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You are here: Home / Economics / C.R.E.A.M. / ‘Centered in Wuhan’ Coronavirus Update, Tuesday / Wednesday

‘Centered in Wuhan’ Coronavirus Update, Tuesday / Wednesday

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C’mon, you *know* I was gonna boost this! Per Deepa Shivaram at NBC:

As focus on the coronavirus intensifies, Massachusetts Sen. Elizabeth Warren is releasing a new plan on how to prevent the transmission of infectious diseases and better prepare for global outbreaks.

Her in-depth agenda focuses on fully funding global health agencies, investing in the development of vaccines and ensuring that health departments and hospitals are prepared to handle potential outbreaks.

“The best way to beat a pandemic is to prevent it from starting in the first place,” Warren’s plan says, “As president, I will work to build the foundations that help us catch infectious diseases before they spread.”

Though Warren does not specify where the funding would come from, a large portion of her plan revolves around funding organizations that would strengthen global health infrastructure. She specifically mentions fully funding the Centers for Disease Control, USAID and the Global Health Security Agenda, which involves 50 countries…

Of note, Warren makes a point to mention the importance of spreading factual information and countering misinformation in the process of combating global outbreaks. She says she will work with the private sector on this issue.

“Science will once again be in charge at the CDC,” the plan says.

The focus on science also ties into Warren’s portion of the plan that tackles the crossover between climate change and disease outbreak. Her plan folds in portions of her previously released plans on climate and adds in a focus on preventing spread of disease after natural disasters…


When a new disease emerges, health organizations turn to a seemingly simple number to gauge whether the outbreak will spread. It’s called the basic reproduction number—R0, pronounced R-nought—and though useful for decision makers, it’s a nightmare for public communication. In brief, R0 is the average number of people who will catch the disease from a single infected person, in a population that’s never seen the disease before. If R0 is 3, then on average every case will create three new cases. But even though it seems incredibly straightforward, it’s hard to calculate and tricky to interpret.

R0 is important because if it’s greater than 1, the infection will probably keep spreading, and if it’s less than 1, the outbreak will likely peter out. So it offers vital information to organizations and nations as they consider how to respond to an outbreak—such as the one the world is currently experiencing…

First, the R0 estimates for the new coronavirus are in line with those for many other diseases. They’re similar to those for SARS (2 to 5) and HIV (also 2 to 5), and considerably lower than those for measles (12 to 16).

Second, a bigger R0 doesn’t necessarily mean a worse disease. Seasonal flu has an R0 that hovers around 1.3, and yet it infects millions of people every year. SARS had an R0 of 2 to 5 and infected just over 8,000 people. The number is a measure of potential transmissibility. It does not actually tell you how fast a disease will spread.

“People make the mistake of thinking that a high R0 means that you’re inevitably going to end up with a pandemic, and that’s not what it means at all,” says Maia Majumder from Harvard Medical School, who published one of the seven estimates for the new virus. In her view, if the number is higher than 1, we should take the disease seriously. But exactly how high it is beyond that threshold isn’t very informative at this stage.

Why? Because third, R0 is an average. Let’s say the virus has an R0 of 2. This could mean that every single infected person passes the virus to two other people. It could also mean that one infected person is a “super-spreader” who infects 100 people, while 49 infected people infect no one. These two scenarios have radically different implications for what will happen during an outbreak.

Fourth, R0 is not easy to calculate. That’s especially true in the early days of an epidemic, when it’s not even clear how many cases there have been. Some people might have been infected without showing symptoms. Others might not have reported their symptoms to health authorities. Absent clear data on who has the disease, let alone how they’re moving around and interacting with other people, scientists have to calculate R0 by doing complicated simulations using a variety of possible methods. That’s why early estimates can vary so wildly, and why they should be taken with a grain of salt…

Interesting details, *if true*:

Reader Interactions

14Comments

  1. 1.

    Mary G

    Thanks as always for so many interesting links, Anne Laurie. I love Senator Warren for having a plan and restoring science.

  2. 2.

    JAFD

    Good morning, jackals and gentlepeople,

    Am wondering, as Mr. Yong mentions, how to tell ‘bad cold’ from ‘the new plague’, any new indications when to go from ‘grandpa’s remedy’* to ‘call the ambulance’ ?

    In other medical news, I mentioned Monday morn that I was going to cardiologist’s appointment.  So: Had ultrasound scans for blood clots in legs, two weeks ago, they were negative.  Doctor said my condition was improving, smiled.  Seems the medics think I should get a pacemaker installed; if so, then the sooner the better, I say.  Will keep you posted.

    My local drugstore is out of face masks (project on workbench will cause lotsa dust…)

    Will be getting a couple of calendars in a day or two.  One for me, one for actual owners of Zola (short for Gorgonzola, pic in August).  Waiting for dust to settle.

    On to February, everyone !

    * Mug of hot tea, with honey and lemon and a shot of Scotch.  If it don’t kill the germs, at least it’ll show them a good time.

  3. 3.

    Martin

    So here’s how to qualitative gauge the R0 dynamic. Look at JHU’s coronavirus dashboard and note the total confirmed cases line chart in the lower left corner.

    Outbreaks follow a classic s-curve – they start out slow, then accelerate and shoot upward quickly then at some point start to round over, slowing down until the turn back into a horizontal line, at that point there are no new cases. It takes a while to ramp up and a while to totally die out, and goes nuts in between. In the middle, usually when things are looking worst you’ll get an inflection point, where it stops accelerating and starts decelerating. This is the point that things start to get under control.

    An R0 value of 1 means that you have linear growth – one new case for each infected person. That’s the inflection point. A higher R0 value means that it will accelerate. A lower R0 value means that it will decelerate.

    On that total confirmed cases, you’re looking for it to start to round over, with the same or fewer cases than the day before. We’re so early in this that just a one day snapshot won’t tell us anything because that’ll just be noise in case detection and communication, but when you see it consistently over a few days, then it’s winding down – quarantines worked, vaccines are working, etc.

    1000 new cases a day isn’t great, but Wuhan has 11 million people, so it’s still down in the 0.01% of the local population contracting it. That’s not a frightening number. It may become one, but it’s not there yet.

    The expats being returned to the US will be landing at March AFB instead of Ontario airport. Ontario was a pretty good place to land, but maybe they didn’t want locals to freak out. March AFB isn’t as out the middle of nowhere as it used to be, but there’s no passenger traffic to deal with and I’m guessing everyone will be quarantined there for a spell.

  5. 5.

    OzarkHillbilly

    I watched Contagion a few weeks ago, just before or just as all this was getting going. It’s a pretty good flick with lots of good actors but the best thing about it is they get the science right (or so I’ve read, of all the sciences biology is not among the ones I am conversant in). It works as a pretty fair explainer of infectious diseases and how they spread, or at least as much as one can expect from Hollywood. For instance, they have an in depth conversation on the R0 number, what it is, what it means, how it’s calculated, and why it changes as investigations proceed.

  6. 6.

    OzarkHillbilly

    @JAFD:

    My local drugstore is out of face masks (project on workbench will cause lotsa dust…)

    Try hardware stores, paint dept. Thanx for the heads up, I have to use them on a semi regular basis and it hadn’t occurred to me that people might be grabbing them up already.

  8. 8.

    EmbraceYourInnerCrone

    @JAFD: good news! Hope everything keeps improving.  Ah I see you use my Mom’s cold remedy, except she used bourbon or maybe hard cider

  9. 9.

    Cermet

    Thanks for the good overview. I wonder what “severe” means? While of course it means it moves into the lungs, does it mean Pneumonia? I’ve had both types of colds – a bad flu i.e. involving a chest cold with bacteria but it wasn’t Pneumonia. I’ve also had Pneumonia – the difference is the location: upper lungs vs. lower lungs for the bacteria infection. If 20% of all cases of severe means upper, than not too much different than normal colds for older people and children; if it occurs in the lower lung section, than that is a world of hurt and is very dangerous.

  10. 10.

    chopper

    @OzarkHillbilly: 

    as luck would have it i just finished a big bathroom reno and have a bunch of face masks. not that N95 masks are the best when it comes to airborne droplets.

  11. 11.

    Formerly disgruntled in Oregon

    Sen. Elizabeth Warren is releasing a new plan on how to prevent the transmission of infectious diseases and better prepare for global outbreaks.

    Good for her – this is an area where we really could use some focused attention.

  12. 12.

    Emma

    Ed Yong is an exemplary scientist and science communicator. He has a lecture on GI microbial diversity that he gave at the Royal Society (up on Youtube) that is both informative and hilarious. His articles in The Atlantic are also always worth reading. By the way, has anyone watched Pandemic on Netflix yet? I can’t tell if it was the BBC series that ran one or two years ago that also had an app for UK residents to report illnesses as the show ran. Very interesting concept.

     

    Thanks for the update as always, AL :)

  13. 13.

    jl

    The economics of epidemic control is like the economics of endogenous growth theory (sorry for econsplaining, but put it in there in case Anderson comes by this thread). The implications are a little different. Efficient control of epidemics is that when the epidemic just starts, you womp on it, put the pedal to the metal to stamp it out or keep it very small. You get increasing returns to additional effort. After it gets a certain size, you cross and irreversable threshold (unless new technology saves you) and you are in the dismal economic world of decreasing marginal returns. And can’t make a policy argument for womping on it. Social welfare is usually far less in that case.

    So, Warrren, still my fav candidate has a good plan.

  14. 14.

    jl

    Also too, the declining case fatality rate was predicted, from over 3 to 3 to 2.75 to just over 2 percent, by my tracking of numbers in the news.

    Early on docs notices a wide range of severity in the cases, so suspected that there were a large number of mild, and therefore, unreported cases walking around. Now with strict surveillance, milder cases being reported and recorded. Still, fatality rate, even at 2 percent, could have serious consequences, and declaration of public health emergencies if it spreads rapidly probably appropriate recourse.

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