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Saturday, March 14, 2020

COVID-19/SARS-CoV-2 open thread


When's the peak expected in your neighborhood? Do you plan to hunker down when it arrives or take your chances?

If you're a Brit, how do you feel about your government's diabolical plan to have you inoculated against SARS-CoV-2 many months before a vaccine is available? It's certainly an interesting experiment, and it might just work, but at what cost?

To be honest, I'm very concerned. This isn't anything like the average flu. Just look at what's already happening in Lombardy, one of the wealthiest parts of Italy and Europe.

Feel free to share your thoughts and experiences in the comments below. However, please note that conspiracy theories are against the rules at this blog. The awesome map below is from nextstrain.org.


Update 18/03/2020: It looks like the UK government read this blog and changed its policy (see here). Many other countries, including the US, are also now taking more serious steps to halt the spread of COVID-19. But will it be enough, and can the global economy handle the pressure?

326 comments:

1 – 200 of 326   Newer›   Newest»
Samuel Andrews said...

In the USA, we reacted a little too late because the media reports sounded like typical bogus gossip about doom and the end of the world.

It wasn't until a few days ago that people took it seriously. Since then lots of Colleges, public schools, pro sports have been shut down.

We didn't react to late though. I doubt anything like what happened in Italy will happen here. Because, now we're isolating the people with the virus before it can spread.

Davidski said...

Unfortunately, I think it's definitely too late in many parts of the US to avert serious health care crises, and it's likely that some parts of the country will resemble Lombardy in a few weeks time.

Simon_W said...

There's the problem that infected people are contagious even before they develop any symptoms. And due to the shortage of tests the true number of infected Americans may be higher than it seems.

For Switzerland I've seen three different models what the progression of the epidemic could look like, depending on what measures are taken.

1. model, if no measures are taken: the peak is expected at the end of April, with 130'000 heavily or critically ill people, which would be much more than the Swiss healthcare system could deal with and with about 79'000 deaths. But in June the spook would be over.

2. model, with medium heavy measures: the peak is expected in May, with no more than a few hundred heavily or critically ill people at the same time, which could be handled by the Swiss healthcare system, and with about 1800 deaths until the end of the year. Downside: The epidemic will only end when a vaccine becomes available, and this still might take a while.

3. model, with draconic measures: the peak is expected early in April, with about 350 heavily or critically ill people, and with about 350 deaths. In this model the epidemic would be over at the end of July.

EastPole said...

Here in Poland we have 81 cases and two deaths. Borders, schools, offices, shops, pubs etc. are closed, only grocery stores and pharmacies are open. They closed the borders too late IMO. But population is properly scared and stays at home.
We hope to flatten the curve thanks to these measures, otherwise it will be a disaster.

Ned said...

You misunderstood what the article said. There is no plan in Britain to vaccinate to provide herd immunity. The government seem to be saying it's a good idea to let everybody catch it because then the survivors will have antibodies and nobody will catch it next year because of herd immunity.
A lot of people are worried because the government are not taking the same actions as all our neighbours, such as the Irish republic, are doing.

Davidski said...

@Ned

I was being sarcastic.

The UK wants to "inoculate" its people against SARS-CoV-2 by letting most of them catch it.

Samuel Andrews said...

Which means 3% of population of UK will die? I don't understand.

Davidski said...

@Samuel

Which means 3% of population of UK will die? I don't understand.

Yep, and possibly much more when the UK healthcare system is overwhelmed in many places.

They're taking this risk in the hope that they can kill the virus locally by making most Brits immune to it.

Of course no one really knows if it'll work because SARS-CoV-2 is still largely a mystery.

Davidski said...

That's why I called it a diabolical plan.

Matt said...

With understanding that we're not experts at all - re; UK, I don't think there is a "herd immunity strategy".

The talk from the Chief Scientific Adviser as reported by mainstream UK media is largely simply about the same sort of conventional shifting and broadening of the peak that every agency talks about, so that the people who will inevitably become infected will get medical care that is needed to survive and become immune.

The idea that there is a divergent strategy to "let" people get infected en masse right now seems to be spread by twitterati and either fringe overseas / more govt critical UK media (left and right) who seem to be are making too much of the fact that the UK govt adviser has explicitly factored in acquired immunity to calculations and talked about it. That this is the plan would be completely in contradiction to everything the CSA has said thus far about broadening and delaying the peak.

The CSA has talked about "herd immunity" but frankly every country's strategy here is predicated on the idea that there is acquired immunity and that getting up to levels of this at a managed rate will mitigate outbreaks. Indefinite quarantine and isolation is just not sustainable (no country will be able to do it). While total containment is also obviously not sustainable, with only perhaps Singapore and Taiwan managing it... if that's even remains robust in future months, probably unlikely even there, certainly in anywhere that isn't concentrated in single cities.

Re, differences in shutting down big events and containment and early quarantine measures. For a mainstream, not-very-govt critical take, see the BBC -

1) https://www.bbc.co.uk/news/science-environment-51874084
2) https://www.bbc.co.uk/news/uk-51858987

Abandonment of containment strategy for delay is possibly more about the generalized patterns of cases in the UK that basically matches urban density (expected to wide ranging global connections). There's no "hot spot" that can be identified to contain, unlike examples like South Korea and Northern Italy. (For all the talk of mass testing, SK basically slowed down the rate by jumping on the Shincheonji pulse - https://twitter.com/sang_woo_park/status/1237875839506644992).

Not shutting down big events and institutions is more about avoiding quarantine fatigue and unintended longer term consequences - kids gather in nurseries not schools, parents who run out of sick pay and capacity for unpaid leave go back to work at peak epidemic, people who've had events shut down go to small and close gatherings instead which worsen the spread (because a few people mixing intensively with one person with Cov19 in a closed space actually results in more spread then many people mixing shallowly with one, in a large open space), etc.

They're also worried about de-emphasizing the most long term effective methods - self-isolation, social distancing, hygiene.

Short-sharp hard quarantines make sense if you think that the summer effect at mitigating Cov19 will be strong and come into play quick and that practical vaccination will be very soon, but otherwise aren't really going to solve anything.

I think the issue of this is that, even if it worked (it may do, or may not), it is not going to politically sustainable in the short term. People will yell that the govt is derelict in duty right now, and they're not going to be evaluated on whether this actually saves lives over the course of Cov19 as a circulating pathogen over even a year, let alone the next decade or so.

They've already caved on big events, so we won't see if the real strategic variances were effective or not.

The situation is fast evolving and people don't really have data. Less than a month ago the WHO was talking about the unnecessary nature of travel bans, etc.

Davidski said...

@Matt

With understanding that we're not experts at all - re; UK, I don't think there is a "herd immunity strategy".

In an article I read recently a UK minister did use the term "herd immunity" in reference to the policy that they were putting into action.

And I found an expert opinion about that policy...

WHO questions UK response to coronavirus

World Health Organization spokeswoman Margaret Harris has questioned the UK’s approach to developing “herd immunity” against Covid-19.

Dr Harris told BBC Radio 4’s Today: “We don’t know enough about the science of this virus, it hasn’t been in our population for long enough for us to know what it does in immunological terms.

“Every virus functions differently in your body and stimulates a different immunological profile. We can talk theories, but at the moment we are really facing a situation where we have got to look at action.”


LINK

Unknown said...

This is weird because this SARS virus is not well known at the moment and everyone around the world work on it. It would be best to delay disease until more research is available.

Italian doctors were telling that this is not the flu as pneumonia rates are very high compared to the flu.

Plus HCQ administration seems to work at least in some. There seems to be other repurposed drugs that work as data from China and now from Italy show.

Mehmet Kurtkaya

Davidski said...

@Matt

In fact, it was England's chief scientific advisor who used that term.

Coronavirus: science chief defends UK plan from criticism

He does also talk about protecting the vulnerable, but that might be very tough in an environment where a large proportion of the people are infected.

In any case, it's clear from that article that "herd immunity" via infection, not vaccination, is an important part of the UK government's policy to fight the virus.

See that's why the experts, including from the WHO, have reacted to it. So have the hoi polloi, and they're not happy either...

A petition calling for the UK to go into lockdown to prevent the spread of coronavirus has reached more than 110,000 signatures, meaning it will be considered for parliamentary debate.

It encourages the UK to follow the containment procedures of countries that have been widely affected by the outbreak, by restricting unnecessary travel and discouraging public gatherings.


LINK

Matt said...

Yes, I'm aware he used the term. I said he used the term in my post ffs (me: 'The CSA has talked about "herd immunity"'). The point is that there's not a lot of substance in divergence on strategy just from the fact that he used the term.

There's a lot of heat and not much light here. It's not clear, that the UK following some kind acceleration strategy to get to herd immunity quicker, rather than this being a longer (very long) term goal, and in fact seems contradicted by everything.

My point is that unless anyone is really talking about strong containment, rather than simply accepting that infection will increase but "flattening the curve", they're reliant on the same assumptions that acquired immunity will reduce cases over time after the peak is seen and that all public authorities can do is manage infection so health care is not overly stressed.

(I.e. a totally conventional version of what twitter thought on this disease last week (for one perhaps unfair example Razib Khan - https://twitter.com/razibkhan/status/1236548417389604865 - "we have one job: flatten the curve. the rest commentary.". But there are about a million tweets from folks who say they are smart and informed saying the same thing... until the British government actually said it was doing it, at which point "Tory anti-science anti-expert blahblahblah" about the same thing that they were proposing as the expert consensus a few days earlier!).)

And it is not clear if strong containment is really sustainable in a longer haul at all.

"Crushing the virus through massive quarantine and then avoiding any reinfection, and ultimately achieve through achive herd immunity without infection through almost universal vaccination" is a different strategy than what UKG is currently doing. If Harris is proposing such measures, and she can actually implement how they would be implemented with the UK's spread of cases, then that's one thing. But if her proposal for "action" would be another iteration of "Delay and flatten the curve", that's not a different strategy.

Davidski said...

@Matt

That's not my impression. It seems to me that the UK government at the very least doesn't mind having a lot of people infected gradually because this is in line with its "herd immunity" strategy.

However, other experts are saying that SARS-CoV-2 needs to be hit early and hard like in East Asia, especially in Taiwan and Hong Kong, otherwise we're in trouble.

Here's an interesting article about that...

https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

JuanRivera said...

It's chaos in Pennsylvania. Schools were closed, stores (Walmarts) nearly shopped dry of stuff, declarations of emergency, and a few cases of COVID-19. Jobs and schools are now providing online options to minimize spread. New York and Washington are way worse. I was monitoring the virus since some of the first cases in Wuhan, in January. A pandemic like this was last seen in 1918. The fact that a blog normally dedicated to population genomics is dedicating a post to this virus shows both how rare it is and how serious it is.

Gaska said...


Here in Spain, 6000 cases, 191 dead (all of them elderly, the youngest 70 years). State of alarm and general quarantine without leaving home. Shops, bars, shopping centers, schools, universities, parks, gyms, theaters, museums, ports, airports, trains, beaches all closed. They are starting to set up field hospitals and use hotels to care for patients. Many infected doctors, nurses etc. My wife is a doctor and she has been recruited to attend emergencies, they look like astronauts when they are working. People are not afraid and we trust the health system, but we need artificial respirators because the virus attacks the alveoli and produces bilateral pneumonia.

The government has decreed a state of alarm today, but it should have done so 15 days ago when cases from Italy began to arrive. Many Spaniards got infected in Lombardia and northern Italy when they went to watch football matches (including basketball players who played their games without the public) but neither Spain nor Italy closed borders.

Italy, France, Germany, Spain, Switzerland, Belgium and the Netherlands, they have no solution, in 30 days we will have hundreds of thousands of infected. This will affect developed countries much more because we have very old populations (several people over a hundred years old have died here)-

All governments have to close borders, suspend Schengen and enact states of emergency-
Transmission is very fast, especially in countries where there is a lot of social life as in southern Europe. The only thing governments can do is try to stagger infections and prevent the collapse of hospitals. Now I understand why the Chinese started building hospitals.

Better not to think about the economic consequences, now we have to defeat this motherfucker virus.The time will also come to ask for responsibilities, I hope that the Chinese stop eating bats, mice and pangolins, because they are going to kill us all.
Beware in the United States, the epidemic is going to be brutal

Ariel said...

I'm following this website: https://nextstrain.org/ncov It has many RNA sequences from many countries, and you can see how the virus is spreading throught the globe. Also I'm following this guy: https://twitter.com/trvrb he is part of the project and he posts to useful info, for example estimations of the size of the epidemic in certain areas based on genetic divergence. It appears right now that there are about 8 emerging clades between Europe and the U.S. with multiple entries in the West that were missed, also some old cases that were supposedly contained like the outbreak in brighton and Bavaria (over a month old) are connected to some recent clades. It gives the sense that this thing is very much unstoppable and sneaky. (and why travel bans dind't work at all)

sds said...

This virus, as I understand it, is more contagious than say, the flu, but the vast majority of people - 80% or more - are not at risk for serious complications or death. The statistics I have seen indicate that those under 60 years of age, as long as they don't have other complication factors, are no more at risk for death than from the typical flu bug. In my region, we just received out first confirmed case. Schools have been shut down and my son's soccer season is on delay. A trip to the local warehouse store is an adventure, with lines out the door. No social distancing here and no toilet paper.

Leron said...

I wonder if certain ancestries are more immune, such as CHG and ANE, judging by higher infection rates outside those areas

Ric Hern said...

Apparently the Virus does not survive in Warm Climates. I would not have been worried in the Summer, but Winter is approaching fast here by us. Also a case of an Italian Man here by us...

pnuadha said...

The West is being exposed. We are high intelligent but naively open and hyper individualistic. We didnt close our borders when we could have. We didnt develop proper testing measures because we dont invest in group preservation. We dont regulate who lives in our countries and the conflicting interests that can and will arise. We allowed bafoons to tell us that calling cov-2 the China corona virus was racist and that the real discease is xenophobia. We should have removed these people from all power and influence. What happens in a low trust soceity when faced with an emergency? The West could have been like South Korea, Japan, and Singapore who all took swift action to save their people. Notice how these are all highly homogenous nations. Its no coincidence that a nation of people is more likely to take care of its people. The US and parts of Europe behave more like an economic zone with an interchangable populus.

We must learn from this and make people realize the virtue in nationhood, in community, rather than "global citizenry" and phoney constructs that replace family and people with elective identities.

Fanty said...

The plan to let everyone catch it, isnt limited to Britain. A German scientist suggested this too (But longer ago. 1 or 2 weeks ago already). But he didnt say one should do this, but that its impossible from stopping this to happen anyways.

He claimed, the Virus expansion could be expected to having a plateau of around 60%. (People who gained immunity by surviving the virus work as a shield/barrier in the infection chains. At 60% immunity, the infection chains supposedly break and herd immunity would set in.

But for this to work properly, the process must be slowed down.

In the last 2 weeks, he kept the 60% value, but focused on the claim, that 60% of the population will catch Corona, spread over a period of the next 2 or 3 years (the gaining herd immunity and the plateau effect went totaly to the background)

When_in_Rome said...

All schools in my city are now closed. People keep saying that everyone is just panicking. They keep saying its not that bad because only some 5,000 people died. In reality, its the other way around, only 5,000 people died because everyone is taking such preventive measures. China claims its numbers have remained steady, which I find somewhat dubious. Regardless, they enacted very strict measures to prevent the spread of the virus. Measures that other countries probably won't do. If China didn't do these measures, the numbers will be much much higher.

Palacista said...

As an Aussie living in England my opinion is that the UK government if fully of idiots, but that was already my opinion before the new virus appeared. The pure arrogance that they can, by policy affect the transmission rate rate is shocking. By policy, in this case, I just mean published requests for community action as this is all that has been done. Has there been any modelling of the possible infection rates by different practical government actions? well no because their have been no government actions and because wishful thinking is all that the Johnson government ever has or ever will do.

The UK government is trailing real decisons made by various bodies outside their influence and reacting to perceived public reaction to yesterdays official piffle.

Rob said...

I haven’t been following it as much as I should, but colleagues are guesstimating 30% of populace infected with 30% requiring hospitalisation. For any developed country, if true, it’ll collapse the health system. Already some hospitals have cancelled all elective surgery apart from cancer, in anticipation; but this is not universal

Lukasz said...

I will advise you all to take most money from bank account. As we have both economic crisis and coronavius in the same time, soon banks could have problems and easiest way to help them by goverment is to allow them to steal some money from people's accounts. Of course as "epidemic special treatment" of their economic condition.

Look at Cyprus in 2013 if you don't believe it is possible, and it was only economic crisis.

I warned you, you will do what you want...

vAsiSTha said...

I agree with Lukasz. Especially for Deutsche bank account holders, and others with questionable stability.

Simon_W said...

@sds yes for the most part it's only dangerous for elderly or otherwise weakened people. About myself I'm not afraid, as I'm only 41 and have a robust health. But well, who doesn't have elderly relatives? And generally I'm trying to be solidaric by washing my hands after having left the home. Facts are: This virus is more deadly than the flu and more contagious than SARS, but less deadly than the latter.

Simon_W said...

In Switzerland someone even suggested to purposely infect the young people so they can develop an immunity. But the idea was rejected because not all young people only get light symptoms, some even might die, and in practice it would be hard to seperate them from the risk groups for the necessary amount of time (about 8 days)

Rob said...

Well apparently even healthy adults can be significantly affected by it. A number of otherwise healthy 4o years in intensive care

Davidski said...

By all accounts there are many young and middle aged people in intensive care and dying in northern Italy.

As far as I know, the healthcare system was a of very high quality in that part of the country until a few weeks ago, much higher than in the US on average.

So yeah, this is a very worrying sign for what we might see in the US within a few weeks.

Matt said...

Couple tweets of relevance on this:

1) Some evidence for large scale asymptomatic (or mild) transmission by young people in South Korea - https://twitter.com/markwby/status/1238867143363567616 .

Looks like the Choson ones are going full bonkers on testing loads of people and this seems to be turning up young people who test positive but "feel fine" (and thus a very low mortality rate to test ratio).

(Apparently contra "Italy (testing of people showing symptoms)" which gives a distorted picture of effects infection on younger people).

If this is accurate it means that much of the advice and measures to try to track transmission in Europe and the US, without massive, almost random testing... just isn't gonna work.

They won't be able to actually identify the true individual vector and they won't be really able to contain it ("All people in contact with Y" doesn't work if the true vector actually wasn't Y but some other totally asymptomatic individual). It also means the idea of enacting quarantine to wipe out the infection locally, then preventing re-entry is going to be hard, if you have asymptomatic carriers coming back in all the time. Shutdowns become less sustainable over time, and less effective, because the true infected population is much higher than we think.

It may also mean that "herd immunity" among the young and healthy will actually progress faster than we think, if the true % cases in the population is higher but we don't detect because they are asymptomatic? But I'm not sure about this; a lot depends on what happens in terms of immune response.

It also means that massive self-imposed social distancing and hygiene measures among general population, and mass testing, become more important relative to shutdowns and self isolation of symptomatic infected?

May or may not actually be right, but at the moment the Koreans are the ones who seem to even approach getting close to anything like population level random sampling to say if it's true or not.

2) https://mobile.twitter.com/AdamJKucharski/status/1238418007824764930 / https://mobile.twitter.com/AdamJKucharski/status/1238821515526897664 -
Kucharski is on the frontline of the UK's Covid19 strategy.

In those tweets, he gives a run through of the process of the modelling that goes into forming the strategy, and why he is deeply disturbed by mischaracterization of it as shooting for herd immunity. "Talk of ‘herd immunity as the aim’ is totally wide of the mark" and they are following a conventional goal of "reducing two main things: peak healthcare demand and deaths". ("A lot of modellers around the world are working flat out to find best way to minimise impact on population and healthcare. A side effect may end up being herd immunity, but this is merely a consequence of a very tough option - albeit one that may help prevent another outbreak.". Side effect, not goal.)

Davidski said...

@Matt

I'm pretty sure that "herd immunity" was a major goal for the UK government, because they were fairly open about that.

It looks like it's now become a side effect after a lot of criticism from many experts. Here's some more of that criticism...

https://www.theguardian.com/uk-news/2020/mar/14/scientists-urge-government-to-enforce-social-distancing-now

Also, it seems to me that you're missing a key point, which is that even if most people show mild symptoms and no symptoms at all, a high rates of infection can still be deadly in direct and indirect ways if the healthcare system is overwhelmed.

Fanty said...

Just dropping the average age of people who died so far from Corona (world wide): 81 years of age.

Couple days ago, a German virus doctor dropped these estaminates (it was in respone to another Virus guy who came up with different numbers:

Age 60 or higher: 20-25% chance to die from Corona.

Adult below 60 years of age: chance to die from Corona 0.2 - 0.3% (this was meant as an estamination of the "true" mortality rate, taking into account the unknown amount of infections that people dont recognise because they feel fine.)

Children below 10: most likely no one will die.

Matt said...

To be honest, if literally this guy saying this is not enough for you to take what he's saying at face value, and insist that this it is more likely that was what they wanted all along and not the (probably much more likely case) of miscommunication by journalists who don't know what they're talking about... It's OK to be wrongly informed by journalists, sometimes... You are very assertive about never backing down on anything you've said, ever, for any reason, sometimes, even if it is misinformation from a third party who don't know what they're talking about.

Davidski said...

@Matt

It's quite clear to me and many others, including experts in highly relevant fields, what the UK government was aiming for.

After some intense, high level and public criticism it's now backing down and planning more immediate and stringent social distancing policies.

So I'm not really sure what you're trying to convince me of here. But never mind, let's now see if this isn't too little too late. I fear it might be.

rozenfag said...

Given what effect the pandemic had on universities, I am afraid that many ancient DNA studies would be delayed. That is of course not very important given that human lives are much more important, but still quite sad.

Al Bundy said...

I'm in Orange County Ca., and I quickly, yesterday, went to the bookstore and stocked up on more books even though I already have many.If I'm gonna be home more what better way to pass the time than to read, or play board games.The store was empty, except for the old book lady.She should've worn a mask but not because of the virus if you catch my drift.

Al Bundy said...

What a joke...don't be in a large crowd but go and pick up all this stuff where you'll see hundreds of more people in a confined space.

Al Bundy said...

Trump banned flights from China very early I think whereas the EU did not.A virus that started thousands of miles away is shutting down large parts of the country and you have Democrats and the media, many of whom essentially support open borders on the Southern border, criticising Trump.That's disgraceful.

epoch said...

Genetics give a nice picture of how this virus spread across various parts of the world. For instance, it looks like the Webeko strain was directly ancestral to the Italian strain.

More info on http://nextstrain.org/ncov.

Also https://twitter.com/trvrb has some interesting stuff.

Davidski said...

@epoch

Nice map!

I'll put it in my blog post.

Matt said...

David, as I say, I'm not trying to persuade you of anything, as you seem rather defensive and unwilling to read and understand any of the links I have posted on the topic explaining what the UKg strategy is and don't have an open mind about understanding it. Those links are for the benefit of any other readers of this blog who want to know what's really going on.

Davidski said...

@Matt

The UK government had a strategy. But it was a stupid strategy. Now its only strategy is to mitigate the damage and hope for the best.

Watch the drama unfold.

EastPole said...

There is a good way to avoid coronavirus when shopping:

https://twitter.com/i/status/1239058899979780096

George said...

We returned from Spain a little over a week ago after a month long vacation. At that time there was no discussion about stopping Las Fallas in Valencia or Santa Semana in Seville or Teruel . The return flight was about 50% full. In the past it would have been ~85% full at this time of year. I only saw a handful of people with facemasks at the various airports with one passenger on the plane wearing one. The only question we got from CBP that could be linked to SARS-COVID19 was did you go anywhere else besides Spain. Both of us were a bit surprised. We are fine but self isolating except when my wife, a neonatologist, has to be at the hospital.

In our area of NY hospitals are on lock down with no elective procedures. Isolation rooms and ventilators will be limiting. Physicians have discussed triage. Hospitals are closely tracking PPE use and count. Medical staff have been reported with SARs COVID19. Dental and private practice offices are rescheduling patients. Drive through testing is being set up in tents outside of hospitals. The schools in our area are closed for at least the next week. Grocery stores in our area are struggling to keep their shelves full.

A major problem I sense is officials have not made a simple repetitive case for reducing social interaction that has reached/convinced the public. I have not heard or seen serious social distancing PR on the radio or banners on Google or YouTube, etc. The herd just doesn’t understand that we will need to use extreme social measures to delay the spread. To paraphrase – We need to understand the difference between liberty and freedom. Liberty is Freedom but it comes with the responsibility to act in the public interest.

Thank you Epoch –Nextstrain.org is a great website.

I’m sure each of you has other favorite info sites. Some of mine are:
a) John Campbell, PhD https://www.youtube.com/watch?v=Etlyvt9n_QE
b) MedCram.com https://www.youtube.com/watch?v=vww1nIIoqmw&t=107s
c) Worldometer https://www.worldometers.info/coronavirus/

And to touch on CoVID19 genetics
http://virological.org/t/response-to-on-the-origin-and-continuing-evolution-of-sars-cov-2/418

Our lives have been significantly changed.
Stay safe

dsjm1 said...

What intrigues me the most is that ‘the virus’ has well and truly taken attention from the growing hysteria on ‘climate change’ after Australia was burned to a crisp (sarcasm).

Also, in 1957 at school in England we had the ‘Asian flu’ (google 1957 Asian flu and read Brittanica article). I didn’t know of any deaths but England and Wales are said to have had 3,500 deaths. USA 69,000. Globally 2 million. The 1968 Hong Kong virus killed more than the 1957 virus. But the 1912 Spanish flu killed 50 million ( more than all fighting in WW1).

Then, think about these numbers
1912 world pop 1.8 billion.
1957 about pop 3.2 billion
2020 about pop 7.8 billion.
2025 you guess, but my bet is, far greater than 7.8 billion no matter what this virus does.

The biggest difference I can think of between 1957 and now, is that social media has become the conduit for global social panic. Twitter is great for tweeting catastrophe. Here in Australia, people are going berserk buying up toilet paper. Strange because I thought we had a very large population of Arabs and Indians who must be wondering WTF such panic buying is for. As one very funny local news commentator said. The issue is near your face not your behind.

Wake me up when the toll hits 2 million.

Davidski said...

@dsjm1

This virus does have the potential to kill more people than the Spanish flu. That's why many countries are now going into lock down to try and slow it down.

Just looking at the curves for the US and UK, and considering how unprepared they are, the situation looks very grim for both countries, and you'll definitely hear about that soon whether you're on social media or not.

There's a storm coming and the people in the know realize this.

https://www.theguardian.com/world/2020/mar/15/coronavirus-senior-nhs-consultant-speaks-out

NeilB said...

I live in the UK. At present (as reported by the BBC) the infectivity rate for covid19 is estimated to be up to 80% of a given population, if no control measures are taken. Mortality rates run at an average of 1% for the population as a whole, to ca. 20% for people 80+ with underlying health problems. Deaths per decade under 80y.o. drop steeply, but over 50's still stand at 5% of dying if infected (data set shown on BBC news 24). Running rough numbers for no intervention in the UK gives: 70 million x 0.8 = 56 million cases x 0.01 = 560,000 deaths. That's for no intervention. A professor of communicable diseases was interviewed also by the BBC, and it was put to him that "So 100,000 cases is the worst case scenario for the UK?" His reply: "No that's some way short of the worst case scenario." If we did have 100,000 cases we might have 1000 deaths.
If you compare covid19 to the UK seasonal flu of winter 2017-2018 (with an ineffective immunization) that virus killed about 50,000 people. So getting back to your point, no I don't think the UK not shutting schools yet or going into massive lockdown is an unreasonable response to the pandemic. From a science based point of view its the correct response. NeilB

Davidski said...

@NeilB

If you compare covid19 to the UK seasonal flu of winter 2017-2018 (with an ineffective immunization) that virus killed about 50,000 people.

There's nothing to compare yet. We can talk about that in six months.

And I'm very sceptical about that 50,000 figure. Where did you pull that out of?

So getting back to your point, no I don't think the UK not shutting schools yet or going into massive lockdown is an unreasonable response to the pandemic.

My point was that the UK did a lousy job at containment, like testing and tracing the early cases and shutting down the border.

Now things are out of control, even though that might not yet be obvious on the ground.

NeilB said...

@ DaviidskiI got the number for excess deaths from seasonal flu in the UK in winter 2017-2018 from the UK government's Office for National Statistics website, here:
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/excesswintermortalityinenglandandwales/2017to2018provisionaland2016to2017final
I know you're a stickler for accuracy, so I found the correct figure before posting (actually it was 50100 extra deaths).
David, I would expect you to follow the data, as you do in genetics (bravo for that!) not jump on the hyperbole bandwagon. I am, for the first time, in many years disappointed in you. NeilB

Matt said...

@David, I think the UK CMO knows more about this than you. Your predictions seem fairly likely to me be wrong (we will possibly, hopefully not, see this as lockdowns become unsustainable and secondary resurgences from failed containments get out of control in other nations and overwhelm healthcare systems) and are in any case based on a mischaracterization in the press of what they're actually doing.

epoch said...

I has arrived for me a few weeks ago. I'm in a hotspot. Just heard schools are closing, pubs are closed. I work in a highly internationally operating company, with lots of contacts to the Asia. I started to wash my hands like a maniac a few weeks ago (20 seconds, like a surgeon), try to stop touching my face. I started to work from home two weeks ago.

gL said...

"However, please note that conspiracy theories are against the rules at this blog."

Publishes link to tabloid, instead of government source...

FrankN said...

Germany seems to have been pretty effective in containing the first wave, i.e. COVID-19 imports directly from Wuhan. All Germans returning from there (mostly employees of car suppliers and their families) were quarantined for two weeks, and apparently none of them developed serious symptoms and/or spread the Virus further.

What caught officials by surprise, though, was the presence of COVID-19 in N. Italy and Switzerland. The first "import" from Italy was identified, and hospitalised (where he died), in the Rhineland. Pretty fast, but not fast enough, because before developing symptoms he visited a local Carneval session, where he effectively spread the Virus in the local community, Heinsberg County (near Aachen). Around a quarter of all currently known German cases come from that County. There is quite some criticism about authorities actually not having cancelled Carneval activities. Afterwards, however, they reacted swiftly, with kindergarden and school closures in Heinsberg County, so that pocket looks as reasonably confined at the moment.

Carneval is holiday season in the Rhineland, and some States such as Hamburg have school holidays in late February, commonly used for going skiing in the Alps. This seems to have provided for a constant trickle-in of infections from N. Italy/ Switzerland. Another case (apparently missing from the nextstrain.org map) occured in Egypt, where a Hamburg firefighter died from COVID-19 after a Nile cruise. His wife was only tested positively a few days after returning home. Here, again, authorities appear to have been too lax in controlling returning tourists, with the consequence of COVID-19 cases now being reported from always everywhere, albeit yet in small numbers. As per today, there are 5.627 attested COVID-19 cases in Germany, with 12 deaths, and 46 completely recovered. It is probably too early to base any statistics on these figures. Yet, they suggest that overall mortality may rather range around "only" 1%.

From tomorrow on, all kindergardens and schools will be closed until at least April 30. Berlin, Hamburg and Bavaria have closed all clubs and bars and cancelled any public events. Borders to Austria, France, Switzerland and Denmark will be closed from tomorrow morning. Already a few weeks ago, most States had prolonged University holidays to April 30. The Football leagues are paused, ice hockey playoffs have been cancelled.

The good news is that a COVID-19 vaccine is ready to go into pre-clinical testing (my niece has been working on it). The bad news is that the development was to be done in cooperation with US companies, which will probably be complicated by the US government's current travel ban.

Katharós said...

Ironically,from a historic perspective,the concept of malicious plague spreaders is a core aspect in treatises on witchcraft. And strikingly the same psychological mechanisms come into play and unfold as back then. Even the idea that some group or secret society produced the virus , is really nothing new. See “1321 lepers' plot” ... And for those who have to stay at home , I recommend the 1964 Vincent Price film , The Last Man on Earth. ;-)

gL said...

Enough of memes.
It is not British plan - this is plan of what England and Whales might do. Rest of Britain has different ideas how to deal with this situation.

However, the so called "diabolical plan" is very logical for the situation while there is no vaccine, as by the time, when this flu goes through most of population, it will mutate enough, that it will become non-threatening to humans.


People with low immunity - sick and old are at risk of dying and it would make more sense to isolate them, than clamping "affected" areas, as now we know, that people can carry virus more than two weeks(4-5 weeks is current estimate) - also not all of them are showing significant signs of sickness. Children seems to be not affected by this flu at all, but they can still spread this virus to adults. The spread of this virus is more rapid than common flu(because of virgin bodies), so any charts will show delayed information of actual spread.

Spanish flu in Europe had fatality rate nowhere near of this virus and was comparable to common flu - not many people in Europe can relate to this virus, as Spain was distant country for most of them. There seems to be other factors, that made Spanish flu lethal for some countries in Africa and Pacific. We can compare it by quantity, but there were also less people on Earth 100 years ago.


@FrankN - can you tell to us nonprofessionals, what is time-frame for testing, before medicine is allowed to use? This might be exceptional case to take away bureaucratic obstacles - as usually there seems to be 2-3 years for most medicine before they are approved, but testing still requires time. So, to not to raise any false hopes, what is realistic estimate, that vaccine will start to arrive? End of year?

FrankN said...

gL: The figures circulating here in Germany range between 12-18 months. German researchers have been leading in developing vaccination against MERS, a close relative of COVID-19, and take their estimates from that process.

The next stage, as I understand it, is to test new vaccines on animals to see whether (i) they are able to stimulate antibody production, (ii) these antibodies provide effective protection against infection and (iii) are reasonably free from side effects.
Corona viruses are zoonoses. E.g., there exists an effective vaccination against the Canine Coronavirus that is regularly given to puppies. The Human coronavirus OC43, a close relative of COVID-19 which is among the viruses that cause the "Common Cold", is known to also infect cattle. As such, chances are high that results from animal trials may also be valid for humans, but this cannot be taken for guaranteed.

The second phase would be pre-clinical testing on human volunteers. If that is mastered as well, clinical testing on a larger scale follows. That Phase 3 may actually be short-cutted, i.e. if COVID-19 is still virulent and a massive problem by the time human pre-clinical testing has been absolved successfully, authorities may decide to already allow vaccination of certain groups on a larger scale.

My niece hasn't provided me with any estimates of how long phases 1 and 2 may take, and will in all likelyhood also not disclose it, as there are a couple of German and US companies currently racing for being the first one to come out with a vaccination.
Anyway - vaccine production capacities, otherwise sometimes an issue, shouldn't matter that much here if the right partner comes on board, which appeared to be the case before the US Government restricted travel to the US.

For details, see otherwise
https://www.reuters.com/article/us-health-coronavirus-pfizer/pfizer-weighs-working-with-biontech-on-potential-coronavirus-vaccine-rd-head-idUSKBN20T03K

Davidski said...

@Matt

You keep suggesting that I'm the one with the strange ideas, but the fact is that the UK government is the outlier here, and it's being openly criticized for that by many experts.

Are you saying that the people quoted in this article were somehow misinterpreted by the journalists?

https://www.theguardian.com/world/2020/mar/15/coronavirus-health-experts-fear-epidemic-will-let-rip-through-uk

Davidski said...

@NeilB

Support for Covid-19 letter: request that the UK government urgently and openly shares the scientific evidence, data and models it is using to inform its Covid-19 public health response

https://docs.google.com/forms/d/e/1FAIpQLSfxKs8sYwHSLwhtQGP_oar1SJwfKtkXwCIJXAXKAsJfGYKF2w/viewform?vc=0&c=0&w=1

Let's see what response Johnson and friends come up with.

epoch said...

@Samuel Andrews

One of the things you can find on that ancestry tree of Nextstrain is that the MRCA of an entirely US confined cluster is dated to 24 January. That seems like spreading for almost 6 weeks before being noticed. Every country started with the notion that their cluster won't be as bad as Italy's. Trust me. Yours, and ours, will.

epoch said...

Piece of good news: Italian doctors are reporting that there seems to be some evidence that an immune response suppressing medicine used for severe arthritis seems to improve bad patients.

https://en.wikipedia.org/wiki/Tocilizumab#Severe_acute_respiratory_syndrome_coronavirus_2019_(COVID-19)

Davidski said...

@NeilB

If the mortality rate turns out to be the 1% many experts are using as their working assumption then that would mean 531,100 deaths. But if Whitty’s insistence that the rate will be closer to 0.6% proves accurate, then that would involve 318,660 people dying.

https://www.theguardian.com/world/2020/mar/15/uk-coronavirus-crisis-to-last-until-spring-2021-and-could-see-79m-hospitalised

epoch said...

@Gaska

It's a rare occasion: I fully and wholeheartedly agree with you.

Davidski said...

@Matt

It looks like the British Society for Immunology needs your help. Maybe they missed all of those Twitter links that you posted here.

https://www.immunology.org/news/bsi-open-letter-government-sars-cov-2-outbreak-response

Rob said...

The genomics of Viruses is interesting. They can be broadly classified on the basis of their replication method - RNA viruses & DNA viruses; and further from that into 6 subclasses; 2 DNA ; 4 RNA classes

https://www.ncbi.nlm.nih.gov/books/NBK21523/bin/ch6f20.jpg

Class I: double stranded DNA (dsDNA): the host cell enzymes transcribe the viral DNA into mRNA, which encodes for its proteans, capsid componenets etc
Most notable example - the Herpes family (common cold sore, Chicken pox, genital herpes, etc)
Also Hep B virus

Class II (parvo varus, literally 'poor virus) as has only single strand of DNA (ssDNA)

The thing about DNA viruses, esp Class I, is their role on oncogenesis - causing cancer (e.g. Hep B - > liver cancer, EBV -> nasopharyngeal cancer, certain type of Herpes - cervical cancer) due to their full integration into host genome

Class III - ds RNA viruses

Class IV: single plus strand of RNA
Coronoviridiae are an example
Having 'plus RNA' means that it does not need to get transcribed, but already encodes for proteins, meaning its already infective on its own, without further help from a host cell
But for replication, it works off a negative RNA strand
Class V: single minus strand of RNA
Classs VI : retro-viruses: double negative strands of RNA. Most notable example is HIV, which ; and the clasic treatment consist of reverse -transcriptase inhibitors.

FrankN said...

epoch: "One of the things you can find on that ancestry tree of Nextstrain is that the MRCA of an entirely US confined cluster is dated to 24 January. That seems like spreading for almost 6 weeks before being noticed."

Well, indeed, different approaches to testing make it quite difficult to understand the effective danger of COVID-19. A reasonable up-to date list of infection and death numbers by country is available here:
https://datawrapper.dwcdn.net/mII6b/1/data

The current (Friday?) worldwide tally stood at 156,099 infections, and 5,819 deaths, yielding a mortality of 3.73%. Of course, that tally is so far dominated by China (80,977 infected, 3,193 dead, 3,94% mortality). Now, what is striking is a huge variation in mortality rates:

i) At the top stand countries like the Sudan and Guyana, each with 1 reported/ 1 dead, i.e. 100% mortality. Obviously cases of serious under-testing, as may e.g. also be assumed for Ukraine (33.3%, 1 out of 3).

ii) OTOH, there are a number of countries with significant (>100) reported cases without any fatality so far. These include (reported cases in brackets) Qatar (337), Malaysia (238), Finland (225), Singapore (212), Bahrain (210), Israel (193), Czechia (189), Portugal (169), Iceland (156), Brazil (151), Romania (123), Estonia (115), Kuwait (104) and Saudi-Arabia (103). Maybe for some of the above the worst is still to come. But the Gulf States and Singapore, a/o, seem to have done a pretty good job so far in protecting their population.

iii) A couple of countries seem to stand out as concerns testing, i.e. they show a fairly high number of infected, but thus far a rather modest mortality. This includes first and foremost S. Korea (8,086 infected, rank 4, 0.89% mortality), Germany (4,585 infected, rank 6, 0.2% mortality), Norway (1,090 infected, rank 11, 0.28% mortality), Sweden (961 infected, rank 12, 0.21% mortality) and Denmark (835 infected, rank 14, 0.12% mortality). Other countries with >100 infected, but mortality rates below 0.6% include Belgium, Austria, Canada, and Slovenia. To some extent, Switzerland (1,359 infected, rank 9, 0,96% mortality) may be placed here as well.

iv) Clear cases where the spread of COVID-19 was initially overlooked, and infection numbers appear too low in relation to mortality are - aside from China, of course - Italy (21,157 infected, rank 2, 6.81% mortality), Iran (12,729 infected, rank 3, 4.8% mortality), and Spain (6,391 infected, rank 5, 3.05% mortality - compare that to 0% mortality so far in Portugal!). Judged by current figures, the same seems to also apply to the following countries (rank for infected/ mortality):

- France (7/2.03%)
- USA (8/1.98%)
- UK (10/1.84%)
- Japan (15/2.85%)
- Phillipines (36/7.21%)
- Iraq (37/9.09%)
- Poland (40/2.91%)
- India (42/1.96%)

Somewhat better than the above - and maybe as such providing a reasonable proxy for a realistic mortality rate - fare:
- the Netherlands (13/1.25%)
- Australia (20/1.20%)
- Greece (22/1.32%)

v) Possibly the best estimate for COVID-19 mortality is delivered by the quarantined cruise ship passengers: 696 infected, 7, deaths, 1.01% mortality.

Coming back to your original point, Dave: The UK and the US seem to be on the best path to not only underperform in comparison to Singapore, Malaysia the Gulf States, Israel, Scandinavia, Czechia, Germany and Austria, but also when it comes to, e.g., Greece. So far, they perform at par with India..

Chad said...

You aren't going to get very accurate death rates as countries have different age averages. For instance, Italy is very old, but in South Korea it was a young Christian group getting the brunt of it. Also, 85% of Korean cases are still active. They will probably be around 2% still. Looking at the death rates of completed infection, dead or recovered, that rate is at 7%.

FrankN said...

To illustrate my point above further:
There were 9 COVID-19 deaths in Germany until Friday (plus four more over the weekend), vs. 54 deaths in the USA, and 21 deaths in the UK. In contrast, Germany has almost double as many attested COVID-19 cases than the USA, and four times as many as the UK.

Now either, German health care is much better than the US and UK one (which may well be the case: According to the OECD, Germany has 8 hospital beds per 1,000 inhabitants, compared to 2.8 in the US and 2.5 in the UK). Or, Germany has done much more comprehensive testing for COVID-19 than the US and the UK. Whatever it is - there is certainly room for improvement in the USA and the UK (and probably also in Germany..)

Chad said...

The US is under-tested. We're probably at 10x what's reported. Get ready for numbers and deaths to jump soon.

FrankN said...

Chad: "You aren't going to get very accurate death rates as countries have different age averages"
Fair point, especially when it comes to Singapore/ Malaysia vs. Europe - albeit this doesn't explain the huge differentials between the former and the Phillipines, also Indonesia (currently 5.21% mortality, from a low reported number of infections).
It does also not explain variation inside Europe. While Italy has the highest median age in the EU, Germany follows immediately afterwards, and then come Portugal and Greece. Yet, all these three fare so far much better than the much younger UK.
https://ec.europa.eu/eurostat/statistics-explained/images/f/f0/Median_age_of_population%2C_2008-18_%28years%29_.png

S. Korea will certainly require more in-depth analysis once the pandemic has been overcome there. Still, from what I have read, S. Korea has over the last weeks applied a rigid approach to testing, which certainly blows up infection cases there in comparison to other countries.

Davidski said...

Things appear to be getting worse in Italy, but I suspect this is because the infection peak in northern Italy was about a week ago. In any case, its healthcare system is now close to breaking point.

Chad said...

Wait 9-10 days. Germany will be in the same boat as Italy is now.

FrankN said...

Chad: "Wait 9-10 days. Germany will be in the same boat as Italy is now."

Don't think so. The main hotspot is still Heinsberg County (between Aachen and Mönchengladbach), where "Patient(s) Zero" were traced to an elderly couple returning from Italy, and spreading the Virus when participating in a Carneval session on February 15th. The situation there wasn't fully contained - some people spread the infection further across Germany and also to the Netherlands - but most of it seems to be under control now, after quarantining almost 600 people and closing most public institutions including schools and kindergardens. Heinsberg County has so far provided for four COVID-19 deaths (out of 13 in all of Germany), a mortality rate of ca. 0.7%, but a month after the arrival of "Patients Zero", the peak there appears to be over. My sister is a doctor in Mönchengladbach, just a couple of kms away, and hasn't yet conveyed the impression of a massive epidemic there to me.

Similarly, in a number of other cases, "Patient Zero"s were identified early and - together with their contacts - quarantined, e.g. a Nurse working at the Hamburg University Hospital who also had acquired the virus during holidays in Italy (A friend of mine, equally a hospital nurse, had contact to that guy but was tested negatively on COVID-19).

Apparently, with lots of people returning from skiing holidays in the Alps, such targeted, individualised approaches are now coming to an end, so matters will become more problematic in the future. Still, currently most reported cases, and all of the fatalities, relate to just three federal states, namely North-Rhine Westphalia (which has mostly to do with Heinsberg County), Bavaria (obviously closest connected to Italy), and Baden-Würtemberg - the latter apparently a/o affected by the COVID-19 spread in Alsace.

As such - yes, it is obviously going to get worse in Germany, but I don't think it will become as bad as it is now in Italy.

JuanRivera said...

I don't think the US will get out clean. For starters, cases are increasing fastly (around 700 hundred new cases from 2 days ago to yesterday, and nearly a whole thousand from yesterday to today), the healthcare system is fragile and seems to be getting gutted to death, testing is scarce, an underprepared populace, and many can't afford treatment. Both cases and deaths are going to be under-reported (the former due to general lack of testing, the latter if people die in remote places, are buried before reporting, or if deaths are ambiguous enough to be mistakenly classified as other causes). Then, some places in the US are poor (most prominently the various territories of the US, especially American Samoa, the Northern Mariana Islands, and highland PR, and some states of the deep south, especially Mississippi).

Davidski said...

@FrankN

Perhaps the different death rates in Germany and Italy can be explained in large part by the poorer air quality in Italy, especially in northern Italy, which has the worst air quality in Europe?

FrankN said...

Dave: Air quality certainly matters when it comes to respiratory diseases, so I wouldn't exclude your point altogether.
However, the prevailing explanation here is that Italy (especially Venice) attracted more Chinese tourists than Germany, at a time when Italian authorities were still unaware of the dangers posed by COVID-19. In addition, Italy has stronger economic ties to China (Wuhan), especially concerning textiles/ clothing and related machinery, than Germany. So, the theory is that COVID-19 reached Italy early from China, but remained under the radar there until it became too late for any effective containment. I haven't yet taken a detailed look at the COVID-19 phylogeny (Epoch may help out in this respect) - it may confirm or refute these theories.

Otherwise, there was that Wartberg Culture study last autumn that a/o demonstrated a fairly different immune response during the MN, compared to today:
https://www.biorxiv.org/content/biorxiv/early/2019/11/21/851188.full.pdf

More specifically, those Wartberg guys had an immune response that was strongly geared against viruses (e.g. Influenza, Corona), while modern Pops are much better equipped against bacteria. IMO, the bacteria that caused that shift was Yarsinia Pestis - the Plague - which appeared in Central Europe just at the time when Wartberg gave way to Single Grave.
Now, available information suggests that certain areas were much more susceptible to the Black Death than others. This might - speculatively - mean that in some areas, a strong immune response against viral infections has prevailed to date, while in others, the genetic predisposition is towards fighting bacterial rather than viral infections. More specifically, areas with low susceptibility to the Black Death included Lombardy and Northern Spain, where we today see high COVID-19 mortality rates. Conversely, heavily affected by the Black Death, but currently relatively immune to COVID-19, were N. Germany and Scandinavia.
Now, that's highly speculative, and certainly requiring backup by DNA testing of the modern populations in question. There are also regions where the analogy doesnt't work, e.g. Czechia with low susceptibility to the Black Death, but apparently also COVID-19. Still, it is a line of thought I deem worthwhile of pursuing.

Samuel Andrews said...

You guys want to hear a Cornavirus joke?

On second thought I won't because none of you will get it.

Al Bundy said...

@Juan As you've seen the American mainstream media has gone into full the sky is falling mode over this.Actually that's been the case for more than 3 years but this has taken it to the next level.That said, closing down a lot of things for a few weeks is what the CDC seems to recommend and even though the numbers will rise, hopefully in a month or so ,because of the preventative measures taken, it won't be as bad as the media seems to be hoping.It's better to overreact and then dial back versus the alternative.I think Fauci said something like let's see where we are in 8 weeks.Let's hope it looks better, for America and everywhere.

Al Bundy said...

It depends on the area too of course, apparently Seattle is practically a ghost town and also NYC.Other places you can't tell until go you go to the supermarket and see people fighting over toilet paper.Here in Orange County Ca there have been very few cases but schools will be closed for a few weeks starting tomorrow.

JuanRivera said...

Here in PA the stores are nearly empty and schools will be closed tomorrow. Jobs are now online too.

Davidski said...

@Al Bundy

Media hype aside, people should be very scared of this thing and governments not toying with the idea of raising infection rates to achieve herd immunity.

The situation in northern Italy is likely to be repeated in many parts of the US and UK soon, which isn't good obviously, but at least it'll help to drive the point home that this virus has to be stamped out.

Al Bundy said...

It really escalated a lot, practically exploded, in the past few days.I've been keeping up with the progress(bad choice of words) of this thing for a few weeks and it's incredible how quickly it can spread.If keeping away viruses is like a war then using soap correctly, short of a vaccine, is the heaviest artillery out there.Which is why I worry about the homeless population who can't that easily use soap and water and this spreading among them unnoticed.

Samuel Andrews said...

Even though I support President Trump, he is not doing enough about the cornavirus. He should get 5 million testing kits, build new hospitals exclusively for cornavirus. But, he isn't. Be's doing as little as possible.

Al Bundy said...

@Andrews He's stepping up now I would say and remember he banned flights from China early.It's a tough situation.It's also about local authorities deciding what to do in their case.Yea, what was Boris Johnson thinking, did his hair get in the way?

Samuel Andrews said...

That's good he banned travel from China early, then banned travel from Europe. But, to me that's still not enough.

".It's also about local authorities deciding what to do in their case.Y"

But, there are things he could do which he isn't. The federal government has power over local government.

Al Bundy said...

As far as the EU goes, is there a sense of combining resources and coordinating things? It seems like it's every country for themselves, and they had no idea Trump would decide on a travel ban.

Al Bundy said...

@Davidski Absolutely, which is why this spreading among the homeless population, which is very large in San Francisco and Los Angeles, is very concerning.What are soup kitchens gonna do?

Rob said...

@ Al
I outlined partly why above

Al Bundy said...

I missed it I'll check it out.

Davidski said...

Apparently, Johnson is urging British manufacturing companies to switch to producing ventilators.

So at least he knows now what's coming.

Ric Hern said...

Here by us we tend to make jokes about catastrophes since we are so used to them. I think it is a way of coping with stressful situations without going crazy...

FrankN said...

Al: "As far as the EU goes, is there a sense of combining resources and coordinating things?
Hmm.. Well, you may call Germany announcing closing the border to France, at the same time as France announces closing the border to Germany, to be some kind of coordination, but effectively it is of course the opposite. Everybody appears to be just panicking, and attempting to demonstrate to the population that they are able to take swift and adequate measures. The EU Comission will during the next days work out a proposal how such border closures can be aligned with the principles of free movement of goods and People. Good luck with that...

Those "toilet paper wars" (I really wonder whether there aren't more important things to stock) have been recently mirrored on German Federal State level by attempts to secure mouth protections for hospital staff (sold out due to increased demand from China, if not anyway produced there). Northrhine-Westphalias Prime Minister recently proudly announced that he had been able to secure some stocks, but refused to disclose the source until the delivery had been received, for fear other States, or neighbouring EU countries, might step in. The guy is btw. also running for CDU leadership and possibly chancellorship, but for the moment seems to have brushed aside any concerns about National or European responsibility (well, o.k., NRW is currently hardest hit by COVID-19..).

There seem to be some pan-European efforts underway geared towards containing the economic impacts of the crisis - of course, subsidies to airlines etc. are under EU regulatory control - but that seems to be it.

However, on lower levels, there are well-established coordination mechanisms, e.g. as concerns cross-border cooperation or health research, which appear to run quite smoothly. For example, a few days ago the governor of the Freiburg Regency lauded publicly the good and intensive cooperation with his Alsacian counterparts across the Rhine in all matters related to the Corona virus.

Rob said...

Viral pandemics usually blow over by 3 months
I wouldn’t invest in ventilator companies just yet
Let’s see ..

Ric Hern said...

I wonder how many examples is needed to see that clustering together in big towns and cities is not a good thing when it comes to diseases etc.? Eg. Cucuteni Tripolye etc.

Davidski said...

The problem is that there aren't enough ventilators in the UK to cope with something like in Italy right now, and no one really knows what's going to happen in the UK soon.

Katharós said...

In a recent speech, Hassan Nasrallah called for worldwide solidarity beyond all divisions and declared COVID-19 the number one enemy. As it seems a Shia Islamist political leader can be more prudent than the Brit-leadership.
https://english.almanar.com.lb/964988

Gaska said...


@epoch said- Gaska It's a rare occasion: I fully and wholeheartedly agree with you.

Well, I hope we get back to our genetic discussions quickly, after all they are more fun than this virus shit

Regarding the motherfucker CV, I think that politicians have a great responsibility regarding the decisions they are taking. What happens in the UK and the USA reminds me of what happened in Spain last weekend with a demonstration of 150,000 people in Madrid celebrating Women's Day, and left-wing politicians encouraging people to attend the demonstration. Consequences? Two infected ministers, an increase of 1,500 cases in one day and one week later, declaration of the state of alarm with the epidemic uncontrolled.
Johnson and Trump may be smarter than the rest of the Western leadership, but they seem to be doing exactly the same thing as Conte, Sánchez and Macron-You have to take into account that the health systems of these countries (Italy, Spain and France)are the best in the world, with many more beds per patient than the USA and with free and universal medical assistance.Thousands of tests have been carried out, which is why there are such a high number of cases, while in other countries people are not being analyzed, with which the magnitude of the contagion is not known exactly in the UK or the USA.

Our government has now asked us to stay home in quarantine, and to voluntarily bankrupt ourselves to save our elders.Ok no problem, we have 11 million old people that we have to take care of, people voluntarily do the shopping for people who cannot leave home and take care of their neighbors until they have to be admitted to the hospital because they stop breathing. This is a brutal drama because with this rhythm of contagions my wife has told me that in a few days the doctors will have to choose which people to save and whom to let die

Seeing what is happening in Italy, the worst is yet to come so we are prepared for more than a month of quarantine-Regarding the number of deaths, in Madrid the virus entered several retirement homes and many old men have died

At least I hope that people learn how important it is to lose freedom of movement and learn to value our rights as free citizens. We are losing a lot of money, we cannot travel, do sports or go out. I also cannot see my wife and I am concerned because she is exhausted. At least I can enjoy my children

Gaska said...

Regarding the Spanish flu, everyone should know that the Anglo-Saxons called it that because Spain (which was a neutral country in WWI) was the only country that freely reported on the pandemic. The epidemic originated in British and American hospitals and from France it went to Spain where 250,000 people died. The British seem to be adept at creating epidemics and blaming other countries. Here in Spain nobody forgets that thanks to the English we had to suffer from Creutzfeldt-Jakob disease (CJD).

Now it seems that our British friends have a plan to end this epidemic and that they can give us lessons on how to behave. Ok we will see what happens, maybe they are right and they are smarter than the rest of the world, or maybe they are just a bunch of airheads that are playing irresponsibly with the health of their citizens. A few days ago Trump tried to humiliate Europe by banning all flights from all countries except the United Kingdom and Ireland and now he has had to rectify. They must forget politics and focus on their people.

Davidski said...

The UK may well achieve herd immunity, at least in the short term, depending on how this virus behaves, but Johnson will have some explaining to do when many old and unhealthy people start dying and so do a few doctors here and there from working too hard.

I don't think Johnson and Trump have much of a future in politics considering how they handled this pandemic at this early, critical stage.

Davidski said...

The situation in Spain looks quite dramatic now...

https://www.theguardian.com/world/2020/mar/16/coronavirus-spain-takes-over-private-healthcare-amid-more-european-lockdowns

wishfulthinking said...

The latest hypothesis on the origin of the Spanish flu is that it originated somewhere in northern China in late 1917. It quickly spread to western Europe with the 140,000 Chinese laborers the French and British governments recruited to do manual labor to free up troops for wartime duty.

Gaska said...

Yeah, the social and political debate focuses on choosing between two situations, each one of them more dramatic.

1-Provoking an unprecedented economic recession throughout Europe (Chinese industrial production has fallen by 13%), adopting a generalized quarantine that paralyzes activity. economic

2-Ignore this situation and let an important part of the population die for not taking preventive measures against the virus.

It is a moral dilemma that we have already considered and apparently our government has chosen to face the virus, try to save as many old people as possible and ruin ourselves collectively. We have always been Quixotes. Other more pragmatic governments may decide that the virus should spread widely and that many people die, but that its economic activity remain at acceptable levels. Who knows who is right?

My personal opinion as a Catholic is that I prefer to ruin myself and save the lives of many people if it were in my hands, but obviously most people do not think so,and obviously I'm not the one to judge anyone.The Madrid region will be Lombardia in 15 days, a war zone with the army patrolling the streets. Many people wonder if all this is necessary even though a 21-year-old man with previous pathologies died today.

In Europe it is very important to take into account the data of infected by million (China-56)

1-Italy 409 cases/million
2-Switzerland-256
3-Norway-238
4-Spain-188
5-Denmark-155
6-Estonia-154
7-Austria-113
8-Slovenia-105
9-Sweden-103
10-Belgium-91
11-France-83
12-Germany-76
13-Netherlands-66
14-UK-20

Obviously the numbers depend on whether the countries are doing generalized tests or not. I suspect that the numbers have to be much higher,

Davidski said...

@FrankN

One Covid-19 hotspot, northern Italy, has particularly high levels of PM10 - microscopic particles of pollution due largely to road traffic.

https://www.theguardian.com/world/live/2020/mar/16/coronavirus-live-updates-us-cdc-events-europe-lockdown-uk-deaths-australia-france-italy-spain-update-latest-news?page=with:block-5e6f78b48f088d7575594382#block-5e6f78b48f088d7575594382

Mr. J said...

Unfortunately it looks like some people can get reinfected.

https://news.sky.com/story/coronavirus-japan-confirms-first-case-of-person-being-reinfected-with-covid-19-11944295

Rod Johnson said...

I Live in Texas. We moved here from California 5 yrs ago. My wife got a promotion and at this moment she is trying to get back from Spain where she was visiting our daughter who now lives and works there. I am very old and have not worked for many years. The virus is spreading here in the Houston area. It was brought here by a group who had vacationed in Egypt. There has been little or no testing here.
@ JuanRivera
I agree with you. The administration here in the United States has a vested interest in keeping the count down since they minimized the threat to begin with and the CDC is still saying no testing unless you are sick. Also very interesting is a group of scientist working in the Seattle area doing research on flu started testing for the coronavirus19 and found out that it had spread far beyond what was being reported, was ordered two days ago by the CDC to stop testing for the Coronavirus19.

FrankN said...

Dave: Yes, of course, air pollution doesn't really help when it comes to containing the impact of respiratory diseases. However, my current impression is that almost 90% of new cases in Germany (of which there have been nearly 1,500 since Friday afternoon, a 30% increase!) directly or indirectly relate to people returning from skiing holidays in the Alps (especially S. Tyrol). The Virus must already be widely present in N. Italy, and tested cases there seem to represent nothing more than the tip of the iceberg…
Still, we now had the first case of a dead in a home for elderly people, where a COVID-19 infection was only identified post mortem. Seems that time, when each infected can still be identified in time and quarantined before spreading the Virus further, is also in Germany coming to an end.

As to the cases per million, Gaska: Norway looks quite realistic, and I find it remarkable that they so far have been able to maintain mortality at 0,3%. The same applies to Estonia (no fatality yet). Germany, Switzerland, Austria and Slovenia are set to import more infected from Italy, who could go unnoticed for a while. France is probably too low, especially considering the situation in Alsace. And the UK figures look ridiciously low. What is your opinion on the Spanish figures?

FrankN said...

Rod Johnson: The Robert-Koch Institute has amended its list of Corona Risk Areas. In addition to China, Iran, Italy, Tirol, Alsace-Lorraine, the Madrid area, and Heinsberg County in Germany, it now also includes the US states of California, Washington and New York. Everybody coming from these risk areas is expected to voluntarily quarantine himself at home for two weeks.

Natsunoame: Are you mistaking me for an American? I am a German. As to the case that you have cited: That's one of the German firms (teams) that apparently has a vaccine ready. I was talking about another German company, BioNtech, where my niece works. The Marburg University, which has done substantial work on developing vaccines against SARS and MERS, also claims to have a vaccine ready for testing.

That whole story is as populist as can get. That CureVac Company is to 80% owned by SAP-founder Dietmar Hopp, who is rich enough to deny any purchase offers. The remaining 20% are owned by the Bill and Melinda Gates Foundation that, for all I know, is American. That foundation has also invested 50 Million USD into BioNtech, where my niece works. If Trump wants access to the research, all that is required is a talk to Bill Gates..
Our Minister of Economy, P. Altmaier (anyway an idiot) was equally populist and far from the point. He not only missed the fact that there is more than one German Team working on a COVID-19 vaccine, but also that there is already US capital involved.

FrankN said...

You read it here first, now its official:
https://www.web24.news/u/2020/03/german-biotech-company-is-making-progress-in-developing-a-corona-vaccine-2.html
https://www.finanzen.ch/nachrichten/aktien/biontech-and-fosun-pharma-form-covid-19-vaccine-strategic-alliance-in-china-1028997878

And - its China, not the USA..

Gaska said...

@FrankN said-"As to the cases per million, Gaska: Norway looks quite realistic, and I find it remarkable that they so far have been able to maintain mortality at 0,3%. The same applies to Estonia (no fatality yet). Germany, Switzerland, Austria and Slovenia are set to import more infected from Italy, who could go unnoticed for a while. France is probably too low, especially considering the situation in Alsace. And the UK figures look ridiciously low. What is your opinion on the Spanish figures?"

Hi Frank, my wife has told me that the Ministry of Health is being absolutely honest and sincere with the figures, that's why the increase is so brutal this week (I don't know if other countries are doing the same)-

1- Madrid has more than half of the cases in all of Spain, there are provinces that only have 2-3 cases, for this reason they have established the quarantine
2-Only half of those diagnosed with Covid19 are hospitalized (around 5.000), the rest with weak symptoms are receiving treatment at home.650 fully recovered.
3-In Madrid there are still beds for sick people, but all those available in private hospitals, hotels and probably army hospitals will be requisitioned.
4-All available mechanical ventilators have been requisitioned. The Chinese have sent many to Italy.
5-Mortality figures are high compared to northern Europe because the virus in Madrid has entered nursing homes and has killed many people.
6-The first death a 102-year-old woman was diagnosed post mortem.
7-The Ministry does not speak of death by Covid19, but of deaths with Covid19, because in many cases the virus has not caused death but has accelerated it.
8-Retired doctors (under 70) and students are being recruited across the country because many are infected.

My wife also says that the number of infected must already be 10 times higher than the official number, but that the vast majority have no symptoms and fight the disease as if it were the flu. The doctors are behaving very bravely, in Madrid, every day at 8 in the afternoon people go out to the terraces to applaud their efforts and to encourage them to sustain their commitment.

weure said...

In a direct TV speech to the nation, what is very exceptional the last time was 47 years ago, the Dutch prime minister held a very decisive speech.

He made very clear that the government chooses for a guided, controlled spread of the virus. In order to avoid a peak. In the end 50/60% get the virus but when guided we can create group immunity. The other options complet lock down or uncontrolled spread are not preferred. He made a demand on the nation to look after each other.

Besides that the government has already announced a 'virus war chest' an economic investment fund in response to the corona crisis, the budget is 90 billion euro (on the scale of the US this is equivalent to 1800 bilion euro or $1440 billion).

Hopefully this an adequate response because we are facing now the same as China and Italy before.....

DDeden said...

Any building/vehicle with ventilation/forced air heating-air conditioning could have a soap-bubble making machine installed to blow zillions of virus-killing soap bubbles periodically.

Any reason to not do that?

weure said...

correction; 1800 billion euro is $2010 billion

Rob said...

The corona virus was created and released by USA
https://patents.google.com/patent/US7220852B1/en

wishfulthinking said...

Natsunoame and Rob, nice conspiracy theories you have. Rob, created AND released? Really? It would be amazing if for once China would accept responsibility for the harm THEY have been causing the world through viral and bacterial pandemics that THEY originate.

Ryan said...

I have family in the British military. Apparently their policy for Covid-19 is "go to work you pansy." No time off, no tests.

That will end well.

vAsiSTha said...

European banking index hit lowest level since 1987. Banks are not as safe as people think.

Davidski said...

@Rob

That patent isn't actually for SARS-CoV! It's for a method of extracting and detecting it. All of the relevant info is in the accompanying text.

This invention relates to a newly isolated human coronavirus. More particularly, it relates to an isolated coronavirus genome, isolated coronavirus proteins, and isolated nucleic acid molecules encoding the same. The disclosure further relates to methods of detecting a severe acute respiratory syndrome-associated coronavirus and compositions comprising immunogenic coronavirus compounds.

And this has nothing directly to do with SARS-CoV-2 or COVID-19. It relates to the SARS virus that emerged in 2002. See here...

SARS coronavirus (SARS-CoV) – virus identified in 2003. SARS-CoV is thought to be an animal virus from an as-yet-uncertain animal reservoir, perhaps bats, that spread to other animals (civet cats) and first infected humans in the Guangdong province of southern China in 2002.

https://www.who.int/ith/diseases/sars/en/

Rob said...

Well, China has pointed the finger back at USA

la señora bibiloni said...

Not Coronavirus related, but interesting:


Published: 06 March 2020
Gene-flow from steppe individuals into Cucuteni-Trypillia associated populations indicates long-standing contacts and gradual admixture

https://www.nature.com/articles/s41598-020-61190-0

Bogdan said...

The only State in the US without a SINGLE case of COVID-19: West Virginia,
Probably can’t get any test kits out along the “Country Roads”: https://www.youtube.com/watch?v=wH8Ajv_6Xj4

weure said...

We get herd immunity when about 60% of a population got the virus and are restored.

Then there are three options:
1. We get the 60% in an uncontrolled way, that means the spread is getting a peak, than it's health care system overload and a lot of vulnerable people are going to die.
2. A total prevention means very long time lock down.....looks an idee fixe IMO. Because you can't lock down for a long time. And when you go this way the society/ economy implodes. So patient safe but without a job so to say.
3. So they the most sensible is to reach a controlled, guided spread (and try to save the vulnerable, and prevent health care system overload). That's tough. But given the situation the most sensible way.....

Davidski said...

@weure

The most sensible course of action is to go early and hard, test a lot of people, close the borders and roads and almost everything else, and try to eradicate the disease.

Then we can ease the restrictions, and put out any local outbreaks if necessary by local lockdowns, as we wait for a cure and vaccine.

The "herd immunity" idea is total bullshit if there's no vaccine.

Samuel Andrews said...

China could have stopped it before it started.
https://www.nationalreview.com/2020/03/coronavirus-china-response-will-weaken-it-on-world-stage/

weure said...

One way or another he populations do have to reach a kind of herd community, therefore is the the need that about 60% of the population get the virus and are recovered. Either the 'rough' or the (somewhat misleading word) 'soft' / guided way.
But it's a false kind of security that corona knocks on the door and when the door is closed it goes away.
When we do close the door and than after a long time, when we all have got long beards, and we open the door than it's surprise surprise.... I'am there.
There is a famous Dutch saying, admitted typical calvinistic, ' we have to bite the sour apple'. In parts of Europe there are big resources (enough???) to soften it and also soften the economic/ society crisis. But in large parts of the world it's going to be the rough way...we ain't see nothing yet.

Palacista said...

There may be a correlation between death rates and smoking rates but I can't find the stats.
Also, for an informed policy, information is the key so I can't see why large scale random testing isn't being rolled out.

Davidski said...

@weure

There's no guarantee of long term immunity from COVID-19 after being infected. This hasn't been studied properly yet.

Another issue is that many of the infected may have suffered permanent damage. There are reports that COVID-19 can permanently damage the lungs and lower fertility. Also, some of the medication that is being used to treat this disease can permanently damage the kidneys.

So if your immune system can't prevent a nasty bout of COVID-19 you might die, but even if you don't, you might end up very sick for the rest of your life.

Testing a lot of people and isolating them to break the chains of transmission is the best short term solution as we wait for a cure that inhibits this virus in some way, and prevents it from reaching the lungs. This is a realistic goal but it'll take at least a few months.

And obviously we also need a vaccine.

weure said...

I guess basically you can't escape that for herd immunity you have to have 60% infected and recovered people.

And what you say it's also true. But the hard thing is we can't prevent this, people are going to starve and people get some life time effect. Hard but true.

Testing is not the issue (do we have test enough by the way), but prevent a peak in healthcare and prevent the most vulnerable is. That's the only way we can guide/ soften the bumpy way we have to take....

That's the tour de force....most parts of the world will not be able to do that. So we are going to experience nasty times....

And don't forget I think before end of this year we will able to produce a serum.

Davidski said...

@weure

Testing is very important, because it's informative about where the virus is exactly and how it's spreading.

You can't stop something if you don't know where it is and which way it's going.

Basically, this SARS-CoV-2/COVID-19 thing should've been handled like SARS-CoV and Ebola from the start.

But I'd love to know who exactly came up with this herd immunity via infection theory bullshit. They did a good job at selling it at a very high level, but they don't look so clever now.

weure said...

The herd immunity is not bullshit, it's common with viruses. For some viruses like diptheria it's 83% and maesles even 94%. But these diseases are spreading even faster than corona. About corona our knowledge it is limited. So in that sense it's a risk. But herd immunity as such isn't.

Testing indeed has advantages. Biut we will have limited tests. That's for sure. So given the limit it is better to test when there are clear symptoms etc. We aren't able to trace everything now and than go back to the source. That stage is passe. And you aren't able to stop it by now by tracing all those lines. Again limited sources to do so. So nice theory, and it would help with limited numbers.....But face the facts.

But it's better to accept that the virus will make progress everywhere and from everywhere. The trick is that we have to slow down it by different measures so that we keep it under control and that the infection rate will suddenly rise to the 60%.....and measures that will protect the old, weak etc.

Davidski said...

@weure

It's extremely unlikely that you'll see infection rates of 60% in any country that deals with this pandemic successfully.

In other words, in countries that limit its spread and then apply a cure and vaccine.

So I'm not sure why you keep repeating this figure.

Boppo Waldbruckner said...

I wonder why there is no discussion in the media about considering a more a pre-emptive geographic compartmentalization of national population and economy into sectors with high and low anti-transmisson policies.

Keep 75 % of a country in full lock down and quarantine, keep the other 25% open and let that part be saturated by the virus, and when intensive treatment demand is overwhelming the hospitals of that part of the country send those patients to the rest of the country in lockdown sector for treatment there. After maybe 4 weeks rotate the policy and let another 25 % sector be free and open, and continue so on.

Instead of one horrendous peak that overwhelms the health infrastructure, we’ll have 4 smaller peeks over a 4 month period. And at least 1/4 of the economy will be running as normal and gradually reopen.

Of course the fraction 1/4 can be swapped to 1/5 or any other ratio that would match the total capacity of whole country health system.

And of course it depends on the assumption that long term health effects are comparable to regular influenza for the communities that have been through saturation.

weure said...

https://www.theguardian.com/world/2020/feb/11/coronavirus-expert-warns-infection-could-reach-60-of-worlds-population

weure said...

https://www.sciencemediacentre.org/expert-comments-about-herd-immunity/

weure said...

" Letting a potentially lethal infectious disease burn through a population is another way to reach herd immunity, but it comes with considerable risks and downsides (see above). This is why we still need to all work together to try to slow down and minimise the spread of Covid-19 by practicing hand hygiene and social distancing. This will hopefully reduce the pressure on the NHS, allowing for more people to be treated and thus reducing the number of people dying of this infection."

Apostolos said...

In Greece the average age those who died is 68 (5 cases, all male, 92 the oldest one) and the average age of those that are in serious/critical condition is 69 (11 currently need mechanical ventilation afaiu, all male again).

FrankN said...

weure, Dave: Human Corona infections are nothing new: A study a few years ago (I think in Scotland) found out that 15% of all cases of "common cold" were caused by Corona viruses. As such, COVID-19 cannot be compared to, e.g., Ebola, which was a completely "new" disease. The better comparison is in fact the flu, which typically is believed to be under reasonable control, albeit killing over 10,000 per year in Germany. Every few years, a particularly virulent influenza strain appears and drives the death toll upwards - the last time in 2017/18, with some 650,000 deaths worldwide. COVID-19 should as such be regarded as a particularly virulent strain of a disease that has affected humans since centuries (millennia?).
As such, the "herd immunity" discussion is somewhat missing the point. As we have a particularly lethal strain of influenza developing every 7-10 years, the same may be expected for Coronaviruses. And the general strategy to cope with that challenge should be similar to the one against influenza:

1.) Promote a reasonable degree of "base immunity" stemming from previous survival of less lethal strains (and the fact that 80% of all COVID-19 infections are mild seems to suggest existence of such base immunity);

2.) Reduce risk factors for respiratory health, e.g. air pollution or smoking;

3.) Install effective early warning and monitoring systems;

4.) Develop and apply vaccination against particularly lethal strains, especially for groups at risk (elder people, pre-existing respiratory problems etc.);

5.) Promote appropriate hygienic measures among the population (hand-washing etc.);

6.) Have your health system prepared for coping with sudden outbursts and seasonal peaks (and in fact, one of the rationales publicly given for drastic measures such as school and restaurant closures in Germany is that hospitals are at the moment still full with influenza patients, so the inevitable COVID-19 peak shall be delayed to after the end of the influenza season);

7.) Accept a certain number of deaths from virus-related respiratory diseases as unavoidable. Possibly. the 2017/18 influenza season may be taken as a benchmark here: In Germany, ca. 9 million patients (11% of the population) sought medical assistance, out of which 45,000 (0.5%) were hospitalised, and 25,100 (0.28%) died.
https://influenza.rki.de/Saisonberichte/2017.pdf
If COVID-19 ultimately results in similar figures (possibly slightly higher, given that no vaccination exists yet), it IMO may be considered as having been successfully contained. A worst case scenario, OTOH, assuming a 60% infection rate and 1% mortality, would result in ca. 500,000 deaths in Germany, which is clearly unacceptable.

FrankN said...

For comparison, here the US figures for the 2017/18 influenza season:
https://www.cdc.gov/flu/about/burden/index.html

45 millions infected (14%)
21 millions medical visits (6.5%, far less than in Germany)
810,000 hospitalisations (0.39% of medically attended, less than in Germany)
61,000 deaths (0.285% of medically attended, same rate as in Germany)

FrankN said...

German virologists are now proposing a different kind of "herd immunity" strategy. They assume that
a) The time, when infected individuals could be effectively isolated, is now over. Per this afternoon, there were 8,547 recorded infections in Germany, up from 4,585 last Friday. Apparently, the Virus now starts to work ist way through the population [Almost 70% of cases, and 95% of deaths, still relate to only three states, namely NRW, Baden-Würtemberg and Bavaria. Within that, the Heinsberg-Aachen Region stil makes up for over 10% of total infections, and almost half of fatalities. However, case numbers are rising quickly in and around Hamburg, which has now the highest number of infected per 100,000 inhabitants. A main factor here were local school holidays in late February, traditionally used by many for going skiing in the Alps (and returning with COVID-19). Ischgl in Tirol seems to have been especially dangerous in this respect.

b) Unlike previously assumed, the COVID-19 spread will probably not be significantly delayed by the arrival of spring and summer. As such, the peak in Germany is now expected for June to August (forget about the Euro 2020 and the Tokyo Olympics..).

Against this background, the recommendation is now towards isolating risk patients, especially elder people. E.g., it is recommended that (Grand-) children stop visiting their old age relatives at home, but instead go shopping for them and deliver the supplies to their door - something apparently already happening on quite a scale. The hope is that by late summer, the infection will have passed through the younger and less vulnerable part of the population, giving them immunity and effectively stopping the pandemy before it has spread to risk groups.
How such approach shall be applied to nursery homes, however, has yet remained unclear to me..

Rob said...

In practicality, vaccines & herd immunity are irrelevant
The main approach is (1) institute Lockdown measures to Halt the doubling effect of incidents 2) isolate whatever cases are known; and (3) manage as best as you can those already infected

weure said...

@Rob a total lock down is stupid as hell. A free, open modern society can stand this for long. How long do you want to contain a lock down till there is a world wide economy implosion? And when the lock is detached from the door, than there stands the virus right in front of it!
Graber POTUS and his mate -the evolution denier-Pence are total incapable of managing this, Trump is like an unguided projectile that is going to make it worse and worse....up to previous week he denied and downplayed the whole virus....I hope some capable governors can do the job, mr narcissus Is only focus is me myself and I not the sake of the world community. He tried to capture a medicine in development from a German compagny. Now he is black jacking with Chinese, and calls the corona virus, foreign or Chinese...applause, this makes no sense at all.
And the working poor In the US are going to criple in the gutter because some ideological fanatics prevent right measures.....mark my words.

Davidski said...

@FrankN

I can't recall any coronavirus or indeed any flu-like virus like this one, which can overwhelm modern healthcare systems within a couple of weeks.

So your point that SARS-CoV-2 isn't totally new is a point, but it's not a useful point in the context of this discussion.

wishfulthinking said...

Amazing Weure. You should remove your Trump-hate brand of glasses. Its clouding your reasoning.
According to Forbes the USA has 3 times the number of ICU beds as Italy and 6 times the number of ICU beds as the UK. I recall that it was in January of 2020 that Trump stopped flights from China.
Things will get worse in the USA. It's how pandemics work. I am happy with the actions of President Trump and disgusted with the actions of China. We can criticize all we want the course of action that the UK vs Italy vs USA have taken. But I think that they are all doing what is in their best interest as nations. My heart goes out to the Italian people. I wish them the best success in winning over this plague situation.

weure said...

@wisffullrhinking what could be a reason to think that Trump see it all clear makes the right and wise decisions.....the only thing I can imagine is misplaced loyalty. You must be wearing thick pink sunglasses to qualify the actions in the corona crisis of Trump and “yes mister president’ ‘of course mister president ‘Pence to make you ‘happy’. Indeed wishful thinking......

Davidski said...

@weure

No country can sustain a 60% infection rate for this thing unless this is stretched out for months, and the only way to achieve this is with a lockdown.

So I'm really not sure what your point is, because whatever we do, lockdown is the only option until a cure and vaccine arrive.

The only question left at this point is whether a sudden lockdown is better than a slightly delayed/gradual lockdown.

FrankN said...

Dave: "So your point that SARS-CoV-2 isn't totally new is a point, but it's not a useful point in the context of this discussion.

Well, I think, it is useful to put SARS-CoV-2 in the context of comparable infections, e.g. the flu, in order for everybody (myself included) getting a better feeling about which measures are adequate, and which not.

I mean - we are now facing -as already expressed by weure and also Gaska - a massive economic implosion. On the industrial level, world-wide supply chains are getting cut - starting already from the Wuhan lock-down that a/o affected mobile phone supply. With VW, the world's largest car builder, today announcing a total lock-down of all German plants, this collapse is just about to reach a dimension that is reminiscent of the early 1930s.

Then, look at global tourism and the hospitality sector. Governments will certainly bail out airlines, probably also large tourism companies like TUI. But what about gym, cinema, club and pub owners, stage equipment rentals, trade fair stall builders, travel agencies, smaller and local tour operators, diving schools etc.? These are small and medium sized businesses with typically little financial reserves. I don't think anyone has a plan for them yet, and even if governments come up with some kind of liquidity aid and guarantee schemes, 80-90% of all enterprises in question will be dead before bureaucracy is ready to address their situation. In many cases, we will be talking about people at the fringe of social security systems - doorkeepers, dishwashers, waiters, taxi drivers, stage helpers etc.

So, when you say "I can't recall any coronavirus or indeed any flu-like virus like this one, which can overwhelm modern healthcare systems within a couple of weeks" you are correct, at least as concerns Wuhan, Italy, probably also Madrid. OTOH - I can't recall Governments and economic actors ever having triggered such a massive economic shut-down and actually global economic collapse. Economically, this may become worse than any Black Friday in history, including 1929 and afterwards. And - however I want to reduce the risk of anybody dying from SARS-CoV-2 - mass unemployment, especially of those already poorly covered by social security, will certainly also increase mortality (homelessness, suicides etc.) already in industrialised countries, and even more so in the Third and Fourth Worlds.

Davidski said...

@weure

Your approach is based on the assumption that it's possible to control the growth of the infections.

But this assumption is wrong. There are really only two options, either do a lockdown or overload the health system.

Total lockdowns don't have to last very long provided they're initiated early and done properly. This has been shown to work in practice, unlike herd immunity via infection for such a deadly and new coronavirus.

Rob said...

@ Weure

''otal lock down is stupid as hell. A free, open modern society can stand this for long. How long do you want to contain a lock down till there is a world wide economy implosion? And when the lock is detached from the door, than there stands the virus right in front of it!''

I'm not sure. But its being institute increasingly (shutting schools and any non-essential transactions). It might just take 2-3 weeks to stop the 'doubling effect' by minimizing large congregations. Then the case number will be manageable & it'll fizzle out

Synome said...

It looks like much of the spread is fueled by asymptomatic individuals, which means that mass testing is the only way to effectively manage the growth of outbreaks in the long term. What mass shutdowns are doing here in the US is buying time for our testing capabilities to ramp up to where they need to be to identify and quarantine infected individuals, including asymptomatic ones.

The earlier and more complete the lockdown, the easier it is to produce and operationalize the required number of tests. Bought time is extraordinarily valuable, as the number of tests required increases exponentially with each passing week, just as infections do.

FrankN said...

"There are really only two options, either do a lockdown or overload the health system. "
Actually, no. Singapore has demonstrated that early identification and effective quarantining of infected can work very well. The thing is just: You have to do this early. Once a certain level of infections is surpassed (as a few weeks ago in Italy, now apparently also in Germany), this approach isn't workable anymore.

The "overload" issue has a/o to do with the capacity of the health system. E.g., Germany has 28,000 intensive care hospital beds, some 20,000 of which are equipped with ventilators. Currently, some 500 people are hospitalised with COVID-19, so the capacity is far from being reached. And, actually, hospitals are asking the government for compensation, as they on government request have post-poned non-critical operations in order to vacate beds for COVID-19 patients that haven't arrived so far.

But, let's do some math: The assumption her in Germany is that 7.5% of acutely infected will require hospitalisation. The WHO currently puts the rate lower, at 5%, but in fact both sides seem to be just guessing. Let's stay with the higher German estimate for the Moment, to be on the safe side.
Let's furthermore assume that
a) all hospitalised require intensive care with ventilation (which is probably overly pessimistic);
b) after accounting for traffic accidents, lung cancer, TB etc., 14,000 beds will effectively be available for COVID-19 (no idea, whether that is realistic or not, but the figure simplifies calculation);
c.) hospitalisation will in average last for two weeks, after which the patient either recovers or has died.

This means, the German health system will be able to cope with 1,000 hospitalisations/ day; which means some 13,500-20,000 registered (!) fresh infections per day, before becoming overloaded.

The SARS-CoV-2 infection rate is to date not known very well, but the WHO estimates it at around 2-2.5. This rate refers to the total time during which an infected may transfer the virus. That time is equally known only poorly. The only thing known so far is that it appears to be shorter than for the flu, because SARS-CoV-2 has a longer incubation period. Let's assume 20 days virulence - this would mean 0.1 - 0.125 new infections per acutely infected and day under "normal" (no lockdown/ quarantine) conditions.

This means, that at worst, the German Health System will w/o lockdown become overloaded if the number of acutely infected has surpassed 110,000. With the upper WHO figures, the critical point lies around 200,000 acutely infected.

Now, the current tally lies around 8,500, with a daily increase by ca. 1,200. How much of this increase is "homegrown", and how much relates to "import" from the Alps, is difficult to say. Probably, it is still often the latter, but turning towards the former, since according to the estimates above, we should now be talking about some 1,000 fresh homegrown cases per day. So let's assume that, by the end of this week, the tally will stand around 15,000, and from then on, "imports" will have mostly ended and any further dynamic is home-grown.

Based on these figures, I have run a simple day-by-day projection. W/o lockdown, Germany will overload its health system in the worst-case scenario (0,125 infection rate/day/infected, 7.5% hospitalisation) on April 10, in the best case (0.1 infection rate/day/infected, 5% hospitalisation) on April 25. "Herd immunity", i.e. 60% of the population healed, may be achieved by around June 25. Now this is Germany, with the highest number of intensive care beds per person in all of the OECD. The UK and the US will in all likelyhood reach the "overload point" earlier, if they don't take strict measures immediately.

So, yes: The point when a lockdown was still avoidable seems to have been passed in most of Europe. However, I fear it will have to last for quite some time, with serious economic consequences.

FrankN said...

Now, there seems to be an alternative that I a few hours ago discussed with my daughter, and that is apparently being given quite some consideration to among students from Berlin:
Starting point was that she might have caught a SARS-CoV-2 infection from her flat-mate, as that girl messed around with the wrong guy one-and-a half week ago - a guy shortly afterwards tested positively for SARS-CoV-2 (5 days w. fever). [We're of course getting here into terrain well known from the 1980's HIV pandemic - how attentive should you get with choosing your sexual partners? I'd say: No kissing w/o mouth protection from now on..]
Now, my daughter said that she actually wouldn't be that unhappy if having caught SARS-CoV-2 already now. Living in downtown Berlin, she anyway reckons with being infected sooner or later. Better sooner, getting over with it, and being able to see the grandparents over Easter w/o any fear of possibly spreading the infection to them. Asides, as the Universities (and clubs/pubs) were closed, there was anyway not much to do at the moment…

As it turned out, the idea of "Let's get SARS-CoV-2 now, it's hardly dangerous for us, but we may reduce risks for our grandparents this way" seems to be quite popular in Berlin - the Robert-Koch Institute recently warned against so-called "SARS parties" becoming fashionable there. I am actually not sure about how risk-less such voluntary self-infection/ self-vaccination of under-30s is, but its certainly an interesting way to intervene into the standard logic of disease progression that is underlying all statistical modelling, including the one provided in my previous comment.

Al Bundy said...

This causes mild colds in the vast majority of people and they recover.Yes,some younger people have died from it but it seems like mostly the elderly and those with underlying conditions have been the victims.All this is just like the flu. Thousands of Americans die from the flu every year,and there's no panic.It's early and as Rob says hopefully it'll fizzle out in a few weeks because of the measures taken.There are worst-case scenarios but you can't plan public policy based on that.It's new,it has an ominous sounding name, and the images coming from Italy and elsewhere are scary because this is being treated as the second coming of the Black Death.I hope this thing is destroyed and a vaccine is discovered and if these drastic measures work I support them, it just seems way over the top.How exactly is this worse than a bad flu?

Al Bundy said...

Yea I guess that's my question, why can this overload the health system?If people weren't completely frightened by the media and this was called a flu or a less scary name, would it still overwhelm the system?

Vladimir said...

Take your mind off the virus. Article about the fact that people lived in Kostenki during the peak of the ice age 25000-15000 years BC. https://doi.org/10.15184/aqy.2020.7

JuanRivera said...

Pointless to get oneself infected with the virus early to visit someone later when the nature of the pandemic means that lockdowns are looming on the horizon everywhere, meaning that people can't exit their homes unless it's for essential purposes.

Tom Bridgeland said...

The hospital I work as a nurse at just had it's first case. They have asked for volunteers to staff an 11-bed iso unit. I joined. We are not far from Chicago, so I am expecting a flood of cases next week, 2 weeks at most. I asked and was told there is no problem getting tests done on patients suspected of corona. However, there is a 2-4 day wait for results! This is silly. To get results from our in-house lab for any other common resp virus the turnaround time is a few hours. Hopefully that will improve promptly.

I feel my hospital admin is doing far too little, far too late. 11 beds? They are dreaming. The ED does not have separate triage areas for people with 'cold and flu' symptoms, separate from people with any other problem.

Locally there has been little panic buying. Store shelves are a bit sparse but far from empty. Schools, restaurants, bars are closed by state order. This was again too little and too late, but better than nothing.

Davidski said...

@Al Bundy

Yea I guess that's my question, why can this overload the health system?

Because the growth of this virus is exponential, more so than that of the seasonal flu. It's like a high speed train coming towards you, and right now all you're seeing are the train lights far away.

And on top of that, COVID-19 is more deadly and harmful than the average flu, so it puts a lot more people in emergency and intensive care units.

Davidski said...

@All

I updated the blog post...

It looks like the UK government read this blog and changed its policy. Many other countries, including the US, are also now taking more serious steps to halt the spread of COVID-19. But will it be enough, and can the global economy handle the pressure?

zardos said...

Even among the younger the rate for death and serious permanent organ damages is many times that of the flu. You never know what kind of immune response you get, even blood groups might make a difference.
Only the very young to the age of 10 being really safe. Everybody else has minimum 2-4 times the risk for death and permanent impairment of a regular flu and its much more contagious.
So even young people are playing with their life and health in a serious way if getting infected. Its just their odds are fairly good to get just mild symptoms. Every additional decade of years or disease you have makes the odds much worse.

But then again, you don’t know your individual immune response, its like gambling.

Iñigo said...

@Al Bundy

Forget about the name, you can call it coronavirus, new flu or X, but it is already collapsing hospitals, and not with people with some fever and cough. My aunt is a nurse working at a hospital in Vitoria, one of the worst places in Spain in terms of coronavirus spread, and she texted me last night saying that yesterday they had 57 people in the Emergency room with Pneumonia, and this is just the beginning...

Andrzejewski said...

@Iñigo “Forget about the name, you can call it coronavirus, new flu or X, but it is already collapsing hospitals, and not with people with some fever and cough. My aunt is a nurse working at a hospital in Vitoria, one of the worst places in Spain in terms of coronavirus spread, and she texted me last night saying that yesterday they had 57 people in the Emergency room with Pneumonia, and this is just the beginning...”

Here president Trump has declared a national emergency but he stopped short of announcing a full blown “lockdown”. Perhaps it’s due to the constitution he cannot so that, or maybe he wants to prevent panic? No one knows for sure. I know that I’m your country it seems like no one can get out of their house but correct me if I’m wrong

Robert Hartmann said...

@Davidski

Respect. A fine job done. Stay healthy!

epoch said...

@Al Bundy

".All this is just like the flu. Thousands of Americans die from the flu every year,and there's no panic."

First of all, the fact that most people underestimate the flu problem is bad enough in itself. Secondly, autopsies from people that died from the flu show badly damaged lungs in some cases. Autopsies from this disease show massive lung damage in all the cases. This isn't like the flu. This is SARS. Only, this time with 80%-85% mild cases (which includes viral pneumonia) that act as distributing agents.

This is NOT the flu.

epoch said...

@FrankN

"Better sooner, getting over with it, and being able to see the grandparents over Easter w/o any fear of possibly spreading the infection to them."

Unless she is tested she can't be sure. Don't take any chances at all.

epoch said...

@Al Bundy

"Yea I guess that's my question, why can this overload the health system?If people weren't completely frightened by the media and this was called a flu or a less scary name, would it still overwhelm the system?"

Everyone admitted to the health system is in serious respiratory trouble. You see, in order to keep as much free beds as is possible all cases that can recover at home are required to.

Tetris said...

A good resource for statistics can be found here:

https://www.worldometers.info/coronavirus/

Death rates look alarmingly high, but we'd have to wait a bit longer for things to settle down in Europe where it's still in the very fast growing phase. Nevertheless, among people under 60 without a previous condition it doesn't look worse than some bad flu.

One thing about economics and conspiracies is that the governments had the choice of doing as little as possible and let a lot of vulnerable people die, not only not hurting the economy, but getting a boost out of it (since those vulnerable ones are an economic burden, generally speaking) or doing as much as possible to protect those vulnerable ones and take a big hit in the economy. It seems clear which have been the priorities of most of the governments if not all (I have no idea if Trump and Johnson were trying to go for the former but pressure forced them to change their stance).

As for the best strategy, it looks like locking down the vulnerable ones should have worked better than anything else. Let normal (healthy, younger) people get on with life and work, even if some would have to stay at home with "flu" (and even if a very small number could die, just as it happens with regular flu), and completely isolate vulnerable people until the virus is gone (3-6 weeks?).

Easy to say, specially now. But shouldn't specialists know about these situations to take the right measures from day one?

Davidski said...

@Mardi

Ending epidemics by isolating cases is known to work in practice.

No one knows yet if building up long term immunity to this virus via infection is even possible, and what sorts of permanent health damage might be suffered by the survivors.

Folker said...

All (especially US residents)
In France and Belgium many people didn't take (and still many don't) take COVID 19 seriously. Mainly because first symptoms are similar with flu, and flu is rare in Spring and Summer.
Governments were on the same line since last week, but changed their line few days ago because statistics are awful. In Italy, it is clear that COVID 19 has expanded exponantially, far more rapidly than anyone would have guess. The same is happening in France, mainly because of 2 clusters: one in Oise (probably caused by a military airport), and in Alsace (because of an evangelist meeting). In Alsace, hospitals are full, and triage has begun. Hospitals in Paris are nearly full too.
Sadly, confinement has only be decided this week in France and Belgium. France has only a 8/9 days margin from Italy in contamination (France has the same numbers than Italy a week ago).
Hospitals in France and Northern Italy are far better than most hospitals in UK or USA. Think about it.
I am following COVID 19 from some times now, and it is clear that R0 is far more than 2,4, probably more between 3 and 7. As fatality rate: the 3,4% found is China is probably accurate (even if for bad reasons, since China is not transparent at all). Please take a good look at South Korea: contamination rate is falling, but fatality rate is up. This is because complications are happening in the 2d week and death in the 3d. The idea that many people are asymptomatics seem to be false as South Korea is testing everyone, and they have already more than 1% deaths.
Be aware of 2 things:
- China has won a battle in Wuhan, not the war. Many provinces are still in quanrantine, and the virus is still there. Other battles are very likely in the next months.
- Nobody knows what is happening in Iran or Africa. Some European clusters have a source in travellers from Egypt. This is probably not coincidental.

Take care of you, stay at home.

zardos said...

@Mardi: That doesnt work, because how do you think complete isolation for the vulnerable will work out with the younger people going on as usual?

And consider that even among those which are young and without a known disease burden the death rate seems to be 0,2 percent. Those seriously illegal approach full percentages of which a high proportion might end up with permanent organ damages, especially on their lungs.

So even on the best group of young adults one of 200 minimum will be seriously affected. That's far worse than the regular flu with the exception of young kids, for which the flu is worse.

Folker said...

Just in case: young people can die of COVID 19 too. Li Wenliang was 34. 15% of contaminated are needing intensive care (in hospital). If there is no bed available, you are likely to die, even if you are young. That is the main cause of death: contamination by COVID 19 is exponantial, and hospitals are very rapidly full with no place for new patients.

zardos said...

Besides if your immune response is out of control, your own defense will lead to organ failure for which there is currently no effective treatment. Most affected by this most serious and deadly progression of the disease are old, but even if the percentages are lower, there are in absolute numbers a lot of young cases. And like I said before, you don't know your immune response. You can get in control of the infection fast, you might be a severe case which survives only with intensive medical care and a respirator, or you end up with an over the top immunce reaction which leads to organ failure. You can't know in which category you fall.

Even worse we don't know how immunity being build up after infection, whether people could get infected next season like this one and we have to consider the possibility of aggressive mutants of the virus being even more deadly. To not having contained the virus as long as it was possible might have been a grave mistake, far worse than most people can imagine right now.

Talking about the flu, people should remember the Spanish flu which came in successive waves, one worse than the one before and killing more young men than WWI, in the highest estimates more than WWI and WWII together! And the longer term potential of Covid-19 is completely unknown. There is reason to take it very, very serious.

Unknown said...

The other day I had mentioned HCQs success in trials. And today here's the latest, research by French doctor Didier Raoult:

https://twitter.com/RiganoESQ/status/1240273631604809728

China also mentioned Japanese drug Favipiravir yesterday as a potential treatment

Mehmet Kurtkaya

Richard Rocca said...

David, trying to find an outlet for all this gloom, so I'll ask a DNA question if I may. Did you ever get the genotypes for this, including the Terramare sample "9309_Co" ???

https://genome.cshlp.org/content/early/2020/03/12/gr.260141.119

Folker said...

Raoult is a bit a lunatic. His sampling is very limited, and it is very difficult to know if there is any effect on COVID 19 in vivo. More testing is on way, so we will know in the coming months if HCQ is useful and could be used safely (posology of HCQ in the articles is a problem by itself: dosage seems very high, probably not without side effects)

Unknown said...

I don'r know Raoult but here's a short article from the US on Korean and Chinese guidelines:

https://docs.google.com/document/d/e/2PACX-1vTi-g18ftNZUMRAj2SwRPodtscFio7bJ7GdNgbJAGbdfF67WuRJB3ZsidgpidB2eocFHAVjIL-7deJ7/pub

Mehmet Kurtkaya

Folker said...

Chloroquine is toxic and overdose can be lethal. Chinese doctors gave 500 mgr per day, wich is already viewed as a high dosage (given persistance in the body), possibly toxic for some. And their sampling is equally small (100 patients of unknown history). Difficult to conclude with so few data. French government has authorized more testing in Lille (where there will be a more neutral approach than Raoult in Marseille).

FrankN said...

Mardi "A good resource for statistics can be found here:

https://www.worldometers.info/coronavirus/"
Thx! 33 new deaths in the UK yesterday - that's not going to end well..

Folker: ".. in Alsace (because of an evangelist meeting). In Alsace, hospitals are full, and triage has begun. "
That's now crossing into Germany. In Baden-Würtemberg, Rhineland-Palatinate and the Saarland, infection numbers yesterday all increased by 30% or more (elsewhere in Germany 5 -20% increase, still substantial).

Zardos: "consider that even among those which are young and without a known disease burden the death rate seems to be 0,2 percent." Actually, the 0.2 percent death rate relates to the total 10-39 age class, with or without disease burden. Diabetes Type 1 is typically diagnosed at the age of 11-13, and seems to in Germany affect around 3% of all juveniles and young adults. If you multiply that with the 7.1% mortality of Diabetes patients, you end up pretty close to that 0.2% mortality.
[Since I have Diabetes (Type 2) myself, I tried to figure out reasons for the increased mortality. One obvious issue is that Diabetes is often (thankfully not in my case) correlated to cardio-vascular diseases and hypertension, which by themselves are major COVID-19 risk factors. Another potential factor is that elevated blood sugar levels glycolise the Hemoglobin, thereby reducing the red blood cells' capacity for oxygene transport, and aggravating respiratory problems. The latter would in particular affect so far undiagnosed (untreated) cases of Diabetes Type 1.]

FrankN said...

Correction: The Diabetes Type 1 (DBT1) rate in Germany among juveniles is rather around 0.35%, and appears to be lower in East Asia. As such, DTB1 may explain part, but not all of the under-40s COVID-19 mortality in China.

zardos said...

@Frank: Yes, the (minumum?) 0,2 in that age group are related to diseases patients already had before getting infected, but there are growing numbrers of cases without a burden. Remind you, its the healthier ones which make it the first two weeks of the infection. The first deaths are always the weakest, but then the numbers for healhier patients, which survived the first weeks, will rise too.
And if you extrapolate the numbers we have right now from places like Lombardy, we potentially deal with hundreds of thousands of deaths in the otherwise healthy population below 60 alone and up to millions for the seniors. So while this Corona strain is right now not the plague, it is a serious burden and produces an big excess of morbidity and mortality in comparison to the pre-Covid-19 situation. The faster the spread of the infection is, the higher the systemic burden, not just on the medical facilities, but the economy and society as a whole.
We might be lucky if the weather makes a huge difference and the current measures produce good results, but the threat of an escalation is very real.

epoch said...

@FrankN

"I haven't yet taken a detailed look at the COVID-19 phylogeny (Epoch may help out in this respect) - it may confirm or refute these theories."

Trevor Bedford (https://twitter.com/trvrb) thinks the Webeko strain is ancestral to a large part of the Italian outbreak.

https://twitter.com/trvrb/status/1235388721081417728

Davidski said...

@Richard Rocca

As far as I know, the genotypes from that paper aren't available online.

It might be useful to get in touch with the contact author in regards to that.

FrankN said...

Did some more thinking and modelling:

1. "Local eradication" is not an option anymore. This is now a global pandemy, and even if one country/region manages to stay clear of it, as soon as borders are (re-)opened, the Virus will be imported from elsewhere. Point in case is the current spread from Alsace into SW Germany. On a global scale, look at Egypt, or the worsening situation in Indonesia (11 new deaths yesterday). What is required is large-scale immunisation, either by a vaccine, or by acquiring "herd immunity".

2. I then tried out some "Lockdown" scenarios for Germany (number of infections per March 22 raised to 20,000 in line with yesterday's increase, mortality 1% before, 2% after health system overload, otherwise same assumptions as per my comment above):

1. No lockdown: Health system overload starting between April 13 and April 27, herd immunity between mid-June and mid-July, 1.4-1,7 million deaths

2. 30% reduction of infection rate via lockdown: Health system overload starting between April 22 and May 27, herd immunity between mid-August and early November, 1.1-1.4 million deaths

3a. 50% reduction of infection rate via lockdown, at 2.5 infection rate: Health system overload starting between June 6 and July 1st, herd immunity by February 12, 2021, 1.05-1.1 million deaths

3b. 50% reduction of infection rate via lockdown, at 2.0 infection rate: infection numbers remain almost constant, no overload, herd immunity sometime in the 2030s, 13.600 deaths until early February 2021 (by when - hopefully - vaccination will be available).

In fact, none of this is a feasible strategy! I understand the argument: Buying time for increasing hospital capacities, improved treatment and vaccination. But even this way, under half-way realistic assumptions, only some four to eight weeks will be gained - a time span that will ultimately save some 300,000 lives, better than nothing! Still, the death toll will still be enormous, and the lockdown will have to last at least half a year, maybe almost a full year, which in all likelyhood even the German economy will not be able to afford.

3. For all the risks involved, one should really consider quick self-infection/ self-vaccination of under 40s. That's around 35 million people, 42% of the total population. Assuming 80% infection rate there, at 0.2% mortality, we're talking some 56,000 deaths here. Provided most of them actually get through with the infection before the health system - with a temporary lockdown - comes to overload, herd immunity would be reached already in late June, some 3-4 weeks earlier than in my scenario 2 above. These 3-4 weeks, in a state of massive health system overload, would mean over half a million less deaths in the over-40 age groups.

After all that number crunching, I understand why Chancellor Merkel, in tonight's address to the nation, spoke of the most serious crisis Germany is facing since WW II.

Richard Rocca said...

@David, OK I just sent them a request.

Davidski said...

@FrankN

We try to eradicate the virus everywhere with more testing, isolating cases and lockdowns, or at least targeted lockdowns.

And we wait for the cures and vaccines, which might start coming as soon as the autumn in the northern hemisphere.

That's the only realistic course of action.

FrankN said...

Dave - Look at the figures:

https://www.worldometers.info/coronavirus/

From March 17 to March 18:
- Italy now at 591 cases per 1M population, with a total death toll nearly as high as (officially) China
- 89 new deaths (over 50% increase) in France
- 33 new deaths (nearly 50% increase) in the UK
- 41 new deaths (nearly 40% increase) in the USA
- 12 new deaths in Indonesia, more than doubling the death toll
- nearly 50% increase in registered cases in Brazil
- 30% increase in registered cases in Australia
- almost 30% increase in registered cases in Germany

and so on..

This can't be eradicated anymore, and numbers virtually everywhere (possibly even Singapore) are getting too large and - more importantly - are rising too quickly for isolation still to work.

Davidski said...

@FrankN

The rise in the infections in Australia is mostly due to imported cases from overseas. There is very little community transmission, and indeed none in most of the country.

So it's still possible to get rid of the virus in Australia with a lockdown of the country, or at least with targeted lockdowns.

Other parts of the world are certainly in a worse situation, but more testing, social distancing and lockdowns can probably prevent disasters from happening in most places until the autumn.

JuanRivera said...

Wonder if people in Antarctica have the virus. On a slightly unrelated topic, lockdown here, if ever implemented, is going to be tricky, since the US is a very large country with a large population and two (three if counting that between Alaska and Russia) porous borders (primarily that between the US and Canada).

Samuel Andrews said...

@FrankN,"After all that number crunching, I understand why Chancellor Merkel, in tonight's address to the nation, spoke of the most serious crisis Germany is facing since WW II."

Even if this is true, to compare cornavrius to WW2 is inappropriate and a huge over reaction.

Folker said...

@Sam
Think about it: WHO (and other specialists) is saying that 60% of World population could be contaminated in the next months. Even with 2% of deaths (which is very unlikely as many countries don't have medic facilities already), it will be more than all deaths of WWII (as the spanish flu caused more deaths than WWI).

Rob said...

Official statement from AMA- “ In Australia, the number of cases is rising increasingly swiftly with a total number of confirmed cases as at 06:00 on 17 March 2020 of 375. However, the instances of community transmission remain minimal at this stage.”

Bogdan said...

“Cheap TV’s, Expensive Flu”...

Samuel Andrews said...

@Folker, "WHO (and other specialists) is saying that 60% of World population could be contaminated in the next months."
"it will be more than all deaths of WWII"

60% of the world's population won't be infected in the next few months. China got over cornavrius. Other countries will to.

Anyways, WWII is a different kind of disasster than cornavirus. WW2 didn't affect the whole world. World-wide WW2 stats aren't helpful in understanding its impact. WW2 only heavily affected a handful of countries. For those countries it had a much bigger effect than cornavrius will in any country.

Merkle is simply being melodramatic. As are many world leaders, like French PM who declared war on cornavrius. It's blasphemous for Merkle to compare conravrius to WW2. For most of us, live will go on as normal. We aren't living in WW2 type situation.

epoch said...

@Samuel and Folker

Before this becomes a silly discussion: Merkel stated that this was the most serious crisis since WW2, therefore explicitely not comparing it to WW2.

epoch said...

@All

We should follow very closely the results of what the Italians are doing with the drug tocilizumab. If they manage to lower the death rate significantly we might have a way through this.

Also, a check in an Italian village called Vo' Euganeo showed that 50% - 75% of the population carrying the virus was without symptoms. Finding and isolating these people significantly lowered the number of new cases until no new cases were added.

https://www.repubblica.it/salute/medicina-e-ricerca/2020/03/16/news/coronavirus_studio_il_50-75_dei_casi_a_vo_sono_asintomatici_e_molto_contagiosi-251474302

Folker said...

@Sam
China didn't get rid of coronavirus (and will not until a vaccine is made). China has won a battle, not the war, as there will be other waves (very likely). By the way, Iran is not very far away from China borders and Xinjiang has a shiite minority (chinese shiites went to Qom in pilgrimage until some weeks ago), and it is dubious China will be able to block all travelers from Central Asia. Moreover, chinese statistics are always unreliable.
Most of countries in the World are not able to deal with a massive pandemy.
I am sorry to say, but no, live will not go on as normal in the next few months. It has already changed everywhere. It is only a matter of time before you'll see the consequences in your personal life.

Folker said...

@epoch
agree. That is what I understood, and the same has been said by Macron (worst crisis since WWII). Nothing "blasphemous" in any case.
Vo' Euganeo is an interesting example, and another proof than quarantine and large testing is the only solution (Korea is using testing to define who will be in quarantine, and it is a better approach).
The size of asymptomatics people is not surprise, as it has already been estimated that at least 80% of contaminated have no or little symptoms. It will be interesting to have the exact ratio of real asymptomatics (probably most of them are young). But from what is said, it could be that "only" half of contaminated are asymptomatics, which is far less than some have estimated (I've heard and read some doctor saying that they guess that 90% are asymptomatics). Overall, it doesn't change much lethality, but it is a confirmation that R0 is far higher than 2.

zardos said...

@Frank: To argue for the quick self-infection of the younger population is totally irresponible. This is like the esotheric trash-talk of some "alternative media" and the false mantra of Covid-19 being like the regular flu. It is not.
Currently the effects of isolation can't be properly evaluated and need time to get effective.
If acting consequently and testing on a broad scale, the virus could be contained. Especially in Europe thats possible and a question of the will to do it.
Currently there is no vaccination and just insufficient treatment options for severe cases, limited medical capacities and warmer weather coming.
So we need at least to flatten the curve drastically and to ignore the measures and even demand self-infection is a criminal act, like a sabotage.

Unknown said...

What FrankN said represents sociapathic worldview just like UK/Johnson and US/Trump were very irresponsible towards their citizens and now they have to backtrack faced with reality !

It is containable. Even if there maybe waves there will be appropriate lockdowns.

By the way the fact that the economy is trashed with a few weeks of lockdowns shows how criminally marginal financial system was because of unmanageable global debt and money printing and corporate/bank bailouts, and sunsequent immense malinvestments. Even Nestle CEO had said that the world can feed 13 billion people couple of years back!

Yes, we can supress the pandemic thanks to advances in treatment and vaccine development that will come in about a year's time. Until then it will be global whack-a-mole type of containment efforts.

Mehmet Kurtkaya

Gaska said...


Forget about China and the Asian countries, they apparently have controlled the epidemic and all they have to do is ask for forgiveness. Now the problem is the European Union because the 27 countries have more cases and deaths than China. We have more than 86.000 cases, and today Italy is going to have more deaths than China (3.300)-And we also have Switzerland and Norway that are also in a difficult situation-Switzerland (3.219 cases, 35 deaths, 372 cases/1M pop), Norway (1.626 cases, 6 deaths, 300 cases/1M pop)

In other words, the situation is dramatic because the epidemic is out of control and the economy is paralyzed and we are going to go into recession immediately.All of us knew it and nobody has done anything to prevent it, and politicians said that what happened in China would never happen in Europe (When Lombardia was already very infected, 5,000 Italians came to Valencia to watch a soccer match)-Now that we are on the way to being infected and ruined, they ask us to stay home-

My wife is not infected yet but there are more than 500 doctors/nurses in Madrid who carry the virus. There are no protective equipment left and we are waiting for ventilators because they are running out. The mortality rate is very high because in some nursing homes up to 20 people have died and they are all infected. Only those who are admitted to hospitals are tested, the rest at home until the symptoms begin to be severe. Positive data- More than 1,500 recovered and that people are being very supportive, the rest sucks

UK, USA, Canada and Australia? have had their opportunity to do things Korean style

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