Questions for Native and Coronavirus discussion Thread

[Californication]

I don’t think they are counting presumptive cases as positive, but only positive results using an FDA-approved IVD device.

HOWEVER...these are not “official” numbers. Because “official” numbers don’t exist. e.g. CDC.

It is easy to infer from this tracker’s info and FAQ that it is positive TESTS, and that has been my absolute assumption all along. Now, check their state ratings regarding the data reliability and you tell me.

About the Data

The COVID Tracking Project collects and publishes the most complete testing data available for US states and territories.

covidtracking.com

There are places trying to test the dead to confirm and cant because we cant even test the living.

I’d feel pretty certain that these would be just the test numbers and thus would be significantly underreporting the total number of cases to this point. How significantly? Anybody’s guess. Same with death toll. Until the numbers of tests reach a truly representative number...not sure what that is, either..we wont know close to accurately. Even then...?

The only data points we have is tests, positive, deaths. You can express those numbers however against the backdrop of whatever demographic or geograhic lines or categories you want. That’s what we’ve got.

Right now, because CA testing per capita is still way behind, I am using the confirmed and suspected hospital patients and confirmed and suspected ICU cases to track the effect of shelter in place. Testing is accelerationg so fast I just don't think the data is worthwhile for seeing an effect but will be useful as we anticpate relaxing shelter in place here. I know hospitalization is a two week lagging indicator, but it is a real, verifiable number, and CA is far enough in to be seeing an effect. Data through April 12 statewide. Blue is total patients, red ICU beds for reporting day, suspected and confirmed cases. Deaths per day has flattened also, though there was just a spike.

 

[FeelLikeAStranger]

Are presumptive cases of COVID-19 (no test, symptoms, doctor diagnosis, possibly remote) counted in the numbers that CDC is publishing all the time? I have seen both yes and no on this (everyone I know that has it has not been tested).

You win the psychic award...

US coronavirus death totals compiled by CDC will now include 'probable' cases

The US Centers for Disease Control and Prevention is now counting "probable" cases of coronavirus among its tabulations, according to the agency's website.

www.cnn.com

(CNN)The US Centers for Disease Control and Prevention is now counting "probable" cases of coronavirus among its tabulations, according to the agency's website.
The inclusion of such cases will add thousands to the total number of patients and deaths by including people who didn't have a positive test but showed signs of having the virus.
It comes after the Council of State and Territorial Epidemiologists suggested the CDC and state health departments add probable cases.
Previously, the CDC was only counting cases that had been confirmed by them or cases where the agency had yet to confirm a test done by a local or private entity.

 

[Bleed Red]

The one thing that concerns me is whether or not asymptomatic people will develop antibodies. Or will they just catch it again, and be a silent vector. Hopefully we learn more about this in the near future.

It really isn't necessary for a person to show symptoms in order to produce an antibody response. They are not related, so it shouldn't greatly affect the number who have immunity. The bigger question will be how long that immunity lasts, which is also not dependent on symptoms.

 

[NorthwoodHusker]

As I understand it, our testing leaves space for the virus to subsist while people are 'cleared' of the virus.
My questions are, are the new tests better at reducing actual true virus
counts, and if so, then how long before we know with very good and reasonable assurance they truly are clear?

The relapses or reinfection question is troubling

 

[Native]

It really isn't necessary for a person to show symptoms in order to produce an antibody response. They are not related, so it shouldn't greatly affect the number who have immunity. The bigger question will be how long that immunity lasts, which is also not dependent on symptoms.

While partially true, the degree to which an antibody gets refined and processed often correlates with degree of infection. So, there is a chance that a mild case may not go all the way through "affinity maturation" and get good memory B-cells for long term protection. Typically, a live attenuated virus is going to provide better immunity than a subunit vaccine. Sometimes a subunit vaccine is all that is necessary. These are the questions that only big data sets and time can answer though, so we are still at the stage where we are making guesses at what the immune response is going to mean, especially difficult at a population level to know. Cause one persons immune response while strong, could be protective, or not protective, as may be misdirected. All these will get worked out in time, however, today, things aren't clear yet.

 

[HuSkaBob]

This isn't a question so much as "finally some public information on a contained population"!

Coronavirus clue? Most cases aboard U.S. aircraft carrier are symptom-free

This doesn't really have any analysis, just the numbers. I don't know that this tells us about cities, but it's definitely interesting information.

 

[Huskerthom]

Normally you would say that it gives a good isolated test case. You could use somethi g like that to determine persentage of people who actually have compared yo the people who display stmptoms. The problem is it is not a fair representation of the general public since most military people are young and id dascent shape.

 

[Red Crawdad]

@Native and @FeelLikeAStranger , what are you thoughts on this report. With the issues with antibody testing today, this makes me a bit suspicious.

Los Angeles County antibody study suggests over 220,000 residents have already had coronavirus

A few days after preliminary results from a large-scale antibody study in Santa Clara...

www.sfgate.com

 

[FeelLikeAStranger]

@Native and @FeelLikeAStranger , what are you thoughts on this report. With the issues with antibody testing today, this makes me a bit suspicious.

Los Angeles County antibody study suggests over 220,000 residents have already had coronavirus

A few days after preliminary results from a large-scale antibody study in Santa Clara...

www.sfgate.com

False negatives are a much bigger issue with these tests based on the post linked here. Any where from 7-13%, whereas the negatives are pretty good.

Questions for Native and Coronavirus discussion Thread

Good breakdown on serology tests. (E.g. antibody tests) http://www.centerforhealthsecurity.org/resources/COVID-19/Serology-based-tests-for-COVID-19.html

forum.huskermax.com

Native might be able to fill in my knowledge gap on false positive rate of people who have had OTHER infections during a similar timeframe. Since we are measuring IgG/IgM, and not COVID-specific antibodies, I think you could see a % that are false pos, but it’s not showing up in the data linked there for some approved serology tests, as the false negative rate is almost zero.

I’m on record as saying we are WAY underestimating the number of past/current cases due to lack of testing capacity, inability to test symptomatic people that are clearly infected within the timeframe of infectious positives. Factor of 10? Easily.

This study and the Santa Clara say anywhere from 30-80X more than reported. I also would believe that these estimates are within the realm of reality. This thing had been spreading undetected for at least 6 weeks before anyone started to test. None of those people tested positive. None of the 2-15 (or whatever the R value was) people they infected got tested during that time.

The info on the aircraft carrier is significantly interesting-60% positives asymptomatic in a healthy, robust “contained” population. 20-50% estimate cited by Fauci may be truer in a more representative population.

If we assume 50% asymptomatic, then automatically double the number of reported cases immediately, as none of those people were tested either. Hell, what % of symptomatic people are being tested? 5%? 10%? It’s easy to believe that 10-20x or 30-80X more were/are infected than reported.

 

[FeelLikeAStranger]

I’m really gobsmacked by with the lack of testing capacity ramping nationwide. I figured we would be able to double testing each week in April.

*opinion alert, may contain potential politically charged thoughts that aren’t necessarily political..and have been edited”

Really upset with the blame being shifted to the states. This IS the CDC’s job and has been every other year prior to this. This is a major fiasco that ultimately needs to be owned, but certainly is not being owned at any level.

The state health labs are part of the Public Health lab system tied in to the CDC. They take direction primarily from the CDC, not the governors, not the universities or hospitals. Testing starts with the CDC and the FDA, who regulates it. An unprecendented event like this...can’t compare H1N1, or even Ebola...requires a swift Federal response and coordination, and we have had neither.

IMO, this week and next are the most critical for every area that didn’t “peak” 1-2 weeks ago, especially the states without shelter-in-place orders. The “protests” for, and premature “reopening” beginning this week is incredibly and recklessly dangerous, and WILL result in another huge spike in cases that will kill thousands, if not 10,000’s more. If people and politicians don’t get “restless” and stuck it out another 2-3 weeks, this wave could roll through and die out rather than build and crash through every area we arent testing adequately enough and hadn’t peaked yet. Unfortunately, it will be parents, grandparents, and the other susceptible populations they will spread it to.

Plan on seeing a huge wave of infections in 1-2 weeks, especially in the midwest, GA, Texas, et al... We may not have an operational packing plant in the country in 2 weeks if this continues unabated as it has been. Nursing homesand packing plants are the epicenters right now. Open up some large businesses or recreational areas and watch the spread...

I will post an update on the weekly numbers soon also.

 

[FeelLikeAStranger]

LabCorp gets EUA for “at home” collection kit. Will be offered to healthcare workers exposed or symptomatic with a doctor’s Rx.

Labcorp COVID-19 Self-collection Test Kit Receives FDA Emergency Use Authorization | Labcorp

Labcorp COVID-19 self-collection test kit receives FDA emergency use authorization. Initial distribution prioritized for frontline healthcare workers and first responders.

www.labcorp.com

 

[FeelLikeAStranger]

Sat Apr 18 2020

56

141,041

722,182

2,976,352

3,698,534

9,906

34,139

3,698,534

Again, barely over 1M tests in a week. This is NOT acceptable or anywhere near sufficient levels of testing. We should be at 4-5x by that by now. Supply chains are still problematic industry-wide, which is contributing to that. Tests aren’t a problem...swabs, extraction kits/plastics are still the short items. While some of the big labs are saying they have unused capacity, damn near every other lab is rationed on something and can’t come close to capacity testing. Plus, the requirement for who can get tested hasn't significantly changed across the country except in the “hotspots”. In Iowa, you still can’t get tested if you’re obviously symptomatic but not admitted.

US Daily Cumulative Totals - 4 pm ET

Date	States Tracked	New Tests	Positive	Negative	Pos + Neg	Pending	Deaths	Total Tests
Sat April 11 2020	56	137,297	523,199	2,142,823	2,666,022	16,593	20,339	2,6

Just over 1M tests in the last week, so barely an increase. Not moving much, which is not encouraging. Next two weeks are critical and we still aren’t able to test nearly enough. I had hoped we’d be doubling testing volume weekly by now.

1,012,821 tests in the last 7 days

 

[Cyberbach]

Thanks for posting FLAS

 

[Bleed Red]

I’m really gobsmacked by with the lack of testing capacity ramping nationwide. I figured we would be able to double testing each week in April.

*opinion alert, may contain potential politically charged thoughts*

Really upset with the blame being shifted to the states. This IS the CDC’s job and has been every other year prior to this, and the current administration has completely abdicated their responsibility. This is a major fiasco that ultimately needs to be owned by the one person conducting the entire clown show, but certainly is not being owned.

The state health labs are part of the Public Health lab system tied in to the CDC. They take direction primarily from the CDC, not the governors, not the universities or hospitals. Testing starts with the CDC and the FDA, who regulates it. An unprecendented event like this...can’t compare H1N1, or even Ebola...requires a swift Federal response and coordination, and we have had neither. This is a complete and utter botch job of both Federal preparednesss and response.

This week and next are the most critical for every area that didn’t “peak” 1-2 weeks ago, especially the states without shelter-in-place orders. The “protests” and premature “reopening” beginning this week is the height of idiotic insanity, incredibly and recklessly dangerous, and WILL result in another huge spike in cases that will kill thousands, if not 10,000’s more. If people and politicians don’t get “restless” and stuck it out another 2-3 weeks and let this wave roll through and die out than build and crash through every area we arent testing adequately enough and hadn’t peaked yet.

Plan on seeing a huge wave of infections in 1-2 weeks, especially in the midwest, GA, Texas, et al...

Personally, I’m not going anywhere I dont absolutely have to for at least another month. Maybe longer.

I will post an update on the weekly numbers soon also.

Is it possible that since everyone is most likely understating the number of people with the disease, by what seems to be a very significant amount, that maybe the "peak" is being arrived at earlier than the projections are saying it would? Not trying to be naive here, but wouldn't that be a potential shift of the peak toward the front of the time line and possibly, repeat possibly, put us further along in the cycle of the disease than the models say we are?

I completely agree with you that the number of positives reported is a very small percentage of the true number of people who have had the disease, due to the high number of asymptomatic people.

 

[Native]

@Native and @FeelLikeAStranger , what are you thoughts on this report. With the issues with antibody testing today, this makes me a bit suspicious.

Los Angeles County antibody study suggests over 220,000 residents have already had coronavirus

A few days after preliminary results from a large-scale antibody study in Santa Clara...

www.sfgate.com

All these tests provide is a jumping point for extrapolation in my opinion. Antibody tests are to date aren't giving reliable data. The false positive/false negative rates and overall lack of specificity make everything murky. It is going to take awhile for an accurate test to be developed and verified. Tougher to do than the RT-PCR. Difficulty even more if you actually want a test that shows you have protective antibodies. I guess is, yes, we have missed a ton of infections, but really we don't have a clue how many. Anybody who says they know is making it up.