Wuhan Virus: Is this the big one?

We've talked about various bugs in here before, and I'm following this one closely. I do hope the death rate drops from its current 3%, and I'm hoping the total number of cases has been under reported up to this point. Many of the articles I'm reading are stating that ill people are being turned away from hospitals because they are overwhelmed. Even a drop to 1% is terribly worrisome if this can't be contained.

Yes, it is worrying on an individual level - the deaths of people we know and love, but overall it might be the check our species needs. That's kind of bloodless, I know, but considering the absolute havoc we've been wreaking on the world since...forever...it might be inevitable that some of it will swipe at us.

In terms of global politics and economics it might hit us even harder than deaths with more lasting effects.

>2 Bookmarque: Yes, I've been mulling over all of that as well. We recovered from the Spanish Flu, so this won't take us down as a species. But, sheesh...

Yeah...there's one thing we aren't short of is more people. And I've always thought that overpopulation has a lot to do with suffering, anger and violence as a whole. If people are less 'valuable' as individuals in their group, it leads to boredom, disaffection and ignorance. Those things generally don't breed anything good. So if we had fewer people and the ones we had were more important and had things to do, maybe our level of misery would go down.

That's just a broad sketch, but it's something I've always thought might be true.

>4 Bookmarque: I hear you.

Also, yikes. Apparently no one is covering what's happening in the countryside around Wuhan, but it's just as bad.

https://www.washingtonpost.com/world/asia_pacific/coronavirus-china-latest-updat...

>5 clamairy: Paywalled. Is it speculation about contagion in the region as whole or about another problem altogether?

Would be interesting to have an idea of proportion of people w. virus, esp. people killed by it, who are old, already weakened for whatever reason, etc. Would be interesting too to have an idea of whether the disease is over- or under-reported--the latter most likely of course but I'd imagine some cases of garden-variety flu & pneumonia have been attributed to it.

France 24 says that 'there are reports that' Wuhan is running out of food but that might well be based on panicked vox pops consensus. I mean it's not as if Wuhan is a Uighur stronghold that ought to be starved into submission.

Sorry about that. Most papers allow a few free views per month. Just cutting and pasting a couple of paragraphs from that piece in The Washington Post...

'One Wuhan resident described sharing the dwindling groceries she had purchased to last for three days with an elderly couple whose food supply had run out.

“I don’t know how to solve this food problem,” wrote the user, Guapidawushi. “Right now I really, really don’t know what to do. I’m completely helpless.” '

.....

"Video distributed by state media showed local officials in adjacent regions taking extreme measures, including using excavators to destroy and block roads, to discourage residents from traveling to infected areas of Hubei to visit stranded relatives inside the quarantine zone."

.....

"The situation appeared to be more dire in the vast Hubei countryside.

The Chinese magazine Caijing reported that some smaller village clinics were rationed only six masks and that large hospitals were within one or two days of running out of supplies. In Jingzhou city, a short distance up the Yangtze River from Wuhan, doctors told reporters that they were wearing rain ponchos because they lacked protective suits."

Just saw the death toll is at 132, with over 5000 confirmed infections and over 6000 suspected. At least that means the percentage of those dying is much lower than it appeared to be when they weren't counting the cases accurately.

https://www.washingtonpost.com/opinions/2020/01/31/can-this-virus-be-contained-p...

Sorry, Washington Post again, saying the virus probably can't be contained.

Yeah can't read it.

Cutting and pasting the text from this piece in The Times.
And here's the link, because there are graphics, maps and photos:

https://nyti.ms/2GOL83q

GLOBAL HEALTH

Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say
Rapidly rising caseloads alarm researchers, who fear the virus may make its way across the globe. But scientists cannot yet predict how many deaths may result.
By Donald G. McNeil Jr.
Feb. 2, 2020
Updated 4:02 p.m. ET

The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world’s leading infectious disease experts.

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease.

“But will it be catastrophic? I don’t know.”

In the last three weeks, the number of lab-confirmed cases has soared from about 50 in China to 14,000 in 23 countries; there have been over 300 deaths, all but one in China.

But various epidemiological models estimate that the real number of cases is 100,000 or even more. While that expansion is not as rapid as that of flu or measles, it is an enormous leap beyond what virologists saw when SARS and MERS emerged.

When SARS was vanquished in July 2003 after spreading for nine months, only 8,098 cases had been confirmed. MERS has been circulating since 2012, but there have been only about 2,500 known cases.

How Bad Will the Coronavirus Outbreak Get? Here Are 6 Key Factors
Here’s what early research says about how the pathogen behaves and the factors that will determine whether it can be contained.
Jan. 31, 2020
NYTimes - Related Link
The biggest uncertainty now, experts said, is how many people around the world will die. SARS killed about 10 percent of those who got it, and MERS now kills about one of three.

The 1918 “Spanish flu” killed only about 2.5 percent of its victims — but because it infected so many people and medical care was much cruder then, 20 to 50 million died.

By contrast, the highly transmissible H1N1 “swine flu” pandemic of 2009 killed about 285,000, fewer than seasonal flu normally does, and had a relatively low fatality rate, estimated at .02 percent.

The mortality rate for known cases of the Wuhan coronavirus has been running about 2 percent, although that is likely to drop as more tests are done and more mild cases are found.

It is “increasingly unlikely that the virus can be contained,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention who now runs Resolve to Save Lives, a nonprofit devoted to fighting epidemics.

“It is therefore likely that it will spread, as flu and other organisms do, but we still don’t know how far, wide or deadly it will be.”

In the early days of the 2009 flu pandemic, “they were talking about Armageddon in Mexico,” Dr. Fauci said. (That virus first emerged in pig-farming areas in Mexico’s Veracruz State.) “But it turned out to not be that severe.”

An accurate estimate of the virus’s lethality will not be possible until certain kinds of studies can be done: blood tests to see how many people have antibodies, household studies to learn how often it infects family members, and genetic sequencing to determine whether some strains are more dangerous than others.

Closing borders to highly infectious pathogens never succeeds completely, experts said, because all frontiers are somewhat porous. Nonetheless, closings and rigorous screening may slow the spread, which will buy time for the development of drug treatments and vaccines.

Other important unknowns include who is most at risk, whether coughing or contaminated surfaces are more likely to transmit the virus, how fast the virus can mutate and whether it will fade out when the weather warms.

The effects of a pandemic would probably be harsher in some countries than in others. While the United States and other wealthy countries may be able to detect and quarantine the first carriers, countries with fragile health care systems will not. The virus has already reached Cambodia, India, Malaysia, Nepal, the Philippines and rural Russia.

“This looks far more like H1N1’s spread than SARS, and I am increasingly alarmed,” said Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine. “Even 1 percent mortality would mean 10,000 deaths in each million people.”

Other experts were more cautious.

Dr. Michael Ryan, head of emergency responses for the World Health Organization, said in an interview with STAT News on Saturday that there was “evidence to suggest this virus can still be contained” and that the world needed to “keep trying.”

Dr. W. Ian Lipkin, a virus-hunter at the Columbia University Mailman School of Public Health who is in China advising its Center for Disease Control and Prevention, said that although the virus is clearly being transmitted through casual contact, labs are still behind in processing samples.

But life in China has radically changed in the last two weeks. Streets are deserted, public events are canceled, and citizens are wearing masks and washing their hands, Dr. Lipkin said. All of that may have slowed down what lab testing indicated was exponential growth in the infection.

It’s unclear exactly how accurate tests done in overwhelmed Chinese laboratories are. On the one hand, Chinese state media have reported test kit shortages and processing bottlenecks, which could produce an undercount.

But Dr. Lipkin said he knew of one lab running 5,000 samples a day, which might produce some false-positive results, inflating the count. “You can’t possibly do quality control at that rate,” he said.

Anecdotal reports from China, and one published study from Germany, indicate that some people infected with the Wuhan coronavirus can pass it on before they show symptoms. That may make border-screening much harder, scientists said.

Epidemiological modeling released Friday by the European Center for Disease Prevention and Control estimated that 75 percent of infected people reaching Europe from China would still be in the incubation periods upon arrival, and therefore not detected by airport screening, which looks for fevers, coughs and breathing difficulties.

But if thermal cameras miss victims who are beyond incubation and actively infecting others, the real number of missed carriers may be higher than 75 percent.

Still, asymptomatic carriers “are not normally major drivers of epidemics,” Dr. Fauci said. Most people get ill from someone they know to be sick — a family member, a co-worker or a patient, for example.

The virus’s most vulnerable target is Africa, many experts said. More than 1 million expatriate Chinese work there, mostly on mining, drilling or engineering projects. Also, many Africans work and study in China and other countries where the virus has been found.

If anyone on the continent has the virus now, “I’m not sure the diagnostic systems are in place to detect it,” said Dr. Daniel Bausch, head of scientific programs for the American Society of Tropical Medicine and Hygiene, who is consulting with the W.H.O. on the outbreak.

South Africa and Senegal could probably diagnose it, he said. Nigeria and some other countries have asked the W.H.O. for the genetic materials and training they need to perform diagnostic tests, but that will take time.

At least four African countries have suspect cases quarantined, according to an article published Friday in The South China Morning Post. They have sent samples to France, Germany, India and South Africa for testing.

At the moment, it seems unlikely that the virus will spread widely in countries with vigorous, alert public health systems, said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University Medical Center.

“Every doctor in the U.S. has this top of mind,” he said. “Any patient with fever or respiratory problems will get two questions. ‘Have you been to China? Have you had contact with anyone who has?’ If the answer is yes, they’ll be put in isolation right away.”

Assuming the virus spreads globally, tourism to and trade with countries besides China may be affected — and the urgency to find ways to halt the virus and prevent deaths will grow.

It is possible that the Wuhan coronavirus will fade out as weather warms. Many viruses, like flu, measles and norovirus, thrive in cold, dry air. The SARS outbreak began in winter, and MERS transmission also peaks then, though that may be related to transmission in newborn camels.

Four mild coronaviruses cause about a quarter of the nation’s common colds, which also peak in winter.

But even if an outbreak fades in June, there could be a second wave in the fall, as has occurred in every major flu pandemic, including those that began in 1918 and 2009.

By that time, some remedies might be on hand, although they will need rigorous testing and perhaps political pressure to make them available and affordable.

In China, several antiviral drugs are being prescribed. A common combination is pills containing lopinavir and ritonavir with infusions of interferon, a signaling protein that wakes up the immune system.

In the United States, the combination is sold as Kaletra by AbbVie for H.I.V. therapy, and it is relatively expensive. In India, a dozen generic makers produce the drugs at rock-bottom prices for use against H.I.V. in Africa, and their products are W.H.O.-approved.

Another option may be an experimental drug, remdesivir, on which the patent is held by Gilead. The drug has not yet been approved for use against any disease. Nonetheless, there is some evidence that it works against coronaviruses, and Gilead has donated doses to China.

Several American companies are working on a vaccine, using various combinations of their own funds, taxpayer money and foundation grants.

Although modern gene-chemistry techniques have made it possible to build vaccine candidates within just days, medical ethics require that they then be carefully tested on animals and small numbers of healthy humans for safety and effectiveness.

That aspect of the process cannot be sped up, because dangerous side effects may take time to appear and because human immune systems need time to produce the antibodies that show whether a vaccine is working.

Whether or not what is being tried in China will be acceptable elsewhere will depend on how rigorously Chinese doctors run their clinical trials.

“In God we trust,” Dr. Schaffner said. “All others must provide data.”

I didn’t realize how far I had my head in the sand. I’ve been following this outbreak with extreme interest, and because I’m also so focused on my video making enterprise, I had no idea this conversation was taking place!

It’s hard to add to the thorough presentation in the Donald McNeil NYT article Clamairy has provided.

Some random thoughts and points:

Definitely heading towards pandemic. Viruses do not respect borders. It is true that we need a lot more info to draw firm conclusions, but the incubation period, the low lethality, and the empirical evidence from ease of spread - within China and in foreigners who had no contact with the seafood market - all argue in favor. Reports thus far are arguing for a variable incubation period of 2-14 days - perhaps that turns out to be wrong - but a short incubation period means there’s little time to trace contacts and utilize traditional public health methods to slow or halt an epidemic. A long incubation period means you have asymptomatic individuals arriving in new places, not sequestered to prevent further infection because it’s not yet evident. Either way, bad. Then there’s the issue of low lethality. This means that the outbreak isn’t slowed by the frequent deaths of the infected. In smallpox, for example, or Ebola, the mortality rate can be high enough that an outbreak can burn itself out, not be self-sustaining. The silver lining in the case of the Wuhan virus (I know! We are supposed to call it 2019-nCoV) is that fewer people will die, on a percentage basis anyway.

Then there’s this question of asymptomatic spread. I know Dr. Fauci has said that no epidemic in the past has been primarily perpetuated by asymptomatic spreaders (“superspreaders”), but to me that is historical cold comfort. Let’s see whether this virus obeys that trend.

I don’t think this is “The Big One”. Lethality is too low. We will survive and get through it, I’m confident of that. But there will be many deaths, many sick all over the world. I think the developed world will handle it better than the developing. And the economic dislocation will be substantial. So sorry to raise the issue of profiting from this, but I do think that in a few weeks or months there will be a major sale available on equity purchases.

One last thing, and I mention it last because it is a brazen piece of gossip, pure conspiracy theory. I merely report something going around that I do not think can be dismissed out of hand. And responsible folks from the CDC can’t discuss this. But there are those who question the Wet Market Theory of the origin of this virus. They note China’s history of lax reins on biomedical research (remember the CRISPR baby gene-editing scandal of a year or so ago?), and the fact that China has few high level virus labs, and their only BSL-4 facility is located in Wuhan. So there. Spreading rumors. We may never know. China could/would never acknowledge such an event unless there were no other option. I’ll leave it there. I’ll follow this discussion closely from here on.

Oh! One last thing. stellarwoman’s cousin just got back from China. Guangzhou. The two went to the opera last week. There are a lot of people at the opera. I was thinking he might be Patient Zero for the NY epidemic. But now it’s Day 16 since he got back, and he seems fine. Let’s hope they are right about the incubation period!

>12 stellarexplorer: Yes, I'd heard that gossip, too, specifically on Twitter. I don't buy into it, since the reporting says that the preliminary sequencing points to bats as carriers for this one. But they could all be lying. ;o)

This is from an article in The Times yesterday:

"It is possible that the Wuhan coronavirus will fade out as weather warms. Many viruses, like flu, measles and norovirus, thrive in cold, dry air. The SARS outbreak began in winter, and MERS transmission also peaks then, though that may be related to transmission in newborn camels.

Four mild coronaviruses cause about a quarter of the nation’s common colds, which also peak in winter.

But even if an outbreak fades in June, there could be a second wave in the fall, as has occurred in every major flu pandemic, including those that began in 1918 and 2009.

By that time, some remedies might be on hand, although they will need rigorous testing and perhaps political pressure to make them available and affordable."

>13 clamairy: I don’t believe it because my standards for belief are much higher than what we’ve got. But the history and practices of the Chinese government, maybe government in general, gives me pause. I’ve read the sequencing arguments, but these are not definitive as it would be likely for naturally occurring sequences to be the building-blocks of viral research. But I’m making too much of it by waxing on.

I believe it will end up burning itself out. Maybe antivirals will play a role. Maybe it goes on long enough for a vaccine to play a role. This is going to be a slog. It will be interesting to see whether it establishes itself elsewhere, as opposed to producing sporadic cases.

>14 stellarexplorer: An antiviral cocktail appears to have done the trick in Thailand:

https://www.cnn.com/asia/live-news/coronavirus-outbreak-02-02-20-intl-hnk/h_f9dc...

I certainly hope this combo works, though I imagine it's going to be expensive. (Which means less affluent countries will suffer even more losses than the deaths brought about by low/no quality healthcare, poor nutrition and lack of ability to sanitize/wash-up frequently.)

So in keeping with my policy of raising while being sure to duly qualify speculation, and then to look squarely in the mirror of the human compulsion to conspiracy, I am officially backing away from the idea that asymptomatic spread ought to be a major concern here. More careful accounts seem to suggest that asymptomatic spreaders actually were symptomatic, if mildly, and it stands to reason that as a respiratory viral illness, the main means of spread ought to be from coughing. I’ve heard speculation about infectivity from fomites, but no evidence of that as a major source.

>15 clamairy: Yes, this thing will be hell if (when?) it spreads to Africa

https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contai...

They have lowered their paywall for stories about the virus.

>18 clamairy: Good, sober assessment. I see that Helen Branswell contributed to the article. I follow her on Twitter; she’s been very good on the eastern Congo Ebola epidemic.

>19 stellarexplorer: I'll go look for her. I have been pretty sporadic with my Twitter usage of late.

This is from The NY Times:

"Experts warn they still lack full data to say definitively how lethal the new coronavirus is. Many residents in Wuhan believe the death toll is much higher than the official tally because people with flulike symptoms are being turned away by overstretched hospitals. The health care system there is so overwhelmed that many cases are not diagnosed because of a shortage of testing kits."

Two new reports of breakthroughs on Reuters this morning. One concerns an effective treatment, and one concerns the claims of a team to have shortened the time it takes to formulate a vaccine. They say they are ready to start testing in animals.

https://news.cgtn.com/news/2020-02-04/Researchers-find-two-drugs-that-can-effect...

https://news.sky.com/story/coronavirus-significant-breakthrough-in-race-for-vacc...

And it looks like African counties are on the cusp of having testing technologies, so for those wondering why no reported cases there, we may be finding out in the coming days.

https://www.reuters.com/article/us-china-health-africa/fragile-africa-prepares-f...

I have a strong inclination toward the apocalyptic, but I can’t help but feel that it’s the calm before the storm everywhere outside China. In China of course it’s already the storm. The image I have is of an asteroid approaching, one we all know about and are monitoring. It’s not an extinction event, but it will be bad. I hope I’m wrong. I have to imagine with all the people returning from China, there have to be many cases incubating. Never a good idea to think about existential dangers at this hour....

>23 stellarexplorer: If today's news is true you have every reason to apprehensive. The NY Times says the authorities are planning to round up all of the infected people in Wuhan and place them in "quarantine centers." This has disaster written all over it.

China’s Death Toll Soars as Wuhan Plans Roundup of Infected https://nyti.ms/383iI1B

My apologies for the pay wall. I will paste a snippet here.

'The city has set up makeshift shelters in a sports stadium, an exhibition center and a building complex. Some went into operation on Thursday. The shelters are meant for housing coronavirus patients with milder symptoms, the government has said.

When Ms. Sun inspected one of the shelters, set up in Hongshan Stadium on Tuesday, she emphasized that anyone who should be admitted must be rounded up, according to a Chinese news outlet, Modern Express. “It must be cut off from the source!” she said of the virus. “You must keep a close eye! Don’t miss it!”

Photos taken inside the Hongshan sports stadium showed narrow rows of simple beds separated only by desks and chairs typically used in classrooms. Some comments on Chinese social media compared the scenes to those from the Spanish flu in 1918.

A widely shared post on Weibo, a popular social media site, said on Thursday that “conditions were very poor” at an exhibition center that had been converted into a quarantine facility. There were power failures and electric blankets could not be turned on, the user wrote, citing a relative who had been taken there, saying that people had to “shiver in their sleep.”

There was also a staff shortage, the post said, where “doctors and nurses were not seen to be taking note of symptoms and distributing medicine,” and oxygen devices were “seriously lacking.” '

It’s easily to believe we are blithely going about our lives as if this monumental typhoon were not about to blow through.
Following closely. Very impressed by the virologists I’ve followed, all of whom are very “It’s coming. How bad? I don’t know”.

As I the only one here who remembers the reactions to bird flu & SARS?

On reddit, one poster asks about legality of being fired from job as waiter because worried customers complained of having someone who looked Chinese bringing food to their tables, and another asking what to do about a HOA that distributed flyers stating that they--i.e. the HOA--had placed his Chinese wife in quarantine.

>26 bluepiano: Yup, I remember both. Luckily I must have distracted during the MERS outbreak in 2012, because I would have been freaking out.

That's horrible. Ignorance and racism so often go hand-in-hand.

Infectious diseases are terrifying, especially new ones whose natural histories are not yet known. Imagine what it must feel like to have your city quarantined while people get sick and die around you. This virus did not exist on Planet Earth 4 months ago. I’m having visions of the thousands of cots full of the dying in 1918, only instead in 2020 New York, London, Dacca... I wonder whether it was even worse in older plagues, before the germ theory?

Japanese researchers report that half of all cases are contracted during the incubation period, before the infected individual becomes symptomatic, contradicting previous refutations of the asymptomatic transmission hypothesis:

https://english.kyodonews.net/news/2020/02/255501851d48-half-of-secondary-virus-...

Then there really is no way to stop it, is there?

This is not encouraging news. There are 'super spreaders' with symptoms that are atypical, so proper precautions aren't being taken:

New Report on 138 Coronavirus Cases Reveals Disturbing Details https://nyti.ms/2S5R1zz

Yes, saw that. Predictions about this are really interesting. I like to look at what insurance rates and the equities markets are saying about risk, because these are determined by either smart people with a stake in being right, or by (in effect) crowdsourcing. For example, home and flood insurance rates are rising for beachfront properties from Florida to Virginia (not sure further north), a seeming prediction that sea level will rise.

In this case, the markets don’t seem to know which direction to go, and they are being influenced by buzz words like “stimulus” which the Chinese government is announcing, by low interest rates, and by past history of the effects of epidemics being short-lived.

On the other hand, all the virologists I can find are sticking with “This is very serious, maybe it can be contained in China without gaining a foothold elsewhere. But the truth is that I don’t know”.
If virologists don’t know, then how could the markets?

The most optimistic idea out there seems to be that coronaviruses don’t thrive in hotter weather, and if we can get to the spring or summer maybe this disappears.

Personally, I don’t see how this fails to disrupt global supply chains given the centrality of China, contributing to economic dislocation. I have altered my personal finances in accord with this possibility. Scott Gottlieb, recent former FDA head, says we should assume there are cases in US cities circulating. It remains to be seen whether they will gain a foothold here. I certainly don’t know. I’m kind of surprised we are not seeing more already, frankly.

I have been curious about what's happening in North Korea, which is another country primed for disaster.

https://www.dailynk.com/english/sources-five-north-koreans-died-coronavirus-infe...

Careful, a ton of pop-up ads with this next link. Similar info to above, but a little more terrifying.

https://www.thedailybeast.com/north-koreas-secret-coronavirus-crisis-is-crazy-sc...

This analysis in The Lancet argues that isolation of cases outside China should be enough to prevent spread:

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30068-2/fullt...

Well, since I can’t get the link to work, I’ll quote it here:

“An important determinant of whether or not 2019 novel coronavirus (2019-nCoV) will ultimately cause a global pandemic is its ability to become established upon its importation to a new country. Cases of 2019-nCoV infection have so far been reported in 24 countries, yet little human-to-human transmission outside of China has occurred.
The key quantity governing whether or not 2019-nCoV can establish and generate a sustained outbreak on arrival in a new country is the reproduction number, R, which represents the average number of individuals that each infector will transmit the virus to. If R is greater than 1, sustained transmission can occur; if R is less than 1, then chains of transmission will simply stutter out.
In the ongoing outbreak, assuming an R of 2·2, as reported by Li and colleagues,1 then just over half of infections must be prevented to bring R below 1. This might be expected to be challenging if 2019-nCoV can be transmitted when infectors are not symptomatic.
However, there is little evidence to suggest presymptomatic transmission of 2019-nCoV.2 Even if 20% of infections are occurring because of presymptomatic infectors (a level roughly halfway between the respective values for severe acute respiratory syndrome and influenza viruses,3 which is likely to be an overestimate), then 80% of infections would be due to symptomatic infectors. Because only slightly more than half of infections need to be prevented to bring R below 1, effective isolation of symptomatic hosts alone should be sufficient to prevent sustained outbreaks of 2019-nCoV outside China.
Of course, detection and isolation of symptomatic hosts is not always carried out effectively, and detection is challenging when symptoms are mild. Therefore, efforts to counter presymptomatic transmission might sometimes be merited. However, when implementing such measures (eg, the UK's isolation of passengers returning from Hubei, infected or not), the substantial cost to individuals who might not be carrying the virus should be considered carefully. With fast isolation of symptomatic individuals alone, including self-isolation of those with mild symptoms, sustained outbreaks outside of China can be prevented.”

Yesterday in two articles I saw the same prediction that in two weeks we will most likely know whether or not this thing has/can be contained. So we just keep watching and hoping in the meantime.

Editing to add: I have a friend who lived in China for several years and she says that we cannot put much faith in the numbers we're seeing. She's sure it's much worse than they're saying. So when I saw this article a few minutes ago I decided to edit my post and add it.

https://www.usatoday.com/story/opinion/2020/02/10/coronavirus-killed-hundreds-ch...

'Writing in The New York Times, Frankie Huang, an American in quarantine in Shanghai, reports that the problem is in trusting the official numbers: “Yesterday, I saw on social media that someone noticed that the ratio in the official figures for the total dead to the total diagnosed cases has remained exactly 2.1 percent every day since Jan. 30. ‘This magical virus is very good at math!’ I felt my face crumple as I stared at the numbers. I had forgotten that every piece of news must be examined for how it is being used to strengthen the regime’s rule. . . . I so badly want to believe in the Chinese government when millions of lives are on the line.” '

From Scott Gottlieb:

Singapore appears to have sustained community transmission of #coronavirus and may be 3-4 weeks ahead of what could unfold in U.S. Both nations should have similar number of imported cases, but Singapore density will make spread manifest more quickly.

It’s deeply concerning that of the cases identified in Singapore, as of Sunday (Feb 9) night, six patients are in intensive care. These are patients of different ages, and not just the older ones.

Another resource for the determined is the podcast TWiV aka This Week in Virology.
A bunch of professional virologists sitting around discussing viruses and currently 2019 n-Cov

Trusting China's official numbers on anything would be asinine. So what is really happening with 2019-nCoV there?

https://www.businessinsider.com/wuhan-coronavirus-75k-infected-doubling-every-64... (31 Jan 2020)
Headline: "The real number of coronavirus cases is more than 75,000, according to a scientific model that says the outbreak will double in size every 6.4 days"

https://www.taiwannews.com.tw/en/news/3871594 (5 Feb 2020)
Headline: "Tencent may have accidentally leaked real data on Wuhan virus deaths: Tencent briefly lists 154,023 infections and 24,589 deaths from Wuhan coronavirus"

Excerpt: "On late Saturday evening (Feb. 1), the Tencent webpage showed confirmed cases of the Wuhan virus in China as standing at 154,023, 10 times the official figure at the time. It listed the number of suspected cases as 79,808, four times the official figure.

"The number of cured cases was only 269, well below the official number that day of 300. Most ominously, the death toll listed was 24,589, vastly higher than the 300 officially listed that day."

https://www.taiwannews.com.tw/en/news/3874013 (10 Feb 2020)
Headline: "Rise in sulfur dioxide could be sign of mass cremations in Wuhan"

Excerpt: "Intelewave on Sunday shared an image on Twitter showing sulfur dioxide levels soaring to 1700ug/m^3 on a map of Wuhan on Windy.com, far above the danger level of 80ug/m^3. Intelewave listed a few possible explanations for this increase in emissions, with the first being a power plant.

"However, none of China's numerous other power plants were seen emitting such large numbers that day. The second possibility proposed was the burning of refuse and animal carcasses, but the author questioned why such burning would be taking place as opposed to the standard practice of burying garbage.

"The third possibility proposed was that: "Dead bodies are being burned on the outskirts of the city, the death numbers are way higher than the CCP is letting on about, and things are really, really bad." One netizen even calculated that it would take the burning of 14,000 bodies to reach such a high level of SO2."

The threaded tweet, with screenshots: https://twitter.com/inteldotwav/status/1226270885532852224

The crematoriums in Wuhan were already rumored to have been working 24/7 for weeks to dispose of infected bodies. I'm seeing variations in the number of facilities and their capacities, which obscures estimates of many human bodies have been cremated in the past two months. Whatever the number, it's hard not to see the evidence and not imagine nightmarish scenes.

And I believe we need to think about those scenes. How ready is the world to prevent worse conditions from this coronavirus?

It seems there is widespread agreement that the numbers are being vastly underreported. First, China is not reliable in reporting on internal problems, second there is a limit imposed by testing capacity, and third only people who have appeared sick or have been located for testing have been tested. There are probably many less severe cases who have chosen not to go to a facility where that know they will be locked up for 2 weeks - I know I wouldn’t do that, which in a edition to sickening the well is why quarantine is a bad idea vs home isolation. If this is correct, the math would lead to the conclusion of greater transmissability and less lethality. Note that the lethality in Wuhan is far higher than elsewhere. I think they are overwhelmed there and can’t provide basic health care for the sick.

Is there a timeline based on the higher estimates of infections and related deaths? I might be overlooking one that isn't based on the say of Chinese officials.

>40 stellarexplorer: "I think they are overwhelmed there and can’t provide basic health care for the sick."

Communities around the world are easily overwhelmed. Living in a rural area of the U.S.A. where basic health care is lacking, I'm particularly concerned about what happens if/when 2019-nCoV arrives (assuming we don't have immunity). Most children here this year have been denied flu shots and access to doctors. Most of the people I know in this area have to go hours away for hospital care. A couple of years ago, our sole ER filled up with people struggling to breathe, and my family endured multiple, unidentified infections that debilitated us for months.

Editing... because I want to talk about this but am not able to form reasoned questions about how 2019-nCoV will compare to what went around in 2018.

>41 aspirit: I definitely understand the concern, and share the fear that this could spread. I find it encouraging that spread outside of China, and from Wuhan to other places in particular, is as limited as it is. As travel has been severely curtailed for many days now, we may not see wide spread outside of China. With a limit in the influx of cases, health care systems can effectively deal with those who do have it. With massive numbers, any healthcare system would be overwhelmed.

But I think it is important to remember that this is not a virus with high lethality. Most people who do get it, get a mild version. The severely ill/death rates may be comparable to the seasonal flu which kills many each year, but since it’s a known threat, concerns are more in line with the reality of the virus and it’s effects.

My biggest concern at the moment, outside of the situation in China, is the possibility of spread to Africa. They are not equipped to deal with this from a public health or healthcare perspective. If it were to become widespread there they’d have a serious problem, but in addition, the avenues for spread outside are greater. It’s one thing to stop travel from one country, another thing to stop it from 54. But even in that case, this is a terrible development, but the vast majority of those who get it will survive and make a full recovery.

>41 aspirit: Oh, timeline. One would expect that within 2 weeks or so, we should know better whether we see spread and sustained transmission outside China. Of course, everyone is using reason and available evidence, both of which are imperfect.

>39 aspirit: I saw the info about suspected cremations yesterday as well. I hyperventilated a little, then decided to wait to see if any mainstream news sources reported it. So far none of them has, so I'm not going to let it freak me out, yet...

I worry about my tiny local hospitals getting overwhelmed, but at that point I imagine even the big ones in more heavily populated areas will be in dire straights. I think my best bet is to stay as fit and healthy as I can so if I do get sick I will be in the best shape to weather it.

Looks like we have an official name.

- The novel coronavirus, previously dubbed 2019-nCoV, is now officially named SARS-CoV-2.

- The disease caused by SARS-CoV-2 is now officially named COVID-19.

That, or another way to say it is that it’s the biggest challenge to the Chinese leadership since tiananmen square.

The markets have been way up, apparently in part due to the perception (and no doubt hope) that the epidemic is slowing. But today China released numbers that show the biggest daily increase yet, from 45,000 cases yesterday to 60,000 today. Some of this is due to new ways of accounting for cases in here region - chest X-ray instead of blood test - but it’s also clear that many people are sick and dying at home, so it’s pretty convincing that the numbers are still an underreporting.

South Korea quickly spikes to around 500 cases, and Iran reporting 6 deaths. Spreading, not contained.

Ugh - ROK to over 600 cases. Not encouraging that I can’t keep up with my own case reporting. Are we at pandemic yet, or two weeks away?

I was slightly hopefully for several days, but not so much anymore. I also suspect many cases are completely under the radar in certain countries.

A US- centric view, from two days ago (meaning: outdated), but with an interesting chart and maps:

https://www.nbcnews.com/health/health-news/u-s-takes-steps-prepare-pandemic-glob...

>52 aspirit: People do like fairy tales ;)

Italy up to 138, Iran up 50% over night. It has to be quietly circulating all over, mostly mild cases mixed in the northern hemisphere with all the flu and winter colds that make it impossible to tease out without testing.

Wanted to note a sister thread. Contains info some may find useful. https://www.librarything.com/topic/316600

>55 davidgn: Thank you.

From the NY Times today:

With all of the coronavirus news, it seemed like a good time for a little perspective. We posed some questions to Donald McNeil, a Times reporter who has covered epidemics and pandemics for nearly two decades.

What worries you about this virus?

It’s more deadly than flu, and it’s spreading like flu. Maybe not quite as fast, but these cases where hundreds of people were infected in one church or aboard one cruise ship — that was scary. That was much faster than I expected.

Why are conspiracy theories gaining traction? We’ve reported on the belief in unfounded claims about the origins of the virus: Some say it came from a lab in Wuhan, while Russian actors have spread a theory alleging the U.S. is behind the outbreak.

Conspiracies are the first thing some people go to when they face something new and scary. This happened with Zika; people rejected the truth that the virus caused microcephaly and blamed pesticides or genetically modified mosquitoes. But in medical school they teach you: If you hear footsteps, assume it’s horses, not zebras. That is, try the obvious diagnosis first.

The obvious origin is the same as we saw in SARS and MERS: that it’s a bat virus that passed through other animals into people.

>56 clamairy: Frankly, the bottom line to me is the origin makes no difference. Speculating it may have escaped from a lab does not, per se, make it any more or less dangerous. It is now simply a fact. How it came to be is irrelevant.

>57 davidgn: It only makes a difference if you start treating people differently because of what you believe about the origins of the virus. There are people trying to point fingers.

The evidence against the escaped-from-the-lab hypothesis is very strong. There are elements in the structure of the viral attachment spikes that are novel and counterintuitive such that no human could have anticipated that these would have enhanced viral binding to cellular receptor binding sites. Unfortunately nature ran experiments and found answers humans would have missed.

Story on lunchtime news about recent patients becoming infected again (already). It's been so interesting to watch this unfold but this if true makes it downright fascinating.

>60 bluepiano: Yeah, that is fascinating... and terrifying.

Glad I qualified iprevious post. An explanation for supposed rapid recurrence that had occurred to me was that post-infection test results weren't sufficiently refined but on news today a doctor said that they were over-refined; altered RNA indicates infection (or exposure?) for some time after recovery. Still verging on the fascinating, though: Apparently one piece of internet wisdom is that putting ample amounts of cologne on skin will be prophylactic. Yeah let's party like it's 1349.

I'm holding out for the snuff-taking revival.

Reinfection is very scary. You would expect a minimum of a short period of immunity. We have a lot to learn about this virus.

Bill Gates’ well-considered opinion piece in the New England Journal:

https://www.nejm.org/doi/full/10.1056/NEJMp2003762

>60 bluepiano: >64 stellarexplorer: Checking with trusted virologists, the most likely explanation for reinfection is lack of full recovery rather than reinfection per se.

Genuine question, from someone in a country (UK) that can sometime be a bit blase about having cradle-to-grave healthcare entirely paid for out of general taxation (NHS), what would happen to you in your country if you got sick?

>67 Cynfelyn: I’d get excellent care and presumably the outcome would be based on the medical situation. But like a substantial portion of the country, I am fortunate to have decent health insurance and education about resources. If you are poor and don’t have those advantages, things might not go as well. Most of the time a person who is sick can get decent care. However it is both true that healthcare is very good for large numbers of people, and that medical bills constitute a major portion of bankruptcies, which is unconscionable.

>67 Cynfelyn: Likewise (assuming funtioning, non-swamped system). However, the public health implications of certain aspects of the US system are...troubling.

Coronavirus: Man receives $3,500 medical bill for test after returning to US from China
Osmel Martinez Azcue only has the flu, but he now owes his insurance $1,400
https://www.independent.co.uk/news/world/americas/coronavirus-test-medical-bill-...

>67 Cynfelyn: I'm in the US. The same thing would happen to me if I were to contact this coronavirus as what happens every time anymore when I get sick. I try to deal with it at home and hope that I don't die.

I don't have medical insurance. Doctors refuse to see me even when I did. The closest hospital, in another city, is understaffed, has wait times for up to four hours even when it's not particularly busy, and has not shown a high level of competency or ability to care about patients in my previous experiences in the ER.

Almost everyone I know in my area, including some in the healthcare industry, drives several hours away for medical care. Those larger cities, unfortunately, have also demostrated an inability to provide safe treatments for routine care. Diagnoses without testing, refusal to listen to patient concerns, lax sterilization, and drug overdoses seem to be common. Our state government gaslights people who bring up concerns, discourages news media to investigate, and doesn't allow for official reporting on most healthcare abuses.

Then there's the issue of money. There's no way to know in advance how much a visit will cost, and each experience with surprise charges further discourages the risk of taking on more. Debt sharks persist for years even on accidental (wrong) charges that the office agrees should not be paid. Flu vaccines, when available, cost only $30 to $40, but sometimes need to be acquired elsewhere; the trips cut into time off work and budgets. Each ER visit tends to cost thousands of dollars. Overnight hospital stays might go into five figures.

In other words, around here, we're conditioned to not do anything but try out home remedies and pray when we get sick, unless we're among the lucky few with wealth.

Meanwhile, government offices, libraries, school supplies, and retail equipment touched by passersby aren't being cleaned daily....

By the way, this isn't specific to any one disease, but NPR does have a feature that spotlights medical billing in the United States of America.

https://www.npr.org/series/651784144/bill-of-the-month

I have stories like these. My friends, relatives, and former coworkers have stories like these. Bill of the Month can't show everything. However, the gist of one of the big problems in the country's medical systems comes across.

I expect someone has studied how every epidemic increases personal debts below the bottom 90% of the economy.

2019-nCoV or whatever its official name is at the moment will kill people. So will debt, in the long run.

>70 aspirit: Goodness. Whereabouts are you, if I may ask?

>72 davidgn: The South. Although, some of the worst stories reported in the news for billing are in metro areas in other regions. (You won't accrue a $50k bill if you don't trust the system enough to get into an ambulance.) The problem with too few medical facilities exists in rural areas through the USA. Outdated treatments and trouble accessing common medications are problems everywhere.

Interesting, but I am aware of how much I would like encouraging news to be true. This is a set up for personal bias, so I’m not prepared to accept that this is true until wider confirmation. Also, given the Chinese tradition of being less than forthcoming with the facts, this is a perfect way to avoid losing face: “our epidemic was caused by a much more virulent virus than yours, which explains our terrible outcome”.

>75 stellarexplorer: I hear ya. I'm just grabbing at every glimmer of hope I find. There are so few of them.

This isn't one of the hopeful stories:

https://www.washingtonpost.com/world/middle_east/coronavirus-pummels-iran-leader...

"The five nurses, who spoke on the condition of anonymity to discuss their working conditions, said some medical staff were being prevented from wearing masks to avoid causing panic and that there were shortages of masks, gloves and other protective gear for workers. The nurses also described a staffing shortage as medical workers were being shifted among hospitals to address the growing caseload."

>76 clamairy: Absolutely - the situation in Iran has to be abominable. At least 23 MPs have the illness. Khameini’s close advisor succumbs. Top intelligence leader dies. 23 year old popular female professional soccer player gone. We are clearly not getting truthful reports out of Tehran. There must be multiples of the reported numbers of ill people to produce these results. And the sick Minister of Health coughing in an interview, contaminating the personnel in the TV studio, and then announced to have the illness...

There are strange political strategies in the US. Donald Trump’s tying his personal prestige to the outcome of the coronavirus pandemic, or to the performance of the stock market, things over which he has little or no control come to mind. But to lie to the Iranian public about shooting down a plane, killing many Iranian students, just as people were ready to rally ‘round the flag, snatching defeat from the jaws of victory and further losing credibility....apparently lesson not learned.

The BBC Radio 4 PM programme tonight was dedicated to coronavirus.

https://www.bbc.co.uk/sounds/play/m000fw1q (may be geographically limited)

I only caught part of it, but was struck by an interview in which Francis Fukuyama ("The end of history" and all that) discussed what might be the lessons learnt when the history of coronavirus is written in a year or so's time. A month on from #12-14 discussing whether the outbreak will be severe enough to burn itself out for want of fresh flesh, what do you think? A wildfire that will die when it runs out of fuel, or an addition of the longterm repertoire of diseases, perhaps becoming a childhood disease for want of unresistant adults?

>74 clamairy: From Laurie Garrett, whom I tend to trust:

“Much coverage of alleged "new form" of #SARCoV2 aka #COVID19 virus. Let's be clear:
1.) There is NO NEW VIRUS
2.) Both clades described in the new paper were 1st ID'ed many weeks ago
3.) "The difference between these groups is minimal and rarely linked..."
false claims of "new" form of #coronavirus
...to changes in severity for which there is no hard evidence presented in the paper." Says gisaid.org .
4.) "The differences betwn the genetic groups in the case of this virus can be likened with
comparing two cars of identical type and color just with a different license plate. That license plate helps you finding out where the car was registered but not how fast it can go.
5.) NO new mutation has emerged that affects #COVID19 disease or transmission.

...these are wrong:
fortune.com/2020/03/04/cor…
&
telegraph.co.uk/science/2020/0…
&
foxnews.com/health/coronav…
Had I time, I'd list more.
But don't blame the messengers: the scientists wrote: "Our results suggest the development of new variations in functional sites"”

So no ray of hope there. But good to have something to hang your hat on.

>78 Cynfelyn: So many good questions are being asked every day, and the answers are so often that we don’t know yet. We may have the genome of the virus, but we are still woefully short of data on its behavior in the world. I can’t remember the number of times in the last week when someone has raised a question, and I have resorted to “Do you want me to speculate?”

So I’ll bite. Barring a vaccine, there is reason to think this will not die out due to exhausting the raw material it thrives upon, namely human beings. At this point, and this is still not certain, there is some reason to think immunity is not permanent after infection. People may receive temporary immunity, but it is possible that a person might be able to become infected again next year, or in several months. Not yet known for sure. This is why a vaccine is so important, or at the least anti-viral medications. However, it is not yet clear whether a vaccine is possible for this virus - there are many smart people working on this - but not every virus is preventable by vaccine.

Couple interesting links from sites that seem reasonably reputable:

https://www.worldometers.info/coronavirus/coronavirus-death-rate/#comparison; https://www.statnews.com/2020/03/03/who-is-getting-sick-and-how-sick-a-breakdown...; https://mashable.com/article/wuhan-kids-app-coronavirus/?europe=true.

A significant point that doesn't always seem to be taken into account is the misleading proportion of serious/fatal cases v mild ones reported in early stages of an epidemic.

The politicalization of who gets counted has me rolling my eyes hard at estimates. In the United States, at least, there's a battle between the politicians attempting to skew the numbers and scientists who actually want to know what's happening in people. "Anyone who wants them" is hugely different than "here's 150 test kits for your entire state to use in the next month".

Hundreds of millions of people do not have access to the test. Many of us have had a respiratory illness since January but won't ever be tested for remnants of the virus (or anything to confirm the cause) if testing were to become available in our areas.

The humans in my household has new sniffles today, so I am feeling annoyed about the data holes. At this time, the estimate that 80% to 90% of the world's population will be infected in the next year looks as reliable as any. For deaths? Who knows.

Do you remember the source of that estimate?

>83 bluepiano: unfortunately, no. I've visited too many places online this week and not taken notes except for local statements.

No, that's most certainly not as reliable as any. I'm sure a consensus amongst epidemiologists about future rate of infection if there is one is very very tentative; they've insufficient data to extrapolate from. Prediction of 80-90% infection rate is in chemtrail territory.

Please don't worry about those sniffles. A lot of people get colds this time of year. If you think you've a respiratory illness, see your GP (or, if you're in US & can't afford to, simply entering specific sypmtoms into google might give more info) though I've not read nor heard on news anything at all to suggest that corvid/flu symptoms persist for months.

>85 bluepiano: "since January" was confusing. What I meant is to have developed a respiratory illness between January and now, not that symptoms persisted in individuals that long.

From what I've heard the first symptoms are a fever and a dry cough. If the first signs are a sniffle it's probably not covid-19.

From what I've heard, the majority of people infected with SARS-CoV show no symptoms. Even with a fever and dry cough (or any other symptoms of respiratory illness), someone will probably stay home, self-medicate, and call around about seeing a doctor or getting to a lab until they're too tired to keep trying for a diagnosis. That's another data point lost.

Well, weigh the potential result of going to a clinic or surgery--infecting others with whatever it is causing the symtoms--v possibly (if test = positive) supplying another wee scrap of data to the stats. I hope it's reassuring to some of the more alarmed posters here that ournational health board's advice is to ring your GP if you've corona symptoms & have been in contact w. a patient or travelled to an affected region or if the severity of symptoms is such that you'd be getting in touch with a doctor anyway. In other words these factors aside, no need to mess with testing or even getting in touch with a doc.

This is The Big Picture thread, isn't it?

I think I've confused people by talking about personal concerns. We need data to see without having to use imagination.

On the larger view of SARS-CoV testing options, what are those? Governments are distributing test kits. In what ways? Home test kits will be provided to Washington state residents by a (Bill and Melinda) Gates fund, but how does that work along with others? An overview would be interesting.

Testing would be great for getting a sense of the prevalence of the virus, and understanding its virulence. Mild cases are largely undetected, leaving a false impression of the percentage of cases that are serious. It is frankly negligent that we in the US had this much advance notice and were unable to produce a test. It wasn’t so long ago that our science and health institutions were second to none. And the political messaging is unconscionable. But enough of politics.

I keep up with many serious virologists and epidemiologists. No one knows the answers to so many questions about the virus yet. But many are estimating that 30-70% of the human race will ultimately get the virus. Fortunately most cases are mild and self-limited.

Since there’s no specific treatment, you stay home and recover over a few weeks. You call the ER first and go in if you develop shortness of breath. If you have special concerns or complicating medical issues, you can call your doctor. It looks like fever is the most common symptom. While I wouldn’t bet the farm on this, it looks like over 90% of people develop fever, with Fatigue and dry cough being very common as well. Unfortunately these are non specific.

It would be nice to know whether you have it, mostly so you’ll know whether you could transmit it to others, especially people in at-risk groups. But for the individual person, it basically comes down to that you’ll recover on your own if you don’t develop shortness of breath. If you do, you will probably need medical attention.

>91 stellarexplorer: Yeah, we've really messed up on the testing, I'm afraid.

We've got a few cases out here on the North Fork, unfortunately. It's not a densely populated area, but there is much coming and going from NYC, especially on the weekends. One of the workers at a very popular brewery in Greenport has been hosptitalized and is expected to recover. He's only in his 40s but he was a rough shape when he was first admitted. There is a woman in her 20s here in Southold who has tested positive and has self quarentined.

In the rest of my county there are only 4 other cases so far, and they are all in Brookhaven. All males ranging in age from 20s to 80s, all of them requiring hospitalization. My guess is there are a lot more cases than that, but again, the testing is an issue.

I'm still doing my regular stuff as of now. Spanish class once a week, a vineyard with friends, shopping, etc. I keep hand sanitizer in the car, and try NOT to touch my face until I've used it. If there are a lot more cases diagnosed by the time the weekend comes I may start skipping things.

>92 clamairy: Those cases of younger people in hospitals makes a point often missed: this tends to be a disease much more dangerous in older people and sick people, but there are MANY cases in the world that do not fit that pattern. I wonder whether these younger people had underlying medical issues. But there have been many doctors in China and Italy in their 20s and 30s who have died, the thinking being that the magnitude of viral burden seems to matter a lot. They had huge exposures.

I am officially working from home as of today. I am going out for essentials and not for nonessentials, and being extremely careful about what I touch, washing hands, I use latex gloves in stores. After a few more doublings, I won’t go out. However my daughter’s school is still open, so I can’t control that. If she weren’t in the middle of 11th grade stress, I’d pull her out. My guess is they’ll do the right thing and cancel schools soon. I wrote to the school superintendent who said she is bound by the decisions of the state authorities.

Bottom line: I believe most people have no idea how bad this could get. I think mitigation efforts will be regional and therefore variable, but many places could become like Italy now.

>93 stellarexplorer: You're wise to work from home, and lucky that you can. I've considered donning gloves myself. Might begin doing that soon to go into stores. Target had packs of N95 masks yesterday, limiting two packs (of two each) to each customer. I did buy two. I'm not taking changes. These are reusable.

I heard a segment on NPR addressing the issue of cities in the US with large homeless populations, and how devastating it will be if the virus hits those extremely vulnerable people. In LA they are desperately trying to set up hand sanitizing stations, since there is little running water.

Just posted my video, "Doctor Explains How to Stop the Coronavirus Pandemic" if anyone is interested. I really hope the whole world wakes up in time!

It can be found here:

https://youtu.be/R70UicCuXu8

>95 stellarexplorer: Thanks for this.

>96 clamairy: Thank you. Just awful that circumstances make it necessary.

>97 stellarexplorer: Yes. I just hope we've caught this in time. I'm finding it hard to process that it's only been about 8 weeks since I posted the first message in this thread, and here it is already on our doorsteps.

I mean literally on our doorsteps. For those who don't know where I live, I'm in a mostly agricultural area about 90 miles East of NYC. It is rather sparsely populated for 10 months of the year. Tuesday evening I found out we had a case of Corvid-19 here in town. By Wednesday it was 3, Thursday 9, yesterday 11, and today it's up to 14 cases. Keep in mind they are only testing people who are symptomatic.

Stay healthy and safe, all of you.

>98 clamairy: Yes, terrible, but entirely predictable once Wuhan made it clear how contagious and dangerous this was. Viruses ride free on airplanes.
And not to rant, but the testing fiasco is beyond negligent. So right, only the sick are getting tested, and we are limited to guesswork to estimate how positive tests of sick people correlate with actual cases in the community...

"Is this the Big One?"

NO!

There you are; relax.

>100 tommi180744: It might not be as deadly at the 1918 influenza, but it's bad enough to cause upheaval on many fronts.

Relax? Are you out of you mind?

Don't panic?! Sure. Panic leads to poor decisions. But this is still a real crisis.

>102 Nicole_VanK: Exactly. There's a big difference, to me at least, between not panicking and relaxing. Might just be an issue of semantics.

On a related topic, I’m now working on a new video exploring what it is about human psychology and the limits of human cognition that make so many people unable to grasp the reality?

Denial is a very powerful and, sometimes at great cost, an effective defense mechanism. Explanation enough for me at any rate.

>103 clamairy: Yeah semantics or, really, connotation. 'The big one' to me suggests mass extinction or at very least Black Death level of mortality. Maybe another difference British/US English?

>105 bluepiano: Yes, I agree that’s part of it. Who would want to face the actual awfulness of the worst case scenario here? But I think it’s more than that. It has to do with a difficulty in responding to threats that are not here today. We react to the charging lion immediately. We might build a lean-to so we won’t get wet when it rains tomorrow. But the famine that might occur in two years is more challenging. And something like climate change, whose full effects might be decades or centuries away, but will only be optimally mitigated by action today, challenges the faculty I’m describing for a lot of people.

Then there’s dealing with math. Exponential growth. Doublings. The fact that the sickness we see today reflects the status of infection a week ago. One or two doublings ago. Current infection numbers much worse. Not the way many people think. Everything seems fine to me....what’s all the hype?

Can I just vent a moment?

I'm starting to get really p****d off by the amount of rubbish information some of my friends and family are 'sharing' about this on facebook. Such as you can cure the coronavirus by gargling salt water. Why the hell can't they do the simplest of googling first?

Thanks for that. I'm already causing friction by my comments--if I posted the above on facebook under my real name half the family would be at daggers drawn with me ...

>107 alaudacorax: I saw some of that as well. I was quick to share the Snopes link before anyone else spread the misinformation.

I suspect people are feeling powerless and so are grasping at anything they think they might do to protect themselves. I guess hand washing and practically shutting down the country isn't enough for them.

I feel similarly about all the "pray to cure the disease" posts. I don't mind them on someone's own page, but do they have to go all over group pages?

Yes, a million pieces of false info. Fear brings out the worst in people.

First case in our circle this AM, the boyfriend of my wife’s cousin woke with 100.9 and flulike symptoms. Would be nice to have testing capacity #raisedeyebrows

Wow I just discovered this thread and group (thanks to Green Dragon for sending me here) Interested in digging deeper but for now I'll start at the top and try to catch up

>110 cindydavid4: Welcome, Cindy!

>28 stellarexplorer: This virus did not exist on Planet Earth 4 months ago.

I find it interesting that four months ago we were impeaching a president. Given the state of our relationship with China and Russia, and Chinese labs, and my very active imagination (have read too many books on this topic) these things gives me pause. Just how badly does someone want to stay in office.

That being said its amazing to me how quickly this has spread. Hope this 'stay inside and work from home' works, just wondering how long it will take to find out.

Anyway taking the tinfoil hat off my head and just hoping that somewhere someone will have a vaccine or cure soon, and it would be available to everyone, but then look at the number of test kits we have and it is frightening)

>39 aspirit: holy shit! do we know if this is true?

>113 cindydavid4: We don't. But I am pretty sure we didn't get accurate numbers.

Glad you found us!

>113 cindydavid4: This article just came out and uses South Korea as a benchmark and using mathematical modeling, argues that the actual China case numbers are closer to 700,000. It’s not yet peer-reviewed so don’t take it as gospel. But it has always seemed unrealistic to think the number was as low as 80,000, given 1) that any bad thing that happens in a place as populous as China has to affect a million people, and 2) that China has a long-established policy of putting out information not based on absolute truth.

https://www.medrxiv.org/content/10.1101/2020.03.14.20036178v1

>104 stellarexplorer: Id love to see it. Are you also looking at the anti vaxxers?

>115 stellarexplorer:

China has a long-established policy of putting out information not based on absolute truth.

Sorry, nothing personal, but I must take exception to this. It's vague enough that it can't be flatly denied (although one might ask for proof that such a policy exists), but more to the point, it's irrelevant to the question whether the Chinese government actively suppressed data in this case.

Especially, I would not venture such statements based on that link.

The fact is that until we understand more about the virus and have reliable diagnostic tests even for people only suspected of having been infected (because of mild or asymptomatic presentation), everything about the "silent" infections is conjecture. People do know that the current lethality rates are provisional (based on current knowledge) and contextual (different locations, with different demographics, access to healthcare, political approaches to the crisis etc.) That's why WHO talks of an average lethality rate, while we can all note the differences in the outcomes in Hubei, Italy, or Germany.

edited for spelling

>117 LolaWalser: No, nothing personal. Yes, agreed, context matters tremendously in lethality and R-0. Way too early for firm conclusions. That article 1) is not currently peer-reviewed and 2) is a mathematical model, not based on actual data.
On the other matter, we may see differently either the likelihood of the Chinese numbers being accurate, and/or the history of Chinese public transparency. Maybe it will all come out in the wash. In the US, we have our own problems with the accuracy of a great deal of information coming from the top.
Either way, the current situation must be dealt with, and data of all sorts will be more and more available. One hopes the current measures can help reduce the burden on the healthcare system. I have no doubt that here in NYC especially, but in many places, the answer to that will have a huge impact on the ultimate mortality numbers.

>118 stellarexplorer:

Agreed. The American response has been dismaying for a good while now (and not only American, but that's a long list to detail).

Regarding China I just want to note that on top of the health crisis, Chinese people or those others suppose of Chinese heritage are experiencing a terrifying onslaught of abuse. As someone whose colleagues are majority Chinese scientists and engineers (almost all adult immigrants) I gained a little familiarity with the problems anti-Chinese sentiment causes them at the best of times. What's happening now is off the scale.

>119 LolaWalser: I completely support what you are saying there. I in no way was intending to contribute toward unfair, ignorant and frankly abominable stigma toward any individuals. My own daughter, of Chinese ancestry, has been the recipient of absurd reactions from people in public until we self-isolated as a family. It’s a terrible thing.

I'm so sorry. I wish you all much strength.

Thank you. To you as well.

>120 stellarexplorer: to be clear-- I am distrustful of the current Chinese government, not its overall people or those who came from China. I am also distrustful of the current US government, not all of its people (of which I'm one).

The links I shared above as a warning of the potential scale of SARS-CoV-2 in a country that had the most data at the time but also a government that is known to suppress information. That message felt on-topic in a thread about the impact this virus might have on the world.

I do not condone aggression toward individuals because of any wrongdoing of their government.

If it's not clear enough--and I'm afraid that if we keep vaguely assuming "everybody knows the Chinese government lies", the context in which I posted >117 LolaWalser: is bound to be lost--I was referring specifically to the content of the link in >115 stellarexplorer:.

Which, again, as stellarexplorer himself noted--is a model based on certain assumptions--not hard data and proof that the Chinese official numbers are wrong. (That is, deliberately wrong. As I said, scientists know the numbers are provisional.)

One ought to stop and consider for a moment what is supposed to be "wrong" and what would be the point of lying about it. The paper speculates about the number of silent infections and proposes that they are much higher than (supposedly) the official projection.

Given that the Chinese seem to have successfully contained the spread of the infection, whatever the "real" number of the infected may be, the official measures seem to be working--for the "moment" at least. (We still don't know how long the "moment" may last, especially if there are other waves of infection and/or the immunity profile allows for reinfection).

To be sure, it's important to know whether there are many, and how many, "silently" infected people spreading it (perhaps) beyond the confined zones. But right now we can't really know.

On the other hand, there is actually evidence that the truly "mild" and "asymptomatic" carriers are many fewer than initially supposed--under 20% of affected population--and that most of even the "mild" cases actually progress to worse symptoms (but not necessarily to the worst, respiratory failure etc.)

In short, this does not present a strong case for the idea that the Chinese have actively suppressed some known data about silent infections, nor is it clear why would it be in their interest to do so. I suppose the conspiracists might say that scaring the population by false numbers (indicating higher lethality than the real one) would help to control it. But I see no evidence that the Chinese needed to scare their people to obtain compliance with the measures. They have already suffered in similar circumstances.

And if anyone doubts the lethality (or as the Anglos say, case fatality) of the virus, well, the US and Italy both offer examples of how high it may be in case of a delayed and inadequate response.

(Not that China reacted perfectly in the circumstances, initially. At least one poor messenger paid the price for bringing the bad news. But it must be recognised they didn't indulge in complacency.)

not sure if this will work, but just saw it in FB and holy sh*t thats scary!

https://www.facebook.com/megha.official/videos/209851106769093/?t=12

In reference to the actual number of infections in China, this is from The NY Times:

"In Wuhan, the authorities continue to turn up cases of people with the virus but without symptoms, fueling growing fears among the Chinese public that the government has failed to disclose or discover a much larger number of infections than the 81,171 cases that have been reported.

In China, officials only count patients with both symptoms and a positive test in the official tally of confirmed cases. The World Health Organization says that all people who test positive are confirmed to be infected, even if they show no symptoms.

China’s approach to counting raises questions about how many people with the virus are circulating freely. There is evidence that asymptomatic people can infect others.

The number of “silent carriers” — people who are infected but show delayed or no symptoms — could be as high as a third of those who test positive, the South China Morning Post, a Hong Kong newspaper, reported on Sunday, citing classified Chinese government data.

After social media accounts circulated over the weekend that China was suppressing the numbers by failing to acknowledge these “silent carriers,” authorities in Wuhan said a patient in the city had tested positive despite not having symptoms."

>126 clamairy: I hit a paywall on NYT. I'm guessing from search results that the article was "China Clamps Down on Coronavirus Coverage as Cases Surge", published 5 February 2020.

https://www.nytimes.com/2020/02/05/world/asia/china-coronavirus-censorship.html

The numbers are more frustrating if China wasn't counting every person who was shown to be infected. Has China changed its reporting to include asymptomatic positives? Do we know of another country that's currently excluding asymptomatic cases in reports? How are the criteria for confirmed deaths varying internationally?

Relevant but tiny on the scale of things is that the first (USA) state-confirmed case of someone my immediate family interacts with is currently asymptomatic. His doctor pushed through testing before the elderly person went through an unrelated surgery. We are going to attempt to start the testing process today. (I have a symptom and pre-existing conditions, not that I expect to hear anything but advice to stay at home and call a doctor if my health worsens in specific ways.)

>127 aspirit: No, it was from today's paper. I'll find a link, but that won't help you if you have paywall issues. It was part of a daily coronavirus update.

https://nyti.ms/2WDKcbi

>128 clamairy: today's?! Yikes.

The search engine must've grabbed at the preview to the new article on an old article.

Knowing the link might help. That can make searching on responses easier.

"In Wuhan, the authorities continue to turn up cases of people with the virus but without symptoms,

Please note everybody--so, not hiding this info for some obscure reason or "policy".

>130 LolaWalser: I do think they're trying now, whatever tragic missteps were taken last Fall.

>131 clamairy:

Yes, me too.

I wonder about these figures for number of infections, given the shortage of test kits. Here in the UK I know of at least 4 people who believe they have had it. None has been tested; as far as I know there's no method of reporting that you think you have it.

>131 clamairy: > 132 I too think that they are being forthcoming now

I deal with my anxiety in part by making videos about it. If anyone is interested, just letting you know that I just finished one on the COVID-19 endgame, ie where are we headed once we suppress cases to near zero? What are the options? How does it end?

https://youtu.be/2i9ZmB9pBvM

Sorry for length but it’s important:

I’ve been warning people that we can’t open society without testing/tracing/isolating or a vaccine or a therapeutic because there will be new outbreaks, and subsequent shutdowns will be much worse economically, not to mention the additional morbidity and mortality, etc.
But I now see a need for a subtle shift in that position: if we open up without these measures, it is inevitable that we will get new outbreaks. There is no other possibility. This is the way the virus behaves.

Politically, the US President desperately wants to be re-elected. It’s his whole rationale for rapid reopening. If it backfires, and we have multiple shutdowns and the economic consequences thereof, his only hope is to successfully shift the blame elsewhere: “The governors did a terrible job opening up”. It’s also why he doesn’t want a federal commitment to producing massive testing and equipment manufacture: then he owns the Pandemic. He’s stuck now with a disastrous strategy, and he can’t take action because action makes him look both responsible for the outcome and incompetent. But so does inaction.

Bottom line, I think his prospects really do rest on whether he does a good job or not. If he doesn’t come up with an ACTUAL reasonable strategy, he has only a hope and a prayer of manipulating enough people to think he isn’t in some way responsible for killing their mother. Granted he’s good at that, but when you look at where we are headed, I think coronavirus kill him too, politically.

People not following closely (or even less closely than I have past few days) may have missed some of Trump's most incendiary behavior.

https://www.washingtonpost.com/outlook/2020/04/17/liberate-michigan-trump-consti...
https://www.nbcnews.com/tech/security/trump-s-liberate-tweets-extremists-see-cal...

"Liberate Michigan" indeed. This on the heels of armed protests at the state capitol here.
https://www.theguardian.com/global/video/2020/apr/16/armed-protesters-demand-an-...

Trump is attempting to fan the embers of an honest-to-goodness insurrection.

>136 stellarexplorer: Yup, he's been a disaster so far, and it looks like he's about to be the direct cause of exacerbating an already dire situation in some places.

Example: At his prodding Florida is easing restrictions even as their case numbers are steadily increasing. You have to be a special kind of ignorant or just plain greedy (or both) to sanction this behavior.

I don't know whether others have come across Trevor Noah's take on Trump & Friends campaign to "open up":

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

On a more serious note, I read somewhere recently - I can't lay my hands on it, but it was probably in the New Scientist or the Guardian - that the level of antibodies in recovered covid-19 patients seems to be in proportion to the severity of their illness. The suggestion being that people that been infected but asymptomatic, or even those that had mild symptoms, may not have a level of immunity that will reliably protect them from re-infecton.

Which puts any hope of "herd immunity" way into the future, even for younger age groups, until enough people have had a serious dose. Which makes "opening up" a really risky business for the more vulnerable groups in society until if and when a vaccine is available.

In the meantime, for all the talk of "flattening the peak", I fear the peak is likely to be a plateau, the new normal.

If herd immunity is the way forward, we will be looking at something unspeakable. Far worse than where we are now. You need 50-70% of the population to be immune to realize the benefits of herd immunity. Imagine the toll this will have taken if that number of people become immune.

>139 Cynfelyn: Okay, that's funny... but it's really not.

And if they're correct about that proportional immunity issue then we are, excuse my language, colossally fucked.

Not to worry, cause it's all a big hoax. Only one man from China arrived in the country with the virus ... and, as Drumpft long ago outlawed the arrival of any more Chinese to the USA ... everyone else can breathe easy.

Amazing...common sense? From Maher?

https://www.youtube.com/watch?v=UcvIQJ-QurQ

Thanks for that. I am not always in agreement with him but this had me nodding my head thro it all. Sharing.

Tomas Pueyo has been very good all along on what strategies ought to be employed:

https://medium.com/@tomaspueyo/coronavirus-out-of-many-one-36b886af37e9

WHO warns that few have developed antibodies to Covid-19

Only a tiny proportion of the global population – maybe as few as 2% or 3% – appear to have antibodies in the blood showing they have been infected with Covid-19, according to the World Health Organization, a finding that bodes ill for hopes that herd immunity will ease the exit from lockdown. ...

https://www.theguardian.com/society/2020/apr/20/studies-suggest-very-few-have-ha...

If herd immunity is the way forward, we will be looking at something unspeakable. Far worse than where we are now. You need 50-70% of the population to be immune to realize the benefits of herd immunity. Imagine the toll this will have taken if that number of people become immune.

If I'm reading this correctly, few people have antibodies because few people have caught the disease. But we've all been on lockdown to stop us catching the disease because the health services won't be able to cope if a lot of people catch it. I don't see where the 'news' is here. This has been the big problem all along,surely? Or am I misunderstanding something?

>148 alaudacorax: I think there’s some “knocking down of a straw man” here, in that it’s not clear who has been hoping for this unrealistic development of herd immunity without a vaccine, and yet that herd immunity advocacy position is being attacked and debunked.

>149 stellarexplorer: " it's not clear who has been hoping for this unrealistic development of herd immunity without a vaccine"

The UK government for one. From the Financial Times (2020-03-22):

Mr Cummings (Dominic Cummings, the prime minister's chief adviser) was also impressed by the initial advice from Sir Patrick (Vallance, chief scientific adviser,) and Chris Whitty, England's chief medical officer, that Britain would be better able to resist a second wave next winter if the population had acquired "herd immunity" in the meantime. By then perhaps 40m people might have been infected.

The acceptance that the disease would inevitably spread widely across British society — but could be managed — meant that Britain did not immediately announce tough social-distancing measures and had a limited testing regime. "Dominic supported the policy 100 per cent," said one Downing Street official.

... Under Sir Patrick's initial modelling, the disease would be controlled so that it remained manageable for the NHS; a peak would be achieved in early summer. After this, thanks to population immunity, it would tail off and not recur at any scale next winter.

It was the modelling which informed chancellor Rishi Sunak's first Budget on March 11, which assumed a relatively short and sharp economic hit this summer, then a rebound. At that time a £12bn package of help was widely seen as generous; a few days later it was seen as painfully inadequate.

Last week, the scientists changed their advice, warning that the virus was accelerating and more cases than expected would end up in swamped hospitals. Research from Imperial College London warned that, if the government continued with its "mitigation strategy", 250,000 could die.

------

That was the point the UK government fell in line with the WHO with a lockdown and social distancing, but not the recommended "testing, testing, testing" (which one Tory minister said wasn't aimed at developed countries like us, but at third world countries, I kid you not), and a side order of a world of pain about the unavailability of PPE now they'd given the rest of the world a fortnight's head start.

So, straw man, no. UK government policy until this time last month, yes.

>150 Cynfelyn: Yeah, I know. I just didn’t take that approach seriously. Maybe I’m too much of a skeptic.

>150 Cynfelyn: Just to clarify, herd immunity as a matter of policy seems to me almost a desperate choice, one a country would only make when it has given up on any other approach. It is basically saying we will let everyone get sick. Yes, we will restrict the movement of the old. But it seems a very risky proposition to believe that you can carefully isolate a small segment of society. And more people will get sick. Heath care systems are more likely to be overwhelmed. And to do this now, you must add that we know very little about the immunity that could be gained this way. Are people immune after getting Covid-19? For how long? What is the herd immunity threshold for this virus? It’s bound to be very high. 70%? 85%? Without a vaccine, herd immunity with Covid just means most people get sick. That’s not my idea of prevention.

June 2020: The good news is that California Governor Newsom has asked all living prior CA governors to create video Public Service Announcements (PSAs) to endorse and encourage the wearing of face masks by all in public during this pandemic. They all did so, including two Republicans. The LA Times has a news article on those PSAs. That could be an idea with legs.

The bad news is that COVID-19 mortality statistics are now looking more like 5%, per Sanjay Gupta, MD, a neurosurgeon at Emory University in Atlanta, Georgia, just down the road from the US Centers for Disease Control and Prevention (CDC). Dr. Gupta is also a medical news reporter for CNN.

Regarding the above discussion of herd immunity, after seeing six months worth of various news articles on herd immunity, I have drawn two conclusions: 1) It's a worst-case scenario that no one supports anymore (except perhaps the President of Brazil). 2) Whose "herd" are we talking about? Given that we are now seeing astronomically higher incidence rates of disease (and death) in a number of ethnic groups, the whole concept of "herd immunity" is beginning to sound less like anyone's recommended policy and more like ethnic cleansing.

The most reliable source I have seen on COVID-19 news is The Economist magazine. It is a weekly magazine, available on major newsstands. They do their medical and economic homework on COVID-19, and their news coverage on that subject is often insightful in ways that are not seen in other news media.

>153 MaureenRoy: I think that’s great for California to get all living ex-governors on board with masks. Can we get Trump to prevail upon Carter, Clinton, W, and Obama to do the same?

hee, oh I am sure they already do. Trump certainly has nothing to do with masks or anything that isn't all about him

>155 cindydavid4: I forgot the irony emoji

Hee, and I totally forgot my irony glasses :)

>157 cindydavid4: We make a good pair!