[magnus]

 The UW virology lab is going through 900 samples a day, and they want to get up to 5k samples per day, iirc.

Even better than that.  They processed 1300 (200 in state,  the rest from out of state) yesterday (Wednesday) and had a capacity of 1500 
[tweet]https://twitter.com/UWVirology/status/1238213114132172800?s=20[/tweet]

[magnus]

 The UW virology lab is going through 900 samples a day, and they want to get up to 5k samples per day, iirc.

Even better than that.  They processed 1300 (200 in state,  the rest from out of state) yesterday (Wednesday) and had a capacity of 1500 
[tweet]https://twitter.com/UWVirology/status/1238213114132172800?s=20[/tweet]

[OutsiderFan]

I suggest everyone watch Rachel Maddow’s interview with NYT reporter tonight. It’s shocking how ill-prepared the U.S. is compared to China. I’ll use it as evidence to support my above claim.

Quite true. China has things in much better control than the US. Just ask the Uyghurs. 

Please stop with the propaganda and focus on resolution.

NOTHING I say is “propaganda” and I take offense to that charge. 

I suggested watching the interview with the NYT reporter because he was reporting valuable truth that could aid in understanding. That’s what this thread is all about.

Since you would rather denigrate truth than find it yourself, let me Force-feed it to you...

- China has what they call fever centers. These are not hospitals or doctors offices that can spread infections to otherwise healthy people (someone in for a broken bone or cut).

- They take people in with fever and ask them their history. They take a white blood cell count to learn if the body has an infection brewing. They then test for regular flu.

- If there is infection and no regular flu, they take a CT scan to look for signs of lung infection.

- if no infection is found, they separate people from their families and put them in mass quarantine areas. This is key because most spread is between family members or people who live together. We don’t have designated quarantine centers to my knowledge.

- If infection is shown on CT scan, patient is tested for Covid-19.

- if positive, admitted to hospital and if not sent to out of home quarantine.

This is the Chinese triage approach, but of course does nothing to do with surveillance testing. I bring it up because I don’t believe the U.S. has these protocols and has no testing. So in this circumstance, the only thing we can do to slow and stop spread is to isolate ourselves from others, which ultimately is the most effective way to stop spread.

This is why people needed to stock up on food and provisions to be in position to do this and limit their need to be out of their homes. 

IOW: #STAYTHEFUCKHOME

[OutsiderFan]

I suggest everyone watch Rachel Maddow’s interview with NYT reporter tonight. It’s shocking how ill-prepared the U.S. is compared to China. I’ll use it as evidence to support my above claim.

Quite true. China has things in much better control than the US. Just ask the Uyghurs. 

Please stop with the propaganda and focus on resolution.

NOTHING I say is “propaganda” and I take offense to that charge. 

I suggested watching the interview with the NYT reporter because he was reporting valuable truth that could aid in understanding. That’s what this thread is all about.

Since you would rather denigrate truth than find it yourself, let me Force-feed it to you...

- China has what they call fever centers. These are not hospitals or doctors offices that can spread infections to otherwise healthy people (someone in for a broken bone or cut).

- They take people in with fever and ask them their history. They take a white blood cell count to learn if the body has an infection brewing. They then test for regular flu.

- If there is infection and no regular flu, they take a CT scan to look for signs of lung infection.

- if no infection is found, they separate people from their families and put them in mass quarantine areas. This is key because most spread is between family members or people who live together. We don’t have designated quarantine centers to my knowledge.

- If infection is shown on CT scan, patient is tested for Covid-19.

- if positive, admitted to hospital and if not sent to out of home quarantine.

This is the Chinese triage approach, but of course does nothing to do with surveillance testing. I bring it up because I don’t believe the U.S. has these protocols and has no testing. So in this circumstance, the only thing we can do to slow and stop spread is to isolate ourselves from others, which ultimately is the most effective way to stop spread.

This is why people needed to stock up on food and provisions to be in position to do this and limit their need to be out of their homes. 

IOW: #STAYTHEFUCKHOME

[M T]

A study (currently a not-yet-reviewed preprint) in Germany (described here) found that

• "The researchers found very high levels of virus emitted from the throat of patients from the earliest point in their illness —when people are generally still going about their daily routines.
  
• "Viral shedding dropped after day 5 [of symptoms] in all but two of the patients, who had more serious illness.
  
• "The scientists said at peak shedding, people with Covid-19 are emitting more than 1,000 times more virus than was emitted during peak shedding of SARS infection, a fact that likely explains the rapid spread of the virus.
  
• "The study suggests that while people with mild infections can still test positive by throat swabs for days and even weeks after their illness, those who are only mildly sick are likely not still infectious by about 10 days after they start to experience symptoms."
  

And from the study itself:

• "The present study shows that COVID-19 can often present as a common cold-like illness."
  

So, if people are spreading the illness before they know they are sick, then maybe a 1-week region-wide lock-down order would be appropriate. 
The idea is to stop the spread long enough for everyone who is infected & doesn't yet know it, to get symptoms.  (I've still seen little report of the ghost asymptomatic cases that some people believe in.)

Suppose there was a 2 week advance notice that  1 week (Saturday to Sunday) will be a Firebreak Stay Home period.  Except for emergencies, no activity outside your living space.  All grocery stores, etc. would be closed, so buy your food ahead of that firebreak.    That might give long enough for those that are infected to develop symptoms and know they are sick.    The only people they might have infected are in their household, which would then need to be quarantined.

This isn't a months-long lockdown like in China.  It is somewhat akin to the year-end closing of many regular businesses.  Having food for a week is not too undue a burden (yes, there will be people for which this is a problem).  (Actually, considering crowds just before & just after this, you probably need 2 weeks of food.)

Yes, it would be very difficult on some people.  What about kids that would go crazy locked in?   What about people that need exercise?  Etc.

But it would be better than overwhelming the health system, lots of deaths and more economic impact.

[M T]

A study (currently a not-yet-reviewed preprint) in Germany (described here) found that

• "The researchers found very high levels of virus emitted from the throat of patients from the earliest point in their illness —when people are generally still going about their daily routines.
  
• "Viral shedding dropped after day 5 [of symptoms] in all but two of the patients, who had more serious illness.
  
• "The scientists said at peak shedding, people with Covid-19 are emitting more than 1,000 times more virus than was emitted during peak shedding of SARS infection, a fact that likely explains the rapid spread of the virus.
  
• "The study suggests that while people with mild infections can still test positive by throat swabs for days and even weeks after their illness, those who are only mildly sick are likely not still infectious by about 10 days after they start to experience symptoms."
  

And from the study itself:

• "The present study shows that COVID-19 can often present as a common cold-like illness."
  

So, if people are spreading the illness before they know they are sick, then maybe a 1-week region-wide lock-down order would be appropriate. 
The idea is to stop the spread long enough for everyone who is infected & doesn't yet know it, to get symptoms.  (I've still seen little report of the ghost asymptomatic cases that some people believe in.)

Suppose there was a 2 week advance notice that  1 week (Saturday to Sunday) will be a Firebreak Stay Home period.  Except for emergencies, no activity outside your living space.  All grocery stores, etc. would be closed, so buy your food ahead of that firebreak.    That might give long enough for those that are infected to develop symptoms and know they are sick.    The only people they might have infected are in their household, which would then need to be quarantined.

This isn't a months-long lockdown like in China.  It is somewhat akin to the year-end closing of many regular businesses.  Having food for a week is not too undue a burden (yes, there will be people for which this is a problem).  (Actually, considering crowds just before & just after this, you probably need 2 weeks of food.)

Yes, it would be very difficult on some people.  What about kids that would go crazy locked in?   What about people that need exercise?  Etc.

But it would be better than overwhelming the health system, lots of deaths and more economic impact.

[cardcrimson]

I’ve mentioned before in this thread and I will mention it again.  The entirety of the Chinese response has to be considered, not just what happened late January when the scale of the pandemic became apparent.  Remember, 5 million people left Hubei province before they quarantined it. 

BC

Thanks for the reminder. . . .

[cardcrimson]

I’ve mentioned before in this thread and I will mention it again.  The entirety of the Chinese response has to be considered, not just what happened late January when the scale of the pandemic became apparent.  Remember, 5 million people left Hubei province before they quarantined it. 

BC

Thanks for the reminder. . . .

[OutsiderFan]

For anyone who wants to see Stanford's Rachell Maddow interview the NYT reporter who provides a fountain of useful insight:

https://twitter.com/MaddowBlog/status/12...2468288512

[OutsiderFan]

For anyone who wants to see Stanford's Rachell Maddow interview the NYT reporter who provides a fountain of useful insight:

https://twitter.com/MaddowBlog/status/12...2468288512

[OutsiderFan]

We all probably have beef with China, but this is pretty amazing and demonstrates a "we're all in this together" mentality we should see a lot more often, without needing a global pandemic:

[tweet]https://twitter.com/dwallacewells/status/1238477908773134338[/tweet]

[OutsiderFan]

We all probably have beef with China, but this is pretty amazing and demonstrates a "we're all in this together" mentality we should see a lot more often, without needing a global pandemic:

[tweet]https://twitter.com/dwallacewells/status/1238477908773134338[/tweet]

[burger]

There was some talk here a few days back about cuts to the CDC budget and the firing of the pandemic response leaders, and someone noted that the overall CDC budget hadn't changed much.  This article from Fortune goes into detail about the Trump administration's large cuts to pandemic response specifically.  https://fortune.com/2020/02/26/coronavir...-us-trump/

The cuts started in 2018, as the White House focused on eliminating funding to Obama-era disease security programs. In March of that year, Rear Adm. Timothy Ziemer, whose job it was to lead the U.S. response in the event of a pandemic, abruptly left the administration and his global health security team was disbanded.

That same year, the Centers for Disease Control and Prevention (CDC) was forced to slash its efforts to prevent global disease outbreak by 80% as its funding for the program began to run out. The agency, at the time, opted to focus on 10 priority countries and scale back in others, including China.

Also cut was the Complex Crises Fund, a $30 million emergency response pool that was at the secretary of state’s disposal to deploy disease experts and others in the event of a crisis. (The fund was created by former Secretary of State Hillary Clinton.)

[burger]

There was some talk here a few days back about cuts to the CDC budget and the firing of the pandemic response leaders, and someone noted that the overall CDC budget hadn't changed much.  This article from Fortune goes into detail about the Trump administration's large cuts to pandemic response specifically.  https://fortune.com/2020/02/26/coronavir...-us-trump/

The cuts started in 2018, as the White House focused on eliminating funding to Obama-era disease security programs. In March of that year, Rear Adm. Timothy Ziemer, whose job it was to lead the U.S. response in the event of a pandemic, abruptly left the administration and his global health security team was disbanded.

That same year, the Centers for Disease Control and Prevention (CDC) was forced to slash its efforts to prevent global disease outbreak by 80% as its funding for the program began to run out. The agency, at the time, opted to focus on 10 priority countries and scale back in others, including China.

Also cut was the Complex Crises Fund, a $30 million emergency response pool that was at the secretary of state’s disposal to deploy disease experts and others in the event of a crisis. (The fund was created by former Secretary of State Hillary Clinton.)

[Goose]

The FDA has approved the Roche corona virus test using their automated system. This will help get more testing online, as lots of labs have these machines.

Gavin Newsom was complaining (yesterday I think) that the CDC test kits were missing some materials necessary to do the test, and that the CDC was "well aware of the fact". I really wish he had stated what components were missing. Does anybody know what was missing? Clearly, all the primers would have to be there. Makes no sense to issue the kit otherwise. The dna polymerase is a bit more generic, and it could be assumed the labs already had it, although that seems like a questionable choice. So what else is needed that wasn't there?

[Goose]

The FDA has approved the Roche corona virus test using their automated system. This will help get more testing online, as lots of labs have these machines.

Gavin Newsom was complaining (yesterday I think) that the CDC test kits were missing some materials necessary to do the test, and that the CDC was "well aware of the fact". I really wish he had stated what components were missing. Does anybody know what was missing? Clearly, all the primers would have to be there. Makes no sense to issue the kit otherwise. The dna polymerase is a bit more generic, and it could be assumed the labs already had it, although that seems like a questionable choice. So what else is needed that wasn't there?

[BobK]

Newsom did state what was missing. I read that yesterday in his statement
So it’s public

[BobK]

Newsom did state what was missing. I read that yesterday in his statement
So it’s public

[cardcrimson]

There was some talk here a few days back about cuts to the CDC budget and the firing of the pandemic response leaders, and someone noted that the overall CDC budget hadn't changed much.  This article from Fortune goes into detail about the Trump administration's large cuts to pandemic response specifically.  https://fortune.com/2020/02/26/coronavir...-us-trump/

The cuts started in 2018, as the White House focused on eliminating funding to Obama-era disease security programs. In March of that year, Rear Adm. Timothy Ziemer, whose job it was to lead the U.S. response in the event of a pandemic, abruptly left the administration and his global health security team was disbanded.

That same year, the Centers for Disease Control and Prevention (CDC) was forced to slash its efforts to prevent global disease outbreak by 80% as its funding for the program began to run out. The agency, at the time, opted to focus on 10 priority countries and scale back in others, including China.

Also cut was the Complex Crises Fund, a $30 million emergency response pool that was at the secretary of state’s disposal to deploy disease experts and others in the event of a crisis. (The fund was created by former Secretary of State Hillary Clinton.)

https://www.factcheck.org/2020/03/false-...emic-work/

Yes, the NSC's Global Health Security Team was reassigned in 2018. Does it matter that is was created in 2017 and didn't even exist under the prior administration?

What difference, at this point, does it make? We as a country need to focus on resolutions.

[cardcrimson]

There was some talk here a few days back about cuts to the CDC budget and the firing of the pandemic response leaders, and someone noted that the overall CDC budget hadn't changed much.  This article from Fortune goes into detail about the Trump administration's large cuts to pandemic response specifically.  https://fortune.com/2020/02/26/coronavir...-us-trump/

The cuts started in 2018, as the White House focused on eliminating funding to Obama-era disease security programs. In March of that year, Rear Adm. Timothy Ziemer, whose job it was to lead the U.S. response in the event of a pandemic, abruptly left the administration and his global health security team was disbanded.

That same year, the Centers for Disease Control and Prevention (CDC) was forced to slash its efforts to prevent global disease outbreak by 80% as its funding for the program began to run out. The agency, at the time, opted to focus on 10 priority countries and scale back in others, including China.

Also cut was the Complex Crises Fund, a $30 million emergency response pool that was at the secretary of state’s disposal to deploy disease experts and others in the event of a crisis. (The fund was created by former Secretary of State Hillary Clinton.)

https://www.factcheck.org/2020/03/false-...emic-work/

Yes, the NSC's Global Health Security Team was reassigned in 2018. Does it matter that is was created in 2017 and didn't even exist under the prior administration?

What difference, at this point, does it make? We as a country need to focus on resolutions.

[SeaLoon]

I think the missing reagent was the RNA Extraction Reagents from some of the CDC kits.

[SeaLoon]

I think the missing reagent was the RNA Extraction Reagents from some of the CDC kits.

[BostonCard]

Because sometimes we all need a little humor...

https://www.youtube.com/watch?v=uo7HB-slsm4

BC

[BostonCard]

Because sometimes we all need a little humor...

https://www.youtube.com/watch?v=uo7HB-slsm4

BC

[Papa John]

Not a topic at the top of everyone's list, I know, but yesterday Little League International recommended suspending all Little League activities until April 6. 

https://www.littleleague.org/player-safe...us-update/

I'm not sure why this is a recommendation and not a flat-out order, but our local Little League near Santa Barbara immediately complied.

[Papa John]

Not a topic at the top of everyone's list, I know, but yesterday Little League International recommended suspending all Little League activities until April 6. 

https://www.littleleague.org/player-safe...us-update/

I'm not sure why this is a recommendation and not a flat-out order, but our local Little League near Santa Barbara immediately complied.

[2006alum]

Apologies if this has already been posted, but it's been one of the best comprehensive advisories I've seen:

University of California, San Francisco 
BioHub Panel on COVID-19
March 10, 2020

• Panelists
  

• • Joe DeRisi:  UCSF’s top infectious disease researcher.  Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford).  Co-inventor of the chip used in SARS epidemic.
    
    
  • Emily Crawford:  COVID task force director.  Focused on diagnostics
    
    
  • Cristina Tato:   Rapid Response Director.  Immunologist.  
    
    
  • Patrick Ayescue:   Leading outbreak response and surveillance.  Epidemiologist.  
    
    
  • Chaz Langelier:   UCSF Infectious Disease doc
    

What’s below are essentially direct quotes from the panelists.  I bracketed the few things that are not quotes.

• Top takeaways 
  

• • At this point, we are past containment.  Containment is basically futile.  Our containment efforts won’t reduce the number who get infected in the US.  
    
    
  • Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak.  In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers.  And to buy time, in hopes a drug can be developed. 
    
    
  • How many in the community already have the virus?  No one knows.
    
    
  • We are moving from containment to care.  
    
    
  • We in the US are currently where at where Italy was a week ago.  We see nothing to say we will be substantially different.
    
    
  • 40-70% of the US population will be infected over the next 12-18 months.  After that level you can start to get herd immunity.  Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
    
    
  • [We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die.  The panelists did not disagree with our estimate.  This compares to seasonal flu’s average of 50K Americans per year.  Assume 50% of US population, that’s 160M people infected.  With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.]  
    

• • • The fatality rate is in the range of 10X flu.
      
      
    • This assumes no drug is found effective and made available.
      

• • The death rate varies hugely by age.  Over age 80 the mortality rate could be 10-15%.  [See chart by age Signe found online, attached at bottom.]  
    
    
  • Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
    
    
  • I can only tell you two things definitively.  Definitively it’s going to get worse before it gets better.  And we'll be dealing with this for the next year at least.  Our lives are going to look different for the next year.
    

• What should we do now?  What are you doing for your family?
  

• • Appears one can be infectious before being symptomatic.  We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms.  We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
    
    
  • How long does the virus last?
    

• • • On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this
      
      
    • The virus is very susceptible to common anti-bacterial cleaning agents:  bleach, hydrogen peroxide, alcohol-based.
      

• • Avoid concerts, movies, crowded places.
    
    
  • We have cancelled business travel.  
    
    
  • Do the basic hygiene, eg hand washing and avoiding touching face.
    
    
  • Stockpile your critical prescription medications.  Many pharma supply chains run through China.  Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing. 
    
    
  • Pneumonia shot might be helpful.  Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
    
    
  • Get a flu shot next fall.  Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
    
    
  • We would say “Anyone over 60 stay at home unless it’s critical”.  CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
    
    
  • We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes.  Then are not letting them out of the house.  The other members of the family are washing hands the moment they come in.
    
    
  • Three routes of infection
    

• • • Hand to mouth / face
      
      
    • Aerosol transmission
      
      
    • Fecal oral route
      

• What if someone is sick?
  

• • If someone gets sick, have them stay home and socially isolate.  There is very little you can do at a hospital that you couldn’t do at home.  Most cases are mild.  But if they are old or have lung or cardio-vascular problems, read on.
    
    
  • If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
    
    
  • There is no accepted treatment for COVID-19.  The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease.  ie to prevent sepsis.
    
    
  • If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China.  Need to find a doc there in order to ask to enroll.  Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19.  If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines.  [More I found online.]
    
    
  • Why is the fatality rate much higher for older adults?
    

• • • Your immune system declines past age 50
      
      
    • Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness.  These conditions are higher in older adults.   
      
      
    • Risk of pneumonia is higher in older adults.  
      

• What about testing to know if someone has COVID-19?  
  

• • Bottom line, there is not enough testing capacity to be broadly useful.  Here’s why.
    
    
  • Currently, there is no way to determine what a person has other than a PCR test.  No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating”.
    
    
  • A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA.  However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives. 
    
    
  • The PCR test requires kits with reagents and requires clinical labs to process the kits. 
    
    
  • While the kits are becoming available, the lab capacity is not growing.  
    
    
  • The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day.  For the nation.
    
    
  • Expanding processing capacity takes “time, space, and equipment.”  And certification.   ie it won’t happen soon.
    
    
  • UCSF and UCBerkeley have donated their research labs to process kits.  But each has capacity to process only 20-40 kits per day.  And are not clinically certified.
    
    
  • Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.
    

• How well is society preparing for the impact?
  

• • Local hospitals are adding capacity as we speak.  UCSF’s Parnassus campus has erected “triage tents” in a parking lot.  They have converted a ward to “negative pressure” which is needed to contain the virus.  They are considering re-opening the shuttered Mt Zion facility.
    
    
  • If COVID-19 affected children then we would be seeing mass departures of families from cities.  But thankfully now we know that kids are not affected.
    
    
  • School closures are one the biggest societal impacts.  We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects.  If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services.  
    
    
  • Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis.  They do not have the capacity to sustain for outbreaks that last for months.  Other solutions will have to be found.
    
    
  • What will we do to handle behavior changes that can last for months?
    

• • • Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.
      
      
    • Kids home due to school closures
      

• • [Dr. DeRisi had to leave the meeting for a call with the governor’s office.  When he returned we asked what the call covered.]  The epidemiological models the state is using to track and trigger action.  The state is planning at what point they will take certain actions.  ie what will trigger an order to cease any gatherings of over 1000 people.  
    

• Where do you find reliable news?
  

• • The John Hopkins Center for Health Security site.   Which posts daily updates.  The site says you can sign up to receive a daily newsletter on COVID-19 by email.  [I tried and the page times out due to high demand.  After three more tries I was successful in registering for the newsletter.]  
    
    
  • The New York Times is good on scientific accuracy.
    

• Observations on China
  

• • Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19.  
    
    
  • While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.
    
    
  • Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand.  Wuhan built 2 additional hospitals in 2 weeks.  Even so, most patients were sent to gymnasiums to sleep on cots. 
    
    
  • Early on no one had info on COVID-19.  So China reacted in a way unique modern history, except in wartime.  
    

• Every few years there seems another:  SARS, Ebola, MERS, H1N1, COVID-19.  Growing strains of antibiotic resistant bacteria.  Are we in the twilight of a century of medicine’s great triumph over infectious disease?
  

• • "We’ve been in a back and forth battle against viruses for a million years."  
    
    
  • But it would sure help if every country would shut down their wet markets.  
    
    
  • As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa.  See article on Wired magazine on sequencing of virus from Cambodia.
    

[2006alum]

Apologies if this has already been posted, but it's been one of the best comprehensive advisories I've seen:

University of California, San Francisco 
BioHub Panel on COVID-19
March 10, 2020

• Panelists
  

• • Joe DeRisi:  UCSF’s top infectious disease researcher.  Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford).  Co-inventor of the chip used in SARS epidemic.
    
    
  • Emily Crawford:  COVID task force director.  Focused on diagnostics
    
    
  • Cristina Tato:   Rapid Response Director.  Immunologist.  
    
    
  • Patrick Ayescue:   Leading outbreak response and surveillance.  Epidemiologist.  
    
    
  • Chaz Langelier:   UCSF Infectious Disease doc
    

What’s below are essentially direct quotes from the panelists.  I bracketed the few things that are not quotes.

• Top takeaways 
  

• • At this point, we are past containment.  Containment is basically futile.  Our containment efforts won’t reduce the number who get infected in the US.  
    
    
  • Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak.  In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers.  And to buy time, in hopes a drug can be developed. 
    
    
  • How many in the community already have the virus?  No one knows.
    
    
  • We are moving from containment to care.  
    
    
  • We in the US are currently where at where Italy was a week ago.  We see nothing to say we will be substantially different.
    
    
  • 40-70% of the US population will be infected over the next 12-18 months.  After that level you can start to get herd immunity.  Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
    
    
  • [We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die.  The panelists did not disagree with our estimate.  This compares to seasonal flu’s average of 50K Americans per year.  Assume 50% of US population, that’s 160M people infected.  With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.]  
    

• • • The fatality rate is in the range of 10X flu.
      
      
    • This assumes no drug is found effective and made available.
      

• • The death rate varies hugely by age.  Over age 80 the mortality rate could be 10-15%.  [See chart by age Signe found online, attached at bottom.]  
    
    
  • Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
    
    
  • I can only tell you two things definitively.  Definitively it’s going to get worse before it gets better.  And we'll be dealing with this for the next year at least.  Our lives are going to look different for the next year.
    

• What should we do now?  What are you doing for your family?
  

• • Appears one can be infectious before being symptomatic.  We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms.  We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
    
    
  • How long does the virus last?
    

• • • On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this
      
      
    • The virus is very susceptible to common anti-bacterial cleaning agents:  bleach, hydrogen peroxide, alcohol-based.
      

• • Avoid concerts, movies, crowded places.
    
    
  • We have cancelled business travel.  
    
    
  • Do the basic hygiene, eg hand washing and avoiding touching face.
    
    
  • Stockpile your critical prescription medications.  Many pharma supply chains run through China.  Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing. 
    
    
  • Pneumonia shot might be helpful.  Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
    
    
  • Get a flu shot next fall.  Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
    
    
  • We would say “Anyone over 60 stay at home unless it’s critical”.  CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
    
    
  • We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes.  Then are not letting them out of the house.  The other members of the family are washing hands the moment they come in.
    
    
  • Three routes of infection
    

• • • Hand to mouth / face
      
      
    • Aerosol transmission
      
      
    • Fecal oral route
      

• What if someone is sick?
  

• • If someone gets sick, have them stay home and socially isolate.  There is very little you can do at a hospital that you couldn’t do at home.  Most cases are mild.  But if they are old or have lung or cardio-vascular problems, read on.
    
    
  • If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
    
    
  • There is no accepted treatment for COVID-19.  The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease.  ie to prevent sepsis.
    
    
  • If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China.  Need to find a doc there in order to ask to enroll.  Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19.  If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines.  [More I found online.]
    
    
  • Why is the fatality rate much higher for older adults?
    

• • • Your immune system declines past age 50
      
      
    • Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness.  These conditions are higher in older adults.   
      
      
    • Risk of pneumonia is higher in older adults.  
      

• What about testing to know if someone has COVID-19?  
  

• • Bottom line, there is not enough testing capacity to be broadly useful.  Here’s why.
    
    
  • Currently, there is no way to determine what a person has other than a PCR test.  No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating”.
    
    
  • A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA.  However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives. 
    
    
  • The PCR test requires kits with reagents and requires clinical labs to process the kits. 
    
    
  • While the kits are becoming available, the lab capacity is not growing.  
    
    
  • The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day.  For the nation.
    
    
  • Expanding processing capacity takes “time, space, and equipment.”  And certification.   ie it won’t happen soon.
    
    
  • UCSF and UCBerkeley have donated their research labs to process kits.  But each has capacity to process only 20-40 kits per day.  And are not clinically certified.
    
    
  • Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.
    

• How well is society preparing for the impact?
  

• • Local hospitals are adding capacity as we speak.  UCSF’s Parnassus campus has erected “triage tents” in a parking lot.  They have converted a ward to “negative pressure” which is needed to contain the virus.  They are considering re-opening the shuttered Mt Zion facility.
    
    
  • If COVID-19 affected children then we would be seeing mass departures of families from cities.  But thankfully now we know that kids are not affected.
    
    
  • School closures are one the biggest societal impacts.  We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects.  If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services.  
    
    
  • Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis.  They do not have the capacity to sustain for outbreaks that last for months.  Other solutions will have to be found.
    
    
  • What will we do to handle behavior changes that can last for months?
    

• • • Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.
      
      
    • Kids home due to school closures
      

• • [Dr. DeRisi had to leave the meeting for a call with the governor’s office.  When he returned we asked what the call covered.]  The epidemiological models the state is using to track and trigger action.  The state is planning at what point they will take certain actions.  ie what will trigger an order to cease any gatherings of over 1000 people.  
    

• Where do you find reliable news?
  

• • The John Hopkins Center for Health Security site.   Which posts daily updates.  The site says you can sign up to receive a daily newsletter on COVID-19 by email.  [I tried and the page times out due to high demand.  After three more tries I was successful in registering for the newsletter.]  
    
    
  • The New York Times is good on scientific accuracy.
    

• Observations on China
  

• • Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19.  
    
    
  • While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.
    
    
  • Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand.  Wuhan built 2 additional hospitals in 2 weeks.  Even so, most patients were sent to gymnasiums to sleep on cots. 
    
    
  • Early on no one had info on COVID-19.  So China reacted in a way unique modern history, except in wartime.  
    

• Every few years there seems another:  SARS, Ebola, MERS, H1N1, COVID-19.  Growing strains of antibiotic resistant bacteria.  Are we in the twilight of a century of medicine’s great triumph over infectious disease?
  

• • "We’ve been in a back and forth battle against viruses for a million years."  
    
    
  • But it would sure help if every country would shut down their wet markets.  
    
    
  • As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa.  See article on Wired magazine on sequencing of virus from Cambodia.
    

[stupac2]

Oakland closes its schools: https://twitter.com/OUSDNews/status/1238514679875391489

I believe this is now most of the East Bay.

My wife's company went from "WFH encouraged" to "WFH mandatory" over the course of like 3 hours. She was WFH today anyway, and did an Trader Joe's trip to stock up on frozen stuff (we emptied our chest freezer in advance of our construction, but that's looking less plausible now) and it was apparently very crowded and missing some amount of stuff, mainly pasta and rice. Fortunately (for us at least) most people don't know how to turn flour into bread, so she was able to stock up on flour.

My company is too small and focused on actual physical stuff to do mandatory WFH, especially my role, but we'll see. Already a number of people staying home because they're sick (even if the symptoms aren't specifically covid-related).

But it would sure help if every country would shut down their wet markets.

Maybe one slight good that will come out of this is that finally, finally actually happening.

[stupac2]

Oakland closes its schools: https://twitter.com/OUSDNews/status/1238514679875391489

I believe this is now most of the East Bay.

My wife's company went from "WFH encouraged" to "WFH mandatory" over the course of like 3 hours. She was WFH today anyway, and did an Trader Joe's trip to stock up on frozen stuff (we emptied our chest freezer in advance of our construction, but that's looking less plausible now) and it was apparently very crowded and missing some amount of stuff, mainly pasta and rice. Fortunately (for us at least) most people don't know how to turn flour into bread, so she was able to stock up on flour.

My company is too small and focused on actual physical stuff to do mandatory WFH, especially my role, but we'll see. Already a number of people staying home because they're sick (even if the symptoms aren't specifically covid-related).

But it would sure help if every country would shut down their wet markets.

Maybe one slight good that will come out of this is that finally, finally actually happening.

[Snorlax94]

Based on an email I received from the local school district, schools in Santa Clara County are shutting down for 3 weeks

[Snorlax94]

Based on an email I received from the local school district, schools in Santa Clara County are shutting down for 3 weeks

[cardcrimson]

It appears that investors have faith in what's being said at the White House presser. Impressive collection of both industry and health. Dow up over 1000 points since the beginning of the press conference.

Time will tell.

[cardcrimson]

It appears that investors have faith in what's being said at the White House presser. Impressive collection of both industry and health. Dow up over 1000 points since the beginning of the press conference.

Time will tell.

[82lsju]

Public schools throughout Santa Clara County will close to students Monday (March 16) through April 3 in light of the coronavirus pandemic, County Superintendent of Schools Mary Ann Dewan announced at a press conference today (March 13).

https://www.losaltosonline.com/news/sect...gatherings

[82lsju]

Public schools throughout Santa Clara County will close to students Monday (March 16) through April 3 in light of the coronavirus pandemic, County Superintendent of Schools Mary Ann Dewan announced at a press conference today (March 13).

https://www.losaltosonline.com/news/sect...gatherings

[cardcrimson]

Apple reopening all it's stores in China.

https://www.reuters.com/article/us-healt...SKBN20Z3VX

[cardcrimson]

Apple reopening all it's stores in China.

https://www.reuters.com/article/us-healt...SKBN20Z3VX

[stupac2]

Don't worry everyone, Stanford is extending the football season tickets renewal deadline! We can all rest easy now.

[stupac2]

Don't worry everyone, Stanford is extending the football season tickets renewal deadline! We can all rest easy now.