Coronavirus: How dangerous a threat?

[movingtarget]

Australia just had it's third death with an 82 year old nursing home resident contracting the virus from a care worker. The only Australian deaths have been two elderly people in aged care homes and one 78 year old man who was on board one of the quarantined cruise ships.

 

[aphronesis]

Per the discussion on the previous page.


“Gilead Sciences, a drugmaker known for price gouging, has been working with Chinese health authorities to see if the experimental drug remdesivir can treat coronavirus symptoms. World Health Organization officials say it’s the “only one drug right now that we think may have real efficacy.” But remdesivir, which was previously tested to treat Ebola virus, was developed through research conducted at the University of Alabama at Birmingham”

I’m not going to link it, nor trying to circumvent new rules, but for those with an interest in US meds and coronavirus see Ryan Grimm in the Intercept.

 

[Mayomaniac]

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.

With the schools closed you have tons of people from northern Italy going on a short skiing vacation right now, that's also not exactly the most helpful thing if you want to contain it.

 

[Jagartrott]

Also, when schools close, there are plenty of children that will be taken care of by their grandparents. Several experts have said the school closures may do more harm than good.

In terms of data, this disease is an epidemiologist's dream of course. Perhaps for psychologists as well. I wonder how much of the anxiety is pushed by the omnipresent numbers and counters. What if we had 'live' counters for cancer, traffic accidents, common diseases? Everybody is left to be his/her own interpreter, and some will laugh it away, some will start fighting over toilet paper in shops.

 

[BlueRoads]

I have been thinking the same about the live counting of cases and deaths...
I suppose at first people would go crazy, after a few weeks they just wouldn't care anymore.
I wished that instead of exact number counting they would just do stuff that might really help. Get more people vaccinated against the flu, for instance. Improve the health services, not only short, but long term (in Germany: radically improve the payment for (young) doctors in hospitals, other countries may have other issues). Make sure, the really vulnerable get the best protection, not by randomly isolating people or cancelling some events, but for instance by introducing shopping services, leaving masks and things to them...

 

[Netserk]

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.

No. Deaths/cases is currently at 3.4 % globally. His (Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine) estimated Case Fatality Ratio is 1.1 % (0.3-2.4 %). Note that is of symptomatic cases only. Of infections it is 0.5 % (0.2-1.2 %).

He makes the point that it is one of the factors, but other factors lower it.

 

[Nirvana]

With the schools closed you have tons of people from northern Italy going on a short skiing vacation right now, that's also not exactly the most helpful thing if you want to contain it.

They can't, now that the lockdown is enforced (and even more extended than first rumored) ski resorts and hotels are closed as well.

 

[Mayomaniac]

They can't, now that the lockdown is enforced (and even more extended than first rumored) ski resorts and hotels are closed as well.

Yes, but that's what has already happened when they only closed schools and unis.

 

[Nirvana]

The real big problem now is the mass that escaped this night before they were able to block them, looking from interviews there were some tourists/foreign workers returning to their country but mainly are people from the south of Italy ready to spread the infection in a third world health care environment. I've read that the governors of Puglia and Sicily don't want anyone because they fear of what could happen.

 

[yaco]

Can say that Japan only test if you have a fever of 37.5 on 4 consecutive days. That drug Resmevir is already been used in Hong Kong and Thailand. HK is aggressive with its use of drugs which stems back to the days of SARS.

 

[postmanhat]

China has reported less than 100 new daily cases for the first time since January 20th. If that becomes a trend then maybe it's already peaked for this year

 

[kiszol]

Italy announces 1492 new cases and 133 deaths in the last 24 hours.
Both are record numbers.
87% of the victims were over 75.
Total number of infected people is 7375, of which 622 are recovered.

Things are not looking good in Italy, and I fear the lockdown achieves too little too late. Most of the provinces has a lot of cases now.

 

[Tricycle Rider]

Italy announces 1492 new cases and 133 deaths in the last 24 hours.
Both are record numbers.
87% of the victims were over 75.
Total number of infected people is 7375, of which 622 are recovered.

Things are not looking good in Italy, and I fear the lockdown achieves too little too late. Most of the provinces has a lot of cases now.

Wow, that's just sad.

Here in Oregon the governor has declared a state of emergency, we are now up to 14 positive cases, but no deaths yet. Yet being the keyword.

 

[GVFTA]

Wow, that's just sad.

Here in Oregon the governor has declared a state of emergency, we are now up to 14 positive cases, but no deaths yet. Yet being the keyword.

In Oregon does a state of emergency have to be declared in order for the governor to ask for Federal help? I've always found this to be a strange requirement in Colorado (usually fire related). In this case, it does no good in regards to increasing the fear and elevating the media rhetoric.

 

[Red Rick]

China has reported less than 100 new daily cases for the first time since January 20th. If that becomes a trend then maybe it's already peaked for this year

It's already peaked in China cause they actually did the right thing to prevent more cases.

On one hand I might be tempted to think if *** really hits the fan in the west people will take it as a lesson and not let things escalate in a next epidemic, but people gonna people and we won't learn.

 

[Koronin]

In Oregon does a state of emergency have to be declared in order for the governor to ask for Federal help? I've always found this to be a strange requirement in Colorado (usually fire related). In this case, it does no good in regards to increasing the fear and elevating the media rhetoric.

To ask for federal help declaring a state of emergency is required. This is a federal requirement not a state requirement. (Have enough dealings with hurricanes out here on the east coast to have learned that.)

China has reported less than 100 new daily cases for the first time since January 20th. If that becomes a trend then maybe it's already peaked for this year

Means it's peaked in China and shows if you do the correct things it appears it'll take about a month and a half to peak and start coming back down.


Here's an article on the virus:

Bloomberg - Are you a robot?

 

[Merckx index]

Some simple factors to keep in mind:

10% increase in cases per day: 1 week to double, two and a half months to increase by 1000.
15% increase per day: 5 days to double, 7 weeks to increase by 1000
20% increase in cases per day: 4 days to double, six weeks to increase by 1000.
25% increase in cases per day,: 3 days to double, one month to increase by 1000
40% increase in cases per day: 2 days to double, three weeks to increase by 1000

It's already peaked in China cause they actually did the right thing to prevent more cases.

But China's government can do things Western governments can't. Their ubiquitous Big Brother network of cameras, coupled with the ability to locate all individuals by access to their cell phones, allows them to track the spread of the virus to an unprecedented degree. The laws in the U.S. would have to be changed--or suspended by the President--for that approach to be used here, and I assume that's the case in Europe, too.

No. Deaths/cases is currently at 3.4 % globally. His (Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine) estimated Case Fatality Ratio is 1.1 % (0.3-2.4 %). Note that is of symptomatic cases only. Of infections it is 0.5 % (0.2-1.2 %).

He makes the point that it is one of the factors, but other factors lower it.

Of course other factors can lower it, particularly the possibility of asyptomatic cases. That Centre has estimated that proportion from the Diamond Princess data, and specifically by estimating the time between identification of a case, death.

 

[Koronin]

Interesting question some people are starting to wonder. China confirmed this out break in January. However, before that people had been traveling. The question is, is it possible this virus has been in the US longer than the first known cases and thus has actually started spreading much sooner thus meaning a lot more of the country is actually either already infected or has already actually had it? Thus is it possible that some of these nasty cold viruses that have been going around are actually milder versions of this particular virus?

 

[Merckx index]

This is the scariest forecast I've seen. Not because it's a worst case scenario, but because it's a this-is-definitely-going-to-happen scenario: Read it at your own peril, but I can't find much wrong with it, unless the world very quickly is able to do more or less everything China is doing. Maybe there will be some other factors that come into play, but right now, this projection is taking into account pretty much everything we know:

• We can expect that we'll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean actual cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.
• We're looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.
• As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won't slow significantly until hitting >>1% of susceptible population.
• What does a case load of this size mean for healthcare system? We'll examine just two factors—hospital beds and masks—among many, many other things that will be impacted.
• The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).
• Let's trust Italy's numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for weeks—in other words, turnover will be very slow as beds fill with COVID19 patients).
• By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)
• If we're wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.
• If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from other (non-COVID19) causes, which seems like a dubious assumption.
• Alright, so that's beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).
• There are about 18M healthcare workers in the US. Let's assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I'm playing conservative at every turn.)
• As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.
• One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.
• How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China.
• Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can't force trade in our favor.
• Now consider how these 2 factors—bed and mask shortages—compound each other's severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.
• HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it's only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.
• We could go on and on about thousands of factors—# of ventilators, or even simple things like saline drip bags. You see where this is going.
• Importantly, I cannot stress this enough: even if I'm wrong—even VERY wrong—about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.
• Undeserved panic does no one any good. But neither does ill-informed complacency. It's wrong to assuage the public by saying “only 2% will die.” People aren't adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.
• I'm an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I've been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.
• Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we're seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.
• But I have no reason to think they'll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don't mock decisions like canceling events or closing workplaces as undue “panic”.
• These measures are the bare minimum we should be doing to try to shift the peak—to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.
• And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?
• Worst case, I'm massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.
• One more thought: you've probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.
• Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.
• But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.
• That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we're talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.
• This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.

http://integralworld.net/dillard38.html

 

[Nirvana]

I think Lombardia health care has definitely collapsed, already yesterday night I've read stories from hospitals' workers that seemed to come from some book about the plague and today suddenly more than 100 deaths and news about people not able to being cured because there aren't places available anymore. Discussing about death rates is useless, we can't build hospitals from nowhere like China and figures can only increase.

 

[Nirvana]

If you have time and a good translator read that (and was Friday night when was considered still "sustainable").

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[Merckx index]

Some cheerier news for us old geezers. While the data definitely suggest older people are at a greater risk of dying, the Diamond Princess numbers indicate a very large proportion of older people didn’t simply survive, but had no symptoms. In fact, they seemed to be more likely to be asymptomatic than younger people, with the qualification that we’re dealing with small sample sizes:

% Asymptomatics, by age:
20-29: 10.7%
30-39: 20.6%
40-49: 29.6%
50-59: 52.5%
60-69: 57.1%
70-79: 59.4%
80-89: 46.3%

The overall rate for all individuals under 50 was 23.2% (that includes under 20, which I haven't included here, because of the very few cases), and that was for a sample size about as large as that for 60-69. The over 50 group as a whole was 54.4%. So while i haven't analyzed this in detail, the age difference seems to be quite significant for this population.

Older people were more likely to become infected, however. The under 50 passengers had a 8.3% infection rate, 50-69 was 17.9%, and 70-89 was 23.4%. It’s not clear whether older people were more susceptible to infection, or just interacted more with others in general, and thus were exposed to the virus more often. Another possible explanation is that since infected older people were more likely to be asymptomatic, uninfected people may have felt freer to interact with them.

Finally, I need to point out that these data are incomplete, since they list a total of 619 cases, whereas the final or at least current tally is nearly 700.

https://cmmid.github.io/topics/covid19/severity/diamond_cruise_cfr_estimates.html

 

[Red Rick]

Some simple factors to keep in mind:

10% increase in cases per day: 1 week to double, two and a half months to increase by 1000.
15% increase per day: 5 days to double, 7 weeks to increase by 1000
20% increase in cases per day: 4 days to double, six weeks to increase by 1000.
25% increase in cases per day,: 3 days to double, one month to increase by 1000
40% increase in cases per day: 2 days to double, three weeks to increase by 1000



But China's government can do things Western governments can't. Their ubiquitous Big Brother network of cameras, coupled with the ability to locate all individuals by access to their cell phones, allows them to track the spread of the virus to an unprecedented degree. The laws in the U.S. would have to be changed--or suspended by the President--for that approach to be used here, and I assume that's the case in Europe, too.



Of course other factors can lower it, particularly the possibility of asyptomatic cases. That Centre has estimated that proportion from the Diamond Princess data, and specifically by estimating the time between identification of a case, death.

I wasn't endorsing Chinese politics by any stretch of the imagination.

Meanwhile, the Indian Wells tennis tournament got canceled.

 

[Jagartrott]

This is the scariest forecast I've seen. Not because it's a worst case scenario, but because it's a this-is-definitely-going-to-happen scenario: Read it at your own peril, but I can't find much wrong with it, unless the world very quickly is able to do more or less everything China is doing. Maybe there will be some other factors that come into play, but right now, this projection is taking into account pretty much everything we know:

This entire scenario hinges on one assumption, namely that the spread is exponential. In almost every epidemic we have seen, this was only the case initially, and then various feedbacks kicked in. So I would say this assumption is very uncertain, and therefore this is not a "this is definitely going to happen" scenario. One important feedback may for example be seasonality - the viral common cold and the flu do not proliferate endlessly - they are clearly affected by the season.

Also, the measures China has taken have caused enormous psychological strain on the population, especially those in Hubei. I would say this warrants some more attention.

 

[Merckx index]

I wasn't endorsing Chinese politics by any stretch of the imagination.

I didn't think or assume you were.

This entire scenario hinges on one assumption, namely that the spread is exponential. In almost every epidemic we have seen, this was only the case initially, and then various feedbacks kicked in. So I would say this assumption is very uncertain, and therefore this is not a "this is definitely going to happen" scenario. One important feedback may for example be seasonality - the viral common cold and the flu do not proliferate endlessly - they are clearly affected by the season.

Yes, that's very true, and it's important to note that tropical countries in SE Asia have had far less incidence of COVID-19 so far (though there are other factors, particularly in Singapore, which is like a mini-China in terms of control of its citizens). Warmer weather usually results in less transmission, and that may happen in S. Korea, Europe and the U.S., among other places.

Believe me, I welcome criticism of this scenario. It's not something anyone wants to promote.