Covid 19 SANITY

Are you an epidemiologist?  

Two key points there. One is "if one assumes..." the other is "more akin to". Closer to 0.1% than 10% or 36% is anything below 5%. Look, that paper was published online on Feb 28. Somehow the media is just discovering it. 

The current estimate being used by the administration is around 0.66% - that's the one published in the Lancet the othe rday, but was pre-print available in mid March and was used for the baseline case in the Imperial College study. That's an estimated infection fatality ratio which includes asymptomatics, not a case fatality ratio which is symptomatic observed only.

fyi:
www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

This is the visualization of John Hopkins University. Their numbers are basis of european decisions on how to proceed.
Germany has extended the social distance rule (which to break is actually a crime) for 2 more weeks, it is most likely to extend a lot longer though. Btw. Germany tests a lot more (per person) than  many  countries incl. the US. So this has to be considered to set number in relation ...
The most disturbing numbers are the numbers of fatal cases, and IMHO - to consider the reduction of these as highest priority is a matter of beeing human. I know, there are other opinions on this. Therefore I explicitly said "in my opinion". Just to be totally clear on that. I do not post this to start another political flame war on how to proceed in the best way.

Here a direct datacenter visualization about the curves of new cases, with the momentary conclusion about "flattening the curve". I just post the link for information, it gets actualized as soon as new numbers appear:
coronavirus.jhu.edu/data/new-cases

Not at all Mark! My thinking is in alignment with yours. The fact that some of the health workers who had "boosted" immune systems, from regularly being exposed to patients... Then being in a "hot spot" like Italy, and dying. THAT makes a big impact with me, as I have a strong immune system myself. Which was from teaching tons of kids per year.                                        Just hearing a small amount of the heart rending stories related to this, is very tough.
Chris

The 0.66% estimate is by the team lead by Verity at Imperial College. It was just published in the Lancet, but was available pre-print in early March and was the basis for the Imperial College paper that had the unlikely do-nothing scenario of ~2 million deaths in the US.

The tie-in to obesity, age, and diabetes had a researcher thinking there may be some viral attack on heme, on the blood itself. All of the risk factors we see result in higher blood sugar, so perhaps this is part of the deadliness.

www.rnz.co.nz/national/programmes/checkpoint/audio/2018740956/pandemic-scientist-makes-breakthrough-on-covid-19-cure

Pandemic' scientist makes breakthrough on Covid-19 cure

Scientists around the world have been racing to develop treatments, cures and a vaccine for Covid-19, and are getting closer by the day.

Jacob Glanville - one of the stars of Netflix documentary Pandemic - runs Distributed Bio, which has been working to find an antibody therapy.



On Monday he tweeted that a development was imminent.

"I'm happy to report that my team has successfully taken five antibodies that back in 2002 were determined to bind and neutralise, block and stop the SARS virus," Dr Glanville told Checkpoint.

"We've evolved them in our laboratory, so now they very vigorously block and stop the SARS-CoV-2 [Covid-19] virus as well.

"This makes them suitable medicines that one could use once they've gone through human testing to treat the virus," Dr Glanville said.

"The new virus is a cousin of the old SARS. So what we've done is we've created hundreds of millions of versions of those antibodies, we've mutated them a bit, and in that pool of mutated versions, we found versions that cross them over.

"So now we know they bind on the same spot as the new virus, Covid-19.

"It binds the spot that the virus uses to gain entry into your cells. It blocks that.

"At this point we know it binds the same spot extremely tightly with high affinity. The next step is we send the antibodies to the military, and they will directly put those on the virus and show that it blocks its ability to infect cells."

Dr Glanville told Checkpoint the military deals with the virus itself as he does not want Covid-19 or SARS in his laboratory.

"The other nice thing about it is you want the stamp of approval of a government military to independently test your work. This is one of the foundations of good science.

"Antibodies are attractive because you can give them to a patient right when they're in the hospital like an antiviral. You can also give them to doctors, you could give them to the elderly people to prevent them from getting sick."

There are a couple of groups around the world who have been working on developing antibodies, he said.

"Part of the reason we think we're moving pretty fast is that instead of starting from scratch discovering an antibody, we went to these existing antibodies that were already extremely well characterised against SARS. And we've adapted them. So we're piggybacking on two years of research.

"It's sort of like a short-term vaccine, except it works immediately.

"A vaccine could take six to eight weeks to take effect, where this will take effect within 20 minutes. You could give it to a patient who's sick, experiencing Covid-19, then within 20 minutes of receiving the shot, their body is flooded with those antibodies.

"Those antibodies will surround and stick all over a virus and make it so it's no longer infectious."

The disadvantage compared to a vaccine is that a vaccine might give you a year or multiple years of protection, Dr Glanville said. Antibodies will only give protection for eight to 10 weeks.

The military will test the antibodies against Covid-19, and another laboratory will start tests to make sure the medicine is safe for humans.

If those are successful, production of the antibodies have to be scaled up.

"We use very exacting manufacturing standards called GMP for making a medicine, and that can take multiple months," Dr Glanville said.

"Once that material is ready we go into a human trial. That's a ... trial where you give it to a series of 400 to 600 people who are in hospitals experiencing symptoms, and then you watch over the next five to 10 days to see whether it helped or not."

He said he and his colleagues are doing everything they can to speed up the process, but it does take time.

"We have saved potentially years of research by piggybacking on the SARS antibodies and our technology is very good at engineering these things to cross and we've succeeded in doing that.

"The next step, the big-time consuming part, is the GMP manufacturer. Traditionally, that takes nine to 12 months, obviously, we can't wait that long. So we've worked with two different partners to try to accelerate that to take a few months but that does take time and there's really no way around."

"Assuming that we're able to complete our study, at the end of summer… and it looks good, then we would use something called compassionate use.

"This is was used in the Ebola crisis. And it's been used in other cases where if you have something that's effective, and there's no other good medicine, you can begin releasing it to the world for use prior to going through all the approval process.

"That could be as early as September. Unfortunately, that's also as far away as September.

"So that's as fast as we can conceive of having this medicine widely available."

He told Checkpoint it is essential for his laboratory that everyone gains access to the medicine.

He said they are talking to the European Commission and there is interest in Asia.

"My feeling is that we should also in anticipation that that study looks good… we should start scaling up a lot more doses, hundreds of thousands to millions for the next step."

As much good news as it is, it seems so many are dead set to disbelieve it and fight to make others believe it's much worse than it really is.

I have no idea why.

The real problem here is the media watching models with *zero* comprehension of their use or assumptions, combined with total fear-mongering and sensationalism.

The Imperial study is a great case. You generate a baseline, then you see what you can do to that baseline by taking certain actions. It's like, if do-nothing costs $100 but I can do option A and save $40 and option B and save $60, then even if do-nothing actually costs $50, you can expect to save $20 and $30 respectively. Obviously they want to make the baseline case as accurate as possible, but you can only roll with the information you've got. The paper clearly states the assumptions, the likelihood or reliability of the base case (not very high!) and says they'll update as they can. None of that is reported. Instead, the media portrays the baseline case as the estimate.

The UW study on the other hand is using information from around the world to try to anticipate hospital load based on observed cases. There are some problems with this - the main one being we aren't testing sufficiently to know. Houston has been reporting that NO ONE is being tested unless they're being admitted in our county hospital. And, tests are running up to 14 days behind. That means you might have a death before the hospital number reflects reality. Unsurprisingly, the UW model is actually under-anticipating deaths right now. The UW model is to inform local officials of what to expect.

It's easier, though, to spread FUD on twitter (you can spread FUD by sensationalism and fear as well as encouraging doubt and unrest!!!)

Yeah. Maybe the real lesson here is that transparency on these kind of models should be discouraged. Maybe the public-facing ones should be nondimensionalized. :/

...and maybe we should listen to people like the Dr. Faucis of the world and then turn off the damn news. Regardless of the supposed bias of whatever news resource we consume, we must remember that they are trying to sell virtual newspapers and ads based on number of eyeballs. They have a near-zero need to report numbers and forecasts and scientific papers accurately. That’s not by and large what attracts viewers.

We should.

Dr fauci is one of the authors that surmises this could ultimately be no worse that a bad flu if we could figure out how many were actually infected, but asymptomatic.