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09 March 2020

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Terence Gore

Thanks

Jack

Sir

I disagree with your point 4. Knowing who are infected allows for their isolation and the containment of the virus. Panics occur IMO when people don’t know or believe there is a plan to counter the pandemic.

South Korea not only tested across the board early by testing everyone that came into contact with those infected, they used that information to aggressively hospitalize those seriously impacted while also isolating those that showed no symptoms. This is working as the growth rate of those infected is reducing. There’s no panic there as everyone knows that the authorities have a plan to identify and take care of those infected.

South Korea is the example we should follow if we want to reduce the spread and reduce concerns in the broader population. People will respond positively if they could voluntarily take tests and self-isolate if they’re infected and can be hospitalized if they have severe symptoms. It is the most common sense plan to contain. While we should continue to develop treatment and vaccines they’ll always be behind the eight ball when the next virulent mutation arrives.

The problem that we have is a completely hapless response where it is clear that the CDC, NIH, FDA and local public health authorities don’t have a coordinated action plan that they’re executing. If they had a national pandemic response plan it is not evident. This IMO is part and parcel of our inability to get what matters done. And it’s not that they don’t have funding. Whether it’s the Boeing Max or our Katrina response, cronyism and short-term personal benefit motivations have taken precedence over honor and competence. We’ve ceded much of our national security to the totalitarian Chinese communists. Can we really fight them when likely much of the parts in our military equipment are sourced from them? As we find out now, the vast majority of the critical ingredients in our pharmaceuticals are manufactured there. Did our political, governmental, and business leadership care? No. They were too busy increasing their personal wealth while strutting around with rhetoric on free markets and open trade.

robt willmann

A friend who was a known cellular and structural biologist explained that washing with soap and water is just about the best thing a person can do externally about viruses, as it kills just about everything. In the case of viruses, the soap basically dissolves or penetrates the outside boundary of the virus and it collapses. Unfortunately, my friend passed away not long ago, or he could provide a lot of insight into numerous issues and unanswered questions about this "coronavirus".

One question is whether a virus has a life span or "shelf life", such that after some period of months or time, it ceases to be active, or is mutated out of effective existence. We talked about that once in general terms, but I do not remember clearly what was said, and so I do not want to repeat it here.

The Twisted Genius

Testing is far more than an information and data drill. Testing identifies infected individuals for targeted treatment, including isolation. Widespread testing allows targeted treatment plans rather than blanket quarantine and social distancing policies. Targeted treatment should reduce fears and effects on the economy. That appears to be how South Korea got it right.

No disruptions at the Fredericksburg VA clinic this morning. Posters about symptoms and recommended actions were displayed at the entrance and in the waiting room. More hand sanitizer than normal was available. Masks were offered to anyone with coughs or sneezes. Patients were asked about health and travel. Other than that, it was business as normal.

turcopolier

TTG and Jack

The flaw in your argument is that this is not a fatal disease for the vast majority of people and/or dogs infected. Most people don't need ANY treatment other than what they would do for a cold. so, what you are doing in treating identified infectees is treating people who really don't need treatment. This is not true for the dotards among you. We are doomed.

Ulenspiegel

"The flaw in your argument is that this is not a fatal disease for the vast majority of people and/or dogs infected. Most people don't need ANY treatment other than what they would do for a cold. so, what you are doing in treating identified infectees is treating people who really don't need treatment. "


Now you, Sir, get it wrong. The strategy must be to delay the spread to avoid to many persons at the same time who need ICU beds. Whether most people only suffer from a cold like disease is not a relevant argument, only the number of ICU cases is and the number of available ICU beds. Italy will face triages within the next two weeks.

The most efficient way is to test people who had contact with an ill person and put positively tested in quarantine. Of course most tested are healty. In South Korea around 30 tests per 1 identified infected person are performed. The hard ceiling is the test capacity (PCR cycler + staff).

The issue in the USA is that you are in a Italy style scenario: The quite high number of dead patients who acquired the virus within their community indicate that thousands of unidentified infected people spread the virus. The low number of identified cases mean that very likely more than 70% of the infected belong to the unidentified.

Jack

Sir

It is not just about treatment but also containment. Identifying those infected allows for containment. Not identifying those infected can lead to draconian actions like what Italy did. That leads to panic IMO.

It is true that for the vast majority it is only like a flu. It is mostly serious only for people in my age group. In any case we are following your suggestion currently.

akaPatience

I'm so very sick -- of the hype about this virus. If it were A LOT deadlier I'd of course feel differently but so far it doesn't seem to pose anywhere near the danger or threat as that of this season's influenza strains.

THUS, I just don't understand why on earth this particular virus has managed to roil markets to the extent it has. It seems irrational. Is it mainly because supply chains linked to China are in jeopardy, or what? If it continues to be so much less deadly a virus than has been hyped, who can we blame for the steep declines in equities' values and bonds' rates of return that we're witnessing???

João Carlos

Vacines - no vacines for more one year. And maybe the vacine can be worse than rhe disease ( the SARS vacine kills the lab rats... and SARS is a coronavirus)
Drugs - hope, but no reality. It's a virus and there is no good antiviral. If we had a good one, influenza was to be no problem.

So, discuss about vacine and drugs is talk about nothing and no thing.

If you identify infected people, including the non-sintomatic, you can isolate them and stop the transmission.

Sorry, but the media is correct. To Not have tests is a helluva bad job.

PS

My country, Brasil, is testing all suspected cases. So, what is wrong with US?

turcopolier

All

Isolating the infected is not a bad idea but the hysteria is a VERY BAD idea. I will be interested in what you hysterics say when the death rate turns out to much lower than you believe.

BillWade

I've read that those infected will shred the disease for only 8 days after infection. We have one case here - she's about 2 miles from me in the hospital, caught it while on a Nile river cruise. I would much rather have testing available to all if they want it. I understand if you want a test for an STD, and don't have any symptoms, they will test you. You can boost your immune system with 500 MG of vitamin c daily - chewable tablets still in stock as far as I know.

A Japanese doctor recently recommended to drink something about every 15 minutes, you need to keep your mucous membranes moist, if the virus is in your mouth or throat the drink may wash it down into the stomach where normal acids will kill the virus. He also says you can self-diagnose for advanced coronavirus by taking a deep breath of fresh air and hold it for 10 seconds. If you feel anxious or cough involuntarily, you should seek immediate medical treatment.

I had an appointment at my dermatology clinic early this morning, no masks, no disinfectant wipes. The tech who treated me said that the parent company was considering not having any elderly patients come in, she laughed and said, "that isn't practical, all of our patients are elderly".

William Fitzgerald

Given the virus's severity, or lack thereof, would it not be logical to allow the disease to run its course? The panic which could well result in financial difficulty and ruin for large numbers will, in my opinion, kill more people than the virus. Consider factory closings, mass layoffs, foreclosures, loss of medical insurance, bankruptcies, evictions and other effects of a looming recession or depression.

WPFIII

turcopolier

William fitzgerald

IMO the panic is more deadly than the disease in exactly the way you mentioned.

Deap

Testing may or may not tell you if you have this particular corona virus or just the regular flu - whatever that is. No difference is follow-up protocol once one knows which virus it is. Or is not.

if you have the flu, you have the flu just like millions of people get the flu during flu season. Which just happens to coincide with the school year - kids bringing home bugs from the dirty school environment. No reason to single out cruise ships - they are not dissimilar to pre-schools, day care or senior care centers - any close environments where bugs are quite happy to get carelessly passed around.

However, it has been learned when a "name" gets attached to the regular flu season, panic increases exponentially. Particularly when that name gets extended to "Trump's Katrina" or the latest "Trump's Chernobyl".

The real infection is Democrat hysteria, so desperate to get their hands back on the taxpayer's check book.

steve

Testing is very important as it lets us know how and where the disease is spreading and what measures we should be taking. These could vary from nothing to voluntary quarantine to mandatory quarantines and isolation like they have in Italy.

We dont really know fatality rates yet. No one quite trusts Chinese data. I would wait for data out of Italy. Also, we dont yet know if there are residual pulmonary issues after people get better. We will want to look at morbidity as well as mortality.

"Isolating the infected is not a bad idea but the hysteria is a VERY BAD idea. I will be interested in what you hysterics say when the death rate turns out to much lower than you believe."

The Italians, who have first world medical care, are reporting that their hospitals are so overwhelmed that they are at the point of collapse, setting up intensive care beds in hallways. I really hope we avoid that. I have seen more than enough people die. So I will get on my knees and thank God if this ends up being a minor issue. That said, we will continue to prepare.

https://www.corriere.it/cronache/20_marzo_07/coronavirus-stiamo-creando-terapie-intensive-anche-corridoi-cb01190a-60be-11ea-8d61-438e0a276fc4.shtml

Steve

turcopolier

steve

But will you worship ME if you are wrong? Why are our hospitals not overwhelmed with influenza patients each year?

Eric Newhill

Sir,
Testing has plusses and minuses.

On the plus side, people who are infected can be quarantined and the disease's spread and etiology can be studied. On the minus side, there is a chance of panic, as you note.

This bug is worse than the flu if it gets into the respiratory tract. If it does, it causes acute respiratory distress and support in an ICU on a ventilator is required to keep the patient alive. Yes, obviously the old and otherwise compromised are more at risk, but it has killed some young and healthy people too (for example the Chinese doctor that first observed and reported the virus).

Panic is never good, even in terrible situations. Here is a cause for concern. In the US there are approximately 65K ventilators on ICUs. Compare that to national demographics. Some of those vents are in use for the usual every day acute admissions. So if this new coronavirus becomes an epidemic, there are going to be a lot of people dying because there are no ventilator units available for them.

You're right that - perhaps - there are many walking around with the bug and not even knowing it and it's not as lethal as some make it out to be. On the other hand, for those hit hard by the bug, there have been ventilators and other intensive ICU care services available and put to use. Without that level of care, the mortality rate would be substantially higher for those with the virus in their respiratory system.

I am agnostic on this situation. Only time will tell.

JJackson

robt Encapsulated viruses normally have a protein shell structure, like a geodesic dome, but the overlay this with some of the of the animal cell membrane as it exits the host cell. This is a phospholipid by-layer, so basically fatty. Hence hot water and and washing up liquid do exactly what they do on your greasy plates.

akaPatients NO! I am sorry to be so blunt but what you are saying is dangerous. Seasonal flu has a CFR of 0.02 ish for COVID we do not know yet but I guess about 1% (i.e. your are 50 times more likely to die of it) IF you get a reasonable level of care and hospitalisation if you need it. The 1918 flu pandemic had a CFR of about 2% and killed 25 million people in about as many weeks and 50 million plus overall. The population at the time was under 2 billion and is now 7.8 so these numbers need to be multiplied by 4. The very severe age related CFR curve means this does not fall evenly by age groups and the China data gives the CFR for the over 80s as 20%+ and the over 60s at 8%. I will link the WHO fact finding post which has graphs for age distribution and the Chinese case growth curves.

ulenspiegel is on the money and I will try and explain why below because the point raised is important in the next epidemic phase - which we have not yet entered.

Population dynamics and Epidemiology are mature sciences with well defined rules. If you infect a yeast cell with virus and let it grow in a vat of yeast cells its growth curve looks just like one from an ebola, flu or CoV outbreak. It starts as exponential growth until it meets a problem e.g. most of the cells are dead or the hosts are immune from previous infection at which point it levels off and then declines. I have graphs from 2009 flu, 1918 flu, Ebola and they all went through the 'Hockey stick' growth phase visible in the daily confirmed case counts in Europe. Humans can mess with this natural pattern with containment measures making artificial problems for the pathogen in finding its next target.

We can also change the CFR through good patient care and the 1% CFR based on Chinese, Korean and the Diamond Princess data are based on this. What ulenspiegel is talking about is what occurs when the patient numbers are such that those who need a bed and oxygen or a ventilator can not get them. Then the fatalities rise very sharply giving a much higher CFR. COVID puts immense strain on some very specific hospital kit for which their is very little surge capacity. PPE is the first item to cause a problem as very few people in a hospital normally need the level of PPE that COVID does and consequently demand is outstripping supply and if not rectified soon HCWs are going to be faced with the dilemma of treating patients, or not, with no protection. If too many get ill polling data shows they will not work and put their families at risk until adequate PPE is available. After PPE the next item that is going to run out is ventilators. As severe double pneumonia is the common symptom for the severe cases the standard treatment is induced coma and mechanical ventilation to oxygenate the blood until the immune system can clear the infection to the point the lungs can take over again. This requires an ICU bed and highly trained staff. England has about 4000 CCs (critical care beds - one level down from ICU but these will include the ICUs) for 50 million population of which 75% are normally in use. In bad flu seasons this capacity will max out.

Which brings us to testing as a containment measure. The aim is stop, or at least slow, spread. If we follow the typical outbreak scenario then patient 0 comes in from outside, he breezes through airport security as he has no temp or symptoms. After a day or two he gets mild general symptoms as the virus begins replicating and may start shedding after another day or two he definitely does not feel well and has a temp then dry cough (normally not a runny nose or much sputum) and suspects COVID and gets tested. It is those 2 or 3 days where he is infecting others that seed the next generation of cases. The trick with contact tracing is finding those contacts and isolating them before they have their turn in spreading the virus. Get to the testing fast and the contact tracing very fast and you can break the transmission chain and end the cluster. Do it repeatedly and you put the epidemic in reverse which frees up more contact tracers so it gets progressively easier to end the epidemic. This is a proven technique that works for most diseases but not flu. China and Korea have used it fairly successfully to bring numbers down to manageable levels but not to stop all transmission. Assuming China can maintain its current case burden they will ONLY have had 100,000 cases in 1.4 billion or 0.1% of the population. If the disease gets out of control this could grow to 20% or more so we are in the very early stages of a full blown pandemic if we can not control it the daily case counts could reach the 100s of thousands. This is not something any of our health systems could cope with and most severe cases would die without ever getting near a hospital. Even if we can not stop it making sure bad city clusters come one after the other - where help can come in from outside - and not in parallel will help spread the load over time so the surge limit is not badly overrun for any length of time.

b

I agree with Ulenspiegel.

It is the overwhelming of ICUs and the whole health care system that makes the new virus much more deadly than it would be without overwhelmed ICUs.

That is because it is a NEW virus and we do not have a basic immunity against it in our societies like we do have against common flu viruses.

For your age Pat, the death rate may be 5% with functional ICUs available. With overwhelmed ICUs the death rate for your age will be above 50%.

Consider that Lombardy, which is now overwhelmed, has now a death rate over all cases of 6% while South Korea, which effectively limited the spread through early testing and is not overwhelmed, limited the death rate to below 1%.

Stephanie

You're wrong. 180 degrees off.

Read this article.

https://www.moonofalabama.org/2020/03/is-the-coronavirus-really-more-dangerous-than-the-flu.html#more

Whatever you may think of the blogger, he is absolutely 100% correct here. Executive summary: if you extend the time period over which the epidemic occurs by testing and quarantining, you reduce the risk that your health care system will collapse, like it has in Italy. South Korea is the case where testing has prevented their health care system collapsing. Their health care system has not collapsed. Italy's has.

And now we will wait and see what happens in the U.S. Trump is betting his re-election on your being right.

JJackson

Sorry again I forgot to add the link
WHO fact finding mission report https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjI0eLHiPfnAhUxQkEAHU7aB-AQFjAAegQIAhAB&url=https%3A%2F%2Fwww.who.int%2Fdocs%2Fdefault-source%2Fcoronaviruse%2Fwho-china-joint-mission-on-covid-19-final-report.pdf&usg=AOvVaw1gO_RTfaIWQuEkjdvq_O7i

Copy of link (posted in previous thread) to background information which should help understand what is happening and why. https://flutrackers.com/forum/forum/the-pandemic-discussion-forum/jjackson-s-workshop/826486-covid-ncov-preliminary-thoughts-jjackson-personal-opinion

The CFR is going to come up a lot and this is a copy of something I wrote explaining how it is calculated can be effected.
I know a lot of effort has gone into CFR calculations but I am not sure I see the point. The CFR is a moving target and is going to vary greatly over time and in different locations. It is calculated for a given population in a given area over a set time period. The real CFR for an epidemic will be calculated after it is all over based on every case's outcome. The CFR for early Wuhan cases will be a reflection of the fact they had no idea what they were dealing with or how to treat it, nor could they even tell who had it until it was isolated, sequenced and PCR protocols established. They would not have known transmission characteristics or what PPE they should use. Later cases from the same population fared much better. Things that will effect the CFR will include overall health, age distribution, proportion with co-morbidities, how quickly they present for treatment (and get it), what treatment is available to them, how knowledgeable their HCWs are, how much load the system is under, what pharmaceuticals there are (and availability), how effective these are etc. You will get a range of wildly different CFRs depending on where and when you look. As mscox points out a major spike will occur anywhere the health system is overwhelmed and life saving treatments stop being available. Key bits of kit will be PPE, Lab capacity, ICU and CC beds, ventilators/ECMO, CT scanners (X-rays can help but are not as useful) & oxygen plus any of the drugs, currently in trials, that turn out to be useful. Ventilators will probably the first thing to max out. China was very good about shipping capacity into Wuhan (people and kit) which saved many at the peak of the wave which was also considerable smaller, than it would have been, due to their containment measures. They barely coped despite both massive interventions. How good other peoples are going to be about shipping their PPE, ventilators and best HCWs to cities on the other side of the country remains to be seen but it could be a major factor in preserving surge capacity and holding down that country's CFR.
Just what I could think of I am sure I missed lots of other important variables.

This is a simple calculator post but it is now 6 days out of date so the numbers inside China are lower and outside China a lot higher.
Here is a little maths problem for you. You will need two numbers 1] Your country's population (in 10s of millions) and 2] How many new cases/day it is reporting (go with a average over a few days). Now divide cases by pop to get your answer.
So if your population is 100m and you are reporting 2 cases a day then 2/10 = 0.2.
Now you know your score how do you compare to others.
For S. Korea 600/5 = 120
Singapore 3/0.6 = 5, Iran 80, Italy 50.
What about China? Which is still the country you are most likely to get asked about at the airport.
China (exc Hubei) 0.1
China (All) 1.4
Hubei 55

Taking daily data (or averages over a short time) is not a very reliable measure but when cases are exploding it is all we have, but it will give an indication of likely disease burden on your health system and how risky contacts with other citizens are. This data also explains why China is taking the same measures, on some outside countries, as they had been applying to China.
Edit
For countries outside China (with rapidly changing numbers) I used the average from the last 3 WHO situation reports, for China (which is fairly stable or slowly falling) I used a 7 day average. Note also that China is dealing with 200 case a day while it had been coping with 2000 so should have no capacity problems and should not be missing much. Iran, on the other hand, has a far higher number of deaths than you would expect implying it has been suffering more community transmission, and for a longer time, than its reported numbers show so its score of 80 is probably an underestimate.

LondonBob

It is about managing the outbreak. Buried in the PM's press conference in Downing Street today was the quiet admission that drastic action to slow everything right up would simply stop it spreading, then when measures were relaxed again we’d get it next Winter. In other words, we need you to get this, but at the time we choose. This Spring/Summer would be the most manageable and would keep the mortality rate at less than one percent.

different clue

If we become able to combine South Korean levels of testing with South Korean levels of applicable plans for what to do about the test results combines with the evident zero-hysteria levels of the Korean public, then Koreaform testing would be a good thing here. Among other things, it might prevent or at least reduce the level of mildly symptomatic or non-symptomatic carriers from spreading the virus to others, including the vulnerable old and/or immuno-compromised or those not-yet-old people who have prematurely old lungs, kidneys, etc.

In the meantime, we should all practice the different keep-safe personal and community behaviors we can.

turcopolier

DC

What are their plans for treatment?

turcopolier

LondonBob

More hysteria. He has no idea what he is talking about. They are blowing smoke up your a-s. Is this like the gassing of the ex-GRU spook and his daughter?

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