Lakewood covid cases

[S209]

Refuah Shelaimah!

Any symptoms?

Headache, slight cough, felt a little unwell, otherwise ok B”H.

DW just developed a fever for the first time, which is weird.

[eyj]

What are you talking about? Less than 20% (an estimated 17.9%) remained asymptomatic.

Source
The best estimate here also did not factor in the limitation you raised- that these “asymptomatic” carriers may just as well be patients who have already recovered from COVID with lingering virus cells. Remember, the study was conducted in August.
So you’re saying that the testing perfectly captures the amount of people who currently have COVID? Got it.

Again, what is your point?

Not what I’ve seen
https://www.usnews.com/news/health-news/articles/2020-06-12/most-asymptomatic-coronavirus-cases-stay-that-way-cruise-ship-data-shows

[PlatinumGuy]

Not what I’ve seen
https://www.usnews.com/news/health-news/articles/2020-06-12/most-asymptomatic-coronavirus-cases-stay-that-way-cruise-ship-data-shows

You're reading that incorrectly. Majority of those who tested positive without symptoms were asymptomatic and not presymptomatic. But that entire cohort is only 20-40% of total Covid carriers

[S209]

Not what I’ve seen
https://www.usnews.com/news/health-news/articles/2020-06-12/most-asymptomatic-coronavirus-cases-stay-that-way-cruise-ship-data-shows

You should reread that article. It doesn’t say what you think it does.

[aygart]

You should reread that article. It doesn’t say what you want it to.

FTFY

[eyj]

You are correct. Early articles did give a very high percentage but that was revised sharply downward in later studies. For example
https://cmmid.github.io/topics/covid19/asymp-transmission.html

Regardless of percent asymptomatic, the dynamic  is still going to be there. Serology studies show that the official number of positives in a population are a fraction of the actual case numbers which means that the vast majority of cases never get tested. Even if most of these uncounted people are mildly symptomatic, if they now come in to get tested because they have more significant (flu) symptoms that brings up the numbers significantly.

[Lurker]

I'm really not sure what the argument is. If doctors in Lakewood say that the actual numbers are safely 5x what the reported cases are, and there are now more people testing because of other reasons (prevalence of other viruses), it stands to reason that more of the cases will now be caught/documented. It doesn't change the actual prevalence of Covid in the community, but it probably should cause people to revise the "5x" calculation.

[Euclid]

I'm really not sure what the argument is. If doctors in Lakewood say that the actual numbers are safely 5x what the reported cases are, and there are now more people testing because of other reasons (prevalence of other viruses), it stands to reason that more of the cases will now be caught/documented. It doesn't change the actual prevalence of Covid in the community, but it probably should cause people to revise the "5x" calculation.

The reason why they estimate the 5x number is because they're extrapolating based on previous waves and how those were tracked. The medical community in Lakewood has a tracker which is run by chemed (a large medical clinic), with the goal that all medical establishments will participate by voluntarily submitting information about positive cases (symptoms, previous positives etc.). While this is a noble and extremely useful project, the majority of practices have not been submitting their information (spoke to a couple of doctors about this; it's somewhat political). Additionally, there's a sizable portion of the community that won't test for ideological reasons. Therefore, chemed has been estimating that they're only tracking 20% of the true number.

[aygart]

I'm really not sure what the argument is. If doctors in Lakewood say that the actual numbers are safely 5x what the reported cases are, and there are now more people testing because of other reasons (prevalence of other viruses), it stands to reason that more of the cases will now be caught/documented. It doesn't change the actual prevalence of Covid in the community, but it probably should cause people to revise the "5x" calculation.

The 5x includes people tested at sites not reporting to this clearing house.

[Lurker]

The reason why they estimate the 5x number is because they're extrapolating based on previous waves and how those were tracked. The medical community in Lakewood has a tracker which is run by chemed (a large medical clinic), with the goal that all medical establishments will participate by voluntarily submitting information about positive cases (symptoms, previous positives etc.). While this is a noble and extremely useful project, the majority of practices have not been submitting their information (spoke to a couple of doctors about this; it's somewhat political). Additionally, there's a sizable portion of the community that won't test for ideological reasons. Therefore, chemed has been estimating that they're only tracking 20% of the true number.

I understand all of that. What I believe @eyj is saying is that many of those cases are now being caught, because people are getting tested for other reasons, such as trying to diagnose other illnesses. Where before someone who was exposed and had either no symptoms or mild symptoms would not have tested, now things like the flu are forcing people into urgent cares and doctors' offices, where they are getting testing (if only to rule out Covid).

This is where positivity rate becomes important.

[Lurker]

The 5x includes people tested at sites not reporting to this clearing house.

I'm not saying eliminate the multiples completely, I'm just saying revise it down to maybe 4x or 3x to account for people who are showing up at the doctor because of a cold, strep, the flu, or other seasonal issues, and are now testing when they wouldn't have otherwise.

[Lurker]

I'm the last person to start downplaying Covid. My personal opinion is that less weight should be given to case counts right now, and more attention should be focused on hospitalizations and positivity rates.

[eyj]

I'm the last person to start downplaying Covid. My personal opinion is that less weight should be given to case counts right now, and more attention should be focused on hospitalizations and positivity rates.

Agree with all of the above. This is a significant uptick and my theory is more academic than practical.

[S209]

I'm not saying eliminate the multiples completely, I'm just saying revise it down to maybe 4x or 3x to account for people who are showing up at the doctor because of a cold, strep, the flu, or other seasonal issues, and are now testing when they wouldn't have otherwise.

I'm the last person to start downplaying Covid. My personal opinion is that less weight should be given to case counts right now, and more attention should be focused on hospitalizations and positivity rates.

The inverse may be true as well. People are more likely to chalk it up to a cold/flu/other virus now that other things are going around.

Hospitalizations always follow cases, so the cases need to be given their proper weight so we don’t reach the point of hospitalizations. Positivity numbers are completely disregarded around town because most people don’t grasp the fundamentals of a positivity rate.

Total cases estimated by CHEMED is a fairly accurate way to gauge current spread, and they should use positivity in their calculation as well. The theory of more asymptomatic/lightly symptomatic people testing because of other viruses is certainly possible, but unlikely to skew the numbers in either direction too much in the grand scheme of things. Viruses go around in lots of places.

[S209]

You are correct. Early articles did give a very high percentage but that was revised sharply downward in later studies. For example
https://cmmid.github.io/topics/covid19/asymp-transmission.html

This is because much (most?) of transmission is presymptomatic, which wasn’t differentiated early (as they did not follow up with most patients to see if symptoms manifested later)

Regardless of percent asymptomatic, the dynamic  is still going to be there. Serology studies show that the official number of positives in a population are a fraction of the actual case numbers which means that the vast majority of cases never get tested. Even if most of these uncounted people are mildly symptomatic, if they now come in to get tested because they have more significant (flu) symptoms that brings up the numbers significantly.

It’s a potential theory, but the inverse can be true as well. You’re assuming that Lakewood is different than the rest of the world- but when countries around the world are shown to miss many cases, that includes many populations with other viruses going around as well, perhaps with some (but likely not massive, or else they would have been noticed by science) variation in detected cases/cases.

It’s not a theory I’d hang my hat on.

[Dirtyshirt]

Definitely other viruses going around Lakewood as well. Several family members have flu like symptoms. Negative covid tests and recent antibodies. Probably the worst I’ve felt since covid in March.  Just standard flu symptoms though. There is obviously a rise in covid numbers in the frum Lakewood  community, no doubt about it, but I really wonder if some of the increased positive numbers we are seeing are exacerbated by so many people testing due to symptoms that are actually caused by the run of the mill virus and incidentally testing positive for covid. Chemed ran out of rapids the other day and I understand that other places are busy as well.

Really wonder if these are truly "Definitely other viruses" or if these are people that are testing too early to show a result. Have they actually tested positive for flu or are they simply negative for Covid after 1 test. There are numerous cases of people retesting after negative results and then testing positive.

[avromie7]

Really wonder if these are truly "Definitely other viruses" or if these are people that are testing too early to show a result. Have they actually tested positive for flu or are they simply negative for Covid after 1 test. There are numerous cases of people retesting after negative results and then testing positive.

Other viruses go around on a pretty frequent basis.
What is too early to test? Is it common for people to test negative after symptoms already started?

[PlatinumGuy]

FWIW the PCR picks up other respiratory viruses. The labs should have data on other viruses circulating and it's probably reported to databases.

[eyj]

Really wonder if these are truly "Definitely other viruses" or if these are people that are testing too early to show a result. Have they actually tested positive for flu or are they simply negative for Covid after 1 test. There are numerous cases of people retesting after negative results and then testing positive.

Other family members tested negative on the PCR with recently Confirmed antibodies. I tested at least a couple days after significant symptom onset and just came back negative. Recently confirmed antibodies as well. Feel pretty lousy but no fever or cough. I’m going to say the overwhelming odds are that this is not a covid reinfection.

[S209]

What is too early to test? Is it common for people to test negative after symptoms already started?

Yes. Depending on the day since infection/exposure, the false negative rate can be up to 50%. My mother tested negative a day before her positive, a day or two after symptom onset. Even at the period with the highest level of viral shed the false positive rate is small but significant.

FWIW the PCR picks up other respiratory viruses. The labs should have data on other viruses circulating and it's probably reported to databases.

The tests being administered are 99.5% specific to COVID-19. IINM the only viruses they can detect are coronaviruses.