Corona Virus

[paddyor]

Based on the acknowledged level of testing of 5.000 per diem, the vast majority based on GP assessment or of HSE personnel, a detection rate of positives of c. 200 per diem is a very positive sign i.e. 4% positive detections.

If we can get to Wednesday with that sort of % positives, the National Emergency Committee should be well pleased with their efforts and the effect of the public co-operation. On that basis we could experience daily growth of c. 8% per diem in total numbers of Covid 19 - about 3,500 by Wednesday evening. If that trend was borne out, we could be looking at reduction in daily numbers by next Sunday night from a high of about 400 per diem by next Friday.

Our treatment of the patients in ICU facilities appears to be superb. 90 at present with double that capacity available, but deaths still at ten per diem. Hopefully that rate will continue and that infection rates of HSE personnel starts to fall soon.

I’m in the wait and see category, it feels like there’s probably way more out there in terms of positive cases, but we just can’t find them for whatever reason. However the numbers do appear the be stable so here’s hoping with fingers and toes crossed

This crops up time and again on twitter. The belief that there's 1000s and 1000s of undiagnosed cases out there. But if that were true then the CFR would be a lot lower than it is now even allowing for a lag in deaths. There are more cases out there but they're mostly in the testing pipeline.

[Oldschool]

Based on the acknowledged level of testing of 5.000 per diem, the vast majority based on GP assessment or of HSE personnel, a detection rate of positives of c. 200 per diem is a very positive sign i.e. 4% positive detections.

If we can get to Wednesday with that sort of % positives, the National Emergency Committee should be well pleased with their efforts and the effect of the public co-operation. On that basis we could experience daily growth of c. 8% per diem in total numbers of Covid 19 - about 3,500 by Wednesday evening. If that trend was borne out, we could be looking at reduction in daily numbers by next Sunday night from a high of about 400 per diem by next Friday.

Our treatment of the patients in ICU facilities appears to be superb. 90 at present with double that capacity available, but deaths still at ten per diem. Hopefully that rate will continue and that infection rates of HSE personnel starts to fall soon.

I’m in the wait and see category, it feels like there’s probably way more out there in terms of positive cases, but we just can’t find them for whatever reason. However the numbers do appear the be stable so here’s hoping with fingers and toes crossed

This crops up time and again on twitter. The belief that there's 1000s and 1000s of undiagnosed cases out there. But if that were true then the CFR would be a lot lower than it is now even allowing for a lag in deaths. There are more cases out there but they're mostly in the testing pipeline.

There are definitely more cases out there.
Who knows, not the HSE because they haven't the capacity to analyse more than a limited number of tests.
That's actually a good thing imho (the fact that there's more cases I mean)
RP might not even test +ve for example because the sample was taken so late.
My brother has the same symptoms as RP at present and he won't be tested unless his situation deteriorates.
As he describes it, "it's worse than any flu he's ever had".
His breathing hasn't deteriorated much so far.
He's on antibiotics. He's O+ve btw.
His Dr told him to keep a hot water bottle on his chest.
And let's not forget the 50% of the population who won't know they have/had it.
When a cheap quick blood test becomes available we might find out what happened but that's not going to be anytime soon.
Bottom line don't take any chances if you are over 65+.or in the at risk category.
To be sure to be sure.
You'll be doing everyone a favour especially yourself.
Wait and see seems like a very sensible option.

[paddyor]

There are definitely more cases out there.
Who knows, not the HSE because they haven't the capacity to analyse more than a limited number of tests.
That's actually a good thing imho (the fact that there's more cases I mean)
RP might not even test +ve for example because the sample was taken so late.
My brother has the same symptoms as RP at present and he won't be tested unless his situation deteriorates.
As he describes it, "it's worse than any flu he's ever had".
His breathing hasn't deteriorated much so far.
He's on antibiotics. He's O+ve btw.
His Dr told him to keep a hot water bottle on his chest.
And let's not forget the 50% of the population who won't know they have/had it.
When a cheap quick blood test becomes available we might find out what happened but that's not going to be anytime soon.
Bottom line don't take any chances if you are over 65+.or in the at risk category.
To be sure to be sure.
You'll be doing everyone a favour especially yourself.
Wait and see seems like a very sensible option.

There are, but the main growth clusters now appear to be around nursing homes and healthcare staff(20-25% of all cases day to day).

They've upped testing cpacity to 5k tests a day, the problem now is testing kits.

I think the bolded is wishful thinking. If 50% of the population had it the ICU capacity would already be overwhelmed. If 50% had the disease a CFR of

Category 	Case fatality Ratio 	Example(s)                                  Deaths

1 	        Less than 0.1% 	        Seasonal flu and swine flu[10]              2400
2 	        0.1–0.5% 	        Asian flu and Hong Kong flu                 12000
3 	        0.5–1% 	                                                            24000
4 	        1.0–2.0% 	 	                                            48000
5 	        2.0% or higher 	        1918 influenza pandemic

Hope your brothers condition improves.

[Oldschool]

There are definitely more cases out there.
Who knows, not the HSE because they haven't the capacity to analyse more than a limited number of tests.
That's actually a good thing imho (the fact that there's more cases I mean)
RP might not even test +ve for example because the sample was taken so late.
My brother has the same symptoms as RP at present and he won't be tested unless his situation deteriorates.
As he describes it, "it's worse than any flu he's ever had".
His breathing hasn't deteriorated much so far.
He's on antibiotics. He's O+ve btw.
His Dr told him to keep a hot water bottle on his chest.
And let's not forget the 50% of the population who won't know they have/had it.
When a cheap quick blood test becomes available we might find out what happened but that's not going to be anytime soon.
Bottom line don't take any chances if you are over 65+.or in the at risk category.
To be sure to be sure.
You'll be doing everyone a favour especially yourself.
Wait and see seems like a very sensible option.

There are, but the main growth clusters now appear to be around nursing homes and healthcare staff(20-25% of all cases day to day).

They've upped testing cpacity to 5k tests a day, the problem now is testing kits.

I think the bolded is wishful thinking. If 50% of the population had it the ICU capacity would already be overwhelmed. If 50% had the disease a CFR of

Category 	Case fatality Ratio 	Example(s)                                  Deaths

1 	        Less than 0.1% 	        Seasonal flu and swine flu[10]              2400
2 	        0.1–0.5% 	        Asian flu and Hong Kong flu                 12000
3 	        0.5–1% 	                                                            24000
4 	        1.0–2.0% 	 	                                            48000
5 	        2.0% or higher 	        1918 influenza pandemic

Hope your brothers condition improves.

Thanks.
I wasn't suggesting that 50% have it, we just don't know.
I think the strategy so far has been pretty good.
By sealing away the 70+s (approx 15%) the major potential load on ICU has been significantly reduced.
If 80% arr more or less low risk that leaves 5% in no man's land.
That's 250,000 people, that's what the HSE are looking at if things were to get out of control.
The unknown is how many will get sick but not need hospitalisation or how many will need hospitalisation with respiration or ventilation.
Identifying and classifying those 250k could prove to be a very useful and life saving exercise.
The clinicians would know what to look for and maybe someone is looking at this or will be very soon.

[Oldschoolsocks]

Based on the acknowledged level of testing of 5.000 per diem, the vast majority based on GP assessment or of HSE personnel, a detection rate of positives of c. 200 per diem is a very positive sign i.e. 4% positive detections.

If we can get to Wednesday with that sort of % positives, the National Emergency Committee should be well pleased with their efforts and the effect of the public co-operation. On that basis we could experience daily growth of c. 8% per diem in total numbers of Covid 19 - about 3,500 by Wednesday evening. If that trend was borne out, we could be looking at reduction in daily numbers by next Sunday night from a high of about 400 per diem by next Friday.

Our treatment of the patients in ICU facilities appears to be superb. 90 at present with double that capacity available, but deaths still at ten per diem. Hopefully that rate will continue and that infection rates of HSE personnel starts to fall soon.

I’m in the wait and see category, it feels like there’s probably way more out there in terms of positive cases, but we just can’t find them for whatever reason. However the numbers do appear the be stable so here’s hoping with fingers and toes crossed

This crops up time and again on twitter. The belief that there's 1000s and 1000s of undiagnosed cases out there. But if that were true then the CFR would be a lot lower than it is now even allowing for a lag in deaths. There are more cases out there but they're mostly in the testing pipeline.

I’m not a big fan of the twitter machine, but the disparity between the expected numbers and the confirmed numbers is huge. Maybe the original model was way off, or at least the assumptions feeding into it? But until I see an updated model closer to what we’re seeing I’m going to assume there’s at least a couple of thousand cases they haven’t found yet OR that our testing is way off

[Oldschoolsocks]

Ok, this is making more sense https://youtu.be/uVg_TXji2hM Philip Nolan walks through the model from 1:45 in the video

[Oldschool]

This obviously comes with a health warning.
https://m.medicalxpress.com/news/2020-0 ... ckers.html

[Oldschool]

So far so.
Now for the biggee again.
What is the exit strategy.
Is it fair to say that any exit strategy must include herd immunity and therefore how to achieve it.
Pubs allowed to open once a week with an age barrier in place for example?

[paddyor]

I’m not a big fan of the twitter machine, but the disparity between the expected numbers and the confirmed numbers is huge. Maybe the original model was way off, or at least the assumptions feeding into it? But until I see an updated model closer to what we’re seeing I’m going to assume there’s at least a couple of thousand cases they haven’t found yet OR that our testing is way off

https://twitter.com/IrishDataViz
That's a good follow. The expected 15k was if we did nothing or if compliance from the public wasn't good enough

[Ruckedtobits]

The total declared number of cases is a direct function of:
a) How many people we are testing;
b) The criteria by which we select those to test: and
c) How many test positive.

Reference was made today about a "15% incidence of positive cases". The number of positive diagnosis was 295 cases. This therefore indicates that only 2,000 tests were conducted. However, if the tests were only conducted on people suspected of having CV 19, it is a great result and suggests that the incidence is lower than anticipated.

The other important consideration relates to the occupancy of our ICU beds. These are limited facilities but critical to the treatment and recovery of patients. How many of todays 295 new cases need ICU hospitalization? If the answer is more than 5% (18 patients) we may be using up those limited facilities too quickly.

Big questions and the answers will determine just how much impact we will experience over the next month.

[Oldschool]

The total declared number of cases is a direct function of:
a) How many people we are testing;
b) The criteria by which we select those to test: and
c) How many test positive.

Reference was made today about a "15% incidence of positive cases". The number of positive diagnosis was 295 cases. This therefore indicates that only 2,000 tests were conducted. However, if the tests were only conducted on people suspected of having CV 19, it is a great result and suggests that the incidence is lower than anticipated.

The other important consideration relates to the occupancy of our ICU beds. These are limited facilities but critical to the treatment and recovery of patients. How many of todays 295 new cases need ICU hospitalization? If the answer is more than 5% (18 patients) we may be using up those limited facilities too quickly.

Big questions and the answers will determine just how much impact we will experience over the next month.

Re the ICU/Ventilator demand.
This is directly related to the number of clusters, the size of those clusters and in particular the type of cluster(age wise).
The nursing home clusters have the capacity to swamp our ICU/Ventilator capacity given that there are 25,000 people in those nursing homes.
A separate curve, specifically for that group would be something I suspect our CMO/Government and experts are looking at.
It's probably the one group that is an achilles heel for most countries. It's where the risk and density of population are both very high.
Isolation and distancing needs to go to another level for this group and quickly.

[Oldschoolsocks]

I’m not a big fan of the twitter machine, but the disparity between the expected numbers and the confirmed numbers is huge. Maybe the original model was way off, or at least the assumptions feeding into it? But until I see an updated model closer to what we’re seeing I’m going to assume there’s at least a couple of thousand cases they haven’t found yet OR that our testing is way off

https://twitter.com/IrishDataViz
That's a good follow. The expected 15k was if we did nothing or if compliance from the public wasn't good enough

cheers Paddy

[paddyor]

SO they've identified the 48hrs before symptons develop as the danger period for asymptomatic transmission.

325 cases is good.

[Oldschoolsocks]

SO they've identified the 48hrs before symptons develop as the danger period for asymptomatic transmission.

325 cases is good.

Is the death rate not doubling every 2.5 to 3 days though?

https://www.irishtimes.com/news/health/ ... -dashboard

I just don’t know what to think at the moment.

[Ruckedtobits]

SO they've identified the 48hrs before symptons develop as the danger period for asymptomatic transmission.

325 cases is good.

Those numbers are almost exactly as expected. Just to briefly describe how the projection arrived at the number. Initially reviwed our experience in the seven days to Saturday night. Then looked carefully at our numbers: a) tests per 100k of population; b) % positives relative to total population; c) % deaths relative to number of positive cases. Then reviwed these numbers against the comparable percentages across all other countries (ex Italy which I consider an outlier because of population age). I then reviewed the projected shape of our graph to identify the average of the three most similar around the world - shown as the daily % growth in total cases. Thus far, it appears that the pace of growth in population infection i.e. overall % of the population, appears to have a certain commonality.

Not so the daily death rate in various countries which appears to have different factors at play, possibly including: average population age, living accomodation, hospital cross-infection, blood type(?), climatic, treatment given to infected patients, date by which hospital care is initiated etc. In this regard the outcome in countries such as India and Malaysia is of real concern. For almost the opposite reasons of life style, the projected death rates in London and New Year still ring warning bells.

Italy and Spain are still suffering badly, despite the sophistication of their health services. Perhaps both populations didn't treat the virus seriously enough at the outset and they are experiencing the consequences. Hopefully they have put the worst behind them, although it may be months before we can truly be certain.

[johng]

Cheers for that Patrick. Is there a live version that updates?

[Peg Leg]

https://www.hpsc.ie/a-z/respiratory/cor ... inireland/

This message is not for Johng:
If using this link on a mobile, page settings> desktop site

[paddyor]

Cheers for that Patrick. Is there a live version that updates?

No, https://twitter.com/IrishDataViz does daily charts though.

This one was updated daily from the 15k projection.


https://twitter.com/osullica

[paddyor]

https://www.hpsc.ie/a-z/respiratory/cor ... inireland/

This message is not for Johng:
If using this link on a mobile, page settings> desktop site

This one is better

https://geohive.maps.arcgis.com/apps/op ... 706c223520

[paddyor]

SO they've identified the 48hrs before symptons develop as the danger period for asymptomatic transmission.

325 cases is good.

Is the death rate not doubling every 2.5 to 3 days though?

https://www.irishtimes.com/news/health/ ... -dashboard

I just don’t know what to think at the moment.

It might be and it probably should given there's a 2-3 week lag for healthy patients to die. The big problem at the moment is the nursing home clusters. THe median age is 80+ of the deaths. Was taling to a solicitor yesterday. An old legal eagle friend of his from Tipp got in a nursing home last week. Decided he'd had a good life, said his goodbyes and rejected a ventilator because it'd be of use to someone else. That's stoicism and pretty selfless. Solicitor had several clients making similar DNR and final words arrangements.