Come for the politics, stay for the snark.

I’m more Christian than these people and I’m an atheist.

A snarling mass of vitriolic jackals

So it was an October Surprise A Day, like an Advent calendar but for crime.

Seems like a complicated subject, have you tried yelling at it?

Narcissists are always shocked to discover other people have agency.

Historically it was a little unusual for the president to be an incoherent babbling moron.

The next time the wall street journal editorial board speaks the truth will be the first.

Their freedom requires your slavery.

Thanks to your bullshit, we are now under siege.

After dobbs, women are no longer free.

Donald Trump, welcome to your everything, everywhere, all at once.

I like you, you’re my kind of trouble.

Republicans don’t lie to be believed, they lie to be repeated.

Bad people in a position to do bad things will do bad things because they are bad people. End of story.

They were going to turn on one another at some point. It was inevitable.

No offense, but this thread hasn’t been about you for quite a while.

Glad to see john eastman going through some things.

Their boy Ron is an empty plastic cup that will never know pudding.

Why is it so hard for them to condemn hate?

Insiders who complain to politico: please report to the white house office of shut the fuck up.

Let’s show the world that autocracy can be defeated.

GOP baffled that ‘we don’t care if you die’ is not a winning slogan.

Good lord, these people are nuts.

It’s not hopeless, and we’re not helpless.

You are here: Home / Economics / C.R.E.A.M. / COVID-19 Coronavirus Update – Wednesday/Thursday, April 15/16

COVID-19 Coronavirus Update – Wednesday/Thursday, April 15/16

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… After the Daegu outbreak, the South Korean government began a massive testing program to try and track the epidemic. Japan has done the opposite.

Even now, more than three months after Japan recorded its first case, it is still only testing a tiny percentage of the population.

Initially, the government said it was because large-scale testing was a “waste of resources”. It’s now had to change its tune a bit and says it will ramp up testing – but several reasons appear to have slowed it down.

Firstly, Japan’s health ministry fears that hospitals will be overwhelmed by people who test positive – but only have minor symptoms. And on a wider scale, the testing is the responsibility of local health centres and not on a national government level.

Some of these local centres are simply not equipped with the staff or the equipment to deal with testing on a major scale. Local hotlines have been overwhelmed and even getting a referral from a doctor is a struggle.

The combination of these reasons mean authorities in Japan don’t have a clear idea of how the virus is moving through the population, says Professor Shibuya.

“We are in the middle of an explosive phase of the outbreak,” he said.

“The major lesson to take from Hokkaido is that even you are successful in the containment the first time around, it’s difficult to isolate and maintain the containment for a long period. Unless you expand the testing capacity, it’s difficult to identify community transmission and hospital transmission.” …

Reader Interactions

95Comments

  1. 1.

    OzarkHillbilly

    Profit over people, cost over care: America’s broken healthcare exposed by virus

    The US government and major health insurers said they are covering the costs of Covid-19 testing and treatment, but fear of bankrupting costs and the byzantine complexities of the system leave unanswered questions about whether people will even seek care, let alone escape a potentially crippling medical bill weeks or months later.

    How much testing and treatment costs individuals depends on if the patient was insured, how they were insured, and whether they survived. For example, a company that pays for its staff’s health insurance could decide not to cover an employee’s treatment, even if the health insurance company it’s using had said it would waive Covid-19 related payments.

    It’s a feature, not a bug.

    The pandemic crisis is being further exacerbated by the system’s devotion to profits over people. Medical workers are being furloughed and losing jobs because of the pandemic – including those on the frontlines – as their employers seek to cut costs.

    Alteon Health, a private-equity backed company which employs about 1,700 emergency medicine doctors and other physicians, said it would temporarily stop providing benefits including paid time off, according to the health website STAT. While intensive care units and emergency rooms are billing sky-high figures, there has been a pause on non-essential care that has, in turn, cut medical system profits.

    Laying off doctors and nurses during a pandemic, yeah, that makes sense!

    This major disruption to the US healthcare system may leave nurses and doctors jobless, but there are early indications insurance companies could be insulated from the damage. Not only did health insurance companies enter the crisis with capital, several analysts have anticipated these companies could have lower costs because fewer people are seeking routine medical care.

    David Blumenthal, president of the global health thinktank the Commonwealth Fund, said people who have coverage year-round will still be paying premiums, while insurers have fewer procedures to cover.

    Choice! It’s all about the right of my employer to choose my healthcare profiteer… I mean “provider”.

    Benjamin Sommers, professor of health policy and economics at Harvard TH Chan school of public health said there are few signs the pandemic is driving the Trump administration to reflect on the healthcare system.

    HA! The idea of the trump admin reflecting on something other than the image they see in the mirror.

    The ICU doctor, Gaffney, said he was certain the way healthcare is financed in the US is exacerbating the overall harm of the epidemic. “At a time of soaring unemployment and at a time of deepening recession, people are going to be losing coverage and seeing more and more medical bills if they get sick,” Gaffney said. “That doesn’t make any sense.”

    Or in those infamous last words:

    But as the death toll mounted, a patient who was about to be put on a ventilator in one of New York City’s stretched to capacity intensive care units had a final question for his nurse: “Who’s going to pay for it?”

    Those were the patient’s final words to his medical team,

    Greatest. Healthcare. In. The. World.

  2. 2.

    ?BillinGlendaleCA

    @OzarkHillbilly:

    Laying off doctors and nurses during a pandemic, yeah, that makes sense!

    It does make sense since doctors and nurses specialize.  For example an OR nurse and an ICU nurse are not substitutes, they have specialized skills.

  3. 3.

    SFAW

    WTF does “It may be time to swing for the fences” even mean? That the US should go into total lockdown?

    English is a great language for expressing both obvious and subtle concepts. It’s too bad more allegedly-native-speakers don’t know how. [Yes, I realize it’s a tweet. So?]

  4. 4.

    SFAW

    @?BillinGlendaleCA:

    It does make sense since doctors and nurses specialize.  For example an OR nurse and an ICU nurse are not substitutes, they have specialized skills.

    They’re getting moved from non-direct care positions to direct care positions at various hospitals, including my wife’s. Some have refused, others not. [My wife is back to wearing scrubs, after being away from that type of work for five-plus years.] NPR interviewed one or more nurses in other areas of the country, who are being asked to do the same thing. In some cases, it may make sense. In others, it sounds like asking a hip/knee surgeon to do rocket/brain surgery.

  5. 5.

    SFAW

    @OzarkHillbilly:

    The ICU doctor, Gaffney, said he was certain the way healthcare is financed in the US is exacerbating the overall harm of the epidemic. “At a time of soaring unemployment and at a time of deepening recession, people are going to be losing coverage and seeing more and more medical bills if they get sick,” Gaffney said. “That doesn’t make any sense.”

    Thank FSM the tyrant Obama wasn’t allowed to move people off employer-“supplied” medical insurance. Same goes for would-be tyrant Elizabeth Warren. [In years past, I might have written “those commies,” but since 2016, that’s apparently a NBD, according to some.]

  6. 6.

    ?BillinGlendaleCA

    @SFAW: The kid’s hospital asked for volunteers in the OR for partial furloughs, she volunteered since she’s in a better financial place* than some of her colleagues.  So rather than work 3/12, she’s working 2/12 and losing a 1/3 of her pay.

    *She’s single and doesn’t have any children.

  7. 7.

    Amir Khalid

    Director-General of Health Dr Noor Hisham Abdullah is giving his daily media briefing right now.

    Meanwhile, Malaysia’s worldometer numbers for today: 110 new cases, total 5,182; one death, total 84. New diagnoses continue their downward trend. 2,766 patients, 53.4% of the total, have recovered and been discharged. Dr Noor Hisham attributes the low mortality and good recovery rate to a policy of isolating and treating patients in hospital as early as  possible in the cycle of the disease. He also praises the cooperation from private-sector healthcare: many doctors and nurses are now volunteering in public hospitals.

  8. 8.

    WereBear

    It’s going to be a mess, nationally, because the ones in charge are all a mess. And we won’t get out of it until next January — hopefully. I’m resigned to that, thanking my lucky stars I’m in a blue state, and figuring on eventually losing my job as the rosy false optimism clears from the nation’s windshield.

    All the Republican tendencies towards doing the exact wrong thing, at the exact wrong time, over and over, have come to full flower.

    Much like that plant which flowers once a century and smells like rotting meat.

  9. 9.

    OzarkHillbilly

    @?BillinGlendaleCA: They share skills too. That way an ICU doctor who has been on duty for 13 and a half hours can get a break from doing some of the more mundane things and concentrating on only those things that require his specialized skills.

  10. 10.

    SFAW

    @?BillinGlendaleCA:

    I hope her sacrifice is appreciated, by both her colleagues and her employer. [I say that absolutely sincerely.] Unfortunately, my experience has been that hospitals tend to be more of “yeah, but what have you done for us lately?” kinds of places.

    On the other hand, not being able to perform elective surgery means a lot of hospitals will — even if they don’t go under — suffer huge financial losses.

    But thank FSM the cruise lines are getting bailed out. [No wordplay intended.]

  12. 12.

    SFAW

    @WereBear:

    All the Republican tendencies towards doing the exact wrong thing, at the exact wrong time, over and over, have come to full flower.

    Quit yer bleedin’ whining. Things are more-or-less OK for the one percenters, which is all that matters to Rethugs.

  14. 14.

    SFAW

    @?BillinGlendaleCA:

    They raise them at The Huntington.

    Sorry, but all I could think of was “And when they’re fully-grown, they become Republicans.” But without the “looking nice” part of the equation.

  20. 20.

    OzarkHillbilly

    @SFAW: And speaking of which: Millionaires to reap 80% of benefit from tax change in US coronavirus stimulus

    Because this economic downturn has hit them soooooo hard. Do you know how much it costs to rent a house in the Hamptons so you can shelter away from the hoi poloi????

    And let’s not forget,

    The first cars arrive at Hard Rock Stadium shortly after 4am. It is three hours until sunrise, and five before the state-run coronavirus drive-through testing station opens its gates, but the early arrivals, some coughing and feverish, all wearing face masks, want to be sure of their slot.

    Even so, some are out of luck. With a daily capacity of only 400 tests, it takes authorities fewer than 120 minutes to exhaust their limited supply of throat swabs, and those at the back of the queue – after hours waiting in temperatures close to 90F – are sent away to try another day.

    Meanwhile, over on Fisher Island, a swanky enclave for the super wealthy barely 15 miles away, and where the average annual income is $2.5m, it is a different story.

    Island managers’ controversial private purchase of thousands of rapid Covid-19 blood test kits from the University of Miami’s health system means there is no need for any resident to leave the island or wait in line with the public at large.

    Here, there is time for a leisurely breakfast and a stroll around the 216 acres of America’s richest zip code before stopping by an air-conditioned medical office for a guaranteed swift blood draw. While those fortunate enough to have received a test at the stadium must wait several days for a result, the instant nature of the in-demand blood antibody tests means islanders learn of their situation within minutes.

  22. 22.

    SFAW

    @?BillinGlendaleCA:

    Glad for her. My wife’s hospital, which has been financially tight (as in, they don’t have a lot of cash to spend on needed stuff) for awhile, may not be so fortunate. And it’s not as if she could/would transfer to Mass General (a/k/a MGH) anytime soon.

    So, let’s see, the Murderer-in-Chief’s dumbass destructive dithering will probably lead to: shitloads of deaths from “it’s just the flu, libtards,” the near-destruction of the US economy, the near-destruction of significant parts of the healthcare system, the impoverishment of millions of Americans. All to pwn the libtards, or at least pwning those persons unwilling to state that he is the greatest person ever to walk the Earth.

  23. 23.

    OzarkHillbilly

    NYT:

    The call for body bags came late Saturday.

    By Monday, the police in a small New Jersey town had gotten an anonymous tip about a body being stored in a shed outside one of the state’s largest nursing homes. When the police arrived, the corpse had been removed from the shed, but they discovered 17 bodies piled inside the nursing home in a small morgue intended to hold no more than four people.

    “They were just overwhelmed by the amount of people who were expiring,” said Eric C. Danielson, the police chief in Andover, a small township in Sussex County, the state’s northernmost county.

    The 17 were among 68 recent deaths linked to the long-term care facility, Andover Subacute and Rehabilitation Center I and II, including two nurses, officials said. Of those who died, 26 people had tested positive for the virus.

    For the others, the cause of death is unknown.

    Of the patients who remain at the homes, housed in two buildings, 76 have tested positive for the virus; 41 staff members, including an administrator, are sick with Covid-19, the disease caused by the coronavirus, according to county health records shared on Wednesday with a federal official.

  24. 24.

    OzarkHillbilly

    @SFAW: Well, he did have a lot of help from rank and file Republicans. It’s not like he did it all by himself.

    Credit where credit is due.

  28. 28.

    SFAW

    @OzarkHillbilly:

    Well, he did have a lot of help from rank and file Republicans. It’s not like he did it all by himself.

    True enough, but you gotta start somewhere. Before COVID-1 (thanks KellyAnne!), I would have put Traitor Turtle at the head of the tumbrel procession, but with the Murderer-in-Chief’s performance for the last two-plus months, I think I’ve moved Moscow Mitch back to “number 2.” Which I guess is also appropriate.

  29. 29.

    Eolirin

    @SFAW: It’s an 82 billion dollar tax cut someone snuck into a 2 trillion dollar spending package. And it’ll be pretty easy to reverse, especially when we’re going to need to do significant tax reforms when we get back into power anyway. Wouldn’t have been worth fighting to remove.

  30. 30.

    Anne Laurie

    @?BillinGlendaleCA: A massive orange corolla with a gross green ‘tongue’ emerging from it… maybe we can declare the corpse flower official emblem of the Trump presidency.

    He’d probably love the ‘Lord of the Flies’ nickname!

  31. 31.

    SFAW

    @Eolirin:

    My “Good Christ” and October Revolution comment was aimed at the “peasants have to fight for testing, while the rich get pampered, etc.” concept. Although the parallel might have been better suited to July 14th, rather than October. [Disclaimer: not enough of an historian to know if either one makes sense. But, hey, if I can’t make bullshit analogies at Balloon Juice, where can I?]

  33. 33.

    OzarkHillbilly

    @SFAW: You know, my wife speaks 4 different languages and I have a hard enough time separating out the English words and trying to make sense of them. Now I gotta do the same with you?

  34. 34.

    SFAW

    @Anne Laurie:

    He’d probably love the ‘Lord of the Flies’ nickname!

    “Dr Fauci came to me, with tears in his eyes, and said ‘Sir, with the way you’ve shown outstanding leadership — the BEST leadership! — on the whole sharonavirus thing, some of the CDC think they should maybe start calling you ‘Beelzebub.’ It’s an old term, in some not-American language, it means ‘Lord’ or something, I think it’s appropriate, don’t you?’ I’m glad to see Dr. Fauci finally giving me the respect I’m due.”

  35. 35.

    Robert Sneddon

    @OzarkHillbilly: Throat swab tests are to confirm ongoing COVID-19 infections by detecting actual virus particles in people’s mucus and saliva. They’re complicated to do, requiring lab techs operating PCR machines with consumable reagents and analysis of results  which means each one takes significant time to carry out.

     

    The blood tests for antibodies are a lot simpler, on the level of pregnancy home-test kits but no-one who is pushing them at the general public is talking about error rates. The one actual statement about this I’ve heard was from a British government minister a couple of weeks ago who, during a briefing mentioned that one unnamed series of prototype tests they were considering buying was returning false results three times out of four. Other similar tests are known to react to many different coronavirus antibodies, not just COVID-19 so if someone had a cold in the past few years they’d get a positive result for antibodies regardless.

    Testing, like masks and contact tracing, are not a golden bullet that will stop this disease in its tracks. Stay at home, wash your hands.

  36. 36.

    SFAW

    @OzarkHillbilly:

    Now I gotta do the same with you?

    Well, I’m honored that you even consider trying to make sense out of my “musings.” The Cyrillic (well, “Kyrillic,” I guess) is (at least according to Google) “October” in Russkie. [I had always thought it was “октябрь,” but the translator tells me otherwise.] It was a reference to the October Revolution of 1917.

    Of course, you probably already figured that out, and are just fuckin’ with me. Which is OK.

    Which four languages does Mrs. Ozark speak? I only speak (what usually sometimes passes for) English, and Ig-pay Atin-lay.

  39. 39.

    OzarkHillbilly

    @SFAW: Catalan (her native language), Spanish (her dictator enforced official language), French (which she loves to use to correct my hillbilly pronunciations of place names around here) (to which I always say, “You go ahead and ask how to get to the Courtois Creek and see how far you get) (in hillbilly it’s “Coat-away) and English. When she gets tired she mixes them up and uses different grammars too.

  42. 42.

    SFAW

    @OzarkHillbilly:

    Neat. Being half-Canuck, I sometimes (mentally) correct when people here pronounce an obviously-French name using ‘Murican pronunciation. [Minor examples: “Gagnon” is “GAG-non” for most around here, but “Gahn-yon” to me. And “Gervais” is pronounced as “Jarvis” by a lot. Oy.]

    I do not generally switch between English and Pig Latin mid-sentence, however.

  43. 43.

    SFAW

    @Amir Khalid:

    So, does Mrs Ozark call the city in Michigan Detroit or “duh-trwah”?

    This comment is merely the latest one of yours which earns my admiration.

  45. 45.

    marklar

    @OzarkHillbilly:

    It does go both ways.  Growing up in Moan-Ree-all, Kay-Beck, (Anglicized to Muntreal, Kweebec) the Francophones would usually clip H’s from English words starting with them, and hadding them to words lacking them. Thus, the ‘ardware store called “Handy Andy” was pronounced “_andy h’Andy”.

  46. 46.

    zhena gogolia

    @SFAW:

    Your problem is that “until October” would have the month’s name as октября, because it would be in the genitive case. But the nominative case (i.e., the form in which the word would be given in the dictionary and the form it would be as the subject of a sentence) is октябрь.

  47. 47.

    artem1s

    Mike Pence says 24 percent of the counties in the US have no coronavirus cases

    24 percent of US counties have had little or no testing

    FTFY Mikey.

  50. 50.

    Enhanced Voting Techniques

    There are few short-term options.
    1. Let the virus go & thousands die.

    Not thousands, millions, if the REAL Americans get their their wet dream the virus will infect 100% of the population in 20 days and kill 1%, that’s 3 million deaths in the United States over two months.  Not to mention the extra deaths from other people who can’t get medical help, then the people who will be crippled from the illness and then vast numbers who will be sick for a month and unable to work for  month from it.  That what, 22% of the population, at lest. So the economy is screwed ether way, but dead or crippled is permanent.

  52. 52.

    YY_Sima Qian

    Early indications of (so far) small second waves, triggered by imported cases, are showing in three regions in China: Harbin in northeastern China, Beijing, and Guangzhou.

    There is a growing cluster in Harbin, the capital of Heilongjiang Province. “Patient 0” appears to be a young student returning from the US, apparently asymptomatic that produced negative PCR and antibody results during screen at point of entry, as well as the start and finish of 14 day self-quarantine. Days later, she was identified as a close contact of a family cluster living downstairs in the same apartment building, and she tested positive for antibodies. Perhaps she was one of those asymptomatic cases that was still contagious, but produced low levels antibodies upon self-healing. It is not published how she infected the daughter of the family living downstairs, but most likely she breached self-quarantine at one time or another. The daughter then infected all of her family living in the same apartment. The father of the family then had a banquet with some friends, and infected several people at the event. One elderly gentle, who turned out to be a super-spreader, then went to a hospital for cerebral apoplexy, and then transferred to another hospital after developing a fever, and went on to infect his own family members, a number of his fellow patients, their caretakers, their families, and few of the nurses working in the two wards, before finally being transferred to isolation ward. 23 confirmed cases found over 7 days from this transmission chain, as well as a number of asymptomatic cases, though some of the confirmed cases are people who were classified as asymptomatic, who then developed symptoms. Of the 11 asymptomatic cases from Harbin yesterday, 6 are nurses working in hospitals. Worryingly, two of the nurses did not work in the hospitals that the super spreader was treated in, and the sources of their infections are currently unknown. Several hundred close contacts of these cases have been traced and quarantined. The situation is still developing.

    Clearly there are gaps in Harbin’s containment and prevention measures in hospitals. It seems hospitals in Harbin are not screening patients checking in for in-patient care, even in the respiratory disease ward. Nurses in non-COVID wards appears to be inadequately equipped, trained or alerted against potentially infected patients. I have no idea how nurses in the respiratory disease ward could have been infected, one would think they would be properly equipped, trained and alert. There is now an investigation into the hospitals. At least Harbin is being very transparent with case reports, including the asymptomatic cases. It seems all hospitals in China will have to adopt the procedures and protocols as those in Wuhan.

    For moral of the story for the common folks is: social distancing should be maintained even after lock downs end, it is not an occasion to party and bar hop with friends and restart social life! It does not matter how low the official case count is. Hospitals should operate under the assumption that any incoming patient may be a SARS-CoV-2 carrier, and protect the HCWs accordingly.

    The new cases in Beijing is scary in a different way. A returnee from the US was tested twice upon entry, both negative. He was deemed a close contact of another confirmed case on the flight, and was transferred from general centralized quarantine for returnees to special quarantine for close contacts. He tested negative again at the end of the 14 day period, and was released to go home. He then developed symptoms a few days later, and proceeded tested positive. By then he had infected three of his family members, with another one currently classified as suspect. Dozens of close contacts of these cases have been traced and are under quarantine. By now it is clear that a percentage (albeit very small) of cases can have incubation periods longer than 14 days. They can slip through the current standard containment measures employed around the world, and cause new outbreaks.

    5 more confirmed and 11 more asymptomatic domestic cases were found in and around Guangzhou yesterday. Most are African nationals living in Guangzhou (though one American), all are close contacts of confirmed cases or had frequented known hot spots, so their epidemiological histories are well understood. They were found via contact tracing or community screening. Fortunately, all of these asymptomatic cases have already been placed under medical quarantine (either as close contacts, or because Guangzhou is placing all members of the African community under medical quarantine, pending test results), so the transmission chains have been cut. Most of the confirmed cases were reclassified from asymptomatic. Perhaps the draconian methods Guangzhou government has employed on its African community will actually contain this outbreak.

    I have been troubled for several days by some of the data from Wuhan and Hubei. It is clear from case reports from the rest of China that the majority of asymptomatic cases (imported or domestic) do eventually develop symptoms and become confirmed. However, we know several hundred asymptomatic cases have been found in Hubei over the past month (including 37 just yesterday). Yet, only 3 new confirmed cases over the same span, and I do not believe they were reclassified from asymptomatic. So why do the asymptomatic cases in Hubei not develop symptoms?! I hope it is not because the municipal and provincial governments are keeping these cases “asymptomatic”, so they can keep the new confirmed case count to 0! On the other hand, the Chinese government has mandated that all COVID-19 treatments are free (even the weeks on the ECMO that costs tens of thousands of US dollars a day), but only if the patient is a confirmed case. I would expect at least some of the patients’ families to raise a stink if the hospitals refuse to confirm them, despite developing clear symptoms. Even if the local and regional authorities are stretching the definition of “asymptomatic”, it is not likely to be a gap in epidemic containment efforts, though. Asymptomatic cases are treat the same as confirmed cases in terms of quarantine and contact tracing. They just receive no medical treatment.

    While researching the above issue, I found a recent report from Wuhan municipal health commission: in the week after the lock down of was lifted Apr. 8, 225,999 people have been screened (number of individuals, not number of tests), 130 asymptomatic cases have been found, and no confirmed cases. That is a 0.0575% positive rate. Over the past several weeks, authorities have only found a handful of confirmed and asymptomatic cases to have been exported from Hubei to other parts of China, despite millions of people traveling. It seems the epidemic has truly been suppressed in Wuhan and Hubei.

  53. 53.

    jonas

    @Barbara: Yep, the same depopulated counties that when you color them red on a map, prove Trump won the popular vote.

    *headdesk

  54. 54.

    jonas

    @OzarkHillbilly: Reminds me of the time I was in the Lexington, KY area and there’s a town near there called Versailles, which my host explained to this fancypants coastal elite was pronounced “Ver-sayles”.

  56. 56.

    SFAW

    @zhena gogolia:

    Thanks for zhena-splaining. I’ll probably continue to make the same (or similar) mistake, but maybe I’ll remember what you’ve tried to teach me.

  57. 57.

    Barbara

    @jonas: “North Versailles” is a town just outside Pittsburgh.  Pronounced “ver-sails.”  However, even more bizarre, there is a town in Virginia called “Buchanan” that is pronounced as if it were spelled “Buck Hannen.”  And the people who settled that patch of woods were definitely from the place where the name was pretty common so I have no idea what happened there.

  59. 59.

    zzyzx

    There’s a lot of controversy on how to pronounce the final word in the Des Moines in King County Washington. Some have the z sound at the end, others don’t.

  61. 61.

    Another Scott

    @YY_Sima Qian: Thanks for these reports.  They are troubling to me though.

    What is your feeling about the false negative rate (and overall sensitivity) in tests in China?  Is it low enough to account for these findings.  Over here we hear stories that tests have 30% false negative rates.  :-(  It sounds like the rate is much lower there, but is it low enough?  Are the tests sensitive enough to detect low levels of virus?  Or are there really cases where it takes longer than 2 weeks for detectable virus loads and symptoms to develop?

    I firmly believe that test and trace is the sensible way forward, but if the tests cannot be trusted, then we’re continuing to fly blind (but with the added false sense of security that the tests are meaningful)…  :-(

    Thanks again.

    Cheers,
    Scott.

  62. 62.

    Another Scott

    @zzyzx: My mom reminded me:

    “There is no noise in Illinois.”

    The American English language is weird.

    Cheers,
    Scott.

  63. 63.

    Barbara

    @Another Scott: But does she refer to Cincinatti as “cincinatta”?  Or “Louisville” as “Lew-a-ville”?

    ETA: I love this kind of diversion but WaPo tells me that today is going to be a horrendous day for death from CV-19.

  64. 64.

    Geminid

    @Barbara: And further down the Valley Staunton is pronounced “Stanton,” like Lincoln’s Secretary of war, not “Staunton,” like the English chess master. It could be a Scotch Irish thing.

  65. 65.

    Ruckus

    @Amir Khalid:

    In our system we specialize, both in skills and labor costs. So that nurse that works in a high cost OR gets paid a different rate than the floor nurse on a ward. Put that nurse on the ward and the ward cost either escalates or the hospital is losing money. It reverberates through the entire system.

    IOW the system is based upon cost per disease/operation, not on over all healthcare. This disease throws all of that made up cost containment/cost exorbitant care concept out the window.

  66. 66.

    Barbara

    @Geminid: Well, it is reminiscent of certain mostly upper class pronunciation “conventions” in England, whereby “St. John” is pronounced “sinjin” (famous scene from Four Weddings and a Funeral) and “Magdalene” is pronounced “maudlin” (giving rise to the word).  An English waiter in Oxford sheepishly asked us how we would pronounce the word spelled “magdalene” and we told him, “magda-lin” and he said he would too, but “around here” it’s ‘maudlin.'”  Derby is “darby” and so on.  We found car rental people to be very helpful with these sorts of things

  67. 67.

    YY_Sima Qian

    @Another Scott: I think the false negative rate for PCR tests was as high as 30 – 40% back in late Jan. to early Feb. in China. It then improved to 15 – 20% in Feb., and approximately 5 – 10% now. That is why China (and others in East Asia) is doing multiple PCRs for both confirmation and clearance even now, supplemented by serology for antigen/antibody and chest CTs. I had to clear two PCRs, two blood screens and one chest CT to be transferred from buffer ward to standard ward. Anyone entering the country is screened at least twice during 14 day mandatory quarantine. A COVID-19 patient is only discharged after two to three negative PCRs spaced at least 24 hours apart, cessation of outward symptoms, and significant improvement in the lungs on chest CT. Anyone traveling from Wuhan to the rest of China first need a negative PCR at Wuhan, and is then tested again at the destination.

    However, the false negative rates are estimates for samples with enough viral particles that the PCR assays should produce positive results. It does not account for the fact that early on during th course of infection there may not be enough viral particles in the nasal or throat area to be detected, or that late in the course of infection most of the virus may be in the lungs and other internal organs, or that some outlier cases would continue to test negative despite having every symptom. PCRs typically can only detect virus from 1 – 3 days before onset of symptoms. That is why PCR tests are not enough by itself, it needs to be employed in conjunction with other tests. That is why thorough contact tracing and isolation of close contacts and suspected cases are critical to get ahead of the curve. With testing alone you will always be several days behind the curve. That is why China is mandating 14 day centralized quarantine for all who enter the country, and 14 day centralized quarantine for recovered patients already discharged from hospital, and 14 day quarantine for close contacts. That is to guard against the false negatives, the asymptomatic and the pre-symptomatics. Some experts in China is recommending 24 day quarantine to be standard.

    The fast antibody tests (finger pricks) are even worse in accuracy, and typically can only produce positive results well into the course of infection, often after onset of symptoms. Blood samples directly from the vein is better. I do not know about Abbott’s fast PCR test… Testing alone is not the solution for this disease.

    As for Wuhan, even tests that has 30% (or 70%, for that matter) false negative rate should be able to detect the presence of an ongoing outbreak, of even 0.5% of the population is currently infected. Therefore, I do believe the epidemic has been suppressed here.

    Mind you, even a 0.0575% positive rate still suggests that there are ~ 10K active asymptomatic cases in metro Wuhan, assuming 18 million people. That also implies 10s of thousands of people may have been infected asymptomatically, and have since recovered, over the course of the epidemic here. Compared to the cumulative 50K confirmed cases in the city, that means an ~ 50% asymptomatic (or very mild) rate, in line with findings from community surveys in Italy and Iceland! Food for thought.

  68. 68.

    Another Scott

    @Barbara: I always chuckle / want to pull my hair out whenever I hear the BBC announcer pronounce “Bernie Sanders”.  It’s almost always “Bernie Saunders” with the “u” varying slightly between the people saying it.

    Maybe it’s related to the color/colour thing – dunno.

    “Hey, let’s add a “u” in there!!”

    Cheers,
    Scott.

  69. 69.

    planetjanet

    One thing I have done to relieve some of my anxiety is to chart the growth rate of new cases in Virginia.  Keep hoping to see that corner turned.  The state is good at providing a number of good charts.  Looking at the number of cases, it was easier to see how big the increase was when the numbers were small, but not as easy now that it is in the thousands.  Their chart does not show a clear decline yet.  I took the total number of cases identified and calculated the percent increase.  To smooth it out, I also did a five day running average.  On March 25, the rate was increasing at 29% a day.  On March 30, the Governor issued the stay at home order.  As of today, the rate is 6%.  We still seem to be stuck at only doing 2000 tests a day.  Stay safe.

  70. 70.

    YY_Sima Qian

    It appears that I am not the only one finding Wuhan’s asymptomatic cases to be curious. Just saw an article by a local expert, who explained the difference between the asymptomatic in Wuhan and those elsewhere. After 70+ days of lock down, anyone who could develop symptoms has already done so, has already been isolated and treated, and close contacts (and their contacts) traced and isolated, too. The remaining asymptomatic cases here are truly asymptomatic, and the vast majority of them are not very infectious (no coughing up a storm of viral droplets, no wipe it all over their hands and the surfaces they touch). The asymptomatic cases in Wuhan are not found from contact tracing of transmission chains, but from random community surveys, or the myriad of screens for other purposes (travel, non-COVID intake at hospitals, etc.). The imported or recently infected cases elsewhere in China, who are currently classified as “asymptomatic” due to lack of symptoms, are mostly pre-symptomatic. They will develop symptoms in the coming days, and become confirmed cases. It actually kind of makes sense…

  72. 72.

    Another Scott

    @YY_Sima Qian: This comment seems to me to be very important and not fully recognized by the US reporting and should have greater visibility.  There’s lots and lots of commentary about lack of testing, but very little [about contact tracing] (except for the Google/Apple voluntary contact tracing initiative using Bluetooth) and the occasional mention of the need for someone to hire hundreds of thousands of people to do tracing.  If (as it appears) testing alone will never be good enough, then we need to get started on tracing NOW NOW NOW.

    Maybe WaterGirl can collect these comments from you and put them in a dedicated page?  Or you could be persuaded to do a guest post/Q&A?

    Thanks again.

    Cheers,
    Scott.

  74. 74.

    planetjanet

    @Barbara:  My family includes Buchanans and that use the same pronunciation, “Buck Hannon’.  Yes, we are from SW Virginia.

  75. 75.

    Barbara

    @planetjanet: It occurred to me that this might be the way they pronounced it in Scotland (or Ireland, when they became “Scotch-Irish”) but it doesn’t seem to be the way that James Buchanan (among others) pronounced it.

  76. 76.

    YY_Sima Qian

    @Another Scott: Just to be clear, I am not a doctor, virologist, epidemiologist, or public health expert, so take everything I say with a grain of salt! ;-) I think Q&A should be reserved for someone with real expertise, not a random guy on the internet. :-D

    A couple of days ago I described China’s “Four Earlies” strategy since late Jan.: early detection, early reporting, early isolation and early treatment. Variations of this strategy is employed by all East Asian countries and regions that are keeping the pandemic under control, and I think should be the fundamental strategy everywhere before vaccines are widely available.

    Right now, there is far too much community transmission in too many epicenters in the US for contact tracing to be that useful. Strictly enforced lock downs are needed to suppress the outbreaks enough that the number of new cases and close contacts are not overwhelming even for hundreds of thousands of contact tracers. This army needs to be mobilized and trained starting from now, though, in preparation of that eventuality.

  77. 77.

    Ksmiami

    @SFAW: The line gets pretty long after that. I don’t see a way forward for this country unless we smash the GOP and destroy the right wing media circus

  81. 81.

    Laura Too

    @YY_Sima Qian: I am lucky to live in a state that has taken all of your playbook and put it to work. (I read your whole post on that and was thrilled a few hours later to hear our Governor repeat it almost verbatim-just didn’t get to reply before the thread was dead)  We can’t get enough tests yet so he won’t open us back up yet and the crazies are getting restless. They are going to stage a protest at the Govenor’s residence Friday. I’m guessing maybe 100 show up. The rest of us will sit at home, point and laugh-or scream. I’ve heard screaming can be theraputic. As for being some rando on the internet, maybe? But you are our beloved rando and you are very good at synthesising volumes of material! Thank you!

  82. 82.

    Kent

    @marklar:

    @OzarkHillbilly:

    It does go both ways.  Growing up in Moan-Ree-all, Kay-Beck, (Anglicized to Muntreal, Kweebec) the Francophones would usually clip H’s from English words starting with them, and hadding them to words lacking them. Thus, the ‘ardware store called “Handy Andy” was pronounced “_andy h’Andy”.

    Texans do the same thing.  I spent a decade living in Texas and never did get used to all the horrible pronunciations of Spanish place names.

    In Waco we had the Brazos River (BRAZ-is)

    In Austin the Guadalupe River (Gwad-ah-LOOP)

    And so forth.

  83. 83.

    Jay

    @YY_Sima Qian:

    last night, coming home, I observed a very young couple at the bus loop. They were definately not “social distancing”. After making out and talking for two bus shifts, ( buses run on the 1/2 hour), they each put on their masks and boarded different buses to go home to their families.

    Romeo and Juliet in a Time of Covid isn’t going to end well.

  84. 84.

    Jay

    @YY_Sima Qian:

    thank you for your always “must read, must think” posts.

    you are providing a very clear window into an aspect that the MSM either ignores in favour of clickbait or murks up.

  86. 86.

    joel hanes

    @planetjanet:

    In my hometown, there was a family name spelled Cahalan, that almost everyone, including many members of that family, pronounced “Caa – laa – han”

    ETA :  there were also families named Tymcsm (“Tim-chism”) and Trcka  (“Thurchka”)  .   (The PE teachers in particular had trouble with calling the roll at the beginning of every year.)  The Tymcsm boy married Gwendolyn Hofnagle, pronounced “Hoof -naygul”, and they hyphenated, so her married name was Gwendolyn Hofnagle-Tymcsm

  88. 88.

    Barbara

    @rikyrah:

    Going out on a limb, there are probably a few things going on.  There probably is a long tail for infectious status that can produce outlier events, but with a disease for which no one has any immunity, these events can result in significant transmission, so we really notice those outliers.  Even a relatively uncommon flu type typically encounters many people with some level of resistance if not complete immunity.  The second thing is that people are probably understating their level of contact with others. They are not doing anything intentionally wrong, but it’s like counting calories.  People really do overlook what they eat during the course of a day if you ask them to report retrospectively.  The third thing is that you don’t know for certain when they came in contact with the virus because you don’t know how many other asymptomatic people they encountered.

    But the underlying issue is the utter lack of prior exposure, which is going to make the sudden introduction of any disease have a much much worse impact on a population.

    I used to wonder why small pox had not decimated Europe the way it had Western indigenous populations, and the answer was that it had probably killed just as many people, if not actually many more, but over the course of hundreds of years, with some percentage of the population having derived resistance, if not from having the disease then from having diseases close in kind (cow pox).

  90. 90.

    Enhanced Voting Techniques

    @YY_Sima Qian: The Four Es sounds like what the doctors want here, so I wouldn’t be to surprised if the current round of screaming from the Right is because of the cost and the government being the solution.

    Worth noting that Germany, Iceland and Norway are doing similar things.  It’s also noticeable that countries that were on the front line for the Cold War like Germany and South Korea are doing the best with this.

  91. 91.

    StringOnAStick

    I’m mailing my 2 week notice to my boss today, no way in Hell am I practicing dental hygiene again until there is a proven effective vaccine.  I used to love working with him but he was so cavalier about this disease and is still convinced he already had it.  Research says that was influenza A going around in December and early January, but some random FL doctor buddy convinced him “everybody already has had Covid-19 so keep your office open, this is all an over reaction”.  Yeah, I’m done.

  92. 92.

    Kelly

    @StringOnAStick: How did your Bend trip go? Between the really late snow this year and the stay home order I may have set a record for fewest ski trips since I started in the early 1970’s.

  93. 93.

    Barbara

    @Enhanced Voting Techniques: Thanks.  I think I had read something like this previously.  Even during the Bubonic Plague, which is theorized to have killed up to 1/3 of certain populations (though I have read that it is exaggerated to say that 1/3 of all European peoples died), the incidence was thought to have been worse because of various environmental conditions, e.g., failed harvests.  But one thing is sure, people living in close contact without prior exposure to a pathogen are at much higher risk of succumbing. I suspect that even now, this is going to be one of the differences between New York City and Italy, and other places.

  94. 94.

    Suzanne

    @Amir Khalid: FWIW, I have been diverted from my normal project work to COVID surge plans in two states…. and it’s looking like they will never be used. Some of these surge spaces have opened and are now closing without seeing a single patient, and the city’s peak (at least the first one) seems to have passed.

     But at least one of my clients is carrying on with surge plans that they don’t expect to build, so that they can be more prepared for a mass shooting, terrorist event, or any other surge situation.

    I am plenty scared here about societal collapse, and I am (and have been) very scared about what happens if people just decide not to comply with quarantines because they’re going to be homeless or starving…

  95. 95.

    YY_Sima Qian

    @Barbara: You are absolutely correct on the dynamics. People with > 14 day incubation, or significant asymptomatic viral shedding, are low percentage outliers. However, they can cause large outbreaks due to lack of immunity. With all the containment and suppression measures, outbreaks are more likely to be caused by these outliers, not the case during the height of the epidemic. With every cluster I have read about, in China or SK, people close to “Patient 0” initially refused to cooperate with the contact tracers, leading to delayed response.

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