Coronavirus: How dangerous a threat?

[djpbaltimore]

That's probably correct. But as I just pointed out, the current estimate of the mortality rate in S. Korea has to be an under-estimate. We'll get a better idea of what that rate is eventually, but based on what we've seen in China, the rate could easily double, to about 1.5%. That's not taking into account asyptomatic cases. But if they doubled the number of total cases, the real rate would be again back at about 0.7%.

In fact, my estimates for S. Korea are closely in line with the best data we currently have concerning asymptomatic cases, from the Diamond Princess. Slightly more than one half (55.5%) of the 700 people who tested positive were asymptomatic, and the mortality rate was 6/706 = 0.85%. That's the nearest thing to a controlled laboratory experiment we're going to get, though the sample size is relatively small.

However, it should be pointed out that cruise ships tend to attract older people, so the demographics probably were skewed to people at greater risk for dying. I haven't been able to get an age breakdown of the passengers on the DP, but according to a report on the cruise ship industry in general, the average age of a passenger is 47, while the median age was somewhere in the 60s. There is a big difference between mean and median, because while there are relatively few younger people, some of them include young children, which lowers the average. In any case, a cruise ship's passenger population is definitely skewed to older people. The mean and median age of people in the U.S. is in the late 30s. But older people may also be more likely to become infected, which could cancel out this effect.

This virus seems to be in a gray area where it is not highly transmissible like Influenza, or clinically obvious like Ebola. This means that it is really anybody's guess whether it can be contained. As for the death rate, we will have better estimates at some point. I agree with your later post that antibody testing is best for retrospective analysis.

It will be interesting to see what CA does with the Grand Princess of the coast of SF. I hope they don't repeat the example set by Japan. Cruises like the Diamond Princess that are in the Far east and longer than 1 week skew old, even by cruise ship standards. Someone posted the demos while under quarantine, and I was amazed at how many 80+ there were on that ship.

ETA. Found it.

About 80% of the ship passengers were aged 60 or over, with 215 in their 80s and 11 in the 90s, the Japan Times newspaper reported.

https://www.reuters.com/article/us-...75-including-quarantine-officer-idUSKBN206019

The problem with this is cost. Most people can't afford the cost of the test even if they have insurance. I'm not entirely sure we'll ever get accurate numbers unless the cost gets figured out. Also many choose not to get tested anyway due to not being able to afford time off work.

I heard some of these experts seem to think the numbers in the US could currently be worse than China, but due to very little testing there's no way to know.

It also involves the criteria set by the CDC for testing. Until earlier this week, a doctor did not have the power to request a test for his patient if they did not fit a specific criteria of traveling from infection hotspots or close contact with someone who did. Even if they had a lower respiratory illness of unknown origin. The manufacture and distribution of the test was also a clownshow TBH.

You bring up a lot of good points about the pragmatics of an infection in the USA. The culture of the US worker is to go into work sick. The reason for that can be debated and the discussion probably ventures too much into GRAPES territory, but it is only going to make this harder to contain here.

Edited to add this link. Apparently there is a company currently in Phase 3 testing for a treatment for this virus. (The way the article is written it says vaccine, but it sounds more like a treatment than an actual vaccine). (The article is more talking about the stock, but the info is worthwhile.)

Coronavirus vaccine could add billions in value to this one stock

Time to back up the truck on Gilead?

finance.yahoo.com

You're right, it is an antiviral. That the editor did not pick up on this speaks the dearth in quality of mainstream journalists writing about science.

 

[Nirvana]

Italy update as of 18:00 today:

*32362 tests done.
*3858 cases (2251 Lombardia, 698 Emilia, 407 Veneto).
*3296 at the moment infected (1777 Lombardia, 658 Emilia, 350 Veneto)
*148 deaths (98 Lombardia, 30 Emilia, 10 Veneto).
*414 recovered (376 Lombardia).
*351 at the moment in intensive care (244 Lombardia).

 

[del1962]

First death in Uk today, underlying health conditions, interesting that Uk have a lot more tests than the US mostly negative, 115 cases in Uk over 13000 tests compared to about 500 tests in USA

 

[Nirvana]

In Germany the cases have started to skyrocketing, almost doubled up compared to yesterday, measuring on Italy evolution they are around 26/27 February, France and Spain around 24/25, I think we could expect thousand of cases like in Italy now at least in these three by the end of next week but also Swizterland, Nederlands and Belgium will come with only some days of delay.

 

[Koronin]

You're right, it is an antiviral. That the editor did not pick up on this speaks the dearth in quality of mainstream journalists writing about science.

Thank you.


I expect numbers in the US to rise dramatically if they ever get around to doing any real testing over here.

 

[Merckx index]

About 80% of the ship passengers were aged 60 or over, with 215 in their 80s and 11 in the 90s, the Japan Times newspaper reported.

Well, that's encouraging, in that with such an age-skewed population, still less than 1% who tested positive died. About 5% were over 80, whereas China's population contains < 1% that age. But actually, about 4% of the U.S. population is over 80, and about 11% is over 70.

So if we used the age distribution of mortalities in that China study, and assumed the number of infected is representative of the U.S. population as a whole, the mortality rate in the U.S. would be 1.2%, just based on those over 70 and over 80. That is, even if no one younger than 70 died, there still would be a 1.5% mortality rate. For S. Korea, which has a slightly younger population, t would be 1.0%.

 

[Koronin]

Maybe some good news?

New Coronavirus Protein Reveals Drug Target

A potential drug target has been identified in a newly mapped protein of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). A

globalbiodefense.com

 

[Archibald]

This won't help... a few million of his followers will now think nothing of heading out and further spreading the virus

"...accusing the World Health Organization of dispensing inaccurate facts about the outbreak and suggesting that those with the disease would be safe going to work."

During expansive remarks on Fox News host Sean Hannity's program, the president continued to break with public health officials' more dire messaging regarding the international crisis and forcefully contradicted the WHO, which earlier in the week pegged the global mortality rate for the coronavirus at 3.4 percent.
"Well I think the 3.4 percent is really a false number. Now, and this is just my hunch, and — but based on a lot of conversations with a lot of people that do this. Because a lot people will have this and it's very mild. They'll get better very rapidly. They don't even see a doctor. They don't even call a doctor," Trump said."

** this is not about Trump and politics, but the effects of his message and it's possible repercussions. World leaders need to be united in such a potential worldwide catastrophe

 

[Merckx index]

Unfortunately, because we don't have much data on asymptomatic individuals, there is a lot of room for speculation. Still, as i pointed out upthread, the Diamond Princess was like a controlled experiment, and about half of the positives had no symptoms. Thst's probably an overestimate, though, because many of the passengers were allowed to return to their home countries before recovering (in fact, to date, less than a third of all the cases have recovered), so we don't know how many positives without symptoms at the time they left the ship might have developed symptoms later.

If we assume that there might be at most an equal number of cases without symptoms, the mortality rate is still in the region of 1-3%. That's nothing to sneeze at (pun intended).

 

[zarnack]

I think the mortality rate is likely below 1%, considering that many people, who fall (mildly) ill don't get reported, don't go to doctor, and stay at home or something.

However, there is an issue. It's not just about deaths. In addition to those plenty of people need intensive care to survive. Can't tell, how much of a % that would be, but perhaps an additional 5-10% to deaths.

Either way that would put too much pressure on medical systems, which is the real issue here. If they are greatly overwhelmed and can't treat patients, the mortality rate would increase too. By the way, how big % of population would be possible to hospitalize anyway?

The side-effect of CoVid would be an economic crash though. Tourist businesses and airlines would be the first to go bankrupt.

 

[sir fly]

Maybe it would make sense to mark the mortality (since it's the main concern) risk groups to prevent further damage and limit the effects of processes related to social attitudes.
It's obvious the virus doesn't affect everybody the same way (and that not everybody infected addressed the physicians), but because it's been unknown the measures are applied without exemption.
I suppose current numbers are sufficient for valid and reliable conclusions.

P.S.
First case here.
Imported from Hungary.

 

[BlueRoads]

It would be really nice to know more about the mortality rates. Although there's something unpleasant about thinking about it in terms of numbers and statistic probabilities, that would really help to judge the measures taken.
Number of cases here so far: about 530. None dead, so far, as far as I know. Some in serious state, though.
RKI (respected health institute)-experts expecting medicines (not vacchines) in not too long a time.
KBV (association of doctors): So far the relevance of the infection is rather media related, not so much medical. We are not expecting to reach our limits even with a quick further rise of cases.
(rough translation by myself)

So, are they being irresponsible? Or just sensible?

 

[King Boonen]

It's not just mortality rate. Any serious case that requires hospitalisation puts an added burden on medical services. This will have an effect on mortality rate (those who need urgent care can't get it as there is no space) and has an impact on non-coronavirus related hospitalisations. It's not even just an extra burden as you obviously can't keep people with an infectious disease on the same wards as people without it but who are more susceptible to infection. This can result in poor utilisation of space etc. A large outbreak of cases could shut down hospitals very easily.

This has all been known for a very long time and both SARS and MERS should have been serious warnings that planning for something like this should be a priority. For whatever reasons, which we can't discuss, this was not the case. As such, the shutdowns of events, restrictions on travel, self-isolation etc. are the only possible way of attempting to control outbreaks and lower transmission.

 

[GVFTA]

Two cases here in Colorado. Both from out of state who had traveled internationally and then came here to visit. One is only 30 yrs. old.

 

[djpbaltimore]

It's not just mortality rate. Any serious case that requires hospitalisation puts an added burden on medical services. This will have an effect on mortality rate (those who need urgent care can't get it as there is no space) and has an impact on non-coronavirus related hospitalisations. It's not even just an extra burden as you obviously can't keep people with an infectious disease on the same wards as people without it but who are more susceptible to infection. This can result in poor utilisation of space etc. A large outbreak of cases could shut down hospitals very easily.

This has all been known for a very long time and both SARS and MERS should have been serious warnings that planning for something like this should be a priority. For whatever reasons, which we can't discuss, this was not the case. As such, the shutdowns of events, restrictions on travel, self-isolation etc. are the only possible way of attempting to control outbreaks and lower transmission.

The bolded is a key point. I don't know about the rest of the world, but hospitals in the USA run at about 90% capacity on average. They don't have the beds and ventilators etc to deal with everybody needing treatment at one time. Part of the reason for mitigation is to slow down the spread so that hospitals don't get overwhelmed.

The first three cases in Maryland confirmed. Below is an interesting read about two different possible outcomes we face if the virus can't be contained. Neither are apocalyptic scenarios, but neither are particularly appealing either.

https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/

 

[Jagartrott]

My take on this. I'm a (beta-)scientist and researcher, but not a medical doctor.

1) the mortality rate is far lower than 3%; support: in cases where everybody was tested (e.g. on the cruises), there always are a fair number of non-symptomatic cases; these people carry the virus without even being aware of it; they would never get tested in 'normal' circumstances, thus do not appear in the official figures; on the other hand, the mortality figures will be pretty accurate, they will not be missing many corona cases there

2) this also means that 'containing' the virus is highly problematic; in Italy, the virus probably has been going around undetected since some time in January; also, most of the cases popping up in Europe now have a connection to Italy - it is highly unlikely they have all been infected by the 3000 known Italian cases; with probabilistic modelling, the 'true' number of cases in Italy (and thus, elsewhere) is likely much higher

3) the virus is here to stay, like those other corona viruses, the common cold; I highly doubt we will be able to get rid of it, like SARS; given the mutations occurring, vaccines will likely not be very effective; flu vaccines have only a 50% effectiveness, by the way

4) the amount of panic, and the extreme emergency measures are extraordinary; I could understand this in case of mortality % that are very high - but now? air pollution kills over 4 million people every year, and causes serious health issues for tens of millions more; possible measures are very difficult to implement because 'economy' - now, a nation of over a billion people have locked themselves up at home (this is not really an exaggeration, I have quite many Chinese contacts) for this virus, while they basically 'shrug off' the air pollution issue; climate change (my area of expertise): when Thunberg says she is afraid, the 'adults in the room' laugh her worries away and shift any meaningful action further back; but by the numbers, climate change has huge, huge consequences for - basically - everything; we need some perspective here I think; yes, being more careful regarding this virus is OK - some of the things we're seeing now, that's a huge over-reaction

5) the real important thing to do: abolish all 'wet markets' forever; apart from that they are cruel, they are also perfect laboratories to create new viruses;

Finally, I'd like to share this bit, from The Guardian's live tracker:

In Koblenz, a city in western Germany, 1400 emergency care doctors and emergency care staff have been meeting for a “Corona Conference” and have warned against the growing hysteria surrounding the virus.
Jörg Brokmann, the congress president, said: “What we have is not a medical situation, we have a political situation”.
Brokmann, who is head of the central emergency department of the University Clinic of Aachen, was highly critical of some of the decisions that had been made, including putting four paediatricians into quarantine in the worst-hit state in Germany, North Rhein Westphalia, even though they had apparently shown no Corona symptoms. The doctors had been in contact with infected patients.
“In my opinion, this is an overreaction to the situation,” Brokmann warned, adding that Germany was in danger of running short of medical staff to treat Corona patients, if it abided too strictly by the rules set by the government advisory institute on health issues, the Robert Koch Institute.
Brokmann said that Corona, or Covid-19 illnesses, were, “looked at closely, a somewhat severe case of flu, which was relatively mild for most patients.”
He said it was therefore a mistake to put doctors, nurses and receptionists into quarantine and to force the closure of medical practices, if they showed no symptoms.
He said it was worth remembering that Germany registered a high number of deaths from influenza every year. The last strong wave of the flu claimed an estimated 25,000 lives, he said.
A spokesman for the conference said there had been no hesitation to hold the conference, in the light of the Corona outbreak. Several participants had cancelled, largely because their clinics had not allowed them absence of leave due to the high demands on medical services caused by the virus.

 

[King Boonen]

The bolded is a key point. I don't know about the rest of the world, but hospitals in the USA run at about 90% capacity on average. They don't have the beds and ventilators etc to deal with everybody needing treatment at one time. Part of the reason for mitigation is to slow down the spread so that hospitals don't get overwhelmed.

The first three cases in Maryland confirmed. Below is an interesting read about two different possible outcomes we face if the virus can't be contained. Neither are apocalyptic scenarios, but neither are particularly appealing either.

https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/

Unfortunately, as with many things, discussing official numbers for hospital capacity will quickly move towards the GRAPES rules, so I'll be careful, but I think those numbers are typcial for most developed nations. There are obvious fluctuations based on seasonal effects (flu season, drunk driver season and so on) and in the UK certain trusts do get overwhelmed already.

 

[djpbaltimore]

OK, I see your point about where that discussion inevitably leads.

Catching up on my earlier post, the Marylanders who were positive had traveled overseas. One was a married couple, the other was unrelated but on the same trip. They were cagy about the details of where the travel occurred, but a cruise was mentioned. It doesn't sound like the Diamond Princess.

During the announcement, the update about testing was that 31 people in the state had been tested. Almost half the samples were still pending. Virginia had performed 21 tests and DC 8 as of Thursday. So, testing still appears to be minimal.

 

[BlueRoads]

I suppose this situation shows what, as human beings, our brains are able to handle - climate change, though it is already affecting so many already and will, eventually, everbody, is not palpable enough. Also we are not able to deal with something that has been going on for so long, is a constant process and will still take more years, decades, go on and on in an amount of time that allows us to "get used to it". Corona on the other hand is a diffuse, but nonetheless very fresh threat, with the possibility to affect us within days.

 

[Jagartrott]

I suppose this situation shows what, as human beings, our brains are able to handle - climate change, though it is already affecting so many already and will, eventually, everbody, is not palpable enough. Also we are not able to deal with something that has been going on for so long, is a constant process and will still take more years, decades, go on and on in an amount of time that allows us to "get used to it". Corona on the other hand is a diffuse, but nonetheless very fresh threat, with the possibility to affect us within days.

Indeed.

Your brain on climate change: why the threat produces apathy, not action

‘Our brain is essentially a get-out-of-the-way machine,’ says Harvard psychology professor Daniel Gilbert

www.theguardian.com

 

[Koronin]

Now two confirmed cases in North Carolina. First person flew to Raleigh from Washington (state). The second case is in Wake Forrest (city not university) who just happened to be at the air port (RDU) around the same time as the first case. No idea if the two even had contact with each, but not on the same flight.

 

[Merckx index]

The situations in S. Korea, Italy and Iran tell a grim story. The first confirmed case in S. Korea was on Jan. 20. There were a few more cases after that, but there were only about 30 cases on Feb. 18. Now there are about 6500 cases, an increase of more than 200 times in 18 days. This is close to the rate in Hubei during the peak spread, when the number of cases increased on average by about 40% a day, or approximately doubled every two days. At that rate, cases increase 1000-fold about every three weeks.

In Iran, the first two cases were recorded on Feb. 19. There are now about 4700 cases, an increase of 2400 in seventeen days. Again, the growth of cases is close to that of the peak in Hubei, actually greater.

In Italy, the first confirmed case was identified at the end of January. There were about 80 cases on Feb. 22. Now there are about 4600 cases, an increase of nearly 60-fold in two weeks. Again, this is not far off from the Hubei peak rate.

So in countries where the draconian measures used by China are not in place, we can see increases in cases as much as 1000-fold in three weeks, or a million-fold in six weeks. It typically takes a little time after the first cases are identified for the virus to take off, but once it does, the spread is inexorable.

The number of cases in most Western European countries, and in the U.S., is now in the hundreds, and I see nothing to indicate that these numbers will not grow at the same rate. I hope I'm wrong, but if these rates are maintained, it appears to be only a matter of time, and not very much time, until hospitals are overwhelmed. In the U.S., for example, if/when the number of cases reached 500,000 – one million—which at the rates I'm seeing in other countries would be in about a month, barring new measures--there will not be enough ventilators for the likely number of serious/critical cases.

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.

 

[spalco]

The thing that absolutely scares the *** out of me regarding this virus, although that might seem self-centered, is not the mortality rate but the effects on business.
If anyone in my office got the virus (and we're probably at extreme risk, having frequent close contact with people coming from italy, iran, china and other affected countries) and the office got locked down for two weeks, it would destroy us. It would be not survivable for our business.

Losing my job i could deal with, but it would seriously hurt a lot of people we're helping.

Probably a lot of people in similar situations.

 

[Nirvana]

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.

 

[Koronin]

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.

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.