COVID-19

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Jason
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Re: Wuhan Coronavirus

Post by Jason »

I guess it was only a matter of time - Wuhan Coronavirusgate.

https://www.washingtonpost.com/world/as ... g-news-bar

ertyu
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Re: Wuhan Coronavirus

Post by ertyu »

Jason wrote:
Thu Feb 06, 2020 10:54 am
I guess it was only a matter of time - Wuhan Coronavirusgate.

https://www.washingtonpost.com/world/as ... g-news-bar
it's behind a paywall for me could you extract relevant quotes

ZAFCorrection
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Re: Wuhan Coronavirus

Post by ZAFCorrection »

https://www.businessinsider.com/asian-s ... rus-2020-1

I think we might also be seeing a retroactive justification of Chinese international student cliquishness. Counter to the TA story in above: a Chinese student in a class I was TA'ing had some question about the class, asked my Chinese labmate (who is not TA'ing for the class), who then has to ask me so she can relay the information to her. In my experience at two universities, Chinese nationals only regularly talk to non-Chinese peeps if they are particularly extroverted or weird. Frequently they go out of their way to avoid talking to anyone else.

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Sclass
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Re: Wuhan Coronavirus

Post by Sclass »

I dunno. Is that story about a student from China? Or an Asian American. There is a big difference.

Indeed the red Chinese students form a clique in the universities.

Hey, how come that whistleblower doctor died? He was 34 and healthy. That’s impossible!

Jason
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Re: Wuhan Coronavirus

Post by Jason »

ertyu wrote:
Thu Feb 06, 2020 12:14 pm
it's behind a paywall for me could you extract relevant quotes
Sorry.

The headline changed over time. Originally it was "Doctor who Warned Chinese Authorities of Wuhan CoronaVirus reported dead.' No explanation provided, so it had a cloak and dagger vibe. It was later revised to indicate that he died of the virus. I guess it shows how things are different than in the US. In the US, he would have been publicly discredited and forced to work in The Animal type locale. In China, they inject you with what they said didn't exist. Either way, along with humanity in general, I'm just happy I'm not a doctor.

Peanut
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Re: Wuhan Coronavirus

Post by Peanut »

Sclass wrote:
Thu Feb 06, 2020 12:51 pm
I dunno. Is that story about a student from China? Or an Asian American. There is a big difference.

Indeed the red Chinese students form a clique in the universities.

Hey, how come that whistleblower doctor died? He was 34 and healthy. That’s impossible!
It's both groups that are being 'avoided' for lack of a better term. Unless you pay close attention to style of dress, maybe, it can be difficult to discern who is native-born and who is a foreigner.

Any word on the doctor was was 44 and died in the Philippines? Worrying profile.

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Sclass
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Re: Wuhan Coronavirus

Post by Sclass »

44 year old doctor in the Philippines? That’s a different one. I’m talking about this guy. He was 34.

https://www.cnn.com/2020/02/06/asia/li- ... index.html

I hope this was just an outlier.

Yup, there’s all kinds of Chinese people. I guess picking them off is as hard as distinguishing a Norwegian exchange student from a blond kid from Indiana. Back in the 90s it was easier to tell but I notice the new people coming over from China have a totally different style.

Pretty soon if this thing is exponential (even though the news shows a quadratic) the disease will no longer have a Asian masked face associated with it. I’m so tired of the stock photos.

AnalyticalEngine
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Re: Wuhan Coronavirus

Post by AnalyticalEngine »

After listening to Congress asking disease experts on this yesterday, I've come to the conclusion that these quarantine efforts have zero chance of working. The problem is the world is too porous. You can ban flights from China, but we're still accepting Chinese cargo ships. There are 8 billion people in the world, and the virus is already in multiple countries. There's so many known unknowns here that panicking and throwing people with mild symptoms into quarantine camp only has the potential to make things worse.

The problem is most people don't change their behavior in a pandemic and they just keep spreading it around. I was reading one study where they wanted to see if canceling school would stop SARS from spreading. The researchers found it made no difference because the kids just left the house to meet up at the park instead of school.

All it takes is a handful of people to break quarantine, which is impossible to stop, and the spread will continue. I think we have to assume the virus is already many more places and the difference is we don't know about it yet.

The real personal solution is social distancing. You can't control what other people do, but you can control yourself. I notice I've been hyper aware of things like people coming in sick to work, people shaking my hand, company potluck...and there's no way you're gonna be able to stop people from hugging each other. There's no way we're gonna contain this.

AnalyticalEngine
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Re: Wuhan Coronavirus

Post by AnalyticalEngine »

Alright guys, second post to summarize my conclusions after researching this all day.

1. There are more infections out there than are being reported. The numbers out of China are pretty much garbage, both due to political reasons and testing limitations. This paper from The Lancet has the most accurate summary. I quote:
In our baseline scenario, we estimated that R0 was 2·68 (95% CrI 2·47–2·86) with an epidemic doubling time of 6·4 days (95% CrI 5·8–7·1; figure 2). We estimated that 75 815 individuals (95% CrI 37 304–130 330) individuals had been infected in Greater Wuhan as of Jan 25, 2020. We also estimated that Chongqing, Beijing, Shanghai, Guangzhou, and Shenzhen, had imported 461 (227–805), 113 (57–193), 98 (49–168), 111 (56–191), and 80 (40–139) infections from Wuhan, respectively (figure 3).
This means we've effectively passed two doubling times since there, bringing the total number of Wuhan cases to be ~300,000.

2. Most 2019-nCoV cases are mild. While we still lack data and this could change, current estimates suggest 2019-nCoV seems to cause mild illness 80% of the time, complications 20% of the time, and death 2% of the time. It also seems to spare children, similar to SARS. This might seem like good news, but there's a downside to this. Coronavirus antibodies don't last very long, meaning you could be reinfected in a few years.

So what are the implications to this fact? Most cases are mild, so people with mild illness will go unidentified, spreading the virus to those around them. This means these big travel bans are unlikely to work (more on that later). 20% of cases become severe. If that happens to you while medical resources are strapped, you might not get the care you need, increasing the mortality rate. This brings me to number 3.

3. 2019-nCoV is almost guaranteed to become a pandemic. With possible cases in Wuhan alone, and give the fact many cases of illness are mild, there's basically no chance that this won't get out. Borders are too porous and the world is too interconnected. Focusing on mass quarantines and travel bans are wasting resources from the things we do need to focus on. So what do we need to do?

Dramatically increasing hospital's ability to treat a surge of severe patients is critical. We need hospitals to stockpile supplies like O2, gowns, masks, etc. We also need to rapidly pour research dollars into developing an on-site, rapid test. Quarantine at the city level won't work due to it being too porous. However, isolation at the individual level will slow spread. But rapid isolation requires a rapid test.

What about a vaccine you ask? That might take at least a year to develop. But we still might need one because...

4. 2019-nCoV may become endemic. Rapid infection across the globe, combined with the fact you can be reinfected, means this disease might not wipe itself out. It could easily go in waves, mutating/evolving as it infects numerous people. Usually this means the disease becomes less lethal, but not always (Spanish flu got worse). Coronaviruses are usually less prone to reproduction errors, due to some special proteins they have to check their RNA, but errors still happen. Looking at future "corona season" on top of flu season is not unlikely.

A vaccine will help though, and by the time it becomes endemic, we might have one developed. That will give you individual disease resistance at least.

5. What does this mean for you? While a 2% case fatality rate may seem low, 2019-nCoV infection obviously does more harm to the elderly and those with per-existing conditions. There's also a sizable number of young, healthy people who die too, and we don't quite know the clinical factors yet that lead to death. This is a novel disease after all, and this information could easily change. So we don't want to underestimate the damage this virus could do to human life.

While large quarantine efforts usually fail due to porous conditions and human error, you can still reduce the odds of contracting it through social distancing. Don't think you're safe just because the virus isn't in your city yet. We lack the capacity to rapidly test, and health authorities are only really testing for cases if you've had recent contact with someone from Wuhan. But if the virus leaks out of Wuhan to somewhere unknown (highly likely), and that person infects another person, who only shows mild illness, and then you have contact with that person, you could still easily contract it. You might not die, but even mild cases can be pretty miserable. There's something to be said for not lying sick in bed for two weeks and then giving it to your elderly grandmother.

So practice social distancing where you can. Avoid crowds, especially avoid contact with sick people. Wash your hands, and if you get sick, isolate yourself.

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Ego
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Re: Wuhan Coronavirus

Post by Ego »

AnalyticalEngine wrote:
Thu Feb 06, 2020 7:28 pm
Coronavirus antibodies don't last very long, meaning you could be reinfected in a few years.

So what are the implications to this fact? Most cases are mild, so people with mild illness will go unidentified, spreading the virus to those around them. This means these big travel bans are unlikely to work (more on that later).
Thanks for your analysis. The piece about reinfection is based on this snippet from Chinese television:

https://youtu.be/GZ99J7mlaIQ?t=49

In it Zhan Qingyuan, the director of pneumonia prevention and treatment at the China-Japan Friendship Hospital said, "The antibody will be generated; however, in certain individuals, the antibody cannot last that long. For those patients who have been cured, there is a likelihood of a relapse. For cured patients, they should also harness their own health safeguards.”

The key phrase there is, "In certain individuals". The ability to store antibodies varies by individual, right? There are people who mount an effective immune response to the flu, for instance, but get reinfected by the same flu because they are not good at storing antibodies.

What I understood him to be saying is that people who have beat the infection could still be reinfected and then reinfect others so they shouldn't get their hopes up for being released from the quarantine anytime soon. In other words, the fact that they are cured is not a get out of jail free card.

There are a bunch of reports out there quoting that same news conference but none by experts. It will be interesting to see if it gets corrected or if it is indeed true that the 2019-nCoV antibodies have a short duration.

classical_Liberal
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Re: Wuhan Coronavirus

Post by classical_Liberal »

@Ego
I'm not an immunological expert, so anyone can correct me where I'm wrong, but I do have some general knowledge.

There are a few different concepts that are applicable with viral "immunity" and adaptive immune system. Antibody response is only part of the picture. Generally, antibodies only have a biological half life of a few weeks. First exposure to a Novel infection creates a primary antibody response which is slow and weak compared to secondary responses. So, someone exposed to a virus who gets sick, can get reexposed a few weeks later, but the secondary response will be much faster and stronger, reducing infection severity. If no secondary exposure occurs or after the secondary infection without additional exposure, then memory B-cells take over as primary defense against reinfection. The B-cells do a whole bunch of cool things if exposed to the same virus again, including secreting new antibodies and identifying infected cells with antigen presenting responses. The research on B-cells shows that they can retain "infection memory" for decades, but it's unclear (at least at my level of understanding) why this seems to vary at times.

The issues with a virus that circulates in the general population is mutation, called shift and drift. This is what happens with influenza. The virus mutates so that it attaches and enters human cell membranes via different biological routes. Which means that the B-cell response produces antibodies that are less or not effective against reexposure after mutation. Annual flu vaccinations are basically educated guesses on potential viral shift and drift each year.

Anyway, this means that if a virus is able to mutate rapidly, there could be inadequate adaptive immune response. The other possibility is poor B-cell memory retention for some reason, which is beyond my pay grade of understanding, as I beleive research in this realm of human biology is still ongoing. I haven't followed too much on Wuhan coronavirus, but given general biology, I would view reports of reexposure infections leading to serious illness with skepticism. Although that doesn't mean it's absolutely impossible that someone could become contagious again with a lesser degree of illness a few weeks later. Again, highly skeptical though. If it survives our containment attempts, then we will have future shift and drift issues for immunizations.

Edit: for simplicity and clarity

AnalyticalEngine
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Re: Wuhan Coronavirus

Post by AnalyticalEngine »

For clarification, my understanding was that the problem is coronavirus antibodies fade after a few years, not a few weeks. So you're probably not going to get reinfected with ncov immediately. Rather, it has the potential to come back in two years and get everyone sick again, like the flu. So you wouldn't want to catch it now because it's probable (but not guaranteed) to evolve to be less lethal.

The reinfection thing is more a problem for herd immunity than individual immunity. It just means the virus could have seasons, like the flu.

I'll try to find a better source on the antibody thing that explains why this happens.

ertyu
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Re: Wuhan Coronavirus

Post by ertyu »

The good part about this epidemic is that once it calms down, say next year or so, all sorts of hustle/geoarbitrage type jobs would become so much easier to get: working on a cruise ship, teaching english in china/south east asia, etc etc.

5ts
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Re: Wuhan Coronavirus

Post by 5ts »

Flu reinfection is due to mutation. Antibodies to a particular strain appear to last for life.

http://content.time.com/time/health/art ... 07,00.html

Be very careful wading into the abyss known as Immunology. It is one of the most complicated areas of biology.

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Ego
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Re: Wuhan Coronavirus

Post by Ego »

5ts wrote:
Fri Feb 07, 2020 12:15 pm
Flu reinfection is due to mutation. Antibodies to a particular strain appear to last for life.
Hum. I admit that I could be wrong, but I believe that it is not solely due to mutation.
https://www.nytimes.com/2018/03/09/well ... twice.html

If the person has sufficient antibodies then they can fight off the second infection.
If they have insufficient antibodies they can get the exact same flu again.
Right? Wrong?

5ts
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Re: Wuhan Coronavirus

Post by 5ts »

Ego wrote:
Fri Feb 07, 2020 2:49 pm
If the person has sufficient antibodies then they can fight off the second infection.
If they have insufficient antibodies they can get the exact same flu again.
Right? Wrong?
**I am not an immunologist or infectious disease expert.**

That's right, in a manner, but being immunocompromised is a different issue. This might mean they have enough antibodies but the immune system is compromised in total so it can't mount a sufficient response. It's not a binary thing. This is where old and young come in, we can think of those ages as sort of an immunocompromised state.

Most healthy people not on immunosupressants would mount a sufficient immune response so they would not be re-infected. Also, even the article I linked is not the total picture because there seems to be a difference in duration of antibody response to flu in actual infection vs immunization.

So the question should be, can a healthy person with a healthy immune system get re-infected? See how this gets really messy?

classical_Liberal
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Re: Wuhan Coronavirus

Post by classical_Liberal »

Ego wrote:
Fri Feb 07, 2020 2:49 pm
If the person has sufficient antibodies then they can fight off the second infection.
If they have insufficient antibodies they can get the exact same flu again.
Right? Wrong?
Wrong, sort of. There are also 5 types of antibodies and a bunch of other biological processes going on in an immunological response.

So, to keep this simple. Presented with the same flu again, antibodies will reappear thanks to memory B-cells.

classical_Liberal
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Re: Wuhan Coronavirus

Post by classical_Liberal »

AnalyticalEngine wrote:
Fri Feb 07, 2020 8:23 am
For clarification, my understanding was that the problem is coronavirus antibodies fade after a few years, not a few weeks. So you're probably not going to get reinfected with ncov immediately. Rather, it has the potential to come back in two years and get everyone sick again, like the flu. So you wouldn't want to catch it now because it's probable (but not guaranteed) to evolve to be less lethal.
I'm guessing they are talking about shift and drift in future incarnations of the virus (ie slight mutations in how the virus attaches and enters human cell membranes). If infected once, you should have the memory B-cells to produce antibodies quickly for life. If you're healthy when reexposed your immune system should kick its ass. However a modified version of the virus attaching to and entering cell membranes differently may or may not create the right kind of response, you can get sick again. Exactly how different the virus needs to be, how that impacts responses, etc, is beyond my paygrade.

So yes, if you get it now you should be immune to a this exact version of the virus for life, as long as you are healthy when reexposed. Also yes, as it mutates slightly over years you can get sick again, like influenza.

Again, the disclaimer, these explanations are for general viral infection. I know very little about the Wuhan Corona Virus specifically. However, I would hold reports of it being different than almost all other infectious viruses with a healthy dose of skepticism until proven otherwise.
Last edited by classical_Liberal on Fri Feb 07, 2020 6:44 pm, edited 2 times in total.

AnalyticalEngine
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Re: Wuhan Coronavirus

Post by AnalyticalEngine »

Right, I do think they were likely talking about strains of the virus shifting in the future. Since it has so many humans to infect, there will be many copies of the virus made. Many copies of the virus increases the odds of genetic drift/evolution.

I also read a paper this morning that even casual infection with the cold-causing coronaviruses increased your odds of contracting MS. MS patients were more likely to have cold coronavirus antibodies than people without MS. Additionally, the Spanish flu was said to cause lifelong complications in survivors, such as loss of color vision (amazingly) and mental health issues. Survivors of Spanish flu were much more likely to later seek treatment for depression than people who were never infected.

And also interestingly, Measles can kill memory B cells: https://www.sciencenews.org/article/mea ... -infection

So the moral of the story is avoid infection at all costs. Infection kills cells, and dead cells make you more likely to suffer from complications later.

JamesR
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Re: Wuhan Coronavirus

Post by JamesR »

jennypenny wrote:
Mon Feb 03, 2020 6:09 pm
Taleb's thoughts ... https://www.academia.edu/41743064/Syste ... rus_A_Note
Clearly, we are dealing with an extreme fat-tailed process owing to an increased connectivity, which increases the spreading in a nonlinear way
...exposure to tail events leads to a certain eventual extinction. While there is a very high probability for humanity surviving a single such event, over time, there is eventually zero probability of surviving repeated exposures to such events.
There's a flaw in this reasoning - that we would still maintain "increased connectivity" after a few such events.

So it kind of seems like a dumb reactive paper to me.

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