Asymptomatic spread(?) of Covid-19

by Judith Curry

I just finished reading an article entitled Asymptomatic Spread Revisited.

A new article in Nature [link] based on an extremely extensive and thorough analysis in Wuhan found no cases of asymptomatic transmission.  Cynically, comments on this paper question whether we can we trust anything coming out of China on this subject?

This article motivated me to go to Google Scholar to look for papers related to asymptomatic spread.   I mostly found mathematical models, not careful analyses like the Wuhan study

I have an anecdote on this.  One of my employees in Colombia came down with Covid-19, along with 11 family members, after a gathering where no one had symptoms.  The first family member came down with symptoms two days after the gathering. Unfortunately, one family member died.

This paper [link] provides insights on aysmptomatic versus pre-symptomatic.

So what to make of this?  Asymptomatic spread seems to be a key assumption under the more extreme lockdown measures.

In any event, we need a new Covid thread, I open this topic up for discussion.  Hopefully the denizens can identify some additional research on this.

297 responses to “Asymptomatic spread(?) of Covid-19

  1. Christos Vournas

    “asymptomatic versus pre-symptomatic.”
    It is a very important nuance – it means we shouldn’t relax and we should continue behaving very cautiously.
    It is a very important thread, thank you.

  2. This article subsequently appeared as a letter in the British Medical journal

    https://lockdownsceptics.org/has-the-evidence-of-asymptomatic-spread-of-covid-19-been-significantly-overstated-2/

    Tonyb

  3. I remain baffled by the numbers coming out of China and for that matter Taiwan assuming that Covid-19 is indeed highly contagious and the rapidity with which people outside of Wuhan became infected.
    Unfortunately, I am so skeptical of data coming out of China that I find a single study, no matter how large, unconvincing. Lysenko had studies as well.

    • I would note that none of the Asian countries are faring poorly, compared to the Western democracies or South American countries.
      The most shambolic governments: Phillippines and India – have per 1M COVID death rates under 1/3 that of Germany, which in turn is 1/3 (or less) of the other large Western democracies.
      It thus seems quite clear that there is some environmental factor in Asia which reduces COVID lethality. Whether it is other coronavirus exposure, BCG, whatever – only time will tell.
      The net net is that China’s numbers are unlikely to be worse than India/Phillippines even if they aren’t comparable to Singapore’s.

      • The most shambolic probably have very shambolic reporting systems, and many cases and deaths are thus escaping surveillance.

        The less shambolic have quite good systems for containing the virus. For example., early on, Thailand recruited a large host of contact tracers/community workers who spread out through the country.

        Japan, which is less serious about it, now has the highest number of cases yet for their country.

      • India has 30 times more deaths than China reports.

        I think it largely about reporting.
        And how much testing is done.
        In US, in the beginning when testing was more limited, probably more people died of China virus, than reported, but due incentives and because large number people who have it, those that die AND have been tested to have virus, are counted, even if death may not actually caused the death.

        Also this is first time we have actually counted deaths from virus, or common flu was a guess of how many died rather rather testing tens of millions of people, and same with COVID a lot old people died and guesses may have been correct. There is need to do some testing, but US as tested 236,617,939 times, nothing has ever been tested this much in less than 1 year.

      • Although India’s reporting is notoriously poor – at the same time – it is equally impossible to believe that death rates and overall mortality are that divergent.
        The key point is still there: All of Asia is doing better, individually and collectively, than the wealthy non-Scandinavian European and North American democracies as well as the South American countries – regardless of policy.

      • what is a covid death? germany had no surmortality,at least where data is available , for a while with quite large number of covid deaths..
        https://www.worldometers.info/coronavirus/country/germany/
        https://www.euromomo.eu/graphs-and-maps/

      • You need to ask whether the sole difference is greater levels of health inequality.

      • Clearly NZ, Australia, and Finland are all doing so well because of all the advantages of being Asian countries.

    • archibaldtuttle

      bernie,

      i have to agree there is a conundrum of trust of these results from China.

      i agree with Judith that the described systemic approach has a more serious emperical validity given statistical validity by the size of the sample compared to theoretical or effectively anecdotal belief in asymptomatic spread, e.g. there are lots of cases so there must be asymptomatic spread seems a more anecdotal than statistical approach.

      But I have difficulty crediting this aspect of the study: “The screening of the 9,865,404 participants without a history of COVID-19 found no newly confirmed COVID-19 cases”. I find that almost inconceivable albeit it was a apparently a screen for active virus not an indirect screen for antibodies. In any event that quoted finding seems to contradict the notion that the study “identified 300 asymptomatic positive cases”. Were asymptomatic cases only found in those with a previous history? And, methodologically, it seems this all could have been more robust with a tandem serology component.

      I’m not sure the line between cynicism and skepticism and perhaps a chinese lockdown has the advantage of totalitarian efficiency, but maybe you can put me down as confused moreso than cynical.

    • I’m skeptical of the China medical statistics.

      Taiwan data I can vouch for due to boots on the ground so to speak. They and Japan already had ‘mask if you’re sick’ and temperature monitoring stations at the ports (thermal image scan of all disembarking passengers at airports for example) culturally engrained from past epidemics and when Covid 19 first was identified as a potential threat they reacted immediately with a short lockdown on travel followed by revised new guidelines on home/hotel quarantining after entering the country. They were very quickly back to business as usual for the most part with 0 new cases for a long time.
      Within the last month a pilot infected somebody locally that created the first in-country transmission and they again rolled out extreme and temporary control measures.

      Their approach appears to balance the best health outcomes at the least impact to economic opportunity costs. USA comparatively has worse health outcomes and more loss of revenue (not to mention defecit spending for bailouts) due to extended health protocols that are only partially and ineffectively communicated/followed.

  4. Thank you for posting this, Dr. Curry. We are ruled by ignorance and fear. At least Trump has come to his senses thanks to honest scientists like Dr. Scott Atlas, while in the UK, they’ve completely gone off the rails.

  5. “Asymptomatic spread seems to be a key assumption under the more extreme lockdown measures.”

    This is misleading. A big concern is pre-symptomatic spread. From the standpoint of mitigation measures, it is equivalent to asymptomatic spread, although the length of the asymptomatic contagious period may be only a day or two.

    In other words, even in the extremely unlikely case that this disease never spreads from asymptomatic infected individuals, the existence of spread from asymptomatic individuals (before symptom onset) is still a big problem. It is the primary reason that COVID19 is so hard to stop.

    As an aside, I have yet to see a COVID19 article on AIER that was even slightly responsible. They all show an extreme bias in favor of letting the virus run wild, with perhaps [not really practical] protection of “vulnerable” [who comprise 40-60% of the US population.

    The article linked at the head of this thread falls into that category. It is polemical and misleading – in other words, it is nothing but propaganda. It engages in a common practice, where people conflate – by accident or in this case, I think, intentionally – totally asymptomatic cases and pre-symptomatic. It cherry picks the science – finding one study that refutes a strawman that it raises.

  6. It was the same in my case, i.e. presymptomatic spread. Our son arrived home in excellent health and before he got symptoms the next day, the rest of the family (another 3 people) were infected

  7. It seems as if both camps do the same thing.

    It concerns me that discussions which are touted as “based on the science” are so unscientific. Usually, the faction that wants to destroy the status quo starts by making unproven, but somewhat plausible affirmations and then grossly overstates dire consequences that require out of proportion measures.

    Rather than focusing on demanding that the first faction prove that the alleged harms are real and the proposed measures proportional, the second faction present lousy arguments that only harm their point.

    I am generally more simpathetic to the second faction, but it concerns me that the first one always wins, because:

    1. They have more resources
    2. Doom messages sell better than optimism
    3. Usually the first faction have greater incentives (make money, get power, …) While the second only tries to do the right thing.

    It is very sad.

  8. Evolution at work…..

    • I agree. It is slightly off-topic.
      My point is that both sides seem to abuse scientific debate whenever an issue gets politicised.
      I made the comment in response to your citing of AIER articles. Yes, they are not based on science, but it does not mean that their conclusions are necessarily false.
      The same applies to pro-lockdowners. They fail to prove the benefits of lockdowns.

  9. “Asymptomatic spread seems to be a key assumption under the more extreme lockdown measures.”

    Source for this claim?

    None. Big strawman. Ideologically motivated of course.

  10. Interesting suggestion from Jeffrey Tucker although his other publications do suggest a slight level of vested interest in returning to the economic status quo. There is also such a thing as the precautionary principle in science, erring on the side of sensible caution on risks or what might be true, but here in the UK we now appear to have a mutant strain, soaring numbers of cases and increasing civil discontent about Christmas being effectively called off. There again, today’s Observer newspaper (20th Dec) points to the Swedish experience where the common sense of the population was trusted (keep your distance, basically) but known cases are now rocketing – heading for around 360,000 I think in a population of 10.3 million. Sweden has a low overall population density, but does have major cities and towns.

    Bright ideas on what to do now which is effective would be welcome, as opposed to bickering about who is right or flagging the benefit of hindsight e.g. “why didn’t the UK, USA and Sweden behave like South Korea, New Zealand and Vietnam (which shut its border with China pdq when it heard about the virus)?” which isn’t actually that helpful. Still for info, I believe NZ’s results (25 dead from COVID-19 in a population of around 5 million people but which is well away from many others) have occurred from the country being basically closed to people coming in unless they were NZ nationals and had been quarantined, while there was a rapid lockdown at little notice; please correct me if I’m wrong. The economic damage was considerable, although relative normality has returned, but the human death toll was very low – look at the UK’s death toll compared to our population. Also, nipping things in the bud means that your health services are not overwhelmed and can thus treat people with assorted cancers, heart disease and other horrors. The (London) Times back in the Summer queried how many people would die as their treatments would be postponed as the NHS battled COVID.

    Anyone happy to take responsibility for getting it right (or not) and being judged accordingly is welcome to run for high office although the possibility of a manslaughter via negligence charge shouldn’t be discounted. Politicians and policy-makers prepared to do this will be rare, though. Lessons for next time (and there will be another one, even if “just” a new strain of flu, rather than another zoonotic horror) need to be learned, though. Precautions will also cost money and it is no use moaning. This may be of interest (admittedly from a known left-wing /liberal source, George Monbiot):

    https://www.monbiot.com/2020/05/26/the-machine-stops/

    • “There is also such a thing as the precautionary principle in science”

      No there isn’t – it is far too vague an expression to be scientific. Indeed, the “precautionary principle” as a concept comes from the world of politics, not science.

      Risk discounting, and cost/benefit analyses are scientific because they involve quantitive methods. By definition, if you are not engaged in quantifying things (i.e. amenable to measurement) you are not engaged in science. Indeed, the way the precautionary principle is typically formulated is fundamentally contra-scientific because it is invariably expressed as, “If you can’t prove that x is harmless, then you can’t do x.” Everything fails this test because you cannot prove a negative.

      That’s why environmentalists love it (it sounds all warm and fuzzy despite being fundamentally stupid and irrational – as anyone capable of even a little bit of reflection should be able to work out).

      • Geoff Sherrington

        aporiac1960 | December 20, 2020 at 7:58 pm
        Agreed. Hard science does not include the ‘precautionary principle’, it even questions whether it should be called a ‘principle’. It is a tactic. Geoff S

    • ‘Risk management can be defined as the systematic scientific identification, evaluation, and prioritization of risks of adverse health effects resulting from human or environmental exposure to hazardous agents or situations, and the economical application of resources to minimize, monitor, and control the probability.” https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/risk-management#:~:text=Risk%20management%20can%20be%20defined,monitor%2C%20and%20control%20the%20probability

      The contrarian bête noire of the precautionary principle comes from risk management. Why they imagine that theirs is a rational argument – repeated every time without fail if it dares to pop its head up – is way beyond me.

      • As pompously incoherent as usual, eh, sport ?

        The “precautionary principle” is specifically used to reject proposed activities that cannot prove a negative (ie. no damage).. It has nothing to do with systematic risk evaluation apart from deliberately ignoring it.

      • I quoted on the practice of risk management as broadly understood by practitioners in science and industry. I can only think that you are a contrarian meme spouting nincompoop with not a real clue.

  11. 250,000 cases a day, and people think that none of them are from asymptomatic spread?

    As mentioned above, the whole question is being gamed by people who have consistently underestimated the trajectory of the pandemic time and time again, for months – and this time they’re playing games by exploiting uncertainty and confusion about the difference between asymptomatic and preaumptimmatic spread.

    Also, the very question of identifying who does and who doesn’t have “symptoms” is quite complicated.

    But think about it – 250,000 cases a day, and people think that none of them are from asymptomatic spread?

    • Joshua, as usual you are right. It seems like simple arithmetic and has not much to do with biology. In California, right now we identify 60,000 new cases per day by test, and that occurs day after day. That implies that (according to the CDC) there are about 7 times that amount of people out there who have the disease and are spreading it unknowingly. So, there are 420,000 people in California with the virus and we have not identified who they are. Each day we use testing to pull out 60,000 from the 420,000, but new infections add 60,000 each day. Many of the 420,000 either have no symptoms, or have only weak symptoms. Clearly, they must be spreaders.

      • Cheby –

        I’ve been promoting Mina for months. You should not that Mina asya that PCR tests are a valuable tool.

        Paul –

        Sure, that’s true. But that plus symptomatic spread only seems unlikely (to me) to explain 250,000 positive tests in a day.

        Much more likely is that your being sold a bill of goods.

    • And about half of them will not qualify as positive cases.

      “Officials at the Wadsworth Center, New York’s state lab, have access to C.T. values from tests they have processed, and analyzed their numbers at The Times’s request. In July, the lab identified 872 positive tests, based on a threshold of 40 cycles.
      With a cutoff of 35, about 43 percent of those tests would no longer qualify as positive. About 63 percent would no longer be judged positive if the cycles were limited to 30.
      In Massachusetts, from 85 to 90 percent of people who tested positive in July with a cycle threshold of 40 would have been deemed negative if the threshold were 30 cycles, Dr. Mina said.

    • “250,000 cases a day, and people think that none of them are from asymptomatic spread? ”
      Contamination may result from contacts with soiled surfaces, without the presence of anyone.

    • The issue is the lack of a logical mechanism by which people who are not sick (ie no symptoms) can spread an upper respiratory tract infection.

      • “The issue is the lack of a logical mechanism by which people who are not sick (ie no symptoms) can spread an upper respiratory tract infection.”

        Coughing, sneezing – people do this when not sick. Talking (aerosolizing virus).

        This isn’t the only respiratory virus with spread by asymptomatic people. A quick search turned up this

      • @mesocyclone

        So virus transmission is of negligible difference between people who are sick and people who aren’t? Interesting conclusion, but the study you linked is long on conclusions and short on details.

        Don’t get me wrong. My understanding of seasonal viruses is that everyone is exposed to them and only some people get sick from them. So it would make sense. But that does throw all the weirdo health measures into question.

      • “So virus transmission is of negligible difference between people who are sick and people who aren’t? Interesting conclusion, but the study you linked is long on conclusions and short on details.”

        The point is that virus transmission from pre-symptomatic people is significant. Beyond that, I don’t care to argue.

        “Don’t get me wrong. My understanding of seasonal viruses is that everyone is exposed to them and only some people get sick from them. So it would make sense. But that does throw all the weirdo health measures into question.”

        Weirdo health measures? Our hospitals are running into capacity limits due to the surge of COVID19 cases. This is already denying routine care to some people, and threatens to force hospitals into triage protocols – giving some patients – COVID19 or others – mere palliative care until they die.

        That’s really serious stuff. Beyond that, the hundreds of thousands of deaths just in the US are nothing to laugh at. A whole lot of people died this year who would be alive if not for COVID19.

        The “weirdo health measures” are to try to reduce the death toll.

  12. Near the beginning, Mr. Tucker wrote, “back then there was no question of extinguishing the virus.”

    That is utter nonsense. Several countries, like South Korea and Taiwan, did largely extinguish the virus.

    The process was simple, though not easy.

    It was not rocket science. They just did what epidemiologists have known needs to be done for a century, to stop the spread of a contagious disease, and they employed modern technology to make the process more efficient. They merely identified the carriers of the disease, and quarantined them until they were no longer contagious.

    That’s all.

    The way they did it was to immediately test everyone suspected of the disease, or of being exposed to it. Then they told them them the results fast: in minutes or hours, not days.

    Then, whenever someone tested positive, he was immediately interviewed, to find his recent contacts. (That’s called “contact-tracing.”)

    Then everyone he might have had recent contact with was immediately notified, typically by text message, robocall, and personal phone call, and told to self-isolate and get a free test.

    Whenever one of those contacts tested positive, that person was quarantined, and the process of contact-tracing and testing was then immediately repeated for his recent contacts.

    South Korea had a big spike in infections early, when tests were still in short supply, yet they nevertheless managed to use this process to stop this disease, almost completely, in just three weeks.

    With the disease out of control in most of the rest of world, preventing all outbreaks in South Korea has proved impossible, but every time they;ve had another outbreak, they stopped it, through that process.

    Note that that process identified and quarantined, not only symptomatic carriers of the disease, but also asymptomatic & presymptomatic disease carriers.

    South Korea is currently battling another spike in cases, their worst yet. But they will surely bring it under control, they same way they’ve brought the previous spikes under control — and this spike in South Korean cases is still only about 1/30-th as large as the current U.S. spike, calculated per-capita.

    As a result of our (U.S.) failure to control the spread of the disease, our per-capita death toll from it is now 74 times higher than South Korea’s, even though the pandemic got a head start in South Korea.

    In the United States, both the State governments and the federal government failed, catastrophically, to control the spread of the disease. Testing was haphazard and slow, reporting of results often took as long as a week, and there was never any serious, systematic effort to identify and notify the contacts of those who had the disease. The result is that 320,000 Americans have died unnecessarily, so far, and we’re currently losing about 2500 more, each day.

    Here in NC, the state government actually made the epidemic worse, by imposing bureaucratic barriers to testing, and to rapid test result reporting.

    In New York City, they didn’t even shut down the mass transit system which was obviously spreading the disease.

    There was a lot of jaw-jawing, but precious little doing, and the measures which were taken were often imbecilic. For example, the governor of New Jersey ordered that public trains, subways and buses be filled to only half-capacity. That meant a Covid-19 patient in a subway car could only infect about 45 other people at a time, instead of 90 at a time. I cannot imagine how any thinking person could believe that was adequate, when many carriers remained unidentified and unquarantined. (In New York, believe it or not, they didn’t even do that much.)

    In the absence of adequate measures to control the spread of the disease, we will have to rely on the vaccines to finally stop it. But we didn’t need to lose a third of a million American lives in the meantime. With competent leadership, the Covid-19 infection and death rates could have been held to a tiny fraction of what we actually endured.

    • Please get back to us when the U.S. becomes a small, demographically homogeneous country without a Bill of Rights and no Republican form of government, daveburton. Also, please identify, by name, any person or group in the U.S. that has the authority to unilaterally shut down all parts of American civic life. Until you accomplish those simple tasks, please keep your political hysteria to yourself.

      • Please get back to us when South Korea is run by an incompetent Federal administration, that thinks its politically expedient to deny the severity of the pandemic, and when some 30% of the South Korean citizens whine like snowflakes about their loss of freedom and terrible inconvenience from wearing masks and contributing to the the common good.

      • Dave Fair, if you disagree with something I’ve written, please quote it. Don’t just invent something (like “shut down all parts of American civic life”), and pretend that I advocated it.

        You seem to have some misconceptions about South Korea, too.

        ● South Korea is not a particularly “small” country. Its population is about 51 million.

        ● There’s no evidence that “demographic homogeneity” affects the spread of the disease.

        ● South Korea does have a republican form of government, albeit with less provincial autonomy than U.S. States enjoy.

        ● The South Korean Constitution does include the equivalent of a Bill of Rights, in Chapter 2.

        ● South Korea was successful at largely stopping the epidemic without a general shutdown. In fact, it was their competence at identifying and quarantining infected people, and thereby mostly halting the spread of the disease, which enabled them to avoid the extensive shutdowns that we’ve endured in the U.S.

      • Joshua, you should have omitted the restrictive adjective “federal.” The truth is that State governments, both Democrat and Republican, also demonstrated spectacular incompetence, in some cases far worse than the feds.

        It is true that the federal government botched their response to the pandemic, but it wasn’t all bad. Their “Operation Warp Speed” program seems destined to save a very large number of lives.

        Thankfully, no U.S. federal (nor South Korean) authorities did anything anywhere near as mind-bogglingly idiotic as Gov. Cuomo’s mass transfer of Covid-19 patients into nursing homes which were unequipped to isolate them, nor even as foolish as Mayor de Blasio’s encouragement to New Yorkers to hit the bars.

      • I have been one to hold up South Korea as a model.

        BUT… South Korea is small compared to the US, and is geographically small.

        South Korea had one big advantage of the US: it was not seeded with a high level of SARS-CoV-2 before the issue was well understood. It has been shown that the US had a lot of virus around before anyone knew it was here.

        Also, South Korea was sensitized by the SARS epidemic, and was thus more ready.

        And very importantly, it did not have a ridiculous bureaucracy that hindered testing and messed up the process. In the US, the FDA ordered organizations such as universities to destroy tests they had already created, because they hadn’t gone through an onerous FDA approval process. This was quite early in the epidemic, where those tests might have made a big difference. The CDC insisted that all testing be done in their laboratories, which did not have the capacity to do the job, plus thus required transport delays to get samples there. Then, the CDC sent out test kits (remember, FDA had crushed all competing testers) which were flawed – one of the controls was contaminated due to lax procedures in the FDA lab.

        FDA has a long history of obstructing useful treatments and tests, and a huge number of Americans have suffered and died as a result. As another example, they dragged their heels for many years before allowing the use of nicotine patches to help with cigarette addiction.

        None of those flaws can be blamed on the President. In fact, the Pence task force, when it became aware of those issues, cracked down on the agencies. But even then, the FDA would not allow highly qualified researchers to use tests unless the FDA forms and all supporting data was sent to the FDA, through the mail, on CDROM’s! That’s what big government does. Only when that was publicized did the FDA back off and allow email submission.

        But, by then it was too late.

        Also, the US has a highly decentralized public health system, with 2100 *independent* public health agencies which do not have to obey federal commands (other than to meet regulatory hurdles that the FDA threw up). And the CDC’s centralized reporting system was not up to the task.

        So while the administration was not perfect in its response by far, it in fact removed roadblocks, and it also created Operation Warp Speed and other initiatives that facilitated the development of solutions by private industry. I do not believe that we would have done better with a Biden or Hillary Clinton administration – the screwups would just have been different.

      • I agree with mesocyclone. South Korea had a much more centralized and efficient bureaucracy. Same with Japan and Singapore. I am guessing they can fire people in gov jobs there.

        The US’s largest screwup was its test rollout. Fauci was telling everyone, including Trump though February, that all the major cities were under surveillance for non-diagnosed flu-like illness, that there was only 15 cases in the US. The truth was he had no idea (since he didn’t have a test) that the actual number was likely close to a 100,000 by March 1st.

      • > BUT… South Korea is small compared to the US, and is geographically small.

        Same would apply to Italy. Geographic size isn’t particularly relevant, but to the extent it is it would be to the US’s advantage in having many areas with sparse population.

        > South Korea had one big advantage of the US: it was not seeded with a high level of SARS-CoV-2 before the issue was well understood.

        ?? Korea had a lot of spread early in. It controlled community spread wkthaa highly centralized and proactive approach. In the US,we had a federal government thst explicitly dow played the threat from community spread. Did you forget 15 down to zero and the comments about how more cases was politically inconvenient and how it ewss going to go away like a miracle by Easter?

        >It has been shown that the US had a lot of virus around before anyone knew it was here.

        Most of the community spread took place long after existence of the virus here became well-known.

      • -snip-

        A top Trump appointee repeatedly urged top health officials to adopt a “herd immunity” approach to Covid-19 and allow millions of Americans to be infected by the virus, according to internal emails obtained by a House watchdog and shared with POLITICO.

        “There is no other way, we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,” then-science adviser Paul Alexander wrote on July 4 to his boss, Health and Human Services assistant secretary for public affairs Michael Caputo, and six other senior officials

        -snip-

        Trump:

        -snip-

        “You’ll develop, you’ll develop herd, like a herd mentality,” explained Trump. “It’s going to be, it’s going to be herd-developed, and that’s going to happen. That will all happen. But with a vaccine, I think it will go away very quickly.”

        -snip-

        Atlas advocates for herd immunity:

        -snip-

        “When younger, healthier people get the disease, they don’t have a problem with the disease. I’m not sure why that’s so difficult for everyone to acknowledge,” Atlas said in an interview with Fox News’s Brian Kilmeade in July. “These people getting the infection is not really a problem, and in fact, as we said months ago, when you isolate everyone, including all the healthy people, you’re prolonging the problem because you’re preventing population immunity. Low-risk groups getting the infection is not a problem.”

        -snip-

        Trump loves him some Atlas:

        -snip-
        Trump last week announced that Dr. Scott Atlas, a frequent guest on Fox News Channel, has joined the White House as a pandemic adviser. Atlas, the former chief of neuroradiology at Stanford University Medical Center and a fellow at Stanford’s conservative Hoover Institution, has no expertise in public health or infectious diseases.

        […]

        “Scott is a very famous man who’s also very highly respected,” Trump told reporters as he introduced the addition. “He has many great ideas…

      • Let’s be clear –

        Because of Trump’s cult following, he would have likely gotten a good bit of support from BOTH sides of the political aisle had he advocated for a more centralized approach. Surely, he would have gotten some pushback as well on both sides. But with the more general ideological compatibility among demz for a more centralized approach, and the personal loyalty for Trump among many pubz, Trump could have likely lead the way towards implementing in this country many of the sorts of policies that have served South Korea well.

        Whether it is because Trump was too stupid to realize the advantages of those policies, or too much of a political coward to risk alienating some of the more extreme elements of his political base, we’ll never know. At his point it doesn’t matter. It’s time to move on from Trump. But it would be nice if his political sycophants could pull the wool from their eyes and accept that dear leader was always self-serving (like virtually any politician) and that sometimes his obsessive focus on his political career actually had significantly harmful effects. Lying about the crowd size at his inaugural was meaningless. Lying about COVID likely cost many lives.

      • Well, The thing that is critical is culture. To ignore this leads to totally wrong conclusions. Many Asian cultures have a culture of compliance with authority that doesn’t exist in the West. Singapore is a prime example.
        Josh has been constantly advocating strict contact tracing. We can’t even prevent 90 straight days of riots and billions of dollars of property damage in Portland with hundreds injured and a few deaths. Why would you fantacize that these same people would report contacts to authorities or obey any government official quarantine, or show up for a test?

        And then our resident teenager Josh pulls out his favorite whipping boy. There is little evidence that the US did a worse job overall than most Western nations with similar cultures. Adults know that life is messy and governments are very blunt and often incompetent instruments. Biased partisan blaming helps no one.

      • Joshua, I wondered where that “herd immunity” insanity was coming from, in the Trump Administration. Paul Alexander, eh?

        It appears that Alexander was a “science advisor” to Michael Caputo, rather than to Trump.

        A Canadian saboteur… maybe baby Trudeau put him up to it? (JUST KIDDING!)

        Scott Atlas is the guy who disproved my expectation that Bannon would be the all-time worst Trump appointment. Atlas’s advice to President Trump was unbelievably bad. Incredibly, Paul Alexander’s advice to Caputo et al was even worse.

      • Americans made great personal and individual sacrifices for the grater good during yhe WWII war effort. I doubt we could reach that level of willingness to sacrifice today for a number of reasons, but the explicit self-centeredness of the president and his elevation of polarization and division as his fundental ideals and political strategic tools made it certain that we’d never know what we might have been able to achieve through a centralized and we’ll-coordinated approach.

        The sad irony is that if had he chosen to lead the country with a shared identity and unitrd approach, it may well have proven to his political advantage. It’s like the situation where if he had lived up to his promises to deliver a strong infrastructure program or to improve healthcare and lower its costs, he would have improved his political fortunes. But sadly he always chose the path of leveraging division and hate- and fear-mongering as his preferred political strategies (and then playing yhe victim card when he engendered returned hostility).

        That’s why this notion of him being some kind of a political genius is so ridicous. Yes, he tapped into a rich source of political populism and rode it far. But it was dumb luck of a very cude and limited kind of talent. If he had any true political genius, he could easily have adapted to fuse his populist wave with some obvious and basic common sense. Imagine how far he might have gone if he had simply taken the pandemic seriously rather than panicking that it would stain his record. Or if he had actually advocated for rebuilding America as he had promised.

      • mesocyclone, I agree with you that South Korea’s experience with SARS (and later MERS) helped them respond more adeptly to Covid. However, that doesn’t excuse the incredibly inept responses of most other countries, including the U.S.

        dpy6629 wrote, “The thing that is critical is culture… Many Asian cultures have a culture of compliance with authority that doesn’t exist in the West.”

        I don’t buy that excuse. The U.S. didn’t do even the most basic, simple things right.

        In August I finally had a long-delayed checkup with my doctor, and he told me about several COVID-19 cases. All of them had apparently been infected in their own homes, by people who visited them: friends, relatives, or, in one case, a plumber.

        The plumber case was especially disheartening. The plumber had felt ill and gotten tested a couple of days earlier. But he was not notified of his positive test result for seven days. In that week he continued to work, and he infected more than a dozen households.

        All those infections were completely unnecessary. None of those infections would have happened if that plumber had been in South Korea.

        The delay was caused by NC’s bureaucracy. Even then we had inexpensive COVID-19 tests available that could give results in under 15 minutes, and more accurate PCR tests that could give results in a few hours, but the State of NC restricted the doctors who were allowed to administer those tests, and restricted who the results were reported to.

        The first and most important thing is to get accurate test results to the patients, themselves, immediately, to enable them to do the right thing. The vast majority will want to do the right thing. They will willingly quarantine themselves, to avoid infecting their friends and family; they will gratefully help an interviewer compile a list of people whom they might have infected, or could have been infected by, so that those people can be quickly notified.

        It’s not a matter of “compliance with authority,” it is a matter of accepting help to avoid killing your grandparents, and the grandparents of your friends and relatives. I very much doubt that Americans are any less willing to do that than are Koreans.
         

        dpy6629 wrote, “Why would you fantacize that these same people would report contacts to authorities or obey any government official quarantine, or show up for a test?”

        Are you telling me that if you were informed that you’d been exposed to a dangerous infectious disease, that you would not accept the offer of a free test, to find out whether you were infected? That you’d rather put your friends and family at risk of contracting the disease, from you?

        Are you telling me that if you were diagnosed with a dangerous infectious disease, that you would resist quarantine, so that you could infect your friends and family?

        Are you telling me that if you were diagnosed with a dangerous infectious disease, you would not be willing to notify your recent contacts that they were at risk, so that they could get necessary care, and avoid infecting their friends and families?

        Really??

      • Dave, North Carolina may have a particularly incompetent governor. Certainly New York’s Cuomo led a criminally incompetent response. That he became a hero with full media complicity is a testament to our corrupt media. State’s did a poor job at protecting nursing homes. That’s not a federal responsibility as state’s regulate these homes. A lot of old folks died because of that. But many of them were already critically ill.

        But we didn’t do much worse than Britain for example, Italy, Spain, etc. Even Germany is experiencing a quite strong second wave, just as we are.

        I just don’t think whining after the fact and comparing us to Korea is sane. Culture makes a huge difference.

        Josh, there are specialists in treating these obsessive compulsive conditions. Also, try to be succinct and actually add something people don’t already know.

      • > mesocyclone, I agree with you that South Korea’s experience with SARS (and later MERS) helped them respond more adeptly to Covid. However, that doesn’t excuse the incredibly inept responses of most other countries, including the U.S.

        I will agree with that as well. But there’s no good reason why (1) we couldn’t have learned from their experiences as well. They didn’t keep the lessons they leaned a secret and, (2) at the beginning of the pandemic, knowing that in Asian countries they had learned lessons, we couldn’t have followed their lead on how to deal with COVID.

        There waa no shortage of people in this country yelling at the top of their lungs that we needed to massively ramp up our test and trace infrastructure. But instead, we had our leaders LYING about the state of our testing and tracing capacity, under the criminally negligent belief that acknowledging our shortcomings and addressing them would be a political liability, and explicitly stating the inane belief that more testing would create more infections,

        And unfortunately, many of our fellow citizens were more interested in enabling incompetence in our political leaders than holding them accountable for their failures. They were willing dupes of political con artists – thinking that if they were their politicians they were honest and actually interested in the welfare of “the people” rather than their own welfare. . . I never thought I’d see that to the extent that I have over the past year.

        But here we are.

      • > mesocyclone, I agree with you that South Korea’s experience with SARS (and later MERS) helped them respond more adeptly to Covid. However, that doesn’t excuse the incredibly inept responses of most other countries, including the U.S.

        I will agree with that as well. But there’s no good reason why (1) we couldn’t have learned from their experiences as well. They didn’t keep the lessons they leaned a secret and, (2) at the beginning of the pandemic, knowing that in Asian countries they had learned lessons, we couldn’t have followed their lead on how to deal with COVID.

      • Dave, Did you read my comment? My point is that there are scores of millions of Americans (many of them rioting in the streets) who wouldn’t do anything an authority figure such as a police officer or a public health official told them to do. You are committing the classic error of assuming that the vast majority of people are good little submitters. Only true in authoritarian cultures or dictatorships.

      • There was no shortage of people in this country yelling at the top of their lungs that we needed to massively ramp up our test and trace infrastructure. But instead, we had our leaders LYING about the state of our testing and tracing capacity, under the criminally negligent belief that acknowledging our shortcomings and addressing them would be a political liability, and explicitly stating the inane belief that more testing would create more infections,

      • And unf-rtunately, many of our fellow citizens were more interested in en-bling incomp-tence in our poli*ical leaders than holding them acco*ntable for their fa*lures. They were will*ng d*pes of political con art*sts – thinking that if they were their pol*ticians they were hon*st and act*ally inter*sted in the w*lfare of “the pe*ple” r*ther than their own w*lfare. . . I nev*r tho*ght I’d see that to the ext*nt that I have ove*r the past ye*r.

        But h*re we are.

      • There was no sh*rtage of people in this country y*lling at the top of their l*ngs that we needed to m*ssively r*mp up our test and trace infr*structure. But instead, we had our le*ders LYING about the st*te of our t*sting and tr*cing capa*ity, under the crimin*lly negl*gent bel*ef that ackn*wledging our sh*rtcomings and addr*ssing them wo*ld be a polit*cal li*bility, and explic*tly stat*ng the in*ne belief that more te*ting would create more inf*ctions,

      • What Josh fails completely to understand about Trump supporters is that is isn’t about Trump per se. It is about the Constitution and the Bill of Rights. We cherish our freedoms and are willing to sacrifice some safety to keep them. It just so happens Trump feels the same way. Your TDS prevents you understanding this.

        This is also why Trump supporters don’t want a centralized authority telling us where we can live, what we can drive, what energy source to use, etc. to “fight” climate change. Our freedoms are worth the risk of adaptation over mitigation.

      • “Our freedoms are worth the risk…”

        This is the most relevant dividing line between Trump supporters and TDS sufferers. The former were impressed at some point that America was exceptional in finding a way to breaking the ageless cycle of power, corruption and tyranny, to enabling the masses to follow personal passions, creating great wealth and a thriving society. The later group believes that the people are just bees that need a strong queen to organize the nest. The truth is in the middle but nobody wants to acknowledge that because….

        I am a huge Trump supporter now even though he was my last choice in the 2016 GOP primary. He exposed so much corruption. Like lifting up a large rock, daylight has shown on problems with big tech, the media, public funded scientific research, China influence and election fraud areas. Trump’s flamboyance, like claiming that Mexico would pay for the wall, did not seem to hurt us in the end.

        On handling Covid, he could have used the virus to punish political enemies but we saw the opposite in NYC in the spring. The NY governor was more willing to shoot himself in the foot than accept help from Trump. The partisanship was sickening.

        Joshua, setting aside the federal screwup on rolling out the test, 50 governors were given autonomy to do contact tracing and testing and lockdowns. We had a great experiment. Which governors do you applaud as doing the best and why?

      • > This is the most relevant dividing line between Trump supporters and TDS sufferers.

        Thanks Ron.

        That’s a perfect example of the problematic world view.

        It’s binary. If you aren’t a Trump supporter, you are deluded.

        No valid criticism exists.

        It’s a cult of personality.

      • Ron –

        > Joshua, setting aside the federal screwup on rolling out the test, 50 governors were given autonomy to do contact tracing and testing and lockdowns. We had a great experiment. Which governors do you applaud as doing the best and why

        There was a reasonable debate as to the extent to which testing and tracing were better organized at the state or federal level. I would imagine there’s no clear optimization there – it would be a series of tradeoffs.

        But all efforts in this country were doomed from the start because of federal level incompetence, a lack of devoted resources, an obstinace about accepting any responsibility at the federal level (because if a political fear of accountability), and LYING aboit capacity and failures.

        You can’t fix problems if you steadfastly refuse to accept that they exist and you LIE about capacity.

        There is no doubt hat happened in this country. Trump explicitly acknowledged that his focus was on political expediency. They clearly lied, over and over, about failures and capacity. They constantly promised testing capacity that never came close to materializing.

        And yet his apologists refuse to acknowledge that a freaking politician acted out of political expediency.

      • “And yet his apologists refuse to acknowledge that a freaking politician acted out of political expediency.”

        I am a Trump supporter but also a critic. I thought for a while that he could have locked down all international flights rather than just from China. We see now that the virus was likely well established in NYC and other places by January. Contact tracing doesn’t work well if you don’t have a test. Would South Korea have provided us their test kits? I don’t know.

        I do know that Trump is one person and the federal bureaucracy is 2.6 million people, most of whom despise Trump and Republicans. Would a President Cuomo or President Biden have had Fauci do a better job? Would they have had better testing? Would they have had Warp Speed?

        Joshua, I asked you which governors did the best job and why, which now can be evaluated objectively. You seemed to have evaded.

        Victor Davis Hanson has an opinion today on all this:

        https://amgreatness.com/2020/12/20/covid-woke-science-and-death/

      • “Joshua, I asked you which governors did the best job and why, which now can be evaluated objectively. You seemed to have evaded. ”

        You will find that Joshua only throws darts. He evades anything that might have the slightest negative impact on his extremely partisan world view.

      • > You will find that Joshua only throws darts.

        Part and parcel with the stance that pointing out obvious failures makes someone delusional.

        The failures at the federal level were widespread and obvious. It’s hilarious, in a sad way, that Trump’s supporters have to pretend his lies, unkept promises, and explicit prioritization of his own political status, didn’t manifest differentially in poorer outcomes.

        As just one example, you, explicitly, have criticized the “herd immunity” approach as both intellectually bankrupt and morally reprehensible. Yet you won’t criticize Trump for (1) his rhetorical embrace of the herd immunity approach and (2) his empowerment of, and reliance upon, “herd immunity” advocates.

        Its a intersting process to watch take place.

      • Good policy depends upon good information and balance. Herd immunity strategy makes sense in the set of scenarios where the vulnerable population are known and can be temporarily protected while the rest of the population undergoes intentional exposure. There was one paper I read that suggested gut infection as a safe type of exposure if it could be prevented from spreading to pulmonary or neurological ACE2 receptors.

        Ironically, it was the liberal establishment medical experts who made the herd immunity option plausible by downplayed the potential for the rapid development of a vaccine. With that belief the herd immunity option makes more sense rather than exposing the entire population to dangerous indefinite lockdowns while it slowly comes to the same endpoint.

        It was Trump’s dismissal of experts like Dr. Ezekiel Emanuel that led him to invest in Warp Speed and support to a limited and targeted lockdowns while waiting for the vaccine.

      • We believe in freedom and honesty. We knew lockdowns would be more costly than this virus:
        https://apnews.com/article/san-francisco-coronavirus-pandemic-a48a148efadbeaa1181148ea367c4d68

    • joe the non epidemiologist

      josh’s comment -” There was no sh*rtage of people in this country y*lling at the top of their l*ngs that we needed to m*ssively r*mp up our test and trace infr*structure. But instead, we had our le*ders LYING about the st*te of our t*sting and tr*cing capa*ity, under the crimin*lly negl*gent bel*ef that ackn*wledging our sh*rtcomings and addr*ssing them wo*ld be a polit*cal li*bility, and explic*tly stat*ng the in*ne belief that more te*ting would create more inf*ctions,”

      typical response from someone with an irrational trump derangement syndrome

      TDS syndrome suffers forget that democrat party leaders were
      1) encouraging parting in the streets of NY during mardi gra
      2) were adamantly opposed to any travel ban that would have greatly slowed the early spread
      3) some democrat leaders were actively pushing covid patients back into nursing homes.
      4) Lack of testing ability to due to FDA screw ups. Note that the Federal buearacracy is heavily dominated by democrat civil servants. Also note that no president has time to supervise every federal employee and that agency heads making $150k – $200k should not need supervision.

      • TDS deserves an entry in DSM manual. It is a debilitating disorder, the first mental affliction that is known to spread from human to human.

      • “TDS deserves an entry in DSM manual. It is a debilitating disorder, the first mental affliction that is known to spread from human to human.”

        well, the first sentence is true. But contagious afflictions have been long known. I’d say that the resistance to mask wear is indicative of another. Moral panics, of which TDS qualifies in some cases, are diseases of mobs that result in members acting irrationally.

      • Did trump lie about testing, repeatedly?

        Yes.

        Did he and his administration make promises over and over regarding testing that they didn’t come close to living up to?

        Yes.

        Did Trump state repeatedly that the number of cases was a function of the number of tests, and that we should test less?

        Yes.

        Did Trump, repeatedly, make statements about the trajectory of the pandemic which severely underplayed the actual trajectory of the pandemic?

        Yes.

        Were multiple experts saying from the very beginning that we needed to devote many more resources to increasing our testing and tracing capacity?

        Yes.

        Did Trump and the Trump administration, from the very beginning, claim that we had sufficient infrastructure capacity to handle the pandemic?

        Yes.

        Did we have sufficient capacity?

        No.

        Did they address the problems resulting from insufficient capacity?

        No, because they systematically denied that they exited.

        Did Trump empower people who said we should be encouraging infections to play pivotal roles in managing the pandemic?

        Yes.

        Did the Trump administration empower people with zero relevant expertise to overrule people with relevant expertise to manage communication with the public regarding the pandemic?

        Yes.

        Did the Trump administration strongly advocate for mask-wearing as a way to reduce spread of the virus?

        No.

        None of that is arguable.

      • Meso,

        The jury is in on masks. They don’t make much if any difference. You can believe what you like, but if you are truly at high risk for this disease you would be wise to accept that reality. They didn’t work in 1918, they didn’t work in subsequent flu studies, and they aren’t working now.

      • “The jury is in on masks. They don’t make much if any difference. You can believe what you like, but if you are truly at high risk for this disease you would be wise to accept that reality. They didn’t work in 1918, they didn’t work in subsequent flu studies, and they aren’t working now.”

        Wrong jury. Masks help – don’t cherry pick just one or two studies.

        But, they can’t be relied upon to save you from infection. They are just one weapon in the armory against the disease.

        BTW… if you use the masks medical people wear, they help a heck of a lot – the N95 respirators, for example. Other masks not as much. I wear procedure masks – helpful but no guarantees.

        https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-research-confirms-critical-role-of-masks-in-preventing-covid-19-infection/ is an example of a recent study sent to me by a rather well regarded research organization – Mayo Clinic.

      • Doug –

        How many people died in Sweden from COVID on Nov 24th and 25th?

      • N95 masks certainly work as does HEPA filtration. The MAYO clinic article confirms what we already know. That the masks we are wearing prevent droplet spread, but it states right in the article that 6ft of separation reduces droplets to background levels. The masks we are wearing don’t block aerosols effectively, and this disease is spread via aerosols. Masks work in an environment were close contact is unavoidable, such as a healthcare setting.

        If this disease had required droplet contact to spread it never would have become a pandemic. Just as Ebola and SARs never became pandemics.

      • “The masks we are wearing don’t block aerosols effectively, and this disease is spread via aerosols.”

        This disease is spread by droplets of many sizes, including aerosols. The masks do reduce aerosol spread, but they are more effective against droplets. Overall, they offer significant improvement over no masks.

        From the article: “”The most common mechanism for COVID-19 transmission is through respiratory droplets which are larger than aerosols and are more easily blocked with masks,” says Dr. Callstrom.”

        From CDC: “Cloth masks not only effectively block most large droplets (i.e., 20-30 microns and larger)9 but they can also block the exhalation of fine droplets and particles (also often referred to as aerosols) smaller than 10 microns ;3,5 which increase in number with the volume of speech10-12 and specific types of phonation.13 Multi-layer cloth masks can both block up to 50-70% of these fine droplets and particles3,14 and limit the forward spread of those that are not captured.5,6,15,16 Upwards of 80% blockage has been achieved in human experiments that have measured blocking of all respiratory droplets,4 with cloth masks in some studies performing on par with surgical masks as barriers for source control.3,9,14”

        https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html

      • Joe - the non epidemiologist

        Mesocycle – you cited the mayo study and the CDC study showing that masks work to slow the spread. Clearly at the individual level, mask should work, which I agree with.

        However, If the masks play a significant factor in slowing the spread, there would be much greater difference between high compliance areas and low compliance areas. California, Minnesota, colorado are states with much higher level of compliance vs low compliance states such as MT, NE, SD ND TX .

        KU center for policy did a study covering the period from July 1 through Oct 23rd which the raw data only showed an 11% delta between mask mandated counties and non mask Mandated counties.

        So while masks should work, the effectiveness is not correlated well at the macro level.

      • “However, If the masks play a significant factor in slowing the spread, there would be much greater difference between high compliance areas and low compliance areas. California, Minnesota, colorado are states with much higher level of compliance vs low compliance states such as MT, NE, SD ND TX .

        KU center for policy did a study covering the period from July 1 through Oct 23rd which the raw data only showed an 11% delta between mask mandated counties and non mask Mandated counties. ”

        As we have seen, it is difficult to measure the impact. Mandates don’t mean compliance, and lack of mandates don’t mean no mask wear. Plus, masks are just part of the equation, and not the most important part.

        I think masks mandates make sense primarily because, compared to other mandates, they are the least burdensome both on individuals and especially on businesses. They are not a magic solution that will make the epidemic just vanish.

        BTW, given the difficulty in measuring actual mask use, an 11% difference is significant. An 11% difference in transmission rates translates into a huge difference in case rates, especially if other measures have move the transmission rate to a low level.

        BTW… I’d love a link to the KU study. I once worked in a KU microbiology research lab.

      • Of course different have shown different results.

        Nonetheless, comparing across areas isn’t informative if you can’t control for confounding variables.

        If an area with high compliance of mask-wearing has an equal rate of spread as an area with low compliance, that doesn’t tell you much and it could certainly be that rate of spread in the high compliance area might have been higher if they hadn’t worn masks as much and the rate of spread in the low compliance area might have been lower if they had worn masks more.

      • Joe - the non epidemiologist

        this is the linke

        https://ipsr.ku.edu/covid19/

        Meso – I agree that it is difficult to measure impact. My point was that data doesnt show much if any correlation at the macro level.

        The kansas study showed 11% for delta for the period 7/1 thru 10/23 & a 13% delta for the period 8/1/ through 10/23.

        The KU study claimed a 40%/50% delta, but that only covered the 3 weeks of oct instead of the entire period. When I did a spot check of approx 25 counties, for 11/1 to 11/16, the delta was 16%. There were 5 or 6 low population non mask counties that really skewed the results. Remove those outliners, and the delta becomes non existent. I asked if they planned to update their study to cover the month of Nov, but received no response.

      • Thank you for that link. I had seen press reports but this is more detail, of course.

        It’s not surprising that they only studied one period – after all, they produced their output shortly after that. Plus, that was the time when the mandate first went into effect, making it a good time to look for a temporal correlation. And, they show a good correlation.

        I saw that same correlation here in Arizona. After the mandates, the cases rose for a couple of weeks, and then they cratered – they dropped so rapidly that Rt dropped to about .7.

        Kansas is interesting because the population was mostly in counties or cities (Manhattan) where the population is concentrated. But, those are the same places where local mandates of other kinds are also more likely.

        But yes, we cannot disentangle cofactors. Also, it would have been better if epidemiologists had done the study – I’ve seen other studies by economists that were way off because they didn’t account for well known epidemiological facts.

        Still, the laboratory evidence, and experience in past epidemics, supports mask wear in situations where droplet or aerosol spread is possible. In other words, indoors with others, period. Outdoors with others if distancing cannot be done. Note – “others” means people not in the individual’s quarantine bubble.

        Also, check out this link from the same group – masks vs no-masks up until the current time. https://ipsr.ku.edu/covid19/images/Weekly_Mask_NoMask_20201208.pdf

      • A century of epidemiology demonstrated that masks as worn by the general population don’t make a significant difference in infectious disease transmission. In March and April authorities decided to ignore a century of studies. Studies performed recently have been politicized. For example, the advantages of masks in the Kansas study completely disappeared when the authors adjusted for the fact that some cities in unmasked counties required masks. The Kansas study states this in black and white. The study is also not a randomly controlled test, it is a correlation study and found, at best, a very weak correlation.

        I know lots of people who have little ability to understand and interpret and they believe masks make much more difference than they do. I think we should stop endangering these people.

      •  Wälde 22 June 2020

        Confronted with a novel, aggressive coronavirus, Germany implemented measures to reduce its spread since March 2020. Requiring people to wear face masks in public places has, however, been a subject of controversy and isolating the effect of mask-wearing on the spread of COVID-19 is not simple. This column looks at the town of Jena and other German regions that introduced face masks before the rest of the country to see whether the requirement makes a difference in the number of new COVID-19 cases. Requiring face masks to be worn decreases the growth rate of COVID-19 cases by about 40% in Germany.

        https://voxeu.org/article/unmasked-effect-face-masks-spread-covid-19

    • It is bazaar that people continue to claim that some countries “eliminated” this virus. Both S. Korea and Taiwan still have cases of COVID19 occurring daily. S. Korea is in the midst of the worst outbreak they have had during the pandemic. Taiwan has only a few cases daily but still inoculating activity is occurring. They have both faired better than Western Europe, the USA, and S. America but they have not eliminated the pandemic.

    • SK and Taiwan set up the infrastructure for mass testing/contact tracing over several years after the SARS outbreak in the early 2000’s. Good for them. It’s a shame we didn’t do the same. But it’s not like the US had the same infrastructure and just chose not to use it.

    • You have not mentioned the most critical points in discussing Taiwan, South Korea etc:

      1) their international borders were closed *immediately*. No Western country could bear to do this, it seems
      2) they did *NOT* close down businesses. According to Taiwan’s Deputy Director of Health (June, 2020), Taiwan closed only the karaoke bars for about two weeks. Nothing else.

      • Taiwan did not have to close down businesses – they caught it in time.

        South Korea’s massive contact tracing capability – and the willingness of their population to cooperate with it – allows them to stop outbreaks without massive shutdowns. But, they now have worse numbers ever and they are going to close bars, gyms and have significant capacity limits on all businesses and other venues.

        Also – of their latest two clusters, one was a super-spreader event at a restaurant.

        So much for your fantasy.

  13. I too ran across anecdotal information about the spread of the Coronavirus when talking to a cargo pilot in the business of transporting goods over the route from Wuhan to Anchorage. There has been virtually no discussion of the fact that there apparently was a Coronavirus outbreak in Anchorage in late 2019 but at the time no one knew anything about covid-19 and the doctors that treated this pilot I talked to, told him he appeared to have an unusual case of pneumonia– that was in November of 2019. If you Google it, you see that cargo traffic from China to Anchorage apparently was terminated in the first week of January 2020. Other anecdotal information of unknown origin indicates that the covid-19 virus may have begun to spread in China as early as August 2019.

    • Unfortunately, getting to the bottom of this would require openness from China which we’re not about to get if they purposefully participated in a crime against humanity by encouraging the spread of the virus worldwide.

      • Yes. Recently there have been studies of hospital specimens and blood showing the virus outside China as early as September 2019. Of Course, China seized on the reports to claim the virus came from Italy. :)
        https://www.cnbc.com/2020/11/15/coronavirus-emerged-in-italy-earlier-than-thought-study-shows.html

      • Now that we have seen the virus evolve at least twice toward contagiousness it stands to reason that it may have started with a much lower spread rate. This would explain its being undetected in Italy in September 2019. China might even have been secretly monitoring and hoping it would fade out. Perhaps it was a new aggressive strain that popped up in early December in Wuhan which prompted authorities there to take overt actions. This would explain the December wet market cluster in Wuhan. China’s attempted to pin a natural origin there, which had plausibility recalling a wet market is where the 2003 SARS got finally traced back to in smuggled palm civets.

        China has been resistant to international investigation to find a natural origin after their held out pangolin covid virus has been mostly rejected as being the SAR2 zoonotic origin.

        There is much genetic and circumstantial evidence the virus came from a lab, though few credentialed experts want to acknowledge this. It is undisputed that Shi Zhengli, the WIV “bat woman” was working on gain of function by genetic manipulation of SARS-like bat viruses. We know this partly because the NIH was funding it through a grant of the Univ of NC and Dr. Ralph Baric. In 2013 the NIH banned funding for gain of function research on viruses as too dangerous, as there had been lab mishaps. However, they grandfathered Baric’s grant and in 2015 the WIV produced a chimera virus by splicing a bat SARS virus with human coronavirus spikes — as long as he didn’t do it in the US. The WIV tested mice and human tissue and found it was viable in both.Then they tried to kill it with Remdesivir and other antivirals with no success. Baric and Zhengli’s paper details all this and concludes that gain of function research is too dangerous to continue.

        The following year the Chinese military collected a bat viruses (ZC45 and ZXC21) that have many RNA segments that are identical to SARS-CoV2. The spike RNA has restriction sites on both sides of its segment, a commonly used technique in genetic engineering research. It allows for the segment to be separated and studied after being cultured. These point were brought out be Dr. Li Meng Yan, who fled Hong Kong to the US to blow the whistle on China. She wrote an unpublished paper that has been negatively reviewed by the virology establishment after she went on Tucker Carlson. For example, Dr. Robert Gallo, (co-discoverer of AIDS) says the military viruses are not close enough be suspect. [He doesn’t question why the military is collecting SARS viruses though.]

        Here is Yan’s paper: https://zenodo.org/record/4028830#.X-FJaNhKhPY

        Here is its review: https://changingtimes.media/2020/10/12/sars-cov-2-lab-origin-hypothesis-gains-traction/

        Yan does discredit herself by asserting China released the virus intentionally since they would behave with identically to cover an accident. She didn’t need to go “full kraken.”

  14. From a purely logical point of view, if we are practicing distancing, masking, good hygiene, it would be very difficult for an infected person without symptoms to provide enough dosage of the virus to infect us. Family gatherings normally do not practice those preventive measures. And perhaps this explains those rare anecdotes of an entire family becoming infected. Of course all of this assumes the test for the presence of the virus is valid. And we know the PCR test is not.

    On November 27, 22 molecular biologists and doctors released an extensively peer reviewed report detailing that the polymerase chain reaction (PCR) test, which is widely used in the US and worldwide to detect the presence of COVID-19, is totally useless for this purpose. https://cormandrostenreview.com/report/

    • Paul McMahan: “Family gatherings normally do not practice those preventive measures. ”

      This is a great point. The question always boils to degree of viral exposures balanced against need and respective precautions available.

      Pre-symptomatic spread is well documented enough to make asymptomatic spread moot, even perhaps with school children. For example, if they are largely asymptomatic and low spreaders are households still being exposed by taking zero precautions at home? I have not heard much on this. If outdoor dining is near zero risk for single households perhaps we leave it to guidelines rather than lockdowns. OTOH, we now have herd vaccination in site.

      Perhaps this is where the most beneficial thing we can do is all agree not to vilify others for their behavior or advocacy and instead allow personal responsibility.

      • “Pre-symptomatic spread is well documented enough to make asymptomatic spread moot”

        Where would one find this documentation?

      • Robert Starkey

        Ryan
        Try googling the topic. You will find links to several studies.

      • @Robert

        Not sure what google search you did. But mine showed a big shrugged shoulders who knows.

      • Ryan, pre-symptomatic spread has been widely reported in all types of media. It’s also common medical knowledge that flu is spread pre-symptomatically as well. This make sense when one knows that virus symptoms lag the infection. In fact, the body’s immune response is often the lethal aspect, not the infection itself.

        Asymptomatic infection viral load is much lower than pre-symptomatic viral load. It is also harder to document a trace of the spread from asymptomatic carriers, (obviously). This leads people to point out that the science has yet to document asymptomatic spread. My point is that for policy purposes it does not matter since pre-symptomatic spread has been confirmed many times over.
        https://scholar.google.com/scholar?hl=en&as_sdt=0%2C39&q=Pre-symptomatic+SARS+CoV2+Covid&btnG=

    • And yet, over and over we see that as PCR positives go up and down, so do hospitalizations, ICY admissions, and deaths.

      There are real problems with using the PCR test for surveillance as opposed to diagnosis (the antigen test is better for assessing infectiousness), but it does have a purpose and the spike in positive tests is importance.

  15. Paul McMahan wrote, “On November 27, 22 molecular biologists and doctors released an extensively peer reviewed report detailing that the polymerase chain reaction (PCR) test, which is widely used in the US and worldwide to detect the presence of COVID-19, is totally useless for this purpose.”

    That is not accurate.

    In the first place, the report is not peer-reviewed, let alone “extensively peer reviewed.”

    Secondly, it does not appear to claim that all PCR tests are “totally useless.” The authors call their document a “report,” rather than a paper, and its stated purpose is to criticize and request the retraction of another paper, Corman et al, Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020 Jan;25(3):2000045. doi: 10.2807/1560-7917.ES.2020.25.3.2000045.

    That paper defines a “workflow” for detection of the SARS-CoV-2 coronavirus using PCR tests, and it was apparently the basis for many different PCR tests, developed by many groups. But even if Corman et al, was flawed (which I’m not qualified to judge), that doesn’t mean the tests don’t work.

    Frankly, it seems very obvious that if the PCR tests didn’t work, then by now somebody would have noticed. It’s not as if nobody has checked. For example:
    Nalla et al. Comparative Performance of SARS-CoV-2 Detection Assays Using Seven Different Primer-Probe Sets and One Assay Kit. J Clin Microbiol. 2020; JCM.00557-20. doi:10.1128/JCM.00557-20

    Nor was the report criticizing Corman et al written by “22 molecular biologists and doctors.” The web site you linked to does list 22 names on the report, but it also lists their roles. Bizarrely, nobody is credited with actually writing it. Only five of 22 individuals contributed to planning and/or conducting the report’s research, and/or “conceptualising the manuscript.” The other 17 are all credited with merely “proofreading” it.

    The five who are credited with contributing in ways other than proofreading are:

    1. PB: Planned and conducted the analyses and research, conceptualising the manuscript.
    Dr. Pieter Borger (MSc, PhD), Molecular Genetics, W+W Research Associate, Lörrach, Germany.

    2. BRM: Planned and conducted the research, conceptualising the figures and manuscript.
    Rajesh Kumar Malhotra (Artist Alias: Bobby Rajesh Malhotra), Former 3D Artist / Scientific Visualizations at CeMM – Center for Molecular Medicine of the Austrian Academy of Sciences (2019-2020), University for Applied Arts – Department for Digital Arts Vienna, Austria.

    3. KMcK: Conducted the analyses and research, conceptualized the manuscript.
    Kevin McKernan, BS Emory University, Chief Scientific Officer, founder Medical Genomics, engineered the sequencing pipeline at WIBR/MIT for the Human Genome Project, Invented and developed the SOLiD sequencer, awarded patents related to PCR, DNA Isolation and Sequencing, USA.

    4. KS: Conducted the analyses and research.
    Prof. Dr. Klaus Steger, Department of Urology, Pediatric Urology and Andrology, Molecular Andrology, Biomedical Research Center of the Justus Liebig University, Giessen, Germany.

    5. UK: Planned and conducted the analyses and research, conceptualising the manuscript.
    Prof. Dr. Ulrike Kämmerer, specialist in Virology / Immunology / Human Biology / Cell Biology, University Hospital Würzburg, Germany.

    So, we have a molecular geneticist, a 3D artist, a biologist (BS), a urologist, and a virologist. Three of the five have MDs or PhDs. (Not quite “22 molecular biologists and doctors,” eh?)

  16. Lockdown due to the more contagious yet still not any more deadly new UK strain reminded me of 28 Days Later:

  17. We have very few cases so far on Vancouver Island (population about 860,000 and most of us are in the 2 cities Nanaimo and Vancouver). Its good because we are a “retirement home” for Canada due to our more pleasant weather. I think we should have gone on a “lock out” in the summer during one of our virus free episodes to keep it extinct locally. But of course, politicians are in charge and they let it come back to the island to “help” the economy. I’m pretty sure our economy would be better if we quarantined everyone coming in. The virus arrives every week with pre-symptomatic passengers on incoming planes and on ferries. Why they don’t have quarantine before or after flights in beyond me. Seeing results from China, New Zealand, Australia, Norway, etc. its pretty obvious that the virus can be eliminated but most countries lack the political will. Left wing countries do far better than right wing countries. (Its just a fact) This might be tactical, its pretty clear that the UK is using the virus to eliminate expensive to care for, elderly people. But its foolhardy too. I said all along that this thing will mutate to become less deadly and to spread more quickly. That’s just how deadly pandemics work. But it only mutates to be less deadly if people eliminate the deadly spread. In the UK they got the bright idea of sending covid19 patients to old folks homes. This probably helped keep the most common strains very deadly. Anyway, the virus can be held back, definitely, it would be a good idea to ban international air travel for a while until the new strain(S) are checked to see if the vaccine can tame them. I have no idea why western countries didn’t follow the Chinese model to contain the virus. But they just decided from the get go “we can’t do that” but obviously, extraordinary times require extraordinary measures. I grew up on a farm in Ireland. We never considered “herd immunity” when Foot and Mouth disease broke out and spread in europe. (because most of the herd would die) quarantine was the only option, and it worked). Its astonishing to suggest herd immunity as an option for a virus that is still evolving and adapting to its new human host. Its insane to suggest it instead of trying to hold down the casualties until reinforcements (the vaccine) arrives. Brian

    • “(Its just a fact) This might be tactical, its pretty clear that the UK is using the virus to eliminate expensive to care for, elderly people… In the UK they got the bright idea of sending covid19 patients to old folks homes.”

      Err.. it was obviously an oversight that patients weren’t tested for covid before being sent back to care homes early in the UK pandemic.

      Something I’ve noticed throughout the year is TV professionals throwing around soundbite summations of other nations’ strategies to justify their own views.

      It’s quite common and not only can it be offensive but scientifically untruthful.

  18. How many of you have seem people just collapse and die on the streets? Any friend of a friend story?

    This really happened in HK during SARS. People dropped like flies on the streets. Now that is something that deserves lockdown and masks. Oops, there was no need to impose one. People did both themselves. People know, when their lives are at stake, what to do. They don’t self quarantine and mask themselves if they don’t perceive the same level of threats.

    Just the notion of having to “compel” people to save their own lives is borderline insanity.

    May be, “experts” need to learn from people’s actual behaviour and bayes-adjust their risk models, just like in financial markets you calibrate to observed prices.

  19. Seems the writer picked an “example” to illustrate his point of how the political science metamorphosized from “slow it down” to “stop” all together… It should stand to reason that asymptomatic or even pre-symptomatic, will shed less viral load than an infectious symptomatic (coughing,sneezing more aerosolized spit). My theory is: less viral load transferred gives more people the chance to develop immunity without overwhelming immune system. While this version is new, Corona viruses are not. I would have to speculate their behaviors are similar and Influenza like. News this morning already talking about how it has mutated in the UK but the vaccine should still have efficacy (my own T-cells may be just as effective). While we focus on immediate and relatively needless protection of health (numbers looking more like Influenza with every “positive” test) from the Sars-CoV-2, we are potentially creating longer-term, anti-societal problems (not just economic ones).

    • joe the non epidemiologist

      “While we focus on immediate and relatively needless protection of health (numbers looking more like Influenza with every “positive” test) from the Sars-CoV-2, we are potentially creating longer-term, anti-societal problems”

      Concur – too much focus was on the short term benefits, while ignoring the long term problems the short term solution was creating. Delaying or retarding the development of the human immune system will have vastly worse long term consequences. The advocates of the lockdowns, etc are essentially promoting the humans should evolve so that humans can only survive in a sterile environment.

      “Seems the writer picked an “example” to illustrate his point of how the political science metamorphosized from “slow it down” to “stop” all together”

      Concur – the virus is too deeply embedded into the general population to be able to stop it.

    • UK-Weather Lass

      To be asymptomatic I must first be infected, but what does this mean? It means I must receive a viral load of sufficient amount from an infectious person that allows the virus to replicate inside my cells. My infection must then appear, if not symptomatically because I don’t give in easily, at least in a RT-PCR test at lower than 24 CT to show I am carrying a viral load sufficient to infect someone else. In this event even if I do not get ill someone else could get ill or die if I infect them. If, however, my viral load is not evident at realistic CT level in a RT-PCR test then I am neither asymptomatic nor infectious and have no reason to be self-isolated. That is surely the way a medical practitioner would see things if I went to a surgery with potential symptoms and said to the GP ‘I wanted to be safe rather than sorry’ and they may give me a properly conducted RT-PCR test to find out or send me on my way with ‘you are fine’ following examination.

      But the reality of the conundrum is that infection is not easy to track without due care and close clinical observation because alternative views and opinions are possible. What if the viral load I have received was only sufficient to trigger my immune system but didn’t infect me? Does this mean the virus didn’t have a chance to replicate in my cells and is that not crucial in understanding this virus?

      Did my immune system’s rejection of the attack mean viral cell replication was prevented or was I at any time, however brief, carrying a viral load sufficient to infect another person? Again, this is crucial information required to understand the virus and how it is controlled. It seems we don’t know or cannot be sure on these matters at a time when the virus is spreading rapidly and so we assume safety first procedures and embrace the idea that I am ‘asymptomatic’ without any clinical investigation at any time other than when and if I become seriously sick with Covid-19 resulting in hospitalisation. If I am ill at home with ‘flu symptoms I won’t know if it is Covid-19 or not. The corollary of that is we are likely missing vital pieces of a jigsaw simply because we are terrified of the spread threat rather than understanding how that threat can properly mitigated or managed without risk to the vulnerable, and that is a situation we face in any and all influenza outbreaks.

      What if a very low viral load passes between these ‘asymptomatic’ people and other individuals? Will this trigger similar immune system behaviour in these other individuals offering a fast route to herd immunity? Will there be the occasional mild disease symptom development or very, very occasional serious illness as a result? And what if this is habitually how we have built up and maintained resistance to novel coronaviruses in the past and the people who got seriously ill or died would have got seriously ill or died anyway had the infection been just another influenza or common cold virus? Isn’t that a perspective worth considering we should know before we impose drastic measures on healthy people?

      Have we been caught being unprepared to deal with SARS-CoV-2 simply because of anxiety, fear and a lack of presence of and confidence in leaders at the levels such people would normally have made themselves known and taken control? Perhaps those people these days were just too busy tweeting and chattering to each other and not paying proper attention to what could be seen, heard and felt around them as they once would have done. The situation demanded a gentle knowing and subtle movement of the tiller, not a complete turn away from normality. Have we turned a recurring ‘normality’ into a crisis and are we doing likewise with climate change because we cannot accept that things cannot always be as we demand them to be no matter how clever we think we are?

      In short instead of really looking out for each other we have mastered the art of exercising our thumbs and looking down at pieces of glass without for one moment thinking about where that dubious dexterity eventually takes us which is a long way from where we want and need to be.

  20. If we lock everyone in for the duration of COVID, the duration of which is unknown at this point, the US would have another Great Depression. Also, overdoses are higher, somewhat offsetting any lessening of deaths from COVID. Then there is the increased suicide rate for Blacks and a decrease for Whites. Yet another disparity for that group.

    THURSDAY, Dec. 17, 2020 (HealthDay News) — The coronavirus pandemic has exacerbated racial divides in health care in numerous ways, and a new study reveals yet another: Suicides among Black people doubled during COVID-19 lockdowns, while suicides in white individuals were cut in half during the same period.

    https://www.usnews.com/news/health-news/articles/2020-12-17/pandemic-tied-to-higher-suicide-rate-in-blacks-lowered-rate-in-whites-study

    The bottom line is we have to keep the economy open in order to survive as a country. This will result in more COVID deaths, but won’t kill the country.

    That doesn’t mean we should do stupid things like send elderly COVID patients back to the nursing home when there is a hospital ship waiting for them in the harbor, like Cuomo did in New York. That’s a Emmy winning strategy for sure!

    https://www.msn.com/en-us/news/politics/emmy-winner-andrew-cuomo-s-no-good-horrible-very-bad-month/ar-BB1bYLUa

  21. I wouldn’t presume to judge winners and losers among societies coping with this strange virus: so infectious and not dangerous to most people while deadly to some. I do note that the response was different in more remote and poorer places. Treatment decisions were taken by doctors close to their sick patients, without the burden of bureaucracies obsessed with high tech Big Pharma silver bullet vaccines. Physicians in many parts of the world scrambled to provide anti-viral medicines and immune-enhancing nutritional supplements, whatever they could get their hands on. An example is Dominican Republic, small island nation depending on tourism, so not isolated. Dr. Redondo:

    “After eight months of active clinical observation and attending about 7 thousand patients of Covid-19 in three medical centers located in Puerto Plata, La Romana, and Punta Cana, Dr. José Natalio Redondo revealed that 99.3% of the symptomatic patients who received care in his emergency services, including the use of Ivermectin, managed to recover in the first five days of recorded symptoms.”

    “The renowned cardiologist and health manager affirmed that Ivermectin’s use against the symptoms of Covid-19 is practically generalized in the country and attributed to this factor, among others, the fact that the risk of dying from this disease in the Dominican Republic is significantly lower than in the United States.”

    He added that “in a therapeutic format duly tested over the years, infections have always been cured faster and leave fewer sequelae if antimicrobial treatment is applied as early as possible since this allows the use of lower doses of the selected drugs. This has been one of the dogmas that remain in our daily medical practice.”

    “From the beginning, our team of medical specialists, who were at the forefront of the battle, led by our emergency physicians, intensivists and internists, raised the need to see this disease in a different way than that proposed by international health organizations,” says Dr. Redondo in his report.

    And he adds that the Group’s experts proposed the urgency of reorienting the management protocols towards earlier and more timely stages. “We realized that the war was being lost because of the obsession of large groups, agencies, and companies linked to research and production of drugs, to focus their interest almost exclusively on the management of critical patients.

    “Our results were immediate; the use of Ivermectin, together with Azithromycin and Zinc (plus the usual vitamins that tend to increase the immune response of individuals) produced an impressive variation in the course of the disease; it was demonstrated that 99.3% of the patients recovered quickly when the treatment was started in the first five days of proven symptoms, with an average of 3.5 days, and a fall of more than 50% in the rate and duration of hospitalizations, and reducing from 9 to 1 the mortality rate, when the treatment was started on time.”

    This is not about HCL or Ivermectin. In any society family physicians and local clinics are the key to preventative medicine. For Covid, so-called “advanced” societies ruled out safe, effective, inexpensive and available treatments that made the contagion manageable.

    But the successes of such unsung heroes in many far away places are also ruled out of social media and 24/7 cable news.

    https://rclutz.wordpress.com/2020/12/19/the-case-for-invermectin-covid-regimen/

    • And you gotta love this:

      > I wouldn’t presume to judge winners and losers among societies coping with this strange virus:

      But I will ask others to judge winners and losses when it serves a political agenda to do so.

    • Dr. Pierre Kory’s statements, the hearing in the senate on Ivermectin, https://youtu.be/YgOAaLmoa68, the doctor’s press conference Dec 4 in Houston? All praising Ivermectin and presenting a collection of well over 25 papers published, which confirm its usefulness in reducing symptoms and CURING people. Can we stop arguing the details and get on with handing out this safe miracle drug, under supervision, and save us all from this nightmare?
      Of course the WHO scoffs at it, but they are not so pure these days. Go to https://ivmmeta.com/ for the publication results, or see the statement put out earlier, available at http://www.flccc.net. And from Dr. Kory’s statement, “Professor Paul E. Marik, has developed a highly effective protocol for preventing and early treatment of COVID-19”. You can read the testimony at the website with the senate hearing. All participants have provided written testimony with references to the publications.
      We’re done with this.
      Look up Kory on Youtube and go from there.

  22. My daughters and grandkids teach and attend schools in 8 different schools and school districts. Each one has different restrictions and arrangements, determined by the local school board. Good luck telling 17,000 school boards they are going to be using one scheme for the 100,000 schools in the US. The science was uncertain 10 months ago and is slowly evolving, but even now there is not unanimity in every facet of the disease and our response to it.

    • Lol. Yeah, everyone is saying that all schools should follow the same procedures irrespective of local conditions like positivity rates or local levels of preparedness.

      Keep hiding from boogeyman under your bed. After all, big daddy is telling you to be scared.

  23. > Joshua, I asked you which governors did the best job and why, which now can be evaluated objectively.

    First my guess is that it was a rhetorical question. But anyway, I don’t know how it could be answered. Conditions varied enormously by state at many levels. As such, the need by states for federal support in order to be effective varied widely and judging by outcomes would necessarily be hard because the starting conditions and relevant variables were so different.

    Even within states, the governors varied their approaches as conditions varied. And of course, bung politicians, they varied what they did based on political expediency.

    But none of that changes the obvious and continuous failures and malignant neglect at the federal level.

    • None of that changes the spectacular success of Operation Warp Speed. It’s also an object lesson on the stifling effects of over-regulation.

      • The vaccine development has been remarkable. To the extent that Trump made a difference, and I think he did to some extent, he deserves credit. But his claiming credit obviously dwarfs his actual contributions.

    • I will note that as hard as it is to judge governors because of the many variables and much uncertainty, Newsome deserved to be impeached for the whole French Laundry disaster.

      That kind of hypocrisy among politicians is toxic and corrodes public trust in public health measures. Just horrendous. Many governors playing politics with mask manates and such isn’t any better. DeSantis using military-style police raids against a COVID data whistle-blower deserves special mention as well.

  24. The worldwide experiments proceed apace.
    Honestly, it doesn’t look like government actions make any difference. Countries and regions which have done well to start with now are accelerating in COVID infections and deaths. California has been in the forefront of lockdowns and what not – its performance now is worse than April.
    We are still at least 6 months away from mass administered vaccine – and may never get there in the US due to anti-vax plus health care profiteering.
    So in the context of years before mass vaccination (or never reaching herd immunity, period), the discussion over economy vs. health still is not settled.

    • Taking some rough numbers from 538, there could be 6 times more cases than known cases. So currently the US has 17,790,376 known cases. That would amount to 106,742,256 actual cases or about 30% of the population. So right off the bat we have that many who should be immune. So there will be 20-40 million vaccinations by year’s end. Cases will continue to mount up, so we should reach herd immunity sooner than you think.

      https://fivethirtyeight.com/features/coronavirus-case-counts-are-meaningless/

      • If the new variant really increases transmissibility by 70%, the herd immunity threshold could be as high as 75% (R0 = 4.0). Right now, it’s too soon to tell, but already a number of countries are banning travel from the UK because of it.

        Also, with that level of transmissibility increase, we would be extremely lucky if our health care systems weren’t dramatically overloaded.

        But, we could have well over 40 million vaccinations by year end – more like 150-200 million more if all goes well (and if we don’t have too many who refuse vaccination).

      • If we vaccinated the most vulnerable, then we could open everything up an let nature take its course. It seems that would be the fastest method to deal with this.

      • “If we vaccinated the most vulnerable, then we could open everything up an let nature take its course. It seems that would be the fastest method to deal with this.”

        That might work. But, right now 10% of those who test positive need hospitalization. I’m not sure how well they can be identified.

        Still, it makes more sense than vaccinating healthy, low risk “essential” workers (including school teachers).

      • Joe - the non epidemiologist

        Mesocycle – “That might work. But, right now 10% of those who test positive need hospitalization. I’m not sure how well they can be identified.”

        Arent those 10% positive test needing hospitalization primarily the vulnerable, so if the vulnerable are getting vaccinated first, then jim2’s plan is both the fastest and most viable.

      • > , then jim2’s plan

        Not sure which is more hilarious. The idea that Jim has a “plan” or the idea that he’s credible to offer a “plan.”

        A “clarification” on some of Jim’s alien abductions level beliefs has been offered, obviously under the threat of a lawsuit:

      • And Sidney Powell has told Smartmatic to “Come on down!”

      • Yeah. And you “forgot” you beliefs about the Seth Rich conspiracy.

        Too funny.

      • > Still, it makes more sense than vaccinating healthy, low risk “essential” workers (including school teachers).

        Keep in mind that some 25% of teachers are not low risk.

        And many low risk essential workers, in terms of their health, are high risk in terms of transmission of infections to people who are at high risk for poor health outcomes from the virus.

      • A bitter spirit will keep you from being a better person.

        Woodrow Kroll

      • School teachers can remote into a class full of kids.

      • Lou Dobbs is running disclaimers and even freakin’ NewsMax is offering a “clarification.”

        You’ve been had, Jim. You’ve been bamboozled. Hoodwinked. You’ve been sold a bill of goods.

        We tried to tell you. Why wouldn’t you listen?

      • Jim2 wrote, “there could be 6 times more cases than known cases. So currently the US has 17,790,376 known cases. That would amount to 106,742,256 actual cases or about 30% of the population.”

        That’s not plausible. Even in hard-hit Spain, where the per-capita Covid-19 death rate is 107% of that U.S.’s, the most recent national seroprevalance study found only 9.9% positives:
        https://www.paudal.com/2020/12/15/one-in-ten-spaniards-has-already-had-covid-19-the-new-results-of-the-national-seroprevalence-study-raise-the-infected-to-almost-five-million/

        In most of the U.S. it is even lower:
        https://www.physiciansweekly.com/covid-19-nationwide-sars-cov-2-seroprevalence-remains-low/

      • “Arent those 10% positive test needing hospitalization primarily the vulnerable, so if the vulnerable are getting vaccinated first, then jim2’s plan is both the fastest and…”

        We can hope so. But again, it is hard to determine who is vulnerable. If you look at comorbidities – over 70% of Americans are overweight or obese, as just one example.

        It does make sense, to me, to vaccinate those who have some appropriate combination of age and comorbidities. But, of those who don’t pass that screen, quite a few will get sick or die. After all, when you are looking at current infection rates under 1% of the population currently sick, if you run that up to 30% or so (unconstrained epidemic), that’s a huge multiple. It would probably be more prudent to try to calibrate mitigations, after the most vulnerable are vaccinated, based on the remaining rate of hospitalization, rather than just “lettin’ her rip.”

      • Possible, but more likely there is significant overlap between the vaccinated and the already exposed.
        More importantly – it isn’t clear to me that 30% immunity actually matters with COVID.
        Ukraine’s anti-vaxing, “post-Russia”, had enormous measles outbreaks among children when documented vaccination levels fell below 60%.

  25. So taking 10% as the magic number, the US would need 35,000,000 million vaccinations. We have room for more!

    • Covid-19 has proved to be very contagious. For a disease this contagious, “herd immunity” requires that about 90% of the population be immune.

      For the U.S., that’s about 300M people, minus perhaps 20 million known to have already had the disease. That means we need to vaccinate about 280 million Americans. If each vaccination requires two doses, that means we need 560 million doses.

      That’s assuming that people don’t eventually require boosters. We don’t actually know how long the immunity will last. If it only lasts a year, we’re going to need another 300 million doses in 2022, and each year thereafter.

      Don’t fret that >10% of the people will refuse to be vaccinated. Despite all the noise from the crackpots, most people are not that stupid.

      • Dave – that was the plan before the current one. Since only a small segment of the population develops severe symptoms or death, the plan now is to vaccinate all of them. Let’s say that amounts to 30-60 million people, then open everything up and let everyone else get it and be done with it.

      • Jim2 wrote, “only a small segment of the population develops severe symptoms or death.”

        It’s not only a small segment of the population who are at risk of severe illness or death. Most Americans have one or more underlying health conditions, which puts them at increased risk from Covid-19. My guess is that roughly 3/4 of Americans have one or more known risk factors: overweight, age >60yrs, diabetes, COPD, asthma or other pulmonary disease, kidney or heart disease, etc. In fact, roughly 2/3 of Americans are said to be overweight.

        It is certainly true that the Covid-19 infection fatality rate is much lower than average for young, healthy people. However, it does kill young and healthy people, and most people are not young and healthy, anyhow.

        Conversely, many people in high risk groups nevertheless weather the disease without much difficulty.
         

        Jim2 wrote, “the plan now is to vaccinate all of them. Let’s say that amounts to 30-60 million people…”

        That’s not a workable plan, because there’s no way to know with any confidence, in advance, who will develop severe illness. This disease is very unpredictable. It is common for spouses, similar in age and condition, to both be infected, but one recovers quickly and the other ends up in the ICU, or the morgue.

        The current plan is to first vaccinate the people who have the greatest risk of infection, and the greatest risk of infecting others when they are infected: healthcare workers, first responders, etc.

        Then people in nursing homes and assisted living facilities (if they’re not deemed “too white”), since they’re at greatest risk of death or severe disease, if they’re infected.

        Then, presumably, will come other high-risk people, such as dialysis patients, healthy elderly, etc.

        Last will come the young and healthy. But even they should be vaccinated. Even if you have only a 0.1% chance of dying or having severe illness from a Covid-19 infection, that’s still much worse than your chances dying or having severe illness from a Covid-19 vaccination.

      • > It is certainly true that the Covid-19 infection fatality rate is much lower than average for young, healthy people. However, it does kill young and healthy people, and most people are not young and healthy, anyhow

        It also increases, significantly, the relative risk of young people for serious illness or death.

      • Dave, you are correct that we can’t perfectly identify everyone who might get severely ill or die. Perfection isn’t achievable. However, we can keep enough people out of the hospital to make it manageable AND we open up the economy. A closed economy is also a serious threat to our well being as individuals even more so as a country.

      • Here’s an article about the planned vaccination schedule:
        https://www.statnews.com/2020/12/20/adults-over-75-frontline-essential-workers-should-be-in-second-covid-19-vaccine-priority-group-says-cdc-advisory-panel/

        Here’s are a few excerpts:

         Operation Warp Speed, the federal government’s program to fast-track vaccine production, estimates there will be enough vaccine to vaccinate 20 million people in December, another 30 million in January, and an additional 50 million by the end of February.
         Phase 1a of the vaccination effort, which began last week, involves offering vaccine to 24 million people. In Phase 1b, 49 million people will be eligible to receive vaccine. Phase 1c is a much larger group, including roughly 129 million people. In total, the first three priority groups will cover 202 million people — double the number of people the country expects to have vaccine for by the end of February.

         Phase 1a, which is currently ongoing, gives top priority to health care workers and residents and staff of nursing homes.

         [the panel] recommended Sunday that adults aged 75 and older, as well as frontline essential workers, be designated as the second priority group to be vaccinated against Covid-19 [Phase 1b].

         the third stage of the national vaccination program [Phase 1c] should focus on adults 65 to 74, people 16 to 64 years old with high-risk medical conditions, and essential workers not included in the second phase of vaccination.
         The committee defined frontline essential workers as first responders, teachers and other education workers including day care workers, food and agriculture workers, correctional facility staff, postal workers, public transit workers, and people who work in manufacturing and in grocery stores.

      • Actually, I think the number of people who won’t accept a COVID vaccine, right now, is more like 50%.

      • Wolf wrote, “Actually, I think the number of people who won’t accept a COVID vaccine, right now, is more like 50%.”

        Only a small percentage of people have the opportunity to accept a Covid vaccine, right now, and I have yet to hear of any of them refusing it.

        The vast majority of people will thankfully take the vaccine, when it is offered to them. Many of them will do so after consulting with their physicians, who will have already been vaccinated.

        A few will refuse it. Of those few, some will pay for that foolishness with significant damage to their health, or even with their lives.

      • @DaveBurton
        Every single survey shows that half or more of Americans don’t want to take the vaccine.
        The reasons vary but are irrelevant for epidemiological purposes.

      • I don’t “want” to get a vaccine, but I will when I get the chance.

        My guess is that when push comes to shove, a lot of people who express resistence will get one in the end.

        There will be some measure of anti-vaxers who will be holdouts. And probably a larger cohort of political diehards that will resist becsuee they think that not getting a vaccine somehow protects them from tyranny.

        But most people don’t want to get sick and/or don’t want to be responsible for killing grandma, so in the end they’ll get it. How many people really have zero sense of social responsibility? I like to think not many.

      • “Covid-19 has proved to be very contagious. For a disease this contagious, “herd immunity” requires that about 90% of the population be immune.”

        So far, the herd immunity threshold is well below 90% (not counting possibilities with the two new variants – UK and South Africa).

        The number needing to be immune is basically calculated by the following formula: 1 – 1/R0. R0 has been estimated between 2.0 and 3.0, giving the threshold as 50%-67%.

        Compare that to measles, with an R0 of maybe 14 (IIRC) requiring 93% of the population to be immune.

      • meso –

        > So far, the herd immunity threshold is well below 90% (not counting possibilities with the two new variants – UK and South Africa).

        How do you derive that conclusion of fact in the face of the many uncertainties?

      • “How do you derive that conclusion of fact in the face of the many uncertainties?”

        Apparently you didn’t read the rest of my post, where I describe how the HIT is calculated.

        The generally accepted R0 range has been 2.0-3.0. I calculated the HIT’s for that, and showed the formulas.

      • You missed my point.

      • For all this nonsense about herd immunity…how long do we suppose it will take before we reach herd immunity for the H3N2 virus that caused the 1968 pandemic and still circulates as a seasonal influenza virus now? Understand why we haven’t reached it for H3N2 and we will be closer to understanding why we are unlikely to reach it for this virus.

      • Doug –

        > Understand why we haven’t reached it for H3n2…

        You mean because the flu apparently mutates a lot more and there’s no vaccine of anywhere near the same efficacy?

        Amazing how people who are so smart about climate also know so much about disease and epidemiology.

      • Bingo, though I am confused by your snark lol. Are you suggesting that the COVID 19 virus is not likely to change sero type?

      • The SARS-CoV-2 virus is mutation. It is hoped and expected that the mutations that would render the vaccine inappropriate will be relatively slow. The vaccines are targeted at parts of the virus that are likely to be conserved – i.e. if they change the virus will not be sufficiently infectious to propagate.

        Also, as Joshua pointed out (with snark added, of course), this vaccine is far more effective than the influenza vaccines.

        However, this mRNA technology is more flexible than that used for influenza, so it may lead to more effective flu vaccines. But,. influenza mutates =faster than coronaviruses.

      • Doug –

        People who actually study this say that mutation is less like to limit the effectiveness of these vaccines compared to the flu vaccine.

        I might suggest that you read what people who actually study this stuff have to say before you formulate your opinions?

        Just a thought.

        https://www.nature.com/articles/d41586-020-02544-6#:~:text=But%20sequencing%20data%20suggest%20that,corrects%20potentially%20fatal%20copying%20mistakes.

      • Meso,

        Thanks, but isn’t the effectiveness of the flu vaccine a function of our ability to predict the dominant serotype? The flu vaccine is very effective against the serotype it is designed to vaccinate against.

        As I have said before I expect this virus to reduce in virulence, just as other viruses do. I don’t expect it to ever stop circulating like measles or mumps though. There are many different serotypes of other human coronaviruses. It has served me pretty well for the last 10 months to assume that this virus will behave like other coronaviruses that cause seasonal respiratory infections.

      • “Thanks, but isn’t the effectiveness of the flu vaccine a function of our ability to predict the dominant serotype?”

        Yes, it is. The problem is that influenza mutates so fast that the target keeps changing. And yet, with SARS-CoV-2, one of these vaccines was designed 11 months ago, and these new variants are expected to still be handled by it.

      • Joshua,
        You have developed a strange habit of posting articles that do not support your point. Perhaps hoping people won’t read them?

      • Doug –

        If you think that article didn’t support the argument that flu is more likely than COVID-19 to mutate in ways that diminish the efficacy of vaccines, then you don’t understand the article.

      • Doug –

        Here. For this one you don’t need to read past the headline:

        https://www.google.com/amp/s/www.livescience.com/amp/coronavirus-mutation-rate.html

      • mesocyclone wrote, “R0 has been estimated between 2.0 and 3.0…”

        That’s with severe measures imposed to reduce transmission. If we were to stop those measures, and “let ‘er rip,” then R0 would be much, much higher.

        “Herd immunity” is achieved when you don’t need such measures.

        As the % of population vaccinated increases, it should become gradually easier to reduce transmission of the disease. But if we want to get back to “normal,” we need a population immunity level which makes R0 < 1 even when strangers shake hands, and the barber and plumber don't wear masks. For this disease, that's probably about 90%.
         

        Wolf1 wrote, “Every single survey shows that half or more of Americans don’t want to take the vaccine.”

        Really? Every single survey? Are you sure about that?

        https://www.forbes.com/sites/andrewsolender/2020/05/08/many-americans-say-they-would-refuse-a-coronavirus-vaccine/?sh=d5813bc71f64

         As many as one in five Americans would refuse to take a coronavirus vaccine, according to a new poll that follows a surge of anti-vaccine content online.
         The poll, conducted by YouGov and Yahoo News, found 55% of respondents said they would get vaccinated for coronavirus, while 19% said they would not and 26% said they’re unsure.
         This follows a Morning Consult poll released Thursday in which 64% of respondents said they would get vaccinated, compared to 14% who said they would not and 22% who said they don’t know. …

        In fact, such surveys are pretty worthless at predicting what people will actually do, because most people are wise enough to be willing to reconsider their early opinions, in the face of new evidence. Almost every doctor in America (and certainly every sane one!) will be advising their patients to get vaccinated, when the vaccine is available. Only the most foolish of those patients will reject that advice.

        If your early opinion is that you should not take the vaccine, but your doctor explains to you why you should, and tells you that he and everyone else working in his office all have been vaccinated, and tells you about the mild or non-existent side effects, and assures you that it doesn’t involve implanting a microchip or turning your offspring into mutants, I’ll bet you’ll get vaccinated. Only the most foolish people refuse to reconsider preliminary opinions when they have more information.

        Fools think their own way is right, but the wise listen to advice.” Proverbs 12:15

        “When my information changes, I alter my conclusions. What do you do, sir?” John Maynard Keynes

         

        Joshua wrote, “People who actually study this say that mutation is less like to limit the effectiveness of these vaccines compared to the flu vaccine.”

        That’s true. Let’s pray that they’re right. This disease has a nasty habit of surprising us.

        The more people have the disease, the greater the frequency of mutations, and the greater the risk of a mutation which will enable the disease to evade one or more of the vaccines. That’s one of the many reasons that people who want to “let ‘er rip, and get it over with” are very, very wrong.

      • “mesocyclone wrote, “R0 has been estimated between 2.0 and 3.0…”

        That’s with severe measures imposed to reduce transmission. If we were to stop those measures, and “let ‘er rip,” then R0 would be much, much higher.”

        Nonsense. R0 by definition is without any mitigation measures, and until the latest mutations, has been estimated at 2-3.

        For most of your post, you want to use Rt, not R0. Rt is more around 1.25, depending on location, because of behavior changes.

        If you want to argue science, you had best familiarize yourself with the basic definitions. The R0 value has been known since March or so.

      • mesocyclone wrote, “R0 by definition is without any mitigation measures, and until the latest mutations, has been estimated at 2-3…”

        You are correct that I was using “R0” loosely, simply to mean “reproduction ratio.” I’m not an epidemiologist, and Rt is closer to my intended meaning.

        But here’s a study reporting a Covid-19 median R0 estimate of 5.7, in China:
        https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article

        It is my understanding that, strictly defined, R0 is the average number of people who each infected person will infect:
        1. when nobody else has immunity, and
        2. when public policy measures, like lockdowns and restaurant closings, designed to mitigate the spread, have not been imposed.

        There’s apparently some variation in the definition. Wikipedia says, “Some definitions, such as that of the Australian Department of Health, add absence of ‘any deliberate intervention in disease transmission’.”

        Rt is similar, but it is after the effect of public policy changes, like lockdowns, travel restrictions, etc., and, after the effect of some of the population having acquiring immunity (from having recovered and/or from vaccination).

        R0 is estimated from the initial (exponential) rate of spread of an outbreak, from the exponential growth rate, plus estimates of delay time from disease exposure to infectiousness.

        So R0 is not simply a characteristic of a disease. It is strongly influenced by the infectiousness of the disease, but it is also strongly influenced by people’s behavior.

        In particular, a higher “contact rate” (between people) causes a higher R0. Each doubling of the contact rate (number of people an average person contacts) will double R0, and each halving of the contact rate will halve R0.

        Since late March, I’ve probably cut my personal contact rate by about 95%, voluntarily. E.g., I currently shop for groceries online, at Walmart. (Here’s a referral link, to save $10 on your 2nd purchase.) I pay electronically, and they load my groceries into the trunk of my car. I never enter the store, I’m never exposed to the store employees & other customers, and they’re never exposed to me.

        Shopping that way is far from normal for me, but it is a voluntary behavior change, made out of caution, so, according to my understanding of the definitions, it arguably lowers both R0 and Rt.

        In contrast, when the governor orders restaurants to close, that lowers Rt, but not R0.

        Despite the widespread and often quite drastic measures taken to reduce the spread of Covid-19, in November the U.S. reported Covid-19 “new case” numbers doubled in about 2.5 weeks. If the average delay from exposure to secondary infection is 7-10 days, that means Rt was around 1.4, which means the strictly defined R0 must be far higher than that, certainly much more than double that figure. That puts it well outside the “2-3” range.

      • Without knowing the actual impact of mitigation measures, you cannot back-calculate the R0. I have been somewhat suspicious that R0 may have increased with the G mutation, but I’ve seen no discussion of that in the literature. On the other hand, I don’t read every bit of the medical literature – there’s too much. I now rely on some of the professionals I follow to mention it if significant changes happen. The new UK variant (also the new South Africa variant) likely have a higher R0 value.

        But it is also possible that over time, pandemic fatigue has led people to cheat on mitigations more effectively than in the past.

  26. As of this comment there are over 100 quarrels and quibbles over what may not be the correct issue. There are currently an estimated 18,000,000 Coronavirus cases in the US, which is a little over ½ of the average yearly flu cases. If the mortality rate was zero would anyone care? IMHO the over 10,000 words written in these comments would have been better spent trying to determine the mortality rate from the CDC list of 276,000 “deaths involving COVID-19” or 126,000 “deaths involving COVID-19 and pneumonia excluding influenza.” If we knew the mortality rate we would have a better idea whether the cure is worse than the disease.

    • Joe - the non epidemiologist

      PMH comment – ” IMHO the over 10,000 words written in these comments would have been better spent trying to determine the mortality rate from the CDC list of 276,000 “deaths involving COVID-19” or 126,000 “deaths involving COVID-19 and pneumonia excluding influenza.””

      PM – its a point worth considering
      First I concur that Covid has a high mortality rate, much higher than the seasonal flu.

      That being said, I have spoken with a couple of mid – to upper level executives in two separate major hospital chains. In an example both gave me, Prior to covid, if a patient came into the hospital and died with heart attack who was also obese and or diabetic with a flu, Then that death would be coded as heart attack with obesity coded as secondary cause and the flu as a third cause.
      The same patient coming in the hospital with heart attack and dying and obese with covid would be coded death by covid with the heart attack being secondary and obesity being the third lower ranked cause.

      The second point both individuals made deals with bed capacity and ICU capacity. The ICU bed count in hospitals is a lot more fluid that than portrayed. With some limitations, most hospitals have the capacity to increase the total number of ICU beds fairly quickly based on demand with the primary limitation, not on available beds since that count is fluid, but on staffing. Further on that point, Hospitals are designed to work at near 100% capacity, that is how hospitals make money. Hospitals normally run close 100% capacity during the various seasons.
      Numerous media reports point out that ICU bed utilization is higher than the previous x period. Essentially providing only a single data point. However, without provided comparative information for prior years, the current change in hospital usage is meaningless.

      • “The same patient coming in the hospital with heart attack and dying and obese with covid would be coded death by covid with the heart attack being secondary and obesity being the third lower ranked cause.”

        That goes against medical ethics and the normal rules for listing cause of death. Doctors are supposed to use their medical judgement to determine the cause of death, and the list other factors as secondary.

        Certainly my friend who is a professor of medicine and a hospitalist has been doing exactly this throughout the epidemic.

        That said… if the patient has COVID, the odds are pretty good that it is the cause of the heart attack. But… that’s up to an MD to determine, not a hospital executive.

        On ICU beds and the rest – yes, what you write is true. And indeed, hospitals, like any other service, are designed to run near capacity, with a margin determined by statistical likelihood of peaks.

        Still, when the hospitals themselves are claiming that they are about out of capacity, they probably are.

      • PMHinSC wrote, “If the mortality rate was zero would anyone care?”

        Since the disease has killed 1.7 million people, including 326,772 Americans, it is safe to say that the mortality rate is not zero.
         

        PMHinSC wrote, “If we knew the mortality rate we would have a better idea whether the cure is worse than the disease.”

        You needn’t wonder any longer: the disease is much worse then the cure.
         

        mesocyclone wrote, “Doctors are supposed to use their medical judgement to determine the cause of death, and the list other factors as secondary. / Certainly my friend who is a professor of medicine and a hospitalist has been doing exactly this throughout the epidemic. / That said… if the patient has COVID, the odds are pretty good that it is the cause of the heart attack. But… that’s up to an MD to determine…”

        Exactly right.

        Furthermore, it is easy to show that, although there are surely some misattributions of the cause of death, the number of Covid deaths cannot be greatly inflated by misclassification of people who die of other causes while only coincidentally infected with Covid.

        Statistically speaking, an average U.S. resident already has about a 0.07% chance of dying within the next month, without a Covid-19 diagnosis.

        With a Covid-19 diagnosis, he has about a 0.9% chance of being killed within the next month by Covid. (BTW, that represents a great improvement over the early stages of the pandemic!)

        So, if someone dies “with Covid” there’s about a 93% chance that Covid is what killed him.

        So even if every death from another cause while coincidentally infected with Covid were misattributed to Covid, it still would only inflate the Covid death toll by 0.07 / 0.9 = 7.8%.

        Of course, most such deaths are not misattributed, simply because most medical examiners and coroners are reasonably competent. So any actual inflation of the number of Covid due to such misattributions is certainly by much less than 7.8%.

      • There have also likely been deaths where people died at home or in a nursing bome when they were never tested – particularly early on in the pandemic. Mant experts say the official count may be an undercount.

        But blog commenters know better. Because TDS.

      • Joshua, I agree that many deaths outside of hospitals in people who were never tested for Covid were surely caused by Covid, but not attributed to it, resulting in an undercount of Covid deaths. But that has nothing to do with Trump or TDS. Here are a couple of articles about it:

        https://statnews.com/2020/10/20/cdc-data-excess-deaths-covid-19/

        https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths

      • “The same patient coming in the hospital with heart attack and dying and obese with covid would be coded death by covid with the heart attack being secondary and obesity being the third lower ranked cause.”

        That this is true was known months ago. It is not the function of any unethical behavior on the part of those reporting the deaths. It is a function of goverment guidelines. COVID19 is a nationally notifiable disease per CDC guidance. If you test positive and die it will be on the death certificate. That is why people who died in accidents occasionally have COVID19 listed.

        Adult influenza is not a nationally notifiable disease, pediatric influenza is. If you are an adult and have other health issues and die from the flu it may or may not appear on the death certificate. It probably won’t because you probably will have never been tested for flu.

        All that said, excess deaths tell the tale. The numbers reported for COVID19 deaths are broadly correct.

      • Excess deaths is a very noisy statistic, particularly given that there are many atypical societal conditions right now.

    • This issue is divisive because limousine liberals and rich libertarians/conservatives are the least affected by lockdowns even if their livelihoods aren’t automatically improved by COVID economics – so naturally favor them.
      People who have to work for a living, however, have a very different equation.
      If you own a business that isn’t a grocery store or similar “vital” service, it is now 9 months of either full closure or significantly impeded operations with at least months more to go.
      Equally, economies that were built on entire sectors: travel, bars, night clubs, fitness gyms, etc etc have also been massively impacted.
      Why wouldn’t these people be angry?
      And of course, people who are “essential” – the Amazon warehouse and delivery workers, the Doordash/PostMates/UberEats food delivery people, USPS, grocery stores, etc get to risk exposure with literally no social or economic protections.
      Nor does it help that the various politicians most gung-ho about restricting – are going to michelin star restaurants, vacationing in Mexico and what not. “Do as I say, not as I do” doesn’t play well with Americans.
      Personally, I think this ongoing incident just shows how feckless the American political and top economic socio-economic classes really are.

      • > Why wouldn’t these people be angry?

        Perhaps someone elected you as spokesperson for “the people” but the 3cidrnxe that we have shows that there’s not a strong signal of class in opinions about interventions to limit the spread of the virus.

      • @Joshua
        Sorry, but you are irrelevant as usual.
        The destruction of huge swathes of the economy is not a class issue per se only because traditional class based views only focus on the top and bottom – not the middle.

      • Wolf –

        > The destruction of huge swathes of the economy is not a class issue per se only because traditional class based views only focus on the top and bottom – not the middle.

        There is no signal of class in response to the implementation of interventions – probably in part because there’s no clear evidence that interventions “cause” economic harm as compared to a “business as usual” alternative of a raging pandemic.

        You can keep ducking all of that, and your concern about the poors is quite touching – but in fact all you’re actually doing is repeating an elitist argument in your self-appointed role as a spokesperson for others.

        Try just speaking for yourself instead.

    • daveburton wrote “Since the disease has killed 1.7 million people, including 326,772 Americans, it is safe to say that the mortality rate is not zero.”
      The Dec 16 CDC weekly reported in my original post, lists 276,061 “deaths involving COVID-19,” which can reasonably be understood to imply that actually death from COVID-19 are less than 276,000; not more (e.g. 326,772). Certainly more than the 6% (16,500) for which COVID-19 was the only cause of death, and less than the 276,000 “deaths involving COVID-19.”
      A cost benefit analysis is a typical tool used to help determine appropriate response. I have not seen a cost benefit analysis, and concentration on transmission at the exclusion of mortality rate seems insufficient at best.
      Mesocyclone’s comment that
      “if the patient has COVID, the odds are pretty good that it is the cause of the heart attack.,” is unsubstantiated and unconvincing. Even assuming his statemen is true, it hardly justifies the inclusion of 13,000 “malignant neoplasms,” 10,000 “Intentional and unintentional injury, poisoning and other adverse events,” 144,000 “All other conditions and causes (residual),” and other questionable categories; note these numbers cannot be added because, if memory serves, there are an average 2.6 comorbidities per death. It seems intuitively obvious that 276,000 death from COVID-19 in the US is inflated and any attempts to handwave the number higher are unpersuasive.

      On the other side of the ledger, shutdowns drive people to poverty and poverty is the number one cause of death. Likewise tens of millions have lost access to medical treatment for fatal diseases such as diabetes, circulatory disease, coronary disease, obesity, etc. Drug overdose and suicide, particularly among the young, are reported increasing. Although In the context of this blog, discussion of transmission scenarios is interesting and informative, I believe it misses the broader and more important issue. It seems more pertinent to make decisions based on mortality rates and cost benefit analysis rather than transmission modes and rates. And unless I missed it, nary a word or number of deaths have been attributed to the consequences of shutdown and other draconian measures.

      • > On the other side of the ledger, shutdowns drive people to poverty and poverty is the number one cause of death.

        You have zero evidence of this. Correlation does not equal causation. For all you know, fewer people will have been driven into poverty with interventions than would have been driven there with an unchecked pandemic.

        You think you know but you don’t know.

      • “Even assuming his statemen is true, it hardly justifies the inclusion of 13,000 “malignant neoplasms,” 10,000 “Intentional and unintentional injury, poisoning and other adverse events,” ”

        Those are listed as contributing causes or comorbidities, because death certificates require that. That list is very different from the actual cause of death, of which there can be only one.

        The fact that some lockdowns were overzealous is simply irrelevant. Science is science, policy is policy. The latter doesn’t change the results of the former.

        When you bring up the costs of mitigation while arguing science, you ares that your are biased towards misreading the science in a way that would lead to less mitigation and thus less economic loss.

      • That poverty is a significant cause of death in the USA is not in dispute.

        https://www.publichealth.columbia.edu/public-health-now/news/how-many-us-deaths-are-caused-poverty-lack-education-and-other-social-factors

        That lock downs will make this worse should not be in dispute. The impacts are even more severe if you look at the impacts of lockdowns on global poverty and death.

      • > That lock downs will make this worse should not be in dispute

        Of course it’s in dispute. The pandemic itself, absent interventions, has a drastic and drastically more devastating impact on poor communities. You have zero evidence that the impact is worse due to interventions.

        Correlation does not equal causation.

        Try to grasp conditional probability. Counterfactual areguments require a high bar of evidence.

        Absent interventions poor people would have not gotten stimulus checks. They would have been fired for not coming into work out of concern about getting infected instead of getting unemployment. They would have been evicted.

        It’s touching that you consider yourself as spokesperson, but polling shows most people wanted interventions and there’s no signal of class in the polling results.

      • Joshua wrote, “The pandemic itself, absent interventions, has a drastic and drastically more devastating impact on poor communities.”

        I think that’s largely because low income Americans are heavy users of public transportation in large cities, and the political leaders of those jurisdictions refused to shutdown public transit, even when it was clear that public transit was killing people by the thousands.

        If you were tasked with inventing a system for spreading Covid, you’d be hard pressed to come up with something more efficient than buses and passenger trains. There’s no better way to spread an airborne infectious disease than in a bus or train car full of people, all breathing one another’s air. The early infection hot-spots in the United States were almost all places where the disease is spread by public transportation, because Democrat mayors and governors refuse to shut down public transit. That refusal cost many tens of thousands of American lives, and the victims were, of course, disproportionately poor people.

        Governor Murphy of New Jersey ordered that public trains, subways and buses be filled to only half-capacity. That meant a Covid patient in a subway car could only infect about 45 other people at a time, instead of 90 at a time. I cannot imagine how any thinking person could believe that’s adequate, while thousands of carriers of the disease remain unidentified and unquarantined.

        In New York, believe it or not, Gov. Cuomo and Mayor DeBlasio didn’t even do that.

      • Lol I consider myself a spokesperson for no one but me. Absent interventions there would have been far less need for those stimulus checks, and you should learn something about economics. Those checks are not free, they must be paid for, probably resulting in high poverty in the future.

        The fact is, the majority of working age Americans are not at serious risk from this disease. The damage we have done is to those who could least afford it. White collar upper middle classes are simply working from home. Those who worked for one of the 110000 restaurants in this country that have closed permanently or for the long term are not so lucky.

        https://restaurant.org/news/pressroom/press-releases/restaurant-industry-in-free-fall-10000-close-in

      • Dave –

        Common sense would ssugest that public transportation is a place where there’s a lot of spread. Without more information it seemed to me that it would have made sense for officials to close mass transit down.

        But from what I’ve seem, thus far there’s not much supporting evidence.

        For example:

        https://www.scientificamerican.com/article/there-is-little-evidence-that-mass-transit-poses-a-risk-of-coronavirus-outbreaks/

        If you have any evidence otherwise let me know.

      • “Common sense would ssugest that public transportation is a place where there’s a lot of spread. Without more information it seemed to me that it would have made sense for officials to close mass transit down.

        But from what I’ve seem, thus far there’s not much supporting evidence.”

        I’ve been pondering this same issue regarding restaurants and bars. I’ve seen recently published statistics showing huge spread in homes, little in those places.

        BUT… I wonder if we aren’t seeing an absence of evidence, rather than evidence of absence. Given the poor contact tracing capabilities in the US (plus the poor compliance of citizens with tracers), it would seem that transmission in the home is easy to detect, while transmission between strangers is much harder. And yet, if we didn’t have transmission between strangers, we’d probably have a much smaller epidemic.

        Consider an example. If someone visits a few restaurants and later becomes infected, how do we know where they got it? If they are living with someone sick, or there is known contact with sick people, we can decide (with some error) that they got it that way. But otherwise… how do we pin down the restaurant.

        If we had good contact tracing, like in South Korea, the problem is a lot easier. And indeed, one of South Korea’s current outbreaks has been traced to a restaurant. Prior outbreaks have been traced to bars there.

        So, I’m not comfortable with the statements that mass transit and restaurants are not major contributors. I think we just don’t know.

      • > a spokesperson for no one but me. Absent interventions there would have been far less need for those stimulus checks, and you should learn something about economics

        You think you know but you don’t know. You don’t get the difference between correlation and causation.

        As I thought. You simply don’t understand. You don’t know what would have happened economically absent the interventions.

        You have no evidence to support your assertions. None.

        You don’t respect uncertainty. It’s like when you thought you knew about the number of deaths it Sweden was experiencing.

      • meso –

        I thought I had rembered something out of the Korean CDC related to contact tracing showing little spread on public transportation… but I can’t find it.

        But I did come across this,..which I thought was kind of interesting:

        https://www.latimes.com/world-nation/story/2020-12-09/five-minutes-from-20-feet-away-south-korean-study-shows-perils-of-indoor-dining-for-covid-19

      • Thanks. I don’t recall the KCDC study, but that means nothing.

        The first study I read – that convinced me to avoid being indoors with strangers whenever possible – came out of Wuhan early in the epidemic. They contact traced a small outbreak at a restaurant, and showed that people downwind of the index cases – way beyond 6 feet for some – were infected, while others, at the same table as the index case, but out of the air stream, were not. I believe that came out in February. In any case, I based my subsequent actions on it.

        It is surprising to me that the US public health establishment seemed to just ignore that study for a long time. Not only was it well done, but it is consistent with other respiratory viruses.

      • It is sad how badly Scientific American has declined. It used to be a wonderful publication. Now they print nonsense like this:

        advocates say… transit can play a crucial role in the pandemic era by reducing air pollution that makes people more susceptible to COVID-19.

        Regardless of its relative safety, transit can play a crucial role in combating climate change and air pollution, advocates said.

        Public transportation produces far less… planet-warming pollution…

        Scientific American, of all publications, now calls the precious air fertilizer “planet-warming pollution,” and blames Covid-19 on bad air. They really ought to rename it “Pseudoscientific American.” It would be funny if it weren’t so tragic.
         

        As for public transit, here’s some evidence of its role in spreading the disease in New York City. This article was way back in July; here’s an excerpt:

        the city’s transit workers were hit particularly badly: more than 4,000 MTA employees have gotten sick so far, and 131 died. “It’s like being in a hospital, but without [personal protective equipment],” says MTA subway conductor William Mora, 50, who was out of work for a month with COVID-19; two coworkers he knew died of the virus.

  27. Geoff Sherrington

    Meanwhile, here in Australia with a population of 26 million, a land area about the same as contiguous USA, a similar system of Government to USA, a right-leaning Prime Minister and seasons out of synch by 6 months from the Northern hermisphere, guess what?
    Australia has almost completely contained the virus. (For now). There are usually fewer than 10 new cases each day, Typically, 90% of these new cases are from people arriving from overseas. The number of daily cases that cannot be traced is near zero. Most States have had zero deaths “from Covid” for months now.
    Some observations:
    1. We seem to have had a low initial viral load, so the containment was easier than for some countries. We have a land-sea border to aid containment.
    2. Politically, similar to USA, where many relevant policies and actions were in the hands of the States, not Federal, so the containment was fragmentary
    3. Left/right politics interfered. The worst outbeak was in the State of Victoria, whose leftist, China loving Premier appears to dislike asking for right-leaning Federal help, like calling in the Army to help enforce lockdowns. A major lockdown effort failed and some 800 elderley died “with Covid” because some of those assigned the tasks of containing travellers were untrained and incompetent.
    4. Many commentators consider the main ongoing danger to be from travellers coming into Australia. A heavy PCR testing and quarantine regime is in place. This tempts some individuals, some wealthy and self-opiniated, to try to evade the system.
    5. The medical preparedness a year ago was abysmal. The reality lof a pandemic seemed too remote for much action. As the pandemic developed, there were conflicting strong opinions about hydroxychloroquine and other medications like vitamins, minerals like zinc and of course speculation about how soon a vaccine might be developed. Potentially important medical arguments persist.The Chief Health Office in Victoria is a strong global warming advocate who published a paper in early 2020 advocating a zero fossil fuel approach to cure a variety of afflictions, as if low CO2 was manna from heaven. But, you have to live with what you are given.
    6. Special pleading by interest groups has been rampant. Sporting groups, Australia Rules Football, Tennis, Rugby, Test Cricket are among some who fought for special treatment even when it was dangerous and against the lockdown logic. Another major group was restauranteurs, plus arts, entertainment and music types whose services are not so essential yet who pushed to entertain the masses when that also threatened lockdown logic.
    At one stage, the Victorian Premier did not object to a mass demonstration by 25,000 BLM protesters, but prevented more than four people from attending any funeral.
    7. Until a vaccine has been shown to work and has been widely used, we face sporadic outbreaks mainly from travellers, any of which could evade the present dense level of testing and spread into the community. People at high risk through age and health view with trepidation the too-rapid opening of borders.
    8. The pandemic has tested our national preparedness in planning, organization, structure of respondents, medical knowledge and readiness and we have not had a good oiutcome. That said, pandemics are rare. A similar shambles would probably follow an asteroid impact.
    9. Like in New York, the elderly and frail consigned to nursing homes have taken the highest proportion of deaths. The micro-management of nursing homes has been pathetic. Their improvement might be the next priority in this struggle.
    Geoff S

    • Australia and New Zealand did the equivalent of not having sex to avoid catching a STD. That’s one way to avoid STDs.

    • Australia is extremely not dense and extremely isolated.
      Using Australia as a comparable is like using a random Pacific island as a comparable: not relevant.

      • Geoff Sherrington

        Wolf1,
        What is relevant is that no matter where you are located, it is possible to ring fence the infected and reduce incoming infecteds to near zero by testing then quarantine, to arrive at zero new cases after 3-5 weeks of diligent application.
        This is an observation that has been known for many decades. It works because the simple math dictates that it will. Reduce the number of virus hosts and the virus will die in 2 weeks or so.
        Countries that are in trouble are in trouble because either the citizens, or their governments, or both, lack the will or the power to take the drastic action that achieves elimination. That is also relevant. Geoff S

      • Geoff Sherrington,
        Very clearly stated. Works with almost all herding/social vertebrates. Basic germ theory 101 and yet to this day the vast majority of the public still seems ignorant of this basic fact of biology. As a corollary, it might help explain the crazy idea that natural herd immunity is a humane policy.

        Nice forecasts: http://cs156.caltech.edu/

      • Geoff,
        Your theory is disproven for any region or nation which isn’t literally isolated.
        California has had extremely militant COVID lockdowns and what not since the beginning – but its COVID progress has only worsened over time. No nation that is remotely interconnected has performed well over the full extent of the COVID pandemic to date.
        So while I am happy that Australia has fared well – the reality is that it is a very isolated nation with low population density.

      • > No nation that is remotely interconnected has performed well over the full extent of the COVID pandemic to date.

        Indeed, outside of Vietnam, Singapore, Thailand, Taiwan, and numerous other countries, your statement is absolutely correct.

        Indeed, the countries thst haven’t done very well haven’t done very well. Where would we be without such insight?

      • Wolf1 wrote, “No nation that is remotely interconnected has performed well over the full extent of the COVID pandemic to date.”

        Where on earth did you hear such nonsense?? Do you think South Korea is not “remotely interconnected?” Did you overlook this comment?

        South Korea is currently battling another spike in cases, their worst yet. But they will surely bring it under control, they same way they’ve brought the previous spikes under control — and this spike in South Korean cases is still only about 1/30-th as large as the current U.S. spike, calculated per-capita.

        As a result of our (U.S.) failure to control the spread of the disease, our per-capita death toll from it is now 74 times higher than South Korea’s, even though the pandemic got a head start in South Korea.

        By doing what Geoff Sherrington, jacksmith4tx, et al advocate, South Korea achieved a per-capita Covid-19 fatality rate 98.6% lower than the United States. Do you not consider that as having “performed well?”

        I sure wish we had performed that poorly.

        BTW, South Korea’s nationwide average population density is reported to be 512/km². The average population density of the United States is about 35/km².

        Of course that’s skewed by places like Alaska and Montana, which have huge expanses of land with very few people. So let’s compare cities:

        New York City is said to have a population density of about 10,431/km². Soul is said to have a population density of about 15,763/km².

        Do you think Soul is less “interconnected” than NYC?

  28. A new meta-analysis estimates that just 17% of cases are asymptomatic. Even if death in younger patients is less common that has organ damage implications for future health burdens.

    https://jammi.utpjournals.press/doi/abs/10.3138/jammi-2020-0030

    Australia has done well in controlling the spread of COCID-19 – twice as well as South Korea on a per capita basis. Most of the cases and most of the deaths were in the Melbourne area in a second wave. It shows the rapidity of transmission once the genie gets out of the bottle. Most cases are of course acquired locally regardless of where patient zero was infected. There is a current outbreak in the Sydney northern beaches area. Other states have closed the door on people from the greater Sydney area. The critical response – however – is effective and timely contact tracing.

    People have been preparing for decades for pandemics. The Coalition for Epidemic Preparedness Innovations (CEPI) is a global partnership launched in 2017 to develop vaccines to stop future epidemics. Australia has a promising ‘molecular clamp’ technology that produced a vaccine that was safe and effective. It involves stabilizing a protein similar to that found in the coronal spike as a target for a T-cell immune response. The technology promises rapid development of ultra safe – because it doesn’t rely on viral deactivation – vaccines. Unfortunately – in phase 1 trials it elicited false positive HIV results. Could they have accidentally developed a HIV vaccine? This was a wrinkle too far given the urgency. We have ordered 50 million doses of the Oxford/AstraZeneca vaccine instead.

    • Most Australians live in cities. And our region includes India, China, etc.

      There will always be a viral reservoir in cats, minks, dogs and bats. The virus is out there and will remain so. Ultimately only vaccines will stop CoVid19 and any new crossover pathogens.

    • Thank you for the very useful link, Robert. It is interesting that they not only concluded that asymptomatic cases were only about 14-20% of total cases, but also that:

      1. The relative risk of transmission from an asymptomatic patient was probably a little over half the risk of transmission from a symptomatic (or presymptomatic?) patient (though the confidence interval was huge for this). And,

      2. The percentage of asymptomatic was probably somewhat higher in old patients than in young patients, even though, in general, the disease is far more serious in older patients. This suggests that some older people have pre-existing acquired immunity, probably from previous exposure to a related coronavirus.

      The asymptomatic proportion ranged from 4% to 41%. Meta-analysis (fixed effects) found that the proportion of asymptomatic cases was 17% (95% CI 14% to 20%) overall and higher in aged care (20%; 95% CI 14% to 27%) than in non-aged care (16%; 95% CI 13% to 20%). The relative risk [RR] of asymptomatic transmission was 42% lower than that for symptomatic transmission…

      Conclusion #2 tantalizingly suggests that there might exist a “cowpox” for Covi-19: a less serious (or possibly even asymptomatic) coronavirus infection which confers incidental partial immunity to Covid-19. If it could be identified, it might offer an alternative means of combatting the pandemic.

      As for Australia, they have, indeed, handled this pandemic very successfully — but they have not done as well as South Korea.

      Despite the disease getting a head start in South Korea, they’ve recorded just 773 Covid-19 deaths, from a population of about 51 million. Australia has recorded 908 deaths, from a population of about 26 million.

      Surprisingly, even though South Korea had a big spike in cases very early (February / winter), when physicians had little experience treating the disease, South Korea’s overall calculated case fatality rate is nevertheless lower than Australia’s, which had its big spike in July-August (winter). I don’t know why.

      Let’s see if WordPress will let me to create an HTML table:

      CountryCases/1MDeaths/1M
      S.Korea1,06815
      Australia1,10335
      USA57,5751,015
      UK32,1581,023
      Belgium54,6671,639

      In case that didn’t work, here’s the same table as <PRE>formatted text:

      Country    Cases/1M  Deaths/1M
      S.Korea     1,068         15
      Australia   1,103         35
      USA        57,575      1,015
      UK         32,158      1,023
      Belgium    54,667      1,639
      
      • “Despite the disease getting a head start in South Korea, they’ve recorded just 773 Covid-19 deaths, from a population of about 51 million. Australia has recorded 908 deaths, from a population of about 26 million.”

        I admit to a maths brain fart. But 820 of those deaths were in the Melbourne area. An object lesson in letting the genie out of the bottle as I said.

        And you seem to be overinterpreting the study.

  29. I thought I’d share this Christmas song 🎶 mixing satire and pathos of the UK Tory government’s handling of the coronavirus:

    • It could be worse, it could be Belgium: Consistently dysfunctional and inconsequential Belgium (and so, quite logically, the EU’s primary seat of government).

      The American Left’s vision for America is, basically, a bigger version of Belgium.

  30. The new strain that has appeared in southern England is quite concerning. It is reportedly significantly more transmissible, although the level hasn’t been well quantified. But, it may be as much as 70% more transmissible (R0x = 1.7R0).

    To put that in perspective:

    Arizona currently has a doubling time of about 21 days (Rt ~ 1.2)

    With this, the doubling time would be about 5.5 days (Rt ~1.7)

    Or alternatively – in 3 weeks the change in cases would go from 2X to around 15X.

    In 6 weeks, it would go from 4X to 225X.

    Officials are saying it doesn’t have a higher death rate. Media is using that to imply “no big deal.”

    But a dramatic increase in transmissibility will certainly kill more people, especially if it translates into hospital overload.

    Meanwhile, many countries are banning travel from the UK, some airlines require negative tests on travel to the US from the UK (as if that will stop it), and the US is considering banning travel from the UK.

    Stay tuned!

    • Here’s an interview with a virologist on this topic: https://slate.com/technology/2020/12/coronavirus-mutation-uk-transmission-united-states.html?utm_source=knewz

      “t would be a disaster on top of a disaster if this is more transmissible and it starts circulating here, or if it already is and people get together for, say, Christmas.”

    • mesocyclone

      Apparently the UK has an advanced genome sequencing ability. Apart from Denmark there is very little capability for Europe to test for this mutant strain.(Denmark has also found this strain in their country)

      The current thinking is that the strain is already prevalent in Europe as the virus was first found back in September. Bearing in mind the huge numbers of people travelling round Europe and the vast amount of freight carried by trucks, it seems very unlikely the strain is not already in Europe in large numbers, it is just they are unable to test for it.

      Bearing in mind the huge number of cases in Germany for example-which previously had been little affected- the greater infectivity of this strain seems to be widely evidenced in Europe.

      The geographic location of the county first affected-Kent- is out on a limb for the rest of the UK but the closest to Europe. This is a major travel hub for ferry passengers but more significantly for trucks. It seems very likely therefore that the strain was introduced into Kent by UK bound travellers rather than the other way round, but time will tell as ‘patient zero’ has not yet been identified.

      tonyb

      • “The current thinking is that the strain is already prevalent in Europe as the virus was first found back in September. ”

        Tony… do you have any references?

        As to genomic sequencing capability, I’d be really surprised if any country in the EU lacked that capability. It’s the sort of thing that can be done in a small lab, although one would want a BSL-3 lab for safety. But it’s not like samples can’t be shipped between countries.

        As for the huge number of cases now – we are seeing that in much of the world, and yet I have seen any reference to this strain being detected anywhere but southern England. We have record high cases in the US right now, too. We have that in Arizona, and Arizona sequences the virus at our local universities.

        Hence, my ask for references.

        There is apparently a related strain with presumed higher infectivity that was isolated in South Africa (note: if they can genetic sequence a strain, I’m sure France and Germany can!).

      • Thanks for that link – very interesting.

        BTW… what markup did you use to cause that to appear as an inline document on this blog?

      • I think it’s just a browser thing. I merely copied and pasyed the
        Ink on my iPad. If I had done it using a different browser it would appear as a text link

        Tonyb

      • Thanks for the info on the link. It frustrates me. I’ve got quite a bit of experience building web pages and the like, going back to the early ’90s. But when there’s a system between you and the pages, it’s hard to know how to get past it.

      • mesocyclone

        I have posted the link again using a different broswer, lets see if you get it inline or as a text link. As I am about to send it, is all purely text-not an image

        It’s worth noting the EU Centre for Disease Control document at https://www.ecdc.europa.eu/sites/default/files/documents/SARS-CoV-2-variant-multiple-spike-protein-mutations-United-Kingdom.pdf state:

        “Small numbers of isolates with the variant VUI 202012/01 have been reported from Belgium, Denmark and the Netherlands. However, most EU/EEA countries sequence much smaller proportions of virus isolates than the UK, so ongoing circulation of this variant outside of the UK cannot be excluded.”

        And also:

        “The UK reports that the deletion 69-70 in the spike protein of the variant causes a negative result from S-gene RT-PCR assays applied in some laboratories in the UK [26]. This specific mutation has occurred many times in different countries and is geographically widespread”.

        tonyb

      • Text link this time.

      • The difference might be that the first time the link to the .pdf file was on a line by itself, and the second time it had plain text after the link, on the same line.

        I’m going to try an experiment. First I’ll post a link to a .pdf file with text after the link, on the same line. Then I’ll post a link to the same .pdf file, but with the link on a line by itself:

        This .pdf is a long, single page, generated by saving a web page in the Opera web browser. Some programs don’t like that kind of .pdf file.

        First, with text after it:
        https://sealevel.info/Do_the_math-Died_with_Covid_means_died_from_Covid-WashingtonTimes2020-12-27_04.pdf is probably showing the link.

        Then without text after it:

        Click to access Do_the_math-Died_with_Covid_means_died_from_Covid-WashingtonTimes2020-12-27_04.pdf

      • I haven’t had a problem posting links. The problem is that I’ve been unable to post inline images.

      • mesocyclone wrote, “I haven’t had a problem posting links. The problem is that I’ve been unable to post inline images.”

        I think it works the same for images as it does for .pdf files: If you post a link to a .png or .jpg on a line by itself, the image gets shown in-line in your comment. But if there’s text on the line after your link, only a link is shown.

        I don’t know whether whitespace counts, and I don’t know how text/whitespace on the line before the link affects it. I just know that when I want to post a graph I put the URL by itself on a line, and it works.

        Let’s do the experiment.

        First I’ll post a link to a .png image file with text after the link, on the same line. Then I’ll post a link to the same .png file, but with the link on a line by itself:

        First, with text after it:
        https://sealevel.info/avg_of_harlingen_and_honolulu_1905-2018_vs_CO2_annot01.png is a graph of sea-level, averaged from two especially high-quality measurement records, on opposite sides of the northern hemisphere.

        Then with no text after it:

    • Here is a UK report on the new variant.

      Excerpts:

      “In summary, NERVTAG has moderate confidence that VUI-202012/01 demonstrates a substantial increase in transmissibility compared to other variants.”

      “Growth rate from genomic dat :which suggest a growth rate of VUI-202012/01 that is 71% (95%CI: 67%-75%) higher than other variants.

      o Studies of correlation between R-values and detection of the variant: which suggest an absolute increase in the R-value of between 0.39 to 0.93.”

  31. More on the new UK variant of SARS-CoV-2 that is of concern due to apparent significant increase in infectivity.

    Who Report

    Genomics of new variant

    ProMed moderator expert comments on these: “We are now in a wait and see mode, pending further investigations. There is a global panic related to this mutation, based primarily on hypotheses. As I mentioned in yesterday’s comment, there was a similar panic that resulted with the D614G variant that became dominant. Fear it was more transmissible and would it lead to more serious diseases were key concerns then. This didn’t happen. Key concerns at present deal with ‘are the changes in the spike protein going to impact on the vaccine efficacy’ and what is the real impact of this variant virus on clinical course? Interestingly, some of the mutations were seen in the Danish mink farm outbreak which also produced a panic response (see COVID-19 update (501): Denmark, Netherlands, mink, human-animal interface 20201122.7963766 and COVID-19 update (520): Denmark, Netherlands, mink, human-animal interface, WHO 20201204.7994061). These mutations occurred in the absence of pressure from vaccine, but rather “spontaneous”, under pressure of widespread infections with pharmaceutical interventions. Studies are underway to address the concerns re: vaccine efficacy (see section [2] below). – Mod.MPP]”

    ProMed post

    • I hope they are better at Climate Security than Network Security. I’m not holding my breath. Anyway, what will they do, put up a Hurricane Fence? BUILD THAT WALL!!!

  32. Only 4 years before everyone is having fun again:
    ..
    As in the Roaring 20s, which followed the 1918 Spanish Flu pandemic, society will revert to an era of indulgence, with Dr Christakis predicting that there will be a surge in “sexual licentiousness as well as a “reverse of religiosity.”

    He predicts the new movement won’t begin until 2024, after we’ve distributed the vaccine and have had time to recover from the socioeconomic devastation.

    “We’re the first generation of humans alive who has ever faced this threat that allows them to respond in real-time with efficacious medicines,” he adds. “It’s miraculous.”

    https://www.independent.co.uk/life-style/love-sex/pandemic-sex-parties-twenties-b1777493.html?amp

  33. UK has ANOTHER more transmissible new covid strain from South Africa! Only two known cases but it doesn’t bode well for brexit and fresh produce from the continent:

    • Yikes. The UK government is ordering quarantine of anyone who has been in South Africa in the last 2 weeks, or who has had contact with same

      2020 is not done with us yet, sadly..

  34. I saw Joshua mentioning Seth Rich here.
    He might be interested that the FBI responded to a FOIA law suit today that they have 20K documents responsive to the request, including Seth Rich’s laptop, (whose existence is acknowledged today for the first time). The FBI is asking the court for three more months to process [scrub] the documents.

    Click to access gov.uscourts.txed.197917.10.0.pdf

  35. We humans seemed to have moved very quickly from the concept of honourable death to incarcerating oneself and forcibly incarcerating fellow humans to avoid 0.20% chance of death pretty quickly.

    Introducing infinities in calculations produce all kinds of weird results. In probability theory you avoid them by explicitly taking 0 x infinity as 0.

    Introducing death in calculus of ordinary life produces all sorts of weird stuff, unless one has the (philosophical) equivalence of dealing with infinities. We usually avoid thinking about, talking about death and much of the life is filled with glorious battles against death (taking control of viruses, war on cancer, etc). We don’t have a good relationship with death.

    Fear of death is one of the strongest unconscious biases that muck up our ability to make good decisions and this was acknowledged in ancient eastern and Indian philosophies. Even accomplished sages struggled with this one.

    I hope i don’t live long enough to see through the consequences of our collective idiocy in dealing with covid19. May I die honourably (preferably, while swimming in open waters!)

    With that, let me wish my fellow travellers of the blogoshpere merry Christmas!

  36. there are many ways to spread the virus not just one. meaning, more will die if we dont stop asymptomatic and presymptomatic spread. the virus is entering cells in the nose,mouth and throat (upper resp) through ace2 receptors. by the time the immune system is engaged there are trillions of virus particles. the lungs act as a pump to push and pull these particles.

    Judith’s anecdotal case is a typical way this works. it is at this peak someone is a superspreader. this period is very short- lasting from hours to a few days. the rest of the time a person could be pcr positive but are not infectious.

    when you look at the whole population, there are only very few infected individuals who have spread everything we are seeing- 330K dead Americans! it is this period of infection we need to be wary of.

    by the time someone infected has symptoms, that is when they become cautious and go see a dr or get testing! it is too late! they have already spread the virus and now they are entering lower viral load period.

    the chance a given individual winds up spreading is mostly due to our lifestyle/behavior. during the weekdays, they may not interact much with others but come friday, sat, sunday they are socially active. during work days the person is behaving like he is self-isolating. so whether the infection started on monday vs thursday winds up determining how many people this individual infects!

    i can go on but i hope you get the picture and can research this yourself. be smart and responsible. ideology/faith/belief is not worth dying over or getting others killed. the point of freedom is to live, meaning not to die!

    remember the story of Anne Frank. if she did not hide from the nazis she would not have had those two plus years. if life/living was not bearable, everyone in prison would commit suicide.

    https://www.nejm.org/doi/full/10.1056/NEJMp2025631

    • “ if life/living was not bearable, everyone in prison would commit suicide.”

      On the other hand, many people do commit suicide in and out of prison. In fact, many young people have committed suicide during the lockdown. In city of feces (SF), overdose deaths exceeds deaths from covid19.

  37. New coronavirus variant announced in Nigeria, Africa. More transmissible yet no more harmful.

    It sounds as though this is going to be a common occurrence for the worldwide pandemic. It’s worth remembering that overwhelmingly it’s only people with pre-existing conditions and who are elderly that don’t make a full recovery. (Of course still a tradegy for the loved ones of those lost)

  38. it maybe more helpful if we do not undermine the objectives of the experts. this is not some trivial political conjecture. it is very hard for anyone other than a very who have the info needed to understand all the nuances of a pandemic and a public health response. classical physics does not mean quantum mechanics is wrong, this falls in the realm of public health with the understanding of virus dynamics/virology, immunology, mathematics/statistics/modeling, ….and on top of all that you have to be clever!

    here is a physicist who gave his hand at it and you can see how off he is!
    https://nafshordi.com/covid/

  39. A climate science lecture by a climate science professor
    https://tambonthongchai.com/2020/12/25/what-if-science/

  40. Blue Ridge Weather

    Dr Curry writes: “In any event, we need a new Covid thread, I open this topic up for discussion.”

    Previously, you have shared articles about the herd immunity threshold being reached earlier than thought. Is that something you still think is correct? Imo recent increases in Covid-19 cases undermine that school of thought.

  41. WHO director-general Tedros conflates three main issues:

    (i) future pandemics
    (ii) how humans interact with animals
    (iii) climate change

    I agree with (i) and (ii) but his calm assertion that humans can control the climate is quietly alarming.

  42. This article asserts that pre-symptomatic transmission is common (for both flu and COVID) but claims that asymptotic transmission is rare. However, we know that the viral load in asymptomatic patients is often just as high is in other patients and that the highest viral load is often present in pre-symptomatic patients the day before symptoms appear. Some asymptomatic patients even show the “ground glass opacity” in chest images. The biggest difference between symptomatic patients and non-symptomatic patients is that symptoms (coughing, clearing the throat, congestion) are not available to propel infected droplets and aerosols from an infected patient to another person. However, neither pre-symptomatic patients nor asymptomatic patients have symptoms to help propel droplet and/or aerosols. To put it crudely, how does the respiratory tract of a pre-symptomatic patient know that tomorrow symptoms will be present and it should start emitting infectious droplets or aerosols today?

    To understand transmission, we need to pay more attention to the mechanism of transmission. IIRC, aerosol droplets are ripped from the moist walls of very narrow air passages by sheer forces. In other words, to transmit via aerosols, coronavirus must have penetrated into the deepest parts of the lung. Larger droplets come from the upper respiratory tract and/or mouth. We can sample one of both of the latter and measure viral load, but we normally have no idea of the viral load deep in the lungs.

    I also believe aerosol transmission is more effective when in colder weather when indoor air is drier. Given their large surface area to volume ratio, emitted aerosols immediately evaporate until there is an equilibrium between moisture in the area and moisture surround the hydroscopic solids emitted inside aerosols. Smaller or lighter aerosols may remains suspended in the air for longer or may be more likely to reach vulnerable sells to infect. This would explain “seasonal influenza” peaks in January and February and why it appears as if coronavirus is going to show the same seasonality. The dramatic increase in COVID this fall developed first in the Dakotas and surrounding states where indoor air is the driest the earliest in fall. In North Dakota, 12% of the population has tested positive for COVID and 14% in Burleigh County with the capital of Bismark. In late spring, seropositivity studies claimed that there were 6-15 undetected cases of COVID for everyone detected by PCR. If the same thing were true more plentiful testing this fall, that would have meant that North Dakota reached herd immunity when its pandemic was at its November peak and was still raging. Obviously we weren’t missing 10 cases or even 5 cases for every case we detected in North Dakota this fall! The interesting question is did approaching herd immunity have anything to do with the slowing of the pandemic in ND after Thanksgiving, or were the fear of overflowing hospitals (ND reached “100% of capacity” on November 10) and public health restrictions the main reason new cases have dropped 80% in the past month.

    I think we need to pay much more attention to the mechanistic aspects of transmission: Where do the infectious particles come from? What is the viral titer in the source tissue? Are symptoms important in getting infectious particles out of the body? (If I have food allergies and blow my nose after every meal, is that functionally equivalent to having a symptomatic infection in terms of getting infectious particles out of my body?) Most discussions of asymptomatic transmission seem grossly over-simplified.

  43. A far more pertinent question is whether anyone of sound mind can trust a single word coming from those with interests in imposing permanent forcible vaccinations on entire continents.

    Let us be clear:
    1. SARS-CoV2 represents a zero, repeat zero, existential threat to humanity. If Bill Gates wants to challenge that, his reputation for having any brain cells whatsoever should be terminally ended.
    2. All healthy people under the age of 65 are absolutely not in need of any vaccination against SARS-CoV2, as they will almost never suffer any harm from the virus greater than a common cold. As a result, the vast ‘market’ for forcible vaccination of entire populations is not one based on human need of the many, rather human greed of the few.
    3. The most logical reason to plug ‘asymptomatic spread’ of SARS-CoV2 is desperate dan vaccine fascists realising that they have to justify injecting populations who don’t need injecting. And saying they ‘spread the virus asymptomatically’ is a wonderfully undisprovable statement, isn’t it?

    All US citizens need to stop assuming that US officials are honest and Chinese ones are liars. They need to start using their own brains, start looking at their own billionaires, Wall Street fascists, their own WEF proponents and their own vaccine-extremists like Anthony Fauci.

    I would not trust Anthony Fauci with my child’s health if you paid me $10m. The man is fatally conflicted, obsessed with power and lost the concept of dispassionate analysis of complex data long ago.

    Now you lot need to start from the skeptical hypothesis that you are being scammed by Fauci, Gates et al and frame a testable hypothesis to try and strike that eminently feasible scenario down.

    • Lol. Thanks for explaining everything for us.

      Do you realize that one reason for people under 65 to get vaccinated is to limit spread to more vulnerable people?

      Just curious…do you know how many people there are in this country who are under 65 and who have conditions that put them at greater risk for seriius illness and death from COVID?

      • Joe - the non epidemiologist

        josh comment – “do you know how many people there are in this country who are under 65 and who have conditions that put them at greater risk for seriius illness and death from COVID?”

        Significantly fewer than those over 65. A tiny fraction –

      • You seem to know how many there are, so why not share?

        How many people are there under 65 and at elevated risk for serious illness and death?

      • Joshua

        In the UK there was a thread about the number of people under 60 who had died of covid out of a population of 66 million without pre existing conditions. Its original point was that the genuinely vulnerable should be shielded , not everyone. I make no comment on the rights and wrongs.

        https://www.huffingtonpost.co.uk/entry/coronavirus-disinformation_uk_5fe848f7c5b6e1ce833a20de?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuYmluZy5jb20v&guce_referrer_sig=AQAAAAhE4hRtjlN1bRL2d5A8Yr77L8OMTb-Xsx6Ca0-6_rGaBUwOsUKRtRATsIFvgQbiohOUSmGMlLHaYmV6zOC1XN80WdJQlzfFZ8JwzKT8jitlywm6WKbE-nRD1BisaV6mYYfuRRqljncS08RoUAyXpIvDMGTp2KY03sHoFKaKD5yF

      • Tony –

        Some 20% of the people who have died from COVID in the US are under 65.

        Obviously, many more than that have become seriously ill.

        That’s because there’s a lot of people under 65 at risk for serous illness or death.

        COVID is one of the leading causes of death for younger people in this country. People are concerned about overdose deaths among the young, as well they should be. Some estimates have put deaths from COVID in the US among young people – contingent on the precise window of time and location – higher than accidental overdose deaths.

        COVID has increased the risk of serious disease and death among young people significantly. But of course, young people are dying at a lower rate than older people. No kidding. That’s true for cancer, long disease, heart disease, etc., as well. Yes, young people die at a lower rate than older people. Yes, that’s true.

        But COVID has jncresed the risk of serious disease and death among young people, significantly. And we don’t yet really know the risk for longer-term complications from COVID.

        > Its original point was that the genuinely vulnerable should be shielded , not everyone.

        Surely, you know the counter argument to this, right? I’m assuming that you do, so are you ignoring it?

      • Here’s the point:

        > These shortcomings and difficulties illustrate why economic theorizing is such a limited tool for determining policy in situations like this. A more robust and humble approach is probably to simply compare this epidemic to those of the past to get a rough idea of the costs and benefits of various policies. This is what economists Sergio Correia, Stephan Luck and Emil Verner do in their study of the Spanish Flu pandemic of 1918-19, in which they found that earlier and longer shutdowns of public spaces increased future economic growth rather than decreasing it.

        > But the biggest problem with this sort of exercise is the uncertainty surrounding the economic assumptions. The authors assumed that lockdowns were the main cause of reduced economic activity — that the reason people aren’t shopping and going to work is that they’re not allowed to. But in reality, fear of coronavirus is probably a much more important factor keeping people in their homes. Evidence from surveys, mobility patterns, pre-lockdown restaurant reservation data and the early results of actual reopenings all point toward fear of the disease being a much more important than government diktats.

        https://www.bloomberg.com/amp/opinion/articles/2020-05-14/coronavirus-reopening-in-u-s-shouldn-t-be-up-to-the-economists

      • Should have reversed the order of those two paragraphs.

      • Joshua asked, “How many people are there under 65 and at elevated risk for serious illness and death?”

        I found someone who looked at some of those numbers, here:
        https://towardsdatascience.com/covid-19-comorbidities-are-the-elephant-in-the-room-7d185bd6cfe2

      • Rather than anecdotal and unsupported comments about how dangerous covid is for young people, how about we look at the actual numbers;

        https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/

        Age (deaths/cases) CFR (95% CI)
        ≤ 9 years (0/416) 0%
        10 to 19 years (1/549) 0.18% (0.03 to 1.02%)
        20 to 49 years (63/19790) 0.32% (0.25% to 0.41%)
        50 to 59 years (130/10,008) 1.3% (1.1% to 1.5%)
        60 to 69 years (309/8583) 3.6% (3.2% to 4.0%)
        70 to 79 years (312/3918) 8.0% (7.2% to 8.9%)
        ≥80 years (208/1408) 14.8% (13.0% to 16.7%)
        Patients with comorbid conditions had much higher CFR rates. Those with no comorbidites had a CFR of 0.9%. Critical cases had a CFR of 49%, no deaths occurred among those with mild or even severe symptoms.

  44. I’m not going to do it, but it is pretty easy to get figures on those under 65 who are obese or have diabetes (or both). It’s a much larger number than Joe-the non-epidemiologist seems to think, at least in the U.S.

  45. Actually, the last time I looked people were estimating that 80% of all deaths occurred in people over age 65. Which means that this country has lost roughly 70,000 people to the disease who were under 65.

    I guess there are some out there who consider that an acceptable sacrifice to preserve their freedom to breathe free air unimpeded by cloth. My opinion is different. My opinion of those espousing such a view harkens back to my opinion of the good Germans watching the horrors of the 1940s.

    The banality of evil is still with us.

    • In the UK only 377 people have died from Covid-19 under the age of 65 without a pre-existing condition. A female radio presenter tweeted this fact this morning and received instant abuse.

      This popular youtuber talks about it here defending her (beware he uses foul language in his rants)

  46. > In the UK only 377 people have died from Covid-19 under the age of 65 without a pre-existing condition.

    How many people under 65 with pre-existing conditions died?

    How many people under 65 with and without pre-existing conditions got seriously ill?

    How many people over 65 with and without pre-existing conditions got seriously ill and/or died?

    Why do you focus on a particular sub-set specifically selected to minimize the impact?

    Do you even know why you do it?

    • “In the UK there was a thread about the number of people under 60 who had died of covid out of a population of 66 million without pre existing conditions. Its original point was that the genuinely vulnerable should be shielded , not everyone. I make no comment on the rights and wrongs.” – tonyb

      No need to get so upset. I’m merely making the same statement as tonyb. With the added complications of new more infectious strains, the alternative strategy is inevitably going to get re-examined.

      I personally have no strong opinions either way. My two sets of parents are all in their 80’s with one of the pair high risk. They have been shielding and isolating as expected. The alternative strategy would have been a lot more stressful for them but they would still have managed to stay safe before a vaccination became available.

      The young and healthy are probably suffering more than most people realise. It’s not an easy situation. It is what it is.

      • >They have been shielding and isolating as expected. The alternative strategy would have been a lot more stressful for them but they would still have managed to stay safe before a vaccination became available.

        Fortunately, then can do isolate and manage to stay safe.

        Unfortunately, because of their life circumstances many older people can’t. Either way, many heroes are sacrificing for the sake of others. As such, personally, I think that those who are making sacrifices deserve special consideration when the interests of different groups has to be balanced.

      • Here’s the fantastic Katie Hopkins ramming the point home:

  47. listen and share!

    • A very sobering account. Just yesterday, after finding the water tap frozen on the farm, I knocked on the door of the farmer to fill my water bottles.

      He looked aweful and said that he’d suddenly come down with illness at 8pm the night before. I said he’d got covid, having had it myself from spicy sausages early in the pandemic (never had processed meat since), I recognised the symptoms when he used the phrase “I feel like I wanna die”. He’s elderly. He said he had someone looking after him, so I left him be with a few words of encouragement.

      His lights were out entirely when I went out to pick my beers out of the fridge. It was a strange feeling not knowing whether he’d been taken to hospital or whether he’ll get through it.

  48. “This was also the moment when, subtly and imperceptibly, we were being asked to think of our fellow citizens not as human beings with dignity and rights but pathogen-carrying disease vectors.”
    Or climate destroying individuals who should feel guilty.
    Sweden.
    They are not pathogen-carrying disease vectors and don’t try to shame them into thinking they are. Jesus.
    When you think of the poor living in Africa, see them as more than climate destroyers wanting coal plants and reliable power. Would you tell them they can’t have their dignity? I hope not.

    • Thanks for the link. Worth a read. The tl;dr version is: a CDC study estimates that more than half of Covid-19 cases were contracted from someone who was asymptomatic or presymptomatic.

      (That’s why people WITHOUT symptoms need to wear masks, unless they have some means of being certain that they are not infected… e.g., they’ve already been vaccinated, at least a month ago.)

  49. It is a problem with asymptomatic spread as people do not know if they have covid or not and they keep going out without realizing that it could spread the virus.
    In a develop countries, I would say most people understand the danger of it and stay at home and just go out for the necessity such as grocery shopping. Those the government provide financial support and free health care. Unfortunately in most Asian countries, the government do not have the ability to provide financial support and if they give, it would not enough to survive on monthly basis. And people still going out to work and do business to keep survive. People would not go to see doctor or hospital if they are sick as it is costly to them. In addition, it could be little information provided to the people. So the virus spread further in the third world countries.