narvik

You do know that they're counting differently starting yesterday, right?

Apparently the "head office" was so upset about how this reporting was switched, they sacked another two in Hubei : https://www.bbc.com/news/world-asia-china-51482994

trueblu

I have to be honest, I don't find the situation today compared with yesterday any more or less discouraging (Diamond Princess excepted: more than 5% of the ship has now been infected, which has to be more than even Wuhan!!).

The actual maximum attributable mortality rate of 'completed' cases hasn't changed at all, if anything, a smidge down at 18%. Outside Hubei, it's reasonably steady at ~2%.

Everyone knew that there were more cases in Hubei/ Wuhan than the 'confirmed' list...there was concern about the true number of deaths, and it's not clear if the additional deaths reported by the revised case definition is retrospective or just what was added yesterday. If the latter, that DOES skew the mortality rate somewhat, but if it includes retrospective deaths, it's, if anything, reassuring.

The BBC suggests that the new clinical definition only applies to Hubei, in which case, there is a potential question mark in the non-Hubei numbers, but although they haven't peaked quite yet, the % daily increase is continuing to go down and is <3% now. with a doubling time of over 12 days. Although H1N1 appears to have been less contagious than SARS-CoV-2, it was steadily doubling every 2 days (as this outbreak was until about end of Jan) for several months.

What _is_ really troubling is the lowish numbers internationally. Diamond Princess, Hubei, the Brit guy and the SG outbreaks tell us that this is a highly contagious virus, at least in a significant proportion of those infected. If we were truly capturing all international cases, we should be seeing, in an absolute best case scenario, lots of mini-outbreaks, which might then be stopped in their tracks due to public health measures.

So, I too am worried, but paradoxically, by what the curves and numbers aren't showing.

tb

narvik

Diamond Princess:

What bothers me most, is that they still seem to treat the passengers and the crew differently. Is the crew REALLY supposed to carry on their "normal" duties???
Now it appears that the passengers are still treated better than the staff. I guess the Cambodian/Filipino staff's lives aren't quite as valuable as the passengers'?

In conjunction with the boat declared "under quarantine", the staff and passengers should have been treated EXACTLY the same; i.e. everyone goes under the exact same quarantine procedures. If there's spare (empty) rooms those are made available to staff to get them out of their "dorm-style" accommodations; larger families or travel groups that occupy multiple rooms (and that do not object), should share accommodation to make room for staff.
Special procedures are put in place for the ESSENTIAL staff that needs to be kept working to maintain the operation of the ship.

Food, and other amenities are brought in from the outside. All disposable stuff; and waste is treated as bio-hazard waste.

This. Is. Not. Rocket.Science.

narvik

Agree, but to be fair, it's an almost impossible task!
If someone dies at home in Wuhan from pneumonia how the heck can this death accurately and timely be attributed to COVID-19 or "normal" pneumonia?

For crying out load, the Japanese can't even control a ~3700 person boat, and the US CDC can't even label the few hundred evacuees from Wuhan's test results accurately!!!
China/Wuhan is dealing in the millions!

invisible

If you've noticed, I was commenting about news coming from elsewhere outside of China.

helvetic

Seems to me like a lot of international cases are just flying under the radar. It's quite obvious that in Singapore right now we have uncontrolled community spread. Infections were up 16% yesterday with all cases having no obvious links to previous cases.

NewbieRunner

Yes.

Coronavirus super spreader Steve Walsh released from hospital

narvik

Sorry, no, I didn't notice; my apologies.
It looks like this is going to get a WHOLE lot worse still...

(I recently perused an older article, and the gist was that this is a critical situation....there were ~20 dead at the time! )

narvik

Recap:

He attends conference in Singapore Jan 20 to 22, where he's infected.
He goes via Ski resort back to UK.
Feels unwell, then gets tested Feb 2 and is confirmed with COVID-19.
10 days later he gets released.

So (in this case) it takes only a few days to be contagious; ~10 days to get symptoms, and another ~10 days to get better.
I guess the virus sort of just goes away within ten days after showing symptoms, even in a "super-spreader".

trueblu

This summary in "Nature News" does a nice job discussing 3 pre-prints posted on international risk of SARS-CoV2 spread (I haven't read the pre-prints yet)...

The basic upshot is: mathematical modelling suggests there should be many more cases in SE Asia than has been reported, and Africa (no cases reported so far) just doesn't have the capacity, by and large, to specifically diagnose the infection, although in response to the crisis, the number of capable labs on the continent has increased from 2 to 8...highly troublesome.

tb

wco81

Cruise industry may take awhile to recover from this.

trueblu

I think one would need to be almost certifiable to take a cruise for the foreseeable future...not just from the very real risk of getting COVID-19, although if one is young and fit, that may not be so bad, but the knock-on consequences.

tb

NewbieRunner

According to press reports I have seen he went for a test after he was informed by the conference organisers about another delegate who had contracted the virus and not because he felt unwell. He was asymptomatic when he tested positive.

The Guardian

Quote:

”As soon as I knew I had been exposed to a confirmed case of coronavirus, I contacted my GP, NHS 111 and Public Health England.”

The Argus

doctoravios

The reason why tests are coming back negative is because in the early stages of infection, a throat or nasal swab is less likely to be able to reach areas of the respiratory tract with significant viral levels. To get a proper sample you really need to have a nasopharyngeal sample or a deep bronchial sample.

This is the nasopharyngeal swab procedure:


This is the bronchoalveolar lavage procedure:


Both are invasive and carry potentially significant risks to both the person being tested and the clinician collecting the sample and neither is amenable to being applied en mass by non-medical staff.

I think it is pointless to continue widescale RT-PCR testing except in those with serious illness already being treated in a medical facility. At this stage we should be using clinical indicators to define cases (as is now the case in Hubei).

iahphx

The run of good luck outside of Wuhan (other than on the Diamond Princess) continues, as at least one of the suspected Delaware cases has come back negative. It's actually pretty amazing how few cases and deaths we're seeing outside of China. Fingers crossed.

https://news.delaware.gov/2020/02/13...r-coronavirus/