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Thread: Disease and pandemics thread (because it's science)

  1. #2161
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    Quote Originally Posted by Jens View Post
    I just ran across an article about why there seems to be inconsistency between the CDC and WHO advice. I had suspected what the person is arguing, i.e. that the WHO is the "world" organization, and is working with many countries where getting masks for everybody is impractical.

    https://abcnews.go.com/Health/cdc-of...ry?id=70958380

    I don't know if it's true or not, but it makes sense.
    I'm not sure it does, given that WHO has been aggressively pushing the mantra of "test, test, test" (as a means of controlling the epidemic) from very early in the spread of this disease, despite the fact many poorer countries simply had no infrastructure to carry out antigen tests, and very little capacity to develop that infrastructure. Their approach is generally: "Here's the ideal towards which national governments should direct their efforts." "Masks for all" would be a more potentially attainable goal to push than "tests for all", if there was a concern about the ability of a country's infrastructure to cope.

    Grant Hutchison

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    I learned from the BBC. A lot more about the 1918/1919 influenza pandemic and its social effects. Many of the major changes, womens’ votes, independence movements, and so on were attributed to the war but hindsight shows the pandemic had long lasting effects. There were major mental health issues among survivors lasting many years, and physical illnesses too. Considering that more people died of influenza than Military action, this social effect was probably skewed at the time. We think of the “roaring twenties” as a pushback and the major depression of the thirties, then war again, from that depression but history has not emphasised the long lasting effects of that pandemic. This time we have a very different pandemic, culling the old mainly and hopefully with far fewer deaths than that pandemic a century ago, yet the social and economic effects may be even greater because of the way governments rushed to close down.

    Now that epidemiologists are saying most transmission has been indoors and severity scales up with age like “normal” death expectancy per year, we can begin to use hindsight again. Survivors in this epidemic also face long lasting health issues and Covid19 may be a regular menace. Testing shows very low “herd immunity” so without a vaccine, we might expect waves of outbreaks like in 1919.

    The biggest difference, it seems to me, from a century ago, is in the biological impetus. Now we know about the RNA of the virus and the different ways to construct vaccines. The worldwide damage will have a scientific silver lining in putting vaccine research into the top priority category even as the financial consequences hit us. We have tackled this pandemic with mediaeval technology but we will now put in the science to prepare for the next challenge, as we should have done before.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
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    Quote Originally Posted by profloater View Post
    Now that epidemiologists are saying most transmission has been indoors [...]
    Can't help but wonder whether that's how the virus works best, or if that's an effect of how well we eliminated so much contact outdoors.

    I'm cringing now though because of a "mass" demonstration (5000 people, used to be when mass was 100k or more!) to do with other major (but political, so no-go) news items, and people from all over our country gathering there in support... Did they think it was OK to go there because of indoors transmission news? I shudder to think what it could mean if there were a bunch of infected people in that crowd, shouting and chanting, and how many new hot spots may come from it. I mean if they're callous enough to gather like that, how serious did they take the measures before or will they afterwards?
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    Maybe ibuprofen isn’t so bad after all - maybe.

    Coronavirus: Ibuprofen tested as a treatment https://www.bbc.co.uk/news/health-52894638


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    Quote Originally Posted by slang View Post
    Can't help but wonder whether that's how the virus works best, or if that's an effect of how well we eliminated so much contact outdoors.

    I'm cringing now though because of a "mass" demonstration (5000 people, used to be when mass was 100k or more!) to do with other major (but political, so no-go) news items, and people from all over our country gathering there in support... Did they think it was OK to go there because of indoors transmission news? I shudder to think what it could mean if there were a bunch of infected people in that crowd, shouting and chanting, and how many new hot spots may come from it. I mean if they're callous enough to gather like that, how serious did they take the measures before or will they afterwards?
    Fair point but indoors has advantages for the virus in both recirculation of the air and exposure time. Standing next to an infectious person outdoors for fifteen minutes no doubt also allows enough virus to transfer. My guess is that under a certain age, people have grasped the risk of death is rather low. For the very young, outdoors risk of lightning strike is a bigger worry.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by Jens View Post
    And a few more. The growth seems to be pretty constant now at about 1.4% per day.
    122 14%
    123 1.4%
    124 1.7%
    125 1.3%
    126 1.3%
    Now, the number seems to be about 1%/day. In reality the number of deaths per day has remained pretty stable, at around 4,000, so that as the numerator increases the ratio naturally gets lower. Just an interesting thing to ponder, regarding herd immunity, but for the whole world to be infected, at this rate (with a stable population) it would take two million days, or 730,000 years. Of course, since about 360,000 babies are born each day, it won't ever catch up with us at this rate...

    127 0.4%
    128 1.6%
    129 1.2%
    130 1.2%
    131 1.4%
    132 1.2%
    133 1.1%
    134 1.1%
    135 1.0%

    ETA: Of course, since I myself mentioned "herd immunity," one can rightly point out that I should be using infections rather than deaths. True. And then, about 100,000 new infections a day means 220 years, discounting the fact that many more than 100,000 babies are born every day...
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    So it seems that we may be seeing a situation where, unless we can push the R0 below 1 and get it to peter out, we will be living to COVID-19 for a long time.
    As above, so below

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    Quote Originally Posted by Jens View Post
    So it seems that we may be seeing a situation where, unless we can push the R0 below 1 and get it to peter out, we will be living to COVID-19 for a long time.
    Yes it does. Testing has shown low levels of antibodies, but as mentioned early in the discussion, it is the local picture that matters. R0 is an average hiding large geographical variation and individual contact rates. When and if a vaccine is available, intelligent use of it can control the epidemics without vaccinating everybody.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by Jens View Post
    So it seems that we may be seeing a situation where, unless we can push the R0 below 1 and get it to peter out, we will be living to COVID-19 for a long time.
    Depending on how you define "a long time", I think that's a given. Personally I think it will be until a vaccine is widely distributed - most optimistically some time next year.

    R0 is also going to be dependent upon the situation. I suspect what will happen (and what seems to be happening in the US) is that R0 will drop down to around 1 or below, we will remove some of the restrictions, and R0 will rise above 1. I suspect we will be at a plateau around 1 and with various restrictions on "normal" behavior for a long time.
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    Quote Originally Posted by grant hutchison View Post
    Quote Originally Posted by Jens View Post
    I just ran across an article about why there seems to be inconsistency between the CDC and WHO advice. I had suspected what the person is arguing, i.e. that the WHO is the "world" organization, and is working with many countries where getting masks for everybody is impractical.

    https://abcnews.go.com/Health/cdc-of...ry?id=70958380

    I don't know if it's true or not, but it makes sense.
    I'm not sure it does, given that WHO has been aggressively pushing the mantra of "test, test, test" (as a means of controlling the epidemic) from very early in the spread of this disease, despite the fact many poorer countries simply had no infrastructure to carry out antigen tests, and very little capacity to develop that infrastructure. Their approach is generally: "Here's the ideal towards which national governments should direct their efforts." "Masks for all" would be a more potentially attainable goal to push than "tests for all", if there was a concern about the ability of a country's infrastructure to cope.
    Further to this, the WHO has now updated its guidance on face coverings, going into considerable detail with regard to the pros and cons. In some ways, they've moved towards the CDC's advice, in some ways maintained their divergence, and in some ways increased their distance from it.
    There's a sixteen-page pdf downloadable here: Advice on the use of masks in the context of COVID-19

    I'd encourage everyone with an interest to download it and take a look--it's a great "worked example" of the complexity of public health decision-making.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    Further to this, the WHO has now updated its guidance on face coverings, going into considerable detail with regard to the pros and cons. In some ways, they've moved towards the CDC's advice, in some ways maintained their divergence, and in some ways increased their distance from it.
    There's a sixteen-page pdf downloadable here: Advice on the use of masks in the context of COVID-19

    I'd encourage everyone with an interest to download it and take a look--it's a great "worked example" of the complexity of public health decision-making.

    Grant Hutchison
    Wear masks in public would have been so much more simple! Just like wash your hands is simple. We are talking about a message to 7.7 billion people.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Quote Originally Posted by Copernicus View Post
    Wear masks in public would have been so much more simple!
    I think the document lays out pretty clearly why they didn't go for that simple message in this case.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    Further to this, the WHO has now updated its guidance on face coverings, going into considerable detail with regard to the pros and cons. In some ways, they've moved towards the CDC's advice, in some ways maintained their divergence, and in some ways increased their distance from it.
    There's a sixteen-page pdf downloadable here: Advice on the use of masks in the context of COVID-19

    I'd encourage everyone with an interest to download it and take a look--it's a great "worked example" of the complexity of public health decision-making.
    Thanks for the link. It appears that the summary message for community wearing of masks is, it is recommended in places where there is community transmission and the outbreak hasn't been contained well by measures such as contact tracing, etc. And it is only recommended in certain situations, where social distancing is difficult, such as when shopping or traveling on public transportation. Actually that is mostly what we have been doing. When we go shopping or get on the train, we always wear masks, but are not very religious about it when we take a walk and there aren't people close by.
    As above, so below

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    I still think masks are a good idea. But I am just an average person who works with sick people who cough and sneeze near me, who spit when they talk. https://medicalxpress.com/news/2020-...al-covid-.html
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Original paper here. Another one of those alarm-bell papers that we're seeing so many of at present--beware publication outside specialty. Not a single epidemiologist, public health specialist or microbiologist was involved - instead, we've got an analysis by atmospheric scientists, geologists and chemists, which conflicts with the epidemiological evidence and the known transmission modes of other coronaviruses.
    I'll be interested to see what commentary this one receives.

    Grant Hutchison

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    I am disappointed, reading that, firstly that scientists perpetuate the wrong use of epicentre, when centre is the simpler word, and the failure to differentiate between indoors and outdoors transmission.

    If airborne droplets are the prime means of infection, then the very different air patterns must be a significant factor in my opinion.
    This matters for the next time and the preparedness we all need.

    According to this analysis and taking hindsight as a guide, vulnerable people stuck indoors are the ones likely to die and to be a reservoir of infection. Gatherings indoors should be moved outdoors, and with masks according to these authors. That makes mask design and training a priotity for engineers and designers, since the problems with masks have been aired.

    I have noted the decision to use electrostatic fog spraying indoors, it seems to be a good technical precaution to me. Relatively easy to roll out in hindsight for the next pandemic and one of the few technologies to lift us from last century devices.

    As to the thorny issue of herd immunity while waiting for vaccines, too early to say.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by profloater View Post
    I am disappointed, reading that, firstly that scientists perpetuate the wrong use of epicentre, when centre is the simpler word...
    That particular etymological boat has long since sailed. "Epicentre" is now embedded in the jargon of epidemiology, meaning "place where prevalence is highest"--a meaning that is not well conveyed by "centre", since the worst part of an outbreak may well be at its periphery. For instance Mike Ryan, an infectious diseases specialist who is Executive Director of the WHO Health Emergencies Programme, described South America as "a new epicentre" of Covid-19 at a recent press conference.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    Original paper here. Another one of those alarm-bell papers that we're seeing so many of at present--beware publication outside specialty. Not a single epidemiologist, public health specialist or microbiologist was involved - instead, we've got an analysis by atmospheric scientists, geologists and chemists, which conflicts with the epidemiological evidence and the known transmission modes of other coronaviruses.
    I'll be interested to see what commentary this one receives.

    Grant Hutchison
    There are plenty of people smart enough to see what the right answer is. If we allow ourselves to be divided into tiny groups of experts, it is also very easy to manipulate a tiny group. It was clear from south Korea and Japan that masks were the answer. Their deaths per million people 5 and 7 respectively, compared to a world wide average of 55.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    More studies listed in this article recommending masks. https://www.washingtonpost.com/healt...avirus-spread/
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Quote Originally Posted by Copernicus View Post
    There are plenty of people smart enough to see what the right answer is. If we allow ourselves to be divided into tiny groups of experts, it is also very easy to manipulate a tiny group. It was clear from south Korea and Japan that masks were the answer. Their deaths per million people 5 and 7 respectively, compared to a world wide average of 55.
    As I say, I'll wait to see what sort of informed commentary the PNAS paper generates.
    Since I clearly fall into your "not smart enough" category, I won't be responding to any more of your posts.

    Grant Hutchison

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    It was clear from south Korea and Japan that masks were the answer.
    Care to explain that?

    Mark

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    Quote Originally Posted by Copernicus View Post
    It was clear from south Korea and Japan that masks were the answer. Their deaths per million people 5 and 7 respectively, compared to a world wide average of 55.
    It is not clear, because it isn’t that simple. There are many confounding factors. For example, in Japan (and maybe Korea) people don’t shake hands or touch much. And they tend to follow social distancing. And they don’t regularly go to large gatherings where people sing together. Plus, the pattern in Japan and Korea is generally the situation in East and Southeast Asia and Oceania.
    As above, so below

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    Quote Originally Posted by grant hutchison View Post
    As I say, I'll wait to see what sort of informed commentary the PNAS paper generates.
    Since I clearly fall into your "not smart enough" category, I won't be responding to any more of your posts.

    Grant Hutchison
    This was in no way intended as an insult to you. It was an acknowledgement that microbiologists, virologists, or epidemiologists are not the only ones smart enough in this area to study this phenomena. This area is now so political that people in the actual field are not allowed to speak their mind on the subject lest they be fired or lose their tenure, or some other bad thing.
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    Quote Originally Posted by Jens View Post
    D

    It is not clear, because it isn’t that simple. There are many confounding factors. For example, in Japan (and maybe Korea) people don’t shake hands or touch much. And they tend to follow social distancing. And they don’t regularly go to large gatherings where people sing together. Plus, the pattern in Japan and Korea is generally the situation in East and Southeast Asia and Oceania.
    All the countries that wear masks frequently, have dramatically lower death rates. And in the US and other countries, almost all of us avoided other people and did not attend mass gatherings, and did not shake each others hands. The basic difference is the mask, yet death rates were about 500 people per million vs 6 deaths per million people.
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    Quote Originally Posted by Copernicus View Post
    All the countries that wear masks frequently, have dramatically lower death rates. And in the US and other countries, almost all of us avoided other people and did not attend mass gatherings, and did not shake each others hands. The basic difference is the mask, yet death rates were about 500 people per million vs 6 deaths per million people.
    "The basic difference". I'm sorry but that is just not true. There are huge differences in social norms, COVID response, healthcare, levels of compliance with the government advice, demographics etc etc. It might be nice to believe that there is a simple answer that could be implemented and make us all safe but the truth is, as Grant has pointed out, that it is more complex than that. And until there is time and space for suitably qualified people to dig into this and extract the weak signals from the mass of data it doesn't help to imply that they are all somehow at fault because they are not saying what you want to hear.

    You are also using a subset of the statistics. Australis and New Zealand have lower death rates, Cuba has a similar one to Japan. There is so much variation in countries and how they report and respond to events. You just can't make a case from this kind of simplistic look at the data.

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    Quote Originally Posted by Copernicus View Post
    There are plenty of people smart enough to see what the right answer is.
    Only when you take into account all the other factors involved. Aside from what Jens said, South Korea did massive testing right at the start, thus reducing the number of outbreak centers, combined with very privacy invasive contact tracing, which in some countries would not be accepted at all (and it's much too late for those kinds of measures to stop the virus early anyway).
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    Quote Originally Posted by Copernicus View Post
    All the countries that wear masks frequently, have dramatically lower death rates. And in the US and other countries, almost all of us avoided other people and did not attend mass gatherings, and did not shake each others hands. The basic difference is the mask, yet death rates were about 500 people per million vs 6 deaths per million people.
    One region has a generally high respect for authority, the other does not. Also you have to consider response times by each of those authorities. Beyond that I cannot venture due to the politics.

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    Quote Originally Posted by headrush View Post
    One region has a generally high respect for authority, the other does not. Also you have to consider response times by each of those authorities. Beyond that I cannot venture due to the politics.
    I’m not exactly sure how to express it, but I think it’s more complex than just respect for authority. It’s also a reluctance to appear to be selfish. If other people are exercising self-control and you are not, it seems to others that you are being selfish. And my feeling is that in East Asia, people don’t like to give that impression. So it’s more than just authority. My honest impression is that Japanese and Koreans are suspicious of authority just like everybody else.
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    Quote Originally Posted by Copernicus View Post
    This was in no way intended as an insult to you. It was an acknowledgement that microbiologists, virologists, or epidemiologists are not the only ones smart enough in this area to study this phenomena.
    It's a much more general insult. What you're suggesting is that decades of actual experience in a relevant specialty are irrelevant--all that's needed to get the "right answer" is a "smart" person, no matter how ignorant they are of the fundamentals of the field, or how naive their data analysis.
    The history of science is littered with the broken reputations of Nobel laureates who thought they were smart enough to speculate outside their fields of expertise.

    Quote Originally Posted by Copernicus View Post
    This area is now so political that people in the actual field are not allowed to speak their mind on the subject lest they be fired or lose their tenure, or some other bad thing.
    This doesn't even make sense. If experts in their field were being fired for stating politically unpopular opinions, why would a geologist or a data analyst who ventured the same opinion (but beyond their expertise) not be fired?

    Grant Hutchison

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    Quote Originally Posted by Copernicus View Post
    This was in no way intended as an insult to you. It was an acknowledgement that microbiologists, virologists, or epidemiologists are not the only ones smart enough in this area to study this phenomena. This area is now so political that people in the actual field are not allowed to speak their mind on the subject lest they be fired or lose their tenure, or some other bad thing.
    Copernicus

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