One of the doctors on one of the press conferences (sorry, can't remember which one), said that she would prefer the term "physical distancing" as well for the same reason.
She said that "social distancing" is a medical technical term that doesn't translate super well to the public.
> She said that "social distancing" is a medical technical term that doesn't translate super well to the public.
Which is 100% the opposite of what I in my daily life observe: everyone, young & old, private & work, calls it social distancing.
It addresses the issue better too, then the "proposed" physical distancing. When you pass people physically the (need and) possibility to keep that 2 meters is often impossible where as while socialising it very much is.
Yeah but that's the point. The use of this term makes people think that this is simply about socializing when it is not. The fact that it's hard to stay 6 feet away from someone else in a city while outside is why people should stop going outside unless they absolutely have to. It's not enough to simply stop hanging out with people, and this idea can't be communicated well with this term. Many people I see outside make no attempt at distancing themselves from strangers they are passing or while shopping.
I travel in full bus squeezed tight with other people, but I am not socializing so I should be then fine, right?
This kind of double meaning will literally kill people out there. Physical distance is a clear term. Social can and will be understood in many ways. I can imagine somebody thinking if he isn't on facebook on phone, he is distancing socially.
right. everyone is using the term, but nobody is abiding by it. i see tons of people still within close physical distances of each other. or people walking up on you in the supermarket. there is literally nothing confusing about physical distancing. social distancing has a lot of ambiguity.
It's also just a disturbing use of language. Human beings are social creatures and derive a ton of benefit from our relationships with other people. If anything we should all be coming together socially to support each other through a difficult time, while trying to maintain an appropriate physical distance from one another.
While you're correct in the term being wrong, I don't think anybody misinterprets it. Moreover, the recommended 2m/6ft gap makes it clear that we are talking about physical distance, not purely social.
> Although they are thought to be only about half as infectious as individuals with confirmed COVID-19, individuals with undetected infections were so prevalent in China that they apparently were the infection source for 86 percent of confirmed cases.
Figuring out how to manage this risk so we can return to society / open venues at a much lower risk of infection (while not giving all of our data to the government) is a challenge with which maybe some of this site's audience could assist.
> For every confirmed case of COVID-19, there are likely another five to 10 people with undetected infections.
I wish this was reflected more in the numbers being presented by various authorities. There is just too much confidence that confirmed cases are representative of the spread of the virus.
This unknown denominator can change mortality rate, and severe case rate by orders of magnitude.
Because of the dearth of testing in the US, it seems highly likely that far more people are infected, and maybe even recovered.
I'm fairly certain I've just recovered from COVID-19 given my symptoms, but can't get tested here in Colorado. By the time I am able to get tested it seems likely that I won't be shedding the virus any longer, and will test negative.
From the number of deaths you can crudely infer the number of infected, assuming the mortality on the Diamond princess and in South Korea (1%). Demographic effects are in play that don't make this quite right.
Totally agree. That’s the number I’ve been watching most to get a sense of how many total are infected for different regions e.g. 1 death today = 50-200 people were infected 2 weeks ago.
Then once you have 2 weeks of death data you can't get the transmission rate. Finally you could go to Seattle and sample 50k people to see how many were infected with a serology test to further refine the 1% assumption
Applied to US data... 21 deaths today. 14% daily increase, doubling time of 5.2 days (2 week lag; hopefully social distancing has lengthened it since then). Assuming 1% fatality, that would mean 2100 "actual" cases two weeks ago. Assume no social distancing and doubling time of 5.2 days, or say it doubled three times in two weeks and you get 16,800 cases today. But we've already got 11k confirmed cases today, and I can't believe our confirmed count has already caught up that much.
I dunno, maybe that's an indication that the fatality rate is lower than 1%. Or that dying takes longer than 14 days.
This gives them a higher median than the general population, but a lower density of the truly old. And deaths are strongly clustered among the truly old.
South Korea went over 1% fatality yesterday, and they're seeing a rise in numbers again... they might not be testing enough either, so natural fatality could still be lower. (Maybe they should have shut down for two weeks.)
If conversations with my family are any indication, yes. People see low-looking numbers and place names of faraway cities in headlines and think it isn't serious.
After making them think about incubation times that starts changing, but it takes a conversation.
What is common knowledge depends very much on who you're common with.
The German virologist Christian Drosten mentioned in his daily coronavirus update that some specialized labs at least in Germany are able to do an antibody blood test.
There are also some commercial antibody tests, which have some error rate and as all antibody tests can identify the virus after 7-10 days after onset of symptoms.
A comment by Bradley Kuszmaul on that blog post gives a good reason why the scenario presented is not likely:
> Given the amount of testing being done in South Korea, we can rule out that there are a lot more people currently infected than we know about. And if there were a lot more people recovered than we know about, we would have seen deaths earlier in South Korea, since South Korea started their testing earlier. I suspect there's a lot more evidence that rules out the "fast and stealthy" hypothesis.
If the people who recover after mild/minimal symptoms do so within <5days (hypothetically), but people who have severe cases take 10 days to get severe, wouldn't that account for "would have seen deaths earlier in South Korea"?
Yes, that would. But what evidence do we have for that? I believe you're engaging in special pleading: appealing to an exception because it fits your conclusion.
The type of testing S Korea does require the Virus to be present in the body and only work in a certain window of time. Once a Serological survey is done, we’ll know the true extant.
Given the amount of testing being done in South Korea, we can rule out that there are a lot more people currently infected than we know about
That's a very strong claim. SK has done a lot of testing relative to most places but it's still:
a) A tiny amount relative to the population
b) Not a random sample of the population
Their tests were done at testing clinics that people had to take themselves to, which in many cases had large queues and generally you'd only go there if you actually felt really sick because otherwise why would you expose yourself to lots of probably really sick and infectious people?
So far there's overwhelming evidence that either a lot of people have the disease without symptoms, or the tests have a very high FP rate. There's also a lot of people writing like the person above, who are sure they've had the disease based on symptoms but were never tested. South Korea wasn't deploying their tests on people who were asymptomatic, they are doing the same as everyone else: testing people who present for testing or who otherwise seem to need it.
China tested hundreds of thousands of people in provinces with known cases, and found very little evidence of asymptomatic circulation. See my comment from a week ago, https://news.ycombinator.com/item?id=22475853, which quotes Bruce Aylward, an assistance director general and epidemiologist for the WHO.
Our current evidence points to there not being millions of asymptomatic people.
I see your HN comment from 2 weeks ago and raise you with a point in this article lifted from a recent Science paper. Namely, ...individuals with undetected infections were so prevalent in China that they apparently were the infection source for 86 percent of confirmed cases.
This is strong evidence of asymptomatic circulation.
This conclusion is not in contradiction to the evidence behind your previous comment. In mid-February with ~60k confirmed cases that would be 300-600k asymptomatic ones. Which means that China did not have millions of asymptomatic people at the time. And so it is no surprise that a broad testing regime failed to find what did not exist at that time.
However what it also means is that as the number of confirmed cases skyrockets, it WILL be true (and possibly already is) that the number of asymptomatic cases will be in the millions.
And has the testing story improved relative to the need?
Also from the article and the same Science paper, For every confirmed case of COVID-19, there are likely another five to 10 people with undetected infections.
He did, and the poker on the show was generally abysmal. But partly for the ‘I’ll see you... and raise you’ prevalence in drama is that it creates a more dramatic situation. The dramatic effect is the very thing that can be taken advantage of in poker, and is why there’s a rule at most professionally run tables that what you claim, on your turn, is what you must do. Once you call, you can no longer raise no matter how much you want to.
Though the bigger reason for not allowing it, is that it can really add confusion and slow down the game when a person says call and the next person now has to wait until they’re sure the current asshole isn’t going to say ‘and raise’ before they can act.
Oh, and keep in mind that poker is full of assholes who will do all kinds of anti social behavior to gain an edge. So the fact that this is a standard rule really gives some idea as to just how annoying it is to the poker community.
But the phrase remains a common idiom. And in an internet discussion like this, the rationale that makes it bad form in poker does not apply. I cannot see anyone's reactions until after my action is complete and I hit "reply". And therefore I cannot gain a read and final decision based on my incomplete first stage of the action.
I haven't been able to make heads nor tales of his logic. In Guangdong province, at the peak of the outbreak, 0.47% of people tested were positive. Guangdong province has a population of about 110 million people. If that was a representative random sample, that would mean a lot of infections, so he's clearly relying on the fact that it's a sample of people who saw a doctor because they had symptoms. Except that I don't see how you can use that to say anything about asymptomatic cases. It just doesn't make sense.
South Korea is far from the only place COVID-19 is present, and most of the rest of the world tests barely anyone, even if they have symptoms and would like a test, either due to lack of resources or formal policies of only testing hospitalised cases. I can detect my infection, but statistics on the rate it is spreading in the UK can't.
It's also pretty well established that even in symptomatic cases where testing is widespread the disease has a multi-day incubation period.
It's possible (likely imho) that there is some missing factor that we have yet to discover that explains the funky nature of the data. Something about the people rather than a property of the disease. Almost like an allergy: peanuts are quite fine for everyone to eat, except those with severe peanut allergies.
What we do know is that it can't be quite "there were zillions of people infected so when we talk about 1% IFR really it's 0.01% so everything is fine", because there are accumulating bodies in various localized places around the world. There's nothing we know to say that pattern wouldn't repeated everywhere.
Yes, but I don't think the PCR test is testing for that, currently. It's looking for pieces of viral RNA that are present in your blood. Antibody serology tests aren't readily available anywhere yet. In fact, the CDC is still developing theirs.
Can't edit this, but to be completely correct, it's looking for viral RNA present in samples, not necessarily blood. More commonly sputum or respiratory samples when it comes to coronavirus.
The current testing that's reported in the media is an antigen tests, that directly tests for the presence of the virus. Once your viral load comes down, you will test negative for the virus. Hence the reason people are declared recovered after having two negative tests in a row.
A test for the presence of antibodies is a serology test. The last time I looked into it (~one week ago), serology tests were under active development, but had not been deployed anywhere in a widespread way.
So, right now the testing will only tell you if you currently have the virus. Coming relatively soon are tests that will tell you if you previously had the virus.
It doesn’t get called out, but when I read about the Spanish Flu I can’t help but feel that certain genotypes got very strong selective pressure.
Conversely, there are probably genotypes running around today that are completely asymptomatic to Covid. You could have whole families shedding virus wherever they go and never even know what they’ve done.
And one of the ways we learn about immunology is to study people who are immune or asymptomatic, so it’s not just about quarantining people that we need to identify infected individuals.
Quick recombination so that a beneficial gene can spread without losing genetic diversity of the population is is one of the benefits of sexual reproduction. And immune resistance to new threats is one of the top reasons why we need this capability.
In fact we broadcast signatures of our immune systems in pheromones and women are attracted to the smell of men whose immune systems are different from their own. This improves the probability that the children will be resistant to a wider range of possible diseases.
I think the term "asymptomatic" gives a wrong picture of the severity of the disease, when various authors use it to mean "testing positive before disease onset" or even outright untested due to testing criteria and availability.
1. The current test is designed for the scenario that someone shows up to medical provider with symptoms. Test answers the question: are the symptoms caused by COVID-19?, quite reliably (negligible false positives, low false negatives).
2. The current test won't produce terribly useful data in someone without symptoms (either before, or after the illness). This is why for example certain well-known political figures saying they have been tested and cleared after potential exposure is not very meaningful.
Therefore ideas like: let's randomly test the population to see how much of this is out there, and I had what I think was COVID-19, I want to be tested to confirm, are not practical.
A test that can determine if someone was infected in the past is in development still.
Number 2 is misleading, Trump got tested to quell opponents' fear mongering about his health. That doesn't make it more useful scientifically but no one thought it was happening for science anyway.
I'm curious about the technical reasons for what you're saying. Can you say more? Is it a problem with figuring out the false negative rate for people without symptoms?
If you test on antigen that matches the virus, then that will return a negative result in the very beginning of infection and after recovery.
If you want accurate numbers for statistics, including people who never had symptoms, you can do antibody testing on a random sample of population, that will indicate people who had the disease - but that's kind of too late for that particular location and those particular patients, that's for epidemiological studies and helping other locations. I recall reading about one such study for Covid, but I don't remember which country did it.
I heard in an interview with Michael Osterholm, that scientists in China started testing people who had come in contact to those who were sick in the early days of the outbreak, and found people who were not showing any symptoms, but had a large amount of viral load in their throats they were actively breathing out.
The first one - if you have the virus, it's multiplying in you and you're infectious then that test will detect it (during that time) no matter if you have severe symptoms or light symptoms or if for you the infection doesn't have any symptoms that you would notice.
Not to mention it is still extremely difficult to be tested in the US. Yes, doctors can test you, but you basically can’t get a test unless you have all of the symptoms and are sick enough to need to visit the ER.
> I'm fairly certain I've just recovered from COVID-19 given my symptoms, but can't get tested here in Colorado.
I'm glad you're better. Please be careful going forward, though. You shouldn't assume you have an immunity unless you have a positive test result.
Even with the strict pre-test screening that focus strictly on high probability patients, some locations are reporting very high (90%) negative test results from assumed cases.
It's best to continue practicing safety cautions as if you did not have a COVID-19 infection
We are also not 100% certain that having the virus once grants immunity.
People have tested positive again after appearing to make a full recovery. While these results are probably better explained by remaining infected and becoming asymptomatic for a period then getting symptoms again, we can’t yet rule out the possibility of reinfection to my knowledge.
https://www.latimes.com/world-nation/story/2020-03-13/china-...
I've heard this before and it's the most troubling. Humans have adaptive immune systems. When our bodies first encounter a virus and a while blood cell successfully attaches too and breaks down a virus, it should either replicate or release the right activator proteins that will aid in breaking down the virus.
Vaccines are all about tricking our immune system into preparing those specific antibodies before an infection occurs, so it can stop it quickly. If reinfection is true, what does that say about the nature of this virus and how difficult it is to create a vaccine? Are there other viruses that reinfect like this?
I've also heard it, but I think we need more data.
If true, it would go against all priors for how humans build immunity to viruses - especially coronavirus (common cold).
There may be a time limit to immunity, but having none at all after recovery would be rare indeed.
Without significant evidence (more than one somewhat anecdotal case of re-emergence), there's little reason to assume the body doesn't "remember" the virus after recovery with antibodies.
Seems like unnecessary FUD to spread that idea around without more evidence.
> If true, it would go against all priors for how humans build immunity to viruses - especially coronavirus (common cold).
Another possible implication is that there could be multiple strains in circulation, not that the first strain wasn’t immunized against.
You are totally right that we need more evidence and this is very unlikely to be happening. But, I am trying to convince OP to continue to be cautious even if they appear to have recovered, both for themselves and for others. It seems reasonable to be cautious. People have presented apparent recovery only to go on to appear infected again.
Yeah, I keep getting stuck on the early test positivity stats in the US. Over the last two weeks, only the most urgent cases were getting tested. But even then, something like 92 - 98% of tests were negative. There are a lot of illnesses out there that are presenting as close enough to COVID to concern health workers, even when it's not COVID.
People don't talk about it much yet, but we really need an immunity test to determine if someone has antibodies.
It seems like you're pushing back on the CFR, possibly driven by trying to pessimize the need for action.
In the small Italian city of Nembro in Bergamo, 0.6% of their entire population has died in the last 12 days. That's 70 people in a small town of 11,000 — typically there are fewer than 70 deaths every six months. Now we're certainly _overestimating_ the denominator and still getting a number that's larger than the flu. While the numerator is also an overestimate (because it includes deaths not related to COVID-19), their healthcare system is stretched beyond capacity due to the virus leading to difficulties treating all illnesses and traumas.
You should include demographic information, since it is relevant to your argument:
[Nembro] Age Distribution (E 2019)
0-9 years 1,018
10-19 years 1,191
20-29 years 1,179
30-39 years 1,192
40-49 years 1,640
50-59 years 1,850
60-69 years 1,465
70-79 years 1,181
80+ years 810
> In 2010, there were 119,551 people residing in Bergamo (in which the greater area has about 500 000 inhabitants), located in the province of Bergamo, Lombardia, of whom 46.6% were male and 53.4% were female. Minors (children ages 18 and younger) totalled 16.79 percent of the population compared to pensioners who number 23.61 percent. This compares with the Italian average of 17.88 percent (minors) and 20.29 percent (pensioners).
Cool, thanks for the data. Looks like their population is 30% over 60, whereas the US (for example) is 20%. Even if we assume _every_ death is someone over 60 (it's not), that'd adjust the percentage to 0.4% in a generic US town.
If you compare the 80+ group (which has a much higher CFR), this town has closer to three times the percentage of the US population.
On top of that, this is in a region of Italy where the healthcare capacity has been completely overwhelmed. That's going to be devastating for the prognosis of an older person who needs a ventilator.
Since Feb 25 there have been 91 deaths with positive COVID-19 diagnoses. In total there have been 330 deaths. I'd be very curious what the age breakdowns are.
Anyhow, this was just a small example that shows that we're already seeing significant mortality relative to the _total population_ and not just by confirmed positive cases.
People are mostly looking at the death count, which is still very low for a pandemic.
It's hard to convince people to sacrifice so much when they look outside their windows and see nothing special, plus read the news and find that some bomb/earth quake/accident somewhere killed more people in a day than the corona virus in a month.
There is a blood serum test already available that can determine if you had coronavirus (by testing for COVID-specific antibodies produced by your body). I'd say wait until the pandemic dies down and then go get that if you're curious.
There's going to be some very interesting population studies done post-pandemic to determine exactly what percentage of people had asymptomatic cases (and thus could have unknowingly been contributing to the spread).
>I'm fairly certain I've just recovered from COVID-19 given my symptoms, but can't get tested here in Colorado
Wow that really sucks, you must be the first HNer, also symptoms include fever and dry cough
> Because of the dearth of testing in the US, it seems highly likely that far more people are infected, and maybe even recovered.
It's not just highly likely, it's absolutely certain. I recommend the recent Khan academy video on this if you want to understand the math and you want a healthy dose of panic:
> This unknown denominator can change mortality rate, and severe case rate by orders of magnitude.
The two best data points we have would be South Korea and the Diamond Princess cruise ship. Both of these groups have high rates of testing and both have had enough time that we can know how the most of the cases played out, and in both cases we see the death rate at about 1%. This doesn't take into account possibly different age group distributions. The cruise ship probably has less children and less 80+ people than on typical distributions.
Additionally both the Diamond Princess and South Korea cases assume ready access to medical treatment. If the medical system is overwhelmed we will see much higher CFR due to critical cases not receiving adequate care.
Fascinating that they recommend you take OFF masks while on things like crowded BART trains and airports (I had lots leftover from forest fires) if you are "healthy", even though that might mean you are asymptomatic, or not yet diagnosed etc.
Despite claims masks (with good adherence to wearing) are highly effective - primarily by reducing hand to mouth/nose contact, secondarily as a direct barrier. And surgical masks are dirt cheap.
It looks like other countries went big on mask production and wearing - be very interesting if the claims that you should NOT wear masks if "healthy" even on crowded BART cars etc checks out in the end.
There is really low number of infected people and also low density of people walking outside in Czech republic. I am not sure you can make a lot out of it. I think requiring face covers outside is more panic than reasonable measure.
I live in Prague and when I go outside I meet someone once in few minutes and majority of the people are not wearing face cover despite it is required. Mostly they have it prepared on the neck to put it on when they go inside. One doctor in TV did not recommend extensive usage of face masks as cheap or improvised masks tend to get wet after 20 minutes. This significantly reduces their effectiveness. Risk of being infected outside is really low unless you are in crowded area.
My understanding is that the urging to not wear masks when healthy is solely due to preserving masks for people who actually need them (sick people and doctors) given a limited supply, not because they're ineffective when healthy.
I think the motivation for this change is to prevent employers from trying to maintain "business as usual" operating conditions.
Anecdotally I've heard of places where the company has made no policy changes about sick leave or what employees who are feeling ill should do and, therefore, hourly workers keep coming in to work with "flu-like symptoms" or days after having had symtpoms because otherwise they don't get paid and could get fired.
I really wish we had widespread testing, or even a test to see if you had COVID-19 in the past. Before we had all been so focused on this thing, my child's friend came back from China in December, and she had a upper respiratory illness with a fever. Then my whole family and I suffered under a low-grade fever and upper respiratory illness for a week or so in early January. I have no idea if it was COVID-19, but it is hard not to wonder.
That's fear talking. Why would you want to be tested? What would you do differently? You had a virus, now you aren't sick any longer. You aren't making other people sick, either.
Well, for one thing, if people can be tested to confirm they had and recovered from the virus and therefore have some immunity to it, those people can more safely assist people who are currently ill and move about more freely in society (unless they are still at risk to transmit the virus to others, of course).
You cannot assume that recovering from the virus confers immunity, especially when "the virus" is already "two strains of virus" (and will almost definitely end up mutating more before this is over).
It certainly confers immunity for a short period of time. How long that immunity lasts for is unknown, but it’s not unreasonable to start with an assumption of “at least a few months”.
There’s also not strong evidence that there are two sufficiently different strains. Viruses experience small, mostly meaningless, mutations with great frequency. The research talking about S and L types are actually just an arbitrary categorization of many different mutations of the virus.
The first confirmed case of community contracted COVID-19 in the United States occurred in MY community, and was treated at MY place of work. So, no it is not entirely fear talking.
Given the ongoing statistics coming out of South Korea (which I'd suggest are the most accurate) where only one person under 50 has died. It seems that these safeguards would be best spent around those aged 60+ and perhaps those 50+ with other health issues.
Those who are younger seem to be mildly affected for the most part and could go on with their lives as long as they didn't interact with the older population.
Deaths are all fine and good, but do you know statistics on hospitalizations for the under 50 crowd? Those are the resources that are important - even if the under 50 doesn't die from it but requires hospitalization that's both a resource that can't be used by the above 50's, as well as a possible death if there isn't a bed for them.
Yeah, but you have to remember, people 20-44 make up more something like 37% of the population. So that actually makes those age groups pretty unlikely to be hospitalized. Around half the chance relative to their share of the population.
In contrast you look at age >=65, they make up 12.4% of the population, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths.
It is kind of funny how desparate some boomers are to push "this virus affects you zoomers too!!!" angle, probably as a response to the "boomer remover" memes. Or just a weird boomer "well if we're going to die, we're gonna take you with us!" thing. I guess understandable but generally reflects the hateful ageist attitudes of boomers towards younger generations. The avocado toast mindset.
Yes, it's still lethal at 0.1% among younger populations. 0.1% doesn't mean nobody dies, it means very few die. This is a disease that primarily affects older populations. Some people are searching for a reason to hope it'll take their kids too.
> as well as a possible death if there isn't a bed for them.
_Two_ possible deaths, if/when we get to the point that hospital systems are overwhelmed. "Under-50s survive when they get dedicated medical care and full access to medications/ventilators/etc they might need" is a _very_ different picture from "Under-50s survive without adequate medical care".
I use their daily updated website* for statistics which don't break down age/hospitalization.
Deaths will come either by the coronavirus and/or by the poverty created by the extreme social measures suggested by the ongoing mania. I tend to believe the latter will kill more and be longer lasting.
A lot of people have responded here - the ICU rates seem very very high for even the young and healthy - which tells me people are going to die as the beds get swamped.
There's already a softening to people's needs in regards to healthcare and the economy - can you imagine the US seriously discussing any form of UBI 3 weeks ago?
While I understand it's going to be a tough hole to get out of, the economic levers seem like they'll be easier to adjust, and are adjustable on a longer timeline, than the acute condition of "not enough beds".
The United States is not necessarily headed down the direction of "not enough beds"* that seems to be fashionable thinking today. There is advance warning and precedent far more information already at hand.
> even if the under 50 doesn't die from it but requires hospitalization that's both a resource that can't be used by the above 50's,
Frankly this is a wrongheaded position from a triage perspective. The macro-socially correct answer is that you should prefer the person who still has 40-60 years of life over the person who is going to die in 5 or 10 or 20.
It's a very boomer-centric perspective that youngs are somehow "stealing a bed" from a boomer. But that's nothing new from that generation. Really it's the other way around, treating grandma is stealing a bed out from underneath her grandkid and leaving them to die.
You may find that crass or distasteful, but that's the reality of triage. You don't do triage until you don't have enough medical resources to go around, but then you have to make choices.
In Italy, they won't admit 70+'s to a hospital at all. That's how triage works. That's the correct way for triage to work. It's harsh but true.
I understand triage, but triage is only triage because it has to be - if we can prevent that from happening we should. That's my point. Let's try as much as possible to prevent these life or death scenarios from occurring. For young people to act in a way that will get us into a triage situation is an incredibly selfish act that is preventable.
We're going to be in a triage situation regardless. Yes, people shouldn't be doing stupid things that increase risk, but is it the cause of the problem, would not doing it fix the problem? No.
Singling out particular groups of people for doing stupid things at one point in time isn't really fair. There are olds who keep going to church as well, they have just as much culpability here.
But it's much more popular to point the news cameras at some kids on spring break than a church packed shoulder to shoulder with boomers. That generation makes a point of shitting on zoomers every chance they get, and if you point it out they cry about ageism as if that's not exactly what they were doing themselves.
It's "avocado toast" playing out all over again.
(in all of these cases, I think the states are rightfully clamping down on what's allowable. My parents spent the last two days whining at me that their reservation at a florida state park got cancelled. So that spring break thing probably won't repeat. And the maximum size for a public gathering is coming down rapidly... states were setting limits like 250 a week or so ago, now that number is 50 and some states are going to 5 or 10. This problem is basically solving itself. But are you being ageist about it by singling out zoomers as being some unique problem here? Yes, absolutely.)
I'm pushing back against the ageism. The initial claim was "Those who are younger seem to be mildly affected for the most part and could go on with their lives as long as they didn't interact with the older population." I'm saying that's not true and irresponsible. Absolutely everyone needs to be held accountable for being irresponsible.
The virus is ageist (it is also sexist and doesn't like smokers much), not the sentence. Specifically, which part of that sentence do you believe is not true?
You may subjectively claim irresponsible, but the measures being taken across the entire population are not without consequences.
Not to be a hardass, but I'd prefer real information not babyfood. Something akin to "Currently predicted US deaths without social distancing: X. With social distancing: Y. Potentially recurring each year"
Social distancing of the entire population also slows the acquisition of immunity with zero and low risk age groups, which drags the whole situation out months longer.
It might even be logical with the above 3 steps in place for zero/low risk group to deliberately seek out the virus. This grants immunity quicker, and if they become sick, they can receive treatment whilst hospitals are still underwhelmed.
Speaking personally I would happily accept a strain of the virus considered to be low risk, then go into 14 day quarantine, if it meant I could afterwards work and socialise without any lockdown or restriction.
My hope is that the thinking is that we have a very disruptive social distancing phase (now), in order to give our medical system time to ramp up to handle much higher surge capacity, and then transition to a more focused isolation / social distancing policy (maybe based on regions or outbreaks).
Italy is proof that we need to slow this down for months longer. Our medical system was projected to only have enough N95 masks and related supplies for two weeks of a pandemic... sure enough, we're having to cobble together makeshift supplies MacGyver style here in Washington.
In a couple weeks, more of our front-line medical staff will start getting sick (the first case just occurred here), and requiring their 14-day quarantine... taking them out of rotation and adding even more strain.
It's going to get bad. We have to slow this down, to reduce the mortality rate. Or that 1% number people are throwing around is going to look like roses.
I wonder if mildly symptomatic healthcare providers should treat patients known to have the same strain. As opposed to fully benching those providers, I mean.
> Social distancing of the entire population also slows the acquisition of immunity with zero and low risk age groups, which drags the whole situation out months longer.
Dragging it out is exactly the point. The total number of active cases should be kept as low as possible in order to stay below our healthcare system's capacity. Look at Italy for what happens when cases exceed capacity. Their death rate is partly so high because they have to let the worst cases die in order to save those that have a better chance at living.
>It might even be logical with the above 3 steps in place for zero/low risk group to deliberately seek out the virus. This grants immunity quicker, and if they become sick, they can receive treatment whilst hospitals are still underwhelmed.
This is extremely irresponsible. The long-term effects of the virus are currently unknown but there are some worrying signs of possible long-term lung and other-organ damage that have been reported (anecdotally) from China and Italy. It's going to take time for these studies to be done.
Not to mention the immunity period length is unknown at this time. If this coronavirus follows the pattern of other coronaviruses, immunity could last 6 months to a year tops. That is ... not good. And a secondary infection could be worse than the first due to immune system overresponse/cytokine storm.
It's important we take the time to study these secondary effects and allow time for treatments and/or a vaccine to be developed and studied before we come up with any long-term plan.
If the immunity period is unknown/short then isn't there some logic in trying to build heard immunity amongst the entire lower risk group before the immunity would be lost. If we shut everything down for a bit, then start returning to normal life, that would stretch out the timeline for everyone being exposed and risk creating a cycle where people get it over and over again.
With half of infections being completely asymptomatic, this doesn't work. You need to do what South Korea and some towns in Italy have been doing successfully: widespread, fast, free testing, and then anyone who tests positive is isolated for 14 days.
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[ 4.5 ms ] story [ 201 ms ] threadSince when they say "social distancing" it seems to mean stay physically distant from each other.
She said that "social distancing" is a medical technical term that doesn't translate super well to the public.
Which is 100% the opposite of what I in my daily life observe: everyone, young & old, private & work, calls it social distancing.
It addresses the issue better too, then the "proposed" physical distancing. When you pass people physically the (need and) possibility to keep that 2 meters is often impossible where as while socialising it very much is.
This kind of double meaning will literally kill people out there. Physical distance is a clear term. Social can and will be understood in many ways. I can imagine somebody thinking if he isn't on facebook on phone, he is distancing socially.
Figuring out how to manage this risk so we can return to society / open venues at a much lower risk of infection (while not giving all of our data to the government) is a challenge with which maybe some of this site's audience could assist.
So I really doubt there are that many i dividual with undetected virus.
I wish this was reflected more in the numbers being presented by various authorities. There is just too much confidence that confirmed cases are representative of the spread of the virus.
This unknown denominator can change mortality rate, and severe case rate by orders of magnitude.
Because of the dearth of testing in the US, it seems highly likely that far more people are infected, and maybe even recovered.
I'm fairly certain I've just recovered from COVID-19 given my symptoms, but can't get tested here in Colorado. By the time I am able to get tested it seems likely that I won't be shedding the virus any longer, and will test negative.
This article captures my feelings on this very well: https://blog.longnow.org/02020/03/14/an-epidemic-of-false-co...
This is considered in the article I posted.
I dunno, maybe that's an indication that the fatality rate is lower than 1%. Or that dying takes longer than 14 days.
This gives them a higher median than the general population, but a lower density of the truly old. And deaths are strongly clustered among the truly old.
https://cmmid.github.io/topics/covid19/severity/diamond_crui...
Is that really the case? I'm finding it to be pretty common knowledge that "confirmed cases" is simply just that.
Furthermore, when you see that (larger) number it has a psychological effect of "this might be serious".
After making them think about incubation times that starts changing, but it takes a conversation.
What is common knowledge depends very much on who you're common with.
That's the necessary data to know when we can start rolling back the extreme measures being taken to slow the spread.
We need a measure to detect herd immunity
https://www.technologyreview.com/s/615379/antibody-test-how-...
I know of one that’s in the works https://www.sciencemag.org/news/2020/02/singapore-claims-fir...
I have seen other talk about such tests on Twitter but it’s too difficult to find it now.
Such tests seem to be called antibody tests or serological tests/assays.
EDIT: this twitter thread discusses such tests https://twitter.com/nachristakis/status/1240689935557865472?...
There are also some commercial antibody tests, which have some error rate and as all antibody tests can identify the virus after 7-10 days after onset of symptoms.
https://www.ndr.de/nachrichten/info/15-Coronavirus-Update-In...
> Given the amount of testing being done in South Korea, we can rule out that there are a lot more people currently infected than we know about. And if there were a lot more people recovered than we know about, we would have seen deaths earlier in South Korea, since South Korea started their testing earlier. I suspect there's a lot more evidence that rules out the "fast and stealthy" hypothesis.
That's a very strong claim. SK has done a lot of testing relative to most places but it's still:
a) A tiny amount relative to the population
b) Not a random sample of the population
Their tests were done at testing clinics that people had to take themselves to, which in many cases had large queues and generally you'd only go there if you actually felt really sick because otherwise why would you expose yourself to lots of probably really sick and infectious people?
So far there's overwhelming evidence that either a lot of people have the disease without symptoms, or the tests have a very high FP rate. There's also a lot of people writing like the person above, who are sure they've had the disease based on symptoms but were never tested. South Korea wasn't deploying their tests on people who were asymptomatic, they are doing the same as everyone else: testing people who present for testing or who otherwise seem to need it.
Our current evidence points to there not being millions of asymptomatic people.
This is strong evidence of asymptomatic circulation.
This conclusion is not in contradiction to the evidence behind your previous comment. In mid-February with ~60k confirmed cases that would be 300-600k asymptomatic ones. Which means that China did not have millions of asymptomatic people at the time. And so it is no surprise that a broad testing regime failed to find what did not exist at that time.
However what it also means is that as the number of confirmed cases skyrockets, it WILL be true (and possibly already is) that the number of asymptomatic cases will be in the millions.
Also from the article and the same Science paper, For every confirmed case of COVID-19, there are likely another five to 10 people with undetected infections.
https://science.sciencemag.org/content/early/2020/03/13/scie...
”We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions.”
https://upswingpoker.com/angle-shooting-string-bet-raise/
Though the bigger reason for not allowing it, is that it can really add confusion and slow down the game when a person says call and the next person now has to wait until they’re sure the current asshole isn’t going to say ‘and raise’ before they can act.
Oh, and keep in mind that poker is full of assholes who will do all kinds of anti social behavior to gain an edge. So the fact that this is a standard rule really gives some idea as to just how annoying it is to the poker community.
But the phrase remains a common idiom. And in an internet discussion like this, the rationale that makes it bad form in poker does not apply. I cannot see anyone's reactions until after my action is complete and I hit "reply". And therefore I cannot gain a read and final decision based on my incomplete first stage of the action.
It's also pretty well established that even in symptomatic cases where testing is widespread the disease has a multi-day incubation period.
What we do know is that it can't be quite "there were zillions of people infected so when we talk about 1% IFR really it's 0.01% so everything is fine", because there are accumulating bodies in various localized places around the world. There's nothing we know to say that pattern wouldn't repeated everywhere.
Shouldn't the test detect antibodies that your immune system has developed?
The current testing that's reported in the media is an antigen tests, that directly tests for the presence of the virus. Once your viral load comes down, you will test negative for the virus. Hence the reason people are declared recovered after having two negative tests in a row.
A test for the presence of antibodies is a serology test. The last time I looked into it (~one week ago), serology tests were under active development, but had not been deployed anywhere in a widespread way.
So, right now the testing will only tell you if you currently have the virus. Coming relatively soon are tests that will tell you if you previously had the virus.
Conversely, there are probably genotypes running around today that are completely asymptomatic to Covid. You could have whole families shedding virus wherever they go and never even know what they’ve done.
And one of the ways we learn about immunology is to study people who are immune or asymptomatic, so it’s not just about quarantining people that we need to identify infected individuals.
Quick recombination so that a beneficial gene can spread without losing genetic diversity of the population is is one of the benefits of sexual reproduction. And immune resistance to new threats is one of the top reasons why we need this capability.
In fact we broadcast signatures of our immune systems in pheromones and women are attracted to the smell of men whose immune systems are different from their own. This improves the probability that the children will be resistant to a wider range of possible diseases.
https://en.wikipedia.org/wiki/Body_odour_and_sexual_attracti... is one of many places that you can start learning more about this topic.
1. The current test is designed for the scenario that someone shows up to medical provider with symptoms. Test answers the question: are the symptoms caused by COVID-19?, quite reliably (negligible false positives, low false negatives).
2. The current test won't produce terribly useful data in someone without symptoms (either before, or after the illness). This is why for example certain well-known political figures saying they have been tested and cleared after potential exposure is not very meaningful.
Therefore ideas like: let's randomly test the population to see how much of this is out there, and I had what I think was COVID-19, I want to be tested to confirm, are not practical.
A test that can determine if someone was infected in the past is in development still.
If you want accurate numbers for statistics, including people who never had symptoms, you can do antibody testing on a random sample of population, that will indicate people who had the disease - but that's kind of too late for that particular location and those particular patients, that's for epidemiological studies and helping other locations. I recall reading about one such study for Covid, but I don't remember which country did it.
What kind of testing they do in those situations?
I'm glad you're better. Please be careful going forward, though. You shouldn't assume you have an immunity unless you have a positive test result.
Even with the strict pre-test screening that focus strictly on high probability patients, some locations are reporting very high (90%) negative test results from assumed cases.
It's best to continue practicing safety cautions as if you did not have a COVID-19 infection
Vaccines are all about tricking our immune system into preparing those specific antibodies before an infection occurs, so it can stop it quickly. If reinfection is true, what does that say about the nature of this virus and how difficult it is to create a vaccine? Are there other viruses that reinfect like this?
If true, it would go against all priors for how humans build immunity to viruses - especially coronavirus (common cold).
There may be a time limit to immunity, but having none at all after recovery would be rare indeed.
Without significant evidence (more than one somewhat anecdotal case of re-emergence), there's little reason to assume the body doesn't "remember" the virus after recovery with antibodies.
Seems like unnecessary FUD to spread that idea around without more evidence.
Another possible implication is that there could be multiple strains in circulation, not that the first strain wasn’t immunized against.
You are totally right that we need more evidence and this is very unlikely to be happening. But, I am trying to convince OP to continue to be cautious even if they appear to have recovered, both for themselves and for others. It seems reasonable to be cautious. People have presented apparent recovery only to go on to appear infected again.
I will continue self-quarantine for another couple weeks, and will definitely continue social-distancing measures etc. etc. after that.
Remember, coronavirus are ~25% of colds. There are many other families (like rhinovirues), that cause what we think of as the cold.
People don't talk about it much yet, but we really need an immunity test to determine if someone has antibodies.
In the small Italian city of Nembro in Bergamo, 0.6% of their entire population has died in the last 12 days. That's 70 people in a small town of 11,000 — typically there are fewer than 70 deaths every six months. Now we're certainly _overestimating_ the denominator and still getting a number that's larger than the flu. While the numerator is also an overestimate (because it includes deaths not related to COVID-19), their healthcare system is stretched beyond capacity due to the virus leading to difficulties treating all illnesses and traumas.
https://www.washingtonpost.com/world/europe/coronavirus-obit...
https://www.citypopulation.de/en/italy/lombardia/bergamo/016...
https://en.wikipedia.org/wiki/Bergamo#Demographics
Note that Florida is similarly 28% over 60.
On top of that, this is in a region of Italy where the healthcare capacity has been completely overwhelmed. That's going to be devastating for the prognosis of an older person who needs a ventilator.
https://translate.google.com/translate?hl=en&sl=it&u=https:/...
Since Feb 25 there have been 91 deaths with positive COVID-19 diagnoses. In total there have been 330 deaths. I'd be very curious what the age breakdowns are.
Anyhow, this was just a small example that shows that we're already seeing significant mortality relative to the _total population_ and not just by confirmed positive cases.
It's hard to convince people to sacrifice so much when they look outside their windows and see nothing special, plus read the news and find that some bomb/earth quake/accident somewhere killed more people in a day than the corona virus in a month.
There's going to be some very interesting population studies done post-pandemic to determine exactly what percentage of people had asymptomatic cases (and thus could have unknowingly been contributing to the spread).
It's not just highly likely, it's absolutely certain. I recommend the recent Khan academy video on this if you want to understand the math and you want a healthy dose of panic:
https://www.youtube.com/watch?v=mCa0JXEwDEk
UK authorities presented this exact number at their press conference last week.
The two best data points we have would be South Korea and the Diamond Princess cruise ship. Both of these groups have high rates of testing and both have had enough time that we can know how the most of the cases played out, and in both cases we see the death rate at about 1%. This doesn't take into account possibly different age group distributions. The cruise ship probably has less children and less 80+ people than on typical distributions.
Additionally both the Diamond Princess and South Korea cases assume ready access to medical treatment. If the medical system is overwhelmed we will see much higher CFR due to critical cases not receiving adequate care.
Despite claims masks (with good adherence to wearing) are highly effective - primarily by reducing hand to mouth/nose contact, secondarily as a direct barrier. And surgical masks are dirt cheap.
It looks like other countries went big on mask production and wearing - be very interesting if the claims that you should NOT wear masks if "healthy" even on crowded BART cars etc checks out in the end.
Czech Republic recently started requiring face covers so we will have results in few weeks.
I live in Prague and when I go outside I meet someone once in few minutes and majority of the people are not wearing face cover despite it is required. Mostly they have it prepared on the neck to put it on when they go inside. One doctor in TV did not recommend extensive usage of face masks as cheap or improvised masks tend to get wet after 20 minutes. This significantly reduces their effectiveness. Risk of being infected outside is really low unless you are in crowded area.
It's just a form of triage.
https://www.cnbc.com/2020/03/19/new-york-gov-cuomo-orders-75...
This is pretty damn close to quarantine, without actually saying quarantine in the headlines.
Anecdotally I've heard of places where the company has made no policy changes about sick leave or what employees who are feeling ill should do and, therefore, hourly workers keep coming in to work with "flu-like symptoms" or days after having had symtpoms because otherwise they don't get paid and could get fired.
There’s also not strong evidence that there are two sufficiently different strains. Viruses experience small, mostly meaningless, mutations with great frequency. The research talking about S and L types are actually just an arbitrary categorization of many different mutations of the virus.
Those who are younger seem to be mildly affected for the most part and could go on with their lives as long as they didn't interact with the older population.
what about virus hanging on to surfaces for like 3 days
A significant number in my opinion. "Young" people are acting not only selfishly, but stupidly.
https://www.infoplease.com/us/comprehensive-census-data-stat...
In contrast you look at age >=65, they make up 12.4% of the population, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
It is kind of funny how desparate some boomers are to push "this virus affects you zoomers too!!!" angle, probably as a response to the "boomer remover" memes. Or just a weird boomer "well if we're going to die, we're gonna take you with us!" thing. I guess understandable but generally reflects the hateful ageist attitudes of boomers towards younger generations. The avocado toast mindset.
Yes, it's still lethal at 0.1% among younger populations. 0.1% doesn't mean nobody dies, it means very few die. This is a disease that primarily affects older populations. Some people are searching for a reason to hope it'll take their kids too.
_Two_ possible deaths, if/when we get to the point that hospital systems are overwhelmed. "Under-50s survive when they get dedicated medical care and full access to medications/ventilators/etc they might need" is a _very_ different picture from "Under-50s survive without adequate medical care".
Deaths will come either by the coronavirus and/or by the poverty created by the extreme social measures suggested by the ongoing mania. I tend to believe the latter will kill more and be longer lasting.
* https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=00...
There's already a softening to people's needs in regards to healthcare and the economy - can you imagine the US seriously discussing any form of UBI 3 weeks ago?
While I understand it's going to be a tough hole to get out of, the economic levers seem like they'll be easier to adjust, and are adjustable on a longer timeline, than the acute condition of "not enough beds".
* https://www.niskanencenter.org/is-u-s-health-care-well-equip...
Frankly this is a wrongheaded position from a triage perspective. The macro-socially correct answer is that you should prefer the person who still has 40-60 years of life over the person who is going to die in 5 or 10 or 20.
It's a very boomer-centric perspective that youngs are somehow "stealing a bed" from a boomer. But that's nothing new from that generation. Really it's the other way around, treating grandma is stealing a bed out from underneath her grandkid and leaving them to die.
You may find that crass or distasteful, but that's the reality of triage. You don't do triage until you don't have enough medical resources to go around, but then you have to make choices.
In Italy, they won't admit 70+'s to a hospital at all. That's how triage works. That's the correct way for triage to work. It's harsh but true.
Singling out particular groups of people for doing stupid things at one point in time isn't really fair. There are olds who keep going to church as well, they have just as much culpability here.
But it's much more popular to point the news cameras at some kids on spring break than a church packed shoulder to shoulder with boomers. That generation makes a point of shitting on zoomers every chance they get, and if you point it out they cry about ageism as if that's not exactly what they were doing themselves.
It's "avocado toast" playing out all over again.
(in all of these cases, I think the states are rightfully clamping down on what's allowable. My parents spent the last two days whining at me that their reservation at a florida state park got cancelled. So that spring break thing probably won't repeat. And the maximum size for a public gathering is coming down rapidly... states were setting limits like 250 a week or so ago, now that number is 50 and some states are going to 5 or 10. This problem is basically solving itself. But are you being ageist about it by singling out zoomers as being some unique problem here? Yes, absolutely.)
You may subjectively claim irresponsible, but the measures being taken across the entire population are not without consequences.
Define "beat Covid-19."
Not to be a hardass, but I'd prefer real information not babyfood. Something akin to "Currently predicted US deaths without social distancing: X. With social distancing: Y. Potentially recurring each year"
dumb question: what happens to the virus a month after John was infected, does it die out?
It is more effective to follow these three simple measures:
1. Symptomatic cases stay at home for 7 days
2. All household members of symptomatic cases stay at home for 14 days
3. Social distancing for the over 70 population only
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
Social distancing of the entire population also slows the acquisition of immunity with zero and low risk age groups, which drags the whole situation out months longer.
It might even be logical with the above 3 steps in place for zero/low risk group to deliberately seek out the virus. This grants immunity quicker, and if they become sick, they can receive treatment whilst hospitals are still underwhelmed.
Speaking personally I would happily accept a strain of the virus considered to be low risk, then go into 14 day quarantine, if it meant I could afterwards work and socialise without any lockdown or restriction.
In a couple weeks, more of our front-line medical staff will start getting sick (the first case just occurred here), and requiring their 14-day quarantine... taking them out of rotation and adding even more strain.
It's going to get bad. We have to slow this down, to reduce the mortality rate. Or that 1% number people are throwing around is going to look like roses.
Dragging it out is exactly the point. The total number of active cases should be kept as low as possible in order to stay below our healthcare system's capacity. Look at Italy for what happens when cases exceed capacity. Their death rate is partly so high because they have to let the worst cases die in order to save those that have a better chance at living.
This is extremely irresponsible. The long-term effects of the virus are currently unknown but there are some worrying signs of possible long-term lung and other-organ damage that have been reported (anecdotally) from China and Italy. It's going to take time for these studies to be done.
Not to mention the immunity period length is unknown at this time. If this coronavirus follows the pattern of other coronaviruses, immunity could last 6 months to a year tops. That is ... not good. And a secondary infection could be worse than the first due to immune system overresponse/cytokine storm.
It's important we take the time to study these secondary effects and allow time for treatments and/or a vaccine to be developed and studied before we come up with any long-term plan.