Covid 7/7/20 | COVID 19 Information Page

Very interesting study – holding many key takeaways – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31483-5/fulltext

“In April, 2020, the Spanish Ministry of Health and the Institute of Health Carlos III, in collaboration with the health services of the Spanish regions (Autonomous Communities), launched ENE-COVID, a nationwide, population-based, longitudinal seroepidemiological study, to quantify the extent of SARS-CoV-2 circulation throughout the country. The study included more than 61 000 individuals from randomly selected households; was designed to be representative by province, age group, and sex; and used two tests for the determination of SARS-CoV-2 antibodies. Here, we describe the study design and the results of the first wave of the study, conducted between April 27 and May 11, 2020”

“Despite the high impact of COVID-19 in Spain, prevalence estimates remain low and are clearly insufficient to provide herd immunity. This cannot be achieved without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems. In this situation, social distance measures and efforts to identify and isolate new cases and their contacts are imperative for future epidemic control.”

The big headline conclusion will be herd immunity will not likely be achievable without more collateral deaths– however I think the other takeaways are just as profound if not more.

“One in three infections seems to be asymptomatic”

“Our results confirm that close contact with people with COVID-19, and particularly those in the same household, increases viral transmission. Appropriate quarantine and separation from other household members can be particularly challenging and not realistic in urban areas and less affluent scenarios. While mass quarantine during the lockdown would reduce the number of potentially infective contacts, it would also increase the transmission of the virus in a confined space, as a recent simulation study has suggested.26”

The above cannot be stressed enough – IF you open economy then infection rise – then you quarantine – household will likely get infected as being indoor as viral load rises is the worse situation to be in. Family/Friends is a main driver for infections not the random stranger you passed by walking in park or grocery store. A long conversation chatting in a room with no fresh air builds viral load.

“We found no differences in seroprevalence between females and males”

“For the few patients who do not develop antibodies against SARS-CoV-2, it is unknown whether they are susceptible to reinfection.29, 31, 32 Prevalence in those participants reporting negative PCR was higher than in those without a PCR test, which might be explained by delayed PCR testing that yields a negative result or by imperfect sensitivity of PCR tests.33”

“One of the most practical conclusions from our survey is that, although the immunoassay had better performance features, our rapid point-of-care test yielded comparable epidemiological information while having a greater uptake, lower cost, and easier implementation. Thus, a high-performance point-of-care test could be a suitable option for large seroepidemiological studies.”

“a substantial number of symptomatic patients with COVID-19 did not undergo PCR testing. However, the fact that only 15·3–19·3% of symptomatic participants had antibodies against SARS-CoV-2 suggests that a sizable proportion of suspected cases might have symptoms not caused by this coronavirus.”

Harris county is reporting more confirmation (3668). There are few things we need to clarify/understand in the confirmation data. The data does not normalize for a person. I have seen multiple reports that employees are required to test 2 negative before coming back to work. Many people are testing positive and testing weekly to wait for the negative. IF someone takes a test each week for 2 weeks in a row somehow the data IF we are trying to track spread should not indicate that person is infected twice. IF more and more employees are requiring weekly testing you could be getting more on more positives as they wait to get 2 negatives in a row to go back to work. True it does grow in positive on a per person BUT if the person takes 14 days to switch to negative one could see 2X more than you think the second week as the volume of test grows. Hospitalization growth cannot be denied – nor can death but the confirmation seems to be conflated. Other rumors that have been discussed is people going to test and leave because took too long and then get news they got tested positive even though they did not get tested. Perhaps rumors to confuse the situation but if true that would be messed up.

From yesterday 212 more in hospitals in Harris county so 212/3668=6% requiring hospitalization…15/212= out of 5% in hospital 7% goes to ICU (0.4% confirms go to ICU) We could potentially take on another 34750 confirmation. This math doesn’t balance with discharge if any also assumes ALL ICU per Covid. IF this occurred we would be close to 2% of the country confirmed –NYC (2.5%).

As I have shown the county level holds the real data as statewide and country wide data is too diluted from the root of the problem. We see NYC is a complete outlier.

We can observe the recent rise and one could say it is from opening up economy to protest. However it could also be from temperatures driving people indoors and closing the windows. Below are HOURLY temps max for the day – so showing at some point AC is starting to kick in during the day. The higher the max the more hours the ac is likely on and you have closed up from the outside. NYC was closed in with heaters running in March – the rest of these areas had their windows open and they were going outside. And now we have a role reversal. My southern friends seem to not to be handle the heat and close up their house and stay inside – if an infected person is over (1 in 3 asymptomatic) and you end up chatting for a few hours eventually viral load will be high enough for infection. Each region I am sure have different thresholds and that going to the beach in the 80’s in Miami is probably okay – but once over 90’s perhaps its time to stay in.