Here are my observations as an actual epidemiologist:
1) Quarantine / non-pharmaceutical interventions effects start to be visible after about 2 weeks from their introduction, and are fully effective after 1.5 months.
2) Daily new deaths growth lags from daily new cases growth about a month (which is somewhat obvious, but needs to be reiterated).
So, unless some new mitigation measures are going to be introduced _right now_, this record-breaking growth will continue for quite more than a few weeks, followed by the corresponding growth of deaths a month later. We are far away from the saturation point and any resemblance of "population immunity".
It takes about two weeks for symptoms to arise and become severe, and then about another two weeks of severe symptoms that require ventilators before people die.
The pre symptomatic time wouldn’t be part of this gap unless the infected person got a test before symptom onset, which I believe is rare (most people who test positive get tested after they develop symptoms)
No, these measures affect new cases, not the already ill - so you've got to build in those 2 weeks to display symptoms for those people who would or wouldn't now be infected.
It’s new cases. Those are people that have tested positive. This usually happens days after the actual time they have been infected. At the time of infection, you’d test negative because it takes time for viral replication to increase viral load to levels that are over thresholds used in the PCR testing process.
But we're not talking testing negative, are we? We're talking those people showing up in the system (the > 2 week lag in time it takes to change course), or did I miss a level of questioning that threw this off course?
If you look at the graphs side-by side for areas with clearly defined peaks (I looked at MA, NY, Italy, Spain, UK, Netherlands) the peak fatality rate is no more than a week behind peak case numbers, and perhaps less. Testing rates in at least some of those areas were fairly constant around the peaks, so that doesn't seem a likely confounding factor.
I'm not sure what to make of the meaning of such a short gap, and of course people may now be testing earlier than they did in the early hot spots, so I'm not sure if this has any predictive value.
One caution about those numbers; many/most sites show cases based on the day that reporting was received and aggregated, _not_ on the day it was taken. This doesn't matter very much now, as turnaround on tests in most places is quick. But a couple of months ago delays of weeks were common.
People are far more likely to be tested before symptoms today than a few months ago; at least in Ireland when a case is detected everyone they've had contact with is tested, and some of those will be pre-symptomatic positives. And then anyone _they've_ had contact with will be tested and so on.
The time for symptoms to show up is of roughly 2 weeks but the median time is at about 6-8 days. After symptoms show up, it takes a while before people get hospitalized, and then mortality seem to take roughly 21-24 days after hospitalization.
This means that from the time someone is infected until they die, a month and a half can have gone through.
By the time you take new isolation measures, you have to wait roughly two weeks to see if daily infection rates start to vary. But the lethality at this point, assuming no change in healthcare system overload, can be more or less statically predicted for weeks after the fact.
Those are called "lagging indicators"; the main thing you try to prevent are deaths, which you can lower by reducing the overload on the healthcare systems, which you can lower by controlling infection rates and keeping them low.
Due to the duration of the disease's evolution, you get to see if your policies really worked more than a month and a half after enacting them, which is extremely slow for a disease that propagates at exponential rates. So people look for proxies like infection rates that are still lagging, but far less so.
Do note that the one good metric you want in the end is going to be "excess deaths", which counts the impact of not just the diseases, but of all other side issues that the disease may have caused. This can usually take months up to years to properly account and analyze.
I don't understand. If it wasn't obvious before then it can't be obvious now. You've had it explained to you. If it was obvious then that would not have been necessary.
Sometimes I will look all over for my keys, only to find them in my pocket. This is the obvious place to check first, but I am not perfect, so sometimes I overlook it.
This is the money question, or rephrased "will deaths spike by end of July?". There is so much debate, so much messy data, in a week or two this debate will be over among reasonable people, in a month even extremists will be eating crow. I, like everyone, have my opinion, but soon enough we'll know for sure. People saying "deaths aren't tracking infections" are premature in their assessment by a couple weeks IMO because earlier and more testing is making this peak be shaped differently than the last one.
Sorry to hijack, your actual question is interesting too. I guess that would mean all the increased infection metrics are entirely from increases in testing and we're actually seeing that infection rates have always been way higher and the virus is way way less deadly than previously thought? Or maybe it has mutated and become less deadly?
Because there is an incubation period, where people already infected start to develop first symptoms. There is a development period (from the first symptoms to the point where they are severe enough for the person to seek medical help — only at this point the case is registered). The introduction of quarantine measures is not immediately effective — there is a transition period of at least few days. There are response / case registration delays. And finally, it takes some time for the new epidemic regime just to be visible on the curve (a perceptive delay until the trend is understandable).
> Here are my observations as an actual epidemiologist
In your recent posts, you’ve said that you just applied for your PhD, that you are a “consultant software engineer” in finance, that you are studying physics and that you have a masters in CS. You really must be a renaissance man.
Yeah, a guy upstairs from me was on a path to get an MD and a PhD in microbiology, I think he was majoring in something else as well. Unusual, but it exists. Some people really like being students.
Especially the case for rich young woman from the Middle East*. As long as they were in school they were free of family obligations. That 4 year BS turned into a 8-10 year BS-MBA-PHD track. If school ever truly finished they’d be back home to SA in a niqab.
Edit: to respond to the question below, it clearly supports a "renaissance man" question by
IAmGraydon above: it confirms both a "“consultant software engineer” in finance" and a "masters in CS." I don't see how it is not relevant. Moreover, it's not that somebody questioned
atemerev's posts based on his qualifications, it's atemerev who claimed to be "an actual epidemiologist" in his first sentence, and that it definitely something that can be tested for veracity, if atamarev wanted to give more credibility to his claim with that (he didn't have to do that -- and then his claim could be evaluated on its own too, but biases by the authors of some claims are also something that could be questioned). Anyway, in this case, it's obvious that atemerev's university degree isn't in epidemiology.
Edit2: atemerev's first claim: "an actual epidemiologist" now gets to be closer to the truth in the response below as "an epidemic modeler." I still believe IAmGraydon was right to question the claim, and that the initial claim was indeed misleading and incorrect.
Could you please remove the link, as it is not particularly relevant here? (I understand your point, I indeed have experience in multiple fields, but right here in the context of this discussion I would prefer to keep only my profile as an epidemic modeler).
So I have an engineering degree, a MBA, and studied history for a while. The latter let to nowhere, but there is no reason why, under different circumstances I couldn't hold a BA in history by now. So yeah, can be legit.
The models are indeed made based on the described assumptions, the actually reported data however isn't as simple as the models. We are of course sure that deaths happen much later as the infections, but what would become the reported "cases" where is hard to model. The "infected but unreported" surely exist and the models rightly also try to account for these too. But everything together is harder than it appeared at the start -- even the number of antibodies among the once infected is not "yes or no, either one has them or not" but something that can be above or below the detection level and that varies through the time in the same individual, decreasing with the time, and undetectable among some who were PCR-test positive.
In short, the good explanations will have to be nuanced, never simple. And we still search for all the nuances.
On number 2: that makes a lot of sense; yet in places that have had peaks (e.g. new york, italy, UK, spain) the peak observed fatality moment is barely shifted vs. the peak positive testing moment - maybe more like a week or so, normally? In all the data it's a little hard to spot trends, especially with testing rates scaling up, but still the graph peaks are not even close to a month apart, even where testing rates don't appear to be too variable.
What's causing this discrepancy? Clearly the disease progression isn't that fast, so... what then? Maybe the more vulnerable groups tend to get hit more quickly, and as cases ramp up either die earlier or lock down more rigorously or both, such that the less-vulnerable form an infection peak after the death peak has passed? Or is it simply that people get tested late in the disease progression?
Given how little the MA testing rate has varied, and that the positive rate peaks also are much closer than a month apart from the fatality peak, I don't think testing changes seem likely to be a primary cause of the (to me) unexpectedly short period between case peak and death peak.
The big difference is testing capabilities. All places hit by big waves early on suffered from poor testing and public awareness, so testing happened in a burst as the deaths were starting to become problematic. And generally those getting tested at peaks were the symptomatic/hospitalized. NYC is estimated to have been around 20% infected, so the actual infection count was highly undereported. It is important to also recognize that every location hit hard was met with immediate lockdown, generally followed well by scared populations.
The situation is far different now, with a good chunk of people actively rejecting even basic distancing measures. If you look beyond positive test numbers at the % positive you can see the rates are rising even faster beyond our testing capabilities. And the idea that only 20-30 year olds are getting the disease is wishful thinking - the highest risk situation is from household transmission, at over 80% likely.
Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.
” And the idea that only 20-30 year olds are getting the disease is wishful thinking - the highest risk situation is from household transmission, at over 80% likely.
Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.”
Three things:
1) It’s been over a month since case count started to grow in the southern states. Hospitalization and deaths by day are not growing at all in FL or AZ, and only hospitalizations are growing slowly in TX:
2) It isn’t “wishful thinking”; the age distributions of positive results out of Texas clearly show that most of the people testing positive are younger, and it seems to be true in FL as well:
3) It’s not very common to see multi-generational households in the US.
Maybe it’s true that this surge will eventually make it’s way to the high-risk, but it’s been over a month already, and that doesn’t appear to be true yet. At some point, predictions of the future have to be tempered by current evidence.
Although treatment has definitely improved outcomes, IMO, at least some of this effect has to be due to the changing demographics of testing.
In the early days patients essentially had to be far along in the progress of the disease to be tested, we simply had very little testing capacity.
Now we are doing many times more tests against a much wider set of subjects. So it is inevitable that we are getting more of the milder cases and cases earlier in their development. This also accounts for the so-called “shift” toward many more young patients.
The disease hasn’t changed. Current testing is sampling a different distribution of patients than previous months had been.
On the other hand, it's only a factor 3, which is certainly nothing to sneeeze at, but still remarkable that that's enough to so strongly decouple mortality from infection, compared to earlier.
How do you explain the "sudden drop" in cases in new York [1] after reaching some 25% infection rate? Do you think herd immunity (ish) can be reached at a lower saturation rate possibly?
It also fits (perfectly) an alternate theory that the population exhibits a wide variation in susceptibility, which lowers the herd immunity threshold.
That it takes that long for this cycle to die out --> (infection, exhibiting symptoms, infecting close contacts(who start this same cycle again), becoming unable to infect others)
> So, unless some new mitigation measures are going to be introduced _right now_,
You will be able to claim that any changes made by local and state governments in the next few days/weeks “did the trick”. Nevertheless, this is a fair escape hatch when the following prediction does not come true:
> this record-breaking growth will continue for quite more than a few weeks, followed by the corresponding growth of deaths a month later. We are far away from the saturation point and any resemblance of "population immunity".
You will be proven wrong, both about the coming “wave of death”, and about how far we are from the saturation point. I’m quoting this and publicly disagreeing today, so that you might remember later on, and maybe even acknowledge that you got it wrong.
Hi. I read the essay "Pandemic Woo" which is linked in your profile.
Is seems like your position is that:
--COVID response strategy based on invalid "post-modern science",
--the conclusion that the disease death rate is order of one percent is incorrect
--and therefore, the policy response is grossly disproportionate and harmful.
It seems like you are arguing about facts not values, and you think the disease death rate is not really order of %1. Is this what you mean?
I'm also asking because I have heard many heated statements about "post-modern" science around here as of late that wherein the speaker seems to treat that concept as common knowledge, and then walks off without explaining themselves, but I don't really understand what they are on about.
The first point is characterized correctly. We are reaping the whirlwind from a pernicious post-modern academic culture that has been thoroughly corrupted, even in the traditionally "harder" sciences to a degree. Here is a much drier, but still excellent, argument along the same lines:
The second characterization is way off base. All IFR numbers are rough estimates at this point, and in fact the number is just a model parameter that does not correspond to anything in the real world, so it's a bit hard to talk about any "fact" there. The disease evolves, treatment protocols change (early venting was a terrible mistake), and susceptibility may vary widely from community to community. Still, the most recent CDC estimate for this model parameter is 0.26%.
The third is a prediction, not an established fact. Right now there is no way to know what the long-term effects of our policy response will be. I have cited many anecdotal "bad" effects which (together with others) I believe will outweigh the "good" effects, but we will have to wait and see.
To your third point, a recent study funded by the Gates Foundation estimates excess deaths over the next 6 months caused indirectly due to the virus response;
> While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food.
At the low end they predict 250,000 excess child deaths and 12,000 excess maternal deaths, and at the high end 1,150,000 excess child deaths and 56,000 excess maternal deaths due to decreased access to health care and food.
The number of missed vaccines and cancer screenings alone multiplied worldwide turns into a massive hit to public health.
I'm not asking about the stakes in that sense. Your claim is only interesting to the extent you can demonstrate a logical basis to believe it to be valid. Can you provide your reasoning?
edit: Ok, I see you are the one with polemic blog post. I see that you seem to think it is "just a cold" because it is a coronavirus.
It seems you are making a categorization error. Like saying because there are garden snakes, having a cobra in your house is no big deal--just a snake!
Why would the waves of death never come? So far more people have died than WWII. The deaths lag new infections, and new infections have spiked. I see you are interested in other folks admitting they are wrong--will you?
Susceptibility varies widely between individuals, with four grades of antibody response, as well as at least one form of T-Cell-mediated response, already documented in the literature. There is enough evidence to suggest that this virus is airborne, and if everyone were completely susceptible the "true" R0 (this model parameter is a convenient fiction, of course) would be close to that of measles. Therefore it has already spread very far in any dense population that was susceptible, and we are basically already at herd immunity in NYC and many other places.
> Ok, I see you are the one with polemic blog post.
Yay, I'm a niche HN celebrity!
> I see that you seem to think it is "just a cold" because it is a coronavirus.
You are skipping over a critical detail, which is that any virus can be much more virulent after it jumps between species. But yes this one is basically a new cold, and in time it will present much like all the others (if it becomes endemic).
> So far more people have died than WWII.
What the fuck???
> I see you are interested in other folks admitting they are wrong--will you?
If half a million Americans die from this thing (not merely with it, and before it becomes just another cold, not over the next 20 years), you can count on it. This will not happen.
The attenuation you seem to be banking on only happens if there is selective pressure toward it. The selective pressure is usually a product of "too deadly or too strong a response prevents the host from spreading" so weaker strains that let the host spread more win out in a game theoretical sense by out-competing. This is not a likely force in this case--this is already spreading really really effectively, so I think the force behind attenuation is missing and your assumption is entirely faulty.
> So far more people have died than WWII.
> What the fuck???
You are right on this one, bad bad misquote on my part.
Sure, a fair point, I am not the all-seeing all-knowing authority. You have mentioned "a few days" — how about meeting here the next Friday and see who was right? There won't be any significant increase in the daily deaths (yet), but there should be another increase in the number of cases.
(I have (unfortunately) already won a few bets like that, but it's always a chance that I am wrong this time, of course).
In fact, there is already a failed prediction in your essay: "but we will fail to see the 'second wave' that was predicted". The second wave happened. Exactly in the way we, "postmodernist scientists", have predicted. I will be the first one to tell you that indeed, there are many problems in modern science. But this is not one of them.
Well sure, but I don't disagree that lots more (both confirmed and probable) cases will be counted over the next week in these places. I'll argue that NYC will not have anything remotely close to Arizona's spike if you like.
How about we meet up in a month and look at the death numbers? I predict that the national 14-day average will continue to decrease, or maybe flatten out for a bit.
Agreed. I don’t see how there won’t be an increase in deaths in a month (save for some new miracle drug, which I doubt — antivirals are hard), so sure, see you in a month. My email is in my profile. (The bet is on nationwide increase).
The confirmed deaths are a known undercount, and cases going up faster than testing also indicates that the confirmed death count will be more of an undercount, because fewer (proportionately) of the deaths due to the disease will be confirmed.
That was not the bet, we’re talking about the national number. I might still lose, it looks like there has been a statistically significant bump in the past week, and it may continue.
Some of it must be due to spread in the southern states, where (by no coincidence) people spend more time indoors during the summer.
Some of it may also be due to the “July effect” which I did not know about:
I think there's an argument that what we're seeing in the US isn't actually a second wave at all; it's stepped first waves in different places. Rates in places like Florida never really went down all that much. The US probably shouldn't be considered a single entity for these purposes.
(To be clear, I would expect that there will be a real second wave in the US at some point, I just don't think that this is it)
In fact the paper explicitly discusses (p. 14-16) potential synergistic effects between zinc and hydroxychloroquine, and provides references to another study suggesting the same. Care to comment, Doctor?
Based on their "risk stratification requirements" it's unclear whether the majority of "non-HCQ" patients were (d) over 60 with pre-existing conditions or (e) under 60 with no symptoms, as those seem to be the two groups excluded from the study. My initial hypothesis, that the paper doesn't mention once anywhere, would be that they were unable to treat significantly more older people with pre-existing conditions, leading to the obvious result of those people being more likely to die.
I looked through their scientific paper and couldn't find any data about the demographics of the declined patients. The only information I can find is the classification of their groups, which seems to exclude the two classes I mentioned above.
If we assume that the majority of "non HCQ" patients were of group (e), young people, then their rate of mortality in this paper would be at least an order of magnitude higher than that of any previous paper, therefor I would expect group (d), old people with complications, to be more likely to have higher representation in their "non HCQ" group.
I didn't conduct this study so I don't have access to the raw data not provided in the paper.
I’ve informally been following testing and it seems like every paper published against hydroxychloroquine is either not peer reviewed, the data is suspect and unavailable, or are promoted by groups with financial interest in another solution.
Assuming that hydroxychloroquine in fact has no benefit, there also seems to be limited evidence that it causes complications and has been widely used without issue until this pandemic. If me or my family were hospitalized with COVID, I would push hard for immediate hydroxychloroquine treatment along with whatever schedule was prescribed assuming no known contraindications.
If tomorrow a new treatment emerged and had consistently repeatable results described in peer reviewed journals, I’d gladly change my strategy. Screw media and political fear mongering. Show me repeatable statistics.
> The long term global economic effects, and possibly the death toll, are clearly in the same order of magnitude as a 20th century global war
According to the WHO about 1.3 million people die from Tuberculosis every year [1]. Another 400.000 die annually from malaria. 462 million are underweight, and 52 million under-fives are suffering from wasting [3]. Covid19 isn't even in the same league as famine and disease. Covid19 is serious but it's not a catastrophe, and it's just one of many things that the world has to deal with, and we can't let it hijack our attention and focus.
> I think the difference is that the people affected are (also) in developed nations. It's easier to ignore famine and disease that don't affect you.
This is a good observation. We can't the fault the author for stating things from their perspective. The point of view has a big influence on what one sees.
Not letting it hijack our attention and focus doesn't have to mean lifting control measures. It just means that we need to transition back to thinking about and tackling other problems as well, rather than saying "none of this matters because of the virus".
Yes exactly. This has taught us that we need to take other viruses more seriously than we have. Maybe we should take some measures at the height of bad flu seasons. Maybe we should just always wear masks on flights and other crowded places. Maybe we should shake hands less and wash them more.
I do think there's a pretty strong case now for coordinating some kind of preplanned "flu control week" with no public gatherings - both to fight the flu and to establish the right social expectations for the next pandemic.
It won't make a difference. In Europe countries have been lifting their lockdown measures and the spike in cases they expected to see didn't happen. Massive protests happened in major European cities and nothing happened. Massive protests in NY didn't result in a spike of cases. In most places COVID-19 is over. Done. When the dust has settled covid19 will be seen as just another really bad flu season.
In case you were serious, the reason things are working out, more or less, in China and Europe is that measures were put in place (and people have stuck to them, by and large) such that the incidence of new cases fell a lot.
Second half of the year in the Americas look less promising.
EDIT: replaced summer and fall by second half of the year, given that half the Americas are south of the equator...
European countries have selectively lifted some lockdown measures and are closely monitoring the situation. Local outbreak spikes are happening. Many protests actually observed at least some degree of distancing, and their impact is mitigated by them happening outside - the strongest infection vector seems to be areosol, which is far more dangerous indoors. Many places are still seing exponential growth.
Anyone who still trots out the "just another bad flu season" claim is just criminally stupid.
How do you explain the spike in cases among 20-29 in MN right after the protests[1]? You can call me stupid all you like, but the data speaks for itself. Even Fauci referred to protests as having the "perfect set-up" conditions for hotspot spreading to take place[2].
The next step is to ask yourself why no similar spike in cases happened after protests in NY or Paris, even though they also had this "perfect set-up" for spreading.
I think that you will be proven correct eventually, but in many circles this argument still prompts a nasty, negative, and thoroughly irrational response.
“In a time of universal deceit, telling the truth is a revolutionary act.” -Unknown
By "the fucking case numbers", I assume you mean only those statistics which are spoon-fed by an industry that makes money scaring people into noticing advertisements.
You're missing the forest for the trees. There are countries where the case numbers have been at hundreds or thousands of new cases daily for months, in some they are still or again rising beyond that.
Germany, with its very successful lockdown measures that have been eased gradually now had a case last week where basically an entire meat packing plant got infected, over 1000 people, leading to ongoing infections in that area.
There is exactly zero indication that it's over, just that lockdown and distancing measures are working, and that a subset of them, combined with diligent testing and contact tracing, may be enough.
You're being down-voted for no good reason, as you were discussing on point. Back to Europe, spikes did in fact happen (I do live in an European country experiencing suck a spike, i.e Romania), but those spikes generally happened in countries that hadn't been affected by the virus all that much in the first run, i.e. the Balkans, Portugal (relatively speaking wen comparing it to neighbouring Spain), I'd say even Czechia.
Spikes didn't seem to happen in countries like Spain or Italy that had been hit pretty damn hard the first time.
He's being downvoted for making blatantly false claims.
Yours are no better. Romania and Serbia aren's seeing "spikes", they're having a second wave that looks like it will very soon eclipse the first. Sweden's case numbers haven't actually stopped growing. Germany, which had one of the highest case numbers for a long time now had a spike with 1300 cases in a single meat factory. Many other countries have stable low case numbers, which means that they're fine at their current level of containment measures, but could easily see a second wave hit quickly if they undo those measures. I don't think there's any European country with case numbers low enough that they could safely rely on contact tracing alone - South Korea tried that, with the result that they went from single-digit daily case numbers back to mid-double digits. The problem is that in crowded indoor conditions, you get "superspreading" events that can completely destroy all the progress made over months of containment.
> they're having a second wave that looks like it will very soon eclipse the firs
Yes, that's what a spike means. And for the record, that's exactly what the Romanian Health minister called it two days ago, i.e. not a second wave, because in his opinion the first wave never stopped, but a spike.
> Sweden's case numbers haven't actually stopped growing.
I know that, and I'll answer that what I answered to other people online: this isn't a video game where we should chase the lowest number of cases the same way as we're chasing a score, this is real life where we should chase the less number of deaths possible. And in Sweden the number of deaths is definitely on a downward spiral.
We're going to have to live with this virus, many of us already do, there are not that many economical resources available to keep the majority of the population locked indoors (to say nothing of the psychic and mental effects this is having on the population).
If you could have seen the local Lowes or a big park in Salt Lake City a couple weeks ago - 70% of people no masks, no social distancing, packed with long lines, many people almost intentionally, defiantly disregarding guidelines. This is happening everywhere in the US and is a totally different level of opening up from what is happening in Europe. Your apples to oranges comparison is completely misguided.
> In Europe countries have been lifting their lockdown measures
Lifting some of them. Some pubs and restaurants just opened here this week under heavy restrictions, for instance; too soon to see what impact that has on cases. And that was after case numbers were brought down to a few a day; we didn't just lift restrictions while we were still seeing hundreds a day. And of course people are being pretty cautious, mostly still on furlough or working from home, etc. Supermarkets are still letting only a few people in at a time. And the list goes on. We're 'reopening', but we are nowhere close to normal, and a return to normality isn't envisaged at this point; there is no deadline by which the supermarkets will return to full capacity, say.
> Massive protests happened in major European cities and nothing happened. Massive protests in NY didn't result in a spike of cases
While the results arguably aren't totally in, you'd expect outdoor, largely masked, protest to be a lot lower risk than, say, pubs and restaurants reopening. Purely from a public health perspective it wasn't ideal, but it wasn't remotely as risky as the last stages of reopening.
> In most places COVID-19 is over. Done
Where? In the last few weeks in Ireland we've had anywhere from 1 to 20 cases per day, more or less at random. It's down a lot from peak, but it hasn't gone away and it could surge back if we screw up (and there are some early indications that it might be doing so; those pubs and restaurants may not be open for long). It's a similar story in most places in Europe (adjusted per capita).
We are at less than 5% seroprevalence globally, and already more than 500,000 deaths. There are additional 95% (or e.g. 70% if you include population immunity effects, which are not particularly strong for COVID). So we are in for 15 times worse than we have today, assuming that healthcare systems all over the world will have the capacity to handle it efficiently (they won't).
The point is people are talking about revolutions and other destructive world collapse nonsense over a decease that’s slightly more risky than seasonal flu.
The 1918 pandemic didn't have basically every country in the world undergoing quarantine measures to reduce the spread - in fact its existence was actively suppressed due to wartime press controls
We didn't really understand a whole lot about flus and pandemics back then, and the majority of the world was much poorer, leading to a global response like we're seeing in Brazil, for instance.
Additionally, there was a war on for a bunch of it, which impacted things.
Like, I actually think that lockdowns are a reasonable approach as a pandemic control strategy. I think it's a reasonable tradeoff against the potential deaths.
Note that this is completely conditional on the existence of a proper social security network, which supports all the people who can't work from home.
Most healthy/young people can fight covid19 off with t-cells, so they never create antibodies. 80% of the world population lives in the northern hemisphere where the flu season is pretty much over and covid with it. And remember that the average age on the planet is only 29, and for people under 50 covid19 is no more dangerous than a regular flu.
With all the focus on the US, maybe it needs to be mentioned that Asia and South America are comparable to North America in new cases. Asia has had a major resurgence because of India, Pakistan, and Bangladesh. And while Europe is relatively under control, Russia has increased the counts a lot.
The latest daily figures I see are 67K North America, 59K Asia, and 63K South America.
1. Yeah, the "it's no worse than the flu" was a line for February. After March/April's toll on New England, it's an asinine thing to keep saying.
2. Honestly though, we really should have been taking the seasonal flu more seriously. A cousin of mine, mother of three young children, died from the flu in 2018 after being put into a medically induced coma. 30k-60k people in the US each year is a helluva lot to keep losing, and while we can't lock down to the degree we are now on a regular basis, we're also seeing that some of our behaviors are more risky than others. What if there are relatively simple changes we could be making to our lives that would slow and stop the spread of the seasonal flu?
I appreciate your comment, even if it's unpopular. I agree that our priorities (as a society) are out of whack and not supported by the data. In my opinion I think we have much bigger problems than corona, but people are largely driven by whatever makes the front page of their preferred media platform every day.
If anything, this corona thing has taught us that we can make real changes if needed. The truth is, people don't want to fix many of the problems we face day to day, for a variety of reasons, but largely because fixing them would be unprofitable for a small number of people who control most of the means of production.
Yes humanity is facing multiple issues. Racism, pollution, global warming, lack of freedom, torture, etc etc etc..
Many people monetize on this by throwing more fuel to their fires-of-preference (the bloody foreigners, the bloody <insert groups you want to blame for the misfortunes of your country>).
We can find 100 ways to hate one another but only a couple to unite and solve these.
And we have taken unprecedented major steps to stop the spread of Covid-19. TB and malaria do not have the entire world economy grinding to a halt every year to stop them. Covid-19 statistics can't really be equally compared to other diseases in other years because the response is completely different.
But the impact of malaria, where it exists, on the economy is massive. In the West there were large-scale public works projects undertaken to drain swamps and eradicate it. Where you have it, the amount of productivity lost because people are too sick to work or go to school and the amount of money spent on treating sick people instead of something productive is just staggering.
Your investors will prevent you. Consider the history of the Panama Canal. The American consortium only succeeded because they brought insect-borne diseases under control along the construction site. The French tried to cover up the difficulties they encountered in their attempt, and there was a massive scandal when it all came to light.
No sure what you mean. Malaria isn't shutting down countries. They learned to live with it and it's factored into society just like cancer and heart-attacks etc is.
That's half a million dead _with_ unprecedented major steps. And TB and malaria are, unfortunately, to a large extent, diseases of poverty; the places where people are dying don't have the resources to eradicate them.
Malaria has killed millions upon millions, half of which under 5 years of age. The typical "with covid" death is over 80 and has 4 comorbidities. There is absolutely no comparison.
Can we start talking about survivors? People with malaria are chronically sick and a drag on the health system, and we are only beginning to learn about the aftereffects of coronaplague. Reduced lung function seems to be common in patients who recovered from covid.
How are you spending that $80 billion? Divided by 700 million people, that's only $114 per person. I don't see how that would lift those 700 million people out of extreme poverty.
If this pandemic were to ravage through the world unmitigated, we'd have, say, 3 bn people infected in short order, resulting in 15 million deaths (assuming a 0.5% IFR). Seems to be in the same league.
The death rate would be far, far higher, perhaps an order of magnitude, because hospitals would be overrun.
Even if the Covid patients had a low death rate at the hospital, millions more would be refused treatment, millions more than that would die because Covid patients took up all the beds.
I saw a news article that described how hospitals were running out of beds (in Houston I think) and then they qualified it by saying that 60+% of the ICU beds were being used by non-corona patients, as if they were afraid of being accused of exaggerating the crisis.
And I was like, oh, yeah, obviously they can just tell those people who don't have the virus to GTFO and make space...wait, why are they in the ICU then?
And if it were truly unmitigated, the fatality rate would increase because the hospitals would be full. The fatality rate would basically rise until it matched the hospitalization rate.
> “Our dosing also differed from other studies not showing a benefit of the drug. And other studies are either not peer reviewed, have limited numbers of patients, different patient populations or other differences from our patients.”
>However, our results should be interpreted with some caution and should not be applied to patients treated outside of hospital settings. Our results also require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety, and efficacy of hydroxychloroquine therapy for COVID-19 in hospitalized patients.
The main issue is that retrospective studies like this show promise all the time and then frequently fizzle out in RCTs. If you're not used to reading studies they will sound very promising, someone who's been reading studies for 10 years will understand why this and the French studies that started the hype early on can be very misleading.
While the text is pleasantly written and free of noticeable counterfactuals, it’s just a recounting of what’s happened. It doesn’t provide new insight.
For reference, the well-worn anecdote about everyone saying "it'll all be over by Christmas" at the beginning of World War I didn't actually really happen.
That was a later anachronism, and the phrase "over by Christmas" doesn't appear until late 1917. It was used as an intentional exaggeration to describe how those in Britain at the end of the war felt about the decision to enter the war in 1914.
The reality is that very observers anticipated an "easy" war. Virtually everybody predicted that the conflict would be the most destructive since the Napoleonic wars, and collapse the world economy. Overwhelming majority of the British public and politicians expressed a preference for neutrality. It wasn't until the Germans marched straight through the heart of neutral Belgium, and their sheer degree of wanton looting and destruction, that public opinion turned.
It's very clear that even in 1914 nobody thought it would be an "easy" war. Germany's Rape of Belgium led Britain, and later America, to reluctantly intervene. However it's a testament to the sheer scale of carnage in World War I that even these very dour predictions turned out to be underestimates.
I think it's pretty disingenuous to compare a disease to a war between major powers.
Russia isn't going to invade Germany if Germany stomps on Coronavirus because Coronavirus kills a duke. Nobody is on the side of the virus. Unlike retaking Eastern France, progress eradicating Coronavirus does not have to necessarily be over other people's dead bodies. Nearly all of humanity wants to see this disease gone. The circumstances are very, very different.
Hm. Are you sure? I thought "home before the leaves fall" was a legit quote (modulo translation). And the German war plans had to predicated on a quick and victorious war, because in the beginning they were not in a position to fight a long one.
> To be fair, George Floyd was brutally murdered by the Minneapolis police department on May 25th, and the predictive blog entry I'm referring back to was posted more than a month earlier.
That's not the only such murder, and it's not the only one caught on video.
If a "predictive blog" isn't based largely on the body of publicly available past evidence (i.e., history), what's the point of the endeavor?
The court will decide if it is “murder”. The official autopsy shows he didn’t die from asphyxiation, rather a heart attack, likely from a lifetime of drug use.
It's a predictive blog entry, not a predictive blog overall. He's not some genius super forecaster like Dom Cummings :-)
He is though successful Sci-Fi author Charles Stross in case you didn't pick that up from the page, and he's penned some pretty insightful posts in his time blogging too.
None of the earlier ones sparked world wide protests, or even much in the way of nationwide protests. That's what he's talking about when he says he didn't predict it.
>Because the US lockdown didn't really begin to lift until June, the USA is hitting this secondary surge right now, and some states are trying to lock down again. Red states with Republican governors who are in complete denial are getting hit badly, though—notably Texas and Florida.
They really had to get partisan, didn't they? Unfortunately, the data doesn't support this claim. The fatality rate in both Texas and Florida has been flat since peaking in April, and their overall number of cases has been just a fraction of what they are in California and New York. But hey, they're run by Republicans, therefore we have to call them evil, meanwhile ignore the thousands of people literally massing in the streets spreading Covid in Democrat-run states...
Overall cases are either flat or slightly increasing, as was predicted. The lockdown was never expected to make Covid go away. Only to ["flatten the curve"](https://healthblog.uofmhealth.org/wellness-prevention/flatte...), e.g. slow down the spread so that hospitals wouldn't get overwhelmed.
A lot of places are doing a lot more testing. That causes case count to rise. That doesn't mean the disease is spreading beyond control. If it were, the fatality rate would also be increasing, which it's not.
Sorry, but you're going to have to find some other reason to justify your partisan hate boner.
Your data doesn't show testing rate. Maybe it could be true, but your data doesn't come anywhere close to showing it... And in fact, when we actually find the data that would prove it, the data shows the opposite. [1]
If you check Florida, you'll see that they actually decreased testing by 22%, and still had an increase in positive cases (over 300%!). Testing less, and getting more sick people is basically the definition of it being out of control.
The Governor of Florida is even quoted in this article as disagreeing with you, and admitting that testing doesn't account for the increase. While he might not be an expert, it should make you take another look, as this is politically damaging for him to say his party leader is wrong.
Denominators are important. Statistics are important. A raw count without other supporting data (how many tests have been given, what is the population in areas where cases are increasing) has absolutely no meaning.
There have been ≈3.5M cases in the US. That sounds awful! That’s out of 35M people tested. At its peak the infection rate for people tested in the US was around 12%. The current infection rate is 9%. The rate is falling, not rising. As more people are tested the numerator increases - it’s a tautology. It’s meaningless without understanding the context.
Media outlets Are going to drown out any rational discussion (and search results) with their hyperbole.
First point: Do you really think it's partisan to point out that governors from the same political party tend to follow similar courses of action?
Second point: let's use your own data against you [1][2]. According to you, overall cases are "flat or slightly increasing" but actually your chart is about deaths. The overall cases have doubled in the last week. Which means, all things being equal, that over the next two weeks or so, we'll be seeing a doubling of deaths follow suit.
It is absolutely partisan to characterize their actions with the phrase "in complete denial", without acknowledging that there are serious and fatal consequences of any lockdown that must be weighed against the benefits. These governors are probably making a good-faith judgement call which (while perhaps in error) is about as far from "denial" as it is possible to be. What else but partisanship could motivate the ridiculous claim that governors belonging to one political party are flatly ignoring the risk of additional infection?
To me personally, the tone comes across as way beyond partisan. It is smug, disgusting bullying.
> meanwhile ignore the thousands of people literally massing in the streets spreading Covid in Democrat-run states...
Those protests were in open air, with a very large majority wearing masks, with people constantly moving about so if you did come near an infected person you probably weren't near them long enough to get an infectious dose.
Also, in some of the cities officials did heavy testing of people at the protests or after they attended. In Minneapolis they got 1.8% positive among 3200 people they tested at the protest, and 1% among 8500 people who sought tests afterwards citing attending the protests as their reason for concern. Seattle had less than 1% positive among the 3000 protestors it tested. Boston had 1.1% among the ~1300 it tested.
As mentioned above, when you encounter an infected person in passing in an open air event with both of you wearing masks, you probably won't get an infectious dose. And with only 1-2% of the people at that event infected, you probably won't encounter enough of them to get an accumulated infectious dose either.
Yes, it is better not to have these protests during a pandemic...but at least they held the protests in places that minimized the risk and the attendees took steps to protect themselves.
Contrast this to groups that are holding their mass gatherings indoors in places where attendees will be relatively static for hours, where most attendees will not take any protective steps, and where they are discouraging even social distancing.
Also, many of the attendees will have not been taking any protective steps in the days or weeks before, so I'd expect the percentage infected going into the event to be higher than it was for the people going into the protests.
The big difference between these events and the protests is that in the later case the organizers recognized the risk and tried to limit it. They may have underestimated the risk of overestimated the effectiveness of their mitigations (although so far the numbers look like they were probably right), but if so that's a quantitative error not a qualitative one.
Those indoor, don't move around, don't mitigate the risk events, are not even trying to mitigate the risk. They are making a qualitative error.
A sure sign someone's brain has been addled by partisanship is if they embrace the idea that certain drugs being researched have a red or blue hue to them.
One output of all this is that those who, for example, reveal their expectation of HCQ to have been one of 'snake oil' simply due to a Trump tweet have taken themselves off the field when it comes to rational discourse.
edit: For those down-voting me, my guess is you were not reading papers back in early February from China and South Korea as I was about early drugs worth trialing. If your expectations of a given drug's efficacy was informed by political tweets you weren't paying attention to the trial pipeline.
The author is British - U.S. partisanship doesn't really affect him, because he can't vote and isn't subject to U.S. laws anyway. This is how the rest of the world sees us.
Most of the U.S. Democratic party (all but the Bernie Sanders wing, really) is to the right of the Tories. Britain has nationalized health care (which isn't really up for debate in Britain the way the much more conservative Obamacare is starkly divisive in American politics), Tories supported LGBTQ marriage before it was legalized in the U.S, and Boris Johnson endorsed Barack Obama.
> Britain has nationalized health care (which isn't really up for debate in Britain
Correct, there's no debate. New Labour under Blair started privatising the NHS, and the Tories simply accelerated the process, taking advantage of opportunities presented to them to do so (e.g. Covid). Alas, this doesn't make the news, so there continues to be no national conversation about how important the NHS is, beyond paying lip service and occasionally clapping for them.
So yeah, there's no debate, because both parties were doing it.
New Labour were more or less analogous to the centre-right Democratic Party in the US.
Old Labour/Corbyn were more or less analogous to the European centre-left mainstream and Bernie Sanders. These centre-left positions are allowed to play a role to continue the appearance of genuine democracy, but they're not allowed to win power.
Some European countries have more extreme left parties. Some have actual Communist parties. These parties never win power either - but they tend to keep the centre-left on the left side of the centre and stop the rightwards drift that happened in the UK.
The British public haven't realised that the NHS - fully socialised medicine - is already over. They're worked out that care levels and service provision have been dropping steadily, but they haven't worked out that this has been happening since the 90s, because all the centre-right parties are ideologically opposed to effective public health care.
Meanwhile Brexit is about oligarch-ing what's left of the UK, very much in the style of post-Soviet Russia. It's a period of planned chaos which will see a small number of rich and well-connected individuals land-grabbing public money and what's left of the public's assets.
Unlike Russia, which had significant physical resources, the UK has very little of value which won't be destroyed by Brexit. The remains of the NHS is on that list, and it will be forced to become a customer of US pharma and insurance with a much-weakened negotiating position.
> For those down-voting me, my guess is you were not reading papers back in early February from China and South Korea as I was about early drugs worth trialing. If your expectations of a given drug's efficacy was informed by political tweets you weren't paying attention to the trial pipeline.
This is, kind of exactly how snake oil works? It's not even the typical South Park / "2. ????" plan.
It's "1. Take a treatment that people are already credulous towards." "2. Sell it for lots of money while pretending it's a sure thing." "3. Run away with lots of money before anyone catches on that it's not actually worthwhile."
The thing with snake oil and real science based medicine is that they both start with that first step, of grabbing a bunch of things that seem plausible. The difference is that science based medicine first tests to see if it works before selling it for lots of money to lots of people as a cure, instead of after (or never). The initial ideas and plausibility are only occasionally different; science is a tool for finding a lot of things that don't work, and a very few that do.
I have no idea what you're talking about. There were medical papers published out of SK in February indicating preliminary signs that some drugs were worth investigating. The investigations happened. The results were published.
If you were sitting through that process feeling like you knew which way it was going to go one way or the other based upon political tweets then you'd describe it as "snake oil" as the author did, when in fact it was just the normal, albeit accelerated, clinical research process with a lot of noise from the bleachers. My own assessment is any scenarios where preliminary data was less than ideal (eg due to non-randomization) was published in the interest of sharing information due to the urgency of the crisis to help guide further controlled trial development. And look, it worked, most of the drugs who had early papers published with clinical patient data pointing in a positive direction did in fact get into trials. Unfortunately so far there have been no home runs but some solid base hits.
The reality is that most of these kinds of things like using the term "snake oil" to describe HCQ are an obvious "tell" on the part of people who consider themselves immune to cognitive dissonance and confirmation bias to be anything but.
I saw something very bizarre yesterday, which seems like it could totally explain the surging case counts while death rate continues to fall, but I can’t quite believe it’s really happening.
Apparently since about mid-April the CDC decided that the COVID Case Count would include not just positive tests, but also “probable” cases.
Probable cases are not like the Presumptive Positive cases we had early on where a state lab had a positive test but they wanted to confirm it at the CDC lab.
The criteria for a “probable case” does not require a positive lab test at all, but simply a combination of symptoms (like a cough or fever) and contact with another person who themselves was positive or probably positive.
Collin County (6th largest county in Texas) had a council meeting which included a presentation on this where they walk through the new criteria, which includes a slide showing how 1 positive lab test can result in the case count increasing by 17.
Here’s an excerpt from that part of the council meeting;
The CDC case numbers are useless. Aside from the "probable" case issue, for a long time they were also including antibody tests in the total. Antibody tests measure the number of people who have ever had coronavirus, not the number of active infections, thus conflating two very different statistics.
Most coronavirus trackers aggregate state & county level data, which doesn't suffer from the same blatant incompetence as the CDC data. It tells the same story, though: case counts are increasing exponentially, with a current doubling time of about a week, and the percent positive rate (a measure of how much testing is undercounting the true infection rate) is rapidly going up in many locations.
Even the NYT COVID tracker page has the following note;
“In the tallies shown on this page, The Times is now including cases that have been identified by public health officials as probable coronavirus patients.”
Deaths lag cases by about a month. Would expect to see the new cases result in deaths a month from now. It can take a while to die from covid, and also death statistics take a delay to compile.
That could be because the newer cases are younger people, and the mortality rate is much lower. There are many people who get it who are completely asymptomatic.
Testing has been on a rather steady increase and was truly awful in April. I know multiple people who had mild symptoms and couldn't get tested in April. We simply can't assume those case numbers from April are anywhere close to accurate. In all likelihood we had a huge case spike in April and we just don't have the test results to prove it. The April peak in new cases is therefore dampened to make it look like we had 3 months of roughly similar new case numbers when in actuality we had 3 months of declining cases. This is generally backed up by the percentage of positive tests[1] which saw a huge drop from April to the beginning of June before starting to increase again in late June. That spike isn't far enough in the past for the lagging death total to start increasing yet. Odds are the daily death increase is right around the corner.
TL;DR - The new cases plot is not predictive of the new death plot because cases are a function of new tests while deaths happen regardless of testing.
I understand what you are describing and generally agree with it, except perhaps for your ultimately prediction. The death rate may ultimately increase, but it would not be simply because the current population of non-recovered cases haven't run their course.
The total case count in theory is a factor of test capacity * positivity rate (ignoring distortions from "probable" cases). Death count also theoretically requires a positive test, so that curve could similarly be impacted by limited testing, but certainly the death part is getting measured in any case. The positivity rate itself can be impacted by limiting testing criteria based on symptoms (but, e.g. perhaps not if you were limiting based on just demographics).
Presuming we were heavily test constrained in March/April, and were limiting testing based on symptoms, so you would have an increase in positivity rate but a lower test count. COVID death count could be low depending on how limited testing was for autopsy purposes, and whether deaths could be ruled being as due to COVID without a positive test.
As testing capacity increases, and testing criteria is loosened, you would expect a lower positivity rate (for the same actual community disease burden) and a greater percentage of actual COVID deaths to be correctly diagnosed (perhaps a lower number of mis-attributed COVID deaths)... there's too many variables here to say for sure, but I would still expect the curves to have the same shape, even if the IFR ultimately goes down because you are catching more cases. The curves are clearly going in different directions.
At first I attributed the divergence to new cases being limited to a younger demographic. If case count is increasing, but it is infecting a demographic with an order of magnitude lower IFR, then death count still decreases over time. But I'm beginning to think this doesn't fully explain it. There are clearly multiple forces at play, and the situation resists simplistic explanations.
And all that is even ignoring the changes in medical protocols, like avoiding ventilators, and more recently, administering dexamethasone. Anecdotally, the majority of cases today come in as a young adult with mild symptoms (someone who probably wouldn't have even been tested in April, let alone admitted), they get a course of dex and antibiotics, are monitored for a couple days, and sent home.
I think if the current active cases were to largely resolve without spreading, or if they spread mainly within their current demographic, then we will not see a major spike in COVID deaths. If the current surge in young adult infections ultimately results in a second wave of elderly infections then it's a different story. But I don't see an inevitable surge in deaths due to the current case count spike. And to the extent that the surge in cases are "probable" and not even confirmed, we could be looking at a lot of smoke without any fire.
Many places are counting suspected COVID-19 deaths in the total which doesn't require a positive test. It is much easier to get an accurate picture of suspected deaths than suspected cases so the lack of testing has a much bigger impact on cases. Beyond that, I agree with you that there are too many variable involved to know exactly what is going on. I simply think the lack of adequate testing means the curve of the new cases plot from early in the pandemic is actively misleading. Your analysis/predictions are more optimistic than mine so hopefully you are right and I'm wrong.
Reporting standards have definitely been changing over a similar time period, but this alone may not be sufficient to explain the recent jump in cases:
This is standard. You can fairly well deduce that someone died from CoVID from their presentation of symptoms, and a CT scan. A test is not necessary to make that determination, and similarly, it is a waste to test the dead when there are plenty of people who are alive and presenting symptoms today.
They certainly were doing this in the NYC area when tests were scarce and the dead were piling up. People were complaining about it without understanding the implications then, too.
To further underline what you're saying is both true and OK; once they started doing that, death tallies started at least getting close to excess deaths, although (IIRC, and I might have misremembered) despite diagnosing covid without PCR, excess deaths always exceeded diagnosed cases - i.e. almost certainly the doctors etc were being fairly conservative.
(Although they didn't try to diagnose people that died before even reaching the hospital, which were thousands - and would have contributed to excess deaths, but not covid numbers).
No one is CT scanning the deceased, but CT scans were both cheaper and more available than CoVID tests, and internationally, diagnosis has been made by symptoms, a chest scan, and ruling out other diseases.
Also: "Adm. Brett Giroir, the man Trump appointed to oversee testing, testified at a House hearing Thursday that "this is a real increase in cases" and not just attributable to increased testing. "There is no question that the more testing you get, the more you will uncover," Giroir said Thursday. "But we do believe this is a real increase in cases because of the percent positives are going up. So, this is real increases in cases." Giroir said the U.S. is not flattening the curve. "The curve is still going up," he testified."
I don’t think parent is right, but the 7 day avg test numbers are largely explained by just the tri-State NYC numbers. NYC, NJ, CT dropped more than the case avg by the June stat.
Why is this so controversial? Hydroxychloroquine's been used for years as a treatment for Malaria and high altitude sickness, since both of those cause a decrease in blood oxygen and it helps increase the body's hemoglobin production.
He's so desperate to Tuck Frump that he's now throwing out good science that disagrees with his politics? No one, not even Trump said hydroxychloroquine was a panacea or vaccine, just something that could potentially help that we were "looking into", and everyone on the left lost their minds.
Edit: To everyone downvoting me, link to proof (e.g. peer reviewed study that hasn't been retracted) that Hydroxychloroquine has absolutely zero benefits, and I'll promise to vote Biden. I'll hold my breath...
We should all agree to come back and read this thread in 3 weeks and, many of us, apologize for being completely wrong in our angry, condescending and ultimately irrational responses, then think deeply about where we were coming from in this moment.
It's mostly hope. But hope is not a strategy and never was. The time to really fix this was early February at the latest. Acting too late in order to protect 'the market' did more damage to the market than would have ever been the case if the initial response had been on point. The difference between the countries that acted immediately, a bit later and much too late is stark.
This is not a very productive comment, but I really love blogs over twitter threads, or instagram story, or any other shallow system, even more so when it is written by a professional writer, with some British humor sprinkled on top of it.
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[ 0.21 ms ] story [ 246 ms ] thread1) Quarantine / non-pharmaceutical interventions effects start to be visible after about 2 weeks from their introduction, and are fully effective after 1.5 months.
2) Daily new deaths growth lags from daily new cases growth about a month (which is somewhat obvious, but needs to be reiterated).
So, unless some new mitigation measures are going to be introduced _right now_, this record-breaking growth will continue for quite more than a few weeks, followed by the corresponding growth of deaths a month later. We are far away from the saturation point and any resemblance of "population immunity".
I'm not sure what to make of the meaning of such a short gap, and of course people may now be testing earlier than they did in the early hot spots, so I'm not sure if this has any predictive value.
This means that from the time someone is infected until they die, a month and a half can have gone through.
By the time you take new isolation measures, you have to wait roughly two weeks to see if daily infection rates start to vary. But the lethality at this point, assuming no change in healthcare system overload, can be more or less statically predicted for weeks after the fact.
Those are called "lagging indicators"; the main thing you try to prevent are deaths, which you can lower by reducing the overload on the healthcare systems, which you can lower by controlling infection rates and keeping them low.
Due to the duration of the disease's evolution, you get to see if your policies really worked more than a month and a half after enacting them, which is extremely slow for a disease that propagates at exponential rates. So people look for proxies like infection rates that are still lagging, but far less so.
Do note that the one good metric you want in the end is going to be "excess deaths", which counts the impact of not just the diseases, but of all other side issues that the disease may have caused. This can usually take months up to years to properly account and analyze.
Thanks!
Sorry to hijack, your actual question is interesting too. I guess that would mean all the increased infection metrics are entirely from increases in testing and we're actually seeing that infection rates have always been way higher and the virus is way way less deadly than previously thought? Or maybe it has mutated and become less deadly?
In your recent posts, you’ve said that you just applied for your PhD, that you are a “consultant software engineer” in finance, that you are studying physics and that you have a masters in CS. You really must be a renaissance man.
(All opinions here are of my own, not of my faculty or the university).
https://reactivity.ai/#about
Edit: to respond to the question below, it clearly supports a "renaissance man" question by IAmGraydon above: it confirms both a "“consultant software engineer” in finance" and a "masters in CS." I don't see how it is not relevant. Moreover, it's not that somebody questioned atemerev's posts based on his qualifications, it's atemerev who claimed to be "an actual epidemiologist" in his first sentence, and that it definitely something that can be tested for veracity, if atamarev wanted to give more credibility to his claim with that (he didn't have to do that -- and then his claim could be evaluated on its own too, but biases by the authors of some claims are also something that could be questioned). Anyway, in this case, it's obvious that atemerev's university degree isn't in epidemiology.
Edit2: atemerev's first claim: "an actual epidemiologist" now gets to be closer to the truth in the response below as "an epidemic modeler." I still believe IAmGraydon was right to question the claim, and that the initial claim was indeed misleading and incorrect.
https://news.ycombinator.com/newsguidelines.html
https://www.worldometers.info/coronavirus/country/uk/
Neither the US graphs reflect that -- difference in the first peak of cases and deaths is 9 days:
https://www.worldometers.info/coronavirus/country/us/
For Sweden daily cases rise steadily for months after the peak of deaths:
https://www.worldometers.info/coronavirus/country/sweden/
The models are indeed made based on the described assumptions, the actually reported data however isn't as simple as the models. We are of course sure that deaths happen much later as the infections, but what would become the reported "cases" where is hard to model. The "infected but unreported" surely exist and the models rightly also try to account for these too. But everything together is harder than it appeared at the start -- even the number of antibodies among the once infected is not "yes or no, either one has them or not" but something that can be above or below the detection level and that varies through the time in the same individual, decreasing with the time, and undetectable among some who were PCR-test positive.
In short, the good explanations will have to be nuanced, never simple. And we still search for all the nuances.
One comparison: https://datagraver.com/corona/#/?regions=italy:hex005FA2,spa...
Massachusetts has fairly well defined peaks too: https://covidtracking.com/data/state/massachusetts
What's causing this discrepancy? Clearly the disease progression isn't that fast, so... what then? Maybe the more vulnerable groups tend to get hit more quickly, and as cases ramp up either die earlier or lock down more rigorously or both, such that the less-vulnerable form an infection peak after the death peak has passed? Or is it simply that people get tested late in the disease progression?
Given how little the MA testing rate has varied, and that the positive rate peaks also are much closer than a month apart from the fatality peak, I don't think testing changes seem likely to be a primary cause of the (to me) unexpectedly short period between case peak and death peak.
The situation is far different now, with a good chunk of people actively rejecting even basic distancing measures. If you look beyond positive test numbers at the % positive you can see the rates are rising even faster beyond our testing capabilities. And the idea that only 20-30 year olds are getting the disease is wishful thinking - the highest risk situation is from household transmission, at over 80% likely.
Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.
Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.”
Three things:
1) It’s been over a month since case count started to grow in the southern states. Hospitalization and deaths by day are not growing at all in FL or AZ, and only hospitalizations are growing slowly in TX:
https://covid-19.direct/state/FL?tab=daily
https://covid-19.direct/state/TX?tab=daily
https://covid-19.direct/state/AZ?tab=daily
2) It isn’t “wishful thinking”; the age distributions of positive results out of Texas clearly show that most of the people testing positive are younger, and it seems to be true in FL as well:
https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#...
https://www.google.com/amp/s/www.news4jax.com/news/florida/2...
3) It’s not very common to see multi-generational households in the US.
Maybe it’s true that this surge will eventually make it’s way to the high-risk, but it’s been over a month already, and that doesn’t appear to be true yet. At some point, predictions of the future have to be tempered by current evidence.
In the early days patients essentially had to be far along in the progress of the disease to be tested, we simply had very little testing capacity.
Now we are doing many times more tests against a much wider set of subjects. So it is inevitable that we are getting more of the milder cases and cases earlier in their development. This also accounts for the so-called “shift” toward many more young patients.
The disease hasn’t changed. Current testing is sampling a different distribution of patients than previous months had been.
On the other hand, it's only a factor 3, which is certainly nothing to sneeeze at, but still remarkable that that's enough to so strongly decouple mortality from infection, compared to earlier.
[1] https://www.nytimes.com/2020/05/20/nyregion/hospitals-corona...
https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v...
You will be able to claim that any changes made by local and state governments in the next few days/weeks “did the trick”. Nevertheless, this is a fair escape hatch when the following prediction does not come true:
> this record-breaking growth will continue for quite more than a few weeks, followed by the corresponding growth of deaths a month later. We are far away from the saturation point and any resemblance of "population immunity".
You will be proven wrong, both about the coming “wave of death”, and about how far we are from the saturation point. I’m quoting this and publicly disagreeing today, so that you might remember later on, and maybe even acknowledge that you got it wrong.
Is seems like your position is that:
--COVID response strategy based on invalid "post-modern science",
--the conclusion that the disease death rate is order of one percent is incorrect
--and therefore, the policy response is grossly disproportionate and harmful.
It seems like you are arguing about facts not values, and you think the disease death rate is not really order of %1. Is this what you mean?
I'm also asking because I have heard many heated statements about "post-modern" science around here as of late that wherein the speaker seems to treat that concept as common knowledge, and then walks off without explaining themselves, but I don't really understand what they are on about.
https://americanaffairsjournal.org/2020/05/science-without-v...
The second characterization is way off base. All IFR numbers are rough estimates at this point, and in fact the number is just a model parameter that does not correspond to anything in the real world, so it's a bit hard to talk about any "fact" there. The disease evolves, treatment protocols change (early venting was a terrible mistake), and susceptibility may vary widely from community to community. Still, the most recent CDC estimate for this model parameter is 0.26%.
The third is a prediction, not an established fact. Right now there is no way to know what the long-term effects of our policy response will be. I have cited many anecdotal "bad" effects which (together with others) I believe will outweigh the "good" effects, but we will have to wait and see.
> While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food.
At the low end they predict 250,000 excess child deaths and 12,000 excess maternal deaths, and at the high end 1,150,000 excess child deaths and 56,000 excess maternal deaths due to decreased access to health care and food.
The number of missed vaccines and cancer screenings alone multiplied worldwide turns into a massive hit to public health.
https://www.thelancet.com/journals/langlo/article/PIIS2214-1...
edit: Ok, I see you are the one with polemic blog post. I see that you seem to think it is "just a cold" because it is a coronavirus.
It seems you are making a categorization error. Like saying because there are garden snakes, having a cobra in your house is no big deal--just a snake!
Why would the waves of death never come? So far more people have died than WWII. The deaths lag new infections, and new infections have spiked. I see you are interested in other folks admitting they are wrong--will you?
Susceptibility varies widely between individuals, with four grades of antibody response, as well as at least one form of T-Cell-mediated response, already documented in the literature. There is enough evidence to suggest that this virus is airborne, and if everyone were completely susceptible the "true" R0 (this model parameter is a convenient fiction, of course) would be close to that of measles. Therefore it has already spread very far in any dense population that was susceptible, and we are basically already at herd immunity in NYC and many other places.
> Ok, I see you are the one with polemic blog post.
Yay, I'm a niche HN celebrity!
> I see that you seem to think it is "just a cold" because it is a coronavirus.
You are skipping over a critical detail, which is that any virus can be much more virulent after it jumps between species. But yes this one is basically a new cold, and in time it will present much like all the others (if it becomes endemic).
> So far more people have died than WWII.
What the fuck???
> I see you are interested in other folks admitting they are wrong--will you?
If half a million Americans die from this thing (not merely with it, and before it becomes just another cold, not over the next 20 years), you can count on it. This will not happen.
> So far more people have died than WWII.
> What the fuck???
You are right on this one, bad bad misquote on my part.
(I have (unfortunately) already won a few bets like that, but it's always a chance that I am wrong this time, of course).
In fact, there is already a failed prediction in your essay: "but we will fail to see the 'second wave' that was predicted". The second wave happened. Exactly in the way we, "postmodernist scientists", have predicted. I will be the first one to tell you that indeed, there are many problems in modern science. But this is not one of them.
How about we meet up in a month and look at the death numbers? I predict that the national 14-day average will continue to decrease, or maybe flatten out for a bit.
Some of it must be due to spread in the southern states, where (by no coincidence) people spend more time indoors during the summer.
Some of it may also be due to the “July effect” which I did not know about:
https://acphospitalist.org/archives/2011/04/coverstory.htm
https://en.m.wikipedia.org/wiki/July_effect
I think there's an argument that what we're seeing in the US isn't actually a second wave at all; it's stepped first waves in different places. Rates in places like Florida never really went down all that much. The US probably shouldn't be considered a single entity for these purposes.
(To be clear, I would expect that there will be a real second wave in the US at some point, I just don't think that this is it)
https://www.preprints.org/manuscript/202007.0025/v1/download
If we assume that the majority of "non HCQ" patients were of group (e), young people, then their rate of mortality in this paper would be at least an order of magnitude higher than that of any previous paper, therefor I would expect group (d), old people with complications, to be more likely to have higher representation in their "non HCQ" group.
I didn't conduct this study so I don't have access to the raw data not provided in the paper.
I’ve informally been following testing and it seems like every paper published against hydroxychloroquine is either not peer reviewed, the data is suspect and unavailable, or are promoted by groups with financial interest in another solution.
Assuming that hydroxychloroquine in fact has no benefit, there also seems to be limited evidence that it causes complications and has been widely used without issue until this pandemic. If me or my family were hospitalized with COVID, I would push hard for immediate hydroxychloroquine treatment along with whatever schedule was prescribed assuming no known contraindications.
If tomorrow a new treatment emerged and had consistently repeatable results described in peer reviewed journals, I’d gladly change my strategy. Screw media and political fear mongering. Show me repeatable statistics.
According to the WHO about 1.3 million people die from Tuberculosis every year [1]. Another 400.000 die annually from malaria. 462 million are underweight, and 52 million under-fives are suffering from wasting [3]. Covid19 isn't even in the same league as famine and disease. Covid19 is serious but it's not a catastrophe, and it's just one of many things that the world has to deal with, and we can't let it hijack our attention and focus.
[1] https://www.who.int/gho/tb/epidemic/cases_deaths/en/
[2] https://www.who.int/gho/malaria/epidemic/deaths/en/
[3] https://www.who.int/nutrition/topics/world-food-day-2019-mal...
This is a good observation. We can't the fault the author for stating things from their perspective. The point of view has a big influence on what one sees.
How many will die from COVID-19 if we lift all of the measures we have taken to stop the spread?
In case you were serious, the reason things are working out, more or less, in China and Europe is that measures were put in place (and people have stuck to them, by and large) such that the incidence of new cases fell a lot.
Second half of the year in the Americas look less promising.
EDIT: replaced summer and fall by second half of the year, given that half the Americas are south of the equator...
European countries have selectively lifted some lockdown measures and are closely monitoring the situation. Local outbreak spikes are happening. Many protests actually observed at least some degree of distancing, and their impact is mitigated by them happening outside - the strongest infection vector seems to be areosol, which is far more dangerous indoors. Many places are still seing exponential growth.
Anyone who still trots out the "just another bad flu season" claim is just criminally stupid.
The next step is to ask yourself why no similar spike in cases happened after protests in NY or Paris, even though they also had this "perfect set-up" for spreading.
1: https://pbs.twimg.com/media/Ebpl1DVU0AAPHMs?format=jpg&name=...
2: https://www.businessinsider.nl/dr-fauci-protests-perfect-set...
“In a time of universal deceit, telling the truth is a revolutionary act.” -Unknown
The irrational position based on deceit is yours.
https://www.washingtonpost.com/investigations/cdc-wants-stat...
https://google.com?q=ny+coronavirus+cases
By "the fucking case numbers", I assume you mean only those statistics which are spoon-fed by an industry that makes money scaring people into noticing advertisements.
Lol, are you trying to tell me what sources I'm using? I'm not even American.
> https://www.washingtonpost.com/investigations/cdc-wants-stat...
What's that supposed to tell me? That a liberal agenda is trying to inflate the numbers? Just looking at actual test results isn't any prettier: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
Look at Russia, Mexico, Ukraine, Sweden.
> https://google.com/?q=ny+coronavirus+cases
https://google.com/?q=florida+coronavirus+cases
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
Germany, with its very successful lockdown measures that have been eased gradually now had a case last week where basically an entire meat packing plant got infected, over 1000 people, leading to ongoing infections in that area.
There is exactly zero indication that it's over, just that lockdown and distancing measures are working, and that a subset of them, combined with diligent testing and contact tracing, may be enough.
Spikes didn't seem to happen in countries like Spain or Italy that had been hit pretty damn hard the first time.
Yours are no better. Romania and Serbia aren's seeing "spikes", they're having a second wave that looks like it will very soon eclipse the first. Sweden's case numbers haven't actually stopped growing. Germany, which had one of the highest case numbers for a long time now had a spike with 1300 cases in a single meat factory. Many other countries have stable low case numbers, which means that they're fine at their current level of containment measures, but could easily see a second wave hit quickly if they undo those measures. I don't think there's any European country with case numbers low enough that they could safely rely on contact tracing alone - South Korea tried that, with the result that they went from single-digit daily case numbers back to mid-double digits. The problem is that in crowded indoor conditions, you get "superspreading" events that can completely destroy all the progress made over months of containment.
Yes, that's what a spike means. And for the record, that's exactly what the Romanian Health minister called it two days ago, i.e. not a second wave, because in his opinion the first wave never stopped, but a spike.
> Sweden's case numbers haven't actually stopped growing.
I know that, and I'll answer that what I answered to other people online: this isn't a video game where we should chase the lowest number of cases the same way as we're chasing a score, this is real life where we should chase the less number of deaths possible. And in Sweden the number of deaths is definitely on a downward spiral.
We're going to have to live with this virus, many of us already do, there are not that many economical resources available to keep the majority of the population locked indoors (to say nothing of the psychic and mental effects this is having on the population).
Lifting some of them. Some pubs and restaurants just opened here this week under heavy restrictions, for instance; too soon to see what impact that has on cases. And that was after case numbers were brought down to a few a day; we didn't just lift restrictions while we were still seeing hundreds a day. And of course people are being pretty cautious, mostly still on furlough or working from home, etc. Supermarkets are still letting only a few people in at a time. And the list goes on. We're 'reopening', but we are nowhere close to normal, and a return to normality isn't envisaged at this point; there is no deadline by which the supermarkets will return to full capacity, say.
> Massive protests happened in major European cities and nothing happened. Massive protests in NY didn't result in a spike of cases
While the results arguably aren't totally in, you'd expect outdoor, largely masked, protest to be a lot lower risk than, say, pubs and restaurants reopening. Purely from a public health perspective it wasn't ideal, but it wasn't remotely as risky as the last stages of reopening.
> In most places COVID-19 is over. Done
Where? In the last few weeks in Ireland we've had anywhere from 1 to 20 cases per day, more or less at random. It's down a lot from peak, but it hasn't gone away and it could surge back if we screw up (and there are some early indications that it might be doing so; those pubs and restaurants may not be open for long). It's a similar story in most places in Europe (adjusted per capita).
Looking at Sweden, not that much.
Additionally, there was a war on for a bunch of it, which impacted things.
Like, I actually think that lockdowns are a reasonable approach as a pandemic control strategy. I think it's a reasonable tradeoff against the potential deaths.
Note that this is completely conditional on the existence of a proper social security network, which supports all the people who can't work from home.
You must have missed the 55K+ new cases in North America alone yesterday.
The latest daily figures I see are 67K North America, 59K Asia, and 63K South America.
Ever heard about the 40-year old British pilot having to be in "two-and-a-half months in a medically induced coma" from "a regular flu"?
"His blood became extremely sticky leading to clots. His kidneys failed meaning they required dialysis and his lung capacity plummeted to 10%."
It's very different from flu, those are known symptoms of Covid-19.
Also, did you know that Vietnam still has zero deaths from Covid-19?
https://www.bbc.co.uk/news/world-asia-53196009
2. Honestly though, we really should have been taking the seasonal flu more seriously. A cousin of mine, mother of three young children, died from the flu in 2018 after being put into a medically induced coma. 30k-60k people in the US each year is a helluva lot to keep losing, and while we can't lock down to the degree we are now on a regular basis, we're also seeing that some of our behaviors are more risky than others. What if there are relatively simple changes we could be making to our lives that would slow and stop the spread of the seasonal flu?
The most cursory glance at the case numbers proves this wrong. Look at Sweden, Russia, Ukraine, Poland, Portugal, Romania...
> And remember that the average age on the planet is only 29, and for people under 50 covid19 is no more dangerous than a regular flu.
Except it is, very much.
Stop spewing this bullshit, please.
If anything, this corona thing has taught us that we can make real changes if needed. The truth is, people don't want to fix many of the problems we face day to day, for a variety of reasons, but largely because fixing them would be unprofitable for a small number of people who control most of the means of production.
We can find 100 ways to hate one another but only a couple to unite and solve these.
[0] https://ourworldindata.org/covid-deaths#what-is-the-total-nu...
That's probably the number directly killed in WW2
But probably not killed by WW2 indirectly.
So you might argue if you count the decade long economic deaths from C19 you also have to count WW2s additional decade long economic deaths.
The death rate would be far, far higher, perhaps an order of magnitude, because hospitals would be overrun.
Even if the Covid patients had a low death rate at the hospital, millions more would be refused treatment, millions more than that would die because Covid patients took up all the beds.
And I was like, oh, yeah, obviously they can just tell those people who don't have the virus to GTFO and make space...wait, why are they in the ICU then?
http://webcache.googleusercontent.com/search?q=cache:http://...
http://web.archive.org/web/20200703132003/http://www.antipop...
https://megalodon.jp/2020-0703-2248-09/www.antipope.org/char...
Sorry for the sad state of your poor thinking process...
https://qmap.pub/
https://www.ijidonline.com/article/S1201-9712(20)30534-8/ful...
> “Our dosing also differed from other studies not showing a benefit of the drug. And other studies are either not peer reviewed, have limited numbers of patients, different patient populations or other differences from our patients.”
>However, our results should be interpreted with some caution and should not be applied to patients treated outside of hospital settings. Our results also require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety, and efficacy of hydroxychloroquine therapy for COVID-19 in hospitalized patients.
The main issue is that retrospective studies like this show promise all the time and then frequently fizzle out in RCTs. If you're not used to reading studies they will sound very promising, someone who's been reading studies for 10 years will understand why this and the French studies that started the hype early on can be very misleading.
Also, who was being quoted in the title?
It's from World War I. See this comment on the (flagged) submission of the last post:
https://news.ycombinator.com/item?id=22897805
That was a later anachronism, and the phrase "over by Christmas" doesn't appear until late 1917. It was used as an intentional exaggeration to describe how those in Britain at the end of the war felt about the decision to enter the war in 1914.
The reality is that very observers anticipated an "easy" war. Virtually everybody predicted that the conflict would be the most destructive since the Napoleonic wars, and collapse the world economy. Overwhelming majority of the British public and politicians expressed a preference for neutrality. It wasn't until the Germans marched straight through the heart of neutral Belgium, and their sheer degree of wanton looting and destruction, that public opinion turned.
It's very clear that even in 1914 nobody thought it would be an "easy" war. Germany's Rape of Belgium led Britain, and later America, to reluctantly intervene. However it's a testament to the sheer scale of carnage in World War I that even these very dour predictions turned out to be underestimates.
Russia isn't going to invade Germany if Germany stomps on Coronavirus because Coronavirus kills a duke. Nobody is on the side of the virus. Unlike retaking Eastern France, progress eradicating Coronavirus does not have to necessarily be over other people's dead bodies. Nearly all of humanity wants to see this disease gone. The circumstances are very, very different.
Just for clarity, I think you meant:
> The reality is that very few observers anticipated an "easy" war.
Surprised it didn’t redirect by itself.
That's not the only such murder, and it's not the only one caught on video.
If a "predictive blog" isn't based largely on the body of publicly available past evidence (i.e., history), what's the point of the endeavor?
He is though successful Sci-Fi author Charles Stross in case you didn't pick that up from the page, and he's penned some pretty insightful posts in his time blogging too.
They really had to get partisan, didn't they? Unfortunately, the data doesn't support this claim. The fatality rate in both Texas and Florida has been flat since peaking in April, and their overall number of cases has been just a fraction of what they are in California and New York. But hey, they're run by Republicans, therefore we have to call them evil, meanwhile ignore the thousands of people literally massing in the streets spreading Covid in Democrat-run states...
[Texas fatality rate](https://www.google.com/search?source=hp&ei=gUn_XoLnLJmxytMPu...).
[Florida fatality rate](https://www.google.com/search?source=hp&ei=tEn_XoKrOpesytMPj...).
Overall cases are either flat or slightly increasing, as was predicted. The lockdown was never expected to make Covid go away. Only to ["flatten the curve"](https://healthblog.uofmhealth.org/wellness-prevention/flatte...), e.g. slow down the spread so that hospitals wouldn't get overwhelmed.
https://www.google.com/search?q=texas+covid+cases
https://www.google.com/search?q=florida+covid+cases
Cases != fatalities.
A lot of places are doing a lot more testing. That causes case count to rise. That doesn't mean the disease is spreading beyond control. If it were, the fatality rate would also be increasing, which it's not.
Sorry, but you're going to have to find some other reason to justify your partisan hate boner.
If you check Florida, you'll see that they actually decreased testing by 22%, and still had an increase in positive cases (over 300%!). Testing less, and getting more sick people is basically the definition of it being out of control.
[1] https://www.propublica.org/article/state-coronavirus-data-do...
The Governor of Florida is even quoted in this article as disagreeing with you, and admitting that testing doesn't account for the increase. While he might not be an expert, it should make you take another look, as this is politically damaging for him to say his party leader is wrong.
There have been ≈3.5M cases in the US. That sounds awful! That’s out of 35M people tested. At its peak the infection rate for people tested in the US was around 12%. The current infection rate is 9%. The rate is falling, not rising. As more people are tested the numerator increases - it’s a tautology. It’s meaningless without understanding the context.
Media outlets Are going to drown out any rational discussion (and search results) with their hyperbole.
First point: Do you really think it's partisan to point out that governors from the same political party tend to follow similar courses of action?
Second point: let's use your own data against you [1][2]. According to you, overall cases are "flat or slightly increasing" but actually your chart is about deaths. The overall cases have doubled in the last week. Which means, all things being equal, that over the next two weeks or so, we'll be seeing a doubling of deaths follow suit.
[1] https://www.google.com/search?source=hp&ei=tEn_XoKrOpesytMPj...
[2] https://www.google.com/search?source=hp&ei=gUn_XoLnLJmxytMPu...
To me personally, the tone comes across as way beyond partisan. It is smug, disgusting bullying.
Those protests were in open air, with a very large majority wearing masks, with people constantly moving about so if you did come near an infected person you probably weren't near them long enough to get an infectious dose.
Also, in some of the cities officials did heavy testing of people at the protests or after they attended. In Minneapolis they got 1.8% positive among 3200 people they tested at the protest, and 1% among 8500 people who sought tests afterwards citing attending the protests as their reason for concern. Seattle had less than 1% positive among the 3000 protestors it tested. Boston had 1.1% among the ~1300 it tested.
As mentioned above, when you encounter an infected person in passing in an open air event with both of you wearing masks, you probably won't get an infectious dose. And with only 1-2% of the people at that event infected, you probably won't encounter enough of them to get an accumulated infectious dose either.
Yes, it is better not to have these protests during a pandemic...but at least they held the protests in places that minimized the risk and the attendees took steps to protect themselves.
Contrast this to groups that are holding their mass gatherings indoors in places where attendees will be relatively static for hours, where most attendees will not take any protective steps, and where they are discouraging even social distancing.
Also, many of the attendees will have not been taking any protective steps in the days or weeks before, so I'd expect the percentage infected going into the event to be higher than it was for the people going into the protests.
The big difference between these events and the protests is that in the later case the organizers recognized the risk and tried to limit it. They may have underestimated the risk of overestimated the effectiveness of their mitigations (although so far the numbers look like they were probably right), but if so that's a quantitative error not a qualitative one.
Those indoor, don't move around, don't mitigate the risk events, are not even trying to mitigate the risk. They are making a qualitative error.
One output of all this is that those who, for example, reveal their expectation of HCQ to have been one of 'snake oil' simply due to a Trump tweet have taken themselves off the field when it comes to rational discourse.
edit: For those down-voting me, my guess is you were not reading papers back in early February from China and South Korea as I was about early drugs worth trialing. If your expectations of a given drug's efficacy was informed by political tweets you weren't paying attention to the trial pipeline.
Labour and Tory mapped well enough to US politics.
Correct, there's no debate. New Labour under Blair started privatising the NHS, and the Tories simply accelerated the process, taking advantage of opportunities presented to them to do so (e.g. Covid). Alas, this doesn't make the news, so there continues to be no national conversation about how important the NHS is, beyond paying lip service and occasionally clapping for them.
So yeah, there's no debate, because both parties were doing it.
Old Labour/Corbyn were more or less analogous to the European centre-left mainstream and Bernie Sanders. These centre-left positions are allowed to play a role to continue the appearance of genuine democracy, but they're not allowed to win power.
Some European countries have more extreme left parties. Some have actual Communist parties. These parties never win power either - but they tend to keep the centre-left on the left side of the centre and stop the rightwards drift that happened in the UK.
The British public haven't realised that the NHS - fully socialised medicine - is already over. They're worked out that care levels and service provision have been dropping steadily, but they haven't worked out that this has been happening since the 90s, because all the centre-right parties are ideologically opposed to effective public health care.
Meanwhile Brexit is about oligarch-ing what's left of the UK, very much in the style of post-Soviet Russia. It's a period of planned chaos which will see a small number of rich and well-connected individuals land-grabbing public money and what's left of the public's assets.
Unlike Russia, which had significant physical resources, the UK has very little of value which won't be destroyed by Brexit. The remains of the NHS is on that list, and it will be forced to become a customer of US pharma and insurance with a much-weakened negotiating position.
This is, kind of exactly how snake oil works? It's not even the typical South Park / "2. ????" plan.
It's "1. Take a treatment that people are already credulous towards." "2. Sell it for lots of money while pretending it's a sure thing." "3. Run away with lots of money before anyone catches on that it's not actually worthwhile."
The thing with snake oil and real science based medicine is that they both start with that first step, of grabbing a bunch of things that seem plausible. The difference is that science based medicine first tests to see if it works before selling it for lots of money to lots of people as a cure, instead of after (or never). The initial ideas and plausibility are only occasionally different; science is a tool for finding a lot of things that don't work, and a very few that do.
If you were sitting through that process feeling like you knew which way it was going to go one way or the other based upon political tweets then you'd describe it as "snake oil" as the author did, when in fact it was just the normal, albeit accelerated, clinical research process with a lot of noise from the bleachers. My own assessment is any scenarios where preliminary data was less than ideal (eg due to non-randomization) was published in the interest of sharing information due to the urgency of the crisis to help guide further controlled trial development. And look, it worked, most of the drugs who had early papers published with clinical patient data pointing in a positive direction did in fact get into trials. Unfortunately so far there have been no home runs but some solid base hits.
The reality is that most of these kinds of things like using the term "snake oil" to describe HCQ are an obvious "tell" on the part of people who consider themselves immune to cognitive dissonance and confirmation bias to be anything but.
Apparently since about mid-April the CDC decided that the COVID Case Count would include not just positive tests, but also “probable” cases.
Probable cases are not like the Presumptive Positive cases we had early on where a state lab had a positive test but they wanted to confirm it at the CDC lab.
The criteria for a “probable case” does not require a positive lab test at all, but simply a combination of symptoms (like a cough or fever) and contact with another person who themselves was positive or probably positive.
Collin County (6th largest county in Texas) had a council meeting which included a presentation on this where they walk through the new criteria, which includes a slide showing how 1 positive lab test can result in the case count increasing by 17.
Here’s an excerpt from that part of the council meeting;
https://twitter.com/sav_says_/status/1278090647140995073?s=2...
And in case you’re dubious, here’s the whole meeting, and you can scroll to about 15:25 to see this part;
https://collincountytx.new.swagit.com/videos/62477
Most coronavirus trackers aggregate state & county level data, which doesn't suffer from the same blatant incompetence as the CDC data. It tells the same story, though: case counts are increasing exponentially, with a current doubling time of about a week, and the percent positive rate (a measure of how much testing is undercounting the true infection rate) is rapidly going up in many locations.
“In the tallies shown on this page, The Times is now including cases that have been identified by public health officials as probable coronavirus patients.”
The daily case count and daily death count initially look like two of the same curve simply shifted — as you might expect.
Since approximately mid-April that has no longer the case and they are fundamentally different curves.
You can see it here if you scroll down to where the daily charts are one above the other;
https://www.nytimes.com/interactive/2020/us/coronavirus-us-c...
Something big changed (or several smaller somethings) mid-April to cause this divergence.
If the case count measurement is no longer measuring actual positive cases, that could be a big part of the problem.
TL;DR - The new cases plot is not predictive of the new death plot because cases are a function of new tests while deaths happen regardless of testing.
[1] - https://coronavirus.jhu.edu/testing/individual-states
The total case count in theory is a factor of test capacity * positivity rate (ignoring distortions from "probable" cases). Death count also theoretically requires a positive test, so that curve could similarly be impacted by limited testing, but certainly the death part is getting measured in any case. The positivity rate itself can be impacted by limiting testing criteria based on symptoms (but, e.g. perhaps not if you were limiting based on just demographics).
Presuming we were heavily test constrained in March/April, and were limiting testing based on symptoms, so you would have an increase in positivity rate but a lower test count. COVID death count could be low depending on how limited testing was for autopsy purposes, and whether deaths could be ruled being as due to COVID without a positive test.
As testing capacity increases, and testing criteria is loosened, you would expect a lower positivity rate (for the same actual community disease burden) and a greater percentage of actual COVID deaths to be correctly diagnosed (perhaps a lower number of mis-attributed COVID deaths)... there's too many variables here to say for sure, but I would still expect the curves to have the same shape, even if the IFR ultimately goes down because you are catching more cases. The curves are clearly going in different directions.
At first I attributed the divergence to new cases being limited to a younger demographic. If case count is increasing, but it is infecting a demographic with an order of magnitude lower IFR, then death count still decreases over time. But I'm beginning to think this doesn't fully explain it. There are clearly multiple forces at play, and the situation resists simplistic explanations.
And all that is even ignoring the changes in medical protocols, like avoiding ventilators, and more recently, administering dexamethasone. Anecdotally, the majority of cases today come in as a young adult with mild symptoms (someone who probably wouldn't have even been tested in April, let alone admitted), they get a course of dex and antibiotics, are monitored for a couple days, and sent home.
I think if the current active cases were to largely resolve without spreading, or if they spread mainly within their current demographic, then we will not see a major spike in COVID deaths. If the current surge in young adult infections ultimately results in a second wave of elderly infections then it's a different story. But I don't see an inevitable surge in deaths due to the current case count spike. And to the extent that the surge in cases are "probable" and not even confirmed, we could be looking at a lot of smoke without any fire.
https://www.washingtonpost.com/investigations/cdc-wants-stat...
Of course this obvious factor is not mentioned anywhere in the headline coverage of the case numbers, which says a lot.
(Although they didn't try to diagnose people that died before even reaching the hospital, which were thousands - and would have contributed to excess deaths, but not covid numbers).
This is easy to compare with the past data:
https://www.worldometers.info/coronavirus/country/us/
Looking at the 7 day moving average:
April 20: around 30K cases per day; May 20: around 24K cases per day; June 12: around 22K cases per day; July 2: 47K cases per day
Doesn't fit at all with the "mid-April" hypothesis. The number of cases stayed for quite a while below 30K, only to surge very recently.
Also see how the curves for different states differ, and note how it's completely different from the shape of the curves following the tests:
https://covidgraph.com/usa/#daily
Also: "Adm. Brett Giroir, the man Trump appointed to oversee testing, testified at a House hearing Thursday that "this is a real increase in cases" and not just attributable to increased testing. "There is no question that the more testing you get, the more you will uncover," Giroir said Thursday. "But we do believe this is a real increase in cases because of the percent positives are going up. So, this is real increases in cases." Giroir said the U.S. is not flattening the curve. "The curve is still going up," he testified."
https://abcnews.go.com/US/coronavirus-updates-arizona-bar-al...
Several studies have now confirmed it's beneficial:
https://www.sciencetimes.com/articles/25658/20200512/hydroxy...
https://amp.cnn.com/cnn/2020/07/02/health/hydroxychloroquine...
and the studies "debunking" it's benefits or claiming it's evenbad have been retracted by their publishers as bad science.
https://bgr.com/2020/06/05/coronavirus-drug-update-massive-h...
https://www.npr.org/sections/coronavirus-live-updates/2020/0...
Why is this so controversial? Hydroxychloroquine's been used for years as a treatment for Malaria and high altitude sickness, since both of those cause a decrease in blood oxygen and it helps increase the body's hemoglobin production.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175905/
He's so desperate to Tuck Frump that he's now throwing out good science that disagrees with his politics? No one, not even Trump said hydroxychloroquine was a panacea or vaccine, just something that could potentially help that we were "looking into", and everyone on the left lost their minds.
Edit: To everyone downvoting me, link to proof (e.g. peer reviewed study that hasn't been retracted) that Hydroxychloroquine has absolutely zero benefits, and I'll promise to vote Biden. I'll hold my breath...