Coronavirus - Overall
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@mariner4life said in Coronavirus: should I be panicking yet?:
@Tim paywall bruss
On January 18, roughly six weeks after China’s deadly coronavirus started to spread in Wuhan, the city’s Baibuting district was preparing for its annual mass banquet. On the 20th anniversary of the event, the organisers would be attempting to break a world record for the largest number of dishes served. Long tables in 10 locations were laid out with a total of 13,986 dishes, some bearing patriotic names such as Motherland in My Heart (cucumber and ham), and One Belt One Road (vegetable salad). The platters were prepared by members of some 40,000 families, according to media reports, with many of them showing up to eat the food and smile for the cameras. Despite those happy scenes, the Baibuting banquets now stand as a symbol of China’s mishandling of a viral outbreak that has killed 565 and infected more than 28,000, and spread to at least 27 countries and territories. The district is now facing a rising toll of infected citizens. Notices saying “fever block” in red and black letters were pasted this week on 57 communal stairwells in the district, according to local reports and photographs seen by the Financial Times. “I feel very lucky I didn’t take part in the banquet, as I have two young kids and thought it was inconvenient to bring them along,” says Sally Zhang, a Baibuting resident. “There are now more than 10 infections among my neighbours”. The epidemic ranks as the biggest crisis to have hit Xi Jinping, China’s Communist party leader, since he took power in 2012. Not only has the outbreak brought large swaths of the world’s second-largest economy to a grinding halt, it also undermines the party’s aura of competence. Piecing together the events in Wuhan shows that for at least three weeks before the banquet, city authorities had been informed about the virus spreading in their midst but issued orders to suppress the news. In effect, they engineered a cover-up that played down the seriousness of the outbreak, according to officials and medical professionals. Residents sit around a table full of homemade dishes on February 9 2018 in Wuhan. The mass banquets in the city's Baibuting district now stand as a symbol of China’s mishandling of a viral outbreak © Wang He/Getty The most fateful consequence of the official silence was that it facilitated the exodus of some 5m people in the weeks before the city was quarantined on January 22, thus helping to transport the virus all over the country and overseas. Slow and sometimes contradictory statements from the World Health Organization, which is responsible for warning the world of public health emergencies, also hampered early efforts to combat the crisis. Just as with China’s Sars outbreak that killed 800 people worldwide in 2002-03, the central shortcomings in China’s response have derived from its rigidly hierarchical political system. “There is no question that the Wuhan government underestimated the disease,” says a senior adviser to China’s central government, who declined to be named. “The mayor of Wuhan has neither the expertise nor the willingness to follow health experts’ advice. His concern is that an escalation in disease prevention may hurt the local economy and social stability.” He adds: “In the current political atmosphere, which values obedience more than competence, local officials have an incentive to avoid taking responsibility.” Jude Blanchette, a China analyst at CSIS, a Washington-based think-tank, also sees a political dimension behind the health emergency. “There’s a natural inclination for party officials at all levels to bury negative information and censor dissenting views irrespective of who’s in charge in Beijing,” says Mr Blanchette. “But under Xi Jinping, the inclination to suppress has become endemic and, in this case, contributed to a prolonged period of inaction that allowed the virus to spread.” Coronavirus Timeline of an outbreak DEC 8 The first patient to be later diagnosed with Wuhan coronavirus presents with symptoms. Chinese medical experts later trace an earlier case of a patient who experienced the symptoms of the virus on December 1. DEC 30 Li Wenliang, a Wuhan doctor, informs fellow doctors in an online chat group of seven new pneumonia cases. But Wuhan medical authorities forbid doctors from making public announcements and order them to report cases internally. JAN 2 Hospitals admit 41 patients in Wuhan, 27 of whom had direct exposure to a local seafood market which is regarded as one of the sources of the virus. JAN 10 Scientists publish the first gene sequencing data on the virus, showing it to be from the same family as the Sars coronavirus. JAN 18 The number of infected patients rises to 62. Wuhan city government holds an annual mass public banquet in Baibuting with some 40,000 families making and sharing food. JAN 21 The US reports the first laboratory-confirmed case as the virus starts to spread beyond mainland China. JAN 23 Wuhan suspends all public transportation from the city, including bus, metro and ferry lines. Additionally, all outbound trains and flights are halted. FEB 5 The count of countries and territories to have reported confirmed cases rises to 27. Several claims made by the Wuhan authorities about the virus, which began to spread as “pneumonia of unidentified causes” from early December, conflict with the testimonies of health professionals. The first issue was the repeated claims by officials that human-to-human transmission of the virus was limited. Zhou Xianwang, mayor of the city of 11m, was still citing this explanation in a state television interview on January 21, when the number of cases had risen to 312. “The reason why the Baibuting community continued to host the banquet this year was based on the previous judgment that the spread of the epidemic was limited between humans, so there was not enough warning,” he said. But Wuhan authorities had been informed weeks earlier that the virus could indeed be spread between humans. In an interview with Huxijie, a medical website, Zhao Jianping, a pulmonologist at Tongji Hospital in Wuhan, said he diagnosed patients with suspected coronavirus as early as December 27. “We didn’t expect the disease to be so severe,” said Mr Zhao. “But we were sure it could spread from human to human.” Mr Zhao said he immediately reported the situation to the Wuhan Centre for Disease Control and Prevention. In addition, the Wuhan Municipal Health Commission, a body that reports directly to the mayor, said as early as January 16 that the virus may have been spread by human contact — two days before the banquets were held and six days before the city was finally quarantined. Scientists in the New England Journal of Medicine said there was transmission between humans in close contact from the middle of December. The other glaring inconsistency in the Wuhan authorities’ account is why the official number of patients identified as having the disease did not rise between January 2 and January 16 — a crucial two-week period when millions of Wuhan residents were starting to return home for Chinese new year. This period coincided with key dates in the city’s calendar. Between January 6 and 11, cadres from across Hubei province gathered in Wuhan for the annual session of the local People’s Congress. At this time, too, Wuhan authorities handed out some 200,000 free or subsidised tickets to local attractions. Premier Li Keqiang, (C), talks to medical workers at Wuhan Jinyintan Hospital on January 27 © Li Tao/AP Nevertheless, several accounts have emerged to show that even though the official count of coronavirus cases did not rise, the number of people becoming infected was surging. A radiologist in a Wuhan public hospital was quoted by Caixin, a Chinese news website, as saying he identified 50 new cases on January 15. The official Xinhua news agency, meanwhile, ran a story on a doctor who fell ill with the virus on January 11. Reinforcing such accounts of a cover-up, Li Wenliang, a doctor at the Central Hospital of Wuhan, informed fellow medics in an online chat group on December 30 of seven new pneumonia cases. But on the same day that Dr Li mentioned his cases, the WMHC was forbidding hospitals from making public announcements and telling hospitals to simply report cases internally. This approach was causing consternation in Dr Li’s chat group, with one writing that “the government still hasn’t determined whether to announce”. The same person added in a subsequent post that “last Friday [December 27], our department was the first to report it to the city centre for disease control”. But in spite of the authorities’ attempts to control the flow of information, news of the virus soon got out. By the evening of December 30, a hashtag of “Wuhan Sars” was trending on the popular Chinese microblog Weibo, before censors removed it. The information crackdown continued with Dr Li being reprimanded by Wuhan police, who made him sign a document saying his statements were inaccurate, according to a photo of the document he shared with Chinese media. At least seven other medical professionals were similarly warned over “rumour-mongering”. Dr Li was by no means the only Wuhan resident to realise something was amiss as early as December. One resident, who identified himself only by his surname, Wu, says: “I heard about it in December, but it wasn’t clear what was going on. There were small news items online, but the government said it wasn’t a problem so we didn’t pay too much attention.” Mr Wu says the moment of realisation in the city was when Zhong Nanshan, an epidemiologist who became famous for his work during the Sars epidemic, confirmed on state television on January 20 what many other health professionals had been saying in private or in online chat groups for weeks: the virus could be spread from human to human. When the FT arrived in Wuhan on January 19, the streets were busy, restaurants and shops were open as usual. The mood transformed overnight on January 22, when the city announced it would close its public transport links the next day. Suddenly, the streets became quieter and almost everyone who ventured outside wore a mask. Most businesses began to close and tens of thousands of people streamed into hospitals with suspected symptoms. Medical staff transfer patients to the newly completed Huoshenshan Hospital on February 4 © EPA-EFE/Shutterstock Eventually, China’s supreme court acknowledged that the suppression by Wuhan authorities of Dr Li’s warnings over the virus along with those of seven others had been wrong. On January 29, the court said the Wuhan police should have been “tolerant” rather than accusing them of rumour-mongering. On the same day, Zeng Guang, chief epidemiologist at China’s Centre for Disease Control and Prevention, criticised local governments for failing to consider public health issues from a purely science perspective. “What we said is only partially incorporated into the decision-making process,” Mr Zeng was quoted by the official Global Times newspaper as saying. “[Local governments] take a political perspective and consider social stability, the economy and whether people could happily enjoy Lunar New Year.” Despite the evidence of a cover-up, some aspects of China’s response to the crisis have been impressive. By January 10, researchers at Fudan University in Shanghai had sequenced the coronavirus gene, a key step in understanding characteristics of the epidemic. In addition, authorities in Wuhan moved fast to build two new hospitals. A 1,000-bed facility called Huoshenshan, was constructed in just 10 days. Nevertheless, the enormous human and economic costs of censorship — both for China and for the rest of the world — are starting to come into sharp relief. Several respected scientists have estimated that the true number of people infected by the coronavirus may be several multiples higher than the official figures from China suggest. Officials in protective gear disinfect Indonesian students as they disembark upon arrival at Hang Nadim international airport in Batam, after being evacuated from Wuhan © Indonesian Embassy/AFP/Getty Gabriel Leung, dean of the University of Hong Kong’s medical school, said on January 31 that in Wuhan alone some 75,800 people may have been infected. Mr Leung’s estimate compared with an official number of confirmed cases in all of China of 11,791 on the same day. The economic cost is also mounting. Li-Gang Liu, chief China economist at Citi, forecasts that the country’s first-quarter growth will slow to 4.8 per cent compared with a full-year rate of 6.1 per cent in 2019. Disruptions to global supply chains are set to deepen. But as the world counts the cost, the WHO’s conduct faces increased scrutiny. It declared a global health emergency on January 30, by which time the virus had spread well beyond China, reversing its own decision of a week earlier to hold off on such a declaration. The WHO said it did not declare a global health emergency at the earlier meeting largely because there had been no evidence of human-to-human transmission outside of China. This was its second public reversal. On January 14, a WHO epidemiologist said there had been “limited” human-to-human transmission of the virus. But later that day the WHO said there had been a “misunderstanding” and that there was “no evidence” of human-to-human transmission. “The WHO is so much in thrall to China’s influence, they have felt compelled to stay close to China’s line on this crisis,” says one UN diplomat who spoke on condition of anonymity. “China wanted to downplay this virus and the WHO felt it had to fall into line, at least until its position became untenable.” However, John Mackenzie, a member of the WHO’s emergency committee, laid the blame for the slow response at China’s door. He told the FT that China must have been withholding information on new cases from the WHO. “Had they [Beijing] been a bit stronger earlier on, they might have been able to restrict the number of cases not only in China but also overseas,” he said. The WHO said it has held “frank” discussions with Chinese leaders. “Keeping open lines of communication between Chinese authorities and WHO has been critical in helping China, and the world, respond to this outbreak,” it said. Many closer to the outbreak’s centre have a more critical view of the Chinese authorities. Li Kun, a resident of Huanggang City close to Wuhan, where more than 1,400 cases have been confirmed, has cut his number of daily meals from three to two after the local government last week ordered every family to send no more than one person out once every two days. “I believed in the government when the disease first broke out,” he says. “Now I think twice whenever officials say something.”
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thanks for posting.
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https://www.nzherald.co.nz/travel/news/article.cfm?c_id=7&objectid=12306916
If he is able to get units into circulation fast, someone is going to get rich fast
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@canefan said in Coronavirus: should I be panicking yet?:
https://www.nzherald.co.nz/travel/news/article.cfm?c_id=7&objectid=12306916
If he is able to get units into circulation fast, someone is going to get rich fast
Look at me, I’m the real life Bubble Boy
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This was a great take from Twitter IMO:
1\ Some pop poli-sci that may be wrong, but I want to air it
People look at the low lethality of Coronavirus (comparable to common flu) and say "But it MUST be bad, otherwise China wouldn't be reacting this way"
I think this misses a crucial point:
2\ Totalitarian regimes have an implicit compact with their citizens:
"We will run everything in your life. In exchange, nothing will ever go wrong."
Because if anything goes wrong, it can only be the fault of the state
3\ This is why Chernobyl was an existential embarrassment for the USSR
With nobody to blame but themselves, the USSR had to cover it up
The CCP can't cover up Coronavirus, so they must instead project strength and decisiveness
4\ Now remember that this is the same CCP that forced the entire country to stop working and kill sparrows in the 60s
Same CCP that has 1M Muslims in concentration camps
Same CCP that's embarrassed by its tardy SARS response
"Proportionality" is not part of the playbook
5\5 Maybe CoV will turn out to be a big deal (I'm betting deaths will be below 10K)
But let's not make the mistake of assuming the CCP is acting in proportion to the risks
Totalitarianism is a public relations game, and the CCP will make economic sacrifices to look in control
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@Tim said in Coronavirus: should I be panicking yet?:
A lot of Universities and companies had their re-opening date pushed back by a week yesterday.
Yep, there are a lot of companies about to learn about supply chain risk
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@Tim said in Coronavirus: should I be panicking yet?:
Love this quote:
I think the place is run by a private company on behalf of the NHS. You can email an order to them and two hours later whatever you asked for shows up. There’s a guy who has ordered bottles of wine, spirits and two crates of beer and he’s keeping them in his bedroom. Tonight he offered me some wine. I felt like I was going into a bar. He gave me a paper cup full of wine. I thought: “Are you kidding me? This is ridiculous!” He’s ordered all of it through this company and they’ve given it to him for free, no questions asked. It’s incredible.
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Swine flu deadlier than coronavirus: AstraZeneca’s Pascal Soriot
Pascal Soriot, chief executive of pharmaceutical giant AstraZeneca, says it is too early to gauge the fallout of the coronavirus outbreak, but has urged for calm, stating the H1N1 pandemic in 2009 was deadlier. AstraZeneca, the largest exporter of pharmaceuticals in Australia, shut down its factory and office in China for an extra week following Chinese New Year. Mr Soriot told The Australian he was expecting a negative impact to the British-Swedish multinational’s operations, but it would take some time to gauge the extent of the fallout. “It’s a good question,” Mr Soriot said when asked about coronavirus. “We have extended the closure of our plant (in China). We are continuing to supply hospitals in China and expect there will be some impact, but we have to wait and see.” AstraZeneca employs about 16,000 staff in China, including a couple of hundred in Wuhan — the epicentre of the coronavirus outbreak. Mr Soriot said up to five staff had been infected with the virus but had recovered. He called for calm, stating that “H1N1 virus killed more people than coronavirus”. “It’s tough and a challenge for them (the Chinese),” Mr Soriot said, adding that the company’s senior management had been holding regular video conferences with AstraZeneca’s team in China. “The world is looking at them but it’s not their fault. The H1N1 (swine flu) virus (outbreak in 2009) started in the US.” The number of deaths in China’s central Hubei province from the coronavirus outbreak has risen 780, according to Chinese regional health authorities. There has been a further 2447 cases detected in Hubei, the epicentre of the outbreak, taking the total in the province to 22,112. This compares with H1N1 2009, which killed 18,449 people and infected 60.8 million. Mr Soriot was speaking as AstraZeneca announced a $200m upgrade of its western Sydney factory which will increase its exports to $4.4bn during the next four years. The investment follows $100m announced in 2017 and will create 250 jobs. “This investment will allow us to bring more life-changing respiratory medicines to patients, with asthma and chronic obstructive pulmonary disease.” British Foreign Secretary Dominic Raab said the investment was testament to the “flourishing UK-Australian trade partnership”. Mr Raab is in Australia on his first overseas trip since Britain finally withdrew from the European Union. “It was great to see first hand how British talent and innovation have enabled Cambridge-based AstraZeneca to announce £100m investment into a state-of-the-art research centre that will focus on sustainable healthcare, which will ultimately benefit people around the world,” Mr Raab said. “This is another example of the great opportunities presented by the flourishing UK-Australian trade partnership and the business links between our two countries.” Mr Soriot said AstraZeneca also planned to plant 25 million trees in Australia as part of its commitment to become carbon neutral by 2025 and the bushfire recovery effort. AstraZeneca had originally planned to plant 10 million trees in Australia but Mr Soriot said they increased the number in the wake of the bushfire disaster. He said the company was finalising where and when the trees would be planted but hoped the project would be completed in the next two to three years. “It will depend on how quickly we can plant,” Mr Soriot said. “The recent Australian bushfires are a powerful reminder of the impact the changing climate is having on our planet. We cannot deny we are in a climate crisis which is why we are doing our part to help with the reforestation of Australia.” AstraZeneca is working with One Tree Planted, a not-for-profit reforestation organisation, and other local organisations to complete the tree planting in Australia, which will account for half of the company’s global commitment to tree reforestation.
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@antipodean nice to get this virus put in context
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See below, posted from a whatsapp thread I'm on:
This is long but worth the read if you are interested. CLSA hosted a Conference call with Coronavirus expert in HK, professor John Nicholls a clinical professor in pathology at the University of Hong Kong and expert on coronaviruses. He was a key member of the research team at the University of Hong Kong which isolated and characterized the novel SARS coronavirus in 2003. He’s been studying coronaviruses for 25 years (full bio here). The recording of the call can be found on the website. Below are notes transcribing the call.
Quick summary: look at the fatality rate outside of Wuhan - it’s below 1%. The correct comparison is not SARS or MERS but a bad cold which kills people who already have other health issues. This virus will burn itself out in May when temperatures rise. Wash your hands.
My notes from the call below:
Q&A Session with Professor Nicholls:
What is the actual scale of the outbreak? How much larger is it compared to the official “confirmed” cases?
People are saying a 2.2 to 2.4% fatality rate total. However recent information is very worthy - if you look at the cases outside of China the mortality rate is < 1%. [Only 2 fatalities outside of mainland China]. 2 potential reasons 1) either china’s healthcare isn’t as good – that’s probably not the case 2) What is probably right is that just as with SARS there’s probably much stricter guidelines in mainland China for a case to be considered positive. So the 20,000 cases in China is probably only the severe cases; the folks that actually went to the hospital and got tested. The Chinese healthcare system is very overwhelmed with all the tests going through. So my thinking is this is actually not as severe a disease as is being suggested. The fatality rate is probably only 0.8%-1%. There’s a vast underreporting of cases in China. Compared to Sars and Mers we are talking about a coronavirus that has a mortality rate of 8 to 10 times less deadly to Sars to Mers. So a correct comparison is not Sars or Mers but a severe cold. Basically this is a severe form of the cold.
You mentioned a shortage of testing kit can you talk more about that?
There are two ways to detect a virus. 1) Through the genetic material – DNA or RNA or 2) to detect the protein of the virus. The rapid tests used in a doctors’ labs look at the protein. The problem with that is that you need an antibody to pick it up. And it takes 8-12 weeks to make commercial antibodies. So right now for the diagnostics tests they are using PCR which give you a turnaround in 1-2 hours. But then you need to run a machine and run 96 runs in 1 hour but then you have to a batch of samples so there’s another delay of 5-6 hours for patient presentation. So that will lead to some problems you can’t turnaround in 5-10m which is what you want when a patient shows up to the emergency room. Because right now you also have influenza going around so what you want is to be able to rule out influenza so you can treat the patients correctly for coronavirus. So that may be why they missed some of the earlier cases.
Your colleague at HK university estimated that the size of the infected population on Jan 25th was 75K with a doubling time of 6.4 days. So by feb first we would have 150k infected. How accurate do you think these models are and how accurate have they been in the past?
Those figures did not take into account restriction on travel, quarantine etc… These reports are likely on the high side. This is not taking into account social distancing. Historically these models have not been all that accurate.
When do you think this thing will peak?
Three things the virus does not like 1) sunlight 2) temperature and 3) humidity. To make you guys really worried. A coronavirus can survive on a stainless steel surface for 36 hours. It hangs around for quite a bit.Sunlight will cut the virus ability to grow in half so the half-life will be 2.5 minutes and in the dark it’s about 13m to 20m. Sunlight is really good at killing viruses. That’s why I believe that Australia and the southern hemisphere will not see any great infections rates because they have lots of sunlight and they are in the middle of summer. And Wuhan and Beijing is still cold which is why there’s high infection rates.
In regards to temperature, the virus can remain intact at 4 degrees or 10 degrees for a longer period of time. But at 30 degrees then you get inactivation. And High humidity the virus doesn’t like it either. That’s why I think Sars stopped around May and June in 2003 – that’s when there’s more sunlight and more humidity. The environment is a crucial factor. The environment will be unfavourable for growth around May. The evidence is to look at the common cold – it’s always during winter. So the natural environment will not be favourable in Asia in about May.
The second factor is that of personal contact. With Sars once it was discovered that the virus was spread through the fecal oral route there was much less emphasis on the masks and far more emphasis on disinfection and washing hands. HK has far more cleanliness (than China) and they are very aware of social hygiene. And other countries will be more aware of the social hygiene (than China). So in those countries you should see less outbreaks and spreading. A couple days ago the fecal-oral route of transmission was confirmed in Shenzhen. In China, most of the latrines are open- there’s more chance of phermites (?) being spread. But in other countries the sanitations systems tends to closed. My personal view is that this will be a bad cold and it will all be over by May.
People talk about the vaccine and this is the big problem that people get from movies. Where in the movie they come out with a vaccine and then three days later it’s all over the world and everybody is saved. In reality this does not happen because for a vaccine you need to go through clinical trials – is it safe and will it work. The last thing you want to do is rush a vaccine too early. If you get any severe reactions, then the anti-vaxxer will just say “I told you so”. You are talking about a working vaccine in 1 to 2 years. With SARS, in 6 months the virus was all gone and it pretty much never came back. SARS pretty much found a sweet spot of the perfect environment to develop and hasn’t come back. So no pharmaceutical company will spend millions and millions to develop a vaccine for something which may never come back. It’s Hollywood to think that vaccines will save the world. The social conditions are what will control the virus – the cleaning of hands, isolating sick people etc…
What do we know about the transmission rate? It’s been estimated around 2.2 to 2.68. What percent of the patients are transmitting while being asymptomatic?
This is a big problem when you talk about asymptomatic that means you have a good diagnostic test- where you can say they are asymptomatic (which we don’t have with this virus).
We actually looked at this with MERS where people were saying it had a high fatality. We went to Camel abattoirs and took serums from the abattoir workers and found that quite a few had low infections with no symptoms. This is what should have been done at the initial stages at the seafood market. But to do that you need a good diagnostic test. A good diagnostic test is necessary to determine to the transmission rate. Now we have normal human airways and we can now look at how long it takes the virus to replicate in that environment. And that will be very useful to determine those who are asymptomatic carriers.
Any sense of whether the estimates of the reproductive number the Ro of 2.5 or 2.7. Do you think that is high or low. What does that mean?
Measles was about 10-15 and influenza is just below 2. I think it’s about 2.2 as it’s being transmitted within the community.
Have we seen any super spreaders? We saw that with Sars and Mers.
There’s talk about that but the epidemiologists are still overwhelmed so no clear answer. But I don’t think there are any super spreaders.
What is the percentage of people transmitting the virus while being asymptomatic?
Unlike SARS, patients were symptomatic at about day 5, some of these cases may be asymptomatic until about day 7. That’s based on the first publications. Asymptomatic is probably the first 5 days.
There’s a paper published looking a familial cluster with a boy who was shedding the virus and he was asymptomatic.
That’s something about kids and we saw this with Sars. Very few kids had very severe disease. We are trying to determine if this is a virus which we call low (unintelligible) kind of inducer or high (unintelligible) kind of inducer. SARS is high [unintelligible] kind of inducer. This means that when it infects the lower part of the lung, the body develops a very severe reaction against it and leads to lots of inflation and scarring. In SARS what we found is that after the first 10 to 15 days it wasn’t the virus killing the patients it was the body’s reaction.
We are doing testing on this now. Is this virus in the MERS or SARS kind picture or is this the other type of virus which is a milder coronavirus like the NL63 or the 229. I think this will be a mild (unintelligible) kind inducer.
Case fatality is about 2.5% or so? Do you expect this to change over time? And are you seeing any difference among the young population and older population in terms or mortality rate?
SARS went really for people in their 30 or 50 years. And MERS on the other hand basically is if you have co-morbidity – try and find somebody in the middle east who does not smoke or does not have high blood pressure etc... The data coming out of China seems to indicate that it’s those with the co-morbidity are most at risk. For the seasonal influenza that’s also what we find. It’s the people with the co-morbidity that have the increase mortality rate. Having said that there’s a guy in the Philippines who died in his mid-30.
I think this looks more like the seasonal influenza where those who die have to co-morbidity. Now that we have better case control definitions outside of mainland China, we will get a true assessment of the fatality rate. I would now put it at about 0.8% to 1%. When you look at all the death reports – separate out the deaths from mainland China and outside China.
Mortality rate in China – is much higher? Why?
Its related to the environment. In the high income countries you don’t have as high a population density, higher level of environment control and hygiene. In Indonesia – it’s unlikely to spread much as it’s very hot and humid. Would this virus move to Africa? I think that’s unlikely – too hot there’s not a lot of travel there.. Europe – possibility higher transmission but environmental care is higher.
At this stage it’s a really bad cold which can cause problems in people. People are talking about the “lethal virus” but seasonal influenza can cause deaths in elderly but we don’t call that “the lethal influenza”
There’s news reports that antivirals are being used and that it’s working what are your thoughts on that?
With SARS it didn’t seem to work at all with the commercially available antivirals. But there seems to be good effects with the case in Washington with the Gilead agent. And it sounds like China will be using it.
Interferon works and it has quite a bit of benefit.
The problem with the antivirals – because the virus has different ways of replicating within the cell, finding a nice common target has been difficult. But the Gilead agent appears to me to be very promising. We now have the virus growing in our labs/cultures so can now test it to see what will work and not work.
Would the opening of the hospitals in China change anything?
What we found with SARS in HK was that a contributing factor to the spread was the overwhelming of the HK healthcare system. Hospitals and doctors were overwhelmed. When China built these Wuhan hospitals – it’s to take the work load off the staff which is likely exhausted.In HK with SARS we found quite a lot of infection of healthcare workers as they are close and doing invasive procedures. But this time around there is not much evidence of the healthcare workers getting sick or dying (but maybe China is not reporting it) so this may suggest that I think it is not being spread by close aerosol contact but more by the fecal-oral route or with droplets. So it will not be as contagious within hospitals. So getting the two hospitals built it will take a lot of the work load off the other hospitals so it should be a big benefit.
The recovery rate now higher than the deaths rate? Thoughts on that?
What we found is that in HK with SARS we didn’t know how long to treat a patient for. Now in China they are using the SARS model but treating patients for shorter time periods so that they don’t get the secondary problems that they did with Sars. Getting actual data on recovery from the mainland is still a bit of a challenge.I’d consider a patient recovered if he’s been discharged. The problem is that with SARS, there were quite a bit of people where the steroid were very beneficial to treat the acute stage and we didn’t know how long the virus would live for so we kept them on the steroids for a long period of time and they came out with all sorts of secondary problems due to the immunosuppression.
I haven’t seen any data on the quality of life of those who have been discharged.
Evidence of E-coli?
Secondary infection are most likely the cause of deaths of the patients in the Philippines and HK.What does it mean for a patient to have recovered?
That means the patient has been discharged from the hospital. That’s the criteria for Hong Kong. But there’s no good data or guidelines on this.What is the probability that this will be contained and eradicated or will it be endemic in the human population?
If it is like SARS it will not be endemic. It most likely will be a hit and run just like SARS. People talk about mutation but what we found with SARS was that there was no mutation and we have been tracking MERS and we have not seen any severe mutation. This is unlike the common coronavirus which when they replicate they don’t have a ”spell check” so they mutate. So if this virus follows the same path as SARS or MERS it won’t mutate. This will not be endemic. I think it will burn itself out in about 6 months.Does mortality rate or fatality rate typically increase over time? That was apparently the case with SARS.
With SARS we didn’t know how long the virus was alive for. So with SARS in the later stages people were not dying of SARS but of the complications of SARS which is why the mortality rate increased. But now people are much more aware of the dangers of over immunosuppression. So the death rate shouldn’t be more severe. Especially with the new hospitals being established which should take some of the workload off of the healthcare workers from Wuhan.If we look at the serious cases being reported it’s about 13% of the total cases being reported. If we assume a 50% mortality rate for the severe cases than we are looking at a mortality rate of 5-6%. Is that a fair assumption?
In Hubei, the milder cases are not making it to the hospital. Because they are so overwhelmed that milder cases are being sent away. So that’s why it’s important not to look at the mortality rate in Wuhan but to look at the mortality rate in Shanghai or Shenzhen or outside of Wuhan. It’s very important to dissect it out.Would it be too early to make conclusion outside of Wuhan? It’s still really early days outside of Wuhan? Are we making assumption with very little data and very early data?
That’s all the data we have to work with. When you are dealing with an epidemic at the early stages – there’s such a variable. But now for political reason people are far more aware of the virus so it won’t be as epidemic as it was early on. There’s far more awareness and controlled environment and changes in social behaviour. Which I’m not sure is taken into account in the models. So it should spread far less outside of Wuhan. -
@canefan said in Coronavirus: should I be panicking yet?:
@antipodean nice to get this virus put in context
Here in Oz the media look like chicken little panic merchants about everything. Fires, influenza, now it's some rainfall and they're losing their minds.
All they needed to do was check the WHO report into the H1N1 pandemic:
Most people who contract seasonal influenza recover without medical attention, but the infection can result in complications and death, particularly among older people, infants and people with underlying chronic medical conditions. Worldwide, seasonal influenza is responsible for an estimated 3.5 million cases of severe illness and 250 000–500 000 deaths each year.
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@antipodean same here. Constantly in search of dramatic headlines they sacrifice objectivity and factual accuracy