Live Blogging 2019-nCoV (Wuhan coronavirus)

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I’m not really going to live blog this virus, but I wanted to get a few thoughts down, and expect to be interrupted by a scheduled event in a few minutes. So, I’ll come back with more later. Perhaps this post will become a regularly updated/edited thing, we’ll see.

Call it 2019-nCoV (pronounced “Encovee”? — rhymes with anchovy –) because if you call it “coronavirus” you will have to spend time in the obligitory sidetrack: “Don’t panic about this virus, there are many kinds of coronaviruses, most of them are harmless, the common cold is a coronavirus.” That is much like saying “don’t panic about this serial killer that just started operating in your neighborhood, they are just humans, and most humans are totally harmless.”

Speaking of coronaviruses, yes, they are common, and this is likely to cause some, maybe much, variation in immunological response to Encovee, since there could be some cross effects of immunity from previous forms of the virus.

It is being noted by many that the flu is a much more common and deadly disease. Let’s talk about that for a second. Yes, it is, but most influenza viruses are moving across an experienced landscape of hosts that have a combination of prior immunity and vaccination. Encovee is treading on immunologically virgin ground. This likely means it will spread fast, almost with impunity. After that, maybe it will become just another one of the coronaviruses.

We really have no idea whatsoever what the rate of illness or mortality is. We can talk about this later, but this is a very complex and generally poorly understood thing. What we do know is that most people who get Encovee don’t die from it. We have no idea how many people are infected but show no symptoms, or the ratio of people who get a little sick vs. very sick, or, really, the ratio of those who get it and die. Graphs of the rate of its spread show an alarming verticality, but with mortality being a low almost flat line, at a very low percentage.

As of last night, here is what WHO was saying:

Their most recent situation report (of Jan 25) shows 1,320 confirmed cases, with most from China, HOng Kong, Macau, and Taipei. There were 23 confirmed cases outside of that area, 21 of which had history travelling to Wuhan, the Chinese epicenter. The others appear to be human to human contact within a family or similar.

Of a subset of 1287 cawses, 237 are counted as severe. There had been 41 deaths.

Note that all the scary numbers and charts you’ve seen, if you’ve seen them, are projections based on various models.

Projecting a disease outbreak at the beginning is like taking a bead on a certain direction and walking that way, and seeing where you get, but with this caveat: At the start of your journey, your compass sucks, and you don’t know how badly it works. Slowly over time, it improves, and it is hard at first to tell how much it improves. Eventually it starts to become a pretty good, but still limited, tool. Put another way, we can model the course (spread, magnitude) of a disease outbreak very very accurately — after it has happened.

Have you read the breakthrough novel of the year? When you are done with that, try:

In Search of Sungudogo by Greg Laden, now in Kindle or Paperback
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13 thoughts on “Live Blogging 2019-nCoV (Wuhan coronavirus)

  1. No doubt a lot of the ‘scare’ is being caused by the attention Chinese authorities are giving to this: lots of footage of people in protective gear, stuff shut down, etc. It does seem to be spreading quickly.

    Two things: A friend’s neighbor has been in Beijing for work. He tried to leave at the end of the week and was told he couldn’t until he’d been checked for exposure, and he couldn’t be checked immediately because of the queue of people ahead of him. Guess I’m a little surprised they can hold people like that, but international travel isn’t my thing.

    Second: I’m glad to see China is reacting more aggresively to this than they did with SARS, but I don’t know whether they’re doing so because they simply learned a lesson, because their health agency is more concerned than it’s letting on, or a combination of the two.

  2. The Chinese mass quarantines, while impressive displays of authoritarian efficiency, are horrible from a public-health and epidemiological perspective: A. The horse is out of the barn – well, make that a whole herd of horses. B. Quarantining sick individuals (preferably with adequate food, water, and medical care!) is effective – but which countries/cities/etc. have the means to do that? Ours certainly does not. (Laboratory scientists and medical authorities have upped their game since Ebola; the government and the public, well, uh …). C. We can already see the massive mess this is creating. Deaths from known 2019-nCoV infections are being reported, more or less in real time – but just as with Hurricane Katrina (how many isolated old folks died not from drowning but from lack of access to pharmacies, etc.), collateral mortality is not.

    Civil liberties are not what I’m addressing here (though I am obviously concerned – look what happened when our own political idiocracy squawked about quarantining AIDS sufferers, etc.).

    “The most advanced reporting says every province has cases and at least 10-fold now reported infected is more likely than stated estimates. Tens of thousands shortly. Millions possible.”

    Friends on the ground in China – provinces with many more cases than officially reported – tell me that everyone is wearing masks, that gyms have been shut down, etc.

    “Dr. William Schaffner, a specialist in infectious diseases at Vanderbilt University Medical Center, said the illness should be viewed in perspective. While a new virus spreading internationally gets more attention, the much more common influenza virus is the bigger hazard for most people, he said.

    If I look at this winter respiratory season, influenza is going to cause many more illnesses and more deaths than this coronavirus,” he said. “It’s one of those circumstances where, if familiarity doesn’t breed contempt, it certainly breeds a certain nonchalance.” – New York Times

    1. Also this, from today’s NYT:

      Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, thought China’s approach to the crisis could easily “backfire,” comparing it to the so-called cordons sanitaires that were imposed to seal off swaths of West Africa during the 2014-2016 Ebola epidemic. Those cordons left people starving and spurred violent uprisings. Others routinely found ways to sneak around or through the boundaries. “It was a disaster,” Dr. Osterholm said.”
      https://www.nytimes.com/2020/01/26/world/asia/coronavirus-wuhan-china-hubei.html
      ________
      Stock up on your N-95 masks, folks – before there’s a run on them (as there might well be.)

  3. And should you choose, on a personal level, to preemptively adopt a survivalist mentality, then as I remarked above, buy yourself a decent N-95 mask. The square-shaped paper or cloth surgical masks you see everyone wearing aren’t completely useless (they do seem to help, psychologically) – but they’re also nowhere as near as effective as what medical professionals like EMS personnel use:

    https://www.amazon.com/Disposable-Particulate-Respirator-Surgical-Package/dp/B07GTJ5FLX/ref=sr_1_23_sspa?keywords=moldex+n95+mask&qid=1580006598&sr=8-23-spons&psc=1&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUEzU1hFOEtMNlFJVEJUJmVuY3J5cHRlZElkPUEwOTA4ODU0MVBZNE9EVE9MTVJYMSZlbmNyeXB0ZWRBZElkPUEwNDU2NzM1MlM4OVlCRzMwNTc5WCZ3aWRnZXROYW1lPXNwX210ZiZhY3Rpb249Y2xpY2tSZWRpcmVjdCZkb05vdExvZ0NsaWNrPXRydWU=

    You ought to be able to find various brands of N-95 particulate masks [you don’t need fancy respirators!] quite easily – you only need one or two of them – at a fairly inexpensive price,* the next time you visit your local pharmacy – but only if you buy now!!! Before there’s a run on them.

    * There’s no need to purchase them in bulk. Unless, that is, any hard-core capitalists among you should wish to make a killing (no pun intended) when the time comes – in which case you could purchase them at Amazon for $5 per mask (or lower-quality ones at a reduced cost elsewhere) and then sell them for three to ten times as much when everyone in your neighborhood is running around in a panic when all masks are sold out. Which will happen, inevitably, when they are really needed.

    Here’s what EMTs do: We don an N-95 particulate mask (the Amazon link shows you the exact one I use) when caring for any patient with a potentially contagious respiratory ailment. Better yet, we also slap a cheaper mask on the patient. (That’s really the very best approach. This way, we don’t need to also wear eye protection, in case the patient projects high-speed aerosolized gunk at our face.) And you might choose to do the same, i.e., slap a surgical mask of some sort on every close-by stranger who is coughing. Good luck with that one.

  4. Two very informative short articles in yesterday’s (Jan.. 28, 2020) The Atlantic:

    1. “The Deceptively Simple Number Sparking Coronavirus Fears – Here’s what the oft-cited R0 number tells us about the new outbreak—and what it doesn’t” – Ed Yong

    https://www.theatlantic.com/science/archive/2020/01/how-fast-and-far-will-new-coronavirus-spread/605632/

    And, building on this topic:

    2. “How to Misinform Yourself About the Coronavirus” – Alexis C. Madrigal

    https://www.theatlantic.com/technology/archive/2020/01/china-coronavirus-twitter/605644/

    1. Joseph:

      Thank you for posting those links. I read both and found them very interesting and informative.

      Thanks again!

  5. This article provides an excellent, current overview and perspective:

    “CAN THIS VIRUS BE CONTAINED? PROBABLY NOT.”
    By John M. Barry

    The Washington Post February 1, 2020 [published online 1/31/2020]

    https://www.washingtonpost.com/opinions/2020/01/31/can-this-virus-be-contained-probably-not/

    “Of the many questions about the Wuhan coronavirus, the most important one is this: Can it be eradicated from the human population, like the coronavirus which caused SARS, or at least contained, like the coronavirus which causes MERS? Here are what the facts seem to be:

    “Analysis puts the “reproductive number” of this virus at 2.2 or higher, meaning each infected person infects at least two other people. This is an explosive number. By comparison, the median value of studies of seasonal and pandemic influenza viruses put the reproductive number of ordinary influenza, which can sicken 10 to 20 percent of the population any given winter, at 1.28, with the 1918 pandemic virus at 1.8 — which was enough to kill between 50 million and 100 million people in a world population that is about a quarter of today?s population.

    “To contain the Wuhan virus, its reproductive number must be brought below 1. Is this possible? The answer depends on whether this virus transmits more like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), or more like influenza.

    “The virus which caused the SARS outbreak also had a high reproductive number. But SARS required close contact for transmission, the incubation period seemed to have been longer than the Wuhan virus, and, most important, people with SARS were most infectious when they were already too ill to mix with the public. (That?s why in Hong Kong, Singapore, and Taiwan, upwards of 90 percent of transmission occurred in hospitals.) Those factors allowed medical interventions — rapid case detection, isolation, contact tracing and stringent infection control in hospitals — to eradicate the disease in humans.

    “MERS has a high reproductive number and a case mortality rate of roughly 40 percent, but it has not spread widely in the general population because it does not transmit easily and, like SARS, cases are frequently clustered in hospitals. It can be controlled, if not eliminated, by the same methods that worked against SARS.

    “By contrast, none of those control measures can contain influenza. In influenza, aerosol transmission is most important, though the virus can survive on a hard surface for hours and so also be transmitted by touch. Also, the incubation period can be as short as one day and the disease can be transmitted by people before they have any symptoms at all, making contact tracing and even quarantine ineffective.

    “Perhaps the most relevant data comes from U.S. Army camps during World War I; in some camps, soldiers were inspected twice a day and immediately isolated if they showed any flu symptoms, and if a unit had more than one symptomatic soldier, the entire unit was quarantined. In camps where measures were rigidly enforced, disease transmission was slowed, but quarantine had no impact on rates of infection or death; where the measures were less than rigidly enforced, they had no impact whatsoever. If quarantine could not work in the military during wartime, one can hardly imagine it working in a civilian community during peacetime.

    “What will work for the Wuhan virus? Reports, so far, suggest that close contact is not necessary for transmission and, while the information is not definitive, health authorities in China have said that asymptomatic individuals can infect others — making it much more like influenza than either SARS or MERS.

    “All that makes containment look impossible, but there is encouraging news. The spatter of cases outside China has not led to any spread in general populations. At this writing, there are 142 people infected in 22 locations outside mainland China — almost all of whom had traveled to the mainland. The fact that only one U.S. case has yet surfaced among someone who did not come from China seems inconsistent with what?s happening there. If this disease were that easy to transmit there should have been many more cases by now.

    “Can it be contained? Again, if the disease transmits like influenza, it appears that containment is all but impossible. Eventually, and more likely sooner rather than later, it will spread in countries around the world.

    “The three most important remaining questions involve morbidity (what percentage of a population will get sick), virulence and how well humans develop an immune response. Since no solid numbers exist as to how many people have become infected — we only know how many have sought treatment and tested positive — we have no idea of the morbidity, and the current estimate of 2 percent case mortality is not reliable. Two percent is a frightening number if the disease spreads widely; that was the approximate case mortality for the 1918 influenza pandemic. We do, however, know that 11 percent to 15 percent of those hospitalized die — suggesting a lethality roughly double seasonal influenza, which kills anywhere from 3,000 to 61,000 Americans each year.

    “Longer term, if this virus does become endemic, will a vaccine protect people against infection? Some vaccines, such as against measles, provide almost 100 percent protection. But the effectiveness of influenza vaccines varies year to year, and have ranged from 10 percent to 62 percent effective. That, in the long run, may be the most important unknown.

  6. Yes, research to create a vaccine is underway in many labs,* in China and around the world. There are compelling medical/scientific/public health incentives for this, as few epidemiologists think 2019-nCoV [some call it “WuCo” ** – easier to say and write, until such time that the virus has an official name] will be contained. More likely, it will progress from epidemic to pandemic to endemic – which is to say, separate self-contained outbreaks will become normal around the world. WuCo would then be the fifth COMMON human coronavirus ( see https://www.cdc.gov/coronavirus/types.html ). If that happens, then – unlike with SARS, which burned out rapidly – there will also be huge market incentives to crank out a vaccine, given – well, given the huge market for it!

    * One such venture to create a vaccine is reported here:

    https://www.kbtx.com/content/news/iBio-partnered-to-develop-and-test-possible-coronavirus-vaccine–567561351.html

    Although one hears reports of a possible WuCo vaccine becoming available within a few months, it will probably take closer to a year before an effective vaccine is available.

    Besides the large trustworthy news organizations – with excellent science reporters – it’s always good to check the CDC and WHO for official updates. Otherwise, the go-to journalist with expertise on this topic is Ed Yong https://www.theatlantic.com/science/archive/2020/02/coronavirus-very-2020-epidemic/605941/ who has been covering evolutionary microbiology for years , e.g.,

    https://www.harpercollins.com/9780062368591/i-contain-multitudes/ (2016)

    For the best specific primer on virus epidemics, I highly recommend Nathan Wolfe’s even earlier book https://us.macmillan.com/books/9781250012210 (2012)

    Yong and Wolfe’s books are available in all formats (Kindle and audiobook as well as hard copy); obviously, both pre-date WuCo.

    And even further back (1994), “Evolution of Infectious Disease,” by Paul Ewald https://global.oup.com/academic/product/evolution-of-infectious-disease-9780195111392?q=paul%20ewald&lang=en&cc=us# had a huge intellectual impact on me as a grad student in biological anthropology. Whereas some of the science is outdated, and it does not deal with WuCo or other very recent epidemics, the conceptual foundation this book provides (and the way it is presented) makes it, still, a wonderful read. I mean, it is THE classic in the field. (But what do I know? I studied brain evolution.)

    ** And about that pesky naming issue:

    https://www.theatlantic.com/science/archive/2020/01/the-virus-that-still-has-no-name/605893/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200131&silverid-ref=MzU1NDUzMzAwMjUzS0

  7. Yes, research to create a vaccine is underway in many labs,* in China and other countries. There are obviously medical/scientific/public health incentives for doing this, as few epidemiologists think 2019-nCoV [some are calling it “WuCo” – easier to say and write, until such time that the virus has an official name **] will be contained.

    More likely, this zoonotic coronavirus will progress from epidemic to pandemic to endemic – which is to say, separate periodic self-contained outbreaks will become normal around the world – like the flu. WuCo would then be the fifth COMMON human coronavirus ( see https://www.cdc.gov/coronavirus/types.html ). If and when that happens, then – unlike with SARS, which burned out rapidly – there will also be huge market incentives to crank out a vaccine, given – well, given the huge market for it!

    * One such venture to create a vaccine is reported here:
    https://www.kbtx.com/content/news/iBio-partnered-to-develop-and-test-possible-coronavirus-vaccine–567561351.html

    Although we read and hear news reports of a possible WuCo vaccine within a few months, it will probably take closer to a year before an effective vaccine is available.

    Besides the trustworthy large news organizations – which all have excellent science reporters – it’s always good to check the CDC and WHO for “official” updates. As far as I’m concerned, the go-to science journalist with expertise on this topic is Ed Yong
    https://www.theatlantic.com/science/archive/2020/02/coronavirus-very-2020-epidemic/605941/    who has been covering evolutionary microbiology for years , e.g., hhttps://www.harpercollins.com/9780062368591/i-contain-multitudes/  (2016)

    For the best primer on virus epidemics, I highly recommend evolutionary virologist Nathan Wolfe’s even earlier book  https://us.macmillan.com/books/9781250012210 (2012)

    Yong and Wolfe’s books are available in all formats (Kindle and audiobook as well as hard copy); obviously, both pre-date WuCo.

    Going much further back (1994) is “Evolution of Infectious Disease,” by Paul Ewald  https://global.oup.com/academic/product/evolution-of-infectious-disease-9780195111392?q=paul%20ewald&lang=en&cc=us#  had a huge intellectual impact on me as a grad student in biological anthropology. Whereas some of the science is outdated, and it does not deal with WuCo or other very recent epidemics, the conceptual foundation this book provides (and the way it is presented) makes it, still, a wonderful read. I mean, it is THE classic in the field. (But what do I know? I studied brain evolution.)

    *** And about that pesky naming issue:
    https://www.theatlantic.com/science/archive/2020/01/the-virus-that-still-has-no-name/605893/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200131&silverid-ref=MzU1NDUzMzAwMjUzS0

  8. Yes, research to create a vaccine is underway in many labs,* in China and around the world. There are compelling medical/scientific/public health incentives for this, as few epidemiologists think 2019-nCoV [some call it “WuCo” ** – easier to say and write, until such time that the virus has an official name] will be contained. More likely, it will progress from epidemic to pandemic to endemic – which is to say, separate self-contained outbreaks will become normal around the world. WuCo would then be the fifth COMMON human coronavirus ( see https://www.cdc.gov/coronavirus/types.html ). If that happens, then – unlike with SARS, which burned out rapidly – there will also be huge market incentives to crank out a vaccine, given – well, given the huge market for it!

    * One such venture to create a vaccine is reported here:
    https://www.kbtx.com/content/news/iBio-partnered-to-develop-and-test-possible-coronavirus-vaccine–567561351.html

    Although one hears reports of a possible WuCo vaccine becoming available within a few months, it will probably take closer to a year before an effective vaccine is available.

    Besides the large trustworthy news organizations – with excellent science reporters – it’s always good to check the CDC and WHO for official updates. Otherwise, the go-to journalist with expertise on this topic is Ed Yong https://www.theatlantic.com/science/archive/2020/02/coronavirus-very-2020-epidemic/605941/   who has been covering evolutionary microbiology for years , e.g.,
    https://www.harpercollins.com/9780062368591/i-contain-multitudes/  (2016)

    For the best specific primer on virus epidemics, I highly recommend Nathan Wolfe’s even earlier book  https://us.macmillan.com/books/9781250012210 (2012)

    Yong and Wolfe’s books are available in all formats (Kindle and audiobook as well as hard copy); obviously, both pre-date WuCo.

    And even further back (1994), “Evolution of Infectious Disease,” by Paul Ewald  https://global.oup.com/academic/product/evolution-of-infectious-disease-9780195111392?q=paul%20ewald&lang=en&cc=us#  had a huge intellectual impact on me as a grad student in biological anthropology. Whereas some of the science is outdated, and it does not deal with WuCo or other very recent epidemics, the conceptual foundation this book provides (and the way it is presented) makes it, still, a wonderful read. I mean, it is THE classic in the field. (But what do I know? I studied brain evolution.)

    ** And about that pesky naming issue:
    https://www.theatlantic.com/science/archive/2020/01/the-virus-that-still-has-no-name/605893/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200131&silverid-ref=MzU1NDUzMzAwMjUzS0

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