I am right in its epicenter in Washington. We suspect our family might have already had mild cases a few weeks ago. We have definitely been repeatedly exposed. We know a lot of people who are very sick from it, some for as long as 2 weeks now. It has turned our lives upside down. My kid's school just got canceled for two weeks last night. Unless we get lucky with the coming of spring, or the virus naturally weakening, this is going to be a huge human tragedy, and have a huge effect on the stock market.
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Coronavirus
- Thread starter Wenche
- Start date
bkp_duke
Well-Known Member
I have to apologize for both of you. Assuming you are both Drs, show some professional courtesy and understand that neither of you are probably 100% right.
Alright, everyone post their NPIs.
Just kidding, don’t do that. I wouldn’t want anyone to get spammed.
Just kidding, don’t do that. I wouldn’t want anyone to get spammed.
SageBrush
REJECT Fascism
Sure, but as one example simple contacts (by definition) are disease free yet handled much differently when the question is Covid-19 rather than e.g. Influenza.
I recommend that you read again either the CDC or WHO case definitions and recommended guidelines for ncov-19. I don't know how to say this any simpler than I have multiple times: Public Health measures affect the natural history of disease.
Regarding 'flu,' the perceived reduction in virulence is not from evolutionary pressure of disease severity, it is due to progressive herd immunological memory until the next large gene sorting event comes along and resets the clock.
Don't tell us; tell the CDC. If they don't care about your possible case, it'll be "thank you and have a nice day". But if they find the information useful, then you've done them a service.
Causalien
Prime 8 ball Oracle
In any case, how much of my advanced warning have later proven to be true. It is up to each individual to make their own assessment. Sage has disagreed with me many times.
As for armchair virologist or geneticist vs those fighting at the front line. I prefer to trust my contact's info on the front line as they are risking their lives.. Right now. And a lot of this virus cannot be explained. We understand the HIV based spike, but most of the other proteins are still a mystery.
And to reiterate, nobody suspected that it was COVID-19 for months, which allowed it to spread widely. And the reason nobody suspected it? Because the outbreak was mild.
And also to reiterate, you're arguing against peer review, which says that such selective factors have already changed the dominance of various strains of the virus.
Evolution from a virus's view
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Since transmission is a matter of life or death for pathogen lineages, some evolutionary biologists have focused on this as the key to understanding why some have evolved into killers and others cause no worse than the sniffles. The idea is that there may be an evolutionary trade-off between virulence and transmission. Consider a virus that exploits its human host more than most and so produces more offspring than most. This virus does a lot of damage to the host — in other words, is highly virulent. From the virus's perspective, this would, at first, seem like a good thing; extra resources mean extra offspring, which generally means high evolutionary fitness. However, if the viral reproduction completely incapacitates the host, the whole strategy could backfire: the illness might prevent the host from going out and coming into contact with new hosts that the virus could jump to. A victim of its own success, the viral lineage could go extinct and become an evolutionary dead end. This level of virulence is clearly not a good thing from the virus's perspective.
Natural selection balances this trade-off, selecting for pathogens virulent enough to produce many offspring (that are likely to be able to infect a new host if the opportunity arises) but not so virulent that they prevent the current host from presenting them with opportunities for transmission. Where this balance is struck depends, in part, on the virus's mode of transmission. Sexually-transmitted pathogens, for example, will be selected against if they immobilize their host too soon, before the host has the opportunity to find a new sexual partner and unwittingly pass on the pathogen. Some biologists hypothesize that this trade-off helps explain why sexually-transmitted infections tend to be of the lingering sort. Even if such infections eventually kill the host, they do so only after many years, during which the pathogen might be able to infect a new host.
On the other hand, diseases like cholera (which causes extreme diarrhea) are, in many situations, free to evolve to a high level of virulence. Cholera victims are soon immobilized by the disease, but they are tended by others who carry away their waste, clean their soiled clothes, and, in the process, transmit the bacterium to a water supply where it can be ingested by new hosts. In this way, even virulent cholera strains that strike down a host immediately can easily be transmitted to a new host. Accordingly, cholera has evolved a high level of virulence and may kill its host just a few hours after symptoms begin.
Though transmission mode is far from the only factor that affects how virulence evolves — the immunity level of the host population, the distribution of the hosts, and whether the host has other infections, for example, matter as well — this key piece of the pathogen's ecology does help illuminate why some diseases are killers. More importantly, it suggests how we might sway pathogen evolution towards less virulent strains. In situations where high virulence is tied to high transmission rates (e.g., cholera), reducing transmission rates (e.g., by providing better water sanitation) may favor less virulent forms. The idea is to create a situation in which hyper-virulent strains that soon kill or immobilize their hosts never get a chance to infect new hosts and are turned into evolutionary dead ends. In fact, biologists have observed this phenomenon in South America: when cholera invaded countries with poor water sanitation, the strains evolved to be more virulent, while lineages that invaded areas with better sanitation evolved to be less harmful.
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To make the statement that US cases are not growing exponentially based on testing data is ridiculous. At the King County press conference yesterday they clearly said that only about 250 people in the entire state of Washington have been tested so far. And that they have not tested any of the patients still inside of Life Care, any of the staff that works there, or their families, or any of the families that have visited their relatives there over the last month. The numbers of confirmed cases in the US are completely irrelevant right now as nobody is being tested yet.
Las Angeles had a press conference yesterday where they said 25 people have been tested so far in LA county.
Causalien
Prime 8 ball Oracle
There is currently no firm conclusion on that. So best to be safe. And the WHO's delay in declaring a pandemic is really discrediting their reputation. Dr. Fauci is the official I think most should listen to from now on with regard to accurate official recommendations.
The air pressure was a protocol established from lessons with sars. If a patient is constantly coughing due to pneumonia and taking deep breath due to suffocating, the air will be constantly saturated with droplets so it is best to assume that you do not want even a tiny bit to leak outside.
Indeed, perfectly reasonable.
And indeed, I think there will be a lot of blame to go around once this is played out. I remember how early on there was a lot of doubt cast on whether the disease even could be transmitted from human to human - pinning it all on animal-to-human transfer in the seafood market - when now we know that this disease was already well established in Wuhan, spreading from person to person contact, and that people from Wuhan were regularly seeding new pockets around the world - not just other parts of China. Something that clearly wasn't given enough attention, as everyone focused on China alone.
E.g. if Italy had gotten a tenth as much attention as, say, Inner Mongolia, perhaps they would have noticed that something was up before it got this bad.
Seems that an important takeaway should be that "there's no such thing as a seasonal flu" when you're facing a potential pandemic disease whose symptoms are flu-like. That some fraction of all test kits should be made available for at least minimal random sampling of any place in the world that seems to be experiencing a seasonal flu outbreak.
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EVNow
Well-Known Member
Common cold continues to be common. So difficult to say. My kids have had cold/cough - and other family members. But no fever. Ofcourse I'm slightly away on the eastside.
At this point we have to consider Seattle area as "heavily-impacted" and act accordingly. Here is something from a Biology Prof of UW.
Carl T. Bergstrom on Twitter
One might object "Who cares? We're all going to get #COVID19 #coronavirus eventually anyway." First of all, I don't think that's a foregone conclusion. Containment at a nationwide scale is not beyond the realm of possibility, though it's looking less and less likely.
But second of all, and critically, anything we can to do *flatten the epidemic curve* helps everyone out. What does this mean? It means that if we can slow down the rate of spread so that our health system is not overwhelmed, we will be much better off.
This leaves excess capacity (or at least ample capacity) to handle patients with complications. This will also buy time for us to develop theraputics for use on later cases, and maybe even develop a vaccine in time to protect some of the population.
But second of all, and critically, anything we can to do *flatten the epidemic curve* helps everyone out. What does this mean? It means that if we can slow down the rate of spread so that our health system is not overwhelmed, we will be much better off.
This leaves excess capacity (or at least ample capacity) to handle patients with complications. This will also buy time for us to develop theraputics for use on later cases, and maybe even develop a vaccine in time to protect some of the population.
EVNow
Well-Known Member
This is the issue. Private businesses not taking this seriously - because of assumed hit on short term revenues. Who is going to this dealership now, anyway ?
NEW: Employee of Toyota of Kirkland (full disclosure: I’m a customer) has tested positive for #coronavirus. Other employees showing symptoms, allegedly were told to continue working according to employee on Reddit. #COVID19seattle
SageBrush
REJECT Fascism
I am not, but try to not confuse published conjecture with science.
For what it is worth, I completely agree with the evolutionary conjecture in general, I am just telling you that it is not applicable to the covid-19 epidemic we have seen thus far. Enough of this for me today, so I'll leave you with an anecdote I remember from Medical School because it encapsulated in a pithy way the ideas you are mentioning:
What do you call a parasite that kills its host ?
Answer: a failure
The general idea is that spread is integral to survival of the species and a dead host impedes spread. OTOH, virulence tends to increase spread so each disease finds its sweet spot. The tenets of evolutionary biology are consistent with this view. The part you are missing is that this process is only one part of the entire story. The natural history of disease is markedly affected by how the susceptible population responds.
One more anecdote:
A few short years before I joined the local university faculty, HIV was running rampant through the US and ravaving the Hemophilia community but it almost entirely spared those in my state. It was not due to a change in HIV, it was from a very forward thinking decision by the state Hemophilia program to not use aggregated commercial Factor 8 products and instead rely on family to supply plasma to their family members.
The RESPONSE to disease by the susceptible population is paramount. Do NOT succumb to paranoia, hysteria, FUD or fatalism. Be smart and take common sense steps to avoid infection, or if infection is suspected take isolation steps and get tested when appropriate, as outlined by the CDC or the WHO.
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You might be right the 6% fatality is too high, but these things can easily go a couple months before being detected, when nobody knows it is in the community, and there is no test for it. Milder cases that don't require hospitalization are just thought of as some crazy new flu bug that is going around, that tests negative on existing tests. The vast majority of people that die are old and have all kinds of other underlying conditions. It is easy to come to the conclusion that they were in a weakened state and caught a nasty bug that led to pneumonia. The other big thing is that the people who die do not die 3 days after they get sick. They die 3-5 weeks after they get sick. So in that couple months window there is a huge amount of room for the first 6 weeks of deaths to get missed, while the virus spreads exponentially, then the crazy amount of deaths follow weeks later.
Agreed. Worth watching, but not something to draw a conclusion from just yet.
This will almost certainly play out repeatedly in the US - it has become our way. And some will point to / draw from our "leadership" for their justification.
This good advice is simply impossible to follow in Washington State right now. They have only tested 250 people in the entire state as of yesterday. The only people that can get tested are the ones that have been admitted to the hospital. Hopefully this will change very soon.
There has been press camped out in front of Life Care Center in Kirkland 24/7 since Saturday. They have been on the front page of every major news paper in the world for days. How many pictures have you seen of CDC teams coming or going from the building? The CDC is doing exactly nothing in Washington State.
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I was afraid that might be the case. More evidence that our idiot federal government has slow walked the CDC into virtual uselessness in relationship to the early stages of this which of course wastes a chance to flatten the spread and that exponential ramp up into disaster. Who knows how many people actually have this virus in the United States but I'm sure it's more than a few hundred. And most of them don't know that they have it. If we don't get widespread testing until we have a hundred thousand known cases, it may be too late to have anything other than a massive pandemic. About the only thing I agree with Sagebrush on is that behaviour changes outcomes. But if we can't get people to change their behavior early on, we just continue to completely unintentionally promote that R-value of somewhere between 2 and 3. Everybody agrees that's a disastrous number.
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