2019-nCoV / Corona virus Pt 2

[JeanTate]

What, now, do Macau, Hong Kong, Taiwan, Singapore, even China and S Korea do (not sure about Japan)?

Do they keep their schools closed, casinos shut, factories barely ticking over (except for those which can be operated remotely), etc?

Or is there a new normal for travel: it takes ~14 days longer to get to hug gramps and grandma because there’s mandatory 14 day quarantine on crossing most borders (which could be state/province, or even city/town)?

 

[Ivor the Engineer]

Just tried phoning my (very extrovert) mother to explain that she's at very significant risk of serious illness and that she should try to minimise social contact as much as possible, including looking after my nephew after school, shopping and seeing friends. Phoned my sister after to try to get the message to mom on two fronts.

Not sure it's going to work. I'm developing a Cassandra complex!

 

[casebro]

I detest Sam Harris but this is an excellent interview with one of Johns Hopkins' leading virologists who gives a bit of hope things won't be as bad as many others have posited - including me:



It's an hour long, but only the first 20 minutes matter.

I'm hoping the doctor is right on every point!

Skip the first five minutes of intro, in the next ten minutes the Johns Hopkins expert re-inforces what I have felt all along. .6% fatality tops, once you figure in all the mild cold like cases. NOT the end of the world. The PANIC will have a bigger effect.

 

[Ivor the Engineer]

Skip the first five minutes of intro, in the next ten minutes the Johns Hopkins expert re-inforces what I have felt all along. .6% fatality tops, once you figure in all the mild cold like cases. NOT the end of the world. The PANIC will have a bigger effect.

.6% => 327m * 0.006 = 1.962m dead in the USA in a very short period of time.

You sir, are either stupid or deluded.

 

[Darat]

Skip the first five minutes of intro, in the next ten minutes the Johns Hopkins expert re-inforces what I have felt all along. .6% fatality tops, once you figure in all the mild cold like cases. NOT the end of the world. The PANIC will have a bigger effect.

If you've read the threads you would see that plenty of people have been posting your experts speculations. You seen rather behind on the latest news.

 

[JeanTate]

Skip the first five minutes of intro, in the next ten minutes the Johns Hopkins expert re-inforces what I have felt all along. .6% fatality tops, once you figure in all the mild cold like cases. NOT the end of the world. The PANIC will have a bigger effect.

What is the estimated death rate for (or from) the PANIC?

The estimated total number of deaths, tops?

 

[JeanTate]

.6% => 327m * 0.006 = 1.962m dead in the USA in a very short period of time.

You sir, are either stupid or deluded.

I suspect the 0.6% is of those infected, not the total population (can you confirm please casebro?).

If so, then the question becomes how to stop a significant %-age of the population from being infected (at least until a highly effective vaccine is given to a majority of the population, which may never be possible, for many reasons).

China, and perhaps S Korea, seems to be an existence proof (so far; never say never) ... and I wonder whether either qualifies for being infected with the PANIC?

 

[angrysoba]

Skip the first five minutes of intro, in the next ten minutes the Johns Hopkins expert re-inforces what I have felt all along. .6% fatality tops, once you figure in all the mild cold like cases. NOT the end of the world. The PANIC will have a bigger effect.

In the first five minutes of intro (that you presumably skipped) Sam explains clearly that he and the Johns Hopkins expert are coming at this from different angles - The JH expert has been busy trying to explain that this is not an apocalyptic pandemic (of the sort that people in his field are anticipating with real dread), whereas Sam is trying to wake people from their complacency that this is "just like the flu."

They both agree that this is not the apocalypse and they both agree that this is an order of magnitude worse than the flu.

In other words, they would both reject your minimizing of the virus.

 

[Ivor the Engineer]

I suspect the 0.6% is of those infected, not the total population (can you confirm please casebro?).

If so, then the question becomes how to stop a significant %-age of the population from being infected (at least until a highly effective vaccine is given to a majority of the population, which may never be possible, for many reasons).

China, and perhaps S Korea, seems to be an existence proof (so far; never say never) ... and I wonder whether either qualifies for being infected with the PANIC?

The UK government is basing its plans on a best worst case estimate of 80% infected with 1% mortality.

Swings and roundabouts really, but knock the 1.962m down to 1.57m dead in the USA if you like.

It isn't the panic in the USA that will kill people, but the inequality of access to treatment and the guns in personal ownership.

 

[casebro]

.6% => 327m * 0.006 = 1.962m dead in the USA in a very short period of time.

You sir, are either stupid or deluded.

It means I have a greater than 99% chance of NOT dying of Covid 19. Stupid or deluded would be to let THAT interfere in my life.

 

[JeanTate]

The UK government is basing its plans on a best worst case estimate of 80% infected with 1% mortality.

Swings and roundabouts really, but knock the 1.962m down to 1.57m dead in the USA if you like.

It isn't the panic in the USA that will kill people, but the inequality of access to treatment and the guns in personal ownership.

Indeed.

And if the PANIC leads to only 40% being infected before an effective vaccine is rolled out, it’s only ~0.5 million deaths.

And so on.

One huge caveat I’ve not seen discussed much: treatments, widely deployed, which can greatly reduce the fraction of mild/bad cases which become deaths. IOW, far better treatment of symptoms, reducing the need for ventilators, stays in the ICU, etc.

Agreed that inequalities in the US are/will make it hard to blunt the impact ...

 

[JeanTate]

It means I have a greater than 99% chance of NOT dying of Covid 19. Stupid or deluded would be to let THAT interfere in my life.

Thanks for the clarification.

If you are a child, you have a very close to 100% chance (99.9999%?) of not dying of covid-19, this year and next anyway.

OTOH, if you are a senior (>65) with a chronic condition that requires regular/frequent trips to the hospital (e.g. metastatic cancer that’s spread to your lungs, kept under control by infusion chemo), my guess is that your chance of dying of covid-19 within the next ~18 months is very high.

But perhaps you are not either a child or such a senior, but have a parent, or grandparent, or favorite uncle or aunt, or ... who is such a senior?

 

[Skeptic Ginger]

I'm not sure if I'd already posted this, but it's worth repeating anyway - it's quite important information: don't take ibuprofen if you get Covid-19.

https://www.theguardian.com/world/2...ory-drugs-may-aggravate-coronavirus-infection

I recall seeing China causing quite a number of deaths by administering prednisone, a hydrocortisone, to patients.

I don't see any research referred to in the Guardian article.

I looked to see what was there.

The Lancet- Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury


This was interesting including temporary post infection antibodies with MERs:

Journal - Systemic Corticosteroid Therapy May Delay Viral Clearance in Patients with Middle East Respiratory Syndrome Coronavirus Infection

Currently, the main treatment of MER-CoV infection remains supportive therapy (1, 13). On the basis of data from the marmoset model, IFN and lopinavir appear to have good inhibitory effects against MERS-CoV (14). Monoclonal and polyclonal antibodies that inhibit the spike protein of MERS-CoV are potentially useful treatment modalities that are undergoing clinical trials in the Middle East (13). Retrieval of convalescent plasma from patients who have recovered from MERS-CoV infection as passive immunotherapy is difficult, as the antibody responses in survivors who had severe disease lasted for less than 1 year, whereas those with milder disease could not maintain antibody response soon after recovery from the acute illness (15). The results of the current observational study (5), together with data from treatment of SARS-CoV infection (6) and seasonal and avian influenza (7–12), suggest that the risk of systemic corticosteroid use would likely exceed any benefit for treatment of MERS-CoV infection (13). More clinical studies, preferably with a randomized controlled trial design with a standardized treatment and serial viral sampling protocol, are needed to evaluate more scientifically the role of interferon, lopinavir, passive immunotherapy such as monoclonal/polyclonal antibodies, and systemic corticosteroids in the clinical management of MERS-CoV infection.

So a year later you might be susceptible again, or sooner if your infection was mild.


I'm not sure this translates to ibuprofen though. I'll keep looking.

 

[Meridian]

The problem is that quarantine is not a cure. When you come out of quarantine you remain susceptible. At this point we are not going to eradicate the virus. So you come out and get infected. You have delayed the infection not prevented it. So why delay?

I don't really understand this argument, which seems to be the one Boris Johnson is making. From what's happened in China and South Korea, it does seem as though a short but pretty thorough lock-down could vastly reduce transmission and (in Europe, say) almost wipe it out.

Yes it wouldn't be complete, but afterwards the case numbers might be small enough for a while that thorough contact tracing could be used to catch most new transmission, which might keep things at bay for quite a while.

And if we only gain some months, that seems like a huge gain. In that time we'll presumably understand transmission much better; perhaps have large numbers of easy to use tests available etc. So we won't be in the same situation just some number of months later.

And even if we are, it's not clear that a few cycles (say until an effective vaccine is available) of relatively short but strict quarantines/lock-downs are worse psychologically or economically than a long period of slow-down and worry.

Plus if this containment approach does work, then N million people will live who would die in the `let it spread' version.

 

[Arcade22]

From what's happened in China and South Korea, it does seem as though a short but pretty thorough lock-down could vastly reduce transmission and (in Europe, say) almost wipe it out.

You don't seriously trust the numbers coming out of those two countries do you?

Everything that's done that's effective is about slowing the rate of infection so as not to overwhelm the healthcare systems of the world. Effectively imprisoning everyone within their homes can do that, but it's disproportionate in terms of the socioeconomic harm it causes compared to what it was supposed to prevent. That is the actual expert consensus, which is not considered highly in China and South Korea.

Spraying disinfectants in public places is a great example of how public relations drive South Koreas response.

 

[Distracted1]

It means I have a greater than 99% chance of NOT dying of Covid 19. Stupid or deluded would be to let THAT interfere in my life.

Of course.
And it is about time that all that congregated Boomer wealth make its' way down to the younger generations anyway.

 

[Giordano]

The problem is that quarantine is not a cure. When you come out of quarantine you remain susceptible. At this point we are not going to eradicate the virus. So you come out and get infected. You have delayed the infection not prevented it. So why delay?

If you do it right you can smear the peak, preventing health services being overloaded. If you do it wrong for us in the North, you push the peak into autumn and you then have it merging into the winter surge in respiratory infections and make things worse. Ideally you want to smear the peak so it is winding down in September.

In theory if you knew a cure or vaccine was coming soon this would justify a quarantine until help arrived. Even the imminent discovery in vitro means months of accelerated human testing then the need to make billions of doses. This is not going to happen before the Northern winter.

So the question is are you best to allow a 'controlled burn' now? Or try to keep a lock down quarantine until a cure / vaccine is available in months, with the devastation of the economy that would mean? Is that even possible? Will people put up with being locked in with their children for months with twice weekly exits for food shopping, and only essential workers allowed to travel for work? The UK is potentially asking over 70's to self isolate for 3 months. This is the length of lock down potentially needed and might just delay the peak not spread it.

From a purely pragmatic PoV it may be the best and most practical response to allow the epidemic to progress but slow it by social distancing and social isolation for anyone with a flu like illness. Spread the peak, but have it passing before winter.

The predicted peak was about 50% of illness occurring over 3 weeks, if the peak could be spread to 9 weeks then this is a three fold reduction in the rate of admission to hospital and demand for beds.

ETA To have an impact school closures need to be for 3 - 4 months. As Covid 19 is not significantly affecting children unlike e.g. flu the benefit of school closures is not great.

I had wondered about geographic cycling of quarantine, so you geographically smeared the peak, allowing the peak to occur at different times in different cities. This then requires a non-country wide but local policy and mutual assistance between areas that are less and more severely affected.

First if one could create a 100% effective quarantine then in a few weeks everyone infected would be through the course of the disease and no longer infectious. Persistence in the environment is at most 4 days or so and there is no animal reservoir in most of the world. The disease disappears.

In the real world quarantine will be less than 100% effective but as in China can work tremendously toward dramatically interrupting the rate of new infections. The curve will be greatly slowed in rate, flattened, and ultimately the number of people infected substantially reduced. The new infections can then be more easily identified, isolated, and treated. The health care system is not overwhelmed. It most certainly reduces total numbers.

This is how most epidemics burn out: the chain of transmission weakens enough. It does not require everyone to get infected.

 

[Giordano]

Yeah, like how long does immunity last, once you’ve gotten infected and have recovered?

Or: how quickly will evolution lead to new strains, for which immunity to other/older strains is no, or little, help?

Or: what if this coronavirus gets together with a handful of others (e.g. flu) and they have a gene swapping party?

On the side of certainty: we’ll start to find out in 2020, and will learn a lot by 2025 (it’s too late to stop this coronavirus from becoming humanity’s most recent fellow traveler, unlike SARS).

It does not appear that coronaviruses rapidly evolve in the way influenza do so although an issue probably not a massive concern. Vaccines are typically designed to create immunity to the common antigens in whatever strains are out there, or sometimes to more than one strain.

Chances of gene swapping between coronavirus and influenza, etc. are extraordinarily close to zero. They are very, very different viruses.

 

[Giordano]

You don't seriously trust the numbers coming out of those two countries do you?

Everything that's done that's effective is about slowing the rate of infection so as not to overwhelm the healthcare systems of the world. Effectively imprisoning everyone within their homes can do that, but it's disproportionate in terms of the socioeconomic harm it causes compared to what it was supposed to prevent. That is the actual expert consensus, which is not considered highly in China and South Korea.

Public disinfectant spraying has been done in Italy and many other countries in addition to S Korea. A show but not restricted to the latter.

Spraying disinfectants in public places is a great example of how public relations drive South Koreas response.

Yes, I absolutely believe the numbers coming out of S Korea. They are an open technologically sophisticated society, plugged into the heart of global health systems that are also monitoring the situation, their government is no more known for lying than that of the U.K. (maybe less so) and access of their people to the internet is very high. We would know if reality was very different from what is being reported.

The Chinese government lied initially but I think that the visibility of the situation there now means that the reports coming out now are more accurate.

If you think quarantine is too economically disruptive now wait until 60% of the population is ill, most have no access to health care, and tens of millions die. As explained upthread the time to invoke strong responses is before they may appear necessary to laypeople.

 

[Dr.Sid]

You don't seriously trust the numbers coming out of those two countries do you?

Everything that's done that's effective is about slowing the rate of infection so as not to overwhelm the healthcare systems of the world. Effectively imprisoning everyone within their homes can do that, but it's disproportionate in terms of the socioeconomic harm it causes compared to what it was supposed to prevent. That is the actual expert consensus, which is not considered highly in China and South Korea.

Spraying disinfectants in public places is a great example of how public relations drive South Koreas response.

For some reason you seem to be putting China and South Korea into same bag. Those countries are radically different, and even the progress and outcome of the outbreak is radically different. We can only with Europe or US will handle the infection the way South Korea did. And Italy will soon wish they did at least as bad as China.