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Messages - Grubbegrabben

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1
Consequences / Re: COVID-19
« on: September 21, 2020, 11:12:15 PM »

For some reason they did not think their scenarios out well enough. If everyone with symptoms isolated that would help so much but that was not the message.

Doing that would also mean that any kid with a runny nose stayed home (at least in the plus 9 group, maybe use another cut off age like 6 or so) but that might be a problem for the parents.

The biggest concern I have with regards to Children is the potential long term brain damage this virus can inflict on seemingly healthy individuals.  Similar, lung and heart complications.

The virus may not kill a child, but the long term complications from an infection are disconcerting, at best.

Sweden has paid parental leave to take care of kids. The number of days that parents used this possibility was up by a staggering 50% in April. Statistics show that parents were home tending their sick kids a total of 2.1 million days in April.

Note that Sweden never closed any schools, yet there are almost no cases of severe illness among school kids (age 0-16). 0,4% of confirmed cases have ended up in ICU. The confirmed cases are a small fraction of total infections. About 20% of antibody tests are positive for <20 year olds. Zero deaths.

The long term brain damage must be a very rare complication because there seem to be zero cases here. Is there a source for that or is it just the usual fear mongering that has taken over this thread?

Quote
Is it really worth the risk?  Would it really be so bad to allow children to stay home from school for a couple of years, to avoid long term damage?

This is a joke right?

2
Consequences / Re: COVID-19
« on: August 21, 2020, 11:50:17 PM »
[...]

A more relevant statistic is that deaths in the first half of this year were 10 % over the average of the five previous years.

Is there a zero missing? And likely the "1" is also wrong.

(Yes I'm very bad in simple math, but I can abstractly diagonalize unbounded operators on infinite dimensional Hilbert space :) )
I'm currently on slow connection, so I won't check euromomo.eu for excess mortality...
Here is a paradigmatic screen shot of all European countries in the euromomo.eu system, week 25 (incl. those without significant excess mortality) which includes the super flu mortality year 2018.


That graph of yours is the excess deaths. This year about twice as high as 2018.

So the first half of this year 10 % excess deaths in Sweden. The year 2018 it was about 5 %. That was a year when no borders were closed, without mask hysteria, etc, etc.

A rare slip-up from Statistics Sweden. Somehow CNN picked it up and didn't realise it's a number that means nothing. Sweden had 4,2 million inhabitants in 1869 so what the number says is perhaps that the famine that year was brutal.

The excess mortality in Sweden expressed as deaths/million for the first half of 2020 is the highest since 2003. So Statistics Sweden was wrong by about 135 years.

3
Consequences / Re: COVID-19
« on: August 03, 2020, 11:54:31 AM »
The Swedish definition of a "Covid-19 death" is simple. If you die within 30 days of a positive PCR test, it is counted as a Covid-19 death.

4
Consequences / Re: COVID-19
« on: August 02, 2020, 08:31:27 AM »
Opening schools might all very well if you look only at the children. Kids can and will transmit to older folk, even absent symptoms or serious consequence to themselves. No way you can make masks, handwash and social distancing work in  bunch under tens, or for that matter any of a typical school body. But what of the staff and the parents ? There are about half a dozen schoolteachers I know will quit if forced to return. Almost every parent I know is looking at homeschooling if they can manage it or outright opting out and braving the penalties, some are lawyering up if the school district forces inperson return. You aint gonna make em march their kids in. 

Sweden did not close schools for kids aged 6-15. Upper level education (age 16-24) moved to online education. The reason to close upper level education was to reduce crowding on public transport since it's very common to commute to a school for this age group. There have been a number of publications about the consequences of this and they show that:

* Teachers do not have significantly higher risk of Covid-19 infection, the relative risk is 1.1 (compared to Taxi drivers 4.8, Bus drivers 4.5 and so on, teachers are very close to average risk of 1.0).

* Compared to Finland, where schools were closed, the rate of infections in age group 6-15 is:
Sweden (schools open): 30/100000
Finland (schools closed): 42/100000

Much can be said about the Swedish Covid-19 strategy, but keeping schools open was absolutely 100% the right thing to do and so far I've seen no scientific evidence that suggests otherwise.
 


5
Consequences / Re: COVID-19
« on: June 30, 2020, 11:30:54 PM »
Robust T cell immunity in convalescent individuals with asymptomatic or mild COVID-19

https://www.biorxiv.org/content/10.1101/2020.06.29.174888v1

Our collective dataset shows that SARS-CoV-2 elicits robust memory T cell responses akin to those observed in the context of successful vaccines, suggesting that natural exposure or infection may prevent recurrent episodes of severe COVID-19 also in seronegative individuals.

6
Consequences / Re: COVID-19
« on: June 17, 2020, 09:50:34 PM »
The infection fatality rate of COVID-19 in Stockholm – Technical report

"Our point estimate of the IFR is 0.6%, with a 95% confidence interval of 0.4–1.1%. For the age group 0–69 years, the IFR is 0.1% (c.i. 0.1–0.2%), and for those of age 70 years or older we get an estimate of 4.3% (c.i. 2.7–7.7%). Comparisons between the cases in our estimation sample and those in the rest of Stockholm and Sweden suggest that our results are generalizable."

Several data sources have been used to analyze and compute the IFR, a very detailed description of the methods, assumptions and calculations is included in the full report.

Link to full report (in english):
https://www.folkhalsomyndigheten.se/contentassets/53c0dc391be54f5d959ead9131edb771/infection-fatality-rate-covid-19-stockholm-technical-report.pdf

7
Consequences / Re: COVID-19
« on: June 07, 2020, 10:02:41 PM »
The problem with Uruguay is that either it permits tourism from Argentina & Brazil starting in November or it will be economically ruined.

We have the same issue in Spain. I would feel comfortable if Spain bans non-essential access to Sweden and the UK (and US) in the summer months, most of the other European countries have the pandemics under control.

Not that many are going to come anyway, which would be "nice" (I can walk in the city center without 1000 tourists crushing me to the ground) , but the Spanish economy will sink very deeply.

The tourist-dependent countries are eager to get tourism up and running. Accepting travellers from countries with the pandemic under control is probably wise. Sweden is blocked by many countries due to high infection rate. However, non essential travel is not recommended to ANY country by the Swedish foreign department, at least not before 15 july. Which means that you can't really go anywhere because  it's impossible to get travel insurance. Double-block :-)

Even IF the pandemic is under control both in the tourist's home country and at the destination, no country has zero infections. Which means that every tourist risk waking up at the hotel one morning with dry cough, high fever and difficulty breathing. Swedes are frequent tourists to many destinations in the world. However, zero people I've spoken to in Sweden are eager to go anywhere before the pandemic is over. Even people who know they had it. You really can't know if/when a second wave hits and you end up stuck at the destination. Or if the airline declares bankrupcy all of a sudden. Too many uncertainities.

8
Consequences / Re: COVID-19
« on: June 01, 2020, 10:35:48 PM »
In Norway this is ALL for free! And we take this for granted, paying our taxes more or less willingly. Despite this we Even survive and have handled this Corona-era fairly well. 

Personally I struggle to find any ups about living in the Promised land these days. But what do I know, being an European!

You do pay for it, by paying taxes. I don't know how it is in Norway, but in Sweden this tax is around 12%. It pays for primary care, hospital care, kids dental care (until you are 21) and - for some reason - public transport.

If you don't like the idea that you pay a percentage of your income for something that everyone has an equal right to, then the promised land is for you.

9
Consequences / Re: COVID-19
« on: May 12, 2020, 08:29:22 AM »

Any updates on Sweden's antibody prevalence?

The Swedes always quote absurdly high numbers for antibodies. But given the number of their dead (3256) it is safe to say that cca 300k-500 k has been infected, ie 3-5% of the population. Definitely below 10%.

The antibody testing on Danderyds Hospital showed that 20% of the staff had antibodies mid-april.
Hospital staff is more exposed than the general population but antibodies in mid-april should indicate that they had the infection at least two weeks earlier? The results of a much larger study will be presented next week I think.

10
Consequences / Re: COVID-19
« on: April 28, 2020, 11:36:38 PM »
The preliminary result of an antibody test in a Swedish hospital, 20% of the staff has Covid-19 antibodies. So far, about 500 have been tested. The study hoped to enroll about 2000 people but, according to the head of the study, people keep signing up and it seems like almost the entire staff will participate, a total about 3000 people.

In addition to giving a blood sample, the test subjects filled in a questionnaire about their symptoms. The evaluation of the questionnaire will be published later.

The study will be followed up after three months with new tests and then tested again after six and twelve months, probably also after two and five years. The follow-up is to show, among other things, how long the antibodies remain.

It seems like the test used is quite accurate;

Quote
In the validation we have done so far, the answer has been correct on everyone. It is one hundred percent in both directions, both sensitivity and specificity. As a researcher, they say that one hundred percent does not exist, but so far the result is very good, says Sophia Hober.
She believes the positive result is because the test not only used a protein from the virus but used many variants at the same time.

Personally, I think there is a problem with this study. Why only include people aged 20-65...?

11
Consequences / Re: COVID-19
« on: April 22, 2020, 12:14:27 AM »
Today, the Public Health Agency of Sweden published a paper that estimates the number of infected in Stockholm.

The report contains an interesting find:

Quote
"Since the degree of infectiousness among the unconfirmed cases is currently unknown, we have put in different scenarios with different assumptions about how contagious an unconfirmed case is in relation to a reported case. The scenario that gives the best fit to the number of reported cases between February 17 and April 10, 2020 are where unconfirmed cases are a tenth as contagious as reported cases."

Does this help explain the results of the antibody tests? Why there can be so many undetected cases while the outbreak is not totally out of control? Unconfirmed are probably asymptomatic/very mild cases.


12
Consequences / Re: COVID-19
« on: April 20, 2020, 12:57:04 PM »
Sweden?
Getting close to full capacity  in ICU ?

Is Sweden getting close to full ICU capacity or not? Remember, this is the most important criterion, whether health care systems are overrun and then collapse.

The numbers in Stockholm have been stable for the last 5-7 days. Around 200 patients in ICU, 1100 hospitalised.
There are an additional 80 ICU beds available as well as 400 "regular" beds.
Also, the back-up military field hospital with 600 beds + 30 ICU is on stand-by.

13
Consequences / Re: COVID-19
« on: April 20, 2020, 11:17:41 AM »
Sweden?
Getting close to full capacity  in ICU ?
Just change the age criteria by a year......problem solved.
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden
Currently in ICU-care for Covid-19:
age     number
60-69  330
80-89   34

Total deaths
age     number
60-69   121
80-89   627

Let  granny die  because she cant earn any money .
(Insert a tirade of profanity to the limit of your imagination )

I would strongly recommend you look up just how many severely ill pneumonia patients aged 80+ that are intubated and put in a ventilator anywhere in the world. I think you're in for a surprise.

Edit: Especially for Covid-19 patients. The lungs of an 80+ patient quickly deteoriates after just 1-2 days in a ventilator. And Covid-19 patients typically need a lot more time than that.

14
Consequences / Re: COVID-19
« on: April 20, 2020, 02:29:14 AM »

It's amazing that they were able to find several thousand ICU nurses and Pulmonary technicians on such short notice.

Of course they haven't. Stockholm has activated an emergency contract/deal for ICU staff. The salary is raised to 220% but the scheduled work time is up from 40 hours/week to 48 hours/week.

Also a number of specialist nurses have been trained to "assist" in ICU care but I don't have details on that.

I just learned that 16.000 ventilators/year are manufactured in Stockholm by some medtech company. Things are easy to make, qualified doctors and nurses - not so easy.

15
Consequences / Re: COVID-19
« on: April 19, 2020, 11:39:58 PM »
Our old people sitting in nursing homes like lame ducks, scared to death

The daily updates for the Stockholm region now lists cases in elderly homes separately. It's a disaster.

Quote
Out of the 5,826 positively sampled, 1,325 persons were sampled at Special housing for the elderly, SÄBO. Of a total of 313 SÄBO in the county, 191 have some residents with a positive diagnosis of covid-19.

Of 921 people who have died in the Stockholm region of covid-19, 380 people are sampled at a SÄBO.

16
Consequences / Re: COVID-19
« on: April 19, 2020, 11:29:26 PM »

...
We are witnessing Trump get away with mass murder for everyone to see. It will not get better.

The same policy of culling of our old ones goes on in the UK, in USA and in Sweden.

Lockdown of those who don't even need to be protected, while those that are most at risk get no protection whatsoever.

"Anger in Sweden as elderly pay price for coronavirus strategy
Staff with no masks or sanitiser fear for residents as hundreds die in care homes"

Our old people sitting in nursing homes like lame ducks, scared to death, waiting to be culled.
And this is due to our experts' ignorance and our politicians' lethargy.

https://www.theguardian.com/world/2020/apr/19/anger-in-sweden-as-elderly-pay-price-for-coronavirus-strategy

I found this part of the strategy severely flawed from the very beginning. I think "protect the elderly" was the message on the very first press briefing of the Covid-19 situation in Sweden. Despite this, protective equipment is STILL a problem. As well as lack of even basic training for the staff in elderly homes.

The article has a few problems though, Lena Einhorn hasn't been a "virologist" for 20 years (she is currently a director/author according to Wikipedia).

Also:
"Einhorn was one of 22 researchers who on Tuesday called for Sweden’s politicians to break with the country’s tradition of entrusting policy to its expert agencies, and to seize control of Sweden’s coronavirus strategy from the agency"

None of the 22 are a researcher, at least not in epidemiology. Also, the suggestion that politicians should seize control is against Swedish law:

Swedish public administration is dualistic, meaning the governmental departments are under the direct control of a minister, but the administrative authorities (or government agencies in other words) under these departments are ostensibly autonomous. The agencies work according to laws and rules decided on by the Riksdag, but apply them on their own accord. So while the agencies are formally associated with some department, a minister cannot exert control over these agencies on individual matters, and they do not have the authority to direct daily operations. Ministers are thus expressly prohibited to intervene in matters relating to the application of the law or the due exercise of an agency's authority, quite unlike the situation in many other countries. If the government believes that an agency has not applied the law correctly, its only remedy is to change the relevant legislation


17
Consequences / Re: COVID-19
« on: April 16, 2020, 11:26:50 PM »

I know you like the Sweden example ('they are going to die anyways'). Well fuck that model.


Yeah the Sweden model again.

This picture illustrates just how reckless the Swedish strategy is. If the government had any sense they would immediately close down the Stockholm subway system. Shocking picture of peak rush hour this morning at 8:20 AM, look at all those people spreading corona virus, working hard on that herd immunity.

18
Consequences / Re: COVID-19
« on: April 13, 2020, 10:03:06 PM »
The official Swedish statistics is posted on:

https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa

The graph "Avlidna/dag" shows deceased/day on the correct day. Other sources only update the number of deceased on the day of the report (such as https://c19.se/).

Example: 112 deaths were reported on april 7. On c19.se this is shown as 112 deaths on that very day. In reality, these cases occured on april 1 to april 6 and have been assigned on the correct days on the official site. The official number of deaths on april 7 is 60. The opposite is also true on some days. 37 deaths were reported on april 5, this is the number shown on c19.se. In reality, 75 Covid-19 deaths occured this day, it's just that they were reported later.

This concept seems incredibly hard to grasp. The internet trolls are going completely apeshit and thinks the Swedish death numbers are being manipulated somehow. In reality, they are trying to be as accurate as possible.

Tomorrow, I'm fairly sure there will be a substantial surge of deaths since there has been four non-working days in a row. Quite possibly over 200. These will be allocated to the correct day in the official statistics but reported as a huge spike in deaths on other sites. I can already hear he screams of the Twitter and Facebook epidemiologists.


19
Consequences / Re: COVID-19
« on: April 11, 2020, 09:02:17 PM »
Sweden: From the weekly report published on april 10.

A randomized test among people in the Stockholm region reveals that 2.5% of the population has an ongoing Covid-19 infection. Notably, 2.8% (0.8-7.1) aged 0-15 years and 2.0% (0.6-5.0) aged 60+. Schools are open (for kids aged 0-16) while people over 70 are asked to self isolate. I guess that explains the difference.

The sentinel testing that tracks influenza A, B, norovirus and Covid-19 saw a big jump in Covid-19 infections among people with respiratory problems in primary care. It jumped from 7% positive in week 13 to 14% testing positive in week 14.

562 deaths in Covid-19 was reported up to week 14.
Average age: 81 years
87% were in the age group 70+
6 deaths in people below 50 years of age
6% (n=30) did not belong to any known risk group. The average age in this group was 76 years,  7 were below 70 years of age.



20
Consequences / Re: COVID-19
« on: April 04, 2020, 08:35:23 PM »
The recovery seems like not a recovery:

Quote
The dark side of ventilators: Those hooked up for long periods face difficult recoveries

People who survive the most dire cases of disease caused by the novel coronavirus are about to learn one of the cruelest lessons of the pandemic: After defeating the virus, the really hard part begins.

Those saved through extreme medical interventions, including being attached to mechanical ventilators for a week or two, often suffer long-term physical, mental and emotional issues, according to a staggering body of medical and scientific studies. Even a year after leaving the intensive care unit, many people experience post-traumatic stress disorder, Alzheimer’s-like cognitive deficits, depression, lost jobs and problems with daily activities such as bathing and eating.
https://www.washingtonpost.com/health/2020/04/03/coronavirus-survivors-recovery/
By Carolyn Y. Johnson and Ariana Eunjung Cha
April 3, 2020 at 12:49 p.m. CST

A relevant observation. Not everything is like on TV shows where everyone arriving in the ER are intubated and revived miraculously.

Statistics from Sweden regarding Covid-19 patients:
Age   Hospitalised/ICU/Deaths
0 to 9  36/0/0
10 to 19  139/0/0
20 to 29  452/16/3
30 to 39  582/21/0
40 to 49  838/64/1
50 to 59  1182/123/15
60 to 69  913/162/26
70 to 79  932/112/101
80 to 89  942/21/157
90+  424/1/70

Only 1 case of the 424 patients aged 90+ has been treated in an intensive care unit (outcome not revealed in the statistics). Judging from the data, it seems like most 80+ patients aren't treated in ICU either.

21
Consequences / Re: COVID-19
« on: April 01, 2020, 09:12:50 PM »
Not long ago Sweden and Denmark had similar coronavirus deaths per million ratios but after today's figures Sweden is pulling away.

Sweden 24 deaths p.million (last three days 36,34,59 deaths)
Denmark 18 deaths p.million (last three days 5,13,14 deaths)
Many have questioned the Swedish laissez-faire strategy and for good reason as your figures point out.

My guess is Sweden is aiming for a herd immunity with limited economic consequences and they trust their efficient health care system to handle the peak of the epidemic. I sincerely hope they are right
They can't. ICUs and hospital beds per habitant are comparable to the rest of Europe. It's a relatively big population. They will suffer a lot of government-caused pain, and COVID will become the first cause of death for a few weeks as it has happened in other countries. Hospitals will be swamped, we already know what happens then.

You don't have any clue how the Swedish health care system works that's for sure. This is a prime example of someone not having a clue about something just pulls a random graph or table from the internet and draws a grossly incorrect conclusion from it. It happens all the time on climate change denial forums and it certainly happens here as well.

In many other countries you are admitted to hospital for things that are handled by the primary care system in Sweden. This has resulted in fewer hospital beds per capita.

Now, the big question is, does this mean anything in regard to the current Covid19 outbreak?

For ICU capacity certainly the answer is a big YES. This is very important. All countries are increasing capacity in this regard. Sweden is no exception, it's been doubled and by next week it will be tripled. No upper limit has been set, capacity will be increased as much as possible by all means possible.

Now, the question is down to the "hospital beds" capacity. What kind of treatment is given? Can it be done from home? Can the primary care doctors and nurses administer the necessary treatment while the patient remains at home, or by a daily visit to a primary care facility? Can necessary treatments be performed in nursing homes?

As I said in a previous post, I think it's currently impossible to draw any conclusions or know what's right or wrong in the middle of the outbreak. Each country has it's own health care system, maybe vastly different from another country even if the number "hospital beds per capita" is identical.

I know one thing though, and that is that I'd hate to live in a country where media, fear, internet experts or populist parties get to decide how to handle the Covid-19 situation. That would be a true nightmare.

22
Consequences / Re: COVID-19
« on: April 01, 2020, 08:26:46 PM »
Not long ago Sweden and Denmark had similar coronavirus deaths per million ratios but after today's figures Sweden is pulling away.

Sweden 24 deaths p.million (last three days 36,34,59 deaths)
Denmark 18 deaths p.million (last three days 5,13,14 deaths)
Many have questioned the Swedish laissez-faire strategy and for good reason as your figures point out.

My guess is Sweden is aiming for a herd immunity with limited economic consequences and they trust their efficient health care system to handle the peak of the epidemic. I sincerely hope they are right

In the end, each and every country will have some level of herd immunity when a share of the population has been infected. There is no cure, no vaccine and almost impossible to stop.

Each and every country will hopefully chose a path that suits their population, health care system and society. What works in one country will not work in another. Some countries will experience failures, where the system is overrun. Some countries will have the resources to go really, really, careful forward.

It is impossible to say that this or that country is doing the right or wrong thing, especially now, in the middle of the outbreak.

I follow the statistics, projections and reports published daily by Swedish health authorities. As of today some new advice and recommendations regarding distancing on public transport and in supermarkets were published. It is now forbidden to visit care homes for the elderly. Other than that, the authorities report that epidemic is progressing more or less as expected. The greatest concern is the shortage of PPE

23
Consequences / Re: COVID-19
« on: March 31, 2020, 01:15:24 AM »
Probably the most accurate representation of infection to test ratios  and death rates to resolved cases is the numbers from Korea ...

No. Iceland is where you go for data. They already tested more than 3% of the total population, far more than anywhere else.
Data here:
https://www.covid.is/data

1086 cases
30 hospitalized (ie. 3% hospitalization ratio!)
10 intensive care (= 1% needing intensive care!)
2 dead ( = 0,2%)

This tells you that there are many more mild and asymptomatic cases than previously believed and both mortality and hopsitalization ratio is much lower than envisioned by most people...

Of course, with extensive testing to find early cases, there may be 2-3 weeks mean time from diagnosis to death.  Take current deaths divided by total cases of 2-3 weeks ago, and the case fatality rate is far higher than that.

Currently two registered deaths.
2 weeks ago: 183 confirmed. Fatality rate = 2/183 = 1%
3 weeks ago: 56 confirmed. Fatailty rate = 2/56 = 3.6%
So, somewhere between 1 and 3.6% then...

"This tells you that there are many more mild and asymptomatic cases..."

Maybe this belongs in the "stupid questions" thread, but how do you look at the data to estimate the asymptomatic cases?


24
Consequences / Re: COVID-19
« on: March 29, 2020, 12:53:35 AM »
Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study

Source: https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

Quote
COVID-19 has spread to most countries in the world. Puzzlingly, the impact of the disease is different in different countries. These differences are attributed to differences in cultural norms, mitigation efforts, and health infrastructure. Here we propose that national differences in COVID-19 impact could be partially explained by the different national policies respect to Bacillus Calmette-Guerin (BCG) childhood vaccination. BCG vaccination has been reported to offer broad protection to respiratory infections. We compared large number of countries BCG vaccination policies with the morbidity and mortality for COVID-19. We found that countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies

25
Consequences / Re: COVID-19
« on: March 29, 2020, 12:22:41 AM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.

Thanks.

The quote below is the main assumption made by the Swedish ministry of health and the basis of all their calculations regarding number of hospital beds and ventilators (intensive care). Google translate.

Apparently many other countries use a significantly higher CAR number in their forecasts, and as a consequence they think stricter regulations are needed. As for the hospitalisation rates - I don't know. Do they look wrong? Emphasis added by me.

Quote
For all outbreaks, both regional and national, we have adopted a Clinical Attack Rate (CAR) of 1%. A CAR of 1% means that 1% of the entire population has been clinically infected after completion of the outbreak. We only include reported cases. Based on analysis of external data, especially from China, we believe that 1% CAR is a realistic worst-case scenario. To estimate probable CAR in China and Italy we have doubled today's accumulated number of infected, as if we were at the top today, and divided by population. In this way we take heed that the outbreak may not be over yet. Given today's situation, that would mean less than 1% of the population of Wuhan city gets a clinical infection, in the Hubei region about 0.2% and throughout China 0.01%. When we do the same for Italy, we get a CAR in Lombardy of 0.7%

Severity distribution among infected per age group given target value of
severity among infected and size of the risk groups.

Severity0-1920-6465+
Mild93%83%67%
Severe6%13%26%
Critical1%4%7%

All mild cases are assumed to be self treated. Severe and Critical admitted in hospital. Critical cases are assumed to need intensive care for an average time period of 14 days.


26
Consequences / Re: COVID-19
« on: March 28, 2020, 11:14:56 PM »
The main news here in Sweden is that the rest of europe or even the world think we are a little bit crazy. The only thing strictly locked down is schools (for people aged 16-25) and gatherings with more than 50 people.

Other than that: Wash hands. Don't touch your face. Work from home. Don't visit old people. Stay home at the slightest flu symptom. If you have been Ill, stay home for two days after symptoms are gone.

Apparently, the rest of the world thinks this is a road to disaster.

The swedish ministry of health has justified the actions with this (and the government follows their recommendations. In line with Greta Thunbergs "Listen to the Scientists"):

1. Young children are not the driving force of this outbreak. Closing kindergartens and elementary schools causes more problems than it solves. Their parents are health care professionals, shop assistants, truck drivers and so on. If they are forced to stay home we are just adding another problem. If we are forcing grandparents to take care of their grandkids we are basically handing out death sentences.

2. Asymptomatic or presymptomatic spread is not the driving force of this outbreak. Forcing entire families into quarantine if just one member is ill causes more problems than it solves (see 1 above).

Last but not least - and this is where social media (largely driven by Chinese and Russian troll factories) goes bananas :

3. A too strict lock down may be "too" effective. The virus won't go away no matter what restrictions we put on ourselves. Once too strict restrictions are lifted, the outbreak will come back and we will be forced to lock down again. This is very disruptive and causes more harm than good. Instead, a well measured and timely implemented course of action will be chosen to ensure that health care can cope with the number of patients (the "flatten the curve" idea).

A quick look around the situation in many EU countries reveals a wide range of restrictions. Poland for example, where a strict quarantine is in effect. Only 1400 cases and 17 deaths. Exactly how are they going to go back to normal? Did they chose to go the other way around, start with complete lock down to shut down the outbreak completely and then step by step reopening? I don't know.

My theory is that many EU contries got scared by the situation in Italy/Spain and implemented very strict restrictions, mainly driven by politicians, media and opinions - not by science and facts. My only worry is that the swedish ministry of health got their assumptions, calculations and forecasts wrong and we end up with an Italian-like situation. Interesting times.

27
Consequences / Re: COVID-19
« on: March 25, 2020, 12:49:47 AM »
Clinical Characteristics of Coronavirus Disease 2019 in Hainan, China
https://www.medrxiv.org/content/10.1101/2020.03.19.20038539v1
Quote
The median time from onset of symptoms to first hospital visit, diagnosis and hospital admission was 4.5 days (IQR, 2-7). For severe patients, the median time from onset of symptoms to severe illness was 11 days (IQR, 7-13). For discharged patients [...] the median time from hospital admission to discharged was 17 days (IQR, 12-21). For dead patients, the median time from onset of symptoms to death was 17 days (IQR, 10.5-37.3), and the median time from hospital admission to death was 13 days (IQR, 1.5-28.3).

I found this useful when trying to make sense of the various tables of numbers published virtually everywhere. I think I read somewhere that time from infection to symptom onset is about 5 days.

Would this timeline be correct, given the numbers above?

Day 1 Infected
Day 6 Symptom onset
Day 11 Hospital admission
Day 17 Severe illness (maybe)
Day 23 Dead (hopefully not)
Day 28 Discharged (yay!)

A) Countries that test everyone have about 17 days lag from number of cases to number of deaths (Day 6 to Day 23).
B) Countries that only test patients admitted to hospital have about 12 days lag from number of cases to number of deaths (Day 11 to Day 23).
C) Any measure taken to reduce spread and pressure on hospitals doesn't have any effect until 11 days later (Day 1 to Day 11).


28
Consequences / Re: COVID-19
« on: March 23, 2020, 12:34:11 AM »

I've never raised children so if I'm missing something please let me know.


You are probably correct.

Where I live they closed high schools/universities because those students often commute on crowded public transport. Seems like a good idea to reduce that. Those students can handle lessons over internet (most already do).

I doubt the benefits of closing primary/middle schools. No you dont lock the kids into the house... This will just mean that more parents have to be home to care for their kids, parents who may well be teachers/doctors/nurses/toilet paper factory workers...

Worst case scenario is that the grandparents will take care of their grandkids. You dont want that.

29
Consequences / Re: COVID-19
« on: March 23, 2020, 12:19:31 AM »
Quote
The mean viral load of severe cases was around 60 times higher than that of mild cases, suggesting that higher viral loads might be associated with severe clinical outcomes

Thoughts? I'm by no means an expert.

This is to be expected.  With the closest virus, SARS, infected individuals only shed virus when symptomatic, and in rough correlation with symptom severity.

Here, there is viral shedding with no symptoms, but amount of shedding would expectedly still be in correlation with symptom severity.

Thank you. As long as family members only have mild or moderate symptoms there is no reason to treat them as having a zombie virus then...

30
Consequences / Re: COVID-19
« on: March 22, 2020, 09:30:42 PM »
Maybe a stupid question. Is there a difference between getting infected, like when you go to the shop. And getting infected in a area where you are exposed to the virus all the time. Like in a hospital, or like in a lockdown like in Wuhan. The entire family infected in an apartment and you have to stay in the apartment together. Does the exposure makes it worse ?
Possibly. There are many reports of health workers getting it real bad even if they're young and fit.
The initial viral load may play a role. If you touch a supermarket surface with your hand and later touch your eyes, it takes days for the viral load to build up and your defense system may have more time to recognize the virus.

+1   Exactly.  I'm not aware of hard data the confirms you get much sicker with a heavy initial viral dose, but it is to be expected.   The more virus particles there are to start with, the more of a head start they get to out-pace the immune response.

Yes I was wondering about this one. Should you isolate sick family members? It may be difficult depending on how you live, with children and so on. The whole family will probably be infected no matter what precautions you take.

What I found was this article: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30232-2/fulltext

Quote
The mean viral load of severe cases was around 60 times higher than that of mild cases, suggesting that higher viral loads might be associated with severe clinical outcomes

My interpretation is that in a home care environment, where the sick person has mild or moderate symptoms, the viral load is low. Family members doesn't need to be treated any different than if they have the flu. There is probably no significant heightened risk for a severe outcome even if you are in close proximity to a sick family member. (People in risk groups excluded of course).

However, severe cases that end up in hospital will release massive amounts (60 times more according to the article) of viral particles that make health care workers more sick than the average Covid-19 patient.

Thoughts? I'm by no means an expert.

31
Consequences / Re: COVID-19
« on: March 21, 2020, 09:48:44 PM »
You are being silly.

Out of the the 1746 Swedish cases so far are 462 imported cases from Italy, 246 from Austria and 30 from France.

Amost all of these are Swedish alpine ski tourists who were in these countries in week 7 to 9 (school winter holiday season), probably in good physical shape and in their 40's. I would assume that these also infected their close relatives and that makes up a good part of the remaining cases.

To draw any conclusions about the CFR from the Swedish cases is utterly pointless. To insinuate that deaths are being covered up is just nuts. Please don't draw any conclusions without a single ounce of analysis of what's behind the numbers.

(Note: Everything I wrote above is available on the Swedish public health agency's public web site, unfortunately not all of it is available in English)

Edit: Language

32
Consequences / Re: COVID-19
« on: March 21, 2020, 11:13:59 AM »
Sweden (among other countries, I assume) has started sentinel testing. The sentinel testing program is used to track the seasonal flu but now also Covid-19. Participating doctors select "randomly" patients that seek care for any illness, and send a sample for Covid-19 testing.

Last week, 206 sentinel tests resulted in 6 Covid-19 positive. It's far too early to say anything meaningful about the numbers but this will be interesting to track.

(Officially, there are 1650 confirmed Covid-19 cases in Sweden, 0,015% of the population)

33
Consequences / Re: COVID-19
« on: March 15, 2020, 11:17:54 AM »
It is difficult to do the right thing. Many families in Norway are fleeing the city, working remotely from their cabins in the countryside.

But now the government is ordering them to return to their homes, because this would overwhelm healthcare in the countryside, where the average age is higher. If necessary by force (civil defense forces).

Wow. I don't think the preppers were prepared for that.

I think the whole idea is to not overload health care in the cities as well as avoid infection altogether. A friend of a friend took his family and elderly mother out to a cabin in the countryside  and plans to stay there isolated a couple of months. They are NOT infected and plan to stay that way. Their pressure on the health care system in the countryside is zero.

I think the government in Norway got this wrong.

34
Consequences / Re: COVID-19
« on: March 09, 2020, 11:24:24 PM »
Article in the swedish paper Aftonbladet.

Quote
It's too late for Italy
The professor doesn't think the giant quarantine will help.

- It's a disaster in Italy. It is too late for them to stop the infection in the country now. There will be more and more infected. Some younger ones will get severe infections, but the vast majority will be healthy. Among the elderly, those over 75-80, quite a few will die, says Agnes Wold, professor in clinical bacteriology.

She fears that health care in Italy can be forced back to a level far below what we are used to today.

- They can be forced to shut down ordinary operations except the most important ones. They have to change completely to be able to cope with those who have severe corona infection and difficulties to breathe. Even though there is a small risk for the individual, there are very many people that must be taken care of right away. It's a horrible scenario and it will be that way until we get a drug for corona, and eventually a vaccine.

- 90 percent of cases in Sweden are Italian travelers. It says a bit about the situation in Italy.

n.b. Current cases in Sweden: 261.

35
Consequences / Re: COVID-19
« on: March 08, 2020, 11:49:13 PM »
China has banned consumption, breeding, transport and trade of all wildlife on land and most wildlife in the sea. The ban includes the whole animal, byproducts, skin, fur, eggs and so on. It's also illegal to advertise or even make recipes including the banned items.

I think this means no more social media videos of people eating bat soup or whatever. At least not from China.

Source: http://www.hubei.gov.cn/xxgk/gsgg/202003/t20200306_2173588.shtml

36
Consequences / Re: COVID-19
« on: March 08, 2020, 11:27:03 PM »
Northern Italy hospitals in desperate situation. Intensive care prioritized for people aged between 40 and 60.

Paywalled link:

https://www.ilfattoquotidiano.it/in-edicola/articoli/2020/03/08/noi-costretti-a-scegliere-tra-i-40enni-e-i-60enni/5729389/

Disclaimer: I have tried to find a second source but failed. I have no idea if that paper is a tabloid or a credible source.

37
Consequences / Re: COVID-19
« on: March 08, 2020, 11:04:46 PM »
It appears as though Asia and Europe are being hit much harder than the Americas, but I expect that much of this is due to the test results that we're privy to.

In Sweden now someone tested positive after returning from the USA. The contagion in the US is under the radar there. The authorities blindfolded themselves.

Contact tracing has been largely successful for the imported cases in Sweden. The source has been mainly Italy and Iran.

Boldly (or foolishly - it remains to be seen) an indoors music event with 20000 visitors was held as planned in Stockholm yesterday. That's the level of confidence in contact tracing so far.

Uncontrolled outbreak in the US will be the spark that ignites the corona explosion. There is no way to keep up with contact tracing if the outbreak source is the US.

38
Consequences / Re: Chinese coronavirus
« on: February 24, 2020, 02:47:35 PM »
Quote
How does it comes that these tests are so bad ? But if you don't test, than where will it end ? These tests are basically to only thing they have to stop it

I did some work on a RT-PCR instrument designed to detect bird flu in 20 minutes. After some redesign it seems like it's still around.

The problem is selecting which parts of the virus DNA to select as markers. You don't want the test to fail if the virus mutates. This is something that needs to be adjusted over time.

Also - sample collecting and preparation may need fine tuning. This virus hasn't been around long enough for proper procedures to be developed.

(Fun fact - a colleague of mine worked with another instrument but for winter vomiting disease. One virus particle is enough to infect you. And you don't get permanent immunity to it. He was sick so many times during the project that he almost gave up)
 


39
Consequences / Re: Chinese coronavirus
« on: February 20, 2020, 09:39:50 PM »
A report from Japanese NIID concludes that

Quote
The decline in the number of confirmed cases, based on reported onset dates, implies that the quarantine intervention was effective in reducing transmission among passengers.


Source: https://www.niid.go.jp/niid/en/2019-ncov-e/9407-covid-dp-fe-01.html

Other sources (mostly news) seem to imply that the decision to create a COVID-19 incubation chamber was a bad idea from start to finish.

40
Consequences / Re: Chinese coronavirus
« on: February 20, 2020, 09:14:30 PM »
Quote
As you know, a WHO-led international team of experts is now on the ground in China, working with their Chinese counterparts to find answers to some of the things we don’t know, including the severity of disease, the transmissibility of the virus and the impact of the measures that China has taken.

The WHO-led joint team brings together leading experts from China and around the world, with a shared commitment to pooling their scientific expertise to better understand the outbreak and save lives.

The mission was launched under the GOARN framework and we thank all partners in the Global Outbreak Alert and Response Network for their continued support and partnership.

The team includes experts in epidemiology, virology, clinical management, outbreak control and public health from the following institutions:

The National University of Singapore

The Saint Petersburg Pasteur Institute

The National Institute of Infectious Diseases, Japan

The Seoul National University College of Medicine, Republic of Korea

The Nigeria Centre for Disease Control

The U.S. Centers for Disease Prevention and Control

The U.S. National Institutes of Health

The Russian National Medical Research Center of Phthisiopulmonology and Infectious Diseases

And the Robert Koch Institute, Germany.

Since the declaration of the PHEIC we have intensified our coordination, both internally and externally.

Source: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19

Are they being transported in limos between clinics with mildly sick patients giving testimony of just good healthcare they are receiving? Or are they shown the real stuff?

Maybe I live in an illusion but I doubt these people expect nothing but fancy dinners and parades.

41
Consequences / Re: Chinese coronavirus
« on: February 17, 2020, 09:23:21 PM »
Found on Reddit (/r/COVID19)

Today China has published a paper with detailed data on more than 44,000 confirmed cases of COVID-19.

Uploaded on github: https://github.com/cmrivers/ncov/blob/master/COVID-19.pdf

42
Consequences / Re: Chinese coronavirus
« on: February 15, 2020, 09:16:20 PM »
Quote
Eight more COVID-19 infections confirmed in Tokyo as Japan sees spate of domestic transmissions

Eight people in Tokyo, three more who have connections to a hospital in Wakayama Prefecture and one person in Nagoya tested positive for COVID-19 on Saturday as Japan struggles with a daily increase in the number of domestic cases of the virus.

Seven of the eight people in Tokyo had had close contact with a taxi driver who this week tested positive for the coronavirus, the Tokyo Metropolitan Government said.

The remaining person in Tokyo is a businessman in his 40s and is in serious condition in hospital. After showing symptoms such as coughing and fever last Monday, the man made a business trip on a Tokaido Shinkansen bullet train to Aichi Prefecture, metro officials said, adding that he has not traveled to China recently.

Source: https://www.japantimes.co.jp/news/2020/02/15/national/eight-coronavirus-infections-confirmed-tokyo-japan-sees-spate-domestic-transmissions/#.XkhRHGhKiCg

43
Consequences / Re: Chinese coronavirus
« on: February 15, 2020, 07:39:23 PM »
Quote
Another 67 people tested positive for the novel coronavirus (COVID-19) on the Diamond Princess cruise ship, Japan's health ministry said on Saturday. This brings the total number of people infected on board to 285.

... On Friday, elderly passengers with chronic illnesses and those who have been tested negative for the new virus were allowed to disembark.

Japanese government trying to limit the fallout from their decision to quarantine a ship which had multiple COVID-19 cases to start with. Now, they're releasing multiple passengers, quite possibly infected (see elswhere in this thread where up to 6 tests are negative and the 7:th is positive). It's like trapping a rabid rat in a box with 3000 other rats and then release them all some random time later. I have no idea what's the thinking behind all this is but it seems like they are making one stupid mistake after another, it's like they want a big COVID-19 outbreak outside China and taking steps to ensure that it will happen.

44
Consequences / Re: Chinese coronavirus
« on: February 11, 2020, 12:50:41 AM »
Quote
Cruise Ship’s Coronavirus Outbreak Leaves Crew Nowhere to Hide
nytimes.com

When will the crew mutiny?

The funny and sad thing is that they (Japan) seem to have pulled some strings to have the cruise ship passengers not count as straight up Japanese cases in the WHO statistics.

They are listed as "International conveyance (Japan)".

To continue their play-pretend, the Japanese authorities isolated the ship. And created the biggest virus outbreak outside China.

*Slow clap*

45
Consequences / Re: Chinese coronavirus
« on: February 09, 2020, 12:48:56 AM »
Once again mortality at 2.1%

These figures from China are complete BS

I think it's quite obvious that basic hospital care (for example treatment with added oxygen) means life instead of death for many severely/critically ill patients. The Hubei province, especially Wuhan City, didn't have hospital capacity to meet demands as the outbreak gained momentum. With the recently added hospital capacity, as well as increased understanding how to treat patients, I expect the death rate to drop quickly. There are 10 000 cases outside of Hubei but only 26 deaths (0,2%).


46
Consequences / Re: Chinese coronavirus
« on: February 09, 2020, 12:34:55 AM »
Russian TV is spreading conspiracy theories about the corona virus on prime time news programmes.

https://www.bbc.com/news/world-europe-51413870


47
Consequences / Re: Chinese coronavirus
« on: February 02, 2020, 12:45:24 AM »
Sweden had its first confirmed case of the coronavirus. This individual - as a precaution - isolated herself when arriving in Sweden after her return from a visit in Wuhan. She had a friend deliver food to her home. When symptoms started to show, she did not go to hospital herself. Instead she contacted health authorities over the phone and was taken to hospital by an ambulance to avoid contact with anyone.

If everyone took this personal responsibility it would be over really quick.

48
Consequences / Re: Chinese coronavirus
« on: February 01, 2020, 09:55:27 PM »
John Hopkins has shifted to hourly reporting .
12037 cases.
259 deaths.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

A change, maybe insignificant but still a small light in the darkness. 259 deaths but 284 recovered, for the first time more people have been discharged from hospital with a future instead of in a bodybag.

Edit: Language

49
Consequences / Re: Chinese coronavirus
« on: January 31, 2020, 12:15:15 AM »
The official web site for the local government (http://www.hubei.gov.cn/) is quite readable even using your favourite translator.

They update the numbers daily, some of which never make it to other reports (the WHO situation reports seem to sum up patients in severe and critical condition and call them "severe").

The latest update on the Hubei web site:
32340 under observation
5806 confirmed cases
804 severely ill
290 critically ill
204 deaths
116 released patients

I got stuck browsing that website, a lot of information and an insight in how the local government is handling the situation. One of the news on the site today was that a science team has sequenced the entire genome of the virus. The go-ahead to start research was given on jan 10. So they set up a high-security lab, manned it, isolated the virus and mapped the whole genome in about 3 weeks. Quite impressive I would say.

50
Consequences / Re: Chinese coronavirus
« on: January 30, 2020, 12:06:18 AM »
What The 1918 Spanish Flu Can Tell Us About The Coronavirus
https://www.peakprosperity.com/what-the-1918-spanish-flu-can-tell-us-about-the-coronavirus/
Quote
.... in a pandemic, you’re going to have supply chain issues like that simultaneously all over the world. So you’re not going to be able to call on any reserve, anywhere, because everybody’s going to be in the same situation whether you talk about hypodermic needles or plastic gloves — any of that stuff. The supply chain issues in a moderate pandemic are a real problem. If you’ve got a severe pandemic, the hospitals can’t cope. There are many fewer hospital beds per capita than there used to be because everything has gotten more efficient. In this past year’s bad influenza season, many, many hospitals around the country were so overwhelmed they all but closed their emergency rooms and weren’t talking any more patients for any reason.

There’s just no slack in the system. What efficiency does is eliminate as much as possible what’s considered waste, but that waste is slack. And when you have a surge in something, you need that slack to take care of the surge. If I were grading generously I would give us a D in terms of overall preparedness. If we had a universal influenza vaccine, maybe we’d be relatively okay, but we don’t.

From the front page of WHO situation report #9 on the Novel Coronavirus(2019-nCoV):

Quote
Today, PSCN is launching the first of several teleconference calls with over 30 private sector organizations and 10 multilateral organizations to develop a market capacity and risk assessment for personal protective equipment (PPE). This assessment will be used as the basis to match the global demand for PPE with the global supply. The market and risk assessment for PPE is expected to be completed by 5 February 2020.

I guess they (WHO) are aware that securing a supply chain for these kind of items is quite important.


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