[pescetom]

cherdano, on 2020-March-12, 03:45, said:

But initially the outbreak was contained in Germany, it took until late February for the numbers to rise.

It was certainly better contained than in Italy where it was not even discovered until 21 February, with 5 deaths just the day after indicating that it had been raging for weeks. But even taking Germany's slow start into account there is no obvious explanation for the divergence in fatality between Germany and other countries. Even if you detract (for statistical caution) all early positives in Italy as presumed dead, and discount this last week where the Italian situation is no longer comparable, the fatality rate is completely different.

Since late February, Germany has been running close to France and Spain in number of positives and yet today we still have:
Spain 2277, 55 dead
France 2284, 48 dead
Germany 2078, 3 dead
The only obvious explanation for a difference of such magnitude that I can imagine is that different criteria are in use for positivity, cause of death or both. There has been fierce debate among Italian experts about the opportunity to maintain WHO criteria for positivity or to revert to the previous Italian protocol of testing anyone who shows initial symptoms (and tracking contacts if they show positive). Maybe Germany is doing something unique here and this is part of the explanation.

[Zelandakh]

cherdano, on 2020-March-12, 07:54, said:

What is the evidence for the claim that (L) is stronger? I.e., I am saying [citation needed]

The original citation is a paper created by the Chinese medical team, which I believe made its way first into the West through Oxford Science Review. It has also been widely reported and confirmed by many other reliable sources, though pretty much every source I have found refers back to this original paper in some way so there is a lot of reliance on the Chinese having done things right.

[pescetom]

Today's statistics in Italy: positive 12839 (+21%), dead 1016 (+23%), no longer infected 1258 (+20%). Fatality rate 7.3%.
So we're back to the usual logarithmic growth rate.

If restrictions on movement really are effective then a major drop must be coming soon. Today all non-essential shops plus bars/restaurants (which were open during the day) were closed down nationwide. Basically one can only leave house to go to work (if approved) or a medical visit or the local food shop - and must have a written declaration.

[shyams]

pescetom, on 2020-March-12, 12:15, said:

Today's statistics in Italy: positive 12839 (+21%), dead 1016 (+23%), no longer infected 1258 (+20%). Fatality rate 7.3%.

Thank you for the regular updates, pescetom.

The numbers indeed make for scary reading. The fatality rate of 7.3% looks very high compared to other nations. I hope the ratios drop soon.

[cherdano]

Zelandakh, on 2020-March-12, 08:20, said:

The original citation is a paper created by the Chinese medical team, which I believe made its way first into the West through Oxford Science Review. It has also been widely reported and confirmed by many other reliable sources, though pretty much every source I have found refers back to this original paper in some way so there is a lot of reliance on the Chinese having done things right.

Here is the main quote from this article comparing L and S:

Quote

We propose that, although the L type newly evolved from the ancient S type, it transmits faster or
replicates faster in human populations, causing it to accumulate more mutations than the S
type. Thus, our results suggest the L might be more aggressive than the S type due to the
potentially higher transmission and/or replication rates.

Nothing in the paper I read suggests that S might be more fatal. (The word "aggressive" refers to its transmission, the way I read it.)

[Cyberyeti]

Just been listening to an interesting discussion on the radio as to why the UK hasn't shut schools.

Their suggestion was that the scientific advice was as it was because:

If you shut the schools:

a lot of health workers would stay home to look after their kids
other kids would be farmed out to their grandparents who tend to be at higher risk

Is this different in other countries ? I'm curious as to why the UK and other European countries have come to different conclusions

[Trinidad]

Cyberyeti, on 2020-March-13, 07:35, said:

Just been listening to an interesting discussion on the radio as to why the UK hasn't shut schools.

Their suggestion was that the scientific advice was as it was because:

If you shut the schools:

a lot of health workers would stay home to look after their kids
other kids would be farmed out to their grandparents who tend to be at higher risk

Is this different in other countries ? I'm curious as to why the UK and other European countries have come to different conclusions

The same holds for the Netherlands.

Universities and colleges are (pretty much) closed. Elementary schools and highschools are open, with the same arguments. The prime minister went as far as to state that the school's primary task is no longer education, but child care. This was heavily debated in parliament, last night (March 12th). A motion to close the schools didn't pass.

However, a motion to suspend penalizing parents whose kids skip school did pass. Normally, the Dutch mandatory school presence is pretty strictly reinforced, in sharp contrast to most laws . So, the fact that parliament passed this motion can have significant impact. I think that the effect might be that a portion of the kids will stay at home, thus lowering the pressure on the schools.

Rik

[barmar]

Cyberyeti, on 2020-March-13, 07:35, said:

Is this different in other countries ? I'm curious as to why the UK and other European countries have come to different conclusions

Last night a radio reporter asked a college president (I think it was University of Virginia) why some colleges took longer to decide to shut down than others. There's still lots of we don't know, and there are many tradeoffs. There was no general guidance from the government, so each had to make their own decisions.

Many conundrums exist for elementary schools. Children don't seem to be at as much risk, but they could transmit the disease. If they don't go to school, where would they go -- day care is just as bad. Children in poor families get their meals at school, so they would be at risk of malnourishment if they have to stay home.

So this can be a "damned if we do, damned if we don't" situation.

[y66]

From Notes from UCSF Expert panel - March 10 by Jordan Schlain MD:

Quote

• At this point, we are past containment. Our containment efforts won’t reduce the number who get infected in the US. Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.
  
• How many in the community already have the virus? No one knows. We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different. 40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
  
• We used their numbers to work out a guesstimate of deaths— `indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months. The fatality rate is in the range of 10X flu. This assumes no drug is found effective and made available.
  
• The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%.
  
• Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
  
• I can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year.
  
• Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
  
• How long does the virus last? On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this. The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based.
  
• Avoid concerts, movies, crowded places. We have cancelled business travel.
  
• Do the basic hygiene, eg hand washing and avoiding touching face.
  
• Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing.
  
• Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
  
• Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
  
• We would say “Anyone over 60 stay at home unless it’s critical”. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
  
• We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in.
  
• Three routes of infection: Hand to mouth / face; Aerosol transmission; Fecal oral route
  
• What if someone is sick? If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on.
  
• If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
  
• There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis.
  
• If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines. [More I found online.]
  
• Why is the fatality rate much higher for older adults? Your immune system declines past age 50
  Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults. Risk of pneumonia is higher in older adults.
  
• What about testing to know if someone has COVID-19? Bottom line, there is not enough testing capacity to be broadly useful. Here’s why.
  
• Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating”.
  
• A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives. The PCR test requires kits with reagents and requires clinical labs to process the kits. While the kits are becoming available, the lab capacity is not growing. The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation.
  
• Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon.
  
• UCSF and UCBerkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified.
  
• Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.
  
• How well is society preparing for the impact? Local hospitals are adding capacity as we speak. UCSF’s Parnassus campus has erected “triage tents” in a parking lot. They have converted a ward to “negative pressure” which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility.
  
• If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected.
  
• School closures are one the biggest societal impacts. We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects. If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services.
  
• Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found.
  
• What will we do to handle behavior changes that can last for months? Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.
  Kids home due to school closures.
  [Dr. DeRisi had to leave the meeting for a call with the governor’s office. When he returned we asked what the call covered.] The epidemiological models the state is using to track and trigger action. The state is planning at what point they will take certain actions. ie what will trigger an order to cease any gatherings of over 1000 people.
  
• Where do you find reliable news? The John Hopkins Center for Health Security site. Which posts daily updates. The site says you can sign up to receive a daily newsletter on COVID-19 by email. [I tried and the page times out due to high demand. After three more tries I was successful in registering for the newsletter.] The New York Times is good on scientific accuracy.
  
  Observations on China
  
  
• Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19.
  
• While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.
  
• Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots.
  
• Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime.
  
  Every few years there seems another: SARS, Ebola, MERS, H1N1, COVID-19. Growing strains of antibiotic resistant bacteria. Are we in the twilight of a century of medicine’s great triumph over infectious disease?
  
  
• "We’ve been in a back and forth battle against viruses for a million years."
  
• But it would sure help if every country would shut down their wet markets.
  
• As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa. See article on Wired magazine on sequencing of virus from Cambodia.

Edit: I see that Shlain took down his post. He did not explain why.

[barmar]

40-70% infected? Ouch!

[pescetom]

Today's statistics in Italy: positive 14955 (+16%), dead 1266 (+25%), no longer infected 1439 (+14%). Fatality rate 7.8%.
So a slight drop in growth rate but still grim reading, particularly the fatality rate now 1 in 13.

One factor that has not been much discussed and yet I suspect is very relevant is air pollution, high levels of which put the lungs under stress and (I have read) cause high levels of the enzyme ACE-2 much loved by this virus. Wuhan was heavily polluted and The Po valley is one of the most heavily polluted areas in Europe, often described as a natural gas chamber: imagine greater London closely ringed by the Pennines and you get the idea. Other regions of Italy are not having the same diffusion rates as Lombardy and this could well be an important factor, with relevance for similar zones in other countries.

[y66]

From Suryatapa Bhattacharya at WSJ:

Quote

TOKYO—The antiviral drug remdesivir appeared to have an effect in American cruise passengers treated for the novel coronavirus in Japan, although data are limited, according to a doctor sent to Tokyo by the U.S. government.

Rear Adm. Richard Childs, an assistant surgeon general and lung specialist at the National Institutes of Health, said 14 Americans who contracted the virus on the Diamond Princess cruise ship and were treated at Japanese hospitals received the experimental drug from Gilead Sciences Inc.

Those 14 were “critically ill people and their average age is 75,” he said. “Many of them were probably going to die in a short amount of time, and two weeks later nobody has died and more than half of them have recovered. It’s just absolutely amazing.” But he cautioned, “It’s going to take us a while to figure out what the impact of the drug has been.”

The drug is being tested in the U.S. and Asia by independent groups as well as Gilead, but no large-scale results are available.

Japan is one of the places where remdesivir is set to be compared with a placebo, a trial design likely to offer a better sense of the drug’s efficacy. “There is a lot of work to do,” said Norio Ohmagari, head of infectious diseases at the National Center for Global Health and Medicine in Tokyo, who is leading the Japanese trial set to start this month.

The cruise passengers probably had better odds than the average person their age. “They are not bedridden, they are high-performing older folk that maybe already have their next cruise planned,” Dr. Childs said.

He said his experience in Japan offered lessons for the U.S., which now has more than 1,700 infected people, and suggested factors beyond drug treatment that increase survival. One is making restoring lung function the priority—sometimes using an advanced form of life support that oxygenates the blood and pumps it back into the same vein from which it was extracted.

“When everything hit the fan, the Japanese knew to focus on the lungs and make sure to get the right kind of support they need,” said Dr. Childs, clinical director at the NIH’s National Heart, Lung and Blood Institute.

The Diamond Princess was put under two-week quarantine Feb. 5 after docking in Yokohama. In the following days, hundreds of passengers were diagnosed with the virus and taken by ambulance to Japanese hospitals. Ultimately more than 700 passengers and crew tested positive, and eight passengers have died—seven in Japan and one Australian who had returned home.

Dr. Childs arrived to help Americans who tested negative return home on evacuation flights Feb. 16, but he said he realized the mission wasn’t over because about 50 Americans were still hospitalized in Japan in isolation rooms.

As in other countries including China, doctors in Japan have been trying a variety of existing drugs, including some used to treat AIDS and influenza, as well as steroids to reduce inflammation. “Once we made it clear there was a possibility of getting remdesivir, most of them jumped at the opportunity,” Dr. Childs said of Japanese doctors.

The American patients were scattered among hospitals in ones and twos. Dr. Childs turned to a former student, Takehito Igarashi, a Tokyo-based endocrinology surgeon, who told the U.S. team that getting the medical records would require faxing individual requests to each doctor. They also got health-ministry approval for an emergency shipment of the experimental drug.

Dr. Childs set up a war room in the U.S. Embassy and studied X-rays, laboratory results and medical history of each patient before 14 Americans were selected to receive remdesivir. Three Japanese patients also qualified.

“This particular situation with Japan absorbing a large number of international cases from the cruise ship was unique,” said Diana Brainard, Gilead’s senior vice president for HIV and emerging viral infections.

In late February, the first patient received the drug, and Dr. Childs traveled to hospitals across the Tokyo region to meet doctors and patients’ families.

Remdesivir is administered intravenously once a day for 10 days, with a higher dose the first day. Dr. Childs said he noticed patients needed less support from a ventilator after getting the drug.

All 17 patients who received remdesivir are alive, though five of the Americans remain critically ill. The situation “certainly has the feel that the drug was doing something. It’s almost impossible to prove it,” Dr. Childs said.

[cherdano]

pescetom, I am really grateful for the perspective you have added with your posts here. Has really helped grow my awareness of what is going to come a little earlier and a little faster.

[pescetom]

Today's statistics in Italy: positive 17750 (+19%), dead 1441 (+14%), no longer infected 1966 (+37%). Fatality rate 7.5%.
Which confirms the slight drop in growth rate but still nothing like what the authorities hope for from the clamp down.

I picked up courage and went to the supermarket today. The scariest thing was the orderly queue with everyone in line and two metres apart, most un-Italian. A friend of mine has symptoms and has been trying to call his GP (required procedure) since 1pm, to no avail. He's about to call the emergency services but of course they are saturated by such calls too. An app or web page for people to report sick is something that should be at the top on any country's TODO list.

[Winstonm]

pescetom, on 2020-March-14, 12:13, said:

Today's statistics in Italy: positive 17750 (+19%), dead 1441 (+14%), no longer infected 1966 (+37%). Fatality rate 7.5%.
Which confirms the slight drop in growth rate but still nothing like what the authorities hope for from the clamp down.

I picked up courage and went to the supermarket today. The scariest thing was the orderly queue with everyone in line and two metres apart, most un-Italian. A friend of mine has symptoms and has been trying to call his GP (required procedure) since 1pm, to no avail. He's about to call the emergency services but of course they are saturated by such calls too. An app or web page for people to report sick is something that should be at the top on any country's TODO list.

I really have sympathy for the Italian people as I have at least an inkling of how difficult the altered social-distancing lifestyle compared to cultural norms of communal piazza and passegiatta must be. It must be awfully difficult to try to undo temporarily a cultural normal.

[pescetom]

Winstonm, on 2020-March-14, 14:15, said:

I really has sympathy for the Italian people as I have at least an inkling of how difficult the altered social-distancing lifestyle compared to cultural norms of communal piazza and passegiatta must be. It must be awfully difficult to try to undo temporarily a cultural normal.

At an individual level, the frightening thing is how quickly (if not easily) one can undo a cultural normal. For an Italian, the first morning without an espresso from the bar is something like a day when the sun does not rise, and crossing the road to avoid a friend is a negation of self. Yet after just a few days, these and many other changes become normal.
But Italians are still Italians, and today at 12am everyone was out on their balconies to applaud for five minutes the medics and emergency services who are doing their utmost and risking their lives in this sad situation.

[Winstonm]

pescetom, on 2020-March-14, 16:04, said:

At an individual level, the frightening thing is how quickly (if not easily) one can undo a cultural normal. For an Italian, the first morning without an espresso from the bar is something like a day when the sun does not rise, and crossing the road to avoid a friend is a negation of self. Yet after just a few days, these and many other changes become normal.
But Italians are still Italians, and today at 12am everyone was out on their balconies to applaud for five minutes the medics and emergency services who are doing their utmost and risking their lives in this sad situation.

Well, I've only managed to get to Italy twice, once in the south and the other in Tuscany, but just with that small taste I developed a real affinity for the country but even more for the people.

[y66]

Noah Smith @noahopinion said:

South Korea beat coronavirus. Let's copy their example.

Jihye Lee 이지혜@TheJihyeLee said:

South Korea reports 76 new coronavirus cases in 24 hours -- this is an all time low since February 20th, and the first time droppping to double digits since then. Third day in a row where released patients outnumber the additional confirmed cases. #killthevirus

I don't understand 'beat'. Going in the right direction at the moment is encouraging.

[FelicityR]

y66, on 2020-March-14, 22:55, said:

I don't understand 'beat'. Going in the right direction at the moment is encouraging.

South Korea is a unique case study. The coronavirus is centred around a South Korean church that has similarities with Jehovah's Witnesses insomuch 144,000 followers are promised that they will go to heaven come the Judgement Day.

https://www.theguard...ch-cult-cluster

So the statistics for covid-19 are very much skewed in this country. The grim reality is that covid-19, and newer coronavirus variants will always be there, in the same way that SARS, MERS and Ebola keep reappearing from time to time.

The medical community eradicated the smallpox virus through immunisation, but the newer viruses will keep evolving and more vaccines will have to be found.

I am very much into herbal medicine these days, so I will share my thoughts about tackling coronavirus if you should get it. (Please do not take this advice in preference to experienced medical advice offered from a doctor or consultant.) But I have made a list of easily available natural remedies that possibly could help you should you develop coronavirus symptoms.

Turmeric, specifically Curcumin; Elderberry; Barberry; Vitamins D,C and Zinc, Garlic; Oregano Oil.

Most of these herbs, spices, vitamins and fruit extracts are already well-known for their effectiveness against influenza, and all have been clinically-tested against various contagions.

There are not a cure, but maybe a way of lessening the effects of the virus. My household has stocked up just in case we are unlucky enough to get covid-19 and have to self-isolate.

[awm]

Does anyone know why so many Americans seem to be suddenly stocking up on toilet paper?

I can understand why there would be shortages of things like hand sanitizer and surgical masks -- these are things that most Americans rarely use under normal circumstances but people want to have on hand now because of the pandemic. It's quite possible that the supply chain isn't able to immediately meet the suddenly increased demand for these things, leading to a panic and people stocking up.

But the US has been producing enough toilet paper for all its residents' needs for a very long time. And the coronavirus does not (AFAIK) increase the need for toilet paper in any significant way. Is this some kind of hedge against the entire economy completely collapsing? It just seems really weird.

We do not have any toilet paper shortages here in Switzerland, although I have noticed an increase in demand for frozen foods (makes sense since people are avoiding bars and restaurants to some extent and are also looking for low-effort meals in case they get sick).