Do you listen/watch his daily press briefings? I highly recommend them if you don’t. And I am fairly certain that he has in fact recognized them, several times (I believe every day since he put out the call for help and the health care workers responded).
With previous epidemics like H1N1, epidemiologists looked at deaths from flu-ish causes to determine the estimated death rate, and that is what they will do this time too. If there are a quarter of a million COVID-19 deaths, that will show up as an enormous spike in the death rate compared to what would be expected in a normal year.
I read a post by a Indian doctor that basically said: The rich who were flying around the world spreading this disease will be responsible for the deaths of millions of the poor. They have no soap and water. No hand sanitizer. No place to shelter by themselves.
Have you seen the photos of millions migrating home in India? A horrible situation.
I agree. We’ve been a couple of steps behind and the cost is obvious. As Dr. Fauci has said, we need to overreact to stay ahead of the curve on the pandemic.
Infected but Feeling Fine: The Unwitting Coronavirus Spreaders
Part 1
The C.D.C. director says new data about people who are infected but symptom-free could lead the agency to recommend broadened use of masks.
As many as 25 percent of people infected with the new coronavirus may not show symptoms, the director of the Centers for Disease Control and Prevention warns — a startlingly high number that complicates efforts to predict the pandemic’s course and strategies to mitigate its spread.
In particular, the high level of symptom-free cases is leading the C.D.C. to consider broadening its guidelines on who should wear masks.
“This helps explain how rapidly this virus continues to spread across the country,” the director, Dr. Robert Redfield, told National Public Radio in an interview broadcast on Tuesday.
The agency has repeatedly said that ordinary citizens do not need to wear masks unless they are feeling sick. But with the new data on people who may be infected without ever feeling sick, or who are transmitting the virus for a couple of days before feeling ill, Mr. Redfield said that such guidance was “being critically re-reviewed.”
Researchers do not know precisely how many people are infected without feeling ill, or if some of them are simply presymptomatic. But since the new coronavirus surfaced in December, they have spotted unsettling anecdotes of apparently healthy people who were unwitting spreaders.
“Patient Z,” for example, a 26-year-old man in Guangdong, China, was a close contact of a Wuhan traveler infected with the coronavirus in February. But he felt no signs of anything amiss, not on Day 7 after the contact, nor on Day 10 or 11.
Already by Day 7, though, the virus had bloomed in his nose and throat, just as copiously as in those who did become ill. Patient Z might have felt fine, but he was infected just the same.
Researchers now say that people like Patient Z are not merely anecdotes. For example, as many as 18 percent of people infected with the virus on the Diamond Princess cruise ship never developed symptoms, according to one analysis. A team in Hong Kong suggests that from 20 to 40 percent of transmissions in China occurred before symptoms appeared.
The high level of covert spread may help explain why the novel coronavirus is the first virus that is not an influenza virus to set off a pandemic.
The new virus spreads about as easily as flu, “and when’s the last time anyone thought anything about stopping influenza transmission, short of the vaccine?” said Dr. Michael T. Osterholm, an infectious disease expert at the University of Minnesota.
With any vaccine still in early development, the best way to mitigate the pandemic is social distancing, he and other experts said. Because people may be passing the virus on to others even when they feel fine, asking only unwell people to stay home is unlikely to be enough. This is why many experts, going against recommendations by the C.D.C. and the World Health Organization, are now urging everyone to wear masks — to prevent those who are unaware they have the virus from spreading it.
Like influenza, some experts now say, this virus appears to spread both through large droplets and droplets smaller than five micrometers — termed aerosols — containing the virus that infected people might release especially while coughing, but also while merely exhaling. They emphasized that the level of virus in both types of particles is low, so simply jogging or walking by an infected person does not put people at risk.
“If you have a passing contact with an infectious person, you would have a very, very low chance of transmission occurring,” said Dr. Benjamin Cowling, an epidemiologist at the University of Hong Kong.
The risk goes up with sustained contact — during face-to-face conversation, for example, or by sharing the same air space for a prolonged time. In addition to its confusing stance on masks, “the W.H.O. has been saying aerosol transmission doesn’t occur, which is also perplexing,” Dr. Cowling said, adding, “I think both are actually wrong.”
Experts agreed that infections were being passed along by people who do not report symptoms — what they call asymptomatic transmissions — but they also noted some confusion around the term.
“There’s no standard definition for it, and you could say to yourself, Well, that’s kind of ridiculous: You either have symptoms or you don’t,” said Dr. Jeffrey Shaman, an infectious diseases expert at Columbia University. But studies by his team have shown, he said, that some people never notice their symptoms, others are unable to distinguish the infection from their smoker’s cough or allergies or other conditions, and still others may feel every pain acutely.
There is also a largely semantic debate about what proportion of people who appear to be perfectly fine but then become ill — as in the report in The New England Journal of Medicine of an apparently asymptomatic spreader who later acknowledged having felt mild symptoms.
Ultimately, Dr. Shaman said, these definitions are unimportant.
“The bottom line is that there are people out there shedding the virus who don’t know that they’re infected,” he said.
https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html
Part 2 of NYTimes report
Where the definitions may matter is in being able to understand the true scope of the pandemic.
Dr. Cowling’s team has analyzed data from China at various stages in the pandemic. The W.H.O.’s mission to China concluded that most people who were infected with the virus had significant symptoms. But in the early weeks of the epidemic, his analysis shows, China set a high bar for what constituted a confirmed case of infection — requiring respiratory symptoms, fever and a chest X-ray for pneumonia.
Their definition left out mild and asymptomatic cases and, as a result, the team vastly underestimated the scale and nature of the outbreak there.
“We’ve estimated in China that between 20 percent and 40 percent of transmission events occurred before symptoms appeared,” Dr. Cowling said.
A separate analysis of the hundreds of people cloistered aboard the Diamond Princess cruise ship bears out this scale. Once the ship docked in Japan on Feb. 5, researchers tested all of the passengers and reviewed those who tested positive for the virus on multiple occasions over a two-week period. They found that 18 percent of the infected passengers remained symptom-free throughout.
“The substantial asymptomatic proportion for Covid-19 is quite alarming,” said Dr. Gerardo Chowell, an epidemiologist at Georgia State University who worked on the analysis.
Dr. Chowell noted that the passengers on the ship tended to be older and therefore more likely to develop symptoms. He estimated that about 40 percent in the general population might be able to be infected without showing signs of it.
There have also been many hints, subtle and not, that the virus can be transmitted via aerosols. Sixty members of a choir in Seattle gathered on March 10 for a practice session for over two and a half hours. None of them felt ill, and they made no contact with one another. But by this weekend, dozens of the members had fallen ill, and two had died.
Their experience points toward airborne transmission via aerosols, which can travel farther than the large droplets the W.H.O. and the C.D.C. have emphasized. The virus is still most likely to be expelled with a cough or a sneeze, as far as eight meters (about 26 feet), according to one study. But studies on influenza and other respiratory viruses, including other coronaviruses, have shown that people can release aerosols containing the virus simply by breathing or talking — or, presumably, by singing.
“I think increasing evidence suggests the virus is spread not just through droplets but through aerosols,” Dr. Chowell said. “It would make a lot of sense to encourage at the very least face mask use in enclosed spaces including supermarkets.”
Several studies have shown now that people infected with the new coronavirus are most contagious about one to three days before they begin to show symptoms. This presymptomatic transmission was not true of the coronaviruses that caused SARS and MERS.
“This is where we got very lucky with SARS, was that it really didn’t transmit until after people were showing symptoms, and that made it much easier to detect it and shut it down with aggressive public health measures,” said Dr. Carl Bergstrom, an expert in emerging infectious diseases at the University of Washington in Seattle.
With the new coronavirus, there is transmission by healthy-seeming people, and often severe symptoms and a high fatality rate. “That whole combination makes it very, very tough to fight using standard public health measures,” he said.
Rapid tests for infection might help detect people, especially health care workers, who are infected yet feel normal. Masks may help. But experts kept returning to social distancing as the single best tool for stopping the chain of transmission in the long term — not lockdowns, necessarily, but canceling mass events, working from home when possible and closing schools.
“We can’t assume that any of us are not potential vectors at any time,” Dr. Bergstrom said. “This is why even though I’m feeling great, and have felt great and haven’t been exposed to anybody with any symptoms of anything, that’s why it would be irresponsible of me to go out and about today.”
White House Economists Warned in 2019 a Pandemic Could Devastate America
A study published last fall went unheeded. One of its authors now says economic shutdowns to fight the coronavirus could last up to eight months.
WASHINGTON — White House economists published a study last September that warned a pandemic disease could kill a half million Americans and devastate the economy.
It went unheeded inside the administration.
In late February and early March, as the coronavirus pandemic began to spread from China to the rest of the world, President Trump’s top economic advisers played down the threat the virus posed to the U.S. economy and public health.
“I don’t think corona is as big a threat as people make it out to be,” the acting chairman of the Council of Economic Advisers, Tomas Philipson, told reporters during a Feb. 18 briefing, on the same day that more than a dozen American cruise ship passengers who had contracted the virus were evacuated home. Public health threats did not typically hurt the economy, Mr. Philipson said. He suggested the virus would not be nearly as bad as a normal flu season.
The 2019 study warned otherwise — specifically urging Americans not to conflate the risks of a typical flu and a pandemic. The existence of that warning undermines administration officials’ contentions in recent weeks that no one could have seen the virus damaging the economy as it has. The study was requested by the National Security Council, according to two people familiar with the matter.
One of the authors of the study, who has since left the White House, now says it would make sense for the administration to effectively shut down most economic activity for two to eight months to slow the virus.
Outside economists have been pumping out analyses on the optimal length of a shutdown almost daily. One that has been shared with officials inside the White House comes from Anna Scherbina, an author of the 2019 study who is now an economist at Brandeis University and the American Enterprise Institute.
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It seeks to determine the optimal length of a national suppression of economic activity, which Ms. Scherbina does not define precisely in the paper. In an interview, she said it would encompass school closures, shutting down many businesses and the sort of stay-at-home orders that many, but not all, states have imposed.
“What it entails is something as drastic as you can get,” Ms. Scherbina said. In the United States right now, she added, “we don’t have it everywhere.”
Ms. Scherbina’s paper evaluates the trade-offs involved in slowing the economy to fight the spread of the virus by, as the paper puts it, “balancing its incremental benefits against the enormous costs the suppression policy imposes on the U.S. economy.”
In a best-case scenario, Ms. Scherbina concludes, a national suppression of economic activity to flatten the infection curve must last at least seven weeks. In a worst case, where the shutdown proves less effective at slowing the rate of new infections, it would be economically optimal to keep the economy shuttered for nearly eight months.
Suppression efforts inflict considerable damage on the economy, reducing activity by about $36 billion per week, the study estimates. Ms. Scherbina said the optimal durations would remain largely unchanged even if the weekly damage was twice that high.
But the efforts would save nearly two million lives when compared with a scenario in which the government did nothing to suppress the economy and the spread of the virus, Ms. Scherbina estimates, because doing nothing would impose a $13 trillion cost to the economy — equal to about two-thirds of the amount of economic activity that the United States was projected to generate this year before the virus struck.
Ms. Scherbina based her estimates on the models she built when she was a senior economist at the Council of Economic Advisers and the lead author of the September paper, “Mitigating the Impact of Pandemic Influenza Through Vaccine Innovation,” which warned of potentially catastrophic death tolls and economic damage from a pandemic flu in the United States.
“I accumulated all this knowledge, and then coronavirus came up,” Ms. Scherbina said in a telephone interview. “So I thought, I should put it to use.”
The 2019 White House study called for new federal efforts to speed up the time it takes to develop and deploy new vaccines. It did not specifically predict the emergence of the coronavirus — instead, it modeled what would happen if the United States was hit with a pandemic influenza akin to the 1918 Spanish flu or the so-called swine flu of 2009. It projected deaths and economic losses depending on how contagious and deadly the virus turned out to be.
At even the highest rates it modeled, the pandemic flu in the exercise was still less contagious and less deadly than epidemiologists now say the coronavirus could be in the United States. The White House study estimated that a pandemic flu could kill up to half a million Americans and inflict as much as $3.8 trillion in damage on the economy. Those estimates did not account for any economic loss incurred by “healthy people avoiding work out of fear they will be infected by co-workers.”
The study’s top-end damage estimate would have been even larger than $3.8 trillion, Ms. Scherbina said, but the final version of the paper was changed inside the Council of Economic Advisers to discount the economic value assigned to the lives of older Americans. It assigned a value of $12.3 million per life for Americans between the ages of 18 and 49, compared with $5.3 million for those 65 and over.
Council officials said on Tuesday that Mr. Philipson was not available for an interview. He gave no indication this year that the study and its predictions had influenced administration officials in their early response to the coronavirus outbreak.
Mr. Philipson, whose academic specialty is health economics, was the acting head of the council when the September report was published. He told reporters in late February that the administration was taking a “wait and see” approach before it began any analysis of possible damage to the economy from the virus.
“If you look at the resilience of the economy to a public health threat,” he said, “certainly we have much bigger threats than the coronavirus.” He went on to recite the number of deaths each year from a typical flu strain.
The study published the previous fall had warned against such a comparison. “People may conflate the high expected costs of pandemic flu with the far more common, lower-cost seasonal flu,” the study said. “It is not surprising that people might underappreciate the economic and health risks posed by pandemic flu and not invest in ways to reduce these risks.”
See here for the most recent numbers of deaths in the US, with some disaggregation by cause: https://www.cdc.gov/nchs/fastats/deaths.htm
I have not really looked at the distribution of deaths by age, but to my mind it is not particularly relevant. From all indications, deaths from COVID-19 skew higher with age, and of course death rates in general skew higher with age.
About 0.07% being an underestimate due to lack of testing, I actually think lack of testing will tend to overestimate the number of deaths from corona, although much will depend on how the availability and speed of testing develop over the next few months. Today, most people who test positive and die will have death attributed to coronavirus, although other factors may have actually caused it. Additionally, as I understand it, most hospitals will only test an incoming patient suspected of having COVID-19 if a positive test would materially change the course of treatment. No doubt some patients in respiratory distress are actually suffering from other maladies, and I do not think anyone will be checking post-mortem in this environment. Both these phenomena would tend to result in an overestimate.
That is the opinion of that doctor in that video but it isn’t the opinion of the video of all doctors or researchers. See the articles I posted above. The virus certainly can trasmit by getting sneezed or coughed on so masks protect against that. I have heard from many here at cc and local friends who try staying 6 feet apart in grocery stores but find they can’t always do that. The doctor in the video was very good but there were a few things he said that I have heard others say something different. I don’t think he is right based on what I have read elsewhere. I think that outside of 6 feet, transmission is very rare if outdoors. In indoor places, if the space is small, especially a space like a train car, that it does transmit through air (there are numerous articles that were published on train car transmission and other indoor transmission). The doctor in the video also didn’t really offer proof that it doesn’t transmit through vapor, just said so. I wonder on what he bases this.
Again, not if you just look at the jump in mortality. I will give you an example : you have a patient who is in the hospital for acute heart attack and in bad shape and on top of it gets COVID and dies. What do you list as cause of death ?
Excess number of dead people march 2020 compared to march 2019 is a very good indicator on how “deadly” COVID is, compared to other viruses. There is also the variation from regular influenza that has to be taken into account but we have pretty good numbers on that.
[The NYS Health site](https://coronavirus.health.ny.gov/county-county-breakdown-positive-cases) lists the number of positive test results by county. There are positive cases all across NYS. Note that the results listed are for the number of positive results and does NOT include the negative tests. So the number of tests administered is higher than the numbers on this chart.
I can’t believe that the amount of information covered at today’s press conference is not getting more coverage here. It was by far the most important and direct presser to date. Fauci and birx. Pence. The president getting tough questions from Acosta and other and they had a respectful dialogue. He also was complimentary about democratic governors. Even mentioning a call with three governors who don’t like him and didn’t before he ran. Having a productive conversation. He seemed nearly normal.
It really was chock full of information and modeling. Dr birx said people in her field all thought the data from China indicated a serious SARS type event. Terrible but somewhat contained. She was in Africa in a January. I know we all want to look in the rear view mirror but she said no one predicted this and this level of speed. Dr Fauci also pushed back on that we should have moved earlier based on the info. Yes we should have but it wasn’t consensus.
China lied and they pretty much said without saying it.
I know everyone here pretty much hates the administration and President trump is flawed.
But it was informative tonight and those who don’t watch but read interpretations are doing themselves a disservice to not have the source data directly.
It was fascinating to me. And anyone who doesn’t think it was primarily a positive q and a isn’t being fair.
Yes the impeachment stuff didn’t add anything. But someone asked the questions.
I also liked that the majority the pre q and a was the experts.
Many people enter the hospital with one issue and die of another. Sounds like in your example he enters with an MI (underlying risk factor) but perhaps what then kills him was COVID. My mother entered the hospital of complications from diverticulitis but died of sepsis.
^^^Anything informative or useful beyond boasting and misinformation?
Do you watch the daily press briefings of governors from other states? Serious question.
[quote=“jym626, post:11893, topic:2080517”]
My mother entered the hospital of complications from diverticulitis but died of sepsis.
I am sorry, it must have been hard for you. In your mother’s case, the cause of her problems was diverticulitis, which is an infection of the bowel that spreads to the rest of the body. If she would not have had diverticulitis, she would not have had the sepsis.
Sometimes, even if you know the cause, you can’t quite tell what ultimately killed the patient.
Sorry if this has been posted already. Heartbreaking story.
https://www.washingtonpost.com/nation/2020/03/31/coronavirus-washington-couple-deaths/
My husband says looks like more than that even.
@1NJParent I thought so today.
the experts didn’t boast at all They had a lot to say. Pence not at all. President trump. A little bit but very little for him. Not really. Actually pretty reasonable and the Acosta and npr reporters asked a lot.
It’s information. Some of the questions are stupid and he bites.
Pretty somber and human today overall. The experts got to answer a lot of questions.
[FL Governor Believes Coronavirus Was Circulating During SuperBowl](Florida governor believes coronavirus was circulating during Super Bowl in Miami), according to WKMG News 6. The Feb. 2nd game was attended by over 62,000 people.
We know now that many spring break travelers left FL for numerous states in the Eastern US, not just New York.
However, the order, which is in effect for the next 2 weeks, applies to only 4 of Florida’s 67 counties.