Corona Virus: It's a Marathon, Not a Sprint

Smoove_B · Post by **Smoove_B** » Sat Jul 24, 2021 1:10 pm

861 new cases today in NJ; by all accounts we should be breaking 1000 at some point next week. Hospitalizations are floating around 400, which is certainly an improvement, as well as the decrease in deaths. Rt. has been hovering around 1.4, which is good (that it stopped increasing), but it means that it's still spreading.

I'd seen information yesterday (I can't find it now) that was comparing 7/23/20 to 7/23/21 nationwide and the similarities were crazy. Basically the total number of cases was close (~71K in 2020 vs 81K in 2021), but hospitalizations were much higher in 2020, as well as deaths. The demographics are changing and it's ripping through younger people now. Not killing as many, but spreading like wildfire and still causing increased (but not completely overloaded) hospitalizations. Yes, some states are overwhelmed, but it's not as widespread as it was last year. If we were testing vaccinated people reliably, I'd guess the numbers are even higher.

The bigger issue is the total number of new cases nationwide. This time in 2020 we had hit our summer peak. There's no indication that our current trend is going to diminish, so that means we're headed into August with that many more cases. Maybe *this* time people will be able to understand exponential growth?

I guess the take home message is that while we have vaccinations, the total number of cases is higher right now than it was last year and it's still going. This means our setup for Fall 2021 is *worse* in terms of the number of cases (compared to 2020) and that's going to impact how this looks for what we thought was going to be the summer "lull" and predicted rise in cases in late September or early October. I'm trying to look for updated models (all useless, some helpful

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Smoove_B · Post by **Smoove_B** » Sat Jul 24, 2021 7:35 pm

I mean, really:

At the beginning of the pandemic, the CDC said that a close contact was somebody that you’re indoors with unmasked for 15 minutes or more. The equivalent of that with the Delta variant is not 15 minutes, it’s one second.

Smoove_B · Post by **Smoove_B** » Sat Jul 24, 2021 11:02 pm

Ok, I'm done doomscrolling for today. If you'd like to read a rational analysis of what might be coming, How bad could the Delta variant get?

A different team of modelers, called the COVID-19 Scenario Modeling Hub, working with the CDC, unveiled a starker set of projections Wednesday. In their most likely scenario, NPR reports, the modelers suggested a mid-October Delta peak of 60,000 new daily cases across the country and 850 daily deaths — about one quarter as bad as the worst previous wave last winter. In their worst-case scenario, the Delta wave would peak at 250,000 new daily cases and 4,000 deaths. Both projections for deaths seem quite implausible to me, given that each would represent an even higher case-fatality rate than we saw in January, when the country’s new daily case rate peaked at 251,000 and the rolling seven-day death total reached just 3,400. Hardly anybody in the entire country was vaccinated then; today we’re just below 50 percent of the total population, and 90 percent of the senior population, where mortality risk is so concentrated.

...

The one other point is this breakthrough infection thing is probably worse than we have estimated. I don’t mean for death and hospitalizations, but in terms of the ability of the disease to burn through the vaccinated to make them get them infected — it’s not looking as good as we’d hoped, I think is fair to say.

...

How do you think it all plays out heading into the fall?
Looking ahead to the fall, I’m optimistic. Delta will have passed through by then — it’ll pass through by late August, or September, if it looks like India or the U.K. or Netherlands. We’ll have a rapid descent, and it’ll burn through. We’ll still have lots of COVID in this country, but it’ll be back to where it was before Delta came. It will be at a lower level. The only question is, is there something lurking that’s worse than Delta? There’s no sign of it yet, but there’s too much of this virus circulating to be confident — too many people in Indonesia and sub-Saharan Africa who are getting sick. But I hope not. I’m hoping that this is as bad as it gets. But if you talk to evolutionary biologists, they’ll tell you the variants are going to get worse.

Daehawk · Post by **Daehawk** » Sat Jul 24, 2021 11:21 pm

Wonder what the next variant will do. And the next.

Ralph-Wiggum · Post by **Ralph-Wiggum** » Sun Jul 25, 2021 7:39 am

Smoove_B wrote:I mean, really:

At the beginning of the pandemic, the CDC said that a close contact was somebody that you’re indoors with unmasked for 15 minutes or more. The equivalent of that with the Delta variant is not 15 minutes, it’s one second.

I am no epidemiologist, but the statement that the Delta variant is 1000x more infectious seems unfounded at the moment. The study they’re referring to (I think?) showed through PCR assays that the viral load was 1000x higher with the delta variant at some time point. That does not mean Delta is 1000x more infectious! That would require a very different type of study.

Smoove_B · Post by **Smoove_B** » Sun Jul 25, 2021 8:24 am

I'm not sure they're saying anything about the infectious nature (or it's pathogenicity or virulence) - it's a comment on how contagious the Delta strain is (using the original strain as a reference point). This article is a good overview on that study (I think). There are lots of terms that sometimes get swapped in and out depending on the audience, though they do have very specific meanings. It's very reminiscent (to me) of the early days of trying to emphasize the differences between quarantine vs isolation.

Ralph-Wiggum · Post by **Ralph-Wiggum** » Sun Jul 25, 2021 8:45 am

That came from a separate quote from the epidemiologist in the article:

I think, unfortunately, with the rise of Delta, which is about a thousand times more infectious than the original strains of the virus, we really do need to think about layering protections.

Smoove_B · Post by **Smoove_B** » Sun Jul 25, 2021 8:58 am

Ah. Then I'd humbly suggest they're using the terms wrong and have made the all-too-common error of saying "infectious" when they instead mean "communicable".

However, I'd never correct them as I am but a peon in the wheel of public health.

Skinypupy · Post by **Skinypupy** » Mon Jul 26, 2021 12:31 am

My immunocompromised co-worker that I’ve mentioned here before finally got the green light from her doctor to get vaccinated last Monday. She has Mast Cell Activation Syndrome, and they have been unsure if her body would be able to handle the vaccine. They still weren’t 100% confident, but figured the vaccine risk offset the risk of her getting COVID and told her to get the shot.

She was all set to get her vaccine Tuesday afternoon, but she and her daughter started feeling ill that morning. Got tested and sure enough, they both have COVID. She’s pretty sure that her daughter (11) got it first, and gave it to her. She did pretty well through last week, but I just got an email from my boss that she was admitted to the hospital tonight. I’m incredibly worried what’s going to happen to her over the next few days.

Sorry, but fuck any selfish asshole who doesn’t get vaccinated at this point. This is exactly the sort of scenario that could - and should - be entirely avoidable if people would simply take some damn responsibility and actually give a shit about literally anyone but themselves.

Kraken · Post by **Kraken** » Mon Jul 26, 2021 12:45 am

Geez Skiny, sorry to learn that. Hope she comes out OK.

The Meal · Post by **The Meal** » Mon Jul 26, 2021 7:25 am

Brutal.

LordMortis · Post by **LordMortis** » Mon Jul 26, 2021 7:38 am

Smoove_B · Post by **Smoove_B** » Mon Jul 26, 2021 9:52 am

Hearing those kinds of stories is absolutely gut-wrenching to me. I'm so sorry to hear it SP.

Unrelated, more info about long-term impacts associated with COVID-19:

The San Antonio researchers are among the teams of scientists from around the world who will present their findings on how COVID-19 affects the brain at the Alzheimer's Association International Conference, which begins Monday in Denver.

What scientists have found so far is concerning.

For example, PET scans taken before and after a person develops COVID-19 suggest that the infection can cause changes that overlap those seen in Alzheimer's. And genetic studies are finding that some of the same genes that increase a person's risk for getting severe COVID-19 also increase the risk of developing Alzheimer's.

...

"Persistent lack of smell, it's associated with brain changes not just in the olfactory bulb but those places that are connected one way or another to the smell sense," he says.

Those places include areas involved in memory, thinking, planning and mood.

COVID-19's effects on the brain also seems to vary with age, de Erausquin says. People in their 30s seem more likely to develop anxiety and depression.

"In older people, people over 60, the foremost manifestation is forgetfulness," he says. "These folks tend to forget where they placed things, they tend to forget names, they tend to forget phone numbers. They also have trouble with language, they begin forgetting words."

I just learned about a cousin that had COVID-19 earlier this year and her sense of smell still hasn't come back. In her words, food and drink taste like "sludge" and there's some concern her sense of smell might never come back given how long it's been out. I hesitate to even send this info along as she's in her 30s.

I'm going to repeat it for those in the back - you do not want to get COVID-19. Death is not the only possible outcome.

LawBeefaroni · Post by **LawBeefaroni** » Mon Jul 26, 2021 10:09 am

Smoove_B wrote: Mon Jul 26, 2021 9:52 am I'm going to repeat it for those in the back - you do not want to get COVID-19. Death is not the only possible outcome.

The problem is that everyone also knows someone who had COVID and, who are, as far as anyone can tell, are completely unaffected after recovering. People have weird cognitive biases when it comes to risk and COVID is making that apparent as all fuck.

Smoove_B · Post by **Smoove_B** » Mon Jul 26, 2021 10:16 am

Very true. I suspect Time magazine will have a "COVID Generation" cover in 2030 featuring stories about people that are dealing with the impacts a decade later.

Maybe it will come with a free snorkel (for those that live in frequently flooded areas) or filtration mask (for those under near constant wild-fire threat).

malchior · Post by **malchior** » Mon Jul 26, 2021 11:05 am

Smoove_B wrote: Mon Jul 26, 2021 10:16 am Very true. I suspect Time magazine will have a "COVID Generation" cover in 2030 featuring stories about people that are dealing with the impacts a decade later.

I fear they'll be talking about the victory of the brave freedom loving people who made sure the economy survived the onslaught of weak-willed libs while politically making sure the impacted get the least help possible.

Smoove_B · Post by **Smoove_B** » Mon Jul 26, 2021 11:45 am

That's going to be tough when its someone that is like 21 or 22 years old in 2030.

NJ's numbers are trending down now, which is good and the state is sharing the sequencing data. 75% of the cases over the last 4 weeks are Delta. I don't know if the downward trend is a weekend artifact or not; we'll know tomorrow; Rt is still elevated (1.44 and therefore, spreading). Hospitalizations in NJ are still up (400+), which is what we'd expect. Deaths are steady, but low (I think 2-5 a day), also what we'd expect to see.

I think the next week or so is going to likely chart the course for us in NJ for August.

El Guapo · Post by **El Guapo** » Mon Jul 26, 2021 11:57 am

I've read a couple articles that suggest that there may be a coorelation between lack of vaccine symptoms and susceptibility to a breakthrough infection. Which concerns me since I didn't have material side effects from the (Pfizer) vaccine. But then I remember a couple months ago seeing stuff that downplayed that possible link.

Dr. Smoove, what's the latest thinking / understanding on that?

Smoove_B · Post by **Smoove_B** » Mon Jul 26, 2021 12:05 pm

I really haven't seen to much debate about that. I think it likely falls under the same argument/belief early on over whether or not the vaccine "worked" based on your body's response.

The only way to know for sure is to draw blood and run a titer. But that's expensive (to broadly implement) so the general assumption is the vaccine worked until proven otherwise.

I had no symptoms after my first shot and mild symptoms after my second one. My wife and daughter were exactly the same. I'm not personally concerned about it, if that changes anything.

I do think they need to do more testing (big surprise, I know) of vaccinated people to really quantify breakthrough risk. That, I think, has been downplayed since broad rollout in the spring because the message was if you're vaccinated there's low risk of infection and death - which hasn't rally changed. However, there does seems to be an increased likelihood that breakthrough infections are more likely for vaccinated elders and immunocompromised people that are exposed to Delta, which is having a higher rate of negative outcomes that (I think) we expected to see prior to Delta becoming the dominant circulating strain.

That's why things need to change in terms of messaging. Not only isn't this over, it's not the same exact problem we had 6 months ago.

Skinypupy · Post by **Skinypupy** » Mon Jul 26, 2021 12:34 pm

Got a message this morning that my co-worker has improved quite a bit. She actually got admitted on Friday night (miscommunication from my boss) with really low Oxygen levels and a high fever. Spent the weekend in the hospital, and they have been able to get both back to normal. They said that if her blood work comes back normal today, they might actually be able to send her home. She feels completely exhausted and miserable, but they think she should be out of immediate danger. That's really encouraging.

One thing was odd though, they apparently will not tell either her or her primary care doctor if she has the Delta variant or not. The lab has apparently said they know, but won't release that info. That struck me as really strange, but maybe it's common procedure. I have no idea.

malchior · Post by **malchior** » Mon Jul 26, 2021 12:42 pm

It's been awhile but that sounds like a HIPAA problem. You have the right under law to see any of your own medical records.

LawBeefaroni · Post by **LawBeefaroni** » Mon Jul 26, 2021 1:12 pm

malchior wrote: Mon Jul 26, 2021 12:42 pm It's been awhile but that sounds like a HIPAA problem. You have the right under law to see any of your own medical records.

If the PCP or hospital ordered the test, I don't see any HIPAA reason for not sharing with the doctor. There is certainly no HIPAA reason for not sharing with the patient.

Glad she's feeling better and especially glad for her daughter.

Smoove_B · Post by **Smoove_B** » Mon Jul 26, 2021 1:21 pm

I wonder if it has to do with how the testing is being done? Namely, the patient/insurance is paying for the COVID-19 test to determine whether or not they have it, but the state health department (being reimbursed by the feds) is going to be running the additional testing to get a strain. If there's no medical need to know the strain (if the treatment isn't going to change and they're following universal precautions at the hospital), I can kinda see why it's not shared, but I honestly don't know what's being communicated at that level (patient to doctor).

The county, state and feds want that Delta information for bigger picture tracking, but I guess I'd argue what is the need for the patient or doctor to know?

Even when they're something like Cholera in the U.S., they get the +/- test and start treatment. It's sequenced and sent to the CDC to see if there's a pattern with other Cholera cases and to assist in tracing efforts. I'm not sure the patient or doctor is ever told about the strain unless they need more information about possible exposure.

It does seem weird regardless (to not get that info), but I'm not sure it matters.

Skinypupy · Post by **Skinypupy** » Mon Jul 26, 2021 2:04 pm

I wonder if it has something to do with our healthcare network system (Intermountain Heath Care). Chatted with two other folks in the same network this morning who said the same thing to them.

Agree that it's probably not critical, but it sure seems like an odd detail to withhold.

Paingod · Post by **Paingod** » Mon Jul 26, 2021 4:02 pm

I hope your co-worker continues to rally and it's not a false start.

malchior wrote: Sat Jul 24, 2021 12:39 pmQuick hot take - people who aren't displaying great judgement or intelligence to begin with are about to get worse. Sounds great.

It'll be interesting to see if anyone ever links voters and their choices to diminished post-COVID cognition.

Smoove_B · Post by **Smoove_B** » Tue Jul 27, 2021 1:19 pm

I guess I could just print these out and start randomly taping them to places around town.

https://twitter.com/EricTopol/status/14 ... 5146214400

Smoove_B · Post by **Smoove_B** » Wed Jul 28, 2021 10:51 am

Just...horrific.

https://twitter.com/JohnDanielMD/status ... 6614766594

Newborn babies are getting #COVID19.

Let me say that again: Newborn. Babies.

If that won’t make people get #vaccinated I don’t know what will.

Please #WearAMask and #GetVaccinated. I am begging from the deepest parts of my soul.

Kurth · Post by **Kurth** » Wed Jul 28, 2021 11:36 am

My sister who runs a large ER department in a FL hospital is despondent. Her hospital is getting hit hard:

I have been having a serious meltdown. Anti-VAXXER induced cases are leading a crippling rise in COVID here. For me there’s no politics in viral pandemics/ in life or death and I can’t stand the way politics has been involved in this weird attitude about vaccinations. If I sound crazy it’s because I am sort of crazy — It’s that bad. Self sacrificing, vaccinated healthcare workers are going to fucking die taking care of these selfish entitled assholes. Sorry I’m literally losing my shit over this. I’ve been crying and freaking out all week- more COVID patients then we’ve ever seen, and no one is vaccinated and no one gives a shit. It’s all ridiculous I’ve given up on humans

Blackhawk · Post by **Blackhawk** » Wed Jul 28, 2021 12:01 pm

Michelle's hospital went down to no COVID cases. In the past couple of weeks they've filled the COVID unit and then had to expand it - twice.

Smoove_B · Post by **Smoove_B** » Wed Jul 28, 2021 12:31 pm

Kurth wrote: Wed Jul 28, 2021 11:36 am My sister who runs a large ER department in a FL hospital is despondent. Her hospital is getting hit hard

I've said it before, but I'll repeat it again - I have no idea how people like your sister (front line medical staff) are still capable of dealing with this. What we asked of them prior to the vaccination was unthinkable. Now that it's largely preventable and they're still putting their own health (as well as their family) on the line to save people that can't be bothered to do the bare minimum to help? They're all better people than I am.

LordMortis · Post by **LordMortis** » Wed Jul 28, 2021 12:55 pm

Smoove_B wrote: Wed Jul 28, 2021 12:31 pm
Kurth wrote: Wed Jul 28, 2021 11:36 am My sister who runs a large ER department in a FL hospital is despondent. Her hospital is getting hit hard
I've said it before, but I'll repeat it again - I have no idea how people like your sister (front line medical staff) are still capable of dealing with this. What we asked of them prior to the vaccination was unthinkable. Now that it's largely preventable and they're still putting their own health (as well as their family) on the line to save people that can't be bothered to do the bare minimum to help? They're all better people than I am.

To say nothing of the retail and food workers we are loathe to pay and are pissed if it pays better to sit at home than to try and live off of $10 or less an hour at "flexible" work schedule. Though I have to admit, I'm a bit taken aback how many grocery workers don't wear a mask when given a choice. I'm reverting to mid 2020 shopping habits. Make one big monthly grin and bear it shop and try to do a lightning quick weekly supplement as necessary. Even as I know grocers are big warehouses with great circulation with people mostly quietly keeping to themselves. It's just too many zones of breathe out to pass through.

Blackhawk · Post by **Blackhawk** » Wed Jul 28, 2021 12:58 pm

Smoove_B wrote: Wed Jul 28, 2021 12:31 pm I've said it before, but I'll repeat it again - I have no idea how people like your sister (front line medical staff) are still capable of dealing with this. What we asked of them prior to the vaccination was unthinkable. Now that it's largely preventable and they're still putting their own health (as well as their family) on the line to save people that can't be bothered to do the bare minimum to help? They're all better people than I am.

And yet I fear for the state of healthcare after this is all over? How many of these people who are too conscientious to leave in the midst of an emergency are going to choose to walk away once it is all done?

And what about the next generation of doctors and nurses? I had considered nursing at one point. If it was something I was considering today, I'd be having serious second thoughts after seeing the way people put themselves at risk (thus putting healthcare workers at extreme risk) out of ignorance and ego, and the way the medical profession itself has chosen to act (such as hospital staff refusing to vaccinate.) And that's not to mention the scorn that some people treat healthcare workers with because they're doing 'lib' work.

We're driving off all of the heroes. Who will be left when the next dragon comes?

Kurth · Post by **Kurth** » Wed Jul 28, 2021 1:44 pm

In other news, my company is holding an all hands meeting this afternoon to announce our back to work plans. This will be interesting.

Word on the street is we’re mandating a 3 day, in office work week Tues-Thurs and allowing people to work remotely Mon and Fri.

I don’t see this going as planned.

My first question: Are we mandating vaccines for those who can get them?

Preliminary answer: No. Too difficult to administer with all the accommodations you’d have to allow for. And no other large companies will be doing that either.

Less than an hour later: Google offices to mandate vaccines

malchior · Post by **malchior** » Wed Jul 28, 2021 2:04 pm

https://twitter.com/sgurman/status/1420444332050554882

malchior · Post by **malchior** » Wed Jul 28, 2021 2:25 pm

Meanwhile in NY - Cuomo clearly indicates who is pulling his strings.

https://twitter.com/ZackFinkNews/status ... 1165995022

LordMortis · Post by **LordMortis** » Wed Jul 28, 2021 2:38 pm

Blackhawk wrote: Wed Jul 28, 2021 12:58 pm We're driving off all of the heroes. Who will be left when the next dragon comes?

This plus the "Better Call Saul" bumped in EBG now has Paul Simon stuck in my head.

What if I die here?
Who'll be my role model
Now that my role model is gone, gone?"

LawBeefaroni · Post by **LawBeefaroni** » Wed Jul 28, 2021 2:50 pm

Blackhawk wrote: Wed Jul 28, 2021 12:58 pm
Smoove_B wrote: Wed Jul 28, 2021 12:31 pm I've said it before, but I'll repeat it again - I have no idea how people like your sister (front line medical staff) are still capable of dealing with this. What we asked of them prior to the vaccination was unthinkable. Now that it's largely preventable and they're still putting their own health (as well as their family) on the line to save people that can't be bothered to do the bare minimum to help? They're all better people than I am.
And yet I fear for the state of healthcare after this is all over? How many of these people who are too conscientious to leave in the midst of an emergency are going to choose to walk away once it is all done?

And what about the next generation of doctors and nurses? I had considered nursing at one point. If it was something I was considering today, I'd be having serious second thoughts after seeing the way people put themselves at risk (thus putting healthcare workers at extreme risk) out of ignorance and ego, and the way the medical profession itself has chosen to act (such as hospital staff refusing to vaccinate.) And that's not to mention the scorn that some people treat healthcare workers with because they're doing 'lib' work.

We're driving off all of the heroes. Who will be left when the next dragon comes?

They're not leaving the profession. They're relocating to where they're wanted, respected, and protected. There is a growing pipeline of nurses relocating north from Florida, for example.

Isgrimnur · Post by **Isgrimnur** » Wed Jul 28, 2021 2:52 pm

Paul Simon looked a lot like Chevy Chase on that video.

Smoove_B · Post by **Smoove_B** » Wed Jul 28, 2021 6:47 pm

This is kinda random, but it's also a bit puzzling - surveillance data shows white-tailed deer in numerous unconnected locations have been testing positive for SARS-CoV-2.

Results of the study indicate that certain white-tailed deer populations in Illinois, Michigan, New York, and Pennsylvania were exposed to SARS-CoV-2.

Samples were obtained opportunistically as part of wildlife damage management activities conducted by APHIS Wildlife Services across 32 counties in the 4 states. These samples were tested at APHIS’ National Wildlife Research Center and National Veterinary Services Laboratories. Antibodies to SARS-CoV-2 were detected in 33% of the 481 samples collected from January 2020 through 2021. None of the deer populations surveyed showed signs of clinical illness associated with SARS-CoV-2.

It's weird because I wouldn't expect humans and deer to be in close enough contact where this type of interaction would result in transmission of the virus at great enough frequency to (1) detect through random sampling and (2) see in multiple locations around the United States.

I mentioned before, when we were learning about West Nile Virus, they started testing every animal they could get their hands on, and not surprisingly they found it all over - because mosquitos were spreading the virus. But this? I can't wait to see the theories.

The finding that wild white-tailed deer have been exposed to SARS-CoV-2 is not unexpected given that white-tailed deer are susceptible to the virus, are abundant in the United States, often come into close contact with people, and that, more than 114 million Americans are estimated to have been infected with COVID-19, according to the U.S. Centers for Disease Control and Prevention (CDC).

I'm curious about this statement - that they are "often" in close contact with people. I wouldn't say that at all.

malchior · Post by **malchior** » Wed Jul 28, 2021 6:49 pm

Weird. The only thing that pops top of mind is waste water.

Edit: Guess what do they define as "close contact". I have a right of way for power transmission behind me and there are deer 50 - 60 feet from me often.