COVID-19

[horsewoman]

Not touching your face is a habit like any other. I've been practicing this for a few years because as a singer with gigs year round every avoided cold means a lot less hassle. The added pressure of the virus would make it a lot easier to get this habit to stick, so I'd encourage everyone to work on it - no matter how this whole scenario pans out, it is a valuable skill to have.

[alice_nrw]

Hello, I am new to this forum (but read this website for years).
I live in Nordrhein Westfalen (Germany). We are already by almost 200 cases. In the agglomeration where I live (about 200 000 people) there is one case detected.
I have a 6 year old kid, that is going to school. My husband and I can work from home.

I don´t know when will be the right moment to not send my kid to school?

Here in town people are very relaxed. Most of them will probably think I am crazy if I will not send my kid to school.

What would you do in my place?

(They are not testing all people for Corona in my community. Only those that went to China or Italy. The spread is therfore probably also larger)
Thanks!

[Seppia]

Per the Oregon Health Authority tweets, it appears Oregon takes a day to crank through 5 COVID-19 tests. There are still 13 patients awaiting results. CDC confirmation takes even longer.

at this frantic testing pace, Trump can claim the USA has "very few cases" for a long time.
I'm starting to think if this is by design

[ertyu]

what was that quote, don't attribute to malice what can be easily explained by stupidity

[jennypenny]

I really hope this thread doesn't get political. Both the WHO and US Health & Human Services have had problems for years. See the horrendous Obamacare rollout or the WHO's botched response to Ebola or Tom Frieden's resignation because of sexual abuse claims or the CDC's failure to disclose lab incidents to Congress ... all of which occurred before Trump was elected.

The WHO has also admitted mistakes in how they've handled COVID-19, which has nothing to do with Trump. So have Japan, China, and Italy.

The US's handling of the outbreak has been poor and I blame Trump for poor messaging and a lack of focus, but not for the US's overall response. HHS/CDC have a terrible track record over the last two decades. I don't know if it's because of a lack of funding, poor leadership, or a poor internal culture, but regardless ... I hope this failure finally brings about some changes.

[Ego]

I'm starting to think if this is by design

I don't really believe they had a choice. If the evidence that community transmission has been happening for weeks is correct then they have no choice but to push pause on the ability to test and confirm until they can guide the public through to the acceptance stage.

I read a second-hand report from the private briefing the chief epidemiologist at Johns Hopkins gave to Morgan Stanley. It sounds like they are now resigned to what we mentioned way up thread, that this will probably become another annually circulating Coronavirus and 40-60% of the population will experience it within a year. Most will think it was like a hard flu. ICUs and hospitals will be overwhelmed and short of supplies. Lots of old and compromised people will die though not as many as first thought because of the skewed death rate numbers.

Looking ahead, the next time this happens, whichever country first discovers the novel virus will be less likely to shut down their economy to keep it from spreading. Let's hope it is not more deadly

[chenda]

Has there been anything comparable to this since 1918 ?

[Ego]

It will be interesting to see who gets the first batches of the vaccine, those most compromised or those on the front line.

[AnalyticalEngine]

I'm starting to think we in the Western world have become too accustomed to living without major infectious disease that we've collectively forgotten how devastating disease outbreaks can be. But throughout history, losing a quarter of the population to smallpox was the rule, not the exception. I think we're seeing such severe reactions by authorities now simply because there's so much we don't know about the illness. The CFR could be anywhere between 0.7% (SK) to 3.4% (Global average) to ~5% (Wuhan) to maybe even a whopping 10% in areas without any medicine and poor nutrition. (This is not unlike the CFR spread of Spanish Flu) Additionally, they thought SARS only had a CFR of 2% when it started. It wasn't until it was all over that they realized it was whopping 10%.

And even if the virus only kills the elderly, most of our elected leaders are in the high risk group. What happens if Pence gets it, gives it to Trump, gives it to congress, gives it the Supreme Court? Continuity of government is extremely important. So it's better to be safe than sorry. Even having 30% of the workforce getting sick at once would be extraordinarily disruptive.

After the Spanish Flu, an economist ran the numbers to see if agricultural economies had excess labor. The theory was that if they did, crops could still be harvested even when the population was sick. The economist determined that there wasn't an excess labor in agriculture because Spanish Flu resulted in crop failures as people were literally too sick to harvest the crops.

If I run a restaurant, and we have an outbreak in my area, people are going to stop coming in for food. Then I won't have revenue, and I can't pay my employees even if I wanted to. Then the employees can't pay their rent. Landlords can't pay the mortgage company. This kind of spiral across the whole economy at once could create massive deflationary pressure.

BUT, what I am most worried about isn't any of that. It's the lifelong complications that severe viral illnesses can leave on their survivors. Take a look at this most recent paper that says SARS-CoV-2 can attack the brain and nervous system. See this paper https://onlinelibrary.wiley.com/doi/pdf ... urce=share

The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients
(emphasis mine)

It is now known that CoVs are not always confined to the respiratory tract and that they may also invade the CNS inducing neurological diseases. Such neuroinvasive propensity of CoVs has been documented almost for all the betacoronaviruses, including SARS-CoV 1, MERS-CoV 11, HCoV-229E16, HCoV-OC4312, mouse hepatitis virus (MHV)17, and porcine hemagglutinating encephalomyelitis coronavirus (HEV)9-10, 18-19.

In light of the high similarity between SARS-CoV and SARS-CoV2, it is quite likely that the potential neuroinvason of SARS-CoV-2 plays an important role in the acute respiratory failure of COVID-19 patients. According to the complaints of a survivor, the medical graduate student (24 years old) from Wuhan University, she must stay awake and breathe consciously and actively during the intensive care. She said that if she fell asleep, she might die because she had lost her natural breath.

If the neuroinvasion of SARS-CoV-2 does take a part in the development of respiratory failure in COVID-19 patients, the precaution with masks will absolutely be the most effective measure to protect against the possible entry of the virus into the CNS. It may also be expected that the symptoms of the patients infected via facal-oral or conjunctival route will be lighter than those infected intranasally. The possible neuroinvasion of SARS-CoV-2 may also partially explain why some patients developed respiratory failure, while others not. It is very possible that most of the persons in Wuhan, who were the first exposed to this previously unknown virus, did not have any protective measure, so that the critical patients is much more in Wuhan than in other cities in China.

Since SARS-CoV2 may conceal itself in the neurons from the immune recognition, complete clearance of the virus may not be guaranteed even the patients have recovered from the acute infection. In support of this, there is evidence that SARS-CoV-2 is still detectable in some patients during the convalescent period 43. Therefore, given the probable neuroinvasion the risk of SARS-CoV-2 infection may be currently underestimated.

This may explain why people test negative then later positive, that so called "reinfection." It could very well be the body clears the virus from the lungs but SARS-CoV-2 is still hiding inside the nerve cells, just like smallpox or herpes viruses. Also concerning because it means we may see biphasic illness like we saw in Ebola. Unfortunately this virus just hasn't exists long enough in humans that we have answers to these questions. It could be as mild as very very severe flu (SK CFR ~0.7%) or as horrible as SARS/Spanish Flu (Wuhan/Iran).

Authorities have to walk the fine line between closing schools/social distancing, which can be very disruptive, or letting unknown super bug run amok. It's a hard call to make. But it's also why I'm not in any rush to get infected despite being in the low risk group. We don't want to underestimate this thing either.

[Seppia]

I really hope this thread doesn't get political.

Why? Politics plays a major role in the response to this kind of issues, I think it can and should be part of the discussion.

We have so far seen three types of responses from governments:

- obfuscation/minimization of the issue (china)
- (maybe) overreaction coupled with massive testing (south korea and italy - which BTW are the ones with -or should I say "finding"- the most cases)
- clear communication and complete openness / relying on the citizens to be intelligent people (Singapore)

I know what I prefer (Singapore)

The USA seem to have a new approach, in th esense that Trump does seem concerned heavily about the impact that this virus can have on markets performance (that he has used since day 1 as a gauge for his performance).
So the obvious lack of testing, the baseless downplayment of the issue, the fact that all communications have to be vetted by Pence etc seem fishy.

This doesn't mean that CDC hasn't fucked up ever before or that Obama is a saint.
People here in europe tend to have a rather negative or very negative view of the general helathcare system in the USA (having tried France, Italy and the USA, I can confirm the reputation is well deserved), so not putting all the blame of all failures on Trump, I know the system is shitty regardless of who's in charge

[chenda]

Singapore's advantage though is that its a small country ruled by a very authoritarian, collectivist regime. Its citizens are used to heavy paternalism from the government. Very difficult to replicate that in a giant nation like China or the US or most other places I would imagine.

[Riggerjack]

Authorities have to walk the fine line between closing schools/social distancing, which can be very disruptive, or letting unknown super bug run amok.

Well, no.

Authorities have a choice between closing school/social distancing with a superbug running amok more slowly, or not closing school, and a superbug running amok at maximum speed.

Sure, more people die from virus and overwhelmed healthcare system if we keep school open, and get hit harder and faster. But also the economic disruption is shorter, if more people catch it simultaneously. Most of them will recover.

That seems to be the math as they have it worked out. I'm just going off of the way the decisions are being made. BAU leads to a faster return to BAU, but higher casualties from the virus.

It sounds callous, but maybe the harder, faster scenario will lead to a lower overall casualty rate than an extended economic crunch.

I'm sure we could build models to support each scenario.

We are in unknown waters, here.

[George the original one]

The US's handling of the outbreak has been poor and I blame Trump for poor messaging and a lack of focus, but not for the US's overall response.

Trump has to be removed from office ASAP. His current message based on his hunch that people can go to work with mild symptoms and they'll be okay (possibly true, but...then you're spreading the virus) is downright dangerous.

More poor messaging: rumour that State of Washington Department of Health will no longer report case numbers "because they might get them wrong", but will allow individual counties to report their numbers. I'm trying to track down a confirmation. Washington stats at this point are 10 deaths and 39 confirmed cases; remember that confirmed cases is based on the old standard that they're not testing unless you were a severe case.

[George the original one]

Confirmation about State of Washington Department of Health from https://www.doh.wa.gov/Emergencies/Coronavirus

Note: To make sure we can provide case counts as quickly and efficiently as possible, we are no longer reporting the number of persons under investigation at a state level. County health officials may choose to report these numbers for their county. This is consistent with other disease outbreaks, where the state generally only reports confirmed cases. Those numbers are changing rapidly as we are now doing multiple runs of tests each day and as commercial labs begin testing, the amount of administrative time needed to track numbers will increase significantly.​

They appear to be continuing to report confirmed cases and deaths, daily at 11a Pacific Time. The last reported count of people under public health supervision is 231.

[Dream of Freedom]

Has there been anything comparable to this since 1918 ?

There has been AIDS. It's a global pandemic that has killed millions and like the 1918 flu it primarily affects people in the prime of life ( unlike coronavirus). Though the social impact may be different. Because of the way it spreads people feel like they have more control.

[George the original one]

How does this pandemic intersect with Census 2020 in the US?

The USA has skipped the census in the past. Was it 1880 or 1890? Anyway, the count didn't happen.

[tonyedgecombe]

That seems to be the math as they have it worked out. I'm just going off of the way the decisions are being made. BAU leads to a faster return to BAU, but higher casualties from the virus.

The thinking in the UK seems to be the longer we can drag this out the less likely the health system is going to be overwhelmed. I find it hard to argue against that.

I was in Oxford this morning and it was very quiet, even at this time of year there are normally quite a few tourists about but today I saw none. It looks like an economic impact is going to be impossible to avoid.

[Seppia]

Singapore's advantage though is that its a small country ruled by a very authoritarian, collectivist regime. Its citizens are used to heavy paternalism from the government. Very difficult to replicate that in a giant nation like China or the US or most other places I would imagine.

Ok but I was making a different point. How do any of the above factors impact the style of communication/approach to reporting numbers and cases?

I think this is amazing, there aren't many politicians that approach their population as if they still have a functioning brain https://www.youtube.com/watch?v=ZyZwtKJn-Ac

[Ego]

This Week in Virology podcast

http://www.microbe.tv/twiv/twiv-special-sars-cov-2/

They mention that there is evidence that the NYC area has had active transmission in the community since mid-February.
Nearly impossible to distinguish between flu and Covid-19 without test
Catch22: It is impossible to test everyone with symptoms.
Physicians should be diagnosing by phone:

• Those in low-risk population should be told to stay home

• Those in high-risk population should be sent directly to ER

Majority of those who test positive are being sent home to self-isolate
No antivirals have demonstrated efficacy.
We should have funded SARS antiviral after the last SARS outbreak
Having effective antivirals would create problems

• The positive patient would have to be hospitalized to receive treatment (no space for that many people) or figure out how to home administer.

• Someone who tests positive would have to be re-tested before providing treatment to ensure we are administering the drug to only
  those who are positive so that we do not run the risk of creating resistance.

• Many antivirals must be started within 48 hours to be effective.

Pre-clinical transmission is a problem and one of the defining characteristics between SARS-1 and SARS-CoV-2
Facemasks should be worn by the sick not those who are healthy

[AnalyticalEngine]

https://anu.prezly.com/coronavirus-is-h ... ent-171409

Good paper discussing possible scenarios and fallout to the economy. I suggest reading the whole paper to understand their modeling methods.