A Great Read About The Virus

[Mrs Glockrunner]

(This explains the importance of social distancing.)

 

The "R naught" connected with the spread of an epidemic (described below) is something I had not heard before ... eye opening!

 

 

Written by physicians in Boston.

“As there is so much confusion, misinformation and denial on social media about the coronavirus we hope to explain, in plain language, why the experts see this as such an emergency. Many people are reading the claim online that this virus is a lot like the viruses that cause colds, and that if you get it, it will probably just seem like a bad cold and you are very unlikely to die. Depending on who you are, this may be true, but there is more to this story that is key to our outcome as a community.

This is a coronavirus that is new to the human population. Although it is related to the viruses that cause colds, and acts a lot like them in many ways, nobody has ever been exposed to this before, which means nobody has any immunity to it.

The virus is now moving explosively through the human population, spreading through respiratory secretions and 10 times more contagious that the flu or cold. Although many people will recover, about 20% will wind up with a serious pneumonia that will require hospitalization. Some will be so ill from the pneumonia that they will die. We estimate this may be 2-3%, but it is higher in Italy’s experience, partially because the healthcare system was overwhelmed so rapidly. In those over age 70, the death rate is 8-20%.

So if a child catches it on a playdate, they can easily transmit it to their grandmother as easily as touching the same doorknob or countertop.

Scientists measure the spread of an epidemic by a number called R0, or “R naught” That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer infectious? The R0 for coronavirus appears to be a number close to 3 – an extremely frightening number for such a deadly disease.

Suppose you catch the virus. You will give it to 3 other people, and they will each give it to three others, and so forth. Here is how the math works, where you, the “index case,” are the first line:

1
3
9
27
81
243
729
2,187
6,561
19,683
59,046
177,147
531,441
1,594,323
4,782,969
14,348,907

So, in just 15 steps of transmission, the virus has gone from just one index case to 14.3 million other people. Those 15 steps might take only a few weeks. With school out and lots of playdates, maybe less. The first person may be young and healthy Brookline child, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in one person's throat.

R0 is not fixed – it can be lowered by control measures. If we can get the number below 1, the epidemic will die out. This is the point of the quarantines and social distancing, but we are not doing it fast enough.

In the US, we have to slow down the virus. American hospitals, Boston hospitals, have limited resources. We have a fixed number of ventilators and an impending calamity on our hands. Our Italian critical care colleagues have shared with us that they simply do not have enough resources (ventilators, physicians and nurse, critical care beds), and are forced to choose who lives and dies based on old tenets of wartime triage.

Older patients do not even get a ventilator and die of their pneumonia. These are decisions nobody should have to face, and we are only 11 days behind Italy’s fate. Their hospitals are quite advanced, and we are no better in Boston. As doctors, we are desperately trying to prepare for the onslaught of patients in the coming weeks. It is already beginning. This is an opportunity for you as the district leadership the time to be aggressive and help us fight this by “Flattening the Curve”.

We implore you, as a group of Boston’s doctors preparing to fight this, to help us. Please send a new email to ALL the Brookline school district families. Social distancing is painful. We know that kids have cabin fever, they are pleading to see their friends, they may have birthday parties coming up or special events they have been looking forward to. All of us need to work and childcare is a big worry. But we need to overcome these issues and boredom for the coming weeks so that we can survive this with as few deaths as possible. What does that mean?

1) No playdates, not even 1:1.
2) No small gatherings, no meetings between a couple families, even for birthday parties.
3) Avoid trampoline parks, climbing gyms, restaurants, movie theaters, anything in an enclosed area. Many of these places are advertising increased cleaning and hygiene. This is not sufficient! Do not go.
4) Cancel planned vacations for the next month. Avoid airline travel that is not an emergency. Many airlines and rental agencies are offering penalty free cancellations.
5) Stay at home as much as possible. Work from home if you possibly can. You may have to go buy groceries and medicine, of course, but make the trips quick and purposeful.
6) Wash your hands thoroughly after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers.
7) Please avoid disseminating social media claims that the situation is not serious or is being exaggerated. This is a national crisis and conveying misinformation to your friends and family may put their lives in danger.

Thank you for taking the time to read this and stay safe and healthy in the coming weeks.”

[BamaBud]

 

Is the Coronavirus as Deadly as They Say?

Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.

Eran Bendavid and

Jay Bhattacharya

March 24, 2020

If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.

Fear of Covid-19 is based on its high estimated case fatality rate—2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.

The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.

Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.

Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.

The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.

How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.

The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.

This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.

If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.

A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.

Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford. Neeraj Sood contributed to this article.

 

 

 

[Mrs Glockrunner]

There is just SO MUCH unknown about this virus, so predictions are all over the map.  But since this is a new virus, and no one has any immunity to it, being extra cautious is probably the smartest thing to do.  I am a healthy person, but I am 68 years old, so I fit into a category that is high risk.  If the people would be smart, and not stupid, about limiting their exposure to themselves as well as anyone else they may come in contact with, we could minimize the danger.

Sure, it's boring to sit home all day, but that is a small price to pay for health.

[janice6]

4 hours ago, Mrs Glockrunner said:

There is just SO MUCH unknown about this virus, so predictions are all over the map.  But since this is a new virus, and no one has any immunity to it, being extra cautious is probably the smartest thing to do.  I am a healthy person, but I am 68 years old, so I fit into a category that is high risk.  If the people would be smart, and not stupid, about limiting their exposure to themselves as well as anyone else they may come in contact with, we could minimize the danger.

Sure, it's boring to sit home all day, but that is a small price to pay for health.

I call it "Retirement".  

[PPQer]

Apologies to Eric and the mods if this is too much.  It's funny, but I didn't want to start it's own thread.  

NYC Health Dept cautions on Rim Jobs.  I would think if you get to that point, you're already exposed to C-19.  Unless of course, New Yawkers walk up to strangers, drop trough, and spread cheeks.

https://nypost.com/2020/03/24/nyc-declares-war-on-rim-jobs-in-graphic-health-department-memo/

NYC declares war on ‘rim jobs’ in graphic health department memo

 

 

NYC’s Department of Health is bending over backwards to warn the public about a whole new threat — “rim jobs.”

The city’s health agency issued graphic guidelines for safe sex practices during the coronavirus pandemic Saturday, and while many were quick to take jabs at the agency for labeling masturbation safer than sex with a partner, most missed the backdoor rim shot.

Yes, the city specifically called out rimming — or using the tongue xx xxx xxxx xxx of another person for sexual pleasure — as particularly dangerous in a jaw-dropping section of the public safety alert.

more at link:

Edited March 25, 2020 by PPQer

[janice6]

Suddenly this is a problem???????????????  C'mon, really this is now an issue!

Leave it to New York City to ferret out the infinitesimal intricacies of Big city living.

Is this so common in NYC that it bears a public caution only in a time of a health crisis for some other reason!

[Bish1309]

Are the bleached ones safe?

 

Asking for a friend.

[Historian]

On 3/25/2020 at 6:15 PM, PPQer said:

 

NYC declares war in graphic health department memo

Edited March 27, 2020 by Historian