Coronavirus prep

cmriverside wrote: »

Nony_Mouse wrote: »

paperpudding wrote: »

yes that is why I am confident we do have it under control in South Australia - and most other australian states.

Because very low number of new cases is not a reflection of less testing - in fact the opposite - as of a week ago, anyone with any flu like symptoms, no matter how mild, can be tested.

Of course there is the possibility of infected people not getting tested - but given high numbers of tests being done and very low numbers of community transmission, that would seem unlikely.

There is also possibility of false negatives - but I guess one has to have some trust in the system - and again very low numbers of community transmission would suggest it is extremely unlikely people are falsely testing negative - because if that were so, they would falsely be getting all clear to go to work etc - and we would see more flow on cases with no known contact cause.

Social restrictions remain in place - but not as tight as some places, including eastern states of Australia.

All incoming people , with very few exceptions, whether from overseas or interstate, must self quarnatine for 14 days.

Yep, same for NZ - so much as a sniffle and you can get tested, and that will continue as restrictions lift. People are being encouraged to contact their GP or Healthline as soon as they feel unwell, because maintaining control requires identifying and isolating any new cases plus close contacts as quickly as possible.

We had a bit of a dip in numbers being tested (Australia did too), simply because there are fewer respiratory illnesses circulating due to the restrictions in place. We haven't actually had any days where full testing capacity was reached (day before yesterday was the highest, with 5289 tests processed, only 6 came back positive).

Here, we have a category of 'probable', for where a test result has come back negative, but all clinical signs point to COVID-19. So of our 1451 total, 338 are probable cases.

Wait. Are you saying they think the testing is not catching the Covid 19 cases, or....what does this mean? I mean, the virus is sequenced..it is or it isn't - pretty cut and dry. I don't get that "probable."

Of course, "probably" a lot of not-tested infected people and a lot who had it and recovered and never got tested.

Lots of ways this can be an majorly imperfect test system because people and chaos.

Probables are people who are symptomatic of COVID-19, clinicians feel likely do have it (possibly due to having close contact with a confirmed case as well as being symptomatic), but for whatever reason, the test came back negative. No test is 100% reliable, and the COVID-19 nose swab test requires getting enough tissue cells on the swab. Some people likely to have it haven't been tested (eg, one of our clusters involved patients in a dementia ward, putting them through testing would have been hugely traumatic, and not changed their treatment, nor the outcome).

From our Ministry of Health case definition:

Probable case
• A case that meets the clinical criteria where other known aetiologies that fully explain the clinical
presentation have been excluded and either has laboratory suggestive evidence or for whom testing
for SARS-CoV-2 is inconclusive, or
• a close contact of a confirmed case that either meets the clinical criteria and for whom testing cannot
be performed, or
• a is a negative result but a public health risk assessment indicates they should be classified as a
probable case.
Laboratory suggestive evidence requires detection of coronavirus from a clinical specimen using pancoronavirus NAAT (PCR).


Full case definition: https://www.health.govt.nz/system/files/documents/pages/covid-19-case_definitions16april2020.pdf

cmriverside wrote: »

lemurcat2 wrote: »

Apparently there are a number of false negatives. Ross Douthat (the conservative NYT columnist) thinks he, his wife, and his son all had it, but Ross's test came back negative and his son's inconclusive, and at that point they were on the mend so did not retest. He was discussing the false negative issue on one of the episodes of his podcast (The Argument).

Actual REAL false negatives or someone like Douthat insisting that he is right and the test is wrong. I mean, that's pretty arrogant.





Kind of like me insisting me and my cat had it even though we didn't get tested?

Yes, there is some evidence that there are a number of false negatives (it's not uncommon for tests). He discusses that in the podcast.

Here's one example: https://www.npr.org/sections/health-shots/2020/04/21/838794281/study-raises-questions-about-false-negatives-from-quick-covid-19-test

Another, probably more relevant to Ross's case: https://www.advisory.com/daily-briefing/2020/04/06/false-negative

(And I'm not convinced Ross had it, I'm just not ruling out the possibility that he did, as with the NZ gov't and their probables.)

I didn't have a chance to look back through all the posts today but wondered if anyone highlighted the fact that here in CA (Santa Clara County) based on autopsy results of people who died at home, we had a COVID-19 death on Feb 7 and another on Feb 17 as confirmed by the CDC. The virus was here earlier than we thought apparently.

I've maintained my suspicion that my husband had COVID-19 in early February after we returned from a trip to SF from Jan 24 to 27. We flew in and out of Oakland, ate at 3 different restaurants, went wine tasting and went on an ice cream tour. About a week after we got home hubby was sick, fever, night sweats, lethargy, and a slight cough. He made an appointment at the doctor after about 6 days of being sick but woke up that morning feeling better and cancelled the appointment.

I'm not counting on the possibility that he had it, and possibly me too, even though I really didn't feel sick, but it would be nice to know. Hoping to get him the antibody test when it becomes widely available. Our daughter and 2 year old grandson (in Golden, Co) said they will be on a plane heading to CA the day after we get those results.

So many questions and so few answers!

corinasue1143 wrote: »

Oops! Non-hodgens, not leukemia.
Sorry, I don’t know how to post links, but maybe you can google it from this.

Thanks - that is super sad and incredibly infuriating. Several medical professionals were negligent here. How did he go from a mild fever to intubation? And post mortem-testing showed no COVID... so what prompted them to intubate, I wonder. I hope his family gets answers.

jenilla1 wrote: »

lemurcat2 wrote: »

...I find the differences between the numbers in various places (for example, NY and CA), even places following basically the same policies for the same amount of time intriguing, although no idea what the answers are.

My understanding is that CA started the mandatory social distancing policies several days before NY. Every day makes a huge difference in slowing things down. I think another big difference is that NY has a huge population all jammed up together in close quarters with a large share of that population using mass transit. CA has a huge number of people, but they are more spread out, and public transportation isn't used by the majority.

Yes, I see those explanations, but the difference still seems huge. This article: https://www.vox.com/2020/4/21/21224944/coronavirus-hot-spots-covid-new-york-michigan-florida poses a number of reasons, including those, but it just doesn't seem entirely sufficient to me.

And based on the new possible infection rate numbers for LA County (which are pretty iffy still from what I've read), it would be less so:

"Skeptics have noted that the conclusions seem at odds with some basic math. In New York City, where more than 10,000 people, or about 0.1 percent of the population, have already died from Covid-19, this estimated fatality rate [based on the new LA numbers] would mean nearly everyone in the city has already been infected. That’s unlikely, since the number of new cases, and deaths, is still mounting, fast."

From here: https://www.wired.com/story/new-covid-19-antibody-study-results-are-in-are-they-right/

There's a new studies out of China that suggest that not only are there numerous strains of the virus, but that some of the mutations are more virulent: https://www.jpost.com/health-science/coronavirus-has-mutated-into-at-least-30-different-strains-new-study-finds-625333

"The study could have future implications on the treatment of coronavirus, as several different strains have been found throughout the world. The United States, which has the world's worst death toll at 42,897, and 799,515 overall cases, has been struck by different mutations. New York, which itself had the worst death rate in the US, and the eastern coast show a strain of coronavirus similar to that found in Europe, whereas the western US has shown similarities with strains found in China."

I'm not sure I believe that (more confirmation necessary), but I do wonder.

On CA shutting down early, the Vox piece says: "The Bay Area issued the first shelter-in-place order in the US on March 16, and California issued a statewide stay-at-home order three days later — while New York didn’t impose its own mandate until March 22."

However, Chicago (and IL as a whole) imposed our shelter-in-place at the same time as CA, and yet the outbreak here seems much worse, even though it also seems likely it was spreading in CA earlier.

CA has had 35,396 positive cases, and 1354 deaths vs. 35,108 cases and 1565 deaths in IL, even though CA has 3 times the population of IL. (CA has tested more, but not if you adjust for it having more than 3x the population.)

Maybe weather is part of it (FL has had a lot of cases, but given many other factors, seems like more would have been expected), and Chicago relies more on public transportation, but it still seems odd.

lemurcat2 wrote: »

fitlulu4150 wrote: »

I didn't have a chance to look back through all the posts today but wondered if anyone highlighted the fact that here in CA (Santa Clara County) bases on autopsy results of people who died at home, we had a COVID-19 death on Feb 7 and another on Feb 17 as confirmed by the CDC. The virus was here earlier than we thought apparently.

I just read a article on that. It spreading in CA by Jan seems somewhat likely at this point, and the first (2/7) death was someone who traveled a lot and worked for a company with people who traveled from Wuhan, as I understand it. So seems plausible.

The first identified case of person to person spread in Chicago (a man whose wife traveled to Wuhan) was on Jan 30, so it being earlier in CA seems quite likely to me and I'm not sure why this is being presented as surprising.

Unfortunately, the current discussion also seems to be that having it, especially a mild case, quite likely does not convey immunity.

Both of the early deaths in CA that were just discovered by autopsy were people with no travel history, which means it had to have been community spread.

ETA Source:
Coronavirus Death in California Came Weeks Before First Known U.S. Death https://nyti.ms/3atiJvW

lemurcat2 wrote: »

jenilla1 wrote: »

lemurcat2 wrote: »

...I find the differences between the numbers in various places (for example, NY and CA), even places following basically the same policies for the same amount of time intriguing, although no idea what the answers are.

My understanding is that CA started the mandatory social distancing policies several days before NY. Every day makes a huge difference in slowing things down. I think another big difference is that NY has a huge population all jammed up together in close quarters with a large share of that population using mass transit. CA has a huge number of people, but they are more spread out, and public transportation isn't used by the majority.

Yes, I see those explanations, but the difference still seems huge. This article: https://www.vox.com/2020/4/21/21224944/coronavirus-hot-spots-covid-new-york-michigan-florida poses a number of reasons, including those, but it just doesn't seem entirely sufficient to me.

And based on the new possible infection rate numbers for LA County (which are pretty iffy still from what I've read), it would be less so:

"Skeptics have noted that the conclusions seem at odds with some basic math. In New York City, where more than 10,000 people, or about 0.1 percent of the population, have already died from Covid-19, this estimated fatality rate [based on the new LA numbers] would mean nearly everyone in the city has already been infected. That’s unlikely, since the number of new cases, and deaths, is still mounting, fast."

From here: https://www.wired.com/story/new-covid-19-antibody-study-results-are-in-are-they-right/

There's a new studies out of China that suggest that not only are there numerous strains of the virus, but that some of the mutations are more virulent: https://www.jpost.com/health-science/coronavirus-has-mutated-into-at-least-30-different-strains-new-study-finds-625333

"The study could have future implications on the treatment of coronavirus, as several different strains have been found throughout the world. The United States, which has the world's worst death toll at 42,897, and 799,515 overall cases, has been struck by different mutations. New York, which itself had the worst death rate in the US, and the eastern coast show a strain of coronavirus similar to that found in Europe, whereas the western US has shown similarities with strains found in China."

I'm not sure I believe that (more confirmation necessary), but I do wonder.

On CA shutting down early, the Vox piece says: "The Bay Area issued the first shelter-in-place order in the US on March 16, and California issued a statewide stay-at-home order three days later — while New York didn’t impose its own mandate until March 22."

However, Chicago (and IL as a whole) imposed our shelter-in-place at the same time as CA, and yet the outbreak here seems much worse, even though it also seems likely it was spreading in CA earlier.

CA has had 35,396 positive cases, and 1354 deaths vs. 35,108 cases and 1565 deaths in IL, even though CA has 3 times the population of IL. (CA has tested more, but not if you adjust for it having more than 3x the population.)

Maybe weather is part of it (FL has had a lot of cases, but given many other factors, seems like more would have been expected), and Chicago relies more on public transportation, but it still seems odd.

I'm wondering about climate a bit because of the big difference in number of cases between North and South Italy.