Coronavirus: How dangerous a threat?

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It appears that both Quest Diagnostic and Lab Corp are starting to do coronavirus testing in the US this week. For those who aren't aware, these are the two big mass lab testing facilities in the US. They do large quantity testing for all kinds of things on a regular basis. With these two companies getting involved it should be larger quantities of not just tests but people tested and faster results. Also likely means within the next two weeks or so it is likely to get huge spikes in numbers in the US.

Now this is a catch 22 as these are obviously private labs and there will be costs associated with the testing through them:

 
Because in China they can build hospitals from nowhere and store as much people they need whereas in Italy (well, for now only Lombardia) they are letting people die in hospital wards because there aren't anymore intensive care places available, in China the population is younger than in Italy and in Italy they are testing only people with high fever and respiratory problems so the real number of infected is higher, maybe even the double.

Anyway is not a common influenza, it's not even comparable the number of people that develop pneumonia and that is almost always acute bilateral interstitial pneumonia, not a normal pneumonia, hospital workers from Lombardia already some days ago were saying it's a tragedy never seen and continues to worsen day after day.
I would think that the army would be capable of building field hospitals, no?

I think the main problem in Italy is that a huge number of old people seem to have been infected. In those first weeks, when the virus was flying under the radar, I'm guessing that it first spread among the active population, but then started to enter pensioners homes, hospitals, etc. Perhaps Italians also visit their (grand)parents more than in Asian countries, or the old people are still going to public places more? Whatever the case, the still hugely skewed mortality towards old people seems to indicate that a lot more, younger Italians have indeed been infected (but not detected) and have been (and are) walking around spreading it further.

One of the first, very important advices should be: cut visits to older people, and stay at home if you don't feel 100% (and also implement measures that make this possible, like food services to old people, paid sick leave, etc.). This, I believe, would do much more good than closing all schools and more of these coarse measures that seem to be more about "look, we're taking harsh measures" than about reasoned action.
 
Perhaps Italians also visit their (grand)parents more than in Asian countries, or the old people are still going to public places more?

Extended families are traditional in China, but the move out of the provinces to the large cities to the east has resulted in many parents leaving their children in the care of the grandparents. So in a place like Wuhan, I would guess there are fewer old people than in the rural areas where the virus would not be so common, though I'm not sure of this.

One of the first, very important advices should be: cut visits to older people, and stay at home if you don't feel 100% (and also implement measures that make this possible, like food services to old people, paid sick leave, etc.). This, I believe, would do much more good than closing all schools and more of these coarse measures that seem to be more about "look, we're taking harsh measures" than about reasoned action.

I don't know about that. Many kids are going to be presymptomatic or asymptomatic, and we still don't know for sure how efficiently they may spread the virus. Remember, one infected child going home has a multiplier effect, putting all the members of his/her family at immediate risk. Also, education is one activity that can be carried out fairly effectively online, or with home schooling in some cases. It's not like many jobs, where you physically have to show up.

Shedding usually does infer infectivity. But in this case, it is viral RNA, not an enveloped virus. I think that is a nuance that would be clarified during peer review. Their main evidence was that swabs from the later time points did not yield anything capable of infecting cell cultures while being PCR positive.

Makes sense. Let me take the opportunity, for people wringing their hands (literally!) over hand sanitizers, that plain old household soap or detergent will work fine. Most proteins are denatured by detergents, and the virus needs these proteins to invade cells and start replicating.

That Iran story you linked is horrifying. I wondered about all the public officials who tested positive (one of them one day after giving a speech in which he assured the public they had nothing to worry about), but thought maybe someone positive had gone to a meeting of officials, many of whom become infected from that one source. But all the other evidence certainly points to a very high incidence of cases.

At first, I thought estimates in the millions were totally unrealistic, but after some very rough, in-the-head calculations, I see how this could be possible, whether or not likely. The first case of the virus emerged in China in early December. Let's assume that someone from Hubei traveled to Iran within a week of that, so the outbreak began there not long after it did in China. We know the Chinese government tried to suppress information about the outbreak, so even if the Iran government did also--or if they just hadn't realized what was going on at the time--the virus in Iran probably would not have spread any faster than it did in China. But it certainly could have paralleled that spread. The number of cases in Hubei started to slow down at about 60,000, around a month ago. We assume that the same number of cases, more or less, existed in Iran at the time, but without the restrictions the Chinese imposed, the cases in Iran continued to grow. Assuming a reasonable increase of 10% per day, the number of cases would double in about a week, and increase roughly sixteen times in a month. That gets them to roughly a million cases now. If the virus began somewhat later in Iran, that number would be smaller, on the other hand, if the rate of spread was faster, it could be higher.

This is purely speculative, but it does indicate that a million cases in Iran is not unthinkable. Note, though, that the first cases were reported there last month, and the reported number has increased roughly in parallel with those in S. Korea and Italy, which began about the same time. So if there really are a million or more cases, the government, needless to say is engaging in massive deception. E.g., if they discovered that the number of cases had reached 20,000, they might have reported 20. When it hit 50,000, they said 50, and so on. In this way, the spread would appear in line with what other hotspots were reporting, while hiding the massive differences in actual cases.
 
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By closing down the schools you also had a ton of elderly taking care of the grandchildren, while there children were working, so I don't know if only closing schools was actually a good measure.
Here in Innsbruck all courses at the university have been cancelled, I fear that the presentation of my dissertation project might also get cancelled, but that's just a minor, personal thing.
 
Can someone explain to me why the mortality rate is only about 2% with those horrifying numbers? It's the numbers you'd expect from SARS, not a common influenza.

I don't know how it feels like to be 80, but wouldn't you expect most people around that age to survive a flu? This one seems to be much more severe.

Because many infected people never suffer any symptom So never enter into the official figures.Merckx Index gave figures of asymtomatic people from the Diamond Princess. From a sample of nearly 700 people just under 40% were asymtomatic. This is why the virus spreads so quickly because you are infectious when healthy.
 
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By closing down the schools you also had a ton of elderly taking care of the grandchildren, while there children were working, so I don't know if only closing schools was actually a good measure.
Here in Innsbruck all courses at the university have been cancelled, I fear that the presentation of my dissertation project might also get cancelled, but that's just a minor, personal thing.
I received a mail from the conveners of a major conference (EGU) to take place in Vienna early May that they advise not to book anything yet, as there are doubts everything can go ahead. I had expected this. For me, though I was scheduled to give a talk and meet up with plenty of colleagues, no drama. Perhaps things like this will finally promote the possibility to follow major conferences online. The interaction is not the same, sure, but it would save a huge amount of CO2 and would also allow more people from less rich countries to join.

I hope this crisis will have a number of silver linings.
 
I received a mail from the conveners of a major conference (EGU) to take place in Vienna early May that they advise not to book anything yet, as there are doubts everything can go ahead. I had expected this. For me, though I was scheduled to give a talk and meet up with plenty of colleagues, no drama. Perhaps things like this will finally promote the possibility to follow major conferences online. The interaction is not the same, sure, but it would save a huge amount of CO2 and would also allow more people from less rich countries to join.

I hope this crisis will have a number of silver linings.
I mean, nowadays conferences are all about networking, otherwise they have become obsolete/one should be able to follow them online, we would save a huge amount of CO2 and people could save a big amount of money
The presentation of my dissertation project is supposed to take place on the 20th, so I don't know if they'll have everything set up until then (I'm a Historian). Oh well, it can't be helped.
 
Can someone explain to me why the mortality rate is only about 2% with those horrifying numbers? It's the numbers you'd expect from SARS, not a common influenza.

I don't know how it feels like to be 80, but wouldn't you expect most people around that age to survive a flu? This one seems to be much more severe.
The real problem is that once the severe cases get so many that you can't give proper treatment for everyone, mortality rate will skyrocket. This will also include people who suffer stroke/trauma/cardiac arrest and can't get proper treatment cause everyone and their mother is trying to treat corona patients.
 
Because in China they can build hospitals from nowhere and store as much people they need whereas in Italy (well, for now only Lombardia) they are letting people die in hospital wards because there aren't anymore intensive care places available, in China the population is younger than in Italy and in Italy they are testing only people with high fever and respiratory problems so the real number of infected is higher, maybe even the double.

Anyway is not a common influenza, it's not even comparable the number of people that develop pneumonia and that is almost always acute bilateral interstitial pneumonia, not a normal pneumonia, hospital workers from Lombardia already some days ago were saying it's a tragedy never seen and continues to worsen day after day.
If they're only testing with high fever and respiratory problems, I fear they may not even diagnose half of all the actual cases.

As for the flu, it's been a terrible comparison from the start as it's literally related to viruses that have killed 10% or more in the cases of SARS and MERS. That's what this can mutate into, and basically we can only hope the spring will soften the blow or that herd immunity will start kicking in at some point. This is very likely to become endemic eventually.
 
I would think that the army would be capable of building field hospitals, no?

I think the main problem in Italy is that a huge number of old people seem to have been infected. In those first weeks, when the virus was flying under the radar, I'm guessing that it first spread among the active population, but then started to enter pensioners homes, hospitals, etc. Perhaps Italians also visit their (grand)parents more than in Asian countries, or the old people are still going to public places more? Whatever the case, the still hugely skewed mortality towards old people seems to indicate that a lot more, younger Italians have indeed been infected (but not detected) and have been (and are) walking around spreading it further.

One of the first, very important advices should be: cut visits to older people, and stay at home if you don't feel 100% (and also implement measures that make this possible, like food services to old people, paid sick leave, etc.). This, I believe, would do much more good than closing all schools and more of these coarse measures that seem to be more about "look, we're taking harsh measures" than about reasoned action.
I think the maximum they can do is something like a big tent like the ones you can see in war zones, a real building in some days out of nowhere is impossible, already finding a place would be a problem. But more importantly there is a lack of the instrumentation to set up intensive care places, i've read they can produce only 500 per month and they placed an order for multiple months but at the moment they basically raided the instrumentation in the rooms dedicated for surgery to increase the places and wasn't enough, like wasn't enough using private and army hospitals, looking at yesterday's numbers also sending people in intensive care to other regions like they started to do during the night has not worked much and on the other hand doing so they risk to saturate other regions hospitals (we are already around 25% of intensive care places of the whole country used). Another bad thing is that also young and healty people need weeks in intensive care with acute bilateral interstitial pneumonia, the "paziente 1" was an ironman, probably healtier and with a stronger body than 99,9999999% of the italians and only strated to breathe without intensive care support after roughly 20 days.

Regarding older people there are a lot that live with their sons (or even grandsons), living with old parents it's pretty common here, especially since after the economic crisys having a stable work and a paycheck big enough to live alone it's very difficult, sometimes even finding a work. I remember when there was the "governo tecnico" in 2012 they said italians were "bamboccioni" as an insult because a lot live with their parents but it's not a choice. Look here almost the 70% of people between 18 and 35 live with their parents, the bigger percentage of the whole Europe, going to school or university would only help infect older people returning at home, the proble is that they do the trick going to illegal parties.
 
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If they're only testing with high fever and respiratory problems, I fear they may not even diagnose half of all the actual cases.

As for the flu, it's been a terrible comparison from the start as it's literally related to viruses that have killed 10% or more in the cases of SARS and MERS. That's what this can mutate into, and basically we can only hope the spring will soften the blow or that herd immunity will start kicking in at some point. This is very likely to become endemic eventually.
Everyone that end up with the acute bilateral interstitial pneumonia it's like he has the SARS, and being on large scale while SARS was very limited (roughly 8000 cases IIRC) can only increase the figures under the death column.

Reading that today looks incredible how much they have understimated the virus, they were saying only 14% needed hospitalization with 5% critical, here even if we double the number of infected are way but way bigger the percentages..

attachment.php
 
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Everyone that end up with the acute bilateral interstitial pneumonia it's like he has the SARS, and being on large scale while SARS was very limited (roughly 8000 cases IIRC) can only increase the figures under the death column.

Reading that today looks incredible how much they have understimated the virus, they were saying only 14% needed hospitalization with 5% critical, here even if we double the number of infected are way but way bigger the percentages..

attachment.php
I think it's likely the actual number of infected is more than double.

What does the mortality rate look like per age category compared to China? Italy's got one of the highest% op people over 65 right?
 
One question, is the south of Italy significantly warmer than the north? That might just mitigate the transmission in the south, but I doubt it will matter very much.

Maybe the US will end up being the reference for this.
 
On Sky they have a study from the ISS on sunday situation:

*Asymptomatics 10%.
*Slight symptoms 5%.
*Normal flu like symptoms 30%.
*More severe symptoms 31%.
*Critical conditions that need respiratory support 6%.
*Can't survive outside of intensive care 19%.


Age distribution:

*1.4% below 19.
*22% between 19 and 50.
*37.4% between 51 and 70.
*39.2% above 70.


62.1% are men and 583 are hospitals workers.
56.6% of deaths are above 80.
 
Everyone that end up with the acute bilateral interstitial pneumonia it's like he has the SARS, and being on large scale while SARS was very limited (roughly 8000 cases IIRC) can only increase the figures under the death column.

Reading that today looks incredible how much they have understimated the virus, they were saying only 14% needed hospitalization with 5% critical, here even if we double the number of infected are way but way bigger the percentages..

attachment.php
I have to say that I'm impressed by the way the Veneto region has been able to keep the numbers so low, despite doing a ton of testing and having the other hotspot of the outbreak around Padova in the Colli Euganei. Luck might also be a factor, but it looks like they actually managed to contain it by testing a ton o people at the start of the outbreak.
BTW, the numbers for Bolzano are obsolete, we already had 36 positives yesterday and the number of tests has been a joke, there are probably at least a few hundred infected in the whole province. Like I said, if freaking Iceland has 69 chases with a smaller total population our numbers have to be many times higher.
 
If they're only testing with high fever and respiratory problems, I fear they may not even diagnose half of all the actual cases.

As for the flu, it's been a terrible comparison from the start as it's literally related to viruses that have killed 10% or more in the cases of SARS and MERS. That's what this can mutate into, and basically we can only hope the spring will soften the blow or that herd immunity will start kicking in at some point. This is very likely to become endemic eventually.
There is generally a selective pressure for a virus to become more transmissible. Often this manifests in less lethality, not more. This might select for mutations that allow a virus to colonize the upper airways instead of deep in the alveoli of the lungs. This would result in less mortality, because less involvement of lung complications. Conversely, bird flu (HPAI) often infects deep in the lungs. With that type of pathogenicity, it is hard to spread from person to person and those outbreaks have been relatively minor, although extremely deadly. This tendency to mutate also means that it is anybody's guess whether the eventual vaccine against the strain in the world today will provide protection against the strain that is circulating next year or the year after.

What makes a virus dangerous to populations is the novelty. In 1918 Spanish Flu wiped out millions because it jumped into a human population that had no pre-existing exposure to it, so no pre-existing immunity. Its viral ancestors have been infecting humans since then, so if we released this 1918 virus into the wild now, it would be no more deadly than a seasonal strain. What makes a seasonal strain relatively innocuous is that it is similar enough to previous influenza strains that it can be partially recognized by your memory immune cells that were generated by prior infection with a related influenza or vaccination, but different enough that this recognition is not perfect.

Comparing COVID-19 to seasonal influenza misses one key point. COVID-19 jumped into humans from an animal. So, again we have a problem of little or no pre-existing immunity. Elderly people don't generate as many new lymphocytes as young people and their memory ones aren't going to help.
One question, is the south of Italy significantly warmer than the north? That might just mitigate the transmission in the south, but I doubt it will matter very much.

Maybe the US will end up being the reference for this.
View: https://twitter.com/JeromeRoos/status/1236729011889418246
 
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I agree that this is mostly speculative at this point in time. We'll see what happens in the summer. It would be interesting to predict what spots in the southern hemisphere would be the ideal niche for future outbreaks in this weather model.
 
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This is very interesting:

A sampling study in a Dutch hospital, where 301 employees were tested - none of which had travelled to a risk zone, and none of which had contact (as far as they knew) with a corona patient - revealed that 28 were infected with covid-19. They tested any employee with cold-like symptoms.

This to me indicates that the infection is widespread, probably all over Europe. It also indicates that the mortality numbers are (much) lower than would seem. The danger - and I guess this happened in Italy - happens when the 'wave' reaches the old and weak, then you end up with a lot of people in hospital, they get overwhelmed, and then the situation is out of control. Slow down spreading of the disease is essential - destroying it (like the Chinese told the public they would) is simply not possible anymore. Therefore, measures should probably focus especially on protecting the old and weak. The others could probably help by working as much as possible from home and generally avoiding 'stupid' behaviour (stop shaking hands etc.). But not that much more - we have to accept that it is there.
 
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Mod hat on:

I've cleared out several posts that were either political opinion or could too easily been considered as such. We are well aware that it's a fine line to walk and we are doing our best to balance it. Please bare this in mind when you post.

Cheers,

KB.
 
Austria has closed it's borders to Italy for Italian citizens, everyone else who is coming back from Italy has to be in quarantine for 2 weeks.
An interesting fact, some people got the virus after coming home from the BIathlon WC, that also suggests that the virus has been here a lot longer than people might think.