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Discussion thread VI - COVID-19 (new coronavirus)

the new Spanish strain , "20A.EU1" was it posted here ?
https://twitter.com/firefoxx66/status/1321725353371586560

could this be responsible for the Euro-Oct04-surge ?

it did spread remarkably fast since mid June from Aragon,Catalunya
not seen outside Europe (but take into account the sequencing delay)

I do not have the sequence (GISAID-secrecy) , so I cannot check how it emerged,
where it came from. All I see are strains that already
have the 4(usual-D614G-related)+7 Spanish mutations
but these were probably not acquired all at once
 
Blue/bruised toes and rashes can be triggered by infections, vaccines and drugs, and maybe interactions between a couple of factors.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820236/
Type II mixed cryoglobulinemia following influenza and pneumococcal vaccine administration

Some of these cases aren't even proven to be related to COVID. People are taking more remedies of all sorts at the first sign of feeling less than well, maybe before being sick. Could be why these symptroms are seen in younger, healthier people - good immune systems overstimulated.
 
https://www.medscape.com/viewarticle/938978#vp_2
Across the board, excess death rates have declined significantly, even going negative in some places like Canada. But in this framework, the US has the dubious honor of being number one in excess deaths. The authors acknowledge that countrywide differences may play a role here; the US is younger in general but has more comorbidities. But, of course, they note that our lackluster public health response may also be to blame.

A Canadian size 10-12 would be the same as a size 8 in the US. US women would have to buy a size or two up in Canada to get a garment that fit. The US did this to increase clothing sales. We are generally overweight compared to Canadians. That is not a good thing with this virus.
 
The coronavirus emergency is worsening by the second. We must take immediate action.

Opinion by Editorial Board
Oct. 30, 2020 at 4:18 p.m. CDT

EVERY SECOND you are reading this, another American is infected with the coronavirus. Every 107 seconds , someone in the United States is dying.

https://www.washingtonpost.com/opin...2be07a-1adc-11eb-befb-8864259bd2d8_story.html

It would be easier to 'take immediate action' if there were any evidence that these actions are sustainable and effective.
Shutting everything down is not sustainable, partial shutdowns do not appear to be effective.
So there is an impasse, which only Sweden appears to have avoided among the Western countries.
At this point, it may be that 'riding it out' is less harmful than renewed shutdowns.
 
Have there been any financial studies related to the:

1. Burden of cost for families that are underinsured and require hospitalization and/or ongoing care?
2. Cost of lost work hours due to chronic COVID complications?
3. Cost of family loss when the primary income member dies or is hospitalized for 2 weeks or is in rehab state for an extended period?
4. Medicare costs for the extended hospitalizations and ancillary services to treat COVID patients?
5. Costs to healthcare systems unable to perform standard procedures and surgeries due to an overwhelmed system providing care to COVID patients?

We focus way too much on the Case Fatality Rate - which is significant, of course.

More significant, however, is the ongoing illness and associated health outcomes that will cost the taxpayers billions of dollars while certainly destroying financial security for the hundreds of thousands that will require hospitalization, cannot work because of the new onset chronic illnesses, and their associated increasing debt.
 
Have there been any financial studies related to the:

1. Burden of cost for families that are underinsured and require hospitalization and/or ongoing care?
2. Cost of lost work hours due to chronic COVID complications?
3. Cost of family loss when the primary income member dies or is hospitalized for 2 weeks or is in rehab state for an extended period?
4. Medicare costs for the extended hospitalizations and ancillary services to treat COVID patients?
5. Costs to healthcare systems unable to perform standard procedures and surgeries due to an overwhelmed system providing care to COVID patients?

We focus way too much on the Case Fatality Rate - which is significant, of course.

More significant, however, is the ongoing illness and associated health outcomes that will cost the taxpayers billions of dollars while certainly destroying financial security for the hundreds of thousands that will require hospitalization, cannot work because of the new onset chronic illnesses, and their associated increasing debt.



These costs, although huge, are small compared to the actual economic losses from the destruction of much of the economic activity.
Services make the bulk of the economy, that has been crushed by the government response to the virus.
The multi trillion jump in the Federal deficit to date is only the start of the cost, probably in the $10 trillion range for the US alone..
 
When looking at costs, another considerable element to factor in are the losses to the economy caused not just by mortality but by the morbidity in people who catch it i.e Long Covid. If @10% of people are taken out of economic activity for 3 months and 5% of the working age population are removed from economic activity (along with significant health costs) for more than 6 months at minimum as the data currently suggest (possibly longer) there will be a considerable long term economic burden from long term disease and ongoing healthcare, and if the infections are allowed to become widespread then critical infrastructures may become compromised due to high volumes of workforce off sick at the same time. Add to that the 'unknowns' about even longer term effects on cardiovascular and neurological health in a fairly large subset of the populations, and the health related economic costs for the longer term could get yet higher. Certainly there are many reports of people who needed ICU now requiring dialysis, with huge costs associated with this outcome and there are countless other odd but serious sequelae in survivors of serious Covid disease, all of which have economic (never mind personal) impacts.

Looking at this recent study http://www.ajtmh.org/content/journals/10.4269/ajtmh.20-1015, it suggests that universal mask wearing in all public spaces, indoors and outdoors, is for now the most cost effective intervention available.

Vaccines look like they may only be partially effective and may take some years to perfect, so perhaps the greater research focus for the immediate term needs to be directed towards interventions that can be made early and limit the severity and duration of disease in people to reduce the risks of needing hospital care, with resultant cost savings made to national economies and a greater justification to carry on 'life as normal'. There is a lot of associative data on e.g. Vitamin D but not yet RCTs to establish causality... but basic things like this might well be then most cost effective options moving forward, in addition to mask wearing, and may permit more of 'life as normal' to carry on. I am trying to collate the research data - positive and negative - so that we can get a clearer picture of what the research says so far, and what studies are underway that might provide more answers. What we don't have though is good economic modelling for any of these scenarios that allow governments - regional and national - to make good decisions when they are looking at economies and what may be best for the country concerned, or even the global economy. The other major short term development would be 'on the spot self testing'. Clear of infection? go to work/school/ out or whatever. Infected? Stay at home and isolate. All of these may be better options as far as balancing the needs of the economy with the health needs of populations, rather than simply letting infections run. We also dont know how common reinfections may be in the longer term, nor how serious they may be.

Then there is the big question what happens when a country comes a point where hospital care is saturated? In the US and every other country you have to question about what happens when large numbers of the population cannot get the expert or supportive care they need when they need it. There are costs for lives and working years lost from those who die, and yet greater costs that can be attributed to individuals who are harmed and unable to work for the longer term with major morbidity sequelae (all age groups are affected). Then there are costs that will come with the inevitable civil unrest that would come when large numbers of people have a loved one cannot get healthcare as there are no beds or staff - especially if its for e.g. a child suffering asthma, or a heart attack. If Covid takes up all the beds, then these patients will suffer too and there will be outrage that the expensive insurance or taxes paid are not sufficient to get care, simply because the system is overwhelmed.

For the UK lack of NHS capacity is a big problem and what is driving lockdowns, which are hugely unpopular - and a similar situation exists in other EU countries. Healthcare systems everywhere have very little slack, and some countries are worse off than others. Whilst I am not a great fan of the Daily Mail, its healthcare reporting is actually reasonable - lots of good data on the UK situation here (page down to get to graphs and keep going) https://www.dailymail.co.uk/news/ar...els-predict-4-000-deaths-day-second-wave.html. The bottom line is that UK healthcare provision has been so limited that on current trajectories healthcare systems will be overwhelmed shortly, so we are locking down (we are trying to maintain non covid care in parallel this time - last time everything else stopped, so covid capacity is even less than before). Without the sort of interventions outlined above, there does not seem to be much in the way of other options.

What is the current position in the US? What would the economic and societal impacts of such a scenario be (i.e where healthcare systems in the US get overwhelmed?). I wish that the all the healthcare modellers were actually involving health economists to start looking at the factors outlined above. It might help national leadership make better decisions, faster.

Re: the original question about Financial Reports, I have not been able to find any of any merit that look holistically at all these different factors and try and estimate these costs and risks, short and long term. I am still looking. There are however many that look at impacts on individual business sectors - happy to post these, just not sure where. It would be useful if they were grouped together.
 
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Re. #119.2 Vibrant thanks for your thoughtful post and I look forward to reading any analysis you do produce, assuming you can find the data needed to produce it.

I would like to consider a little the implications of letting it rip as advocated in the Great Barrington declaration. I think this is an exceptionally bad idea and note that Great Barrington quickly came out to dissociate itself from this manifesto.

We can debate the terminology but I think we are still in the first wave which has yet to reach its peak. It is not a classically smooth wave due to the intervention we have made to slow it.


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The graph above shows the Global 7 day rolling average number of new cases.

It may not feel much like it but this pandemic is still in its early phase and has the potential to go much further. The consequence being that we really do not know what the long term impact on the health of those who have had it will be. Gs posted drop in I.Q. figures but I do not know what they were based on, are these short term changes or are they permanent, if long term are they cumulative if we get reinfected every year or two will we keep taking a hit?

Next I would like to have a look at Belgium as an example of a high burden country. It is running at about 20,000 cases per day, not the highest in the world, but if you consider its population and scale it up to US numbers that would be about a third of a million cases a day or if sustained at that level for November would equal 10 million cases or more than all US cases up to today. In active case terms this would be a little over 9 million current infections as opposed to the 3 million the US currently has. Under current measures Worldometer projection data shows the US needing nearly twice as many ICU beds by late Jan. than were used in the April/May peak. Is this a level we can cope with, what about if we get to Belgian levels?
Deaths have come down substantially, as we have stopped trying counterproductive interventions, and worked out how to best manage cases despite not having any disease specific treatments.


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These graphs show Belgian cases and deaths again as 7 day rolling averages.

What are the likely outcomes of letting it rip and what would be the objective?
The objectives seem to be getting the economy going and reaching herd immunity the first could be quickly achieved by removing restrictions but the evidence seems to suggest that current levels of restriction are not enough to stop cases growth and relaxation would quickly place the US at Belgian levels or worse. Herd immunity, in the traditional sense i.e. having so many people immune the virus cannot find new hosts, does not seem achievable and probably will not be even with the vaccines in the pipeline. Serology data from early infections shows antibody titers closely related to the severity of disease with mild/asymptomatic cases falling to very low levels even within the limited time since infection. The more severe cases start with higher levels, so will be protected for longer, but it is too early to say if, and when, these will plateau and if they do what protection that will confer. What data there is looks very like the other common respiratory diseases like the CoV component of the common cold and flu. SARS-1 and MERS follow the same pattern but we have no re-challange data for them. The CoV in colds does not prevent infection but if residuals antibody levels are high enough disease is asymptomatic or mild and re-boosts levels. We do not know how severe these CoVs were when they had their zoonotic moment so we do not know how severe they would be in if they met a completely naive adult we do know on first infection of children but SARS-2 has a different pathology in this age group and they may too. We do know that SARS-1 had about 10 times the CFR of SARS-2 despite being a very close relative so small genetic change can cause very different pathology so direct comparison with colds and SARS-1 is a poor guide but all we have at present.


What is immunity, this is something we need to be very clear about. Protection against infection or protection against disease? It does not look as if infection or vaccination are likely to prevent reinfection for very long, if at all. I expect protection to infection from high levels of neutralising antibodies to last about 3 months and, hopefully against severe disease for a couple of years but after a few months infections may be mild/asymptomatic but the infected will probably be shedding infectious virus. This would mean herd immunity, as per the MMR shot, would require 75% of the population to have been infected or vaccinated every 3 months. A more likely outcome is annual flu/SARS shots giving a similar level of protection as the flu vaccine but what we do not yet know is what that means in terms of either preventing disease or slowing spread. We will probably have to wait at least until next winter to find out.

Where did it all go wrong? We were unprepared, yet again. Anyone awake and paying attention would have been aware that zoonotic disease emergence is part of our history and challenges across the species barrier are occurring all the time. We have paid some attention to influenza but nothing like enough data is collected in the wild bird population to understand what strains are circulating and how close to the point of jumping to us as a host. CoVs are the next most problematic viral family with 4 endemic forms and 3 recent jumps, plus SADS which is currently causing problems in pigs and shows zoonotic potential. In bats we have very little data to base anything much about the range of potentially dangerous strains and what we do have shows the alpha, rather than the SARS1/2 beta strains, are the probably a bigger long term problem. We did develop a broadly acting antiviral for flu but did not bother to do so for Corona virus, not because it was a particular problem to do so but there was no commercial market until this pandemic. The same applies to a vaccine. With the benefit of hind sight this was a costly mistake but we never seem to invest in preparing for any kind of attack apart from by other humans. The other line of neglected research is gain of function experiments, this seems unpopular here at Flutrackers, but is crucial to understanding which of the strains circulating in wild animals are those we should be worried about. We have built ABSL labs of various levels to do exactly this kind of work. We need to find strains that have made the jump, but not sustained h2h, and then use animal models to investigate why they failed to gain a foothold. Serology data tells us that CoVs have infected millions of us, but without going any further, we need to see why and if there are strains in birds, bats or rodents that have that mutation. In SARS case the bat population RBD/Ace2 receptor binding is bat optimised but there are many variants. RtG13 is the one found that is closest to human optimised, of the few we have sequenced but there are going to be others if we look, one of which has successful made the jump twice this century.​ The RtG13 sequence find was serendipitous as the team were actually looking for Nipah virus. Nipah and Hendra are bother recent zoonotic viruses with 50%+ CFRs from bats with pig and horse as intermediate hosts respectively, Ebola probably from bats and HIV came from primates so looking for flu and CoVs is a good start but not the only virus families that need primary research.

The data and graphs come from either Stat news or Worldometer
 
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29-OCT-2020
New analysis reveals 'long-hauler' COVID-19 patients with prolonged skin symptoms

LUGANO, 29 October, 2020 - Some COVID-19 patients experience long-lasting skin symptoms that vary according to type of COVID-19 skin rash, a late-breaking abstract will reveal today at the 29th EADV Congress, EADV Virtual.

Analysis of the largest registry of COVID-19 patients with dermatological symptoms has revealed a subset of patients, called 'long-haulers' or 'long COVID', who experience prolonged symptoms (lasting >60 days) on their skin (1).

... Skin symptoms vary by COVID-19 severity. Some symptoms, such as retiform purpura, are associated with severe COVID-19, since 100% of these patients were hospitalised, while COVID toes travel with relatively mild disease, with only 16% hospitalised. Furthermore, although COVID toes often appear 1-4 weeks after initial infection, 15% were found to still be PCR positive for COVID-19.

https://www.eurekalert.org/pub_releases/2020-10/sc-nar102820.php
--------------------------------
Going viral: A brief history of Chilblain-like skin lesions (“COVID toes”) amidst the COVID-19 pandemic
2020 May 23
doi: 10.1053/j.seminoncol.2020.05.012
Paul R. Massey, MDa and Krystal M. Jones, MDb,⁎
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245293/
 
Facts from the Going Viral" article don't support the virus being causal directly. A politically driven media and research establishment is giving more attention and credibility to the long haul claims and to this toe thing than I think we'll see after the election.

"In one of the first studies on the topic, Piccolo et al reported 63 cases of chilblain-like lesions during the Italian COVID-19 outbreak; PCR data was available for 11 patients, and only 2 (18%) were positive [10]. Recalcati et al reported no positive cases in a separate Italian series of 14 patients [21]. In a Spanish series of 12 cases with available PCR data, again no patients were found to be positive [23]. The strongest correlation between COVID-19 and chilblain-like lesions is provided by a Spanish study in which 71 cases were reported, 41% with confirmed COVID-19 [7]. At the time of this writing in early May 2020, 17 reports have detailed a pooled 566 patients with new-onset chilblain-like lesions suspected to be related to COVID-19 (Table 1 )[5], [6], [7], [8], [9], [10], [11],[21], [22], [23], [24], [25], [26], [27], [28], [29]; formal investigation for active infection, usually by PCR, was undertaken in 172 instances. Among these patients, SARS-CoV-2 was detected in 41 (29 reported by a single study), yielding an overall confirmed infection rate of 23.8%.
This is a strikingly low rate of testing positivity for a viral-associated phenomenon, especially as SARS-CoV-2 can shed for up to 37 days in some patients [30]; at the same time, 23.8% is also above expected background rates of active COVID-19 infection in study locations."
 
Animal models are sentient beings. My opinion is that they suffer needlessly in these GOF experiments taking animal viruses and altering them to infect new species. We are endangered by this curiosity. I agree we need to be more prepared in ways that transcend the question of the 'natural' vs research lab release issue.
From the top down to individuals, I think the needs are clear.
 
We are going backwards.

https://www.newstatesman.com/scienc.../10/why-scientists-fear-toxic-covid-19-debate
30 October 2020
Why scientists fear the “toxic” Covid-19 debate
The hyper-polarisation of discussions about how to handle the coronavirus pandemic risks stifling nuance and undermining scientific inquiry.
By Laurie Clarke
...

However, the backlash that Gupta and some of her compatriots have caused, and the rapidity with which they’ve been tarred as right wing or “unscientific”, hasn’t gone unnoticed by other academics. Baral describes a “tremendous amount of fear in the scientific community” about positing ideas that challenge the positions espoused by Western governments, the UK government advisory panel Sage and health bodies such as the WHO. 

He and like-minded scientists have formed a support network to discuss the situation in private. “We have a WhatsApp group, where we share concerns about talking publicly about these things,” he says. “There are these big names out in the space right now that have a lot of influence, and I think that one doesn’t want to be seen as going up against them.” 

Some epidemiologists I approached for this article said they couldn’t speak to me for this reason. One said by email that for someone who, like them, is at an early stage in their career, “putting your head above the parapet is a dangerous thing to do at the moment”. They said growing frustration “means there is a lot of anger, and a lot of the scientific discourse has become very acrimonious and even personal... It’s beginning to feel like open discussion is being stifled.”

As part of a Reddit Ask Me Anything, GBD author Bhattacharya said: “I've been at Stanford for over 30 years, both as student and professor, and I have never felt a more oppressive environment regarding open discussion of key issues than I do now.”...
 
Emily I am not sure what you mean by sentient as this is a nebulous concept which seems to vary from the original philosophical definition, a range of theological definitions and a more modern scientific definition. They cover the range from self aware which would only be us to being able to sense external stimuli which would include plant phototropic responses and my white blood cells migrating along cytokine gradients. As an omnivorous atheist I would probably go with Vulcan philosophy arguing 'the needs of the many outweigh the needs of the few'. From a more Gaian point of view not eating animals seems a better solution to animal suffering and has the added advantages of reduced human animal interaction - so far less chance of zoonotic disease emergence, less land usage - again less human wild animal interact and slower loss of biodiversity and less usage of water a limited resource which we are already using unsustainably. The suffering of the lab animals is not needless it has a distinct purpose with tangible benefits for other animals including humans. If the experiments are done in appropriate levels of bio-containment for the risk of any given lab escape I think the risk/benefit calculus is acceptable and minuscule compared to a provocative comment by our political leaders about another country. Re. 'From the top down to individuals, I think the needs are clear' I am not sure what you were referring to and I am not sure any of this is very clear. Everything has some risk and you and I obviously are not very clear about which are the greatest.
 
Sweden was in summer - with that new Euro-surge it could be different ...

Czech,Belgium,Switzerland
France tried it without lockdown , but gave up
 
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