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The patterns of a pandemic

by Frank Schnittger Mon Mar 23rd, 2020 at 11:53:13 AM EST

Update [2020-3-23 23:40:41 by Frank Schnittger]:Table updated

You can find the table above constantly updated here, where you can also sort it by each column header.

A number of factors can influence the spread and mortality rate of the pandemic in different countries:

  1. Timing - the number of days since the first case in a region
  2. Preparedness - the ability of local hospital facilities to cope with rapidly elevating demand
  3. Timing and effectiveness of counter-measures taken - principally non-pharmaceutical interventions like the closure of schools, pubs, restaurants, non essential business contacts, sporting events, and the practice of self isolation, physical distancing and personal hygiene.
  4. Level of testing and contact tracing
  5. Demographics - older people (and men), especially with pre-existing serious medical conditions, are disproportionately at risk

All countries can be criticised for being too slow to take effective counter-measures, but some were slower than others. China, as the first in the front line, can be forgiven for taking some time to identify the threat, but acted most effectively thereafter, driven by their SARS experience. They are also the first and only country to have effectively contained the outbreak, and yet other countries were slow to take their advice.

Some countries, principally the USA, were in effective denial, and thought the outbreak could be contained by PR, bluff and bluster, their standard response to any threat. Others, principally the UK and Holland, flirted with herd immunity theories, more appropriate in the context of vaccination drives, and recanted only when presented with evidence of the high mortality rates implied by that strategy. In practice, they may still be following that approach, but cannot say so openly as that would involve taking responsibility for those deaths.

Other countries are limiting the amount of testing they are doing to hospital admissions only, resulting in a gross overall case under-count, and eliminating contact tracing as a possible counter-measure despite the fact that this was central to the ultimately successful Chinese containment strategy. This results in the "Confirmed case fatality rate" column in the table above becoming much elevated as the denominator - "Confirmed cases" is a gross under-estimate. The USA, UK, and Holland may be in that camp, although the relatively early stage of their pandemics has yet to be translated into a much higher than average fatality rate.

Germany has a remarkably low Confirmed Case Fatality Rate of 0.42%, probably because of a more rigorous testing regime and a health service not yet overwhelmed by case numbers concentrated in a particular area. Other demographic factors, such as an ageing population, are similar to Italy, and are less likely to be a cause of the discrepancy between that low rate and Italy's catastrophic 9.26% fatality rate.

Those countries that were slow to take radical action because of their political cultures or social norms are now paying a terrible price. Spain, in particular, was slow to close its cafes and now is proceeding rapidly up the deaths table column. Ireland, despite being led by a small minority caretaker government recently resoundingly defeated at the polls took radical action quite early in the pandemic, and may now be starting to reap the benefit with new case numbers stabilising despite a massive increase in testing:

(Update [2020-3-23 22:33:3 by Frank Schnittger]:Since this diary was written, there has been a record 219 increase in cases in Ireland on 23/03/2020 as shown above). Further update: 204 new cases were confirmed for 24/03/2020, 235 cases for 25/03/2020, 255 for 26/3, 302 cases for 27/3, 294 cases for 28/3,and 200 cases for 29/3.

It is too early to say whether Ireland has turned the corner, however, because there is a massive backlog of 40,000 people waiting to be tested, and those tests would only have been ordered if there was some symptomatic reason for doing so. Additional testing sites are being opened all over the country, and so an additional surge of confirmed cases can be expected. So far the death rate, at 0.44%, is comparable to Germany's however, and the health system has not yet been overwhelmed. An increasing number of health workers are testing positive however, so staffing could soon become a problem.

terms (Timing (n/period), Preparedness (?), effectiveness of counter-measures (?), "Level" (vol or val?) tests, (vol or val?) contacts) of the frequency deaths, confirmed cases
to solve a multi-valent qualitative problem.
Is this what a "number pattern" is suppose to reveal?
by Cat on Mon Mar 23rd, 2020 at 04:08:43 PM EST
I'm sure those are all variables in the epidemiological models used by Imperial College and others to estimate the outcomes of various scenarios - which led the UK government to do a swift about turn (at least officially) on their "herd immunity strategy". I don't know if they have published the parameters of their model or made it available to other researchers.

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Mon Mar 23rd, 2020 at 05:55:18 PM EST
[ Parent ]
equivalent US and UK total estimated population size

All the numbers are ratios, [any case] incidence per 100,000. That is, the authors' modeling has no factual basis of measurement--time, area, family size, business size x occup'n, school class x grade, contact duration, recover duration, etc-- occurring in the target population any or each level of "sample" analysis.

They transpose recorded frequencies from Wuhan as if these cultural norms were equivalent.

This crude dressing down medical srvc utilization to zero ("peak") for an "NPI" policy recco. whatevs. I bet they animate the curves for Boris.

But here's a particularly wild claim, citing MedRix.org (wtf) not peer-reviewed data sources, which definitively impugns merits of the study.

Analyses of data from China as well as data from those returning on repatriation flights suggest that 40-50% of infections were not identified as cases 12. This may include asymptomatic infections, mild disease and a level of under-ascertainment. We therefore assume that two-thirds of cases are sufficiently symptomatic to self-isolate (if required by policy) within 1 day of symptom onset, and a mean  delay from onset of symptoms to hospitalisation of 5days. The age-stratified proportion of infections that require hospitalisation and the infection fatality ratio(IFR) were obtained from an analysis of  a subset of cases from China 12.

by Cat on Mon Mar 23rd, 2020 at 11:02:54 PM EST
[ Parent ]
Social distancing ... pretty please?

'Sapere aude'
by Oui (Oui) on Mon Mar 23rd, 2020 at 04:10:27 PM EST
TfL has reportedly reduced the number of trains.As a result, the remaining trains are more crowded, because people still commute to work.

In France, lockdown is strictly applied and the trains/buses schedules have been reduced and redirected to support healthcare personnel (who can now ride nationwide for free when on a mission).

by Bernard (bernard) on Mon Mar 23rd, 2020 at 06:56:34 PM EST
[ Parent ]
One figure that has puzzled me since MSM first publicized it is, US influenza CFR is 0.1%. This figure is patently false. My question therefore was terms of the expression which produced it.

I suspected the error is the selected value of the denominator. I have shown here that the estimated frequency produced by CDC FluView modeling derives from deaths/hospitalization--ergo diagnosed, or "confirmed", cases, given numerous limitations in data collection, admitted by CDC.

Indeed, in review of numerous, spurious expositions published by innerboob amateur exposition, TOTAL POPULATION SIZE is the choice CFR denominator. This is stupidity beyond the pale of rudimentary principles of statistical description. And a problem in itself that cannot be remedied by quantities of money or PPE hastily delivered to everyone on the planet.

by Cat on Mon Mar 23rd, 2020 at 04:22:16 PM EST
Since Little Ronnie RayGuns started it Republicans have steadily chipped away at federal and state funding for Public Health.  Can't do data gathering and analysis if the people aren't there.

She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre
by ATinNM on Mon Mar 23rd, 2020 at 08:01:09 PM EST
[ Parent ]
There's huge confusion between CFR, Infection Fatality Rate, and Population Mortality.

CFR - deaths/known cases
IFR - deaths/estimated infections
PM - deaths as an absolute percentage of the population

You can't estimate the IFR accurately without statistically significant random population sampling. No country has done this, although Germany may have come closest. (Korea's sampling was skewed by explicit tracking of one subgroup.)

All of the above depend on the quality and availability of health care. There's no formal measure for Base Mortality, which is what you'd get if you exposed a large population and didn't provide any health care at all. That would be a population worst case, and for obvious reasons no one does this - although in fact it would still depend on basic health, social customs, and so on.

Allowing for 80% infection, which is an epidemiological worst case (likely true in the UK, not so much in countries with good early lockdown, plentiful testing, and case tracking) according to one estimate the likely population mortality will be around 0.15%.

Case Fatality Rates

Although the horror stories are getting the most attention, the reality is that around 70% of cases are either asymptomatic or mild.

But the others are bad news, because the remaining numbers will still overwhelm most health care systems - even the well prepared ones. And with asymptomatic transmission, the total number of infections will be higher than it would have been otherwise.

Putting all of that together with some guessing, the final death toll in the UK will likely be in the low six figures, or high five figures if the country is very lucky.

That's better than seven figure estimates you get by naively applying CFR to the entire population. But it's still going to be a life-changing outbreak for a lot of people, one way or another.

by ThatBritGuy (thatbritguy (at) googlemail.com) on Tue Mar 24th, 2020 at 01:57:49 PM EST
[ Parent ]
France was ready to shut border had UK not toughened coronavirus measures
PARIS -- French President Emmanuel Macron told British Prime Minister Boris Johnson on Friday that he would close the border if the U.K. did not take more restrictive measures to contain the coronavirus.

"We had prepared the closure of our border and told Prime Minister Johnson we would implement it that day if there was no evolution [of British measures]," a senior French official familiar with the conversation told POLITICO.

French paper Libération reported Saturday evening that Macron had "threatened" Johnson. The French official said that was "too strong a word" to describe the call.

Continental blockade barely averted.

by Bernard (bernard) on Tue Mar 24th, 2020 at 08:57:15 PM EST
[ Parent ]
Entente cordiale on full display.

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty
by melo (melometa4(at)gmail.com) on Sat Mar 28th, 2020 at 02:35:00 AM EST
[ Parent ]
I'll just leave this here for posterity, when the fingers quit wagging. Central limit etc etc

CDC | How CDC estimates Influenza-Associated Deaths in the U.S.

Laboratory-confirmed influenza-associated hospitalization rates are obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), a collaboration between CDC, the Emerging Infections Program Network, and selected state and local health departments in 13 geographically distributed areas in the United States that conduct population-based surveillance. The network includes hospitals that serve roughly 9% of the U.S. population. The reported numbers of hospitalizations are used to calculate hospitalization rates and the rates are adjusted to correct for under-detection of influenza.  This adjustment is done by using the percent of persons hospitalized with respiratory illness who were tested for influenza and the average sensitivity of influenza tests used in the participating FluSurv-NET hospitals. The data on influenza testing can lag up to two years after the end of the season, so for more recent seasons, testing data from prior seasons is used (1).
Some people with influenza will seek medical care, while others will not. CDC estimates the number of people who sought medical care for influenza using data from the 2010 Behavioral Risk Factor Surveillance Survey, which asked people whether they did or did not seek medical care for an influenza-like illness in the prior influenza season (6).
The methods to estimate the annual number of influenza-associated deaths  have been described in detail elsewhere (1-2). The model uses a ratio of deaths-to-hospitalizations in order to estimate the total influenza-associated deaths from the estimated number of influenza-associated hospitalizations.
beside me da's urn, etched "failure to thrive"
Doctors And Nurses Say More People Are Dying Of COVID-19 In The US Than We Know
In the US, state and county authorities are responsible for collecting data on cases of [INSERT DISEASE], and deaths. The data is then reported to the Centers for Disease Control and Prevention.
by Cat on Sat Mar 28th, 2020 at 02:55:59 AM EST
[ Parent ]
Propounding categorical error and propaganda.

In most cases, I think, medical pros are trained to respond to hearts and minds of the living with a visceral, idiomatic explanation of death at the moment of death--whether or not its circumstance is "violent". However, additional responsibilities for and discrete knowledge of death's process also burden the medical pro. (eg. I had a strangely satisfactory exchange with the resident neurologist on evolving locutions for "brain death," while my ma lay dead and intubated.)

Final value assignment--industrial purpose for quantification--necessarily subordinates pathological minutia normally dismissed by the bereaved: proximal (pneumonia, myocardial infarction, etc) and distal (COVID-19, emphysema, etc) and comorbid disease(s)(diabetes, TB, etc) and pathogen (SARS-CoV-2, Staphylococcus, etc) and medical error or fraud.
Sorting Things Out, Classification and Its Consequences + diverse "bioethical" tracts in consideration of disparate bodies of information operating on perceptions of competence

by Cat on Sat Mar 28th, 2020 at 02:05:01 PM EST
[ Parent ]
The Data Whisperer
She has a way of spelling out the implications of the virus to Americans in personal terms while offering reassurances that the administration is approaching the pandemic with a data-driven mindset.
"knowledge base," sociolect, "experience-based" creditial. ahem.
Others worry that Birx, who stepped away from her job as the U.S. global AIDS coordinator to help lead the White House coronavirus response, may be offering Trump cover to follow some of his worst instincts as he considers whether to have people packing the pews by Easter Sunday.
< wipes tears >
by Cat on Sat Mar 28th, 2020 at 04:35:18 PM EST
[ Parent ]

Based on original flu modeling report from Imperial College in London with faulty assumptions.

'Sapere aude'

by Oui (Oui) on Sat Mar 28th, 2020 at 05:27:39 PM EST
[ Parent ]
by Cat on Sat Mar 28th, 2020 at 06:04:55 PM EST
[ Parent ]
Probably true at this stage, given they have wasted so much time when they could have been working on reducing that number!

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Sat Mar 28th, 2020 at 07:19:21 PM EST
[ Parent ]
contact traced -> zero "exponentially"
by Cat on Mon Mar 23rd, 2020 at 05:10:45 PM EST
In the last two days I've seen two different facebook cut and paste postings from two very different old friends. One reposted by an anti-abortion maga type purported to be a description of a chance meeting with an old man who very charmingly described how in his day America had real viruses like polio and measels, but didn't let them shut down the country. The other was reposted by a very liberal love to all mankind sort and purported to be from an ER doctor complaining about 3M and P&G not doing their part to get them the equipment they need.
Both stories were several paragraphs long. Both mentioned America winning two world wars because it was so great. Both were unsigned without noting any sort of location. Both felt like fiction from the same writer.
That's some cynical shit.
by Andhakari on Mon Mar 23rd, 2020 at 08:52:01 PM EST
Texas: Sometimes We Are FOR Choice

Texas Anti-Vaxxers Fear Mandatory COVID-19 Vaccines More Than the Virus Itself

On Friday, just after Governor Greg Abbott declared a statewide emergency in response to the coronavirus, Sarah posted a worried plea on a local anti-vaccine Facebook group. She worried that the declaration gives the government the right to "force vaccinations" on unwilling Texans.

But for anti-vaxxers, it's a question of individual liberty.

"It's our human right to be able to decide what is put into our bodies," said Jessica Davis, a mom of five in East Texas. "I will not sacrifice my family or my body so others can feel `safe' from a virus that is affecting so few people."

Winnike said the fear that men in masks will start knocking on doors and forcing people to get vaccinated is "an invention" of the anti-vaxxer movement. "It's part of their fear mongering," she said. "That's not how we do public health in the United States."

Texans for Vaccine Choice, the PAC, posted on Facebook Saturday that they're not against medical advancements, "as long as they are never, ever at the expense of informed consent, medical privacy, and vaccine choice."

Reached for comment, the PAC wrote, "It is also our position that the fast-track designation of the vaccine which began human trials today is cause for concern, as essential steps in the safety assessment process will not be undertaken before administering the vaccine to healthy individuals."

Houston-based company ready to test COVID-19 'vaccine candidate,' but doesn't have the funds

PS The survivors of a crisis never had a problem with the hard choices made ...

'Sapere aude'

by Oui (Oui) on Mon Mar 23rd, 2020 at 09:42:48 PM EST
[ Parent ]
Everybody over here knows that the US of A won WW1 AND WW2. Also Korea, Vietnam, Iraq, Afghanistan, and Syria. Plus the Cold War. Ask anybody.
by asdf on Wed Mar 25th, 2020 at 11:28:34 PM EST
[ Parent ]
It's now shielding of the vulnerable and elderly ... shit almost 1:1 with Mark Rutte and his statement on Dutch policies today ...

... and the tribe from His Master's Voice across the BIG Pond!


How do these measures differ from the social distancing guidance for vulnerable people issued?

You are strongly advised to stay at home at all times and avoid any face-to-face contact for a period of at least 12 weeks from the day you receive your letter.

People who are not clinically extremely vulnerable who have contracted coronavirus (COVID-19) and recovered will be able to go about their normal business. If you are in this group we strongly advise that you should remain at home at all times.

PS If you do get the symptoms of the coronavirus infection, do not bother to call a medic, ambulance or go to a hospital. The next phase is our protocol for hospital treatment. When you have read this, please return to START.

filmato fine

'Sapere aude'

by Oui (Oui) on Mon Mar 23rd, 2020 at 10:21:50 PM EST
Watching the "Eugenics Experiment" Unfold

At least president Trump approved funds for NYC to build facilities with 5000 beds.
In London PM Boris Johnson designated the ExCel Center as a Florence Nightingale Hospital. Even Communist China saw the necessity to build an Emergency Hospital for 10,000 beds.

Mark Rutte and his right wing Conservative clan has presently 1500 IC beds and could increase it by 100 😟

The Dutch have their IC treatment protocol with a number of phases upto RED and worst-case BLACK. Some regional hospitals have reached this level. Choice will be made by doctors for CoV-2 patients who will be admitted based on assumed chance of survival.

Code Red in Zuyderland: This is the largest stress test we've ever endured

In the evening TV News, the reporter spend a large segment on an interview with an IC coordinator who explained the choices that need to be made. Unbelievable.

'Sapere aude'

by Oui (Oui) on Wed Mar 25th, 2020 at 06:32:04 PM EST
[ Parent ]
I am certainly no fan of Mark Rutte, let alone the VVD. The response of the Dutch government was far too slow, even when the province Noord-Brabant started showing infections, and for the life of me I can't understand the "shortage of test capacity" which somehow only exists in a handful of countries (ans looking at Groningen not even everywhere in all countries). However I do think you are painting a false picture here, some some clarifications:

  • As far as I know, the examples of emergency hospitals in other countries refer to non-IC beds. The code red/code black escalation mainly concerns IC/patients on respiratory equipment.

  • Expansion of IC beds is being worked on. Not by 100, as you claim, but by up to 850 beds
    (which would be a 70% increase). And of course it is quite difficult to increase IC capacity since it requires a long list of both equipment and trained personnel.

  • While some hospitals in Noord-Brabant (and in nearby municipalities) are indeed at or close to maximum capacity, there is now a country wide coordination for the redistribution of corona patients (though the lack of coordination let alone early planning for this by the health department should be noted).

What is being extensively discussed now (as opposed when it's too late) is what choices will be made should the number of critical patients exceed country wide capacity. If that does indeed happen it is certainly fair to blame the early dithering by the government for quite a few of the resulting dead. However I don't see evidence of a lack of preparing for the coming peak by the government. What can be done is being done, they only question might be if the measures to keep the spread down are strict enough.
by Anspen on Thu Mar 26th, 2020 at 01:30:58 AM EST
[ Parent ]
March 13
https://www.nos.nl/artikel/2327032-code-rood-voor-brabantse-ziekenhuizen-geplande-operaties-mogelijk -afgezegd.html

Voor de bühne ...

Rutte was clearly a proponent of a ill-founded and callous herd immunity policy ... similar and most likely coordinated with British policy coming from Downing Street 10. Also same lack of preparation as used by Trump and the White House, hiding from criticism and dissent. His director RIVM van Dissel is on the same page on herd immunity ...

The signal of code red/black was officially launched early March, as was the promise of 850 IC beds. They are not there as of today.

Nice photo for the PR minister De Jonge on the Erasmus MC in a large empty space. A physical coordination center in a digital age? Putting key persons in harms way in a period of a contagious virus?

No, Mark Rutte has his playbook ready for PR and a coordinated and centralized voice to illustrate unity. No Dr. Fauci in his group of policy makers.

All early clusters infected hospital workers including doctors and nurses. There was insufficient testing available abd as a result there was an outbreak that could not be contsined. All the same bull of its nothing more than a flu and loved ones will die. Tha facts on the ground in Wuhan gave a vast different situation ... time was wasted to protect Dutch citizens. The Dutch and Mark Rutte were criticizes by the WHO, Belgian authorities and most recently from the mayor of Bergamo. No, for Mark Rutte with all his intelligence and long experience at the helm as leader with a top notch healthcare system, he has been an utter failure ... a Conservative a€€hole in his DNA.

You can find his mindset in CNBC interviews at this year's Davos happening and his White House appearance and charade end of January praising president Trump. Do you think Donald kept his calling card? I don't think so.

Of course you May have a different view ... so does my best friend .... sometimes a period of a lockdown has some advantage. 😉

Unfortunately, there is no real opposition party on the left, accept perhaps the Green party ... with a new crisis, no one is mentioning the climate crisis. The Christian Democrats (CDA) of Balkenende and De Hoop Scheffer has moved to the right and are in Rutte's Conservative cabinet. The Dutch have become Liberal in a freemarket sense, but not in progressive values of sustainability. Ever since 9/11 the Dutch have become Islamophobic followed by Xenophobia ... not my kind of people: Wilders and Baudet.

'Sapere aude'

by Oui (Oui) on Thu Mar 26th, 2020 at 04:51:54 AM EST
[ Parent ]
by Oui (Oui) on Thu Mar 26th, 2020 at 09:11:36 AM EST
[ Parent ]
According to the doctor who gave that 20% number (20 out of 100 patients) this is "congruent with the average from other countries". I would also say you can't simply take such a number at face value since it is rather important who is admitted to hospital. People with symptoms are advised to stay home unless their condition worsens. If, for example, there are 1000 corona patients in the area of the hospital it would be a death rate of 2%. On the higher side, but not extreme.
Rutte did seem to imply that the government would aim for herd immunity in general, though in his address he clearly also stated that measures would be taken. Once again while I'm not a fan and I do think the early part was botched, loosing use weeks of time to prepare, I feel your conspiracy theories ("most likely coordinated with British policy"
I'm sure that Rutte erred significantly on the side of not influencing society and (gasp) the economy too much. Especially since the Dutch voters have had a tendency to punish the government in power during crises in the last few decades. But one reason Rutte has been in power for 10 years is that he moves when he sees something isn't going to work, politically but also in reality.

Some other things:

A physical coordination center in a digital age?
Well Yes? A few people in a Rotterdam hospital (who would be on site anyway) are taking part of their day to (digitally!) coordinate the redistribution.

The signal of code red/black was officially launched early March
March was the start of  code red, and thereby the "reveal" of the code system by journalists. That protocol has been in place for far longer. There is still no code black situation anywhere

as was the promise of 850 IC beds. They are not there as of today.
And you are basing this on....? All hospitals are working hard on increasing capacity, but there is no reason why a hospital in, say Amsterdam, should have people standing around an empty IC bed until it is needed. Maybe you are right and the beds wont materialize, but so far I haven't seen any indication that the planning/preparing isn't progressing.

With regard to the lack of testing: Follow the Money, the quite effective investigative journalist group has an interesting piece today. According to them the relative lack of testing is the result of a partial monopoly. Apparently 80% of the machines used for testing are from the same manufacturer (Roche) who is both incapable/unwilling to fulfil demand for the materials needed to do the testing (only 30% of orders are fulfilled) and refuses to release the recipe of one crucial fluid. This also explains how UMCG in Groningen is able to  do far more tests: it has machines from multiple maunfactures
by Anspen on Thu Mar 26th, 2020 at 12:03:59 PM EST
[ Parent ]
"I feel your conspiracy theories ..." 😊))

As Rutte has been consistent over 10 years, so have I followed his tenure as PM over the same period. His favoritism to the British Tories has been clear over a decade. As I watch British and US news outlets, I see and hear in real time the changes in rhetoric. All coincidental .. I don't think so. Same with the press briefings from the White House during the Obama administration of major events, here at home Mark Rutte followed suite. On the same page ... Rutte has heard a lot of criticism the last two years from France and Germany ... separation in rhetoric and EU policy. I don''t think these three leaders are on friendly terms anymore. Rutte looking for support to the Northern countries. Rutte is weak on foreign policy as he follows his instincts ... or business interests of his corporate supporters.

I learned to do more than just criticize PM Mark Rutte when he personally moved to right-wing xenophobic rhetoric to get the votes from the groups supporting Geert Wilders. Election result was his sustained goal. I could accept the opposition from someone like Pim Fortuyn, but the VVD clan of Geert Wilders, Ayaan Hirsi Ali, Rita Verdonk  and today Mark Rutte are despicable on refugees and asylum seekers. His covert support for terror groups in Syria in step with the UK and the US is abhorrent, truly criminal.

In the 1970s I participated in the elections to Workers Council (Ondernemingsraad) in a large multinational with original HQ in Eindhoven. The unions of FNV and CNV couldn't quite appreciate that. However Den Uyl and his policy was a bit unrealistic for me. Now most Dutch parties have moved so far to populism and to the right, I find myself once again in a minority position. That's fine with me. So was I during the late 60s and the Vietnam War.

'Sapere aude'

by Oui (Oui) on Thu Mar 26th, 2020 at 12:41:55 PM EST
[ Parent ]
In Ireland the hospitalisation rate is 26% of confirmed test patients. If 20% of those were to die that would imply a 5.2% case mortality rate. In Ireland the case mortality rate is currently 0.58%, implying the Tilbourg hospital has a ten times worse case mortality rate. However this is no worse than the overall average Dutch case mortality rate of 5.55%.

Assuming the Irish and Dutch health care systems are broadly equivalent, this ten fold disparity in case mortality rates could be due to a number of factors:

  1. Greater testing in Ireland - resulting in a higher denominator of cases confirmed relative to the virus' real spread in the community.
  2. Ireland being at an earlier stage in the pandemic - and thus the disease has run its course in less cases
  3. Lower average age profile of all cases in Ireland - median age in Ireland is 45 - I don't know what it is in Holland.
  4. The hospital system in Tilburg has been overwhelmed by a concentration of severe cases, and is no longer able to provide optimum life saving care.

Germany is the other comparator to Holland with a tenfold lower case mortality rate. I'm not sure this makes the overall handling of the pandemic in Holland look good. Whether you want to apportion blame to Rutte or to other factors, I leave to you guys to debate.

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Mar 26th, 2020 at 12:45:20 PM EST
[ Parent ]
Survival ...

I took measures a few weeks ago not to be in harm's way, and not place my trust in a reluctant government sending mixed signals. It's one or the other, it can't be both at the same time.

'Sapere aude'

by Oui (Oui) on Thu Mar 26th, 2020 at 01:16:15 PM EST
[ Parent ]
The Irish are proably hospitalising too many people (by continental standards), presumably because they can... so far.

In France, 10k hospitalised out of 25k tested positive, but you pretty much have to be symptomatic to get tested (and even then, they will tell you there's no point in testing). Of the 10k, 2500 in intensive care, and 1300 dead... very high death rate, very comparable to the Netherlands... but the base line for number of cases is not comparable with Ireland, where testing has been much more  widespread.

The differential in death rate will likely start to show up soon, between the countries in lockdown and the others.

Or not. Perhaps Rutte (and Boris, and the Swedes) are right...

It is rightly acknowledged that people of faith have no monopoly of virtue - Queen Elizabeth II

by eurogreen on Thu Mar 26th, 2020 at 02:28:39 PM EST
[ Parent ]
The numbers are certainly weird all around.

In this interview Annibale makes the point that the ridiculously high death rate in Italy is concentrated in the Lombardy. Not in Piedmont and Veneto with around 3% and neither in the much poorer Sicily and Sardinia. And while he has no explanation he mentions that Lombardy is a much more friendly environment for private health insurance, which might have led to people getting treatment too late.
I'm also pretty livid that I get this from an American podcast, while our state TV goes to their London correspondent for news on the health of the royal spawn.
by generic on Thu Mar 26th, 2020 at 02:51:31 PM EST
[ Parent ]
I have read that the COVID stays in the air much longer when it has lots of fine particles to adhere to, and that this could have been a major factor in its early widespread propagation, in Wuhan and in Lombardy in particular. Likely Ile de France and London too.

Luckily, the air has become a whole lot cleaner these last couple of weeks.

It is rightly acknowledged that people of faith have no monopoly of virtue - Queen Elizabeth II

by eurogreen on Thu Mar 26th, 2020 at 03:09:27 PM EST
[ Parent ]
Every time there's a lull in winds and rain to clean Milan's skies and the smog piles up over the city and hinterland, the full amount of Lombardia's pollution is suddenly revealed. If in winter the particulate counts go far higher as most central heating is from legacy diesel oil combustion.
I have workstayed in Milan many times and while not Bangkok levels, the pollution levels were stifling, only relieved when (extremely acid) rain would fall and temporarily rinse the air. Summer, while better from the heating being off, is also worse because of the intense heat buildup from hot weather radiating from the cement almost till dawn and the sun's interaction with the emissions, L.A. style.
Traveling on a 'pendolino' (short commuter trainride from city centre to suburbs and back) there haunted me for days as never elsewhere in Europe have I felt such a palpable sense of desolate doom as exhausted low food-chain workers (mostly POC) returned home in silence, body language of crumpled defeat, 1000 mile stares, the implicit acceptance and sadness of that knowledge parallel with the grimy light and sepia sorrow of the scene.
It was 20thC Dickensian, an Italian Ruhr valley.

Looking at European pollution maps the obvious immediate suspects, the big cities, Brussels, Paris and like stand out till you grok that a triangle between Piemonte, Lombardia, Veneto and Emilia-Romagna pumps out more pollution than anywhere else. The Italian Wuhan, iow.
The hotbed and stronghold of Italy's AFD party, the Lega di Salvini, whence come regular calls to secede from the 'lazy, parasitical' south (whose starving emigrés powered the North's workhouses during the golden years of Italian industrialisation), before Fiat jumped ship to the USA after sucking public bailout funds for years after Italy's boom hit reality's shoals. Alitalia is on a similar teat right now, huge payouts to heads of failed companies, who then fall upwards to helm other state/private shipwrecks.
Northern Italians have been so much wealthier than Southern counterparts since Alpine trade routes opening to North European markets supplanted the South's historical sources of maritime trade wealth that there are basically 2 Italy's now, and little love lost between them.
Northerners mostly vote C. right and hard right, like Republicans in the USA they hate central government because they only want to pay less taxes, Berlusconi's siren song. Southerners take free fish dinners and are slipped E50 to vote for whom the mob tell them to vote for, whoever accomodates their simbiosis, deals not ideals, party-agnostic, or don't bother voting at all, (understandably as it hasn't detectably improved their lot much).
This concentration of wealth in the north has much weakened any unity Italy enjoyed, sapping civic sense and national identity.

Perhaps this crisis will humble the hothead Salvini, whose 30% poll ratings make him the shoo-in next PM if Conte drops the ball and Italy goes to new elections.
Tellingly Salvini carbon-copied Trump, Bolsonaro, Johnson and Rutte in his initial economy-trumps-human collateral damage and similarly has U-turned and is now rabidly baying for tighter control, tanks in the street etc.
Renzi suffers equally from media attention deficit syndrome (and love for Berlusconismo) and so his perennially polemic yappings punctuate and pollute the political discourse further even than when he was PM. His job is to outyap his own ovious-to-all-but-him political irrelevance and together with Salvini stir shit to undermine Conte, whose continued popularity infuriates both of them. The Pekinese and the Pitbull running maximum interference to Conte's smoothly calming leadership so far in this crisis.
In an Italian political climate that favours hysteria and hype Conte stands out for dignified aplomb. After some initial message fumbling 3 weeks ago he has kept his head commendably during this epic crisis, treading the finest of political lines between health and wealth calmly and seriously.
For which in these saddest of times I and many, many others here am incredibly grateful.

(Especially watching how other state leaders are comporting themselves evem after so much time and warning.)

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Sat Mar 28th, 2020 at 04:20:49 AM EST
[ Parent ]
Thanks for insightful post. 🇨🇮 🇨🇭

'Sapere aude'
by Oui (Oui) on Sat Mar 28th, 2020 at 06:46:13 AM EST
[ Parent ]
Even today, the pollution in Lombardia is the worst in Western Europe, even worse than the Ruhr area:

by Bernard (bernard) on Sat Mar 28th, 2020 at 09:50:49 AM EST
[ Parent ]
by Oui (Oui) on Sat Mar 28th, 2020 at 11:24:29 AM EST
[ Parent ]
by Oui (Oui) on Sat Mar 28th, 2020 at 10:07:10 PM EST
[ Parent ]
Brilliant comment Melo  - no chance you could convert into Diary? "The politics of Pestilence and Pollution"???

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Sat Mar 28th, 2020 at 10:54:38 AM EST
[ Parent ]
10k hospitalised out of 25K tested positive is a 40% hospitalisation rate - higher than Ireland's 26%.

You also have to be symptomatic to be tested in Ireland and the criterion has recently been tightened from one symptom to two. There is a 40K backlog of people waiting to be tested so presumably that will result in another spike of positives as the testing rate ramps up to 10K per day. Currently 1564 have tested positive out of c. 18k tests carried out - a c. 9% positive rate which would indicate the 40,000 backlog will reveal another 3.6K positives when completed.

More statistics  in official epidemiological report

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Mar 26th, 2020 at 03:08:48 PM EST
[ Parent ]
Ah there you go, only 39 in ICU out of 305 hospitalisations.

Bearing in mind that triage is in full swing in France : in the East, and in the Paris region, you certainly won't get a respirator if you're not deemed likely to survive. Also, hospitals are not admitting COVID patients from old people's homes, they are literally leaving them to die in their institutions.

These are the decisions that they make every day in hospitals; that is what doctors do, and there's no point in criticising. The French health system is apparently expecting the peak to arrive in the middle of next week. I certainly hope it's that soon.

It is rightly acknowledged that people of faith have no monopoly of virtue - Queen Elizabeth II

by eurogreen on Thu Mar 26th, 2020 at 03:22:42 PM EST
[ Parent ]
From yeterday's post - Trump: It's About #Me, Not Others

Daily Situation Report - Robert Koch Institute

Chronology: Germany and the Coronavirus | Berlin Spectator |

The number of cases keep on rising ...

The man with the white shock of hair in Room 4 of the intensive care unit wasn't able to breathe. But now, a tube has been placed in his throat and oxygen is flowing into his lungs. You can see through the window on the door to the room how his chest is moving up and down in time with the ventilator, 28 times a minute. The 83-year-old is fighting the SARS-CoV-2 virus.

[Source: Are Hospitals Ready for the Coming Wave of Corona Cases? | Der Spiegel |]

Controled treatment with attention for compassion!

'Sapere aude'

by Oui (Oui) on Thu Mar 26th, 2020 at 03:42:46 PM EST
[ Parent ]
I'm not aware of anyone being refused optimum hospital care in Ireland yet whether from an old folks home or otherwise. Of course that may change, but for the moment it would explain a large part of the 10 fold difference in case mortality rates

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Mar 26th, 2020 at 08:58:16 PM EST
[ Parent ]
10 more deaths and 255 new cases confirmed in the Republic: Ten more patients with Covid-19 have died, by far the highest daily death toll so far in the outbreak.
The deaths occurred among three women and seven men; nine were from the east of the country and one from the south.

Thursday also saw a record daily number of new confirmed cases, at 255, according to the National Public Health Emergency Team.

There have now been a total of 1,819 cases of coronavirus in the Republic, and 19 deaths.

The average age of those who died is 79, NPHET said. Some 68 per cent were male and 32 per cent were female.

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Mar 26th, 2020 at 09:03:22 PM EST
[ Parent ]
Also : the test used in France is acknowledged to have a high rate of false negatives, up to 40% ... Myself, I'd rather not bother with the test.

The strategy here is to roll out mass testing, with a new generation of rapid and more reliable tests, at the end of the confinement stage.

It is rightly acknowledged that people of faith have no monopoly of virtue - Queen Elizabeth II

by eurogreen on Thu Mar 26th, 2020 at 03:32:22 PM EST
[ Parent ]
Coronavirus: French PM warns 'first 15 days of April will be even more difficult' as death toll rises - The Local
France orders one billion masks from China

Veran said the government's aim was three-pronged: Increase the number of intensive care beds, get the necessary equipment and human reinforcements for hospitals and to transfer patients around the country to ease pressure on certain hospitals.

The number of intensive care beds in France was initially 5,000, which has since risen to around 10,000 but the government hopes to increase it to 14,500.

Veran said the government was exploring various avenues to get hold of enough masks for French health workers, notably via an increase in production within France to make 8 million a week and by ordering more than one billion from China.

Five million tests ordered

The French health minister also said the country had ordered 5 million coronavirus tests that will be able to show a positive or negative result within 15 minutes.

Between now and the end of April France will be able to carry out 30,000 more tests a day. That number will rise to 60,000 in May and 100,000 a day by June, said Olivier Veran.

France currently carries out around 12,000 tests a day.

Separately the health minister has asked elderly care homes known as Ehpad to keep residents in individual isolation. It comes after numerous deaths have occurred in care homes, especially in eastern France.

by Bernard (bernard) on Sat Mar 28th, 2020 at 08:24:49 PM EST
[ Parent ]
o, m'k. Hold my beer.
by Cat on Sat Mar 28th, 2020 at 10:15:34 PM EST
[ Parent ]
Stunning headline ...

One in five coronavirus patients in Tilburg Hospital had died | AD |

Quite a batting average|

Cluster carnaval -- Loon op Zand - outbreak ..,

Even yesterday before Dutch parliament, RIVM director Van Dissel made some remarkable statements of a curve "leveling off"?

'Sapere aude'

by Oui (Oui) on Thu Mar 26th, 2020 at 05:03:25 AM EST
[ Parent ]
Regarding the Chinese government, I would say it's a story of failure and corruption at the beginning which turned the epidemic into a crisis and then a story of insane efforts to contain it. After SARS things did change very much for the better but still in this case there was the usual suppression of bad news, experts silenced, and evidence destroyed. And now that the spread has been 'officially contained' in China, I wouldn't expect to see trustworthy statistics from now on.

More than a decade ago there were warnings that the culture of consuming wild animals in South China was a ticking public health time bomb. It's these two factors, 'shoot the messenger' and exotic animal consumption [for homeopathy], that have created this crisis, a product 'Made in China' we all could have lived without. Obviously that doesn't excuse the performance of other governments and organizations.

Why Did the Coronavirus Outbreak Start in China? - Yi-Zheng Lian - NYT

... consider the fate of one of Confucius's beloved students, Zi Lu (子路) ... after he ran afoul of the precept: For trying to rebuke a usurper in a power struggle between feudal lords, he was killed and his body was minced. (It is said that Confucius never ate ground meat again.)

... Beliefs surrounding the health benefits of certain wildlife foods -- which are discussed in newspaper columns and on numerous dedicated internet sites, as well as taught in China's medical schools -- permeate the culture.

... But what is notable about China is that these beliefs about the special powers of some foods have been accepted, are now a given, even among people who do not put them into practice. They have become firmly embedded in the Chinese collective consciousness.

Regarding Italy, it seems to have had the misfortune of being one of the first international recipients of the virus. The epidemic there has probably been going on since the end of last year. A lot of younger people, infected and undetected, eventually carried it to their older compatriots. Combined with the nonlinear effect of the overwhelmed hospitals, that could explain the discrepancy in fatality rates.

Schengen is toast!
by epochepoque on Mon Mar 23rd, 2020 at 10:33:17 PM EST
Do we have any evidence that "exotic animal consumption" led to the Zoonotic transfer of the virus from bats to humans? Wiki
Zoonoses can be caused by a range of disease pathogens such as viruses, bacteria, fungi and parasites; of 1,415 pathogens known to infect humans, 61% were zoonotic.[5] Most human diseases originated in other animals; however, only diseases that routinely involve non-human to human transmission, such as rabies, are considered direct zoonosis

While there is little dispute that the virus originated in China and also that China is an authoritarian state with some (to us) odd beliefs, is that a correlation or a causative factor?

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Mon Mar 23rd, 2020 at 10:47:37 PM EST
[ Parent ]
COVID-19 coronavirus epidemic has a natural origin - The proximal origin of SARS-CoV-2 - Nature Medicine
The researchers proposed bats as the most likely reservoir for SARS-CoV-2 as it is very similar to a bat coronavirus. There are no documented cases of direct bat-human transmission, however, suggesting that an intermediate host was likely involved between bats and humans.

... But the scientists found that the SARS-CoV-2 backbone differed substantially from those of already known coronaviruses and mostly resembled related viruses found in bats and pangolins.

The pangolin ("most trafficked animal in the world") whose scales are used for medicine, or some similar animal seems to be the prime candidate for the intermediate host. Analogous to SARS where it went from bats to civets.

Schengen is toast!
by epochepoque on Mon Mar 23rd, 2020 at 11:04:41 PM EST
[ Parent ]
Public health: a strategy of 'search and destroy' involving mass testing, screening, separate health facilities/lodgings, tracing with lots of volunteers, somtimes uncomfortable surveillance methods, maybe taking shortcuts with vaccines etc.

Economically: Plug the gap from the bottom with helicopter money. The Danish approach of giving the whole economy a 3 month paid vacation seems more elegant than the multifangled relief efforts in the rest of Europe.

Something will have to give, otherwise it will turn into an economic and social catastrophe as well.

Schengen is toast!

by epochepoque on Mon Mar 23rd, 2020 at 10:51:59 PM EST
APsplainin Europe eyes smartphone location data to stem virus spread , "community spread"
The tools in question are apps that would use real-time phone-location data to track the movements of VIRUS CARRIERS and the people they come in CONTACT with.
That worries privacy advocates, who fear such ubiquitous surveillance could be abused in the absence of careful oversight, with potentially dire consequences for CIVIL LIBERTIES.
unidentifiable individuals
But there is a powerful argument in favor of more powerful digital tools, even if they SHRED PRIVACY: They have been used by several of the Asian governments most successful at containing the pandemic, including in China, Taiwan, Hong Kong, South Korea and Singapore. Last week, Israe ...
"estimated as a range"
The White House has reached out to Big Tech companies for help in the worst pandemic in a century, but Google and Facebook both told the AP they are not sharing people's location data with governments. A Google spokesperson said the company was exploring ways to use AGGREGATED LOCATION information against COVID-19, but added that the location data Google normally gathers from phone users isn't accurate enough for CONTACT TRACING.
archived Mon Feb 3rd, 2020
by Cat on Tue Mar 24th, 2020 at 07:13:50 PM EST
In my circle of retired and semi-retired friends I am starting a conversation how life will have changed after the pandemic and will citizens be better or worse off for it.

The economic and financial hardship will be similar to a major event such as the aftermath of World War I, the Stock Market Crash of 1929 and years of depression: huge unemployment. Many businesses, community services, corporations will fail and won't recover. Similar to the year 2000 and the digital impact, once again the super companies will get a boost and will determine the fate of mankind. Let's say the trillion $$$ corporations or those above $500bn.

Education will get a remarkable boost into the digital age and so will the financials, banking, community services of cities, districts, states and countries. Robots will spread like a new automation virus. AI will be used as consultancy.

Those are some of my personal thoughts.

Remarkably, the CoV-2 pandemic will see the overthrow of Trump and his Conservative stooges. Regardless of the surge in popularity of the moment, as the crisis smothers the US economy and too many lives of Americans are lost causing grief and hardship, after the Summer the ratings for president Trump will slump into a normal one-third, his hardcore supporters. Not sufficient to win another term as the incumbent.

The predicted "End of Globalisation" and America into isolation from planet Earth will be reversed. Political leadership and insightful corporate leaders will follow the policy of multilateralism into this decade as "building the wall" is a BIG FAILURE.


Searching the Internet:

Liberty, solidarity, and a new world dawning

'Sapere aude'

by Oui (Oui) on Wed Mar 25th, 2020 at 10:22:27 AM EST

'Sapere aude'
by Oui (Oui) on Wed Mar 25th, 2020 at 12:59:05 PM EST
[ Parent ]

'Sapere aude'
by Oui (Oui) on Sun Apr 19th, 2020 at 04:28:27 PM EST
[ Parent ]
Two more deaths and 235 new cases confirmed in Republic
The total number of cases now numbers 1,564, NPHET said at its briefing on Wednesday evening.

Detailed figures released on Wednesday from the Health Protection Surveillance Centre of the 1,164 cases recorded as of midnight on Monday, March 23rd are as follows:

    55 per cent are male and 45 per cent are female with 63 clusters involving 289 cases
    The median age of confirmed cases is 45 years
    305 cases (26 per cent) have been hospitalised
    Of those hospitalised, 39 cases have been admitted to ICU
    283 cases (24 per cent) are associated with healthcare workers
    Dublin has the highest number of cases at 559 (57 per cent of all cases) followed by Cork with 133 cases (11 per cent)
    Of those for whom transmission status is known: community transmission accounts for 49 per cent, close contact accounts for 23 per cent, travel abroad accounts for 28 per cent

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Wed Mar 25th, 2020 at 09:53:28 PM EST
magical rounded number
US reaches 1,000 deaths in coronavirus crisis (68,572 confirmed cases, hospitalized or not)
America's first death was reported on Feb. 29 and the rate has spiked over the past two weeks as extreme public health measures [?!] go into effect to COMBAT the virus.
Governors and local governments are playing an outsized [BWAH!] role during the crisis as states enjoy broad autonomy under the Constitution and the Trump administration has left most of the decision-making to them.

border "screening"
Protesters in Mexico block lanes at Arizona border crossing to demand stricter coronavirus screenings, (405 confirmed cases)

As of Wednesday afternoon, Arizona's Department of Health Services has confirmed more than 400 cases [CSSE: 401], including at least six deaths resulting from the coronavirus. All four Arizona border counties confirmed additional cases Wednesday, including Santa Cruz County, which includes Nogales.
Some of the signs asked U.S. residents to "stay at home." Others called on Mexico President Andrés Manuel López Obrador to step up controls and restrictions along the U.S.-Mexico border to contain the spread of COVID-19.
The demands call for a temporary ban on visits for tourism and minor medical procedures in Mexico for both U.S. citizens as well as Mexicans living in the U.S. The group is asking for Mexican health officials to step up screenings of everybody crossing the border for symptoms of COVID-19. The protesters emphasized the risk to border communities if health officials don't properly screen all migrants that U.S. border officials are deporting or sending back into Mexico.
by Cat on Thu Mar 26th, 2020 at 03:33:37 AM EST
Why don't the Mexicans build a wall - and pay for it?
by gk (gk (gk quattro due due sette @gmail.com)) on Thu Mar 26th, 2020 at 03:37:11 AM EST
[ Parent ]

< pick teeth, suck vigorously >

Diversity is the key to economic and political evolution.

by Cat on Thu Mar 26th, 2020 at 07:49:28 PM EST
Politico's story 24 hrs ago.
Trump team failed to follow NSC's pandemic playbook

which omitted a link to the Holy Grail

by Cat on Thu Mar 26th, 2020 at 09:45:13 PM EST
[ Parent ]
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Mar 26th, 2020 at 11:14:37 PM EST
[ Parent ]
Smoking, vaping and hospitalization for COVID-19
"There is a lot of speculation about the effects of smoking on Corona Virus Disease 2019 (COVID-19)."

< wipes tears >

by Cat on Sat Mar 28th, 2020 at 10:31:33 PM EST

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