Coronavirus: How dangerous a threat?

[Nirvana]

Today data from Italy as of 17:00:


*Tested 36359.
*Total cases 4636 (Lombardia 2612, Emilia 870, Veneto 488).
*Infected at the moment 3916 (Lombardia 2008, Emilia 816, Veneto 454).
*Recovered 523 (Lombardia 469).
*In intensive care at the moment 462 (Lombardia 309). Note that there are roughly 5000 intensive care places in Italy.
*Deaths 197 (Lombardia 135, Emilia 37, Veneto 12).



They are planning a new special law to lock other areas of Lombardia (even if the regional government want only two small towns near Bergamo) and to put in action students of medicine and former doctors, today they already started to use private and military hospitals.

 

[Nirvana]

Data for other countries (from various news so something could be not the last one available):

*China 80712 cases and 3042 deaths.
*Korea 6593 cases and 44 deaths.
*Iran 4747 cases and 124 deaths.
*Germany 712 cases (+290) and 2 deaths.
*France 653 cases (+230) and 9 deaths.
*Japan 381 cases (+50) and 6 deaths.
*Spain 401 cases (+119) and 8 deaths (+5).
*US 320 cases and 16 deaths.
*Switzerland 214 cases and 1 death.
*UK 163 cases (+48) and 1 death.
*Netherlands 128 cases (+46) and 1 death (+1).
*Belgium 109 cases (+59).

 

[Merckx index]

That's close to the cost I've seen in articles for the test in the US. I've seen if you have insurance without a huge deductible the cost is likely still going to be around $1,500 for someone. Not exactly something most people over here can afford. Apparently the US doesn't exactly have a large number of tests either which is the more frightening part. Due to the cost, the fact most Americans can't afford to take time off work (no sick days and expected to work when sick and you may get fired for calling in sick), plus the lack of test kits, I suspect we'll never get accurate numbers out of the US. Unless they make the test free it's going to be hard for a large portion of the US population to afford.

Again, though, the CDC is supposed to pay for all tests. Certainly if you have symptoms, and you go to the ER (you will have to pay for that), and you tell them you flat-out can't afford the test, they're going to test you, anyway. Also, the Administration has just announced that Medicare will cover the cost of testing. Medicare, of course, covers the older people who are most at risk for dying. Private companies like Quest have now been given the green light to offer testing, which they weren't allowed to do before, and while that testing won't be free, some companies, like Cigna (on some of its plans), and some states, like Washington, are waiving all out-of-pocket costs.

It seems to me that the virus is making. a great argument for Medicare for All. In Japan, where of course they have national health insurance, the test costs a little more than $150, or about $50 for people with some additional forms of national insurance.

Today data from Italy as of 17:00:


*Tested 36359.
*Total cases 4636 (Lombardia 2612, Emilia 870, Veneto 488).

So about 13% of the people tested are positive. They're obviously testing a lot of people without symptoms, but I assume probably they're focusing on people considered most at risk--if it's voluntary (?), people who feel they've been exposed would be more likely to submit. Because even in a high risk region, 13% of a random sample would not be positive. Even in Hubei, only a little more than 1/1000 people are positive.

 

[Koronin]

Again, though, the CDC is supposed to pay for all tests. Certainly if you have symptoms, and you go to the ER (you will have to pay for that), and you tell them you flat-out can't afford the test, they're going to test you, anyway. Also, the Administration has just announced that Medicare will cover the cost of testing. Medicare, of course, covers the older people who are most at risk for dying. Private companies like Quest have now been given the green light to offer testing, which they weren't allowed to do before, and while that testing won't be free, some companies, like Cigna (on some of its plans), and some states, like Washington, are waiving all out-of-pocket costs.

It seems to me that the virus is making. a great argument for Medicare for All. In Japan, where of course they have national health insurance, the test costs a little more than $150, or about $50 for people with some additional forms of national insurance.



So about 13% of the people tested are positive. They're obviously testing a lot of people without symptoms, but I assume probably they're focusing on people considered most at risk--if it's voluntary (?), people who feel they've been exposed would be more likely to submit. Because even in a high risk region, 13% of a random sample would not be positive. Even in Hubei, only a little more than 1/1000 people are positive.

I missed the part about Medicare is now supposed to cover the testing cost. That will definitely help. Of course they need to actually have tests which is another issue.

I did see where Washington's Governor was waving the out of pocket costs. California appears to be looking at ways to reduce risk and get test kits out there.

Oh apparently the VA Hospital (husband works at one of them) just sent out a message that all contractors and patients (and guests) coming in starting next week are going to be tested before they can come in the building. They'll get around to testing employees later, unless someone is in the high risk category.

I agree it's making a very good case for Medicare for all or something similar.

 

[djpbaltimore]

On Sky a couple of hours ago they said that in the US a test cost 3200$ and only 500 has been tested, in the UK they have roughly the same number of infected but with 15000 tested, in Italy they had to cut drastically the number of tests after some days because they would have run out of kits to perform the tests, in Korea they don't put limits and test a lot much than everyone else and they are already beyond 150000 tests performed, so to have a reliable source to study on scientists have decided to use the inhabitants of the locked town of Vo' as guinea pigs and they'll test everyone there on a regular basis.

Not quite that bad. The 500 number was the last update from the CDC website before they stopped posting updates. A journalist did some digging and suggested the number was more like 1800 earlier today. Still pretty poor.

$3200 for a glorified rt-PCR reaction? Oligos cost pennies. Most grad students in the biological sciences could devise an assay for detection. Insanity....

 

[Merckx index]

$3200 for a glorified rt-PCR reaction? Oligos cost pennies. Most grad students in the biological sciences could devise an assay for detection. Anybody who says these tests are cost prohibitive are lying or misinformed IMO.

Just what I was thinking. What an outrageous markup, but this is typical of health care. Most of my health insurance savings come not from free procedures, but from the insurer bargaining the provider down to 10-20% of what the uninsured pay. It's a scandal.

It makes me think that a major reason for the opposition to expanding health coverage to the currently uninsured is that if that happens, the insurers will lose a large portion of their income. They seem to depend on making huge profits off the uninsured in order to offer lower rates to the insured. I know some of the insurers's power comes from scale, getting a group rate, but still, the discrepancy is enormous.

 

[djpbaltimore]

The cost to sequence a person's genome (exomes) is about $1000 nowadays for perspective. Insanity....

 

[Nirvana]

So about 13% of the people tested are positive. They're obviously testing a lot of people without symptoms, but I assume probably they're focusing on people considered most at risk--if it's voluntary (?), people who feel they've been exposed would be more likely to submit. Because even in a high risk region, 13% of a random sample would not be positive. Even in Hubei, only a little more than 1/1000 people are positive.

Today on Sky they explained how has worked and works now, in Italy at the beginning the test was only for who returned from China with breathing problems and fever, after the first two clusters came out they tested randomly in the area then when they realized there weren't infinite kits they started to test only symptomatics and people supposed to have been exposed to infected ones. If someone is symptomatic or connected with an infected can ask for testing, a lot probably have asked since here is free. What wasn't explained is if who is tested more than one time, like the ones in isolation, is counted only one time in the tests number or every time is counted again and that could make a big difference because they are tested regularly.

On a side note they said they also found the "paziente zero", they were desperately searching for him since they discovered the first two clusters, apparently he's a German that live and work for a multinational near Munich, he met a woman from Shanghai in a meeting for his company around the 20th of January then he missed work with flu for some days at the end of the month. He's believed to be the first infected in Europe and his company has an office near Lodi and others in locations around Europe (plus one in Mexico) all close to clusters.

 

[Merckx index]

Thanks for the info, Nirvana.

 

[Koronin]

Well it appears there is a vaccine that is starting trials in Seattle. (Trial will last 14 months).

Coronavirus vaccine ready for clinical trials in Seattle

Researchers seek 45 participants to help gauge the immune response of a new vaccine for 2019 novel coronavirus.

www.king5.com

 

[Merckx index]

Well it appears there is a vaccine that is starting trials in Seattle. (Trial will last 14 months).

I would volunteer for that study, but I'm too old, alas.

 

[Koronin]

I would volunteer for that study, but I'm too old, alas.

I would as well, but I'm on the other side of the country.

Due to the two cases we have in NC and how the second person got it, I suspect the numbers here are going to rise soon.

 

[Jagartrott]

I continue to see Japan as a beacon of hope, though. There were roughly the same number of cases in Japan at about the same time in the middle of February as there were in S. Korea, Italy and Iran, yet that number has grown by only about five times since. Shutting down schools, sporting and other mass attendance events, and encouraging people to work at home whenever possible is having a major effect.

From Feb 17th-26th, Japan only tested 4200 people - compare that to S-Korea. So, is a country doing better because they are detecting less cases? S-Korea also closed down school, stopped mass events, etc. That's why also the focus on the rise in cases is not always helpful. Probably, there were a lot more cases in Wuhan in early January than reported, same for Italy late January/early February, etc. - so if you use the faulty data to draw graphs and make predictions, you're likely to make mistakes.

Meanwhile, the reagents used for the test are in short supply. Most are made in China, and they keep it for themselves and China has bought up much of the other stocks as well. Some experts are now saying that, given the ability of the virus to fly under the radar and the large spread, there is too much focus on the tests anyway. The test costs 20 euros in Belgium by the way. You Americans are crazy.

Finally, let's not forget the age profile of those who die. The average age of those that have died from covid19 in Italy is 81.

 

[sir fly]

I would volunteer for that study, but I'm too old, alas.

If you recovered from Spanish flu I think you're safe.

 

[Merckx index]

From Feb 17th-26th, Japan only tested 4200 people - compare that to S-Korea. So, is a country doing better because they are detecting less cases? S-Korea also closed down school, stopped mass events, etc. That's why also the focus on the rise in cases is not always helpful.

S. Korea appears to be testing more than any other country outside of China, but that can't explain all the difference between the situation there and in Japan. S. Korea has eight times as many deaths (in a population less than half the size of Japan's), so the difference in cases is not simply the result of more asymptomatics being tested. The difference in deaths in fact underestimates the situation, because the more rapid the spread of the virus, the smaller the proportion of closed cases, and the greater the underestimate of the number of deaths. In S. Korea, only about 2.5% of total cases are closed, so the mortality rate is greatly underestimated. The rate of spread is less in Japan, and even if Japan were missing a lot of asymptomatics, this won't affect the calculated rate of spread, as long as the ratio between asymptomatics and those with symptoms is more or less constant.

Probably, there were a lot more cases in Wuhan in early January than reported, same for Italy late January/early February, etc. - so if you use the faulty data to draw graphs and make predictions, you're likely to make mistakes.

What's your evidence for that?

The test costs 20 euros in Belgium by the way. You Americans are crazy.

Won't get any argument from me on that.

The average age of those that have died from covid19 in Italy is 81.

Yes, the mortality rate appears to be far higher for older people, possibly one hundred times greater for those over 80 than for those under 70.

 

[Jagartrott]

What's your evidence for that?

The local government was not allowing negative stories in the run-up to some important Party convention, where bad news would be bad news for the local leaders. First, they pressured the doctor who discovered the virus into signing an agreement to shut up, then, they hardly bothered testing potential cases for weeks. Even after that, they could only test 200 cases/day for a while. Result: (a) they missed the window of opportunity where they actually could have stopped the virus from spreading, (b) the numbers paint a distorted picture with regards to the speed of the spread. Similar to Italy, by the way, where the virus was probably flying under the radar for multiple weeks.

This can be found in news stories, but I also got a lot of information from Chinese colleagues. The Chinese are furious with the Wuhan government, by the way.
e.g. https://www.nytimes.com/2020/02/01/world/asia/china-coronavirus.html

The more widespread presence of corona in Wuhan was already speculated upon fairly quickly by people doing probability analysis and looking at cases popping up in other cities after travel from Wuhan. Again, this is similar to Italy.
e.g. https://www.bbc.com/news/health-51148303

S. Korea appears to be testing more than any other country outside of China, but that can't explain all the difference between the situation there and in Japan. S. Korea has eight times as many deaths (in a population less than half the size of Japan's), so the difference in cases is not simply the result of more asymptomatics being tested. The difference in deaths in fact underestimates the situation, because the more rapid the spread of the virus, the smaller the proportion of closed cases, and the greater the underestimate of the number of deaths. In S. Korea, only about 2.5% of total cases are closed, so the mortality rate is greatly underestimated. The rate of spread is less in Japan, and even if Japan were missing a lot of asymptomatics, this won't affect the calculated rate of spread, as long as the ratio between asymptomatics and those with symptoms is more or less constant.

OK, but why is the situation better in Japan then? My Chinese colleagues are saying Japan is being much less strict in the measures they are taking. They also handled the cruise ship situation quite poorly. So, what is Japan doing differently that is working then? To me, it seems like S-Korea was unlucky, with that Christian sect serving as a huge incubator for spreading it rapidly.

 

[yaco]

Interesting test case currently in Hong Kong. They have just flown back 400 stranded residents from Wuhan. Obviously everyone will be tested during their quarantine. I suggest that if you get 0 to 5 positives then China‘s containment policy is working.

Edit; Just reported that one person has tested positive. Interestingly the person is asymtamatic. I wonder in this case how long it takes for the person to expell the virus.

 

[Unchained]

I will offer this up on the most primitive of perspectives..supposed to get underway on a motorcycle trip w 4 others going from San Diego to Austin and back for the MotoGP races April 3-5. Camping at a small place right outside the Circuit of the Americas is @$175 bucks.. Decent space and not water and electricity.
The 3 day tickets for the motorcycle races themselves vary but @$300 is probably average.
Food and drink are normally expensive and under calculated expenditures.
Last year I bought pins,hats,stickers and T-shirts..for the sake of embarrassment I won't disclose the cost.
We will stop at a couple of spots a Booking.com providing a foul weather option if we start getting lots of rain and camping looks like a pain in the butt.
if the event gets cancelled..SXSW..the biggest most lucrative music event just announced its a NO for this year..if the motorcycle races follow..I will probably lose @$1000 bucks for planning and logistics costs..
All without contracting the virus..so far.
I will pre type a similar rant for the Tour of California..which I hope to enjoy..and the tired phrase of "God willing" is taking on a little more serious meaning.
I really don't see a responsible path forward for promoters of big intentionally crowded events but to cancel. No matter my trivial personal loss of not seeing racing or drinking overpriced beer..
I hope that the experts are wrong and this thing fizzles..fingers crossed

 

[Nirvana]

Lombardia health care is collapsing, after sending people in intensive care to private and military hospitals they are starting to send them to other regions and intensive care workers issued a statement saying is a tragedy and they could be forced to start choosing who could receive intensive care and who would be let outside and then will die. Note that Lombardia health care is one of the excellences of Italy, if this is the situation there, it's frightening to think what could happen in case of a similar situation with a third world health care like Calabria or Campania.

Coronavirus, i medici delle terapie intensive in Lombardia: "Azioni tempestive o disastrosa calamità sanitaria". L'ipotesi delle priorità d'accesso: "Prima chi ha più probabilità di sopravvivenza" - Il Fatto Quotidiano

Porre un limite d’età per l’accesso alla terapia intensiva, basato sulle maggiori possibilità di sopravvivenza. È quello che ipotizza la Società italiana di anestesia, analgesia, rianimazione e terapia intensiva in un documento tecnico legato all’emergenza coronavirus. “Può rendersi necessario...

www.ilfattoquotidiano.it

 

[Netserk]

The Coronavirus, by the Numbers (Published 2020)

A mathematician who studies the spread of disease explains some of the figures that keep popping up in coronavirus news.

www.nytimes.com

His twitter account is worth following too.

 

[Nirvana]

Today data from Italy (as of 18:00), it's limited because there isn't the usual PDF of Protezione Civile.

5883 cases of which 589 have recovered, 233 have died and 5061 are infected at the moment, during the press conference they said also the number in intensive care but I can't find it, if I recall correctly was around 580.

 

[Nirvana]

According to the latest rumors a new special law is coming with the complete lockdown of the whole Lombardia and 11 provinces in other regions, pubs and discos closed everywhere, heavy limitations to other activities.

 

[Koronin]

The test costs 20 euros in Belgium by the way. You Americans are crazy.

I'm not going to argue that one.

 

[Nirvana]

In Milan people are assaulting railway stations to escape before the rumored lockdown...

Coronavirus, “fuga” da Milano: la stazione ferroviaria presa d’assalto da centinaia di persone

Centinaia di persone stanno raggiungendo in queste ore le stazioni ferroviarie di Milano

www.fanpage.it

 

[Merckx index]

The local government was not allowing negative stories in the run-up to some important Party convention, where bad news would be bad news for the local leaders. First, they pressured the doctor who discovered the virus into signing an agreement to shut up, then, they hardly bothered testing potential cases for weeks. Even after that, they could only test 200 cases/day for a while. Result: (a) they missed the window of opportunity where they actually could have stopped the virus from spreading, (b) the numbers paint a distorted picture with regards to the speed of the spread. Similar to Italy, by the way, where the virus was probably flying under the radar for multiple weeks.

Oh, I'm aware of that, but the rates I discussed for Hubei came well after the Chinese government realized its mistake, and began reporting all cases.

OK, but why is the situation better in Japan then? My Chinese colleagues are saying Japan is being much less strict in the measures they are taking. They also handled the cruise ship situation quite poorly. So, what is Japan doing differently that is working then? To me, it seems like S-Korea was unlucky, with that Christian sect serving as a huge incubator for spreading it rapidly.

That's a very good question about Japan. I don't know why the rate of spread is so low, I just obsrerve that it is. I agree about S. Korea, but what that means, basically, is that it's gotten to a point that other countries will probably get to, only sooner.

His twitter account is worth following too.

He makes the point, as I've done several times upthread, that the mortality rate as calculated from deaths/cases is an underestimate, because not all cases are closed. But he doesn't mention two other points I've discussed before. First, the degree of underestimate is related to the rate of spread. The faster the virus is spreading, as % of total cases added per unit time, the greater the underestimate. And second, one can also estimate the mortality rate from deaths/closed cases, but this gives an overestimate. As the virus stops spreading, these two rates will converge, as is happening in China. While the virus is spreading, the true mortality rate will lie somewhere between these two rates, though the gap can be very large.

I agree with his estimate of the mortality rate of 0.5 - 3.0%. This is close to what I said, 1-3%. I think he's factoring in, as I am, the possibility that as many as half of all actual positives are asymptomatic.