COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...

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RU848789

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The new coronavirus is definitely spreading in the US, as expected, given new cases now in LA and NYC and many other states, as well as the significant outbreak in Washington, where there have now been 10 deaths, meaning things are certainly poised to get much worse in the US in the short term. However, there was some good news, today and recently, worth sharing (yeah in a new thread, IMO), which should help keep this from becoming as bad as many doomsday scenarios are painting, as per below.

https://www.nytimes.com/2020/03/04/...show&region=TOP_BANNER&context=storyline_menu

Today, agreement was reached, in principle by the House and Senate on a bipartisan $8.3 billion law providing emergency coronavirus funding for testing, treatments, supplies, quarantining facilities, tele-diagnosis technology, etc. and the CDC has lifted restrictions on who can be tested for the coronavirus (all that is needed is a doctor's approval), as test kits are becoming available in large numbers everywhere in the US, which means we should quickly get a far better handle on total infection rates and hospitalization/mortality rates in this country (and it will provide peace of mind to those worried that their flu or cold could be the coronavirus - or it will confirm their fears, but at least then allow treatment and self-quarantining). Good to see bipartisan support on this.

The Centers for Disease Control and Prevention on Wednesday broadened the guidelines for coronavirus testing, allowing anyone who has symptoms like a fever, cough or difficulty breathing to receive a test if a doctor agrees.

Doctors were encouraged to first rule out other causes of respiratory illness, like influenza, and to take into consideration whether there are other local coronavirus cases, officials said.


https://www.nytimes.com/2020/03/04/us/politics/coronavirus-emergency-aid-congress.html

https://www.nytimes.com/2020/03/04/health/coronavirus-test-demand.html

In addition, a recent editorial in the New England Journal of Medicine (by leading MDs in the National Institute of Allergy and Infectious Diseases and the CDC) suggests that the mortality rate of the coronavirus, once milder cases are factored in, could be <1%, more akin to a severe flu season ("normal" flu seasons have mortality rates around 0.1-0.2%).

This would still be a very serious threat, potentially killing maybe 5-10X more people than than the flu (which kills 15-60K per year in the US), if no precautions/interventions are taken, given the greater mortality rate and greater transmission rate than influenza. But aggressive interventions (frequent hand-washing, avoiding crowds, aggressive testing, self-quarantining, closure of schools, telecommuting, etc.) are capable of significantly lowering the actual transmission rate (and, obviously the actual number of deaths). Here's an excerpt from the Times article about this and a link to that (and below that is an excerpt from the actual journal article).

Early estimates of the coronavirus death rate from China, the epicenter of the outbreak, have been around 2 percent. But a new report on 1,099 cases from many parts of China, published on Friday in The New England Journal of Medicine, finds a lower rate: 1.4 percent.

The coronavirus death rate may be even lower, if — as most experts suspect — there are many mild or symptom-free cases that have not been detected.

The true death rate could turn out to be similar to that of a severe seasonal flu, below 1 percent, according to an editorial published in the journal by Dr. Anthony S. Fauci and Dr. H. Clifford Lane, of the National Institute of Allergy and Infectious Diseases, and Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention.

https://www.nytimes.com/2020/02/29/health/coronavirus-flu.html?
action=click&module=RelatedLinks&pgtype=Article


And below is an excerpt from the actual Journal article. The biggest thing to keep in mind is that with influenza the ratio of deaths to confirmed cases (by testing) to total infected people is well known after decades of study (and it's re-evaluated for each year), while, currently, all that is "known" now (and not known well yet) is the ratio of deaths to confirmed (by testing) cases (the ~2% number most of us have heard, where most confirmed cases by testing are serious cases, like pneumonia, while the number of infected people is simply unknown and that number is needed to get a true mortality rate (and is why many experts believe the ultimate mortality rate will be <1%).

On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.2

https://www.nejm.org/doi/full/10.1056/NEJMe2002387
 

RU4Real

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So I think the 1% mortality rate is a number that is no more realistic than any of the other previous estimates.

This early in the outbreak, we have basically nothing to go on in determining mortality. Here in the United States there are currently 148 confirmed cases with 11 fatalities. However - there are only 8 cases that are resolved - meaning that the patient is fully recovered.

This means that there are 129 cases that are completely unresolved, either through recovery or death. What's the basis, statistically, for predicting how many of those 129 people will die?
 

DJ Spanky

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In addition, a recent editorial in the New England Journal of Medicine (by leading MDs in the National Institute of Allergy and Infectious Diseases and the CDC) suggests that the mortality rate of the coronavirus, once milder cases are factored in, could be <1%, more akin to a severe flu season ("normal" flu seasons have mortality rates around 0.1-0.2%).
It is so hard to put any veracity on those numbers, as we need to see what the rate actually is in a 1st world country with excellent hygiene standards and a good healthcare system.
 

RU848789

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So I think the 1% mortality rate is a number that is no more realistic than any of the other previous estimates.

This early in the outbreak, we have basically nothing to go on in determining mortality. Here in the United States there are currently 148 confirmed cases with 11 fatalities. However - there are only 8 cases that are resolved - meaning that the patient is fully recovered.

This means that there are 129 cases that are completely unresolved, either through recovery or death. What's the basis, statistically, for predicting how many of those 129 people will die?
The point is the mortality rate for influenza that is widely reported is deaths per symptomatic illnesses (where illnesses are estimated and deaths are known reasonably well) and that number usually varies between 0.1 and 0.2%. For coronavirus, the only data available, so far (mostly) is deaths per confirmed cases, where the confirmed cases are mostly very serious cases of pneumonia, which is why mortality rates of 2-3% have been reported.

There has been some testing beyond serious cases, so there are known symptomatic coronavirus cases and the Journal article I referenced is assuming the number of mild to moderate cases are likely at least as many as the serious cases (which would drop a mortality rate of 2% to 1%) and possibly much more, which could drop the mortality rate to 0.5% or lower, getting close to the influenza mortality rate.

Your question is a different one, which probably has no answer at this point, especially given that the population of the 129 is heavily skewed towards older, less healthy people, which we know will likely have a higher mortality rate - I was thinking more macroscopically once we have tens of thousands of people infected, which we very likely will soon, as were the authors of that article.
 

RU848789

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It is so hard to put any veracity on those numbers, as we need to see what the rate actually is in a 1st world country with excellent hygiene standards and a good healthcare system.
Actually, mortality rates will likely be much less affected by hygiene and health care systems, given that there are minimal effective treatments at this point (other than for secondary bacterial infections) - transmission rate will be though and transmission rate in the US is an unknown right now and will continue to be for awhile - and it will evolve as we see more outbreaks and behaviors change, which is almost inevitable now.
 

mdk01

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There's a cluster in Washington State at that nursing home. I think that skews the statistics.
 
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cohwx

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Pay attention to SKorea. I said this in another thread, but they have been doing vast amounts of testing and have presumably identified many cases that other countries would miss. This should give a more accurate idea of the true rates of symptomatic cases, serious cases, fatal cases. Unfortunately the outbreak is in the early stages and it will be weeks before current cases are resolved.

I don't trust any of the numbers out of China though I do believe their case rates are slowing. I think they kind of have to when the entire population of a province is locked inside their buildings. How many are sick and/or dead in there? And what happens when people start being let out, do infection rates soar again?
 

RUJohnny99

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I saw a report that said the mortality rate for those over 80 is currently 15%.
 

RU848789

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Pay attention to SKorea. I said this in another thread, but they have been doing vast amounts of testing and have presumably identified many cases that other countries would miss. This should give a more accurate idea of the true rates of symptomatic cases, serious cases, fatal cases. Unfortunately the outbreak is in the early stages and it will be weeks before current cases are resolved.

I don't trust any of the numbers out of China though I do believe their case rates are slowing. I think they kind of have to when the entire population of a province is locked inside their buildings. How many are sick and/or dead in there? And what happens when people start being let out, do infection rates soar again?
Agree - South Korea and Japan are pretty hygienic countries with good health care systems and are "ahead" of us on the outbreak. We should watch them closely. Italy also. Countries like Iran, though, would be a bad model - some third world or close to third world countries could be hit extremely hard. Let's hope this ends up being seasonal and transmission rates go down with the warmer/more humid weather, like influenza.
 

cohwx

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Agree - South Korea and Japan are pretty hygienic countries with good health care systems and are "ahead" of us on the outbreak. We should watch them closely. Italy also. Countries like Iran, though, would be a bad model - some third world or close to third world countries could be hit extremely hard. Let's hope this ends up being seasonal and transmission rates go down with the warmer/more humid weather, like influenza.
Have you seen any statistics about the Italy outbreak? The number of deaths is quite high (3.4% or so) and there are a LOT of serious/critical listed, over 10% of identified/active cases. They've tested and identified quite a bit more than we have (over 3000 cases now). Wonder how many of those bad cases are elderly but I haven't seen any breakdown of the cases by age, etc.
 

RU848789

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25,000 deaths out of 3 million cases per year for over 65.
Yep, but was 51,000 deaths in people over 65 in 2017-2018, a bad year for the flu and for those over 65, although those over 65 usually account for 80-90% of total flu deaths, despite being the group with the greatest vaccine rates (sometimes being old and not very healthy just sucks). Flu stats since about 2010 are in the link below.

https://www.aarp.org/health/conditions-treatments/info-2018/older-flu-deaths-rising.html
 

RU848789

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Have you seen any statistics about the Italy outbreak? The number of deaths is quite high (3.4% or so) and there are a LOT of serious/critical listed, over 10% of identified/active cases. They've tested and identified quite a bit more than we have (over 3000 cases now). Wonder how many of those bad cases are elderly but I haven't seen any breakdown of the cases by age, etc.
Death rate in SK is 28 out of 4812 cases or 0.6%, whereas Italy is 107/3089 or 3.5%, both as of 3/3. Obviously very different numbers, probably due to the much older population in hard hit areas in Italy, as per the Times article, vs. SK or maybe due to differences in testing/reporting - hard to say very early in an outbreak.

http://www.cidrap.umn.edu/news-pers...ovid-19-related-protective-equipment-shortage

https://www.nytimes.com/2020/03/04/world/europe/coronavirus-italy-elderly.html
 

RU4Real

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Death rate in SK is 28 out of 4812 cases or 0.6%, whereas Italy is 107/3089 or 3.5%, both as of 3/3.
See, this is what I'm saying. You can't do this.

Of the 3089 cases in Italy, only 383 are resolved - 107 dead and 276 recovered. The remaining 2706 people are still infected and so can't be used in calculating mortality rate. Your 3.5% assumes all of those people will live. That is clearly not the case.
 
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cohwx

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Death rate in SK is 28 out of 4812 cases or 0.6%, whereas Italy is 107/3089 or 3.5%, both as of 3/3. Obviously very different numbers, probably due to the much older population in hard hit areas in Italy, as per the Times article, vs. SK or maybe due to differences in testing/reporting - hard to say very early in an outbreak.

http://www.cidrap.umn.edu/news-pers...ovid-19-related-protective-equipment-shortage

https://www.nytimes.com/2020/03/04/world/europe/coronavirus-italy-elderly.html
Thanks, I knew I had read somewhere that Italy's population was much older but didn't realize it was that extreme. Article notes that "most" deaths were in the over 70 group but doesn't break it down any more than that.


See, this is what I'm saying. You can't do this.

Of the 3089 cases in Italy, only 383 are resolved - 107 dead and 276 recovered. The remaining 2706 people are still infected and so can't be used in calculating mortality rate. Your 3.5% assumes all of those people will live. That is clearly not the case.
Yeah, even in the China case listing (if you believe any of their numbers), there are still over 27000 active cases with 6400 severe. If you were to use only the reported resolved cases you'd get a CFR of 5.6% instead of the 3.7% using the total number of cases. Incidentally, the CFR from the China data has been creeping up as the number of "new" cases is decreasing more rapidly than the deaths. Kind of expected that given the long disease course.

The big question is, how many total infections were there (including minor ones that weren't tested) and how many total deaths were there. Both were certainly under-reported by quite a bit though what the ratio is, no way of knowing. That's where I think SKorea comes in but I'd like to know those numbers now!
 

RU848789

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See, this is what I'm saying. You can't do this.

Of the 3089 cases in Italy, only 383 are resolved - 107 dead and 276 recovered. The remaining 2706 people are still infected and so can't be used in calculating mortality rate. Your 3.5% assumes all of those people will live. That is clearly not the case.
I understand that. I'm simply comparing different rates from different countries. Plus if this virus has twice as many people infected who don't become seriously infected (or more, like flu), the variations we're talking about here get lost in the wash when looking at total mortality rates vs. total infections with symptoms, like we do with the flu.
 
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rutgersguy1

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From CNBC:

5 pm: NIH official questioned about WHO mortality rate

NIH official Dr. Anthony Fauci told lawmakers the mortality rate for COVID-19 could change depending on how many people ultimately fall ill and die from the virus. World health officials said Tuesday that the current mortality rate was around 3.4%, significantly higher than previous estimates. “As a group, it’s going to depend completely on what the factor of asymptomatic cases are,” he said, adding the more asympotmatic cases, the lower the mortality rate. “What we’re hearing right now on a recent call from the WHO this morning is that there aren’t as many asymptomatic cases as we think, which made them elevate, I think, what their mortality is,” he said. “I’m torn. If we get enough data to have a big [numerator] it’s gonna be bad news for us.” -- Hirsch, Higgins

https://www.cnbc.com/2020/03/03/who...-globally-higher-than-previously-thought.html



The World Health Organization had said last week that the mortality rate of COVID-19 can differ, ranging from 0.7% to up to 4%, depending on the quality of the health-care system where it’s treated. Early in the outbreak, scientists had concluded the death rate was around 2.3%.

During a press briefing Monday, WHO officials said they don’t know how COVID-19 behaves, saying it’s not like influenza. They added that while much is known about the seasonal flu, such as how it’s transmitted and what treatments work to suppress the disease, that same information is still in question when it comes to the coronavirus.

“This is a unique virus, with unique features. This virus is not influenza,” Tedros said Monday. “We are in uncharted territory.”

Dr. Mike Ryan, executive director of WHO’s health emergencies program, said Monday that the coronavirus isn’t transmitting the same exact way as the flu and health officials have been given a “glimmer, a chink of light” that the virus could be contained.

“Here we have a disease for which we have no vaccine, no treatment, we don’t fully understand transmission, we don’t fully understand case mortality, but what we have been genuinely heartened by is that unlike influenza, where countries have fought back, where they’ve put in place strong measures, we’ve remarkably seen that the virus is suppressed,” Ryan said.
 

T2Kplus10

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So I think the 1% mortality rate is a number that is no more realistic than any of the other previous estimates.

This early in the outbreak, we have basically nothing to go on in determining mortality. Here in the United States there are currently 148 confirmed cases with 11 fatalities. However - there are only 8 cases that are resolved - meaning that the patient is fully recovered.

This means that there are 129 cases that are completely unresolved, either through recovery or death. What's the basis, statistically, for predicting how many of those 129 people will die?
The mortality rate will end up being well under 1% (most older and compromised patients), just like the typical flu. The story continues to head in that direction.

#mediahysteria
 

RU4Real

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The mortality rate will end up being well under 1% (most older and compromised patients), just like the typical flu. The story continues to head in that direction.

#mediahysteria
Show your work.

Seriously - this is meant to be as much a fact-based discussion as possible. You're busy being the reason why threads get moved. Your entire post was completely baseless.
 

T2Kplus10

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Show your work.

Seriously - this is meant to be as much a fact-based discussion as possible. You're busy being the reason why threads get moved. Your entire post was completely baseless.
I have stated my logic multiple times. The denominator is grossly underestimated. It is asinine to even speculate on the fatality rate without legit prevalence data. Such speculation is all media (MSM and social) hype. There are on average 40 million cases of the flu each year. Does that mean all 40 million were "confirmed"? Hell no. A tiny biased fraction even saw a doctor. The ones that did and became "confirmed" cases are those that are much more sick than the norm. That 40 million comes from decades of data and models. If we calculated the fatality rate of the flu with only "confirmed" cases, the rate would skyrocket.
 
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LC-88

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Have you seen any statistics about the Italy outbreak? The number of deaths is quite high (3.4% or so) and there are a LOT of serious/critical listed, over 10% of identified/active cases. They've tested and identified quite a bit more than we have (over 3000 cases now). Wonder how many of those bad cases are elderly but I haven't seen any breakdown of the cases by age, etc.
Read an article Monday night, cant find it now, that said all 79 deaths as of Monday afternoon in Italy were all over age 63.
 

RU848789

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I have stated my logic multiple times. The denominator is grossly underestimated. It is asinine to even speculate on the fatality rate without legit prevalence data. Such speculation is all media (MSM and social) hype. There are on average 40 million cases of the flu each year. Does that mean all 40 million were "confirmed"? Hell no. A tiny biased fraction even saw a doctor. The ones that did and became "confirmed" cases are those that are much more sick than the norm. That 40 million comes from decades of data and models. If we calculated the fatality rate of the flu with only "confirmed" cases, the rate would skyrocket.
Generally agree with this (except for the media hysteria part - the media need to be sharing the range of potential outcomes and the uncertainties involved). As I posted above, for influenza, the correlations of deaths to hospitalizations to infected with symptoms (but not tested/confirmed, which is the vast majority) are very well known from decades of data. The extrapolation from deaths to hospitalizations/confirmed cases (the same thing, almost, in China) to symptomatic but not serious cases for nCoV are not well known at all, however, as the data just don't exist - we just don't know if it's moderately underestimated or grossly underestimated and until we know that, we need to take the conservative approach and assume the worst credible case.

If the death rate vs. total symptomatic infected patients (most of whom aren't seriously ill) ends up being as low as ~0.5% or even lower, which would not be much greater than the 0.1-0.2% rate for influenza, then this will likely end up being kind of like a severe flu season (but better, since intervention levels will likely be much greater than for the flu). However if the real mortality rate vs. symptomatic infected patients is 1-2%, then without significant interventions, this would likely be much worse than a severe flu season.

I will say when you make solid posts like above, it's more helpful than when you make flippant posts dismissing the risks. I also assume you'd agree that it was great to hear that the testing restrictions have been lifted by the CDC and that working kits are now out there all over the US, which should finally be able to provide us a much more accurate denominator in the US, so we can much better understand the threat.
 
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R1766U

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What are the odds that NJ school districts close because of this? I think a pretty good chance it happens, especially with the advent of digital learning.
 

1984

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Guys, let me say that I love the insights and facts. Several of you're clearly really smart....but when your post 2000 word jornal entries you lose most folks.

You're all smart enough to be able to make your points in 25% of that. I love reading your stuff but just like politicians and other technical presentations...I stop after 2 paragraphs.

Fwiw. Carry on.
 

T2Kplus10

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What are the odds that NJ school districts close because of this? I think a pretty good chance it happens, especially with the advent of digital learning.
Since there are currently 0 confirmed cases in NJ, I hope the chances are also 0.
 

rutgersguy1

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Bergen County gets NJ's 1st case...

The patient, a man in his 30s, is being hospitalized in Bergen County following a “presumptive positive result” of the coronavirus, or COVID-19

The man has been hospitalized since Tuesday, they said. The announcement did not name the hospital or say if the man tested positive after traveling or whether it could be a case of community spread.

https://www.nj.com/coronavirus/2020...ed-positive-case-of-coronavirus-in-state.html
 

RUfromSoCal?

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So, in other words, it's a virus and the professionals of a modern economy are handling it?

Got it. thank you.
 
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