Cont: 2019-nCoV / Corona virus Pt 3

[Planigale]

Where did the author of that article get her information? I see everyone repeating it in some form or another including Rush Limbot.

This a good example of how if a journalist does not understand what they are writing about, it can be nonsense. I can recognise that there are a lot of facts and opinions in the article that could have been given by doctors. But they have been lumped to gather in a way that makes no sense and no coherent article. There has always been an awareness that ventilators like all treatments have side effects. Covid-19 is an unpredictable illness at present, it is hard to judge who can get away without ventilation and who will need ventilation, and for whom ventilation will be a pointless intervention since death is inevitable.

There are issues with covid-19 we don't see with e.g. flu pneumonia. In some cases we see features that are more common in VHF. The issue in some severe cases appears to be endothelial (the lining of the blood vessels) damage with dysregulation of the blood clotting system. This can result in bleeding including into the lungs, but also abnormal clotting (consumption coagulopathy) so we also see blood clots forming in the lungs, this results in abnormal blood flow through the lungs and a phenomenon known as oxygen resistance as blood effectively by passes the lungs (which is when ECMO can be of benefit). This is associated with the development in some cases with kidney failure requiring dialysis and the so called 'cytokine storm' - a term I dislike.

 

[PhantomWolf]

Surely that is a pretty big "all their masks are doing". If there are a lot of asymptomatic carriers, then them being able to prevent the spread surely makes a difference.

This is a big "if" too and according to the medical statements I have been reading, there are a lot less that first believed. About 25% of infected people can be infectious 48 hours before first symptoms become obvious, and according to the RNZCGP, there is little evidence now that people can be completely asymptomatic. And in all this, you need to have had close contact with an infected person to become infectious yourself. So if you are Self Isolating, practicing good hand hygiene, and social distancing at least 2m when you absolutely must go out, then you're not going to get it to be spreading it even if others are in that 48 hour window.

Although, you will have to talk me through the physics of how the virus cannot get out but will definitely get in. How does that work?

I would suspect mostly because breath is blow directly into the mask material when you breath out, it hits it, some passes out through the cloth, a lot ends up being redirected up, down, or to the sides. But the droplets the virus are on have to touch the cloth and can be absorbed. In getting in, there are two ways. If you touch or encounter droplets that touch the mask, then virus gets into the weave and can slowly penetrate the filters on the mask until it passes through. This is why masks/filters need to be changed regularly or washed if cloth. For poorly-fitted masks, droplets still hanging in the air can come around the side of the masks when you breath in, obviously this requires close contact with an infected person though.

Do you have any evidence for this?

I don't have the exact studies, but here's one of the quotes I was going off, this one for cloth masks. I have seen others for filtered ones about changing filters regularly and keeping them clean...

For those who wanted to make their own, a T-shirt has been shown to block 70 per cent of virus-sized particles, Dickinson said.

"If somebody around you is coughing, you can protect yourself by breathing through the sleeve of your shirt or just pull up your shirt to your face to breathe through."

Previous studies have shown cloth masks were unhelpful for healthcare workers at blocking influenza infections, because while they initially absorb infected droplets, viruses were able to slowly work their way through the mask.

"To reduce this risk, cloth masks should be removed and cleaned when you are home alone to stop you breathing in anything infected from the fabric," Dickinson said.

I'll also point out that I use both disposable N95 and surgical masks for work currently and they are both one use items to prevent infectious agents passing through them over multiple uses.

 

[GraculusTheGreenBird]

Most studies are saying that while about 30% of people may test positive prior to displaying symptoms, that 75% of people don't become infectious until they have symptoms. The others become symptomatic within 48 hours of becoming infectious. According to a The Royal New Zealand College of General Practitioners report this week, there is a lot of debate over if totally asymptomatic carriers even exist with little to no evidence for effected people not having any symptoms, even if such are mild. Based on all of this, it is exceedingly unlikely that you have been infected by a asymptomatic carrier, but if you have reason to believe you have come in close contact, then wearing a mask is a good idea, I haven't said otherwise, and in fact stated multiple time, if you think you are sick, wear a mask. I'll add to that, if you think you have had contact and might be infected, get tested and wear a mask.

Not talking about them suddenly deciding that they are invulnerable, I'm talking about them getting sloppy. Why is it that people on a skeptic's board always seem to jump to strawman arguments?

What is more likely is that people will reuse masks and touch them with contaminated hands when they adjust them, thus increasing their likelihood of being infected.

Let's have a look at these countries should we?

Hong Kong, as well as masks they closed the borders early, they instituted a lock down, banned social gatherings and went on a wash your hands and social distancing campaign.

Macu. Also banned social gatherings, closed the borders, and vital hygiene campaign emphasizing washing hands and social distancing.

South Korean. Major, major testing campaign testing campaign (1 in 200 people) followed by isolation for positive tests, social distancing and hygiene push.

Taiwan. Learned lessons of SARS-CoV so closed borders early, worked on isolation of cases, social distancing, and self isolation for non-essential workers, restrictions on travel and social gatherings. Personal Masks were actually donated to the govt on a I don't need mine, you take it program

I'll give you another... New Zealand. Currently 1283 total cases, 2 deaths, 373 recovered, with active cases having dropped by 18 in the past 48 hours.

Closed borders early, pushed restrictions on social gathering and travel, then went into lock down, oh, and no requirement for masks.

See I can do anecdotal data too.

Lock down was what was working, coming out of lock down too soon is what caused the new outbreak.


Your belief doesn't substitute for science.

Here's a question. When a person is maintaining social distancing (2-3m), and keeping up with proper hand hygiene and avoiding touching their face with potentially contaminated hands, how exactly do masks help avoid getting infection?

So those 25% who are contagious but are not yet showing symptoms for 2 days will reduce their transmission if they wear masks. Surely that's better than them being free to transmit? Thus wearing mask improves the situation.

Sorry, didn't mean to imply that getting sloppy equals thinking oneself invulnerable, I was glibly paraphrasing after seeing this argument has been made by many, including governments and the WHO. I don't buy that having an extra layer of protection makes one the get sloppy on other layers of protection. In places where we are wearing masks like Hong Kong, we are informed about mask contamination, and know that touching it can contaminate the hands.

I live in Hong Kong. There is no lockdown in place, not sure where you got that idea. People are still free to go outside, go shopping, go to restaurants although working from home is recommended. They banned social gatherings of more than four people just 2 weeks ago, due to an influx of imported cases from US, UK and Europe. At that point tourists were banned, until then, the borders were still open. They are still open to HK citizens.

70% of the imported cases are from UK, where they don't wear masks. A recent local outbreak was tracked back to expat entertainment area, where the expats are less likely to wear masks.

Yes, there has been a handwashing and social distancing campaign since the beginning, as there has in all countries. You'd be hard pressed to find a country that doesn't have one.

Macau and Taiwan only closed borders 18 March, so for 2 months they were open.

Regarding your question, indeed, I suppose wearing a mask would not help that much if everyone was acting perfect in that way. However, since not everybody will act perfectly, the extra layer of protection that a mask gives helps. People travelling in buses, etc, can't maintain that distance, and a study from Chinese scientists showed droplets from an infected person on a bus affected people 6m away, due to air circulation.

Even if the effect was small, to me it seems wrong to ignore that extra layer of protection.

Your point about New Zealand is a good one.

 

[PhantomWolf]

So those 25% who are contagious but are not yet showing symptoms for 2 days will reduce their transmission if they wear masks. Surely that's better than them being free to transmit? Thus wearing mask improves the situation.

They can only transmit to people close to them. Hence Social Distancing.

Sorry, didn't mean to imply that getting sloppy equals thinking oneself invulnerable, I was glibly paraphrasing after seeing this argument has been made by many, including governments and the WHO. I don't buy that having an extra layer of protection makes one the get sloppy on other layers of protection. In places where we are wearing masks like Hong Kong, we are informed about mask contamination, and know that touching it can contaminate the hands.

fair enough.

Regarding your question, indeed, I suppose wearing a mask would not help that much if everyone was acting perfect in that way. However, since not everybody will act perfectly, the extra layer of protection that a mask gives helps. People travelling in buses, etc, can't maintain that distance, and a study from Chinese scientists showed droplets from an infected person on a bus affected people 6m away, due to air circulation.

Fair point, if you are going to be in an enclosed space with people that are outside of what we term as your "Bubble", then yes, go for a mask, I'd go for the best one I could get. Well I wouldn't go on buses and trains, but if you have to, then yeah I have no argument about not wearing one in that case.

Even if the effect was small, to me it seems wrong to ignore that extra layer of protection.

It's a case of harm/benefit. If you have the ability to stay out of the bubble of harm then masks can be a negative if they get contaminated, but if you have no choice but to be inside that bubble of danger, then yeah masks. Hence why I wear them at work. When I am dealing with someone that could potentially infect me, I have an N95, though as I say facial hair makes it less useful, and when I am dealing with someone outside my Bubble who I could infect if I was infectious, I wear a surgical one.

The big issue I have with unnecessary wearing is that if all the public are buying them, it makes it harder for those medical professionals that desperately need them to do their jobs to get hold of them.

Your point about New Zealand is a good one.

Hopefully it'll stay that way. We probably do have a bit more room to make sure of our 2-3m gaps than you do in HK.

 

[Squeegee Beckenheim]

However, 4,571 people with COVID-19 have so far died in New York City, which represents 0.054% of the entire population of the city, which means that the fatality rate for COVID-19 is at least 0.054% and almost certainly several times that because most people haven't actually got infected yet.

It's also worth noting that a few days ago a New York official said that there were 200-300 deaths per day that weren't being counted because the people were dying in their own homes and so wouldn't subsequently be tested. So the official figures are too low.

 

[Squeegee Beckenheim]

The major issue I see coming from all this is claims that the precautions weren't really needed because it wasn't as bad as it was claimed it could be, all while ignoring the huge effort that has gone in to keep the virus from spreading and doing its worst.

Right near the beginning of all of this an expert was quoted saying that you'll never know if you've over-reacted, but you'll definitely know if you didn't do enough.

 

[Squeegee Beckenheim]

Don't wash your fruit and veggies in soapy water though as they are porous and the soap can get into them and make you ill. A 30-45 second wash under running water will work for them, removing up to 99.5% of any bacteria and virus on their surface.

Normal cooking temperatures are likely high enough to kill the virus, too.

 

[angrysoba]

This is a big "if" too and according to the medical statements I have been reading, there are a lot less that first believed. About 25% of infected people can be infectious 48 hours before first symptoms become obvious, and according to the RNZCGP, there is little evidence now that people can be completely asymptomatic.

Still, a 25% infection rate sounds like a good deal to me. Remember, nobody is talking about a perfect solution here, just some extra things as well as handwashing etc.. which are also not perfect.

I would suspect mostly because breath is blow directly into the mask material when you breath out, it hits it, some passes out through the cloth, a lot ends up being redirected up, down, or to the sides. But the droplets the virus are on have to touch the cloth and can be absorbed. In getting in, there are two ways. If you touch or encounter droplets that touch the mask, then virus gets into the weave and can slowly penetrate the filters on the mask until it passes through. This is why masks/filters need to be changed regularly or washed if cloth. For poorly-fitted masks, droplets still hanging in the air can come around the side of the masks when you breath in, obviously this requires close contact with an infected person though.

So if everyone is wearing masks the transmission chances are lower. Again, nobody is talking about perfect.

I don't have the exact studies, but here's one of the quotes I was going off, this one for cloth masks. I have seen others for filtered ones about changing filters regularly and keeping them clean...

But there are studies showing they are effective. Not for cloth masks, maybe, but certainly for surgical masks.

 

[Squeegee Beckenheim]

This study was done with surgical masks, not N95 ones. It showed strong attenuation of coronavirus in both droplets and aerosols . Interestingly, it didn't show that for flu virus.

FWIW, some testing has shown that a home-made mask made out of the right materials can be as effective as, or even sightly more effective than a surgical mask at filtration. Quilter's cotton on the outside with flannel on the inside appears to be the best option for a home-made mask.

 

[Darat]

Needlessly snarky, sarcastic, and rude. The outbreak still exists and people are traveling into and out of Wuhan. I don't see how the amount of time that's passed so far would make it wise, if lockdowns are indeed wise, to fully open everything up already.

Because that isn’t what has happened. There are still many restrictions in place. You still need to be green etc.

 

[PhantomWolf]

Still, a 25% infection rate sounds like a good deal to me. Remember, nobody is talking about a perfect solution here, just some extra things as well as handwashing etc.. which are also not perfect.

Correct hand washing procedure is the best defense. Staying 2m+ away from other people is number 2. It doesn't really matter if 25% are infectious is you're doing that.

So if everyone is wearing masks the transmission chances are lower. Again, nobody is talking about perfect.

If everyone stays 2m plus away from everyone outside of those that they live with, and maintain proper hygiene then transmission drops to near zero.

Masks are really only effective when you are in a situation where you have no choice but to be within an enclosed space with others who might be infectious. Here none of our buses, taxis, or trains are running to avoid that.

I'm not saying no-one should be wearing masks, or even that you shouldn't wear one if you want to. Mostly I'm saying if you do, make sure you have the right type and know how to use it correctly. Wash or replace it regularly and try not to touch it with your hands (or gloves) unless you have just washed or sanitized them, and understand that wearing a mask will not always protect you, so still keep on doing the other more effective methods of prevention.

I'm pointing out that masks are not the panacea that will stop this virus as some seem to be believing them to be.

But there are studies showing they are effective. Not for cloth masks, maybe, but certainly for surgical masks.

I haven't seen any studies that say surgical masks are effective for preventing you from getting a virus if you are in a viral loaded space, and all Doctors I have heard speak on it have said that they are not effective. They aren't designed to prevent the wearer being infected, they are designed to prevent the wearer (usually a surgeon) infecting their patients during surgery.

 

[Roboramma]

Needlessly snarky, sarcastic, and rude. The outbreak still exists and people are traveling into and out of Wuhan. I don't see how the amount of time that's passed so far would make it wise, if lockdowns are indeed wise, to fully open everything up already.

The number of active cases in China is quite small right now.

With the amount of testing being done, I think they're confident that they've found all those who are currently sick, and have them being treated and isolated from the population at large, so ending the lock down won't expose other places to risk of infection.

Other measures that are being implemented mean that if they've missed some people, they will likely be found before they infect others, or at least if they do infect anyone, those people will be found and contact tracing will lead back to the source, so it's unlikely that we'll get another uncontrolled outbreak.

Everyone is still wearing masks here. I took my girlfriend to the dentist today, to get into the building we had to scan a QR code, which brings up a screen showing your recent movements. Mine showed that I'd finished my quarantine after returning from abroad. To go into the dentist's office we had to scan it again, and fill out a form, as well as having our temperature checked (at both points).

Opening up Wuhan doesn't mean that China has just decided that there's no need for vigilance anymore. It's a considered measure given current circumstances.

 

[GraculusTheGreenBird]

The big issue I have with unnecessary wearing is that if all the public are buying them, it makes it harder for those medical professionals that desperately need them to do their jobs to get hold of them.

We can agree on this definitely.

HK and many places in Asia have an in-place supply chain from China, Vietnam and other countries, as the historic convention here has always been to wear a mask if you are sick, this started even before the original SARS.

The HK government has incentivised local businesses to switch streams to start manufacturing hundreds of thousands a day, which is starting to ramp up delivery. Even prisoners in HK jails are making them, as part of their daily work.

So whilst there were initial runs and price gouging, this has now ameliorated, and a box is 50 is now only 4 times is pre-January cost, and there are sufficient stocks for health staff not to have go short.

For other countries that don't have this in place, its a harder justification, I can see that, and medical staff should be given priority. Other countries should start to make them themselves, I hope after this finishes governments will realise the need for more investment in health service and local manufacturing.

However, I do see a bit of a contradiction here. If they are not really effective against catching it from someone else, why do medical professionals need them, when dealing with potential infected? Just because it may help a bit, and unlike the general public they can be trusted to follow mask discipline?

 

[PhantomWolf]

However, I do see a bit of a contradiction here. If they are not really effective against catching it from someone else, why do medical professionals need them, when dealing with potential infected? Just because it may help a bit, and unlike the general public they can be trusted to follow mask discipline?

Not really a contradiction, just different circumstances. Medical professionals have to be inside the 1-2m danger zone when dealing with patients, and also in high viral load areas whereas the general public don't. It's the same as saying that the General Public don't need to all be walking about wearing bullet resistant vests, but the police and military have a need for them.

 

[Squeegee Beckenheim]

If everyone stays 2m plus away from everyone outside of those that they live with, and maintain proper hygiene then transmission drops to near zero.

Masks are really only effective when you are in a situation where you have no choice but to be within an enclosed space with others who might be infectious. Here none of our buses, taxis, or trains are running to avoid that.

I'm not saying no-one should be wearing masks, or even that you shouldn't wear one if you want to. Mostly I'm saying if you do, make sure you have the right type and know how to use it correctly. Wash or replace it regularly and try not to touch it with your hands (or gloves) unless you have just washed or sanitized them, and understand that wearing a mask will not always protect you, so still keep on doing the other more effective methods of prevention.

I'm pointing out that masks are not the panacea that will stop this virus as some seem to be believing them to be.

I've got a home-made mask (made using the materials that have tested most effective), but I don't bother using it for when I'm out walking the dog, because it's easy enough to stay away from other people. I've got it in case I need to go up the shops or something, because in my experience even in supermarkets people don't pay much attention to social distancing.

And, yes, I understand that it's primarily going to prevent other people from catching it from me, rather than to prevent me catching it from other people. But I think it must reduce the likelihood of catching it from someone else, even if only slightly.

Say, for the sake of argument that there's a permanent cloud of virus-containing droplets hanging in the air at mouth height (for the moment let's just look at the mouth and ignore everything else) and that I walk through it with my mouth open. If I'm not wearing a mask, then I'm getting the virus in there, no question. If I'm wearing a mask, then the virus has to either get in the side somewhere and work its way towards my mouth, or it has to work its way through the mask. Both of which are more circuitous, and both of which require time during which I could have got home and put the mask in the wash. It may not be much protection, but it's greater than zero.

And, yes, I understand that shopping is low-risk anyway. The evidence suggests that it's not so easy to catch it from surfaces (and that should be ameliorated by hand-washing when getting home, leaving goods for several days, etc.), and if you have to get close to people then due to viral load you're at less risk if you pass them quickly than you are if you remain in close proximity for some time. But, again, it's not zero risk.

Since I live with someone who is at-risk and I'm at-risk myself, I don't think it's an unreasonable precaution.

That said, I'm not actually going shopping myself, because the household is at risk enough for it to be discouraged and the local council are encouraging people to use their volunteers to do their shopping for them anyway. But if I do find myself in a situation where I have to go out somewhere where I think it might be difficult to maintain my distance from other people, I think the reduction of risk, even if only by a very small amount, is worth it.

 

[Belz...]

Surgical masks do help with droplets going out, which if you re-read my post I actually stated, that it helps to protect others from us if we are infected.

There is little evidence that they help over just keeping your 2-3m distance from other people. They might help if someone comes up and coughs or sneezes on you, but if that happens then the material is likely to get into your eyes anyways, so....

The N-95 type filter masks will help, but only if worn correctly, otherwise the virus can just come in around the edges of the mask. Assuming that you're within the 2-3m danger zone with an infectious individual. This is why Medicial staff really need them more that the general public does.

A simple "you are correct" would've sufficed.

 

[ceptimus]

Here are some tables for few countries showing the number of days taken for each doubling in the number of reported total deaths. Most countries showed doubling rates of two to three days in the early stages, and have begun to slow that lately, perhaps as a result of lockdown measures. The tables include the data released up to and including yesterday (Thursday).

Iran's figures continue to stand out. Based on their reported figures, they've now got their doubling days figure up in the two weeks to one month or more range - better than the USA or most European countries.

[table=head]{colsp=4}USA COVID-19 total deaths : doubling days
Target|Actual|Date|Days
15+|15|03-06| -
30+|30|03-10|4
60+|60|03-15|5
120+|124|03-18|3
240+|256|03-20|2
500+|508|03-23|3
1000+|1195|03-26|3
2000+|2221|03-28|2
4000+|4053|03-31|3
8000+|8451|04-04|4
16K+|16691|04-09|5
32K+|?|?|(0+)
[/table]

[table=head]{colsp=4}Italy COVID-19 total deaths : doubling days
Target|Actual|Date|Days
3+|3|02-23| -
6+|7|02-24|1
12+|12|02-26|2
24+|29|02-29|3
48+|52|03-02|2
100+|107|03-04|2
200+|233|03-07|3
400+|463|03-09|2
800+|827|03-11|2
1600+|1809|03-15|4
3200+|3405|03-19|4
6400+|6820|03-24|5
12K8+|13155|04-01|8
25K+|?|?|(8+)
[/table]

[table=head]{colsp=4}Spain COVID-19 total deaths : doubling days
Target|Actual|Date|Days
2+|2|03-04| -
4+|8|03-06|2
8+|8|03-06|0
16+|17|03-08|2
32+|36|03-10|2
64+|84|03-12|2
128+|133|03-13|1
256+|289|03-15|2
500+|533|03-17|2
1000+|1002|03-20|3
2000+|2206|03-23|3
4000+|4365|03-26|3
8000+|8464|03-31|5
16K+|?|?|(9+)
[/table]

[table=head]{colsp=4}France COVID-19 total deaths : doubling days
Target|Actual|Date|Days
3+|3|03-02| -
6+|7|03-05|3
12+|16|03-07|2
24+|30|03-09|2
48+|48|03-11|2
100+|127|03-15|4
200+|264|03-18|3
400+|450|03-20|2
800+|860|03-23|3
1600+|1696|03-26|3
3200+|3523|03-31|5
6400+|6507|04-03|3
12K8+|?|?|(6+)
[/table]

[table=head]{colsp=4}UK COVID-19 total deaths : doubling days
Target|Actual|Date|Days
3+|3|03-08| -
6+|6|03-10|2
12+|21|03-14|4
24+|35|03-15|1
48+|53|03-16|1
96+|104|03-18|2
200+|233|03-21|3
400+|422|03-24|3
800+|1019|03-28|4
1600+|1789|03-31|3
3200+|3605|04-03|3
6400+|7097|04-08|5
12K8+|?|?|(1+)
[/table]

[table=head]{colsp=4}Iran COVID-19 total deaths : doubling days
Target|Actual|Date|Days
3+|3|02-21| -
6+|6|02-22|1
12+|12|02-24|2
24+|26|02-27|3
48+|54|03-01|3
100+|108|03-05|4
200+|237|03-09|4
400+|429|03-12|3
800+|853|03-16|4
1600+|1685|03-22|6
3200+|3294|04-03|12
6400+|?|?|(6+)
[/table]

[table=head]{colsp=4}The Netherlands COVID-19 total deaths : doubling days
Target|Actual|Date|Days
3+|3|03-08| -
6+|10|03-13|5
12+|12|03-14|1
24+|24|03-16|2
48+|58|03-18|2
100+|106|03-20|2
200+|213|03-23|3
400+|434|03-26|3
800+|864|03-30|4
1600+|1651|04-04|5
3200+|?|?|(5+)
[/table]

[table=head]{colsp=4}Germany COVID-19 total deaths : doubling days
Target|Actual|Date|Days
3+|3|03-12| -
6+|8|03-13|1
12+|13|03-16|3
24+|24|03-17|1
48+|48|03-20|3
100+|114|03-23|3
200+|206|03-25|2
400+|433|03-28|3
800+|931|04-01|4
1600+|1810|04-06|5
3200+|?|?|(3+)
[/table]

[table=head]{colsp=4}Luxembourg COVID-19 total deaths : doubling days
Target|Actual|Date|Days
1+|1|03-14| -
2+|2|03-18|4
4+|4|03-19|1
8+|8|03-21|2
16+|18|03-28|7
32+|36|04-05|8
64+|?|?|(4+)
[/table]

 

[The Atheist]

I don't know how reliable this source is, but if its true that there are 100,000 Chinese nationals doing seasonal work in northern italian fashion suppliers...whoa! Maybe it explains some stuff

That's true, I believe but I think it's a red herring.

We know for sure it first spread through ski resorts and I doubt any Chinese labourers would be hitting the slopes.

 

[abaddon]

Needlessly snarky, sarcastic, and rude. The outbreak still exists and people are traveling into and out of Wuhan. I don't see how the amount of time that's passed so far would make it wise, if lockdowns are indeed wise, to fully open everything up already.

Nope. There is a lag. Surely you are aware of that given your pronouncements of expertise?

 

[dann]

That's true, I believe but I think it's a red herring.

We know for sure it first spread through ski resorts and I doubt any Chinese labourers would be hitting the slopes.

No, the spreading from ski resorts in Austria and Italy was to Northern Europe. I also doubt that you would find a single Chinese national on the slopes, but the question is how it got to the slopes in the first place. Austrians and Italians were probably the carriers, but the question is how they got infected before they went there.