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COVID-19 detected in United States (5 Viewers)


Jacob

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I like that chart. I think it is telling to a certain extent. My question about it is does it include those who go to the ER with possible symptoms because they use the ER like a primary care physician? I, unfortunately, know people that do that.

I'm sure they are included, but I would think that's probably a pretty constant noise that the overall signal would drown out.
 

Jacob

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There's a handful of countries in Europe now that may be peaking/rolling over on infections. Will be interesting to see if this is some kind of testing artifact or if they start seeing steady/reduced numbers over the next few weeks. Countries to keep an eye on include Belgium, Netherlands, Switzerland, France, and Germany.

Here's the daily cases from Belgium. It's an oddly sharp curve

Screenshot_2020-11-16 Belgium WHO Coronavirus Disease (COVID-19) Dashboard.png
 
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KoD

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Colleague of mine said 127 out of the 288 covid-19 tests yesterday from the Huntsville Fever and Flu clinic were positive. That's frightening.
 

Mike S

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Jacob

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One key point in the article is a vaccine is supposed to help those who have tested positive a second time, which I have heard several examples of this happening. Glad we seem to be progressing.

One problem with the people testing positive multiple times is how we are testing. Labs around the state (and much of the country) are running PCR tests at 40-42 cycles, which is going to give you a lot of false positives and catch a lot of people that aren't sick/infectious.

I've read a good bit about people testing positive twice, I've found far fewer stories on people being sick twice.

Note that that's not really a comment on the current rise in cases. The numbers are going to be inflated when you run the PCR tests at that many cycles, but that doesn't change the larger underlying signal.
 

Evan

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There's a handful of countries in Europe now that may be peaking/rolling over on infections. Will be interesting to see if this is some kind of testing artifact or if they start seeing steady/reduced numbers over the next few weeks. Countries to keep an eye on include Belgium, Netherlands, Switzerland, France, and Germany.

Here's the daily cases from Belgium. It's an oddly sharp curve

View attachment 4884

Belgium instituted a sharp lockdown on November 1st. Coincidentally, Belgium's average new daily cases peaked on November 1st as well and have dramatically declined since then.

We've seen this play out elsewhere before. Governments and people tend to be reactive instead of proactive, especially when governments are considering lockdowns. It goes without saying that individuals in Belgium started taking action as cases grew, and those actions help explain why a decline was able to start before the lockdown was even put into place.

The sharpest decline in cases came about 5-7 days after the lockdown was implemented. That fits with what we know about the average incubation time for COVID, and it also fits with the idea that a majority of people begin to modify their behavior about 7-10 days before cases peak in a given area.

I'm not pro or anti lockdown. I think social restrictions are something that may be necessary in certain regions or areas depending upon case trends and whether or not a majority of individuals are complying with voluntary mitigation recommendations.

It's somewhat ironic that the likelihood of a government imposed lockdown is often negatively correlated with how likely individuals in a given area are to comply with voluntary mitigation recommendations. And, once people experience a lockdown, certain subsets of the lockdown-wary population become even LESS likely to follow voluntary mitigation recommendations out of a desire to push back against lockdowns.

So, what's the solution? I'm really not sure. But, I do know that the more voluntary compliance there is the less likely a government in a given area will feel it necessary to impose any kind of lockdown. I strongly believe we have to balance economic risk alongside the health risks imposed by the virus (not to mention a need to balance the social repercussions). Unfortunately, I think both governments and people tend to vacillate on which risk is most important at any given time, and that lack of consistency is part of the reason why we've been unable to get the virus under control in our own country.
 

Jacob

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Belgium instituted a sharp lockdown on November 1st. Coincidentally, Belgium's average new daily cases peaked on November 1st as well and have dramatically declined since then.

We've seen this play out elsewhere before. Governments and people tend to be reactive instead of proactive, especially when governments are considering lockdowns. It goes without saying that individuals in Belgium started taking action as cases grew, and those actions help explain why a decline was able to start before the lockdown was even put into place.

The sharpest decline in cases came about 5-7 days after the lockdown was implemented. That fits with what we know about the average incubation time for COVID, and it also fits with the idea that a majority of people begin to modify their behavior about 7-10 days before cases peak in a given area.

I'm not pro or anti lockdown. I think social restrictions are something that may be necessary in certain regions or areas depending upon case trends and whether or not a majority of individuals are complying with voluntary mitigation recommendations.

It's somewhat ironic that the likelihood of a government imposed lockdown is often negatively correlated with how likely individuals in a given area are to comply with voluntary mitigation recommendations. And, once people experience a lockdown, certain subsets of the lockdown-wary population become even LESS likely to follow voluntary mitigation recommendations out of a desire to push back against lockdowns.

So, what's the solution? I'm really not sure. But, I do know that the more voluntary compliance there is the less likely a government in a given area will feel it necessary to impose any kind of lockdown. I strongly believe we have to balance economic risk alongside the health risks imposed by the virus (not to mention a need to balance the social repercussions). Unfortunately, I think both governments and people tend to vacillate on which risk is most important at any given time, and that lack of consistency is part of the reason why we've been unable to get the virus under control in our own country.

The lockdown certainly could be the reason for the dramatic decrease in cases in Belgium, but like you also pointed out, the peak had already occurred before the lockdown was instituted. I probably could've picked a better nation as an example, but I suspect the main difference we'll see in areas with less restrictions is a flattening of cases instead of a pure reduction of cases like we've seen in Belgium. Sweden's more open approach back in the spring had a similar pattern to that. They peaked about the same time and with the same magnitude as others, but the resulting decline was slower in nature.
 

Jacob

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I'm not sure if this is better suited for this thread or the political thread, but can anybody explain why states are discouraging interstate travel and requiring quarantines when moving between states? It's not like there's any states where community transmission is non-existent, while other states are a dumpster fire.

Vermont is a perfect example, they have one of the highest estimated RT values in the country, but they've implemented a 14 day quarantine for people traveling to the state. It is going to cripple their ski industry this winter, which is very big in that state. A ton of their customer base is in Massachusetts and New York, but with the 14 day quarantine, nobody will be traveling to their ski resorts.

These state orders just feel like they are done to make it seem like they are doing something, despite the actual orders having little to no affect on the spread of the virus.
 

gangstonc

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I'm not sure if this is better suited for this thread or the political thread, but can anybody explain why states are discouraging interstate travel and requiring quarantines when moving between states? It's not like there's any states where community transmission is non-existent, while other states are a dumpster fire.

Vermont is a perfect example, they have one of the highest estimated RT values in the country, but they've implemented a 14 day quarantine for people traveling to the state. It is going to cripple their ski industry this winter, which is very big in that state. A ton of their customer base is in Massachusetts and New York, but with the 14 day quarantine, nobody will be traveling to their ski resorts.

These state orders just feel like they are done to make it seem like they are doing something, despite the actual orders having little to no affect on the spread of the virus.
Best I can tell, states with stricter restrictions are leery of people coming from states with little to no restrictions.
 

Evan

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The lockdown certainly could be the reason for the dramatic decrease in cases in Belgium, but like you also pointed out, the peak had already occurred before the lockdown was instituted. I probably could've picked a better nation as an example, but I suspect the main difference we'll see in areas with less restrictions is a flattening of cases instead of a pure reduction of cases like we've seen in Belgium. Sweden's more open approach back in the spring had a similar pattern to that. They peaked about the same time and with the same magnitude as others, but the resulting decline was slower in nature.

Well, the other example you used back on Saturday was the Netherlands. They, too, implemented a lockdown in early November after moving to a partial lockdown in mid-October. Their average daily cases trend is similar to Belgium and corresponds to the biggest reduction coming after a full lockdown.

It's correlation and not necessarily causation, but if people won't voluntarily comply with rational mitigation measures then what is a government to do? Just let COVID run amok and cause thousands of deaths? It's a serious question -- I'm not being flippant. The alternative to a lockdown is that people act sensibly and follow the voluntary mitigation measures laid out by public health authorities. The problem is that even if 75% of the populace are doing so, the anti-maskers and the "ain't nobody 'gon tell me what to do" crowd are choosing not to follow the voluntary mitigation measures and that's why governments are exasperatedly implementing new lockdowns.

It's fairly obvious these central and state governments do NOT want to implement lockdowns else they'd have done so in all of the places where cases started to rise. Almost all of them have waited until hospital capacity has become an issue and *then* they're going with a lockdown. In many instances, they've even tried partial lockdowns or heightened messaging on complying with voluntary mitigation efforts but either people let their guard down or that small minority refuses to comply because they see COVID as a hoax or think that mask-wearing, social distancing, hand-washing, etc are infringements upon their freedom.

Without making this political, let me say that I've always been very Libertarian. I don't want a lot of regulation or big government. But, I have also always believed that ones freedom ends when it begins to infringe upon my own freedom. We've had public health authorities and quarantine laws on this planet for centuries to protect against infectious disease outbreaks. One of the reasons we have the life expectancy that we have today in the 1st world is because of public health authorities building out proper sanitation and having the infrastructure and resources to surveil, identify, mitigate and then control infectious disease outbreaks. Why people suddenly see that as some kind of existential threat to liberty is beyond me. People do not have the right to go around spreading a communicable disease simply because they're lazy, ignorant, or have a political point they want to make.
 

Jacob

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Well, the other example you used back on Saturday was the Netherlands. They, too, implemented a lockdown in early November after moving to a partial lockdown in mid-October. Their average daily cases trend is similar to Belgium and corresponds to the biggest reduction coming after a full lockdown.

It's correlation and not necessarily causation, but if people won't voluntarily comply with rational mitigation measures then what is a government to do? Just let COVID run amok and cause thousands of deaths? It's a serious question -- I'm not being flippant. The alternative to a lockdown is that people act sensibly and follow the voluntary mitigation measures laid out by public health authorities. The problem is that even if 75% of the populace are doing so, the anti-maskers and the "ain't nobody 'gon tell me what to do" crowd are choosing not to follow the voluntary mitigation measures and that's why governments are exasperatedly implementing new lockdowns.

I picked Belgium/Netherlands moreso because they were the first to see such large surges, and their pattern of peaking basically 1.5-2.5 months into the surge fits with just about everywhere else, regardless of the amount of restrictions. They perhaps aren't the best example of post-peak pattern because of the lockdowns.

As for your second paragraph (yes, there's some tin-foil hattiness in this, but bear with me), I think the reaction and how places handle this virus is still directly related to what now appears to have been blatant Chinese propaganda coming out of Wuhan in January/February. The people falling dead in the streets, convulsing in the streets, etc, and estimated IFRs of up around 5% or higher frightened the entire world for obvious reasons. It sounded like it was a more contagious SARS or MERS. I think a lot of the people and governments still treat this current virus that is circulating as if it is the same virus we saw videos of from Wuhan, when it clearly isn't.

If we had been warned of a virus that would be equal to or less deadly than the flu for young, healthy adults, but roughly 5x more deadly for the elderly than the flu, would the world have panicked as much as we did and treated this the same way? Obviously I know it is more contagious than the flu, but how many flu deaths a year would be attributed to it if we counted flu deaths the same way we do COVID deaths? I wish it was more than a hypothetical scenario, but unfortunately it isn't. I don't know what the actual number of COVID deaths are, but I'm quite skeptical with how we report COVID deaths, where basically anybody that dies within a certain window after having a positive test is considered a COVID death.

I was as pro-lockdown as it came when this first started, largely because I was scared of what I saw coming out of China. I started grabbing double of most grocery items by the first week of February so that by the time March came around I had a freezer full of food and a couple extra shelves stocked. I have done almost a full 180 on that position since the spring, especially on the large scale. Even if I was still in support of lockdowns, the biggest mistake the US made was treating everywhere equally and locking down areas that had very little virus. But I suppose that's another topic all together.

I think we should have (and should be) encouraging young people to live their lives as normally as they can, and try to develop ways to help keep seniors isolated (if they want to be). Increasing spread among young/healthy adults in the long run will protect the older less healthy adults. Restrictions tend to even out the spread among all age groups. A good example of this was Florida during their summer wave, where the positive cases were much more plentiful in the younger demographics. Back in the spring in the NE, most positive cases were in the older age groups, though testing for symptomatic people only likely skewed that a bit.

There's another angle to the story and that is the prospects of a good vaccine. I'm less against restrictions if it is a guarantee of a good vaccine on the near future. Obviously the current news is optimistic, but I'm still skeptical given the relatively small numbers of people in the trials and that this vaccine is still the first of its kind. If you have major side effects in say 0.25% (I'm pulling this number as an example, not the study) of people, but mass vaccinate people, you likely have caused more harm than good, at least for the younger generations.

I'm not good at putting coherent long winded posts together like you are (this is actually meant as a compliment, heh), so forgive me as I bounced from point to point somewhat erratically in this post.
 
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One reason we couldn't do targeted lockdowns from the start was because of the poor testing availability early on, we had no idea where the virus was. As we've seen, it takes a couple of weeks from the time the virus starts spreading in an area to when the critically ill start pouring into hospitals. By then, it's too late.
 

Jacob

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One reason we couldn't do targeted lockdowns from the start was because of the poor testing availability early on, we had no idea where the virus was. As we've seen, it takes a couple of weeks from the time the virus starts spreading in an area to when the critically ill start pouring into hospitals. By then, it's too late.

I don't really disagree here, I give almost all governments passes for the earliest actions back in the spring. My comment on that was more of a in-hindsight type deal. There wasn't enough information on spread, info on the disease, etc. to make good decisions that early on.
 

Evan

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Jacob,

I will respond in-depth to your post in the next day or so, but I wanted to briefly stop by and update the thread.

There were 192k COVID-19 cases in the United States today. Yet another record high. Additionally, there were 2065 deaths -- the highest number the country has experienced since May 07 -- which happened to occur during the trailing period in early May in which the Northeast United States was hit extremely hard (especially in nursing homes and long-term care facilities).

Last Friday, I mentioned that I thought there was very little in the way that would prevent a growth in average daily cases to 250-275k by November 30th, and by all accounts we seem to remain on track for that to occur.
 

Evan

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204k COVID cases and 1,999 deaths yesterday.
 

Jacob

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Moody, AL
Just as a comparison, the blue line is approximate cases if we were testing at the current levels, and the gray line is actual positive cases. The current rise is obviously the largest and very real, but I think this paints a more clear picture of where we are vs. where we were in the summer.

Normalized Cases.png
 
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