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10 March 2020

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Peter

mortality rate

One should be clear as to definitions.
Case fatality rate is the rate of diagnosed cases with fatal outcome. If 1000 are diagnosed and 6 die, the CFR rate is 0.6%

The mortality rate is the rate of fatal outcome of a population at risk, so in the case of a nation it could mean all of its citizens, or only a selected group like adults, seniors or children.

Serge

TTG

There is a reason so many diseases throughout human history originate from China. Why don't we see a similar phenomenon in India, with its equivalent population density and increased humidity to boot? The Indians aren't eating everything with a heartbeat. As an Israeli rabbi recently said "the virus is the result of the fact that the goyim eat anything". We see a similar phenomenon in Africa with HIV and Ebola linked to the consummation of bushmeat. Unlike the Africans, the Chinese don't have the starvation excuse. They eat pangolins and bats because it is part of their culture. If they don't want to change their culture they should be penalized by the world community, or more realistically the US, for the disruption they are causing to the rest of us.

JJackson

Walrus
The ACE2 receptor is ancient, in evolutionary terms, and consequently be found in birds, reptiles, amphibians, fish and mammals. I warned before the outbreak left China that genetic differences across populations may come into play and that the Han population was genetically fairly homogeneous but I am not convinced yet that a slightly higher ACE2 density is having any noticeable effect. The virus is finding more than enough binding sites in Caucasian to spread freely. I was talking to a geneticist whose team were to the first to sequence the H1N1(2009) strain but was told not to release the data - Why because he worked at a US navy lab and was told 'let a civilian agency announce if it comes from us the conspiracy nuts will say it was a bio weapons experiment that escaped the lab.'
re the Pangolin and wet market. Something was the intermediate host between the sequence data from COVID's and those we have for bats and pangolins. That we do not know what it was no surprise as so little data is collected from wild animals having no relevant sequences for a decade or more is not uncommon. A burst of effort went into finding a source post SARS hence the few sequences we do have but stopped when it did not reappear, the same happened for all the vaccine and pharmaceutical as you will have gathered if you have been listening, like ulenspiegel, to Vincent's TWiVs (he has been very kind with his time over the years answering my technical questions on virology, as have several others in the field). The dead pangolin you saw will definitely have been swimming in virus the question is could they infect humans? It probably did not have any CoV and if it did it will probably have been similar to those found in pangolins which is well removed from CoV-SARS-2 and lacks a novel furin cleavage site which is probably why it spreads well in humans. All these question have really long and complex answers, if there is an answer at all, so I end up saying things like 'I do not think pangolins are the source' they may be but so could several other much more common species.

As you look at the case numbers they are tiny for the size of a country but this belies the fact that they re all very concentrated and hospitals at the centre can be facing meltdown while an hour down the road all is quiet. The following are extracts from a post by a hospital doctor working Bergamo.

"I myself looked with some amazement at the reorganizations of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly "emptied", the elective activities interrupted, the intensive therapies freed to create as many beds as possible. Containers arriving in front of the emergency room to create diversified routes and avoid any infections. All this rapid transformation brought in the corridors of the hospital an atmosphere of surreal silence and emptiness that we still did not understand, waiting for a war that had yet to begin and that many (including me) were not so sure would never come with such ferocity . (I open a parenthesis: all this in silence and without publicity,
"
then
"
Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded and the battles are uninterrupted day and night. One after the other the unfortunate poor people come to the emergency room. They have far from the complications of a flu. Let's stop saying it's a bad flu. In these 2 years I have learned that the people of Bergamo do not come to the emergency room at all. They did well this time too. They followed all the indications given: a week or ten days at home with a fever without going out and risking contagion, but now they can't take it anymore. They don't breathe enough, they need oxygen.

Drug therapies for this virus are few. The course mainly depends on our organism. We can only support it when it can't take it anymore. It is mainly hoped that our body will eradicate the virus on its own, let's face it. Antiviral therapies are experimental on this virus and we learn its behavior day after day. Staying at home until the symptoms worsen does not change the prognosis of the disease.

Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sick, of different colors depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the same cursed: bilateral interstitial pneumonia.

Now, tell me which flu virus causes such a rapid tragedy. Because that's the difference (now I'm going down a bit in the technical field): in the classical flu, apart from infecting much less population over several months, cases can be complicated less frequently, only when the VIRUS destroying the protective barriers of the Our respiratory tract allows BACTERIA normally resident in the upper tract to invade the bronchi and lungs, causing more serious cases. Covid 19 causes a banal influence in many young people, but in many elderly people (and not only) a real SARS because it arrives directly in the alveoli of the lungs and infects them making them unable to perform their function.

Sorry, but to me as a doctor it doesn't reassure you that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least the tablet for pressure or diabetes. I also assure you that when you see young people who end up in intubated intensive care, pronated or worse in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the organism, hopefully, heal your lungs), all this tranquility for your young age passes.

And while there are still people on social networks who pride themselves on not being afraid by ignoring the indications, protesting that their normal lifestyle habits are "temporarily" in crisis, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us. The cases multiply, we arrive at the rate of 15-20 hospitalizations a day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing.

Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the first aid management software works and a few minutes later they are already downstairs, next to the warriors on the war front. The screen of the PC with the reasons for the access is always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency etc ... Exams, radiology always with the same sentence: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized. Someone already to intubate and go to intensive care. For others it is late ...

Intensive care becomes saturated, and where intensive care ends, more are created. Each fan becomes like gold: those of the operating rooms that have now suspended their non-urgent activity become places for intensive care that did not exist before. I found it incredible, or at least I can speak for Humanitas Gavazzeni (where I work) how it was possible to put in place in such a short time a deployment and a reorganization of resources so finely designed to prepare for a disaster of this magnitude. And every reorganization of beds, wards, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more.

Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted. The staff is exhausted. I saw fatigue on faces that didn't know what it was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?" or "leave that hospitalization alone." Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal an already marked destiny.

There are no more shifts, schedules. Social life is suspended for us. I have been separated for a few months, and I assure you that I have always done everything possible to constantly see my son even on the days of taking the night off, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have not voluntarily I see neither my son nor my family members for fear of infecting them and in turn infecting an elderly grandmother or relatives with other health problems. I am satisfied with some photos of my son that I regard between tears and a few video calls.

So have patience, too, that you cannot go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem like an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only to indispensable things. Do not go en masse to stock up in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are higher. You can go there as you usually do. Maybe if you have a normal mask (even those that are used to do certain manual work) put it on. Don't look for ffp2 or ffp3. Those should serve us and we are beginning to struggle to find them. By now we have had to optimize their use only in certain circumstances, as recently suggested by WHO in view of their almost ubiquitous impoverishment.

Oh yes, thanks to the shortage of certain devices, I and many other colleagues are certainly exposed despite all the means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues have in turn infected family members and some of their family members already struggle between life and death. We are where your fears could make you stay away. Try to make sure you stay away. Tell your elderly or other family members to stay indoors. Bring him the groceries please."
The conversation here has moved forward a lot with many showing significant understand of the situation.

Jack

Mass testing and isolating those infected either in hospital if they need it or in self-quarantine if they show only mild or no symptoms seems to be the best containment strategy. At least that is the implication in the Bloomberg article that blue peacock linked above quoting the CDC director Robert Redfield.

This makes sense in light of the South Korean experience of deploying this exact strategy right away weeks ago. The question that needs to be asked is why was South Korea able to deploy and test over 180,000 people and we still aren’t able to test at any scale? What about the Korean CDC management made them more effective in developing and deploying at scale than our CDC who has a vastly larger budget?

The screwups continues with our testing ability, now apparently due to a lack of reagents.

https://www.politico.com/news/2020/03/10/coronavirus-testing-lab-materials-shortage-125212

The private sector is responding to this government incompetence by shutting down activities making the economic and social impact greater than if the government response was competent and timely early on 60+ days ago. Coachella, SXSW and many other events are now postponed or cancelled. Many companies are now requiring their employees to work from home including Google & Microsoft. Colleges like MIT, Harvard, Amherst College and others are asking their students to leave campus and return home. United Airlines is reporting a 70% reduction in bookings. None of these types of broad measures were necessary in South Korea. Their response was timely and highly targeted focusing on identifying and isolating those infected to break the spread.

This type of hapless response by governmental institutions to domestic emergencies is becoming more of the norm not the exception. Of course the failures always have a myriad excuses and no one is generally held to account. To me it seems that it is always an execution problem. Which implies ineffective management. What about our system has led to the poor hiring of leadership in our institutions?

KenM

Jury is still out on the source apparently - neither pangolins or bats confirmed under latest studies.
From Nature: https://www.nature.com/articles/d41586-020-00548-w
"The press-conference report was the result of an “embarrassing miscommunication between the bioinformatics group and the lab group of the study”, explains Xiao Lihua, a parasitologist at the South China Agricultural University and a co-author of the paper. A whole-genome comparison found that the pangolin and human viruses share 90.3% of their DNA."

JJackson

Eric
Pneumonia is just liquid in the lung impairing the ability of the alveoli to absorb oxygen. In seasonal flu secondary bacterial infections are responsible for nearly all the pneumonia. In 1918 much of the damage was due to primary pneumonia caused by an over aggressive immune reaction which caused white blood cells, summoned to the site of infection by cytokines, to damage the lung as well as attacking the virus (this is known as cytokine storm). COVID's pneumonia is also primary with very little bacterial co-infection although it is not clear if the lung damage is being caused by the virus or by an over enthusiastic immune response.

Andrey Subbotin

South Korea has 12 hospital beds per 1000 population, while Italy has 3.1, that might very well explain the mortality difference between SK and Italy

https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds

Harry

Italy Sir.

https://www.reddit.com/r/medicine/comments/ff8hns/testimony_of_a_surgeon_working_in_bergamo_in_the/

Regards

Keith Harbaugh

Walrus:
Concerning your assertion that

the UNZ review author ... then makes the snide insinuation that this proves Coronavirus is a Bio engineered weapon
That simply is not true.
Nowhere in the article does Walton make any such insinuation,
nor does he ever use the word "weapon".
A page search on that word shows it appears numerous [about 26] times, but only in the comments. Indeed, its first appearance is in comment 13, by Craig Nelsen.
It would appear that you are confusing what the commentators say
with what the article author, Lance Welton, says.
Is that not the case?

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