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  #151  
Old 02-19-2020, 08:06 PM
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And now for a word from "reality check"!



Number of new daily cases decreasing, even with the expanded liberal case definition now in use in Hubei.



Total number of worldwide deaths outside of Hubei Province: 94. Out of 13,617 identified cases. Identified case fatality rate 0.6% - only slightly higher than influenza (and still likely subject to a selection bias to the sickest cases being identified).
And subject to the opposite bias that this virus does not lead to death in a day or two. The cases outside of Hubei have all arisen more recently and therefore we wouldn't expect to see many deaths yet.



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Number of cases considered recovered outside of Hubei: 5787. That's 42% of all identified cases outside of Hubei are already considered recovered. The recovered rate inside Hubei is under 17% to date. If the death rate outside of Hubei is lagging the recovery rate sure is not!

The virus, or minimally identifiable disease caused by the virus, has apparently NOT spread like wildfire across China outside of Hubei. And outside of Hubei identified cases are recovering more often and after fairly short courses of illness with a fraction of the case fatality rate.
Or there may be more aggressive efforts to identify mild cases outside of Hubei, made possible because the medical infrastructure is not overwhelmed, so you'd expect to see more recoveries (and a lower death rate, for that matter) because you're not looking at the same more severe subset of cases.




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There is of course reason for some concern and for appropriate actions that reduce risk. But "numerical literacy" and "calm consideration" leads to a conclusion that the these actions are, appropriately, reducing a fairly tiny risk to one even smaller, because the risk is of something potentially big. Rational thought would have people even more concerned about much larger established risks that can be reduced with relatively little efforts.
I think we can all agree that people who don't mitigate known risks by getting flu shots are acting unwisely.



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  #152  
Old 02-19-2020, 08:11 PM
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Which one? The hong Kong paper which has already been shown to be *way* off in its predictions?
(The paper itself is correctly tentative in its speculations, but it got reported in much of the media as "experts say")

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No. The two articles I'm referring to are the large epidemiological study found here, which was widely reported on:
http://weekly.chinacdc.cn/en/article...b-fea8db1a8f51

And this case study and pathology findings here:

https://www.thelancet.com/journals/l...076-X/fulltext


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  #153  
Old 02-20-2020, 12:48 AM
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And subject to the opposite bias that this virus does not lead to death in a day or two. The cases outside of Hubei have all arisen more recently and therefore we wouldn't expect to see many deaths yet.





Or there may be more aggressive efforts to identify mild cases outside of Hubei, made possible because the medical infrastructure is not overwhelmed, so you'd expect to see more recoveries (and a lower death rate, for that matter) because you're not looking at the same more severe subset of cases. ...
I think you are missing the point of those numbers.

If we are not seeing many deaths because "the cases outside of Hubei have all arisen more recently", then we should not be seeing many completely recovered yet, because "the cases outside of Hubei have all arisen more recently".

Yes, there are many more relatively milder cases being identified outside of Hubei, whereas in Hubei the relatively mild cases are not being identified. THAT IS PRECISELY THE POINT. It is why the statement that the virus "kills 2 out of every hundred people it infects" is a complete mis-statement, based on a faulty understanding of what the current identified or "confirmed" case fatality rate, mostly driven by the subset of confirmed cases in Hubei, means.

Also notable - per that China CDC article (Table 1) there have been up through 2/11/20 only under a thousand cases confirmed in children 19 and under. It is very plausible (and it seems to be) that children get milder or even asymptomatic disease more often, but it is not so likely that there are actually that few kids catching the virus.
  #154  
Old 02-20-2020, 01:22 AM
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Please also be aware - the comparison is being made to influenza fatality rates. For that we have years of developing the models and the standard approach uses multipliers of as reported/confirmed cases are known to be just the tip of the iceberg. But we have ways to deduce how big that iceberg is from the tip.

Right now the cases identified outside of Hubei in China are likely only the tip of the total number of cases ... we just don't yet have the means to completely model how big the iceberg is. We know it is larger than the tip. The larger the iceberg is, of course, the lower the actual fatality rate, which again, outside of Hubei is already not very far off from influenza's number.

A pandemic infecting many millions with a case fatality rate even significantly lower than influenza would still be a big deal. Containing it if possible is VERY appropriate.
  #155  
Old 02-21-2020, 01:55 PM
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Has anyone who replied earlier in the thread with "on a scale of 1 to 10, 0", "not much", "not at all", "I'm less concerned about this virus than the ordinary flu" changed their mind now that new cases of COVID-19 have been popping up all over the world?
  #156  
Old 02-21-2020, 02:33 PM
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On a scale of 1 to 10, I am still about a Meh. It sucks, but so did SARS and MERS and we managed to survive.

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  #157  
Old 02-21-2020, 05:35 PM
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Has anyone who replied earlier in the thread with "on a scale of 1 to 10, 0", "not much", "not at all", "I'm less concerned about this virus than the ordinary flu" changed their mind now that new cases of COVID-19 have been popping up all over the world?
I am more concerned now that cases from Iran, South Korea, and in Beijing itself (as well as clusters of infections in three Chinese provinces) are being reported. It seems highly likely to spread globally now.

Given that a number of the Chinese docs caring for patients with the virus (even young ones) have died, I am more worried on a personal level.
  #158  
Old 02-21-2020, 05:37 PM
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Server error duplicate.

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  #159  
Old 02-21-2020, 06:45 PM
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I am more concerned now that cases from Iran, South Korea, and in Beijing itself (as well as clusters of infections in three Chinese provinces) are being reported. It seems highly likely to spread globally now.

Given that a number of the Chinese docs caring for patients with the virus (even young ones) have died, I am more worried on a personal level.
I think the spread to healthcare workers is partly or mostly due to infectious feces.
Based on my experience caring for patients with C-diff, the addition of this vector makes contamination much more of a risk.
  #160  
Old 02-21-2020, 06:59 PM
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I am more concerned now that cases from Iran, South Korea, and in Beijing itself (as well as clusters of infections in three Chinese provinces) are being reported.
I'm more concerned that no cases have been reported from Indonesia.
  #161  
Old 02-21-2020, 07:25 PM
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I’m traveling this weekend, granted not to Asia. I survived SARS in the Middle East, but I’m not as young as I was then..get off my lawn...
  #162  
Old 02-21-2020, 08:10 PM
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I think the spread to healthcare workers is partly or mostly due to infectious feces.
I've heard reports of virus in fecal samples, but not live virus or transmission from that. ?
  #163  
Old 02-21-2020, 09:52 PM
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It seems like that ship would have given them a good sampling how how diverse are seriousness of the symptoms. How many required seeking medical treatment or not. Mortality rate might be better determined from a more controlled sample such as this. For all we know maybe only 1 in 5 seeks medical treatment and are never reported.
  #164  
Old 02-22-2020, 12:49 AM
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I've heard reports of virus in fecal samples, but not live virus or transmission from that. ?
I am not aware of any confirmation of this route. Pure speculation based on the virus being present in feces.

10 minute (!) old article in Pathogens
"The transmission of 2019-nCoV is often spread from person to person through the respiratory droplets generated during coughs or sneezes from an infected person. Human-to-human transmission is reported in countries such as Germany, Japan, Vietnam, and the United States [12]. The confirmed cases through inter-human transmission have increased the fear and panic accompanying the 2019-nCoV outbreak. It is still unknown whether the virus spreads only through human contact or if there is possible transmission through oral-fecal contact as well"

Both MERS and the original SARS had a GI component, with the virus being present in feces, particularly SARS (The Lancet 2020). SARS was known to have spread via this route.

My particular thoughts on this are related to the spread through hospitals and to healthcare providers. Dealing with fecal transmission, particularly diarrhea, is much harder than strictly airborne transmission.
  #165  
Old 02-22-2020, 12:51 AM
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It seems like that ship would have given them a good sampling how how diverse are seriousness of the symptoms. How many required seeking medical treatment or not. Mortality rate might be better determined from a more controlled sample such as this. For all we know maybe only 1 in 5 seeks medical treatment and are never reported.
I think the Diamond Princess is going to be featured in future textbooks on Public Health and Epidemiology.
  #166  
Old 02-22-2020, 08:19 AM
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...Dealing with fecal transmission, particularly diarrhea, is much harder than strictly airborne transmission.
That really surprises me. I would have thought that solids and liquids are easier to contain and clean up after than air.
  #167  
Old 02-22-2020, 08:33 AM
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That really surprises me. I would have thought that solids and liquids are easier to contain and clean up after than air.
They are.

Not sure why the poster thinks otherwise.
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  #168  
Old 02-22-2020, 10:20 AM
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Some concerning developments in the last couple of days.

A significant loss of containment in South Korea with the cases doubling each day for the last couple of days.

And Iran has 28 cases, but 5 deaths. That's an implied mortality rate of 18%. My thinking is the mortality rate is still around 2%, but there's a couple hundred infected running around, unknown to the authorities.

Last edited by blue infinity; 02-22-2020 at 10:20 AM.
  #169  
Old 02-22-2020, 10:39 AM
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Interesting. China's only level 4 bio lab is located in....... Wuhan.

A quote from Xi: "A national system to control biosecurity risks must be put in place “to protect the people’s health,” Xi said, because lab safety is a “national security” issue."

In other news, Italy is starting to shut places down in 12 cities in response to links to the virus.

Off to buy more soap and disinfectant.
  #170  
Old 02-22-2020, 11:09 AM
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Some concerning developments in the last couple of days.

A significant loss of containment in South Korea with the cases doubling each day for the last couple of days.

And Iran has 28 cases, but 5 deaths. That's an implied mortality rate of 18%. My thinking is the mortality rate is still around 2%, but there's a couple hundred infected running around, unknown to the authorities.
According to the Times this morning much of the South Korean issue comes from a cultish church, where people pray close together and where you are not supposed to get sick. The members seem to have been out in public, so it will get worse.
  #171  
Old 02-22-2020, 12:27 PM
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I think the Diamond Princess is going to be featured in future textbooks on Public Health and Epidemiology.
In the section on government officials infected with Moronavirus, no doubt.
  #172  
Old 02-22-2020, 01:48 PM
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Btw, I was on the Diamond Princess about 12 years ago. My parents, who cruise a lot, have been on it several times.
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  #173  
Old 02-22-2020, 02:46 PM
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I am more concerned now that cases from Iran, South Korea, and in Beijing itself (as well as clusters of infections in three Chinese provinces) are being reported. It seems highly likely to spread globally now.

Given that a number of the Chinese docs caring for patients with the virus (even young ones) have died, I am more worried on a personal level.
Let me add to this:

● Italy now has at least 58 confirmed cases, making it the largest hot spot in Europe.

● Nine South Korean tourists who recently toured Israel and the occupied West Bank tested positive for coronavirus Saturday.

It's pandemic time. There will be huge economic implications around the globe. Maybe the long awaited recession trigger?
  #174  
Old 02-22-2020, 03:23 PM
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● Nine South Korean tourists who recently toured Israel and the occupied West Bank tested positive for coronavirus Saturday.
I don't know about the Palestinians, but Israel has been spending the day quarantining anyone it can find who got within 100 feet of those Korean tourists.
  #175  
Old 02-22-2020, 05:39 PM
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Wonder how long until people start making serious and concerted efforts to avoid quarantine? Other than that one lady in Russia who broke out on her own.
  #176  
Old 02-22-2020, 05:54 PM
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Could the Corona virus be the Black Swan that finally picks this colossal debt bubble?
  #177  
Old 02-22-2020, 05:55 PM
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Yeah, it could.

So could other things.

Buckle in, folks, 2020 could be a wild ride!
  #178  
Old 02-22-2020, 08:54 PM
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Wonder how long until people start making serious and concerted efforts to avoid quarantine? Other than that one lady in Russia who broke out on her own.
Probably not until the quarantine becomes oppressive. When it's a small number of people, and they are well-treated within quarantine, most will likely comply. When it's a large number being warehoused in close quarters with others who might be more likely to be infected, they are more likely to try to evade quarantine.
  #179  
Old 02-22-2020, 10:30 PM
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Wonder how long until people start making serious and concerted efforts to avoid quarantine? Other than that one lady in Russia who broke out on her own.
How long did it take for the planet to take HIV seriously? It was a really easy disease to prevent from spreading.

Last edited by Magiver; 02-22-2020 at 10:31 PM.
  #180  
Old 02-23-2020, 02:50 AM
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I've been seeing people on Twitter start writing about how in America you should be stock-piling as much canned goods and cash as possible due to the fact a lot of people are going to start losing their jobs once the virus becomes a pandemic in the United States.

Curious how fear mongering this is, they're also suggesting own at least one gun as well.
  #181  
Old 02-23-2020, 03:30 AM
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I've been seeing people on Twitter start writing about how in America you should be stock-piling as much canned goods and cash as possible due to the fact a lot of people are going to start losing their jobs once the virus becomes a pandemic in the United States.

Curious how fear mongering this is, they're also suggesting own at least one gun as well.
It is complete fear mongering. As to guns, I think the US already has like 3 guns per person.
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Old 02-23-2020, 03:33 AM
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Yes, but not every person has three guns. Or even one gun. MOST Americans don't own any guns, but a minority own a lot of guns.
  #183  
Old 02-23-2020, 03:35 AM
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I've been seeing people on Twitter start writing about how in America you should be stock-piling as much canned goods and cash as possible due to the fact a lot of people are going to start losing their jobs once the virus becomes a pandemic in the United States.
Of course, once you lose your job in the US you also lose your health insurance - ha, that's going to work well with a pandemic....
  #184  
Old 02-23-2020, 05:55 AM
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You don't usually lose your job immediately upon becoming ill. Not do you lose your insurance immediately upon losing your job. And COBRA is expensive, but looks like a good deal if you are hospitalized when you are making the decision. I think most Americans who are employed when they contact covid-19 will stay insured through their treatment.
  #185  
Old 02-23-2020, 06:11 AM
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You don't usually lose your job immediately upon becoming ill.
No, but if too many staff are ill/quarantined your employer may go out of business, in which case you can lose your job even if you aren't sick.

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Not do you lose your insurance immediately upon losing your job. And COBRA is expensive, but looks like a good deal if you are hospitalized when you are making the decision.
It's a "good deal" only if you have the money to pay for it. With many Americans unable to pull $400 out of their pocket for an emergency expense many will simply not be able to make even one COBRA payment.

Sure - there will be a window of a couple weeks before their coverage is cancelled, but rest assured the insurance industry will drop people as fast as possible.

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I think most Americans who are employed when they contact covid-19 will stay insured through their treatment.
You are more of an optimist than I am in this area.

I would not be surprised if this causes the complete collapse of the so-called US medical "system". Great, world-class facilities but millions without access to them. In the US, if you don't have insurance you don't get access, and even if you do have insurance a two-week stay in quarantine will financially break tens of millions of Americans between "co-pays" and "not covered" and no income coming in for at least two weeks. Is the quarantine facility you're being shipped to "in network"? If not, you're screwed.

Last edited by Broomstick; 02-23-2020 at 06:14 AM.
  #186  
Old 02-23-2020, 09:12 AM
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I've been seeing people on Twitter start writing about how in America you should be stock-piling as much canned goods and cash as possible due to the fact a lot of people are going to start losing their jobs once the virus becomes a pandemic in the United States.

Curious how fear mongering this is, they're also suggesting own at least one gun as well.
VERY fear-mongering. But to answer let's back up a bit.

During normal influenza seasons the excess mortality rate due to the three main strains of influenza in China add up to 5.5/100K, and in bad influenza seasons, be it the first big H1N1 year, or other bad seasonal years, gets to nearly four times that.

For a region like Hubei, population roughly 60 million, that means that most influenza seasons lead to 3 to 4K excess influenza deaths and a bad flu season leads to about 10 to 16K. Most years 80% of the deaths in those over 60 and/or with other existing health issues

So far Hubei, the epicenter, has reported under 2400 deaths from COVID-19 with a similar age distribution to most influenza seasons. Let's assume it is an undercount - more yet to die (although it does seem to be slowing there) and some deaths from it out of the count yet - double it. Still not far off from what most flu seasons do and (assuming no overlap between the sets) adding it to what most influenza seasons do, still a much less impact than what bad influenza seasons have done in recent decades.

The equal of a bad influenza season would be bad. In the United States a mild flu season kills 12,000 and a bad one nearly 80,000. It would wonderful to be able to prevent the equal of a recent bad flu season (adding a COVID- pandemic on top of a moderate influenza season). That's potentially ten to tens of thousands of avoidable deaths in the United States. Tragic. Bad. But recent bad flu seasons have not resulted in economic collapse and breakdown of American society. Even in the 2009 H1N1 year that skewed younger morbidity and mortality impacts.

Last edited by DSeid; 02-23-2020 at 09:14 AM.
  #187  
Old 02-23-2020, 10:59 AM
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on whether surgical masks work : I had been puzzled by this in recent days because a number of people were saying surgical masks were useless for stopping the virus, but giving incorrect reasons like that the masks cannot stop the tiny virus particles (it doesn't need to; it only needs to stop water droplets (as virus particles are not free-floating), which surgical masks do).

But then I saw a disease expert also saying surgical masks do not stop infection. On reading the article though, I find the reasoning is because they don't make an airtight seal. Which is fair enough but I think it makes the overall comment somewhat misleading; surgical masks may still be useful, they just would just not be a good choice if you're actually caring for someone with the disease and are likely to be walking into sneeze clouds (in which case even the best masks are not going to be completely effective since droplets getting into your eyes could also spread the disease).

I think the comments about usage over a long time by non professionals is correct though. I have failed to wear any mask correctly for more than an hour or two. Sooner or later I find myself touching exposed parts of my face after having touched the outside of the mask.





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  #188  
Old 02-23-2020, 11:33 AM
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VERY fear-mongering. But to answer let's back up a bit.

During normal influenza seasons the excess mortality rate due to the three main strains of influenza in China add up to 5.5/100K, and in bad influenza seasons, be it the first big H1N1 year, or other bad seasonal years, gets to nearly four times that.

For a region like Hubei, population roughly 60 million, that means that most influenza seasons lead to 3 to 4K excess influenza deaths and a bad flu season leads to about 10 to 16K. Most years 80% of the deaths in those over 60 and/or with other existing health issues

So far Hubei, the epicenter, has reported under 2400 deaths from COVID-19 with a similar age distribution to most influenza seasons. Let's assume it is an undercount - more yet to die (although it does seem to be slowing there) and some deaths from it out of the count yet - double it. Still not far off from what most flu seasons do and (assuming no overlap between the sets) adding it to what most influenza seasons do, still a much less impact than what bad influenza seasons have done in recent decades.

The equal of a bad influenza season would be bad. In the United States a mild flu season kills 12,000 and a bad one nearly 80,000. It would wonderful to be able to prevent the equal of a recent bad flu season (adding a COVID- pandemic on top of a moderate influenza season). That's potentially ten to tens of thousands of avoidable deaths in the United States. Tragic. Bad. But recent bad flu seasons have not resulted in economic collapse and breakdown of American society. Even in the 2009 H1N1 year that skewed younger morbidity and mortality impacts.
You're making a comparison to a flu season with no outside interference against the Hubei area under heavy lock-down which is unlikely in other countries.

We already have a judge in the US blocking quarantines in the US. There is little chance the rest of the world will be able to engage the disease on a scale similar to what China is doing.
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Old 02-23-2020, 01:04 PM
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You are operating under the mistaken belief that there is any evidence that the lock-down has been effective in any way other than as a public relations move. And while "social distancing" as a means to reduce the speed of spread makes some rational sense, there is in fact no reason to conclude that it, especially started after the virus had probably already spread around the province, has done much to prevent the extent of spread. It mostly closed the barn door after the horse had left.

Best estimates for seasonal influenza in China is an attack rate of about 5.5% overall. The morbidity and mortality is heavily focused on those over 60 and/or with significant pre-existing risk conditions. Relatively few kids gets seriously ill with influenza. But the numbers of kids who have gotten the disease, just relatively mild versions of it? 32% of those 0 to 4 and 19% of those 5 to 14. That's consistent the global annual attack rate of 20–30% in children

Yet there are very very few confirmed cases of COVID-19 in children under 19. Huh. A viral disease spread by casual human to human not infecting kids most often (even if they are minimally ill from it themselves)? It simply does not happen.

The true number of cases of COVID-19 in Hubei, most mild disease in those under 60 and without significant pre-existing conditions, is unknown. But the number of adults with it is very likely a massive undercount, only labelling the most ill, and the number of kids with it is likely four to five times that number.

Remember that to be tested based on illness in Hubei you have to have pneumonia or worse at this point. One good point from that article (which starts out with a sensationalist lede):
Quote:
Meanwhile, hints of how many people in Wuhan may really be infected with the virus come from tests of the 750 people who have been repatriated from the city to Germany and Japan. Of these, 10 infections were found. We know details of eight of these cases, of which five were symptomless. This suggests that 1.3 per cent of people in Wuhan may have the virus, many unknowingly.

Based on this, Ferguson’s team calculates that, by 31 January, there were at least 24,000 new cases a day in Wuhan, which calls into question the current fall in case reports, which number around 3000 a day. This could also mean that total case numbers in China may now be as many as a million. If this is the case, and if all deaths in Wuhan are being detected, then, says the team, the overall death rate is only around 1 per cent – which matches Leung’s prediction.

But age matters.
Age matters. And that estimated 1.3% likely actual infection rate within Hubei is considering just adults and extrapolating, not considering that the infection rate (with mild to asymptomatic infection)is likely several-fold higher in children. Given that, we are likely near the range of typical seasonal annual influenza infection rate.

Really not much reason to believe that the lock-down has been all that effective at preventing the extent of spread within the province. It may be slowing it down some. And it plays well.

Last edited by DSeid; 02-23-2020 at 01:05 PM.
  #190  
Old 02-23-2020, 02:05 PM
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I've seen references to comparing this bug and the flu as a form of "whataboutism".

They two really aren't comparable. It distracts from the main point.

Yes, people die from flu all the time. People also die from smoking, bad eating habits, car crashes, etc.

If you want to talk about a sort-of comparable bug, look at SARS. In particular, look how hard it impacted the hospitals where patients went to.

Then multiply the number of cases.

This is a new bug, that we know very little about, with no vaccine and questionable treatments that infects and kills health care workers. That's the Achilles heel of the matter. If seriously ill people can't go to a functioning hospital and get care, things will be so much worse than the flu or whatever else you're thinking about.

The flu we have a lot of knowledge about, vaccines, partial immunity from most strains due to previous exposure, etc. How is this comparable???
  #191  
Old 02-23-2020, 02:09 PM
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on whether surgical masks work : I had been puzzled by this in recent days because a number of people were saying surgical masks were useless for stopping the virus, but giving incorrect reasons like that the masks cannot stop the tiny virus particles (it doesn't need to; it only needs to stop water droplets (as virus particles are not free-floating), which surgical masks do).

But then I saw a disease expert also saying surgical masks do not stop infection. On reading the article though, I find the reasoning is because they don't make an airtight seal. Which is fair enough but I think it makes the overall comment somewhat misleading; surgical masks may still be useful, they just would just not be a good choice if you're actually caring for someone with the disease and are likely to be walking into sneeze clouds (in which case even the best masks are not going to be completely effective since droplets getting into your eyes could also spread the disease).
n95 masks, which make a better seal, are probably reasonably good at reducing your risk of infection from viruses suspended in airborne water droplets. Surgical masks not so much, because a lot of the air you breathe gets pulled in around the side. They are better for preventing YOU from infecting others, which is what they are designed for. But I've seen commentary that even a surgical mask reduces the risk somewhat.

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I think the comments about usage over a long time by non professionals is correct though. I have failed to wear any mask correctly for more than an hour or two. Sooner or later I find myself touching exposed parts of my face after having touched the outside of the mask. ...
Well, touching your cheek or forehead isn't very risky, even if your hands are a little contaminated. The risk is mostly from touching your nose, mouth, or eyes.

I routinely wear a surgical face mask when I fly, especially long flights. I do it to keep hydrated, not to block disease transmission, so I don't make any real attempt to not touch the outside. I also take the mask off and set it aside when I eat and drink and go to the restroom. (the latter because seeing a mask can make others feel uncomfortable.) But it really DOES reduce how much I touch my nose and mouth, and doesn't increase the amount I touch my eyes. It probably decreases it, because I'm more conscious of it.
  #192  
Old 02-23-2020, 02:28 PM
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In personal terms, I am just sort of watching. I was horrified to learn that the American citizens released from the Diamond Princess cruise ship were returned to the US on an airplane full of healthy people before being ordered to self-quarantine. The stupidity burns. The optimum conditions for surface survival of the virus are low humidity and temperature below 80 degrees F. So it could survive on that airplane, and the belongings of anyone who rode on it, for up to three days. Lovely.

Many of the people I love best are either young, or older, or have asthma, or in some other way vulnerable. I don't want to see a new virus introduced to their environment.

My concern for the people of China, and now Japan, is quite deep. I remember well the overall sense of betrayal and disorientation I felt when I learned how public policy was failing to protect the population from the AIDs outbreak. When politics gets in the way of proper public health there is a deep emotional toll even to those not immediately affected by the illness. I think the Trump Administration will be even worse.
  #193  
Old 02-23-2020, 02:40 PM
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I've seen references to comparing this bug and the flu as a form of "whataboutism".

They two really aren't comparable. It distracts from the main point.

Yes, people die from flu all the time. People also die from smoking, bad eating habits, car crashes, etc.

If you want to talk about a sort-of comparable bug, look at SARS. In particular, look how hard it impacted the hospitals where patients went to.

Then multiply the number of cases.

This is a new bug, that we know very little about, with no vaccine and questionable treatments that infects and kills health care workers. That's the Achilles heel of the matter. If seriously ill people can't go to a functioning hospital and get care, things will be so much worse than the flu or whatever else you're thinking about.

The flu we have a lot of knowledge about, vaccines, partial immunity from most strains due to previous exposure, etc. How is this comparable???
When people are imagining societal collapse from an infectious disease, comparisons to what we know based on what known is the only rational way forward. This bug is in fact by best estimates of actual infection attack rates behaving much more similarly to influenza than to SARS, both in virulence and infectivity.

You don't think that healthcare workers are among the tens of thousands who die of influenza in the United States every year??? The morbidity and mortality of those on the frontlines of infectious disease is real even when it is not "news". Having ANY more than an average year of that would be tragic. And not something that would lead to societal collapse.
  #194  
Old 02-23-2020, 03:05 PM
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You don't think that healthcare workers are among the tens of thousands who die of influenza in the United States every year???
I've never seen or heard of a healthcare worker in my province getting critically ill or dying from influenza. Maybe it happens but it must be rare and not even close to the rate of death/critical illness reported for medical personnel exposed to, and infected by, the new coronavirus (or SARS).

ETA: The New York Post is not the best source for a cite.

Last edited by KarlGauss; 02-23-2020 at 03:05 PM.
  #195  
Old 02-23-2020, 03:54 PM
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In personal terms, I am just sort of watching. I was horrified to learn that the American citizens released from the Diamond Princess cruise ship were returned to the US on an airplane full of healthy people before being ordered to self-quarantine.
...


That's not what happened. The infected passengers were identified after being loaded onto buses for the flight home. They were flying with other cruise ship passengers, some of whom would test positive on their arrival. Not "healthy people". The planes had containment areas for infected patients.

While ideally, all of the patients from that ship would have been placed in land based quarantine in Japan, I personally agree with this decision. Those passengers were minutes from being returned home after enduring a long period of confusion and containment. The other people on those buses were already exposed. They also weren't "being ordered to self quarantine". They were all returned to mandatory quarantine on bases in the US.

This was a judgement call. I personally think it was the right thing to do for humanitarian reasons. Unusual in these times.

NPR story on the process.
  #196  
Old 02-23-2020, 04:00 PM
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I've never seen or heard of a healthcare worker in my province getting critically ill or dying from influenza. Maybe it happens but it must be rare and not even close to the rate of death/critical illness reported for medical personnel exposed to, and infected by, the new coronavirus (or SARS).

ETA: The New York Post is not the best source for a cite.
NY Post is a perfectly fine cite to prove that healthcare workers occasionally die of influenza, just like any other human being. In fact, I found that same article when I Googled "nurse dies of flu." However, I'd be astonished to learn that a city the size of New York had anything like 10 deaths per year. Perhaps DSeid has some data on this.

In any case, as someone mentioned earlier in this thread, the Diamond Princess should illustrate the mortality rate of this virus in the adult population quite well, although it is a fairly small sample size. There are about 700 confirmed infections out of the 3700 people on the ship. I assume the demographics on the ship tend towards the geriatric, but relatively healthy; these aren't nursing home residents or the terminally ill. So far there are 3 deaths, all in patients aged >80. My understanding is that there are a few dozen patients in critical condition.

Now, I may be reading this data wrong, but according to the CDC mortality rates for patients aged >65 with the flu in 2017-18 was about 100 out of 11000, or 1%. If only a handful more passengers die, this would mean a Covid-19 infection is about as bad as the flu. If a few dozen or more die, especially if they are among the younger passengers or crew, that would imply that this virus is significantly worse.

https://www.cdc.gov/flu/about/burden/2017-2018.htm

Last edited by Shmendrik; 02-23-2020 at 04:00 PM.
  #197  
Old 02-23-2020, 04:53 PM
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The equal of a bad influenza season would be bad. In the United States a mild flu season kills 12,000 and a bad one nearly 80,000. It would wonderful to be able to prevent the equal of a recent bad flu season (adding a COVID- pandemic on top of a moderate influenza season). That's potentially ten to tens of thousands of avoidable deaths in the United States. Tragic. Bad. But recent bad flu seasons have not resulted in economic collapse and breakdown of American society. Even in the 2009 H1N1 year that skewed younger morbidity and mortality impacts.
One major, major difference is that we don't quarantine for influenza. That's where the biggest economic damage will be with covid - the quarantine, the loss of time at work, the lost wages.

Although I don't think it will result in "breakdown of American society". It will cause massive disruption if this gets lose like the flu and governments attempt to lock up everybody who might have been exposed.
  #198  
Old 02-23-2020, 05:05 PM
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Originally Posted by Shmendrik View Post
1. In any case, as someone mentioned earlier in this thread, the Diamond Princess should illustrate the mortality rate of this virus in the adult population quite well, although it is a fairly small sample size. There are about 700 confirmed infections out of the 3700 people on the ship. I assume the demographics on the ship tend towards the geriatric, but relatively healthy; these aren't nursing home residents or the terminally ill. So far there are 3 deaths, all in patients aged >80. My understanding is that there are a few dozen patients in critical condition.

2. Now, I may be reading this data wrong, but according to the CDC mortality rates for patients aged >65 with the flu in 2017-18 was about 100 out of 11000, or 1%. If only a handful more passengers die, this would mean a Covid-19 infection is about as bad as the flu. If a few dozen or more die, especially if they are among the younger passengers or crew, that would imply that this virus is significantly worse.

https://www.cdc.gov/flu/about/burden/2017-2018.htm
1. Further info on age range in this article,
https://www.japantimes.co.jp/news/20.../#.XlL-lU9KjIU
80% of passengers are over 60 yrs old it says. But around 1100 of the 3700 are crew (per std sources about the ship not that article) with age distribution presumably closer to the general population, perhaps younger than Japan's general distribution of ages. Overall still older though and 'elderly people made up the large majority of those newly infected with the virus' it says, speaking of the few dozen cases just added when the article was written.

2. I believe that's what it does say, recent flue had a death rate of around 0.14% for all ages but more like 1% for people over 65, though as you suggest, including already seriously ill people over 65 who probably don't go on cruises, and also seems a majority of the passengers are Japanese, where life expectancy/health of people of a given older age tends to be better than in most other countries.

All in all I agree once the cruise ship case plays out (too many people from the ship seriously ill to draw a conclusion now) it will be a relatively clear data point, at least compared to speculating that the death rate must be much lower than it seems to be in the original area because of a large number of unreported cases (which of course doesn't cut in a strictly optimistic direction, since that could also be a reason it appears less and less likely this epidemic will be contained). And the rate I agree will have to be judged against typical flue for the age distribution of people aboard which would be higher than overall normal flue death rate.

Last edited by Corry El; 02-23-2020 at 05:06 PM.
  #199  
Old 02-23-2020, 05:23 PM
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There are two death rates (and several intermediate positions):
People untreated for the disease
People treated in advanced Western hospitals

Almost everyone in the Japanese cruise ship who needs it is treated in the advanced Western hospitals. The problem is that these advanced Western hospitals have relatively little excess capacity and will shortly get overwhelmed with cases (just like Wuhan). When this happens the death rates will start massively increasing.
  #200  
Old 02-23-2020, 05:27 PM
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Originally Posted by PastTense View Post
There are two death rates (and several intermediate positions):
People untreated for the disease
People treated in advanced Western hospitals

Almost everyone in the Japanese cruise ship who needs it is treated in the advanced Western hospitals. The problem is that these advanced Western hospitals have relatively little excess capacity and will shortly get overwhelmed with cases (just like Wuhan). When this happens the death rates will start massively increasing.
Talk about fear mongering. How about a cite for anything at all about "people untreated for the disease".
Or a death rate for same. Or Western hospitals having little excess capacity. Or really anything that backs up anything in your post.

Last edited by steatopygia; 02-23-2020 at 05:29 PM.
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