COVID COVID-19 Coronavirus Containment Efforts

[hagopbul]

Could there is multiple strains of Covid-19 ?

 

[chemisttree]

The CDC really needs to update https://www.cdc.gov/coronavirus/2019-ncov/hcp/identify-assess-flowchart.htmlto be used by healthcare professionals for identifying potential COVID-19 cases. The bolded part should be “...tests negative for flu...”“For the evaluation of patients who may be ill with or who may have been exposed to 2019 Novel Coronavirus (2019-nCoV)

1. Identify if in the past 14 days since first onset of symptoms a history of either travel to china or close contact with a person known to have 2019-nCoV illness*
2. AND the person has fever or symptoms of lower respiratory illness (e.g., cough or shortness of breath)

if both exposure and illness are present

1. Isolate

• Place facemask on patient
• Isolate the patient in a private room or a separate area
• Wear appropriate personal protective equipment (PPE)

2. Assess clinical status.
EXAM

Is fever present?

Subjective?

Measured? _____°C/F

Is respiratory illness present?

Cough?

Shortness of breath?

3. Inform

• Contact health department to report at-risk patients and their clinical status
• Assess need to collect specimens to test for 2019-nCoV
• Decide disposition

If discharged to home

Instruct patient as needed depending on severity of illness and health department consultation

• Home care guidance
• Home isolation guidance

Advise patient if the patient develops new or worsening fever or respiratory illness

• Call clinic to determine if reevaluation is needed
• If reevaluation is needed call ahead and wear facemask

* Documentation of laboratory-confirmation of 2019-nCoV may not be possible for travelers or persons caring for patients in other countries. For more clarification on the definition for close contact see CDC’s https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.”

 

[OmCheeto]

Italy’s numbers are startling. 18 new cases bringing their total to 39 with 2 deaths and 16 critical cases. # of critical cases ratio to total cases approaching 40%! Something is not right there. CFR is ~5%. Not right at all.

Two deaths, according to my synthetic model, indicates at least 10,000 people are infected.
That would yield a current "actual" CFR of 0.02%.
So, Italy's numbers are startling, to me anyways, in that they indicate their CFR is roughly 1/10 as lethal as the common seasonal flu. (0.14% [ref])

Of course, this doesn't jibe with my other data, that indicates the Covid-19 CFR is about 0.8%, and still rising, so I wouldn't take me too seriously.

Btw, has anyone seen a model like I posted on Thursday?

 

[Ygggdrasil]

Italy’s numbers are startling. 18 new cases bringing their total to 39 with 2 deaths and 16 critical cases. # of critical cases ratio to total cases approaching 40%! Something is not right there. CFR is ~5%. Not right at all.

Mortality from respiratory disease is not uniform across the population. Younger people will have much less mortality than elderly people or people with complications (e.g. people who smoke, people with pre-existing health issues). An outbreak in a university dormitory would have much lower mortality rate than an outbreak in a retirement home. With such small numbers, it's hard to extrapolate information about mortality without more knowledge about the infected population.

 

[Ygggdrasil]

Btw, has anyone seen a model like I posted on Thursday?

Here are some studies cited by the WHO in my previous post that study the issue:
https://www.medrxiv.org/content/10.1101/2020.01.29.20019547v2.full.pdf
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-2019-nCoV-severity-10-02-2020.pdf
https://institutefordiseasemodeling...ality_rates_and_pandemic_risk_assessment.html

 

[mfb]

Italy put 11 villages with a total population of 50,000 under quarantine.
The two deaths that tested positive were both old people (76 and 77). The second victim went to the emergency room for other reasons earlier, so she was probably not in good health anyway.

Edit: Quickly rising confirmed infection numbers in Singapore (discussed+plotted before) and in Japan (33->66 in 4 days, 66->134 in 5 days), and exploding numbers in South Korea (51->556 in 3.5 days). Some of that will come from increased awareness and more tests, but that can't be all.

 

[atyy]

File under, “No Good Deed.” China has filed a patent against Gilead’s patented Remdesivir anti-viral medication for use in treating nCoV. The Wuhan Institute claims to have made the application out of “national interest” and won’t exercise their patent rights if foreign pharmaceutical firms work with China to curb the contagion. In other words, “let us make it in China license-free or we’re just going to steal it from you!”

What an outrage!
https://time.com/5778216/china-patent-coronavirus-drug/

Hmmm, what is the status on this?
http://www.koreabiomed.com/news/articleView.html?idxno=7405
"It is not true that the Wuhan Institute of Virology registered the patent of remdesivir in China. The institute on Jan. 21 sought the China Patent Office’s approval for an urgent use of the remdesivir patent to fight the new coronavirus.

The system allows an administrative order on a third party to use a patent, regardless of the opinion of the patent holder, for a special public need and compensates the patent holder later."

A remdesivir trial is registered here:
https://clinicaltrials.gov/ct2/show/NCT04257656

 

[atyy]

The BC case traveled to Iran and returned home back in January! That’s a long time both for incubation and for the virus to be circulating in Iran.

Which BC case? This one arrived in BC in February:
https://bc.ctvnews.ca/b-c-s-6th-cov...igation-as-new-cases-add-up-in-iran-1.4822454
https://vancouversun.com/news/local...-provide-update-on-novel-coronavirus-thursday

 

[kadiot]

Italy put 11 villages with a total population of 50,000 under quarantine.

Quarantine, a medical term (from Italian: quaranta giorni, forty days) is the act of keeping people or animals separated for a period of time before, for instance, allowing them to enter another country. By doing this, it is possible to limit the risk of spreading disease.

Now the word is being used again in Italy, applied to the government’s draconian reaction as the Coronavirus and the disease known as COVID-19 appear to be hitting the country with a vengeance. More than 50,000 Italians living in 10 communities are literally locked down, facing jail sentences and fines if they leave their homes.

 

[bhobba]

Just listening to a debate on this at the moment. What seems the main concern is bans etc will only slow it down. The only real answer is the vaccine. But what got me and left me gobsmacked is the government only gave $2m to developing the vaccine, but gave, just as an example and in no way addressing the issue if it should be celebrated, $6m to celebrate Captain Cook discovering Australia. That's bonkers - the money allocated to a vaccine should be virtually carte blanche. Containment will fail, the only real answer is the vaccine. Richard Feynman was right - we do not live in a scientific age - god help us.

Thanks
Bill

 

[chemisttree]

Which BC case? This one arrived in BC in February:
https://bc.ctvnews.ca/b-c-s-6th-cov...igation-as-new-cases-add-up-in-iran-1.4822454
https://vancouversun.com/news/local...-provide-update-on-novel-coronavirus-thursday

Yes, I’m reading that now but not before.

“Dr. Bonnie Henry said the woman in her 30s visited the Middle East country in January and returned to B.C. that same month. She was diagnosed after taking herself to hospital with flu-like symptoms, she added, but was sent home.”

 

[chemisttree]

Containment will fail, the only real answer is the vaccine.

I think it’s time to admit that containment has failed. The infuriating thing is that in practically the same breath as the PHEIC declaration, WHO recommended against travel restrictions from China. If you want to point to the instant that quarantine failed, it was back on Jan. 30th.

“In making the announcement, WHO leaders urged countries not to restrict travel or trade to China, even as some have shut down borders and limited visas.”

 

[Bandersnatch]

So, humour me here. And I'm asking @chemisttree mostly, as they seem the most concerned.
The current estimates show the virus has IFR and R0 on the same order of magnitude as the seasonal flu. Similar at-risk populations too.
Why get oneself worked up now, when year after year people generally ignore the flu?

 

[chemisttree]

So, humour me here. And I'm asking @chemisttree mostly, as they seem the most concerned.
The current estimates show the virus has IFR and R0 on the same order of magnitude as the seasonal flu. Similar at-risk populations too.
Why get oneself worked up now, when year after year people generally ignore the flu?

Ask the Chinese, the Italians, the Japanese, the South Koreans, Singapore. They are certainly a bit “worked up.” The flu can’t be stopped and no one even tries. We have a vaccine that sometimes works and even if it doesn’t completely work, it usually gives partial protection. You get sick with this thing and go to the hospital, you could be captured, isolated and people around you don spacesuits.
It ain’t the flu.

Oh, by the way. My preferred pronouns are “he, him.”

 

[Bandersnatch]

I don't mean to be flippant. Looking at the available data, this does seem like a massive overreaction, so I'd like to understand people's concerns.

Oh, by the way. My preferred pronouns are “he, him.”

I will keep that in mind.

 

[bhobba]

Why get oneself worked up now, when year after year people generally ignore the flu?

Fear off the unknown. We know the flu, and this seems to have, in developed countries, a bit higher death rate - although I think that is a somewhat fluid. It attacks the same group too - people like me with compromised immune systems - I take methotrexate and a biologic - both potent immune suppressants. It's not a question of should I get the flu shot each year - its merely a question of when (about end of March - start of April).

I personally am not worried - I have faith in the scientists working around the clock fast tracking the vaccine using the new technologies available. We truly live in the age of magic - and yet we have anti vaccine nutters - go figure. It certainly is an interesting age. Although it greatly annoys me, even the measly $2m given to develop it is not that great a problem. The research groups can easily play on that fear to virtually get any amount they want if it is needed.

Thanks
Bill

 

[chemisttree]

I don't mean to be flippant. Looking at the available data, this does seem like a massive overreaction, so I'd like to understand people's concerns.

I don’t think it’s overreaction. What I believe is going on is that during the height of flu season, we have a rapidly spreading, largely unknown thing. If the caseload stays manageable, if the population demographics are favorable and the CFR is about the same as the flu, if the R0 can be kept close to 1 or lower, if we have enough supplies, if it will die out in the summer it might not be so bad. Lots of “ifs.” If it blows up and overwhelms the local healthcare system, we go from prevention and mitigation to just mitigation which is looking to me more and more like palliative care. I wonder what the CFR is when only palliative care is available?

And we don’t know much about reinfection. What happens if you catch it again? Will it be mild like a cold or serious like dengue? Already there are scattered reports of reinfection. Perhaps the patients never actually cleared the virus in the first place but you would think their own immunity would be able to deal with it after testing negative in the hospital. I haven’t seen anything about ADE in these reinfected patients but I’m hoping it isn’t a problem.

This isn't the flu. Yet.

 

[chemisttree]

Springer Nature has made all of its COVID-19 reports available for free.

https://www.springernature.com/gp/researchers/campaigns/coronavirus

I don’t know how to value this.

 

[atyy]

So, humour me here. And I'm asking @chemisttree mostly, as they seem the most concerned.
The current estimates show the virus has IFR and R0 on the same order of magnitude as the seasonal flu. Similar at-risk populations too.
Why get oneself worked up now, when year after year people generally ignore the flu?

Current IFR estimates include numbers that are 10 times greater than the flu.
https://www.who.int/docs/default-so...ation-reports/20200220-sitrep-31-covid-19.pdf
"Since the publication of modeling estimates in yesterday’s ‘Subject in Focus’, one research group (Ref. 12) has provided a correction of their estimate of the Infection-Fatality Ratio (IFR), with the new estimate being 0.94% (95% confidence interval 0.37-2.9). This replaces the lowest estimate of IFR of 0.33%, but remains below the highest estimate of 1.0% (Ref. 11)"

Also, even if people do recover, it seems many more need intensive care. Singapore has more than 80 cases, with about 4 in intensive care. https://jamanetwork.com/journals/jama/fullarticle/2761890

That article also says "Although published reports to date have identified preexisting chronic noncommunicable diseases as being a risk factor for clinical deterioration, the experience to date in Singapore is that patients without significant comorbid conditions can also develop severe illness."

At one stage, it was reported that 8 were in critical condition in the intensive care unit.
https://www.moh.gov.sg/news-highlig...ree-new-cases-of-covid-19-infection-confirmed

Here is a news report about the experience of one patient who did recover from being critically ill. Apparently, at one stage the doctors even considered extracorporeal membrane oxygenation (ECMO), but it turned out they didn't need it in this patient.
https://www.channelnewsasia.com/new...id19-survivors-on-fighting-the-virus-12459198

 

[dRic2]

I live in Italy, near one of those villages. I know it is bad, but I do not justify this general hysteria. I am a little hypochondriac and the most difficult part is dealing with all the people going nuts about it. I am a bit anxious myself and if all the people around you are all going crazy it's not a very nice feeling.

Let's hope for the best! :DPs. I do think that the quarantine is a good try to prevent it from spreading even more

 

[chemisttree]

I live in Italy, near one of those villages. I know it is bad, but I do not justify this general hysteria. I am a little hypochondriac and the most difficult part is dealing with all the people going nuts about it. I am a bit anxious myself and if all the people around you are all going crazy it's not a very nice feeling.

Let's hope for the best! :DPs. I do think that the quarantine is a good try to prevent it from spreading even more

Good luck! I have seen pictures of the shops in Milan with empty shelves. I’ve lived through that every time a hurricane threatens landfall close to San Antonio, Texas. What have you seen that you call “people going nuts” and “general hysteria?” Are you able to still go to work with the restrictions?

 

[bhobba]

Ps. I do think that the quarantine is a good try to prevent it from spreading even more

It must be tried to give us the time to develop the silver bullet - the vaccine. Groups around the world are working around the clock to get the best one. They already have it (evidently a number of groups do including the UQ group I posted about which has the patent for a fast track technique being used - but this is a global effort - when a possible pandemic is at stake who holds the patent goes out the widow - as it should)- it's just determining effectiveness and safety. The time-table is April for a vaccine to be used by first responders, then June - July for general distribution. I listen to what the UQ says on the matter - even highly credentialed immunologists saying years do not seem to be up with the latest technology we now have.

I have to laugh at the US talk shows on this - they all say, basically, the US biotech companies will find the solution. This is not just a US effort - its a world wide effort of which the US is just a part - of course a major part - but they are, like everyone else, all working together on this one.

Thanks
Bill

 

[kadiot]

“In making the announcement, WHO leaders urged countries not to restrict travel or trade to China, even as some have shut down borders and limited visas.”

I cannot help but laugh. At least 30 countries already reported infections and deaths, and yet... Geneva always like to do it political. Not until Italy reported more cases and deaths that Geneva started talking about a “possible pandemic”. The World Health Organization's headquarter is located in Geneva, Switzerland. The distance between Geneva and Italy is 652 km. The road distance is 906.5 km.

 

[kadiot]

OVERHEARD: "When a pandemic is declared, stringent containment measures will be abandoned and priorities will shift to efficient case management and mitigation of transmission. Travel bans may still remain but will be less essential to the response."

Is it true?

 

[dRic2]

What have you seen that you call “people going nuts” and “general hysteria?” Are you able to still go to work with the restrictions?

Empty shops, closed work offices and universities (and schools), public events are cancelled. Basically all you can do is stay at home and talk to your family or friends. And the conversations go something like:
A- how are you?
B- fine
A- hope we don't get it. I heard at the news that...
(Sneeze)
B- oh. Are you sure you are ok? Maybe we should leave town for a while

 

[dRic2]

The time-table is April for a vaccine to be used by first responders, then June - July for general distribution

Local news said we should wait till next year (18 months required)

 

[StatGuy2000]

Mortality from respiratory disease is not uniform across the population. Younger people will have much less mortality than elderly people or people with complications (e.g. people who smoke, people with pre-existing health issues). An outbreak in a university dormitory would have much lower mortality rate than an outbreak in a retirement home. With such small numbers, it's hard to extrapolate information about mortality without more knowledge about the infected population.

To @chemisttree and @OmCheeto ,

@Ygggdrasil is correct in that mortality from respiratory disease is not uniform across populations. People who are elderly or with pre-existing medication conditions have much higher mortality rates from all respiratory diseases (including the common flu) than younger people or people who are in good health.

The 2 deaths in Italy as far as we know were among those who were elderly, and it may well be possible that they had other medical conditions that would have made them especially at risk from any serious respiratory infections, not just COVID-19. So we cannot conclude that somehow COVID-19 is more virulent or deadly based on such limited data.

 

[kadiot]

The 2 deaths in Italy as far as we know were among those who were elderly, and it may well be possible that they had other medical conditions that would have made them especially at risk from any serious respiratory infections, not just COVID-19. So we cannot conclude that somehow COVID-19 is more virulent or deadly based on such limited data.

Cause of death is very difficult to prove. I think it requires pathologist as expert witness.

 

[jbriggs444]

Cause of death is very difficult to prove. I think it requires pathologist as expert witness.

Difficult even to define. But we are not after proof here. We are after supportable metrics.

 

[kadiot]

Difficult even to define. But we are not after proof here. We are after supportable metrics.

I find this problematic because Covid-19 is deadly to elderly, the very young and those with medical conditions. We can't tell the number of people who actually died in Covid-19 out of the total number of reported deaths.