PlagueWatch 2020-23 - Coronavirus

[mr. synellinden]

Just to give an idea of the situation, there is a timeline graph showing the number of cases confirmed per day in the US since Jan 21:

https://www.nytimes.com/interactive/...-us-cases.html

As you can see, yesterday there was a new high of 400 cases confirmed. That in and of itself is not the scary part. The scary part is the speed with which the daily number of confirmed cases is increasing. If this trend continues over the next week, or two weeks, think about how big things can get.

Also, important to note that this is only confirmed cases. That of course underestimates the number of actual cases even in the best of circumstances. And we are not in the best of circumstances (nor are we remotely close to it) in terms of being able to identify cases.

I feel like this is a must read on the spread of this virus, how to contain it and why time is so much of the essence here.

* I see CDU already posted this but it really is a must read.

[OldPhiKap]

Why? Is it because people will refuse to follow orders? If China demonstrates that total infections can be kept under 100,000, and if it is not too late to use similar procedures here, then who in this country is going to insist on procedures that allow the number to rise to 70 million?

1. China's numbers are bogus.
2. It is too late as described above.
3. You expect National martial law here? I don't see that happening, nor do I think the government has the resources to do it.
4. That would cause a complete collapse of our free market system -- ain't gonna happen.

[CDu]

Why? Is it because people will refuse to follow orders? If China demonstrates that total infections can be kept under 100,000, and if it is not too late to use similar procedures here, then who in this country is going to insist on procedures that allow the number to rise to 70 million?

There are several reasons:

1. China has some geographic and socioeconomic things working in its favor in terms of mass quarantining that the US simply doesn't have. More land barriers, population in tighter pockets separated by large expanses of land, etc.
2. The cases in China were largely contained to a single region for a good chunk of time (for reasons related to point 1), which is most definitely not the case here
3. Because of #2, it probably IS too late to use a similar procedure here and get similar results.

We are seeing ~400 confirmed cases a day at the moment. But the problem is that the actual number of new cases is probably 5-10 times that many (based on the evidence from China), because we don't know a case is a case until it gets tested, and people simply don't realize they have the condition for days - even weeks in some cases - before that. And given how poor our testing rate has been (it's among the worst among the developed world, on orders of magnitude below those of other countries), the number of actual cases my be well more than 10x the confirmed cases.

The window to replicate China's results was weeks ago, not now. Doing what China did would be helpful, but it isn't likely to lead to the same success China had, because we're starting soooooooo much later in the race than they did. And with outbreaks, when you start matters A LOT.

[DukieInKansas]

Why? Is it because people will refuse to follow orders? If China demonstrates that total infections can be kept under 100,000, and if it is not too late to use similar procedures here, then who in this country is going to insist on procedures that allow the number to rise to 70 million?

1. China's numbers are bogus.
2. It is too late as described above.
3. You expect National martial law here? I don't see that happening, nor do I think the government has the resources to do it.
4. That would cause a complete collapse of our free market system -- ain't gonna happen.

China doesn't have as much freedom of movement as the US so there are more areas to try to contain here. I think they did the lock down at the beginning of February ( https://www.reuters.com/article/us-c...-idUSKBN2081DB ), so we might be on that same timeline if it was done now - but there would be a much larger area to lock down.

Also, China also resorted to welding some doors shut to keep people in their homes/apartment buildings. Do you honestly see that being done in the US?

[PackMan97]

There are several reasons:

1. China has some geographic and socioeconomic things working in its favor in terms of mass quarantining that the US simply doesn't have. More land barriers, population in tighter pockets separated by large expanses of land, etc.
2. The cases in China were largely contained to a single region for a good chunk of time (for reasons related to point 1), which is most definitely not the case here
3. Because of #2, it probably IS too late to use a similar procedure here and get similar results.

We are seeing ~400 confirmed cases a day at the moment. But the problem is that the actual number of new cases is probably 5-10 times that many (based on the evidence from China), because we don't know a case is a case until it gets tested, and people simply don't realize they have the condition for days - even weeks in some cases - before that. And given how poor our testing rate has been (it's among the worst among the developed world, on orders of magnitude below those of other countries), the number of actual cases my be well more than 10x the confirmed cases.

The window to replicate China's results was weeks ago, not now. Doing what China did would be helpful, but it isn't likely to lead to the same success China had, because we're starting soooooooo much later in the race than they did. And with outbreaks, when you start matters A LOT.

The only blessing right now is that we haven't seen a spike in pneumonia cases showing up at hospitals.

It can't be underestimated the simple fact China has one epicenter. we have NYC, Seattle and Boston as ones well on their way and a ton of smaller ones that are working their way there.

[CDu]

The only blessing right now is that we haven't seen a spike in pneumonia cases showing up at hospitals.

It can't be underestimated the simple fact China has one epicenter. we have NYC, Seattle and Boston as ones well on their way and a ton of smaller ones that are working their way there.

Yep. Containment is much easier when (1) there aren't that many cases, (2) they are confined to a small area, and (3) the containment plan is swift and drastic. We've missed that window on all counts.

We can hope for the best moving forward. But there is virtually no reason to expect similar containment success as was seen in China (and that's even assuming China's success is truthful).

Italy's trends are much more comparable to what we're facing. But again, Italy has the advantage of being a small country that could "easily" shut down the entire country. And their cases have largely been in the northern part of the country, which helps with containment. And even then, Italy's results aren't looking very promising, with pretty dramatic growth in cases and deaths over the past week.

[budwom]

at least we don't have that many pangolins. Other than that, we don't have too many advantages.

[ChemGod]

Again, I’ll defer to rsvman here, but — look, I’m not saying this is the ideal situation, but is this not a little reassuring in a way? If our actual case load is that high in some areas, it means that the hospitalization rate is lower than we think? I haven’t seen or heard anything about hospitals being overloaded in the States so far, though the situations in Seattle — and soon in NYC — are troubling.

Short answer is no. They are looking retrospectively at death attributed to, but not tested, from flu...guess what?

Not sure of magnitude, but HHS Sec admitted it was an issue.

The magnitude of the ignorance of overall problem is what should keep everyone up at night.

[rsvman]

Good news on the ground, at least here in my children's hospital, is that we have not been inundated yet. I feel like I'm lucky that I chose pediatric infectious diseases rather than adult infectious diseases, given the disparate effects of the virus based on age, and the information, so far, that suggests that children do much better overall than do adults.

Time will tell.


I agree with others that we can't control people in this country. We have a mindset of independence, freedom, and individuality, and we don't like being told what to do. We are enforcing social distancing only by taking away things of interest that people want to go to, which will likely help, but it's not the same as a "lock-down."

[swood1000]

Yep. Containment is much easier when (1) there aren't that many cases, (2) they are confined to a small area, and (3) the containment plan is swift and drastic. We've missed that window on all counts.

We can hope for the best moving forward. But there is virtually no reason to expect similar containment success as was seen in China (and that's even assuming China's success is truthful).

Italy's trends are much more comparable to what we're facing. But again, Italy has the advantage of being a small country that could "easily" shut down the entire country. And their cases have largely been in the northern part of the country, which helps with containment. And even then, Italy's results aren't looking very promising, with pretty dramatic growth in cases and deaths over the past week.

According to the article, one can roughly arrive at the number of actual true cases by multiplying the number of deaths by 800. In the U.S. we have had 41 deaths, giving us roughly 32,800 true cases. On 1/22 in Hubei there were 12,000 true cases.

There are two questions: (1) do we have the political will and practical ability to effectively lock down a geographic area in the U.S. the way they did in China, and (2) if we did, is it too late for that to have any effect on the course of the virus in that area.

Let’s just address (2). Regardless of how widespread in the country the virus now is, if we applied the same procedures to a specific U.S. geographic area that were applied in to the Hubei geographic area then it would seem that we would have the same result within that area as in the case of Hubei.

Unlike in China, in this country the infection started all over the place at the same time as people flew back to different locations carrying the infection. Even if we had started weeks ago we still would have had to address multiple areas simultaneously, by identifying an actual case, estimating how widely it had spread, and then establishing a quarantine zone around that geographic area and establishing rules concerning travel.

[CDu]

According to the article, one can roughly arrive at the number of actual true cases by multiplying the number of deaths by 800. In the U.S. we have had 41 deaths, giving us roughly 32,800 true cases. On 1/22 in Hubei there were 12,000 true cases.

There are two questions: (1) do we have the political will and practical ability to effectively lock down a geographic area in the U.S. the way they did in China, and (2) if we did, is it too late for that to have any effect on the course of the virus in that area.

Let’s just address (2). Regardless of how widespread in the country the virus now is, if we applied the same procedures to a specific U.S. geographic area that were applied in to the Hubei geographic area then it would seem that we would have the same result within that area as in the case of Hubei.

Unlike in China, in this country the infection started all over the place at the same time as people flew back to different locations carrying the infection. Even if we had started weeks ago we still would have had to address multiple areas simultaneously, by identifying an actual case, estimating how widely it had spread, and then establishing a quarantine zone around that geographic area and establishing rules concerning travel.

Regarding (2), the problem is that it is no longer at all isolated, so we don’t know where to apply any containment. And since there are likely thousands if not tens of thousands of people with the virus unwittingly infecting others now, the only way to quarantine now would be to force everyone in the US on isolation for a month or so. Which would be an even larger undertaking than what China did. And without the benefits of a state-run society like China to enforce it (getting to point #1). You can’t just quarantine a small segment of the population and expect major country-wide benefits now because the cat is already out of the bag.

But again, we are back to the original response. Since we are already well past where China was when they shut things down, AND showing no signs of implementing any drastic measures, AND still woefully undertesting, what in that suggests we can realistically hope for anything remotely close to the outcome that China has seen.

[MChambers]

According to the article, one can roughly arrive at the number of actual true cases by multiplying the number of deaths by 800. In the U.S. we have had 41 deaths, giving us roughly 32,800 true cases. On 1/22 in Hubei there were 12,000 true cases.

There are two questions: (1) do we have the political will and practical ability to effectively lock down a geographic area in the U.S. the way they did in China, and (2) if we did, is it too late for that to have any effect on the course of the virus in that area.

Let’s just address (2). Regardless of how widespread in the country the virus now is, if we applied the same procedures to a specific U.S. geographic area that were applied in to the Hubei geographic area then it would seem that we would have the same result within that area as in the case of Hubei.

Unlike in China, in this country the infection started all over the place at the same time as people flew back to different locations carrying the infection. Even if we had started weeks ago we still would have had to address multiple areas simultaneously, by identifying an actual case, estimating how widely it had spread, and then establishing a quarantine zone around that geographic area and establishing rules concerning travel.

Unfortunately, we don't know the number of deaths, because, as someone said earlier, not all deaths in this country are tested for the virus.

[FUBARDoorBuster]

I feel that the modelling or projections that are out there are complicated by the fact that there are TWO version of the virus. Hard to know which one is spreading, and where. For instance, are the German and Italian experience affected by these differences?
https://www.scmp.com/news/china/soci...y-it-addresses
https://academic.oup.com/nsr/advance...searchresult=1
Money quote Our results suggest that the development of new variations in functional sites in the receptor-binding domain (RBD) of the spike seen in SARS-CoV-2 and viruses from pangolin SARSr-CoVs are likely caused by mutations and natural selection besides recombination. Population genetic analyses of 103 SARS-CoV-2 genomes indicated that these viruses evolved into two major types (designated L and S), that are well defined by two different SNPs that show nearly complete linkage across the viral strains sequenced to date. Although the L type (∼70%) is more prevalent than the S type (∼30%), the S type was found to be the ancestral version. Whereas the L type was more prevalent in the early stages of the outbreak in Wuhan, the frequency of the L type decreased after early January 2020. Human intervention may have placed more severe selective pressure on the L type, which might be more aggressive and spread more quickly. On the other hand, the S type, which is evolutionarily older and less aggressive, might have increased in relative frequency due to relatively weaker selective pressure.

The WHO test might be positive for both, as earlier SAS viruses will also turn that test positive. But the Spike in positive cases in China had to be based on clinical changes, "ground glass" findings on CT but there were test abnormalities so clinical findings were used.
The US test had two specific RNA? binding areas, as well as a third site that would turn positive with the old SARS coronavirus. This test "failed" when ..
"The Association of Public Health Laboratories told us more specifically that a negative control, which should not have reacted to any of the primer and probe sets, was coming back positive for the third set, which was the test for all SARS-like coronaviruses.
https://www.factcheck.org/2020/03/th...virus-testing/
So what if the American test was not giving false positives: the general SARS-like was positive, but specific Covid 19 were negative because the newer strain did had mutations in those RNA ranges for the specific probes? We probably have two strains circulating in the US, but I am not sure that tests will return positive here for both strains. If you read this far, correct me if I am wrong. I got slapped on the hand for sending a second test this week...

[swood1000]

Regarding (2), the problem is that it is no longer at all isolated, so we don’t know where to apply any containment. And since there are likely thousands if not tens of thousands of people with the virus unwittingly infecting others now, the only way to quarantine now would be to force everyone in the US on isolation for a month or so.

Well, here’s how National Geographic looked at that question. And China didn’t have to limit it to just a single province. Here’s what it looked like in China:

1000px--COVID-19_Confirmed_Cases_Animated_Map.webm.jpg

The situation in China was hardly localized to one area. The fact that the virus has become diffuse just means that we have to address different regions separately. Our government has the authority. Whether they would be able to pull it off would depend on whether the population gets on board. If they did, they might, for example, subject quarantine-breakers to social sanctions. No doubt some will say that 700,000 deaths is just absurd fantasy, and maybe it is.

[swood1000]

1. China's numbers are bogus.
2. It is too late as described above.
3. You expect National martial law here? I don't see that happening, nor do I think the government has the resources to do it.
4. That would cause a complete collapse of our free market system -- ain't gonna happen.

It may not be too late to address individual geographic areas, as I mentioned above. You could be right, though, that it ain’t gonna happen for reasons having to do with political will and practical ability. Let’s assume that China’s numbers are not bogus and that they have managed to drastically reduce the new cases. And let’s use the estimate of 70 million cases in the U.S. (Angela Merkel estimated that there would be almost this many in Germany alone.) So we’re looking at 700,000 U.S. deaths.

The irony is that in the future China would tout this as an advantage of their system over ours in the case of a pandemic, resulting in .004 the number of casualties even though they have over four times the population.

I’m not sure why it would cause a complete collapse of our free market system. How long does it take to eradicate the virus? China has gotten it down to 8 new cases in 50 days. Would the free market not be able to withstand a quarantine of 90 days? Various shocks come along in life – fires, stock market crashes, disasters of all types – and people go on.

I don’t want to be mistaken for suggesting that anything about this would be easy. But if reality includes the cancelling of March Madness, then everything’s on the table.

[MChambers]

It may not be too late to address individual geographic areas, as I mentioned above. You could be right, though, that it ain’t gonna happen for reasons having to do with political will and practical ability. Let’s assume that China’s numbers are not bogus and that they have managed to drastically reduce the new cases. And let’s use the estimate of 70 million cases in the U.S. (Angela Merkel estimated that there would be almost this many in Germany alone.) So we’re looking at 700,000 U.S. deaths.

The irony is that in the future China would tout this as an advantage of their system over ours in the case of a pandemic, resulting in .004 the number of casualties even though they have over four times the population.

I’m not sure why it would cause a complete collapse of our free market system. How long does it take to eradicate the virus? China has gotten it down to 8 new cases in 50 days. Would the free market not be able to withstand a quarantine of 90 days? Various shocks come along in life – fires, stock market crashes, disasters of all types – and people go on.

I don’t want to be mistaken for suggesting that anything about this would be easy. But if reality includes the cancelling of March Madness, then everything’s on the table.

There have been several thoughtful articles comparing the responses of other countries to that of the U.S. If you're really interested in this topic, as you seem to be, you might want to do some research. Here's a Washington Post article about what the U.S. can learn from Hong Kong's very successful response. https://www.washingtonpost.com/world...arn-hong-kong/

[FUBARDoorBuster]

I’ve been posting Mainly based on published articles... but so proud of Zion. Check Out what he is doing for New Orleans. Hard to post it here, but Google his announcement or check it out on Instagram

[-jk]

Good news on the ground, at least here in my children's hospital, is that we have not been inundated yet. I feel like I'm lucky that I chose pediatric infectious diseases rather than adult infectious diseases, given the disparate effects of the virus based on age, and the information, so far, that suggests that children do much better overall than do adults.

Time will tell.


I agree with others that we can't control people in this country. We have a mindset of independence, freedom, and individuality, and we don't like being told what to do. We are enforcing social distancing only by taking away things of interest that people want to go to, which will likely help, but it's not the same as a "lock-down."

You'd mentioned that the virus was somewhat fragile, and couldn't last outside a host very long. Reports today suggest in lab conditions it can live for days. Does that translate meaningfully to the real world?

thanks,

-jk

[OldPhiKap]

I’ve been posting Mainly based on published articles... but so proud of Zion. Check Outfit he is doing for New Orleans. Hard to post it here, but Google his announcement or check it out on Instagram

Thread on front page:

https://forums.dukebasketballreport...es-for-30-days

Good for Zion.

[FUBARDoorBuster]

Thread on front page:

https://forums.dukebasketballreport...es-for-30-days

Good for Zion.

Thanks. Needed the good news and I am happy that we are sharing on multiple streams