Life and Death in a Wuhan Coronavirus ICU
straitstimes.com
straitstimes.com
That is so rough, especially since some healthcare workers are now among the dead: specifically, I saw that Li Wenliang had died.
https://www.straitstimes.com/asia/east-asia/chinese-doctor-w...
The absolute definition of heroes. It blows my mind to imagine ever having that sort of selfless dedication to helping others. For all the crappy things in the world these days, it's stuff like this that gives me hope for humanity.
This was one of the most tragic things in that article.
The doctors, nurses, and health workers are the front line soldiers in this fight against the virus. And they don’t have the protective gear that they need to stay safe, and to keep the population safe, as well as the rest of the world.
I hope they can fight the infection, and survive, and live to fight another day. We need them!
Medical staff in Wuhan wear disposable protective overalls that are made of a thin layer of polypropylene (as intended so it would be light and cheap) and easily torn. Thus it's necessary to avoid taking them on and off between shifts because the act will probably rip it beyond repair. Some also took the additional step of strapping plastic bags to their feet and forearm to protect against rupture. None of this would have been necessary if they had enough to go around.
* https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-...
* https://www.wm.edu/offices/sponsoredprograms/_documents/ppe_...
I’ve asked for clarifications and was told that yes, the outer layer is indeed disposable, but medical staff need to wear multiple layers of protection, and the dressing and removal processes do take an hour or more each.
I'm not an authority on the subject, but I was under the impression that those were soldiers and conscripts and they were ordered to go.
It's rather common to see our cultures honor fallen soldiers and regard them as the archetypal case of heroes. Being on duty has never been considered a limitation.
Anyway, I feel like it’ll be an epidemic ( it already is, I believe ) in China, and be much better controlled outside of China.
Unfortunately my wife is also stuck in Chongqing; Taiwan is essentially closing up its borders and we don’t know if she’ll be able to move here to Taiwan to live with me. At least not until things blow over ( I assume summer time ).
I live in Taiwan and they’ve been very good at containing this, afaik. Just this morning they released a map of Taiwan with nav-points where all the cruise ship people were at in Taiwan before they went on the ship, and released information on what to do if you experience certain symptoms. 13 people have been diagnosed and quarantined.
This is a pretty irrational reaction if you ask me, the CCP is actually the more open, quasi-democratic side of Chinese government and politics. There are loose 'factions' as part of the CCP that are cautiously pushing for more openness, and the Chinese should be aware of them and be supportive. Frustration and anger are not helpful.
The mortality rate of 2% is consistent with the number of cases and deaths reported by other countries.
Is it that there are a large number of undiagnosed cases? That is kind of a given and is probably also the case in other countries.
The timespan between first case and until it gets reported to who and quarantines start is less than a month. To me that seems very fast (but I am just a layperson).
I don't know why they would do that, but they are accused of doing this kind of thing frequently.
If they sat on the news of the virus for an extended period they might have known the mortality rate they needed to align with long before the rest us.
Deaths are easy to count. Minor cases of the virus are likely the most common sort, and never show up in a hospital at all.
Numbers don’t line up based on a basic statistical analysis.
Checkout these videos for reference. https://www.youtube.com/watch?v=hSIt496d82s
In short, we have no idea, and it’s very dishonest to claim that either number is remotely reliable at this point.
Less severe cases on the other hand have a tendency to end up unreported, not in the hospital. Neither deadly. Still leaves a number of never reported cases. All in all, unreported cases are likely to be higher than unreported deaths. As a result, qualitatively speaking, mortality should be lower.
Of course, but that doesn’t mean that mortality will be lower. A much smaller number of unreported deaths can shift the rate upward. At a 2% mortality rate, you only need one unreported death for every 50 unreported infected to maintain the same rate. That might be laughably high or laughably low. We just don’t know.
But the people in the best position to know, the Chinese government, seem to be taking this pretty damn seriously.
There has been some discussion about changing the guidelines to discharge patients after 3 days without viral titre but I'm not sure if this has been adopted. Any comment about recovery time would have to be made after the dust settles.
As a new disease, with the first cases possibly being acquired as early as late November 2019, it wasn't until mid to late January 2020 that city and national authorities appeared to start taking the outbreak seriously.
I'm not aware of other novel outbreaks outside of China and how quickly those have attracted notice, though there's the case of the 1976 initial outbreak of Legionaire's Disease, reported within a week of first outbreak (though the disease was both fast-acting and rapidly lethal for many victims). However epidemiologists also realised that there had been previous, unrecognised outbreaks, dating to the 1950s. See:
https://en.wikipedia.org/wiki/1976_Philadelphia_Legionnaires...
The case of HIV/AIDS in the US and elsehwere would be a case of a disease with ascribed social and moral assocations, for which early responses were very much delayed, on of several examples of stigma associated with the disease: https://en.wikipedia.org/wiki/Discrimination_against_people_...
Reponse to the 2012 MERS outbreak appears to have been swift -- in November of 2012: https://en.wikipedia.org/wiki/2012_Middle_East_respiratory_s...
The 2003 SARS epidemic, also emerging in China, also first emerged in November, but was not internationally reported until the following March:
https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...
(The fact that SARS, MERS, and 2019-nCoV all appear to have emerged during November may be significant.)
Point being:
- China are slow to detect, report, and respond to new contagious epidemics. Notably so in the case of SARS, and less so, but still, with 2019-nCoV.
- Other countries, including the US, have had similar failures.
- Early unofficial public disclosure of 2019-nCoV was prosecuted by Chinese authorities, though at what direction is unclear.
- Trust between the people and the government is somewhat frayed.
- There are also numerous actors with incentives to make the most of any missteps of the government, or to inflate distrust.
Several of those groups have legitimate gripes against the Chinese government, and I've seen reports associated with Falun Gong, Hong Kong, and Taiwan specifically. I've not seen any associated with Tibet or Uygher populations. And there are various rabble-rousing actors elsewhere, doomers, and conspiracists (generally of the nutcake variety).
This ... clouds information. Many of the criticisms are legimate, some are not, and sorting fact from fiction (both between and within reports) is challenging. China are in the position where both locked-down and unfettered communications are potentially harmful -- the first for preventing accurate information from being available to both public and government, the latter for allowing agents provacateurs to rumourmonger, exaggerate bad news, and spread active disinforation. This is strong shades of attacks the West has seen over the past several years (within the US, UK, EU, and elsewhere), some of it from China itself.
How China responds will be interesting.
However I would like to inquire why you see Dr.Li's detention as evidence of "shutting down initial reports of the outbreak"?
First of all we do not have any kind of real insight on what Dr.Li was actually saying, and what was the severity of his reprimandation.
When something is on the lose that has the potential to kill millions, you need to be quick and purposeful in controlling the message. Wrong information can make people underprepare, but it can also make people overprepare.
The letter of admonition he received has been posted, see:
https://en.m.wikipedia.org/wiki/Li_Wenliang#/media/File%3A李文...
https://en.wikipedia.org/wiki/Li_Wenliang
I don't speak or read Chinese but can rely on multiple news reports (e.g., BBC: https://www.bbc.com/news/world-asia-china-51403795, SCMP: https://www.scmp.com/news/china/society/article/3049561/dr-l...) and Wikipedia's inclusion and characterisation as strongly reliable indicators.
The BBC is the UK's national broadcaster. SCMP is owned by the Alibaba group, a major mainland China corporation. Each clearly labels Dr. Li as a whistleblower. SCMP's story includes a highlighted summary "China’s health authorities and the public have offered their condolences over the death of the doctor, whom police tried to silence in the early days of the outbreak".
Both articles focus on Li's acts in breaking the nCoV story -- without really wanting or intending to -- the initial negative response of Wuhan police, and the narrative now, from authorities such as Zeng Guang, chief epidemiologist at the Chinese Centre for Disease Control and Prevention (reported in the SCMP story) that "that the eight people punished by the police should be held in 'high regard'", again, quoting the SCMP directly.
As for ongoing suppression of discussion adjacent to the nCoV outbreak, messages of support for Li and criticism of the Chinese government continue to be censored:
The top two trending hashtags on the website were "Wuhan government owes Dr Li Wenliang and apology" and "We want freedom of speech".
Both hashtags were quickly censored. When the BBC searched Weibo on Friday morning, hundreds of thousands of comments had already been wiped.
(From the BBC story.)
From [1]: The “seasonal” reflects the fact that viruses can’t tolerate high heat and humidity, preferring the cool and dry conditions of winter and spring, Webby said. That’s why flu, as well as the four coronaviruses, are less prevalent in warm, humid months.
1: https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...
Also less prevalent in warm and humid regions (though spread in Singapore and Thailand is ... interesting).
This is among the reasons my concerns' been on a breakout in North Korea, which has both a meterological and political/epidemiological climate that seems highly favourable to outbreak of a disease such as 2019-nCoV.
Though it's politically viable to order a near-complete shutdown of transportation and travel, the likelihood of this being effective (particularly against high-level party members breaking quarantine), or pragmatically possible to sustain (what exists of the PRK economy likely requires people in close contact), limiting epidemiological effectiveness.
And there are also rumors out there saying the lack of medical resources. Sick people couldn't get proper medical treatment and dying at home or somewhere. Because they didn't get diagnosed before they die, so the number won't be added to the official number. Don't know if it's true or how many people are dying there, but sure it's terrifying.
About misreporting, they did do it back in January, mainly because they want to control the panic as they always do, (and probably they didn't know it's gonna be this bad), but it should be much better now (I hope).
The data I got is that among the people who really got the virus, positive rate of the test is only 30% - 50%. So false negative rate is as high as 50-70%.
The news report (in Chinese):
So unless you believe authorities are getting with hiding hundreds of deaths at hospitals being under international scrutiny, while simultaneously hiding the fact that dead people pile up at their homes, this theory seems kind of unlikely. Especially since international numbers outside of mainland China are more or less in line.
Test your information against samples from people with relations to ground-truth. Then you can panic.
But hey, you want to panic, go for it. But do it for yourself. Because now the "independent" media, the "propaganda" and the WHO numbers are more or less the same.
My wife, when she went to the hospital to be diagnosed, said that they had a separate room for those that were diagnosed with having the Wuhan virus, and a separate room for those that did not.
She saw several people in that room, and yet over the next few days, only one new case was reported from that hospital.
I don’t know if this is due to unconfirmed or bad diagnosis, but this is just yet another red flag in a country full of red flags.
As for my wife, she only had a respiratory infection and got medicine for it. She’s better now, but now her mother is sick -.-
As a reminder, don't mix this rate with case fatality (or lethality) rate, which is counted on ended cases and is about 30%. This is your real chance when you're infected.
You can't take a case into account until you know its outcome. What am I missing?
0. https://medical-dictionary.thefreedictionary.com/lethality+r...
No idea where you got that 30% from. Even in Wuhan, with its medical infrastructure close to the breaking point, we are talking about 4.9%.
31,211 confirmed cases and 637 deaths in China. Makes a rate of roughly 2.04%. And I trust the WHO to get the calculation behind that right.
Another stat is that there are roughly 700 deaths and 2400 recoveries, which would indicate a mortality rate of 23%. Of course, this suffers from the same delay issue as the 2% calculation (T_death < T_recovery). But the possible range is 2% < M_rate < 23%
This paper gives a discussion of different biases:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504518/
There's a standard paper on this topic the authors I forget atm but all estimates will be biased. The best estimates are sort of unintuitive and account for estimated time-to-death and the time since diagnosis.
According to https://coronavirus.app/ we have 34955 infected, 726 dead, 2287 recovered as of now. Total resolved cases are dead + recovered, which is 3013. Fatality rate is 726 / 3013 = 24.1%. At the time of my original post it was 30%.
The correct way to calculate A's case fatality rate would be to select a cohort, Group B, for example: everyone infected in the first week. And calculate:
(deaths in Group B by Feb 9th) / (deaths in Group B by Feb 9th + recovered in Group B by Feb 9th)
An incorrect way to calculate A's case fatality rate would be:
(deaths by Feb 9th) / (deaths by Feb 9th + recovered by Feb 9th)
This is incorrect because "deaths by Feb 9th" includes all deaths from people infected between Jan 1st and Feb 2nd, while "recovered by Feb 9th" only counts the recovered patients who were infected between Jan 1st and Jan 9th. The above equation basically expands to:
(deaths in Group C by Feb 9th) / (deaths in Group C by Feb 9th + recovered in Group D by Feb 9th)
Where:
Group C: infected between Jan 1st and Feb 2nd
Group D: infected between Jan 1st and Jan 9th
Since disease A is spreading exponentially, it's clear that Group C is a few orders of magnitude larger than Group D.
Go to WeChat Pay -> Health
The numbers are updated each day.
Which could just be the common conspiracy theory suspicions of parts of a population...
Modern theory of Spanish flu[1] is that the flu itself was not that deadly. Combination of influenza with bacteria in the lungs caused most of the deaths. It was the World War I with lots of wounded in the same place, bad hygiene conditions, many with scarred lungs from poison gas and civilians suffering from malnutrition.
[1]: Bacterial Pneumonia Caused Most Deaths in 1918 Influenza Pandemic - Implications for Future Pandemic Planning https://www.nih.gov/news-events/news-releases/bacterial-pneu...
> However, it is possible that — as in 1918 — a similar pattern of viral damage followed by bacterial invasion could unfold, say the authors. Preparations for diagnosing, treating and preventing bacterial pneumonia should be among highest priorities in influenza pandemic planning, they write. "We are encouraged by the fact that pandemic planners are already considering and implementing some of these actions," says Dr. Fauci.
https://www.news.com.au/lifestyle/health/health-problems/chi...
The half a million people who died of the Spanish flu in USA did not die because lots of wounded in the same place and scarred lungs from poison gas.
btw. I did not say WWII was the single cause for high mortality. Hygiene, malnutrition etc. contributed. And the virus itself had higher mortality rate than usual, but not as much as previously thought.
E.g. https://www.quora.com/Which-country-was-most-affected-by-the... cites some resource which shows an estimate of 2.3 M people dead in Europe, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634693/ shows an estimate of 2.6 M excess deaths in Europe i.e. 1.1% of population.
The vast majority of the worldwide deaths from Spanish flu were in Asia; the region with most deaths was India.
In europe 1.1%.
>Whatever is taken as estimation of the American pandemic death burden, it is well below the European estimations we provide and others have provided. A possible explanation is that, at the end of WW1, Europe was characterised by massive civilian and army movements, a health care system put at its minimum and frail populations. This has very likely heavily impacted the European death toll.
This doctor is working on the absolute worst of cases and even they, it seems, have a high overall probability of survival. Also good to see some figures on the progression of the virus - 5-10 days of incubation, 1 week before symptoms either improve or worsen, then one more week before severe cases recover or die.
Regardless, we should all be paying attention to the quarantined cruise ships. In a few weeks or so we'll have much a more accurate mortality rate. I feel for those people but perhaps there is some comfort in knowing that their losses will not be without value.
Moreover, while many terrible rumors ostensibly from educated and/or directly witnessing sources from the dregs of the web have turned out to be true, these sources are even less reliable than the CCP, given the propensity of netizens for exaggerating and/or deliberately spreading falsehoods. Which is to say reports out of China may not be that much less reliable than much of what is floating around and at this point, as ridiculous as I know it sounds, I'm almost willing to relax my suspicion and cling to slivers of hope.
The undesputed facts so far are grim. 80-90% of the Chinese GDP has been shut down, we still don't know with certainty just how contagious or dangerous the virus actually is, but it is obviously more virulent than any of the previous viruses from the Corona family, and if for whatever reason containment fails for an extended period of time in a region, you can expect severe social hardship. How long can China continue to operate at 10% capacity?
It is only prudent in my opinion to make at least minimal preparations now with 1-2 months of food and water before panic potentially sets in and stores are emptied. There is still a high probability that the virus will be sufficiently contained and minimally deadly, but this also is shaping up to possibly be the biggest threat faced by civilization in centuries, exceeding the Spanish Flu of the early 1900s. I'm about halfway through Gallaher's report linked in these comments (very thankful for it) and I hope I'm wrong, but even his numbers are understandably prefaced with uncertainty.
I don't know who this guy is but he and his son are awesome.
In times of a crisis like this, some signal will get through.
Specifically in the category of news media companies.
There are many stories that they simply can not publish, being based out of Beijing. These stories, at best, will be published to social media by individuals in the thick of it.
I do the same. If you can read Chinese, I strongly recommend you read Sina Weibo, a micro-blogging social media in China, or Toutiao. Read them quickly before posts are inevitably deleted by the censors. There are some truly harrowing stories of ordinary people being refused treatment and left to die at home.
It’s an account from a 23 year old healthy male who contracted the virus late December. He was hospitalized with fever and developed pneumonia. Within a week he was in critical condition with near fatally low blood oxygen (claimed 60%) and digestive issues. He would have died without medical treatment.
There are several stories like this shared on Chinese media but they’re not shared with the rest of the world.
I've had people try to tell me "You don't need to worry, the virus only affects elderly people, younger people who get it will be fine." (paraphrasing)
I respond with this datapoint to let people know the virus can be severe, requiring hospitalization, even for young people.
Also, do you have any opinion on this:
I have closed friend work there and speak highly about the integrtity of their reporting and the content I am reading seems aligned to that.
One general point so. That WHO has now a te dedicated to counter false rumours and theories on the internet is telling. And HN would be best served if we, educated, critical thinking people, would stick in that with the experts. Who are the WHO.
Wow, that’s disgusting.
CNA (Chinese) https://www.google.com/amp/s/www.cna.com.tw/amp/news/firstne...
There could be other reasons for this, no? I mean, specifically in Japan's case, a huge cluster of that is from cruise ships. That seems more like a [bad] luck thing rather than the result of proactive action.
Also, I think we should make the distinction between "cases" and "confirmed cases". I'm in Singapore and one of the reasons given why Singapore has so many confirmed cases (3rd most) is that the Government is relentless about tracking infections.
Maybe that's just a positive spin. Either way, I think there's a lot of reasons to take these early numbers with a grain of salt.
https://www.japantimes.co.jp/news/2020/01/28/national/japan-...
Taiwan blocked tour groups from Hubei on 1/24 and ordered to evict existing groups. There are two confirmed cases whom are WuHan tourists entered before 1/24. Fortunately they did not caused domestic transmission.
The case I referred on that evacuation plane is a confirmed case and there is still a chance there might be more cases from that plane since the on-plane protection is reported to be sloppy.
https://www.youtube.com/watch?v=9vMXSkKLg2I
The danger here is that the healthcare system gets overwhelmed by the high percentage of patients requiring intensive care.
https://www.fwdeveryone.com/t/puzmZFQGRTiiquwLa6tT-g/confere...
"A study has found that 40 health-care workers were infected with the novel coronavirus by patients at a single Wuhan hospital in January, underscoring the risks to those at the frontlines of the growing epidemic."
https://www.straitstimes.com/asia/east-asia/coronavirus-chin...
>...South Central Hospital. The deputy director went there to help in their ICU. He found that two-thirds of the medical staff in the ICU were already infected.
I was thinking maybe they should get low risk health workers (young fit) to deliberately get the virus under holiday conditions and then return to run the hospitals when immune.
So I'm not going to just shrug and say it's no big deal. It could be. I'm a programmer, I know powers of 2 intimately. We're at 2^15 and doubling every 5 days. If that keeps up for a month we'll be at 1M infected and 16K dead. From there it's another 50 days to 1B infected and 1-2M dead. I'm keeping an eye on that, if it doesn't slow down before 2^20 (1M) then I've already planned to bug out with my loved ones to the mountains of Panama for a couple months until this blows over.
I think it won't come to that, but I'm keeping an eye on the progression and doubling rate. The thing with exponential growth is it always ends. The question here is does it end in time?
I found this in the article posted above:
”So the 20,000 cases in China is probably only the severe cases; the folks that actually went to the hospital and got tested. The Chinese healthcare system is very overwhelmed with all the tests going through. So my thinking is this is actually not as severe a disease as is being suggested. The fatality rate is probably only 0.8%-1%. There’s a vast underreporting of cases in China. Compared to Sars and Mers we are talking about a coronavirus that has a mortality rate of 8 to 10 times less deadly to Sars to Mers. So a correct comparison is not Sars or Mers but a severe cold. Basically this is a severe form of the cold.”
Look at the mortality rate outside of Wuhan to see what the real mortality under a controlled environment look like.
If the rest of China looks like Hubei in a few weeks, we will be in pandemic conditions throughout all of China. If other countries start to look like China in a month or two, we will be in pandemic conditions throughout the world.
Your "if" is completely unfounded. Outside of China infections are not following any exponential trend at all.
The Chinese government’s senior medical adviser has said the disease is hitting a peak in China and may be over by April. He said he was basing the forecast on mathematical modelling, recent events and government action.
Dale Fisher, chair of the Global Outbreak Alert & Response Network that is coordinated by the World Health Organization, said that predicted “time course” may well be true if the virus is allowed to run free in Wuhan.
The flu-like virus has killed more than 1,100 people and infected nearly 45,000, predominantly in China and mostly in Wuhan.
Singapore has reported 50 coronavirus cases, one of the highest tallies outside China, including mounting evidence of local transmission.
[...]
Asked why there were so many cases in Singapore, he said there were comparatively more tests being conducted on the island.
“We have a very low index of suspicion for testing people so...we do have higher ascertainment,” he said, but added that there was a lot about transmission of the virus yet to be understood.
I'm not sure what to tell you. Unless you think that this virus somehow only targets people living in China, it's only a matter of time before it takes hold in other countries. This is not one that you can simply quarantine and isolate away like SARS. This one seems to be communicable at the earliest onset of symptoms, or even perhaps before.
The response indicated that the deaths were likely significantly under-reported, as in: not counting the people dying while waiting to get into the hospital, or who never make it there. Plausible since there is both no incentive to report higher rates than confirmed, and not a lot of spare bandwidth to test cases already lost.
The real question now is which is more under-reported, cases or deaths. Either way, reading here details of the mechanism of death, it is far too virulent and deadly for complacency.
Looks like the prevailing approach is a very healthy Normalcy Bias.
Much of the rest of the world has sufficient capacity to hospitalize patients to prevent an outbreak. China being China is behind both due to recent industrialization and also an authoritarian state which lied about the dangers.
Take it how you want, but this is a severe flu which would not have survived in more industrialized nations.
What are your thoughts on this?
You may be a programmer, but certainly not a virologist. That’s not how that works.
Before a billion infected, well obviously. Flu infects about 9-45 million people a year, so there's a ballpark model. If we take 45M and 2% mortality as the worst case scenario - and really, it could be worse than that even. It's still a million deaths. That hasn't been seen since the Spanish flu at the end of World War I.
> We're at 2^15 and doubling every 5 days. If that keeps up for a month we'll be at 1M infected and 16K dead.
Obligatory: https://imgs.xkcd.com/comics/extrapolating.png
This is also math. But it’s not the way things work.
The fact that you are already planning to bug out, despite being on a different continent is also a little bit telling.
Traveling will increase the risk to become in contact with somebody who is infected.
https://www.bbc.com/news/uk-51425702
Four adults and a child were diagnosed with the virus after coming into contact with a British national who recently returned from Singapore.
The five Britons, who stayed in the same ski chalet, were not in a serious condition, French officials said.
The entire world is going into a freaking panic over this. And they’re spewing out nonsense that the China government is lying, and their numbers cannot be trusted. Which doesn’t really help the situation, and it clouds the scientific understanding of this incident.
Then the 2 moronic scientific papers that were published whipped everyone up into a frenzy.
(1) The German paper said that people can transmit it asymptomatically, which means this is some kind of Frankenstein virus that can transmit over 14 days, and infect others when not showing any symptoms.
(2) The Indian paper that suggested that this virus was man-made, and thus fueled the conspiracy theories about it being a bio weapon. And this fed more fuel to the fire for #1.
Two scientific papers that were both terribly wrong!
And what was the result? It created mass panic.
So there you have it. Fake news that created real mass panic in the real world.
Some good highlights from this transcription were:
* This is like SARS, but less deadly. Yes, it is infectious and contagious, but it is also less deadly than SARS.
* The virus will likely burn out in May, because it doesn’t do well in warm and humid weathers. So Australia with its hot wildfires will be spared. Go take a vacation in the hot and dry outback of Australia everyone. You’ll be fine out there.
* The 2.2 reproductive R0 number is a perfect theoretical scenario, but it will likely not happen in this case, since China mandated the quarantine. And the entire country is a ghost town, with people wearing face masks in public, and avoiding any outdoor activities. This should help to slow the spread, and kill off the virus, like how SARS mysteriously disappeared.
So, governments around the world, need to be vigilant, and do what they can to contain the spread of the virus, but we should be ok. There is no need to panic right now. The fear is worse than the disease.
The leaders of the world needs to step forward and make regular public health announcements about this. And to calm the public down, and stick to known scientific facts and evidence.
Unfortunately, we have morons as our elected leaders.
There are other virology / epidemiology forums which may be of use, but I don't have these links at-hand.
For instance, the following link is a highly descriptive, accessible analysis of nCoV-2019: http://virological.org/t/analysis-of-wuhan-coronavirus-deja-...
OPs article does have merit, as far as giving a first-person account of treating the virus and quarantine procedures, but you'll learn a lot more about the virus itself if you follow the research.
“ nCoV2019 has a furin-sensitive motif at the traditional S1/S2 border fo the spike protein, i.e. RRAR, that was lacking in SARS (which depends on cathepsin cleavage a few amino acids downstream). nCoV2019 lacks the secondary minimal furin cleavage site, i.e. RNTR, that is found in SARS. Therefore, the endoproteolytic cleavage pattern is expected to be different between nCoV2019 and SARS.
Prediction of O-glycosylation sites reveals a cluster of Serine residues, just before and after the RRAR cleavage site, with a high propensity to form a “mini-mucin” patch at that site. It is positioned to protect the putative fusion peptide region in the native or pre-fusion Swiss-Model projection of the probable nCoV2019 structure.”
Not sure how to ‘follow the research’ when the first page has 12 proper nouns/terms I’ve never encountered...
Spike protein --> the proteins on the surface of a virus used to attach onto or enter a host cell. https://en.wikipedia.org/wiki/Peplomer
RRAR --> This is a group of amino acids: Arginine Arginine Alanine Arginine. Here is the list of abbreviations: https://www.ncbi.nlm.nih.gov/Class/MLACourse/Modules/MolBioR...
For a discussion of cleavage --> https://en.wiktionary.org/wiki/endoproteolytic
For a discussion of it relevant to another virus --> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC103966/
Mucin --> https://en.wikipedia.org/wiki/Mucin
O-Glycosylation --> https://en.wikipedia.org/wiki/O-linked_glycosylation
So this is a discussion of the differences in how these viruses uses their respective spike proteins to trigger endoproteolytic cleavage in the host cell. Specifically, what the impact of different positionings of their amino acids is.
For example, the idea "Furin-sensitive motif" means that there is a section of the spike protein which contains the amino acids described (RRAR), which is sensitive to the protein Furin in host cells.
See here as well: https://www.researchgate.net/publication/6756975_Proteolysis...
1) In complex problems outside your domain, trust the experts.
2) These experts should go out and sell the truth in way laypeople understand them. Which is incredibly hard as everyone prefers dooms day scenarios it seems.
Just kind of sad even HN doesn't get that as this thread clearly shows.
----
Caixin: Based on your clinical experience, what's the disease progression of the new coronavirus?
Peng: Lately I've been spending the daytime seeing patients in the ICU, then doing some research in the evenings. I just wrote a thesis. I drew on data from 138 cases that South Central Hospital had from Jan 7 to Jan 28 and attempted to summarise some patterns of the novel coronavirus.
A lot of viruses will die off on their own after a certain amount of time. We call these self-limited diseases.
I've observed that the breakout period of the novel coronavirus tends to be three weeks, from the onset of symptoms to developing difficulties breathing. Basically going from mild to severe symptoms takes about a week. There are all sorts of mild symptoms: feebleness, shortness of breath, some people have fevers, some don't. Based on studies of our 138 cases, the most common symptoms in the first stage are fever (98.6 per cent of cases), feebleness (69.6 per cent), cough (59.4 per cent), muscle pains (34.8 per cent), difficulties breathing (31.2%), while less common symptoms include headaches, dizziness, stomach pain, diarrhea, nausea, vomiting.
But some patients who enter the second week will suddenly get worse. At this stage, people should go to the hospital. The elderly with underlying conditions may develop complications; some may need machine-assisted respiration. When the body's other organs start to fail, that's when it becomes severe, while those with strong immune systems see their symptoms decrease in severity at this stage and gradually recover. So the second week is what determines whether the illness becomes critical.
The third week determines whether critical illness leads to death. Some in critical condition who receive treatment can raise their level of lymphocytes, a type of white blood cell, and see an improvement in their immune systems, and have been brought back, so to speak. But those whose lymphocyte numbers continue to decline, those whose immune systems are destroyed in the end, experience multiple organ failure and die.
For most, the illness is over in two weeks, whereas for those for whom the illness becomes severe, if they can survive three weeks, they're good. Those that can't will die in three weeks.
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Whole thing is worth reading.
> Some experts argue that the virus triggers a cytokine storm, which ravages the stronger immune system of young adults
> Based on my observations, a third of patients exhibited inflammation in their whole body. It was not necessarily limited to young adults. The mechanism of a cytokine storm is about whole-body inflammation, which leads to a failure of multiple organs and quickly evolves into the terminal stage. In some fast-progressing cases, it took two to three days to progress from whole-body inflammation to the life-threatening stage.
Note Dr. Peng in the interview is one of the authors of the JAMA article.
EDIT: What makes you think highly educated people just doing epidemics didn't have that ideas alrwady and didn't base their numbers on that?
That is, the tail end is clearly deadly -- but for the average case, are symptoms much worse than the yearly flu, or around the same?
It’s effectively a distributed denial of service attack (DDOS) on the medical system.
There are a lot of old people in Wuhan and the province, that those that gets a heart attack or an old age ailment, where they normally would have been saved, will now die. This is a terribly tragic secondary effect.
The best approach is certainly self-isolation with sufficient food, then you have zero chance of becoming infected.
I'm not at that point yet in Europe. But if I lived in Singapore or Hong Kong I might start considering it.
more like feeling like you've been hit by a truck for 2 weeks while you shiver in bed with a fever, coughing your lungs out, unable to function
Despite not being vaccinated, my husband was feeling 80% better within three days and fully recovered within four days. He was miserable for the first two days, but still not the level of ‘got hit by a truck’ that I remember from previous cases. I took five days to recover and also had relatively mild symptoms - it was undeniably different from a common cold (muscle soreness, chills and night sweats, fatigue) but I wouldn’t have thought it was the flu if the rest of my family wasn’t infected. My daughter seemed to be recovered within 48 hours, though she later contracted pneumonia. Even that was managed within 24 hours of starting amoxicillin and a nebulizer.
This post has gotten pretty long, but my point is that, for whatever reason, we came down with a flu that wasn’t nearly as bad as the norm. Even the doctors were skeptical until the test results came back.
Fevers of 5+ degrees F (lasting 3-5 days), chills, aches, chest pain, etc. And complications (eg pneumonia) are fairly common and can be deadly.
I would wager that most "flu" cases people self-report aren't actually the flu.
https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-sy...
Not directly caused by the flu but correlated, fortunately quite rare.
EDIT: not to minimize the flu though. Comparing a flu to a cold is like comparing a migraine to a tension headache.
There are test kits but China has very few of them compared to the mass of patients who have flu-like symptoms. So... from what I heard we dont really know.
Edit: my thought is that maybe they could use blood counts to separate it from the flu
Doctor observed that three weeks seemed to determine the difference between life and death.
- Patients with stronger immune systems would start to recover in a couple of weeks
- Second week, some cases would take a turn for the worse.
- In the third week, keeping some of these acute patients alive might require extraordinary intervention. For this group, the death rate seems to be 4 per cent to 5 per cent.
If there's little or no infection near you, I wouldn't do anything yet.
That's the principle mechanism of public health to epidemiological outbreaks: reduce the likelyhood and rate of transmission between people.
This is why the appropriate response is to curtail transport, especially long-distance modes which occur faster than onset of symptoms (e.g., air flights from known epidemic zones). It's why locking down cities within epidemic zones, restricting mobility between cities where outbreaks have occurred, wearing barrier protection to prevent both contracting and transmitting particles, disinfecting infected surfaces, and limiting social and business contact, are all primary responses.
Get a flu shot, if you haven't already. Not because it'll keep you from getting 2019-nCoV, but because you don't want to be confusing having the flu with having nCoV, and you don't want to have to be out getting treated for flu whilst nCoV's circulating. And having all others treating you like Typhoid Mary to boot.
Wash your hands.
Carry (and use) alcohol-based hand sanitiser. (Antibiotic is useless against virus.)
Wash the doorknobs, light switches, taps, knobs/pulls, and bannisters in your home, regularly. Keep visitors and guests to a minimum. Don't touch your hands to your face, eyes, nose, or ears.
Look for indications of breakout in your area on news or online. Realise that if there's a breakout, the disease has likely already been circulating for several weeks, e.g., the risk is high. Currently, outside of China, there are very few places at risk -- Singapore, Hong Kong, Japan, Korea, Japan, Thailand, and South Korea are the major additional locations.
Transmission seems to require several hours of fairly close contact.
Stocking up on cleaning supplies generally makes more sense than masks, which are of limited use or efficacy.
Some somewhat nonobvious practices (salt-infused masks, apparently, others may exist) seem to reduce transmission or viral capability profoundly.
For now, the containment trends are strongly positive, outbreaks outside China are quite limited, and it looks as if measures are effective. It'll be another few weeks before this is certain, things could still go quite badly, but signs are encouraging.
Most notably, the new cases and deaths trends are dropping well below their initial exponential trajectory:
https://en.m.wikipedia.org/wiki/2019–20_Wuhan_coronavirus_ou...
https://en.m.wikipedia.org/wiki/2019–20_Wuhan_coronavirus_ou...
Comments I made yesterday on Diaspora regarding this, and pointer to a now 10-day-old post based on the then exponential growth, in which I'd suggested we should see containment working on new cases by early February, and deaths by mid-February (we're actually trending well ahead of that):
https://joindiaspora.com/posts/17158824
Disclaimers: lay views, not an expert.
https://www.bbc.com/news/uk-51425702
Five Britons have tested positive for coronavirus in eastern France, the French health minister confirmed.
Four adults and a child were diagnosed with the virus after coming into contact with a British national who recently returned from Singapore.
http://www.sixthtone.com/news/1005146/dispatches-from-hubei-...
This is a brilliant strategy for spreading the virus to any patients who might've come in with regular cold or flu and hadn't been infected with coronavirus yet.
This is like a commercial for why we need to build medical telepresence robots.
https://www.worldometers.info/coronavirus/
And know that in 3 weeks everyone either dies or has recovered.
Doesn't that mean we will see a large amount of total deaths in a couple of weeks?
Those graphs are both exponential!
Remember that cases are subjectively selected, while deaths have a fixed statistical variance!
If you look at the daily change in amounts of deaths from this data series, it is more of a wobbly straight line:
https://i.imgur.com/gQajRT9.png
I did a linear projection of this data series to see how long it would take for a 1000 a day to be perishing if this trend and I came up with 8/8. Can anyone else replicate this?
I would hope containment would slow these numbers, but it is possible it could go another way. If the data itself is underreported then it could also be worse.
I guess the number of serious condition jumping from 5000 to 6000 since last I looked yesterday or the day before was what startled me...
This disease is virulent and unpredictable. A 34 year old doctor died. 12 hospitals are being built at breakneck speed. This will become endemic at this rate. Either we create a vaccine or we each roll the dice on acquired immunity and too many people die in the process. It is time to be concerned.
If you had read the whole article you would have learnt that treatment is free for those affected.
> It is time to be concerned.
Concerned sure, alarmed no, like your post seems to tend towards.
I had the unchecked belief that China claiming to be a communist country would be covering medical costs.
Above reminded me of this: "'He cannot speak or look after himself': A 17-year-old with cerebral palsy died after being left alone for 6 days while Chinese authorities quarantined his father over coronavirus fears" - https://www.businessinsider.com/teenager-cerebral-palsy-dies...
Edit: I really can't understand why anyone would downvote this comment - the downvotes are making me laugh.
China has made more gains in medical R&D than pretty much any other country besides the US and a lot of that has to do with the fact that it allows firms to profit like the US does. It's the second biggest drug market after the United States and I believe it's also the second biggest market for clinical trials after the US.
Generally in China you buy your way into a hospital bed if it's busy.
And "Big Sickness" (the Chinese term for cancer and heart surgery) ruins family finances, similar to the USA.
By your same logic, everyone who has a baby in the US must be ruined financially as well?
(This is my dad’s case...)
Canada's system likewise has pros and cons to it, and I believe once democracy and freedom is stabilized via adequate distribution of resources sharing the technological gains of this century, then society must first focus on analyzing, conversing about, our health systems in depth. The conversation for too long has been primarily held, lead, by industrial complexes and specialized professionals in funnels that are more indoctrinated, non-interdisciplinary, than is healthy.
China is communist in name only, and has been for a very long time.
According to some Twitter videos I saw from Wuhan that is not actually the case, as in supposedly the local hospitals still ask people for money. There are also cases like this one [1] of people not being let in even though their relatives have paid some money.
This latter link might also be interesting for the HN crowd as the lady from the video can be heard shouting at a hospital security guard that het older mother wasn't able to pay the money through any phone apps (supposedly because of her age and her not knowing to use this modern stuff), which made me think again about how eliminating cash and person-to-person transactions is really detrimental for large swaths of the population (in this case older and sick people).
[1] https://twitter.com/jenniferatntd/status/1224959223915827200
This is the problem with socialist, they believe the government is always the good guy, and entrust it to provide for everyone.
We capitalist know that government in all cases the worst solution to any problem
GPS is a public utility, as are GLONASS and Galileo, so I'm not even sure what "privately funded geolocation satellites" you are talking about.
Regardless, your claim was a universal (the state is worse at providing ALL services) so showing some services which the state is much better at providing is enough to prove you were wrong.
That's not capitalism, that's anarchism my friend.
Communism and socialism are two different things.
Communist states like China are very different than socialist states like in Europe that have free health care. Why confuse the two?
(wow, what a huge amount of fear mongering and conspiracy theories there)
That humility is hard for engineers is something I try to remind myself daily.
[0] https://www.npr.org/2020/01/28/800442646/acclaimed-harvard-s...
article linked by someone above is quite a good antidote to the worries
Source? I've not seen any published number higher than 5%.
(High-consequence flu strains such as H5N1 can have case fatality rates of as much as 60%. Not all flus are created equal.)
Case mortality rate for 2019-nCoV has been reported from 1% to as high as 6%, with lower values more plausible.
That's a 10x to 120x greater mortality, and again, lower rates appear more likely. The high end isn't great, but is still below 200x.
Key differences are that we have vaccine and curative treatment for influenza. Neither are 100%, but both are effective in many cases.
https://qz.com/1798887/china-coronavirus-fatality-rate-is-to...
Up to the limits of medical facilities, your odds will be good, but it takes a lot of resources to keep patients alive when they are experiencing complications, and those resources are inherently limited.