https://www.cdc.gov/media/releases/2017/p1213-flu-death-esti...
Larger cities can have excellent treatment, smaller cities less so. After a car accident I had pin-hole surgery on a badly broken collar bone (three pieces and several fragments) and only afterwards discovered the lead surgeon was internationally published in leading journals for his work, and the second surgeon would soon be departing for Northern Europe for a 2 year secondment to complete his PhD. Physiotherapy with minimal but sufficient. After-patient care consisted of being invited to dinners with other ex-patients for sharing over dinner, which is very unlike the West.
Certainly I was fortunate and the vast majority of care is not like this, which is why I don't use the word 'primitive' but prefer 'inconsistent'. The doctors described hospitals more like factories: There's a lot of throughput. He chuckled "You get lots of practice, but the focus is on how to do things better."
Edit: When I say 'not patient focused' here's a typical process flow:
1. Go to ER. Have a friend, family member or colleague pay a fee for consultation for a General Practitioner, and specify Chinese Medicine or Western Medicine GP.
2. Wait to see the GP, usually in a queue or ticketing system. There's a nurse on front desk and if it's obvious and urgent you'll be fast-tracked.
3. See the GP. They'll have some idea and request further work, like an X-Ray, Blood Test, CT Scan, etc. That's all in ER. Have the friend, family member or colleague pay a fee for that and wait in a queue/ticketing system or get fast-tracked again.
4. Get the results and return to GP for further prognosis. They'll recommend medicine (go to the front desk, pay a fee, etc, then go to a separate part, typically a separate floor, for that), operation, or other work. At this point you're referred to a specialist department and need to make your own way there, or if urgent have a wheelchair or stretcher and nurse take you there.
5. Turn up at the specialist department. Now this varies. For urgent treatment you'll likely be seen immediately, better, larger hospitals work 24/7. For non-urgent there might be a ticketing system. For something like a bone operation as I had there'll be a junior doctor on front-desk who will make a further assessment. If non-urgent and they're busy, schedule a few days later.
6. A ward consists of several rooms, typical Marie-Curie design with a central lift block and wards coming off from that. Rooms are rarely individual, if fortunate you'll have 2 to a room, sometime 8 or more. Some pre-op, some post-op. Nurses don't do a lot other than administer drips, observe, and escalate to the doctor on-call. For stuff like getting in or out of bed when you can't walk, friends, family or colleagues are there for that. Often you'll see family members on rotation with a small chair or camper bed next to the patient. You can also hire private unskilled unqualified helpers.
How to choose a hospital: Always go with a Medical University. It's a rule-of-thumb the world over and especially true in China. They have the most experienced, best qualified, best paid (outside of a handful of private international hospitals in Shanghai/Beijing/etc) doctors. If there's a #1, #2, #3 etc affiliated hospital, go to the #1, if that's too far, go down the numbering system until distance/urgency tradeoff works best. If you're out in the countryside, the quality of the care isn't likely to be the best.
Sorry, wrote quite a lot there. Thought it would be interesting to share with Hacker News as most readers here probably won't have had experiences with hospitals in China.
In the crisis like Wuhan at the moment I imagine they'd be incredibly overworked.
Comparison to what? Isn't US hostpitals notorious in that regard? Getting flu and either dying or being bankrupt.
This happens regularly in western europe, especially by pediatricians. The charitable interpretation is that the doctor knows the child will get better in a few days anyway, but has to give _something_ to soothe the parents. Giving the substance-free stuff is better than unnecessarily medicating the child, and placebo-effect can also play a positive role.
In China there is some historical reason for it - Mao needed something to placate the peasants while trying to figure out how to provide healthcare to rural areas[0]. Unfortunately the government is still trying to figure that out.
I don't know what the history is in Germany that caused it to be the way it is.
[0] https://respectfulinsolence.com/2019/05/29/mao-triumphant/
Today, lobbying powers of a profitable industry also play into it.
Here in Belgium all the doctors that have seen my kids have no problem saying paracetamol and they'll be fine in a few days.
W-Europe is particularly hostile to medical quackery IMHO.
Kids can get high fevers really fast and you just want to make sure their lungs & heart are ok, they don't have a throat / ear infection etc. A doc can verify that for you in 5 min so I rather be safe than sorry, an "OK" is all I need.
In the USA or China?
Seems few believe the official numbers, people visit numerous hospitals without being able to seen, and even those that get seen have problems getting tested, and people who posts about the situation get the post pulled or pressured to pulled themselves.
Here's an article describing the censorship (pulled posts), arrests for "rumor mongering", difficulty in getting tested, etc:
https://www.reuters.com/article/us-china-health-testing-insi...
This one documents 15% of 41 people getting hospitalized dying:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
And secondly, that more people have died than have recovered doesn't say much other than that it takes longer to recover than to die. If you are going to die, it would appear that it would happen sooner rather than later. Whereas if you aren't going to die, you may take awhile before you've been officially cured.
That isn't to say that is absolutely what is happening here. But both scenarios are fairly likely, and therefore should mediate some of the bleakness of those numbers for the time being.
There are reports of hospitals turning people away unless they a very sick, and also not testing every ill patient because they're overwhelmed.
I've see death certificates posted online with "viral pneumonia" because they aren't able to test everyone - and certainly don't bother testing those who have already died.
The errors are both ways and huge.
The only thing we can conclude is that it's contagious, deadly, and more deadly than the seasonal flu.
But yes it does indicate that the real number is much higher than the confirmed cases. It's really hard to track an outbreak of this magnitude especially when many people are carriers showing mild symptoms. It's actually a good thing if cases are being severely underestimated as it implies a lower death rate (deaths are harder to fudge).
Are you sure about this? AFAIK, the Chinese government does not disclose someone as dead by this virus unless they tested the person positive. That means that if someone dies from respiratory complications on the street or in their home, they will write it off as pneumonia. Right now Wuhan city only has the capacity to screen roughly 6000 samples everyday. Add to this that many sick people are basically just told to go home. Not many cars are driving, city is shutdown so god knows how many are sitting lifeless in their livingroom. I have also seen much evidence that communities are barring the doors of infected households so they can't leave their apartments.
The death count can only be expected considerably higher than reported.
Best wishes for your recovery!
Would that not be a proper reason for a corona virus caused death? Or does it have to be specific if the exact cause is known?
Either way, it makes the data far less useful.
If they don't know, fine. Albeit sloppy, given the context.
If they do know, and don't say, it's deceptive.
> Most patients were men, with a mean age of 55·5 years (SD 13·1; table 1). 50 (51%) patients had chronic diseases, including cardiovascular and cerebrovascular diseases, endocrine system disease [and some others]
The findings conclude:
> In general, the characteristics of patients who died were in line with the early warning model for predicting mortality in viral pneumonia
Also the group was self-selecting of people who went to hospital before Jan 20th.
In summary: old men with pre-existing health conditions are going to have a rough ride. Am yet to see this play out in 2020 Presidential Election odds though.
I doubt that the 50 years old Hospital doctor who died had any serious per-existing health condition. In fact, you could argue hat most doctors have a stronger immune system than average since they are exposed to more germs due to their profession. So this 50y old professional dropping dead is a bad sign! (and hands off to him for his bravery in doing his job).
You could only argue that he cough the strain very early. A virus jumping into a new species is more aggressive at the beginning, later it adopts more to the new host and becomes less aggressive.
If you are referring to the doctor in Wuhan - Liang Wudong - he was 62-years old.
It isn't that bad. It means that this virus won't kill more than 50% of population even if we were to shut down all research right now.
>There is a high level of health seeking behaviour in Taiwan. It is part of the Taiwanese culture to take medicines or to seek medical help frequently, even for minor ailments.
>The average outpatient department visit rate is 14 times per year per person.
Trust me, I know what I'm talking about. I've played plague inc.
It's just that neutrally observing that 50% of a population would die is at least off-putting.
Given your explanation, maybe you were mocking the credulous. Mocking doesn't work well on HN either.
I've looked at comment histories for many shadowbanned users, and I'm just echoing commentary.
The major lethal consequence for this virus in the Coronavirus family is Acute Respiratory Distress Syndrome (ARDS). A strong outcome for this is we knock you out, put a tube down your throat, and have you breath via mechanical ventilator. It's intense to say the least.
Source: Medical student
https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
There may be some slight differences, but even seasonal influenza and a cold frequently present differently.
I’ve heard that “the common cold” is actually a few completely different infections that isn’t worth strictly classifying for the most, and that coronavirus is one of them. If so, this is “a common cold” except maybe death rates are statistically higher.
In reality, though, people who are going to die don't die at the moment of infection confirmation and people who are going to live do lag in the log because it takes time to confirm if someone has recovered and virus-free.
Some will suggest to simply compare the deaths to the confirmed case from a week? ago but this assumes that the patients are admitted at the same stage of their infection and all cases at the time are accounted for(deaths are probably much better tracked than the infection and the publicity has a huge impact on the reporting). It would be a guesstimate at best.
I would say, let's stick to official numbers since the calculation requires each patients timeline. Surely an educated guess can be constructed by modelling the patient prognosis and virus behaviour but that also requires much more data than what the public has.
This is why epidemiologists (ref: https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408... or https://news.ycombinator.com/item?id=22195827 for my comment on the paper) prefer instead this formula which only counts patients for which the eventual outcome is already known:
deaths / (deaths + recoveries)
With this formula, there is no need to guess the "patient timeline". If you do the math right now for the largest case study known to date (published yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... covering 99 patients, 11 dead, 31 recovered) you get:
11 / (11 + 31) = 26% case fatality rate
If you do the math on ALL data from mainland China (170 deads, 124 recovered as of 2020-01-29 http://www.nhc.gov.cn/xcs/yqtb/202001/e71bd2e7a0824ca69f87bb... or in english: https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%932...), you get:
170 / (170 + 124) = 58% case fatality rate
This formula gives a pretty good estimate of the eventual observed CFR according to the paper I referenced above. Of course, there are caveats, for one deaths or recoveries may not be properly tracked: there could be many patients with mild cases that are not even detected/confirmed and end up recovering on their own.
PS: I am not stating the lower bound CFR is 26%! Another method I applied (described in twitter thread https://twitter.com/zorinaq/status/1222427708723879936) suggest it could be as low as 9%.
I'm not an epidemiologist, but I believe I see flaws in your application of the methods from the paper.
[1] At the bottom page 481 it clearly say the virus peaked on March 27th. The first date they use data for the e2 calculation is April 6th. Two full weeks past the peak.
Citation needed. I am not aware of data supporting this (or the reverse.)
How does that produce a meaningful number? If you got 1000s of infected people, and 1 dies... The formula would be 1 / (1 + 0) = 100%. What does that mean?
The way you used it "1 / (1 + 0) = 100%" means just "the knowledge used in the formula is that one patient died, zero recovered." In that case, yes, the fatality rate is "everybody dies." But using the sample of 1 is of course not meaningful for any statistics, not only for that formula.
Any numbers we've seen so far seem very tame to me, compared to the pictures out of Wuhan.
The reporter, Chen Qiushi, describes his observations in Wuhan, a city of more than 10 million.
His preamble:
"My name has been flagged in China."
"If the content contains 'Chenqiushi' or 'CQS', or my face, it will not be sent on Wechat. ... if you [share on wechat], your wechat account will be deleted, like mine.""
He describes visits he made to hospitals in Wuhan and the general state in the city.
It is well worth listening to / reading.
Some points that stuck with me:
People cannot get to hospital because there is a critical lack of transportation.
There is a critical lack of test kits, so residents do not believe they will be diagnosed, so they stay home.
The original (not translated) is here: https://www.youtube.com/watch?v=iXozpbomAns
(thanks Roritharr)
How far does the censoring actually go?
That said you aren't going to be blacklisted for a single comment on HN. That sounds like the kind of thing the US would do.
If you don't want to read subtitles for 26 minutes here's all the subtitles copy-pasted from the video: https://pastebin.com/6hJ4h4rm
(You can hit the "..." above the red subscribe button and select "open transcript", but it shows up in a tiny window).
I suppose the WHO saying they're very impressed with how China is handling the situation is because they felt the pressure to save China's face.
Reading through it made it clear that:
1 - Wuhan's health care system is overwhelmed
2 - There's not enough transportation, test kits, masks, and hospital beds, or volunteers
3 - Many sick people are not even bothering to go to the hospital
4 - There's poor communication and rumors flying around
5 - People are frightened, panicking, and suspecting the worst
This tells me that:
A - there are likely way more people infected than there are confirmed cases, but possibly more deaths too of those who never made it in to hospitals
B - Many wouldn't have died had they had more adequate health care, better transportation and more test kits
So, for the rest of us who are sitting on our hands now, glued to social media or the television waiting to see how this will unfold, our time would be much more productively spent planning for when the outbreak hits our local area.
Volunteer. Get connected with volunteer organizations. Donate. See what you can do to ensure there's adequate transportation, communication and resources when the outbreak hits your area.
One thing I'm really curious about that I haven't heard covered yet is if people who get sick and recover become immune. If so, they should feel safe in volunteering to come in contact with the sick and help them directly after they've recovered themselves.
Cooperation, preparation, organization, and mutual aid are crucial.
Yes the WHO are playing politics when they focus on the good things China is doing and ignore the bad. But personally I think they are closer to the truth than those who present an entirely negative version of events. China's response has been 70% good :)
Not really, they jailed the experts who told them that they needed to act quickly, sat on it for a month, and finally did something about it when it was already out of hand.
If you don't mind me asking, where did you see that info?
I watched the CDC press conference today and saw nothing but fear written on their faces. And that is with far more advanced notice than the Chinese had.
[1] http://www.ddl.ish-lyon.cnrs.fr/fulltext/pellegrino/Pellegri...
I wouldn't even go that far. I've been using this as an excuse to figure out the D3 v5 API using the Johns Hopkins data. Most provinces outside of Hubei are not reporting deaths yet. It's possible nobody's died outside of Hubei, but that seems suspect to me. There is almost certainly strong federal and local pressure to under report deaths, but this sort of thing is much harder to hide in Hubei because it's the epicenter.
I don't believe for a moment that China would've attempted to quarantine 60 million people so quickly if the case fatality rate were only 2%. 2% is bad but SARS saw around 15% in many countries and things weren't locked down this tightly.
More to the point, Hubei is reporting 204 deaths and 5,806 confirmed cases which works out to about 3.5%. This is compared to 76 deaths and 1,423 confirmed three days ago (or 5%). If you'd like to look at death compared to known outcomes you're looking at about 64% of the outcomes being death (204 deaths, 116 recoveries). It's not clear which part of the equation is lagging more in Hubei.
presumably fatality is only one of many factors here. 15% of 100 infections is a different beast than 2% of 1M. And if it takes up to 14 days to see symptoms...
There were roughly 8,000 SARS infections and currently about 10,000 nCoV infections so the comparisons aren't quite as absurd.
Source: https://www.who.int/csr/sars/press2003_04_01/en/ (search for "deaths")
On the flip side, the R0 (rate of transmission) and death rate might be a good clip lower than currently estimated. On the other hand, China walled off a city but part of their motivation might have been the flack they got for moving slowly with SARS.
As she said, we will only know once the thing is over.
Assuming the average time from symptom onset and diagnosis to death is 7 days, we're looking at at 20% death rate (830 confirmed infected 1 week ago). Even a 5 day lag between symptom onset to death is a ~9% death rate (1,975 confirmed infected 5 days ago).
This is exactly how the fatality rate of SARS played out.
Do you have evidence of that in this case?
Viruses vary widely on how many are asymptomatic. My understanding is that having people be infectious and asymptomatic only happens with diseases that are well-adapted to their hosts. Which this one, having recently crossed a species barrier, isn't. (Its fatality rate is also high for the same reason.)
However that is a general understanding and I don't have data to base it on on this case. Do you?
If they in fact can't transmit, then this is OK. If they can or, even worse, have a long latency period and will show symptoms in 2 weeks, that is very, very scary.
Our best tool for diseases like this is contact tracing. And asymptomatic carriers make that very hard.
(Useless trivia, the first documented asymptomatic carrier who was infectious was a short order cook named Mary Mallon. She is better known as Typhoid Mary.)
When she was first identified, she cooked for a number of families. The outbreak that got her put away for life was due to working as a cook at Sloane Hospital for Women.
I cannot immediately find record of her being a short order cook specifically. However that is my recollection from https://www.amazon.com/Betrayal-Trust-Collapse-Global-Public...
- how many infected but not confirmed. They could be asymptotic or mild enough not to seek medical treatment. This would increase the denominator.
- time between infection to first symptom to death. Therefore we don’t know which way the remaining confirmed cases will go. Probably increase the numerator over time but don’t know by how much.
- unclear how accurate the reported numbers are.
We don't know how many people are infected. We only have numbers of confirmed cases and those numbers are heavily skewed because 1) people don't know they are sick 2) stay at home or 3) are not diagnosed properly. Those diagnosed in China are probably severe cases with a multiple not being diagnosed. Also, it is unclear how good the reporting is.
We don't know how many of those who are infected will die and how many will recover. We only know of deaths of confirmed patients in the hospital. Of roughly 10000 confirmed cases 200 are dead, 200 are recovered and 9600 are yet to be determined. From that you could deduce 2% or 50%, less than 2% or more than 50% or anything else. Right now we don't have good data. Also we don't know how long it takes to die or to recover and on most patients we will probably lose track.
Since the infection takes about 2 weeks, we have to wait a few weeks until the smoke starts clearing.
100%
Streets are deserted. The few that go out all wear a mask. Restaurants, museums, cafes, bars have been demanded shut across the country, ostensibly until the end of the weekend but I can see this being extended. The first working day after the Chinese New Year was supposed to be February 3rd, but the city I'm in have extended this to February 9th - offices have been told not to open. Shops are open, there is food, and new fresh vegetables, fruits, meats are being stocked.
Long answer: wait a week or two.
We've fixed the typo in the GP comment.
Disclosure: no I'm not an epidemiologist. But for a reference to a paper by actual epidemiologists see https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408... section Simple Estimators, specifically this formula:
e₂(s)=D(s)/{D(s)+R(s)} which is: deaths / (deaths + recoveries)
The paper concludes: "The second simple estimate based on the ratio of deaths of those for whom the outcome is known, e₂, is reasonable at most points in the epidemic" ie. produces a good estimate of the eventual observed case fatality rate (in fact in their example it slightly underestimates the actual case fatality rate)
I suppose one way to reduce uncertainty is to examine a cohort of patients and follow it meticulously. To do that, we can look at the 99-patient case study published in The Lancet yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... 11 died, 31 were discharged, and 57 remain in the hospital. This suggests a CFR of 11/(11+31) = 26% The assumption epidemiologists make when they use this formula is that the 57 still in the hospital have the same chance of dying as those who already died in the hospital.
This is a very straightforward application of survival analysis, and those still in the hospital are "censored" observations - we know their outcome takes place in the future, but we're not sure when.
There are methods for calculating things like CFR in the presence of censoring, which will change based on what type of model you're using.
Another way of looking at probabilities, out of the 57 patients left in the hospital:
If 0 die (ie. all recover), the CFR is 11% (11 deads, 88 recovered)
If 15 die (26% of 57 still hospitalized), the CFR is 26% (11+15=26 deads, 73 recovered)
If 57 die, the CFR is 69% (11+57=68 deads, 31 recovered)
So the CFR bounds are 11-69% and if the trend on remaining patients continue it should be 26%.
In other places that are better prepared and which have more resources the outcomes will likely be better, in worse prepared places with fewer resources the outcomes will likely be worse.
Let's keep that in mind before we extrapolate from Wuhan to the rest of the world.
Only 7% of hospitalized flu cases died in 2018-2019 (34 157 out of 490,561): https://www.cdc.gov/flu/about/burden/index.html The coronavirus would thus appear to be 4 times more deadly (26%.)
I doubt this. WHile this may be true for a known disease, we have to ask, how much can the hospital do in this cases? It is a little bit like HIV in the beginning. Watch them die?
Interestingly, China is trying HIV medications on the infected.
For more info on ARDS and treatment in the context of the current pandemic, see this informative explanation: https://www.youtube.com/watch?v=okg7uq_HrhQ
still can't believe them.
See: http://www.nhc.gov.cn/jkj/s3578/201904/050427ff32704a5db64f4...
At
https://www.who.int/emergencies/diseases/novel-coronavirus-2...
, you can see the standardized protocols for the hospitals dealing with 2019-nCov, such as the anonymizing CRF (Case Record Form):
https://www.who.int/docs/default-source/coronaviruse/who-nco...
Which describes both the CORE and DAILY forms for an electronic database.
Some selected sentences from the pdf:
===
* The CRF is designed to collect data obtained through examination, interview and review of hospital notes. Data may be collected retrospectively if the patient is enrolled after the admission date.
* DO NOT INPUT ANY PATIENT IDENTIFIERS: THIS INCLUDES NAMES, ADDRESSES, DATE OF BIRTH OR PLACE OF BIRTH.
* Step 1: Contact [email protected] to become a contributor to the nCoV global platform.
* Step 2: You will be contacted by ISARIC, platform manager, for assignment informational pack and instructions on how to use the REDCap nCoV platform.
[...]
* If your site would like to collect data independently, establishment of locally hosted database is possible.
* Standard reports will be provided on regular basis to all contributors. Additional analysis for operational public health purposes will be determined by an independent WHO clinical advisory group.
===
As you can see, the only way to get this anonymized data, is to be a contributor, and to be a contributor, you'd have to be a hospital, or somehow be granted access by WHO.
Remember the live outbreak map by John Hopkins? It also displays the number of people that recovered, the dates and definition of recovery duration are helpful in estimating mortality. Note that the other maps and graphs online only publish contaminations and deaths, which is not useful for calculating mortality. Why does John Hopkins deserve access, and why can I not get access, if I wish to fit a statistical model to the epidemic observations?
https://www.who.int/healthinfo/statistics/en/
Use their API or the web search, however you like.
If you're going to complain about not having up to the minute data available for 2019-nCov, keep in mind that they're not getting the data submitted regularly from China, it's all in daily reports rather than from hospitals.
I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless. It's likely that at this point the Chinese government doesn't even have accurate data.
1) No dataset is perfect, and everything leaves traces, so clever people can and do constantly deduce insights from apparently worthless data.
2) It is in the interest of the Chinese to cooperate with submitting these CRF's to their best ability.
3) The little data the WHO does release to the public seems quite accurate for an outbreak, if you look at the log-linear plots and so on. (I am not saying the "known infections" represent the actual number of infections, just that it looks like accurate reporting of exactly that "known infections", and if one reads the forms you see it was designed to take into account overcapacity effects, like sending a patient back home, forwarding to a different hospital, etc...).
>I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless.
What do you mean with "in there somewhere" ?
1) If you mean the WHO has the database, then of course the WHO has the CRF database, that's what my original message pointed out.
2) If with "in there somewhere" you meant that it's publically available on their website, then no, it isn't it explicitly states it isn't:
" State Parties are invited to contribute Anonymized nCoV Data to the nCoV Data Platform. State Parties should please contact WHO at [email protected] to obtain more information about, including log-in credentials for, the nCoV Platform.
To preserve the security and confidentiality of the Anonymized nCoV Data, State Parties are respectfully requested to take all necessary measures to protect their respective log-in credentials and passwords to the nCoV Data Platform. "
So they are sitting on the data as I originally claimed. On some of the clearly popularity boosted "contra-infodemic" threads, they even openly admit they can't give more detailed information even though they have access, when people ask them what they base their numbers on. [throughout the rest of the threads they typically go to great lengths to give the impression they work on the same aggregate numbers you and I can publically see, as if there is no censorship on the anonymized CRF data]
Also, why would I care about live to the minute data? I am looking for the actual data (noisy or not), and I don't care if it's delayed by a few days.
As I said, I am would like to build a statistical model.
As a lesson, perhaps not for this epidemic, but then the next: if the average chinese person can afford a smartphone, then surely they can afford a couple of UV-C LED's with a battery pack, with the LED's shining through a reflective manifold (think a pipe bent back and forth with U-bends), then breathing airflow together with proper dose (X mJ per square cm) should sterilize microbes, viruses in the air. Then it just needs to be recharged, instead of trying to manufacture 61Mega masks a day. The air sterilizer (to be attached to a face mask) could be reused for new epidemics every 5 or 10 years (in which time they might have bought 3 or 4 cell phones...)
EDIT: I see on change.org that there have been petitions towards the WHO on other issues before, perhaps someone should submit a petition to release the CRF database to the public domain. And it's not a question of hosting bandwidth, since the WHO can publish cryptographic hashes, and put up torrent magnets...
https://www.youtube.com/watch?v=7AI3R41dGnU
Edit: removed remark
* 15,000,000 – 21,000,000 who had the flu
* 8,200 – 20,000 deaths from the flu
The morality rate ranges from 0.03% to 0.09% or 3/10000 9/10000
https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...