It‘s so sad to watch, but compared to any other developed and affluent nation (and with equal time to prepare), the US is a complete shitshow at this point.
The complete lack of leadership and resulting power vacuum resulted in valuable time lost bickering, blaming and thumb twiddling that could have gone towards preventing the second wave. This is a community spread at this stage and another hundred thousand people are all but guaranteed to die. It‘s mindblowing.
Here in Germany, I‘m getting my test results within 3 days via SMS (usually same-day for positive results) and can enter it into an app to warn others.
Everybody wears a mask indoors and nobody but a very small minority complains. Social distancing is enforced by usually friendly police which the people mostly trusts to do its job.
It‘s just so sad to see how personal „freedom to choose“ turned into the achilles heel of one of the formerly greatest nations on Earth.
I am not so sure if Europe in general and Germany specifically could not be hit with similar situations again.
- After the April lock down it is clear, that we cannot repeat this economically again.
- Population becomes tired of maintaining the hygiene regiment. Improperly worn masks are on the rise. Dining out is increasing / bars/gyms/pools are reopening and are starting to get crowded.
- Decision making is pushed down from Federal to State and local levels (at least in Germany) causing a lack of cohesion of plans and making it impossible for the public to understand what policy is enforced where and why. One good example of this is that the general mask wearing mandate is still in place but many states have allowed for employees (e.g. in stores) to forego masks.
- Schools closed for summer have paused a likely source of many transmission routes.
After going below 2000 infection per week, we are set to hit 4000 per week after the weekend in Germany.
I hope with mandated masks (properly worn, no valves) and targetted lockdowns, the general lockdown can be prevented. Restaurants, schools/kindergardens and any public venue will likely be closed first.
That's not a dangerous virus. At least not in Germany. And it's the same virus everywhere, so questions must be asked about why so many countries have seen no real change in excess deaths and others did (but even when they did, it's not high relative to the reaction).
We'll overcome this, I am sure of it with how well everyone is banding together and doing the right thing. (Australian in Victoria where an outbreak is occurring)
It's possible, but I would not be surprised to see community acquired cases pop up in Taiwan at some point. Testing is currently extremely limited.
For example Taiwan performed 94 tests yesterday[1]. This is for a population of around 24 million. Since June 18, the average number of daily tests was 153 [1][2], which are almost entirely nationals returning from overseas.
Compare this to ~700k/day in the US for a population of ~330 million.
The ubiquitous wearing of masks and attention to hand hygiene etc. in Taiwan makes it more likely that any community transmission will be a lot slower (and thus slower to lead to a serious case that is more likely to be detected), but could easily still be a greater than zero.
"freedom" isn't our Achilles heel. ignorance is our Achilles heel. it comes from awful education and leads to a culture where your own opinion is as good as some other guy's fact.
Depends on the definition of freedom. If one were to think that they are free to spread their infection then freedom would be an Achilles heel. (On top of ignorance, that is)
If you add up all of the infections in the EU, you get numbers similar to the US, and test results are very situational. If you get tested in a state that doesn't have an outbreak, it'll go faster than one that does. The US Federal government doesn't have the authority to swoop in and play hero in the same way the EU itself can't come in and dictate to Germany what they must and must not do. For the US, habeus corpus among other laws and our constitution are reasons why. What the federal government has done is print money and hand it to the states and people directly which IMO, is a solid initial move while all the other machinery is brought to bear.
Never discount a European's willingness to poo-poo the united states. It's like a pass time.
As for data.
Peer Reviewed Antivirus\Seriological studies show a mortality rate of .9-1.1% when hospitals\ICU's are not overloaded. When they are overloaded, the observational data shows that rate jumps up to double digits. Something like 30% of patients require hospitalization. There's also a body of observational evidence this virus also reinfects people; GISAid shows 6 distict strains at this point.
So your enemy looks like it can infect and reinfect and every round, if your healthcare system isn't built up, it kills double digits.
India has an exponential breakout they will not be stopping any time soon, Brazil is following suite it seems as well. It doesn't require a lot of scientific infrastructure to count body bags and the fundemental reason the numbers are so f'd up is due to the fact once body bags begin piling up people freak out and try something new.
If you are smart you'll take this thing seriously, wear a respirator or CBRN Gas mask, and work at getting yourself healthy.
Numbers for the EU do not add up to the US. They are many multiples lower. I checked for all of Europe except Russia and Turkey. So more than just the EU.
Total cases are less than half. Daily new cases yesterday were 8K vs US’s 65K+. Deaths yesterday were 150 vs US’s 900+.
What numbers were you referring to? Did you think the numbers are similar, but they aren’t now and haven’t been for months?
Your numbers are way off. The current best estimate of infection fatality rate is 0.65%, which is significantly lower than 0.9 - 1.1%. Even when hospitals are overloaded the IFR is nowhere near double digits (10%). Nor is the hospitalization rate anywhere near 30%.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
How about the fact that the US deaths per capita is lower than France, Italy, Belgium, Sweden, UK and plenty of other countries... I consider those to be developed nations so I’m not sure their point really holds.
I thought you were making a point about death statistics, not about policy. Now I could be wrong, but I think that the timing and location of early hotspots is pretty much random. Later, once the epidemic is firmly established in the population, the law of large numbers kicks in and statistics become more meaningful and predictive.
I didn’t say cases I said deaths - both countries have adopted the same guidelines for counting deaths. I would also argue that it is outcomes that matter here - deaths. You can argue as to why Belgium policy failed worse than other countries (population density) but at the end of the day it is outcomes that matter.
Additionally, yes the US has some very sparsely populated areas but the thing is they don’t affect the numbers that much because they are just that - sparsely populated.
The article I linked is literally titled "Why Belgium's death rate is so high", you didn't even took the time to just click on it before replying to me.
I'm just tired with people taking Belgium as a "worse situation" example, while our lockdown had been quite successful in flattening the curve. A counterpoint though, we really badly handled the nursing homes, and most of our deaths come from there.
It's unlikely this is going to remain the case. The US had 3 straight days of ~1100 deaths. If that continues for 2 months (and doesn't get worse or better, more likely to get worse given the infection rates) the US will be far worse than Italy and France and gaining on the top 2 spots. If it increases as it should, it will be much, much sooner.
> It‘s so sad to watch, but compared to any other developed and affluent nation, the US is a complete shitshow at this point
Idunno man, here in Canada the testing woes are about the middle of the pack, when compared with each of the states, the case fatality rates are higher than in Texas. The overall death rates are still much higher in the UK than either the U.S. or Canada.
I think you're being extremely lopsided in your analysis of this, which I don't blame you entirely for, given how much American-made anti-American propaganda there is out there.
> It‘s just so sad to see how personal „freedom to choose“ turned into the achilles heel of one of the formerly greatest nations on Earth.
It didn't, it's a spectacular country and will continue to be for a long time still. The places in the U.S. where there was more choice and personal freedom did better on almost every metric so far, and we haven't even tallied the totals yet (we'll know for real in a couple years, when we correct our death records, and look at real overall mortality over the whole event, rather than rates on a given date).
You can not simultaneously warn about a second wave and dismiss the Swedish model out of hand. In reality, we won't know who was right until much later.
Which, yup, Canada and the US aren't that far apart, and the UK has a higher CFR.
And Canada…it's worth noting that Canada is a bunch of city-states bound loosely together by Tim Horton's, and the responses varied quite a bit by province. British Columbia bent their curve early, and made some really key decisions in regards to nursing homes and other long-term care facilities that made a big difference versus Ontario and Quebec. (Last I checked 81% of COVID deaths here were in such facilities. If we'd managed to secure nursing homes and figure out protections for farm workers, there'd be far fewer deaths. ICUs never, ever hit anywhere near capacity, at least in Toronto.)
And pure off-topic anecdote: testing has gone very well for me. My local hospital here on the east side of Toronto was on top of this early, and my tests have all come back in less than 24 hours. (Though I live with a front-line healthcare worker, which makes me think they're giving me just a little extra speed.)
> If we'd managed to secure nursing homes and figure out protections for farm workers, there'd be far fewer deaths.
Yeah, it was sad to watch. It seems like it was a mistake made by a lot of places up here in the north. The States and Provinces which had more time got to see it working out poorly ahead of time seem to have been able to change course.
> My local hospital here on the east side of Toronto was on top of this early, and my tests have all come back in less than 24 hours.
I've heard good things about that area, yes. A lot of places were having long delays earlier on because they were overflowing to the regional labs, or somesuch.
> Though I live with a front-line healthcare worker, which makes me think they're giving me just a little extra speed
The answer to that is understandably yes
It has been mercifully mild here in Hamilton, most of the patients in the hospitals are still elderly people from LTC facilities, as far as I'm aware. The panic has been minimal.
One thing here in Hamilton is the handful of people who don't care much about anything in life (Hamilton has a high concentration of such people, being a hub for social services), who will gladly pretend to cough indoors near you just to make you uncomfortable.
Yup. Americans are notorious for not knowing much about what happens outside their borders, so the comparisons to other countries is entertaining.
Spent some time in British Colombia. I’d say 10% are wearing masks (there is no mandate). Went to the lake and the beaches are packed. Recent outbreak in town because the bars are packed.
And Americans say “man! we’re so stupid to not wear masks. why can’t we be like other countries?”
No, that’s just yellow journalism. The USA is doing just fine thank you. The “second wave” is the whole point of flattening the curve, as long as hospitals aren’t overwhelmed, our response is successful.
Look at our respective stock markets for a more accurate view of the situation. They’re tracking very close, even adjusting for currency float. The USA is nowhere near falling apart.
> The “second wave” is the whole point of flattening the curve
We didn't really flatten the curve except briefly in a few places like CA; the supposed national curve flattening is an artifact of the fact that the New York epidemic peaked a declined as the rest of the country was (and largely still is) on the upswing.
This is just the first wave hitting more places with no effective mitigation, not a second wave.
> as long as hospitals aren’t overwhelmed, our response is successful.
Hospitals are overwhelmed in a growing number of parts of the country, out response is not successful.
> Look at our respective stock markets for a more accurate view of the situation.
Not really, the big firms on most stock markets are international conglomerates, and the major indexes don't really have much to do with national conditions.
Where are hospitals overwhelmed in the USA? And I mean, like, in a region. Not a single hospital - brief overloads in single hospitals happens in normal times too.
Hospitals are now at the point of being overwhelmed in several hotspots, particularly in Texas. You're just flat at wrong on every aspect of your comment.
There is so much misinformation online and in this thread. Take off the s of that figure in the US. That is a lie, the death count is only over a hundred thousand and COVID-19 deaths at their peak accounted for only 20 % of deaths In the country. So everyone had an 80% chance to die from something other than COVID-19. Today you have about 95% chance of dying from something other than COVID-19 in every age group. While it reasonable to be afraid of death, you should now be much more afraid of dying from other causes than dying from COVID-19. The curve has more than been flattened.
That article doesn’t provide any meaningful information on deaths. It does saying they are “spiking” in certain states but any review of data in the US will show that deaths are not increasing nationwide and the “upticks” in COVID-19 deaths are very very small compared to the history, every person who actually views the data would call it flat. We are talking about a roughly 70% decrease in deaths from COVID-19 from the peak. As I mentioned you used to have 22.25% chance a death was caused by COVID-19 and now if you die there is only roughly 5% chance it was from COVID-19 and that number doesn’t even require laboratory testing to verify, if they thought COVID-19 was a likely cause of death without testing it is still counted in those numbers.
For the cases given as examples in the article, from Georgia and Texas, even if they got prompt test results both those states are doing badly at contact tracing which further exacerbates the situation.
Georgia is currently tracing just 7% of contacts. They were in the 7-9% range from mid May to early June, then fell slowly to about 4%, then briefly in late June got up to 19%, and then immediately went into decline back down to 7%.
Texas is doing 6%. They were at 19% in mid May, rising to 42% near the end of May, fell to 25% in early to mid June, jumped to 33% by June 11, and then have been on a decline down to the current 6%.
Experts say this needs to be 90% withing 48 hours of infection.
California peaked at 39% in mid May and has followed roughly a declining sawtooth since then, currently at 22%.
Florida is just 3%. They peaked at 40% at the start of June and went steadily down hill since then. They curve looks like a capacitor discharge curve.
The only states that currently either have enough contact tracers or have planned expansions that will get them enough are: Alaska, Hawaii, South Dakota, and everything north or east of Pennsylvania except for Rhode Island, .
Of those, all but New Jersey, Massachusetts, Alaska, and Hawaii currently have sufficient contact tracers on hand.
The remaining ~40 states do not have enough and do not plan to get enough.
A state needs 5-15 tracers per daily positive test. Georgia has 0.33, Texas 0.31, California 1.07, and Florida 0.15. Compare to New York at 13.75. (Missouri and Alabama are tied for the worst here, at a paltry 0.08).
Reading between the lines, I think that several states hired enough to handle the load near the end of lockdown, with perhaps some room to spare for a minor raise as they reopened. When the rise was faster than they anticipated, they failed to slow down reopening or to boost their budget for contract tracing.
> Reading between the lines, I think that several states hired enough to handle the load near the end of lockdown
Government being government, I understand why this doesn't work, but states literally have a list of people without jobs and their occupations that they're already paying. If the health department could/would just talk to the unemployment department...
That’s an unfair statement. The powers that be need to be motivated and stuff gets done.
Northeast states like NY, NJ, CT, Mass were able to mobilize after the initial crisis and rapidly hired and got systems in place to do contact tracing.
In the south, you have the conflict between municipal and county authorities managing the crisis on the ground while the obsequious governors are busy sucking up.
It’s depressing that the tragedy of what happened in April didn’t result in more intelligent actions in other places based in the lessons learned.
It seems to me that it's probably a money issue. States can't run deficits and the Federal government hasn't stepped up to backstop municipalities, just private corporations. Extend the states an unlimited line of credit from the Treasury for contact tracing and most of the states would probably ramp up.
There were some recent fixes to it, but we've allowed our phone system to be completely overrun by scams and spam. So we don't even have a trusted line of communication between government and citizens other than mail, which is too slow. Most people have had to just block all unknown numbers.
The only reason for it was because offering spam blocking service was a cash cow for phone companies, so hey lobbied against any effective governance to stop it (finally some was passed in late 2019). If people have an interest in something, the government is barely responsive, it took years and years. Special interests that can pay to lobby for it get their way right away unless there is pretty huge backlash.
Is there not a website, either state or federal, where one can go and report contacts?
Why does the roll need to be performed by boots on the ground (exclusively?).
I could just be ill-informed here. We have one active case in hospital quarantine here is Tasmania who is a resident returning from Victoria, and I’m not really paying much attention so.
You’re right, but, at the same time this is an extremely puzzling phenomenon. We have millions of people out of work whom we could be paying to do contact tracing, and, yet, we don’t. Even if the states are low on funds, the federal government could either subsidize or fully fund such programs. Doing so would be a huge step toward dealing with COVID-19, as well as providing a partial solution to all the unemployment that’s been created by the lockdowns.
Why don’t we do this? It’s a jobs program, not an entitlement, so, theoretically, Republicans should eat it up. And, I don’t see Democrats opposing it, either. Instead, we’re pointing fingers, calling it the “China flu,” or the “Trump virus,” while over 130k have died, and many more get infected by superspreaders who could easily have been identified and isolated were there enough contact tracing in place. Even California, which I thought was handling the crisis well at first, has faltered by prematurely reopening sectors of the economy.
I’d like to say it’s a lack of leadership, but I think it’s more that our leaders are serving interests that are not ours. This is a nonpartisan statement — Trump is to blame for a lot of it, but Democratic governors and mayors, by and large, haven’t stepped up, either. It’s time to ask cui bono? It’s time to really drain the swamp, instead of continuing to vote for the mosquitoes who suck the life out of the American people.
States and cities can't run deficits and so can't create the funding for this out of thin air. Republicans have campaigned for years on a platform that "Government doesn't work" and have been remarkably committed to providing evidence for that claim when elected. Both hiring people and solving a crisis with government intervention go against their instincts.
I addressed the “states can’t run deficits” when mentioning that the federal government could, and should have stepped in. As to the Republican playbook of starving programs for funding and saying “Look! It doesn’t work,” that’s literally part of the problem.
There are loads of teachers, librarians, sports coaches, parks employees, etc, etc that can’t do their jobs due to COVID. Those people could be doing contact tracing.
Teachers are still working during COVID, in fact they probably have to do more work to adapt to hasty, scrappy adoption of online learning.
I don’t think the other ones exist in significantly large amounts to be meaningful and even then, keep in mind that furloughed people are not getting paid. The money has to come from somewhere to start paying them for whatever again, and states and cities have limited funding resources even before COVID blew a hole in most tax revenues.
You do have to pay people money to hire them though, and states and cities do not have the financial slack to just hire more people as tax revenues keep falling.
The only entity capable of nationwide deficit spending is the federal government, which seems unwilling to step up to the plate.
States and cities often have balanced budget laws. Even if these were repealed (look how easy that has been for the Eurozone), states do not have the mechanism for bankruptcy (see: Puerto Rico). And cities have one but it can get extremely messy (see: Detroit, New York in the '70s)
The feds have decided to prioritize the economy in an election year, for some short-sighted definition of a good economy. And the party in power has never liked a strong federal government anyways.
My question was regarding the federal government's involvement. I can't fathom why they would let so many people die, unless we elected hundreds of sociopaths to federal office.
Good luck making it work in a hyper individualistic society. Person A who has been told they're required to do contact tracing will get annoyed that their neighbour B doesn't have to do it but is still getting money. Add to that mix the antivaxxers, conspiracy theorists, people that dislike government, etc.
These people are already being paid their normal salaries by the government. If they don't want to work, they can quit. Now, if someone is in a high risk group, they probably shouldn't be out in the field, but a lot of contact tracing is done over the phone.
In CA, when Gavin Newsom began reopening the state (many folks thought, "too early"), he repeatedly insisted it was not because of political pressure, but because of the data.
But at the same time, there were health officials being given PUBLIC DEATH THREATS by people who insisted that wearing a mask was dangerous to their health.
Ultimately, I suppose you have to give into politics and public pressure. A mandate that nobody respects and can't really be enforced has no value at all. It's plausible that responding to political pressure and trying to reopen, or give dates and phases, would result in better adherence than just telling the whole state "sorry, stay home indefinitely".
> A mandate that nobody respects and can't really be enforced has no value at all.
A mandate is essentially unenforceable, yes, but it's valuable regardless. It's about setting social norms and expectations. If public figures had put forward a consistent message regarding masks from the beginning, we'd have seen better compliance and fewer people would be dead now.
States borrow but almost all must balance the budget. When they borrow it should be a project, not to cover a shortfall. This is not a federal requirement but a restriction the states put on themselves.
State and local governments are allowed to borrow and they do quite a lot of it. The difference is they don’t have a guaranteed buyer for their debt like the federal government does with the federal reserve.
On April 8, 2020, the Board of Governors of the Federal Reserve System
(the Board), by the unanimous vote of its five members and with the approval of
the Secretary of the Treasury, authorized the establishment and operation of the
Municipal Liquidity Facility (MLF) under section 13(3) of the Federal Reserve
Act (12 U.S.C. § 343(3)). The MLF is intended to support lending to state, city,
and county governments.
Under the MLF, the Federal Reserve Bank of New York (Reserve Bank)
will commit to lend on a recourse basis to a special purpose vehicle (SPV). The
SPV will purchase eligible notes directly from eligible issuers at the time of
issuance.
[...]
The Department of the Treasury, using funds appropriated to the Exchange
Stabilization Fund under section 4027 of the Coronavirus Aid, Relief, and
Economic Security Act (CARES Act), will make a $35 billion equity investment
in the SPV in connection with the MLF.
Why not? It’s not like it demands any specific skills, and there are a lot of people out of work who would jump on the chance to not go back to their old jobs right now.
It demands somewhat general but far from universal skills. Look at for example the CDC's suggested training (https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/cont...) - this isn't something the average person will be able to pick up quickly and easily.
>We have millions of people out of work whom we could be paying to do contact tracing
I was recently (a year and a half ago, time flies) out of work, and I did get a solicitation about a contact tracing job since the epidemic started. I didn't think my experience was applicable, nor am I free, but somehow they found me. Maybe they have indeed been trying to recruit pretty widely?
> Experts say this needs to be 90% withing 48 hours of infection.
Statements like this always bother me. Which experts? What happens if the value isn’t reached? How did they even arrive at these numbers? The statement makes it seem totally made up on the spot, which isn’t helpful in a time when so much of the “expert advice” is already disregarded (often for good reason! Remember when “experts said” that masks were ineffective at reducing transmission of this disease that has very few asymptomatic carriers?)
You're mainly taking offense with the lack of a citation, I think, but I might be able to at least explain the timeframe mentioned here. I'm neither a doctor nor working in this field, so take everything with a grain of salt:
The incubation period is usually five days or more, while patients can already be infectious two days before symptoms show. That means there is a window of opportunity of 2-3 days to find contacts of the current case and put them into quarantine before they start infecting even more people.
Where the percentage comes from, I do not know but I would assume that it is meant to push the number of new infections per case (R = reproduction number) to 1 or even better well below it (R < 1 means it would eventually fizzle out). Super sketchy math: if the reproduction number is ~2.5 and you trace and quarantine 90% of the contacts (1 - 0.9) * 2.5 ~= 0.25 new cases will slip through. They might be aiming at such a high number to compensate for other cases where no tracing is done (e.g. because it was not known that the patient was Covid-19 positive) to keep the overall reproduction number low.
Once again - I am not a professional and just offering some thoughts about the problem (and happy to be corrected / to learn more).
At the time the belief was that COVID spread largely through touching infected surfaces. That combined with the fact that there was a massive shortage of masks meant that they warned against using masks. Also, the role of asymptomatic carriers wasn’t all that clear.
And it was probably the right call based on the information we had then (the real question is what the US government was doing for the many months notice it had and why it did not use its powers to deploy companies to manufacture masks or as in the case of GM agree to pay the at cost rates they were offering the US government for manufacturing PPE and ventilators).
Once it became clear that asymptomatic carriers and spreaders existed, and that the majority of spread was through water droplets emitted during actions like speaking and singing (unlike most other viruses where it’s usually sneezing and coughing), the advice was changed rapidly since regular cloth masks could be effective for this purpose.
This wasn’t a failure of expertise but was the natural consequence of facing a novel threat that was moving faster than we were learning about it.
I recall articles saying that there's no point in lay folk wearing an mask. They're impossible to wear properly without four years of medical training, presumably mostly focused on mask wearing rather than silly things like anatomy, so anyone else wearing one is a complete waste. Leave it to the professionals.
I'm exaggerating but not by much...
Contrast with the current messaging. They work but are in short supply. If you have a stash of new surgical or N-95 masks, please donate it. If you have a used mask, please continue wearing it. You're encouraged to make, wear, and sell/give to anyone non-medical-grade reusable masks. Anything is better than nothing.
Unfortunately yes they did. Even in my hospital I remember when the recommendations were that masks were unnecessary unless in a covid room. I’ve been treating covid pts since April.
Edit: maybe for clarity I should add that I don’t remember anyone saying it was ineffective, just unnecessary. I witnessed several physicians wearing their own masks be told by higher ups to stop though. I’ll have to look through old emails, things have changed on a weekly basis.
I can't say for US, but yes, both WHO and local government health figures were spouting that masks don't work. LAter they recanted that the reason they said that was because there weren't enough, but the initial dialog was they were ineffective. (from a previous discussion, I think France was the same)
Their statements were worded to state they were probably ineffective for healthy people to wear for their own protection in the general environment. That is probably true in that the point of masks is mostly to protect others. So if you don't have enough masks (for total coverage,) a higher risk group using them all was not going to be effective in protecting the high risk individuals unless they tend to cluster.
Correct. It was always said if someone was sick they should wear a mask (more studies have come out confirming this). Once asymptomatic became such a big transmission vector it made sense for everyone to wear a mask. PPE was/is still an issue, so cloth masks were also questionable early on, but have since shown effectiveness.
More precisely they stated that there were no studies proving effectiveness. They were hiding behind the scientific method to serve some other purpose.
I think the problem is rather that the public was looking for ideally easy and hopefully definitive answers and were confused when they saw scientific progress unfold in real time instead, with all uncertainties, theories and what it entails.
I definitely had a good share of discussions revolving around "scientists are saying different things every week" in the last few months. My closer connections seem to understand now.
The US Surgeon General went a step further and literally said "You can increase your risk of getting it by wearing a mask if you are not a health care provider"
Somewhere I read that among the reasons for ordinary people not to wear N95 masks is that the valve lets air out freely, while filtering incoming air. This would make you more likely to infect others if you are infected, than some other kind of mask.
It's not that you increase your own risk per se, but you increase the risk of your class, of civilians, by wearing it.
With the valve they are pointless if the werarer is positive/transmits the illness.
The valveless ones are fine, but both with valve and valveless are not as useful as they promise (filtering 95% or so) because the wearer must be trained to use them AND the masks need to be suitable to the wearer, after a proper "fit test" AND the wearer must be medically tested to be able to breath with reduced flow.
The exact method the fit test (and the medical check) is performed varies by country/norm, but check this:
Basically you choose among 10-12 different models the one that seemingly fits better your face, then you put the mask on, a sort of transparent plastic hood is put over your head and a small quantity of substance is sprayed (usually vanilla or similar highly penetrating odour) under the hood, if you can smell it, the mask is not the proper fit or has not been put on properly and you start again.
Then, the particular model of mask with which you passed the test is "your" mask (and you won't use another model).
And of course you need to be cleanly shaved.
A "surgical mask" has a much lower filtering potential, but unlike the N-95 masks (FFP-2 in Europe) anyone can reach it without issues.
I seem to recall Dr Fauci on 60 minutes saying they don't really work. That they might make you feel better for wearing one but also have unintended consequences because you're always fiddling with such a thing. So he wasn't suggesting people wear them at the time.
Even though I would generally agree with you: what makes you think that Fauci and his colleagues did not simply not know that mask are as effective as we now know they are?
Not exactly a citation[1], but this agent-based simulation suggest that mitigations like quarantine are highly sensitive to how thoroughly they are applied: https://www.youtube.com/watch?v=gxAaO2rsdIs
[1] I'm putting this firmly in the "all models are wrong, but some models are useful" camp
The state aggregated data for California doesn't make much sense. San Diego county is still contact tracing at 90% (was 98% earlier) https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs... Since this stat is monitored state wide as a reopenning criterion other populous counties should be comparable.
No amount of budget-boosting would be enough to keep up with exponential growth. If they hired enough people to cope with the contact tracing load near the end of lockdown plus a little bit of an increase, and then the increase was faster than expected, that sounds like a pretty clear sign that contact tracing is not a workable solution. (Which is, as I understand it, pretty much what we'd expect. Contact tracing has not conventionally been seen as even remotely viable for a respiratory disease like this one.)
SARS is both much more deadly than COVID-19 and less infectious (in particular, people didn't seem to spread it prior to developing symptoms). Both of those things make contact tracing far more viable - the high hospitalization and death rate means that outbreaks could be detected really promptly and reliably because people turned up in hospitals with symptoms, and the fact it spread less effectively made it easy to track down the other people in the outbreak and quarantine them. On the other hand, COVID-19 is similar enough to the flu that contact tracing it should be even more futile than trying to contain the flu via contact tracing.
Also, if the things that worked successfully to stop SARS from doing what COVID-19 has done worked for it as well, then it would have been stopped just like SARS. All the western countries like the US, UK, Italy (I think), etc did SARS-style contact tracing starting really early on. It just didn't work this time around. There's not a huge amount of media coverage of this because it doesn't fit the narrative, but you should be able to find some.
to be fair, if nothing had been done, it is pretty likely that the surge of deaths would have trashed the economy just as well.
Not that I disagree that the US response has been among the worst .. and the bar is pretty low with only a handful of countries (like south korea and Taiwan) having been able to promptly adopt effective strategies.
I'll posit that political will counts double because you need everyone behind you to contact trace, both the agencies and the populace. It's not just budget.
Anecdote. An acquaintance is a disease export working for NIH near DC who also does contract tracing in the field. Sometimes their contact with the public includes death threats, refusals to cooperate, and even been spit on. They are good people trying to prevent more illness. Some of the public has been coached that the doctors are taking their jobs, closing employers, etc.
Leadership needs to get everyone behind the same spear so we can snuff this out quickly.
We're not going to snuff this out quickly regardless of whether people cooperate with contact tracers. SARS-CoV-2 will become the fifth circulating endemic coronavirus in the worldwide human population (plus some animals). Eradicating it has become effectively impossible, and not even the development of a vaccine will change that.
It's concerning to me to see this downvoted. As far as I know, almost every health official on the planet believes the virus can't be eradicated at this point, even in the countries that have kept it heavily suppressed. The long-term goal is to get it under control in the same way as tuberculosis.
Government officials, unfortunately, have to pursue policies that work in the specific area they're responsible for. If contact tracing isn't effective in their area, they have to respond to that - it's unproductive for them to say it should in principle work based on what other governments have seen.
It’s not the physical locations that are making a difference. It’s the people and policies working together that make social distancing and contract tracing etc effective or not.
The physical location matters a lot as well. Geographical barriers like oceans and mountains do a lot to reduce transmission across borders; getting domestic cases under control won’t help much if new ones keep getting imported.
This is particularly important for metro areas that span multiple local jurisdictions: a single authority can’t do significantly better (or worse) than its neighbors, so they have to act in concert with each other. Ruling by committee is inevitably slower than by fiat, which makes it harder to handle highly dynamic situations.
Local jurisdictions within a city should have little to no control over policies in a pandemic like this. Giving them that control rather than operating at a higher level is idiotic. China was relatively successful because they sacrificed the economy of Wuhan early, but acting even sooner could have completely contained the virus and prevented the pandemic.
But you have to use the power structures that were in place pre-epidemic, and lots of them stop at arbitrary boundaries where the modern cities don’t. In the US, health policy is generally handled at the state level, but you’ve got places like the DC metro area where the city effectively spans both Federal land and parts of two states.
I am saying polices are the reason why some areas failed. Saying this is how things are done is justification for failing policies, but it doesn’t mean they actually work.
The CDC was specifically created because diseases need a nationwide response, the US simply failed.
> No amount of budget-boosting would be enough to keep up with exponential growth.
Right now it would take an atomic mushroom cloud and/or the military in the streets to keep people at home for an extended period of time. And even then we would see 3-6 weeks of exponential rise in case numbers because testing is just so far behind and you will have tons of follow-up cases.
This discussion thread is in response to an article called "What's the point of Covid-19 test that takes 19 days for results?" If the contents are to be believed, that seems pretty far behind to me...
The title makes it sound like a significant fraction of them are taking this long, which is simply not true. The article takes a few anecdotes and makes it sound like it's like that in every case. Then the article predictably shits on Trump, whose (verifiably true) statements that the US leads the world in testing throughput at the moment it is unable to refute with facts, so it uses the aforementioned anecdotes to make it seem like this doesn't matter, tacking on a few more anecdotes and opinions towards the end.
Daily testing numbers aren't really important except as they compare to daily new cases. Countries that have already controlled the spread of Covid (many Asian nations, NZ, a lo of Europe at this point) don't need to do many tests because they have few cases. And on that metric, the US is doing worse than all of Europe and all of Asia except maybe Japan.
We sit just between Nigeria and India, but well ahead of Brazil and Mexico.
More concretely, 0.5% of the tests in Germany, the UK, and Italy are positive. For us, between 8 and 9% are positive. So to do the same level of testing per-case, we need to do 15x as many tests as we have been.
The point is that as a nation we don't get brownie points for handling the outbreak so badly that we need to do things that other nations do not.
No one but the US (or Brazil or India, perhaps) has any business having the most tests per day, and few other nations have the need for a significant number of tests per capita, because cases per capita are so low that it's not worth it.
That's why I have to qualify my sarcasm with /s on this site, including my post above: the population density is too high. /s Trump sarcastically suggested it, but there never was such a "plan". Nor could there be one: the president of the United States does not have the authority to shut down (mostly private) testing.
It seems that for non-proirity cases, Quest is saying that it now takes 7 days or more for results to come in. This is ~125k of the daily tests performed in the US. Of course, based on this information alone, there's no telling how other labs are doing on test result turnaround times. I will also say, for what it's worth, that personally when I was tested a few days ago it took less than 24 hours to get results, and I doubt I was a priority case. But I also didn't go to a federally funded testing site.
It's unclear. Rates in South Korea are rising, and they've generally used somewhat broad shutdowns in addition to contact tracing. (For example, when there were positive cases found in Seoul bars, they closed all the bars in the city for weeks.)
It is unclear to me why this wasn't doable in more countries but this has been one of the very few winning strategies. (not trying to be malicious here, I admit that I don't know the logistics of large scale testing and why it wasn't applicable to more countries).
it seems that it is viable up to a specific scale, and we're already past that scale.
Honestly, my imagination fails to come up with a remotely plausible math model of containment, say in CA, of further spread from the current 400K (4M after the CDC 10x multiplier with the most being unaware of being a carrier) cases in 40M population.
If you want to be incredibly angry at the ineffectiveness of the current testing regime that we as a country are heavily investing in, listen to this episode of the This Week In Virology podcast:
The way to beat the pandemic is to have cheap, disposable instant tests that anybody can take in their homes, everyday, to see if they have a large amount of virus in their system. These instant tests will not have the sensitivity or specificity of the PCR style test, but it doesn't matter. The PCR style test can test for levels of virus that are billions or trillions times smaller than necessary, yet we disqualify other types of tests because they aren't as accurate as the PCR tests. So we set an impossible standard that all other tests, no matter how practically useful they could be, fail to reach.
We all could have cheap, accurate enough instant tests, but do not because they aren't as accurate as a test that is ridiculously accurate but takes so long to get results at scale it becomes completely ineffective. It's complete madness.
A company here in Canada tried to bring one to market, but I think it was completely disapproved because it was not precise and specific enough, which baffled me since I don't really see the downside of it being available even if that's the case.
Yes, accuracy is a nice thing to have, but if you aren't tested at all you are worse off. You can still follow precautions if you are negative on an inaccurate test, but we can't afford to have everyone take the precautions that those with positive tests should.
If the test is highly sensitive but biased toward false positives, that would also be a useful form of test.
If it's not specific enough a significant portion of the population will have to go into quarantine for no obvious reason, and if it's no precise enough you either need to keep the restrictions or let a significant portion of the infected population move around with no precautions whatsoever.
I'm not sure why you're not seeing any problems with this.
It doesn't have to lead to quarantine. Many people are running around acting as though the virus is gone. Some are staying indoors with a cold thinking they might have the virus. If they could self-test and make their own decision about the risk of changing their behavior, it would help immensely.
Listen to the TWiV episode. The idea behind the cheap test is that it picks up COVID at maybe a billion times greater viral load than an RT-PCR test would.
If a billion sounds like a lot, it’s not. The virus goes from undetectable to rampant within hours. The cheap test will miss out the very early stage of infection. But we are talking hours.
Such a cheap test could allow kids to go to school or adults to go to work. It would be revolutionary.
My understanding of the tests is they are very accurate at determining if somebody has a lot of virus, but not at detecting lower thresholds of virus. So compared to PCR tests, they have a lot of false negatives.
The Abbott ID NOW COVID-19 rapid result machine that the white house uses has the same properties:
> Based on our findings we could argue that the Abbott ID NOW detects samples with high viral load or possibly viable virus that could be of importance for transmission. But, the fact that it misses positive samples on patients being admitted to the hospital with clinical picture of COVID-19 makes this technology unacceptable in our clinical setting [1]
So they will have very few false positives, but a lot of false negatives. However... being negative for having a lot of virus is actually meaningful, whether you have the virus or not, because the best assumption is that contagiousness is related to amount of virus in your system.
So basically, the tests aren't perfectly accurate, but they do provide useful information, and they are instant. That is the key. A PCR test that is perfectly accurately is useless for contact tracing/isolation and peace of mind if it takes 14+ days to get the results.
Think of a pregnancy test. If it comes back positive, you are very likely pregnant but should get it confirmed by a doctor. If it comes back negative, you likely aren't pregnant, but maybe it's too early to tell. Pregnancy tests are widely used even though they have these characteristics because people understand the quirks and the information they provide is useful and of course, comes instantly.
That's like saying "the way to beat poverty is for everyone to have a billion dollars". Both true and impossible at the same time. At least impossible outside Zimbabwe, that is.
Yes but can we easily afford a pandemic that goes on for years? Interesting you mention Zimbabwe, do we print money to help those out of work due to this?
We can have a functional economy without the average person getting in planes and moving around the world. It is enough for essential staff and cargo to move around the world. No reason why that shouldn't work and we can't all make money. We will just be making money doing different things in different ways with different norms.
Mother's day? Restaurant? Nah. What should we order from uber eats? Who delivers flowers. Etc. Gap year? Let's travel in the same country / same state, and go deeper rather than wider.
Did this pervasive level of criticism, animosity, and negativity exist a hundred years ago during the last serious pandemic? Every week there's some new crisis.
It feels like the entire media is always trying to highlight the next systemic failure. "This is wrong." "This failed." "We don't have enough ventilators." "New York cases are surging." "California cases are surging." "We don't have enough PPE." "We don't have hand sanitizer." "We don't have masks." "We don't have enough tests."
Are things actually this consistently bad, or does the media magnify the negative and ignore the positive developments (of which there are plenty)?
It's like the difference between acute inflammation (which is good for the body when it's fighting an infection) and chronic inflammation (which causes a lot of problems).
I mean, in the United States, 149,324 deaths is a systemic failure. Another 834 today, and the day isn't over. Do you not think that constitutes a massive crisis?
That's my point. The Spanish flu killed 750,000 in the United States at a time when the population was around 100 million. It was certainly a massive crisis.
What was the reporting like and how has it changed?
I think it was actually relatively the same. Different styles etc, but there were people back then that didn't feel like distancing or wearing a mask and there were laws put in place that would land you in jail if you went out without a mask. And there were protestors against that, just like now. And they too got infected, spread it around and some died.
It's an excellent (sad) example of history repeating itself.
On the other hand, things aren't all that comparable. Consider the distances people travel, the amount of people that use the same space, but also the amount of single-use things we have now that we didn't have (at scale)
back then (even simple things like spoons, napkins, cups).
People love to make comparisons, but it's not always as useful or helpful as one might think (even if we went all the way down the rabbit hole and tried to find all the variables between now and then).
When talking about mortality rates I don't think it is easy to make a comparison of these two virus.
Firstly, the medical technologies of 1918 were nothing like what we have today.
For example, even though it would have been no help fighting Spanish Flu, wide spread use of penicillin was still some 20 years, showing just how far behind the medical system of that time really was.
That difference also shows up in things like life expectancy which back then was in the low 50s where as today it is in the 70s.
Finally the two virus are very different.
One factor that made the Spanish Flu virus so deadly was it killed both young and old.
If COVID-19 had the same death profile I suspect we would be seeing those same 750,000 totals.
Back then there was hardy any reporting at all. They tried to keep it under wraps as much as possible. It’s the whole reason it was called the “Spanish” flu, as Spain was the only country accurately reporting on the crisis, which made it seem like a problem unique to them.
We also know more about how the virus spreads and treating people who are severely ill with it than we did 3-4 months ago. Part of why Germany’s death rates were a lot lower than its neighbors is likely due to having far more ICU beds per capita before the crisis, but also, hitting our infection rate peak a bit later. Those two things combined meant that our doctors had more time to figure out what does and doesn’t work, and never came close to the horrible decisions doctors in Italy had to make - Germany was even able to take in several hundred patients from Italy and France.
Also of interest: Germany has almost as many ECMO-equipped hospitals as the US does, despite having 1/4 the population and a tiny fraction of the land area.
Italy you can maybe excuse that they were caught by surprise, but yes, the other countries in Europe handled it badly initially. The surprising thing about the US is that somehow it's handling it worse.
From what I can tell, Italy being caught by surprise was a largely self-inflicted problem - they seem to have not tested any patients who were hospitalized with potential symptoms unless they'd travelled to China or had contact with someone who had. Other countries like the US had testing policies that, on paper, excluded those patients but in reality they did get tested anyway often enough that community spread was detected relatively early on. Italy only spotted theirs when someone happened to be hospitalized who'd had contact with a person that'd travelled to China but hadn't caught it from them.
This is very different from the narrative the American and British press have been pushing, probably for political reasons - in that narrative Italy was just unlucky, and it was the other countries that didn't learn from them and stop themselves following in Italy's footsteps that failed. That doesn't seem to match reality. As best I can tell, Italy screwed up so badly that they doomed not only themselves, but any hope of containing Covid-19 in Europe and America. Everywhere else seems to have done a reasonably good job of stopping it coming from China, and it was the unexpected, undetected cases from Italy when they claimed to be completely clean that caused the outbreaks.
But the rest of Europe stood around, slack-jawed, while things spiraled out of control in Italy. I live in a different European country, and the lead-up to the COVID crisis was like watching a someone being chased down by a snail -- the only reason the snail caught them was because they didn't bother to move out of the way. For example, people were regularly traipsing off to the Italy for vacation up until the point when things started to spin out of control and they shut the country down.
But in the country of 330000000 this is relatively minor. Yes, this happened quickly, but other, and more importantly, preventable deceases are killing way more people over time. Yet we don’t test for flu, don’t close McDonald’ses or allow driving only with special permit once a week. Basically current hysteria is disproportionate.
Not only it could, it did. Adjusted for today’s population Spanish flu would kill 2 million. Yet lockdowns were way less severe and schools, for example, reopened. Moreover, looking at current numbers, covid is not on track to reach 2 million by any degree of imagination.
America is objectively doing terribly with covid-19. Massive business disruption combined with massive cases. The view from outside america is of widespread mismanagement and systemic failure. It is a death blow to America’s perception as a competent world power to be relied upon.
In this context, negative headlines are hardly surprising.
It also happens to be the case that Houston is the major processing center for all of the major lab groups for the south/southwest. They literally pointed at the single most congested part of the network, during a period of global supply shortages, and went "well, that's not working well."
Well, yeah, it's not fucking working well. We're cranking out tests and running analyses at an unprecedented level. And we're doing a decent job of ramping up, actually, but not perfectly evenly across the board.
My healthcare center is not particularly large or particularly well-connected. We've been getting our tests back in 3 days. At one point our partner started getting too heavily inundated, things were lagging to 5 days, so we switched to another that didn't require shipping to Houston for processing. We're back to 3 days.
But we're lucky - we're small enough that we don't have to partner with a Houston-based center. Others aren't.
I suppose ever since newspapers were invented they've done whatever they can to attract readership
fact is the news needs their audience to feel that news is essential to their daily life, and if it was just good news I could make the choice to watch something a little more interesting, but by choosing stories that feel urgent and dramatic, they create the urgency to stay tuned to 'stay informed'
No one needs to stay informed of the good news, although I do miss when the late night shows would make fun of light hearted news that was a once daily reminder that there's a lot going on in the world that's not american politics
No, a hundred years ago people accepted that death from infectious disease is common and got on with their lives. Certainly they had no months-long lockdowns at the time.
Actually many municipalities did lock down in response to the Spanish Flu epidemic here in the US. The epidemiological studies of these cities are in part why we chose to lock down this time too.
Yes, but they locked down for much shorter than we did. San Francisco had restrictions in 1918 for just over 1 month, for example. Nowhere you’d have found things like 5 months+ lockdowns like we have now in many places, with no end in sight.
And now, a few months later, we're seeing the affects of the lockdown. Businesses are closing everywhere.
It's incredibly sad.
The vulnerable should have stayed isolated - cleansed everything from the outside. That ensures their safety. The healthy should have been able to go forward.
Responsibility without control is cruel. Financial debt accumulates, but hey, stay inside, don't go to work.
Do you have evidence that this is true? It's pretty hard to believe that people were more willing to stay inside in an era when nobody had the Internet or even TV.
> does the media magnify the negative and ignore the positive developments (of which there are plenty)?
The media crafts its daily narrative with an eye on objectivity and plays right down the middle. Just the facts, always. To suggest otherwise is quite dangerous.
If tests are much more useful if they come back quickly, then first come first served with huge queues is the exact wrong way to handle excessive demand. Instead you should test the newest round of specimens that you have ready, and catch up on older ones if you can when you have a lull.
That incentivizes gaming the system by getting multiple tests, though, and hoping one will be lucky to be the newest batch.
If you can centralise test assignment enough to eliminate that, you can do something smarter, like prioritising health workers, at-risk demographics and those who are already asymptomatic. Assign any remaining capacity quasi-randomly to get the best possible statistical data for your epidemiologists: if your systems are that overwhelmed it's far too late for contact tracing to be useful, but the data scientists may learn something.
Having inefficient assignment of test resources is a problem inherent to privatised distributed healthcare that doesn't just go away if you solve the financial side with Obamacare or the like.
Thus the need for cheaper, quicker tests, even if the accuracy is t that great. TWIV Podcast episode #640 covers this. $1 per day test that quickly gives a result, but perhaps is only 50% accurate.
"Apparently even the "less sensitive" tests are in fact sensitive enough to catch these who produce a lot of virus. Those who produce a lot of virus have many orders of magnitude more virus RNA present in their samples than those who are in the phase of infection where they aren't so dangerously infective."
Thinking more about it, the most important point I'd add now is:
We should learn not to think about "the test" but about (at least) two different kinds of tests for different purposes:
1) fast tests to reduce the chance of virus spreading. Anybody isolated before managing to spread the virus is better than not testing, so it doesn't have to be too precise. We just have to understand its limits.
2) more reliable tests for clinical purposes, whenever they are needed. Interestingly, even in such scenarios antibody tests could find their use and allow cheaper or faster results, something like this:
E.g. if somebody has symptoms and IgM (or IgM and IgG), that could be good enough of information to decide how somebody is to be treated. One more example where I'd guess nobody needs to wait for a PCR result.
I think quick is more about getting the results back quicker. But in terms of taking the test, it takes time to get to a testing site. A take home test would be a huge boon.
I'm not the person you asked, but I also get tested often and quickly due to some work on physical access controls.
Often being: once a week. Not considered often compared to physical contact workers, but considered often compared to work-from-home workers. Heck, even considered often compared to the entire continent of North America.
Quickly being: drive-in test or walk-in test that is done in 5 minutes, results within 3 days, usually within 24h, either by SMS text message or phone call (depending on the test center).
Test center appointments are generally divided based on proximity, there are 4 test centers nearby for me (4 kilometres to max 30 kilometres -- sadly the one closest is usually queued up full for 1 or 2 days). So far my experience has been that they are very efficient; a lot of open space, about 6 people physically there at the most, testing room is about the size of a shipping container, one person doing the tests, one person observing/checking/entering data. The most efficient one was actually in a parking lot next to the hospital that also has a lab where they do mass testing. There is space for about 30 cars, but they regulate the appointments in a way that even when some people come early only 4 cars are there. Half the spaces are blocked/crossed out, entry and exit are made using ramps and zigzags (if that makes sense) so they are very accessible but also naturally prompt people to keep their distance (aside from the stickers/billboards all over the place). Because it's a single-direction flow for both cars and people and the people flow exit ends where the car parking flow starts you never run in to anyone getting in or out.
That's exactly was is talked about in the podcast by the doctor. It's not random 50% accuracy, it catches all the people it needs to catch, because accuracy depends on amount of viruses they shed. Accuracy on people who are transmitting decease is more than enough.
Suppose you test a population of 100 people in which 10 are infected. The coin flip test reports 50 people infected on average. Among those positive tests, at least 40 have to be to be false positives Because there are only 10 infected to begin with. That’s a false positive rate at least 80%. Among negatives, we would expect 5 to be false (since 10 people are infected and each of them have a coin flip chance of testing negative) or 10%.
I’m not sure that you can have a test that’s 50% accurate and errs equally in both directions. At least, I’m not sure what it would mean.
There is _some_ value in knowing that you had it even after the fact. Having a positive PCR test is way better than a positive antibody test. This knowledge means that it is unlikely that you will get it again soon. (Though, we don't have very good data on that. It will take some time till we know how long immunity lasts and how well it works.)
For test and trace to suppress the epidemic you'd want to have results before people become infectious to chase the infection chain quicker than it spreads. That means contact identification and test results in the order of 1-2 days (the faster the better but with peak about 3-8 days after infection you want to be on the lower end). Right now this strategy is not feasible since there are just too many cases coming in. Therefore this calls for a hard lockdown until the case rate is manageable again. Since the lockdown is not going to happen it will continue to spread till the hot zones burn out. Getting to herd immunity without overloading the hospitals is unlikely and would probably take years. Therefore overloading the hospitals is inevitable now. The difference between hospitals overloaded by a factor 3, 10, 100 does not seem so very big since you can't care for most patients anyways. Overloading heavily on the other hand has the advantage that it might be over soon and you are done with it (or maybe not, we don't know how long lasting immunity is and how many people will have serious health problems afterwards). So in summary: We are probably beyond the point of no return and whatever happens will happen. I wish you all and your loved ones good health and good luck.
I find it interesting how daily new deaths in Sweden seem to have levelled off to a low level. Of course there could be a second wave in the fall, but I think Sweden might have reached the low herd immunity threshold.
What I'm wondering is why it seems to have levelled off despite case numbers being wildly different in different regions of Sweden. Are people's habits different, leading to very different thresholds for herd immunity? Are reported case numbers off? Something else?
The point is that if they administered tests daily at the daily capacity for testing (24h result turnaround) then many people who want to be tested would be turned away, and become aware immediately of the testing bottlenecks.
It’s a form of bufferbloat.
I sometimes wonder how many fewer USians would have died in this pandemic had it occurred outside of an election year.
I don't think there's any need for a deliberate conspiracy here; hard capping the number of tests at exactly the daily capacity would require quite complicated real-time feedback between the multiple sites taking samples and the labs processing them, and would be worse in that it couldn't prioritize cases which need test results most urgently. This problem isn't unique to the US either; back when the press in other countries was pointing to Germany's testing program as proof their country was falling behind, I even had a conversation with a German on here who was convinced their testing was the failure because of similar delays.
People would be mad about it, but it would be reasonably straightforward to discard samples that were not urgent (so that testing for urgent samples remained prompt and available).
There also seem to be some utilization problems. Some folks I know got tested after 1 person had enough symptoms. The person with symptoms got sampled several days before 3 other people and got their result last, probably because of which lab was used.
Yes, my question admits that it is inevitably a factor.
But the incompetent response was incompetent because it was incompetent, not because a sensible electoral strategy was pursued ahead of pandemic control.
As things play out, responding incompetently and saying nice things about the economy looks like a really bad strategy through the electoral lens.
> But the incompetent response was incompetent because it was incompetent, not because a sensible electoral strategy was pursued ahead of pandemic control.
I don’t think this is an either/or situation. If incompetence and corruption is on the menu this administration seems to always take two scoops, one of each.
There should be zero doubt about it. Republicans are desperate to have the economy going again only because it is such a strong factor in elections. As Bill Clinton famously said, "it is the economy, stupid."
(Indeed, the economy is the only issue/criteria in which Biden still trails Trump in polls, but even that margin has been decreasing.)
This relentless push to reopen things has resulted in many, many more deaths.
Considering that most of the deaths are among the elderly population who tend to vote republican, that doesn’t make much sense.
Unless you want to get really cynical and say there was a political motive in Democrat governors for sending positive patients into nursing homes and causing most of those deaths...
If true, this would mean that Republican senators and governors who aren't up for reelection in 2020 should be strongly pro-shutdown. Is that the pattern we're seeing?
> I sometimes wonder how many fewer USians would have died in this pandemic had it occurred outside of an election year.
The time to judge the different strategies has not come yet. At the least, we need to wait until the pandemic is over and the counts are in. I don't trust any count until somebody takes a good look at the excess mortality. Right now it's just way too easy to manipulate the numbers in any direction until your hospitals overflow (and even then, the press might not report it). The real case numbers may be off by a factor of below 2 or over 10 and immunity in the population may already exist due to other corona viruses or maybe not, we don't know yet. Other counties which seem to be doing very well until now may still fail horribly. The economic impact may play out in vastly different ways. Currently it seems that hard containment is the best strategy but it requires coordination in a large area and high compliance in the population. In a few months, the vaccine could be available any day and it might work perfectly or very poorly.
Sweden seems to get it under control now. Cases and deaths are falling quickly. In the beginning they made some big mistakes (in retrospect) but now the strategy seems to work (for now at least, we will see in a few months when the people get tired and want to return to normal life).
OZ has a problem.
NZ is in a similar situation as VN where a local transmission appeared today without known infection chain. It only takes one error and you're back to square 1.
> Sweden seems to get it under control now. Cases and deaths are falling quickly.
The death rate has been declining pretty much linearly since April. Restrictions were lighter than pretty much everywhere else in Europe, and have been successively loosened since they were implemented in March.
But your comment implies that Sweden is "doing something" recently, and that there haven't been any results until recently either.
And neither of that is true.
> we will see in a few months when the people get tired and want to return to normal life
Uh, it already is pretty much normal. There are signs everywhere reminding people to keep distance, restaurants have fewer tables than usual, and large gatherings are still banned, same as everywhere else. There never was a "reopen" debate in Sweden, because there wasn't really anything to reopen.
But the media image of Sweden is incredibly distorted right now, it's pretty fascinating to watch what happens when a country goes against a major news narrative.
I'm not IN Sweden, so I only have the media image.
Can you comment on what measures have brought down the infection numbers? Why were they so high in the beginning and why are they falling so quickly now?
After implementing measures it can take a few weeks to show results since detected cases can lag a lot behind actual infection events and there's local transmission chains (inside families/communities) that need to burn out before case numbers fall.
Also speaking of measures, to my knowledge, the government did not take hard measures but rather suggested a lot of the same things that other countries put into law and the Swedish population is very compliant. So it is hard to make an apples-to-apples comparison.
> Can you comment on what measures have brought down the infection numbers?
Working from home, banning large gatherings, remote education for universities and secondary schools, reminders to keep the distance, table service only at restaurants and more space between tables.
> the infection numbers?
Sweden, like pretty much every other country, has no idea how large the number of unknown infections were back in March and April. The only certain numbers we have are ICU patients and deaths, and those have been declining constantly since mid-April. Presumably, actual cases follow the same curve.
> Why were they so high in the beginning
Exponential growth before any measures were taken.
> why are they falling so quickly now?
They're not falling quickly now, deaths and ICU patients have been falling linearly since mid-April. Death curve here: https://adamaltmejd.se/covid/
As to why, my best guess is that this virus simply wasn't much different from any other flu virus. A bit more deadly, but whatever measures people in Sweden took was enough to curb it. Also, herd immunity is probably much easier to achieve than earlier models suggest.
> After implementing measures it can take a few weeks to show results
Yes, and actual analysis of mobility shows that people voluntarily took a lot of measures before actual recommendations were put into place. Same as everywhere else. Most EU countries implemented their lockdowns weeks after the peak.
> Also speaking of measures, to my knowledge, the government did not take hard measures but rather suggested a lot of the same things that other countries put into law and the Swedish population is very compliant.
Yes. That said, mobility dropped less in Sweden compared to neighbour countries who had stronger recommendations and rules in place. You can compare the mobility curves between countries at the bottom of this page: https://covid19.healthdata.org/sweden
> I'm not IN Sweden, so I only have the media image.
I'm sorry, the media image is absolutely bananas. I have never seen such blatant bias to skew everything to make Sweden look like a zombie apocalypse to drum up support for lockdowns. But it looks like lockdowns are much less effective than people think. And it looks like a small amount of meaningful measures pushed the effects of this down to less than a regular flu season.
Unmitigated, it would have been worse, but it's been mitigated everywhere, and here we are.
I’m not sure that we could call the disease ‘mitigated’ in many places, it has been devastating.
Have you got any sources on the “less than a regular flu season”? Sweden seems to have had a lot more deaths than it normally does and I haven’t seen anything saying otherwise - however you clearly have.
> Sweden seems to have had a lot more deaths than it normally does and I haven’t seen anything saying otherwise - however you clearly have.
Most countries experience excess deaths during flu season, and some flu seasons are worse than others. Sweden absolutely had excess deaths for a couple of months this year, but you have to look at the bigger picture.
Now, 2020 isn't over yet, there might be a second wave of covid-19 in the winter, but given how the virus has died out with the small amount of measures taken, I don't think that's very likely. So far, 2020 in Sweden is tracking below average total deaths, even if you include all the covid-19 deaths.
If this year was "devastating", then what would you call the flu season of 1988, 1993, or 1999? Those flu seasons saw higher excess deaths than 2020 in Sweden, and no-one noticed or cared. No news articles, no reports, no lockdowns, no face masks, no travel closures, nothing. We did nothing out of the ordinary.
Now, covid-19 is more lethal than the viruses of those flu seasons, and we have no vaccine for this one, so some response is warranted. But the current worldwide hysteria is unprecedented, we have never before cared this much for this few deaths.
Corona started when the flu season normally ends and it seems that summer with the majority of activity outdoors has quit some damping effect on the spread. We will have to live through the winter till next spring to do a comparison.
If you want to compare COVID-19 with the flu I think that the data so far suggests that letality rate is about 10 times higher and the number of infections is also about 10 times higher due to lack of immunity from previous infections.
I don't say that the "normal flu" is harmless, either. Nor that COVID-19 is like the plague or "harmless" like the flu. Nor that we should simply do nothing when the next infection wave comes.
It's a respiratory virus, it spreads through droplets, the symptoms are very similar to those of influenza, and the demographics of the people dying of this virus are very similar to the demographics of the people who usually die of influenza. The IFR seems to be a little bit higher than that of recent influenzas.
No, it's not a flu virus, but it's definitely comparable. This thing looks nothing like ebola or measles or herpes, for example.
Here's an interesting article saying that people compare counted covid-19 deaths to projected/estimated flu deaths, and when you do a more apples-to-apples comparison, it looks like covid was killing people (in the US in April) at about 20 times the peak rate of flu in a typical season.
"On average, the CDC estimates of deaths attributed to influenza were nearly 6 times greater than its reported counted numbers. Conversely, COVID-19 fatalities are at present being counted and reported directly, not estimated. As a result, the more valid comparison would be to compare weekly counts of COVID-19 deaths to weekly counts of seasonal influenza deaths."
Ok, it's 20 times as deadly if you count in this weird fashion.
The reason the influenza attributions are estimated higher than actual counts is because we know we're systematically underreporting influenza deaths. It also doesn't look like the US is underreporting covid-19 deaths to the same degree, so saying that the reported numbers are equally true for both diseases doesn't make sense when we know one of them is more underreported than the other, right?
Cause of death is also not an exact science, did a patient die from something or with something? Which something actually killed the patient? All of it? Some of it?
The only 100% true statistic we have is total all-cause deaths. I posted a link above that graphs total deaths per million per month going back 40 years for a couple of countries, and 2020 does not stick out in any way, shape, or form. The excess death spikes from covid-19 looks very similar to excess death spikes during regular flu seasons.
If it's 20 times as deadly, why isn't that reflected in the all-cause deaths?
> If it's 20 times as deadly, why isn't that reflected in the all-cause deaths?
How many people already had it in Sweden? About 5%? And how many will get it until herd immunity is reached? About 70%? Then it seems that it will probably come back next winter and probably with force. What we've seen this spring and summer may only be a tenth of what's about to come.
Those numbers are only some estimates and we don't know for sure but time will tell.
The "70%" herd immunity number is something someone pulled out of their ass in the early days. Recent studies show widespread T-cell immunity, and together with how a virus infection selects people for immunity (it's not the same distribution as a vaccine campaign), it seems that when 10-20% of the population has had it, that's enough for very strong community resistance, causing the virus to die out.
> What we've seen this spring and summer may only be a tenth of what's about to come.
How?
We've gotten better at treating covid-19 as the months passed, we figured out that ventilators was a pretty crap treatment, and instead figured out that oxygen, steroids and blood-thinners worked much better.
A large part of the population has already had it and built up immunity to it, and because of how a virus spreads through a population, the best spreaders are usually hit first.
The population that died from it were mostly the old and frail and at-risk, and we've gotten better at protecting them with time as well.
When we were unprepared, this thing killed less people than a regular flu season does. Why would it suddenly kill ten times as many people, now that we are prepared, and now that a significant part of the population is immune? What possible chain of events could lead to that outcome? Magic?
> The "70%" herd immunity number is something someone pulled out of their ass in the early days. Recent studies show widespread T-cell immunity, and together with how a virus infection selects people for immunity (it's not the same distribution as a vaccine campaign), it seems that when 10-20% of the population has had it, that's enough for very strong community resistance, causing the virus to die out.
Granted, the 70% number is based on an R0 of 3.5 and homogeneous transmission. It's probably lower than that in many cases. In some cases it like prisons or close contact workplaces or other close contact activities it's going to be even higher as some incidents show.
The T-cell immunity is something we don't understand very well yet.
I hope that only 20% of the population will be enough to stop it, i really do, but right now i don't think it's very likely. We may have the first solid data points after the winter.
Yes, we get better at treatment and protective measures. As long as the hospitals are not overrun this may lower the fatalities a great deal. In Sweden it's looking quite good right now. In some areas in the US not so much for the coming weeks. When the hospitals are overrun, you can't help much and the fatalities will increase a lot.
Until next summer I will not judge which strategy works best. But I'd rather err on the safe side health wise and advocate for stronger protective measures even if it may mean a higher economic cost (that won't crash the economy completely). If we err on the wrong side, we could lose both, health and economy at the same time. After the numbers are in, we can say with hindsight what would have been the best course of action.
> NZ is in a similar situation as VN where a local transmission appeared today without known infection chain. It only takes one error and you're back to square 1.
That's the problem with the NZ model of draconian lockdowns. Of course it can work, but only temporarily, and you can't stay locked down forever. I doubt the people of New Zealand are prepared to lock down over and over again every time the virus re-emerges.
The Swedish model is one that people can live with for long periods of time.
> NZ is in a similar situation as VN where a local transmission appeared today without known infection chain. It only takes one error and you're back to square 1.
Could you clarify this? I wasn't aware of any local transmission for months but I suspect an 'if' is missing from your sentence.
I think that a full breakout takes a lot more than one error and it requires a whole chain of them and a lot of systems to fail. We have had errors like this.
The battle now seems to be keeping those quarantine contained. There are near daily escape attempts and some are going to public places or covering significant distances.
I presume the comment you're replying to is referring to this case in Vietnam today: https://www.nytimes.com/2020/07/25/world/asia/coronavirus-vi... Elderly guy with no travel history who rarely even left his home and has no ties to any known potential source of infection, only discovered as a result of him being hospitalized - everything about this strongly suggests that containment has already failed and Vietnam just hasn't realized it yet. (Also, they waited a whole week after he was hospitalized and tested positive before publicly admitting that this had happened? Ouch. Most recent public social interaction prior to symptoms was visiting a hospital? Double ouch. I really hope this doesn't say what I suspect it does about what's happening in Vietnam right now.)
The WHO reports that transmission from animals is known to have occurred among some mink farmers. Whether it can be transmitted from common domestic animals is unknown, although dogs and cats can definitely be infected.
The one error is the spark that starts the forest fire. Yes, the forest needs to be dry. But we don't want to carry all the water every day to keep it wet.
The case here https://ncov.moh.gov.vn/ on "11:00 25/07/2020" seems to be a local transmission if the google translation is correct. The infection must have happened two weeks ago and they are currently contact tracing. Taking an average of 4 days, we are now on generation 2-3 of follow-up cases (or even more if the infection source/chain is older and has been spreading for a longer time). Let's hope that nobody else got infected and there are no asymptomatic patients running around by now, unaware that they are spreading it all over the country.
Taking an R0 of 3 (since they don't have any hard measures right now), we are currently expect 3 * 3 * 3 cases if this person somehow got it from out of country. Finding those cases could take a bit of time and then we would look at 3 times more cases to find every 4 days. Assuming that some youngster got it and this older person is the first one to go to the doctor we could easily have 3 * 3 * 3 * 3 * 3 * 3 = 729 cases by now and that would probably already be out of control without instating a hard lockdown on all possibly affected regions and testing the whole population like China did.
> NZ is in a similar situation as VN where a local transmission appeared today without known infection chain. It only takes one error and you're back to square 1.
Citation? I'm not seeing it on any of the usual NZ news sites, and I rather suspect it would be big news.
edit: oh, i see, I've misparsed your sentence. VN is where the local transmission occurred, not NZ. nevermind.
Even in a place like Oregon which seems fairly well managed, we have major test shortages. It just seems to me that the first benchmark should be if we have enough test availability (some combo of more tests and less infections) to be able to get results with 24 hours of symptoms, so we can effectively contact trace. If we don't have that, then all this Phase1 Phase2 stuff just means that you're increasing the epidemic. But here in Oregon, all the counties are in Phase1 or Phase2, none of them are in the "Baseline" lockdown phase. Shouldn't we all be in the Baseline phase until we have enough test availability?
I'm betting there's a good answer, like maybe the amount of test availability Oregon has is dependent on the rest of the nation. Like, if our epidemic goes down 90%, maybe our test availability will go down 90% anyway because other states will get further prioritized.
But anyway, it seems like that should be the basic standard nationwide. Lock it down until you can get test results within 24 hours, and then only slowly open it up while proving you can keep that test availability - if you can't, freeze or go back.
I work for a big institution that includes a massively funded hospital network. I don’t actually work for the medical part of the institution. I am technically deemed an essential worker because we have servers on-site.
Recently I had some minor symptoms and wanted to get a test. By going through my employer’s employee testing process I
A) got a test scheduled for the same day I called
B) got my negative result under 12 hours later
This was a transformative moment for me in recognizing that there is an intentional, and centralized project to stress testing capacity in the United States. There is no shortage of materials or staff, just funding for lab capacity. This is an incredibly solvable problem that our leaders are choosing not to solve.
I truly believe the future historical narrative of this moment will cast our elected leaders as the orchestrators of mass genocide. It’s hard to consider living, breathing, contemporary people who hold esteemed positions to be on the level of evil as historical Nazis. But as time passes and we consider the impact their choices are having, it will both become easier to cast them in such a light, and to question the passivity of a population that accepts their decisions. It has never been more clear to me how such atrocities can happen and at the same time become normalized.
so you are saying that test results are intentionally being delayed?
i am not a fan of this administration and feel there is plenty of blame to go around but i would love for more insight on why you think there is some intentional malice happening...
While a wait time of 19 days is much too long, the connection drawn by the article to the CDC recommended 2-week quarantine ("That’s five days longer than the quarantine period of two weeks recommended by the CDC") is spurious. That's the time in which the virus is expected to present, not the point at which it's okay to leave your home regardless.
From the CDC article which they link right there, "[q]uarantine helps prevent spread of disease that can occur before a person knows they are sick or if they are infected with the virus without feeling symptoms."
Even in places that are willing to accept some amount of spread, testing allows people to make informed decisions before doing particularly risky things. I have friends who for example take a test just before visiting their grandparents - if we lived in an area with week-long turnarounds, they wouldn't be able to do that, and would have to choose between a significant risk of infecting them or leaving them isolated for months on end.
Because the official government policy is "just deal with it" and proper testing isn't compatible with that policy. Essentially the test is a fobbing off measure.
Sorry but i didn't get claims about lack of public investing in healthcare.
Why when i am already paying like 500$/mo for insurance and making one physical in a year at most. Also during this physical i asked about help with my panic attacks and was told "well we don't have capacity at all for this, you will wait for ~month for your visit and it won't be useful since they are not going to have enough time to look at you". And this visit would be paid.
May be AHA shouldn't limit number of doctors educated to make it available to public? Money is clearly not an issue.
Spending is not synonymous with investment. Around half of your money is going to middlemen - think about how many people have full time jobs deciding what to charge, coding it, shipping invoices around, etc. not to mention trying to figure out how to profit as much as possible? How much goes to emergency care because preventative care is not covered and healthy lifestyles are actively discouraged by public policy?
None of that is going to medical professionals, infrastructure, or research. We pay considerably more than anyone else per-capita but that’s waste: as far as outcomes go we rank much lower than our peers.
This is also interesting when you compare tax rates: Americans pay taxes + insurance at a combined rate around “expensive” countries like Denmark but we don’t get anywhere near as much for our money.
You’re right! Only about 20% of healthcare spending goes to physicians and half of that does to practice expenses like malpractice insurance. So even forcing physicians to work for free wouldn’t do very much to lower healthcare prices.
I think it’s reasonable to discuss lowering of standards - not all doctors do the same kind of work so we shouldn’t hold them all to the same high-standards that coincidentally place, what I feel, are unreasonably high barriers to entry to working as a doctor in the US.
For example, I understand that (and please correct me if I’m wrong) that all foreign-trained and foreign-qualified doctors regardless of age, experience, and position (and country of origin, country of education, etc) have to go through the same rigorous process as a fresh-faced med-school grad in the US - even though most US doctors would fail the same process if they were also 5+ years out of med-school.
Personal anecdote: my sister is a GP in London. I asked her if she’d ever consider working here in the US and she said she considered it but she didn’t want to spend a full year or more having to re-qualify from scratch, despite her professional qualifications and experience (she has her medical masters from LSHTM and is a published researcher with her papers in the US’ PubMed).
We have international portability of licensing for drivers licenses - and many places allow for portability of professional engineering licenses too - it seems arbitrary (if not outright protectionist) to not have some degree of medical license portability in the US.
They’re getting their misinformed rants wrong too - the usual theory is that the AMA (not AHA) is restricting the supply of doctors which isn’t true and hasn’t been for ~25 years. There’s a literal budget line in the Medicare omnibus that could double the number of residents trained every year.
Do you mean a physical visit (as opposed to virtual), or a regular physical exam? There's good evidence to suggest that there's no reason for healthy adults to receive a regular physical check-up.
I'd also like to remove the artificial limits on the number of doctors, but I don't see how it would help in this case. This delay is in the labs, not the doctors' offices.
Not only the time frame but it seems like all the tests have significant false + and false - results.
I don't see any benefit from being tested at this time.
I definitely don't want to spread the virus if I'm positive or be around people who are positive and can spread it to me but the time frame and false +/- results, testing doesn't seem viable to provide any actionable knowledge.
I think we'll see the limits of what testing can do to prevent the spread of the virus with the start of NFL training camp/season.
Without knowing the base rate for a community isn’t specificity and sensitivity like a numerator without a denominator?
“Roche’s SARS-CoV2 antibody test, which has a specificity greater than 99.8% and 100% sensitivity3 (14 Days post-PCR confirmation), can help assess patients’ immune response to the virus.”
We are in this mess fully because of trump. It’s unfortunate we have a president that has no empathy for people and is constantly fanning the conspiracy theories as he also doesn’t believe in science. But finally he seems to have realize it’s bad for him so he might actually try to listen to his scientists for a day or two.
Given people are already so predisposed to their theories not sure how many people actually will listen without a full lockdown. Also it’s highly unlikely the red states will lockdown ahead of the election and go against trump. We are in a real mess. The pessimist in me is thinking we will probably have to really solve it after the election it if trump wins probably never until we get a vaccine.
Without contact tracing, there's an argument that tests don't give you much actionable information. If you're sick, you'll (hopefully) self-quarentine anyway. If you're sick enough to go to the hospital, you'll go anyway and be presumed to have covid. If you feel healthy, unless you're being tested because of your job, you probably aren't going to get tested.
The case that's somewhat interesting is the one in article where someone might have gotten people sick at a party.
The tests helped my wife make a decision. She and I slept through most of one weekend (very unusual) and had mild congestion and headaches. However, calling off work for two weeks would've been difficult for her. She works at a daycare where staff have been leaving one after another. And the daycare doesn't give paid sick days. (I still insisted she stay home until the results came in 2 days later). We had to go with likelihood of being a spreader instead of getting to play it safe.
positive test probably goes a long way towards allowing people at minimum wage / hourly style jobs to call in sick without risking their jobs. Although they are likely forced to go to work without telling anyone as they lack sick leave and cannot afford a missed paycheck.
Clearly, the reporter didn't really want the question answered because three points come to mind, immediately.
1) Testing of corpses and blood samples thereof. The CDC recently changed its guidelines for cause of death determination to be "if it looks like COVID, just mark it down as COVID." Being able to test corpses, who are in no rush, could help more accurately pin down mortality rates.
2) Knowing that you are not likely to catch it again, or, alternately, are still at risk. Yes, I know there's some debate as to whether or not you can catch it again due to declining antibodies. I am not believing that at current.
3) Being able to use antibodies cultivated from patients who have recovered in those who are currently quite ill. That's a common enough concept, cheaper than cultivating monoclonal antibodies.
The complete lack of leadership and resulting power vacuum resulted in valuable time lost bickering, blaming and thumb twiddling that could have gone towards preventing the second wave. This is a community spread at this stage and another hundred thousand people are all but guaranteed to die. It‘s mindblowing.
Here in Germany, I‘m getting my test results within 3 days via SMS (usually same-day for positive results) and can enter it into an app to warn others.
Everybody wears a mask indoors and nobody but a very small minority complains. Social distancing is enforced by usually friendly police which the people mostly trusts to do its job.
It‘s just so sad to see how personal „freedom to choose“ turned into the achilles heel of one of the formerly greatest nations on Earth.