Symptom Surveillance
Even I couldn't have been this optimistic... that is some drop. Seasonality at its finest.
Testing Data
~1.9 million tests is the 7 day average. 1 week ago it was 2 million.
~165k positives is the 7 day moving average with % positive at ~8.8%. 1 week ago this was 208k/10.1%.
Hospitalization Data
Hosp. 124--> 109k (-12%)
ICU.... 23.2k--> 20.9k(-10%)
Vent... 7.7k--> 6.8k (-12%)
Deescalating quickly.
Fatality Data
Total deaths at 411,823 per CTP.
7 day moving average is ~3077
State Data
Mississippi.
Syndrome surveillance in MS has fallen off of a cliff from ~11% New Years Day to ~2% currently. Cases and hospitalizations have followed suit. Hospitalizations down 32% in 3 weeks and 17% in a week. Again, even better than I would have expected. So why expect different? Let's look at the graph below and review a few things.
Note the nice symmetrical 12 week timeline of the summer curve highlighted by the green arrows. This is a perfect epidemic curve. Now look at the fall/winter curve. It doesn't look like an epidemic curve at all. No symmetry with a very slow rise. Look at the drop off that is now occurring. A very rapid descent to normality is underway. Here is what I think happened. I initially thought the purple area was the beginning of the winter epidemic curve but it isn't. That is the beginning of natural coronavirus season with a nice slow endemic rise as you would expect with herd immunity. If the entire state had herd immunity this would have continued in a manner to what you see with the purple line. However, if there is anything we an learn from the last several months is that this virus tends to do its own thing and works in local clusters. The small yellow curves represent what I think are the local clusters responsible for the remaining hospitalizations that push us up into epidemic territory. Once a certain threshold has been achieved (15-20%) the virus is suppressed. It returned and made its way more slowly through the remaining susceptible population. I think the endemic season has waned and we now see a more rapid descent consistent with an epidemic curve. That's my take. I could be wrong there but I don't see any other explanation for the shape of the curve which is not following Farr's law.
Texas:
13858--> 12785 (-8%)
Laredo still the problem area. I don't have an answer. Every other region in the state looks better except this locale. Nearly 50% of hospitalized are CV19 patients in that area. I cannot explain it. The state is otherwise doing better as a whole.
Florida.
Hosp: 7448--> 6899 (-7%)
Alabama.
Hosp: 2798--> 2285 (-18%)
Georgia:
5902--> 5231 (-11%)
California.
Hosp 20968--> 18347 (-12%)
Run by an imbecile. The data is too complex for the public to understand so they wont release how they determined lockdowns. Oh, OK. This is coincidence then I'm sure, right?
50% fewer ICU beds available now than when restrictions were added? Yep, it's all too confusing.
Comments:
1. Panties in a bunch achieved I see. By the way, can someone point me to where I said the vaccine would only be 40% effective? I missed that post. I think that is referencing earlier posts of mine where I stated the flu vaccine was only 40% effective so we shouldn't pin all our hopes on a vaccine. I'm not sure what that has to do with anything. I also said with time the vaccination absolute risk reduction would improve if the effectiveness held up and didn't wane. Every intervention has risks. How is this even debatable or news? Whatever... you'll see what you want I guess. I shouldn't mention the mortality rate for this vaccine vs the influenza vaccine then, right? No, I shouldn't... you know why? Because a lot of people receiving the vaccine are in nursing homes and are very ill anyway and it would be irresponsible for me to do that until we have more data. Sort of like the PCR test... right? Saying someone died from something just because they had a recent +PCR for it? Yes, that kind of irresponsible. Let me explain a little further. When I do a procedure on a patient, we have a discussion:
1. Why are we doing the procedure
2. What is involved logistically and medically
3. What can the patient expect before, during, after
4. WHAT ARE THE RISKS AND BENEFITS of the procedure. Does one outweigh the other? Anytime you stick a needle under the skin, you better have solid footing for the benefit being greater than the risk. I don't expect non-physicians to understand, but this is how we function every day. However, ask yourself one question. Who would you want doing your procedure, the one keeping it real or the one pumping sunshine and rainbows assuming equal skill? Exactly. Always keep it real. If I'm going to put in a carotid stent and the risk of that procedure to cause a stroke is 1% and your risk reduction from the procedure for a stroke is 1%... we don't do the procedure because it provides no benefit. The vaccine is no different. Like vaccinating patients with prior infection... the risk/benefit ratio is not in favor of vaccination in that population. I'm pro vaccine but caution is always warranted. Not sure why that is so controversial. I've had anti-vax persons attack me as well for not saying enough so I must be doing this correctly.
For some good vaccination news here is a summary of the progress so far nationally. I can't give you any other "good news" about the vaccine because there hasn't been enough time lapse and data collection as of yet. Of note, Israel has the best vaccination program in the world and it's not even close. Here, Florida is the best state and it's not even close with over 20% of their massive senior population now vaccinated. I think if the vaccine were causing mass casualties as I've seen people try to say, Florida would be having some serious issues and they are not. The J&J and Astra Zeneca vaccines should have approval soon which would help ramp up vaccination. These two vaccines are more traditional based tech and are not mRNA vaccines.
2. It appears the herd immunity threshold may be around 40% if you look at Sweden as their smaller 2nd wave has waned significantly of late. Not 20% as I thought, not 60% as experts reported... right in the middle. This is consistent with NYC data as well. The difference between predicted (60-70%) and actual required is probably the resistance of children to infection and transmission. Reminder, no excess deaths in Sweden for 2020 compared with the prior 5 year average. Traditional pandemic management works.
3. Speaking of children... yet another study showing they are not major pandemic contributors. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775656
"In this cross-sectional study, the spread of SARS-CoV-2 infection during a period of lockdown in southwest Germany was particularly low in children aged 1 to 10 years. Accordingly, it is unlikely that children have boosted the pandemic."
3. Everything is fine... https://www.bloomberg.com/news/arti...st-rise-in-poverty-rate-in-more-than-50-years
And no, this isn't pandemic induced. This is intervention induced. Evidence? South Dakota's unemployment rate is less than pre pandemic. Florida's is almost back to pre-pandemic. Lockdowns are destructive and it will take a decade to recover. I'm not sure the UK is ever going to recover. That place is madness.
4. Don't worry. All that PPE you're wearing couldn't possibly harm you. https://www.msn.com/en-us/health/me...hospital-covid-ward-study/ar-BB1cAVBI?ocid=st
"It added that hospital staff, possibly out of fear of the coronavirus, were wearing multiple layers of personal protective equipment (PPE), which is not recommended and in fact heightens the risk of microbe transmission. There were also instances of extended PPE use and re-use."
5. Go look it up. My PCR post from the spring. The WHO this past week... unbelievable. They admitted to false positive problems and that testing should be interpreted in the setting of the clinical scenario. Holy crap, you mean we are supposed to practice medicine again? https://www.who.int/news/item/20-01-2021-who-information-notice-for-ivd-users-2020-05
Meanwhile, the Kansas DH reduced the Ct of their PCR without saying a word. How convenient.
sentinelksmo.org
Still not good enough. Should be 32 or less IMO.
6. Don't forget about the antibody. This stuff works really well. Lilly trial showing up strong in nursing home patients. https://www.prnewswire.com/news-rel...up-to-80-percent-for-residents-301212159.html
"For the pre-specified subgroup of nursing home residents, there was also a significantly lower frequency of symptomatic COVID-19 in those treated with bamlanivimab versus placebo in this important population (odds ratio 0.20; p=0.00026). These results suggest that residents randomized to bamlanivimab have up to an 80 percent lower risk of contracting COVID-19 versus residents in the same facility randomized to placebo."
"Among the 299 residents in the prevention group, there were 4 deaths attributed to COVID-19 at the time of death, and all occurred in the placebo arm. There were no COVID-19 attributed deaths in the bamlanivimab arm. "
Why isn't this being used more? Crazy. Maddeningly underutilized.
7. UK starting a large Ivermectin trial. https://t.co/5jtatjy8h5?amp=1
City of Mexico has started using IVM as well. https://www.infobae.com/america/mex...anecera-en-semaforo-rojo-la-siguiente-semana/
Financial Times article on IVM. The FT is read by a ton of people. https://t.co/6pyvI0h7Wt?amp=1
8. Can you spot the correlation between how lockdowns prevent deaths? Yeah, me either. Let's check this again in a year and see if hard lockdown areas have higher mortality... it'll happen but its going to take a while to show up in the data. Starting to show up in California's.
Speaking of hard lockdowns causing death. The CDC numbers for 2020: Florida: 13.8% excess death (211,320 expected, 240,484 observed) California: 15.5% excess deaths (269,247 expected, 310,850 observed) And it’s getting worse for CA: December saw 40.3% excess deaths, vs 15.8% in FL. Wow. 40%... let that sink in just a bit. https://t.co/WMFhvFKXHR?amp=1
9. https://www.medpagetoday.com/blogs/vinay-prasad/90658
"Nearly 2 million kids attended school from March to June, as the outbreak surged. Kids were not asked to wear masks. Despite this, only 15 kids developed severe COVID-19 or multi-inflammatory syndrome requiring ICU stay, of whom four had underlying medical problems. No children died." But I'm sure those teacher's unions have the kids best interest at heart... "kids are resilient."
10. California really has top notch vaccination prioritization.
Gavin's a joke. What a clown. CA ranks dead last in vaccination per capita. LAST. Vote for Chamath if you live in CA. All of his policies aren't up my alley but the guy is a certifiable genius and thinks so outside the box to fix common issues... AND everything he touches turns to gold... https://www.chamathforca.com/
11. By the way... lost the link but Germany is now requiring N95 masks when you leave the house... you know, because the cloth ones worked so well.
12. Massive benefit for Ivermectin in an Egyptian trial. https://www.researchgate.net/profil...D-19-in-Egypt-A-Randomised-clinical-trial.pdf
"Fifteen contacts (7.4%) developed COVID-19 in the ivermectin arm compared to 59 (58.4%) in the nonintervention arm (P <0.001)."
13. 315 days to slow the spread.
14. Wish I'd thought to do this. Combining the two US climate zones into one Hope-Simpson curve vs. the US curve. Astonishingly accurate.
14. Buy some Bitcoin. Nice dip of late. Might see 26-29k this week. Take advantage and dollar cost average your position.
Cheers RGers
Even I couldn't have been this optimistic... that is some drop. Seasonality at its finest.
Testing Data
~1.9 million tests is the 7 day average. 1 week ago it was 2 million.
~165k positives is the 7 day moving average with % positive at ~8.8%. 1 week ago this was 208k/10.1%.
Hospitalization Data
Hosp. 124--> 109k (-12%)
ICU.... 23.2k--> 20.9k(-10%)
Vent... 7.7k--> 6.8k (-12%)
Deescalating quickly.
Fatality Data
Total deaths at 411,823 per CTP.
7 day moving average is ~3077
State Data
Mississippi.
Syndrome surveillance in MS has fallen off of a cliff from ~11% New Years Day to ~2% currently. Cases and hospitalizations have followed suit. Hospitalizations down 32% in 3 weeks and 17% in a week. Again, even better than I would have expected. So why expect different? Let's look at the graph below and review a few things.
Note the nice symmetrical 12 week timeline of the summer curve highlighted by the green arrows. This is a perfect epidemic curve. Now look at the fall/winter curve. It doesn't look like an epidemic curve at all. No symmetry with a very slow rise. Look at the drop off that is now occurring. A very rapid descent to normality is underway. Here is what I think happened. I initially thought the purple area was the beginning of the winter epidemic curve but it isn't. That is the beginning of natural coronavirus season with a nice slow endemic rise as you would expect with herd immunity. If the entire state had herd immunity this would have continued in a manner to what you see with the purple line. However, if there is anything we an learn from the last several months is that this virus tends to do its own thing and works in local clusters. The small yellow curves represent what I think are the local clusters responsible for the remaining hospitalizations that push us up into epidemic territory. Once a certain threshold has been achieved (15-20%) the virus is suppressed. It returned and made its way more slowly through the remaining susceptible population. I think the endemic season has waned and we now see a more rapid descent consistent with an epidemic curve. That's my take. I could be wrong there but I don't see any other explanation for the shape of the curve which is not following Farr's law.
Texas:
13858--> 12785 (-8%)
Laredo still the problem area. I don't have an answer. Every other region in the state looks better except this locale. Nearly 50% of hospitalized are CV19 patients in that area. I cannot explain it. The state is otherwise doing better as a whole.
Florida.
Hosp: 7448--> 6899 (-7%)
Alabama.
Hosp: 2798--> 2285 (-18%)
Georgia:
5902--> 5231 (-11%)
California.
Hosp 20968--> 18347 (-12%)
Run by an imbecile. The data is too complex for the public to understand so they wont release how they determined lockdowns. Oh, OK. This is coincidence then I'm sure, right?
50% fewer ICU beds available now than when restrictions were added? Yep, it's all too confusing.
Comments:
1. Panties in a bunch achieved I see. By the way, can someone point me to where I said the vaccine would only be 40% effective? I missed that post. I think that is referencing earlier posts of mine where I stated the flu vaccine was only 40% effective so we shouldn't pin all our hopes on a vaccine. I'm not sure what that has to do with anything. I also said with time the vaccination absolute risk reduction would improve if the effectiveness held up and didn't wane. Every intervention has risks. How is this even debatable or news? Whatever... you'll see what you want I guess. I shouldn't mention the mortality rate for this vaccine vs the influenza vaccine then, right? No, I shouldn't... you know why? Because a lot of people receiving the vaccine are in nursing homes and are very ill anyway and it would be irresponsible for me to do that until we have more data. Sort of like the PCR test... right? Saying someone died from something just because they had a recent +PCR for it? Yes, that kind of irresponsible. Let me explain a little further. When I do a procedure on a patient, we have a discussion:
1. Why are we doing the procedure
2. What is involved logistically and medically
3. What can the patient expect before, during, after
4. WHAT ARE THE RISKS AND BENEFITS of the procedure. Does one outweigh the other? Anytime you stick a needle under the skin, you better have solid footing for the benefit being greater than the risk. I don't expect non-physicians to understand, but this is how we function every day. However, ask yourself one question. Who would you want doing your procedure, the one keeping it real or the one pumping sunshine and rainbows assuming equal skill? Exactly. Always keep it real. If I'm going to put in a carotid stent and the risk of that procedure to cause a stroke is 1% and your risk reduction from the procedure for a stroke is 1%... we don't do the procedure because it provides no benefit. The vaccine is no different. Like vaccinating patients with prior infection... the risk/benefit ratio is not in favor of vaccination in that population. I'm pro vaccine but caution is always warranted. Not sure why that is so controversial. I've had anti-vax persons attack me as well for not saying enough so I must be doing this correctly.
For some good vaccination news here is a summary of the progress so far nationally. I can't give you any other "good news" about the vaccine because there hasn't been enough time lapse and data collection as of yet. Of note, Israel has the best vaccination program in the world and it's not even close. Here, Florida is the best state and it's not even close with over 20% of their massive senior population now vaccinated. I think if the vaccine were causing mass casualties as I've seen people try to say, Florida would be having some serious issues and they are not. The J&J and Astra Zeneca vaccines should have approval soon which would help ramp up vaccination. These two vaccines are more traditional based tech and are not mRNA vaccines.
2. It appears the herd immunity threshold may be around 40% if you look at Sweden as their smaller 2nd wave has waned significantly of late. Not 20% as I thought, not 60% as experts reported... right in the middle. This is consistent with NYC data as well. The difference between predicted (60-70%) and actual required is probably the resistance of children to infection and transmission. Reminder, no excess deaths in Sweden for 2020 compared with the prior 5 year average. Traditional pandemic management works.
3. Speaking of children... yet another study showing they are not major pandemic contributors. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775656
"In this cross-sectional study, the spread of SARS-CoV-2 infection during a period of lockdown in southwest Germany was particularly low in children aged 1 to 10 years. Accordingly, it is unlikely that children have boosted the pandemic."
3. Everything is fine... https://www.bloomberg.com/news/arti...st-rise-in-poverty-rate-in-more-than-50-years
And no, this isn't pandemic induced. This is intervention induced. Evidence? South Dakota's unemployment rate is less than pre pandemic. Florida's is almost back to pre-pandemic. Lockdowns are destructive and it will take a decade to recover. I'm not sure the UK is ever going to recover. That place is madness.
4. Don't worry. All that PPE you're wearing couldn't possibly harm you. https://www.msn.com/en-us/health/me...hospital-covid-ward-study/ar-BB1cAVBI?ocid=st
"It added that hospital staff, possibly out of fear of the coronavirus, were wearing multiple layers of personal protective equipment (PPE), which is not recommended and in fact heightens the risk of microbe transmission. There were also instances of extended PPE use and re-use."
5. Go look it up. My PCR post from the spring. The WHO this past week... unbelievable. They admitted to false positive problems and that testing should be interpreted in the setting of the clinical scenario. Holy crap, you mean we are supposed to practice medicine again? https://www.who.int/news/item/20-01-2021-who-information-notice-for-ivd-users-2020-05
Meanwhile, the Kansas DH reduced the Ct of their PCR without saying a word. How convenient.
KDHE quietly reduced cycle threshold on COVID tests - The Sentinel
KDHE reduced the cycle threshold ath the sttate labe from 42 to 35 on January 7, but didn't respond to questions about private labs.
sentinelksmo.org
6. Don't forget about the antibody. This stuff works really well. Lilly trial showing up strong in nursing home patients. https://www.prnewswire.com/news-rel...up-to-80-percent-for-residents-301212159.html
"For the pre-specified subgroup of nursing home residents, there was also a significantly lower frequency of symptomatic COVID-19 in those treated with bamlanivimab versus placebo in this important population (odds ratio 0.20; p=0.00026). These results suggest that residents randomized to bamlanivimab have up to an 80 percent lower risk of contracting COVID-19 versus residents in the same facility randomized to placebo."
"Among the 299 residents in the prevention group, there were 4 deaths attributed to COVID-19 at the time of death, and all occurred in the placebo arm. There were no COVID-19 attributed deaths in the bamlanivimab arm. "
Why isn't this being used more? Crazy. Maddeningly underutilized.
7. UK starting a large Ivermectin trial. https://t.co/5jtatjy8h5?amp=1
City of Mexico has started using IVM as well. https://www.infobae.com/america/mex...anecera-en-semaforo-rojo-la-siguiente-semana/
Financial Times article on IVM. The FT is read by a ton of people. https://t.co/6pyvI0h7Wt?amp=1
8. Can you spot the correlation between how lockdowns prevent deaths? Yeah, me either. Let's check this again in a year and see if hard lockdown areas have higher mortality... it'll happen but its going to take a while to show up in the data. Starting to show up in California's.
Speaking of hard lockdowns causing death. The CDC numbers for 2020: Florida: 13.8% excess death (211,320 expected, 240,484 observed) California: 15.5% excess deaths (269,247 expected, 310,850 observed) And it’s getting worse for CA: December saw 40.3% excess deaths, vs 15.8% in FL. Wow. 40%... let that sink in just a bit. https://t.co/WMFhvFKXHR?amp=1
9. https://www.medpagetoday.com/blogs/vinay-prasad/90658
"Nearly 2 million kids attended school from March to June, as the outbreak surged. Kids were not asked to wear masks. Despite this, only 15 kids developed severe COVID-19 or multi-inflammatory syndrome requiring ICU stay, of whom four had underlying medical problems. No children died." But I'm sure those teacher's unions have the kids best interest at heart... "kids are resilient."
10. California really has top notch vaccination prioritization.
Gavin's a joke. What a clown. CA ranks dead last in vaccination per capita. LAST. Vote for Chamath if you live in CA. All of his policies aren't up my alley but the guy is a certifiable genius and thinks so outside the box to fix common issues... AND everything he touches turns to gold... https://www.chamathforca.com/
11. By the way... lost the link but Germany is now requiring N95 masks when you leave the house... you know, because the cloth ones worked so well.
12. Massive benefit for Ivermectin in an Egyptian trial. https://www.researchgate.net/profil...D-19-in-Egypt-A-Randomised-clinical-trial.pdf
"Fifteen contacts (7.4%) developed COVID-19 in the ivermectin arm compared to 59 (58.4%) in the nonintervention arm (P <0.001)."
13. 315 days to slow the spread.
14. Wish I'd thought to do this. Combining the two US climate zones into one Hope-Simpson curve vs. the US curve. Astonishingly accurate.
14. Buy some Bitcoin. Nice dip of late. Might see 26-29k this week. Take advantage and dollar cost average your position.
Cheers RGers
