The Official Coronavirus Discussion

[peAk]

The curve flattening seems to be effective so far.

it actually is. Austria - after being the major European infection center (tourist + greedy and stupid tourism owners = spread throughout Europe) - has taken steps before others have done and we have been doing quite well with it. Luckily, our health system never was at maximum capacity and numbers are going down. starting may 1st, the lockdown restrictions (you were basically limited to work, shopping, some forms of sport,...) are lifted. You still need to keep distance and wear annoyingly unnecessary facemasks (according to WHO those are not really too helpful; obviously also not bad...) when shopping or using public transport and gatherings are limited to 10 people.
larger stores and restaurants are allowed to reopen in stages and with limitations.

So far, I think, we were lucky in getting this thing "under control" and preventing the worst. As far as I have read, Austria will be a guinea pig to other European stages to observe how things play out after these next steps.

Stay safe everyone and all the best!

Just curious, I had read an article the other day that was stating Germany lifted their restrictions recently and they were starting to show cases rise again.

You being a fairly close neighbor, any truth to this? Or maybe there are some German members on here that can chime in.

Texas reopens tomorrow for most things. Seems a little early IMO but I understand you have to get things moving again.

[jimilee]

I think that you will see cases rise. People are tired of staying in.  There will be a second wave as predicted, I just hope it's not worse.


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[matmosphere]

Yeah, we've kept cases to a manageable level but 2000 deaths a day is still way to much.

Maybe someone on here can help me understand why everyone thinks it's okay to start backing off restrictions. I don't feel like anything has really changed, so if we back off things what will keep this from all blowing up again?

[TheDude]

Yeah, we've kept cases to a manageable level but 2000 deaths a day is still way to much.

Maybe someone on here can help me understand why everyone thinks it's okay to start backing off restrictions. I don't feel like anything has really changed, so if we back off things what will keep this from all blowing up again?

The clamoring to reopen the economy in the US is a result of a lot of factors, but regardless of them, it seems that most people clamoring to have everything reopened all fall into two categories: they have not been directly affected (majority), or they are cold hearted and believe the fact that everyone will die someday is a valid reason to not change their daily lives in order to protect others.

Its been really interesting to see how families react when a loved one who went off about the virus being a hoax, or blown out of proportion or whatever. When we have such a large population spread out an incredibly large swath of land, its easy to play this off as a 'them' problem, but as soon as someone they know is gone due to this, it rocks their world. Of course, this also has a reverse affect when a family already believes its a hoax, then a family member survives it...

And, don't forget that a significant portion (not a majority, but significant minority) of those stumping to reopen the economy are internet meme-educated, mouth breathing, political geniuses who won't leave their house because THEY don't have to, but other people need to be getting back to work so the economy can get going again. Imagine arguing for something that puts others at risk when you're not willing to take the risk yourself. Oh, wait, you're telling me that's 98% of modern politicians who stump for war? Hmm, wonder where these people picked it up from... Talk about privilege, ha.

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[EBK]

I have to laugh at this so it doesn't drive me further insane:
My wife has decided that now is a good time to refinance our mortgage.  My first thought?  Let's wait until utter economic collapse when we can refinance for a couple rolls of toilet paper and a live chicken.  I don't have a live chicken, and now, on top of all my very real stress, I have a mortgage broker asking me for documentation and signatures.  I know from past experience that you can never satisfy a mortgage broker with just the documents they ask for.  I'm sure it will eventually come down to me needing to give them documents showing my COVID-19-negative status and proof of my life insurance coverage.
Yay!  First World problems in a post-apocalyptic world! 

[benny_profane]

Yeah, we've kept cases to a manageable level but 2000 deaths a day is still way to much.

Maybe someone on here can help me understand why everyone thinks it's okay to start backing off restrictions. I don't feel like anything has really changed, so if we back off things what will keep this from all blowing up again?

From a strictly public health perspective, there is little evidence to support backing off restrictions (in the United States). The result will be that we implemented lax half-measures of containment only to ease back because modest results were noticed.

'Flattening the curve' is a public health concept designed to alter the epidemiologic curve to alleviate the stress on the health system. Avoiding a rapid spike has achieved a plateau of sustained case incidence and mortality. The measures of social-distancing and preventative closures of non-essential scenarios where people would be in sustained, close proximity to large volumes of people outside of their familial network cut down on the creation of new clusters. The health system was not catastrophically overwhelmed and materials for supportive therapy were deployed to increase capacity.

However, we're at a point of sustained incidence and mortality. Most of these efforts have been reactionary and have not included prospective measures. Backing off of the preventative interventions now will make everything that has been done thus far merely a slowing down (which was the point of distancing etc.). In public health practice, what this allows is time to develop solutions while avoiding a collapse of the health system—it is not intended to be an end unto itself. At a minimum we need to:

- Develop effective treatment beyond supportive treatment to limit in-hospital treatment time and avoid sequelae.
- Deploy robust surveillance programs that provide mechanisms for monitoring and evaluating the prevalence and incidence of the disease. Right now, testing is ad hoc and largely ignores asymptomatic patients. There is really no firm grasp on the true extent of the disease's spread. Since you can't manage what isn't measured, there are a lot of assumptions about how things are without concrete data showing how things actually are.
- Manage expectations as to what 'normal' now means. We cannot now—or probably ever—move to the same life as before. Particularly so without effective treatment, surveillance, or a vaccine. This also has massive psychological impact as people need to be able to readjust to what normal is and be able to adjust their own behavior.

What is necessary to get back to the closest semblance of our previous 'normal' is a viable, effective, and safe vaccine. There isn't conclusive evidence that persons infected with SARS-CoV-2 develop a lasting immune response that would result in immunity (on any timeline). Coronaviruses are rather insidious and do not (generally) cause a strong immune response. Early indications also show that reinfection is certainly possible.

But, the world doesn't operate according to public health programming. Economics and politics run the show. The demands of those are what is motivating us to relax the current guidelines and policies. The most likely result from doing this, though, is that all of the efforts thus far will have just put us in a limbo of sustained incidence that will give way to a larger spike. At that point, we will have to do the whole exercise over again. Countries with large case incidence that put much stronger interventions in place saw greater reduction. When the extreme measures were relaxed, they still kept basic distancing practices in place.

[Aentons]

Yeah, we've kept cases to a manageable level but 2000 deaths a day is still way to much.

Maybe someone on here can help me understand why everyone thinks it's okay to start backing off restrictions. I don't feel like anything has really changed, so if we back off things what will keep this from all blowing up again?

From a strictly public health perspective, there is little evidence to support backing off restrictions (in the United States). The result will be that we implemented lax half-measures of containment only to ease back because modest results were noticed.

'Flattening the curve' is a public health concept designed to alter the epidemiologic curve to alleviate the stress on the health system. Avoiding a rapid spike has achieved a plateau of sustained case incidence and mortality. The measures of social-distancing and preventative closures of non-essential scenarios where people would be in sustained, close proximity to large volumes of people outside of their familial network cut down on the creation of new clusters. The health system was not catastrophically overwhelmed and materials for supportive therapy were deployed to increase capacity.

However, we're at a point of sustained incidence and mortality. Most of these efforts have been reactionary and have not included prospective measures. Backing off of the preventative interventions now will make everything that has been done thus far merely a slowing down (which was the point of distancing etc.). In public health practice, what this allows is time to develop solutions while avoiding a collapse of the health system—it is not intended to be an end unto itself. At a minimum we need to:

- Develop effective treatment beyond supportive treatment to limit in-hospital treatment time and avoid sequelae.
- Deploy robust surveillance programs that provide mechanisms for monitoring and evaluating the prevalence and incidence of the disease. Right now, testing is ad hoc and largely ignores asymptomatic patients. There is really no firm grasp on the true extent of the disease's spread. Since you can't manage what isn't measured, there are a lot of assumptions about how things are without concrete data showing how things actually are.
- Manage expectations as to what 'normal' now means. We cannot now—or probably ever—move to the same life as before. Particularly so without effective treatment, surveillance, or a vaccine. This also has massive psychological impact as people need to be able to readjust to what normal is and be able to adjust their own behavior.

What is necessary to get back to the closest semblance of our previous 'normal' is a viable, effective, and safe vaccine. There isn't conclusive evidence that persons infected with SARS-CoV-2 develop a lasting immune response that would result in immunity (on any timeline). Coronaviruses are rather insidious and do not (generally) cause a strong immune response. Early indications also show that reinfection is certainly possible.

But, the world doesn't operate according to public health programming. Economics and politics run the show. The demands of those are what is motivating us to relax the current guidelines and policies. The most likely result from doing this, though, is that all of the efforts thus far will have just put us in a limbo of sustained incidence that will give way to a larger spike. At that point, we will have to do the whole exercise over again. Countries with large case incidence that put much stronger interventions in place saw greater reduction. When the extreme measures were relaxed, they still kept basic distancing practices in place.

In the long term, does some herd immunity compensate for the initial distancing we've needed for this initial wave?

[davent]

In the long term, does some herd immunity compensate for the initial distancing we've needed for this initial wave?

Has it even been established there is immunity after surviving infection, don't think so, what goes around just keeps coming around.
dave

[TheDude]

Yeah, we've kept cases to a manageable level but 2000 deaths a day is still way to much.

Maybe someone on here can help me understand why everyone thinks it's okay to start backing off restrictions. I don't feel like anything has really changed, so if we back off things what will keep this from all blowing up again?

From a strictly public health perspective, there is little evidence to support backing off restrictions (in the United States). The result will be that we implemented lax half-measures of containment only to ease back because modest results were noticed.

'Flattening the curve' is a public health concept designed to alter the epidemiologic curve to alleviate the stress on the health system. Avoiding a rapid spike has achieved a plateau of sustained case incidence and mortality. The measures of social-distancing and preventative closures of non-essential scenarios where people would be in sustained, close proximity to large volumes of people outside of their familial network cut down on the creation of new clusters. The health system was not catastrophically overwhelmed and materials for supportive therapy were deployed to increase capacity.

However, we're at a point of sustained incidence and mortality. Most of these efforts have been reactionary and have not included prospective measures. Backing off of the preventative interventions now will make everything that has been done thus far merely a slowing down (which was the point of distancing etc.). In public health practice, what this allows is time to develop solutions while avoiding a collapse of the health system—it is not intended to be an end unto itself. At a minimum we need to:

- Develop effective treatment beyond supportive treatment to limit in-hospital treatment time and avoid sequelae.
- Deploy robust surveillance programs that provide mechanisms for monitoring and evaluating the prevalence and incidence of the disease. Right now, testing is ad hoc and largely ignores asymptomatic patients. There is really no firm grasp on the true extent of the disease's spread. Since you can't manage what isn't measured, there are a lot of assumptions about how things are without concrete data showing how things actually are.
- Manage expectations as to what 'normal' now means. We cannot now—or probably ever—move to the same life as before. Particularly so without effective treatment, surveillance, or a vaccine. This also has massive psychological impact as people need to be able to readjust to what normal is and be able to adjust their own behavior.

What is necessary to get back to the closest semblance of our previous 'normal' is a viable, effective, and safe vaccine. There isn't conclusive evidence that persons infected with SARS-CoV-2 develop a lasting immune response that would result in immunity (on any timeline). Coronaviruses are rather insidious and do not (generally) cause a strong immune response. Early indications also show that reinfection is certainly possible.

But, the world doesn't operate according to public health programming. Economics and politics run the show. The demands of those are what is motivating us to relax the current guidelines and policies. The most likely result from doing this, though, is that all of the efforts thus far will have just put us in a limbo of sustained incidence that will give way to a larger spike. At that point, we will have to do the whole exercise over again. Countries with large case incidence that put much stronger interventions in place saw greater reduction. When the extreme measures were relaxed, they still kept basic distancing practices in place.

Very eloquently spoken and informative, thank you sir. I defer to this man from here on out

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[benny_profane]

In the long term, does some herd immunity compensate for the initial distancing we've needed for this initial wave?

I should clarify: When I said that coronaviruses do not generally impart strong adaptive immunological responses, I meant that with SARS and MERS the indications are that the adapted response lasts a period of years rather than a lifetime. For the CoVs that cause common colds, the pathogenesis is less extreme and may elicit a weaker response. Hence, why people get the same non-rhinovirus or -adenovirus CoV common cold infection multiple times in their lifetime. NOTE: there are many types of the viruses that cause the common cold—even though an immune response to one may last years, or decades, you are still susceptible to the many others that cause it because they are different enough (from your immune system's point of view).

If I understand your question, you're asking if those that have antibodies will offset some of the relaxation of social-distancing because they won't be a risk of transmission? If that's it, I can't fully answer the question about herd immunity because there is so much that isn't known. We know that antibodies are present in those that have had an adaptive immune response, however, we don't know what the relationship between the antibody titer and what that means for efficacy of response or timeframe is. Also, and very importantly, we don't know if someone that has antibodies is infectious or not. That second point is very important because if someone is effectively immune, but shedding infectious viral material, they become an asymptomatic carrier.

Herd immunity is a concept that related to the effective replication rate of a pathogen. The percentage of a population that needs to be immune (either from vaccination or adaptive immune response) is a function of replication value of the pathogen. The idea is to get it so that the infection cannot spread. Different pathogens have different requirements based on their transmissibility and infectiousness.

[DLW]

Yeah, we've kept cases to a manageable level but 2000 deaths a day is still way to much.

Maybe someone on here can help me understand why everyone thinks it's okay to start backing off restrictions. I don't feel like anything has really changed, so if we back off things what will keep this from all blowing up again?

From a strictly public health perspective, there is little evidence to support backing off restrictions (in the United States). The result will be that we implemented lax half-measures of containment only to ease back because modest results were noticed.

'Flattening the curve' is a public health concept designed to alter the epidemiologic curve to alleviate the stress on the health system. Avoiding a rapid spike has achieved a plateau of sustained case incidence and mortality. The measures of social-distancing and preventative closures of non-essential scenarios where people would be in sustained, close proximity to large volumes of people outside of their familial network cut down on the creation of new clusters. The health system was not catastrophically overwhelmed and materials for supportive therapy were deployed to increase capacity.

However, we're at a point of sustained incidence and mortality. Most of these efforts have been reactionary and have not included prospective measures. Backing off of the preventative interventions now will make everything that has been done thus far merely a slowing down (which was the point of distancing etc.). In public health practice, what this allows is time to develop solutions while avoiding a collapse of the health system—it is not intended to be an end unto itself. At a minimum we need to:

- Develop effective treatment beyond supportive treatment to limit in-hospital treatment time and avoid sequelae.
- Deploy robust surveillance programs that provide mechanisms for monitoring and evaluating the prevalence and incidence of the disease. Right now, testing is ad hoc and largely ignores asymptomatic patients. There is really no firm grasp on the true extent of the disease's spread. Since you can't manage what isn't measured, there are a lot of assumptions about how things are without concrete data showing how things actually are.
- Manage expectations as to what 'normal' now means. We cannot now—or probably ever—move to the same life as before. Particularly so without effective treatment, surveillance, or a vaccine. This also has massive psychological impact as people need to be able to readjust to what normal is and be able to adjust their own behavior.

What is necessary to get back to the closest semblance of our previous 'normal' is a viable, effective, and safe vaccine. There isn't conclusive evidence that persons infected with SARS-CoV-2 develop a lasting immune response that would result in immunity (on any timeline). Coronaviruses are rather insidious and do not (generally) cause a strong immune response. Early indications also show that reinfection is certainly possible.

But, the world doesn't operate according to public health programming. Economics and politics run the show. The demands of those are what is motivating us to relax the current guidelines and policies. The most likely result from doing this, though, is that all of the efforts thus far will have just put us in a limbo of sustained incidence that will give way to a larger spike. At that point, we will have to do the whole exercise over again. Countries with large case incidence that put much stronger interventions in place saw greater reduction. When the extreme measures were relaxed, they still kept basic distancing practices in place.

I agree with a lot of what you have said here. However, I'm a little more bullish on the natural immunity point. The CoV-2 infection is controlled in virtually every person infected with CoV-2; that is to say, peak viral titer occurs early and continues to decline until recovery/death. This is not due to latency like happens with retroviruses. Rather, it is almost certainly a consequence of a protective anti-viral response. Even in folks that succumb, they have relative (to themselves earlier in the infection) low viral titers at death, and the death is brought on by edema, clotting, etc. caused by an exuberant immune response that fails to resolve properly. Second, high inoculum size and high peak viral titers definitely correlate with disease severity and mortality. I hope I didn't give that impression in the previous sentences. This is why prophyaxis treatments will likely and Remdesivir already has shown benefit. I'd bet that high viral titer early has a bigger influence on the ability to resolve inflammation than overwhelming the ability to eliminate the virus. Third, in virtually every situation where humans have naturally and fully resolved a viral infection, we have developed some amount of protective memory. Lastly, early evidence suggests that CoV-2 doesn't mutate or shift nearly as much as seasonal flu. This is reassuring from a natural immunity and vaccine perspective. It seems unlikely that we will engage in 'immunity whack-a-mole game', like we do with seasonal flu....This is all roundabout way of saying...Although, it's still open question regarding CoV-2, because well, it's a novel virus, I think it is more likely than not that humans won't be exterminated by SARS-CoV-2. Immunity may not be long-lived and may not be sterilizing, but previous exposure will almost certainly be beneficial upon reexposure. I also think the prospects for a successful vaccine are high, and (eventual) herd immunity higher.

[m-Kresol]

Just curious, I had read an article the other day that was stating Germany lifted their restrictions recently and they were starting to show cases rise again.

You being a fairly close neighbor, any truth to this? Or maybe there are some German members on here that can chime in.

Texas reopens tomorrow for most things. Seems a little early IMO but I understand you have to get things moving again.

I actually haven't followed. News are all over the place and I never can keep up with which info is from where. Germany is handling it's states separately I think, so not sure.

[Scruffie]

Just curious, I had read an article the other day that was stating Germany lifted their restrictions recently and they were starting to show cases rise again.

You being a fairly close neighbor, any truth to this? Or maybe there are some German members on here that can chime in.

Texas reopens tomorrow for most things. Seems a little early IMO but I understand you have to get things moving again.

I actually haven't followed. News are all over the place and I never can keep up with which info is from where. Germany is handling it's states separately I think, so not sure.

I spoke to my old partner from Germany at the weekend and she indeed was going back to work starting this week.

There have been some rises there too, yes, although possibly not 'hard' rises. And it is a state issue, not a federal so this doesn't apply everywhere.

[benny_profane]

I agree with a lot of what you have said here. However, I'm a little more bullish on the natural immunity point. The CoV-2 infection is controlled in virtually every person infected with CoV-2; that is to say, peak viral titer occurs early and continues to decline until recovery/death. This is not due to latency like happens with retroviruses. Rather, it is almost certainly a consequence of a protective anti-viral response. Even in folks that succumb, they have relative (to themselves earlier in the infection) low viral titers at death, and the death is brought on by edema, clotting, etc. caused by an exuberant immune response that fails to resolve properly. Second, high inoculum size and high peak viral titers definitely correlate with disease severity and mortality. I hope I didn't give that impression in the previous sentences. This is why prophyaxis treatments will likely and Remdesivir already has shown benefit. I'd bet that high viral titer early has a bigger influence on the ability to resolve inflammation than overwhelming the ability to eliminate the virus. Third, in virtually every situation where humans have naturally and fully resolved a viral infection, we have developed some amount of protective memory. Lastly, early evidence suggests that CoV-2 doesn't mutate or shift nearly as much as seasonal flu. This is reassuring from a natural immunity and vaccine perspective. It seems unlikely that we will engage in 'immunity whack-a-mole game', like we do with seasonal flu....This is all roundabout way of saying...Although, it's still open question regarding CoV-2, because well, it's a novel virus, I think it is more likely than not that humans won't be exterminated by SARS-CoV-2. Immunity may not be long-lived and may not be sterilizing, but previous exposure will almost certainly be beneficial upon reexposure. I also think the prospects for a successful vaccine are high, and (eventual) herd immunity higher.

I don't disagree with you regarding acquired immunity in principle; however, from a cautious public health standpoint, I'd rather have definitive proof and have measurable indicators that can be used for programmatic planning before acting on that information. I think that you're probably right about adapted immune response, but questions remain on how to test/measure that response and also be sure that those with adapted responses are not shedding infectious material.

Can you show me where you've seen the titer analysis? I wasn't aware that there was a uniform presentation of viral load with disease progression? Also, I don't think that viral titer has been meaningfully associated with severity of pathogenesis? Remdesivir is an interesting case. It's been tried with almost all recent viral outbreaks after showing promise in the lab / animal trials (practical application hasn't worked so well). The results so far with compassionate administration and the case/control study do indicate that there's some level of treatment efficacy. It's rather modest and far from anything that can be considered a gold standard treatment, though, so I think there's still much more that needs to be developed. I haven't heard much regarding successful prophylaxis treatments?

I agree with all your points regarding viral mutation and human adaptation to pathogens. That being the case, even with historic speed of vaccine development (aided by a rather stable virus), we're still quite some time before it would hit the market. I'm concerned that clinical phases may be fast-tracked to the point that we might not end up with the most efficacious/safe vaccine if things are too accelerated. There are things that simply cannot be rushed. Then, we have to deal with scaling production and coordinating administration (not to mention getting people to actually trust in a vaccine—which seems harder every year).

My concerns come primarily from a perspective of short- to medium-term public health (PH) programming. Until vaccine research and treatment development can catch up, PH interventions are the best thing that we have to limit the burden of disease and the best way to support the efforts of vaccine/treatment development. Because of this, I think the PH interventions outlined above—particularly robust surveillance—are absolutely necessary before moving forward with relaxing behavioral interventions. However, the PH aims are competing with political and economic demands. Both of which are putting everything on an accelerated timeline.

[Willybomb]

In the meantime, Australia is recording only a couple new cases a day in total.  In some states, none.  It'll be interesting to see how we go in terms of relaxing restrictions.