"Weird cold" in February checking in. I did not have any temperature variations or fevers, but I got struck with a fatigue like no other. For the first time since I was 3 years old, I took afternoon naps three days in a row because I was just completely wiped out. It's rare for me to take a nap at all (happens maybe once a year)! It took two weeks to get out of this fatigued state. My other symptoms were "chills-like" sensations throughout the day, post-nasal drip and burning feeling in my chest/lungs but very minimal cough. My child did have COVID-19 symptoms back around Feb/March (can't remember exact time-frame) and I even wrote about that here on HN. Maybe I should take this test.
I still think there's a possibility this virus was already in the US before 2020. I don't think they ever found a cause to the "mystery respiratory virus" in Virginia from July 2019:
> Three people have also died, but Dr. Benjamin Schwartz of the Fairfax County Health Department said Wednesday afternoon that those who died were "older" and had complex health problems. Officials don't yet know the extent to which the respiratory illness contributed to their deaths, he said.
I agree with you on being open to thinking that COVID-19 arrived earlier than was initially thought. When I first shared my "weird cold" story on HN, the consensus was that I was a crazy person and there was no way that could be COVID-19. There would be more deaths if it had been here. But now there are some deaths, and a large number of people with "weird cold" stories, and it really makes me think that a lot of people have already had this. Maybe the doctors at the time didn't recognize it as COVID-19 (I didn't when I had my weird cold). Maybe the numbers that we see now are just wrong; i.e. the recorded cases we have are just the tip of the iceberg (and if you tested everyone every week, we would have hundreds of millions of cases).
Or maybe that weird cold was just a weird cold and nothing more. It seems unlikely to me, but I'm open to it. I hate to make public policy suggestions on anecdotes... but someone should really look into that weird cold. Everyone in New York had it. It sure is weird.
people say that because .25% of the population in NYC are dead from covid. we dont see those numbers here -- if it was widespread in feb, what caused the discrepancy?
While it's harsh to say: People die every day. The CDC officially states that, on average, ~880 people per 100,000 die every year in the United States (in 2017). Extrapolating that to NYC, this means that the city can expect to loose about 0.1% of its population every year (possibly even more; I imagine some forms of death are more prevalent in large cities. Possibly less; healthcare is better).
Yes, losing 2x+ the annual number in one quarter should be noticed. But, maybe the virus evolved additional transmissibility over time, or maybe it evolved to be a little more deadly.
It simply seems less likely that this virus was first noticed in November, by China, yet it didn't hit major urban areas in the rest of the world for another four months. We're too interconnected as a species; nearly half a million people came to the US from China alone, after COVID-19 was classified there [1]. It feels more likely that people have been getting it, and dying from it, well before March; these cases were just simply miscategorized as the flu.
I guess we need to know the total number of cases to figure out what the deaths mean, and until everyone has gotten an antibody test, we can't know that total number.
To make the numbers work for the "weird cold" in early February case, I guess we have to work backwards. Assume that when we went into lockdown was the actual peak, 8 million people in New York City had COVID-19. That means that there is one death for every 500 cases. Then we have to pick a reproduction rate, which I have no idea how to pick, so I'll say that it increases by 1.5x every day (so on day one you have x cases, then on day 2 you have x + 1.5x, then on day 3 you have x + 1.5x + (1.5)^2x, etc. Going back a month from March 20 (which is approximately 30 days, and when a lot of people report their "weird cold"), that would mean we'd expect around 8 million / 383500 = 20 cases on Feb. 20. With 1 death per 500 cases, you'd have 0 deaths at that level.
I know I've pulled these numbers out of my nether region and so they are likely very wrong. But with some back-of-the-envelope math, I think we can have some sick people in February without a lot of deaths.
Obviously my 8 million total cases in NYC number is too high, and the 20 cases on 2/20 is too low for me and my friends to be those cases. But that exponential can be tweaked to make something plausible. If we make it 1.2 instead of 1.5, then we should have had about 7000 cases on 2/20, and that means around 14 deaths. That seems quite plausible to me. So I dunno. There was a weird cold. It's weird. It could mean anything.
I signed up to get an antibody test. 1 test is not data, but it will be very interesting to see the results.
> Then we have to pick a reproduction rate, which I have no idea how to pick, so I'll say that it increases by 1.5x every day (so on day one you have x cases, then on day 2 you have x + 1.5x, then on day 3 you have x + 1.5x + (1.5)^2x, etc
> I know I've pulled these numbers out of my nether region and so they are likely very wrong. But with some back-of-the-envelope math, I think we can have some sick people in February without a lot of deaths.
Yeah, in two ways: That's not how the growth rate math works, but if we went by your math instead of the number, that's about 4-5x faster than what we were seeing in March.
A growth rate of 1.5 means if we had X cases on day 1, we'd have X(1.5^1) on day 2, and X(1.5^2) on day 3. This virus's growth rate at the beginning of the pandemic stage was around 1.4 (or to use your math, 0.4? I'm not sure what you meant by "(1.5)^2x", is that a typo of "(1.5^2)x" or did you mean 1.5^(2x)"? The second one is straight wrong).
1 out of 421 NYC residents have died, based on today's numbers, and recent serological tests estimated that 20% of residents were exposed. If that's right, then the death rate would be about 1/84, or about 1.2%. But I've seen other claims that the exposure rate in NYC is higher, which would give a lower fatality rate.
Don't forget to factor this breaking through to long term care facilities. From the last I looked at this, if it had not hit long term care, the number of deaths would have been low enough that it may have gone undetected longer. (In WA, 92% of the deaths are still folks over sixty! I don't know the numbers for how many of them were in long term care.)
Which is to say, you can't just look at the population death rate and really appreciate just how dangerous this is for older populations. The CFR for over sixty is a staggering 15% in WA. That is ridiculously high and completely masked if you look at all cases.
> Don't forget to factor this breaking through to long term care facilities.
If they're not taking any precautions (because there's no knowledge of the virus in the community) then it can spread to those types of facilities very easily. In New Zealand where only 1,500 people have have COVID-19 (likely to be very accurate, 200,000 tests have been conducted) there's already been two outbreaks in nursing homes.
Certainly. I am not implying that we should just let it run its course. Just as I would not let any disease we have a vaccine for loose in a nursing home without the vaccine.
I just think the total IFR actually undersells how dangerous this is.
I'm sure we would have noticed. I'm not sure we would have noticed as quickly. We certainly would not have tested to find that nearly a quarter of NYC could have it.
Yes, it can do damage and is very dangerous for an at risk group. No, we don't know who that is, yet. Age clearly proxies for a risk factor. But which one?
Unless you are wanting to claim that no children have gotten this. Which, seems highly unlikely. (Or is the risk whether it will provoke an immune response?)
If I'm interpreting this[0] right, it looks like the normal death rate is 3.51 per 421 people per year. 1/421 in NYC (is that just COVID cases or all excess deaths?) is over much less than a year, so it seems fairly serious.
But I also had a truly "weird cold" go through my workplace early this year in SFBA, so I still have to wonder what that was.
That's a great point although obviously its very hard to estimate something that has a horizon of atleast a month. the bay area did shut down quite a bit earlier, it could be that the lack of deaths is simply due to a better response.
> people say that because .25% of the population in NYC are dead from covid
Source? I can only get a rate that high by taking the highest death count I can find (which involves extrapolations to attribute deaths to Covid-19) for New York State and dividing it by the population of New York City (which is clearly invalid).
From https://www1.nyc.gov/site/doh/covid/covid-19-data.page I compute 0.23% of NYC's population has died of Covid-19, counting confirmed + probable deaths and dividing by 8.399 million people. That's 1 out of every 421 people.
hm, care to explain more? that's exactly how I think about it. Total deaths in NYC attributable to covid (~20k) over the total population (8.5M) = ~.25%. In my mind this is a very easy lower bound to estimate, what am I missing here?
In anycase, even a rate of ~.1% would be absurd given ~20% of people are testing positive by antibody tests.
Actually, I was asking <i>you</i> to explain, or at least give your source.
I subsequently found what I believe you are working from here: https://www1.nyc.gov/site/doh/covid/covid-19-data.page
which does specify New York City (as opposed to New York State) so both the numerator and denominator refer to the same thing.
Interestingly, they appear to be using a larger denominator than your 8.5 million (NYC metro vs. NYC proper perhaps?) and get a rate of 0.175% = 175.66/100,000, eg in the "citywide total" line of https://github.com/nychealth/coronavirus-data/blob/master/by...).
But this is at least closer to your figure than I was able to get previously.
Specifically has numbers for NYC. You can sum the boroughs or use the total listed below. Using confirmed by pcr cases you get ~15k/8.6 = ~.175% as you said.
Using probable excess deaths adds an extra 5k deaths, hence ~.25%
We haven't confirmed functional mutations. One of currently known mutations (D614G being a prime suspect) can be functional and we can't rule out the possibility.
We don't yet know why (or even if) more people died in New York than on the west coast, per capita. We certainly cannot yet attribute it to a different strain.
I keep reading people asserting this, and I assume it's because we believe that a virus that becomes less lethal would have an evolutionary advantage.
But, wouldn't lengthening the incubation period also be a successful evolutionary strategy regardless of lethality?
It seems to me that there are many possible strategies that a mutating virus might gain an advantage and we shouldn't just assume that the only one that they would use would be to become more mild.
> Trade-offs between different components of parasite fitness provide the dominant conceptual framework for understanding the adaptive evolution of virulence (Alizon et al. 2009).
...
> By far, the most widely studied trade-off involves transmission and virulence (Anderson and May, 1982; Frank, 1996; Alizon et al. 2009). Transmission and virulence are linked by within-host replication: increasing parasite abundance increases the likelihood of transmission, but also increases the likelihood of host death; mathematically, this assumption can be formalized by making transmission rate β an increasing function of parasite-induced mortality rate ν. Nearly all of the literature we summarize below assumes this trade-off. However, another potential trade-off suggested by an examination of R0 involves virulence and recovery rate (Anderson and May, 1982; Frank, 1996). This trade-off is also mediated by replication rate, with high abundance increasing the likelihood of host death, but also decreasing the likelihood of the host clearing the infection (Antia et al. 1994); mathematically, this assumption makes recovery rate γ a decreasing function of parasite-induced mortality rate ν.
'Tend to' doesn't mean some conscious, directed effort. On large enough scale, this is generally the more probable direction, and that's about it. Its truly random by nature.
It can very well go the other way as with 1918 'spanish' flu. Or it can change in ways that won't affect overall mortality much.
It's interesting you should mention the 1918 flu. That one had two waves, the first one less lethal... Evolution is random, add you say, but that's not quite what happened.
It was in the middle of world war 1. Soldiers were infected, and the ones that became the most ill were sent home to recuperate, or die. Either way they spread the virus better than the ones who weren't as ill, and who stayed in the field.
So the usual evolutionary pressure was upside down here.
You're neglecting the other side of things in that analysis. The more successful deadly viruses tend to eliminate their victims, so the surviving population has a higher concentration of people who are resistant or immune to it, including those who acquire immunity after being exposed to the virus.
A lot of the opinion I've read suggests that so called super-spreaders are seeding the majority of flare-ups. In other words, there may be some individuals with very high R0 compared to the vast majority of others. My theory is that Covid-19 was circulating for some time here until the right people became infected, then it really started spreading rapidly.
> I still think there's a possibility this virus was already in the US before 2020.
Yeah, I don’t understand why people are so against the idea of it being in the U.S. before 2020. There’s no possible way we can trace every American who may have traveled within the China region or interacted with another person who was in that region around the start of COVID spreading. Just because there were no official cases of COVID does not mean it was not here.
I had a roommate visit Japan in November. He came back and was extremely ill for about a week. No hospitalizations but he was out of commission and isolated by himself.
I think the main evidence against it being here siginifgantly earlier is that we see how it spread when it was definitely here, so why wouldn't we have seen hot spots like Atlanta and New York earlier then?
Yeah - if someone could point me to a nursing home where 5% of the population died in a week in December/January I'd believe it - anecdotes about people being having the flu in the winter isn't the most convincing.
> if someone could point me to a nursing home where 5% of the population died in a week
Sure, if we were talking about mortality rates but we’re not. we’re simply talking about prevalence of COVID prior to the major breakout of February and beyond. These are two completely different things to be looking at.
I’ve worked in nursing homes during that time of December where people were dying. Did we think to send bloodwork off to test for some novel coronavirus? Of course not. Secondly, using the example of a nursing home as the sample population is silly as they are not the ones who were traveling. It’d be their family members and caregivers who traveled and then brought the disease into the facility.
I think you are missing the statistical point I and others are making. If the disease was introduced in a meaningful way in December/January it would be a statistical certainty we would see signs of it (such as nursing homes having huge waves of deaths or total mortality in subregions surging).
I'm not sure what your counterclaim is? There are no samples in America tested from that time period that would show that there was Covid nor is there any statistical evidence that would suggest there was Covid.
What specific evidence would you be expecting to see in December or January? The infection fatality rate for this disease is probably below 1%, and we don't know what percentage of the population is infected. We don't truly know how quickly it spreads. Nursing home populations are at greater risk, but even if the IFR is 3-5% for that cohort, the population mortality would be some fraction of that, and most of the deaths would be people with pre-existing conditions, and the deaths would be attributed to those conditions.
If there was a year-on-year increase of 1-2% in nursing home deaths for a month or two, would that register with anybody? Maybe they would have noticed if a lot of people were being put on respirators? But if no one knew about COVID they would probably just chalk that up to it being a bad flu season.
> Nursing home populations are at greater risk, but even if the IFR is 3-5% for that cohort, the population mortality would be some fraction of that,
Looking much higher than that. 80+ is 15-20% and 70-79 is 8% (https://www.worldometers.info/coronavirus/coronavirus-age-se...). It'll be concentrated more in people with pre-existing conditions so I expect nursing homes would see greater figures than that.
> Statistics from Kirkland now appear to tell the national story. Of 129 staff members, visitors and residents who got sick, all but one of the 22 who died were older residents,
So we're not talking about one or two deaths but a large proportion of your residents suddenly getting ill in the same way and of those a large proportion dying over a short period.
> Looking much higher than that. 80+ is 15-20% and 70-79 is 8%
The percentages you're citing are from the Chinese CDC [1] and represent the case fatality rate. They don't represent the infection fatality rate, let alone the overall population mortality. There's a big difference between these numbers which has been repeatedly ignored in the popular media, they keep on taking the scariest one (CFR) and presenting it in an unbalanced context. [2]
(To be fair, CFRs are the numbers we are the most certain about, but when you cherrypick the worst ones like the newspapers do they're also the scariest and least useful.)
The working definition of CFR in the Chinese study is basically people who saw a doctor, were suspected or confirmed of having COVID, and then died. But many other people would have caught the disease and not been seen by a doctor. Most of them would have been milder cases and they wouldn't have died. Key point is this number is not at all indicative of total Covid-related mortality in an exposed population.
The Kirkland story is really tragic, but it's just one data point and doesn't prove that ~15% of all nursing home populations will die. The conditions in other nursing homes could be very different, in fact that nursing home in Kirkland has since been investigated and fined $600,000 for unsafe practices [3].
Why does it have to be introduced in a “meaningful way” to be relevant? If there was at most a single case of it within the U.S. that would show that the disease spread earlier than what is assumed. Again, your argument rests solely on the idea of there must be thousands of death in order for this disease to exist within the states. That is an odd way to think about this.
It’d also be kind of hard to go back and rerun tests for people during those months, which shows why it’s very difficult to pinpoint when this disease started to really spread. I mean, if France and China both had cases during the month of November and December, you’d be hard pressed to say it’s not possible there were similar cases in the U.S albeit undiscovered.
It is not particularly unusual for a nursing home to see very high death rates around flu season. In the UK, where they have an excellent healthcare system, the average lifespan of a nursing home resident is 2.2 years.
somewhat of a dated article (2010) but the average lifespan of those admitted to nursing homes for EoLC is actually only about six months.[1]
however, some may stay longer, but then they have to worry about their condition worsening and eventually not allowing them to do ADLs (bathing, eating, dressing) on their own. the average length of stay before disablement is close to two years [2]
I understand that line of thinking but that would imply the prevalence rate of COVID was in complete parallel with the incidence rate. The former is what we do not know and that's clear when we've had patients labs reran from 2019 and found it was positive for COVID. Government data from China says the first case can be traced back to 17 November 2019 and even then they're unsure if that was patient zero[0]
How many American's were in Asia, China, or surrounding areas between October and December of 2019? How many of them were possibly infected? Nobody knows because there was no plan put in place with regard to travel to mainland China until the end of January 2020; even then since 1 January 2020, there were 430,000 people who traveled from China to the U.S.[1]
I have been wondering why it is considered to have originated in Wuhan rather than Wuhan simply being the first major outbreak where it was identified as a novel coronavirus. Is it always the case that hospitals will be capable of identifying a new type of virus based on some patients who look like they have the flu?
One thing that's known about covid-19 is that it has an unusual spread pattern. In some circumstances it might not spread too much (eg. average R0 is well less than 10) but in other circumstances where air is recirculating a lot or a particular patient is very contagious, it seems to spread a lot more. Couple that with many people being asymptomatic. So, what if it had been spreading in many places but Wuhan was simply the first place where it was detected? It seems to be capable of spreading without being detected for quite a while in many other parts of the world. (eg. Singapore's foreign worker dormitories)
In Russia, virus lab had major incident at Sep 16 2019. Paint job caused blast and fire, so responders come in to fight fire and STOLE SOME EQUIPMENT FROM LEVEL 4 VIRUS LAB, which was caught on video here: https://youtu.be/_w7SAeNcXA8?t=63 (look at man in uniform in background).
Almost correct. The "lab" was actually doing corona virus research, and funded by the US govt.
Corona is so contagious, that combined with Wuhan being an international airport that connects to Shanghai, the #8 international airport in the world, this was the perfect storm for a pandemic.
If by "funded by the US govt" you mean funded primarily by the Chinese government, with additional funding provided by the US and EU, due to the nature of the lab's work...
"Weird cold" in February checking in. Fever, back pain, chills, post nasal drip. Felt bad for ~3 days and then felt better. Getting antibody tested tomorrow, will report back.
Same here. Rushed to the hospital after two nights of not sleeping from the back pain and chills at end of Feb. First time I've ever taken an injection for pain relief.
Crazy, I had the exact same symptoms during last week of Feb / first week of Mar.
I was so wiped out that I was taking naps in a conference room at lunch. A friend of mine caught me and was surprised because normally I work through lunch, let alone sleep.
No cough, no fever but just this terribly uncomfortable feeling of congestion in my throat and upper chest. Best thing I can compare it to is postal nasal drip like you said.
I'm a family physician working in an outpatient office... there's just so many viruses that can explain those types of symptoms that are STILL more common than sars-cov-2.
I saw a 31yo 2/18 with primarily sore throat, aches/feverish (not documented), and again on 2/20 because the sore throat got significantly worse. I started feeling iffy 2/21 (Friday) evening and worse Saturday with a bad sore throat and fever around 102F, lymphadenopathy, this persisted for at least 2 days. I went to work on Tuesday and did a rapid strep (I did not feel I had strep but the other doctor wanted to do it)... I'm not really thinking that was covid19.
This is just about identical to my experience in early March. No (or at least no observed) fever, a distinctive but not awful sore throat, and intense fatigue. Urgent care clinic did not test for the virus, or even for the flu.
I still think there's a possibility this virus was already in the US before 2020. I don't think they ever found a cause to the "mystery respiratory virus" in Virginia from July 2019:
https://www.nbcwashington.com/news/local/health-officials-to...
> Three people have also died, but Dr. Benjamin Schwartz of the Fairfax County Health Department said Wednesday afternoon that those who died were "older" and had complex health problems. Officials don't yet know the extent to which the respiratory illness contributed to their deaths, he said.