10 ms·

Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely hi

Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely high, far higher than anyone thought?

taeric 6y ago
I also want to add that this doesn't make the virus less deadly. It just gives it a very population varied IFR. It appears far more deadly for some populations. Near harmless for others. But no clear way to confine it to the harmless crowd.
- vmception 6y ago
  > But no clear way to confine it to the harmless crowd. That won't be what the public policy decisions will be based around if the asymptomatic and already exposed rate is so high. We don't know enough to make that decision yet, but testing more broadly was the first step. Remaining steps: - Do they get sick in two weeks? - Skip testing for current sickness, and test for antibodies instead. - Get a better antibody test that is more accurate - Understand how well antibodies work, and for how long and then we can make decisions, even if they are as simple as "this is a systemwide over the air update, some people will get bricked" it's becoming clear that we might end up with a society where the average BMI is under 24.9 simply due to the lower oxygen and resource requirements to support those body systems.
  - taeric 6y ago
    Not sure I follow. I confess I'm biased in thinking we could have locked down nursing homes and shaved a large chunk of deaths. Catch is, we should have done that in January.
    - pbhjpbhj 6y ago
      > locked down nursing homes // How would you do that without locking down the rest of the population? You're going to isolate all nursing home workers?
      - taeric 6y ago
        We could have done dedicated housing for them for cheaper than what we have currently done. So, maybe?
        pbhjpbhj 6y ago
        I'm in the UK, I can't see this being accepted: it would be pretty hard for every care home to have space found near it to create temporary housing for all the workers. And basically imprisoning workers just because of their current job wouldn't be popular with the population -- if they quit, how do you replace them? Who would sign up? Confining people to their own home, and locking them in their workspace are markedly different. I'm not sure there's a better solution; financial incentives and let the workers decide if they want to do it? Care home workers have their own families and dependents too, but that could make it possible for many of them without having to lock them up against their will.
        taeric 6y ago
        Apologies, my thought was it would not have to have been Draconian. We could have basically done a tight job on funneling access to them. Would have been expensive, but so is everything we have been doing. Which is a large part of my point/question. Would it have been more effective than what we have been doing? This is frustrating with a lot of news coming out that it had been spreading longer and faster than thought. Conceivable that much of the peak in deaths is the highest risk crowd having hit a saturation.
    - vmception 6y ago
      My post is just a blueprint for letting us know what to do at all. Its the plan for making a plan.
SpicyLemonZest 6y ago
Like with the death rate, I expect we'll seamlessly transition from "this isn't proof, in 2 weeks you'll see" to "this isn't news, everyone always believed that so it doesn't imply any changes in strategy".
- wegs 6y ago
  Well, it isn't proof. It is evidence, though. And in two weeks, we will have a lot more evidence. A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad. It could also be there are bad and not-so-bad strains. Or it could be bad down-the-line. Until we do have proof, I'm advocating being conservative. In 2 weeks, we'll know if people are turning up in ERs or in morgues. In a few months, we'll know about lung damage, immune system damage, strokes, or a lot of the other potential consequences. In a year, we'll know about vaccine and long-term immunity. I think the key problem here is failure to understand risk management. I can believe one think, but act another way just in case I'm wrong. Or I can be unsure. And so on. That nuance is lost in the right/wrong discussions.
  - Zach_the_Lizard 6y ago
    > A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad. I think at this point we know enough to say: 1) For most of the population, the virus is not that serious 2) For a subset of the population the virus is seriously deadly. For example, ~20% of NY state coronavirus deaths were from nursing homes, ~37% are 80 or older. By contrast, there were 2 people under the age of 10 at the time of this post. [0] > I think the key problem here is failure to understand risk management I think another key problem is a failure to be frank about the cost-benefit of our actions. I have had to make stronger cases about changing the color of a button or optimizing a backend call than I've seen presented by authorities who are shutting down or reopening or anywhere in between. [0] https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Fatalities?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n https://covid19tracker.health.ny.gov/views/NYS-COVID19-Track...
AnthonyMouse 6y ago
> Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely high, far higher than anyone thought? Presumably in two weeks, when we know whether more of these thousands of people go on to develop symptoms or not. Is anybody following up on stories like this? Do we have any from two weeks ago?
- onlyrealcuzzo 6y ago
  The asymptomatic rate being that high and that many people being infected implies three things. 1) that the asymptomatic rate for this Coronavirus is much higher than other Coronaviruses. 2) but at the same time, it's more deadly than most Coronaviruses. 3) and it's also the R0 is much higher than other Coronaviruses. Isn't it more likely there's a testing issue? This seems a lot like a person that runs a SQL query that overturns all established data at a business, and instead of first assuming that their query is wrong, they instead assume everyone at the business is wrong. I'm not saying the tests are inaccurate. I'm saying when you get highly conflicting data that has critical implications, you shouldn't jump to conclusions. And you should prepare for the worst case, not assume the best.
  - whiddershins 6y ago
    If the asymptomatic rate is higher, then it is less dealt, no?
  - robocat 6y ago
    > the R0 is much higher than other Coronaviruses R0 depends on the population you measure. In a high contact, crowded place, the R0 could be very high. In a population staying at home, the R0 could be very low.
  - marcosdumay 6y ago
    > instead of first assuming that their query is wrong, they instead assume everyone at the business is wrong All those 3 numbers you cite are taken from the same small set of models where the rate of asymptomatic cases is an input. So, no, that's not right.
tyingq 6y ago
There's also the nuance of US state prison care quality. "Without symptoms" could just mean "not obviously gasping for air".
- londons_explore 6y ago
  "Not dead yet"
  - DoreenMichele 6y ago
    "Just their usual whining because that's what prisoners do. These are not the symptoms you are looking for. Move along."
- deleted 6y ago
  [deleted]
- Pfhreak 6y ago
  This is absolutely my reading. That someone is not really observing or listening to prisoner symptoms with much care either because of distrust between the prisoner and the medical technicians or because prisoners receive such poor care.
- code_duck 6y ago
  Sure, in New Mexico there are routinely lawsuits against the state and county’s for completely ignoring inmates’ communicated medical needs (or worse). https://www.santafenewmexican.com/news/local_news/what-happened-to-carmela-devargas-in-santa-fe-county-jail/article_a28399c5-3e98-5e4b-a211-b2f2ccf450e2.html https://www.santafenewmexican.com/news/local_news/what-happe...
- lostlogin 6y ago
  Amnesty International campaign against this and are currently calling for the release of ICE detainees. Judging by a skim of their releases even those obviously gasping for air don’t necessarily get the care they need. It’s a truely massive system which in itself is part of the problem, though the exceptionally low bar for the care of prisoners is Amnesty’s primary angle. https://www.amnesty.org/en/latest/news/2020/04/usa-covid19-pandemic-authorities-must-release-immigration-detainees/ https://www.amnesty.org/en/latest/news/2020/04/usa-covid19-p...
sroussey 6y ago
It’s always high on these antibody tests, low on tests approved by the FDA.
cjlars 6y ago
I'll venture a guess that by Wednesday the news cycle will be deep in the implications of very high asymptomatic case count... Assuming we don't start seeing contradicting evidence.
- vanniv 6y ago
  Nah, that has too much risk of admitting that eternal house arrest isn't a good solution, so we can be certain that won't be the media narrative.
  - code_duck 6y ago
    I’m confused about this version of events that some are supporting. In your view, why does the media have a motive to engage in a secret conspiracy to not present any solutions other than an endless shutdown? How would that benefit ‘The media’?
    - vanniv 6y ago
      I don't really have enough karma to be able to waste responding, but I'll make an exception for you, since you asked more politely than most. First, there's not much secrecy involved. It isn't a secret at all that, Hollywood, the American mainstream media, and the political left are all on the same side. It's been obvious for 30 years now. What we are currently living through is a left-authoritarian consolidation of power. Like other similar consolidations in the 20th century. That is why, within 24 hours of the first house-arrest orders, propaganda about how our old lives of freedom are gone forever because they were "irresponsible", and how we must all get used to "the new normal" began. Dr. Fauci says that physical human contact is a thing of the past ("nobody will ever shake hands ever again"), governors, especially those of "blue states" have all acted to either make their house-arrest orders indefinite (like in CA) or to declare that they will continue for multiple years (as VA announced yesterday, for example). Enforcement is gradually increased everywhere, and citizens are increasingly encouraged to snitch. Political protests are banned. Even organizing them online is being locked down, with states pressuring Facebook and Google into deleting people's accounts if they even mention the existence of a protest. The thing is, it takes time to take a society used to freedom and fully consolidate it. The house arrest orders are the start -- now, when the government eventually let's people out of their houses, but only on conditions (like wearing a tacking wristband, showing your papers to any government official, having to have "a legitimate purpose"), people will be so desperate to leave home that they'll agree. With "contact tracing" apps and "mandatory isolation", the government will be able to declare any person they need to silence as "contaminated", and they go back to imprisonment, with no recourse, no due process, no burden of proof. Even better, having communicated with a "contaminated" person automatically adds you to the list of the unpersoned. The economic disruption has already made 1 in 4 Americans dependent upon government handouts to survive. Every week, another 4-5% join them. An authoritarian government needs it's people to be dependent for survival, in order to ensure cooperation. Meanwhile, the food supply is being turned off. We already have a third of our food production offline, and are most of the way toward driving all independent farmers and ranchers into bankruptcy. We are pretty much guaranteed to have widespread hunger by the fall. This will leave the way for a government takeover of food production. But, in order for the consolidation to work, they have to keep us all imprisoned willingly until they finish consolidating enough power to make it permanent, or we will all just go back to our lives as free people, the economy will recover, and people won't be dependent upon the would-be dictators for their continued survival. The next 3-6 months are critical to breaking the back of the capitalist system and soften everyone up to accept the new freedomless world. It will take that long to drive enough people to poverty, hunger, and desperation for them to be willing to go to the authoritarians and beg to be ruled. This isn't a secret, and it isn't really new. It's more or less how every current left-authoritarian state was formed -- only with more technology and fewer guns.
ouid 6y ago
You have to account for events like the Diamond Princess, if you want to run with that story.
FabHK 6y ago
It’s not like this is the first population that has been nearly exhaustively tested. There was the cruise ship, there was the navy ship, etc. Those have shown between <20% (among the elderly cruise ship demographic) to 60% (among healthy soldiers) asymptomatic. This certainly adds another data point, but I wouldn’t throw conventional wisdom out the window yet.
Terretta 6y ago
Note that until this past week, officially, the symptoms had to be the first three defined by CDC, not the eight or so CDC have expanded now: fever, cough, shortness of breath, chills, repeated shaking, muscle pain, headache, sore throat and new loss of taste or smell, could all appear between two and 14 days after exposure. In the field it appears many/most of the less severe cases don’t exhibit the initial set they had defined, so patients experienced illness written off as not COVID-19. From what I’ve heard from the field, a careful patient history finds there was typically a bout of unusual “but it can’t be COVID” illness with a set of the expanded set of symptoms in almost every “asymptomatic” patient. It’s further speculated these variations may have to do with level of exposure and path of infection, along with the earlier noted lung health and comorbidities.
- FrojoS 6y ago
  Very interesting point. If this is how symptomatic was defined, yours should be the top comment of the thread.
alkonaut 6y ago
> at what point When at least one large studied group has an outcome (symptomatic recovered, asymptomatic recovered, or dead). So for this group I guess a few more weeks.
fzeroracer 6y ago
When we know the full extent of the virus? It's an easy question to ask, but an incredibly hard one to answer. For example, they've been finding that the virus can trigger strokes in otherwise healthy individuals. That's individuals that either exhibit no symptoms or minor symptoms. So while they may otherwise be asymptomatic, we can't know unless we do a full extensive test to see if they're also suffering from unseen clotting issues.

Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely high, far higher than anyone thought?

taeric 6y ago

I also want to add that this doesn't make the virus less deadly. It just gives it a very population varied IFR. It appears far more deadly for some populations. Near harmless for others. But no clear way to confine it to the harmless crowd.

vmception 6y ago
> But no clear way to confine it to the harmless crowd. That won't be what the public policy decisions will be based around if the asymptomatic and already exposed rate is so high. We don't know enough to make that decision yet, but testing more broadly was the first step. Remaining steps: - Do they get sick in two weeks? - Skip testing for current sickness, and test for antibodies instead. - Get a better antibody test that is more accurate - Understand how well antibodies work, and for how long and then we can make decisions, even if they are as simple as "this is a systemwide over the air update, some people will get bricked" it's becoming clear that we might end up with a society where the average BMI is under 24.9 simply due to the lower oxygen and resource requirements to support those body systems.
- taeric 6y ago
  Not sure I follow. I confess I'm biased in thinking we could have locked down nursing homes and shaved a large chunk of deaths. Catch is, we should have done that in January.
  - pbhjpbhj 6y ago
    > locked down nursing homes // How would you do that without locking down the rest of the population? You're going to isolate all nursing home workers?
    - taeric 6y ago
      We could have done dedicated housing for them for cheaper than what we have currently done. So, maybe?
      - pbhjpbhj 6y ago
        I'm in the UK, I can't see this being accepted: it would be pretty hard for every care home to have space found near it to create temporary housing for all the workers. And basically imprisoning workers just because of their current job wouldn't be popular with the population -- if they quit, how do you replace them? Who would sign up? Confining people to their own home, and locking them in their workspace are markedly different. I'm not sure there's a better solution; financial incentives and let the workers decide if they want to do it? Care home workers have their own families and dependents too, but that could make it possible for many of them without having to lock them up against their will.
        taeric 6y ago
        Apologies, my thought was it would not have to have been Draconian. We could have basically done a tight job on funneling access to them. Would have been expensive, but so is everything we have been doing. Which is a large part of my point/question. Would it have been more effective than what we have been doing? This is frustrating with a lot of news coming out that it had been spreading longer and faster than thought. Conceivable that much of the peak in deaths is the highest risk crowd having hit a saturation.
  - vmception 6y ago
    My post is just a blueprint for letting us know what to do at all. Its the plan for making a plan.

SpicyLemonZest 6y ago

Like with the death rate, I expect we'll seamlessly transition from "this isn't proof, in 2 weeks you'll see" to "this isn't news, everyone always believed that so it doesn't imply any changes in strategy".

wegs 6y ago
Well, it isn't proof. It is evidence, though. And in two weeks, we will have a lot more evidence. A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad. It could also be there are bad and not-so-bad strains. Or it could be bad down-the-line. Until we do have proof, I'm advocating being conservative. In 2 weeks, we'll know if people are turning up in ERs or in morgues. In a few months, we'll know about lung damage, immune system damage, strokes, or a lot of the other potential consequences. In a year, we'll know about vaccine and long-term immunity. I think the key problem here is failure to understand risk management. I can believe one think, but act another way just in case I'm wrong. Or I can be unsure. And so on. That nuance is lost in the right/wrong discussions.
- Zach_the_Lizard 6y ago
  > A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad. I think at this point we know enough to say: 1) For most of the population, the virus is not that serious 2) For a subset of the population the virus is seriously deadly. For example, ~20% of NY state coronavirus deaths were from nursing homes, ~37% are 80 or older. By contrast, there were 2 people under the age of 10 at the time of this post. [0] > I think the key problem here is failure to understand risk management I think another key problem is a failure to be frank about the cost-benefit of our actions. I have had to make stronger cases about changing the color of a button or optimizing a backend call than I've seen presented by authorities who are shutting down or reopening or anywhere in between. [0] https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Fatalities?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n https://covid19tracker.health.ny.gov/views/NYS-COVID19-Track...

AnthonyMouse 6y ago

> Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely high, far higher than anyone thought? Presumably in two weeks, when we know whether more of these thousands of people go on to develop symptoms or not. Is anybody following up on stories like this? Do we have any from two weeks ago?

onlyrealcuzzo 6y ago
The asymptomatic rate being that high and that many people being infected implies three things. 1) that the asymptomatic rate for this Coronavirus is much higher than other Coronaviruses. 2) but at the same time, it's more deadly than most Coronaviruses. 3) and it's also the R0 is much higher than other Coronaviruses. Isn't it more likely there's a testing issue? This seems a lot like a person that runs a SQL query that overturns all established data at a business, and instead of first assuming that their query is wrong, they instead assume everyone at the business is wrong. I'm not saying the tests are inaccurate. I'm saying when you get highly conflicting data that has critical implications, you shouldn't jump to conclusions. And you should prepare for the worst case, not assume the best.
- whiddershins 6y ago
  If the asymptomatic rate is higher, then it is less dealt, no?
- robocat 6y ago
  > the R0 is much higher than other Coronaviruses R0 depends on the population you measure. In a high contact, crowded place, the R0 could be very high. In a population staying at home, the R0 could be very low.
- marcosdumay 6y ago
  > instead of first assuming that their query is wrong, they instead assume everyone at the business is wrong All those 3 numbers you cite are taken from the same small set of models where the rate of asymptomatic cases is an input. So, no, that's not right.

tyingq 6y ago

There's also the nuance of US state prison care quality. "Without symptoms" could just mean "not obviously gasping for air".

londons_explore 6y ago
"Not dead yet"
- DoreenMichele 6y ago
  "Just their usual whining because that's what prisoners do. These are not the symptoms you are looking for. Move along."
deleted 6y ago
[deleted]
Pfhreak 6y ago
This is absolutely my reading. That someone is not really observing or listening to prisoner symptoms with much care either because of distrust between the prisoner and the medical technicians or because prisoners receive such poor care.
code_duck 6y ago
Sure, in New Mexico there are routinely lawsuits against the state and county’s for completely ignoring inmates’ communicated medical needs (or worse). https://www.santafenewmexican.com/news/local_news/what-happened-to-carmela-devargas-in-santa-fe-county-jail/article_a28399c5-3e98-5e4b-a211-b2f2ccf450e2.html https://www.santafenewmexican.com/news/local_news/what-happe...
lostlogin 6y ago
Amnesty International campaign against this and are currently calling for the release of ICE detainees. Judging by a skim of their releases even those obviously gasping for air don’t necessarily get the care they need. It’s a truely massive system which in itself is part of the problem, though the exceptionally low bar for the care of prisoners is Amnesty’s primary angle. https://www.amnesty.org/en/latest/news/2020/04/usa-covid19-pandemic-authorities-must-release-immigration-detainees/ https://www.amnesty.org/en/latest/news/2020/04/usa-covid19-p...

sroussey 6y ago

It’s always high on these antibody tests, low on tests approved by the FDA.

cjlars 6y ago

I'll venture a guess that by Wednesday the news cycle will be deep in the implications of very high asymptomatic case count... Assuming we don't start seeing contradicting evidence.

vanniv 6y ago
Nah, that has too much risk of admitting that eternal house arrest isn't a good solution, so we can be certain that won't be the media narrative.
- code_duck 6y ago
  I’m confused about this version of events that some are supporting. In your view, why does the media have a motive to engage in a secret conspiracy to not present any solutions other than an endless shutdown? How would that benefit ‘The media’?
  - vanniv 6y ago
    I don't really have enough karma to be able to waste responding, but I'll make an exception for you, since you asked more politely than most. First, there's not much secrecy involved. It isn't a secret at all that, Hollywood, the American mainstream media, and the political left are all on the same side. It's been obvious for 30 years now. What we are currently living through is a left-authoritarian consolidation of power. Like other similar consolidations in the 20th century. That is why, within 24 hours of the first house-arrest orders, propaganda about how our old lives of freedom are gone forever because they were "irresponsible", and how we must all get used to "the new normal" began. Dr. Fauci says that physical human contact is a thing of the past ("nobody will ever shake hands ever again"), governors, especially those of "blue states" have all acted to either make their house-arrest orders indefinite (like in CA) or to declare that they will continue for multiple years (as VA announced yesterday, for example). Enforcement is gradually increased everywhere, and citizens are increasingly encouraged to snitch. Political protests are banned. Even organizing them online is being locked down, with states pressuring Facebook and Google into deleting people's accounts if they even mention the existence of a protest. The thing is, it takes time to take a society used to freedom and fully consolidate it. The house arrest orders are the start -- now, when the government eventually let's people out of their houses, but only on conditions (like wearing a tacking wristband, showing your papers to any government official, having to have "a legitimate purpose"), people will be so desperate to leave home that they'll agree. With "contact tracing" apps and "mandatory isolation", the government will be able to declare any person they need to silence as "contaminated", and they go back to imprisonment, with no recourse, no due process, no burden of proof. Even better, having communicated with a "contaminated" person automatically adds you to the list of the unpersoned. The economic disruption has already made 1 in 4 Americans dependent upon government handouts to survive. Every week, another 4-5% join them. An authoritarian government needs it's people to be dependent for survival, in order to ensure cooperation. Meanwhile, the food supply is being turned off. We already have a third of our food production offline, and are most of the way toward driving all independent farmers and ranchers into bankruptcy. We are pretty much guaranteed to have widespread hunger by the fall. This will leave the way for a government takeover of food production. But, in order for the consolidation to work, they have to keep us all imprisoned willingly until they finish consolidating enough power to make it permanent, or we will all just go back to our lives as free people, the economy will recover, and people won't be dependent upon the would-be dictators for their continued survival. The next 3-6 months are critical to breaking the back of the capitalist system and soften everyone up to accept the new freedomless world. It will take that long to drive enough people to poverty, hunger, and desperation for them to be willing to go to the authoritarians and beg to be ruled. This isn't a secret, and it isn't really new. It's more or less how every current left-authoritarian state was formed -- only with more technology and fewer guns.

ouid 6y ago

You have to account for events like the Diamond Princess, if you want to run with that story.

FabHK 6y ago

It’s not like this is the first population that has been nearly exhaustively tested. There was the cruise ship, there was the navy ship, etc. Those have shown between <20% (among the elderly cruise ship demographic) to 60% (among healthy soldiers) asymptomatic. This certainly adds another data point, but I wouldn’t throw conventional wisdom out the window yet.

Terretta 6y ago

Note that until this past week, officially, the symptoms had to be the first three defined by CDC, not the eight or so CDC have expanded now: fever, cough, shortness of breath, chills, repeated shaking, muscle pain, headache, sore throat and new loss of taste or smell, could all appear between two and 14 days after exposure. In the field it appears many/most of the less severe cases don’t exhibit the initial set they had defined, so patients experienced illness written off as not COVID-19. From what I’ve heard from the field, a careful patient history finds there was typically a bout of unusual “but it can’t be COVID” illness with a set of the expanded set of symptoms in almost every “asymptomatic” patient. It’s further speculated these variations may have to do with level of exposure and path of infection, along with the earlier noted lung health and comorbidities.

FrojoS 6y ago
Very interesting point. If this is how symptomatic was defined, yours should be the top comment of the thread.

alkonaut 6y ago

> at what point When at least one large studied group has an outcome (symptomatic recovered, asymptomatic recovered, or dead). So for this group I guess a few more weeks.

fzeroracer 6y ago

When we know the full extent of the virus? It's an easy question to ask, but an incredibly hard one to answer. For example, they've been finding that the virus can trigger strokes in otherwise healthy individuals. That's individuals that either exhibit no symptoms or minor symptoms. So while they may otherwise be asymptomatic, we can't know unless we do a full extensive test to see if they're also suffering from unseen clotting issues.