Covid19mathblog.com

Not much press for Chinese vaccine as one cant really make money off them like hyping a stock traded particularly given IF China does develop they will likely give it to the world for FREE given they are partially to blame as the source of it. They clearly have an incentive they clearly have the means – and they are more likely to be able to test and distribute faster than other countries given the “patriotic” stance of their citizens. This shows the reach they have to get their vaccines going – https://www.latimes.com/world-nation/story/2020-10-29/china-coronavirus-covid-19-vaccine-secret

“The employee — who did not give his name for fear of reprisal — is one of hundreds of thousands of Chinese citizens who have received COVID-19 vaccines before they have been proved safe in clinical trials. China’s military began getting vaccinations in June. Medical workers and employees of state-owned companies working abroad were soon included in an “emergency use” program. In September, a China National Biotec executive said 350,000 people outside clinical trials had already received the vaccine.”

“Several cities in Zhejiang province have also reportedly begun offering vaccines made by Sinovac. In Yiwu city, Chinese media found a clinic offering vaccination shots for about $30 each on a “first come, first served” basis. Most of those receiving shots were people planning international travel, though they did not have to prove it, according to local reports.”

“None of the vaccines have completed Phase 3 trials, which often catch rare side effects that go undetected in earlier phases.”

“Chinese health authorities have said that the vaccines are safe, with no severe adverse effects, and that their “emergency use” is justified to protect against imported infections or a domestic resurgence of COVID-19. But health experts outside China are questioning the safety and ethics of such a strategy, especially when China has largely contained the COVID-19 pandemic.

“It’s a huge gamble, because you’re giving the vaccine to people who are healthy,” said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University.

Such a risk might make sense in a country where the virus was rapidly spreading and front-line workers were constantly exposed to COVID-19 — as in in the United States — but Western health experts and vaccine makers have been wary of prematurely rolling out a vaccine.

“I would not expect a country with a highly developed regulatory and safety system like the United States, the European Union [states] or Japan to allow that kind of wide access to an unproven vaccine,” Gostin said. “It’s unethical, and it’s dangerous.””

There it is the last statement – so IF it is successful do you not take it because the means of proving success was unethical? They end up beating all these major pharma companies because they can test 100K+ people way before any pharma gets above 100. Which one would you feel comfortable taking?

“The opacity of China’s vaccine experiments has sparked backlash. Papua New Guinea complained in August when China sent mine workers who’d received vaccines to their country without fully disclosing whether they were part of a trial or the risks involved in receiving vaccinated workers.

But many countries are also clamoring for China’s coronavirus vaccines, which Chinese President Xi Jinping has pledged to make a “global public good.” Brazil’s health regulator approved the import of 6 million vaccines from Sinovac this week. The United Arab Emirates approved its own emergency use of a Sinopharm vaccine in September. Sinovac has agreed to supply 40 million doses of its vaccine to Indonesia by March.

China announced this month that it was joining COVAX, a global initiative to ensure equitable distribution of vaccines to developing countries. Sinopharm also announced this month that it was preparing production lines in Beijing and Wuhan to produce 1 billion doses of its vaccines next year.

Such moves have bolstered China’s soft power regardless of questions about vaccine transparency, especially in comparison to the United States, which has struggled to contain its COVID-19 outbreak, withdrawn from the WHO and refused to participate in COVAX.

“We cannot claim that moral high ground when we accuse China of using the vaccine to achieve their foreign policy goals. No matter what they are doing, at least they benefit people in the developing world,” Huang said. “We like to talk about China exercising vaccine diplomacy, but the U.S. is not even part of the game.””

Wouldn’t it just be crushing to pharma companies to realize all their hardwork is for nothing IF china does it for free – or do we put a tariff on that? Tough call….

Lets travel the world ….first stop Vietnam – https://www.bbc.com/news/amp/world-asia-52628283

“Despite a long border with China and a population of 97 million people, Vietnam has recorded only just over 300 cases of Covid-19 on its soil and not a single death.

Nearly a month has passed since its last community transmission and the country is already starting to open up.”

“Vietnam enacted measures other countries would take months to move on, bringing in travel restrictions, closely monitoring and eventually closing the border with China and increasing health checks at borders and other vulnerable places.

Schools were closed for the Lunar New Year holiday at the end of January and remained closed until mid-May. A vast and labour intensive contact tracing operation got under way.

"This is a country that has dealt with a lot of outbreaks in the past," says Prof Thwaites, from Sars in 2003 to avian influenza in 2010 and large outbreaks of measles and dengue.”

Last point brings me back to 2 stories in the New Earth by Eckart Tolle – Is that so & maybe story – never at that time in 2003 and 2010 would you consider those events as blessings – but here we are saying those events are key to their success now. Lets hope we can say that about covid-19 a decade from now….

“By mid-March, Vietnam was sending everyone who entered the country – and anyone within the country who’d had contact with a confirmed case – to quarantine centres for 14 days.

Costs were mostly covered by the government, though accommodation was not necessarily luxurious. One woman who flew home from Australia – considering Vietnam a safer place to be – told BBC News Vietnamese that on their first night they had "only one mat, no pillows, no blankets" and one fan for the hot room.”

“Everyone in quarantine was tested, sick or not, and he says it’s clear that 40% of Vietnam’s confirmed cases would have had no idea they had the virus had they not been tested.”

“While Vietnam never had a total national lockdown, it swooped in on emerging clusters.

In February after a handful of cases in Son Loi, north of Hanoi, more than 10,000 people living in the surrounding area were sealed off. The same would happen to 11,000 people in the Ha Loi commune near the capital, and to the staff and patients of a hospital.

No-one would be allowed in or out until two weeks had passed with no confirmed cases.”

“Even in a one-party state like Vietnam, you need to ensure the public is on board for such a sweeping strategy to work.

Dr Pollack says the government did "a really good job of communicating to the public" why what it was doing was necessary.”

“While Vietnam’s authoritarian government is well used to demanding compliance, Dr Pollack says the public largely rallied behind the government because they "saw that they were doing everything they could do and having success, and doing whatever it cost to protect the population".”

“Prof Thwaites’s team is based in the country’s main infectious diseases hospital. He says if there had been unreported, undiagnosed or missed cases "we would have seen them on the ward – and we haven’t".

His team has also carried out nearly 20,000 tests, and he says their results match the data the government is sharing.

Even if there were some missed cases, he says "what there wasn’t was a systematic cover up of cases – I am very confident of that".”

“Enforcing social distancing and quarantine relied on its entrenched system of "loyal neighbourhood party cadres spying on area residents and reporting to superiors", says Phil Robertson of Human Rights Watch,

There were undoubtedly "rights-violating excesses" in the process, he told the BBC.

"But not many people will hear about those episodes because of the government’s total control of the media," he adds, citing cases of people being fined or prosecuted for criticising the government response.

The huge imp Prof Thwaites says the kind of policies applied in Vietnam "just wouldn’t stand up" in countries now suffering widespread infections, but for the few countries yet to be hit "the lesson is there".

"Prevention is always better than a cure and always cheaper generally," he says.”act on the economy and the extent to which other social and medical issues were neglected by the single-minded virus mission is also not yet clear.”“

Last points pretty much means their approach is unachievable in our society unless we want to change to that way.

Lets go to a less authoritative govt that had success Taiwan – https://bgr.com/2020/10/29/coronavirus-update-taiwan-has-best-covid-19-record-in-the-world/

“Taiwan, an island nation of 23 million people, has not recorded a local COVID-19 case in 200 days.

Moreover, Taiwan has only recorded 550 coronavirus cases since the start of the pandemic, as well as only seven deaths.”

““Taiwan is the only major country that has so far been able to keep community transmission of COVID eliminated,” Peter Collignon, an infectious disease physician and professor at the Australian National University Medical School, told the magazine. Furthermore, he added that Taiwan “probably had the best result around the world,” something that’s “even more impressive” for an economy with a population about the same size as Australia’s — and with many people living in close proximity to each other, in apartments.”

“We stressed that it’s been 200 days since Taiwan recorded a local case, but the nation actually essentially imported 20 cases over the past two weeks, according to news reports. They came from other Southeast Asian nations, so it remains to be seen if those imported cases go on to spur a local outbreak.”

Quite an amazing feat but no in-depth discussion on how and what was done.

Lets go to the USA – LA CA where they have been in lockdown and they have not opened school – yet they are the top county in the US to see confirmations and death rise – https://losangeles.cbslocal.com/2020/10/26/california-thanksgiving-gathering-guidelines/

“The state is telling people to gather with no more than three households present and that Thanksgiving dinner must be held outside.”

““The recommendations are right on the money for what we are looking for, for infection control,” said Erin Bromage, a professor of immunology and infectious diseases at the University of Massachusetts.

Bromage said outdoor gatherings are 20 to 30 times safer than indoor.”

Hmmm where was this mentioned in terms of the white house spread issue which insisted it was from the lawn event – even though many went inside?

“If you get indoors, in an enclosed environment that is poorly ventilated, what is being breathed out by an infected person builds up in that space, allowing other people to inhale it and bring it in, giving them a chance of infection. Take that same gathering outside, it can’t build up,” Bromage said.

Gatherings are also required to last less than two hours, according to the state.

“You don’t just get infected from being close to a single, viral particle. You usually need to get hundreds, thousands of them inside you, in order to get that one that will establish an infection,” Bromage said.

Some have questioned why you can gather indoors at grocery stores and shopping malls, but the same rules do not apply inside homes.

Bromage pointed out that there are much better ventilation and space in a large store.

“And then it’s the sustained contact that you have. When you’re shopping, the longest contact you’ll have is with the cashier, and in most cases now, it’s behind plexiglass,” he said.”

“Bromage said we will likely see spikes in the virus across the country as the weather cools, as the virus lives longer in colder, dry weather.

Holiday travel could also increase caseloads.

Okay so far all the above is fine – logical in terms of outcomes risk/reward….Not sure how one polices or enforces – but the discussion part seems fine….

“Holiday travel could also increase caseloads.

“California has been great at getting their infection rates down, but what if family visits from Texas, where there are communities in Texas that are getting smashed, the infection rates of Texas then get brought to California and then started all over again,” Bromage said.

Bromage said he knows that some Californians will not follow these guidelines. He said, if you do gather indoors, keep windows open while using fans for ventilation and wear masks as often as possible.”

Now that’s some BS – so are we comparing apples to apples – or is this person looking at some northern ca county with a visiting border town county – or should the comparison be a major metropolitan visiting a major metropolitan – IF Any the risk is the other way – LA County the odds of finding someone who has or had covid is remarkably high 13.6% confirmed/per capita vs. Houston (Harris County) 3.7%

Now perhaps they want to compare it El Paso TX – a border town who has closed down and do not have in person school and is now locking down – https://www.usatoday.com/story/news/health/2020/10/29/covid-news-california-disneyland-india-cvs-new-york/6062713002/

“El Paso, Texas, orders 2-week shutdown amid COVID-19 surge

A judge in El Paso County, Texas, ordered a two-week shutdown of nonessential services starting at midnight Friday amid growing hospitalizations in the COVID-19 crisis.

El Paso continued to hit unprecedented levels in the outbreak with record numbers of active cases, patients in the hospital, intensive care and a soaring positivity rate. Public health officials reported Thursday morning a record 14,359 known active cases, 934 people hospitalized, 245 in ICU, and a 17.24% rolling seven-day average positivity rate.”

I just wonder all these confirmations and root causes of these confirmations – will shutdown actually solve why the confirmations are rising?

Massachusetts – https://abcnews.go.com/Health/massachusetts-covid-19-response-science-based-cases-rising/story?id=73905739

“Massachusetts’ initial pandemic response is considered to be among the best in the country.

Residents have been wearing masks and the state has collected COVID-19 data and launched one of the nation’s first contact tracing programs. For months, the safety measures seemed to be working, but now, cases are on the rise once again. On Thursday, Massachusetts reported 1,243 new COVID-19 cases, according to the health department, marking the sixth day in a row it logged more than 1,000 single-day cases.”

“Daily case counts now look similar to what the state was experiencing in mid-May, with a seven-day average for new cases up nearly 339% since early September, according to an ABC analysis of state data.

In addition to rising case counts, 121 communities across Massachusetts are currently considered "high risk," according to the state department of health. Identified communities have an average rate of new cases greater than eight per 100,000 over the past 14 days.

To date, Massachusetts has reported more than 151,740 COVID-19 cases. The state has also had 9,727 deaths, more than 65% of which were in long-term care facilities, according to analysis of data provided by the state health department.”

“"The only silver lining is that the number of deaths has stayed fairly stable since the springtime," said Dr. Howard Koh, a professor at Harvard T.H. Chan School of Public Health.

"But we also know that when cases go up, hospitalizations and ultimately deaths generally follow," said Koh, the former public health commissioner in Massachusetts during the late 1990s and early 2000s.”

“while there’s evidence that people under the age of 30 are driving the rebound in new cases this fall, Galea doesn’t think the rise is related to Boston’s high density of universities, some of which have opened in person.

"Transmissions are quite low," he said of schools.

Instead, he pointed to informal gatherings, especially among young people. "Whether those can come under control is an open question," Galea said. "It’s fluctuating day by day."

The weather isn’t helping either. States across the country have seen rising COVID-19 cases and hospitalizations in recent weeks. "Drier conditions are creating more transmission," said Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital and an ABC News contributor. "People are starting to spend more time indoors with the temperature coming down."”

“the state took a more proactive COVID-19 response than almost any other place in the country and seemed to have the virus in check throughout the late spring and summer.

That’s in part because of the strong public health infrastructure that existed in the state before the pandemic, including a hub of universities and hospitals in Boston. "This is a state with a strong public health position and a concentration of medical and public health expertise," Koh said. "This is a state that has been science-based in its response. They’ve been looking at data every day."”

“In Galea’s opinion, Massachusetts officials have done their best to balance the state’s public health and economic needs. He applauded leaders for ramping up contact tracing and for giving the public clear public health messaging about COVID-19.

"If you did a Melbourne-style lockdown, you would probably bring cases down," Galea said, noting that at one point last month, Massachusetts had the highest unemployment rate in the country. "That’s really hard," he added.

As for places that could be improved, Galea pointed to testing. "Testing remains hampered by general federal chaos," he said. "It’s hard to think of ways Massachusetts could be better in the vacuum, absent a broader federal strategy."”

So takeaways? BEST and most proactive state still couldn’t get it done like Taiwan or Vietnam. MA sacrificed employment to be the highest unemployment in country – but in the end has succumbed to the spread. OUR behaviors are driving the disease – the informal gathering – we cant all just stay at home and not congregate with relatives and friends and skip the celebrations… We cannot police nor likely will get to the point to deny people the right to leave their homes. EVEN if we put a rule in place it becomes unenforceable….do you plan to lock people up while unfunding the police and prison system for violating covid quarantine rules? Are you going to ask the police to do arrest people on actions they are probably doing themselves – e.g. getting together with family on Thanksgiving and watching football which by the way last more than two hours? Or do we accept our YOLO attitude and let destiny be what it is….or do you ASSUME draconian measures work and in the long run makes it all worthwhile?

As a last and final option you do what you can to reduce risk from mechanical solutions – ventilation – wearing mask – avoiding public places that are crowded and not well ventilated – then you work on your health with exercise and eating well – and you do that because you know whatever preventative measures you do it will never be 100%. By doing the above – in the long run you feel better and could live longer due to your new lifestyle – and then we can go back to the Eckart Tolle and remark about Covid-19 as being a blessing even though we cannot see it now…..

No country over 1k

TX leads in confirmations and death

Very disperse reporting today compared to historical county level data

If we look at the top counties its Cook IL LA CA – then El Paso TX in regards to confirmation. In deaths it’s a first that Hillsborough FL leads – then Cook IL, then Palm Beach FL , then El Paso TX

The BIG 6? – really only 5 – El Paso added because showing up in confirmations – Cook IL and El Paso TX on a tear in terms of confirmation – so far deaths are stagnant. Over 5.4% of El Paso population is confirmed – still over half of LA.

Sweden confirmation rising as their deaths drop

Another great article highlighting the need for ventilation guidelines for buildings and potentially homes and also shows how mask help and supports the general thesis that spread is not a function of associations with random strangers in a location – https://english.elpais.com/society/2020-10-28/a-room-a-bar-and-a-class-how-the-coronavirus-is-spread-through-the-air.html?ssm=TW_CC

“Some 31% of coronavirus outbreaks recorded in Spain are caused by this kind of gathering, mainly between family and friends.”

“the European Center for Disease Control and Prevention’s (ECDC) observation that not a single case of fomite-caused Covid-19 has been observed”

– over use of chlorine wipes and hand sanitizers likely in terms of trying to prevent Covid-19

Hang out with people who are silent….or strangers given likely not going to have a long winded conversation nor are they likely going to sing for you.

“In the spring, health authorities failed to focus on aerosol transmission, but recent scientific publications have forced the World Health Organization (WHO) and the CDC to acknowledge it. An article in the prestigious Science magazine found that there is “overwhelming evidence” that airborne transmission is a “major transmission route” for the coronavirus, and the CDC now notes that, “under certain conditions, they seem to have infected others who were more than six feet [two meters] away. These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example, while singing or exercising.””

The data was clear it was airborne – I am no expert but the studies and the data has been very clear since Apr/May.

“If the premises are ventilated, which can be done with a good air conditioning unit, and the time spent in the bar is shortened, there is only the risk that one person will be infected.”

“Schools only account for 6% of coronavirus outbreaks recorded by Spanish health authorities. The dynamics of transmission via aerosols in the classroom change completely depending on whether the infected person – or patient zero – is a student or a teacher. Teachers talk far more than students and raise their voices to be heard, which multiplies the expulsion of potentially contagious particles. In comparison, an infected student will only speak occasionally. According to the Spanish National Research Council (CSIC) guidelines, the Spanish government has recommended that classrooms be ventilated – even though this may cause discomfort in the colder months – or for ventilation units to be used.”

“If the room is ventilated during the lesson, either with fresh air or mechanically, and the class is stopped after an hour in order to completely refresh the air, the risk drops dramatically.”

Given the continued discussion on ventilation it is clear the US govt and local official should come out with guidelines and rating system for every building/store. There should be a jobs program for ventilation calculators to come and give each facility a numerical rating showing the amount of fresh air per hour. There are ways that do not cost significant amounts of money to increase fresh air into facility. Expect to pay higher utility bill but compared to closing the store or not getting any customers it is nothing. Each commercial hvac system has an economizer that can be adjusted and perhaps some comfort can be sacrificed to gain a reduction of viral load.

Another under 1K death reporting US 994 – crazy level of confirmations 78981

TX leads in death and confirmation

Interesting to see Rhode Island jumping up in death and confirmation. Leading county in death at 21 2nd place in confirmation – with Cook IL toping at 2276

Given the big jump in confirmation below is the county view bar graph noting the county for those above 300 confirm– given everything is being seen through political lens – I put the % of county voting for Democrat in 2016 on top of the bar. Hopefully local officials get accountability for the covid spread as it really is localized and a federal policy can only do so much.

Good news Ireland confirmations coming down….not so good news no one else

Another Vitamin D study – https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827

“25OHD levels are lower in hospitalized COVID-19 patients compared to population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.”

The last statement tempers the conclusion – but once again on a risk/reward – risk includes cost and side effects – it would seem like a no brainer.

School review:

Looks like El Paso closure of school didn’t help as other things are causing confirmation

Broward open up and confirmation rises – but both Palm Beach and Pinellas has been open so something more is going on

It is really amazing the entire CA is so restrictive even though most cases in LA region….San Diego most open at 10% was at 20% and barely any difference

Lorain is rising even though no in school. Rising overall likely shows not a function of school

Boulder is not rising and has limited school – but at the same time Boulder saw a surge first.

Centre did see a surge first but Dauphin rising now and with still no inperson.

Still under 1K worldwide – US leads at 985 with 73.2K confirmed

TX leading both death and confirmation

County wise its LA leading in deaths at 27 – plus with high confirmations 1463 – lockdown not working for LA. El Paso TX lead the confirmations for TX 1445 – once again a border town. The other high reporting county was Cook IL at 1367

Now 5 counties listed below – all states are seeing lower temps other than FL

Sweden and Denmark are actually reducing confirmations everyone else still rising.

Covid19mathblog.com

Big push to let people know the alarming level of confirmation in US – yet not many deaths so far. Also discussion of greater hospitalization as if that metric is without a doubt a real metric above beyond a confirmation. Unfortunately hospitalization data is not uniform and not accessible for every state and there are revenue concerns driving some of that number. From John Hopkins database we do see the surge in confirmation surpassing the summer peak. We also see the death figures holding flat.

If we look just at the last two weeks we see the big drivers of over 30% come from TX, IL, CA, WI, FL, and TN.

Those top states certainly have increased testing

If we look further down the county leaders Cook IL represents 2.6% of total confirmations the past 2 weeks followed by LA Ca at 2.1% then El Paso TX at 1.5%. LA has been in lockdown but to no avail. All our democratic run counties.

Very good day in terms of death reporting not so much so on confirmations. US at 477 with 67K confirmed

TN leads the death count at 32. High confirmation per capita is likely indicating double dipping in confirmed.

Leading death county Riverside CA at 16 – confirmations are El Paso TX and Cook IL both over 1500

Cook IL has surpassed their previous peak – on the positive front deaths/confirmed keeps falling for them. There is no pick up in any deaths even 3 weeks back for IL. It would seem they are testing quite a bit and not getting much issue. Temps have fallen and hence more likely for increased confirmation as congregating inside with less ventilation is likely.

As seen above France is leading the confirmations and continue to show bid increases – deaths are slowly rising – now 200 deaths per day

Covid19mathblog.com

A great overview of what we know about covid-19 – SARS-CoV-2 – https://www.bmj.com/content/371/bmj.m3862

A very good point as discussed numerous time is the PCR test – what are you trying to test for – existence at some point or infectiousness?

“In the respiratory tract, peak SARS-CoV-2 load is observed at the time of symptom onset or in the first week of illness, with subsequent decline thereafter indicating the highest infectiousness potential just before or within the first five days of symptom onset”

“Reverse transcription polymerase chain reaction (RT-PCR) tests can detect viral SARS-CoV-2 RNA in the upper respiratory tract for a mean of 17 days; however, detection of viral RNA does not necessarily equate to infectiousness, and viral culture from PCR positive upper respiratory tract samples has been rarely positive beyond nine days of illness”

“Symptomatic and pre-symptomatic transmission (1-2 days before symptom onset), is likely to play a greater role in the spread of SARS-CoV-2 than asymptomatic transmission”

“SARS-CoV-2 is an enveloped β-coronavirus, with a genetic sequence very similar to SARS-CoV-1 (80%) and bat coronavirus RaTG13 (96.2%).2 The viral envelope is coated by spike (S) glycoprotein, envelope (E), and membrane (M) proteins"

“(1) The virus binds to ACE 2 as the host target cell receptor in synergy with the host’s transmembrane serine protease 2 (cell surface protein), which is principally expressed in the airway epithelial cells and vascular endothelial cells. This leads to membrane fusion and releases the viral genome into the host cytoplasm (2). Stages (3-7) show the remaining steps of viral replication, leading to viral assembly, maturation, and virus release”

“Coronaviruses have the capacity for proofreading during replication, and therefore mutation rates are lower than in other RNA viruses. As SARS-CoV-2 has spread globally it has, like other viruses, accumulated some mutations in the viral genome, which contains geographic signatures”

“The G614 variant in the S protein has been postulated to increase infectivity and transmissibility of the virus.3 Higher viral loads were reported in clinical samples with virus containing G614 than previously circulating variant D614, although no association was made with severity of illness as measured by hospitalisation outcomes.3 These findings have yet to be confirmed with regards to natural infection.”

“SARS-CoV-2 has a higher reproductive number (R0) than SARS-CoV-1, indicating much more efficient spread.”

“SARS-CoV-2 has structural differences in its surface proteins that enable stronger binding to the ACE 2 receptor4 and greater efficiency at invading host cells.1 SARS-CoV-2 also has greater affinity (or bonding) for the upper respiratory tract and conjunctiva,5 thus can infect the upper respiratory tract and conduct airways more easily”

“peak SARS-CoV-2 load is observed at the time of symptom onset or in the first week of illness with subsequent decline thereafter, which indicates the highest infectiousness potential just before or within the first five days of symptom onset (fig 2).7 In contrast, in SARS-CoV-1 the highest viral loads were detected in the upper respiratory tract in the second week of illness, which explains its minimal contagiousness in the first week after symptom onset, enabling early case detection in the community.”

“Quantitative reverse transcription polymerase chain reaction (qRT-PCR) technology can detect viral SARS-CoV-2 RNA in the upper respiratory tract for a mean of 17 days (maximum 83 days) after symptom onset.7 However, detection of viral RNA by qRT-PCR does not necessarily equate to infectiousness, and viral culture from PCR positive upper respiratory tract samples has been rarely positive beyond nine days of illness”

“While asymptomatic individuals (those with no symptoms throughout the infection) can transmit the infection, their relative degree of infectiousness seems to be limited.91011 People with mild symptoms (paucisymptomatic) and those whose symptom have not yet appeared still carry large amounts of virus in the upper respiratory tract, which might contribute to the easy and rapid spread of SARS-CoV-2.7 Symptomatic and pre-symptomatic transmission (one to two days before symptom onset) is likely to play a greater role in the spread of SARS-CoV-2.1012 A combination of preventive measures, such as physical distancing and testing, tracing, and self-isolation, continue to be needed.”

WE NEED TO SEPARATE CASES BY ASYMPTOMATIC vs non – this is ridiculous the testing output we need more information. The next article I describe the CT numbers – these need to come associated with the test results to – also noted before.

“Target host receptors are found mainly in the human respiratory tract epithelium, including the oropharynx and upper airway. The conjunctiva and gastrointestinal tracts are also susceptible to infection and may serve as transmission portals.6”

“Most transmission occurs through close range contact (15 minutes face to face and within 2 m),13 and spread is especially efficient within households and through gatherings of family and friends.12 Household secondary attack rates (the proportion of susceptible individuals who become infected within a group of susceptible contacts with a primary case) ranges from 4% to 35%.12 Sleeping in the same room as, or being a spouse of an infected individual increases the risk of infection, but isolation of the infected person away from the family is related to lower risk of infection.12 Other activities identified as high risk include dining in close proximity with the infected person, sharing food, and taking part in group activities 12 The risk of infection substantially increases in enclosed environments compared with outdoor settings.12 Aerosol transmission can still factor during prolonged stay in crowded, poorly ventilated indoor settings (meaning transmission could occur at a distance >2 m).12141516”

“SARS-CoV-2 binds to ACE 2, the host target cell receptor”

“the distribution of ACE 2 receptors in different tissues may explain the sites of infection and patient symptoms. For example, the ACE 2 receptor is found on the epithelium of other organs such as the intestine and endothelial cells in the kidney and blood vessels, which may explain gastrointestinal symptoms and cardiovascular complications.21 Lymphocytic endotheliitis has been observed in postmortem pathology examination of the lung, heart, kidney, and liver as well as liver cell necrosis and myocardial infarction in patients who died of covid-19.122 These findings indicate that the virus directly affects many organs, as was seen in SARS-CoV-1 and influenzae.”

“the initial inflammatory response attracts virus-specific T cells to the site of infection, where the infected cells are eliminated before the virus spreads, leading to recovery in most people.23 In patients who develop severe disease, SARS-CoV-2 elicits an aberrant host immune response.”

“Cytokines normally mediate and regulate immunity, inflammation, and haematopoiesis; however, further exacerbation of immune reaction and accumulation of cytokines in other organs in some patients may cause extensive tissue damage, or a cytokine release syndrome (cytokine storm), resulting in capillary leak, thrombus formation, and organ dysfunction”

“Sex-related differences in immune response have been reported, revealing that men had higher plasma innate immune cytokines and chemokines at baseline than women.30 In contrast, women had notably more robust T cell activation than men, and among male participants T cell activation declined with age, which was sustained among female patients. These findings suggest that adaptive immune response may be important in defining the clinical outcome as older age and male sex is associated with increased risk of severe disease and mortality.”

“Covid-19 leads to an antibody response to a range of viral proteins, but the spike (S) protein and nucleocapsid are those most often used in serological diagnosis. Few antibodies are detectable in the first four days of illness, but patients progressively develop them, with most achieving a detectable response after four weeks.35 A wide range of virus-neutralising antibodies have been reported, and emerging evidence suggests that these may correlate with severity but wane over time”

PCR and cycles as discussed before are very important to understand – not much is discussed as it is quite nerdy and complicated but its important. PCR test are not black and white – investigated before https://covid19mathblog.com/2020/09/covid-9-28-20/

In this paper they discuss correlations between PCR Cycles Threshold and positive and infectiousness – https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1491/5912603

“Several works published recently and based on more

than 100 studies attempt to propose such cut off for Ct value and duration of eviction with a

consensus at approximately Ct > 30 and at least 10 days, respectively [2–5]. However, in an

article published in this journal, a group reported that patients could be not be contagious

above 25 Ct as the virus was not detected in culture above this Ct”

“It can be observed that at Ct=25, up to 70% of

patients remain positive in culture and that at Ct=30 this value drops to 20%. At Ct=35, the

value we used to report positive result for PCR, less than 3% of culture are negative. Our Ct

value of 35 initially based on the results obtained by RT-PCR on control negative samples in our laboratory and initial results of cultures [8] is validated by the present work and is in

correlation with what was proposed i.e. in Korea [9] or Taiwan [10]. We could observe that

subcultures, especially the first one, allow increasing percentage of viral isolation on high Ct

samples, confirming that these high Ct are mostly correlated with low viral loads. From our

cohort, we now need to try to understand and define the duration and frequency of live virus

shedding in patients on a case-by-case basis, in the rare cases where the PCR is positive

beyond 10 days, often at a Ct above 30. In any cases, these rare cases should not impact

public health decisions.”

Ct and the patient classification of asymptomatic or not will aid in interpreting the cases we are seeing. Labs need to start releasing this data. Ct decision does not seem to be universal. This could cause misinterpretation and worse yet hysteria when there does not need to be – at the very least transparency would help everyone understand what is going on.

Super low numbers worldwide even for a Sunday – US 340

TX leads at 40 deaths….keep watching N. Dakota – until that changes from 99% tested/capita we know they are triple counting vs. the state data.

Leading county is Cook IL at 12. Highest TX county was Harris at 8

Added Cook Il onto our county watch – now Big 5 – you can see the cold weather bringing an increase in confirmations for Cook IL

Europe deaths are rising – Belgium and Czech certainly are alarming

Covid19mathblog.com

One of the best written data interpreted article – wish I wrote it…. There are glimpses of what has been written here since the beginning from noting how focus but contagious covid19 is. Also noting how state or country data really doesn’t tell the picture of what is going on. VIRAL LOAD is key – ventilation! I hope EVERY policy maker reads this and accept the conclusions.

https://www.theatlantic.com/health/archive/2020/09/k-overlooked-variable-driving-pandemic/616548/

“By now many people have heard about R0—the basic reproductive number of a pathogen, a measure of its contagiousness on average. But unless you’ve been reading scientific journals, you’re less likely to have encountered k, the measure of its dispersion. The definition of k is a mouthful, but it’s simply a way of asking whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once. After nine months of collecting epidemiological data, we know that this is an overdispersed pathogen, meaning that it tends to spread in clusters, but this knowledge has not yet fully entered our way of thinking about the pandemic—or our preventive practices.”

“The now-famed R0 (pronounced as “r-naught”) is an average measure of a pathogen’s contagiousness, or the mean number of susceptible people expected to become infected after being exposed to a person with the disease. If one ill person infects three others on average, the R0 is three. This parameter has been widely touted as a key factor in understanding how the pandemic operates. News media have produced multiple explainers and visualizations for it. Movies praised for their scientific accuracy on pandemics are lauded for having characters explain the “all-important” R0. Dashboards track its real-time evolution, often referred to as R or Rt, in response to our interventions. (If people are masking and isolating or immunity is rising, a disease can’t spread the same way anymore, hence the difference between R0 and R.)

Unfortunately, averages aren’t always useful for understanding the distribution of a phenomenon, especially if it has widely varying behavior. If Amazon’s CEO, Jeff Bezos, walks into a bar with 100 regular people in it, the average wealth in that bar suddenly exceeds $1 billion. If I also walk into that bar, not much will change. Clearly, the average is not that useful a number to understand the distribution of wealth in that bar, or how to change it. Sometimes, the mean is not the message. Meanwhile, if the bar has a person infected with COVID-19, and if it is also poorly ventilated and loud, causing people to speak loudly at close range, almost everyone in the room could potentially be infected—a pattern that’s been observed many times since the pandemic begin, and that is similarly not captured by R. That’s where the dispersion comes in.

There are COVID-19 incidents in which a single person likely infected 80 percent or more of the people in the room in just a few hours. But, at other times, COVID-19 can be surprisingly much less contagious. Overdispersion and super-spreading of this virus are found in research across the globe. A growing number of studies estimate that a majority of infected people may not infect a single other person. A recent paper found that in Hong Kong, which had extensive testing and contact tracing, about 19 percent of cases were responsible for 80 percent of transmission, while 69 percent of cases did not infect another person. This finding is not rare: Multiple studies from the beginning have suggested that as few as 10 to 20 percent of infected people may be responsible for as much as 80 to 90 percent of transmission, and that many people barely transmit it.”

“Using genomic analysis, researchers in New Zealand looked at more than half the confirmed cases in the country and found a staggering 277 separate introductions in the early months, but also that only 19 percent of introductions led to more than one additional case. A recent review shows that this may even be true in congregate living spaces, such as nursing homes, and that multiple introductions may be necessary before an outbreak takes off. Meanwhile, in Daegu, South Korea, just one woman, dubbed Patient 31, generated more than 5,000 known cases in a megachurch cluster.”

“Unsurprisingly, SARS-CoV, the previous incarnation of SARS-CoV-2 that caused the 2003 SARS outbreak, was also overdispersed in this way: The majority of infected people did not transmit it, but a few super-spreading events caused most of the outbreaks. MERS, another coronavirus cousin of SARS, also appears overdispersed, but luckily, it does not—yet—transmit well among humans.

This kind of behavior, alternating between being super infectious and fairly noninfectious, is exactly what k captures, and what focusing solely on R hides.”

““Diseases like the flu are pretty nearly deterministic and R0 (while flawed) paints about the right picture (nearly impossible to stop until there’s a vaccine).” That’s not necessarily the case with super-spreading diseases.”

“Nature and society are replete with such imbalanced phenomena, some of which are said to work according to the Pareto principle, named after the sociologist Vilfredo Pareto. Pareto’s insight is sometimes called the 80/20 principle—80 percent of outcomes of interest are caused by 20 percent of inputs—though the numbers don’t have to be that strict. Rather, the Pareto principle means that a small number of events or people are responsible for the majority of consequences. This will come as no surprise to anyone who has worked in the service sector, for example, where a small group of problem customers can create almost all the extra work. In cases like those, booting just those customers from the business or giving them a hefty discount may solve the problem, but if the complaints are evenly distributed, different strategies will be necessary. Similarly, focusing on the R alone, or using a flu-pandemic playbook, won’t necessarily work well for an overdispersed pandemic.”

“Western world was getting distracted by the trees, and got lost among them. To fight a super-spreading disease effectively, policy makers need to figure out why super-spreading happens, and they need to understand how it affects everything, including our contact-tracing methods and our testing regimes.”

“In study after study, we see that super-spreading clusters of COVID-19 almost overwhelmingly occur in poorly ventilated, indoor environments where many people congregate over time—weddings, churches, choirs, gyms, funerals, restaurants, and such—especially when there is loud talking or singing without masks. For super-spreading events to occur, multiple things have to be happening at the same time, and the risk is not equal in every setting and activity, Muge Cevik, a clinical lecturer in infectious diseases and medical virology at the University of St. Andrews and a co-author of a recent extensive review of transmission conditions for COVID-19, told me.”

“Cevik identifies “prolonged contact, poor ventilation, [a] highly infectious person, [and] crowding” as the key elements for a super-spreader event. Super-spreading can also occur indoors beyond the six-feet guideline, because SARS-CoV-2, the pathogen causing COVID-19, can travel through the air and accumulate, especially if ventilation is poor.”

“we don’t need to know all the sufficient factors that go into a super-spreading event to avoid what seems to be a necessary condition most of the time: many people, especially in a poorly ventilated indoor setting, and especially not wearing masks. As Natalie Dean, a biostatistician at the University of Florida, told me, given the huge numbers associated with these clusters, targeting them would be very effective in getting our transmission numbers down.”

“Right now, many states and nations engage in what is called forward or prospective contact tracing. Once an infected person is identified, we try to find out with whom they interacted afterward so that we can warn, test, isolate, and quarantine these potential exposures. But that’s not the only way to trace contacts. And, because of overdispersion, it’s not necessarily where the most bang for the buck lies. Instead, in many cases, we should try to work backwards to see who first infected the subject.

Because of overdispersion, most people will have been infected by someone who also infected other people, because only a small percentage of people infect many at a time, whereas most infect zero or maybe one person. As Adam Kucharski, an epidemiologist and the author of the book The Rules of Contagion, explained to me, if we can use retrospective contact tracing to find the person who infected our patient, and then trace the forward contacts of the infecting person, we are generally going to find a lot more cases compared with forward-tracing contacts of the infected patient, which will merely identify potential exposures, many of which will not happen anyway, because most transmission chains die out on their own.”

“The reason for backward tracing’s importance is similar to what the sociologist Scott L. Feld called the friendship paradox: Your friends are, on average, going to have more friends than you. (Sorry!) It’s straightforward once you take the network-level view. Friendships are not distributed equally; some people have a lot of friends, and your friend circle is more likely to include those social butterflies, because how could it not? They friended you and others. And those social butterflies will drive up the average number of friends that your friends have compared with you, a regular person. (Of course, this will not hold for the social butterflies themselves, but overdispersion means that there are much fewer of them.) Similarly, the infectious person who is transmitting the disease is like the pandemic social butterfly: The average number of people they infect will be much higher than most of the population, who will transmit the disease much less frequently”

“Even in an overdispersed pandemic, it’s not pointless to do forward tracing to be able to warn and test people, if there are extra resources and testing capacity. But it doesn’t make sense to do forward tracing while not devoting enough resources to backward tracing and finding clusters, which cause so much damage.”

“Another significant consequence of overdispersion is that it highlights the importance of certain kinds of rapid, cheap tests. Consider the current dominant model of test and trace. In many places, health authorities try to trace and find forward contacts of an infected person: everyone they were in touch with since getting infected. They then try to test all of them with expensive, slow, but highly accurate PCR (polymerase chain reaction) tests. But that’s not necessarily the best way when clusters are so important in spreading the disease.

PCR tests identify RNA segments of the coronavirus in samples from nasal swabs—like looking for its signature. Such diagnostic tests are measured on two different dimensions: Are they good at identifying people who are not infected (specificity), and are they good at identifying people who are infected (sensitivity)? PCR tests are highly accurate for both dimensions. However, PCR tests are also slow and expensive, and they require a long, uncomfortable swab up the nose at a medical facility. The slow processing times means that people don’t get timely information when they need it. Worse, PCR tests are so responsive that they can find tiny remnants of coronavirus signatures long after someone has stopped being contagious, which can cause unnecessary quarantines.”

“Meanwhile, researchers have shown that rapid tests that are very accurate for identifying people who do not have the disease, but not as good at identifying infected individuals, can help us contain this pandemic. As Dylan Morris, a doctoral candidate in ecology and evolutionary biology at Princeton, told me, cheap, low-sensitivity tests can help mitigate a pandemic even if it is not overdispersed, but they are particularly valuable for cluster identification during an overdispersed one. This is especially helpful because some of these tests can be administered via saliva and other less-invasive methods, and be distributed outside medical facilities.”

UGH govt, restrictions…

“Unfortunately, until recently, many such cheap tests had been held up by regulatory agencies in the United States, partly because they were concerned with their relative lack of accuracy in identifying positive cases compared with PCR tests—a worry that missed their population-level usefulness for this particular overdispersed pathogen.”

“Overdispersion makes it harder for us to absorb lessons from the world, because it interferes with how we ordinarily think about cause and effect. For example, it means that events that result in spreading and non-spreading of the virus are asymmetric in their ability to inform us. Take the highly publicized case in Springfield, Missouri, in which two infected hairstylists, both of whom wore masks, continued to work with clients while symptomatic. It turns out that no apparent infections were found among the 139 exposed clients (67 were directly tested; the rest did not report getting sick). While there is a lot of evidence that masks are crucial in dampening transmission, that event alone wouldn’t tell us if masks work. In contrast, studying transmission, the rarer event, can be quite informative. Had those two hairstylists transmitted the virus to large numbers of people despite everyone wearing masks, it would be important evidence that, perhaps, masks aren’t useful in preventing super-spreading.”

“Take Sweden, an alleged example of the great success or the terrible failure of herd immunity without lockdowns, depending on whom you ask. In reality, although Sweden joins many other countries in failing to protect elderly populations in congregate-living facilities, its measures that target super-spreading have been stricter than many other European countries. Although it did not have a complete lockdown, as Kucharski pointed out to me, Sweden imposed a 50-person limit on indoor gatherings in March, and did not remove the cap even as many other European countries eased such restrictions after beating back the first wave. (Many are once again restricting gathering sizes after seeing a resurgence.) Plus, the country has a small household size and fewer multigenerational households compared with most of Europe, which further limits transmission and cluster possibilities. It kept schools fully open without distancing or masks, but only for children under 16, who are unlikely to be super-spreaders of this disease. Both transmission and illness risks go up with age, and Sweden went all online for higher-risk high-school and university students—the opposite of what we did in the United States. It also encouraged social-distancing, and closed down indoor places that failed to observe the rules. From an overdispersion and super-spreading point of view, Sweden would not necessarily be classified as among the most lax countries, but nor is it the most strict. It simply doesn’t deserve this oversize place in our debates assessing different strategies.”

“South Korea’s aggressive and successful response to that outbreak—with a massive testing, tracing, and isolating regime—shows. Since then, South Korea has also been practicing sustained vigilance, and has demonstrated the importance of backward tracing. When a series of clusters linked to nightclubs broke out in Seoul recently, health authorities aggressively traced and tested tens of thousands of people linked to the venues, regardless of their interactions with the index case, six feet apart or not—a sensible response, given that we know the pathogen is airborne.

Perhaps one of the most interesting cases has been Japan, a country with middling luck that got hit early on and followed what appeared to be an unconventional model, not deploying mass testing and never fully shutting down. By the end of March, influential economists were publishing reports with dire warnings, predicting overloads in the hospital system and huge spikes in deaths. The predicted catastrophe never came to be, however, and although the country faced some future waves, there was never a large spike in deaths despite its aging population, uninterrupted use of mass transportation, dense cities, and lack of a formal lockdown.

It’s not that Japan was better situated than the United States in the beginning. Similar to the U.S. and Europe, Oshitani told me, Japan did not initially have the PCR capacity to do widespread testing. Nor could it impose a full lockdown or strict stay-at-home orders; even if that had been desirable, it would not have been legally possible in Japan.

Oshitani told me that in Japan, they had noticed the overdispersion characteristics of COVID-19 as early as February, and thus created a strategy focusing mostly on cluster-busting, which tries to prevent one cluster from igniting another. Oshitani said he believes that “the chain of transmission cannot be sustained without a chain of clusters or a megacluster.” Japan thus carried out a cluster-busting approach, including undertaking aggressive backward tracing to uncover clusters. Japan also focused on ventilation, counseling its population to avoid places where the three C’s come together—crowds in closed spaces in close contact, especially if there’s talking or singing—bringing together the science of overdispersion with the recognition of airborne aerosol transmission, as well as presymptomatic and asymptomatic transmission.”

“Oshitani contrasts the Japanese strategy, nailing almost every important feature of the pandemic early on, with the Western response, trying to eliminate the disease “one by one” when that’s not necessarily the main way it spreads. Indeed, Japan got its cases down, but kept up its vigilance: When the government started noticing an uptick in community cases, it initiated a state of emergency in April and tried hard to incentivize the kinds of businesses that could lead to super-spreading events, such as theaters, music venues, and sports stadiums, to close down temporarily. Now schools are back in session in person, and even stadiums are open—but without chanting.

It’s not always the restrictiveness of the rules, but whether they target the right dangers. As Morris put it, “Japan’s commitment to ‘cluster-busting’ allowed it to achieve impressive mitigation with judiciously chosen restrictions. Countries that have ignored super-spreading have risked getting the worst of both worlds: burdensome restrictions that fail to achieve substantial mitigation. The U.K.’s recent decision to limit outdoor gatherings to six people while allowing pubs and bars to remain open is just one of many such examples.””

“Could we get back to a much more normal life by focusing on limiting the conditions for super-spreading events, aggressively engaging in cluster-busting, and deploying cheap, rapid mass tests—that is, once we get our case numbers down to low enough numbers to carry out such a strategy? (Many places with low community transmission could start immediately.) Once we look for and see the forest, it becomes easier to find our way out.”

Another under 1K death day – US at 914 – big headline in media is the large confirmation numbers.

TX leads both the death and confirmation – 142 and 9795 respectively. Still the data for confirmation is not corrected – e.g. N. Dakota showing 99% tested per capita – however as noted yesterday ND own dataset shows a third of that is unique test!

The leading county in deaths is actually Cook IL 17 – highest death county in TX Harris at 16. The big confirmation county is El Paso TX at 2529.

Big 4 – LA is gaining in confirmation even though they are the most restrictive county.

This graph shows the peak of the confirmation hitting again but as noted confirmation numbers have some errors in it.

Italy fatality rate climb is not a good sign for them.

Big smile on my face as I read the article – https://www.bbc.com/news/world-europe-54599593 – but a big disappointment sets in as it took this long for A country to realize what the data had been saying all along. I hope crony capitalism has not caused this misallocation of capital and human resource. Certainly vaccine would bring more $ than fixing/modifying HVAC and the distribution of funds would be distributed among society as you have skilled labor winning out vs. executives. True capitalism could have brought this to the US sooner – but we put so many barriers and legal ramifications for people to implement potential lifesaving mechanical solutions.

“The German government is investing €500m (£452m; $488m) in improving ventilation systems in public buildings to help stop the spread of coronavirus.

The grants will go to improve the air circulation in public offices, museums, theatres, universities and schools. Private firms are not yet eligible.”

“The government also wants schools lacking central air conditioning systems to at least get mobile air purifiers. But much will also depend on how easily rooms can be ventilated simply by opening the windows.

The Bavarian broadcaster BR24 reports that the mobile ventilators, which filter out tiny particles and cost from €2,000 each, can effectively purify a room within minutes.

But German experts say apparatus that relies on UV-light, ionisation or ozone can be ineffective against coronavirus, and in some cases worsen the air quality.”

“Fresh air has, for a while now, been seen as a key to dealing with coronavirus too. L for Luft (air) was recently added to A for Abstand (distance), H for Hygiene and A for Alltagsmaske (mask) – the official government directives on how to live in corona times.

So choirs rehearse in rooms open to the elements. Train windows are cranked open. Diners are still being served outdoors at many establishments, prompting a national ethical debate over patio heaters.

But, as the air turns sharper and colder, it is education ministers who are feeling the chill. It has been mooted – not always in jest – that children should attend lessons wrapped in coats, gloves, hats and perhaps a duvet, prompting fury among teachers.”

“And many German classrooms, in poor repair after prolonged underinvestment, simply do not have windows that open. German engineers are on the case though. I recently visited a company which usually manufactures heating and ventilation systems. It has now created an air filtration system designed with windowless classrooms in mind.”

“The German government’s advice is to open windows for at least five minutes every hour, for example during class changeovers in schools.

The UK’s Health and Safety Executive also recommends fans to dissipate pockets of stale air in rooms and using a fresh air supply, instead of just recirculating air through the air conditioning system.”

Lets review the US county data as this is where the truth lies – not in country data, not in state data – aggregation of data is statistical killer. The level of precision is needed to at least a county level given the spread is somewhat focused.

Below is every county with over 1000 confirmations. You will note the avg confirmation in the US is 3.2% with the highest being 22% Trousdale TN – as noted https://covid19mathblog.com/2020/6/covid-6-27-20/ – this is a prison county. Nonetheless months later the death per capita there ended up at only 0.1%! You can also see that population and the amount of confirmed is independent of the death per capita.

If we zoom in to only counties with 8% of confirmed/capita we get the following

Researching Chattahoochee given essentially 0% death – its hard to find out what really is going on.

I came across this article which shows perhaps they are more cognizant of other issues beyond covid?

https://www.wtvm.com/2020/10/22/chattahoochee-county-school-district-puts-focus-mental-health-students/

“The school district is putting the mental health of their students first during this school year due to COVID-19.

A study conducted at the national level says roughly 72 percent of children ages five through 17 are suffering from some sort of mental condition triggered by the coronavirus.

To help students cope with that, Chattahoochee schools are focusing more on mental health awareness and making sure every child is heard in their Free Your Feels program.

Fifth-grader Taylor Leach said with her counselor’s help, she has been able to work through feelings like anxiety.”

This is so real – there is going to be a big mental health impact on this youth and I hope policy makers realize this.

I also found this article – https://www.gpb.org/news/2020/08/06/georgia-surpasses-200000-covid-19-cases-hot-spots-remain

We are well past the timeline if deaths were going to knock – article August 6th 2020 – https://www.gpb.org/news/2020/08/06/georgia-surpasses-200000-covid-19-cases-hot-spots-remain

“One of the continuing COVID-19 hot spots is in Chattahoochee County, near Columbus in west Georgia.

The county contains a large part of Fort Benning, an Army post that is implementing strict measures to contain the spread of COVID-19.”

Chattahoochee County is listed as having the highest virus rate in Georgia over the past two weeks and among the highest in the nation, according to state Public Health figures and the New York Times.

In mid-June, the county had 304 people infected. Now it’s at 696, up 31 cases just over the past day. Fortunately, Chattahoochee has recorded just one COVID-related death.

ConnectingVets.com reported in June that more than 140 new recruits at Fort Benning had tested positive for COVID-19. All but four had tested negative previously, when they arrived at the facility. “

One would think this would be worthy of a study? Perhaps just youth sick – perhaps test bad – perhaps they have great treatment? Prisons and Army facility is where you want to get covid? Given the results SHOULD Chattahoochee kids be isolated and not allowed to go to school?

Another day below 1K worldwide – US leads at 943

Texas leads in death 114

Hidalgo TX county leads the US – once again a border county in TX – Mobile AL post 2320 confirmation day.

Deaths are not coming down in Europe – this along with confirmation rising. Quarantine is not WORKING – it could actually cause more as people are not going into facilities that COULD reduce viral load – e.g. public/office buildings Germany deaths are way lower than most of the other major European countries.

Covid19mathblog.com

Another potential drug for treatment – this is unique in that it is inhaled therefore goes straight to the issue and is focused on the monoclonal antibody – https://www.biorxiv.org/content/10.1101/2020.10.14.339150v1.full.pdf

“Delivering the antiviral treatment directly to the lungs has the potential to improve lung bioavailability

and dosing efficiency. As the SARS-CoV-2 Receptor Binding Domain (RBD) of the

Spike (S) is increasingly deemed to be a clinically validated target, RBD-specific B cells

were isolated from patients following SARS-CoV-2 infection to derive a panel of fully

human monoclonal antibodies (hmAbs) that potently neutralize SARS-CoV-2. The most

potent hmAb, 1212C2 was derived from an IgM memory B cell, has high affinity for

SARS-CoV-2 RBD which enables its direct inhibition of RBD binding to ACE2. The

1212C2 hmAb exhibits in vivo prophylactic and therapeutic activity against SARS-CoV-2

in hamsters when delivered intraperitoneally, achieving a meaningful reduction in upper

and lower respiratory viral burden and lung pathology.”

“The therapeutic efficacy achieved at an exceedingly low-dose of inhaled

1212C2 supports the rationale for local lung delivery and achieving dose-sparing

benefits as compared to the conventional parenteral route of administration. Taken

together, these results warrant an accelerated clinical development of 1212C2 hmAb

formulated and delivered via inhalation for the prevention and treatment of SARS-CoV-2

infection.”

UK deciding to focus on the prime driver of deaths from covid – https://www.bloomberg.com/news/articles/2020-10-21/covid-puts-a-spotlight-on-the-food-industry-s-role-in-obesity

“The link between obesity and more severe cases of the virus helped inspire Johnson to ditch his libertarian stance in favor of state intervention over the past several months. His government has proposed curbing junk-food advertising, banning certain promotions on sugary and fatty foods, and forcing cafes and restaurants to slap calorie labels on more products.

The crackdown has given investors in the $3 trillion global food and drink sector reason for pause. As the pandemic throws a spotlight on the importance of a healthy diet, governments beyond the U.K. may choose to impose more anti-obesity measures, further shifting the way makers of sodas, ­breakfast cereals, chocolate bars, and ready-to-eat meals do business.”

“Companies that make food often derided as “junk” face a number of risks, ranging from sugar taxes and limits on marketing and sales to tobacco-like health warnings and product labeling. This is on top of litigation and reputational threats, as well as the potential for consumers to curb their appetite for unhealthy food. But these companies also have opportunities to adapt to new regulations and tastes. This is why fund managers—especially those with a bent for ESG investing—are reviewing food companies in their portfolios, scrutinizing product ingredients, screening medical literature, and tracking changes to product recipes for signs of progress. They’re also pushing companies for greater information disclosure.”

“Reformulations cost money, however, and selling healthier food for cheap could whack profit margins. This is why many healthier options tend to cater to wealthier parts of society. The challenge is to make less-fattening foods mainstream and accessible to a broader population, says Nick Hampton, chief executive officer at Tate & Lyle Plc, an ingredients maker that says it’s helping companies cut out sugar, fat, and calories. “It can’t just be healthier. It has to be accessible and affordable to people,” he said at the virtual Future Food-Tech Summit in September.”

That is such a cop out – “HEALTHIER options tend to cater to wealthier” – lol – healthier “fancy” options that one can repackage and sell perhaps – but beans, grains, rice, bananas, apples are all the bottom end in terms of food cost. No one has died from eating those items….imagine a world where those items are essentially free and easily accessible – then you have the choice to indulge every so often on other stuff but you always have access to be healthy and you are not marketed constantly and pushed with addictive food items.

We are now accessing the John Hopkins state data for testing – which interestingly is 10 Million less in total test vs. the country total data. Another interesting thing is they have a column People Tested – which we hope means its unique vs. people taking 5 test should not result in 5 people tested. Well N. Dakota must have lots of time and love to be tested as the data shows 98.7% of their population has been tested!

ND own website shows Unique Individual at 277K vs. 791K processed – so even the source of all data being reported (John Hopkins) is somewhat flawed. https://www.health.nd.gov/diseases-conditions/coronavirus/north-dakota-coronavirus-cases

So it looks like each person gets around 3 test each – hopefully this means confirmed represents only 1 not multiple confirms. How do we know its not just some data oops?

We need to stop testing for just existence – we need to test for infectious levels. This is now data overload and not helping. Can you imagine if they did this with the flu? Do you know the database on flu does not even try to test for asymptomatic people – but they do exist – and can be up to 50%! This is a report back in October 2005! Note some key points. https://www.centerforhealthsecurity.org/cbn/2005/cbnreport_103105.html#:~:text=As%20many%20as%2050%25%20of,%E2%80%9Creservoir%E2%80%9D%20for%20the%20virus.

“As many as 50% of infections with normal seasonal flu may be asymptomatic, which may in part be due to pre-existing partial immunity [1]”

“Quarantine, as commonly conceived, is of unproven utility.

Quarantine is commonly meant to convey the large-scale sequestering of persons with the purpose of trying to stop the spread of a contagious disease. It is different from isolation, in which symptomatic persons with a contagious disease are isolated individually so they do not infect others. There are no studies of quarantine in the setting of influenza. Experience with the SARS epidemic suggests that large scale quarantine of a population or geographic location is logistically very difficult [15]. Further, mathematical models of quarantine for flu show that there must be a nearly perfect degree of limitation of travel to be effective [16]. One method of disease containment that might be appropriate during a flu epidemic would be the isolation of persons of a small discreet group, such as people on a contaminated airplane or ship. In such a case, all passengers and all crew members could be confined in isolation for the duration of the incubation period. In this scenario, the isolated individuals would need to be separated form each other to avoid increasing their risk of exposure. Another appropriate use of isolation might involve sequestering healthcare workers exposed to lethal and contagious cases of flu strain (such as a pandemic H5N1 strain); this would no longer make sense once such a disease were circulating widely.”

So comparing Flu fatality and Covid Fatality is already skewed as they have NEVER tried to quantify even think about testing the population for flu. Imagine the deaths from someone who had traced amount of flu virus in the body and then attributed that death partially to the flu – but the person had natural immunity to the flu therefore it didn’t necessarily matter. The point here we need to advance the test vs. just testing for trace – test for the infectious level? – this CAN be done.

School review time – still showing school are not super spreader events relative to other activities – there are better ways to keep schools open and we need to learn from those schools that do it better:

Texas Travis county has just opened up to 90% but before then they were closed – Ft. Bend has always been open and no big change. Harris is removed due to the sporadic confirmation testing data. El Paso the most closed in school – yet their confirmation is rising proving its not school.

FL all counties are no in person – before no difference from Broward vs. Palm and Pinellas who were opened.

CA is the worse sample state San Diego backed down their opening from 20 to 10 but for no real reason.

OH Lorain looks to not be opening schools effectively compared to other other. Lorain has stayed closed but they are also seeing the rise so its not SCHOOL!

In Colorado El Paso and Adams confirmations have risen – but deaths in check. The rise was already occuring for adams and school opening did not noticeably accelerate it. Boulder was closed before their hump and now they have opened but no notice of change in confirmation.

In PA Centere was open and did see a rise but it has since come back down and deaths ticked up only slightly. Dauphin is seeing a rise and the schools are non in person.

No one above 1K – US leads at 856

CA leads death at 89 – one of the most closed in state!

The leader in County is LA with 12 deaths – once again the leading county in closed society – yet its not working!

Added for the big 4 chart in person schooling. Miami-Dade now fully open along with Maricopa….time will tell – LA has been 0

What is going on with LA? No in person school and CA lowest rating in open state

https://www.areavibes.com/los+angeles-ca/crime/

It probably will only get worse not better if they don’t do something! Good news based on their stats total violent crime is down so far YTD compared to last year – however the details are not very supportive- http://lapd-assets.lapdonline.org/assets/pdf/cityprof.pdf

Motor vehicle theft is up 35.5%! Homicide up 24.9% – good news Rape down 23%

France is topping Europe at 27285 confirmations per day on a 7 Day MA. 156 deaths per day

Continuing with the economic view of covid – this report notes an estimated $16 Trillion impact accounting for the cost of death similar done for climate change calculations – https://jamanetwork.com/journals/jama/fullarticle/2771764

“Since the onset of coronavirus disease 2019 (COVID-19) in March, 60 million claims have been filed for unemployment insurance. Before COVID-19, the greatest number of weekly new unemployment insurance claims (based on data from 1967 on) was 695 000 in the week of October 2, 1982. For 20 weeks beginning in late March 2020, new unemployment claims exceeded 1 million per week; as of September 20, new claims have been just below that amount.”

“The Congressional Budget Office projects a total of $7.6 trillion in lost output during the next decade.”

“The total cost is estimated at more than $16 trillion, or approximately 90% of the annual gross domestic product of the US. For a family of 4, the estimated loss would be nearly $200 000. Approximately half of this amount is the lost income from the COVID-19–induced recession; the remainder is the economic effects of shorter and less healthy life.”

Certainly life is priceless – but we all will die its just a matter of how we die and what we do about it. For the mass of society – history has shown a choice of economic prosperity outweighs health risk – hence the industrial revolution. Most don’t want to beg on the streets or worry about getting food on the table each day and rather take the risk of doing preventative actions to shift the odds into their favor – wear mask, leave location or create ventilation, wash hands, take vitamins, stay healthy eat well and exercise. When society breaks down people will do things that perhaps they would not do e.g. crime. The preventative measures that are being taken need to consider these ramifications. Many note initially quarantine was done to mitigate the hospital from being overwhelm and the unknown was so great – all makes sense at the time. Now things have changed we clearly know more hence mortality rates are down. All these emergency hospital spaces never got used outside NY. We do have buffer and we should plan to use SOME of it given the potential dire economic consequences. Would closing society mitigate covid spread – yes somewhat– but it will also do other things and we need to seriously weigh the consequences. Does closing society actually achieve the level of results needed for sustain opening – NOT in the US – just look at LA and many other counties in US. Peoples behavior is too hard to police unless we move to the China govt. model.

This study is driving the new statement of close contact by CDC – which is now anyone you spend 15 min within 24 hr even if noncontiguous – but in reality it SHOULD be to fix ventilation in rooms which will have people in it other than yourself- https://www.cdc.gov/mmwr/volumes/69/wr/mm6943e1.htm?s_cid=mm6943e1_w

“On August 11, 2020, a confirmed case of coronavirus disease 2019 (COVID-19) in a male correctional facility employee (correctional officer) aged 20 years was reported to the Vermont Department of Health (VDH). On July 28, the correctional officer had multiple brief encounters with six incarcerated or detained persons (IDPs)* while their SARS-CoV-2 test results were pending. The six asymptomatic IDPs arrived from an out-of-state correctional facility on July 28 and were housed in a quarantine unit. In accordance with Vermont Department of Corrections (VDOC) policy for state prisons, nasopharyngeal swabs were collected from the six IDPs on their arrival date and tested for SARS-CoV-2, the virus that causes COVID-19, at the Vermont Department of Health Laboratory, using real-time reverse transcription–polymerase chain reaction (RT-PCR). On July 29, all six IDPs received positive test results. VDH and VDOC conducted a contact tracing investigation† and used video surveillance footage to determine that the correctional officer did not meet VDH’s definition of close contact (i.e., being within 6 feet of infectious persons for ≥15 consecutive minutes)§,¶; therefore, he continued to work. At the end of his shift on August 4, he experienced loss of smell and taste, myalgia, runny nose, cough, shortness of breath, headache, loss of appetite, and gastrointestinal symptoms; beginning August 5, he stayed home from work. An August 5 nasopharyngeal specimen tested for SARS-CoV-2 by real-time RT-PCR at a commercial laboratory was reported as positive on August 11;”

“Although the correctional officer never spent 15 consecutive minutes within 6 feet of an IDP with COVID-19, numerous brief (approximately 1-minute) encounters that cumulatively exceeded 15 minutes did occur. During his 8-hour shift on July 28, the correctional officer was within 6 feet of an infectious IDP an estimated 22 times while the cell door was open, for an estimated 17 total minutes of cumulative exposure. IDPs wore microfiber cloth masks during most interactions with the correctional officer that occurred outside a cell; however, during several encounters in a cell doorway or in the recreation room, IDPs did not wear masks. During all interactions, the correctional officer wore a microfiber cloth mask, gown, and eye protection (goggles). The correctional officer wore gloves during most interactions. The correctional officer’s cumulative exposure time is an informed estimate; additional interactions might have occurred that were missed during this investigation.”

AS STATED OVER AND OVER SINCE EARLY ON – Its VIRAL LOAD – if you have an infected person in a room they eventually build a viral load in the space by breathing/talking and obviously coughing sneezing…..You can wear a mask and keep the viral load in check from getting into your body – but lets say you TAKE OFF the mask because the person left the room – well that doesn’t change the viral load level in room unless new air is pushed in our you have something deactivating the virus – and now you inhale without your mask well guess what – you will now be infected – you had to air out the room or sterilize it before taking the mask off! When outdoors you don’t need a mask unless the air is stagnant is because as the coal polluters know the solution to pollution is dilution. VIRAL LOAD is concentration – if you are outside the odds of the virus being in the air is much lower given the volume. IF you are really not wanting to get covid wear the mask but everyone will do their own calculation on that risk – I typically do not wear a mask outside.

It is really amazing to still hearing mask deniers – ugh….The Japanese are spending their time to prove mask work at some level for mitigation – perhaps at some point they will show that breathing allows you to live longer. https://www.reuters.com/article/uk-health-coronavirus-japan-masks-idUKKBN2770DF

“A cotton mask reduced viral uptake by the receiver head by up to 40% compared to no mask. An N95 mask, used by medical professionals, blocked up to 90%. However, even when the N95 was fitted to the face with tape, some virus particles still sneaked in.

When a mask was attached to the coughing head, cotton and surgical masks blocked more than 50% of the virus transmission.”

Along with toilet paper and hand sanitizer – add mouthwash to the next run – https://onlinelibrary.wiley.com/doi/10.1002/jmv.26514

“A 1% baby shampoo nasal rinse solution inactivated HCoV greater than 99.9% with a 2‐min contact time. Several over‐the‐counter mouthwash/gargle products including Listerine and Listerine‐like products were highly effective at inactivating infectious virus with greater than 99.9% even with a 30‐s contact time. In the current manuscript we have demonstrated that several commonly available healthcare products have significant virucidal properties with respect to HCoV.”

US over 1K

CA leading the way at 112

Palm Beach FL leads all counties at 43

Poland is shutting down as their confirmations are up – but also deaths are very high per confirmed

It has been cold in Poland

Decent positive coverage on the Covid front – https://www.npr.org/sections/health-shots/2020/10/20/925441975/studies-point-to-big-drop-in-covid-19-death-rates

“The study, which was of a single health system, finds that mortality has dropped among hospitalized patients by 18 percentage points since the pandemic began. Patients in the study had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance.

That’s a big improvement, but 7.6% is still a high risk compared with other diseases, and Horwitz and other researchers caution that COVID-19 remains dangerous.

The death rate "is still higher than many infectious diseases, including the flu," Horwitz says. And those who recover can suffer complications for months or even longer. "It still has the potential to be very harmful in terms of long-term consequences for many people."”

“"The people who are getting hospitalized now tend to be much younger, tend to have fewer other diseases and tend to be less frail than people who were hospitalized in the early days of the epidemic," Horwitz says.

So have death rates dropped because of improvements in treatments? Or is it because of the change in who’s getting sick?”

“"Clearly, there’s been something [that’s] gone on that’s improved the risk of individuals who go into these settings with COVID-19," he says.

Horwitz and others believe many things have led to the drop in the death rate. "All of the above is often the right answer in medicine, and I think that’s the case here, too," she says.”

“Horwitz believes that mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients.”

I think the last point is very important. IF you get a surge of virus in your body perhaps it causes the cytokine storm – but if the body slowly gets infected at a manageable level perhaps the body doesn’t go crazy. “Healthy” individuals in ER etc.. died as their dosage was potentially much higher than the common individual. VIRAL LOAD is key. Being healthy helps keep the viral load bar higher. Mask at some level will reduce viral load. No matter the mortality rate as an individual I would not like to get sick even a common cold – so do what you can to reduce that by washing hands, ventilate areas, wear a mask, and stay healthy exercise eat healthy and take Vitamin C, D, Zinc, and melatonin.

Vitamin D support again – https://www.nature.com/articles/s41598-020-74825-z

“We find a significant negative association between UVI and COVID-19 deaths, indicating evidence of the protective role of UVB in mitigating COVID-19 deaths. If confirmed via clinical studies, then the possibility of mitigating COVID-19 deaths via sensible sunlight exposure or vitamin D intervention would be very attractive.”

Winter is coming….get your Vitamin D – get out in the Sun when possible – There should be a govt. push for this. Free distribution to the poor neighborhoods – Dr. Fauci admits to taking it why doesn’t society deserve it?

Today I thought I would show the otherside of the equation to quarantine/lockdown – employment/unemployment. Below chart shows that before covid essentially around 60% of population was employed and unemployment rate under 5%. We have the score of re-opening from https://www.multistate.us/issues/covid-19-state-reopening-guide . Also added in the chart is the amount of deaths and confirmations = in THEORY more opening more confirmation. We can see TX and FL surge past NY in confirmation but limited deaths. Ohio had a relatively open policy compared to all the states but confirmations did not blow up – and of recent FL has opened up more.

IF we look at the metric vs. open ranking in just August we can see that opening and unemployment are connected but the confirmation per capita is not so much so. Human behavior and the ability to police that seems to overwhelm any policy. Even though CA most restrictive it hasn’t really helped them in managing spread. OH most open but one of the lowest confirmation per capita.

Still under 1K for US

FL leading US states at 84 – Confirmation in TX jump over 5K

LA leading all US counties in death 35 – El Paso leading TX in confirmation at 709 and they have the schools closed.

The big 4 is still trending down….

Belgium is rocketing up in confirmation