Coronavirus and Walt Disney World general discussion

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brianstl

Well-Known Member
You are correct. That is what I get for just looking at some headlines and not reading the data. I am guilty of what I just accused others of.

While the death rate is up 25.5%, the actual death count is down by 8%. The seemingly conflicting percentages are the result of the dramatic drop in miles driven.

 

SamusAranX

Well-Known Member

I mean, this definitely is true just from common sense and the fact that insurance companies, even for profit ones (!) returned premium credits!
 

Heppenheimer

Well-Known Member
It may just be that nobody cared before, but this is nothing new. It happens with most causes of death. If someone gets shot in the head and dies instantly it’s pretty cut and dry. With any disease there’s almost always multiple contributing factors. It’s not as cut and dry as people want it to be. That doesn’t mean it’s being intentionally done to fear monger or trick people it’s just the way it is. Google H1N1 worldwide pandemic and you will find multiple sources with a different death count. Again, not a conspiracy just the way it is because not all reporting is great and not all deaths are cut and dry. The CDC officially gives a range not even a total. They also didn’t issue the final report with their final numbers until a few years after the outbreak. Again, common practice. So the outrage over the UK changing their number is likely to be repeated again and again as everyone finalizes numbers. You personally may not have been talking about it as a conspiracy, but others called the actions malicious and said hospitals looking to pad the numbers for their bottom line. That’s tin foil hat stuff any way you slice it.
Just a few follow up points.

1st: As you noted, the death of a hospitalized patient is almost never a matter of "cause of death: pneumonia" without any other contributions. It is often a combination of various issues, like septic shock, renal failure, NSTEMI, etc. When someone with poor overall health gets severely ill, multiple organs start to go down the toilet, despite the initial inciting disease starting in, lets say, the lungs or bladder. There just usually isn't a cut-and-dry single cause or contributor.

2nd: Death certificates are filled out by the attending physician, who may be a hospital employee, or an independent practitioner who has practice rights at the hospital. Not a hospital administrator. In the states where I have practiced, the certificate gets filed electronically in a secure system. Only medical providers registered in that state can fill out or alter the information, and once it is finalized, nobody else can change it. This is as much of a legal document as the rest of the medical record, and the same penalties for deliberate falsification apply. Although there is some level of subjectivity involved in what to include, it is usually filled out in the best judgement of the person who knows the case best, the attending physician. The idea that thousands of medical providers across the globe are deliberately conspiring to fabricate medical data for... oh, I don't know, reasons of some kind, is simply preposterous, and downright insulting.
 

DCBaker

Premium Member
Numbers are out - (note the * on the results for 8/11)

They did not include the "change in deaths since previous report" - there were 148 new reported deaths.

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mmascari

Well-Known Member
I’m not making any argument. I’m just accepting what I now see as reality. My optimism for any sort of real control for the world as a whole outside of lockdowns erodes each day.
I’m only asking what will happen if a vaccine is actually not around the corner? How long can this be sustained throughout the world? No one talks about a plan B.
Plan A is to contain the virus, get as much of the economy open as possible, keep as many people safe as possible and wait for a vaccine. We know some activities just aren’t possible and some businesses can’t be open or be open with any meaningful demand. That’s part of the process. If we get to the point where there’s no hope for a vaccine we then have to see what the state of the virus is to form a plan B.
Yeah. I appreciate all this but i don’t think you’re understanding me. I’m not questioning restrictions in the present. I’m questioning that there is no option even being discussed if the vaccine doesn’t work out. All the eggs are in the vaccine basket with no other viable option being considered for the long term. It should definitely be discussed now. Not planning for this is a horrible idea. Plan B should be ready to go if the vaccine doesn’t come.
Vaccine or no vaccine doesn't matter. The plan always has the same goal, "reduce the transmission enough that the sources of virus have no place to replicate and it's contained". A vaccine is just one way that's done, but it's not the only way. Likewise, the tools for doing this is different if there are only a few cases or if it's rampant with many active cases. It makes no sense to use the wrong tools for the wrong conditions.

Our issues are not about how to accomplish containing an infectious disease. They're around what we're willing to do vs the things that need to be done based on the active conditions.

When things were out of control with large community spread, we did the things to deal with that, at least some. But, we fell apart and continue to fall apart on the things needed to contain smaller community spread in most places. The problem becomes, if you don't contain smaller community spread, it gets bigger. We're doing pretty good at slowing the increase in community spread, so it'll get to widespread less quickly than it did the first time. But we're not really doing enough to reduce it.

In the US, we don't have rampant TB spread. There's a vaccine, but it's not really used in the US, and yet we still don't have rampant TB spread. What we do have is well understood and used isolation protocols, contact tracing, and surveillance testing for TB. It helps that we've been able to keep the community spread low enough that these things are practical. Although, in recent years funding has struggled for even this and cases have gone up as things are missed. The same with several STD diseases too. I'm sure one of the hospital workers posting can comment on what they do when there is a suspected TB case for isolation, testing, and then tracing if it's positive. Along with how long it takes from suspicion to test result, plus the extra pain maintaining the isolation is during that time.

That's the goal, get the community spread small enough that we don't need any restrictions designed to "slow the spread" because the spread can be contained instead.

  • A vaccine can do that, as it eliminates people who can be infected.
  • A lock down is temporarily good when spread is rampant, because it stops all interaction. Its' not good when spread is smaller, it's like using a sledgehammer to drive deck nails.
  • Rapid testing, contact tracing, targeted isolation works when spread is small and testing is fast enough. This is how TB is handled. We're not reporting on testing that's fast enough for this vs just tests taken. Anecdotally, this is where we're clearly failing. If every contact is assumed positive, isolates until they get their result, and traced when positive, this can contain instead of slow. But it doesn't work with slow testing. Even if the contact isolates for two weeks while getting a result, they still may have infected people in the days before they isolated. Contacts that will never be traced based on a result that comes back a week late.
  • Surveillance testing, with rapid results followed by contact tracing. This works to catch gaps in the primary testing, things that slip through for whatever reason. For opening schools, this would mean doing some amount of surveillance testing of the school population often enough to get ahead of spread instead of after someone shows symptoms. To know that there is an issue before it's effectively impacted everyone.

We've seen both the NWSL and NBA do this on much smaller scales. Those worked because they could reduce their community spread to 0 and then keep it there.

That's the plan, reduce community spread to a manageable level that it can be contained, and acted on fast enough to keep it contained. It's the only plan. Everything is just how we get there.



So then really it is a moot point talking about daily death numbers. No one will know the real numbers for weeks
Exactly. For the death numbers, just read the updated and corrected numbers from up to 3 weeks ago. Ignore everything newer than that, it'll all be adjusted and is just noise. Which also means the deaths number isn't a very good monitor for current conditions. Between deaths lagging infections to begin with, and then death statistics reporting lagging more, as a measure it's great at telling you what was going on a month or two ago but not so much what's going on now. Just like most economic data that is reported a month or quarter after the fact. It's still important to know, to understand the big picture, but it's not going to help with the detailed picture for today.
 

Heppenheimer

Well-Known Member
Did you read this?
Page 7 seems to contain information that contradicts the proposition that " CDC has found that no adult contacts of infected children in school settings have tested positive "

"The attack rate among household contacts of index cases aged 09 years and 1019 years was 5.3% and 18.6%, respectively, indicating transmission potential in both children and adolescents, and possibly more effective transmission in adolescents than in adults [70]. "

What they did find, though, was that they could not find evidence of children to adult transmission within the schools (page 12):

"In summary, where COVID-19 in children was detected and contacts followed-up, no adult contacts in the school setting have been detected as SARS-CoV-2 positive during the follow-up period. The conclusion from these investigations is that children are not the primary drivers of SARS-CoV-2 transmission to adults in the school setting."

But as the previous poster noted, these were from voluntary surveys.
 

Heppenheimer

Well-Known Member
In the US, we don't have rampant TB spread. There's a vaccine, but it's not really used in the US, and yet we still don't have rampant TB spread. What we do have is well understood and used isolation protocols, contact tracing, and surveillance testing for TB. It helps that we've been able to keep the community spread low enough that these things are practical. Although, in recent years funding has struggled for even this and cases have gone up as things are missed. The same with several STD diseases too. I'm sure one of the hospital workers posting can comment on what they do when there is a suspected TB case for isolation, testing, and then tracing if it's positive. Along with how long it takes from suspicion to test result, plus the extra pain maintaining the isolation is during that time.
It's a big pain, let me tell you. Fortunately, our medical forebears in this country did the leg-work to make a TB a rather rare disease, so I've only had maybe two cases in my career. It was a massive public health effort. I shudder to think how it would go over today.
 

kong1802

Well-Known Member
Page 7 seems to contain information that contradicts the proposition that " CDC has found that no adult contacts of infected children in school settings have tested positive "

"The attack rate among household contacts of index cases aged 09 years and 1019 years was 5.3% and 18.6%, respectively, indicating transmission potential in both children and adolescents, and possibly more effective transmission in adolescents than in adults [70]. "

What they did find, though, was that they could not find evidence of children to adult transmission within the schools (page 12):

"In summary, where COVID-19 in children was detected and contacts followed-up, no adult contacts in the school setting have been detected as SARS-CoV-2 positive during the follow-up period. The conclusion from these investigations is that children are not the primary drivers of SARS-CoV-2 transmission to adults in the school setting."

But as the previous poster noted, these were from voluntary surveys.

I actually got excited to read it until I quickly realized it was a freaking voluntary email survey that had no scientific follow up on the answers.

It's not really worth the internet space it takes up, frankly..

My favorite nugget:

"Many countries are not testing asymptomatic cases, so it is difficult to detect and understand transmission among mild or asymptomatic children and teachers"

And since children seem to be more likely to be asymptomatic...what are we even doing here?!

And this one:

"Interpretation of outcomes of school outbreak reports in the midst of ongoing community transmission is difficult "

So basically we can't know if it's being spread at home or at school..
 

havoc315

Well-Known Member
Very creative work with those numbers. Impressive fear mongering.

It's not "fear mongering" to honestly and openly discuss the real numbers?

Cases in Florida are declining overall, which is a good thing. But that overall decline is being driven by the more populous dense areas.... we are now seeing the disease grow in more rural counties.

Suwanee County -- Population just a bit over 40,000... after 400+ cases yesterday, another 233 reported cases today. Lafayette county -- population just only 8700! But 276 cases reported today. That's 3% of the entire county testing positive in just 1 day.
 

mmascari

Well-Known Member
It's a big pain, let me tell you. Fortunately, our medical forebears in this country did the leg-work to make a TB a rather rare disease, so I've only had maybe two cases in my career. It was a massive public health effort. I shudder to think how it would go over today.

I'm assuming that's two positives? I'm guessing you've seen more possible cases that require a negative test to rule it out. Probably someone traveling from a place where it's more common. Where the hospital does all the isolation, masks, etc until the test result comes back. Probably taking longer on a weekend for the result. Which, as you said, is negative more often.
 
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