
Second U.S. coronavirus case of unknown origin confirmed in Santa Clara County - beefman
https://www.mercurynews.com/2020/02/28/santa-clara-county-announces-new-coronavirus-case/
======
sciinfo
The first patient was confirmed after having been intubated for >= 4 days. On
average it takes 9 days from infection to ARDS, which requires intubation,
according to a Lancet study. She was confirmed 5 days ago (on Feb 23rd). So
she could be infected 9 + 4 + 5 = ~18 days ago.

Since only around 20% of patients require hospitalization, we can estimate
there are ~5 infected in her cohort. With doubling time outside China at 5-6
days, that means around 3 doublings: 2^3 * 5 = 40 infected today (Many of them
will not show serious symptoms; some who will require admission have not
progressed to that stage yet.) So far we have assumed that all hospitalized
cases are detected, however.

Some who are hospitalized might still not be detected, since without a test or
a CT scan, its symptoms are similar to other viral pneumonia. Let's say
infected per detected is a factor of 1.5-4. Very rough estimates: ~60-160
infected in the Bay Area now.

[https://www.wired.com/story/community-spread-
coronavirus/](https://www.wired.com/story/community-spread-coronavirus/)

[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)30183-5/fulltext)

Doubling time outside China: [https://ncov.r6.no/](https://ncov.r6.no/)

~~~
TuringNYC
Curious why a CT scan is required as opposed to a more routine inexpensive
chest XRay?

------
panarky
Because the US is doing nearly zero surveillance testing, we don't know what
we don't know.

Maybe there's community transmission right now beyond these two cases and we
don't know because we're only testing people returning from China or from the
cruise ship.

~~~
GeekyBear
The CDC had issues with quality control on the test kits that must be
distributed before labs outside of CDC Atlanta can begin doing their own
testing.

[https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html](https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html)

The plan was always to expand testing, but you need a working test kit first.

>Six public health labs in the US plan to start monitoring the general
population for the new coronavirus this week. The Centers for Disease Control
and Prevention (CDC) says that the risk of the virus still remains low for the
general population. But activating the disease surveillance network will allow
the CDC and other public health officials to find any undetected virus
circulating through the country.

[https://www.theverge.com/2020/2/24/21147157/coronavirus-
lab-...](https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-
surveillance-flu-cdc-virus-tracking-testing)

Edited to add that according to Pro Publica the problem stems from the CDC
trying to get a little too fancy.

>The federal agency shunned the World Health Organization test guidelines used
by other countries and set out to create a more complicated test of its own
that could identify a range of similar viruses.

[https://www.propublica.org/article/cdc-coronavirus-
covid-19-...](https://www.propublica.org/article/cdc-coronavirus-
covid-19-test)

~~~
pmorici
South Korea tested on the order of 10,000 people today alone and found roughly
300 positive cases. The USA has managed to test around 500 in the past two
months.

I'm extremely concerned this isn't being treated with an appropriate level of
hair on fire urgency. They said 2 weeks ago they were going to start expanded
testing in 5 cities and they are still developing a testing procedure?

~~~
chiefalchemist
> I'm extremely concerned this isn't being treated with an appropriate level
> of hair on fire urgency.

Or, the actions are to be given more weight that the words. That is, perhaps
the response is actually appreciate.

Let's recap: The CDC has made a couple statements. The POTUS has down played
things. On the other hand, the mainstream media has pinned the sensationalism
meter.

Fact: It's been a fairly active "traditional" flu season. Plenty have gotten
sick. Plenty have died. Coverage? Zero. Comparison between the flu and this
corona virus? Again, zero.

There's disconnected and mixed messages, and plenty of misinformation. I'm not
dismissing the threat. Just the same the signal to noise ratio is ridiculous.

Full disclosure: I carry a lot of contempt for the mainstream media. My level
of trust, close to zero. The coverge of this issue does more to deepen my
mistrust more than gain it. Based on discussions I've had with peers, I'm not
alone.

~~~
jonahbenton
Your contempt leads you to falsehoods and further confusion. Put it away
before it gets you hurt.

There is no comparison between flu and Corona. Deaths of non-immune
compromised flu sufferers in the US are tiny (1 in my state, NYS, this whole
season).

Corona appears to be at least 100 times as deadly as the flu for non-immune
compromised, probably more, and there are so many unknowns (eg repeat
sufferers).

There is no universe in which "POTUS has down played things" is anywhere near
a rational distillation of the behavior of this administration.

Take the glasses off. Put away the contempt. Use your brain. Don't be a fool.

~~~
chiefalchemist
Outside of China...number of deaths?

One death for the common flu in all of NY this season? Nah. Not credible. NYC
alone has more than one.

[https://weather.com/health/cold-flu/news/2020-01-28-flu-
more...](https://weather.com/health/cold-flu/news/2020-01-28-flu-more-deadly-
than-coronavirus)

Is there a concern about corona? Possibly. Does the data and the media's
depiction currently support the frenzy? No.

Fool? That funny because your data is wrong. I'm questioning you, you have no
answers, and I'm the fool? That's not how it works here.

------
dvduval
It's getting real now. Wash you hands, and avoid touching your face. Plan to
spend less time in close proximity to others.

I saw a message at a dance studio in Monterey Park, which is like a Chinatown
section of Los Angeles. The sign outside says that if you have been to China
recently, please self quarantine yourself for 14 days before entering the
dance studio.

I could definitely notice a difference in the approach they had. They are
already worried about it and they are taking steps. I'm not really sure we're
ready for this thing. But it's here. It sure seems that way anyway.

~~~
tanilama
> The sign outside says that if you have been to China recently

It is no longer only China at this moment, it is literally EVERYWHERE....

~~~
avocado4
97% of cases have been in China so far.

~~~
tanilama
But US had rejected China travelers' entry and it had been almost 3 weeks now.

The chance that people here in get the virus from travelers from
Italy/Japan/South Korea/Middle East is MUCH higher than that from China at
this very moment.

~~~
WillPostForFood
US citizens are still allowed to travel to and from China, and there are
multiple flights every day.

~~~
usaar333
Yes, and they are supposed to self-quarantine on return for 14 days.

No such rule is present with S. Korea or Italy.

A random traveler from S. Korea/Italy is far "riskier" at this point.

(Bonus: It's actually really hard to fly directly from China to the US at this
point. Your best bets (esp. in the north) are transit through S. Korea or
Japan, both infected places)

------
amluto
I am suspicious that a _lot_ of people in the Bay Area have mild cases of
COVID-19. I also see no reason to believe that the total number of cases isn’t
a couple of orders of magnitude higher than reported, making the overall
fatality rate quite low.

Ideally, enough serological tests could be produced that a public health
authority could randomly sample a population and get an actual unbiased
estimate of the infection rate.

~~~
omgwtfbyobbq
I've suspected the same in SoCal. DW and I have been feeling kind of bleh over
the past few days, and as of today both of our families haven't been feeling
great either. It could be something else too, but I wouldn't be surprised
either way.

~~~
01100011
Allergy season? It's hitting me as of mid-week. In the bay area here.

~~~
omgwtfbyobbq
It could be allergies. Whatever it is, it's fairly regular. I have a once a
day spike in symptoms, only at night so far, where I feel like I'm about the
catch the flu (runny nose, scratchy throat, a bit of coughing, and generally
feeling poor), but the symptoms fade after an hour or two. Besides that I just
feel tired, and at the start of whatever this is I had a day of loose BMs. DW
and I's family also started feeling crummy a few days after we did, which
could admittedly just be a coincidence.

On the flip side, it's also fairly common to think the flu is just a cold
virus or allergies because most people don't display much in the way of
symptoms.

[https://www.npr.org/sections/health-
shots/2014/03/17/2908789...](https://www.npr.org/sections/health-
shots/2014/03/17/290878964/even-if-you-dont-have-symptoms-you-may-still-have-
the-flu)

Odds are this is just some random virus (>90% chance), but I wouldn't be
surprised if it was COVID-19 either (<10% chance).

Edit - I also have a cousin living in LA that developed pneumonia, which again
could just be coincidental.

------
kaisersjc
Not in the news yet but there is an admission at kaiser San Jose of a
potential covid-19 patient. Have all the symptoms, traveled and tested
negative for flu!!

~~~
russellbeattie
How have the mods left this sitting here for 3 hours? Rumors like this cause
panics and get people killed. So fucking irresponsible.

~~~
imperialdrive
What is the rumor? There are many people working in hospitals that know a
thing or two but aren't in a position to share it outside the workplace. I'd
rather the facts be allowed out rather than covered up... it's more
responsible and will keep people from getting killed.

------
torpfactory
My wife is an ER nurse. (West Coast but not California) Kind of wondering if
I’m going to have to isolate myself from her just in case. She’s almost surely
going to be coming into contact with patients soon.

Starting to get real for sure.

~~~
rconti
Probably not worth it, unless you're in a group most likely to die of the
effects.

If anything, I wonder if one would prefer to get exposed earlier rather than
later.

Of course, my wife works in a hospital in Santa Clara.

~~~
jessriedel
Even young and middle-age people have a 0.2% mortality rate, which at the US
statistical value of life (~$10M) works out to $20,000. (And if you're a well-
paid software developer, you can probable 5x that.) Whatever you would do to
avoid losing $20k-$100k, you should probably do to avoid getting Covid-19
(modulo questions about how long immunity lasts).

~~~
lhl
One thing to note is that even though there are age range breakdowns from this
initial analysis
([https://www.ncbi.nlm.nih.gov/pubmed/32064853](https://www.ncbi.nlm.nih.gov/pubmed/32064853)),
there is also a breakdown based on pre-existing conditions, with
Cardiovascular, Diabetes, Chronic respiratory disease, Hypertension, and
Cancer being 5-10X hazard ratios vs those with no pre-existing conditions.

Sadly, the paper is in Chinese, but you would probably want to look at the
percentage of non-mild cases in your age bracket and adjusted for your pre-
existing condition risk to see how your actual risk might be modeled:
[http://rs.yiigle.com/yufabiao/1181998.htm](http://rs.yiigle.com/yufabiao/1181998.htm)

But I think we'll just have to see how the medical response is in each
specific locality to really get a good idea of what the real risk is.

I don't necessarily think that a dollar amount is actually the best way to
think about it. It's very hard to think about what value you'd place on
avoiding a hypothetical 1/500 risk of death (adjust based on percentage of
population you think will contract this). Note that as a 40yo, your odds of
dying _period_ within that year is actually about 1/500:
[https://www.finder.com/life-insurance/odds-of-
dying](https://www.finder.com/life-insurance/odds-of-dying)

You can then split this up by percentages for cause of death:
[https://www.advisory.com/daily-
briefing/2019/01/16/deaths](https://www.advisory.com/daily-
briefing/2019/01/16/deaths) (Chart 2, select your age category)

UK chart, but also some charts on annual death risk:
[http://www.bandolier.org.uk/booth/Risk/dyingage.html](http://www.bandolier.org.uk/booth/Risk/dyingage.html)

And lastly, the almost useless CDC data/charts - they include leading causes
and absolute number by cause and age-group, but not the population size so you
have no idea what your odds are:
[https://www.cdc.gov/injury/wisqars/LeadingCauses.html](https://www.cdc.gov/injury/wisqars/LeadingCauses.html)

In any case, once you have the odds down, you can place the amount of effort
you'd spend relative to the amount of effort you spend on other risks.

~~~
jessriedel
> I don't necessarily think that a dollar amount is actually the best way to
> think about it. It's very hard to think about what value you'd place on
> avoiding a hypothetical 1/500 risk of death

It's not that hard if you try. We face risk-benefit tradeoffs everyday. You
either (1) have an _implicit_ price you put on small risks to your own life in
the sense that you accept risks below that price and reject ones above it, or
(2) you are acting inconsistently, in the sense that you could strictly reduce
risks to your life while making more money (or saving more time, etc.).

> Note that as a 40yo, your odds of dying period within that year is actually
> about 1/500:

Sure. And I think that if people could purchase immortality for their 40th
year for $20k, they should probably do it.

> In any case, once you have the odds down, you can place the amount of effort
> you'd spend relative to the amount of effort you spend on other risks.

Sure, now just find out how much you pay routinely to avoid this effort (e.g.,
how much you pay your accountant to do your taxes), and you've got a risk-
dollar exchange rate.

~~~
lhl
As you mention effort/value can be converted to dollar value, so I don't think
we actually disagree that strongly - the missing word from my critique would
be "fixed" dollar amount - using the hypothetical $10M lifetime worth.

There's more to it, but the point I was trying to make is that the amount of
time/effort/money you spend worrying about coronavirus should (rationally) be
relative to what you spend for other similar risks.

For your last example, I think that what you pay to save time or effort saving
services might be on a different calculus since there's a guarantee of how
much time or bother it might save you, vs a potential downside calculation.

~~~
jessriedel
> the missing word from my critique would be "fixed" dollar amount

Sorry, are you just saying different people may have different amounts? Sure,
sure. But for a given individual the amount has to be fixed across the choices
(at least all the choices close enough in time that the money is fungible).

> since there's a guarantee of how much time or bother it might save you, vs a
> potential downside calculation.

When I decide to wear a mask to the store, there is a guarantee of how much
bother it _costs_ me. The only thing that's uncertain is the risk to my life.
But, as previously argued, each person should have a linear risk-dollar
exchange rate for small risks.

------
softwaredoug
Serious question: don’t we pass a threshold where it’s not practical to cancel
travel or events because of covid-19? It’s just going to spread anyway?

For example, once, say, Olympics roll around, is there really any value in
canceling them if it’s going to be everywhere anyway?

Is containment even possible and, if not, is the disruption to the economy
worth it?

~~~
brohoolio
It’s about smoothing the curve so the healthcare system can absorb the influx
of patients. If the healthcare system is overwhelmed then it’s a problem.

Here’s a link to a great article.

[https://blogs.scientificamerican.com/observations/preparing-...](https://blogs.scientificamerican.com/observations/preparing-
for-coronavirus-to-strike-the-u-s/)

~~~
rambojazz
This is exactly what's happening in Italy. The majority of people are
asymptomatic or only have mild symptoms, but smaller hospitals are nearing
full capacity and thus are redirecting patients to other hospitals. ICU beds
cannot all be reserved to covid patients, there are regular patients as well.
All the restrictive measures put in place should help contain the spread and
avoid overwhelming the healthcare system.

------
rhegart
I’m sick in Santa Clara County as is my household. Do I just wait it out for a
few weeks? Sister called in sick but is being pressured to work

~~~
asdf21
The ethical thing to do would be to self-quarantine.

Feel better soon

------
naringas
if this gets bad enough in the 'western' world maybe the Chinese could spin
the narrative into "look how well we were able to control it in the place it
started"

time will tell...

~~~
hangonhn
It has already happened. My parents live in China and my mom was raving about
how quickly they built that hospital in Wuhan and what a great leader they
have. I told her Stanford is a really great hospital. _shrug_

~~~
lawnchair_larry
Opinions on how well they’re handling things aside, I must say, I was pretty
impressed with how quickly they built that hospital. We could never do that in
the US.

~~~
rcpt
Critical infrastructure to slow a deadly pandemic?? Not in MY backyard!

~~~
kevdragon6
[https://www.ocregister.com/2020/02/22/why-here-costa-mesa-
oc...](https://www.ocregister.com/2020/02/22/why-here-costa-mesa-oc-officials-
question-feds-plan-for-coronavirus-quarantine-site/)

------
war1025
I am hearing wildly varying opinions on the severity of the covid-19
situation.

It seems like the general conversation here on HN has been much more doom and
gloom than some other places.

Anyone have opinions on why that is?

Possibly the higher than normal concentration of members here on the West
Coast?

Maybe the general tendency of people with stronger opinions on a topic to
comment on threads about that topic?

Obviously there's a chance the concerns raised here are of the proper severity
and everyone else is just under-reacting, but it also seems entirely possible
that this is already way more widely spread than people realize and the
percentages are just skewed because most people wouldn't bother going to the
doctor for a cold.

I guess we'll find out one way or another...

~~~
onlyrealcuzzo
Doom and gloom as compared to what? I would say it's Doom and gloom before I'd
call it a "hoax". If anything, I see a lot of people on here making flu-like
comparisons. I'd say I'm more doomish than that, too.

Because so many people are trying to conceal information to keep tourism
going, stability, re-election, GDP and so on, we really don't know how bad it
is.

But when's the last time a flu caused a 13% sell-off? It seems pretty serious.

After reading The Fifth Risk by Michael Lewis, I'm really starting to be
convinced our collective willful ignorance is becoming problematic.

~~~
Scipio_Afri
If you compare what we know about it now to the flu, it’s 20x more lethal than
the flu at current estimates with many of those who get it severe enough to go
to the hospital requiring intensive care to recover. It’s legit.

~~~
_bxg1
Source on the 20x number?

~~~
Scipio_Afri
Heard specifically the .1% flu and 2% for COVID19 was from Dr. Adam Bernheim
from Mount Sinai hospital in NYC who was interviewed as part of a Bloomberg
investing podcast called “Bloomberg Surveillance”. He’s citing roughly what
I’ve seen in journals regarding the study of COVID (note I’m not in the
medical field but semi-competent and enough to find articles in medical
journals, read them and understand what they’re saying) but I haven’t been
able to find a number for typical season flu strains being “about .1%” is what
he specifically says and “about 2%” for COVID19. He compared various aspects
of it to the typical seasonal flus at 11 minutes into the show, specifically
11minutes 40seconds for mortality comparison.

Bloomberg Surveillance podcast is free and also availability through other
platforms but here it is through Apple podcasts:

[https://podcasts.apple.com/us/podcast/bloomberg-
surveillance...](https://podcasts.apple.com/us/podcast/bloomberg-
surveillance/id296237493?i=1000466868582)

------
rosybox
It's good the company where I work, which employs about 70 people, allows us
all to remote. We have a large space that we rent in a WeWork office in San
Francisco but we can also work from home if we want. We have remote employees
in other states and over the last year have built a very strong remote
culture. All of our meetings have people who are remote, in fact often more
people are remote than not these days. I imagine our company's work from home
policy will help avoid downtime and really make a difference compared to
companies that are just going to have to shut down when faced with the reality
of this horrible virus.

------
awb
TLDR;

> The infected patient is an older adult woman with chronic health conditions
> who was hospitalized for a respiratory illness, county officials said.

> This would be the 63rd confirmed case in the U.S. Of those, 44 were people
> who had been aboard the Diamond Princess cruise ship and repatriated to the
> U.S., three were repatriated from Wuhan, 12 were people who had recently
> traveled in China and two caught it from a close family member. This week's
> two cases in Solano and Santa Clara counties involved people with no known
> exposure risk.

~~~
jasondclinton
> [the] patient [...] is now at El Camino Hospital

~~~
gfodor
Mt View

~~~
01100011
It wasn't clear from the article. I wasn't sure if it was Los Gatos or MtnV.

~~~
mikeyouse
It'll definitely be Mountain View, they're set up with a proper ICU and
isolation.

------
heligate229
test kit can be in hundreds, not a lot can afford it. The governor should do
something about reducing the cost for cost-effective testing.

------
courtf
My husband is a career public health clinician who organizes vaccination
clinics (has given out hundreds of thousands of vaccines for infectious
disease, many for free via grants). At the state level here in US, he has
mounted responses to H1N1, ebola, measles and now this coronavirus. The
conventional wisdom around this outbreak, right from the beginning, has been
that almost everyone on the planet will be exposed. It's no surprise this is
hopping around stateside.

The virus has a two week incubation period, during which the host is not
infectious, but also has no symptoms, making tracking vectors difficult. In
addition, after incubation there are a couple of days where the host is highly
infectious, and _still_ has no symptoms. The term for this period is
"prodrome" (pre syndrome). Under certain circumstances, it's also airborne,
which is can be a problem for providers. It's spreading fast because of these
characteristics.

Similar to flu, it is expected that this virus will find enough hosts to
essentially never stop circulating. Expect to see it again next year, and the
year after, etc, in perpetuity.

Get your flu shots! You might prevent someone from getting very sick or dying,
even if you don't see symptoms yourself.

~~~
gdubs
“Of course, it's also airborne“

This is new to me — I was under the impression that it could spread by
droplets, but hadn’t heard anything definitive about being airborne?

~~~
courtf
Apparently, there are some conditions where it can go airborne, but most
transmissions are by droplet. I'll amend my comment. Healthcare providers will
been using airborne protocols, which was where i got the idea.

------
easytiger
The over_reaction to this is utterly ridiculous in Europe.

~~~
asdf21
How so? Have you seen Italy’s numbers?

------
avocado4
Why is everything happening in Bay Area? Do local official ignore CDC
protocols to spite Trump?

------
earthtourist
Is the main goal just to delay the widespread infection until we have a
vaccine produced?

It seems like this was always an impossible goal. So does it even matter when
this goes pandemic? Sure, more preparation would get us more masks or
something, but anything that would really help?

~~~
npunt
Think about capacity and throughput of hospitals. If everyone gets it all at
once, they'll be overwhelmed and many people will die, since severe cases
often need respirators, drugs, and close monitoring.

The goal is to smooth out the cases over a longer period so we're less
capacity limited. That means everyone taking extreme precaution with hygiene.

~~~
earthtourist
Has this ever been done for any pandemic virus?

We have a "flu season" where hospitals are flooded every year. From what I
read, there's not even a strong immunity after being infected with this virus,
so won't people just get re-infected?

It doesn't seem like there's any version of this where things are not terrible
for a while. I hope I'm wrong though.

~~~
npunt
Yes, we can lower the R0 infection rate and smooth it out over a longer period
of time by adopting better hygiene practices and making behavior changes.
You're seeing that right now as different countries mobilize and react
differently.

If your re-infected comment is regarding the reports of people getting it a
second time, I believe that's been debunked and is an artifact of imperfect
tests rather than the virus itself.

What I've read from multiple sources is that SARS family coronaviruses are
pretty stable evolutionarily, so once you have immunity you should be able to
fight it off in the future. This is in contrast to influenza which evolves
quickly, which is why 'the big one' in pandemics is much more likely to be
influenza (or a bacteria) rather than coronaviruses. See also: Spanish Flu,
Black Death

~~~
earthtourist
Thanks for the thoughtful reply! I was basing the immunity question on
comments from doctors like the below quote. It sounds like one won't easily be
re-infected with the same strain? But if it mutates later, or your antibodies
diminish, then you could get re-infected? That doesn't sound as bad as being
stuck in an infinite loop of re-infection.

 _If you survive, are you immune?

People who are infected and then recover will likely show some immunity to the
virus.

But it’s not lifelong. It wanes over time. If it’s seasonal, it may ebb and
flow._

[https://www.mercurynews.com/2020/02/11/coronavirus-
the-8-big...](https://www.mercurynews.com/2020/02/11/coronavirus-the-8-big-
questions-that-scientists-are-asking/)

~~~
npunt
It seems that way but I’m not sure honestly, this is past the limits of my
knowledge. Probably good to keep an eye on the subject though since it may
affect our behavioral choices.

------
bitxbit
My biggest fear is this virus hitting an antivax community. It’s really hard
to stop a virus like this in the US because travel rate is higher while we
still have high density areas. It’s very difficult to contain without
resorting to Martial law type of traffic ban which is not feasible in the US.

~~~
robbiep
What are your specific fears about it hitting an antivax community? It’s not
like they have any ad- or disadvantage compared to the rest of the population
wrt. Immunity at the current time

~~~
anigbrowl
Even if they have no direct medical vulnerabilities, anti-vaxxers are prone to
rejecting or subverting public health recommendations, eg voluntarily bringing
their kids to measles parties to 'get it over with'. As recently as 2 days ago
Rush Limbaugh (a conservative talk radio host) was saying that Covid-19 is
essentially just the common cold and the health scare was misplaced.

~~~
robbiep
There are a lot of other groups this applies to. For example, the current
Korean outbreak was started by a religious member who refused to be
quarantined. The US’s response is being lead by someone that doesn’t believe
in science. If you want to get worried about something, there are a lot of
other places to start

