Coronavirus Disease 2019 Situation Summary | Hacker News Reader

Coronavirus Disease 2019 Situation Summary

cdc.gov

146 pointsmooreds135 comments

> An important part of CDC’s role during a public health emergency is to develop a test for the pathogen and equip state and local public health labs with testing capacity.

Testing for COVID-19 has been an unmitigated failure in the US.

Whatever advantage may have accrued from closing travel routes has been fritted away by preventing local authorities from testing. Without testing, there's no way to say anything about the safety of the American people.

CDC needs to explain the American public how this was allowed to happen, especially since other governments seem to have had no problems despite being called into action much sooner.

Without a clear explanation, the public will have no confidence in what the CDC says as the disease spreads.

The self-congratulation on the presidential podium during the last two pressers has been disgusting and disgraceful. There's nothing to celebrate or congratulate here. The entire group dropped the ball.

> Testing for COVID-19 has been an unmitigated failure in the US.

Same in Germany. Authorities have tracked and followed infection paths of several 10k people in China to contain the spread and reach a massive slowing in disease spread (confirmed by WHO) due to drastic containment measures.

In Germany 35 (without the "k") people were infected in the state of NRW and authorities gave up following infection paths. They're barely testing despite crazy rising numbers and nationally we have discussions about containment measures.

The conclusion is that we will likely not contain any communities or cancel events just yet. Because it would impede on individual freedom which is regarded as more important than preventing the spread of a dangerous pandemic.

I think CDC "failed" testing for Covid-19 intentionally: in order to avoid panic and please Trump administration.

This is a failure of our politicians who have been slashing funding of said institution. How do you expect them to do their job properly when underfunded?

No. The CDC budget was never slashed.

The president proposes budgets, but that's the starting point of negotiations within Congress. Congress has consistently increased the CDC budget. https://apnews.com/d36d6c4de29f4d04beda3db00cb46104

The Trump administration fired the U.S. pandemic response team in 2018 to cut costs.

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

COVID19 was not a surprise; that is, it was known to exist in China some time before the first cases appeared in the US. It is not unreasonable for a government to assemble a team to respond to something like a pandemic as needed, as opposed to having people dedicated solely to the purpose and nothing else. Both the NBC News and Washington Post articles the Snopes piece cites describe the action as part of moving people to related departments as part of the new National Security Advisor's desire to have his own hierarchy, and the head of the dedicated team resigning after not getting his desire to keep the team the way it was.

You may or may not agree with this. But please don't claim that this is somehow prima facie proof of the Trump administration's malfeasance/evilness.

Yes. The Trump administration fired the U.S. pandemic response team in 2018 to cut costs.

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

>This virus is NOT currently spreading widely in the United States.

Curious how this is known given practically zero tests have been done and numerous cases with no contact external to the US have been discovered.

This will be based on models using what we currently know about the time it takes patients to show symptoms, the number of people currently detected showing symptoms, and the expected rate of detection of symptomatic patients.

'Numerous' is a bit of a loaded term, there have been cases of community spread in three areas so far, as described in the CDC summary.

> The coronavirus has been circulating undetected and has possibly infected scores of people over the past six weeks in Washington state, according to a genetic analysis of virus samples that has sobering implications for the entire country amid heightening anxiety about the likely spread of the disease.

https://www.washingtonpost.com/health/coronavirus-may-have-s...

Yes, correct, scores of people in the areas the CDC report there being cases, and in which they say people are at increased risk. That's not 'widely in the united States'.

They also say that widespread transmission is eventually likely to occur. They are simply, and as far as I can tell very clearly and responsibly, drawing a distinction between what is happening now and what is likely to occur in the future.

As there has been community transmission and aren't actively testing symptomatic people (unless in known direct contact with someone who has traveled to an affected area, or traveled there themselves), it's questionable if they have a sufficient grasp on "what is happening now".

>and aren't actively testing symptomatic people

The article even has pictures of the test kits they've been distributing.

“Widely” is sort of a vague word.

It might be only in a few states but Florida, California, Washington, and New York could have a lot.

It is suspected that in Washington the virus has been spreading undetected for 6 weeks.

There's a model floating around out there now [0]. I think the main point of it is the transmission efficacy. The Gates article recently published in the New England Journal of Medicine states the average person infected will go on to infect two to three additional [1].

I'm of the opinion that, while China appears to be the root cause, the advantage they have is a very authoritarian control on the response. People were literally welded into their apartments [2]. In the US, for example, there are many people that will blindly ignore all requests by politicians, local, state and national government. Many Chinese don't have that option for fear of strong repercussions. While I'm not condoning that use of force - I'm just stating as an observation. Beyond that the US seems to be in an odd spot given the upcoming election and divisive divide along party lines.

[0] https://drive.google.com/file/d/1bS6S4oNRuMHD4ezh177QSf3UU6a...

[1] https://www.nejm.org/doi/full/10.1056/NEJMp2003762

[2] https://www.cbc.ca/player/play/1703503427818

The question about China's draconian response is, was it an overreaction? They are doing a lot of damage to themselves by welding people in to their apartments and shutting everything down. Maybe it will turn out that the Korean approach of testing, canceling events, and you know, not putting people in camps, will end up with less overall damage.

They are using a high threshold of "widely", ignoring the math of exponential growth and what that says about the next several weeks.

Oh really: https://twitter.com/trvrb/status/1233970271318503426

"This strongly suggests that there has been cryptic transmission in Washington State for the past 6 weeks."

You mean as described in, and entirely consistent with the CDC summary?

Yeah, this is absurd. Surveillance testing isn’t even being done at anywhere near the levels to make this claim, nor are any of the only known effective mitigation strategies, like bans on mass gatherings, being put in place.

Compare this to what is being done in Singapore with effective quarantines and extensive contract traces, or Korea with on-demand, drive-thru testing, and the complacency is staggering.

The CDC isn’t even releasing treatment details for recovered patients so doctors and hospitals can prepare to respond:

https://amp.cnn.com/cnn/2020/03/01/health/coronvirus-patient...

Before you advocate 'surveillance testing', you should provide a link to hard data showing what the false-positive rate is.

Not assurances of how accurate it might be...

I want a definitive false-positive rate.

Until we have that, surveillance testing may be more harmful than beneficial.

That’s insanity. The WHO themselves insisted that aggressive surveillance testing is necessary to formulate an adequate response and it’s what Korea and Singapore are doing right now. There have been no reports of widespread false positives, only false negatives, and even in that case, testing was ramped up because it’s better to catch some than none.

Sigh...

I wrote: "Not assurances of how accurate it might be..."

Yet, that's exactly what you responded with...

Once again, what is the false positive rate?

If you don't know, so be it. But, if its 5% or so (like many similar viral tests), you may wish to give some thought as to what you are going to do with the tens of thousands of healthy 'false positives' your proposed surveillance testing will uncover.

Easy. %20 of the cases require some type of hospitalization. %80 are mild and don't require medical attention. If you have Covid-19 rampant in your town - the hospitals will fill with persons experiencing a bad flu - that %20.

https://www.businessinsider.com/coronavirus-80-percent-cases...

>%20

>%80

that's not how percentages are written, ever.

Is it still the case that you have a two week latency before symptoms? If so, that would make detecting the early stages of an outbreak without testing exceptionally hard.

Last I read it was anywhere from 2 - 14 days.

> Current estimates of the incubation period range from 1 to 14 days with a median of 5 to 6 days, although recent case reports suggest that the incubation period may be as long as 24 days, which is longer than the 14 days that WHO and the US Centers for Disease Control and Prevention (CDC) have been using to inform quarantine policies.

https://jamanetwork.com/journals/jama/fullarticle/2762510

Here is some data from 1100 early cases in China. Median incubation period is 4 days, interquartile is 2-7 days. 14 days is a very distant outlier, and it's possible there was an intermediate carrier or two in those cases.

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

I think that's true only if transmission is possible before noticing symptoms.

Relatively rare but transmission between asymptomatic people has been detected/confirmed for this virus.

Yeah, this is more serious than the flu, but not as serious as MERS or SARS. Like the seasonal flu, the main worry is older people and/or people who are already respiratory compromised. I don't want to catch this much like I don't want to catch the flu, but my main worry is for my parents and grandparents.

This is way more serious than the flu in multiple ways. First of all, estimates show that the case fatality ratio (CFR) is around 2%, which is 20x higher than the flu. This number is likely to rise when ICUs are becoming over-constrained and cannot take new patients. This is already happening in the north of Italy as we speak.

Second, the transmissibility of the SARS-nCov-2019 (the virus causing COVID-19) is much higher than the seasonal flu. This means the period within which a demand will be made on healthcare services will be much shorter and much more intense.

Third, there are reports showing lasting damage to kidney and lung tissue (sponge-like structures). Even when surviving COVID-19, previously healthy people might become chronically ill.

Fourth, in order to prevent at least part of what I am describing, very stringent measures are required. These already have a historic impact on our worldwide economy and will hit developed countries the most (since they require a worldwide infrastructure). It is very likely that the impact will become unprecedented as various continents are considering and implementing large-scale quarantine measures.

Concluding, comparing COVID-19 with the regular flu is both simplistic and dangerous. Prepare yourself and your loved ones for a bumpy ride.

Care to explain the down-voting?

I'll take a stab at why you're being down-voted.:

>case fatality ratio (CFR) is around 2%, which is 20x higher than the flu.

[Citation needed]

>This number is likely to rise when ICUs are becoming over-constrained and cannot take new patients. This is already happening in the north of Italy as we speak.

[Citation Needed] I can find citations for crowded hospitals in popular media, but nothing about the death rate increasing.

>Third, there are reports showing lasting damage to kidney and lung tissue (sponge-like structures). Even when surviving COVID-19, previously healthy people might become chronically ill.

[Major Citation Needed]

>very stringent measures are required

[Citation Needed]

That's probably why. There are 4 claims you've made that need to be backed up with facts.

HN is not Wikipedia. I am more than happy to provide evidence for my claims, but I'd be downvoting almost every single comment on HN if those were the requirements.

The CFR is easy to find with a Google search. There are multiple studies currently providing strong lower and upper bounds on CFR.

My second statement has the word 'likely' in it. W.r.t. Italy, I am talking about an Italian media article describing over-constrained hospitals and the provisioning of military field hospitals.

Third statement has some evidence in other parts of the thread.

Fourth statement: many, many experts are warning that we are doing too little to late. The need for a response is logical given the high R0, CFR and needed hospitalization. If needed, I can provide some links, but going to my next meeting right now.

HN is not wikipedia, correct. But there is a baseline for expectation, from what I can tell. If you're going to make claims of fact, especially for something controversial, you need to support with facts. That's your job as the person making the claim.

Otherwise, you need to put a sentence in there that all of these things are just your opinion.

And your response to me is just more hand-waving "i'm right i'm right" with zero content. You're still doing it.

> Third, there are reports showing lasting damage to kidney and lung tissue (sponge-like structures). Even when surviving COVID-19, previously healthy people might become chronically ill.

you can't say that and not point to a source.

Well, this [1] is an article describing extensive GGO [2] and subpleural parenchymal bands in recovered patients. I have read other reports from Wuhan doctors describing these effects, but some search terms seems to be censored these days. I am not a specialist, but it was described as lasting damage.

[1] https://pubs.rsna.org/doi/10.1148/radiol.2020200370

[2] https://en.wikipedia.org/wiki/Ground-glass_opacity

Here's an article from the Lancet describing patients with high rates of organ function damage. It's not as useful as the one linked by edejong because it's a very early study. It shows that quite a few patients already had damage on admission, more than those that subsequently died so clearly many patients survived with organ damage, but it doesn't follow up on how many more may have suffered such damage after admission. So it's evidence, but not as strong.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736...

> First of all, estimates show that the case fatality ratio (CFR) is around 2%, which is 20x higher than the flu.

These estimates are mostly from China. Obviously likely to be higher for a respiratory condition in a place with some of the worst air quality in the world. There is also some question about whether the less serious cases are even being identified -- if your sample is only of the people with severe symptoms, you get the wrong number for the percentage of people with severe symptoms.

> Second, the transmissibility of the SARS-nCov-2019 (the virus causing COVID-19) is much higher than the seasonal flu. This means the period within which a demand will be made on healthcare services will be much shorter and much more intense.

Fortunately flu season is coming to an end, so there will be less contention for resources there and the same reasons people get the flu less often in April than January will help to mitigate this.

> Third, there are reports showing lasting damage to kidney and lung tissue (sponge-like structures). Even when surviving COVID-19, previously healthy people might become chronically ill.

That can also be true of the flu, isn't it?

> Fourth, in order to prevent at least part of what I am describing, very stringent measures are required. These already have a historic impact on our worldwide economy and will hit developed countries the most (since they require a worldwide infrastructure).

This is probably just not going to happen. They'll try to contain it using strong measures when the number of cases is small enough that there is some hope of that actually happening, but strong measures aren't that problematic when they're only applied to a small number of people.

If they fail in the early stages and millions of people become infected, the strong measures can't be justified at a large scale because once it's that widespread they won't be effective anyway. The point of the strong measures is to prevent that from happening. They aren't worth continuing after you've already lost.

The estimates seem to be reflected by international numbers to a certain degree, ranging from 1%-3%. With the disease in exponential growth, dividing #death/#cases is not the right calculation to make, as it might take 3-5 weeks before a patient dies from the disease. The Princess Diamond ship is currently at 1.2% iirc.

Your factor of under-representation of cases seems to cancel out the delayed onset of mortality at the moment.

The end of the flu season is incomparable with the demands on the health-care system due to COVID-19 since flu-demand is at least 1-2 orders of magnitude smaller. The advantage of the end of the flu season is that we can identify cases quicker.

W.r.t. lesions caused by COVID-19 comparable to the flu. Yes, both cause permanent damage. However, COVID-19 seems to attack more of the lungs and in general, both lungs, whereas influenza often is isolated to one lung. I am not a specialist, but I have read scary descriptions of COVID-19 lungs from specialists.

The stringent measures are already happening and the effects are already being felt. The stock market has responded by evaporating 4000 billion in value. Given the past lackadaisical response of government, it is likely we will see further effects either way: response or not.

If nothing is done and millions of people will get infected (think: 2 billion people) in a short amount of time (1 year), we will see widescale breakdown of services, global turmoil and panic. Hopefully, we will be able to slow the spread, develop a vaccine and 500 million people will get infected instead.

There’s something of a social stigma around treating this thing seriously but alarm bells should be ringing at this point.

We have, essentially, a hurricane off the coast (so to speak) and no one can say with certainty whether it will blow over or whether people are going to take a direct hit.

Like with storms, there’s the fear that hyping it up too much will lower trust in the future. However, not preparing people and then having the worst happen is many times worse.

This thing should absolutely be taken seriously. The responsible thing at this point is to prepare for worst and plan. The worst being an overwhelmed healthcare system because too many people require hospitalization all at once.

If the hurricane blows over, we’ll have stocked up our emergency kits that we, frankly, all should have had in the first place.

But we should really stop comparing this to the flu.

I'm not sure we have the confidence to run the logic that way right now. There are still some ways to harmonize "this hit China really hard" and "this won't impact much of the rest of the world" at this point. I've seen it hypothesized since before it even spread out of China that this may happen to target some people more than others based on different levels that people express the receptor that this virus targets. There's also some reason to wonder if China is getting hammered due to widespread smoking [1], and even more widespread exposure to pollution levels that are not entirely dissimilar to smoking. If, perchance, all of these factors are true at once, then it could be that what was in China was a perfect storm for them, and it'll be just a cold for everybody else.

We still don't really have the evidence in yet to know. At the moment we can fit the facts both to "everyone's in big trouble" and "it isn't that big a deal anywhere else". In some ways, the best possible news would be that it's been spreading in the US for weeks... and we didn't notice, because it's literally not noticeable because it's not that big a deal here. I'm not pitching that as "truth" at the moment, but it's on the table.

[1]: https://www.preprints.org/manuscript/202002.0051/v1 - note this preprint disagrees with the "differential expression" theory; given it's "early days" I'm taking this merely as a data point, not proof yet. This could explain how it's a catastrophe in a high-pollution city and just "a cold" everywhere else. This scenario raises the interesting possibility that covid-19 could have started anywhere, and it simply wasn't noticed until it happened to get to Wuhan through normal mechanisms. What if "patient 0" turns out to be an asymptomatic business traveler from $NOT_CHINA? I'll call this a low-probability outcome, but what if we start widespread testing in the US only to discover that almost everyone already has it?

That is probably why they capitalized "NOT": To deflect from the fact that they do NOT know anything.

And for extra security they added "widely", which makes this statement stretchable after-the-fact to fit any imaginable reality.

Especially with news like this:

https://www.expressnews.com/news/local/article/CDC-Coronavir...

One thing you can be sure. This will be a political football played aggressively by both or multiple sides trying to get an edge...

And the news of course will amplify things —they have since it emerged in China where they vacillated on whether it’s an overreaction or whether its a economy destroying pandemic.

You should back up your claims.

The CDC reports that over 470 tests have been done to date. Is that practically zero?

https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

"numerous cases" You'll have to back that up as well given the linked article clearly states the cryptic transmission in Washington is accounted for. They call it "Community Spread."

Yes, that's practically zero, when compared to other places doing tests.

not even a rounding error in the grand scheme of things.

Switzerland has done 1300 tests to date and has the capacity for ~1000 tests a day: https://www.swissinfo.ch/eng/covid-19_switzerland-confirms-s...

So, yeah, I'd call that practically zero for a country with 38 times the population of Switzerland.

https://www.cnbc.com/2020/03/02/coronavirus-new-york-city-do...

This was my first thought! My child here in Oregon has all the symptoms (fever, cough, and respiratory issues) and was exposed to a VERY close proxy of the person here in Oregon that recently tested positive. The doctor at the urgent care (we've gone twice now) even heard crackling in the lungs. They labeled it as the flu (note: my kid was vaccinated this year) but they didn't test for the flu and they only prescribed steroids to clear up the lung issues.

Given the mismanagement I've seen first hand, at this point I am reasonably sure the virus is indeed wide-spread.

EDIT: Just to clarify in case anyone thinks I'm being overly paranoid: the person that tested positive in Oregon is a school employee and acquired it via community-based transmission. The kids that my child goes to school with have siblings that were directly exposed to that person. The time-frame fits within the two week incubation period as well.

Criteria as set out by the CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-crite...

> Fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath) AND Any person, including healthcare workers, who has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset

For healthcare professionals to brush off these facts as "the flu" without first performing a flu test to validate such a claim is irresponsible and indicative of an issue where this virus has gone undetected with valid cases being mislabeled as the flu despite evidence suggestive of Covid-19. Further supported by: https://www.washingtonpost.com/health/coronavirus-may-have-s...

It is Coronavirus pandemic only if you are testing.

If you are not testing - it is just a regular flu.

If anyone is curious, it's now officially in NYC.

Someone came off a plane from Iran. She was officially tested but since she wasn't dying the hospital sent her home for self-quarantine.

Feel free to Google it to read it on whatever site you prefer, but here's a snippet from the Weather channel's site (I saw it when checking the weather today):

> A woman in her late 30s contracted the virus while traveling in Iran, Gov. Andrew Cuomo's office said on Sunday. She is currently self-quarantined in her Manhattan home. The woman has respiratory symptoms “but is not in serious condition and has been in a controlled situation since arriving in New York," the governor's office said. The statement didn't say when the woman returned to the city after her travels, though a statement from Mayor Bill de Blasio said the travel was recent.

First tested and confirmed case in NYC. There have been numerous reports from NYC residents who returned from areas with community spread, got sick, tested negative for the flu, and the CDC wouldn’t test them.

I think in a few weeks we’ll find out that Coronavirus has actually been spreading in NYC for 3+ weeks.

The CDC is incompetent.

The CDC doesn't do much local testing. Mainly they provide test kits to local labs which do the tests.

Please bear in mind that CDC funding for international coordination on pandemic control was cut by 80% a few years ago, and since 2018 they have not had a representative on the National Security Council, and had their senior Pandemic response positions eliminated.

Reports that their overall funding was cut are not accurate, Congress fortunately re-instated their basic funding in the budgets before it came to that, but they have taken a severe political beating and been very much sidelined in recent years, which has not set them up to do their best work.

The problem seems to be one of political perception. Most epidemic and pandemic threats originate outside the US and so significant parts of the CDC are oriented towards detecting, isolating and eliminating threats outside the US borders. They also work closely with international health agencies. The current US administration confuses this with 'aid for foreigners', when it's actually vital national defence.

>The CDC doesn't do much local testing. Mainly they provide test kits to local labs which do the tests.

Yes, but the CDC first botched their test kits and set ridiculously limited guidelines for testing (recent travel to China) that would have caught community transmission much earlier had they been widened.

If this continues, we’re going to reach a point where states and local authorities are going to start ignoring the lagging directives of the CDC out of self-preservation. This already happened in NYC when they told the CDC to get bent with their botched test kits and just started manufacturing their own.

I would upvote 100 times if I could.

The two World Wars of the last century (and again 9/11) have driven home the concept that military security in an interdependent world requires a global perspective. Now is the time to understand that health security needs the same perspective, or even more so - because nature does not care about political borders.

Of course, this is not related to the weird issue with tests not being available. Local hospitals are being prevented from running their own tests not by a lack of availability, but by a special directive that activates during a public health emergency.

That was a serious mistake, certainly. The CDC realy doesn't seem to have been on the ball. In fact a series of mistakes. Why not use the proven WHO test kits in the first place? I hope that wasn't driven by business considerations, or that having 80% of their international activities budget cut limited their ability to co-ordinate with the WHO and other national health agencies.

Can you elaborate on that? I haven't heard of this.

Take a look at this: https://twitter.com/davidalim/status/1233032552056807426

Fortunately I heard this is in the process of being lifted. We should see the tests coming soon.

The CDC doesn't do much (any?) local testing but they established ridiculously stringent guidelines for having people tested. There was a case in NYC over the weekend from a man who had recently returned from a trip to Japan. The CDC wouldn't test him because Japan wasn't on the list at the time and so his case didn't meet their overly strict criteria. The hospital discharged him and he went home... on the subway. Flu symptoms but no flu, recently traveled to a country with community spread, and the CDC said he didn't qualify for a test kit.

According to the CDC there were no cases in NYC until yesterday but that is almost certainly a lie. The quoted numbers from the CDC are completely worthless.

This lack of transparency and accountability is causing people to panic more than they might otherwise. And now that proper testing is finally (maybe?) getting underway we're likely to see the number of cases skyrocket which will cause people to freak out even more.

This panic response from the general public could have been and could still be avoided if the CDC and the federal government would just be open, honest, and transparent with people. But they aren't. They are tripping over themselves relentlessly which is causing panic and stirring conspiracy theorists.

I agree completely, the response internally, and co-ordination with international agencies have both been woeful. My point is that this is hardly surprising considering 80% of their budget for international operations was cut, along with their NSC representation and a handful of their most senior positions responsible for pandemic response. What effect would you expect that to have, when within a year or two of that happening suddenly there's an international health crisis and pandemic?

The CDC, WHO and health care experts all over the world have been saying it's only a matter of time before something like this happens again ever since swine flu, MERS and SARS, but they have been treated like scare mongers and jumped up welfare programs by politicians. Of course they're not up to the task. If they're going to be sidelined, derided and de-funded how on earth could they be?

I've been in NYC every weekend over the last few months, and all members of my family/household has come down with a cold, cough, and congestion. My wife had it the worst (2 weeks), and I had it just for a day. For what it's worth, my wife works from home and didn't leave the house during those two weeks.

I hate not knowing if we've been exposed or if this is just a typical winter thing. We're all individuals with healthy immune systems, and I'll probably never know.

You might know if one day you get tested for whatever reason, they will pick up the antibodies.

> The CDC is incompetent.

Incompetent in achieving what goal?

Building an accurate Coronavirus map has a questionable value, considering that Coronavirus is quite similar to a regular influensa.

CDC was successful so far in delaying Coronavirus panic. Now the US public will learn that the scary disaster did happen several weeks ago and nobody even noticed.

That cognitive dissonance will cause brief embarrassment, but then the general public will calm down and move on to other worries.

Testing is starting to ramp up now and because the CDC is incompetent the numbers are likely going to grow from 80 to several thousand in the span of a week.

Let’s see if people freak out when the CDC tries to explain why that is. “Don’t worry, these numbers are normal, we are just incompetent and weren’t testing thoroughly.”

The panic hasn’t even started yet. It will.

These new [bigger] numbers will show that Coronavirus is less deadly than a regular flu. That happy news will quickly stop the panic.

Situation reports for the whole world from the World Health Organization (WHO) are posted here every day: https://www.who.int/emergencies/diseases/novel-coronavirus-2...

This link was posted 34 days ago on Hacker News, but was then [flagged], but I am not sure why (?): https://news.ycombinator.com/item?id=22168119

Seems like social distancing and a recommendation from the CDC of cancelling mass gatherings of > 5000 would be a great measure to slow the waves of infection that are likely to hit and overwhelm healthcare systems if such measures are not taken.

HIMSS 2020, a conference of ~45000 attendees from 90+ countries is still scheduled to go forward at Orange County Convention Center Orlando March 9-13 - even as major participants withdraw from the event and Florida declares a state emergency. It's very telling of the motives in the health tech industry.

Oh, and many of these 45000 attendees are in fact healthcare workers! So following the event, any attendees exposed to COVID19 are likely to bring it back to the healthcare facilities and communities where they work, creating many additional clusters of infections and transmission.

South by Southwest is still, as far as I can tell, planned to go from March 13 - March 22.

A change.org petition to have it cancelled: https://www.businessinsider.com/10000-call-for-sxsw-to-be-ca...

But the organizers have doggedly soldiered on: https://www.sxsw.com/attendee-safety/

Just want to drop this story from Reddit: https://old.reddit.com/r/nyc/comments/fayko1/my_covid19_stor...

Striking summary from the WHO report: https://www.who.int/docs/default-source/coronaviruse/who-chi...

> Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

Sent this to my friends and family yesterday:

> it is important to note that current global circumstances suggest it is likely that this virus will cause a pandemic.

CDC really isn’t mincing words - this is going to be bad and we should start social distancing to slow the spread.

Sometimes, it's good to be an introvert.

Pandemic is defined when a virus reaches multiple continents so it’s already the case.

For those who want constant updates about the international situation, this is the best source I found so far: https://www.worldometers.info/coronavirus/

By the way , I'm wondering how much the high cost of the test in the US is responsible for a number which looks (to me at least) suspiciously low.

I personally like the CNN new feed for keeping up on new developments:

https://www.cnn.com/asia/live-news/coronavirus-outbreak-03-0...

I also like the wikipedia articles because of the nice data tabulation:

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

I am glued to this. Seems to update in realtime.

I’m a big fan of the Johns Hopkins COVID-19 map, with the ability to click on individual states: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...

Using the JH dashboard numbers, is the death rate calculated by 3000/(3000+45000) or 3000/89000?

Neither, both would be skewed. That's because death happens after infection and recovery takes longer than death, and the number of cases is growing. What you want is dead/recovered N (28 for example) days after infection, which you will have to find elsewhere.

And now I have to question the accuracy of the reports by a government agency that is under a constant threat of job termination if it does not comply with misleading the public..

> Updated February 29, 2020

Why post this here/now?

This page is updated once every few days and there is no change log so it is hard to see news. I don't think anything has changed significantly in the past couple days.

I find it interesting to compare what's CDC is doing right now ( messed up tests, not enough testing, protecting markets but not people) to what we can see CDC doing in movies like Contagion where they are on top of everything before anyone else even knows that the there is a new virus in the wild.

It's not just the CDC, Hollywood movies are modern US propaganda. Soldiers and cops are cool, wars are fun and epic, CDC is omnipotent and omniscient, Eastern European/Asians are always the bad guys, &c.

I can tell you with absolute certainty that the CDC often does know about outbreaks and events before it's generally known to the public. Usually these instances are only of interest to the local communities they are operating in. This is of a different magnitude, and while they haven't slept on the job there's been both external factors and misjudgments in the response that have left them playing catch-up.

You know a handfull of people at the org, and were downplaying problems at the CDC last month.

The CDC slept on this during critical periods, and employees at the CDC did not step up and whistleblow when there was a chance to have a meaningful impact on the spread of the virus.

Stop making excuses for them.

I don’t find it interesting. One is a movie, the other is real life. It’s very difficult to collect accurate data, suss out errors, publish it, revise it, etc. I think the CDC and other agencies do as good a job as can be expected given the current tools and political climate.

See also how 'hacking' is portrayed in movies compared to real life.

My family just got over some sort of respiratory bug that had most of us sick last week. This morning I awoke to find that 2 cases of this thing have been identified in my area. Huh.

We most likely just had a cold. Most likely.

Go for testing. The virus is still present (but not contagious anymore) some time after you recover.

Risk assessment says not to set foot in a medical facility right now unless I'm actively dying, thank you very much.

I don't know where you live but here in UK if you ring 111 and say you suspect you might have the virus they will send someone to drop a testing kit through your letterbox and take it back for testing. No need to go anywhere.

EDIT:

Updated my bad currency exchange math. Thanks, mprev.

In the US, you have to go to a doctor or hospital, hope your insurances covers it, or else you’re out $3000 (£2300).

Minor point but I'm glad to say $3k is more like £2,300.

Then stay at home. If you're sick, refusing to get tested and continue to live like everything is fine you're actively and willingly spreading a deadly virus.

Be calm, I'm all better.

Being calm and following health organizations guidelines (or even common sense) aren't mutually exclusive.

The current guidelines are to test only those with respiratory symptoms who have also traveled to certain countries recently.

Resources are limited, having everyone with a minor case of the sniffles rush the hospitals all at once doesn't sound like a good plan.

The guidelines are also to notify the authorities and to self quarantine if you suspect you could have it, which you just self confessed.

> having everyone with a minor case of the sniffles

But that's exactly what the virus will be for the vast majority of us, the whole point of getting tested is traceability and knowing that you should self quarantine as to not expose people at risk.

edit: and btw that's how they discovered the first case in Berlin. https://translate.google.com/translate?sl=de&tl=en&u=https%3...

> The young man's infection was only discovered because the Berlin Charité also tests the new virus Sars-CoV-2 as standard with every influenza test.

This just shows how bad the US is at handling the situation. In Germany you get tested as soon as you have any symptoms, in the US CDC refuses testing even if you're showing all the symptoms.

why would s/he pay $3000 to get tested for something s/he already recovered from?

https://twitter.com/NickKristof/status/1234140218023989253

This is plain ridiculous. It's like the US is 50 years late on social/health/worker conditions. Mandatory paid sick leave sounds like a win/win thing no matter how you look at it.

> The U.S. is the ONLY wealthy nation that doesn't guarantee all workers paid sick leave, paid family leave & health coverage. This means many workers go to work sick

Don't blame the US. Here in Germany, its 300 EUR out of pocket to get tested (source: tagesspiegel from a few days ago, a story about a guy in Berlin, returning from a trip to Italy and wanting to get tested before getting together with his wife and kids. Doctors didn't want to see him, and the only clinic that was willing to do the test would charge 300 EUR. Public health insurance doesn't pay. Private health insurance probably would though, but it sounded the like he had just public).

If this spreads in the US, dark days are ahead. Many people refuse to go to the doctor because they cannot afford it. A valuable lesson may soon be learned that when everyone has healthcare we are better as a whole. But, COMMUNISM IS BAD, YOu SoCIalIst. /s :|

Exactly. Why are you even paying taxes?

Online people report the CDC test is free.

https://www.reddit.com/r/China_Flu/comments/fc265u/covid19_t...

The $3000 figure seems only sourced from Business Insider, not exactly the paragon of ethical journalism.

Not really, according to this article:

https://www.miamiherald.com/news/health-care/article24047680...

Fun fact: a used PCR machine is only $2500. And if the prices on tests kits out of asia are accurate... You could literally test yourself in your own home for that price. And then you could test a thousand of your friends. If you wanted to

Tampa? That one has me perplexed as, if I read right, those two didn't even travel. That would indicate an unknown carrier, meaning our own guesses of number of cases is probably way off.

Eh, one had traveled to Italy recently, the other is UNK. I've been surprised Florida didn't come up sooner, given all of the tourism here (and winter is tourist season).

Thanks for the correction, I see that now. I had the same thought, especially for Orlando. Here's hoping we handle it well. An outbreak here would likely be far deadlier than most other states, if not all.

Serious question...

In light of the fact that this virus has never been tested for before, how does one know the virus hasn't been part of the popilation for centuries? How do you know your last flue wasn't in fact Covid-19?

With some illnesses -- say smallpox -- you can 'count' the number of cases by symptoms alone.

But for this, it seems the symptoms in the majority of cases are inonsequwntial... similar to the flu or cold.

I don't know what happened in Wuhan. But, as far as the rest of the world, there does not appear to be any significant increase in actual illnesses requiring hospitalization. At least nothing that wouldnt otherwise manifest itself during flu season.

According to this very report, 80% of cases are "mild or moderate". This can mean anything from getting the sniffles for a while, to full on pneumonia (but not enough pneumonia to have to go to the hospital).

Yes it is technically correct that the majority of cases are mild. I wouldn't call that "inconsequential", or "similar to the flu". Maybe "Similar to the worst flu you've ever had", although the important distinction (need hospital vs get better on your own) remains the same. But that statement is true in roughly the same way (and with roughly the same probability(+)) as saying "the majority of people who play Russian Roulette win". Yes, I have an 83% chance of living. I still don't want to play that game

----

(+) According to this very study that we are all commenting on right now, ~20% of cases need hospitalization, and a majority of those cases will be fatal without it

Thanks for the response.

But, my question remains... what evidence is there that this virus is new as opposed to something that has been in the milieu -- causing pneumonia and deaths in the elderly -- for decades?

Put aside the 'confirmed cases' and the like, and focus on sheer symptoms: is there any statistically significant uptick in the number of seriously ill people in the non-Wuhan populations? (I exclude Wuhan because, frankly, neither I now anyone else knows what the hell is going on there.) I keep hearing of one or two 70- or 80-year olds dying here and there... In the same time-frame thousands in this same cohort have died from, presumably, influenza and any other number of respiratory illnesses.

How do we know that the elderly haven't been getting Covid-19 and dying of it at these rates for decades?

I'm genuinely curious. At this point, the story is being driven by politicians and bureaucracies with incentives to plan for the worst... I don't expect a logical and rational analysis from them. But, I do from HackerNew posters. Surely I'm not the only one looking at these numbers, the dearth of information about the test's false-positive rates, the utterly inconsistent data coming from Wuhan vs. the rest of the world, and scratching my head? Am I?

I dont have much to add I’m afraid (feel free to downvote me) but I’m quite intrigued of the HN reaction to this thing. The smartest people in the world (kind of) are also just scared I guess. The usual coolheaded rationalism seems for the first time skewed towards ”its bad I just know it”. I look at the numbers and still cant quite understand what they’re seeing that I dont. I guess its the fear doing it, because we really dont know, and thats just plain scary. And maybe a tinge of satisfaction to be part of this huge drama plays a part too :)

The entire COVID-19 genome has been sequenced and compared to known viruses.

"Phylogenetic analysis of the complete viral genome (29,903 nucleotides) revealed that the virus was most closely related (89.1% nucleotide similarity) to a group of SARS-like coronaviruses (genus Betacoronavirus, subgenus Sarbecovirus) that had previously been found in bats in China" [0]

"This phylogeny shows evolutionary relationships of HCoV-19 viruses from the ongoing novel coronavirus COVID-19 pandemic. All [148] samples are still closely related with few mutations relative to a common ancestor, suggesting a shared common ancestor some time in Nov-Dec 2019. This indicates an initial human infection in Nov-Dec 2019 followed by sustained human-to-human transmission leading to sampled infections."[1]

[0] https://www.ncbi.nlm.nih.gov/pubmed/32015508 [1] https://nextstrain.org/ncov

“Updated February 29, 2020”

It’s March 2nd already why this is still not yet updated again? This has to be updated frequently...

What is "funny", is that the CDC pandemic team was not replaced by the Trump administration. They quit because they got less funding.

So calling the CDC incompetent doesn't seem to describe the complete story.

I was curious why Canada has not had a breakout, given that Canada didn't shut down any flight, and many people from China, Iran, and Korea fly in and out of Canada.

I dont know if it counts as a breakout but Canada has 19 confirmed cases so far.

the data posted to the CDC website seems all over the place. e.g. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

right above the table the report says:

   Updated February 29, 2020

Looking at their editing history on archive you can see how their numbers evolved over time: https://web.archive.org/web/*/https://www.cdc.gov/coronaviru...

inconsistencies/errors in the report (e.g. 21st Feb they claimed 479 total tests): https://web.archive.org/web/20200221040933/https://www.cdc.g...

updating sites without linking to versioned data doesn't give a lot of confidence, but then it's hard to blame them considering Trump admin slashed their budget in 2018.

.. Trump didn’t succeed in slashing the budget, however.

> Trump’s budgets have proposed cuts to public health, only to be overruled by Congress, where there’s strong bipartisan support for agencies such as the CDC and NIH. Instead, financing has increased.

https://apnews.com/d36d6c4de29f4d04beda3db00cb46104

thanks for clarifying that

On the other hand I should add that the staff was cut or changes, with severe impact nonetheless.

From https://news.ycombinator.com/item?id=22446649 :

> However he did indeed cut the people tasked to deal with pandemics. https://foreignpolicy.com/2020/01/31/coronavirus-china-trump....

>> But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.

>> In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 1

I don't think that's the full story. Trump will replace and bully everyone that is not on his side ( just look at his Twitter)

Look at the mess at the Trump administration where competent people just quit and some people stay in the background, fixing things.

They don't even dare to answer the press anymore and limit freedom of speech/journalism.

I'm not suprised that the CDC officials were replaced by Trump loyalists and the current mess he left behind.

Even his main goal of building the wall is too fill his own pockets through friendly contractors.

And I wouldn't be suprised that he tries to manipulate stocks also, people in the past didn't believe him anymore after his multiple attempts to manipulate stocks. Then he actually tried something and went broke multiple times ( Trump casino's). He's more worried about the stocks and low taxes, than the health of US citizens.

And that is not the most worrying part. During his presidency, I have yet to see any sign of intellect.

So here's a serious question.

What are the odds of you getting this virus by handling a DVD that was shipped in the mail from someone who is infected?

I'm actually thinking about suspending my Netflix DVD subscription for a bit because if people are put on "self quarantines" then they might be inclined to watch movies which means they are potentially shipping contaminated DVDs around the country.

Can this virus live for 1-3 days without a host?

This seems like a really bad way for it to spread if it can survive without a host for a bit. There you are, sick, laying in bed at night, maybe rubbing your nose, coughing, touching various parts of your body, laying in a bed you've been in all week while you recover, and then you handle the DVD with your hands, seal it up and send it across the country which is then shipped to someone else.

From the WHO:

>From previous analysis, we know coronaviruses do not survive long on objects, such as letters or packages.

Thanks.

Although, their definition of "do not survive long" isn't crystal clear.

The WHO article you've quoted came from here: https://www.who.int/emergencies/diseases/novel-coronavirus-2...

But that's specifically in reference to receiving letters from China which might take a decent amount of time to cross the globe without human contact. In the Netflix case, I'm sure the turn around time for a DVD to go from household A to household B is a lot less time than China to the US.

If anyone is reading this a few days after this post.

Medical experts who are working with this specific virus wrote:

> Many believe that in most circumstances, the virus can live for a couple of hours to a couple of days, depending on the surface and the environment around it.

That is taken from one of the "verified" replies in https://www.reddit.com/r/Coronavirus/comments/fdf5fq/we_are_....

So a DVD being shipped "in a few days" (which is completely reasonable) falls in line with potentially still being infected if a glossy coated DVD sleeve or DVD is a material that can host this virus for days.

I called Netflix about this and they said they do sanitize DVDs between shipments since they contain personally identifiable data like fingerprints but didn't mention how it was sanitized or guaranteed it would be sanitized. They also didn't mention the sleeve being sanitized that contains the DVD which is definitely re-used between shipments since it's always in questionable shape.

Serious answer: If you're that concerned, disinfect the DVD.

Reply on news.ycombinator.com