Coronavirus Medical news (NOT political)

A thread to share medical news about the virus, let’s please not make it another politics thread, about Trump.

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From the abstract (emphasis mine):

Conclusions The population prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases. Population prevalence estimates can now be used to calibrate epidemic and mortality projections.

This isn’t peer reviewed yet, but it is an extremely significant finding. It was already known that Dr Jay Bhattacharya, Professor of Medicine at Stanford University was given a grant to do a pair of studies for Covid-19 antibodies. One in Santa Clara County which comprises this paper; and one in Los Angeles County which I assume will be announced in a separate paper.

This study result shows far greater penetration of Covid-19 than previously estimated. With a confidence interval of about 50x to 85x previously confirmed cases.

Many had thought Dr. Bhattacharya’s study ought to find this outcome as this appears to be the most reasonable explanation for why the US and Canada west coast in total has fewer cases and far fewer deaths than New York City alone. Even today, nearly three months following the first cases confirmed in Washington state and California, Covid-19 is still progressing much more slowly and likely was doing that long before the shutdown orders were issued.

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On the contrary,these data show that infection was progressing far more rapidly than thought. What evidence is there to suggest that the slow down was occurring long before the shutdown orders were issued?

Perhaps I phrased that poorly. Infections have been increasing far more rapidly than thought, but the value of this finding is that Covid-19 is evidently not as bad or as fatal on a percentage basis as previously assumed, hence the confirmed cases haven’t approached the New York numbers, hence it seems a lot slower than New York.

Essentially the two facts coexist and have to be reconciled: (1), there are fewer cases and far fewer deaths in California relative to New York and (2), the level of infection in California is far greater than previously assumed.

Now to look at your assertion: there is no proof either way as we didn’t have antibody tests back then. So any reasoning about this will have to inferred from other evidence that we do know about.

First, we know there were cases in Wuhan as far back as October when the alarm was first raised there. There could have been cases present as far back as September given it would likely have taken some time to reach a mass critical enough to get the Chinese doctors to raise the initial alarm.

Second, we know the approximate level of travel between Wuhan and the west coast of the US and Canada. Which as you repeatedly asserted never really stopped.

Third, we may be able to infer a much higher infection rate in Wuhan than previously assumed. If the Chinese have their own antibodies test, they could have told us that because it could have informed their decision to restart in Wuhan. So infected persons could easily have traveled to Vancouver, Seattle, SF and LA all along.

With these factors present, I don’t think it is unreasonable to infer that the infection was already present in California and Washington state well before the first cases were confirmed there in mid-January.

Looking for your counterpoint.

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It will be interesting tee see the results of antibody testing in NY. They may have the same factor of ~65 greater infection rate than appreciated.

CA was quicker to mitigate.

And may also be in NY.

We do?

Perhaps. I know a number of people who believed that they had the disease back in September.

Overall this good news. If we have this greater infection rate than “confirmed”, we would be ~20% of the way to herd immunity. We still have a long way to go.

dvdjs . . .

On the contrary,these data show that infection was progressing far more rapidly than thought. What evidence is there to suggest that the slow down was occurring long before the shutdown orders were issued?

The Stanford data.

THE SUBWAYS SEEDED THE MASSIVE CORONAVIRUS EPIDEMIC IN NEW YORK CITY

Ya think? Seems to be the rationale for the need of social distancing, stay at home, and shut down of businesses that contribute to such “seeding”.

Along those lines, we have this:

and this:

CA had no official distancing policy until Governor Newsom and Los Angeles Mayor Garcetti announced shutdowns on March 16 to take effect three days later although many entities were taking smaller steps sooner.

There isn’t much about pre-December discovery any more as the Chinese have suppressed this quite hard. I saw articles around a group of doctors in Wuhan who sounded the alarm in October and were silenced, but now I cannot find any of them. Suspicious. I won’t weigh in on the debate around the exact origin, but there is some inference pointing to cases dating back to last fall, before the official acknowledgement of a December origin. Here’s one article along those lines.:

Other articles that infer an earlier start:


and

If we’re take the much higher infection rate as fact, as appears to be the case, that in itself implies a much earlier start than supposed.

An infection rate of 30% in an area implies that area is much closer to the end than the beginning. Days if not weeks.

Thanks for the links @Zzyzx

Or it could be wholly due to a higher rate transmission, a greater Ro, over the same, given time frame. I don’t think that the Santa Clara or MA studies necessarily reflect an longer time of exposure to the virus - but the mutation studies - may. The epi studies in Milan and China may. And that may be possible now, in retrospect: this work makes it clear how difficulty it is to see the whole picture are the start of what only later is recognized as an outbreak.

I read the Stanford paper. It may suffer from a self-selection bias, IMO. The respondents were not representative of the community on gender zip-code and race. (The results were weighted to compensate). But even at face valuer, they were talking about a ~3% infection rate. That is still a long, long way from herd immunity.

The MA studies involves cluster sites. The results are interesting, again pointing to high rates of transmission. But because they are cluster sites, the results there should not be assumed to reflect the infection rate throughout MA, or even the Boston area.

Closed environments facilitate secondary transmission of coronavirus disease 2019 (COVID-19)

Hopefully the research will lead to opening parks, people need sun and exercise.

In Montreal most parks are still open but are heavily patrolled to enforce physical distancing; the fine is $1546 CDN if you don’t. They did close the parking lots in major parks to avoid too many people accumulating but you can still walk/ride/use public transit to get to them. They are asking that folks use the parks in their own neighbourhood as much as possible.

Also cycling, walking and running are still all permitted, also with physical distancing. I live in a rural area and have been biking around 160 km a week (100 miles), weather permitting, since the snow melted. It has helped me retain my sanity.

Admittedly it can be a bit tricky maintaining distancing in the city, because the sidewalks are too narrow. However low traffic levels have helped, and on major arteries the city has been closing down traffic or parking lanes to make more room for pedestrians.

Some other towns though have closed parks. I do agree that fresh air and exercise are beneficial. In order to reduce risk, I’ve mapped out a 25 km road cycling circuit that keeps me within a 10 km radius of my home, i.e. I could walk home if I had a breakdown. I do 1, 2, 3 or 4 circuits depending on how ambitious I am; usually two does the trick. Today I did the same for a gravel road circuit.

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Covid19 and toilet transmission

Keypoints:

  • 35 aerosol samples were taken from different sites of two different hospitals in Wuhan, China
  • The samples were taken from filtered air and surface areas in the respective locations
  • A PCR test was done to confirm the presence of SARS-CoV2
  • Most places the detection was negligible except for the ICU and patient toilets
  • After rigorous sanitization, they were no longer detectable
  • Conclusion- room ventilation, open space, proper disinfection of toilet can limit transmission

Analysis:

  • Toilets may be another source for air to air or surface to air transmission
  • Air transmission is possible up to 3 hours
  • Surface transmission is possible up to 3-4 days
  • Consider separate toilets for self - quarantine or sanitize the toilet daily 3 - 4 hours after the Covid+ family member uses the toilet
  • Ventilation of the toilet is another issue as it can transmit to other areas if it is an apartment complex.

Source:

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” CDC Director Robert Redfield said in an interview with The Washington Post. “And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.”

“We’re going to have the flu epidemic and the coronavirus epidemic at the same time,” he said.

Having two simultaneous respiratory outbreaks would put unimaginable strain on the health-care system, …

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The virus found in her eyes appeared to be viable and continuously replicating after 27 days.

RE all of the testing showing asymptomatic people - could the tests be wrong?

Maybe there could be a co-ordination between southern and northern continents regarding medical resources to cover for the different seasons.

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