(1) Understanding the importance of changes in "Confirmed #COVID19 Cases per Infection":

Not all Infections are discovered, so Confirmed Cases underestimates actual Infections.

Early in the pandemic a very small percentage of Infections were Confirmed (Level 1). Image
(2) Because testing was primarily limited to patients at emergency departments at hospitals, only patients with moderate to severe or even critical symptoms were tested. Image
(3) For instance, we know from the New York seroprevalence study that there were more than 9-12 times as many Infections as Confirmed Cases during the New York outbreak. Image
(4) In New York, at that time the Case Fatality Rate (CFR) was reported to be roughly 7%, but only 10% of the Infections were being confirmed, so this translates to an Infection Fatality Rate (IFR) of about 0.7%.

cdc.gov/coronavirus/20… ImageImage
(5) Over the course of the pandemic, the United States has increased its daily COVID-19 testing by about 10-fold.

This has allowed people with minimal to mild symptoms to be tested, for asymptomatic contacts to be tested, and for workplace screening and community surveillance. ImageImage
(6) As a result of this increased testing, the percentage of Infections that become Confirmed Cases has increased.

Where we were confirming ~10% of Infections we are now confirming ~25% today. For each Confirmed Case there are 3 other Infections, rather than 9.
(7) Due solely to this increase in the percentage of Infections that become Confirmed Cases, the 7% CFR is expected to drop by a factor of four tenths to 2.8%.

This assumes the same underlying age distribution and 0.7% IFR (a constant Standard of Care).
(8) The actual United States CFR has dropped to about 1.6%, which may indicate an improvement in the Standard of Care, or may indicate a shift in the age distribution of Infections. Image
(9) There really isn't a single IFR that fits all populations well, but there is an IFR v. Age curve that does a pretty good job.

What it reveals is that we are seeing a high percentage of Infections for people 50y old and older, and a much lower percentage for young adults. Image
(10) In summary, as testing expands the Confirmed Cases count goes toward the actual Infections count, and Case Fatality Rates (CFRs) drop.

Comparing CFRs from different times or locations does not provide an indication of Quality of Care. Many other factors must be considered.

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More from @39Magilla

5 Oct
@enchiridion47 @yaneerbaryam (1) Quick & Dirty Peru SITREP:

The test positivity data for Peru shows an extremely low Tests-to-Cases ratio of only about 4-to-1, where targets are 30-to-1 or higher to achieve significant benefits of testing and isolation. Most of the community spread is not being detected. Image
@enchiridion47 @yaneerbaryam (2) For recent data in Florida, the current Infections-per-Case ratio is estimated at 4.5X to 5.5X, and the fatality rate for people over 70 plateaus at about 10%.

In Peru, they are seeing 25-40% fatalities, suggesting I-to-C ratios of 12:1 to 20:1. ImageImage
@enchiridion47 @yaneerbaryam (3) While Peru does seem to be conforming to mask mandates in Lima, there may be other transmission vectors in play. Peru is notorious for discharging untreated wastewater, including human fecal waste, directly in the ocean. This may be a rare vector impacting their spread. Image
Read 10 tweets
4 Oct
(1) A wide distribution of sputum aerosol droplets containing coronavirus leave the nose and mouth of the infected person, but they all shrink as they evaporate, concentrating the virus and making filter masks less effective against them.
(2) The infected person's filter mask catches a larger percentage of the initial particles and also limits their outward velocities.

The combined effect is estimated to be a 95% reduction in viral transmission.
(3) If the infected person doesn't wear a mask, the aerosol particles are projected further and they arrive with concentrated virus bound to much smaller aerosol droplets, making a susceptible person's mask less effective.
Read 8 tweets
3 Oct
(1) US Excess Deaths for Adults aged 25-44 now exceeds 21,000:

Over 10,000 Women, aged 25 to 44, have died:
- Young adults
- Young partners
- Moms

For comparison: 149 women (who now make up 15% of US Armed Forces) have died in the "War on Terror".

cmrlink.org/sitrep/full/gr… Image
(2) Evidence References for US Excess Deaths for Adults aged 25-44.

CDC Source URL:

US Military Women Killed in War URL:
cmrlink.org/sitrep/full/gr… ImageImageImageImage
(3) Basis Discussion, Part 1:

1. Lower est. based on Maximum value of weekly deaths for the years 2015-2019, adjusted up by 0.6% for three years (1.01810822 X).

2. 50-50 est. based on Average value of weekly deaths for the years 2015-2019, adjusted up by 0.6% for three years. Image
Read 7 tweets
18 Sep
(1) How people build their own bubbles on Facebook and Twitter:

When you first join either RB or Tw, you have no following list. As a result, you have nothing in your feed.

Twitter offers you some vanilla ideas, and then you tend to follow some of your friends. ImageImageImage
(2) As you add friends or your favorite celebrities and news personalities, you will start receiving tweets and retweets.

This will immediately bias your feed to the tastes of your most active friends and celebrities.

When you read a retweet, you can follow its author. Image
(3) Pretty soon, you're encased in a bubble that is designed to be aligned with your biases.

As you follow, unfollow, mute and block accounts, you shape the bubble to your liking, but it is difficult to communicate between bubbles. Image
Read 17 tweets
16 Sep
(1) How and when did Trump's propagandists brainwash Small Town and Southern White America? An exploration.
(2) Donald J. Trump is an odd hero for the American South. He's famously been caught mocking Jeff Session's Southern drawl, at CPAC (video). In addition, the @NewYorker reported that "Trump Called Jeff Sessions a 'Dumb Southerner.' "

(3) Trump's popularity with Small Town America seems equally bizarre. His proposed "2020 Budget Devastates Rural America". His poorly planned trade war with China has also been devastating. Still they stand by him, but why and when?

Read 45 tweets
9 Sep
(1) Last thread, Trump's German heritage, I showed that both his grandparents were born in Kallstadt, Germany and had the bulk of their family there during WW I.

Trump's grandfather died of the 1918 Spanish Flu, & his grandmother, Elisabeth, was alone.

(2) This thread, we will cover Fred Trump, Donald's father.

Fred's father, Friedrich returned to Kallstadt, Germany in 1901, and by the next year, met and married Elisabeth Christ. They moved to New York City, where their first child, Elizabeth, was born in 1904.
(3) Later that year, the family returned to Kallstadt & Fred Christ Trump was conceived in Bavaria, where his parents wished to re-establish residency, but Frederick Sr. was banished for dodging the draft. The family returned to the Bronx in 1905, where Fred was born 11/11.
Read 28 tweets

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