Novel Coronavirus Update – Saturday / Sunday

18Comments

1. 1.

   Martin

   February 9, 2020 at 4:33 am

   Noticed the big uptick in headlines. Every day has and will bring more cases and more deaths, so don’t let the ‘largest number’ headlines lead you to think something has changed – it hasn’t.

   There has been a decent uptick in cases outside of China, but that’s mostly due to one cruise ship off Japan. There are still virtually no cases in the US, and virtually no spread in the US.

   Inside China, the number cases hasn’t accelerated over the last 4 days, which is encouraging. Supposing it’s not a lull in reporting or lack of testing kits or whatever, it might signal that the containment is beginning to work.

   Containment isn’t about getting new cases to 0, it’s about getting R0 below 1. That’s the point where each infected person infects less than one additional person. That’s the the point where this starts to wind down as each incubation time period (around 10 days) will result in fewer infected than the previous period.

   So, the data isn’t alarming and is starting to show the potential for optimism.

2. 2.

   joel hanes

   February 9, 2020 at 5:25 am

   The Trump maladministration has spent three years tearing down the pandemic response apparatus created in response to the Ebola and SARS scares by the Obama administration.

3. 3.

   Cermet

   February 9, 2020 at 5:58 am

   So China is holding the line, which is good news for us; the illness is likely to hit the poor far harder – no surprise there with profit drive heathcare systems. The death rate still appears to be 2% (while four times worse than the current flu – that later illness is something that most people are completely indifferent about getting.)

   Considering all these factors, not alarming compared to previous outbreaks – like AGW, illnesses are getting stronger (as the environment degrades and more animals are forced into human contact and/or are eaten due to presures on food sources these plagues are highly likely to continue.)

4. 4.

   Rusty

   February 9, 2020 at 6:29 am

   Had an interesting conversation with someone that manages a project team in China (several hours from Wuhan).  They pulled all the Americans three weeks ago.  The report from those that remained is that the authorities have been sending the sick home since there is no capacity to house them. They are dieing at home and not getting reported.  Normally I would think this as unsubstantiated rumor, but there have credible reports of this.  Containment may well be working, but it’s quite likely the death toll is higher than reported.  I think where we have been lucky is that this has not spread to areas of the world with much weaker health systems.

5. 5.

   YY_Sima Qian

   February 9, 2020 at 6:42 am

   A few updates from me:

   1. Dad is 3/4 of the way through his quarantine at March ARB, no symptoms; nor is anyone else on the flight, so clock should not have to be reset.
   2. Mom made it on a flight to New York, and has reached her final destination; symptom free and entering 14 days of self-quarantine; I told her not to wear mask after leaving the airport, despite it being the more responsible thing to do, I did not want her harassed…
   3. I repeat, there is no social unrest in Wuhan, no breakdown of public services or public order, no significant shortage of basic necessities. Food and daily supplies are more cumbersome to obtain, and selection more limited, but no one is in danger of starvation or malnutrition. I see a lot of ignorant and hysterical pontifications in western MSM on social media, even comment sections of self-styled “reality based communities”. (Not here on Ballon-Juice, to everyone’s credit).
   4. I mentioned it before in previous comments, but it bears repeating: when analyzing the numbers, one should keep in mind the following: confirmed cases is a lagging indicator for the spread of the virus (due to previous shortage of test kits, especially in Wuhan), deaths are even further lagging indicators. Furthermore, one should treat the numbers for Wuhan, Hubei province ex-Wuhan, and China ex-Hubei as separate sample populations, vastly different circumstances producing vastly different results (see the mortality rates, at 4%, 1.5% and 0.2%, respectively)
   5. Wuhan is a cautionary tale of a what happens when an epidemic has reached critical mass before effective response is implemented: no city in the world has the number of isolation ICU beds ready for a significant outbreak of virulent respiratory infectious disease, so it is imperative to contain the outbreak at the very early stages before the virus has substantially adapted to human physiology and starting widespread human-to-human transmission. Otherwise, the hospitals are quickly overwhelmed with overcrowding, dire shortage of basic medical supplies, and high risk of infection of medical staff and cross-infection of patients. Severe and critical cases require a lot of intervention to keep the patient alive long enough to his/her immune system a fighting chance, if hospitals are overwhelmed and collapsing, many patients won’t get that chance. The period of relative inaction during second and third weeks of Jan. (perhaps due to the back to back Party congresses at the city and provincial levels) pretty much baked in what has happened since. I doubt any other city in the world would have produced significantly better outcomes if placed in position of Wuhan on Jan. 23, likely worse since almost no government has the capacity to mobilize and organize resources on short notice and at all levels of society to respond to disasters as the CCP regime. So, don’t let it get to that point!
   6. Stop focusing only on the mortality rate. What is stressing the medical system is the ~ 15% morbidity rate, each case requiring significant resources and long time to treat. Even those who ultimately survive may have residual effects, such as reduced lung capacity. IMO, what makes the 2019-nCoV so pernicious is the relatively long incubation period, relatively contagious, the large number of mild or asymptomatic cases that are still contagious, the relatively high percentage of severe to critical cases among the elderly and those with medical complications, and the long time in ICU to full recovery. Perfect cocktail to overload any medical system.
   7. The data from the last four days have been fairly encouraging, with daily increase of confirmed and suspect cases generally trending down in Wuhan and Hubei, and rest of China. It appears the quarantines and public education campaigns are having an effect. The numbers from Wuhan most certainly greatly under count the numbers of infected (many mild cases not captured in the statics, due to not being tested) and deaths (people passing before having a chance of being tested and treated), I can only hope that the trend still reflects the underlying reality. Wuhan is launching an effort to confirm the vast majority of suspect case and those showing symptoms over the next two days (I tend to cringe when governments sets such hard targets, creates all kinds of unintended but perverse incentives). I would not be surprised to see jumps in confirmed cases. The confirmed cases in many provinces have already reached inflection, possibly indicating that that lock downs and public warnings and awareness happened just in time to avoid additional Wuhans in rest of China, outside of Hubei. Hopefully it is not local governments messaging the data, as they are under tremendous pressure from Beijing to achieve containment. Many provinces have responded more quickly and effectively than Wuhan and Hubei.
   8. I am sure everyone in China, from President Xi down to the average citizen, is waiting with bated breath, as much of the country return to work tomorrow. Some local governments have pushed return dates a week further out, and many companies seem to have implemented policies of requiring 10 – 14 days of self-quarantine if the returnee took public transportation. People are encouraged to work from home if at all possible. We shall see if there is a new wave of spread in the coming two weeks.
   9. The cities in rest of Hubei province has been somewhat neglected by both Chinese and international media, but their situations are no less precarious than Wuhan in some cases. Beijing just announced that 16 provinces and municipalities will “adopt” a city each in Hubei to assist in providing medical and other assistance to help contain the situation. Something similar was implemented after the devastating 2008 Wenchuan earthquake. Each province and municipality “adopted” a country or prefecture in the affected area, to lead its reconstruction. This eased the burden on the central and Sichuan provincial government, and promoted competition among the provinces to achieve the most positive outcome. Traveling through western Sichuan in 2011, the result was quite impressive, especially the physical aspect of recovery. I hope it has a similarly positive effect here.
6. 6.

   YY_Sima Qian

   February 9, 2020 at 7:26 am

   @Rusty: Wuhan is now implementing a five tier system to get the infected and potentially infected away from their families and the general population: confirmed critical cases go to the temporary hospitals; the confirmed severe cases go to the hospitals; confirmed mild cases go to the centralized temporary medical facilities, converted from public arenas, for monitoring and treatment; suspect cases are quarantined into commandeered hotels waiting for confirmation; people under medical observation are quarantined into other commandeered hotels. The ones worst off are the suspect cases already in severe or even critical condition, but have not yet been confirmed. Such cases would be lucky to get into a hospital, and the hotels they may be quarantined in have minimal medical staff. All the more imperative that Wuhan clears most of the backlog of suspect cases.

   Previous SOP was to send the mild cases back home to self-quarantine. The idea was to prevent them from overcrowding the hospitals and keep them away from the general population. However, for some their conditions worsened to severe or critical without getting a chance to be confirmed (even the confirmed had to wait in line for the limited beds in isolation wards), and they continued to jeopardize their families.

7. 7.

   Rusty

   February 9, 2020 at 7:57 am

   @YY_Sima Qian:  Thank you for the explanation. Your comments have been very appreciated.

8. 8.

   MattF

   February 9, 2020 at 8:07 am

   Ebola became a RW meme, because Obama. I once tried pointing out to a winger that you had to be in close contact with an infected, very sick person to get it, and he just ignored me. Of course, what with America being Great Again, no worries.

9. 9.

   MattF

   February 9, 2020 at 8:11 am

   @YY_Sima Qian: We’re all grateful for your reports.

10. 10.

    Laura Too

    February 9, 2020 at 8:34 am

    @YY_Sima Qian: Thank you!

11. 11.

    arrieve

    February 9, 2020 at 9:41 am

    @YY_Sima Qian: Thanks very much for the update. I really appreciate your taking the time to let us know the situation on the ground. And I’m so glad your mom was able to get on a flight!

12. 12.

    artem1s

    February 9, 2020 at 10:03 am

    @YY_Sima Qian:

    thank you for this thoughtful update! I wish our media was more focused on information gathering and dissemination during any kind of crises.  It’s always been comforting to me when I have some understanding of the hidden infrastructure involved in this type of event. Maybe that’s naive? But it certainly beats Fox News hysteria outbreaks.

    I’m so glad to hear your family is OK

13. 13.

    Betty

    February 9, 2020 at 10:17 am

    It is so helpful to have this on the ground objective information. Thank you YY.

14. 14.

    Joseph

    February 9, 2020 at 10:21 am

    @Cermet: I’m not a statistician, but to arrive at a 2% rate, one would divide the number of deaths by the number of confirmed cases. Wouldn’t a more accurate number be derived by dividing the number dead by the number recovered? This would produce a roughly 30% death rate.

15. 15.

    susanna

    February 9, 2020 at 10:45 am

    @YY_Sima Qian: Great read!  China is impressive with its reaction and solutions to this outbreak.  I’d imagine the next few weeks will reveal the state of successful medical response.

    Thank you for this helpful, interesting reporting and do keep us up to date with future information about this.

16. 16.

    J R in WV

    February 9, 2020 at 12:27 pm

    @YY_Sima Qian:

    I too want to thank you for the detailed in person reporting you have been providing. The B J jackals are as well informed as possible thanks to you. Best of luck at ground zero.

17. 17.

    Emma

    February 9, 2020 at 12:37 pm

    The US media attention would be good… if they didn’t insist on going all “Yellow Peril: Sequel #184785.” I’ve been reading the Angry Asian Man, and it feels like half the content recently is about idiot Americans being racist toward Chinese and Chinese Americans. Probably non-Chinese that idiots assume are Chinese, too.

    https://www.grubstreet.com/2020/02/chinatown-restaurants-suffering-amid-coronavirus-fears.html

    https://www.columbiaspectator.com/news/2020/02/06/anti-chinese-message-written-in-butler-as-anxiety-rises-over-coronavirus/

    https://www.nbcnews.com/news/us-news/coronavirus-hate-attack-woman-face-mask-allegedly-assaulted-man-who-n1130671

18. 18.

    YY_Sima Qian

    February 9, 2020 at 8:13 pm

    @Emma: That’s why I told my mom to remove her mask as soon as she has collected her luggage and separated from the other people on her flight.