Day 58: COVID-19 “Shelter-in-Place”

 

170 countries and territories affected worldwide. Few jurisdictions left not dealing with the virus.

But focusing today on the US: New York had more new cases yesterday than California’s total accumulated cases to date? The Times Union is placing the New York number at 1374, 1106 fewer cases than the Worldometer.com table. According to the Times Union 

Here are the latest virus numbers mapped in New York state. Please note, the figures are based New York Department of Health confirmed cases and Times Union reporting. The counts represent where the affected person is a permanent resident, not where they caught the virus.

So, what is true? Maybe someone from the Northeast can tell us what is going on. [Update: Times Union has now updated their count to 2382 which is now only 99 below the Worldometer.com tabulation.]

There was a kerfuffle between Gov Cuomo and NYC Mayor de Blasio: The Mayor said NYC residents should prepare for “shelter in place”, but the Governor said that was his call and he had no intention of ordering it.

Meanwhile, the Bay Area has solved its traffic problem.

[Note: Links to all my COVID-19 posts can be found here.]

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  1. MarciN Member
    MarciN
    @MarciN

    About five years ago I read a wonderful book on leadership by a Navy SEAL commander, Brian Hiner. I learned a lot about how the SEALs process volatile situations. I’m sure it’s how our doctors do it too, just remembering how they responded to the Boston Bombing. It’s a talent that is perfected through learning. The SEALs, first responders, and doctors think in terms of the VUCA of a situation: volatility, uncertainty, complexity, and ambiguity. 

    It sounds like that is the current state of mind in Massachusetts right now. :-) 

    • #1
  2. Rodin Member
    Rodin
    @Rodin

    Italy’s numbers are updated and news is still grim. As predicted, South Korea count now below all major European countries and US poised to pass them soon as well.

    • #2
  3. Rodin Member
    Rodin
    @Rodin

    Singapore was earlier looking like a model for handling the virus. Their numbers were flattening, nobody died, and they had a very transparent public communications system. But there was a recent uptick in cases that makes you wondering if something has changed.

    • #3
  4. Lee Member
    Lee
    @user_281935

    Rodin (View Comment):

    Singapore was earlier looking like a model for handling the virus. Their numbers were flattening, nobody died, and they had a very transparent public communications system. But there was a recent uptick in cases that makes you wondering if something has changed.

    Yes,  Singapore and Taiwan have both been hit in the last week by natives returning home from other countries with the virus.

     

    • #4
  5. Ed G. Member
    Ed G.
    @EdG

    The % of confirmed cases classified as “Serious, Critical” seems to vary widely from below 1% to 7%. Considering that the serious, critical rate for normal flu is somewhere in the 1%-2% range, I’m still not quite seeing the justification for the disparate response to the Wuhan Virus. 

    • #5
  6. MarciN Member
    MarciN
    @MarciN

    I keep thinking about the SARS epidemic that occurred from November 2002 to July 2003. Scientists stopped working on the vaccine development because SARS seemed to burn out and the pharmaceutical companies stopped funding the development. I hope in the post-Covid-19 world, the pharmaceutical companies will pursue vaccine development and create a library of vaccine formulas that they can tap into when needed. 

     

    • #6
  7. Joshua Bissey Inactive
    Joshua Bissey
    @TheSockMonkey

    Ed G. (View Comment):

    The % of confirmed cases classified as “Serious, Critical” seems to vary widely from below 1% to 7%. Considering that the serious, critical rate for normal flu is somewhere in the 1%-2% range, I’m still not quite seeing the justification for the disparate response to the Wuhan Virus.

    I looked at data yesterday, and saw that Italy’s percentage of deaths compared to infections was about twice that of China, and surpassed S. Korea’s by even more. I think the people in charge don’t want to be Italy, or at least don’t want to be blamed for it.

    • #7
  8. Kozak Member
    Kozak
    @Kozak

    Rodin (View Comment):

    Italy’s numbers are updated and news is still grim. As predicted, South Korea count now below all major European countries and US poised to pass them soon as well.

    Although disturbingly SK and Singapore are seeing an uptick in new cases.  SK in particular getting new cluster in Seoul which is troubling.

    • #8
  9. Kozak Member
    Kozak
    @Kozak

    Ed G. (View Comment):

    The % of confirmed cases classified as “Serious, Critical” seems to vary widely from below 1% to 7%. Considering that the serious, critical rate for normal flu is somewhere in the 1%-2% range, I’m still not quite seeing the justification for the disparate response to the Wuhan Virus.

    So you want to what, cross your fingers and hope we don’t go down Italys path?

    • #9
  10. Kozak Member
    Kozak
    @Kozak

    Joshua Bissey (View Comment):

    Ed G. (View Comment):

    The % of confirmed cases classified as “Serious, Critical” seems to vary widely from below 1% to 7%. Considering that the serious, critical rate for normal flu is somewhere in the 1%-2% range, I’m still not quite seeing the justification for the disparate response to the Wuhan Virus.

    I looked at data yesterday, and saw that Italy’s percentage of deaths compared to infections was about twice that of China, and surpassed S. Korea’s by even more. I think the people in charge don’t want to be Italy, or at least don’t want to be blamed for it.

    And the numbers that came out of China and Iran are crap. Period.

    China did everything it could to manipulate the stats.

    Limited testing to 3000 a day , so could never be more then 3000 new cases.

    Refused to test anyone not in hospital.  Any deaths that occurred in that case, not added to the stats.

    God only knows how many people died in their homes and were never diagnosed.

    Iran is no better.

    Italy has been the one hard hit area with believable stats and they are not comforting.

    • #10
  11. Ed G. Member
    Ed G.
    @EdG

    Kozak (View Comment):

    Ed G. (View Comment):

    The % of confirmed cases classified as “Serious, Critical” seems to vary widely from below 1% to 7%. Considering that the serious, critical rate for normal flu is somewhere in the 1%-2% range, I’m still not quite seeing the justification for the disparate response to the Wuhan Virus.

    So you want to what, cross your fingers and hope we don’t go down Italys path?

    Dude, step back a bit. My comment says exactly what I think: I’m still not quite seeing the justification for the disparate response to the Wuhan Virus. 

    That’s it. There’s a whole range of action between crossing your fingers and shutting everything down in order to flatten the curve. I’m skeptical that shutting everything down is a justifiable response especially considering our relative non-response to other serious viruses.

    • #11
  12. rgbact Inactive
    rgbact
    @romanblichar

    Kozak (View Comment):

    And the numbers that came out of China and Iran are crap. Period.

    China did everything it could to manipulate the stats.

    Limited testing to 3000 a day , so could never be more then 3000 new cases.

    Refused to test anyone not in hospital. Any deaths that occurred in that case, not added to the stats.

    I don’t understand what you’re complaining about. A high death rate is the worst stat….so theres no incentive to manipulate/not test people that aren’t on death’s door…as testing these people will lower the death rate.

    Right now….I only see 4 “problem countries” in the entire world. Thats Italy, Iran, Spain, and possibly France. And thats whats driving much of the current panic. Is everyone else lying or fudging numbers? Seems silly, since the cat’s out of the bag now.

    • #12
  13. Goldwaterwoman Thatcher
    Goldwaterwoman
    @goldwaterwoman

    Kozak (View Comment):
    Italy has been the one hard hit area with believable stats and they are not comforting.

    When I think ahead to the current hugely problematic economic ramifications of all the restrictions on business throughout the world compared to the relatively mild economic disruptions during past health concerns such as SARS, Ebola, etc., I believe we are making a mistake that will result in a world-wide depression. And yet — when I look at the stats out of Italy — the reality of a worst-case scenario comes sharply into focus almost to the point of eliminating all economic considerations in how we treat this threat. We are damned if we do everything we can to contain the spread and damned if we don’t.

    • #13
  14. Mendel Inactive
    Mendel
    @Mendel

    Ed G. (View Comment):

    The % of confirmed cases classified as “Serious, Critical” seems to vary widely from below 1% to 7%. Considering that the serious, critical rate for normal flu is somewhere in the 1%-2% range, I’m still not quite seeing the justification for the disparate response to the Wuhan Virus.

    Remember that those percentages are often more of a reflection of how many people are getting tested than how many are actually sick. And in the end, it’s not just relevant how the serious/critical rate compares with the flu itself, but what percentage of the population it infects. If both coronavirus and influenza have a 1% rate of serious infections but coronavirus infects 5x as many people in a seasonal outbreak….

    In the end, one of the simplest and most relevant criteria is: how many people in an affected jurisdiction will die due to the disease?

    Over the past 4 years, the average number of people to die from influenza in all of Italy is about 18,000 each flu season (officially measured over 27 weeks).

    The Lombardy region of Italy – where the Italian coronavirus outbreak is most intense – has one-sixth of all Italians. So very roughly speaking, about 3,000 people die in Lombardy each year on average across the entire 27-week official flu season.

    In this past week alone, over 1,200 people have died in Lombardy from coronavirus. While this calculation may use some rough figures and simplified math, that’s a frightening statistic.

    • #14
  15. rgbact Inactive
    rgbact
    @romanblichar

    Goldwaterwoman (View Comment):

    Kozak (View Comment):
    Italy has been the one hard hit area with believable stats and they are not comforting.

     , I believe we are making a mistake that will result in a world-wide depression. And yet — when I look at the stats out of Italy — the reality of a worst-case scenario comes sharply into focus almost to the point of eliminating all economic considerations in how we treat this threat. 

    If the true mortality rate is 1% or less….its just not worth killing the economy over imo.  Yet, 1% is what the US is running at right now, even with a lack of testing. So, I sure hope if we haven’t turned into Italy in 2 more weeks……that US policy makers rethink things.

    • #15
  16. Quietpi Member
    Quietpi
    @Quietpi

    Something that is going to be a factor in death rates, that came up in a recent meeting with an MD.  This virus kills relatively slowly.  He said that with seasonal influenza, death occurs, if it is going to occur, usually within five days of the patient entering the hospital.  In the case of this virus, symptoms progress rather slowly, and the patient may linger for a couple weeks or longer before succumbing.  So we should expect an offset between infections and deaths.   

    • #16
  17. cirby Inactive
    cirby
    @cirby

    There’s still that ongoing suspicion that there’s more than one strain of Wuhan virus running around – or (and this really worries me) that there’s a second, unrelated virus that’s also infecting some people.

    What I’m really hoping for is that the chloroquine treatment turns out to be a real thing.

    For those that haven’t heard this story, multiple labs across the world have claimed startling results in treating COVID 19 with chloroquine, which is normally used to treat malaria. The good news is that it’s incredibly cheap to make (five to ten cents a pill), and works fast (some people are going from desperately ill to virus-free in three or four days).

    The bad news is that there probably isn’t enough of it at the moment.

     

    • #17
  18. Goldwaterwoman Thatcher
    Goldwaterwoman
    @goldwaterwoman

    cirby (View Comment):
    For those that haven’t heard this story, multiple labs across the world have claimed startling results in treating COVID 19 with chloroquine, which is normally used to treat malaria. The good news is that it’s incredibly cheap to make (five to ten cents a pill), and works fast (some people are going from desperately ill to virus-free in three or four days).

    If this is true, it can save the world from economic ruin as some companies will start producing this by the millions ASAP. I sooooo hope you are right.

    • #18
  19. Mendel Inactive
    Mendel
    @Mendel

    cirby (View Comment):

    For those that haven’t heard this story, multiple labs across the world have claimed startling results in treating COVID 19 with chloroquine, which is normally used to treat malaria. The good news is that it’s incredibly cheap to make (five to ten cents a pill), and works fast (some people are going from desperately ill to virus-free in three or four days).

    The bad news is that there probably isn’t enough of it at the moment.

    Having worked in the field of antivirals in the past, I’d caution against putting too much hope in anecdotal stories (often from China) based on observations made in the fog of ICU war. Considering that the vast majority of hospitalized patients do recover, it can be difficult discerning between genuine improvement through the drug and simple natural healing, especially when a small number of patients are involved.

    That being said, it’s encouraging that France will start rigorous, medium-scale testing of hydroxychloroquine, since that should give us a much clearer picture within a reasonable time frame. It’s also encouraging that manufacturer Sanofi claims to have enough on stock to treat 300,000 patients.

    • #19
  20. Rodin Member
    Rodin
    @Rodin

    This might be a good time to remind people that I “like” all of the comments to my posts as an acknowledgement and “thank you” for taking the time to write a comment. My “likes” are not to be construed necessarily as agreement or support of a comment when it is disputing another commenter.

    • #20
  21. Snirtler Inactive
    Snirtler
    @Snirtler

    Rodin (View Comment):

    This might be a good time to remind people that I “like” all of the comments to my posts as an acknowledgement and “thank you” for taking the time to write a comment. My “likes” are not to be construed necessarily as agreement or support of a comment when it is disputing another commenter.

    Me too.

    As well as thanking you all for engaging with me, my “likes” across these covid posts may sometimes be construed as disagreement, but that I prefer to do other things than pick a fight.

    EDIT: This is maybe the wrong post for me to have added this disclaimer to.

    • #21
  22. cirby Inactive
    cirby
    @cirby

    Mendel (View Comment):
    Having worked in the field of antivirals in the past, I’d caution against putting too much hope in anecdotal stories (often from China) based on observations made in the fog of ICU war. Considering that the vast majority of hospitalized patients do recover, it can be difficult discerning between genuine improvement through the drug and simple natural healing, especially when a small number of patients are involved.

    We’re up to at least three unrelated labs that have gotten positive results, and the turnaround they describe is impressive. It’s being used in South Korea, which may explain some of their positive results in fighting the virus.

    That’s not “simple natural healing.”

    There’s also a fairly good described mechanism (more than one, actually, with synergistic effects) for the drug to get the effect it does, from what I’ve read. There have been previous studies about using chloroquine compounds to fight other, related coronaviruses, so it’s not much of a stretch. The CDC claims it’s effective against SARS, for example.

    One interesting tidbit is that the UK has (without public comment) decided to not allow the export of chloroquine. They’ve never done this before, for this drug.

    • #22
  23. Scott R Member
    Scott R
    @ScottR

    NY and FL are comparable in population size and density and started their Coronavirus journeys in comparable situations. NY now has nearly ten times the confirmed cases as FL and over twice the deaths.

    That is, spiraling community transmission isn’t happening in FL because it’s warm — a pattern we’ve seen worldwide for months. So get FL back to work.

    NY, hang in there, we’ll get you back working as we move deeper into spring.

    If we had sense.

    • #23
  24. Mendel Inactive
    Mendel
    @Mendel

    cirby (View Comment):
    We’re up to at least three unrelated labs that have gotten positive results, and the turnaround they describe is impressive. It’s being used in South Korea, which may explain some of their positive results in fighting the virus.

    It’s still from uncontrolled observational studies with very small numbers of patients, which are a very low level of evidence and highly subject to random effects and bias. We’re below climate change research in terms of confidence level here.

    And there have been no reports of how much it’s actually being used in South Korea and whether it is genuinely effective there, just one article that’s been passed around a million times now claiming they’ve incorporated it into a treatment guideline. That’s not evidence of actual utilization or efficacy.

    cirby (View Comment):
    There have been previous studies about using chloroquine compounds to fight other, related coronaviruses, so it’s not much of a stretch. The CDC claims it’s effective against SARS, for example.

    Yes, in cell culture. I also developed an amazing cure for influenza in cell culture years ago using an already-approved drug. Any guess as to why you’ve never heard of it? There are countless antiviral drugs that are promising in the pre-clinical phase that disappoint in clinical trials.

    I’m in no way saying these reports are wrong or that the drug won’t work, only that the degree of confidence that many are already showing about chloroquine is not yet substantiated by the available evidence. That doesn’t mean it won’t prove to be effective once more serious trials start in a few days. I sure as heck hope it does.

    But everyone should be aware that based on years of experience with similar drugs, there is still a decent chance it will disappoint.

     

    • #24
  25. MarciN Member
    MarciN
    @MarciN

    Scott R (View Comment):

    NY and FL are comparable in population size and density and started their Coronavirus journeys in comparable situations. NY now has nearly ten times the confirmed cases as FL and over twice the deaths.

    That is, spiraling community transmission isn’t happening in FL because it’s warm — a pattern we’ve seen worldwide for months. So get FL back to work.

    NY, hang in there, we’ll get you back working as we move deeper into spring.

    If we had sense.

    I’ve been watching this too. I think that’s what will happen and that the Northeast will soon settle down. I can feel the spring humidity coming back. It’s a different kind warm southern air than the cold North Atlantic air we get all winter.

    It’s going to be an early spring. Which is logical given how ridiculously warm it was this past fall and winter. We never even got a deep frost on Cape Cod. Maybe one or two light frosts at some point. Two inches of snow. But way below what we usually get. It has frankly been a spring-like winter here. It won’t take much to warm the area.

     

    • #25
  26. Snirtler Inactive
    Snirtler
    @Snirtler

    Mendel (View Comment):

    But everyone should be aware that based on years of experience with similar drugs, there is still a decent chance it will disappoint.

    One thing I’m curious about is if it’s more likely a treatment or a vaccine comes first, if we get either one at all.

    • #26
  27. Ed G. Member
    Ed G.
    @EdG

    Mendel (View Comment):

    Ed G. (View Comment):

    The % of confirmed cases classified as “Serious, Critical” seems to vary widely from below 1% to 7%. Considering that the serious, critical rate for normal flu is somewhere in the 1%-2% range, I’m still not quite seeing the justification for the disparate response to the Wuhan Virus.

    Remember that those percentages are often more of a reflection of how many people are getting tested than how many are actually sick. And in the end, it’s not just relevant how the serious/critical rate compares with the flu itself, but what percentage of the population it infects. If both coronavirus and influenza have a 1% rate of serious infections but coronavirus infects 5x as many people in a seasonal outbreak….

    In the end, one of the simplest and most relevant criteria is: how many people in an affected jurisdiction will die due to the disease?

    Over the past 4 years, the average number of people to die from influenza in all of Italy is about 18,000 each flu season (officially measured over 27 weeks).

    The Lombardy region of Italy – where the Italian coronavirus outbreak is most intense – has one-sixth of all Italians. So very roughly speaking, about 3,000 people die in Lombardy each year on average across the entire 27-week official flu season.

    In this past week alone, over 1,200 people have died in Lombardy from coronavirus. While this calculation may use some rough figures and simplified math, that’s a frightening statistic.

    Yes, we don’t know total cases – a higher denominator would only decrease the rate of “serious, critical”. Yes Italy is having worse outcomes than elsewhere – is that an indicator of a characteristic of the virus or is that more a characteristic of Italy? Will Italy’s serious, critical rate get worse or start to level out then decline? Even if it stays where it’s at, doesn’t it look like Italy is an outlier and that Italy’s rate is not a characteristic of the virus itself?

    • #27
  28. Valiuth Inactive
    Valiuth
    @Valiuth

    Goldwaterwoman (View Comment):

    Kozak (View Comment):
    Italy has been the one hard hit area with believable stats and they are not comforting.

    When I think ahead to the current hugely problematic economic ramifications of all the restrictions on business throughout the world compared to the relatively mild economic disruptions during past health concerns such as SARS, Ebola, etc., I believe we are making a mistake that will result in a world-wide depression. And yet — when I look at the stats out of Italy — the reality of a worst-case scenario comes sharply into focus almost to the point of eliminating all economic considerations in how we treat this threat. We are damned if we do everything we can to contain the spread and damned if we don’t.

    Economic pain is bound to happen from uncontrolled spread of the disease. The way I view it we might as well think of it as a sunk cost. The question is can we at least use that to mitigate the medical risks? We can make more wealth, we can’t bring people back from the dead. 

    • #28
  29. Valiuth Inactive
    Valiuth
    @Valiuth

    Ed G. (View Comment):
    Yes, we don’t know total cases – a higher denominator would only decrease the rate of “serious, critical”. Yes Italy is having worse outcomes than elsewhere – is that an indicator of a characteristic of the virus or is that more a characteristic of Italy? Will Italy’s serious, critical rate get worse or start to level out then decline? Even if it stays where it’s at, doesn’t it look like Italy is an outlier and that Italy’s rate is not a characteristic of the virus itself?

    Yes, different populations will have different risks for various reasons, some biological, some social. We see how bad it is in Italy, we see it was less bad in Korea. Which is America closer to both socially and biologically? Even if it is only half as bad as it is in Italy for us this will still make it far deadlier than the average seasonal flu. 

    • #29
  30. Ed G. Member
    Ed G.
    @EdG

    Valiuth (View Comment):
    Even if it is only half as bad as it is in Italy for us this will still make it far deadlier than the average seasonal flu. 

    Will it though? Based on what?

    • #30