corona virus alerts - Latest cruising Information for vessels/locations/rules

[lestersails]

Hi all
A good article in NY Times on cruisers in the VI.
Stay healthy!

https://www.nytimes.com/2020/04/17/t...gtype=Homepage

P.S. If you don't subscribe, I think you can register with the NYT online site for free and get access to up to ten articles a day. Also, their primary coronavirus articles are not behind the paywall.

[Montanan]

Reports suggest many have had coronavirus with no symptoms
MARILYNN MARCHIONE
Associated PressApril 19, 2020,

https://www.yahoo.com/news/reports-s...040707505.html

A flood of new research suggests that far more people have had the coronavirus without any symptoms, fueling hope that it will turn out to be much less lethal than originally feared.

While that’s clearly good news, it also means it’s impossible to know who around you may be contagious. That complicates decisions about returning to work, school and normal life.

In the last week, reports of silent infections have come from a homeless shelter in Boston, a U.S. Navy aircraft carrier, pregnant women at a New York hospital, several European countries and California.

The head of the U.S. Centers for Disease Control and Prevention says 25% of infected people might not have symptoms. The vice chairman of the Joint Chiefs of Staff, Gen. John Hyten, thinks it may be as high as 60% to 70% among military personnel.

None of these numbers can be fully trusted because they’re based on flawed and inadequate testing, said Dr. Michael Mina of Harvard’s School of Public Health.

Collectively, though, they suggest “we have just been off the mark by huge, huge numbers” for estimating total infections, he said.

Worldwide, more than 2.3 million infections and more than 160,000 deaths have been confirmed. The virus has caused nearly unprecedented economic and social harm since its existence was reported in early January.

STEALTH CASES

Based on known cases, health officials have said the virus usually causes mild or moderate flu-like illness. Now evidence is growing that a substantial number of people may have no symptoms at all.

Scientists in Iceland screened 6% of its population to see how many had previously undetected infections and found that about 0.7% tested positive. So did 13% of a group at higher risk because of recent travel or exposure to someone sick.

Aboard the aircraft carrier USS Theodore Roosevelt, where one crew member died from the virus, “the rough numbers are that 40 percent are symptomatic,” said Vice Adm. Phillip Sawyer, deputy commander of naval operations. The ratio may change if more develop symptoms later, he warned.

In New York, a hospital tested all pregnant women coming in to deliver over a two-week period. Nearly 14% of those who arrived with no symptoms of coronavirus turned out to have it. Of the 33 positive cases, 29 had no symptoms when tested, although some developed them later.

Previously, tests on passengers and crew from the Diamond Princess cruise ship found nearly half who tested positive had no symptoms at the time. Researchers estimate that 18% of infected people never developed any.

FLAWED METHODS

These studies used tests that look for bits of the virus from throat and nose swabs, which can miss cases. Someone can test negative one day if there’s not much virus to detect and then positive the next.

Symptoms also may not appear when someone is tested but turn up later. One Japanese study found more than half of those who had no symptoms when they tested positive later felt sick.

Better answers may come from newer tests that check blood for antibodies, substances the immune system makes to fight the virus. But the accuracy of these, too, is still to be determined.

On Friday, researchers reported results from antibody tests on 3,300 people in California’s Santa Clara county: Between 1.5% and 2.8% have been infected, they claimed. That would mean 48,000 to 81,000 cases in the county — more than 50 times the number that have been confirmed.

The work has not been formally published or reviewed, but some scientists were quick to question it. Participants were recruited through Facebook ads, which would attract many people likely to be positive who have had symptoms and want to know if the coronavirus was the reason. Some neighborhoods also had way more participants than others, and “hot spots” within the county might have made infections seem more common than they are elsewhere.

Ships, maternity wards and single counties also don’t provide data that can be used to generalize about what’s happening elsewhere. And many of the figures have come from snapshots, not research on wide populations over time.

NEXT STEPS

Antibody testing in particular needs to be done “in an unbiased approach” on groups of people that are representative of the geographic, social, racial and other conditions, Mina said.

The CDC and other groups plan such studies, and they could guide public health advice on returning to normal life for people in certain areas.

If infections are more widespread than previously understood, it’s possible that more people have developed some level of immunity to the virus. That could stifle the spread through what’s called herd immunity, but scientists caution that there is still much to learn about whether mild illnesses confer immunity and how long it might last.

It will probably be months before enough reliable testing has been done to answer those questions and others, including how widespread infections have been and the virus's true mortality rate, which has only been estimated so far.

“If they’ve all seen the virus before, then maybe you can relax in that neighborhood” and ease social distancing, Mina said. “We’re not anywhere close where we need to be” on antibody testing to do that yet, he said.

[dannc]

Originally Posted by lestersails

Hi Dan
Appreciate your post - but it is actually extremely hard. Your idea of simply subtracting the prior year death rate would work only if absolutely nothing else was different last year compared to this. This is essentially never the case. The epidemiologists have to adjust for all sorts of things. As an example, the pandemic will probably lead to lower traffic fatalities (as those are mostly proportional to total miles driven). Also, how do you count someone who has terminal cancer, with a <50% probability of surviving 6 months, who gets COVID19 and dies? How do you attribute the cause of death in that person? A tough nut to crack. They also have to account for policy changes and human behavior, which will change every week.
There are literally hundreds of such variables in the statistical models and the epidemiologists debate them vigorously, which is why the estimates vary. Take a look at the FiveThirtyEight.com aggregation of estimates to see the effects of these variations.
These estimates are extremely useful for those who have to make policy decisions - the only rational thing to do is to use the best available evidence, even if we all know it is imperfect.

I agree but what you mention is trying to reach a near perfect result in calculating the number of dead. The reality is that 100% accurate result is not possible. It is impossible. One can argue, I use that word in the politest of ways, what level of accuracy one can get, 90%, 95%, 98%, etc. But that is trying to reach a level of exactitude that is not really relevant at the current time. Leave that to the historians.

Right now, we need to now the magnitude of the problem, not a minute exactitude of accuracy.

The Dutch did just this exercise, comparing the number of death this year, with the three previous years, to look at the likely number of virus deaths. Is it exact? Nope, but it does not need to be either.

Certainly, the death rate from car accidents and crime, over the last 5 weeks in my state, has been dramatically reduced and those number are known and can be accounted for in any calculation.

The number of virus dead in NC is 199 and I think that is a pretty accurate number since NC has not be overwhelmed with cases. One of the first guestimates put out on https://covid19.healthdata.org/projections, said that NC would have 1,597 deaths. There next update said 496 dead and the latest is 251 deaths. I would like to believe the latest guestimates will be accurate but the virus has gotten into nursing homes across the state and infected hundreds. That will not end well.

Later,
Dan

[Lake-Effect]

Originally Posted by Montanan

Reports suggest many have had coronavirus with no symptoms
MARILYNN MARCHIONE
Associated PressApril 19, 2020,

https://www.yahoo.com/news/reports-s...040707505.html

A flood of new research suggests that far more people have had the coronavirus without any symptoms, fueling hope that it will turn out to be much less lethal than originally feared.
...
In the last week, reports of silent infections have come from a homeless shelter in Boston, a U.S. Navy aircraft carrier, pregnant women at a New York hospital, several European countries and California.

The head of the U.S. Centers for Disease Control and Prevention says 25% of infected people might not have symptoms. The vice chairman of the Joint Chiefs of Staff, Gen. John Hyten, thinks it may be as high as 60% to 70% among military personnel.
...

Paging CF virologists...

Is this common- that a virus with the potential to be serious or to kill some can also be asymptomatic in a significant percentage of others infected?

Further, that those who were asymptomatic don't often produce antibodies?

It's like two different diseases, or like one that sometimes opens the door to another...

[pathlesschosen]

Interested in the results of the seroprevalence testing from LA, supposedly announced sometime today. If you see the results announced please post here.

[Montanan]

Texas is beginning to ease restrictions. The City of Ulvade's response:

"Due to the coronavirus, the Uvalde Police Department is asking that all criminal activities stop until further notice. Thank you for your anticipated cooperation in the matter. We will update you when we deem it’s appropriate to proceed with yo bad selves."



Humor is the best medicine. And maybe the only medicine effective for treating Covid-19.

[conachair]

Interesting piece in Al jazeera might be of some interest..

https://interactive.aljazeera.com/aj...ers/index.html

[Discovery 15797]

Originally Posted by Lake-Effect

Paging CF virologists...

Is this common- that a virus with the potential to be serious or to kill some can also be asymptomatic in a significant percentage of others infected?

Further, that those who were asymptomatic don't often produce antibodies?

It's like two different diseases, or like one that sometimes opens the door to another...

I'm not a virologist, but...

Yes, it is possible. Here is a study of asymptomatic cases from the first SARS virus. It is also well documented that project as much as 70% of influenza cases are asymptomatic.

Maybe. Antibodies are usually present in anyone who had the SARS-Cov-2 virus in their system. However, there is one study (out of China) that suggests some patients didn't develop anti-bodies. But, it is generally thought some level of antibodies will be present. Here is a pretty good overview of anti-body testing.

I agree it is almost like there are different diseases. The NextStrain website genetic breakdown of this virus shows how it spread around the world which might also explain the dramatic difference between the west and east coasts of the US.

[Montanan]

Chaos reigns with more than 110 coronavirus antibody tests in use — and only 4 with government approval

Alexander Nazaryan
National Correspondent
Yahoo News April 20, 2020
https://www.yahoo.com/news/chaos-rei...205807881.html

With President Trump and many others eager to see the country recover from the coronavirus, antibody tests are emerging as a crucial marker of just how prepared the nation is to lift restrictive measures that have kept about nine out of 10 Americans under lockdown for weeks.
Those tests have been quickly brought to market, with maximum speed and minimum oversight, recalling the disorganized rollout of diagnostic tests throughout March. And this time around, the near-total absence of federal regulation could result in the American market being flooded with tests that one former director of the Centers for Disease Control and Prevention described as “junk.”

There are now 110 different corporations and laboratories offering coronavirus tests, but only four of those tests have been vetted by the Food and Drug Administration under Emergency Use Authorization guidelines, which can expedite approval of medical products during a public health crisis.

Lockdowns have so far slowed the spread of the coronavirus, which has infected 722,000 Americans and resulted in more than 34,000 deaths. Although infections and deaths are continuing, Trump said last Thursday some states could begin to lift measures that have brought the American economy to a virtual standstill.
Antibody blood tests will be an important aspect of that effort. Those tests can reveal who has already been infected with the coronavirus and whether they showed symptoms at the time. The nasal-swab tests that have been administered to more than 3 million Americans are meant to tell people they are sick, whereas antibody tests are able to tell them they had been sick earlier and (presumably) don’t have to worry about becoming sick again.
Reliable antibody testing could, therefore, be a key aspect of reopening the country.
“Antibody testing is very important. It’s just that it needs to be done right, so that it improves the effort against COVID-19,” says Dr. Mark Birenbaum, director of the National Independent Laboratory Association, a group that represents many smaller laboratories around the country.
In other words, the tests have to be accurate in order to be useful.

Antibodies are proteins deployed by the immune system against disease. When found in the bloodstream, they indicate that a person is either fighting off or has recently fought off a disease, and can confer immunity against future infection. Some nations have considered so-called immunity passports that would authorize those who have recovered from COVID-19, the disease caused by the coronavirus, to return to work.
Doctors believe that people who contracted a coronavirus infection and then cleared the virus from their systems are immune, at least for a period of time, although the scope of that immunity remains a point of intense debate in the medical community.
In addition, people who have recovered from COVID-19 can donate their blood plasma to be harvested for antibody-rich convalescent serum, which can then be used to treat other patients.
But if the antibody tests give false results, they could actually severely hamper a return to normal.

Right now, 106 of the 110 tests being marketed in the United States have not gone through the external validation process pharmaceutical companies are subject to. And many of the unauthorized manufacturers are based in China, where biosecurity has long been a concern. Patients will simply have to hope that LifeAssay Diagnostics (Cape Town, South Africa), Euroimmun (Lübeck, Germany) and Lepu Medical Technology (Beijing) are responsible marketers of their products.
The lack of regulation and organization could present an opening to unscrupulous operators. In fact, it already has. Florida-based CoronaCide is suing a California company, the Wellness Matrix Group, for reselling its antibody tests as home kits. The tests were intended to be used specifically in medical settings.

“The FDA has been very cautious about the antibody tests,” Dr. Deborah Birx, response coordinator of the White House coronavirus task force, said at a briefing last week. Birx then referred to reports of other nations experiencing high error rates in their antibody tests. “You never want to tell someone that they have an antibody and potential immunity when they don’t,” Birx said.

At that same briefing, Trump celebrated the authorization of two antibody tests by the FDA. Missing was context — that while there are four tests that do have such authorization, there are 106 that do not.

The problems already evident in the rollout of antibody tests by private companies like CoronaCide and Euroimunn, and the federal government’s receding oversight of that process, recall the delays, errors and disorganization that dogged the implementation of diagnostic tests throughout February and March. The experience of other nations suggests that more aggressive testing in the early stages of the pandemic could have reduced its eventual spread. Testing in later stages of a pandemic could keep it from coming back.

If those tests are even accurate.

“These tests create more uncertainty than before,” infectious disease specialist Kelly Wroblewski of the Association of Public Health Laboratories told reporters last week. Her group represents state-run laboratories, none of which are yet using antibody tests.

Approved tests are coming. The first test approved under the Emergency Use Authorization was developed by the North Carolina-based company Cellex and manufactured in Suzhou, China. But it has not yet been available in the United States because Chinese customs officials have held up exports of the tests, a company representative told Yahoo News.

“They are quite hopeful that they will receive clearance to ship next week,” the Cellex representative said.
The other tests have been granted what amounts to blanket approval under a March 16 guidance from the FDA that said antibody tests, also known as serology tests, did not immediately require the same Emergency Use Authorization certification that Cellex asked for and received. The other manufacturers were encouraged to obtain a certification but could still sell their tests in the U.S. without one.
The guidance appeared to signal a recognition that greater testing capacity is desperately needed if the United States wants to follow Germany’s path out of the pandemic. In that country, antibody tests have helped chart the course.
But whereas Germany was prepared to test its population for the virus, the U.S. — with four times as many people — was not. Desperate to catch up, the FDA needs what help it can get from the private sector, and it is willing to cede some of its regulatory power for the sake of speed. Hence the March 16 guidance says that tests “should be validated prior to use” but does not make that validation mandatory.

While there could be obvious legal consequences for a company that peddles faulty tests, for now the federal government is tacitly sanctioning the sale of such tests. Because those consequences are so obvious, the FDA appears to be calculating that most corporations that have the know-how to market a coronavirus antibody test will know better than to attempt profiteering during a public health crisis.
The guidance additionally “recommends” that manufacturers make clear in their marketing that the government has not approved their tests. But again, they are not required to.
Claiming the imprimatur of the federal government could be an attractive way to gain a competitive edge in a crowded market. Wellness Matrix Group, the California company accused of misrepresenting antibody tests as suited for home use, had its stock suspended from trading by the Securities and Exchange Commission earlier this month because of assertions “made through affiliated websites and a company consultant about selling at-home COVID-19 testing kits that had been approved by the FDA.”

Large institutional entities will probably buy their tests from like-sized vendors. Some, like the Mount Sinai Medical Center in Manhattan, will even develop their own antibody assays. But both demand and supply are high enough, and oversight hands-off enough, for disaster to strike.
“The problem is that we don't know what the rates are for any of these kits when used ‘in the field,’” Birenbaum of the National Independent Laboratory Association wrote to Yahoo News in a text message. “So how can we pick the best to use to slow the spread of the COVID-19 virus?”

Birenbaum said that while some of his member laboratories have discussed implementing antibody tests, they have been hesitant to do so. “Our labs are all CLIA-certified,” he told Yahoo News, using the acronym for a set of regulations known as Clinical Laboratory Improvement Amendments, adding that members of his association “only use tests that meet CLIA requirements.” None of the tests currently on the market appear to meet that certification.
The skepticism was validated by a brief on serological testing published last week by the American Clinical Laboratory Association, which represents some of the biggest corporate laboratories in the nation (Birenbaum’s group, NILA, tends to represent smaller labs). That brief identifies several problems, including supply chain bottlenecks and the proliferation of incorrect results.

“To ensure that the U.S. can reopen and stay open for business, the federal government must play the leading role in scaling up and financing widespread SARS CoV-2 serologic testing,” the association said, using the formal name of the coronavirus pathogen.

The financing issue has seemingly been resolved, with the Trump administration saying that the cost of the tests should be covered. But scaling up, and doing so with a commitment to testing accuracy, has presented a challenge.

Diagnostic testing got off to a slow start in the U.S. in part because the CDC insisted on creating its own assays, instead of using the ones that had been developed by the World Health Organization and successfully deployed in China. The CDC-created test was faulty, and fixing it took several weeks.

The Trump administration eventually lifted restrictions on who could manufacture and deploy diagnostic tests, falsely asserting that those measures had been put in place by the Obama administration. With the antibody tests, however, medical experts fear federal officials may have erred in the other direction, letting private industry decide virtually every aspect of the antibody testing regime.

An official working on the White House coronavirus response told Yahoo News that “the Task Force is aware of the quantity of tests, and is in the process of developing distribution concepts that will assist in moving our country and economy forward. Test quantities are shared on a confidential basis by the manufacturer.”

But that official would not say whether a single task force official was working with private companies to coordinate where those antibody tests were going. Because so many companies have been permitted to sell antibody tests, such coordination would be extremely difficult.

The federal government is also scrambling to collect data on the tests that are already in use. FDA spokesperson Stephanie Caccomo told Yahoo News that “serology test developers should notify FDA that they have validated their tests, even when they do not provide validation or accuracy data at this time to the FDA. Developers also should include certain disclaimers on any results generated by their tests.”
Caccomo added that the FDA is working with the National Institutes of Health, the Biomedical Advanced Research and Development Authority and the CDC to “rapidly evaluate the performance characteristics of these tests.”

The situation could improve as large corporate laboratories create antibody tests of their own. Even without federal guidance, they have the institutional resources to create safe, reliable tests. Biomedical giant Abbott Laboratories is in the process of shipping 4 million of its own antibody tests, company public affairs manager Shelley Lange told Yahoo News, adding that Abbott expected to have 20 million antibody tests available to the public by June.

Mayo Clinic Laboratories, another leader in the field, is also expected to introduce its own antibody test soon, with a projected capacity of 8,000 tests per day.
But for now, the antibody testing landscape is a free-for-all, where profits compete with well-intentioned public health imperatives. That tension even worries the FDA, whose March 16 announcement that private companies could proceed without federal approval largely created the current scenario.

“I am concerned that some of the antibody tests that are on the market that haven’t gone through the FDA scientific review may not be as accurate as we’d like them to be,” FDA Commissioner Stephen Hahn said on “Meet the Press” last week, without mentioning that those tests did not have to go through an FDA review because the agency waived the review process.

And whereas both state and private laboratories clamored for diagnostic tests for much of February and March, both are now staying away. There are now antibody tests being offered in Seattle — where the coronavirus epidemic began in the U.S. — according to city spokesperson Chelsea Kellogg. New York City, which has been devastated by the disease, has only Mount Sinai, the Manhattan hospital, conducting antibody testing.

It is impossible to say whether that discrepancy represents a wariness on the part of public health officials, disorganization on the White House coronavirus task force, snags in the biomedical supply chain or a combination of all three factors.

The greatest worry is that the tests incorrectly tell people they are immune from the coronavirus (a false positive) or fails to detect that they do have antibodies to the disease (a false negative). That could unduly frighten people or give them a false sense of security.

“We can’t really afford to spend a lot of resources on trying to make heads or tails out of what will turn out to be not-good data,” Association of Public Health Laboratories program director Eric Blank warned last week. “We can’t really rely on those 90-odd tests that FDA has on that list.” (The number of tests on that FDA list has grown by about two dozen since Blank made those comments.)

That concern has evidently been confirmed by reports from South Korea that an antibody test widely deployed there has been giving inaccurate results. That is the situation public health officials in the U.S. are desperate to avoid. And that is why many state and private laboratories are staying away for now, even if antibody testing is a tantalizing tool that could help America beat back the coronavirus.

[pathlesschosen]

Latest news from the Los Angeles seroprevalence study. 28-55 times higher than confirmed cases. Same range as the recent seroprevalence test in Santa Barbara.

https://www.latimes.com/california/s...ting-la-county

LISTING OF DEPARTMENT OF PUBLIC HEALTH PRESS RELEASES

[AKA-None]

We’ll have a better understanding when some place opens back up as it was before. If tshtf then any concept of herd immunity will be tested in the real world

[DeepFrz]

So, another review of the Stanford "study" that completely debunks the paper.

https://www.youtube.com/watch?v=R8Pv77R3g1E

[pathlesschosen]

Yep. Several potential issues with the Stanford “study”. Looking forward to seeing results from additional seraprevalence test.

[DeepFrz]

Originally Posted by pathlesschosen

Yep. Several potential issues with the Stanford “study”. Looking forward to seeing results from additional seraprevalence test.

I disagree with the word "potential". The study is very flawed and I believe has been shown to be worthless.

[Discovery 15797]

Originally Posted by DeepFrz

So, another review of the Stanford "study" that completely debunks the paper.

This guy would be a lot more credible if he actually produced a paper rather than dissecting data and adding political commentary.

Notice he compared Sweden to Norway and Denmark, but did not show the data for Switzerland and the Netherlands.

He is spot on regarding the accuracy of serological testing. That is why there are only 4 approved by the FDA out of the hundreds submitted for trail. However, good researchers understand there is a fudge factor with false negatives or false positives. They also understand that one study does not provide strong evidence which is why they are repeating the study, and why Washington state is starting to look at this also.