OT: Corona virus

[Kull]

ORIGINAL: obvert

This is interesting, and I'm confused as I saw earlier posts suggesting a very different situation. Does this take into account how may of those beds are actually being used on a normal basis? The number of actual respirators and other necessary equipment? ( I haven't looked at links as I'm home doing some parenting, but will).

Not "how many are available" (since that's a fluctuating number, probably higher in the summer and lower during flu season), but the count per country. The EU and US data is fairly old, unfortunately, but I couldn't a table like this anywhere else.

This is what will drive death rates. When a country exceeds it's available CCB capacity (some amount of which, yes, is already in use for other illnesses and injuries), mortality will get ugly.

[Canoerebel]

The pandemic is essentially over in China, South Korea, and probably Japan.

Italy is next in terms of "riding the bell-shaped curve." Italy is currently ascending the "discouraging side" of the bell. How long will that increase continue or is it about to begin a downswing? We don't know yet. Any day could bring a change. But every day the number increases is sobering, as it takes that much longer to get back down to a minimal level. (Iran would offer a parallel to Italy, but there seems to be a lot of uncertainty about the reliability of the numbers coming from Iran.)

Spain (and probably France) are now on the upswing on that discouraging upward trend on the bell-shaped curve. How Italy ultimately fares will help us know how long the bad news will continue in those two countries. Germany and UK might or might not have similar experiences - at the moment, mortality there is significantly lower.

Since Italy has imposed strong countermeasures, followed soon thereafter by most European countries, will that have a dampening effect on the pandemic there? We'll see. It should be noted that Italy has already suffered far more mortality than South Korea.

Thanks to our European "cousins," the USA had the benefit of seeing things develop in Italy, et. al. and to begin taking strong countermeasures relatively early in the ride up the bell-shaped curve. Here, we'll be on the upswing for quite some time but possibly not as steeply nor as long as we would have had Europe not been a week or 10 days ahead of us.

Right now, the news is an unending cycle of calamity or despair, and with some reason. I'm not on social media, but my children and some friends tell me it's even worse there. But some of the underlying numbers look fairly encouraging (South Korea, for instance). We've discussed some of those things in here. If Italy turns in the next week - and I think it probably will - the news cycles will begin to offer some encouraging words. As other countries come to grips with the pandemic and begin to report South Korea-type bell-shaped-curve trends, a sense of optimism will return.

The economic impact of this will be huge, but the optimism/euphoria when the news turns good and when things begin to return to normal will help a bit. (Oil prices were already depressed and are now even more so; production will be curtailed; when things begin ramping back up, production will lag and prices will probably spike.)

I'll be surprised if Europe and the USA don't begin the "hey, are things turning now?" phase in a week or two. Possibly even this week. But I'm no prophet, which is why I don't bet on sporting events or other games of chance.

[witpqs]

ORIGINAL: Lokasenna

ORIGINAL: RangerJoe

ORIGINAL: witpqs



The specialist who was interviewed (the link Erik provided) said at this time there is no reason to believe warmer temperatures will slow it down, although it was too early to tell. IIRC he said it's similar to the MERS virus, which transmits just fine at 110F.

[:(]

From what I read, it is more similar to the SARs virus. In fact, if the vaccine for that would have been made, that vaccine might provide some immunity to this latest Corona virus.

Do you have a background that's relevant to vaccines and virology?

I have read and heard from several authoritative sources that the name given the disease is:
COVID-19 (I've seen use and placement of capital letters and hyphens vary)

The name given the virus itself is:
SARS-CoV-2 (again use and placement of capital letter and hyphens might vary)

[witpqs]

ORIGINAL: obvert

ORIGINAL: Kull

There's a lot of talk about "hospital bed count", but the important number is "Critical Care Beds". Attached is an interesting chart, showing CCBs per 100,000 inhabitants. With a population of about 60M, that means Italy has 7500 CCBs. The current worlodometers chart says there are 1672 serious/critical Covid-19 cases in Italy, so at a minimum that's consumed 22% of all national CCBs. And since those are sprinkled around the country and the majority of Italian cases are in Lombardy, the real bed consumption rate in the affected zones could be 2-4 times higher.

By contrast, Germany has vastly more CCBs (almost 25K) and few reported serious/critical patients. Which means CCB availability is not an issue (at least for now), and is probably at least one reason why the death rate is so much lower. It also suggest that Germany can weather a lot more critical cases before the system is "stretched" and the death rate increases. Something to watch going forward (the same applies to the US).

We keep hearing about "not exceeding healthcare system limits", and this gives a way to analyze and predict what might be coming (i.e. how close is it to Italy)

This is interesting, and I'm confused as I saw earlier posts suggesting a very different situation. Does this take into account how may of those beds are actually being used on a normal basis? The number of actual respirators and other necessary equipment? ( I haven't looked at links as I'm home doing some parenting, but will).

Anyway, I know here there are several proposals to essentially create more using both private care hospitals and even hotels. Best Western have offered their hotels to the NHS and if they can be equipped could provide a lot of secondary space, perhaps for non-critical cases.

In Italy I know part of the problem is that it has been concentrated in one area more.

In one of the interviews I posted a link to I heard them say the US has fewer ICU bed per population than many countries. Is it possible the "critical care" count used here has a wider definition than what is usually tallied as "ICU"?

[Canoerebel]

Here's Chickenboy's analysis from page one (Feb. 26). It makes interesting reading, from our own in-house expert.

I think that Chickenboy would modify some of his thoughts with the benefit of an additional three weeks of information, but if you read back through his comments, the man knows his stuff.

I wish he would post more.

ORIGINAL: Chickenboy

I believe that this virus and disease will have a similar trajectory to that of MERS/SARS some 17 years ago. Coronaviruses are not Orthomyxoviruses (influenza) and act differently in transmissiblity and mutation rates, so again the MERS/SARS analog is probably more useful than H1N1 (1918; 2009) or other seasonal influenzas.

In the case of MERS/SARS, the virus circulated amongst mainland China for some time before diagnosed, a bit longer before there was recognition of it by central authorities and then longer yet before there was even a haphazard and incomplete response. International spread was a feature of the disease. Here's a very interesting and concise timeline from the CDC's website:

https://www.cdc.gov/about/history/sars/timeline.htm

To whit: The disease ran rampant in China for a while. Then it spread internationally. Cases that were not laboratory-confirmed were later re-stated (see entry for July 2003) and halved. In between, the overreaction to cases was addressed (de-stigmatization of SARS) and travel advisories lifted after a few months.

A curious thing about the SARS virus was how it disappeared after a year or so. No isolates were recovered post-2004. Poof. Gone. NIH states that the disappearance was due to quarantine and isolation of affected cases and-of course-due to the research money poured into NIH on interventional strategies.

https://www.niaid.nih.gov/diseases-cond ... onaviruses

COVID-19 does behave somewhat differently in the human host (replicates higher in the respiratory tract versus deeper in the lungs like SARS) and therefore may spread more readily. By nature of its replication patterns, it will also probably have a lower case fatality rate. That's exempting the exacerbatory effects of other co-pathogens (COVID-19 PLUS influenza, streptococcal pneumonia, TB, asthma, emphysema, other respiratory disease in the same patient) of course. I have not seen *any* efforts to parse the effects of COVID-19 from other co-pathogen effects in infected, but this is likely one of the rationale for making sure to get one's annual flu vaccine ASAP if you haven't already done so.

Viruses spread more readily when they make one sick, but aren't fatal. Paradoxically, the sicker people are with a particular virus, the easier it is to diagnose and ultimately contain. The Los Angeles Times had a nice article on this a couple weeks ago.

https://www.latimes.com/california/stor ... a-epidemic

What do I think will happen? Something more akin to SARS, albeit with a more significant global spread in the interim. I expect the peak of this will probably not be too far off and that, with the onset of warmer weather in most of the Northern Hemisphere it will abate. I would be surprised if we heard much about this 12 months from now, excepting in cooler climates (you listening, Oz land?) as they slip into their annual influenza cycle.

The economic and social impacts on our increasingly globally connected supply chains are a totally 'nuther question. I'm limiting my observations to the disease cycle and virus longevity in our public per se.

[Canoerebel]

Partial tallies today.

[Erik Rutins]

ORIGINAL: witpqs
In one of the interviews I posted a link to I heard them say the US has fewer ICU bed per population than many countries. Is it possible the "critical care" count used here has a wider definition than what is usually tallied as "ICU"?

From what I've seen, we in the US have fewer hospital beds per capita than many other developed countries, but far more critical care beds per capita.

[Canoerebel]

Why do we have far fewer? That seems counter-intuitive. Are we able to project needs better? Are we, on average, less in need of hospital beds? Are some beds re-purposed easily? Are more of our cases handled through assisted living, home healthcare, or rehab?

[Kull]

Let's take a closer look at Italy. The map (#1 on the attachment) shows the various regions, and then we have two charts showing cases and deaths by region, as of March 15 (yesterday).

I've highlighted in red the provinces of "Northern Italy", which is where the vast majority of cases and deaths are happening. Specifically, 88% of all cases and 93% of all deaths are in Northern Italy. Also worth noting that as a percentage of cases, the death rates are appalling; 7.8% in the north and 4.5% in the south.

This is something we need to watch in days to come - how many new cases will arise in the south? Did the lockdown happen in time, or did all the refugees from the north bring enough early stage infections with them that we'll see numbers blossom in those regions? And what about the north - how long until we see the effects of the lockdown? And what happens to the death rates? Drop? Rise? Stay constant? We'll see.

Edit: Ooops! Included "Marche" in the northern Italy cases, but not the deaths (it is not part of northern italy). That has a NOTICEABLE impact on the percentages, and modifies this sentence to read: "Specifically, 83% of all cases and 93% of all deaths are in Northern Italy. Also worth noting that as a percentage of cases, the death rates are appalling; 8.2% in the north and 3.3% in the south".

That is a MUCH larger delta between the regional mortality rates.

[witpqs]

ORIGINAL: Kull

Let's take a closer look at Italy. The map (#1 on the attachment) shows the various regions, and then we have two charts showing cases and deaths by region, as of March 15 (yesterday).

I've highlighted in red the provinces of "Northern Italy", which is where the vast majority of cases and deaths are happening. Specifically, 88% of all cases and 93% of all deaths are in Northern Italy. Also worth noting that as a percentage of cases, the death rates are appalling; 7.8% in the north and 4.5% in the south.

This is something we need to watch in days to come - how many new cases will arise in the south? Did the lockdown happen in time, or did all the refugees from the north bring enough early stage infections with them that we'll see numbers blossom in those regions? And what about the north - how long until we see the effects of the lockdown? And what happens to the death rates? Drop? Rise? Stay constant? We'll see.

Also, just looking at the currently published number for Italy as a whole, Italy has 409 total cases per 1 million population. Even just in the north, there is a very large pool of people in place who might already be in those early stages of infection as you mention, or about to become infected.

This is very sobering when you think about the percentages of the population which WHO officials and other health officials have estimated might become exposed and/or infected over the coming months (even out to 2 years).

[Canoerebel]

+1, Kull.

Italy is the bellwether now.

I didn't realize it was so localized there. Lombardy seems analogous to the "Hubei" province in China, and other Italian areas are similar to other areas in China. Hubei had huge outbreak numbers while many others in China had modest or even minimal numbers (see that ubiquitous Johns Hopkins map for details). China's drastic countermeasures mostly limited the outbreak to Hubei. Maybe Italy's measures will have a similar effect.

[witpqs]

From Peter Attia, MD's show notes for one of the PODcasts I posted a link to. The point of this is that SARS-CoV-2 is such a problem because it is a combination of infectious enough and deadly enough. Add in the fact that an infected person is contagious perhaps 7 days before symptoms appear.

[Encircled]

Well, not very reassuring that the UK has put out calls for manufacturers to "retool" equipment to make more ventilators.

And we continue to have a different plan to the rest of the world.

Fine if you are trying to create an empire based on control of the seas I suppose, but SFA use in a global health crisis

[Encircled]

But on the plus side, this Italian Opera singer belting out "Nessun Dorma" to his neighbours is pretty good

https://www.facebook.com/mauriziomarchi ... =2&theater

[Kull]

ORIGINAL: Canoerebel

+1, Kull.

Italy is the bellwether now.

I didn't realize it was so localized there. Lombardy seems analogous to the "Hubei" province in China, and other Italian areas are similar to other areas in China. Hubei had huge outbreak numbers while many others in China had modest or even minimal numbers (see that ubiquitous Johns Hopkins map for details). China's drastic countermeasures mostly limited the outbreak to Hubei. Maybe Italy's measures will have a similar effect.

Thanks for the comment on "localization". I drove down another level and just looked at the death rates in the two hardest hit provinces of Lombardy and Emilia-Romagna. Together (and individually), they have a mortality rate of 9.2%. By contrast, the other provinces of northern Italy are at 4.1%, which is closer to the rate we see in the rest of the country. Furthermore, although the caseload in both provinces is "only" 66% of the total, they have 83% of the deaths in the whole country.

This appears to be clear statistical evidence that once the CCB capacity is overloaded, death rates will spike. Lombardy is probably the most developed province in all of Italy, yet look what's happening.

[Spikeosx]

The private sector continues to take the lead in countermeasures. Here in Las Vegas, NV, MGM and its 9 major casino-hotels announced suspending operations. Same with Wynn resorts and its properties. NFL announced April draft will be without public event.

[Kull]

ORIGINAL: witpqs

Add in the fact that an infected person is contagious perhaps 7 days before symptoms appear.

I keep hearing this (and here's an article with lots of information on where in the body the virus builds up and when), but nobody is explaining how that translates into spread. No symptoms means no coughing, and every major health organization has been emphatic that the primary spread comes from coughing. Biting your nails or picking your nose and touching stuff, perhaps, but that's easily avoided by simple hygiene practices.

Maybe this?

"Researchers in China are warning that the virus causing the novel coronavirus infection COVID-19, which has affected over 100,000 people and killed more than 3,200 globally, can potentially be transmitted through feces.

The reports, published online in Gastroenterology, found that more than 50% of people infected with SARS-CoV-2 have the virus in their stool; some patients have vomiting and diarrhea; and some test positive for virus in stool even after respiratory samples test negative for the pathogen."

So what, right? How many people play with their feces, and yeah there are those animals that refuse to wash their hands after wiping their butts, but it's still a surface transmission mechanism, yes? Ummm no:

When you flush a toilet, the swirling water that removes your waste from the bowl also mixes with small particles of that waste, shooting aerosolized feces into the air.

Low-flow toilets have decreased this risk — they don't gush or blast as much as other types of johns — but countless old toilets are still in use today and can really spew.

Philip Tierno, a microbiologist at New York University, says that aerosol plumes can reach as high as 15 feet.

"It is a good idea to lower the seat, especially if the bathroom is used by multiple people."

Aside from yet another factor increasing the rate of "within household transmission", just think about the last public toilet you used. Most are NOT single-seaters alone in a room, but rather a row of partitioned cubicles (usually open at the top) AND (the best part) containing only seats and no lids. Meaning they create the plume with EVERY flush.

Anyway, add this to your list of "things to be careful" about. So far I haven't seen ANY Covid-safety tips that address this issue.

[Canoerebel]

I had an unusual experience today. On the way back from lunch, I turned on the radio. The broadcaster made essentially the same points we've made in here earlier today about Italy and bell-shaped curves and the importance of it flattening out, etc. He made them so similarly that it was like he was reading a transcript of the forum. He then went on to discuss today's update from Italy, transmitted at 1 p.m. eastern time, and it sounded bad - still on the wrong side of that curve, darn it.

[witpqs]

AFAIK and remembering/interpreting what I have heard in those interviews with experts, they look at droplets coughed out but also just at the plain old exhalation from an infected person. Certainly cover your own coughs, and certainly wash your hands, but one of the experts stressed multiple times that so far the evidence was (always might be new evidence by now) that the primary means of transmission was simply breathing.

One of them commented on what he judged the really bad idea of keeping the passengers on cruise ships with infected passengers, because cruise ships (as he said it) are notorious for recirculating the air through the passenger cabins. They (as he said it) basically insured more people would become infected, and IIRC he even termed it a form of torture.

So, I'm sure you can catch it by other means too, but it seems (IIRC) the most insidious route is simply an infected person breaths out and a non-infected person breaths in enough of that, then becomes infected.

[alanschu]

I keep hearing this (and here's an article with lots of information on where in the body the virus builds up and when), but nobody is explaining how that translates into spread. No symptoms means no coughing, and every major health organization has been emphatic that the primary spread comes from coughing. Biting your nails or picking your nose and touching stuff, perhaps, but that's easily avoided by simple hygiene practices.

Not having a cough from a flu doesn't mean that people never cough as well. I can have a coughing fit because of random dumb luck because some saliva went down into my esophagus and my involuntary reaction to that is to cough. I also live in a dry atmosphere and can casually cough throughout the day just from the dryness. It's just not a coughing fit nor chronic all day. I've obviously not really done empirical studies in my personal life, but I find it interesting how *common* coughing is now that I'm additionally anxious about it.

There was a study done with children that found that healthy kids tended to have coughing episodes about 11 times per day, ranging from 1 to 34. https://www.ncbi.nlm.nih.gov/pubmed/8758131

This would exclude things like sneezing or blowing one's nose (normal numbers for a health person seem to be about 4 times per day). And there's a lot of difficult habits people have as well. I definitely picked up on one my teachers all did: wetting a finger tip to flip through a stack of papers.

There also seems to be an idea that viral load spikes early in the cycle: http://www.cidrap.umn.edu/news-perspect ... 19-viruses

I'm certainly not an epidemiologist, but it doesn't feel surprising to me that if something is contagious enough the day to day actions can still be pretty contagious even if the specific symptoms (which would probably increase transmission rate) haven't yet started to occur. Doubly so if the viral load is particularly high.


EDIT: As witpqs points out, there will be some transmission from breathing alone as well. And if contagious factor is high enough with enough contact with someone else (or large groups of people), odds will go up.