74 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.

   Reply

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

   Reply

   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.

   Reply

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/

   Reply

   1. Joseph:

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

      Thanks again!

5. Rick:

   You’re very welcome!

   This “fresh new hell” [apologies to Dorothy Parker] is, hmm, interesting:

   https://www.nejm.org/doi/full/10.1056/NEJMc2001468

   Reply

6. 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.

   Reply

7. 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

   Reply

8. Any attempts to create a vaccine?

   Reply

   1. Yes, Jim

      – See my initial [Feb 2] answer, above.

      joe

9. 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

   Reply

10. 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

    Reply

11. “LIVE BLOGGING 2019-nCoV (WUHAN CORONAVIRUS)” [continued]
    Covid-19 Update as of March 1, 2020
    ______________ So what’s new? ______________

    • How deadly is the coronavirus?
    https://www.bbc.com/news/health-51674743

    • Can anyone make any sense of what’s been happening in terms
    of recent U.S. responses to the coronavirus “crisis”? Events these
    past three days have not been encouraging. To wit:

    (1) AT PRESIDENT TRUMP’S WEDNESDAY, FEB. 26, PRESS CONFERENCE – VICE PRESIDENT MIKE PENCE WAS APPOINTED TO OVERSEE THE CORONAVIRUS-19 (COVID19) RESPONSE.

    As the following day’s Wall Street Journal summed up this new state of affairs:

    Washington (Wall Street Journal – Thursday, Feb. 27) —The White House is taking steps to better coordinate messaging on the coronavirus outbreak, instructing senior officials to seek approval from Vice President Mike Pence’s office before speaking publicly about the epidemic, according to people familiar with the directive.

    The administration has struggled to provide a consistent message on the coronavirus threat as it tries to improve coordination between federal agencies and states amid growing public concern. On Wednesday, President Trump put Mr. Pence in charge of federal coronavirus-response efforts , and on Thursday, Mr. Pence named Dr. Deborah L. Birx, who currently coordinates America’s global efforts to curb HIV and AIDS, as White House coronavirus-response coordinator.

    (2) DRAMATIS PERSONAE:

    – PRESIDENT DONALD J. TRUMP, EPIDEMIOLOGIST-IN-CHIEF

    • Trump fired the federal pandemic response security team in 2018, and also cut CDC’s funding for epidemic preparedness by 80% – including work with China.

    – VICE-PRESIDENT MICHAEL R. PENCE, CORONAVIRUS TASK FORCE LEADER

    • As governor of Indiana, Pence was instrumental in fueling an HIV epidemic. In tiny Austin, Indiana (pop. 4200) – the only place where people could get HIV testing – Planned Parenthood was defunded.

    • Many AIDS patients in Austin were co-infected with Hepatitis B and/or Hepatitis C (HCV), causing further illness and costly treatment.

    • Pence was adamantly opposed to needle exchanges, although they are of proven public health benefit and efficacy in reducing these infections which can be transmitted sexually or by shared needles.

    • Here, too, Governor Pence was known for cutting funding for the state’s public health departments. Indiana spent $12.40 per person on public health, compared to $220 per person spent on public health in West Virginia. 

    • As a member of Congress, Pence voted against the State Children’s Health Insurance Program although he professes belief in “the sanctity of life.”

    • While initially supporting Medicaid expansion in Indiana, albeit while requiring enrollees to pay a premium, Pence as VP has called for repealing it.

    • Pence’s beliefs have been contrary to established public health stances in other ways, as well. For example,  in 2000, Pence stated, “Despite the hysteria from the political class and the media, smoking doesn’t kill.”

    • In 2002, Pence stated, “condoms are a very, very poor protection against sexuality transmitted disease.”

    • Pence is anti-evolution and in 2001 stated, “Global warming is a myth,” adding for good measure, “There – I said it!”

    • As governor of Indiana, Pence aggressively supported the imprisonment of women undergoing abortions even in cases of serious fetal abnormality (e.g. microcephaly).

    • Vice President Pence now advocates cuts (both implemented and proposed) in Medicaid and food stamps, and backs Trump’s plan to pay for the coronavirus response by cutting heating assistance for poor people and other health programs.

    • Only hours after being anointed Coronavirus Czar by Trump, Pence announced the appointment of Ambassador Deborah Birx to be his Coronavirus Response Coordinator.

    – DR. DEBORAH L. BIRX, CORONAVIRUS RESPONSE COORDINATOR

    • Dr. Debbie Birx has served as Ambassador-at-Large and United States Global AIDS Coordinator since being appointed by President Obama in 2014. In this role she has been responsible for PEPFAR (President’s Emergency Plan for AIDS Relief), a US $6.6 billion program launched in 2003 by President George W. Bush, which operates primarily in Sub-Saharan Africa, supporting HIV/AIDS treatment and prevention programs. With implementation of condom distribution and clean needle exchange, PEPFAR is credited with saving over 17 million lives.

    • Dr. Birx was one of relatively few expertly-credentialed upper-echelon health administrators retained by the Trump-Pence administration, in part because of her strongly professed evangelical Christian beliefs and hence her ability to jive with the prevailing white-house zeitgeist – but also, much to her credit, due to her proven efficacy at communicating the importance of evidence-based medical care to right-wing Christian conservatives.

    • Whereas Debbie Birx is a highly-trained internist and immunologist who has garnered well-earned respect in the medical community at large, it may turn out to be not so much her religious faith as her career military indoctrination (U.S. Army Colonel) that hampers her effectiveness, since that could make her almost constitutionally reluctant to buck the chain-of-command and challenge Pence if he goes off the deep end. (I mean, when …)

    (3) SO WHERE DO WE GO FROM HERE?

    • In terms of Covid-19 messaging, the Trump administration seems hell bent on dong China one better [a.k.a. ONE WORSE] in terms of muzzling free exchange of biomedical information – with a parochial governmental mindset locked into maximizing counterproductive political propaganda obsessed with “controlling the message” even if it means denying and distorting factual information at the potential cost of millions of lives, billions of dollars.

    • Is there even the remotest chance that the Trump Plague Dream Team – this eleventh-hour hodgepodge of political lackeys, civil service hacks, and bona fide public health servants – tasked to the limits of their self-admitted befuddlement with conflicting requirements for reporting upwards, downwards, sideways, crossways, and leaky-ways to Vice President Pence, HHS Secretary Azar, Surgeon General Adams, and the White House itself – while charged at the very same time with keeping lateral lines of communication open to more knowledgeable governmental peers in the CDC (Redfield, Schuchat, Fauci), NIH, HHS, DHS, FEMA, and – even beyond such domestic agencies – to the World Health Organization, and collateral infectious disease & epidemiology NGOs – WILL NOT rapidly become, like an ferocious knotted glob of just-emerged-from-hibernation copulating-snakes blasted by an early Spring frost – the most monumentally inept medico-economic clusterfuck since 1918?

    (4) ON NOT LEARNING FROM HISTORY and George Santayana (“Those who cannot remember the past are condemned to repeat it”):

    • “The coronavirus and how political spin has worsened epidemics.” By Evan Osmos. The New Yorker (Feb. 28, 2020)
    https://www.newyorker.com/news/daily-comment/the-coronavirus-and-how-political-spin-has-worsened-epidemics

    • “The Spanish Influenza Pandemic: A lesson from history 100 tears after 1918.” By M. Martin, V. Gazzaniga, N.L. Bragazzi, and L. Barberis. Journal of Preventive Medicine and Hygiene 60(1):E64-E67, March 2019.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477554/

    Reply

12. Here is an interesting article published in today’s Science.
    “Can China’s COVID-19 strategy work elsewhere?” | Science-March 6, 2020

    Short report – but interesting food for thought:
    https://science.sciencemag.org/content/367/6482/1061

    Reply

13. Today’s (March 7) THE LANCET published a rather stunning op-ed as its lead article. Stunning to me anyway. We’ve all heard Admiral Farragut’s command, “Damn the torpedoes – Full speed ahead!!”

    Let me paraphrase this: “Damn all civil liberties, let’s go all-out medieval on ‘Covid-19!'” [? for which a name change is underway, even as I write].

    Because this is precisely what this prestigious medical journal (think NEJM of the UK) now seems to be advocating:
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30522-5/fulltext

    WOW!

    Reply

14. Exclusive: The Strongest Evidence Yet That America Is Botching Coronavirus Testing
    https://www.theatlantic.com/health/archive/2020/03/how-many-americans-have-been-tested-coronavirus/607597/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200306&silverid-ref=MzU1NDUzMzAwMjUzS0

    “I DON’T KNOW WHAT WENT WRONG [my emphasis],” a former CDC chief told The Atlantic, March 7, 2020  (Robinson Meyer and Alexis Madrigal)

    “The figures we gathered suggest that the American response to the coronavirus and the disease it causes, COVID-19, has been shockingly sluggish, especially compared with that of other developed countries. The CDC confirmed eight days ago that the virus was in community transmission in the United States—that it was infecting Americans who had neither traveled abroad nor were in contact with others who had.”
    ————————-
    I am continually impressed at how, among major non-medical news sources, The Atlantic consistently excels at real-time, scientifically responsible reporting on Covid-19 [Severe Acute Respiratory Syndrome Coronavirus 2, or SARS-CoV-2 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it ].

    The most interesting aspect of today’s article in The Atlantic is its state-by-state – many states, anyway – comparison, in terms of readiness for testing and diagnosing new cases, e.g., Washington State can test roughly 1,000 people a day https://www.youtube.com/watch?v=C1WS2uhadNQ ; cf. Arkansas, which is able to test only four or five patients a day.

    Reply

15. For more context, California leads all states with its claimed ability to test 6,000 potential Covid-19 cases daily. Unfortunately, the CDC is currently not allowed to publish state data on number of Covid-19 cases (as opposed to results of tests the agency itself has conducted). Also, this [Johns Hopkins] is my favorite map (although I do wish it were animated):
    https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
    Some of these maps ARE animated https://www.healthmap.org/covid-19/ – and provide very useful snapshots of this novel human coronavirus’s very rapid spread [source: University of Minnesota Center for Infectious Disease Research and Policy]:
    http://www.cidrap.umn.edu/covid-19/maps-visuals

    Reply

16. IMPORTANT:  I’d like to make a request, unsolicited by Greg, and cloned to his three Covid-19 blog posts up to this date:

    Fellow GLB blog readers, each of Greg’s three posts since this story went viral (sorry) earlier this year devoted itself to a specific aspect or question concerning Covid-19. It shouldn’t be all that difficult to keep our comments more or less on-topic – yet I notice they’re now spread out all over the place. This diminishes the accessibility and utility of the considerable amount of information that appears on the aforementioned posts.

    Not surprisingly, several recent comments that have little to do with sub-Saharan Africa appear following Greg’s most recent (Feb. 25) column. I mean, it’s the most recent post, and hence the most physically accessible. This being said, if someone comments “ectopically” on an issue that was already introduced/covered at length in an earlier published essay, any would-be replier has no choice but to reply to the inconveniently-located new comment, creating a positive feedback cycle of fluctuating on-/off-topic/malpositioned posts.

    Come on, folks, we can do better than this.

    Greg, on January 26, wrote [“famous last words?” OR “the best-laid plans …”?] as follows: “I’m not really going to live blog this virus.” But with its exploding, deleterious impact on personal and public health, economy, civil liberties, political systems, supply chains, international relations (etc.) likely to get much worse very quickly (I mean, let’s get real – this is terrible enough that many of us are bound to lose family members and friends to this disease), Greg will probably have little choice but to follow up on the scientific dimensions of Covid-19 that lie within his domains of interest and expertise.

    Let’s try our best not to complicate things by asking the writer/moderator of this blog to clean up/curate our mess. After all, irrespective of whether Greg composes further “main features” on the subject, due to its very nature – and if this discussion remains alive and current – there will soon be dozens of links, hundreds of comments, and thousands of words on Covid-19 – all theoretically accessible here. If we do our part.

    There’s some good information (and timely references) available here, covering many dimensions of this crisis – which make this a useful go-to source, especially given that it is such a wide-ranging (“Evolution – Climate Change – Education – Politics [and now, Coronavirus?]”) blog on the intersection of science and society.

    So here’s my suggestion: If you have contributions to the ongoing discussion here concerning this novel human coronavirus – any aspect of it – use the Search function (*the little magnifying glass!) at the top right of Greg’s masthead, and figure out which of these three columns is the most relevant place to post your remarks, regardless of where you’ve posted them previously. And if they don’t truly fit under the two recent specialized subtopics (African Covid-19 / Face masks and contagion prevention) – then, please, go back to “Live Blogging 2019-nCoV (Wuhan coronavirus) (Jan. 26)” https://gregladen.com/blog/2020/01/26/live-blogging-2019-ncov-wuhan-coronavirus/ and post there. This way, your general and miscellaneous remark(s) on Covid-19 will appear highlighted in red for all to see – under Recent Comments at the top of GLB – thereby keeping “Live Blogging 2019-nCoV” alive.
    ——————————

    GLB READER’S GUIDE TO COVID-19 COLUMNS (Jan. 26–Feb. 25) — *Remember the magnifying glass – you don’t have to scroll through dozens of posts!

    • Lack of coronavirus COVID-19 in Subsaharan Africa? (Feb. 25)
    https://gregladen.com/blog/2020/02/25/lack-of-coronavirus-covid-19-in-subsaharan-africa/

    • Should I wear a facemask to avoid the flu or some other nasty virus like Coronavirus COVIC-19? (February 12)
    https://gregladen.com/blog/2020/02/12/should-i-wear-a-facemask-to-avoid-the-flu-or-some-other-nasty-virus-like-coronavirus-covic-19/

    • Live Blogging 2019-nCoV (Wuhan coronavirus) (Jan. 26)
    https://gregladen.com/blog/2020/01/26/live-blogging-2019-ncov-wuhan-coronavirus/

    Reply

    1. Joseph,
       My optimism is based on the dramatic decline in new cases and deaths being reported from China and South Korea. The latter has implemented a mandatory, two week self quarantine for those thought to have been in contact with a carrier:

       https://www.technologyreview.com/s/615329/coronavirus-south-korea-smartphone-app-quarantine/

       As for acceleration vs linear growth, the rates we see right now might be very different next week. Here is an article discussing the two viewpoints:

       https://www.bloomberg.com/opinion/articles/2020-03-07/coronavirus-world-splits-into-two-camps-of-thought

       For now, I am somewhere in the middle.

    2. You can see the decline in S. Korea:

       https://mobile.twitter.com/AlexPMGR/status/1236955907453595648/photo/1

17. Snape,

    I won’t disparage your optimism. But cherry-picking the very few countries where new cases seem to be plateauing or even declining is useful only insofar as they provide comparative case studies vis-à-vis places where the reverse pattern holds. What’s more, Brook Sample’s Bloomberg op-ed is, to put it bluntly, unscientific gibberish – it’s a paradigmatic example of the “let’s present both sides” journalistic fallacy run amok.
    __________
    PART ONE – Recommended Reading

    First, see this excellent March 9th post on “The Spinoff,” an award-winning New Zealand online magazine, because everything I write here relates to it in some way

    THE THREE PHASES OF COVID-19 – AND HOW WE CAN MAKE IT MANAGEABLE
    By Siouxsie Wiles
    https://thespinoff.co.nz/society/09-03-2020/the-three-phases-of-covid-19-and-how-we-can-make-it-manageable/

    Then, once you’ve digested this simple but informative article, please re-examine and carefully consider the implications of the third graph – the animated one.

    It’s simplistic, yes. However, should you wish to do so, you can easily locate more sophisticated graphs, depicting actual simulations with multiple labelled variables. But this cartoon works – and its creator, Siouxsie Wiles, is a rigorously trained, highly accomplished and well-regarded microbiology/infectious disease researcher, not to mention popular science writer and commentator:
    Siouxsie Wiles  http://en.wikipedia.org/wiki/Siouxsie_Wiles
    http://thespinoff.co.nz/author/siouxsie-wiles/

    Regardless of how you evaluate China’s response, at least three other countries seem to be getting their approach right, and in all three places the common denominator has been an efficient combination of non-partisanship, forthright factual communication, and remarkably close cooperation and trust between government officials, medical experts, and citizens. Not to mention a timely response to a serious public health challenge they recognized and prepared for early on.

    In Dr. Miles’ illustrations, you can think of these three countries as the orange-clad WOMAN and the corresponding orange-colored curve:
    • South Korea
    https://www.cnn.com/2020/03/09/asia/south-korea-coronavirus-intl-hnk/index.html
    • Singapore:
    https://www.medpagetoday.com/infectiousdisease/covid19/85254
    • Canada
    https://ottawacitizen.com/opinion/editorials/editorial-on-coronavirus-canadas-leaders-are-getting-it-right

    Italy’s response to Covid-19 has been undeniably draconian, especially given that Italy, politically, is no China; it is not even Singapore. Yet its medical reporting is highly reliable. This is a developed Western country with a decent health care system and 60 million residents. But it is not a rich country, and its population is disproportionately old.

    Again – referring to Miles’ animated graph – if the triumvirate of South Korea, Singapore, and Canada is the orange-clad woman, the United States is the green-clad MAN (we da man! – take that!). And we are on the verge of becoming the bulging green curve.

    Reply

18. __________
    PART TWO – Current Situation & Prospects

    What’s important to note here is that while China, North Korea, and Singapore MIGHT have “flattened the curve” (Canada’s a work in progress), the United States has emphatically not done so. In other words, for us the containment boat has sailed and we are now in phase two – community transmission – and unlike the apparent situation in Korea which you cite, or for that matter China, our number-of-cases curve is not flat.

    Instead, the number of verified Covid-19 cases – the height of the peak – is still increasing geometrically. In Massachusetts, reported cases doubled in the past 48 hours – we are currently at 96. Our governor, Charlie Baker, earlier today declared a state of emergency – and yes, this applies to the entire commonwealth:
    https://www.wcvb.com/article/governor-charlie-baker-declares-state-of-emergency-coronavirus-3-10-2020/31356404

    In other words, the United States is poised to become another Italy:
    https://www.medpagetoday.com/infectiousdisease/covid19/85324?xid=nl_popmed_2020-03-10&eun=g1138744d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=CoronaBreak_031020&utm_term=NL_Daily_Breaking_News_Openers_Active

    Reply

19. Joseph,
    You have given me a lot of homework! Before I get started, let me leave with you with an observation and my current mindset:

    Initially, new cases were accelerating in Wuhan. The timing was terrible – a holiday period, with people traveling all over the country. Given the estimated RO value, and expert opinion, it seemed inevitable that the virus would infect millions.

    Didn’t happen. Only a few weeks later the daily increase in new cases had become linear. Then declining. Here are the numbers after more than two months since the outbreak started:

    – only about 1 in 15,000 Chinese citizens have tested positive.
    – only about 1 in 500,000 have died (mostly the very old or sick).

    *****
    Bottom line, the widespread testing/quarantines are disruptive, but so far have proven to be very effective. Nations around the world will probably need to follow China or S. Korea’s example.

    Reply

20. NEW STUFF ADDED TO BEGINNING OF POST

    Reply

21. Thanks for your up-to-date news summary and for adding the primary sources. I’ve read them all – and incidentally, it’s admirable that these journals (and several major news organizations as well) are lifting their normal embargoes on public access, especially (in the case of journals) to preprints.

    I’ll rephrase what’s been my consistent message since my very first coronavirus comment. The actual science – and the likely epidemiological trajectory following initial outbreaks (except for Italy, which did blindside me) – has been pretty clear to me all along. Not because I’m some sort of savant, but because for those of us who’ve been following this field (by which I mean, specifically, the evolution of zoonotic diseases in susceptible human populations) it’s well, not exactly rocket science.

    Still, I’m enjoy reading informative posts by my cup-half-full co-commenters on this blog. Optimism, even religious faith, can be psychologically healthy things to express – as in gene expression. Alas, I didn’t inherit those genes (or maybe my messed-up gut microbiome sabotaged them) – and anyway, there’s probably some sort of balanced polymorphism model that can explain the eternal persistence of pessimists and optimists. Or for that matter, realists and reality-deniers. I’ve never looked into this.

    So now, all I want for NEXT Christmas is a rational government-led infrastructural response, in this country. (As of this writing, a dozen states have declared a state of emergency. Pretty much all colleges are or will be closing. What happens to unmarried students without families, or to international students, ordered to vacate dormitories and campuses – by Monday, in Harvard’s case???) We already know that this pandemic will be extremely costly by all measures in most domains (excepting the scum who, like arms dealers during times of war, always manage to make out like the bandits they are – also an eternal evolutionary verity). I remain far less worried about “containing” the virus [again, too late] or “flattening the curve” than I am about the literally incalculable damage that will be done by misguided actions intended to accomplish the latter.

    On this note, I’m happy to announce the addition of a fourth country to my short list of rationally behaving societies, namely, Taiwan. (It’s an amazing place, with a thriving democracy, universal health care, and a vibrant society by almost every measure. And yet, as a former sinologist it’s long been my impression that, given the complex sensitivities regarding China-vs-Taiwan and our precarious semi-supportive but mainly speaking “don’t ask don’t tell” relations with this “beautiful isle” (Formosa) and schizoid policies towards the Chinese mainland – well, lots of folks just sort of hope it (the so-called “Taiwan problem”) will go away.

    • South Korea
    https://www.cnn.com/2020/03/09/asia/south-korea-coronavirus-intl-hnk/index.html
    • Singapore:
    https://www.medpagetoday.com/infectiousdisease/covid19/85254
    • Canada
    https://ottawacitizen.com/opinion/editorials/editorial-on-coronavirus-canadas-leaders-are-getting-it-rightt
    • Taiwan
    https://www.usnews.com/news/best-countries/articles/2020-03-10/lessons-learned-from-taiwans-response-to-coronavirus

    I’m utterly certain there are other pockets of governmental sanity in the world, so if other readers can update us on these – it’ll be all-too-rare GOOD NEWS to see them added to this list. Plus, Snape will be happy.

    Reply

22. All true, but we still have to realize that thinking others will do the right thing is not justifed because so many people are effing idots.

    The coronavirus is no joking matter, and the NBA made that clear Wednesday night, suspending its season after a Utah Jazz player preliminarily tested positive for COVID-19.

    A person familiar with the situation confirmed to USA TODAY Sports that the player was Utah center Rudy Gobert. And on Monday, Gobert had appeared to joke about the coronavirus after an interview session with reporters.

    He made a point to touch all of their tape recorders and microphones on his way to the team’s shootaround.

    Need more evidence things are getting serious? From the Houston Chronicle:

    Coronavirus causes Sisters of Perpetual Indulgence to postpone Hunky Jesus competition

    Reply

23. “Even if the coronavirus kills only 1 percent of its victims, 1 percent of 60 percent of 7 billion people is a staggering death toll, placing the coronavirus alongside the three biggest pandemics of human history – the 14th-century plague, the 1918 influenza, and the current HIV/AIDS toll.”

    – Laurie Garrett (Feb. 15, 2020)

    Laurie Garrett wrote “The Coming Plague: Newly Emerging Diseases in a World Out of Balance” (1995) and “Betrayal of Trust: The Collapse of Global Health” (2001). She is no fear-monger, but a preeminent microbiology/iinfectious disease-trained science journalist, winner of the Pulitzer Prize for Explanatory Journalism for her reporting on the Ebola crisis in Zaire (1996).

    https://www.youtube.com/watch?v=X1NssI4jRtQ

    https://www.youtube.com/watch?v=v_z297eni8c

    Reply

24. “A lot has happened in the past 24 hours. (My colleague joked that yesterday “was a long year.”)”

    – Caroline Mimbs Nyce
    Senior Associate Editor, The Atlantic
    —————

    Like an increasing number of major news outlets, The Atlantic has removed the paywall for their newsletter coverage of “CORONAVIRUS: COVID-19” – and you can sign up for email alerts.
    https://www.theatlantic.com/category/coronavirus-covid-19/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200312&silverid-ref=MzU1NDUzMzAwMjUzS0

    As most of you know, this magazine has a history of very good scientific reporting, geared towards an educated lay audience. Plus informative op-eds almost guaranteed to depress you and (be you conservative OR liberal) raise your blood pressure.

    Here are some examples, published in the past 24 hours:

    • What You Need to Know about the Coronavirus: The Atlantic’s Guide to Navigating a Global Pandemic
    https://www.theatlantic.com/health/archive/2020/03/coronavirus-covid-19-the-atlantics-most-crucial-coverage/607906/

    • The Extraordinary Decisions Facing Italian Doctors
    There are now simply too many patients for each one of them to receive adequate care.
    https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

    • The Worst Outcome: If somebody other than Donald Trump were in the White House, the coronavirus crisis would not be unfolding this way:
    https://www.theatlantic.com/ideas/archive/2020/03/trump-ensuring-worst-possible-outcome-coronavirus-crisis/607867/

    • Why Trump Intentionally Misnames the Coronavirus: When conservative figures continually refer to the “Wuhan virus” or “Chinese coronavirus,” it’s clear they’re doing it to make a point.
    https://www.theatlantic.com/culture/archive/2020/03/why-trump-intentionally-misnames-coronavirus/607900/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200312&silverid-ref=MzU1NDUzMzAwMjUzS0

    Reply

25. What further should be done to control COVID-19 outbreaks in addition to cases isolation and contact tracing measures?

    Zhenjian He  – BMC Medicine (March 13, 2020
    https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01551-8#auth-1)

    Key Laboratory of Tropical Disease Control
    School of Public Health
    Sun Yat-sen University
    Ministry of Education
    Guangzhou, 510080, China

    Reply

    1. Joseph,
       I have changed my mind and now agree with you. The virus is looking much worse than I had previously guessed.

       The seriousness hit home when I came across some first hand observations. Look for Steve Mosher in the comments section:

       https://wattsupwiththat.com/2020/03/13/the-math-of-epidemics/

    2. Who wrote that crapstain Willis’ article for him? He’s never demonstrated that he knows what simple arithmetic is before this.

       His asinine rant against “fake racism” is laughable too.

       But seriously — if you only take something as valid only when it’s on a criminally dishonest web site (lik watts’) you’ve got a problem.

26. How Many Adults Are at Risk of Serious Illness If Infected with Coronavirus?

    This article [very reputable source] provides a bit more resolution on some of the concerns (as applied to the U.S.) discussed over the past six weeks above. If you notice, this site also provides a downloadable .pdf:

    https://www.kff.org/global-health-policy/issue-brief/how-many-adults-are-at-risk-of-serious-illness-if-infected-with-coronavirus/?utm_campaign=wp_to_your_health&utm_medium=email&utm_source=newsletter&wpisrc=nl_tyh&wpmk=1

    Reply

27. FIVE PLACES, FIVE RESPONSES, FIVE OUTCOMES – Can we learn ANYTHING?

    Although some of this information has been covered above, please pay special attention to this new article comparing KOREA’s response to that of ITALY
    https://www.reuters.com/article/us-health-coronavirus-response-specialre-idUSKBN20Z27P

    Note especially two take-home messages:

    1. Young adults are asymptomatic “carriers”; old adults get sick and die. (If this pattern holds true in the States, will this be the Democratic Party’s de facto way of getting rid of fossilized, white, right-wing Republicans?)

    2. Wide-spread testing needs to be done here.

    Okay. Sure. Test everyone. This would be of inestimable value to epidemiologists and health-care planners. (Actually, for these purposes, there are well worked-out statistical paradigms for systematic random sampling that would be far less costly, far more efficient, and yield just as valuable data. But no one would stand for that, so let’s forget about it. In any case, reliable data on infection incidence/outcomes is a totally different thing from the information individuals require in order to decide whether to self-isolate or obtain treatment.)

    BUT DO THIS THOUGHT EXPERIMENT:

    Suppose, first, that in a month or two we have the ability to test every American resident. Scientists already have enough information to project what proportion of us will (say, by May) test positive – never mind what our “fearless [I doubt it!] leaders” in Washington are telling us.

    Now imagine most of us are told to self-isolate – stay home for two weeks (or in the case of recovered hospitalized patients, remain out of commission for as long as a month).

    Next, consider – using realistic information – what proportion of Americans actually CAN gear up to “work from home.”

    Answer: A significant majority of our citizens lack this option, MOSTLY because of the nature of their jobs. But also because, perhaps, they live alone and depend on Social Services (visiting nurses, housekeeping assistance, Meals on Wheels, elder care, etc. – life-sustaining services that, by the way, are already collapsing due to city shutdowns; this is already occurring in Cambridge, Massachusetts,, where I live – and things have scarcely begun to get bad); for socioeconomic reasons; because they’re mobility-impaired or wheelchair-bound and depend on subsidized rides to take them to dialysis centers three times a week, or to other essential medical appointments; or because they’re retired but nonetheless (when out and about) contribute to the economy, etc.

    The “unintended consequences” of testing every single citizen – with the goal being to “flatten the curve” – will, I assure you, FLATTEN SOCIETY. Regardless of the efficacy (probably not much – we’ve reacted too late) for tamping down the number of simultaneous cases in order to mitigate the burden on our dysfunctional medical system, there are so many other factors to consider that – and this is an admittedly brutal (or if you prefer, Benthamite) argument I’m making – a “zoomed-out” view of the situation would recognize that there are so many critical factors to consider, above and beyond INDIVIDUAL access to medical treatment, that the same kind of triaging logic the Italians are applying to their Covid-19 patients ought to be applied to American society overall.

    In other words, we need to do a better job of rationally assessing what needs to be sacrificed and why, for the net greater good. Mainly the greater good of our democracy, to the extent that it is one – but also for the essential welfare (which does not mean luxury buying or frivolous entertainment) of most Americans.

    The Covid-19 pandemic, contrary to impressions gleaned from the news media and somehow ingrained in the psyches of most Americans, is not the only thing going on. It is not even our most important existential threat (though a bungled response to it might be).

    Some people will argue, yes, this is true, but we can tackle more than one challenge at a time. Can we? Do we have the requisite attention span, the ability to multi-task, In “normal” times – let alone when many people are sick and the rest are also staying home? Please, we shifted gears (in what now seems a nanosecond) from a presidential-impeachment bogus outcome, to near-total preoccupation with the longest two-many-horses-on-the-track political horse race I’ve ever witnessed, to a dangerous pandemic that has been very high on the top-ten existential threat “hit list” (along with bioterrorism, asteroid strikes, nuclear war, nanotechnology run amok, and so forth) for at least three decades. A deadly global pandemic – whether triggered by a sloppy lab accident releasing some genetically engineered pathogen, or by a “terrorist,” or by a natural zoonosis – well, the scenario we’re witnessing (and this is only the “First Act”) has been foreseen, not by psychics or soothsayers or doomsday prophets, but by highly trained experts who study and write about such things for a living, and – alas – are frustratingly accustomed to seeing their warnings ignored. I know many of them. They are the Cassandras of our time.

    And so, America, can we please learn something from the following:

    • TAIWAN
    https://www.npr.org/sections/goatsandsoda/2020/03/13/814709530/with-odds-against-it-taiwan-keeps-coronavirus-corralled

    • TAIWAN / SINGAPORE / HONGKONG
    https://www.nytimes.com/2020/03/13/opinion/coronavirus-best-response.html

    • KOREA / ITALY
    https://www.reuters.com/article/us-health-coronavirus-response-specialre-idUSKBN20Z27P

    Reply

28. FIVE PLACES, FIVE RESPONSES, FIVE OUTCOMES – Can we learn ANYTHING? (continued)

    My preceding comment began:

    Although some of this information has been covered above, please pay special attention to this new article comparing KOREA’s response to that of ITALY
    https://www.reuters.com/article/us-health-coronavirus-response-specialre-idUSKBN20Z27P

    Note especially two take-home messages:

    1. Young adults are asymptomatic “carriers”; old adults get sick and die. (If this pattern holds true in the States, will this be the Democratic Party’s de facto way of getting rid of fossilized, white, right-wing Republicans?)

    2. Wide-spread testing needs to be done here.
    ____________
    It turns out I made a mistake, which I noticed too late to edit. Although the Reuters report (published March 12) is very important, the first of my two so-called “take-home messages” – that infected and contagious young adults, being largely asymptomatic, are out and about infecting older age cohorts – was communicated not by this report, but by a Twitter feed initiated by Mark Byrne @markwby
    https://mobile.twitter.com/markwby/status/1238867143363567616

    The point here – note the striking bar graph “Coronavirus cases (%) in South Korea and Italy by age groups” – is that broad testing of the population (Korea) revealed a huge number of asymptomatic individuals, mostly in the 20-29 cohort. Since Italy only tested individuals with symptoms, cases APPEAR to increase with age. Sure – the old people were the ones who got disproportionately sick. But the opposite tack taken by the two countries with regard to testing means that we can’t really compare numbers of Covid-19 cases as a function of age.

    Look at the graph two more times:

    First, squint your eyes and ignoring South Korea (red), draw an imaginary regression line through the Italy cases (green). Notice that per your imagined line – sloping upwards – the percentage of coronavirus increases with age.

    Second, squint your eyes again, and this time.”look” only at South Korea (red), ignoring Italy (green). Your imagined regression line now slopes downwards – the percentage of coronavirus cases decreases with age.

    Is it really likely that there is an opposite relationship between percentages of coronavirus cases versus age in the two countries? Of course not! What’s being compared are apples (widespread, representative testing in South Korea) and oranges (selective coronavirus testing in Italy). So all we really know at this point is that there is widespread community transmission of the coronavirus by asymptomatic carriers.

    Finally – to be fair to Italy – they HAD to switch from testing anyone, to testing only symptomatic individuals. The epidemic bomb exploded, medical capacity imploded – and with testing resources (number of kits and sheer human capacity) depleted, there was no other reasonable choice.

    Reply

29. Thank you, Joseph M, for your diligent research and link-sharing on this.

    It seems this post, Greg’s first on the subject, is the place for general comments, while the second of his posts (“Should I wear a face mask?”) should get comments on self-protection.

    Accordingly, I’ll start with an opinion by Megan McArdle. She is one of the Washington Post columnists who I generally disagree with, but on coronavirus she has been quite sensible. Here she touts Americans’ ability to start from behind and catch up by pulling together.

    https://www.washingtonpost.com/opinions/2020/03/12/there-are-reasons-be-optimistic-regarding-coronavirus/?arc404=true

    Reply

30. Along the same lines as Megan McArdle, Dr. Leana S. Wen advises us not to waste time on pointing fingers. I agree.

    https://www.washingtonpost.com/opinions/2020/03/06/finger-pointing-isnt-going-halt-coronavirus/

    Reply

31. While I think pointing fingers is counterproductive, I also maintain that we should hold Trump accountable for his mistakes. On Thursday, Yamiche Alcindor asked him about his 2018 action disbanding the Pandemic Response Team. He lied, claiming he knew nothing about it and took no responsibility.

    https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/

    Today, the news broke (reported by several sources) that Trump offered “a large sum of money” to German vaccine company CureVac in an attempt to buy its vaccine work for the exclusive use of the USA.

    This is both immoral and stupid, since many US companies and scientific institutions are working on a coronavirus vaccine.

    The Guardian has the story:

    https://www.theguardian.com/us-news/2020/mar/15/trump-offers-large-sums-for-exclusive-access-to-coronavirus-vaccine

    Reply

32. Some good news from our northern neighbor:

    https://www.narcity.com/news/ca/sk/coronavirus-vaccine-made-in-saskatchewan-is-now-in-the-testing-stages

    As I wrote earlier, coronavirus vaccines are being worked on in many places.

    Reply

    1. Yes, Christopher, indeed coronavirus vaccines are being worked on in many places. Which all in all is good news.

       And although I’m not saying we should curb our enthusiasm about this – still, caveat lector.

       As an MD-PhD in the field wrote to me:

       “Join the crowd. This is only for headlines/glory/stock price and of little clinical value.”

       “I think this is the fourth or 5th COVID 19 vaccine I’ve heard about that’s being trumpeted, pun intended, and ‘rushed’ to market.”

       “The one developed and headlined from Boston area is skipping animal testing, which I don’t understand how they got past an IRB. Well I guess if they die we’ll be reminded that faster is not always better.”

       https://en.wikipedia.org/wiki/Arrowsmith_(novel)

    2. Joseph has already beaten me to the punch.

       My first job in medical research was working on vaccine development – I can assure everyone that it’s not always as simple as Jenner’s (et al…) paradigm-setting brainwave to use Vaccinia to innoculate against Variola. But we shall see…

       It’s worth repeating some basic points:

       1) Social distancing, scrupulous hygiene, and cessation of travel are the three most powerful preventative tools that we have at our disposal.

       2) Testing of suspected cases (and quarantine of contacts) comes right behind these three, and despite the Republican vehement and squealing truculence* about it, a sensible society will test widely and freely in order to reduce transmission as much as possible – every prevented case helps in an exponential model.

       3) In practice it’s going to take 6 months or more (especially if we are successful in slowing transmission) for widespread community (“herd”…) immunity to develop. Similarly for an effective vaccine, barring miracles, and policy cannot be predicated on miracles. So control as outlined in (1) will need to continue for at least this long, and not the two-four weeks that many seem to imagine is all that’s required. Think about what that will do** to a country, particularly if its more like a year than six months…

       4) If these controls/measures are relaxed prior to the disease being preventable via immunisation/herd immunity, the outbreaks will simply resume. China seems to be moving to relax whatever draconian measures they took in Wuhan – it will be instructive to see what happens with their infection numbers if/when they relax controls…

       I was going to make a few more points but I’ve had an hour-long conversation in the interim and they’ve evaporated.

       But to touch on the matters arising…

       *The cornavirus has shown how capitalism has failed many in society in this emergency, and how it will itself fail as an economic model under the weight of this emergency. Societies with models of democratic and humanitarian socialism (no all you knee-jerks, not communism…), and with a much more egalitarian wealth distribution, are probably going to weather this storm better, especially if the bottom isn’t as low as it might possibly be. The experiment is now in progress – we’ll get an idea of the results over the next year…

       And it’s not just poor people, casual workers, low-skilled workers and such that will show up the failure of capitalism in this mess. Traditional businesses like restaurants, pubs, cinemas, airlines, hotels, tourism-related industries – heck, even sectors like car sales – will suffer with social distancing and lack of travel. Watch as many formerly and rabidly fervent capitalists suddenly ask for socialism to help them out of their holes.

       **Following on from the economic havoc that will likely be wreaked as touched on above, a Depression style slump will greatly harm the US both economically and politically. Businesses lost, political credit gone, capacity to play on the international stage destroyed – these are real looming threats. But look at how China, with its iron-fisted control of its people and its draconian responses to the outbreak, has flattened the curve in their country… If they can keep things together long enough to arrive at a vaccine, they might not lose as many social pillars as the West and as the US in particular may. China could emerge as the indisputable world power and leader, just as Chernobyl pretty much led to the downfall of the Soviet Union…

       https://www.abc.net.au/radionational/programs/bigideas/chernobyl-and-the-fall-of-the-soviet-union/12007162

       Imagine that sort of a world…

       And then there’s climate change, which most of the world has ignored for decades. Coronavirus is just the quick warm-up act for climate change (see what I did there…) and conservatives are still as blind to climate change as they were even a few days ago when they said that universal testing was communism and one can still go to work whilst infected with coronavirus “flu”…

       Buckle up people, because we’re never getting back our world as it was.

    3. Oh, and Republicans should consider the possibility of this…

       https://twitter.com/AutumnMandrake/status/1239789478710935552

33. Joseph:

    I didn’t mean to give the impression that things are, or soon will be, fine. Certainly, development of a vaccine for coronavirus has a long road ahead of it. (I should probably have made that last sentence plural.)

    Still, I think good news can help alleviate the sense of unease which, predictably, many scammers are rushing to exploit. It’s an aspect of the situation that I haven’t seen discussed here.

    https://hotforsecurity.bitdefender.com/blog/coronavirus-medical-supply-scams-prey-on-fear-22570.html

    “Wholsale protective masks” — give me a break.

    Not all scammers have trouble spelling common words, of course.

    Reply

34. Bernard and Jospeh:

    I’ve been following the stock market closely and I’ve seen a number of companies’ share prices soar on the possibility that they will contribute to a solution of the COVID-19 outbreak — whether or not staff of the companies helped that along.

    In most cases, the hype has evaporated quickly and the stock price has fallen back to pre-scare levels. One example is CytoSorbents Corporation (CTSO) which touts its product as helpful in the coronavirus pandemic. Its CEO, a medical doctor, has written this:

    The underlying cause for these complications is often a cytokine storm that results in a massive, systemic inflammatory response, leading to the damage of vital organs such as the lungs, heart, and kidneys, and ultimately multiple organ failure and death in many cases. Steroids are being used reflexively to try to control this inflammation, despite WHO recommendations against using steroids in COVID-19 infection, and evidence from other coronavirus infections (e.g. SARS and MERS) and influenza that its use can delay viral clearance and increase mortality.

    The company makes equipment which can cleanse blood of cytokines. I think what the doctor says is true and CTSO is a reputable firm, but doubt its ability to ramp up production fast enough to get ahead of the caseload in China, Iran, and Europe. (The product is not yet approved in the U.S.)

    Over the past three months, the stock price rose above $7 then fell back to end today at $4.16, not far from its five-year low of $3.11. I think this indicates that the market has a sober view of the company’s value.

    I should probably add that this is not intended to recommend either for or against purchase of stock in CTSO or any other company.

    Reply

35. Bernard,

    Thank you for your complimentary remark above and for your informative posts. I won’t be able to reply in any detail – like most of us, I am suffering from the coronavirus “paninfodemic” (I think this was Greg’s coinage?) – and just doing my wee part, like you, to combat the panmisinfodemic.

    But it’s overwhelming.

    Reply

    1. Thank you Joseph for your very worthy contributions.

       The big lesson that humanity needs to take from this is not just how properly to deal with pandemics, but how to listen to the science that’s telling us that human-caused climate change is the very, very big brother to coronavirus…

       And yes, overwhelming indeed. Do take time to smell the roses!

36. Christopher,

    Thank you, as well, for your compliment(s) and provocative contributions to this discussion. There is room, at least on some matters, for disagreement. Of all sites, GLB is not the place for ad-homimen troll-one-upmanship (troll-upmanship?) [? I THINK I just made this up, but – in the Internet Age – who knows???].

    But let’s face it, trolls are present everywhere, and unlike viruses their N-naught has yet to be calculated.

    Reply

37. There has been a great deal of heated discussion, in too many places to mention, about the political ramifications [Translation: Stephen-Miller-to-Trump’s-Ears-Xenophobia] of the now-obsolete but always problematic appellation, “Wuhan coronavirus.” Here’s a different take, with several interesting points:

    This email excerpt comes from a good friend of mine, a fellow Harvardian and a professor at Yilan University, in northern Taiwan, for almost three decades. He has dual U.S.-Taiwan citizenship. And I feel his uniquely informative perspective is worth sharing.
    ———–

    “Interestingly, everyone in Taiwan calls this disease “Wuhan pneumonia” ???? or “Wuhan virus” ????. They want to emphasize who got us into this mess. 

    “Tomorrow my school is giving me two hours of training on how to use software to conduct classes online. Hopefully I won’t have to use my new knowledge. The Ministry of Education has a clear policy – if there are two coronavirus cases at a university, they will close it down for at least two weeks. 

    “US universities instantly closed because they’re terrified of liability. Students are on the university’s medical insurance, so the school is legally and morally responsible for whatever happens. In contrast, Taiwan has a single-payer system, so the government is responsible for their health care. That means that the universities can stay open until they’re affected by the virus. 

    “In the last two days Taiwan has had a spike of cases (up from one or two a day to 7 or 8) – all of them contracted abroad or from contact with people returning from abroad. It’s unfathomable that there are people traveling for pleasure during a pandemic. Hopefully Taiwanese in other countries are in the process of coming home. Then either they will stay put abroad, or else they will stay in Taiwan and the number of imported cases will fall. 

    “I have ZERO faith in the ability of the US government to handle this. So far the response is just random chaos. It makes Taiwan’s government look really professional.”

    – March 16, 2020

    Reply

38. There has been a great deal of heated discussion, in too many places to mention, about the political ramifications [Translation: Stephen-Miller-to-Trump’s-Ears-Xenophobia] of the now-obsolete but always problematic appellation, “Wuhan coronavirus.” Here’s a different take, with several interesting points:

    This email excerpt comes from a good friend of mine, a fellow Harvardian and a professor at Yilan University, in northern Taiwan, for almost three decades. He has dual U.S.-Taiwan citizenship. And I feel his uniquely informative perspective is worth sharing.
    ———–

    “Interestingly, everyone in Taiwan calls this disease “Wuhan pneumonia” ???? or “Wuhan virus” ????. They want to emphasize who got us into this mess. 

    “Tomorrow my school is giving me two hours of training on how to use software to conduct classes online. Hopefully I won’t have to use my new knowledge. The Ministry of Education has a clear policy – if there are two coronavirus cases at a university, they will close it down for at least two weeks. 

    “US universities instantly closed because they’re terrified of liability. Students are on the university’s medical insurance, so the school is legally and morally responsible for whatever happens. In contrast, Taiwan has a single-payer system, so the government is responsible for their health care. That means that the universities can stay open until they’re affected by the virus. 

    “In the last two days Taiwan has had a spike of cases (up from one or two a day to 7 or 8) – all of them contracted abroad or from contact with people returning from abroad. It’s unfathomable that there are people traveling for pleasure during a pandemic. Hopefully Taiwanese in other countries are in the process of coming home. Then either they will stay put abroad, or else they will stay in Taiwan and the number of imported cases will fall. 

    “I have ZERO faith in the ability of the US government to handle this. So far the response is just random chaos. It makes Taiwan’s government look really professional.”

    – March 16, 2020

    Reply

39. I just saw this notice from the WHO: Do not use ibuprofen to relieve COVID-19 symptoms. The thought is that it could worsen the effect of the virus.

    https://www.yahoo.com/news/avoid-taking-ibuprofen-covid-19-symptoms-202007508.html

    Reply

    1. Following up on my notice warning about ibuprofen use with COVID-19 symptoms, this is probably false. It seems to have come from a single French report, with no corroboration.

40. COVID-19: WHAT IS IN STORE FOR THE UNITED STATES

    The Johns Hopkins CSSE map, updated one hour ago, reports these numbers of confirmed Covid-19 cases:

    1. China 81,138
    2. Italy 35,713
    3. Iran 17,361
    4. Spain 14,769
    5. Germany 12,327
    6. U.S. 9,415
    7. France 9,054
    8. South Korea 8,565
    8. Switzerland. 3,067
    10. U.K. 2,644
    11. Netherlands 2,056
    12. Austria 1,646
    13. Norway. 1,591
    14. Belgium 1,486
    15. Sweden 1,301

    and so on …
    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

    To put these stats in context, consider the following points:

    1. The European Union, obviously, has been hit extremely hard.
    2. Meanwhile, Chinese cases have leveled off. And SO – if this pattern holds –

    With the United States three to thirty times more populous than (excepting China) the other most-affected/infected countries, if the present exponential trajectory persists, we will surpass China and lead the world in numbers of confirmed Covid-19 within 10-14 days.

    3. None of the most-affected countries listed here even have enough residents to give us a run for our money: Everyone there would have to become infected many times over for this to happen.

    4. Not for a nanosecond do I believe the low numbers reported for Russia, Central Asia, India, Indonesia … or the African and South American continents. (But, bear in mind, it is still fall in the Southern Hemisphere – Old Man Winter has yet appear on the scene.)

    5. AND SO AGAIN I STATE THE IMPLICATIONS from data here and from scientifically reliable projections elsewhere. This is not being “pessimistic,” and it is certainly not “fear-mongering” –

    (1) THERE WILL BE MORE PEOPLE INFECTED WITH THE SARS-CoV-2 VIRUS IN THE United States THAN IN ANY OTHER COUNTRY IN THE WORD, barring a resurgence of Covid-19 in the People’s Republic of China or much more reliable reporting from India.

    (2) This is shaping up to be THE WORST DOMESTIC CRISIS THAT THE U.S. HAS FACED SINCE THE CIVIL WAR, only with far more ominous global repercussions, which – via multiple positive feedback loops – will challenge our national survival more than anything else ever has.

    Reply

    1. I would like to update my comment above (“COVID-19: WHAT IS IN STORE FOR THE UNITED STATES”) from two days ago. I won’t be making further revisions to this – the numbers are simply changing too fast, and the vast majority of countries on earth simply lack the health-care infrastructure and medical culture to offset current biases in our statistical picture of this pandemic.

       In other words, from here on out this is a waiting game in which we are all, to varying degrees, both observers and participants. And unfortunately – like most games – most “players” lose.
       ______________
       Every time I peek at the updated Johns Hopkins COVID-19 map, with countries seemingly jockeying for rank, it feels like watching some twisted horse race from hell.

       I can’t be the only one noticing that some horses move up, while others drop back. But in any real-life horse race I’ve ever seen, the speed of all the horses doesn’t simultaneously increase.

       I wonder if there isn’t some macabre Vegas betting on this. If so, they should bet on “long shot” entries from the Southern Hemisphere
       .
       For now (March 20 – 3:43 GMT):

       1. China 81,281
       2. Italy 47,021
       3. Spain 21,571
       4. Germany 19,848
       5. Iran 19,644
       6. U.S. 19,624
       7. France 12,632
       8. South Korea 8,652
       9. Switzerland. 5,544
       10. U.K. 4,014
       11. Netherlands 3,003
       12. Austria 2,649
       13. Norway. 1,591
       14. Belgium 2,257
       15. Norway 1,959
       and so on …
       https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html?fbclid=IwAR3VWG7xreVkP2iiZDbp7swNVLmYjBh4HH94HBuiZc_eXpHXYr43u9x6hww#/bda7594740fd40299423467b48e9ecf6

       Observations:

       1. Europe, obviously, has been hit disproportionately hard. Partly this is a reporting artifact of a more developed medical infrastructure. But only partly.

       2. Meanwhile, reported Chinese cases have leveled off. However, a true two-orders-of-magnitude difference in numbers of cases between eastern and western provinces strains credulity – not only for political reasons (Imagine Chairman-of-Everything Xi saying, “We’ve now got this thing under control and the world is applauding – don’t spoil my Party”) – but also in terms of infectious disease dynamics.

       3. With the United States four to thirty times more populous than (excepting China) the other most-affected/infected countries, if the present exponential trajectory persists, we will surpass China and lead the world in numbers of confirmed Covid-19 within 14-21 days.

       Few of the most-affected countries listed here even have enough residents to give us a run for our money: Everyone there would have to become infected many times over for this to happen.

       4. Not for a nanosecond do I believe the minuscule numbers reported for Russia, Central Asia, India, Indonesia … or the African and South American continents. (But, bear in mind, it is still fall in the Southern Hemisphere – Old Man Winter has yet to appear on the scene.)
       ————
       Still, to repeat – judging from the currently available data and barring a rebound in China or more reliable reporting from India (to say nothing of Nigeria, etc.) – the U.S. will wind up having more known Covid-19 cases than anywhere else. The only question is, how soon?

41. This is a topic that has been addressed many times here and in Greg’s other posts. I wish it weren’t necessary to belabor the point – but here’s an important new editorial, just published:

    CORONAVIRUS AND THE SPREAD OF DISINFORMATION
    Areeb Mian and Shujhat Khan
    BMC Medicine (March 18, 2020)
    https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01556-3

    ____________
    And in the same spirit:

    It’s both admirable– and very sad – that the National Center for Science Education (NCSE), so long in the forefront of evolution and climate change education, must now add Covid-19 to its “portfolio”:
    https://ncse.ngo/search/node?keys=coronavirus
    But this is what’s necessary when scientific illiteracy spreads faster than the most contagious virus.

    Reply

42. Bernard J (no Reply tag at foot of your posts for some reason)

    Excellent posts as usual Bernard J

    The big lesson that humanity needs to take from this is not just how properly to deal with pandemics, but how to listen to the science that’s telling us that human-caused climate change is the very, very big brother to coronavirus…

    It doesn’t take much searching to find articles discussing the implications of anthropogenic global warming induced climate change on the way in which pathogens mutate and migrate.

    I hope you don’t mind but I took the liberty of included a section of your excellent March 18, 2020 at 2:02 am post in a Facebook post that I made, not hard to find. The following is the section, I included a link to your post so that the entirety and context could be viewed.

    “The cornavirus has shown how capitalism has failed many in society in this emergency, and how it will itself fail as an economic model under the weight of this emergency. Societies with models of democratic and humanitarian socialism (no all you knee-jerks, not communism…), and with a much more egalitarian wealth distribution, are probably going to weather this storm better, especially if the bottom isn’t as low as it might possibly be. The experiment is now in progress – we’ll get an idea of the results over the next year…

    And it’s not just poor people, casual workers, low-skilled workers and such that will show up the failure of capitalism in this mess. Traditional businesses like restaurants, pubs, cinemas, airlines, hotels, tourism-related industries – heck, even sectors like car sales – will suffer with social distancing and lack of travel. Watch as many formerly and rabidly fervent capitalists suddenly ask for socialism to help them out of their holes.

    …

    And then there’s climate change, which most of the world has ignored for decades. Coronavirus is just the quick warm-up act for climate change (see what I did there…) and conservatives are still as blind to climate change as they were even a few days ago when they said that universal testing was communism and one can still go to work whilst infected with coronavirus “flu”…

    Buckle up people, because we’re never getting back our world as it was.”

    Not only is the human effect on climate making the spread of pathogens more likely but so is the human attack on biodiversity.

    ‘Tip of the iceberg’: is our destruction of nature responsible for Covid-19?

    Those of us with enquiring minds have anticipated the collision of our various less than fully informed actions on our planet and its ecosystems.

    The increased sale of arms in the US is a frightening indication that we are heading into a ‘dystopian novel’ world. It has only just begun.

    Reply

    1. No problem at all Lionel.

       I’m not finding it yet, but maybe soon, after the spiders have done their work…

43. I’m not finding it yet, but maybe soon, after the spiders have done their work…

    Well I best get the twenty four tarantula that I look after for a grandson on the job too.

    My assistance started at the end of 2018 when the lad decided to go on a world nature tour, a few months after his return he had a forced change of lifestyle so they came back to me. Still temporary – I hope.

    Lionel Smith – hint.

    Reply

44. CONSIDER THIS:

    To date, China and Italy have approximately the same number of reported deaths from Covid-19. To be precise, Italy (3,405) yesterday surpassed China (3,132) with respect to number of reported Covid-19 deaths.

    China (1,386,000,000) is twenty-three times as populous as Italy (60,480,000).

    Expressed as percentages of their respective populations, Italy has 23 times the number of Covid-19 deaths as China.

    Think about it: Italy – though 1/23 the size – has (relatively speaking) 23 times the number of deaths as its top rival for the Covid-19 mortality prize.

    China’s deaths have leveled off. Italy’s continue to skyrocket.

    Notwithstanding any caveats about Covid-19 testing and reporting discrepancies, or Italy’s “head start” on the epidemic, we have – considering for now just Italy and the United States – two developed Western nations with advanced medical expertise and health care systems.

    Two countries, with one ocean and half a sea between them, which share in common the fact that their politicians diddled away precious time while meanwhile their scientific experts, alarmed by the newly emerged zoonosis in Wuhan, were pulling the alarms and screaming “FIRE IN THE THEATER!.”

    What did the audience do? They sat – transfixed in their seats, gobbling down popcorn – as the Chinese horror flick went on … and on … and on.

    And now we can observe that both nations are following the same mathematical trajectory – with newly reported Covid-19 cases doubling daily.

    Only, compared with Italy, America is just getting started.
    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6.

    Reply

45. I would like to update my comment above (“COVID-19: WHAT IS IN STORE FOR THE UNITED STATES”) from two days ago. I won’t be making further revisions to this – the numbers are simply changing too fast, and the vast majority of countries on earth simply lack the health-care infrastructure and medical culture to offset current biases in our statistical picture of this pandemic.

    In other words, from here on out this is a waiting game in which we are all, to varying degrees, both observers and participants. And unfortunately – like most games – most “players” lose.
    ______________
    Every time I peek at the updated Johns Hopkins COVID-19 map, with countries seemingly jockeying for rank, it feels like watching some twisted horse race from hell.

    I can’t be the only one noticing that some horses move up, while others drop back. But in any real-life horse race I’ve ever seen, the speed of all the horses doesn’t simultaneously increase.

    I wonder if there isn’t some macabre Vegas betting on this. If so, they should bet on “long shot” entries from the Southern Hemisphere
    .
    For now (March 20 – 3:43 GMT):

    1. China 81,281
    2. Italy 47,021
    3. Spain 21,571
    4. Germany 19,848
    5. Iran 19,644
    6. U.S. 19,624
    7. France 12,632
    8. South Korea 8,652
    9. Switzerland. 5,544
    10. U.K. 4,014
    11. Netherlands 3,003
    12. Austria 2,649
    13. Norway. 1,591
    14. Belgium 2,257
    15. Norway 1,959
    and so on …
    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html?fbclid=IwAR3VWG7xreVkP2iiZDbp7swNVLmYjBh4HH94HBuiZc_eXpHXYr43u9x6hww#/bda7594740fd40299423467b48e9ecf6

    Observations:

    1. Europe, obviously, has been hit disproportionately hard. Partly this is a reporting artifact of a more developed medical infrastructure. But only partly.

    2. Meanwhile, reported Chinese cases have leveled off. However, a true two-orders-of-magnitude difference in numbers of cases between eastern and western provinces strains credulity – not only for political reasons (Imagine Chairman-of-Everything Xi saying, “We’ve now got this thing under control and the world is applauding – don’t spoil my Party”) – but also in terms of infectious disease dynamics.

    3. With the United States four to thirty times more populous than (excepting China) the other most-affected/infected countries, if the present exponential trajectory persists, we will surpass China and lead the world in numbers of confirmed Covid-19 within 14-21 days.

    Few of the most-affected countries listed here even have enough residents to give us a run for our money: Everyone there would have to become infected many times over for this to happen.

    4. Not for a nanosecond do I believe the minuscule numbers reported for Russia, Central Asia, India, Indonesia … or the African and South American continents. (But, bear in mind, it is still fall in the Southern Hemisphere – Old Man Winter has yet to appear on the scene.)
    ————
    Still, to repeat – judging from the currently available data and barring a rebound in China or more reliable reporting from India (to say nothing of Nigeria, etc.) – the U.S. will wind up having more known Covid-19 cases than anywhere else. The only question is, how soon?

    Reply

46. Here’s an intriguing glimpse into the scientific quest to craft countermeasures to the novel coronavirus:

    https://www.nytimes.com/2020/03/17/science/coronavirus-treatment.html

    Reply

47. Here’s a nifty little online app – conceptually very valuable – developed at the University of Toronto, which facilitates do-it-yourself modeling of Covid-19 pandemic spread. It’s limited insofar as it relies primarily on R-0 (Basic Reproductive Number) and what happens with and without effective control measures – but incorporating additional variables would only make results messier, and the “lean and mean” quality of this tool make it a recommended addition to your ever-expanding arsenal of Covid-19 resources..
    https://art-bd.shinyapps.io/nCov_control/

    Reply

    1. I ran a basic analysis with the SIR model — used the numbers on US infections through March 19 (did all the work in R, so easily reproducible). Even with a very conservative choice for mortality rate the numbers were horrific.

       Since that work doesn’t take any “sheltering in place” or other interventions, the takeaway is clear: don’t do anything and we’re really screwed.

       With the ass-clowns heading up the response we’re still likely screwed, but….

    2. Dean, I’ve been modelling the Australian spread for the last week, and the accumulating infection data thus far have been absolutely consistent for the dates at which one thousand, ten thousand, one hundred thousand, and one million cases are reached. In other words, the control measure that we’ve instituted to date have had no effect on a straightforward exponential rate of growth. That’s probably to be expected given that I’m likely still just tracking the infections that occurred before action was seriously taken, but I was hoping to see even a hint that the one million mark might be being pushed back (last night it came forward a day, but I suspect that might be noise…).

       My model predicted 1,067 cases on 21 March – we reached 1073 identified on that day. It currently projects 10884 by 1 April, although I anticipate that the countermeasures will start to manifest and that this date will be pushed back from then. Currently it shows that it would take to 12 April and 22 April respectively to reach 100k and one million cases, but I’m certain that those are going to be significantly pushed back, hopefully by weeks and months respectively…

       The thing that concerns me though is the current apparent momentum in the spread. Yet even this weekend there were thousands of people crowded on Sydney’s beaches – everything that our government is doing seems to be reactive to obvious problems that should have been resolved weeks ago. And they’re still encouraging students to go to school – with the numbers where they are, and unidentified infections likely to be much greater, children are going to be a prime vector for further spread, even if they do not suffer much from the infection.

       It’s clear that conservative politics has a fatal flaw in its capacity for emergency response, when that response threatens the capitalist economic model. And the coronavirus response by conservatives exactly models in scale their response to the looming climate crisis, which will be several orders of magnitude more devastating to humanity, just as it is several orders of magnitude slower…

       I take no satisfaction in telling the right wingers I know that I told them so when I remind them that I’d warned them about pandemic years ago (after SARS). They claim that I didn’t – the cognitive dissonance is profound. And when I then remind them of the climate crisis they still say that it’s not real, or that I’m exaggerating – these people just don’t seem to be able to learn…

48. Closely related is yesterday’s (3/21) Boston Globe article, “WHEN WILL THE CORONAVIRUS PANDEMIC END? WHAT SCIENTISTS CAN SAY ABOUT LIFE RETURNING TO NORMAL,” by Naomi Martin [Short answer: In about two years]. Note especially Figure 4 [Source https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf ] which graphs the projected severity of Covid-19 cases, over time, as a function of intermittent social distancing measures (U.S. and U.K.)
    https://www.bostonglobe.com/2020/03/21/nation/when-will-coronavirus-pandemic-end-what-scientists-can-say-about-life-returning-normal/?et_rid=1745483642&s_campaign=todaysheadlines:newsletter

    Reply

    1. Joseph M Thanks for your posts.

       Looking at the table on page 5 of the Imperial College COVID-19 Response Team report I noted the jump in fatality ratio from the 50 to 59 and 60-69 age group, and again at the 69-70 threshold. Being a septuagenarian (UK) with heart failure things could get rough. My other half has issues with digestion which limits the type of foods she can eat without causing sudden necessary surgical intervention. Thus restricting some foods to only three items will impact her. If the virus doesn’t get her malnutrition will. We don’t hoard, because of mobility issues we couldn’t if we wanted to. But then I know of many worse off.

       Our other concern is that we have daughters and now granddaughters in the front-line of health care and as reported they have been woefully ill supported by politicians at best out of their depth – as some of us knew they would be.

49. THE SHOCK WAVE OF COVID-19 (The New Yorker Radio Hour)

    “As the coronavirus pandemic brings the country to a standstill, David Remnick and New Yorker writers examine the scope of the damage—emotional, physical, and economic. Remnick speaks with a medical ethicist about the painful decisions that medical workers must make when ventilators and hospital beds run out; John Cassidy assesses how the economic damage will compare to the Great Depression; and an E.R. doctor describes her fear for her safety in treating the onslaught of COVID-19 without adequate supplies.”

    https://podcasts.google.com/?feed=aHR0cDovL2ZlZWRzLndueWMub3JnL2dvb2dsZXBsYXlfdG55cmFkaW9ob3Vy&episode=MjQxYTUyMWEtZWZhYi00NjBjLThmYjItNDNjOTZjMTUzMzg3

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50. There’s mounting evidence that a sudden loss of sense of smell or taste is a reliable indicator of the presence of coronavirus.

    https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html

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    1. Too early to evaluate this. However, if – as your source article suggests – anosmia sometimes presents prior to sinus congestion – this might indicate early CNS involvement (= total speculation. on my part). If so, well – NOT a good thing.

       At this very early state of. purely anecdotal information, my sense is that these symptoms (loss of smell/taste). should be considered consistent with any URI.

    2. Starting March 9, I’ve noted the dates when a doubling of total fatalities from COVID-19 occurred (global).

       3/09/20: 4,000
       3/17/20: 8,000
       3/23/20: 16,000

       https://www.worldometers.info/coronavirus/

    3. Going back further…

       2/05/20: 500
       2/10/20: 1,000
       2/18/20: 2,000
       3/09/20: 4,000
       3/17/20: 8,000
       3/23/20: 16,000

       https://www.worldometers.info/coronavirus/

51. “At this very early state of. purely anecdotal information, my sense is that these symptoms (loss of smell/taste). should be considered consistent with any URI.”

    I’ve heard news people saying something very similar today.

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    1. Obviously there’s a helluva lot more we’d like to know but can’t yet know. But there is more than enough solid information to digest – I mean, too much of it TO digest. And what we already KNOW is, I think we’d all agree, very bad. So let’s stick with what we know …

52. Very interesting news article published today, and its main primary source:
    https://www.sciencealert.com/the-new-coronavirus-could-have-been-percolating-innocently-in-humans-for-years
    https://www.nature.com/articles/s41591-020-0820-9

    As anyone who’s been following zoonoses knows, this is a very typical story. People tend to think – recall the initial days of HIV-AIDS, which turned out to be nothing but “initial” –– that these mutations appear out of nowhere and spread like wildfire, i.e., become pandemic diseases. That’s not the way it works.

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53. The scientific (vs political) jury is still very much out on hydroxychloroquine as a potential clinical treatment for Covid-19. I have read six or seven individual case reports (“Letters”) of serious adverse effects – but I think that those clinical reports, and the study cited in the article I’m linking to, simply show that this medication – and anything else a team can throw at a critically ill patient – must be evaluated and used on an individualized basis.

    As for uninfected and/or asymptomatic patients popping hydroxychloroquine, zinc lozenges, or any of a dozen proposed prophylactic agents (prescribed or OTC) – sheer lunacy.
    https://www.medscape.com/viewarticle/928798?src=wnl_edit_tpal&uac=26807CR&impID=2349039&faf=1

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