Coronavirus thread

[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...-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 ), 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 ), 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

FYI Clorox info page HERE. Recommends only 30 seconds of wet exposure to this product. Pretty quick, it seems.

[RoyGBiv]

Tangent...

Weekly U.S. Influenza Surveillance Report

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

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