Outside Topic Covid-19 considerations

[OutsiderFan]

Given we are on the verge of an unprecedented public health crisis, I hope the mods don't shut this down because it is too "controversial" to discuss here, but information is power, and I have some that I feel will help people at least a little.

Let me preface by making clear I'm not a doctor or scientist, though I have a "scientific mind" if that makes sense. I've been following the Novel Coronavirus SARS-CoV-2 that leads to Covid-19, for over a month, pretty closely.  

First some facts based on the best available scientific and medical data, much not peer-reviewed, but still useful:

NOT Flu
- The flu has a Rate of Transmission (Ro - "R naught) of about 1, meaning basically 1-1 spread that doesn't grow much.
- Covid-19 has a Ro of at least 2.5 and probably closer to 5 or 6, meaning geometric spread.
- The virus transmits from people not showing symptoms, to others, and can incubate for up to 24 days before symptoms show.
- Spreads in multiple ways, including surfaces, water droplets (sneeze), and via air (think what you see floating in room with sun beam).
- Shows signs of being able to live 9 days on surfaces while flu is up to 48 hours.
- The complication rate (pneumonia/lung infection) is about 20% of those diagnosed with Covid-19. 
- Complication requires oxygen, ventilator and on average 8-day hospital stay.
- Death rate ~ 2% based on known data; flu is .1% = this is 10x-20x more deadly than flu.
- Re-infection is occurring.
- Some research shows second infection worse, because immune system overreacts and attacks body, could complicate vaccine development.

Other items to think about
- Health workers at severe risk; patients visit with virus showing no symptoms, spread to care givers, they see new patients, who transmit to others.
- Chinese doctor who blew whistle on virus (and died) was an Ophthalmologist.
- He didn't have Personal Protective Equipment (PPE) to see patients who had the virus but not showing symptoms, because why would he?
- South Korea has tested 10's of thousands and has nearly 2,000 cases.
- U.S. has tested less than 500; it's more than likely spreading in U.S. and CA in particular with nobody knowing.
- Flu cases in U.S. may actually be Covid-19 because CDC has had inadequate Covid-19 testing requirements.
- Masks really do not help much.
- Stock up on food and water - just in case.
- According to my insurance company (Anthem), someone has to declare a "national health emergency" before they will cover testing (not require out of pocket payment that creates economic incentive to avoid testing) for a virus.  When asked who, Anthem rep said "we don't know."

Personal Anecdote
I'm living in CT now and have a friend who is a nurse who specializes in infection control. He went to a meeting yesterday with a medical director for a local hospital he has known and respected for years. Friend was told of a Covid-19 case confirmed in New Haven on Wednesday morning, Feb. 26. The reason I bring this up is because this person was not reported as part of official CDC U.S. case count on Wednesday. It seems to be proof the U.S. numbers are not accurate. Everyone has probably heard about the UC Davis case now being attributed to community spread (nobody knows how the person got infected), but I believe this New Haven example is also such a case, and this thing is already spreading significantly in the U.S., undetected, maybe even in those who are thought to just have the flu.

This is the best information I have to provide. I hope you all appreciate it and take appropriate measures to protect yourself, your families, and communities.

[BobK]

I believe this is very important and thank you for posting. No politics need to be added here. Just to great health for all

[CowboyIndian]

(not require out of pocket payment that creates incentive to not get testes) 

The transitional community is concerned.

PS - Thanks for the info

[OutsiderFan]

(not require out of pocket payment that creates incentive to not get testes) 

The transitional community is concerned.

PS - Thanks for the info

OK, smarty, fixed the typo and re-worded for your pleasure!

[Publius]

Thanks OutsiderFan.  I hope we can keep this thread alive as I have found theCARDboard to be one of the best sources of information and insight on a whole range of topics.

[2006alum]

Speaking for this mod only, I am A-OK with this. Thanks for sharing the helpful information, and alarming that the New Haven case hasn't even been reported. I am probably on the more distrustful/assume-the-worst side just by temperament, but I have been assuming this will be worse than most have seemed to assume. Once I heard that someone tested positive 27 days after leaving Wuhan and without showing any symptoms, that made me think this will be an extraordinarily difficult virus to detect and contain.

[burger]

@OutsiderFan's post is great but comes with a couple of caveats:

1) The early mortailty estimates may be wrong.  With H1N1 flu (swine flu, 2009), some of the early fatality rate estimates were off by a factor of 100.  Not saying that's true here, but there is quite a bit of uncertainty, and the numbers could change either way.  There could be deaths that were not attributed to the virus (this would mean the rate is actually higher), and there could be mild cases that didn't count towards the total (which would mean a lower death rate). 

2) I would be cautious about some of the extreme reports. There are alternate explanations for the 27-day incubation period (early test failed to detect or the patient picked up the virus elsewhere) and the second infection (patient never recovered, initial false positive test, etc.).  Again, I'm not saying these things are wrong.  It's just uncertain until more data come in.

One thing I think not mentioned above is that the disease seems to hit older (over 60, maybe) and immune compromised people much harder.  So if that's you, be extra careful.

[M T]

I've seen report that the death rate was about 7% for 65+ patients, down to 1% for children.  
This 2-week old report indicates death rate as
   0-39 0.2%
 40-49 0.4%
 50-59 1.3%
 60-69 3.6%
 70-79 8.0%
 80+  14.8%
Males: 2.8%
Females: 1.7%

Edit: CNN report on the same Chinese study 

The new study examined data from 72,314 patients, 44,672 of which were confirmed cases of the virus (61.8%), along with 10,567 clinically diagnosed cases (14.6%) and 16,186 suspected cases (22.4%). An additional 889 cases examined did not show any symptoms.

What I haven't seen is any indication of the percent of people that don't get this disease even if exposed. 
As of Feb. 24, the number of people infected in China as 77,000 (13.8% severe, 4.7% critical - I think those are disjoint).  The city of Wuhan has a population of 11M.  The density of infection in the population is less than 0.7% (based on all cases having been counted and all are in that city - neither of which is right)

(For comparison, L.A. metropolitan area has a population of 18.7M (Calif. 39.5M).  An equal infection density would be 131,000.
13.8% = 18,000;  4.7% = 6,000, total 24,000.  The entire state of California has about  74,000 beds, suggesting L.A. metropolitan area might have 35,000 beds.)

I don't know the normal housing situation, the use of mass transit, nor how health care is provided in the most impacted area in China.  In California, "retirement" homes tend to pack older people into community housing at a denser rate than younger people, with shared eating & common areas, with shared staff serving many of them.  I can imagine that would tend toward having a higher infection rate (and spread) among such people.  However, death rate (as a % of infections) would initially seem to be independent of that.  Lack of resources ($) and overwhelmed care could impact death rates.

In our area, the densest packing of people would seem to be in mass transit.  Sporting events also converge a large group of otherwise strangers into a tight group.   Schools & churches & work places tend to have smaller, but more, groups brought together.   People that live together (families, dorms, senior housing, etc.) are going to expose one another.  (I would classify cabs/Uber/Lyft as dense packing because of the number of people in each vehicle during a 9-day period.)

I'd expect we soon will have strong pleas of "Stay home if you have ANY symptoms."  (Who doesn't have some symptoms?  I've been blaming allergies for an occasional little cough or sneeze.)   That will give way to stronger warnings or measures.  But what person struggling to support their family is going to figure they need to stay home for a mild flu?   For instance, in my work space, I might avoid coworkers that might be sick, but what about the cleaning staff that comes into every office & common area at night, or the guards that periodically patrol our halls? We share doorknobs, elevator buttons, light switches, trash cans, basins, etc.

The purpose of a general quarantine or shutdown of mass transit & businesses, if it should come to that, is to spread the infections out over time, so health facilities aren't overwhelmed (reducing effective care to those in that big wave).   I'm sure there will be some that will question the effectiveness or the fairness of such a decision.  (I won't be questioning it.  I'm more likely to question why did it take so long.)

I hope that many people are able to telecommute (voluntarily or otherwise) and reduce their risk & the risk to others they might have otherwise exposed.  But there are many people (including most of the lower income people) that can't.

Good luck to us all.

Btw, studies do show that thoroughly washing hands is better than using the alcohol-based hand sanitizers, for removing viruses from hands.  But the sanitizers are effective if you don't have access to soap & water.  (The "antibacterial" hand washes are now generally banned as not having been shown as safe & effective.)

[OutsiderFan]

The data is not slam dunk reliable at this point for sure. Maybe call it directional in nature, kind of like how a Hurricane might weaken or not threaten a given location, but you certainly want to be prepared.  Many have speculated China's death numbers are way higher than officially reported, and other countries have way under-reported cases.

The country with the best data - and tried to get out in front of it most - appears to be South Korea, but still has ~2,000 cases now after just 30 at this time last week. France is now up to 38 officially confirmed cases today, so it's getting harder to believe it isn't a big threat in the U.S.

The Saudi Kingdom just stopped all visits to Mecca and Medina - a monumentally of immense proportions deal for Muslim world.

[JJJ]

Japan has announced closure of elementary and middle schools until April. It would’ve been the end of the academic year soon so not as mind-boggling as if done in the US but still unprecedented. At least one international school (on US timetable) is shifting to “distance” (online) learning. 

https://www.japantimes.co.jp/news/2020/0...lgnOyVuiEc

[oldalum]

a couple comments:
1. very little truly hard information is known, so I would say most facts are actually "facts" at the present.
2. the true mortality rates are less than the stated ones, because the denominators are currently unknown and likely much larger than used to calculate those mortality rates at present (i.e., many mild and even asymptomatic infections are not counted because the individuals are not being tested)

[M T]

Friend was told of a Covid-19 case confirmed in New Haven on Wednesday morning, Feb. 26. The reason I bring this up is because this person was not reported as part of official CDC U.S. case count on Wednesday. It seems to be proof the U.S. numbers are not accurate.

FYI, the CDC website says

This page will be updated regularly on Mondays, Wednesdays, and Fridays.
COVID-19: Confirmed Cases in the United States*†
† Numbers closed out at 4 p.m. the day before reporting.

From what you wrote, I see no evidence that "the U.S. numbers are not accurate", much less "proof".  The numbers may be slightly out of date (up to 3.5 days), but that is documented.

Added: WHO's sitreps of COVID-19.

[cardcrimson]

This 2-week old report indicates death rate as

   0-39 0.2%

 40-49 0.4%

 50-59 1.3%

 60-69 3.6%

 70-79 8.0%

 80+  14.8%

Males: 2.8%

Females: 1.7%

If this is true, I'm in trouble--my death rate will nearly triple within a year. . ..

[Snorlax94]

I appreciate this thread and especially look forward to insights and information from people with a medical background.

This thread has listed some facts that I haven't seen listed elsewhere, and I'd be interested to see the sources for them. I'm not disputing them, but there have been some assertions I haven't seen mentioned elsewhere, so I'd like to dig into them more.

For example, it was listed here that Covid-19 has an Ro of at least 2.5. I haven't read any place listing a number that high. And if it were that high, how is it that the numbers from Wuhan have come down so much?

Also, I haven't heard of case(s) where symptoms didn't show up until 24 days later. The CDC currently lists 2-14 days. 
https://www.cdc.gov/coronavirus/2019-nco...ptoms.html

Also, it was suggested that reinfection, if that is verified, could complicate the development of a vaccine, but the description I've seen was that the virus was dormant. This could make containment more difficult, but from my reading, it wouldn't necessarily complicate vaccination.
https://news.sky.com/story/coronavirus-j...9-11944295

I'm also curious about 2 things from other Cardboard members.
1) How wide of an impact do they think (or predict) it will ultimately be, and
2) Are they taking any particular actions or preparations

For my part
1) Domestically, I think there is <50% chance there will be significant fatalities in the US (enough to significantly change the typical annual US flu fatalities). I would expect that with increased hygiene and caution (people wash their hands better, stay home when they are sick, and self-quarantine after international travel),  I could see a >50% chance that the total number of flu+covid 19 fatalities in the US in 2020 and 2021 will actually decrease (be below the annual average of ~40,000). Globally, I could see thousands to tens of thousands of covid 19 fatalities in less developed nations, and a good chance (>35%) of a significant global economic impact. 
2) With that domestic expectation I am not making many changes in my life. I am washing my hands even more thoroughly that I usually do. I was considering some international travel this summer, and have stopped considering that. I have decided not to attend a conference in Las Vegas in June that I usually go to, but still plan on driving to the San Diego Comic Con this summer (first time attendee!). I am somewhat reducing even my domestic travel plans this year, and if I fly, I will purchase refundable tickets just in case there is a regional flare-up. But otherwise, I haven't made any other changes. I still plan to take the family to see my parents in Washington over Christmas. I don't plan to stock up on supplies any more than I usually do as part of my earthquake preparedness. I'll try to make sure I have more than a month's supply of any prescriptions in case there is a supply disruption. I already had a small supply of N-95 masks due to my allergies and sensitivity to CA fire smoke, but haven't purchased any more due to covid 19 (although I would if there was not any price gouging).

[JJJ]

- South Korea has tested 10's of thousands and has nearly 2,000 cases.

For those who don't know but want to read about the South Korean cases.

Then, on Feb. 17, a 31st case surfaced at a health clinic in Daegu, a city about 150 miles (240 km) south of the capital where the vast majority of known infections were located. An unidentified 61-year-old woman, who lived there and occasionally commuted to Seoul, tested positive for the novel coronavirus.



It seemed like a standard case until public health authorities started tracing the patient’s tracks. What they learned shocked them. The woman had, during the previous 10 days, attended two worship services with at least 1,000 other members of her secretive religious sect whose leader says the end of days is coming.

https://www.japantimes.co.jp/news/2020/0...lhDgUpujIU

[oldalum]

At this point I'm only making travel plans that are fully refundable (on Southwest, full credit-able). I've read that travel insurance generally will not cover cancellations due to the virus, except for the very expensive "cancel for any reason" policies.

It is making life more complicated for those of us with children studying abroad this spring. My daughter has tickets for a week break to go to Milan and Venice in 3 weeks, but just today I persuaded her to change her destinations.

[fullmetal]

I did read the Ro figure as greater than 2 in a couple places online.  You may presume that 15-16 Chinese cities (45 million people) would not have been quarantined (essentially martial law for 3+ weeks now) if the Ro were not truly worrisome.  (Think about that scale.)  The Chinese govt is taking this extremely seriously.  It's very hard to contain a disease where contagious carriers don't know they're infected until 2-14 days after initial infection.


The reported mortality rates mean that you as an individual probably have a decent chance of survival, but applied to entire populations, the implications are not good.  Modern society, and the economy, can't handle large numbers of the population out of commission with the illness even if they do survive.  What we do in response to this virus is to protect all of us and not just ourselves as individuals.

[82lsju]

At this point I'm only making travel plans that are fully refundable (on Southwest, full credit-able). I've read that travel insurance generally will not cover cancellations due to the virus, except for the very expensive "cancel for any reason" policies.

It is making life more complicated for those of us with children studying abroad this spring. My daughter has tickets for a week break to go to Milan and Venice in 3 weeks, but just today I persuaded her to change her destinations.

related to this Stanford is recalling students from Florence

Stanford students currently studying abroad in Florence will have to return home before the start of next week, the Bing Overseas Studies Program (BOSP) announced to program students Tuesday, as Italy’s coronavirus outbreak became the worst outside Asia. 

A decision on the spring program has not yet been made, the announcement said, but Stanford will “continue to actively monitor the developing system” and make a decision by March 20. Students enrolled in the spring program are currently set to arrive on March 26. 

https://www.stanforddaily.com/2020/02/25...its-italy/

[2006alum]

I'm on my phone on the go but WaPo reported the 27 day incubation: 

https://www.washingtonpost.com/world/asi...story.html

That was in China, so who knows how accurate that was. But there seems to be some question about the 14-day max estimate.

[M T]

I have a medical condition that makes me prone to pneumonia (3x in 5yr).  I flew domestically last week and wore a surgical mask on the flights & at a concert because this is flu season (not for Covid-19).   I tried 3 drug stores in the Bay Area and was unable to find any masks, but I had one from my last hospitalization.  I did find a box of masks at my destination.

I don't see Covid-19 being any better contained than the common cold in the US or abroad.  Maybe it can be delayed a few months, but it will spread throughout the global population.   It may hit first in the US in, say, San Jose, but I believe that by the end of the year, it will hit every major city and most, if not all, minor cities.  We will be (rightly) focused on the first few cases which will get stringent isolation, but then it will have to be treated more economically.  When you get it (or, rather, think you have it). you may go to your doctor or clinic to be evaluated as to whether you need further care.

US Health and Human Services Secretary Alex Azar said

“It's really important we correct this impression that it will require this massive hospital isolation for normal patients,” Azar said. “If we end up having broader spread, it’ll be a much more common approach."

 

However, if classes of those infected have high fatality rates, this will be a problem.  I am in one of those classes.  Will the US employ containment strategies like China did?  I don't know, but whether it does or not, any decision will be unpopular.

The CDC indicates that for flu (not Covid-19) death rates were 2 per 100,000 US population in 2017.
The CDC indicates that currently 2641 Covid-19 deaths in the 59,170,000 people in Hubei province, a death rate of 4.5 per 100,000 population, so far, even with the dramatic measures taken.  (Note this is looking at the ground-zero province of the outbreak only.  I expect it is higher in the main city, and much lower if you looked at all of China.)  All other outbreaks of Covid-19 are too new.