There are some indications that the authors of the Santa Clara study got the math wrong. They advertised for participants on Facebook. Although they attempted to target the ad to different groups of people, they ended up with too many white women and too few Asians, Hispanics and men. They therefore weighted each white woman less, and each other participant more, to reflect the actual demographics of Santa Clara County. (There is nothing wrong with doing this; it’s standard.)
However, there’s some reason to believe that the test produces false positives. There’s reason to believe that the number of false positives could be as high as 1.5%. Before re-weighting the sample, there were about 1.5% positive results. In other words, they could have all been false positives!
They should have done the false positive correction before re-weighting.
"estimated prevalence of SARS-CoV-2 antibodies is about 2.49-4.16% "
Let’s do some math, using a 3% prevalence, which is in the middle of the estimate.
Assumed # of infections in Santa Clara County: 3% * 2 million people = 80,000
Santa Clara County deaths: 73
Calculated infection fatality rate: 0.09%
Deaths in New York City: 8900
NYC residents infected, using calculated infection fatality rate: 9.9 million
Population of New York City: 8.8 million
So, unless we believe that 112% of New Yorkers have been infected with COVID-19 and not one single more New Yorker will die (I wish), there is something wrong with the Santa Clara County calculations.
Going back to vaccines COVID vs. flu – I read long piece last week that influenzas are known to frequently change and hence the yearly ‘stab’ by vaccine makers when formulating a particular year’s vaccine.
Coronaviruses have been less ‘slippery’ (the doctor’s word) so there is assumption a vaccine will be more effective compared to flu vaccine.
Because in general it’s the same virus and there’s no reason to expect health care in NYC is any less in top notch capability than that of SCC.
There may be different strains of the virus (mutations) making some more deadly than others, but it’s the fatality rate of the virus overall that folks are trying to key in on.
Right now the death rate per capita in New York State is 873 per million residents (whether the person is known to be sick or not). Doing the math (1,000,000/873) we get one death in every 1,145 people. That’s pretty darn close to 0.1% among all people - not just sick folks - and it will only grow in the near future. Since we know it’s skewed toward older and away from youth there’s a lot of death among adults going on in the state.
Either NYS has a particularly dangerous strain or the death rates that were circulating earlier (based upon age) seem to be pretty spot on because this is assuming all people in NYS - not just those testing positive or suspected of having the disease - and we know (via testing) that not everyone in NY has it.
Personally, NY’s numbers are sobering - the worst reported in the world outside of San Marino (per capita) and that is essentially a city with < 1 million in population so is more skewed in data.
NY has a problem that they shut down late (esp schools - 20+ school teachers have been among the deaths) and NYC is crowded so the virus has spread a lot compared to other places. What I think we should learn is that the virus really is deadly for a large segment of the population. It’s far more deadly than the flu and it isn’t just older people dying. For some it seems to be luck of the draw.
My first telemedicine appointment left much to be desired.
It was scheduled for 11:20. They called at 11:00 to collect my credit card information for my co-pay, which they had told me they would do. At noon, I received another call saying they were “behind,” and that there were three people were ahead of me. Would I like to reschedule my time for later that afternoon - how was that going to help?? With nothing going on, I declined. She said it could take up to 30 more minutes before I got my log in info text. Said behind because people struggled setting up their mics and cameras. At 1:10 (so an hour and ten minutes later), I received the text to connect. Mic/camera set up took two seconds.
Spoke with a nurse for a couple of minutes. Then had about a 3 minutes wait before the PA?NP? - no idea - talked to me. Follow up is never with the doc. Went over my results. Took very little time - maybe 5 minutes.
My point is - there were no delays collecting my payment, but it was nearly two hours past my scheduled appointment before I “saw” someone - much longer than I would have had to wait in an actual waiting room. If the challenge for some people is the technology involved with the cameras and mics, just do a follow up with a phone call. There was NO reason why I had to lay eyes on someone to get the information. But, I’m sure they MUST do it that way or they cannot bill insurance.
Ill be interested to see what my PCP does the first week of May. I have an appointment that really doesn’t need to be done in person. I sent my bloodwork results to them. Wondering if they will just cancel?
It is my understanding that hospitals are reimbursed by the feds for the uninsured if they have COVID. Or suspected COVID. Or someone in the chain of command decides it was most likely COVID.
Just a thought…wouldn’t that be an incentive to mark a death in such a way as to be covered for the costs?
The physician indicates the cause of death. Surely you do not think physicians would commit fraud and violate their integrity and license in order to boost hospital reimbursement?
No idea if it would be an incentive, but I know this is one family that would be happy if it’s true considering my lad went in for a supposedly free test, didn’t get it because his symptoms weren’t enough to qualify, likely has it (but not certain) according to them as per a chest x-ray & symptoms, and we’ll be responsible for the bill if there is one because he dropped his insurance when he changed jobs last Nov (doing the usual, “we’re young and healthy and can’t afford it” reasoning).
There’s a big difference in cost between free test and ER chest xrays + whatever else they did.
My telehealth session with BCBS went surprisingly smoothly. It was 15 minutes between scheduling the appointment and my call with an MD. She actually initiated the appointment 5 minutes before the scheduled time. What I didn’t think was great was the follow up summary. Basically said nothing but she herself was helpful and I didn’t feel rushed.
My father was a very wise man. He told us to always have health insurance…because you are healthy until you are not. Very true.
There are a number of drive up test sites opening in our state now…seems like several a day this week. Still, you have to pass a screening to be eligible for the free tests. Supplies are still limited.
Scientists have looked at mutations in the SARS-CoV-2 genome, and, as expected with coronaviruses, they have not seen any that would make the virus more virulent (increased ability to infect and damage the host). General consensus is that coronaviruses are relatively stable, and any changes make the virus weaker, not stronger.
Scientists in Singapore published a paper in March documenting a 382-nt deletion in the viral genome in 8 patients. The virus’s ORF8 transcription- regulatory sequence was deleted. This deletion was also seen in SARS-1, and it is “associated with reduced replicative fitness of the virus”. The authors of the paper hypothesize that the deletion may have contributed to SARS-1 fading out of the human population. This sounds like good news, but then again, the eight patients with the deletion were still hospitalized, and the paper does not include clinical outcomes. Link to paper (has not been peer reviewed): https://www.biorxiv.org/content/10.1101/2020.03.11.987222v1.full
Another interesting point in the paper is that the authors estimate from their research that SARS-CoV-2 jumped to humans in mid-November 2019. It seems like it takes about a month of circulation in communities before someone gets sick enough for it to stand out as unusual. (Perhaps longer if the sick person is elderly with pre-existing conditions, so it is reasonable for doctors to think they have influenza or some non-Covid pneumonia.)
We’re doing a reductio ad absurdum here; we’re just doing back of the envelope calculations. Why strain at the gnat of assuming infection fatality rates are the same in Santa Clara County and New York City, and swallow the camel of assuming not one single person more will from COVID-19 in New York City?
Let’s do another back-of-the-envelope calculation, which will again be a reductio ad absurdum. We’ll make conservative assumptions. We’re trying to evaluate the plausibility of the calculated Santa Clara County infection fatality rate of about 0.1% (0.09% is the number I used before, but the round up to 0.1% is also in their interval.) Assume that, because of the crush of cases, New York doctors cannot offer optimal care to every patient, and the NYC true infection fatality rates are 30% higher: 0.13%. Assume that of the people who will die from COVID-19 in New York City, three quarters have already died, something I’m sorry to say I believe is a gross underestimate.
We still end up with more people being infected in New York City than there are people in New York City. This cannot be correct. It also cannot be correct that almost everyone in New York City is infected right now. We know this because the city is testing people in New York City every day, with a big bias toward testing very sick people showing up at hospital emergency rooms, and still getting a lot of negative test results.
But even if this strain is less likely to replicate and more likely to die out, the other strains are still around and replicating and transmitting, so I don’t see why this would be thought of as good news.
And this is what we told our lad too back in Feb when we visited. When one is young and healthy, sometimes they have to learn via experience I suppose. Actually, that happens with older folks too. I can think of many examples. It’s not super easy for many to learn from the experiences of others.
We have test sites in our area where one only needs symptoms (which my lad had) to get tested. Going off our area is why I suggested he get tested if he felt worse. I had no idea they would take him into the ER instead to run the tests. If I knew that I’m not sure what my advice would have been. Knowing what I know now and the potential costs I’d have had him investigate if there were a private company offering tests for a fee as that fee is bound to be less than the ER if he has to pay for it.
Anyway, different areas are different. NC has low numbers. Now I know why. Their numbers are definitely higher than reported because there are some cases reported even in his very small city (those will be high risk people or maybe private tests). It’s not at all a stretch to assume he got it from one of the two places he went (grocery shopping and volunteering to help his church put stuff online).
Regardless, many who get tested turn up negative. I really wish for the money we had answers and we won’t. If he has antibodies he could be more useful volunteering for other older folks in his area once he’s over it.
@“Cardinal Fang” – how do you explain the different infections vs. death rate in Germany vs. Spain or Italy?
NYC has very different demographics than Santa Clara county. Covid 19 impacts African Americans at a disproportionately high rate - NYC is about 25% African American, Santa Clara County around 3%. About a third of all Covid 19 fatalities are African American. So that in itself would contribute to a significant difference in fatality rates.