Daily numbers, graphs, analysis thread 3

[Barracker]

Welcome to thread 3 of the daily updates.

Resource links:
Worldometer UK page
Financial Times Daily updates and graphs
HSJ Coronavirus updates
Johns Hopkins Coronavirus Resource Centre
NHS England stats, including breakdown by Hospital Trust
Covidly.com to filter graphs using selected data filters
ONS statistics for CV related deaths outside hospitals, released weekly each Tuesday

Thank you to all contributors for their factual, data driven, and civil discussions.

Using plasma from people who have antibodies to a disease is a classic treatment that has worked for diseases in the past
and has gained interest again the last few years after e.g. the Ebola epidemic

(2015) Convalescent plasma: new evidence for an old therapeutic tool?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781783/

Convalescent blood products could be a valid option in the treatment/prophylaxis of several infectious diseases both in association with other drugs/preventive measures and as the only therapy when a specific treatment is not available.

However, there are still some issues to consider in determining the advisability of implementing a large-scale convalescent plasma transfusion programme.

John Burn-Murdoch@jburnmurdoch (FT stats geek)

NEW: Wed 8 April update of coronavirus trajectories
NB: we’ve reverted to the 7-day moving average

Daily new deaths:
• General trend in US and UK is still more deaths every day than the last
• Japan joins this chart, deaths tracking Italy

Now cumulative deaths:

• US has cut straight thought Italy’s curve; on course for highest death toll globally within ~5 days
• Australia still looking promising

• UK still parallel to Italy

Now daily new cases:
• US slope softening, but due in part to the weekend reporting dip.
Careful before declaring a plateau here ⚠️

• Austria’s new cases have now been falling for 10 days.
They plan to ease lockdown next week 👀

• US infections still rising more steeply than in any other country this far into its outbreak
• Reported Indian infections picking up speed after slow early pace

Now ~subnational~ daily deaths:

• NY seeing far higher daily deaths than those recorded in any other part of the world at any time

• London still on trend of more deaths each day than the last
• Catalonia & Madrid look to be past their peak

Subnational death tolls cumulatively:
• NY likely to have world’s highest subnational death toll within days

Now small multiples of subnational daily deaths:
• We’re showing UK countries here:
England still increasing much more steeply than Scotland & Wales; many more deaths every day than the last

• Stockholm sloping steadily up
• Illinois added

Small multiples for daily new deaths in 42 countries:
• Norway locked down while Sweden didn’t; Norway’s daily death toll rising much more slowly than Sweden’s
• Brazil & Turkey tracking China

• Ireland much shallower curve than UK

Japan’s delayed outbreak continues ⚠️
• New Zealand’s early action means it may have turned the corner early 🇳🇿📉

Things to note:
• Daily covid data is extremely noisy and implies false precision
• This is why we use a rolling average.
Watch for general trends.
Focus on slopes, not specific daily numbers

Important pre-print about the importance of testing windows and false negative rates in SARS-CoV-2 testing.

The authors report on serial (repeated) testing over time of the same infected patients. 298 tests on same 30 patients.

False negatives are a function of time since onset of symptoms.

Day 1? 7% false negative.
Day 10? 40% false negative.
Day 20? 90% false negative

So here you see the impact of testing windows! RT-PCR testing, used now for screening, is useless a week after the first symptoms appear. It's no better than a coin flip.

TL;DR:
IF PEOPLE HAVE TO WAIT DAYS FOR TESTING, YOU MAY AS WELL NOT TEST THEM.

Above taken from this twitter thread

twitter.com/c0nc0rdance/status/1248094573928251398?s=20

If anyone is interested in how this crisis is being tackled in Luxembourg and comments by the WHO European regional director then look at this.
It is less than a five minute read, in English.

luxtimes.lu/luxembourg/40362-looking-at-life-after-corona-as-new-infections-slow

Pocketem blimey! So a large proportion of tests in hospital?

I asked this a few times on older thread as it did seem a very important point.

Our tests are coming back 1/4 positive I think

Yes, by the time someone gets into hospital they've generally already been symptomatic for a few days, so chances of a false negative already starting to increase. Plus it takes much longer before antibodies show up in high enough quantities to be detectable by current tests, so there is a gap for most hospital patients where their RNA load in throat/nose swabs has become too low to be detectable yet their antibody load is also too low to be detectable yet. Will lead to lots of false negatives.

This is a pre-print so not peer reviewed yet but will be a big deal if backed up by other studies

Is anyone else finding it interesting reading about how we've received a vast amount of PPE and tests from China which have been defective?

How they they apparently kept figures so low and conducted all these tests without correct equipment.

It probably does explain the figures, but if the tests don't work it may be that they are from an early stage of development - the Chinese had to develop everything from scratch while trying to contain / treat the infection. I think the intention is to help.

Yes, by the time someone gets into hospital they've generally already been symptomatic for a few days, so chances of a false negative already starting to increase

There was an article* in The Observer this Sunday by Dominc Minghella describing his admission to Kings on day 12 of his illness . His 2 swab tests came back negative but his lung x rays show the classic picture of Covid infection.

I wonder if hospitals in order to priortise tests for staff could adopt a protocol of clinical diagnosis for patients admitted and having had symptoms for ? 7 days .I assume most will be at this stage by time admitted .

*well worth a read and some nicely judged black humour . Can't find on line Observer article but maybe in Telegraph .

This?

www.google.co.uk/amp/s/deadline.com/2020/04/doc-martin-creator-dominic-minghella-recounts-harrowing-coronavirus-experience-1202898524/amp/

Thanks DuLang that looks like it !

Over on a "take VitD " ( plus calcium and K2 ) thread, this link was posted with protocols recommended by the Eastern Virginia Medical School,US.

drive.google.com/file/d/1P-4LOBRFfn84h8lBs98IEjC6ml7Nv6tx/view?fbclid=IwAR08EWGMPvFQ2QP604OrpP0IA71EbOdUC98UNBsXUSDMTVQfUazmFjrrXLY

What struck me ( although the use of Vit supplements is interesting ) was the emphasis on trying to avoid intubation and the damage to lungs that it may cause .

^We have zero success for patients who were intubated. Our thinking is changing to postpone intubation to as long as possible, to prevent
mechanical injury from the ventilator. These patients tolerate arterial hypoxia surprisingly well. Natural course seems to be the best.”^

This is not your “typical ARDS”.

Mechanical Ventilation may be doing harm. We need to think of alternative treatment strategies.

Brings to mind Boris in ICU but not on mechanical ventilation and the stats re deaths of ventilated patients .

formatting fail ,sorry .

Interesting about the negative tests. dd is in a London hospital, and they have significant number of symptomatic patients on "non-Covid" wards who show symptoms but test negative. She says she now "knows" when someone has Covid, but it hard to convince anyone until the patient deteriorates, which can be frighteningly fast

She says chest X-rays are often very distinctive.

BigChocFrenzy, those FT stats are really interesting. Especially as they agree pretty much exactly with my opinions which I've garnered mostly from this thread!

Sweden isn't doing as well as everyone thinks - excluding all the very low population density areas, their figures would be high (and climbing).

It looks as though suspicions about Japan minimising, possibly to try to save the Olympics, may be true.

Thanks for that google drive link, peridito

Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – eighth update (8 April)

https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-rapid-risk-assessment-coronavirus-disease-2019-eighth-update-8-april-2020.pdf

there is currently no indication at EU/EEA level that the peak of the epidemic has been reached.

Based on data from EU/EEA countries,

32% of the diagnosed cases have required hospitalisation and
2.4% have had severe illness requiring respiratory support and/or ventilation.

The crude fatality rate was 1.5% among diagnosed cases and 11% among hospitalised cases.
.....
Strain on health and social care systems and healthcare workers continues,
with shortages reported in laboratory and testing capacity, personal protective equipment and healthcare capacity (including ICU ventilator and healthcare workforce capacity).

In several EU/EEA countries with available data,
between 9% and 26% of all diagnosed COVID-19 cases are in healthcare workers.

There are also increasing reports of COVID-19 outbreaks in nursing homes across Europe,
highlighting the vulnerability of the elderly in long-term care settings
and the importance of infection control measures to protect vulnerable populations.

In the present situation, where continuous spread of the virus can be expected,
the assessment is

⏺ that the risk of severe disease associated with COVID-19 in the EU/EEA and UK is currently considered moderate for the general population
and very high for populations with defined risk factors associated with elevated risk;

⏺ that the risk of increasing community transmission of COVID-19 in the EU/EEA and the UK in the coming weeks is moderate if mitigation measures are in place,
and very high if insufficient mitigation measures are in place

⏺ that the risk of health and social care system capacity in the EU/EEA and the UK being exceeded in the coming weeks is considered high with mitigation measures in place
and very high if insufficient mitigation measures are in place.
........
In the current situation, a strong focus should remain on comprehensive testing and surveillance strategies (including contact tracing),
community measures (including physical distancing),
strengthening of healthcare systems and informing the public and health community.

Very useful advice on prophylactic measures, perdito

Also interesting from that doctor:
over-60 is medically judged at higher risk,
not over 65

• the difference to govt figures is probably because many people still have to work at age 60-65

That's quite worrying about false negatives.

Hurry up with the antibody tests, please. [to world in general]

It was orginally posted by
EmMac7 Wed 08-Apr-20 17:38:53
I’m taking Vit D, Zinc, Vitamin C and Quercetin.

This is an extract re vits

Prophylaxis
"While there is very limited data (and none specific for COVID-19), the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease, especially amongst the most vulnerable citizens
in our community; i.e. those over the age of 60 years and those with medical comorbidities. While there is no high level evidence that this cocktail is effective; it is cheap, safe and should be readily available. So what is there to lose?
• Vitamin C 500 mg BID and Quercetin 250-500 mg BID
• Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1-2 months, reduce the dose to 30 to 50mg/day.
• Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 1-2 mg at night
• Vitamin D3 1000-4000 u/day (optimal dose unknown). Likely that those with baseline low 25-
OH vitamin D levels and those > living at 40o latitude will benefit the most.
Mildly Symptomatic patients (on floor):
• Vitamin C 500mg BID and Quercetin 250-500 mg BID (if available)
• Zinc 75-100 mg/day
• Melatonin 6-12 mg at night (the optimal dose is unknown)
• Vitamin D3 1000-4000 u/day
• Enoxaparin 40-60mg day (if not contraindicated; dose adjust with CrCl < 30ml/min)
• Optional (and if available): Chloroquine 500 mg PO BID for 5 days or hydroxychloroquine 400mg
BID day 1 followed by 200mg BID for 4 days
• Observe closely.
• N/C 2L /min if required (max 4 L/min; consider early t/f to ICU for escalation of care).
• Avoid Nebulization and Respiratory treatments. Use “Spinhaler” or MDI and spacer if required.
• Avoid non-invasive ventilation
• T/f EARLY to the ICU for increasing respiratory signs/symptoms."

That guy (Dr Paul Marik) is a quack. Claims that vitamins can cure sepsis.

twitter.com/ADAlthousePhD/status/1245383740588769286?s=20

Like, a bit of extra vitamins D, B and C (in safe quantities!) isn’t going to hurt our chances of getting through this ok, but the idea that vitamins can cure anything but vitamin deficiency is a bit bonkers (happy to be proved wrong by future peer-reviewed research!)

People with a good diet, plenty of sunshine and a body that still works well will probably have good levels of vitamins and gain little if any benefit from taking any

Unfortunately, especially under lockdown and especially for older people, many will be low on fruit, veg & sunlight
and deficient in some vitamins

• which might lower the efficiency of their immunity system

pocketem
I thought it was vitamins in conjunction with the standard treatment rather than alone.

He is hardly a quack even if his theory wasn’t proved is there any evidence of harm to patients in trying this. He was still giving the standard treatment. Cognitive bias - yes but quackery- bit extreme.