COVID-19 Coronavirus Containment Efforts

[mfb]

In the case of the current Coronavirus outbreak, there is very little we can do at an individual level to try to prevent an infection beyond what general hygienic practices to prevent other infections, such as frequent hand-washing and sanitizing door handles. So why should I expend my precious emotional resources in worrying or panicking about this?

There are some concerns that the virus might be able to travel via international shipping, China thinks that at least paper money is a problem. See also the post above this one.

You can avoid flying to China. That's an obvious one. But what about flying to e.g. Singapore or Japan, where some domestic infections happened? Even if your personal risk of getting the virus might be small: Many countries imposed travel restrictions on people who were in China (map). Will these restrictions be extended to more countries if the virus spreads there? How many conferences in China will be canceled - and how many outside? I know at least three people who consider this risk in their travel plans. Maybe all this doesn't affect you, but don't generalize too quickly please. And I didn't even start with people in China. They obviously want to know what is the best case, what is the worst case, what is how likely and so on.

Edit: Reality was faster than my post. Several countries already have quarantine measures for people who were in Singapore. And the list of suspended travel/new restrictions/cancelled events is growing daily.

 

[kadiot]

Regarding https://edition.cnn.com/2020/02/17/health/novel-coronavirus-surfaces-study/index.html

1. Children seems to be not affected by the novel-coronavirus. Do you know of a child who does? I know I read about the newly born baby infected with it. But how about older children?

Singapore's Case 76 is a 1-year old male Singapore Citizen who was among the group of Singaporeans who were evacuated from Wuhan on 9 February. He was without symptoms when he boarded the flight, and was put under quarantine upon landing in Singapore. All Singaporeans evacuated from Wuhan were tested for COVID-19 as an added precaution.

 

[chirhone]

There are some concerns that the virus might be able to travel via international shipping, China thinks that at least paper money is a problem. See also the post above this one.

International shipping from china?

I'm concerned about this because I ordered something from china and it is on the way:

When I receive it, how do I initiate decontamination procedure? Would cleaning the box with alcohol help? How about the inside of the package? I need to clean every millimeter with alcohol or do I have to wait 10 days for the viruses to self destruct (by heat or starvation)?

You can avoid flying to China. That's an obvious one. But what about flying to e.g. Singapore or Japan, where some domestic infections happened? Even if your personal risk of getting the virus might be small: Many countries imposed travel restrictions on people who were in China (map). Will these restrictions be extended to more countries if the virus spreads there? How many conferences in China will be canceled - and how many outside? I know at least three people who consider this risk in their travel plans. Maybe all this doesn't affect you, but don't generalize too quickly please. And I didn't even start with people in China. They obviously want to know what is the best case, what is the worst case, what is how likely and so on.

Edit: Reality was faster than my post. Several countries already have quarantine measures for people who were in Singapore. And the list of suspended travel/new restrictions/cancelled events is growing daily.

 

[chemisttree]

What article did you read these numbers in?

https://www.worldometers.info/coronavirus/coronavirus-expert-opinions/#lipsitch-021720

 

[chemisttree]

But frankly, your posts on this thread sound far more like panic. And when has panic ever done any good? Especially for a problem on which we don't have full knowledge of (even the quotes about the 60-70% infection rates are educated guesses, and the 70-80 million deaths are also estimates).

Strawman: Your posts sound like panic.
Attack the strawman: When has panic ever done any good?

The 60-70% infection potential rates are estimates (they were presented as such) but they are guesses by experts in the field.

“I think it is likely we will see a global pandemic. If a pandemic happens, 40% to 70% of people world-wide are likely to be infected in the coming year. What proportion is asymptomatic, I can't give a good number.”Prof. Marc Lipsitch
Prof. of Epidemiology, Harvard School of Public Health
Head, Harvard Ctr. Communicable Disease Dynamics

Ignore it if you choose but don’t tell me I’m in a panic because I pass along the info.

 

[kadiot]

International shipping from china?

I'm concerned about this because I ordered something from china and it is on the way:

View attachment 257269

When I receive it, how do I initiate decontamination procedure? Would cleaning the box with alcohol help? How about the inside of the package? I need to clean every millimeter with alcohol or do I have to wait 10 days for the viruses to self destruct (by heat or starvation)?

I doubt it...too far travel time. But I recall what they did with anthrax scare me... well, it was a bacteria, not a virus.

 

[mfb]

I'm concerned about this because I ordered something from china and it is on the way:

The risk is very, very small, but if in doubt you can put it in some remote corner for a week.

 

[chemisttree]

More from Prof. Marc Lipsitch:"Why do I think a pandemic is likely? The infection is in many parts of China and many countries in the world, with meaningful numbers of secondary transmissions. The scale is much larger than SARS for example (where the US had many introductions and no known onward transmission)

Why do I think 40-70% infected? Simple math models with oversimple assumptions would predict far more than that given the R0 estimates in the 2-3 range (80-90%). Making more realistic assumptions about mixing, perhaps a little help from seasonality, brings the numbers down.

Pandemic flu in 1968 was estimated to _symptomatically_ infect 40% of the population, and in 1918 30%. Those likely had R0 less than COVID-19. Below is from https://stacks.cdc.gov/view/cdc/11425

What could make this scenario not happen? 1) conditions in Wuhan could be so different in some fundamental way from elsewhere that we are mistaken in expecting further outbreaks to have basic aspects in common. No reason I know of to think that but a formal possibility

2) There could be a higher degree of superspreading than has been appreciated ("dispersion in R0") which could mean that many locations outside Wuhan could "get lucky" and escape major onward transmission. https://hopkinsidd.github.io/nCoV-Sandbox/DispersionExploration.html

This seems the most likely way a pandemic might be averted, but given the number of countries infected and likely missed imports in many of them https://medrxiv.org/content/10.1101/2020.02.04.20020495v2 that seems a lot to hope for

3) Control measures could be extremely effective in locations that have had time to prepare. Maybe in a few, but seems unlikely that is the case in all, especially countries with stretched health systems.

4) Seasonal factors could be much more powerful at reducing transmission than we currently expect. That doesn't help the Southern hemisphere, and is not consistent with behavior in China (preprint in queue from @MauSantillana et al.)

So that's my reasoning. It is as tight as I can make it and is an effort to use the science as we have it to make our best estimate about the future. Predictions can be wrong and I very much hope this is, but better to be prepared."
Marc Lipsitch Twitter Account - @mlipsitch , Feb. 14, 2020

 

[Ygggdrasil]

1. Children seems to be not affected by the novel-coronavirus. Do you know of a child who does? I know I read about the newly born baby infected with it. But how about older children?

Like other respiratory diseases such as the flu, COVID-19 poses less risk to healthy individuals, and the majority of those infected (~80%) experience only mild symptoms. The elderly and those with certain predisposing conditions (e. g. smokers, immunocompromised individuals, people with heart disease or diabetes) are at greater risk for more severe symptoms, like pneumonia.

2. It mentioned that "These human coronaviruses, such as SARS and MERS, have been found to persist on inanimate surfaces -- including metal, glass or plastic surfaces -- for as long as nine days if that surface had not been disinfected, according to research published earlier this month in The Journal of Hospital Infection."

There are some concerns that the virus might be able to travel via international shipping, China thinks that at least paper money is a problem. See also the post above this one

International shipping from china?

I'm concerned about this because I ordered something from china and it is on the way:

When I receive it, how do I initiate decontamination procedure? Would cleaning the box with alcohol help? How about the inside of the package? I need to clean every millimeter with alcohol or do I have to wait 10 days for the viruses to self destruct (by heat or starvation)?

From the World Health Organization: https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

How long does the virus survive on surfaces?

It is still not known how long the 2019-nCoV virus survives on surfaces, although preliminary information suggests the virus may survive a few hours or more. Simple disinfectants can kill the virus making it no longer possible to infect people

Is it safe to receive a package from China or any other place where the virus has been identified?

Yes, it is safe. People receiving packages are not at risk of contracting the new coronavirus. From experience with other coronaviruses, we know that these types of viruses don’t survive long on objects, such as letters or packages

Not sure if new information will change these guidelines, but this seems to be their current guidance. Nevertheless, because we are in flu season, it's good practice to frequently wash your hands with soap and water or alcohol-based disinfectants, and avoid touching your mouth, nose or eyes with uncleaned hands. See https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

 

[StatGuy2000]

Strawman: Your posts sound like panic.
Attack the strawman: When has panic ever done any good?

The 60-70% infection potential rates are estimates (they were presented as such) but they are guesses by experts in the field.

“I think it is likely we will see a global pandemic. If a pandemic happens, 40% to 70% of people world-wide are likely to be infected in the coming year. What proportion is asymptomatic, I can't give a good number.”Prof. Marc Lipsitch
Prof. of Epidemiology, Harvard School of Public Health
Head, Harvard Ctr. Communicable Disease Dynamics

Ignore it if you choose but don’t tell me I’m in a panic because I pass along the info.

Dr. Lipsitch above is giving his own educated guess/opinion, based on limited data that is available to him. And I don't disagree with him either -- a global pandemic of the new Coronavirus is certainly a distinct possibility (I'm not confident to say that a COVID-19 pandemic will be an inevitability, but a global pandemic of some sort of new virus or bacterium is an inevitability).

Dr. Lipsitch is also expressing his uncertainty about what proportion of the COVID-19 infections are asymptomatic, since that is something that is unknown at the present time even among those in China, the epicenter of the current epidemic. It could indeed be the case that there are many more infections in China than the officially confirmed cases due to asymptomatic infections escaping detection (btw, the more asymptomatic infections there are, the lower the overall fatality rate).

My contention is the tone of your posts on this thread, which is frankly that of panic.

 

[StatGuy2000]

As an update, here is a Scientific American article about how computer models simulate the future spread of COVID-19, and the uncertainty involved in the simulations (noting the uncertainty in differences in the values of R0).

https://www.scientificamerican.com/...imulate-the-future-spread-of-new-coronavirus/

 

[kadiot]

Former FDA Commissioner, Scott Gottlieb similarly answered such question.

Check around 2:40

 

[kadiot]

Is it possible that Covid-19 will stop at some point when enough people have built up an immunity to the virus or bacterium or have a natural immunity to it?

 

[Rive]

Once it is that common it is more likely to have a mutation which can spread anew, like the different flu strains.
So the Covid-19 will actually end, but...
Of course this depends on the stability of the virus.

 

[Ygggdrasil]

Is it possible that Covid-19 will stop at some point when enough people have built up an immunity to the virus or bacterium or have a natural immunity to it?

Once it is that common it is more likely to have a mutation which can spread anew, like the different flu strains.
So the Covid-19 will actually end, but...
Of course this depends on the stability of the virus.

STAT News had a nice piece discussing the possibility of the virus becoming endemic. In it, they discuss the fact that coronaviruses typically have lower mutation rates than influenza, suggesting that those exposed to the virus could have long-lasting immunity, but that immunity could wane over time allowing the virus to persist. Indeed, there are already four endemic coronaviruses that cause colds in the general population, so it's not a stretch to think that COVID-19 could be the fifth endemic coronaviral disease.

The genome of the novel Coronavirus consists of a single strand of RNA. Microbes with that kind of genome mutate “notoriously quickly,” said biologist Michael Farzan of Scripps Research, who in 2005 was part of the team that identified the structure of the “spike protein” by which SARS enters human cells.

But SARS has a molecular proofreading system that reduces its mutation rate, and the new coronavirus’s similarity to SARS at the genomic level suggests it does, too. “That makes the mutation rate much, much lower than for flu or HIV,” Farzan said. That lowers the chance that the virus will evolve in some catastrophic way to, say, become significantly more lethal.

The Coronavirus “may not change [genetically] at all” in a way that alters function, said biologist Andrew Rambaut of the University of Edinburgh, who has been analyzing the genomes of the 2019-nCoV’s from dozens of patients. “It is transmitting quite well already so it may not have to ‘evolve’ to be endemic.”

Any evolution that does take place in an endemic coronavirus, including one that spikes seasonally, might well be toward less virulence. “It doesn’t want to kill you before you transmit it,” Farzan said. “One would therefore expect a slow attenuation” of virulence if the virus becomes like seasonal flu. Dead people don’t transmit viruses, “and even people sitting in their beds and shivering” because they are seriously ill “don’t transmit that well,” he said.

The toll of a seasonal-flu-like Coronavirus also depends on immunity — which is also scientifically uncertain. Exposure to the four endemic coronaviruses produces immunity that lasts longer than that to influenza, Webby said, but not permanent immunity. Like respiratory syncytial virus, which can re-infect adults who had it in childhood, Coronavirus immunity wanes.

https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/

 

[StatGuy2000]

STAT News had a nice piece discussing the possibility of the virus becoming endemic. In it, they discuss the fact that coronaviruses typically have lower mutation rates than influenza, suggesting that those exposed to the virus could have long-lasting immunity, but that immunity could wane over time allowing the virus to persist. Indeed, there are already four endemic coronaviruses that cause colds in the general population, so it's not a stretch to think that COVID-19 could be the fifth endemic coronaviral disease.
https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/

It is certainly a possibility that COVID-19 could end up becoming endemic.

At the same time, it may be worth noting that the severity of COVID-19 (in terms of both morbidity and infectious spread) is due to the fact that the human population is immunologically naive (i.e. lack of immunity) due to the novel nature of the virus.

If the virus becomes endemic, with enough people gaining immunity from the original strain, it is likely that the severity of the illness will decline and the disease will more likely end up resembling the common cold or flu.

 

[Mary Conrads Sanburn]

Global Supply Chain, Affecting 5 Million Companies​

By Wesley Dockery
02/18/20 AT 12:44 PM

A recent study https://www.dnb.com/content/dam/english/economic-and-industry-insight/DNB_Business_Impact_of_the_Coronavirus_US.pdf indicates the ongoing Coronavirus outbreak in China could dramatically impact the global supply chain, affecting 5 million companies worldwide.

The report, titled “The Worldwide Business Impact of the Coronavirus,” looked at the 19 Chinese provinces that have had 100 cases or more of Coronavirus -- officially dubbed Covid-19 -- as of Feb. 5, and analyzed their influence on the global economy. Five of the Chinese provinces in the impacted area -- Guangdong, Jiangsu, Zhejiang, Beijing, and Shandong -- make up 50% of total Chinese employment and 48% of total sales volume in the country.

There are currently 49,000 businesses in the impacted region that are branches or subsidiaries of companies headquartered outside China. Nearly half of these global companies are headquartered in Hong Kong while the U.S. has 19%. Japan accounts for 12%, and 5% of the companies there are headquartered in Germany.

Around 51,000 global companies have “tier 1” suppliers in the impacted region, while at least 5 million companies have “tier 2” suppliers in the area.

[. . .]

###
https://www.ibtimes.com/coronavirus...srupt-global-supply-chain-affecting-5-2924375

 

[chemisttree]

A recent study https://www.dnb.com/content/dam/english/economic-and-industry-insight/DNB_Business_Impact_of_the_Coronavirus_US.pdf indicates the ongoing Coronavirus outbreak in China could dramatically impact the global supply chain, affecting 5 million companies

And Wuhan is a major source for pharmaceutical API compounds. Some pharmaceutical API feedstocks ( starting materials, not finished, active ingredients) are sole sourced from China.

This is an unprecedented interruption of the global supply chain and time will tell where it will lead. I think it will be an eye-opener to most just how dependent we are on China.

 

[mfb]

Is it safe to receive a package from China or any other place where the virus has been identified?

Yes, it is safe. People receiving packages are not at risk of contracting the new coronavirus. From experience with other coronaviruses [...]

I trust tests done with this particular virus more than experience from other coronaviruses.

 

[kadiot]

The number infected by Covid-19 are those actually diagnosed. When 75,176 were diagnosed, how many were undiagnosed at that same time? I mean its possible more are avoidant of being detected and carriers.

 

[StatGuy2000]

And Wuhan is a major source for pharmaceutical API compounds. Some pharmaceutical API feedstocks ( starting materials, not finished, active ingredients) are sole sourced from China.

This is an unprecedented interruption of the global supply chain and time will tell where it will lead. I think it will be an eye-opener to most just how dependent we are on China.

Just as we are dependent on China, China too is dependent on the rest of the world in terms of its economy.

No doubt that the COVID-19 epidemic there will have an economic impact, both within China and the world economy, in the short term (difficult to say about long-term impacts). What the impact will be and how severe it would be is unknown at the present time.

It is also important for other economies (including various businesses) to look into building more resiliency so that the world economy won't be so reliant on anyone country, be it China or the US (or anywhere else in the world). And I fully admit I have no idea how that can be done.

 

[chemisttree]

The number infected by Covid-19 are those actually diagnosed. When 75,176 were diagnosed, how many were undiagnosed at that same time? I mean its possible more are avoidant of being detected and carriers.

We’ll never know. Even in the US we are stuck at 15 cases which seems unlikely. To try and find potentially hidden cases we are testing patients with flu like symptoms that test negative for the flu. Good idea BUT we are only doing the extra COVID-19 screening in LA, NYC, Chicago and Seattle.

Oops! And San Francisco.

 

[kadiot]

At the same time, it may be worth noting that the severity of COVID-19 (in terms of both morbidity and infectious spread) is due to the fact that the human population is immunologically naive (i.e. lack of immunity) due to the novel nature of the virus.

On the other hand, while the Covid-19 is "novel," it is part of a large family of Coronaviruses. This means some people have been previously exposed to one of its family members, and therefore, have developed partial resistance. What do you think?

 

[Ygggdrasil]

On the other hand, while the Covid-19 is "novel," it is part of a large family of Coronaviruses. This means some people have been previously exposed to one of its family members, and therefore, have developed partial resistance. What do you think?

According to the STAT news piece I posted earlier, "The common-cold-causing coronaviruses are different enough that an infection from one won’t produce immunity to another," so it is unlikely that exposure to other coronaviruses could produce immunity to the Covid-19 virus.

The Covid-19 virus is genetically similar to the SARS CoV, but (non-peer reviewed) experimental studies with the spike protein on the outside of the Covid-19 virus suggests that antibodies that target the SARS spike protein do not cross react with the Covid-19 spike protein. This result suggests that prior exposure to the SARS CoV is unlikely to confer immunity to Covid-19.

 

[BWV]

The interesting number here is deaths are about 12% of resolved cases, which is trending downward.

 

[BWV]

Some amazing econ data here, gathered from alt sources as official Chinese data is suspect
https://www.capitaleconomics.com/the-economic-effects-of-the-coronavirus/

This is coal consumption, for example:

 

[OmCheeto]

The interesting number here is deaths are about 12% of resolved cases, which is trending downward.

I find all the numbers interesting.
Probably because I couldn't understand graphs of the actual trends, so I decided to "attempt" to model the disease in a spreadsheet.
O.M.G.
Hopefully there are PhD students working on it, as my numbers are all over the place.

I think it was the "CFR" plot over time that got me started on this.
I decided to use the numbers excluding Hubei, as if you do that, China and the rest of the world numbers seem to match up quite well.

I can understand why the CFR drops initially, but why would it go up after that?
I suspect it is the caused by the lag time between infection and death.

When I graphed the CFR with deaths shifted by varying numbers of days, I found that 9 days yields the most horizontal plot.

So I guess I'll have to up my CFR to 0.8%.

Please note that the above graphs are based on actual numbers, and not my attempt at a simulation.

In my simulation, nearly 10,000 people were infected by the time the first person died. I find that difficult to believe.

----
CFR = Case Fatality Rate = deaths per those infected
which should not be confused with "Mortality rate", which is deaths per total population

 

[mfb]

Somewhere there should be data about the time the dead patients were registered as infections, that would give the true time lag distribution between infection and deaths (for people who died).

One of the German infections is a child, too, by the way. So far all of them are linked to a single company and family members of employees there.

 

[chemisttree]

I find all the numbers interesting.
Probably because I couldn't understand graphs of the actual trends, ...

...Please note that the above graphs are based on actual numbers, and not my attempt at a simulation.

In my simulation, nearly 10,000 people were infected by the time the first person died. I find that difficult to believe.

Tough to model China’s GIGO, eh?

 

[OmCheeto]

Tough to model China’s GIGO, eh?

By GIGO, do you mean "garbage in, garbage out"?
Is so, I'm not sure I understand.
With the exception of Hubei, their numbers became virtually indistinguishable from the rest of the world, about a week ago. And as I mentioned, in my simulation, 10,000 people would have been infected when the first death occurred, which would explain why Hubei's numbers are still quite a bit off from just about everyone. I do find a few locations in China suspicious, as they have a lot of confirmed cases, but still no deaths.
Zhejiang is one in particular I've been curious about.

1175 confirmed​

613 recovered​

0 deaths​

If they don't hurry up and let someone die, everyone is going to recover!

flu and SARS included for CFR comparison only
​

 

[chemisttree]

By GIGO, do you mean "garbage in, garbage out"?
Is so, I'm not sure I understand.
With the exception of Hubei, their numbers became virtually indistinguishable from the rest of the world, about a week ago. And as I mentioned, in my simulation, 10,000 people would have been infected when the first death occurred, which would explain why Hubei's numbers are still quite a bit off from just about everyone. I do find a few locations in China suspicious, as they have a lot of confirmed cases, but still no deaths.
Zhejiang is one in particular I've been curious about.

1175 confirmed​

613 recovered​

0 deaths​

My point only was that you have to exclude a massive set of data (Hubei) to make sense of it. What part of the data are you modeling that gives you the 10K cases before the first fatality? Does it include or exclude Hubei?

I think the R0 is very fluid. When the virus is imported in large numbers by quite mobile carriers into new areas its R0 is likely much lower than in a region where it was allowed to gain a massive foothold and overwhelm any systems of control. Also, I haven’t seen this discussed but perhaps it is possible that the highly mobile portion of the population might have very different demographics than those that chose to stay behind in Wuhan. Perhaps younger and with milder symptoms and so the R0 of the virus in that more mobile cohort is significantly less than for Wuhan.

There is kind of a strange symmetry with the cases outside of China. There are the cases on the “Princess Corona” and there is the rest of the world.

 

[kadiot]

And I have yet to see or hear more Caucasians contracting the COVID-19.

 

[chemisttree]

I think we’ll know more from the cruise ship passenger data if they release it.

 

[kadiot]

Excerpts from the book published in 1981.

Errie prediction or the chinese read the book and made it real?

 

[OmCheeto]

My point only was that you have to exclude a massive set of data (Hubei) to make sense of it.

I don't understand this.

What part of the data are you modeling that gives you the 10K cases before the first fatality? Does it include or exclude Hubei?

I didn't really want to share it, as it's a lot more complicated than I can model.
It's more to give a qualitative feel to someone who isn't an epidemiologist (me!), of what is going on, how this all happened, and why the numbers don't seem to add up, and yet do.

According to the toll of deaths in Hubei, with my notHubei CFR of 0.8%, about 300,000 people there are infected.
I believe mfb said they can test around 5000 people a day. With todays confirmed tally of infections at 62,000, and only 2/3 of the people testing positive, it would take at least 2 months to confirm the number.

I think the R0 is very fluid. When the virus is imported in large numbers by quite mobile carriers into new areas its R0 is likely much lower than in a region where it was allowed to gain a massive foothold and overwhelm any systems of control. Also, I haven’t seen this discussed but perhaps it is possible that the highly mobile portion of the population might have very different demographics than those that chose to stay behind in Wuhan. Perhaps younger and with milder symptoms and so the R0 of the virus in that more mobile cohort is significantly less than for Wuhan.

There is kind of a strange symmetry with the cases outside of China. There are the cases on the “Princess Corona” and there is the rest of the world.

I'd be interested in seeing your model of what is happening.