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Just now, schoeppeya said:

Sure, but there are also plenty of accounts of young adults going from healthy to dead in a 24 hour period from the Spanish Flu. That doesn't happen to healthy young adults from Covid. There is also a hypothesis that older populations had some antibody protection from the Russian Flu in 1890, but nothing conclusive. 

The point I was making was that even comparing the time period when we really didn't have an answer for Covid, the Spanish Flu was more deadly.

Yes of course. The disease kills different demographics. 

There was a study that compared the two in NYC, the pandemic wave there was about 70% as deadly as the spanish flu. 

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1 hour ago, Stebo said:

No it isn't and idk what your vested interest is in misinformation but around here we deal in facts.

Ok lets deal in facts. Look at the chart the poster above this statement posted. Look at the link I provided for you to look through. You are either a really good troll or too obtuse to digest data that is presented to you. The last chart clearly shows an increase in testing and a decrease in the percentage of positive tests, along with a downward trend of total positive cases and a dramatic decline in hospitalizations. So please, explain to me my vested interest in misinformation while I provide you with facts.

184546055_ScreenShot2020-08-30at3_05_31PM.png.de25184ebea01b9c25e2d336e689b4c7.png1561979946_ScreenShot2020-08-30at3_05_21PM.png.3bc4fec8eaefb2651f44e75cb18e2227.png1005757110_ScreenShot2020-08-30at3_04_35PM.png.7d3bfdebdc179df36bfbd4a6ae4e57cd.png

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1 hour ago, Inverted_Trough said:

In case you haven't heard, there's a vaccine for the flu.  I get it every year.

And despite the vaccine it still kills a half a million people each year.

So, how many is too many?

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1 hour ago, Stebo said:

numbers are still misleading

This sums up COVID right here. It's a respiratory disease with a low fatality rate and it impacts people in bad health primarily. 

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56 minutes ago, schoeppeya said:

Ok lets deal in facts. Look at the chart the poster above this statement posted. Look at the link I provided for you to look through. You are either a really good troll or too obtuse to digest data that is presented to you. The last chart clearly shows an increase in testing and a decrease in the percentage of positive tests, along with a downward trend of total positive cases and a dramatic decline in hospitalizations. So please, explain to me my vested interest in misinformation while I provide you with facts.

184546055_ScreenShot2020-08-30at3_05_31PM.png.de25184ebea01b9c25e2d336e689b4c7.png1561979946_ScreenShot2020-08-30at3_05_21PM.png.3bc4fec8eaefb2651f44e75cb18e2227.png1005757110_ScreenShot2020-08-30at3_04_35PM.png.7d3bfdebdc179df36bfbd4a6ae4e57cd.png

Those first 2 images are Houston based and the 3rd image is showing that it is going up recently. Plus I am saying the south there is more than Texas and Houston in the south. That first image isn't cases either its hospitalizations, that is different than total cases.

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10 minutes ago, Stebo said:

Those first 2 images are Houston based and the 3rd image is showing that it is going up recently. Plus I am saying the south there is more than Texas and Houston in the south. That first image isn't cases either its hospitalizations, that is different than total cases.

I’m aware of what the images show. The third image is testing, which is increasing, which is exactly the point. Did you see the graphic where Texas, California, Georgia, Tennessee and Florida are leaders for the amount of testing they have done? 

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1 minute ago, schoeppeya said:

I’m aware of what the images show. The third image is testing, which is increasing, which is exactly the point. Did you see the graphic where Texas, California, Georgia, Tennessee and Florida are leaders for the amount of testing they have done? 

Baum's graphic says cali and the northeast and midwest lead in testing. 

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FL/TX being higher is a function of population. Per capita its the midwest and northeast which OSU pointed out.

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22 minutes ago, Stebo said:

Baum's graphic says cali and the northeast and midwest lead in testing. 

 

19 minutes ago, Stebo said:

FL/TX being higher is a function of population. Per capita its the midwest and northeast which OSU pointed out.

Lol. You’re trolling. 

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19 hours ago, RyanDe680 said:

Hmm...  not sure what to think of this

 

https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html

The above article states this:

Officials at the Wadsworth Center, New York’s state lab, have access to C.T. values from tests they have processed, and analyzed their numbers at The Times’s request. In July, the lab identified 794 positive tests, based on a threshold of 40 cycles.

With a cutoff of 35, about half of those tests would no longer qualify as positive. About 70 percent would no longer be judged positive if the cycles were limited to 30.

In Massachusetts, from 85 to 90 percent of people who tested positive in July with a cycle threshold of 40 would have been deemed negative if the threshold were 30 cycles, Dr. Mina said. “I would say that none of those people should be contact-traced, not one,” he said.

how is this not getting more attention?

 


 

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3 hours ago, Jonger said:

And despite the vaccine it still kills a half a million people each year.

So, how many is too many?

The threshold should be 1) a novel influenza virus; 2) IFR of at least 0.75%.  If those criteria are met, then no Taylor Swift concerts.

The last time that threshold was met was 1918.  The 2009 swine flu was much milder than the traditional flu.  1968 flu pandemic also had an extremely low IFR.

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2 hours ago, schoeppeya said:

Narratives matter.

Its not a narrative thing. The FDA initially approved the highly sensitive RT-PCR tests that are excellent for clinic diagnosis. Thats their typical purview. They are not tailored to only find contagious patients in a community setting. Dr. Michael Mina is big on pushing for a different category of testing...one for the community survaillance. Those tests would be much cheaper, could be taken at home and often. Theyre not as sensitive but the people that need to be found to slow community transmission have very high levels of viral RNA which would be found by these new tests. 

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2 hours ago, RyanDe680 said:

The above article states this:

 


 

People are being tested way too late. What good is it to find someone with mild symptoms who was actually contagious 7 or 10 days ago? How can you contact trace that far back? 

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1 hour ago, OSUmetstud said:

Its not a narrative thing. The FDA initially approved the highly sensitive RT-PCR tests that are excellent for clinic diagnosis. Thats their typical purview. They are not tailored to only find contagious patients in a community setting. Dr. Michael Mina is big on pushing for a different category of testing...one for the community survaillance. Those tests would be much cheaper, could be taken at home and often. Theyre not as sensitive but the people that need to be found to slow community transmission have very high levels of viral RNA which would be found by these new tests. 

It’s not a narrative that upwards of fifty percent of people who have tested positive possibly shouldn’t have and it’s barely being talked about? Total number of positive cases has been the most important metric by which this pandemic has been measured for months now. That has been the narrative that has justified much of the decision making as we’ve transitioned through the summer and fall - you really think that if all of the sudden people found out that over half of positives shouldn’t have been, they’re not going to be upset? 

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19 minutes ago, schoeppeya said:

It’s not a narrative that upwards of fifty percent of people who have tested positive possibly shouldn’t have and it’s barely being talked about? Total number of positive cases has been the most important metric by which this pandemic has been measured for months now. That has been the narrative that has justified much of the decision making as we’ve transitioned through the summer and fall - you really think that if all of the sudden people found out that over half of positives shouldn’t have been, they’re not going to be upset? 

Dude. Theyre positive. Its just that theyre late in their illness. We missed when they were actually infectious. Thats the point that michael mina is making. Not that they don't or didn't just have covid. 

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Know another person who has it.  One of my mother's friends.  She is around 70 and the ironic thing is that she's a teacher who recently retired 1 year early due to concern about contracting the virus at school.  

She likely got it while helping her friends move.  Nobody was wearing a mask and one of those people tested positive several days before she did.  Last I heard she lost her sense of smell and has a cough.  Hopefully it stays at that.

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22 minutes ago, OSUmetstud said:

Dude. Theyre positive. Its just that theyre late in their illness. We missed when they were actually infectious. Thats the point that michael mina is making. Not that they don't or didn't just have covid. 

Dude. Read the article again. Although Mina mentions that some of the low viral load positives are taken before or after they reach the peak, the intent of the article is to make the case that there are a ton of positive tests from carriers with a viral load too low to be transmissible. The article lists many reasons that this is possible beyond capturing the virus before or after an increase in viral load. 

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6 hours ago, schoeppeya said:

Dude. Read the article again. Although Mina mentions that some of the low viral load positives are taken before or after they reach the peak, the intent of the article is to make the case that there are a ton of positive tests from carriers with a viral load too low to be transmissible. The article lists many reasons that this is possible beyond capturing the virus before or after an increase in viral load. 

Yes, that's from the long tail of viral RNA that persists in people a few weeks after they have contagious virus. Were testing people outside of this window mostly. The article never suggests that these people never were contagious. By the time people have significant enough symptoms to think to get tested, weve missed most if not all of the window. 

People infected with the virus are most infectious from a day or two before symptoms appear till about five days after. But at the current testing rates, “you’re not going to be doing it frequently enough to have any chance of really capturing somebody in that window,” Dr. Mina added.

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17 hours ago, Stebo said:

I will say the numbers have gotten better since the mask mandates even if the mask usage isn't what it is in the north or northeast.

I am not an anti-masker so don't go off on that but is this a case where correlation does not imply causation? Is it the natural cycle of ramp up peak and then go down or is it due to mask wearing?  I don't know but you state this as fact.  I'd be curious how much is attributable to each source.

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4 hours ago, OSUmetstud said:

Yes, that's from the long tail of viral RNA that persists in people a few weeks after they have contagious virus. Were testing people outside of this window mostly. The article never suggests that these people never were contagious. By the time people have significant enough symptoms to think to get tested, weve missed most if not all of the window. 

People infected with the virus are most infectious from a day or two before symptoms appear till about five days after. But at the current testing rates, “you’re not going to be doing it frequently enough to have any chance of really capturing somebody in that window,” Dr. Mina added.

"Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said. A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on."

These doctors are clearly making the argument that people are testing positive when they shouldn't be-its also been shown over and over again that a large number of people with a low viral load will never have a higher one. Which is why so many people, maybe even the majority, never have symptoms. Our entire response the last few months to the virus has been the huge number of positive tests. If fifty percent of those positive tests were taken away, our response would be different. Do you disagree with that? 

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Just now, schoeppeya said:

 

"Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said. A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on."

These doctors are clearly making the argument that people are testing positive when they shouldn't be-its also been shown over and over again that a large number of people with a low viral load will never have a higher one. Which is why so many people, maybe even the majority, never have symptoms. Our entire response the last few months to the virus has been the huge number of positive tests. If fifty percent of those positive tests were taken away, our response would be different. Do you disagree with that? 

Where? You made that up. Asymptomatic people and presymptomatic people have high viral loads, too. The difference in disease seems like its mostly related to a poor immune response. 

I agree with lowering the threshold for community surveillance. The high sensitivity stuff is best used for the hospital when a patient has obvious symptoms. We need to optimize testing to find people who are actually transmitting, not to catch people who are late in their disease course. 

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39 minutes ago, OSUmetstud said:

Where? You made that up. Asymptomatic people and presymptomatic people have high viral loads, too. The difference in disease seems like its mostly related to a poor immune response. 

I agree with lowering the threshold for community surveillance. The high sensitivity stuff is best used for the hospital when a patient has obvious symptoms. We need to optimize testing to find people who are actually transmitting, not to catch people who are late in their disease course. 

I did word that poorly for sure. There are people who just don’t end up with a large viral load for whatever reason that is. 
 

I agree. The newer quick result tests will hopefully go a long ways in getting us on a faster trajectory back to normal. 

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18 minutes ago, schoeppeya said:

I did word that poorly for sure. There are people who just don’t end up with a large viral load for whatever reason that is. 
 

I agree. The newer quick result tests will hopefully go a long ways in getting us on a faster trajectory back to normal. 

That's fair. I'm sure there's some natural variation in viral load from person to person just because of biological variations. The super spreading seems mostly venue dependent (large, indoor gatherings with poor air circulation), but there could be some people who just have a bit more virus in the upper respiratory tract than others. 

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This may have been posted already but this was interesting from the CDC - https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm?fbclid=lwAR2PcFrRYmWibcz886GrQnZPmJqSswslIV9mXkhTkip14YaTRC-8qSfGLxpw

Wonder what this situation would look like if we had a healthier population in the US. 

Comorbidities

Table 3 shows the types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019 (COVID-19). For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.6 additional conditions or causes per death. The number of deaths with each condition or cause is shown for all deaths and by age groups.

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On 8/30/2020 at 5:45 AM, Hoosier said:

Hopefully the mask wearing keeps the cold and flu rate lower.  The less confusion we can have between what illness somebody has, the better.

I can speak from first hand experience, the confusion is a pain in the ass. As many know, I'm a physician. My daughter is 18 months old and in daycare, she caught some sort of a URI virus and brought it home and gave it to me. I had the typical viral sore throat and developed some body aches and chills. Under any other circumstances I would easily work through something like this and just take a Tylenol and she throat lozenges.  With covid circulating that's a no go. It would be the wrong answer to go in mildly sick and be wrong that is just a regular cold and accidentally spread covid to the staff and patients.

So I got tested and it was negative thankfully but I couldn't just go back to work because our policy is 7 days from symptom onset even if the covid test is negative. Not the end of the world but it wasn't an easy call to go get tested knowing that is have to take off for 7 days. Really disruptive to my patients and colleagues. Worse if I had a job that is hourly and would lose income from going to get tested.

If we have a meaningful flu and other respiratory virus season, it's going to be a mess.

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11 hours ago, WestMichigan said:

I am not an anti-masker so don't go off on that but is this a case where correlation does not imply causation? Is it the natural cycle of ramp up peak and then go down or is it due to mask wearing?  I don't know but you state this as fact.  I'd be curious how much is attributable to each source.

There is a correlation with those places where mask wearing is more prevalent having better numbers, but it also a function of how much is open and yes there could be weakening of the virus itself, but that last factor is a bit more unknown.

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On 8/30/2020 at 12:48 PM, schoeppeya said:

Narratives matter.

 

On 8/30/2020 at 12:36 PM, RyanDe680 said:

The above article states this:

 


 

Interesting article, thanks for sharing it. I think both of your take aways miss the point though. Those positive tests are still positive cases and we cannot infer one way or another whether or not they were infectious at some point in their infection. The authors imply from study of other viruses that they probably aren't infectious at highly amplified/very sensitive(40 cycle) thresholds for test positivity rates. This is probably true and they are probably right that these people aren't the best targets for testing in terms of isolation and contact tracing efforts. Keep in mind, these are not false positives but if the test threshold were lowered then they would be false negatives. So the total number of true cases are still out there but just not recognized.

The authors of the article make the more important point that non PCR based testing and fast preferable home based results that identify all the people with high levels of virus is the best way to utilize testing to accomplish the goal of isolating highly infectious individuals. We've been waiting on the testing technology to give us this tool. Hopefully it's used wisely. A competent federally coordinated response with transparency and end points communicated openly would be preferred.

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This thing is wrapping up in Michigan.

Virtually everything is opening up again this week or next in Michigan.

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Starting to run rampant here in PA, two local colleges with large outbreaks going all online, two nursing homes hard hit, one with 26 deaths in last 3 weeks...local jail and federal jail with ongoing outbreaks.

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