First Case of New Coronavirus Detected in U.S. | Hacker News Reader

First Case of New Coronavirus Detected in U.S.

npr.org

315 pointsadenner203 comments

China has been covering it up for 2 months. Minimal action was taken to prevent the disease from spreading and they kept denying until a couple days ago when it was no longer possible to cover it up because it is spreading to neighboring countries who have been complaining for the whole time. Regional/local governments have been trying to downplay it because it makes them "look bad". It is essentially a replay of SARS. Only admit and take action when it's too late.

Well, didn't they hide the true extent of the Great Famine as well for multiple decades?

China doesn't get to decide the scientific consensus. Teams of scientists spanning multiple countries + NGOs like the WHO make the risk assessment. The reason the scientific consensus was that there was no human-human transmission was because...there was no evidence of human-human transmission. All previous cases could be directly traced back to the market, and there were previously no clear evidence of healthcare workers or relatives with no exposure to the market but exposure to an infected individual getting sick.

Unlike anonymous users online, professional scientists can't make a claim, especially a very serious one, without evidence. If they do so, later the public will crucify them if it turns out the virus actually cannot spread from human-human.

It's only in the past three days that it because clear that there is evidence of people who don't have a direct link to the market being infected. A big reason for this breakthrough was that the genome of the virus was identified (by, yes, Chinese scientists working within two weeks of realizing a novel outbreak, which is also impressive). This genome sequence makes possible very sensitive tests for identifying infected people more accurately.

Hence, in the light of this new information, the scientific consensus has been updated to reflect likely human-human transmission.

Please stop spreading false information and unnecessary hatred. This only makes the response to a crisis worse.

All previous cases that had been reported to the WHO could be directly traced back to the market. That might be a rather important distinction if the rumours about regional and local governments covering up possible cases are accurate...

It's really sad to see that Chinese scientist and health workers are somehow 'sacrificed' due to some covering up of some regional and local official. When people refer to China I think it's more like the local officials who have done all the cover-up not only to 'save face' but more like to save their position. Yeah but I agree that a distinction between groups of Chinese people has to be clarified and referred to more precisely.

Well, in this case professional scientists actually made claims about the classification of the virus as soon as they had evidence, and before the government had put out an official statement. But then they got prosecuted for "spreading rumors" and people stopped talking publicly about the progress of their research.

Now the government is getting criticized for this by e.g. Hu Fanzhu of East China Normal University's National Discourse Environment Research Center, whose open letter you might want to read if you think stopping people from "spreading false information" is what's important here.

https://mp.weixin.qq.com/s/toFmfLsLn_x6PhGFliictg

The Chinese central government has already admitted their officials have been trying to cover it up. The president Xi had made it clear that he would "nail" the officials who are covering it up on the "pillar of shame" and those people will be "criminals of 10 thousand years".

Well looking at a large scale public health incident from only science perspective is a naive simplification.

Source?

From wikipedia:

> The first suspected cases were reported on 31 December 2019

It is just pointless bashing, covering up 2 months? Think how this pandemic had escalated in a week, and neighboring countries will not notice it for 2 months?

Some people have some weird imagination

There were no new cases in China except Wuhan and HongKong a week ago, how's that possible if they weren't covering up?

Why is this covering up?

Firstly there isn't one case confirmed in HongKong yet.

Secondly, the virus could take up to 2 weeks to start showing symptoms and it is only until recently the method to detect this virus efficiently had been discovered.

This is a new virus, and its behavior takes time to understand.

> Firstly there isn't one case confirmed in HongKong yet.

[0], [1]

I agree this is a new virus we know little about, but did you know folks in Wuhan were still gathering in crowds without any precautions [2], and ppl got caught spreading so-called fake news of this virus?

[0] https://twitter.com/alvinllum/status/1219911842723553283

[1] https://news.rthk.hk/rthk/ch/component/k2/1504214-20200122.h...

[2] https://twitter.com/Xhnsoc__Redflag/status/12194676125282181...)

I don't think you follow the news there. Just because you've only heard it yesterday doesn't make it new. The neighbouring countries have been on guard on the issue. There have been lots of news, leaks and complaints on this issue for the past several weeks. In fact the wet market in Wuhan had been officially "closed" for at least 3 weeks due to the disease. That means the pandemic has been spreading far longer than that.

Now they suddenly started to release updated numbers (due to pressure from their neighbouring countries) and you think it'd only "escalated in a week".

Some people have some weird imagination

* http://www.chinadaily.com.cn/a/202001/01/WS5e0c6a49a310cf3e3...

Chinese sources have been reporting on the issue from 2019 December. How does your reference a proof that the chinese gov has been covering it up?

I have been following the issue since start of this month from Chinese media, where is the covering up?

Where is due to the pressure part? At first there had not been showing enough evidence of the virus's capacity to spread from human to human, which only confirmed recently because the medical staff gets infected and 2 cases in Guangdong, so the alert level is much lower than it is now.

You can blame the Chinese authority for not fully predicting the severity of the situation, but intentionally covering stuff up is a different accusation you better have strong evidence to support that.

Some people indeed had some weird imagination.

It's hard to cover it up now. It's called the Wuhan virus.

An important side story is that CCP's active political interference of Taiwan's participation in World Health Organisation and other international coordination effort in the past few years, can affect Taiwan's ability to contain any pandemic from spreading.

And since there is estimated 200,000 Taiwan nationals living across the strait, their mobility especially during the Spring festival can become a huge conduit for spreading infection from China into Taiwan.

It is high time that the UN commits to a resolution to insulate shared global issues (hygiene and environment) from politics, and stop China from playing with fire again and again.

> It is high time that the UN commits to a resolution to insulate shared global issues (hygiene and environment) from politics, and stop China from playing with fire again and again.

To play devil's advocate, let's say China continues with her "eff you, no" foreign policy. Now what? The UN has limited powers to enforce such a resolution. What limited powers it has depend on cooperation by member nations, typically including a majority of the security council permanent members. None of those countries want to upset current relations with China, so the UN can't really coerce China to do anything.

From 2009 to 2016, Taiwan participated in the World Health Assembly under the name "Chinese Taipei", which has been a formula similar to its Olympics team that is known to be workable if health is the concern. Of course when the political winds changed, Taiwan no longer wanted to participate under this name, but you can't say with a straight face that CPC is solely at fault here. Taiwan wants to play politics just as much.

Regardless, this has no bearing on containing pandemics. Taiwan sends a panel to the WHA anyway, just not under a country flag. Nice propagandistic farce that works for the domestic audience on both sides.

There has been critics in Asia on that the ex-Director General (2006-2017) of WHO, Margaret Chan, who was sponsored by China for the position, had been building up influence in the organization for China during her term so WHO would work in China's favour. Its effect is showing this time in how WHO handled this incident. Instead of taking a lead and look into the whether China had handled the pandemic properly upon its onset, WHO just parrot China's official stance, in fear of offending China.

* https://en.wikipedia.org/wiki/Margaret_Chan

If you're scared just read the wiki on SARS - the previous coronavirus infection - to refresh your memory.

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

It was a LOT worse that time - Chinese government basically covering up for the first 6 months, virus isolated only much later, sequenced months later.

The coverup is such an important part of why SARS turned out so bad. It mutated after the initial outbreak from a relatively benign virus to a much more deadly variety. (The longer the outbreak lasts and the more people are infected, the more likely such a mutation is) This time the Chinese government has been much more open (relatively), and the virus has been identified at a much earlier stage. I'd be pretty optimistic if it weren't for the Lunar New Year holiday, which could really screw up the efforts to contain the spread.

If anyone wants to track the progression of the virus, I created a quick site with a Google Maps embed to show where the virus has been found so far. I'll be improving it over the next few days.

http://www.coronavirusmap.com/

Is it just me, or does it not even have Wuhan?

Seems it only marks the countries where the virus has been found, not paticullar cities.

You're missing the confirmed case in Queensland, Aus

Person was released out of containment, was feared to have it.

I was about to do a cheeky edit on that comment, but yeah, old mate was cleared :)

Here's a much better map: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...

As someone who lives quite close to the hospital in the article, it was interesting seeing reactions this morning at the office. Some people immediately wondered about their immuno compromised friends and family, while others (myself included) just sort of said "huh" and went about our day. It will be interesting to see how this plays out.

I live in a building with a quite a few nurses that work at that hospital. It kind of scares me that one of them open mouth coughed in the elevator with me the other night. Probably nothing more than a tired nurse and a dry throat, but still kind of weird to read about a thing that is a block away from where you live.

Hah after reading this there’s no way I’m getting near the light rail for the next month or two.

It’s a direct line from SeaTac where people we be flying into from SE Asia after lunar new year is over, and is currently undergoing construction so railway cars are packed at rush hour.

It is not SARS, but it is highly possible that it was caused by people who kill and sell wild animals in the live poultry market. Where these animals like gem-faced civet got virus from bats. It is a long-held tradition for certain regions in China to eat wild animals. We even have a Chengyu called: 山珍海味, meaning precious and tasty animals from mountains and seas. Most wild animals are not evolved to be eaten by human, so not like beef or pork, they do not taste well. People only eat it because they can. Because they want to show others that they can. This is sad.

Literally every culture hunts wild game. This is such a weird thing to consider unique to China.

Do indian people?

What they're describing is different from the hunting culture that persists in developed societies. It's more like hunter gatherer hunting for bushmeat embedded in an agricultural and livestock raising society where such hunting is unnecessary so the hunt is more about status, which is a bit unique.

> It's more like hunter gatherer hunting for bushmeat embedded in an agricultural and livestock raising society where such hunting is unnecessary so the hunt is more about status

It seems like you just described "the hunting culture that persists in developed societies".

Just like with Ebola, we really like using "bushmeat" as othering language to describe hunting.

Never thought of it like that but “bushmeat” is just hunted game. Right?

Yep.

Good point but evidence suggests that this case from a fish market

You're right that the name is 华南海鲜市场 (Huanan seafood market). But the name is actually not accurate. The market sells a wide range of wild animals spanning from rabbits to Chinese bamboo rat, which is suspect to be the source of the virus.

There is also a newly opened medical research facility that investigates pathogens in Wuhan. It's possible the virus escaped.

Coronaviruses are transmitted in what seems to be the same manner as influenza and generate some of the same symptoms. Why do the worst coronaviruses, like SARS, transmit so slowly, while the flu is practically ubiquitous?

Probably has to do with the conditions it can survive in. For example they may both be able to be spread by coughing, but the coronaviruses may not survive as long at room temperature and therefore have a smaller window to inoculate. Granted, this is purely just my guess as I have no actual idea.

Both of them are enveloped viruses, so differential survival is somewhat unlikely. But there are a lot of things that go into how transmissible a virus is.

While SARS does have a longer incubation period, typically 2-7 days compared to the common flu's 1-4 days, the "slow transmission" that you've witnessed is more likely the successful work of national and international public health agencies preventing its spread. Especially by means of contact tracing and quarantine.

Seasonal flu variants have a lethality of around 0.1%. The Spanish flu of 1918 was around 2%. SARS has a fatality rate of around 10%. There is minimal difference in transmission between strains. The only thing preventing disaster is effective public health response.

MERS had a 36% fatality rate.

Just according to superficial stats, it looks like the flu kills orders of magnitude more people than SARS and MERS. Is the public health response to these diseases really so effective as to account for most of this difference? I don't pay close attention but also wouldn't off the top of my head be able to describe anything that, say, Washington State does to effectively respond to CoV incidents to keep it from propagating rapidly through the population the way the flu does.

(I'm asking because I'm curious and seriously have no clue how this stuff works).

> Is the public health response to these diseases really so effective as to account for most of this difference?

Yes. The public health response to the common flu is 'You should, like, get vaccinated. Or whatever. Maybe take a day off, if you work a job that gives you sick days.'

Just according to superficial stats, it looks like the flu kills orders of magnitude more people than SARS and MERS.

This is the "ratio vs. number" distinction: the seasonal flu, despite seeming to have a mortality rate on the order of 1/1000, killed more people just in the US than estimates of people who contracted SARS at all anywhere in the world.

Flu stats: https://www.cdc.gov/flu/about/burden/index.html

SARS stats: https://www.who.int/csr/sars/country/table2004_04_21/en/

When H1N1 was spreading while I was in college, any people who were confirmed cases would have to undergo two weeks of house quarantine. That's a lot of people saved from potential contact. I imagine Washington State's procedures for quarantine aren't too different.

Yes, seasonal flu in the US alone kills around 30,000 each year, and may have killed as many as 60,000 during the 17-18 flu season alone [1]. MERS and SARS have each killed less than 1,000 worldwide.

A few things that may interest you:

* The rate of transmission for a disease is estimated by its R0 or basic reproduction number. R0 estimates the number of new cases from the unaffected population that one infection will cause. A disease with R0 <1 will die out by itself. SARS has an estimated R0 of 3-5, while seasonal flus are between 1 and 2 [2]. So by this measure alone SARS is more "infectious" than the flu. Note that R0 is not a rate and is estimated from mathematical models [3].

* Seasonal flu predominantly kills the young, the elderly, and the immunocompromised. Interestingly, some strains, such as the Spanish Flu, have very different mortality curves that kill healthy middle aged adults far more than average [4]. I would expect a dramatically different public health response compared to normal seasonal flu if a future pandemic had a similar mortality curve.

* In the US, the "tip of the spear" for disease response would be the CDC's Division of Global Migration and Quarantine [5].

[1] https://www.cdc.gov/flu/about/burden/index.html [2] https://www.ncbi.nlm.nih.gov/pubmed/19545404 [3] https://web.stanford.edu/~jhj1/teachingdocs/Jones-on-R0.pdf [4] https://en.wikipedia.org/wiki/Spanish_flu#/media/File:W_curv... [5] https://www.cdc.gov/ncezid/dgmq/quarantine-fact-sheet.html

So lots of people get the flu, but few people die from it.

Few people get SARS/MERS, but they're much more likely to die.

There are a lot of reasons for that. And yes, Washington State can effectively respond to CoV incidents - contact tracing, which is what you need to get people into isolation, is very labor intensive, and probably going on right now. State health departments help support hospitals in doing infection control work (to prevent within hospital transmission) and a lot of coordinating.

SARS has a higher fatality rate than 10%. It's more like 25%. The reason why the numbers are so low is because China underreported the number of deaths. Look at Canada for a more reliable number. And that's not including any long term problems the infected people got even after recovering.

My dad was in China during the SARS time. He said they shut down entire hospitals and basically let people die from it. These are things you don't hear about at all.

Having looked through more stats in the last hour, it appears I also dramatically underreported the lethality of the Spanish Flu. Some sources put it at 10-20%. It may have killed 3-6% of the world's population.

>The WHO based its estimates on an analysis of the latest data from Canada, China, Hong Kong, Singapore, and Vietnam. "On the basis of more detailed and complete data, and more reliable methods, WHO now estimates that the case fatality ratio of SARS ranges from 0% to 50%, depending on the age group affected, with an overall estimate of case fatality of 14% to 15%," the agency's announcement said.

>The fatality ratio is less than 1% for people younger than 25, 6% for those aged 25 to 44, 15% for those aged 45 to 64, and more than 50% for people 65 or older, officials said.

>WHO officials observed that calculating the case-fatality ratio for a disease outbreak is difficult while the outbreak is still evolving. The true ratio cannot be determined until the outbreak is over, when the total numbers of deaths and recoveries are known.

http://www.cidrap.umn.edu/news-perspective/2003/05/estimates...

If it is similar to SARS, 19 nCoV could affect developed countries with elderly populations more.

>Of the 298 infected, nearly 230 are being treated in the hospital. Among them, around 60 cases are critically ill. Others who are sick have recovered or been sent home from the hospital. And six people have died.

>It’s possible there are many more people with the virus out there who have very mild symptoms or who are asymptomatic, said Dr. Jeremy Farrar, director of the Wellcome Trust, a research charity focused on global health. If that’s the case, and there are thousands carrying 2019-nCoV while only a few people have died, this outbreak will look milder.

https://www.vox.com/2020/1/21/21075017/sars-wuhan-pneumonia-...

The actual mortality rate will be determined by how many of the critical ill patients recover or die. Long term disability is another thing that needs to be measured.

Spanish flu was more 20% than 2%

I read somewhere that you can get the flu by being exposed to as few as 25 flu virus particles. Maybe the coronaviruses require more actual virus particles?

They suspected a man in Australia of having it and were awaiting test results yesterdayish too https://www.smh.com.au/national/first-australian-monitored-f...

There is also /r/China_Flu/ for those that wanta centralized location for news.

I think this is certainly not a great thing but I urge people not to panic. Any time some sort of new disease starts to spread a portion of the population immediately overreacts and starts to get a little nutty "how do I protect myself? What should I buy? Will bleach kill it?! How about OmniCide, Madacide, Opticide?!?!".

Keep in mind that colds and regular flu are going around right now too, if you feel sick it's probably not this virus. Last week my office had a stomach bug, by Friday a few people had bad head/chest colds, this week the stomach bug is all gone and half the office has a head/chest cold and definitely not this virus yet someone on second shift has a hospital mask on (and as far as I know don't have a valid medical reason to remotely justify it).

I wish wearing hospital masks was more accepted. Out of the listed reactions, it's probably the least overreaction possible, especially if it's a fashionable one and not actually hospital color...

I've read such conflicting information on them. Some sources say they protect other people from you more than they do you, some say they protect you 60-80%, some say washing your hands properly (and frequently) is more effective etc.

Either one of those cases is good, especially in cases where you're contagious before you have symptoms (not sure if this is such a case).

Even if the mask doesn't actually protect you, it will prevent you from touching your face and mouth absent-mindlessly.

Do you have any data about that?

As an epidemiologist, this is an "and" not an "or".

You need to wash your hands to supplement a mask. If you believe it's working, the mask is now covered in infectious fomites, and you need to get it off you without infecting yourself.

The good news is coronaviruses are enveloped, and thus relatively susceptible for disinfectants.

If you're sick or believe you may be sick and can't simply isolate yourself at home, then definitely wear one. I see folks wear them occasionally though its second best compared to just staying home and resting.

I wear one everytime I fly (which is 8-10 times a month on average) and I just don‘t care about the reactions. Also, keep your bare hands the hell away from your eyes and nose.

I travel almost every week and washing my hands every time I can plus never touching my face have kept me ill-free for a couple of years now. Of course I also take other precautions like avoiding closed spaces with sick people, good sleep, drink water and exercise regularly.

How did you break the constant need to touch your face? I tried to do that, and in 5 minutes I am back in touching some part of my face.

I've been able to mostly stop rubbing my eyes or nose, when I'm serious about staying healthy.

If I'm desperate, I rub them with some piece of clothing that's not much exposed to the air, such as the inside of my t-shirt. Or alternatively, washing my hands carefully with soap and water immediately before rubbing my eyes.

I can't say for sure if those measures helped, but it seems plausible based on my experience.

You must be attentive enough to your impulses to catch yourself wanting to do it before you actually do it.

It takes years to develop that level of attentiveness, but it's oh-so-worth-it. And not just because it lets you avoid the seasonal colds :)

Interesting. I have an absolute control over this kind of things. If I decide not to touch my face with my hands it just happens. It feels like mentally setting an exception in my loop. As soon as the hand comes closer to the face or my eyes itch, I realize what‘s happening and stop. I never saw that as anything special, though, is it?

I always thought wearing hospital masks was for infected people, not the other way around.

This is probably why it would carry a negative stigma here since that's been the norm in this country where the sick people have to wear masks, not the healthy people.

I remember being in Urgent Care and having to wear a mask when SARS broke out and I had a cough that wouldn't go away. People wouldn't come near me. One guy came over, saw that I was wearing a mask and gave me a look as if to say, "Oh hey man, that's cool, I'll just stand here." and kind of side stepped away from me.

In China, the pollution is so bad, people have been wearing masks for so long, seeing them in public isn't a big deal anymore. Here, in the US, you're right, its always been the sick people wear masks, not the healthy ones. I feel it would be incredibly hard to get people to overcome this ingrained idea since its so uncommon to see people out in public with surgical masks on.

In Asian cultures it is. In western cultures, sick people aren't nearly so respectful, so then the masks become for the healthy folks.

Hospital masks by itself would not help prevent things like SARS. In Toronto, health care workers were getting infected even after following the strictest protocols.

If there was definite evidence that wearing masks helped prevent catching flu, at the very least you would see them used in occupations where the cost of an employee being out with the flu for a week is very high. Since we don't see this, they are probably ineffective.

You need to wear it properly, some if not all regular people adjust their mask looser so they can breathe easier

What reaction? Someone eye balling your mask isn’t that bad.

I've already started a course of Forsythia.

https://www.mobs-lab.org/2019ncov.html

Current modeling estimates put the likely number of infections between 1 and 6.2 thousand, primarily concentrated in China.

This estimate [0] puts it at 4,000 as of Jan 18.

It’s weird to not have government numbers that are actionable and we have to use models that range from 1-9.7k.

[0] https://www.imperial.ac.uk/mrc-global-infectious-disease-ana...

It's actually not all that weird. The link I posted above is from a group that was funded by the NIH in a program called MIDAS (Modeling Infectious Disease Agent Study). The express goal was to produce modeling platforms usable by the government.

Imperial's MRC group has a very similar mandate, IIRC. Where these numbers are coming from, and the range of uncertainty around them, is very much characteristic of an emerging infectious disease (bad early data, stochasticity, etc.).

Reports are that China has just quarantined Wuhan, a city of 11 million people.

Government officials are being prohibited from leaving, not regular citizens.

Logistically, how can they do this?

China has the largest active military in the world, according to this list in Wikipedia:

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

Racoon city

"Zeng, who is leading the Chinese government's efforts to respond to the outbreak, made clear that his recommendation was not a government-imposed quarantine."

Flights are still departing Wuhan:

http://www.whairport.com/jc/ch/dep/depGlList.jhtml

Wuhan is in the middle of China, every transit passes through it. It’s like the Chicago of China. There is no way in hell the government is going to able to lock it down.

and yet they just did

I read on Reddit that Chinese New Year is the largest regularly occurring human migration event in the world. Millions of Chinese people gather on public transport and planes To go home to celebrate. It’s in a few days I think.

Also I’m not sure how the CDC is preparing for this under 45, but given the state of the federal government I would guess it’s less prepared than the days of the Ebola scare.

Hopefully things will not be too interesting. I hate it when things are interesting.

It'll be on January 25th.

Like a coming tsunami of people travelling. At least it's all over the country, not just in one place, but still tons of close contact on the train systems.

There are some good docs on Chinese New Year transit on trains and it gets dicy and competitive for space.

To make it worse, Wuhan is one of the major hubs for people traveling east/west. It's a 11 million city that will see a lot more visitors and connecting traffic over the next weeks.

Wow, I had been under the impression that the Arba'een Pilgrimage[0] was the largest human annual migration but the Lunar New Year easily surpasses it. This article has some good info on the sizes of a few recurring migrations and their size: https://www.forbes.com/sites/niallmccarthy/2018/02/14/chines...

The infographic is absolutely crazy: https://blogs-images.forbes.com/niallmccarthy/files/2018/02/...

[0] https://en.wikipedia.org/wiki/Arba%27een_Pilgrimage

I was under that impression too! Maybe it’s because the Hajj has much more disparate travelers that I bin it under “migration”.

Whoops, confused Hajj with Arba’een. I did not know about the latter and I assumed that they were the same. Arba’een is much larger than the Hajj.

That's surprising, Hajj gets a lot more press/prestige it seems. Saudi is a similar sized population as Iraq, that infographic comparison is interesting to say the least:

https://en.wikipedia.org/wiki/List_of_Middle_Eastern_countri... (Iran, not listed, is 81.16M)

The Hajj is a once in a lifetime pilgrimage for most Muslims while the Arba'een is an annual regional event of Shia solidarity. The former is done by a far greater number of unique individuals but the latter can be bigger on an annual basis.

What about the Kumbh Mela known as the worlds largest congregation of pilgrims?

TIL!

> Also I’m not sure how the CDC is preparing for this under 45, but given the state of the federal government I would guess it’s less prepared than the days of the Ebola scare.

Despite "45" apparently being such a comic book villain as to warrant "guess[ing the CDC is] less prepared", the CDC has actually had guidelines out since August 2019: https://www.cdc.gov/coronavirus/mers/preparedness/checklist-...

This is part of how we even know of this case: the CDC under "45" was prepared, a local HCP was informed about what to watch for, and the system worked as intended. We have literally been through a very similar situation already with SARS and those protocols worked very well.

I mean, it’s not like I’ll be happy if the CDC and the federal government is unprepared and this becomes concerning and people die. If they’re prepared, then that’s good for everybody, and I am wishing the CDC success in its efforts to keep us safe. Thank you for posting links!

Guidelines for what in relation to the current emerging new coronavirus? Mers is an entirely different coronavirus that’s been around for a few years. https://en.wikipedia.org/wiki/Middle_East_respiratory_syndro...

Here’s the cdc page on the coronavirus that’s the subject of this thread https://www.cdc.gov/coronavirus/2019-ncov/ much of this is still emerging re what we know, Afaics the mortality rate appears to be well below both SARS and MERS

A couple notes, from an infectious disease epidemiologist:

- The CDC Director is, in rare form for this administration, not someone devoted to dismantling the agency he's in charge of. I work with the CDC fairly frequently, and they're in pretty good shape.

- This is our third novel coronavirus, and the 2nd out of China. There's been a lot of prep work for this.

That's wonderful to hear!

But wouldn't prevention require to screen all returning passengers from China and/or other Asian countries after Chinese New Year? I'm not sure how feasible that would be with the number of connecting flights with passengers from China arriving in the US each day. Or is it enough to isolate patients once they are ill enough to seek treatment?

Generally speaking in the U.S., quick isolation and contact tracing once cases do arise works well enough when combined with good infection control at the point of treatment.

I was in Guangdong when SARS happened in 2003, I have heard rumors for months until the Chinese gov eventually admitted there's such virus exists. Ever since then I basically have zero trust in the Chinese gov. For this time, since Chinese new year is coming, I had actually warned my coworkers do not go back to China, especially Wuhan, a couple days back. So bad not everyone listen, now they are kind of scared.

Yup SARS did not coincide with hundred of millions of people stuffed in closed compact train cars and plane seats for hours at a time. This coronavirus might mutate faster than we could predict. Nobody should be traveling to China right now

I feel like it has been so long since the swine flu, bird flu, H1N1 flu, and other flu scares that we are due for one.

Like the recessions the flu scares are cyclical.

Don't forget Ebola scare as well.

Ah, but they've developed a vaccine for Ebola.

https://www.fda.gov/news-events/press-announcements/first-fd...

Maybe it‘s like acid rain - the scare is keeping it from becoming what it could potentially be.

And at some point there will definitely be a major pandemic.

define “major pandemic”. By % of humans affected the trend was very clearly towards almost 0.

By absolute number of people affected it also has been trending down since around 1900 despite the population growth

Bird flu (H5N8) is actually back in central Europe right now, coming in through eastern Europe from Central Asia.

We’re all sickened for about two weeks already... this year’s flu is definitely a thing, although seems to be contained in the NL (personal, anecdotal evidence)

Bird Flu spreads very rarely to Humans, you're probably talking about other flu viruses or just the common cold.

Recessions happen somewhat cyclically because imbalances build up in the economy that ultimately cause some sort of dislocation.

The same is not true in virology. There is no "pent up" mechanism that needs to periodically release an outbreak.

It is entirely random and in these types of outbreaks simply becomes more likely when many animal species exist in close proximity, allowing virus cross-over. It's no coincidence this happened in a live animal market.

One exception to cyclic nature is immunity. In cases where the same disease outbreaks because the human population is no longer immune - ie the Black Death which returned every couple generations in the old world. ...but that phenomenon only applies to SAME disease returning - not different ones.

Maybe the mechanism is in the cynicism. After some time people forget why they are freaking out over something that never happened as far as they remember.

A bit like the Y2K bug that was supposed to end the world but nothing happened but nothing happened because we took measures successfully. There are many people out there using this as an example of alarmist to draw parallels with the climate change concerns.

Maybe we as a species need to have people around who remember things and when they are gone we simply re-learn the lessons. Writing seems to be effective on passing the knowledge on how to do or avoid things but not very effective about the reasons.

black plague in England was on a 20 year cycle I hear.

Recessions happen somewhat cyclically because imbalances build up in the economy that ultimately cause some sort of dislocation.

Actually recessions seem to be driven by random events. Our brains impose a cyclic explanation on what is actually a stochastic process.

See https://www.philadelphiafed.org/-/media/research-and-data/pu... for more.

I think is more about the perceptions and at what point does the media and people start to pay attention aka "flu scare". I have the feeling it has nothing to do with the actual number of people that are sickened.

The Spanish Flu was almost exactly 100 years ago. Recent enough that we think of it as being in modern times with relatively modern medicine and hospitals. My grandmother lived through it, so this isn't the distant past.

Current estimates are that it killed up to 100,000,000 million people, as many as the black plague.

We have much better medicine now, thankfully. But we also live in a much more deeply connected world with millions of people flying every single day.

Great book about this (and, more broadly, the rise of medicine as a scientific endeavor):

https://www.amazon.com/gp/product/0143036491/

Seconded: I just finished this last week, really great historical piece, doesn't leave much out.

> We have much better medicine now, thankfully.

Do we? Against a deadly and virulent flu virus causing viral pneumonia? Not really without development of a highly effective vaccine.

You have better life support, but that's about it. Something like ECMO is extremely invasive and limited to maybe a few per ICU.

We have anti-virals now, when back then we didn't.

Not sure if they'd actually work on these strains, but it's something.

"Something like ECMO is extremely invasive and limited to maybe a few per ICU."

Better supportive intensive care is exactly what lowers the case fatality rates for viral pneumonia. And this is very unlikely to become a hospital capacity problem.

imagine the impact on global warming, or real estate prices

It's curious how little cultural impact it has compared to the world wars or Black Plague despite the death-toll. I've never seen a TV series or film about it or any art, songs or phrases. There is no iconic photograph that comes to mind. It's just a minor footnote to WW1. I don't know if it's wartime censorship or just overshadowed but it's really quite odd.

First thing that comes to mind is the scaled impact as a % of global population. The population was so much smaller during the Black Plague that it was comparably a bigger event.

> little cultural impact

How many people are dying today from preventable causes? Have you heard songs about them?

The Spanish Flu was, by definition, not curable since so many people died of it.

There have been many films, books, and other media about other epidemics. HIV/AIDS, bubonic plague, smallpox, and polio come to mind.

I think GP was pointing out how much WW1 overshadowed everything else that was going on at the time. In any other moment in history, the Spanish Flu would have been a significant occurrence.

> It's curious how little cultural impact it has compared to the world wars

Erm, it could be argued that the Spanish Flu is what stopped World War I.

That's pretty significant.

It's 100% due to war time censorship. Unusually, it hit young able bodies people the hardest. ie, young men who were being conscripted into the war. There were huge problems with swaths of people in barracks all getting sick and messing with the deployment process. In every country involved in the war. And it absolutely couldn't be let known that anyone was having problems fielding new recruits. So the news was heavily censored.

Spain was neutral, and therefore didn't have tons of people packed into barracks waiting to be deployed. As a result, they suffered the least. Relatively few Spaniards got sick. However, since they weren't at war, there was no wartime censorship, and it was covered by the Spanish press. Therefore the pandemic came to be known as the Spanish flu.

Extra credits did a series on it, which is worth checking out IMHO. Six episodes, ten minutes each. https://www.youtube.com/playlist?list=PLhyKYa0YJ_5BZ3gQleTk-...

The Spanish Flu also influenced the design of old radiator heating systems.

"The Spanish influenza epidemic, which took place during the winter of 1918–19, had a dramatic effect on the way heating engineers sized radiators," explains Dan Holohan, author of several books on steam heat and founder of HeatingHelp.com. "Central heating was relatively new then and the world had never seen anything as horrible as the Spanish flu, which caused an estimated 50 million deaths. Because the flu was airborne, the Board of Health started a campaign the following year that urged (more like demanded) people to keep their windows open so fresh air could enter the rooms."[1]

[1] https://www.citylab.com/life/2014/02/our-indispensible-guide...

Interesting, but I'm not sure that's still valid. At least for European apartments I've lived in, radiators were never sized so that they could've heated apartments on the coldest day with wind and windows open. In older apartments cold days with wind can already be a challenge with windows permanently closed.

So I guess that fell out of favor at some point when heating costs became a bigger issue.

> it killed up to 100,000,000 million people

Jesus Christ, that's more than 100,000 Earths! No wonder people were upset.

Joke aside, it was 50-100 million; the black plague was 100-200 million. Of course there was lot less people then.

Oops! Decided to write out the number but forgot to delete the word. :)

First, this isn't a flu. This is a coronavirus, related (but not identical) to both the common cold and (more closely due to subtypes) SARS. That said, while I am not an epidemiologist, this doesn't seem nearly as fatal - about a 2% compared to a 9.5% of SARS and 10-15% of the Spanish Flu. Remember that known cases will usually have more serious reactions than less serious cases - milder cases won't go to doctors.

I am hoping that this ends up being an overreaction. That said, SARS most definitely wasn't, and I wonder if we could make life a lot better if we generally treated the common cold and flu the same way, preventing the outbreaks in the first place.

I am an epidemiologist. Right now, the case fatality definition is bonkers. 2.3% is the low estimate, and it goes way up. The high estimate is 91%. That's just a uselessly broad figure because it's still very early days.

If I had to guess, I'd guess it's probably around the level of SARS/MERS.

I made the mistake of assuming the official numbers being reported were accurate. If the Weibo rumors are true, this is truly scary and uncontrolled within China.

Bit alarming considering chinese new year is coming up.

This virus is going to spread a lot wider and faster in the next month as chinese new year is next week. Most people are going to their home town then back to major cities all over the world not just China.

Anyone have a sober perspective of how bad this is likely to get? Is this comparable to a bad but forgetten-by-the-next-year flu strain? To SARS? To the Spanish Flu?

I don't think we can know yet. It's infected around 300 people, 6 of whom have died, putting a mortality rate of around 2%. Thats not as bad as SARS, which was 10%, but its early. SARS ended up being restricted to around 8000 people, mostly concentrated in China, though eventually spreading to dozens of countries, but its impossible to say how far and wide this one could spread, especially given that the outbreak is occuring on the eve of Chinese New Year.

According to some of the sources I've found online, coronaviruses tend to be much less easily spread from human to human than something like the flu, but just a few days ago officials were saying they didn't think this virus was transmissible between humans, which they now have confirmed is in fact possible, so clearly its a very fast developing situation.

That mortality rate isn't at all reliable at this point - we have lots of unconfirmed cases which messes with the denominator, and we haven't had all the people who do have it develop their outcome.

2% is very much a best-case estimate right now.

SARS was about as lucky as you can get without pandemic.

With the availability of international airline travel, there's no limit to how far and fast a disease can travel now.

Toronto had a big SARS scare when one of the patients who was told to quarantine himself instead went to work ...

On the average-case risk, it is unlikely to get "bad." (if bad is defined as being similar to SARS or MERS.) However, its current worst-case risk is similar severity, with n=(500-1000) individuals who may pass away fatally if it does get "bad."

I'm an infectious disease epidemiologist who has worked on Ebola and MERS (along with some other stuff).

I'd peg it, right now, at SARS-levels of bad. Most early modeling estimates, from people who know their stuff, are estimating the number of infections at a few thousand. Bad in China, likely sporadic outbreaks elsewhere due to infection control failures treating hospitalized patients (i.e. the South Korean MERS cases).

A traveler from China landing on US soil, and detected at the airport (Seattle). This isn't spreading in the US population... yet. (And won't be from this, if containment procedures in Seattle work... and if they didn't transmit it to others on the plane... and maybe a few other ifs.)

According to the Washington Post[0], it wasn't caught at the airport, and he isn't a traveller, he is a resident in the Seattle area returning from China.

> Washington state health officials said the man, a resident of Snohomish County, Wash., returned from a trip to the region around Wuhan, where the outbreak began. He arrived at Seattle’s international airport last Wednesday. Shortly afterward, he began feeling ill and reached out to his health-care provider on Sunday. Local, state and federal officials quickly collected samples and sent them to the Centers for Disease Control and Prevention, where his case was confirmed Monday as the coronavirus

Officials say they are trying to track down people he may have had contact with. Sounds like he was on top of things, and so they identified things as quickly as possible, but the disease is not necessarily contained.

[0] https://www.washingtonpost.com/health/2020/01/21/coronavirus...

Hmm. The Reuters article says the same. Either it was updated, or I misread it.

So... yeah. Maybe not so contained.

> he isn't a traveller, he is a resident in the Seattle area returning from China.

A traveller is somebody who travels, e.g., from Seattle to China and back.

The implication seemed to be that it was someone passing through, as opposed to a resident. But yes, my read could have been wrong.

It confused me a bit on initial reading because a non-traveller in Seattle would have to have caught it there.

The U.N. should declare an emergency to curb the spreading of the coronavirus(they are still talking over this like wtf!). Neighboring countries have amped up screenings of flyers from China.

Scary stuff, I'm travelling with my family through China into Russia. Make sure you mask and hand sanitizer handy.

First the swine flu kills half the pigs in China. Now this thing.

The marketing department of the beer company must be livid.

Not if they're smart enough to capitalize on this.

With just the right touch, they could potentially crush it with the Super Bowl coming.

I don't know. Maybe a bunch of people sitting around holding Corona Light beers with hospital masks on. They are just looking at each other. Then at their beers. They can't take their masks off. One guy tries to drink it through the mask, just kind-of chokes. Another tries to pour it through the little cracks at the top of the mask... no good. Finally, one guy says screw-it, takes his mask of and drinks the beer. Everyone else follows.

Then, to be a little tongue in cheek, a guy at the very end of the commercial coughs.

The Chinese government has had difficulties handling the situation. I think we might need WHO to jump in soon.

(Chinese New Years is in 3 days and few hundred million people will travel in congested trains and flights. Also people in China usually don’t cover their mouths when they cough)

Coronavirus: Chinese hospitals not testing patients, say relatives https://www.theguardian.com/world/2020/jan/21/coronavirus-ch...

Wuhan virus kills fourth patient, infects hospital staff amid fear of ‘super-spreader’ https://www.scmp.com/news/china/society/article/3046908/new-...

man in Wuhan infected with coronavirus went to hospital but got sent away, took a flight to Dalian & became Patient Zero in Dalian https://www.reddit.com/r/China/comments/erszdd/disease_contr...

If they have difficulty dealing with this in a country where the government has a lot of control over people's coming and going just think what it'll be like if it gets going in the US.

I think otherwise.

If there is one government that can tackle this, it will be the Chinese government. It is much more powerful and effective to enforce crowd control than other countries.

And you better hope it succeeds, for your own benefits.

The WHO is a policy org. They don't have any power to do anything on their own. They can only recommend things.

Maybe a million fevers a day in China

As someone who takes regular flights on planes I find this disturbing.

Wearing an N95 mask and washing your hands properly will prevent the overwhelming majority of transmission. Could someone still sneeze in your eye? Sure. Could you wear your mask improperly because you haven't been fit tested, yeah. But you sure can reduce your risk a lot.

I just googled N95: I have a bunch of those in my toolshed! They look ominous. :) But I have 12 flights in the next 5 weeks from US to Europe to Israel so I may have to risk looking like a weirdo.

> Could you wear your mask improperly because you haven't been fit tested, yeah.

It is next to impossible to wear an N95 mask correctly.

They come in a lot of different flavors. I have been fit-tested several times with success. Some are definitely easier than others.

Do I think that every 0.3 micron or above particle is getting filtered out by the mask for the duration that I wear one? Not really, but I do believe confidently that it is getting the vast majority. Certainly enough to measurably reduce risk.

It's also not at all clear that N95 masks are meaningfully superior to surgical masks.

One of several studies on the topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868605/

>Wearing an N95 mask and washing your hands properly will prevent the overwhelming majority of transmission.

My understanding is that there is no evidence wearing an N95 mask reduces transmission to the person wearing it. It prevents transmission from the that person to others.

No, this is very wrong. You're thinking of surgical mask, in which case the standard precautions conform to what you said in their intent, and studies show both are actually effective in preventing transmission when worn by patients. [1]

An N95 is the current recommended standard (for medical works to wear) to prevent droplet transmission when working with high-risk patients on respiratory precautions since it is actually capable of filtering particles (like airborne droplets originating from the respiratory tract) down to 0.3 microns. These have been shown to be effective.[2] Interestingly, some studies show surgical masks are also effective.

A surgical mask is, I believe, still the standard to place on high risk patients on respiratory precautions to help prevent dissemination of droplets.

[1]https://academic.oup.com/cid/article/49/2/275/405108

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868605/

From your second citation: "Although N95 respirators appeared to have a protective advantage over surgical masks in laboratory settings, our meta-analysis showed that there were insufficient data to determine definitively whether N95 respirators are superior to surgical masks in protecting health care workers against transmissible acute respiratory infections in clinical settings."

Insufficient data to show that N95 is better than a surgical mask, not insufficient data that N95 works. My guess is that whether the mask fits and makes a good seal, whether the user wears it consistently, and whether the user washes his hands before handling food or touching his mouth or nose all matter a lot more than the type of mask.

Agreed, but many of these studies were done in a medical context, which is close to a best-case scenario in terms of training for the use of an N95.

Yes, except that studies showed surgical masks are likely as effective, which strongly suggests that precise fit confirmed by a fit-test probably isn't necessary.

I read on the news first symptomes observed in USA,also here who[0] emergency prep. responses, given details about some cases [0]https://www.who.int/csr/don/archive/year/2020/en/

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