Coronavirus thread

[LittleLebowski]

The following is directly from my infectious diseases doctor brother in law this morning.

47565


This was Monday. as of Tuesday now over 400 as of last night.

It has spread and human to human

Chinese New Year is in 3 days. Very critical next few weeks

Will know more about lethality and who is dying (chronic illnesses, propelling diseases or young) or hospitalized.

Spread to countries with freedom of press so information updates will be rapid

[LittleLebowski]

Cases now up to 543

Hong Kong case is 39 yo male who took high speed train with family of 4. The family are already in Manila. So safe to say cat is out of the box.

[Casual Friday]

We have a confirmed case of it in WA. The infected subject is at Providence Hospital in Everett.

[Seven_Sicks_Two]

My wife just left on Monday for a two week work trip to Manila with layovers both ways in Japan. I'm sure the risks are pretty low, but it is still worrisome.

[Greg]

SARS 2.0 ?

[Grey]

They are saying not as bad as sars but id be concerned. China saying dont travel to Wuhan during lunar near year is a big red flag people should be noticing.

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[FPS]

Wuhan now under quarantine - https://www.foxnews.com/health/china-quarantines-wuhan-coronavirus-outbreak-reports

[RoyGBiv]

Wuhan now under quarantine - https://www.foxnews.com/health/china-quarantines-wuhan-coronavirus-outbreak-reports

Better late than never...

Chinese started traveling for the holiday a week ago.

Population of Wuhan is >11 million.

https://www.youtube.com/watch?v=Wl0rGYNXZ1Q

Professor Neil Ferguson, an expert in mathematical biology at Imperial College London told reporters in London the death rate for the new strain of coronavirus is "roughly the same as for The Spanish flu epidemic, at around one in 50".

[Nephrology]

Just going to post this again:

Wikipedia on SARS (https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome):


Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the SARS coronavirus (SARS-CoV). Between November 2002 and July 2003, an outbreak of SARS in southern China caused an eventual 8,098 cases, resulting in 774 deaths reported in 37 countries,[1] with the majority of cases in China and Hong Kong[2] (9.6% fatality rate) according to the World Health Organization (WHO).[2]

Influenza-associated mortality in the US (per CDC (https://www.cdc.gov/flu/about/burden/faq.htm#deaths), emphasis mine):


As it does for the numbers of flu cases, doctor’s visits and hospitalizations, CDC also estimates deaths in the United States using mathematical modeling. CDC estimates that from 2010-2011 to 2017-2018, influenza-associated deaths in the United States ranged from a low of 12,000 (during 2011-2012) to a high of 79,000 (during 2017-2018). The model used to estimate flu-associated deaths uses a ratio of deaths-to-hospitalizations in order to estimate the total flu-related deaths during a season.

I don't have great comparative data re:mortality rate in flu positive patients, but roughly speaking, pneumonia and influenza account for ~7% of all deaths (https://www.cdc.gov/flu/weekly/#S2) in the United States per year.

https://i.imgur.com/grxdKlP.jpg

[Nephrology]

Better late than never...

Chinese started traveling for the holiday a week ago.

Population of Wuhan is >11 million.

https://www.youtube.com/watch?v=Wl0rGYNXZ1Q

Lol, comparing mortality rate of this coronavirus vs. historical mortality of 1918 flu pandemic is silly for a few reasons :

1. This bug is still new and majority of cases likely are yet to present; selection bias means these first detected cases are unlikely to be representative of total patient pop (i.e. currently numbered cases do not include people not sick/concerned enough to seek medical care)

2. All stats re: 1918 Spanish flu pandemic are hard to compare for many reasons; data are incomplete and less rigorously collected, patients received wildly different standard of care in 1918 than they do today, etc. It does make for very sensational quotes however.

3. His numbers are correct per the WHO's most recent release (https://www.who.int/csr/don/21-january-2020-novel-coronavirus-republic-of-korea-ex-china/en/). 278 lab confirmed cases and 6 reported deaths = ~2.15% mortality rate. All of these patients are admitted to the hospital and in isolation per same source.

Versus a study (https://www.ncbi.nlm.nih.gov/pubmed/31203513) of mortality among hospitalized flu patients:


Of the 396 patients who tested positive for influenza 96 (24.2%) had influenza A and 300 (75.8%) influenza B. Twenty-two (5.6%) died in hospital and the 90-day mortality rate was 9.4%.

This is sort of an apples-to-oranges comparison as likely all patients with lab confirmed novel coronavirus are being admitted for isolation precautions, whereas not all Austrians with flu like symptoms were admitted to the hospital. However, vs. people sick enough with flu to warrant being admitted to the hospital, 90 day mortality rate is 5 fold lower vs. this population of Austrian flu patients. YMMV

[farscott]

China has closed the airport and suspended public transportation in Wuhan; of course, the horse is well outside of the barn. https://www.cnn.com/2020/01/22/asia/china-wuhan-coronavirus-deadly-intl-hnk/index.html

[pangloss]

The guy in the office next door to me was teaching a coronavirus lecture this afternoon. He had to update one slide after lunch because the morning slide on case numbers for this virus was already too dated. Much of back background is in respiratory immunity to viruses and vaccine development against the same, but these emerging coronaviruses just don't interest me as much as the emerging mosquito-borne viruses. With this virus, China can quarantine whole cities and we can check people as the get off planes. Those sorts of things will definitely help. It's much harder to control mosquitos. Anyway, like Nephrology said, no reason to get all stirred up. (However, scary viruses can translate into more money for scientist, so if this really bothers you, feel free to write your congressmen in support of more funding for science along with more opposition to gun control.)

[awp_101]

Who else remembers this?


https://youtu.be/HPKk204nOTk

[Cypher]

I used to own ferrets and they were subject to something called Coronavirus and it was vicious. It caused massive intestinal bleeding. They basically bled to death in their guts

[pooty]

Nephrology

Why do these outbreaks happen in China all the time, I know they're dirty and it's highly crowded but they seem to have more of these dangerous new flus than India or Indonesia, also dirty and crowded.

[jellydonut]

Nephrology

Why do these outbreaks happen in China all the time, I know they're dirty and it's highly crowded but they seem to have more of these dangerous new flus than India or Indonesia, also dirty and crowded.

Live animal markets full of all sorts of strange wild animals.

[LittleLebowski]

Nephrology

Why do these outbreaks happen in China all the time, I know they're dirty and it's highly crowded but they seem to have more of these dangerous new flus than India or Indonesia, also dirty and crowded.

It comes down to animal husbandry.

[Grey]

It comes down to animal husbandry.

Comes down to eating weird animals... They are saying it jumped from bats to civet cats that were being sold in market for consumption.

Similar to issues seen in Africa with the practice of eating "bush meat."

[LittleLebowski]

Comes down to eating weird animals... They are saying it jumped from bats to civet cats that were being sold in market for consumption.

Similar to issues seen in Africa with the practice of eating "bush meat."

Partly, but the larger part of it is not much genetic deviation, mass use of antibiotics, crowded unhealthy living environment making their livestock operations a haven for a virus outbreak.

[Grey]

Partly, but the larger part of it is not much genetic deviation, mass use of antibiotics, crowded unhealthy living environment making their livestock operations a haven for a virus outbreak.

Gotcha, yeah it would of helped if I read the context of the original comment.

100% agree with your assessment.

[Hambo]

Just going to post this again:

Wikipedia on SARS (https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome):



Influenza-associated mortality in the US (per CDC (https://www.cdc.gov/flu/about/burden/faq.htm#deaths), emphasis mine):



I don't have great comparative data re:mortality rate in flu positive patients, but roughly speaking, pneumonia and influenza account for ~7% of all deaths (https://www.cdc.gov/flu/weekly/#S2) in the United States per year.


You just had to piss facts into somebody's panic punch bowl, didn't you? :cool:

[Hambo]

Better late than never...

Chinese started traveling for the holiday a week ago.

Population of Wuhan is >11 million.

https://www.youtube.com/watch?v=Wl0rGYNXZ1Q

This might be a good time for people to read https://markmanson.net/why-you-should-quit-the-news?utm_campaign=mmnet-newsletter-202003-01-20&utm_medium=email&utm_source=mmnet-newsletter&utm_content=read-why-you-should-quit-the-news

[Grey]

This might be a good time for people to read https://markmanson.net/why-you-should-quit-the-news?utm_campaign=mmnet-newsletter-202003-01-20&utm_medium=email&utm_source=mmnet-newsletter&utm_content=read-why-you-should-quit-the-news

Probably shouldn't google Spanish Flu...

[Josh Runkle]

Coronaviruses are a large grouping of viruses which can range from lethal to mild (like a common cold).

https://www.cdc.gov/coronavirus/about/symptoms.html

We should refer to the specific 2019-nCoV from Wuhan instead of just saying Coronavirus.


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[Nephrology]

Nephrology

Why do these outbreaks happen in China all the time, I know they're dirty and it's highly crowded but they seem to have more of these dangerous new flus than India or Indonesia, also dirty and crowded.


It comes down to animal husbandry.


Live animal markets full of all sorts of strange wild animals.

Correct. It probably has more to do with the concentration of livestock and non-livestock food sources than anything. IIRC SARS and MERS were both originally restricted to non-human reservoirs (civet cats and camels, respectively) and made the jump to humans, where it adapted to be able to live and replicate inside human hosts. This same general pattern of transmission is also how HIV made the jump to humans.

Doesn't really per se have anything to do with the Chinese being "dirty," but lots of livestock + human contact with said livestock will give you enough rolls of the dice that eventually jumping from animals to humans is bound to happen.

FWIW, some of the earliest swine flu outbreaks started here in the US. It's definitely not something unique to China.



You just had to piss facts into somebody's panic punch bowl, didn't you? :cool:

Lol, I've been accused of this more than once in my life

[Hambo]

Probably shouldn't google Spanish Flu...

Nephrology already addressed that up thread.

[Dog Guy]

Read "Spillover", by David Quammen. It's about zoonotic diseases which spill over from animal reservoirs into human populations. He has an excellent section on how and why so many of these events start in China. He also does a great job of showing how the initially obvious source of an outbreak often turns out to be a false lead.

[TGS]

Nephrology

Why do these outbreaks happen in China all the time, I know they're dirty and it's highly crowded but they seem to have more of these dangerous new flus than India or Indonesia, also dirty and crowded.

Obviously Nephrology might have a better answer, but I would be concerned about reporting/sampling/documentation as a factor when talking about India in particular.

India is very unique. It's hard to describe how broken that country/culture is compared to the rest of the world (including other impoverished nations [shitholes] lacking public health/sanitation), but hundreds of people will die at a time in India from various tragedies and it won't even break the news. Just life as normal.

I'd be surprised if there were not all kinds of outbreaks that kill scores of people in India. We just don't hear about it, because nobody in India gives a shit about death, including mass deaths. Your child gets electrocuted by live, exposed wiring in your property? 140 people burn to death while collecting gas in buckets from a spilled gas tanker when it finally gets lit? Natural disaster? Collapsing infrastructure? It's just death, it happens, life goes on, whereas in almost any other country there would be some sort of genuine concern whether it was based on scientific concern, humanitarian grounds, or purely economics (ex: "we can't have our cheap labor being killed off"). In India, nobody (including the descendants family) will fix the wiring, nobody makes regulatory improvements about traffic/vehicle safety or transporting HAZMAT or makes some sort of financial impact on those who fail to act in good faith (Boeings punishment via the public and whos buying what plane is far more severe than the FAA could be), and nobody will address public planning to deal with the landslides, or sanitation infrastructure to deal with an outbreak killing people because you routinely mix poop with your water source....shit, you don't even know how many people die per year because of poopy water because you don't even care enough to research/measure/report it.

[Josh Runkle]

https://www.google.com/amp/s/www.livescience.com/amp/new-coronavirus-origin-snakes.html

2019-nCoV may have been transmitted from snakes which were sold at the seafood market.




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[pangloss]

https://www.google.com/amp/s/www.livescience.com/amp/new-coronavirus-origin-snakes.html

2019-nCoV may have been transmitted from snakes which were sold at the seafood market.




Sent from my iPhone using TapatalkThat report is from a Chinese group and rather speculative (based on analysis genomic sequence and codon usage and not on experiments like, say, checking to see if the virus can infect snakes). Offhand, I can't think of any viruses that can infect warm-blooded AND cold-blooded animals. Relatively small changes in temperature, like fever for example, can have big in vivo effects.

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[Josh Runkle]

That report is from a Chinese group and rather speculative (based on analysis genomic sequence and codon usage and not on experiments like, say, checking to see if the virus can infect snakes). Offhand, I can't think of any viruses that can infect warm-blooded AND cold-blooded animals. Relatively small changes in temperature, like fever for example, can have big in vivo effects.

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There’s also this (non-scientific) report. Yuck.

https://www.dailystar.co.uk/news/world-news/scientists-blame-coronavirus-bats-pics-21337997?fbclid=IwAR358R1rnfDi3aKr41uaMpzcupSmRe0h D_-n34Tb7OmyxtAt9UnxAHX3Dss


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[Totem Polar]

Q: What goes with a corona virus?

A: Lyme disease.

;) ;)

[Sensei]

This is not a reason to stock-up on ammo, short stocks, or put all of your assets in gold. If you were praying for a calamity to thin the urban heard ahead of the 2020 election, you’ll need to keep praying for the meteor.


However, rest assured that it will cost us hundreds of billions in terms of lost productivity, misallocated resources, and a general media-perpetuated hysteria.

[RoyGBiv]

This is not a reason to stock-up on ammo, short stocks, or put all of your assets in gold. If you were praying for a calamity to thin the urban heard ahead of the 2020 election, you’ll need to keep praying for the meteor.


However, rest assured that it will cost us hundreds of billions in terms of lost productivity, misallocated resources, and a general media-perpetuated hysteria.

At least it's more real than anthropomorphic global warming.

[TiroFijo]

The chinese are trying to isolate 40 million people, and are rushing to build a dedicated hospital with 1,000 beds in 10 days.

There must be fear of something behind all this expense.

[blues]

The chinese are trying to isolate 40 million people, and are rushing to build a dedicated hospital with 1,000 beds in 10 days.

There must be fear of something behind all this expense.

So that means they'll have to exterminate how many of their citizens who don't fit into the hospital...?

[Nephrology]

This is not a reason to stock-up on ammo, short stocks, or put all of your assets in gold. If you were praying for a calamity to thin the urban heard ahead of the 2020 election, you’ll need to keep praying for the meteor.


However, rest assured that it will cost us hundreds of billions in terms of lost productivity, misallocated resources, and a general media-perpetuated hysteria.

I bet we'll see a spike in coronavirus-themed R01 applications going to the NIAID

[Yung]

So that means they'll have to exterminate how many of their citizens who don't fit into the hospital...?

From what little I know of speaking to expats and foreign exchange teachers, the hospital may as well be the extermination site.

[RevolverRob]

I bet we'll see a spike in coronavirus-themed R01 applications going to the NIAID

I said the same thing in passing to one of our grants officers. They responded with, "We have two labs here prepping R01s with a coronavirus slant." :rolleyes:

This isn't much different than a politician saying, "Never let a good crisis go to waste."

[Grey]

This is not a reason to stock-up on ammo, short stocks, or put all of your assets in gold. If you were praying for a calamity to thin the urban heard ahead of the 2020 election, you’ll need to keep praying for the meteor.


However, rest assured that it will cost us hundreds of billions in terms of lost productivity, misallocated resources, and a general media-perpetuated hysteria.Thanks a lot buzz killington. I was totally going to use this an excuse to get some more shit.

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[HeavyDuty]

Now there is a single case here in Chicago. Local news is wigging out.

[LittleLebowski]

This is not a reason to stock-up on ammo, short stocks, or put all of your assets in gold. If you were praying for a calamity to thin the urban heard ahead of the 2020 election, you’ll need to keep praying for the meteor.


However, rest assured that it will cost us hundreds of billions in terms of lost productivity, misallocated resources, and a general media-perpetuated hysteria.


Banned for buzzkill.

[LittleLebowski]

My infectious diseases doctor brother in law is implementing screenings at his hospital.

[LittleLebowski]

I guess that the run on N-95 masks (https://www.amazon.com/gp/product/B002AUVWSC/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1) has already begun :D

47661

[Maple Syrup Actual]

Spoke to my dad briefly yesterday. He phoned me up on account of this thing - every time there's a new infectious disease that makes the news I get this call.

To be fair he is pushing 80 so I don't blame him for lacking a bit of perspective on whether each new possible pandemic could be a serious threat.

But it's getting harder to disappoint him each time so this time I just said, "yeah, maybe this will be the one. The population has to crash sooner or later."

I'm just trying to help the guy stay positive.

[kwb377]

"Everybody was Kung Flu fighting..."

Too soon?


https://uploads.tapatalk-cdn.com/20200124/c198b317464c13a732eb82e26c175a76.jpg

[Sensei]

My infectious diseases doctor brother in law is implementing screenings at his hospital.

I think that it’s a good practice for every healthcare provider to elicit a travel history in everyone with symptoms of a communicable disease - from EMT up to doctor. It’s part of the dog and pony show that I do for anyone with the respiratory crud, GI trots, or any unexplained fever.

However, there is no reason at this point to pay overtime setting up hospital response teams, making everyone in healthcare take PAPR training, causing death by PowerPoint for every public worker, or ordering expensive Respiratory Viral Panels on everyone with a fever and sniffles.

FWIW, my last shop spent close to $2M in Ebola-related BS 5 years ago. The fact that the Dow shed 100 points today in response to a second traveler being sick is the type of hysteria that I expect from a high school cheerleader slumber party - not the most powerful country in the world.

[RoyGBiv]

Better for mowing the lawn. (https://www.amazon.com/BASE-CAMP-Breathing-Woodworking-Activities/dp/B07RLLCJZF/ref=sr_1_3?keywords=Base+camp+mask&qid=1579891438&sr=8-3)


47663

[LittleLebowski]

I think that it’s a good practice for every healthcare provider to elicit a travel history in everyone with symptoms of a communicable disease - from EMT up to doctor. It’s part of the dog and pony show that I do for anyone with the respiratory crud, GI trots, or any unexplained fever.

However, there is no reason at this point to pay overtime setting up hospital response teams, making everyone in healthcare take PAPR training, causing death by PowerPoint for every public worker, or ordering expensive Respiratory Viral Panels on everyone with a fever and sniffles.

FWIW, my last shop spent close to $2M in Ebola-related BS 5 years ago. The fact that the Dow shed 100 points today in response to a second traveler being sick is the type of hysteria that I expect from a high school cheerleader slumber party - not the most powerful country in the world.

For what it’s worth, I’d much rather have you as my BIL, no homo :D

[farscott]

FWIW, my last shop spent close to $2M in Ebola-related BS 5 years ago. The fact that the Dow shed 100 points today in response to a second traveler being sick is the type of hysteria that I expect from a high school cheerleader slumber party - not the most powerful country in the world.

100 points on the Dow is 0.34%. Bigger moves come from President Trump's tweets.

[RevolverRob]

The fact that the Dow shed 100 points today in response to a second traveler being sick is the type of hysteria that I expect from a high school cheerleader slumber party - not the most powerful country in the world.

I mean...it's hysteria, because the most powerful country in the world can't control its own borders...oh wait you meant the US as the most powerful country in the world...Okay Boomer. ;)

[Old Man Winter]

Minnesota Dept of Health has two people in isolation that returned from China last week. Samples were sent to the CDC after they showed up at a hospital and triggered an alert.

People coughing and sneezing in public gives me the willies so this China thing creeps me the f#@k out. Giving serious debate about heading up north to spend the winter ice fishing and snowmobiling ride out the apocalypse in the middle of nowhere.

[Darth_Uno]

The fact that the Dow shed 100 points today in response to a second traveler being sick is the type of hysteria that I expect from a high school cheerleader slumber party - not the most powerful country in the world.

You died? More money for me. Unless you're a Chinese peasant. Then it's about the same.

[Maple Syrup Actual]

I think that it’s a good practice for every healthcare provider to elicit a travel history in everyone with symptoms of a communicable disease - from EMT up to doctor. It’s part of the dog and pony show that I do for anyone with the respiratory crud, GI trots, or any unexplained fever.

However, there is no reason at this point to pay overtime setting up hospital response teams, making everyone in healthcare take PAPR training, causing death by PowerPoint for every public worker, or ordering expensive Respiratory Viral Panels on everyone with a fever and sniffles.

FWIW, my last shop spent close to $2M in Ebola-related BS 5 years ago. The fact that the Dow shed 100 points today in response to a second traveler being sick is the type of hysteria that I expect from a high school cheerleader slumber party - not the most powerful country in the world.
Well, if you want a more optimistic take on that...you could always consider it this way: the market doesn't have to be a predictor (or even representative) of RATIONAL behaviour.

It could be correctly assessing that humans will irrationally react to this situation by placing obstacles to smooth and easy trade between Asia and America. As such, the market might drop a little not because the market is overreacting, but because it only has to reflect the actual conditions businesses face, which include human consumers and regulators who DO overreact.

So maybe the Dow is not being hysterical, but predicting hysteria.

[Hambo]

The chinese are trying to isolate 40 million people, and are rushing to build a dedicated hospital with 1,000 beds in 10 days.

When you consider they aren't building hospitals for the other 1.36 BILLION Chinese, it puts it in perspective. That's if it's actually true, which is probably unlikely.

[Caballoflaco]

https://youtu.be/UcwfEMdV-aM

[ST911]

"Everybody was Kung Flu fighting..."

Too soon?



https://www.youtube.com/watch?v=nLJB7tatdzM

[UNK]

Deleted cant get link to work

[Borderland]

This is not a reason to stock-up on ammo, short stocks, or put all of your assets in gold. If you were praying for a calamity to thin the urban heard ahead of the 2020 election, you’ll need to keep praying for the meteor.


However, rest assured that it will cost us hundreds of billions in terms of lost productivity, misallocated resources, and a general media-perpetuated hysteria.

I'd like to add to that.:D

https://youtu.be/wFY1aSL7p_k

[blues]

coronavirus is people


https://cdn.trendhunterstatic.com/phpthumbnails/269/269307/269307_1_800.jpeg

[TGS]

When you consider they aren't building hospitals for the other 1.36 BILLION Chinese, it puts it in perspective. That's if it's actually true, which is probably unlikely.

Just to put it into perspective, when my hospital system was planning for the Ebola outbreak, we planned a slightly lower amount of beds for two counties composing just 500,000 people. We had a decommissioned hospital and decommissioned psych hospital we were going to convert to palliative care concentration camps.

[Totem Polar]

...the type of hysteria that I expect from a high school cheerleader slumber party - not the most powerful country in the world.

To be fair to concerned HS cheerleaders everywhere, Taran Tactical is still out there.

[Hambo]

Just to put it into perspective, when my hospital system was planning for the Ebola outbreak, we planned a slightly lower amount of beds for two counties composing just 500,000 people. We had a decommissioned hospital and decommissioned psych hospital we were going to convert to palliative care concentration camps.

How many Ebola patients did you end up with? Less than 10, or more than 10?

[TGS]

How many Ebola patients did you end up with? Less than 10, or more than 10?

Actual EVD patients? Zero. We had approximately 30 or so EVD candidates.

[Coyotesfan97]

At the height of that hysteria our Fire/Medical was staging for possible Ebola patients and sending the Blue Canaries in first. Yeah you guys with no PPE check it out and let us know what’s up.

[ranger]

I still have canned food in the basement for when they were bringing in Ebola patients to Atlanta.

[Nephrology]

At the height of that hysteria our Fire/Medical was staging for possible Ebola patients and sending the Blue Canaries in first. Yeah you guys with no PPE check it out and let us know what’s up.

"Do jaws of life count as PPE? No? ... can we use em anyway?"

[paherne]

At the height of that hysteria our Fire/Medical was staging for possible Ebola patients and sending the Blue Canaries in first. Yeah you guys with no PPE check it out and let us know what’s up.

That's some bullshit, right there. I have my guys stage for medical calls, traffic control only.

[Totem Polar]

So long as *everyone* is changing the disease topic:

[Dog Guy]

An interesting visualization of cases can be seen at https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 .

[Joe in PNG]

The general level of health & sanitation in the USA is generally a level higher than a good part of the rest of the world.
Having clean running water, flush toilets, toilet paper, and a general habit of using soap helps lots in keeping this sort of thing from really hurting us.

[Mark D]

An excellent, long-ish article:

https://foreignpolicy.com/2020/01/25/how-to-tell-whats-really-happening-with-the-wuhan-virus/

[TiroFijo]

An excellent, long-ish article:

https://foreignpolicy.com/2020/01/25/how-to-tell-whats-really-happening-with-the-wuhan-virus/

Excellent... and scary. Who knows what the real situation is in the epicenter of the outbreak. China is all about lies.

[willie]

Has anyone pointed out that China's policy will be lying about disease stats? It will be cover up as usual. About India and China. The "bribe" gets things done in these countries. Hence, not much will be done within needed time constraints. That is an observation and not a criticism.

[pangloss]

I still feel strongly that this will be a non-event in terms of US public health, thanks in part to the Public Health Service and also thanks to the Pacific ocean. With the quarantines that China put in place, I suspect that the we are near the high point for imported cases. I'm not following it closely, but I haven't heard about any domestically acquired cases yet.

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[Grey]

I still feel strongly that this will be a non-event in terms of US public health, thanks in part to the Public Health Service and also thanks to the Pacific ocean. With the quarantines that China put in place, I suspect that the we are near the high point for imported cases. I'm not following it closely, but I haven't heard about any domestically acquired cases yet.

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Experts disagree. Quarantines went into effect after 5mil people left wuhan

[Joe in PNG]

Excellent... and scary. Who knows what the real situation is in the epicenter of the outbreak. China is all about lies.

Tyrannical states can't help it. Everything that makes the State look bad MUST be suppressed and covered up and lied about- even if thousands of people will die because of inaction.

[Warped Mindless]

Epidemiologist Dr. Eric Ding post some interesting stuff on his Twitter about it. @DrEricDing.

He seems to believe it will go global and is calling for for the WHO to declare an emergency. That doesn't mean the sky is falling but it does mean that people should maybe take it a bit seriously.

[Nephrology]

Epidemiologist Dr. Eric Ding post some interesting stuff on his Twitter about it. @DrEricDing.

He seems to believe it will go global and is calling for for the WHO to declare an emergency. That doesn't mean the sky is falling but it does mean that people should maybe take it a bit seriously.

Still not stressed.

[critter]

Jan 27, 9pm est, 4744 confirmed, 100 deaths. Confirmed cased are just about doubling daily. I think this will be a shitstorm for China. I'm not too worried about a world pandemic. Depends on how many of those travelers who left the infected areas (estimated 5 million) prior to the quarantine were actually infected and to where they have dispersed.

[JoeSixPack]

If it's true that asymptomatic transfer is happening and 5 million left Wuhan as reported, the genie is out of the bottle. Plan accordingly.

[HCM]

Still not stressed.

The Corona people are...

47889

[idahojess]

The Corona stuff reminds me of this (yeah, 18 years ago -- or maybe 10, not sure):


http://youtu.be/pjU54HULngY

[TiroFijo]

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

4.474 infected, 107 deaths

Still largely confined to China, for now...

With China's history of less than transparent handling and reporting, who knows what the real numbers are. But it is growind exponentially.

In Hubei, the epicenter, there are 2,714 infected being reported, and 100 deaths. That's a 3.68% mortality rate for an extremely contagious disease, suspected of asymptomatic transmission.

[echo5charlie]

I was hoping for #Meteor2020 (https://pistol-forum.com/usertag.php?do=list&action=hash&hash=Meteor2020) , but now I'm really behind #CaptainTrips2020 (https://pistol-forum.com/usertag.php?do=list&action=hash&hash=CaptainTrips2020)

[Coyote41]

Is it too soon to go move to Nebraska and find Mother Abagail?


Sent from my iPhone using Tapatalk

[HeavyDuty]

I was hoping for #Meteor2020 (https://pistol-forum.com/usertag.php?do=list&action=hash&hash=Meteor2020) , but now I'm really behind #CaptainTrips2020 (https://pistol-forum.com/usertag.php?do=list&action=hash&hash=CaptainTrips2020)


Is it too soon to go move to Nebraska and find Mother Abagail?


Sent from my iPhone using Tapatalk

You will spend eternity with your phiz in a bowl of soup...

[Yung]

Well, it's here in Arizona now.

No points if you said ASU.

[Chance]

From BBC News (https://www.bbc.com/news/world-us-canada-51299635):


Some 200 US citizens are due to be quarantined in California after arriving from Wuhan, China amid the coronavirus outbreak.

The passengers, mostly diplomats, were evacuated via a chartered flight that landed on US soil on Wednesday.

They will be quarantined for at least 72 hours, but could be kept isolated for up to two weeks if they have any symptoms, officials said.

The flight landed at a US air base near Riverside, California.

Earlier, the flight stopped in Anchorage, Alaska, to refuel while the 201 were given an initial screen for symptoms. None exhibited any signs of the coronavirus, according to the state's chief medical officer. Five cases of coronavirus have been confirmed in the US as of Tuesday.

[NEPAKevin]

IIRC, someone in an earlier post stated that a large problem with the spread in China is due to the poor sanitary conditions. Don't most if not of all the major cities in California have this little issue of large populations of homeless/mentally-ill/drug addicted living in close contact with poor sanitary conditions and marginal health care?

[RevolverRob]

IIRC, someone in an earlier post stated that a large problem with the spread in China is due to the poor sanitary conditions. Don't most if not of all the major cities in California have this little issue of large populations of homeless/mentally-ill/drug addicted living in close contact with poor sanitary conditions and marginal health care?

Not just California. It is a common problem in all major urban areas. More so anywhere - where mass transit is likely to be used, because that's one of the few areas were general population interacts with the homeless population. However, it still isn't likely to be a major source of transmission.

It's not that you may not be exposed to a virus like this - you're exposed to coronaviruses - all the time. Since they are one group of viruses known to cause the common cold, probably everyone here has had a coronavirus. It's highly unlikely that even if you got 2019-nCOV you'd die or even suffer significant effects of it. Because if you're a healthy human being who is properly hydrated, fed, and not suffering from another infection, you're not likely to be taken out of action by such an infection. It's when you're immuno-compromised, nutritionally compromised, etc. that you're more likely to die.

___

The thought of the homeless populations being afflicted first and frequently by viral outbreaks is a good one though. It's quite possible that the first populations hit significantly by the AIDS epidemic were not homosexual males like previously thought - but homeless intravenous drug-users in urban areas like New York City (https://en.wikipedia.org/wiki/History_of_HIV/AIDS#Homeless_people_and_intravenous_drug_users_in _New_York).

[NEPAKevin]

The thought of the homeless populations being afflicted first and frequently by viral outbreaks is a good one though. It's quite possible that the first populations hit significantly by the AIDS epidemic were not homosexual males like previously thought - but homeless intravenous drug-users in urban areas like New York City (https://en.wikipedia.org/wiki/History_of_HIV/AIDS#Homeless_people_and_intravenous_drug_users_in _New_York).

So it wasn't from chocolate milk?


https://www.youtube.com/watch?v=Tzgx7XV8rOw

[JoeSixPack]

South China Morning Post (https://www.scmp.com/news/china/society/article/3048150/china-coronavirus-confirmed-mainland-cases-rise-7158-deaths-now) now reporting 7731 cases and 170 deaths with over 9000 more suspected cases. Also reporting asymptomatic transmission in several countries.

FWIW, the web address for the article seems to have a different message... "www.scmp.com/news/china/society/article/3048150/china-coronavirus-confirmed-mainland-cases-rise-7158-deaths-now".

[Mark D]

IIRC, someone in an earlier post stated that a large problem with the spread in China is due to the poor sanitary conditions. Don't most if not of all the major cities in California have this little issue of large populations of homeless/mentally-ill/drug addicted living in close contact with poor sanitary conditions and marginal health care?

I can't speak to specific issues pertaining to homeless populations and viruses, but there's certainly an awareness in California that homeless populations can, and are, negatively impacting water quality due to, um, sanitary habits. Various water bodies can be effected, with potential human health impacts.

[littlejerry]

Not just California. It is a common problem in all major urban areas. More so anywhere - where mass transit is likely to be used, because that's one of the few areas were general population interacts with the homeless population. However, it still isn't likely to be a major source of transmission.

It's not that you may not be exposed to a virus like this - you're exposed to coronaviruses - all the time. Since they are one group of viruses known to cause the common cold, probably everyone here has had a coronavirus. It's highly unlikely that even if you got 2019-nCOV you'd die or even suffer significant effects of it. Because if you're a healthy human being who is properly hydrated, fed, and not suffering from another infection, you're not likely to be taken out of action by such an infection. It's when you're immuno-compromised, nutritionally compromised, etc. that you're more likely to die.

___

The thought of the homeless populations being afflicted first and frequently by viral outbreaks is a good one though. It's quite possible that the first populations hit significantly by the AIDS epidemic were not homosexual males like previously thought - but homeless intravenous drug-users in urban areas like New York City (https://en.wikipedia.org/wiki/History_of_HIV/AIDS#Homeless_people_and_intravenous_drug_users_in _New_York).

FWIW, as a frequent traveler to this area of China, our worst cities don't approach the level of squalor of the average manufacturing town in China.

[RoyGBiv]

Coronavirus spreads for first time in U.S., CDC says (https://www.nbcnews.com/health/health-news/coronavirus-spreads-first-time-u-s-cdc-says-n1126566)

A person living with the patient diagnosed in Chicago has tested positive for the new coronavirus.

I wonder how many people THAT person infected. And those people. And those people.
2 Weeks is a long incubation period, able to transmit the disease without showing symptoms.

[TheNewbie]

I’m in somewhat regular contact with Chinese nationals. Many of them who went home during the last couple of months.

I’ve got gloves and make and years of germ OCD to keep me safe. :cool:

[Grey]

Coronavirus spreads for first time in U.S., CDC says (https://www.nbcnews.com/health/health-news/coronavirus-spreads-first-time-u-s-cdc-says-n1126566)


I wonder how many people THAT person infected. And those people. And those people.
2 Weeks is a long incubation period, able to transmit the disease without showing symptoms.Yup, shit could be getting shifty pretty soon.

Sent from my SM-G950U1 using Tapatalk

[Tod-13]

Coronavirus spreads for first time in U.S., CDC says (https://www.nbcnews.com/health/health-news/coronavirus-spreads-first-time-u-s-cdc-says-n1126566)
I wonder how many people THAT person infected. And those people. And those people.
2 Weeks is a long incubation period, able to transmit the disease without showing symptoms.

More details here. Wish they were more clear about "close contact". Having sex versus living together makes a big difference.

https://www.foxnews.com/health/person-to-person-transmission-coronavirus-reported-in-us-cdc

Officials stressed that the husband, who is in his 60s and has underlying health issues, and his wife had continued close contact while she was symptomatic, exposing him to the virus.

[Grey]

WHO finally gets off their ass and declares public health emergency. Thanks for wasting a week.

Sent from my SM-G950U1 using Tapatalk

[Borderland]

The thought of the homeless populations being afflicted first and frequently by viral outbreaks is a good one though. It's quite possible that the first populations hit significantly by the AIDS epidemic were not homosexual males like previously thought - but homeless intravenous drug-users in urban areas like New York City.

If that's true, which I suspect it may be, a lot of people are going to be infected in Seattle. They cultivate the homeless population and drug use in that city.

[Ed L]

This reminds me of an old British TV series from the 1970s Called Survivors, which dealt with a global plague that started exactly this way.

Just watch the first minute of the first episode:


https://www.youtube.com/watch?v=zAyjkaFYnzE

[farscott]

We am starting to see economic impacts from the coronavirus; the manufacturing facilities in China have had the return from the Lunar New Year holiday closure pushed back indefinitely. The return date was originally scheduled as 10-FEB (one extra week), so things were running a bit tight as there are about two to three weeks of parts in transit. Since we get some components from Wuhan province, we are seeing supply chain impacts. Eventually we will not be able to ship product and will shut down one or more OEM assembly plants.

[critter]

DISCLAIMER: NOT A PEER REVIEWED PAPER -- AMPLE GRAINS OF SALT APPLY


This is an interesting read purportedly out of China which estimates the R0 value at 4.08. Imagine the scenario a month or two from now if the is even close to accurate. Unless China's updated numbers are tens of thousands under-reported, or simply unknown, this seems impossible.


link to pdf (https://www.medrxiv.org/content/10.1101/2020.01.27.20018952v1.full.pdf)

[theJanitor]

I've been imploring my MIL to get the hell out of the country. She's been nonchalant about the whole thing, but does now have a flight out on 2/3. She's just outside of HK in Shenzhen

[blues]

I've been imploring my MIL to get the hell out of the country. She's been nonchalant about the whole thing, but does now have a flight out on 2/3. She's just outside of HK in Shenzhen

She (and your wife) will be in my thoughts.

[theJanitor]

She (and your wife) will be in my thoughts.

Thanks, blues. I had told her earlier, to just take the two hour bus ride to HK, and get a hotel room. Then fly out of HK at her convenience. Flying out of HK is way easier than flying out of PRC.

ETA. Last year my wife, went to China to bring back her dad, who had a heart attack and passed in Guangzhou. She called me to tell me she took her first crap in a hole, when the train stopped for a break. I said that was to be expected. Then she called me the next day to say the bathrooms had no hand soap. I said that was to be expected too. Then she said it was the HOSPITAL that had no hand soap.....:eek:

[Warped Mindless]

DISCLAIMER: NOT A PEER REVIEWED PAPER -- AMPLE GRAINS OF SALT APPLY


This is an interesting read purportedly out of China which estimates the R0 value at 4.08. Imagine the scenario a month or two from now if the is even close to accurate. Unless China's updated numbers are tens of thousands under-reported, or simply unknown, this seems impossible.


link to pdf (https://www.medrxiv.org/content/10.1101/2020.01.27.20018952v1.full.pdf)

I could be wrong but I believe the latest research is putting it at a RO of 2.2.

[farscott]

Thanks, blues. I had told her earlier, to just take the two hour bus ride to HK, and get a hotel room. Then fly out of HK at her convenience. Flying out of HK is way easier than flying out of PRC.

ETA. Last year my wife, went to China to bring back her dad, who had a heart attack and passed in Guangzhou. She called me to tell me she took her first crap in a hole, when the train stopped for a break. I said that was to be expected. Then she called me the next day to say the bathrooms had no hand soap. I said that was to be expected too. Then she said it was the HOSPITAL that had no hand soap.....:eek:

Your MIL may have some issues travelling to the USA. There is a new travel restriction on foreign nationals and different restrictions on US citizens who have been in China. My understanding is that there is an exception for foreign nationals who have US citizens as immediate family; they also go to quarantine. From https://www.cnn.com/asia/live-news/coronavirus-outbreak-01-31-20-intl-hnk/index.html


The Trump administration announced a ban on foreign national travel for those who have been in China within the last 14 days, Health and Human Services Secretary Alex Azar announced Friday.

The United States, Azar said, is "temporarily suspending the entry into the United States of foreign nationals who pose a risk of transmitting the 2019 novel coronavirus."

Azar noted that any US citizen who has been in the Hubei Province in the last 14 days will be subject to up to 14 days of mandatory quarantine upon return to the United States. US citizens returning from the rest of mainland China who have been there in the last 14 days will undergo screening at US ports of entry and up to 14 days of self-monitoring.

The ban will be in effect beginning at 5 p.m. ET Sunday.

The basis for the temporary ban, Dr. Anthony Fauci told reporters, is “the unknown of the aspects of this particular outbreak."

[TiroFijo]

I suspect the chinese goverment is keeping a lid on both the real number of infections and the severity of the cases...

Nothing to see, move along

The Government is taking care of everything

[critter]

I suspect the chinese chinese goverment is keeping a lid on the real number of infections and the severity of the cases...

I would think so too just considering the nature of that type of government. Even those praising the Chinese for their rapid response indicate that the numbers are probably much higher for a variety of reasons. In the official numbers, between 9pm yesterday and 2pm today, there were only about 150 new confirmations and the 'recovered' is now a larger number than the deaths (the latter shift being something that would be expected at some point anyway unless this was an actual apocalyptic nightmare scenario).

Having now spread outside direct Chinese government propaganda control, and with one confirmed case in India -- which almost certainly isn't a singular event -- India may well become the litmus test for how severe this thing really is. It's like China in early December.

[theJanitor]

Your MIL may have some issues travelling to the USA. There is a new travel restriction on foreign nationals and different restrictions on US citizens who have been in China. My understanding is that there is an exception for foreign nationals who have US citizens as immediate family; they also go to quarantine. From https://www.cnn.com/asia/live-news/coronavirus-outbreak-01-31-20-intl-hnk/index.html

I believe she is classified as a dual national (U.S. / Hong Kong), holds a U.S. passport, and hasn't been to Hubei/Wuhan. These new restrictions are exactly why I told her to leave mainland China, last week

[critter]

damn... the 7pm update jumps another 2000+ confirmed. So much for the appearance of a slowdown.

[Suvorov]

Noticing a whole lot more passengers at the airports wearing face masks than in the previous "outbreaks." Maybe even a full 5% or so. Most of the masks are just the simple hospital type face mask and not the N95 type which has me wondering just how effective they are? Are they simply placebo, or are they actually effective in an environment like an airport or full airplane or do they simply prevent you from touching your mouth and face?

[willie]

My opinion is that China's healthcare system is feeble and further the government may not know what to do other than quarantine cities by blocking movement. Since party leaders' main concern is staying in power, their decision making may be hampered to the extent that best medical practice policy is not promoted.

[critter]

Here's an interesting exercise in delusional dipshittery. Wired story.

Using the archive link so idiots receive no click-bait money:

We Should Deescalate the War on the Coronavirus (http://archive.ph/yMdz0)

[RJ]

I was wondering what “R0” was upthread, so I searched and found this helpful:

https://www.healthline.com/health/r-nought-reproduction-number

On topic - This stuff scares me. I have friends at work with family in China. Flu is no joke. We both had it last year; Mrs.RJ worse than me. We were getting treated at the clinic, and the Doc said he had four deaths in greater Clearwater FL alone (where we were living at the time). This crap is serious as a heart attack.

I hope our respective governments get on top of this ASAP.

[TGS]

damn... the 7pm update jumps another 2000+ confirmed. So much for the appearance of a slowdown.

If we take the Chinese reported numbers as true, isn't that a slowdown? Total cases were doubling for the first week. Now it's spreading as a fraction of the total number of cases.

If it weren't slowing down, it'd be tens of thousands of people by now, not 11,000 total. Or am I reading the numbers wrong?

[TGS]

Noticing a whole lot more passengers at the airports wearing face masks than in the previous "outbreaks." Maybe even a full 5% or so. Most of the masks are just the simple hospital type face mask and not the N95 type which has me wondering just how effective they are? Are they simply placebo, or are they actually effective in an environment like an airport or full airplane or do they simply prevent you from touching your mouth and face?

I found this, which suggests it would help prevent the spread in public areas but not ensure protection: https://www.cnet.com/how-to/which-face-masks-protect-against-coronavirus/

FWIW, I landed at Dulles yesterday and a bunch of the CBP officers were wearing masks while asking us the China questions.

[Grey]

If we take the Chinese reported numbers as true, isn't that a slowdown? Total cases were doubling for the first week. Now it's spreading as a fraction of the total number of cases.

If it weren't slowing down, it'd be tens of thousands of people by now, not 11,000 total. Or am I reading the numbers wrong?

Its easy to double from 100 to 200, look at the total number of cases increasing rather than a %.

Sent from my SM-G950U1 using Tapatalk

[critter]

I was wondering what “R0” was upthread, so I searched and found this helpful:

https://www.healthline.com/health/r-nought-reproduction-number

On topic - This stuff scares me. I have friends at work with family in China. Flu is no joke. We both had it last year; Mrs.RJ worse than me. We were getting treated at the clinic, and the Doc said he had four deaths in greater Clearwater FL alone (where we were living at the time). This crap is serious as a heart attack.

I hope our respective governments get on top of this ASAP.

First off, I'm not a virologist nor microbiologist - just a guy who researches just about everything in existence for the hell of it. So I'm sure others with much more actual knowledge will come along to elaborate or correct mistakes.

For a bit of perspective -- if I remember correctly, which is a hit or miss these days, mumps had an R0 of around 8, and measles about 12 -- which are ridiculously infectious.

The insidiousness of this one is the lack of immunity + the length of time people can show no symptoms at all and be spreading the virus + the length of time it can survive outside of a host on the back of an airplane seat or tray, luggage, pants leg, whatever, or floating in the breeze, etc.

An early preliminary Wuhan 'study' with a very small sample (I think it was 41, which is next to nothing scientifically, but they were attempting to learn anything they could about this as quickly as possible for obvious reasons) indicated that males are actually more susceptible than females due to a naturally higher level/ratio of a specific enzyme which allows the virus to attach to the cells more easily.

On a brighter note... Not long ago one of the ebola variants mutated into a less deadly form which pretty much snuffed out that epidemic by natural inoculation. Many influenza variants have done this as well. Mutations are not always a bad thing. The virus itself may intervene to slow itself down.

[RJ]

I just heard Dr. Oz say on TV that the death rate on normal Flu is 1:1000, but this Corona virus is 1:50.

Holy shit. Is that true?!

[EPF]

I just heard Dr. Oz say on TV that the death rate on normal Flu is 1:1000, but this Corona virus is 1:50.

Holy shit. Is that true?!

I have been reading various versions of that number for days. After spending quite a bit of time looking in to it, the only honest answer is: how could anyone know? The Chinese have blocked all information and the only statistics available come from them.

I will say this, everyday new information comes to light. Each time it’s the worst case scenario. Airborne? Check. Long incubation period? Check. Passed on during incubation period? Seems like it is. And on and on.....it’s like some perverse “choose your own adventure” children’s book where we keep getting the worst case scenario.

As someone with kids who lives 8 miles from a major international airport in one of the most international cities in America I’m following this closely.

[RJ]

I have been reading various versions of that number for days. After spending quite a bit of time looking in to it, the only honest answer is: how could anyone know?

Crap I have no clue either.

I know where I used to live in Clearwater, we had a lot of retirees, and of course one would expect the mortality rate to be higher than average, but it did shock me to hear we had 4 deaths last year just in the immediate area of our small clinic. And that was a normal, routine illness. You get a flu shot, hope to not get the flu, but if you do, you stay home and get rest and avoid contact to not give it to others. But that's it.

As to mortality rates of this new virus, maybe Nephrology or another board doc can weigh in.

Seems like whatever the number, the Authorities are treating this pretty damn seriously.

[EPF]

Crap I have no clue either.

I know where I used to live in Clearwater, we had a lot of retirees, and of course one would expect the mortality rate to be higher than average, but it did shock me to hear we had 4 deaths last year just in the immediate area of our small clinic. And that was a normal, routine illness. You get a flu shot, hope to not get the flu, but if you do, you stay home and get rest and avoid contact to not give it to others. But that's it.

As to mortality rates of this new virus, maybe Nephrology or another board doc can weigh in.

Seems like whatever the number, the Authorities are treating this pretty damn seriously.

Definitely taking it seriously. Maybe mutation in the concern? Who knows.

I guess the point I was trying to make is that no matter how much knowledge anyone has, doctor or otherwise, without reliable information from the Chineese no assessment can be made. It makes me very uncomfortable that they have refused international scientific help and specifically refused the American offers.

It seems clear that the numbers of cases they are providing are low just based on anecdotal evidence. I watched the WHO press conference this week and let’s just say that confidence was not inspired 🙄

[TGS]

Seems like whatever the number, the Authorities are treating this pretty damn seriously.


Definitely taking it seriously.

Well, by comparison, we only let non-essential personnel at US Embassy Freetown fly home during the last Ebola scare, whereas US Consulate Wuhan has been ordered evacuated and is essentially shut down, and every other mission in China that isn't directly in a "Coronavirus crisis zone", if you will, still having the option to fly home non-essential personnel.

So, if we take as a barometer......

[Nephrology]

I just heard Dr. Oz say on TV that the death rate on normal Flu is 1:1000, but this Corona virus is 1:50.

Holy shit. Is that true?!

The mortality rate for influenza depends on which numbers you use.

Because the number of people who get sick from flu every year is so large as to be impossible to measure directly, the CDC uses mathematical modeling to estimate the number of people who a) get symptomatic flu; b) seek medical care for flu; c) are hospitalized for flu ; d) die from flu.

So, the mortality rate depends on which number you use as the denominator (is it # of deaths vs everyone who gets sick? sees an MD for flu? requires hospitalization?) and how you think that compares to coronavirus numbers.

Most likely the "total cases" of reported coronavirus are most comparable to either b or c. This is because without PCR based testing, you have no way of knowing if your upper resp. infxn is flu, coronavirus, or one of a million other viruses out there. You will not get PCR based testing unless you seek medical care, so the "denominator" for these stats is probably a big under-estimate of total patients actually sick with the virus (i.e. the current number of 12,000 mostly represents those sick enough to require care).

If we accept that the mortality rate for coronavirus is probably based on a total case # that represents a a mix of people who present for medical care (b) and those who require hospitalization (c), a more comparable mortality rate for influenza is between 7% and 0.2% (based on most recent preliminary flu season data for 2018-19, found here (https://www.cdc.gov/flu/about/burden/index.html)).

I will say that this new coronavirus has spread more rapidly than SARS, which is an interesting development. We'll see what happens in the long run but I am still not freaking out. It is still not anywhere near the 2009 H1N1 "swine flu" pandemic in terms of overall # of cases (infected 61 million people in USA alone) and also still very unlikely to kill nearly as many Americans this year as regular influenza.

[Stephanie B]

Tyrannical states can't help it. Everything that makes the State look bad MUST be suppressed and covered up and lied about- even if thousands of people will die because of inaction.

More like a classical monarchy. Nobody wins favor by being the one to bring bad news to the emperor. Nobody wins favor by being the one who makes the emperor look bad. So the tendency of the imperial bureaucracy will always be to try and minimize bad news and adverse effects. It's a pattern that's been repeated over and over again in China.

[Grey]

I just heard Dr. Oz say on TV that the death rate on normal Flu is 1:1000, but this Corona virus is 1:50.

Holy shit. Is that true?!Ehhh whats his data. Hes a tv doc... salt shaker worth of salt.

Sent from my SM-G950U1 using Tapatalk

[RJ]

The mortality rate for influenza depends on which numbers you use.

Because the number of people who get sick from flu every year is so large as to be impossible to measure directly, the CDC uses mathematical modeling to estimate the number of people who a) get symptomatic flu; b) seek medical care for flu; c) are hospitalized for flu ; d) die from flu.

So, the mortality rate depends on which number you use as the denominator (is it # of deaths vs everyone who gets sick? sees an MD for flu? requires hospitalization?) and how you think that compares to coronavirus numbers.

Most likely the "total cases" of reported coronavirus are most comparable to either b or c. This is because without PCR based testing, you have no way of knowing if your upper resp. infxn is flu, coronavirus, or one of a million other viruses out there. You will not get PCR based testing unless you seek medical care, so the "denominator" for these stats is probably a big under-estimate of total patients actually sick with the virus (i.e. the current number of 12,000 mostly represents those sick enough to require care).

If we accept that the mortality rate for coronavirus is probably based on a total case # that represents a a mix of people who present for medical care (b) and those who require hospitalization (c), a more comparable mortality rate for influenza is between 7% and 0.2% (based on most recent preliminary flu season data for 2018-19, found here (https://www.cdc.gov/flu/about/burden/index.html)).

I will say that this new coronavirus has spread more rapidly than SARS, which is an interesting development. We'll see what happens in the long run but I am still not freaking out. It is still not anywhere near the 2009 H1N1 "swine flu" pandemic in terms of overall # of cases (infected 61 million people in USA alone) and also still very unlikely to kill nearly as many Americans this year as regular influenza.

Thanks Neph. Hope all is well.

I appreciate you guys who have to deal with this posting. I honestly dunno if I’d like to even go to a Hospital or ER these days. Eek.

[RJ]

More like a classical monarchy. Nobody wins favor by being the one to bring bad news to the emperor. Nobody wins favor by being the one who makes the emperor look bad. So the tendency of the imperial bureaucracy will always be to try and minimize bad news and adverse effects. It's a pattern that's been repeated over and over again in China.

I’ll be honest, most of what I think I know about Asia is from reading James Clavell novels growing up. But I can totally believe this.

[Stephanie B]

I just heard Dr. Oz say on TV that the death rate on normal Flu is 1:1000, but this Corona virus is 1:50.

Holy shit. Is that true?!

If Dr. Oz said he was on fire, I’d not believe him until the fire was fully involved.

[theJanitor]

As someone with kids who lives 8 miles from a major international airport in one of the most international cities in America I’m following this closely.

The Feds announced that the airport a couple miles from my house and work, will be one of 7 US airports to receive flights from China.

[EPF]

The Feds announced that the airport a couple miles from my house and work, will be one of 7 US airports to receive flights from China.

I saw that. Leave it to the Government to take away the geographic advantage you have for this one 🙂

[blues]

Maybe they'll reopen the leper colony on Moloka‘i.

[farscott]

A study published in The Lancet suggests more than 75,000 people have been infected just in Wuhan. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30260-9/fulltext#articleInformation


Findings

In our baseline scenario, we estimated that the basic reproductive number for 2019-nCoV was 2·68 (95% CrI 2·47–2·86) and that 75 815 individuals (95% CrI 37 304–130 330) have been infected in Wuhan as of Jan 25, 2020. The epidemic doubling time was 6·4 days (95% CrI 5·8–7·1). We estimated that in the baseline scenario, Chongqing, Beijing, Shanghai, Guangzhou, and Shenzhen had imported 461 (95% CrI 227–805), 113 (57–193), 98 (49–168), 111 (56–191), and 80 (40–139) infections from Wuhan, respectively. If the transmissibility of 2019-nCoV were similar everywhere domestically and over time, we inferred that epidemics are already growing exponentially in multiple major cities of China with a lag time behind the Wuhan outbreak of about 1–2 weeks.

Interpretation

Given that 2019-nCoV is no longer contained within Wuhan, other major Chinese cities are probably sustaining localised outbreaks. Large cities overseas with close transport links to China could also become outbreak epicentres, unless substantial public health interventions at both the population and personal levels are implemented immediately. Independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions. Preparedness plans and mitigation interventions should be readied for quick deployment globally.

I am not qualified to review the data or the study methodology, but I am familiar with issues caused by mathematical modeling (extrapolation) from small samples. I am also familiar with the Chinese penchant for burying bad news. As such, my instinct is to say that China is erring to under reporting of cases. By how much is an interesting question. If the study's inference and interpretation are correct, the number of reported cases from other large Chinese population centers should start to dramatically increase very soon.

[critter]

The Feds announced that the airport a couple miles from my house and work, will be one of 7 US airports to receive flights from China.

Well as long as it's only seven smh. Anyone familiar with airport procedure know whether there is a sterilization procedure for cleaning aircraft under such circumstances? Seems unlikely that the airlines would absorb the cost of doing it without being ordered to do so or several cases being traced directly back to airplanes.

[Wondering Beard]

https://i1.wp.com/www.powerlineblog.com/ed-assets/2020/02/China-sneezes.png?resize=600%2C565&ssl=1


https://i1.wp.com/www.powerlineblog.com/ed-assets/2020/01/image057-2.jpg?w=568&ssl=1


https://i1.wp.com/www.powerlineblog.com/ed-assets/2020/01/image023-3-1.jpg?w=399&ssl=1

[theJanitor]

Fears coronavirus spreading in Hong Kong, as hospital staff back strike

https://www.scmp.com/news/hong-kong/health-environment/article/3048558/fears-coronavirus-spreading-locally-hong-kong

and......

China reports outbreak of deadly bird flu among chickens in Hunan province, close to coronavirus epicentre of Wuhan

https://www.scmp.com/news/china/society/article/3048566/china-reports-outbreak-deadly-bird-flu-among-chickens-hunan

[idahojess]

This is interesting:

Washington state health officials used an unapproved antiviral drug developed to fight Ebola to treat the first patient with novel coronavirus in the U.S., they announced after publishing their treatment course on Friday.

https://www.spokesman.com/stories/2020/jan/31/washington-state-coronavirus-patient-treated-with-/

[Nephrology]

A study published in The Lancet suggests more than 75,000 people have been infected just in Wuhan. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30260-9/fulltext#articleInformation



I am not qualified to review the data or the study methodology, but I am familiar with issues caused by mathematical modeling (extrapolation) from small samples. I am also familiar with the Chinese penchant for burying bad news. As such, my instinct is to say that China is erring to under reporting of cases. By how much is an interesting question. If the study's inference and interpretation are correct, the number of reported cases from other large Chinese population centers should start to dramatically increase very soon.

If 75,000 have been infected in wuhan, 260 deaths/ 75,000 * 100 = 0.3% mortality rate.

[Guinnessman]

If 75,000 have been infected in wuhan, 260 deaths/ 75,000 * 100 = 0.3% mortality rate.

Your facts do not help in creating mass hysteria via Social Media.🤣😜.

When people are canceling their vacation, it’s the best time to travel.

[farscott]

If 75,000 have been infected in wuhan, 260 deaths/ 75,000 * 100 = 0.3% mortality rate.

The best news about the coronavirus outbreak has been the relatively small number of fatalities; the annual influenza kills more people. Flu is also more widespread. My state has a current (this week) flu rate of greater than 5%, and we have acquaintances who have tested positive. One local school system is closing for one week due to widespread flu.

[Joe in PNG]

More like a classical monarchy. Nobody wins favor by being the one to bring bad news to the emperor. Nobody wins favor by being the one who makes the emperor look bad. So the tendency of the imperial bureaucracy will always be to try and minimize bad news and adverse effects. It's a pattern that's been repeated over and over again in China.

And one of the reasons you have so many different dynasties. If telling the Emperor that the Mongols/ Ming/ Manchus are massing to invade gets you killed, best to hold off and let someone else bear the bad news... and who knows- maybe the Mongols/ Ming/ Manchus will be a bit more merciful.

[critter]

If 75,000 have been infected in wuhan, 260 deaths/ 75,000 * 100 = 0.3% mortality rate.

I would guess that if the factual number approaches 75,000 of actual infected then the actual number of deaths would likely be much higher as well. We simply don't know and probably won't know until we have real information in the hands of those who understand these things from somewhere other than what China feeds us. The numbers outside of China do not appear to be increasing, thus far anyway, at an apocalyptic pace. That's a pretty good sign.

[Nephrology]

I would guess that if the factual number approaches 75,000 of actual infected then the actual number of deaths would likely be much higher as well. We simply don't know and probably won't know until we have real information in the hands of those who understand these things from somewhere other than what China feeds us. The numbers outside of China do not appear to be increasing, thus far anyway, at an apocalyptic pace. That's a pretty good sign.

the Lancet article that estimated 75k infected is using modeling to predict the total # of cases based on the location and number of confirmed cases from outside mainland China. i.e., independent of Chinese government figures.

[critter]

the Lancet article that estimated 75k infected is using modeling to predict the total # of cases based on the location and number of confirmed cases from outside mainland China. i.e., independent of Chinese government figures.

Thanks for the elaboration.

[TiroFijo]

the Lancet article that estimated 75k infected is using modeling to predict the total # of cases based on the location and number of confirmed cases from outside mainland China. i.e., independent of Chinese government figures.

That is only an estimation, and it could be way off

According to current data from the chinese, in the epicenter where it had more time to run its course the mortality is about 3,6%

[Dog Guy]

Another non-alarmist article: https://pjmedia.com/news-and-politics/coronavirus-update-13989-cases-304-deaths/

[Nephrology]

That is only an estimation, and it could be way off

According to current data from the chinese, in the epicenter where it had more time to run its course the mortality is about 3,6%

See my previous discussion re: mortality rates

[Totem Polar]

There’s a theory floating out there that the virus escaped a research facility in Wuhan. Knowing less than zero about the probability that this could be true, I’ll leave some internet postulating here, and let folks who know more about this stuff weigh in.

https://www.zerohedge.com/health/man-behind-global-coronavirus-pandemic

[Borderland]

There’s a theory floating out there that the virus escaped a research facility in Wuhan. Knowing less than zero about the probability that this could be true, I’ll leave some internet postulating here, and let folks who know more about this stuff weigh in.

https://www.zerohedge.com/health/man-behind-global-coronavirus-pandemic

We have bats. My neighbor just removed one from his wood shed. I think he carefully relocated it.

This may be like a terrorist blowing himself up only on a much bigger scale.:D

[Totem Polar]

This may be like a terrorist blowing himself up only on a much bigger scale.:D

Considering who sponsors the research, and how they have gone about acquiring some of the know-how, it’s within the realm of possibility, age-old caveats about enemy action and incompetence being indistinguishable notwithstanding.

[Borderland]

Gov't to limit short selling. That doesn't sound like a small economic problem.


https://www.reuters.com/article/us-health-china-shortselling/china-moves-to-limit-short-selling-as-virus-looms-over-market-reopening-idUSKBN1ZW0P2

[Totem Polar]

https://www.engadget.com/2020/02/02/twitter-bans-zero-hedge-over-coronavirus/

That doesn’t surprise me, since I saw the email and phone at the end of the article. Plus, zerohedge.

Still, BSL-4 lab with Chinese safety standards and a bat research project vs a food market that we now know didn’t sell bats.

[Suvorov]

There’s a theory floating out there that the virus escaped a research facility in Wuhan. Knowing less than zero about the probability that this could be true, I’ll leave some internet postulating here, and let folks who know more about this stuff weigh in.

https://www.zerohedge.com/health/man-behind-global-coronavirus-pandemic

Not that I buy this theory (or don't buy it because I don't know enough about infectious diseases but I wouldn't put anything beyond a communist government that has already killed millions of its own people), but who benefits from a disease that kills off a large percentage of its aged population? A country who's biggest economic challenge is the fact that it has a huge number of elderly that it has to feed. (https://time.com/5523805/china-aging-population-working-age/)

[Squib308]

If 75,000 have been infected in wuhan, 260 deaths/ 75,000 * 100 = 0.3% mortality rate.

that is assuming the reported total # of cases have recovered. in midst of on ongoing epidemic mortality will always look low in the beginning. the only certainty here is overall under-reporting in china. a multitude of reasons including overflowing hospitals, insufficient testing (not everyone with symptoms is getting PCR'ed), likely govt suppression of the #'s. hopefully the under-reporting is consistent in both the numerator and denomenator so your proposed mortality rate is correct.

to date what I find most perplexing are the # of "recovered cases". the illness appears to have both variable presentation (eg the young do better) and highly variable duration. the case in Washington the guy was watched for like a week before getting sick. if he truly recovered with nucleoside analog med (remdesiver) then it's hard to invoke the secondary pneumonia argument that I keep hearing. there are so many damn questions here it's mindblowing. it is certainly more infectious (at least the R0) than SARS and I'm guessing mortality will be close to it despite everyone claiming otherwise.

[Borderland]

Not that I buy this theory (or don't buy it because I don't know enough about infectious diseases but I wouldn't put anything beyond a communist government that has already killed millions of its own people), but who benefits from a disease that kills off a large percentage of its aged population? A country who's biggest economic challenge is the fact that it has a huge number of elderly that it has to feed. (https://time.com/5523805/china-aging-population-working-age/)

Lots of Boomers on the dole. :D

[critter]

There’s a theory floating out there that the virus escaped a research facility in Wuhan. Knowing less than zero about the probability that this could be true, I’ll leave some internet postulating here, and let folks who know more about this stuff weigh in.

https://www.zerohedge.com/health/man-behind-global-coronavirus-pandemic


I'm not buying into (or out of) any of that, at least not at this time, but if this turned out to be factual (or another similar scenario) I wouldn't be surprised in the least. There appears to be some questions/debate/speculation/assertions from "Chinese sources" (purported medical personnel* doing the research inside Wuhan) over whether the earliest infections can actually be traced back to that market. Lots of speculation about this can be found on such reliable sources as YouTube.


*credentials/positions cannot be verified, nor can anything else for that matter.

[TGS]

If it were an "escaped" virus from a research facility, anyone associated with such in China would already be dead, and there'd be no sources to give info about said escaped project.

[Nephrology]

that is assuming the reported total # of cases have recovered. in midst of on ongoing epidemic mortality will always look low in the beginning. the only certainty here is overall under-reporting in china.

The 75k figure is an estimate based on (now ~week old) data from cases described outside of mainland China. Their model does not seek to predict or measure severity of illness/mortality, simply overall size of patient pop.



to date what I find most perplexing are the # of "recovered cases". the illness appears to have both variable presentation (eg the young do better) and highly variable duration. the case in Washington the guy was watched for like a week before getting sick. if he truly recovered with nucleoside analog med (remdesiver) then it's hard to invoke the secondary pneumonia argument that I keep hearing. there are so many damn questions here it's mindblowing. it is certainly more infectious (at least the R0) than SARS and I'm guessing mortality will be close to it despite everyone claiming otherwise.

Young always do better than very old/very young/very comorbid, which is not a huge surprise. H1N1 was so "exciting" because it seemed to hit younger, healthier patients much harder than older patients.

Not seeing where you're getting variable duration - it looks like it lasts ~1-2 weeks, per this article in the Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext) that describes clinical features of an early patient cohort. Note that the median age for this population (all admitted to hospital) is 49, which is about right.

Re: remdesivir, it's not really clear to me this drug actually did anything for the US patient in question, and there is no reason to think that it would have prevented a bacterial pneumonia anyway. From what I know it sounds like this virus is predominantly killing older/sicker people (like basically every other infection/disease process), so 2° pneumonia is one of many possible coffin nails (10% of patient pop described in article above).

Infectivity and virulence are not necessarily related (if anything, more frequently negatively correlated). SARS had a mortality rate of ~10%; so far death rate is nowhere near that number. This may change but so far has not been trending higher.

[Nephrology]

If it were an "escaped" virus from a research facility, anyone associated with such in China would already be dead, and there'd be no sources to give info about said escaped project.

Also, microbiology research is not nearly as exciting as it seems on TV, very few people work with anything that exciting, pathogens simply don't easily "escape". This notion is more Resident Evil than reality.

[critter]

The 75k figure is an estimate based on (now ~week old) ...

...it looks like it lasts ~1-2 weeks,

using the wuflu.live numbers and tracking back a week -- to where the number of confirmed infections are relatively close to the current total numbers of dead and recovered as individual infections runs their course (the ones they're apparently tracking). That would appear to indicate a higher death rate/ratio than a low single digit percentage when the numbers of case resolutions and confirmed match up. Not sure if that makes sense the way I phrased it.

Can you explain, um, in layman's terms, why it may appear that way but actually isn't?

[Nephrology]

using the wuflu.live numbers and tracking back a week -- to where the number of confirmed infections are relatively close to the current total numbers of dead and recovered as individual infections runs their course (the ones they're apparently tracking). That would appear to indicate a higher death rate/ratio than a low single digit percentage when the numbers of case resolutions and confirmed match up. Not sure if that makes sense the way I phrased it.

Can you explain, um, in layman's terms, why it may appear that way but actually isn't?

Not 100% sure what you are asking, but if you're referring to the 3rd graph down (below the map and two tables), take a look at the chart labels. The big block of purple in the background are the total # of cases (i.e. vastly higher than either # dead/recovered).

Also, to drive this point home yet again, the reason the Lancet used mathematical modeling to estimate total # of infected patients is because the number of PCR-confirmed cases are certainly much lower than total # of people infected. Among this subgroup, disease severity is substantially lower by definition - if they aren't sick enough to require medical care, they will not get PCR'd and so they will not be a confirmed case. Because the cases that are not captured by official data are likely to not be very sick, this means that mortality rates are likely lower than calculated using official data.

[Tod-13]

Also, microbiology research is not nearly as exciting as it seems on TV, very few people work with anything that exciting, pathogens simply don't easily "escape". This notion is more Resident Evil than reality.

I'll differ there. Lab folk get blase about safety procedures--an issue exacerbated by fake "safety rules" and a lack of desk space for use outside of the lab.

After 9-11 the Feds did some checks in the Texas Medical Center and found traces of research diseases (not cancer, but sepsis and other diseases) down the hallways from the lab to the bathrooms and break rooms and cafeteria. Watch how many people have lab coats and surgery gowns (or hats or booties) in the hallways -- all safety/cleanliness violations.

The main difference is what they're spreading generally isn't too catchy or lethal.

Even inside a lab, people are really bad about safety and cleanliness. And some of the new rules about UV light sources (for cleaning) make that safety step difficult to use and maintain the rules. (I don't recall the specifics but it is one of those "you can have the light but it can't be used in a way that actually cleans the surfaces" type of rule, to prevent UV exposure to humans because someone did something stupid with one.)

Some animal handling rules are things like you can't visit the "cleaner" facility later in the day after visiting the "dirtier" facility. But that rule assumes you change clothes and shower that night. Which some of the people don't -- and then wear the same clothes into the "cleaner" facility the next day.

[Nephrology]

I'll differ there. Lab folk get blase about safety procedures--an issue exacerbated by fake "safety rules" and a lack of desk space for use outside of the lab.

After 9-11 the Feds did some checks in the Texas Medical Center and found traces of research diseases (not cancer, but sepsis and other diseases) down the hallways from the lab to the bathrooms and break rooms and cafeteria. Watch how many people have lab coats and surgery gowns (or hats or booties) in the hallways -- all safety/cleanliness violations.

The main difference is what they're spreading generally isn't too catchy or lethal.

Even inside a lab, people are really bad about safety and cleanliness. And some of the new rules about UV light sources (for cleaning) make that safety step difficult to use and maintain the rules. (I don't recall the specifics but it is one of those "you can have the light but it can't be used in a way that actually cleans the surfaces" type of rule, to prevent UV exposure to humans because someone did something stupid with one.)

Some animal handling rules are things like you can't visit the "cleaner" facility later in the day after visiting the "dirtier" facility. But that rule assumes you change clothes and shower that night. Which some of the people don't -- and then wear the same clothes into the "cleaner" facility the next day.

I'm doing my PhD on post-influenza MRSA pneumonia. Literally just starting an overnight culture of USA300/LAC MRSA, which is a famously virulent form of MRSA that causes necrotizing hemorrhagic pneumonia and killed a lot of young, otherwise healthy people in the early-mid 2000s. It is also one (of many) bacteria that can cause sepsis.

Just as you say, these bugs are not actually that harmful when you take basic precautions that largely consist of "wash your hands" and "work in a bio safety cabinet." This is because the way they are used experimentally does not lend itself to easily causing disease. For this reason, MRSA and other strains of S aureus are BSL-2 (https://en.wikipedia.org/wiki/Biosafety_level#Biosafety_level_2) organisms, and are handled fairly casually. In the US, about 1% of the population is colonized with MRSA anyway. It's not that big of a deal.

BSL-3 organisms (easily transmitted via aerosol, e.g. SARS) and above require substantially more safety precautions (like specialized HVAC systems) and, for this reason, are less commonly studied. For example, there are only 2 BSL-4 research labs in the USA. Both the precautions required and the reduced interest in studying these organisms that result mitigates risk substantially. Even if we accept that these pathogens can escape, it is infinitely less likely that this outbreak is due to a virus from a research lab than it is that it hopped species, as they have done in the past.

[Tod-13]

<snip> Even if we accept that these pathogens can escape, it is infinitely less likely that this outbreak is due to a virus from a research lab than it is that it hopped species, as they have done in the past.

I did not mean my post to suggest that I thought this outbreak was or wasn't a lab virus.

I was just disputing the idea that stuff getting out of a lab is the realm of fiction. Stuff gets out of labs all the time.

[critter]

Not 100% sure what you are asking, but if you're referring to the 3rd graph down (below the map and two tables), take a look at the chart labels. The big block of purple in the background are the total # of cases (i.e. vastly higher than either # dead/recovered).

Also, to drive this point home yet again, the reason the Lancet used mathematical modeling to estimate total # of infected patients is because the number of PCR-confirmed cases are certainly much lower than total # of people infected. Among this subgroup, disease severity is substantially lower by definition - if they aren't sick enough to require medical care, they will not get PCR'd and so they will not be a confirmed case. Because the cases that are not captured by official data are likely to not be very sick, this means that mortality rates are likely lower than calculated using official data.

Thank you. I think it finally sank into the brain. Please allow me to attempt to explain it back to see if I have this close to correct.

The nature of the Chinese gov't, first of all, would (mostly) dissuade any but the very sick from drawing attention to themselves or their families by seeking medical care. There is little to no random testing. These numbers provided are, for the most part, from the most susceptible demographic and the most sick of that group -- and then the outcomes for that group. So any conclusions drawn from the official numbers are naturally skewed even if completely accurate. The mathematical models take this into account and extrapolate from a less skewed data pool to more accurately ascertain the current state of infection and the most likely future scenarios....???

[Wondering Beard]

So would it be fair say that what we are dealing with, so far, is a highly contagious flu but not really terribly lethal?

[Nephrology]

Thank you. I think it finally sank into the brain. Please allow me to attempt to explain it back to see if I have this close to correct.

The nature of the Chinese gov't, first of all, would (mostly) dissuade any but the very sick from drawing attention to themselves or their families by seeking medical care. There is little to no random testing. These numbers provided are, for the most part, from the most susceptible demographic and the most sick of that group -- and then the outcomes for that group. So any conclusions drawn from the official numbers are naturally skewed even if completely accurate. The mathematical models take this into account and extrapolate from a less skewed data pool to more accurately ascertain the current state of infection and the most likely future scenarios....???

Yes, that is correct, though I don't have any reason to think the Chinese gov't is dissuading people from seeking medical care - people find lots of reasons to not go to the doctor on their own. It's most likely that a lot of these uncaptured cases are not sick enough to warrant medical care to begin with, just like the millions of people in the US who get seasonal influenza and do just fine with chicken soup and time on the couch.


So would it be fair say that what we are dealing with, so far, is a highly contagious flu but not really terribly lethal?

Well, to define our terms, "flu" refers to Influenza virus. This is a coronavirus, which is similar in that it it a virus that primarily causes an upper respiratory infection, but is otherwise a different species entirely.

I honestly am not expert enough to tell you how infectious this virus is except that it is clearly more infectious than SARS/MERS were. Per discussion above it is hard to evaluate exactly how severely ill it will make an average, otherwise healthy adult. However, even on the high end of the numbers available to us, it seems clear that the vast majority of people infected will recover just fine with supportive care.

[TiroFijo]

So would it be fair say that what we are dealing with, so far, is a highly contagious flu but not really terribly lethal?

It seems so...

But likely far more lethal than normal flu. Otherwise the chinese would not bother so much, in spite of all their efforts to downplay this. Nor would the rest of the world.

Who knows what the real numbers of infected, those who are in critical condition, and fatalities are.

It also seems the reported high percentage of patients in critical condition (around 13%) that need in-hospital treatment combined with the potential for a very large outbreak can collapse the medical infraestructure in third world countries. Numbers have a quality of their own...

As longt as just a few cases emerge outside China and can be confined and well treated, the pandemic is going to be contained.

OTOH,

https://www.cnbc.com/2020/02/03/mayo-clinic-dr-gregory-poland-coronavirus-basically-at-a-pandemic.html

[Aisin Gioro]

Yes, that is correct, though I don't have any reason to think the Chinese gov't is dissuading people from seeking medical care - people find lots of reasons to not go to the doctor on their own.

"You must understand...facts are different here", said a Chinese forestry official in charge of cracking down on illegal logging, who did almost nothing to stop it, yet was not himself involved in illegal logging.

The Chinese government is actually doing just the opposite, very publicly encouraging people to get checked out and report themselves if they are showing any symptoms. There are reports of people being forcibly detained, removed from their homes, etc. if they have signs of infection. In many cities, towns, and villages, there are now big public announcements and banners saying things like "People who have fever and don't report it are class enemies lurking among the people!" (in very old-school Cultural Revolution style language in Chinese, which you never see anymore otherwise)

However...

In practice, a lot is being done to discourage all but the worst cases from coming in, in part because many hospitals are severely lacking in even basic PPE at this point. Patients are being very cursorily examined, and in many cases summarily sent home without even seeing a doctor. Local officials are complicit in this, because they don't want their numbers going up, so they support (and, in at least some cases, "encourage") medical centres in dealing with things is a very skewed manner. Word of this is being put out all across China, but especially in the hardest-hit provinces, so while the official line is "get checked out right away!", the actual position is more like, "You better not show up with a cold or the flu".

Bear in mind that China does not have a functional primary care model anything like most Western countries or Japan. Essentially, all medical care is delivered in hospital settings, even the most routine things like eye exams and flu shots. As a result, many hospitals were already somewhat overburdened before this even started. China has greatly expanded access to healthcare centres over the past 10 years or so, but hasn't done as much to actually increase healthcare facilities, staff, or equipment, so you have enormous, often very dense, populations crammed into severe bottlenecks. I was talking to a good friend of mine who is a physician in a major city about 7 hours away from Wuhan, in a neighbouring province, and for several days now they have had no N95s for staff outside of isolation wards, and are now getting one gown, cap, and surgical mask per day. Footie scrubs are gone, and they are down to mixing up their own disinfectant. This is at a modern hospital in a prosperous city, so you can imagine what it's like in Wuhan or some lesser hospitals around Hubei.

[Aisin Gioro]

It also seems the reported high percentage of patients in critical condition (around 13%) that need in-hospital treatment combined with the potential for a very large outbreak can collapse the medical infraestructure in third world countries. Numbers have a quality of their own...

That's the thing. To borrow another quote, this time from Noel Coward, "Very big, China." Wuhan - a city many foreigners have never even heard of - has over 11 million people, larger than New York, London, Rio, etc., and is still considered a "second-tier city" in China. Chongqing municipality has over 30 million people, which would actually place it in the top 50 most populous countries in the world if it was independent (more than Australia, for example). There is a lot of variation in the proposed reproduction number for this virus (1.5 to 4.08), but even assuming a fairly modest 5% of the population infected, that's 1.5 million people in CQ alone.

Extrapolate that to a country like the US. 330 million people, roughly 10 times the size of Chongqing. Seasonal influenza has an R0 of about 1.5 (1.4 to 1.85), at the very lowest end of the estimates for 2019-nCoV. Flu infects about 3 to 11% of the US population per year, so lets go with a low, easy number of 5% again. If 2019-nCoV were to infect 5% of the US population (= 16.5 million people) and only 33% as many needed hospital care as currently appear to in China, that's almost 800,000 people. There are currently just under 1 million hospital beds in the US...of which about 20-40% are actually available at any given time. The numbers on that one are not encouraging, even in a first world country.

I should say, though, that I don't think we are really going to be looking at such high hospitalization rates, especially in countries with more expanded primary care models. The early cases, and the politics of the issue, are skewing things towards the more severe cases. In a few months or a year, I think post-epidemic surveys are going to show widespread, but generally more minor infections that flew under the radar (or were pushed under the radar...) at the time. It's probably more severe on a case-by-case basis than most seasonal flu strains, but I strongly suspect that the case fatality rate and even hospitalization rates are going to be cut significantly by larger numbers of lesser or even sub-clinical infections over time.

[Aisin Gioro]

If 75,000 have been infected in wuhan, 260 deaths/ 75,000 * 100 = 0.3% mortality rate.

Interestingly, that tracks right about where the case fatality rate is in China overall, excluding Hubei province and Wuhan proper. Using fairly early numbers about a week ago (which, yes, are both outdated and probably mostly wrong to being with :p), the CFR in Wuhan was 5.5%, Hubei ex-Wuhan was 1%, and China ex-Hubei/Wuhan was 0.3% I hesitate to call that "reasurring", but "less alarming", maybe.

[Dog Guy]

Interestingly, that tracks right about where the case fatality rate is in China overall, excluding Hubei province and Wuhan proper. Using fairly early numbers about a week ago (which, yes, are both outdated and probably mostly wrong to being with :p), the CFR in Wuhan was 5.5%, Hubei ex-Wuhan was 1%, and China ex-Hubei/Wuhan was 0.3% I hesitate to call that "reasurring", but "less alarming", maybe.

AG, can you provide a very brief version of your background so that I can put your posts in context? No problem if the answers is no (personal security being paramount), but you seem to have good info and I'd like to get a sense of where you're coming from.

[RoyGBiv]

Any suggestions on a better surface disinfectant than this one?
Looking to have something on hand for use at home, for counters, sinks and toilets, etc.

Clorox® Clean-Up Cleaner + Bleach (https://www.clorox.com/products/clorox-clean-up-cleaner-bleach/original/)

FYI Clorox info page HERE (https://www.clorox.com/how-to/disinfecting-sanitizing/cold-flu-other-diseases/help-prevent-the-spread-of-the-human-novel-coronavirus-2019-ncov/). Recommends only 30 seconds of wet exposure to this product. Pretty quick, it seems.

[RoyGBiv]

Tangent...

Weekly U.S. Influenza Surveillance Report (https://www.cdc.gov/flu/weekly/index.htm)


CDC estimates that so far this season there have been at least 19 million flu illnesses, 180,000 hospitalizations and 10,000 deaths from flu.

[theJanitor]

Any suggestions on a better surface disinfectant than this one?


I use this, or a generic (Target brand) equivalent at home. For areas that I don't want bleach, I use alcohol in a spray bottle. It's cheap and effective, to my knowledge

[Aisin Gioro]

AG, can you provide a very brief version of your background so that I can put your posts in context? No problem if the answers is no (personal security being paramount), but you seem to have good info and I'd like to get a sense of where you're coming from.

I'm happy to, though I will be a little bit vague. I'm not really concerned for myself, since at this time I'm located outside of China, but I may occasionally reference people, places, and topics that could potentially cause difficulties for people there. China isn't North Korea, but there can still be some negative consequences for crossing certain lines. The PRC authorities put a lot of effort into triangulating small bits of information across a wide range of platforms, using it partly to identify people there who share things that are unfavourable or contrary to the official line or deal with sensitive information. With family, professional, and personal ties to China and other places in east Asia (Taiwan, Singapore, etc.), less personal information to create a hub of reference is usually better.

My background is journalism and academic editing, not clinical (that's my wife's side). International, and particularly east Asian, healthcare has been a particular focus, along with a range of other topics, and I keep in close touch with people in China and throughout east Asia, some of whom are in positions where they have information or perspectives that are especially enlightening or interesting, if it's a topic of interest in the first place. :)

[HeavyDuty]

Tangent...

Weekly U.S. Influenza Surveillance Report (https://www.cdc.gov/flu/weekly/index.htm)

Influenza is real. I lost my wife to it in 2015.

[farscott]

Influenza is real. I lost my wife to it in 2015.

Yes, it is much more dangerous than the coronavirus appears to be. I am sorry for your loss; we lost my grandfather to the flu in the 1980s. I remember being shocked that the flu was fatal to a man I remembered as a force of nature.

[Dog Guy]

I'm happy to, though I will be a little bit vague. I'm not really concerned for myself, since at this time I'm located outside of China, but I may occasionally reference people, places, and topics that could potentially cause difficulties for people there. China isn't North Korea, but there can still be some negative consequences for crossing certain lines. The PRC authorities put a lot of effort into triangulating small bits of information across a wide range of platforms, using it partly to identify people there who share things that are unfavourable or contrary to the official line or deal with sensitive information. With family, professional, and personal ties to China and other places in east Asia (Taiwan, Singapore, etc.), less personal information to create a hub of reference is usually better.

My background is journalism and academic editing, not clinical (that's my wife's side). International, and particularly east Asian, healthcare has been a particular focus, along with a range of other topics, and I keep in close touch with people in China and throughout east Asia, some of whom are in positions where they have information or perspectives that are especially enlightening or interesting, if it's a topic of interest in the first place. :)

Thank you.

[RoyGBiv]

Don't know what to make of this..... Passing it along..

Tencent may have accidentally leaked real data on Wuhan virus deaths (https://www.taiwannews.com.tw/en/news/3871594)


Tencent briefly lists 154,023 infections and 24,589 deaths from Wuhan coronavirus

[Borderland]

Don't know what to make of this..... Passing it along..

Tencent may have accidentally leaked real data on Wuhan virus deaths (https://www.taiwannews.com.tw/en/news/3871594)

I doubt you could hide something like 24K deaths even in China. The virus doesn't seem to be that deadly in other countries where it has been found. A person that was treated here was released from the hospital and is recovering at home.

https://www.heraldnet.com/news/first-u-s-coronavirus-patient-released-from-everett-hospital/

[TiroFijo]

OTOH, the chinese are behaving like they are scared shitless about this epidemic, which clearly signals that is not just another flu.

[Aisin Gioro]

I doubt you could hide something like 24K deaths even in China. The virus doesn't seem to be that deadly in other countries where it has been found. A person that was treated here was released from the hospital and is recovering at home.

https://www.heraldnet.com/news/first-u-s-coronavirus-patient-released-from-everett-hospital/

It's the ratio that makes me question those numbers, but not the scale. Especially under the lockdown conditions in the hardest hit areas, it would be more possible to hide 24k deaths in China that it might seem. Bear in mind that even before all of this, most people in China genuinely have no idea or understanding of the fact that the government currently has approximately 1 million people held in internment camps in western China. Now, there is much less communication, and horizons have been narrowed dramatically. At this point, the authorities in many cities are allowing one person per household out of their homes every 2 or 3 days to obtain food and essentials only. The now have PLA (regular army) troops and Ministry of Public Security (civil security forces) patrolling some areas to enforce quarantines and curfews. In places like Wuhan, public transportation (essential and heavily relied upon in most Chinese cities) has been suspended and even private cars are banned from the road. Cities 1000km/650 miles away have been rolling out similar restrictions on movement this week. Internet censorship and surveillance have been stepped up considerably over the past week, and are increasing every day.

However, as you say, the evidence outside of China certainly suggests that the case fatality rate isn't nearly as high as 24k per 154k infections. That's ~15%, five times even the initial CFR indications. While Wuhan might be seeing disproportionate case fatality rates due to overwhelmed health services, it seems highly unlikely that the overall CFR in China is anywhere close to that. 24k deaths and 1 million infections wouldn't surprise me, though...

[TiroFijo]

The official statistics show that out of 563 deaths in all of China, 549 (97.5%) are in Hubei and only 14 (2.5%) elsewhere.

This despite Hubei having 70.0% of all confirmed cases. This shows the collapse of the health system in the area due to overwhelming numbers, but also makes me go hummm... about the veracity of the reports overall.

Outside Hubei there are 14 deaths out of 8420 cases, or 0.17%.

In the rest of the world, with no expenses spared to treat patients, there are 2 deaths out of 259 patients (0.77%).

IMO the most important things are the 14% of reported cases in critical condition, and high transmition rate (3- 4 newly infected from 1 case).

[Nephrology]

I use this, or a generic (Target brand) equivalent at home. For areas that I don't want bleach, I use alcohol in a spray bottle. It's cheap and effective, to my knowledge

70% ethanol is what we use to clean our lab benches. We bleach liquid waste.

[Aisin Gioro]

News just in...Li Wenliang, the Chinese doctor who tried to warn people about the outbreak as early as late December, and was detained, given a formal police caution, and intimidated by the authorities for it, has died of 2019-nCoV. He was diagnosed last week after contracting the disease from a patient he had treated as an opthalmologist, and had been in hospital in Wuhan.

(link in Chinese..."Dr. Li Wenliang, the whistleblower of the epidemic, died tonight, in memoriam"!

"Media confirmed that Dr Li Wenliang died at 21:30 on February 6 from pneumonia caused by the novel coronavirus. Li Wenliang, an ophthalmologist at Wuhan Central Hospital, is known as the "whistleblower" because he issued a protective alert to the outside world as early as December 30, 2019. On February 1, Li Wenliang announced his diagnosis of novel coronavirus pneumonia on his microblog.

Remember him! Hopefully, he will be given a formal memorial!"

https://mp.weixin.qq.com/s?__biz=MzIzMjI0MjMwMQ==&mid=2651319435&idx=1&sn=4f260f5935cc2fc8286b00a12b28ca7b&chksm=f364a199c413288f8a20f8d0144051aa81e90ecb2d6c a7eff75267a6ab8843b94866c70a2e2a&mpshare=1&scene=1&srcid=&sharer_sharetime=1581002672618&sharer_shareid=0cad8e62adaeed360bde88ebdf3e71c5&exportkey=AlNEhJEqKGNdEmEAwlOUfkU%3D&pass_ticket=bHdYeqszyioWg8GopunIV%2F1fwl3pt6bi1NC0 wBs0VyYXzMPPE%2BQM6LSW3hTsHyVR#rd

English coverage:

"Coronavirus 'kills Chinese whistleblower doctor Li Wenliang'"
https://www.bbc.com/news/world-asia-china-51403795

and some background:

"The Chinese doctor who tried to warn others about coronavirus"
https://www.bbc.com/news/world-asia-china-51364382

"This Chinese doctor tried to save lives, but was silenced. Now he has coronavirus"
https://edition.cnn.com/2020/02/03/asia/coronavirus-doctor-whistle-blower-intl-hnk/index.html

[TiroFijo]

My respects to Dr Li, a civil hero.

[Borderland]

News just in...Li Wenliang, the Chinese doctor who tried to warn people about the outbreak as early as late December, and was detained, given a formal police caution, and intimidated by the authorities for it, has died of 2019-nCoV. He was diagnosed last week after contracting the disease from a patient he had treated as an opthalmologist, and had been in hospital in Wuhan.

This speaks volumes about China and their health care system. They seem to be more concerned about controlling the appearance of having control than actual control of an infectious virus. That tells me they probably know they can't control these health care threats, only control the information about them. Probably the next best thing but that doesn't solve the internal problems of controlling the economic fallout which seems to be substantial. If it's sending a shock wave thru the global economy, which apparently it is, things may be worse than they care to admit.

https://youtu.be/Z4T_Gs9xNjA

[Aisin Gioro]

They seem to be more concerned about controlling the appearance of having control than actual control of an infectious virus. That tells me they probably know they can't control these health care threats, only control the information about them.

That's very true, and it is a reflection of a major difference between China and democratized nations. People who "spread rumours" or "disrupt social order" by posting "unverified information" about the 219-nCoV outbreak can now be imprisoned for up to seven years. What is "unverified information"? It's information that does not come from state institutions or state media. "Users should learn about the epidemic information from disease control or medical institutions and authoritative news media. The relevant epidemic prevention information is subject to the official website of the provincial and municipal health departments and health committees."

In China, laws, social institutions, and public policies are primarily structured to protect the interests of the state, not the citizenry. While it's easy to feel like that is sometimes the case in Western nations (and certainly it is in certain instances), it's fundamental and institutionalized in China. For example, in a survey, 1 in 4 Chinese women reported being the victims of domestic violence in the previous 12 months (with the actual number being almost certainly far higher - "keep ugly things inside" is a common saying in Chinese, and people don't like to share unpleasant information even with those close to them). However, until 2016, China had no domestic violence laws, but it had lots and lots of laws about what people could say or do online for a long time prior. Control of people is the primary concern.

[Kanye Wyoming]

Those who know about this stuff - what do you think? Sounds not good.


It is also clear to me as a physician – listening to the Chinese doctors – and viewing footage from the hospitals and clinics – that this is many orders of magnitude worse than what they are saying. Common sense will tell you that as well – are they really going to torpedo their entire industrial heartland for months – just because 300 people have died? — I think not – I think this is way worse than we can possibly imagine.

My mother-in-law lives in a smaller city – far on the western fringe of China – If Wuhan were Atlanta – she would be in a place like Boise. She had a fever about 8 days ago. Please note – official statistics note that there are 9 people in her province confirmed to have the virus. This belies the fact that she (never known to me to be a liar or fabulist ) has been telling my wife for days that there are hundreds upon hundreds of people all over the sidewalks and streets outside the hospital – and that the hospital is completely filled with patients. And apparently the crematorium has been very busy. Of most grave concern to her – is Beijing nationalized all of their small province’s health care workers and sent them to Shanghai or Beijing – leaving their city of a million with only a handful of doctors. When she had her fever – a nurse looked at her for 10 minutes. They found out she had a runny nose – and because of the runny nose told her she did NOT have the virus. NO TEST WAS EVER DONE – WHY? they simply do not have enough kits – and are having to go by their gut instinct. She was sent back to her own home – and placed in quarantine there – never having been tested.

. . . .

My other question is for us in the USA. Our supply lines – especially in things like medicine are DEPENDENT now on China. I have been saying for years this is a national security issue. And now their industrial heartland is on its knees. I do not know anything about auto parts and widgets – I do know a lot about medicine. There are many many things (saline bags, cardiac IV meds, antibiotics, blood pressure meds, diabetes meds, I can go on and on) that are only made in China. For the first time since this crisis began – late last week saw the very first issues I am having with my patients not being able to get things. We are promised this will just be the beginning. [emphasis mine — rd] There is no way that we can re-engineer factories quickly to start making things here – it will be at least a year.

https://www.theamericanconservative.com/dreher/the-plague-pushes-china-to-breaking-point-coronavirus/

[Aisin Gioro]

Those who know about this stuff - what do you think? Sounds not good.
https://www.theamericanconservative.com/dreher/the-plague-pushes-china-to-breaking-point-coronavirus/

Point by point, I would question some of the things in the article, but overall I think the tone and the issues it raises are all valid and substantially correct, based on the information I'm getting. I'm not aware of any situations where CCTV (China Central Television, the primary state TV media) is broadcasting live arrests like that, though. For one thing, that would be counter to the image they want to preserve in their very carefully controlled presentations, and it's also unlikely that the PLA would be the ones doing it. It's possible it was the national civil police agency, the People's Armed Police (PAP), and for an international observer it might be possible to mistake them for PLA, though I think if his wife is Chinese she would probably know the difference.

Also, while getting international calls in and out of Wuhan might be hard, other means have been working fine. Weixin (international version: WeChat) has become a primary means of communication in China of the past few years, and its VOIP calls are as common as mobile calls for many people, and work internationally. The government is certainly watching Weixin public posts and chat groups closely these days, but direct messages and VOIP seem to be largely OK, at least right now.

The last point about Nanjing is a bit of an exaggeration. Nanjing is not under lockdown in the way that Wuhan or Huanggang are, but there is definitely a strong police and military presence and most people are not going out unless absolutely necessary. This is true across most of China, though the degree varies widely. A good friend's elderly father lives in Zhejiang province, which has seen the third most cases in China, though far less than Hubei. He goes out every day to "buy food and do other things", despite my friend's protests for him to stay home. The authorities in Nanjing and other areas are not just rounding up people or going door to door checking temperatures. (In at least some parts of Wuhan, that is happening, though.) However, it's very likely that a person not wearing a mask outdoors will be stopped and get anything from an intimidating lecture to a detention, depending on the circumstances. For example: walking alone on an empty street, lecture...going into a supermarket with other people around, detention.

All that said, the article is right that the situation on the ground across China is without doubt far more serious and extensive than the official numbers would say. A friend who is a physician in another major city in a low-medium intensity infection area directly alludes to this with comments like, "There is a lot of bad news that doesn't get reported. Medical professionals know the stories." It's also absolutely true that large numbers of probable cases are not being tested or evaluated properly, even in areas where there really isn't as much of the virus. There are severe shortages of manpower and materiel across China, and a lot of pressure to triage people according to very rough and changeable guidelines. "Runny nose is not a symptom, you have a cold. Go home now," would be very common. This is complicated by the fact that at this time of year, everybody in China has a cold at some point. Where the average European or American might get 2 or 3 colds in a year, the average person in China, especially in a city, will get 5 or 6, or effectively one a month in season. High population density, high mobility, and miserable air quality all contribute to respiratory infections being rife. If they were testing every person who had a cough, aches, sore throat or fever over a month they would be running hundreds of millions of tests, perhaps literally over half a billion. That's just impossible in the current circumstances, and it means that very large numbers of actual 2019-nCoV infections are being swept up in the giant tide of seasonal colds and flu. And that's before we even get into the overtly manipulated numbers...

It's also true that medical staff are being moved from low intensity areas to high intensity areas. Some of them are deployed PLA medical personnel (at least 2,000 PLA doctors, medics, nurses and others have been sent directly to Wuhan alone), but many are just regular medical staff from around China. This doesn't seem to be uniform or consistent, but it's widespread in a scattered kind of way, pulling some from here, some from there. Another thing happening in many places is medical staff being reassigned to infection and isolation units. For example, a neurologist might be pulled from his department and moved to an isolation ward to care for 2019-nCoV patients for the duration of the outbreak, leaving his existing cerebrovascular patients under-served. This has contributed to preventable deaths from other causes. At least they don't appear to be rotating them in and out at whim, moving potentially exposed doctors around the hospital or around the country. Once the medical personnel have been assigned to 2019-nCoV, they are with it until this gets better.

[Kanye Wyoming]

@AisinGioro - very interesting, thanks.

[TiroFijo]

@AisinGioro thanks a lot

Do you think the numbers are being manipulated so that at least the percentages (Infected: 82% mild and 18% serious or critical condition ; and about 2% death of all reported cases) reflect reality?

[TGS]

Great perspective, Aisin Gioro.

Makes sense. It's hard to say, "there's only X number of patients" when you don't even have enough test kits to even begin to cover all of the presenting candidates, and are simply turning people away with poor excuses to hide the fact that you simply can't even test them. So, the numbers are obviously completely incorrect from the get-go.

[Aisin Gioro]

@AisinGioro thanks a lot

Do you think the numbers are being manipulated so that at least the percentages (Infected: 82% mild and 18% serious or critical condition ; and about 2% death of all reported cases) reflect reality?

Unfortunately, over time it's looking more and more like even the percentages and overall ratios are unreliable. The National Health Commission has issued a statement that "confirmed cases" have been counted differently since Feb. 7. Now, even positive tests "without symptoms" will no longer be counted as "confirmed" (or, presumably, counted at all). This is sadly also a reflection of institutional thinking in China, and utterly improper by accepted international medical guidelines. It lowers the overall numbers, so the people in charge think it makes them look better. In practice, by only counting the symptomatic cases, it actually skews the ratios significantly towards the more severe cases, so the case fatality rate is going to look much worse. In reality, it also strongly implies that those without symptoms are going to be even less likely to get tested at all, since even if they test positive for 2019-nCoV, they won't be considered a "case". If every actual case was counted, while the overall numbers would rise, the case fatality rate would undoubtedly be much lower, since there are likely very large numbers of asymptomatic or mild cases that now will be officially suppressed.

[Aisin Gioro]

Great perspective, Aisin Gioro.

Makes sense. It's hard to say, "there's only X number of patients" when you don't even have enough test kits to even begin to cover all of the presenting candidates, and are simply turning people away with poor excuses to hide the fact that you simply can't even test them. So, the numbers are obviously completely incorrect from the get-go.

Exactly, and now with the new official policy (see below), we know for a fact that the numbers are being blatantly manipulated, in addition to the distortions already being caused by lack of proper testing. When everyone calls for greater transparency, and the government's response is, "OK, we'll confirm that we are lying", that's not a step in the right direction. :(

[TiroFijo]

Unfortunately, over time it's looking more and more like even the percentages and overall ratios are unreliable. The National Health Commission has issued a statement that "confirmed cases" have been counted differently since Feb. 7. Now, even positive tests "without symptoms" will no longer be counted as "confirmed" (or, presumably, counted at all). This is sadly also a reflection of institutional thinking in China, and utterly improper by accepted international medical guidelines. It lowers the overall numbers, so the people in charge think it makes them look better. In practice, by only counting the symptomatic cases, it actually skews the ratios significantly towards the more severe cases, so the case fatality rate is going to look much worse. In reality, it also strongly implies that those without symptoms are going to be even less likely to get tested at all, since even if they test positive for 2019-nCoV, they won't be considered a "case". If every actual case was counted, while the overall numbers would rise, the case fatality rate would undoubtedly be much lower, since there are likely very large numbers of asymptomatic or mild cases that now will be officially suppressed.

Yes... currently with this "method" of counting there is a 20% death rate of outcomes

https://www.worldometers.info/coronavirus/

Currently Infected
36,078
Mild Condition
29,583
(82%)
Serious or Critical
6,495
(18%)

Cases with Outcome
4,575
Recovered/Discharged
3,665
(80%)
Deaths
910
(20%)

[farscott]

Exactly, and now with the new official policy (see below), we know for a fact that the numbers are being blatantly manipulated, in addition to the distortions already being caused by lack of proper testing. When everyone calls for greater transparency, and the government's response is, "OK, we'll confirm that we are lying", that's not a step in the right direction. :(

On the plus side, it confirms something that has bothered me, namely that the Chinese response to the coronavirus has been widely disproportionate to the number of cases reported and/or its seriousness. In other words, the numbers of coronavirus patients and deaths reported by China are dwarfed by the number of influenza cases and deaths in the USA, a country with less than one-third of the population. Yet the Chinese government has sacrificed something like 2% (per week) of GDP because of this whereas the USA is operating normally. That makes little sense, especially for a country like China that looks as people as essentially cannon fodder for the goals of the state.

So why shutdown the country? Is it to deprive other countries of Chinese-made goods? A way to say that China is THE superpower? Or is the coronavirus worse than China has stated? Or something else? Or a combination thereof? There is a crisis, and someone or several someones is not letting it go to waste.

[TiroFijo]

On the plus side, it confirms something that has bothered me, namely that the Chinese response to the coronavirus has been widely disproportionate to the number of cases reported and/or its seriousness. In other words, the numbers of coronavirus patients and deaths reported by China are dwarfed by the number of influenza cases and deaths in the USA, a country with less than one-third of the population. Yet the Chinese government has sacrificed something like 2% (per week) of GDP because of this whereas the USA is operating normally. That makes little sense, especially for a country like China that looks as people as essentially cannon fodder for the goals of the state.

So why shutdown the country? Is it to deprive other countries of Chinese-made goods? A way to say that China is THE superpower? Or is the coronavirus worse than China has stated? Or something else? Or a combination thereof? There is a crisis, and someone or several someones is not letting it go to waste.

I think it is obviously far worse than official numbers indicate, or else the chinese government would not bother so much/at all.

All indications point to a higher transmission rate than normal flu, higher % of complications/critical, and higher death rate. It doesn't get much worse when you see the potential implications.

The Spanish Flu had "only" a 2.5% death rate at yet killed 50+ milion people in 1918-20, circling the globe (by sea) twice. This was 3.0% of the global population at the time.

[Aisin Gioro]

Yes... currently with this "method" of counting there is a 20% death rate of outcomes

The new method makes the case fatality rate look so disturbing, if that becomes a focus of worldwide reporting I wouldn't be surprised to see the government revert to the preferred method. Right now, everybody is focusing on total case numbers and total death numbers, so if you cut out a large number of the total and implicitly cut out a portion of the deaths (since some people who die from it are just not getting tested, either intentionally or simply because the resources don't exist to test them), it gets closer to the desired goal of lowering absolute totals. If the case fatality rate starts looking like an embarrassment, that could all change again. There is a longstanding view among many Chinese senior officials that it's easier to do something again than it is to do it right the first time. That said, there is a lot of rigidity among others that pushes for persisting in errors, because a change of course acknowledges a mistake, so really it could go either way, depending on which faction makes the best arguments in secret.

[Aisin Gioro]

On the plus side, it confirms something that has bothered me, namely that the Chinese response to the coronavirus has been widely disproportionate to the number of cases reported and/or its seriousness. In other words, the numbers of coronavirus patients and deaths reported by China are dwarfed by the number of influenza cases and deaths in the USA, a country with less than one-third of the population. Yet the Chinese government has sacrificed something like 2% (per week) of GDP because of this whereas the USA is operating normally. That makes little sense, especially for a country like China that looks as people as essentially cannon fodder for the goals of the state.

So why shutdown the country? Is it to deprive other countries of Chinese-made goods? A way to say that China is THE superpower? Or is the coronavirus worse than China has stated? Or something else? Or a combination thereof? There is a crisis, and someone or several someones is not letting it go to waste.

I just finished talking with a doctor in a major city in central China, whom I've known for some time. When I mentioned the new government case-count guidelines, his response was, "Well, data is just data, right? Who knows what's true and what's not?" Like many people in China, he fully expects to see the government manipulating the stats, he was just mildly surprised that they would acknowledge it.

The shutdown comes from two main reasons. One, it's without doubt much worse than the official numbers suggest. This has lead to both a sense of alarm from the population and a need for an overwhelming show of force from the government. Stability is the overarching principle that guides most public decisions in China, and it's both a genuine desire (after many generations of historical and recent upheaval) and a prime excuse to exercise more control over people. The government will do whatever it takes to ensure what it defines as "stability", and locking down 60 million people writes "government capabilities" in very large characters.

Related to that is the spectre of SARS in 2002-2003. The government worked hard for months on end to suppress that. It worked better domestically in those days, because only about 6% of Chinese people had internet access at the time and there was no Weixin/WeChat, etc. Even mobile phones were a semi-luxury item that perhaps 10% of people had. However, that did nothing to stop the actual spread of the disease, and when word got out to the rest of the world - along with infections and deaths - it was a blow to the government's line that they had everything in hand. Xi Jinping is far more savvy and far more focused on building an enduring position of power than any other Chinese leader since Mao, and he's not thinking of slipping past the crisis and enjoying a long retirement like Jiang Zemin or Hu Jintao before him. He successfully navigated the removal of term limits two years ago, making himself president-for-life. He knows that he must maintain an image of being capable and in control, and the overwhelming "epidemic theatre" response to 2019-nCoV is part of that. Unfortunately, so is deliberately altering the numbers to make that response seem more effective. I'm very concerned that the end result of all this will be a terrible outbreak that is eventually overcome, but with lies and distortions that allow it to be presented as a great victory lead by Xi.

[farscott]

I just finished talking with a doctor in a major city in central China, whom I've known for some time. When I mentioned the new government case-count guidelines, his response was, "Well, data is just data, right? Who knows what's true and what's not?" Like many people in China, he fully expects to see the government manipulating the stats, he was just mildly surprised that they would acknowledge it.

The shutdown comes from two main reasons. One, it's without doubt much worse than the official numbers suggest. This has lead to both a sense of alarm from the population and a need for an overwhelming show of force from the government. Stability is the overarching principle that guides most public decisions in China, and it's both a genuine desire (after many generations of historical and recent upheaval) and a prime excuse to exercise more control over people. The government will do whatever it takes to ensure what it defines as "stability", and locking down 60 million people writes "government capabilities" in very large characters.

Related to that is the spectre of SARS in 2002-2003. The government worked hard for months on end to suppress that. It worked better domestically in those days, because only about 6% of Chinese people had internet access at the time and there was no Weixin/WeChat, etc. Even mobile phones were a semi-luxury item that perhaps 10% of people had. However, that did nothing to stop the actual spread of the disease, and when word got out to the rest of the world - along with infections and deaths - it was a blow to the government's line that they had everything in hand. Xi Jinping is far more savvy and far more focused on building an enduring position of power than any other Chinese leader since Mao, and he's not thinking of slipping past the crisis and enjoying a long retirement like Jiang Zemin or Hu Jintao before him. He successfully navigated the removal of term limits two years ago, making himself president-for-life. He knows that he must maintain an image of being capable and in control, and the overwhelming "epidemic theatre" response to 2019-nCoV is part of that. Unfortunately, so is deliberately altering the numbers to make that response seem more effective. I'm very concerned that the end result of all this will be a terrible outbreak that is eventually overcome, but with lies and distortions that allow it to be presented as a great victory lead by Xi.

Thank you for the very enlightening reply.

[Wondering Beard]

For the legally minded among us: The Coronavirus and the Constitution (https://reason.com/2020/02/10/the-coronavirus-and-the-constitution/)

[RoyGBiv]

North Korea’s Secret Coronavirus Crisis is Crazy Scary (https://www.thedailybeast.com/north-koreas-secret-coronavirus-crisis-is-crazy-scary)


North Korea’s worries about an epidemic are all the more intense because of its shortage of basic medicine and equipment. As cases mount, authorities are working feverishly to contain a disease that, if unchecked, could undermine Kim’s grip over his 25 million people, most of whom live in poverty worsened by hunger.
“Because health conditions and health care in North Korea are so bad,” said Bruce Bennett, long-time analyst at the Rand Corporation, “they cannot allow the replication process to develop without severe intervention”—that is, they have to take drastic steps to keep the virus from spreading fast.

Starving. Little modern medicine/infrastructure.... Potentially catastrophic for them.
The only slightly good news is that NK is already cut off from much of the rest of the world.
I keep looking for where this disease will break out.... Seems inevitable, honestly.

[Aisin Gioro]

North Korea’s Secret Coronavirus Crisis is Crazy Scary (https://www.thedailybeast.com/north-koreas-secret-coronavirus-crisis-is-crazy-scary)



Starving. Little modern medicine/infrastructure.... Potentially catastrophic for them.
The only slightly good news is that NK is already cut off from much of the rest of the world.
I keep looking for where this disease will break out.... Seems inevitable, honestly.

You are absolutely right, NK is a low-intensity powder keg at the best of times, and a major crisis that could upset the balance of power is a serious risk. Ironically, the only country that NK isn't almost completely cut off from is China, which makes up more than 90% of their foreign trade. The border with China is officially very tight, but NK relies on goods coming in from China every day, so there has to be some flow back and forth. Two things keep a lid on things, though. First, well established dictatorships can turn quickly and enact the kind of draconian measures that might prevent or curtail an outbreak. That includes medieval actions undertaken with modern efficacy (a sinister thought in the context of NK history...). Second, despite all the horrors of NK, 70 years of family rule, indoctrination, and cultural isolation have made very many (not all, but very many and perhaps most) North Koreans legitimately warped in their view of both the Kim dynasty and the world at large. I'm really not sure even if an epidemic swept through the country that it would make much difference to people's thinking. Though nominally atheist, NK is, as Christopher Hitchens once said very rightly, "the most religious state it's possible to imagine".

The Kim family is essentially an extension of the god-kings of the ancient world, human manifestations of divine providence. People are taught from birth that when Kim Jong-il was born on the sacred Mt. Paektu, flocks of cranes (the traditional bird of Korea) flew across the country, double rainbows appeared, birds sang in Korean (really, I'm not making this up...), and a new star was formed in the night sky. (Actually, he was born at a Soviet military base in the Russian Far East where his father had retreated, but saying so is punishable by death in NK.) When he died, cranes flew around the statue of his father, Kim Il-sung (dead since 1994, but still the official head of state, or "Eternal President", even today), the peak of Mt. Paektu "glowed red like fire", and the frozen Heaven Lake at the top of the mountain cracked and shook the earth. In between, he learned to walk and talk at a few weeks of age, wrote over 1,500 books just during his three years of college, and made time to compose six full operas ("better than any in the history of music"). A sporty guy, he also scored at 38-under with 11 holes in one the first time he picked up a golf club, and ended the afternoon by giving the top golfer in NK lessons. His first, and perhaps only, experience with bowling was a perfect 300. He could save time for all of this because he, like his father, did not produce bodily waste, unlike mere mortals who need to stop for washroom breaks. All of this is taught as part of the official school curriculum in NK. When I once asked a South Korean government official/academic if the teachers themselves believed all this, his response was a rather serious, "They don't have a choice what to believe." The whole country is an exercise in Stockholm Syndrome.

His son, Kim Jong-un, has been busy, too. Even before coming to power in 2011, he could drive by age three, paint masterpieces as a child, and correct all of his teachers in school. Since 2011, he has developed a cure for AIDS, some kinds of cancer, and Ebola, all with one drug. He eradicated disabilities among the people (that one might be chillingly accurate, if you focus on the "eradicated" part...), then went on to discover a unicorn's lair, right in the middle of the capitol and - hey, stop laughing, I'm not making this up! :D (Really, they actually do teach this.)

[Maple Syrup Actual]

wrote over 1,500 books just during his three years of college

To be fair, some undergraduate degrees don't really have an overly heavy workload. I knew some sociology second years who did have a lot of free time.

[theJanitor]

https://www.worldometers.info/coronavirus/


Cases increased by 15,000 today....

[Aisin Gioro]

To be fair, some undergraduate degrees don't really have an overly heavy workload. I knew some sociology second years who did have a lot of free time.

Haha, he might have done Film Studies, so that makes sense. ;)

[TiroFijo]

Cases increased by 15,000 today....

...but who knows what the real numbers are.

[Aisin Gioro]

Cases increased by 15,000 today....

This highlights the craziness in how the Chinese government is compiling and manipulating stats. A few days ago, we saw the government change the counting protocol to nominally exclude lab-confirmed cases that showed no symptoms (in reality, everybody who wasn't very sick). Of course, this made the case fatality rate rise, and also drew some criticism for being improper under WHO and other international protocols. Now, it seems that the faction paying attention to case fatality rates has bent the ear of the authorities, so they have again revised the case counting protocols to cast a very wide net, and they are now testing and counting vastly more people than they were under the February 7 protocol.:rolleyes:

[theJanitor]

This highlights the craziness in how the Chinese government is compiling and manipulating stats......and they are now testing and counting vastly more people than they were under the February 7 protocol.:rolleyes:

Pretty much what I'm thinking. when we look back on this virus, the stat people will highlight is the mortality rate, not the total number of cases

[TiroFijo]

Of course, the might as well (most probably) severely under reporting the number of deaths...

[critter]

In Georgia, according to this International Business Times article (https://www.ibtimes.com/coronavirus-usa-update-200-monitored-georgia-new-case-confirmed-california-2920463) 200 recent returnees from China (not Wuhan area) currently are being monitored. No confirmed cases in GA so far.





KEY POINTS

- Georgia health authorities are monitoring 200 residents that recently returned from a trip to China
- This large group went nowhere near Hubei Province
- There are no confirmed cases of infections from Covid-19 in the state



Further...




GDPH said the Georgians have shown no symptoms of the coronavirus and have self-quarantined themse[l]ves inside their homes.

According to the U.S. Centers for Disease Control and Prevention (CDC) self-quarantine means staying at home for 14 days, the illness’ incubation period, and avoiding direct physical contact with other persons



If this is indeed the situation, what's to keep self-quarantiners from running up to Walmart if they feel the urge? Seems like a much bigger risk (and potential cost) than simply housing them somewhere sequestered and secure for 14 days.

[willie]

Who is surprised that China's leadership has elected to misrepresent the crisis? Nobody. During the world wide flu epidemic killing 50 million people the term Spanish flu came about because Spain correctly reported deaths. Hence, on paper Spain's death rate exceeded that of other countries. The other countries lied. Southern states in the past lied at times about pellagra, yellow fever, and malaria stats because they were an embarrassment, especially pellagra. Hookworm, pellagra, and malaria were serious health issues especially in rural areas.

Feeble is the term best applied to China's health care system. It follows that the response to this crisis can only be feeble. Is the rest of the world sending China needed supplies and other assistance? I hope so. I wonder if China will accept this help and avoid a practice of warehousing and not using supplies? I have a comment that is not a criticism though it may sound like a harsh statement. This crisis is one where there is no place for a bribe. The result is inaction.Too, managers are reluctant to take initiative. Paralysis has occurred in decision making.

[OlongJohnson]

Is the rest of the world sending China needed supplies and other assistance?

China is where the rest of the world's supplies come from.

[Nephrology]

Cases increased by 15,000 today....


This highlights the craziness in how the Chinese government is compiling and manipulating stats. A few days ago, we saw the government change the counting protocol to nominally exclude lab-confirmed cases that showed no symptoms (in reality, everybody who wasn't very sick). Of course, this made the case fatality rate rise, and also drew some criticism for being improper under WHO and other international protocols. Now, it seems that the faction paying attention to case fatality rates has bent the ear of the authorities, so they have again revised the case counting protocols to cast a very wide net, and they are now testing and counting vastly more people than they were under the February 7 protocol.:rolleyes:


...but who knows what the real numbers are.

Cases and deaths increased substantially because they are now including empirically diagnosed patients (i.e. have a clinical picture consistent with CoVID 19 but have not been confirmed positive via PCR). This new expanded number undoubtedly includes individuals who are sick with something that is not CoVID 19 (eg rhinovirus RSV influenza parainfluenza etc).

Still not alarmed.

[willie]

Great point, Olong. That reality escaped my dim mind.

I just now thought of a reality that I have not seen discussed. China has a high incarceration rate. Certainly the virus is present in these populations. I predict that many of these victims will be euthanized to make room for others to occupy beds and face the same treatment. TB, hepatitis, and HIV are over represented in custodial populations. This group will be severely affected when its individuals contract the C virus. They will be the first patients euthanized. Note that I did not say executed. In China there is a difference.

[TiroFijo]

Cases and deaths increased substantially because they are now including empirically diagnosed patients (i.e. have a clinical picture consistent with CoVID 19 but have not been confirmed positive via PCR). This new expanded number undoubtedly includes individuals who are sick with something that is not CoVID 19 (eg rhinovirus RSV influenza parainfluenza etc).

Still not alarmed.

Do you have faith in the numbers coming from China?

I pay more attention at the way they are behaving, and they are not only alarmed but very, very scared.

No one, and China least of all, closes down entire cities and regions for just another very virulent flu. This must be costing them untold billions and loss of face.

[Nephrology]

Great point, Olong. That reality escaped my dim mind.

I just now thought of a reality that I have not seen discussed. China has a high incarceration rate. Certainly the virus is present in these populations. I predict that many of these victims will be euthanized to make room for others to occupy beds and face the same treatment. TB, hepatitis, and HIV are over represented in custodial populations. This group will be severely affected when its individuals contract the C virus. They will be the first patients euthanized. Note that I did not say executed. In China there is a difference.


China is where the rest of the world's supplies come from.


A lot of biotech/medical stuff is not usually made there (e.g. the PCR based testing kits, though it is basic enough technology). The US has offered to send teams from the CDC to help evaluate and manage risk, but AFAIK the Chinese have not extended them an invitation yet.


Do you have faith in the numbers coming from China?

I pay more attention at the way they are behaving, and they are not only alarmed but very, very scared.

No one, and China least of all, closes down entire cities and regions for just another very virulent flu. This must be costing them untold billions and loss of face.

I have faith in the numbers we can extrapolate from the now substantial number of cases recorded outside of China, which so far are in line with the numbers that China has provided.

To be blunt, I think the panic in China (and the rest of the world) is because of a lack of perspective on global all-cause mortality. People die of infectious diseases all the time, and in large numbers. I have highlighted flu plenty, but there are plenty of other common and life threatening pathogens we co-habitate with every day that do not cause this degree of alarm. CoVID 19 is just a new one, from Asia (spooky), that we don't understand perfectly well yet. Not to mention the much longer list of illnesses statistically far more likely to kill adults than a virus (e.g. cardiovascular disease, cancer, accidents/trauma).

For perspective, just the other day I was in the OR with anesthesia. We had two cases back to back of an otherwise healthy man and woman who were getting lobectomies (lobes of their lungs removed) for non-tubercular mycobacterial (NTM) infections. NTM refers to a host of intracellular bugs like M. avium, M. intracellulare and M.abscessus that are very similar to tuberculosis. These are bugs that live abundantly in the soil around you and, if you're unlucky, will cause a colonizing pulmonary infection that we will attempt to treat with months of extremely unpleasant antibiotics (which often fail). When they fail, you have to go to the OR and I get to watch the surgeons take a piece of your lung the size of a small football out of a 2" hole in your chest. How do you prevent yourself from getting this infection? You can't. It just happens. IMO, way scarier than coronavirus. Is it in the news ? No.

Back to CoVID 19. The big open question for me is whether or not there is seasonality to this virus, how far it will propagate into Western world, and what mortality will look like in a country with ample ICU and hospital facilities. I imagine it will take time for us to figure this out.

[RoyGBiv]

DPRK gets serious about enforcing their quarantine.

Dig the headline ..... shot a dead guy?

North Korea 'shoots dead coronavirus patient' after he's 'seen at public baths' (https://www.dailystar.co.uk/news/latest-news/breaking-north-korea-executes-coronavirus-21488604)

[scw2]

Back to CoVID 19. The big open question for me is whether or not there is seasonality to this virus, how far it will propagate into Western world, and what mortality will look like in a country with ample ICU and hospital facilities. I imagine it will take time for us to figure this out.

I think Singapore will be important to watch in this regard. While population density is higher than much of the western world, their facilities are arguably better prepared for something like this outbreak given the lessons they learned and proactive steps they took after SARS (such as building negative pressure rooms).

I also think their healthcare system may use more GP like we do here, whereas in China they lean heavily on hospitals. That could help manage spread of the disease in hospitals and among healthcare workers which appears to be a big problem in Wuhan.

I also wonder what their climate says about the seasonality factor you raised since they're fairly warm and humid, which might suggest the onset of summer weather here may not be the panacea many were hoping for initially.

[Nephrology]

I think Singapore will be important to watch in this regard. While population density is higher than much of the western world, their facilities are arguably better prepared for something like this outbreak given the lessons they learned and proactive steps they took after SARS (such as building negative pressure rooms).

I also think their healthcare system may use more GP like we do here, whereas in China they lean heavily on hospitals. That could help manage spread of the disease in hospitals and among healthcare workers which appears to be a big problem in Wuhan.

I also wonder what their climate says about the seasonality factor you raised since they're fairly warm and humid, which might suggest the onset of summer weather here may not be the panacea many were hoping for initially.

Per Tony Fauci's (Head of Natl. Inst. Allergies & Infectious Disease) Feb 6 interview on JAMANetwork, it seems like CoVID 19 is behaving much more like infuenza (highly infectious, lower mortality rate) than SARS or MERS, its close cousins (less infectious, much higher mortality rate). This does bring hope that there will be a seasonal component as well.

The important thing re:seasonality is the not the actual temperature outside but what it does to human behavior. Cold and shitty = more people inside, share smaller spaces with recirculated air. I don't really know what winter looks like in SE Asia, and it's hard to compare vs. flu as this virus still likely has a lot farther to go across the globe, but we will find out. Definitely a lot more open questions than answers.

[Aisin Gioro]

Feeble is the term best applied to China's health care system. It follows that the response to this crisis can only be feeble. Is the rest of the world sending China needed supplies and other assistance? I hope so. I wonder if China will accept this help and avoid a practice of warehousing and not using supplies? I have a comment that is not a criticism though it may sound like a harsh statement. This crisis is one where there is no place for a bribe. The result is inaction.Too, managers are reluctant to take initiative. Paralysis has occurred in decision making.

There is quite a bit of international aid being sent to China, though the scale of everything in China somewhat stymies smaller, less organized interventions. Overall, there are still severe shortages, but there is also a lot of national and international effort going in to reducing them. How effective that is at the moment, it's too early to say. As for warehousing supplies, that's a much more local issue. I don't doubt that there are some officials who are commandeering and holding on to supplies, selling them, or trading them for favours, but for the most part they are being put to use. Is bribery and corruption playing a role? Absolutely, yes. To give Xi Jinping credit, he has genuinely reduced corruption in China, though a large part of that has been more by concentrating the corruption rather than eliminating it. The government recognized the inefficiency of a highly corrupt society, but it also didn't like the competition from various diverse corrupting influences. Small-scale (not big enough to bother with) and large-scale corruption (often tied to the national government) is still rampant, but the sort of "middle class" of corrupt officials has been reduced. However, the senior administration in most healthcare organizations in China is still frequently highly corrupt and venal, especially so by the standards of democratic societies.

[Aisin Gioro]

Great point, Olong. That reality escaped my dim mind.

I just now thought of a reality that I have not seen discussed. China has a high incarceration rate.

I'm not sure that China's actual incarceration rate is all that high, though you are absolutely right that the lives of those incarcerated are subject to the whims of the authorities. The number of incarcerated people is certainly very high because of the enormous population, but per 100,000, it's actually very comparable to countries like Australia or Spain. According to international NGO estimates, China's incarceration rate probably doesn't exceed 170 per 100,000, even if you include pre-trial detention, administrative custody, and non-judicial detention, and may even be as low as about 115 per 100,000, comparable to Canada. However, I haven't been able to determine if the higher estimates include the current camps interning perhaps 1,000,000 people in western China, though even that wouldn't dramatically increase the overall rate. China has moved away from the mass detention methods of the past and generally runs a leaner, more flexible apparatus based on surveillance, social consequences*, and non-custodial punishment much more now than it did previously.

*The "social credit score" programme of Xi is a good example of this. People who run afoul of things like internet censorship, political dissent, etc. - or even associate with people who do - may find themselves unable to purchase train or airline tickets, be denied promotions at work, or have things like government subsidies for housing costs (ubiquitous and heavily relied upon in China) reduced or eliminated.

[Aisin Gioro]

Per Tony Fauci's (Head of Natl. Inst. Allergies & Infectious Disease) Feb 6 interview on JAMANetwork, it seems like CoVID 19 is behaving much more like infuenza (highly infectious, lower mortality rate) than SARS or MERS, its close cousins (less infectious, much higher mortality rate). This does bring hope that there will be a seasonal component as well.

The important thing re:seasonality is the not the actual temperature outside but what it does to human behavior. Cold and shitty = more people inside, share smaller spaces with recirculated air. I don't really know what winter looks like in SE Asia, and it's hard to compare vs. flu as this virus still likely has a lot farther to go across the globe, but we will find out. Definitely a lot more open questions than answers.

I think Fauci, et al. have a good view on this. There is a tendency to equate CoVID-19 with SARS because microbiologically it's very similar, but epidemiologically, it's probably much more like influenza. The big question now is whether it will behave very much like the flu in terms of overall mortality (not just CFR) and clinical severity. As Scott Gottlieb points out, if the basic reproduction number is comparable to seasonal influenza (R1.3) and the CFR is even 0.2% (one-third of the CFR we have seen outside of China, with 3 deaths per roughly 522 cases), it would be a substantially more significant public health threat than seasonal influenza (CFR 0.06%), especially globally. Of similar concern is the clinical severity. We don't really know at this point what percentage of cases require interventional treatment and the extent that it would strain healthcare systems internationally. I agree with you...the truth is, there are too many variables at this point and we just don't have enough information to really forecast the scope and scale of it.

Winter in SE Asia is basically a lot like summer, except (depending on the region) it's often wetter and windier. Singapore, for example, is hot and humid in winter, and a bit hotter and drier in the summer. Much of SE Asia, including Singapore, has two monsoon cycles from roughly June to October and again from December to late February/early March, which are rainy and windy. In general, the weather in SE Asia is hot year round, and more or less humid (generally more) except for some short breaks in late spring/early summer and again in late autumn/early winter. There isn't nearly the seasonal variation seen in places like Europe or East Asia.

Japan, for example, has lots of places with true four-season climates, and the weather around Tokyo is very similar to Washington, DC. China overall is extremely diverse in climate, much like the US. Going to the centre of the outbreak, Wuhan is famous even in China for its humid, windy microclimate with unpleasant winters and hot summers. It's called one of the "Four Furnaces" of China for the stifling summer heat (100F/38C with high humidity), but winters are damp, windy, and fairly cold, like northern England.

[Nephrology]

I pay more attention at the way they are behaving, and they are not only alarmed but very, very scared.

One more brief point here. The tyvek space-suits and other PPE you see the Chinese wearing in photos in the media are very impressive looking but absolutely not evidence based at all. The literature on the efficacy of using gowns, etc, for contact precautions in hospitalized patients is already poor to begin with - it is likely that the bulk of teh benefit comes from increased hand washing, not the gowns. They likely do absolutely nothing to attenuate infectivity when used in public spaces - it is literally all for show. It is doing a great job at freaking everyone out, however.

More here (https://www.infectioncontroltoday.com/standard-precautions/contact-precautions-ongoing-quest-definitive-guidance-and-policy).

[Aisin Gioro]

Cases and deaths increased substantially because they are now including empirically diagnosed patients (i.e. have a clinical picture consistent with CoVID 19 but have not been confirmed positive via PCR). This new expanded number undoubtedly includes individuals who are sick with something that is not CoVID 19 (eg rhinovirus RSV influenza parainfluenza etc).

Still not alarmed.

Just to add some nuances to the new methods in use, the categorization of cases based on empirical diagnoses only applies in Hubei province. In China ex-Hubei, the official stats still do not permit the inclusion of cases without lab confirmation. There is no stated reason for this, but most likely it's because Hubei, with the overwhelming percentage of cases even in China, doesn't have nearly the resources or capability to keep up with the demand for tests, so they are giving them the slack to make the call based on clinical judgment instead.

I suppose I would call my position on this "Not alarmed, but still concerned".

[Nephrology]

Just to add some nuances to the new methods in use, the categorization of cases based on empirical diagnoses only applies in Hubei province. In China ex-Hubei, the official stats still do not permit the inclusion of cases without lab confirmation. There is no stated reason for this, but most likely it's because Hubei, with the overwhelming percentage of cases even in China, doesn't have nearly the resources or capability to keep up with the demand for tests, so they are giving them the slack to make the call based on clinical judgment instead.

I suppose I would call my position on this "Not alarmed, but still concerned".

Concerned is fair. From what i read it sounds like the PCR tests weren't super sensitive/specific (media is just saying "30-40% inaccurate, so not sure which) and also overwhelming demand meant a bunch of people with symptoms consistent with CoVID 19 were sent home w/o testing.

I think it's likely that the numbers aren't great for a variety of reasons so I reserve my ultimate judgment for the future. I've been reading the most current case reports and they are interesting. JAMA published a recent article (https://jamanetwork.com/journals/jama/fullarticle/2761044) describing 138 hospitalized patients with CoVID 19. Like many of the other reports out there so far, the patients are largely older (mean age ~50s) but they are fairly sick. Not really sure how this applies to gen pop or compares to other bugs.

[theJanitor]

My MIL left China through Hong Kong, before everything got closed down. She was well aware of the situation, and had shut herself in for awhile before leaving. She was screened in HK and in Honolulu.

Her comments were that cities like Wuhan are better off, aside from the dense population. The hospitals are pretty good and there's certainly high-tech bio companies there. The South Koreans announced they were going to build a biotech facility there, right when covid-19 erupted. She says its the small towns and villages that will be hard hit. The lack of medical staff and facilities, combined with generally poor conditions will make the virus hard to manage. And there will be little to no counting, likely until the crisis has passed

I shipped out PPE to her family in HK last week. And we shipped out a couple hundred face masks to the family of one of my staff in HK yesterday.

Nephrology They will take ANYTHING that will reduce their chances of catching the virus, even if minutely. I assume the same can be said for the healthcare workers. 1% safer is still 1% safer, and if feeling safer means they can work more effectively, than it's likely a benefit

ETA: I want to thanks everyone for info and their interpretation of it. My wife's family is in areas of concern, and we're always looking for a better perspective of the situation and info

[Nephrology]

Nephrology They will take ANYTHING that will reduce their chances of catching the virus, even if minutely. I assume the same can be said for the healthcare workers. 1% safer is still 1% safer.

Surprisingly, it isn't necessarily that straightforward. In addition to added costs, excessive use of PPE has other costs/risks, which are better discussed here (https://www.ncbi.nlm.nih.gov/books/NBK115274/). Not to mention the alarm it causes.

[theJanitor]

Surprisingly, it isn't necessarily that straightforward. In addition to added costs, excessive use of PPE has other costs/risks, which are better discussed here (https://www.ncbi.nlm.nih.gov/books/NBK115274/). Not to mention the alarm it causes.

I would assume everyone in China is alarmed :D So when I was buying masks for the relatives, I mentioned that it would be more economical for me to buy them a real respirator, pre-filters and filters. My wife said, "You're gonna get your ass arrested if you walk around Hong Kong like that!!". So I bought disposables...

[Aisin Gioro]

Concerned is fair. From what i read it sounds like the PCR tests weren't super sensitive/specific (media is just saying "30-40% inaccurate, so not sure which) and also overwhelming demand meant a bunch of people with symptoms consistent with CoVID 19 were sent home w/o testing.

I think it's likely that the numbers aren't great for a variety of reasons so I reserve my ultimate judgment for the future. I've been reading the most current case reports and they are interesting. JAMA published a recent article (https://jamanetwork.com/journals/jama/fullarticle/2761044) describing 138 hospitalized patients with CoVID 19. Like many of the other reports out there so far, the patients are largely older (mean age ~50s) but they are fairly sick. Not really sure how this applies to gen pop or compares to other bugs.

I agree about the PCRs and general degradation of validity in testing, especially in places like Wuhan and Hubei generally. Even if the kits themselves are fairly reliable (and they may not be), it's hard to run a lab set up to process 125 samples per day and push through 1,000 per day while maintaining quality assurances. When you take a step back and look at all of the variables in China, the picture gets less clear, rather than more clear.

Some of the skewing in that patient population may also be cultural. Because of the strong sense of xiao (usually translated as "filial piety", but also a more broad sense of respect for and obligation to elders) that is still quite real in most of China, older people and especially older men tend to get prioritized in both family and healthcare settings. It will be interesting to see mean ages outside of China, especially as the patient populations get to be statistically large enough to draw conclusions across cultures.

[Aisin Gioro]

My MIL left China through Hong Kong, before everything got closed down. She was well aware of the situation, and had shut herself in for awhile before leaving. She was screened in HK and in Honolulu.

Her comments were that cities like Wuhan are better off, aside from the dense population. The hospitals are pretty good and there's certainly high-tech bio companies there. The South Koreans announced they were going to build a biotech facility there, right when covid-19 erupted. She says its the small towns and villages that will be hard hit. The lack of medical staff and facilities, combined with generally poor conditions will make the virus hard to manage. And there will be little to no counting, likely until the crisis has passed

I shipped out PPE to her family in HK last week. And we shipped out a couple hundred face masks to the family of one of my staff in HK yesterday.

Nephrology They will take ANYTHING that will reduce their chances of catching the virus, even if minutely. I assume the same can be said for the healthcare workers. 1% safer is still 1% safer, and if feeling safer means they can work more effectively, than it's likely a benefit

ETA: I want to thanks everyone for info and their interpretation of it. My wife's family is in areas of concern, and we're always looking for a better perspective of the situation and info

My thoughts and best wishes are with your wife's family. Outside of China, it's hard for people to understand how much impact this is having on people's lives there, or the worry people have both in the near and long term. I wish them all the best...加油武汉Â…加油湖北Â…加油中国人民!

That's so true about the conditions in rural healthcare settings in China. Though they have come a long way recently, there are still a lot of places that would shock Western observers. Until you've seen a live pig in the waiting area of a rural hospital, you haven't really experienced rural Chinese healthcare.;) (The pig wasn't a patient, but was accompanying one because he was in town for the market and didn't have anywhere to park the pig while getting seen by a doctor. Nobody batted an eye.)

[Aisin Gioro]

I would assume everyone in China is alarmed :D

No kidding.:D Right now, showing up someplace without a mask is much more likely to cause alarm than anything else. As you know, this is a culture where masks are common and routine, especially in winter but even year-round, due to pollution, dust storms (springtime in Beijing), etc.

For what it's worth, in many cities, they are telling (but still stopping just short of requiring) people not to wear N95 respirators, but instead to go with surgical masks "in order to preserve supplies for medical personnel". One of my friends in BJ felt so guilty about her stock of N95s that she messaged around her Weixin community group to find someone she felt was more deserving, and ended up giving them to a nurse who lives in her building (in a touch-free exchange in the hallway, like a Cold War prisoner exchange).

[scw2]

Concerned is fair. From what i read it sounds like the PCR tests weren't super sensitive/specific (media is just saying "30-40% inaccurate, so not sure which) and also overwhelming demand meant a bunch of people with symptoms consistent with CoVID 19 were sent home w/o testing.


I agree about the PCRs and general degradation of validity in testing, especially in places like Wuhan and Hubei generally. Even if the kits themselves are fairly reliable (and they may not be), it's hard to run a lab set up to process 125 samples per day and push through 1,000 per day while maintaining quality assurances. When you take a step back and look at all of the variables in China, the picture gets less clear, rather than more clear.

Someone shared that it often took 5-11 days the PCR tests begin turning positive and was considered an established clinical feature in China and why clinical diagnosis w/ CT was done. This was in response to a question about a quarantined pt in Japan testing positive after 10 or 11 days. Wish I had better data or a source to confirm.

Is the CDC here still providing guidance to treat based on PCR results only? Would seem like CT is the way to go, but not sure how we'd deal with the healthcare costs here...

[Squib308]

Someone shared that it often took 5-11 days the PCR tests begin turning positive and was considered an established clinical feature in China and why clinical diagnosis w/ CT was done. This was in response to a question about a quarantined pt in Japan testing positive after 10 or 11 days. Wish I had better data or a source to confirm.

Is the CDC here still providing guidance to treat based on PCR results only? Would seem like CT is the way to go, but not sure how we'd deal with the healthcare costs here...

diagnosis via chest CT carries major limitations, specifically many early in the course are unlikely to show characteristic radiodensities. this will result in people being characterized as negative when they will develop consolidation later in their course. people will end up getting multiple chest CT's along the way. bear in mind during an epidemic the diganosis beceomes increases in prevalance to the point that diagnostic criteria can be made more lax and still be accurate. for example if enough people in your population have SARS-CoV-2 infection one could diagnosis it on clinical criteria alone (e.g. shortness of breath, cough). while there may be shortcomings in PCR based diagnosis, this is undoubtedly the correct path. when optimized, it is far more sensitive (minimizes false negatives) and specific (minimizes false positives) than a CT chest.

further, every time we bring someone to a CT scanner we're running the risk of healthcare exposure and nosocomial spread. PCR will allow for testing of people outside the hospital including families under quarantine, prisons or nursing facilities.

[Nephrology]

Someone shared that it often took 5-11 days the PCR tests begin turning positive and was considered an established clinical feature in China and why clinical diagnosis w/ CT was done. This was in response to a question about a quarantined pt in Japan testing positive after 10 or 11 days. Wish I had better data or a source to confirm.

Is the CDC here still providing guidance to treat based on PCR results only? Would seem like CT is the way to go, but not sure how we'd deal with the healthcare costs here...

PCR itself is a pretty quick technique, depending on what they are doing (qRT-PCR or simple PCR). It requires a lot of resources and manpower to process lots of samples, however, which is why many people are untested. It's also imperfect, as we have seen.

The reason that it's important to use a PCR or other molecular biology assay to determine if the infection is CoVID 19 or not is that this virus produces a range of symptoms that heavily overlap with a number of other common upper respiratory pathogens (influenza, for starters). A CT might give you nice images of the lungs, but the findings are non-specific. Diagnosis in the absence of PCR is a game of clinical suspicion. Exposure history, clinical symptoms and the natural history of infection might give you a clue but are not definitive.

For this reason, it isn't possible to determine for certain that someone's upper respiratory infxn is caused by coronavirus based on symptoms alone. However, this does not really mean very much for treatment. Because there is no specific drug or vaccine for CoVID 19, treatment is non-specific supportive care - intubation and ventilation for patients in respiratory failure, for example. There are a few drugs that people hypothesize might have activity against the virus but it would be non-specific, so efficacy is unlikely to be high.

[Stephanie B]

Any suggestions on a better surface disinfectant than this one?
Looking to have something on hand for use at home, for counters, sinks and toilets, etc.

Clorox® Clean-Up Cleaner + Bleach (https://www.clorox.com/products/clorox-clean-up-cleaner-bleach/original/)

FYI Clorox info page HERE (https://www.clorox.com/how-to/disinfecting-sanitizing/cold-flu-other-diseases/help-prevent-the-spread-of-the-human-novel-coronavirus-2019-ncov/). Recommends only 30 seconds of wet exposure to this product. Pretty quick, it seems.

Save your money. Buy good old-fashioned bleach, mix a half-cut to a cup in a gallon of water. Spray that on surfaces, let it sit for ten minutes and then wipe off.

“Surfaces” are everything touchable, including handles, light switches, etc. If someone is sick and uses the toilet, after it's flushed, dump in a half-cup of bleach and flush again.

That's pretty much what's recommended for killing noroviruses.

[Lex Luthier]

Save your money. Buy good old-fashioned bleach, mix a half-cut to a cup in a gallon of water. Spray that on surfaces, let it sit for ten minutes and then wipe off.

Surfaces is everything touchable, including handles, light switches, etc. If someone is sick and uses the toilet, after it's flushed, dump in a half-cup of bleach and flush again.

That's pretty much what's recommended for killing noroviruses.

Pretty close to the recommended cleaning protocol for C. Difficile, too.

[nalesq]

Pardon my trivial question, but is there an established way one is supposed to pronounce that which is written as “CoVID?”


Sent from my iPhone using Tapatalk Pro

[farscott]

For those members who have more medical knowledge than I (most members), multiple companies and at least one nation state have announced vaccines for CoVID-19 are in development. But my understanding, flawed that it is, is that this virus is in the same family of viruses as the common cold. Since there is no vaccine for the common cold, is a vaccine possible for this virus? Or is it going to end up being something like the flu shot which is required annually as different strains propagate? Or is it too early for discussions of a vaccine?

[Nephrology]

For those members who have more medical knowledge than I (most members), multiple companies and at least one nation state have announced vaccines for CoVID-19 are in development. But my understanding, flawed that it is, is that this virus is in the same family of viruses as the common cold. Since there is no vaccine for the common cold, is a vaccine possible for this virus? Or is it going to end up being something like the flu shot which is required annually as different strains propagate? Or is it too early for discussions of a vaccine?

Well, "the common cold" is actually caused by a number of viruses, of which the coronavirus family is only one. This is one big reason there is no vaccine for the common cold - as these viruses structurally are not necessarily very similar, it is impossible to make a vaccine that would provide adequate coverage for all of them. The other reason, of course, is that the common cold is not life threatening, which makes the economics of developing such a vaccine fairly unattractive.

The reason that flu shots are required every year is because the flu has a segmented genome. This means its genetic material is highly rearrangeable (think Legos) and, as it co-inhabits a host with other strains of flu virus, they swap big chunks of genetic material, giving rise to a structurally very distinct new virus almost overnight. Because vaccines work by training your immune system to recognize very specific viral proteins, each time the flu undergoes a genetic shift it produces a variant of flu that is most likely not covered by the last year's vaccine. CoVID 19 is not a segmented virus, so that should not be a problem.

As for this virus, CoVID 19 is a specific strain that is fairly structurally distinct. I don't know enough about virology or vaccine production to tell you how difficult it will be to make a vaccine against this virus - that is outside my wheelhouse. Usually, vaccines are simply purified, heat-killed virus, injected into your body so your immune system is exposed to the bug in a harmless form. There may be something about the coronavirus family that makes this approach more challenging, but like I said, outside my wheelhouse.

Because several of the proteins this virus makes as part of its life cycle are similar to proteins used by other viruses, there are existing anti-viral therapies that may be efficacious against it. Remdisivir, for example, the experimental anti-viral drug used on the first US case, works by acting as a 'suicide' building block for new viral copies. There are a couple other anti-virals that have been suggested may have efficacy against CoVID 19 but I don't remember them off the top of my head.

[Nephrology]

PS - a good article on the psychology of risk assessment re: CoVID 19

https://www.nytimes.com/2020/02/13/world/asia/coronavirus-risk-interpreter.html?action=click&module=Top%20Stories&pgtype=Homepage

[ST911]

Useful link for N95 use: Strategies for Optimizing the Supply of N95 Respirators
https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-supply-strategies.html


This document offers guidance on how to optimize supplies of N95 filtering facepiece respirators (commonly called “N95 respirators”) in healthcare settings in the face of potential ongoing 2019 Novel Coronavirus (2019-nCoV) transmission in the United States. The recommendations are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in healthcare institutions to protect healthcare personnel (HCP) from job-related risks of exposure to infectious respiratory illnesses.

Also: Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html


Supplies of N95 respirators can become depleted during an influenza pandemic (1-3) or wide-spreadoutbreaks of other infectious respiratory illnesses.(4) Existing CDC guidelines recommend a combination of approaches to conserve supplies while safeguarding health care workers in such circumstances. These existing guidelines recommend that health care institutions:

[willie]

My thoughts and best wishes are with your wife's family. Outside of China, it's hard for people to understand how much impact this is having on people's lives there, or the worry people have both in the near and long term. I wish them all the best...加油武汉Â…加油湖北Â…加油中国人民!

That's so true about the conditions in rural healthcare settings in China. Though they have come a long way recently, there are still a lot of places that would shock Western observers. Until you've seen a live pig in the waiting area of a rural hospital, you haven't really experienced rural Chinese healthcare.;) (The pig wasn't a patient, but was accompanying one because he was in town for the market and didn't have anywhere to park the pig while getting seen by a doctor. Nobody batted an eye.)

55 years ago I saw a chicken with his feet tied in a rural Mississippi doctor's waiting room.

[blues]

55 years ago I saw a chicken with his feet tied in a rural Mississippi doctor's waiting room.

Guess he crossed the road once too many times...

[willie]

I just now saw a news blurb that more than 1700 health care workers in China have been diagnosed with the virus.

About NK executing the infected official seen in a public bath when told to avoid going out. In our world that is barbaric. In this case NK may have saved lives by taking this action--getting rid of an infected dumb ass and setting an example. Though I do not recommend this action, I feel small sympathy for the victim who is an official in a country that has no health care system.