COVID-19 Coronavirus Containment Efforts

[anorlunda]

Real life imitates the Hollywood version:

Leaked Coronavirus plan to quarantine 16m sparks chaos in Italy
Thousands tried to flee south after decree to confine people until 3 April was revealed

Thousands crowded train stations in Lombardy or jumped into their cars after details of a draft decree banning people from leaving or entering the region were revealed by Corriere della Sera late on Saturday afternoon.

On Sunday morning dozens of police officers and medics wearing masks and hazmat suits waited in Salerno, in Campania, for passengers who had boarded overnight trains from Lombardy. The passengers will be registered and obliged to self-quarantine as fears mount over the virus’s spread in the south.

“What happened with the news leak has caused many people to try to escape, causing the opposite effect of what the decree is trying to achieve,” said Roberto Burioni, a professor of microbiology and virology at the Vita-Salute San Raffaele University in Milan. “Unfortunately some of those who fled will be infected with the disease.”

 

[PeterDonis]

What would cause a change?

People who have symptoms voluntarily quarantining themselves, and people who don't have symptoms taking appropriate precautions.

In other words, that "freedom" thing that was mentioned earlier in this discussion.

Note that we don't forcibly quarantine people during flu season every year.

 

[PeterDonis]

It's a pretty misleading argument to make when the scientific research suggests 40 to 70% of the population is likely to get the virus.

Does "scientific research" just mean "extrapolating a trend way beyond where it will actually remain valid"?

 

[anorlunda]

Note that we don't forcibly quarantine people during flu season every year.

It goes back to what you said earlier.

I don't think they will keep rising at that rate. I expect the rate of new cases to taper off more quickly in the US and other developed countries than it did in China.

China's tactics may be outrageous by our standards, but those tactics are being credited as being effective and having caused the taper off of new cases in China. That may be false, but that is what is being claimed. If true, then we should not expect the rate to taper off as rapidly in western countries.

The undisciplined freedom in Italy, (see #666) may cause the rate of new cases in Italy to accelerate.

 

[Jarvis323]

Does "scientific research" just mean "extrapolating a trend way beyond where it will actually remain valid"?

The 40% to 70% estimate is coming from Marc Lipsitch at Harvard.
https://scholar.google.com/citations?user=cBEV4DcAAAAJ&hl=en

Marc Lipsitch: That is a projection, so we will find out if it's accurate as things go on. It is the best estimate that I've been able to make based on a combination of the mathematical models that we use to track and predict epidemics.

https://www.cbsnews.com/news/corona...ldwide-virus-expert-warning-today-2020-03-02/

I don't know, it sounds more reliable than a hunch.

 

[PeterDonis]

it sounds more reliable than a hunch

It looks like it's an estimate based on mathematical models. From what I can tell from the CBS interview (which doesn't tell much), the basic reason for his very high estimate of the total number of people who will eventually get infected is that he thinks the number of people who already have it but don't know it is large--in other words, that the numbers we currently have for how many people are infected, how many new cases are found every week, etc., are way too low. We'll see.

 

[chemisttree]

“For those without a balcony, they are trying to circulate more fresh air into the ship.”

This is a scary development. Imagine if it were successful and every cabin were under a slight positive pressure. An airborne contagion would be guaranteed to travel all areas within the ship. Perhaps some details about air handling in the ship might make this less of a problem. If the corona princess is an early example of the ventilation for the Princess ships, those people are in big trouble.

 

[hagopbul]

hello all:

just remember

DO NOT PANIC

Best
Hagop

 

[Jarvis323]

It looks like it's an estimate based on mathematical models. From what I can tell from the CBS interview (which doesn't tell much), the basic reason for his very high estimate of the total number of people who will eventually get infected is that he thinks the number of people who already have it but don't know it is large--in other words, that the numbers we currently have for how many people are infected, how many new cases are found every week, etc., are way too low. We'll see.

This may be an invalid extrapolation. But he also said somewhere around 1% of infected might die. If we combine his estimates, that would be 28,000,000 to 49,000,000 deaths worldwide, whereas the flu kills about 290,000 to 650,000 people worldwide per year. Besides the deaths, we might be looking at much more hospitalizations as well. Hopefully that doesn't happen.

 

[hagopbul]

i didnt said avoid

i said remember

there is a difference

 

[bhobba]

Widespread mask use would be a really useful measure, especially since most people are un-diagnosed and mostly asymptomatic while contagious. The problem is that we don't have masks (not even enough for nurses and doctors).

Every single expert I have heard on the matter says unless you have the disease its useless. In fact its likely to make things worse. The reason is it gets a bit uncomfortable under the mask and you tend to scratch under it which is a main route to infection. If you have the disease it traps the breathing out of the virus so is of some vale, but if you have it you should be self isolated so do not need it - except when seeing the doctor. For that ring ahead, and when you arrive you will be given a mask to protect others before seeing the doctor. You simply do not need a mask.

The main things are to maintain social distance (about 3 feet), wash your hands, and do not touch your face. The last one I find hard because I have Psoriasis and my face gets a bit itchy, plus, as is common with Psoriatic Arthritis, your eyes are a bit dry and thus tend to water a bit so you brush away dried tears every now and then. If asymptomatic, social distancing and coughing into your elbow should be enough to protect people, plus unless necessary stay home anyway.

Thanks
Bill

 

[bhobba]

This may be an invalid extrapolation. But he also said somewhere around 1% of infected might die. If we combine his estimates, that would be 28,000,000 to 49,000,000 deaths worldwide, whereas the flu kills about 290,000 to 650,000 people worldwide per year. Besides the deaths, we might be looking at much more hospitalizations as well. Hopefully that doesn't happen.

The latest thinking is if you are under the age of 60 it has about the same death rate as the flu - maybe slightly higher - .02% compared to .01% - but they have seen a lot of variation with the coronovirus depending on where the outbreak is - it can be as high as the 1% you mentioned. Why is still being investigated. But over 60, especially when combined with other conditions like diabetes, the death rate rises sharply to levels that are worrying - but then again that is the same with the flu - occasionally the young and healthy die from the flu - but mostly it is the elderly with underlying conditions. The big problem here is for the flu we have a vaccine, for this, as yet, we do not. Without the vaccine I am not sure what the death rate would be with the flu if we have a strain not seen before - a lot of the time many people already have the antibodies for the flu strain doing the rounds.

Thanks
Bill

 

[mfb]

People who have symptoms voluntarily quarantining themselves, and people who don't have symptoms taking appropriate precautions.

That happens already, or at least I don't see why this would become much more common over time.

Note that we don't forcibly quarantine people during flu season every year.

Yes, and ~10% of the population get it, despite the flu spreading less effective than this virus and the flu vaccine. If the flu would kill 2% of the people it infects we would probably do much more to limit its spread.

It looks like it's an estimate based on mathematical models. From what I can tell from the CBS interview (which doesn't tell much), the basic reason for his very high estimate of the total number of people who will eventually get infected is that he thinks the number of people who already have it but don't know it is large--in other words, that the numbers we currently have for how many people are infected, how many new cases are found every week, etc., are way too low. We'll see.

What else than a mathematical model would a prediction be based on? Or, asked differently, what is your expectation based on?
It doesn't matter that much how many people are infected right now if the spring doesn't stop this - a lower number now would mean we get most infections later.

 

[PeterDonis]

what is your expectation based on?

On looking at the publicly available data on how the number of active cases and the number of deaths worldwide have grown over time, as shown, for example, here:

https://www.worldometers.info/coronavirus/

That rate has tapered off a lot in the last few weeks. (The easiest way to see that is to look at the logarithmic plots.) I have simply assumed that that data is a reasonably accurate representation of how the disease is spreading worldwide. That data suggests that the total number of cases worldwide is going to level off sometime in the next month or so, probably somewhere around 150,000 to 200,000.

Obviously the prediction of Mark Lipsitch that was referenced earlier is based on a very different assumption, that the publicly available data on active cases grossly misrepresents how the disease is actually spreading worldwide. The only way we'll know for sure whose assumption was right is to see how things progress over the next few months.

 

[bhobba]

It's a pretty misleading argument to make when the scientific research suggests 40 to 70% of the population is likely to get the virus. Under this kind of analysis, no virus (even one that would send us to extinction) would be as bad as the common cold.

I have heard some experts say that as well, but other experts put it at a much lower figure. It's hard to really know at this stage. I would say a lot depends on when we get a vaccine. To be clear we already have a number of vaccines, UQ did theirs in 3 weeks, such is the advancements we have made in biotechnology. But the hard part is testing it - that could take a year to 18 months - but if we are lucky maybe less. If that happens in the next 6 months it will make a big difference,

Thanks
Bill

 

[mfb]

On looking at the publicly available data on how the number of active cases and the number of deaths worldwide have grown over time, as shown, for example, here:

The overall cases are dominated by China, which - as discussed before - used measures we are unlikely to see in democracies. And even if we do, it would still mean it's "a huge new issue we haven't dealt with before".
Don't expect case numbers to drop on their own just because drastic measures in China made them drop.

That data suggests that the total number of cases worldwide is going to level off sometime in the next month or so, probably somewhere around 150,000 to 200,000.

Not at all. Unless we use the same approach as China everywhere.

Sorry, but are you really using curve-fitting of a sum of completely different curves to argue with actual mathematical models by experts?

 

[PeterDonis]

are you really using curve-fitting of a sum of completely different curves to argue with actual mathematical models by experts?

First, I put less weight in "actual mathematical models by experts" than you appear to, unless I have evidence of a good past predictive track record for those mathematical models. I have no knowledge of any such track record for the models referenced in the article that was linked to earlier. (As I noted, the article doesn't give much information at all about them, and the article is the only information about them that I have.)

Second, you are basically arguing that my assumption is wrong--that the publicly available data does not accurately represent how the disease is spreading. That's fine, you can argue that my assumption is wrong. But that is all the "mathematical models by experts" are doing. The "experts", at least as far as I can tell from the article that was linked to (which, as I said, doesn't tell very much), do not have access to significant data that you and I do not. They are simply making different assumptions about how representative that data is, and then constructing a mathematical model based on those assumptions. Experts can't do magic.

As I said, the only way we'll know whose assumption is right is to see how things develop over the next few months.

 

[PeterDonis]

The overall cases are dominated by China, which - as discussed before - used measures we are unlikely to see in democracies.

As far as I know, China did not use those measures until the disease had already spread very widely. So the fact that they did eventually use those measures is only weak evidence that those measures make a lot of difference, as compared to the simple fact of people having knowledge that the disease is out there and taking obvious common sense precautions. When the outbreak started in China, the Chinese people themselves didn't know about it, so they could not take precautions. The whole world now knows about it, so circumstances are not the same.

 

[chemisttree]

Every single expert I have heard on the matter says unless you have the disease its useless. In fact its likely to make things worse. The reason is it gets a bit uncomfortable under the mask and you tend to scratch under it which is a main route to infection. If you have the disease it traps the breathing out of the virus so is of some vale, but if you have it you should be self isolated so do not need it - except when seeing the doctor. For that ring ahead, and when you arrive you will be given a mask to protect others before seeing the doctor. You simply do not need a mask.

How long are you going to continue to spread this false information? Who are we saving the masks for? We are saving them for healthcare workers. And that’s because we don’t want a healthy healthcare worker getting sick from being in proximity to infected patients. Why does it work for doctors and nurses and not for the rest of us? Can anyone point to a single randomized study that supports the assertion that they are useless for healthy people? Not opinions - science.

Here’s some science for you. Will you believe it or continue spreading gossip?

“Conclusions: This is the first RCT on mask use to be conducted and provides data to inform pandemic planning. We found compliance to be low, but compliance is affected by perception of risk. In a pandemic, we would expect compliance to improve. In compliant users, masks were highly efficacious. A larger study is required to enumerate the difference in efficacy (if any) between surgical and non-fit tested P2 masks.”

“Highly efficacious” in this study was 80% effective. This year’s flu vaccine is only 45% effective.

 

[Jarvis323]

That rate has tapered off a lot in the last few weeks. (The easiest way to see that is to look at the logarithmic plots.) I have simply assumed that that data is a reasonably accurate representation of how the disease is spreading worldwide. That data suggests that the total number of cases worldwide is going to level off sometime in the next month or so, probably somewhere around 150,000 to 200,000.

You can also view the plots with China excluded, which shows a clear exponential trend.

https://www.worldometers.info/coronavirus/coronavirus-cases/#case-tot-outchina

As mentioned, China did almost everything imaginable to try and contain it including: allowing only one person per residence to leave their home once per week, locking people in the city, mandating the wearing of masks outside of the home for everyone, temperature checks at every public entrance, mandating gloves in addition to mask to enter every public building, making violations of quarantine efforts or hiding of symptoms punishable by death, using trucks and robots and workers to spray disinfectant over practically the entire city twice a day, using drones to catch people on the streets without masks or congregating in groups and warn them off, using extreme surveillance measures to monitor everyone and everywhere, and building a large hospital within 7 days.

Also there is uncertainty about how honest China's reporting is. I believe that those containment efforts had a huge economic cost and I'm not sure maintaining it an extended time would have been feasible. If we could trust China's numbers, it would perhaps be interesting to see how things change as they lighten up.

There is no way the US or pretty much any other nation could or would use containment measures this extreme. And it should be worth mentioning that many nations are a lot worse off than others. If the hospitals don't get overwhelmed, that would be good. But if they get overwhelmed, then bigger problems occur, as healthcare staff get infected or go into quarantine, supplies run out, and there aren't enough respirators. I think we should shoot to slow the spread to a pace that we can keep up with as we try to build up our resources and secure facilities for patients.

 

[PeterDonis]

You can also view the plots with China excluded

Ok, this is useful.

 

[OmCheeto]

Grant Sanderson of 3Blue1Brown pointed out the odd linearity of the log curve of cases outside of China yesterday on Twitter.

"COVID-19 cases outside mainland china follow an exponential so closely it could be a literal textbook example for exponential growth."​

Today he posted a video.

 

[mfb]

Second, you are basically arguing that my assumption is wrong--that the publicly available data does not accurately represent how the disease is spreading. That's fine, you can argue that my assumption is wrong. But that is all the "mathematical models by experts" are doing. The "experts", at least as far as I can tell from the article that was linked to (which, as I said, doesn't tell very much), do not have access to significant data that you and I do not. They are simply making different assumptions about how representative that data is, and then constructing a mathematical model based on those assumptions. Experts can't do magic.

I don't disagree with the data, I disagree with your way to analyze it.
Experts can't do magic but they do spend more than 5 minutes on this, and they do more than just look at the global case numbers. A decrease in China and a rapid increase elsewhere can make global numbers look like they level out - but only for a week or so, and that week has passed. In the total cases you can already see the exponential on top of the (roughly constant) Chinese numbers, and of course "outside China" is as exponential as it can get.

As far as I know, China did not use those measures until the disease had already spread very widely.

The Wuhan lockdown was implemented January 23 when all of China had 830 confirmed cases. The city was isolated and public transport was stopped. Several other cities followed within a day. I don't find the date of the earliest restrictions on leaving the house now, the latest February 2 when China had 17,000 cases.
Italy and surrounding countries (if we count all of China we should probably count all of Europe) were way beyond that point when Italy put several regions (with a total population just a bit larger than Wuhan) under quarantine, they didn't stop public transport as far as I know. Europe has ~12,000 cases now, 2500 from the last daily update.
China acted way earlier than European countries.

As I said, the only way we'll know whose assumption is right is to see how things develop over the next few months.

We won't know who is right until later, but we can find wrong assumptions today already. Like the wrong assumption that China would have been late with their reaction.

 

[Bandersnatch]

Here’s some science for you. Will you believe it or continue spreading gossip?

Go to the website of WHO, NHS, NSW, CDC, or whatever healthcare agency is appropriate for your locale, and you'll see the same 'gossip' being repeated.
What you're doing is putting your layman's reading of a study over the expertise of medical professionals.
It's one thing to say you don't understand why they are all not recommending the use of masks for general public, or why they're saying there's no evidence for the usefulness of masks in limiting the spread of the infection outside of specific contexts, and another to decide you know better anyway because you've done your own research.

 

[Haorong Wu]

I am seriously worried about the measures other countries are taking. China has demonstrated some mistakes, and why other countries would just repeat them?

For example, Wuhan announced block down several hours before the city was really block down. A great number of people fleet out of the city to other privinces. Many people around China criticize the government. We believe that a block down should be implemented immediately so that no infected people could spread to other regions. But the situation happened again in Italy.

Also, some masks are detained by Dali, a city in south China. The masks were sent to Sichuan province. The local government has been punished for this. And yet, same situation happened in EU.

In the early stage, we let patients with mild symptoms quaranteened at home, which led to a whole infections in a family. After we realized this mistake, we built ark hospitals by using large buildings such as stadium to support those mild patients. Yet some countries still let mild patients stay at home.

We have made some mistakes, and I hope other countries would avoid them.

 

[Mary Conrads Sanburn]

Grand Princess cruise ship hit by Coronavirus will dock Monday in California

USA TODAY•March 8, 2020

The Grand Princess cruise ship will begin to allow guests to disembark Monday after 21 people aboard tested positive for coronavirus on Friday.

Princess Cruises announced early Sunday it had been informed by state and local officials that the cruise, off the coast of California, would be able to dock in the Port of Oakland on Monday, though an exact time was not available, cruise line public relations director Negin Kamali told USA TODAY.

Guests who "require acute medical treatment and hospitalization" will be first to disembark. Kamali said it was "unclear" if other passengers would also be allowed off the ship Monday, or if they would have to wait further.

"California residents will go to a federally operated facility within California for testing and isolation, while non-Californians will be transported by the federal government to facilities in other states," read a statement provided by Kamali. "Crew will be quarantined and treated aboard the ship."

[ . . . ]

###
https://news.yahoo.com/grand-princess-cruise-remains-limbo-135510647.html

 

[Jarvis323]

Go to the website of WHO, NHS, NSW, CDC, or whatever healthcare agency is appropriate for your locale, and you'll see the same 'gossip' being repeated.
What you're doing is putting your layman's reading of a study over the expertise of medical professionals.
It's one thing to say you don't understand why they are all not recommending the use of masks for general public, or why they're saying there's no evidence for the usefulness of masks in limiting the spread of the infection outside of specific contexts, and another to decide you know better anyway because you've done your own research.

They aren't saying masks are not effective. They are saying that misusing masks takes away from their effectiveness (worst negligence conceivably making it worse) and they are implying that the general public is not capable of using them correctly (I guess overall). But their main point, and why they are stressing this so much, is that they are desperately trying to conserve masks for those most in need (nurses, doctors, etc.). I.e. if you are capable of figuring out how to wear a mask correctly, then it will help you, but you should forgo the masks unless absolutely necessary in order to save them for others who need them more. There are lots of online videos showing how to use them. It takes about 3 minutes. So if you have one, and have decided your risk is high in a certain situation (e.g. elderly going to get groceries), you should absolutely use it, and learn how to wear it correctly before you do.

 

[PeterDonis]

The Wuhan lockdown was implemented January 23 when all of China had 830 confirmed cases.

Since the number of confirmed cases in China has grown by roughly a factor of 100 since January 23, it would not seem like the lockdown did much good.

 

[jedishrfu]

Another recent article from propublica on the virus from a reporter who lived through SARS and reported on Ebola with some good advice.

https://www.propublica.org/article/...estions-we-should-be-asking-about-coronavirus

 

[atyy]

Since the number of confirmed cases in China has grown by roughly a factor of 100 since January 23, it would not seem like the lockdown did much good.

That is not correct. It would have grown by far more if not for the lock down. The number of new cases per day is decreasing. This does not happen without some intervention.

 

[PeterDonis]

The number of new cases per day is decreasing. This does not happen without some intervention.

It does not happen without some kind of change in the circumstances. But that change could be individual people taking common sense precautions because they know about something they didn't before. I don't think we know how much of the change was due to that vs. the top-down government interventions.

To be clear, I'm not saying the government should do nothing. Since we the people have given the government a number of jobs, including disseminating accurate information, coordinating testing and procuring test kits, analyzing samples, giving good advice to people on what precautions they should take, analyzing all of the available data and trying to make predictions, giving good advice to localities on what actions they should take, etc., obviously the government needs to do those jobs, and we should hold the government accountable for how well it does them.

 

[Haorong Wu]

Since the number of confirmed cases in China has grown by roughly a factor of 100 since January 23, it would not seem like the lockdown did much good.

This is misleading. The cases continue to grow because the incubation period is 14 days. From the curve, we can clearly see that the speed of increase droped after 14 days.

Also, an important change happened on February 13, that the leader of Wuhan is replaced by Ying Yong. The former leader of Wuhan did not implement the lock down correctly. Some people were still hanging around outside. The strict lock down started after Ying Yong take over the government.

A research led by Zhong Nanshan reveals that if the lockdown is delayed by 5 days, the scale of the outbreak would be larged by 3 times while if it was lock down 5 days earlier, we may cut half of the cases.

Here is a table in that research

 

[PeterDonis]

A research led by Zhong Nanshan

Do you have a link to the complete paper?

 

[PeterDonis]

The cases continue to grow because the incubation period is 14 days.

14 days seems like the high end of a pretty wide range of 2 - 14 days (although some outliers with longer incubation periods have been reported); the mean appears to be somewhere between 3 and 6 days.

https://www.worldometers.info/coronavirus/coronavirus-incubation-period/

 

[chemisttree]

Go to the website of WHO, NHS, NSW, CDC, or whatever healthcare agency is appropriate for your locale, and you'll see the same 'gossip' being repeated.
What you're doing is putting your layman's reading of a study over the expertise of medical professionals.
It's one thing to say you don't understand why they are all not recommending the use of masks for general public, or why they're saying there's no evidence for the usefulness of masks in limiting the spread of the infection outside of specific contexts, and another to decide you know better anyway because you've done your own research.

When I see medical experts saying things like we have a strategic reserve of masks and other PPE for use by healthcare providers in one breath and then say those same masks are useless for the general public, I can spot the lie easily. When I see medical experts demonstrate the improper use of an N95 (upside down and inside out) and conclude they are useless while reporting that front line nursing staff at The University of Nebraska Medical Center use N95 masks as a component of their basic uniform, I can spot the lie easily.

And, by the way, I have used PPE every day of my professional career as a research synthetic chemist. I taught proper use and selection of PPE for many years. I have written numerous protocols for safe handling of highly carcinogenic compounds, explosives, radioactive, volatile radioactive materials and safe handling of nerve agents.

I am no layman.