COVID-19 Coronavirus Containment Efforts

[vela]

Information science requires strong skepticism but even as a senior citizen I question whether a virus that does not adversely affect young people should be considered an existential threat to our species.

I don't think the concern is that the virus is going to wipe out our species. It's that if it's allowed to go unchecked, the severe cases may overwhelm the health care system, like what happened in Italy.

 

[OmCheeto]

I don't see how this is a deadly disease. Has the deathrate in wuhan increased disproportionately? Wuhan has a pop of 11 million people and so far only ppl who died who had the virus were old ppl.

For a serious deadly virus it seems to have a low deathrate compared to the average daily global deathrate.

Perhaps this will answer your question.
This is an extrapolation of the growth of deaths each day, plotted alongside the number of normal number of deaths each day.

The COVID19 plot:

1. assumes everyone on the planet will be infected​

2. assumes the "case fatality rate" turns out to be 1%​

3. excludes data from China​

I think the graph is open to interpretation.
One thing is a fact: 60 million people were going to die this year, mostly from old age, regardless.

--------
reference material
curve fit for COVID19 death rate is derived from 2/21/2018 thru 3/15/2018 data

 

[BillTre]

It's that if it's allowed to go unchecked, the severe cases may overwhelm the health care system, like what happened in Italy.

If it were to overwhelm the health care system, then the death rate would go up for the strongly affected people, increasing the overall death rate and the overall numbers of deaths.

It would likely also lead to increased infections of the health care personnel due to their working under more difficult conditions, which in turn would further stress the health care system and further exacerbate problems for the sick.

Classic vicious cycle and something that should be avoided if possible!
That is why the flatten the curve strategy has received so much attention.

 

[sqljunkey]

OmCheeto I don't understand your plot very well. You said one fact is true and that is that 60 million people are going to die this year for certain, mainly of old age. So I divide 60 million by 365 days and I get an average of 164,383 of mostly old people dying on average daily. If I multiply that by 60 days for the two months we had this year, jan and feb, I get 9,863,013 people who died mostly of old age on average.

Has this number drastically changed from last year, during the same months? By at least a million, I know the aging population is growing globally, and perhaps that may affect these numbers.

So far we know that less than 10,000 people who had the corona virus who were also in their twilight years have passed away during these two months. If I divide that by the 10 million people who already died, who were mostly old, I get 0.001%.

I did this in another post already, but I will do it here also for reference, Wuhan has a population of 11 million and statistics show that 7 out of 1000 people die a year in china, mostly of old age. If I extrapolate that to Wuhan, in a rather crude way I get that 77,000 people die on a yearly basis in Wuhan mostly of old age. Dividing that by twelve and multiplying the answer by 2 months gets me 12,833 people who probably died of old age in Wuhan this or last year during the first two months on average.

Dividing that with the current GLOBAL, not local to Wuhan, but GLOBAL corona death reported numbers gives me, 10,000 / 12,833 = 0.78 or 78%. So if we were to use this number even, which is probably a ridiculous number, I find that it is less than the 100% total of people who probably died in Wuhan these past months of old age. Even here I see that, the total corona deaths have been less than expected in Wuhan alone.

But I don't know the numbers of total death in Wuhan for these two months, I don't know who keeps track of them. Maybe the doctors are and are not showing it. Maybe you have it OmCheeto, and if we get it we can see better whether this virus has indeed claimed more lives than the usual expected death rate in the aging population.

 

[OmCheeto]

OmCheeto I don't understand your plot very well.
...

sqljunkey I don't understand the "..." portion of your post.

hmmm...

 

[sqljunkey]

omCheeto, give me the number of deaths in the past two months in Wuhan. Less people probably died than last year in the last two months. Because of increased life expectancy, but I don't know since I don't have the numbers.

 

[Dr. Courtney]

The flatten the curve strategy makes sense to me, but some of the government efforts don't compute:
1. The mayor of New Orleans didn't just close bars and restaurants, she banned transportation of alcohol and firearms. Prohibition ain't going to help.
2. Many counties in the SF Bay area have given "shelter in place" orders for THREE weeks. Folks are already resisting. Orders need compliance to work.
3. When issuing recommendations and orders, governments keep saying "this is the new normal", "it might last longer." Flattening the curve shouldn't require extreme measures longer than a few weeks. First of all, we'll know in a couple weeks if the curve has been flattened in a given geography. Secondly, compliance will dwindle the longer measures are extended.

 

[phinds]

I have it from a so-far accurate source (he told me the NY restaurants would be closed then day before Cuomo closed them) that Cuomo is going to shut down the NY borders to all but essential travel (mail, food, gas, etc deliveries) in and out. I can't decide whether I hope that's just a rumor or think it's a good idea. I'm leaning to good idea if it doesn't go on for too long. What do you all think?

Apparently the closing of borders must have been a NYC Mayor De Blasio idea that was at least mooted because it was specifically shot down by NY State Governor Cuomo in this statement today saying that De Blasio does not have the authority to call for a "shelter in place" order for the city, as that would have to be statewide and he (Cuomo) has no plans to do that or shut the state borders or any city borders.

 

[OmCheeto]

omCheeto, give me the number of deaths in the past two months in Wuhan. Less people probably died than last year in the last two months. Because of increased life expectancy, but I don't know since I don't have the numbers.

pffft!
Do your own maths and research.
Interpolate, where necessary.
And include references for data.

Otherwise, it's the big "IGNORE" button for you...

 

[sqljunkey]

I thought you had the numbers. You made a plot. I saw an exponential curve going up. sorry.

I hope marco rubio, who is against the marshall law has these facts and figures at least.

 

[BillTre]

Here is a Science magazine news review article on the seasonality of diseases.
Its a complex problem (many diseases with different seasonality characteristics). Different diseases peak at different times of the year.

There several possible reasons that different diseases may do better or worse during different seasons, such as temperature of humidity affecting different diseases differently, differences in the immune system during different seasons, different structures of a virus (have a membrane of not).
Some corona viruses seem to "go away" later in the year, which is encouraging for our current situation, but far from definitive.

 

[StoneTemplePython]

Wars are local and severe impact, so it is hard to judge them in such qualitative terms -- but I don't agree that "Europe survived".

In terms of global deaths statistics impact, the Spanish Flu was much, much worse; something like an order of magnitude worse. In terms of economic impact, I'm not sure. I haven't looked at the cost of WWII or Spanish Flu.

I think you have some of the better posts on this thread, but this can't possibly be right. Estimates of infections of spanish flu are $\frac{1}{2}$ billion and estimates of deaths are $20-100$MM. Death estimates in USSR alone in WWII are $20-30$MM, including an estimated $5-7$MM with St Petersberg. Spanish flu cannot be an order of magnitude higher than all European deaths in WWII.

 

[BillTre]

According to this Science magazine news article, social isolation can also have negative effects on humans:

Over long periods of time, social isolation can increase the risk of a variety of health problems, including heart disease, depression, dementia, and even death. A 2015 meta-analysis of the scientific literature by Julianne Holt-Lunstad, a research psychologist at Brigham Young University, and colleagues determined that chronic social isolation increases the risk of mortality by 29%.

Technologically based interactions may overcome some of these problems.

Just another of the many facets of dealing with the corona virus problem.

 

[vxiaoyu18]

Are y’all still locked down?

My home is not in wuhan area, so I began to work from February 13. When I'm at home, I basically don't use any protective gear. To avoid going near others, I only wear a mask when I go shopping in the supermarket. Most of our young people use mobile phones for payment. Wuhan has been closed since January 23, and the blockade of nearby cities has been gradually lifted. Our company's colleagues near wuhan have come out to prepare for work, and once they arrive at the workplace, they will still be subject to 14 days of self-isolation. They can't start work until they have no symptoms.

------news-------
Recently, the number of newly diagnosed pneumonia in wuhan has remained in single digits for several consecutive days. Li lanjuan, a member of the Chinese academy of sciences, said in an interview with China news service on Thursday that the epidemic prevention and control in wuhan has entered a "sprint" stage. The number of new diagnoses is expected to be zero by around March 20, and will be monitored for another two weeks. If there is no more newly diagnosed patients, wuhan can gradually return to work and labor.

 

[Vanadium 50]

I get an average of 164,383 of mostly old people dying on average daily. If I multiply that by 60 days for the two months we had this year, jan and feb, I get 9,863,013 people

Good heavens. Please use significant figures. Think of it as an opportunity to show off your numeracy.

The average Chinese death rate is 7.402 per 1000 people per year. The population of Hubei is 58 million, so the number of deaths in the last two months is something like 72,000, so Coronavirus is a 5% effect - i.e. 7.4 is now more like 7.8. (China last saw a death rate at that level in 1976, however, extrapolations based on the aging population suggest that number will again be reached around 2023).

Italy's death rate is about 10.5 (it's population is, on average, older than China's). It has 60M people, So over the last month, about 53,000 people died, so again, it's about a 5% effect on the death rate.

A 5% effect in the US death rate over two months is 24,000 additional deaths. (This is not a prediction of any sort; it's merely to provide context) That would be a ~50% uptick in influenza/pneumonia deaths (but concentrated in two months and not spread over 12) and by itself around #22 (Leukemia) or #23 (Falls) in causes of death.

 

[vxiaoyu18]

omCheeto, give me the number of deaths in the past two months in Wuhan. Less people probably died than last year in the last two months. Because of increased life expectancy, but I don't know since I don't have the numbers.

As of March 17, wuhan:
Cumulative diagnosis: 50004
Cumulative death: 2,480
-------------
Outbreak statistics from around the world can be found at:
https://voice.baidu.com/act/newpneumonia/newpneumonia/?from=osari_pc_1

 

[wukunlin]

There are still new cases in Wuhan, coming out of quarantined residential areas, which is worrying, thought they got them all.

 

[Klystron]

I don't think the concern is that the virus is going to wipe out our species. It's that if it's allowed to go unchecked, the severe cases may overwhelm the health care system, like what happened in Italy.

Concur. I intended to react to the existential societal implications of the Stat article, not the existence of humanity as a species. Certainly strained health care affects our entire society; a subject addressed in other articles.

A virus that kills primarily the elderly while not affecting young people in large numbers should not have a deleterious effect on our species; particularly now that knowledge is preserved beyond individual living contributors.

I also acknowledge the issues expressed by @russ_watters and other posters that the economic and social repercussions of mitigation efforts will affect young workers, students and children now, and in their future, even if the virus does not directly affect their immediate health. Thanks.

 

[sqljunkey]

I agree that this is all numerology. But how did you get to the 5% for the Hubei population vanadium? Because 58,000,000 multiplied by 0.007402 is equal to 429,316 and if I multiply that by 2/12 I get 71,552 which is roughly what you said, 72,000.

And of that 72,000 roughly 3,000 were found to have the virus prior to death.

And I guess the total number of deaths in Hubei could have also gone down, the world death rate has gone down from 7.8 to 7.5 for 1000 persons between 2010 and 2017 because of advances in the medical field. Which is a decrease of 0.042 every year if I were to take the simple yearly average. Now if I was so bold to extrapolate that to China's deathrate per 1000 person and also assume, for sake of argument that your 7.402 rate was last year's rate I will end up with a deathrate for this year of 7.361 for every 1000 live persons, which after tedious calculations would indicate a 2020 deathrate of 426,938 in Hubei which in turn is 71,156 for the two last months. Which would be a small but nonetheless significant decrease in deaths.

So in lieu of actual numbers I'm reduced to numerology which does show a decrease in deaths in china as of now.

 

[sqljunkey]

https://www.cdc.gov/heartdisease/facts.htm

 

[russ_watters]

I think you have some of the better posts on this thread, but this can't possibly be right. Estimates of infections of spanish flu are $\frac{1}{2}$ billion and estimates of deaths are $20-100$MM. Death estimates in USSR alone in WWII are $20-30$MM, including an estimated $5-7$MM with St Petersberg. Spanish flu cannot be an order of magnitude higher than all European deaths in WWII.

Thanks, and you're right; it looks like I may have mistaken the number ill for the number dead. Those numbers put the Spanish Flu actually in close alignment with each other. The worst (best?) I could get to by scaling against the population is perhaps double.

You also imply substantial local/national differences, which is valid as well. Right now the dire projections people are making for Europe and the US don't seem to be in alignment with what happened in China and South Korea, the only two countries I'm aware of where the virus is declining (though that may be an anomaly in S. Korea). China has only had 3,200 deaths in a population of 1.86B so far, a number they hit by 2am on a normal day. If they are all concentrated in Wuhan city, of 11 million (I'm not sure of the geographic distribution), that's a normal couple of weeks. If the total flatlines at 4,000 this ends up being kinda bad for Wuhan (basically a worse than average flu season) but an insignificant statistical blip for the whole of China. It's hard to get from there to Spanish Flu for the rest of the world unless for some reason the rest of the world does a substantially worse job of containment than China did.

[edit] ...oh, I see that's the thrust of @Vanadium 50's post.

 

[kadiot]

There are still new cases in Wuhan, coming out of quarantined residential areas, which is worrying, thought they got them all.

Second wave?

 

[wukunlin]

Second wave?

Not sure, probably people without symptoms living among these places.

 

[morrobay]

uh... myth busted
View attachment 258830

So if viruses were on the hands then it is assumed they touched a surface with the virus with transfer, then the risk of infection by touching face. While it is of course in order to take precautions washing hands. It is questionable if there would be enough of the virus to infect with this chain of indirect contacts. The CDC has reported no documented infections from surfaces. https://www.cdc.gov/coronavirus/2019-ncov/community/election-polling-locations.html
See middle first paragraph

 

[kadiot]

A BIT OF HOPE: PLAQUENIL, the anti-malaria medicine, could help treat COVID19 patients; lab trials are promising, declares SANOFI .

 

[russ_watters]

Quite the social experiment we have here:

One day after Philadelphia courts closed until April 1 to limit the spread of the coronavirus, Police Commissioner Danielle Outlaw notified commanders Tuesday that police will be delaying arrests for nonviolent crimes, including drug offenses, theft, and prostitution...

...covers all narcotics offenses, thefts, burglary, vandalism, prostitution, stolen cars, economic crimes, such as bad checks and fraud, and any existing bench warrants.

https://www.inquirer.com/health/cor...jail-overcrowding-larry-krasner-20200317.html

 

[Ygggdrasil]

Here's an important piece about the response to the coronavirus: https://www.technologyreview.com/s/615370/coronavirus-pandemic-social-distancing-18-months/

The piece summarizes a recent report from researchers at Imperial College London who model the effects of various mitigation or containment strategies on the Coronavirus outbreak. They conclude that the best strategy may involve periodic extreme social distancing for the next 18 months:

In a report yesterday (pdf), researchers at Imperial College London proposed a way of doing this: impose more extreme social distancing measures every time admissions to intensive care units (ICUs) start to spike, and relax them each time admissions fall. Here’s how that looks in a graph.

.
The orange line is ICU admissions. Each time they rise above a threshold—say, 100 per week—the country would close all schools and most universities and adopt social distancing. When they drop below 50, those measures would be lifted, but people with symptoms or whose family members have symptoms would still be confined at home.

What counts as “social distancing”? The researchers define it as “All households reduce contact outside household, school or workplace by 75%.” That doesn’t mean you get to go out with your friends once a week instead of four times. It means everyone does everything they can to minimize social contact, and overall, the number of contacts falls by 75%.

Under this model, the researchers conclude, social distancing and school closures would need to be in force some two-thirds of the time—roughly two months on and one month off—until a vaccine is available, which will take at least 18 months (if it works at all). They note that the results are “qualitatively similar for the US.”

What's the alternative?

Without social distancing of the whole population, they found, even the best mitigation strategy—which means isolation or quarantine of the sick, the old, and those who have been exposed, plus school closures—would still lead to a surge of critically ill people eight times bigger than the US or UK system can cope with.

So while this thread has been focused on the relatively low mortality of the disease, it has so far not really considered that ~10-20% of cases require hospitalization, and that when hospitals are overwhelmed, mortality rates from the disease can increase by a factor of ten.

So, if the ICL report is correct, we either face an extreme surge of cases in ICUs (worse than what happened in Wuhan or what is happening in the hardest hit areas of Italy) or extreme economic disruption for the next 1.5 years. Would getting the public to go along with periodic social distancing for the next 1.5 years even be possible?

Edit to add: for balance, I should point to the Ioannidis piece that I linked to previously as a counterpoint. The ICL study is based off of modeling and if the parameters of the model are wrong, then so could the conclusions: https://www.statnews.com/2020/03/17...e-are-making-decisions-without-reliable-data/

 

[kyphysics]

Would the potential lives saved from the intervention be worth the economic costs? I'm not an economist, so I can't make that judgement. However, here's a case from a statistician that maybe we don't have sufficient data to make that call yet.

That was a great overall post, Ygggdrasil.

Just quoting your last paragraph. I think the saving of lives is not entirely detached from economics. There is surely an economic cost to locking down society. But, in a worst case or very bad case scenario of not doing a societal lockdown and letting people get infected with minimal "protections," that could also greatly damage an economy.

A large portion of people could be sick and out of work. Those who have more severe symptoms could overflood our hospital capacity and cause a lot more deaths and complications than expected. Those who die from all of this are humans with lives attached to loved ones (who will be greatly affected and likely less productive in their work for some time). A high enough death rate could just be so morale crushing as to halt an economy. There certainly could be a lot of economic chaos from letting the virus run through society.

It's a very interesting intellectual question, however.

 

[kyphysics]

2. Many counties in the SF Bay area have given "shelter in place" orders for THREE weeks. Folks are already resisting. Orders need compliance to work.

Would local law enforcement be enough to enforce those quarantines?

Quite the social experiment we have here:
https://www.inquirer.com/health/cor...jail-overcrowding-larry-krasner-20200317.html

In my area, they are releasing some non-violent offenders (with a form a house arrest to follow), who have little time left, for the same purposes, Russ.

 

[kyphysics]

Here's an important piece about the response to the coronavirus: https://www.technologyreview.com/s/615370/coronavirus-pandemic-social-distancing-18-months/

The piece summarizes a recent report from researchers at Imperial College London who model the effects of various mitigation or containment strategies on the Coronavirus outbreak. They conclude that the best strategy may involve periodic extreme social distancing for the next 18 months:

I could easily see that sort of protocol working in a country like Singapore. It is homogeneous in culture/identity, has a voluntary acquiescence to loss of common developed world civil liberties by its populace, and a very low crime rate. Plus, it's population is ~5M - small enough to "control" or have little major resistance to such policies.

I don't know about the U.S. Would people lose patience with such a program? Without UBI, I worry crime could rise significantly in some areas under such lockdown protocols over 18 months.

ETA: I'm not saying the alternative in the study is better either. It may be worse. Just asking questions and commenting.

 

[OCR]

Would local law enforcement be enough to enforce those quarantines?

Lol, and your serious ! . Well, it just might depend on how long, and how determined the folks that are

already resisting. . . might decide to continue the resistance . .

.

 

[kyphysics]

https://thehill.com/policy/healthca...ice-nationwide-ask-criminals-to-halt-activity

I swear this isn't from The Onion.

Police nationwide ask criminals to halt activity during Coronavirus outbreak

Police in Ohio, Wisconsin, Kentucky, Utah and Washington have called on criminals to take a break to allow officers to respond to coronavirus-related issues.

The Salt Lake City Police Department, for example, requested in a post on Facebook last week that “all criminal activities/nefarious behavior to cease until further notice.”

“We appreciate your anticipated cooperation in halting crime & thank criminals in advance,” the department said. “We will let you know when you can return to your normal criminal behavior.”

 

[kadiot]

What concerns me is people who are non-symptomatic, but can carry the virus and spread it to the most vulnerable members of the family - elderly and those with medical conditions. How do you combat against this?

 

[atyy]

What concerns me is people who are non-symptomatic, but can carry the virus and spread it to the most vulnerable members of the family - elderly and those with medical conditions. How do you combat against this?

While there is some uncertainty about whether pre-symptomatic people can spread the disease, the WHO report said that truly asymptomatic transmission is probably not a major factor in the transmission of the disease. The CDC website says the same. At least in Singapore, the overall public health view is still that the disease can be well fought as long as symptomatic people self-isolate - the important point is that even mildly symptomatic people must self-isolate. https://www.channelnewsasia.com/new...responsible-behaviour-doctor-hopping-12522200

At least from the news reports, this makes sense, since there are many report of people who stopped spending time with co-workers and family after onset of symptoms, and in these cases, the co-workers and family did not get infected. For example, from this news report one can see that the two cases who were isolated after onset of symptoms did not pass the infection to family members: https://www.nytimes.com/interactive/2020/03/13/world/asia/coronavirus-death-life.html

Also, detailed contact tracing suggests that it is the mildly symptomatics that are responsible for many large clusters. For example, in the reports you posted earlier about the linking cases between the Life Church and Grace Assembly cluster, the linking cases were only uncovered by contact tracing after they had recovered. Here the transmission occurred at a Chinese New Year party on Jan 25, and one of the linking cases (case 91) reported onset of symptoms on Jan 23. https://www.straitstimes.com/singap...mega-cluster-linked-to-2-wuhan-tourists-via-a

In the SAFRA cluster, contact tracing suggests that one person transmitted it to 18 others at the same dinner. In this case, we know the one person was symptomatic at the dinner on Feb 15, as the person (case 94) had reported symptoms a few days before on Feb 11.
https://www.channelnewsasia.com/new...-mar-5-patients-discharged-new-cases-12505112
https://www.channelnewsasia.com/new...institution-student-coronavirus-case-12475870

 

[mfb]

Wars are local and severe impact, so it is hard to judge them in such qualitative terms -- but I don't agree that "Europe survived".

WW2 wasn't local in Europe... but people rebuilt.

I don’t think so. Russ was referring to an 18 month lockdown. Lockdown means nobody working. Nobody making anything.

That's an absurd straw-man scenario. Of course important activities are kept up.

Anyway. A lockdown for a few weeks to reduce the overall case numbers, increasing the testing capabilities a lot in that time, and then contact tracing of remaining cases afterwards might be a viable strategy to defeat the virus before it reaches a large fraction of the population. Regions that do this would have to keep testing people at borders to other regions until this is done globally or we have a vaccine.

What are Sweden and Switzerland doing that's more serious than the US? I just checked svd.se and saw nothing serious on the front page.

Any particular reason to pick these two countries instead of e.g. Italy, Spain or Denmark?
Sweden didn't do much so far and their cases are still going up rapidly. What I see: Banning large gatherings, quarantine for some people, better sick leave arrangements, apart from that most things seem to be an advice instead of mandatory. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden
Switzerland closed bars and various non-essential shops and similar things. They also banned large gatherings, some regions closed schools and universities. Their border with Italy is largely closed, the border to Germany is partially closed. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Switzerland
As part of the Schengen area, they banned entry for "EU foreigners" from outside Schengen (with some exceptions), but that on its own doesn't do much.

But I'm not sure what your point is. The quote was about an estimate of the death toll in the US, given one scenario for the government response. It doesn't say anything about what the US will do in the future, and it doesn't have anything to do with other countries.

Would the potential lives saved from the intervention be worth the economic costs? I'm not an economist, so I can't make that judgement. However, here's a case from a statistician that maybe we don't have sufficient data to make that call yet.

That article is complaining about missing some data we have already:
a) The large-scale testing of South Korea, including tests not done to specifically check persons at risk. Unless the author proposes that these tests are missing most cases South Korea's estimates should be good.
b) We know an uncontrolled spread overwhelms hospital systems. See Wuhan, see northern Italy. This is different from the seasonal flu.
c) Deaths from this virus in e.g. Italy are already much higher than influenza deaths. I don't have Italy-specific influenza numbers but if we scale the number for the US by population we get 4000-10000 deaths in 6 months, or 22-55 influenza deaths per day in the season. Italy reported ~350 COVID-19 deaths on Sunday, Monday and Tuesday each. On average 1800 people die in Italy every day from all causes combined (2019 numbers). Adding 350 deaths per day is a significant impact, ~20%. Sure, some of these would have died within a year from other causes, but it's still a big change. We also know deaths are ~2-3 weeks behind infections, so we can expect deaths per day to increase beyond the current 350.

@Vanadium 50 decided to average over a month, which means including days where Italy had exactly 3 confirmed cases. Not sure why this would be a useful time range.

@sqljunkey and @russ_watters: Wuhan got the outbreak under control relatively early. Pointing to Wuhan and saying "see, is not so bad" is misguided. Pointing to Wuhan to argue against measures to contain the spread is even worse. It's like saying "you shouldn't have wasted money on a parachute" - after you landed safely with it. It wasn't so bad in Wuhan because China used extreme measures to stop the spread.

So while this thread has been focused on the relatively low mortality of the disease, it has so far not really considered that ~10-20% of cases require hospitalization, and that when hospitals are overwhelmed, mortality rates from the disease can increase by a factor of ten.

I mentioned that quite a few times.