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WHO declares coronavirus outbreak a public health emergency (cbc.ca)
495 points by colinprince on Jan 30, 2020 | hide | past | favorite | 439 comments



For those who are referencing the flu and it's mortality rate here are estimates from the CDC for 2019

* 15,000,000 – 21,000,000 who had the flu

* 8,200 – 20,000 deaths from the flu

The morality rate ranges from 0.03% to 0.09% or 3/10000 9/10000

https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...


Those are US numbers only. The CDC estimates that 291,000 to 646,000 people die worldwide every year. You cannot take the US mortality rate and assume it would apply to any other country and especially not China.

https://www.cdc.gov/media/releases/2017/p1213-flu-death-esti...


Indeed. China’s medical system is primitive by comparison. They have shiny highways and trains, but hospitals are overcrowded and underfunded.


I wouldn't use the word primitive, but inconsistent, non-patient-focused and underfunded in many places.

Larger cities can have excellent treatment, smaller cities less so. After a car accident I had pin-hole surgery on a badly broken collar bone (three pieces and several fragments) and only afterwards discovered the lead surgeon was internationally published in leading journals for his work, and the second surgeon would soon be departing for Northern Europe for a 2 year secondment to complete his PhD. Physiotherapy with minimal but sufficient. After-patient care consisted of being invited to dinners with other ex-patients for sharing over dinner, which is very unlike the West.

Certainly I was fortunate and the vast majority of care is not like this, which is why I don't use the word 'primitive' but prefer 'inconsistent'. The doctors described hospitals more like factories: There's a lot of throughput. He chuckled "You get lots of practice, but the focus is on how to do things better."

Edit: When I say 'not patient focused' here's a typical process flow:

1. Go to ER. Have a friend, family member or colleague pay a fee for consultation for a General Practitioner, and specify Chinese Medicine or Western Medicine GP.

2. Wait to see the GP, usually in a queue or ticketing system. There's a nurse on front desk and if it's obvious and urgent you'll be fast-tracked.

3. See the GP. They'll have some idea and request further work, like an X-Ray, Blood Test, CT Scan, etc. That's all in ER. Have the friend, family member or colleague pay a fee for that and wait in a queue/ticketing system or get fast-tracked again.

4. Get the results and return to GP for further prognosis. They'll recommend medicine (go to the front desk, pay a fee, etc, then go to a separate part, typically a separate floor, for that), operation, or other work. At this point you're referred to a specialist department and need to make your own way there, or if urgent have a wheelchair or stretcher and nurse take you there.

5. Turn up at the specialist department. Now this varies. For urgent treatment you'll likely be seen immediately, better, larger hospitals work 24/7. For non-urgent there might be a ticketing system. For something like a bone operation as I had there'll be a junior doctor on front-desk who will make a further assessment. If non-urgent and they're busy, schedule a few days later.

6. A ward consists of several rooms, typical Marie-Curie design with a central lift block and wards coming off from that. Rooms are rarely individual, if fortunate you'll have 2 to a room, sometime 8 or more. Some pre-op, some post-op. Nurses don't do a lot other than administer drips, observe, and escalate to the doctor on-call. For stuff like getting in or out of bed when you can't walk, friends, family or colleagues are there for that. Often you'll see family members on rotation with a small chair or camper bed next to the patient. You can also hire private unskilled unqualified helpers.

How to choose a hospital: Always go with a Medical University. It's a rule-of-thumb the world over and especially true in China. They have the most experienced, best qualified, best paid (outside of a handful of private international hospitals in Shanghai/Beijing/etc) doctors. If there's a #1, #2, #3 etc affiliated hospital, go to the #1, if that's too far, go down the numbering system until distance/urgency tradeoff works best. If you're out in the countryside, the quality of the care isn't likely to be the best.

Sorry, wrote quite a lot there. Thought it would be interesting to share with Hacker News as most readers here probably won't have had experiences with hospitals in China.

In the crisis like Wuhan at the moment I imagine they'd be incredibly overworked.


Well it might be partially due to culture. Large parts of population is skeptical to the modern western medicine, and rather use traditional Chinese medicine practices.


Yea those damn antivaxxers. Oh wait


I have to wonder at what point "culture" becomes an excuse for being ignorant and/or under-educated about what science is.


Especially away from the large cities.


> China’s medical system is primitive by comparison.

Comparison to what? Isn't US hostpitals notorious in that regard? Getting flu and either dying or being bankrupt.


At least you have options. Some countries only have the first.


Countries such as?


...because they are not for profit so people can actually afford to get help even if they are poor


Well, yes... but that's not really the point. There's plenty of better hospital systems, socialized or not.


Large parts of the world have government-funded healthcare, including many countries where it's anything but "overcrowded and underfunded."


I think you're a bit off the mark. Healthcare is cheap in China, but people are even poorer. Only rich people can afford the important stuff. It's common for young people from poor families to work or forgo their education to pay their sick parent's medical costs. Usually old people just die because they can't afford medical care where in the west, they would be treated. Also doctors are poorly paid and commonly supplement their income with under the table drug sales. Oh, and most of them prescribe fake herbal medicines as if it was real and patients are fooled by it because their culture tells them it works. Imagine getting a vial of homeopathic diluted water and a sugar pill when you complain about a cough. I once knew someone who had TB and was recommended to treat it with an OTC sachet of herb from the pharmacy! It's common to find beggars outside hospitals with signs asking for money to continue their treatment. Insurance? Yes, that exists but the excess is often something like 1/3 the total cost so if you couldn't afford it yourself, you still can't afford it with insurance. That's if you have a high enough income to afford insurance in the first place.


> Imagine getting a vial of homeopathic diluted water and a sugar pill when you complain about a cough.

This happens regularly in western europe, especially by pediatricians. The charitable interpretation is that the doctor knows the child will get better in a few days anyway, but has to give _something_ to soothe the parents. Giving the substance-free stuff is better than unnecessarily medicating the child, and placebo-effect can also play a positive role.


In your subsequent comment you add the important point - this is Germany. Having lived both in Germany and (now) in China, i can confirm that both of these countries have a problem with quack medicine. I've never been anywhere else in the world where you need to argue with pharmacists to persuade them to sell you evidence-based medicine.

In China there is some historical reason for it - Mao needed something to placate the peasants while trying to figure out how to provide healthcare to rural areas[0]. Unfortunately the government is still trying to figure that out.

I don't know what the history is in Germany that caused it to be the way it is.

[0] https://respectfulinsolence.com/2019/05/29/mao-triumphant/


Note that homeopathy was invented by a German doctor, Samuel Hahnemann. It grew big at the turn of last century, with hundreds of homeopathic societies with their own apothecaries.

Today, lobbying powers of a profitable industry also play into it.


Curious about the downvotes -- this is common practice e.g. in Germany, and one that I consider largely beneficial to society.


This probably only works with parents who're too dumb to comprehend what's being prescribed, or ones that are ok with homeopathics?

Here in Belgium all the doctors that have seen my kids have no problem saying paracetamol and they'll be fine in a few days.

W-Europe is particularly hostile to medical quackery IMHO.


The parents that know they're gonna get a placebo because the kid will get better regardless probably aren't bringing their kids to the doctor for the kinds of ailments that result in a placebo.


Anecdotally, 90% of the times I've taken my toddlers to the doctor I've gone home with advice to take paracetamol and wait it out.

Kids can get high fevers really fast and you just want to make sure their lungs & heart are ok, they don't have a throat / ear infection etc. A doc can verify that for you in 5 min so I rather be safe than sorry, an "OK" is all I need.


> Insurance? Yes, that exists but the excess is often something like 1/3 the total cost so if you couldn't afford it yourself, you still can't afford it with insurance.

In the USA or China?


China


yes, but still they are not as developed in human indices


The scary part is that of the official 8,200 or so people that have been confirmed to have the virus there's been 171 deaths, and 143 recoveries. So more people dead than recovered, does make one wonder about the 8,200.

Seems few believe the official numbers, people visit numerous hospitals without being able to seen, and even those that get seen have problems getting tested, and people who posts about the situation get the post pulled or pressured to pulled themselves.

Here's an article describing the censorship (pulled posts), arrests for "rumor mongering", difficulty in getting tested, etc:

https://www.reuters.com/article/us-china-health-testing-insi...

This one documents 15% of 41 people getting hospitalized dying:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...


Well there is something to be said for both potential biases in those counts. First of all, those being hospitalized are obviously among the most severe cases. And presumably people with the mildest cases will potentially not even be diagnosed, so the mortality rates would be skewed higher.

And secondly, that more people have died than have recovered doesn't say much other than that it takes longer to recover than to die. If you are going to die, it would appear that it would happen sooner rather than later. Whereas if you aren't going to die, you may take awhile before you've been officially cured.

That isn't to say that is absolutely what is happening here. But both scenarios are fairly likely, and therefore should mediate some of the bleakness of those numbers for the time being.


The numbers we're getting out of China are a mess and almost entirely useless.

There are reports of hospitals turning people away unless they a very sick, and also not testing every ill patient because they're overwhelmed.

I've see death certificates posted online with "viral pneumonia" because they aren't able to test everyone - and certainly don't bother testing those who have already died.

The errors are both ways and huge.

The only thing we can conclude is that it's contagious, deadly, and more deadly than the seasonal flu.


There was one interesting number though. The Japanese had been evacuating 200 people from Wuhan and found 3 cases. Assume that a plane of evacuees like that is somewhat random sampling. And that evacuees have similar or better hygiene. This puts infection rate at 1% of the population. Official population of Wuhan is 11 million, it is possible that it is larger. This puts the number to 100k cases.


Isn't taking the population of Wuhan as 11 million cherry picking? You could choose the population of central Wuhan and get a higher estimate or the population of Hubei province and get a lower estimate. Presumably the distribution of Japanese people evacuated does not match the distribution of people in Hubei province, since many will be tourists (more likely to be in the city centre). Moreover their chance of being infected will depend on where they were staying: there is an epicenter.

But yes it does indicate that the real number is much higher than the confirmed cases. It's really hard to track an outbreak of this magnitude especially when many people are carriers showing mild symptoms. It's actually a good thing if cases are being severely underestimated as it implies a lower death rate (deaths are harder to fudge).


> deaths are harder to fudge

Are you sure about this? AFAIK, the Chinese government does not disclose someone as dead by this virus unless they tested the person positive. That means that if someone dies from respiratory complications on the street or in their home, they will write it off as pneumonia. Right now Wuhan city only has the capacity to screen roughly 6000 samples everyday. Add to this that many sick people are basically just told to go home. Not many cars are driving, city is shutdown so god knows how many are sitting lifeless in their livingroom. I have also seen much evidence that communities are barring the doors of infected households so they can't leave their apartments.

The death count can only be expected considerably higher than reported.


Korea evacuated 400 today, 1 couldn't board the plane because known infected, on arrival 4 were tested and found to be infected. This is consistent with the Japan flight from yesterday that you mention.


So, you are infected? How does it compare to the flu? Are symptoms very different?

Best wishes for your recovery!


1, not I. I think you mis-read.


GP didn't say anything about being infected.


On top of that, 2 of the returnees refused to be tested. Who knows what they're up to… work? Seeing family? Hanging around in the park with a Strong Zero for a chat?


> I've see death certificates posted online with "viral pneumonia"

Would that not be a proper reason for a corona virus caused death? Or does it have to be specific if the exact cause is known?


I'd expect that death certificates would specify the specific cause, if it's known. But I don't know if that's true.

Either way, it makes the data far less useful.


How is "viral pneumonia" not the specific cause of death?


Thats like saying the person died form lack of blood after being shot. Its technically correct, but actually useless.


Medically it seems much more specific though. You could die from numerous things after a gunshot wound, so naming the specific cause of death is more accurate.


Doesn't say which virus.

If they don't know, fine. Albeit sloppy, given the context.

If they do know, and don't say, it's deceptive.


I'm not sure that it's deceptive; generally the "cause of death" is just one part of a larger report that can give further detail.


New data, based on "all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020": 11% "died of multiple organ failure" and 23% are in intensive care unit https://www.thelancet.com/journals/lancet/article/PIIS0140-6...


Interesting, however:

> Most patients were men, with a mean age of 55·5 years (SD 13·1; table 1). 50 (51%) patients had chronic diseases, including cardiovascular and cerebrovascular diseases, endocrine system disease [and some others]

The findings conclude:

> In general, the characteristics of patients who died were in line with the early warning model for predicting mortality in viral pneumonia

Also the group was self-selecting of people who went to hospital before Jan 20th.

In summary: old men with pre-existing health conditions are going to have a rough ride. Am yet to see this play out in 2020 Presidential Election odds though.


>50 years is not old. I don't know what is considered old but I know that >75y has a two magnitudes higher mortality rate with the flu.

I doubt that the 50 years old Hospital doctor who died had any serious per-existing health condition. In fact, you could argue hat most doctors have a stronger immune system than average since they are exposed to more germs due to their profession. So this 50y old professional dropping dead is a bad sign! (and hands off to him for his bravery in doing his job).

You could only argue that he cough the strain very early. A virus jumping into a new species is more aggressive at the beginning, later it adopts more to the new host and becomes less aggressive.


>I doubt that the 50 years old Hospital doctor who died had any serious per-existing health condition.

If you are referring to the doctor in Wuhan - Liang Wudong - he was 62-years old.


"Old" might be the wrong word, but the gist of it is that, like the flu, it's potentially worse around the 50-60+ age group.


> The scary part is that of the official 8,200 or so people that have been confirmed to have the virus there's been 171 deaths, and 143 recoveries.

It isn't that bad. It means that this virus won't kill more than 50% of population even if we were to shut down all research right now.


Uh, in what world is wiping out half a population not that bad??


The new world, post smallpox that wiped out up to 90% of the population. That's setting quite a low bar though, it would still be about on par with the black death.


One could argue that thinning the population of the older demographic with pre-existing (and expensive) conditions could be a net benefit to governments with socialized healthcare. See Taiwan which has repeatedly had to refund their system because of an aging population and the related growing costs.


I'm not disputing your point, but with respect to Taiwan, the fact that visiting a doctor is almost a sport certainly doesn't help - An average of 14 visits per year per person:

>There is a high level of health seeking behaviour in Taiwan. It is part of the Taiwanese culture to take medicines or to seek medical help frequently, even for minor ailments.

>The average outpatient department visit rate is 14 times per year per person.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960712/


That's not what I meant. I was saying that there's at least 50% chance that you might be immune to this virus. Who knows, there might be 1000 people who were infected but never went to hospital because they got better without medical care.


It would be good for the environment


Humans are part of the environment. Every bit as much as a tree or a koala is. So it wouldn't be good for all of the environment.


Christ. I can't imagine wanting half the population to die "for the greater good"...


I've noticed it's never people in a vulnerable group that talk this way.


If they really believed in it, they could start by giving the example and hope others follow.


Thanos Did Nothing Wrong /s


Sarcasm doesn't do well on HN. Maybe for good reason.


There was no sarcasm here. The comment just states that the virus' 0 day fatality rate is at most 50%. Why are you offended by this fact? Obviously we might see some twists like the virus becoming more resiliant, and obviously we won't shut down all research. The actual death count of this disease will be much lower.

Trust me, I know what I'm talking about. I've played plague inc.


I didn't mean that your comment is factually incorrect.

It's just that neutrally observing that 50% of a population would die is at least off-putting.

Given your explanation, maybe you were mocking the credulous. Mocking doesn't work well on HN either.

I've looked at comment histories for many shadowbanned users, and I'm just echoing commentary.


Are the symptoms about the same as the flu? Does having it feel like a flu?


It's like a worse version of the flu. The way that you'll die from the flu is getting a secondary pneumonia infection from Staph aureus or Steptococcus pneumonia, the virus just makes you more susceptible and weaker.

The major lethal consequence for this virus in the Coronavirus family is Acute Respiratory Distress Syndrome (ARDS). A strong outcome for this is we knock you out, put a tube down your throat, and have you breath via mechanical ventilator. It's intense to say the least.

Source: Medical student


If you have that ventilator, can you still die? How? Can the "respiratory distress" get worse without limit?


ECMO could be used in extreme cases, I imagine.

https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...


The lung's capacity to take oxygen from air decreases as the infection spreads


Basically, yes - it's an upper respiratory infection. Indistinguishable from seasonal influenza or a cold, until symptoms are severe.

There may be some slight differences, but even seasonal influenza and a cold frequently present differently.


Isn’t coronavirus itself a kind of common cold?

I’ve heard that “the common cold” is actually a few completely different infections that isn’t worth strictly classifying for the most, and that coronavirus is one of them. If so, this is “a common cold” except maybe death rates are statistically higher.


Yes, coronavirus is a broad class of flus. SARS and MERS are both coronaviruses and there seems to be a lot of genetic similarity to SARS.


The flu is the influenza virus, period. The common cold is typically caused by a rhinovirus, but coronaviruses, adenoviruses, and influenza viruses can cause colds too.


But note that “the influenza virus” is a term that includes many genetically distinct mutations.


Sure, and there are around 160 known types of rhinovirus, 50 adenovirus types, and now 7 known forms of human corona viruses. Flu refers to a specific family of RNA viruses, common cold is a much more broad term.


Any idea what the rates are for the corona virus?


People mistakenly calculate %2 and %50 simultaneously because they assume that when a case is confirmed the death or cured status is also determined at that moment.

In reality, though, people who are going to die don't die at the moment of infection confirmation and people who are going to live do lag in the log because it takes time to confirm if someone has recovered and virus-free.

Some will suggest to simply compare the deaths to the confirmed case from a week? ago but this assumes that the patients are admitted at the same stage of their infection and all cases at the time are accounted for(deaths are probably much better tracked than the infection and the publicity has a huge impact on the reporting). It would be a guesstimate at best.

I would say, let's stick to official numbers since the calculation requires each patients timeline. Surely an educated guess can be constructed by modelling the patient prognosis and virus behaviour but that also requires much more data than what the public has.


«assume that when a case is confirmed the death or cured status is also determined at that moment»

This is why epidemiologists (ref: https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408... or https://news.ycombinator.com/item?id=22195827 for my comment on the paper) prefer instead this formula which only counts patients for which the eventual outcome is already known:

deaths / (deaths + recoveries)

With this formula, there is no need to guess the "patient timeline". If you do the math right now for the largest case study known to date (published yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... covering 99 patients, 11 dead, 31 recovered) you get:

11 / (11 + 31) = 26% case fatality rate

If you do the math on ALL data from mainland China (170 deads, 124 recovered as of 2020-01-29 http://www.nhc.gov.cn/xcs/yqtb/202001/e71bd2e7a0824ca69f87bb... or in english: https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%932...), you get:

170 / (170 + 124) = 58% case fatality rate

This formula gives a pretty good estimate of the eventual observed CFR according to the paper I referenced above. Of course, there are caveats, for one deaths or recoveries may not be properly tracked: there could be many patients with mild cases that are not even detected/confirmed and end up recovering on their own.

PS: I am not stating the lower bound CFR is 26%! Another method I applied (described in twitter thread https://twitter.com/zorinaq/status/1222427708723879936) suggest it could be as low as 9%.


The problem is that the method that you use and the paper referenced (https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408...) only applies the calculation on data 3 weeks, 4 weeks and 5 weeks after the epidemic has peaked. Of course you can get valid data once things have peaked and are slowing down. The issue is trying to get valid data while still in the exponential growth portion. And it seems like this method would have all the same flaws as other methods on rapidly changing data (if not worse due to the lag between recovery and deaths.).

I'm not an epidemiologist, but I believe I see flaws in your application of the methods from the paper.

[1] At the bottom page 481 it clearly say the virus peaked on March 27th. The first date they use data for the e2 calculation is April 6th. Two full weeks past the peak.


Patient timelines still matter. It takes longer to recover than it does to die, so it would make sense to compare current recoveries with the number of deaths from several days ago. But without knowing the patient timeline, I couldn't tell you how many.


This is a great point and we should also normalize it to similar flu's in the region. Quality of treatment will vary greatly.


«It takes longer to recover than it does to die»

Citation needed. I am not aware of data supporting this (or the reverse.)


> deaths / (deaths + recoveries)

How does that produce a meaningful number? If you got 1000s of infected people, and 1 dies... The formula would be 1 / (1 + 0) = 100%. What does that mean?


You simply have to have the known numbers of confirmed dead and recovered patients.

The way you used it "1 / (1 + 0) = 100%" means just "the knowledge used in the formula is that one patient died, zero recovered." In that case, yes, the fatality rate is "everybody dies." But using the sample of 1 is of course not meaningful for any statistics, not only for that formula.


It means that nobody has succesfully recovered following a confirmed infection, which is exactly what your data suggests.


What exactly a margin of %9 to %56 tells us anyway?


Nothing conclusive but if a new disease emerges has a mortality rate even approaching 9% and a basic reproduction number (R0) of 1 or greater, it's a significant cause for concern. Combined with the incubation period, asymptomatic transmission, and the population density in which the outbreaks occurred, in this case it's enough to declare a global public health emergency.


The official figures in China are 8,163 cases 171 deaths which is 2% right now, but take these with a big grain of salt. They could go up (some of those confirmed cases will be very recent and may get worse) or down (more cases might have happened but be unreported). Its really hard to tell what it will look like in a month or two.


I recommend everyone to watch this on-site commentary from the chinese human rights lawyer Chen Qiushi: https://www.youtube.com/watch?v=7AI3R41dGnU

Any numbers we've seen so far seem very tame to me, compared to the pictures out of Wuhan.


I watched the whole thing. It was riveting. Don't forget to turn on CC if you need translation. It is a volunteer transalation.

The reporter, Chen Qiushi, describes his observations in Wuhan, a city of more than 10 million.

His preamble:

"My name has been flagged in China."

"If the content contains 'Chenqiushi' or 'CQS', or my face, it will not be sent on Wechat. ... if you [share on wechat], your wechat account will be deleted, like mine.""

He describes visits he made to hospitals in Wuhan and the general state in the city.

It is well worth listening to / reading.

Some points that stuck with me:

People cannot get to hospital because there is a critical lack of transportation.

There is a critical lack of test kits, so residents do not believe they will be diagnosed, so they stay home.

The original (not translated) is here: https://www.youtube.com/watch?v=iXozpbomAns

(thanks Roritharr)


I really wonder if I made myself unemployable in China because I posted this.

How far does the censoring actually go?


It goes far enough that your concern is valid. Since HN is not exactly mainstream and many Chinese people are posting similar kinds of videos, you're probably okay in this case. However, if you want to make honest comments about China online and still want to travel there, I highly recommend that you post anonymously.


I’ve removed a couple HN posts that were super critical of China for fear of some type of online repercussions. You never know.


China is an autocratic dictatorship so the rules can and do change at any time, retroactively and arbitrarily.

That said you aren't going to be blacklisted for a single comment on HN. That sounds like the kind of thing the US would do.


No, that sounds like the thing China would do once it has perfected pattern recognition in 2023 or so.


TL;DW/DR the subtitles: he saw a lot of chaos in Wuhan's hospitals. Not enough testing kits, not enough government-requisitioned emergency taxis. Taxi drivers were already talking to each other in December saying "avoid the market".

If you don't want to read subtitles for 26 minutes here's all the subtitles copy-pasted from the video: https://pastebin.com/6hJ4h4rm

(You can hit the "..." above the red subscribe button and select "open transcript", but it shows up in a tiny window).

I suppose the WHO saying they're very impressed with how China is handling the situation is because they felt the pressure to save China's face.


Thank you so much for this transcript.

Reading through it made it clear that:

1 - Wuhan's health care system is overwhelmed

2 - There's not enough transportation, test kits, masks, and hospital beds, or volunteers

3 - Many sick people are not even bothering to go to the hospital

4 - There's poor communication and rumors flying around

5 - People are frightened, panicking, and suspecting the worst

This tells me that:

A - there are likely way more people infected than there are confirmed cases, but possibly more deaths too of those who never made it in to hospitals

B - Many wouldn't have died had they had more adequate health care, better transportation and more test kits

So, for the rest of us who are sitting on our hands now, glued to social media or the television waiting to see how this will unfold, our time would be much more productively spent planning for when the outbreak hits our local area.

Volunteer. Get connected with volunteer organizations. Donate. See what you can do to ensure there's adequate transportation, communication and resources when the outbreak hits your area.

One thing I'm really curious about that I haven't heard covered yet is if people who get sick and recover become immune. If so, they should feel safe in volunteering to come in contact with the sick and help them directly after they've recovered themselves.

Cooperation, preparation, organization, and mutual aid are crucial.


The way the central government is handling this is impressive, quarantining a city of that size is unprecedented and has bought the world extra time to prepare.

Yes the WHO are playing politics when they focus on the good things China is doing and ignore the bad. But personally I think they are closer to the truth than those who present an entirely negative version of events. China's response has been 70% good :)


> The way the central government is handling this is impressive

Not really, they jailed the experts who told them that they needed to act quickly, sat on it for a month, and finally did something about it when it was already out of hand.


> they jailed the experts who told them that they needed to act quickly

If you don't mind me asking, where did you see that info?


I don't have the exact articles on hand right now, but here is a newer article on the suppression: https://www.nytimes.com/2020/02/01/world/asia/china-coronavi...


It would be more impressive if it wasn't a month after the problem started and after 5M people left.


Huh, I would say you're in the wrong thread to claim it's "impressive", if this guy's video is to be believed, it's a whole lot of chaos and lack of supplies...


We have gone from the first confirmed human-to-human transmission to tens of thousands of cases in something like two weeks. No amount of preparation will prevent chaos and shortages in a situation like this.

I watched the CDC press conference today and saw nothing but fear written on their faces. And that is with far more advanced notice than the Chinese had.


Totally off topic but... Chinese seems like a very efficient language. The guy doesn't seem to be speaking so fast but the subtitles are conveying a lot of information really fast.


Here's [1] a paper on information density vs speed of speech, done by the University of Lyon. I am not sure how accurate their methods are, but they seem to believe that some languages convey more information per syllable and for 5 out of 7 languages, that ones with lower information density are spoken faster. Note that the sample size was only 59 and only compared how fast 20 different texts were read out, all silences that lasted longer than 150 ms were edited out as well.

[1] http://www.ddl.ish-lyon.cnrs.fr/fulltext/pellegrino/Pellegri...


Interesting. In that paper Mandarin has the lowest syllable rate and the highest information density.

https://imgur.com/4zwH1Ml


It's a tonal language, which enables multiple use of a single letter/tone. Evidently English speakers have trouble detecting proper tone..


Subtitles, slightly edited for reading:

https://pastebin.com/raw/VrLPVC2H


The official figures in China are 8,163 cases 171 deaths which is 2% right now, but take these with a big grain of salt.

I wouldn't even go that far. I've been using this as an excuse to figure out the D3 v5 API using the Johns Hopkins data. Most provinces outside of Hubei are not reporting deaths yet. It's possible nobody's died outside of Hubei, but that seems suspect to me. There is almost certainly strong federal and local pressure to under report deaths, but this sort of thing is much harder to hide in Hubei because it's the epicenter.

I don't believe for a moment that China would've attempted to quarantine 60 million people so quickly if the case fatality rate were only 2%. 2% is bad but SARS saw around 15% in many countries and things weren't locked down this tightly.

More to the point, Hubei is reporting 204 deaths and 5,806 confirmed cases which works out to about 3.5%. This is compared to 76 deaths and 1,423 confirmed three days ago (or 5%). If you'd like to look at death compared to known outcomes you're looking at about 64% of the outcomes being death (204 deaths, 116 recoveries). It's not clear which part of the equation is lagging more in Hubei.


> I don't believe for a moment that China would've attempted to quarantine 60 million people so quickly if the case fatality rate were only 2%. 2% is bad but SARS saw around 15% in many countries and things weren't locked down this tightly.

presumably fatality is only one of many factors here. 15% of 100 infections is a different beast than 2% of 1M. And if it takes up to 14 days to see symptoms...


15% of 100 infections is a different beast than 2% of 1M.

There were roughly 8,000 SARS infections and currently about 10,000 nCoV infections so the comparisons aren't quite as absurd.


That 2% is only among those confirmed. When most people get sick they just stay home, then get better and never visit hospital or get into confirmed cases. Those who die usually have some other disease as well.


On April 1st 2003, when SARS was in full swing, the WHO reported 1622 cases and 58 deaths. That is a rate of 3.5%. In June 2003 (at the end of the SARS outbreak) the official figure was almost ten percent. From this comparison you can expect the mortality rate of the new corona virus to be at around 6 to 8%.

Source: https://www.who.int/csr/sars/press2003_04_01/en/ (search for "deaths")


It is dangerous to extrapolate like this because the big differences are in incubation time and the fact that the novel coronavirus is likely spreadable before the carrier has a fever or other detectable sign. If that's the case, tracking the spread might as well be impossible because multiple people could be the potential source without a clear way to trace it, especially in a hospital setting.

On the flip side, the R0 (rate of transmission) and death rate might be a good clip lower than currently estimated. On the other hand, China walled off a city but part of their motivation might have been the flack they got for moving slowly with SARS.


I saw an interview with a German virologist. Her estimate was to have fatality rate of around 2%. Also stated the issues of calculating these number during the outbreak as not all cases are known, not everyone is either cured or dead. She also hinted at a bias towards the severe cases as most minor ones, symptoms like a cold, aren't reported yet and most likely not admitted to a hospital.

As she said, we will only know once the thing is over.


It's currently 171 deaths, 8,288 confirmed infected, which is 2% dead. However, what needs to be taken into consideration is that infected individuals don't die the day they are confirmed infected, there is a lag of several days.

Assuming the average time from symptom onset and diagnosis to death is 7 days, we're looking at at 20% death rate (830 confirmed infected 1 week ago). Even a 5 day lag between symptom onset to death is a ~9% death rate (1,975 confirmed infected 5 days ago).

This is exactly how the fatality rate of SARS played out.


I'm not an expert on viruses by any means but that seems unnecessarily pessimistic. The number of infections is likely much much higher than the confirmed cases (laboratories have only so many test kits available per day) but most people stay asymptomatic. This would reduce the actual mortality rate, not increase it.


If indeed most people stay asymptomatic (but contagious), you're right that the actual mortality rate is lower. But this same outlook would translate to an increase in total fatalities as it greatly complicates containment.


The number of infections is likely much much higher than the confirmed cases (laboratories have only so many test kits available per day) but most people stay asymptomatic.

Do you have evidence of that in this case?

Viruses vary widely on how many are asymptomatic. My understanding is that having people be infectious and asymptomatic only happens with diseases that are well-adapted to their hosts. Which this one, having recently crossed a species barrier, isn't. (Its fatality rate is also high for the same reason.)

However that is a general understanding and I don't have data to base it on on this case. Do you?


There have been quite a few cases covered in the press about patients which carried the virus but didn't show any symptoms. Most recently: https://asia.nikkei.com/Spotlight/Coronavirus-outbreak/Three...


Thanks.

If they in fact can't transmit, then this is OK. If they can or, even worse, have a long latency period and will show symptoms in 2 weeks, that is very, very scary.

Our best tool for diseases like this is contact tracing. And asymptomatic carriers make that very hard.

(Useless trivia, the first documented asymptomatic carrier who was infectious was a short order cook named Mary Mallon. She is better known as Typhoid Mary.)


She wasn't a short order cook, she cooked for a number of families.


She was both.

When she was first identified, she cooked for a number of families. The outbreak that got her put away for life was due to working as a cook at Sloane Hospital for Women.

I cannot immediately find record of her being a short order cook specifically. However that is my recollection from https://www.amazon.com/Betrayal-Trust-Collapse-Global-Public...


There's a good docu on her story. It might be on YouTube.


7 days is too short. In the 2 Lancet studies (the 41 person cohort and the 99 person cohort), the time from diagnosis to the first recorded death is 11 days later, but most happened sometime after that. It's likely safe to say that diagnosis to death is 2-3 weeks.


The number of deaths is likely to be much more accurate than the number of infections, which are likely much more than 8,288, leading to a much lower fatality rate.


Too many unknowns to say. We don’t know:

- how many infected but not confirmed. They could be asymptotic or mild enough not to seek medical treatment. This would increase the denominator.

- time between infection to first symptom to death. Therefore we don’t know which way the remaining confirmed cases will go. Probably increase the numerator over time but don’t know by how much.

- unclear how accurate the reported numbers are.


IMHO assuming a 2% rate this early is a bit disingenuous. This due to the 8,288 confirmed cases not having registered an outcome yet. If you look at people cured vs. people dead, the picture looks much worse, but yeah a lot of variables still come into play (they were prob. the most vulnerable, they were the first ones so treatment may not have been the best, etc.).


Do a sanity check: does your 20% number make any sense based on what is known about the cases outside of China?


1 week ago there were only 6 confirmed cases outside of China.


We don't know.

We don't know how many people are infected. We only have numbers of confirmed cases and those numbers are heavily skewed because 1) people don't know they are sick 2) stay at home or 3) are not diagnosed properly. Those diagnosed in China are probably severe cases with a multiple not being diagnosed. Also, it is unclear how good the reporting is.

We don't know how many of those who are infected will die and how many will recover. We only know of deaths of confirmed patients in the hospital. Of roughly 10000 confirmed cases 200 are dead, 200 are recovered and 9600 are yet to be determined. From that you could deduce 2% or 50%, less than 2% or more than 50% or anything else. Right now we don't have good data. Also we don't know how long it takes to die or to recover and on most patients we will probably lose track.

Since the infection takes about 2 weeks, we have to wait a few weeks until the smoke starts clearing.


It seems to be too early to tell. There are most likely a lot of undocumented infected cases as well as the incubation period for the virus might be different than the flu. Which can move mortality rate both ways.


Not being flippant, as you've had good answers already, I can tell you the rate of fear of this novel coronavirus:

100%

Streets are deserted. The few that go out all wear a mask. Restaurants, museums, cafes, bars have been demanded shut across the country, ostensibly until the end of the weekend but I can see this being extended. The first working day after the Chinese New Year was supposed to be February 3rd, but the city I'm in have extended this to February 9th - offices have been told not to open. Shops are open, there is food, and new fresh vegetables, fruits, meats are being stocked.


Short answer: seasonal flu << ncov < SARS.

Long answer: wait a week or two.


Even this we don’t know yet. Could be worse than SARS, although most likely not lower than flu. Not enough data to tell yet.


NCOV (new corona) 2%, SARS (2012) around 10%, yearly normal flu around 0.01%-0.05% and Ebola 50-90%


During the SARS outbreak in April 2003 the reported rate was around 3.5% (58 deaths on 1622 "probable cases").

Source: https://www.who.int/csr/sars/press2003_04_01/en/


What's your point? I don't think it obviously follows that the NCOV fatality rate is under-reported just because the SARS fatality rate was.


Ignore the people telling you it's 2-3%. The case fatality ratio is between 9 and 56% according to proper epidemiological methods, such as using the formula "deaths / (deaths + recoveries)": https://mobile.twitter.com/zorinaq/status/122242770872387993...

Disclosure: no I'm not an epidemiologist. But for a reference to a paper by actual epidemiologists see https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408... section Simple Estimators, specifically this formula:

e₂(s)=D(s)/{D(s)+R(s)} which is: deaths / (deaths + recoveries)

The paper concludes: "The second simple estimate based on the ratio of deaths of those for whom the outcome is known, e₂, is reasonable at most points in the epidemic" ie. produces a good estimate of the eventual observed case fatality rate (in fact in their example it slightly underestimates the actual case fatality rate)


If hospitals err on safe side and do not report recoveries promptly (they probably have other business to deal with), applying this method at such early stage would not result in correct numbers, even supposing the virus is well-studied enough to tell when a patient has recovered.


Agreed, when using the "deaths / (deaths + recoveries)" formula, recoveries being under-reported is possible and would skew the CFR upward. But also, if deaths are under-reported in the same proportion as recoveries, then it would not affect the CFR.

I suppose one way to reduce uncertainty is to examine a cohort of patients and follow it meticulously. To do that, we can look at the 99-patient case study published in The Lancet yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... 11 died, 31 were discharged, and 57 remain in the hospital. This suggests a CFR of 11/(11+31) = 26% The assumption epidemiologists make when they use this formula is that the 57 still in the hospital have the same chance of dying as those who already died in the hospital.


...that's not the assumption epidemiologists make. For the very simple reason that there are many "just so" stories you can tell about those still in the hospital - are they sicker, and thus there longer? Are the secondary cases, which in the case of MERS had a much lower CFR?

This is a very straightforward application of survival analysis, and those still in the hospital are "censored" observations - we know their outcome takes place in the future, but we're not sure when.

There are methods for calculating things like CFR in the presence of censoring, which will change based on what type of model you're using.


Assigning 50% chance of death to any patient remaining in the hospital when calculating mortality rate would be nuts, I can only thank the epidemiologists for not publishing the number.


Not 50%, you misunderstand me. I edited my comment to clarify. What I meant is out of those who came out of the hospital (either dead or recovered), 26% died. So those remaining in the hospital are assumed to have a 26% chance of dying.

Another way of looking at probabilities, out of the 57 patients left in the hospital:

If 0 die (ie. all recover), the CFR is 11% (11 deads, 88 recovered)

If 15 die (26% of 57 still hospitalized), the CFR is 26% (11+15=26 deads, 73 recovered)

If 57 die, the CFR is 69% (11+57=68 deads, 31 recovered)

So the CFR bounds are 11-69% and if the trend on remaining patients continue it should be 26%.


Looking only at hospitalized populations creates severe selection bias when applied to the question people want answered here, namely "If I get nCOV, what's my chance of dying?" Only the most severe cases a physician sees end up hospitalized, and only the most severe cases within the general population end up being seen by a physician and confirmed as nCOV. You've already got two levels of selection bias (with an unknown percentage passing through each filter) before reaching the denominator in your numbers.


Not only that, but Wuhan's hospitals and health care system in general seem to be overwhelmed.

In other places that are better prepared and which have more resources the outcomes will likely be better, in worse prepared places with fewer resources the outcomes will likely be worse.

Let's keep that in mind before we extrapolate from Wuhan to the rest of the world.


Correct there is a bias. However even when comparing the coronavirus to the seasonal flu (hospitalized patients only), the coronavirus still looks much more severe:

Only 7% of hospitalized flu cases died in 2018-2019 (34 157 out of 490,561): https://www.cdc.gov/flu/about/burden/index.html The coronavirus would thus appear to be 4 times more deadly (26%.)


Or the hospitals are more overwhelmed now, so only the sickest patients are being admitted.


I suspect that “chance of dying” varies based on treatment, and that treatment in an overwhelmed Wuhan hospital is likely not the same as treatment as, say, the first patient in France to get the disease.


"I suspect that “chance of dying” varies based on treatment, "

I doubt this. WHile this may be true for a known disease, we have to ask, how much can the hospital do in this cases? It is a little bit like HIV in the beginning. Watch them die?

Interestingly, China is trying HIV medications on the infected.


One of the main causes of death of the new coronavirus seems to be Acute Respiratory Distress Syndrome (ARDS). This can be treated fairly effectively with ventilation, but such treatment would obviously require a bed, ventilation system, and attentive nurses, at the very least. It's easy to imagine how these requirements may currently not be met for all patients with ARDS symptoms in Wuhan.

For more info on ARDS and treatment in the context of the current pandemic, see this informative explanation: https://www.youtube.com/watch?v=okg7uq_HrhQ


That's you touting your own feed, and you don't appear to be an epi scientist


I'm just applying the work of epi scientists. I'd love to get feedback from one. Your comment isn't useful.


Given you're posting on Twitter, adding the #epitwitter will get you plenty of exposure to ID epidemiologists, myself included.


couldn't believe these numbers, read the link. correctness is obvious in retrospect, numbers are trivial to calculate by hand by just looking at daily data.

still can't believe them.


"Just looking at daily data" is your mistake. Essentially, it takes N days for the virus to kill, so deaths will lag confirmed cases by N days, and thus the calculated case fatality rate using this method is incorrect. This is why epidemiologists call it a "naïve esimator" (see section 3.1 in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540071/).


It taks longer time to confirm recoveries than death.


Based on "all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020": 11% "died of multiple organ failure" and 23% are in intensive care unit https://www.thelancet.com/journals/lancet/article/PIIS0140-6...


You've quoted this deeply misleading statistic without context more than once. Please desist!


This is not statistics, these are all confirmed local cases of a 20 days period. However, the future distribution may not follow this pattern.


Well 170/~7000 is ~2.4% which is about 8x deadlier.


I think you're off by a few orders.


Like one order? You might be more wrong than him.


Isn't it like 0.09% of deaths vs 2% of deaths? I certainly could be misunderstanding the data!


0.1 vs 2 is slightly over one order of magnitude.


Oh my. Yes. My bad.


It’s actually about 27x - 80x deadlier than 0.03% - 0.09%


In 2018, China had 600k flu cases and 153 deaths. So the new virus has caused 10 times more deaths in this Jan. Is it serve?

See: http://www.nhc.gov.cn/jkj/s3578/201904/050427ff32704a5db64f4...


I would like the WHO to be as transparent as we demand China to be (and perhaps they are):

At

https://www.who.int/emergencies/diseases/novel-coronavirus-2...

, you can see the standardized protocols for the hospitals dealing with 2019-nCov, such as the anonymizing CRF (Case Record Form):

https://www.who.int/docs/default-source/coronaviruse/who-nco...

Which describes both the CORE and DAILY forms for an electronic database.

Some selected sentences from the pdf:

===

* The CRF is designed to collect data obtained through examination, interview and review of hospital notes. Data may be collected retrospectively if the patient is enrolled after the admission date.

* DO NOT INPUT ANY PATIENT IDENTIFIERS: THIS INCLUDES NAMES, ADDRESSES, DATE OF BIRTH OR PLACE OF BIRTH.

* Step 1: Contact EDCARN@who.int to become a contributor to the nCoV global platform.

* Step 2: You will be contacted by ISARIC, platform manager, for assignment informational pack and instructions on how to use the REDCap nCoV platform.

[...]

* If your site would like to collect data independently, establishment of locally hosted database is possible.

* Standard reports will be provided on regular basis to all contributors. Additional analysis for operational public health purposes will be determined by an independent WHO clinical advisory group.

===

As you can see, the only way to get this anonymized data, is to be a contributor, and to be a contributor, you'd have to be a hospital, or somehow be granted access by WHO.

Remember the live outbreak map by John Hopkins? It also displays the number of people that recovered, the dates and definition of recovery duration are helpful in estimating mortality. Note that the other maps and graphs online only publish contaminations and deaths, which is not useful for calculating mortality. Why does John Hopkins deserve access, and why can I not get access, if I wish to fit a statistical model to the epidemic observations?


You can. See this page:

https://www.who.int/healthinfo/statistics/en/

Use their API or the web search, however you like.

If you're going to complain about not having up to the minute data available for 2019-nCov, keep in mind that they're not getting the data submitted regularly from China, it's all in daily reports rather than from hospitals.


would you mind sharing a more precise link to the actual 2019-nCoV CRF database? I want to independently recalculate mortalities


There's not much point, because the data WHO has on the outbreak is being collated from Chinese sources who probably aren't telling the truth. WHO doesn't have a lot of people on the ground in Wuhan and the rest of China feeding them information.

I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless. It's likely that at this point the Chinese government doesn't even have accurate data.


>There's not much point, because the data WHO has on the outbreak is being collated from Chinese sources who probably aren't telling the truth.

1) No dataset is perfect, and everything leaves traces, so clever people can and do constantly deduce insights from apparently worthless data.

2) It is in the interest of the Chinese to cooperate with submitting these CRF's to their best ability.

3) The little data the WHO does release to the public seems quite accurate for an outbreak, if you look at the log-linear plots and so on. (I am not saying the "known infections" represent the actual number of infections, just that it looks like accurate reporting of exactly that "known infections", and if one reads the forms you see it was designed to take into account overcapacity effects, like sending a patient back home, forwarding to a different hospital, etc...).

>I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless.

What do you mean with "in there somewhere" ?

1) If you mean the WHO has the database, then of course the WHO has the CRF database, that's what my original message pointed out.

2) If with "in there somewhere" you meant that it's publically available on their website, then no, it isn't it explicitly states it isn't:

" State Parties are invited to contribute Anonymized nCoV Data to the nCoV Data Platform. State Parties should please contact WHO at EDCARN@who.int to obtain more information about, including log-in credentials for, the nCoV Platform.

To preserve the security and confidentiality of the Anonymized nCoV Data, State Parties are respectfully requested to take all necessary measures to protect their respective log-in credentials and passwords to the nCoV Data Platform. "

So they are sitting on the data as I originally claimed. On some of the clearly popularity boosted "contra-infodemic" threads, they even openly admit they can't give more detailed information even though they have access, when people ask them what they base their numbers on. [throughout the rest of the threads they typically go to great lengths to give the impression they work on the same aggregate numbers you and I can publically see, as if there is no censorship on the anonymized CRF data]

Also, why would I care about live to the minute data? I am looking for the actual data (noisy or not), and I don't care if it's delayed by a few days.

As I said, I am would like to build a statistical model.

As a lesson, perhaps not for this epidemic, but then the next: if the average chinese person can afford a smartphone, then surely they can afford a couple of UV-C LED's with a battery pack, with the LED's shining through a reflective manifold (think a pipe bent back and forth with U-bends), then breathing airflow together with proper dose (X mJ per square cm) should sterilize microbes, viruses in the air. Then it just needs to be recharged, instead of trying to manufacture 61Mega masks a day. The air sterilizer (to be attached to a face mask) could be reused for new epidemics every 5 or 10 years (in which time they might have bought 3 or 4 cell phones...)

EDIT: I see on change.org that there have been petitions towards the WHO on other issues before, perhaps someone should submit a petition to release the CRF database to the public domain. And it's not a question of hosting bandwidth, since the WHO can publish cryptographic hashes, and put up torrent magnets...


Global numbers are more interesting.



It's too early for data on this coronavirus. There isn't enough organizational capacity in Wuhan to properly capture the numbers; to start with it's difficult for people to get to the hospitals because transit is shutdown, and if they get there it's often pointless because there are very few test kits and no free beds. How many have been infected is impossible to determine.

https://www.youtube.com/watch?v=7AI3R41dGnU

Edit: removed remark


This is (imo) the right course of action to (at minimum) alert countries wrt the gravity of this outbreak; however, I was disappointed to see the tiptoeing around potentially offending China. From the press conference, it seemed that Dr. Tedros made it painfully (maybe even unnecessarily) clear that this action wasn't faulting China for their handling of this situation. It's just weird to see that global politics is creeping into these public health decisions.


It's not just politics. This is matter of trying to placate China so that they don't hide numbers from international/outside health organizations to save face.

My understanding is that China was less than forthcoming about actual infection/death rates when SARS was making it's rounds.

Disclaimer: I do not have a source for this. This is heresay from the hubub around the current crisis so take it with a grain of salt.


I was surprised by an NPR blurb yesterday talking about how China may have to put off its annual Communist party planning meeting, and how that would be an embarrassing concession by the Chinese.

I was so disappointed in them. How should it be embarrassing to take a deadly and contagious pneumonia outbreak seriously? Do you want them to feel they should hide it?

(You being NPR). I know you don't mean anything bad by it.


I think you’re reading that incorrectly. NPR is likely not saying they should be embarrassed, they’re saying they would be embarrassed. That’s just a fact.


“Save face”. Unfortunately there is a LOT to unpack in that statement, and will continue to be a difficult problem throughout the coming century.


That wasn't necessarily meant to be derogatory. And you are right, there is indeed a lot to unpack. My wording there might be a bit too glib.


Unfortunately global politics has always crept into global public health decisions. There's no avoiding it.


Seeing current situation, what positive things that can be gained from faulting China?

Imo it may cause china to become hostile and turn off cooperation.


Or they are just concentrating on stopping the diseas and don't really care about the politics. If sucking up to China will help then why not? Less serious people (like Trump) can bluster about after lives have been saved.


Health care is rife with problems of shame, and how it prevents people from getting treatment, from STDs to drug dependency to psychological conditions.

The WHO is simply simply scaling up some tactics used in routine care to the nation-state level. Which, incidentally, is pretty close to their original charter.


Also good real-time chart: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...

tracks confirmed cases and recoveries too.


BNO has a helpful timeline with a timestamp for each individual case update (and links to reputable sources):

https://bnonews.com/index.php/2020/01/the-latest-coronavirus...


>Last Update: Jan 30, 2020 11 am EST.

It is not a real-time map, I find it bizarre that people believe that we can track the population's wellbeing in real-time. Are you ready to be hooked up to such a system?


That's being overly pedantic.

About the update rate: It's updated regularly. If you want to go down this rabbit hole, is 1m update real-time? Is 1s update realtime? Where do you draw the line? For most people, anything less than 12h, in the case of tracking confirmed cases, is perfectly fine described as "real-time"

About the data: Obviously it's showing confirmed cases and not actual health of people. The UI makes that pretty clear, it says "Confirmed cases" in big font. No one expects the latter...


No and no. "Realtime" has an actual definition, as in "data is immediately available".


No information is available real time. There will always be a lag even with stock trading. Determining what is acceptable for real time depends on the context. A few seconds would be unacceptable for stock information but would be more than enough for a 911 real time notification system to first responders. 12 hours for global viral outbreak stats seems acceptable for real time status.


CSSE is manually aggregating data from official sources. It's updated, at most, twice a day so there is hefty lag from when the official numbers are updated and CSSE updates their site. It's about the best source of statistics that laypeople will have but it's hardly worth calling it 'real time'.


There's a difference between latency and delay.

If I "touch a.txt" then run "ls", and see "a.txt", I'd consider my filesystem realtime. There's no point in being pedantic about "but there's a 50ms delay when I hit enter after typing ls so it's not realtime!!!".

"Realtime virus outbreak" implies that the site is somehow automatically identifying where the virus is and updating it's stats, rather than waiting for a human to update it.


Since "implies that the site is somehow automatically identifying where the virus is" is obviously impossible with current tech & infrastructure, the next most "real-time" interpretation is that it has the most up-to-date data as it becomes available... which it basically does AFAIK, assuming it automatically pulls from its data sources, such as the WHO situation report feed.

What would you recommend calling it instead?


It's not impossible, most countries have digitized medical records. It wouldn't be technically difficult to automatically send out a ping to a centralized location when a new patient is diagnosed with novel coronovirus. Politically, on the other hand, it's not going to happen.


Just call it an "up-to-date" map that is often updated.


It is a real time map of data that has been reported.


I don't think that's the case, it is a map of data updated by an editor. The website in question doesn't seem to fetch data automatically as the sources are making it available.


In your example you (human) created a file and you can now request the content of that file (from your filesystem) at any point.

In the given example there's a tracker (updated by humans) and you can see the current state of the tracker at any time (from their database).

I'm not sure what the distinction is here if you consider one realtime and the other not.


I don't believe that the data on this website is gathered through automatic means.

Real-time is not all about latency, live TV or a Skype call also has a latency but it is real-time for all means and purposes since it is automatically gathered, transformed and transported without human labour and immediately.


I don't believe that the data on this website is gathered through automatic means.

Almost all of it is done by hand by the folks at the Johns Hopkins University's CSSE department. It gets updated around twice a day and they're constantly fiddling with the layout and whatnot.


In other words, it is a plot of data that is regularly updated.


In other words, it is a plot of data that is regularly updated.

No, it's updated quite irregularly. Given the time difference between the East Coast and China I'd expect that quite a bit of delay is to be expected between information being released and CSSE updating their site. They're also combining data from different sources and clearly are batching updates together.

https://i.imgur.com/pL1Kg0A.png


So:

In other words, it is a plot of data that is quite regularly updated.


This comment and the replies to it really give a glimpse into the psyche of the more pedantry-prone members of HN.

For me, if someone says X, and a literal interpretation of X would be impossible/ridiculous, I naturally assume the more generous interpretation Y. I would find it bizarre to believe that X was intended.

Some people however cannot escape the interpretation X, and find the statement bizarre fullstop.


> For me, if someone says X, and a literal interpretation of X would be impossible/ridiculous, I naturally assume the more generous interpretation Y. I would find it bizarre to believe that X was intended.

I naturally assume it either doesn't know what it is talking about, or is trying to be manipulate through intentional misuse of words.

Words have meaning. You don't get to arbitrarily decide to change that meaning. I'm not defending the extreme pedantry, but at some point word use is just flat wrong, and that is the case with the original post.


Although not on topic, I think you point highlights a rather unaddressed issue with data and systems relevance. As you imply, not only is it inherently not possible to track a whole population's "wellbeing", doing so in "real-time" is even more ludicrous. So many measures and metrics are really nothing more than utter fabrications that are totally incompatible in spite of being named similarly, and no, that hardly ever seems to dissuade anyone from hooking up to anything but the most obviously egregious offending systems and their garbage data/information.

Just a single aspect of this issue is, what does real-time mean for aggregate, global measures? Days? Hours? Is it somehow more useful to have 100% accuracy at either interval? And what are the criteria that even determine accuracy at all, let alone precision. This is all a kabuki dance with approaching no relevance, especially in the case of the pandemic when there is also approaching zero confidence in the Chinese numbers at all, and it does not matter how many fancy dashboards are put together by "hooking up to such a system", when the numbers could be 2x as high, 5x, 100x, or who knows because they very system of governance and ideology actively evades honesty and responsibility.

ALL of these numbers should be fundamentally caveated every single time any of them are provided with "that they are Chinese data and the Chinese lie about lying, while lying about the fact that they lied. At the very least currently, trusting any Chinese person is an act of insanity, regardless of whether any given individual Chinese person is honest 100% of the time. How much more do people have to be lied to, deceived, cheated, stolen from, plundered, spied on, and infected with communicable diseases that could crash all of civilization by killing millions before we realize there is a mentally ill manic insanity going around that starts with the insanity of not having a common framework for data and information collection, processing, and conveyance.


Nothing is real time due to the finite speed of light.


I would say flightradar24 is real-time plane tracking and wouldn't say that Reddit is a real-time news source. The difference would be that there's a system in place that consistently and automatically updates the information by gathering data from other real-time systems.


Here’s another chart that’s more mobile responsive: https://flu.io/


another one here: intraday real-time coronavirus infected count predictor with log scale. If I am right it goes up every minute or so https://www.coronaviruschart.com/


Anyone know what APIs is the map hooked onto?


It seemed during the conference that they were trying their best to not step on Beijing's toes. I wonder if they think China would stop cooperating if they called them out on their poor containment procedures.


How is locking down an entire city "poor containment".

Find it staggering to insinuate that were it originating in Western countries we'd do the same?


> How is locking down an entire city "poor containment".

Because it followed a week of ignoring the issue and then another week of arresting people who were reporting on the issue. This has been an issue since December 28th, but China and the WHO are pretending it began just recently.

It's "containment" in much the same way that the Soviet Union just couldn't stop lying about Chernobyl because people miles away were melting from the inside, so they took drastic actions to pretend they were on top of things.

Those "hospitals" they are building (and selectively live streaming parts with glorious Party tunes on the background)? Those were resorts that were almost complete, but since tourism in the area is going to be dead for a decade, they're turning them into hospitals and claiming they're brand new buildings.

What is staggering to me is not that China finally moved when it realized the problem could not be swept under the rug, it's that the WHO is going along with the doublespeak of saying "all is well" but then also declaring an emergency, but don't cancel your trips to China!


Can you find me what the 8 people arrested for actually wrote?

5 have been arrested in Malaysia and 2 in Thailand also, have read the viral fake news they wrote and have no problems with their arrest at all.

In the shadier parts of the internet I'm already seeing services for ruining your competitors with viral social media fear campaigns.

r/Australia has a big sticky of all the nonsense being peddled in the country and the NSW health department is constantly having to repudiate popularly shared content. The bullshit asymmetry principle at work.

> China finally moved when it realized the problem could not be swept under the rug

Again, if this outbreak was in the US or Northern Europe, would they _move_ as quickly? Would huge cities be quarantined? Find it incredibly hard to believe.

It's 2020, hiding things a la Chernobyl is not so easy. I think they are doing a half decent job given the circumstances and it's just the usual China bashing by people who have absolutely no idea about the country and only knowledge comes from the newsmedia


> Can you find me what the 8 people arrested for actually wrote?

One of the doctors saw the initial cases before they were officially confirmed. He told the news in WeChat groups to their friends who were also doctors about a SARS-like virus that's being identified and warned their doctor friends to beware. The other 7 just spreaded the message and they are also doctors. They weren't arrested though. They were warned by the police and forced to promise that they won't do it again.

The one who originally wrote the message were also later found to be infected by the virus. Here is an interview in which he told the story: https://m.mp.oeeee.com/a/BAAFRD000020200130255882.html?&laye...


You speak of quarantining huge cities like it's some sort of accomplishment worthy of praise and not a brute force response to the effects of their own negligence.

Being critical != bashing, why are you being so defensive about the situation? Why are you trying to drag other countries down saying they wouldn't do any better? What is your goal?


You got any sources for that b/s?

Like the hospitals being almost finished resorts? They are building these things from the ground up, there was nothing there, you could even see this in those live streams, from multiple camera angles.


Corona virus was first detected in mid December. Things got pretty serious over the next 4 weeks, 5M people left the city before any containment happened.

So of course now everywhere in China has it, not exactly a good containment. The Wuhan mayor said he'd been talking to the China administration for 4 weeks before being allowed to talk about it to the public.


On timeline of events, there was a week or so of delay between first death + ICL paper and the city lockdown. It can be argued the lockdown was very late.

The OP might also mean poor containment within China - which is only relying on other countries right now.


> containment within China

I find it incredibly hard to believe if this happened in other countries they'd simply ban all travel into and out of the nation.

Would your country do that given the same circumstance?


Very late relative to what?

Certainly later than one would hope, but is there a real world benchmark for the handling situations like this that they fell short of? Have similar viruses crossed over in other countries and been handled better?


International Conventions on Quarantines were basically established at a time when the most common global transmission of viruses was by sea https://en.wikipedia.org/wiki/Quarantine#International_conve...


I felt the same way. They went over and over and over stating that WHO endorsed every Xi Jinping's decisions so far.


apparently science is not working as "how things feel/look like", but about evidence and proof. Same thing applies to gov or org, it's not guided by message on social media, but according to the guidance and standard procedure. This kind of practice are very normal cross every industry, from construction safety guide to medicine testing. According to [1], WHO or CDC will only report phase 2 and take actions when there is no evidence of human-to-human infection, and declare phase 5 or 6 base on the information unveiled. And from [2], declare PHEIC when there is human-to-human infection cross border.

> A PHEIC is defined in the IHR (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This definition implies a situation that is:

* serious, sudden, unusual or unexpected;

* carries implications for public health beyond the affected State’s national border; and

* may require immediate international action.

[1]: https://www.who.int/influenza/resources/documents/pandemic_p...

[2]: https://www.who.int/news-room/q-a-detail/what-are-the-intern...


How is this worse than your normal influenza cycle with 3-5Mio infections and 290k-650k death to warrant such an emergency?


Without delving into any of the numbers here since they're still mostly speculation (we don't know how many people are really infected / dead), I think it's safe to say that two deadly seasonal illnesses is worse than one and is an outcome worth trying to prevent.


The issue isn't absolute numbers. We don't know the deadliness of the current outbreak. Lets take the flu for example. According to CDC https://www.cdc.gov/flu/about/burden/preliminary-in-season-e.... The death rate is around 0.09% at the worst according the numbers on the cdc estimates (Which is a very pessimistic estimate). If the coronavirus has a mortality rate of 1/100 it would make 10x more deadly than the flu.


That's the mortality rate in the US. Worldwide it's much higher and goes up to 600,000 deaths annually.


Yes, and for Cononavirus, it will be even more.


I would love nothing more than to wager on that claim with anyone keen.

This thread is full of cringeworthy doomsdayers and armchair epidemiologists throwing around unsubstantiated nonsense. When your only knowledge of this comes from the media people should be a bit more selfaware.

The fact that qAnon folks are all over this and one day old accounts turning up saying millions will die speaks volumes for the level of discourse here.

Bet on the above comment stands for anyone. $1000 USD sound ok? Put your money where your mouth is.


Is there any platform where this could be done, or any proxy that one could trade in order to place this bet? I would also gladly put US$1000 on this.


Long Bets (longbets.org) would be one. Unfortunately, the minimum period there seems to be 2 years.


How are you any different than the other “armchair epidemiologists” in this thread? If anything, I’d say you’re worse than others as you want to profit over a potential pandemic where thousands may die.

The stock market has taken a hit over this outbreak fear. Go place your contrarian bets there if you’d like.


So $1000 then on the above statement I was responding too? Am keen, there's numerous p2p betting marketplaces we can do this in.

Put your money where your non-contrarian mouth is if you are so sure, the media told you so it must be true right?

Mark my words no one will mention this stuff in 3 months.


That's a good hedge bet for whoever takes it.


[citation needed]


People keeps saying things like, "Yeah, well last year way more people died of the flu!"

Yeah, well that was an entire year. This is a few weeks. The goal is to get ahead of things, not to wait until it's too late.


I'm still not sure I understand this. If US alone has ~60k deaths from the flu a year, that still works out to be much more (1153 deaths per week).


It's actually very simple. The Flu has a stable amount of people it kills per year and is already quite established in the human population so it infects a very large number of people per year. nCov on the other hand is a new and poorly understood virus and has only just been introduced to humanity. Extrapolating the number of people it's killed out a few weeks or months, the death rate would be much higher than the flu. The mortality rate is also not firmly understood, with estimates ranging between 2% and 20%.


> If US alone has ~60k deaths from the flu a year

That was one particularly bad season. It's usually in the 30k - 40k range.

> that still works out to be much more (1153 deaths per week)

That particularly bad season had ~45MM cases, so that was an average of 865k infections per week. 2019-nCoV is that 1% of that infection rate.



The reported confirmed counts have grown by a factor of ~1.5 every day, fitting reasonably well with exponential growth. If this rate continued, in 35 days it would reach the world population. Obviously, in the real world the growth flattens out way earlier, from natural causes, and especially because of the attempts to confine it.

Comparing the total number of cases or deaths to flu outbreaks from previous years does not make much sense at this point, when the numbers are growing rapidly, but in a month they probably are easier to compare. Neither does comparing average counts per week, because the growth is not linear. The data for the progression of flu (or any other disease) outbreaks exists, and comparing to their growth rate would put it better in perspective. Regardless of armchair analysis, the WHO declaration means it's something requiring unusual action, which flu is not.


Something else to consider is that flu outbreaks aren't typically taken very seriously by most people, while the widespread fear and media coverage of the 2019-nCov all but guarantees more serious responses from both the general public and the government.

Consider the recommendations to thoroughly wash one's hands during flu season as a precaution against getting the flu. How many people take that advice seriously? You can bet there'll be a lot more hand washing all around once this coronavirus hits people's local areas, not to mention all the mask wearing that'll happen (though unfortunately, most people will be wearing those dinky surgical masks which will be of dubious effectiveness), and people isolating themselves.

On the other hand, we have vaccines for the flu that are available well in advance of flu outbreaks (though not nearly enough people take them), while we've got no publicly available ones for 2019-nCov. That's another confounding variable that makes it hard to compare the two.


As an exercise in understanding exponential growth, for one month would you rather receive $20,000 or 1 penny on day one, 2 on day two, doubling each day until the end of the month. Try it with a calculator or program.

People are concerned because this has a high growth rate that, unless contained, would cause large number of deaths


More importantly, the flu has a vaccine. New versions of it are released each year according to what health organizations think will be the dominant variants.

The new virus has no vaccine.


I think you mean 1 strand of the flu has a vaccine that only a small percentage of the public administer.


Usually it's a 4-strain vaccine but your point stands.


But, it has a vaccine. If it were necessary to prevent a pandemic, governments around the world could create emergency vaccination programs and emergency production programs for more of the vaccine, and they could be tailored to the strain that was creating the danger.

That's not an option to stop this Coronavirus at all.


Because:

* Coronavirus has no vaccine

* Coronavirus infected can be contagious for longer than flu patients

* The longer incubation period means more chances for people to get sick, especially since the disease comes on gradually. People will think they have an ordinary cold, go to work, and infect people.

* We understand the progression of the flu in most variants. We don't know all the effects of the Coronavirus, we just have descriptions of the symptoms.

* Flu is basically everywhere already, Coronavirus is not. It's not a choice between one or the other, it's a choice between one or both. If we could declare an emergency and have some chance of stopping flu from getting to some part of the population, we would.

* People with compromised immune systems like the elderly, or babies, or people with existing illnesses or lung problems know to avoid people infected with influenza. Since it's possible for people capable of infecting others with Coronavirus to not even know they carry it, it's harder to avoid for those vulnerable to it.

It's much cheaper to respond to a virus like this in early stages than it is to wait until we see "how serious" it is. All in all, getting things moving now is a good idea.


You mixed up your numbers. 3-5 Mio SEVERE CASES, not overall infections.

> Worldwide, these annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths.

https://www.who.int/news-room/fact-sheets/detail/influenza-(...

> The flu has resulted in 9.3 million to 49 million illnesses each year in the United States since 2010. Each year, on average, five to 20 percent of the United States population gets the flu.

https://www.healthline.com/health/influenza/facts-and-statis...

Let's assume 10 mil Corona cases in US (like flu lower bound), with 2% mortality. That's 200k deaths. If we assume 49 mil cases (flu higher bound), it's 1 mil deaths just in US.


This 2% number that keeps being thrown around is based on dividing the number of confirmed deaths (which is likely to be relatively accurate) by the number of confirmed infections (which is almost certainly a massive underestimation). It's basically meaningless.


Simply because it has a mortality rate a couple of orders of magnitude greater than the flu's. Something like 8 percent of the world gets the flu in a given year. Millions will die if that happens for this one.


Assuming the CFR remains stable. Most new infectious diseases rapidly drop in mortality because of natural selection: those variants of the virus that make people sickest result in their hosts not surviving or not coming into contact with other people to spread the virus, so the strain that becomes endemic tends to become less virulent and more adapted to its host. This has happened with leprosy, syphilis, HIV, and Ebola, and there's no reason to believe it wouldn't happen with nCOV (if the outbreak isn't contained entirely, as SARS was).


In fairness though, the containment ship has sailed for nCOV.

It’s scary to see it so close to home. I’m in Northern Ireland and saw two hazmat ambulances gunning it into the center of Belfast today.

I’ve never seen a hazmat ambulance in this country - wouldn’t have even known we had them or what they looked like.

I suspect we’ll get outbreaks in many more regions over the next few days.


It's highly unlikely that those ambulances are related to the virus. There are 0 confirmed cases in Northern Ireland, and if it was a suspected case the government and media would be all over it to find people who were potentially infected.


I’m afraid you have more faith than I do in local government.

I wouldn’t expect them to try to “cover it up” but I’d very much expect them to act slowly in notifying and not take it as seriously as they should.


The measure of transmissibility seems to be as high as the Spanish Flu, and the mortality rate is still an open question.

The Spanish flu killed 50-100 million people. Worth reading about it.


While infected to mortality is 3% according to official numbers, which is bad, recovered:dead is less than 50% by the same numbers. Ok have trouble with these reported numbers however, and believe recovered higher. We just don't know. Cross species infection vectors are never good.


Maybe the emergency is less about severity and more about the urgency of attempting containment.

The possibility has been raised that if this goes global, it could become an illness that, like the flu, just sort of continually floats around and we're stuck dealing with it. We don't really want another such illness. If freaking out about it right now can even move the needle on the odds of avoiding that scenario, it might be a good plan.


I haven't heard of the flu shutting down a 11 million habitant city. The flu doesn't kill 290-650k per cycle, its more like 12-60k.


It sounds like a lot, but seasonal influenza does kill 290-650k people annually. The 12-60k range is for the U.S., alone.


> 290k-650k death

Where are you getting that number? It a magnitude of 10 off



Global deaths due to seasonal influenza are in that range.


Because it has a higher lethal rate than Influenza and it has the potential to evolve and become much more infectious than it is currently.


"it has a higher lethal rate than Influenza"

That is not known at this point.


It's not, for now. The problem is that you'll never know if the virus is serious or not until it's too late.


The rates of those requiring ICU seem a lot higher for one.


If nothing else, it's worse in that there's zero vaccination mitigation available. If the flu vaccine was 0% effective this year, that would also be a health emergency.

On top of that, it seems to have worse mortality rate, transmissibility rate, and asymptomatic contagion -- so a little worse in every way, probably.

As with the flu, you're very unlikely to be personally killed by it unless you're over 65, under 5, or in poor health.


I thought flu vaccine efficacy varies year to year and is frequently not that great.


You're correct. See [1]. It's usually less than 50% effective, and as low as 19%. A troubling fact is that effectiveness has been on a downward trend the last 4 years.

[1] https://www.cdc.gov/flu/vaccines-work/effectiveness-studies....


Flu can be managed with vaccine, on-the-spot test kits and antiviral drugs.


AFAIK the flu vaccine is terrible ineffective. I would have to google numbers but the reliability is low.


Although it's not perfect (you're not totally immune), it's still effective at significantly bringing down hospital visits & mortality rates.

This is especially true for those with weak immune systems. As for a source, see the "Effectiveness" section https://www.health.nsw.gov.au/Infectious/Influenza/Pages/you...

Quote "One European study in 2008 found a 66% vaccine efficacy (VE) against confirmed influenza for children aged 9 months to 3 years, while a Japanese study of children aged 6 months to 6 years found VE against influenza A ranged from 42% to 69% depending on the vaccine match"

Another source with an effectiveness section has similar numbers: https://www.cdc.gov/flu/prevent/misconceptions.htm

That's very far away from your "flu vaccine is terrible ineffective" statement.


I used to think commenters on this site were somewhat smart.


Please don't post unsubstantive comments here. If you know more than others, share some of what you know so that we all can learn, or simply don't comment.

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