OT: Coronavirus chat

[Sheet]

The reported daily positivity rate is also going down which would signal past the peak. Commercial labs don’t always give out the negatives either, so that going down with the commercial labs spooled up would reinforce that idea.

Even as a healthcare worker I can’t entirely disagree with what you say regarding prolonged shut downs causing us substantial long lasting economical damage in the long run. I have a hard time reconciling my own “big picture” views with my more immediate health concerns and I’m not sure what the best answer is. Healthcare systems around the country are becoming inundated, some self inflicted frankly, others not so much. Collapsing or over stretched healthcare facilities increases bad out comes, but in my mind a long lasting recession has a worse overall prognosis to American health.

What I will say is be cautious in how you view “positivity rate”. There has been a big shift in testing strategy. At least here in NY we shifted from a test everything to a test conservatively strategy. We sort of made the mistake of overwhelming lab facilities with a bombardment of low probability tests. Most public health departments are pushing hard for clinical course testing. The idea is at this stage of the game if you’re going to order home quarantine and not admit, maybe hold off on testing. It doesn’t change your treatment plan. If you’re admitting, which requires specialized placement within the hospital, then testing is more prudent. Or maybe there is clinical objective evidence of a pneumonia that isn’t bacterial in origin and ruled out by typical nasal swab testing. That would warrant a covid test as well.

There is going to be a decrease in positives because of this shift in strategy but it doesn’t necessarily mean the rate of transmission truly slowed. Proven positive cases likely make up a smaller percentage of total positives then you’d think. I do think, without evidence to support this outside of typical coronavirus behavior, that we may see a seasonal slow.

While Cuomo was rather over zealous with his projections, you have to understand that his entire job is to look out for New York first and foremost and I can’t fault him for lobbying hard for the best available resources. The projections he provided weren’t fabricated. They were developed in conjunction with the department of health and the CDC, granted he really only operated on a worst case scenario assumption and portrayed it as this will happen, not so much this may happen.

I will say though, when you take into account how many icu beds a hospital typically has and compare it to the total used currently it’s very mind blowing. Rural hospitals are lucky to have 5-10 total. A lot of large hospitals could have several more, 50ish plus per facility, but you quickly run out when you have thousands needing an icu bed. It certainly did tap NYC out on icu beds and required impromptu makeshift units to be created.

I don’t think we’ve peaked. If we have, we aren’t on the downhill slope yet. As clinicians, we need to be better at admitting those that truly need it and not those that we know have covid but we’re scared to send home because of the unknown. That’s partly what is truly taxing the healthcare system. Admissions that probably didn’t need to happen.

 

[Balthazar]

What I will say is be cautious in how you view “positivity rate”. There has been a big shift in testing strategy. At least here in NY we shifted from a test everything to a test conservatively strategy.

Exactly. That's why the variance between the daily number of confirmed cases is to be taken with a big grain of salt.

 

[Sheet]

Exactly. That's why the variance between the daily number of confirmed cases is to be taken with a big grain of salt.

There’s an element of dumb luck involved too. There’s a 25% chance of false negatives (25% is what I was told by our infectious disease doctors. I don’t have first hand knowledge of that as fact.) I personally had two patients we were dead sure was positive. Both came back negative. Tested again. Both positive. No change in symptoms or clinical objective evidence. Not hospital acquired.

 

[CharlesPuck]

Exactly. That's why the variance between the daily number of confirmed cases is to be taken with a big grain of salt.

daily hospital admissions are also down.

 

[henchman21]

Even as a healthcare worker I can’t entirely disagree with what you say regarding prolonged shut downs causing us substantial long lasting economical damage in the long run. I have a hard time reconciling my own “big picture” views with my more immediate health concerns and I’m not sure what the best answer is. Healthcare systems around the country are becoming inundated, some self inflicted frankly, others not so much. Collapsing or over stretched healthcare facilities increases bad out comes, but in my mind a long lasting recession has a worse overall prognosis to American health.

What I will say is be cautious in how you view “positivity rate”. There has been a big shift in testing strategy. At least here in NY we shifted from a test everything to a test conservatively strategy. We sort of made the mistake of overwhelming lab facilities with a bombardment of low probability tests. Most public health departments are pushing hard for clinical course testing. The idea is at this stage of the game if you’re going to order home quarantine and not admit, maybe hold off on testing. It doesn’t change your treatment plan. If you’re admitting, which requires specialized placement within the hospital, then testing is more prudent. Or maybe there is clinical objective evidence of a pneumonia that isn’t bacterial in origin and ruled out by typical nasal swab testing. That would warrant a covid test as well.

There is going to be a decrease in positives because of this shift in strategy but it doesn’t necessarily mean the rate of transmission truly slowed. Proven positive cases likely make up a smaller percentage of total positives then you’d think. I do think, without evidence to support this outside of typical coronavirus behavior, that we may see a seasonal slow.

While Cuomo was rather over zealous with his projections, you have to understand that his entire job is to look out for New York first and foremost and I can’t fault him for lobbying hard for the best available resources. The projections he provided weren’t fabricated. They were developed in conjunction with the department of health and the CDC, granted he really only operated on a worst case scenario assumption and portrayed it as this will happen, not so much this may happen.

I will say though, when you take into account how many icu beds a hospital typically has and compare it to the total used currently it’s very mind blowing. Rural hospitals are lucky to have 5-10 total. A lot of large hospitals could have several more, 50ish plus per facility, but you quickly run out when you have thousands needing an icu bed. It certainly did tap NYC out on icu beds and required impromptu makeshift units to be created.

I don’t think we’ve peaked. If we have, we aren’t on the downhill slope yet. As clinicians, we need to be better at admitting those that truly need it and not those that we know have covid but we’re scared to send home because of the unknown. That’s partly what is truly taxing the healthcare system. Admissions that probably didn’t need to happen.

This is a good post. We don’t really disagree first and foremost. With the testing being more selective and more skewed towards targeting individuals showing signs, you’re naturally more likely to get a higher rate of positives. The more random and wide a sample you get, you’ll naturally get more negatives. This a pretty simple concept with any sampling, but has shown clearly in testing for this virus. So with it being more regulated, targeting a more narrow part of the population, and the numbers going down is a strong signal of a decrease. A few simple things could change that path, but it is a trend that is following other trends.

Even when the exponential growth stops, which hasn’t happen yet, but getting close... even when it does the raw case numbers will climb for while and there will still be a strain. It is just another signal and can be a predictable one. IE Cuomo now staring a peak is based on that data coming in. A trend change doesn’t mean all over and back to normal, but start figuring out how to get to normal if it continues.

To me the mistake Cuomo made was basing his whole opinion off flawed data. We simply have not and still don’t know enough about the virus. You need to learn and attempt to get the best data possible. Be willing to accept limitations in models and adjust quickly. He pounded the table for all the equipment and help based upon flawed data. Made a huge deal about needing 30,000 ventilators. Taking supply away from other parts of the state and supply away from other states. Where people could and may die from logistics because they will now need moved around. It isn’t exactly a new thought here either. A Stanford epi write exactly about this data issue a week before Cuomo’s rants. He’s spoke about it publicly on how we’ve based the response on bad and incomplete data. Instead of digging in, even a couple days ago (and today for that matter),he should be flexible and react when data is more supports it.

On that note, the UW model keeps getting revised to a high degree. Some states are down 90% in that model’s projections over the past 10 days (and they still overshot NY by 40% in one day). With how we know this virus spreads and data gets collected, the data coming in now was impacted by the viral spread in the third and forth week of March. There has been a rush to be first and a lot of bad models spread around. Which I believe may cause a bigger long term issue. Say this passes in May and the deaths come out far less than the millions or hundreds of thousands predicted by a large degree. That can cause a simple distrust for the next time something comes along. The next time they say millions, people may blow it off as another saga that is overblown. And distrust of science is something we really don’t need more of right now.

 

[Balthazar]

This is a good post. We don’t really disagree first and foremost. With the testing being more selective and more skewed towards targeting individuals showing signs, you’re naturally more likely to get a higher rate of positives. The more random and wide a sample you get, you’ll naturally get more negatives. This a pretty simple concept with any sampling, but has shown clearly in testing for this virus. So with it being more regulated, targeting a more narrow part of the population, and the numbers going down is a strong signal of a decrease. A few simple things could change that path, but it is a trend that is following other trends.

Even when the exponential growth stops, which hasn’t happen yet, but getting close... even when it does the raw case numbers will climb for while and there will still be a strain. It is just another signal and can be a predictable one. IE Cuomo now staring a peak is based on that data coming in. A trend change doesn’t mean all over and back to normal, but start figuring out how to get to normal if it continues.

To me the mistake Cuomo made was basing his whole opinion off flawed data. We simply have not and still don’t know enough about the virus. You need to learn and attempt to get the best data possible. Be willing to accept limitations in models and adjust quickly. He pounded the table for all the equipment and help based upon flawed data. Made a huge deal about needing 30,000 ventilators. Taking supply away from other parts of the state and supply away from other states. Where people could and may die from logistics because they will now need moved around. It isn’t exactly a new thought here either. A Stanford epi write exactly about this data issue a week before Cuomo’s rants. He’s spoke about it publicly on how we’ve based the response on bad and incomplete data. Instead of digging in, even a couple days ago (and today for that matter),he should be flexible and react when data is more supports it.

On that note, the UW model keeps getting revised to a high degree. Some states are down 90% in that model’s projections over the past 10 days (and they still overshot NY by 40% in one day). With how we know this virus spreads and data gets collected, the data coming in now was impacted by the viral spread in the third and forth week of March. There has been a rush to be first and a lot of bad models spread around. Which I believe may cause a bigger long term issue. Say this passes in May and the deaths come out far less than the millions or hundreds of thousands predicted by a large degree. That can cause a simple distrust for the next time something comes along. The next time they say millions, people may blow it off as another saga that is overblown. And distrust of science is something we really don’t need more of right now.

You shouldn't assume that NY or any other state has peaked or is even close to it. We're not even sure if Europe has and they are 2 to 3 weeks ahead of North America. The virus hasn't even fully arrived in 3 of the biggest states yet (FL, TX and CA). Based on what we are observing elsewhere, this is just the beginning.

 

[henchman21]

You shouldn't assume that NY or any other state has peaked or is even close to it. We're not even sure if Europe has and they are 2 to 3 weeks ahead of North America. The virus hasn't even fully arrived in 3 of the biggest states yet (FL, TX and CA). Based on what we are observing elsewhere, this is just the beginning.

The US peaking now would fit the worldwide trend so far. The rate is certainly slowing and there is evidence it will slow further with heat... which can help explain those states too. The models that were quoted everywhere predicting the enormous issues are consistently being revised downward and massively. States where it would get out of control like NY and Louisiana are not only showing signs that they already peaked, but decreases. It is certainly still early and the virus will likely come back. But there is a lot of evidence there is clearing happening. I’m not saying open up tomorrow and everything is back to normal, but there are positive trends appearing

 

[Foppa2118]

The US peaking now would fit the worldwide trend so far. The rate is certainly slowing and there is evidence it will slow further with heat... which can help explain those states too. The models that were quoted everywhere predicting the enormous issues are consistently being revised downward and massively. States where it would get out of control like NY and Louisiana are not only showing signs that they already peaked, but decreases. It is certainly still early and the virus will likely come back. But there is a lot of evidence there is clearing happening. I’m not saying open up tomorrow and everything is back to normal, but there are positive trends appearing

There hasn't been any peer reviewed studies showing the virus will slow with heat. There's no way for anyone to know how the virus will react in the summer since it didn't have a full season in the southern hemisphere during our winter. Which is how they make flu vaccines every year.

There is an assumption that it may slow down during the summer, because that's what other viruses tend to do, but no one knows for sure that will happen with this new coronavirus.

The evidence of slowing right now is believed to be due to the mitigation efforts we've all been doing.

 

[Freudian]

On the news here in Sweden they showed a test for antibodies at a Swedish home for the elderly. Sample size is obviously so small it doesn't tell us anything but from 15 tests for antibodies 4 had immunity and 3 from the current staff had corona and had to be sent home.

It'll be interesting to see the results once we roll out widespread antibody tests.

 

[Sheet]

daily hospital admissions are also down.

This is double sided. Two things are happening. Space available means you become more selective. Also, in the beginning we were admitting every single potential case that came through, keeping them until we got results. Whether their condition warranted admitting or

it’s a new disease with a kind or hard to predict trajectory. The science isn’t well known yet. Quite literally everything is speculative at this point. You don’t want to be the HCP that sent a 24 year old home and told them to self isolate and then in three days they show up in full blown ARDS. We were admitting every single case because we had the luxury of empty beds. That’s not the case any more. Two things happen now. Admission rates go down but it’s artificially so, and deaths will start increasing.

 

[CharlesPuck]

This is double sided. Two things are happening. Space available means you become more selective. Also, in the beginning we were admitting every single potential case that came through, keeping them until we got results. Whether their condition warranted admitting or

it’s a new disease with a kind or hard to predict trajectory. The science isn’t well known yet. Quite literally everything is speculative at this point. You don’t want to be the HCP that sent a 24 year old home and told them to self isolate and then in three days they show up in full blown ARDS. We were admitting every single case because we had the luxury of empty beds. That’s not the case any more. Two things happen now. Admission rates go down but it’s artificially so, and deaths will start increasing.

I am only talking about Colorado's data.

 

[Bill Peckerskull]

Sources: MLB, players eye May return in Arizona

 

[Cousin Eddie]

I don’t get people’s fascination with everybody needing to be tested. Whether you have it or not, you’re going to be told to stay home and quarantine. Just stay the f*** home and act like you and everybody else has it.

I understand the need to test essential workers and the vulnerable population, but all these Facebook warriors who have no job and have nothing to do need to stop worrying about being tested for the sake of getting tested. Just stay home.

 

[Foppberg]

I don’t get people’s fascination with everybody needing to be tested. Whether you have it or not, you’re going to be told to stay home and quarantine. Just stay the f*** home and act like you and everybody else has it.

I understand the need to test essential workers and the vulnerable population, but all these Facebook warriors who have no job and have nothing to do need to stop worrying about being tested for the sake of getting tested. Just stay home.

Yup... Think you have it? Stay home. Have a cough? Stay home? Feel slightly off? Stay home. Just stay home idiots.

 

[henchman21]

I don’t get people’s fascination with everybody needing to be tested. Whether you have it or not, you’re going to be told to stay home and quarantine. Just stay the f*** home and act like you and everybody else has it.

I understand the need to test essential workers and the vulnerable population, but all these Facebook warriors who have no job and have nothing to do need to stop worrying about being tested for the sake of getting tested. Just stay home.

Personally, I think it is a lack of understanding how testing and the epidemiology around it works. Typically, the US only clinically tests between 1-2m people for flu per year... somewhere between 15-25% will test positive. So we might get true, positive numbers of a few hundred thousand people... then epis go to work on projecting the spread, how many cases there were, deaths resulting, etc. Which is why you see such a range. But we know flu fairly well and can project from a sample, fairly realistically, what has happened. During bad flu seasons the tests may spike up another million, but there isn't capability to do much more than that in a given flu season. Right now, we aren't getting good data to project from because of the limited criteria of the testing. It isn't a random sample yet, and likely won't be this season.

A not so fun fact... of the deaths prescribed to flu in any given year, upon autopsies, it is usually found that well less than 30 percent (as low as 14%) are diagnosed with flu post mortem. They are still listed under flu deaths, but we don't study much further and it is accepted that a wide range of respiratory illnesses outside of flu are really in that mortality. This includes coronaviruses like OC43 that can also be quite deadly, but has floated around for so long, we don't care to track it individually.

 

[S E P H]

People in Asia are literally forced to wear face masks not to protect themselves but to protect others. Infected people with masks are less likely to spread droplets containing the virus.

Literally forced? Bruv this is one of the biggest hot-takes I've read here; Asia, especially countries/city-states like Japan, Korea, Taiwan, Hong Kong, etc., have a social etiquette where if you have symptoms of anything (regardless of even thinking of covid) you should wear a mask in public. It is a public courtesy and not some sort of "where a mask or die" programme, I actually wish we had this etiquette in the Western world.

I don’t get people’s fascination with everybody needing to be tested. Whether you have it or not, you’re going to be told to stay home and quarantine. Just stay the f*** home and act like you and everybody else has it.

I understand the aspect behind it, test everyone as much as possible and you can beat the incubation period before the symptoms stop by quarantining the infected. In a way, you wouldn't really have to go to extreme measures to shutdown everything. Korea did something similar, where I think all they've had was at most a two week mandatory period, but because they tested a chuck of the population their country isn't as dead economically as others like the entire rest of the world. Now in USA and Canada, it's beyond the period of testing as both should be heading to the peaks in each country. Getting everyone tested should've happened in the very beginning, but both countries seriously were not prepared, which is why Korea was and they had history with SARS/MERS before.

 

[the_fan]

Sources: MLB, players eye May return in Arizona

MLB wants to play games without fans and I dont think that will be a problem since baseball is a boring game and there is hardly any noise in the stadium anyway. I dont think that will work for the NHL.

 

[Hasbro]

MLB wants to play games without fans and I dont think that will be a problem since baseball is a boring game and there is hardly any noise in the stadium anyway. I dont think that will work for the NHL.

The Marlins have been doing it for decades.

 

[Balthazar]

Literally forced? Bruv this is one of the biggest hot-takes I've read here; Asia, especially countries/city-states like Japan, Korea, Taiwan, Hong Kong, etc., have a social etiquette where if you have symptoms of anything (regardless of even thinking of covid) you should wear a mask in public. It is a public courtesy and not some sort of "where a mask or die" programme, I actually wish we had this etiquette in the Western world.

For f***s' sake did I really need to specify not ALL of Asia?

 

[S E P H]

For f***s' sake did I really need to specify not ALL of Asia?

Don't need to be so testy Balth, you could've just said China because I took your comment as all of Asia as you specified Asia.

 

[Mighty Makar]

Another Avs’ player tested positive. That’s 3?

 

[Bill Peckerskull]

Another Avs’ player tested positive. That’s 3?

Yes

 

[Sheet]

In a perfect world we would test every soul and have concrete numbers and that’d really help the modeling.

New York made a college try at testing every upper respiratory infection we couldn’t pin on another pathogen at first and we shot ourselves in the foot. It’s part of the reason we have to wait days and days for results even now. The back log is still out of control.

It makes me worry about specimen degradation. There’s a fairly high chance of false negatives. I’ll be very curious when the hot wash happens if they look into time from collection to test in those false negatives.

For what it’s worth I think even if we’re pretty sure it IS covid we shouldn’t test always. Essential personnel that need to work, people that will be hospitalized, or high risk for bad outcome is what I’d prefer it to be limited to, but I would never want to see HCP autonomy infringed either.
Everyone else can just home quarantine.

 

[CharlesPuck]

Weird discrepancies for Colorados data...

The Colorado gov site says there are 179 total deaths and 1 new death today. The Denver Post says there are 179 total deaths (same numbers) with 29 new deaths today (28 higher)...

The Colorado gov site says there was 154 total deaths on April 2nd with daily increases of 11/7/6/1 to get to todays total of 179.

 

[Bonzai12]

it's gonna kill us all. We just like to debate about it until it happens

/the_end