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Day 112: COVID-19 Missing Correlations?
“We know everything about Sars-CoV-2 and nothing about it. We can read every one of the (on average) 29,903 letters in its genome and know exactly how its 15 genes are transcribed into instructions to make which proteins. But we cannot figure out how it is spreading in enough detail to tell which parts of the lockdown of society are necessary and which are futile. Several months into the crisis we are still groping through a fog of ignorance and making mistakes. There is no such thing as ‘the science.’” — Matt Ridley
Hat tip to Al French of Damascus for directing my attention to the Matt Ridley piece from which the quote starts the entire discussion of where we are in this epidemic.
Ridley introduces a new word into my vocabulary: nosocomial. That is the word that medical personnel use to refer to infections acquired within a medical facility or place where one receives medical care. Another quote from Ridley’s piece:
The horrible truth is that it now looks like in many of the early cases, the disease was probably caught in hospitals and doctors’ surgeries. That is where the virus kept returning, in the lungs of sick people, and that is where the next person often caught it, including plenty of healthcare workers. Many of these may not have realised they had it, or thought they had a mild cold. They then gave it to yet more elderly patients who were in hospital for other reasons, some of whom were sent back to care homes when the National Health Service made space on the wards for the expected wave of coronavirus patients.
The evidence from both Wuhan and Italy suggests that it was in healthcare settings, among the elderly and frail, that the epidemic was first amplified. But the Chinese authorities were then careful to quarantine those who tested positive in special facilities, keeping them away from the hospitals, and this may have been crucial. In Britain, the data shows that the vast majority of people in hospital with Covid-19 at every stage have been ‘inpatients newly diagnosed’; relatively few were ‘confirmed at the time of admission’. The assumption has been that most of the first group had been admitted on an earlier day with Covid symptoms. But maybe a lot of them had come to hospital with something else and then got the virus.
When we think of the nosocomial phenomena we tend to think of hospitals. But nursing homes and any form of group elderly care would also qualify. Are we missing some correlations?
The other day Governor Andrew Cuomo of New York issued a report citing 66% of those hospitalized in New York had been “staying at home” before they became ill. How many of these patients’ “home” was a nursing home or other form of group care for the elderly? They did not say.
There is another report back on April 13 that 2,400 of the deaths in New York from COVID-19 occurred in nursing homes or assisted living facilities — not at hospitals. That was about 25% of recorded deaths from COVID-19 at the time. Did that pace continue? If those deaths are counted as “hospitalizations” before death and those nursing home and assisted living residents who were actually hospitalized are segregated out of the “home” statistics for the hospitalized in that report, what percentage of total COVID-19 illness is attributable to nursing homes, assisted living, and hospital care as opposed to all other infections?
A final note from the Ridley article:
Once the epidemic is under control in hospitals and care homes, the disease might die out anyway, even without lockdown.
Could it be that simple? If not simple, could it at least conform to the 80-20 rule — focus our attention on these facilities and gain most of the benefit?
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
(continued, yet again… this time from comment #30)
My response may seem selfish or callous or heartless… but that is only because this is right at the forefront of everyone’s minds, and it is being discussed in a vacuum. It is no more callous or heartless than our response to literally any other problem. Why are 70K lives lost to covid an appropriate test of humanity while 60K lives lost to any other respiratory illness are simply a part of life? The only difference is that this is where our focus currently is, and when this newly-ADD-riddled global population gets its mind set like a laser beam on one problem, it loses all context and perspective. But context is everything.
So what would I do? What would I recommend with respect to covid? That all depends. I would say that people need to think of covid in exactly the same way they think of any other respiratory illness. If you are overweight, lose weight. If you are diabetic or have hypertension, get it under control (and probably lose weight). If you live in a big city, slap yourself in the face, get a life, and realize that stress is probably going to kill you… then, move out of the big city, start voting republican, and get a concealed-carry permit. If you are extremely old, realize that you have entered the phase of life where death is lurking around every corner. Enjoy every moment with your family and try to dust off the Bible that you received 70 years ago at your baptism. All of that sounds heartless, no? Not really. It is the approach we take with virtually everything, because we simply cannot live our entire lives in fear of death and illness. This latest illness is one that has just been added to the list of things that are trying to kill us. For the old and infirm, they should treat this exactly the way they do the flu – both can kill you. Half as deadly as “dead” isn’t much better…
But what should our response be? I don’t think our response to covid should be any different than anything else. It is a good reminder to hospitals and governments that it would be a good idea to be better prepared for disaster and pandemics. Maybe we shouldn’t be so heavily in debt, such that we can actually afford to provide relief when something flares up. Maybe instead of spending billions on ridiculous pet projects, graft, and personal favors for individual politicians, we should incentivize research and innovation through grants and so forth (which will still be subject to graft and favors). When we see a massive problem in nursing homes (as covid seems to indicate), maybe we should be attempting a more targeted response… there are books of regulations (and as a lawyer, I’ve read them!) for these facilities, and it may be that they need to be improved…
(last one, I swear it… sorry, it should have just been a separate post)
All that to say – what we really need to do is [expletive]-ing snap out of it. We are experiencing a major panic that is largely driven by media/social-media and fear of the unknown. This latest unknown has somehow led us into forgetting that our lives are absolutely chock full of unknowns, and whether this is twice or three or five times as deadly as the well-known and already accepted flu, it still exists on the margins, and it still falls into roughly the same category.
Somehow, we have decided that this latest hazard necessitates a complete shift in our way of thinking – it reminds me of the first Bolshevik revolution in 1917, which bubbled and stewed, and then just spread like a tsunami, resulting in decades of misery. Covid is the earthquake out in the middle of the ocean that started that wave, but the tsunami is now a thing all its own.
Consider what we’re doing. We’ve started with the absolute most extreme. Essentially, house arrest. Whether this is effective in stopping the spread of this particular disease is up for debate, of course, but I don’t think that is the most important consideration. If we were to look at anything in a vacuum, we could start to solve the problem the way we’re “solving” covid. We could ban driving to cut back on automobile accidents, we could ban all guns to cut back on violence (whoops… I guess that’s a different post). So, people are pretty fed up with this solution, right? People suffering from other ills are fed up with this notion that we’ve taken this one problem and elevated it above literally all other problems. But we don’t get to open up that vacuum and let in the rest of life. This becomes a negotiation process, for some reason. What are you willing to compromise? What are you willing to give up? We still, apparently, need to stay laser-focused on this one problem… ok, so let’s start talking about privacy rights. You willing to give those up? We need extreme contact tracing, we need large-scale testing. Let’s start talking about individual rights. We need you all to put on this mask. Complain? Well, you don’t complain about having to wear pants, do you?! Nevermind that the two are in no way comparable. Do you want off this house arrest, or what?
All this over what? No – you can’t say that! If you say that, you are basically sacrificing lives. Even our own Mendel put it in those terms. My freedom at the expense of lives. Intervention is OK just as long as it doesn’t impact me directly, right?
No – the problem is that this is a fundamental shift in the way we solve problems… (damnit, one more:)
This is a new phenomenon. In April a veterans’ home in Massachusetts lost 70 patients in the course of a few weeks. That would get people’s attention under any circumstances. I believe we have reacted to this virus completely understandably.
For us to look at the impact of the virus on the world’s human population with the clear view of hindsight, we can now safely say, “It’s this type of disease that strikes this type of person. We can mitigate some of the symptoms. We can’t prevent all of it, we can protect some people from exposure to it, and we can’t cure any of it at the moment. It turns out that although many people have it, not everyone dies from it.” The death part is what we weren’t sure of a month ago. Now we are.
I just can’t work up any anger at the people who came up with the idea of closing up shop for a few weeks. They reacted the way any of us would who came upon a spectacular car accident. They stopped.
I’m glad we are coming out of this pandemic shutdown now. I hope we’ll have answers by November when it is sure to come back.
(last one, I promise)
The problem is not that I fail to recognize that this particular respiratory illness is to some degree more deadly than the other respiratory illnesses that we accept as a part of our lives… it is that we really do need to start focusing on limiting principles, because the fact is, this particular respiratory illness is not different enough from those other accepted illnesses to necessitate so drastic and fundamental a change in our underlying views of what are and are not appropriate responses to this category of harm.
So what’s my solution? Let grandma die? Shrug our shoulders just as long as we’re not personally impacted? No, you don’t get to accuse me of that, because the exact same accusation could be levied against anyone who isn’t fully on board with pushing every other harm aside in favor of your preferred harm. My solution is that we should handle this exactly the same way we handle literally everything else that we face on a daily basis. Smart people who are motivated to do so should continue attempting to work on the problem. Profit-driven drug companies should still home to capitalize on people’s fears by providing effective treatments. Doctors should continue to abide by the Hippocratic oath and do their best to save lives. People in at-risk categories should continue to protect themselves from all the final-straws. People with at-risk loved ones should help out. And all of us should focus our time and energy on trying to solve our individual problems.
As a lawyer, I spend my time working with teenagers who are abused or neglected. That’s a problem. It has lasting effects on their lives. Some will die because of lifestyle choices resulting from trauma or despair. Some will grow up and abuse their own spouses or children. If we all put down everything we’re doing and worked together, maybe we could help these kids. Maybe, though, we’d do more harm than good. Undoubtedly, we’d be putting down what we otherwise would be doing. If a doctor stopped seeing patients in order to help me solve my problem, he wouldn’t be solving his own problems, and people would suffer as a consequence of that.
Interestingly, the free market still works, even with pandemics… There are still a million and one problems that need to be solved, the result of which lives are very much at stake. This notion that we should stop everything we’re doing to solve this one particular problem is taking us back to the bolshevik revolution… My own governor, Jay Inslee, released his 4-phase plan for release. We see posters up everywhere, ads on TV… everyone needs to work together.
He may just as well call it a 5-year plan, and we can start producing the Yugo all over again, all in it together, all solving just one problem.
a) We don’t know yet how different enough it is, regardless of what you think you know about the virus. There is data that strongly suggests that it would be substantially deadlier than the worst influenza pandemics if left unchecked; there is also data that strongly suggests it may be somewhat less deadly than those same pandemics (which didn’t trigger widespread hysteria at the time). But we don’t know yet for sure.
b) I’m not calling for a “drastic and fundamental change”. I’m calling for some change – however small – in our own behavior to mitigate a threat of as-yet undetermined magnitude. Yet you have previously vehemently ranted against perhaps the lowest-cost, lowest-impact measure that might feasibly mitigate some of the pandemic: wearing masks. That would not be a drastic and fundamental change. It would be an inconvenience at worst. Yet you have attacked masks with a similar vehemence as you attack the lockdowns, seemingly lumping them together in one group.
I actually agree with 99% of your rant so you can spare me your rage. We are focusing far, far too much on this one issue.
But I don’t agree with your notion that the way to counter vast overreaction in one direction is by overreacting in the other direction. Which is what you are doing.
@mendel
I am becoming increasingly convinced that this virus has mutated into many strains now. It’s interesting to me that they are able to track some of it in sewage because it means it is surviving in the intestines where I understand viruses mutate. If so, that would explain why it might be unstable. I know there are at least two, the one that struck New York City via Europe and the one that struck California via Asia. There’s speculation that the South Korea virus was less virulent than Boston’s. But I’m wondering if there may be more, such as the one that is leading to the symptoms in children that seem to be newly occurring.
Is it possible that the reason states and cities and entire countries are having vastly difference experiences and therefore vastly different debates is that there are many strains of this virus out there now?
And if the virus is unstable, it seems to me it would be difficult to develop a vaccine. On the other hand, it also seems possible that it will morph into a less lethal virus all by itself, without our help. I read that scientists believe that’s what happened the SARS outbreak in 2003.
There is a lot more to predict with a model than total deaths. Some people want one model for every purpose, but that’s not always a reasonable expectation.
@mendel
Another question: I have been sure since this began that the unusually warm winter globally was at the root of this outbreak. This is not global warming. It is the natural cyclical shift of weather patterns. However, it has been warmer than usual globally. I spent two years with geology books, and it’s as likely to be sunspots or ocean floor volcanoes as anyone’s lawn mower. Nevertheless, it has been warmer on a global basis.
One year when there were a colds and infections among the kids in my school district, my pediatrician ascribed the rise in sick kids to the unusual warm winter we were having. This was thirty years ago. But he said whenever you go from one temperature and humidity band to another as the seasons change, different viruses spring up that the no one has seen for a while. There’s always some of that effect when the seasons change, but when temperatures and humidities change more than normal, there’s more sickness in general.
Then last winter I remember seeing that it was hard for scientists to see this virus sometimes in bloodwork because there were so many active viruses and bacteria circulating. The signal-to-noise problem. In fact, I think that essentially what happened with the first test the CDC was using for covid-19. It was picking up a lot of other viruses and bacteria.
All of the above has made me watch for evidence of the uptick in bacteria and viruses worldwide. And here is a really interesting article on just that, the global rise of other diseases. Which I expected a year ago.
What do you think? When the weather slips back into a more normal temperature and humidity pattern for the globe, perhaps the virus will quiet down on its own. Right? And since we are two years into this cycle, perhaps it will change in the fall and we won’t get the “second wave” pandemic. Wouldn’t that be wonderful. I’m hopeful. :-)
Certainly it has, but what difference the current strains make is another question.
I have no idea what you are accusing me of here.
Do we not agree that every action and decision in life is some form of trade-off? We don’t have a speed limit of 5 MPH because we consider that saving some time driving is worth the excess deaths. But we have some speed limit because we consider the excess deaths caused by drivers going 150 MPH not to be worth the time savings.
In other words, sometimes we say that our wants and needs are more important than others’ lives. Other times we don’t. It’s called balancing interests. I’m trying to find a middle ground that balances our interests in lowering the number of people who will die of the virus (especially those who might look forward to some years of quality life) versus everyone else’s clear and present need to keep their lives intact.
We’re presently very far away from that balancing point. But I don’t see how complete disdain for one side of the equation gets us any closer to that point, either.
Exactly. Every RNA virus mutates, but not all mutants differ in any meaningful way from their “parent” virus.
We still don’t know whether any of the genetic variants currently circulating exhibits any relevant phenotypic differences. They might, they might not.
Nobody seems to have any good idea. I’ve read good explanations that the virus might be highly dependent on weather conditions, and others that it might not. So I certainly think this is something worth being hopeful about.
The biggest expectation is that transmission will die down – at least somewhat – over the summer, both due to heat and because people will be spending more time outside. Even if it comes back in the fall, there’s a decent chance we’ll have a much better idea how to treat/detect/manage the virus by then, so even if a second wave came we would probably be able to handle it much better.
I’m holding onto that thought. :-) Thank you.
This. ^
I am not a doctor or a virologist but I pretend to be one on Ricochet.
All solutions have a cost but most lack net benefits.
Is there something about the calculations of R factor that takes into account the amount of time a virus released in a given environment from a sick person before it finds and infects another host? Sort of like giving credit for freshness dating. Fresh virus is more likely than stale 3-day old virus to make someone sick, all other things being equal. But a half stale virus could still make a vulnerable person sick. Stale viruses might make a healthy person get a cold for a little while, they likely would recover, but in the process, the body has gone through some reaction that might make them more resistant to additional exposure, and given some interval, the body might generate detectable antibodies.
Because the infection fatality rate is on the order of 0.1%, and the virus is known to spread very rapidly, the remaining 99.9% who are exposed will develop immunity in the population nearly as quickly as the virus spreads. That makes a case against isolation of healthy people from one another because it prevents the spread of resistance/immunity, ultimately destroying the virus by the mechanism of herd immunity.
If I absolutely wanted the freshest virus, I would go exactly to those places you mention. I’m willing to bet that the main benefit most of us receive from social distancing (distancing, face coverings, hand washing and surface santizing) is that any viruses that 99% of us still get exposed to are of the stale or near dead varieties.