Coronavirus: How dangerous a threat?

[Merckx index]

At this point, the incidence of asymptomatic or mildly symptomatic patients with CoV is unknown. To use an analogy, we see the tip of the iceberg, but can't gauge it's depth.

You’re assuming that the relevant authorities are telling the truth about the number of new cases. It seems to be to be the tip of the iceberg, with only those exhibiting symptoms being checked.

Yes, this is a fair point. To KB's warning, I won't speculate on authorities hiding the number of cases, but they may honestly not know, because in the West, there hasn't been much testing. It's been pointed out, e.g., that the first apparent community-based case in the U.S. almost certainly came from an infected individual not in the current count . A recent study of Iran, which has reported 300+ cases, estimates there could be 18,000 infected people.

OTOH, we have the largest dataset by far from China, and the slowing down of new cases there indicates that there are relatively few infected people under the radar. Or if there are, they aren't transmitting the virus very efficiently. And the mortality rate is > 2% in China. Below, I've linked to a more detailed analysis of a group comprising more than half the cases in China.

Also, S. Korea is now carrying out extensive testing, thousands of people a day, and as data accumulate, we should have a better idea of how many people are infected. As of a day ago or so, about 65,000 people had been tested. The total number of known positives in the country is about 3% of that, but the population being tested is people with respiratory symptoms.

A lot of viruses can remain dormant before reactivation. People on anti-retroviral therapy have undetectable levels of HIV in the blood, but it doesn't mean that they are cured. The 'reinfection' case in Japan agrees with observations of a similar phenomenon seen in China. It is just another hurdle to combating the spread of the virus.

COVID-19 is not a retrovirus. There are other viruses that can have latent phases, e.g., herpes and papilloma, but I'm not aware of any flu or related viruses that behave in this way.

the world's media who really love nothing more than a big scare.

Yes, the media are loving this. Really bad news sells.

Edit: Here's a very interesting analysis of the cases in China, which suggests that age really is a huge factor. About 15% of the cases resulted in .death for patients 80 years or older, and 8% for patients 70-79. The death rate for individuals age 10-69 was less than 0.2%, and no deaths were reported for children under 10 years old. All the deaths resulted from cases classified as critical (about 5% of all cases, with a death rate of about 50%).

This is only one study, and the disease may manifest differently under other conditions. E.g., the very high death rate in Iran, still around 10%, is worrisome (but is also a reason why some think the actual number of infections is much higher). Still, if you are under 70 years of age, and/or have mild or even severe symptoms, the outlook does look very good. These data also raise the question of how many people who have died from the virus were at significant risk for dying even before infection. The high death rates for older people may reflect that this group has a very high rate of other health problems, and not so much age per se. At the very least, the data suggest that older people should be a priority in precautionary measures, including testing and confinement.

https://jamanetwork.com/journals/jama/fullarticle/2762130

 

[Sciatic]

For those who've been making flu comparisons (as in, flu is much worse), here's one big difference that is happening right now just up the road from me in Seattle: two official cases confirmed in nursing facility--but another 50 patients and staff are showing symptoms but don't have test results back yet (the U.S. has only just starting allowing local COVID-19 testing yesterday). For the flu, most of these elderly patients would have gotten flu shots. That's not a guarantee of safety (because the vaccine can only include the 3 most likely strains of virus), but in most years that helps provides protection for that vulnerable population. No such protection is available for them right now, and we may see consequences.

 

[Nirvana]

1128 cases and 29 deaths in Italy as of 18:00 today, cases are starting to pop up also in southern Italy but from Monday the only limitation will be the schools closed in Lombardia, Veneto and Emilia.

 

[Tricycle Rider]

Well, the virus has arrived in Oregon and we've already had a death up in Portland - apparently the person was a 50yr. old woman who was already ill with other things, but she did not travel nor was exposed to someone who did travel recently. So these kind of cases are especially mysterious.

Aside from going shopping for non-perishables and having plenty of household cleaner, latex gloves and other First Aid items on hand I don't think there is anything else I can do... I do still have a package of N95 masks from some past DIY projects, but it's my understanding they're no good unless they're fitted and you know how to use them properly. If need be I will just have to wing it.

In the meantime I'm not freaking out, just letting you all know we have joined the party.

 

[Merckx index]

And now in Washington state. A nursing home in Kirkland has reported two positives--one of them 70+--and dozens of cases with symptoms suggestive of COVID-19. This is about the worst case scenario for the elderly.

https://www.kiro7.com/news/local/re...ggest-coronavirus/2YXV65ZP6VBSZDVX53SUWXLYYU/

 

[Tricycle Rider]

And now in Washington state. A nursing home in Kirkland has reported two positives--one of them 70+--and dozens of cases with symptoms suggestive of COVID-19. This is about the worst case scenario for the elderly.

https://www.kiro7.com/news/local/re...ggest-coronavirus/2YXV65ZP6VBSZDVX53SUWXLYYU/

That is especially worrisome being the elderly confined in a nursing home are already in a very weakened state, sadly I don't have much hope for the most of them.

 

[Koronin]

I read there has been a death from the virus in the Seattle area?

 

[Merckx index]

I read there has been a death from the virus in the Seattle area?

Yes, apparently at that Kirkland facility. It was a man in his 50s with no known previous health problems, not to mention no recent travel nor contact with people known to have the virus. This is the first reported death from COVID-19 in the U.S. It probably isn't coincidental that it's on the West coast, where more travelers from Asia enter the country. While the man may have had no direct contact with someone coming from Asia, he presumably had indirect contact, involving a chain leading back to China, I would guess.

I think it's worth adding that while the mortality rate for younger people is still considered to be very low, about 20% of cases are classified as severe or critical, and I assume younger people are at some risk for this. A severe case is not treated by staying in bed a couple of days and drinking a lot of fluids. It usually means pneumonia, and hospitalization. Beyond the health impacts alone, if large numbers of even relatively young people develop severe cases, that will have en enormous economic impact.

 

[Koronin]

Yes, apparently at that Kirkland facility. It was a man in his 50s with no known previous health problems, not to mention no recent travel nor contact with people known to have the virus.

Wonderful. That doesn't sound good.

 

[Tricycle Rider]

Yes, apparently at that Kirkland facility. It was a man in his 50s with no known previous health problems, not to mention no recent travel nor contact with people known to have the virus. This is the first reported death from COVID-19 in the U.S. It probably isn't coincidental that it's on the West coast, where more travelers from Asia enter the country. While the man may have had no direct contact with someone coming from Asia, he presumably had indirect contact, involving a chain leading back to China, I would guess.

I think it's worth adding that while the mortality rate for younger people is still considered to be very low, about 20% of cases are classified as severe or critical, and I assume younger people are at some risk for this. A severe case is not treated by staying in bed a couple of days and drinking a lot of fluids. It usually means pneumonia, and hospitalization. Beyond the health impacts alone, if large numbers of even relatively young people develop severe cases, that will have en enormous economic impact.

It's possible we may be talking about the same person but the news people had confused Washington State with Washington County (the latter we have here in Oregon), so I stand corrected, Washington State does have the first reported death in the US. (Not that anyone should be eager to win that race.)

We do still have confirmed cases and now school closures in the Portland area though, so, it's probably just a matter of time.

 

[Merckx index]

Japan has banned attendance at all its remaining preseason pro baseball games, with a decision yet to be made on the upcoming regular season.

Major sports leagues in the U.S. have some big decisions to make. Tens of thousands of fans at some sporting event present an obvious risk for transmission of the virus, as do players in the locker room. Also, when teams go on the road, one positive player could conceivably spread the virus in several different cities in a few days or weeks. I think all pro and major collegiate athletes will have to be regularly tested. In the next few months, we have the NCAA basketball tournament, and the NBA and NHL playoffs, along with the start of the Major League Baseball season.

 

[Koronin]

That doesn't even count all the auto races both national series and local tracks, plus the XFL and college world series.

 

[Nirvana]

1577 cases and 34 deaths in Italy as of 18:00 today.

Edit: according to the local government there are seven more deaths in Lombardia so 41 in Italy.

Edit2: 1577 are the ones positive at the moment, the total cases are 1694 includind deaths and recoveries, but the Protezione Civile doesn't count the 7 extra deaths and circa 100 cases announced by Lombardia.

Comunicati stampa

L'elenco dei comunicati stampa del Dipartimento della Protezione Civile. Mail ufficio.stampa@protezionecivile.it - Tel 06 68202373

www.protezionecivile.gov.it

 

[Koronin]

Apparently there are now cases in Illinois and Rhode Island. The RI case the woman had been in Italy.

 

[Tricycle Rider]

the NCAA basketball tournament

Oh dear god, don't you ever touch my March Madness!

Ah well, if it does come down to it I would prefer the athletes stay in and stay healthy. (It's not like my bracket has been all so great for the past few years.)

 

[Koronin]

Oh dear god, don't you ever touch my March Madness!

Ah well, if it does come down to it I would prefer the athletes stay in and stay healthy. (It's not like my bracket has been all so great for the past few years.)

Sounds like if they have to they do play games without fans, but they want to have fans if at all possible.

 

[Merckx index]

The Japanese pro baseball league has already banned all fans from the remaining preseason games, with a decision yet to be made about what to do when the regular season begins. I believe some recent soccer games in Japan were also played in empty stadiums.

Supporting that every cloud has a silver lining, it's now reported that there has been a dramatic reduction in air pollution over major Chinese cities, thought to be a result of the lockdown. Nitrogen dioxide causes a lot of respiratory problems, so one might speculate that prior to the economic slowdown--and maybe even during it to some extent--it might have increased the severity of symptoms from the virus.

https://earther.gizmodo.com/chinas-air-pollution-rates-plummeted-after-coronavirus-1842010373

 

[djpbaltimore]

Also, S. Korea is now carrying out extensive testing, thousands of people a day, and as data accumulate, we should have a better idea of how many people are infected. As of a day ago or so, about 65,000 people had been tested. The total number of known positives in the country is about 3% of that, but the population being tested is people with respiratory symptoms.

COVID-19 is not a retrovirus. There are other viruses that can have latent phases, e.g., herpes and papilloma, but I'm not aware of any flu or related viruses that behave in this way.

And as I suggested, the ramping up of testing in S. Korea and other locales is showing a much lower mortality rate. And I believe the test is still missing asymptomatic individuals. A retrospective analysis of antibody responses will likely be a better measure of that.

https://twitter.com/x/status/1234103571236499456

View: https://twitter.com/thehowie/status/1234103571236499456


Dormancy is not the same thing as latency. Ebola is an RNA virus that recurred in some individuals after a period of dormancy. I seriously doubt that these people are being re-infected with CoV. There is little evidence for that in the case of the Japan tour guide.

https://www.sciencedirect.com/science/article/pii/S1201971215002921

 

[King Boonen]

I thought dormancy and latency were the same thing? Or is there confusion between biological and clinical terms here? (I think clinical latency is the incubation period?)

 

[djpbaltimore]

From a general biology perspective they are probably the same thing. Virologists use the term latency in a more specific manner. (I learned this from a lab rotation where they studied Varicella Zoster Virus.)

Although many viruses are capable of subclinical infection, only a few are known to undergo true latency. In latent infection, the full viral genome is retained in the host cell, but its expression is dramatically restricted, such that few viral antigens and no viral particles are produced. To qualify as latency, this cryptic form of infection must display two additional properties: persistence and reversibility.

Only a few virus families are known to be capable of true latency, as strictly defined above. Chief among these are the herpesviruses, a huge and widely distributed family of DNA viruses that are important pathogens in their native vertebrate hosts. The capacity for latency is a defining feature of herpesviruses: all known herpesviral infections display latency in every infected individual.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914632/

 

[King Boonen]

That's my understanding (or a more complicated version of my understanding) for both dormancy and latency, I think the term used can be based on semantics (i.e. a virus is capable of latency when it can lie dormant in the host cells). Latency in clinical terms is, I think, the part of the incubation period where the infected person is non-contagious. In this case the virus is not dormant.

 

[djpbaltimore]

I agree re: semantics. I used the term dormancy but there is really not enough evidence to know what is going on during the subclinical period in the people who get a reactivated infection. Mouse CoV can be neurotropic, causing an MS type illness, so COVID-19 could have some persistent presence in the CNS.

The most interesting data I have seen is the lack of serious cases among children. Given the degree that kids pass around seasonal CoVs, I think there may be some protection offered by recent infection with the seasonal strains. Would also be interesting to see how many of the serious adult cases have young children or grandchildren.

 

[nevele neves]

warmer climate countries do not seem to have the same amount of infections.

 

[Koronin]

It appears there are now confirmed cases in both Florida and New York. Oh and someone in San Antonio had been released from the hospital and went to the mall before returning to quarantine. Go figure.

 

[jmdirt]

Was it already world wide, but now they are identifying sick people with it?