COVID COVID-19 Coronavirus Containment Efforts

[atyy]

I agree largely with the above points. All of the information about COVID-19 that we have available indicates to me that this outbreak will more closely resemble the flu, as opposed to MERS and SARS, in terms of fatality rates and the severity of the disease (despite the fact that COVID-19 comes from the Coronavirus family like MERS and SARS).

It's also worth noting that the CFS rate (that is used to estimate fatality, and is currently estimated to be around 2-3%) is based on the number of deaths out of confirmed cases of COVID-19 infection. Since the evidence is strong that many people infected exhibit no symptoms or only very mild symptoms (and thus escape detection) the true infection fatality rate (IFS) is likely far lower - again, more in line with the common flu. And there does not seem to be any evidence indicating that the virus is mutating to become either more virulent or more severe in terms of illness.

The one area where I disagree is the value of containment. Containment at this stage is still useful to slow the spread of the illness (to reduce the possibility of a more virulent mutation that could emerge) and to give more time for researchers to develop vaccines or more effective antiviral treatments for those at greatest risk of developing severe illness, even if complete containment is not possible.

It doesn't seem like the common flu. In Singapore, out of about 90 cases, about a tenth have had to be warded in an intensive care unit https://www.channelnewsasia.com/new...institution-student-coronavirus-case-12475870. Also, there may not be that many missing cases https://www.statnews.com/2020/02/25...fatality-rate-who-expert-says/comment-page-2/. So I agree it is important to slow the spread of the illness, otherwise hospitals and intensive care units may be swamped.

 

[StatGuy2000]

It doesn't seem like the common flu. In Singapore, out of about 90 cases, about a tenth have had to be warded in an intensive care unit https://www.channelnewsasia.com/new...institution-student-coronavirus-case-12475870. Also, there may not be that many missing cases https://www.statnews.com/2020/02/25...fatality-rate-who-expert-says/comment-page-2/. So I agree it is important to slow the spread of the illness, otherwise hospitals and intensive care units may be swamped.

I have read a quote from a US CDC official which indicates that approximately half of infections could in fact be asymptomatic, and out of those who are symptomatic, approximately 80% of patients exhibit only mild symptoms.

Also, it is worth keeping in mind that the link you've provided with respect to the Singaporean cases doesn't identify the age or health status of those who are in the ICU's. It may well be the case that these patients have other medical conditions that would have led them to be especially vulnerable to respiratory infections.

It's also worth pointing out that the very claim that cases are not being missed in China has been challenged in that very same StatNews article. And I'm inclined to agree with the criticism -- after all, someone who is asymptomatic or only exhibiting mild symptoms will likely escape detection, and thus not be counted as confirmed cases. And these asymptomatic or mild symptom cases are the most likely sources of new infections outside of China.

 

[atyy]

Also, it is worth keeping in mind that the link you've provided with respect to the Singaporean cases doesn't identify the age or health status of those who are in the ICU's. It may well be the case that these patients have other medical conditions that would have led them to be especially vulnerable to respiratory infections.

https://jamanetwork.com/journals/jama/fullarticle/2761890
"Third, given the wide spectrum of clinical severity, clinical criteria and biomarkers are needed that can help differentiate individuals more likely to progress to severe illness. 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."

 

[chemisttree]

This is also true of the seasonal flu. #cases of seasonal flu is modeled rather than counted, death rates are higher with comorbidity, etc...
This still looks 10X worse than seasonal flu. CFR 1% vs 0.1%, hospitalization rate ~20% vs ~2%.

The biggest differences are the quarantine, travel restrictions, empty shelves, etc.

Went to COSTCO yesterday. Here is the section where rice is sold in 50 lb bags. Its been selling briskly!

When I went back 15 minutes later, everything was gone.

 

[Mary Conrads Sanburn]

Spreading Coronavirus forces U.S. administration’s targeted response plans

Thursday, February 27, 2020 by Kim Riley

[. . .]

The White House Office of Management and Budget (OMB) earlier this week sent Congress a total $2.5 billion emergency supplemental spending request to fight the Coronavirus outbreak, which U.S. government health officials warned will inevitably spread across the United States.

[. . .]

###
https://homelandprepnews.com/counte...-u-s-administrations-targeted-response-plans/

 

[StatGuy2000]

https://jamanetwork.com/journals/jama/fullarticle/2761890
"Third, given the wide spectrum of clinical severity, clinical criteria and biomarkers are needed that can help differentiate individuals more likely to progress to severe illness. 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."

The quote above only states that patients without significant co-morbid conditions can potentially develop severe illness. But this was already known from the experience of those patients in China, and it is also true (although to a lesser extent) to both the common flu and (much more significantly) to the H1N1 pandemic.

At any rate, I am still skeptical of the claim made by Dr. Aylward that somehow asymptomatic patients were not missed in China (and thus the CFR is an accurate reflection of the fatality rate).

 

[StatGuy2000]

This is also true of the seasonal flu. #cases of seasonal flu is modeled rather than counted, death rates are higher with comorbidity, etc...
This still looks 10X worse than seasonal flu. CFR 1% vs 0.1%, hospitalization rate ~20% vs ~2%.

The biggest differences are the quarantine, travel restrictions, empty shelves, etc.

Went to COSTCO yesterday. Here is the section where rice is sold in 50 lb bags. Its been selling briskly!
View attachment 257816
When I went back 15 minutes later, everything was gone.

I would be curious to see what proportion of patients are asymptomatic to infection from the seasonal flu. At any rate, while I recognize the seriousness of the current COVID-19 outbreak, I still feel that the response from the public is disproportionate to the nature of the risk, at least in terms of the empty shelves.

 

[mfb]

This is one of the BEST articles of the COVID19 illness. Many points are raised here, some of which I have been thinking of but didn’t feel like I was qualified to discuss.

It uses misleading comparisons, e.g. the number of deaths from the virus up to day with the total number of influenza-caused deaths per year. I don't trust people who feel the need to make comparisons between numbers that have completely different background.

5. Many patients in the Diamond Cruise showed they had COVID19 in their blood, but exhibited no symptoms, which is why unlike H1N1 and other deadly viruses that were quickly contained because patients were too ill to walk around, COVID19 infected patients will spread the virus without knowing as many of them are asymptomatic.
6. The world’s governments and the world’s foremost scientists are doing their best—seriously, cut them some slack.

Note that these claims are in contradiction to the article you liked so much.

All of the information about COVID-19 that we have available indicates to me that this outbreak will more closely resemble the flu, as opposed to MERS and SARS, in terms of fatality rates and the severity of the disease (despite the fact that COVID-19 comes from the Coronavirus family like MERS and SARS).

The WHO estimates 0.94% infection-fatality ratio (95% confidence interval 0.37-2.9%). Where does your much lower estimate come from (the seasonal flu is below 0.1%), and why do ignore the higher estimate?

I totally agree, and I think this point gets lost in the media hype over the issue. 2-3% overall mortality would be really scary, but 2-3% of people already hospitalized is not.

It's ~10% of people who need to be hospitalized. People don't die immediately when they are tested, this takes some time, so death numbers are always behind infection numbers.

The Diamond Princess may be a good self-contained test. As of today, 705 cases and 4 deaths, or 0.6%. I would assume everyone onboard was tested, so the number of cases is probably reasonably solid.

That's an order of magnitude above the flu already, and as far as I know most of these cases are still having the disease. 4 died. How many recovered?
While cruise ships have a higher average age than the population they are also selected for health - people unable to walk around on a ship won't go there, and poorer people with worse access to healthcare are less likely to be on board as well.

Is anyone here AVOIDING public places and staying home more due to this virus?

No. No infection anywhere near me so far and the flu cases are quite limited, too.

And for goodness sake, there is no reason to avoid hotels or public bathrooms or cancelling your trip! That's an overreaction.

I think I said that before, but you generalize too much. For trips to China or out of China you might have to cancel your trip simply because there are no flights or because borders have been closed. For trips to South Korea you might face quarantine when you come back. If you planned to go to a conference that was canceled you might want to cancel your trip. And so on.

 

[mfb]

This is one of the BEST articles of the COVID19 illness. Many points are raised here, some of which I have been thinking of but didn’t feel like I was qualified to discuss.

It uses misleading comparisons, e.g. the number of deaths from the virus up to day with the total number of influenza-caused deaths per year. I don't trust people who feel the need to make comparisons between numbers that have completely different background.

5. Many patients in the Diamond Cruise showed they had COVID19 in their blood, but exhibited no symptoms, which is why unlike H1N1 and other deadly viruses that were quickly contained because patients were too ill to walk around, COVID19 infected patients will spread the virus without knowing as many of them are asymptomatic.
6. The world’s governments and the world’s foremost scientists are doing their best—seriously, cut them some slack.

Note that these claims are in contradiction to the article you liked so much.

All of the information about COVID-19 that we have available indicates to me that this outbreak will more closely resemble the flu, as opposed to MERS and SARS, in terms of fatality rates and the severity of the disease (despite the fact that COVID-19 comes from the Coronavirus family like MERS and SARS).

The WHO estimates 0.94% infection-fatality ratio (95% confidence interval 0.37-2.9%). Where does your much lower estimate come from (the seasonal flu is below 0.1%), and why do ignore the higher estimate?

I totally agree, and I think this point gets lost in the media hype over the issue. 2-3% overall mortality would be really scary, but 2-3% of people already hospitalized is not.

It's ~10% of people who need to be hospitalized. People don't die immediately when they are tested, this takes some time, so death numbers are always behind infection numbers.

The Diamond Princess may be a good self-contained test. As of today, 705 cases and 4 deaths, or 0.6%. I would assume everyone onboard was tested, so the number of cases is probably reasonably solid.

That's an order of magnitude above the flu already, and as far as I know most of these cases are still having the disease. 4 died. How many recovered?
While cruise ships have a higher average age than the population they are also selected for health - people unable to walk around on a ship won't go there, and poorer people with worse access to healthcare are less likely to be on board as well.

Is anyone here AVOIDING public places and staying home more due to this virus?

No. No infection anywhere near me so far and the flu cases are quite limited, too.

And for goodness sake, there is no reason to avoid hotels or public bathrooms or cancelling your trip! That's an overreaction.

I think I said that before, but you generalize too much. For trips to China or out of China you might have to cancel your trip simply because there are no flights or because borders have been closed. For trips to South Korea you might face quarantine when you come back. If you planned to go to a conference that was canceled you might want to cancel your trip. And so on.

(the US put that guy in charge of fighting a Coronavirus outbreak)

 

[StatGuy2000]

It uses misleading comparisons, e.g. the number of deaths from the virus up to day with the total number of influenza-caused deaths per year. I don't trust people who feel the need to make comparisons between numbers that have completely different background.Note that these claims are in contradiction to the article you liked so much.The WHO estimates 0.94% infection-fatality ratio (95% confidence interval 0.37-2.9%). Where does your much lower estimate come from (the seasonal flu is below 0.1%), and why do ignore the higher estimate?It's ~10% of people who need to be hospitalized. People don't die immediately when they are tested, this takes some time, so death numbers are always behind infection numbers.That's an order of magnitude above the flu already, and as far as I know most of these cases are still having the disease. 4 died. How many recovered?
While cruise ships have a higher average age than the population they are also selected for health - people unable to walk around on a ship won't go there, and poorer people with worse access to healthcare are less likely to be on board as well.No. No infection anywhere near me so far and the flu cases are quite limited, too.
I think I said that before, but you generalize too much. For trips to China or out of China you might have to cancel your trip simply because there are no flights or because borders have been closed. For trips to South Korea you might face quarantine when you come back. If you planned to go to a conference that was canceled you might want to cancel your trip. And so on.

(the US put that guy in charge of fighting a Coronavirus outbreak)

For starters, my intention on this thread is to temper the tone of some of the posts which seem to liken COVID-19 to the worst contagion the world has ever faced in history. My specific comparison to the flu was to place COVID-19 to other Coronavirus outbreaks like SARS or MERS, & all evidence to date indicates that COVID-19 is less severe with lower morbidity and death than these. It is more severe than most seasonal flu outbreaks, but not by an extraordinarily high measure.

And as far as cancelling trips, of course one should use good judgement. Cancelling trips to China is sensible. Cancelling a trip to, say, Spain or Hawaii is not sensible.

 

[kadiot]

Sorry if this sounds a stupid question to ask but Asymptomatic don't get sick but can infect others... so if they can not find a cure yet for covid-19, why not study the possibility of turning people into becoming asymptomatic. Is that possible? What's in their blood or body system?

 

[bhobba]

Absolutely not. It's important to keep in mind that the risk of someone contracting COVID-19 in the US and Canada is very low.

Same for Australia. I can't speak for other countries. I listen to the Wall St Journal each day, which is what I am doing right now as I write this. It seems some in the US are worried the President did not appoint a coronovirus Tsar. He has appointed the vice president to oversee it - I can't see exactly what a Tsar would do the vice president can't so I would not worry about that. It's now a game of slowing the spread until the vaccine, which as per my posed interview with the the head of immunology at the university on the Gold Coast, we now have, and has been sent to Australia's CSIRO for mass production, but will not be used until it passes safety and efficacy trials, except maybe for first respondents. That may be why we hear from sources its 18 months away - it takes time to do those trials. But how long with modern methods I do not know, and exactly what the CDC will recommend if it gets out of hand I do know either.

BTW with regard to face masks, while they are useless if you do not have the disease, and if you do, you should be quarantined; if you are going to the doctor because you think you may have it, ring ahead and they will supply you with a face mask on arrival, isolate you until the doctor can see you, then advise on precisely what you should do. That's how it works here and I suspect the same in other modern countries. What worries me is in the US due to cost people may not do that - so please, please if anyone asks you what to do make sure they get checked out. Hopefully procedures will be put in place for those that can't afford to see a doctor in places that do not have 'free' health care.

I also found out from the same professor on the Gold Coast, why the ship in Japan was so bad. It's so simple I do not know why I didn't see it - certainly the Japanese doctors should have seen it. The air conditioning on ships does not contain the filters that filter out viruses, airplanes do, but not ships, so virus laden air was circulated around the ship. They should all have been taken from the ship and isolated in a proper environment. Now the Olympics are in doubt.

Thanks
Bill

 

[bhobba]

Much of the same fears and anxieties about COVID-19 were also expressed during both of these, and (for the most part) people around the world survived through these. I don't see the current situation as being all that different.

Your not kidding. I had many 'discussions', especially with young people, who were obviously scared out of their minds. Their parents should have been explaining this stuff (maybe they were but didn't know the facts well enough), even their schools. One was so worried she even posted - I am going to die before I have had sex. That required a rather diplomatic response. But it does show schools should be getting the facts out to their students - possibly even getting people like the professor I mentioned before to come out and speak to the students - at least show them the interview I saw with him.

Thanks
Bill

 

[bhobba]

Sorry if this sounds a stupid question to ask but Asymptomatic don't get sick but can infect others... so if they can not find a cure yet for covid-19, why not study the possibility of turning people into becoming asymptomatic. Is that possible? What's in their blood or body system?

Not a stupid question. I suspect the hope is the number of people not symptomatic, but still able to spread the disease, is small enough (at the moment anyway), providing the other simple measures like hand washing are taken, it will not trigger an outbreak. But I have to say we do not know for sure. We now have a fast antibody test:
https://www.sciencemag.org/news/202...se-antibody-test-track-coronavirus-infections

It may be we could be required to go to the chemist, doctor or some other community center regularly to be tested.

Thanks
Bill

 

[atyy]

For starters, my intention on this thread is to temper the tone of some of the posts which seem to liken COVID-19 to the worst contagion the world has ever faced in history. My specific comparison to the flu was to place COVID-19 to other Coronavirus outbreaks like SARS or MERS, & all evidence to date indicates that COVID-19 is less severe with lower morbidity and death than these. It is more severe than most seasonal flu outbreaks, but not by an extraordinarily high measure.

It may be high enough that if you don't take it seriously, the medical services may not be able to cope. So I think comparing it to seasonal flu is misleading.

 

[bhobba]

why quarantine your self ?

If you know you have the virus, are not symptomatic, then quarantine is warranted. We now have antibody tests that can detect such people quickly. Likely though, unless there is mass screenings, you will not be picked up. Singapore is doing it, but nowhere else I am aware of, however that may just be a matter of time.

Thanks
Bill

 

[russ_watters]

I won't be. I wouldn't go on a cruise to China anytime soon...

So, I've now read that cruise ships nowhere near China are being denied entry into ports if there are passengers with respiratory infection symptoms. Here's one [not] in the Dominican Republic:
https://www.usatoday.com/story/trav...uses-cruise-ship-amid-virus-fears/4897600002/

My parents just got back from a cruise in that vicinity last week! At the time I didn't think there was any risk, but now I'd say cruises anywhere should probably be avoided, not necessarily due to Coronavirus itself, but due to the potential fallout from fear of the coronavirus.

 

[bhobba]

At the time I didn't think there was any risk, but now I'd say cruises anywhere should probably be avoided, not necessarily due to Coronavirus itself, but due to the potential fallout from fear of the coronavirus.

Agreed. Even before this you were always hearing of sickness spreading rapidly on ships and ruining peoples holidays - should have installed virus filters in air conditioning years ago. The Australians on the ship in Japan, were all tested before they were flown back to Australia, and only those that tested negative were allowed back. But it was stated they expected more cases to show up once they reached Australia and quarantined. Sure enough - 7 if I remember correctly did. Interestingly some complained about the conditions where they were quarantined:
https://www.northerndailyleader.com...hithams-on-arrival-at-darwin-quarantine-camp/

Yes they were legit issues, but the way I was bought up was Australians put up with deprivations when larger issues were at stake.

Thanks
Bill

 

[atyy]

Not a stupid question. I suspect the hope is the number of people not symptomatic, but still able to spread the disease, is small enough (at the moment anyway), providing the other simple measures like hand washing are taken, it will not trigger an outbreak. But I have to say we do not know for sure. We now have a fast antibody test:
https://www.sciencemag.org/news/202...se-antibody-test-track-coronavirus-infections

It may be we could be required to go to the chemist, doctor or some other community center regularly to be tested.

Thanks
Bill

I'm not sure whether the antibody test will detect people who are not symptomatic and able to spread the virus. First, this assumes that these are people in the early stage of the disease, who have the virus, have no symptoms, and can spread the disease - these may not be sginificant, because it is unclear whether people spread the disease significantly when not symptomatic. But suppose we grant that there are such people. I am not sure whether the antibody test will detect these, because the article you linked discusses that the aim of the antibody test is to detect people who had the disease, and have recovered from it - ie. they are asymptomatic because they have no more virus - the article gives one case that is an example of this. The test can also of course detect people who are in the mid or late stages of the disease, who have both the virus and antibodies - the article also gives one case that is an example of this.

The reason I don't know whether the antibody test is effective early in the disease is that it takes time (don't know how long) for antibodies to develop. See Fig 3 of https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266036/ for an example in mice.

 

[mfb]

For starters, my intention on this thread is to temper the tone of some of the posts which seem to liken COVID-19 to the worst contagion the world has ever faced in history.

I don't think that's a good reason to post wrong information and advice that can be harmful. There is enough correct information available to calm down panicking people.

It seems some in the US are worried the President did not appoint a coronovirus Tsar. He has appointed the vice president to oversee it - I can't see exactly what a Tsar would do the vice president can't so I would not worry about that.

Let me put it that way: You certainly want someone in charge who is willing to listen to scientists and their results. I'll leave implications to the readers as I don't want to go more into politics here.

 

[bhobba]

You certainly want someone in charge who is willing to listen to scientists and their results. I'll leave implications to the readers as I don't want to go more into politics here.

Fair point. I was thinking in terms of power to get things done. But willingness to listen to scientists I have no idea. I too do not want to get into politics here, since this forum is not the place to discuss it, plus I only know about Mike Pence from a interview he gave when he visited Australia.

Thanks
Bill

 

[bhobba]

The reason I don't know whether the antibody test is effective early in the disease is that it takes time (don't know how long) for antibodies to develop. See Fig 3 of https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266036/ for an example in mice.

Good point. But I am sure its being worked on because being able to detect early in the disease, then quarantine will slow its spread significantly. That is assuming the very new test Singapore is using does not detect it. There is so much we do not know right now, but I am constantly amazed at the pace of progress and that gives me hope. I haven't read Australia's exact response yet - it's been produced - but will read it soon and post it up. Although I did see a headline it involved mass immunization - but I really need to read the whole document.

Thanks
Bill

 

[bhobba]

Ok. Our PM in Australia has activated our emergency plan:
https://www.news.com.au/lifestyle/health/health-problems/scott-morrison-tells-australians-to-prepare-for-coronavirus-pandemic/news-story/63e23a96e2e8fd3ba189285ab0ce6de0

This is just the first phase. Later phases, if required, include mass compulsory vaccinations and other 'draconian' measures - but IMHO you would need a very good medical reason to refuse a vaccination:
https://www.theguardian.com/world/2...plan-mass-vaccinations-and-stadium-quarantine

Thanks
Bill

 

[atyy]

Good point. But I am sure its being worked on because being able to detect early in the disease, then quarantine will slow its spread significantly. That is assuming the very new test Singapore is using does not detect it. There is so much we do not know right now, but I am constantly amazed at the pace of progress and that gives me hope. I haven't read Australia's exact response yet - it's been produced - but will read it soon and post it up. Although I did see a headline it involved mass immunization - but I really need to read the whole document.

Yes, an effective vaccine would be best. I also hope that some of the anti-viral drugs (remdesivir, or the protease inhibitors) mentioned earlier in the thread might work. Informally, there is hope about remdesivir https://www.pharmaceutical-technology.com/news/who-gilead-remdesivir-coronavirus/.

But back to your idea that if there is significant spread from asymptomatic individuals, I believe the existing PCR test would already do it (just maybe slow and expensive), since if asymptomatic individuals are able to spread the disease, their viral load must be significant.

Not exactly the same idea, but in the same spirit as yours, the UK is randomly testing people with flu-like symptoms for COVID: "In 100 GP surgeries, those coming in with milder flu-like symptoms - dry coughs, fever, shortness of breath - will be tested." https://www.bbc.com/news/uk-51641243

 

[Rive]

Sorry if this sounds a stupid question to ask but Asymptomatic don't get sick but can infect others... so if they can not find a cure yet for covid-19, why not study the possibility of turning people into becoming asymptomatic. Is that possible? What's in their blood or body system?

I see no chance that such dubious tinkering with the immune system at the level where individual differences already matters would gain approval faster than a 'simple' vaccine.

 

[StatGuy2000]

I don't think that's a good reason to post wrong information and advice that can be harmful. There is enough correct information available to calm down panicking people.Let me put it that way: You certainly want someone in charge who is willing to listen to scientists and their results. I'll leave implications to the readers as I don't want to go more into politics here.

Excuse me, but at what point did I give wrong or false information?

Everything I've posted on this thread is based on the available information I've gathered from news sites, published journal articles, and conversations I've had with those in the health-care sector (of which I'm involved as a biostatistician), along with my own analysis and speculation based on these.

And at no point did I claim that COVID-19 is not serious. In particular, any major outbreak will put a strain on the health care systems of those countries affected. My intention was to put all of this in perspective.

 

[chemisttree]

Why don’t we just keep the discussion to the containment efforts for the virus? Nitpicking the “tone” (whatever that is!) or some minor errors doesn’t interest me at all.

So, it’s here in the US and Europe in small numbers. Mistakes were made and people are prepping. Preparing is NOT PANIC. What is certain is that more mistakes are in our future, that Singapore seems to have the best response so far, Japan miffed it initially, Korea is probably a close second to Singapore in handling it and now it’s Iran and Italy’s time in the barrel.

 

[berkeman]

This seems to be a new twist. Can an infected animal infect a human?

https://www.kron4.com/news/dog-test...irus-first-known-pet-amid-worldwide-outbreak/

 

[OmCheeto]

This seems to be a new twist. Can an infected animal infect a human?

Let me fix that for you; "Can an infected human infect their pet?"

Off the top of my head, based on the calliope of vector candidate beasts, I would say yes.

 

[chemisttree]

Foods I’m giving up for Lent

1. Bats. I’ll miss those spicy wings.
2. Snakes. No more late night stops at the House of Slitherin
3. Pangolin. I didn’t like it anyway. Too many scales.
4. Dogs. Tastes too much like Pangolin.
5. Jackfruit. Just because...