WHO declares coronavirus outbreak a public health emergency
cbc.ca
cbc.ca
* 15,000,000 – 21,000,000 who had the flu
* 8,200 – 20,000 deaths from the flu
The morality rate ranges from 0.03% to 0.09% or 3/10000 9/10000
https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...
Any numbers we've seen so far seem very tame to me, compared to the pictures out of Wuhan.
If you don't want to read subtitles for 26 minutes here's all the subtitles copy-pasted from the video: https://pastebin.com/6hJ4h4rm
(You can hit the "..." above the red subscribe button and select "open transcript", but it shows up in a tiny window).
I suppose the WHO saying they're very impressed with how China is handling the situation is because they felt the pressure to save China's face.
Yes the WHO are playing politics when they focus on the good things China is doing and ignore the bad. But personally I think they are closer to the truth than those who present an entirely negative version of events. China's response has been 70% good :)
Not really, they jailed the experts who told them that they needed to act quickly, sat on it for a month, and finally did something about it when it was already out of hand.
If you don't mind me asking, where did you see that info?
I watched the CDC press conference today and saw nothing but fear written on their faces. And that is with far more advanced notice than the Chinese had.
Reading through it made it clear that:
1 - Wuhan's health care system is overwhelmed
2 - There's not enough transportation, test kits, masks, and hospital beds, or volunteers
3 - Many sick people are not even bothering to go to the hospital
4 - There's poor communication and rumors flying around
5 - People are frightened, panicking, and suspecting the worst
This tells me that:
A - there are likely way more people infected than there are confirmed cases, but possibly more deaths too of those who never made it in to hospitals
B - Many wouldn't have died had they had more adequate health care, better transportation and more test kits
So, for the rest of us who are sitting on our hands now, glued to social media or the television waiting to see how this will unfold, our time would be much more productively spent planning for when the outbreak hits our local area.
Volunteer. Get connected with volunteer organizations. Donate. See what you can do to ensure there's adequate transportation, communication and resources when the outbreak hits your area.
One thing I'm really curious about that I haven't heard covered yet is if people who get sick and recover become immune. If so, they should feel safe in volunteering to come in contact with the sick and help them directly after they've recovered themselves.
Cooperation, preparation, organization, and mutual aid are crucial.
The reporter, Chen Qiushi, describes his observations in Wuhan, a city of more than 10 million.
His preamble:
"My name has been flagged in China."
"If the content contains 'Chenqiushi' or 'CQS', or my face, it will not be sent on Wechat. ... if you [share on wechat], your wechat account will be deleted, like mine.""
He describes visits he made to hospitals in Wuhan and the general state in the city.
It is well worth listening to / reading.
Some points that stuck with me:
People cannot get to hospital because there is a critical lack of transportation.
There is a critical lack of test kits, so residents do not believe they will be diagnosed, so they stay home.
The original (not translated) is here: https://www.youtube.com/watch?v=iXozpbomAns
(thanks Roritharr)
How far does the censoring actually go?
That said you aren't going to be blacklisted for a single comment on HN. That sounds like the kind of thing the US would do.
[1] http://www.ddl.ish-lyon.cnrs.fr/fulltext/pellegrino/Pellegri...
Source: https://www.who.int/csr/sars/press2003_04_01/en/ (search for "deaths")
On the flip side, the R0 (rate of transmission) and death rate might be a good clip lower than currently estimated. On the other hand, China walled off a city but part of their motivation might have been the flack they got for moving slowly with SARS.
I wouldn't even go that far. I've been using this as an excuse to figure out the D3 v5 API using the Johns Hopkins data. Most provinces outside of Hubei are not reporting deaths yet. It's possible nobody's died outside of Hubei, but that seems suspect to me. There is almost certainly strong federal and local pressure to under report deaths, but this sort of thing is much harder to hide in Hubei because it's the epicenter.
I don't believe for a moment that China would've attempted to quarantine 60 million people so quickly if the case fatality rate were only 2%. 2% is bad but SARS saw around 15% in many countries and things weren't locked down this tightly.
More to the point, Hubei is reporting 204 deaths and 5,806 confirmed cases which works out to about 3.5%. This is compared to 76 deaths and 1,423 confirmed three days ago (or 5%). If you'd like to look at death compared to known outcomes you're looking at about 64% of the outcomes being death (204 deaths, 116 recoveries). It's not clear which part of the equation is lagging more in Hubei.
presumably fatality is only one of many factors here. 15% of 100 infections is a different beast than 2% of 1M. And if it takes up to 14 days to see symptoms...
There were roughly 8,000 SARS infections and currently about 10,000 nCoV infections so the comparisons aren't quite as absurd.
As she said, we will only know once the thing is over.
Assuming the average time from symptom onset and diagnosis to death is 7 days, we're looking at at 20% death rate (830 confirmed infected 1 week ago). Even a 5 day lag between symptom onset to death is a ~9% death rate (1,975 confirmed infected 5 days ago).
This is exactly how the fatality rate of SARS played out.
Do you have evidence of that in this case?
Viruses vary widely on how many are asymptomatic. My understanding is that having people be infectious and asymptomatic only happens with diseases that are well-adapted to their hosts. Which this one, having recently crossed a species barrier, isn't. (Its fatality rate is also high for the same reason.)
However that is a general understanding and I don't have data to base it on on this case. Do you?
If they in fact can't transmit, then this is OK. If they can or, even worse, have a long latency period and will show symptoms in 2 weeks, that is very, very scary.
Our best tool for diseases like this is contact tracing. And asymptomatic carriers make that very hard.
(Useless trivia, the first documented asymptomatic carrier who was infectious was a short order cook named Mary Mallon. She is better known as Typhoid Mary.)
When she was first identified, she cooked for a number of families. The outbreak that got her put away for life was due to working as a cook at Sloane Hospital for Women.
I cannot immediately find record of her being a short order cook specifically. However that is my recollection from https://www.amazon.com/Betrayal-Trust-Collapse-Global-Public...
- how many infected but not confirmed. They could be asymptotic or mild enough not to seek medical treatment. This would increase the denominator.
- time between infection to first symptom to death. Therefore we don’t know which way the remaining confirmed cases will go. Probably increase the numerator over time but don’t know by how much.
- unclear how accurate the reported numbers are.
Disclosure: no I'm not an epidemiologist. But for a reference to a paper by actual epidemiologists see https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408... section Simple Estimators, specifically this formula:
e₂(s)=D(s)/{D(s)+R(s)} which is: deaths / (deaths + recoveries)
The paper concludes: "The second simple estimate based on the ratio of deaths of those for whom the outcome is known, e₂, is reasonable at most points in the epidemic" ie. produces a good estimate of the eventual observed case fatality rate (in fact in their example it slightly underestimates the actual case fatality rate)
still can't believe them.
I suppose one way to reduce uncertainty is to examine a cohort of patients and follow it meticulously. To do that, we can look at the 99-patient case study published in The Lancet yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... 11 died, 31 were discharged, and 57 remain in the hospital. This suggests a CFR of 11/(11+31) = 26% The assumption epidemiologists make when they use this formula is that the 57 still in the hospital have the same chance of dying as those who already died in the hospital.
Another way of looking at probabilities, out of the 57 patients left in the hospital:
If 0 die (ie. all recover), the CFR is 11% (11 deads, 88 recovered)
If 15 die (26% of 57 still hospitalized), the CFR is 26% (11+15=26 deads, 73 recovered)
If 57 die, the CFR is 69% (11+57=68 deads, 31 recovered)
So the CFR bounds are 11-69% and if the trend on remaining patients continue it should be 26%.
Only 7% of hospitalized flu cases died in 2018-2019 (34 157 out of 490,561): https://www.cdc.gov/flu/about/burden/index.html The coronavirus would thus appear to be 4 times more deadly (26%.)
In other places that are better prepared and which have more resources the outcomes will likely be better, in worse prepared places with fewer resources the outcomes will likely be worse.
Let's keep that in mind before we extrapolate from Wuhan to the rest of the world.
I doubt this. WHile this may be true for a known disease, we have to ask, how much can the hospital do in this cases? It is a little bit like HIV in the beginning. Watch them die?
Interestingly, China is trying HIV medications on the infected.
For more info on ARDS and treatment in the context of the current pandemic, see this informative explanation: https://www.youtube.com/watch?v=okg7uq_HrhQ
This is a very straightforward application of survival analysis, and those still in the hospital are "censored" observations - we know their outcome takes place in the future, but we're not sure when.
There are methods for calculating things like CFR in the presence of censoring, which will change based on what type of model you're using.
In reality, though, people who are going to die don't die at the moment of infection confirmation and people who are going to live do lag in the log because it takes time to confirm if someone has recovered and virus-free.
Some will suggest to simply compare the deaths to the confirmed case from a week? ago but this assumes that the patients are admitted at the same stage of their infection and all cases at the time are accounted for(deaths are probably much better tracked than the infection and the publicity has a huge impact on the reporting). It would be a guesstimate at best.
I would say, let's stick to official numbers since the calculation requires each patients timeline. Surely an educated guess can be constructed by modelling the patient prognosis and virus behaviour but that also requires much more data than what the public has.
This is why epidemiologists (ref: https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408... or https://news.ycombinator.com/item?id=22195827 for my comment on the paper) prefer instead this formula which only counts patients for which the eventual outcome is already known:
deaths / (deaths + recoveries)
With this formula, there is no need to guess the "patient timeline". If you do the math right now for the largest case study known to date (published yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... covering 99 patients, 11 dead, 31 recovered) you get:
11 / (11 + 31) = 26% case fatality rate
If you do the math on ALL data from mainland China (170 deads, 124 recovered as of 2020-01-29 http://www.nhc.gov.cn/xcs/yqtb/202001/e71bd2e7a0824ca69f87bb... or in english: https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%932...), you get:
170 / (170 + 124) = 58% case fatality rate
This formula gives a pretty good estimate of the eventual observed CFR according to the paper I referenced above. Of course, there are caveats, for one deaths or recoveries may not be properly tracked: there could be many patients with mild cases that are not even detected/confirmed and end up recovering on their own.
PS: I am not stating the lower bound CFR is 26%! Another method I applied (described in twitter thread https://twitter.com/zorinaq/status/1222427708723879936) suggest it could be as low as 9%.
Citation needed. I am not aware of data supporting this (or the reverse.)
I'm not an epidemiologist, but I believe I see flaws in your application of the methods from the paper.
[1] At the bottom page 481 it clearly say the virus peaked on March 27th. The first date they use data for the e2 calculation is April 6th. Two full weeks past the peak.
How does that produce a meaningful number? If you got 1000s of infected people, and 1 dies... The formula would be 1 / (1 + 0) = 100%. What does that mean?
The way you used it "1 / (1 + 0) = 100%" means just "the knowledge used in the formula is that one patient died, zero recovered." In that case, yes, the fatality rate is "everybody dies." But using the sample of 1 is of course not meaningful for any statistics, not only for that formula.
Long answer: wait a week or two.
We don't know how many people are infected. We only have numbers of confirmed cases and those numbers are heavily skewed because 1) people don't know they are sick 2) stay at home or 3) are not diagnosed properly. Those diagnosed in China are probably severe cases with a multiple not being diagnosed. Also, it is unclear how good the reporting is.
We don't know how many of those who are infected will die and how many will recover. We only know of deaths of confirmed patients in the hospital. Of roughly 10000 confirmed cases 200 are dead, 200 are recovered and 9600 are yet to be determined. From that you could deduce 2% or 50%, less than 2% or more than 50% or anything else. Right now we don't have good data. Also we don't know how long it takes to die or to recover and on most patients we will probably lose track.
Since the infection takes about 2 weeks, we have to wait a few weeks until the smoke starts clearing.
100%
Streets are deserted. The few that go out all wear a mask. Restaurants, museums, cafes, bars have been demanded shut across the country, ostensibly until the end of the weekend but I can see this being extended. The first working day after the Chinese New Year was supposed to be February 3rd, but the city I'm in have extended this to February 9th - offices have been told not to open. Shops are open, there is food, and new fresh vegetables, fruits, meats are being stocked.
The major lethal consequence for this virus in the Coronavirus family is Acute Respiratory Distress Syndrome (ARDS). A strong outcome for this is we knock you out, put a tube down your throat, and have you breath via mechanical ventilator. It's intense to say the least.
Source: Medical student
https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
There may be some slight differences, but even seasonal influenza and a cold frequently present differently.
I’ve heard that “the common cold” is actually a few completely different infections that isn’t worth strictly classifying for the most, and that coronavirus is one of them. If so, this is “a common cold” except maybe death rates are statistically higher.
https://www.cdc.gov/media/releases/2017/p1213-flu-death-esti...
This happens regularly in western europe, especially by pediatricians. The charitable interpretation is that the doctor knows the child will get better in a few days anyway, but has to give _something_ to soothe the parents. Giving the substance-free stuff is better than unnecessarily medicating the child, and placebo-effect can also play a positive role.
In China there is some historical reason for it - Mao needed something to placate the peasants while trying to figure out how to provide healthcare to rural areas[0]. Unfortunately the government is still trying to figure that out.
I don't know what the history is in Germany that caused it to be the way it is.
[0] https://respectfulinsolence.com/2019/05/29/mao-triumphant/
Today, lobbying powers of a profitable industry also play into it.
Here in Belgium all the doctors that have seen my kids have no problem saying paracetamol and they'll be fine in a few days.
W-Europe is particularly hostile to medical quackery IMHO.
Kids can get high fevers really fast and you just want to make sure their lungs & heart are ok, they don't have a throat / ear infection etc. A doc can verify that for you in 5 min so I rather be safe than sorry, an "OK" is all I need.
In the USA or China?
Comparison to what? Isn't US hostpitals notorious in that regard? Getting flu and either dying or being bankrupt.
Larger cities can have excellent treatment, smaller cities less so. After a car accident I had pin-hole surgery on a badly broken collar bone (three pieces and several fragments) and only afterwards discovered the lead surgeon was internationally published in leading journals for his work, and the second surgeon would soon be departing for Northern Europe for a 2 year secondment to complete his PhD. Physiotherapy with minimal but sufficient. After-patient care consisted of being invited to dinners with other ex-patients for sharing over dinner, which is very unlike the West.
Certainly I was fortunate and the vast majority of care is not like this, which is why I don't use the word 'primitive' but prefer 'inconsistent'. The doctors described hospitals more like factories: There's a lot of throughput. He chuckled "You get lots of practice, but the focus is on how to do things better."
Edit: When I say 'not patient focused' here's a typical process flow:
1. Go to ER. Have a friend, family member or colleague pay a fee for consultation for a General Practitioner, and specify Chinese Medicine or Western Medicine GP.
2. Wait to see the GP, usually in a queue or ticketing system. There's a nurse on front desk and if it's obvious and urgent you'll be fast-tracked.
3. See the GP. They'll have some idea and request further work, like an X-Ray, Blood Test, CT Scan, etc. That's all in ER. Have the friend, family member or colleague pay a fee for that and wait in a queue/ticketing system or get fast-tracked again.
4. Get the results and return to GP for further prognosis. They'll recommend medicine (go to the front desk, pay a fee, etc, then go to a separate part, typically a separate floor, for that), operation, or other work. At this point you're referred to a specialist department and need to make your own way there, or if urgent have a wheelchair or stretcher and nurse take you there.
5. Turn up at the specialist department. Now this varies. For urgent treatment you'll likely be seen immediately, better, larger hospitals work 24/7. For non-urgent there might be a ticketing system. For something like a bone operation as I had there'll be a junior doctor on front-desk who will make a further assessment. If non-urgent and they're busy, schedule a few days later.
6. A ward consists of several rooms, typical Marie-Curie design with a central lift block and wards coming off from that. Rooms are rarely individual, if fortunate you'll have 2 to a room, sometime 8 or more. Some pre-op, some post-op. Nurses don't do a lot other than administer drips, observe, and escalate to the doctor on-call. For stuff like getting in or out of bed when you can't walk, friends, family or colleagues are there for that. Often you'll see family members on rotation with a small chair or camper bed next to the patient. You can also hire private unskilled unqualified helpers.
How to choose a hospital: Always go with a Medical University. It's a rule-of-thumb the world over and especially true in China. They have the most experienced, best qualified, best paid (outside of a handful of private international hospitals in Shanghai/Beijing/etc) doctors. If there's a #1, #2, #3 etc affiliated hospital, go to the #1, if that's too far, go down the numbering system until distance/urgency tradeoff works best. If you're out in the countryside, the quality of the care isn't likely to be the best.
Sorry, wrote quite a lot there. Thought it would be interesting to share with Hacker News as most readers here probably won't have had experiences with hospitals in China.
In the crisis like Wuhan at the moment I imagine they'd be incredibly overworked.
Seems few believe the official numbers, people visit numerous hospitals without being able to seen, and even those that get seen have problems getting tested, and people who posts about the situation get the post pulled or pressured to pulled themselves.
Here's an article describing the censorship (pulled posts), arrests for "rumor mongering", difficulty in getting tested, etc:
https://www.reuters.com/article/us-china-health-testing-insi...
This one documents 15% of 41 people getting hospitalized dying:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
And secondly, that more people have died than have recovered doesn't say much other than that it takes longer to recover than to die. If you are going to die, it would appear that it would happen sooner rather than later. Whereas if you aren't going to die, you may take awhile before you've been officially cured.
That isn't to say that is absolutely what is happening here. But both scenarios are fairly likely, and therefore should mediate some of the bleakness of those numbers for the time being.
There are reports of hospitals turning people away unless they a very sick, and also not testing every ill patient because they're overwhelmed.
I've see death certificates posted online with "viral pneumonia" because they aren't able to test everyone - and certainly don't bother testing those who have already died.
The errors are both ways and huge.
The only thing we can conclude is that it's contagious, deadly, and more deadly than the seasonal flu.
Best wishes for your recovery!
But yes it does indicate that the real number is much higher than the confirmed cases. It's really hard to track an outbreak of this magnitude especially when many people are carriers showing mild symptoms. It's actually a good thing if cases are being severely underestimated as it implies a lower death rate (deaths are harder to fudge).
Are you sure about this? AFAIK, the Chinese government does not disclose someone as dead by this virus unless they tested the person positive. That means that if someone dies from respiratory complications on the street or in their home, they will write it off as pneumonia. Right now Wuhan city only has the capacity to screen roughly 6000 samples everyday. Add to this that many sick people are basically just told to go home. Not many cars are driving, city is shutdown so god knows how many are sitting lifeless in their livingroom. I have also seen much evidence that communities are barring the doors of infected households so they can't leave their apartments.
The death count can only be expected considerably higher than reported.
Would that not be a proper reason for a corona virus caused death? Or does it have to be specific if the exact cause is known?
Either way, it makes the data far less useful.
If they don't know, fine. Albeit sloppy, given the context.
If they do know, and don't say, it's deceptive.
It isn't that bad. It means that this virus won't kill more than 50% of population even if we were to shut down all research right now.
>There is a high level of health seeking behaviour in Taiwan. It is part of the Taiwanese culture to take medicines or to seek medical help frequently, even for minor ailments.
>The average outpatient department visit rate is 14 times per year per person.
Trust me, I know what I'm talking about. I've played plague inc.
It's just that neutrally observing that 50% of a population would die is at least off-putting.
Given your explanation, maybe you were mocking the credulous. Mocking doesn't work well on HN either.
I've looked at comment histories for many shadowbanned users, and I'm just echoing commentary.
> Most patients were men, with a mean age of 55·5 years (SD 13·1; table 1). 50 (51%) patients had chronic diseases, including cardiovascular and cerebrovascular diseases, endocrine system disease [and some others]
The findings conclude:
> In general, the characteristics of patients who died were in line with the early warning model for predicting mortality in viral pneumonia
Also the group was self-selecting of people who went to hospital before Jan 20th.
In summary: old men with pre-existing health conditions are going to have a rough ride. Am yet to see this play out in 2020 Presidential Election odds though.
I doubt that the 50 years old Hospital doctor who died had any serious per-existing health condition. In fact, you could argue hat most doctors have a stronger immune system than average since they are exposed to more germs due to their profession. So this 50y old professional dropping dead is a bad sign! (and hands off to him for his bravery in doing his job).
You could only argue that he cough the strain very early. A virus jumping into a new species is more aggressive at the beginning, later it adopts more to the new host and becomes less aggressive.
If you are referring to the doctor in Wuhan - Liang Wudong - he was 62-years old.
https://www.youtube.com/watch?v=7AI3R41dGnU
Edit: removed remark
See: http://www.nhc.gov.cn/jkj/s3578/201904/050427ff32704a5db64f4...
At
https://www.who.int/emergencies/diseases/novel-coronavirus-2...
, you can see the standardized protocols for the hospitals dealing with 2019-nCov, such as the anonymizing CRF (Case Record Form):
https://www.who.int/docs/default-source/coronaviruse/who-nco...
Which describes both the CORE and DAILY forms for an electronic database.
Some selected sentences from the pdf:
===
* The CRF is designed to collect data obtained through examination, interview and review of hospital notes. Data may be collected retrospectively if the patient is enrolled after the admission date.
* DO NOT INPUT ANY PATIENT IDENTIFIERS: THIS INCLUDES NAMES, ADDRESSES, DATE OF BIRTH OR PLACE OF BIRTH.
* Step 1: Contact EDCARN@who.int to become a contributor to the nCoV global platform.
* Step 2: You will be contacted by ISARIC, platform manager, for assignment informational pack and instructions on how to use the REDCap nCoV platform.
[...]
* If your site would like to collect data independently, establishment of locally hosted database is possible.
* Standard reports will be provided on regular basis to all contributors. Additional analysis for operational public health purposes will be determined by an independent WHO clinical advisory group.
===
As you can see, the only way to get this anonymized data, is to be a contributor, and to be a contributor, you'd have to be a hospital, or somehow be granted access by WHO.
Remember the live outbreak map by John Hopkins? It also displays the number of people that recovered, the dates and definition of recovery duration are helpful in estimating mortality. Note that the other maps and graphs online only publish contaminations and deaths, which is not useful for calculating mortality. Why does John Hopkins deserve access, and why can I not get access, if I wish to fit a statistical model to the epidemic observations?
https://www.who.int/healthinfo/statistics/en/
Use their API or the web search, however you like.
If you're going to complain about not having up to the minute data available for 2019-nCov, keep in mind that they're not getting the data submitted regularly from China, it's all in daily reports rather than from hospitals.
I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless. It's likely that at this point the Chinese government doesn't even have accurate data.
1) No dataset is perfect, and everything leaves traces, so clever people can and do constantly deduce insights from apparently worthless data.
2) It is in the interest of the Chinese to cooperate with submitting these CRF's to their best ability.
3) The little data the WHO does release to the public seems quite accurate for an outbreak, if you look at the log-linear plots and so on. (I am not saying the "known infections" represent the actual number of infections, just that it looks like accurate reporting of exactly that "known infections", and if one reads the forms you see it was designed to take into account overcapacity effects, like sending a patient back home, forwarding to a different hospital, etc...).
>I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless.
What do you mean with "in there somewhere" ?
1) If you mean the WHO has the database, then of course the WHO has the CRF database, that's what my original message pointed out.
2) If with "in there somewhere" you meant that it's publically available on their website, then no, it isn't it explicitly states it isn't:
" State Parties are invited to contribute Anonymized nCoV Data to the nCoV Data Platform. State Parties should please contact WHO at EDCARN@who.int to obtain more information about, including log-in credentials for, the nCoV Platform.
To preserve the security and confidentiality of the Anonymized nCoV Data, State Parties are respectfully requested to take all necessary measures to protect their respective log-in credentials and passwords to the nCoV Data Platform. "
So they are sitting on the data as I originally claimed. On some of the clearly popularity boosted "contra-infodemic" threads, they even openly admit they can't give more detailed information even though they have access, when people ask them what they base their numbers on. [throughout the rest of the threads they typically go to great lengths to give the impression they work on the same aggregate numbers you and I can publically see, as if there is no censorship on the anonymized CRF data]
Also, why would I care about live to the minute data? I am looking for the actual data (noisy or not), and I don't care if it's delayed by a few days.
As I said, I am would like to build a statistical model.
As a lesson, perhaps not for this epidemic, but then the next: if the average chinese person can afford a smartphone, then surely they can afford a couple of UV-C LED's with a battery pack, with the LED's shining through a reflective manifold (think a pipe bent back and forth with U-bends), then breathing airflow together with proper dose (X mJ per square cm) should sterilize microbes, viruses in the air. Then it just needs to be recharged, instead of trying to manufacture 61Mega masks a day. The air sterilizer (to be attached to a face mask) could be reused for new epidemics every 5 or 10 years (in which time they might have bought 3 or 4 cell phones...)
EDIT: I see on change.org that there have been petitions towards the WHO on other issues before, perhaps someone should submit a petition to release the CRF database to the public domain. And it's not a question of hosting bandwidth, since the WHO can publish cryptographic hashes, and put up torrent magnets...
My understanding is that China was less than forthcoming about actual infection/death rates when SARS was making it's rounds.
Disclaimer: I do not have a source for this. This is heresay from the hubub around the current crisis so take it with a grain of salt.
I was so disappointed in them. How should it be embarrassing to take a deadly and contagious pneumonia outbreak seriously? Do you want them to feel they should hide it?
(You being NPR). I know you don't mean anything bad by it.
Imo it may cause china to become hostile and turn off cooperation.
The WHO is simply simply scaling up some tactics used in routine care to the nation-state level. Which, incidentally, is pretty close to their original charter.
tracks confirmed cases and recoveries too.
https://bnonews.com/index.php/2020/01/the-latest-coronavirus...
It is not a real-time map, I find it bizarre that people believe that we can track the population's wellbeing in real-time. Are you ready to be hooked up to such a system?
About the update rate: It's updated regularly. If you want to go down this rabbit hole, is 1m update real-time? Is 1s update realtime? Where do you draw the line? For most people, anything less than 12h, in the case of tracking confirmed cases, is perfectly fine described as "real-time"
About the data: Obviously it's showing confirmed cases and not actual health of people. The UI makes that pretty clear, it says "Confirmed cases" in big font. No one expects the latter...
Real-time is not all about latency, live TV or a Skype call also has a latency but it is real-time for all means and purposes since it is automatically gathered, transformed and transported without human labour and immediately.
Almost all of it is done by hand by the folks at the Johns Hopkins University's CSSE department. It gets updated around twice a day and they're constantly fiddling with the layout and whatnot.
No, it's updated quite irregularly. Given the time difference between the East Coast and China I'd expect that quite a bit of delay is to be expected between information being released and CSSE updating their site. They're also combining data from different sources and clearly are batching updates together.
In other words, it is a plot of data that is quite regularly updated.
If I "touch a.txt" then run "ls", and see "a.txt", I'd consider my filesystem realtime. There's no point in being pedantic about "but there's a 50ms delay when I hit enter after typing ls so it's not realtime!!!".
"Realtime virus outbreak" implies that the site is somehow automatically identifying where the virus is and updating it's stats, rather than waiting for a human to update it.
What would you recommend calling it instead?
In the given example there's a tracker (updated by humans) and you can see the current state of the tracker at any time (from their database).
I'm not sure what the distinction is here if you consider one realtime and the other not.
For me, if someone says X, and a literal interpretation of X would be impossible/ridiculous, I naturally assume the more generous interpretation Y. I would find it bizarre to believe that X was intended.
Some people however cannot escape the interpretation X, and find the statement bizarre fullstop.
I naturally assume it either doesn't know what it is talking about, or is trying to be manipulate through intentional misuse of words.
Words have meaning. You don't get to arbitrarily decide to change that meaning. I'm not defending the extreme pedantry, but at some point word use is just flat wrong, and that is the case with the original post.
Just a single aspect of this issue is, what does real-time mean for aggregate, global measures? Days? Hours? Is it somehow more useful to have 100% accuracy at either interval? And what are the criteria that even determine accuracy at all, let alone precision. This is all a kabuki dance with approaching no relevance, especially in the case of the pandemic when there is also approaching zero confidence in the Chinese numbers at all, and it does not matter how many fancy dashboards are put together by "hooking up to such a system", when the numbers could be 2x as high, 5x, 100x, or who knows because they very system of governance and ideology actively evades honesty and responsibility.
ALL of these numbers should be fundamentally caveated every single time any of them are provided with "that they are Chinese data and the Chinese lie about lying, while lying about the fact that they lied. At the very least currently, trusting any Chinese person is an act of insanity, regardless of whether any given individual Chinese person is honest 100% of the time. How much more do people have to be lied to, deceived, cheated, stolen from, plundered, spied on, and infected with communicable diseases that could crash all of civilization by killing millions before we realize there is a mentally ill manic insanity going around that starts with the insanity of not having a common framework for data and information collection, processing, and conveyance.
Find it staggering to insinuate that were it originating in Western countries we'd do the same?
The OP might also mean poor containment within China - which is only relying on other countries right now.
Certainly later than one would hope, but is there a real world benchmark for the handling situations like this that they fell short of? Have similar viruses crossed over in other countries and been handled better?
I find it incredibly hard to believe if this happened in other countries they'd simply ban all travel into and out of the nation.
Would your country do that given the same circumstance?
Because it followed a week of ignoring the issue and then another week of arresting people who were reporting on the issue. This has been an issue since December 28th, but China and the WHO are pretending it began just recently.
It's "containment" in much the same way that the Soviet Union just couldn't stop lying about Chernobyl because people miles away were melting from the inside, so they took drastic actions to pretend they were on top of things.
Those "hospitals" they are building (and selectively live streaming parts with glorious Party tunes on the background)? Those were resorts that were almost complete, but since tourism in the area is going to be dead for a decade, they're turning them into hospitals and claiming they're brand new buildings.
What is staggering to me is not that China finally moved when it realized the problem could not be swept under the rug, it's that the WHO is going along with the doublespeak of saying "all is well" but then also declaring an emergency, but don't cancel your trips to China!
5 have been arrested in Malaysia and 2 in Thailand also, have read the viral fake news they wrote and have no problems with their arrest at all.
In the shadier parts of the internet I'm already seeing services for ruining your competitors with viral social media fear campaigns.
r/Australia has a big sticky of all the nonsense being peddled in the country and the NSW health department is constantly having to repudiate popularly shared content. The bullshit asymmetry principle at work.
> China finally moved when it realized the problem could not be swept under the rug
Again, if this outbreak was in the US or Northern Europe, would they _move_ as quickly? Would huge cities be quarantined? Find it incredibly hard to believe.
It's 2020, hiding things a la Chernobyl is not so easy. I think they are doing a half decent job given the circumstances and it's just the usual China bashing by people who have absolutely no idea about the country and only knowledge comes from the newsmedia
Being critical != bashing, why are you being so defensive about the situation? Why are you trying to drag other countries down saying they wouldn't do any better? What is your goal?
One of the doctors saw the initial cases before they were officially confirmed. He told the news in WeChat groups to their friends who were also doctors about a SARS-like virus that's being identified and warned their doctor friends to beware. The other 7 just spreaded the message and they are also doctors. They weren't arrested though. They were warned by the police and forced to promise that they won't do it again.
The one who originally wrote the message were also later found to be infected by the virus. Here is an interview in which he told the story: https://m.mp.oeeee.com/a/BAAFRD000020200130255882.html?&laye...
Like the hospitals being almost finished resorts? They are building these things from the ground up, there was nothing there, you could even see this in those live streams, from multiple camera angles.
So of course now everywhere in China has it, not exactly a good containment. The Wuhan mayor said he'd been talking to the China administration for 4 weeks before being allowed to talk about it to the public.
> A PHEIC is defined in the IHR (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This definition implies a situation that is:
* serious, sudden, unusual or unexpected;
* carries implications for public health beyond the affected State’s national border; and
* may require immediate international action.
[1]: https://www.who.int/influenza/resources/documents/pandemic_p...
[2]: https://www.who.int/news-room/q-a-detail/what-are-the-intern...
This thread is full of cringeworthy doomsdayers and armchair epidemiologists throwing around unsubstantiated nonsense. When your only knowledge of this comes from the media people should be a bit more selfaware.
The fact that qAnon folks are all over this and one day old accounts turning up saying millions will die speaks volumes for the level of discourse here.
Bet on the above comment stands for anyone. $1000 USD sound ok? Put your money where your mouth is.
The stock market has taken a hit over this outbreak fear. Go place your contrarian bets there if you’d like.
Put your money where your non-contrarian mouth is if you are so sure, the media told you so it must be true right?
Mark my words no one will mention this stuff in 3 months.
Yeah, well that was an entire year. This is a few weeks. The goal is to get ahead of things, not to wait until it's too late.
Comparing the total number of cases or deaths to flu outbreaks from previous years does not make much sense at this point, when the numbers are growing rapidly, but in a month they probably are easier to compare. Neither does comparing average counts per week, because the growth is not linear. The data for the progression of flu (or any other disease) outbreaks exists, and comparing to their growth rate would put it better in perspective. Regardless of armchair analysis, the WHO declaration means it's something requiring unusual action, which flu is not.
Consider the recommendations to thoroughly wash one's hands during flu season as a precaution against getting the flu. How many people take that advice seriously? You can bet there'll be a lot more hand washing all around once this coronavirus hits people's local areas, not to mention all the mask wearing that'll happen (though unfortunately, most people will be wearing those dinky surgical masks which will be of dubious effectiveness), and people isolating themselves.
On the other hand, we have vaccines for the flu that are available well in advance of flu outbreaks (though not nearly enough people take them), while we've got no publicly available ones for 2019-nCov. That's another confounding variable that makes it hard to compare the two.
That was one particularly bad season. It's usually in the 30k - 40k range.
> that still works out to be much more (1153 deaths per week)
That particularly bad season had ~45MM cases, so that was an average of 865k infections per week. 2019-nCoV is that 1% of that infection rate.
People are concerned because this has a high growth rate that, unless contained, would cause large number of deaths
The new virus has no vaccine.
That's not an option to stop this Coronavirus at all.
On top of that, it seems to have worse mortality rate, transmissibility rate, and asymptomatic contagion -- so a little worse in every way, probably.
As with the flu, you're very unlikely to be personally killed by it unless you're over 65, under 5, or in poor health.
[1] https://www.cdc.gov/flu/vaccines-work/effectiveness-studies....
Where are you getting that number? It a magnitude of 10 off
This is especially true for those with weak immune systems. As for a source, see the "Effectiveness" section https://www.health.nsw.gov.au/Infectious/Influenza/Pages/you...
Quote "One European study in 2008 found a 66% vaccine efficacy (VE) against confirmed influenza for children aged 9 months to 3 years, while a Japanese study of children aged 6 months to 6 years found VE against influenza A ranged from 42% to 69% depending on the vaccine match"
Another source with an effectiveness section has similar numbers: https://www.cdc.gov/flu/prevent/misconceptions.htm
That's very far away from your "flu vaccine is terrible ineffective" statement.
> Worldwide, these annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths.
https://www.who.int/news-room/fact-sheets/detail/influenza-(...
> The flu has resulted in 9.3 million to 49 million illnesses each year in the United States since 2010. Each year, on average, five to 20 percent of the United States population gets the flu.
https://www.healthline.com/health/influenza/facts-and-statis...
Let's assume 10 mil Corona cases in US (like flu lower bound), with 2% mortality. That's 200k deaths. If we assume 49 mil cases (flu higher bound), it's 1 mil deaths just in US.
* Coronavirus has no vaccine
* Coronavirus infected can be contagious for longer than flu patients
* The longer incubation period means more chances for people to get sick, especially since the disease comes on gradually. People will think they have an ordinary cold, go to work, and infect people.
* We understand the progression of the flu in most variants. We don't know all the effects of the Coronavirus, we just have descriptions of the symptoms.
* Flu is basically everywhere already, Coronavirus is not. It's not a choice between one or the other, it's a choice between one or both. If we could declare an emergency and have some chance of stopping flu from getting to some part of the population, we would.
* People with compromised immune systems like the elderly, or babies, or people with existing illnesses or lung problems know to avoid people infected with influenza. Since it's possible for people capable of infecting others with Coronavirus to not even know they carry it, it's harder to avoid for those vulnerable to it.
It's much cheaper to respond to a virus like this in early stages than it is to wait until we see "how serious" it is. All in all, getting things moving now is a good idea.
It’s scary to see it so close to home. I’m in Northern Ireland and saw two hazmat ambulances gunning it into the center of Belfast today.
I’ve never seen a hazmat ambulance in this country - wouldn’t have even known we had them or what they looked like.
I suspect we’ll get outbreaks in many more regions over the next few days.
I wouldn’t expect them to try to “cover it up” but I’d very much expect them to act slowly in notifying and not take it as seriously as they should.
The Spanish flu killed 50-100 million people. Worth reading about it.
That is not known at this point.
The possibility has been raised that if this goes global, it could become an illness that, like the flu, just sort of continually floats around and we're stuck dealing with it. We don't really want another such illness. If freaking out about it right now can even move the needle on the odds of avoiding that scenario, it might be a good plan.
-5,974 confirmed cases
-170 deaths
[1]For comparisons the SARS outbreak of 2003:
-8,098 people worldwide became sick
-774 died
It's also worth noting that the ~8k confirmed cases are bottlenecked by how fast China can perform tests. Here's an article guesstimating that there were up to 100k infections a few days ago:
https://www.theguardian.com/science/2020/jan/26/coronavirus-...
Do you have more info on this? I thought the test was a simple swab deal that a country like China could crank through like nobody's business. Like, at least for a few more orders of magnitude.
Coronavirus:
-5,974 confirmed cases
-170 deaths
-143 recoveries
-5,661 still sick
SARS:
-8,098 cases
-774 deaths
-7,324 recoveries
When AIDS/HIV was near its peak, folks would often compare it in a similar fashion to cancer. If we ignore the fact that cancer is a big diverse bucket, most/many cancers really don't have any 'virulence' so getting public attention to drive best practices to mitigate spread just don't make any sense.
Currently the number of fully recovered people is lower than the number of deaths.
Unless you are in a sensitive age group or have other health problems, data suggests you're most likely to get over it as a regular flu.
It's not all perfect and is worse than a regular flu, but especially now after the announcement some people may way over-stress themselves which doesn't do good to your immune system.
First reaction is "I need to avoid becoming infected at all costs". However, the costs are steep. An extreme plan to “sit at home with a month’s worth of supplies” seems plausible, but it would not be healthy to reduce movement so much and if everyone suddenly starts doing that there will be issues with food availability in the area (I live in HK).
If I am statistically so unlikely to die from this infection, I am going to take measures that prevent me from spreading it to someone who isn’t, but I won’t e.g. panic and call police if someone without a mask is near me.
Shouldn't you also plug in estimated unreported fatalities too?
Death is more difficult to hide than fever.
Unfortunately, both numbers are fluid, but the assumption is that death count is less so. If the number of deaths is underreported by orders of magnitude then my argument would not stand of course.
EDIT: I consider the number of deaths unlikely to be very underreported based on personal communication with folks in China and HK. There is a fair amount of panic on social media, but “someone I knew died, it seems related to the new virus and deaths may be underreported” so far seems not among the things people panic about. Most panic (some of which is being blown out of proportion for hype and metrics by less than scrupulous sources) appears to be fueled by other things: number of people admitted to the hospital, possible hospital staff infections, and others panicking.
If we looked at deaths against reported recoveries than the rate is much higher (I am guessing a lot of recoveries are not reported).
I remember reading or hearing that one input to recent wildfires was the fact that decades of controlled burns to limit the spread of wildfires left a lot of available fuel that otherwise would have burned naturally.
So in that vein, do we have humans with compromised immunity thriving but susceptible to inter-species mutations like this novel coronavirus?
But this virus spreads via droplet transmission, so just being within 6 feet of someone who's infected (and coughs/sneezes) is enough to spread it.
If you're referring to the overuse of hand sanitizer and other disinfectant agents, it might be reasonable to conjecture that their use contributes to the spread of pathogenic bacteria because they destroy non-pathogenic bacteria that could out-compete the pathogenic ones for resources. But this is a virus. It doesn't reproduce outside the body, so I don't think that train of thought applies here.
I'm thinking more generally: I was thinking along these lines because the news report I heard [1] described 'wet markets' as a place where disease spread. I'd never heard of it before. But it occurred to me that centuries ago, this kind of thing might have been more common. Processes and regulations for handling of animal products are a net benefit but I wonder if there are any drawbacks.
[1] https://www.npr.org/2020/01/29/800725826/why-wet-markets-are...
On the other hand, people don't seem to be symptomatic for 2 weeks, so they won't be coughing or sneezing during that time, so ordinary hygiene should be enough to prevent most infections during the incubation period.
After people do become symptomatic, the widespread media attention and fear among the general public will likely cause them to go to the hospital or isolate themselves from each other, which should further reduce infections.
Everybody sneezes occasionally, coughs to clear their throat, etc. Smokers more so.
A similar problem developed in California due to overzealous fire fighting that built up the forest floor over decades and led to some devastating fires.
Yes, my mistake, that's probably it.
An additional worry is that northern and southern fire seasons will overlap, leading to a global strain on shared resources.
On evolutionary timescales, it's better to expose whole population from time to time, so that we don't lose the immune system response against these altogether.
His takes are bad.
He's called this virus's R0 the worst he's seen in his career, which is absurd. He's conflated R0 and attack rate. Familiar errors because no one pays attention to ID epidemiology until there's an outbreak, and then suddenly decides they're an expert.
If one must go to Twitter for ones epidemiology, I'd suggest Tara Smith (@aetiology) or Maia Majumder (@maiamajumder), both of whom are actual ID epidemiologists and science communicators.
If this were a tech problem - a big problem that seemed insurmountable - I would break it down into chunks as best I could, look at all the parts of the chain, and ask myself which I could be most effective in tackling first. Treat it like a sprint. Which part of the chain would that be?
With the caveat I'm not a domain expert, obviously, I'd go for the lack of testing kits - what makes testing for something like this so hard and so hard at scale?
Maybe it isn't and it's the supply of kits. Is this not something that is also "fixable"? There's a lot of intelligent and capable people on this forum, why not throw some pasta at the wall?
Now imagine how to prevent a net virus from spreading, where it doesn't show any symptom and scanning it before 1 week shows negative result, while during that time it can easily infect other.
Testing in real people isn't cheap, and currently there is no proven cure either (afaik).
Vaccine is the best solution but it hasn't been found yet.
Obviously I'm as arrogant as the the next guy, but I think that arrogant next guy is probably already working on this issue and has a bunch of background in domain expertise and specific knowledge of the logistics I won't manage in a side project while commenting in between fixing bugs on the Equity/Credit analysis app I'm working on right now.
Just my 2 cents, and 2 cents is not worth much in this economy.
As it is, I'd prefer the focus moved to solutions from speculation, at least it's an attitude I'm more comfortable with.
Roche: https://www.bloomberg.com/amp/news/articles/2020-01-30/roche...
LAMP: https://virologyj.biomedcentral.com/articles/10.1186/1743-42...
The tricky part is know exactly what the "correct" epidemic model is: length of latent/infectious/etc periods, etc.
Full disclosure: I was once one of the main developers of this epidemic modeling framework.
Are there any existing models to start with?
I'm not an epidemiologist, but rather a space alien cat, so factor accordingly.
It it experience based on historical data. A virus jumping to a new host (species) will be more aggressive in the beginning until it has adopted (mutated) to his new host.
While this is not a universal truth, it is experience and could also be backed up mathematically (>host dies to soon, virus can not spread) and by game theory.
At some point they vapidly ask "Where is the science behind this?". The science behind this is the discovery of viruses and the impossibility of teleportation.
>At some point they vapidly ask "Where is the science behind this?". The science behind this is the discovery of viruses and the impossibility of teleportation.
but it's true though. there's limited evidence that travel bans will stop the spread of the infection. the evidence ranges between "no effect at all" to "delayed infection by a few days".
https://www.vox.com/2020/1/23/21078325/wuhan-china-coronavir...
You don't need science to grok this.
> But the trouble is, they don’t appear to be helpful. At best, travel restrictions, and even airport screenings, delay the spread of disease but don’t impact the number of people who eventually get sick. Instead, they make it harder for international aid and experts to reach communities affected by disease. They are also expensive, resource-intensive, and potentially harmful to the economies of cities and countries involved.
On the H1N1 travel bans:
> Again, reduced travel delayed (by three days!) but didn’t stop disease spread. The authors wrote, “No containment was achieved by such restrictions and the virus was able to reach pandemic proportions in a short time.”
So, why?
> It’s expensive and nearly impossible to seal off the borders of a country, the authors of the paper wrote. People will inevitably move — even indirectly from the countries that are quarantined.
---
The article gives a number of examples as well.
That's why staying home from work when sick actually helps.
The article doesn't deny that. One study found exactly what you've claimed.
>A study looking at [the arrival of H1N1 swine flu in 2009] found [travel restrictions] “only led to an average delay in the arrival of the infection in other countries (i.e. the first imported case) of less than three days.”
The problem with quarantines seems to be that their effects are minimal unless you lock everything down AND somehow find and quarantine the already infected who got in, which no country has ever done.
This can mean The difference between multiple cities being ravaged by a disease instead of smaller groups of infected individuals.
That sounds nice in theory, but there's no literature backing this up.
This took me less than a minute to find: https://www.who.int/bulletin/volumes/92/12/14-135590/en/
That WHO post argues against travel restrictions, yet:
“In one simulation, border controls preventing 99.9% of cases entering any given country delayed epidemic spread by up to 35 days.”
35 days is a lot of time, assuming a vaccine rollout is inevitable and successful
There are other papers which are proponents for controlling and restricting travel.
> Internal travel restrictions in England, Scotland and Wales in the United Kingdom were predicted to have minimal impact on the magnitude of the peak and in delaying the spread of the epidemic – possibly because there are some densely populated urban areas and relatively high levels of population movement. However, in a recent review, it was estimated that a combination of internal and international travel restrictions could help to stagger the impact of a pandemic within a country such as the United Kingdom, by desynchronizing localized outbreaks.
This is exactly the kind of unforeseen interaction effects I had in mind a few comments above when I said I'm not convinced we are able to conclude that "travel restrictions do not work" from the present studies. This particular effect will quite obviously also depend on epidemiological factors such as the length of incubation period, whether the disease is transmissible during the incubation period and so on.
There are far too many variables to account for and far too little experimentation has been done so far to conclude anything firmly.
I wonder if they don't want to piss off China and make it say, "Fine, we're not going to cooperate with you. We'll handle it ourselves."
From what I've read, China, and especially the Chinese government, doesn't seem to respond well to the sort of light criticism that people and governments in the west would blow off.
Source: Live in China.
Watching the group in Imperial College closely as they've been giving closest analysis so far.
This was my favorite:
> "The main reason for this declaration is not what is happening in China but what is happening in other countries," said WHO chief Tedros Adhanom Ghebreyesus.
Obvious cautious tip-toe is obvious.
Yes and no. The guidelines for declaring a (Phase 5) outbreak is to have person to person transmission in 2+ regions of the world. https://www.who.int/influenza/resources/documents/pandemic_p... So, yes, it is about what's happening outside China.
"Our greatest concern is the potential for this virus to spread to countries with weaker health systems which are ill-prepared to deal with it."
I'd call it simply stating their reasoning rather than 'tip-toeing' or 'artificial praise'.
"Notably, the new coronavirus provides a new lineage for almost half of its genome, with no close genetic relationships to other viruses within the subgenus of sarbecovirus. This genomic part comprises also half of the spike region encoding a multifunctional protein responsible also for virus entry into host cells[30, 31]. The unique genetic features of 2019-nCoV and their potential association with virus characteristics and virulence in humans remain to be elucidated."
Hmmm... interesting.
Edit, full title of article. "Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event"
b) Recognizing their effort is fine and the right thing to do. Saying 'oh, we don't need travel blocks' when the virus seems to mainly be spread from one province is dangerous. And this following part is just wildly misleading and a clear attempt to babysit the Chinese government's feelings:
"The main reason for this declaration is not what is happening in China but what is happening in other countries," said WHO chief Tedros Adhanom Ghebreyesus.
We detached this subthread from https://news.ycombinator.com/item?id=22194996.
Her: "They just declared a global health emergency over Coronavirus." Me: "Who did." Her: "The World Health Organization." Me: "That's what I said."
>The premise of the sketch is that Abbott is identifying the players on a baseball team for Costello, but their names and nicknames can be interpreted as non-responsive answers to Costello's questions. For example, the first baseman is named "Who"; thus, the utterance "Who's on first" is ambiguous between the question ("Which person is the first baseman?") and the answer ("The name of the first baseman is 'Who'").
https://www.youtube.com/watch?v=sShMA85pv8M
I imagine that kind of ambiguity has been 'played' with for forever, though.
Sorry if I took you away from fact checking open mic night. :-D
If you actually meant the World Health Organization, you'd have to interpret that as "World Health Organization did". This is obvious incorrect, and rather should be "The World Health Organization did". So there is no way for your daughter to have interpreted what you said as talking about the World Health Organization, whether initialism or acronym.
> Sorry if I took you away from fact checking open mic night. :-D
No, I wasn't distracted at all. Thanks for the concern, though.
This is why the longer incubation time of this coronavirus is such a concern. It gives a potentially fatal disease more time to spread before it self limits. Also, I've heard reports that some infected are asymptomatic, so it may continue to spread even while taking out some people.
https://evolution.berkeley.edu/evolibrary/news/071201_adenov...
https://www.pnas.org/content/pnas/early/2014/11/26/141333911...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639916/pdf/896...
http://hedrick.ucsd.edu/BICD136/PDF-links/Galvani-Epid-evol....
I understand the basics of evolution. I also don’t have any trouble understanding the trades between transmission and virulence. However, this is not the same as saying that the typical virus becomes less virulent over the short term during a major outbreak.
Edit: In order to make this a little less dismissive, the actual argument in that Twitter post is that due to lag between first symptoms appearing and death, you can't divide fatalities by total cases to get the mortality rate, and should instead use total cases N days ago. Makes sense superficially, but
* cases that get reported are biased towards people who get more sick
* the 20-56% mortality rate claimed based on guessing N=6 is inconsistent with the mortality rates outside of China, where no one has died so far.
But I'm no epidemiologist, so don't believe me either.
Data gets aggregated and used in mathematical models that can predict outcomes in various hypothetical scenarios, but given that this is a real-world situation, the professionals are going to be looking at the actual data first to find out what’s happening. They can directly answer questions such as, of the patients diagnosed 1 week ago, what’s their status today?
Anyone looking at only total numbers of cases per day simply doesn’t have the data required to compute the things they’re trying to compute with much accuracy. It’s possible to produce estimates with confidence intervals based on sensitivity analysis, but nobody doing that with any care using aggregate data is going to come out with a number as high as 20% for a lower bound. Given that N=6 is a guess, the range reported should be bounded by plugging in plausible extreme values for your guess of N, not assuming your guess of N=6 is exactly correct.
True, the data is biased.
«the 20-56% mortality rate claimed based on guessing N=6 is inconsistent with the mortality rates outside of China, where no one has died so far»
It's not statistically inconsistent. When China had 100 cases confirmed, they had reported only 2 deaths. Now there are 100 cases outside China, so statistically we should expect 2. 0 actual vs 2 expected is statistically insignificant. Also the rest of the world is so much more prepared after the wake-up alarm call from China that out of the 100 confirmed outside China, they are probably receiving superior healthcare than overwhelmed Chinese hospitals. I would expect the mortality rate outside China to be slightly inferior.
It also means though, that the first death outside China should happen soon. I predict in the next week.
My point here was that the China data is probably biased because the medical system there is overtaxed, but outside of China it isn't. Therefore, estimating mortality based on non-China data seems safer, and no one outside of China has died so far.
If I take your low end mortality estimate, 20%, and apply that to the number of non-China cases 6 days ago (12), you get only a 6% probability of all of these people surviving. Note that this already contains a lot of assumptions (going back 6 days, taking your lowest mortality estimate) that work in favor of your alarmism.
I think that "going back 6 days" is insufficient, so your conclusion of a 6% probability is unsupported. Given the extreme state of paranoia around the world (eg. authorities testing people coming out of airplanes) it is likely that cases outside China are detected very early after the onset of symptoms. As such, death, when it takes place, will probably take more than 6 days after a confirmed case is detected.
In fact, the studies in The Lancet document cases of patients that take much more than 6 days to die.
Everybody is taking this seriously, but playing prophet of doom is really shitty and has all sorts of potential negative consequences in the real world.
You tried to point out 1 inconsistency, and I replied back saying it wasn't an inconsistency ("0 actual vs 2 expected is statistically insignificant.") It's too early to tell if the CFR outside China will differ from the CFR in China.
* Zhejiang: 428 confirmed; 0 deaths; 4 recovered
* Guangdong: 354 confirmed; 0 deaths; 10 recovered
* Henan: 278 confirmed; 2 deaths; 2 recovered
* Hunan: 277 confirmed; 0 deaths; 2 recovered
* Anhui: 200 confirmed; 0 deaths; 2 recovered
* Chongqing: 182 confirmed; 0 deaths; 1 recovered
* Jiangxi: 162 confirmed; 0 deaths; 5 recovered
* Shandong; 158 confirmed; 0 deaths; 1 recovered
* Sichuan: 142 confirmed; 1 deaths; 1 recovered
* Jiangsu; 129 confirmed; 0 deaths; 1 recovered
Although there's a clearly a lag between confirmed cases and death, there's likely to be less lag in outcomes between patients who recover and patients who die.
On this admittedly small sample, we get 29 recovered and 3 deaths, or about a 10% death rate. That's still pretty high, but it's nowhere near the 20-56% death rate.
If people go from being infected to dying more quickly than they go from being infected to being declared to have recovered, then that would lower the rate. The recovered rate seems to have been increasing faster than the death rate in the last couple of days, which might indicate this is the case. In addition, these cases obviously only include patients who present with symptoms. If some people are asymptomatic, that would also lower the death rate.
Nitpick: I don't claim "20-56%" death rate, but "9-56%", thus your observation of a 10% CFR is in line with my claim.
* 29th: deaths 133, recovered 126
* 30th: deaths 171, recovered 143
But for Hubei, we get:
* 29th: deaths 125, recovered 88
* 30th: deaths 162, recovered 90
Which looks like the death rate is going up in Hubei.
Subtracting Hubei though, for the rest of the world (but mostly China) we get:
* 29th: deaths 8, recovered 38
* 30th: deaths 9, recovered 53
* difference: deaths 1, recovered 15
Of course these numbers are too small to have real significance, but they're worth watching over the next day or two. It looks like outcomes are very different outside of Hubei from in Hubei.
Other possible explanations are that the healthcare system in Hubei is overwhelmed, so more patients die, or alternatively they're just too busy to accurately report recoveries.
Edit: Oh you mentioned this yourself in another comment.
It remains to be seen if the rest of the world can keep the infection rate low enough to not repeat the Hubei progression.
True, however I fail to see how this point is relevant when comparing statistics with past diseases - as the same could be said of our historical data we have for SARS or anything else. In any case, we only have reported confirmed cases. Doesn't seem to make sense to me to factor in a unknowable variable here but not in other cases...
Even when compared to SARS in that chart it looks like it has a lower R0 value and about the same fatality rate, minus some odd outliers and what it likely fake news (it doesn't have a fatality rate of 56%). And the citation for that 56% number is a link another link to Twitter… that is self referential. And actually I think YOU are also that person.
When people talk about "fake news" this is what they are talking about. This is like 3-layers deep of fake news. You are linking to yourself in a post that uses yourself as a citation.
However, for your information, the 56% case fatality ratio is calculated according to an epidemiological method known to produce a good estimate. See https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408..., section Simple Estimators, specifically this formula:
e₂(s)=D(s)/{D(s)+R(s)} which is: deaths/(deaths+recoveries)
And the paper concludes: "The second simple estimate based on the ratio of deaths of those for whom the outcome is known, e₂, is reasonable at most points in the epidemic" ie. produces a good estimate of the eventual observed case fatality rate.
You are creating and spreading fake news. You might not be a bad person, but right now you are being a bad person.
That's a non-answer. My data is valid. I challenge you to point out specific errors.
My data comes from two sources:
1) Initially I replicated the chart by Dr. Melvin Sanicas, a vaccinologist and public health physician, that he posted on twitter (here: https://twitter.com/Vaccinologist/status/1220469109378502658). He had no citations for his numbers. So I performed light fact-checking but didn't bother documenting citations for each number because (a) he is a doctor and (b) his chart got massive reviews on twitter and no one pointed out significant errors.
2) For the rest of the number, I plugged them in myself WHILE adding proper citations to either peer-reviewed papers or to the best estimates available today.
As to empty cells, they are empty when the data is not yet researched, or not known, or because it is irrelevant (eg. for most older diseases that have vaccines available I didn't bother researching if asymptomatic transmission is possible because it is irrelevant: most people in developed countries are vaccinated as such such diseases are no longer prevalent.)
If you're not a troll you should take a step back and actually THINK about what you are doing. You are creating misinformation, posting it, then reposting it elsewhere and citing yourself.
Stop it. Stop being a garbage human trying to scare people with nonsense. Be better. No "what ifs" or "whatabouts". Delete your comments, delete your tweets and try to be a better person.
Another non-answer. It is perfectly valid to compare various epidemiological characteristics like I did, and like Dr. Melvin Sanicas did (are you going to criticize him too?) A lot of us on HN are sufficiently educated to have decent discussions about topics we are not experts in. If you have constructive criticism, give it to me instead of your non-answers.
A: The entire table is misinformation.
It is not valid to do what you did. You are wrong. You are misleading people. The “question” is whether you are doing it intentionally or not. I don’t have that answer, only you do.
Would you consider fucking off?
This is your third or fourth bullshit post on this thread combining a sensationalist falsehood with a link to your Twitter feed.
If you have something substantial to post, then do it, otherwise please respect the guidelines of this site ...
Serious, yes. But it's quite a hurdle to go from what we're seeing now to "worse than seasonal influenza".