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Experts Warn of Possible Sustained Global Spread of New Coronavirus (scientificamerican.com)
84 points by nopinsight 31 days ago | hide | past | web | favorite | 61 comments



So reading or watching the news makes all this sound very worrying, but if you look up the amount of deaths from influenza every year, "Up to 650,000 respiratory deaths per year"[0] then this will just become a run-of-the-mill thing, or am I missing something here?

0. https://en.wikipedia.org/wiki/Influenza


Two points against this general "but the flu" argument:

An October 2019 novel Coronavirus simulation by Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation [1][2], projected 65 million dead and widespread knock-on economic and societal problems during 18 months of pandemic. Not that this is a likely outcome for nCoV-2019 (which is likely less lethal than the imaginary virus), but it's worth understanding SARS-like viruses can be significantly more serious than the flu.

Secondly, the flu is "baked in the cake" in our general medical and societal infrastructure. A novel virus will be additive to flu infections and even at similar rates of infection/death could cause a noticeable impact. As an analogy, 1.25 million people die in road crashes each year, but if some catastrophic, widespread automotive software bug/malware caused an additional 1.25 million road deaths in 2020, it would rightfully be a massive story, could potentially overwhelm emergency and medical services, and would be something to be concerned about mitigating as much as possible.

[1] http://www.centerforhealthsecurity.org/event201/scenario.htm... [2] https://youtu.be/AoLw-Q8X174



A logistic curve looks exponential until it doesn't. There is no telling just from looking at this when it will plateau.


Yeah, and if you project to Feb 28, you get ~100 million deaths. Deaths have plateaued somewhat over the past few days, but even then we're looking at a million or so.


There is a table circulating the internet that’s been eerily accurate for the last week or so. In both cases and deaths. I will try to find it and link to it ina follow up comment.

It predicts a million deaths in a month from now, based on the observed R0 of this coronavirus.


> because the true severity of the outbreak isn’t yet known, it’s impossible to predict what the impact of that spread would be

This seems to be a key quote.

When you're making a bet, you should know the odds. Influenza is a known thing. I'm not going to think about that facemask knowing that influenza is going around, etc.


According to Dr Charles Leung from HK (some high ranking public health official? Didn’t get his job title) - early numbers in pandemics are usually underestimated.

He called on preparing for a global outbreak, calling odds not insignificant. His live interview is on YouTube. He estimates 44k already infected globally.


I can't find the interview. Could you link it?



Here's another source which mentions the 44K number. The previous comment might have got the name wrong.

http://www.cidrap.umn.edu/news-perspective/2020/01/experts-n...


Yes, Gabriel Leung is the correct name. Thank you.


Yes. The normal flu is very widespread and has a mortality rate of around 0.1%. The official figures out of Hubei are down to about 3.6% (closer to 5% yesterday). There are too few deaths outside of Hubei to draw any meaningful conclusion. To make an apples to oranges comparison you'd be looking on the order of tens of millions of deaths annually if we don't get the mortality and/or infection rate down.


The Spanish flu has a similar mortality rate as this and managed to kill 5% of the world's entire population.


I've been trying to understand the number from the Spanish flu and it seems utterly confusing for some reasons.

The consensus seems to be 30% population of the world was infected, with a case-fatality rate of 2.5% (which is another commonly quoted number), it doesn't add up to 5% of the world's population. The case-fatality rate will have to be around 20% for it to kill that many people. This happens even in the same academic paper (for example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291398/ )

> An estimated one third of the world's population (or ≈500 million persons) were infected and had clinically apparent illnesses (1,2) during the 1918–1919 influenza pandemic. The disease was exceptionally severe. Case-fatality rates were >2.5%, compared to <0.1% in other influenza pandemics (3,4). Total deaths were estimated at ≈50 million (5–7) and were arguably as high as 100 million (7).

?!

Can anyone more knowledgable explain what is going on with all those numbers?


They seem to be confusing mortality rate (MR) with case fatality rate (CFR). Mortality rate is deaths per thousand per year applied to the whole population. Despite its name, CFR is the proportion of actual cases who die, and is a probability rather than a rate.

The CFR is estimated at between 10 - 20 %, i.e. a symptomatic member of the population (a case) has a 10 - 20 % chance of dying. 30 % of the global population of 1.8 billion were infected over the several year course of the epidemic, which equates to 600 million cases leading to 60 - 120 million deaths.

MR was >2.5 %, so more than 2.5 % of the global population died per year during the epidemic. With a population of 1.8 billion, this equates to >45 million deaths per year over several years.


I think Spanish flu doesn't tell us much about how this will play out - different virus, different connectedness of the world, no air travel, lots of the dead were from secondary bacterial infections and there were no antibiotics back then. Too many things are different


I think majority of the deaths relating to Spanish flu were actually from secondary infections (bacterial pneumonia) rather than the virus itself


China infection rates could be as high as 100K, as the 5% number is based on tested cases.


Right, and that could reduce the mortality rate.

But then, perhaps the influenza mortality rate is also an overestimate, in that people who aren't severely affected won't get diagnosed.


The problem is that you don't know if the virus is going to mutate to become more lethal/virulent or less as time goes on. Each identified outbreak that passes a certain threshold needs to be treated as a potential pandemic. The risks of letting another Spanish Influenza or Ebola go global are not worth it.

There is also some unsubstantiated talk (CDC has come out and said it's not evidence supported yet) that this virus can spread before the host shows symptoms which is unusual. Your healthy coworker could come into the office and infect everyone, then come down three days later with the symptoms, and a week later the whole office is out sick. Or school.


I too, wonder about this.

The article starts with:

> Some infectious disease experts

But only two experts quoted in the article predict a potential pandemic.

The main worry, though is that it's infectious while asymptomatic, which apparently was not the case with SARS:

> Tools like quarantine and isolation—which were key to controlling SARS—are unlikely stop spread of a virus that can transmit during the period from infection to symptoms, experts say.

Also, of those who died, how many were weak/immunocompromised to begin with, and how many were healthy adults?


Everyone is so fixiates on deaths.

25% of SARS survivors have lungs mangled so badly they cannot exercise or walk very much. Does that count as healthy adults not dying?


Flu is an example of a virus that we cannot control and now comes back every year, kills hundreds of thousands and puts huge strain on global healthcare systems. One thing we are desperately trying to prevent is the Coronavirus becoming another seasonal virus on top of the flu.

There are also additional risks like a higher fatality rate in otherwise healthy people and the likelihood of the virus mutating into something that can spread like wildfire.


If you happen to be lucky and live in a country with a functioning health care system, the flu is easily managed.

There are vaccines, test kits and antiviral medications.

An anecdote: my daughter had some fever in Japan, so we took her to the doctor. No other symptoms. The doctor did a swab test which tested positive for flu. Next, a nurse came in and administered a drug that is breathed in by taking deep breaths. Next day, my daughter was all fine like nothing happened. No sign of flu.

(And I didn't have to pay a single yen. I looked up the price of the of the flu test kits and they will set you back at least $200 a piece in the US)


The differince I imagine is how it has 'fresh' hosts, and can spread quickly, possibly overwhelming care, or complicating other medical issues. The flu seems throttled by varied, but somewhat common, resistance in humans, where this has little or none. Otherwise, no, it seems to me, a layman, as being about as intense as the flu from a purely individual, symptomatic perspective.


it might be less, the same or more. we don't know yet. it has potential to be more deadly than the flu because of the unknowns, including prevention and treatment.


> am I missing something here?

There are vaccines and antiviral meds available for flu though.


Might be that the demographies matter. Influenza kills economically unproductive members of society while Corona (not sure, I’m speculating here) Is more severe in the productive groups. Or more simply, the mortality might be higher


So you're proposing that influenza has a net positive effect on society as a cleanser of the unproductive or unfit? I don't know if I should consider that thinking closer to Darwinian or to Nazi theories...


I don't see that as Darwinian. Darwin just describes what happens and how that led to differences in species, he doesn't give it value judgments like "net positive" afaik.


And neither do I give a value judgment on the difference in alert level between the yearly Influenza and this Corona outbreak: I’m just - speculatively - attempting an explanation, without necessarily endorsing it.

It’s the same reasoning behind the alarm behind HIV in Africa: not only it kills, it removes the economically active demographic from the economy while tying up even more in their assistance...

Everyone please take time to read and make sure you properly understand what you have just read before reacting.


US State Department advisories:

Travel Alert Level 4 Do Not Travel to Hubei - Tue, 28 Jan 2020

Travel Alert Level 3 Reconsider Travel to China - Tue, 28 Jan 2020

Health Alert Update – Novel Coronavirus in China - Sun, 26 Jan 2020

China Travel Advisory Update: Level 4 – Do Not Travel to Hubei Province - Fri, 24 Jan 2020


Statement and statistical model of the epidemic from HKU researchers. They're quite pessimistic.

• Likely ~75k infections in China already

• Chongqing likely the next big city to experience full uncontained outbreak

• Drastic measures required to prevent full pandemic, including a drastic reduction in mobility (no large group gathering, no travel, etc)

https://www.youtube.com/watch?v=CwXMPsbxFfo


Thank you for posting that video. He sounds most reasonable and with zero slogans, and even though with restraint he certainly thinks this can spin out of control.


A positive effect of a higher number of infection is, that it would reduce the fatality rate of the virus.


Indeed, but there's also very credible rumors saying that the number of dead patients in Wuhan is severely underreported.

For example, this video shows someone walking around a hospital in Wuhan, where you see dead bodies in the hallways just sitting around.

That doesn't happen when you only have 100 deaths in the province. That happens when you're so overwhelmed with dead patients that you just can't deal with it fast enough.

If this is true, which I'm inclined to believe, then we're very likely looking at thousands of deaths already.

https://twitter.com/ezracheungtoto/status/122064100006384844...


Nobody blockades 10 cities and quarantines 50 million people over 100 deaths.

Shanghai closed all non essential businesses. Schools closed until Feb 17th. Hongkong is in state of emergency.

Several military medical battalions have been deployed overnight in China.

This is not a drill.


Isn’t it more likely that they are asleep than dead?


That's the thing: we don't know. We don't even have data to make a guesstimate. That's the scary part: we can't tell if that is more likely.


Why isn't quarantining all flights to and from china not an option?

Lose a couple months of GDP vs. dying is not worth it?


Remember that people travel to and from China. I'm pretty sure it's illegal for a country to prevent its own citizens from returning to their homeland.


This is what I don't understand. A global pandemic of epic proportions is about to occur and you're concerned about legality?

Ship them back on a one way trip.


You're assuming preventing death is a priority of the China government.


Not talking about China. Talking about OTHER countries.

https://www.google.com/flights?lite=0#flt=SFO./m/0l3cy.2020-...

Here flights to WUHAN brought to you be the USA. I'm assuming preventing death is the priority of ALL governments.



It would be interesting to see what the process is for testing for this, costs involved and what the bottlenecks are.

For example, you might not even get treated in the Philippines if you don't bring money with you or don't have insurance.

Once a panic sets in, can a hospital in a developing country even continue testing? Or do they start turning people away?

Do hospitals in developing countries have the resources to mass test people? How much total cost is involved?

Given the challenges, I imagine these confirmed cases are going to be seriously constrained vs actual cases which might even go to the hospital to get checked.


Isn't it already to late? It has two weeks incubation time roughly, it's already been observed in Europe and America? It's not contained in a small area in China anymore.

I would bet that enough people are infected with it as we speak that it can sustain itself and no amount of quarantining will save us from it. The only option would be an instant complete travel, logistics and congregation ban around the world. Which is I without a global government.


I don't think we know the answer to this yet. Without an answer, it pays to be paranoid.


If I got it right there is not a single case of transmission outside of China reported. Yet.


Give it another 2 weeks and we’ll know for sure. If those that returned from Wuhan to say the US were contagious prior to showing symptoms then anyone they infected prior to them showing symptoms won’t be symptomatic just yet. We’ll find out soon enough how bad this is.


Germany has a patient near munich that didn't travel to China.


This one is the worst one. The guy contracted it from a lady who was at training in the company. She contracted it when her parents from Wu-chan visited back in China. The guy has been in contact with 40 people apparently. No idea about the woman. This alone yields huge figures if the spread while in incubation period is confirmed.


There are three more infected people in the same company (Webasto, a car parts manufacturer) now, it is not unlikely that other people from the same company, at the hotel where the Chinese lady stayed and from the same airplane she travelled with have been infected.

https://www.straitstimes.com/world/europe/germany-confirms-f...


I've been following this closely since Jan 2nd. This is looking like it will be far worse than SARS and MERS, and far harder to contain. I imagine it'll look a lot closer to the Spanish flu.

I wonder what absolutely drastic measures China could implement to get this under control. Short of a total curfew of the country for a few weeks, I don't know what they can do to prevent a full blown pandemic at this stage.


I believe we're only a couple days out from the total confirmed cases of Coronavirus to match the total confirmed cases of SARS. At that point, SARS will still have far more deaths.

There's a lot of graphs on projections vs actual numbers since this thing started being heavily tracked. I don't know what sources are most authoritative. Each seem to work on different timelines but all show fast growth.


Well at the time the SARS cases were confirmed, those individuals weren't dead yet either. That happens some time later.


It should exceed the old SARS day after tomorrow if it keeps on that exponential curve.


I'm afraid it won't be contained - and similar to other tough viruses it will kill millions in coming years.


Wuhan Coronavirus (2019-nCoV) Global Cases (by Johns Hopkins CSSE) [1]

1. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...


Google's put the document on lockdown so if you want to save a copy of the data yourself this will get you an ODS file (for now):

https://docs.google.com/spreadsheets/d/1yZv9w9zRKwrGTaR-YzmA...




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