month old comes to the ED with a fever we are just going to have to guess. Of course if flu and Covid are not additive, or worse synergistic, then we will be OK. If they are, then I guess we just figure out whom to blame.
Steve
No, I’m arguing that the lockdowns have transmogrified from a short term measure intended to save the health care system from collapse to a self-justifying perpetuity.
Illinois’s number of deaths per day has been flat for a solid month now as its case fatality rate has declined. Restrictive measures are being increased and threats are being made about a return to lockdowns.
Youyang Gu of covid19 projections had an interesting tweet thread about the unknown, possibly unknowable role, policy interruptions have on virus spread. It seems like behavioral response may be largely independent, if things seem to be getting bad, people respond on their own, policy is often lagging. There is also the potential role of some type of immunity which is restraining outbreaks going too far, or essentially directing the spread to areas that previously did not have large outbreaks.
Helen Branswell should read it.
https://twitter.com/youyanggu/status/1292898685173534722
@steve, testing does not appear to be a problem in a lot of areas of the country. I think the turnaround time around here has slowed, and I think that’s a problem for a test to be used to isolate people who test positive. But a lot of people are testing around here without symptoms who need to work, travel, or get healthcare, and don’t care as much how long it takes.
This has been discussed among St. Louis Cardinal fans, who don’t have much baseball to discuss, and it does seem to differ from place to place. Some are getting 24 hour results right now.
‘Beat back COVID-19’ is just another slogan and a demand for increased funding by fearmongers intent on extracting the most out of the ‘pandemic’.
A disease that takes up to two weeks to become symptomatic does not lend itself to contact tracing, the contacts and recontacts become exponential too fast even for a near-hermit like me. The only way to even possibly attempt real contact tracing would be to chip and monitor everyone 24/7/365-1/4. I can see that happening on the next day to never, and I’m just talking about the production and infrastructure required to make the chips and the tracking system. And any attempt to force universal ‘vaccination’ of such a thing would start a shooting war. And what for? Hell, we don’t even have a reliable test for the bug or its antibodies.
I love science fiction and fantasy stories (at least the older ones). But I always know it’s not real. They’re acting as if what they want is possible. It ain’t.
which brings up a point I believe I mentioned a while ago but not lately. We can vaccinate our own population but we can’t vaccinate the entire world. At this point resistance is likely to be so strong as to hold it up as a solution is wishful thinking. There will always be tens of millions of unvaccinated individuals.
Which means the disease will be with us for the foreseeable future.
“@steve, testing does not appear to be a problem in a lot of areas of the country.”
Yes. Distribution is erratic. Turnaround time (TAT) for our outsourced PCR test is now averaging 48 hours, but the beta is large. 10 days is still not unusual. What is really bad is our in house fast test. Reagents are all being sent elsewhere. When they are in stock our lab has gotten very fast at this test, but obtaining reagents is totally unreliable.
“Illinois’s number of deaths per day has been flat for a solid month now as its case fatality rate has declined.”
You know that there is a world outside of Illinois? I think that we have already established that Illinois is exceptionally bad.
“The only way to even possibly attempt real contact tracing would be to chip and monitor everyone 24/7/365-1/4.”
No, as Tabarrok pointed out the other day, the “instant” tests (15-20 minute results) have a lot of false positives since they miss some people who are infected. However, it looks like they may catch almost everyone who is infectious. And these tests are, or can be, pretty cheap. The real problem would be having enough personnel who know what they are doing.
Steve
potential role of some type of immunity which is restraining outbreaks going too far
I keep reading about a T-cell response being found in people who have not been exposed suggesting to researchers that Covid-19 may not be entirely novel. If so we may be closer to herd immunity than statistics would say.
I prefer to deal with the specific, concrete, and what I know rather than generalisations about which no one really knows.
I have been saying that for some time. I have faulted Trump for not demanding more production of PPE and reagents for testing but I suspect a graver bottleneck than reagents is personnel. I doubt much can be done about that in the short term. IMO there is an underlying problem of trying to continue a system with mass consumption and artisanal production but neither political party is much interested in doing anything about that for fairly obvious reasons.
“It seems like behavioral response may be largely independent, if things seem to be getting bad, people respond on their own, policy is often lagging.“
Which is why it became clear to me from early days that all but the most draconian, and therefore unsustainable, strategies We’re doomed from the start.
“ There is also the potential role of some type of immunity which is restraining outbreaks going too far, or essentially directing the spread to areas that previously did not have large outbreaks.“
I doubt the virus is using Google maps but this is why the Northeast was hit early and the southeast was hit late. But the southeast was simply shifted in time. Right now it seems that it is cresting and on its way down.
The arrogance of the medical community, and the vile motivations of the political class have been breathtaking. Meanwhile, Sweden got it right.
We’ll see. If prevalence and mortality begin to increase in Norway and Finland but remain flat or declining in Sweden, I would say you were probably right. Presently, there are a few signs of that but they are very weak signs.
BTW I think that dealing in aggregates, as we are tending to do with respect to COVID-19, is very misleading and the more aggregated the aggregate the worse it is. State and local level statistics are more revealing than national ones.
“State and local level statistics are more revealing than national ones.â€
I think that’s absolutely correct. And you have commented numerous times that the one size fits all strategy is a mistake. Even in a country like Sweden, relatively homogenous, I’m sure the statistics vary by location.
If I run across the graphics for Sweden again I will link them. The outcome is undeniable.
You can go here and quickly put in the SC, GA, and FL case rates and see the quick rise and then fall in cases. Interestingly, the peak in all three states seems to be about 4-6 weeks after the uptick. I don’t know why, but I doubt its random.
https://www.bing.com/search?q=georgia+us+covid+trends&form=ANNTH1&refig=23494f606bf645c89cf59ccdcabe2968&sp=-1&pq=georgia+us+covid+trends&sc=0-23&qs=n&sk=&cvid=23494f606bf645c89cf59ccdcabe2968
With the fall in the case rates be sure the argument and media reporting will now shift to sensationalized school stories. However, the Savannah parochial schools opened a couple weeks ago – in person – and they aren’t ordering body bags.
Texas is ordering body bags. I asked you where you thought it would peak and you never answered.
https://www.forbes.com/sites/nicholasreimann/2020/08/12/texas-reports-more-coronavirus-deaths-in-a-day-than-any-state-outside-northeast/#23fc7e943836
“However, the Savannah parochial schools opened a couple weeks ago ”
Lets just review so that everyone knows how the disease works. First the number of people infected goes up, then the number hospitalized increases. Then you have deaths. Since the average person is in the hospital 2-3 weeks before they die you expect 4 weeks or so until you expect deaths to start increasing. So even if Covid is spreading like crazy in Savannah it wont show up in deaths for at least a couple more weeks.
Steve
And then some Georgia schools needed tossup down again after opening. Note that in the article we found out the girl who made the photos public is receiving threats over it. We would hear no end of cancel culture if this was some leftie group.
https://www.npr.org/sections/coronavirus-live-updates/2020/08/10/900846570/georgia-high-school-temporarily-switches-to-virtual-learning-after-9-positive-te
Steve
Sweden vs Belgium vs NY (snicker) There’s a lot of these type graphs going around.
https://fee.org/articles/why-sweden-succeeded-in-flattening-the-curve-and-new-york-failed/
NYC population 8.4 million. Stockholm 1.5 million. NYC twice the density. Now compare Sweden with its neighbors, a more similar population and environmental characteristics.
Steve
So I will bite; there is good evidence that deaths (as marked by the rolling 7 day average) are peaking or already peaked.
On isolation — here is an article today about its importance and basically selling “forced isolationâ€. Sigh, I accept at this point, forced isolation will never happen in this country and even incentivized isolation will not be tried.
https://www.bloomberg.com/news/articles/2020-08-13/forced-isolation-may-be-the-only-way-to-stop-resurgence-of-virus?srnd=premium
I think the one strategy no one is talking but should be considered is to deliberately infect people with one of the mild coronavirus. There is strong and getting better evidence that they confer cross-immunity.