trueblu

A few thoughts this morning:

1. US request for $2B funding in total has me very concerned: this is the sort of sum that would help fight a few limited local outbreaks, perhaps less than 1000 total infected. Gosh, I hope they're right, somehow I think they're wrong. Perhaps this is all political grand-standing given it's election year.

The total number of tests performed in the US still has me very worried, less than 500 a month or more into the global emergency. UK has performed close to 10k. To be fair, almost all have come back negative, but that's pretty reassuring that there aren't clusters of undiagnosed COVID-19 lurking around. We just have no idea in the US. Hopefully that's the case, but it could suddenly blow up like it did in Korea or Iran or Italy, where there was just very little on-the-ground suspicion. It also suggests the CDC-touted plan of testing samples that were sent for influenza but were flu negative hasn't yet been implemented. This is by far the best way to get an early warning system in place...

2. Global doubling time has shrunk to 4 days...this is to be expected (in the early days in China, doubling was 2 days!), but it means that the doubling rate is going down instead of up, which would fit with a model of multiple dispersed outbreaks...in single communities, rates would eventually slow due to control measures and behaviour self-modification. If doubling rate remains unchanged, we should have 100k non-China cases in 3-4 weeks, crikey!

3. In Korea, more non-Daegu than Daegu cases in the most recent batch of positives. Iran is completely out of control given number of recent returnees from Iran testing positive (reminiscent of Wuhan just before lockdown, where point prevalence was estimated at 0.1-0.5% of the population). I don't know geographic spread of these positive returnees, but if we have 0.1% prevalence in Iran, that's 100k people just in Iran!! Let's hope it's less than that, but I would estimate in the thousands.

4. I am worried about the relative mortality rate outside of China currently. I _think_ this suggests we are hopelessly under-counting the number of cases in Italy/Iran, OR it's as some of our posters have suggested, really bad news...too early to call.

tb

narvik

I wouldn't read too much into that.
It's not like they could request funding now for what it may ACTUALLY cost; you have to start small[ish].
Just imagine the panic that would ensue if they'd ask for $1 trillion?

I think they're asking for a realistic number (although I am reading conflicting reports; some are saying $2B, some are saying $1.2B).

trueblu

Yep, I think that's the truth of the matter. There is to be a confidential briefing of Senators this morning, and I think best and worst-case scenarios will probably get discussed behind those closed doors. One things for sure: I'm pretty sure the NIH budget won't be slashed this year!

tb

trueblu

Without a doubt, in terms of long-term global burden of disease, as you say, HIV has killed ~30M over last 40 years, tuberculosis between 60-90M and so on. However, their _pandemic potential_ for causing a collapse of world-wide infrastructure is limited because of either how they are transmitted (primarily sexually for HIV) and that it takes a long time to die, and being poor and under-nourished are major risk factors for death (tuberculosis). Small-pox was the truly terrifying outlier infectious disease: droplet transmission (like COVID-19) but with a 20-30% mortality [mortality for TB without treatment is around 50%, but since it's mostly a poor person's disease NOW, we don't care so much about it, and even with treatment, mortality remains >5% for the severely under-privileged]. Outside of the Americas, however, the sweeping pandemics occured hundreds and thousands of years ago, so there was wide-spread herd immunity. But we know what it did to the native Americans. The film "contagion" (where Ian Lipkin was advisor) was somewhat modelled on similar notion, a coronavirus (I'm not sure they explicitly called it that, but the template was SARS) with similar transmission potential and mortality as small pox.

So yes, it is possible to have such a nightmare scenario, in fact we've had it, historically, 500 years ago in the Americas. I don't think COVID-19 is that, luckily, but generally speaking, highly transmissible infections that can infect the majority of the population tend not to have high mortality, but yes, there are outliers.

tb

invisible

Sir, your mentioned that you would rather write less in this thread. I and I think number of other regular posters here would instead see you to post more often.

Because you and only one other poster are the ones who really are into this topic - that's your profession and you understand what is going on. Your opinions are factual and based on science. And considering that (as moderators mentioned) that this thread become source of valuable information pretty much for the rest of FT, it would be beneficial for the community as well.

Have you seen the article at the Atlantic magazine? It basically confirms what you've been saying so far.

You’re Likely to Get the Coronavirus

Most cases are not life-threatening, which is also what makes the virus a historic challenge to contain.
https://www.theatlantic.com/health/a...accine/607000/

invisible

As usual, you've been correct. The headline below from BBC is sufficient:
Iran's deputy health minister tests positive for coronavirus

Some insights what is happening in Iran



Live reporting is on BBC
https://www.bbc.com/news/live/world-51628990

trueblu

Thanks for posting, a very nicely written article. For the sake of both my sanity and actually getting some work done under difficult circumstances, I can't make responding to FT my #1 priority, even though it gives the dopamine hit more effectively and instantaneously than writing a rebuttal for a manuscript in revision after months of work...but I actually get paid to work on the latter and not on the former!

I also don't want to toot my own horn: I do have some expertise on infectious diseases but I am by no means omniscient. In a bizarre twist, some weeks ago I said it was very unlikely that we could contain COVID-19, that there were bound to be cases internationally that we just haven't counted. Sadly, that turned out to be true, but somehow I'm not feeling smug! On the other hand, China's response has been far more effective, especially outside of Hubei, than I would have predicted. This suggests a potential roadmap for early response to outbreaks in other countries before prevalence breaches a criticial threshold, which may be as low as 0.1% prevalence.

tb

GadgetFreak

There is also the issue of how fast they can spend the money. NIH for instance has only a smallish number of people working in infectious disease. CDC is likely similar. Neither agency is likely severely resource limited without this new money. More opportunity in the extramural community but they need to figure out how to disperse the money as effectively as possible. Even if they get rid of the normal process to disperse grants and contracts, or accelerate it a lot, it will take time.

narvik

I was wondering if it's possible that there's already different strains of this virus floating around?

How long does it normally take for such a virus to mutate?

yosithezet

Duke-NUS Medical School Dr. Danielle Anderson in CNA just now confirmed that discharges recovered patients have immunity.

If re-exposed you may become reinfected but the antibodies will fight off the infection.

She also says that people exposed to SARS have antibodies 17 years later.

She was interviewed about the testing they used to trace some 30 cases in Singapore where they found the commonality and hence source of the outbreak across the two churches.

2 people from Wuhan visited Singapore and attended church where they infected 9 people. A married couple from the church went to a CNY gathering where they infected 7 people. 1 person from that gathering went to another church where he infected 16 people.

nk15

Some of the reviews complain that the masks ship in an open plastic bag with no signage of any kind, and/or appeared used. You should also be mindful of new vendors with no reviews, as there could be scammers just trying to get your money (it has happened to me on Amazon, although you get your money back).

narvik

Masks:

Many places in USA are sold out. McMaster-Carr has only a few versions left, but only the very expensive N99, N100 and P100 (and thereabouts):

(the last one on this list - P100 for $11.17/each - is still available also)

invisible

Iran is getting more and more attention:

I don't have too much hopes for Iran. The unfortunate fact is that vast majority of the population is moderate or indifferent the state ideology/religion, but it is conservative (almost fanatic) religious establishment running the country, while refusing admitting the scale of the problem. Clerics in Qom don't even want to hear word 'quarantine'. If they will stick with their line and won't allow to have quarantine measures in place and refuse international/WHO inspection, in worst case scenario soon Iran will have more cases than Wuhan and without quarantine. Soon after that people in cities will release what is going on and mass exodus from cities will start.

Aha. Seems things are going towards worst case scenario:

Global Adventurer

Exactly. Most of the ones I've run across while traveling were fake. One of the pharmacist told me it has two layers which makes it a N95🤣

On edit: I've been watching prices on Amazon in the UAE, U.S., and Mexico and all of a sudden many of their N95s, Goggles, and P100 respirators starting selling out, so I just went ahead and bought googles, indirect vent and swimming goggles and a 3M 7500 series mask and gloves to add to my 3M N95 masks while they are still available. I'll be traveling again in 6 weeks for two months and I have no clue what will happen on my journey. Safe than sorry.

invisible

This was posted in Japan thread:

https://www.flyertalk.com/forum/32111406-post425.html