Author Topic: How long can we wait while flattening the curve?  (Read 253663 times)

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1850 on: May 12, 2020, 10:23:37 AM »
I hope so, and I hope it happens sooner rather than later.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1851 on: May 12, 2020, 10:51:39 AM »
Do we have evidence yet that exposure to Covid-19 actually prevents re-infection?  That's what all the 'herd-immunity' discussions really rely on.  My understanding was that this is suspected but has not yet been proven.

No we don't.  We also don't have evidence to the contrary.  That's the rub, we cannot know what CV is until the virus is basically contained.

if we don't get herd immunity from contracting the virus, then how would a vaccine ever work?

It would be akin to annual influenza vaccination. Good short-term immunity, poor long-term immunity.

We donít know enough about this virus to know whether long-term herd immunity is possible. One cannot project the possibility of long-term immunity from short-term primate studies.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #1852 on: May 12, 2020, 11:08:24 AM »
I read a book ages ago on disease spread that pointed out, from the disease's evolutionary viewpoint, that it is really advantageous to make your host really sick if the method of infection is helped this way (i.e. insect vectors like mosquitoes and lice, diarrheal diseases) but for respiratory diseases like the colds and flus it is best to let your host feel OK, so the host can go out into the world coughing and sneezing (but not too much or they stay home) and spread you all over the place.

And of course lots of diseases are so well in sync with us that they just sit there doing nothing until our immune system is weakened by something else, and then they spring into action.  Strep throat for example.  And notice how as a student you worked like mad and then got sick right after exam time?  Your immune system was all revved up and stressed, and then the stress was over and you relaxed, and boom!

dignam

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Re: How long can we wait while flattening the curve?
« Reply #1853 on: May 12, 2020, 11:32:10 AM »
I posted those scientific articles not to debate whether herd immunity is possible, since for the purposes of the article it is assumed that it is possible for COVID-19.  With that assumption in mind (whether it's true or not), it is very likely that the immunity threshold is significantly lower than we were modeling for originally.  If and when future waves come about, this is good news.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #1854 on: May 12, 2020, 01:24:22 PM »


if we don't get herd immunity from contracting the virus, then how would a vaccine ever work?
It would be akin to annual influenza vaccination. Good short-term immunity, poor long-term immunity.

We donít know enough about this virus to know whether long-term herd immunity is possible. One cannot project the possibility of long-term immunity from short-term primate studies.

I believe Kenmor's question is in regards to whether our antibodies provide immunity to covid-19 or not.  If they don't, it's unlikely we can develop vaccine for it.  Fortunately, this is nearly certain not the case.  We do in fact develop effective antibodies for common influenza, the problem is the strain mutates very fast and any antibody developed is ineffective in the following season hence we need new vaccine for each season.  So far it appears that CV19 is relatively stable (doesn't mutate as fast), and scientists are confident a single vaccine should work.

« Last Edit: May 12, 2020, 01:32:14 PM by HBFIRE »

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1855 on: May 12, 2020, 01:43:35 PM »


if we don't get herd immunity from contracting the virus, then how would a vaccine ever work?
It would be akin to annual influenza vaccination. Good short-term immunity, poor long-term immunity.

We donít know enough about this virus to know whether long-term herd immunity is possible. One cannot project the possibility of long-term immunity from short-term primate studies.

I believe Kenmor's question is in regards to whether our antibodies provide immunity to covid-19 or not.  If they don't, it's unlikely we can develop vaccine for it.  Fortunately, this is near certainty not the case.  We do in fact develop effective antibodies for common influenza, the problem is the strain mutates very fast and any antibody developed is ineffective in the following season hence we need new vaccine for each season.  So far it appears that CV19 is relatively stable (doesn't mutate as fast), and scientists are confident a single vaccine should work.

I have a doctorate in immunology and more than a decade of research experience so I do have just a bit of an understanding here. Of course we develop antibodies to foreign antigens (unless we have an immunoglobulin deficiency). The efficacy of the vaccine and natural infection will depend on the types of antibodies elicited and the mechanisms triggered. This can also have an effect on disease pathology, as, for example, antibody-mediated complement could actually trigger more damage to host tissue via excessive inflammation.

There are now multiple strains of SARS-CoV-2 (based on literature Iíve reviewed for my job in the last month) and itís an RNA virus so itís more prone to mutation. I repeat, it is still too early to answer these questions with certainty. Short-term research doesnít tell us whether the immunity developed against one strain will be effective against other existing strains or future strains resulting from antigenic shift/drift, because if the memory B and T cells respond to a viral epitope encoded by a hyper variable region of the viral genome, the same epitope would likely not be present after further mutation. We also donít know which vaccine will be safe, effective, and scalable for production. Clinical trials arenít snap procedures, even when thereís urgency.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #1856 on: May 12, 2020, 01:46:43 PM »

I have a doctorate in immunology and more than a decade of research experience so I do have just a bit of an understanding here. Of course we develop antibodies to foreign antigens (unless we have an immunoglobulin deficiency). The efficacy of the vaccine and natural infection will depend on the types of antibodies elicited and the mechanisms triggered. This can also have an effect on disease pathology, as, for example, antibody-mediated complement could actually trigger more damage to host tissue via excessive inflammation.

There are now multiple strains of SARS-CoV-2 (based on literature Iíve reviewed for my job in the last month) and itís an RNA virus so itís more prone to mutation. I repeat, it is still too early to answer these questions with certainty. Short-term research doesnít tell us whether the immunity developed against one strain will be effective against other existing strains or future strains resulting from antigenic shift/drift, because if the memory B and T cells respond to a viral epitope encoded by a hyper variable region of the viral genome, the same epitope would likely not be present after further mutation. We also donít know which vaccine will be safe, effective, and scalable for production. Clinical trials arenít snap procedures, even when thereís urgency.

Thanks!  This clarifies quite a bit.  I was just helping to clarify Ken's question as I think it might have been misunderstood.  There are still some fears that antibody doesn't provide even short term immunity and that reinfection is possible.  To my understanding, we haven't scientifically proven this is not the case, even if it's highly unlikely.
« Last Edit: May 12, 2020, 01:50:17 PM by HBFIRE »

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1857 on: May 12, 2020, 02:06:26 PM »

I have a doctorate in immunology and more than a decade of research experience so I do have just a bit of an understanding here. Of course we develop antibodies to foreign antigens (unless we have an immunoglobulin deficiency). The efficacy of the vaccine and natural infection will depend on the types of antibodies elicited and the mechanisms triggered. This can also have an effect on disease pathology, as, for example, antibody-mediated complement could actually trigger more damage to host tissue via excessive inflammation.

There are now multiple strains of SARS-CoV-2 (based on literature Iíve reviewed for my job in the last month) and itís an RNA virus so itís more prone to mutation. I repeat, it is still too early to answer these questions with certainty. Short-term research doesnít tell us whether the immunity developed against one strain will be effective against other existing strains or future strains resulting from antigenic shift/drift, because if the memory B and T cells respond to a viral epitope encoded by a hyper variable region of the viral genome, the same epitope would likely not be present after further mutation. We also donít know which vaccine will be safe, effective, and scalable for production. Clinical trials arenít snap procedures, even when thereís urgency.

Thanks!  This clarifies quite a bit.  I was just helping to clarify Ken's question as I think it might have been misunderstood.  There are still some fears that antibody doesn't provide even short term immunity and that reinfection is possible.  To my understanding, we haven't scientifically proven this is not the case, even if it's highly unlikely.

You're welcome. It's always fun (for me at least) to discuss adaptive immunity!

Scientists haven't proven either way yet, as it's all too new to make definitive conclusions. It's unclear, for example, whether people who recover and later test positive are still producing virus, which would suggest a viral reservoir of some sort, or whether they've been re-infected with a different strain. Moreover, different disease presentations are popping up in different parts of the world (e.g., the more prevalent loss of smell/taste in Europe/N. America than in China; the rather alarming Kawasaki-like disease affecting some children in Europe/N. America), and the potential effects of different strains on symptoms and outcomes aren't fully understood. Of course, much of that could be incomplete record-keeping at the beginning of the outbreak, as the clinicians in Wuhan originally had no idea what the hell they were seeing.

If this weren't so tragic and disruptive on a global scale, it would be really fascinating from a scientific perspective.

kei te pai

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Re: How long can we wait while flattening the curve?
« Reply #1858 on: May 12, 2020, 02:26:15 PM »
This is very interesting. While case numbers on a world scale have been low in NZ and Australia, I have noticed that while proportionately the same percentage of cases have died, the case numbers for hospitalisations and ICU/ventilated have been significantly greater in Australia.
Initially I thought fewer mildly symtomatic cases were being tested in Australia, but tests have ramped up and there does not seem to be community transmission. The health systems are not too different, so may be the predominant strains are different?
The Ruby Princess also left a cluster of infection here by the way!

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1859 on: May 12, 2020, 02:50:40 PM »
This is very interesting. While case numbers on a world scale have been low in NZ and Australia, I have noticed that while proportionately the same percentage of cases have died, the case numbers for hospitalisations and ICU/ventilated have been significantly greater in Australia.
Initially I thought fewer mildly symtomatic cases were being tested in Australia, but tests have ramped up and there does not seem to be community transmission. The health systems are not too different, so may be the predominant strains are different?
The Ruby Princess also left a cluster of infection here by the way!

No idea. All of this is in such early stages. And the differences could also be the result of host factors (e.g., how the host responds to the virus) rather than viral factors. People exposed to a spreader in the same space would be expected to take in similar viral doses, but some f those people end up on ventilators (or dead) while others have a mild cold. A lot more interesting data will emerge over time.

js82

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Re: How long can we wait while flattening the curve?
« Reply #1860 on: May 12, 2020, 03:16:00 PM »

There are still two macro-level philosophies - bring cases low and keep them low via contact tracing as you reopen(this is *not* lockdown until a vaccine), or minimize damage on the way to herd immunity, but the nuts-and-bolts details of accomplishing either approach can vary widely(due in particular to large differences in initial infection rate and density

Not sure I agree.  The purpose of lockdown for USA was to not overwhelm our hospitals.  It didnít stop spread, it just created a backlog of infections - it was essentially a temporary pause button.  To actually stop the virus you would need to contain it very early - and even if this is done, it will re-emerge eventually particularly in an international country with open borders as large as USA.  I wish that Fauci would admit our strategy is herd immunity. I guess heís afraid of the response and backlash of actually stating it.

I'm not sure we're in disagreement here.  I consider "don't overwhelm our hospitals" a necessary piece of the herd immunity strategy(again, assuming the objective is to get there with the minimum possible deaths and economic damage).  What I'd argue is that if we consistently look at the problem through the lens of the herd immunity endgame, we were far too aggressive with our lockdowns in many areas while if you look at it through the "containment" philosophy we weren't nearly aggressive enough in most spots.  The article you cite describes exactly that - that in some areas we're still advocating the containment philosophy, while in others we're clearly running contrary to it.

And FWIW, I agree that our opportunity to "contain" this virus has long since passed in North America and the EU.  But we haven't articulated/established a coherent national philosophy and it's painfully evident in the way things are playing out.
« Last Edit: May 12, 2020, 03:26:24 PM by js82 »


rachellynn99

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Re: How long can we wait while flattening the curve?
« Reply #1862 on: May 12, 2020, 03:44:56 PM »
What are you all seeing "opening back up" where you are?
Where I'm at ( Arkansas) you can now go out to eat in a restaurant, go to a salon or get a massage, go to church ( recommended social distancing guidelines) and a few other things. Gyms are opened back up and many stores like Books a Million never closed.

I teach college and started working from home on March 13th. My husband's company started the 15th and is at home until at least June 1st.  We live in a rural area, no neighbors, lots of places for the kids to run and play, lots of animals etc. so the kids are loving it. I've been to "town" exactly 3 times to do a grocery pickup or a pharmacy pickup.

Just curious as to the state that others are living in currently.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1863 on: May 12, 2020, 04:13:21 PM »
What are you all seeing "opening back up" where you are?
Where I'm at ( Arkansas) you can now go out to eat in a restaurant, go to a salon or get a massage, go to church ( recommended social distancing guidelines) and a few other things. Gyms are opened back up and many stores like Books a Million never closed.

I teach college and started working from home on March 13th. My husband's company started the 15th and is at home until at least June 1st.  We live in a rural area, no neighbors, lots of places for the kids to run and play, lots of animals etc. so the kids are loving it. I've been to "town" exactly 3 times to do a grocery pickup or a pharmacy pickup.

Just curious as to the state that others are living in currently.

Grocery stores, pharmacies, gas stations, convenience stores, hardware stores, clinics, and golf courses are open. Essential workplaces are open, and manufacturing was authorized to begin opening up this week. Restaurants are open for carry-out/delivery/drive-through only until the end of the month. Non-essential retail is open for curbside pick-up/delivery. Parks are open, but most equipment and amenities are closed. Museums, libraries, schools, and government offices are closed.

rachellynn99

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Re: How long can we wait while flattening the curve?
« Reply #1864 on: May 12, 2020, 04:24:40 PM »
The library in our county never closed- you can request books online and then pick them up curbside. We haven't done that- but I'm sure it's helpful to many that are at home.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1865 on: May 12, 2020, 04:26:41 PM »
The library in our county never closed- you can request books online and then pick them up curbside. We haven't done that- but I'm sure it's helpful to many that are at home.

I hope ours will move to that model over the summer. We have access to two good e-book databases, but those don't have everything that we can get in the local libraries or via transfers from other cities.

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #1866 on: May 12, 2020, 09:34:02 PM »
What are you all seeing "opening back up" where you are?
Everything is still entirely locked down in NYC. Some people are getting antsy, but so far it seems like it's mostly being obeyed.

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #1867 on: May 12, 2020, 10:13:11 PM »
There are now multiple strains of SARS-CoV-2 (based on literature Iíve reviewed for my job in the last month) and itís an RNA virus so itís more prone to mutation.
I understand that nothing is certain with any particular virus, but my understanding is that they tend to evolve to less lethal versions - simply because if a virus kills people quickly and easily, it doesn't get passed on as much as one which doesn't.


Is this correct?

AnnaGrowsAMustache

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Re: How long can we wait while flattening the curve?
« Reply #1868 on: May 12, 2020, 11:32:16 PM »
There are now multiple strains of SARS-CoV-2 (based on literature Iíve reviewed for my job in the last month) and itís an RNA virus so itís more prone to mutation.
I understand that nothing is certain with any particular virus, but my understanding is that they tend to evolve to less lethal versions - simply because if a virus kills people quickly and easily, it doesn't get passed on as much as one which doesn't.


Is this correct?

Kind of but not really. They just evolve as they evolve. The more lethal strains may or may not get edited out quicker. Rather depends on how long you can be infectious but symptom free or with mild symptoms.

ROF Expat

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Re: How long can we wait while flattening the curve?
« Reply #1869 on: May 13, 2020, 01:23:24 AM »
There are now multiple strains of SARS-CoV-2 (based on literature Iíve reviewed for my job in the last month) and itís an RNA virus so itís more prone to mutation.
I understand that nothing is certain with any particular virus, but my understanding is that they tend to evolve to less lethal versions - simply because if a virus kills people quickly and easily, it doesn't get passed on as much as one which doesn't.


Is this correct?

Let me start out by saying that I am not an epidemiologist or biologist, but I have had some direct involvement in programs to address epidemics.  I think I know enough to articulate relevant points in layman's terms, but a scientist might say I know enough to be dangerously inaccurate.  If the latter is the case, I welcome correction from technical experts. 

Although your question about evolving to become less lethal intuitively seems reasonable, my understanding is that, in practice, it isn't consistent enough to be part of a practical solution.  One reason is because the lethality of the virus is only one of many factors, and those other factors can counterbalance it.  Others factors might include speed of transmission, ease of transmission, and whether there is transmission during an asymptomatic period.  So, yes, a virus that kills its host is less likely to be passed on, but high lethality can continue to exist if other factors allow it to continue.  Ebola is probably an example of a virus where high (and more importantly, rapid) lethality limits spread.  Ebola has a very high death rate and kills quickly, but there isn't asymptomatic transmission and transmission pretty much requires direct contact with infected bodily fluids.  Ebola hasn't wiped out populations in Africa where it has long existed; probably because it tends to burn it self out by killing off people before they can spread it widely.  So yes, Ebola might spread wider if it mutated to become less lethal.  But it could also spread wider if it mutated to act more slowly or more easily transmissible. 

Another highly lethal virus is HIV, but it has spread far more than Ebola.  Modern treatments are highly effective, but those treatments aside, it appears that pretty much everyone who gets infected with HIV will eventually develop AIDS and AIDS pretty much kills 100% (or at least it weakens your immune system to the degree that something else kills you).  HIV/AIDS essentially always kills its host and it isn't easily transmissible, but it has spread globally (unlike Ebola).  Why?  HIV's "success" as a virus seems based on the fact that its very long period of asymptomatic transmission outweighs its lethality. 

So yes, a virus becoming less lethal might make it more successful, but so could any number of other mutations.  Mutation and evolution can take a lot of paths to "success," and sometimes (most times) they just lead to failure. 


dignam

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Re: How long can we wait while flattening the curve?
« Reply #1870 on: May 13, 2020, 06:53:40 AM »
What are you all seeing "opening back up" where you are?
Where I'm at ( Arkansas) you can now go out to eat in a restaurant, go to a salon or get a massage, go to church ( recommended social distancing guidelines) and a few other things. Gyms are opened back up and many stores like Books a Million never closed.

I teach college and started working from home on March 13th. My husband's company started the 15th and is at home until at least June 1st.  We live in a rural area, no neighbors, lots of places for the kids to run and play, lots of animals etc. so the kids are loving it. I've been to "town" exactly 3 times to do a grocery pickup or a pharmacy pickup.

Just curious as to the state that others are living in currently.

I've been WFH since early March.  Work is downtown in a medium sized city, home is about 20 minutes away.  Honestly it hasn't really been that difficult for us.  OK, so we had to buy hand sanitizer and masks to wear at the grocery store; big deal.  My gf still has to go to work every day (hospital), and my job is 99.9% doable from home anyway.  My dog is for sure loving us being around more.  She is my shadow lately.

Just this week retail shops were allowed to reopen, provided they follow distancing guidelines (can't serve more than 5 customers at a time).  I think this was directed toward the mom and pop stores on main streets.  The governor has set "gating" criteria to reach phases of reopening the state.  I think as of today we've satisfied 5 or 6 criteria for the first phase of reopening.
 Criteria are things like a decrease in the 14 day average of positive tests vs. # of tests performed; decrease in # of people showing up to the hospital with flu OR covid symptoms, etc.

Shane

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Re: How long can we wait while flattening the curve?
« Reply #1871 on: May 13, 2020, 07:47:25 AM »
This blog post by a UMass Dartmouth professor of biology specializing in infectious diseases is relevant to the discussion in this thread. It has a lot of practical tips on how to avoid getting sick that seemed like they might be useful as our states and countries begin opening back up again.

rachellynn99

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Re: How long can we wait while flattening the curve?
« Reply #1872 on: May 13, 2020, 08:48:03 AM »
What are you all seeing "opening back up" where you are?
Everything is still entirely locked down in NYC. Some people are getting antsy, but so far it seems like it's mostly being obeyed.

When you say everything? Are grocery stores open? How are folks getting food? Subways closed down? I don't know why I'm fascinated by this...

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Re: How long can we wait while flattening the curve?
« Reply #1873 on: May 13, 2020, 08:57:29 AM »
What are you all seeing "opening back up" where you are?
Everything is still entirely locked down in NYC. Some people are getting antsy, but so far it seems like it's mostly being obeyed.

When you say everything? Are grocery stores open? How are folks getting food? Subways closed down? I don't know why I'm fascinated by this...

you can read about it in detail here:
https://www1.nyc.gov/site/coronavirus/index.page

short version:  people deemed 'essential workers' can be out.  this includes food delivery services and grocery stores.  The subway and buses still run but for the first time ever there is a planned complete shutdown for cleaning every morning (1am-5am, I believe).  Front-facing businesses are all closed.
Otherwise residents are asked to stay inside or go for short walks around their neighborhood.  There's a $1,000 fine for violating, and a line you can report violators. 

It's pretty strict compared to most everywhere else in the US, and Io've got ,multiple family members living there.

Cooper62

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Re: How long can we wait while flattening the curve?
« Reply #1874 on: May 13, 2020, 09:15:50 AM »
The Ohio Department of Health announced yesterday that they had a handful of symptomatic patients back in January that have now been confirmed via antibody tests to have had COVID. The first confirmed case in the state was March 9th:

https://www.wkyc.com/article/news/health/coronavirus/dr-amy-acton-antibody-testing-shows-coronavirus-has-been-in-ohio-since-january/95-b78f9efa-bed4-4c02-898c-adc3e6846c9f

The first confirmed case in the US was in Washington state January 21. So the virus either traveled from Washington to Ohio in no time, where it infected multiple people in multiple counties, or it's been spreading in various travel hubs in the US for weeks longer than anybody really knew (Seattle, SF, LA, NYC, Boston, Atlanta, etc)


We live in Ohio and wondering myself if it was spreading in various travel hubs before anyone really knew.  I have a daughter in college.  One of her good friends in her dorm studied abroad in Italy during January winter term.  Friend became ill with flu-like symptoms upon her return from Italy to school.  She was pretty sick for several weeks and flu and other tests came back negative.  Other friends living near her in the dorm become ill with flu-like symptoms as well.  My daughter was very sick for a couple of weeks in February with a fever of 103-104 for several days and pneumonia.  Doctor said she had the flu (she did have a flu shot earlier in the year) but they never actually tested her for flu.  Tamiflu medicine did not help which normally does when someone in the family has the flu.  Wondering if the friend that was studying in Italy for the month of January brought Covid19 back to dorm.  When antibody tests are available would like to have my daughter tested. 

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1875 on: May 13, 2020, 11:15:36 AM »
The Ohio Department of Health announced yesterday that they had a handful of symptomatic patients back in January that have now been confirmed via antibody tests to have had COVID. The first confirmed case in the state was March 9th:

https://www.wkyc.com/article/news/health/coronavirus/dr-amy-acton-antibody-testing-shows-coronavirus-has-been-in-ohio-since-january/95-b78f9efa-bed4-4c02-898c-adc3e6846c9f

The first confirmed case in the US was in Washington state January 21. So the virus either traveled from Washington to Ohio in no time, where it infected multiple people in multiple counties, or it's been spreading in various travel hubs in the US for weeks longer than anybody really knew (Seattle, SF, LA, NYC, Boston, Atlanta, etc)


We live in Ohio and wondering myself if it was spreading in various travel hubs before anyone really knew.  I have a daughter in college.  One of her good friends in her dorm studied abroad in Italy during January winter term.  Friend became ill with flu-like symptoms upon her return from Italy to school.  She was pretty sick for several weeks and flu and other tests came back negative.  Other friends living near her in the dorm become ill with flu-like symptoms as well.  My daughter was very sick for a couple of weeks in February with a fever of 103-104 for several days and pneumonia.  Doctor said she had the flu (she did have a flu shot earlier in the year) but they never actually tested her for flu.  Tamiflu medicine did not help which normally does when someone in the family has the flu.  Wondering if the friend that was studying in Italy for the month of January brought Covid19 back to dorm.  When antibody tests are available would like to have my daughter tested.

I am in Ohio as well.  My wife was sicker than she has ever been in her life in January.  She had most of the COVID symptoms.  We've been wondering whether she had it and will likely be taking an antibody test eventually.

LaineyAZ

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Re: How long can we wait while flattening the curve?
« Reply #1876 on: May 13, 2020, 11:31:47 AM »
This blog post by a UMass Dartmouth professor of biology specializing in infectious diseases is relevant to the discussion in this thread. It has a lot of practical tips on how to avoid getting sick that seemed like they might be useful as our states and countries begin opening back up again.

Thank you for this article, I've forwarded it to some family and friends.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1877 on: May 13, 2020, 11:35:17 AM »
The Ohio Department of Health announced yesterday that they had a handful of symptomatic patients back in January that have now been confirmed via antibody tests to have had COVID. The first confirmed case in the state was March 9th:

https://www.wkyc.com/article/news/health/coronavirus/dr-amy-acton-antibody-testing-shows-coronavirus-has-been-in-ohio-since-january/95-b78f9efa-bed4-4c02-898c-adc3e6846c9f

The first confirmed case in the US was in Washington state January 21. So the virus either traveled from Washington to Ohio in no time, where it infected multiple people in multiple counties, or it's been spreading in various travel hubs in the US for weeks longer than anybody really knew (Seattle, SF, LA, NYC, Boston, Atlanta, etc)


We live in Ohio and wondering myself if it was spreading in various travel hubs before anyone really knew.  I have a daughter in college.  One of her good friends in her dorm studied abroad in Italy during January winter term.  Friend became ill with flu-like symptoms upon her return from Italy to school.  She was pretty sick for several weeks and flu and other tests came back negative.  Other friends living near her in the dorm become ill with flu-like symptoms as well.  My daughter was very sick for a couple of weeks in February with a fever of 103-104 for several days and pneumonia.  Doctor said she had the flu (she did have a flu shot earlier in the year) but they never actually tested her for flu.  Tamiflu medicine did not help which normally does when someone in the family has the flu.  Wondering if the friend that was studying in Italy for the month of January brought Covid19 back to dorm.  When antibody tests are available would like to have my daughter tested.

I am in Ohio as well.  My wife was sicker than she has ever been in her life in January.  She had most of the COVID symptoms.  We've been wondering whether she had it and will likely be taking an antibody test eventually.

Good thing everyone who wants a test can easily and quickly get it.  I know it's true, because the president of the United States has said it.  Dozens of times over the past couple months.

bigblock440

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Re: How long can we wait while flattening the curve?
« Reply #1878 on: May 13, 2020, 11:50:56 AM »
Do we have evidence yet that exposure to Covid-19 actually prevents re-infection?  That's what all the 'herd-immunity' discussions really rely on.  My understanding was that this is suspected but has not yet been proven.

If it didn't, how would the plasma treatments work?

hops

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Re: How long can we wait while flattening the curve?
« Reply #1879 on: May 13, 2020, 11:56:12 AM »
The Ohio Department of Health announced yesterday that they had a handful of symptomatic patients back in January that have now been confirmed via antibody tests to have had COVID. The first confirmed case in the state was March 9th:

https://www.wkyc.com/article/news/health/coronavirus/dr-amy-acton-antibody-testing-shows-coronavirus-has-been-in-ohio-since-january/95-b78f9efa-bed4-4c02-898c-adc3e6846c9f

The first confirmed case in the US was in Washington state January 21. So the virus either traveled from Washington to Ohio in no time, where it infected multiple people in multiple counties, or it's been spreading in various travel hubs in the US for weeks longer than anybody really knew (Seattle, SF, LA, NYC, Boston, Atlanta, etc)


We live in Ohio and wondering myself if it was spreading in various travel hubs before anyone really knew.  I have a daughter in college.  One of her good friends in her dorm studied abroad in Italy during January winter term.  Friend became ill with flu-like symptoms upon her return from Italy to school.  She was pretty sick for several weeks and flu and other tests came back negative.  Other friends living near her in the dorm become ill with flu-like symptoms as well.  My daughter was very sick for a couple of weeks in February with a fever of 103-104 for several days and pneumonia.  Doctor said she had the flu (she did have a flu shot earlier in the year) but they never actually tested her for flu.  Tamiflu medicine did not help which normally does when someone in the family has the flu.  Wondering if the friend that was studying in Italy for the month of January brought Covid19 back to dorm.  When antibody tests are available would like to have my daughter tested.

My SO and some of her friends (physicians scattered around the country, mostly at sprawling academic hospitals) think back now on flu-negative patients from earlier in the year whose symptoms were consistent with Covid-19. Many had recent travel histories. Most survived but a couple didn't.

In several cases the medical workers who'd been exposed to the patients later became ill themselves. They don't have much faith in antibody tests yet, so for most it remains a big question mark. As more information came out about common non-fever, non-hacking symptoms there was, at least for us, an ominous feeling of "Boy, that sounds familiar."
« Last Edit: May 13, 2020, 11:57:54 AM by hops »

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1880 on: May 13, 2020, 12:14:44 PM »
Do we have evidence yet that exposure to Covid-19 actually prevents re-infection?  That's what all the 'herd-immunity' discussions really rely on.  My understanding was that this is suspected but has not yet been proven.

If it didn't, how would the plasma treatments work?

Plasma treatments aren't proven to work, they're still experimental at this point are they not?

bigblock440

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Re: How long can we wait while flattening the curve?
« Reply #1881 on: May 13, 2020, 12:52:31 PM »
Do we have evidence yet that exposure to Covid-19 actually prevents re-infection?  That's what all the 'herd-immunity' discussions really rely on.  My understanding was that this is suspected but has not yet been proven.

If it didn't, how would the plasma treatments work?

Plasma treatments aren't proven to work, they're still experimental at this point are they not?

There haven't been clinical trials yet, but anecdotally, they work. 

https://www.jsonline.com/story/news/2020/04/27/nearly-2-600-covid-19-patients-u-s-treated-survivor-plasma-coronavirus/3033521001/ 

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1882 on: May 13, 2020, 01:13:01 PM »
Do we have evidence yet that exposure to Covid-19 actually prevents re-infection?  That's what all the 'herd-immunity' discussions really rely on.  My understanding was that this is suspected but has not yet been proven.

If it didn't, how would the plasma treatments work?

Plasma treatments aren't proven to work, they're still experimental at this point are they not?

There haven't been clinical trials yet, but anecdotally, they work. 

https://www.jsonline.com/story/news/2020/04/27/nearly-2-600-covid-19-patients-u-s-treated-survivor-plasma-coronavirus/3033521001/

Anecdotally, so did hydroxychloroquine.  Until it was shown that it didn't.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #1883 on: May 13, 2020, 01:32:03 PM »
How do people ever recover in the first place if their body doesn't produce antibodies to kill the virus?  I understand it's not guaranteed lifelong immunity and that has to be researched more in depth, but how could we possibly have 1.6M+ recovered people if their bodies didn't produce effective antibodies?

nereo

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Re: How long can we wait while flattening the curve?
« Reply #1884 on: May 13, 2020, 01:37:16 PM »
Do we have evidence yet that exposure to Covid-19 actually prevents re-infection?  That's what all the 'herd-immunity' discussions really rely on.  My understanding was that this is suspected but has not yet been proven.

If it didn't, how would the plasma treatments work?

Plasma treatments aren't proven to work, they're still experimental at this point are they not?

There haven't been clinical trials yet, but anecdotally, they work. 

https://www.jsonline.com/story/news/2020/04/27/nearly-2-600-covid-19-patients-u-s-treated-survivor-plasma-coronavirus/3033521001/

Anecdotally, so did hydroxychloroquine.  Until it was shown that it didn't.

Anecdotal evidence is the weakest form of evidence in medicine and science.  Itís used when something is untested, based on hearsay, or highly speculative.
AS an example, if a coworker had a cold and then tried a new Ďhealth supplementí which had clove-oil, and then he claimed that he got over his cold ďmuch faster than normalĒ, one could say there was ďanecdotal evidence that clove oil shortens the duration of the common coldĒ.

Itís that weak.

YttriumNitrate

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Re: How long can we wait while flattening the curve?
« Reply #1885 on: May 13, 2020, 01:47:22 PM »
How do people ever recover in the first place if their body doesn't produce antibodies to kill the virus?  I understand it's not guaranteed lifelong immunity and that has to be researched more in depth, but how could we possibly have 1.6M+ recovered people if their bodies didn't produce effective antibodies?

It's unlikely, but there could be a situation similar to HIV where people get sick after the initial infection, recover, and then die years later when their immune systems burn out.
« Last Edit: May 13, 2020, 01:49:28 PM by YttriumNitrate »

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1886 on: May 13, 2020, 01:48:05 PM »
How do people ever recover in the first place if their body doesn't produce antibodies to kill the virus?  I understand it's not guaranteed lifelong immunity and that has to be researched more in depth, but how could we possibly have 1.6M+ recovered people if their bodies didn't produce effective antibodies?

There are multiple types of antibodies, some that are present in active infection and some that are present in those recovered. Iíll defer more complex explanations to people like @OtherJen since the immune system always kind of gives me a headache.

nereo

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Re: How long can we wait while flattening the curve?
« Reply #1887 on: May 13, 2020, 01:53:57 PM »
How do people ever recover in the first place if their body doesn't produce antibodies to kill the virus?  I understand it's not guaranteed lifelong immunity and that has to be researched more in depth, but how could we possibly have 1.6M+ recovered people if their bodies didn't produce effective antibodies?

It's unlikely, but there could be a situation similar to HIV where people get sick after the initial infection, recover, and then die years later when their immune systems burn out.

I donít even consider it that far fetched. Plenty of deadly viruses cause (of are correlated with) medical ailments years or even decades later. It would not surprise me to learn that those who have had a severe or even moderate case of Covid in 2020 are more susceptible to another ailment years later. We are learning that it has some pretty freaky and extensive effects on the body.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1888 on: May 13, 2020, 02:06:20 PM »
Are there any known corona viruses that cause symptoms years after the initial infection? 

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #1889 on: May 13, 2020, 02:26:37 PM »
How do people ever recover in the first place if their body doesn't produce antibodies to kill the virus?  I understand it's not guaranteed lifelong immunity and that has to be researched more in depth, but how could we possibly have 1.6M+ recovered people if their bodies didn't produce effective antibodies?

There are multiple types of antibodies, some that are present in active infection and some that are present in those recovered. Iíll defer more complex explanations to people like @OtherJen since the immune system always kind of gives me a headache.

Maybe itís autoimmune, temporal arteritis? ;/

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1890 on: May 13, 2020, 02:30:53 PM »
How do people ever recover in the first place if their body doesn't produce antibodies to kill the virus?  I understand it's not guaranteed lifelong immunity and that has to be researched more in depth, but how could we possibly have 1.6M+ recovered people if their bodies didn't produce effective antibodies?

There are multiple types of antibodies, some that are present in active infection and some that are present in those recovered. Iíll defer more complex explanations to people like @OtherJen since the immune system always kind of gives me a headache.

Honestly, antibodies give me a headache. I was a T cell biologist. B cells are weird. :)

Okay. So, different antibody classes have different purposes, even if they bind to the same epitope (section of a protein that the antibody recognizes). An antibody molecule is shaped like a Y. The F(ab) part of the molecule, or the arms of the Y, are what bind to an epitope on a pathogen or allergen or other foreign material. The Fc part is the tail of the Y, and this part can bind to receptors that it recognizes on various white blood cells. These binding interactions can trigger different types of reactions from white blood cells (e.g., this is how IgE antibodies trigger mast cells, which have IgE receptors, to release histamine during allergy season).

Initially, mature B cells only produce IgM antibodies so when a reaction is first triggered against a virus, lots of virus-specific IgM will be present in a person's blood. Over the course of the infection, B cells become plasma cells, which are basically antibody factories. This occurs along with class switching, in which the antibody genes are spliced differently to switch the antibody to a more effective isotype to combat the infection (IgG for things like viruses). Class switching is influenced by things like cytokines, which are proteins secreted by T cells to adjust the inflammatory level of the immune response. So someone who's further into the course of infection would pump out IgG. Eventually, the IgM molecules will be eliminated, and some of the IgG-producing plasma cells will persist after the infection and become memory B cells. The presence of these virus-specific IgG antibodies in someone who's recovered would indicate at least some level of longer-term immunity. The question is whether this immunity would still be effective against a mutated form of the virus.

Thanks for letting me nerd out a bit. It has been more than a decade since I studied B cells, and this was fun. I relied a bit on this article to jog my memory and check my understanding. It's long and a bit jargony, but it provides good explanations: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184973/

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1891 on: May 13, 2020, 02:32:19 PM »
How do people ever recover in the first place if their body doesn't produce antibodies to kill the virus?  I understand it's not guaranteed lifelong immunity and that has to be researched more in depth, but how could we possibly have 1.6M+ recovered people if their bodies didn't produce effective antibodies?

There are multiple types of antibodies, some that are present in active infection and some that are present in those recovered. Iíll defer more complex explanations to people like @OtherJen since the immune system always kind of gives me a headache.

Maybe itís autoimmune, temporal arteritis? ;/

It's not autoimmune, but arteritis could certainly be a form of collateral damage from an intense inflammatory immune reaction.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #1892 on: May 13, 2020, 02:38:21 PM »
This is one of the best write ups I've seen.  Yes, I know it's reddit -- but all the citations are there.


https://old.reddit.com/r/LockdownSkepticism/comments/gcu6sc/i_believe_states_are_reopening_too_soon_please/fpdiwjv/

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1893 on: May 13, 2020, 07:08:19 PM »
At our hospital quite a few people were sick from the flu (confirmed), despite vaccination. We generally had high fevers for several days and took on average 2 weeks to recover. The point being that the flu this year was fairly symptomatic. It may be interesting from an academic standpoint but probably not worth spending the money and resources on testing at this point.

Hospitalizations for covid has doubled in our county in SoCal, and weíre at 20% of total ICU capacity for covid alone. Reopening non-essential businesses is probably not prudent until this slows down.

Tom Bri

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Re: How long can we wait while flattening the curve?
« Reply #1894 on: May 13, 2020, 07:26:34 PM »
Do we have evidence yet that exposure to Covid-19 actually prevents re-infection?  That's what all the 'herd-immunity' discussions really rely on.  My understanding was that this is suspected but has not yet been proven.

If it didn't, how would the plasma treatments work?

Plasma treatments aren't proven to work, they're still experimental at this point are they not?

We started using them about a week ago. The docs seem to think they are working. We have had a steady stream of patients and have become very familiar with the normal course of the disease, so if anything is significantly better I think we could see it.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #1895 on: May 13, 2020, 07:27:17 PM »

Hospitalizations for covid has doubled in our county in SoCal, and weíre at 20% of total ICU capacity for covid alone. Reopening non-essential businesses is probably not prudent until this slows down.

Which county is that?

js82

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Re: How long can we wait while flattening the curve?
« Reply #1896 on: May 13, 2020, 07:59:34 PM »
There are now multiple strains of SARS-CoV-2 (based on literature Iíve reviewed for my job in the last month) and itís an RNA virus so itís more prone to mutation.
I understand that nothing is certain with any particular virus, but my understanding is that they tend to evolve to less lethal versions - simply because if a virus kills people quickly and easily, it doesn't get passed on as much as one which doesn't.


Is this correct?

(Disclaimer - not an immunologist/epidemiologist)

Correct, or very close to correct.  Evolution favors the virus that is most efficient at replicating itself, which generally favors a virus that is highly contagious but not particularly harmful.  Killing the host is unhelpful- and to take it a step further, if the virus makes you sick enough that you're staying inside until you feel better, that's not helpful for a virus whose main goal is to find new hosts in which to replicate itself.

In this respect, the common cold might be considered the pinnacle of viral evolution(as far as human-infecting viruses are concerned).  Contagious, but frequently mild enough that people still go about their business even when infected, thereby exposing multitudes of others to infection.

On a related note, Covid-19's long incubation period(during someportion of which it's contagious) and significant number of asymptomatic yet contagious cases ought to be evolutionarily-favored.
« Last Edit: May 13, 2020, 08:01:29 PM by js82 »

Spud

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Re: How long can we wait while flattening the curve?
« Reply #1897 on: May 14, 2020, 02:03:43 AM »
I'm not sure if this attachment will work.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #1898 on: May 14, 2020, 02:08:24 AM »
That's a really interesting chart and is very relevant to the QALY calculations.

It would be helpful if every jurisdiction compiled epidemiological data like this.

Australia provides a handy breakdown:

https://www.health.gov.au/resources/publications/coronavirus-covid-19-at-a-glance

Quote
COVID-19 cases were reported across all ages.
The median age of all cases is 48 years (range: 0 to 101 years).
The median age of deaths is 80 years (range: 42 to 96 years).

So amazing that 50% of all deaths have been 80+ year olds. 0% of deaths have been people under 42.

I haven't seen any newspaper headlines to this effect, even though it's quite astonishing data that must surely play a role in the ledger balancing act.

former player

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Re: How long can we wait while flattening the curve?
« Reply #1899 on: May 14, 2020, 02:12:42 AM »
That's a really interesting chart and is very relevant to the QALY calculations.

It would be helpful if every jurisdiction compiled epidemiological data like this.

Australia provides a handy breakdown:

https://www.health.gov.au/resources/publications/coronavirus-covid-19-at-a-glance

Quote
COVID-19 cases were reported across all ages.
The median age of all cases is 48 years (range: 0 to 101 years).
The median age of deaths is 80 years (range: 42 to 96 years).

So amazing that 50% of all deaths have been 80+ year olds. 0% of deaths have been people under 42.

I haven't seen any newspaper headlines to this effect, even though it's quite astonishing data that must surely play a role in the ledger balancing act.
I have to ask: have you ever known any 80 year olds?

Also, as regards your own retirement plans, are you proposing to run out of money and kill yourself aged 79?

Enquiring minds would like to know.