COVID-19 Mega thread

[Florida Man for Crime]

So far there are 17 dead with 900 or so reported cases. That comes out to a 1.9% fatality rate so far. Of course, a good deal of the people in those 900 are newer cases who may still die but may not have died yet. So 2% seems like a low end estimate of the fatality rate that is likely to emerge over time, but it is likely to go somewhat higher than that.

The big thing is stopping the spread as soon as possible and buying more time through that for development of antivirals/vaccines.

This is one case where maybe having Trump be President might not be a totally bad thing. He is a germaphobe, right? So that might hopefully motivate him to deal with this properly... The Wuhan quarantine seems prudent, but more may be needed despite apparently fairly low communicability.

Probably the biggest thing to hope for now is that the fairly small #s of cases that have already emerged outside of Wuhan/China can be contained without spreading further and creating other areas with larger numbers of cases in other countries, so that then local containment measures in China/Wuhan can put an end to it.

This is a good source for detailed information/reports - https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus

[Florida Man for Crime]

Since this is Atlas, there have to be maps. And there are... showing locations of confirmed cases and deaths:

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

It looks like it may be more spread around China already than I had thought (without having started paying close attention to news articles).

[Florida Man for Crime]

I actually think that fatality rate is overstated.  What often happens with outbreaks of respiratory illness is that the mild cases never get reported.  That's why swine flu looked really scary at first when it was in Mexico- we just never knew about all the people with mild illness.  Based on the international spread, experts think there have really been thousands of cases- presumably with most of the unknown ones not having been severe enough to merit a doctor's visit.

Good point, there are some estimates that there may in reality be anywhere from 1000 to 9700 cases (including potential milder un-reported ones) so far:

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/

[Florida Man for Crime]

All this panic is an overreaction

You don't want to panic, but this is something that should definitely be treated seriously. More information will make things clearer over the next few days, but at the moment China is now up to 7 cities (all near Wuhan) with 23 million people reportedly under travel restrictions/quasi-quarantine.

https://twitter.com/CNBCTheExchange/status/1220409319839162368

[Florida Man for Crime]

Possible (not confirmed) 2nd case in the USA, in College Station TX. This is seemingly unrelated to the Washington State case, it is a Texas A&M student who had traveled to Wuhan recently.

https://www.wtsp.com/article/news/health/possible-case-of-coronavirus-in-brazos-county-health-department-confirms/67-c0fb43c0-6c58-4011-bc1d-7ccfa329169f

[Florida Man for Crime]

10 people being checked for Coronavirus in Alameda County CA

https://sanfrancisco.cbslocal.com/2020/01/23/10-patients-tested-deadly-coronavirus-alameda-county/

[Florida Man for Crime]

And now in New Jersey (NYC area)

https://www.pix11.com/news/local-news/new-jersey/nj-health-department-investigating-possible-coronavirus-case

[Florida Man for Crime]

Another suspected case in TN from a student at Tennessee Tech with recent travel history (presumably to Wuhan/China)

https://fox17.com/news/local/tennessee-tech-student-undergoing-testing-for-possible-infection-with-coronavirus

[Florida Man for Crime]

It's interesting that everyone is downplaying it compared to Ebola, when Ebola was happening in a very economically isolated part of the world and seems to have required a "spouse" level of physical contact for human to human transmission in a city with indoor plumbing.   If I recall correctly, Ebola was (initially) more likely to kill you than not if you contracted it?  That seems to be the major difference that would make this disease less scary assuming we have accurate information about it?

The threat of ebola was also, in hindsight, exaggerated because it was new, and because the first outbreaks were in countries with health systems ranging from poor to nonexistent. We used to think upwards of 90% of people who contracted ebola would die; the fatality rate now that we've figured out how to treat patients is around 50%, and less than that in developed countries. (The ongoing ebola outbreak in the Democratic Republic of the Congo has a case fatality rate of around 61% — not good, but probably the best you can do given infrastructure and the ongoing conflict in the region.)

Part of it is also that initially, as with any outbreak of a new virus strain, it was not entirely clear just how contagious/transmissable it was (similarly that is not entirely clear at the moment with this Coronavirus strain).

Ebola had been around for many years before 2014, and has always had a very high death rate, so that part was not new - the main reason for concern back then was uncertainty about how transmissable it was.

[Florida Man for Crime]

I do not want this to be the pandemic, but no matter what I post here, the facts cannot be changed. Any objective dispassionate analysis will show there is no comparison between nCov and SARS. See below:

https://twitter.com/LanceAndrews/status/1220523146178191363

The things that you are posting as allegedly being "facts" are not necessarily facts. They tend to be more speculative. It is possible that they might end up being correct, but you seem to be relying on sources that are not the best (in particular tweets from random people without specific expertise), and it is too early to tell for sure what the actual facts are in many cases.

Example 1 of this -

The tweet above that you posted is just from some random person with no apparent qualifications. The idea that it is "Currently spreading much faster than SARS" is simply this guy's interpretation, but is not necessarily correct. He is assuming a number of things, such as that the #s he has are correct. There have been some epidemiologists who have suggested that possibly the current Coronavirus outbreak may have started earlier than reported. That may or may not be true, of course, but if it is, then this random guy's analysis is wrong.



Example 2 of this -

https://twitter.com/Juronaut/status/1220822800300113923

This is only one out of 4-5 or so different studies trying to estimate R_0. The WHO's earlier estimate was 1.4-2.5. The one you posted is the most pessimistic one. Here is a more complete list of studies that have estimated R_0 (there may be more since this was posted, also note this tweet is actually from an epidemiologist, not from some random dude):

https://twitter.com/C_Althaus/status/1220723566272045057

Various analyses highlighting potential for sustained human-to-human transmission of #nCoV2019. Current 'estimates' of R0:

- @JulRiou & @C_Althaus: 2.2 (90% interval: 1.4-3.8)
- @JonRead et al.: 3.8 (95% interval: 3.6-4.0)
- @maiamajumder & @mandl: 2.0-3.3
- @nextstrain: 1.5-3.5

So 3.8 could be correct (and indeed, if it is that high have very good reason to seriously worry), but it may well be an overestimate.



Also, the tweet you posted about the JonRead study misrepresents its findings. The actual mean estimate (if R_0 is really 3.8) is 190k cases by Feb 4 in Wuhan, not 250k. That is because the distribution is not normal (due to the exponential growth pattern in viruses spreading). The tweet incorrectly just assumes that the mean is the midpoint between the two sides of the confidence interval. Why does it incorrectly assume that? Partly because the guy who wrote the tweet is just some random guy - who does seem to be intelligent, but not something with particular knowledge relating to epidemiology and who apparently didn't really read the paper other than maybe skimming it, and simply assumed that there was a normal distribution without considering whether that assumption was appropriate.

[Florida Man for Crime]

Can we get some direction from the mods as to whether we should be posting here or in the International Discussion thread? I have been posting there mostly, but it seems like most posts have gone here (despite much of the discussion in this thread being about China).

[Florida Man for Crime]

In 2018, Trump apparently disbanded the National Security Council team that was responsible for leading the US response to pandemics...

Top White House official in charge of pandemic response exits abruptly

The top White House official responsible for leading the U.S. response in the event of a deadly pandemic has left the administration, and the global health security team he oversaw has been disbanded under a reorganization by national security adviser John Bolton.

The abrupt departure of Rear Adm. Timothy Ziemer from the National Security Council means no senior administration official is now focused solely on global health security. Ziemer’s departure, along with the breakup of his team, comes at a time when many experts say the country is already underprepared for the increasing risks of a pandemic or bioterrorism attack.

Ziemer’s last day was Tuesday, the same day a new Ebola outbreak was declared in Congo. He is not being replaced.

...

The personnel changes, which Morrison and others characterize as a downgrading of global health security, are part of Bolton’s previously announced plans to streamline the NSC. Two members of Ziemer's team have been merged into a unit in charge of weapons of mass destruction, and another official's position is now part of a unit responsible for international organizations. White House homeland security adviser Tom Bossert, who had called for a comprehensive biodefense strategy against pandemics and biological attacks, is out completely. He left the day after Bolton took over last month.

So if the US response turns out not to be well-coordinated, well, this may have something to do with it...

[Florida Man for Crime]

CDC reports no new cases since last update, 110 individuals being screened in the meantime  

Seems like the authorities have this under control, we can all calm down.

The realistic concern is not so much the immediate future, but the longer term over the next weeks and perhaps months. Of course there is very little immediate danger to people in the USA, but that is obviously not the point.

Beet is of course being a (counter-productively) total idiot about this, but that doesn't mean that this is not a serious concern. Suppose that it turns out to have even just a 0.1% fatality rate. During the 2009 pandemic, an estimated 59 million people just in the USA contracted H1N1. If this were to spread (over a period of months) to 59 million people with a 0.1% fatality rate, that works out to 59,000 dead in the USA alone. That alone is significant, and unless I am missing something it is quite plausible still that the death rate could be an order of magnitude or so higher than that (perhaps also a bit more), and also that it could spread to more than ~18% of the population (which is approximately what 59 million is). IE suppose that 150 million people (a bit less than half the US population) contract it and it has a CFR of 1%. That is 1.5 million dead in the USA alone, and obviously many millions more across the world.

As far as I can see, that is the real concern, not so much Beet's deliberate sensationalizing about a 100% case fatality rate.

[Florida Man for Crime]

https://twitter.com/alexandraphelan/status/1221859547918110720

This is a pretty important error correction in the WHO Situation Report released last night. The past 3 Sit Reps had global risk as "moderate" in error, when it should have been "high".

https://twitter.com/alexandraphelan/status/1221859547918110720

(OK, I guess I will start posting about the international stuff in this thread, since this seems to be where everyone is and nobody is paying attention to the international discussion thread)

[Florida Man for Crime]

The new case (newly reported this morning USA time) in Germany is human-to-human transmission from someone who was asymptomatic and didn't even know they were sick:

https://www.theguardian.com/science/live/2020/jan/28/coronavirus-first-death-in-beijing-as-us-issues-new-china-travel-warning-live-updates

A German man who tested positive for the strain of coronavirus sweeping across China was infected by a work colleague, officials said on Tuesday, in what is believed to be the first human transmission in Europe, AFP reports.

The man had not visited China but a Chinese work colleague who was in Germany last week had started to feel sick on the flight home on 23 January, said Andreas Zapf, the head of the Bavarian state office for health and food safety.

He had attended a training session given by his Chinese colleague on 21 January at the office of a car parts supplier Webasto in Stockdorf in Bavaria and tested positive for the virus on Monday evening. Unlike the other patients, the 33-year-old had not recently travelled to China.

So the Chinese person who had the got the virus in China, flew to Europe without showing any symptoms, infected someone in Europe, still without showing any symptoms or feeling sick, and then only started to feel sick and show symptoms 2 days later, when they were not even in Germany any more and were on a plane flying back to China (possibly infecting others on the plane, of course).

This seems like undeniable human-to-human asymptomatic transmission from someone who was still in the incubation period. And since this occurred in Germany, it can't really be written off as "maybe it is just a false report from China" or "maybe they got it from someone else who did actually show symptoms."

This being the case, does anyone see any possible way that this could plausibly be contained??? It seems like a sure thing that this will spread around the whole world now, just a matter of time.

Hell, you can still buy plane tickets (look on google flights or wherever you buy plane tickets) from Wuhan to the USA (and elsewhere), not to mention from the rest of China (where there are also cases) to the USA and everywhere else in the world.

Right now on google flights I am looking and you can buy a ticket from Wuhan to Los Angeles leaving tomorrow (Jan 29) for $1271. Or to New York for the same $1271. These are not good tickets (2 stops and takes a long time), but they are tickets. Or to Tokyo for $650. The only thing that is closed down are DIRECT international flights from Wuhan to other places, but you can still easily take a flight from Wuhan to anywhere else in China, and then from there to anywhere in the world.

Given the case in Germany, how can it plausibly not be the case that quite a few people who have the virus but are still in the incubation stage, or don't feel sick yet and don't have a fever yet, DON'T spread all over the world with that, and then infect other people without realizing it? At this stage it will also start being people from random parts of China also, not just from Wuhan.

I am not trying to be alarmist here (like Beet), but just trying to look at the facts - and I don't see how it can possibly not spread globally as long as this is the case. That seems to render to quarantine measures that have been put in place for road/train/etc travel fairly meaningless, except as something to slow the spread a bit (but not actually turn it back).

Is there anything I am missing here? Seriously, someone please correct this - show me that this is somehow wrong, I would LOVE to know that the above is somehow incorrect!!!!!!


- edit - just to clarify, I am not trying to say that all flights should necessarily be canceled or that that would help other than to slow it down. If it can be transmitted asymptomatically/while in the incubation period, it seems like it would eventually spread everywhere anyway regardless.

[Florida Man for Crime]

The Chinese lady who visited Germany and was asymptomatic until on her flight back to China apparently infected at least 4 people, not just 1.

https://twitter.com/HelenBranswell/status/1222274139618185216

The #2019nCoV count in Germany is up to 4 now, all stemming from the visit by a Chinese woman who worked for a German car parts supplier. She reportedly only became symptomatic on her flight back to China.

It was hoped that maybe people who were still in the incubation phase/were asymptomatic would not be good carriers - and while they might infect 1 person occasionally, they wouldn't infect many (in which case, maybe the virus could be stamped out more easily).

If this report of the additional infections in Germany is correct though, it looks like that is probably not the case, and asymptomatic people CAN transmit the virus fairly efficiently. That would seem to be quite bad news for any remaining hopes of containing this over the longer run. While it may be slowed down in places by preventative measures, over a period of months, how does this not spread everywhere? Particularly if/when it gets going in places like India and in Africa where resources to counter it are lacking.

[Florida Man for Crime]

I'll be honest- I think I was a little too optimistic last week about this thing.  I think I said that the worst-case scenario would be roughly a repeat of swine flu from 2009, but I'm starting to think that "swine flu 2.0" might actually be our best case scenario.  The big thing that changed was that this appears to be legitimately contagious for at least part of the incubation period.  I still don't expect a pandemic as severe as Beet fears, but I could see this spreading worldwide and infecting hundreds of millions of people- perhaps even north of a billion people.  I don't think it's super deadly, so I think the worst case scenario is probably 1% of the world dying, which would still be a tragedy that very few of us have seen in our lifetimes.

That seems about right to me at this point, I agree the plausible range seems to be probably something between 2009 swine flu and 1% of the global population dying, although possibly it could be a bit more - depends on what exactly the fatality rate is and what % of the population gets infected.

As more confirmed cases are coming in, it seems like the fatality ratio is ever so slightly lower - 131/5572 = 2.35%. Hopefully there are lots and lots of un-confirmed cases, which would push the actual ratio lower. On the other hand the reported # confirmed leads the reported # of fatalities because people who die don't all die immediately. Some whose cases were confirmed will die over the next days and weeks, but are not counted as amongst the dead yet. How much the fatality rate goes down (it does seem more likely to go down than up) depends on which of those effects are stronger and by how much.

Just for reference, 1% of the world's population hypothetically dying is 78 million people. That is in the general range of how many people died in World War 2... Or even if it were half or 1/10 of that, that is still quite a lot of dead.

[Florida Man for Crime]

The vast majority of cases in the west are stable and recovering. Except for a case in France where an 80 year old man is in severe condition. That seems like a precursor for whats to come sadly. The elderly and people with compromised immune systems will be the ones who will face the worst of this.

Edit: Im still hopeful this will sort itself soon. But always a good idea to be prepared.

However, the cases in the west/outside of China are also newer - on average the people outside of China that are infected got it later. So while most in the west are stable now, they may get worse. Also cases outside of China are likely to be demographically biased - towards people that are either capable of traveling to other countries themselves, or else to people who socio-economically associate with travelers (so likely to be better off economically and in better than average health).

And they will have tended to have received good medical care right away, which is probably not the case in China now for a great many and definitely will not be the case across the 3rd world if it gets going in places like Africa. And might also not be the case later even in the 1st world if the medical system gets overwhelmed.

It does seem pretty clear that it will primarily affect the old and people with various pre-existing conditions. For that reason I am not all that worried about myself personally. But I am worried especially for others.

[Florida Man for Crime]

Regarding the conspiracy theory that it is a bio-weapon:

https://twitter.com/EBKania/status/1222621133163433985

As @NarangVipin has highlighted, a good bioweapon “in theory has high lethality but low, not [high], communicability.”

Whereas the virus likely doesn't have those characteristics (if anything probably in the opposite directions on both counts).

[Florida Man for Crime]

It's refreshing to have an epidemic where the only two inhabited continents to not have any confirmed cases are Africa and South America.

That is not on pace to last very long, so enjoy it while it lasts.

[Florida Man for Crime]

Japan confirms infections without symptoms

Japan's health ministry officials have confirmed the first two cases of coronavirus infection without any symptoms in the country. They say the cases without signs of infection are the first to be made public outside of China.

...

A man in his 40s and a woman in her 50s do not have any signs of infection, but they have tested positive.

Another man in his 50s reported pain in his throat and later developed a fever before testing positive.

[Florida Man for Crime]

Details on the asymptomatic transmission which occurred in Germany -

https://www.nejm.org/doi/full/10.1056/NEJMc2001468

This case of 2019-nCoV infection was diagnosed in Germany and transmitted outside of Asia. However, it is notable that the infection appears to have been transmitted during the incubation period of the index patient, in whom the illness was brief and nonspecific.3

The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak. In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery. Yet, the viability of 2019-nCoV detected on qRT-PCR in this patient remains to be proved by means of viral culture.

Despite these concerns, all four patients who were seen in Munich have had mild cases and were hospitalized primarily for public health purposes. Since hospital capacities are limited — in particular, given the concurrent peak of the influenza season in the northern hemisphere — research is needed to determine whether such patients can be treated with appropriate guidance and oversight outside the hospital.

[Florida Man for Crime]

And now we learn that the asymptomatic lady who visited Germany apparently infected at least 5 people, not just 4. All without realizing she had it.

https://afludiary.blogspot.com/2020/01/germany-confirms-5th-locally-acquired.html

One wonders how many other such people might be infected and asymptomatic, but nevertheless spreading the virus in other locations and have not been detected yet. And if this single person could infect 5 in Germany, how many are other possible asymptomatic carriers in other places spreading it to?

110 others are being tested related to this cluster in Germany, so there may be more on the way.

[Florida Man for Crime]

A deadly virus with high infectivity and no known cure is not being “blown out of proportion.” I bet within a month, this post will look terrible.

Isn't this also true of the flu?

Supposing that this ends up like the flu, a persistent virus that spreads every year and kills many thousands globally, that would be very bad by itself.

It is realistically possible that it could be worse than that, however. It may not be, but it might be, it seems to be still too early to tell how this will go reliably (in particular with regards to the fatality rate, though at least to me the evidence on contagiousness appears to be at least somewhat clearer).

[Florida Man for Crime]

First two cases of coronavirus confirmed in the UK. Turns out the Yorkshire alert I posted about yesterday (below) was real, and a married Chinese couple have tested positive.

Viral outbreak on the same day as Brexit. Fabulous timing.