Typo in my tweet below. #Covid19 death toll in China is 2442. https://t.co/Yfg21mpAcB
— Helen Branswell (@HelenBranswell) February 23, 2020
2. Of the international #COVID19 cases, 45% are people who were infected on cruise ships. For a while, the cruise ship infections made up more than half of all out-of-China cases. With most (?) people off ships & spread picking up in Italy, Iran, South Korea, this is shifting. pic.twitter.com/XROnOzIsxh
— Helen Branswell (@HelenBranswell) February 22, 2020
New stage in public perception, if not in the actual spread of the virus — “science journalist. molecular biologist. curious. Contributing Correspondent at @sciencemagazine”:
For me and for everyone I know who has been following #covid19, the last few days have felt like a profound shift in the epidemic. We are clearly entering a new phase. And since I've had some time to digest recent news, here is a short thread about that „window of opportunity“
— Kai Kupferschmidt (@kakape) February 22, 2020
The @WHO and @drtedros have emphasized again and again that there is a “window of opportunity” to contain #COVID19. On Friday, Tedros said he believed that window of opportunity was still there, but narrowing. Personally, I think the last days have shown that time is up.
— Kai Kupferschmidt (@kakape) February 22, 2020
From the summary: "we estimated that about two thirds of COVID-19 cases exported from mainland China have remained undetected worldwide, potentially resulting in multiple chains of as yet undetected human-to-human transmission outside mainland China"
— Kai Kupferschmidt (@kakape) February 22, 2020
The massive efforts in China have bought us time. But we should be using that time to prepare and that includes preparing the world by communicating what is happening, what is likely to happen and what the response might look like. That is the “window of opportunity” we have now.
— Kai Kupferschmidt (@kakape) February 22, 2020
Scoop: Trump will ask Congress for emergency funds to fight coronavirus, although health officials fear the request – potentially $1B – will be too small and quickly exhausted. https://t.co/XhHCn7gA6K
— Dan Diamond (@ddiamond) February 23, 2020
Importantly as well, pandemic doesn’t mean the apocalypse. This is absolutely not a good situation, but it’s important to note that pandemic is a reference to the geographic scope of ongoing transmission, not the mortality caused by the virus. https://t.co/rsqWYM8lLU
— Stephen Goldstein (@stgoldst) February 22, 2020
Looks like my thread on countermeasures to #Covid19 got split up for many readers. Thanks @threadreaderapp and maybe some humans who helped (?) for putting it all together. Here it is as one thing. https://t.co/LFibP68x8l
— Marc Lipsitch (@mlipsitch) February 23, 2020
I really appreciate this perspective. Simple things we can do to prep: get ahead on prescriptions, have non perishable food on hand, think about how you will care for your family, wash your hands a lot, practice not touching your face… simple but helpful advice. https://t.co/NiSeXHcmJM
— A/Prof Jenny Richmond (@JenRichmondPhD) February 23, 2020
And *don’t* be like sales guy on TV:
Viruses don’t “morph”. They are not Power Rangers. There is no evidence that the #SARSCoV2 #COVID19 #coronavirus circulating in Iran or anywhere else are fundamentally different from viruses in the rest of the world. https://t.co/gmanUDGQyz
— Dr. Angela Rasmussen (@angie_rasmussen) February 22, 2020
The Trumpies have spent three years tearing down the pandemic reaction apparatus constructed by the Obama Administration during the SARS and Ebola scares.
@joel hanes: Obama did get lots of bad news coverage, so he must have been doing it wrong. Trump’s response will be to whine on twitter about the tv coverage making him look bad. Which will save the government a lot of money compared to what medical personnel would cost. He’s just looking out for the little guy.
We have tickets on Iceland Air to Paris in late April. Our youngest is fretting about us going, because of COVID19. I reassured her that yes, we are still going and that we’ll be fine, but mr opiejeanne will be 73 and I’ll be 70. Not too worried about myself, but starting to worry about him, a little.
On the other hand, some of the places we’ll be going may not be crowded and we will be very careful.
At home, stocking up on meds and non-perishable foods is good advice because some things may become hard to get for a while. When we had a cabin the little pantry was always stocked with canned goods like tuna fish and baked beans, crackers, pasta and sauce, and baking supplies, in case of five feet of snow (it happened) or icy conditions (that happened, too).
That sounds great, but the American insurance system won’t let you “get ahead in prescriptions.” I’m reminded of when we were going on a two-week trip to Europe and our prescription coverage wouldn’t pay for getting Ms. Redshift’s necessary prescription refilled before we left because the time it was due for a refill wasn’t until three days after we were leaving.
I’ve been reading some peer reviewed epidemiological modelling studies. They start by comparing the official tallies of infected cases and the officially estimated basic reproduction rate and ask whether they match up with the outbreaks occurring in other countries, cruise ships, evacuation flights, etc. They claim the numbers don’t match up. So, fitting flu-type epidemiological models, in the papers I’ve seen, they get total infections 6 to 9 times the official count, and fatality rates between 0.3% to 0.6%.
If that is true, that is sobering news. The disease will slowly spread and we’ll have to deal with periodic outbreaks of a flu like disease that is 2 to 4 times as deadly as seasonal flu.
I can’t find the folder with the articles, but google recovered one of them for me:
The Rate of Underascertainment of Novel Coronavirus (2019-nCoV) Infection: Estimation Using Japanese Passengers Data on Evacuation Flights J. Clin. Med. 2020, 9, 419; doi:10.3390/jcm9020419
Who is that guy on the last clip talking about a new strain? Virus mutate so rapidly, any large viral epidemic will have several strains of the virus circulating. Some of the epidemiological models assume circulation of two or three strains to get a good model of the early spread in Wuhan.
So, unless this new strain is much more easily spread, or much deadlier, it isn’t really news at all.
@opiejeanne: Physician and PhD Epidemiologist Dear Leader President Trump has informed us that, in his infinite expertise, these kinds of things go away when it gets warmer. So, don’t become alarmed.
I like that they think someone is going to use their heart/BP meds to get high on. It is possible though that they are considering that the price may go up between refills and some one will be missing a bit of profit there.
What would ever give you the idea that I’m cynical?
I guess for some good news, the protein structures of the little knobs that give the virus it’s name have been characterized. So, that is great news for quick development of rapid detection, better supportive care and a vaccine. Apparently most of the serious cases are in older people, and many of them die from a hyper reaction of their own immune system to the knobs on the virus, so understanding them will help with supportive treatment..
I’m not sure but I believe that the diploma that he uses to show that he has all these degrees that make him smarter than a bucket of warm spit was written on toilet paper with a sharpie and says that his degree is in doofus and which he has no understanding of the meaning of the word, because well he is one.
I am not an actuary, but more than one actuary has told me that the rationale for not refiling scrips ‘early’ is that a small but predictable number of users will die between refills (or, even more treacherously, change insurers). Spread over a large enough insured base, the money saved by not letting those morbidity cases ‘waste’ the unused doses adds up!
(I was an admin drone at a life company, so it didn’t matter if they were caught sharing the budget-sparing secrets of the other financial tribe.)
@jl: I saw Dear Leader’s comments, but Singapore is a pretty warm place and it’s still spreading there, and Singapore is known for how clean it is.
We had planned to travel mostly by train but now I’m wondering if a rental car might be a better (safer) choice health-wise for us. We have one for a little trip to Mont St Michel. Maybe we should rent one for the rest of the trip.
@Redshift: I forgot about that little snag. I have three pens left of my Lantus prescription (insulin), and that’s about 75 days at the rate I’m using it, plus what’s left in the current pen. (The package came with 5 pens). At that rate I’ll run out of insulin a week before I fly home, but I’m not sure I can refill it before I run out. I’ll have to check with my doctor to see if I can refill before I leave, because the dosage is set by trial and error by the user with guidance from the doc, and the insurance company has no idea about the dosage I dial in each morning.
@jl: Been arguing these exact points for awhile – this does appear four times more deadly than the “so-called” common flu BUT it doesn’t kill children (unlike the common flu) and VERY likely does not kill older people at a greater rate than the common flu as long as there is no pre-existing lung damage (i.e. smoking or long term air pollution exposure.)
Whether this becomes seasonal – that is still compleletly unknown. Also, while many cases have spread outside China in all likelyhood, it has been sufficently mild not to be distinguished from the common cold. But we will see if this is true once more test kits become available in large numbers outside China and are rountinely used.
Re early medication refills (I work for a pharmacy benefits manager), plans have a refill tolerance built in. (eg 75% or 90% of your meds should be gone before a refill will pay) most plans will allow a vacation override if you call – especially for international travel. (if you’re traveling within the US, why can’t you go to local Big Box Store when you’re on vacation? Not convenient but some plans do go that route)
Depending on the cost of the meds you need (cheap blood pressure stuff versus pricy insulin), a discount card (Goodrx, etc) might be able to bring the price down enough that you afford it.
If you want to stockpile though , you can regularly fill as early as they let you (eg 1 week ahead of schedule or whatever) every month. Less of an option, typically, on controlled meds, but that’s how I got enough birth control pre Obamacare to get from college graduation (and my dad’s insurance) to getting insurance with my new job 3 months later.
Toadglanz being the little guy?
I can’t help but notice that the linked news articles about DT dismantling Obama infrastructure, which I’m sure are 100% correct, do not seem to be major media outlets. Sigh.
Well, at least if this happens next year our new President can shake his finger at the supervirus and have his chiefs of staff tweet pictures of guillotines at it.
@Anne Laurie: I don’t understand the advice to stock up on medications because there aren’t any known medications that are effective against this virus.
Data out of China continuing the recent trend. Only 19 new confirmed cases total in China ex-Hubei. Hubei (including Wuhan) saw an uptick in new confirmed cases, possibly due to reversion of definition for confirmation a few days ago, shifting cases to suspect pool, and taking little time for testing and showing positive response. Actively cases continue to fall at a rapid clip everywhere, including Wuhan. Chinese news reports revealed that the Chinese central authorities have sent investigation teams to Sichuan and Henan to check on the prisons there, so don’t be too surprises if outbreaks are reported in the near future.
In not so welcome news, mortality rate in China ex-Hubei has increased to 0.8% over the past two weeks, as those infected in late Jan. & early Feb. reach case resolution. Therefore, I would not be overly optimistic that the mortality rate even in the developed world with not yet overly burdened medical systems will ultimately be < 0.5%. If medical systems are overwhelmed, you might start to see Hubei or Wuhan levels of mortality rate. That is not including people who die from other causes due to inadequate treatment, because the medical resources are crowded by the COVID-19. WaPo had an article on this subject yesterday, though evidence is anecdotal, and not clear how widespread the phenomenon is in China. I am quite sure it was happening in Wuhan, but there is no excuse it should happen anywhere else.
Sitting in my apartment in Wuhan, the outbreaks in the rest of the world simply leave me saddened. Wuhan, Hubei and much of China have taken unprecedented measures, with enormous toll in human/societal/economic/political terms, both to avert a much worse outcome within China, and to buy the rest of the world time to prepare and hopefully contain outbreaks early. I would hope the cautionary and laudatory lessons from Wuhan and China would inform the responses elsewhere. Reading the latest developments, I am just not certain that is the case. It feels like South Korea is where Wuhan was in mid to late-Jan., Japan like Wuhan in early Jan. (but with exasperatingly lackadaisical response by Japanese authorities so far), northern Italy like Wuhan in mid- to late Dec., and Iran possibly like multiple Wuhans in early to mid- Jan. These countries are fast running out of time to avoid being forced to take draconian measures like China has. Would they even be willing or able to take such measures if and when they are required? Seems like the outbreaks happened without the Italian and Iranian authorities' notice, until discovered by accident. South Korea has declared emergency in the worst hit areas, but mass anti-government rallies continue despite being banned, and many elderly protesters are not wearing masks. So uncooperative segments of the population is compounding the situation, and may render government measures ineffective. Out of the ten ASEAN countries in SE Asia, only Singapore's data make sense: initially cases introduced by visitors from China, sustained but limited community transmission, no exponential growth due to the rigorous government actions. The other nine countries only show the relative few cases introduced by visitors early on, without new cases in over a week, or none reported at all. Are there outbreaks happening in these countries, undetected by the authorities, waiting to be uncovered by accident?
I fervently hope I do not have to fly my parents from the US back to China in a few months to escape a pandemic, and it remains to be seen whether the epidemic can be contained in China.
@Cermet: Not just lung conditions, any underlying medical condition greatly increases the risk of the COVID-19 case progressing quickly to critical or fatal – hypertension, diabetes, hepatitis, heart issues, major surgery, etc.
There’s a very real worry about supply chain issues. A lot of medications for chronic diseases are made in China, or in India from Chinese materials. If the only factories producing those medications / materials are shut down by a COVID-19 quarantine, I’ve seen estimates that U.S. pharmacies have only 2-3 months of some very common ‘maintenance drugs’. Same problem if the shipments of these drugs are tied up at docks either in Asia or on the West Coast. So people who *can* buy extra insulin, high blood pressure medication, statins, etc. — not many Americans using insurance, unfortunately — are being advised to ‘stock up’ in advance, just in case.
It’s a reasonable precaution; after Puerto Rico was ravaged by the hurricane, some ‘common, cheap’ medications were suddenly at a premium. I take a generic high-blood pressure pill, atenolol; my (very good) health service had to scour the country to find back-up suppliers & I was warned I might be switched to a different, much more expensive, possibly less-effective-for-me alternative. It was much worse for some cancer patients, because (IIRC) only one company in PR was making the specialized infusion bags required for some treatments — people who were already at serious risk had to pause their treatments, and hope they could start over / again before it was too late.
Why would Trump want to fight this? The current situation in China is his dream scenario. He could cancel the election, have the CBP stop mass movement on the highways and break up mass gatherings and probably not get a lot of protest.
I just bought a ticket to Israel in mid-April and now they are talking about closing its borders to non-residents. My feeling about travel is that if the planes are flying, I’ll go. But I think this trip is 50-50 at best right now.
@Cermet: “VERY likely does not kill older people at a greater rate than the common flu as long as there is no pre-existing lung damage (i.e. smoking or long term air pollution exposure.)”
You have no basis to say this. We. Do. Not. Know.
Sister Rail Gun of Warm Humanitarianism
@Redshift: Most American insurance will allow you to get a refill up to a week before you run out. It’s no help now, but if you schedule your refills carefully over several months, you can get a couple of months ahead.
(So long as you’re not getting your drugs from CVS. Dratsab, but they screwed me over on this; I was having to throw tantrums to get refills before I ran out. My drug stash is still recovering.)
It’s something I do obsessively as part of my hurricane-preparedness effort.
@Anne Laurie: I was reading that recommendation as normal “hurricane is coming” preparations because of the possibility that people have to avoid other people for extended periods of time. If you get sick and are told to stay home so you don’t infect others, you need supplies. Possibly the government might try to tell the whole population in an area to stay home. They always tell us to have prescriptions for an emergency.
its always a problem for prescriptions.
Sister Rail Gun of Warm Humanitarianism
Hmm, wonder what the justification is for pushing people into a 3-month refill schedule? Because I’ve been fighting that one for more than a year.
I took it to mean stocking up on your regular meds so that in a crisis you don’t have to go out as much. Just like stockpiling nonperishable food.
ETA: Also what Anne Laurie said.
@Anne Laurie: Individually, people could try to stock up, but any mass response even in advance of manufacturing shutdown circumstances would likely create shortages sooner. This is a hard situation to manage, but drugs are not produced like other manufactured goods. The quality requirements of the manufacturing process make it hard to increase quantity over a short time period. Even if that response makes sense, I wonder whether it would be done in a way that we would hear about it.
Obviously the solution is to relax or remove these arbitrary, government-imposed “quality” regulations and let the free market work its magic.
Speaking of coronavirus idiocy, cracked.com has a rundown today. It is a sad world where a humor site gives more accurate health advice than some governments.
Anecdata: I had lunch yesterday with a friend who just got back from a trip to Bali. She stayed at the home of an ex-pat friend. She said the hospitality industry there has been hit hard by the sudden absence of Chinese tourists. They went to an extremely popular restaurant in Denpasar (largest city and provincial capital) and were only one of two tables being served. At an ex-pat party a guy who manages a big-name resort property told her that his company is losing $1 million a week. Ripple effects of the disease.
Good point. Stocking up on limited critical resources is great advice that you hope most other people don’t take. At least not until your own larder is full. Now if the government had an organized response of professionals coordinating to increase supplies in areas of shortage … wait who’s the president again?
Sister Rail Gun of Warm Humanitarianism
Yes. Ideally, people would already have been doing this over the course of several months. At this point, the best you can do is pick up your next refill as soon as you’re allowed and vow to never be in this situation again.
Even beyond shortages, it can be impossible to get existing stock if the pharmacy can’t process the refill. We encountered that when there was a disruption in communications between us and the offices of the pharmacy benefits contractor. Or they can’t process the payment for the copay. Or….
Since I’m a prepper, I actually won’t be contributing to the shortage should it arrive. I’ll be able to stay inside and out of everyone’s way.
Here is a map showing the percentage of companies returning back to work in different provinces.
The map says 76% in Shanghai, but from the perspective of my house it feels a lot less. Most companies (for example mine) are back at work but also on work from home orders. I have been “back at work” for 2 weeks – tomorrow will be week three – but haven’t actually left my housing compound during that time.
Many or most restaurants are still closed. Most are trying to emphasize their take-out offerings, but I’m not sure how many will survive this prolonged closure.
Schools are closed until March 2, when they will begin online learning, with video broadcast classes. I assume this means in-person classes will not start before April but who knows. The same goes for other kid’s programs, like the gymnastics program my kids used to go to. Closed indefinitely until schools re-open. I hope they remain in business.
The local quarantine rules are being relaxed in some areas of China. For example if people return to Beijing from the US, they are not required to quarantine for 2 weeks. Shanghai theoretically has the same rule allowing returnees from the US to avoid quarantine, but most district governments seem to be enforcing the 2 week quarantine against US returnees. (Like other Chinese cities, Shanghai is divided up into districts).
The general expectation is that there will be additional outbreaks in China ex-Hubei as people come back to work. So I guess I have that to look forward to whenever my company stops work from home. In any event, the current arrangement just doesn’t seem sustainable. Unless the entire country moves to an entirely delivery-based economy with no face-to-face interactions.
From what I can tell the WHO delegation that came to China may or may not be going to Hubei province? The last announcement was that they have been visiting the best hospitals in the country in Beijing, and also Sichuan and Guangdong. None of which is Hubei.
I have seen some experts speculating that Iran likely has the largest population of cases ex-China. Which unfortunately seems like a reasonable estimate.
I am now guessing Indonesia has the most cases ex-China. They currently report 0, but two people who have left Indonesia tested positive. Indonesia has a lot of interaction with China, both business and tourists headed to Bali.
@Armadillo: Part of the team should have came to Wuhan yesterday. Not sure how long they are staying, and no report of their findings, yet.
@Barbara: I think the restock is to be insurance against possible shortages due to disrupted supply chains. If your hospital is overwhelmed,or the pharmacist sick, where do you get them?
This thread was informative. And also, to me, makes me think of all the ways the Trump Admin is likely to screw the pooch on this. He’s a mercurial idiot. Who has a fleet of incompetent advisors and cabinet members. It has the potential to get really ugly.
ETA: Using twitter’s embed tweet cut n paste doesn’t work for me. Any tips?
I read that in the case of SARS one of the issues was places that were overly air conditioned, because the virus survived better at low temperatures. May be the same here given the similarity.
@Raoul: I expect that he’s sitting back, waiting for the time when he can close the borders to everyone he doesn’t like.
He apparently was already furious that the people on the Diamond Princess were airlifted back to the USA…
@Raoul: It looks like it worked normally for you. Only front-pagers can post the Twitter graphics. As long as you remember to use the Text tab in the comment editor, it works ok (sans graphics) for us normal people.
@CarolDuhart2: There are some supplies, like gloves and face masks, where stockpiling in advance of possible ballooning of needs coupled with run on existing stocks totally makes sense. This might apply to certain drugs, but drugs are not commodities in the same way, as they often require precise handling and storage in addition to manufacturing standards. In addition, people’s needs are so specific that it is hard for me to see how this could be done across the board. There may be specific products like insulin where this would be a practical step. A state like California might be able to pull this off.
@Another Scott: I just manually did all that formatting. But the text tab tip was the trick, I now see.
@Princess: Current mortality rates in countries outside China are seeing a 0.4% death rate for people. So I do have a bases – certainly not scientific nor proven but certainly is consistent with current mortality rates. I prefer caution and going with trends outside China since their rates (like West Nile virus in the past) are scewed by a less healthy population compared to Western countries.
Maybe not but until the data shows otherwise, my current statements are consistent with that mortality rate ( 4x worse than the flu but no where near the 2%+ China is enduring.)
Zero cases of Covid have been reported in Turkey. Being trade partners with Iran, sharing a long border and housing a dictator for leadership, Turkey’s silence is suspect. No news is not good news when you don’t tell any news. There are no cases being reported in North Korea. South Korea’s Covid numbers are swelling like a balloon.
news articles about DT dismantling Obama infrastructure … do not seem to be major media outlets.
Not shiny and fast-moving enough for “media”. Won’t generate clicks, or likes, or followers.
Actual journalists do still exist :
@opiejeanne: Paris won’t be much fun if it’s under soft quarantine like lots of tourist areas in Italy already are, and probably Venice and Milan soon.
@YY_Sima Qian: I don’t think this is going to be eradicated at this point. It must have spread to some 3rd world country unable to eradicate for now. I was expecting a worldwide shutdown for a year but with the relatively good control now in China/Taiwan/Singapore/Hong Kong perhaps we can keep it down to rolling quarantines were at any point a couple of cities are locked down but the world as a whole goes on.
Unfortunately the lack of universal health care and sick leave in the US makes it poorly set up for eradication or even control measures. People won’t go to the doctor for testing if they can’t pay for it and they won’t self-quarantine for 2 weeks if that means they’ll starve due to no wages. And what about the homeless?
J R in WV
So if there is a local outbreak you don’t have to go to town for your insulin as quickly… you can time the visit to limit your exposure if you have a stockpile of tuna and insulin.
Old Johnny Carson line: “I’m just stocking up before the hoarders get here!”
Redacted because late.
@Fair Economist: I’ve already spent about $4k on this trip, for plane tickets, hotels, car rentals. I bought trip insurance for the plane ride, but I’ll have to check the rules for cancellation or postponement. Some of the hotels and travel arrangements are refundable this far out.
I’m not sure what to do yet. The prospect of getting sick while out of the country is daunting despite the excellent medical care in France. The idea of getting sick and not knowing it, and leaving a trail of infection everywhere we go is very troubling.
We were planning to go to Geneva Switzerland the first weekend after the trip to Mont St Michel, then a week in Provence, back to Paris to stay for a few days, a day trip to Giverny, to Monet’s house and garden. The return flight is from Amsterdam, so a few days there, and a two day stopover in Reykjavik before finally coming back home. Planes, trains, and automobiles.
Well we knew he didn’t give a damn even if the people involved were American doctors on a humanitarian mission
Now that I think about it… Trump is a notorious germaphobe. If anyone can convince him that coronavirus has been identified at a MAGA rally they could shut down all his obnoxious rallies in short order.
@Jinchi: Rumors are probably as good as confirmation toward that end. It’s not as if he listens to experts.
@YY_Sima Qian: that’s good news
@opiejeanne: The places you should be concerned about are not the towns you will be visiting, but the potentially crowded transportation hubs getting there and back: airplanes/airports, trains/trains stations, metros/buses, etc. Neither Europe or North America has the culture/tradition of wearing masks during flu season, or when one has a cold. The cheap medical masks is of limited utility preventing the wearer from infection, but is effectively at preventing the wearer from infecting others.
At 70+, and if the insulin is for diabetes, then you are definitely in the high risk demographic.
If you do decide to go, and the risk in France is more than minimal at that time, then I recommend stocking up on alcohol wipes and hand sanitizer. Wipe down any surface you sit down at, and religiously wash your hands. Of course, that also applies if you are in the States, if there are outbreaks near where you live.
Definitely recommend renting a car, and avoid public transportation as much as possible.