Coronavirus

[Garlands]

Note that this revision of the case fatality rate down to 0.94% is consistent with the non-Hubei CFR ratio calculated in the WHO's latest report:

https://www.who.int/docs/default-so...na-joint-mission-on-covid-19-final-report.pdf

View attachment 516736

"As of 20 February, 2114 of the 55,924 laboratory confirmed cases have died (crude fatality ratio[CFR2]3.8%)(note: at least some of whom were identified using a case definition that included pulmonary disease). The overall CFR varies by location and intensity of transmission (i.e. 5.8%in Wuhan vs. 0.7%in other areas in China). In China, the overall CFR was higher in the early stages of the outbreak (17.3% for cases with symptom onset from 1-10 January) and has reduced over time to 0.7% for patients with symptom onset after 1 February (Figure 4). The Joint Mission noted that the standard of care has evolved over the course of the outbreak."
​

(Emphasis added.)

This estimate is in line with the mortality rate estimates I gave in the investor thread before I saw this report, but maybe some people will believe me more if they see the same figure in a WHO report.

Note that the 0.7% estimate is subject to both downward and upward biases - but my guess would be that there's still a significant upward bias in the mortality rate, because it's in the very best interest of mild cases to attempt to sit it out at home instead of subjecting themselves to weeks of quarantine and potential negative social stigma.

At this point it appears likely that while the coronavirus is more serious than regular flu which has an average mortality rate of 0.13%, the 0.70% figure and the much lower hospitalization rates are certainly much better than early estimates.

There's of course no telling how the markets will react to this next week - they might continue freaking out, or they might get greedy at the Fed news and at the improving stats of the coronavirus.

note that the end of the summary in this paper they stated:

(Paragraph revised 18 Feb.) With combined evidence about transmissibility and severity, as viewed through CDC’s Novel Framework for Assessing Epidemiologic Effects of Influenza Epidemics and Pandemics (Reed et al 2013), evidence to date points toward 2019-nCoV having the potential to have comparable severity to the 1918 flu pandemic in the absence of effective control and treatment, when averaged across all ages.

 

[mrdoubleb]

The CDC is right that this will eventually prove uncontainable. But there will be a lull in the summer months that I’m worried will lead to a false sense of security. There’s a reason they call winter “flu season” - that’s when these diseases spike every year, due more to changes in human behavior rather than any changes in the environment itself. Transmission will fall in the warmer months just like it will for good ol’ influenza. When influenza picks up again in the late fall, so will COVID-19. By that time, Dear Leader will have claimed total and absolute victory the likes of which has never been seen before. Which will probably help his re-election chances among the uneducated sheeple that voted for him the first time. And our society’s response will have been hamstrung by a false sense of security.

I get the flu shot every year (free perk at my company, so why not?) and for some time now it has H1N1 by default. Last fall they gave me Vaxigrip, which had H1N1, H3N2, both which belong to the type "A" strain and it had 2 of the "B" strains as well. End of this year i fully expect COVID-19 will be added if possible. If not, we'll get it as a separate shot - no big deal.

 

[mrdoubleb]

Not sure if this was captured here and does not mean a successful vaccine is ready just yet, but this is encouraging:
"Moderna Therapeutics, a biotech company based in Cambridge, Mass., has shipped the first batches of its COVID-19 vaccine. The vaccine was created just 42 days after the genetic sequence of the COVID_19 virus... Moderna’s vaccine against COVID-19 was developed in record time because it’s based on a relatively new genetic method that does not require growing huge amounts of virus. Instead, the vaccine is packed with mRNA, the genetic material that comes from DNA and makes proteins. Moderna loads its vaccine with mRNA that codes for the right coronavirus proteins which then get injected into the body. Immune cells in the lymph nodes can process that mRNA and start making the protein in just the right way for other immune cells to recognize and mark them for destruction.

As Dr. Stephen Hoge, president of Moderna, told TIME earlier this month, “mRNA is really like a software molecule in biology. So our vaccine is like the software program to the body, which then goes and makes the [viral] proteins that can generate an immune response.” That means that this vaccine method can be scaled up quickly, saving critical time when a new disease like COVID-19 emerges and starts infecting tens of thousands of people."

Source is The Time (Feb. 25), so hopefully that still stands for something.

 

[SageBrush]

Source is The Time (Feb. 25), so hopefully that still stands for something.

It doesn't.

mRNA vaccines have been thought to be the future of vaccination for decades but the results have been disappointing for many reasons. This time could be different of course but a secret sauce or a paradigm shift is needed. FWIW, mRNA vaccination is quite clever as an idea since it tries to co-opt the virus playbook of using host machinery

This wikipedia article on antigen presenting cells (APC) is a nice introduction. mRNA vaccination presumes that an APC will take up the mRNA, transcribe and process it to quarternary protein identical to (or similar enough) to wild type, and then present the protein in an MHC complex on its cell surface for presentation to other immune system cell types.

My personal opinion is that mRNA vaccination runs counter to the evolution of the immune system designed to identify and process foreign protein. I presume that mRNA is taken up to some degrees by mammalian cells and some of it is transcribed, but those proteins do not get the post-transcription processing that would occur in a virus infected cell and the natural history of immunization to newly produced virus does not take place.

 

[hobbes]

Daily graphs:

• France is rising; Germany is declining. They're still just offshoots of Italy, but there is some local transmission component.

Germany is not declining, there is something wrong with your data. This is data from WHO (via COVID-19-Fälle in Deutschland – Wikipedia):

IMHO it would make sense to only call a decline if that happens for a moving average over a few days or even a week.

Also, do you have source for cases in Germany being an "offshoot of Italy"? AFAIK the first cases in Bavaria were traced back to a Chinese business person visiting. Most of the new cases can be traced back to an event in the state of Northrhine-Westfalia where one person infected quite a few others. However, for him it is still unclear where he got infected in first place. Only a few have been linked to being infected during a vacation in Italy.

 

[Fact Checking]

note that the end of the summary in this paper they stated:

(Paragraph revised 18 Feb.) With combined evidence about transmissibility and severity, as viewed through CDC’s Novel Framework for Assessing Epidemiologic Effects of Influenza Epidemics and Pandemics (Reed et al 2013), evidence to date points toward 2019-nCoV having the potential to have comparable severity to the 1918 flu pandemic in the absence of effective control and treatment, when averaged across all ages.

It was significantly revised on February 19:

"While the uncertainty remains large, this estimate now excludes CDC’s reference estimate for the 1957 H2N2 pandemic flu (0.1 to 0.3 percent) and is only two-fold lower than and overlapping with CDC’s reference estimate of 2.04 percent for the 1918 H1N1 pandemic flu."​

Note that the WHO estimate of 0.7% for late stage infections since February is 3 times lower than the estimated 2.04% mortality rate of the 1918 pandemic.

The 0.7% rate is possibly still over-estimated, and it could further drop in economies with advanced health care.

But the error bars are still pretty large, so I'm not saying this with absolute certainty.

 

[hobbes]

Since tonight we have more closed cases than open cases in total.
The daily trend we have globally since 11 days is that more cases are closed than new ones added. Thats extremely positive and the trend is our friend!

March 1st, 9:30 am CET
Active Cases: 41,663
Closed Cases: 45,330

If you have a wild spreading not well controlled epidemic situation it is the other way around and you would have more active cases than closed cases daily. That did so far not happen and we would need a sudden explosion of cases somewhere to change that trend.

I am not saying the virus is not dangerous and cases growing in some countries but we should put thinks into perspective and look at the real data and stop assuming and speculating.

All of this happened while +60 countries have been added which was for many the argument while an uncontrolled out-break with exponential growth will happen but the reality is until today cases did shrink in the last 11 days.

A Szenario for that to reverse would be that we would need a situation like we had at start in China but its hard for me to imagine where that should happen and with all the world has learned about the virus and is alarmed about isolating it we are better prepared to fight it than ever before.

Even if the cases I some countries are growing especially when the virus just arrived or has been detected, people feel its an uncontrolled break-out but what we have seen from most countries is that the total numbers are not growing that much and we have now even countries who don't have any active cases any more.

The ability of the world to control the virus will very likely get better from here not worse.

I hope that this data will help people to calm down and see the situation for the economy more realistic and balanced.

Looking at the worldwide total case numbers is very misleading. They are as of now dominated by mainland China. As in that region the epidemy started earlier and is now declining, the cases closing there also dominate the rise in other countries when added up. This is WHO data including yesterday for cases outside PR China (cumulative cases; unfortunately I think this does not subtract resolved cases though - does anyone have that data?).

Also I am afraid we have a very basic statistical problem: at least in Germany people are only tested if they have been to a risk area (China, Italy etc.) or if they had contact to a person previously diagnosed. This way, there is a strong bias towards only cases being in the statistic where the origin can be traced, which makes it look like there is no wild spreading. However, as the symptoms are so minor, it is well possible that much more people are affected and just not being tested.

 

[hobbes]

So those charts look very dramatic and scary to people, but later data, once they started testing masses for COVID-19 is much more indicative of the actual rate of how this spreads.

Did they really start "testing masses"? AFAIK they only test people who have been to risk areas or had contact to infected people. Therefor IF (just a possibility) a much larger amount of people than we see now are infected and only have mild symptoms, they would still not be included in the statistics we are looking at.

 

[KarenRei]

BBC reports on this:

But sources in the country's health system have told BBC Persian that the death toll currently stands at 210.​

Source: Coronavirus misinformation clouds over Iran

Iran's daily toll today is already up to 385. But they need to be finding thousands per day. :Þ

It's unfortunate, but people tend to misinterpret the high numbers out of Italy and South Korea as being bad signs and the low numbers out of Iran as good signs. Just the opposite is the case.

 

[defc0n]

Looking at the worldwide total case numbers is very misleading. They are as of now dominated by mainland China. As in that region the epidemy started earlier and is now declining, the cases closing there also dominate the rise in other countries when added up. This is WHO data including yesterday for cases outside PR China (cumulative cases; unfortunately I think this does not subtract resolved cases though - does anyone have that data?).

Also I am afraid we have a very basic statistical problem: at least in Germany people are only tested if they have been to a risk area (China, Italy etc.) or if they had contact to a person previously diagnosed. This way, there is a strong bias towards only cases being in the statistic where the origin can be traced, which makes it look like there is no wild spreading. However, as the symptoms are so minor, it is well possible that much more people are affected and just not being tested.

To me it is obvious a lot more people have it than what ends up being reported and recover on their own. And it is obvious a lot less people end up dying from it than the quoted 2% or so.

Not to say that it isn’t deadly obviously but not quite as bad as most believe.

Let’s hope there is still vaccine progress to at a minimum help people hopefully stop freaking out quite as much.

 

[hobbes]

Same in Belgium on our (Flemish) national news: not the top news anymore.

IMHO this is the governments trying to prevent panic, at the cost that people take this too lightly. Though I admit I am usually on the cautious side.

 

[hobbes]

Iran's daily toll today is already up to 385. But they need to be finding thousands per day. :Þ

Why do you keep using this smiley as if all this was funny??

 

[EVNow]

Here is an important tweet-storm from a scientist FredHutch looking into the community outbreak in WA.

Trevor Bedford on Twitter

The team at the @seattleflustudy have sequenced the genome the #COVID19 community case reported yesterday from Snohomish County, WA, and have posted the sequence publicly to http://gisaid.org. There are some enormous implications here.

This strongly suggests that there has been cryptic transmission in Washington State for the past 6 weeks.

I believe we're facing an already substantial outbreak in Washington State that was not detected until now due to narrow case definition requiring direct travel to China.​

I think it is wrong to assume this has happenned only in Snohomish. We probably have such cases in most US cities by now. The reason Korea has 1,000 cases and US only a handful is the # of tests done. Korea did 10k tests in a week. US has done 500 or less.

CDC has completely bungled the response. They should have closed the travel / quarnatined everyone coming from affected countries in Jan.

ps : Market is going to find out what happens when you have a conspiracy minded, ineffective president and equally bad administration who are more worried about controlling information than controlling the outbreak.

 

[hobbes]

To me it is obvious a lot more people have it than what ends up being reported and recover on their own. And it is obvious a lot less people end up dying from it than the quoted 2% or so.

Why is it obvious that less people are dying from it? If people are not tested, the resulting deaths will also not be reported. So we´d have both a underreporting of cases and deaths, leaving the lethality ratio unchanged in first approximation.

 

[SageBrush]

Why do you keep using this smiley as if all this was funny?

She is sticking her tongue out at the Iranian authorities to signal her skepticism of the reported case number.

 

[SageBrush]

Why is it obvious that less people are dying from it? If people are not tested, the resulting deaths will also not be reported. So we´d have both a underreporting of cases and deaths, leaving the lethality ratio unchanged in first approximation.

To a second degree approximation the people dying are in hospitals, and those people are tested.

 

[EVNow]

Why is it obvious that less people are dying from it? If people are not tested, the resulting deaths will also not be reported. So we´d have both a underreporting of cases and deaths, leaving the lethality ratio unchanged in first approximation.

It is more likely that sick people, hospitalized are tested than those who are not sick.

 

[KarenRei]

Germany is not declining, there is something wrong with your data. This is data from WHO (via COVID-19-Fälle in Deutschland – Wikipedia):

That 31 cases data listed for yesterday (actually, I see 38 from BNO) was reported today, It was not yet present in the data. It hit BNO at 11:13 today, and will be present in today's graphs. This significantly alters the picture.

Yesterday (29 Feb) I see 4 cases, all in North Rhine-Westphalia. One reported at 07:44, three at 10:48.

For 28 Feb I do actually see a bug in my data, so I'm glad I rechecked... not sure what happened, but it appears to have been accidentally zeroed out. I see 26 new cases, not at all in accordance with what you posted:

Acht Hessen mit Coronavirus infiziert
Erneuter bestätigter Corona-Fall in Baden-Württemberg
+++ 23:59 Nach Quarantäne-Verstoß: Russland weist 88 Ausländer aus +++
Gesundheitsministerium informiert gemeinsam mit Kreis Segeberg: Erster bestätigter COVID-19-Erkrankter in Schleswig-Holstein im Kreis Segeberg
https://sozialministerium.baden-wue...is-heinsberg.de/aktuelles/aktuelles/?pid=5138
+++ 23:59 Nach Quarantäne-Verstoß: Russland weist 88 Ausländer aus +++
Zwei weitere bestätigte Corona-Fälle in Baden-Württemberg
Zwei weitere bestätigte Corona-Fälle in Baden-Württemberg

If I'm not mistaken, your above graph appears to have a time lag in terms of registering the cases.

Also note that there may be difference in that I attribute Diamond Princess cases to the Diamond Princess and not the country in which an individual was diagnosed. And the day to which I attribute numbers and some other arbitrary source might attribute numbers might be shifted by multiple factors - e.g. numbers reported late at night / early in the morning, differences in times between a case is reported and when its registered in some official dataset, etc.

IMHO it would make sense to only call a decline if that happens for a moving average over a few days or even a week.

It did appear to be declining over several days, though part of that was due to the accidental zeroing.

Also, do you have source for cases in Germany being an "offshoot of Italy"?

Some of the cases being reported are people who returned from Italy. Examples:

Gesundheitsministerium informiert gemeinsam mit Kreis Segeberg: Erster bestätigter COVID-19-Erkrankter in Schleswig-Holstein im Kreis Segeberg
Coronavirus-Fall im Lahn-Dill-Kreis | Hessisches Ministerium für Soziales und Integration

That said, the Italian share is probably overstated, and I defer to your correction. I don't generally try to track sources, just the numbers. I just happened to notice the "traveled to Italy" cases as they're especially marked.

 

[KarenRei]

Why do you keep using this smiley as if all this was funny??

This is a smile: : )
This is a grin: ; )
This is a sad face: : (
This is an expression of frustration: :Þ

Frustrated tongue Emoticons and Smileys :P, =P, :-P, :P, :-P, :P

Normally in English people use : P, but I use :Þ because IMHO it looks more natural (human tongues don't come out of the side of the mouth).

 

[SageBrush]

The Korean CDC reports covid-19 here
KCDC

From the last two batches, The 9am report found 595 cases and the 4pm reported additional 210 cases.

The latest confirmed cases are ~ 800 daily but the new suspected cases are 4x higher. I don't know if suspected means awaiting testing or awaiting confirmatory testing after a positive screening test. The historical results are that ~ 1/2 of the suspected cases are confirmed.