There’s a lot being written about COVID-19, the new coronavirus, maybe too much in my opinion. There’s a lot that can be said about China’s political reaction to the virus, although even there we are at the beginning of things, and there’s a lot we don’t know.
I read a short and well-written article last night in Science magazine. It got me thinking about what I’m looking for in news about the virus. The mathematics of disease transmission are similar to the mathematics of chemical kinetics, which was part of my life as a chemist. That’s where my questions originate.
There is no evidence that the virus was generated as part of a biological warfare program. Its DNA has been sequenced, and there would be clues there if that were the case. It most likely originated in bats, as has been true for other coronaviruses, and was transmitted through another animal in a live-animal market. Tom Cotton lies; but we knew that.
We know very little of the parameters that are necessary to predict how widely the virus will spread or how dangerous it will be. Epidemiologists are collecting data, but the parameters depend on statistics that we need more of or time-consuming laboratory work that may be hard to carry out while treating sick people is the first priority.
- How many cases are there? Some cases have been carefully diagnosed with appropriate laboratory tests. The reported number shot up during the past week when China loosened the criteria for reporting. Some people may be infected without symptoms or may have minimal sniffles and may not be counted. This website from Johns Hopkins gives confirmed cases, deaths, and recoveries.
- How contagious is the virus? This is represented by R0, the measure of how many people one person with the virus infects. We don’t know whether the virus is contagious before people show symptoms. We don’t know how long the incubation period is. R0 is derived from observations, so it is likely to change as more information comes in. I have seen a wide range of estimates for R0.
- What happens to the virus as the seasons change? Some common cold viruses, including coronaviruses, become less infective as the weather warms in spring. But not all coronaviruses, and we just don’t know about this one.
Every day, there is more information available, but I doubt there will be a reliable R0 for some time. Each case can provide a bit of data – I particularly hope that good records are being kept on that cruise ship in Japan.
James Palmer is a good Twitter follow on the subject for the big picture. He’s lived in China.
Starfish
Thank you for posting the link to the JHU website. I had seen people posting screenshots of it on Twitter, but I did not know where they were getting the information.
Goku (aka Amerikan Baka)
That’s the big fear in places like Africa; there was recently a confirmed case there (forget exactly where). The continent doesn’t have the medical infrastructure to deal with a large scale outbreak aside from a few nations like South Africa.
So far, most of the deaths are from the elderly and those who have underlying health conditions. It seems the vast majority of those infected are either asymptomatic or have mild symptoms on par with a bad cold/flu. However, at least in China, 20% have had severe symptoms, to the point of needing to be on a ventilator because of pneumonia. ICUs provide these services and there a limited number of those, obviously. Imagine hospitals and ICUs being overwhelmed by COVID-19 cases; other serious conditions, such as CAD, MI, etc requiring ICU treatment won’t go away just because there’s a COVID-19 epidemic.
Combined with the possible economic fallout of this new virus, I think everybody should be concerned about COVID-19. No, it’s not Captain Trips, but it’s not the flu either. Most people infected will be fine. The real trouble will be if/when healthcare systems become overwhelmed, the world goes into a depression because supply chains are interrupted, and COVID-19 becomes endemic to multiple populations.
I’ve seen reports of cases in Japan and (I believe) SK as well as Taiwan that haven’t been traced to any travel from China, which perhaps suggests community transmission may already be taking place. I have to wonder how many cases that don’t fit testing criteria are flying under the radar now.
Finally, I understand it’s counterproductive to panic. But I feel that too many people, including government authorities in several countries, aren’t taking this more seriously. There’s a lot of ground between “we’re all gonna die!!!” and “the flu kills more people, who cares”.
trollhattan
IIUC the Chinese initially handled it as though it were not transmissible before symptoms showed and it was later shown to be an incorrect presumption. If so it reminds me of how PG&E operated the pipeline that failed in San Bruno–they didn’t have records of what type of pipe it was and presumed it was stronger than in reality.
Oops.
MattF
At the moment, we get daily reminders that we don’t even know the order of magnitude of basic parameters, and we don’t get much insight into the meaning of those parameters— even if we knew their values. It might be useful to identify a set of parameters and get a sense of what the numbers mean. So, e.g., if R0 is less than one, there’s no epidemic, while if it’s eleventy gazillion, we’re in big trouble.
J R in WV
Thanks for the information, Cheryl. Always good to see data !!
swiftfox
Good article in Statnews that indicates the virus will become another influenza-type sickness that we will have to prepare for. I see articles in BJ that stress the severity of the outbreak and the blasé attitude on CNBC.
wvng
Cheryl, I’ve read that air quality is very poor in Wuhan province, and that lots of people (men in particular) also smoke. To what extent could mortality rates in that area (and I suppose China generally) be particularly high due to having a large population with compromised respiratory systems?
The Dangerman
@Goku (aka Amerikan Baka):
Yeah, bad time for an Olympics in Tokyo.
I also wonder how Trump weaponizes this (in a figurative sense) as the elections heat up
ETA: Watching Tom Petty on AXS now and getting sad; getting old blows but the alternative blows worse.
JCJ
Good afternoon Cheryl
I was in Bangkok at Chinese New Year and there were large numbers of tourists from China there and elsewhere in Thailand cor the holiday. I suppose the epidemiologists are looking at cases there as tourists were diagnosed. Spread within Thailand would give an idea of transmission.
I stopped by a 7-11 one afternoon near our condo and there were probably 20 tourists there. I didn’t even go to the Grand Palace or any tourist sites. My wife reads news from Thailand every day. In Chiang Mai there are reports of about 200 tourists every day seeking to extend their visas in order to stay in Thailand and forestall returning to China.
opiejeanne
Thanks, Cheryl. My kids asked us yesterday if we were still going to Europe this spring, because of COVID-19. We told them yes. We’re beginning to be elderly, will both be over 70 by mid-March, and we know that it’s more of a danger to us, but doggone it, we are going and we intend to have a great time.
Another Scott
I’ve probably missed it, but I would like to know:
I’m not expecting answers here, these are just thing rattling around my head that I hope are answered sometime soon.
Thanks.
Cheers,
Scott.
Mary G
I watched Chernobyl, China has disappeared at least one person who was reporting, and Twitler has control of the administration and still wants to cut the CDC more. So I worry, but there’s nothing I can do about it, so not too much. I am glad that they’re finally letting people off the cruise ships; that must have been a nightmare being stuck on those.
opiejeanne
@wvng: I would guess that both the smoking and poor air quality definitely have an impact. Wasn’t this virus killing mostly men at first?
oldster
Tom Cotton is one of those fundamentally immoral people who won’t be happy until he starts a war. He doesn’t care much who it’s with — Iran, China, it’s all good. He just lusts after war the way normal people lust after pleasure. He is a sick f*ck, and he’s going to get some people killed. Let’s hope it’s just himself.
And thanks, Harvard, for giving us another highly credentialed psychopath. What is it — do you make monsters, or just attract them? Maybe it’s a bit of both, and you’re the finishing school.
Ninedragonspot
@Goku (aka Amerikan Baka): There was one death in Taiwan announced in the last 24 hours. The victim had not traveled to China, but was a driver who may have been exposed via a tour group originating in China. He was diagnosed post mortem, as the Taiwanese CDC was (re)testing all pneumonia cases looking for similar cases. They’ve turned up just one more. Total number of coronavirus cases is about 20. Taiwan has been doing pretty well in handling COVID despite their exclusion from the WHO. Or maybe that’s a benefit these days.
https://twitter.com/royngerng/status/1229010383563739138?s=21
WaterGirl
@Mary G: More power to the people who will still go on cruises, but I don’t believe I will ever be one of them. I can only imagine being confined to one of those tiny little cabins for days/weeks.
:: shudder ::
Cheryl Rofer
@J R in WV: I wish there were more data!
Cheryl Rofer
@wvng: Compromised lung capacity from smoking or air pollution is likely to be a factor, in both transmission and how severe the illness becomes, once it is contracted.
opiejeanne
@WaterGirl: I can’t even imagine it.
The Disney Cruise we went on was great, and the tiny cabins were only for crew. My daughter worked as a character & dancer in the shows, and we got to see hers. Awful living conditions for the crew, but apparently better than other cruise lines.
We are looking at maybe a cruise to Alaska from Seattle sometime in the future, but I wouldn’t book an inside room. Too claustrophobic.
JaySinWA
@WaterGirl: Outbreaks of norovirus on cruises should be evidence enough of the risks of cruise quarters
The death rate from norovirus appears to be fairly low though https://wwwnc.cdc.gov/eid/article/19/8/13-0465_article
Cheryl Rofer
@Another Scott: I wonder about your #1 too. I haven’t seen a lot about symptoms. It seems to be mainly a respiratory disease that goes over into pneumonia rather easily.
Partial answer to #2: I was wondering about this too, and why SARS just seemed to die out. I found an R0 of less than 1 for SARS, which is an explanation in itself, as MattF points out.
To me, the big overall question is why we’re not seeing more transmission outside of China. That suggests a low R0, or perhaps not so much lung damage from air pollution and smoking.
3. I’ve wondered about that too. Have no idea whether it’s COVID-19 or something else.
4. Cases in China seem to be leveling off the past couple of days. If that continues, the quarantine and restrictions probably are part of it.
The Dangerman
I see Donald and Melania showed up for the Daytona 500. She always looks so excited to be out among the Great Unwashed. Maybe she has a bad case of uncontrollable diarrhea.
germy
Cheryl Rofer
@germy: That’s what I was referring to
germy
@Cheryl Rofer: Oh, when I saw the word “reiterates” I thought he did it a second time after you mentioned it.
LuciaMia
Did AIDS originate in bats? (too lazy to Google)
Goku (aka Amerikan Baka)
@LuciaMia:
Primates (chimps), I believe. It crossed over to humans in the 1920s
Goku (aka Amerikan Baka)
@Ninedragonspot:
Thanks!
MisterForkbeard
@opiejeanne: We took a princess cruise from San Francisco to Alaska several years back – we got a not-too-expensive canbinnwith a small balcony, brought an entire suitcase of books, and had a great time.
I also got to be one of 10 people taking the “behind the scenes tour”, and got to see the crew area. The laundry room and the kitchens were super interesting. The crew bedrooms were really tiny. :/
Luigidaman
I was living in Xi’an China this summer (home of the Terracotta Warriors) and one thing you can count on is that the leaders of the country will lie constantly and continually. They make Trump look like an amateur when it comes to weaving a bullshit story. The people of China pretty much buy the paternal party line and do whatever the elders tell them to do. With luck, the Coronavirus will have already peaked and headed downward in its spread. But, that is with luck only. Watch what the WHO says now that they are on the ground and that will give you a clear idea of what is happening.
Sab
@Cheryl Rofer: Chinese cities have really terrible air. So their middle-aged and elderly are already compromised healthwise.
Ksmiami
@JCJ: monkeys
@LuciaMia:
Mel
@WaterGirl: I’m with you!
I can’t imagine being in such a contained space with such a large quantity of strangers (introvert here), with the only escape being the tiny suite.
Plus, the whole “floating petri dish” thing is a pretty off-putting. I have had norovirus. I do NOT want to ever repeat that experience.
Apologies to those who love cruises (includes my nephew and niece, who always seem to have a great time).
J R in WV
@Sab:
When I was a little kid, in the 1950s, when dad would take me with on business trips to Charleston, Chemical Valley, I was always shocked by how bad the air was in the Kanawha Valley. From the Du Pont plant in, wait for it, Du Pont east of the big city to Union Carbide in South Charleston and across the river in Institute, were pumping poison into the air 24/7/365, not to mention into the river as well.
When you came out of the Turnpike tunnel into Cabin Creek back in the ’50s, the air was literally yellow with a wide variety of toxins, including Chlorine, Agent Orange, Carbon diSulfide (my personal favorite, I still have skin problems from exposure to Carbon biSulfide) and things too commercially valuable to be revealed to the public. People were evacuated from time to time when a plant had a large volume spill or poison.
Trump wants to bring back the days of breathing poison, if it makes him a plugged nickle.
opiejeanne
@Mel: No need to apologize. We were on a Norwegian Lines Cruise, coerced into it, about 8 years earlier and it was night and day with the Disney Cruise. It wasn’t bad, but the Disney experience was just so much better. There were sanitation stations everywhere on board the Disney Wonder, and you weren’t allowed into your dining room without using the one at the door. My kid told us that the first sign of the Norovirus, the cruise would be cancelled and everyone sent home. A lot of the crew had worked on other cruise ships without the stringent sanitation policies and were grateful.
The ship limited the number of children aboard, and there were a lot of people without any. There were places to be with your kids and places where no children were allowed so you didn’t have to be with other people’s kids. Heck, they had “nannies” who would watch your kids if you didn’t want to be around your own, for no extra fee. It was a great trip, out of Cape Canaveral with stops at Nassau and the island that was only for Disney Cruse ships.
Movies any time of the day, snacks available all day for no extra fee, etc. Movie-themed shows in the evenings. Fireworks one night with a live show on deck. Watching my kid get harnessed to fly across from the smoke stacks to the lower deck on a cable was a bit terrifying.
She’s the tiny dancer in the green harem costume. The singer was fabulous, just so much better than this shows. The poster was Rhonda Kramer, who some in Los Angeles may know from her traffic reports on various radio stations: https://youtu.be/qjrLf-ifW9s
Villago Delenda Est
The members of Tom Cotton’s Iraq platoon need to explain why he didn’t get the Niedermayer treatment. Because the man fits nicely into the total asshole junior officer stereotype, and I say this as a former junior officer.
Sab
@J R in WV: Yeah. I remember when the Cuyahoga River spontaneously burst into flame and my town smelled like burning tires every day. Chinese cities are so bad you can barely see across the street. James Fallows had some remarkable photos back before they hosted the Olympics.
catclub
I was interested in the exponential growth curves for the numbers and found this article
which suggests to me that it no longer looks exponential, and may be turning over. It is up to feb 16, so recent.
YY_Sima Qian
Everyone, a quick look at the huge disparity in mortality rates between Wuhan, Hubei ex-Wuhan, and China ex-Hubei, should tell you that impact from smoking and air pollution is at best a marginal factor as of this moment. Clearly, what is driving the mortality (and morbidity) rate at Wuhan and Hubei province is the overwhelmed medical system. If you take out Hubei, and looking at the mortality/morbidity rate province by province, and plot against air quality, then one might be able to discern if there is any impact from air pollution.
The impression of “aircopalyse” levels of air pollution is no longer up-to-date in China, and hasn’t been for the past three years or so. The combination of the massive push to replace coal with natural gas for electricity generation and heating, the investment in green/hydro power, and the slowing economy has significantly improved air quality, though winters are still noticeably worse. Wuhan is middling in terms of air quality among major cities in China.
Unfortunately, India seems to have taken over that mantle.
By the way, the R0 number is not some intrinsic property of a virus. It is still heavily dependent on effectiveness of the response by governments and society, and awareness/education/prevention measures, and other extrinsic factors like climate and conditions of human habitation.
As for why SARS seemed to die out, it had short incubation period, generally severe symptoms that were easy to spot, so patients could be relatively quickly identified and isolated, and the chains of transmission much easier to construct. The COVID-19’s spread mechanic appears to be closer to the flu.
China did construct a national infectious disease warning and tracking system. It had proved effective in containing the spread of the H7N9 and MERS in China. There was apparently a reemergence of SARS in 2015 in Guangdong, but it was very quickly addressed and stamped out. Nobody remembers or even know these events, because they did not become widespread in China and did not make the news. However, possibly due to the institutional memory from these much more virulent viruses, plus bureaucratic culture of the CCP regime that values stability (or appearance thereof) over rocking the boat and sounding the alarm, the COVID-19 basically landed squarely in the CCP’s institutional blind spot. My guess is if the novel coronavirus had been as virulent as SARS, the institutional response would have been much quicker.
Finally, I am a bit concerned that mortality rate in rest of China ex-Hubei has been creeping upward, from ~ 0.15% a week and half ago to ~ 0.7% now. Perhaps the severe/critical cases from the initial wave of introduction from Hubei in late Jan., as well secondary infection locally, are now reaching resolution…
Another Scott
@YY_Sima Qian: Thanks very much for your comment. It’s always good to hear from you.
Fingers crossed.
Cheers,
Scott.
Mel
@opiejeanne: Wow! She’s a talented kiddo! So graceful, poised, and elegant!
Bruce Baugh
A supplemental note about James Palmer: he hasn’t just lived in China. He reports on it for Financial Times and other sites, and has done so for a long time. He has connections in its business and political worlds, and is an outstanding interpreter of cultural/social pressures shaping people’s actions there at key moments. Read him for a while and you actually come away better informed. Highly recommended.