Author Topic: Coronavirus  (Read 233868 times)

Cigarbutt

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Re: Coronavirus
« Reply #2520 on: March 26, 2020, 06:06:36 AM »
The mean age of the patient subsample was 79.5 years (standard deviation [SD], 8.1), of whom,
only 601 (30.0%) were women.
Of all patients who died, 117 (30%) had ischemic heart disease,
126 (35.5%) had diabetes,
72 (20.3%) had cancer,
87(24.5%) had atrial fibrillation,
24 (6.8%) had dementia, and
34 (9.6%) had had a stroke.

The mean number of comorbidities was 2.7 (standard deviation, 1.6).
Only 3 patients (0.8%) had no underlying diseases,
89 (25.1%) had one, 91 (25.6%) had two, and 172 (48.5%) had three or more.

http://www.cidrap.umn.edu/news-perspective/2020/03/italian-doctors-note-high-covid-19-death-rate-urge-action

The patients were sicker than I thought before. 
They had 2.7 comorbidities on average including comorbidities like cancer and stroke.
Only 0.8% with no underlying disease.

The underlying scientific article says following:
https://jamanetwork.com/journals/jama/fullarticle/2763667

Definition of COVID-19–Related Deaths
A second possible explanation for the high Italian case-fatality rate may be how COVID-19–related deaths are identified in Italy.
Case-fatality statistics in Italy are based on defining COVID-19–related deaths as those occurring in patients who test positive for SARS-CoV-2 via RT-PCR, independently from preexisting diseases that may have caused death. This method was selected because clear criteria for the definition of COVID-19–related deaths is not available.
.......
Electing to define death from COVID-19 in this way may have resulted in an overestimation of the case-fatality rate.
.........
The presence of these comorbidities might have increased the risk of mortality independent of COVID-19 infection.

Best post on this thread so far.

Thanks
This study and related have been mentioned before and limitations related to the conclusions also (co-morbidities are now rampant).
Italy has done relatively poorly in terms of outcomes and there are several potential explanations: definition of death cause (when completing a death certificate, one has to document a cause leading to death and to add proximate causes which can be determinant), policy response (timing and type), healthcare resources and management as well as a relatively fragile population.
For the last part, a study published in November 2019, dealing with excess mortality related to influenza in Italy (study available if interested), the authors included the following: "Over 68,000 deaths were attributable to influenza epidemics in the study period. The observed excess of deaths is not completely unexpected, given the high number of fragile very old subjects living in Italy."


drzola

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Re: Coronavirus
« Reply #2521 on: March 26, 2020, 06:12:45 AM »
I am an Population and virology migrant species modeller so read the below rule;

Denominator problems

Another major problem with surveillance is the lack of denominator to calculate incidence rates. Surveillance systems provide data only on cases of disease, not on the population from which they came. The population denominator, which is often unknown in humanitarian emergencies, must come from somewhere else.

Uncertain population denominator

In Goma, Zaire in 1994, deaths were counted by counting the bodies which were picked up for burial by the size of the road. For the month between July 14 and August 14, 48,347 bodies were counted. To calculate the mortality rate, this number of deaths was divided by the population. But what was the population? Some early very rough estimates put the number as high as 1,000,000. Later estimates were 500,000 - 800,000. One camp had an estimated population of 350,000 until a more accurate assessment was done using aerial photography, when the estimate dropped to 180,000. Which number do you put in the denominator?

One recurrent problem in acute humanitarian emergencies is initially using a very rough estimate of total population which everyone knows is probably inaccurate for want of anything better. Then a registration, census, or more accurate assessment is done. Often, the apparent incidence rate of disease jumps suddenly because the population denominator has suddenly declined. To avoid such sudden changes in disease rates, most public health workers continue to use the old, inaccurate estimate unless there is other evidence of a sharp rise in the incidence rate. Or they will apply past disease totals to the new population estimate and recalculate past rates so that they can be accurately compared to current rates using the new population estimate.

In addition, the size of the population in emergencies often changes rapidly. Keeping track of an accurate population size is often very difficult unless there is an ongoing registration of people leaving or entering the population.


Schwab711

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Re: Coronavirus
« Reply #2522 on: March 26, 2020, 06:19:00 AM »
The mean age of the patient subsample was 79.5 years (standard deviation [SD], 8.1), of whom,
only 601 (30.0%) were women.
Of all patients who died, 117 (30%) had ischemic heart disease,
126 (35.5%) had diabetes,
72 (20.3%) had cancer,
87(24.5%) had atrial fibrillation,
24 (6.8%) had dementia, and
34 (9.6%) had had a stroke.

The mean number of comorbidities was 2.7 (standard deviation, 1.6).
Only 3 patients (0.8%) had no underlying diseases,
89 (25.1%) had one, 91 (25.6%) had two, and 172 (48.5%) had three or more.

http://www.cidrap.umn.edu/news-perspective/2020/03/italian-doctors-note-high-covid-19-death-rate-urge-action

The patients were sicker than I thought before. 
They had 2.7 comorbidities on average including comorbidities like cancer and stroke.
Only 0.8% with no underlying disease.

The underlying scientific article says following:
https://jamanetwork.com/journals/jama/fullarticle/2763667

Definition of COVID-19–Related Deaths
A second possible explanation for the high Italian case-fatality rate may be how COVID-19–related deaths are identified in Italy.
Case-fatality statistics in Italy are based on defining COVID-19–related deaths as those occurring in patients who test positive for SARS-CoV-2 via RT-PCR, independently from preexisting diseases that may have caused death. This method was selected because clear criteria for the definition of COVID-19–related deaths is not available.
.......
Electing to define death from COVID-19 in this way may have resulted in an overestimation of the case-fatality rate.
.........
The presence of these comorbidities might have increased the risk of mortality independent of COVID-19 infection.

Best post on this thread so far.

Thanks

It's funny that all of this was posted, but because of the conclusion it's the best post in the thread. This has been known. Overall CFR is going to be slightly less than 1% (probably in the ballpark of +/- 0.5%, depending on efforts to slow down the spread). It increases the expected mortality of every individual on Earth by 2x - 5x (see 2nd post). On average, it is ~100x more deadly than the flu right now (because none of us have immunity this year and treatments are still in experimentation).

Depending on testing, US will look more like China, not Italy. I say that because SK's initial cluster was not representative of the population. It is likely that clustering in NYC at this point is probably representative (maybe skews young).

I still predict everyone will call this a nothingburger in 6 months because the global resources dedicated to improving HC outcomes will make it look like we overreacted. Basically, it's going to be a catch-22 imo. If we stay the course, things will look good and skeptics will think they are right and people will jump back in to spending because of pent up demand. If we say we should just move on, things will get pretty rough, people will stop going out, and we'll overrun the HC system/have a more severe recession. I'm guessing the opposing views will either choose the course of action or be right, but not both.

SK vs. Italy (they have the same CFR by age bracket, infected clusters in Italy were generally older):
https://www.cornerofberkshireandfairfax.ca/forum/general-discussion/coronavirus/msg400925/#msg400925

It's just like the flu:
https://www.cornerofberkshireandfairfax.ca/forum/general-discussion/coronavirus/msg400726/#msg400726

Schwab711

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Re: Coronavirus
« Reply #2523 on: March 26, 2020, 06:20:39 AM »
I am an Population and virology migrant species modeller so read the below rule;

Denominator problems

Another major problem with surveillance is the lack of denominator to calculate incidence rates. Surveillance systems provide data only on cases of disease, not on the population from which they came. The population denominator, which is often unknown in humanitarian emergencies, must come from somewhere else.

Uncertain population denominator

In Goma, Zaire in 1994, deaths were counted by counting the bodies which were picked up for burial by the size of the road. For the month between July 14 and August 14, 48,347 bodies were counted. To calculate the mortality rate, this number of deaths was divided by the population. But what was the population? Some early very rough estimates put the number as high as 1,000,000. Later estimates were 500,000 - 800,000. One camp had an estimated population of 350,000 until a more accurate assessment was done using aerial photography, when the estimate dropped to 180,000. Which number do you put in the denominator?

One recurrent problem in acute humanitarian emergencies is initially using a very rough estimate of total population which everyone knows is probably inaccurate for want of anything better. Then a registration, census, or more accurate assessment is done. Often, the apparent incidence rate of disease jumps suddenly because the population denominator has suddenly declined. To avoid such sudden changes in disease rates, most public health workers continue to use the old, inaccurate estimate unless there is other evidence of a sharp rise in the incidence rate. Or they will apply past disease totals to the new population estimate and recalculate past rates so that they can be accurately compared to current rates using the new population estimate.

In addition, the size of the population in emergencies often changes rapidly. Keeping track of an accurate population size is often very difficult unless there is an ongoing registration of people leaving or entering the population.

+1! It's hard to make accurate estimates quickly

thepupil

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Re: Coronavirus
« Reply #2524 on: March 26, 2020, 06:26:32 AM »
So this is admittedly hearsay / anecdote, but I have several friends that are doctors/on the front lines and they speak of a lot of 30-50 year olds with no co-morbitities that are intubated and/or critical, as well as hospitals not being particularly forthright with respect to the number of cases and severity thereof.

 I have not taken any investment action with respect to this, I maintain long-term optimism, but I do not think this should be dismissed as only killing the old and the already sick.

I always prefer data to anecdote, but these are people I've known for 10 years / went to college with; they are credible and are tops in their respective field (prestigious undergrad, med schools/fellowships.

drzola

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Re: Coronavirus
« Reply #2525 on: March 26, 2020, 06:43:52 AM »
CO-founder of Canadian Cooperative Wildlife Health Center here in Saskatoon Saskatchewan Canada where I collaborate on multidisciplinary directed studies told on of our PHD candidates in these exact words ' it's the dosage and morbidity rate that sets the endemic rate of growth". I never forgot that.

Cheers.

LC

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Re: Coronavirus
« Reply #2526 on: March 26, 2020, 06:54:14 AM »
Quote
If we stay the course, things will look good and skeptics will think they are right and people will jump back in to spending because of pent up demand. If we say we should just move on, things will get pretty rough, people will stop going out, and we'll overrun the HC system/have a more severe recession

I agree with this, and then of course the inevitable political bickering that will result from it.
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orthopa

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Re: Coronavirus
« Reply #2527 on: March 26, 2020, 06:54:27 AM »
Granted this is an opinion piece but this has been my position all along. Will be interesting to see what the end result of this. Glad to see this was published in WSJ.

Yes, your opinion is that, let's say, 6 million were infected as of March 9th. If the infection rate doubles every 3 days, there should be 200 million infected. And by Friday, every single person in the US will be infected.

The problem is that no evidence supports this opinion.

I guess better then your opinion that I was adding zero value by assuming there were way more infections then thought? I believe I said hundreds of thousands/millions fuck me for not zeroing it in with all of my up to the minute tests. How about your 3000 people tested 100 infections in Ontario or whatever that was you posted. I was right in theory, but you my friend were completely wrong with your opinion. Still bothers you huh? ;D

cubsfan

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Re: Coronavirus
« Reply #2528 on: March 26, 2020, 07:14:19 AM »
The mean age of the patient subsample was 79.5 years (standard deviation [SD], 8.1), of whom,
only 601 (30.0%) were women.
Of all patients who died, 117 (30%) had ischemic heart disease,
126 (35.5%) had diabetes,
72 (20.3%) had cancer,
87(24.5%) had atrial fibrillation,
24 (6.8%) had dementia, and
34 (9.6%) had had a stroke.

The mean number of comorbidities was 2.7 (standard deviation, 1.6).
Only 3 patients (0.8%) had no underlying diseases,
89 (25.1%) had one, 91 (25.6%) had two, and 172 (48.5%) had three or more.

http://www.cidrap.umn.edu/news-perspective/2020/03/italian-doctors-note-high-covid-19-death-rate-urge-action

The patients were sicker than I thought before. 
They had 2.7 comorbidities on average including comorbidities like cancer and stroke.
Only 0.8% with no underlying disease.

The underlying scientific article says following:
https://jamanetwork.com/journals/jama/fullarticle/2763667

Definition of COVID-19–Related Deaths
A second possible explanation for the high Italian case-fatality rate may be how COVID-19–related deaths are identified in Italy.
Case-fatality statistics in Italy are based on defining COVID-19–related deaths as those occurring in patients who test positive for SARS-CoV-2 via RT-PCR, independently from preexisting diseases that may have caused death. This method was selected because clear criteria for the definition of COVID-19–related deaths is not available.
.......
Electing to define death from COVID-19 in this way may have resulted in an overestimation of the case-fatality rate.
.........
The presence of these comorbidities might have increased the risk of mortality independent of COVID-19 infection.

One of the best posts here.

As it frames the strategic choice faced by the administration.

Risk losing control of the virus and decimating the country? or perhaps we are over reacting?

How about risk over reacting and risk the lives of hundreds of thousands of Americans that will succumb to
suicide and depression due to their financially ruined lives?

It's a real dilemma - and in a few months we'll know whether the present administration walked the line successfully.

We will come our of this - Trump will be judge accordingly. No doubt, if he locks down too hard and too long UNECESSARILY,
the toll in lives will be greater than that of the virus.

The President's job is to BALANCE the views of his medical experts and his economic advisors - and we will see if he
successfully walks the line.

Liberty

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Re: Coronavirus
« Reply #2529 on: March 26, 2020, 07:14:54 AM »
Trump believes that shelter-in-place is a media plot to undermine his presidency:

https://twitter.com/realDonaldTrump/status/1242905328209080331?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Etweet

This tells us that he is resisting it in order to save his presidency.

Based on his way of operation so far (everything good is because of him, everything bad is someone else's fault who he then hardly even knew), here's what I think his plan is:

He says he wants to reopen. When he can't because governors and cities and companies stay shut, he blames them for the bad economy, says it's not his fault, says they just do it to hurt him, so it shouldn't be held against him in election. Runs election as underdog who's being attacked by all, and all his great plans for the country would happen if not for all the obstruction.

If the measures taken work and we beat this thing, he says "see, I was right, it wasn't a big deal, we went through this for nothing, if you had listened to me, everything would've been fine." (like those saying Y2K was no big deal without realizing it was exactly because of all the mitigation efforts... it's anti-vaxxer logic -- "who needs vaccines, there are so few infectious diseases these days?").

If we're lucky (heavy seasonality? great therapeutics?) and can actually reopen quickly after a peak, he also takes credit for having known it (even though it was a pure gamble with the lives of others).

If things get really bad, he says he always knew it and it's all the fault of governors/mayors/deep state/democrats/etc who are incompetent/evil, as he's already been doing ("I always knew it was going to be a pandemic" "Cuomo could've bought more ventilators years ago" (everybody could've bought more of everything, that's not even wrong.. but he's not exactly bragging about his administration shutting down epidemic units, right, if he had so much foresight..?)).

He sets things up so that the has something to say whatever happens, even if he's actually not trying to figure out what's best to do to beat this thing as quickly and painlessly as possible, because that may be inconvenient to his election and businesses and he doesn't have the intellectual tools to understand complex problems -- his skills as a salesman/BS artist don't help with pandemics.
« Last Edit: March 26, 2020, 09:38:58 AM by Liberty »
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