We have been blessed with two straight days of coronavirus briefings. On Tuesday, really nothing notable, focus on some school issues. Yesterday, not really much at all, either, focus on bars and restaurants. A variety of state officials spoke, and every time this happens I am struck by how incapable they all seem. Bureaucrats plain and simple, all eager to parrot the political line. Of course we heard that restaurants and bars were a very important part of the economy and we had to consider their interests. The actions of the state have put a huge number of these facilities out of business permanently, with a substantial job loss, especially for minorities and low-income workers. There was and is no balance. It is getting colder here, if the state doesn’t relent on its baseless indoor capacity rules, we will lose even more of these supposedly important businesses. And from somewhere they managed to dredge up a restaurant owner who said the way the state was handling things was just great, although acknowledging that his restaurants were down 60% in revenue. Must be a lifelong member of the Incompetent Blowhard’s party or they promised to let him break the rules if he would testify about how great they were. Masochism lives.
A couple of pieces related to children. This study compares flu and CV-19 in children. (JAMA Article) There were 315 children diagnosed with CV-19 and 1402 with influenza. There was no statistical difference in rates of hospitalization, ICU use or ventilator use. The study did not talk about deaths, but from other data we know that more children die of influenza than have of CV-19. In raw percents, 17% of the CV-19 patients ended up hospitalized and 21% of the influenza ones. The average age of the hospitalized influenza children was much lower than that for CV-19.
More on viral loads in children in this study from China. (RS Paper) 35 children were included, 40% of whom were asymptomatic and the remainder had mild illness. The immune response to infection was similar to that of adults. Viral load peaked at around the time of symptom onset and decreased thereafter. Viability of the virus was not assessed, but by viral load, it was likely infectiousness was limited by the seventh day after infection.
This article examined outcomes of CV-19 for young adults. (JAMA Article) The study was based on 3222 adults aged 18 to 34 who had serious CV-19 illness, as they were hospitalized. That is only 5% of all CV-19 hospitalizations, a severe underrepresentation to the proportion of the population. This group was heavily minority and had serious pre-existing illness, most notably a very high prevalence of obesity, hypertension and diabetes. 2.7% of these patients died, again almost all with these comorbidities.
A couple of studies on household transmission. The first, from Denmark, covered 6782 households with a primary case. (Medrxiv Paper) 82% of potential contacts of these primary cases were tested within 14 days and 17% of those tested positive, so the attack rate was 17%. Those aged under 24 were less likely to be primary cases, but if they were a primary case, they were equally likely to be responsible for a secondary transmission. The attack rate increased with age. Denmark’s brief lockdown resulted in an increase in the proportion of all CV-19 cases originating in households. The second comes from Peru, which is having the worst epidemic in the world, along with the strictest lockdown. (Medrxiv Paper) Among 52 households, there was a 53% secondary attack rate, so that household transmission appeared to account for a large proportion of all cases. No age breakdown was provided.
How much CV-19 may be floating around in hospitals is a concern. This paper conducted a review of studies on the topic and suggested that while there may be a fair amount of virus in hospital environments, there is limited evidence that it is actually viable or has caused infections. (Medrxiv Paper)
Unfortunately some people actually picked up the coronavirus at a medical facility or office. This study examined how often that happened in one large medical center. (JAMA Article) Out of over 9000 patients, only 2 appeared to possibly become infected in the hospital. That is encouraging if replicated across the country.
Another modeling exercise on what might be correlated with the strength or shape of an epidemic in a country. (Medrxiv Paper) Since testing varies so widely I view this as somewhat pointless. But this group found that the strongest effect on lower cases and deaths was amount of sunlight and vitamin D levels. Factors correlated with higher number of cases and deaths were use of air conditioning/heating systems, population density, relative humidity (but not temperature), and use of mass transit. Mask use and lockdowns seemed to have no correlation with epidemic severity. The researchers also suggest possible low levels of infection needed for population immunity. And they found that mortality may be overstated in some places, with deaths attributed to CV-19 that were due to comorbidities, and some potential undercounting in other places.