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RamblinRed

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About RamblinRed

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  1. Hospitalizations have been rising for about 3 weeks and really took off this week. That is a bad sign considering we haven't even made it to Nov yet. And now we are seeing deaths start their typical increase 2-3 weeks after hospitalizations. 7 day avg deaths went up by almost 100 this week. I'm concerned that the last chart is going to have a much higher spike than we saw during the summer. We're starting at a place where deaths were already 40% higher than when the last surge started and cases are about 75% higher. As I linked in an earlier post, medical professionals are really worried because it is happening in so many places now that simply moving medical personnel from one area to another likely isn't going to be as available as the 1st two waves and if the personnel get stretched thin, then all the gains made in the last 6 months in treatments that lower the mortality rate can disappear if you don't have the personnel capable of providing the level of care necessary - not to mention if the theraputics are in short supply.
  2. Head of NIH says there may not be a vaccine authorized for EUA by end of the year. While he remains "cautiously optimistic" that the United States could have a Covid-19 vaccine authorized by the end of the year, the National Institutes of Health's Dr. Francis Collins warned on Friday that "it might take longer." "I’m cautiously optimistic that by the end of 2020, there will be at least one vaccine that has reached that stage of an emergency use authorization but I don't know that for sure — and it might not happen and it might take longer," Collins, director of the NIH, said while speaking to the National Press Club in a virtual event on Friday. Collins added that it remains "a good thing" the US has more than one vaccine candidate in development. "It’s a good thing we have this menu of diverse scientific approaches," Collins said. "If you were betting the whole thing on one vaccine I'd be a lot more worried." Additionally, a potential Covid-19 vaccine will need to have at least 50% effectiveness to be considered for approval by the US Food and Drug Administration, Collins said. "FDA is not going to approve a vaccine that has less than 50% effectiveness," he added. Fauci starting to lean towards thinking we need a mask mandate Dr. Anthony Fauci said the country should probably mandate mask use, even if people complain about the trouble with enforcing it. “If everyone agrees that this is something that's important, and they mandate it and everybody pulls together and say, you know, 'We're going to mandate it but let's just do it'. I think that would be a great idea to have everybody do it uniformly,” he said Friday on CNN. “I get the argument, say, ‘Well, if you mandate a mask, then you're going to have to enforce it and that'll create more of a problem.’ Well, if people are not wearing masks, then maybe we should be mandating it."
  3. New MMWR from the CDC. I include it because it has really interesting info on excess deaths in the US. While in raw numbers the majority of excess deaths have occurred in older people, in terms of the highest percentage increases in excess deaths have occurred in younger people. (ie. alot more older people die than younger people in a given year, so the base is much smaller in younger people) https://www.cdc.gov/mmwr/volumes/69/wr/mm6942e2.htm#:~:text=conduct all analyses.-,From January 26%2C 2020%2C through October 3%2C 2020%2C,excess) (Figure 1). What is already known about this topic? As of October 15, 216,025 deaths from COVID-19 have been reported in the United States; however, this might underestimate the total impact of the pandemic on mortality. What is added by this report? Overall, an estimated 299,028 excess deaths occurred from late January through October 3, 2020, with 198,081 (66%) excess deaths attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino persons. What are the implications for public health practice? These results inform efforts to prevent mortality directly or indirectly associated with the COVID-19 pandemic, such as efforts to minimize disruptions to health care. Although more excess deaths have occurred among older age groups, relative to past years, adults aged 25–44 years have experienced the largest average percentage increase in the number of deaths from all causes from late January through October 3, 2020. The age distribution of COVID-19 deaths shifted toward younger age groups from May through August (9);
  4. I don't think a vaccine is anywhere as close to widespread distribution as is being suggested. Best case scenario right now is a limited supply ready for sometime this winter - most likely for healthcare workers and maybe some of the most vulnerable. After that, it looks like Spring or Summer before there will be enough for widespread distribution. Read an article last week with comments from alot of vaccine experts that if we could have everyone vaccinated by next fall then that would be a huge accomplishment. Right now we don't have any real safety data on vaccines. That comes in phase III when you test in large numbers and those studies are underway now. Even the farthest along of the various vaccinnes (Pfizer) has the third week of November as the earliest it will have enough data to determine efficacy and safety. And once we get a vaccine we have to have a strong supply chain set up. The vaccines talked about right now mostly require 2 doses and have to be stored at an extremely low temperature (below -70 farhenheit) and there are only so many places that can store it and so many trucks that can transport it. Also as you mention, how many people take it will have a major impact. If only 50% take the vaccine then it will be of limited value as not enough people will be innoculated. Unfortunately it has become tied up in the politics in the US at least and that is causing people to doubt whether vaccines will work. I fall into that group that won't run out to get it. If the scientists say it is safe and effective than I will get it, if a politician says its safe and effective i won't. Frankly, wearing masks are likely to be a stronger way to combat COVID than a vaccine in the short term. Right now, the requirements are only that the vaccine is 50% effective. So if 100% of the people got the vaccine that would still mean 50% would actually be protected - and you won't know if you are in that 50%. Given that the likely percentage to get it is going to be a fair bit lower, I would expect that the vaccine may only be in the 30-35% effective territory overall - not nearly high enough to simulate 'herd immunity'. Meanwhile if we would all wear masks, we could almost get transmission to 0 since it is largely spread through the air.
  5. As Rick Bright said last week. We game planned for all sorts of possibilities and outcomes. The one thing we didn't game plan for was that the President of the United States would not act in the best interests of the country.
  6. America Poised to Enter its Worst Stretch Yet https://www.washingtonpost.com/health/2020/10/23/covid-us-spike-cases/ The unprecedented geographic spread of the current surge makes it especially dangerous, with experts warning it could lead to dire shortages of medical staff and supplies. Already, hospitals are reporting shortfalls of basic drugs needed to treat covid-19, the disease caused by the novel coronavirus. And it’s not simply a matter of increased testing identifying more cases. Covid-19 hospitalizations increased in 38 states over the past week and are rising so quickly that many facilities in the West and Midwest are already overwhelmed. “One key way we got through previous waves was by moving health-care workers around. That’s just not possible when the virus is surging everywhere,” said Eleanor J. Murray, an epidemiologist at Boston University. The high case numbers of recent days have stoked concerns because the country has not even hit the stretch of holidays and cold weather, which experts have long warned will send cases soaring even higher. More interactions could mean more transmission during celebrations of Halloween, Christmas and the New Year. The winter’s cold, dry air will also help the virus stay stable longer, even as it drives people to hunker down together indoors. Hospitals from Missouri to Idaho are starting to reach capacity. On Thursday, America had more than 40,000 current covid-19 hospitalizations — the first time that level has been reached since August. In the past three weeks, 34 states saw sizable increases in hospitalizations, and the number has more than doubled in Connecticut, Montana, New Mexico and Wyoming. Experts said the problem facing many hospitals this winter won’t be finding enough beds. It will be ensuring that hospitals have sufficient specialized staffing. “Creating beds is relatively easy, but what do you do when you outstrip ICU nurses, doctors and teams?” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. In recent months, health-care workers have been able to lower mortality rates — the ratio of patients who die once infected. Much of that progress has come through hard-earned expertise by ICU staff — new approaches and knowledge about how to combat the virus, such as when to use ventilators, the adoption of treatments such as steroids and proning patients, which helps with breathing by shifting them onto their abdomens. But the hard-won battle to lower mortality rates could be imperiled as hospitals are overwhelmed and staffing gets stretched, Osterholm said. And as the pandemic has seeped into rural swatches of the Midwest, skeleton staffs at smaller hospitals are shrinking further as doctors and nurses fall ill. A report this week by Osterholm’s center showed shortages in 29 of the 40 basic but critical drugs often used for covid-19 patients. That includes antibiotics, sedatives like propofol that are used to calm patients during intubation and heart medication such as norepinephrine. And because of the widespread nature of the infections, hospitals are finding it harder to draw from excess supplies of such drugs elsewhere. Even as hundreds of people are dying each day, “there’s this false sense of calm right now,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security. “We have the president saying, ‘We’re rounding the corner.’ We have state leaders openly defying public health guidances.” Inglesby pointed to plans and metrics many states laid out last spring for reopening. “That’s been completely disregarded in many places,” he said. “It’s been framed as this false choice between full shutdowns and doing nothing, but that’s not the case,” said Inglesby, who urged people to wear masks and avoid large gatherings. Politicians also need to stop minimizing the risk posed by the virus and start discussing openly with the public the hard decisions and trade-offs that lie ahead, Murray said. Is it, for example, worth keeping bars open if it means having to close schools? “I worry sometimes about being too pessimistic,” she said. “We are not making predictions and saying this dark winter is somehow inevitable. We’re trying to warn people this is how it will be if we don’t do something about it.
  7. At this point I think we are just waiting to Spring. There certainly is not going to be any kind of normal Holiday season. With rates in the US and Europe skyrocketing it just feels like March or April before anything major is attempted again. I'm guessing some of the studios might release a handful of smaller films over the Holidays but there is no way they are going to release any major movies in the winter with COVID spiking.
  8. I'm not expecting much until at least March, maybe April. With the way cases are going in both Europe and the USA there simply won't be a demand to keep theaters open even if there was supply. With European countries starting to implement more lockdowns an curfews that is going to take care of any movie watching there.
  9. This is a petty distressing thought from a Wash Post article. https://www.washingtonpost.com/world/2020/10/19/coronavirus-spike-united-states-europe-reaction/ Nor does it seem that any society has achieved anything close to herd immunity. “One of the hopes in some quarters had been that herd immunity could provide some protection, with places hard-hit in the spring sheltered from the worst of any resurgence in the virus due to increased antibody levels,” noted the Financial Times. “Unfortunately, that has proved not to be the case so far, with many of the centers of the outbreak in the spring also suffering the worst in the autumn, both at the country and subnational region level.”
  10. Hard to disagree with any of this. Politicians hate to deliver bad news and most will turn themselves into pretzels to try to prevent having to be super negative. The 1918 Flu Pandemic ran for 3 years. i suspect we will see something similar. Their mitigation measures were not much different then today. In regards to the BBC article on the re-infection. They still seem pretty rare, but it does suggest that any vaccine is more likely to have to be a re-occurring vaccine -like the flu - rather than a one time event like MMR, Polio, etc. The key will be what will be the frequency and over time will newer vaccines arrive that will have higher efficacy and/or longer immunity than early vaccines.
  11. After Sidelining Scientists, Europe Plays Catchup with new Coronavirus Wave https://www.politico.eu/article/scientists-eu-coronavirus-second-wave/ Some scientists say they're aghast at the complacency of political leaders, given that they had projected caseloads would rise in any event with the colder weather and social life returning indoors. “We see exactly the same thing happening again — it’s like we have a communal loss of memory of what happened six months ago,” said Debby Bogaert, a professor of infectious diseases at the University of Edinburgh. Bogaert lamented that politicians are moving at "their own speed" — and it's much slower than experts would move. "They wait and wait and wait, whereas people in public health ... know that you need to act now — not in a week or next month — because then you're running again after the fact," she said. But some warn a rise in deaths is now almost certain — it's simply a matter of math. “The death rate — given the age distribution and given the incidence rate — will be exactly what it was in the spring,” said Karl Lauterbach, a German scientist and parliamentarian from the Social Democrats. And the situation will be worse, he said, in countries that “postpone important, necessary measures the longest.” Bahar Tuncgenc, a psychologist at the University of Nottingham, said government should not blame citizens but communicate more clearly. She said she was perplexed at why politicians didn't prepare the public for a resurgence. “There's no way governments didn't know that this would continue into the winter," Tuncgenc said. "All scientific advice was saying that.”
  12. One note from above. Even if Biden is elected, he doesn't become President for 10 more weeks, and i doubt Trump if he loses is going to be in a place where he wants to do anything helpful for the country. So it is late January before you are likely to see any significant changes in US strategy.
  13. That's what I was getting at. I don't think it is seasonal in the sense that it is easier for it to survive or anything like that in any significant way. It's seasonal from the standpoint that as you mentioned whenever people are indoors more, its going to spread easier.'
  14. Good article on rising hospitalizations in the US https://www.politico.com/news/2020/10/16/pandemic-states-virus-rebound-429753 Utah, WI, IN, MO, Dakotas, parts of TX, NM all seeing all-time highs in hospitalizations Covid Tracking Projects weekly blog https://covidtracking.com/blog/weekly-update-oct-15 Third wave is here. Looks different than the first 2. Much more spread out across the country with rising numbers just about everywhere. Worst places are some of the spots in the Midwest, Plains and Mountain states but seeing increases all over the country. Also, WHO said today that if Europe does't get things under control quickly its deaths could be 4-5X what they were in April by January. One other note. FL continues to outpace all other states in terms of deaths. On a per capita basis only AL and SD are doing worse. It is also one of the worst states in terms of testing, just 1 per 1,000. Only MS is worse and most states are testing 2-4 times or more per capita.
  15. Pfizer has announced it won't seek an EUA until late November at the earliest. That is the quickest timeframe that it can meet that FDA safety requirements. https://www.politico.com/news/2020/10/16/pfizer-coronavirus-vaccine-authorization-election-429797
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