[Health] The Infectious Diseases Thread

[Paingod]

one random doctor

All the best things start with one random person bucking the trend and going against the grain. Just ask all the kids of anti-vaxxers.

[AWS260]

Yeah, not to get too P&R, but if you look up that guy's writing pre-COVID, he often takes positions that I would characterize as outside the public health mainstream, but well within the NY Post mainstream.

Still, the overarching issues he raises are important ones. It's clear that the COVID response had led to fewer people receiving other important health services, for example. I just wouldn't necessarily take his word as gospel on these topics.

[Ralph-Wiggum]

This one random doctor who correlates risk to Chinese immigrants coming to New York. Stupid.

I didn't read the article, but didn't a study come out last week indicating that the strain of the virus most prevalent in NY most likely originated in Europe?

[Paingod]

It's clear that the COVID response had led to fewer people receiving other important health services, for example.

I absolutely agree with this. I've postponed having a couple things checked on by doctors that suddenly didn't feel urgent enough to take up their time or expose myself to their waiting rooms.

[AWS260]

This one random doctor who correlates risk to Chinese immigrants coming to New York. Stupid.

I didn't read the article, but didn't a study come out last week indicating that the strain of the virus most prevalent in NY most likely originated in Europe?

Yes. Which makes sense, because our airports get many more travelers from Europe than China. That was the one line in the article that made me roll my eyes.

[Anonymous Bosch]

Yeah, not to get too P&R, but if you look up that guy's writing pre-COVID, he often takes positions that I would characterize as outside the public health mainstream, but well within the NY Post mainstream.

Still, the overarching issues he raises are important ones. It's clear that the COVID response had led to fewer people receiving other important health services, for example. I just wouldn't necessarily take his word as gospel on these topics.

Be that as it may, I wasn't suggesting anyone ought to accept his opinion (or anyone else's, for that matter) as gospel.

[YellowKing]

The thing that bugs me about articles like this is that nobody is really arguing that we don't need to open back up. The only argument is how to do it in the safest possible manner.

In other words, this guy isn't telling us anything we don't already know. Yes, we need to open back up. Yes, we need to do it based on data. States were already doing this before his article.

Claiming that there are all these states that are locked down out of "fear" is just a false construct. States locked down because of facts on the ground and models, not fear. And (most) are opening back up based on those same facts on the ground and new models.

The "worst case scenario" models he derides were exactly what they reported to be: worst case scenario models that demonstrated the outcomes without social distancing or lockdowns. Because those numbers didn't come to pass is not because the models were flawed. It's because we locked down, flattened the curve, and did precisely what the models told us we needed to do to AVOID the worst case scenario. To claim that the virus is not as bad as initially thought because we took measures to make it not as bad is flawed reasoning.

And while we're on the subject, I"m tired of the argument that "people die anyway." COVID deaths are *in addition* to normal deaths, and are largely preventable. We have 60,000 dead Americans, the vast majority of which would not be dead today if not for COVID. To pretend that these deaths were some normal, inevitable outcome is completely erroneous.

[Zaxxon]

To claim that the virus is not as bad as initially thought because we took measures to make it not as bad is flawed reasoning.

Indeed, but as was stated here and elsewhere right from the start, this exact argument was inevitable.

[malchior]

To claim that the virus is not as bad as initially thought because we took measures to make it not as bad is flawed reasoning.

Indeed, but as was stated here and elsewhere right from the start, this exact argument was inevitable.

Yeah. Still, one advantage to predicting it is to be ready to throw it back at them to disarm them from spreading their mind poison to others outside the bubble.

[Daehawk]

Half the country lives in the bubble with them.

[Alefroth]

Claiming that there are all these states that are locked down out of "fear" is just a false construct. States locked down because of facts on the ground and models, not fear. And (most) are opening back up based on those same facts on the ground and new models.

It's ironic that this contingent whose lives basically revolve around fear of something are now complaining about lockdowns being due to fear. They even want to force re-opening based on fear.

[stessier]

The sacrifices we make.

Belgians urged to eat fries twice a week as coronavirus creates massive potato surplus

Belgians are being called upon to eat fries at least twice a week as more than 750,000 tons of potatoes are at risk of being thrown away.

The coronavirus crisis has led to a surplus of potatoes in the small European country, as demand for frites — a national dish of twice-fried potatoes often eaten in bars and restaurants — has slumped amid Belgium’s government-enforced lockdown.

Speaking to CNBC in a phone call on Monday, Romain Cools, secretary general of Belgian potato industry body Belgapom, said around 750,000 tons of potatoes — enough to fill 30,000 big lorries — would probably not be processed because of the pandemic.

The issue was largely down to a fall in demand in the frozen potato sector, which accounts for around 75% of Belgium’s potato processing, he said. As inventories built up, freezer capacity was being squeezed. In order to mitigate the problem, Belgapom was appealing to Belgians to up their weekly intake of fries.

“We’re working with supermarkets to see whether we can launch a campaign asking Belgians to do something for the sector by eating fries — especially frozen fries — twice a week during the coronavirus crisis,” Cools said. “What we are trying to do is to avoid food waste, because every lost potato is a loss.”

[gameoverman]

Harm is being done by being shut down, economic and health related harm. But look at the meat processing plants that were shut down. Food supply is essential yet when the workers start getting sick you have to shut down. Harm is going to be done no matter what. Isn't it better to control it? I think so. We sacrifice up front to pay less later. Otherwise we might see the meat processing plant situation happen in all aspects of our economy AND see an elevated rate of infections. A situation where Disneyland is open...oops it's closed...oh wait, it's open again...aww, it's closed again, would not be workable imo. It sounds good in theory, we reopen and kickstart the economy, but it will be impossible to build economic momentum if it's all sporadically getting shut down again.

Someone who is putting off chemo right now is in a bad situation, no argument from me. But how is it better if they can't get chemo anyways because the hospital is shut down due to everyone there getting sick? For someone out of work and therefore without income, isn't it better to have unemployment and/or other financial aid rather than to have to go to a job where they are only getting part time hours because the business is struggling? You can't plan on that paycheck, since the business could be shut down anytime due to infections or simply because of bankruptcy. On top of all that the worker still has to worry about getting infected at work. I'm not seeing the upside of rushing to reopen.

[Sudy]

The potential fatal effects of COVID-19 are rapid and irreversible. The fatal effects of increased poverty and economic strife are delayed and in many cases potentially correctable, even if it takes time (and even if they may not be, because our system still doesn't care enough about those most in need). The push to re-open prematurely serves best those who are comfortable placing a financial value on lives. Anyone who serves compassion should agree that hard medical science must decide. If science agrees that we've done the best that we can and the health care system is stable, it's rational to re-open carefully. But it's frustrating that we'll never have done as well as we could have.

[YellowKing]

I read a good article a few days ago that was basically exploding the myth of some giant economic boom if everything opens back up. It's not going to happen.

If you go back to pre-virus "normal," people are going to start getting sick en masse again, which means they'll be out of work, deaths will climb, etc. As gameoverman mentioned above, that's not going to work. it's not feasible to pretend the virus just doesn't exist anymore. That path leads to death and hospitalization on a massive scale, which does nothing to help the economy and only undoes everything we've already sacrificed. Going that route would mean we torpedoed the economy for zero gain, which is unfathomable.

Ok, so we open things back up with social distancing, requiring masks, etc. That's great, but that's not "normal". And it's not going to magically produce normal economic results. Restaurants at half capacity only need wait staff at half capacity. You're still going to have vulnerable parts of the population staying in that would normally be out and about. Tourism is still dead. Concerts and sports events are still dead. All the people who still don't have a job likely still don't have a job and aren't spending the money they were spending pre-virus. Yes, it's *something* compared to what we have now, but it's a tiny fraction of what things were pre-virus.

I hate to sound pessimistic as I'm a pretty big optimist. But this is a worldwide problem that threatens all of humanity. That's not the kind of issue that just goes away when you decide you're tired of being inconvenienced. If there was an easy solution to it, we'd have already done it.

[LawBeefaroni]

Someone who is putting off chemo right now is in a bad situation, no argument from me. But how is it better if they can't get chemo anyways because the hospital is shut down due to everyone there getting sick? For someone out of work and therefore without income, isn't it better to have unemployment and/or other financial aid rather than to have to go to a job where they are only getting part time hours because the business is struggling? You can't plan on that paycheck, since the business could be shut down anytime due to infections or simply because of bankruptcy. On top of all that the worker still has to worry about getting infected at work. I'm not seeing the upside of rushing to reopen.

My experience is that chemo isn't being put off. Or rather, it is only being put off if a doctor deems it not extremely time-sensitive. Not being an oncologist, or any other type of clinician, I'm not sure how often it is vs. isn't but I do know for a fact that our chemo and infusion centers have remained open 24-7 and are among the service lines near normal capacity.

That doesn't mean there aren't issues (missed diagnoses and biopsies due to postponed routine exams, for example) but the image of an ill cancer patient being told to skip a crucial chemo treatment while COVID-19 patients lounge about the infusion center are bullshit.

[LawBeefaroni]

Ok, so we open things back up with social distancing, requiring masks, etc. That's great, but that's not "normal". And it's not going to magically produce normal economic results. Restaurants at half capacity only need wait staff at half capacity.

Yep.

If they're at half capacity, they'd be lucky. But even if they do manage to get 50% of their old business back, even if they are able to manage with half-staff levels, their margins will be all kinds of messed up. Most will probably end up closing anyway.

Is their rent/mortgage going to be halved? Will customers be willing to pay more?


I was thinking about my local bar. It's usually not full but they make at least 50% of their money on crowded weekend nights and also do decent spillage business after Cubs games. That's all gone for sure. OTOH I hear alcohol consumption is up and day drinking has increased. Maybe they can just open at 9am instead of 4pm and bring back the $1 PBR special.

[RunningMn9]

Ah another case where the majority of doctors and scientists in the entire world are wrong, and this one random doctor has seen through the conspiracy to bring us the truth.

I scanned it to see that it quoted the USC and Standford studies as evidence for mortality rate, saw that they were referenced and immediately threw the hold thing in the trash.

[Anonymous Bosch]

Claiming that there are all these states that are locked down out of "fear" is just a false construct. States locked down because of facts on the ground and models, not fear.

OK, then what scientific, factual evidence is being used to justify keeping huge swaths of the west coast locked down until at least through early May? Gov. Newsom suggests "the virus could spread if people travel to and from places with eased restrictions," but that's merely an opinion (arguably based on fear) with no facts presented:

Along the West Coast, Democratic governors, who were among the first in the nation to issue stay-at-home orders, are facing pressure and defiance from some counties to relax uniform stay-at-home policies. Unlike states such as Georgia and Texas that are beginning to ease restrictions, Mr. Inslee, California’s Gavin Newsom and Oregon’s Kate Brown aren’t bending from plans to keep strict orders in place at least through early May.

“We do not have the same level of exposure that San Francisco or Los Angeles has, and we’re watching our local economy collapse,” said Ron Sullenger, chairman of the board of supervisors in Sutter County, about 40 miles north of Sacramento. “One size doesn’t necessarily fit all counties in our situation and we would want some flexibility.”

Mr. Sullenger and other elected officials in Sutter are sending a letter to the governor asking him to grant certain counties flexibility to open local businesses. The county has so far reported three coronavirus-related deaths and 42 confirmed cases.

Mr. Newsom has argued that a broader approach is necessary because the virus could spread if people travel to and from places with eased restrictions. He acknowledged in a briefing Thursday that he is hearing grievances from several counties. “By making sure all of us are checking off the same list, then we are going to be able to advance some loosening of our stay at home orders sooner as opposed to chasing folks down that get ahead of themselves only to find that perhaps they went too soon, too fast,” Mr. Newsom said.

The "worst case scenario" models he derides were exactly what they reported to be: worst case scenario models that demonstrated the outcomes without social distancing or lockdowns.

Dunno which model you're referring to, but the influential IHME model specifically did include social distancing.

Because those numbers didn't come to pass is not because the models were flawed.

Plenty of experts disagree:

Influential COVID-19 model uses flawed methods and shouldn’t guide U.S. policies, critics say

A widely followed model for projecting Covid-19 deaths in the U.S. is producing results that have been bouncing up and down like an unpredictable fever, and now epidemiologists are criticizing it as flawed and misleading for both the public and policy makers. In particular, they warn against relying on it as the basis for government decision-making, including on “re-opening America.”

“It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to projecting Covid-19 deaths, epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health told reporters this week, referring to projections by the Institute for Health Metrics and Evaluation at the University of Washington.

Others experts, including some colleagues of the model-makers, are even harsher. “That the IHME model keeps changing is evidence of its lack of reliability as a predictive tool,” said epidemiologist Ruth Etzioni of the Fred Hutchinson Cancer Center, who has served on a search committee for IHME. “That it is being used for policy decisions and its results interpreted wrongly is a travesty unfolding before our eyes.”

The IHME projections were used by the Trump administration in developing national guidelines to mitigate the outbreak. Now, they are reportedly influencing White House thinking on how and when to “re-open” the country, as President Trump announced a blueprint for on Thursday.

The chief reason the IHME projections worry some experts, Etzioni said, is that “the fact that they overshot will be used to suggest that the government response prevented an even greater catastrophe, when in fact the predictions were shaky in the first place.” IHME initially projected 38,000 to 162,000 U.S. deaths. The White House combined those estimates with others to warn of 100,000 to 240,000 potential deaths.

That could produce misplaced confidence in the effectiveness of the social distancing policies, which in turn could produce complacency about what might be needed to keep the epidemic from blowing up again.

It's because we locked down

Cite? Because it seems kinda silly and highly unscientific to assume the colossal difference between COVID-19 deaths in New York vs. the most populous state in the union was solely because the state of California was locked down one day earlier than New York.

[RunningMn9]

Did you just like the IMHE model as a credible example of the models showing that they included social distancing, and then immediately link to a an article explaining why that specific model is flawed?

The IMHE model was latched onto by the White House, so it’s influential in that regard.

The initial models that showed the high ends (like the 2.5M ones) very clearly indicated that they were projections based on doing nothing. They repeated it often.

The IMHE model has never modeled the impact of social distancing and lockdowns because it’s not an epidemiological model that can factor those things in to their predictions. It can’t because it’s a statistical model.

Which you should know, as you just linked us to an article explaining that.

[Anonymous Bosch]

I was in kind of a hurry when I posted, so mea culpa for any SNAFUs. I mentioned the IHME model simply because it was influential and also flawed, and linked to their FAQ in which they explain how social distancing measures have been factored into their model:

How do social distancing measures factor into your model?

We use social distancing measures in our model to project COVID-19 deaths. Data from Germany, Italy, the US, China, and Spain have demonstrated how social distancing measures can save lives. Using data from these countries helps us understand how quickly we can expect deaths to decline after a location implements social distancing measures.

Starting April 17, we began using anonymized mobile phone data to better assess the impact of social distancing across locations. These data revealed that social distancing was happening to a larger degree than previously understood, and even before social distancing mandates went into effect.

With this new insight from mobile phone data, we have revised our projections for COVID-19 deaths. This has important implications for locations with few or nonexistent social distancing mandates, namely that the death projections are lower and peaks are projected to occur earlier. Beginning April 17, our model no longer assumes any future changes in social distancing mandates. To learn more, visit our estimation update for April 17.

Note that our model does not yet reflect how easing or lifting social distancing measures could increase COVID-19 infections and deaths. We are working to project COVID-19 trends in areas that have eased social distancing measures, and we will release these projections as soon as possible.

[YellowKing]

OK, then what scientific, factual evidence is being used to justify keeping huge swaths of the west coast locked down until at least through early May?

Ummm...models like this? It's one model that shows high death tolls for Georgia if they open prematurely. And it's one of seven that the CDC listed showing the same thing for states opening prematurely. It's not like people are just making this stuff up.

So what makes a state "safe" to relax lockdowns? There are numerous data points out there that offer solid criteria for when it's safe to re-open. For North Carolina (which is also staying locked down until May 8th), these include:

- Sustained Leveling or Decreased Trajectory in COVID-Like Illness (CLI) Surveillance Over 14 Days
- Sustained Leveling or Decreased Trajectory of Lab-Confirmed Cases Over 14 Days
- Sustained Leveling or Decreased Trajectory in Percent of Tests Returning Positive Over 14 Days
- Sustained Leveling or Decreased Trajectory in Hospitalizations Over 14 Days

In addition to these, there are also thresholds for testing, tracing, and PPE supplies on hand.

Our hospital is using 12 different data points to determine when they can move to a phase 1 re-opening. On the flip side, they also have 5 data points which would trigger a second lockdown.

In short, the claim that states are staying locked down "out of fear" is simply not true. I can't speak for California, but in NC they are based on data thresholds. If X criteria are met, models show risk is relatively low for additional outbreaks. If X criteria are not met, models show risk is high for additional outbreaks. It's not rocket science. I would assume California is not unlike NC in that they are using similar data points to drive their decision making.

I'd also caution against throwing the baby out with the bathwater when it comes to modeling. Of course no model is perfect, particularly for a new virus that we're still learning about. You make decisions based on the models you have at the time, and you refine those decision as newer, better models come along.

[Xmann]

I'm struggling on when to decide it's ok for my teenage son to go back to work at Chic Fil A. He's been off since this has started and is bored out of his mind. Making some extra money for college next year would be nice too.

On one hand, what's the difference in letting him go back tomorrow compared to a month from now? He doesn't cashier, he works the back. I don't know if wearing a mask is required.

Our community is opening back up Friday and my thought was to wait and see what happens with people. But again, what is my deciding factor?

I can completely understand your concerns. Our local supermarket is heavily staffed by teenagers and 20 somethings in front-line positions and I'm genuinely amazed at what they're willing to do in light of everything going on.

Last week the FDA released a "best practices" document that was sourced from the restaurant industry leaders. If I were being asked to come back to work in a restaurant or retail food operation, I'd want to know how they're following the recommendations here. They don't seem unreasonable, but the key would be local management and what their policies/modifications to address workflow, sick staff members and customer interactions.

In terms of risk, I am not capable of communicating that unfortunately. Depending on how it is trending in your area there very well could be greater or diminished risk sending him there today or a month from now. Whether or not it's an appreciable risk, I cannot say. Unfortunately this is going to be something that needs to be addressed regardless in the mid to long term (modified work process) for anyone working retail so above and beyond actual risk right now, having risk mitigation plans in place that are being followed would be paramount (for me).

Not sure how helpful that is, but it's nice to see the industry helping to form guidelines.

Pretty much what I was thinking.

His boss is a really nice and understanding man. I talked to him today to ask what precautions his restaurant is taking for safety measures. And they are...

#1. Sanitizers outside by the front door all employees have to use before coming inside. Once inside, they have to wash their hands.

#2. Temperature taken before starting work.

#3. Gloves worn at all times.

#4. All employees are required to wear a mask at all times, no exceptions.

#5. 6 feet a part as much as possible.

#6. Every 20 minutes staff must wash their hands.

#7. Clothes must be washed before each shift.

My son cooks so even when they open back up, he will be limited to being around the other guys he cooks with in the back.

[RunningMn9]

I was in kind of a hurry when I posted, so mea culpa for any SNAFUs. I mentioned the IHME model simply because it was influential and also flawed, and linked to their FAQ in which they explain how social distancing measures have been factored into their model:

Again, read your other links for all the reasons why this model is mocked by other epidemiologists.

I don’t know jack shit about epidemiology. What I do know is that as soon as I started seeing data reported in this model, I immediately turned to Smoove_B and asked why is this one telling me different things? What’s right or wrong with it. We waiting for actual epidemiologists to weigh in, and the verdict appears to be “we think it’s crap”.

[Anonymous Bosch]

In short, the claim that states are staying locked down "out of fear" is simply not true. I can't speak for California, but in NC they are based on data thresholds. If X criteria are met, models show risk is relatively low for additional outbreaks. If X criteria are not met, models show risk is high for additional outbreaks. It's not rocket science. I would assume California is not unlike NC in that they are using similar data points to drive their decision making.

I'd also caution against throwing the baby out with the bathwater when it comes to modeling. Of course no model is perfect, particularly for a new virus that we're still learning about. You make decisions based on the models you have at the time, and you refine those decision as newer, better models come along.

Fair enough. But California is more than three times the size of NC, and Gov. Newsom has provided little in the way of facts or the particular model(s) being used to justify his decision to extend the lockdown, even in counties where they've had hardly any coronavirus-related deaths at all. Just last month he was projecting that 56 percent of the population of California would be infected with coronavirus over an eight-week period. So his "facts on the ground and models" seem more than a wee bit dubious to say the least.

[gameoverman]

Cite? Because it seems kinda silly and highly unscientific to assume the colossal difference between COVID-19 deaths in New York vs. the most populous state in the union was solely because the state of California was locked down one day earlier than New York.

I hope no one assumes that. To assume that means you assume every other possible factor in how this virus was spread is exactly the same in both states. Since this pandemic is still ongoing, we're not in a position to know all that.

I don't think it's silly to assume days are vital when dealing with something like this, and it's not silly to assume the quicker response helped keep things from getting as bad as they might have gotten.

The problem is we really have no way of knowing how bad it would have become without that response. We have no way of knowing how it got to NY vs how it got to California, information which might have a big impact on how fast and far it could spread once it did arrive. A bunch of people packed in a subway vs individuals each driving their own car and with no other passengers, does it matter and if so how much? Who knows? Maybe some day when all the numbers are in and everything is final we'll know.

[em2nought]

My mother's condo has a tiny stuffy mail room that everyone must enter to check their mail. I do not like going in there right now Sam I am. There's a suggestion box for the development, and I plan to ask that an exhaust fan be installed in that little mailroom, and that the pay attention to the direction they send the exhaust. Shouldn't be too expensive. It's the creepiest place I go, but Walmart isn't far behind. Sam I am does not like going to Walmart anymore, it was much better when I could go there at midnight with on one else around which is what I used to do.

[Daehawk]

I dont like how they say your pet can get it from you but not the other way around. I sure dont believe that one. Its just common sense it works both ways if one way.

[Smoove_B]

I dont like how they say your pet can get it from you but not the other way around. I sure dont believe that one. Its just common sense it works both ways if one way.

It might seem that way but no, it's not. There are "dead end" hosts for agents. Take for example, influenza A:



Aquatic water fowl give it to everything. Horses give it to dogs (potentially). Chickens give it to humans (potentially). Pigs and humans can pass it back and forth, but no other species. This is why influenza strains vary every year - that human/pig connection and the genetic mixing that can occur when it goes back and forth. But sometimes, diseases are just one way streets.

[Anonymous Bosch]

Here's an amusing video that sums up much of the various coronavirus advice and recommendations that has been provided:

[Defiant]

Cite? Because it seems kinda silly and highly unscientific to assume the colossal difference between COVID-19 deaths in New York vs. the most populous state in the union was solely because the state of California was locked down one day earlier than New York.

The dates listed there aren't correct. New York locked down on March 22nd. It was only announced on March 20th.

[Jaymann]

Alabama: Hey, at least we were ahead of Missouri and South Carolina.

[Daehawk]

All this reopening is just going to make a new flood of deaths and a new lock down and worse problems. Heck CNN right now has people saying exactly that. Georgia is supposed to have a lot more deaths because of it.

[Isgrimnur]

For when your sickness is as much mental as physical...

[Daehawk]

Lol. Gotta agree. Used to like seeing the Steelers kick their butt in the Superbowl in the 70s. Steelers were my favorite team.

[Freyland]

I dont like how they say your pet can get it from you but not the other way around. I sure dont believe that one. Its just common sense it works both ways if one way.

It might seem that way but no, it's not. There are "dead end" hosts for agents. Take for example, influenza A:



Aquatic water fowl give it to everything. Horses give it to dogs (potentially). Chickens give it to humans (potentially). Pigs and humans can pass it back and forth, but no other species. This is why influenza strains vary every year - that human/pig connection and the genetic mixing that can occur when it goes back and forth. But sometimes, diseases are just one way streets.

Admits to being curious what logic jump prompted the revelation that flu travels from aquatic water fowl to whales....

[Isgrimnur]

[Kraken]

MA just extended stay-at-home for 2 more weeks. We are right at the top of the curve, probably, we hope. Realistically, we won't be reopening Boston until June.

[gilraen]

For when your sickness is as much mental as physical...

LOL, you might laugh but I ordered a set with my hockey team logo today. 'Cause...why not.

[Anonymous Bosch]

..