COVID-19 Coronavirus Containment Efforts

[chemisttree]

Global health emergency = pandemic?

 

[kadiot]

Global health emergency = pandemic?

A pandemic (from Greek pan all + demos people) is an epidemic of infectious disease that spreads through human population across a large region (for example a continent), or even worldwide. It is also infectious.

 

[chemisttree]

A pandemic (from Greek pan all + demos people) is an epidemic of infectious disease that spreads through human population across a large region (for example a continent), or even worldwide. It is also infectious.

https://www.google.com/amp/s/www.nytimes.com/2020/02/02/health/coronavirus-pandemic-china.amp.html

Not sure what to call it or if it really matters. A rose is a rose.

 

[mfb]

So far n-COV is less fatal than SARS and even comparable in severity to the common flu. Most patients have already recovered.

17,400 confirmed cases, 362 deaths, 486 recoveries based on this website. For people where the outcome has been determined, 40% died. The longer people survive the more likely they are to recover, so 40% is an upper limit on the death rate, but "most patients have already recovered" in general is wrong. There are many people who are currently ill, we'll have to see how many recover and how many die.

If deaths follow confirmed infections with one week delay then we have 361 deaths from 2794 infections (using these numbers), that's a 10% death rate. If they follow with just three days delay we get 4% death rate.

This doesn't take into account that there can be many undiscovered cases, while deaths are obviously more visible. It also doesn't take into account that official Chinese numbers are not always very reliable.

----

Thailand 'cures' Coronavirus with anti-HIV drug cocktail in 48 hours
It's a single case so it's unclear how much was luck and how much was the drug, but the quick recovery looks promising.

 

[kadiot]

https://www.google.com/amp/s/www.nytimes.com/2020/02/02/health/coronavirus-pandemic-china.amp.html

Not sure what to call it or if it really matters. A rose is a rose.

Yes, increasingly like Pandemic. However, despite sensational media reporting, nCov cannot yet cause sustained and efficient human-to-human transmission.

 

[mfb]

Yes, increasingly like Pandemic. However, despite sensational media reporting, nCov cannot yet cause sustained and efficient human-to-human transmission.

Where do you get that from? That disagrees with every single estimate for R0 I have seen. Here are some, they are all larger than 1.

If by "sustained" you mean being present over months: Well, that's trivial if the disease is not months old.

 

[kadiot]

Where do you get that from? That disagrees with every single estimate for R0 I have seen. Here are some, they are all larger than 1.

From a Viber post from an infectious diseases doctor (will omit name). Looks like it is NOT accurate and is a mix of facts, unverified assertions, and pseudoscience because that doctor has taken it down. Sorry for that. I'll stick to official sources of information including Philippine-DOH and WHO. However, I noticed that DOH uses a different gauge - PUIs, not RO. I have no idea on what PUI accronym mean. Anyway, I am attaching the latest nCoV report from DOH wherein PUI is mentioned. I hope DOH will determine this RO in coordination with CDC and WHO.

By the way, according to Singapore's Ministry of Health, there is currently no evidence of community spread in Singapore. Does it mean Singapore's RO is below 1?

 

[kadiot]

Humanity continues to triumph...

http://www.xinhuanet.com/english/20...OSXpXLIrEikNjnyxTK-xZJkeWo32wkXOSTTkDhywTr32A

 

[mfb]

However, I noticed that DOH uses a different gauge - PUIs, not RO. I have no idea on what PUI accronym mean.

Patients under investigation according to the image you attached, that's not a measure how fast it spreads.

Singapore had just 18 cases, certainly possible that a spread (or lack thereof) is different there but with the low statistics we don't know if that was luck or not.

 

[Mary Conrads Sanburn]

Data sources: WHO, CDC, ECDC, http://www.nhc.gov.cn/yjb/s3578/new_list.shtml and DXY.
2019-nCoV Global Cases by Johns Hopkins CSSE
Confirmed Cases by Country/Region
20,401 Mainland China
20 Japan
19 Thailand
18 Singapore
15 Hong Kong
15 South Korea
12 Australia
12 Germany
11 US
10 Taiwan
8 Vietnam
8 Macau
8 Malaysia
6 France
5 United Arab Emirates
4 Canada
3 India
2 Italy
2 Russia
2 Philippines
2 UK
1 Nepal
1 Cambodia
1 Spain
1 Finland
1 Sweden
1 Sri Lanka
Last Update: 2/3/2020
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

 

[Ygggdrasil]

Apparently, the report in the NEMJ about transmission of 2019-nCoV by an asymptomatic individual was erroneous:

The letter in NEJM described a cluster of infections that began after a businesswoman from Shanghai visited a company near Munich on 20 and 21 January, where she had a meeting with the first of four people who later fell ill. Crucially, she wasn’t sick at the time: “During her stay, she had been well with no sign or symptoms of infection but had become ill on her flight back to China,” the authors wrote. “The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak.”

But the researchers didn’t actually speak to the woman before they published the paper. The last author, Michael Hoelscher of the Ludwig Maximilian University of Munich Medical Center, says the paper relied on information from the four other patients: “They told us that the patient from China did not appear to have any symptoms.” Afterward, however, RKI and the Health and Food Safety Authority of the state of Bavaria did talk to the Shanghai patient on the phone, and it turned out she did have symptoms while in Germany. According to people familiar with the call, she felt tired, suffered from muscle pain, and took paracetamol, a fever-lowering medication.

https://www.sciencemag.org/news/2020/02/paper-non-symptomatic-patient-transmitting-coronavirus-wrong

If it hold up that people aren't contagious until they begin showing symptoms, then that is very good news for efforts to contain the virus.

 

[chemisttree]

Patients 3 and 4 had no contact with the (now symptomatic) index patient. I believe patients #3 and #4 contracted it from patient #1 before he had symptoms.

 

[Mary Conrads Sanburn]

• Isn’t this a pandemic yet?

New Coronavirus threat galvanizes scientists
Barely 1 month after Chinese health authorities reported the first cases of a mysterious new pneumonia in the city of Wuhan, the world may be on the cusp of a new pandemic. As Science went to press, the number of confirmed cases of the novel coronavirus, dubbed 2019-nCoV, had shot up to more than 4500, most of them in mainland China but more than 80 in 17 other countries and territories. China has quarantined 35 million people in Wuhan and several other cities in a desperate attempt to slow the spread of the virus. But as the case numbers keep soaring, the realization has set in that it may be too late to have much impact.

Even seasoned epidemiologists are astonished at the virus's dizzying spread. Early estimates of the number of infected people—thought to far exceed the number of confirmed cases—became obsolete overnight. “Our original results are NO LONGER VALID,” University of Hong Kong epidemiologist Gabriel Leung tweeted on 22 January, 1 day after his group had posted its first mathematical model of the epidemic. Leung is now estimating that Wuhan alone had 43,590 infections by 25 January—and that the number is doubling every 6 days. “How widespread does this go?” asks Marion Koopmans, a virologist at Erasmus Medical Center. “This deserves our full attention.”

[. . .]

###

1. Jon Cohen

See all authors and affiliations

Science 31 Jan 2020:
Vol. 367, Issue 6477, pp. 492-493
DOI: 10.1126/science.367.6477.492
https://science.sciencemag.org/content/367/6477/492

 

[kadiot]

Heard from the grapevine that Taiwan was removed as an exposure country.

 

[StatGuy2000]

Patients 3 and 4 had no contact with the (now symptomatic) index patient. I believe patients #3 and #4 contracted it from patient #1 before he had symptoms.
View attachment 256598

According to your chart above, it looks like Patient 4 had contact with Patient 1 on the very verge that Patient 1 was displaying symptoms, and thus more likely to be able to infect others (other coronaviruses have been show to be transmissible through droplets released during breathing).

I'm also curious as to how investigators were able to confirm which dates Patients 3 and 4 had contact with Patient 1. It's difficult to be precise about these timelines, so I'm not sure that it really tells us just how transmissible the Coronavirus is.

 

[kadiot]

What does Taiwan have to say about this?
Territory of China?

 

[Ygggdrasil]

Patients 3 and 4 had no contact with the (now symptomatic) index patient. I believe patients #3 and #4 contracted it from patient #1 before he had symptoms.

According to your chart above, it looks like Patient 4 had contact with Patient 1 on the very verge that Patient 1 was displaying symptoms, and thus more likely to be able to infect others (other coronaviruses have been show to be transmissible through droplets released during breathing).

I'm also curious as to how investigators were able to confirm which dates Patients 3 and 4 had contact with Patient 1. It's difficult to be precise about these timelines, so I'm not sure that it really tells us just how transmissible the Coronavirus is.

Just to clarify, the possibility still exists that asymptomatic individuals can spread the disease, we just don't have solid evidence of whether or not this is true. There have been anecdotal reports from doctors in China that this is the case (discussed in the Science news piece I posted earlier), but we await further evidence. Hopefully, the doctors in Germany who published the NEMJ piece can provide an updated paper to clarify how patients 3 and 4 were infected.

 

[chemisttree]

Countdown to “SARS Level Lethality” is about 4 days now.

https://ncov.r6.no/

 

[chemisttree]

What does Taiwan have to say about this?
Territory of China?

I’ve seen blog posts asserting that China essentially owns the WHO. China objected to Taiwan’s inclusion in the WHO and so Taiwan isn’t a member. This is just another datapoint supporting that assertion.

What does Taiwan have to say? Taiwan is “outraged.”

https://www.worldtribune.com/taiwan...part-of-china-on-who-coronavirus-declaration/

 

[bhobba]

I just finished watching a virologist talk about the latest with this virus. He said human to human transmission has been confirmed - its droplet spread. The death rate is about 5%.

But keep calm - the silver bullet is coming. We now have the technology to create vaccines very quickly - evidently the University of Queensland near were I live (as mentioned previously it swung into action immediately and is making progress at an amazing rate) has just completed the first one, or it soon will be completed. The two enablers are the synthesized virus created by the University of Melbourne and the 'molecular clamp' technology (whatever that is) invented and patented by UQ scientists.

I had no idea our local university was so advanced. Then its to trials and mass production. The thinking is April when it can be used by humans and ready for mass inoculation a bit after that - certainly all in a maximum of a 6 months time frame.

The virologists concern was we do not know how fast it is mutating. It's very similar to both a virus that causes the common cold and the even deadlier SARS virus. If it goes in the cold direction it may just peter out - if it goes in the SARS direction then its all stops out on the vaccine.

Finger's crossed - but it seems we have the technology.

Added later: Watching TV makes me think people are really starting to worry. If you live in a modern country like the US, UK ,or Australia - don't. With modern care I think the death rate will be much lower than 5% - maybe about the same as the flu. I am a hypochondriac with a comprised immune system from two drugs - Methotrexate and a Biologic and even I am not worried despite being the exact person that would be in trouble if they got it. What they found with the the SARS virus was even simply ensuring you wash your hands frequently and certainly every time you use the bathroom made a big difference.

Thanks
Bill

 

[kadiot]

I’ve seen blog posts asserting that China essentially owns the WHO. China objected to Taiwan’s inclusion in the WHO and so Taiwan isn’t a member. This is just another datapoint supporting that assertion.

What does Taiwan have to say? Taiwan is “outraged.”

https://www.worldtribune.com/taiwan...part-of-china-on-who-coronavirus-declaration/

With cases that are confirmed I just don't know the reason why Taiwan was removed.

 

[kadiot]

I just finished watching a virologist talk about the latest with this virus. He said human to human transmission has been confirmed - its droplet spread. The death rate is about 5%.

But keep calm - the silver bullet is coming. We now have the technology to create vaccines very quickly - evidently the University of Queensland near were I live (as mentioned previously it swung into action immediately and is making progress at an amazing rate) has just completed the first one, or it soon will be completed. The two enablers are the synthesized virus created by the University of Melbourne and the 'molecular clamp' technology (whatever that is) invented and patented by UQ scientists.

I had no idea our local university was so advanced. Then its to trials and mass production. The thinking is April when it can be used by humans and ready for mass inoculation a bit after that - certainly all in a maximum of a 6 months time frame.

The virologists concern was we do not know how fast it is mutating. It's very similar to both a virus that causes the common cold and the even deadlier SARS virus. If it goes in the cold direction it may just peter out - if it goes in the SARS direction then its all stops out on the vaccine.

Finger's crossed - but it seems we have the technology.

Great news! Thanks.

Here's another one:

Scientists in Singapore have successfully cultured the Coronavirus from an infected patient’s clinical sample. This will help in developing new diagnostic methods, monitoring potential mutation and testing for potential vaccine and drugs. The team from Duke-NUS Medical School, Singapore General Hospital, National Centre for Infectious Diseases and MOH are the third country in the world outside China to do so. Read how scientists are racing against time to learn more about the 2019-nCoV.

https://www.moh.gov.sg/news-highlig...coronavirus-(the-sunday-times-2-feb-2020-pb6)

Added later: Watching TV makes me think people are really starting to worry. If you live in a modern country like the US, UK ,or Australia - don't. With modern care I think the death rate will be much lower than 5% - maybe about the same as the flu.

How about Singapore? Is she considered a modern country?

 

[kadiot]

Just to clarify, the possibility still exists that asymptomatic individuals can spread the disease, we just don't have solid evidence of whether or not this is true. There have been anecdotal reports from doctors in China that this is the case (discussed in the Science news piece I posted earlier), but we await further evidence. Hopefully, the doctors in Germany who published the NEMJ piece can provide an updated paper to clarify how patients 3 and 4 were infected.

The first confirmed case in the Philippines was detected using the DOH/WHO protocols in place and is asymptomatic. No definitive evidence of infectiousness in asymptomatic patients yet, although I've hrard it is possible. She had a mild cough.

 

[bhobba]

How about Singapore? Is she considered a modern country?

Of course - its like asking is Japan a modern country . I was thinking more of places like Mexico, India etc. And even there if you have the moolah you can likely get good care. The real advantage of first world countries is they have the facilities to ensure everyone, rich or poor, will be taken care of during emergencies, poor countries simply do no have the resources to do that. I am a bit (notice the word bit - I am no alarmist) worried about climate change, and think we need much better computer models (and much more powerful computers to run them on) to understand what's going on better. A real worry is the big emitters are all poor - they do not have the resources to do what may be necessary - somehow we need to change that not only for climate change but for outbreaks like this, That's why I am personally a fan of Bjorn Lomberg as is one of my heroes, Feynman's good friend - Freeman Dyson - the professor without even a PhD. Of course it goes without saying he could get the even higher award DSc anytime he wants simply by submitting a few papers of his voluminous work. I think Feynman was secretly jealous of that because he would have loved to say - hey buddy even I know that and I don't even have a PhD . God I wish that man was still alive - he had the kind of mind valuable in crisis like this - he cut through 'crap' like a hot knife through butter. Not a lot of people know this but he also did research work in biology.

Thanks
Bill

 

[mfb]

A real worry is the big emitters are all poor

The big emitters are (nearly) all rich. There is an extremely strong correlation between wealth and CO2 emissions. The big emitters just don't live in countries with a population of 1 billion, that's why the per country numbers are often smaller. Per capita is the only useful measure on the level of people: The average US or Australian citizen contributes as much to CO2 emissions as an Indian family of 8-9.

The real advantage of first world countries is they have the facilities to ensure everyone, rich or poor, will be taken care of during emergencies, poor countries simply do no have the resources to do that.

In at least one of these first world countries many die because they don't go to a hospital unless it's a really life-threatening emergency (and then often to late to save them) - because they have to fear absurd hospital bills.

To contain such an outbreak the governments spend significant resources on isolation and treatment of the cases, luckily. No death in first world countries yet (~100 cases).

 

[bhobba]

The big emitters are (nearly) all rich.

Yes I goofed and forgot abort the US and China. I should have said - India.

To contain such an outbreak the governments spend significant resources on isolation and treatment of the cases, luckily. No death in first world countries yet (~100 cases).

The US is an obvious anomaly here. They will spend resources on isolating and helping those they know about, but its dysfunctional medical system discourages many from seeking medical help so the system knows about them. I have said for a long time the US medical system is crazy. The silly thing is if it wasn't for vested interests it could be a lot better. But its not perfect here in Aus either. Get this one - normally, ie outside of hospital, X-Rays are free - the government reimburses the full cost, and they do not even charge the patient. But go into a private hospital and guess what - no reimbursement - you must pay and your insurance only partly covers it. I had to pay over $2000.00 just for x-rays and one MRI scan alone. And believe me they hit you for every little thing. When I left they gave me, without my consent, a diabetes kit with a packet of Jelly Beans to bring up sugar lows. I personally use honey for that. No asking or anything - check ring - $1.50 for what a chemist sells at 50 cents. Small change, but its maddening.

Thanks
Bill

 

[jim mcnamara]

We are going geopolitical and semewhat anecdotal. Which is okay, but not in the Biology forum. Moving to General Discussion.

 

[chemisttree]

Now a Nature report states that Remdesivir and the generic chloroquine are effective against nCoV.

https://www.nature.com/articles/s41422-020-0282-0

They are starting double blind trials in China so that the “effectiveness” can be scientifically demonstrated. If it works out, we will have two drugs already available on the market that can beat this thing! I’m starting to feel optimistic!

Expect results by sometime in April.

quoted from the report:

“Chloroquine is a cheap and a safe drug that has been used for more than 70 years and, therefore, it is potentially clinically applicable against the 2019-nCoV.”

The first US case was treated with Remdesivir after the patient began to develop pneumonia.

“at a period consistent with the development of radiographic pneumonia in this patient, clinicians pursued compassionate use of an investigational antiviral therapy. Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development10,11) was initiated on the evening of day 7, and no adverse events were observed in association with the infusion. Vancomycin was discontinued on the evening of day 7, and cefepime was discontinued on the following day, after serial negative procalcitonin levels and negative nasal PCR testing for methicillin-resistant Staphylococcus aureus.

On hospital day 8 (illness day 12), the patient’s clinical condition improved...”

https://www.nejm.org/doi/full/10.1056/NEJMoa2001191?query=featured_home

This patient has since been discharged and has joined the ranks of the “cured.”

 

[chemisttree]

Thinking of chloroquinine triggered a distant memory of O-chem professor teaching us about the use of quinine to treat malaria. He had worked on a total synthesis for Sch###’s as a lower cost alternative to its cinchona bark natural source. He mentioned that quinine was used as the bittering agent in tonic water. So, googling antiviral activity of quinine gets me here:

https://www.sciencedirect.com/science/article/abs/pii/S0168170218302375

Quinine inhibits RNA reproduction against at least one virus.

Oh man! Could it be that perhaps maybe could be that gin and tonic could help cure nCoV? I can imagine a gin and tonic drip while going through this!

 

[kadiot]

To contain such an outbreak the governments spend significant resources on isolation and treatment of the cases, luckily. No death in first world countries yet (~100cases).

Wait, let's learn some lessons here...is the quarantine area a problem? Why not use passenger vessels or cruise ships...then stationary on the shore?

https://www.cruiseindustrynews.com/...-for-14-days-10-positive-for-coronavirus.html

 

[kadiot]

It’s confusing - China imposed self lockdown on January 23 to prevent further spread of the virus and the rest of the world doing travel bans and quarantine measures - is this for real ? Am I missing something here ?

It’s quite difficult to explain to the public. We have travel ban but WHO says it’s wrong to impose such move ?

https://cnnphilippines.com/news/2020/2/6/World-Health-Organization-China-travel-ban-novel-coronavirus.html?fbclid=IwAR1-ZM_8lcjAANHrrFgaKK-gbJCAVb3fLL-rEbY9g4J-pO3F2TeAqnb4Iz4

 

[chemisttree]

Wait, let's learn some lessons here...is the quarantine area a problem? Why not use passenger vessels or cruise ships...then stationary on the shore?

Top ten reasons not to use cruise ships as quarantine hospitals.

10. Being seasick on top of nCoV sick is NO FUN.
9. Who’s going to clean up THAT MESS?
8. The buffet isn’t allowed anymore.
7. The authorities aren’t willing to give command over to a captain.
6. A big ship like that is going to get in the way of commerce.
5. Need to book rooms at least two months in advance.
4. Nobody would ever use that ship again for travel while a popup hospital could be repurposed.
3. Hard to find workers willing to work at sea.
2. Bad optics for cruise ship operators.
1. That’s plan “B”

 

[Ygggdrasil]

It’s confusing - China imposed self lockdown on January 23 to prevent further spread of the virus and the rest of the world doing travel bans and quarantine measures - is this for real ? Am I missing something here ?

It’s quite difficult to explain to the public. We have travel van but WHO says it’s wrong to impose such move ?

https://cnnphilippines.com/news/2020/2/6/World-Health-Organization-China-travel-ban-novel-coronavirus.html?fbclid=IwAR1-ZM_8lcjAANHrrFgaKK-gbJCAVb3fLL-rEbY9g4J-pO3F2TeAqnb4Iz4

Research done on travel bans suggest that they could delay, but not stop the spread of pandemic diseases. For example, the WHO performed a meta-analysis on studies of past influenza outbreaks and concluded:

The results of our systematic review indicate that overall travel restrictions have only limited effectiveness in the prevention of influenza spread, particularly in those high transmissibility scenarios in which R0 is at least 1.9 (Box 2). The effect size varied according to the extent and timeliness of the restrictions, the size of the epidemic, strain transmissibility, the heterogeneity of the travel patterns, the geographical source and the urban density of international travel hubs. Only extensive travel restrictions – i.e. over 90% – had any meaningful effect on reducing the magnitude of epidemics. In isolation, travel restrictions might delay the spread and peak of pandemics by a few weeks or months but we found no evidence that they would contain influenza within a defined geographical area.

https://www.who.int/bulletin/volumes/92/12/14-135590/en/

While travel bans don't provide much benefit, there are a number of negatives associated with the imposition of travel bans:

Even if it were feasible to keep Coronavirus out through travel bans, these measures can make us less safe. Travel bans can penalize countries that report cases, which may in turn reduce countries’ willingness to share information about their outbreaks. Travel bans may also interrupt the flow of essential supplies upon which we depend to control the epidemic. China is a large producer of critical medicines and personal protective equipment — it is in our best interest to stay positively engaged with China in responding to this epidemic.

https://www.washingtonpost.com/outlook/2020/02/03/fighting-coronoavirus-with-travel-bans-is-mistake/

Travel bans can also restrict the flow of supplies and experts to sites of outbreaks, which can also harm efforts to contain epidemics.

Here's another news article that links to additional research on the topic: https://www.theglobeandmail.com/can...st-travel-bans-tied-to-coronavirus-backed-by/

 

[kadiot]

Research done on travel bans suggest that they could delay, but not stop the spread of pandemic diseases. For example, the WHO performed a meta-analysis on studies of past influenza outbreaks and concluded:https://www.who.int/bulletin/volumes/92/12/14-135590/en/

I wonder if there are other studies conducted on the same subject and came up with different findings.

While travel bans don't provide much benefit, there are a number of negatives associated with the imposition of travel bans:

https://www.washingtonpost.com/outlook/2020/02/03/fighting-coronoavirus-with-travel-bans-is-mistake/

Travel bans can also restrict the flow of supplies and experts to sites of outbreaks, which can also harm efforts to contain epidemics.

Maybe they have own channel or usual transport for supplies and medical expert go in than back must self-quarantine.

Here's another news article that links to additional research on the topic: https://www.theglobeandmail.com/can...st-travel-bans-tied-to-coronavirus-backed-by/

Only Canada followed the WHO's advice. The rest of the world does not agree. Approach is variable from country to country. I’d like to believe that worst case scenario is the best . It’s logical to stonewall a country. It’s basic.

 

[mfb]

Delaying the spread can come with benefits like a better availability of treatment options - and that way it might prevent an outbreak elsewhere.