Hot mic at White House Covid press briefing. "Everybody here's been vaccinated anyway."

[0R0 + 6,251]

3 hours ago, Ernst Reim said:

Sorry, "never in a million years going to happen"? Where do you get this security?

Currently, 0.14% of the New York City population died from COVID-19. If you extrapolate this to the whole of the US, that is **already close** to half a million and NYC is not over yet. Why do you assume that, without any measures, the rest of the US would behave differently than NYC? In rural areas it will spread slower... but it will still spread.

The 2 million dead are assumed on: no vaccine or break-through wonder cure, 1% mortality and 60% of the population infected until the end of the year. None of these four assumptions are currently contradicted by any data we have.

1st those numbers are inflated. Those are not cause of death numbers but boxes checked for CV19 on death reports from hospitals. They don't check whether the CV19 actually killed them, or was incidental to their deaths. e.g. if you had pneumonia AND CV19 then you died of CV19.  Actual numbers will take months to collect and count, which is why nobody tried to do so yet since cause of death is in text or freehand.

All of the assumptions for the prediction are incorrect.

Treatments are available that reduce the progression of the disease if administered early enough. HCQ/Z among them, also Remdesivir, and the HIV cocktail. They reduce the number of hospitalizations and deaths. Antibody treatment can be applied, monoclonal antibodies are in trial.

Moderna's RNA vaccine is already in trials. Appears safe enough so far. Results will show up in a couple of months. Conventional vaccines are unlikely to succeed, but worth trying. Another vaccine that Oxford physicians are confident enough with so as to start production, is in trials. 

The infection progression is fast. I expect at least 30% of New Yorkers (NYC) and probably far more than that - 70-80% is likely, will eventually turn out to have been infected. 

NY serology test (CNBC)

The results differed across the state with the largest concentration of positive antibody tests found in New York City at 21.2%. On Long Island, 16.7% of the people tested were positive and in Westchester and Rockland counties, 11.7% of the tests were positive. Westchester County is where the state's first major outbreak originated. The Covid-19  pandemic across the rest of the state is relatively contained with just 3.6% of positive test results. 

Similar results of 31% infected from Boston's Chelsea district. 

By the NYC stats, 9 mil X 21.2 % infected = 1.9 Mil NYC cases 12k dead in the 5 boroughs gives 0.65% as the top possible IFR. Actual numbers will have to be lower. 1. because of the reporting bias. 2. because this sampling method may be selective to those less likely to be infected. 

On a NY state basis, that is 2.7 million infected according to this preliminary test, thus 0.58%.

More representative testing will have to be done. But results from CA are also showing much lower fatality rates than these NYC stats show. 

Finally, simple use of an effective mask and gloves lowers your chances of infection substantially. The shutdown, as the people who decided upon it already knew when they decided to do so, was unnecessary. 

[0R0 + 6,251]

1 hour ago, Ernst Reim said:

Ignoring the first part, which is a bit too conspiracy-like for me and ignores the fact that there is a whole world outside the US, let's look at the second statement.

The linked news report is about a new NY antibody study. Let's for the moment completely accept it as fact as reported: "positive antibody tests found in New York City at 21.2%." Thus if the predictions hold true that without vaccination and without isolation measures, infection will go up to 60-80% of the population, you look at a worst case scenario of around 30k to 40k death in NYC, equivalent to 0.4-0.6% of the total population. (That's 1.3 -2.0 million for the total US.)

If you take into account sampling bias (from the linked report: "The testing results also may be artificially high because these are people who were out and about shopping"), you are easy in the reach of the 1% mortality rate which is the number everybody is talking about currently.

It will be interesting to see what some of the experts think of the study. As I said, these antibody tests have high false positive rate, there is a strong sampling bias and whether 3000 tests is "a significant data set" might be argued. But as I said: even believing all of these numbers to be unshakeable truth... they do not even provide an argument for "no need to be afraid".

The people out and about shopping would be segregating from the high transmission group of subway commuters, who would likely not be about shopping in the middle of the workday. Same kind of problem they had in the Stanford study where the SF area population they sampled was self selecting since they sought volunteers via Facebook, so got a  sample of majority white upper class women. Their resulting prevalence data was at less than half the rate of the Santa Clara survey (same area as Stanford) where passers by were asked to volunteer. 

Don't be a panic monger like the epidemiologists hanging on to their solitary moment of importance. 

[Ernst Reim + 33]

First, I am not arguing lock-down vs. other measures here. My reply was to a claim that it is evident now that the initial assumptions were exaggerated. What the right measures would be at exactly this moment, is a completely different kettle of fish.

Second, the probable error bar goes into the other direction: even the linked report of the antibody study notes that sampling the part of the population which you actually find on the streets is more likely to sample infected people. You cannot just claim "because this sampling method may be selective to those less likely to be infected. Actual numbers will have to be lower." Thus IMO and also according to the news flash it is more likely that less than 20% are infected than more than 20%. (Btw. if 80% would be infected already, we would see massive herd immunity effects.)

For the number of deaths, one has to double-check these with the number of excess deaths compared to expectations from recent years.(That's how flu mortality is calculated, btw.) This corrects for deaths wrongly assigned to COVID19 from other causes (people dying with, but not off COVID19) and adds those which were COVID19-caused, but not detected as such. NYC (as Italy, France and the UK) shows more excess deaths than are currently attributed to COVID19. Thus, if the number need to be corrected, than most likely upwards.

But, although I honestly believe in the above, let's ignore any corrections and fly with your numbers: 0.6-0.7% IFR is very close to the number on which the initial prediction were based. Thus, we see that 20% of NYC got infected within weeks before the social distancing measures. I honestly cannot see from these numbers where you can get the security that an uncontrolled spread would not reach 50-80% of the US before the end of the year? And that, using your numbers, would be 1-1.8 million people dead.

Thus from your own numbers, the initial doomsday prognosis that an uncontrolled spread might end up with 1-2 million deaths in the US (which I personally did not believe at that time) seems to be bang on target ! (I am even ignoring that politicians had to react to the likelihood of danger and could not wait until it was evident.)

I readily agree is that there is no reason to continue with a "one-size-fits-all" solution for everybody. What needs to be done in NYC, might not be needed in Utah. One can even argue that the "shut everything down"-reaction was a panic reaction, but that's hindsight. You meet a lot of soldiers who will tell you embarrassing stories of how they overreacted to a danger signal. (That's because you never get to meet the ones who underreact.)

Btw. : I personally think you are overly optimistic with the vaccine. But, again, to evaluate this is really above both our paygrades.

PS:

Just saw your 2nd reply after answering: Actually, the Santa Clara study used a marketing firm to contact people and to balance population. The Stanford one, asking for volunteers via social media, was severely blasted for sampling bias.

But for the NY study, you have an argument. I still think it is more the other way around, but you do have an argument.

I really would not see me as a panic monger, since I rather went from grudgingly following the recommendations to "I have actually underestimated this". But in all cases where we have relatively reliable numbers on actual infections and deaths, the IFR boils down to around 1%. The only justification to claim inflated panic mongering would be if the possibility to infect 60-80% of the population until the end of the year is vastly inflated. However, the flu reaches 5-20% of the population every year, despite vaccination and natural resistance, and everybody so far agrees that the coronavirus spreads faster than the flu.

Edited April 24, 2020 by Ernst Reim

[Douglas Buckland + 6,308]

Perhaps you are correct, there seem to be many unknowns, and assumptions made on these unknowns, concerning the virus.

What is known, and is irrefutable, is that the Draconian measures taken to combat this virus, based on unknowns, is driving the economy into the ground and destroying the quality of life for many, many Americans and others around the world.

A common sense balance must be reached.

[0R0 + 6,251]

27 minutes ago, Ernst Reim said:

Second, the probable error bar goes into the other direction: even the linked report of the antibody study notes that sampling the part of the population which you actually find on the streets is more likely to sample infected people. You cannot just claim "because this sampling method may be selective to those less likely to be infected. Actual numbers will have to be lower." Thus IMO and also according to the news flash it is more likely that less than 20% are infected than more than 20%. (Btw. if 80% would be infected already, we would see massive herd immunity effects.)

 

Incorrect argument in the article. 

It disregards that the highest transmission condition is crammed in a subway at high traffic times. Not out on the street. Same condition, or worse than prison outbreaks where, e.g. Marion OH and Pickaway, the entire prison buildings where there was infection were all infected. All the prisoners and nearly all the guards and staff.  Patient 0 in one of the outbreaks is known, had been on sick leave since Mar 24. 3 weeks later, 1200 people in his building are infected. Practically all of them. 

Test people coming off the subway to get a better sampling of the high probability population.

The argument they made in the article is just plain stupid and comes of ignorance and driven by the need to make a point rather than address reality. 

We can't see herd immunity effects while in quarantine.

Make a sensible argument, not a panicked media argument. 

[Ernst Reim + 33]

7 minutes ago, 0R0 said:

We can't see herd immunity effects while in quarantine.

Make a sensible argument, not a panicked media argument. 

No flaming please!

You have herd immunity when a carrier does not find enough uninfected persons to keep the disease spreading. Typically this is assumed to be reached around 60% infection rate in the population. With 80% of the population infected, NYC would have a seen an extremely strong decline even without quarantine. If you combine 80% of an immune population and quarantine, we would have had zero new cases for weeks.

I just checked the Derek Lowe blog on his take on vaccines and there does not seem much hope for anything before the end of the year: https://blogs.sciencemag.org/pipeline/archives/2020/04/15/coronavirus-vaccine-prospects#comment-317435 He has his opinions, of course, but tries his best to give an objective summary of what came out recently. Well, apart from today's blog post, which he marked as a political rant.  

Edited April 24, 2020 by Ernst Reim

[Ernst Reim + 33]

31 minutes ago, Douglas Buckland said:

Perhaps you are correct, there seem to be many unknowns, and assumptions made on these unknowns, concerning the virus.

What is known, and is irrefutable, is that the Draconian measures taken to combat this virus, based on unknowns, is driving the economy into the ground and destroying the quality of life for many, many Americans and others around the world.

A common sense balance must be reached.

Could not agree more and I am normally more used to be the "we cannot stay locked down forever"-side of the argument.

But ignoring actual numbers by presuming that anybody has an interest in ruining the economy is just plain unhelpful. It seems that the initial assumptions were not far off the mark. But a lot of other countries show reduced or at least stagnating numbers and we need a sensible plan to get restarted which avoids the absolute horror scenario that we might need to stop again.

[footeab@yahoo.com + 2,190]

On 4/21/2020 at 10:17 PM, SUZNV said:

With that lie, only a fool who doesn't know how a test developed believe in. You need first: early access to infected population to take samples and then for developing the tests and try it on infected population. And then prepare all the supplies and start the mass productions. Then will be the delivery with priority.

Lesson for the next disease spreading by air, get used to wearing a mask.  Don't show discrimination against anyone with a mask. He may want to protect you.

TO spare your health: Ignore Enthalpic other than to get a good laugh. 

PS: Et all; highly probable there will NEVER be a vaccine.  Pretending there will be one is absurd.  Only way is herd immunity which means the only true way is to let everyone under the age of 45 get the bug and let it burn through while everyone over 60 self quarantines. 

[0R0 + 6,251]

36 minutes ago, Ernst Reim said:

For the number of deaths, one has to double-check these with the number of excess deaths compared to expectations from recent years.(That's how flu mortality is calculated, btw.) This corrects for deaths wrongly assigned to COVID19 from other causes (people dying with, but not off COVID19) and adds those which were COVID19-caused, but not detected as such. NYC (as Italy, France and the UK) shows more excess deaths than are currently attributed to COVID19. Thus, if the number need to be corrected, than most likely upwards.

 

There was a good analysis of the issue in Italy. They had people remain at home untreated due to the overwhelmed hospitals and ambulance services. This is the cause for the elevated mortality. The problem they had was due to two errors, 1st taking out kids from school without giving their parents leave, so the kids were put with the grandparents. 2nd, they used populated nursing homes to put in CV19 patients. Those nursing homes saw enormous rates of infection and high death rates. 

US even NYC mortality stats for the period are not showing that at all. They show fewer deaths from normal health conditions, heart attacks and strokes. Flu and Pneumonia appear to be declining as well. 

From what we have seen so far, sardine can conditions on flights and worst of all subways, and also bars, 1. put you in close proximity to many people at a time, 2. provide an opportunity for a huge initial infection because of being in someones face when they coughed up the phlegm laden with CV19 virus.

Rational thinkers focused on the mechanics of this will get it right. Those looking at it from the point of view of epidemiological models based on collision theory mathematics will get it all wrong. The population is not uniform. R0 is highly differentiated between high density cities and low density ones. Public transport being the main differentiator, but far from the only one.

This virus is passed by touching public surfaces as well by aerosol. Which is why contact tracing will never help you stop it as it has ultimately failed in Taiwan and Japan and S Korea. It very much did curtail the spread, but was not worth the effort expense and loss of privacy. Oppose it. 

[Douglas Buckland + 6,308]

2 minutes ago, Ernst Reim said:

Could not agree more and I am normally more used to be the "we cannot stay locked down forever"-side of the argument.

 

But ignoring actual numbers by presuming that anybody has an interest in ruining the economy is just plain unhelpful. It seems that the initial assumptions were not far off the mark. But a lot of other countries show reduced or at least stagnating numbers and we need a sensible plan to get restarted which avoids the absolute horror scenario that we might need to stop again.

 

As I said, a common sense balance.

Surviving the pandemic only to be jobless, homeless and broke is not an acceptable balance UNLESS you assume that the State will take care of you from that point onwards.

[footeab@yahoo.com + 2,190]

5 minutes ago, Ernst Reim said:

Could not agree more and I am normally more used to be the "we cannot stay locked down forever"-side of the argument.

 

But ignoring actual numbers by presuming that anybody has an interest in ruining the economy is just plain unhelpful. It seems that the initial assumptions were not far off the mark. But a lot of other countries show reduced or at least stagnating numbers and we need a sensible plan to get restarted which avoids the absolute horror scenario that we might need to stop again.

 

Uh, only countries showing stagnating numbers are those with very few cases to start with.  That way the few cases can be tracked.  Once you have hundreds of thousands?  No, it has not slowed down other than social distancing effects.  In that case, may as well send everyone back to work who is  young and "socially distance" everyone else.

[0R0 + 6,251]

8 minutes ago, Ernst Reim said:

No flaming please!

You have herd immunity when a carrier does not find enough uninfected persons to keep the disease spreading. Typically this is assumed to be reached around 60% infection rate in the population. With 80% of the population infected, NYC would have a seen an extremely strong decline even without quarantine. If you combine 80% of an immune population and quarantine, we would have had zero new cases for weeks.

I just checked the Derek Lowe blog on his take on vaccines and there does not seem much hope for anything before the end of the year: https://blogs.sciencemag.org/pipeline/archives/2020/04/15/coronavirus-vaccine-prospects#comment-317435 He has his opinions, of course, but tries his best to give an objective summary of what came out recently. Well, apart from today's blog post, which he marked as a political rant.  

Well, here it is

 

You see the high temp readings rate in this subway commuter county slowing every weekend (the stairstep pattern) and stopping on 3.14 after the Friday before quarantine. 

 

[Ernst Reim + 33]

1 minute ago, footeab@yahoo.com said:

Uh, only countries showing stagnating numbers are those with very few cases to start with.  That way the few cases can be tracked.  Once you have hundreds of thousands?  No, it has not slowed down other than social distancing effects.  In that case, may as well send everyone back to work who is  young and "socially distance" everyone else.

Aehm, no. Have a look at the numbers on https://www.worldometers.info/coronavirus/#countries

Italy has decreasing numbers of new cases since March 22nd. In Spain, France and Germany the number of new cases go down. Of the top 6 in absolute case numbers, only the UK and the US do not show a clear decline of new cases.

 

 

[Ernst Reim + 33]

9 minutes ago, 0R0 said:

Well, here it is

You see the high temp readings rate in this subway commuter county slowing every weekend (the stairstep pattern) and stopping on 3.14 after the Friday before quarantine. 

 

I am not sure if we do not misunderstand each other. I completely agree that normally you cannot develop herd immunity in quarantine. But you said that you expect NYC to already have 80% of infected cases. If that would be the case, herd immunity would have been already achieved and we should see way less cases.

[0R0 + 6,251]

1 hour ago, Ernst Reim said:

But, although I honestly believe in the above, let's ignore any corrections and fly with your numbers: 0.6-0.7% IFR is very close to the number on which the initial prediction were based. Thus, we see that 20% of NYC got infected within weeks before the social distancing measures. I honestly cannot see from these numbers where you can get the security that an uncontrolled spread would not reach 50-80% of the US before the end of the year? And that, using your numbers, would be 1-1.8 million people dead.

 

Those are the CAPS or upper bound numbers for IFR. Actual numbers should be well below that. 

Particularly if they finally figure out to test prevalence from people at the subway and bus stops. Which is where the core infected population of NYC was most likely acquiring it. Those in the Bronx, Queens, Nassau, Kings, and E. New Jersey. Those people are not shopping in the street. They cram the cars twice a day every day. Those will have high infection prevalence. I would be surprised by anything less than 50% and disappointed in my estimates if it is lower than 60%.

If that is in the ballpark, like it was for Chelsea by Boston, then the IFR would be in the 0.2% range for high exposure conditions like subways, and much lower than that where people are not subject to close proximity over prolonged periods repeatedly. Note that the CFR off the official data is highest in NYC and Detroit. Likely because of these conditions.

[footeab@yahoo.com + 2,190]

14 minutes ago, Ernst Reim said:

Aehm, no. Have a look at the numbers on https://www.worldometers.info/coronavirus/#countries

Italy has decreasing numbers of new cases since March 22nd. In Spain, France and Germany the number of new cases go down. Of the top 6 in absolute case numbers, only the UK and the US do not show a clear decline of new cases.

 

 

So, you did not BOTHER to LOOK at your own link.... Or do not know how to read a graph.....  They are all increasing still.  Only thing that has changed is that the DEATH rate has gone down as how to TREAT it has improved... 

[Ernst Reim + 33]

Just a small clarification: The IFR is the same for high and low exposure conditions. It is your risk when you get infected. High and low exposure does not influence the IFR, just how fast the disease is spreading. NYC got is fast for exactly the reasons you mentioned. But you have to apply the same IFR to the total population as long as you do not dispute that 50-80% will get infected without a vaccine.

[0R0 + 6,251]

1 minute ago, Ernst Reim said:

I am not sure if we do not misunderstand each other. I completely agree that normally you cannot develop herd immunity in quarantine. But you said that you expect NYC to already have 80% of infected cases. If that would be the case, herd immunity would have been already achieved and we should see way less cases.

We saw New Yorkers infect the members of their households. And recover over the early quarantine period. I calculated the integral of the elevated temperature rates and normalized it to flu and pneumonia prevalence and reached ~30% infected by 3.14. Presuming (that is a weak one) 3 people per household with only one infected in each at the start of quarantine, you would easily cross to >80%.

Also, the % positive numbers indicate that people showing up with what would be Flu and Pneumonia symptoms were getting + CV19 results in a growing pattern  reaching a peak of 58% of those tested in places like Queens about 2-3 weeks after the peak on the temperature charts. 

[Ernst Reim + 33]

26 minutes ago, footeab@yahoo.com said:

So, you did not BOTHER to LOOK at your own link.... Or do not know how to read a graph.....  They are all increasing still.  Only thing that has changed is that the DEATH rate has gone down as how to TREAT it has improved... 

Less caps please!

I do not understand where you are going. I said "Italy has decreasing numbers of new cases since March 22nd ". Here is the graph from the link I mentioned:

You probably looked at the first graph "Total Coronavirus cases". That is the cumulative total. It will never decrease.

Edited April 24, 2020 by Ernst Reim

[0R0 + 6,251]

4 minutes ago, footeab@yahoo.com said:

So, you did not BOTHER to LOOK at your own link.... Or do not know how to read a graph.....  They are all increasing still.  Only thing that has changed is that the DEATH rate has gone down as how to TREAT it has improved... 

As footeab is pointing out, France and Italy prohibited use of HCQ/Z for treatment of CV19. As of 2 or 3  weeks ago they permitted it and now 75% of French and Italian patients get the drug cocktail. 

[Ernst Reim + 33]

7 minutes ago, 0R0 said:

We saw New Yorkers infect the members of their households. And recover over the early quarantine period. I calculated the integral of the elevated temperature rates and normalized it to flu and pneumonia prevalence and reached ~30% infected by 3.14. Presuming (that is a weak one) 3 people per household with only one infected in each at the start of quarantine, you would easily cross to >80%.

Also, the % positive numbers indicate that people showing up with what would be Flu and Pneumonia symptoms were getting + CV19 results in a growing pattern  reaching a peak of 58% of those tested in places like Queens about 2-3 weeks after the peak on the temperature charts. 

I am sorry, I am really too slow to get your point right now. If you are right and you have 80% of people already infected, than you do have herd immunity! There are only 20% of people left, which you could infect and it would be under quarantine conditions extremely difficult to actually get these. But we still see daily new cases from NYC, which means that we cannot have reached that point.

5 minutes ago, 0R0 said:

As footeab is pointing out, France and Italy prohibited use of HCQ/Z for treatment of CV19. As of 2 or 3  weeks ago they permitted it and now 75% of French and Italian patients get the drug cocktail. 

That has nothing to do with that graph. It reports new cases of infection. For this graph, it does not matter how you treat them afterwards.

Edited April 24, 2020 by Ernst Reim

[0R0 + 6,251]

29 minutes ago, Ernst Reim said:

I am sorry, I am really too slow to get your point right now. If you are right and you have 80% of people already infected, than you do have herd immunity! There are only 20% of people left, which you could infect and it would be under quarantine conditions extremely difficult to actually get these. But we still see daily new cases from NYC, which means that we cannot have reached that point.

Yes, among subway commuters and their households. Not all of NYC residents. Positives only hit about 40% of tests in Manhattan, while they hit 52-58% among all outer boroughs and commuter counties in NJ and CN. Manhattan got its dose of extra infections upon the return of spring breakers from the infection sharing events of New Orleans Miami Palm Springs etc... Manhattan offers rather short commutes to Manhattan, if any. 

So if you are an upper class NYC resident with no kids at home you probably didn't get infected.

If you are with a kid at home then there is a high likelihood that the whole family had it. 

If you are a daily rush hour subway or bus commuter then probably you and your family all have it. 

Things are not that positive for low density populations of car riders or in CA and WA that shutdown early, where transmission rates were low with R0 <<2 but above 1, as prevalence is in the under 5% and only 5-10% in the city. The only good news is that you would still have a lower chance of getting it and a lower chance of overwhelming your hospitals. 

The big mystery is why FL didn't have more of a breakout than it did. Could be that it was all in the spring breaker population that just left at shutdown, not passing it on to locals and their families. 

Edited April 24, 2020 by 0R0

[Ernst Reim + 33]

3 minutes ago, 0R0 said:

The big mystery is why FL didn't have more of a breakout than it did. Could be that it was all in the spring breaker population that just left at shutdown, not passing it on to locals and their families. 

Wondered about that myself!

[0R0 + 6,251]

30 minutes ago, Ernst Reim said:

33 minutes ago, 0R0 said:

The big mystery is why FL didn't have more of a breakout than it did. Could be that it was all in the spring breaker population that just left at shutdown, not passing it on to locals and their families. 

Wondered about that myself!

I think it is the spring breakers. Because contrary to the rest of NYC, high infections peaked on 3.17 rather than 3.14 in line with the return from spring break. 

And the infection rate dropped precipitously in Miami after the spring breakers left. 

 

[Dan Warnick + 6,100]

Good discussion.  Thanks, guys.