Coronavirus: How dangerous a threat?

[Jagartrott]

What puzzles me most is why there are hardly any cases in India and Indonesia. Both are countries with enormous population clusters and with often questionable hygienic conditions. Is this a matter of simply not detecting cases (that are there in reality), or is there another factor - like climate - playing?

One interesting remark I read yesterday: Wuhan apparently has very bad air quality, even according to Chinese standards. I wonder if the high mortality is partly caused by this. Pre-existing lung damage would likely increase vulnerability to any respiratory disease, and covid-19 has its most detrimental effects via lung infection.

 

[yaco]

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?

You hit the nail on the head. Authorities believe the virus has been in the USA since mid to late January.

 

[aphronesis]

Artist Asked Not to Attend UK Fair Because “Asians Are Seen as Carriers” of Coronavirus

New York dealer Raquelle Azran told artist An Nguyen that their presence “would unfortunately create hesitation on the part of the audience to enter the exhibition space.”

hyperallergic.com

 

[yaco]

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

Going by these figures that indicates nearly 40% show no symptoms. Doubt you will get true figures but think this figure could get up to around 50%.

 

[Red Rick]

Gonna go guess Italy won't even be hit the hardest in the western world cause they're actually doing what they can to contain it.

Things are getting frustratingly lax over here.

 

[Mayomaniac]

South Tyrol has finally increased the testing and til now they've found 36 positives. It was pretty obvious that we just didn't test, if freaking Iceland of all places had 50 positives than a region so close to northern Italy and filled with Italian tourists should have way more chases. In 2 days all hotels, B&Bs and ski stations will be closed in South Tyrol.

 

[zarnack]

What puzzles me most is why there are hardly any cases in India and Indonesia. Both are countries with enormous population clusters and with often questionable hygienic conditions. Is this a matter of simply not detecting cases (that are there in reality), or is there another factor - like climate - playing?

They just aren't testing. That's the thing with developing countries. They don't have the means to take on this virus in any way. So in the end they'll just be counting dead bodies without even understanding, what is happening. And this applies to Africa too, in addition to regions you mention.

 

[Nirvana]

That goes right on top of my personal idiocy ranking, it's even worse than people escaping from Milan.

Coronavirus, in Francia 3500 persone vestite da Puffi sfidano l'epidemia: "Pufferemo il virus". E i social insorgono

L'obiettivo era battere il record mondiale dei raduni dedicati ai personaggi di fantasia del disegnatore Pejo. Sul web valanga di insulti

www.repubblica.it

 

[djpbaltimore]

They just aren't testing. That's the thing with developing countries. They don't have the means to take on this virus in any way. So in the end they'll just be counting dead bodies without even understanding, what is happening. And this applies to Africa too, in addition to regions you mention.

Maybe, but there is decent research that ambient temperature and relative humidity influences the survival of coronaviruses on surfaces. Humidity also effects the distance that airborne droplets can travel. And UV light also is detrimental to spread of enveloped viruses. Only time will tell if COVID-19 behaves in a similar manner, but I would be cautiously optimistic on that front.

As of midnight, there had been ~4000 tests in the USA, so we are up to about 1K tests a day. Still woefully inadequate, but at least it is improving. As for the private sector coming to the rescue. My partner works at an urgent care center and was on the phone yesterday about Labcorp's tests because they had their first potential infected patient and there seems to be a ton of red tape getting samples actually tested. Japan supposedly is developing a new test that can be performed in 30 mins. The technology has not been elucidated, but RIKEN has a good reputation, so hopefully that becomes widely available.

ETA. Interesting findings from doctors in Germany. It is pre-peer review, but it seems crucial that people were still positive for the virus by PCR later during the infection despite not shedding infectious virus particles. They were able to detect infectious virus particles early on, so that is consistent with its observed ability to spread quickly.

ETA2. Cutting through the jargon. Once you are starting to recover, there is a good chance that you are not able to pass on the virus even if you test positive for it by PCR.

https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1

 

[Koronin]

You hit the nail on the head. Authorities believe the virus has been in the USA since mid to late January.

Then we should be much father along in the saturation level of the country with this thing then, esp since anyone before the first "known" case here would have been treating it like a nasty cold.

 

[djpbaltimore]

I think it is widely accepted that the first known case arrived in Seattle from Wuhan on January 15. The scary thing is that he was quickly identified and in a secure medical facility on January 19. He didn't stumble around area ERs like in the movies. The authorities traced dozens of contacts, who were all found to be negative. But somehow they missed someone and the virus has been spreading in the community since then. Sequencing the circulating virus genomes support this chain of events.

Seattle 'Patient Zero' doesn't represent the root of all the cases in the country as it is almost assuredly true that the virus was introduced multiple times, but probably not much earlier than January 15. The response has been handled poorly, but I don't know whether perfect handling would've even been sufficient to stop the virus from taking root here.

 

[Koronin]

There likely was someone who was asymptomatic or very minor symptoms that was never found or tested and that is likely "Patient zero". I also agree that there was more than 1 "patient zero".

Oh on another note, Ohio's Governor announced today that there are 3 new cases in Cuyahoga county (Cleveland area). Also a case in Charlotte, NC.

 

[Nirvana]

According to Rai the whole Italy will be put in lockdown with strictier measures because of italians not following the rules set, on Rai1 they stopped the regular schedule for an "edizione straordinaria" of the TG1 on the matter,

 

[Jagartrott]

I highly doubt that such large scale but coarse measures will do much good. I think politicians are playing 'panic football' at the moment, just kicking the ball away and hoping for the best. If you implement far-reaching measures in a rushed manner, you get a lot of unwanted side-effects that potentially do more harm. The prison riots are one example.

 

[Nirvana]

I highly doubt that such large scale but coarse measures will do much good. I think politicians are playing 'panic football' at the moment, just kicking the ball away and hoping for the best. If you implement far-reaching measures in a rushed manner, you get a lot of unwanted side-effects that potentially do more harm. The prison riots are one example.

And what they should do? The Lombardia health care is collapsed with people left dying out of intensive care, this morning they sent people even here because they don't know where to put them. And despite that there are people escaping the lockdown to go on vacation or students organizing illegal parties to avoid the closure of pubs and discos while the number of cases continue to rise as well as death rate and can only worsen with no place for the infected. If they are unable to limit their lifestyle the government is right in doing everything possible to limit the losses before a Lombardia like situation will happen in three/four other regions and we will have to count deaths by thousands per day.

 

[Red Rick]

From what i understand, Italy is still not testing very strictly, as 46% of tests are coming back positive.

 

[Nirvana]

From what i understand, Italy is still not testing very strictly, as 46% of tests are coming back positive.

They did it at the beginning but then they risked to run out of kits so now they test only people with fever and respiratory problems, that's another reason to lock people in their houses instead of letting asymptomatic or people with slight symptoms work as "untori" because they can't stay at home if they aren't forced to do so.

 

[Nirvana]

Italian data as of 17:00 today:

*53826 tested.
*9172 total cases.
*7985 infected at the moment.
*733 in intensive care at the moment.
*463 deaths.
*724 recovered.


Lombardia alone:

*20135 tested.
*5469 total cases.
*4490 infected at the moment.
*440 in intensive care at the moment.
*333 deaths.
*646 recovered.


Note that it's not specified if people in intensive care sent outside Lombardia is counted in Lombardia data.

 

[Red Rick]

They did it at the beginning but then they risked to run out of kits so now they test only people with fever and respiratory problems, that's another reason to lock people in their houses instead of letting asymptomatic or people with slight symptoms work as "untori" because they can't stay at home if they aren't forced to do so.

So it's probably going a lot more exponential than what data is showing. Terrifying.

 

[Jagartrott]

And what they should do? The Lombardia health care is collapsed with people left dying out of intensive care, this morning they sent people even here because they don't know where to put them. And despite that there are people escaping the lockdown to go on vacation or students organizing illegal parties to avoid the closure of pubs and discos while the number of cases continue to rise as well as death rate and can only worsen with no place for the infected. If they are unable to limit their lifestyle the government is right in doing everything possible to limit the losses before a Lombardia like situation will happen in three/four other regions and we will have to count deaths by thousands per day.

It's like imposing a speed limit of 50 in the hopes of people driving less than 120. If you cannot enforce the rules, and you have not prepared for something as far-reaching as this, it will have many, many unwanted side-effects. The closing of schools that has been going on is one example: it can force medical personnel with children to stay at home, it can cause children to be left with their grandparents - so is the net effect than positive? Emergency plans should have been thought out years ago, but I get the feeling countries are making it up as they go along. I can't comprehend this, I'm simply astounded that it seems like half of the measures are improvised. Any proper, anti-fragile system should have buffers in place. This is something that will make long waves into the future. For instance, the lack of testing is now due to lack of reagents, which are produced mostly in China - yet China's production first slowed, then China stopped most exports, then it bought up much of the available stocks elsewhere. Same for the face masks - a couple of hundred million Chinese need to wear face masks when walking outside (which is total overkill), yet here, doctors are running out of stock. Crazy that we are so reliant on one country.

 

[Nirvana]

After what happened yesterday and today i'm pretty sure from tomorrow we'll see the army patrolling the streets and the police checking at least railway stations with airports almost closed like happened at Malpensa. Maybe they can't stop everyone from attempting the public health but even cutting by an half people around compared to today will be huge.

 

[Velolover2]

Italian data as of 17:00 today:

*53826 tested.
*9172 total cases.
*7985 infected at the moment.
*733 in intensive care at the moment.
*463 deaths.
*724 recovered.


Lombardia alone:

*20135 tested.
*5469 total cases.
*4490 infected at the moment.
*440 in intensive care at the moment.
*333 deaths.
*646 recovered.


Note that it's not specified if people in intensive care sent outside Lombardia is counted in Lombardia data.

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.

 

[Merckx index]

ETA2. Cutting through the jargon. Once you are starting to recover, there is a good chance that you are not able to pass on the virus even if you test positive for it by PCR.

https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1

Just glanced at the Abstract, but don't they say the opposite?

The present study shows that COVID-19 can often present as a common cold-like illness. SARS-CoV-2 can actively replicate in the upper respiratory tract, and is shed for a prolonged time after symptoms end,

Maybe it's shed in ways not very contagious? (they mention stool)

Can someone explain to me why the mortality rate is only about 2% with those horrifying numbers

The 2% or lower figure is based on a lot of data from a lot of countries, and the growing belief that maybe roughly half of all positives show no symptoms.

Wrt places like India and Indonesia: I think it's somewhat a matter of chance. Even in Hubei, with the highest concentration of cases in the world, only a little more than 1 in a thousand have been infected--and the large majority of those now are recovered or have died. So when people from China--or now S. Korea, Italy, etc--travel to another country, it's somewhat of a crapshoot whether an infected person is in that group, and if so, whether s/he spreads the virus to the point where community takes over. The Philippines had the first death outside of China, a Chinese man, but only his partner and one other person tested positive, and both recovered. This was several weeks ago, so there could have been no community spread. Now cases are popping up in the Philippines. Some positive foreigner or foreigners must have arrived, and this time community took over. I think there's a lot of chance in that.

The Philippines, by the way, will be a test case of temperature and humidity, since both are always high there.

But the most puzzling, and potentially valuable, situation seems to be in Japan. The virus is still spreading, but continues to do so far more slowly than in most othercountries where it has been firmly established. Why? Whatever Japan is doing, we need to bottle it.

Among unintended consequences, one thing that seems obvious to me, at least in countries that haven't yet locked down, is more driving of cars. For example, in the Bay area, where I live, many people generally commute by BART, the subway. During rush hours, cars are usually packed with people. I can't imagine a more favorable environment for spreading the virus. I've railed against cars for decades, but in this situation, I can't blame anyone for driving one, if they can't work at home and they live too far to bike. I think people will even be reluctant to use the many busses, vans and carpools available. Public transportation, after all the efforts made to encourage it, is now a great danger.

 

[djpbaltimore]

Some indirect evidence that the situation in Iran is beyond dire.

Iran Has Far More Coronavirus Cases Than It Is Letting On

The surprising number of Iranian government officials succumbing to COVID-19 offers a hint that the disease is far more widespread than the official statistics indicate.

www.theatlantic.com

Just glanced at the Abstract, but don't they say the opposite?



Maybe it's shed in ways not very contagious? (they mention stool)



The 2% or lower figure is based on a lot of data from a lot of countries, and the growing belief that maybe roughly half of all positives show no symptoms.

Wrt places like India and Indonesia: I think it's somewhat a matter of chance. Even in Hubei, with the highest concentration of cases in the world, only a little more than 1 in a thousand have been infected--and the large majority of those now are recovered or have died. So when people from China--or now S. Korea, Italy, etc--travel to another country, it's somewhat of a crapshoot whether an infected person is in that group, and if so, whether s/he spreads the virus to the point where community takes over. The Philippines had the first death outside of China, a Chinese man, but only his partner and one other person tested positive, and both recovered. This was several weeks ago, so there could have been no community spread. Now cases are popping up in the Philippines. Some positive foreigner or foreigners must have arrived, and this time community took over. I think there's a lot of chance in that.

The Philippines, by the way, will be a test case of temperature and humidity, since both are always high there. Also, UV light should be less of a factor, because in the tropics, daylight hours are close to constant all year round. But longer daylight hours could be a factor in those many countries in more temperate zones.

But the most puzzling, and potentially valuable, situation seems to be in Japan. The virus is still spreading, but continues to do so far more slowly than in most othercountries where it has been firmly established. Why? Whatever Japan is doing, we need to bottle it.

Among unintended consequences, one thing that seems obvious to me, at least in countries that haven't yet locked down, is more driving of cars. For example, in the Bay area, where I live, many people generally commute by BART, the subway. During rush hours, cars are usually packed with people. I can't imagine a more favorable environment for spreading the virus. I've railed against cars for decades, but in this situation, I can't blame anyone for driving one, if they can't work at home and they live too far to bike. I think people will even be reluctant to use the many busses, vans and carpools available. Public transportation, after all the efforts made to encourage it, is now a great danger.

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.

 

[Nirvana]

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 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.