Some twitterers say the death rate is an example of something called Simpson's Paradox and just you wait we're screwed. The one time I saw fomite infection quantified it was 3% of cases but I recall no other details.

https://twitter.com/kaydeegrace132/status/1277756961455366144

This young woman's experience sounds un-fun, and she was trying to be careful.

I'd be very interested if anybody has seen statistics on the ratios of:
Asymptomatic
Mild
Flu-like (severity similar to what Megan described)
Severe
Death

And what percentage of people have longterm symptoms.

I've seen estimates of the death rate from 0.3% to 0.9%, but I haven't even seen estimates for the other categories.

While the US has been unusually horrible at containing the spread, our case fatality rate is actually on the low end (at least last I checked). I've read various theories for why this is, but none have been super convincing.

The stories about weird/awful long term health problems are notable for the fact that there are never any statistics. How common are these outcomes? How much more common than long term consequences for pneumonia in general?

4: Who knows? Is it just that we don't want to know or is it hard to track these lingering longer- term consequences in a fragmented system.

3/4 are exactly what I was wondering.

3: Hospitalizations to death ratios should be pretty easy to find, which should give you your "severe" number. ("Flu-like" is a little strange as a category since, some people do get severely sick or die with the flu, but I think I know what you mean. Maybe "miserable" would be a better word.)

Surface transmission seems to be less of a thing than we were initially afraid of. My biologist friends now seem to think that person-to-surface-to-person-to-respiratory-tract transmission involves a chain of too many low-probability events to warrant worrying about, unless someone literally sneezes on their hand and wipes it on something you're about to pick up. This virus is (relatively) weak and is easily broken down in sunlight, soapy water, etc. The research is somewhat difficult because testing for the presence of RNA is relatively easy, but testing for infectious virus particles - what actually matters - is a lot more difficult and expensive.

So it does seem to be all about the droplet/aerosol transmission, and avoiding sharing breathing air with anybody else is the really big thing.

I've seen reports of that for a while, but I still tend to wipe the groceries.

1 - this may or may not be the twitter thread you're thinking of but anyway it's on the same lines: https://twitter.com/mbeckett/status/1278750652160634880

Instead of wiping groceries, we usually just let everything sit for a day (the one exception being wiping cold beer I just picked up and want to consume tonight). Which is apparently what Fauci does, too, so I don't feel too paranoid. So while I think what Nathan says is probably right, I'd rather err a bit on the side of caution.

My practice is not to eat all my groceries when I first get them home, but rather to stretch them out over time.

With kids, that saves needing to regurgitate-up meals for them.

I'm so glad you asked the question. I've been wondering that myself, and specifically, been wondering how all those cruise ship passengers who were initially not infected, but infected, when they were all quarantining in small groups (pairs, one presumes) in their staterooms. It seems hard to believe that the ventilation (which shouldn't be leading from room-to-room one presumes, but rather thru central units) could spread the rona that efficiently, but who knows ....)

That's the set of cases that it seems like, the only explanation is fomites. But otherwise, yeah, it seems like fomites aren't as dangerous as previously described.

I still wear gloves whenever I go outside the house, and wash my hands before-and-after I take 'em off. Ditto wash all my groceries. And leave all dry goods in another room until I need 'em (after having sprayed 'em down with Windex).

I've never worn gloves for Covid.

I've been resisting gloves. They're probably only useful if you put them on to do exactly one thing (pump gas, maybe) and then immediately take them off (and can do so carefully, not touching the outside surface, etc). Wearing them for an extended period of time, they're no different from your finger in terms of ability to pick up a fomite and infect you.

I just didn't have any when it started.

We wore gloves en route to visit my parents, at rest stops. It felt really counter-instinctive to walk out without washing your hands.

Yes. Washing hands after using the restroom was one of the harder changes to get used to with Covid.

I almost don't notice the urge to lick public doorknobs anymore.

20: If only everyone could be so self-controlled.

re: 16

That's what I do. One-time-use disposable gloves.

If I'm going shopping or to the post office, or pharmacy, I'll stick a pair of disposable gloves on when I walk in, and bin them when I walk out. The stuff I've bought, bagged by this point, I'll wipe down when I get home. But I'm not obsessive about the wiping down. Some things I just give a very cursory wipe over.

I've kept the habit of washing/wiping down items when I get them home, even after the revised notice about surface transmission not being a big deal. I'm just used to it now.

After the worrying blip this week, our 7 day averaged positive rate is going down again. Apparently we had our lowest single day positive rate since early March yesterday.

In the bookstore this afternoon the person in front of me in the checkout line was buying the new book about Epstein's death. The checkout person quipped "There might be a sequel coming out soon!"

21: Somebody should tell her about how glass works when it breaks.

16: Tim used to do that to pump gas, mainly because he did not want gas on his hands, but he's a chemist and also obsessive. He had to let that go post COVID, because you can't get them. I wipe down plastic milk bottles and yogurt containers with alcohol wipes or Lysol wipes. Everything else I've been leaving out for a day. Most of our meals are coming from Sunbasket.

I started washing more of my vegetables, because I know you're supposed to do that anyway and I wasn't.

I just have Trader Joe's hand sanitizer spray on hand. If I'm in the car and want to take my mask off, I use the sanitizer, fold it in half, in a ziplock and use the sanitizer again.

When I get home, I wash my hands before touching the mask and wash them again after taking it off.

Coronavirus safety and dentistry question:

I can go to either of two clinics. Which is safer, do you think?

Clinic One is downtown, serves mostly downtown workers who are likely to be relatively sequestered, is fairly posh and always has the latest gadgets....but has its chairs in bays separated by partial floor-ceiling walls.

Clinic Two is at the university, serves staff, faculty and students but students mostly aren't on campus right now, is old and kind of run down, but has individual rooms. Drawback - I don't know what the actual ventilation system is like and there's a long hall between rooms.

I would get the first Monday appointment at either clinic, but I'm worried about someone getting an aerolsolizing procedure in the room/bay next to me. I have N95s and a pair of lab goggles to wear to and from the dental chair, can bring purell for donning and doffing, etc.

I was going to make, like. comments about statistics and long-haul stuff, but then I thought, "Unfoggers are clever, perhaps they can help me game this out".

I'd go with the one with separate rooms. Why is it these two?

My dentist is requiring that we wear masks and use hand sanitizer when we go in. She's also making you wait outside. She has several hygienists, but she's the only dentist.

I think I'd feel better about clinic 2 but Tim likes clinic 1. He thinks lab goggles might be overkill, but I am agnostic and defer to an infection control specialist. What do you need done?

On the dentistry question, you might ask them if they are doing multiple patients or only one at a time.

27: These are the two clinics I've been to before so I'm familiar with the layout. Also I don't have a car and both are within biking distance.

What is in favor of clinic 1? I just picture all the aerolsolized virus floating around the walls.

As I understand it, both clinics do multiple patients but a reduced schedule overall.

I have some kind of cavity. I'm not sure whether they'll deal with it same-day or look at it and tell me to schedule a second appointment. The tooth is sensitive and sometimes hurts when I bite down. If it can wait, I'll let it wait, but I'm worried about it getting worse and needing to go during a spike.

29: can you ask about their air purification?

Do we even know what sit purification works?

Anyway, I recommend not delaying on tooth pain. It can turn from where you need a filling to where you need a root canal.

Why would my phone change "air" to 'sit" after I typed "purification"?

Anyway, I made a dentist appointment for a check-up because I'm 18 months from my last one. I didn't ask about their covid protocol, but it's a very small practice and I've rarely been in there when another patient was there.

I had to get glasses in a mad rush just before the shutdown. At the time, I was barely able to read in the only pair of glasses I had with intact frames and the only pair I had that let me read without a headache had the lens held on by hot glue.

Here's the thing that bugs me about the social media based speculation on the lagging death rate: Shouldn't the CDC be tracking this and updating us with their best explanations? Isn't that what's going on in countries that haven't intentionally hobbled their health care systems?

I feel like part of the reason everyone's an epidemiologist now is that the actual epidemiologists aren't communicating with the public well enough.

Chalky!

True story. Epidemiologists are just biostatisticians who found math too hard.

Uncertainty about the virus is keeping me from making plans, but uncertainty about the economy is keeping me from buying taxidermy squirrel with lobster claws for hands.

Related: Somebody selling a very expensive "tactical stove" pulled their products from Etsy because Etsy allows people to sell "Blue Lives Murder" t-shirts.

35: It seems obvious that the upper management and public relation portions of the CDC have been thoroughly corrupted. Even if they were to be producing such reports, I would place little stock in it until reputable academic epidemiologists had a chance to weigh in.

keeping me from buying taxidermy squirrel with lobster claws for hands.

What is screwy about those is that every time you see one, you know that somewhere there is a corresponding lobster with squirrel hands for claws.

I put something about known damage rates in the thread where ground glass opacities were discussed, but here are the numbers I could find: out of hospitalized patients (~20%), 20% have some form of heart damage, 27% had kidney failure, 45-62% had ground glass opacities, with 94% not fully resolved at discharge, 76% had abnormal liver function tests, 21% with liver injury (range 15-53%). These are pretty much all separate publications, so it's hard to tell whether about 20% of patients experience all as they die or whether there isn't that much overlap in these groups. There are very small numbers of patients with Guillain-Barre syndrome (5 per 1-1.2k hospitalized in northern Italy), but that may Not be representative.

I'm not even going to guess about PTSD or other lingering mental health effects, post-viral syndrome, ME/CFS, fibromyalgia, or anything non-quantifiable.

Asymptomatic (not presymptomatic, eventually converting) looks to be 17-33%.
http://med.stanford.edu/content/dam/sm/id/documents/COVID/AsymptCOVID_TransmissionShip.pdf

Isn't that really high for a disease you don't want to spread to everybody?

I bet the virus is pretty pleased with itself.

The Texas hospitalization rate has been remarkably stable at 8% for the past three months.

One obvious reason for the lower death rate is that they've figured out stuff like don't intubate if oxygen will do, don't release infectious patients to nursing homes and try steroids if the immune system goes crazy. The learning curve at hospitals was slow because the caseload ramped up so quickly. Also, something about draining swamps while being up to one's ass in alligators. If I have to get COVID, I'd like to be towards the end of the line.

The big problem fighting COVID has been that no one knew anything about it. Now we know that most transmission is by aerosols, and wearing masks, being outdoors and using HEPA filters cut the risks. We also know it is a blood disease as much as a respiratory disease.

I'd go with the private room dental clinic if I were you, unless the other clinic can give a very good explanation of their precautions and why they might help. Are they still doubling up during the pandemic? I had my teeth cleaned, and they had me wait in the car until they called me. I was the only patient in the waiting area, and I was only their briefly. Everyone wore masks, except for me during the cleaning. They had HEPA filters running all over the place. HEPA is the hospital high efficiency standard. It's all very Andromeda Strain.

Moby!

46: Yes, but the number of patients hospitalized has quadrupled since Memorial Day, and Houston hospitals are basically full now.
https://www.texastribune.org/2020/07/01/coronavirus-texas-houston-hospitals-cases-surge/

Houston Fire Chief Samuel Peña said his paramedics sometimes have to wait for more than an hour while emergency room workers scramble to find beds and staffers to care for patients brought in by ambulance -- a bottleneck that's tying up emergency medical service resources and slowing emergency response times across the region.

Part of the problem, Peña said, is that when his crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it. That's a problem that's likely to deepen as a growing number of medical workers have been testing positive for the virus, according to internal hospital reports. Just as New York hospitals did four months ago, some Houston hospitals have posted on traveling nurse websites seeking nurses for "crisis response jobs."

49: what are they doing? New York hospitals had high rates of hcw- acquired infections. In Boston - at least in my system's hospitals - most infections were acquired in the community, and the people treating actual COVID patients had the lowest rates.

A friend of mine is an oncologist in San Antonio who has been taking care of COVID patients. She's from New York - Queens - and when she started wearing hospital-grade masks that she bought and brought in sometime in March/April, the nurses gave her a hard time.

49: oh man, I definitely did not mean to imply that the current surge has stabilized in any way, shape, or form. I just meant that maybe it reflects something about the epidemiology of the disease if it's been that stable, during times when the virus was barely here and when it's raging.

Houston is in a lot of trouble. The Rio Grande Valley is also enormously concerning. Their hospitals are nearly full, and that area has just about every possible risk factor working against it.

Our region still isn't doing so hot, either. Our positivity rate has been consistently between 20-30% for weeks now.

But don't worry. After giving barely any guidance, the Texas Education Association released a statement last week that said, come hell or high water, Texas school children will have to take their standardized tests next year, so happy birthday Pearson.

Good friends of mine are New Zealanders who have been living in Houston for the past couple of years. They are going back to new Zealand for an extended visit. They are driving their vehicle to LA (and leaving it with a son there) and then flying from LA. Their preparation for the trip though what I dubbed Covid Alley include a portable toilet thingy and a setup for sleeping in their truck. If things went according to plan they spent last night at Caprock State Park. When they get to New Zealand they will be required to spend two weeks in a hotel room and then be tested* before release.

*The New Zealand health minister just stepeed down over "missteps" in handling the virus (which has been absolutely crushed there so far). According to my friend his missteps seem to have been 1) went out acoule of times during quarantine (kind of a mini-Dominic Cummings) and 2) two Brititsh visitors were somehow released from quarantine without being tested and subsequently were shown to be postiive (they went to a number of different places but did not seem to infect anyone). I envy those "missteps." The fring offense here would have been his admitting he did something wrong.

53.2 Must be nice to live in a functioning society.

Now that we have a real! live! mask order! I'm kind of surprised at how white-hot my ire was at the grocery store yesterday, at people walking around with their masks deliberately pulled aside or under their noses or whatever. I want them to suffer.

It was impossible to get tested in NYC in April unless you were really sick, so the earlier death rate was probably an overestimate.

55: Yeah, being at a store where employees are supposed to be masked and seeing at 50% of them with masks just covering the chin, or hanging jauntily from one ear, is really getting old. I'm not even talking about customers (yet). That was the local Food Lion and I think I know them well enough to know which shift manager was in charge that day.

After a month of putting it off, I finally made a trip to the local Lowe's, too (aka death cult central here in my red state) at an hour when it was uncrowded. Not only were employees unmasked, but when, after 5 minutes fruitless search for staple gun staples, I asked an employee, he turned out to be a yeller, someone whose natural voice would penetrate cinderblock walls. The various animations of aerosolization (and the Seattle choir event) make me think he's probably got a cloud of pollution 20x bigger than the average person (if he were infected). I kept my distance. I'm definitely noticing the yellers more (another at a roadside vegetable stand but at least that was outside in a breeze).

||

So who's planning to vote for Kane West?

|>

I've been shopping at Lowe's a fair bit, mostly because I've read the Home Depot has Trump-y owners now. The employees are masked here.

Also, my staircase is now all painted. We got the windows installed maybe six years ago and never painted until now.

If we're stuck home for much longer, I'm going to put on new siding.

I'm assuming my wife still doesn't read this blog.

55: I went to a doctor's appt at a specialty hospital. They make you use hand sanitizer and put on a fresh surgical mask, but on the floor of the actual appt, the person who verifies you're insurance had her nose uncovered. Then one of the secretaries took hers off.

Most doctors offices have been extra careful, but I thought this was pretty bad for an ENT's office.

58: what we've been doing with our Target purchases is ordering online and then picking it up at customer service. Does Lowe's offer a similar service?

They do here, but customer service is the most crowded place in the store that isn't the register.

66. Oh! So that's why the long line at the customer service desk as I entered. It seemed clear that they were not doing the "bring it to your car" level of pickup shopping, so I thought that they'd just suspended pickups. But that makes sense, and yes, would be worse than waiting in a regular checkout line.

Most doctors offices have been extra careful, but I thought this was pretty bad for an ENT's office.

I agree, that's bad.

Is it weird that the President is just going from state to state recklessly creating conditions for superspreading events? It seems weird to me. And bad. Very bad.

64: I wrote that in my feedback in what they could improve. The worst was the patient who:had just been seen who was checking ou5 and had his pulled off whose first language was not English. The front desk person had her mask off and looked like she was going to spit on him as she tried to communicate with him.

69- it is amazingly blatant it's like he thinks he could shoot somebody on 5th Avenue and get away with it. So this is just a paranoid fantasy but trying to come up with something appropriately diabolical maybe he needs his base really terrorized and desperate maybe he thinks that will improve his chances of becoming president for life I assume he will give us the blame say that liberals were deliberately spreading disease among Trump voters

The Atlantic article is interesting - in particular notes that the US public health infrastructure expected China to not be forthcoming about disease outbreaks, and had a number of safeguards with this specifically in mind (CDC observers in Wuhan!) which the administration never cared enough to use or support.

However, it inspired me to make a thing.

Is it weird that the President is just going from state to state recklessly creating conditions for superspreading events? It seems weird to me. And bad. Very bad.

We know he believes seriously - has brought it up often over the years - in genes/bloodlines as the basis of worth. I realize his dopiness explains enough, but after all these months I seriously wonder if there's also a "cull the weak" element.

It's only a matter of time before they go full Death Eater.

72.2 hahaha that's brilliant!

Is there a template or did you draw it?

That is terrific.

Scraped off the replaced text in Paint, then added the text with Imgflip.

This is delightful

Man, I'm trying not to be condescending to our poor benighted friends in red states, and I realize that even blue states aren't handling this well. Getting a message from the school like 52 would really suck, but from our school district in DC we've just got no details at all, just multiple conference calls with no specific plans or warnings. And for anecdata about life here in rural California, I'd estimate mask usage was below 50 percent at a recent gathering(!) where almost everyone was over 70(!!) and there was at least one cancer patient(!!!)

All that being said, I've rarely felt better about being from Vermont, one of the states that's apparently handling this the best, nor looked forward more to going there soon.

One of my best friends in Florida, whose job can be done just fine from home, is ordered back to work tomorrow, because July 7th is the date that was set months ago for reopening and come hell or high water, this giant research university is going to stay on schedule. (They haven't reopened summer classes as planned, to be fair. Just mandating my ASTHMATIC friend back, with no waiver process for health exemptions.) I am livid.

Both links in 72 are very good.

I love it, Minivet!

My usually very conscientious, neurotic, knee-jerk liberal colleague is telling me about how she drove from the Bay Area to LA County this weekend and stayed in a hotel, went out for two (outdoor) meals a day with her friend every day, and also shopping, and feels so much better now and is really glad she made the trip. I should probably be righteously angry, but I just feel this terrible sadness.

I'm of the opinion that nobody should feel better after a visit to Los Angeles.

My usually very conscientious, neurotic, knee-jerk liberal colleague is telling me about how she drove from the Bay Area to LA County this weekend and stayed in a hotel, went out for two (outdoor) meals a day with her friend every day, and also shopping, and feels so much better now and is really glad she made the trip. I should probably be righteously angry, but I just feel this terrible sadness.

Was she wearing a mask when shopping and when otherwise surrounded by strangers? If so, sounds OK.

I want to rent a cabin somewhere up in the Pennsylvania woods and spend a week out doors in social isolation. My family thinks a week at home doing nothing is better.

I mean, yes it would be boring and less comfortable. But still, a change of scenery is good.

I'm just going to start a home repair project every weekend until into agree to go to a cabin just to stop it.

83 actually seems fine to me. I mean, it's outside of my personal comfort zone at the moment, and this past week was not a great time for new excursions in LA, but the described activity doesn't sound particularly irresponsible.

You'll need to subtly make clear that you won't be trying to upgrade the cabin, Moby. They might worry that you want to go into the wilderness so you can excavate your own root cellar or build out of cob or something.

85: I'm sure she did everything right as far as that goes. Would it have been reasonable to do the same thing in late April in NYC, in a world where restaurants were open for patio dining? Sincere question; I don't know the answer. Maybe so!

I'm not sure what's going on with LA County on the dashboard, but the LA Times is reporting that "Los Angeles County officials said Sunday that the holiday weekend saw the highest single-day count of new cases since the pandemic began. More than 3,200 new cases were reported in the county on Friday."

||
Oh no, RIP Ennio Morricone. Sorry Barry, shit news to wake up to.
|>

91.last amended, I'm a day late. Also I need a motherfucking vacation. Vacations to Covid hotspots are fine now? Let me go down the list...

90: I'm only looking for land on which to build a cob house.

Anyway, I don't want to leave the state because I don't want to get into an actual quarantine situation.

94 We're not doing quarantines. Yet.

I took a test on Thursday, got the result this morning: neg. So, I don't have it. Yet.

If Frowner's around, what did you decide to do about the dentist and how did it go?

96: I'm still on the fence about going, since it's not at all clear to me whether I have actual tooth pain or TMD pain plus tooth pain - all my teeth on the TMD side of my jaw seem to be sore and sensitive in turn. One is a little worse than the others, but it's also right at the back.

However, some incredibly clever person upthread whose comments I can't find now was talking about HEPA filters at the dentist, and I googled "HEPA dentist Minneapolis" and found that there is a small private practice a couple of miles from my house which has both private rooms and HEPA filters and seems to be taking the whole thing very seriously, so I'm going to cancel my existing appointment and make one there if I need one.

It's a posh dentist in a posh neighborhood so I assume most of the customers are probably working from home, etc, which will probably make it safer.

So, cases are spiking in Tulsa.

Go figure

97: I was obliged to visit the dentist last week here in MA, as I had the first stage of a root canal performed at the end of February and I figure we're probably at the nadir of active cases at the moment. The dentist performed his work with a gown, N95 and face shield, as did his assistant. Temp screen and asked about symptoms on entry, don't know about HEPA filtration. But he's pretty serious. He serves low income clientele in a local hotspot, in what used to be one of the harder hit areas of the world, and dental procedures aerosolize pathogens.