outbreak! (ebola, sars, coronavirus, etc)

It is a grim certainty that New Year's Eve is not going to be very cheerful this year, even with our leaving 2020 behind and the early doses of vaccine becoming available for emergency use. We're already hitting 150,000 new (known) cases a day.

I know this doesn't mitigate against the national totals, but what we are seeing now is still nowhere near as intense as what we saw in March-May, it's just that it's spread across the 50 states. On a per million severe and dead basis, no state is suffering anything close to what NY and NJ suffered, and so far I don't know that you can say that we're on a trajectory to get there. It may just be the nature of less dense states that you're going to get an ongoing slow burn rather than a raging wildfire.

what we are seeing now is still nowhere near as intense as what we saw in March-May

I think a large part of the intensity depends on how overwhelmed the regional hospitals become. When there are many more patients in dire need of care than there are nurses and doctors available to administer to them, things get intense in that area, no matter how it's spread out across other parts of the country.

and so far I don't know that you can say that we're on a trajectory to get there.

how can you look at trends that are exponentially rising and say you don't know that we're on a trajectory to get there?

give 103% growth another several days to exponentially grow, you'd be surprised

yes agree

Since cases first started popping up in Illinois, I've been checking the stats every day, but after the last couple of days I think I need to stop doing that. This shit is getting scary.

If your takeaway from the current spike/trajectory is that this is a "slow burn" and somehow "better" than what happened March in NY/NJ, you are in for a ride.

ie

taking sides: 1500+ Americans/day vs. 1500+ tri-staters/day

i felt like such a fucking idiot, earlier today.

my mom said, "so what would happen if some of us take vaccines, and the others don't? why can't we just go back to normal, and if some people don't take them, they don't take them?"

(the context is that my mom doesn't trust any vaccine and thinks this is all a conspiracy)

my two quick answers, in the moment, a bit frenzied because there was a lot of racist bullshit going on in the same conversation), were:

1) people that don't take a vaccine will quickly be exposed (due to going back "to normal"), and even though they are dumb, they don't deserve to suffer
2) the aforementioned people which don't take the vaccine will continue to overload the healthcare system, which, in addition to creating unsightly ~temporary morgues in the visible area~ would also lead to worse conditions for everyone else in the healthcare system.

am i missing anything else? it ends up killing a bunch of people and also makes things worse for everyone else? was too overwhelmed in the moment to game it out

that vaccines are not 100% effective so we have to rely on that "herd immunity" they keep talking about for them to really work, otherwise we will not be back to normal

maybe not a good idea to introduce to a conspiratorial thinker's mind, they will just go "but it's not 100% effective" and not understand that that's how it's meant to work

I will get the vaccine, but still wonder how I'll feel if it's 90% effective but 40-50% of the population refuses to get it and could still infect me.

how can you look at trends that are exponentially rising and say you don't know that we're on a trajectory to get there?

― @oneposter(✔️) (Karl Malone), Sunday, 15 November 2020 00:54 (one hour ago) link

Because I don't think any state in America is at the point we were in March where literally nothing was closed, no one was taking any precautions, no one knew how to deal with COVID, hospitals didn't know how to treat it, people were actually being told NOT to wear masks, etc. Even in red america I just don't think we are at the equivalent of early stage tri-state.

We would not be able to (in your Mom's words) "return to normal" because many people would continue dying from the disease and it would (continue to) overwhelm medical facilities. We would be in a state of perpetual yo-yo of social distancing/masks/shelter-in-place and cautious relief until another crisis outbreak.

there are 7 states so far that have had over 1,000 deaths per million - NJ, NY, CT, MA, RI, LA, MS - but the numbers in other states are rising rapidly

the total number of cases is the area under the curve, which can be larger even with a slower increase in cases than NYC in march because it's over a longer time. but this is a fast increase in cases so idk. looks bad.

We also don't have a graph that shows how fast the rise in cases actually was in the tri-state in March, because we didn't have anywhere near the levels of testing we have now. It's definitely bad now, I just think the graphs and numbers can lead to a misleading comparison to March that doesn't apply, at least yet.

also, death rates for covid cases have fallen

Yeah but I'm still worriedly curious to see what the life expectancy for survivors is gonna ultimately wind up being.

But it's 99.7% survivable ROIGHT?

If you don't mind living out yr remaining years in an iron lung, I have some very good news for you

https://www.reuters.com/article/us-health-coronavirus-mental-illness/one-in-five-covid-19-patients-develop-mental-illness-within-90-days-study-idUSKBN27P34L

I think the calculated infection fatality rate (IFR) has been just a hair under 1%, based on the best available statistics so far. So call it about 99.05% survivable. Maybe. This is not a stat that ordinary people should be encouraged to dwell upon, since most people are really bad at connecting numbers to reality.

in all seriousness, i keep wondering how people think that hospitalizations, which are now at record levels (meaning many hospitals in many states are full) could somehow be managed if they were ten times higher than they are now, which is what would happen if we went back to normal.

yeah I mean "survivable" is not really the best metric as I'm sure we're all aware, as per my terrifying link above

wonder if most would be ok with having an inflamed appendix, being told there's no room in the hospital for you, it bursting and you getting peritonitis, and still being told there's no bed for you anywhere, and you just dying of a preventable issue.

I was mostly sarcastically making the "survivable" quip as I argued with some taintpickle today who was claiming nobody dies from it, which even if it were true, is only one of several major issues going on simultaneously with the pandemic.

https://www.reuters.com/article/us-health-coronavirus-mental-illness/one-hundred-percent-of-humans-living-in-era-of-covid-19-develop-mental-illness-because-i-mean-fuck-how-do-u-not

Vaccines (given they aren’t 100% effective) are much more effective in a population that isn’t a raging garbage fire of infection.

As ever its all about probabilities

If the vaccine is 90% effective if administered correctly in sa small lab population that is good, but what about degradation of effectiveness, the Pfizer vaccine is already 2 doses for full effectiveness, so what if a bunch of people miss their second dose? What about breaks in the the incredibly complex -70C cold chain? How does it even work against a representative population. It’s all chips away at the effectiveness as does any lack Of uptake.

A 90% effective vaccine quickly becomes a 30% effective vaccine, and when you are trying to build up hers immunity this is useless.

The most successful vaccines programmes have been against endemic, rather than pandemic, diseases.

There’s still a long way to go.

xps:

Early infection fatality rate was 0.97% inferred from NYC seroprevalence surveys. It's probably improved since, maybe 0.6-0.8%, thanks to better care protocols (corticosteroids, anticoagulants, avoiding mechanical ventilation as long as possible with proning and CPAP). But, given we seem to be in an era where sociopathy is condoned and encouraged, public messaging about deaths is utterly ineffectual. Perhaps there will be more success messaging about "long Covid", as there aren't many 20-somethings that would want to spend the next 50-60 years with impaired lung, heart, kidney, brain, or testicular function.

Meanwhile, this short thread was disheartening:

I have a night off from the hospital. As I’m on my couch with my dog I can’t help but think of the Covid patients the last few days. The ones that stick out are those who still don’t believe the virus is real. The ones who scream at you for a magic medicine and that Joe Biden is

— Jodi Doering (@JodiDoering) November 15, 2020

The most successful vaccines programmes have been against endemic, rather than pandemic, diseases

https://www.theguardian.com/world/2020/nov/15/damage-to-multiple-organs-recorded-in-long-covid-cases

A little more scary long covid stuff. Feel like this is the rebuke to all the person fakenames going on about 99.5 survival rate that is likeliest to sink in: if you can’t make them see that a disease that kills 1 in 200 (and requires hospitalisation in 3% of cases) spreading unchecked could be a problem there might be a small chance that this huge unknown that is potentially v bad might give them pause

Given it requires them to think longer-term than their next vitally important manicure or burger, I wouldn't count on it.

I absolutely need a burger right this instant but I wouldn’t eat it inside a restaurant for a million dollars

A good way to connect to people who think 1 in 200 are good odds would be to have them imagine how eager they would be to visit their local Starbucks if the employees were required to kill every 200th customer.

and maul every 5th, with unspecified future effects

I'll take a tall Pike

A Slaynta

question: if a vaccine is "90% effective" does that mean it is 100% effective for 90% of people or that it's 90% effective for each individual case of exposure?

I believe means that the treatment group had only 10% as many infections as the control group at the endpoint they evaluated. But it might mean something more complicated than that.

So i.e. maybe they unblinded data for initial analysis when they had 110 infections and found 100 infections in the placebo group and 10 in the treatment group. (Then also they have to have a sufficiently high-powered study for this to have an acceptable chance of being near the true effect size. There are frequentist statistical models involved.)

so the question i'm asking isn't answerable in the terms i'm presenting?

It means they don’t have data that could tell you that (probably) (I don’t know that there’s a paper yet)

Like they don’t know how many times each participant was exposed to covid 19, the endpoint they’re tracking here is covid-19 infections between the vaccine and placebo group. The vaccine is effective if fewer people in the vaccine group get infected, to an extent distinguishable from random chance, within a margin of error:

Also yeah neither of your options is correct and I don’t think there’s a way you could know either of those things.

2020: the year where neither of my options are correct and there's no way I could know things

What about breaks in the incredibly complex -70C cold chain?

-70C is not incredibly complex, I handle lab supply shipments that cold all the time. It just requires a styrofoam cooler packed with a few pounds of dry ice pellets. Can keep things colder than -70C for 48 hours and that's assuming no freezer storage at the shipping depots which won't be the case for COVID vaccines, UPS is stocking up on freezers. And they'll probably use better coolers than the styrofoam ones we use! Also after we unpack the dry ice shipments I drop the pellets in my tea so it looks like I'm drinking a magic potion.

One challenge is you can’t necessarily deliver many vaccines to a population in a short time (such as every employee of a large medical center) without loads of free -80 space to put doses in, and now a bunch of institutions are probably gonna start buying up -80s, because capitalism ensures efficient distribution of resources

My university knocks out 1-2k flu shots per day during their yearly vaccine drives. Even at half that rate you can just top up the shipping containers with fresh dry ice as they arrive, you don't even need electric freezers. They won't be sitting around for very long.

Not to say it will be easy, but stuff like large-scale vaccination and cold shipping and storage are solved problems, and we've got very strong motivation to throw a lot of resources at this disease. I'm more worried about healthcare worker burnout than the logistical issues, because, as you say, capitalism.