CDC: Possible ‘community spread’ coronavirus case in Bay Area | Hacker News Reader

CDC: Possible ‘community spread’ coronavirus case in Bay Area

kron4.com

84 pointsremote_phone132 comments

This is in the same county (Solano) that the flight carrying people stranded on a cruise ship with corona virus infected people flew into. I wonder if that is connected in some regard, or if that's just a huge coincidence.

This virus seems to be right at the cusp of something we should really fear. ~3% mortality rate and at least semi easily transmissible. The fact is that this could be a lot worse and we are already seeing some ugly behavior from it. I imagine chaos if mortality climbs by an order of magnitude. We need to keep our heads here and figure out how to stop this thing.

As a programmer, there are two options:

1. quarantine. 2. vaccine.

Given the fact that people will not self-quarantine mainly due to economic reason, the hope is to rush the vaccine as fast as possible through the FDA, and then to mass-produce it.

As laid out by the actual expert at Trump's coronavirus press conference tonight (not Trump), American regulations on safety and efficacy mean that "rushing" a vaccine will take about one year.

Quarantine isn't the only way to slow down the spread of a disease, and it's not unheard of for large changes in behavior to happen in response to large risks. Hand washing or even mask wearing could become more popular. E.g. https://zoomingjapan.com/life-in-japan/why-japanese-wear-sur...

From what I’ve read “rushing” for vaccines means it will be ready in 2 years

Since this is the first time that the world is facing such a pandemic, this must and I assume will be changed.

It will, thus bringing the ETA to 1 year or so.

I'm not sure that it is possible to do so.

Vaccines take a long time to develop; just throwing more money at it isn't a solution. You need to understand the pathogen, which just takes time. Getting the IGg out of horses or whatever takes time. Making sure you can use horse IGg versus rabbit IGg takes time. Trying it out on volunteers takes time. Mass producing it takes time. The officials aren't joking when they say 2 years.

SARS still really doesn't have a vaccine, and that effort started in 2003. Heck, Malaria took ~50 years for a kinda-okay-ish vaccine.

Fact is, there is a very low chance of a vaccine for this one.

Wash your hands, don't touch your face, stay calm.

First there is a small safety trial of several months, followed by an efficacy trial of I think six months. We could possibly skip the efficacy trial at the expense of potentially loading up people with multiple not-very-effective vaccines. And getting through safety trials doesn't mean there are no side effects, so we'd have to deal with those compounded as well.

Nah, the mortality rate is higher, around 9%, similar to SARS. Dividing total deaths by total cases is wrong. You need to divide by the sum of deaths plus total recovered cases. With that in mind it's already way higher.

That doesn't work either because the definition of 'recovered' is something like 'symptom free for 40 days' and most people dying are doing so within 1-2 weeks. What you really need to do is divide the total deaths by the total known cases two weeks ago (roughly when the most recent deaths would have been infected).

Last time I did this it looked like the overall death rate would come out at ~4.5%, reporting methods have changed since then and now it's coming out as more like 4%.

Yes this is what people miss. There is a delay between known cases and deaths.

Even worse, we don't know how many people have actually been infected. The reported death rates aren't reliable either.

All the estimates we're seeing are almost entirely from unreliable data coming out of China.

So I'd take these estimates with a huge grain of salt for now. We should be in a much better position to have reliable estimates in a month or two.

True. On the plus side, the higher the actual number of infections, the lower the death rates that we should be expecting. There's a growing consensus that the virus can spread asymptomatically which (while not good for containment) means we're only seeing a small fraction of cases and the death rate is going to be much more like that of the flu (which isn't great but also hasn't destroyed civilization as we know it).

While there may be asymptomatic spread (it's too early to be certain of that yet either), "asymptomatic transmission likely plays a minor role in the epidemic overall, WHO says. People who cough or sneeze are more likely to spread the virus, the agency wrote"[1]

[1] - https://www.sciencemag.org/news/2020/02/paper-non-symptomati...

Counterpoint:

> US traders were particularly rattled by the Centres for Disease Control and Prevention confirming a COVID-19 infection in California in a person who apparently had no relevant travel history or exposure to another known patient. [1]

One asymptomatic carrier may not infect many people but if they infect even one new person in an as-yet-uninfected population center they'll create a new outbreak. The only defense against this is universal testing, otherwise by the time you start seeing symptoms it's too late.

[1] https://www.abc.net.au/news/2020-02-28/asx-carried-away-in-w...

> At present, it is tempting to estimate the case fatality rate by dividing the number of known deaths by the number of confirmed cases. The resulting number, however, does not represent the true case fatality rate and might be off by orders of magnitude...

> A precise estimate of the case fatality rate is therefore impossible at present.

Taken from https://smw.ch/article/doi/smw.2020.20203

Mortality rate is much, much lower than 3% if you exclude the elderly and the critically ill. Based on the Chinese CCDC's report released last week, covering 72,314 confirmed infections, mortality rate for a young healthy person is an order of magnitude lower.

80+ years old: 14.8%

70-79 years old: 8.0%

60-69 years old: 3.6%

50-59 years old: 1.3%

40-49 years old: 0.4%

30-39 years old: 0.2%

20-29 years old: 0.2%

10-19 years old: 0.2%

0-9 years old: no fatalities

I think most people are blowing it out of proportion. It's just a bad flu, and it seems to be responding well to remdesivir treatments in early trials. I also think that, with the news we're getting now about asymptomatic/minor cases, it's highly likely the real number of infections is much larger, which would mean the CFR numbers are way too high.

You’re citing numbers from the Chinese govt. You can’t be serious.

Another bad flu is a terrifying prospect. If this coronavirus becomes cyclical like the flu, it will be a gigantic driver of global mortality.

These numbers are bullshit and I'm tired of having to repeat this everywhere. The Chinese government is lying about infections and there are legal and infrastructural issues which prevent the vast majority of cases from being diagnosed and reported, even if there wasn't an ongoing official attempt at minimization.

The virus has a ≈15% critical illness rate[1]. There are less than 100k ICU beds in the entire United States. They will very quickly be overwhelmed, exactly as they are in China, SK, Iran, Italy...the list is getting too long to keep up with. At that point the mortality rate approaches 15%. This is not the god damn flu and people who dismiss it as such are being hugely irresponsible.

1. I believe this article is referencing the published paper in Lancet that I was referring to https://coercioncode.com/2020/01/27/breaking-news-coronaviru...

Also bear in mind that the study is out of China, so it is most likely extremely conservative because the government has been publicly cracking down on anyone "spreading rumors" about the virus.

The peoples' collective, deliberate obviousness at this point is unbelievable.

Edit: wait a minute, I don't think I've even seen the paper I linked yet. This one reports 32% ICU admission rate and 15% death with lasting damage in recovered patients. Some 2 dozen Chinese authors to boot. Get your fucking heads out of the sand!

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

> The virus has a ≈15% critical illness rate[1].

This is completely implausible.

Why do you say that? That’s what all the reporting says. That’s why the health care systems were overwhelmed.

Not at all. The number of serious/critical outside of China are about 3% and mostly elderly people.

We are seeing a lot of cases that are only being discovered after the patient has had symptoms for some period of time. It seems like a number of these cases have been mild enough that a lot of people would not have even sought care.

The idea that 1/6 cases are "critical" just doesn't align with this reality.

A 15% critical rate is very plausible. A widely shared report [1] on Chinese media described how an entire family died to virus. A man, his sister, mother, and father all died to the coronavirus. His wife is in serious condition.

Using the reported death rates posted above, the odds of this happening are 1.3% * 1.3% * 8% * 8% = 1/924556. That's nearly 1 in a million. I concede that the medical system in Wuhan was overwhelmed, and these 5 patients did not have access to medical care.

[1] https://www.caixinglobal.com/2020-02-17/four-deaths-in-one-f...

No it is not, Diamond Princess is the only controlled environment we have and it didn't have even close to 15% critical rate.

Exactly... also see this report: https://twitter.com/balajis/status/1232797151941611520

The situation is horrible, but look at the hospital workers rate of infection vs mortality.

Even horrible things can still be made to look more horrible.

"The virus has a ≈15% critical illness rate[1]. There are less than 100k ICU beds in the entire United States. They will very quickly be overwhelmed, exactly as they are in China, SK, Iran, Italy...the list is getting too long to keep up with. At that point the mortality rate approaches 15%"

It's not just an ICU severely ill people need, but artificial respirators. I haven't seen numbers on how many the US has, but it may not be enough.

In addition, this illness has the potential to take a significant amount of medical personnel out of commission, either directly by making them sick or killing them, through attrition as they overwork themselves and collapse (we've been seen all of the above happen in China).

So even if you get in to an ICU you could still be screwed.

That said, the numbers coming out of China are just not trustworthy right now. We'll have to wait and see how bad it is outside of China (assuming enough people get tested and the tests actually work, neither of which are a certainty yet).

Thank you for this post and pointing out the fact that we will be out of ICU beds very quickly.

The complacency of ignorance on this really beggars belief.

remdesivir treatments

The synthesis route from Wikipedia does not look encouraging. Eight steps, some conducted at low temperature - good luck with scale-up! Production scale at dry ice temperature requires a dedicated facility, your garden-variety contract shop doesn't have the equipment.

I think your post is intended to be reassuring to the presumable majority younger demographic on HN.

But it strikes me as very insensitive. Ignoring the validity of the source of those numbers, even if they hold up. We all know people over 40. We all know people with existing illness that put them in higher risk brackets. And we all know people in other regions of the world with poorer healthcare systems where the fatality rate may go up.

The parent’s fatality rate was broadly correct. You can’t just select out a big portion of the population to give a better survival rate. Then compare your hacked fatality rate to the unhacked seasonal flu rate. “Just a bad flu” that is up to 20x worse than the regular flu is a big big deal. The near wartime like response in China is not “just a bad flu.” This is affecting a lot of people in very serious and real world ways.

To me, his last paragraph was the most important part. We've seen that the case rate increases dramatically as more tests are administered.

This is implying a very strong selection bias in the past testing towards the most severe cases. The mortality rates are certainly much lower than these estimates.

>We've seen that the case rate increases dramatically as more tests are administered

Is that really true though?

The UK has administered some of the most tests at over 7,119 but only 13 confirmed cases. US has done a measly 445 tests, yet 60 cases? Might be things are just starting to ramp up, and yet we're behind on testing...

>US has done a measly 445 tests, yet 60 cases?

I think the US tests were much more targeted to those most likely to have contracted it. Like US citizens returning from Wuhan/Hubei.

Yeah that makes sense, although that would be a selection bias towards most likely cases, not necessarily most severe. Although China's data is most likely to be biased towards most severe...

Its very possible that I was incorrect. I now realize that my statement was based on something someone told me, and I can't find original sources.

I do continue to believe that the real cases are much higher than the reported cases, though, and many of these unreported cases are the ones with the mildest symptoms. This will continue to skew statistics for some period of time.

There's also reports that if somebody is dead then they won't treat them due to limited resources, they'll just ship them to the crematorium. Because of this I'd expect the 3% rate to hold at the very least, if not slightly increase.

It's not that those people groups don't matter, it's just that if it wasn't COVID-19, it could have been one of a dozen of other common ailments with elevated CFRs for those populations. My Nana beat cancer multiple times, but ultimately succumbed to a minor cough that turned into pneumonia.

Eventually time gets the better of us all. I don't think that's an insensitive statement, just pragmatic/realistic.

So what in your opinion would present a public health danger worth worrying about? A 6 percent mortality rate? 10 percent? Or is there no mortality rate worth fretting about if it only affects people 50-years-and-older?

> But it strikes me as very insensitive.

And here I am pondering if the generational time bomb's been defused. Parent's downright warm'n'fuzzy.

> it strikes me as very insensitive

It's a physical fact that older people's bodies aren't as able to fight off diseases, and they are likelier to have mortality rates.

If no one's allowed to actually explain the physical facts of how the physical universe works, because it's "insensitive" to mention that older people are more likely to die when they're sick, how is our society supposed to come to correct [1] answers when it comes to medical science and health policy?

[1] By "correct," I mean minimizing the incidence and severity of illness within relevant resource constraints.

Agreed. Statements in contexts like this should be evaluated as either correct or incorrect. Worrying about sensitivities in science is typically counterproductive.

I think most people are blowing it out of proportion. It's just a bad flu

This isn’t science, it’s someone’s opinion on how concerned other people should be based on their interpretation of some very incomplete data.

> I think most people are blowing it out of proportion. It's just a bad flu

It isn’t just conveying information, its downplaying the severity of the situation.

29 to 40 year old Chinese doctors have already died. If it was really only 0.2/0.4% for them, those events would have been extremely unlikely.

Also, in Iran it is concerning how much higher the CFR is there; which are leading some to think the virus may be exhibiting different behavior there.

and yes, the severe/critical case rate is somewhere around 14%-18%, which means you need hospitalization.

if you don't trust the chinese data, the data in south korea and italy is very trustworthy, and looks just as bad on those too.

Do you mean the Chinese doctors who were in prison for revealing the coronavirus to the public?

I imagine their health was terrible just from a few weeks living in a Chinese prison.

Are those numbers supposed to be comforting?

> 80+ years old: 14.8%, 70-79 years old: 8.0%

That makes it extremely likely that at least one friend or family member while die of this.

> 30-39 years old: 0.2%

To put things in perspective (https://www.statista.com/statistics/241572/death-rate-by-age...), that doubles this risk of death this year for that age bracket.

> 10-19 years old: 0.2%

That roughly quadruples the rate of death for that bracket.

And besides that, it's not the mortality that's the biggest worry but the amount that need critical care (10-20%). In a large outbreak there will simply be more critical cases than there are ventilators to put them on.

Edit - Does anyone know what sort of triage China put in place? Ie, when they don't have enough capacity are they favoring treating young people and giving up on the 80+?

Why would you exclude people over 50, transplant patients, people with lung ailments or cardiovascular disease, people being treated for auto-immune disease, etc?

This reaction that it's OK as long as it doesn't kill young healthy people is sociopathic.

By the way, your "blown out of proportion" comment means you are fine, just fine, with an expected death toll of 4 million Americans, if it were to go epidemic and infect 40% of the US.

> Mortality rate is much, much lower than 3% if you exclude the elderly and the critically ill

Yeah, fuck them, right?

Do you get as upset when those same figures are given for the flu?

What same figures? The CDC says the high end of flu deaths is 40,000 [0]. You think that number compares with a 3 percent mortality rate for the 70 million Americans who are 60+ years old?

[0] https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...

I do when people downplay the flu and say it's just a bad cold.

Nearly a quarter of the United States population is 60 and older.

https://censusreporter.org/profiles/01000US-united-states/

The most significant experience is that efforts should be made before medical services were overwhelmed by flood of patients. Mortality would be higher if patients were not properly looked after.

Flu is also heavily dependent on age —

The mortality rate for seasonal flu for 18-49 year olds is .02% — so by your own numbers, this is 10 times worse.

Can you explain those percentages? Why do they add up to ~30% and not 100%?

Death rate by age bucket

Say this holds out, but say it's fast evolving. A woman in Japan for instance recovered from the virus 2 weeks ago, and is in the hospital w/ it for the 2nd time.

If you don't die the first time, what's to say you don't get this 3-4 times in the next year and the 4th time gets you?

> 80+ years old: 14.8%

Great. My grandparents have a more than insignificant chance of dying if they (probably) catch it. This really assuages my fears.

> Mortality rate is much, much lower than 3% if you exclude the elderly and the critically ill.

Why would we do this?

Not trying to be mean, but stopped reading after "based on the Chinese CCDC's report".

mortality depends on the country in which the patient is treated in my view.

according to WHO's situation report, Singapore has 91 confirmed cases and 0 death so far. in most developed country, mortality rate seems to be on much lower side. Of course these numbers can change at any minute.

https://www.who.int/docs/default-source/coronaviruse/situati...

It's more patients vs resources than developed vs undeveloped, it's much easier to handle 91 cases at once than 900 or 9000. Italy is also a developed country and the mortality is around ~3% so far in Italy, Japan is developed and it's at ~1.5%. At the moment it seems like Korea is the biggest outlier with mortality under 1% but also with a lot of cases.

I'd rather be in a developed nation, but you're cherry picking your example.

Handy tracker, death vs survivor counter:

https://www.worldometers.info/coronavirus/

note the extra links at the top too

ps. 2% of 7 Billion is 140 Million people

The info on this website is useful, but the banner ads around the perimeter are making me feel sick for some reason

There are ads on the internet? Is your ublock broken?

This has been my favorite:

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...

Mobile version:

https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2...

Fuck it. Time to WFH for a couple weeks. I'm going to miss the free espresso.

It’s going to take more than a couple weeks for this to take its course.

Right, but I can make the decision then on whether to return to work. As I said in another thread, I know I'll probably get it eventually and be fine, but I don't want it when the first wave hits and the health care system is jammed. Better for everyone if we WFH if possible.

Are you stocked up for six months? If everyone works from home, Amazon, Uber Eats and Wholesale ain't delivering.

Everyone can't WFH. But if you can, you probably should.

Stocking up for months is entirely realistic. Canned beans, pasteurized milk, etc.

Feasible, but realistic for most people?

A can of beans has around 350 calories, a pound of uncooked rice has 1700 calories

Assuming you want to avoid losing weight, you'll want around 2000 calories/day.

So you'll need 180 cans of beans and 180 lbs of rice. A 5 gallon bucket of rice weighs around 40 lbs so that's 5 5 gallon buckets.

And you'll want more than rice and beans, so you'd want to store more than that.

I don't think many people realistically have the space, money, or inclination to store that much food, especially families.

20 lbs of Rice at Walmart is about $9.00.

2 lbs of Black Beans is $2.22. (figure it to make 4 cans worth).

So about $190 gets that.

I'd throw in a bunch of Ramen Noodles (pro bachelor tip).

But my favorite is the Shore Lunch Soup Mixes:

https://www.menards.com/main/c-1528988295732.htm?searchTermT...

Lots of variety, cheap, easy to fix meal for 5-6 people.

Great, so you can feed your family of 4 for $800 - where are you going to store that all in your apartment?

I didn't say it's impossible, but not realistic to expect all or even most Americans to stockpile that much food... especially when the government insists everything is under control.

> where are you going to store that all in your apartment?

Right by the ammo locker.

Firstly, I have a modestly sized apartment, and even for me storing ~100 kg of rice would not be particularly difficult. Its quite compact if you get stackable plastic containers - I just used those to pack a few hundred liters of clothes.

Secondly, the idea is not to survive apocalypse - even having a week's supply will enable you to weather the worst of it, and give you confidence. I think it's an investment well worth it.

But it's not just "100 kg" of rice - it's 100kg of rice and 100kg of beans (or other foods). That's going to seriously eat into your closet space.

I'm not the one that recommended storing 6 months of food, I was replying to that post saying it's unrealistic. I keep 2-3 weeks of food (and 1 week of water) stashed away for an emergency.

I was actually thinking about the water issue and that's much harder. How much water do you store? Many houses in uk have storage heaters, it's a 100+ litre tank with an electric heater. It would probably double up as an emergency water storage?

I just have 10 gallons of water, plus a water filter -- I live about 200 feet from a freshwater lake, so I'll have access to water.

Actually, I have 2 water filters, the primary one is a LifeStraw Family that claims to be a purifier that can filter both bacteria and viruses and will last for 5000 gallons), and I have a small hiking filter (a katadyn, I think) and some purifying tablets as well.

I also have a "WaterBob" bathtub water bladder so if there's a disaster where I still have water and think I might lose it (like if there's an earthquake+power failure, I might have water for a few hours), I can fill it and store 60 - 80 gallons of water.

Oh, and like you, I have a tank style water heater so have 40 gallons (150 liters) of water in my hot water heater that will probably be salvageable unless the earthquake knocks it loose from its straps or there's a water contamination issue (which the filter will probably work for). In that case, the house may not be livable either, so I'll probably be in a shelter anyway.

This was all pretty cheap, excluding the hiking filter (which I owned anyway and cost over $100), I paid around $80 for everything.

I just looked online and the Lifestraw is selling for $170, I paid less than a third of that price, might be a lot of people buying them now so inventory is scarce.

The reason to stockpile food before the coronavirus is so you don’t have to go to the store and buy groceries. This reason doesn’t apply to water and I don’t think there’s any chance the utilities are going to shut down. Even if everyone gets infected, the death rate is low enough the there will still be people keeping stuff running.

Stockpiling some water makes more sense in California where the water is piped in from far away and we are at risk of big earthquakes that can break those pipes.

In an apartment, your best bet for adding water storage is probably stackable 7 gallon jugs like this: https://www.rei.com/product/618168/reliance-aqua-tainer-7-ga...

A gallon per day per person is enough.

If you have land and want to store more, you could get 55 gallon water barrels.

Be careful with those 7 gallon jugs -- make sure everyone in the household can lift them. My wife can barely move our 5 gallon jugs, I'm considering buying a few 2.5 gallon ones that are easier to move.

She'd never be able to lift a 60 lb 7 gallon jug to carry it upstairs from the garage to our living space, I'm not even sure she can safely tip it over to spill enough water to make it light enough to carry.

Maybe it would be better to get it early before the health care system is jammed?

Assuming getting the virus conveys immunity, yes, although you'd be hard pressed to catch it intentionally at this point.

> I know I'll probably get it eventually and be fine

unfortunately, you don't know you'll be fine or even probably fine (which applies for everyone else, too), and it's unhelpful to be propagating such misinformation.

"probably fine" with 95% confidence actually fits the data

You are making a flawed assumption that we have good enough data from which to conclude such definitive statements.

It is obvious that we still have a lot to learn about how bad it is actually going to be, and it is obvious that a lot of the figures we've received so far are untrustworthy.

How confident are you in your confidence interval?

UC Davis's coverage of this case is less optimistic:

> approximately 80 percent do not exhibit symptoms that would require hospitalization

[ https://www.davisenterprise.com/local-news/newly-diagnosed-c... ]

You seem to be assuming that once you get it you'll be immune. But there's some evidence that patients can be reinfected and the subsequent infection is worse.

Definitely not assuming that. I don't think I implied it either.

Yeah sorry, mis-click, meant to reply to the post below that said maybe catching it early is better.

Might be better in the long run to just develop some immunity to it.

No, it would be better to postpone getting it as long as possible. The technology/industry learning curve is just beginning for this virus, so later products will be better than current ones.

Barring total societal collapse, that is.

...

After the quarantine was done, it's been established that he doesn't have the virus and can't transmit to you.

He can however get infected after an outbreak in your community

Yes, that's how quarantine works. Did you expect him to be locked up forever,?

I would have expected your company to give him the option to work from home a couple of weeks more. That seems like a slam dunk to minimize cases of people that show no symptoms but still spread the virus.

Finally, some good news.

Personally I think this whole thing is an interesting test of how "extremely online" people react to media manipulation. The actual flu seems pretty boring and ordinary.

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