Since only around 20% of patients require hospitalization, we can estimate there are ~5 infected in her cohort. With doubling time outside China at 5-6 days, that means around 3 doublings: 2^3 * 5 = 40 infected today (Many of them will not show serious symptoms; some who will require admission have not progressed to that stage yet.) So far we have assumed that all hospitalized cases are detected, however.
Some who are hospitalized might still not be detected, since without a test or a CT scan, its symptoms are similar to other viral pneumonia. Let's say infected per detected is a factor of 1.5-4. Very rough estimates: ~60-160 infected in the Bay Area now.
Doubling time outside China: https://ncov.r6.no/
Maybe there's community transmission right now beyond these two cases and we don't know because we're only testing people returning from China or from the cruise ship.
I'm not dismissing the possiblity of a threat; only how accurate self-reported data is known to be.
Missing from the discussion is the whole debacle around the HHS staff that was sent to check the repatriated American citizens from Wuhan, who had no protection, were not trained, and were released back into the general public without further monitoring.
According to the Washington Post, the people from the CDC who interacted with the quarantined patients all had full protective gear.
Allegedly there were social workers from HHS also sent to help assist who were not trained in how to don full gear and so were wearing just masks and gloves.
Note this all happened back at the end of January. So it seems unlikely that anyone was actually exposed, unless you think that there are HHS workers who got sick and it was kept out of the news.
That doesn't follow, both because the incubation period is now thought to be as long as 28 days and because infected individuals can be asymptomatic.
A study of 1,099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020.
"The median incubation period was 4 days (interquartile range, 2 to 7)."
New England Journal of Medicine, Feb 28, 2020
Edit: I found reference to various leadership positions that would help respond to a pandemic be eliminated or left vacant , though I think that says something a bit different (still bad though) than the entire US pandemic response capability, or "unit", being axed.
Not sure how much more explicit that 2018 WaPo article can be.
The previous administration converted the highly successful infrastructure they built up while responding to the Ebola virus into permanent infrastructure which was quickly dismantled by the current administration.
"funding for the CDC’s global disease outbreak prevention efforts had been reduced by 80%, including funding for the agency’s efforts in China. But that was the result of the anticipated depletion of previously allotted funding, not a direct cut by the Trump administration.
Since January 2019, actual funding (vs. requested/proposed funding) is controlled by the House leadership of the opposition party.
Also, that paper will have no clinical impact. Thread: https://twitter.com/drlukeor/status/1233547995192279040?s=21
"CT should not be used to screen for or as a first-line test to diagnose COVID-19"
Maybe they are wrong, but a post on HN is not exactly a credible refutation.
Is there a site tracking the response of CDC and public health departments to this emerging pandemic?
So it seems what the CDC is doing is trying to minimize the number of confirmed cases to make things look better.
The CDC has seemed relatively dysfunctional in these outbreaks to me before. During Ebola, there were only a few concurrent (maybe just 1) cases of Ebola in the country. At the same time as the CDC was having news conferences and the CDC experts were presumably in meetings, the handful of nurses doing the actual care for one of the only ebola patients in the country were left completely alone by the CDC:
"After days of asking, Pham said, the nurses were given hazmat suits. She said all the decisions to upgrade the protective gear and precautions were made by the nurses “on the fly.”
Sadly, one of the nurses caught Ebola.
So while it may not have been malice, there is a very straight line to be drawn from the actions of a couple of years ago and the inept handling of the situation today.
USA: Suppress the creation of damaging facts.
The POTUS just said this was a "democratic hoax." After appointing someone to deal with it.
It's beyond politics at this point. Trump can't run the country, and because of his policies, our response is limited and ineffective.
I had to watch the actual rally where he said the words. Article after article uses the decontextualized "the new hoax", or simply "hoax", and most even editorialize that he's claiming there's no threat from the virus.
This sort of thing is what gives Trump credibility when he accuses the media of "fake news".
The moment that the numbers take a turn for a worse (and they will, because we are not at all prepared for this and are doing nothing to prepare) he'll call them fake, made up and continue down the line of a democratic hoax.
He's doing the exact same thing he did during Hurricane Maria and I would hope that people would learn quickly from the way he's behaved in the past.
Now the Democrats are politicizing the coronavirus. They have no clue, they can't even count their votes in Iowa. This is their new hoax
At that point it does not matter if he believes the coronavirus is fake or if he believes that the virus is a complete non-issue because the end result is the same.
A staffer telling Trump “this is their new ‘hoax’” has a readily understandable meaning which is not even remotely calling Coronavirus itself a hoax.
"The Democrats are politicizing the coronavirus," he told the crowd in North Charleston.
"One of my people came up to me and said, 'Mr. President they tried to beat you on Russia, Russia, Russia. That didn't work out too well," Trump said. "They tried the impeachment hoax."
"This is their new hoax," he said, apparently referring to Democrats' criticism of the official coronavirus response.
Trump, who opened the rally by declaring the "fake news just doesn't get it," accused the press of being "in hysteria mode" in its coverage of the virus.
The plan was always to expand testing, but you need a working test kit first.
>Six public health labs in the US plan to start monitoring the general population for the new coronavirus this week. The Centers for Disease Control and Prevention (CDC) says that the risk of the virus still remains low for the general population. But activating the disease surveillance network will allow the CDC and other public health officials to find any undetected virus circulating through the country.
Edited to add that according to Pro Publica the problem stems from the CDC trying to get a little too fancy.
>The federal agency shunned the World Health Organization test guidelines used by other countries and set out to create a more complicated test of its own that could identify a range of similar viruses.
First, they made it needlessly complicated by trying to make it test for other SARS-like viruses, and those tests were flagging a large number of false positives.
Secondly, labs that are developing their own tests to mirror the CDC are being prohibited from using them due to onerous and absurd requirements like demonstrating their test wouldn’t falsely identify MERS as COVID-19, when MERS samples are nearly impossible to obtain.
I'm extremely concerned this isn't being treated with an appropriate level of hair on fire urgency. They said 2 weeks ago they were going to start expanded testing in 5 cities and they are still developing a testing procedure?
Or, the actions are to be given more weight that the words. That is, perhaps the response is actually appreciate.
Let's recap: The CDC has made a couple statements. The POTUS has down played things. On the other hand, the mainstream media has pinned the sensationalism meter.
Fact: It's been a fairly active "traditional" flu season. Plenty have gotten sick. Plenty have died. Coverage? Zero. Comparison between the flu and this corona virus? Again, zero.
There's disconnected and mixed messages, and plenty of misinformation. I'm not dismissing the threat. Just the same the signal to noise ratio is ridiculous.
Full disclosure: I carry a lot of contempt for the mainstream media. My level of trust, close to zero. The coverge of this issue does more to deepen my mistrust more than gain it. Based on discussions I've had with peers, I'm not alone.
There is no comparison between flu and Corona. Deaths of non-immune compromised flu sufferers in the US are tiny (1 in my state, NYS, this whole season).
Corona appears to be at least 100 times as deadly as the flu for non-immune compromised, probably more, and there are so many unknowns (eg repeat sufferers).
There is no universe in which "POTUS has down played things" is anywhere near a rational distillation of the behavior of this administration.
Take the glasses off. Put away the contempt. Use your brain. Don't be a fool.
One death for the common flu in all of NY this season? Nah. Not credible. NYC alone has more than one.
Is there a concern about corona? Possibly. Does the data and the media's depiction currently support the frenzy? No.
Fool? That funny because your data is wrong. I'm questioning you, you have no answers, and I'm the fool? That's not how it works here.
I'd like to call out the fact that the impediments to testing in the US were and are entirely bureaucratic in nature.
The CDC publicly published a real-time RT-PCR protocol (including primer and probe sequences) at the end of January. Since that time, it has been entirely possible (from a technical standpoint) for any properly equipped lab to perform tests.
By properly equipped, I mean BSL-2 with a real-time RT-PCR machine - this in not at all an uncommon setup. Other types of PCR machines would require making appropriate modifications to the protocol, but any lab that already does such work will posses the required expertise (seriously, this stuff is _trivial_ by academic standards).
Entirely separate from technical ability to perform an assay is legal status with regard to testing human samples for diagnostic purposes. To that end, the FDA failed to approve any vendor-specific test kits in a timely manner. This is frankly ludicrous under the circumstances, as South Korea managed to approve and make available at least two different test kits in the same time frame - they even have drive-thru testing stations set up!
The denominator for the ~1% mortality rate is obviously bigger than we realize -- which means the mortality rate is potentially a lot lower.
There are cases like this one popping up, where people are asymptomatic (and even test negative) and are not getting sick, despite being infected:
I saw a message at a dance studio in Monterey Park, which is like a Chinatown section of Los Angeles. The sign outside says that if you have been to China recently, please self quarantine yourself for 14 days before entering the dance studio.
I could definitely notice a difference in the approach they had. They are already worried about it and they are taking steps. I'm not really sure we're ready for this thing. But it's here. It sure seems that way anyway.
It is no longer only China at this moment, it is literally EVERYWHERE....
The doctor didn't have advice besides to ask the emergency room, who weren't going to send anything in unless I had a high fever and a recent trip to Hubei.
I'd hoped 3 more weeks was enough time for the US to get prepared, but it seems not. Am I carrier? Who knows.
The chance that people here in get the virus from travelers from Italy/Japan/South Korea/Middle East is MUCH higher than that from China at this very moment.
No such rule is present with S. Korea or Italy.
A random traveler from S. Korea/Italy is far "riskier" at this point.
(Bonus: It's actually really hard to fly directly from China to the US at this point. Your best bets (esp. in the north) are transit through S. Korea or Japan, both infected places)
Plus China recent donated 12,500 test kits to Japan 
Of course, you seems to dismiss anything from China's official account, then you can choose to believe whatever depends on you political stance.
I would be much more alert right now as regards to people from Europe/Middle East. Iran is a pretty powerful source of infections to the whole region and so far is just keep escalating.
BTW: in Iran's case, they banned entry from China early on, but one of the merchants gets to China via 3rd country and bring the virus back home.
Once Manhattan reports its first confirmed case, then it’s over. This thing will go full blown.
It's time to assume the brace position, prepare for the worst and hope for the best.
It is airborne. This virus attacks the lungs (please google). Why on earth are people saying wash your hands. It transfers through: "respiratory droplets produced when an infected person coughs or sneezes." Wash your hands sure, but this isn't going to save you --- watch what you BREATH.
This is in contrast to diseases like anthrax, where particles can be carried on air currents basically indefinitely and direct infection from the airborne disease is likely.
Nonetheless, I understand that it's aerosolised and this does carry further than just a sneeze to the face. So, worse than crooked-v says, but better than airborne.
Happy to be corrected though.
Ideally, enough serological tests could be produced that a public health authority could randomly sample a population and get an actual unbiased estimate of the infection rate.
Our doctor said she's seen a ton of flu lately.
EDIT: There's a point where engaging with nutjobs is mostly about the fun of it and warning others, whether it's the doomsday corona types or bizarre extreme deniers. You're part of the very rare latter group.
4 people died (so far) from the cruise ship, out of <700 infected (including asymptomatic), so statistically the case fatality rate can only be so low.
On the flip side, it's also fairly common to think the flu is just a cold virus or allergies because most people don't display much in the way of symptoms.
Odds are this is just some random virus (>90% chance), but I wouldn't be surprised if it was COVID-19 either (<10% chance).
Edit - I also have a cousin living in LA that developed pneumonia, which again could just be coincidental.
It seems to already be spreading in Bay Area with 2nd case of unknown origins..
Tight information control from Dear Leader's right hand man is how we know everything will be OK.
Private citizens and state/local officials can say anything they want - subject to HIPAA restrictions, which I suspect is what this thread is about.
From the Kaiser Principles of Responsibility:
“discuss patient information:
- only when it is required to do your job”
Random HN readers may not be able to identify this person, but one of their coworkers might. How would you feel if you went to the hospital with suspicious symptoms during the height of epidemic hysteria and one of the employees started posting tidbits about you on the Internet?
How many people might avoid going to the hospital with symptoms of this or something else because they don’t want to risk a gossiping employee outing then on the Internet?
Starting to get real for sure.
If anything, I wonder if one would prefer to get exposed earlier rather than later.
Of course, my wife works in a hospital in Santa Clara.
Sadly, the paper is in Chinese, but you would probably want to look at the percentage of non-mild cases in your age bracket and adjusted for your pre-existing condition risk to see how your actual risk might be modeled: http://rs.yiigle.com/yufabiao/1181998.htm
But I think we'll just have to see how the medical response is in each specific locality to really get a good idea of what the real risk is.
I don't necessarily think that a dollar amount is actually the best way to think about it. It's very hard to think about what value you'd place on avoiding a hypothetical 1/500 risk of death (adjust based on percentage of population you think will contract this). Note that as a 40yo, your odds of dying period within that year is actually about 1/500: https://www.finder.com/life-insurance/odds-of-dying
You can then split this up by percentages for cause of death: https://www.advisory.com/daily-briefing/2019/01/16/deaths (Chart 2, select your age category)
UK chart, but also some charts on annual death risk: http://www.bandolier.org.uk/booth/Risk/dyingage.html
And lastly, the almost useless CDC data/charts - they include leading causes and absolute number by cause and age-group, but not the population size so you have no idea what your odds are: https://www.cdc.gov/injury/wisqars/LeadingCauses.html
In any case, once you have the odds down, you can place the amount of effort you'd spend relative to the amount of effort you spend on other risks.
It's not that hard if you try. We face risk-benefit tradeoffs everyday. You either (1) have an implicit price you put on small risks to your own life in the sense that you accept risks below that price and reject ones above it, or (2) you are acting inconsistently, in the sense that you could strictly reduce risks to your life while making more money (or saving more time, etc.).
> Note that as a 40yo, your odds of dying period within that year is actually about 1/500:
Sure. And I think that if people could purchase immortality for their 40th year for $20k, they should probably do it.
> In any case, once you have the odds down, you can place the amount of effort you'd spend relative to the amount of effort you spend on other risks.
Sure, now just find out how much you pay routinely to avoid this effort (e.g., how much you pay your accountant to do your taxes), and you've got a risk-dollar exchange rate.
There's more to it, but the point I was trying to make is that the amount of time/effort/money you spend worrying about coronavirus should (rationally) be relative to what you spend for other similar risks.
For your last example, I think that what you pay to save time or effort saving services might be on a different calculus since there's a guarantee of how much time or bother it might save you, vs a potential downside calculation.
Sorry, are you just saying different people may have different amounts? Sure, sure. But for a given individual the amount has to be fixed across the choices (at least all the choices close enough in time that the money is fungible).
> since there's a guarantee of how much time or bother it might save you, vs a potential downside calculation.
When I decide to wear a mask to the store, there is a guarantee of how much bother it costs me. The only thing that's uncertain is the risk to my life. But, as previously argued, each person should have a linear risk-dollar exchange rate for small risks.
Lot's of useful data: Age is very significant: 0-9: 0%, ..., 60-69: 3.6%, 70-79: 8.0%, 80+: 14.8% i.e. the kids will be fine, but watch out for the elderly. Men are more affected (2.8%) than women (1.7%). The regional breakdown is apparently a useful approximation of mortality rates when the healthcare system is overwhelmed (Hubei 2.9%) vs not (outside 0.4%). "Health workers" (all employees in a hospital setting) is 0.3% which amongst all the occupational buckets is the lowest. 81% of cases is mild symptoms.
I don't think we know yet how easily a previously exposed person can get reinfected. We do know that people can catch a cold multiple times in a short period, and those are varieties of coronavirus. Mutation rate will also play a factor.
One of the biggest risks is running out of ICU beds, ventilators, ECMO machines due to the 10-15% hospitalization rate.
If it goes wide enough then there will not be treatment available and the mortality rate will skyrocket.
Here's an article from the WSJ about how using serum from recovered measles patients prevented an outbreak decades before the vaccine was developed.
Maybe you should question your marriage.
For example, once, say, Olympics roll around, is there really any value in canceling them if it’s going to be everywhere anyway?
Is containment even possible and, if not, is the disruption to the economy worth it?
Here’s a link to a great article.
Also, the virus is more likely to mutate the more hosts it infects.
Economy over lives probably isn’t going to fly..
Feel better soon
time will tell...
In most other countries, I think such speedy research funding, rapid construction and drastic measures would have been challenged in courts or would have been far slower passing through the long chains of approvals or simply delayed due to critics from political oppositions.
Of course, the US especially can’t complain about that now that they are actively suppressing news about the virus even after we know it’s a real virus and that it’s here.
It seems like the general conversation here on HN has been much more doom and gloom than some other places.
Anyone have opinions on why that is?
Possibly the higher than normal concentration of members here on the West Coast?
Maybe the general tendency of people with stronger opinions on a topic to comment on threads about that topic?
Obviously there's a chance the concerns raised here are of the proper severity and everyone else is just under-reacting, but it also seems entirely possible that this is already way more widely spread than people realize and the percentages are just skewed because most people wouldn't bother going to the doctor for a cold.
I guess we'll find out one way or another...
Because so many people are trying to conceal information to keep tourism going, stability, re-election, GDP and so on, we really don't know how bad it is.
But when's the last time a flu caused a 13% sell-off? It seems pretty serious.
After reading The Fifth Risk by Michael Lewis, I'm really starting to be convinced our collective willful ignorance is becoming problematic.
Seems like the majority of comments I've read are basically of the "go into quarantine lock down" variety.
The current sell-off is because people are scared of the uncertainty. It could turn into something more and get even worse, but we have to wait and see for that.
I don't know that it's so much "willful ignorance" as it is the perpetual feeling that we're "at the end of history." I.e. the opinion that bad things happened in the past and bad things can't happen now because we're beyond it.
Something catastrophic is absolutely going to happen world-wide eventually, but at this point I can't say one way or another whether this is it.
Right now we're at a point of probably peak uncertainty. We know enough to be nervous, but it isn't real until it's real.
Bloomberg Surveillance podcast is free and also availability through other platforms but here it is through Apple podcasts:
many people have pointed out that covid-19 threads gets burried alot quicker here on HN
> The infected patient is an older adult woman with chronic health conditions who was hospitalized for a respiratory illness, county officials said.
> This would be the 63rd confirmed case in the U.S. Of those, 44 were people who had been aboard the Diamond Princess cruise ship and repatriated to the U.S., three were repatriated from Wuhan, 12 were people who had recently traveled in China and two caught it from a close family member. This week's two cases in Solano and Santa Clara counties involved people with no known exposure risk.
The virus has a two week incubation period, during which the host is not infectious, but also has no symptoms, making tracking vectors difficult. In addition, after incubation there are a couple of days where the host is highly infectious, and still has no symptoms. The term for this period is "prodrome" (pre syndrome). Under certain circumstances, it's also airborne, which is can be a problem for providers. It's spreading fast because of these characteristics.
Similar to flu, it is expected that this virus will find enough hosts to essentially never stop circulating. Expect to see it again next year, and the year after, etc, in perpetuity.
Get your flu shots! You might prevent someone from getting very sick or dying, even if you don't see symptoms yourself.
This is new to me — I was under the impression that it could spread by droplets, but hadn’t heard anything definitive about being airborne?
It is not infectious during incubation, by definition. Then there is a "prodrome" period of a few days during which you would be infectious.
Missing a word there. Now I'm in suspense.
It seems like this was always an impossible goal. So does it even matter when this goes pandemic? Sure, more preparation would get us more masks or something, but anything that would really help?
The goal is to smooth out the cases over a longer period so we're less capacity limited. That means everyone taking extreme precaution with hygiene.
We have a "flu season" where hospitals are flooded every year. From what I read, there's not even a strong immunity after being infected with this virus, so won't people just get re-infected?
It doesn't seem like there's any version of this where things are not terrible for a while. I hope I'm wrong though.
If your re-infected comment is regarding the reports of people getting it a second time, I believe that's been debunked and is an artifact of imperfect tests rather than the virus itself.
What I've read from multiple sources is that SARS family coronaviruses are pretty stable evolutionarily, so once you have immunity you should be able to fight it off in the future. This is in contrast to influenza which evolves quickly, which is why 'the big one' in pandemics is much more likely to be influenza (or a bacteria) rather than coronaviruses. See also: Spanish Flu, Black Death
If you survive, are you immune?
People who are infected and then recover will likely show some immunity to the virus.
But it’s not lifelong. It wanes over time. If it’s seasonal, it may ebb and flow.