What do I need to know about coronavirus?

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Birdstrike said:
Here's study out of Oxford’s Evolutionary Ecology of Infectious Disease group estimating that 36-68% of the U.K. population and 60-80% of Italy likely have already have been infected with COVID-19, that COVID-19 was around longer than we thought, that fewer than 1 in a 1000 of those infected will become ill enough to need treatment in a hospital, while also agreeing with the social distancing measures enacted.

Here's the study itself.
Here's a layman's summary from @thegenius 's fave, Financial Times.
Click to expand...

The summary is behind a paywall unfortunately.
 
hebel said:
The summary is behind a paywall unfortunately.
Click to expand...
Coronavirus may have infected half of UK population — Oxford study
March 24, 2020 4:19 pm
Coronavirus
New epidemiological model suggests the vast majority of people suffer little or no illness

If the results of the study are confirmed, they imply that fewer than one in a thousand of those infected with Covid-19 become ill enough to need hospital treatment © Tolga Akmen/AFP

The new coronavirus may already have infected far more people in the UK than scientists had previously estimated — perhaps as much as half the population — according to modelling by researchers at the University of Oxford.

If the results are confirmed, they imply that fewer than one in a thousand of those infected with Covid-19 become ill enough to need hospital treatment, said Sunetra Gupta, professor of theoretical epidemiology, who led the study. The vast majority develop very mild symptoms or none at all.

“We need immediately to begin large-scale serological surveys — antibody testing — to assess what stage of the epidemic we are in now,” she said.

The modelling by Oxford’s Evolutionary Ecology of Infectious Disease group indicates that Covid-19 reached the UK by mid-January at the latest. Like many emerging infections, it spread invisibly for more than a month before the first transmissions within the UK were officially recorded at the end of February.
The research presents a very different view of the epidemic to the modelling at Imperial College London, which has strongly influenced government policy. “I am surprised that there has been such unqualified acceptance of the Imperial model,” said Prof Gupta.

However, she was reluctant to criticise the government for shutting down the country to suppress viral spread, because the accuracy of the Oxford model has not yet been confirmed and, even if it is correct, social distancing will reduce the number of people becoming seriously ill and relieve severe pressure on the NHS during the peak of the epidemic.

The Oxford study is based on a what is known as a “susceptibility-infected-recovered model” of Covid-19, built up from case and death reports from the UK and Italy. The researchers made what they regard as the most plausible assumptions about the behaviour of the virus.
The modelling brings back into focus “herd immunity”, the idea that the virus will stop spreading when enough people have become resistant to it because they have already been infected. The government abandoned its unofficial herd immunity strategy — allowing controlled spread of infection — after its scientific advisers said this would swamp the National Health Service with critically ill patients.

But the Oxford results would mean the country had already acquired substantial herd immunity through the unrecognised spread of Covid-19 over more than two months. If the findings are confirmed by testing, then the current restrictions could be removed much sooner than ministers have indicated.
Although some experts have shed doubt on the strength and length of the human immune response to the virus, Prof Gupta said the emerging evidence made her confident that humanity would build up herd immunity against Covid-19.
To provide the necessary evidence, the Oxford group is working with colleagues at the Universities of Cambridge and Kent to start antibody testing on the general population as soon as possible, using specialised “neutralisation assays which provide reliable readout of protective immunity,” Prof Gupta said. They hope to start testing later this week and obtain preliminary results within a few days.
 
Birdstrike said:
Here's study out of Oxford’s Evolutionary Ecology of Infectious Disease group estimating that 36-68% of the U.K. population and 60-80% of Italy likely have already have been infected with COVID-19, that COVID-19 was around longer than we thought, that fewer than 1 in a 1000 of those infected will become ill enough to need treatment in a hospital, while also agreeing with the social distancing measures enacted.

Here's the study itself.
Here's a layman's summary from @thegenius 's fave, Financial Times.
Click to expand...

I'm not a statistician nor an epidemiologist. I don't know what to make of that paper.

What I know (almost all from reading) is that herd immunity exists somewhere between 50-70% of a population depending on the source.
I also read that most people believe there will be an additional spike in the future.

So if a country like Italy, which has 60M people, has already reached herd immunity according to their models, then
1) all the deaths occurred at the end of the viral spread (which is not my understanding of epidemiology)
2) there will be no spike. This is it. Nothing more.
3) lastly it makes the death rate extremely low. Let's say Italy ends up with 20,000 dead (right now they are at 7,500). 20,000 / 30,000,000 = 0.066% That is very very very low and we shouldn't even social distance.

Why did everybody in Italy die at the end of the spread? Are we not counting deaths properly?

It's hard for me to critically appraise that paper because I just don't know enough about it.

I know these are probabilities, and they offer different probability models within their paper with different confidence intervals.

Would love other people who know a lot more about this to chime in.
 
thegenius said:
Why did everybody in Italy die at the end of the spread? Are we not counting deaths properly?
Click to expand...
Probably because viruses like this one spread incredibly fast, but someone critically infected won't necessarily die fast. For example, grandma gets infected 14 days ago, its 7 days before grandma gets symptoms, her symptoms take another 7-10 days to progress to the point of intubation. She lingers in the ICU for another weak on vent, on pressors, gets some hydroxychloroquine, antibiotics and whatever other antivirals the team can think to throw at her and then she dies, 21 days after being infected. In that 21 days, the virus has spread to 10,000 other people, most of who don't die, but who proceed to spread it onward. So there's a lag and it's going to seem the deaths bunch up at the end of the viral spread, because the virus can spread more quickly among the population of people most of whom don't get sick, than it can destroy the entirety of a single person. And if you think about it, it makes sense. It's easy as hell for a coronavirus to cause a runny nose, and another and another, but harder to destroy you en total. And the statistics bear this out: 99% get infected but don't die, and only 1% get killed, because the infecting is quicker and easier, than is the killing which lags.

Just imagine if we gave everyone a COVID-19 vaccination today and stopped any new spread. You'd still have a trailing number of patients dying from it, because they're already infected, immune system already overwhelmed, organs already failing and on track to die.
 
honestly, what percentage of covid patients that coded would ultimately survive to discharge assuming ROSC could actually be established?
 
dadaddadaBATMAN said:
I hope the test characteristics aren’t ****, I don’t want to deal with a flood of false positives seeking reassurance.
Click to expand...
In this case a positive test would tell someone they already had COVID-19, had antibodies and were immune. This specific test, tests for antibodies, not active infection. The test itself, should give reassurance.
 
Birdstrike said:
Probably because viruses like this one spread incredibly fast, but someone critically infected won't necessarily die fast. For example, grandma gets infected 14 days ago, its 7 days before grandma gets symptoms, her symptoms take another 7-10 days to progress to the point of intubation. She lingers in the ICU for another weak on vent, on pressors, gets some hydroxychloroquine, antibiotics and whatever other antivirals the team can think to throw at her and then she dies, 21 days after being infected. In that 21 days, the virus has spread to 10,000 other people, most of who don't die, but who proceed to spread it onward. So there's a lag and it's going to seem the deaths bunch up at the end of the viral spread, because the virus can spread more quickly among the population of people most of whom don't get sick, than it can destroy the entirety of a single person. And if you think about it, it makes sense. It's easy as hell for a coronavirus to cause a runny nose, and another and another, but harder to destroy you en total. And the statistics bear this out: 99% get infected but don't die, and only 1% get killed, because the infecting is quicker and easier, than is the killing which lags.

Just imagine if we gave everyone a COVID-19 vaccination today and stopped any new spread. You'd still have a trailing number of patients dying from it, because they're already infected, immune system already overwhelmed, organs already failing and on track to die.
Click to expand...

Yea I understand that concept you wrote. However their death rate is like 100 fold better than predicted. So something is amiss. The paper is probably out of my league for critical appraisal.

I don't think herd immunity occurs that quickly in a community. The Spanish flu lasted 3 years. And they did social distancing too.
 
Birdstrike said:
Probably because viruses like this one spread incredibly fast, but someone critically infected won't necessarily die fast. For example, grandma gets infected 14 days ago, its 7 days before grandma gets symptoms, her symptoms take another 7-10 days to progress to the point of intubation. She lingers in the ICU for another weak on vent, on pressors, gets some hydroxychloroquine, antibiotics and whatever other antivirals the team can think to throw at her and then she dies, 21 days after being infected. In that 21 days, the virus has spread to 10,000 other people, most of who don't die, but who proceed to spread it onward. So there's a lag and it's going to seem the deaths bunch up at the end of the viral spread, because the virus can spread more quickly among the population of people most of whom don't get sick, than it can destroy the entirety of a single person. And if you think about it, it makes sense. It's easy as hell for a coronavirus to cause a runny nose, and another and another, but harder to destroy you en total. And the statistics bear this out: 99% get infected but don't die, and only 1% get killed, because the infecting is quicker and easier, than is the killing which lags.

Just imagine if we gave everyone a COVID-19 vaccination today and stopped any new spread. You'd still have a trailing number of patients dying from it, because they're already infected, immune system already overwhelmed, organs already failing and on track to die.
Click to expand...

I couldn’t get the article to read — but is that consistent with the fairly low positive tests we are getting (10-15%) in the people we MOST think have covid19??

Does the study take into account data from countries that did test extensively, even mild patients, like S Korea?

seems to me if the virus can infect everyone in a country that quickly then the countries that did test super-aggressively would have had higher rates of positives??
 
Birdstrike said:
In this case a positive test would tell someone they already had COVID-19, had antibodies and were immune. This specific test, tests for antibodies, not active infection. The test itself, should give reassurance.
Click to expand...

Well....given there is nothing to do for COVID-19, a false positive might get them out of the ER faster.

Then they are going to say
"Dooooc...why do I have a fever and dry cough and LIMP-A-PENEA??? Do I have COVID-19?"
"Your test says you already had it. So probably not."
"Doooooccccc I don't believe you. AAAGGGHHHHGHGHGHGH"

and ER life returns back to the way it was in the past.
 
thegenius said:
Yea I understand that concept you wrote. However their death rate is like 100 fold better than predicted. So something is amiss. The paper is probably out of my league for critical appraisal.

I don't think herd immunity occurs that quickly in a community. The Spanish flu lasted 3 years. And they did social distancing too.
Click to expand...
Herd immunity only can come as quick as the virus can spread. Commercial air travel was not widespread in 1918, and the first transatlantic flight didn't happen until Lindberg in 1927, so that virus took years to spread, person to person. Cities and the world, was also not so densely populated. Today, with world population much greater, tightly packed cities, mass transit and thousands of flights going from continent to continent every hour, spread is accelerated dramatically. The quicker a virus spreads, the quicker it triggers it's hosts to make antibodies, thereby reducing the amount of targets for itself to land on.
 
WilcoWorld said:
I am fully in favor of modifying our current behavior in response to new data.

Also, I'd like public policy to be guided by data, not guided by a preconceived target date.
Click to expand...

I'd love that too, but all of our current existing data is either partial, not-relevant to our population, or in some cases completely unreliable (China). If we can't get a complete picture that makes sense, then we need to come off lockdown and take the risk at some point.
 
doctalaughs said:
I couldn’t get the article to read — but is that consistent with the fairly low positive tests we are getting (10-15%) in the people we MOST think have covid19??

Does the study take into account data from countries that did test extensively, even mild patients, like S Korea?

seems to me if the virus can infect everyone in a country that quickly then the countries that did test super-aggressively would have had higher rates of positives??
Click to expand...
I posted the article's full text of the summary article above in post 1262 and the paper itself is here. But yes, it's consistent with only 10-15% testing positive, because that only tells you who has the disease right now. It doesn't tell you if an additional 40%, for example, already had it and developed antibodies and have recovered. Those people would test negative for active COVID-19, despite having been exposed and resolved, and would only test positive if you ran an antibody test on them. Such antibody tests are in development right now, but mostly not up an running. I linked above on that is in development in UK to be sold on amazon and also Mt. Sinai has one in the works.
 
Birdstrike said:
In this case a positive test would tell someone they already had COVID-19, had antibodies and were immune. This specific test, tests for antibodies, not active infection. The test itself, should give reassurance.
Click to expand...

Well that’s what I get for not clicking on the link. I assumed it was a home Elisa based test looking for active infection. There are similar tests on the market for hiv.

perhaps I’m overly cynical, but I envision two scenarios playing out:

1.) it’s positive! I have the corona!
2.) it’s negative! I’m not immune! It must be an active infection!

however, it is wonderful that someone is willing to develop and produce this. Ultimately it is a good thing.
 
dadaddadaBATMAN said:
perhaps I’m overly cynical, but I envision two scenarios playing out:

1.) it’s positive! I have the corona!
2.) it’s negative! I’m not immune! It must be an active infection!
Click to expand...
Of course! :laugh:

dadaddadaBATMAN said:
however, it is wonderful that someone is willing to develop and produce this. Ultimately it is a good thing.
Click to expand...
Yes. Can't happen soon enough.
 
thegenius said:
Well....given there is nothing to do for COVID-19, a false positive might get them out of the ER faster.

Then they are going to say
"Dooooc...why do I have a fever and dry cough and LIMP-A-PENEA??? Do I have COVID-19?"
"Your test says you already had it. So probably not."
"Doooooccccc I don't believe you. AAAGGGHHHHGHGHGHGH"

and ER life returns back to the way it was in the past.
Click to expand...
"But doc, my Aunt Melba use-ta clean bedpans at a nursing home during the war (pronounced whoahh) and she said it can 'm o o - tate' and and I probably have anotha
s t r a i n . . ."
 
Birdstrike said:
Herd immunity only can come as quick as the virus can spread. Commercial air travel was not widespread in 1918, and the first transatlantic flight didn't happen until Lindberg in 1927, so that virus took years to spread, person to person. Cities and the world, was also not so densely populated. Today, with world population much greater, tightly packed cities, mass transit and thousands of flights going from continent to continent every hour, spread is accelerated dramatically. The quicker a virus spreads, the quicker it triggers it's hosts to make antibodies, thereby reducing the amount of targets for itself to land on.
Click to expand...

I understand that...and social distancing also markedly reduces time to herd immunity.
Remember Spanish Flu occurred during WWI, so if you weren't fighting the war in Europe you were probably sitting inside your home doing not much of anything. Because a war was going on.

All I'm saying is there is enough heterogeneity among all the epidemiological sources I'm reading that I call into question whether herd immunity can happen that quickly. At this time it's all conjecture
 
Birdstrike said:
Here's study out of Oxford’s Evolutionary Ecology of Infectious Disease group estimating that 36-68% of the U.K. population and 60-80% of Italy likely have already have been infected with COVID-19, that COVID-19 was around longer than we thought, that fewer than 1 in a 1000 of those infected will become ill enough to need treatment in a hospital, while also agreeing with the social distancing measures enacted.
Click to expand...

When theoretical modeling does not align with empirical data, the empirical data is always the more reliable parameter. We have data from nursing homes where the mortality rate is in the double digit percentage. We have the Diamond Princess cruise ship, where the mortality rate was over 1%. Sure, both those populations skew older and sicker than the general population, but think about how many very old and very sick people there are in Italy and the UK. Close to if not more than 10 million. We'd already be seeing hundreds of thousands of deaths if 60-80% of those people were infected, but we're not, because we're still in the very early phase of this thing. Even in Italy, I doubt much more than 1% of the population has been infected at this point, which has scary implications for how much worse the situation can get.

The Imperial College study reached diametrically opposite conclusions, and unlike this Oxford study, its findings actually match up with what we're seeing in the real world: exponential growth in heavily affected epicenters and progressive and inexorable overwhelming of the healthcare infrastructure.
 
Birdstrike said:
Different source, same subject

"A simple coronavirus antibody home-testing kit could soon be available to order on Amazon" A simple coronavirus home-testing kit could soon be available to order on Amazon in the UK
Click to expand...

Ever talk to someone for a while, start to think you know them, feel like they're a cool, sensible person....and then they burst out w/ some ridiculous claim about ‘functional medicine’

Yeah. You’re that guy to me.

(hopefully you’re right btw)
 
E=mc^2 said:
These comments have aged well.
Click to expand...

Hey no low blows here (although he did write that).

We need a prediction thread...I mean we don't need one, but we do. Problem is my prediction changes every week. I'm standing by a normal flu season range of deaths in the US after 24 months (25-50K)
 
thegenius said:
Hey no low blows here (although he did write that).

We need a prediction thread...I mean we don't need one, but we do. Problem is my prediction changes every week. I'm standing by a normal flu season range of deaths in the US after 24 months (25-50K)
Click to expand...

Not trying to take a shot at anyone, I think these comments are just more about how underprepared we have been as a country for this. This virus will need to be controlled at a population level. We can do all we can as providers, but it starts at the top and it starts with the healthy people. Imo NYC should have been shut down 2 weeks ago. No planes traveling in or out of the city. Most of the cases were from there. Now we look at it and it has seeded all over the country. China shut everything down, and it appears to have worked. Yet as a society we are more concerned with individualism, we dont have militias standing on the street, or highways and roads blocked. I'm not saying we should have malitas in the street, but stronger enforcement of social distancing is certainly something one could argue should be more strongly enforced. I certainly hope that the levels are low, but my concern is there could be waves of this, where we finally get it under control and then it comes back. Spanish flu certainly came in waves, and it hit hardest in the fall. My optimistic value is around 100k. I think this is going to linger though and kill about about 400,000. 10x the mortality + no vaccine + more contagious - affects of social distancing.
 
Birdstrike said:
2019-2020 US Deaths


Influenza: >8,000 (including >50 children)

Coronavirus: 0


-CDC
Click to expand...
E=mc^2 said:
These comments have aged well.
Click to expand...
If you’re talking about accuracy, those numbers have aged incredibly well. They were accurate then and the ratio has held. And here’s the numbers now. Per CDC, US deaths during the 2019-2020 season:

Influenza: 23,000-59,000 deaths (149 children, season, 5 children, past week)
COVID-19: 1,001 deaths (1 child, which now they're saying may not be due to COVID-19.)

Those numbers were accurate on that date. And these numbers are accurate now. Did you think not a single extra person would get the flu or COVID-19 from that point on, and that time would stop because someone posted a ratio on SDN?
 
Last edited:
turkeyjerky said:
Ever talk to someone for a while, start to think you know them, feel like they're a cool, sensible person....and then they burst out w/ some ridiculous claim about ‘functional medicine’

Yeah. You’re that guy to me.

(hopefully you’re right btw)
Click to expand...
Lol. Dude it’s a news article and the original, much better link was broken. Did you expect me to post a double blinded randomized placebo control trial on a test that doesn’t exists yet? But yeah, it’s all good. Just go balance your energy fields and you'll be alright in no time. :laugh:
 
Last edited:
Money-Moniker said:
When theoretical modeling does not align with empirical data, the empirical data is always the more reliable parameter. We have data from nursing homes where the mortality rate is in the double digit percentage. We have the Diamond Princess cruise ship, where the mortality rate was over 1%. Sure, both those populations skew older and sicker than the general population, but think about how many very old and very sick people there are in Italy and the UK. Close to if not more than 10 million. We'd already be seeing hundreds of thousands of deaths if 60-80% of those people were infected, but we're not, because we're still in the very early phase of this thing. Even in Italy, I doubt much more than 1% of the population has been infected at this point, which has scary implications for how much worse the situation can get.

The Imperial College study reached diametrically opposite conclusions, and unlike this Oxford study, its findings actually match up with what we're seeing in the real world: exponential growth in heavily affected epicenters and progressive and inexorable overwhelming of the healthcare infrastructure.
Click to expand...
The Imperial College model predicted 2,200,000 million American will die of COVID-19 this season. We’re at 1,000, or 0.0004% of that. You still think your “exponential growth” (which viruses don’t follow, they follow logistic growth) is going to get us there?
 
Birdstrike said:
The Imperial College model predicted 2,200,000 million American will die of COVID-19 this season. We’re at 1,000, or 0.0004% of that. You still think your “exponential growth” (which viruses don’t follow, they follow logistic growth) is going to get us there?
Click to expand...

I sincerely hope not.

Two weeks ago there were 37 deaths.

Today there are over a thousand.

Every day there have been more deaths than the day before. We are about to become the country with the most cases in the world, and it’s unclear if even the extreme measures we have taken are having a meaningful effect.


there are now 12 states with over a thousand cases and only about 12 states with under a hundred, and I don’t know that I trust the epidemiology in a place like South Dakota (not disparaging it, I just think logistically it would be very difficult), though the population density may provide enough protection for those numbers to be real.

there are a lot of concerning factors in the current state of affairs. I’m not sure the article you posted earlier regarding the virus circulating really passes a sniff test to me. I respect differing opinions on this, and feel the stats in the paper probably goes outside most of our expertise.

In terms of hopeful news there is some appearance in the Italian numbers of things leveling off. Hopefully this is not a false lull caused by decreased testing or an overwhelmed northern Italian health system, though I have heard no data to support that theory. And hopefully when Italy returns to normalcy it doesn’t flare immediately to its prior state.

edit:
Additional point: Italy has about 17,000 flu deaths each year. This virus has killed half that many in a month, and it isn’t anywhere near done yet
 
dadaddadaBATMAN said:
there are now 12 states with over a thousand cases and only about 12 states with under a hundred, and I don’t know that I trust the epidemiology in a place like South Dakota (not disparaging it, I just think logistically it would be very difficult), though the population density may provide enough protection for those numbers to be real.
Click to expand...
Here's a breakdown in every U.S. state
www.worldometers.info

United States COVID - Coronavirus Statistics - Worldometer

United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
www.worldometers.info www.worldometers.info
 
Birdstrike said:
The Imperial College model predicted 2,200,000 million American will die of COVID-19 this season. We’re at 1,000, or 0.0004% of that. You still think your “exponential growth” (which viruses don’t follow, they follow logistic growth) is going to get us there?
Click to expand...

We've been dealing with SARS-2 in this country for a couple months now, but the vast majority of deaths have occurred only in the last several days, and that number will be dwarfed in the days to come. That's what happens with exponential phenomena, they lull you to sleep in the long windup then go supernova by which stage stopping them is almost impossible. Sure they follow an S curve, but all that means is that the population isn't infinite. Saying that new infections will eventually level off even if we don't do anything isn't very comforting when you consider that the reason for the leveling off is that most of the population will have become infected and either pulled through or died.
 
miacomet said:
So, what would be your plan for getting doctors, nurses, police officers, firefighters, pharmacists, green grocers etc to work? Pray tell us....
Click to expand...

That’s true, especially since a significant portion of people working there don’t live in the city.

A certain portion of it is probably necessary. I don’t think it needs to remain open to the entire population.

It’s as bad or worse than an airplane.
 
I wonder how our country is going to address the fact that NYC residents will soon start leaving the city in droves...assuming that has not already started to happen. All those lovely personalities from Manhattan, Queens, and the Bronx seeding infection across the country as they scatter across America. The same goes for Detroit and New Orleans which are right behind NYC in terms of new cases.

I think the Escape from New York is on Netflix. Pretty soon it may be time to embrace our inner Snake Plissken.
 
dadaddadaBATMAN said:
That’s true, especially since a significant portion of people working there don’t live in the city.

A certain portion of it is probably necessary. I don’t think it needs to remain open to the entire population.

It’s as bad or worse than an airplane.
Click to expand...

Actually, the people who live IN the city need it more.
What would be an efficient way, beyond what they have done with essentially a shelter in place order, to dissuade people from using the subway? Issue IDs to grocery clerks?
 
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