Coronavirus

[SMAlset]

I thought this was an interesting article on a link to pangolins and coronaviruses and possible connection to the Wuhan market. Had no idea what a pangolin was either until I looked it up. Sort of scaled anteater, but reminds me of armadillo.

Coronaviruses Similar to The COVID-19 One Have Just Been Found in Pangolins

 

[wdolson]

You solve the latency problem through contact tracing. You test everyone that person has been in contact with. You don't have to be 100% successful, you only have to make sure that each case results in less than one new case and the virus will die out. Is it possible? It seems to be working in Korea. Combine it with social distancing and other measures and maybe it will work here.
The first phase of a vaccine trial has started so there is hope.

In some cases you can contact trace, but the virus can live for up to three days on metal and plastic surfaces and 24 hours on cardboard. It also has an incubation period up to 14 days in which the person is contagious. The Germans found people who were asymptomatic in at least some cases were more contagious than people who were sick.

To contact trace you'd have to find everything the person touched from the time they were infected. Did the person cough or sneeze in public during that time? Who was present? I have been home a lot the last 14 days and I've been careful about what I did touch and I still can't give you a list of every surface I touched outside of home.

Even if you could get a complete list of everywhere the person has been the last 14 days and what they've touched, how do you find out who touched the surfaces they touched afterwards? If they sneezed or coughed in a public place, how do you find who shared that airspace while droplets may have still been in the air?

With diseases with limited vectors like an STD, contact tracing can work well, but with this it becomes useless after a few cases. You end up with a grid of spaghetti and a lot of question marks.

I don't think we are going back to the good old ways anytime soon.

IMO this current era was always going to be an era of rapid change, the virus has kick-started that.. but i bet a lot of what happens over the next decade was going to happen anyway

Companies will not want to expose themselves to lawsuits by exposing employees to unnecessary risk...

Outside of work, socialising is at your own risk.... that is an individual decision...

In 12-18 months we probably have a vaccine and things start returning to normal, but my bet is the following changes linger on in a permanent fashion:-

• temp checks at all borders and possibly at airlines before boarding flights.
• fewer meetings more video conferencing
• more working from home..
• more emphasis on hygiene and distancing at work..
• many fewer cruise trips..
• fewer work lunches, balls, parties.

In simple terms companies may consider socialising is a risky activity which is best done when they are not legally responsible.

As @Daniel in SD said there are many people who have it but never have a temperature. The only way to be completely sure if someone has it is to test for active virus instead of just taking temperature. Just testing for temperature will lead to false negatives.

And people aren't socializing at their own risk, they are socializing at the risk of everyone they come in contact with for weeks after socializing, including people who touch the same doorknob within 3 days of their using it. A lot of people don't get symptoms or only get mild symptoms, so they aren't socializing at their own risk, they are putting everyone else in danger.

There are a few viruses easier to spread than this one, but this spreads super easy. MERS and SARS were easy to shut down because they don't spread as easily.

We need to get out of the libertarian mindset that everyone is an island completely responsible for themselves. Your odds of surviving this may be extremely high, you may only get a mild case (likely for younger people in good health), but if you're healthy but contagious you are ticking time bomb with everyone who crosses your path. In a big epidemic outbreak it becomes impossible to trace, so you will never know who you infected, but what if you found out you gave 10 people the disease that killed them? You were fine, but 10 people are now dead because of your carelessness.

It's about all of us, not just us independently. If too many people are reckless and infect too many others in too short a time span, hospital systems break down and a lot of people die. That's what we're dealing with.

 

[jerry33]

you seem to be using the phrase comp time differently than I would.

we have no vacation time, we have no sick time, we have only comp time. I'm not even sure what you are comping for if it's "same week": same week as what? Every week is a week.

Same week means the same week in which you worked the overtime (which is how you get comp time).

 

[jerry33]

Companies will not want to expose themselves to lawsuits by exposing employees to unnecessary risk....

This is what will probably produce the most results, but there needs to be a few real cases (that are not overturned by the Supreme Court, which will almost certainly favour the corporation over the employee) to show that corporations need to take this seriously.

temp checks at all borders and possibly at airlines before boarding flights

Will work for a few months until people forget and demand relaxing of the rules.

fewer meetings more video conferencing

Not unless upper management completely changes. I'm not hopeful.

more working from home

Not unless middle management completely changes. I'm not hopeful about this either.

more emphasis on hygiene and distancing at work

Will work for a few months until people forget (A few people won't forget, but if it's similar to my extended family, only one person who lived through the 1918 flu kept the practice out of thirty.)

many fewer cruise trips

This will almost certainly happen. It will probably last a good ten years.

fewer work lunches, balls, parties

In the twenty years I worked for the previous company there were two of these events and they were closer to the beginning of the twenty years.

The video conferencing and working from home have been practical for decades, but there is always management push to eliminate them because the majority of managers believe work-at-home is equivalent to not-working, regardless of the many studies that have proven otherwise. I believe the real reason for this is that when there is work-from-home the manager really is only a coordinator, which means there's almost no need for a manager, certainly not at the one manager per six employee level that corporations seem to favour.

 

[jbcarioca]

In the '70s I spent a few days in a small town named Osvaldo Cruz in Sao Paulo state. Is there a connection to the good doctor?

Looks like yesterday's low counts in WA were an aberration or data collection problem. King County +218 today and Snohomish looks to be +130-ish. Deaths +16 representing 12% growth.

In a tiny way yes, they are related. Osvaldo Cruz changed its name from California to the present one in homenagem to Cruz, according to the Wiki. FWIW, Oswaldo Cruz started in his post MD work with Louis Pasteur working on developing the germ theory. he subsequently did pioneering work in epidemiology and disease vectors that paralleled the work being done in Europe by, mostly, other Pasteur-influenced people. We have that group of pioneers to thank for the present state of immunology, epidemiology, parasitology and numerous other related disciplines.

Lucky for me one of the most thoughtful people I ever met taught History of Science. He devoutly believed that "those who fail to learn the lessons of history are doomed to repeat them". I wonder how many times the world must endure one epidemic after another and still so relentless ignore being prepared. Just now I am feeling reflective as so many world leaders are so disastrously ignoring facts.

The genius President Bolsonaro has declared churches as 'essential services' and is encouraging people to gather together in churches to pray. Thus far few people have heeded him, but the weekend is coming.

Lest we forget: spread from Wuhan to South Korea came through a huge religious convention. The first large breakout near New York City happened within an insular religious community. Major parts of outbreaks in Italy and Spain happened with religious gatherings in retirement communities. For at least 130 years we have known that communicable disease spread most efficiently within large closely packed groups. Social distancing works. Now we have at least two Presidents pretending that religious gatherings are self-protective or protected by their diety.

Decades ago I was in Banares (Varansi) looking at the funeral pyres and assorted pollutants in the Ganges. My devout friend told me none fo those pollutants could affect people because the river was a holy river thus was purified.

Denial of the seriousness and spread of this virus is no different. People are happy to deny truth if they disbelieve in science. Today more and more influential people disbelieve in science. The world is paying a high price for willful ignorance.

end rant.

 

[1208]

Coronavirus: Boris Johnson tests positive for COVID-19

 

[jbcarioca]

That’s fake news. You assume every single person in the country would get the virus and there’d be a 5% death rate? You must watch cable news all day

Not fake news. If we intend to know the consequences of inaction we must model the effects. Such numbers are NOT expected. They are the probable effects of total inaction. Nobody expects taht to happen.

Every serious person will understand that when we consider the astronomical costs of containment, we all need to understand the effects of the alternatives. Obviously, no sane person wants to halt social distancing before the outbreak has been contained.

There are many political leaders who do not understand science nor statistics and disbelieve what their own specialists tell them. There are severe consequences of stopping before the outbreak has been contained. One fo teh disbelievers, Boris Johnson, is now infected.

Perhaps I am influenced overmuch by my own participation in epidemiology. Many diseases are close to containment when funding and policies are lifted and victory declared. A short time later more virulent versions come roaring back. Check out the 1918 flu epidemic, the one that killed Donald Trumps grandfather, for a good example.

How I long for somebody like Dwight Eisenhower. He was not perfect, but he was pragmatic and relentlessly devoted to rational thought based on science.

 

[cusetownusa]

I'm talking about how many individual people a single passenger is next to over the course of cruise. I've never been on a cruise, maybe it's even worse than I imagine.
For one person to spread it to 696 people makes it seem pretty contagious. I don't know of any other explanation for the exponential growth in deaths we're seeing (positive test results can obviously be influenced by many factors). Is there some new conspiracy theory I'm not aware of?

was the spread attributed to just 1 person bringing it onboard?

 

[jbcarioca]

Details details details

You going to tell people that she was visiting her son from Bulgaria and wasn't a citizen?

Just saying, important tid-bit of information there.

Once again, sir, you're conflating a political view with a pragmatic epidemiological view. A virus does not distinguish based on visa status, citizenship or health plan eligibility they're not smart enough to do that. As a result smart people, regardless of political view, will treat anybody at all who has the disease, even if they object morally to treating people who cannot pay. After all, even illegals can spread a communicable disease.

You, sir, ought to know better than to draw such a distinction. That is not to say the current US administration would act rationally.

 

[Mich]

Coronavirus: Boris Johnson tests positive for COVID-19

I think it is ok to rate this as funny.

 

[jhm]

I think it is ok to rate this as funny.

No. This is funny.

 

[EinSV]

I'll admit I don't get all the fixation about IFR and CFR estimates around here, but I do like to look at data. So I'll lean back in my comfy armchair and post at chart.

View attachment 526301

I do really like that this chart is in units of deaths per million inhabitants (DPM). It might just give us some perspective on what a 0.1% IFR might look like.

Notice that Italy continues to lead the world on deaths per capita. Italy is currently at 136 DPM, ant it is still climbing. Eyeballing it, it looks to me that ultimate deaths could 200 to 500 DPM.

How does this line up with the IFR estimate from Iceland? Well, at the low end 0.05% IFR gives you 500 DPM if the the whole population is infected. So keeping deaths below 500 DPM while IFR is as small as 0.05% would suggest limiting the infection rate is pretty important.

I'm not so much making a scientific point here, but asking more of a humanities question. What would it really mean for Italy to watch their death rate climb to 500 DPM or 0.05% of population? Italy has a population of about 60M. 136DPM is already 8200 deaths, but imagine going to 30,000. Now if at the upper end is a IFR of 0.14%, this would expose the possibility of Italy facing nearly 84,000 deaths at 100% infection. No doubt we are talking about a devastating scale of societal trauma. I see no comfort in an IFR as low as this. It is still devastating at pretty much any infection rate. We can appreciate why shutting down the economy is necessary to minimize infection. Ultimately infection rate will likely land in range of 40% to 80%. Maybe that's inevitable, but it can be stretched out over the next 18 months. Slowing down the infection rate is the only way to normalize this. It would at least give the people time to bury their dead

I hate to say it but as far as I can tell with the current death rate and trajectory in Italy a fatality rate in the range of 200-500 DPM in the relatively short term is a near certainty. It could even be higher with the hospitals completely overwhelmed in some areas. The only thing I can see that will stop that is some miraculous treatment breakthrough in the very short term, which seems highly unlikely. One crude model I posted recently estimated that deaths in Italy would be in the range of 25000-32000, which would put the DPM at the high end of your range, and it is not clear this model adequately factors in the added fatalities from an overwhelmed medical system. https://www.medrxiv.org/content/10.1101/2020.03.25.20041475v1.full.pdf

I would appreciate your thoughts about this as I have great respect for your modeling, and I'm basically spitballing here.

The reason I am interested in IFR and/or serological testing is to have some sense of where we will be in different parts of the world after social distancing and other policies have taken effect and the virus is under control at least temporarily. Will 50% of the population already be exposed and herd immunity in effect, or will we barely be scratching the surface with only 1-5% exposed? That's a critical question and we don't seem to have a clue.

One of the problems with deciding how to tackle this virus or plan for it is that almost all of the attention is focused on the short term (understandable in a crisis but still a problem). We lack the most basic information necessary to predict how things will play out in the medium to long term. If we tamp it down in the next couple months in the Northern hemisphere, is it going to come roaring back with equal or greater force after we lift restrictions, or next winter (assuming it is temperature sensitive -- IMO probably yes but another issue where the jury still seems to be out).

 

[mikevbf]

Here is a summary of NewYork-Presbyterian Hospital's update from yesterday:

General:
-Yesterday 1000, today 1,100, 236 require ventilator support

-Less than optimal positions on PPE

-We have about 200 ventilators available, and 250 anesthesia machines so for the time being we are ok, but there is a crunch


Clinical updates:

-Our current strategy for testing is to focus on the sickest patients


-Antibody tests eventually will be in wide circulation for after you have had COVID

-There is no longer quarantine post travel. It is all about symptoms now. As soon as you experience symptoms stay home, wear a mask if you have one to protect your co-habitants, and call NYP on demand


PPE:

-Looking at mask sources where we can get high throughput

-Now we are happy to say we have a larger supply of surgical masks, and we now feel we have enough of these to provide to our healthcare workers to provide one everyone so that anytime you are on the premises at work around other people you can wear the surgical mask so that you can work safely. Throughout the course of the day, if you are in the hospital or in clinical areas we want everyone to move to surgical masks ON. If you are alone in your office no need to wear it. If you’re eating, eat in a space where you are socially distanced.

-Within the next 24-36 hours we will give everyone who is involved in direct care ONE N95. The concept of this is real conservation. The first set of face shields didn’t work out perfectly, so we are getting them ready for circulation. An N95 mask can be conserved with a surgical mask or face shield over it. Our guidance remains the same: prioritize N95 for aerosol generating procedures.

 

[jhm]

Let's play Armchair Epidemiologist.

On what day will the US cross the 10 deaths per million inhabitants? (To be precise, 3310 deaths as published here https://www.washingtonpost.com/graphics/2020/world/mapping-spread-new-coronavirus/)

Post your guesses.

My guess is March 31.

 

[Dr. J]

Let's play Armchair Epidemiologist.

On what day will the US cross the 10 deaths per million inhabitants? (To be precise, 3310 deaths as published here https://www.washingtonpost.com/graphics/2020/world/mapping-spread-new-coronavirus/)

Post your guesses.

My guess is March 31.

April 1.

 

[EinSV]

.

Let's play Armchair Epidemiologist.

On what day will the US cross the 10 deaths per million inhabitants? (To be precise, 3310 deaths as published here https://www.washingtonpost.com/graphics/2020/world/mapping-spread-new-coronavirus/)

Post your guesses.

My guess is March 31.

March 30.

 

[jbcarioca]

In that picture you're only right next to 5 people. This isn't the zombie apocalypse, it takes a week to be contagious.

No!! It does NOT '...atke a week to be contagious". The gestation period varies from <one day to ~three weeks. The fourteen day is arbitrary; after all there must be a convention for such rules, and outliers will happen in any rule at all.

For example (anecdotes are useful only to indication possibilities, nothing more): Three of my relatives were at a wedding two weeks ago. All three acquired COVID-19 and all three were diagnosed the day after the wedding. They all had significant symptoms after only a day. There was a confluence of events in this case, but the material one os that the three in question are both wealthy and influential. Further one of them was a major donor to a large hospital in their city. Surprise, they all were diagnosed almost instantly, tested with results in only 24 hours.

Now imagine how many people have similar rapid onset but are not so lucky to have superior medical care at their beck and call? yes, almost everyone.

So, we only know that the gestation period is highly variable, that serious symptoms are correlated highly with co-morbidities and that very old people are more at risk. Bluntly, that means it is a communicable disease, not really much more, because these issues are common to many diseases.

It seems that young people are less susceptible to COVID-19. Nobody knows about SARS-CoV-2. Symptomless does NOT mean inability to transmit.

Until extensive testing takes place with statistically valid sampling (universal testing is unneeded for this purpose) we will not know what actual distribution of the virus actually is.

AFAIK, there are only two cases of extensive testing to give us clues. On in Iceland and the other in Vò,
Scientists say mass tests in Italian town have halted Covid-19 there
The Icelandic case is probably the more interesting, done by these people:
NEWS & EVENTS
but even there problems happen:
Iceland Slows COVID-19 Testing Due to Shortage of Swabs
and their results have limitations:
Iceland’s Extensive COVID-19 Screenings Indicate Virus Is Not Yet Widespread

So, we have a guess from all this that probably half or so of carriers are non-symptomatic. If that is true, and if those non-symptomatic people still can transmit the virus, R-naught would be expected to rise substantially.

The world is desperate to make reliable and valid forecasts. That is not possible today. There are only informed guesses. in the face of these questions it seems to me that aggressive social distancing is the only rational response.

Once we have reliable treatment,
Once we know the probability of permanent heart and/or lung damage from teh infections,
Once we know how to achieve effective immunization,

Then we can resume life as we have known it, hopefully having learned a great deal about the world as it is evolving. There will be more epidemics on their way, so maybe we'll prepare better.
Finally, the political debate about socialized medicine has no place in epidemics. In those, treat and protect all human beings. That is the only way. national governments and international institutions are necessary if the next time is not to be worse.

 

[Causalien]

Coronavirus: Boris Johnson tests positive for COVID-19

Meanwhile Putin, the tough SOB is walking around in full hazmat.

 

[bkp_duke]

Once again, sir, you're conflating a political view with a pragmatic epidemiological view. A virus does not distinguish based on visa status, citizenship or health plan eligibility they're not smart enough to do that. As a result smart people, regardless of political view, will treat anybody at all who has the disease, even if they object morally to treating people who cannot pay. After all, even illegals can spread a communicable disease.

You, sir, ought to know better than to draw such a distinction. That is not to say the current US administration would act rationally.

Actually, the user that posted that is well-known for advocating for very socialistic policies. That's fine, that's his right, but they are "pie in the sky" ideas with no real rational thought put forward on how to pay for them.

The title he posted was essentially click bait, and it IS a very important consideration for how something will be paid for and changes the discussion considerably.

There are VERY few countries that if I, as a US citizen, go to and get sick that they will pay for my healthcare. That's just a fact of how our world works.

Politically, we are having enough problems figuring out how to pay for US citizens healthcare. And while I sympathize with the plight of a visitor getting sick and needing care, I do believe that if they are going to visit, they should have the forethought to purchase temporary insurance to cover the potentiality of getting sick here.

 

[TheTalkingMule]

Denial of the seriousness and spread of this virus is no different. People are happy to deny truth if they disbelieve in science. Today more and more influential people disbelieve in science. The world is paying a high price for willful ignorance.

A ray of hope I'm seeing is the liberal community has now taken the denier role in American society. Trump's moronic denial if urgency has created a massive liberal reaction very similar to the act of voting for Trump.

We've shut down the entire nation (which I'm 100% FINE with) with no real scientific indication it's anywhere near a net positive health policy. There was no real push to go down the path of testing and isolation that was not only recommended strongly by the WHO, but was extremely successful in other countries. We're basing policy on a doomsday scenario that was never real

If you think of a Trump voter as a person who's thrown up their hands and sat down in the middle of the path, you could draw a pretty good parallel to left leaning America right now.

I take that as a good indicator we're moving toward a time of greater understanding and cooperation. Though I'm an irrational optimist.