COVID-19 Coronavirus Containment Efforts

[chemisttree]

Which BC case? This one arrived in BC in February:
https://bc.ctvnews.ca/b-c-s-6th-cov...igation-as-new-cases-add-up-in-iran-1.4822454
https://vancouversun.com/news/local...-provide-update-on-novel-coronavirus-thursday

Yes, I’m reading that now but not before.

“Dr. Bonnie Henry said the woman in her 30s visited the Middle East country in January and returned to B.C. that same month. She was diagnosed after taking herself to hospital with flu-like symptoms, she added, but was sent home.”

 

[chemisttree]

Containment will fail, the only real answer is the vaccine.

I think it’s time to admit that containment has failed. The infuriating thing is that in practically the same breath as the PHEIC declaration, WHO recommended against travel restrictions from China. If you want to point to the instant that quarantine failed, it was back on Jan. 30th.

“In making the announcement, WHO leaders urged countries not to restrict travel or trade to China, even as some have shut down borders and limited visas.”

 

[Bandersnatch]

So, humour me here. And I'm asking @chemisttree mostly, as they seem the most concerned.
The current estimates show the virus has IFR and R0 on the same order of magnitude as the seasonal flu. Similar at-risk populations too.
Why get oneself worked up now, when year after year people generally ignore the flu?

 

[chemisttree]

So, humour me here. And I'm asking @chemisttree mostly, as they seem the most concerned.
The current estimates show the virus has IFR and R0 on the same order of magnitude as the seasonal flu. Similar at-risk populations too.
Why get oneself worked up now, when year after year people generally ignore the flu?

Ask the Chinese, the Italians, the Japanese, the South Koreans, Singapore. They are certainly a bit “worked up.” The flu can’t be stopped and no one even tries. We have a vaccine that sometimes works and even if it doesn’t completely work, it usually gives partial protection. You get sick with this thing and go to the hospital, you could be captured, isolated and people around you don spacesuits.
It ain’t the flu.

Oh, by the way. My preferred pronouns are “he, him.”

 

[Bandersnatch]

I don't mean to be flippant. Looking at the available data, this does seem like a massive overreaction, so I'd like to understand people's concerns.

Oh, by the way. My preferred pronouns are “he, him.”

I will keep that in mind.

 

[bhobba]

Why get oneself worked up now, when year after year people generally ignore the flu?

Fear off the unknown. We know the flu, and this seems to have, in developed countries, a bit higher death rate - although I think that is a somewhat fluid. It attacks the same group too - people like me with compromised immune systems - I take methotrexate and a biologic - both potent immune suppressants. It's not a question of should I get the flu shot each year - its merely a question of when (about end of March - start of April).

I personally am not worried - I have faith in the scientists working around the clock fast tracking the vaccine using the new technologies available. We truly live in the age of magic - and yet we have anti vaccine nutters - go figure. It certainly is an interesting age. Although it greatly annoys me, even the measly $2m given to develop it is not that great a problem. The research groups can easily play on that fear to virtually get any amount they want if it is needed.

Thanks
Bill

 

[chemisttree]

I don't mean to be flippant. Looking at the available data, this does seem like a massive overreaction, so I'd like to understand people's concerns.

I don’t think it’s overreaction. What I believe is going on is that during the height of flu season, we have a rapidly spreading, largely unknown thing. If the caseload stays manageable, if the population demographics are favorable and the CFR is about the same as the flu, if the R0 can be kept close to 1 or lower, if we have enough supplies, if it will die out in the summer it might not be so bad. Lots of “ifs.” If it blows up and overwhelms the local healthcare system, we go from prevention and mitigation to just mitigation which is looking to me more and more like palliative care. I wonder what the CFR is when only palliative care is available?

And we don’t know much about reinfection. What happens if you catch it again? Will it be mild like a cold or serious like dengue? Already there are scattered reports of reinfection. Perhaps the patients never actually cleared the virus in the first place but you would think their own immunity would be able to deal with it after testing negative in the hospital. I haven’t seen anything about ADE in these reinfected patients but I’m hoping it isn’t a problem.

This isn't the flu. Yet.

 

[chemisttree]

Springer Nature has made all of its COVID-19 reports available for free.

https://www.springernature.com/gp/researchers/campaigns/coronavirus

I don’t know how to value this.

 

[atyy]

So, humour me here. And I'm asking @chemisttree mostly, as they seem the most concerned.
The current estimates show the virus has IFR and R0 on the same order of magnitude as the seasonal flu. Similar at-risk populations too.
Why get oneself worked up now, when year after year people generally ignore the flu?

Current IFR estimates include numbers that are 10 times greater than the flu.
https://www.who.int/docs/default-so...ation-reports/20200220-sitrep-31-covid-19.pdf
"Since the publication of modeling estimates in yesterday’s ‘Subject in Focus’, one research group (Ref. 12) has provided a correction of their estimate of the Infection-Fatality Ratio (IFR), with the new estimate being 0.94% (95% confidence interval 0.37-2.9). This replaces the lowest estimate of IFR of 0.33%, but remains below the highest estimate of 1.0% (Ref. 11)"

Also, even if people do recover, it seems many more need intensive care. Singapore has more than 80 cases, with about 4 in intensive care. https://jamanetwork.com/journals/jama/fullarticle/2761890

That article also says "Although published reports to date have identified preexisting chronic noncommunicable diseases as being a risk factor for clinical deterioration, the experience to date in Singapore is that patients without significant comorbid conditions can also develop severe illness."

At one stage, it was reported that 8 were in critical condition in the intensive care unit.
https://www.moh.gov.sg/news-highlig...ree-new-cases-of-covid-19-infection-confirmed

Here is a news report about the experience of one patient who did recover from being critically ill. Apparently, at one stage the doctors even considered extracorporeal membrane oxygenation (ECMO), but it turned out they didn't need it in this patient.
https://www.channelnewsasia.com/new...id19-survivors-on-fighting-the-virus-12459198

 

[dRic2]

I live in Italy, near one of those villages. I know it is bad, but I do not justify this general hysteria. I am a little hypochondriac and the most difficult part is dealing with all the people going nuts about it. I am a bit anxious myself and if all the people around you are all going crazy it's not a very nice feeling.

Let's hope for the best! :DPs. I do think that the quarantine is a good try to prevent it from spreading even more

 

[chemisttree]

I live in Italy, near one of those villages. I know it is bad, but I do not justify this general hysteria. I am a little hypochondriac and the most difficult part is dealing with all the people going nuts about it. I am a bit anxious myself and if all the people around you are all going crazy it's not a very nice feeling.

Let's hope for the best! :DPs. I do think that the quarantine is a good try to prevent it from spreading even more

Good luck! I have seen pictures of the shops in Milan with empty shelves. I’ve lived through that every time a hurricane threatens landfall close to San Antonio, Texas. What have you seen that you call “people going nuts” and “general hysteria?” Are you able to still go to work with the restrictions?

 

[bhobba]

Ps. I do think that the quarantine is a good try to prevent it from spreading even more

It must be tried to give us the time to develop the silver bullet - the vaccine. Groups around the world are working around the clock to get the best one. They already have it (evidently a number of groups do including the UQ group I posted about which has the patent for a fast track technique being used - but this is a global effort - when a possible pandemic is at stake who holds the patent goes out the widow - as it should)- it's just determining effectiveness and safety. The time-table is April for a vaccine to be used by first responders, then June - July for general distribution. I listen to what the UQ says on the matter - even highly credentialed immunologists saying years do not seem to be up with the latest technology we now have.

I have to laugh at the US talk shows on this - they all say, basically, the US biotech companies will find the solution. This is not just a US effort - its a world wide effort of which the US is just a part - of course a major part - but they are, like everyone else, all working together on this one.

Thanks
Bill

 

[kadiot]

“In making the announcement, WHO leaders urged countries not to restrict travel or trade to China, even as some have shut down borders and limited visas.”

I cannot help but laugh. At least 30 countries already reported infections and deaths, and yet... Geneva always like to do it political. Not until Italy reported more cases and deaths that Geneva started talking about a “possible pandemic”. The World Health Organization's headquarter is located in Geneva, Switzerland. The distance between Geneva and Italy is 652 km. The road distance is 906.5 km.

 

[kadiot]

OVERHEARD: "When a pandemic is declared, stringent containment measures will be abandoned and priorities will shift to efficient case management and mitigation of transmission. Travel bans may still remain but will be less essential to the response."

Is it true?

 

[dRic2]

What have you seen that you call “people going nuts” and “general hysteria?” Are you able to still go to work with the restrictions?

Empty shops, closed work offices and universities (and schools), public events are cancelled. Basically all you can do is stay at home and talk to your family or friends. And the conversations go something like:
A- how are you?
B- fine
A- hope we don't get it. I heard at the news that...
(Sneeze)
B- oh. Are you sure you are ok? Maybe we should leave town for a while

 

[dRic2]

The time-table is April for a vaccine to be used by first responders, then June - July for general distribution

Local news said we should wait till next year (18 months required)

 

[StatGuy2000]

Mortality from respiratory disease is not uniform across the population. Younger people will have much less mortality than elderly people or people with complications (e.g. people who smoke, people with pre-existing health issues). An outbreak in a university dormitory would have much lower mortality rate than an outbreak in a retirement home. With such small numbers, it's hard to extrapolate information about mortality without more knowledge about the infected population.

To @chemisttree and @OmCheeto ,

@Ygggdrasil is correct in that mortality from respiratory disease is not uniform across populations. People who are elderly or with pre-existing medication conditions have much higher mortality rates from all respiratory diseases (including the common flu) than younger people or people who are in good health.

The 2 deaths in Italy as far as we know were among those who were elderly, and it may well be possible that they had other medical conditions that would have made them especially at risk from any serious respiratory infections, not just COVID-19. So we cannot conclude that somehow COVID-19 is more virulent or deadly based on such limited data.

 

[kadiot]

The 2 deaths in Italy as far as we know were among those who were elderly, and it may well be possible that they had other medical conditions that would have made them especially at risk from any serious respiratory infections, not just COVID-19. So we cannot conclude that somehow COVID-19 is more virulent or deadly based on such limited data.

Cause of death is very difficult to prove. I think it requires pathologist as expert witness.

 

[jbriggs444]

Cause of death is very difficult to prove. I think it requires pathologist as expert witness.

Difficult even to define. But we are not after proof here. We are after supportable metrics.

 

[kadiot]

Difficult even to define. But we are not after proof here. We are after supportable metrics.

I find this problematic because Covid-19 is deadly to elderly, the very young and those with medical conditions. We can't tell the number of people who actually died in Covid-19 out of the total number of reported deaths.

 

[jbriggs444]

I find this problematic because Covid-19 is deadly to elderly, the very young and those with medical conditions. We can't tell the number of people who actually died in Covid-19 out of the total number of deaths.

It is the same for many diseases. They are deadly to the elderly, to the very young and to those with certain medical conditions. But regardless of this, with only two putative "positive" events, one is not going to improve the trustworthiness of a statistical measure greatly by carefully determining whether a particular death was or was not caused by Covid-19. One is going to improve the measure by waiting for an increased sample size.

 

[bhobba]

Local news said we should wait till next year (18 months required)

I know - there is differences in views on this. I have heard highly qualified immunologists saying the same. This is the timetable UQ is working to - we will see who is right. Fingers crossed UQ is right because everyday we seem closer to a pandemic.

Thanks
Bill

 

[eachus]

Just a post to defend (real) statistics. Computing the mortality of an epidemic by computing deaths/number of cases is wrong. Especially early in an outbreak, deaths will trail confirmed cases significantly. There are two ways to compute a reasonable estimator. If you have good data on patient recoveries you can use Deaths/(deaths+number of recoveries). If deaths occur relatively early compared to recoveries, you need an ARIMA (time series) model with different lags for deaths and recoveries.

Where does this lead for Covid-19? Given the data here: https://www.worldometers.info/coronavirus/ the death rate is around 9.4%. Around 10% is probably a better statement that takes into account all the variables in the figures.

 

[Ygggdrasil]

It must be tried to give us the time to develop the silver bullet - the vaccine. Groups around the world are working around the clock to get the best one. They already have it (evidently a number of groups do including the UQ group I posted about which has the patent for a fast track technique being used - but this is a global effort - when a possible pandemic is at stake who holds the patent goes out the widow - as it should)- it's just determining effectiveness and safety. The time-table is April for a vaccine to be used by first responders, then June - July for general distribution. I listen to what the UQ says on the matter - even highly credentialed immunologists saying years do not seem to be up with the latest technology we now have.

Do you have sources for these timetables? A recent press release from the university suggests that they don't expect the vaccine to be ready for clinical testing until after the middle of the year:

The group continues to work to a much-accelerated timetable to keep on track for investigational clinical testing after the middle of the year.

https://www.uq.edu.au/news/article/2020/02/significant-step’-covid-19-vaccine-quest

Testing can take a while, so it will be a while after testing begins before the vaccine is available for general distribution. This also doesn't take into account the time needed to scale manufacture of the vaccine. For example, Science reports that the UQ team would need 6 months to produce 200,000 doses of the vaccine (far fewer than would be needed to contain a worldwide pandemic).

 

[mfb]

If UQ alone can produce 200,000 in 6 months, how much can we produce globally? Several millions would cover the most critical medical staff.

 

[Ygggdrasil]

Just a post to defend (real) statistics. Computing the mortality of an epidemic by computing deaths/number of cases is wrong. Especially early in an outbreak, deaths will trail confirmed cases significantly. There are two ways to compute a reasonable estimator. If you have good data on patient recoveries you can use Deaths/(deaths+number of recoveries). If deaths occur relatively early compared to recoveries, you need an ARIMA (time series) model with different lags for deaths and recoveries.

Where does this lead for Covid-19? Given the data here: https://www.worldometers.info/coronavirus/ the death rate is around 9.4%. Around 10% is probably a better statement that takes into account all the variables in the figures.

This approach is also wrong. Infection with the Covid-19 virus results in many mild cases which are not reported, so your approach greatly overestimates the mortality of the disease. The WHO has cited a few studies which try to model the proportion of mild cases and estimate that the mortality of the disease (or more precisely, the infection fatality ratio or IFR) to be 0.5-1.0%. For more information, see these studies (though note that only the first has been published in a peer reviewed journal):
https://www.mdpi.com/2077-0383/9/2/523
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-2019-nCoV-severity-10-02-2020.pdf
https://institutefordiseasemodeling...ality_rates_and_pandemic_risk_assessment.html

 

[Ygggdrasil]

If UQ alone can produce 200,000 in 6 months, how much can we produce globally? Several millions would cover the most critical medical staff.

From the Science piece I cited earlier:

Even when experimental vaccines work in clinical trials, mass producing them quickly is inevitably a huge challenge. If Moderna devoted all of its vaccine manufacturing capabilities to one product, it could make 100 million doses in a year, Bancel says. Inovio can only produce 100,000 doses a year now, but is “actively speaking with a larger manufacturer,” Kim says, which could increase their output to “multimillion” doses. The Queensland team says it could make 200,000 doses in 6 months.

https://www.sciencemag.org/news/202...te-new-coronavirus-vaccines-they-may-come-too

I don't know enough about the specifics of the vaccines produces to know how easily it would be for one facility to produce a vaccine based on another group's specific vaccine technology.

 

[chemisttree]

Local news said we should wait till next year (18 months required)

During the 2009 swine flu outbreak, several countries (Australia, Great Britain and the US) promised to fulfill export orders and donations (US promised to export 10%) only to withdraw those offers until their own domestic needs were met. In the US there were manufacturing problems that seriously curtailed supply to the point that there wasn’t enough vaccine to go around for our healthcare workers. We didn’t receive vaccine from offshore until mid October, which was too late to be effective in stopping the outbreak in the US.
I believe that unless you have a domestic production capacity sufficient to fill domestic needs and they don’t have problems, not much can be guaranteed as far as projected delivery. If a country has little to no domestic production, like most of Africa, it is at the mercy of those that do. Let's hope we don’t have a repeat of 2009 here.

 

[OmCheeto]

To @chemisttree and @OmCheeto ,

@Ygggdrasil is correct in that mortality from respiratory disease is not uniform across populations. People who are elderly or with pre-existing medication conditions have much higher mortality rates from all respiratory diseases (including the common flu) than younger people or people who are in good health.

The 2 deaths in Italy as far as we know were among those who were elderly, and it may well be possible that they had other medical conditions that would have made them especially at risk from any serious respiratory infections, not just COVID-19. So we cannot conclude that somehow COVID-19 is more virulent or deadly based on such limited data.

Seems reasonable.
Btw, did you notice the odd demographics of the Singapore "confirmed infected"?
They're missing a very large age group.

I just checked the latest numbers, and there's still no one in the 3-24 age group.
I also checked the age demographics at wiki. Age groups seem fairly evenly distributed.
Anyone have a clue or guess why there is no one in that age group that is infected?

 

[chemisttree]

OVERHEARD: "When a pandemic is declared, stringent containment measures will be abandoned and priorities will shift to efficient case management and mitigation of transmission. Travel bans may still remain but will be less essential to the response."

Is it true?

I think that’s what we’re seeing in China now where positive cases are being warehoused in military barracks and convention centers. Even those emergency hospitals look suspiciously like containment facilities rather than hospitals.

https://www.taiwannews.com.tw/en/news/3870468

https://www.google.com/amp/s/www.nytimes.com/2020/02/06/world/asia/coronavirus-china.amp.html

 

[chemisttree]

Btw, did you notice the odd demographics of the Singapore "confirmed infected"?
They're missing a very large age group.

View attachment 257620
I just checked, and there's still no one in the 3-24 age group.

Anyone have a clue or guess why there is no one in that age group that is infected?

It could be due to the superspreader’s contacts at church.

 

[chemisttree]

To @chemisttree

So we cannot conclude that somehow COVID-19 is more virulent or deadly based on such limited data.

Yes, I believe one of the deaths was a cancer patient. I’ve seen firsthand what treatment does to the immune system.

I said,” # of critical cases ratio to total cases approaching 40%! Something is not right there. CFR is ~5%. Not right at all.”

 

[dRic2]

Lets hope we don’t have a repeat of 2009 here.

I don't really know what happened because I was like 12 at that time. Btw I've been to the doctor today for a regular check up and at the end of the visit she said something like: "Next week we are getting it. At least I am." But she didn't seem too worried. A little bit, but not very much. Don't know if she was pretending to make me feel safer though...

 

[chemisttree]

...at the end of the visit she said something like: "Next week we are getting it. At least I am." But she didn't seem too worried. A little bit, but not very much. Don't know if she was pretending to make me feel safer though...

That is the best news I’ve heard since the beginning of this thing. If things get dire and you need something that I might be able to ship, PM me.

 

[kadiot]

Seems reasonable.
Btw, did you notice the odd demographics of the Singapore "confirmed infected"?
They're missing a very large age group.

View attachment 257620
I just checked the latest numbers, and there's still no one in the 3-24 age group.
I also checked the age demographics at wiki. Age groups seem fairly evenly distributed.
Anyone have a clue or guess why there is no one in that age group that is infected?

We need to protect our elderly from this virus. Younger people will probably just have what looks like a bad cold. Older people with chronic illnesses have a much higher risk of dying based from China CDC first major report dated February 14, 2020. Avoid unnecessary travel especially if you are above 60 years old.