virus news … (+ some dark humor)

Fox's Neil Cavuto is so, so done with this dangerous Trump sycophant anti-science bullshit.

Cavuto: When's the last time you have [treated a patient]?
Biggs: I'm not a trained physician–
Cavuto: But you're telling the ones who ARE to get out! pic.twitter.com/MZtKdaQsVw

— Brian Tyler Cohen (@briantylercohen) July 2, 2020

from Rocketing Covid-19 infections expose Trump’s callous claim pandemic is ‘handled’

https://www.cnn.com/2020/07/03/politics/donald-trump-coronavirus-texas-arizona-florida/index.html

The United States, the world leader in Covid-19 infections and deaths, is reeling from an out-of-control resurgence of the virus that is racking up record numbers of 50,000-plus new infections each day now.
Texas, Florida and Arizona — Republican-run states that most aggressively embraced Trump’s impatient demands to get the economy open again — are heading into what one expert warned is a viral threat that is approaching “apocalyptic” levels.

CBS host reveals Trump has blocked Dr. Fauci interviews for ‘last three months’https://t.co/b7z3LEDXck

— Raw Story (@RawStory) July 5, 2020

After attending a church coronavirus party with no face mask requirement, a 17 y.o. girl was given antibiotics, hydroxychloroquine & oxygen at home after falling ill 9 days later. Her parents declined intubation & she died in a Miami-Dade County hospital. https://t.co/Z5cOmCEqHh

— Woobie🌹Tuesday (@WoobieTuesday) July 7, 2020

zn wrote:

Coronavirus herd immunity may be ‘unachievable’ because antibodies disappear after a few weeks in some people

more

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from COVID-19: Trying for herd immunity without vaccine ‘unethical’ and ‘unachievable

https://www.bioworld.com/articles/436257-covid-19-trying-for-herd-immunity-without-vaccine-unethical-and-unachievable

A large epidemiological study published in the July 6, 2020, advance online issue of The Lancet found that most individuals who became infected with SARS-CoV-2 developed antibodies to the virus, confirming that infection usually results in at least a short-term immune response.

However, the results of antibody testing also showed that at least a third of SARS-CoV-2 infections were asymptomatic, and in some of those patients, the antibody response waned more quickly, potentially leaving them vulnerable to reinfection.

…

Within Europe, Sweden’s attempt to achieve herd immunity via avoiding lockdowns for the general population has resulted in one of the highest per capita COVID-19 death rates of the world. But as of the end of April, around 7.4% of the Swedish population had antibodies to SARS-CoV-2.

In a commentary that was published along with the ENE-COVID study results, researchers at the University of Geneva’s Center for Emerging Viral Diseases wrote that “any proposed approach to achieve herd immunity through natural infection is not only highly unethical, but also unachievable.”

The authors of the study themselves made the same point. “Despite the high impact of COVID-19 in Spain” – which was the epicenter of the European outbreak after Lombardy, and has had the highest number of diagnosed cases of any country in the European Union – “prevalence estimates remain low and are clearly insufficient to provide herd immunity,” they wrote. Such herd immunity “cannot be achieved without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems.”

Conservative media: "we shouldn't have to wear masks"
Liberal media: "it's so embarrassing that we aren't even allowed to travel to Europe"
Millions of people: https://t.co/as1inmxAHd

— Kate Willett (@katewillett) July 7, 2020

Hospitalizations are a leading indicator, deaths are a lagging indicator. What’s happening in Texas is not bolstering the “fewer deaths” narrative. https://t.co/wjJNyhdYdq

— Jane McManus (@janesports) July 7, 2020

White House appears to be deliberately excluding Dr Fauci from today’s task force press briefing after @realDonaldTrump said yesterday he “disagrees” with Fauci on COVID. https://t.co/Qc2cpMUEmS

— Paula Reid (@PaulaReidCBS) July 8, 2020

Many state legislators flouted recommendations to wear a mask inside the Capitol in recent weeks, but now, about one in six lawmakers have tested positive for the virus. https://t.co/gU0LUGSmLe

— Clarion Ledger (@clarionledger) July 8, 2020

from COVID-19 Cases Are Rising, So Why Are Deaths Flatlining?

https://www.theatlantic.com/ideas/archive/2020/07/why-covid-death-rate-down/613945/

For the past few weeks, I have been obsessed with a mystery emerging in the national COVID-19 data.

Cases have soared to terrifying levels since June. Yesterday, the U.S. had 62,000 confirmed cases, an all-time high—and about five times more than the entire continent of Europe. Several U.S. states, including Arizona and Florida, currently have more confirmed cases per capita than any other country in the world.

But average daily deaths are down 75 percent from their April peak. Despite higher death counts on Tuesday and Wednesday, the weekly average has largely plateaued in the past two weeks.

…

What follows are five possible explanations for the case-death gap. Take them as complementary, rather than competing, theories.

1. Deaths lag cases—and that might explain almost everything.

You can’t have a serious discussion about case and death numbers without noting that people die of diseases after they get sick. It follows that there should be a lag between a surge in cases and a surge in deaths. More subtly, there can also be a lag between the date a person dies and the date the death certificate is issued, and another lag before that death is reported to the state and the federal government. As this chart from the COVID Tracking Project shows, the official reporting of a COVID-19 death can lag COVID-19 exposure by up to a month. This suggests that the surge in deaths is coming.

In Arizona, Florida, and Texas, the death surge is already happening. Since June 7, the seven-day average of deaths in those hot-spot states has increased 69 percent, according to the COVID Tracking Project.

The death lag is probably the most important thing to understand in evaluating the case-death gap. But it doesn’t explain everything. Even where deaths are rising, corresponding cases are rising notably faster.

2. Expanded testing is finding more cases, milder cases, and earlier cases.

… That’s just wrong. Since the beginning of June, the share of COVID-19 tests that have come back positive has increased from 4.5 percent to 8 percent. Hospitalizations are skyrocketing across the South and West. Those are clear signs of an underlying outbreak.

Something subtler is happening. The huge increase in testing is an unalloyed good, but it might be tricking us with some confusing weeks of data.

In March and April, tests were scarce, and medical providers had to ration tests for the sickest patients. Now that testing has expanded into communities across the U.S., the results might be picking up milder, or even asymptomatic, cases of COVID-19.

The whole point of testing is to find cases, trace the patients’ close contacts, and isolate the sick. But our superior testing capacity makes it difficult to do apples-to-apples comparisons with the initial surge; it’s like trying to compare the height of two mountains when one of the peaks is obscured by clouds. The epidemiologist Ellie Murray has also cautioned that identifying new fatal cases of COVID-19 earlier in the victims’ disease process could mean a longer lag between detection and death. This phenomenon, known as “lead time bias,” might be telling us that a big death surge is coming.

And maybe it is. Maybe this is all as simple as nationwide deaths are about to soar, again.

But there are still three reasons to think that any forthcoming death surge could be materially different from the one that brutalized the Northeast in March and April: younger patients, better hospital outcomes, and summer effects.

3. The typical COVID-19 patient is getting younger.

The most important COVID-19 story right now may be the age shift.

In Florida, the median age of new COVID-19 cases fell from 65 in March to 35 in June. In its latest daily report, the Florida Department of Health says the median age is still in the high 30s.* In Arizona, Texas, and California, young adults getting sick have been driving the surge.

If the latest surge is concentrated among younger Americans, that would partly explain the declining death count. Young people are much less likely to die from this disease, even if they face other health risks. International data from South Korea, Spain, China, and Italy suggest that the COVID-19 case-fatality rate for people older than 70 is more than 100 times greater than for those younger than 40.

The youth shift seems very real, but what’s behind it is harder to say. Maybe older Americans are being more cautious about avoiding crowded indoor spaces. Maybe news reports of young people packing themselves into bars explain the youth spike, since indoor bars are exquisitely designed to spread the virus. Or maybe state and local governments that rushed to reopen the economy pushed young people into work environments that got them sick. “The people in the service economy and the retail industry, they tend to be young, and they can’t work remotely,” says Natalie Dean, an assistant professor at the University of Florida. Texas Governor Greg Abbott blamed reckless young people for driving the spike, but the true locus of recklessness might be the governor’s mansion.

No matter the cause, interpreting the “youth surge” as good news would be a mistake. Young people infected with COVID-19 still face extreme dangers—and present real danger to their close contacts and their community. “We see people in their 20s and 30s in our ICUs gasping for air because they have COVID-19,” James McDeavitt, the dean of clinical affairs at Baylor College of Medicine, told The Wall Street Journal. Young people who feel fine can still contract long-term organ damage, particularly to their lungs. They can pass the disease to more vulnerable people, who end up in the hospital; a youth surge could easily translate into a broader uptick some weeks from now. And the sheer breadth of the youth surge could force businesses to shut down, throwing millions more people into limbo or outright unemployment.

4. Hospitalized patients are dying less frequently, even without a home-run treatment.

So far, we’ve focused on the gap between cases and deaths. But there’s another gap that deserves our attention. Hospitalizations and deaths moved up and down in tandem before June. After June, they’ve diverged. National hospitalizations are rising, but deaths aren’t.

The hospitalization and death data that we have aren’t good enough or timely enough to say anything definitive. But the chart suggests some good news (finally): Patients at hospitals are dying less.

Indeed, other countries have seen the same. One study from a hospital in Milan found that from March to May, the mortality rate of its COVID-19 patients declined from 24 percent to 2 percent—”without significant changes in patients’ age.” British hospitals found that their hospital mortality rate has declined every month since April.

So what’s going on? Maybe doctors are just getting smarter about the disease.

In early 2020, the novelty of the coronavirus meant that doctors had no idea what to expect. Health-care professionals were initially shocked that what they assumed to be a respiratory disease was causing blood clots, microvascular thrombosis, and organ damage. But millions of cases and hundreds of white papers later, we know more. That’s how, for example, doctors know to prescribe the steroid dexamethasone to rein in out-of-control immune responses that destroy patients’ organs.

Finally, it’s notable that mortality declined in Italian and British hospitals when they weren’t overrun with patients. This is another reason why flattening the curve isn’t just a buzzy slogan, but a matter of life and death. As hospitals across Texas and Arizona start to fill up, we’ll see whether hospital mortality increases again.

5. Summer might be helping—but probably only a little bit.

….as more people wear masks and move their activities outside in the summer, they might come into contact with smaller infecting doses of COVID-19. Some epidemiologists have claimed that there is a relationship between viral load and severity. With more masks and more outdoor interactions, it’s possible that the recent surge is partly buoyed by an increase in these low-dosage cases.

Study of 17 Million Identifies Crucial Risk Factors for Coronavirus Deaths

link https://www.nytimes.com/2020/07/08/health/coronavirus-risk-factors.html

An analysis of more than 17 million people in England — the largest study of its kind, according to its authors — has pinpointed a bevy of factors that can raise a person’s chances of dying from COVID-19, the disease caused by the coronavirus.

The paper, published Wednesday in Nature, echoes reports from other countries that identify older people, men, racial and ethnic minorities, and those with underlying health conditions among the more vulnerable populations.

“This highlights a lot of what we already know about COVID-19,” said Uchechi Mitchell, a public health expert at the University of Illinois at Chicago who was not involved in the study. “But a lot of science is about repetition. The size of the study alone is a strength, and there is a need to continue documenting disparities.”

The researchers mined a trove of de-identified data that included health records from about 40% of England’s population, collected by the United Kingdom’s National Health Service. Of 17,278,392 adults tracked over three months, 10,926 reportedly died of COVID-19 or COVID-19-related complications.

“A lot of previous work has focused on patients that present at hospital,” said Dr. Ben Goldacre of the University of Oxford, one of the authors on the study. “That’s useful and important, but we wanted to get a clear sense of the risks as an everyday person. Our starting pool is literally everybody.”

Goldacre’s team found that patients older than 80 were at least 20 times more likely to die from COVID-19 than those in their 50s and hundreds of times more likely to die than those below the age of 40. The scale of this relationship was “jaw-dropping,” Goldacre said.

Additionally, men stricken with the virus had a higher likelihood of dying than women of the same age. Medical conditions such as obesity, diabetes, severe asthma and compromised immunity were also linked to poor outcomes, in keeping with guidelines from the Centers for Disease Control and Prevention in the United States. And the researchers noted that a person’s chances of dying also tended to track with socioeconomic factors like poverty.

The data roughly mirror what has been observed around the world and are not necessarily surprising, said Avonne Connor, an epidemiologist at Johns Hopkins University who was not involved in the study. But seeing these patterns emerge in a staggeringly large data set “is astounding” and “adds another layer to depicting who is at risk” during this pandemic, Connor said.

Particularly compelling were the study’s findings on race and ethnicity, said Sharrelle Barber, an epidemiologist at Drexel University who was not involved in the study. Roughly 11% of the patients tracked by the analysis identified as nonwhite. The researchers found that these individuals — particularly Black and South Asian people — were at higher risk of dying from COVID-19 than white patients.

That trend persisted even after Goldacre and his colleagues made statistical adjustments to account for factors like age, sex and medical conditions, suggesting that other factors are playing a major role.

An increasing number of reports have pointed to the pervasive social and structural inequities that are disproportionately burdening racial and ethnic minority groups around the world with the coronavirus’s worst effects.

Some experts pointed out flaws in the researchers’ methodology that made it difficult to quantify the exact risks faced by members of the vulnerable groups identified in the study. For instance, certain medical conditions that can exacerbate COVID-19, like chronic heart disease, are more prevalent among Black people than white people.

The researchers removed such variables to focus solely on the effects of race and ethnicity. But because Black individuals are also more likely to experience stress and be denied access to medical care in many parts of the world, the disparity in rates of heart disease may itself be influenced by racism, said Usama Bilal, an epidemiologist at Drexel University who was not involved in the new analysis. Ignoring the contribution of heart disease, then, could end up inadvertently discounting part of the relationship between race and ethnicity and COVID-19-related deaths.

The study was also not set up to conclusively show cause-and-effect relationships between risk factors and COVID-19 deaths.

Regardless of the methodological drawbacks of this study, experts agree that “the causes of disparities, whether in COVID-19 or other aspects of health, are intricately linked to structural racism,” Mitchell said.

In the United States, Latino and African American residents are three times as likely to become infected by the coronavirus as white residents, and nearly twice as likely to die.

Many of these individuals work as front-line employees or are tasked with essential in-person jobs that prevent them from sheltering in place at home. Some live in multigenerational households that can compromise effective physical distancing. Others must cope with language barriers and implicit bias when they seek medical care.

Any study publishing data on an ongoing and fast-shifting pandemic will inevitably be imperfect, said Julia Raifman, an epidemiologist at Boston University who was not involved in the study.

But the new paper helps address “a real paucity of data on race,” Raifman added. “These disparities are not just happening in the United States.”

With regard to the racial inequities in this pandemic, Barber said, “I think what we’re seeing is real, and it’s not a surprise. We can learn from this study and improve on it. It gives us clues into what might be happening.”

from ‘Code blue’: Texas COVID deaths higher than publicly reported – and spiking

https://www.houstonchronicle.com/news/houston-texas/houston/article/As-COVID-19-continues-to-slam-Houston-the-death-15400462.php

Centers for Disease Control and Prevention data shows Texas is one of 24 states that publicly reports only confirmed COVID deaths, not “probable” ones. And with rampant testing shortages in Texas, many patients likely died without being screened for the disease, experts said.

Texas ranks 40th out of 50 states and the District of Columbia in deaths per 100,000 population on the CDC COVID tracer. But that is potentially misleading since it compares Texas with 27 states that include “probable cases.” Nearly one in five deaths reported in New York City, the national epicenter for COVID-19, was reported as a “probable.”