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Old 09-19-2020, 01:17 PM   #6616
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Thanks for all the information Snaggy.

Is it safe to say the positive test volumes are no longer appropriate to use to determine local infections?

Or safe for now but gradual decline in accuracy due to the issues in reporting?
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Old 09-19-2020, 06:55 PM   #6617
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Thanks for all the information Snaggy.

Is it safe to say the positive test volumes are no longer appropriate to use to determine local infections?

Or safe for now but gradual decline in accuracy due to the issues in reporting?
I think point of care tests are the future, and there may not be mechanism to make sure they’re being reported, not so far. Anytime there’s a form that takes 5 minutes to fill out and fax at a docs office, there’s gonna be fails. The paperwork could be simplified, or the EHR or insurance company could help capture the data. I don’t think that many POC tests are being done at the moment, but Abbot reckons to change that with $5 BiNax. If the associated app were widely adopted by patients, maybe government could pull it off the phones. But that info has always been collected not only for the sake of collecting public health data but as a mechanism to trace subjects and enforce quarantines and treatment compliance. People may not like that part.

Maybe a form gets generated at registration including patient info, the test operator checks pos or neg. info goes to health dept, the chart, and patient gets a digital or paper “passport” to work, travel and socialize.

Abbot could probably sell 10 billion BiNax tests @ $5 each. They have the EUA and are ramping up.

Apparently sewage treatment plants have been fertile ground for discovery too. Viral RNA can be measured and can predict the number of cases in a community a few days later.


https://www.abbott.com/BinaxNOW-Test-NAVICA-App.html
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Old 09-19-2020, 07:46 PM   #6618
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Old 09-19-2020, 08:01 PM   #6619
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Yeah. I’ve posted a few sewage threads in here. I think it’s the direction we should go.

Thanks for the info again
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Old 09-21-2020, 07:37 AM   #6620
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  • Eric Topol, MD posted a helpful summary of the protocols for the three clinical trials underway in the United States - Astra-Zeneca, Moderna and Pfizer. Key parameters of these protocols:
  • Each expect to enroll 30,000 participants
  • Pfizer and Moderna plan to administer the vaccine to 15,000 participants, with 15,000 receiving a placebo; Astra-Zeneca plans to administer 20,000 vaccines and 10,000 placebos
  • Pfizer and Moderna each set the efficacy target - the risk reduction provided by the vaccine - at 60%; AstraZeneca set this at 50%, which is consistent with the WHO standard. Each company set the 95% confidence limit - the minimum acceptable risk reduction - at 30%; this is consistent with the FDA standard for vaccine approval
  • Each company has identified at least one interim checkpoint during the trial; these checkpoints provide for the possibility of early termination of the trial, in the event of especially-positive results. Pfizer has established 4 interim checkpoints; Pfizer, 2 and Astra-Zeneca, 1
  • The Centers for Disease Control and Prevention (CDC) publishes weekly updates of COVID-19 hospitalizations, via its COVID-NET website. This includes a breakdown of hospitalization rates by age group. As of September 12 (latest-published data):
  • Persons under 18 years of age have 1/10th the hospitalizations per capita as the overall population
  • Persons aged 65-74 have a 2x rate of hospitalizations per capita
  • Persons 75-84 have a 3.2x rate
  • Persons 85 and older have a 5x rate
  • Testing in the United States showed improvement over the past week
  • The 7-day average test volume has increased now on five consecutive days; on a week-over-week basis, testing as of yesterday was up 24%
  • The test-positive rate declined yesterday, for the 4th consecutive day; On a 7-day average basis, the rate has now declined on six consecutive days
  • New cases and the infection rate has increased for the past week or so:
  • New daily cases, which had declined for seven weeks, began increasing six days ago; On a week-over-week basis, new cases were up 11.5% yesterday versus one week ago
  • New cases on the weekend were higher than any of the past four weekends
  • On a 7-day average basis, the new daily infections per capita rate bottomed-out on September 12 and has risen each day since then; yesterday's rate was back up to the rate last experienced on September 6
  • Wisconsin and Utah experienced the steepest increase in this rate, relative to two weeks ago, followed by North Dakota, Nebraska, Wyoming and Oklahoma; Hawaii experienced the steepest decline in this rate, followed by Louisiana and Mississippi
  • Congrats again to the team from the state government of Vermont; this state experienced only 7 new daily cases per 1 million over the past 7 days. We are honored to have several of the key state officials among our regular readership
  • Despite the upturn in new cases, pressure on the healthcare system from COVID-19 continued to ease:
  • Inpatient COVID-19 census has declined on five consecutive days and 50 of the past 59
  • ICU COVID-19 census has declined on five consecutive days and 48 of the past 60
  • As a % of all ER visits, visits for COVID-19 like illnesses continued its now 3+ month-long decline
  • Deaths with the coronavirus continued to decline:
  • On a 7-day average basis, reported daily deaths have declined on six consecutive days
  • There were fewer deaths reported over the weekend than on any weekend since the Independence Day holiday
  • There are now nearly 21 persons reported as recovered from the virus for each death
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Old 09-21-2020, 11:00 AM   #6621
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So, serological testing determines if the body has produced antibodies to an infection.

In clinical speak, conversion means they’re present, comparative IgM and IgG concentrations help determine if the infection is pretty new, and titers estimate the quantitative vigor of the response.

The rapid lateral flow assays will be binary yes/no for antibodies, no real ability to determine anything else. Titers can be measured in a clinical lab, for instance, when using convalescent plasma, to make sure the material has a useful number of antibodies. Not much value otherwise at this time in patient care. Currently, comparative IgG and IgM assays are a research tool.

Rapid tests for antibody probably have had disappointing specificity, meaning a positive test doesn’t really prove an infection has occurred. If a lateral flow test is developed with a highly specific monoclonal antibody that does not react to previous corona infections, that will improve. I do not know when those will appear, or have yet.
So, useful in specific instances wrt convalescent plasma, but not very useful outside of that. Thanks for the info!
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Old 09-23-2020, 09:42 AM   #6622
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This morning briefing was interesting.

Science mag posted this "perspective" piece. I think it's their version of an op-ed.

Here are a few excerpts from the article:
  • “Multiple studies of contacts of primary and secondary school children with known SARS-CoV-2 infection showed minimal outward transmission in schools”
  • (There is an opportunity to) "generate a 'best practice' that balance young peoples' rights to an education with the need to protect the broader community from further transmission"
  • “School closures and attendant loss of other protective systems for children (such as limited social care and health visiting) highlight the indirect, but very real, harms being disproportionally borne by children and teenagers as a result of measures to mitigate the COVID-19 pandemic”
  • “Educational settings play a limited role in transmission when mitigation measures are in place”
  • “School closure should be undertaken with trepidation given the indirect harms that they incur”
Now, on to today's report:
  • The highest rate of infection spread worldwide continues to be in certain island, European and South American countries: Aruba continues to experience the highest rate per capita. Among countries with > 1 million population, Israel, Bahrain, Spain, Costa Rica and Argentina lead this list
  • Testing has ramped back up in the United States. The 7-day average rate as of yesterday was higher than any day since July 30. The important test-positive rate increased somewhat yesterday (7-day average) yet, remains just above the strict WHO target
  • New daily cases have increased 5.9% on a week-over-week basis. The rate of increase, however, has slowed each of the past three days; there were fewer new cases yesterday than on any Tuesday in the past 14 weeks, except for Labor Day week
  • New daily infections per capita, on a 7-day average basis, have been essentially level for the past 4 days.This rate had been increasing since Labor Day, so its encouraging to see it at least plateau.
  • North and South Dakota, Wisconsin and Oklahoma continue to experience the highest rates in the country. Vermont's rate dropped again, to 4 new daily infections per million population
  • On a 7-day average basis, reported deaths with the virus have declined for seven consecutive days; there were fewer deaths reported yesterday than on any other Tuesday in the past ten weeks, except for Labor Day week
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Old 09-25-2020, 07:51 AM   #6623
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Originally Posted by Nephron
Throughout the week we have spoken about a potential change in the direction of case progression in the US. We hate to end the week with this, but present another alternative view of progression on the most updated data, and it isn’t promising. The chart below shows the number of days it has taken for the US to progress through 500K case milestones. The US hit the first 1mm cases on April 28th, some 18 days after passing through 500K cases. The next couple 500Ks took 20 and then 24 days. However, beginning in June case growth accelerated and each of the next 4 500K marks were met quicker and quicker. We saw a positive inflection after recording 4mm cases in the US as the next 5 milestones each took longer to hit. Now, we are projecting the US records its 7 millionth case today, just 11 days since hitting 6.5mm cases. Said another way, cases grew faster than the last 500K.



Next, we show the progression through million case milestones, again assuming we record the 7 millionth case today. The longer view shows that we are still making some progress as it took 25 days to hit the most recent million, up from 22 days to hit 6mm, 17 days to 5mm and 15 days to 4mm. Unfortunately, when juxtaposed with the chart above, it also demonstrates that the acceleration in cases appears to be very recent, or in the past two weeks.

What's this mean? Likely a third "wave" is bubbling up.

Here is another article

https://thehill.com/policy/healthcar...s-builds-in-us
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Old 09-25-2020, 08:54 AM   #6624
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Throughout the week we have spoken about a potential change in the direction of case progression in the US. We hate to end the week with this, but present another alternative view of progression on the most updated data, and it isn’t promising. The chart below shows the number of days it has taken for the US to progress through 500K case milestones. The US hit the first 1mm cases on April 28th, some 18 days after passing through 500K cases. The next couple 500Ks took 20 and then 24 days. However, beginning in June case growth accelerated and each of the next 4 500K marks were met quicker and quicker. We saw a positive inflection after recording 4mm cases in the US as the next 5 milestones each took longer to hit. Now, we are projecting the US records its 7 millionth case today, just 11 days since hitting 6.5mm cases. Said another way, cases grew faster than the last 500K.

What's this mean? Likely a third "wave" is bubbling up.
The creator of that graph was stretching for a new way to scare people. Of course the virus is spreading. That's what viruses do. The size and population density of the country limit rate of spread, and lockdowns slow it further, but it will get around.

This graph uses the same source of data but presents it in a more straightforward way:



The good news:
  • New-case rate is down by one-third from the mid-summer peak.
  • Hospitalizations are also down since mid-summer and up only slightly from the late spring low.
  • Deaths are WAY down from the April peak, in spite of a higher new-case rate.
Does the post-Labor Day upturn in new cases predict a new wave? No way to know. Re-opening of schools in many places will drive spread, but, so far, neither hospitalizations nor deaths have followed.
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Old 09-25-2020, 09:00 AM   #6625
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I don’t know what you do Dan or who you work for but I should point out Nephron Research is of high quality.

They’re a very well respected Healthcare Research Investment Firm.

They want Covid gone so healthcare starts buying again, for them to publish this goes against their inherent bias.

Weren’t you also suggesting a while ago that it was all over? But now it’s spreading? Sorry where’s the disconnect? I thought we had herd immunity?
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Old 09-25-2020, 09:16 AM   #6626
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Old 09-25-2020, 09:34 AM   #6627
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I will also add, Covid tracking project is the go to for data on this but they do adjust their metrics a little to frequently for my liking. I know things are fluid and they have to adjust but every adjustment means we aren't comparing apples:apples anymore.

The last 2 weeks are possibly a great display of this. On the 18th, they changed the way they calculate positive tests. So it's hard to say if we can compare the last 2 weeks. I am waiting on next weeks data to compare before I make any callouts.
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Old 09-25-2020, 09:38 AM   #6628
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I don’t know what you do Dan or who you work for but I should point out Nephron Research is of high quality.

They’re a very well respected Healthcare Research Investment Firm.

They want Covid gone so healthcare starts buying again, for them to publish this goes against their inherent bias.
I did not suggest that their graph is inaccurate. I said that it is a deceptive presentation intended to frighten. Days between half-million milestones? Really?

Quote:
Weren’t you also suggesting a while ago that it was all over? But now it’s spreading? Sorry where’s the disconnect? I thought we had herd immunity?
I contend that the Tri States (NY, NJ, CT) are at herd immunity. Their new-case rate has been flat and < 5 per 100K population for three months, while the rate in the rest of the country tripled and remains 3x higher. Something much different is happening there.

Date of arrival, population density, and suppression measures differ widely across the country. Spread of the virus over time will vary similarly.
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Old 09-25-2020, 09:42 AM   #6629
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I did not suggest that their graph is inaccurate. I said that it is a deceptive presentation intended to frighten. Days between half-million milestones? Really?
ah, thanks for the clarity. Yeah, why create milestones if you create additional arbitrary subsets of them as well. I don't like it but I understand. If I could identify an impetus to the reasoning, it might make more sense ie... a holiday that would drive infections would be a reason to subset so you can monitor.
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Old 09-25-2020, 09:46 AM   #6630
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I will also add, Covid tracking project is the go to for data on this but they do adjust their metrics a little to frequently for my liking. I know things are fluid and they have to adjust but every adjustment means we aren't comparing apples:apples anymore.

The last 2 weeks are possibly a great display of this. On the 18th, they changed the way they calculate positive tests. So it's hard to say if we can compare the last 2 weeks. I am waiting on next weeks data to compare before I make any callouts.
Thanks for the heads-up. I'll take a look. For info, for California, COVID Tracking Project data is identical to California Department of Public Health (EDIT: but one day late).
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