Coronavirus (COVID-19)

[seriously27]

5 minutes ago, mission27 said:

I personally think there was highly compelling evidence in early March that CFR was far below 1% tbh.  MoL was saying this at the time and getting a lot of **** for it, which whatever, but it was also a widely held belief in the epidemiological community.  The CFR assumption in the Imperial model was not particularly justifiable even at the time.

Anyway, bottom line, yes it got people to lockdown.  I personally think a good argument could be made that pursuing a more balanced approach with more limited social distancing that balanced public health / need to not overwhelm hospitals with other considerations - which was generally the goal of most countries outside of China prior to March 9th - would have been a better approach.  Going from zero public health response to a full lockdown of the entire world in 10 days was pretty extreme. 

And I think people rushing to take the most extreme measures in response to a flawed study that had not been peer reviewed is fundamentally similar to giving a bunch of people a medicine with anecdotal evidence of success but no hard research.  I get why it happened, because people were under pressure without a lot of time, but that doesn't mean it was the right decision. 

Coming from that community, yes most people considered the number to be around 1% when you considered the lifestyle and health of the people of Wuhan. What you are not considering with your take of a more balanced lockdown is the fact that we, as a country, were also way too slow in our response to the virus. Without getting political at all, our federal government failed to see how big of an issue this virus was going to be and did nothing. This allowed the virus to take a pretty strong hold in the US. Had your idea of a balanced lockdown been done in the beginning then I think that would have worked. Unfortunately we were not starting from a point of zero infections and no models could show us where we stood at the time. 

This is something you really need to remember as well and it's something I try to tell everyone to consider when talking about opening up. Virus's love to mutate. And the more times you get a virus to replicate, the more chance there are to make a more aggressive strain of the virus. If you were to combine a more aggressive strain with the ability to replicate and transmit itself before you show symptoms that the virus already has....well I don't have to tell you that it would make our mortality numbers look pretty weak. People often forget this when they are talking about herd mentality and things of that nature. This virus will go through millions of mutations that won't make it past the coding phase and will be destroyed or will never make the viral proteins...but all it takes is one. And the more people who get infected  make the probability of it occurring even higher. 

[mission27]

2 minutes ago, seriously27 said:

This is something you really need to remember as well and it's something I try to tell everyone to consider when talking about opening up. Virus's love to mutate. And the more times you get a virus to replicate, the more chance there are to make a more aggressive strain of the virus. If you were to combine a more aggressive strain with the ability to replicate and transmit itself before you show symptoms that the virus already has....well I don't have to tell you that it would make our mortality numbers look pretty weak. People often forget this when they are talking about herd mentality and things of that nature. This virus will go through millions of mutations that won't make it past the coding phase and will be destroyed or will never make the viral proteins...but all it takes is one. And the more people who get infected  make the probability of it occurring even higher. 

Sure but the chances of a deadlier form of the virus becoming the dominant strain seem pretty low dont they... deadlier strains will cause more obvious outbreaks which will lead to more aggressive public health responses whereas less deadly strains will remain undetected longer and infect a larger number of people, likely conferring some degree of protection against the more aggressive strains

 

 

4 minutes ago, seriously27 said:

Coming from that community, yes most people considered the number to be around 1% when you considered the lifestyle and health of the people of Wuhan. What you are not considering with your take of a more balanced lockdown is the fact that we, as a country, were also way too slow in our response to the virus. Without getting political at all, our federal government failed to see how big of an issue this virus was going to be and did nothing. This allowed the virus to take a pretty strong hold in the US. Had your idea of a balanced lockdown been done in the beginning then I think that would have worked. Unfortunately we were not starting from a point of zero infections and no models could show us where we stood at the time. 

Understand we weren't starting at zero and that the US along with many other countries (in Europe, Canada, etc.) were slow to react.  Clearly there were some areas of the country and of Europe that needed to go into full lockdown immediately to prevent a complete collapse of the healthcare system, NYC being the best example.  Other areas of the country, like California, IMO will never have that many fewer cases than had in March or have right now and were not experiencing major active outbreaks.  So I question whether these areas needed to lockdown, unless we truly plan to lockdown everywhere until a vaccine comes around, which I dont think anyone is seriously suggesting.  I wish we had tried more balanced social distancing measures in those places because it would've helped us learn a lot more about what works and what doesn't and give us better ideas for re-opening hot spots like Milan and New York.

To be fair, there were a few states that resisted lockdowns, which tells us something, and what we've learned from those states in my opinion is:

1. The big outbreaks are happening in predictable settings like meat packing plants and nursing homes regardless of what measures are put in place, these facilities are highly conducive to spread and can't be shut down

2. Outside of those settings there is limited community spread in rural communities (limited =/= none)

3. Clearly public transportation plays a huge role in transmission 

4. The difference between Texas, Florida, and California vs. the northeast makes me more confident there is some measurable seasonality,

But I do get that we were dealing with incomplete information at the time and its easy to criticize in hindsight.  I thought it was an overreaction at the time in some areas, and still do, but I get why it happened.  My biggest issue is not with the lockdown but with some who are not focusing right now how to re-open in a smart way, either the people who say we can just re-open everything and there's no risk or the people who say any moves to re-open are always too soon.  I also worry going into full lockdown we created the false impression in some people's minds that the virus was going to be eradicated, or that eradication / absolute minimal number of infections was a realistic goal, whereas the goal was always to prevent healthcare system overload and it was never realistic to expect we could protect most people from being exposed.  

[naptownskinsfan]

24 minutes ago, mission27 said:

Yeah its horrible whats happening at nursing homes but realistically this is going to get into the nursing homes and once it does it spreads like wildfire

So when you consider a majority of deaths are at these senior living facilities, its an even strong argument imo for re-opening, and hopefully we can turn some of our focus to helping people who are in these facilities

I'll be the first to say that I don't know the logistics of moving people out of there- both from a transportation perspective as well as food- but there is no way that hotels or some of the hospitals/field hospitals in the areas couldn't have taken some of the people for a couple nights to isolate cases, sanitize the buildings and then send people back as they were cleared.  We've heard a lot of talk from NYC about doctors choosing who lives and who dies.  Well, we just closed the doors to nursing homes and did the same thing.  

[mission27]

@ramssuperbowl99 when we estimate herd immunity thresholds to slow or stop the spread, I do think one factor you need to take into account is...

Even if only 5% of the population has been exposed, that number is by definition much higher among groups of people who are most likely to be disease vectors (frequent travelers, essential works, and people who live in dense urban areas and take public transport)

So even if we aren't "at" herd immunity or even close, that should help to slow the spread when we re-open, because a disproportionate number of those who are not immune to the virus are the types of people who are less likely to get exposed to any infectious disease anyway, because of their living conditions or lifestyle

[ramssuperbowl99]

1 minute ago, mission27 said:

@ramssuperbowl99 when we estimate herd immunity thresholds to slow or stop the spread, I do think one factor you need to take into account is...

Even if only 5% of the population has been exposed, that number is by definition much higher among groups of people who are most likely to be disease vectors (frequent travelers, essential works, and people who live in dense urban areas and take public transport)

So even if we aren't "at" herd immunity or even close, that should help to slow the spread when we re-open, because a disproportionate number of those who are not immune to the virus are the types of people who are less likely to get exposed to any infectious disease anyway, because of their living conditions or lifestyle

Don't epidemiologists use a "batch" approach to account for that? You have different societal populations, with traffic between them?

I know I'm not using the right terminology here, but you know what I mean. I don't think people are using a homogeneous population.

[seriously27]

18 minutes ago, mission27 said:

Sure but the chances of a deadlier form of the virus becoming the dominant strain seem pretty low dont they... deadlier strains will cause more obvious outbreaks which will lead to more aggressive public health responses whereas less deadly strains will remain undetected longer and infect a larger number of people, likely conferring some degree of protection against the more aggressive strains

A deadlier strain would be obvious.....after about two weeks. And with the way this virus is transmitted, it would basically be the same exact situation if we were fully open. It's really the ability to be contagious so early in it's transmission to the host that makes this virus almost perfect. You think this shutdown is bad, imagine a virus that transmits itself almost immediately after infection and has a mortality rate close to 15 to 20% like SARs or MERS. This is the fear. You could contain those because you could contain people when they were sick. You contain them and anyone who saw them in the past 24 hours. That's easy. That's how those corona viruses were contained.  But now try to contain everyone someone has been in contact with in two weeks. Then everyone those people have been in contact with. It's impossible. You couldn't do it. 

 I don't think you are one of them, but there is a growing contingent of the population who want the US to open back fully. Malls, salons, restaurants, schools. They want everything to just go back to normal. This can't happen yet. A slow opening of stores with an obvious set of rules is what is needed. Loitering in malls and cutting down on walk-ins in Salons and the like. These are not options, they need to be the rule.  

[mission27]

10 minutes ago, seriously27 said:

 I don't think you are one of them, but there is a growing contingent of the population who want the US to open back fully. Malls, salons, restaurants, schools. They want everything to just go back to normal. This can't happen yet. A slow opening of stores with an obvious set of rules is what is needed. Loitering in malls and cutting down on walk-ins in Salons and the like. These are not options, they need to be the rule.  

Absolutely

Lockdown cannot go on forever but distancing rules at restaurants and appointments to get a haircut and wearing masks at malls?  That's all tolerable and the cost-benefit makes a lot of sense.  Anyone who is unwilling to put up with months of those types of restrictions is being stubborn and unrealistic and ideological.

People want to leave their homes, have normal social contact, go back to work, see friends and family, etc.  That's all stuff that can be done in a smart way, while taking basic precautions to keep the curve as flat as we can

[mission27]

14 minutes ago, seriously27 said:

A deadlier strain would be obvious.....after about two weeks. And with the way this virus is transmitted, it would basically be the same exact situation if we were fully open. It's really the ability to be contagious so early in it's transmission to the host that makes this virus almost perfect. You think this shutdown is bad, imagine a virus that transmits itself almost immediately after infection and has a mortality rate close to 15 to 20% like SARs or MERS. This is the fear. You could contain those because you could contain people when they were sick. You contain them and anyone who saw them in the past 24 hours. That's easy. That's how those corona viruses were contained.  But now try to contain everyone someone has been in contact with in two weeks. Then everyone those people have been in contact with. It's impossible. You couldn't do it. 

I guess this is my question though, is there any reason that deadlier strain would become the dominant strain?  We're talking about a group of mutations originating with one person right?  So even if we don't see the new outbreak for a couple weeks, and it infects some people, the vast majority of active cases would still be the old strain.

Could we contain it completely, no, but I would think it would spread at the same rate or slower compared to the already dominant strain, with the lower CFR, and would never become a high percentage of overall cases. 

If the disease simultaneously mutated to become both much more deadly and much contagious, or if a deadlier strain emerged and the milder strain conferred no immunity, that's a worst case apocalyptic scenario.

[MikeT14]

4 hours ago, Tyty said:

I like that everyone on here can have contradictory views and it’s still civil. Information is being posted and no ones being an idiot. Meanwhile Facebook is a cesspool 

And twitter. Although at least on twitter I can unload everything that I want to say on here about whatever lol.

[mission27]

5 minutes ago, mission27 said:

I guess this is my question though, is there any reason that deadlier strain would become the dominant strain?  We're talking about a group of mutations originating with one person right?  So even if we don't see the new outbreak for a couple weeks, and it infects some people, the vast majority of active cases would still be the old strain.

Could we contain it completely, no, but I would think it would spread at the same rate or slower compared to the already dominant strain, with the lower CFR, and would never become a high percentage of overall cases. 

If the disease simultaneously mutated to become both much more deadly and much contagious, or if a deadlier strain emerged and the milder strain conferred no immunity, that's a worst case apocalyptic scenario.

And tbh given what we’ve seen where there are some small clusters with incredibly high observed CFR (Like 5 members of one family die) and other large populations with basically no deaths and many cases, it wouldn’t shock me if there are materially more deadly strains circulating at low levels.  Seems plausible 

[mission27]

FDA just gave emergency approval for Remdesivir 

[seriously27]

Just now, mission27 said:

I guess this is my question though, is there any reason that deadlier strain would become the dominant strain?  We're talking about a group of mutations originating with one person right?  So even if we don't see the new outbreak for a couple weeks, and it infects some people, the vast majority of active cases would still be the old strain.

Could we contain it completely, no, but I would think it would spread at the same rate or slower compared to the already dominant strain, with the lower CFR, and would never become a high percentage of overall cases. 

If the disease simultaneously mutated to become both much more deadly and much contagious, or if a deadlier strain emerged and the milder strain conferred no immunity, that's a worst case apocalyptic scenario.

Think of the flu....there are many many strains of influenza out there with them basically taking turns being the dominant strain each year.  The way one strain could become the dominant strain is if that strain were to be the catalyst for the second wave. And yes, this would be the worst case scenario. But don't let the idea of it happening fool you. It's not likely....but its a possibility. And never has there been a better strain of virus with the ability to mutate into that scenario than COVID-19. 

Even still, if that strain spreads as fast as the current one, even in a world that not locked down but has social distancing rules....the mortality numbers would be very very high. Going from 1% to 15 or 20% would be absolutely devastating. It doesn't have to mutate to become more  contagious, as I stated before, barring a completely airborne virus this virus is about as perfect as you can get in terms of transmission. Not to sound like the worlds biggest nerd but virus's are literally aliens in our world and probably the real dominant species. All we can do is try to keep up .

[Shanedorf]

4 minutes ago, seriously27 said:

All we can do is try to keep up .

Huge thanks for the knowledge nuggets, greatly appreciated

[Ty21]

38 minutes ago, MikeT14 said:

And twitter. Although at least on twitter I can unload everything that I want to say on here about whatever lol.

I don’t let footballsfutures filters or censors stop me from saying whatever I want here. 

[mission27]

5 minutes ago, seriously27 said:

Think of the flu....there are many many strains of influenza out there with them basically taking turns being the dominant strain each year.  The way one strain could become the dominant strain is if that strain were to be the catalyst for the second wave. And yes, this would be the worst case scenario. But don't let the idea of it happening fool you. It's not likely....but its a possibility. And never has there been a better strain of virus with the ability to mutate into that scenario than COVID-19. 

Even still, if that strain spreads as fast as the current one, even in a world that not locked down but has social distancing rules....the mortality numbers would be very very high. Going from 1% to 15 or 20% would be absolutely devastating. It doesn't have to mutate to become more  contagious, as I stated before, barring a completely airborne virus this virus is about as perfect as you can get in terms of transmission. Not to sound like the worlds biggest nerd but virus's are literally aliens in our world and probably the real dominant species. All we can do is try to keep up .

On the flip side, even though this virus is the perfect storm of transmissibability, it seems to mutate more slowly than influenza or other respiratory viruses from what I've read

Do we have any examples of a virus mutating to become 30-40x more deadly after months of relative stability over millions of cases (assuming we are currently at a 0.5% CFR, which seems to be the high end of the range based on serology)?  Spanish Flu is the classic example of a more deadly second wave and I'm not finding estimated CFRs for the two waves separately, although in that case there is a well understood mechanism for why the more severe strain became dominant (WWI), which was considered highly unusual.  And even the deadlier strain only had a CFR in the 2-3% range

I'm not saying it can't happen just trying to drill down to, is this a real serious issue we need to be worried about or a one in a million scenario?