Examples. Schools are open. Temperatures of children must be taken and questions answered and forwarded every morning and the school will inform via app if the child may go. There are plexiglass shields in classrooms protecting teachers and students. The masks the world is short of are worn by all. And Taiwan is exporting and donating 10s of millions of them. Restaurants also have shields. Life is pretty non-scary.
So says family member who teaches there and has lived there for 30 years.
I don't know how the general health of the German population compares with other countries but I doubt that's the key factor. The reason is this: as already stated, data shows cardiac disease to be a key predictor of outcome. Historically, France has had the lowest cardiovascular mortality of large European countries...
Err, a lot more of us seem to be dying than Germans, though...
The probability of you, as an individual contracting the disease from touching one contaminated surface and then touching your face such that viable virus enters your body is going to be very small. However each of us touch lots and lots of surfaces in a day... and there are a lot of people out there so you then multiply that up again and surfaces might be important on the population level. There appears to be big variations in the infection rates.
On the other hand, this leaves me confused again. Given that multiplication factor, you'd think that infection rates would be worse than they are. Or at least that's my uninformed perception. I find it very frustating that little is (can?) be done to trace where people have caught the disease now.
Sorry, not trying to confuse. But it's all mathematics...
It depends on:
- The number of virus particles deposited on a given surface
- The decay rate of viable virus on said surface
- what proportion are then transmitted to the hand of someone touching the surface
- what proportion is then transmitted to the respiratory tract
- the infective dose*
All of these are unknown. I suspect the rate of transmission that's not directly person to person is low. But if the person infected then goes on to infect 6 more, the very small number remains potentially significant. In the real world, it's possible to demonstrate the individual steps but totally impractical to track this process in real time. To a large extent the importance of this route of transmission can be retrospectively inferred from gaps in contact tracing. I.e. someone who tests positive with no know contacts...
But given that we're not even set up for doing that - which is what is absolutely critical when you start relaxing social restrictions...
Anyway back to the point; transmission via surfaces can happen; we don't really know how often although it will probably be a minority of cases. Probably a very small fraction.
Does that help?
As to the pre-existing general health point and Germany. I don't think the Germans are significantly more healthy than the Brits cardiovascularly. Therefore the much lower mortality must be due to something else: I.e. the German response to the pandemic has been much much better. If it was pre-pandemic general health, you'd expect France and Mediterranean countries to be doing better because they have lower rates of coronary disease than the UK which seems to be the best predictor of mortality.
*infective dose is in reality very complex but the concept is simple; how many virus particles do you need to take in to get an infection? In principle, it could be one as viruses (or bacteria for that matter) replicate very quickly and exponentially. In reality, a small number of virus particles will not usually cause infection because the innate immune system will deal with them. So it's how many thousands or millions do you need to take in vs how many are on the surface in question...
Ok, question: am I the only one on this thread who doesn't have in-depth knowledge of medicine, science, and stats?
My take is that what makes you so unusual is your ability to understand and acknowledge your own limitations, combined with your willingness to participate with such a non-combative approach. It's why I appreciate your contributions so much.
There is now strong data that the biggest risk factor for Covid mortality is pre-existing cardiac disease. (Even more than respiratory disease). I also strongly suspect there is a significant genetic component. The fact that some people get profound and often fatal effects whilst others get few or no symptoms implies an underlying difference between those patient groups.
The following is speculation but the virus probably binds to a specific cell protein in order to invade the cell. If said protein is one that varies between individuals then that would be a good explanation for why some are clearly much more vulnerable than others despite equivalent health statuses.
I'm reminded of an NPR interview with the author of a book about genetics, in which the author said something to the effect that the degree of genetic variation in our physical appearance is dwarfed by that of our immune systems.
Also, I've been wondering how much the variability in severity of the disease in younger patients with no known underlying health issues might be explained by infection dose.
To judge by the deaths of previously healthy nurses and doctors, infection dose must in some way be related to severity of disease. The more the immune system has to fight, the harder it is and the greater the risk of losing the fight.
and also the likely effect of a very large infective dose; I.e leading to more severe disease. This is only really a risk for healthcare workers. The expert opinions are extrapolation from other, similar viruses but data from Italy shows that performing a throat examination without protective equipment is REALLY high risk (possibly 100% transmission which is really rare in normal circumstances). This fits with the fact that ENT surgeons have been over-represented among the dead in both Italy and the UK.
Someone upthread was asking about nursing homes. This afternoon I had a long chat with my GP, because he is a member of the church. He said that as a GP he can’t just test anyone who he thinks should be tested, but that he has to ask and justify every test. And regarding nursing homes, he was told that if a facility of 6 beds (our smallest is this small, being mainly a day centre) had suspected cases they should only test 2 residents and if they are positive, assume the rest are too.
Thanks for the link to NHS England website. I got my answer earlier; NHS England clearly counts only hospital deaths. The note I saw (which was on the gov,uk website) referred to UK (not English) stats and the small number of non-hospital deaths seems to have referred to some evidence from Scotland, Wales or N Ireland.
I understand the arguments in favour of using hospital deaths only in the consideration of trends and the impact of trends on policy.
These graphs - link show if there is tail off, and there isn't in the USA. Italy and Spain yes, UK and USA no.
The graph you linked to is showing the total number of deaths per day. The graph I referred to was showing the number of new cases, not deaths. Typically the rate of death will lag behind new cases sometimes up to two weeks. Consequently, I would not be surprised to see American deaths continue to increase for the next couple of weeks.
I'm not sure that's the case. Nursing homes have staff who interact with their residents and then go home to their families. Then those family members go interact with other people in the community. Nursing home aren't hermetically sealed off from the communities in which they're located, especially for something as contagious as COVID-19.l.
That wasn't my point. My point was that sometimes one county will have many cases while an adjacent county will have far fewer.
The ordinary citizens of the higher county are no more likely to be exposed to the virus than the ordinary citizens of the lower county if all the excess cases are from nursing homes. There was a newspaper account of a nursing home in Henrico county with a nursing home that had hundreds of residents, many of whom came down with covid. The county total of people who were infected is 368. Adjacent New Kent county has 12 cases. The population of Henrico county is fifteen times that of New Kent, but the incidence of covid is twice as high. I assume the reason for the discrepancy is that New Kent does not have any nursing homes with covid.
I started this train of thought when I wondered which counties were most dangerous to visit.
Is the USA testing everyone? Because the UK is not, and without that testing the number of new case data is worthless. Here it relates to hospital cases confirmed and does not include people remaining at home in self isolation, as most of us are recommended to do. We really have no idea how many cases we have and our deaths data is missing information too - particularly English nursing home and deaths at home. The ZOE tracking project is trying to get some handle on it but only has 2 million taking part in the UK.
We also need testing to be able to withdraw quarantine because without we're stuffed.
Is the USA testing everyone? Because the UK is not, and without that testing the number of new case data is worthless. Here it relates to hospital cases confirmed and does not include people remaining at home in self isolation, as most of us are recommended to do. We really have no idea how many cases we have and our deaths data is missing information too - particularly English nursing home and deaths at home. The ZOE tracking project is trying to get some handle on it but only has 2 million taking part in the UK.
We also need testing to be able to withdraw quarantine because without we're stuffed.
New cases in the US refers to hospitalizations and positive tests. No, we are not testing everyone. Deaths are Covid-19 related deaths.
I wish the statistics would indicate what percentage of cases are from nursing homes, as compared with the general community. They are equally important in themselves, but cases in the community have public health implications that nursing homes do not.
I have been looking at a map showing cases in Virginia by counties. Some counties have many cases while adjacent counties have relatively few. I have seen newspaper articles about nursing home epidemics in some of the seriously-affected counties. However, I have seen no reports about other seriously-affected counties. I would like to know what's going on.
I'd like to know if they are counting deaths in hospitals within that county (or zipcode, given our local metro area).
That would account for some counties/zipcodes having massive numbers, while just next door there's minimal numbers.
Though I suspect the answer to my question varies by state.
No, the U.S. is not testing worth a darn, though availability and accessibility will depend on your location. I've pretty much resigned myself to never knowing if I've had it--unless (God forbid) I get a case sufficiently severe to hospitalize me. I doubt anything less would qualify for a test.
In the US if someone tests positive or diēs they are reported in their state of permanent residence, not whichever state they happen to be where their covid-19 is discovered.
One could imagine county reporting works like that too. But then again it might not.
No, the U.S. is not testing worth a darn, though availability and accessibility will depend on your location. I've pretty much resigned myself to never knowing if I've had it--unless (God forbid) I get a case sufficiently severe to hospitalize me. I doubt anything less would qualify for a test.
Hopefully, you'll be offered an antibody test at some point. That shows who's immune which as you unwind the restrictions is key information but also tells you that you were exposed to the virus.
Just to clarify (apologies if people already know this), there are two different tests that are important.
1) Is diagnostic testing.
The test here is a PCR test that detects active virus particles. In general, this is a brilliant technique and should have a very low false-negative rate (i.e. if you have the virus the test will be positive*). This is what you need when people are sick to know if it's Covid-19 or if it's something else. It's also vital for well patients having certain procedures to you know if you're exposing healthcare workers to risk.
2) Testing for immunity
Once you have exposure to the virus, you generate antibodies. The class of antibody that matters here is called IgG - this implies immune memory. So anyone who's had Covid-19 and got better and anyone who's had it without any symptoms would be expected to be IgG +ve. In many ways, this is the more important test as it tells you who is safe from contracting the virus**
From what I hear of the US, it's similar to the UK in that testing remains a shambles. We don't currently seem to have a reliable antibody test available in the UK.
AFZ
*It's a little more complex than this because it depends on the swab technique and we're not sure when in the life-cycle of the virus, it will be present in the nose. This will get better with more data, but a PCR diagnostic test is a very good test and should be very reliable.
**As we discussed a couple of pages back, the long-term immunity is not well understood and it might be that there is a reinfection risk, however, in general, being IgG positive for any specific pathogen infers that one is safe. (For example, following Hepatitis B vaccinations, I have a little certificate showing that I have IgG to Hep B antigens and thus am immune and allowed to do high-risk procedures. This is standard for healthcare workers in many parts of the world: Hep B vaccination is routine part of the occupational health work-up before you start work).
Yes. I understand that Fauci (not Trump, thank God!) has said that we may have antibody tests available in a couple of weeks, though God knows how/when/if they'll filter through to the various states, given a certain Someone's propensity for taking political revenge on governors and such. Still, it's Fauci, so I have cautious hope. I had a minor brush with a fever etc. last week, in spite of being almost totally isolated for a couple weeks, and the best possible outcome would be to find that it was a brush with COVID and that I contracted it from my (asymptomatic) essential-worker husband. Otherwise, we're both still at risk of a severe case and a bad outcome.
List of countries with at least 5,000 known COVID-19 cases.
United States - 532,879 (481,849 / 30,453 / 20,577)
Spain - 163,027 (87,312 / 59,109 / 16,606)
Italy - 152,271 (100,269 / 32,534 / 19,468)
France - 129,654 (89,431 / 26,391 / 13,832)
Germany - 125,452 (65,181 / 57,400 / 2,871)
China - 82,052 (1,138 / 77,575 / 3,339) 4.1%
United Kingdom - 78,991 (68,772 / 344 / 9,875)
Iran - 70,029 (23,725 / 41,947 / 4,357)
Turkey - 52,167 (48,101 / 2,965 / 1,101)
Belgium - 28,018 (18,686 / 5,986 / 3,346)
Switzerland - 25,107 (11,971 / 12,100 / 1,036)
Netherlands - 24,413 (21,520 / 250 / 2,643)
Canada - 23,318 (16,237 / 6,428 / 653)
Brazil - 20,962 (19,649 / 173 / 1,140)
Portugal - 15,987 (15,251 / 266 / 470)
Austria - 13,806 (6,865 / 6,604 / 337)
Russia - 13,584 (12,433 / 1,045 / 106)
Israel - 10,743 (9,301 / 1,341 / 101)
South Korea - 10,512 (2,930 / 7,368 / 214) 2.8%
Sweden - 10,151 (8,883 / 381 / 887)
Ireland - 8,928 (8,583 / 25 / 320)
India - 8,446 (7,189 / 969 / 288)
Ecuador - 7,257 (6,531 / 411 / 315)
Chile - 6,927 (4,990 / 1,864 / 73)
Peru - 6,848 (4,928 / 1,739 / 181)
Japan - 6,748 (5,878 / 762 / 108)
Norway - 6,409 (6,258 / 32 / 119)
Poland - 6,356 (5,773 / 375 / 208)
Australia - 6,303 (2,979 / 3,265 / 59)
Denmark - 5,996 (3,781 / 1,955 / 260)
Romania - 5,990 (4,941 / 758 / 291)
Czechia - 5,902 (5,362 / 411 / 129)
Pakistan - 5,011 (4,163 / 762 / 86)
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries nineteen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3).
A classic non-apology from Priti Patel, "I'm sorry if you feel there isn't enough equipment". This actually blames health staff, and has become the standard way of avoiding an apology.
Deaths do have to be registered and a physician does need to certify the cause or causes of death. So the Office of National Statistics will show more comprehensive figures. Yes there will be an element of judgment for those who die at home or in homes. But we should be able to see more clearly the relationship between hospital deaths and all deaths more clearly by comparing NHS and ONS figures.
Where you are entirely right is about the numbers who have actually caught the disease. So far as I can see, public policy is going to have to be based on sample testing, both of those who believe they have had symptoms and the population in general. Even when that evidence becomes available, the decision to relax some restrictions is going to be a risk assessment decision.
A test question might relate to rush hour travelling on trains, buses, underground systems. Another might be crowd events like sports and concerts. At current assessed levels of population infection, opening these up any time soon looks like a recipe for a second wave. But we need better data to do risk assessments re such activities.
Those who are arguing that strict restrictions must remain in force until at least we have better therapies for the minority of life threatening cases (those requiring hospitalisation) seem to me to have it right. I'm not sure how we survive economically.
However you look at it, any exit strategy is fraught with risk and danger.
If this was a world war, would we expect it to be over in a month ? Expectations about how long we manage a whole society crisis seem a bit weird at the moment.
If this was a world war, would we expect it to be over in a month ? Expectations about how long we manage a whole society crisis seem a bit weird at the moment.
Absolutely. A world of instant fixes is now confronted by something which, if it can in some sense, be "fixed", is going to take a very long time.
The Spanish flu pandemic lasted for three years (1918 to 1920) and had three major spikes. In less mobile times it infected about half a billion people (a quarter of the world's population) and killed maybe as many as 100 million people.
The world population is three to four times greater and there is much more movement of people and goods than in 1918-20. And this pandemic is still in its relatively early stages. We face monumental challenges; not least of which is whether it is possible to produce global co-ordinated responses in a world of increasing nationalism.
It's because of the particular person who is governor - Mike DeWine.
I didn't vote for him, because I've never voted for a republican, but if he could somehow get his name on the ballot by November I would vote for him for president. He has been everything you want a leader to be, but thought only existed in the movies. He speaks to us every afternoon right after Trump speaks and the contrast between his quiet, serious attitude which is all about the health and safety of Ohioans, and the bragging, uninformed, floundering of the other is startling.
From the very first, before Ohio had a single case, Dewine was listening to medical experts, observing countries around the world, and taking every measure he reasonably could to "flatten the curve." So we've been self-isolating and social distancing earlier than most states and many of us have started wearing masks when we have to go out. Very early on Dewine canceled big events, most importantly he canceled the physical primary election, delayed it and turned it into a mail-in only election, in spite of lots of push-back. His daily talks keep us from feeling panicky while reminding us that we're all working together to help each other get through this.
Ohio has three very big cities, Columbus, Cincinnati, and Cleveland, yet today we have only roughly 6000 cases, Indiana, much smaller. on the west border 7000 cases and Pennsylvania on the east border 21,000 cases. New York is just across the lake. BBC article about Dewine
No matter what party he belongs to, he obviously has far more sense, understanding, and ability, than the floundering f*ckwit he (presumably) still acknowledges as his leader...
Just looking at Irish deaths from corona, 320 reported, in a population of 5 million. The UK - 10 000 in population of 66 million. So UK deaths are running well ahead of Irish deaths.
Well, there are many confounding factors, Ireland may be more rural, with fewer large cities, and less overcrowding. Another scary idea is that Ireland locked down earlier, thus, St Patrick's Day was basically cancelled, whereas in the UK, there were large gatherings, e.g., the Cheltenham Festival, football matches, pop concerts.
A lot of this is guesswork, but why aren't the media digging into this? Because it might embarrass the govt?
Not wishing to minimise anything (or start a dangerous trend), quetz, but it did strike me that if found to be somewhat helpful, drinking Guinness would be an extremely popular therapy ....
A lot of this is guesswork, but why aren't the media digging into this? Because it might embarrass the govt?
Yes. The servile duplicity of the media in not calling out the utter shambles this government has made and the thousands of deaths they've caused is sickening.
Reading media from two countries in two languages, I think focusing on the errors being made by neighbouring countries rather than one's own is a popular sport. Certainly the BBC has been French-bashing since time immemorial and this period is no exception.
A lot of this is guesswork, but why aren't the media digging into this? Because it might embarrass the govt?
Yes. The servile duplicity of the media in not calling out the utter shambles this government has made and the thousands of deaths they've caused is sickening.
Well, if the UK followed Ireland statistically, there would be 4 000 deaths, not 10 000. I suppose a lot of the media don't care, as long as Boris is canonized. 6 000 excess deaths?
I started this train of thought when I wondered which counties were most dangerous to visit.
All of them! Governor Northam has issued a stay at home order [PDF] and he didn't do it for his own perverse amusement. Wondering about which Virginia counties to visit at this point is kind of like wondering which people are safe to give a big, sloppy kiss. If you're not already there, don't start.
Just looking at Irish deaths from corona, 320 reported, in a population of 5 million. The UK - 10 000 in population of 66 million. So UK deaths are running well ahead of Irish deaths.
Well, there are many confounding factors, Ireland may be more rural, with fewer large cities, and less overcrowding. Another scary idea is that Ireland locked down earlier, thus, St Patrick's Day was basically cancelled, whereas in the UK, there were large gatherings, e.g., the Cheltenham Festival, football matches, pop concerts.
A lot of this is guesswork, but why aren't the media digging into this? Because it might embarrass the govt?
Ireland had its first case of coronavirus later than the UK, and may simply be at an earlier stage in the curve.
Scotland has a population not much larger than Ireland (5.5 million), and 556 deaths so far, a lower proportion than that of the UK as a whole. But Scotland had its first case later than England, and I've heard this given as an explanation; we are just lagging behind, rather than doing better. However, it also means that the UK lockdown hit Scotland at an earlier point in the curve than England, which might mean lower figures in the longer term.
Why am I not surprised that it is the Scottish government we can rely on for stats, rather than the gang of gobshites which passes for the English version?
Yes, the trouble is, any comparison is a big undertaking, with many differences between Ireland and UK, another one may be air pollution. There are probably factors unknown. And some English towns are showing low rates, e.g., Darlington.
Sorry if it's been asked (I have looked, but not noted it) but why are we the sick man of Europe again? Why is the UK going to be worse than anybody, pro rata? Time will tell in the analysis, but until then? Because we were going for herd immunity before Imperial College said half a million by August?
I forgot that some of the Irish media were scathing about the Cheltenham Festival being held, good craic, shame about the virus.
All gatherings of more than 500 were banned in Scotland from Monday , March 16th, so we haven't had an equivalent of the Cheltenham Festival. This may have helped, too.
Of giving bad scientific advice to the government, leading to decisions which have produced avoidable deaths.
I can think of loads of reasons why the Irish data looks for the time being to be better than ours. Most of them have got nothing to do with the policies of the respective governments.
One note in favour of the UK government briefings. They are in sharp contrast to the US briefings, within which there has been mixed messaging and contradiction of the scientific opinion and advice. We haven't seen any of that.
So there is public evidence, as well as assertion, to support the argument that UK policies and the timings of their introductions are based on the scientific advice. Hence my question.
Comments
Examples. Schools are open. Temperatures of children must be taken and questions answered and forwarded every morning and the school will inform via app if the child may go. There are plexiglass shields in classrooms protecting teachers and students. The masks the world is short of are worn by all. And Taiwan is exporting and donating 10s of millions of them. Restaurants also have shields. Life is pretty non-scary.
So says family member who teaches there and has lived there for 30 years.
Sorry, not trying to confuse. But it's all mathematics...
It depends on:
- The number of virus particles deposited on a given surface
- The decay rate of viable virus on said surface
- what proportion are then transmitted to the hand of someone touching the surface
- what proportion is then transmitted to the respiratory tract
- the infective dose*
All of these are unknown. I suspect the rate of transmission that's not directly person to person is low. But if the person infected then goes on to infect 6 more, the very small number remains potentially significant. In the real world, it's possible to demonstrate the individual steps but totally impractical to track this process in real time. To a large extent the importance of this route of transmission can be retrospectively inferred from gaps in contact tracing. I.e. someone who tests positive with no know contacts...
But given that we're not even set up for doing that - which is what is absolutely critical when you start relaxing social restrictions...
Anyway back to the point; transmission via surfaces can happen; we don't really know how often although it will probably be a minority of cases. Probably a very small fraction.
Does that help?
As to the pre-existing general health point and Germany. I don't think the Germans are significantly more healthy than the Brits cardiovascularly. Therefore the much lower mortality must be due to something else: I.e. the German response to the pandemic has been much much better. If it was pre-pandemic general health, you'd expect France and Mediterranean countries to be doing better because they have lower rates of coronary disease than the UK which seems to be the best predictor of mortality.
AFZ
Edit: @Jay_emm explained it better! X-post.
*infective dose is in reality very complex but the concept is simple; how many virus particles do you need to take in to get an infection? In principle, it could be one as viruses (or bacteria for that matter) replicate very quickly and exponentially. In reality, a small number of virus particles will not usually cause infection because the innate immune system will deal with them. So it's how many thousands or millions do you need to take in vs how many are on the surface in question...
It's because of the particular person who is governor - Mike DeWine.
My take is that what makes you so unusual is your ability to understand and acknowledge your own limitations, combined with your willingness to participate with such a non-combative approach. It's why I appreciate your contributions so much.
I'm reminded of an NPR interview with the author of a book about genetics, in which the author said something to the effect that the degree of genetic variation in our physical appearance is dwarfed by that of our immune systems.
Also, I've been wondering how much the variability in severity of the disease in younger patients with no known underlying health issues might be explained by infection dose.
https://www.sciencemediacentre.org/expert-reaction-to-questions-about-covid-19-and-viral-load/
and also the likely effect of a very large infective dose; I.e leading to more severe disease. This is only really a risk for healthcare workers. The expert opinions are extrapolation from other, similar viruses but data from Italy shows that performing a throat examination without protective equipment is REALLY high risk (possibly 100% transmission which is really rare in normal circumstances). This fits with the fact that ENT surgeons have been over-represented among the dead in both Italy and the UK.
AFZ
Thanks for the link to NHS England website. I got my answer earlier; NHS England clearly counts only hospital deaths. The note I saw (which was on the gov,uk website) referred to UK (not English) stats and the small number of non-hospital deaths seems to have referred to some evidence from Scotland, Wales or N Ireland.
I understand the arguments in favour of using hospital deaths only in the consideration of trends and the impact of trends on policy.
The graph you linked to is showing the total number of deaths per day. The graph I referred to was showing the number of new cases, not deaths. Typically the rate of death will lag behind new cases sometimes up to two weeks. Consequently, I would not be surprised to see American deaths continue to increase for the next couple of weeks.
That wasn't my point. My point was that sometimes one county will have many cases while an adjacent county will have far fewer.
The ordinary citizens of the higher county are no more likely to be exposed to the virus than the ordinary citizens of the lower county if all the excess cases are from nursing homes. There was a newspaper account of a nursing home in Henrico county with a nursing home that had hundreds of residents, many of whom came down with covid. The county total of people who were infected is 368. Adjacent New Kent county has 12 cases. The population of Henrico county is fifteen times that of New Kent, but the incidence of covid is twice as high. I assume the reason for the discrepancy is that New Kent does not have any nursing homes with covid.
I started this train of thought when I wondered which counties were most dangerous to visit.
We also need testing to be able to withdraw quarantine because without we're stuffed.
New cases in the US refers to hospitalizations and positive tests. No, we are not testing everyone. Deaths are Covid-19 related deaths.
Saw something on the news yesterday: a nursing home where the staff have chosen to stay in the home full-time and be locked down with the residents.
Interestingly, staff and residents were sitting around together, and all seemed quite happy about it. I'm guessing maybe they care about each other.
Not sure where it is.
Are you maybe a person with a Real Life™?
I'd like to know if they are counting deaths in hospitals within that county (or zipcode, given our local metro area).
That would account for some counties/zipcodes having massive numbers, while just next door there's minimal numbers.
Though I suspect the answer to my question varies by state.
One could imagine county reporting works like that too. But then again it might not.
Hopefully, you'll be offered an antibody test at some point. That shows who's immune which as you unwind the restrictions is key information but also tells you that you were exposed to the virus.
Just to clarify (apologies if people already know this), there are two different tests that are important.
1) Is diagnostic testing.
The test here is a PCR test that detects active virus particles. In general, this is a brilliant technique and should have a very low false-negative rate (i.e. if you have the virus the test will be positive*). This is what you need when people are sick to know if it's Covid-19 or if it's something else. It's also vital for well patients having certain procedures to you know if you're exposing healthcare workers to risk.
2) Testing for immunity
Once you have exposure to the virus, you generate antibodies. The class of antibody that matters here is called IgG - this implies immune memory. So anyone who's had Covid-19 and got better and anyone who's had it without any symptoms would be expected to be IgG +ve. In many ways, this is the more important test as it tells you who is safe from contracting the virus**
From what I hear of the US, it's similar to the UK in that testing remains a shambles. We don't currently seem to have a reliable antibody test available in the UK.
AFZ
*It's a little more complex than this because it depends on the swab technique and we're not sure when in the life-cycle of the virus, it will be present in the nose. This will get better with more data, but a PCR diagnostic test is a very good test and should be very reliable.
**As we discussed a couple of pages back, the long-term immunity is not well understood and it might be that there is a reinfection risk, however, in general, being IgG positive for any specific pathogen infers that one is safe. (For example, following Hepatitis B vaccinations, I have a little certificate showing that I have IgG to Hep B antigens and thus am immune and allowed to do high-risk procedures. This is standard for healthcare workers in many parts of the world: Hep B vaccination is routine part of the occupational health work-up before you start work).
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries nineteen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3).
Pakistan has been added to the list since the last compilation.
Deaths do have to be registered and a physician does need to certify the cause or causes of death. So the Office of National Statistics will show more comprehensive figures. Yes there will be an element of judgment for those who die at home or in homes. But we should be able to see more clearly the relationship between hospital deaths and all deaths more clearly by comparing NHS and ONS figures.
Where you are entirely right is about the numbers who have actually caught the disease. So far as I can see, public policy is going to have to be based on sample testing, both of those who believe they have had symptoms and the population in general. Even when that evidence becomes available, the decision to relax some restrictions is going to be a risk assessment decision.
A test question might relate to rush hour travelling on trains, buses, underground systems. Another might be crowd events like sports and concerts. At current assessed levels of population infection, opening these up any time soon looks like a recipe for a second wave. But we need better data to do risk assessments re such activities.
Those who are arguing that strict restrictions must remain in force until at least we have better therapies for the minority of life threatening cases (those requiring hospitalisation) seem to me to have it right. I'm not sure how we survive economically.
However you look at it, any exit strategy is fraught with risk and danger.
Even if the coronavirus is 'defeated' within the next few months, the consequences - personal, national, and global - will be felt for years to come.
The Spanish flu pandemic lasted for three years (1918 to 1920) and had three major spikes. In less mobile times it infected about half a billion people (a quarter of the world's population) and killed maybe as many as 100 million people.
The world population is three to four times greater and there is much more movement of people and goods than in 1918-20. And this pandemic is still in its relatively early stages. We face monumental challenges; not least of which is whether it is possible to produce global co-ordinated responses in a world of increasing nationalism.
I didn't vote for him, because I've never voted for a republican, but if he could somehow get his name on the ballot by November I would vote for him for president. He has been everything you want a leader to be, but thought only existed in the movies. He speaks to us every afternoon right after Trump speaks and the contrast between his quiet, serious attitude which is all about the health and safety of Ohioans, and the bragging, uninformed, floundering of the other is startling.
From the very first, before Ohio had a single case, Dewine was listening to medical experts, observing countries around the world, and taking every measure he reasonably could to "flatten the curve." So we've been self-isolating and social distancing earlier than most states and many of us have started wearing masks when we have to go out. Very early on Dewine canceled big events, most importantly he canceled the physical primary election, delayed it and turned it into a mail-in only election, in spite of lots of push-back. His daily talks keep us from feeling panicky while reminding us that we're all working together to help each other get through this.
Ohio has three very big cities, Columbus, Cincinnati, and Cleveland, yet today we have only roughly 6000 cases, Indiana, much smaller. on the west border 7000 cases and Pennsylvania on the east border 21,000 cases. New York is just across the lake.
BBC article about Dewine
Well, there are many confounding factors, Ireland may be more rural, with fewer large cities, and less overcrowding. Another scary idea is that Ireland locked down earlier, thus, St Patrick's Day was basically cancelled, whereas in the UK, there were large gatherings, e.g., the Cheltenham Festival, football matches, pop concerts.
A lot of this is guesswork, but why aren't the media digging into this? Because it might embarrass the govt?
Yes. The servile duplicity of the media in not calling out the utter shambles this government has made and the thousands of deaths they've caused is sickening.
Well, if the UK followed Ireland statistically, there would be 4 000 deaths, not 10 000. I suppose a lot of the media don't care, as long as Boris is canonized. 6 000 excess deaths?
All of them! Governor Northam has issued a stay at home order [PDF] and he didn't do it for his own perverse amusement. Wondering about which Virginia counties to visit at this point is kind of like wondering which people are safe to give a big, sloppy kiss. If you're not already there, don't start.
And there is comment (Guardian) that the UK daily death rates are higher than Italy at the height of their crisis
Of what?
Ireland had its first case of coronavirus later than the UK, and may simply be at an earlier stage in the curve.
Scotland has a population not much larger than Ireland (5.5 million), and 556 deaths so far, a lower proportion than that of the UK as a whole. But Scotland had its first case later than England, and I've heard this given as an explanation; we are just lagging behind, rather than doing better. However, it also means that the UK lockdown hit Scotland at an earlier point in the curve than England, which might mean lower figures in the longer term.
The Scottish government is issuing excellent statistics, including the number of patients in intensive care. For example, there were 91 patients with COVID 19 in hospital in my region, Grampian, of whom 14 were in intensive care:
https://www.gov.scot/publications/coronavirus-covid-19-tests-and-cases-in-scotland/
Come over, O Alba, into Britannia, and help us...
Yes, the trouble is, any comparison is a big undertaking, with many differences between Ireland and UK, another one may be air pollution. There are probably factors unknown. And some English towns are showing low rates, e.g., Darlington.
(Not that I wish it any different for that Fair Town!)
All gatherings of more than 500 were banned in Scotland from Monday , March 16th, so we haven't had an equivalent of the Cheltenham Festival. This may have helped, too.
I can think of loads of reasons why the Irish data looks for the time being to be better than ours. Most of them have got nothing to do with the policies of the respective governments.
One note in favour of the UK government briefings. They are in sharp contrast to the US briefings, within which there has been mixed messaging and contradiction of the scientific opinion and advice. We haven't seen any of that.
So there is public evidence, as well as assertion, to support the argument that UK policies and the timings of their introductions are based on the scientific advice. Hence my question.