Random discussion of Covid-19 not specifically related to restaurants or food

Yes. The number of influenza deaths in the table (about 6000) are those in the reporting period, February 1 to mid-May. Most of the cases and deaths from flu took place much earlier in the season, and covid didn’t really take off until mid- to late February. So not much overlap with the covid. Still some, a small fraction, probably had both at the same time.

I’m familiar with this plot. My DH’s grandmother died on October 1, 1918, right at the beginning of the major wave of the Spanish Flu. On the death certificate, it says: Cause of death: Pneumonia. Contributing condition: Influenza.

Covid can lead directly to viral pneumonia, but it can also weaken your body’s defenses against bacterial pneumonia. I still think it’s a good idea to get a bacterial pneumonia shot. It can’t hurt (so to speak). And it’s a once in a lifetime thing, not annual like flu shots.

Oh, right you are. Some states are so stupid and/or irresponsible that they didn’t even wait for the curve to flatten or decline.

There’s an easy way to get a rough estimate of deaths from Covid-19. Whether some of them also were suffering from seasonal flu is irrelevant.

Or they manipulate the curve…

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She is a wonderful young woman, Katie. She tested very good for a long period of time. And then all of a sudden today she tested positive. So, she tested positive out of the blue. This is why the whole concept of tests aren’t necessarily, right, the tests are perfect but something can happen between a test where it’s good and then something happens and then all of a sudden, she was tested very recently and tested negative.

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Exactly. That’s the problem with serial testing of individual people who present themselves for tests. It gives a result that applies to a given person at that one moment – not later the same day, not the next day, not the next week. Randomized cotemporal testing in conjunction with small-sample statistics, extrapolated to a larger population is a more meaningful use of limited testing resources, IMO. I’m not a mathematician, but there are those who know very well how to do this. They also give a snapshot at just one moment in time, but it’s of the overall population in a given region at that time, and not one person after another tested over a period of time. IMO, randomized small-sample testing, as was tried in New York State with surprising results, is what should be used to guide government decisions, as opposed to serial testing, which is what we’re doing now. Until that magic, instant, at-home test is available and cheap enough for all to administer daily self-tests, that’s our best bet. In terms of when and how restaurants should re-open to sit-down dining, a mathematically sound and widely accepted credible indicator of the ongoing virulence of the disease in a given region needs to be established. As I’ve said, I’m willing to assume the personal risk when the government decides it’s OK to re-open restaurants for sit-down dining, because dining out is indeed an important part of my life. But I’d be more comfortable about it if I had greater confidence in the testing scheme and interpretation of the test results that led to the government’s decision.

This is a relevant plot that’s been updated daily in the SD Union-Tribune. It shows a two-week rolling average of the ratio of positive tests to total tests in SD County. Positive cases are those that are reported in the news as “confirmed cases”, or just “cases”.

That ratio is now down to about 4% It’s been declining more or less linearly since early May, presumably because more people without symptoms but simple interest can now be tested by just signing up for an appointment (5 or so days out; lines when you go; and results 24 - 72 hrs. later if the system works) at a County testing site. Those being tested right now represent a pretty specialized cohort, IMO.

So what the heck does 96% negative tests mean, then, exactly?

I think it means we’re wasting precious testing resources. In SD County we’re aiming for 5000 tests a day. There are 3.4 million people in SD County. The arithmetic is easy. We don’t have the luxury of that much time.

A carefully constructed and analyzed – mathematically, scientifically, and medically – random, bi-weekly or weekly sampling using the same number of testing resources would be much more helpful in understanding where we stand.

And much more helpful in deciding when it’s safe to leave our cells and seek out a restaurant. Get in a trolley and go to Ironside in Little Italy for buck-a-shuck oysters during Happy Hour. Pho tai at Pho Hoa. Beer tasting at Ballast Point in LV.

you should really read about why countries like South Korea were so far very successful in “managing “ the coronavirus- they do the opposite of random testing but large scale focused testing - 3T is the way to go - test, track and trace

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A lot of places have been testing random samples of their populations and more are doing it every week. Everybody who’s at all informed knows that they’re necessary for public health planning. Anyplace with an ample supply of tests that’s not using some on random samples is mismanaged, but a lot of places still don’t have enough tests for hospitals.

need to add isloation/quarantine to stop the intra family contamination. move positive tested people into isolation. Jin Kim was on the Dave Change podcast recently talking about how to go on the offensive against Covid.

Well, “3T” + quarantine is what we should have done right at the beginning, immediately after the first case was detected in the US, for people showing symptoms. Then after that, as much as possible. I think we all know why that didn’t happen. Probably not a feasible strategy to implement successfully now that it’s so widespread, especially with an unknown number of anonymous, asymptomatic carriers and limited testing capacity.

It is still by far the best approach to have a chance to minimize the impact of corona now.

Agreed - centralized quarantine etc is definitely also another necessary tool we should implement.

I don’t question the usefulness of 3T+Q; I’m supportive. A dragnet of detective work that filters out infected people and isolates them. I just wish it had been implemented much earlier. But I find it hard to believe that we can now possibly muster the needed resources, including an army of tracker/tracers, necessary at this late date for 3T+Q to throttle covid spread significantly. In other words, I think it’s too late to apply that approach; I don’t think there’s a problem with the approach itself. We still don’t have a unified national plan for using test data; coordination doesn’t seem to extend beyond the local, county, and state levels. Yet decisions at all levels of government need to be made urgently for restaurants to decide which way to go: close permanently, or hang on and try out business under the restrictions. Politics aside, government decisions are being made using the best available data. Opinions and options are being proposed and assessed almost every single day by government employees in conjunction with their contractors and consultants. Decisions are being made quickly. “All options need be on the table”, as they say, and evaluated and discussed amonst non-political experts in the various fields that need to come to bear; namely, microbiology, biology, virology, epidemiology, toxicology. As well as mathematics, engineering science, medical science, and fluid mechanics. We need a Manhattan Project, not a disheveled, disconnected mass of well-intentioned but unconnected specialists working independently.

In my opinions it is the only good option we have now (even at this late time point).

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Regionally it’s doable.

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

From the CalMatters article:

But the National Association of County and City Health Officials estimate that the nation will need 30 contact tracers for every 100,000 Americans to handle the pandemic. Which means that California’s 2,845 contact tracers fall far short of the 12,000 needed to track the virus through California’s population of nearly 40 million.

Still, there’s one major caveat to the state’s efforts to bolster contact-tracing, she said: people must be willing to cooperate, particularly if cooperating means missing work and wages — and potentially putting friends, family, and coworkers out of work for two weeks, too.

Tracing/Tracking was the way to go at the outset when the number of people involved was small. But now?

Every virologist I know through work (or you read on media (including Fauci) or biotwitter etc - Scott Gottkieb has also written some good articles about it) makes it very clear that 3T (coupled with some other efforts, e.g. centralized quarantines etc) is absolutely essential now to have a chance to tackle covid (the reason why Massachusetts has started to hire significant numbers of tracers etc - but again what would be necessary is having a coordinated effort on the state and federal level (which we don’t have and why it will have just limited local effects). We should learn from countries who were so far successful in their efforts (SK, Taiwan, Germany etc) - all of them had massive focused testing work (higher than the US) and implemented 3T

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Contact tracing is quite practical in areas where the Rt is less than 1, the number of current cases is low, and public health orders based on good science are keeping things that way. In Alameda County (population 1.67 million), where I live, hospitalizations peaked at 93 on April 10 and have been between 73 and 85 since April 15.

https://rt.live/

This is very interesting. I haven’t seen this kind of information until now. Let’s hope that Rt drops significantly below 1 in all states, to provide some headroom.

In SD County, population 3.3 M, covid hospitalizations have been almost constant, varying between about 350 - 400 since early April. This is about twice the per capita number compared to Alameda. I’m not sure what to make of that, though, in the context of your post.

You can see past Rt numbers. States with irresponsible reopening plans will almost certainly have higher numbers in a month.

Alameda County and the rest of the Bay Area have been in lockdown since March 16.