If we fail to stop the spread of the virus now, it may become a fact of life with an even higher annual death rate than the flu. We've already got plenty of infectious diseases and based on the data so far, it's worth extreme measures trying to stop it.
Thank you smart people in the WHO and global health community.
We need to stop comparing this to the flu. The flu is an established widespread virus with a very low mortality rate. This is a new, so far still spreading, virus with what appears to be a high mortality rate.
If you had to choose between being infected with the flu or COVID19 you’d chose the flu because you’re about 20 times more likely to die from COVID19 based on the data available at the moment.
If COVID19 has spread globally and becomes established then it will be similar in terms of deaths to the Spanish Flu. Nobody wants that and it is perfectly reasonable for people to be concerned about wanting to prevent that from happening.
If this does spread into a pandemic then you will be able to rightly come back in 24 months and compare the annual total deaths from COVID19 to the seasonal flu. Until then it’s an entirely incorrect comparison.
Can you justify this? I want to be convinced, because at the moment I think it's very optimistic. (There are different estimates for seasonal flu mortality, but it seems to be around 0.1%, so I'm assuming that's roughly the number you mean.)
So it looks like 2% is kind of the upper bound but that the actual rate will be lower.
You have to divide dead over dead+recovered, and outside of China those numbers are still too small to get a reliable number.
In China it is 2% outside Wuhan, but inside Wuhan it is over 4% since the medical system has broken down.
One more pandemic like the flu to contend with is also not a good idea.
The key metric that determines whether COVID-19 can establish and generate a sustained outbreak is it's ability to reproduce, "R", which represents the average number of individuals to which each transmitter transmits the virus.
- If "R" is greater than 1, the transmission may become sustained; - If “R” is less than 1, then the transmission will simply dissipate.
In the current outbreak, it represents an R of 2.2 [1], meaning that on average each patient has been spreading infection to 2.2 other people.
Only a little bit more than half of the infections should be avoided so that R falls below 1. Preventive isolation and the measures established by the protocols should be sufficient.
Besides, there is little evidence to suggest the presymptomatic transmission of COVID-19
[1] https://www.medrxiv.org/content/10.1101/2020.02.10.20021675v...
[1]: https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v...
It seems completely unsurprising to me that we aren't seeing more cases in other countries so far - almost every country with the exception of Singapore are only testing people who have been in Hubei (or China, if symptoms are serious). Meanwhile Singapore, which actually has been testing more people, has been finding more and more locally transmitted cases, despite huge efforts tracking down and isolating contacts of previous cases.
>Serious cases and mortality (2%) will be adjusted downwards safely in the coming weeks, as the detection of mild cases increases.
Or it could adjust upward, as it seems to often take 3+ weeks to kill. In Singapore 8/50 cases are in critical condition in the ICU (And Singapore has detected many mild cases, even asymptomatic ones). For the flu in the U.S. it seems about 0.1% of cases end up in the ICU, so that's some compelling evidence that this is 10-100x as dangerous as the flu. And what happens to the fatality rate when we run out of ICU beds, as already happens during particularly bad flu seasons?
I'm not saying this will be globally devastating, but I think the chance is high enough that I'm disappointed more extreme actions aren't being taken worldwide.
edit: I also assume the case numbers in China outside of Hubei have been looking better recently because they also can no longer rely on the fact that a sick person has recently been to Hubei to know who to test.
No idea whether the conference should be cancelled, but it's not an irrational idea. There could be a large number of silent cases outside of China already.
Can any of them come infected by the COVD-19?
The probability is very low. Almost all of the participants will come from areas where the presence of the COVD-19 is nil or extremely low.
By comparison, a number of passengers equivalent to three times the MWC go through the airports of Atlanta or Los Angeles, two times pass through the airports of London, Paris or Amsterdam each day, and 1.5 times through Madrid and Barcelona each day. And none of them closed so far.
The basic hygiene measures (handwashing, not sneezing or coughing to the open) and common sense are more solid and effective.
If we follow the same line of thinking (we shouldn't), we would have to close all the airports tomorrow.
edit: typo
I don't think this is known or knowable at the moment. Hence the worry.
You are right that airports are probably a greater risk. Perhaps they should be closed. On the other hand, that would be far more disruptive.
As for basic hygiene, yes, we all should. At the same time, we all know that a significant fraction of the population can't or won't do this.
Edit: Here's the proper method: https://www.who.int/gpsc/clean_hands_protection/en/
A significant caveat is that the sink/restroom must allow proper handwashing. Many lack paper towels, for example. If you have to touch the faucet handle or the door after you start washing (which takes two minutes), the method has not been followed. It's harder than it looks.
[1]: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
It only takes one person leaving without washing their hands for the irony to be apparent.
Holding MWC without Huawei, ZTE, BBK, Xiaomi and co. is pretty much meaningless
Infected case growth has slowed down primarily because of the quarantine of Hubei province. The virus has up to a two week incubation period, and today two weeks later we're able to result of this quarantine. Case growth in Hubei has slowed down.
The issue now is that every major city in China has local infection clusters, and these infection clusters are growing exponentially.
https://i.imgur.com/lQcyqAX.jpg
Even if the net case growth rate is decreasing, the situation is less under control than ever before. Look at China's actions; they're past containment methods and now acting on mitigation.
https://en.wikipedia.org/wiki/2019%E2%80%9320_Wuhan_coronavi...
The Wikipedia page says:
"On 6 February, the Chinese National Health Commission started to change how cases were reported – asymptomatic carriers, who tested positive for the virus but did not show clinical symptoms, would no longer be included in the number of confirmed cases. This had the effect of reducing the total number of cases reported, but also meant that potentially contagious individuals were ignored in reports."
Wuhan is nearing the top of its S-curve, while other cities are still near the start. As such it would make sense for the number of cases to slow down even if it isn't actually being stopped.
It is surprising to me that anyone would simply accept them as fact.
Once the big exhibitors pull out you then see attendees doing likewise as meetings they were travelling for get cancelled, and finally smaller exhibitors deciding it’s not worth the effort.
> To put things in perspective, although perhaps inaccurate, the number of cases of COVID-19 infection in China is less than 3 cases / 100,000 inhabitants.
What kind of perspective are we getting by adding the entirety of China to a locked down Wuhan when considering the infection rate? And then to go on to compare that to flu rates in Catalonia. Really, what point is that supposed to make?
> Our Health Alerts and Emergencies system works, works as a team and the protocols established in the EU apply: detect the case, isolate it, treat it and follow all possible contacts. In this way, the transmission chain can likely be properly controlled.
How can this possibly work if carriers are infectious for lord knows how many days before symptoms appear? It's laughable. How does this crack team of contact follow uppers deal with the case of a single infected metropolitan commuter?
Many years ago, I remember my company canceling some sales event because of, I think, Gulf War I because they didn't want to tell European employees in particular to travel to the US often on American carriers.
Literally laughed out loud. Take an upvote!
Not a practical strategy for thousands of conference attendees packed closely together for a short period of time before flying back home. This virus is too infectious and has too long of an incubation period. That's why so many public events are being canceled. This exact scenario is playing out right now aboard the cruise ship docked in Japan.
Los Alamos study today suggests R0 is between 4.7 and 6.6:
https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v...
https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v...
>The novel coronavirus (2019-nCoV) is a recently emerged human pathogen that has spread widely since January 2020. Initially, the basic reproductive number, R0, was estimated to be 2.2 to 2.7. Here we provide a new estimate of this quantity. We collected extensive individual case reports and estimated key epidemiology parameters, including the incubation period. Integrating these estimates and high-resolution real-time human travel and infection data with mathematical models, we estimated that the number of infected individuals during early epidemic double every 2.4 days, and the R0 value is likely to be between 4.7 and 6.6. We further show that quarantine and contact tracing of symptomatic individuals alone may not be effective and early, strong control measures are needed to stop transmission of the virus.
An upper end of 6.6 changes everything.
As for comparisons to the Flu, I see this so often and it always misses the point: it's not one or the other, so why would the medical establishment not fight in the extreme to stop many thousands of deaths that would result if another flu-like disease came along? Second, there is an entire industrial complex complete with seasonal ramp up in staffing to deal with Flu season, and we still see non-negligible fatality rates. Without that support network, which again we don't have for COVID-19, how much worse would things be with the flu? So we should all stop using the flu as some type of benchmark for what a reasonable COVID-19 response looks like.
There are factors that could move that number in both directions.
Yes, presumably there are many mild cases that haven't been counted. But unfortunately coronavirus deaths are probably also undercounted -- for example, https://www.washingtonpost.com/world/as-families-tell-of-pne...
This point I'm not sure about, because it seems bizarre that everyone would make such an obvious mistake, but: as far as I can tell, the death rate is simply calculated as [current total of recorded deaths] / [current total of recorded cases]. But when the fatal cases take quite a long time to kill (from what I've read, it tends to take a week or so from the onset of symptoms for them to become severe, and up to another two weeks for death to occur -- see https://www.straitstimes.com/asia/east-asia/reporters-notebo...) and the total number of cases is rising dramatically, surely that skews the figure toward a significant underestimate?
In the cases of NCV, there is already significant evidence of under reporting of fatalities by Chinese authorities in Wuhan (some sources suggest that up to 90% of NCV deaths in China may be unreported).
And as the cruise ship stuck outside of Japan demonstrates, the virus may be far more virulent (i.e., contagious) than previously thought.
China just changed how it classifies NCV cases to reduce the number of cases by eliminating those who are infected but not symptomatic meaning the numbers are even less reliable than they were before.
The problem with this is that a number of the superspreaders, like the British fellow that infected 11 other people, and the passenger that infected the cruise ship quarantined in Japan, were not symptomatic when they were infecting others.
Those might still use it in conversation amongst each other, sure, but any actual analysis will be based on far more data than a single number. Fundamentally this is the press trying to boil things down to a double soundbite. As usual.
The case fatality ratio is literally defined as deaths over cases, and that's not useless, but it isn't something you should spend much time thinking about either. Reality is always more complex than any single number. Probably you want to know something like "What are the odds of dying if I'm infected" -- that's a different parameter entirely.
2% is almost certainly an underestimate, in this case. I read an article the other day which did statistical analysis on various groups of cases; it came up with a CFR of 18% for Wuhan (95%, 11% to 80-something), and while the expectation for cases in Singapore is still a little over 2%, that's because the medical system in Singapore isn't overwhelmed.
Reporting that would be an equally bad idea, though. The case fatality ratio only counts infections that are severe enough for the patient to go to hospital and become a case, and we know a large fraction of infections don't. Probably over 90%. Which would push that back down to 2%.
Not that a death rate of 2% of all infected is anything short of apocalyptic, but that's why they're trying so hard to quarantine it.
Another perspective is that there were only 41 reported cases in China six weeks ago, and now there are 60,000. So while there are only 500 cases outside China so far, we might want to wait six more weeks before declaring victory.
China desperately wants to save face, at the cost of lives. They rejected help from the U.S. CDC as to not appear weak. They already thought they had it under control, before locking down over 50 million people and damaging their economy.
People at risk for the flu can get a flu shot. This disease kills the healthy and average aged. And we all have family members at increased risk.
Even a 2% mortality rate is absolutely horrific. Would you play Russian roulette with those chances? If 60% percent of the world gets infected we are talking many many millions of dead.
How are you going to track contacts, when someone working in a brothel gets it, or someone preparing food in a McDonald's? What if someone takes the virus back to India or Africa?
With 20% needing intensive care, even modern European countries will suffer badly. There simply are not enough beds available, even in the bigger cities.
Mortality is a red herring when you do not count the people still hospitalized after months! Look at the tiny amount of recovered people.
Despite their titanic and gruesome methods to contain it, China has failed. Imagine such an effort in Europe, where people gladly will walk away from quarantine and can not be cowered into compliance or snitching on their coughing neighbors.
We simply do not know enough about morbesity and mortality to say we overreact. Better safe than sorry when uncertainty abound.
From your own source:
"The statistical methods used by the Chinese CDC should be revised, as deaths from pneumonia caused by the flu, for example, are not counted, the observer said."
If you ignore death by pneumonia, the deaths for coronavirus are very low too.
"An analysis led by Chinese scientists published in The Lancet Public Health in September 2019 found that there were 84,200 to 92,000 flu-related deaths in China each year, accounting for 8.2 percent of all deaths from respiratory diseases."
Oops.
That's literally the point. If the U.S. has 330M people and 30k flu deaths per year, then all else being equal one would expect that what China reports as 144 deaths is really 120,000. Which means that if Corona virus has already killed 7.8 times as many people who have died of the flu (per China's reporting), one would expect that it's really killed 936,000.
Obviously that's very simplistic, but that's basically why people are worried -- no one knows what the real numbers out of China are, so that kind of back-of-the-napkin math is about the best we can do right now.
The same companies that rejected to go to Barcelona are attenting ISE in Amsterdam. That makes me thing they junt needed a reason to pull out of Barcelona.
https://www.independent.co.uk/news/uk/home-news/coronavirus-...
What is the death rate for the 360 person flu group?
[1]: https://www.npr.org/sections/goatsandsoda/2020/02/07/8036804...
Suicide kills 47000 a year which makes you wonder why we aren't spending more effort on mental health given it's a bigger cause of death.
A spike of emulation suicides after a widely publicized suicide is known as the Werther effect.
https://en.wikipedia.org/wiki/Copycat_suicide
Unbelievably you are correct. You can "catch it". Amazing.
https://www.nationalelfservice.net/mental-health/suicide/sui...
It was an article regarding the latter which made the general case (and I'll see if I can't turn it up). Effectively: if you have a phenomenon which includes transmission from carrier to susceptible populations, then you're dealing with a case of epidemic.
This generalises in some interesting (and quite probably controversial) ways. Richard Dawkins's notion of the meme -- a unit of transmissible cultural information -- falls squarely within the model, and suggests a further generalisation:
Epidemics exist where there is an infectious agent (biological, material, energetic, informational) originating from some source or reservoir which causes a negative functional or behavioural change in a susceptible population spreading along vectors of transmission. They further have characteristics of exposure-response, latency, transmissivity (e.g., source => individual, sometimes individual => individual), susceptibility or resistance, symptomatic / asymptomatic periods, morbidity and mortality rates, etc.
This means we can look at agents including the familiar bacteria, aemoebae, parasites, and viruses, but also more exotic notions: prions, chemical, physical, and radiological triggers (say, heavy metals, asbestos / PM2.5 matter, radon or plutonium), and cultural or informational ones: cults, religions, mythologies, ideologies, psychological disorders, stress, and the like.
What the model offers are notions of potential containment. I've done some research to see if there's an underlying theory or model of public health or epidemiology (and would expect it to closely correspond to the above). What I've found looking through introductory texts is that there largely is not, but instead the focus is on teaching statistical monitoring methods used within the field. I'm not sure if I'm looking in the wrong places, or if there simply is no such generalised model.
But again: if you can identify specific agents (biological, material, informational, energetic), sources, vectors, susceptibility factors, and the like, then it's possible to apply fairly standard epidemiological notions to prevention.
Note that the direct medical intervention of cure is not on that list -- it's an expensive and uncertain intervention, and one that comes with very high costs. Far better to practice avoidance, increase resistance, and reduce transmission, as well as monitor aggressively for outbreaks. All of which are what we're seeing in the case of 2019-nCoV.
In the case of mental health, the study of suicide itself is foundational to sociology (Emil Durkheim's book of the same title, Suicide: https://archive.org/details/DurkheimEmileSuicideAStudyInSoci...), for numerous reasons. It turns out that rates are very consistent across time, with a few notable exceptions. There's considerable variance across place, whether triggered by culture or natural environment isn't clear. As David Simon, author of The Wire notes, dead bodies are hard to hide (see his excellent "The Audacity of Despair", ignore the recording and speaking quality issues: https://www.invidio.us/watch?v=nRt46W3k-qw). And suicide itself is an extreme act. So by looking at trends with time, you're finding a exceptionally strong signal of underlying social dysfunctions.
Looking at the epidemiological model, isolating yourself might reduce some dynamics of infection (vectors of transmission), but would quite likely increase others (susceptibility through social isolation). The model's underlying premise is that you simply cannot assess these factors in isolation, which would point out the flaw in your reasoning.
We don't need a perpetual cycle of coronavirus in addition to the perpetual cycle of the flu that we already have, in addition to suicide and every other cause of death. The world's health organizations are trying desperately to curtail it before it becomes a norm.
Which is why saying "Oh, why cancel this it's no biggie" is just so misled.
If the world was in a situation where we could seriously contain and eliminate the flu, we would surely take every possible measure to do so.
This is a contagion. Read about the Spanish Flu. This looks to be both more contagious, and more deadly in most of the published studies. We hope they are biased and overly pessimistic, but whataboutism isn't helpful here.
Your argument is like if the rug in your living room is on fire, and you say "why worry about that rug--we should really invest in fixing that roof leak." I agree roof leaks are also bad.
https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...
Given r0, the Covid-2019 would infect 60,000,000 and kill 1,000,000 if unchecked in the US.
Edit: The point is, it's all about money. There's no rational reason to spend so much on terrorism and so little on mental health, yet we do.
China, and specifically Hubei Province and its capital Wuhan, suffer an epidemic that they are trying to control with titanic efforts. 99% of cases of coronavirus (COVID-19) infection, today more than 40,000 with a thousand deaths, have been registered in China. Of them, almost 70% in Hubei. Only 1% of cases have been registered outside China, in 24 countries (including Spain), with transmission chains (secondary cases from a first imported case) very short so far.
To put things in perspective, although perhaps inaccurate, the number of cases of COVID-19 infection in China is less than 3 cases / 100,000 inhabitants.
The flu, in Catalonia, this week has reached figures of 360 cases / 100,000 inhabitants: more than 120 times higher than the incidence of COVID-19 infection in China.[1]
Our Health Alerts and Emergencies system works, works as a team and the protocols established in the EU apply: detect the case, isolate it, treat it and follow all possible contacts. In this way, the transmission chain can likely be properly controlled.
There are many things we do not know for sure about this disease, but most cases (80%) are mild. Serious cases and mortality (2%) will be adjusted downwards safely in the coming weeks, as the detection of mild cases increases. There is WHO data that indicate that control measures are slowing the epidemic in Hubei and better controlling the situation in the rest of China.
[1]: http://canalsalut.gencat.cat/web/.content/_Professionals/Vig...