Coronavirus/COVID-19, Thread 2

[Parliament10]

Read on Twitter

[Slax]

I've been reading a lot about Sweden, and ran across this.

Read on Twitter

?s=12

Is it just that they're treating the infected earlier than us so they don't need ventilators, or are we jumping the gun on using ventilators and the ventilator themselves are contributing to deaths? Or is this unrelated?

The same guy (the bad cat) is saying that "there is no evidence that lockdowns reduce deaths and solid evidence they do not."

Read on Twitter

So before believing anything this bad cat pushes on Twitter, I would like to make sure he's comparing apples to apples.

I think I'll pass on his information, at least for now.

Yeah if you read further down the tweet thread, the New York data comes from a peer-reviewed study of 12 Northwell Health hospitals that was recently published in JAMA, and the Stockholm "data" is just a news article where a chief physician from a single hospital gave an interview where the newspaper paraphrased that roughly 80 percent of the first batch of early ICU patients either survived intensive care or survived after being discharged from intensive care (unclear which - the article was paraphrasing the physician, and was inconsistent in what it said), so you really can't do a direct comparison between the two. I have three suspicions:

1. The Northwell Health study is probably biased toward higher death rates than actually happen, because one of its limitations was that it couldn't include patients who were still hospitalized but had not yet died: "Fifth, clinical outcome data were available for only 46.2% of admitted patients. The absence of data on patients who remained hospitalized at the final study date may have biased the findings, including the high mortality rate of patients who received mechanical ventilation older than age 65 years." In other words, there are a lot of people who required intensive care, survived, but are still in the hospital recovering, and who will be discharged at some point within the next few weeks, and the authors of the study understand that it is biased to report higher death rates because those patients can't be included in their data yet. The Stockholm physician was only talking about the "first batch" of ICU patients, people who would have had more time to recover and be discharged, and thus you would expect to see a much higher percentage of survivors showing up in the data.
2. The Stockholm hospital would necessarily be an extremely small sample size and extremely difficult to generalize. The article was published on April 15, and according to the article, the hospital itself is 177 ICU beds, and the physician is only referring to the first batch of patients who were admitted to that ICU, which means we're talking about patients who were first admitted like late March and early April. Which means we're probably looking at what, a preliminary look at a few dozen patients from a single hospital from before the peak of their COVID-19 outbreak? Compared to a comprehensive study of thousands of patients from a multi-hospital New York hospital system from the peak of New York's COVID-19 outbreak.
3. A lot of weird statistics are going to come from decisions like "who gets admitted to a hospital?" and "who is receiving intensive care?" When New York reached the peak of its COVID-19 crisis, hospital resources were so overtaxed that a lot of people who would normally be hospitalized and admitted to the floor were instead told to go home and wait it out, and a lot of the patients who would have normally been admitted to the ICU were instead treated on the floor. During the COVID-19 peak, my wife's hospital (an independent community hospital in Brooklyn, not part of Northwell) was dedicated almost entirely to treating COVID-19 patients, and her description of what the floor looked like at her hospital was just a sea of beds filled with people who constantly needed to be intubated to survive. I'm confident these people would normally be treated in the ICU, but in a study like this, they would show up as just "hospitalizations" rather than "intensive care". So because Stockholm in late March had a much lower hospital system crunch than New York in early April, the fact that ICU patients in New York were sicker, were more likely to be vented, and had higher fatality rates might partially just reflect different classifications of patients due to differences in patient load and ICU availability. Consider that a very large majority (coincidentally, about 80%) of hospitalized patients in the Northwell study were discharged - it's not as if going to a New York hospital to get treated for COVID-19 was a death sentence because they're putting everyone on ventilators and destroying their lungs. Basically, by the time anyone is considering putting you on a ventilator, you are already in REALLY bad shape, and probably New York ICU patients were on average in way worse shape than Stockholm ICU patients, so New York ICU patients were getting vented at higher rates and dying at higher rates than Stockholm ICU patients - they are correlated, but it's not yet clear that one caused the other.

It might still be true that Sweden has way better ventilation protocols than the US and we can learn from them to significantly improve COVID-19 survival rates, but I wouldn't jump to that conclusion based on what this guy provided in his tweet thread. It's basically some off-hand comments by a single Swedish hospital and a text conversation with one Swedish doctor. There aren't any serious studies here that you can go off of.

[SuperDeluxe]

3. A lot of weird statistics are going to come from decisions like "who gets admitted to a hospital?" and "who is receiving intensive care?"

That's exactly what I was thinking. Protocols in hospitals may vary from state to state, not to mention from country to country. For all we know, that hospital in Sweden may be more conservative than the hospitals in NY, and may be placing patients in the ICU at an earlier stage of the infection as a preventative measure. Or maybe some patients in NY are arriving later to the ICU than they should because there are no ICU beds left. We really have no idea.

Having said that, and leaving aside this bad cat twitting twat's barrage, comparing stats from different countries should be done carefully. Here in Canada, each province has a different way of reporting so the federal government itself is being very cautious when analyzing the data and releasing it to the public.

[Slax]

3. A lot of weird statistics are going to come from decisions like "who gets admitted to a hospital?" and "who is receiving intensive care?"

That's exactly what I was thinking. Protocols in hospitals may vary from state to state, not to mention from country to country. For all we know, that hospital in Sweden may be more conservative than the hospitals in NY, and may be placing patients in the ICU at an earlier stage of the infection as a preventative measure. Or maybe some patients in NY are arriving later to the ICU than they should because there are no ICU beds left. We really have no idea.

Having said that, and leaving aside this bad cat twitting twat's barrage, comparing stats from different countries should be done carefully. Here in Canada, each province has a different way of reporting so the federal government itself is being very cautious when analyzing the data and releasing it to the public.

For sure, it's a really interesting problem with data that is hard to deal with. You even see this across periods of time as methodologies change. COVID-19 death tolls jumped up in a bunch of states when they started including suspected COVID-19 deaths instead of just confirmed deaths, so you can't even reliably compare a death count now to a death count two weeks ago within the same state!

[Bad-Thoma]

3. A lot of weird statistics are going to come from decisions like "who gets admitted to a hospital?" and "who is receiving intensive care?"

That's exactly what I was thinking. Protocols in hospitals may vary from state to state, not to mention from country to country. For all we know, that hospital in Sweden may be more conservative than the hospitals in NY, and may be placing patients in the ICU at an earlier stage of the infection as a preventative measure. Or maybe some patients in NY are arriving later to the ICU than they should because there are no ICU beds left. We really have no idea.

Having said that, and leaving aside this bad cat twitting twat's barrage, comparing stats from different countries should be done carefully. Here in Canada, each province has a different way of reporting so the federal government itself is being very cautious when analyzing the data and releasing it to the public.

For sure, it's a really interesting problem with data that is hard to deal with. You even see this across periods of time as methodologies change. COVID-19 death tolls jumped up in a bunch of states when they started including suspected COVID-19 deaths instead of just confirmed deaths, so you can't even reliably compare a death count now to a death count two weeks ago within the same state!

I had the same thought process on the ICU stats in that flawed comparison but I really didn't pay attention past this

there is no evidence that lockdowns reduce deaths and solid evidence they do not.

so when can we end this paternalistic authoritarian cosplay of "protecting society"?

that's not what this is about anymore.

it's just political career salvage.

That's an agenda filled quote right there, someone trying to back fill their assumption/agenda with any data that makes it seem right. Straight in the trash pile. There is going to be a lot of analysis of the data vs approach of different countries/states/etc. when this thing is over (and as it goes on) but it's a little soon in the game to be drawing conclusions on them that run contrary to historical models, i.e. flatten the curve to save lives.

[Slax]

That's exactly what I was thinking. Protocols in hospitals may vary from state to state, not to mention from country to country. For all we know, that hospital in Sweden may be more conservative than the hospitals in NY, and may be placing patients in the ICU at an earlier stage of the infection as a preventative measure. Or maybe some patients in NY are arriving later to the ICU than they should because there are no ICU beds left. We really have no idea.

Having said that, and leaving aside this bad cat twitting twat's barrage, comparing stats from different countries should be done carefully. Here in Canada, each province has a different way of reporting so the federal government itself is being very cautious when analyzing the data and releasing it to the public.

For sure, it's a really interesting problem with data that is hard to deal with. You even see this across periods of time as methodologies change. COVID-19 death tolls jumped up in a bunch of states when they started including suspected COVID-19 deaths instead of just confirmed deaths, so you can't even reliably compare a death count now to a death count two weeks ago within the same state!

I had the same thought process on the ICU stats in that flawed comparison but I really didn't pay attention past this

there is no evidence that lockdowns reduce deaths and solid evidence they do not.

so when can we end this paternalistic authoritarian cosplay of "protecting society"?

that's not what this is about anymore.

it's just political career salvage.

That's an agenda filled quote right there, someone trying to back fill their assumption/agenda with any data that makes it seem right. Straight in the trash pile. There is going to be a lot of analysis of the data vs approach of different countries/states/etc. when this thing is over (and as it goes on) but it's a little soon in the game to be drawing conclusions on them that run contrary to historical models, i.e. flatten the curve to save lives.

Yeah I think what's going on with that twitter user is some very... motivated thinking. If you have some strong political or ideological objection to lockdowns, or even if you just wish you could go out and get your hair cut again (and trust me, I do too!), it would sure be super convenient for you if lockdowns were actually unnecessary and ineffective, and therefore just some unnecessary evil imposed on us by charlatans. So you come up with a correlation showing that reduced social mobility in March actually correlates with higher death counts and therefore "lockdowns don't work" (obviously earlier social distancing was a response to the mid-March outbreaks observed in those states, which have had higher death tolls because of those early outbreaks). You look abroad to alternative models that don't involve lockdowns, and Sweden pops up as a potential nice example because while it has been enforcing some form of social distancing, it hasn't been as strict in shutting down its economy as other countries, and early results haven't been nearly as bad as other countries with high rates of infection. But then you have to come up with some unifying explanation for what makes Sweden different from Italy and Spain and New York and Wuhan in a way that allows you to avoid the unacceptable death tolls that showed up in the latter places when they had large COVID-19 outbreaks, so you come up with that one simple trick that can be easily used to cut case fatality rates, hence "Italy and New York are just killing off all their patients by putting them on ventilators, but in Sweden they figured out that you can just turn everyone on their stomachs and let them rest and they will almost all recover". And checking further down the twitter feed, you attempt to come up with plausible-sounding criticisms of the preliminary studies that suggested that hydroxychloroquine was either unsafe or not especially effective at treating COVID-19, because miracle cures that make COVID-19 easy and safe to treat would mean we can reopen the economy without worrying about the effects on our health. Basically, this is someone who is trying to come up with a justification for why it's OK to end lockdowns immediately and without any serious plans for more testing or contact tracing or recurring shutdowns, but having to make this argument in the face of a reality where nearly everywhere that had a big COVID-19 outbreak has ended up with an unfathomable amount of misery and death, and therefore anything that might result in uncontrolled spread will be morally unacceptable for most people.

Outside of conspiracy theory la la land, Sweden genuinely is interesting, and I think if in a few weeks we see whether their social distancing without full lockdowns doesn't result in a huge death toll, we should try to learn whatever lessons from that about what made Sweden different from say New York (whether that's their approach to social distancing, superior treatment protocols, demographic differences, whatever) and use this to guide our own public health response. It's just way too early to even tell whether Sweden is successfully managing COVID-19, much less to try to identify one or two extremely simple explanations for why they're succeeding.

[Slax]

By the way, if anyone is interested in a more reasonable take on shifting thought on ventilation protocols, here's an interesting Reuters article on how some doctors think we are intubating too early/often for COVID-19 treatment, and alternatives that may be safer and more effective in some situations: https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE. Note that nobody interviewed in the article is saying that almost all patients who were put on mechanical ventilators and died would have survived if they hadn't been, nor that we should stop depending on ventilators.

[SuperDeluxe]

Another thing to keep in mind regarding that odious comparison between Sweden and NY: everybody is different. This article says that most of the people who were put on ventilators and then died had high blood pressure, obesity or diabetes. Maybe those conditions are not so prevalent in Sweden as they are in America.

https://www.washingtonpost.com/health/2020/04/22/coronavirus-ventilators-survival

And this part completely destroys that Gato Malo comment:

Eighty-eight percent of the 320 covid-19 patients on ventilators who were tracked in the study died. That compares with the roughly 80 percent of patients who died on ventilators before the pandemic

[KGboss]

Man...

Sent from my SM-G950U using Tapatalk

[SuperDeluxe]

I stumbled upon this article and am glad I gave it a look: https://science.sciencemag.org/content/368/6489/356?utm_campaign=toc_sci-mag_2020-04-23

One snippet, which is in line with the Washington Post article I shared earlier today:

Mangalmurti says she has been “shocked by the fact that we don't have a huge number of asthmatics” or patients with other respiratory diseases in her hospital's ICU. “It's very striking to us that risk factors seem to be vascular: diabetes, obesity, age, hypertension.”

Abstract:

[SuperDeluxe]

Inside the COVID-19 hot zone in a Montreal hospital:

https://www.cbc.ca/player/play/1728899139901

[threrf23]

Outside of conspiracy theory la la land, Sweden genuinely is interesting, and I think if in a few weeks we see whether their social distancing without full lockdowns doesn't result in a huge death toll, we should try to learn whatever lessons from that about what made Sweden different from say New York (whether that's their approach to social distancing, superior treatment protocols, demographic differences, whatever) and use this to guide our own public health response. It's just way too early to even tell whether Sweden is successfully managing COVID-19, much less to try to identify one or two extremely simple explanations for why they're succeeding.

Regarding the bolded, this isn't very complicated IMO. Foreign tourism/travel, population density, living quarter density, the subway, etc.

I think it is pretty obvious that Sweden has been, at best, reckless. You can keep things open, while also making testing more accessible where needed and taking special precautions to protect the vulnerable. And, relative to population density and what not, per capita, and compared to similar locations, their death toll has been exceptionally high in the short term.

But what interests me in general, is that for all the talk about protecting the vulnerable from contracting the virus, when social distancing measures were introduced, if you read what was stated and you look at the graphics displayed, the intention was not necessarily ever to protect anybody from contracting the virus. The goal was simply to slow the spread of the virus, to balance demand on hospitals and resources, so that those contracting the virus could receive help if needed. In that specific sense, it seems Sweden has succeeded so far.

A comparison of South Korea to almost everywhere else shows the value of testing and tracking. If we are to consider the value of social distancing if not preparation in general, a good comparison might be San Francisco vs NYC. San Fran might not be NYC, but it still has a very high population density, sizable foreign/Chinese communities, and is relatively dependent on its public transportation (which includes a train/subway).

Factoring confirmed/suspected/projected deaths, NYC is seeing at least close to 100 times as many deaths per capita as San Fran. Part of this is because NYC is NYC, NYC had a stiffer task at hand and probably less time to react. But San Fran / Cali has been noticeably more progressive than NYC / NY, too.

San Francisco's mayor declared a state of emergency on February 25th (NYC declared on March 13th), and when San Fran experienced it's first confirmed cases a week or two later, they told the public they had been expecting it and preparing for it, as if they were getting ready to fight a battle. NYC experienced it's first confirmed case a few days before; one public official took to Twitter to reassure New Yorkers that the risk of spread was exceptionally low, while Andrew Cuomo assured New Yorkers that they "had the best health care system in the world." Several days later, an outbreak in Westchester traced to a single train passenger, and Andrew Cuomo went on tv and tried to downplay the threat of the virus, claiming it was a "bad flu" and that if anyone had been infected by the infamous train passenger, they would have already developed symptoms. A quote: "Remember what we're really trying to do here is avoid the massive disruption of closing everything down for two weeks, the way China did, the way Italy is doing. "

As San Fran banned large gatherings, Bill de Blasio encouraged New Yorkers to go about their normal life if they were healthy (NY did ban large gatherings on the 12th). San Fran schools were closed a week before NYC schools, and they had a Shelter in Place in effect five days before NYC. In fact, as the shelter in place was announced in San Fran, Bill de Blasio told New Yorkers that they should prepare for the possibility of a shelter in place, and Andrew Cuomo responded angrily, making it clear that de Blasio was powerless and there were no plans for a shelter in place.

San Fran shut down it's train/subway system by the end of March (although buses still ran). NYC, in response to lots of public transit workers becoming hospitalized or quarantined, shortened it's subway service which led to increased rider density. Not related to social distancing, but Cuomo also signed into law a new budget at this time, which decreased hospital funding by $400 million. Since then, he has yapped about reopening the economy at least as much as any other governor, he has refused to rule out the possibility that NYC could be reopened by the end of May, and he has been telling the public how NY did all it could have done to prevent the situation we have seen in NYC.

(Yes, I took this opportunity to rant about Andrew Cuomo. It is crazy that he has developed a reputation as the anti-Trump, and that there are folks out there who want him to run for president in place of Biden.)

[Fencer reregistered]

[K For Three]

We're living in some strange times, folks.

Read on Twitter

Spoiler:

[K For Three]

Man...

Sent from my SM-G950U using Tapatalk

Only time I nearly reached this point was game threads on this forum. And the "FIX THE BENCH DANNY RIGHT NOW!!!!!" crew."

Anyway speaking of that crew who shows up in game threads to complain and hate on everything Celtics...they literally vanished.

[zoyathedestroya]

Watch on YouTube

[Parliament10]

Watch on YouTube

I like this.
It's tough to keep together, while being apart.

[SichtingLives]

We're living in some strange times, folks.

Read on Twitter

Spoiler:

Wash your hands after each roll? Sounds like fun

[Bad-Thoma]

I don't even like sharing this. Ugh.

https://www.npr.org/sections/coronavirus-live-updates/2020/04/25/844939777/no-evidence-that-recovered-covid-19-patients-are-immune-who-says?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&fbclid=IwAR0FKy99ZnozQW_jyInMwOh_rx8ytK0ABWvi9iL89NRfrsN1-9To6KbCITk&fbclid=IwAR1PTprwMQUGR-wzYSIALshMrT9DM6BmmKLjiUx1thkgIIZ_rOmefnlJE6M

[SuperDeluxe]

This is not fun either:
https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients