New Coronavirus threat

[tonnyc]

I recommend taking both the number of (confirmed) cases, as well as the growth in cases, with a large grain of salt. In some areas, the availability of testing has (FINALLY!) started to open up, so that more people have been able to get tested. However, there still remain areas (including whole states) where testing for COVID-19 remains confined to symptomatic patients being admitted to hospitals OR symptomatic patients who had contact with known positives OR symptomatic patients who had overseas travel within two weeks of onset OR healthcare workers/first responders who are symptomatic.

Incidentally, with regard to Indonesia, as we deploy more PCR testing, expect the number of confirmed cases to go into high five digits, possibly breaking a hundred thousand eventually in a few months. Our response is late, and our testing capability is limited, but we are trying to catch up. But this does mean that the upward trend in confirmed cases for the near future will reflect the increased capability of identifying previously undetected cases.

Reagent availability is worrying though, as global supply becomes increasingly difficult to secure due to high demand. Right now the official government target is ten thousand PCR tests/day but my amateur estimate suggests that we need a much higher number of tests/day if we want to bring the pandemic under control quickly. Serology test is used to help identify people who needs to be tested, but is no longer considered sufficient by itself. So PCR testing availability will be a bottleneck. Not sure how to solve that since my understanding is that both reagent and thermocycler have a long wait list now.

 

[vonnoobie]

Going to be interesting to see Canada's not to mention Mexico's response to the US just relaxing restrictions with out even before going into opening borders back up. With a lack of real bipartisan agreement in the US in regards to how to handle the covid-19 I see the US being one of the worst of nations to have it keeping coming back again and again. Off hand I reckon nations best of to handle this in the long term are island nations or regions (states/territories). At least it is easier for many of them to seal off their borders compared to land locked nations who often wont be able to monitor each and every border they have.

 

[hauritz]

I am amazed by the lack of bipartisanship in America. Having the President and States publically engaged in twitter wars during a national emergency has me gobsmacked. That you have crowds in the street demanding that the lockdown be ended and the President openly siding with them against their state government is madness.

If I were Canada or Mexico I would definitely be beefing up my border security because I am beginning to think that the US might be too politically fractured to deal with this pandemic.

Coronavirus: President Trump defends tweets against US states' lockdowns

He says some measures are "too tough", but health experts warn lifting them will increase infection.

www.bbc.com

 

[Todjaeger]

Incidentally, with regard to Indonesia, as we deploy more PCR testing, expect the number of confirmed cases to go into high five digits, possibly breaking a hundred thousand eventually in a few months. Our response is late, and our testing capability is limited, but we are trying to catch up. But this does mean that the upward trend in confirmed cases for the near future will reflect the increased capability of identifying previously undetected cases.

Reagent availability is worrying though, as global supply becomes increasingly difficult to secure due to high demand. Right now the official government target is ten thousand PCR tests/day but my amateur estimate suggests that we need a much higher number of tests/day if we want to bring the pandemic under control quickly. Serology test is used to help identify people who needs to be tested, but is no longer considered sufficient by itself. So PCR testing availability will be a bottleneck. Not sure how to solve that since my understanding is that both reagent and thermocycler have a long wait list now.

From my POV a viable serology test, which AFAIK remains in development since there are a number of currently known unknowns... would be more useful in determining who is no longer vulnerable to infection from the coronavirus due to having sufficient anti-bodies. This is of course predicated upon researchers being able to determine what/how many anti-bodies are needed for immunity.

Both types of tests are still needed, as they perform different but related diagnostic functions.

 

[Todjaeger]

Going to be interesting to see Canada's not to mention Mexico's response to the US just relaxing restrictions with out even before going into opening borders back up. With a lack of real bipartisan agreement in the US in regards to how to handle the covid-19 I see the US being one of the worst of nations to have it keeping coming back again and again. Off hand I reckon nations best of to handle this in the long term are island nations or regions (states/territories). At least it is easier for many of them to seal off their borders compared to land locked nations who often wont be able to monitor each and every border they have.

AFAIK the Federal gov't of Mexico has essentially ordered a nationwide lockdown, which has disrupted supply chains that exported goods to the US, which in turn has led to the (hopefully temporary) closure of some US-based facilities due to a lack of parts. This is one of the other areas where the current administration's talk of re-opening the economy is IMO more hubris than any real plan or action. Even if US restrictions were to be lifted, despite what that would likely mean in terms of additional cases/transmissions of the virus, until supply chains are either restored or replaced, many facilities cannot resume operations. This is especially true in facilities which operate using a JIT or even worse, JIT/JIS model. For all the power, authority, and expertise someone likes to claim, the actual reality is rather different and certainly more complex than is being portrayed.

While I am uncertain to what degree Canada has closed/restricted it's border with the US, I have heard from people in Canada that there are period checkpoints as well as people getting stopped to check if they are actually engaged in essential travel. IIRC there is the potential for a substantial fine for those who are traveling who should not be, though I believe our Canadian posters could illuminate their situation better and more accurately.

I am amazed by the lack of bipartisanship in America. Having the President and States publically engaged in twitter wars during a national emergency has me gobsmacked. That you have crowds in the street demanding that the lockdown be ended and the President openly siding with them against their state government is madness.

If I were Canada or Mexico I would definitely be beefing up my border security because I am beginning to think that the US might be too politically fractured to deal with this pandemic.

Coronavirus: President Trump defends tweets against US states' lockdowns

He says some measures are "too tough", but health experts warn lifting them will increase infection.

www.bbc.com

Honestly the situation in the US has gone beyond partisan politics IMO, although that certain has played a role in getting into the current mess. I will not detail it here, as very little of it is defence related and there are strong ties to politics and ideology as well. I do fear that not only will bad choices be made, but that those responsible for making bad and/or corrupt decisions will not be held accountable in the years to come.

 

[ngatimozart]

Some wits over here have suggested that Mexico is now begging the US to hurry up and finish building the wall. Same wits also reckon Canada is considering building a border wall

I too cannot fathom the US response to the pandemic. Many here are just shaking their heads, mostly in bemusement more than anything else because of the ongoing dramas over the last 3 years that have inflicted themselves upon US governance. Unfortunately in recent weeks this political dysfunction has resulted in the needless loss of thousands of American lives, and even now is helping spread the disease. That is criminal in anyones language. And yes @Todjaeger I know that the culprits will not face justice for their actions or lack thereof, even though it could possibly be argued that their actions constitute crimes against humanity.

 

[Projectman]

Going to be interesting to see Canada's not to mention Mexico's response to the US just relaxing restrictions with out even before going into opening borders back up. With a lack of real bipartisan agreement in the US in regards to how to handle the covid-19 I see the US being one of the worst of nations to have it keeping coming back again and again. Off hand I reckon nations best of to handle this in the long term are island nations or regions (states/territories). At least it is easier for many of them to seal off their borders compared to land locked nations who often wont be able to monitor each and every border they have.

Countries which have acted decisively to stop the spread will come off better , whether islands or not.
UK is a good example of how not to act. They are a island but already have 15500 official hospital deaths. Emphasis on hospital as deaths in care homes have not been counted(estimated to be around 7500).

'7,500 care home deaths' and British vaccine hopes - BBC News

Saturday's papers report a UK "breakthrough" in the search for a coronavirus vaccine.

www.google.com

UK still has its airports open with negligible screening.It's like trying to fill a bucket with a large hole in the bottom.
Their is so much about this virus that is unknown. The major points are -

1. Why is it so fatal in the European countries and usa ? Japan and china have a large aged population but are comparatively unaffected.

2. Do some ethinicities have a resistance to the virus , esp. in south Asia, as the expected surge in deaths has not occurred in the last 2 months. Highly congested living with poor hygiene due to shared accommodations and facilities.

3. Again, how did the Chinese infection rate just fall off so abruptly and why was only one province in china effected ? Though the recent increase in chinese figures of 1250 deaths was to be expected in a closed society, it's still low as compared to the western countries. This puzzles me a lot if you check the daily infected figures.The infected figures went from 1000s to zero in a few days. This is important as other countries can replicate the actions of China. Germany is a good example of a disciplined country which did everything right but is not able to reduce the infected so dramatically.

 

[Todjaeger]

Countries which have acted decisively to stop the spread will come off better , whether islands or not.
UK is a good example of how not to act. They are a island but already have 15500 official hospital deaths. Emphasis on hospital as deaths in care homes have not been counted(estimated to be around 7500).

'7,500 care home deaths' and British vaccine hopes - BBC News

Saturday's papers report a UK "breakthrough" in the search for a coronavirus vaccine.

www.google.com

UK still has its airports open with negligible screening.It's like trying to fill a bucket with a large hole in the bottom.
Their is so much about this virus that is unknown. The major points are -

1. Why is it so fatal in the European countries and usa ? Japan and china have a large aged population but are comparatively unaffected.

2. Do some ethinicities have a resistance to the virus , esp. in south Asia, as the expected surge in deaths has not occurred in the last 2 months. Highly congested living with poor hygiene due to shared accommodations and facilities.

3. Again, how did the Chinese infection rate just fall off so abruptly and why was only one province in china effected ? Though the recent increase in chinese figures of 1250 deaths was to be expected in a closed society, it's still low as compared to the western countries. This puzzles me a lot if you check the daily infected figures.The infected figures went from 1000s to zero in a few days. This is important as other countries can replicate the actions of China. Germany is a good example of a disciplined country which did everything right but is not able to reduce the infected so dramatically.

For a variety of reasons I have very little faith in the numbers released by the PRC. The official death toll in Wuhan was recently revised upwards by ~50%, and this new revised number might still be considerably lower than the actual number. Given the interests the gov't would have in maintaining control, I could easily see the official gov't tally being deliberately lower than is actually accurate.

In order for other nations to replicate both the efforts and results achieved by China, accurate reporting on both what was done and the outcomes is required.

 

[Todjaeger]

Widespread testing remains unavailable, which means that not only are asymptomatic COVID-19 cases not being captured, but also many suspected COVID-19 cases still are not getting tested despite a patient's symptoms, because they do not fit the testing requirements. Further, a number of places in the US are no longer even attempting to do contact tracing which is effectively a concession that community spreading has and is occurring to a degree where it is no longer practical to try and track. What this indicates is that while there might be a total of ~700k confirmed COVID-19 cases in the US, the actual total is higher than that and possibly by a significant margin.

From my POV, it also appears that to a certain extent some of the testing might be getting discouraged so that the number of cases look 'good' with a lower number of confirmed cases. To provide more context, the US just recently (either Thursday or Friday) just passed over the threshold of having tested 1% of the US population. More specifically, the state I reside in has a population comparable to that of Singapore but has completed a third the number of COVID-19 tests compared to Singapore, which works out to testing getting performed at two-thirds the rate vs. the average US testing rate.

As an addition to the above with regards to testing, some US epidemiologists believe that the actual number of COVID-19 cases in the US might number into the millions when the current count of confirmed cases is just over 700k. There has apparently been reporting where ~10x the number of people reporting with symptoms of COVID-19 vs. the number of actual tests done, all due to the restrictions on who gets tested.

I do recall seeing some projections when the count of confirmed cases in the US was just over 200k that the total number of cases at the time might be nearly 10x that number. Unfortunately (and this is something I personally confirmed yesterday) there is a feeling that the attitude among some governmental leadership is that as long as cases remain unconfirmed, they are not 'real'. This also ties in with limits on testing as decision makers really do not want what many responders and experts believe to be more accurate numbers to get confirmed.

 

[Rangitoto]

I'm surprised by how politically biased some of the opinions in this thread are, so I thought I'd post some metrics that actually mean something (they also highlight China's joke numbers). These are the country mortality rates from Johns Hopkins:

Mortality Analyses

 

[tonnyc]

Not trying to be political, but merely showing the official death per 100,000 is so meaningless there is no argument that can be made from it. I don't know how you can claim that the graph you quoted mean something. It could mean something if you add more supporting data like PCR test ratio and whether untested deaths are counted or not so we can take a holistic view, but if it's just that graph? It doesn't mean anything because it is insufficient.

 

[Rangitoto]

Not trying to be political, but merely showing the official death per 100,000 is so meaningless there is no argument that can be made from it. I don't know how you can claim that the graph you quoted mean something. It could mean something if you add more supporting data like PCR test ratio and whether untested deaths are counted or not so we can take a holistic view, but if it's just that graph? It doesn't mean anything because it is insufficient.

That's why the link is in there.

 

[Todjaeger]

I'm surprised by how politically biased some of the opinions in this thread are, so I thought I'd post some metrics that actually mean something (they also highlight China's joke numbers). These are the country mortality rates from Johns Hopkins:

My honest take is that those charts from Johns Hopkins do not actually mean all that much, since the chart data leaves a number of very important data sets out, or it fails to address the significance of a data set.

The first data set has to do with the number of confirmed cases. I cannot really speak about the testing regimes of nations other than the US as I am not involved with them, but I can state that testing here in the US remains inadequate, there has been too little testing and accurate testing got started too late. That in turn mean that, as large as the now 750k+ confirmed positive cases seems, the actual number of cases in the US is larger still.

The other data sets which are also of significance are the number of active cases and the number of resolved cases. Trying to determine something like the case fatality rate of a disease which is still very much actively infecting people, as well as getting largely under reported, is IMO an exercise in futility. Especially when there are large numbers of known active cases.

As for the views on the politics of the disease... I think most here on DT tend to find politics distasteful. What I find so aggravating about the US politics with respect to COVID-19 is the degree to which actions are taken or statements made based off political objectives, as opposed to what would be/have been done or said if the objective wase overcoming and recovering from the COVID-19 pandemic.

 

[Todjaeger]

That's why the link is in there.

But even the rest of the data available from the link is incomplete, even for the known data fields. Per the link the US has/has had 759,086 confirmed cases and 40,661 deaths. However the link does not address how many of the 718,425 as yet non-fatal cases are still active. From another source I have seen, it appears that there are ~650,000 still active and unresolved known cases in the US. If the pandemic was over and the numbers given were the final numbers, then it would be meaningful. Trying to show a CFR when only a small fraction of the cases have actually run their course is essentially meaningless.

 

[ngatimozart]

I'm surprised by how politically biased some of the opinions in this thread are, so I thought I'd post some metrics that actually mean something (they also highlight China's joke numbers). These are the country mortality rates from Johns Hopkins:

Mortality Analyses

Why do you think some posts are politically biased? Some are observations based on material and sources that are widely available. There are 3 sometimes 4 moderators active on this thread and we do keep a close eye on it, especially for political statements / posts. There is a difference between informed critiques and political rubbish that you see on social media.

You've posted some diagrams that make nice pretty pictures, but that's all because you've given them no real context. What do the numbers mean? The countries chosen are subjective. They don't give the R factor which is the most important variable. New Zealand today had a R factor of R=0.48. The R factor is the infection rate of how many others one person will infect. So R<1.0 is good, R≥1.1 is not good. IIRC at the PM press conference today the Director of Health said that that internationally R=2.55.

 

[tonnyc]

That's why the link is in there.

Let me try again and I'll be more direct. What is your thesis? What statement is it that you want to make? What is the core of your argument? Because the numbers from John Hopkins University is just the raw numbers. It doesn't make any sort of statement other than "here's the raw numbers". If you want to claim that some posts here are politically biased then you need to say something more than "here's some numbers and graphics". Are you saying the the US did well? Bad? Or is it more about Belgium? Or Iran? China? Say something and then support it. And say it plainly. Because that graph you think says everything you want to say? We aren't getting anything useful out of it.

 

[hauritz]

Charts are really only as accurate as the data that goes into creating them. To date, nobody knows the actual numbers of infections that have gone undetected. Also death rates no doubt increase when medical systems are overwhelmed. When tests on the wider community are undertaken we will have a better idea of the actual numbers.

 

[John Fedup]

More data will answer many questions currently in circulation. For many, worldwide data analysis on patients who died is of prime interest. Patient age, underlying health issues, sex, access to health care, economic circumstances, and geographic location are some factors. Given Europe/USA death figures compared to Asia, racial background may also be factor with the caveat Chinese data is likely false and Asian response has been superior.

 

[Todjaeger]

More data will answer many questions currently in circulation. For many, worldwide data analysis on patients who died is of prime interest. Patient age, underlying health issues, sex, access to health care, economic circumstances, and geographic location are some factors. Given Europe/USA death figures compared to Asia, racial background may also be factor with the caveat Chinese data is likely false and Asian response has been superior.

An unfortunate reality though is that a fair amount of the data needed for accurate answers to important questions will most likely only become available after the pandemic is largely over and the world is either well into recovery operations if not beyond that stage. That could be helpful in planning a response to a future pandemic. However, one would then need to adopt and stick to any such plans developed. I could unfortunately see authorities in the US doing a repeat of what has been (not) done responding to the COVID-19 pandemic. Much would depend on whom those future authorities were.

For those not familiar with the topic, US pandemic response materials that were updated following the 2009 H1N1 'swine flu' outbreak, as well as the 2012-2013 influenza season which was particularly bad, included tactics like social distancing and others slow or stop the spread. These materials are still available (access might be restricted for some materials by DHS to those in the US) and unchanged. This is why I am so gobsmacked that so many 'talking heads' are being listened to not only by members of the public, both also by governmental leaders at both the state and Federal level, as these non-medical 'talking heads' keep pushing to have the stay home/shelter-in-place orders lifted and facilities and businesses reopened. These containment efforts are believed to be having a positive impact on slowing the spread of the virus, but the degree of success is still uncertain given the limited scope of testing. I and a number of other first responders and healthcare workers that I know and have worked or trained alongside are horrified that after two weeks or less of restrictions, and before widespread testing has provided any real indication of the degree of community penetration and spread of the virus, as well as before the number of new cases drops below the number of new recovered cases, that restrictions are being lifted and non-essential businesses are being told they can now reopen.

Lifting such restrictions while the infection status of almost all the population remains unknown is almost certainly going to lead to a spike in virus transmission, despite that some protective measures are being taken (by some of the population anyway) like wearing face masks to minimize the amount a potentially infected person could spread. This could easily trigger a 2nd, forced shutdown in a few weeks time if a spike in infections causes a cascade in hospital admissions. As a side note, I know of a number of medical facilities (hospitals and convalescent/nursing homes) that are not advising when they transfer COVID-19 patients, because some receiving facilities have been refusing to accept such transfers... In a number of areas as yet not 'hard hit' hospital bed space remains at 50% - 60% capacity but could very easily change if there were to be a super spreader event or a cluster to develop like with some of the food plants in the US Midwest.

 

[John Fedup]

@Todjaeger ...are flu vaccinations free in the US like they are in Canada? Any idea on the population % that bother to get vaccinated?