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.
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.
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).
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.
2. Latest Chinese incubation period data:
The median incubation period was 3.0 days (range, 0 to 24.0 days).
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."
4.China is past containment, into mitigation stage. The US could be at that stage in 2 to 4 weeks.
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.
b)… a key test used to confirm new cases is failing to catch large numbers of people with the disease.
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.
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.
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,…
"this video explains what a cytokine storm is, how that actually is the cause of harm, and additional troubling information that nCoV (now "covid-19") spreads through the air."
Feb 11th news:
1. By mid-January there were 500 confirmed COVID-19 cases among Wuhan medical workers and 600 more suspected cases.
2. Hong Kong's leading public health epidemiologist says that two-thirds of Earth's population could get COVID-19, if it can't be contained.
3. Hong Kong's PolyU invented a machine that can diagnose 40 pathogens for respiratory disease with one sample in an hour.
4. A few details roughly transcribed from Coronavirus: The New Pandemic? - Public Health Grand Rounds at the Aspen Institute:
If the disease can be transmitted by people who are asymptomatic or even mildly symptomatic, it makes it really clear we won’t be able to stop it spreading in the US.
In the short term, this year, we don’t have mitigation strategies. No vaccine for a year, We don’t have a specific countermeasure. So when we talk about mitigation, what we’ll be talking about is things like social distancing, stay home if you’re sick, “cover your cough”, wash your hands.
[The US has] a federal health care system that isn’t really a federal health care system. [We have a hodgepodge of private, public, state level, etc.]
[Coping with the pandemic is] going to require funding… from congress … an emergency package.
Getting the hospitals ready… the system moves super slowly.
5. About that one report of a 24 day incubation period. Dr. Roger Seheult, MD of Medcram suggests this outlier is an instance of (immediate) reinfection. [At 10:13]
I knew that immunity from recovery wasn't perfect, but immediate reinfection is scary, even if rare.
Feb 12th news:
1. The CDC is preparing for community spread, for COVID-19 to "take a foothold". Meanwhile the test kits sent to states are giving "indeterminate" results.
According to Dr. Robert Redfield, the CDC will conclude that containment has failed in the US ...
“Once we get greater than three — so four or more is our view — [generations of] human-to-human transmission in the community … and we see that in multiple areas of the country that are not contiguous, then basically the value of all of the containment strategies that we’ve done now then really become not effective,” he said. “That’s when we’re in full mitigation.”
2. Scott Gottlieb told a Senate committee,
Models suggest that from the time of first introduction of the virus into China — which we now suspect occurred sometime in November — to the time of epidemic spread in China, was about 10 weeks.
... if cases were imported into the U.S. in early January and remain undetected, then we could still be early in our own evolution toward broader outbreaks. Right now, we’re depending largely on clinical surveillance as our primary tool for identifying potential outbreaks since we’re just now deploying diagnostic tools to the Laboratory Response Network. Moreover, we still haven’t broadened our screening criteria to include patients who don’t have a connection to recent travel to China. This limits our ability to identify secondary spread.
3. Among hospitalized patients getting anti-viral meds and antibiotics, 26% ended up in ICU and 16% had respiratory failure. 8 days was the mean from first symptoms to acute respiratory distress syndrome (ARDS).
4. A study of 59 COVID-19 patients found that all has abnormal kidney X-rays, and most had renal impairment symptoms.
5. A US preprint, not peer reviewed, concluded that in the early epidemic, the number of infected doubled every 2.4 days, suggesting an R0 value from 4.7 to 6.6.
6. Here's a short video on how to remove contaminated gloves.
News from 13th & 14th
1. COVID-19 severly attacks the heart.
Reinfection can hasten fatal heart attack.
2. Using a lung CAT scan for rapid diagnosis, as China is now doing along with virus tests, makes sense to me because there is "radiological evidence of lower respiratory tract lesions in patients who do not present with clinical pneumonia."
Infected individuals produce a large quantity of virus in the upper respiratory tract during a prodrome period, are mobile, and carry on usual activities, contributing to the spread of infection.
There seem to be three major patterns of the clinical course of infection: mild illness with upper respiratory tract presenting symptoms; non-life-threatening pneumonia; and severe pneumonia with acute respiratory distress syndrome (ARDS) that begins with mild symptoms for 7–8 days and then progresses to rapid deterioration and ARDS requiring advanced life support...
3. "Hand washing reduces the risk of respiratory infections by 16%."
4. US Military says the number of Chinese COVID-19 cases is probably several orders of magnitude higher than their new numbers.
5. "A toilet flush can release up to 80,000 polluted droplets and leave them suspended a metre in the air for hours if the lid is left up, a new study has found."
The current estimated R0 for the novel coronavirus varies from two to three…
a potential crisis simmers in the shadows: The global dependence on China for the production of pharmaceuticals and medical equipment.
China is also the largest supplier of medical devices in the U.S. These include things like MRI equipment, surgical gowns, and equipment that measures oxygen levels in the blood.
It could take years to develop the necessary infrastructure to reestablish U.S. manufacturing capacities...
Wuhan is a significant player in the biotechnology and pharmaceutical industry, with multiple pharmaceutical companies located in the city.
Here's what we recommend you focus on now
by Chris Martenson
Friday, February 14, 2020,
How to remove a face mask.
Thanks, Ruth, for this valuable information!
Update from 2/16
1. Neil Ferguson:
[Mortality estimates] have four fold uncertainty in each direction, so anywhere from about a quarter of a percent… All the way up to 4%, which is more comparable with the 1918 Spanish flu epidemic.
[Total percent of population infected] The complete attack rate can vary, depending on the pandemic. 60% might be a central estimate for the first year.
Relevant Reddit comment from above thread:
Collapse of health care system and additional deaths not taken into account in neils models from my understanding. Also additional deaths from other medical conditions that will go under / untreated as well as medical supply shortage related deaths not taken into account here either.
2. Phylogenetic estimates
Genetic diversity of SARS-CoV-2 (formerly 2019-nCoV), the virus which causes COVID-19, provides information about epidemic origins and the rate of epidemic growth.
Bayesian and maximum likelihood phylogenetic methods indicate that the virus was introduced into the human population in early December and has an epidemic doubling time of approximately seven days.
3. Christian L. Althaus, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
We argue that reported COVID-19 cases and deaths outside China are less prone to bias and could provide more precise estimates of the absolute CFR...
Figure 2. Probability distribution of time from onset of COVID-19 symptoms to death. The distribution is based on publicly available data collected by Linton et al. (4). Dashed and dotted lines correspond to the mean (15.1 days) and median (14.1 days).
News from 17th and 18th
1. Rapid algorithm to diagnose from CTs.
The system can complete the recognition process within 20 seconds.
The diagnosis algorithm was developed by Alibaba’s research institute Damo Academy. Researchers at the academy said they have trained the AI model with sample data from more than 5,000 confirmed cases, adding that the system can identify differences in CT scans between patients infected with the novel virus and those with ordinary viral pneumonia with an accuracy of up to 96%.
Usually, it will take a doctor 5 to 15 minutes to analyze a CT scan of one suspected patient—which could include more than 300 images—to give a clinical diagnosis.
In ten hospitals in Beijing, Hunan and Guangdong, chloroquine has recently been tested on patients with COVID-19.
Patients in China who were given chloroquine for a week showed less fever, improved lung function, and were sooner virus-free and cured,…
It had been considered for SARS in 2004, but the epidemic was over before it could be deployed.
“Technically speaking, the [World Health Organization] wouldn’t be calling this a global pandemic. But it certainly is on the verge of that happening reasonably soon unless containment is more successful than it is right now.”
4. A Harvard study looked at the effects of absolute humidity and temperature, concluding,
Sustained transmission and rapid (exponential) growth of cases are possible over a range of humidity conditions ranging from cold and dry provinces in China… to tropical locations... Our results suggest that changes in weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in case counts…
A study of what’s necessary to address a dangerous flu pandemic concluded that 10 billion dollars would be needed. Emergency funds expended for Zika haven’t even been replaced.
... will not necessarily work against the new virus.
The deadly new coronavirus is up to 20 times more likely to bind to human cell receptors and cause infection than severe acute respiratory syndrome (Sars), a new study by researchers at the University of Texas at Austin has found.
News from 21st
1. The US CDC now divides confirmed cases into those repatriated by the State Department and those identified by the public health network.
2. The viral load in an asymptomatic patient was similar to that of symptomatic patients, i.e. they're just as infectious.
3. Chinese case study of an entirely asymptomatic 20 year old woman who infected 5 others, she tested negative, had normal CT, and only later tested positive.
4. Research will be done to screen a library of approved and partially validated investigational medications for activity against the coronavirus.
News from 22nd
1. "Dr. Scott Gottlieb, the former commissioner of the U.S. Food and Drug Administration, said he believes we’re right about at the pandemic state.
WHO “will be slow to make that call, but it’s kind of there...""
2. Coronavirus has been found in patients’ urine, not just feces.
3. "... about two thirds of COVID-19 cases exported from mainland China have remained undetected worldwide, potentially resulting in multiple chains of as yet undetected human-to-human transmission outside mainland China."
4. Only three public health labs in the US have the verified CDC test. No promises when others will get them, and when they do the verification process must begin all over. No emergency money has been given by the administration. Meanwhile HHS is exhausting funds transferred from other programs.
5. Wuhan has converted 13 venues, such as a stadium, into temporary "hospitals", and plans to build 19 more makeshift health care venues with a total of 30,000 beds.
6. "Chinese public health officials said they had been ordered to change how they count cases for the third time in eight days – and the second time in 24 hours."