Second U.S. coronavirus case of unknown origin confirmed in Santa Clara County | Hacker News Reader

Second U.S. coronavirus case of unknown origin confirmed in Santa Clara County

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217 pointsbeefman234 comments

The first patient was confirmed after having been intubated for >= 4 days. On average it takes 9 days from infection to ARDS, which requires intubation, according to a Lancet study. She was confirmed 5 days ago (on Feb 23rd). So she could be infected 9 + 4 + 5 = ~18 days ago.

Since only around 20% of patients require hospitalization, we can estimate there are ~5 infected in her cohort. With doubling time outside China at 5-6 days, that means around 3 doublings: 2^3 * 5 = 40 infected today (Many of them will not show serious symptoms; some who will require admission have not progressed to that stage yet.) So far we have assumed that all hospitalized cases are detected, however.

Some who are hospitalized might still not be detected, since without a test or a CT scan, its symptoms are similar to other viral pneumonia. Let's say infected per detected is a factor of 1.5-4. Very rough estimates: ~60-160 infected in the Bay Area now.

https://www.wired.com/story/community-spread-coronavirus/

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

Doubling time outside China: https://ncov.r6.no/

Curious why a CT scan is required as opposed to a more routine inexpensive chest XRay?

Because the US is doing nearly zero surveillance testing, we don't know what we don't know.

Maybe there's community transmission right now beyond these two cases and we don't know because we're only testing people returning from China or from the cruise ship.

I don't think community transfer is a "maybe". If two people have been infected without any link to known cases, there must be at least one single person that links known cases to the two new infections. That can't really be debated. And what are the chances there is only one? And they only infected two more people, won't infect anyone else, and those two people didn't infect anyone before being quarantined? I think this thing is in the wild now.

It seems the odds are high there is more than 1 because if there is only one there would be something in common between these two recent community cases. But from what I’ve seen there’s nothing linking these two together which means there are at least two distinct groups in California at the moment in which community infections are happening.

The past whereabouts of these people is self-reported, correct? It certainly possible that they're not being completely transparent. The simple solution? Take their phone geo records and see where and when there's an intersection.

I'm not dismissing the possiblity of a threat; only how accurate self-reported data is known to be.

There’s now a third case of unknown origin in Oregon, so it’s confirmed:

https://www.washingtonpost.com/world/2020/02/28/coronavirus-...

And possibly one in the Seattle metro area - there is an 8pm PT presser with King, Snohomish and Washington State Public Health officials this evening.

https://twitter.com/passantino/status/1233587757198405632?s=...

> we're only testing people returning from China or from the cruise ship

Missing from the discussion is the whole debacle around the HHS staff that was sent to check the repatriated American citizens from Wuhan, who had no protection, were not trained, and were released back into the general public without further monitoring.

This is discussed in the NYT:

https://www.nytimes.com/2020/02/27/us/politics/coronavirus-u...

It was in fact broken by the Times and it is an inside source talking to their reporter that we know it happened.

Actually the Washington Post broke the story (according to the AP).

According to the Washington Post, the people from the CDC who interacted with the quarantined patients all had full protective gear.

Allegedly there were social workers from HHS also sent to help assist who were not trained in how to don full gear and so were wearing just masks and gloves.

Note this all happened back at the end of January. So it seems unlikely that anyone was actually exposed, unless you think that there are HHS workers who got sick and it was kept out of the news.

> So it seems unlikely that anyone was actually exposed, unless you think that there are HHS workers who got sick and it was kept out of the news.

That doesn't follow, both because the incubation period is now thought to be as long as 28 days and because infected individuals can be asymptomatic.

Clinical Characteristics of Coronavirus Disease 2019 in China

A study of 1,099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020.

"The median incubation period was 4 days (interquartile range, 2 to 7)."

New England Journal of Medicine, Feb 28, 2020

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

This is also in part because the White House fired the CDC Pandemic Response Unit and cut their funding in 2018.

I'm not saying I don't believe something was cut, but I can't find an official CDC reference to something called "pandemic response unit"

Edit: I found reference to various leadership positions that would help respond to a pandemic be eliminated or left vacant [0], though I think that says something a bit different (still bad though) than the entire US pandemic response capability, or "unit", being axed.

[0]https://www.snopes.com/fact-check/trump-fire-pandemic-team/

> The top White House official responsible for leading the U.S. response in the event of a deadly pandemic has left the administration, and the global health security team he oversaw has been disbanded under a reorganization by national security adviser John Bolton.

Not sure how much more explicit that 2018 WaPo article can be.

From what I can tell though, that was more of an oversight team at the NSC level though, not the actual CDC folks or HHS folks that would really be dealing with this stuff. Again, I'm not saying that isn't bad, but it's not the same as saying the "pandemic response unit" was disbanded, which doesn't seem to be the official name of any actual unit, and it's a phrase that seems to imply that all of our pandemic response capabilities were dismantled. They weren't.

https://www.washingtonpost.com/news/to-your-health/wp/2018/0...

Was that part of the CDC or part of the NSC?

Like why didn't they send people who had a few years ago dealt with Ebola. It's not like we didn't have people who went over there to help or people who treated infected people stateside --granted Ebola transmission is different but you still need PPE, but people know the protocol in practice, not just reading about how to wear PPE.

Those people were fired by the Trump administration in 2018.

https://www.snopes.com/fact-check/trump-fire-pandemic-team/

Not sure why you’re being downvoted because that’s the exactly correct answer.

The previous administration converted the highly successful infrastructure they built up while responding to the Ebola virus into permanent infrastructure which was quickly dismantled by the current administration.

It could be because he is misrepresenting the content of the article.

Quoting: "funding for the CDC’s global disease outbreak prevention efforts had been reduced by 80%, including funding for the agency’s efforts in China. But that was the result of the anticipated depletion of previously allotted funding, not a direct cut by the Trump administration.

Since January 2019, actual funding (vs. requested/proposed funding) is controlled by the House leadership of the opposition party.

how exactly is it controlled by the "House leadership of the opposition party." when bills need to pass the senate too, and the republicans are flat out refusing to pass anything.

All spending bills originate in the House.

Because any suggestion that somehow politics and politicians are directly responsible for bad shit gets instantly down voted to oblivion on HN.

It's like I'm living in a simulation or the movie Idiocracy and I desperately want out.

Hope you have plenty of guns to kill the zombies

Yes. California is monitoring 8,400 people for corona virus. They currently have 200 test kits.

https://sanfrancisco.cbslocal.com/2020/02/27/gov-newsom-coro...

The CDC is targetting routine bedside testing of COVID19 like we have for flu. It will take "months". Surveillance testing is enhanced by this. Recently an attempt to broaden testing ran into issues, now resolved. I expect test numbers to increase sharply. Monitoring those who are most likely vectors makes sense.

https://abcnews.go.com/Politics/cdc-moves-rapidly-expand-cov...

I read that a CT scan outperforms the lab test at detecting it

A CT scan is not an appropriate screening test for COVID-19.

Also, that paper will have no clinical impact. Thread: https://twitter.com/drlukeor/status/1233547995192279040?s=21

Follow-up from the American College of Radiology: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Stat...

"CT should not be used to screen for or as a first-line test to diagnose COVID-19"

The latest guidelines published by the Chinese CDC claimed so too, a CT scan is required, and RT-PCR tests have to be applied multiple times before claiming a patient is cured.

Any idea why a chest X-ray cannot be used, as is for TB?

CT scans involve a lot of ionizing radiation. Definitely something to be avoided unless necessary.

According to [1], a chest CT scan rad dose ranges from 4 to 18 milliSieverts. Annual background dose is ~3 milliSv. [2] states that a 100 mSv dose would increase risk of cancer by 0.5% (5/1000).

[1] https://www.health.harvard.edu/cancer/radiation-risk-from-me...

[2] https://www.scientificamerican.com/article/air-travel-expose...

You cannot compare an annual background dose to the dose received in a CT scan. Similarly, the 100 mSv dose of your reference number 2 is an inappropriate comparison because it is spread out over time compared to a CT scan. Your premise is like saying, walking puts an impact of .8 J on my foot. I walk 10,000 steps a day. 10,000*.8 is 8,000 J. A bullet produces an impact of 168 J when fired from a .22 rifle into a human body. Therefore walking is much more dangerous than a bullet from a rifle.

The Sievert unit is based upon the Gray unit of radiation dose, but it also includes a weighting factor for the type of biological tissue that is exposed to radiation. You can also read up on the linear no-threshold model of radiation exposure for more information. In terms of cancer risk, radiation doses on a range from 1 mSv to 100 mSv can definitely be compared, regardless of the duration of the exposure. There is a range of higher doses e.g. above 1 Gy that would cause acute radiation syndrome if received all at once, where different biological effects would predominate.

What you suggest seems plausible, but I can't immediately calculate, for example, DNA repair rate vs. X-ray photon flux and cross-sections. Can you point me to something that confirms incidence or severity of radiation-induced disease depends on flux rather than dose? Tnx.

Sun burns are known to significantly increase cancer risks vs similar exposure over longer periods. Sun burns are rather similar to accuse radiation poisoning suggesting similar issues.

Both dose and flux matter.

Above, there is a link to a report from Harvard Medical School, that claims otherwise.

Maybe they are wrong, but a post on HN is not exactly a credible refutation.

And yet, this Harvard Medical School link (not a report, not peer reviewed, but whatevs) clearly states that one CT scan of 4 to 18 mSV increases cancer risk by 0.7%, which is higher than the increase of 0.5% from 100 mSV exposure over a greater period of time. So, no. The Harvard Medical School link does not refute in any way my point. In fact, it supports my point.

0.5% absolute points or by 0.5%? Chance of cancer is already really low. Multiplying it by 1.005 doesn't make much of a difference. Adding 0.5% does.

Wouldn't tracking a virus like this be such a necessary situation?

What is the CDC actually doing? Presumably they've deployed a team to Santa Clara to deploy test kits, review hospital admissions and help construct isolation units? Or hopefully soon?

Is there a site tracking the response of CDC and public health departments to this emerging pandemic?

According to this reddit post the CDC won't even test you unless you're so sick that you need hospitalization even if you were in a country with an outbreak AND have flu symptoms:

https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_stor...

So it seems what the CDC is doing is trying to minimize the number of confirmed cases to make things look better.

Meanwhile, Hong Kong is able to test dogs (https://www.businessinsider.com/coronavirus-dog-isolated-tes...) and Singapore is able to provide detailed updates to the public (https://www.moh.gov.sg/news-highlights/details/four-more-cas...)

Never attribute to malice that which can be adequately explained by stupidity.

The CDC has seemed relatively dysfunctional in these outbreaks to me before. During Ebola, there were only a few concurrent (maybe just 1) cases of Ebola in the country. At the same time as the CDC was having news conferences and the CDC experts were presumably in meetings, the handful of nurses doing the actual care for one of the only ebola patients in the country were left completely alone by the CDC:

"After days of asking, Pham said, the nurses were given hazmat suits. She said all the decisions to upgrade the protective gear and precautions were made by the nurses “on the fly.”

Sadly, one of the nurses caught Ebola.

http://res.dallasnews.com/interactives/nina-pham/

Except the government learned from the Ebola outbreak, improved its response and setup infrastructure to handle future such scenarios based on their learning. The current administration dismantled that entire infrastructure.

So while it may not have been malice, there is a very straight line to be drawn from the actions of a couple of years ago and the inept handling of the situation today.

China: Suppress the disclosure of damaging facts.

USA: Suppress the creation of damaging facts.

USA: Lower interest rates and the corporate tax rates to save the stock market. Pretend coronavirus is fake news.

USA: Promote Alternative Facts

Nothing.

The POTUS just said this was a "democratic hoax." After appointing someone to deal with it.

It's beyond politics at this point. Trump can't run the country, and because of his policies, our response is limited and ineffective.

You have a citation for that quotation? Looks fake.

https://www.cnbc.com/2020/02/28/trump-says-the-coronavirus-i...

The quote they use is so decontextualized I had to go find another source to figure out what he actually said. It's pretty clear he's saying the Democrats' criticisms of his administrations response to coronavirus is "the new hoax", not the virus threat itself.

I had to watch the actual rally where he said the words. Article after article uses the decontextualized "the new hoax", or simply "hoax", and most even editorialize that he's claiming there's no threat from the virus.

This sort of thing is what gives Trump credibility when he accuses the media of "fake news".

He's literally saying that the Democrats are politicizing it and that it's a hoax.

The moment that the numbers take a turn for a worse (and they will, because we are not at all prepared for this and are doing nothing to prepare) he'll call them fake, made up and continue down the line of a democratic hoax.

He's doing the exact same thing he did during Hurricane Maria and I would hope that people would learn quickly from the way he's behaved in the past.

Without context your can't tell. He obviously doesn't believe coronavirus is a hoax, so it appears what he said is the Democrats attacks on unpreparedness is "their new hoax". The full comment is:

Now the Democrats are politicizing the coronavirus. They have no clue, they can't even count their votes in Iowa. This is their new hoax

When he says the coronavirus is a hoax, he's explicitly referring to the numbers and the people infected. Because again, he's already done this exact same plan before!

At that point it does not matter if he believes the coronavirus is fake or if he believes that the virus is a complete non-issue because the end result is the same.

When who says? Trump? Because he's never said that coronavirus is a hoax, at least not from what I can find. Certainly not in the decontextualized quote being talked about now.

This is just the typical way that Trump is misquoted. Drop a word here or there, ignore the context, and you have another great headline.

A staffer telling Trump “this is their new ‘hoax’” has a readily understandable meaning which is not even remotely calling Coronavirus itself a hoax.

Pompeo won’t say that the coronavirus is not a hoax.

https://mobile.twitter.com/owillis/status/123341176640054067...

It appears more like he refused to entertain Rep. Ted Lieu's mischaracterization of something that Mick Mulvaney said.

Really? Seems pretty in-character for him.

Sadly legit.

https://thehill.com/homenews/campaign/485245-trump-hits-demo...

"The Democrats are politicizing the coronavirus," he told the crowd in North Charleston.

"One of my people came up to me and said, 'Mr. President they tried to beat you on Russia, Russia, Russia. That didn't work out too well," Trump said. "They tried the impeachment hoax."

"This is their new hoax," he said, apparently referring to Democrats' criticism of the official coronavirus response.

Trump, who opened the rally by declaring the "fake news just doesn't get it," accused the press of being "in hysteria mode" in its coverage of the virus.

The CDC had issues with quality control on the test kits that must be distributed before labs outside of CDC Atlanta can begin doing their own testing.

https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html

The plan was always to expand testing, but you need a working test kit first.

>Six public health labs in the US plan to start monitoring the general population for the new coronavirus this week. The Centers for Disease Control and Prevention (CDC) says that the risk of the virus still remains low for the general population. But activating the disease surveillance network will allow the CDC and other public health officials to find any undetected virus circulating through the country.

https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-...

Edited to add that according to Pro Publica the problem stems from the CDC trying to get a little too fancy.

>The federal agency shunned the World Health Organization test guidelines used by other countries and set out to create a more complicated test of its own that could identify a range of similar viruses.

https://www.propublica.org/article/cdc-coronavirus-covid-19-...

Apparently the CDC has screwed up the “test kit” in numerous ways.

First, they made it needlessly complicated by trying to make it test for other SARS-like viruses, and those tests were flagging a large number of false positives.

Secondly, labs that are developing their own tests to mirror the CDC are being prohibited from using them due to onerous and absurd requirements like demonstrating their test wouldn’t falsely identify MERS as COVID-19, when MERS samples are nearly impossible to obtain.

https://www.propublica.org/article/cdc-coronavirus-covid-19-...

South Korea tested on the order of 10,000 people today alone and found roughly 300 positive cases. The USA has managed to test around 500 in the past two months.

I'm extremely concerned this isn't being treated with an appropriate level of hair on fire urgency. They said 2 weeks ago they were going to start expanded testing in 5 cities and they are still developing a testing procedure?

> I'm extremely concerned this isn't being treated with an appropriate level of hair on fire urgency.

Or, the actions are to be given more weight that the words. That is, perhaps the response is actually appreciate.

Let's recap: The CDC has made a couple statements. The POTUS has down played things. On the other hand, the mainstream media has pinned the sensationalism meter.

Fact: It's been a fairly active "traditional" flu season. Plenty have gotten sick. Plenty have died. Coverage? Zero. Comparison between the flu and this corona virus? Again, zero.

There's disconnected and mixed messages, and plenty of misinformation. I'm not dismissing the threat. Just the same the signal to noise ratio is ridiculous.

Full disclosure: I carry a lot of contempt for the mainstream media. My level of trust, close to zero. The coverge of this issue does more to deepen my mistrust more than gain it. Based on discussions I've had with peers, I'm not alone.

Your contempt leads you to falsehoods and further confusion. Put it away before it gets you hurt.

There is no comparison between flu and Corona. Deaths of non-immune compromised flu sufferers in the US are tiny (1 in my state, NYS, this whole season).

Corona appears to be at least 100 times as deadly as the flu for non-immune compromised, probably more, and there are so many unknowns (eg repeat sufferers).

There is no universe in which "POTUS has down played things" is anywhere near a rational distillation of the behavior of this administration.

Take the glasses off. Put away the contempt. Use your brain. Don't be a fool.

Outside of China...number of deaths?

One death for the common flu in all of NY this season? Nah. Not credible. NYC alone has more than one.

https://weather.com/health/cold-flu/news/2020-01-28-flu-more...

Is there a concern about corona? Possibly. Does the data and the media's depiction currently support the frenzy? No.

Fool? That funny because your data is wrong. I'm questioning you, you have no answers, and I'm the fool? That's not how it works here.

> The plan was always to expand testing, but you need a working test kit first.

I'd like to call out the fact that the impediments to testing in the US were and are entirely bureaucratic in nature.

The CDC publicly published a real-time RT-PCR protocol (including primer and probe sequences) at the end of January. Since that time, it has been entirely possible (from a technical standpoint) for any properly equipped lab to perform tests.

By properly equipped, I mean BSL-2 with a real-time RT-PCR machine - this in not at all an uncommon setup. Other types of PCR machines would require making appropriate modifications to the protocol, but any lab that already does such work will posses the required expertise (seriously, this stuff is _trivial_ by academic standards).

Entirely separate from technical ability to perform an assay is legal status with regard to testing human samples for diagnostic purposes. To that end, the FDA failed to approve any vendor-specific test kits in a timely manner. This is frankly ludicrous under the circumstances, as South Korea managed to approve and make available at least two different test kits in the same time frame - they even have drive-thru testing stations set up!

Why can't the CDC make a working test kit? After China, every other country seems to have been able to do it in like 2-3 days after a few cases were discovered.

They can and did. The issues in the US are entirely bureaucratic in nature.

Oh there is. These two cases have no known contacts.

Isnt this a good thing? Isnt the fact that 8% of the bay area is not dying an indication the diamond princess cmr is more accurate than iran or wuhan, which is to say this is a normal seasonal virus?

In my non-epidemiologist view, yes, it's a good thing.

The denominator for the ~1% mortality rate is obviously bigger than we realize -- which means the mortality rate is potentially a lot lower.

There are cases like this one popping up, where people are asymptomatic (and even test negative) and are not getting sick, despite being infected:

https://www.theguardian.com/world/2020/feb/22/coronavirus-as...

It's getting real now. Wash you hands, and avoid touching your face. Plan to spend less time in close proximity to others.

I saw a message at a dance studio in Monterey Park, which is like a Chinatown section of Los Angeles. The sign outside says that if you have been to China recently, please self quarantine yourself for 14 days before entering the dance studio.

I could definitely notice a difference in the approach they had. They are already worried about it and they are taking steps. I'm not really sure we're ready for this thing. But it's here. It sure seems that way anyway.

> The sign outside says that if you have been to China recently

It is no longer only China at this moment, it is literally EVERYWHERE....

I'm not going to disagree with you on this point. I was more just reporting what I saw at this dance studio in Chinatown.

97% of cases have been in China so far.

Of course if you don't test, there's no case. I came back from Japan 3 weeks ago, when I saw the news of the community transmission there (happened 4 weeks ago) I figured I'd get tested because of flu symptoms.

The doctor didn't have advice besides to ask the emergency room, who weren't going to send anything in unless I had a high fever and a recent trip to Hubei.

I'd hoped 3 more weeks was enough time for the US to get prepared, but it seems not. Am I carrier? Who knows.

But US had rejected China travelers' entry and it had been almost 3 weeks now.

The chance that people here in get the virus from travelers from Italy/Japan/South Korea/Middle East is MUCH higher than that from China at this very moment.

US citizens are still allowed to travel to and from China, and there are multiple flights every day.

Yes, and they are supposed to self-quarantine on return for 14 days.

No such rule is present with S. Korea or Italy.

A random traveler from S. Korea/Italy is far "riskier" at this point.

(Bonus: It's actually really hard to fly directly from China to the US at this point. Your best bets (esp. in the north) are transit through S. Korea or Japan, both infected places)

New cases outside China now out number new cases in China. So the balance is shifting.

South Korea has tested 66k 2 days ago. China has no such capacity to test even that much, let along 800 million in quanrantine, and people have been welded in their own homes with no escape. The dead bodies have been going straight to the furnace in Wuhan. Which government’s number would you rather trust?

Their Fire Eye lab claims to process 10k tests per day. Wuhan in total can process 25k per day [1]

Plus China recent donated 12,500 test kits to Japan [2]

Of course, you seems to dismiss anything from China's official account, then you can choose to believe whatever depends on you political stance.

[1] https://m.chinanews.com/wap/detail/zw/kong/2020/02-26/910563...

[2] https://www.youtube.com/watch?v=E18_1mwDTrM

Countries that are heavily affected right now primarily have open borders with China (still!!?) - japan, South Korea, Italy, Iran, with tons of Chinese workers going back and forth

US had banned travelers with recent Chinese history from entering the countries effectively from Feb 2nd.

I would be much more alert right now as regards to people from Europe/Middle East. Iran is a pretty powerful source of infections to the whole region and so far is just keep escalating.

BTW: in Iran's case, they banned entry from China early on, but one of the merchants gets to China via 3rd country and bring the virus back home.

At this point, I suspect that the East Coast, like New York or Boston, is going to get hit next. And the infected vectors are going to come in from Europe.

Once Manhattan reports its first confirmed case, then it’s over. This thing will go full blown.

What does it matter anymore who can and can't enter really ? It's everywhere, it's spread the globe, it's now in American communities and it's here to stay. It's no longer just a foreign issue now.

It's time to assume the brace position, prepare for the worst and hope for the best.

Because GP's username is "taiwan boy" and if you look at his comment history it would be obvious why it matters for him.

Italy has blocked flights to and from China pretty early. It seems that this prevented tracing and monitoring people coming from China, because they just flew in through a different country.

" It's getting real now. Wash you hands, and avoid touching your face. Plan to spend less time in close proximity to others."

It is airborne. This virus attacks the lungs (please google). Why on earth are people saying wash your hands. It transfers through: "respiratory droplets produced when an infected person coughs or sneezes." Wash your hands sure, but this isn't going to save you --- watch what you BREATH.

The virus isn't truly airborne. The respiratory droplets can be carried in the air short distances, but direct infection from that is extremely unlikely outside of someone literally sneezing in your face.

This is in contrast to diseases like anthrax, where particles can be carried on air currents basically indefinitely and direct infection from the airborne disease is likely.

Did you make this up? Can you site a source?

I'm too lazy to cite sources but I'll say I've read plenty that confirm that it is not 'airborne'.

Nonetheless, I understand that it's aerosolised and this does carry further than just a sneeze to the face. So, worse than crooked-v says, but better than airborne.

Happy to be corrected though.

Droplets contaminated public surfaces like door handles, elevator buttons, etc, and one person normally touches his/her face hundreds of times per day.

Because there are other vectors of contact besides breathing. Since we can't stop breathing, we can at least minimize infection through other vectors, even if they represent less likely avenues of infection.

Not sure why you are getting downvoted. There are many unknowns with this and if you see what is happening in China to disinfect, they clearly believe it is airborne.

I am suspicious that a lot of people in the Bay Area have mild cases of COVID-19. I also see no reason to believe that the total number of cases isn’t a couple of orders of magnitude higher than reported, making the overall fatality rate quite low.

Ideally, enough serological tests could be produced that a public health authority could randomly sample a population and get an actual unbiased estimate of the infection rate.

I share your concern. Perhaps it is because of heightened awareness, but I don't recall any previous winter where so many people were sneezing and coughing at the office as there were this past week. No hacking rib crackers, just lots of muffled throat clearing. Are we the slowly boiling frogs?

I have flu right now and so does the rest of my family (got tested). We all had flu shots but I guess they aren't very effective this year. The illness has been very mild but that's likely because of the shot.

Our doctor said she's seen a ton of flu lately.

Where have you read about a lot of mild cases? Genuinely curious, information about this whole thing is super sparse and evolving too fast...

Last I heard the number of 'mild' cases was very low, and low enough to not make it a talking point as far as diminishing the seriousness of the situation.

Over 80% of covid-19 cases have been mild or asymptomatic. Stop spreading fear.

Ok, Comical Ali!

I’m not sure why you feel like this is an intelligent response, but it shows others that you aren’t worth taking seriously, so keep it up.

Ok, Comical Ali!!

EDIT: There's a point where engaging with nutjobs is mostly about the fun of it and warning others, whether it's the doomsday corona types or bizarre extreme deniers. You're part of the very rare latter group.

You have a point. I don’t know why I’m bothering to engage with obvious nutjobs.

Oh snap!

> I also see no reason to believe that the total number of cases isn’t a couple of orders of magnitude higher than reported, making the overall fatality rate quite low.

4 people died (so far) from the cruise ship, out of <700 infected (including asymptomatic), so statistically the case fatality rate can only be so low.

As I recall, the passengers in question were all tested, but a lot of those tests were administered long before the last time those passengers could have been exposed. I see no a priori reason to believe that the number of cases is accurate.

I've suspected the same in SoCal. DW and I have been feeling kind of bleh over the past few days, and as of today both of our families haven't been feeling great either. It could be something else too, but I wouldn't be surprised either way.

So you've been feeling bleh and a few others you know - and the conclusion is COVID-19? Not allergies? https://www.pollen.com/

It's more likely some other random virus, but it could be COVID-19. It's unlikely to be allergies in my experience. See my above response for more info.

Allergy season? It's hitting me as of mid-week. In the bay area here.

It could be allergies. Whatever it is, it's fairly regular. I have a once a day spike in symptoms, only at night so far, where I feel like I'm about the catch the flu (runny nose, scratchy throat, a bit of coughing, and generally feeling poor), but the symptoms fade after an hour or two. Besides that I just feel tired, and at the start of whatever this is I had a day of loose BMs. DW and I's family also started feeling crummy a few days after we did, which could admittedly just be a coincidence.

On the flip side, it's also fairly common to think the flu is just a cold virus or allergies because most people don't display much in the way of symptoms.

https://www.npr.org/sections/health-shots/2014/03/17/2908789...

Odds are this is just some random virus (>90% chance), but I wouldn't be surprised if it was COVID-19 either (<10% chance).

Edit - I also have a cousin living in LA that developed pneumonia, which again could just be coincidental.

Everything is in bloom right now in Santa Clara County, which is certainly going to make allergies flare up. Anecdotally, there does seem to be something going around. It’s smart for people to take care of themselves regardless by getting rest, etc. Even if you’re down and out from allergies, caution is warranted and working from home if you’re able to is a good idea.

Allergies got me rubbing my eyes all the time. I'm screwed

FWIW, try not to act on that assumption being correct. Because if you’re wrong, you now have two illnesses simultaneously...

Not in the news yet but there is an admission at kaiser San Jose of a potential covid-19 patient. Have all the symptoms, traveled and tested negative for flu!!

People could also have the flu and coved-19 at the same time.

How have the mods left this sitting here for 3 hours? Rumors like this cause panics and get people killed. So fucking irresponsible.

What is the rumor? There are many people working in hospitals that know a thing or two but aren't in a position to share it outside the workplace. I'd rather the facts be allowed out rather than covered up... it's more responsible and will keep people from getting killed.

Did they contract it in CA or while traveling?

It seems to already be spreading in Bay Area with 2nd case of unknown origins..

Source on this?

I work there!

Thank you!!

Is the virus transmissible via tcp/ip? Let me check my Norton updates...

Good luck and stay safe.

My wife is an ER nurse. (West Coast but not California) Kind of wondering if I’m going to have to isolate myself from her just in case. She’s almost surely going to be coming into contact with patients soon.

Starting to get real for sure.

Probably not worth it, unless you're in a group most likely to die of the effects.

If anything, I wonder if one would prefer to get exposed earlier rather than later.

Of course, my wife works in a hospital in Santa Clara.

Even young and middle-age people have a 0.2% mortality rate, which at the US statistical value of life (~$10M) works out to $20,000. (And if you're a well-paid software developer, you can probable 5x that.) Whatever you would do to avoid losing $20k-$100k, you should probably do to avoid getting Covid-19 (modulo questions about how long immunity lasts).

One thing to note is that even though there are age range breakdowns from this initial analysis (https://www.ncbi.nlm.nih.gov/pubmed/32064853), there is also a breakdown based on pre-existing conditions, with Cardiovascular, Diabetes, Chronic respiratory disease, Hypertension, and Cancer being 5-10X hazard ratios vs those with no pre-existing conditions.

Sadly, the paper is in Chinese, but you would probably want to look at the percentage of non-mild cases in your age bracket and adjusted for your pre-existing condition risk to see how your actual risk might be modeled: http://rs.yiigle.com/yufabiao/1181998.htm

But I think we'll just have to see how the medical response is in each specific locality to really get a good idea of what the real risk is.

I don't necessarily think that a dollar amount is actually the best way to think about it. It's very hard to think about what value you'd place on avoiding a hypothetical 1/500 risk of death (adjust based on percentage of population you think will contract this). Note that as a 40yo, your odds of dying period within that year is actually about 1/500: https://www.finder.com/life-insurance/odds-of-dying

You can then split this up by percentages for cause of death: https://www.advisory.com/daily-briefing/2019/01/16/deaths (Chart 2, select your age category)

UK chart, but also some charts on annual death risk: http://www.bandolier.org.uk/booth/Risk/dyingage.html

And lastly, the almost useless CDC data/charts - they include leading causes and absolute number by cause and age-group, but not the population size so you have no idea what your odds are: https://www.cdc.gov/injury/wisqars/LeadingCauses.html

In any case, once you have the odds down, you can place the amount of effort you'd spend relative to the amount of effort you spend on other risks.

> I don't necessarily think that a dollar amount is actually the best way to think about it. It's very hard to think about what value you'd place on avoiding a hypothetical 1/500 risk of death

It's not that hard if you try. We face risk-benefit tradeoffs everyday. You either (1) have an implicit price you put on small risks to your own life in the sense that you accept risks below that price and reject ones above it, or (2) you are acting inconsistently, in the sense that you could strictly reduce risks to your life while making more money (or saving more time, etc.).

> Note that as a 40yo, your odds of dying period within that year is actually about 1/500:

Sure. And I think that if people could purchase immortality for their 40th year for $20k, they should probably do it.

> In any case, once you have the odds down, you can place the amount of effort you'd spend relative to the amount of effort you spend on other risks.

Sure, now just find out how much you pay routinely to avoid this effort (e.g., how much you pay your accountant to do your taxes), and you've got a risk-dollar exchange rate.

As you mention effort/value can be converted to dollar value, so I don't think we actually disagree that strongly - the missing word from my critique would be "fixed" dollar amount - using the hypothetical $10M lifetime worth.

There's more to it, but the point I was trying to make is that the amount of time/effort/money you spend worrying about coronavirus should (rationally) be relative to what you spend for other similar risks.

For your last example, I think that what you pay to save time or effort saving services might be on a different calculus since there's a guarantee of how much time or bother it might save you, vs a potential downside calculation.

> the missing word from my critique would be "fixed" dollar amount

Sorry, are you just saying different people may have different amounts? Sure, sure. But for a given individual the amount has to be fixed across the choices (at least all the choices close enough in time that the money is fungible).

> since there's a guarantee of how much time or bother it might save you, vs a potential downside calculation.

When I decide to wear a mask to the store, there is a guarantee of how much bother it costs me. The only thing that's uncertain is the risk to my life. But, as previously argued, each person should have a linear risk-dollar exchange rate for small risks.

That data looks it's from this Chinese CDC article in English: http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...

Lot's of useful data: Age is very significant: 0-9: 0%, ..., 60-69: 3.6%, 70-79: 8.0%, 80+: 14.8% i.e. the kids will be fine, but watch out for the elderly. Men are more affected (2.8%) than women (1.7%). The regional breakdown is apparently a useful approximation of mortality rates when the healthcare system is overwhelmed (Hubei 2.9%) vs not (outside 0.4%). "Health workers" (all employees in a hospital setting) is 0.3% which amongst all the occupational buckets is the lowest. 81% of cases is mild symptoms.

I can't believe you just changed the value of your life to a money amount you would theoretically lose.

You don’t know about actuary tables?

So the mortality rate is 0.2 %. You're missing the likelihood of contracting covid in your calculation. If you calculate with that the risk is even lower.

It could mutate still.

Even if you're in the demographic not likely to die, you will be in contact with people who are likely to die from the virus and you can infect them.

And also if he gets sick, it will make things more difficult for his wife (who will probably recover earlier). That hurts the health care system.

Drawing things out so that you're not sick at the same time if possible seems like a win for both of you, and for the health care system in general. The slower it goes, the less health care providers get slammed with too many people to cope with.

>"Exposed earlier rather than later"

I don't think we know yet how easily a previously exposed person can get reinfected. We do know that people can catch a cold multiple times in a short period, and those are varieties of coronavirus. Mutation rate will also play a factor.

There are at least 100 active viruses with similar symptoms labeled as the common cold. My understanding is that healthy people tend to have a high degree of immunity to a particular strain they have come in contact with, for at least a few years. If someone gets "the cold" multiple times in a year, they are almost certainly getting different strains.

This is a coronavirus like them though, so likely to mutate. Also the flu has fewer dominant strains, and reinfection still common, especially for people already at higher risk or compromised immune systems. But yes, Chances of reinfection should be lower than initial infection, but are non-zero, and while your body keeps you symptom-free while fighting off the reinfection your still, short term, a carrier.

It 100% is better to get it early or not at all.

One of the biggest risks is running out of ICU beds, ventilators, ECMO machines due to the 10-15% hospitalization rate.

If it goes wide enough then there will not be treatment available and the mortality rate will skyrocket.

Yeah I think the issue is that you can be contagious without being symptomatic. I don’t want it on my conscience that I may end up infecting others, even though I personally will probably be fine.

Edit: spelling

Sure if you don't mind lung scaring.

Later, because they're more likely to have some sort of treatment, there's a large number of studies going on now.

Here's an article from the WSJ about how using serum from recovered measles patients prevented an outbreak decades before the vaccine was developed.

https://www.wsj.com/articles/how-a-boys-blood-stopped-an-out...

> Kind of wondering if I’m going to have to isolate myself from her just in case.

Maybe you should question your marriage.

Serious question: don’t we pass a threshold where it’s not practical to cancel travel or events because of covid-19? It’s just going to spread anyway?

For example, once, say, Olympics roll around, is there really any value in canceling them if it’s going to be everywhere anyway?

Is containment even possible and, if not, is the disruption to the economy worth it?

It’s about smoothing the curve so the healthcare system can absorb the influx of patients. If the healthcare system is overwhelmed then it’s a problem.

Here’s a link to a great article.

https://blogs.scientificamerican.com/observations/preparing-...

This is exactly what's happening in Italy. The majority of people are asymptomatic or only have mild symptoms, but smaller hospitals are nearing full capacity and thus are redirecting patients to other hospitals. ICU beds cannot all be reserved to covid patients, there are regular patients as well. All the restrictive measures put in place should help contain the spread and avoid overwhelming the healthcare system.

You would still want to slow the spread as much as possible to ease the load on hospitals and make sure you can take care of as many of the serious cases as you can.

It at least can slow the spread, cushioning the impact on hospital resources.

Also, the virus is more likely to mutate the more hosts it infects.

> Is containment even possible and, if not, is the disruption to the economy worth it?

Economy over lives probably isn’t going to fly..

Yeah but this is the United States where we've rolled up and stowed away all the social safety nets should one lose their job which is going to start happening soon if this economic disruption continues. In short, bad economy equates to lost lives. So it really isn't a question of economy over lives.

Right but it’s not a blatant disregard.

I’m sick in Santa Clara County as is my household. Do I just wait it out for a few weeks? Sister called in sick but is being pressured to work

The ethical thing to do would be to self-quarantine.

Feel better soon

if this gets bad enough in the 'western' world maybe the Chinese could spin the narrative into "look how well we were able to control it in the place it started"

time will tell...

I think China has indeed handled it really well and I doubt if many other countries would have been so effective. On Dec 31, the first case reported and the virus didn't even have a name. The first death didn't even occur until Jan 10. By Jan 22, the death toll was still under 20 and China was able to seal off city 3 times larger than LA the next day. They did create two 1000 bed hospital is literally a weekend from scratch. At this point, virus DNA was already analyzed and possible medicine already underway testing. BioArxiv had over 30 papers posted by this date mostly from Chinese scientists.

In most other countries, I think such speedy research funding, rapid construction and drastic measures would have been challenged in courts or would have been far slower passing through the long chains of approvals or simply delayed due to critics from political oppositions.

I mean, the big knock against China would be the initial secrecy which prevented earlier discovery of the virus.

Of course, the US especially can’t complain about that now that they are actively suppressing news about the virus even after we know it’s a real virus and that it’s here.

It has already happened. My parents live in China and my mom was raving about how quickly they built that hospital in Wuhan and what a great leader they have. I told her Stanford is a really great hospital. shrug

COVID19 overloads medical systems. It doesn’t matter how great Stanford hospital is when it is out of capacity.

Opinions on how well they’re handling things aside, I must say, I was pretty impressed with how quickly they built that hospital. We could never do that in the US.

Not surprising considering how much practice China has building out their country's infrastructure over the past few decades. The US back in the 1900s was also handling some of the largest and most advanced civil engineering projects of the time. But after all the obvious improvements are done and demand for infrastructure dried up the US forgot how to do civil engineering like that after a few decades. In 50 years we'll probably be admiring the civil engineering in Nigeria while complaining about the outdated infrastructure in China. Countries at different stages of development are good at different things.

Critical infrastructure to slow a deadly pandemic?? Not in MY backyard!

https://www.ocregister.com/2020/02/22/why-here-costa-mesa-oc...

It's not a hospital

Is there any accuracy to my belief that China caused this by arresting the doctors who were talking about this instead of investigating it? If so, are people in China aware of this? Do they see it as an issue?

Yes we do. But given how other countries are reacting to COVID19 after so many deaths “it is just the flu”, I imagine this thing would have played out the same if the doctor were not arrested.

Actually yes, the incident has had an unprecedented impact on the Internet. People have sharply criticized the actions of the Wuhan government and supported the doctor, and the central government has demanded an explanation from them. Finally, the Wuhan government also apologized. The whole incident is a lesson for China. If you want to know if people are aware of this or still be insensitive. I haven't done scientific statistics, but my 80 yr grandma told me that this doctor is a great man, we need to speak for him, and the government should apologize for it.

I am hearing wildly varying opinions on the severity of the covid-19 situation.

It seems like the general conversation here on HN has been much more doom and gloom than some other places.

Anyone have opinions on why that is?

Possibly the higher than normal concentration of members here on the West Coast?

Maybe the general tendency of people with stronger opinions on a topic to comment on threads about that topic?

Obviously there's a chance the concerns raised here are of the proper severity and everyone else is just under-reacting, but it also seems entirely possible that this is already way more widely spread than people realize and the percentages are just skewed because most people wouldn't bother going to the doctor for a cold.

I guess we'll find out one way or another...

Doom and gloom as compared to what? I would say it's Doom and gloom before I'd call it a "hoax". If anything, I see a lot of people on here making flu-like comparisons. I'd say I'm more doomish than that, too.

Because so many people are trying to conceal information to keep tourism going, stability, re-election, GDP and so on, we really don't know how bad it is.

But when's the last time a flu caused a 13% sell-off? It seems pretty serious.

After reading The Fifth Risk by Michael Lewis, I'm really starting to be convinced our collective willful ignorance is becoming problematic.

I suppose it all depends what you're tuned in and listening for.

Seems like the majority of comments I've read are basically of the "go into quarantine lock down" variety.

The current sell-off is because people are scared of the uncertainty. It could turn into something more and get even worse, but we have to wait and see for that.

I don't know that it's so much "willful ignorance" as it is the perpetual feeling that we're "at the end of history." I.e. the opinion that bad things happened in the past and bad things can't happen now because we're beyond it.

Something catastrophic is absolutely going to happen world-wide eventually, but at this point I can't say one way or another whether this is it.

Right now we're at a point of probably peak uncertainty. We know enough to be nervous, but it isn't real until it's real.

If you compare what we know about it now to the flu, it’s 20x more lethal than the flu at current estimates with many of those who get it severe enough to go to the hospital requiring intensive care to recover. It’s legit.

Source on the 20x number?

Heard specifically the .1% flu and 2% for COVID19 was from Dr. Adam Bernheim from Mount Sinai hospital in NYC who was interviewed as part of a Bloomberg investing podcast called “Bloomberg Surveillance”. He’s citing roughly what I’ve seen in journals regarding the study of COVID (note I’m not in the medical field but semi-competent and enough to find articles in medical journals, read them and understand what they’re saying) but I haven’t been able to find a number for typical season flu strains being “about .1%” is what he specifically says and “about 2%” for COVID19. He compared various aspects of it to the typical seasonal flus at 11 minutes into the show, specifically 11minutes 40seconds for mortality comparison.

Bloomberg Surveillance podcast is free and also availability through other platforms but here it is through Apple podcasts:

https://podcasts.apple.com/us/podcast/bloomberg-surveillance...

Anecdotally the crowd on here tends towards the anxious, with a fringe minority dipping into outright paranoia. So I calibrate for that whenever I'm reading people's takes on something.

> the general conversation here on HN has been much more doom and gloom than some other places

many people have pointed out that covid-19 threads gets burried alot quicker here on HN

It's good the company where I work, which employs about 70 people, allows us all to remote. We have a large space that we rent in a WeWork office in San Francisco but we can also work from home if we want. We have remote employees in other states and over the last year have built a very strong remote culture. All of our meetings have people who are remote, in fact often more people are remote than not these days. I imagine our company's work from home policy will help avoid downtime and really make a difference compared to companies that are just going to have to shut down when faced with the reality of this horrible virus.

TLDR;

> The infected patient is an older adult woman with chronic health conditions who was hospitalized for a respiratory illness, county officials said.

> This would be the 63rd confirmed case in the U.S. Of those, 44 were people who had been aboard the Diamond Princess cruise ship and repatriated to the U.S., three were repatriated from Wuhan, 12 were people who had recently traveled in China and two caught it from a close family member. This week's two cases in Solano and Santa Clara counties involved people with no known exposure risk.

> [the] patient [...] is now at El Camino Hospital

Mt View

It wasn't clear from the article. I wasn't sure if it was Los Gatos or MtnV.

It'll definitely be Mountain View, they're set up with a proper ICU and isolation.

test kit can be in hundreds, not a lot can afford it. The governor should do something about reducing the cost for cost-effective testing.

My husband is a career public health clinician who organizes vaccination clinics (has given out hundreds of thousands of vaccines for infectious disease, many for free via grants). At the state level here in US, he has mounted responses to H1N1, ebola, measles and now this coronavirus. The conventional wisdom around this outbreak, right from the beginning, has been that almost everyone on the planet will be exposed. It's no surprise this is hopping around stateside.

The virus has a two week incubation period, during which the host is not infectious, but also has no symptoms, making tracking vectors difficult. In addition, after incubation there are a couple of days where the host is highly infectious, and still has no symptoms. The term for this period is "prodrome" (pre syndrome). Under certain circumstances, it's also airborne, which is can be a problem for providers. It's spreading fast because of these characteristics.

Similar to flu, it is expected that this virus will find enough hosts to essentially never stop circulating. Expect to see it again next year, and the year after, etc, in perpetuity.

Get your flu shots! You might prevent someone from getting very sick or dying, even if you don't see symptoms yourself.

“Of course, it's also airborne“

This is new to me — I was under the impression that it could spread by droplets, but hadn’t heard anything definitive about being airborne?

Apparently, there are some conditions where it can go airborne, but most transmissions are by droplet. I'll amend my comment. Healthcare providers will been using airborne protocols, which was where i got the idea.

Are you making a typo? The disease is definitely contagious in gestation period, which is why it is so hard to contain the spread.

I did make a typo, I should have used "incubation," not "gestation."

It is not infectious during incubation, by definition. Then there is a "prodrome" period of a few days during which you would be infectious.

> two gestation

Missing a word there. Now I'm in suspense.

Thanks! Fixed it

Presumably we would have a vaccine and something like tamiflu for treatment in a few months. Otherwise we're f'd.

The over_reaction to this is utterly ridiculous in Europe.

How so? Have you seen Italy’s numbers?

Why is everything happening in Bay Area? Do local official ignore CDC protocols to spite Trump?

Is the main goal just to delay the widespread infection until we have a vaccine produced?

It seems like this was always an impossible goal. So does it even matter when this goes pandemic? Sure, more preparation would get us more masks or something, but anything that would really help?

Think about capacity and throughput of hospitals. If everyone gets it all at once, they'll be overwhelmed and many people will die, since severe cases often need respirators, drugs, and close monitoring.

The goal is to smooth out the cases over a longer period so we're less capacity limited. That means everyone taking extreme precaution with hygiene.

Has this ever been done for any pandemic virus?

We have a "flu season" where hospitals are flooded every year. From what I read, there's not even a strong immunity after being infected with this virus, so won't people just get re-infected?

It doesn't seem like there's any version of this where things are not terrible for a while. I hope I'm wrong though.

Yes, we can lower the R0 infection rate and smooth it out over a longer period of time by adopting better hygiene practices and making behavior changes. You're seeing that right now as different countries mobilize and react differently.

If your re-infected comment is regarding the reports of people getting it a second time, I believe that's been debunked and is an artifact of imperfect tests rather than the virus itself.

What I've read from multiple sources is that SARS family coronaviruses are pretty stable evolutionarily, so once you have immunity you should be able to fight it off in the future. This is in contrast to influenza which evolves quickly, which is why 'the big one' in pandemics is much more likely to be influenza (or a bacteria) rather than coronaviruses. See also: Spanish Flu, Black Death

Thanks for the thoughtful reply! I was basing the immunity question on comments from doctors like the below quote. It sounds like one won't easily be re-infected with the same strain? But if it mutates later, or your antibodies diminish, then you could get re-infected? That doesn't sound as bad as being stuck in an infinite loop of re-infection.

If you survive, are you immune?

People who are infected and then recover will likely show some immunity to the virus.

But it’s not lifelong. It wanes over time. If it’s seasonal, it may ebb and flow.

https://www.mercurynews.com/2020/02/11/coronavirus-the-8-big...

It seems that way but I’m not sure honestly, this is past the limits of my knowledge. Probably good to keep an eye on the subject though since it may affect our behavioral choices.

My biggest fear is this virus hitting an antivax community. It’s really hard to stop a virus like this in the US because travel rate is higher while we still have high density areas. It’s very difficult to contain without resorting to Martial law type of traffic ban which is not feasible in the US.

What are your specific fears about it hitting an antivax community? It’s not like they have any ad- or disadvantage compared to the rest of the population wrt. Immunity at the current time

Even if they have no direct medical vulnerabilities, anti-vaxxers are prone to rejecting or subverting public health recommendations, eg voluntarily bringing their kids to measles parties to 'get it over with'. As recently as 2 days ago Rush Limbaugh (a conservative talk radio host) was saying that Covid-19 is essentially just the common cold and the health scare was misplaced.

There are a lot of other groups this applies to. For example, the current Korean outbreak was started by a religious member who refused to be quarantined. The US’s response is being lead by someone that doesn’t believe in science. If you want to get worried about something, there are a lot of other places to start

Are you concerned that, once there is a vaccine, antivax communities will continue being hit and/or spreading COVID-19? Or is the concern that non-vaccinated individuals will end up in hospital and get something else on top of COVID-19, and that something else was avoidable via vaccination?

Why? There doesn't exist a vaccine for the coronavirus yet.

There’s not going to be one for several months.

It could very well be like the flu and require vaccines for new strains every year. It has a similar single strand rna structure prone to mutations.

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