nk15

I think the pathogen load theory seems plausible and seemingly fitting with the data. It perhaps explains why there so many deaths and severe cases in Hubei, and not in the rest of the world. From a layperson's perspective, it make sense. I am also thinking there may be a difference to those who get infected by a heavily symptomatic person versus an asymptomatic one (or a lightly symptomatic one), in that those infected by asymptomatic people may get a light pathogen load, and have a better response. This can probably be tested with the data, although there will be confounding factors to control. If this is true, and those infected by asymptomatic people and/or lighter pathogen load have better outcomes, this could be extremely helpful in managing the pandemic, as it will be much easier to protect yourself from already symptomatic people, and getting a lighter load from somewhere may not be so bad (on average), in terms of illness severity. If all these are true, the pandemic will be much more manageable. Trueblu, does this make sense scientifically?

trueblu

No idea to both of the above posts...but it may make sense. I'm trying not to post too regularly, but will read the thread from time to time...so apologies if I don't respond to all posts. I just wanted to reiterate my strongly held opinion that nothing we've seen about COVID-19 suggests it's a "unique" disease, or that SARS-CoV2 is somehow very different any other known virus.

One thing IS different, however, and may well make a material impact. In modern times, we've never had a pandemic due to a virus with zero host immunity (assuming no cross-immunity, positive or negative from other coronaviruses). And yes, this may well explain some of the paradox we are seeing in exposure within context of low prevalence (which would lead to a single discrete exposure) and possibly repeated exposures in a short space of time before onset o protective immunity in places of high prevalence.

However, the Diamond Princess would also be a model of the latter. I think we can all assume now that quarantine was ineffective, despite the Japanese stance. Although the (lowish) number of new cases amongst the quarantined pax (as opposed to crew) suggests it was more effective than e.g. I had feared. From what we know, about 5% of the DP cases were "severe", and this is amongst a population that was very heavily weighted towards older age and co-morbidities. I assume that prior to quarantine in early Feb, if there were several hundred cases on-board, those people did get 'multiple exposures', but no evidence, as yet, that this led to catastrophic outcomes...

much still to learn.

tb

nk15

(second bolding above mine)

But as you pointed out earlier, a major benefit of all these containment efforts, even if eventually futile at containment and at great cost, is to slow things down substantially, until we (a) study and learn more about the virus, (b) develop prevention/immunization and treatment methods, if any (c) prepare infrastructures within China and around the world for dealing with it, and (d) allowing for warm weather or other unknown factors to kick in to aid halting the spread or eradicating the virus, if we are lucky.

In other words, it may still worth it to continue strong containment efforts, even at a substantial cost. (But as for identifying every single case in Hubei, this is a tactical decision that may be ineffective/harmful, as you said, and/or executed wrongly).

STS-134

If China, the country where this all started and where the most cases are, does actually manage to successfully contain this and stamp out every last case, then there are zero excuses for the rest of the world being unable to accomplish the same. If it's possible to stamp out every last case of this virus despite the fact that it got a 3-4 week headstart because of the stupidity of some local officials and spread to a few thousand cases before they locked down the city (and had hundreds of thousands flee to other areas before the lockdown), then there's absolutely no reason why it cannot be contained and stopped in the rest of the world at this point.

notquiteaff

I don't know how this works in the rest of the world, but it seems here in the US it still takes a long time to get test results back from suspected infected patients.

https://www.times-standard.com/2020/...e-know-so-far/

As of Friday, the problem with the test kits appears to be unresolved based on the transcript of this CDC conference call
https://www.cdc.gov/media/releases/2...-covid-19.html

trueblu

1.4B people under authority of a single, all-powerful centralised gov that can command incredible resources and doesn't care about other (non-pol) fall-out. Versus 6B in >190 disparate states of varying competence and autonomy and >4.5B in states with poor healthcare and other infra-structure, and the other 1.5B in countries where individualism and personal wealth take (psychological) precedence over notions of the greater good (I'm over-generalising, apologies). Not to mention orders of magnitude difference in access/ land areas/ number of cities etc

Now, if China does manage to contain COVID-19 that would be an incredible and unprecedented achievement. Unfortunately, I don't think it means the rest of the world even has the capability and resources to be even remotely close to replicating. Even if money were no object, the US/ EU and China would need to cough up maybe $10 trillion (plucking a number out of a hat) to finance this...

tb

STS-134

Well I can see one possible scenario where some areas succeed in stamping out the outbreaks and prevent unabated community spread and others do not, and the world actually fragments into two different zones, with movement not allowed from the areas with unabated community spread to areas with this under control except by going through 2+ weeks of quarantine. At that point, these other zones won't have a choice. Either they get rid of it or they can't join the rest of the world again until they do.

iahphx

Obviously, mistakes were made in China in dealing with this virus. But most of those mistakes were made early. It's very hard to fault China's recent containment activity (I'm talking from a containment perspective, not a civil rights one). Compare recent Chinese decisions to recent Japanese ones. The Chinese are looking great. And the situation is improving in Beijing and Shanghai. I can't say the same in Tokyo.

trueblu

I really doubt this is viable on any level, even in the medium, let alone long term. The world is so inter-connected, and even rich countries, ever on the look-out for the next 'growth opportunity' are more than willing to explore less developed regions if there's a buck in it.

Eradication with the aid of a vaccine may be possible, however. If that does become the case, it shows that other infectious diseases (e.g. polio) could be easily eradicated with enough resources and political will: this event may even end up being a net positive for the planet.

tb

MSPeconomist

I'd like to understand how the Wuhan Princess cases are counted. I assume that if someone has left the ship at the end of the "quarantine" and is diagnosed in Japan, it counts as a Japan case, while if someone (including those on the evacuation flights) is diagnosed while physically present in some other country, it could count as a confirmed case in that country, even if the person had obviously contracted the WuFlu while on the ship.

However, there were supposedly the fourteen infected Americans on the evacuation flight, who don't seem to be included in the USA numbers, assuming that the twenty proposed transfers from northern to Southern California are people who are newly diagnosed at the quarantine center. IIRC most of the fourteen (twelve or thirteen of them) were taken to the Nebraska containment facilities and I don't think there was a jump in the number of USA confirmed cases when the evacuation flights arrived.

When it becomes time to tabulate the Wuhan Princess outcomes, I would expect statistically different results depending on where the people are ultimately treated, which in many cases is determined by their citizenship/residency.

BTW, the people who were evacuated from Wuhan by the Americans, Brits, etc. seem to generally have done pretty well with surprisingly few infections discovered during their quarantine periods. To me, this is suggesting that the virus was much more prevalent in higher concentrations on the ship than in central Wuhan, which I guess isn't surprising given the differences in the overall infection rates observed for these two populations, even recognizing that the Wuhan Princess represents a relatively small sample size.

jiejie

Piecing together from the CDC numbers, comments, and quarantine people released, I've come up with this (as of Feb 22):
14 cases USA, from individuals traveled from China (12) plus person-to-person/spouse transfer (2). Scattered over the country but most in California.
3 cases from Wuhan evacuees, out of total of 743 (approx) evacuated on 5 flights and placed at bases March, Travis, Miramar, Lackland, Ashland. Sick/positive testing evacuees in hospital near Miramar (2) and Lackland.(1)
18 cases from Diamond Princess, out of total of 329, evacuated on 2 flights and placed at Travis, Lackland. Ill and positive evacuees at Travis (5), Lackland (2) and Nebraska special unit (11).

There is overlap between the 14 "confirmations" given by the Japanese at the last minute before the flights left Japan, and the 18 CDC-listed cases, but it seems that only 12 or 13 of the 14 have been confirmed by the CDC and 1 or 2 so far are negative. Implying at least a false positve or two from the Japanese testing. Then there are a few others who the Japanese tested negative and who flew back, then subsequently tested positive. Whether they came back harboring the virus (false negative) or whether they caught it on the flight back, we'll never know. I personally lean toward the former, and consider all the testing the Japanese did, as suspect. I'd have considered all 329 people on that flight as potentially positive, not "healthy and cleared" based on Japanese quarantine and testing, which seems to have been cursory at best.

Basically, the 35 cases officially listed for the USA include the Wuhan and D.P. transferrees. However, I don't know if the 14 positives found by the Japanese are also included (double-counted) in the Diamond Princess official numbers.

The whole thing about the transfer from Travis to southern California sounds confused. The locals in southern California supposedly heard about this on Thursday evening, yet CDC in the Friday teleconference never mentioned anything about transfers, about extra people testing positive, etc. And on Friday evening or Saturday morning professed to not know anything about it. Perhaps we will hear more about this on Monday. I cannot imagine why they would want to move people from Travis area--either quarantine without symptoms and without positive test, or confirmed positives.

I said in some upthread post that I'd much rather face the situation in Wuhan cocooned in an apartment, vs being stuck on the Diamond Princess, due to having more control over the situation and surroundings. I think the comparative numbers above of Wuhan vs D.P. evacuees, is validation.

nk15

That medical podcast discussed a recent journalistic article about research on bats finding that bats harbor 400 types of coronaviruses, some of which allegedly seem to jump directly to humans, without an intermediately host. Sounds alarming.

https://www.npr.org/sections/goatsan...ers-arent-rare

Global Adventurer

So, Austria closed it's border to train traffic from Italy today.

doctoravios

I agree, it certainly is worth continuing strong efforts to reduce the rate of spread but these should be measured and sensible. For example, it makes complete sense to step up hygiene standards, isolate and restrict travel to hotspots, cancel any unnecessary public events which could accelerate spread as well as switch to remote operations whereever possible (e.g. work/education etc). However, there comes a point at which, depending on the circumstances, excessive restrictions and quarantine is potentially more harmful than good (cf Diamond Princess).

I know this is going slightly off-topic but it is interesting and concerning to see how things are playing out in Italy - mass panic, stockpiling food, trains being prevented from running because a couple of passengers have coryzal symptomse etc. This kind of mass panic is really not the best response to a global challenge like coronavirus (which will be a marathon, not a sprint) and only serves to instil unhelpful fear. And people who are afraid are more susceptible to believing "fake news" and foolish behaviours which could, paradoxically, put them at greater risk of harm.

notquiteaff

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

seems to be counting DP cases in Japan separately. For a while they also excluded the infected 14 from the US count and had a footnote explaining that the did that to accurately reflect community spread in the country. Not sure at this time if the 14 are now included in the 35 for the US or in the DP count. And what happens if/when a “safe” DP in Japan gets sick.