Covid 19 virus

[PlainName]

In general it's not a case of knowing better (or not). If one's intuition suggests one thing and expert advice suggests another, shouldn't one try to find out why there is that difference? Many of the responses in here start out like that but get taken as know-nothings thinking they know better, or know-betters scoring a hit, and it degenerates from there into implacably entrenched views.

[paulca]

In the UK the government launched a helpline were people could volunteer to help the NHS take care of the vulnerable in the community.

In a single night, 250,000 people signed up overshooting the target considerably.

This is the spirit we like to see.

Additionally supermarkets are allowing NHS staff in early and greeting them with applause and flowers.

[engrguy42]

In the UK the government launched a helpline were people could volunteer to help the NHS take care of the vulnerable in the community.

In a single night, 250,000 people signed up overshooting the target considerably.

This is the spirit we like to see.

Additionally supermarkets are allowing NHS staff in early and greeting them with applause and flowers.

Really?? That's wonderful.

I dunno, I've grown up with a huge respect for the people in the UK. Y'know, "stiff upper lip" and all. They always seemed to be the "adults in the room" while the rest of the world is flailing around. Not sure how it's been in recent years, but it's good to see that they're yet again a role model. 

[BravoV]

 

[paulca]

In the UK the government launched a helpline were people could volunteer to help the NHS take care of the vulnerable in the community.

In a single night, 250,000 people signed up overshooting the target considerably.

This is the spirit we like to see.

Additionally supermarkets are allowing NHS staff in early and greeting them with applause and flowers.

Really?? That's wonderful.

It is.
https://www.bbc.co.uk/news/uk-52029877


However we have our share of assholes too.

Coronavirus: Doctor 'kicked out' by Headington landlady

https://www.bbc.co.uk/news/uk-england-oxfordshire-52032909

This (and other things) makes me suggest creating a "When this is over" register.  People like this land lady will be listed on it.  When this is all over with these people can be rounded up and hung by their arms in the street for people to ridicule and humiliate them.

[Mr. Scram]

This is called "appeal to authority", and is utterly stupid here, because everyone here has looked at what WHO and other expert groups have to say. The fact that some others have reached a different conclusion than you, in a really complex matter, does not mean that you are now officially representing WHO and have understood everything they say 100% correctly. You can agree to disagree, but laughing at others like you are some magical God of the True Information sent by WHO not only makes you look stupid, it's detrimental to the quality of discussion. Maybe just drop it? No need to run in circles for pages after pages.

Posts here show that people very blatantly haven't looked at or understand what the WHO is saying or why. Pointing at what they say in conjunction with other evidence and sources isn't an appeal to authority, it's corroborating the story. If you're going to make claims which differ from the leading institution you not only better make bloody sure you know what you're talking about, but also prove it beyond doubt. You do understand that risky behaviour gets people killed in a very literal sense? Good intentions kill people all the same. Dropping it because people can't accept their gut feeling doesn't jive with the best evidence we have isn't an option. This isn't an inclusivity club.

[engrguy42]

paulca, I like your idea of a "when this is over" register. Probably want to include all the self proclaimed experts who sit on their butts commenting on stuff they know nothing about, solely to boost their own egos, rather than getting off their arses and taking a lesson from the UK. I'm hoping the US follows suit. Then people like me can get off their arses and do something useful.

Thanks for the breath of fresh air. 

[Siwastaja]

Pieces of status from Finland:

The government "seems" to take this corona thing quite seriously, but acting still slowly.

Media has focused on the fact that Sweden seems to lag behind on the actions even worse than Finland. While this seems to be true, the race to see who's the worst and who's the second worst isn't what we should be doing right now. Both Finland and Sweden are repeating the footsteps of Italy. Let's back this up by looking at three example countries which have approximately the same number of infections per capita,

Finland 154 cases / 1M people:
schools still partially open (all 1st to 3rd graders); restaurants, bars, etc. still allowed to fully operate; police still stands behind their statement that they have no means (by law) or will to enforce the limitations of people gathering. So we are basically still relying on "suggestions", and people doing "the right things" on their own. Which, of course, works to some extent.

USA 166 cases / 1M people
or, Germany 406 cases / 1M people (known to test more easily, hence showing higher number of verified infections, compared to Finland for example):
large scale curfews, travel restrictions, schools actually closed wherever necessary, restaurants, bars completely closed or heavily limited (for example, by how many customers can go in at once).

The response in Finland is clearly lacking behind compared to our peers. Though, it seems, we are quite content with the fact Sweden is lacking even more. (Just to make sure no one misunderstands, I don't share this joy.)

Now, the government has decided to close the restaurant and bars, actually they have already talked about it for over a week. On Monday came the preliminary information that the restaurants would be finally closed on Tuesday (yesterday). Yesterday, we were informed that "if everything goes perfectly well", the restaurants "may be closed as soon as Saturday", and all this delay is because of doing everything "by the book", including the multi-step legal process (which can be only accelerated to certain extent). Note, there is 100% agreement about having to implement these limitations, shared by the government, and the opposition. Opposition is supporting the government and demanding them to work faster.

Last weekend, Finland brought 2500 Finnish tourists home from Spain. To the surprise of everyone, no quarantine, no medical control. People were given a piece of paper with a suggestion of staying home "if possible". Instead, the reporters witnessed these high-risk people from the worst hit areas get into crowded buses, and head to restaurants to have some coffee. This is seen as alarming because many of these people live outside the most hit Helsinki Uusimaa region; outside this region, the number of cases are still fairly low.

The government is actually "planning" on isolating the Helsinki Uusimaa region, so for the first time, activating some real travel restrictions inside Finland. Sadly, it seems this is coming a bit too late, as well; the numbers outside the Helsinki region are rising already (and there is the 2-week delay between infection, and detection). Bringing in the tourists from Spain just before the isolation of the Helsinki area naturally does not help. Legal experts have (correctly, AFAIK) stated that the current state of emergency law does allow the government to isolate the Helsinki area any minute with no legal issues. Yet, planning to do exactly this has continued for almost a week now. It may happen today or tomorrow, we are hopeful.

We are clearly acting very poorly here, but it must be noted we are likely not the very worst offenders. Indeed, it seems Sweden is doing even worse. This argument is used to suppress critique; people are still quite happy how the government is doing. Many actually think that the actions are stronger than elsewhere, and "too" strong. We do see news from Italy and Spain, but not very much; I guess people still won't understand how serious this disease actually is, and how strong the actions in most other countries actually are.

[nctnico]

In general it's not a case of knowing better (or not). If one's intuition suggests one thing and expert advice suggests another, shouldn't one try to find out why there is that difference?

This is exactly what the WHO does! They look at the research and information from all the experts from different countries and base the information they supply on that. As usual truth is what the majority thinks is right but I rather follow advice resulting from balancing many different opinions than that of a limited group of people (government advisors included).

[Mr. Scram]

paulca, I like your idea of a "when this is over" register. Probably want to include all the self proclaimed experts who sit on their butts commenting on stuff they know nothing about, solely to boost their own egos, rather than getting off their arses and taking a lesson from the UK. I'm hoping the US follows suit. Then people like me can get off their arses and do something useful.

Thanks for the breath of fresh air.

Careful now, you don't want to keep tripping over those passive aggressive assumptions.

[drussell]

SK South Korea death vs amount of cases is increasing and currently 1.379% (126/9137*100)

Of course that number is going up.  You're conveniently just totally ignoring the 5281 cases that don't have a known outcome yet.  (Well, you're not ignoring them, per se, you're actually just lumping them all in with the known recovered to calculate a meaningless percentage.)

Of the first 3856 cases in South Korea where there is an outcome, 126/3856 = 3.27%

You cannot just assume that the other active 5281 cases all miraculously recover with no more deaths.  While an epidemic is ongoing, calculating a crude CFR that way is disingenuous at best, dangerous at worst if it makes people complacent.  There is a multi-week delay between the detection of most cases and an outcome.  During exponential growth in spread it takes time for the outcome numbers to track the new cases.  You must look at the trends for forecasting, not the absolute numbers, and when calculating numbers you need to look at what set of patients actually represents your known outcomes.

If you look at the US' number right now and calculate a crude CFR, it would be 802/55243 = 1.45%
Some media has been continuing to report this kind of number, saying things like look, it's only 10x worse than the flu....  But it appears to actually be potentially closer to another order of magnitude higher.

It is still far too early in the US' outbreak to make any conclusions as to what the actual CFR there will be in any particular region.  With only 354 declared "recovered" so far nationwide, the naive calculation based on actual outcomes is currently just as meaningless, (other than to watch trends, of course.)  We know it will not end up being the current 69.4% once more cases have known outcomes.

[Stray Electron]

An infected person tugging at a virus soaked mask sounds like a great idea.

  An infected person out in public without a mask and sneezing on everyone sounds like a worse thing to me.

  The WHO acts like no one outside of the medical system has ever used a mask before and is clueless. There are tens of millions of people in this country alone that have been taught how to use masks in the fire departments, police departments, military, industrial welders and many other occupations.

    In every previous medical situation, the medical professionals have recommended using masks but now that the hospitals are short, suddenly they're telling everyone else NOT to use one and that suddenly they're ineffective.  Seriously?  Or are you just trying to keep all of the masks for yourself and your medical colleagues?

   I'll be happy for the rest of you not to wear a mask since it will leave more for me but given the choice I will wear one.

   A personal note, when the last polio epidemic went around in about 1960, my mother was was of the few trained nurses in our area and I well remember her going around to houses that had been quarantined to check on the people and to take them food and medicine and she always wore a mask.  No one debated the effectiveness of the masks,  you just wore one, no questions asked.

[drussell]

The case fatality rate (CFR) represents the proportion of cases who eventually die from a disease.
Once an epidemic has ended, it can simply be calculated with the formula: deaths / cases.

While an epidemic is still ongoing, as it is the case with the current novel coronavirus outbreak, this formula is, at the very least, "naïve" and can be "misleading if, at the time of analysis, the outcome is unknown for a non negligible proportion of patients."

In other words, current deaths belong to a total case figure of the past, not to the current case figure in which the outcome (recovery or death) of a proportion (the most recent cases) hasn't yet been determined.

The correct formula, therefore, would appear to be:

CFR = deaths at day.x / cases at day.x-{T}
(where T = average time period from case confirmation to death)

This would constitute a fair attempt to use values for cases and deaths belonging to the same group of patients.

One issue can be that of determining whether there is enough data to estimate T with any precision, but it is certainly not T = 0 (what is implicitly used when applying the formula current deaths / current cases to determine CFR during an ongoing outbreak).

...or, you can use the known outcomes like I did for rough current calculations, knowing that accuracy will improve as more outcomes are known, etc. by just using the CFR = deaths / (deaths + recovered)

In any case, simply using deaths / total cases is essentially currently meaningless given the high rate of daily new infections and the lengthy time period before there is a known outcome.

[Mr. Scram]

  An infected person out in public without a mask and sneezing on everyone sounds like a worse thing to me.

  The WHO acts like no one outside of the medical system has ever used a mask before and is clueless. There are tens of millions of people in this country alone that have been taught how to use masks in the fire departments, police departments, military, industrial welders and many other occupations.

    In every previous medical situation, the medical professionals have recommended using masks but now that the hospitals are short, suddenly they're telling everyone else NOT to use one and that suddenly they're ineffective.  Seriously?  Or are you just trying to keep all of the masks for yourself and your medical colleagues?

   I'll be happy for the rest of you not to wear a mask since it will leave more for me but given the choice I will wear one.

   A personal note, when the last polio epidemic went around in about 1960, my mother was was of the few trained nurses in our area and I well remember her going around to houses that had been quarantined to check on the people and to take them food and medicine and she always wore a mask.  No one debated the effectiveness of the masks,  you just wore one, no questions asked.

At this point we're really going in circles. I'll refer to the previous n pages for the how and why on masks. Though it surprises me how intent people are on this "you're just keeping the masks for yourself" conspiracy. Resource management is important in the sense that masks shouldn't be wasted on ineffectual deployment, but the suggestion they're just out to hoard them for doctors is another thing. Let's please not use 1960s healthcare as any kind of example for our current situation. We don't have all the answers now so they definitely didn't have them back then.

[edavid]

In general it's not a case of knowing better (or not). If one's intuition suggests one thing and expert advice suggests another, shouldn't one try to find out why there is that difference?

This is exactly what the WHO does! They look at the research and information from all the experts from different countries and base the information they supply on that. As usual truth is what the majority thinks is right but I rather follow advice resulting from balancing many different opinions than that of a limited group of people (government advisors included).

But doesn't e.g. South Korea have its own WHO equivalent?  Why did they come to the opposite conclusion from WHO regarding masks?

Also, you could argue that the Chinese health authorities know more about the problem than anyone, and they seem to be very pro-mask.   Again, why?

WHO has failed to establish a consensus or to make a solid case for their anti-mask statements.

[Bud]

paulca, I like your idea of a "when this is over" register. Probably want to include all the self proclaimed experts who sit on their butts commenting on stuff they know nothing about, solely to boost their own egos, rather than getting off their arses and taking a lesson from the UK. I'm hoping the US follows suit. Then people like me can get off their arses and do something useful.

Taking a lesson from the UK?

They did not do a thing until French president Macron got furious and threatened to shut down the border with them.

[not1xor1]

So when you advice "wear a face mask" they tend to think they will get a big box with face masks delivered to their doorstep, with an "user manual" inside, and they will wear a mask and their life will continue exactly as it was before..

well they might order this mask from amazon
and then feel very safe

[nctnico]

In general it's not a case of knowing better (or not). If one's intuition suggests one thing and expert advice suggests another, shouldn't one try to find out why there is that difference?

This is exactly what the WHO does! They look at the research and information from all the experts from different countries and base the information they supply on that. As usual truth is what the majority thinks is right but I rather follow advice resulting from balancing many different opinions than that of a limited group of people (government advisors included).

But doesn't e.g. South Korea have its own WHO equivalent?  Why did they come to the opposite conclusion from WHO regarding masks?
Also, you could argue that the Chinese health authorities know more about the problem than anyone, and they seem to be very pro-mask.   Again, why?

You'd have to ask the WHO. There probably is a report somewhere on their website which explains the basis for their recommendations.

WHO has failed to establish a consensus or to make a solid case for their anti-mask statements.

That is your opinion.

[thinkfat]

People here playing with numbers tell you you're 50% likely to be in the same space as an infected person while shopping food. Without getting hung up on the assumptions going into these calculation and their merits, let's just assume it being very likely. You'll casually meet this person with a certain probability. You'll become infected with a certain probability. Now imagine everyone wears a scarf in front of their mouth. Does this reduce the risk of getting infected or not?

In the end, your whole train of argument boils down to just one: People shouldn't wear masks because they will feel protected and exhibit risky behavior. But they do that anyway and wearing protection isn't going to make it worse. The instructions and procedures for wearing face masks are designed for highly infectious and hazardous environments. Your local Costco is no such environment. The London Underground - not so sure. Best avoid entirely, with a mask or not.

The whole idea behind all recommendations to not wear masks is anyway not increased risk of infection to the wearer, but because they are needed elsewhere and creating additional competition for the resource is a really bad idea right now. If the resource was plentiful, nobody would be making such recommendation. Rather, the opposite.

Again: a mask on Joe Averages' face will not protect him. But it will protect others from Joe spreading the virus without knowing. But so does a scarf. Should you therefore wear a mask that would better suit a medical professional - NO. Should you wear a scarf - Yes, by all means.

No, not by all means. We've been over this a couple of times now and the answers remain the same. You're forgetting the part where untrained people touch all kinds of things they shouldn't touch and may very well make things worse. Dispensing advice which differs from the WHO guidelines is a huge risk even for a well respected medical professional. Even when it's well intended laymen should probably refrain from doing so.

I've looked into the two links you posted earlier in the thread. One is a study about food workers likelihood to performing proper hand hygiene in activities with and without gloves. The other ones is an expert opinion on the mertis of using gloves and face masks in a pandemic situation.

From the study:

These results suggest that workers who wear gloves do not remove them and wash their hands as they should. Although some researchers and practitioners have contended that glove use can promote poor hand washing practices [...],little data exists on this issue. More research is needed to understand the relationship between glove use and handwashing.

And:

Appropriate hand washing and glove use were also related to worker busyness — these hand hygiene behaviors were less likely to occur when workers were busy (i.e., engaged in relatively larger numbers of activities needing handwashing)

The study does _not_ show conclusively a dependency between hand hygiene and glove use. Just as likely, time pressure may be the driver here, as removing the gloves before washing and putting them on again afterwards are time consuming activities. The generalization from here to "protective gear promotes careless behavior" is not obvious to me.

As far as expert opinions go:
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30134-X/fulltext

It is time for governments and public health agencies to make rational recommendations on appropriate face mask use to complement their recommendations on other preventive measures, such as hand hygiene. WHO currently recommends that people should wear face masks if they have respiratory symptoms or if they are caring for somebody with symptoms. Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission. In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available. Universal use of face masks could be considered if supplies permit. In parallel, urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged. Taiwan had the foresight to create a large stockpile of face masks; other countries or regions might now consider this as part of future pandemic plans.

[Mr. Scram]

The major problem I see is the many nations/cultures tend to look after an easy solutions to this pandemic problem.

So when you advice "wear a face mask" they tend to think they will get a big box with face masks delivered to their doorstep, with an "user manual" inside, and they will wear a mask and their life will continue exactly as it was before..

But wearing a mask is only one thing off MANY others you shall to do.

There are measures at State level (a long list) and then a list what general public should do (a shorter list).

Wearing a face mask is NOT a substitution for "stay at home, do social distancing, wash your hands, ..". You shall DO ALL..

Thus the thought like "wearing a face mask could give you a false feeling of safety" indicates an absolute misunderstanding of the overall process. And the authorities in some countries shall be really careful with what they are telling to their citizens in that matter.

The notion that wearing PPE leads to more risky behaviour isn't a misunderstanding. It's been shown to happen in trained health care and food industry professionals. Thinking it's speculation is the misunderstanding here. It's baffling people are still confused.

[nctnico]

   A personal note, when the last polio epidemic went around in about 1960, my mother was was of the few trained nurses in our area and I well remember her going around to houses that had been quarantined to check on the people and to take them food and medicine and she always wore a mask.  No one debated the effectiveness of the masks,  you just wore one, no questions asked.

You are stepping over a very important detail here. Your mother likely put a new mask on before entering each home and took it off after leaving the home and disposed the mask properly. It would surprise me if she was wearing the same mask the whole day long!

BTW the WHO is recomending to wear a face mask while in the vincinity of an infected person.

[not1xor1]

SK South Korea death vs amount of cases is increasing and currently 1.379% (126/9137*100)

Of course that number is going up.  You're conveniently just totally ignoring the 5281 cases that don't have a known outcome yet.  (Well, you're not ignoring them, per se, you're actually just lumping them all in with the known recovered to calculate a meaningless percentage.)

Of the first 3856 cases in South Korea where there is an outcome, 126/3856 = 3.27%

You cannot just assume that the other active 5281 cases all miraculously recover with no more deaths.  While an epidemic is ongoing, calculating a crude CFR that way is disingenuous at best, dangerous at worst if it makes people complacent.  There is a multi-week delay between the detection of most cases and an outcome.  During exponential growth in spread it takes time for the outcome numbers to track the new cases.  You must look at the trends for forecasting, not the absolute numbers, and when calculating numbers you need to look at what set of patients actually represents your known outcomes.

If you look at the US' number right now and calculate a crude CFR, it would be 802/55243 = 1.45%
Some media has been continuing to report this kind of number, saying things like look, it's only 10x worse than the flu....  But it appears to actually be potentially closer to another order of magnitude higher.

It is still far too early in the US' outbreak to make any conclusions as to what the actual CFR there will be in any particular region.  With only 354 declared "recovered" so far nationwide, the naive calculation based on actual outcomes is currently just as meaningless, (other than to watch trends, of course.)  We know it will not end up being the current 69.4% once more cases have known outcomes.

I agree with you, but please notice that your remarks do not disprove what I never intend to prove or mean 
Please read more carefully my message in the context of the message I was replying to

[SiliconWizard]

As far as expert opinions go:
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30134-X/fulltext

It is time for governments and public health agencies to make rational recommendations on appropriate face mask use to complement their recommendations on other preventive measures, such as hand hygiene. WHO currently recommends that people should wear face masks if they have respiratory symptoms or if they are caring for somebody with symptoms. Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission. In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available. Universal use of face masks could be considered if supplies permit. In parallel, urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged. Taiwan had the foresight to create a large stockpile of face masks; other countries or regions might now consider this as part of future pandemic plans.

Which is almost exactly what I said earlier. And as I'll repeat (from my previous post), I completely understand the resource management issue, so I understand why the WHO statements would be what they are, and why they are much more political (not in a bad sense) than that of medical doctors.

[PlainName]

An infected person tugging at a virus soaked mask sounds like a great idea.

Just a thought - if the mask is virus-soaked then aren't those virii not in the person? Without the mask, they would have been breathed in, wouldn't they?

[Mr. Scram]

I've looked into the two links you posted earlier in the thread. One is a study about food workers likelihood to performing proper hand hygiene in activities with and without gloves. The other ones is an expert opinion on the mertis of using gloves and face masks in a pandemic situation.

From the study:

These results suggest that workers who wear gloves do not remove them and wash their hands as they should. Although some researchers and practitioners have contended that glove use can promote poor hand washing practices [...],little data exists on this issue. More research is needed to understand the relationship between glove use and handwashing.

And:

Appropriate hand washing and glove use were also related to worker busyness — these hand hygiene behaviors were less likely to occur when workers were busy (i.e., engaged in relatively larger numbers of activities needing handwashing)

The study does _not_ show conclusively a dependency between hand hygiene and glove use. Just as likely, time pressure may be the driver here, as removing the gloves before washing and putting them on again afterwards are time consuming activities. The generalization from here to "protective gear promotes careless behavior" is not obvious to me.

As far as expert opinions go:
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30134-X/fulltext

It is time for governments and public health agencies to make rational recommendations on appropriate face mask use to complement their recommendations on other preventive measures, such as hand hygiene. WHO currently recommends that people should wear face masks if they have respiratory symptoms or if they are caring for somebody with symptoms. Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission. In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available. Universal use of face masks could be considered if supplies permit. In parallel, urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged. Taiwan had the foresight to create a large stockpile of face masks; other countries or regions might now consider this as part of future pandemic plans.

It's important to understand it's not a black and white matter. Discussions on the internet tend to end up heavily polarized but that's not how real life works. This means that the advice given can change as the situation develops and new information become available. This also means that most measures do some harm and some good and the trick is to pick the ones which do least harm and most good.

In regards to the conclusiveness of the links provided I'd invite you to look into the matter yourself. If possible, talk to surgeons or other staff working in areas where a lack of hygiene flat out kills people. PPE use and the negative impact it has on behaviour is a recognized issue in the medical world. A lot of attention is paid to when there is a positive or negative net gain and this is what the WHO does too. There are very likely some gains to be had, but there are various interactions which mean the result is far from what seems intuitive to many people in this thread. The WHO isn't just glossing over all the arguments made here. Most trained medics will be well aware of them and it's a matter of carefully weighing all the available information and converting that very nuanced position into a clear and simple to understand message. Judging by the assumptions and confusion we see in this comparatively well educated thread that may very well be the right approach.