Covid-19 vs 1918 influenza

Written By: - Date published: 5:29 pm, August 15th, 2020 - 67 comments
Categories: covid-19, health, history, science, Social issues - Tags: , ,

It has been interesting and rather disheartening reading a number of idiotic articles in the NZ Herald in recent days calling for a change in the way that we handle outbreaks of covid-19 in NZ. Implicit in the articles was that the risks that covid-19 poses to the population of NZ over time are less than the economic damage.

So far I haven’t seen anything that convinces me that this is the case.

One basic precept that is common to these dialogues is that covid-19 is no worse than a bad flu season. That is complete crap written by lazy fools who haven’t bothered to look at its epidemiology in any depth. Nor apparently can they are bothered by examining history of the 1918 epidemic.

For instance consider the research letter from the JAMA Network Open referred to in The New York Times entitled “In N.Y.C.’s Spring Virus Surge, a Frightening Echo of 1918 Flu“. This did a analysis and comparison of public data from New York with actual mortality figures from the surge period of the 1918 flu epidemic and comparing it to the actual mortality rates at the peak surge in 2020.

In both time periods, they compared with the mortality rates for the same period in three previous years prior to the outbreaks to determine a baseline mortality rate. This approach effectively eliminated most questions about the cause of death and allowed for better inter-period comparisons.

The 1918 influenza pandemic is the deadliest in modern history, claiming an estimated 50 million lives worldwide, including 675,000 in the United States.

By some measures, the toll of the Covid-19 surge in New York City this spring resembled that of the 1918 flu pandemic. In March and April, the overall death rate was just 30 percent lower than during the height of the pandemic in the city, despite modern medical advances, according to an analysis published on Thursday in JAMA Network Open.

Many people liken Covid-19 to seasonal influenza while regarding the 1918 flu pandemic as a time of incomparable devastation, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston and lead author of the analysis.

“But in reality, what 1918 looked like is basically this,” he said, except with dead bodies in refrigerated trucks rather than piled in the streets.

“I want people to realize the magnitude of what we just saw this spring, what we’re seeing now again, is truly historic,” Dr. Faust added.

Historians who have studied the 1918 pandemic agreed. “It’s especially important to the pandemic deniers who are saying, ‘Oh, this isn’t any worse than, say, the 1968 flu pandemic,’” said Dr. Howard Markel, a historian at the University of Michigan.

“This is a pretty deadly pandemic. And it’s only getting worse — that’s the scary part.”

New York Times: In N.Y.C.’s Spring Virus Surge, a Frightening Echo of 1918 Flu

In New York in 2020 between March 11 and May 11th 33,500 people died. This was about 202 deaths per 100,000 people-months. It was about 4 times that death rate for the same period in the previous three years. It was despite the best of medical treatment that is available in one of the richest cities per capita in the world.

In New York of 1918 in October and November, there were 31,589 deaths giving about 287 deaths per 100,000 person-months – slightly higher than 2020. However this was only about 3 times higher than the death rate in same period for the three years prior.

The cumulative deaths over the months added up.

In the end, 4.7 of every 1,000 New Yorkers died of the 1918 influenza, a lower rate than those of other cities on the East Coast: 6.5 in Boston and 7.4 in Philadelphia, Mr. Wallace wrote.

“New York did not suffer as badly as some other cities,” said Paul Theerman, the library director at the New York Academy of Medicine. “It’s always had a vigorous public health movement,” he said. “And luck.”

New York Times: “What New York Looked Like During the 1918 Flu Pandemic“

The graphs of mortality over the comparable period are striking.

Deaths in New York City During the 1918 H1N1 Influenza Pandemic and the Coronavirus Disease 2019 (COVID-19) Pandemic and During the Preceding Years of Both Pandemics.
JAMA Network Open: “Comparison of Estimated Excess Deaths in New York City During the COVID-19 and 1918 Influenza Pandemics” Figures A, B

1915-1917 was a much more unhealthier time than 2017-2019 – the base level of deaths in 1915-1917 in New York was higher than in 2020. Back then medicine was really primitive. It wasn’t in a war zone. Essentially the United States had remained at peace inside their own country – merely sending troops in 1917 to Europe.

Given the enormous leaps in medicine over the past century, the similarity in death rates today and in 1918 is particularly disconcerting, she and other experts said.

In 1918, a vaccine against the flu mistakenly targeted Haemophilus influenzae, a bacterium, instead of the flu virus. Penicillin — which would have vanquished the bacterial pneumonia that killed many people with the 1918 flu — would not be discovered for another decade. Intravenous fluids to hydrate the severely ill came into use even later.

Without these tools, the hospitals of 1918 were little more than places to rest.

“There was no such thing as an intensive care unit, there was no ventilator, there was nothing,” said Dr. Eric Topol, director of the Scripps Research Translational Institute in San Diego.

“I mean, they basically had masks and distancing. We have so much more, and yet the mortality is roughly comparable.”

New York Times: In N.Y.C.’s Spring Virus Surge, a Frightening Echo of 1918 Flu

As the research paper succinctly points out:-

One limitation of this study is that a direct comparison of the native virulence of the 1918 H1N1 influenza strain and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not possible. It is unknown how many deaths due to SARS-CoV-2 infection have been prevented because of modern interventions not widely available a century ago, including standard resuscitation, supplemental oxygen, mechanical ventilation, kidney replacement therapy, and extracorporeal membrane oxygenation. If insufficiently treated, SARS-CoV-2 infection may have comparable or greater mortality than 1918 H1N1 influenza virus infection.

These findings suggest that the mortality associated with COVID-19 during the early phase of the New York City outbreak was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.

JAMA Network Open: “Comparison of Estimated Excess Deaths in New York City During the COVID-19 and 1918 Influenza Pandemics” My bold and italics.

My view is that it is quite clear that covid-19 is clearly worse than the 1918 pandemic in terms of mortality in humans. The level of lock down present in New York in the 1918 was far lower than was present in New York of 2020. These public health measures limit the spread of the disease and the rate of infection considerably.

Covid-19 has a much longer incubation period, people are infectious before they are symptomatic whereas with H1NI victims feel quite sick when they are become infectious, and it lasts a lot longer in its effects and infectiousness. Where it breaks loose into a city without adequate social distancing or control, it will overwhelm the medical system in the way that it did to New York in 2020.

As an aside, compared to the 5.5 million in New York in 1918 our 1918 response can only be described as chaotic and poorly run. I wrote about this in a previous post “On Mike the Moron and handling infectious diseases“. This was reflected in the results – it is estimated that New York had 20,000 deaths directly from influenza – about 3.6 people per thousand. NZ was a population of about 1.15 million in 1918 and had 9,000 deaths – about 7.8 people per thousand in a much lower density environment.

But covid-19 is a far greater long term risk. This corona family of viruses isn’t like H1N1 influenza. There are no signs that it is waning over 2 months as influenza did in every area that it hit hard.

It isn’t going to disappear to be a mild recurring disease. From the available data to date, it appears to be unlikely to become something that as a population we can acquire a herd immunity to naturally. By the time that immunity is acquired by a sufficient proportion of the populations, it seems likely that the immunity levels in some of the earlier infected will have waned enough to allow the epidemics to continue.

The reported known levels of herd immunity in Stockholm are appalling low compared to what is required to limit spread. It looks to me like that level of herd immunity will merely slow the rates of infection to something that will cause waves of reinfection. Based on the data available about immunity exhaustion of patients infected with covid-19, we’re likely over time to find that having covid-19 in our communities just causes a slow progressive deterioration in overall health of communities.

Regardless strategies human societies take, over time covid-19 with limited mitigation appears likely to impose large significiant costs on our economies for decades or even hundreds of years. It is more likely to be akin to the black death in its impacts than either measles or influenza.

Unless we beat the odds and find a effective vaccine. Or society changes radically to limit its impacts.

In the meantime I’m content to be a slow follower in NZ that got lucky. The economic cost of learning how to lock the disease out by suffering the odd lock down is economically cheaper than having it become endemic when there isn’t a vaccine or effective treatment. Meanwhile we should keep watching the infected parts of the world to see what works and what does not.

But I’ll get around to writing another post about that topic.

67 comments on “Covid-19 vs 1918 influenza ”

  • Comments are now closed

  1. dv 1
    15 August 2020 at 6:10 pm

    'It was despite the bets of medical

    Best?

    Love your analysis LP

    • lprent 1.1
      16 August 2020 at 12:35 am

      Fixed. I'm surprised that was the only one you picked up. I was blocked on some code today, so I kept ducking back and tweaking this every time I got blocked. I'm mostly surprised on a reread that it seems almost coherent.

  2. Incognito 2
    15 August 2020 at 6:14 pm

    Unless we beat the odds and find a effective vaccine. Or society changes radically to limit its impacts.

    QFT

    It seems that (too?) many are still hedging their bets on the first scenario and are not even willing to contemplate the second one 🙁

    • Draco T Bastard 2.1
      16 August 2020 at 12:25 am

      The second requires the end of globalisation and there are many who oppose that because it will represent a massive decrease in their income. Essentially, large businesses that sell to the world now will become small businesses that sell locally under the second option.

  3. georgecom 3
    15 August 2020 at 6:15 pm

    wow,what a morbid prognosis. Not arguing with you, but commenting on the conclusions you arrive at. I hope they are proven wrong. Heaven help us if what you write turns out to be the true picture.

    • lprent 3.1
      16 August 2020 at 12:44 am

      So do I. However at present this seems to me to be the most likely set of scenarios.

      I think we'll get viable vaccines – eventually. I'm also sure that of the 168 (vague memory that is the last one I read) vaccines currently being developed we will mostly get duds. Either they don't work well at preventing covid-19 or they cause the immune system to overreact – which was the problem with SARS vaccines.

      The real issue is that it seems likely that the period of time that the effective vaccines confers immunity for will be short. For a good briefing on vaccines issues see this economist article

      Treatments seem more likely.

  4. SPC 4
    15 August 2020 at 6:31 pm

    In the meantime I’m content to be a slow follower in NZ that got lucky. The economic cost of learning how to lock the disease out by suffering the odd lock down is economically cheaper than having it become endemic when there isn’t a vaccine or effective treatment.

    Totally agree. But we will have a problem preserving our bubble because

    1. those who doubt we can find a vaccine want us to accept community spread (more deaths sooner because we cannot bubble forever).

    If we did that and then got a vaccine there would have been preventable death, preventable serious illness, and preventable long term health damage.

    2. those on the right who put open border economy before other weaker people – poverty/poor health, aged as a matter of class interest. And the economic damage would in fact be greater.

    • Enough is Enough 4.1
      17 August 2020 at 11:28 am

      I agree with your first point.

      I also think civil disobedience will become an issue if no vaccine is developed and we keep going in and out of lockdowns over a period of years.

      People won't quietly sit at home and comply forever.

      That would mean the state will need to intervene with more heavy handed surveillance, which again would cause even more civil unrest.

      There is no easy answer or end game here.

  5. In Vino 5
    15 August 2020 at 6:44 pm

    Thank you LPRENT

    It seems that many people may be underestimating the seriousness of this virus just as badly as they underestimate or ignore the threats of global warming.

    Distressingly few will listen to what they want to see as unhinged prophets of doom. It's enough to make one feel a bit like Benjamin the Donkey in Orwells' Animal Farm.

  6. Patricia Bremner 6
    15 August 2020 at 6:51 pm

    Thanks for this in depth look at a sober position.

    BAU should be treated as a mirage, we need new skills to survive.

    We all need to value what we have far more.

    Some will try to corner resources.

    The desperation of the vaccine buying happening in the UK right now is an indication of what the “wealthy” nations will do.

    • SPC 6.1
      16 August 2020 at 8:35 am

      If the Oxford vaccine is viable that would be good. It's already in mass production in India so its ready for supply as soon as it passes the stage 3 trial. The sheer scale of production (China and Russia will have their own) so as to supply India is good for many others.

  8. Sabine 8
    15 August 2020 at 7:58 pm

    yes, pretty much what it is.

  9. Andrew 9
    15 August 2020 at 8:56 pm

    It is very difficult to comprehend the economic hardship reality when you only use NY statistics for almost everything in your article.

    Here are some facts you seemed to not find

    98-99% of people worldwide who died of Covid is 82years old and already dying of another condition.

    [lprent: Link to the authoritative source missing? ]

    Most countries suicide rates that have been able to report them almost doubling. Most can directly related this to debt, depression and inability to imagine a future

    [lprent: Link to the authoritative source missing? ]

    in Thailand for example, 83 old people died of Covid. Every two days 56 die from suicide (previous daily numbers were 28).

    So every 2 days the same number of young healthy people kill themselves as a direct result of no income from Covid related lack of income as old sick people died of Covid in 6 months.

    [lprent: Link to the authoritative source missing? ]

    I do not know the facts for NZ, but perhaps if you looked globally and compared easy to find suicide rates locally you might be able to see why many people feel the cure is worse than the disease

    [lprent: The post was about the comparison on the 19i8 and 2020 pandemics in a urbanised environment to see how much different the diseases really were.

    New York was the obvious choice because there are clearly defined statistics allowing a direct comparison between the 1918 pandemic mortality rate and those of 2020. It was a highly urbanised area in 1918 and also in 2020. In both periods it launched a particularly strong and well guided local response to the local epidemic. It was also not a European city involved in the WW1 – removing a confounding factor. It was a case of being able to compare an big apple with a big apple to look at the differences between two pandemics.

    Here are some facts that you seemed to not be able to find…

    I can’t see any recent analysis by age world wide. Maybe someone else can pull it out of the who.int – but I can’t see it?

    Here are the statistics by age for countries with reasonably clear statistics – none of them support your fantasy. The nearest would be the ageing population in the UK. Yes – the deaths are higher in the over 50s age groups and higher in the older age groups.

    But there is nothing like your fantasy of 98-99% of deaths at or over 82 years old.

    covid-19 deaths in the United States by age.
    covid-19 deaths in the Sweden by age
    covid-19 deaths by age in UK (Figure 6)

    You will note that each of these links shows where they sourced their data from. US Center for Disease Control, UK Office for National Statistics, and Swedish Public Health Agency (you might need to get a subscription to statistica to see that).

    Similarly I can’t see any reported up spike in suicides world wide in the order of magnitude you are postulating. Double? Across the world? You must be a blithering idiot if you think that wouldn’t have been noticed in statistics.

    In NZ the nearest thing that I can find an effect so far has been a 33% increase in the number of calls to support services – hardly surprising when people are stressed and cooped up. See the section on Mental Health concerns in here.

    If you want to make an assertion of fact on this site then you are expected to provide authoritative sources. If you don’t then ultimately one of the moderators will ban you for deliberately lying. If it is just your unsubstantiated opinion rather than a fact (as all of your assertions appear to have been) then say so.

    Personally I think you deliberately lied – and a particularly stupid one. I can’t be bothered wasting time on someone who is incapable of creating a viable argument. If I see you comment in this style under any name on my post again, I will ban you from the site. ]

    • PaddyOT 9.1
      16 August 2020 at 12:38 am

      Dear Andrew,

      In regards to your never mind them comment

      "98-99% of people worldwide who died of Covid is 82years old and already dying of another condition."

      My parents both 86 years old and going storng, have actually worked their whole lives and still are contributing generously to their community in active ways. They are not wealthy by any means, they are not diseased nor in a rest home either.

      They are much loved by over 50 plus descendants aged a few months to 65 years old ( ie. nearly technically to be dead soon too). By the way we are all also useful and contribute to many other's wellbeing on a daily basis. Active atruism and getting on with the tough shite mutually supporting others is at the core of our parent's actions and values.

      The adults in this clan are also paying members of the tax system which supports the recovery from Covid19.

      We would love you to personally come and visit our clan at your convenience and face our treasured Ma and Pa. They would actually listen to your theory as to why you think they should be sacrificed and despatched early.

      Kind regards Paddy

      • PaddyOT 9.1.1
        16 August 2020 at 12:50 am

        Was also thinking of the other Mum who died last year aged 97 years, she would have loved to come and give you a piece of her still nimble mind. Then with her dexterity she would have delivered a " fong up the arse".

    • Poission 9.2
      16 August 2020 at 12:50 am

      In NZ we had the lowest death rate for covid for all OECD countries,and had a decrease in deaths from all causes.

      There was also a significant decrease in injury statistics ie a decrease in acc claims,decrease in crime,excess drug use,burglaries,vehicle accidents,these also affected the economy negatively as they would have reduced economic activity in those areas,which suggest that economic measurement alone is fatally flawed.

      https://blogs.otago.ac.nz/pubhealthexpert/2020/07/10/weekly-deaths-declined-in-nzs-lockdown-but-we-still-dont-know-exactly-why/

      https://blogs.otago.ac.nz/pubhealthexpert/2020/07/22/nzs-team-of-5-million-has-achieved-the-lowest-covid-19-death-rate-in-the-oecd-but-there-are-still-gaps-in-our-pandemic-response/

    • UncookedSelachimorpha 9.3
      16 August 2020 at 9:39 am

      Haven't checked all this (and you have provided no references) – but at a glance seems odd. Total Covid-19 deaths recorded for Thailand seems to be 58 total? You mention "83 old people"

      In New Zealand reports are that suicide rates fell during lockdown:

      "The provisional trend suggests the suicide rate was lower during the Alert Level 4 period than the 33 days prior to it (22 February – 25 March 2020).

      "The suicide rate during Alert Level 4 was also lower than the rate for the same period from 2008 to 2020."

      Here is a more nuanced discussion of the potential effect of Covid-19 on suicide and mental health, one thing is clear – the effects are not known yet. And of course, how much mental stress is caused by lockdowns, and how much by the effects of the virus itself (fear of death or losing loved ones)?

      The effect of crises on suicide rates will depend on the situation before the crisis, the nature of the crisis and the support offered during the crisis. For example, poor farmers in India commit suicide in the face of natural disasters etc – but this is probably because they are often already in heavy debt and utterly impoverished (and stressed!) before the disaster. On the other hand, both World Wars did not increase suicide rates overall and possibly decreased them.

      If people feel we are all working and suffering together to overcome a common problem, I don't think suicide rates need to rise while we deal with Covid. It is much worse if you are poor and without a job, while the rest of society seems to be sailing along just fine.

      Stong support (economic and social) for everyone is what we need!

      • Draco T Bastard 9.3.1
        16 August 2020 at 11:32 am

        In New Zealand reports are that suicide rates fell during lockdown: "The provisional trend suggests the suicide rate was lower during the Alert Level 4 period than the 33 days prior to it (22 February – 25 March 2020). "The suicide rate during Alert Level 4 was also lower than the rate for the same period from 2008 to 2020."

        Possibly because everyone was staying home creating a better feeling of community and belonging and thus decreasing loneliness and other factors that lead to suicide.

        If true then it would indicate that the economy was the problem.

        EDIT:
        No, I do not know how 9.3.1 got there as the page stopped responding to me. It can safely be removed.

    • Craig H 9.4
      16 August 2020 at 10:20 am

      You make it sound like dying from Covid is a merciful release for a geriatric lingerer, when in reality, most accounts suggest it is a very unpleasant way to go.

    • Wayne Mapp 9.5
      16 August 2020 at 7:37 pm

      Have a look at Hooton’s article in the Herald (and no, I am not linking it, it is readily available) on the age spread. The previous author is not far wrong.

      Now as it happens I disagree with the view that NZ should follow the Swedish approach. Both major parties agree that eradication is the correct path, at least for the foreseeable future. We are an island nation and should be able to achieve this. Those who want a different approach can vote for other parties. They have that right and have the right to express their views. The medicos who want censorship on this are wrong.

      I personally support stricter border control. Not the 3,000 or 4,000 per week, more like 1,000 or so. It will mean doing a priority list of citizens and PR’s. Quite a few medicos I know want this. They know the border and quarantine has not been well managed. Too many staff with insufficient skills.

      As it happened I had quite a significant accident yesterday and had to have an operation at Middlemore, because of their specialist skills. I was super impressed with everyone working there. Our medical workforce is a true United Nations. Which I knew since I have been a heavy user of our hospitals in the last three years. Middlemore is in way better condition than all the scare stories would indicate, though it a bit of a rabbit warren.

      • McFlock 9.5.1
        16 August 2020 at 8:03 pm

        oh dear about the accident – get well soon.

        As for numbers, as long as things aren't strained I'm not worried whether it's 4k or 40k a week, as long as they're all tested and properly isolated (and this cluster has revealed some things that need to improve in that regard).

        Especially if this thing turns out to like frozen freight in very rare circumstances, and we're the ones who noticed because its low occurrence meant it only becomes obvious in a zero-rate environment.

        • Poission 9.5.1.1
          16 August 2020 at 8:17 pm

          Numbers are really restricted to the availability of ICU beds,fast shocks such as CHCH events,or white island we were overcapacity overnight.

          OZ with double the capacity limits arrivals to 4k.

          • McFlock 9.5.1.1.1
            16 August 2020 at 10:50 pm

            I think there was also mention of lack of suitable iso facilities? I recall reading in odt that they'd scoped out Dunedin, but felt none of the hotels were suitable. Dunno what the specific criteria they were working on was, but dunners has more than a few hotel from 1 to 5 stars, so the requirements must be pretty precise, or just rule out Dunedin completely (but Rotorua is fine?)

  10. Macro 10
    15 August 2020 at 9:21 pm

    Great article LPrent. Do you mind if I share some of it with an online community in the US at WTF? They would be very interested to read this.

    Incidentally Dr Anthony Fauci pretty much agrees with your analysis:

    If the United States allowed coronavirus infections to run rampant to achieve possible herd immunity, the death toll would be massive, especially among vulnerable people, the nation’s top infectious doctor said.

    Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, explained the risks during a live Instagram session.

    "If everyone contracted it, even with the relatively high percentage of people without symptoms … a lot of people are going to die," Fauci said.

  11. Robert Guyton 11
    15 August 2020 at 9:36 pm

    "He seems to represent a less dangerous future for National and – given there will occasionally have to be National governments – that needs to be encouraged. All the more reason for centrists inclined to (sometimes) support National to vote AGAINST the party this year – to crush the Collins leadership and drive her faction (promoted by Cameron Slater and his allies through dirty tricks and blackmail, as outlined in Dirty Politics) out of the party."

    Dr Shane Reti, National's Health Spokesman, applies the scalpel to the Party.

    http://lefthandpalm.blogspot.com/2020/08/the-diagnosis-isnt-good-judith.html

  12. Andre 12
    16 August 2020 at 7:15 am

    This Vox piece has a good rundown of some of the approaches being tried for creating a vaccine that are different to older established vaccines. The hope is these new technologies will allow faster development and production ramp-up. But it seems to me a completely new technology also carries a lot of questions and unknowns around rare side-effects and interactions.

    https://www.vox.com/2020/8/13/21359025/coronavirus-vaccine-covid-19-moderna-oxford-mrna-adenovirus

  13. SPC 13
    16 August 2020 at 8:28 am

    Back in 1918, it was the later wave Sept-Dec 1918 that killed most of the Americans

    At the moment the official total is 160,000, but the number of deaths is 200,000 higher than for the previous year.

    The American population is over 300M – so at over 300,000 deaths would be 1%. On current trends it will do so by the end of the year. Long before a vaccine is available. For reference to us that is 50,000 people.

    • Andre 13.1
      16 August 2020 at 8:42 am

      Sneaky things, those zeroes and decimal points. 300,000 deaths in 300 million population is a 1 per thousand death rate, ie 0.1% not 1%. Transfer that to NZ, that would be 5,000 dead not 50,000.

      New York City is at around 23,500 deaths in 8.4 million population, so that's 0.28% population death rate. There's a few zip codes where the population death rate is over 0.5%.

      https://www1.nyc.gov/site/doh/covid/covid-19-data.page

      (scroll down that NYC page for interesting data broken out by age, ethnicity, poverty etc)

      • SPC 13.1.1
        16 August 2020 at 8:58 am

        Thanks. I'll get some sugar in to fuel/activate a higher per centage of the gray matter.

      • lprent 13.1.2
        16 August 2020 at 9:55 am

        Yep. 1% in an area seems to be the culmative worst so far.

        But the real issue with covid-19 in my view is that so far it doesn't appear that it stops making people sick and killing.

        It hasn't hit that high a percentage of people in any one population outside of confined spaces like food processing cool stores and prisons. That means that whenever the lockdowns and social controls are relaxed – it reappears and infects another bloc of the population – and adds more bodies to the cumulative total.

        That is totally unlike H1N1 in 1918-20 which mostly did one big sweep through any population and then was unable to do another big sweep again, probably mostly because of herd immunities. That strain of the H1N1 effectively became extinct.

        What I am worried about with C19 is that infection conferred immunity will be weak and it will keep sweeping through populations for decades because there never gets to be a herd immunity

        • SPC 13.1.2.1
          16 August 2020 at 10:19 am

          The long recovery will also become a growing concern, but worse will be the permanent health damage to some.

        • PaddyOT 13.1.2.2
          16 August 2020 at 4:54 pm

          Prof. Michael Baker​ talking on the 3 main strategies, elimination, suppression, or mitigation.

          He says "Mitigation, the least vigorous method, could include so-called herd immunity approaches.
          Sweden tried mitigation, but it hadn’t worked, and the Nordic country now used a suppression-like approach.

          Baker says, herd immunity theory had major problems, where the pandemic had been intense, antibody testing results were unimpressive.

          Baker said tests elsewhere often showed only 5 or 10 per cent of people in outbreak hotspots acquired antibodies.

          Even if herd immunity was viable, probably at least 60 per cent of New Zealanders would likely have to get infected. Baker said some modelling indicated that would mean 15,000 people would die, if death rates were only 0.5 per cent.

          That estimate didn’t account for additional deaths when overwhelmed health systems couldn’t help people sick with non-coronavirus illnesses, or those seriously injured in accidents."

          http://www.stuff.co.nz/national/health/coronavirus/300082182/coronavirus-elimination-of-covid19-still-best-strategy-for-nz-experts-say?cid=app-android————-

          Worrisome, is that modelling at this point to predict outcomes for NZ still has unknown risks if choosing mitigation models like herd immunity. Uncertainty of what a government might choose to do is also worrisome.

          Modelling of risk factors has only had a relatively short time frame to observe the disease's progress on which the studies of Covid19 come from.

          In a NZ scenario discussing applications of the studies of other 'populations' has unknown consequences if mitigation such as herd immunity is applied.
          The models of other populations of Covid19's behaviour are yet to be observed with the unique variables in a NZ setting. ( and hope they never will be tested )

          A factors that is unique in trying to predict NZ mortality rates during a Covid19 outbreak include the current health status of NZers. ie. What is the risk already posed for those with 'poor' health ? – An example NZ MOH statistics show 1 in 3 adults in NZ are obese and that this has the potential to increase the mortality rates above predicted outcomes of other countries' models.

          https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-statistics

          NZ's diversity of ethnicity also challenges the predictions of impacts for New Zealand.

          https://www.nature.com/articles/s41366-020-0635-2

          https://www.newshub.co.nz/home/world/2020/07/pacific-islanders-living-in-united-states-significantly-overrepresented-in-covid-19-statistics.html

          • lprent 13.1.2.2.1
            16 August 2020 at 8:59 pm

            Baker said tests elsewhere often showed only 5 or 10 per cent of people in outbreak hotspots acquired antibodies.

            That seems to be consistent with the majority of people getting mild symptoms (haven't seen data linking severe symptoms with antibodies yet – but I expect them). The problem with antibodies is that b-cell production is late in the immune responses.

            There seems to be little available data on t-cell responses to covid-19 recovered patients. Mostly what I see are articles and articles complaining that the data isn't available or just started being collected 🙁 From the limited data reported (9 cases!) it looks like t-cells are present in covid-19 patients.

            Hearing that SARS patients have active t-cells against covid-19 after 11 years was somewhat more interesting. It suggests that stopping SARS vaccine development was a really bad idea – even if the disease had gone extinct in human populations.

            But in 20:20 hindsight you get the idea that there is a problem with stopping research too early. I suspect that a SARS vaccine would have been particularly effective against COV-2

            • PaddyOT 13.1.2.2.1.1
              16 August 2020 at 10:56 pm

              Looking for information on the different methods of vaccine development being attempted was a minefield in itself.

              I thought this link was succint discussing the four current scientific approaches in an understandable way. Thought it was better to look then wait for a Gerry theory.

              "..dead ‘subunit’ vaccines and live (attenuated) vaccines. Novel approaches are also in the works, such as viral vector and nucleic-acid based vaccines."

              https://www.science.org.au/curious/people-medicine/finding-vaccine-covid-19

              At the end of the article doubt was cast I thought.
              "Due to recent technological advances, scientists are confident that one of these approaches—or another technique altogether—will be successful in producing a vaccine." Kind of gets one's hopes up then yeah…nah.

              It talks of at least another 12 to 18 months from current trials. The interesting one was that it seems the recent announcements of vaccines are more the 'passive ' methods you talk about with antibodies.

              I am uncertain how public will be informed of how the eventual vaccine/s perform. A Russian job?? ( bad pun)
              I also think there has been little space given by all parties at a crucial time to help a fuller understanding of real impacts of their election choices as you have outlayed them. Thanks for that.

    • SPC 13.2
      16 August 2020 at 8:53 am

      The rise in infections in Europe seems particularly linked to activities like barhopping, clubbing and partying among younger people, as well as the rush to welcome international visitors and reopen tourism and its related activities.

      the U.K. Joint Biosecurity Center, for example, has suggested that an acceptable incidence for Britain is 1,000 symptomatic new cases per day

      This should be a cause for serious concern. The recent experiences of Israel and the state of Victoria in Australia show that even a handful of daily new cases can easily become hundreds and thousands.

      https://www.nytimes.com/2020/08/14/opinion/coronavirus-europe-vacation.html?campaign_id=39&emc=edit_ty_20200814&instance_id=21278&nl=opinion-today®i_id=105215441&segment_id=36110&te=1&user_id=9142031648891a79204ee9b70e83177e

      To sum it up – Dr Devi Sridhar chair of global public health at the University of Edinburgh.

      We Will Pay for Our Summer Vacations With Winter Lockdowns. This was Europe’s chance to beat back coronavirus before winter comes. We’re wasting it.

      He calls for Europe to adopt the border quarantine for travellers while closing down local cluseters with mass testing of contacts as we here are doing etc.

  14. greywarshark 14
    16 August 2020 at 11:13 am

    edit
    Misinformation discussed on Radionz Media Watch this morning. It means primarily that we miss information we should know and we get confused in the changing scenarios we face.

    https://www.rnz.co.nz/national/programmes/mediawatch/audio/2018759504/covid-19-confronting-the-deluge-of-conspiracies-over-the-latest-lockdown
    David Farrier (documentary maker and Spinoff contributor) had a lot to say in an authoritative manner and I didn’t accept some of what he said and wondered about his background.

    It is unfortunate that his name and David Farrar’s (Kiwiblog) are alike. What a coincidence.

    • SPC 14.1
      16 August 2020 at 11:46 am

      He wrote of his concern about conspiracy theory spread here.

      https://webworm.substack.com/p/im-just-outlining-facts-watching

      His expertise is probably in weird stuff journalism, including the great tickling blackmail scam. A local verison of Theroux, get alongside these weird people and relate to them. On CT his advice to gently wean people away from the lie, by connecting and understanding is consistent with psychological advice about how to change peoples opinions.

      • greywarshark 14.1.1
        16 August 2020 at 5:16 pm

        Thanks for that SPC – sounds reliable and thoughtful. In the clip of protest in Whangarei I saw what seemed to be the flag of the United Tribes of NZ 1835 style. Is that a sign of the negativity expressed by the Maori academics coming up with counter-productive stuff about racism because of government protecting Maori with quarantine measures where necessary to prevent them spreading infection amongst each other?

        My feeling about the spread of conspiracy theory is to stop using social media so much, and listen to news on radionz and private to get two lines of thought. Drop most of tv, it's high artificial colouring rarely seems to be adjusted in homes I go in, and it seems equivalent to getting too much sugar in your diet, leading to obesity in weight, rotting teeth, and diabetes. (I've two of those already so can speak from experience.) Read the papers, it encourages them to keep trying! You can note and trace s..t faster from reading than anywhere else I think.

  16. Sione 16
    16 August 2020 at 6:48 pm

    Seeing how bad it is only a few months in, imagine a few more waves. I think the world is entering a great depression like the 1930s, if we aren't in it already. If we only have to wait another year to get a vaccine, a great depression is actually the best-case scenario.

    But imagine all this by the same time next year, and still seemingly no closer to a vaccine. Then another year… then another. What then?

    Worst case scenario: human society itself breaks down. The longer this goes on with no light at the end of the tunnel, despair could set in and things go rapidly downhill like a dystopian novel.

    > over time covid-19 with limited mitigation appears likely to impose large significiant costs on our economies for decades

    That is true, but it wouldn't take decades for the psychological toll of multiple waves with no end in sight to cause society to snap on a mass scale. 3 years? 5 years? We can avoid complete chaos here in NZ with elimination.

    Ultimately, humanity needs a global solution. "Socialism or barbarism!"
    I hope we do get a vaccine.

  17. greywarshark 17
    16 August 2020 at 10:01 pm

    Victoria is in an extended state of emergency over Covid-19 for 4 weeks from 16 August. Schools will remain open, old people have special shopping hours.

    A state of emergency and a state of disaster – Victoria has both running at the same time. Explanation: https://www.abc.net.au/news/2020-08-16/victoria-state-of-emergency-disaster-explained-coronavirus/12563680

    15/8 Victoria records 303 new infections in fourth day of decreasing number of active cases

    15/8 The number of cases without a known source in Victoria has reached 3383.
    However, Premier Daniel Andrews said today this figure is not a cause for concern.

    16/8 Victoria records for this day 279 new cases, 16 deaths.
    https://www.9news.com.au/national/coronavirus-australia-live-updates-august-16-influencer-lockdown-restrictions-victoria-covid-19-cases-new-zealand/cb76659f-7732-49f6-94e9-c0752311ca03

    https://www.abc.net.au/news/2020-08-16/which-countries-have-zero-cases-of-coronavirus-how/12555562

  18. lprent 18
    17 August 2020 at 8:34 am

    A report in NYT this morning looks a bit more hopeful about immune responses.

    Even mild Covid-19 cases confer ‘durable immunity,’ new studies find.

    Scientists who have been monitoring immune responses to the coronavirus for months are now starting to see encouraging signs of strong, lasting immunity, even in people that developed only mild symptoms of Covid-19, a flurry of new studies has found.

    Disease-fighting antibodies, as well as immune cells called B cells and T cells capable of recognizing the virus, appear to persist months after infections have resolved — an encouraging echo of the body’s robust immune response to other viruses.

    and some notes about why some of this data has been so slow to arrive.

    Research on the coronavirus is proceeding so quickly, and in such volume, that the traditional review process often cannot keep pace. For the studies discussed here — as with un-peer-reviewed studies in general — The Times arranged for several experts to read and evaluate them.

    Although researchers cannot forecast how long these immune responses will last, many experts consider the data a welcome indication that the body has a good chance of fending off the coronavirus if exposed to it again.

    I'll have a peek through whatever is visible later after work. But seeking data about possible reinfection immunity is way better than rushing forward in a blithe presumption that there is a viable immune response against reinfection. When you see the times involved for determining that there is a viable immune response from test vaccines for covid-19 you realise how crucial it is – it requires months just to test that and to look for adverse responses. Then of course there is a question about how long the immunity persists for.

    The Chinese are testing at least one of their vaccines in the UAE simply because there isn't enough community transmission covid-19 in China to test with. The oxford vaccine is getting phase 3 testing in several countries including Brasil to ensure that suppression measures don't cut into the results.

    President Jair Bolsonaro’s cavalier handling of the crisis has made Brazil the ideal test environment. "Coronavirus Crisis Has Made Brazil an Ideal Vaccine Laboratory". I suspect that will be his sole claim to have any historical impact. He even makes Donald Trump look vaguely competent.

  19. SPC 19
    17 August 2020 at 12:20 pm

    Those who want a daily overview of what is going on around the world could do worse than follow this guy on You Tube.

    PS He reckons that the virus spreads further on cigaratte smoke, which raises issues for the social distancing at the managed isolation centres.

  20. Jeremy 20
    17 August 2020 at 4:07 pm

    Out of all the absurd and hysterical articles I've seen about Sars-Cov-2 this has to be up there with the most ridiculous.

    IFR for Spanish Flu ~2.5%, Sars-Cov-2 ~0.1% – ~0.40%

    Average Age of Death for Spanish Flu ~26, Sars-Cov-2 ~80.

    But yeah, they're the same.

    Using an outlier such as New York as a basis for anything is fundamentally flawed, just as if I used Qatar to pretend that Sars-Cov-2 is not more serious than the regular Flu.

    The below is just a short list of factors about New York confirming that it should not be used in isolation as evidence for anything:

    • Likely high virus load at time of exposure due to naivety of the risk, the nature of the transport system and population density – all factors increasing dire outcomes.
    • Very high population density.
    • High rates of comorbities such as obesity and diabetes.
    • High proportion of minorities which are seemingly at higher risk, possibly due to Vitamin D issues.
    • At lastly and most pertinently, it is now obvious that in places such as Sweden, the UK and New York the authorities panicked and cleared Covid-19 positive patients from their hospitals directly into rest homes causing herd immunity to be reached at the cost of the most vunerable parts of the population, causing a nosocomial spike in the death rate of the epidemic.

    I could type another 10,000 words about why every single "fact" presented in this article makes no sense and is the basis for continuing our dangerous, irrational and immoral status quo indefinitely, the consequences of which are trashing our Bill of Rights and will decimate the future our country with the poor paying the highest price – as per usual.

    • SPC 20.1
      18 August 2020 at 9:59 am

      The poor often live in more crowded environments, have obesity and diabetes, use public transport and the ethnic poor lower levels of Vitamin D, so I do not see our poor assisted by a let it spread policy.

      There is certainly a case for Vitamin D use by ethnic minorities each winter, (also by those over 60 as skin production declines with age) and a blood test of the Vitamin D of anyone infected and mega doses given if necessary.

    • SPC 20.2
      18 August 2020 at 5:34 pm

      In the case of Sweden I read that they gave morphine to the infected in rest homes so they would not burden the hospitals.

      https://www.bbc.com/news/world-europe-52704836

  21. Whispering Kate 21
    17 August 2020 at 8:54 pm

    I survived the Hong Kong flu in UK which killed 1 million approx world wide. It was the 1968/69 H3N2 flu variant. It was a disgustingly nasty illness but unlike the Covid19 virus it did not have lingering side effects. This Covid19 virus is a terrible beast. There are a myriad of serious long lingering side effects which will have long term burdens on world wide health systems. Flu is deadly for some people but survivors do develop at least some immunity to further flu outbreaks as vaccines are modified each year to attempt to cover all the bases. I certainly did not have blood clots, scarring on the heart, have seizures, loss of taste and chronic fatigue for months/years afterwards. The future looks bleak for us all, we can but hope that some sort of vaccine will be developed in the future. This Corona virus is a whole different beast to the common flu strains we get.

    • Jeremy 21.1
      18 August 2020 at 6:45 am

      I thought we were done with these apocryphal scaremongering stories about long term effects months ago. It was Kawasaki disease then (debunked) and now this nonsense (at least this has some kernel of truth).

      Dr. Katz an MD from New York and former founder of a specialist public health response group at Yale, and who treated patients in New York during their epidemic and was asked about this very issue yesterday at the NZ symposium on Covid-19.

      He advised that Covid-19 can cause thrombosis, but once this was identified it has since been treated quite easily by making anti thrombotics a standard part of treatment after hospital admission. Additionally he said that there are some serious side effects to the lungs after long term admission to the hospital, but this is not unusual and does not seem to dissimilar to other ICU cases he's treated for very bad cases influenza or pneumonia – which he added do often clear up, even after this level of seriousness, over the following year. He said these cases are exceedingly rare and get reported on globally, just like anytime someone under 40 without a comorbidity dies.

      I'm heartily sick of the unscientific and conspiracy theory-esque nonsense circulating about this virus. I guess anything goes once you've mentally committed to lockdown delusion.

      • lprent 21.1.1
        18 August 2020 at 9:13 am

        He advised that Covid-19 can cause thrombosis, but once this was identified it has since been treated quite easily by making anti thrombotics a standard part of treatment after hospital admission.

        Sure it is easy to treat once people get tested and treated. But that isn’t the whole story. What about the people who are otherwise non-symptomatic and don’t get tested or treated, then die.

        One of features of this disease has been the far higher mortality rates above the norms in areas where it is widespread and where the cause of death would normally be pretty accurate. The statistics on that appear to be typically in the order of about 25-30%.

        Conversely most countries with good reporting that have low covid-19 infections and lock downs or social restrictions like NZ or Taiwan have been reporting lower than usual mortality rates.

        Some of that could just be from under-reporting of the cause of death where an underlying condition killed after being infected with covid-19. But given the scale of additional deaths, the often non-symptomatic way that the infection proceeds and that covid-19 infections are known to cause clotting – it is hard to dismiss the possibility of thrombosis in untreated infected.

        Any realistic person who wasn’t deluded with their own sense of authoritative hubris would have to give that consideration. However you do not.

        Certainly an covid-19 infection was one of the things that I got checked after I had a first time TIA during lock down.

        In essence your comment just makes you look like a patronising simpleton who has a narrow focus and limited understanding of risk.

        • Jeremy 21.1.1.1
          18 August 2020 at 5:15 pm

          Authoritative hubris?

          Pot, kettle, black. I studied forensic science and I believe you're in IT and management?

          Show me the peer reviewed data from multiple studies that these side effects are long term and large in number and then I'll agree with you – with pleasure. Until then I will chalk this under the growing number of borderline conspiracy theories which would require Covid-19 to be different from every other coronavirus (or respiratory illness for that matter) that seem to be abounding now from lockdown fanatics that it is clear that elimination is untenable – which I've been saying on this site since late March.

          In April there was certainly significant excess death, I ate crow on that as that is how science should be, in most jurisdictions since then there has been reported deaths below the previous 5 year average indicating that, very sadly, a number of the people who died would have within the next year. Prof. Neil Ferguson, who created the absurd model that lead in part to these incredibly destructive lockdowns, estimated it at 66%. Vindicating the stance that lockdowns and border closures remain a destructive tool, that cost 100s of times more years of life than they save.

          None of the above is close to Spanish Flu, the comparison remains absurd.

          • Incognito 21.1.1.1.1
            18 August 2020 at 5:36 pm

            This is not a willy-waving contest.

            You’re conflating so many things such as elimination, excess mortality rates, short- and long-term effects of lockdowns on health and economic outcomes, et cetera.

            It appears then that, unlike influenza, severe and fatal SARS-CoV infections do not result from the combined occurrence of viral and bacterial pneumonia but are due to a secondary vascular and inflammatory disease in which immune responses dysregulation and host factors have a role.

            https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30650-2/fulltext [It is peer-reviewed]

          • SPC 21.1.1.1.2
            18 August 2020 at 5:48 pm

            Sort of obvious, that when health systems were overwhelmed the most vulnerable would die, and when lockdowns managed the numbers more people would survive – especially as treatment improved.

            The overweight, those with heart, kidney (diabetes) and respiratory issues are still vulnerable (have you looked at our population profile and number of ICU's and limited trained staff) – these people are given flu vaccine for a reason.

            It's worse of course that spread will go through poor communities in crowded housing faster than otherwise, thus posing a threat to the health system.

            The health complications of this virus on that population will lead to increased numbers unable to work and with greater health support needs than they do now.

          • lprent 21.1.1.1.3
            18 August 2020 at 8:37 pm

            *sigh*

            I studied forensic science and I believe you’re in IT and management?

            Nope. There is nothing particularly odd or unknown about what I do or have done. I did a BSc in earth sciences and geology, I worked in management until I got irritated with my lack of accounting knowledge. Did a MBA, after which I worked out of management and became a computer programmer because that is what I decided that I actually wanted to do.

            Did a few graduate papers in CompSci. I have been working as a computer programmer for three decades since. Mostly in startups or engineering companies. I get called an software engineer these days. But I haven’t had anything much to do with IT outside of programming concerns. IT is a whole different ballgame. I avoid management because, while it is pretty easy, and it really isn’t a lot of fun for me.

            But mostly I’m a person who has never stopped reading fast and voraciously and who has pretty good memory. The training just helps to guide me on how to explore the things I dig into.

            Studying forensic science is an interesting way to phrase it. That covers everything from slicing histology samples as a technician, to a police grunt picking up garbage as clues, to one of the very few doctors in NZ who specialise in autopsy. A vast range of skill sets. If you want to lay claim to enabling expertise, then saying the equivalent of “I did science” without specifying it was only at school Year 10 just opens you for ridicule. That is a debating trick beloved of the truly ignorant – it is like throwing numbers error ranges on them around with providing a source for where they came from (which I see that you did in an earlier comment).

            Show me the peer reviewed data from multiple studies that these side effects are long term and large in number and then I’ll agree with you – with pleasure

            Show me the ones that say they definitely aren’t. FFS: Both of us must know (if you had any science expertise) that neither scenario is currently been looked at in any depth in the medical journals. They are barely trading singleton examples and small groups in the non-peer reviewed online journals. Not enough data because they only started observing it a few months ago and there are still people dying of respiratory infection.

            All we have as ‘authoritative’ is what you pointed to in your comment. An opinion by a doctor that you quoted and then effectively said that is all that needs to be proven. That isn’t proof, peer reviewed or anything else. That is an opinion by a doctor and that is what anyone who’d done any science, including that doctor, could of would say it was. It simply isn’t definitive.

            A lack of clear knowledge like that means that if you’re managing public risk, you have to make your plans based on worst case balanced against available resources. In other words as a pessimist.

            If you look at the known mortality from covid-19 across the world, you can see the countries who were optimists. They’re the few at the top with a hell of lot of dead citizens who are known to have died from covid-19. And this epidemic is probably only just starting. It looks like it is like the influenza of 1918 – comes through in waves of infection as it gets a foothold in a population.

            None of the above is close to Spanish Flu, the comparison remains absurd.

            And now we finally get to the point past all of your bombastic blustering.

            I’ve pointed at a research letter that is specific for a particular city that indicates that a current epidemic has effective mortality rates based on real known total death rates that are very similar in effect to those of the previous pandemic a century ago.

            It wasn’t looking at the particular disease or the particular characteristics of that disease. It was looking at two different epidemics at different times in a concentrated population at the same location for the same duration of time at the peak of wave of each of the epidemics. It only looked at and compared the morbidity of the two pandemics. It was purely statistical.

            It ignored the vast advances in medical knowledge in the last century, the far better health of the people in that city across all age groups, and a immensely better health system.

            They compared the numbers of deaths against the same period in the previous three years for each time period to establish a baseline, and did an analysis on a basis that was an aggregate and a ratio to warm bodies.

            Sure the disease is different. But wasn’t what the statistical analysis was looking at. It was looking at total deaths in a population after excluding base line morbidity and doing it as part of the population. What they were shocked about and I was as well was just how similar the morbidity was despite that century of better living and medical care.

            I haven’t been looking at your comments particularly. But I haven’t seen you refute a single point in that research letter. In fact from your lack of attention to it, I suspect that you haven’t even gotten around to reading it. Certainly you’re ignoring verifiable hard data and preferring anecdotes that support what you want to believe.

            What has been clear from a few of your comments is that you absolutely nothing about the pandemic nor about New York in 1918. One of my interests is history. So let me assist.

            Likely high virus load at time of exposure due to naivety of the risk, the nature of the transport system and population density – all factors increasing dire outcomes.

            Very high population density.

            High proportion of minorities which are seemingly at higher risk, possibly due to Vitamin D issues.

            Exactly the same in 1918. Go and read any history or stats of New York in 1918 about population densities. It was at the time the largest port in the US in terms of traffic and sailors. It has very high density areas.

            FFS: New York was the immigration capital of the US and still is. Look up Harlem, Little Italy, New York Chinatown.

            High rates of comorbities such as obesity and diabetes.

            Sure – that was why the baseload morbidity was so high prior to 1918. In 1918, there were people coughing their lungs out with TB, there were adults that suffered severe diseases that left them half crippled, others with weakened immune systems. That was why the base level morbidity was higher.

            … the UK and New York the authorities panicked and cleared Covid-19 positive patients from their hospitals directly into rest homes…

            FFS: Perhaps you should read the history of the 1918 pandemic rather than talking in the vacuum of your head.

            That particular epidemic struck down those healthy younger adults. Especially those in their 20s and 30s and even in their 40s. They shoved them all together in outdoor hospitals to effectively die because there were no treatments. The people treating them were largely in those same age groups and they were largely doing it without any effective PPE. The young and the elderly were relatively untouched.

            But you also clearly missed the point of the research letter and my post. It wasn’t who was dying that was important. It was a statistical look at how many died from two different diseases at two different times compared to the previous morbidity at those times. The result of the analysis was that the actual amount of deaths per population in the period was extremely similar.

      • SPC 21.1.3
        19 August 2020 at 4:23 pm

        Multisystem inflammatory syndrome, the severe illness that strikes some children with the coronavirus, is distinct from both Kawasaki disease and from Covid-19 in adults, according to a new study.

        https://www.nature.com/articles/s41591-020-1054-6

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