Jan 27, 2020, 9:09 am
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The following two links are updated daily:
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Coronavirus / COVID-19 : general fact-based reporting
Mar 12, 2020 | 6:39 pm
#3826
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Interesting; I didn’t know we paid for a dedicated physician (+staff) for Congress and Supreme Court.
https://en.wikipedia.org/wiki/Brian_P._Monahan
”Monahan received his B.S. summa cum laude from Fairfield University and M.D. magna cum laude from the Georgetown University School of Medicine. He trained in internal medicine and later hematology and medical oncology (HMO) at National Naval Medical Center (NNMC).[4] He is certified by the American Board of Internal Medicine in internal medicine, hematology and medical oncology.”
I am sure he is an excellent physician. Since he doesn’t appear to be a infectious disease specialist, I assume he is basing his assessment of the situation on advice from and on modeling from subject matter experts (maybe CDC internal modeling).
The estimates mentioned in the article are in the same ballpark as those I have seen mentioned by subject matter experts, e.g.,
https://thehill.com/changing-america...-preparing-for
Note: that was published a month ago, on Feb 15.
https://en.wikipedia.org/wiki/Brian_P._Monahan
”Monahan received his B.S. summa cum laude from Fairfield University and M.D. magna cum laude from the Georgetown University School of Medicine. He trained in internal medicine and later hematology and medical oncology (HMO) at National Naval Medical Center (NNMC).[4] He is certified by the American Board of Internal Medicine in internal medicine, hematology and medical oncology.”
I am sure he is an excellent physician. Since he doesn’t appear to be a infectious disease specialist, I assume he is basing his assessment of the situation on advice from and on modeling from subject matter experts (maybe CDC internal modeling).
The estimates mentioned in the article are in the same ballpark as those I have seen mentioned by subject matter experts, e.g.,
https://thehill.com/changing-america...-preparing-for
Harvard epidemiologist Marc Lipsitch told The Wall Street Journal that "it's likely we'll see a global pandemic" of coronavirus, with 40 to 70 percent of the world's population likely to be infected this year.
"What proportion of those will be symptomatic, I can't give a good number," added Lipsitch, who is the Director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.
Two other experts have recently given similar estimates.
Ira Longini, a biostatistician and adviser to the World Health Organization (WHO), has predicted that two-thirds of the global population may eventually contract COVID-19.
"What proportion of those will be symptomatic, I can't give a good number," added Lipsitch, who is the Director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.
Two other experts have recently given similar estimates.
Ira Longini, a biostatistician and adviser to the World Health Organization (WHO), has predicted that two-thirds of the global population may eventually contract COVID-19.
Mar 12, 2020 | 6:48 pm
#3827
Join Date: Nov 2009
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University of California, San Francisco BioHub Panel on COVID-19
Below is an email that is worth sharing. Scott founded Intuit .
---------- Forwarded message ---------
From: Cook, Scott <
Date: Wed, Mar 11, 2020 at 6:29 PM
Subject: Latest on COVID-19 from UCSF's top infection disease researchers
To:
With Brook Byers help I was able to arrange a discussion yesterday on COVID-19 with USCFs top researchers in infectious disease. Here are the notes. I bolded some of the more notable comments from the researchers.
UC San Francisco is either the #1 or #2 hospital in California depending on which survey you read. It is the 4th largest medical research center in the US, based on research grants.
scott
University of California, San Francisco BioHub Panel on COVID-19
March 10, 2020
Whats below are essentially direct quotes from the panelists. I bracketed the few things that are not quotes.
---------- Forwarded message ---------
From: Cook, Scott <
Date: Wed, Mar 11, 2020 at 6:29 PM
Subject: Latest on COVID-19 from UCSF's top infection disease researchers
To:
With Brook Byers help I was able to arrange a discussion yesterday on COVID-19 with USCFs top researchers in infectious disease. Here are the notes. I bolded some of the more notable comments from the researchers.
UC San Francisco is either the #1 or #2 hospital in California depending on which survey you read. It is the 4th largest medical research center in the US, based on research grants.
scott
University of California, San Francisco BioHub Panel on COVID-19
March 10, 2020
- Panelists
- Joe DeRisi: UCSFs top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic.
- Emily Crawford: COVID task force director. Focused on diagnostics
- Cristina Tato: Rapid Response Director. Immunologist.
- Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist.
- Chaz Langelier: UCSF Infectious Disease doc
Whats below are essentially direct quotes from the panelists. I bracketed the few things that are not quotes.
- Top takeaways
- At this point, we are past containment. Containment is basically futile. Our containment efforts wont reduce the number who get infected in the US.
- Now were just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.
- How many in the community already have the virus? No one knows.
- We are moving from containment to care.
- We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.
- 40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
- [We used their numbers to work out a guesstimate of deaths indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flus average of 50K Americans per year. Assume 50% of US population, thats 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.]
- The fatality rate is in the range of 10X flu.
- This assumes no drug is found effective and made available.
- The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%. [See chart by age Signe found online, attached at bottom.]
- Dont know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
- I can only tell you two things definitively. Definitively its going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year.
-
- What should we do now? What are you doing for your family?
- Appears one can be infectious before being symptomatic. We dont know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
- How long does the virus last?
- On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this
- The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based.
- Avoid concerts, movies, crowded places.
- We have cancelled business travel.
- Do the basic hygiene, eg hand washing and avoiding touching face.
- Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in Chinas manufacturing.
- Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
- Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
- We would say Anyone over 60 stay at home unless its critical. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
- We at UCSF are moving our at-risk parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in.
- Three routes of infection
- Hand to mouth / face
- Aerosol transmission
- Fecal oral route
- What should we do now? What are you doing for your family?
- What if someone is sick?
- If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldnt do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on.
- If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
- There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis.
- If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines. [More I found online.]
- Why is the fatality rate much higher for older adults?
- Your immune system declines past age 50
- Fatality rate tracks closely with co-morbidity, ie the presence of other conditions that compromise the patients hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults.
- Risk of pneumonia is higher in older adults.
- What about testing to know if someone has COVID-19?
- Bottom line, there is not enough testing capacity to be broadly useful. Heres why.
- Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating.
- A Polymerase Chain Reaction (PCR) test can detect COVID-19s RNA. However they still dont have confidence in the tests specificity, ie they dont know the rate of false negatives.
- The PCR test requires kits with reagents and requires clinical labs to process the kits.
- While the kits are becoming available, the lab capacity is not growing.
- The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation.
- Expanding processing capacity takes time, space, and equipment. And certification. ie it wont happen soon.
- UCSF and UCBerkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified.
- Novel test methods are on the horizon, but not here now and wont be at any scale to be useful for the present danger.
- How well is society preparing for the impact?
- Local hospitals are adding capacity as we speak. UCSFs Parnassus campus has erected triage tents in a parking lot. They have converted a ward to negative pressure which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility.
- If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected.
- School closures are one the biggest societal impacts. We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects. If elementary kids are not in school then some hospital staff cant come to work, which decreases hospital capacity at a time of surging demand for hospital services.
- Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found.
- What will we do to handle behavior changes that can last for months?
- Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.
- Kids home due to school closures
- [Dr. DeRisi had to leave the meeting for a call with the governors office. When he returned we asked what the call covered.] The epidemiological models the state is using to track and trigger action. The state is planning at what point they will take certain actions. ie what will trigger an order to cease any gatherings of over 1000 people.
-
- Where do you find reliable news?
- The John Hopkins Center for Health Security site. Which posts daily updates. The site says you can sign up to receive a daily newsletter on COVID-19 by email. [I tried and the page times out due to high demand. After three more tries I was successful in registering for the newsletter.]
- The New York Times is good on scientific accuracy.
- Where do you find reliable news?
- Observations on China
- Unlike during SARS, Chinas scientists are publishing openly and accurately on COVID-19.
- While Chinas early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.
- Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots.
- Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime.
-
- Every few years there seems another: SARS, Ebola, MERS, H1N1, COVID-19. Growing strains of antibiotic resistant bacteria. Are we in the twilight of a century of medicines great triumph over infectious disease?
-
-
- "Weve been in a back and forth battle against viruses for a million years."
- But it would sure help if every country would shut down their wet markets.
- As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa. See article on Wired magazine on sequencing of virus from Cambodia.
-
Mar 12, 2020 | 9:26 pm
#3828
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Interesting article from today's Financial Times, contains this alarming graph. It suggests that extremely aggressive measures are needed for any hope, if already not too late.
https://www.ft.com/content/a26fbf7e-...3-955839e06441
https://www.ft.com/content/a26fbf7e-...3-955839e06441
Mar 12, 2020 | 9:27 pm
#3829
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According to experts there has been believed transmission of the virus during the incubation period in which the infected was asymptomatic. If true wearing a mask in any circumstance could be considered wearing it to protect others.
As far as surgical masks, FDA guidelines
"Surgical masks are not intended to be used more than once. If your mask is damaged or soiled, or if breathing through the mask becomes difficult, you should remove the face mask, discard it safely, and replace it with a new one. To safely discard your mask, place it in a plastic bag and put it in the trash. Wash your hands after handling the used mask."
https://www.fda.gov/medical-devices/...sks-face-masks
https://www.nejm.org/doi/full/10.1056/NEJMc2001468
"The incubation period for a virus is the time between catching the virus and showing symptoms of disease. For thenovel coronavirus SARS-CoV-2, health officials estimate an incubation period of between one and 14 days.
Most people start showing symptoms about five days after becoming infected,"
https://www.livescience.com/coronavi...ms-appear.html
As far as surgical masks, FDA guidelines
"Surgical masks are not intended to be used more than once. If your mask is damaged or soiled, or if breathing through the mask becomes difficult, you should remove the face mask, discard it safely, and replace it with a new one. To safely discard your mask, place it in a plastic bag and put it in the trash. Wash your hands after handling the used mask."
https://www.fda.gov/medical-devices/...sks-face-masks
We are reporting a case of 2019-nCoV infection acquired outside Asia in which transmission appears to have occurred during the incubation period in the index patient.
The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak.
https://www.nejm.org/doi/full/10.1056/NEJMc2001468"The incubation period for a virus is the time between catching the virus and showing symptoms of disease. For thenovel coronavirus SARS-CoV-2, health officials estimate an incubation period of between one and 14 days.
Most people start showing symptoms about five days after becoming infected,"
https://www.livescience.com/coronavi...ms-appear.html
Mar 12, 2020 | 9:38 pm
#3830
Join Date: Jul 2002
Location: Hong Kong
Posts: 677
Interesting article from today's Financial Times, contains this alarming graph. It suggests that extremely aggressive measures are needed for any hope, if already not too late.
https://www.ft.com/content/a26fbf7e-...3-955839e06441
https://www.ft.com/content/a26fbf7e-...3-955839e06441
Mar 12, 2020 | 9:39 pm
#3831
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The decision by Macau to close the casinos for a few weeks should have been a big warning to the rest of the world how serious this virus is.
Mar 12, 2020 | 9:41 pm
#3832
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Posts: 38,543
How fast they get infected makes a big difference on the survival rate. Compare the mortality rate in Hubei (3.4%) with the rest of the world (<1%). That's not because Hubei has bad medical equipment, it's because the medical facilities were swamped. Plenty of patients that could be saved died because there weren't enough ventilators.
Mar 12, 2020 | 11:13 pm
#3833
Join Date: Sep 2004
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Posts: 1,466
Three key developments in the last hour:
- Australia is banning gatherings of more than 500 people, excluding schools and universities, from Monday
- Australia has put a Level 3 Travel Advice in place to reconsider non-essential international travel (i.e. worldwide)
- Singapore is halting docking of cruise ships effective immediately
Mar 12, 2020 | 11:27 pm
#3834
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Also Singapore to ban arrivals from Italy/France/Spain/Germany.
Mar 12, 2020 | 11:46 pm
#3835
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Posts: 11,688
The scary thing is both Singapore and Taiwan are preparing for a 2nd, worse wave. Sources: Singapore PM's address and TW CDC lining up 50 hospitals and 167 testing points.
Mar 13, 2020 | 12:02 am
#3836
Join Date: Apr 2013
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Posts: 2,060
Any idea how many people have been tested in Alabama? About 100 in total. I wouldnt confuse lack of cases with lack of confirmations. How many residents have flown through Atlanta or other metros? Just 100? How many college kids traveled over the past few weeks? Just 100?
If you never come in contact with the virus you wont get it. I think that is obvious, but why do you wonder about this? How would they theoretically get the virus?
If you never come in contact with the virus you wont get it. I think that is obvious, but why do you wonder about this? How would they theoretically get the virus?
Yes, that is obvious. But people who live isolated still do get sick--what those odds are and how they apply to this situation is the question. I know people that live 'out in the booies' so it will be interesting to see if they are still safe long after everyone is infected.
Mar 13, 2020 | 12:05 am
#3837
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AUB students and faculty and others in Alabama often use Atlanta as their gateway to fly. Just like ORD gets a lot of people originating there for trips to/from Indiana or Wisconsin, so do plenty of people in Alabama drive to ATL to fly In and out.
When it comes to rural medical centers in the parts of the the US that are wealthier than the rural South in the US, it seemed like many of the ones that were asked didnt have any in-house ability to test in-house (or even with affiliated private labs in the same counties) for this even on Friday. Even in rather rural parts of the US, teachers and students have been abroad rather recently even in places that have been heavily hit by this coronavirus. One case I know about in rural WI has the substitute teacher under quarantine of sorts because they know of a visit to Italy but they werent able to get the substitute teacher tested fast enough .... due to the lack of testing kit availability.
When it comes to rural medical centers in the parts of the the US that are wealthier than the rural South in the US, it seemed like many of the ones that were asked didnt have any in-house ability to test in-house (or even with affiliated private labs in the same counties) for this even on Friday. Even in rather rural parts of the US, teachers and students have been abroad rather recently even in places that have been heavily hit by this coronavirus. One case I know about in rural WI has the substitute teacher under quarantine of sorts because they know of a visit to Italy but they werent able to get the substitute teacher tested fast enough .... due to the lack of testing kit availability.
Mar 13, 2020 | 12:08 am
#3838
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This explains some of the reasons behind the challenges on testing: https://www.cbsnews.com/video/dr-ant...esting-system/
Mar 13, 2020 | 12:27 am
#3839
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Three key developments in the last hour:
- Australia is banning gatherings of more than 500 people, excluding schools and universities, from Monday
- Australia has put a Level 3 Travel Advice in place to reconsider non-essential international travel (i.e. worldwide)
- Singapore is halting docking of cruise ships effective immediately
Mar 13, 2020 | 12:39 am
#3840
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Not-peer-reviewed study on the effect of temperature and humidity on coronavirus transmission: https://papers.ssrn.com/sol3/papers....act_id=3551767
Obviously a lot more research required, but if the effect is confirmed it could help to explain the relative lack of transmission in places that are hot+humid at this time of year.
Obviously a lot more research required, but if the effect is confirmed it could help to explain the relative lack of transmission in places that are hot+humid at this time of year.