Coronavirus

[Winstonm]

A preliminary Chinese study puts the death rate at 8% for 70-79 and 15% for 80+. It's a preliminary study and is based on confirmed cases, so it likely on the high end as it wouldn't include people who weren't diagnosed for the virus.

 

Still, compare these rates to the ~0.2% mortality rates for those under 50 and anybody can see the potential risk for super seniors.

 

There is little solid information on this virus, but there is a good understanding of the 1918-1919 influenza pandemic. The issue with that influenza pandemic was that the mortality risk was highest not in the young and old but for people in their prime.

 

It is unknown what the mortality rate was for very stable geniuses.

[barmar]

Just the coronavirus supercharging the development of China into a complete surveillance state, with a thoroughness George Orwell couldn't have imagined.

To be fair, China already had a head start in this direction. The Chinese people are used to being monitored and ordered around by the government, so it's probably easy for them to accept the additional levels due to coronavirus.

[pescetom]

A preliminary Chinese study puts the death rate at 8% for 70-79 and 15% for 80+. It's a preliminary study and is based on confirmed cases, so it likely on the high end as it wouldn't include people who weren't diagnosed for the virus.

 

Still, compare these rates to the ~0.2% mortality rates for those under 50 and anybody can see the potential risk for super seniors.

 

Exactly 8 days since the first Italian cases were discovered, yesterday evening Italy had 1835 confirmed cases of which 52 dead (2.8%) and 166 in intensive care (9.0%, or 11.8% counting also those no longer here). Almost half the cases have no symptoms, but the vast majority of those with symptoms require hospitalization (40.4%). Today's data will be available soon, but almost certainly you can just take these numbers and add on one fifth. There is no public breakdown of cases and victims by age group, but a few days ago the TV said no victims were under 60.

 

This is nothing like influenza.

[pescetom]

Update on 3 March: now 2263 confirmed cases (+23% in a day) of which 79 dead (3.5% of cases) and 229 alive in intensive care (10.0%).

[Winstonm]

Exactly 8 days since the first Italian cases were discovered, yesterday evening Italy had 1835 confirmed cases of which 52 dead (2.8%) and 166 in intensive care (9.0%, or 11.8% counting also those no longer here). Almost half the cases have no symptoms, but the vast majority of those with symptoms require hospitalization (40.4%). Today's data will be available soon, but almost certainly you can just take these numbers and add on one fifth. There is no public breakdown of cases and victims by age group, but a few days ago the TV said no victims were under 60.

 

This is nothing like influenza.

 

The truly spooky part - to me - is that those half of cases with no symptoms may still be spreading virus unknowingly. I have not heard if that is or is not the case.

[awm]

The truly spooky part - to me - is that those half of cases with no symptoms may still be spreading virus unknowingly. I have not heard if that is or is not the case.

 

There seems to be a great deal of certainty that this is not the case; asymptomatic people are not contagious. The problem is that for many people the symptoms of the virus are quite mild (like a bad cold) and that those people are contagious.

[pescetom]

There seems to be a great deal of certainty that this is not the case; asymptomatic people are not contagious. The problem is that for many people the symptoms of the virus are quite mild (like a bad cold) and that those people are contagious.

 

My understanding is that all positive cases are contagious or were so in the past, symptoms or not. Beyond that I think it's a question of how you define asymptomatic: the specific symptom is pneumonia, but many have only a mild fever or nothing at all. Nobody here has reported people having symptoms like a cold or influenza.

[thepossum]

Another article about Covid19 vs Flu and latest on Covid19 from an editorial by Dr Fauci in the NEJM - admittedly from several days ago but...

 

NY Times - Covid19 vs Flu

NEJM - Dr Fauci Editorial

 

NEJM - latest

 

Plenty of other resources around.

 

I cant help wondering if cases of influenza, especially severe and fatal cases, were reported in the same way as Covid19 there could be a bit more perspective on overall risks. Some of the behaviour in community caused by anxiety of the new virus already seems rather out of proportion but.......as I was trying to express above, addressed by Ken and others, my concerns were simply a reasnoably informed community member being rather concerned about perceptions of risk. I hope nobody misunderstood my post that I was trying to downplay risks etc. But having read a great deal about the illness so far, apart from the lack of vaccine at this stage, it seems that many of the figures (eg severity, fatality percentages) are heading towards being comparable with a serious flu outbreak. Do people know, for example how many people are estimateed to die from influenza every year - directly and from complications - the nature of the symptoms, treatment and what causes mortality. I genuinely feel that community concern, while obviously warranted, is potentially getting out of hand towards panic behaviour. That is simply the understanding, reading and concerns of a community member - nothing more

 

I'm wondering how everyone feels the communication of severity and risk perceptions have been communicated and received in different countries and through different media platforms. The thread to date (of course early days) shows much of the lack of clarity common everywhere to my view

 

PS I have great confidence in the respective experts and agencies. Please, I hope nobody misunderstands my posts as anything else

[Winstonm]

My understanding is that all positive cases are contagious or were so in the past, symptoms or not. Beyond that I think it's a question of how you define asymptomatic: the specific symptom is pneumonia, but many have only a mild fever or nothing at all. Nobody here has reported people having symptoms like a cold or influenza.

This is from the NYT article to which the possum linked:

 

In both flu and the illness caused by the coronavirus, people may be contagious before symptoms develop, making it difficult or even impossible to control the spread of the virus. Nobody knows how many people infected with the coronavirus have only very mild symptoms or none at all.

[pescetom]

In both flu and the illness caused by the coronavirus, people may be contagious before symptoms develop, making it difficult or even impossible to control the spread of the virus.

Seems reasonable to me: I don't think that contradicts anything I said.

 

Nobody knows how many people infected with the coronavirus have only very mild symptoms or none at all.

Medical authorities must be starting to get an idea by now. Data from the Italian Health Ministry about people diagnosed (not the same as people infected, of course) suggests that about 50% have no symptoms, 10% have mild symptoms and 40% have severe respiratory problems.

A Chinese study published in the Lancet found that lung changes were evident in asymptomatic cases however and that of those with symptoms, 90% had abnormalities in both lungs.

[pescetom]

Today's updated figures from Italy: 2706 cases (+20% on yesterday) and 107 dead (+35% on yesterday), a ratio of 3.95%.

 

A medic told me that from their point of view, the biggest concern is the sheer time people need to stay tubed up in intensive care before recovery.

[Winstonm]

If one were feeling mildly under the weather and could still pass on the virus it would be enough to make it dangerous to all those in this country who don't have paid sick leave and can't afford to miss work, much less go to the doctor.

[pescetom]

If one were feeling mildly under the weather and could still pass on the virus it would be enough to make it dangerous to all those in this country who don't have paid sick leave and can't afford to miss work, much less go to the doctor.

 

Maybe you still have a rosy eyed view of the situation. Here in just the second week of an outbreak many workers are already at home because they are obliged, or no longer have work to go to (given collapse of many industries linked to mobility or China) or must care for their children with the schools closed. Almost nobody dares go to the doctor. It may well be the same in the rest of Europe by the end of the month. Don't know about USA but somehow I doubt it will beat Europe in terms of freely available intensive care, as long as that can cope.

[y66]

From Andrew Harrison, Chief Commercial Officer at my favorite airline:

 

Please be assured that Alaska Airlines is closely monitoring the situation, including conducting daily briefings with some of the best medical experts in the nation. Our top priority is always the safety of you and our employees. Check out our blog on the extra steps we are taking to keep our guests safe with additional cleaning and updates to onboard procedures.

 

At Alaska, we are optimistic about the future and hope you feel that way too. We launched our Peace of Mind policy so that you can take comfort in knowing that any ticket purchased after February 27, 2020 can be changed or canceled without a fee (applies for any travel through February 28, 2021). Today, we launched our biggest fare sale yet with fares starting as low as $20 one way* for travel between March 19, 2020 and May 20, 2020. And, we’ve got great deals to Hawaiʻi, New York and Florida starting at $99 one way.* We hope the combination of these great fares and our Peace of Mind policy will help those who want to travel this spring but are concerned their plans may change.

 

We understand that everyone is in a different place when it comes to what is best for you and your family. Just recently, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention, said “I just want to echo again that the risk is low—the risk is low. I encourage Americans to go about their life. That includes travel to California, Oregon and the state of Washington.”

 

In closing, some of you may know that my wife and I are blessed with eight children. We have a family trip to Hawaiʻi planned for spring break this year, and we can’t wait to go! We know things can change, but we are looking forward to our trip together as a family. Hopefully we will see some of you there.

 

Thank you for being a Mileage Plan™ member.

[Winstonm]

Maybe you still have a rosy eyed view of the situation. Here in just the second week of an outbreak many workers are already at home because they are obliged, or no longer have work to go to (given collapse of many industries linked to mobility or China) or must care for their children with the schools closed. Almost nobody dares go to the doctor. It may well be the same in the rest of Europe by the end of the month. Don't know about USA but somehow I doubt it will beat Europe in terms of freely available intensive care, as long as that can cope.

 

Here in the U.S. we have a very sick (psychologically) man in the White House who is claiming the virus isn't dangerous and the risk is exaggerated because it makes him look bad and deflects attention away from him.

[pescetom]

Today's updated figures from Italy: 3296 cases (+18% on yesterday) and 148 dead (+38% on yesterday), 414 recovered for a ratio of 3.98% deaths. 351 in intensive care (10.8% of all cases).

 

In an interview in 'La Stampa' today a virologist from San Raffaele Hospital in Milan casually announced that the main virus strain circulating in Lombardy is not identical to the original chinese strain: she said it originated in Bavaria. People have been hinting at this for several days but this is the first public confirmation I have seen.

[kenberg]

My thoughts often run in a simple mode, in this case for diagnosis. At https://phpa.health....oronavirus.aspx we see their estimate that it might be 2 to 14 days before symptoms occur. Obviously we cannot all be going off to get tested every three or four days. While out for a morning walk, I got to wondering: Might a person engaging in strenuous activity notice symptoms earlier than a person sitting in from of a tv? One of the symptoms is shortness of breath. I might not notice any shortness of breath while watching Miss Fisher re-runs. Never mind just how far I walk or at what pace, my point is that it took about the same time and the same energy as it did yesterday and as it did last week.

It's critical that the infected realize that they are infected as soon as possible. Pushing yourself a bit every day and noticing any changes in breath might help in self-diagnosis. Also it might not help, I realize that. But we know so little, I would not rule it out.

 

I should make it clear that I realize that here in Maryland we have three, not three hundred or three thousand or more, or many more, diagnosed cases. I recognize the difference. But we all need to be thinking about this. Keeping the number low is, well, it's obvious how to finish the sentence.

[barmar]

Might a person engaging in strenuous activity notice symptoms earlier than a person sitting in from of a tv? One of the symptoms is shortness of breath. I might not notice any shortness of breath while watching Miss Fisher re-runs.

But your shortness of breath might just be because of the strenuous exercise. Unless you're in good shape, you expect this.

 

Being short of breath when you aren't doing anything energetic is an obvious symptom.

 

Basically, the symptoms of COVID-19 are not much different from a cold or flu: fever, coughing, shortness of breath. I'm not sure how people are expected to distinguish them, so probably lots of people with colds and flu are going to doctors to get tested, and there aren't yet enough test kits.

[Winstonm]

Business

White House economic adviser Larry Kudlow claims coronavirus is 'contained,' says Americans should 'stay at work'

Brendan Morrow

The WeekMarch 6, 2020, 10:53 AM CST

 

 

This is what we have to deal with in the U.S. - BS straight from the top.

[pescetom]

But your shortness of breath might just be because of the strenuous exercise. Unless you're in good shape, you expect this.

 

Being short of breath when you aren't doing anything energetic is an obvious symptom.

 

Basically, the symptoms of COVID-19 are not much different from a cold or flu: fever, coughing, shortness of breath. I'm not sure how people are expected to distinguish them, so probably lots of people with colds and flu are going to doctors to get tested, and there aren't yet enough test kits.

 

Close but not on target, I fear. From local medics and acquaintances (multiple cases within 20 miles of here in last few days) it seems the initial symptoms are fever and sore throat - shortness of breath only comes later and often after a period of several days of apparent remission. And the worst thing for control of the disease is that for all this time until things deteriorate again you may test false negative (this happened in the case nearest to us, and the person was so happy he went dancing the day before he was tubed up) even if they have enough kits to test you.

[pescetom]

Today's updated figures from Italy: 3916 cases (+22% on yesterday) and 197 dead (+33% on yesterday), 523 now healthy for a ratio of 3.3% deaths.

 

Finally (some) official numbers about who is getting ill and (more) about who is dying. The average age of those infected is 61 (it would be nice to know the actual breakdown by age group and gender). The average age of those dying is 81 (we do have a breakdown by age group here, similar to China) and 73.3% (!) are male. 75% suffered from high blood pressure before the onset of virus, only 16% had one or less chronic illness.

[cherdano]

This is tragic:

[hrothgar]

This is tragic:

 

What I find tragic is that this stupid virus might take Trump down when children in cages didn't..

[pescetom]

Italian democratic party leader Nicola Zingaretti tested positive today, but luckily for him he is only 54 years old.

Also the first two positive bridge players (in Rome).

 

Today's Italian statistics: infected 5061 (+29%), deaths 233 (+18%), no longer infected 589 (+13%). Ratio of deaths/cases 4.1%.

[y66]

From The Coronavirus, by the Numbers by James Gorman at NYT:

 

Adam Kucharski studies how diseases spread, but he’s not handling viruses in the lab or treating sick people in the hospital. He’s a mathematician at the London School of Hygiene & Tropical Medicine, and he uses math to understand outbreaks of diseases like Ebola, SARS, influenza and now Covid-19. His goal is to design better ways to control outbreaks.

 

In an eerie coincidence, he wrote a book called “The Rules of Contagion,” before the current outbreak, which has been published in Britain and will be released in September in the United States. In it he talks about the math of contagion involving not only physical diseases, but also ideas, rumors and even financial crises.

 

In a recent experiment for the 100th anniversary of the 1918 flu, he worked with another mathematician and BBC presenter, Hannah Fry, of University College London, and collaborators at the University of Cambridge, to create a documentary, “Contagion: The BBC Four Pandemic,” using a phone app to track social contacts and map how an infection might spread.

 

The news of coronavirus epidemics around the world involves a flood of numbers that are a challenge for any nonscientist to digest. I asked Dr. Kucharski to help us navigate some of these numbers, and to tell us which ones we should pay attention to. We talked on the phone and corresponded by email this week. This is an edited version of our back and forth.

 

We hear a lot about the percentage of sick people who are dying. Is that the case fatality rate?

The case fatality rate measures the risk that someone who develops symptoms will eventually die from the infection.

 

And how is that rate calculated?

Ideally, we would monitor a large group of people from the point at which they develop symptoms until they later die or recover, then calculate the proportion of all these cases who had died.

 

So can we just look at the total number of deaths and the current number of cases?

 

The problem with just dividing the total number of deaths and total number of cases is that it doesn’t account for unreported cases or the delay from illness to death. The delay is crucial: If 100 people arrive at hospital with Covid-19 on a given day, and all are currently still alive, it obviously doesn’t mean that the fatality rate is 0 percent. We need to wait until we know what happens to them eventually.

 

Any deaths will be people who got sick two to three weeks ago, so it’s not simply deaths at the moment divided by cases at the moment. Plus some cases might be missed: If you have two deaths from two cases, as happened in Iran last month, that most likely means you’ve missed a bunch of cases.

 

We’ve seen all sorts of numbers for fatality rates. Does the latest estimate of 3.4 percent globally make sense?

Early on, people looked at total current cases and deaths, which, as I said, is a flawed calculation, and concluded that the case fatality rate must be 2 percent based on China data. If you run the same calculation on yesterday’s totals for China, you get an apparent CFR (case fatality rate) of near 4 percent. People are speculating that something is happening with the virus, where it actually is just this statistical illusion that we’ve known about from Day 1. I’d say on best available data, when we adjust for unreported cases and the various delays involved, we’re probably looking at a fatality risk of probably between maybe 0.5 and 2 percent for people with symptoms.

 

I had a short Twitter thread explaining this (and predicting the rise) a couple of weeks ago:

 

If the number of reported confirmed cases of #COVID19 continues to slow down, the 2% fatality rate people have been quoting will appear to rise. But it will be a statistical illusion. Let me explain why...

What about another number we hear about all the time, R, the reproductive number, or how many people a given patient is likely to infect. Why is it important and what goes into calculating it?

At its simplest, R is the answer to the question: How worried should we be about infection? If R is above one, each case, on average, is giving it to at least one other person. You’re going to see growth.

 

If it’s less than one, then a group of infected people are generating less infection. From a policy-planning point of view, it gives you a very clear objective. For example, in the Ebola response in 2014, it was a really prominent part of the response. The aim was to get R below one.

 

That seems very simple and straightforward, but you write that it’s more complicated than it seems. In your book you say that to calculate R you’ve got to know duration, opportunity, transmission probability and susceptibility (the “DOTS”). Let’s take them one by one. What is duration?

How long someone is infectious. If someone is infectious twice as long, then that’s twice as long that they are around to spread infection.

 

Do we know what the duration is for this coronavirus?

On average, we’d probably be looking at a week or two. Of course, if people get hospitalized, then they’re not in the community spreading infection in the same way.

 

The second component is opportunity. How do you determine that?

That’s a measure of how many people you come into contact with for every day you’re infectious. With something like flu, you’re not infectious very long but a lot of your interactions could potentially spread it. Whereas with something like HIV, the duration is much longer but the number of sexual partners you have relative to the number of conversations you have is obviously much lower.

 

And transmission probability?

This is a measure of the chance the infection will get across during an interaction. For example, during a sexual encounter, the virus won’t necessarily get across.

 

Finally there’s susceptibility. How do you determine that?

Susceptibility measures the chance the person at the other end of the interaction will pick up the infection and become infectious themselves.

 

Once you’ve got numbers for these four components, what’s the equation to come up with R?

If you multiply them together, you get the reproduction number. So if you scale up or scale down any one of these things, it directly affects the value of R.

 

How does this knowledge help public health planning?

Generally, susceptibility is the easiest one to reduce if we have things like vaccines. If we don’t, then we have to think about targeting the other aspects of transmission, such as reducing opportunities through social distancing, or probability of transmission during things like handshakes by encouraging hand washing.

 

What if you’re not in public health, but are thinking about your own personal chances and what your behavior should be?

If you imagine you’ve got a reproduction number of two, each person’s infecting two others, on average. But some situations are more likely to spread infection than others. We’ve found for things like Covid-19, it’s close-knit interactions that seem to be most important.

 

What we need to think about — and what a lot of our modeling is certainly thinking about — is not just how much transmission is happening, but where is that transmission happening. If you’re going to change your behavior, think how to reduce those risky situations as much as possible.

 

If you were the average person, what would you pay attention to — in terms of the news and the numbers?

One signal to watch out for is if the first case in an area is a death or a severe case, because that suggests you had a lot of community transmission already. As a back of the envelope calculation, suppose the fatality rate for cases is about 1 percent, which is plausible. If you’ve got a death, then that person probably became ill about three weeks ago. That means you probably had about 100 cases three weeks ago, in reality. In that subsequent three weeks, that number could well have doubled, then doubled, then doubled again. So you’re currently looking at 500 cases, maybe a thousand cases.

 

I think the other thing that people do need to pay attention to is the risk of severe disease and fatality, particularly in older groups, in the over-70s, over-80s. Over all we’re seeing maybe 1 percent of symptomatic cases are fatal across all ages. There’s still some uncertainty on that, but what’s also important is that 1 percent isn’t evenly distributed. In younger groups, we’re talking perhaps 0.1 percent, which means that when you get into the older groups, you’re potentially talking about 5 percent, 10 percent of cases being fatal.

 

In thinking about social behavior and thinking about your interactions, the question should be, “How do we stop transmission getting into those groups where the impact could be really severe?”