Coronavirus Thread

[Deleted member 2897]

I continue to be confused about where the news gets their news. Not too long ago, they said South Carolina didn't have a stay at home order, when we actually did for like 3 weeks already. Now this morning on the national news (I've heard it a few times), they stated that not a single state qualifies to start reopening under the federal government guidelines...for having seen among other things a 2 week reduction in cases. According to our state health agency, we peaked for new cases around April 5th-8th. That was over 3 weeks ago. Furthermore, you should also want to take into account current hospital capacity and total case load. Our current infection rate is less than 50% of that in Michigan, 25% of that in Connecticut, 25% of that in Massachusetts, and so on. Also, I've read you want to be around 5%-10% positives max in testing to ensure you're testing enough people. We haven't ever maxxed out our testing capability. We've run 8% positives all-time in our testing, and that doesn't include all the people who asked about getting tested, but didn't pass the pre-screening criteria. I haven't seen any data published on how many people get screened out, but our positive test percentages are probably well under 5%. On hospital capacity, we currently have statewide 77 COVID-19 patients total in the ICU. We have 405 ICU beds available. So we're running at 20% capacity in the ICU. All beds needed total right now for COVID-19 we're at 305 out of a max capacity of 4,700. So we're running at 6% capacity there.

I mean I don't fault us for having shut down 6 weeks ago - we did the best we thought with the information we had at the time. But all the data available that I see is we should absolutely be opening and while everyone should be careful, social distance, etc., we should be opening much more aggressively than we are actually.

 

[RonJohn]

I'm not sure what you mean. Everyone who has been diagnosed with influenza and dies of it has it listed on their death certificate. Usually something like congestive heart failure secondary to influenza.

I suppose it's possible that there's more testing of CoViD than influenza in hospitals, but 6x the identified deaths for Influenza and zero unidentified deaths from CoViD seems statistically unlikely.

What I mean is that I read the CDC's website to understand how they estimate the flu burden. https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm For deaths, they say:

Why doesn’t CDC base its seasonal flu mortality estimates only on death certificates that specifically list influenza?
Seasonal influenza may lead to death from other causes, such as pneumonia, congestive heart failure, or chronic obstructive pulmonary disease. It has been recognized for many years that influenza is underreported on death certificates. There may be several reasons for underreporting, including that patients aren’t always tested for seasonal influenza virus infection, particularly older adults who are at greatest risk of seasonal influenza complications and death. Even if a patient is tested for influenza, influenza virus infection may not be identified because the influenza virus is only detectable for a limited number of days after infection and many people don’t seek medical care in this interval. Additionally, some deaths – particularly among those 65 years and older – are associated with secondary complications of influenza (including bacterial pneumonias). For these and other reasons, modeling strategies are commonly used to estimate flu-associated deaths. Only counting deaths where influenza was recorded on a death certificate would be a gross underestimation of influenza’s true impact.

For even just counting the number of hospitalizations, they use data from 9% of the US population and extrapolate hospitalizations for the entire country out of that. For number of people infected, they use the number of hospitalizations and information from a behavioral survey to estimate how many people didn't even seek medical care.

Overall, the actually measured and available numbers for flu are not accurate according to the CDC. The numbers for COVID-19 are being looked at and measured to a much higher level than the flu is every year. I am pretty certain that there are a lot of people who have been infected who weren't tested. I am pretty certain that some of the deaths being attributed as COVID-19 deaths were not caused by COVID-19. I am pretty sure that there are some people who died from COVID-19 who are not being counted. I am pretty sure that there are people who die every year from complications from the flu who are not counted.(Thus the CDC uses model estimates since they know they don't have all of the information).

In percentage, I believe there are more people who die every year from the flu and don't have it listed on their death certificates than are dying this year from COVID-19 without that being listed on their death certificates. I believe that because hyper attention is being paid to COVID-19, while in normal years nobody pays attention to flu. The uncertainty in COVID-19 deaths is less than the uncertainty in flu deaths. However, I don't know how much uncertainty there is in either of those.

What I was saying before is that there isn't enough information available to take the uncertainty out of either and make an apples to apples comparison. It is entirely possible to have many times more unattributed deaths due to flu and than to COVID-19 because hyper attention is being paid to COVID-19.

 

[Supersizethatorder-mutt]

I wish it were that simple. But the problem isn't just preexisting heart disease. The virus itself creates a crisis that's a big stressor on the heart and lungs both. You can't just not use it on the worst patients because CoViD tends to worsen very quickly and you have no time to stop treatment before the cardiac toxicity is suddenly enough combined with the crisis to kill the patient.

FWIW, I also have taken it for travel, at a much lower dose than used for treating malaria. I also like a good quinine filled tonic water with my gin. The highest studied dosage before CoViD is a fifth of what in vitro studies suggest is the minimum concentration to fight CoViD.

Well designed studies that treat at those concentrations had to be stopped because they were killing patients:

https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v2



Maybe you're thinking of the original work done in Wuhan that the Wuhan government tried to supress? It's certainly a retrospective study, but right now all the published studies are low quality.

So we don't know anything with certainty, but that's the price of skepticism and science. But it's also not true to say there are no risks.

I don't trust anything coming out of China, but what I said about the VA study is the way it was described in what I saw, a very incomplete, and poorly carried out study.

 

[MWBATL]

I'm not sure what you mean. Everyone who has been diagnosed with influenza and dies of it has it listed on their death certificate. Usually something like congestive heart failure secondary to influenza.

I suppose it's possible that there's more testing of CoViD than influenza in hospitals, but 6x the identified deaths for Influenza and zero unidentified deaths from CoViD seems statistically unlikely.

You are correct about influenza but not about coronavirus. As the meme goes, "man shot in head 78 times, dies of coronavirus". The CDC's orders are to count ANY death as a coronavirus death if the person tested positive, no matter what the coroner's opinion states as the cause of death.

 

[MWBATL]

I continue to be confused about where the news gets their news. Not too long ago, they said South Carolina didn't have a stay at home order, when we actually did for like 3 weeks already. Now this morning on the national news (I've heard it a few times), they stated that not a single state qualifies to start reopening under the federal government guidelines...for having seen among other things a 2 week reduction in cases. According to our state health agency, we peaked for new cases around April 5th-8th. That was over 3 weeks ago. Furthermore, you should also want to take into account current hospital capacity and total case load. Our current infection rate is less than 50% of that in Michigan, 25% of that in Connecticut, 25% of that in Massachusetts, and so on. Also, I've read you want to be around 5%-10% positives max in testing to ensure you're testing enough people. We haven't ever maxxed out our testing capability. We've run 8% positives all-time in our testing, and that doesn't include all the people who asked about getting tested, but didn't pass the pre-screening criteria. I haven't seen any data published on how many people get screened out, but our positive test percentages are probably well under 5%. On hospital capacity, we currently have statewide 77 COVID-19 patients total in the ICU. We have 405 ICU beds available. So we're running at 20% capacity in the ICU. All beds needed total right now for COVID-19 we're at 305 out of a max capacity of 4,700. So we're running at 6% capacity there.

I mean I don't fault us for having shut down 6 weeks ago - we did the best we thought with the information we had at the time. But all the data available that I see is we should absolutely be opening and while everyone should be careful, social distance, etc., we should be opening much more aggressively than we are actually.

Most "news" channels have an agenda

 

[takethepoints]

What you consider a balance of powers issue, I see as an overstepping your authority issue. Would you be equally ok with Trump saying he was not going to sign anything Congress gave him that takes away his authority or that of any future President. IIRC, you are one of the ones who have been saying forever that Trump is acting like a dictator, so I doubt you would support his saying that. So why would you support a governor saying it? He could, as Whitmer could, obviously veto any bill he or she doesn't like, but congress or the Michigan legislature still have the final word through the overriding of the veto.

This shows a basic misunderstanding about the difference between federal and state power.

If Trump were to say what Whitmer did, it would be dictatorial because his power is hemmed in by the need to get Congressional approval for his actions. Emergency declarations can side rail some of that, but not all. Of course, he would never sign any legislation that did limited his power, unless Congress gave him no choice (attaching it to a defense spending bill, for instance). They're good at that.

States, oth, have a very large reserve of "police power" that was inherited from the common law and that isn't dependent on legislative approval, as Whitmer has pointed out. I might also add that in emergencies it isn't much limited by constitutions either. A governor can't do things that violate civil liberties, federal or state, without a good reason (a pandemic qualifies), but there aren't many restrictions besides the inevitable political ones at the next election. Governors don't usually use these - though see Kemp's declaration ruling out local variances from his orders - because people generally don't like it when they do. That isn't the case in Michigan; the stay-at-home orders have wide approval so far. So Whitmer ignoring the "demonstrators"/goons who show up at her capitol building and extending her orders without legislative approval isn't dictatorial; it's well within her powers to do so. Indeed, I'm surprised that she bothered to negotiate with her legislature at all.

 

[GTRX7]

You are correct about influenza but not about coronavirus. As the meme goes, "man shot in head 78 times, dies of coronavirus". The CDC's orders are to count ANY death as a coronavirus death if the person tested positive, no matter what the coroner's opinion states as the cause of death.

That might be what the "meme" says, but is that true? While I think it is true that a death can be counted as a COVID death if there is reason to believe the patient had COVID, even if not tested, and that COVID played a role in the death, I don't think it is true that a COVID positive patient is counted as a COVID death if the patient died of causes completely unrelated to COVID.

As far as I can tell, the CDC instructs that: "If COVID–19 played a role in the death, this condition should be specified on the death certificate. In many cases, it is likely that it will be the UCOD, as it can lead to various life threatening conditions, such as pneumonia and acute respiratory distress syndrome (ARDS). In these cases, COVID–19 should be reported on the lowest line used in Part I with the other conditions to which it gave rise listed on the lines above it." LINK

Maybe you are right, but I am skeptical. Pretty sure any doctor who sees a patient that has been shot in the head 78 times would not conclude that "COVID-19 played a role in the death" whether they had tested positive or not.

 

[GTRX7]

I continue to be confused about where the news gets their news. Not too long ago, they said South Carolina didn't have a stay at home order, when we actually did for like 3 weeks already. Now this morning on the national news (I've heard it a few times), they stated that not a single state qualifies to start reopening under the federal government guidelines...for having seen among other things a 2 week reduction in cases. According to our state health agency, we peaked for new cases around April 5th-8th. That was over 3 weeks ago. Furthermore, you should also want to take into account current hospital capacity and total case load. Our current infection rate is less than 50% of that in Michigan, 25% of that in Connecticut, 25% of that in Massachusetts, and so on. Also, I've read you want to be around 5%-10% positives max in testing to ensure you're testing enough people. We haven't ever maxxed out our testing capability. We've run 8% positives all-time in our testing, and that doesn't include all the people who asked about getting tested, but didn't pass the pre-screening criteria. I haven't seen any data published on how many people get screened out, but our positive test percentages are probably well under 5%. On hospital capacity, we currently have statewide 77 COVID-19 patients total in the ICU. We have 405 ICU beds available. So we're running at 20% capacity in the ICU. All beds needed total right now for COVID-19 we're at 305 out of a max capacity of 4,700. So we're running at 6% capacity there.

I mean I don't fault us for having shut down 6 weeks ago - we did the best we thought with the information we had at the time. But all the data available that I see is we should absolutely be opening and while everyone should be careful, social distance, etc., we should be opening much more aggressively than we are actually.

I am not rendering any opinion whatsoever on whether South Carolina should be reopening right now. That is an extremely complicated issue, and South Carolina does appear to be a great candidate based on the total cases and hospital load you mention. But is it true that South Carolina has had a 2 week reduction in cases?

Here is the data I currently see for South Carolina on new cases per day and new deaths per day (I wonder why yesterday seemed so bad for deaths?) LINK

 

[GT_EE78]

I know a bit about this because I have a family member who is a hospitalist in Philly. There's five peer reviewed studies on the subject, two of which show a small positive effect and three of which fail to exclude the null hypothesis. Four studies were aborted recently because of harm to participants.

She says using chloroquines is a really bad idea, especially with azithromycin because both elongate the QT interval. In a patient whose heart is already under a lot of stress you'd be asking for an arrythmia.

Most of what you said has already been debunked earlier in the thread. Yea, its a long thread.
It's just sad that so much media is putting out disinformation while others are saving lives and trying to get therapies approved.
Note - debunked means that of the studies i think your referencing have already been explained they were irrelevant due to either late application, lack of zinc, much larger dosage than the covid-19 dose, or in the VA case just scientific misconduct, so i'd request that you link your sources.Some of these just winnowed down what works and doesn't; which is as it should be. The Z-pack isn't for everyone,at least one other antibiotic that also works has been identified.

> the first french study was small
the mortality in the third French study (1061 patients) was 0.47%, and presently the IHU-Mediterrannee Infection is reporting 15 fatalities in 3181 patients treated for more than 3 days with HCQ/AZ, which is still a mortality rate of 0.47%.
Patients not treated with HCQ in other hospitals in the Mareille area: 128 deaths in 4763 cases. (2.7%)
Given the same proportion of fatalities as in the non-HCQ cohort one would have expected more than 85 deaths in the HCQ treated patients.
This is a highly significant difference, p < 0.0002. (not to mention 0 side effects over 1061 patients)
.
Ten comparative studies were identified involving 1,642 patients (965 patients treated witha 53chloroquine derivative) from fivecountries (Brazil, China, France, Iran, and USA) (Table S1).When considering all ten included studies (Figure 1, Table S2), chloroquine derivatives were associated with a lower need for hospitalisation (n = 1, Odds ratio (OR) 0.35, p = .024), shorter duration of cough (n = 1, OR 0.13, p = .001), shorter duration of fever (n = 1, OR 0.14, p = .001), decreased C-reactive protein level (n = 1, OR 0.55, p = .045), and increased hospital discharge (n = 1, 67OR 0.05, p =.050).
CQ derivatives were associated with a beneficial effect (OR < 1) for 11 of the 12 outcomes analysed (Figure 1). Of the comparisons made, 19 were favourable (Table S1).Accordingly, the two-sided sign-test p-value was 0.015. The fatality rate was analysed in two studies with an opposite direction of effect. The study reporting an increased fatality rate was suspected of scientific misconduct (patientsweresignificantly more severe in the treated group [7]). No significant negative effect was observed. https://www.mediterranee-infection....cy-of-Chloroquine-derivatives-in-COVID-19.pdf

>> 91.6 % success over 2333 patients ) an excellent idea rather than a bad one
Hydroxychloroquine Has about 90 Percent Chance of Helping COVID-19 Patients, States Association of American Physicians and Surgeons (AAPS)
To date, the total number of reported patients treated with HCQ, with or without zinc and the widely used antibiotic azithromycin, is 2,333, writes AAPS, in observational data from China, France, South Korea, Algeria, and the U.S. Of these, 2,137 or 91.6 percent improved clinically. There were 63 deaths, all but 11 in a single retrospective report from the Veterans Administration where the patients were severely ill.The antiviral properties of these drugs have been studied since 2003. Particularly when combined with zinc, they hinder viral entry into cells and inhibit replication. They may also prevent overreaction by the immune system, which causes the cytokine storm responsible for much of the damage in severe cases, explains AAPS. HCQ is often very helpful in treating autoimmune diseases such as lupus and rheumatoid arthritis. https://finance.yahoo.com/news/hydroxychloroquine-90-percent-chance-helping-155637974.html
>> 5 studies?? here's a list of over 20 peer reviewed studies from AAPS
"Historical controls are used in many previous studies in medicine. In this respect, the safety of Hydroxychloroquine is well documented. When the safe use of this drug is projected against its apparent effect of decreasing the progression of early cases to ventilator use, it is difficult to understand the reluctance of the authorities in charge of U.S. pandemic management to recommend its use in early COVID-19 cases. "
https://docs.google.com/document/d/1545C_dJWMIAgqeLEsfo2U8Kq5WprDuARXrJl6N1aDjY/edit

 

[MWBATL]

That might be what the "meme" says, but is that true? While I think it is true that a death can be counted as a COVID death if there is reason to believe the patient had COVID, even if not tested, and that COVID played a role in the death, I don't think it is true that a COVID positive patient is counted as a COVID death if the patient died of causes completely unrelated to COVID.

As far as I can tell, the CDC instructs that: "If COVID–19 played a role in the death, this condition should be specified on the death certificate. In many cases, it is likely that it will be the UCOD, as it can lead to various life threatening conditions, such as pneumonia and acute respiratory distress syndrome (ARDS). In these cases, COVID–19 should be reported on the lowest line used in Part I with the other conditions to which it gave rise listed on the lines above it." LINK

Maybe you are right, but I am skeptical. Pretty sure any doctor who sees a patient that has been shot in the head 78 times would not conclude that "COVID-19 played a role in the death" whether they had tested positive or not.

After looking into this further, I have to agree with you. Although the CDC guidelines do encourage the listing of covid if the attending physicians feel it contributed to death....which is indeed different from the way influenza cases are counted.....78 bulets in the head would NOT be counted as a covid death. If you can ignore the political stuff in this article, the doctor in question does have a point about how he would count flu cases vs covid cases under these guidelines, but your objection is much more accurate than my flippant meme remark.

https://www.foxnews.com/media/physician-blasts-cdc-coronavirus-death-count-guidelines

 

[GT_EE78]

> it may have taken two months but at least they're finally doing it
New York Gov. Cuomo says NYC subway system is disgusting and deteriorating, orders cleaning plan
https://www.cnbc.com/2020/04/29/new...g-and-deteriorating-orders-cleaning-plan.html

 

[lauraee]

 

[Techster]

 

[Supersizethatorder-mutt]

This shows a basic misunderstanding about the difference between federal and state power.

If Trump were to say what Whitmer did, it would be dictatorial because his power is hemmed in by the need to get Congressional approval for his actions. Emergency declarations can side rail some of that, but not all. Of course, he would never sign any legislation that did limited his power, unless Congress gave him no choice (attaching it to a defense spending bill, for instance). They're good at that.

States, oth, have a very large reserve of "police power" that was inherited from the common law and that isn't dependent on legislative approval, as Whitmer has pointed out. I might also add that in emergencies it isn't much limited by constitutions either. A governor can't do things that violate civil liberties, federal or state, without a good reason (a pandemic qualifies), but there aren't many restrictions besides the inevitable political ones at the next election. Governors don't usually use these - though see Kemp's declaration ruling out local variances from his orders - because people generally don't like it when they do. That isn't the case in Michigan; the stay-at-home orders have wide approval so far. So Whitmer ignoring the "demonstrators"/goons who show up at her capitol building and extending her orders without legislative approval isn't dictatorial; it's well within her powers to do so. Indeed, I'm surprised that she bothered to negotiate with her legislature at all.

I think the Michigan legislature would disagree. I have no idea what the laws in Michigan allow, but it sure seems like the legislature is not happy, and whether what she is doing is popular or not (I doubt very seriously the overall popularity of it), and whether or not it is within her implied powers, the legislature can still dump her, if they so choose.

 

[gthxxxx]

States, oth, have a very large reserve of "police power" that was inherited from the common law and that isn't dependent on legislative approval, as Whitmer has pointed out. I might also add that in emergencies it isn't much limited by constitutions either. A governor can't do things that violate civil liberties, federal or state, without a good reason (a pandemic qualifies), but there aren't many restrictions besides the inevitable political ones at the next election.

Hrmm, I wonder about that. When you say federal civil liberties, if you mean those protected by the Constitution, then the only "good reason" for suspending the Constitution that is written in the Constitution is "when in cases of rebellion or invasion the public safety may require it." A pandemic might qualify as an invasion, but I don't think that has been tested exhaustively (if at all?) in court.

 

[GTNavyNuke]

Sex & Drugs & Rock and Roll. Wish I was back then.

Tomorrow I'll update the total weekly death numbers in the US based on CDC. Joy.

Enjoy the day / night.

 

[GT_EE78]

I think the Michigan legislature would disagree. I have no idea what the laws in Michigan allow, but it sure seems like the legislature is not happy, and whether what she is doing is popular or not (I doubt very seriously the overall popularity of it), and whether or not it is within her implied powers, the legislature can still dump her, if they so choose.

> Sounds like they will fight it out in court
Michigan House Won’t Extend State of Emergency, Votes to Sue Gov. Gretchen Whitmer Instead
Whitmer’s initial state of emergency order, which is separate from the stay-at-home order, expires on Thursday and requires legislative action to be lengthened.
Negotiations on that front fell apart on Wednesday when Whitmer refused to make any concessions on the matter, asserting she has the ultimate control of emergencies.
So the House voted to authorize Speaker Lee Chatfield to sue the governor, saying Whitmer’s “unchecked and undemocratic approach” is not the best way, ABC 12 reported.The House also passed a resolution restricting a governor’s state of emergency declarations to 14 days. Whitmer has vowed to veto that legislation.
https://www.breitbart.com/politics/...y-votes-to-sue-gov-gretchen-whitmer-instead/#

 

[GT_EE78]

Do Lockdowns Save Many Lives? In Most Places, the Data Say No
Wall St Journal via wordpress
https://danfromsquirrelhill.wordpre...ve-many-lives-in-most-places-the-data-say-no/

 

[Supersizethatorder-mutt]

This shows a basic misunderstanding about the difference between federal and state power.

If Trump were to say what Whitmer did, it would be dictatorial because his power is hemmed in by the need to get Congressional approval for his actions. Emergency declarations can side rail some of that, but not all. Of course, he would never sign any legislation that did limited his power, unless Congress gave him no choice (attaching it to a defense spending bill, for instance). They're good at that.

States, oth, have a very large reserve of "police power" that was inherited from the common law and that isn't dependent on legislative approval, as Whitmer has pointed out. I might also add that in emergencies it isn't much limited by constitutions either. A governor can't do things that violate civil liberties, federal or state, without a good reason (a pandemic qualifies), but there aren't many restrictions besides the inevitable political ones at the next election. Governors don't usually use these - though see Kemp's declaration ruling out local variances from his orders - because people generally don't like it when they do. That isn't the case in Michigan; the stay-at-home orders have wide approval so far. So Whitmer ignoring the "demonstrators"/goons who show up at her capitol building and extending her orders without legislative approval isn't dictatorial; it's well within her powers to do so. Indeed, I'm surprised that she bothered to negotiate with her legislature at all.

Actually, governors cannot do things that violate the US Constitution. When they take office, they are bound to support the state constitution PLUS the US Constitution. They do not have the power to do anything that violates the freedoms guaranteed to ALL the people by the Bill of Rights and the entire Constitution.

 

[Deleted member 2897]

I am not rendering any opinion whatsoever on whether South Carolina should be reopening right now. That is an extremely complicated issue, and South Carolina does appear to be a great candidate based on the total cases and hospital load you mention. But is it true that South Carolina has had a 2 week reduction in cases?

Here is the data I currently see for South Carolina on new cases per day and new deaths per day (I wonder why yesterday seemed so bad for deaths?) LINK

If you drew a trend line, the answer is yes. Furthermore, the absolute value of the numbers are extremely low. In other words, if we had massively high numbers, dropping for 2-3 weeks may not be enough to reopen. Not only are we 3 weeks passed our peek (our state runs weekly totals which smooth the data), but the numbers are also small. We only have 60 in ICU in the entire state and are at 15% capacity. The numbers are well well below average for other states and we are well well below hospital capacity.

I live in a 500,000 person Charleston County. We’ve had less than 10 cases a day 18 of the last 20 days. We’ve had 3 days of 0 new cases. We’ve been running about 1/3rd our peak daily number for 3 weeks now.