Monday, April 20, 2020

Apologies--And A Recommended Read Re COVID

Apologies--it's past lunch, and I haven't even read the news. Or, not much of it. I've been engaged with other things.

Here, however, is an interesting article that addresses the issue of, How many people really have been infected by this Wuhan virus? Covid19 "deniers" want to say that so many have been infected that we already have 'herd immunity.' There's no comfort in this article for that view. Even with the highest levels of infection, it's not enough for that.

On the other hand, there's the puzzle of it all. Why are infection rates and deaths at high levels in some places and low levels elsewhere? We can understand high infection levels but low deaths on a Navy ship, since most of the persons on board are young and healthy, with few if any co-morbidities. But you get differences between entire countries--Germany and Italy/Spain/France, for example, or between Western Europe and the US. And within the US the New York Metro area--not just the city but really stretching from New Jersey to Boston--stands out glaringly from most of the rest of the country.

There's a lot that's simply not known about the Wuhan virus. Or, not well enough known to be comfortable making policy decisions that affect so many people's lives. And yet decisions will need to be made.

These are some of the issues that Trump has to wrestle with. Here's the article, with a very brief excerpt:

Reports Suggest Many Have Had Coronavirus With No Symptoms

If infections are more widespread than previously understood, it’s possible that more people have developed some level of immunity to the virus. That could stifle the spread through what’s called herd immunity, but scientists caution that there is still much to learn about whether mild illnesses confer immunity and how long it might last. 
It will probably be months before enough reliable testing has been done to answer those questions and others, including how widespread infections have been and the virus's true mortality rate, which has only been estimated so far.


  1. I think the reason the Boston to New Jersey area is so bad is that they have idiots for leader i.e. DeBlasio, Murphy etc. I also believe the virus is mutating to a less dangerous form.

    Rob S

  2. The highest infection rate in USA is caused by the purposeful actions of NYC.

    NYC intentionally reduced their subway schedules so there would be fewer cars available for NYC people to use. Rather than leaving the subway schedules unchanged, which would have allowed the reduced commuter demand to spread out among the existing trains, they eliminated trains, forcing the reduced commuter demand into reduced supply.

    So stupid it's hard top believe it's not malicious.

  3. Mass transit combined with crowded cities pave the way.

  4. There's a ton of, what I'll call isolated evidence, that the virus exposure has been far, far more widespread than ~2% testing can confirm, if only because the testing hasn't been random--it's targeted to confirm diagnosis.

    In other words, the testing can't do what it hasn't be designed to do--estimate population-wide exposure.

    Most recently, a widescale antibody test in Santa Clara County, CA indicates infection incidence at 50-85 times greater than the diagnostic testing indicates.

    Frankly, the results should be expected. The so-called "official" numbers have not been collected in any way that can produce population-wide estimates.

    Naturally, "experts" are questioning the test because it goes against the narrative.

    I've see three or four other stories of similar results, e.g. serology testing results showing a multiple of those with antibody as compared to active infections.

    A study in Germany similar to the Santa Clara study, with similar implications.

    A homeless shelter in SF, where all 362 resident tested positive. Most symptom-free, one hospitalization resulted. Of course, communal living in a homeless shelter would be suggestive this level of contagion.

    This is no different than most families contracting the infection from one another, as social distancing in the home is impossible.

    I grew up with three brothers--whoever brought the mumps, measles, German measles, chicken pox home from school spread it to the rest of us. Somehow, one of my brothers never got the mumps even as three others of us had it.

    Yet, somehow my mother coped without shutting the country down. YMMV.

    1. Re Santa Clara county, that testing by the guys from Stanford was supposed to show that population wide infection would reach herd immunity levels, ~ >50%.


      The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%).

      Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%).The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%).

      The study in Germany was of a town that held the pre-Lent carnival, and someone with the virus showed up and participated in the bacchinalia. Result? 15% infection rate. No herd immunity.

      It seems pretty clear that this virus requires 6 ft. 10 minutes, as we've been told.


      Interesting post.

    3. The pattern I'm seeing, and it appears consistent (Pine St. Inn, Chelsea, MA, LA) is that more people have been exposed to and recovered from the virus than we previously thought. De facto, that makes the bug less lethal.

    4. True. The different results in different areas, however, has to give pause. In my deep blue state where the one and only metro area accounts for most deaths by far, we just learned that fully 25% of deaths have occurred in nursing homes. Add to that the deaths to the infirm and ill who don't happen to be in a nursing home, and you can understand why the governor is today voicing the possibility of reopening on a regional--I presume county by county--basis. I can support that, and there are vast swaths of the country that probably can, too. I know that in my town, which has a high infection/death rate for bucolic suburban areas, we have a number of nursing homes. We lack transparency--I'd be willing to bet that's where our deaths are, but nobody will tell you.

      This is part of why I've been consistently talking about the uniqueness of the US's "human geography." Look at a COVID map of CA and you'll see. CA is a huge part of our economy, and there's probably no reason to shut it down. The NE may be a different question--at this point.

      There are still plenty of uncertainties. But decisions must be made.

    5. The focus on herd immunity, for me, is interjected for the purpose of moving the goal posts--as our petty dictators push the public around with one power grab after another.

      Flattening-the-curve was the objective so to avoid overwhelming hospital resources while getting the infection to burn itself out as the contagion/reinfection rate drops below 1.

      The same politicians and "experts" who were sanguine about the virus into March now, apparently, have the judgment to dictate measures going forward. Consider me unconvinced.

    6. There's plenty of moving of goal posts going on.

      For example--re infection rates and herd immunity. We were being assured for a while that serological testing would confirm that herd immunity was already in place. Testing across the US has pretty well confirmed that nothing of the sort has happened--even the highest local infection rates are nowhere near enough for herd immunity. So the same people are now saying, well, the same data means the virus is "just a cold."

      I've been saying pretty consistently that herd immunity is very unlikely, simply because this virus doesn't appear to be contagious enough to reach sufficient people, given our "human geography." Instead it could hang around picking off immuno-compromised people. Or, if not picking them off, then causing further long term damage to their health. There are far more people in that category than most people are aware of.

  5. USA: Doc, I got flu bad this year.
    CDC: It's not the flu. It's COVID19.
    USA: OK. What's the cure?
    CDC: I'm afraid the leg has to come off.
    USA: What?
    CDC: Amputation is the best treatment.
    USA: Cut off my leg?
    CDC: Not your leg. Everyone's leg. With no legs, people won't be able to spread COVID19. It's for the best.
    USA: Are you insane?
    CDC: It's just temporary.
    USA: Is this a Monty Python skit?
    CDC: So you think this is a joke? This is a deadly disease we're dealing with.
    USA: What about that "do no harm" thing for doctors?
    CDC: Only idiots believe in that phrase these days. Don't be an idiot. Lie down now and no screaming.

  6. dfp21, I would hope you are not riffing on the actor who just lost his leg to a complication of COVID-19. Clotting that cut off circulation to foot/toes. Nick Cordero? Handsome guy, pretty wife, cute baby. A sad outcome for one too-young patient.

    Interesting program last night Mark Levin had Drs. Katz and Ioannidis as guests. The subject was whether the cure (the shutdown) was worse than the disease. They could not satisfy anyone that this is all over yet… Try to find a recording of the program…best heard firsthand.

    1. After UCLA imposed work-from-home orders we were asked how that would affect our groups' effectiveness. I responded that staff's emotional health will quickly degrade. I think I am proving my prediction to be correct.

    2. Check out Sailer:

      USC Antibody Test of 863 Representative People in L.A. County Finds 4.1% Infected, Far from Herd Immunity

      USC and UCLA are pretty much the same, right?

    3. Yeah we're all the same. Except they drive Ferraris & we drive Toyotas.

  7. A videoed interview with Dr. Ioannidis on COVID-19 (4/17) plus links to three previous interviews and his studies:

  8. The difference is how the elderly are and are not protected in nursing homes, and how other hospital patients are and are not protected medical facilities. It really is that simple.

    I wrote several other places over a month ago, and I probably did here in a thread early on, too. The way to prevent 50% of the deaths was to keep COVID-19 patients in entirely separate facilities with dedicated staff that didn't work in any other hospital- and test those staff relentlessly, like once a day. Do the same with nursing homes- no staff work elsewhere, and are tested relentlessly. Test the patients in both kinds of facilities fairly often- shut down all in-person visits.

    Some countries have done this better than others, and some states have done this better than others in the US, but, still, they waste testing resources on people for whom the result isn't going matter. In our zest to try to protect everyone, we have ended up not protecting the most vulnerable the best that we could have, and we are ruining the economy for very little benefit at this point.

    1. Good point vis-à-vis cross contagion. At the end of January, I read an emergency dept bulletin from Mt. Sinai Hospital (NYC) regarding the Coronavirus, and it was immediately apparent that triage to separate patients to prevent cross contagion would be the great challenge for medical facilities. I assumed they knew what they were doing in this regard.

      Then they had the gall to complain about the high rates of infection suffered by medical personnel--when they were their own worst enemy not doing enough to prevent such contagion.