COVID19: Perspective From A (Sort Of...) Expert-Adjacent Person

It seems to be getting better but too early to judge.
Lombardy has been hit hard, with Bergamo and Brescia provinces being the worst places, but numbers have been improving.
Other regions have their ups and downs but so far nothing similar to Lombardy, it seems that lockdown has been effective in containing the spread and keeping it mostly within our region.
But we’re having warm sunny days and the risk of people loosening distancing is high, there’s already more and more people around even here in Lombardy.
As I said, too early to judge, we can expect strict measures to go on util July or so, at least.

Should be mentioned, it seems to me that here lockdown was enforced more strictly than in the US. People aren’t allowed to move from region to region, then they could move outside of their municipalieties only for work, health, food shopping or serious reasons, there are police checks in the streets and everyone has to carry a paper declaring why they’re outside of their home if they get checked - and police asks proof, too. Being outside for no valid reason can result in a fine, and if a positive person that should have been home in quarantine is caught outside, they can be penally charged (something like “voluntary epidemic” or such).
Businesses like restaurants, clubs, hotels and such have been immediatly shut down, mass gatherings of any kind were prohibited (including church services and such), schools were closed right from the start, productive/manufacturing businesses are still running.
Not sure how’s the lockdown being enforced in the US but I understand that small gatherings are still allowed, people can move from state to state and so forth.

As for the rest, we’re lagging behind. I think we handled it “decently” at the start, with the lockdown and such, but our government is stalling hard on other matters, like supporting businessess, getting people back to work and protective gear supplies.

Rest of Europe, meh.
Spain is on a deadly tangent, in a few days they’ll have worse numbers than ours, situation is critical there. Wish we were in a better situation here to help them out.
France just recently updated their numbers since they were only counting positives and deaths in hospitals, i.e. they didn’t take into account people dying in retirement homes or at home, adjusted like this their number have spiked too.
Note that Spain, France, UK and Netherlands all have a death rate around 10% now.

I would also be careful (seen a few links in other threads) when posting articles about northern european countries like Sweden, Norway or Iceland, since they provide no useful context. Those countries cover a large area, with a small population and density, people can’t really apply their situation to those of other countries with high density.
Just to give an idea, Iceland has something like the population of two italian regions, spread over an area of fifteen italian regions. They have tested something like 20.000 people and made a study case of asymptomatic positives being 50% - too bad that out of the 20.000 people they tested, 1% were positive (180, precisely), and 50% of them asymptomatic (90).
So, yeah, I wouldn’t take studies like that seriously.

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Also, for the first time since the pandemic started the number of patients in ICUs has dropped…

Everyone is supposed to be isolated and staying home with the exception of essential trips. Doesn’t mean everyone is following that.

I think we are at a point where everyone avoid this is much easier than trying to figure out the specific people to isolate. We don’t know enough yet. And the US is going to have an insane number of people who have conditions which put them at risk that have never been diagnosed.

You keep coming back to this idea and it won’t work for numerous reasons in the US.

  1. It requires widespread and fast testing and disease surveillance to be effective, which we don’t have in place.

  2. it requires an early start. Once serious community spread starts, that is no longer an effective strategy, specifically because of the long period of viral latency. There is no effective way (without immense testing scale and 5 minute quick results) to determine which asymptomatic people don’t have the virus and which do.

  3. Look at the evidence of your eyes. NYC is already overwhelmed. Let’s say that we did what you propose. The current evidence points directly to healthcare overwhelming numbers even if none of the nursing home/elderly got sick in NYC. Which means only isolating the at risk population will change nothing in terms of the scale of sickness.

There are a bunch of other reasons this won’t work for the US now, but I don’t feel like writing them all up.

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Another one is the large number of people with preexisting conditions who live in impoverished areas. No one cared about those places when they were shooting each other in large numbers so why would we care now?

Here’s a question for you: what are the costs of doing what is necessary to minimize risks and shut down as little as possible for the sake of the economy, vs. shutting everything down for several months?

Here’s another study - four fifths of cases are asymptomatic

I’m not him but this is absolutely impossible to answer. Like impossible to even begin an attempt at answering. Many, many parts of the economy will not be effected by giving an all clear right now. Some will, but a lot won’t. Shutting down for several months is vague as we don’t know what shutdown or several months mean. Even saying 2 months vs 4 months would have massive implications to answering. As would shutdown. A lot of people in my community spent money today at places in the community. And not online I mean in person. Gas stations, restaurants, grocery stores.

I would say the government saying shutdown over in two weeks is going to have very little impact on certain sectors of the economy. And even with that all clear some of those places won’t even bother opening for a while.

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You still have to keep certain basic things open or people will be starving, you can only go so far.

Either way it won’t bounce right back because people are scared to go out after seeing nothing but coronavirus in the news for weeks. But like you are saying, the longer this goes on the worse the damage will be so maybe it’s better to come up with a different plan based on the new information. Right now old and sick people are still going out to buy food and medicine, and taking public transportation, while people at extremely low risk for any sort of complication are sitting at home for weeks on end. It makes no sense to continue like that.

Agreed. That’s why I said how you define shutdown matters. We have people who aren’t in those industries working.

Well that is obvious. What’s the new information? Isn’t the new information saying stay home? Are you looking at the US numbers and saying well shit what are we at home for?

How do you know they are at low risk? How do you know they would change their behavior?

I’m not going out in big crowds until I’m guaranteed to know I don’t have the chance to effect someone who is more vulnerable than me. And a shit ton of people feel that way. Most of my friends are between 30 and 40. Most of them are social distancing more for that fact than any shelter in place order.

You seem to think (maybe I’m wrong just from what you post) that old people are the only ones getting this. If that was the case it would be a whole lot easier.

The recovery in sectors like tourism, sporting events, movies isn’t based on us “opening” the economy back up. It’s based on people being healthy and having a desire to be around a lot of people. It’s not like it will bounce back faster if we open tomorrow or a week from now. At least not in a really significant way.

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This is why we can’t have nice things.
Please stop derailing this thread.

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That’s not a study. It’s a news article covering the topic. It even says “News” at the top. Just because it appears in a journal doesn’t mean it’s a research study. They have editorial boards and other sections.

The race to find all of these things out has been going on already and it is intensifying. The problem is that nobody knows yet, and regardless of the current prevalence you can’t discount the evidence of an overflowing hospital system and people dying by the thousands. Even if the virus has been around for longer than previously known and many more people have it than previously known, it still doesn’t change the numbers dying and hitting hospitals. That still needs to be addressed regardless. Again, Navy hospital ship to handle overflow. That’s not normal for “flu” seasons.

H factor put out a pretty good answer on your question. You didn’t define any specifics, leaving the question too vague to answer meaningfully, and even if you had tried to define specifics we don’t know enough yet to do that.

It sucks to be in the grey area, but that’s where we are.

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50-80% of cases are asymptomatic. What I’m saying is that a different approach would work better, keep the old and sick at home and let the rest continue with some semblance of normalcy. Right now those old and sick people are still going out for essential things, at the very least, and they are the ones who really should be at home. Deliver food, etc., to them instead.

Right now very little is being done to lower the risk for those most at risk.

I think the realization that for the vast majority of people this is either nothing or a mild illness puts it in a different perspective. Of course there are certain groups that are at an extremely high risk, and the measures in place aren’t doing much to address that. I’m not qualified to come up with a comprehensive plan to deal with this situation, but it’s becoming increasingly clear to me that this is not the right way to go about things.

Let’s take the non science stuff towards Aragorn and I to the other thread?

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no, you appear to ignore the concept of viral latency. Many initially appear asymptomatic for up to fourteen days prior to getting sick and/or (if the infection is severe) rapidly deteriorating.

1: Up to 25% of people with COVID-19 may not show symptoms | Live Science
Dr Robert Redfield (head of the CDC) has exclaimed up to (as in… maximum) 25% of those infected REMAIN asymptomatic

2:

“asymptomatic proportion is at 17.9% (95%CrI: 15.5–20.2%)”
“The model accounted for the delay in symptom onset and also for right censoring, which can occur due to the time lag between a patient’s examination and sample collection and the development of illness.”

As to children infected… the demographic of which you seem to believe is totally fine when it comes to infection…

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30198-5/fulltext

(53%) patients had moderate clinical type with pneumonia; 17 (47%) had mild clinical type and either were asymptomatic (ten [28%]) or had acute upper respiratory symptoms (seven [19%])

Pneumonia is fairly serious… Furthermore it should be noted this virus is also culpable (far moreso than the common cold/flu) for inducing cardiomyopathy

I’m not sure what the mechanism is, I’d assume it might be different from typical viral myocarditis as can be occasionally seen with influenza/the common cold (myocarditis can induce dilated cardiomyopathy). I know they’re talking about whether it’s safe for people to continue taking ACE inhibitors, so perhaps the mechanism has something to do with ACE II?

Either way, this isn’t a joke… stay the fuck at home

It should finally be noted, when authors talk about “underlying conditions”… they’re not talking about fucking cancer (well, that would obviously factor in)… but they’re talking about conditions the populace tends to have (esp the American, Australian etc populace).

  • hypertension
  • type 2 diabeties
  • obesity
  • cardiovascular disease (coronary artery disease, LVH induced by hypertension etc)

For instance, adipose tissue requires oxygenation, if you’re very fat, said tissue can suck up oxygen away from organs that vitally require said oxygen (heart, brain etc). Covid-19 scars the lungs, reduces lung capacity (and can cause respiratory failure in extreme cases)… fat people are obviously at higher risk for servere complications. Incubating a fat person is also fairly difficult. If they’re diabetic and/or have uncontrolled hypertension they may have some semblance of LVH/cardiomyopathy to begin with.

Now… what percentage of the populace is overweight and/or obese?

Should be known this is literally one day. It’s a worrysome trend, but initially Singapore contained the virus very efficiently. Furthermore if I recall a 120 case spike is still less than a 10% spike in case numbers ( or ever so slightly above 10% ) for them… Magnitudes better than the USA was doing when there was 1000 cases

Singapore will probably start shutting down work, school, possible mandate social distancing… In which case cases will rise very, very slowly

If you’re trying to argue Singapore is in just as much shit as France, Belgium, Spain, Italy and most of all… the USA I’d disagree… As a matter of fact Italy and the USA in particular really shit the bed on this one.

Australia could’ve done a better job too, most countries should’ve heeded warning when they saw what happened in China + Italy.

The USA

Singapore

Finally… Australia (as of recently.implimenting full on authoritarian measures we appear to have the spread under control)

No, you appear not to know what you are talking about. Asymptomatic is not the same as pre-symptomatic, everybody who gets infected and has no symptoms at first. There are three recent studies showing that at least 50% have no symptoms at all, one from Iceland, one from Italy, and one from China. The US doesn’t have enough testing kits so they have no way of knowing how many are actually infected.

The news here is now saying the same thing I have been saying for the last couple days, maybe they read my posts.

In Iceland, where the population is fairly small, authorities are testing almost everyone and finding out just as many people had the virus and didn’t know it as those who had mild to severe symptoms.

Even on the doomed Diamond Princess cruise ship (an almost perfect petri dish for COVID research), only about half of those who tested positive ever developed symptoms.

So rather than having us all cower at home for the full duration, wouldn’t it be possible to request high-risk persons stay isolated while slowly releasing low-risk Canadians to go back to a limited form of normal?

Bullshit… I may not be a doctor, but I know what I’m talking about when I say the viral latency with this particular illness is long, some don’t present with symptoms until weeks after detectable exposure.

Show me the studies, prove that they account for the variable of time in relation to symptomatology reported.

We need to move this argument to a different thread, arguments absent of actually linking clinical data don’t belong on this thread.

One of the studies I believe you’re talking about (the Iceland one) was conducted via testing… Not following up to make sure asymptomatic patients remain asymptomatic… According to the one study i posted prior, only about 17% of those infected are continuously asymptomatic.

I don’t believe your asymptomatic vs pre-symptomatic argument is true

The definition of asymptomatic in terms of medicine is “Have an illness or condition (such as early stage high blood pressure or glaucoma) but do not have symptoms of it”

Just like high bloods pressure “the silent killer” … People can be initially asymptomatic, over time they develop LVH, hypertensive heart failure, renal failure etc over a very long period of time if left uncontrolled. People with covid 19 (a virus with a long latency period) may be initially asymptomatic prior to developing symptoms and rapidly deteriorating

Why not ask an actual medical professional about this… Because I could be wrong.

I could ask one of the many medical professionals (some in the middle of this mess)… But I’m sure someone will accuse me of “running to my parents” despite the fact that this isn’t who I’d be asking… Given there is no way for me to prove I know MD’s without revealing who I actually am… Let’s ask @EyeDentist

Are 50-80% of those infected with covid-19 asymptomatic for the entire duration the virus is present within their body.

Also, Canada isn’t controlling the spread particuarly well… Loosen restrictions at this point and you’re looking at a lot of deaths.

Can’t you go ask an actual doctor, epidemiologist/virologist about this? Or at the very least read the clinical data available that has been published within peer reviewed journals rather than look at the news/media articles.

If the virus isn’t that severe, why are so many people dying in NYC? Do you really think we’ve got over a million infections in New York alone… But the majority aren’t showing symptoms

My brothers GF’s cousin fucking died from this, my cousin (slightly older than I) became critically ill, this isn’t some benign illness like the common cold… And you can’t lock up the elderly only, allow normal people to go to work, then come back home wherein they might be living with those at risk

You also appear to think perhaps only the elderly are at risk… Simply not true, an alarming number of young, otherwise healthy people without prior predisposition are falling critically ill.

The virus enters the body through ACE II… ACE II receptors exist within the myocardium, already a difference to the cold/flu. When viral cardiomyopathy develops from the cold/flu it’s a result of the virus reaching the heart… With covid 19 it’s far easier for the virus to reach the heart… That’s scary as fuck

There are three studies that say you are wrong

Go look them up yourself, I already posted links to them or articles on them. It has been in the news in Canada for the last couple days.

I have to link the same three studies in every post?

Sorry, what was the question?