OT: Corona virus

[JohnDillworth]

I think the dangerous assumption many parties are making is that this will "go away" when the weather gets warmer like the flu does. That may, or may not, be true, but I have not seen any evidence of why people seem so sure of this assumption. I hope so. I think it would be prudent to hope that it does, but prepare like it won't.

[Anachro]

The economic effects are greater than the health risks...for younger people that is. The death rate seems to go up a lot among the elderly and those with exposed immune systems. 700 million people are under some form of quarantine in China, even in Beijing the restrictions have been more strict in the past week than the week previous. This already has an impact on global economic activity; now if the virus spreads to Japan, Korea, Italy, etc. with restrictions in place than that is more economic activity that is slowed or halted, etc. etc.

[Chickenboy]

I believe that this virus and disease will have a similar trajectory to that of MERS/SARS some 17 years ago. Coronaviruses are not Orthomyxoviruses (influenza) and act differently in transmissiblity and mutation rates, so again the MERS/SARS analog is probably more useful than H1N1 (1918; 2009) or other seasonal influenzas.

In the case of MERS/SARS, the virus circulated amongst mainland China for some time before diagnosed, a bit longer before there was recognition of it by central authorities and then longer yet before there was even a haphazard and incomplete response. International spread was a feature of the disease. Here's a very interesting and concise timeline from the CDC's website:

https://www.cdc.gov/about/history/sars/timeline.htm

To whit: The disease ran rampant in China for a while. Then it spread internationally. Cases that were not laboratory-confirmed were later re-stated (see entry for July 2003) and halved. In between, the overreaction to cases was addressed (de-stigmatization of SARS) and travel advisories lifted after a few months.

A curious thing about the SARS virus was how it disappeared after a year or so. No isolates were recovered post-2004. Poof. Gone. NIH states that the disappearance was due to quarantine and isolation of affected cases and-of course-due to the research money poured into NIH on interventional strategies.

https://www.niaid.nih.gov/diseases-cond ... onaviruses

COVID-19 does behave somewhat differently in the human host (replicates higher in the respiratory tract versus deeper in the lungs like SARS) and therefore may spread more readily. By nature of its replication patterns, it will also probably have a lower case fatality rate. That's exempting the exacerbatory effects of other co-pathogens (COVID-19 PLUS influenza, streptococcal pneumonia, TB, asthma, emphysema, other respiratory disease in the same patient) of course. I have not seen *any* efforts to parse the effects of COVID-19 from other co-pathogen effects in infected, but this is likely one of the rationale for making sure to get one's annual flu vaccine ASAP if you haven't already done so.

Viruses spread more readily when they make one sick, but aren't fatal. Paradoxically, the sicker people are with a particular virus, the easier it is to diagnose and ultimately contain. The Los Angeles Times had a nice article on this a couple weeks ago.

https://www.latimes.com/california/stor ... a-epidemic

What do I think will happen? Something more akin to SARS, albeit with a more significant global spread in the interim. I expect the peak of this will probably not be too far off and that, with the onset of warmer weather in most of the Northern Hemisphere it will abate. I would be surprised if we heard much about this 12 months from now, excepting in cooler climates (you listening, Oz land?) as they slip into their annual influenza cycle.

The economic and social impacts on our increasingly globally connected supply chains are a totally 'nuther question. I'm limiting my observations to the disease cycle and virus longevity in our public per se.

[Chickenboy]

ORIGINAL: geofflambert
I'm not being political when I say Trump is an imbecile.

Yeah, actually, you are. And you should stop. Take your political screed elsewhere.

[Chickenboy]

ORIGINAL: JohnDillworth

I think the dangerous assumption many parties are making is that this will "go away" when the weather gets warmer like the flu does. That may, or may not, be true, but I have not seen any evidence of why people seem so sure of this assumption. I hope so. I think it would be prudent to hope that it does, but prepare like it won't.

Heat and sunlight are amongst the best disinfectants for labile viruses like coronaviruses or orthomyxoviruses (influenza). In general, people tend to spend more time outdoors with nicer weather and less time in cramped indoor quarters where respiratory diseases can be more readily spread. Survivors of a novel viral pathogen will tend to mount an immune response to that identical pathogen with future exposure, which further reduces its RO. Add in the fact that SARS (a similar virus to COVID-19) just kind of petered out within a year and I think the grounds to suggest that the same outcome for COVID-19 are reasonable conjecture.

But you're right about prudence and preparedness. For this (or any other novel viral agent), being able to work from home and have basic sanitation away from infectious hosts or carriers for a time is helpful. Anyone that doesn't have a 72-hour bug-out bag / kit for the family ought to update their disaster preparedness planning in general.

[USSAmerica]

ORIGINAL: Chickenboy

I believe that this virus and disease will have a similar trajectory to that of MERS/SARS some 17 years ago. Coronaviruses are not Orthomyxoviruses (influenza) and act differently in transmissiblity and mutation rates, so again the MERS/SARS analog is probably more useful than H1N1 (1918; 2009) or other seasonal influenzas.

In the case of MERS/SARS, the virus circulated amongst mainland China for some time before diagnosed, a bit longer before there was recognition of it by central authorities and then longer yet before there was even a haphazard and incomplete response. International spread was a feature of the disease. Here's a very interesting and concise timeline from the CDC's website:

https://www.cdc.gov/about/history/sars/timeline.htm

To whit: The disease ran rampant in China for a while. Then it spread internationally. Cases that were not laboratory-confirmed were later re-stated (see entry for July 2003) and halved. In between, the overreaction to cases was addressed (de-stigmatization of SARS) and travel advisories lifted after a few months.

A curious thing about the SARS virus was how it disappeared after a year or so. No isolates were recovered post-2004. Poof. Gone. NIH states that the disappearance was due to quarantine and isolation of affected cases and-of course-due to the research money poured into NIH on interventional strategies.

https://www.niaid.nih.gov/diseases-cond ... onaviruses

COVID-19 does behave somewhat differently in the human host (replicates higher in the respiratory tract versus deeper in the lungs like SARS) and therefore may spread more readily. By nature of its replication patterns, it will also probably have a lower case fatality rate. That's exempting the exacerbatory effects of other co-pathogens (COVID-19 PLUS influenza, streptococcal pneumonia, TB, asthma, emphysema, other respiratory disease in the same patient) of course. I have not seen *any* efforts to parse the effects of COVID-19 from other co-pathogen effects in infected, but this is likely one of the rationale for making sure to get one's annual flu vaccine ASAP if you haven't already done so.

Viruses spread more readily when they make one sick, but aren't fatal. Paradoxically, the sicker people are with a particular virus, the easier it is to diagnose and ultimately contain. The Los Angeles Times had a nice article on this a couple weeks ago.

https://www.latimes.com/california/stor ... a-epidemic

What do I think will happen? Something more akin to SARS, albeit with a more significant global spread in the interim. I expect the peak of this will probably not be too far off and that, with the onset of warmer weather in most of the Northern Hemisphere it will abate. I would be surprised if we heard much about this 12 months from now, excepting in cooler climates (you listening, Oz land?) as they slip into their annual influenza cycle.

The economic and social impacts on our increasingly globally connected supply chains are a totally 'nuther question. I'm limiting my observations to the disease cycle and virus longevity in our public per se.

Good stuff, CB. Curious what your thoughts might be on the "mortality rate" aspect of COVID-19.

I read somewhere yesterday that the mortality rate in Wuhan was around 2.4% and everywhere else in China and the rest of the world it was around .7%. I can't site the reference for those numbers, so let's just use them as an exercise. Is it a safe assumption that it's calculated from all the reported deaths and all the total reported infection cases? In other words, isn't it very reasonable that there are many cases that were never officially reported, at least in China/Wuhan, as the individual didn't go to the doctor or a hospital? It seems to me those unreported cases would really cut the official, reported mortality rate. My guess would be cutting the reported rate in half.

Too many assumptions on my part? Am I just way out in left field?

[HansBolter]

My favorite comment in the linked thread is 'why did they name it after a beer'.....

[JohnDillworth]

ORIGINAL: HansBolter

My favorite comment in the linked thread is 'why did they name it after a beer'.....

You know what goes with Carona virus? Lyme disease

[Chickenboy]

ORIGINAL: USSAmerica

ORIGINAL: Chickenboy

I believe that this virus and disease will have a similar trajectory to that of MERS/SARS some 17 years ago. Coronaviruses are not Orthomyxoviruses (influenza) and act differently in transmissiblity and mutation rates, so again the MERS/SARS analog is probably more useful than H1N1 (1918; 2009) or other seasonal influenzas.

In the case of MERS/SARS, the virus circulated amongst mainland China for some time before diagnosed, a bit longer before there was recognition of it by central authorities and then longer yet before there was even a haphazard and incomplete response. International spread was a feature of the disease. Here's a very interesting and concise timeline from the CDC's website:

https://www.cdc.gov/about/history/sars/timeline.htm

To whit: The disease ran rampant in China for a while. Then it spread internationally. Cases that were not laboratory-confirmed were later re-stated (see entry for July 2003) and halved. In between, the overreaction to cases was addressed (de-stigmatization of SARS) and travel advisories lifted after a few months.

A curious thing about the SARS virus was how it disappeared after a year or so. No isolates were recovered post-2004. Poof. Gone. NIH states that the disappearance was due to quarantine and isolation of affected cases and-of course-due to the research money poured into NIH on interventional strategies.

https://www.niaid.nih.gov/diseases-cond ... onaviruses

COVID-19 does behave somewhat differently in the human host (replicates higher in the respiratory tract versus deeper in the lungs like SARS) and therefore may spread more readily. By nature of its replication patterns, it will also probably have a lower case fatality rate. That's exempting the exacerbatory effects of other co-pathogens (COVID-19 PLUS influenza, streptococcal pneumonia, TB, asthma, emphysema, other respiratory disease in the same patient) of course. I have not seen *any* efforts to parse the effects of COVID-19 from other co-pathogen effects in infected, but this is likely one of the rationale for making sure to get one's annual flu vaccine ASAP if you haven't already done so.

Viruses spread more readily when they make one sick, but aren't fatal. Paradoxically, the sicker people are with a particular virus, the easier it is to diagnose and ultimately contain. The Los Angeles Times had a nice article on this a couple weeks ago.

https://www.latimes.com/california/stor ... a-epidemic

What do I think will happen? Something more akin to SARS, albeit with a more significant global spread in the interim. I expect the peak of this will probably not be too far off and that, with the onset of warmer weather in most of the Northern Hemisphere it will abate. I would be surprised if we heard much about this 12 months from now, excepting in cooler climates (you listening, Oz land?) as they slip into their annual influenza cycle.

The economic and social impacts on our increasingly globally connected supply chains are a totally 'nuther question. I'm limiting my observations to the disease cycle and virus longevity in our public per se.

Good stuff, CB. Curious what your thoughts might be on the "mortality rate" aspect of COVID-19.

I read somewhere yesterday that the mortality rate in Wuhan was around 2.4% and everywhere else in China and the rest of the world it was around .7%. I can't site the reference for those numbers, so let's just use them as an exercise. Is it a safe assumption that it's calculated from all the reported deaths and all the total reported infection cases? In other words, isn't it very reasonable that there are many cases that were never officially reported, at least in China/Wuhan, as the individual didn't go to the doctor or a hospital? It seems to me those unreported cases would really cut the official, reported mortality rate. My guess would be cutting the reported rate in half.

Too many assumptions on my part? Am I just way out in left field?

Not at all, USS Mike.

I'm a diagnostician by training and trade. So I need a solid working case definition. "Suspect" versus "Probable" versus "Confirmed" cases mean something very different to me and so do the means at achieving the diagnosis. So the first question I always ask is, "How are you defining a case?" It's the building block of disease interventional strategy and is usually glossed over in the lay press. Unfortunately, it makes all the difference in the world. You would hope to have a diagnosis which is informative, selective and efficient without being too broadly inclusive.

With COVID-19 (or SARS or influenza), do you want a 'case' to be an instance of virus recovery (or PCR positive) from someone? Is that sufficient? A general canvassing of the population regardless of associated illness? Well, that tends to lead to exhorbitantly high numbers of samples being processed and laboratory sample throughput issues. You can't build laboratory capacity sufficient to meet that spike in cases.

Which is why Wuhan changed their reporting measures ('case definition') dramatically a couple weeks ago. A backlog in laboratory confirmation (from 'sick' patients) led to their easing of the case definition to symptomatology. If you have respiratory disease, a fever and/ or CT/MR changes consistent with lower respiratory disease you're a 'case' by the new definition. Hence an overnight 'surge' in cases recogized.

But case numbers based upon self-reported symptomotology are really 'squishy'. They are prone to conflation with myriad other diseases with similar symptoms. Or there may be co-infections. Or they may not be an exact match for what you're trying to measure. Is a person from Wuhan with a severe respiratory disease and no fever a case? How about a person with a fever from Hong Kong with no respiratory component?

If a 'case' is someone that's exposed to the virus, then how many cases are there? Dunno. Virus (PCR) testing has been abandoned as the gold standard at this point. We don't know how many people have been exposed to the virus that haven't gone in for 'confirmation'. I read somewhere that some 15 million Chinese left Wuhan before the 'quarantine' barriers were erected. How many of those had been exposed to the virus. Nobody knows. I think probably a fair number.

I think it's also fair to say that a case fatality rate for an identical pathogen exposure would vary depending on the nature of the medical care sought that may lead to patient survival. Biased comment follows: I doubt the quality of medical supportive care afforded someone in those newly erected Wuhan tent hospitals would approach that of the Mayo Clinic. If your measure is outcomes (death or no death from viral exposure), quality of care variables make a big difference.

Without having a solid grasp on what a 'case' actually constitutes and the numbers exposed that may be aclinical / subclinical, you can't formulate a meaningful 'case fatality rate'. And you can't readily cross-compare case fatality rates with different standards of medicine or baseline diseases of co-morbidity that confound symptomatic diagnoses.

What does my gut say? If your 'case fatality' case definition is: 'people exposed to the virus (and only the virus) that die from the virus (and only the virus)', then that number is very very low. Not zero. But very very low. Other risk factors (additional infectious disease exposure, smoking habits, air pollution, environments that engender person-to-person spread, age of patient, immunosuppressive background diseases, access to antivirals, access to ventilators, etc.) are IMO every bit as important or more important than this virus' unique abilities.

[Canoerebel]

Thanks, Chickenboy.

This kind of info is why I created this thread. It's one of the reasons I love the Forum. Tremendous spectrum of knowledge here.

P.S. If there's ever a need in the Forum to know songs of southern high country birds, or how to combat thigh chaffing when backpacking, I'm at your service.

[jeffk3510]

ORIGINAL: Canoerebel
P.S. If there's ever a need in the Forum to know songs of southern high country birds, or how to combat thigh chaffing when backpacking, I'm at your service.

How do you combat that?

I'm asking for a friend..

[Canoerebel]

Anti-Monkey Butt Powder is the cure. To apply, stand on your head and have a friend sprinkle the afflicted regions (or you can use a cotton duster or bellows).

[jeffk3510]

ORIGINAL: Canoerebel

Anti-Monkey Butt Powder is the cure. To apply, stand on your head and have a friend sprinkle the afflicted regions (or you can use a cotton duster or bellows).

You may not understand how comfortable I am around people. I would let my friends apply this, using your method.

[Canoerebel]

Here's hoping your friends are of the type on the left, rather than the right. [8D]

[USSAmerica]

Thank you for the detailed info, Andre!

ORIGINAL: Canoerebel

Thanks, Chickenboy.

This kind of info is why I created this thread. It's one of the reasons I love the Forum. Tremendous spectrum of knowledge here.

P.S. If there's ever a need in the Forum to know songs of southern high country birds, or how to combat thigh chaffing when backpacking, I'm at your service.

Dan, when we need great historical stories, often from a fantastic personal perspective, we go to you. [8D]

[RangerJoe]

ORIGINAL: Canoerebel

P.S. If there's ever a need in the Forum to know . . . how to combat thigh chaffing when backpacking, I'm at your service.

Simple, quit backpacking!

[MakeeLearn]

ORIGINAL: Chickenboy


Anyone that doesn't have a 72-hour bug-out bag / kit for the family ought to update their disaster preparedness planning in general.

There is a subject in need of ken.

[Ian R]

ORIGINAL: JohnDillworth

I think the dangerous assumption many parties are making is that this will "go away" when the weather gets warmer like the flu does. That may, or may not, be true, but I have not seen any evidence of why people seem so sure of this assumption. I hope so. I think it would be prudent to hope that it does, but prepare like it won't.

It has been fairly hot down this way for the last 3 months, which you would think tends against the warm weather idea. However, according to the latest AHPPC sitrep, in every known case here, the patient acquired the virus outside the country, and all 22 patients have been quarantined.

In Australia there is still effective containment of the COVID-19 outbreak with only 22 cases diagnosed so far. Fifteen of these were linked to travel from Hubei province prior to 1 February, and seven more recent cases were imported with the returning passengers from the Diamond Princess cruise ship. GPs and hospitals are continuing to screen returning travellers for illness, and there have been several thousand negative tests to date.

There is no evidence of community transmission in Australia at present and there is no reason for the general community to take additional precautions, such as wearing masks, or avoiding restaurants and other places of public gathering. However, it is a timely reminder that everyone should practise good hygiene to protect against infections.

https://www.health.gov.au/news/australi ... s-covid-19

[DOCUP]

I am curious about the comorbidities (other health issues ie respiratory issues, diabetes, cardiac, etc) of the patients that have past away? Did the patients that died get a pneumonia on top of the coronavirus?

USS America, a response to your question on page one. Mortality rate. A few reasons why the mortality rate is higher in Wuhan.

1. Wuhan has been hit the hardest. It's the epicenter of COVID-19. I don't know the numbers off the top of my head, and a quick google search isn't bearing any fruit. Lets just say that Wuhan (just looked it up 3 hospital, I can't read Chinese so I don't know the specifics about these hospitals) had 3 hospitals totaling 1150 beds (350 beds is a medium size hospital in USA). In the winter time respiratory illness usually go up, this will add more patients to the hospitals than any other season. It is currently winter time in China. This means that these hospitals will be running closer to max capacity. Now COVID-19 starts to add more patients and its severity is worse than the other types of Coronavirus. These patients start hitting the intensive care units. We will say around 50 ICU beds in an acute care hospital (say 150 Adult ICU beds in all 3 hospitals), now there will be fewer Pediatric ICU beds (I would say probably no more than 25 beds in the city). Now they can transfer ill patients to hospitals outside of Wuhan. When those hospitals get full they have to send these sick people farther away, it's dangerous to transport patients to other facilities. This delay in treatment can result in accidental death or the transfer alone can kill a patient.

2. Lets talk about the staffing of these hospitals. I was just reading a few articles today about staffing in Wuhan. I will estimate that these three hospital have around 1,300 nurses per hospital (so 4,000 nurses or so). Next count in the doctors, respiratory techs, x-ray techs, patient care techs, and the list goes on and on. What happens when these people get sick. According to the China's national health commission around 3,200 health care personnel have contracted COVID-19. Staff is working sick, long hours, have over crowded hospitals and probably short on everything that is needed to keep patients alive. So, short on fluids to keep patients hydrated when they can't eat (probably most of the respiratory patients,) fluids to reconstitute antibiotics or other medications. Medications will run short. What about ventilators (machines that will breath for the patients), IV pumps, monitors, and other vital equipment will be in use, hospitals only keep some many of each machine. These over worked, tired, sick medical staff will probably make some mistakes and accidentally hurt or kill a patient due to the conditions. They may not see the patient going into septic shock or respiratory distress. Drugs may be given in the wrong dose, at the wrong time or not at all due to fatigue, not being there at all.

The medical system in Wuhan is over extended, that is one of the reasons that they have a higher death ratio than other areas. I doubt that its because of poor medicine but due to much at one time.

Also some deaths may not be reported due to patient was of an older age or some other comorbidity that the local officials might not have wanted the death to be examined. In the US death at a certain age or with certain comorbidities can be called natural death and the body sent to the funeral home.

Chickenboy made a good comment about comorbidities of the patients. Few people die from Coronavirus, its the patients other problems or did a pneumonia or a hospital acquired infection tag team the patient. When Swine Flu hit years ago it was MRSA pneumonia that killed most of the patients.

[Ian R]

ORIGINAL: Chickenboy

What do I think will happen? Something more akin to SARS, albeit with a more significant global spread in the interim. I expect the peak of this will probably not be too far off and that, with the onset of warmer weather in most of the Northern Hemisphere it will abate. I would be surprised if we heard much about this 12 months from now, excepting in cooler climates (you listening, Oz land?) as they slip into their annual influenza cycle.

See linked sitrep in above post - measures have been put in place, including quarantine. My parents' generation remembered TB sufferers being sent away to what might be described as a more comfortable version of a concentration camp. The legal framework for that sort of thing still exists.

Anyway, winter here is about the same temperature as summer in Europe.