No wasn't being sarcastic. There seems to be a lot of "green" around/on the "reds". When they ban inside seating, don't they do it by towns/counties?

The entire states of SC and NC have banned eating in restaurants since last week and both have green.

Id assume its a Franchise vs corporate decisions?

Very sorry to hear this.

I just read that Orleans, Jefferson, and St. Bernard's parishes combined have under 70 ICU beds available currently. I'm sure they can scale up to some degree, but when this hits mid-level cities it's going to be awful.

Question for those who may be a bit more knowledgeable- I've read about people feeling no symptoms or very mild symptoms. Especially in regards to the believe that someone could have it and not know it and spread it.

My question is- when they mention no or only mild symptoms do they mean that there is a percentage of people who will get this and only have no/mild symptoms or is it that people can start out that way but over time their symptoms will definitely get worse? Or is it both maybe?

I've heard both. Some people barely know they ever had it, if at all, and others start out slow and ramp up.

Someone I worked with in our Little League had the virus and is now recovering. He gave me permission to tell others and just gave me what he thinks is the full timeline so I thought I would share it:

1. Thinks he got it between March 9 and March 11. The reason is a guy he worked with tested positive and he was around him those three days fairly close.

2. He had his first symptoms on March 15 (101.5 fever, etc). So, he thinks he was carrying it for 4-5 days before he knew. That means he could have infected a bunch of people. Both his wife and son got it from him in that time (he thinks).

3. He had the fever and had no energy for 7 days. Could barely move around. He's overweight and in his 40s (not sure about his other health issues) but his wife ended up getting tested because she was more functional (came back positive). He was never tested, but I think it's a fair assumption that he had it. All three had the same symptoms, but he had it the worst.

That 4-5 day "non-symptom" period is a I think what makes this so dangerous. Once he got the fever, he wasn't infecting anyone - but he thinks a bunch of damage was done beforehand (esp with his own family). After hearing his story, it just reinforces the social distancing plan for the time being until we get a better handle on things. He and his family are completely recovered now and he's working from home.

As an aside, even though all three had it and recovered, his whole scenario counts as 1 mild case (wife was only tested) with no recovery in the numbers (no one has followed up since his wife recovered).

Both. We don't fully understand why it gets worse in some people than others, but I've heard a lot of people don't get it bad at first. If you're unlucky though, it's gets worse until you get into the pneumonia territory and you have trouble breathing. And that's where the hospital visit often happens.

Thanks for this account especially that last bit. Very good information to consider as I am trying to make sense of the data.

Yeah, I still contend between 500K and a million (or more) have it or have had it in the US. If three people in Ahwatukee, Arizona have had it - a tons more must have. Just in this one instance we know a guy who traveled back east came to Phoenix and gave it to atleast one co-worker, who then gave it to his entire family. I'm sure he wasn't the only one and that whole situation counts as 2 people. I bet 20 ended up getting it from that one person.

I also just saw that 15 college kids at Arizona State tested positive. My guess is the real number is 10X that.

Sorry, wall of text coming ...

Here's what i picked up from having it explained by a couple of friends working/studying in Virology/Epidemiology/Infectious diseases as well as a few Podcasts of german Virologists:

- As for mild/moderate/bad cases: Basically it is thought to start out decently 'mild' in most cases but then some progressively get worse until onset of Pneumonia while most don't get to that point. Then a few of those that get Pneumonia, their immune system and/or lungs/heart have trouble dealing with the reaction.
By comparison the seasonal flu (not the common cold !) has a tendency to more often just bowl you over going from fine to be happy to stay lying in bed within a matter of hours.

This is one part of why this is so dangerous in terms of contagion/spread. (Nevermind the fact there is no working medication) --> More people are able to function pretty normally for a decent amount of time and interact with a lot more people than the average flu patient. (again: Seasonal Influenza, not the common cold)


1) Infected People are thought to be able to infect others before symptoms, which is based entirely on observing known contacts and make assumptions (!) as to when the transmission occured. So not an exact science.

2) But this is also NOT going to happen on day 1 either. A person won't get it, turn around and infect the next person he/she meets nor even likely the 10th he meets on day 2,3.

3) Essentially, there needs to be a certain amount of Virus RNA accumulated for it to be able to be 'shed' in amounts that enable it to spread from one person to the next.

4) The more RNA there is and the more shedding occurs, the more likely it is that a sufficient amount gets 'transferred' via droplets. It's simply math. And the same math dictates that the more contacts there are within society, the more likely each infected person is to spread it to more people. But again, not even every close contact with a person with symptoms would be an automatic infection (This isn't Ebola afterall, thank goodness).

4a)This also means that the 'closer' you are to developing symptoms the more likely you are to infect someone else, simply because you have more viral RNA in your upper respiratory system.

4b) Here now comes the kicker: The better your overall health, the more virus is needed to cause noticeable symptoms but that doesn't mean there is less Viral RNA available to potentially spread around !

4c) Now, if you just sit next to a person for a minute the spreading of viral RNA is obviously much less likely than if you Slow Dance for an hour or otherwise closely interact with a lot of face-to-face time.
And why passing 100 people for a second each in the supermarket (and standing in line facing the back of the person in front is essentially irrelevant btw) is still less likely to lead to Transmission than say going clubbing with your mates, sitting at a restaurant table for 2 hours or interact at school/uni all day long. Or visit your grandparents and talk with them in close proximity.
This is also where the recent study of if being detectable in the air or on surface is misleading. There was no attempt to specify how much there is, only that it is there. So you can assume it happens, but the propabilities don't make this the thing to watch out for.

Anway ...

4d) The more contacts and the more close contacts you have during the time you are infectious before symptoms (be it 1 or 2 days) or while you have only mild symptoms the more likely it is you spread it to more people. And obviously people with mild symptoms or none will have a bunch more contacts than people lying in bed at home. So while those lying at home will be more contagious in a vacuum (they have more Viral RNA to shed and they shed it more violently due to coughing and heavy breathing), they simply don't get into many close interactions.

This is also why obviously people in professions with lots of personal contact are more at risk than others and doctors, nurses and others directly interacting with people with heavy symptoms are most at risk of catching it.

Which is why they are the ones in desperate need of protective gear and lots of it. Not the people that are essentially self-quaranting themselves (which is good) and are afraid to catch it in the supermarket.

4e) Now consider this: What if multiple infected happen to be in the same 'closed' group every day of, say, people at work or University or in Schools ? Because suddenly you have those 10% (fictional number) chances of infection for each person adding up.

And then all those people are likely to interact with at least a handfull of the more vulnerable people outside that close group eventually. None of whome will have any immunity via a Vaccine or due to being infected with a similar flu strain within the last couple years. Meaning the chance of infecting an elderly person (or any other person) with this novel Corona Virus is a lot bigger than with the seasonal flu. Even if you feel perfectly fine.

As i understand it (i am certainly not an expert or knew this before) these points are basically why young and healthy people are thought to be more dangerous as 'spreaders' with this illness than they would be with the flu (which is why that is spread much slower)

Younger, healthier people are less likely to develop symptoms or only mild symptoms yet are still be spreading it in significant enough amount of cases that the vast uptick in human-to-human interactions is the most important factor as compared to those that get really sick fast.

Based on all of this the tentative consensus is that on average without any prohibitive measures a person would be likely to be able to infect about 3 other people. On average, so one might infect 5 and another none. Which is still a lot, especially if you go down the line: 1.4 (flu) x 1.4 x 1.4 etc ends up quickly being a vastly lower total than 3 x 3 x 3 etc. (5 transmission cycles later you are at 243 vs 5.4).

Which is why, in a nutshell, is why scientifically it is essential to impose social distancing with the goal of that lowering the average spread of each infected person to somewhere at least close to the amount of time it happens with the seasonal flu.

It's been stated in various ways, but bears repeating, and Arlie's story is a perfect example: we can't make sense of the data in the U.S. It's incredibly incomplete.





Per a credible rumor, it sounds like my mid-level city is going to get a shelter in place order today due to identified community spread.

And because we don't have enough data, the only option to mitigate the damage is to have everyone isolate. Limiting who isolates won't work because we don't know where the virus has spread.

Another 700 dead in Italy ... And looking at the number of new and actives cases as well as hospitalisations this will go like this for a while still. And for the first time in a while more deaths occured outside Lombardy than inside, which in itself is not exactly encouraging ...

I hope some countries (Germany included) find a way to justify sparing more to help. A few patients have yesterday been transported by aircraft to Germany but that was barely a dozen. But then again this isn't exactly cut and dry with the symptoms progressing so rapidly and the equipment you need during transport (not just on the plane but to and from the airport)

Meanwhile, according to German News Outlet "Spiegel" the G7 can't agree on a joint resolution/statement because the US insists on calling it the Wuhan Virus or it won't sign.

And Pompeo is basically only talking about China's "disinformation" as if that's the important thing to concentrate on right now.

This sounds terrible even if you aren't hospitalized.

https://www.nytimes.com/2020/03/24/m....co/flNUY63O6v

Italy's been at that level for a while now though, so things may be starting to get a bit better in Lombardy. Lower US deaths so far at least than what we've seen the last few days also. Nowhere I see that's having a particularly bad day compared to recent trends. . The way this is going, I'll take that.

3 of the last 4 days have shown a decrease in infections and deaths though which is promising. It seems the exponential growth has at least curbed some. We can hope.

Yeah you gotta see the positives, agreed.

Speaking of which: As the trend in Germany really does seem pretty stable and the numbers simply 'add up' more than elsewhere (low deaths per reported case should mean that it is under at least decent controll) and new development in the medical sector seem imminent* the experts seem more and more optimistic that the Easter date is at least a viable time to shift gears and enter a new stage. Basically there is a point, that now seems semi-realistic, where one can go from damage controll back to sort of hunting down the virus with more and faster tests and concentrate more on procedures to protect vulnerable groups rather than everybody because you can't track who spreads it to whome anymore (as is the case now).
And the longer one can keep the curve flat now the more you can get ahead in areas like protective gear**, testing ressources etc and can then use that spread more widely. So basically it seems semi reasonable that instead of merely avoiding collapse we might be able to get ahead.

It will take longer for the US to get there though i would say and even longer for Spanin or Italy. But even there some news are good: China has ramped up production of medical equipment again (remember, they are the No1 supplier) and Spain has ordered a shitload of everything.

* According to one of the foremost virologists advising on this a usable Antibody/Genetic Test is very close
** New data suggests that the lesser quality masks offer a more reasonable protection for the healthy than initially thought. But of course, those have to be produced as well before you can use them on a wide basis.


Would wait until the evening, as more cases and deaths are processed it becomes more likely they just haven't been entered into the database(s) yet. Sth. to keep in minds on weekends as well. I mean, ultimately it doesn't matter as it's not healthy to check them every hour anyway and doesn't tell much either, but you just know a guy like He-Who-Must-Not-Be-Named will see low numbers one Sunday evening or Monday morning and tell everybody the worst is over.
And then when the numbers go up the next 2 days will yell on Twitter how the CDC/Governors are lying on the stats because they want to hurt the economy.

I have to say I'm a little bit worried that the beefed up unemployment benefits in the relief\stimulus bill appear to be presented as if they're going to be offered to be everybody but are also explicitly being announced as benefits for 'furloughed' workers (AKA nobody).

Here's one I didn't expect: schools in my province are being ordered to dismantle their play structures, since I guess parents are still taking kids to play on them despite the orders not to.

I have seen picture here of public playstructures that had to be boarded up. People are people, sometimes you have to help them along on the path to making a smart decision ;)

An example of what definitely is overkill, unless there is a disease circulating that only he is aware off:

https://twitter.com/Paris__G/status/1242584266585899008

In any case he might consider brewing his own coffee ...

Seeing so many people in parks together now



SI

Genetic tests of the virus showed it probably started spreading in the Seattle/Tacoma area in mid to late January. As far as I know they never identified the person that spread it to the Kirkland nursing home which shows it was already out of control. Based on how quickly we're seeing it spread we can draw some conclusions as to how widespread it was before we even got testing underway.

The University of Oxford infectious disease lab had a statistical model that reported that the virus arrived in the UK in mid-January and has infected up to half of the UK population by now.

Coronavirus May Have Infected Half of UK, Oxford Study Says

And the numbers from most European countries are showing less than their peak of new cases and deaths the last few days.

The Stanford biology professor who won the Nobel Prize and pretty closely projected the China trajectory has an optimistic view of the U.S. trajectory.

Nobel laureate predicts US will have much faster coronavirus recovery than expected

Certainly some good news out there.

I live in a town home complex with a very nice green belt / park area in the center. Typically, my wife and I walk our dog in there with no one around. The last couple weeks it's been packed. People are staying in clumps, and usually do a good job of keeping their distance from other clumps...but there are soooooooo many more people around than typically.

I actually dread going outside, because I don't want to have to talk to any of my neighbors. I really don't.

I saw that Oxford study. Just doesn't seem plausible. If it were the case, why weren't we seeing cases showing up in the ICU? Did that 50% not have any serious cases?

Then again, without enough data, we are flying blind. It could be anywhere between this study and the Imperial one. We just don't know till we have mass testing for the virus and antibodies.

I read that study (it is very short) and seems very sketchy.

If that study was true the UK would have somehow (even going from their numbers that pretty much assumes this isn't even as dangerous as the flu, which is insane unless british seniors and other vulnerable groups have somy mystical protection) and if you assume the death rates are somehow even less high than hospitalisation rates: they must have managed to miss about 60k additional hospitalisations over a 2 month period* that pretty much all showed the same range of symptons. Considering they dont have all that many hospital capacity i find that hard to believe.

* And exponential and undetected growths means a lot of people get sick at the same time after a few weeks and then more and more, not the same amount every day from the start. So not 8k a week but youd start at a few hundred hospitalisations (easy to miss) and would have reached insanity by now.

How do you go from 50 people infecting 150 infecting 450 etc to 10-15 mio in the end (at the same time) mio and never get a wave of seriously ill people that you would notice ?

But then again i fully expect the narrative to gain steam that the lower growth rate in the next few weeks (hopefully) will mean the restrictions were overblown rather than the reason why the curva was flattened.
And Italy and Spain were just unique outliers and not merely too late with restrictions for what spread they had missed early.

I also think what's happening in Spain and Italy show how unlikely it is. If this wasn't that deadly, why are they seeing so many deaths?

I haven't seen support for the assumption that hospitals had the same traffic as usual in February. The CDC has said that flu hospitalizations were high in February, double that of some other years. And nobody outside of Washington was testing then. Even though we know for a fact it was here.

Even now, while we're hearing reports here and there of busy hospitals at capacity, it doesn't seem to be at a crisis level in most of the U.S. yet in that regard. It doesn't seem crazy to me that hospitals are overall "very busy" now following a "busy" February that didn't necessarily warrant national news. And infections peaking now or a little later would mean a "very very busy" April. (or a month later if it takes longer).

And the opposing question is, if nobody or only a small amount of people were infected in February, why was the virus so dormant for weeks when other evidences indicates it spreads quickly and easily, often through highly mobile young people with no or mild symptoms?

Is that any more unlikely than the guy coming back to Seattle from China with it in mid-January, somehow spreading it to a nursing home in Kirkland in mid-February (but nowhere else) , before it took off at the beginning of March?

I think the nba team testing shows some evidence that this isnt true. They have quite a bit of exposure to other people and when they tested full teams, you usually had 1-2 positive. Other sports teams have similar rates.

Not dormant, exponential growth. The average person infects 3 others with no barriers put up to slow it. Some more, some less but only a small portion of people an infected person interacts with catch the disease from him. This is way more contagious as the flu,but it isnt some sort of super-virus.
And even going from mid January: thats enough time to be widespread, but not Close to being this widespread unless there was a really, really high number of chinese infected coming in in a very short period of time.

The first few weeks it is absolutely feasible that there are merely a few more flu-like cases (although this disease does not progress and present the same way as the flu once in the hospital stage, otherwise the chinese would not have noticed as early as they did) and it skates past. But the cases would not grow in a linear fashion but exponentially. You don't go from 1k to 2 to 3 to 4. You go from 1 to 3 to 9 to 27k.
And even if it starts to spread mainly in, say, the 20 - 40 year old demographic. All those people interact with their parenty and grandparents as well, no ? And it is just not the case that you spread it to the first 3 or 4 (young) people you meet and thats it. That's not how transmission works.

Italy and Spain do have societal factors in play (more Young adults living with their parents and a lot of 3 geneeation living and Close family contact in general) but that does not explain that much of a difference if really 50% of both populations would have it by now.

Yes. Not knowing the details admittedly, but one unusual case is a lot more likely to happen than thousands.

Based on what we know of the Kirkland nursing home it's incredibly unlikely.

Two people died of the Coronavirus on February 26th and at that time an additional 50 residents and employees of the nursing home were showing symptoms. In the days and weeks leading up to that point the nursing home had taken zero precautions. They were having family visits, group activities, and parties.

I'll put it a different way - do people really think there are only 65,000 total cases in the US? Knowing everything that we do about how this gets passed (esp in early March before people were social distancing), it has to be 10-times that at a minimum. Just the two cases I know around me as an example. There were 8 people that got it in mid March and all have fully recovered. Yet, only two were tested and not followed up with (so the 8 recoveries are shown as 2 people in mild condition with no resolution yet). I think each recorded case probably involves atleast another 5+ not tested/caught.

Oh I think it's way more prevalent in the population. I just don't think it hit half the country already and we avoided seeing a massive jump in hospital stays like they are in Italy, Spain and New York.

Italy and Spain are showing this is much more deadly than the flu just on sheer volume of deaths.

This is bad news.

3/ OK,

here's something worrisome (as if we needed it)

If you look at the new cases reported since yesterday's update, there were 5k new cases reported from NY, and 12k new tests, for a 42% positive rate. That is astonishing, and suggests that the outbreak hasn't peaked yet

— Farzad Mostashari (@Farzad_MD) March 25, 2020

It also seems to indicate there is virtually no tracing and testing of known contacts most tests happen in hospitals on patients showing up with symptoms. Otherwise you would not not get such a track record. But that again would point to it being fairly widespread to create that many people they can easily identify. (Because 12k is by far not enough to assume they do widespread non-targeted testing, i think)

Even in Germany quite a few hospitals are having to use newly created intensive care beds with Ventilators already and by all Accounts we have it under decent controll numbers wise, have a lot of younger positively tested (47 avg vs 65 in italy) and started with just about the highest per-capita number in the world for these beds.

The problem is the patients that need them need them for a long time with many needing them for 10 days or more (,which must be a harrowing ordeal). So if a hospital has 100 of those, that's really only 10 per day.
And once they are above capacity, death rates are bound to spike. And again, you cant easily move them from one hospital to the next and shift them around at will or know how many of your 'moderate' patients will need one and when.
And of course other illnesses don't take a holiday now either. This would be a very bad time to fall seriously ill in New York or even fall down the stairs.

You were right. Hope got the better of me, I'd been checking at about the same time daily but some of the reports were apparently later than usual today which makes sense. Worst death count yet for Spain and at best the US will be about even with recent days. New York is running out of beds/ventilators in spots now and thinks they are still three weeks minimum from the worst of it.

TLDR: Crap.

Ah, now i get it. But yeah, what Rainmaker said : much more widespread, but cant possibly even close to half the population.

Also, nursing homes are 'closed systems' and in those 1 or 2 infected patients by visitors are bad enough but as soon as a nurse has it it will quite naturally lead to this spread. It happened at one here where you could pretty definitely track all 30 infections and 10 deaths to one family that visited.

Oops, I shared something and then was told not to....you didn't see NUTHIN.

Same in the hospitals where my friends work. Though they said essentially most of the drop is due to the current situation discouraging those with the stupid and/or harmless shit people show up with usually way to often. Plus yeah, a lot less accidents big and small Especially walk-ins are way down to the point one of my friends is volunteering for shifts at the 'welcome desk' to get a paper done he's working on.

And ideally potential covid19 patients should be checked pretty much anywhere but the ER i assume due to the risk of spreading it there to other patients with underlying conditions, injuries or staff.

Maybe "visits" are actually based on admission (just assuming) even the walk ins might not show up ?

At least the 2 hospitals i know people at try to seperate them as early as possible. Potentials will be isolated as much as possible from each other already and those that were tested before (those that were tested early and then quarantined) definitely are.

Not a lot of Covid patients yet, so remains to be seen if it can be done so neatly.

That makes sense.

Also, german hospitals have been rescheduling a ton of procedures (either moved them forward or postponed them) for the last few weeks and especially stuff like orthopadic surgery or anything elective is pretty much put on hold. And other departments were moved to different partner hospitals that are not well equipped for Covid patients anyway.

And many staff get crash courses on procedures and machines to step in if regulars fall ill.

Definitely a weird time for them from what i gather.

There was interview with an epidemiologist professor on the BBC just now who said that the stats so far show that the peak number of cases seems to be 4 weeks after lockdown, and then they start to plateau...

So immediately I’m thinking well that sounds like we’ve got to have at least 6 weeks of lockdown then right? 4 for it to peak, however long the plateau lasts, then at least 2 weeks for symptoms to show/not in those remaining?

The hospital where I work currently has a "dirty" entrance to the ER where those with symptoms are taken directly into an isolated area and then the "clean" entrance for those with typical ER issues.



Washington has canceled all elective procedures along with any procedure that can be postponed for 90 days without causing long term damage to the person's health. This has allowed where I work to temporarily close several departments and use the top 2 floors for potential COVID patients.

The problem is that it's true of /all/ of the data from fatality rate to what a "mild" case is. The biggest body of data is from the China cohort but it's pretty clear that it's heavily biased if not downright altered. Most of the other data is too recent to draw meaningful conclusions. And pretty much every other country is playing fast and loose, too, be it from deliberate incompetence (USA) to garden variety incompetence (Italy) to selective data interpretation (Germany).

At the end of the day, the "official" count of the infected and dead is going to be dwarfed by the actual count. It'll be a fascinating case study down the road. But I don't want to be part of that data.

SI

My best guesses have us reaching about 1M actual cases this week. That's a lot but that's still only 1/300th of the population. That's far from a peak.



SI