A diagram putting the danger of infection with COVID-19 in perspective:
A little perspective on how contagious the new #coronavirus is. pic.twitter.com/NcN26YyPp3
— Dr. Ahna Skop (@foodskop) March 1, 2020
Not shown is the human cost. Deaths from the coronavirus in Washington state have crept up to 6. All of them were people over 70; the death rate for the afflicted over that age is 15%. The virus isn’t done yet, either.
“We expect the number of cases to increase in the coming days and weeks,” said Jeff Duchin, health officer for the public health agency, who stressed that most cases will be mild. “We are taking this situation extremely seriously.”
Uh-oh. My mother lives in King County, and she is over 70. I hope she’ll take this as an excuse to quarantine herself and stay home for a while.
Some of the comments at the link question the data, although they aren’t very specific about the issues nor what the impact would be if the data agreed with their exceptions…whether the COVID-19 would be worse or better.
I’m agreed, COVID-19 is an issue, but how do we call this out for what it is? A global concern that requires global partnership that is not happening. US leading the way with not helping
So far, the basics of virology are still sound: wash your hands before you eat, be very careful around a cough.
It’s still an evolving situation. We still don’t know for sure how many people with mild or no symptoms are transmitting the disease. If you have no reason to believe you have the coronavirus, you’re less likely to take precautions against spreading it.
I’m a little concerned about my trip to the UK in a few weeks. I’ll be staying with my elderly parents in the run up to my dad’s 90th birthday, and I will have no idea whether I picked up the virus on the flight, sharing the same small space as several hundred other people. I guess there will be a lot of handwashing going on…
SARS-CoV-2 (the official name of the virus, the disease is Covid-19) appears to be considerably more infectious than the original SARS, which was successfully contained. So I’m very dubious about the information in your link, PZ, as are a number of the comments as robro points out.
ouch, yo. I’m actually a person.
The Chinese authorities have relaxed some of their containment measures around work and travel. Whether they were wise to do so, we will presumably see over the next couple of weeks. But even if they have genuinely got the outbreak in China under control, it will continue to spread from secondary centres.
sorry, confused that text with Ro-Bro. thought thou thought I was a bot.
Smart, honest science on this outbreak
https://twitter.com/KrutikaKuppalli
https://twitter.com/aetiology/
https://twitter.com/ScottGottliebMD
https://twitter.com/angie_rasmussen
You all will be the first folks I have told:
I am sure I will lose my mother. I think my wife will lose her parents. I expect I will get very sick.
I hope with increased response, to best of our ability, we can drive the fatality rates down, but they are not going to go down much for the highest ages and folks with other conditions.
We need to slow the spread while science works on this from multiple angles, which they are doing, none of which will be widely available for a while.
In the mean time the best counter moves are washing hands often, no touching your face with unwashed hand, wash surfaces and touch points, stay 6 ft from a sick person. I was not in field, but those were literally the only methods my colleagues in field had when combating ebola in 2014 and it worked.
Leave masks for the front line folks.
Small actions at scale can make a difference, wash hands, social distance, it has been proven.
I think that this figure is an underestimate. Our analysis suggested an R0 closer to 4 or 5 in Wuhan before significant public health measures were in place, which is significantly different in terms of the magnitude of necessary interventions required for control. R0 will be dependent on where the disease is spreading as well as the biology of the pathogen, so its not clear how things will play out. The reality is that there are a lot of unknowns so we simply don’t have an exact figure quite yet; but, IMO its unlikely that the very fast growth rate is consistent with an R0 lower than SARS (consider the epidemic trajectory of SARS vs COVID-19, both coronaviruse). Preprint below (fyi: this has not been peer reviewed and is not yet published in a journal)
https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1
@5 & Robro pointed out, that graphic is, well, to put it politely, bullshit.
It’s derived from the R0, taking no other factors into consideration and hence, is bullshit between two slices of rye, with some straw on top of the bullshit and they’re calling it a Reuben sandwich. This is why we have epidemiologists, they know that the R0 is not the be all or end all of any communicable disease.
Now, how in the frigging hell can anyone get a realistic R0, when in Wuhan, most SARS-CoV-2 patients had mild clinical symptoms or subclinical symptoms, given that the only ones tracked were the hospitalized cases?
Virulence factors weren’t considered in that idiotic graphic, risk by age also ignored, so frankly, the graphic is a bullshit sandwich.
I’ll stick with a real Reuben, in spite of the sauerkraut.
Typically, once a year, my cholesterol is quite elevated as a normal baseline and statins and I have a wonderful relationship, a hate-hate relationship.
If anyone is interested in our reasoning, I’m happy to discuss it and the other lines of evidence that causes us to think that COVID is more contagious than the initial estimates (I’m one of the co-authors on that preprint).
@11, I’m sure that the R0 is beyond underestimated by a lot, as many subclinical and mild illness patients in Wuhan were sent home and not counted. That alone, due to the sheer volume of cases that did result in hospitalization would tip the R0 into a cocked hat.
I’ve e-mailed a friend who is an epidemiologist, hopefully he’ll have the time to pop in and give some pointers. I understand the basics well enough to point out something missed in a screening survey, his type approve expansion as needed and crunch the numbers in ways I’d only foul up – even with a computer.*
Hell, even the fatality rate is bullshit, for the same reason that the R0 won’t be realistically arrived at until the current outbreak is long over. After all, if say, only 10% that are ill are tabulated and non-hospitalized patients aren’t counted, the death rate sinks into the subbasement once one accounts for those not accounted for.
Still, encouraging is, the hospitalization to fatality rate is still only a tad above half of what the SARS fatality rate was.
*I’ve worked with epidemiologists in the military, but on non-emergent cases of FBI casualties on bed rest, as well as measles and polio outbreaks inside of a conflict zone. I’ve nothing but respect for them!
Interesting preprint obie4rs
I like this point.
R0 isn’t a fixed value.
It depends on a lot of variables, some of which are under human control.
If we use quarantine and other social distancing tactics, it can go from 4.7-6.6 down to 2.3-3.0.
Still high though. To stop an epidemic, you want the R0 to go below 1.
Hmmm… Increased risk to those over 70… Increased risk if there are underlying health issues… Obvious increased exposure risk if you’re around a lot of people… Hey, I know! Maybe Trump will come down with COVID-19 and die of it!
whheydt @ #16 — He also recently traveled to India, one of the COVID-19 hot spots. Plus, he’s around a lot of people who travel to China and other far-flung destinations. Still, as a self-avowed germaphobe, he probably washes his hands fifty times a day.
@17:”he probably washes his hands fifty times a day.”
Given his know nothingness and general sloppiness he probably does it all wrong and just spreads the viruses.
Even the R0 zero values we know are wrong in that infographic. Influenza varies from season to season with different strains, but it averages out to about 1.2-1.3 depending on your data source. The graphic suggests 2.5, which is simply wrong. The R0 for SARS is disputed, but the sources I’ve read suggest is was much harder to transmit than flu.
Beyond the R0 numbers there is so much more going on. A lot of the comparison diseases have effective vaccines, and most of them only require hospitalisation in severe cases. Early data for Covid-19 suggests one in five need hospitalisation, with one in five of those requiring a stay in ICU. We could end up in a situation with 1% or more of the population needing hospitalisation at the same time, which is simply more hospital beds than any western nation has on hand. Here in Australia, the total number of hospital beds (private + public, metro + regional/rural) is roughly equal to 0.2% of the population. You know what happens when you have five times more people needing hospitalisation than there are available beds? A LOT of folks die, including young adults in good health who may otherwise have survived. In Wuhan, when people requiring hospitalisation couldn’t be put into a bed, the death rate spiked.
Our governments need to take this shit seriously NOW and start preparations, but with Trump, Johnson, and Morrison in charge, we are FUCKED.
Selected R0 values from Wikipedia (because I couldn’t be bothered trawling the literature):
Measles 12-18
Diphtheria 6-7
Smallpox 5-7
Polio 5-7
SARS 2-5
COVID-19 1.4-3.8 (4.7-6.6 in obier4s’ preprint)
1918 flu 2-3
Ebola 1.5-2.5
MERS 0.3-0.8
Also, R0 is not a simple number to calculate or interpret.
I thought the first death was a chronically ill 50-60 year old? The case fatality rate in people 70-80 is somewhere between 5 and 10%. Not great odds when you’re talking about dying, but most 70 year olds who get covid will survive. You will not all lose your family members unless it mutates into something much worse. But most of us will lose at least some of them. I’m worried not only about my 85 year old father and 77 year old mother, but my chronically ill 57 or so year old close friend and my nephew-in-law who works with the public.
Yes, this will be much worse because of the US admin’s incompetence.
Sorry for the delayed response. I think that everyone is making good points: R0 is a mixture of agent, host, and population factors that means that its variable between populations (sometimes even greatly). It’s also true that in emerging infection situations that the data are very poor in the early epidemic (poor case definition, lack of sensitive tests, overwhelmed medical systems). We attempted to deal with this by basing our estimates on the first arrival of infected cases outside of Huebi province (but still in China). We were able to access high resolution travel data so we know how many people were traveling from Wuhan during the very early epidemic period. This allowed us to get a much more clear picture of what was occurring in the early epidemic. It’s a somewhat technical argument, but other lines of evidence are point in the same direction now. The exponential growth rate in the diamond princess was about 0.22.day and the growth in deaths in the early epidemic also grew at about 0.25/day. Given that deaths are much less ambiguous than confirmed cases (and should follow a delayed exponential growth curve with approximately the same rate), we think that this is reasonable evidence that the growth rates are high. It’s still possible that R0 is not as high as we estimated, but with high growth rates, its much less likely.
It’s also a good point that we simply don’t know the true case fatality ratio. In these situations, as another commenters pointed out, the CFR tends to come down as we learn to detect more mild cases–it’s likely lower than 1% in my opinion.
Two more follow up points: it does look like the CRF is much higher in 65+ persons, so even if its true that the mean CFR is low, it might still be very dangerous for certain populations. It’s important not to get misled by means.
Another point is that our public health system has been decaying for decades. The fact that many Americans don’t have access to medical care, and even those that have insurance, might not be able to afford treatment for pneumonia is a huge problem not just for those people, but for all of us. One of the (many, some problematic) reasons that the Chinese response has been effective is that the time from first symptoms to hospitalization when form about 2 weeks to about 2 days after people became aware of the disease. I don’t see us being able to replicate that kind response here. The logic of public health is most stark in these kind of mass emergency situations; hopefully there will be some kind of momentum for a more sane and humane health system because of this.
Another problem in the US is spread: Many people, especially in food service jobs, simply don’t have paid sick leave. Many more, especially in health care, work in a cultural milieu that shames taking sick leave. This means more people coming to work with a “cold” (which is all that some people ever have) and passing it to others, including (health care, remember) ill and immunosuppressed people.
Also customs: In most countries, you wait maybe 10, 15 minutes to get into the country. In the US, it’s hours. Hours of tired, stressed people standing around coughing on each other. Yeah, that’s not a problem at all.
We’ll find a lot more coronavirus once we look for it. If we look for it. I wouldn’t be surprised if 45 declares the epidemic over and simply stops testing for it.
I suggest supplementing with vitamin D. I used to get two or three colds annually. Since supplementing about five years ago I’ve had few and mostly very mild colds.
Check with your doctor.
jack16
jack16 — can you cut it out with the crappy unexamined n=1 anecdotal stories?
Vitamin D supplements in winter are indicated for most people.
Marginally helps a bunch of things including mood, bone density, and immune system.
Only marginally though. You can still get depressed, break your bones, and get sick.
@27
might help way up north were it is a lot darker in winter going outside down here is cheaper and more fun less slipping though watch out for the wet grass of course
uncle frogy
I’m happy to see all these reasonable comments.
In Croatia, we test only people suspected of having the virus because they were in contact with already known cases or have traveled to Italy, and are now sick. They do not test people who simply have flu symptoms but haven’t been to Italy or had contact with known patients, meaning we have no idea how many people are walking around thinking they only have the flu.
And I’m sure there are some, considering the very mild symptoms all the known patients have. Who knows how many people on the bus, in a tram or at work they have infected? Not everyone is going to volunteer themselves for quarantine, especially if they can’t afford not working for 14 days (state offers compensation, but it’s ridiculously low).
Well, geez, PZ, it’s clear that the main factor connecting the danger spots is that you have family near all of them. Obviously what we ought to do is use your family as a stealth weapon against economic competitors by giving them all-expenses-paid luxury vacations to prosperous regions.
Fifteen percent of SIX items? This is your idea of statistical math? Wow!
jack16
I’m not a biologist, but I’m really curious to know – for SARS-CoV-2, why is an intermediate animal required for transmission from bats? Or if I kept a bunch of horseshoe bats in a cage, could I get it directly from an infected one?