Coronavirus - worldwide spread and control

[Jonathan Edwards]

So I think we pretty much have it on record that herd immunity was the government’s primary aim.

I don't think what Vallance says puts herd immunity as the primary aim. It is a part of the mechanism they hooped would unfold but a relatively minor part. I think it has been latched on to when it is not the main issue.

The primary aim was to avoid the severe lockdown that was assumed would be needed to have any home of keeping infection rates low enough to track and keep genuinely under control - essentially a sociopolitical aim to avoid upsetting people of in the business world and to avoid expected social unrest. The hope was that the epidemic could be allowed to run its course without too much damage in short enough time to preserve business interests. Herd immunity would have helped a bit but in reality not that much since it would only kick in at about 80%.

Or put more simply the aim was to allow almost everyone to get infected, with the vague hope that the elderly and vulnerable could hide away for long enough to manage to escape infection.

 

[ME/CFS Skeptic]

20% of positive cases will test negative (based on studies of the tests used in China, but similar results elsewhere)

I've found these two studies comparing chest CT scans to PCR tests, with the latter showing greater sensitivity, in about 1000 Chinese patients.
https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200642

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200432

Do you happen to have any other decent studies on the sensitivity of PCR testing for COVID-19 at hand (or anybody else)?

 

[Barry]

https://www.theguardian.com/world/2020/mar/13/herd-immunity-will-the-uks-coronavirus-strategy-work

The government’s “nudge unit” seems to favour this strategy. Dr David Halpern, a psychologist who heads the Behavioural Insights Team, said on BBC News: “There’s going to be a point, assuming the epidemic flows and grows, as we think it probably will do, where you’ll want to cocoon, you’ll want to protect those at-risk groups so that they basically don’t catch the disease and by the time they come out of their cocooning, herd immunity’s been achieved in the rest of the population.”

Dr David Halpern, a psychologist ...

 

[Sasha]

Surprising...

 

[Barry]

Surprising...

Bearing in mind the y-axis is logarithmic, so the shapes of the graphs makes the numbers look much more benign than they really are.

 

[ME/CFS Skeptic]

Today´s numbers from the Robert-Koch-Institute (I though looked today in the morning and got older ones) are

confirmed cases: 67.366 ........ (+5.453)
deaths: 732 .............................(+149)
death rate: 1.1%

Yes the CFR has been rising in Germany and it now seems to have passed 1%. The same is true in South-Korea where it has now passed 1.6%. About two weeks ago Ioannidis highlighted the low CFR in these countries, namely 0.2% and 0.7% (at the time). Things can change quite rapidly!

 

[Mij]

So would that be like the chickenpox virus that can reactivate to cause shingles yrs later, or am I displaying my ignorance lol?

I heard a few infectious disease doctors say that once we get infected (produce antibodies) and recover, then we can't get reinfected. But who knows? It's a new virus.

 

[Snow Leopard]

I heard a few infectious disease doctors say that once we get infected (produce antibodies) and recover, then we can't get reinfected. But who knows? It's a new virus.

It's not a "new" virus, it's simply a novel variant of known viruses. We know from SARS and MERS that immunity is maintained for a few years at least.

 

[wigglethemouse]

I'm wondering, everybody is talking about ventilators.

From what I understand, that's for the most severe cases.

When I read the first stories and papers coming out of China a month or so ago, I seem to remember them saying ventilators were not that effective as the virus had caused changes in the lungs so oxygen couldn't be absorbed well. What made the difference was ECMO.

ECMO stands for extracorporeal membrane oxygenation. The ECMO machine is similar to the heart-lung by-pass machine used in open-heart surgery. It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest. When you are connected to an ECMO, blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into your body.

Source : https://www.ucsfhealth.org/treatments/extracorporeal-membrane-oxygenation

Since the virus has exploded in Europe and the US I have not heard anything about ECMO and I have no idea why that is??????????????? Anyone know?

The figures I saw quoted today in the US was that 80% of COVID-19 patients on ventilators die. I don't know if that is true or not, but if it is, shouldn't we also be using ECMO?

 

[shak8]

How Taiwan handled the virus. We didn't hear much about it because China has forbidden mention of it, and they clout at WHO.

http://www.dailymirror.lk/opinion/I...-to-COVID-19-possible-in-Sri-Lanka/172-185720

 

[Trish]

I tried the video, @shak8. It won't run. It says it's private.

 

[spinoza577]

Yes the CFR has been rising in Germany and it now seems to have passed 1%. The same is true in South-Korea where it has now passed 1.6%. About two weeks ago Ioannidis highlighted the low CFR in these countries, namely 0.2% and 0.7% (at the time). Things can change quite rapidly!

That the death rate is rising could mean two things, if I am not wrong:

• the virus now spreads more under vulnerable people
• the virus spreads faster than the testing is detecting positive cases

Until now it seems that Korea (wearing masks) and Germany (wearing no masks) had a comparable outcome, death rate wise. This may be from massive testing.

But now it may become to differ. What could it mean, that masks were slowing down the death rate?

I am still hoping that the amount of the first viral loads one has taken up is a parameter. This would go along - if it turns out to be so - that countries without a slowing down procedure (Italy, UK and others) had a worse death rate. It might though be not the case.

 

[Adrian]

We are getting 30 ventilators next week, according to BBC news. (The NHS says they need 30,000). Even the newsreader seems pretty shocked..

It always seemed naive to think that someone could just come in and manufacture thousands of ventilators. Even with a design already done or being adapted it will take a while to get a production line up and running and to get quality up.

The next issue seems to be a lack of oxygen.

 

[Marco]

Mass testing as per the WHO guidelines may not be feasible for many european countries :

EU countries unable to follow WHO's call for mass testing

As many other European countries face testing shortages, some health authorities across the continent believe that those who do not show any symptoms have no reason to be tested - even if they have been in contact with an infected person.

https://euobserver.com/coronavirus/147830

and may not be currently desirable :

Germany Reaching the Upper Limit of Testing Capacity

There is a danger that the lack of reagents could soon mean that fewer tests will be available than there are today. Meanwhile, the number of infections is expected to continue increasing.

To manage the looming shortage, lab operators have called for an even stricter decision-making process for who gets tested and who doesn't. Only people who are at risk or showing symptoms should be tested, they argue. "At the moment, we're still testing way too many healthy people," says Borucki. Well over 90 percent of the tests evaluated by Bioscientia come back negative. "We're wasting valuable reagents."

Perhaps time for less emphasis on numbers and more on intelligent use of testing? :

Because testing capacity is now reaching its limits, "intelligent testing" is necessary, says Hoelscher. "Police officers, fire fighters and especially people in the health-care industry are regularly in contact with at-risk patients. There we have to be as sure as we can that these people are not infected."

The rest of the population should only be tested when they exhibit strong symptoms that require hospital care, Hoelscher says. "Those that only have mild symptoms should please stay home and not demand a test."

https://www.spiegel.de/internationa...pacity-a-4d75e7bd-dd0e-41e3-9f09-eb4364c43f2e

 

[spinoza577]

Perhaps time for less emphasis on numbers and more on intelligent use of testing?

More intelligent because of limited resources. The massive testing itself will hardly have been wrong, in terms of understanding and assessment, as well as in terms of dealing (comparing the outcome of countries having done massive testing with other countries).
---
Virologist Hendrik Streeck is carrying out an evaluation in Germany, Heinsberg, an area having been highly affected early on. Investigating how many people of the population have already been in contact with the virus, using some antibody test. They think also to get some information about how the virus may have spread (family, asf.). Sample size is 1500.

(Information from TV)

 

[FMMM1]

I've found these two studies comparing chest CT scans to PCR tests, with the latter showing greater sensitivity, in about 1000 Chinese patients.
https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200642

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200432

Do you happen to have any other decent studies on the sensitivity of PCR testing for COVID-19 at hand (or anybody else)?

I think I recall that in China they discovered that the scans (CT?) could be used to quickly diagnose people --- 20 minutes? So when you turned up for testing they immediately scanned your lungs. As @Jonathan Edwards said images from scans of people who have coronavirus, and have begun to develop lung problems, are very characteristic. If your weren't diagnosed via the scan then presumably they took the nasal/throat swabs for the PCR/antigen test and 8 hours later the results from the test were available. If the results of the scan, or PCR/antigen test, were positive then you didn't go home - you were quarantined.

Scans presumably won't pick up people who haven't developed lung problems to some extent.

PCR/antigen test presumably have sampling errors (don't swab properly); don't know how accurate the Chinese PCR/antigen test was but that's also a source of error ---. So if there's scan data, and PCR/antigen test data, then that would be interesting i.e. is the PCR/antigen test missing some of the people diagnosed via the scan?

 

[Marco]

More intelligent because of limited resources. The massive testing itself will hardly have been wrong, in terms of understanding and assessment, as well as in terms of dealing (comparing the outcome of countries having done massive testing with other countries).

Not necessarily. There are negative consequences where you have a relatively small percentage of the population currently infected and a test with an approximate 10% error rate.

Imagine quarantining 10% of healthcare workers due to false positives or conversersely releasing 10% of infected cases back into the community due to false negatives.

A hypothetical example :

The perils of mass coronavirus testing

https://www.aei.org/articles/the-perils-of-mass-coronavirus-testing/

 

[Leila]

It always seemed naive to think that someone could just come in and manufacture thousands of ventilators. Even with a design already done or being adapted it will take a while to get a production line up and running and to get quality up.

The next issue seems to be a lack of oxygen.

Our health minister kept on saying that he has ordered 10.000 ventilators in press conferences - as if that means anything until he actually has them delivered.

Everybody is ordering them now.

How are companies going to decide who will get them? The highest bidder? The country that needs them the most?

I was wondering about oxygen, too when the demand now is so high.

 

[FMMM1]

Not necessarily. There are negative consequences where you have a relatively small percentage of the population currently infected and a test with an approximate 10% error rate.

Imagine quarantining 10% of healthcare workers due to false positives or conversersely releasing 10% of infected cases back into the community due to false negatives.

A hypothetical example :

The perils of mass coronavirus testing

https://www.aei.org/articles/the-perils-of-mass-coronavirus-testing/

As @Jonathan Edwards has said this is a % game.

So if your 90% right, and R naught reduces to less than 1, then the outbreak cannot be sustained.

On the other hand sitting on your ass and doing nothing, since the test isn't 100%, well you can see the results in the UK.

Presumably you'd also pick up the positive health care worker*/positive member of the public via contact tracing --- oh if you did it!

*EDIT: The chances of two consecutive tests giving false negative (if the test is 90% accurate) would be 0.1 X 0.1 i.e. 1 in a hundred.

 

[Cheshire]

Asian countries face possible second wave of coronavirus infections

Daily numbers of confirmed cases rising again as people rush home to beat border closures

Asian countries that started to feel tentative hope that their responses to the coronavirus pandemic were bearing fruit are now facing possible second waves, brought by a rush of panicked people racing home to beat border closures and quarantine orders.

As daily numbers of confirmed cases start to rise again, and new evidence of asymptomatic cases spark fear of unwitting community transmission, many have now brought in far stricter measures.

https://www.theguardian.com/world/2..._medium&utm_source=Twitter#Echobox=1585817265