Coronavirus - worldwide spread and control

[Arnie Pye]

I don't know what Farr's law is.

It is described in the article/blog. I had never heard of it either.

Fact #14: There is a predictive model for the viral arc of COVID-19, it’s called Farr’s Law, and it was discovered over 100 years ago
Dr. Lass, in his interview highlighted above, also made a point that we already knew, long before the lockdowns, how COVID-19 was likely to behave because, well, we’ve been dealing with new viruses since the dawn of man:

If you look at the coronavirus wave on a graph, you will see that it looks like a spike. Coronavirus comes very fast, but it also goes away very fast. The influenza wave is shallow as it takes three months to pass, but coronavirus takes one month.

...

 

[Jonathan Edwards]

Well, JB Handley, if you look at Worldometer you can see that no country has followed Farr's law so it does not apply!!
No point in remembering a law when the real facts are sitting your desktop.

 

[lunarainbows]

Thread

 

[JaneL]

There isn't reasonable evidence that there are any "asymptomatic" cases at all. I suggest such assumptions based on poor test specificity.

The recent paper (not yet reviewed) might be worth a look:

The contribution of asymptomatic SARS-CoV-2 infections to transmission - a model-based analysis of the Diamond Princess outbreak
Status: Paper under peer review | First online: 06-05-2020 | Last update: 06-05-2020
Authors: Jon C Emery, Timothy W Russell, Yang Liu, Joel Hellewell, Carl A.B. Pearson, CMMID nCov working group, Gwen Knight, Rosalind M Eggo, Adam J Kucharski, Sebastian Funk, Stefan Flasche & Rein M G J Houben*.* corresponding author

This study has not yet been peer reviewed.

Background: Some key gaps in the understanding of SARS-CoV-2 infection remain. One of them is the contribution to transmission from individuals experiencing asymptomatic infections. We aimed to characterise the proportion and infectiousness of asymptomatic infections using data from the outbreak on the Diamond Princess cruise ship.

Methods: We used a transmission model of COVID-19 with asymptomatic and presymptomatic states calibrated to outbreak data from the Diamond Princess, to quantify the contribution of asymptomatic infections to transmission. Data available included the date of symptom onset for symptomatic disease for passengers and crew, the number of symptom agnostic tests done each day, and date of positive test for asymptomatic and presymptomatic individuals.

Findings: On the Diamond Princess 74% (70-78%) of infections proceeded asymptomatically, i.e. a 1:3.8 case-to-infection ratio. Despite the intense testing 53%, (51-56%) of infections remained undetected, most of them asymptomatic. Asymptomatic individuals were the source for 69% (20-85%) of all infections. While the data did not allow identification of the infectiousness of asymptomatic infections, assuming no or low infectiousness resulted in posterior estimates for the net reproduction number of an individual progressing through presymptomatic and symptomatic stages in excess of 15.

Interpretation: Asymptomatic SARS-CoV-2 infections may contribute substantially to transmission. This is essential to consider for countries when assessing the potential effectiveness of ongoing control measures to contain COVID-19.

Full pre-print, supplementary material, and code used are all available.

Figure: A) Prior (blue) and posterior (red) probability distribution for the proportion progressing to asymptomatic infections. B) Prior (blue) and posterior (red) probability distribution for the relative infectiousness of asymptomatic infections. C) number of asymptomatic infections and symptomatic cases detected (dark red) and not detected (light red) in the outbreak. Error bars indicate 95% posterior intervals). D) Posterior probability distribution for proportion of transmission that is from asymptomatic individuals. Dotted lines show median and interquartile range.

https://cmmid.github.io/topics/covid19/asymp-transmission.html

 

[Snow Leopard]

The recent paper (not yet reviewed) might be worth a look:

https://cmmid.github.io/topics/covid19/asymp-transmission.html

That is a modelling study with far too many questionable assumptions.

No data were available on how many individuals that tested positive in the absence of symptoms became symptomatic after disembarkation

As such, it is important not to confuse pre-symptomatic and individuals who are deliberately not reporting symptoms (there is a strong incentive to do so if you wish to disembark!) with being asymptomatic.

Likewise, PCR tests are not foolproof, with contamination being a risk (which was a problem for the CDC tests initially too)
https://www.cbc.ca/news/canada/north/covid-19-false-positives-1.5555322

 

[Snow Leopard]

Well, JB Handley, if you look at Worldometer you can see that no country has followed Farr's law so it does not apply!!
No point in remembering a law when the real facts are sitting your desktop.

JB Handley is also a vaccines-cause-autism guy.

 

[mango]

There have been a couple of news articles recently in Swedish media about the aftermath in Italy, about people's "unhealed emotional wounds" and growing anger, the need to hold someone accountable for the fact that some of their elderly family members were denied medical care and died during the worst part of the crisis, back when there weren't enough ventilators or hospital beds for everyone who needed them.

I find it "interesting" how they write about Italy, compared to how they write about the corresponding situation here in Sweden.

The official message from the Swedish government, the impression I've been getting as a reader, has always been that "everything is under control, there are enough ventilators and hospital beds in the intensive care units", "everybody who needs medical care is receiving it", "no one is being put so low on the list of priorities that they aren't receiving the medical care they need" etc, despite the numbers of deaths rising.

At the same time, a few published opinion pieces, by among others a professor in geriatrics, have accused some Swedish doctors of euthanizing (actually they used the word "avliva" which is the word for when you kill/put animals down) desperately ill elderly patients with covid related symptoms in care homes; criticising doctors for refusing to see these patients in person but choosing to diagnose over the phone instead, which reportedly has often resulted in pallative care (morphine, sedatives, anti-anxiety and anti-nausea meds etc) and deaths, instead of the treatments recommended in the covid guidelines (profylactic anti-coagulants, antibiotics, intravenous fluids, oxygen, hospitalisation, ventilation etc). Here's an example of the replies the opinion piece have gotten.

In one of the news papers' written reporting of the Public Health Authority's live-streamed press conferences the other day it said that 50% of the covid deaths in Sweden so far has happened in care homes. (25% of the deaths have been people who had home care.) I haven't been able to find a written source for those numbers, though.

Recent news reports show 30% excess deaths in care homes on average in the country, while the number for Stockholm is 100%. The official numbers from the National Board of Health and Welfare is 40%.

According to SVT Agenda (a current events television program) last week, only 10% of the 1 739 people who died of covid in care homes got hospital care.

There have also been some official complaints regarding people with urgent need for intensive care due to other diagnoses (kidney disease, for example) who have had to go without due to the prioritisation of covid patients, even though apparently there were available intensive care beds.

Yesterday the Swedish newspaper SvD published an article (paywalled) with numbers clearly showing how suddenly, during the worst part of the crisis, much much fewer elderly people were getting intensive care. They also compare the numbers of people above 70 years old who receive intensive care in Denmark (49%) and Norway (30%), compared to Sweden (21%). They argue that this is because elderly people are not being prioritised.

I really hope there will be accountability here in Sweden too.

 

[mango]

So far the most repeated response by the Swedish chief epidemiologist Anders Tegnell, when faced with criticism, seems to be "In the fall we will know what countries were successful". It really irks me, because to me it sounds as if they won't even consider changing their approach, no matter what happens, regardless of the rising number of deaths and the constantly growing amount of data.

For example, judging by the Public Health Authority's actions (or rather lack of action) they seem to be aiming for herd immunity and concentrating their efforts along those lines (despite the obvious: no one knows the scientific facts about covid-19 immunity, so it's all just based on assumptions and speculations). However, when asked about it they deny that herd immunity would be their aim, saying that "herd immunity is simply a fact, the more people who have had the disease, the fewer are able to spread it." ...

Then they do a study on antibodies and are surprised by the result (7,3% i Stockholm, 3.7% in Västra Götaland, the region of Göteborg/Gothenburg which is Sweden's second largest city) which turns out to be way lower than they had expected based to their models: most recently around 20%, but just a few weeks ago they speculated that herd immunity of 40-60% could be reached in Stockholm in May... In interviews Tegnell chose to focus on the possible reasons why the result may be wrong (sample may not be representative, the number may have risen a lot in the 2 weeks since, maybe the tests aren't accurate enough, maybe not all those who have been infected have developed anti-bodies etc etc etc...).

Another Swedish study that was in the news yesterday reports that among people younger than 19 years nearly 8% have developed antibodies. Among people between 20–64 years old 7% and among people older than that around 3%.

In the light of that, I was very surprised to see some slightly self-critical comments by Tegnell in an interview today:

"Should we encounter the same disease, with exactly what we know about it today, I think we would land in doing midway between what Sweden did and what the rest of the world did. [...]
I think there is potential for improvement in what we have done in Sweden, quite clearly".

Unlike many other countries in Europe, Sweden chose a strategy that would limit the spread of the corona virus, while protecting risk groups. Not pushing it down as much as possible.

The strategy has allowed us to have a more open society.

But it has also caused the spread of infection in society, albeit at a lower level and even if the deaths have dropped, nearly 50 people still die in Sweden a day. And a total of more than 4,000 people have died in Sweden after being infected by the new corona virus.

State epidemiologist Anders Tegnell has constantly argued that Sweden had the most sustainable strategy, but he is now also self-critical. It is among other things the high death tolls that got Anders Tegnell to think about.

Have too many people died too soon in Sweden, so far?

- Yes absolutely.

And had it been possible to do something about it?

- Yes, that is what we might consider in the future if there was any way to prevent it.

"In the future"? Why not now, today? There's still time to take action to prevent further avoidable deaths! The numbers of deaths and infected still keep rising in large parts of the country, and there's plenty more we could be doing to try and stop that. Don't make it sound as if it's something inevitable that is going to happen no matter what. You have the power to make the necessary changes, today! Where's the sense of urgency?!

It really irks me that the news websites publish articles with big headlines on the days when the reported number of deaths are low, which usually happens on the weekends when there's a delay in data registration. It's really really misleading. For example last Wednesday there were 95 reported deaths, Friday 84, Saturday 45, yesterday 65 and today 74. On Sunday there were no reported deaths and immediately there were news articles with big headlines like "No deaths reported - has not happened since March 13". However, when the numbers rise dramatically again the next day, as expected (since the reported numbers in question never reflected reality), there are no headlines, or maybe there's just some sentence in the middle of an article saying something like "the numbers are no longer decreasing".

And if you check the numbers published by Statistics Sweden (a government agency) you can clearly see how the reported number of covid deaths for any given day keep changing over time, usually rising in the space of several weeks before they are final, sometimes by a lot (due to delays in registration of data etc). The misleading numbers keep getting all the attention, which in my opinion is a big problem.

And then they act surprised when more and more people stop following the recommendations about social distancing, travel restrictions etc...

 

[Snow Leopard]

As so many people appear to be asymptomatic

Further on the topic of "asymptomatic",

The Chinese authorities claim they have tested 9.9 million people in Wuhan!!! They claim 300 positive results, however they tried (and failed) to culture live virus from 106 of these samples to see if they were genuine. They also collected 3,343 additional samples from the belongings of "asymptomatic" cases such as masks, toothbrushes etc and none of those samples tested positive. None of the "asymptomatic" cases were associated with infecting others.
en.nhc.gov dot cn/2020-06/03/c_80586.htm

Whether you wish to believe these results (no symptomatic cases!?!) is a different question...

So far the most repeated response by the Swedish chief epidemiologist Anders Tegnell, when faced with criticism, seems to be "In the fall we will know what countries were successful". It really irks me, because to me it sounds as if they won't even consider changing their approach, no matter what happens, regardless of the rising number of deaths and the constantly growing amount of data.

Indeed. The fact is, the more time that passes, the worse the Swedish strategy looks.

Sweden has just overtaken France into 5th position in most deaths per million (of non-microstates). They will also overtake Spain and Italy within a few months, ultimately leaving the UK and Sweden to battle it out to see which country is a greater failure in 3-6 months.

 

[Adrian]

Further on the topic of "asymptomatic",

The Chinese authorities claim they have tested 9.9 million people in Wuhan!!! They claim 300 positive results, however they tried (and failed) to culture live virus from 106 of these samples to see if they were genuine. They also collected 3,343 additional samples from the belongings of "asymptomatic" cases such as masks, toothbrushes etc and none of those samples tested positive. None of the "asymptomatic" cases were associated with infecting others.
en.nhc.gov dot cn/2020-06/03/c_80586.htm

Whether you wish to believe these results (no symptomatic cases!?!) is a different question...

The thing with asymptomatic cases is probably more complex in that there may be people with mild symptoms who basically just ignore them and carry on as normal. They're not really asymptomatic but behave as if they were. I think as a society we have become quite conditioned to trying to carry on working and doing stuff with minor infections/colds etc so I wonder if this can make the problem worse.

 

[Trish]

Also in the UK anosmia has only recently been added to fever and persistent dry cough as Covid-19 symptoms, yet I understand many report things like muscle aches, fatigue, nausea, diarrhoea and other symptoms instead but tested positive. If they were only asked if they had a fever or a persistent dry cough and everything else was ignored, they could have been listed as asymptomatic.

 

[mango]

According to a news article today, the Swedish government is apparently trying to save face by asking international diplomats/ambassadors to portray Sweden's covid strategy in a more positive light. Possibly in response to the negative attention the strategy has gotten internationally lately, as well as the fact that several countries aren't very keen to welcome Swedish tourists this summer?

The message they want to send is that "Sweden's strategy isn't as different as it is said to be".

“Sweden shares the same goals as all other countries. We work with the same challenges and use similar tools as most other countries, "says [Ann Linde, Minister of Foreign Affairs] [...]

The words the same and similar are marked in bold.

Several foreign media - including the New York Times - have reported that the Swedish strategy aims to create herd immunity against the virus. Something the government thinks is based on a great misunderstanding."

"Let me be clear that there is no strategy for creating 'herd immunity' in response to covid-19," says Linde.

Member states allowing visits by tourists from some EU countries while others are refused - as is happening now when Cyprus welcomes Norwegian and Danish travelers but not Swedish - is wrong, according to Linde.

“A coordinated approach is very important, as is the need to ensure that measures are balanced and non-discriminatory."

Julia Eriksson Pogorzelska at the Foreign Ministry's press service writes in an email:

- For a high-tech and export-dependent country like Sweden, awareness of and confidence in our country abroad is important.

 

[mango]

I was very surprised to see some slightly self-critical comments by Tegnell in an interview today

Lots of articles about this around the world today, in English: The Guardian, Bloomberg, Politico, Reuters, Independent, AFP, New York Times and others.

ETA: Here's another interview in Swedish, where Tegnell shares his own thoughts and opinions a bit more in depth. Google Translate, English

Sweden should have started testing sick people in elderly care much earlier. This is the opinion of state epidemiologist Anders Tegnell.

- There are things we could have done better, but in the main I think Sweden has chosen the right path, he tells DN.

 

[Andy]

Doctors condemn secrecy over false negative Covid-19 tests

Research has found as many as 29% of swab tests on infected people come back negative

Wayback Machine link to get around sign-up wall, https://web.archive.org/web/2020060...mn-secrecy-over-false-negative-covid-19-tests
Original if you have an account with the Guardian already, https://www.theguardian.com/world/2...mn-secrecy-over-false-negative-covid-19-tests

 

[rvallee]

According to a news article today, the Swedish government is apparently trying to save face by asking international diplomats/ambassadors to portray Sweden's covid strategy in a more positive light. Possibly in response to the negative attention the strategy has gotten internationally lately, as well as the fact that several countries aren't very keen to welcome Swedish tourists this summer?

The Chinese government did the same and it was pretty controversial at the time so I hope this will be too. Whew this is so bad. And when damage control takes precedence it only further commits to the initial mistakes.

Ideology guiding medicine is always horrible. This practice has to end.

 

[NelliePledge]

Another UK Cabinet Minister Alok Sharma Business Secretary is now isolating awaiting results of test. He showed symptoms while speaking in Parliament.

 

[Amw66]

 

[Kitty]

Another UK Cabinet Minister Alok Sharma Business Secretary is now isolating awaiting results of test. He showed symptoms while speaking in Parliament.

I'm sorry to hear that he's ill, but it's possible he's done other MPs and staff a favour by highlighting the risks of reconvening parliament and stopping remote attendance. It seems particularly obtuse to replace a functioning system of digital voting with time-consuming, risky queuing.

 

[mango]

The fact that more and more people are ignoring the recommendations are showing up in the statistics now

After weeks of reports that Swedish people are moving about and travelling more despite the recommendations not to, a continuously high number of covid-19 deaths, and a rising number of infected people for the last 2+ weeks, new recommendations have been announced today:

Recommendations for domestic travel will be relaxed
From June 13, symptom-free people can travel in Sweden, says Prime Minister Stefan Lövfen.

In order for the relaxation of travel recommendations to work, everyone must follow the rules of keeping a physical distance very carefully, the government says.

The government recognizes that the danger is not over and that Sweden is still in a serious situation.

https://www.krisinformation.se/nyheter/2020/juni/reserekommendationer-lattas

Why??

The public health authority has made the decision after consulting with other authorities and people.

- It is important for mental and physical health to have a meaningful holiday. This is a decision that makes it easier for people to plan their summer without having to think about what is a necessary trip and not.

https://www.folkhalsomyndigheten.se...s-for-dampad-smittspridning-vid-okat-resande/

Here are the current recommendations (in effect until 13 June):

3. Keep a distance from each other on public transport and in other general means of transport; [...]

6. avoid traveling during rush hour; and

7. refrain from unnecessary travel.

We have spread in the society in more and more parts of Sweden. Therefore, we recommend that you think about whether the trip is necessary to make. [...]

Those who are ill should not travel at all and risk groups should especially think carefully about traveling or receiving visits.

What applies to shorter trips in Sweden?

Traveling for 1-2 hours is an approximate time and means that, provided you are not ill, you can make shorter trips from your home. Longer trips, or a trip where you need to use public transport, should be avoided. This is so you can return home if you are in need of healthcare, so as not to burden healthcare in another region.

https://www.folkhalsomyndigheten.se...tt/aktuella-utbrott/covid-19/fragor-och-svar/

 

[lunarainbows]

Well

https://www.theguardian.com/society...e-operating-fully-until-september-coronavirus

NHS test-and-trace app ‘not fully operational until September’