My Covid-19 Story in Brooklyn | Hacker News Reader

My Covid-19 Story in Brooklyn

reddit.com

337 pointsmunirusman202 comments

> This is a tough one. I'm an attending physician.

> Guidelines are there for a reason. As much as I despise our Commander in Chief, I don't think the CDC is compromised. Fear doesn't rank over guidelines, but I understand the situation. No one wants to be the doctor that discharges patient zero.

> Personally, I'd admit you for fever of unknown origin for the time being and monitor you for any signs of sepsis. If everything looks good from an observation stand point, I'd discharge you with strict droplet precautions until the fever subsides.

> I think your doctor did the right thing given the context.

Given the above comment, most replies here are arguing against CDC regulation saying it is too stringent. Its very helpful to understand comments in this lens, rather than that the CDC is just under-testing for unknown reasons.

I keep hearing rumblings about test kits not being where they need to be, but nothing in the news. It would be so hard to make a clinical diagnosis of COVID-19 when the chief complaints are "Fever, cough, shortness of breath". Is that the common cold or is this SARS-CoV-2? Giving a massive diagnosis like and being wrong is bad.

Apparently some kits were recalled because they were flawed and there is a shortage as a result. So it is somewhat understandable that the CDC doesn't want to test just anyone with flu like symptoms.

During flu season.

That line is always left out of this: the CDC doesn’t want to test just anyone with cold and flu symptoms ... during flu season.

The false positives are basically guaranteed to absolutely swamp the true positives at this time, and demolish any attempt to target the sick.

They are supposed to only test people with flu like symptoms that test negative for flu. Which this person did.

Still, the test specificity (or more generally, its predictive power) is likely to be quite low simply due to the sheer number of flu cases.

Otoh, this doesn’t really explain why there would be regulations against developing in-lab tests (as another of the sibling comments mentions).

Shit-tons of people with the flu test negative for flu. It’s not a very sensitive test.

the CDC doesn’t want to test just anyone with cold and flu symptoms ... during flu season.

This wasn't just "anyone" though. But someone who tested negative for the usual suspects -- and just came back from a high-risk country.

The guidelines for testing were so absurdly stringent because there was almost no testing capacity in the US, despite their being hundreds of labs with RTPCR equipment, because the CDC screwed up their test kits and the FDA used emergency powers to prohibit labs from developing their own tests, and forbids the creation of commercial test kits and the importation of foreign ones. Three weeks after CDC (after an already unconscionable delay) shipped the non working tests, they have "fixed" this situation by permitting labs to use the 2 of the 3 primers in the original test that mostly work. So as of yesterday we are starting to have the ability to actually test, and the criteria are being loosened.

Details from sciencemag.org (A magazine from the American academy for the advancement of science):

https://www.sciencemag.org/news/2020/02/united-states-badly-...

>Well-equipped state or local labs can use these—or come up with their own—to produce what are known as a “laboratory-developed tests” for in-house use. But at the moment, they’re not allowed to do that without FDA approval.

Wow this is frankly insane. Pretty much every biology laboratory in the USA should have the tools available to perform these tests. More than that, RT-PCR is a routine assay that any self-respecting wetlab biologist can do. If they are struggling to produce these kits they should be letting people order their own primers. Even if less reliable, at least then they would be able to test patients properly.

Yeah, I don't understand why it's literally illegal to take a swab and run a PCR against the known, published viral sequence. Forget "any self-respecting wetlab biologist," I'm pretty sure an undergrad with a year's worth of lab experience could run the test, at least under supervision.

Edit: I suppose you do need a "self respecting wetlab biologist" to synthesize the primers, but running the test itself is pretty simple.

Running the test is simple but getting good primers nowadays is easy because they can be bought and arrive 24 hours later. If the sequence is published, then even the lab manager can get them.

Yes, labs don't synthesize their own primers. They buy them from suppliers. The kind of primers you would use for SARs-Cov2 would be about $10-$20AUD (similar for USD) a vial and be sufficient for several hundred reactions (maybe a hundred or so tests with triplicate replicates, pos and negative controls). The thermocycler and the technician doing the pipetting are the expensive bits, not the primers!

>> forbids the creation of commercial test kits and the importation of foreign ones

I was wondering about this... Very hard to justify that in my opinion.

Seems pretty mucked up.

With these kinds of things it's always better to error in the direction of caution. Controlling which way you fail is extremely important. You have to know your modes of failure

Hmm, this is bad. A ton of people from NYC / Brooklyn also commute back to the east end of Long Island for weekends so this has a potential to spread pretty quickly.

I don't keep up with the news at all but recently I started reading some articles from major news outlets just for more info about this virus. It's mind boggling at how different each channel's reporting is (I'm in the US).

I was at the store this morning and they had a TV playing. One channel down played it like it's nothing and it's even "technically" less potent than the regular flu because they compared yearly flu deaths to covid-19's deaths and played it off like "we're no where near the number of deaths that the flu has killed this year!" and then all of the surrounding anchors all agreed with the spokesperson they had on, etc.

Others make it out to be 1 notch away from an apocalyptic event.

So I guess this is really what "fake news" is? I don't get it. You can get a life time of prison for ordering someone to kill someone else but somehow it's ok to potentially gamble with the entire human population by not giving accurate information about a virus that's killing people.

You seem to have made up your mind about which news channel was correctly reporting. Why do you think your opinion and that of many others conflicts with the WHO and CDC?

To me it feels like the experts (WHO/CDC) are 'downplaying' while nonexperts (internet commenters who read a few articles) are doing the opposite.

I haven't made up my mind because most media outlets have conflicting information. That was why I posted the comment.

I mean, it doesn't help when you hear stories like the one posted on Reddit too. Of course it makes you think things like "why wouldn't they test him? Is it because they want to keep the registered cases down or is it because there's not enough tests to go around or maybe it's because the tests aren't accurate?".

These are questions I have as someone who isn't working at the CDC and I'm sure other regular citizens are thinking the same. I thought the media's responsibility was to take information from experts and present that information without bias to people who are not experts in the matter.

>I thought the media's responsibility was to take information from experts and present that information without bias to people who are not experts in the matter.

The media's job is to take attention from people who are not experts in the matter and present it to advertisers.

Media which doesn’t have advertisers to care about, what’s their job?

If not advertisers, there's someone else giving them money. Everyone's job, media or not, is to appease the person who can decide they receive more or no more money.

I just saw a virologist give out the flu argument in addition to presenting the naive mortality rate and making an intentional arithmetic mistake (100-3.5=97, perhaps 96.5 does not feel such a big number anymore).

I would recommend to study this site https://www.worldometers.info/coronavirus/ if you want to be more informed.

Rounding up .5 is considered proper form.

I agree. If you only have two significant digits to work with, pretending to have more precision is a different kind of dishonesty.

100 - (3.5 +/- epsilon) is 96.5 +/- epsilon.

The Swiss government issued the following guidelines [1] to prevent further spread of the virus. Masks are considered useless unless you are infected.

- Wash your hands thoroughly. https://www.youtube.com/watch?v=jvcvvRp3lsY

- Cough and sneeze into a paper tissue/handerchief or the crook of your arm. https://www.youtube.com/watch?v=M3_rFPtQgKE

- If you experience shortness of breath, have a cough or fever: • Stay at home. • Contact a doctor immediately by phone or call the coronavirus infoline. • Avoid contact with those around you. • Do not go directly to the doctor or to a hospital emergency room.

[1] https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-...

>Masks are considered useless unless you are infected

Considering there are multiple papers out of china which suggest the virus is aerosolized, I think it's irresponsible for anyone to claim masks are useless PPE. Anything less than n99 or p99 might be useless, but that's a different story.

There's also one paper which claims that treating a mask with saline solution makes it substantially more effective against viruses. I'll see if I can't dig it up.

Governments the world over have already demonstrated that they cannot be trusted to properly handle this virus.

Governments have other concerns besides your individual health. They need to prevent panic as much as possible, prevent economic collapse, etc. The response to events like this can be worse than the initial problem.

What do you think happens if the CDC says everyone needs to wear masks, you go to your local store, and there are no masks? There would be violence in the streets.

Then why don't they have millions of masks stockpiled for an event like this?

They do. But they aren’t stockpiled for you: they are stockpiled for medical professionals.

And the 30 million the US has stockpiled is short by a factor of ten: https://time.com/5785223/medical-masks-coronavirus-covid-19/

In any case we need more than masks for this. Medical equipment like mechanical ventilators, intubators, and external oxygenation machines. Those will run out very quickly.

>They need to prevent panic as much as possible, prevent economic collapse, etc. The response to events like this can be worse than the initial problem.

If this event is half as bad as all the literature out of China is suggesting, panic is the least of our worries. What a responsible government should do is initiate some sort of recommendation for gradual stockpiling of goods - perhaps a lottery just to encourage the majority of people to calmly stock up in turns.

In any case the CDC has already issued warning to prepare for "severe disruption to everyday life." Now it's up to the ignorant population to wake up and realize that this isn't just another flu.

There simply is not enough supplies for everyone to slowly stockpile goods. Supply chains are already being disrupted. In China beekeepers are not able to get their bees to crops. The bees are starving. This will negatively impact global honey and crop yields for years. In Italy panic buys are already leaving shelves empty. If the government tells everyone to slowly stock up what will really happen is panic buys and wide spread violence.

The alternative is a mass panic when the virus arrives.

Exactly. If you have to choose between guaranteed mass panic today and probable mass panic tomorrow, always choose tomorrow. This is what the professionals at places like the CDC understand.

>If this event is half as bad as all the literature out of China is suggesting, panic is the least of our worries

No. The risk of dying from this disease is negligible for most American adults. The real issue with the corona virus is economic disruption and overburdening of the healthcare system. All of which is significantly exarbarated by panic.

>The real issue with the corona virus is economic disruption and overburdening of the healthcare system. All of which is significantly exarbarated by panic

Which is literally the point of my post. The population ideally will have started gradual, orderly preparation sooner. At this point it's better to have a short panic early rather than end up in a situation where the government kept quiet but suddenly the virus is here and people are running out of food and there's a mass panic.

The longer the government waits, the worse the outcome will be.

Say what you want, but 2% is not negligible. That's 1 of every 50 people. With 330,000,000 population that's over 6.5mil people.

Yes, the mortality changes with age younger people are about 0.2% but older are close to 15%.

Having health issues such as cardiovascular or diabetes increases the risk further, and Americans aren't the healthiest people.

You are mixing up several different measurements.

First, parent was talking about the risk to an individual adult person; you yourself note that varies with other parameters including age. This isn't comparable to the 2% figure.

Second, the mortality figure is 2% of people who are infected, not of the total population. So it's substantially less than 6.5 million people, unless literally everyone in the country catches the bug.

Mortality rate in China is 3.8% nation wide, 5.8% in Wuhan.

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

No. The risk of dying from this disease is negligible for most American adults.

Can you tell us please:

(1) What your numeric definition of "negligible" is

(2) And on what math this is estimate based?

current risk for healthy adults appears to be 0.1-0.2% which is comparable to a bad flu season while the chance of getting infected is lower by several magnitudes given how relatively few numbers of cases there are even if you assume there's a lot of asymptomatic cases.

If we take China as a comparison, a country with urban agglomerations of 50 million people and more and the 80k cases as rough estimate then the chance that you're even going to be infected in the US is marginal.

So unless you panic literally every time you leave your house I don't see why this is appropriate to cause a panic.

So you are arguing that the CURRENT risk is way less, with no consideration given to the exponential spread of the disease as we have seen in China and now South Korea, Italy and Iran? The only thing keeping the exponential spread in check is everyone literally bunkering in place for weeks, but there is no logical reason the spread won't pick up again as soon as people are forced to go out and interact again.

The virus seems to persist for quite a while so you can't simply wait a couple of weeks (or even months) for this to blow over - best case is the seasonal change will slow it considerably, but that isn't a guarantee either. Historically, viruses with these characteristics weaken over time because they don't benefit from killing their host.

So hopefully 2 years from now this will be another annoying virus that comes and goes, that is the best case natural outcome. Maybe we have some breakthrough in vaccines or luck with off-label cures like the malaria drug in trial now, but those are longshots. So it is LIKELY that this is going to be a long and unhappy situation globally.

That's the thing - the commenter doesn't even bother to distinguish between current and future risk. Let alone the risk to someone living in a major, congested, filthy city v. in a shack on a mountaintop somewhere.

So there's not much we do with their prognosis.

Current risk for healthy adults appears to be 0.1-0.2% which is comparable to a bad flu season while the chance of getting infected is lower by several magnitudes given how relatively few numbers of cases there are even if you assume there's a lot of asymptomatic cases.

Not sure what to do here. This isn't even a coherent sentence. Nevermind the handwavey logic.

> Governments have other concerns besides your individual health.

Exactly. And that's why I'm gonna look out for myself.

Aerosolization of coronavirus seems to be mostly limited to hospital operations such as intubation?

Anyhow, here in Hong Kong the virus has been, kind of, contained. Mask wearing, along with hand washing and other measures, have been adopted by the majority population.

One of the problems with the Wuhan virus is that there are quite a few asymptomatic cases, and AFAIK at least one preprint study has confirmed that these hosts can transmit the virus to others, making mask wearing for "healthy" people an even more desirable measure in preventing the virus from spreading.

Masks are considered useless unless you are infected.

This is a bizarre claim that can be countered against the reality that every front-line worker is equipped with a mask.

EDIT: Almost immediately I dropped to -2. Bizarre. Again, every health agency the world over equips health workers who deal with potential COVID-19 with N95+ masks. For some reason people desperately want to clutch onto the notion that it's useless because otherwise..uncomfortable and uncool mask, right? Another poster mentioned that the source didn't even state that about masks, but instead about surgical masks which is a tiny subset.

-Masks prevent aerosolized matter (e.g. a sneeze) from getting at mucous membranes (where it needs to get to yield an infection).

-Masks prevent you from touching your hands to the vulnerable areas of your face. It is effectively a check. So when you touch that door handle leaving the subway station it's far less likely you'll transfer to your mouth or nose, and we naturally touch our face thousands of times a day. Ideally one would have a mental process they follow where you clean thoroughly before taking it off.

Those alone seem like an absolutely enormous win for masks.

https://time.com/5785223/medical-masks-coronavirus-covid-19/

https://www.livescience.com/respirators-prevent-coronavirus-...

I'm certainly not at the point where I'm going to wear a mask in public, but the whole "Hurrr masks don't work at all" seems like either disinformation (e.g. stop buying all the masks because we want them), or people trying to comfort themselves in some bizarre way. Every bit of evidence says otherwise.

The moderation through this is absolutely cartoonish and ignorant.

Those paper masks do little if anything to help the wearer from taking in anything. They do not filter the air—they are far too porous and loose-fitting to filter. They do help prevent the wearer from spreading their germs and touching nose/mouth as you said, but they are not an effective air filtration device.

As mentioned by others, surgical masks don't filter, but N95 masks absolutely do and are what health care workers are being equipped with.

N95 masks just look like cheap little paper things that you stick on your face.

No they don’t. N95 are solid looking and sometimes have a plastic square housing on the front [0] and surgical masks are paper and pleated [1]

[0] https://images.app.goo.gl/RZAgMSssThGJQrnf6

[1] https://images.app.goo.gl/fRW2dmSxUo1Lm1Dh8

Yes, yes they do. I can find a million pictures of N95 masks that look just like a cheap little paper mask (not like surgical masks -- not rectangular. Just cheap and like it's made of paper similar to a paper filter).

https://cdn10.bigcommerce.com/s-rxcy1k/products/11668/images...

Now you seem to be just arguing for arguments sake or you’re the kind of person who can’t ever admit to making a mistake or being wrong.

Your linked image in no way objectively looks “just like” cheap square pleated surgical masks. https://i.ebayimg.com/images/g/LyoAAOSwMTFeMbmh/s-l300.png

There is terminological confusion. Several things are colloquially called ‘masks’. Surgical masks do not significantly protect the wearer. Filtering facepiece respirators do.¹ ² The parent comment's links refer to N95, so they mean the latter, which are protective (assuming they're worn properly and genuine³).

In addition, the permanent rubber units provide protection when fitted with suitable filters; NIOSH calls these half masks (as distinct from full facepieces, colloquially ‘gas masks’). Where I am, these are still languishing on the shelves⁴, which means that the sort of people who are willing to spend five minutes looking up that P95 ≥ N95 are not yet panicking.

¹ https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInf...

² https://www.fda.gov/medical-devices/personal-protective-equi...

³ https://knowits.niosh.gov/

⁴ https://www.canadiantire.ca/en/pdp/3m-performance-reusable-p...

I personally believe that any sort of cover or mask is likely to have an effect even if not 100%. However..:

This is a bizarre claim that can be countered against the reality that every front-line worker is equipped with a mask.

This is not necessarily to protect the front-line workers. Since the incubation period is so long, it makes sense for front-line workers to wear masks to prevent them infecting other people even if it has zero effect in preventing them being infected in the first place.

Agreed. Even before Covid it was standard for healthcare workers to wear masks. They constantly work with patients with compromised immune systems and the like. They could be be asymptomatic and wouldn't risk passing it to someone weaker

One thing I'm wondering about is "useless in what sense?"

Will they prevent you from getting sick? Unlikely unless it is N95 or even N100 PPE

But I'm been wondering if they are not useless in terms of the speed at which the human body experiences a high viral load.

If only one virus particle gets through that should be enough to infect if it takes root and multiplies, but going from one virus to tons in your body takes times since they have to multiply.

Compare that with an infected person coughing right in your face. In this situation, potentially thousands of virus particles will infect you. In this situation, the viral load your body experiences will climb high quickly.

The faster the viral load climbs the less time your immune system has to be able to develop antibodies and learn to fight off the infection.

I imagine this is not too dissimilar from how vaccines work.

If this is the case, that might explain why Li Wenliang died at 34 years of age. Being at the center of it all, it's likely he was exposed to many more virus particles than the typical person. I imagine this would be enough to trigger a cytokine storm if the viral load got high fast enough.

Disclaimer, IANAE (i am not an epidemiologist), I'm just reasoning from first principles here.

Frankly it's your tone that sucks. People initially thought you were referring to the generic medical masks, which are useless unless you're already sick. Being clear in your initial comment would have helped with the confusion.

My first comment specifically indicated N95 masks.

Remarkably two people have criticized me for not being specific when replying to a blanket (and incorrect) post, when I was actually specific. Amazing.

Then again, the one guy claims that health-care workers only wear masks to protect patients, which is just cartoonishly incorrect (beyond in the abstract "protect patients by the healthcare workers not getting infected" way). To the point that is has to be malicious.

This whole discussion is beyond ignorant. It demonstrates, again, how painful any discussion outside of code is on HN. It's almost as bad as HN talking about AGW (where it turns out 80% of the residents here are deniers). Embarrassing.

It’s not cartoonishly incorrect, in fact it’s mostly correct. Healthcare workers wear masks mostly to protect their patients. They themselves may get some protection from splashing/spurting bodily or other fluids, but not from any airborne contaminants or infections.

> A. Masks were introduced into clinical practice at the beginning of the 20th century to protect patients from microorganisms being expelled from healthcare workers’ respiratory tracts during clinical procedures (Wilson, 2006).

https://www.nursingtimes.net/archive/when-should-staff-wear-...

Surgical masks. We all know that. Everyone knows that.

N95 masks are distinctly and absolutely worn to protect the wearer. N95 masks are recommended for front-line staff when dealing with viral outbreaks. H1N1, SARS, MERS, and now COVID-19 -- staff wear self-protection masks. During flu outbreaks front-line staff wear N95 for clinics.

This discussion -- what we are talking about -- is COVID-19. Every front-line staff dealing with this, worldwide, is equipped with an N95 mask, or there is a problem. Because when your front-line staff get sick things really break down.

Ok, yeah it sounds like there’s a terminology and context breakdown going on. Typical healthcare setting vs. current COVID-19 setting etc. When you said

> Then again, the one guy claims that health-care workers only wear masks to protect patients, which is just cartoonishly incorrect (beyond in the abstract "protect patients by the healthcare workers not getting infected" way). To the point that is has to be malicious.

it’s not clear which (COVID-19/typical healthcare) setting is being referred to (maybe same for comment you’re responding to as well).

Apologies for any confusion on my part.

Any post that fails to distinguish between N95 respirators and ASTM 3 surgical masks is too ignorant on this topic to make comments worthy of an upvote.

The Surgeon General, on the other hand, does understand the difference and made an appropriate comment.

"EDIT: Almost immediately I dropped to -2. Bizarre."

I downvoted you because you talked about your downvotes.

If you're keeping track of scoring, HN is perhaps not the right community for you.

Masks are considered useless unless you are infected.

That's not what the guidelines said. They guidelines were referring only to "hygienic masks" a.k.a. generic surgical masks:

The Federal Office of Public Health (FOPH) does not recommend that people who are well wear hygienic masks (surgical masks). If you are in good health, they do not protect you effectively against an infection with respiratory viruses (i.e. self protection). Wearing a mask therefore can give you a false sense of security.

This is a known point. But they did not mention -- nor did they advise against the use of -- properly rated and certified masks (such as N95 masks). Which do provide some protection (albeit with caveats).

Also, just think for minute around the basic logic of what you're saying. If (properly rated and certified) masks provide "no protection" (for unprotected individuals) - then why are the health care workers using them?

You can actually increase your odds of infection by different deceases by having a paper mask since they are often uncomfortable or fit poorly and people put their hands to the face to adjust them.

This seems like an invented rationalization given that the average person touches their face up to 3000 times a day already (up to. It is trivial to find details of this range). If you adjust a mask a few times, but in return it stops you from touching your nose/mouth constantly, that's an enormous win.

And just to clarify, again people are talking about surgical masks. N95 masks, which are still "cheap paper masks", indisputably work. This is way beyond debate.

It is what I read by an associate in microbiology and infection control [1]. I tend to listen to experts but maybe he's wrong about the field he is studying, I'm not an expert :)

Translated from Norwegian:

- Does a facemask help against spreading virii?

- No, not when you are using it out among people. The point is that you will scratch your face and get your fingers in contact with your soft tissue. So it is counterproductive to use these regular paper masks, says associate in microbiology and infection control at the University of Southeast Norway, Jörn Klein.

[1] https://www.nettavisen.no/nyheter/smittevernforsker-munnbind...

But we already touch our face endlessly. Again, this sounds like he invented this on the spot. This wasn't studied, isn't the result of an analysis, it's just a lazy response. Further, again he was talking about surgical masks.

Surgical masks don't work. Surgical masks are a subset of masks, and it is grossly inaccurate to extrapolate that out to "masks don't work".

I never claimed all masks don't work, I was talking about cheap paper masks. It might not have been clear enough in the original comment.

>The point is that you will scratch your face and get your fingers in contact with your soft tissue.

So they're saying that... masks will help if you don't touch your face? Makes sense to me, the PPE that the CDC recommends involve a face shield in addition to a mask.

Again this is about "regular paper masks" -- not specially rated masks such as N95.

Also, it dodges the question of - "What if, being adults, we train ourselves not to scratch our face (in view of the seriousness of the issue)? Will masks help then?"

Tangent, but 3000 times per day is about once every 20s awake. That seems high?

That's the high, though apparently the average is more in the range of 550 times or so.

The article I refer to in the sibling comment claims 23 times an hour on average so it would mean about 550 times during a day/night if you don't sleep. It sounds a bit more plausible.

Citation for the 3000 value? That seems to be a meme : I can't find evidence for it. A study [1] found 23 times an hour which is 368 times in a 16 hour day.

https://www.ncbi.nlm.nih.gov/m/pubmed/25637115/

I've heard the opposite rationale. Having 'any' kind of mask decrease the number of times you touch your mouth or nose..

I concur. Wearing a mask makes it less likely you'll inadvertently touch your mouth, nose, or eyes.

They provide no /self/ protection. As I have said in multiple threads on this topic: we wear astm3 masks to protect /patients/ from /us/. A lot of hospital PPE is oriented towards /patient/ protection.

And N95s are heavy and uncomfortable. No one can wear them for long. But if anyone wants to, they’re welcome to it.

N95 masks are used in many industries to protect their wearers from particulates, including wet particulates. Many of them have check valves that make them useless for protecting other people from the wearer. We don't yet know how much protection they provide against SARS-CoV-2 infection, because we don't know how essential saliva droplets are to contagion, but they probably provide some.

Although there are different kinds of N95 masks, the most common kind weighs a few grams; this is not uncomfortable.

Have you worn an N95 for any particular amount of time? Honest question. Because Uou refer to a few grams as “not uncomfortable.”

I find N95 face masks insufferably hot and muggy, with their “few grams” hanging off my nose and ears eventually very annoying. I don’t know if any hc workers that find N95s tolerable for very long.

I've spent a summer in +30°C heat doing demolition and foam insulation in a house that had been through a fire. I had to wear a heavy half face cartridge respirator the whole time due to both the toxins from the fire, and the toxins from the foam insulation.

I wouldn't say that was fun. But it was tolerable. A N95 mask is fine by comparison - not much worse than a surgical mask.

That’s funny, because I wear the cartridge respirator outside of work for some hobbyist reno stuff I do, and find it much more tolerable than the N95. To each their own, I suppose.

I have worn N95 masks for probably hundreds of hours due to having had a job in a factory with poor indoor air quality. Wearing them for 30-60 minutes during high risk activities like riding in a packed subway car would not be a problem for most people.

Can you please clarify:

(1) Which category of mask are you saying provides "no" self protection -- ASTM 3 and N95? (I've read over your post multiple times, and not entirely clear).

(2) So to be clear - are you saying that N95s provide "no" self protection? Not just that they can be misused; or that protecting against surface droplets is more important; but literally "no" self protection?

(3) And if the answer to (2) is yes, can you provide a source or two we can use for further illumination on this topic?

I'm not trying to waste your time, here. I'd actually really appreciate your input.

Sorry if I was unclear. ASTM3s do not provide self protection. They are estimated to reduce ambient virion uptake by about 2/3 - which just isn’t enough to make a meaningful difference most of the time, as 1/3 of the usual droplet output is already more than is needed to cause infection.

Thanks for clarifying.

N95 masks may only be effective used with eye protection. Surgical masks may not help at all.

Looked for interventional studies testing whether face masks and eye protection work in humans to protect against airborne viral particles. A big issue with many such studies is that medical staff only use masks and/or eye protection at work, opening them to being infected outside of work.

Found a small study [1] getting around this problem by exposing subjects (n = 28, avg age 30.5 years) to monodispersed live attenuated influenza vaccine particles by placing them in front of a vibrating-orifice aerosol generator for 20 minutes, subsequently testing for infection using RT-PCR and culture in nasal washes.

RESULTS

- No precautions: 4 out of 4 infected.

- Ocular exposure only: 4 out of 4 infected.

- Surgical mask only (3M 1818): 5 out of 5 infected.

- Surgical mask with eye protection (Z87 Uvex non-vented): 5 out of 5 infected.

- N95 mask (3M 1860/1860S) only: 3 out of 5 infected.

- N95 mask with eye protection: 1 out of 5 infected.

1. Bischoff WE, Reid T, Russell GB, Peters TR. Transocular entry of seasonal influenza-attenuated virus aerosols and the efficacy of n95 respirators, surgical masks, and eye protection in humans. J Infect Dis. 2011;204(2):193–199.

Thanks for the great reference. I am tired of people saying how masks are inefficient and all, based only on speculations.

Just because masks are not 100% effective doesn’t mean they’re not effective at all. The Surgeon General also dismissed masks and is spreading misinformation.

The Surgeon General dismissed medical masks, which are useless against this virus, they were not talking about masks that are sealed to your face and actually filter germs. Your post itself is misinformation.

I don't think most people know how to properly fit test an N95 respirator though.

Assuming they actually have one and not a fake one from amazon

Learning how is as easy as watching a 5 minute YouTube video. I have read this argument in other places and it is never mentioned that, while laypeople may not know how to properly wear a mask right now, it is not hard at all for them to learn.

If you think wearing a mask doesn’t reduce your risk, I have nothing to tell you. It’s so blatantly obvious.

One of the key findings coming out of China is that CT scans can outperform reverse-transcription polymerase chain reaction (RT-PCR) lab tests in diagnosing the Coronavirus[1].

[1]https://www.itnonline.com/content/ct-provides-best-diagnosis...

If the CDC's current tests are flawed or too few, then the CDC should provide guidelines to health providers to quickly diagnose potential patients using CT scans.

A CT scan is fairly standard procedure for diagnosing many things. Why do doctors and hospitals need CDC permission to use it to test? This seems like a bad movie where the CDC is not doing much due to political pressure. Why can't doctors act in their patients' best interest on their own?

If you want to see the outcome of a country's health department ignoring this outbreak for political purposes, look no further than Iran.

https://www.newyorker.com/news/our-columnists/how-iran-becam...

A CT has a pretty high radiation dose. As far as I understand, for every 2000 people given a chest CT we expect 1 person to get a fatal form of cancer due to the CT.

Compared to the natural incidence of getting a fatal cancer in your lifetime (about 400 in 2000), this is a very low. And for serious conditions, a CT can literally be a life saver.

But if you apply chest CTs to screen for a disease with (let's say) a 0.1% fatality rate, the side effects of your screening increases the fatality rate by 50%.

From what we can tell, SARS-CoV-2 has a 2% mortality rate among those diagnosed. That seems like a pretty decent trade in odds if it accelerates early stage treatment.

Considering you just read an article on how the CDC has told people to not test people who aren't obviously going to die, you may want to revise that figure downward some out of sample bias.

2% within confirmed cases. There is a part of the iceberg which we cannot see because mild cases will not seek care. Actual mortality rate is far lower than that. You should check mortality rate for outside wuhan population. It is 0.08%

Italy's 52 deaths vs 1900 cases is higher than 2% - https://www.theguardian.com/world/2020/mar/02/italys-coronav...

It's ~29000 deaths / 70M CT scans per year.

That's 414 micromorts, which is almost exactly as risky as skydiving once on average.

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

Source: US NCI 2007

The wikipedia article says skydiving is 8 micromorts per jump. So more like skydiving 50 times?

I don’t think biologic math always works combinatorially like multiple sky dives.

This sometime troubles me with radiation dosing comparisons. Another is time distribution, when a radiologic imaging study is equated with exposure from X amount of time in an airplane at high altitude. The time frames are different—- drinking 1 liter of water in an hour is usually safe, and drinking 50 liters of water is fine spaced out over a longer time period—-but not 50 liters over an hour. Radiation doses are often quite time dense.

Yeah, 1 in 2000 is 500 micromorts, somewhere in the 400-500 micromorts region.

Yes, the rule of thumb I know is that you can get about 25 CT scans in your lifetime before having a significantly increased risk of cancer. By contrast you can get about 25,000 chest X-rays.

As someone who interprets CTs, the findings described in that paper are totally nonspecific and just indicate a pulmonary infectious/inflammatory process. The takeaway I have is if the CT is totally clear, COVID is unlikely. Otherwise, you need confirmatory testing to figure out what is going on with the lungs.

CT changes did not occur before disease progression. In one study it occurs after 3-5 days after being admitted to hospital.(I could not find the link right now sorry.) Therefore cannot be use for 'quickly diagnosing'

This implies that our government is managing the propaganda around Covid-19 by simply not testing suspected cases. Is this true?

To a substantial extent, yes.

UC Davis Medical Center statement on refusal of CDC to grant permissions to test suspected patient:

https://health.ucdavis.edu/health-news/contenthub/novel-coro...

"UC Davis Health does not control the testing process."

Florida refusal to release testing data:

https://www.politico.com/states/florida/story/2020/02/27/flo...

Note that Spring Break in the US, in which about 10 million college students consume substances, exhibit poor judgement, congregate in large numbers, swap bodily fluids, and return to some 3,000+ institutions of higher education, begins today. With Florida and cruise ships as prime destinations.

https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_on_c...

I just posted my own update on COVID-19 yesterday (after watching events overtake me for 4 days -- I'd started after listening to the US CDC press conference on Feb 25):

https://joindiaspora.com/posts/bc04cb503c840138f4b8002590d8e...

On the Media's episode this week focuses strongly on COVID-19 and if anything is rather more alarmed and alarming than my own take (I very conciously strove for verified data and sober takes):

https://www.wnycstudios.org/podcasts/otm/episodes/on-the-med...

Audio: https://www.podtrac.com/pts/redirect.mp3/audio.wnyc.org/otm/...

Features Laurie Garrett, excellent content. Focuses to a large extent on both government mishandling and information suppression -- in the US having no information to report rather than China's suppressing avaiable information) -- as well as other forms of mis- and dis-information.

> consume substances

I find this kind of euphemism use really weird. "Substances"? Water is a "substance". A carpet is too. Why not just say what one is actually referring to?

Beer, wine, rum and maybe some herbal drugs.

I believe this usage is in reference to “controlled substances”, a legal term.

You might care to insert "mind altering" before the phrase.

But as used, relatively common in standard English.

yes and extend that to many governments.

It appears to be pretty much all western governments. at least 3 countries in the middle east appear to be pretty transparent, including surprisingly, Iran

The level of censorship around unquestionably authentic videos coming out of China has left me in a deep state of shock

You must be joking about Iran, based on pure math, it’s clear they are lying about the number.

Or, more likely: they don't actually know the real numbers. So you can treat what you do get from them as lower bounds, that's the bits they are sure about so they report them but events have possibly overtaken the authorities there to the point that their reporting is completely botched.

There's some evidence that the Iranian government knows the number of coronavirus deaths there is much higher than they're admitting to: https://www.bbc.co.uk/news/world-middle-east-51673053 Of course, even just the official number of deaths implies that coronavirus is a lot more widespread there than their numbers say.

It's pretty easy actually: they report about 600 cases and 50 deaths, That means they are an outlier in the number of deaths or that their stats are seriously compromised. I would give them some leeway about that being malice though, I suspect they are simply totally overwhelmed by this.

Maybe they're incompetent.

What videos are you referring to?

There is, unfortunately, no such thing as an unquestionably authentic video in the modern era. It’s not reasonable to assume that everything you see in a video on Twitter is true.

No, it does not imply that. The facts are that the CDC followed their protocol and so the person was not tested. It could imply the protocols are too stringent, or that they are successful because the user might not have the coronavirus.

Its unclear to me where 'managing the propaganda' came out in relation to the reddit post.

I’d at least entertain the possibility that this means the CDC has a limited number of test kits right now and can’t yet afford to give one to every single person who has a cough. It would be a bummer for some serious cases who wouldn’t get tested, if they had to test everyone who asked as long as they had kits available.

They were pretty clear yesterday that they’re ramping up test kit production and test sites as fast as possible. They didn’t answer a direction question about how many sites there were yesterday, implying to me that the number is pretty low.

https://www.cdc.gov/media/releases/2020/t0228-COVID-19-updat...

Pretty much. The CDC tried to finally roll out a test to New York City that local labs could use to carry out broader surveillance testing, after some early problems, but the local labs don't trust it and won't use it: https://www.propublica.org/article/cdc-coronavirus-covid-19-...

> At this point, the hospital called the CDC requesting permission to perform the COVID-19 testing. The CDC denied the request on the ground that I did not have the most life-threatening symptoms

Two questions:

1. Why would the hospital require permission to run a test?

2. Why would the CDC not want to test suspicious cases before severe symptoms present? From what I've read, the virus is contageous whether severe symptoms are present or not.

Because it's a CDC test in limited supply, and they're doing their best to try to balance the available supply with detecting as many cases as possible. The challenge is that the spread is changing rapidly enough that the guidelines will inevitably be a day or two behind periodically.

They are also banning hospitals from doing their own tests. All hospitals have equipment to test for virus presence. In fact we learned about first case of local virus spread, because a hospital ignored CDC and tested the suspected patient anyway.

The core problem is that the CDC (and country) has had the capacity to test only a few hundred samples per day. Meaning, they don’t have the ability to test everyone with flu-like symptoms.

Nobody thinks it’s right to NOT test every potential case. It just wasn’t possible.

Good news: Just today, they released new rules that should increase testing capacity by 400x.

The CDC doesn't run the tests. The hospitals and independent labs do. There has been some issues with the test kits distributed by the CDC, but since the virus genome has been sequenced you don't actually need a test kit (it's just a faster process if you have one).

However the CDC has enacted emergency powers to make it illegal for hospitals to use their own testing equipment, which they have in-house, to test their own patients unless they first get CDC approval. And the CDC has ridiculously stringent requirements for approving these tests.

As a result, the only confirmed case of community-spread COVID-19 in the US is in Northern California, because the UC Davis hospital basically said "go fuck yourself" to the CDC and tested anyway.

This is not because COVID-19 is not spreading throughout the community--it is!--but rather because the CDC's stringent testing requirements prevent testing of any case that cannot be rationalized away as having been caught elsewhere. If you don't test for the virus, then you don't confirm the presence of the virus, so there is no virus, amirite?

> the only confirmed case of community-spread COVID-19

There are now 4 confirmed cases of community-spread COVID-19. 2 in california, 1 in oregon, 1 in washington.

https://abcnews.go.com/US/high-school-student-washington-lat...

There's now a nursing home in Washington with a staffer, and a resident[1][2] confirmed to have COVID-19, and ~50 people in that nursing home showing symptoms. But, since only those 2 people have been tested, the national stats look amazing! Only 4, no, scratch that, 6 transmissions!

[1] https://nymag.com/intelligencer/amp/2020/02/two-new-us-coron...

[2] Neither of them have been to China.

Some clarification based on what I've been able to put together (caveat: I'm not an expert in this area)

The CDC developed a testing protocol (crudely, a set of 3 conserved RNA sequences of the virus to chemically "grep" for). The protocol is here [1] and I think anyone with suitable equipment (an RT-PCR machine and an oligonucleotide synthesizer to make the primers and probes?) could run tests using just the information on that web page, though they would probably also want known positive samples of the virus to validate against. And there are lots of labs with suitable equipment. But as that page says, it is not legal to do this clinically.

The CDC also sent out test kits [2]. These are just vials of primer/probe pairs synthesized from the short sequences on the above page, and a fake positive control to validate with. These were authorized by the FDA, and so are legal to use. But apparently somehow they screwed up the production of primer #3 (or maybe the sequence itself is wrong), and so almost all the labs were not able to validate the test. After several weeks the CDC has still not fixed this problem, but labs are now allowed to run tests using just primer 1 and 2, so testing capacity is rapidly increasing (though of course who knows how sensitive or specific the tests are).

The federal organization preventing labs from running tests is the FDA [3], not the CDC. It is also the FDA who would have to approve the commercially produced test kits.

[1] https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-p... [2] https://www.fda.gov/media/134922/download [3] https://www.fda.gov/emergency-preparedness-and-response/mcm-...

What you say is correct, but is conflating a separate issue.

You are correct that FDA approval is required for a clinical test, and for that a CDC test kit must be used (even though the biochemistry involved is trivial and a grad student with access to the right tools could put together their own kit...)

An entirely separate issue is that the CDC has used its emergency powers to restrict usage of these kits--you cannot use the kit to test a patient unless the CDC gives the OK for doing so. Even though for a long time many of these kits were not being used to available capacity...

My understanding was that prior to Friday, CDC Atlanta's comically limited RT-PCR capacity was backlogged even under the "see-no-evil" testing criteria, and that approximately no other labs were able to do tests (since validation of the CDC issued tests failed). If there was also unused lab capacity that is good to know, do you have a source?

"Good news: Just today, they released new rules that should increase testing capacity by 400x"

How can new rules increase testing capacity? All you can do, is adjust the rules to the existing capacities ...

Presumably they have obtained more resources and have updated the rules to reflect that.

The capacity basically existed, but couldn’t be used until it had gone through fda certification for the virus. The new rules allow labs to perform testing after sending the required information to the fda but before the fda has had time to review that information

Because all test samples are sent to the CDC headquarters in Atlanta for testing. They only have a certain number of people available to analyze the test results. And the number of test kits is limited so the CDC is trying to triage cases until the supply opens up.

They don't post anything about the costs, but that would likely be the defining vector in this whole situation.

I mean, let's face it — noone's going to go get tested if it means you'll have to pay 5k+ out of pocket for the experience (even if it's a negative test and you require no further treatment), plus would have to be fired from your job for missing work and doing a self-quarantine for 2 weeks (if it's positive yet mild enough to not require hospitalisation), plus be evicted from your apartment for failing to pay rent due to the loss of the income (possibly having to cut the self-quarantine short in the first place due to any such pending evictions or the prospect thereof).

For this whole thing to work, testing has to be free, workers have to have protections, housing has to be affordable and plentiful, and Andrew Yang's UBI (Universal Basic Income) suddenly sounds like it might be a pretty good idea, after all.

So is there a way to prepare our bodies for getting sick? Me and my wife and our 8 month old live 40 hours a week in public, so it's going to happen.

We already eat healthy, me and the wife workout. But the kid? Not sure how to prepare him.

Young kids appear to be unaffected currently. Not sure if this will change but also if your kid is breastfeeding then he be protected by mom's immune system. I would minimize people holding him that aren't you or your wife and obviously wash hands frequently.

Protein is vital for your immue system and to fight viral and bacterial infections. Chicken soup with lots of potein and vitamins is a not just an old wives tale.

But unless your kid has an underlying health issue or vitamin deficiency, then not really. Eat well, get some sunlight if you can, wash your hands often, don't touch your face, follow the guidlines doctors are mentioning at your state/local or federal level.

It's widely recommended that babies receive vitamin D supplementation even in the best of times.. but under these circumstances, and certainly if you're in the northern hemisphere, it's worth being proactive with this in advance.

I'd say you're doing the only thing a person can.

You see many people speak of "boosting your immune system" but it's pure quackery. A person's immune system is many layers and types, a system, it's not a single thing that can be adjusted at will.

The way I see my immune system is a 100 liter tank of water. You can't overfill it but it can be low. At most it can only be 100 liters. Your immune system can only be as good as normal there's no turbo button to over-boost it.

Get enough sleep.

Yes, this is often understated. Not enough sleep and stress makes our body not protect itself as well as it could.

Yes. Pure speculation, but lack of sleep might have been a factor in relatively young doctors in Wuhan dying from the virus. And quantity of viral matter might also be an important factor.

Zinc + vitamin c

There is a potential risk with having a very healthy immune system in cases like this. It's called 'Cytokine release syndrome' and happens in healthier and younger individuals and it is far deadlier than the viral infection itself.

I don't believe that applies here. I remember seeing on another thread that you would expect to see lots of 20-50 year old deaths with CRS, like the Spanish flu. From what I've seen, COVID mortality seems to be proportional to age, with a lot of very old people succumbing.

Everything I read so far about it is saying that the virus is nothing special for anyone under 10 year old.

https://www.worldometers.info/coronavirus/coronavirus-age-se...

Also you can read about SARS which is similar.

Seems like what kills most people is the immune system overreacting.

Based on the statistics so far the most vulnerable people are the elderly, the lower the age the easier the recovery seems. Many people had mild symptoms and you might even think you just had regular flu, unless you are one of the unlucky ones.

I have a brutal cold right now with a ton of congestion and a fever. I am trying decide on if I should go to the hospital here in California - has anyone read anything that helps you make that decision?

I am a Caltrain rider daily and I feel like it is not fair to subject other folks to this if it is a COVID-19 - but I don't also want to overload the health system unnecessary if there are folks with Acute symptoms.

Either way you should call first — speak to a doctor on the phone and get their recommendations.

stupid, mostly-unrelated question: how does 'call a doctor' usually work? do most people have a doctor that they can just call? If I had a need to call a doctor (fortunately I don't at the moment), but don't know any doctors, what should I do?

Assuming you’re in the US and have insurance you can usually go on your insurance company’s website and find a local provider (doctor). You can then just call them up and say you’re looking for a new primary care physician.

Also, many areas have urgent care centers for things that are serious but maybe not emergency room serious.

Unfortunately, cost is a variable in the US and I can’t give any good guidance on that. (Not a doctor, standard disclaimer.)

Good luck with using the insurance company’s website. The doctors they list in my area seem to either be deceased or not accepting new patients.

It doesn't seem like CA has a well publicized number you can call for advice (yet?) but you should call your hospital and ask them for guidance instead of going in. I'm currently traveling in Europe and that's been the MO here - you call a hotline and until recently they then told you whether to go in or not and they now come and test you at your home if it's deemed necessary. CA might not have a number or clear process yet but your hospital should at least have some guidance.

Advice for England: https://111.nhs.uk/service/covid-19

I don't know what the US advice is, but the English advice is "please don't visit hospitals unless you've been told to do so".

We have people who'll come out and test you if needed, and we have "drive through" testing stations.

Telephone 111 or your GP for advice.

https://twitter.com/DrSdeG/status/1233715830170562561?s=20

https://www.gov.uk/guidance/coronavirus-covid-19-information...

Apparently having a runny nose is not common, only 30% of patients had it, but the study was of 40-ish people: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Still, a bad cold isn't fair to subject others to, either.

If you have a fever it is probably best to avoid exposing yourself to others anyway. There are plenty of other bugs similar to COVID-19 that can kill the vulnerable and there's no need for you to help spread them! Stay home, chill out, wait for the symptoms to pass before going out and you can help stop the spread of these illnesses :)

I'm fascinated that it never occurred to you to STAY HOME and stop infecting everyone in your office with whatever you have, COVID-19, flu, or something else.

Doctors give out the "unknown virus" diagnosis literally all the time. It's extremely common.

China: underreports diagnosed cases.

U.S.: underdiagnozes cases.

Not sure which is worse.

At least in China, somebody knew the ground truth.

As much as I criticised China's initial response, their eventual containment has proved highly effective.

The US (and numerous other countries) are point-by-point repeating China's initial failures.

This will delay control by days. Growth is presently doubling every 3 or so days, increasing by an order of magnitude every week. Delays will increase consequences directly proportionate to those rates, both infections and deaths.

As it is, if Rest-of-World (RoW) response is where China was ~22 January, we can expect to see 100x present cases (~2 orders of magnitude) and ~500x present deaths (~2.5x OOM). Very roughly.

What was your critique of China's measures?

To me the extreme measures were just an indication that they understood better than they let the rest of the world know what they are dealing with. I mean, they locked down entire cities at who knows what costs, and they were _disinfecting the streets_. Or maybe they did let everyone know via official channels. Frankly, I was surprised that WHO didn't treat this as an emergency much earlier.

I criticised the initial response, largely from ~mid December 2019 - ~21 January 2020, specifically attempts to shut down any and all discussion of the outbreak initially, as well as downplaying reports. See from three weeks ago this thread: https://news.ycombinator.com/item?id=22274827

In terms of the actual epidemiological response, most especially since ~22 January, limiting travel, events, large congregations of people, and shutting down workplaces and schools, has been absolutely appropriate. Those measures have received some criticism, including by Chinese citizens. I don't feel those criticisms are at all warranted.

The information environment is difficult to navigate. I'd argue that China's erred on the side of too much control, as it tends to do, but in general, after 22 January, the process as a whole has worked, judging by results. The challenges are certainly staggering, particularly at China's scale. The avoiding of mass panic and protest is commendable.

The fact that other governments -- Japan, Korea, Iran, and the United States, notably, and all but certainly North Korea, are repeating many of the same mistakes (or multiplying them several-fold, in the case of Iran and PRK) -- shows that this is highly typical.

I'm also quite disappointed by the international response, and that of the United States quite specifically.

One of the first references I posted to HN following news of the Wuhan outbreak was Albert Camus' 1948 novel, The Plague. The story it tells, of society, government, and individuals, in the face of pestilence, is timeless. And contains valuable lessons:

https://antilogicalism.com/wp-content/uploads/2018/03/the-pl... (PDF)

HN submission: https://news.ycombinator.com/item?id=22150237

> At least in China, somebody knew the ground truth.

I wouldn't go that far, judging from reports of death certificates with "Unknown viral pneumonia". But I agree that China seemed a little more on top of it... once the world got wind of it.

China didn't know what it was dealing with, how to assess it, or who to test. It did the legwork on all of that, for which the rest of the world should be grateful.

Test-kit availability has been constrained throughout the epidemic, and yes, that means that full confirmation has been only partial and lags outbreaks. But information I've seen is that once China was aware of what it was dealing with, it was testing as broadly as it could.

South Korea seem to be taking this even further, with many thousands of tests within a few days in outbreak areas. The US CDC have refused doctors' requests to test suspected patients and control the availability and use of test kits. That's simply fucking insane and stupid. (Again: the UC Davis Medical Center instance: https://health.ucdavis.edu/health-news/contenthub/novel-coro...)

Amateur hour is over.

Oh, don't get me wrong. The U.S. totally botched this, and it seems like it has had one of the worst responses of countries I've followed closely.

I'm not going to say flat out the worst. But relative to capabilities, knowledge, and experience, the furthest from potential.

Otherwise agreed.

Let's assume what you said is true. In the first case, the person being diagnosed will know if he/she was in fact infected, and will be told to stay at home if so, so less potential public harm. The second case is way worse.

The reality is that containment has long been off the table, which should be obvious to anyone who understands the jist of R0, the long incubation, the reality of global travel and the lack of tests.

It is time to switch modes from quarantine to containment and stop pointing fingers. Openly tracking potential cases in realtime can help communities slow the spread so we don't get crushed with huge spikes of critical cases all at the same time.

Not to state the obvious, but there's not been a diagnosis of covid-19 yet, so let's keep that in mind before concluding this person has it.

Also, otherwise healthy 30-year olds need to do exactly what this person is doing: quarantine & treat it with the same meds as the flu.

The story is rather worrying, and as there is at least one news report about it now I assume at least a basic amount of checking has been done to verify it.

From what I read, in many of the publicized cases here in Europe that started with a single person travelling there were several confirmed cases in people with close contact to the original patient.

The reports from the US are mostly about single patients with no known source of infection and about denied tests. If you don't test, you don't actually know how widespread the virus is right now. It seems plausible to me that the low number of cases in the US is mostly because of the far more limited testing, and not because there are actually that few cases.

Korea had few confirmed infections. Then a few people got very sick they started testing everyone those people were in contact with now they have thousands of confirmed infections why because they tested thousands of people not because thousands of people are very sick. So I agree not just the US many other countries probably have larger number of infected but few severe cases so not much testing.

On the face of it, seems stupid you didn't get tested. But I don't know the other side of the story. If there really is a limited supply of these tests, it makes sense for CDC to assign them accordingly. Frankly, if you don't end up with COVID-19, this is a bit of a non-story.

Regardless, it sounds like a bigger budget should be set aside for for testing. If I was in charge and had the resources, EVERYONE coming back from an infected country would be tested; symptoms or not.

If it turns out you do have it, my thoughts and best wishes go out to you. (I'm sure the media coverage will explode; shame these things don't get the attention until after the fact).

The CDC has undoubtedly pushed massive amounts of funds into test kits...but that has to be manufactured. It doesn't just appear instantly and out of thin air. Then you have to distribute it to clinics/ERs. Testing will gradually expand, and the requirements for testing will be loosened once supply can finally meet demand.

In the mean time, why not import test kits from Italy or South Korea? Those countries test hundreds daily, if not thousands.

I would assume because Italy and South Korea need those kits since they actually have massive outbreaks where in the US it has been very muted.

Welp. I've been a bit wary about riding the subway while corona is bouncing around, and this pretty much confirms that I should be.

What is this? We don't know whether this person even had the corona virus.

It's going to spread here, I'd rather have it and get immunity sooner than later when it's full swing and treatment might be limited.

Easier said than done :)

you dont get immunity to it. you can re-catch it, at least according to certain sources. woman in japan got it again, or at least it seemed to have gone away entirely, and then came back.

This helps highlight just how much of this is nothing more than FUD.

The CDC counts real flu deaths and estimates infections. It doesn’t test for them. As a result you get a relatively low fatality rate.

But for COVID-19 we are using only confirmed deaths and confirmed tested infections to come up with a fatality rate that seems much higher than it actually is because most infections go unreported.

This is just a reality of the post-fact based world we now live in. Everything is bonkers.

Medical statisticians are not tards, and the math used to estimate CFRs is reasonable. Yes, there's uncertainty, because when something is massively growing, it's not meaningful to test the population at large and ordinary surveillance mechanisms are not effective yet. We also don't really have serological testing (allegedly Singapore has a good serological assay?) which doesn't help.

It's worth noting that the real issue is that CFR skyrockets when the medical system saturates. With good medical care available, the CFR is still much higher than the flu but less crazy. The problem is, COVID-19 can create enough severely ill cases to saturate medical systems with uncontrolled spread.

>Medical statisticians are not tards

This paper has 4000 citations: https://journals.lww.com/epidem/Abstract/1990/01000/No_Adjus...

So? It has a point. I disagree with a lot of it, but...

* The fundamental point: A study with 100 comparisons will erroneously reject the null hypothesis at p<0.05 for 5 of them, which is a good part of why we adjust for multiple comparisons. But the same issue holds if we do 100 studies, and reject null for 5 of them. One of the fundamental problems with p values is that we don't really know the baseline number of things being compared in unpublished and preliminary research, which in turn makes the p value somewhat meaningless.

In effect, we've unfairly penalized the study with multiple comparisons vs. the same findings showing up from studies with individual comparisons.

* Studies with multiple comparisons are great engines of hypothesis generation. Setting too high a bar for rejecting associations means that we'll possibly discard too much.

* Most of our tests for multiple comparisons assume a degree of statistical independence which just isn't present.

The abstract is particularly horribly written, but those three points are reasonable points. (At the same time, there's circumstances where obviously we need to adjust appropriately or get absolutely stupid, irreproducible results-- e.g. fMRI data.

I keep seeing similar arguments. Does that mean China's response is based on FUD? If it is really just a flu, then why the drastic measures?

Because the flu is really bad. But it’s not unusual.

I don't remember a recent flu year that's prompted governments to weld people inside their dwellings.

Yeah, because it didn’t fit a narrative. It didn’t have a scary name. In 2018, 80,000 people died from the flu in the United States alone. 80,000. The bulk of those deaths happened in a four month window. Sometimes hundreds or thousands of people died PER DAY. Think about that for a moment. Let that sink in. There was a weekend in 2018 that likely saw more deaths from the flu in the US alone than during this entire saga globally, which started back in November.

I don't think the Chinese government is unduly worried by narratives and scary names, but is instead inclined to be ruthlessly pragmatic.

Diseases spread. Yes, in their early phases of spread, the total devastation isn't that high.

Your statements would hold just as true for the early phases of the 1918 pandemic-- lots of people die from flu every year; still fewer have died than happened last year; etc. They're statements that are true until they're not.

There's no guarantee of catastrophe, but the potential for it is there.

Read the WHO comment: Guangdong, China, tested 320000 samples with postive rate of 0.15%. So no they did not miss a lot of light cases. The death rate is real, esp for the vunerable population. Medical system will be overwhelmed if this goes unchecked.

I agree that this is likely true, but it's worth noting the big caveat: sensitivity of the tests are poor, particularly (to an unknown extent) in people with mild disease. Until we have good serological antibody testing it's going to be difficult to quantify.

Reply on news.ycombinator.com