The COVID-19 pandemic

[tomh009]

MONDAY 2020-09-28

Waterloo Region reported 10 new cases for today (6.2% of the active cases) -- with one more case for yesterday (now 8 new cases, 5.7% of actives).  85 new cases for the week (-8), averaging 8.0% of active cases. 161 active cases (+21 in the last seven days).

Next testing report on Tuesday.

Ontario reported a whopping 700 new cases today with a seven-day average of 465, going up quickly. 331 recoveries and one death translated to an increase of 368 active cases and a current total of 4,564. A weekly total change of +1,265 active cases. 41,111 tests for a 1.70% positivity rate. The positivity rate is averaging 1.22% for the past seven days.

The new cases are 15.3% of the number of active cases, averaging 11.7% over the past seven days.

ICU patient count is at 29 (+1). Total hospital population is now at least 128 (on par with July) but not all hospitals reported yesterday so likely higher.

• 344 cases in Toronto: 10.5 per 100K population
  
• 104 cases in Peel: 10.4 per 100K
  
• 89 cases in Ottawa: 8.9 per 100K
  
• 56 cases in York: 5.1 per 100K
  
• 20 cases in Niagara: 4.4 per 100K
  
• 15 cases in Halton: 2.2 per 100K
  
• 13 cases in Hamilton: 2.0 per 100K
  
• 9 cases in Waterloo: 1.5 per 100K (based on provincial reporting)
  

Ugh. GTA is getting to be a dumpster fire.

[tomh009]

IF we were to roll out a vaccine next spring that would be years faster than any prior vaccine rollout, with unknown implications, questions around lasting immunity and a whole range of different strains around the globe. Most people may simply choose not to get it and even if they do it would likely be not adequately tested and it would probably be largely ineffective. 

And to your question. I dont know. I think that's something the whole world is having to come to grips with right now. People are going to die, and what point to we just turn a blind eye, how much do we do to help etc. Ideally I'd like to save as many lives as possible. 

Life is something we shouldn't put a price on imo, but my point was moreso that half assed lockdowns do unnecessary damage to the economy whilst not really changing the long term trajectory of the disease. Either social distance, wear masks and keep everything open and just let what happens happen. Or lockdown until theres no community transmission. As long as community transmission is occurring and untraceable, resurgence will be inevitable when things open back up.

Resistance to being vaccinated will be most likely in our neighbour to the south; in other countries people tend to trust governments (and medical professionals) more.

As to lockdowns, do you call our current situation a lockdown? Because for the most part, life is going on, and people are able to go about their business, most of the restrictions apply only to food/drink establishments.

[danbrotherston]

This is categorically false.

It is quite likely a vaccine will be approved this year, and should be rolled out next year. We already have more effective treatments than we did 3 months ago.

But leaving all that aside, I'm curious as to how many lives you feel the economy is worth?

Yes I am aware we have more effective ways of treating it now, but theres still no tried and truth method or medication to help handle covid at this point. I'm sure there will be clinical recommendations by the end of the year, but suggesting we'll have viable vaccines soon if at all is naive. 

IF we were to roll out a vaccine next spring that would be years faster than any prior vaccine rollout, with unknown implications, questions around lasting immunity and a whole range of different strains around the globe. Most people may simply choose not to get it and even if they do it would likely be not adequately tested and it would probably be largely ineffective. 

And to your question. I dont know. I think that's something the whole world is having to come to grips with right now. People are going to die, and what point to we just turn a blind eye, how much do we do to help etc. Ideally I'd like to save as many lives as possible. 

Life is something we shouldn't put a price on imo, but my point was moreso that half assed lockdowns do unnecessary damage to the economy whilst not really changing the long term trajectory of the disease. Either social distance, wear masks and keep everything open and just let what happens happen. Or lockdown until theres no community transmission. As long as community transmission is occurring and untraceable, resurgence will be inevitable when things open back up.

It's not naive, go read the actual news, they are actually doing this. There are a dozen vaccines or more in or nearing stage 3 trials. Most vaccines that make it through to stage 3 trials are eventually approved. There is a very high probability that at least one of the vaccines in stage 3 trials now will be approved by EOY. There is no longer a question of if, or even when, but of patience...

https://www.nationalgeographic.com/scien...ments-cvd/

Yes, it is unprecedented, it's amazing what human being can accomplish when we set our priorities right.

As for treatements, there are few medical treatments that are 100%, but our treatment of COVID has improved dramatically, we have both better drugs, and better techniques than we had 3 months ago. In three months, there will be people alive who would have died if we had not locked down and deferred their illness. The long term trajectory absolutely has changed.

Yes, we aren't done yet, this is why we should lock down again now that we are seeing surging case numbers. But the end is in sight.

If you want to save as many lives as possible than we must have a lockdown now, and we must continue to lock down every time cases increase until we have a vaccine broadly available mid next year.

[taylortbb]

Yes I am aware we have more effective ways of treating it now, but theres still no tried and truth method or medication to help handle covid at this point. I'm sure there will be clinical recommendations by the end of the year,

This really dramatically understates just how much better at treating Covid-19 the world has gotten since 6 months ago. Mortality is still to high for wide reopening, but the difference in survival rates is substantial. So to is the difference in the amount of damage done during treatment, the early focus on ventilators lead to a lot of permanent lung damage in formerly hospitalized survivors that we can now avoid.

but suggesting we'll have viable vaccines soon if at all is naive. 

IF we were to roll out a vaccine next spring that would be years faster than any prior vaccine rollout, with unknown implications, questions around lasting immunity and a whole range of different strains around the globe. Most people may simply choose not to get it and even if they do it would likely be not adequately tested and it would probably be largely ineffective. 

Normal timelines really don't apply right now. How long it normally takes to roll out a vaccine doesn't tell us anything about how long it takes during a global crisis. Normally one would not build factories or sign purchase agreements for a vaccine until it was fully approved, but right now we're doing just that for vaccines that are merely in early clinical trials. We'll probably spend tens of billions on dead ends, which normally wouldn't even remotely be a possibility, but right now seems like a small price to pay to shorten things by just a couple months.

There's valid questions around length of immunity, but they can be addressed with booster shots. Buying the world a couple years of immunity while we develop better second generation vaccines would still be a huge improvement over the current situation.

As for mutations, every virus mutates and has various strains, but the vast majority of them can still be vaccinated against with a single vaccine. There are some viruses, like influenza, that have been particularly tricky, but there's currently no evidence suggesting that SARS-CoV-2 is one of them (it lacks the features that let influenza mutate so readily).

I think that expecting the world to instantly revert to normal in early 2021 is certainly far too optimistic, but extreme pessimism that the vaccine efforts are pointless is also incorrect. We do effectively vaccinate against the vast majority of viruses successfully.

[ac3r]

Not specifically related to Waterloo Region itself, but I wanted to share this online conference that Daniels Faculty at the University of Toronto is hosting this Thursday at 6:30PM and didn't want to start a new thread. It'll discuss Covid-19 in relation to public spaces, architecture, health and how we can design and build architectural spaces in the future to deal with these events: https://www.daniels.utoronto.ca/events/2...ng-society

We spend more time indoors due to COVID-19—limiting social contact to reduce disease transmission. Even before this era of quarantine, 80% or more of our time as a society was spent indoors. This has significant impacts on health and wellbeing. Now more than ever, attention to indoor environmental quality and how it effects people is critical to architectural design and building operation. This event brings together five experts on the indoors, from research scientists to building engineers to architects, examining how buildings should be designed to encourage health and wellbeing in this difficult time.

If you're interested, click the "Zoom" link at the top and you can register to get the URL.

[danbrotherston]

Yes I am aware we have more effective ways of treating it now, but theres still no tried and truth method or medication to help handle covid at this point. I'm sure there will be clinical recommendations by the end of the year,

This really dramatically understates just how much better at treating Covid-19 the world has gotten since 6 months ago. Mortality is still to high for wide reopening, but the difference in survival rates is substantial. So to is the difference in the amount of damage done during treatment, the early focus on ventilators lead to a lot of permanent lung damage in formerly hospitalized survivors that we can now avoid.

but suggesting we'll have viable vaccines soon if at all is naive. 

IF we were to roll out a vaccine next spring that would be years faster than any prior vaccine rollout, with unknown implications, questions around lasting immunity and a whole range of different strains around the globe. Most people may simply choose not to get it and even if they do it would likely be not adequately tested and it would probably be largely ineffective. 

Normal timelines really don't apply right now. How long it normally takes to roll out a vaccine doesn't tell us anything about how long it takes during a global crisis. Normally one would not build factories or sign purchase agreements for a vaccine until it was fully approved, but right now we're doing just that for vaccines that are merely in early clinical trials. We'll probably spend tens of billions on dead ends, which normally wouldn't even remotely be a possibility, but right now seems like a small price to pay to shorten things by just a couple months.

There's valid questions around length of immunity, but they can be addressed with booster shots. Buying the world a couple years of immunity while we develop better second generation vaccines would still be a huge improvement over the current situation.

As for mutations, every virus mutates and has various strains, but the vast majority of them can still be vaccinated against with a single vaccine. There are some viruses, like influenza, that have been particularly tricky, but there's currently no evidence suggesting that SARS-CoV-2 is one of them (it lacks the features that let influenza mutate so readily).

I think that expecting the world to instantly revert to normal in early 2021 is certainly far too optimistic, but extreme pessimism that the vaccine efforts are pointless is also incorrect. We do effectively vaccinate against the vast majority of viruses successfully.

Indeed, this is a good point. I am of the optimistic position however, that given the incredible amount of testing and tracing around this virus, and the efforts behind immunizing against it, we may not need more than a year of immunity, this virus is new, and only within the human population, if we have a vaccine given broadly enough, we can extinguish it permanently, this is not without precedent.  Smallpox is the most well known one, but it occurs to me that SARS v1 and MERS also were extinguished.

Of course, the biggest threat to this is the delusional anti-vaxxers in the western world...sadly.

I'm also not suggesting things will go back to normal in 2021--I expect there to be long term lasting changes to our society--I hope there will be for that matter. But I do expect that the pandemic will effectively ended in most western countries by the end of 2021 (yes, I do realize that prioritzing western countries, vs. vulnerable people world wide is the wrong strategy to minimize loss of life, but I do suspect it will happen anyway). But even if the pandemic is ended, the recession won't be reversed immediately, and the damage to small businesses will last much longer, if it is ever repaired, but that's a different thread.

[Bjays93]

Yes, we aren't done yet, this is why we should lock down again now that we are seeing surging case numbers. But the end is in sight.

If you want to save as many lives as possible than we must have a lockdown now, and we must continue to lock down every time cases increase until we have a vaccine broadly available mid next year.

I agree with this absolutely. I dont consider this lockdown at all, but I dont think our lockdown before was strict enough either. 
 
I think the most effective option is total lockdown, till there is no community transmission, like some countries have done. Continue with that method during a resurgence of infections, until there is viable and consistent treatment

[jwilliamson]

MERS hasn't been eradicated I believe. Wikipedia says there were 212 cases last year.

[danbrotherston]

MERS hasn't been eradicated I believe. Wikipedia says there were 212 cases last year.

I stand corrected, you're right, MERS has not been eradicated.

Nevertheless, SARS v1 was eradicated, and I'm a little surprised MERS hasn't been, since it's reproduction appears to be lower, and the death rate higher, which should make it easier to eradicate.

In anycase, I remain hopeful.

[Bjays93]

Yes, we aren't done yet, this is why we should lock down again now that we are seeing surging case numbers. But the end is in sight.

If you want to save as many lives as possible than we must have a lockdown now, and we must continue to lock down every time cases increase until we have a vaccine broadly available mid next year.

I agree with this absolutely. I dont consider this lockdown at all, but I dont think our lockdown before was strict enough either. 
 
I think the most effective option is total lockdown, till there is no community transmission, like some countries have done. Continue with that method during a resurgence of infections, until there is viable and consistent treatment

[tomh009]

MERS hasn't been eradicated I believe. Wikipedia says there were 212 cases last year.

I stand corrected, you're right, MERS has not been eradicated.

Nevertheless, SARS v1 was eradicated, and I'm a little surprised MERS hasn't been, since it's reproduction appears to be lower, and the death rate higher, which should make it easier to eradicate.

I believe the primary reason MERS has not been eradicated is because there continues to be camel-to-human transmission, the primary method of transmission.

"Saudi Arabia: Farmers flout Mers warning by kissing camels"
https://www.bbc.com/news/blogs-news-from...e-27393045

[danbrotherston]

I stand corrected, you're right, MERS has not been eradicated.

Nevertheless, SARS v1 was eradicated, and I'm a little surprised MERS hasn't been, since it's reproduction appears to be lower, and the death rate higher, which should make it easier to eradicate.

I believe the primary reason MERS has not been eradicated is because there continues to be camel-to-human transmission, the primary method of transmission.

"Saudi Arabia: Farmers flout Mers warning by kissing camels"
https://www.bbc.com/news/blogs-news-from...e-27393045

Right, yes, that is of course the other vector through which a virus can continue to exist.

It is a herculean task to eradicate a virus within our own species, doing so in two would be an even greater challenge.

That being said, I have not heard that this is happening with SARS CoV-2, certainly it had to have happened once, but that is no guarantee that it is functioning as a vector today, and it was not the case that SARS v1 did either.

[danbrotherston]

Yes, we aren't done yet, this is why we should lock down again now that we are seeing surging case numbers. But the end is in sight.

If you want to save as many lives as possible than we must have a lockdown now, and we must continue to lock down every time cases increase until we have a vaccine broadly available mid next year.

I agree with this absolutely. I dont consider this lockdown at all, but I dont think our lockdown before was strict enough either. 
 
I think the most effective option is total lockdown, till there is no community transmission, like some countries have done. Continue with that method during a resurgence of infections, until there is viable and consistent treatment

I agree the lockdown now, is....well...not a lockdown. Even the new limits amount to approximately nothing [1]. I do think the original lockdown was fairly strong, and the case numbers show that it was largely effective at controlling the virus, eliminating community spread is a great goal, but fairly difficult to achieve...we were close though, if the lockdown had continued, we may have gotten there.

The problem with a stronger lockdown is people don't obey, we can sanction and shutdown businesses pretty effectively, but unlike say, China, we lack the resources and will to literally weld doors shut on houses to lock people inside. We also lack the infrastructure to deliver food and supplies during such a lockdown. And for that matter, the very need to do so, makes a total shutdown impossible, people would starve if they aren't people still running the food supply.

In our case, the issue is determing which public policies will be most effective in modifying behaviour in the context of our society. Yes, if everyone went and sat in their rooms for two weeks, we'd be out of this in short order, but that isn't going to happen, nobody has that level of control over people in this country. So, a balance must be struck, the right policies to achieve the most change to behaviour. Now maybe our government could have implemented some things more strongly, but I don't know.

And I think it is fine that it was not a total lockdown...we saw very low rates of transmission for several (admittedly summer) months. If we kept reliably increasing the lockdown in response to rising numbers, we would be able to control this for the 6-10 months before we have a vaccine start to be available.

It's also the case that as we learn more about the virus, and ramp up our testing and data, we can tailor the lockdowns more precisely. We didn't know at the beginning how big an issue surface transmission was, turns out it was very low, as well, we didn't know how bad indoor spaces were, turns out a big problem, so we can stop wasting time trying to decontaminate every single surface, and instead work on improving ventilation and allowing more activity to take place outside.

That being said, I don't think that's happening right now, the concern is not peoples behaviour, but the choice to continue operating businesses even though we know it will kill people. Cases are rising as fast as they did before, and our government is choosing not to respond. I saw many quotes today about the next wave being worse, and I agree, it's turning out that way, but it was a choice we made...or our government made on our behalf.

[1] It's worth noting that our economy has not significantly rebounded as a result of the lifting of the lockdown, as you noted, even without the lockdown we'd have economic decline, as people choose not to go out...and frankly without a lockdown the economic harm can be even greater, because while most won't go out, enough will that the virus will spread and cause disease which also harms the economy. There isn't a lot of evidence that the economic decline is any worse with a lockdown...and historical studies of the 1918 pandemic suggest that cities which locked down more strongly, saw less decline.

[tomh009]

[1] It's worth noting that our economy has not significantly rebounded as a result of the lifting of the lockdown

It has not? Stats Canada begs to disagree:
https://tradingeconomics.com/canada/employment-change

3M jobs lost in March and April, 1.7M recovered up to the end of August. Not out of the woods by any means, but to say there has been no rebound is disingenuous.

[tomh009]

I believe the primary reason MERS has not been eradicated is because there continues to be camel-to-human transmission, the primary method of transmission.

"Saudi Arabia: Farmers flout Mers warning by kissing camels"
https://www.bbc.com/news/blogs-news-from...e-27393045

Right, yes, that is of course the other vector through which a virus can continue to exist.

It is a herculean task to eradicate a virus within our own species, doing so in two would be an even greater challenge.

That being said, I have not heard that this is happening with SARS CoV-2, certainly it had to have happened once, but that is no guarantee that it is functioning as a vector today, and it was not the case that SARS v1 did either.

Indeed it's not the case with either SARS or COVID-19 (SARS-CoV2 is the actual virus, similar to SARS-CoV and MERS-CoV). MERS is different in this regard.