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Technically true, but collectively nonsense

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You are here: Home / Healthcare / COVID-19 / COVID-19 Coronavirus Update – Tuesday / Wednesday, May 19-20

COVID-19 Coronavirus Update – Tuesday / Wednesday, May 19-20

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This is really interesting:

… SARS-CoV-2, like two of its cousins, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), seems especially prone to attacking groups of tightly connected people while sparing others. It’s an encouraging finding, scientists say, because it suggests that restricting gatherings where superspreading is likely to occur will have a major impact on transmission, and that other restrictions—on outdoor activity, for example—might be eased.

“If you can predict what circumstances are giving rise to these events, the math shows you can really, very quickly curtail the ability of the disease to spread,” says Jamie Lloyd-Smith of the University of California, Los Angeles, who has studied the spread of many pathogens. But superspreading events are ill-understood and difficult to study, and the findings can lead to heartbreak and fear of stigma in patients who touch them off.

Most of the discussion around the spread of SARS-CoV-2 has concentrated on the average number of new infections caused by each patient. Without social distancing, this reproduction number (R) is about three. But in real life, some people infect many others and others don’t spread the disease at all. In fact, the latter is the norm, Lloyd-Smith says: “The consistent pattern is that the most common number is zero. Most people do not transmit.”…

That could explain some puzzling aspects of this pandemic, including why the virus did not take off around the world sooner after it emerged in China, and why some very early cases elsewhere—such as one in France in late December 2019, reported on 3 May—apparently failed to ignite a wider outbreak. If k is really 0.1, then most chains of infection die out by themselves and SARS-CoV-2 needs to be introduced undetected into a new country at least four times to have an even chance of establishing itself, Kucharski says. If the Chinese epidemic was a big fire that sent sparks flying around the world, most of the sparks simply fizzled out.

Good news:


Reader Interactions

22Comments

  1. 1.

    Amir Khalid

    Malaysia’s daily numbers: 31 new cases; 10 of these cases were foreign nationals. 21 cases are from local infection and 10 are imported infections in repatriated Malaysians. Total 7,009 cases. 60 more patients recovered, total recovered 5,706 or 81.4% of all cases. Of 1,189 active cases, 11 are in ICU of whom seven are on ventilators. No new deaths, total deaths stands at 114.Infection fatality rate 1.63%, case fatality rate 1.96%.

  2. 2.

    OzarkHillbilly

    (NYT) Nita Pippins, a Mother to AIDS Patients, Dies at 93

    One day in 1987, Nita Pippins received a call from her only child, Nick, a 33-year-old actor in Manhattan who was dying of AIDS. “Mom, I’m in bed. I can’t get out of bed,” her son told her. “It’s time.”

    Ms. Pippins, a retired nurse living in Pensacola, Fla., put her belongings in a friend’s house, took what she could and moved to New York to care for her son. At age 60, she began an improbable and remarkable second act.

    Devastated and ashamed by her son’s AIDS diagnosis, and troubled that he was gay, Ms. Pippins initially kept the illness a secret from her family and friends. And she felt out of place in the big city. On breaks while caring for her son, with whom she had moved in, she would sit inside the Nathan’s Famous restaurant then in Times Square and repeat, “I hate New York. I hate New York. I hate New York.”

    But Ms. Pippins nursed her son for three years as AIDS ravaged his body and he went in and out of the hospital. She saw members of the theater group he had founded and residents of their midtown building, Manhattan Plaza, falling sick also. And by the time her son died, in 1990, Ms. Pippins had been transformed.

    She became close with her son’s gay friends, and decided to stay in New York. She dedicated herself to AIDS causes. She became a tireless volunteer for Miracle House, a charity that provided out-of-town families of AIDS patients with housing and support.

    For mothers working through anger, guilt and sadness, Ms. Pippins served as a parent who had been there. For men estranged from their families, she became a replacement mother, sometimes holding their hands as they died.

    “She didn’t come here to be an activist,” said Irwin Kroot, who met Ms. Pippins through her son’s partner, Dennis Daniel, and interviewed her for a possible memoir. “She was filling a void. She was usually with young men who were dying and was, at their request, a go-between for them and their families.”

    Ms. Pippins died on May 10 at Amsterdam Nursing Home in Manhattan. She was 93. The cause was complications of the novel coronavirus, Mr. Kroot said.

    At a time when AIDS was widely misunderstood and gay men who suffered from the disease were treated like pariahs, Ms. Pippins called on countless families across the country to come visit their children. Often, those parents had little sense of their sons’ lives in the city or how sick they were.

    Ms. Pippins would tell them to set aside differences and be present for their child. Some took her advice, some didn’t.
    ………………………….
    Ms. Pippins, who was present at the end of life for so many during the AIDS crisis, died alone on Mother’s Day.

  3. 3.

    satby

    @OzarkHillbilly: so many things to be angry about because of the misadministration’s handling of this pandemic, but so many people dying alone away from family and friends unable to say goodbye, is probably the cruelest thing.

  4. 4.

    debbie

    I cannot imagine businesses agreeing to the idea of lockdown/relaxation cycles.

  5. 5.

    debbie

    Hey, DOJ:

    Georgia church closes two weeks after reopening as families come down with coronavirus

    The church had been reopened for two weeks before closing its doors once again as multiple families contracted the virus.https://t.co/5i0QVjJtbM
    — Travis Akers (@travisakers) May 19, 2020

  6. 6.

    Kristine

    I’m on a couple of STAT mailing lists. Yesterday during my morning walk, I listened to a Covid-19 vaccine discussion sponsored by Bloomberg. Nothing else to say except there are way too many things to keep up with.

  8. 8.

    YY_Sima Qian

    1 new domestic confirmed case reported in China yesterday, by Jilin City, a resident of the High Tech Zone. He is a close contact of a confirmed case, have been in self-quarantine at home from 5/12 – 5/18 (when he was merely a “connected” person “at risk”), and was moved to centralized quarantine on 5/18 when someone he was in close contact with became a confirmed case. Shulan is escalating its lock down measures, any residential compound with confirmed, asymptomatic or suspect cases are closed off with no one in or out, food and basic necessities are sourced and delivered by property management and neighborhood and community organizations. No anti-fever medication are allowed to be sold. All private and out-patient clinics are temporarily shut, only fever clinics are open. I think that last one is overkill. There is not a large outbreak in Shulan, I would venture there are still many more people with non-COVID illnesses than COVID-19 in Jilin City. However, after the nosocomial clusters in hospitals at Harbin, Mudanjian and Qingdao, no local authority is taking any chances.

    Overall, despite some missteps by local administrations, regions across China have done a commendable job preventing clusters from developing into “second waves”. Since the COVID-19 epidemic was largely suppressed across China by end of Mar., there has been multiple outbreaks of varying sizes in the country, causing varying degrees of lock downs and restrictions on movement: small cluster of several doctors at Ji County in Henan Province in late Mar., small nosocomial cluster in Qingdao in Shandong Province in early Apr., larger clusters at Harbin and Mudanjiang in Heilongjiang Province throughout Apr., and a large cluster at Guangzhou in Guangdong Province. Each cluster has been vigorously traced and contained as they emerged. As of now there are no active cases in Henan and Heilongjiang (all having recovered), only 1 active case in Shandong (an imported case), and only 3 active cases in Guangdong. Since mask wearing is still very common, mass gatherings are still discouraged or banned as matter of public policy, and most people are avoiding large gatherings as much as possible, Rt is probably nor substantially above 1 even as clusters develop, allowing authorities the time to test, trace and isolate. While case reports still indicate transmission vectors of small gatherings and visits to relatives and friends, there have no super spreading events at large gatherings, and very few at the work place, that we have seen in the US.

    Having closely followed the case reports in China over the past month and half, as well as reading about events elsewhere post-peak (such as South Korea), below are my semi-educated thoughts on effective responses to contain new outbreaks, after the first wave has been suppressed:

    1) For the regions that never had large community outbreaks, and are maintaining strict border control to minimize probability of imports (Hong Kong, Macau, Taiwan, Vietnam, Thailand, New Zealand, Iceland, and possibly Australia), risk of new clusters is pretty low.

    2) For those countries that have seen widespread community spread (South Korea, Thailand, Poland, Czech Republic, Hungary, Slovakia, Slovenia, Croatia, Austria, Norway, Finland, China), even after substantial suppression, the virus is certainly hidden below the surface, and risk of new clusters kicking off the second wave is substantial. Most of these countries also face greater challenges with imported cases. Although the first wave outbreaks in most Chinese provinces were similar or smaller than those seen in Taiwan or Hong Kong, many of they are at greater risk of introduction from overseas returnees or migrants from former hot spots.

    3) For those regions that have seen very widespread community spread and are still on the down slope (Italy, Spain, France, Germany, the Netherlands, Denmark), I do not believe they have suppressed the epidemic enough to even fully recognize new clusters as they form, and in any case they may not be aiming for suppression or eradication, just flattening the curve low enough so as to not overload the health care system. In that case, the game they will be playing is not whack-a-mole, but controlled burn.

    4) For the regions that are yet to peak (the US ex-NY/WA/OR, Brazil, Russia, India), they have to pass the trial of the initial wav, first.

    For the regions in the second group:

    1) Substantial social distancing must be maintained, so that any new outbreak has Rt of less than 1.5 or so. Given the nature of COVID-19, with the vast majority being asymptomatic or mild cases, and pre-symptomatic transmission a key driver, initial detection will always lag infection. As we have seen around the world in Mar., unless Rt is kept below 2, by the time authorities detect a cluster, it will have already spread enough to stress contact tracing capacity. This is especially true if there is one or more super spreading event. There is no going back to 2019 normal, until vaccines are widely available.

    2) Testing should be widely available and strongly encouraged, and mandatory for as many situations as the capacity can absorb. It doesn’t matter if the positive rate is 1% or 0.1% or 0.01%, if there has been a substantial outbreak before, there is undetected infection in the community. The more testing is done, the more likely asymptomatic and pre-symptomatic cases are detected, and clusters are detected while they are still small. The more testing is done, the more social distancing can be relaxed somewhat. While the government does not widely publicize its testing strategy and statistics (for whatever reason), I think China has done exceptionally well here. Everyone returning to work is tested, everyone returning to the classrooms are tested. Everyone traveling from former hot spots or current Medium Risk areas are tested both at the origin and destination. Testing is also available on demand, at a reasonable cost.

    3) Once clusters are detected, which is inevitable, rigorous contact tracing and vigorous isolation become key. If cases are walking into hospital receptions and ERs, or being caught in community surveys, then the authorities are still behind the curve. If the new cases are all close contacts, but they are testing positive immediately upon identification, then the authorities are barely keeping up, at best. They likely have infected others before being traced and isolated. However, if all of the cases are those who are already quarantined, ideally for a few days, then the authorities can be confident that they are ahead of the outbreak, and progressing toward containment and suppression. The more effective the contact tracing and isolation, the less likely lock down measures will be have to be reimposed, and the less severe the measure that are deployed. Unfortunately, there is a trade off between effective contact tracing and protection of privacy. The countries with very effective contact tracing (China, South Korea, Taiwan, Hong Kong, Singapore) all employing very invasive means. Malaysia and Australia are heading in that direction, as well.

    4) If there is community spread, especially if the spread is faster than the capacity for contact tracing, then some form of lock down is required. We have all seen the cartoons about flattening the curve to save the hospitals. Well, I believe the same concept applies to flattening the curve to save the contact tracers. Human endeavors, such as medical care and contact tracing, tend to scale linearly, but the virus spreads exponentially. Just as with hospitals, the higher the existing capacity for contact tracing, the less likely it will be overwhelmed by the initial spurt of exponential growth. However, unless the effective contact tracing quickly extinguishes the new fire, it will eventually be overwhelmed.

    I think most nations and peoples have yet to internalize that local lock downs will be a fact of life going forward, and that the earlier and harder the lock down (when necessary) in a localized area, the more likely a lock down of a greater area can be avoided, and the earlier the lock down can be lifted. Procrastination will always result in a worse outcome. It is an unpalatable prospect, even for authoritarian regimes, but real choices will have to be made nonetheless as circumstances arise.

    Unless, of course, if the national strategy is herd immunity or slow burn, even if by default.

  9. 9.

    JeanneT

    I wonder if the Georgia church’s service included singing, and if the congregants were masked….

  10. 10.

    YY_Sima Qian

    Just saw on Chinese online media that the US Embassy in Beijing posted on Weibo (Chinese counterpart to Twitter) to boast about the US’s “comprehensive national effort” to fight COVID-19: 9.5M tests, US$ 5.7B fund for emergency protective measures, 142 “Airbridge” flights. Below the post is a flood of derision by Chinese posters, and not just government bots or paid trolls, either. Of course, many highlight the ongoing effort to test 10M residents in Wuhan in a couple of weeks. Others highlighting that the province of Guangdong alone has already conducted more than 10M tests from the start of the epidemic until 5/11, on nearly 7M individuals, detecting a total of 1589 confirmed cases (and may be a hundred or so asymptomatic cases). This just makes Trump’s rumination that the US’ high case count is a positive sign of the amount of testing even more laughable than it already is.

    I ruefully remember the US Embassy’s daily posts on Weibo about Beijing’s air quality measurements during the “airpocalypse” days of 2010. It annoyed both the central and local CCP leaders to no end. Yet, it was closely followed and trusted by most of Beijing’s citizens, alerting most people in China (for the first time) to the danger that PM2.5 particles presented to their long term health. At the time, Chinese government at all levels referred to the choking air as combination of fog and pollutant, when it was just pollution. Even Chinese policymakers had to concede that the US Embassy’s updates helped raise the awareness toward air pollution in China, and helped to prod the central government to kick off the decade lone and still ongoing effort to improve air quality across China, to substantial effect.

    That is a perfect example of the immense soft power the US used to enjoy, even after eight years of the GWB administration and GFC significantly decreased the US’ hard power. Everyone thought that GWB was an aberration, and that election of Obama represented both a return to the norms, and a showcase of America at its most inspiring. We have been watching that soft power melt away before our eyes since Trump was elected, and the COVID-19 pandemic is accelerating that process. Trump’s election certainly made me strongly question whether I have actually been blind to the real America, which I thought I knew intimately.

  11. 11.

    terben

    From the Australian Dept of Health:

    ‘As at 3:00pm on 20 May 2020, a total of 7,079 cases of COVID-19 have been reported in Australia, including 100 deaths and 6,444 have been reported as recovered from COVID-19.

    Over the past week, there has been an average of 14 new cases reported each day. Of the newly reported cases, the majority have been from Victoria.

    To date, over 1,111,500 tests have been conducted nationally. Of those tests conducted 0.6% have been positive.’

    Since yesterday, a net increase of 11 new cases (+13, -2 false positives) and the one death which I mentioned in yesterday’s post. The number of ICU cases in down to 9. (from 11)

    There is some controversy in Australia between the Federal and State Governments. Nearly all States locked down their borders very early and have imposed a 14-day quarantine period on anyone who crosses the borders. Two States with the most cases were the exceptions and it is NSW that is complaining about the border lock-downs still being in place.

    All this matters, because each state is reopening its, pubs, clubs, cafes, restaurants, gyms, etc according to their own timelines. Another factor is the approach of winter and the annual migration of many to the warmer north of the country.

  12. 12.

    YY_Sima Qian

    @terben: Of the 7079 cases found in Australia, how many are imported and how many are domestic infections?

    Given the relatively low number of cases, I would think interstate blocks can be lowered before indoor bars and gyms are allowed to be reopen, as long as effective contact tracing across states can be managed. Crowded and confined spaces are where super spreading events happen. People exhale a great deal when exercising, and shout a great deal when drunk.

  14. 14.

    Ten Bears

    On parr with the bimbo that cut a hole in her mask because it was hard to breathe.

    Cuts a big hole in the suggestion these are the smartest people in the world.

    Though maybe they’re just selling a false sense of security. Open wide!

  15. 15.

    a thousand flouncing lurkers was fidelio

    I haven’t yet heard that Tennessee has succumbed to the urge to doctor statistics that has made such a mess in Georgia and Florida. Here’s the section of the state health department website devoted to the COVID-19 stats: https://www.tn.gov/health/cedep/ncov/data.html

    Tennessee is a largely rural state, with a few cities, most small by East Coast/West Coast standards. As you’d expect, Memphis/Shelby County and Nashville/Davidson County have the highest numbers, along with their suburban counties.
    There are outbreaks of varying size in all but one of those counties without hospitals of their own, but the worst of these is in Lake County, at the state penitentiary.
    Other penitentiary outbreaks are in Bledsoe and Trousdale Counties. Trousdale has a privately-run prison which is now responsible for the overwhelming majority of the 1,384 cases reported in that county.
    The other prisons don’t seem to be doing too badly; I don’t know if their wardens & staff were more on the ball, or if they just got blindsided. Reading between the lines in the Department of Corrections website, I get the distinct impression they advised the management at the Trousdale Turner Correctional Center on best practices but were ignored.

    The governor is a Republican bidnessman, with everything that suggests. However, the mayors of Memphis & Nashville have taken a strong line on closures, despite some resistance, which has helped. There seems to be a good understanding that what works in Smith County (estimated population 20,157 and 29 diagnosed cases) isn’t good policy for Nashville, an hour and a bit west.

  16. 16.

    terben

    @YY_Sima Qian: One source gives the following breakdown:

    Overseas acquired   4406

    Locally acquired – known source   1945

    Locally acquired – unknown source    601

    Locally acquired – interstate travel   112

    Under Investigation    15

  17. 17.

    YY_Sima Qian

    @terben: Thanks! So local transmission is not high. However, 30% of local cases do not have clear chains of transmission? That seems high…

  18. 18.

    ziggy

    @YY_Sima Qian: Unless, of course, if the national strategy is herd immunity or slow burn, even if by default.

    Yes, it seems the majority of the population of the US has signaled that they are willing to accept a certain amount of death “nobody I know”), in order to try and resurrect the economy faster. Pinning all our hopes on a fast-tracked successful vaccine.  A “slow burn” seems to be the plan at this point, though no one will put it in words. It remains to be seen if we can even accomplish that, or if we end up in more conflagrations that require lockdowns again. I am very curious about how much contact tracing is actually happening, as I haven’t heard anything about it (other than recruiting and training).

  20. 20.

    YY_Sima Qian

    @ziggy: If contact tracers are being recruited and trained, that is good news! There are a lot of people layed off or furloughed, so there is a large labor oool to draw from, with the trillions of dollars being thrown to cushion the depression, surely a few tens of billions can be spent on standing up a force of contact tracers.

  21. 21.

    J R in WV

    Thanks to all you overseas jackals for keeping us informed of your local conditions…

    Esp to YY_Sima Qian for your excellent advice on contact tracing, which so far as I am aware is not happening nationwide here, but state by state, New York is starting up a good effort in particular. There the state government is recruiting people laid off because of the Covid-19 epidemic.

    A vital part of standard health methods to deal with spreading illness for over a hundred years, ignored by the federal government! Unbelievable that Trump is being allowed to screw up such an important thing as protecting the health of the nation!!!

  22. 22.

    Gvg

    @debbie: I can actually. Not with clowns in charge though. Get a competent administration in and it woildn’t Seem outrageous. If it were planned, businesses could adjust.

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