Wuhan Coronavirus, also known as 2019 nCoV, has a current death rate of 2-3%. This isn't as high as SARS, but similar to 1918 Spanish influenza. In Wuhan the number of infected is doubling every 6 days. Containment is complicated by the fact that patients can transmit infection before they know they're sick, before any symptoms. Mild infections resemble the flu. Patients can recover from symptoms, feel well, and still be highly contagious. Not all patients have symptoms, and asymptomatic people are potentially contagious. How infectious the dead bodies are is unknown.

Each patient infects 2.2 to 2.5 others. It's about as transmissible as Spanish flu. Ebola infects 2, but it's more lethal. It will not be controlled until each patient infects less than 1 other.

It appears to be out of control in China. Concerns are that countries with "fragile" public health sectors could become secondary sources for global infection. It might become endemic in some areas. The earliest any vaccine might be available is this Summer.

https://www.nature.com/articles/d41586-020-00236-9

https://www.sciencemagazinedigital.org/sciencemagazine/31_january_2...

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

So far the youngest patient to die was 39. It mostly kills older people with health conditions such as high blood pressure or diabetes.

As a vulnerable person by age and health, I consider Wuhan coronavirus a personal threat.

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In the official Wuhan virus update, we learned:

Over half of the infected in China are not in Hubei provence. Those arriving in the US from Hubei will be quarantined. Those arriving from elsewhere in China will be subject to monitored self-quarantine.

The CDC test for Wuhan is "not absolutely sensitive and specific." "We don’t know the accuracy of our test," they said. The virus can be detectable in a patient, and 3 days later not be detectable, then 3 days later be detectable.

Much of our medical supply products come from overseas.

The virus is now in 23 other countries besides China.

Scary!

Cases of Wuhan coronavirus continue to rise rapidly as US bans trav...

Researchers in Hong Kong on Friday estimated there could be more than 75,000 people in Wuhan alone infected with the virus. They warned that their model suggested that "epidemics are already growing exponentially in multiple major cities of China with a lag time behind the Wuhan outbreak of about 1-2 weeks."

Study author Gabriel Leung, chair of public health medicine at University of Hong Kong, said in a statement that their predicted number could be much higher than confirmed cases because "not everyone who is infected with (the virus) would require or seek medical attention," thus many may go uncounted. It may also be impacted by the delay between when someone gets infected, when they show symptoms, and when a lab is able to confirm. [emphasis mine]

Pretty clever splash guard, no?

Surgical masks are only helpful to stop droplets carrying virus. Coronaviruses don't travel more than 6 feet before settling out. Close contact is defined as being within 6 feet of a patient without gowns, gloves, N95 respirator for a prolonged period, or having direct contact with a patient or their secretions (such as being coughed on).

Meanwhile, "villages and cities in China have resorted to flying drones with speakers to patrol streets and scold people not wearing masks in public amid the coronavirus outbreak, according to Chinese state media." 

The good news is, it doesn't seem to be lethal to the young. The youngest person I've read about who died was 33.

The bad news is, “Independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions.”

"Researchers at Northeastern University and Imperial College London estimate that the number of cases may be five or ten times higher than what has been reported." 

https://www.nytimes.com/interactive/2020/world/asia/china-wuhan-cor...

This is partly because only confirmed cases are reported. There's a limited supply of tests, and a delay from taking the sample till it's reported. Also, mild and asymptomatic cases don't come to the attention of authorities.

I fear we may never again hear from our friend in Guangdong.

One helpful bit of advice from a Reddit Ask Me Anything thread:

"Are there any obvious signs that separate it from traditional flu?"
Yes, actually. The majority of cases so far have resulted in a fever followed by a cough followed by shortness of breath, but rarely sniffles or sneezing. If you're symptoms are predominantly a stuffed nose and sneezing, which are typically the first symptoms of a cold or flu, then you likely don't have the coronoavirus. None of the 99 patients from the original study of hospitalized patients had a runny nose or sneezing as their first symptom, most of them didn't have it at all. [emphasis mine]

One woman improves and tests negative two days after receiving a combination of antivirals.

Chinese woman infected with the new coronavirus showed a dramatic improvement after she was treated with a cocktail of anti-virals used to treat flu and HIV, Thailand's health ministry said Sunday.

The 71-year-old patient tested negative for the virus 48 hours after Thai doctors administered the combination,...

The doctors combined the anti-flu drug oseltamivir with lopinavir and ritonavir, anti-virals used to treat HIV, Kriengsak said, adding the ministry was awaiting research results to prove the findings. [emphasis mine]

Thailand 'cures' coronavirus with anti-HIV drug cocktail in 48 hours

The researchers report that screening travelers is not very effective for the 2019 coronavirus -- that it will catch less than half of infected travelers, on average -- and that most infected travelers are undetectable, meaning that they have no symptoms yet, and are unaware that they have been exposed. So stopping the spread of the virus is not a matter of just enhancing screening methods at airports and other travel hubs.

"This puts the onus on government officials and public health officials to follow up with travelers after they arrive, to isolate them and trace their contacts if they get sick later,"...

One major concern, Lloyd-Smith said, is that other countries, especially developing nations, lack the infrastructure and resources for those measures, and are therefore vulnerable to importing the disease.

"Much of the public health world is very concerned about the virus being introduced into Africa or India,... [emphasis mine]

First childhood flu helps explain why virus hits some people harder...

A few days ago,

Researchers at Northeastern University and Imperial College London estimate that the number of cases may be five or ten times higher than what has been reported. 

Today from Tiwann news,Tencent may have accidentally leaked real data on Wuhan virus deaths

As many experts question the veracity of China's statistics for the Wuhan coronavirus outbreak, Tencent over the weekend seems to have inadvertently released what is potentially the actual number of infections and deaths, which were astronomically higher than official figures.

On late Saturday evening (Feb. 1), Tencent, on its webpage titled "Epidemic Situation Tracker," showed confirmed cases of novel coronavirus (2019nCoV) 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.

Moments later, Tencent updated the numbers to reflect the government's "official" numbers that day. Netizens noticed that Tencent has on at least three occasions posted extremely high numbers, only to quickly lower them to government-approved statistics.

Some are speculating that a coding problem could be causing the real "internal" data to accidentally appear. Others believe that someone behind the scenes is trying to leak the real numbers.

However, the "internal" data held by Beijing may not reflect the true extent of the epidemic. According to multiple sources in Wuhan, many coronavirus patients are unable to receive treatment and die outside of hospitals.

A severe shortage of test kits also leads to a lower number of diagnosed cases of infection and death. In addition, there have been many reports of doctors being ordered to list other forms of death instead of coronavirus to keep the death toll artificially low.

[emphasis mine]

Main points from 10 minute video by Prof Neil Ferguson, Director of the MRC GIDA, J-IDEA, Imperial College London: (crudely summarized, emphasis mine)

  • On China, they’re picking up 10% or less of all infections, the most severe.
  • Overseas, we think sensitivity (of detection) is somewhat higher. But still we may be detecting maybe a quarter of all infection.
  • We estimate 50,ooo new infections a day in China.
  • We think the epidemic is doubling roughly every five days at the current time.
  • It’s hard to estimate how effective controls are, but there’s limited evidence of it slowing in China. At the moment we can’t see much evidence of the epidemic slowing down.
  • If there’s a lot of community transmission going on, as we think there is, it will be very hard to control this epidemic the way, for example, we controlled the SARS epidemic.
  • There’s uncertainty around, for example, every case producing 2.6 other cases. A range anywhere between 2.1 to 3.3.
  • We think the delay between from when someone develops symptoms and when they die may be 20 days, three weeks or so. [This makes it hard to judge mortality rate.]

Here's an overview of news from Feb 6th & 7th, source follows summary.

Overview of virus news from past 2 days, source follows quote r summary.

  1. Half of transmission occurs during incubation, before the patient knows they’ve been infected. https://english.kyodonews.net/news/2020/02/255501851d48-half-of-sec...

 2. Some patients who are recovering two weeks in suddenly take a turn for the worse.

Dr Peng Zhiyong: Jan 6, 2020.

I've observed that the breakout period of the novel coronavirus tends to be three weeks, from the onset of symptoms to developing difficulties breathing. Basically going from mild to severe symptoms takes about a week. There are all sorts of mild symptoms: feebleness, shortness of breath, some people have fevers, some don't. Based on studies of our 138 cases, the most common symptoms in the first stage are fever (98.6 per cent of cases), feebleness (69.6 per cent), cough (59.4 per cent), muscle pains (34.8 per cent), difficulties breathing (31.2%), while less common symptoms include headaches, dizziness, stomach pain, diarrhea, nausea, vomiting.

But some patients who enter the second week will suddenly get worse. At this stage, people should go to the hospital.

https://www.straitstimes.com/asia/east-asia/reporters-notebook-life...

The sudden relapse is likely from bacterial secondary infection. Here’s some history.

A National Institute of Health (NIH) study found that most deaths in the 1918 viral flu pandemic were caused by bacterial pneumonia. The secondary pneumonia infection occurred "when bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs."

https://www.nih.gov/news-events/news-releases/bacterial-pneumonia-c...

  1. People who recover from 2019 nCoV can get sick again.

…according to Chinese health officials, the antibodies created after a 2019-nCoV infection aren’t always strong enough to keep patients from getting sick again.

“For those patients who have been cured, there is a likelihood of a relapse,” Zhan Qingyuan, the director of pneumonia prevention and treatment at the China-Japan Friendship Hospital, said during a Friday press conference.

“The antibody will be generated,” he added. “However, in certain individuals, the antibody cannot last that long.”

https://www.straitstimes.com/asia/east-asia/reporters-notebook-life...

BTW, the four already circulating coronaviruses (which we experience as 30% of  colds;  they last 10 days) have a similar history of time-limited immunity. However, later infections are usually milder.

  1. Superspreaders. When doctors don’t suspect the virus, because patients lack fever and cough, they can fail to take proper precautions. One patient came in with abdominal pain and infected 4 other patients and 10 doctors.

About 10 percent of the patients did not initially have the usual symptoms, cough and fever, but instead had diarrhea and nausea first. Other uncommon symptoms included headache, dizziness and abdominal pain.

https://jamanetwork.com/journals/jama/fullarticle/2761044

 

  1. More than one source suggested that we can’t count of Summer to quench spread in the Northern Hemisphere, unlike seasonal flu.

University of Hong Kong public health expert Gabriel Leung says there are signs that the outbreak of the novel coronavirus will not come to an end when warmer weather arrives, unlike the 2003 Sars outbreak.

"What I have, in fact, seen is that places with very different climates than we have, such as Singapore and Thailand, they are enjoying weather that we usually enjoy in the summer, and yet their numbers are higher than ours," Leung said.

"So I wouldn't rely, as a principle means of combatting this particular epidemic, on climatic factors."

https://www.nytimes.com/2020/02/07/health/coronavirus-patients.html

Thanks for your updates and summaries, especially of videos!

Updates from Feb 8th & 9th. (Apologies for bad HTML)

  1. Several institutions have developed faster diagnostic tests. The fastest is

– A team of researchers at Hong Kong University of Science and Technology (HKUST) claim to have invented the world’s fastest portable 2019-nCoV diagnostic device.

From sampling to testing, the device is apparently able to detect the novel coronavirus in just 40 minutes. In comparison, the polymerase chain reaction (PCR) technology that is currently in use can take between 1.5 to 3 hours.

… a silicon-based micro-heater … can speed up temperature rises,…

https://www.bioworld.com/articles/432927-hong-kong-researchers-crea...

  1. Chinese doctors find throat swabs often miss the infection.

"The disease occurs in the lungs, that is, the lower respiratory tract, and sometimes the pathogen is not found in the throat of the upper respiratory tract."  

"Not all patients can detect nucleic acid positives, and for patients with a true new type of coronavirus infection, it is only 30% to 50%. Positive rate. By collecting throat swabs of suspected cases, there are still many false negatives. "In other words, probably more than half of people who are truly infected with the new coronavirus will be negative.”

http://translate.google.com/translate?sl=zh-CN&tl=en&u=http...

3. One boy in Hong Kong has avian flu. Along with the Northern Hemisphere’s usual influenza, this complicates diagnosis. https://www.scmp.com/news/hong-kong/health-environment/article/3049...

    1. The coronavirus not only transmits by droplets, aerosol (airborne) transmission has been found. This travels further than 6 feet.

… aerosols are small liquid or solid particles that are stably dispersed and suspended in the air …

https://www.bbc.com/zhongwen/simp/world-51427216

5. The virus attaches to ACE2 receptors. At first it was thought men had more of these, but now they say smoking increases them. 

“...we observed significantly higher ACE2 gene expression in smoker samples compared to non-smoker samples. This indicates the smokers may be more susceptible to 2019-nCov…”

  1. WHO says 18% of novel coronavirus cases lead to “severe” or “critical” illness.

https://www.youtube.com/watch?v=CQtuKNM5gCg&feature=emb_title

Some Wuhan doctors claim that healthy adults are being impacted heavily, not just the elderly and those with preexisting conditions.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)...
  1. Many experts now expect it can’t be stopped and will become endemic.

“Once you get critical mass, it is very hard for tried and true public health approaches to make an impact,” said Dr. Robert R. Redfield, director of the U.S. Centers for Disease Control and Prevention. “… it is time to start thinking about not how to contain it but to cope with it, and repurpose our health care facilities,” said Adalja.

  1. According to the New York Times, US hospitals aren’t well equipped. We are already at capacity due to a heavy flu season, and are dependent upon China for many medical supplies.

“All the hospitals are taxed with a large flu season and other bugs,”…

“Everybody is at maximum capacity,” Dr. Jarrett said.

 Some hospitals in the United States are already “critically low” on respirator masks,… … masks that are made in China are being diverted for use there. …

The mask shortage highlights just how dependent the United States health care system is on goods from China.

“If there were exports from China that were no longer coming to the U.S., our hospitals and our health systems would cease to function within a couple of months,” said Ms. Gibson,…

Summary for Feb 10th

1. Conflicting death rate (case fatality ratio (CFR) estimates:

WUHAN has an official registered fatality rate of 4.06 per cent, Tianmen, a nearby city, has 5.08 per cent. Sunday (Feb 9). 

https://www.straitstimes.com/asia/east-asia/coronavirus-hubei-provi...

At UK’s imperial College they think the true overall CFR is about 1% (95% confidence interval 0.5%-4%). They included asymptomatic cases and mildly ill cases that would not have gone go to hospital.

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/...

2. Latest Chinese incubation period data:

The median incubation period was 3.0 days (range, 0 to 24.0 days).

https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1

I think the German infection cluster found a median incubation of 5 days, during which transmission occurred.

3. "According to medical experts and frontline doctors, 15% to 20% of new coronavirus patients could develop severe conditions, and among them 25% to 30% worsen to critical condition."

https://outline.com/8Gs6vx

4.China is past containment, into mitigation stage. The US could be at that stage in 2 to 4 weeks.

a)

They’re not mutually exclusive, containment and mitigation. We’re in containment in the US. It doesn’t mean in two weeks from now or four weeks from now we won’t need to look at mitigation strategies.

https://www.reddit.com/r/China_Flu/comments/f1wuim/obviously_in_chi...

b)… a key test used to confirm new cases is failing to catch large numbers of people with the disease.

https://www.caixinglobal.com/2020-02-08/key-diagnostic-test-might-b...

c)

Chinese National Health Commission has changed their definition of #WuhanCoronavirus "confirmed case" in their latest guidelines dated 7/2. Patients tested positive for the virus but have no symptoms will no longer be regarded as confirmed.

[Details below are unverified, from a Reddit comment]

People who test positive on PCR test but don't show any symptoms now go under their own separate category called "asymptomatic carrier" instead of "confirmed cases" . Asymptomatic carriers are treated slightly differently, they are allowed to be home quarantined for example. People in close contact with an asymptomatic carrier still need to be tested for nCoV as if they had close contact with a confirmed case. Should an asymptomatic carrier start to show symptom, they are immediately reclassified as a confirmed case.

5.

Coronavirus patients may be mildly ill for more than a week before condition becomes severe SINGAPORE - Several of the locally infected patients with no known links had seen a doctor two or three times before they were sent to hospital. This is because the illness generally starts mild with non-specific symptoms such as cough, sore throat, slight fever and feeling tired, ... These are symptoms tens of thousands of people suffer from every day in Singapore alone, she added.

https://www.straitstimes.com/singapore/health/coronavirus-patients-...

6. A plasma reactor being developed to control airborne pathogens in animal husbandry might help.

One possibility of curbing the spread of airborne pathogens is a NONTHERMAL PLASMA REACTOR. After testing in the lab and at livestock facilities, we’ve shown that the reactor reduces the number of infectious viruses in an airstream by more than 99%. We’re developing the technology for use in animal agriculture, but it might also be useful where people are concentrated in enclosed spaces, including commercial aircraft. In our tests, the plasma reduced how many infectious viruses were in the air by more than 99%, but the viruses themselves remained with their DNA largely unchanged. This means that the plasma didn’t destroy the virus but rather altered its ability to infect. We’re working to understand how this happens,…

https://www.inverse.com/science/a-new-plasma-reactor-can-eradicate-...

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