wco81

After this crisis is over, I hope there are massive reforms.

Like huge improvements made to food security and public health. Scale up their FDA with thousands of food inspectors for wherever livestock are raised.

And then the city and provincial governments must hire health inspectors and shut down illegal wet markets and track down anyone keeping wild animals.

It would be a lot cheaper to make such investments than whatever it must be costing the nation to quarantine a whole province and stress the medical infrastructure like they're doing, not to mention the big loss in productivity they're suffering now.

It would be logical but who knows what the CCP is thinking. There's no transparency or accountability in governance so it's not like people can demand these kinds of reforms.

percysmith

NYtimes said it already

CPG was aware of the problem post-2003 SARS - that was suspected to come from masked palm civets

But other priorities got in the way

Local govts don't want to risk popular backlashes for policy objectives that the CPG doesn't consider priority post-SARS. Eating wild animals really is popular.

NYtimes used it to illustrate local govt-CPG disconnect

invisible

Strong AC is not in that cruise ship and couple of other places where outbreak happened in HK. What is common, it seems - closed quarters combined with high concentration of people.

Who is going to pay for it?

Logically you are absolutely correct. And in reality we've witnessed twice Tragedy of Commons...

P.S. BTW, SARS1 had 10% of mortality rate however it didn't spread too much and overall number of infected/dead was not significant. SARS2 has lower (compared to previous) mortality level but spreads way faster and number of infected is magnitude higher. I think you can guess what SARS3 would look like, unless people change their behavior...

LapLap

I wonder if the Princess Diamond Cruise ship and Wuhan have something in common that is giving these higher figures. Is it possible that older people are more likely to become infected than younger people? The inhabitants of the cruise ship, obviously, have rather high average age, but with a third of the population of Wuhan clearing out in the run up to CNY I can’t help but imagine that the average age of those left behind went up considerably and will be making up the alarming data that is coming out from there. (Not to mention that many of those who left Wuhan went on to be with other older people).
There are all kinds of age related changes that could make it easier for a virus to take hold, one of them is drier mucus membranes. Couldn’t this tilt in the age demographic of both these places have the kind of effect on the percentages you’re seeing?

npei

It’s usually twisted economic consideration of not spending short term massive budgets to eradicate problem A, when money can be spent on other “urgent” problems B,C,D,etc. and kicking problem A further down the road.

trueblu

For me the take home message of Wuhan and Diamond Princess is that a) high point prevalence and b) cramped quarters add up to very bad news with COVID-19. Age may also be a contributing factor, and although older people are definitely over-represented in the COVID-19 cases in China, there are fair number of middle-aged people too.

In Wuhan and possibly Hubei, there seems to be a non-virtuous (don't want to use the word viscious!) cycle...suspected cases that aren't actually infected are brought into close contact with actual cases and that feeds the epidemic growth. Now that numbers from Hubei have stabilised at the 'new normal', we're still seeing 9% daily growth, vs. just over 2% in the rest of China.

News reports today that one of the British cases, but NOT the most recent one attended a conference in London -- regarding public transport of all things!! That might also be a case of close quarters with risk of spread. Luckily, if it was sponsored by the British government, I doubt a plush buffet was on offer, which may have limited opportunities for cross-contamination!

Re: Singapore vs Thailand, without a doubt, Thailand missed some cases. BUT, most of the cases we are seeing in SG are now local spread, so has nothing to do with number of incoming tourists from Wuhan. It's quite possible that if the Wuhan tourists went to a secluded beach in Thailand, there were few opportunities for local transmission. Having said that, in all the vacations we've been to in Thailand, the one thing the Chinese tourists always partake in are the breakfast and dinner buffets offered at the hotel...so definite risk there.

tb

LapLap

Thank you for that response!
I’m not sure I actually understand what “high point prevalence” means. Is it OK to ask you to elaborate on that a bit?

trueblu

The number of people with the disease at any one time. My back of the envelope estimates from the Wuhan evacuees testing positive from all nations that have reported suggests it's between 0.5-1% of all people in Wuhan have been infected, which is about 50-100k people (as of a week or two ago...will be higher now!). On the Diamond Princess, it's well over 5%, since about 50% of those they have tested are positive, and they represent about 6% of the total manifest...I would guess it's more likely to be 10% or more of the cruise ship population, which is just extraordinarily high...

The implications of high point prevalence in infectious diseases is that the probability of 'random encounters' involving infected persons becomes extremely high. In Beijing, ~350 confirmed cases out of a population currently of ~15M, means if everything was truly random, only 1/30k people have the infection and the chances of 'bumping' into one of them is vanishingly small. Let's assume that's a 10-fold underestimate of actual numbers infected, the chances are still really low: you go to a fever clinic, and if you aren't infected, chances of sitting next to someone who is is low. In Wuhan, chances of the same increase massively.

tb

ETA: I just realised that for the Diamond Princess, as soon as someone is confirmed to have been infected, they are removed from the ship...so the actual point prevalence is much lower than my initial estimate stated above. But it does mean, without a shadow of a doubt, that they are seeing massive, ongoing transmission...someone really ought to get shot (figuratively!!) on how this has been totally mismanaged...they just need to bite the bullet and get everyone off the ship, perhaps at a military location.

889

There have been reports that China is tracking down people across the country who have been in Hubei.

I just got an SMS on my China Mobile number informing me that if I text back "cxmyd" I'll get a report of the provinces and cities I've been in during the past 15 and 30 days. How silly that seems: you obviously know where you've been.

The underlying message of course is that the authorities now also have this information. Indeed, at a checkpoint they just have to ask you for your phone.

trueblu

I guess they are concerned about leaky borders around Hubei...in places that are equipped to test effectively, things are not quite under control, but manageable. But that could change if they get a big influx of people who for sure won't want to be engaging with healthcare infrastructure in an honest fashion for fear of being found out where they've come from!

tb

invisible

Latest Updates

February 14:

• 9 new case in Singapore (6 linked to Grace Assembly church). With two patients discharged today, 17 people have now fully recovered from the disease.
• 2 new cases in Japan. Both are connected to the previously confirmed case of a taxi driver. One had attended a Taxi Union New Year's party with 80 participants, including the infected taxi driver.
• 3 new cases in Hong Kong. 1 case had attended a family gathering of twenty-nine at a restaurant in North Point on January 26, which resulted in a total of 8 cases so far, with at least 2 additional people pending test results.

OK, about two weeks ago I made an estimation that by Feb 20th we should have about 80 cases in Singapore. Seems we are on track... /s

The National Health Commission of China, in its February 14 official report, deducted 108 previously reported deaths and 1,043 previously reported cases from the total in Hubei Province due to "repeated statistics." We have updated the daily (Feb. 12 and Feb. 13) and cumulative totals accordingly.

I think we can assume that statistics in Hubei are 'not reliable' if one can use mildest expression applicable to this case...

The central districts of Yunmeng County in Xiaogan, Hubei entered wartime control. What this means, anyone can explain?

cockpitvisit

But they are only testing for infection after symptoms develop, so those infected have ample time to infect others during the incubation period.

BTW, are any numbers for mortality outside China? In other words, does a (supposedly) better healthcare make a difference?

bosleto

Japan has had a rash of new cases and is up to 37 now (not counting the love boat).

Also, there’s a report that 10 taxi drivers from that party are now ill (not yet tested though).

trueblu

Only 3 people have died outside the mainland (approx. mortality 1%), and the maximum attributable mortality outside Hubei on the mainland is around 2% (so probably similar to what's happening outside China). However, from HK/ Singapore and Japan who have reported on number of serious/ critical cases, between 10-20% of those confirmed infected are at least in serious condition...

This is not trivial -- since if we get a full-blown pandemic, heath-care service infrastructure will be completely overwhelmed. To put this in context, let's say 20% of the UK population gets infected in total, but at peak pandemic, in a worst-case scenario, 2-5% are infected at one time. This is actually within the ballpark of what's happening in Wuhan. That would represent 1.2M-3M cases. If 10% of those are serious enough to require hospitalization, that would need 120-300k hospital beds. The entire NHS capacity of all beds, for all purposes I believe is 150k beds.

If we assume that the reduced mortality oustide of Hubei is at least in part to optimal supportive care in hospitals, that benefit will be completely lost in a full-blown pandemic situation.

If we are heading into a global pandemic, we won't have a vaccine in time for this round. We _may_ be able to use anti-viral drugs, but they will be reserved for the most serious cases, which may actually be futile once things get really bad, and anyway, the total global reserve of the drugs likely to be effective is going to be completely inadequate: the experimental remdesivir probably only have enough for a few thousand cases, and even with HIV protease inhibitors, outside of Africa, where there _may_ be adequate stocks due to the HIV pandemic there, will be enough for a million doses, maybe a little more (I am totally guessing these latter numbers, no evidence, as a caveat).

Honestly, at this moment in time, I think the best we can do is to trust, like Trump, that the weather will mitigate this to some extent, and we delay global spread enough that we don't see such widespread infection rates until we have (hopefully!) a vaccine.

I vacillate daily between optimism and despair. Unlike some of the posters here, I think the low, but not ultra-low mortality of this infection is the most dangerous aspect to it. Early panic about 30% mortality was in some ways reassuring: usually in such cases, patients can be identified and with supreme effort, the spread brought under control. With an illness which is mild in most, but devastating to a few, it's much harder to control, as we're seeing on Diamond Princess and in Wuhan.

Hope I'm wrong about the doomsday scenario above. The real black hole continues to the international case growth rate. Discounting Diamond Princess, it's trivial: is that real? If so, fantastic, but not because of anything we've done including border controls at this stage: no border control is perfect, and we're just not seeing the number of cases we should be from the other epidemiological evidence. Or is it that we're just not capturing it. US still worries me a lot. UK has now tested over 2000 people, only 9 positive. US has tested a few hundred...its delayed roll-out of the kits due to QC issues is presenting a bottleneck to adequate active contact tracing and testing.

tb

narvik

Aye, that seems to be the case. I read a recent article that (likely erroneously) mentions he went to seek medical help AFTER he fell ill. I now think that was misreported.