COVID-19 Coronavirus Containment Efforts

In summary, the Centers for Disease Control and Prevention (CDC) is closely monitoring an outbreak of respiratory illness caused by a novel (new) Coronavirus named 2019-nCoV. Cases have been identified in a growing number of other locations, including the United States. CDC will update the following U.S. map daily. Information regarding the number of people under investigation will be updated regularly on Mondays, Wednesdays, and Fridays.
  • #1,646
Maybe Australia can shed some light on this. The deputy chief medical officer has just given his opinion, and because of his position (the deputy gave the briefing because the chief was in conference with the PM) likely Australia's official position. It was testing. We have one of the highest testing and tracing rates in the world. We have now reached over 1000 but only 7 have died ie a death rate of a bit under .7%. In China, outside Hubei province, it was also low because they were prepared - I seem to recall it was about .4%. My suspicion is its preparedness and testing. BTW the reason it's not a complete lockdown yet in Aus is going to school is now optional - the schools will remain open. The reason is it is estimated 1/3 of health workers will be taken out of action if they are shut. The consensus of commentators is they will eventually be shut and we will be in complete lockdown in about a week, and some other arrangements will be made for healthcare workers.

BTW regarding beaches, they closed access but people went over the barricades etc. The life savers tried to stop them, but were ignored. Police will be used in future, just like they were called in for panic buying. That is sad, very sad, and takes police away from other important duties.

BTW you can form your own opinion what caused those 2700 people to be allowed to leave a ship after the law was passed to not even allow ships to land:
https://www.theguardian.com/world/2...ngers-disembarked-without-coronavirus-testing

Thanks
Bill
 
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29 min ago
More than 32,000 US Coronavirus cases and 400 deaths
From CNN's Jamiel Lynch

There are at least 32,149 cases of novel Coronavirus in the United States, according to CNN Health's tally of cases that are detected and tested through US public health systems.
At least 400 people have died. The total includes cases from all 50 states, the District of Columbia and other US territories, as well as all repatriated cases.
https://us.cnn.com/world/live-news/coronavirus-outbreak-03-22-20/index.html
 
  • #1,650
wukunlin said:
Over 102 cases in New Zealand now. Our public healthcare system does NOT have the capabilities to deal with an outbreak. This is really bad.

And they laughed at the PM when she mostly locked down the country. Australia followed in a couple of days. It looks like you can't go too hard, too early with this thing.

Queensland has now closed its state borders, which of course is illegal (at least for Australian citizens), but nobody is complaining. The only trouble is the border runs through the Gold Coast - in fact right through the airport. Amazing. Interestingly I just had a 'discussion' with my sister who said it was at the Tweed river - I had to read her the article about it. Seriously its a big problem for those that live on one side of the border and have businesses or work on the other side.

Oh - Australia has now entered what NZ calls level 4 except for schools which needs special consideration to not impact needed health care workers. It is predicted by virtually all commentators to be at your level 4 some time this week

Thanks
Bill
 
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“Anything that doesn’t feel like an overreaction now is probably an under reaction.”
I need to learn from my mistakes, things are happening in half the time I predict.
 
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  • #1,652
Tom.G said:
Here is a rather detailed article on how COVID-19 reaches and progresses thru the body. Rather graphic writing, if you are easily upset you have been warned.

And students in Australia are not taking STEM subjects because they are too hard. At a minimum every student should read the above and have to write a report, even if it's just in English class.

And to top it off my sister just told me her daughters room-mate believes the cornavirus is a conspiracy - God help us.

Thanks
Bill
 
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I'm not looking forward to NZ being under alert level four, to be effective 11.59pm Wednesday. Fun times ahead.
 
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bhobba said:
And to top it off my sister just told me her daughters room-mate believes the cornavirus is a conspiracy - God help us.
The whole existence? Like... there is no virus and everyone is making that up?

Border, by the way, without "a".

Italy's new cases per day, will be interesting to see how the next few days will look like:
italy.png
 
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mfb said:
The whole existence? Like... there is no virus and everyone is making that up?

She didn't detail. She was more worried about how I was going to eat now all I can get is takeaway. There is a Takeaway up the road I will go to.

mfb said:
Border, by the way, without "a".

Will fix

And yes - fingers crossed on Italy's cases. They even got Chinese advisers into help.

Thanks
Bill
 
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USA numbers on the rise, fast. It overtook Spain, Germany, Iran, France and South Korea, trailing Italy.

US.jpg
 
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Africa: Coronavirus epidemic is advancing in the Subsaharan Africa
More than 500 contaminations were reported on 20 March in the Subsaharan African according to authorities of many countries; 200 tested positive in South Africa, the biggest number in the continent.
.../...
Plus de 500 contaminations avaient été rapportées au 20 Mars en Afrique subsaharienne, selon les autorités des divers pays, don't 200 en Afrique du Sud, le plus grand nombre de cas sur le continent.

https://www.lemonde.fr/afrique/arti...iVRQzp_QnPn3mA62ymGlMAtsC_LJAeSzsTjh502IdKivU
 
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Now for some good news! We know older adults are at higher risk for severe Covid-19 but it is NOT a death sentence. A 93-year-old woman in South Korea and a 95-year-old woman in Italy have fully recovered becoming the oldest persons to overcome Covid-19 infection.

http://m.tbs.seoul.kr/efm/news/newsView.do?seq_800=10382358&typ_800=P&fbclid=IwAR29laHyGBgem5_RAUCKmFqPG2XtxrRtpGL9bvWE4eYQ9yVtdqpZ2rfQ11w

https://www.thesun.co.uk/news/11232069/italian-coronavirus-grandmother-oldest-recover/
 
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Ygggdrasil said:
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.
I believe it has been confirmed that a person can be asymptomatic and contagious. The Science Mag article discusses "a paper published on 30 January in The New England Journal of Medicine (NEJM) about the first four people in Germany infected with a novel coronavirus".

NEJM also has an article "First Case of 2019 Novel Coronavirus in the United States."
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191

As of January 30, 2020, a total of 9976 cases had been reported in at least 21 countries, including the first confirmed case of 2019-nCoV infection in the United States, reported on January 20, 2020.

On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China.

On hospital day 8 (illness day 12), the patient’s clinical condition improved.
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Washington_(state)#January:_first_case
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Washington_(state)#February:_first_deaths
On February 24, a 54-year-old man was transferred from the Life Care Center of Kirkland to Harborview Medical Center and died there on February 26.

On February 28, a high school student in Everett was confirmed as having the virus. The following day, researchers confirmed the Coronavirus strain in the student's case may be related to the Coronavirus strain in the first confirmed U.S. case from January 19, suggesting that the virus may have been spreading in the area for up to six weeks.
This shows the importance of early detection, but also the responsibility of folks who are ill to take precautions so as not to infect others with who they have contact, and once the virus has started to spread, the importance of social distancing or stay-at-home. It is instructive to compare the dealyed NY state response to more proactive WA state response. US infection statistics are being driven by infections in NY and the NY City metropolitan area.

The first case was not the only traveler to enter the US with an infection, nor in Washington state. California reports 24 persons repatriated to the US. In the New York metropolitan area, several travelers had returned from Europe or the Middle East with infections.

The challenge facing national, state and local governments is how to control/mitigate a highly contagious disease (virus) when so many people are infected where some fraction of those infected to not know.

https://www.nytimes.com/interactive/2020/03/21/upshot/coronavirus-deaths-by-country.html
 

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  • #1,663
Astronuc said:
I believe it has been confirmed that a person can be asymptomatic and contagious. The Science Mag article discusses "a paper published on 30 January in The New England Journal of Medicine (NEJM) about the first four people in Germany infected with a novel coronavirus".

NEJM also has an article "First Case of 2019 Novel Coronavirus in the United States."
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Washington_(state)#January:_first_case
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Washington_(state)#February:_first_deathsThis shows the importance of early detection, but also the responsibility of folks who are ill to take precautions so as not to infect others with who they have contact, and once the virus has started to spread, the importance of social distancing or stay-at-home. It is instructive to compare the dealyed NY state response to more proactive WA state response. US infection statistics are being driven by infections in NY and the NY City metropolitan area.

The first case was not the only traveler to enter the US with an infection, nor in Washington state. California reports 24 persons repatriated to the US. In the New York metropolitan area, several travelers had returned from Europe or the Middle East with infections.

The challenge facing national, state and local governments is how to control/mitigate a highly contagious disease (virus) when so many people are infected where some fraction of those infected to not know.

https://www.nytimes.com/interactive/2020/03/21/upshot/coronavirus-deaths-by-country.html
I agree with everything you said. Just a quick comment on the highlighted bit. It's physical distancing, not social distancing. WHO corrected itself.

https://www.msn.com/en-us/tv/corona...BLjIlcC8QTlbmErpftOvwvXFvBtlkrvEraOZAnK7SiI6Y
 
  • #1,664
Astronuc said:
I believe it has been confirmed that a person can be asymptomatic and contagious. The Science Mag article discusses "a paper published on 30 January in The New England Journal of Medicine (NEJM) about the first four people in Germany infected with a novel coronavirus".

The paper is flawed as the person was symptomatic. https://www.sciencemag.org/news/2020/02/paper-non-symptomatic-patient-transmitting-coronavirus-wrong

However it is likely that a person can be asymptomatic and contagious. Overall, however, it is likely that pre-symptomatic transmission is not a major driver of the pandemic. In other words, strictly self-isolating after onset of symptoms, even mild ones, would be a huge contribution to controlling the spread of the disease. See post #1329.
 
  • #1,665
By searching (in silico) for drugs that would interfere with corona virus-human protein interactions, researchers have developed a list of 69 drugs to test.
These are candidates for using to treat the corona virus.
NY Times article here.
BioRxiv here.
Some have been used on oher diseases, others not.
 
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xkcd
sabotage.png

Mouseover:
"So excited to see everyone after my luxury cruise home from the World Handshake Championships!"
 
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atyy said:
Yes, I am aware. I was linking back to Ygggdasil's post of Feb 3. It has subsequently (last week or two) been determined that perhaps 4 of 5 (80%) of those infected and who are contagious do not realize they are infected.
atyy said:
However it is likely that a person can be asymptomatic and contagious. Overall, however, it is likely that pre-symptomatic transmission is not a major driver of the pandemic. In other words, strictly self-isolating after onset of symptoms, even mild ones, would be a huge contribution to controlling the spread of the disease. See post #1329.
Anecdotally, in NY State, there are infections for which the original case cannot be linked to a symptomatic individual, e.g., the attorney who is related to at least 50 additional cases.
 
  • #1,668
Astronuc said:
It has subsequently (last week or two) been determined that perhaps 4 of 5 (80%) of those infected and who are contagious do not realize they are infected.

Do you have a reference for the "and who are contagious" part? AFAIK our best current understanding is that an asymptomatic person who is contagious will soon become symptomatic (within a day or so), so they will soon know they are infected. And as I understand it, that is only a fairly small fraction of asymptomatic people who are infected--most asymptomatic infected people will stay asymptomatic forever (and by inference would not be contagious).
 
  • #1,669
PeterDonis said:
Do you have a reference for the "and who are contagious" part? AFAIK our best current understanding is that an asymptomatic person who is contagious will soon become symptomatic (within a day or so), so they will soon know they are infected. And as I understand it, that is only a fairly small fraction of asymptomatic people who are infected--most asymptomatic infected people will stay asymptomatic forever (and by inference would not be contagious).
I'm looking for more information on that. Sanjay Gupta (CNN commentator) mentioned it last Thursday. I have yet to see a peer-reviewed report/article on the subject.

Yes, those who are infected will become symptomatic, but symptomatic can mean feeling like one has a mild cold to severe with diarrhea/vomiting and and in the extreme with pneumonia.

I don't know how the following relates to the 80% don't know they have it, but . . .
Thus, the key findings, that 86% of infections went undocumented and that, per person, these undocumented infections were 55% as contagious as documented infections, could shift in other countries with different control, surveillance and reporting practices.
https://science.sciencemag.org/content/early/2020/03/13/science.abb3221

Using data from China -- where the COVID-19 outbreak originated -- epidemiologists developed a mathematical model of infectious disease spread. The model estimates nearly 80 percent of confirmed cases of the disease originated from so-called "undocumented" cases, or those who experienced mild, limited or no symptoms and went undiagnosed as a result.
https://www.upi.com/Health_News/202...le-who-dont-know-they-are-sick/7771584372104/

One such potential case:
(CNN)Emma, a 12-year-old girl, is "fighting for her life" in an Atlanta hospital after testing positive for the coronavirus, according to her cousin.
Justin Anthony told CNN that Emma was diagnosed with pneumonia on March 15 and tested positive for Coronavirus on Friday night. As of Saturday, she was on a ventilator and is currently in stable condition, Anthony said.
Emma had no pre-existing conditions. She has not traveled recently and it's unknown how she contracted the virus, according to Anthony.
https://www.cnn.com/2020/03/22/us/georgia-coronavirus-girl-hospitalized/index.html This case demonstrates the severity of the illness in young folk.

In two communities where I live, there are cases for which the original contact is unknown, i.e., the victim cannot identify a contact is symptomatic, or it is not know if a symptomatic person was in contact with the victim (casual contact or passerby).Update/Edit: NY State just release today's statistics (March 23, 2020 | 3:03PM): NY City 12305 positive cases and the entire state (including NY City) 20,875 cases including 157 deaths.

Washington State (Updated on March 23, 2020 at 3:07 p.m) now up to 2221 confirmed COVID-19 cases and 110 deaths.
 
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  • #1,670
Astronuc said:
those who are infected will become symptomatic, but symptomatic can mean feeling like one has a mild cold to severe with diarrhea/vomiting and and in the extreme with pneumonia

Yes, I understand that "symptomatic" can take a variety of forms, but all of them involve some kind of abnormality, so you know you have some kind of illness.

What I'm concerned about is not so much the present--I understand that right now things are changing rapidly and it's not always going to be possible to tell how a particular infected person got infected (as in the examples you give). What I'm concerned about is the future--at whatever point, say a few months from now, the rate of new cases has dropped to zero, or close enough to that, for a long enough time that anyone who has not yet developed symptoms could reasonably be assumed to either not have the virus or to have overcome it. At that point, would anyone (other than people who are symptomatic and are being treated, and presumably isolated to prevent them infecting others) still be contagious? Or could a significant number of people still become contagious at some point after that? And if so, when would they be contagious? Would a period of being contagious always be followed by them getting some kind of symptoms?

I realize we might not have good answers to all these questions right now. But a lot of people seem to be talking as though we do--for example, when people talk as though there will definitely be a second outbreak of COVID-19 if we let up on social distancing at some point in the future. So I'm wondering if anyone has actually seen hard evidence on these points.
 
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  • #1,671
PeterDonis said:
What I'm concerned about is not so much the present--I understand that right now things are changing rapidly and it's not always going to be possible to tell how a particular infected person got infected (as in the examples you give). What I'm concerned about is the future--at whatever point, say a few months from now, the rate of new cases has dropped to zero, or close enough to that, for a long enough time that anyone who has not yet developed symptoms could reasonably be assumed to either not have the virus or to have overcome it. At that point, would anyone (other than people who are symptomatic and are being treated, and presumably isolated to prevent them infecting others) still be contagious? Or could a significant number of people still become contagious at some point after that? And if so, when would they be contagious? Would a period of being contagious always be followed by them getting some kind of symptoms?
All good questions and I have the same concerns. I think it is too early to tell, but I expect there are those who are trying to answer those questions. I'm looking for any peer-reviewed study.

My sister, a pediatrician, and a family friend, physician's assistant, are dealing with this first hand. I'm also looking at what state and local health departments are reporting in the two areas of concern for me.

PeterDonis said:
if we let up on social distancing at some point in the future.
I imagine that will happen once there is a vaccine and enough people are vaccinated.

Prior to COVID-19, we were seeing a resurgence of measles around the US. There were clusters where folks were not having their children vaccinated. For example, Washington State had two outbreaks of measles in 2019.
https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Measles/Measles2019

Some good news, Gilead's remdesivir seems to work as treatment. See the article on the first COVID-19 case in Wa state.
The bad news: Gilead is overwhelmed with requests for remdesivir and will have to ration it. It is still in trials.
https://www.nytimes.com/2020/03/23/health/coronavirus-drugs-remdesivir.html
 
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  • #1,672
Prediction: For the near future, the term, “COVID-19 Recovered” will appear on resumes along with “previous experience” and “references available upon request.”
 
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As far as rationing Remdesivir, I’m not surprised they are running low. Making this stuff is a bit complex.
1584998721516.png
Chloroquine and its analog hydroxychloroquine, however, is brutally easy! Chloroquine is much easier. Just mix the diamine ( 4-diethylamino-1-methylbutylamine) with the 4,7-dichloroquinoline.
1584999296191.jpeg
 
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From World Health Organization (WHO): DO THE FIVE
Help stop coronavirus
1 HANDS - Wash them often
2 ELBOW - Cough into it - I would add, wear a facemask
3 FACE - Don't touch it
4 SPACE - Keep safe distance
5 HOME - Stay if you can

6 If one is ill, stay away from others, do not go out in public and do not take public transportation, which is how some of the virus has spread.
 
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Florida has declared child-care-facilities as a critical infrastructure that must be allowed to stay open, because people with essential jobs need child care.

But in the past 48 hours more than 100 child care centers in central Florida closed because they have no customers. Parents don't want their children to go there.

I worry about employees of critical infrastructure staying away from work because they don't want to put their families at risk.
 
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  • #1,676
PeterDonis said:
What I'm concerned about is not so much the present--I understand that right now things are changing rapidly and it's not always going to be possible to tell how a particular infected person got infected (as in the examples you give). What I'm concerned about is the future--at whatever point, say a few months from now, the rate of new cases has dropped to zero, or close enough to that, for a long enough time that anyone who has not yet developed symptoms could reasonably be assumed to either not have the virus or to have overcome it. At that point, would anyone (other than people who are symptomatic and are being treated, and presumably isolated to prevent them infecting others) still be contagious? Or could a significant number of people still become contagious at some point after that? And if so, when would they be contagious? Would a period of being contagious always be followed by them getting some kind of symptoms?

I realize we might not have good answers to all these questions right now. But a lot of people seem to be talking as though we do--for example, when people talk as though there will definitely be a second outbreak of COVID-19 if we let up on social distancing at some point in the future. So I'm wondering if anyone has actually seen hard evidence on these points.

Here is an example where it seemed like there were no new cases for a month (partly due to narrow definition of a suspected case and lack of testing), then cases were uncovered. The details of the tree have changed a bit with more data, but the overall picture suggested remains the same.
https://bedford.io/blog/ncov-cryptic-transmission/

In this transmission cluster, evidence suggests that symptomatic people (who probably thought they had a cold or flu) helped to transmit Covid-19.
https://www.latimes.com/world-nation/story/2020-03-18/coronavirus-spread-nursing-homes
https://www.bloomberg.com/news/feat...ronavirus-spread-from-patient-zero-in-seattle

However, it is worth noting that many have suggested that if surveillance and quarantine are in place to suppress the new outbreaks, then perhaps the "second" peak need not require measures as severe (near lockdown, massive closing of businesses) to control. In Trevor Bedford's words, "However, I'm not quite that pessimistic. Although I agree that basic mitigation efforts won't stop the epidemic, I have hope that we can solve this thing by doing traditional shoe leather epidemiology of case finding and isolation, but at scale, using modern technology." Tomas Pueyo has written similar thoughts that he calls the hammer and the dance.
 
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So my doctor is sick and canceled her appointment with me tomorrow, I am going to meet with a nurse physician in the morning, well I vomit in the mornings, they said if I am sick, I won't be allowed in. So I told them to schedule me in the afternoon, I feel better in the afternoons, They don't have doctors in the afternoons. So I'll pretend to be ok and then vomit on them. I've been this way all of my life. I had trouble attending school because I couldn't make it in most mornings. I had to get jobs where I came in late, then finally was able to work at home.
 
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atyy said:
The article starts: "The man who would become Patient Zero for the new Coronavirus outbreak in the U.S. appeared to do everything right." He was sick when he returned to the US. He arrived Jan 15, and on Jan 19, after 4 days of being ill (cough and fever), he was tested and confirmed on Jan 20. He did alert the authorities that he had returned from Wuhan. He'd already exposed others, since he had to travel from Seattle-Tacoma airport (SEA) to Snohomish County, where he lived.
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191

From the bloomberg article
On Jan. 15, when the traveler to Wuhan who became the first known U.S. case returned to Seattle-Tacoma International Airport, he took group transportation from the airport with other passengers, county officials have said.

On Jan. 17, the U.S. began checks of passengers from Wuhan at airports in New York, Los Angeles and San Francisco.
Two days too late for the 35 year old traveler who arrived Jan. 15, and there were probably infected travelers arriving at LAX and SFO, and possibly EWR (NJ) and JFK (NY), and protocols were not in place at the airports.
More U.S. cases were reported in places including Illinois, California and Massachusetts, suggesting other travelers may have brought it home with them. For every dozen cases the U.S. caught, it probably missed 20 or 25, estimated Marc Lipsitch, an epidemiology professor at the Harvard T.H. Chan School of Public Health.

The 35 year old man is one of many 'patient zeros', and each should be traced, but as time goes on, that becomes less likely. Cases in NY were from started with people returning from Europe and Middle East. California has cases independent of those in Washington, and at least 24 patient-zeroes.

I looked up roundtrip flights between LAX, SFO and SEA to Wuhan (WUH), and there are many combinations, all connecting in intermediate city, e.g., Beijing, Tokyo, Taipei, Shanghai, Guangzhou, and others. Similarly, one could many options for flights to WUH from ORD, EWR and JFK. Passengers could be immigrants visiting family, students, or business people.

The highest concentration of SARS-CoV2 (2019-nCoV) infections in the US have one thing in common - international airports and infected/ill folks returning from overseas without any precautions.
 
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atyy said:
Why do you doubt China's statistics? The WHO visited China and were able to see their practices for themselves.
https://www.who.int/docs/default-so...na-joint-mission-on-covid-19-final-report.pdf
That paper is syrupy-sweet, and does not read like a 3rd-party assessment (and includes Chinese writers).

What I find incredible is the idea that China, the source of the outbreak, which punished people responding to the outbreak with prison, could export the outbreak worldwide and then be pretty much the only country on Earth to successfully contain the outbreak to one geographic region. It doesn't seem like it should be possible, especially since:
Keith_McClary said:
I stand corrected! The Chinese are more mobile than I thought. So how is it possible they successfully contained the virus?

I just don't believe it is possible that they did.
 
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atyy said:
The WHO visited China and were able to see their practices for themselves.

Does the term "Potemkin village" ring a bell? I'm sure the Russians are not the only ones to have come up with the idea.
 
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