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Seattle-Area Patient With Coronavirus Dies (npr.org)
126 points by erentz 29 days ago | hide | past | web | favorite | 153 comments

Is it possible that the virus has been circulating in the states since Christmas or earlier?

I live in the states, though not in Seattle. My wife's best friend teaches ESL at a major university. She has several Chinese students in her class who went home over the semester break in December and January. In mid-to-late January, the teacher, her husband, my wife, and I all came down with the "flu" in swift succession, we all rode it out at home and none of us were tested to see if we actually had the flu virus. We just assumed flu because what else could it be? At that point, we'd never heard of novel corona virus.

The illness we all got was characterized by a deep and persistent cough and chest congestion, brutal sore throat, and a fever with teeth chattering chills and soaking sweats. We all had various levels of relapses of the cough and chest congestion (generally without fever) after the initial recovery.

I stayed home from work, of course, when I was ill, but a few people I had contact with at work also came down with something similar right after me. Many had had the flu shot since we get it for free at work. The general sentiment was that this years flu shot was a dud. I've been wondering if it wasn't actually flu going around.

The general sentiment was that this years flu shot was a dud.

The flu shot is a guess at which viruses will be most prevalent this year. A recent study I saw (sorry, I don't have a link) suggested that a single flu shot has little impact on your likelihood of getting the flu this year. If you regularly get flu shots, however, after 4 years, your immunity is significantly increased (I presume because you have be immunised against enough different viruses).

No comment on your situation, exactly; I just thought it was an interesting and relevant factoid.

Correct, I've been told by medical professionals that there are hundred(s) of strains but the flu shot only covers the handful of strains they expect to be prevalent for that flu season. I have been wondering how they come up with that prediction though...


Seems pretty straightforward. They look at which strains people have been testing positive for and how successful the previous vaccines were.

the challenge with influenza vaccines is that the virus can shift character faster than a vaccine can be produced so its a crap shoot of sorts for a good match.

This is why we need to perfect much more expedient vaccine production technology other than the attenuated virus method

The morbidity and mortality weekly report from a month or so back said that in intentional lab infections the influenza vaccine was only 45% effective in preventing infection this year.

One wonders if the flu metagenome is evolving to evade our primitive strain selection 'algorithm'

> We just assumed flu because what else could it be?

The by far most likely scenario? Not the flu, but any one of the numerous upper respiratory viruses (hundreds but likely rhinovirus) that cause the “common cold”

Notably absent from your description of symptoms is fast onset weakness and body aches. Colds can cause short high spiking fever though.

It was not a cold. Nor was a cold the most likely scenario. I've had plenty of colds.

I felt okay in the morning and was in bed shivering by dinner time. My wife reported body aches. They are not typical for me even with flu, but I was on ibuprofen almost the entire time anyway. I had a fever for four days, and felt unbearably horrible as soon as the ibuprofen would start to wear off.

There was nothing "rhino" about this virus. None of us had any nasal congestion.

If my wife hadn't started to feel somewhat better when she did, I would have taken her to the hospital for pneumonia. But it's lucky that she did start to feel better when she did because almost as soon as she was up I was down. Still, even through the next week or so when she was up and moving around again she said she never really felt like she was breathing quite right.

The cough was different than any cough I've had before. Since my nose and sinuses were clear, there was no drainage from my nose and sinuses into my chest. It was all originating in my chest.

Same thing with our family here in the Bay Area, although it happened in mid-February so we're still recovering in some degree or another. Everyone had flu tests across multiple days and all came back negative for both type A & B.

Doctors thought about a coronavirus, but since we didn't travel to or have direct contact with anyone who did travel to China, they knew the CDC wouldn't approve the test.

In January I also had similar symptoms (and I live in a community With probably 30% Chinese). They claimed it was probably influenza B, so perhaps you had that as well (or my docs were wrong)?

In either case, I have pneumonia to go with it and gotta day it was awful - 5 days of 105 fever, cough, I could hardly do anything.

For point of reference, the clinic where my wife works has been testing for coronavirus since January 25. There are many private institutions with the ability to test patients as they saw fit. I know the protocol was more focused on travel but it seems like there would have been more reports since then.

With that said, my family has indeed suffered from the same kind of persistent cough you describe, so I don't know what to make of that.

Do you know how many the clinic has tested since then? The ratio between the confirmed cases vs the test count seems about 3% in US, and the total tested number in US is 472 according to CDC.

I don't know but my wife helped out with a few tests, all negative. The number from the CDC seems low, maybe it's only the tests that were shipped to them?

FWIW our family got hit with the same thing. The cough was... different than anything we’ve experienced in recent memory. I assumed it was the flu (we stayed home and didn’t get tested, but it was pretty brutal.)

Yes. I have trouble describing how bad the cough and lung symptoms were. At one point I remember saying "my lungs itch" and wishing I could find a way to scratch them from the outside.

My wife fractured a rib from coughing just to give a sense of how bad it was.

I think it was also around December when me and a number of coworkers at the cafe I was working at got sick like this too. I don't know what they did, but I was out for a few days to recover and never went to see a doctor since I don't have any health insurance or provider. I recovered after about a week or so of rest.

I no longer work there and am looking for a new job now, but these are tough times. I couldn't have picked a worse time to be looking for work. I wonder how things are gonna go for people such as me who work in jobs that inherently need people at a physical location interacting with people. We can't just remote into work and make coffee for people.

This is certainly a situation that makes clearer the failings of our healthcare policy.

We might end up worse than China with so many not having access or being able to afford a doctor or hospital visit.

Almost certainly not. If it had been around for three months, with no control at all, it would be extremely obvious by now.

That's fair, I guess, unless there are many unreported mild cases where infections don't result in pneumonia.

Also, it's only been two months since christmas, not three, and many schools' winter breaks last into January, so maybe more like 1.75 months for it to spread from the hypothetical vector of returning Chinese students?

Sure, but just trace the exponential growth curve China started with two months ago, without the flattening out due to quarantine measures. If this were true, we would have more infections than China by now, people would have noticed.

In fact the first symptomatic case in Wuhan was identified on Dec 1, and by Jan 16 there were 41 cases of pneumonia identified. That is about the same span of time as between the end of winter break and today. And Wuhan is a dense city of 11 million while I live in a relatively sprawling American city of < 2 million with essentially nonexistent public transit, so transmission could be slower.

Alos, I don't know what typical air quality is like in Wuhan in the winter, but given what I've heard about Chinese cities, more severe impact of respiratory symptoms in China seems plausible too.

In any case, I agree that there's a fair amount of uncertainty, but a verdict of "certainly not" seems unwarranted.

We will know more when/if widespread serology testing ramps up. As I understand it, this tests for the presence of antibodies for the coronavirus and thus gives a snapshot of recent infections across the population.

Definitely. Imagine how long it took for news of the virus to bubble up the Chinese bureaucracy and how many people traveled during that time period.

My brother's wife is also an ESL teacher. She had multiple students who traveled home to Wuhan during the winter break. Shortly after school starting she came down with a cold, gave it to my brother, and he had a pretty bad cough for a month. He's just now getting over it.

Last winter in Cambridge, UK, both me and my wife went through something labelled the Queen's Cough. In theory, that was an adenovirus: apart from the brutal cough that got worse if you rested and layed down, it regularly resulted in inner ear inflammation.

We suffered from it for nearly a month, we had to take mild tranquilizers - valerian extract - to fall asleep, only to get up coughing for 10-20 mins non stop in tge middle of the night.

There are loads of nasty chest infections out there.

> the Queen's Cough

I wonder if that name is derived from "the King's Evil".

The King's Evil was scrofula, which is basically infected/inflamed lymph nodes cause by tuberculosis.

Yes, obviously.

Considering how contagious it seems to be, I think if it had been circulating in the U.S. for months under the guise of flu, there would have been a mysterious number of deaths of young, healthy people from flu that would have been recognized in hindsight as Covid-19.

Mortality in people under 40 for Covid-19 is only 0.2% according to the CCDC study:


We’d be seeing a number of deaths in older people who would have otherwise been fine

The mortality estimates we have now are mostly based on numbers coming out of China, which are just not reliable.

We should have better estimates in a couple of months, once more numbers come out of countries outside of China.

Also, mortality rates are impacted not just by the disease itself but things such as how overwhelmed the health care system is, what measures are used to treat the disease, how many people actually get treated, population-specific or location-specific factors, etc.

All of these factors could vary widely from place to place and cause different mortality rates, even if the virus infecting everyone is the same.

In either demographic the mortality is so much higher than the flu that it would be noticed. Otherwise we wouldn’t be worried; it would be like just another strain of the flu.

To be fair, even if this new virus was equally deadly as the flu, it would be concerning. We don't have a "tamiflu" to treat it, it's more contagious than the flu, and could therefore overwhelm our health care systems.

It's not clear that we would recognize it in hindsight. Flu seasons vary heavily in magnitude, and a large majority of flu tests come back negative in any season.

A ton of people at work were sick this December without contact with Chinese students. I would guess it wasn't covid-19 but whatever regular virus was making the rounds.

Interesting thought, there was something that was going around, very contagious that everyone got

Amazon recently announced that all non essential work travel is cancelled. Friend who works there said they are taking it very seriously - any "essential" travel must be approved from the highest levels.

They also announced that interviews will be conducted via VC going forward during the outbreak.

I wonder if they 'shut down' campus and encourage everybody to work from home after this, self quarantine kind of thing.

IMO it's the right thing to do. Not all sectors can have all of their workers stay home, but Amazon employees (in Seattle, fulfillment centers are a totally different thing) can easily work from home in almost all cases.

I wonder if this “temporary alteration” will impact the way business is conducted long-term. Instead of choosing between conference calls or flights, choose VC.

As someone who doesn't have to do business travel very often, I enjoy the trips to go meet with long-lost colleagues. But at the same time, it's pretty clear at least to me that most of these things are a waste of company money and don't really move the ball forward much compared to typical electronic collaboration. Selfishly, I'd be sad if business travel suffered a large permanent reduction. But it would be better for the business and the environment if it did, even ignoring the risk of propagating diseases.

I just got done planning a 20 person meeting in Germany for July. It will cost almost $5k USD per participant for travel, lodging, and food.

We were only half joking when we said the company could FedEx us each a top of the line video conference setup, and then throw it in the trash afterwards, and it would still be cheaper.

$5k per person? Are these business class seats? this can certainly be done for cheaper.

Nope. Just premium economy seats. Summer flights from US to Germany with no weekend stay are really expensive.

An interesting side effect if it does lead to long-term change is the airlines. Currently ticket prices are kept low by expensive business class tickets and late purchased business travelers. If either of those sees a >10% drop, some major disruptions are going to hit the aviation companies and ticket prices.

I have to ask—since you admit to causing environmental harm with your admittedly unessisary travels—how do you morally accept the damage your selfish actions are causing? I’m genially asking, and not trying to be judgmental.

The company I work for uses high quality carbon offsets to reach carbon neutrality for all business activities, including business travel by employees. Of course, this isn't scalable, so it doesn't really absolve me. But the travel I do is also not really optional. I just personally don't think it's necessary or helpful. Doesn't mean I don't have to do it when I'm called upon to do so.

The other thing I do is live a fairly carbon efficient lifestyle. I travel much less than other folks in my income bracket, and I live in the most carbon efficient city in the U.S. I take mass transit to work and don't own a car. There is of course more that I could do, but if I zero out my usage it will make precisely no difference to the outcome. So I also vote with my dollars and my actual votes for political candidates who will push in the right direction on this issue.

But more than anything, I think if I'm honest, I don't justify it. I just do it. These scales cannot be balanced -- the human mind cannot encompass actions whose harms are so incrementally minor and diffuse, but corporately so major and severe. Our social heuristic engine is not equipped to process it, and mine isn't an exception.

Thank you for an honest and good answer

Generally speaking, people almost always find some way to justify their actions to themselves, if they even think about what they do in ethical terms at all.

They justify it by convincing themselves their actions are necessary to feed their families, or they think what they do isn't as bad as what someone else does, or everyone else is doing it, or they'll compromise for now but do better later, or they just don't care about most others and are looking out for themselves, their friends and family.

Given the impact airline travel has on global warming I hope it results in fewer companies using air travel in place of video conferencing.

These comments are being voted down. But I think it warrants some justification. These actions are just and rational, however in the wake of the climate emergency they are just as just and rational. I do believe governments and companies should answer for why they haven’t taken them before, and if they revert after this outbreak is over, they should have to answer for why.

Whether they want to or not, they are now being forced into running a large scale experiment of only conducting interviews over VC. Should at least yield some interesting data.

I personally hate doing VC interviewing. It's already hard enough to make a decision from an hour long in person meeting, but VC complicates that more.

Having ubiquitous, reliable access to good VC doesn't eliminate the need to travel. Humans communicate so much better face to face.

Source: I work in Google, spending up to half of my working time in VC. Still need to hop in a plane when something is important enough.

Exactly. We’ve had long-distance telephone for a long time, and it actually works much better than the audio of most internet teleconferencing I’ve experienced. It’s not a complete substitute for face to face communication.

> Humans communicate so much better face to face.

No, they don't. They communicate more, but not better.

It depends.

I find that the lack of massive volume of communication that is face-to-face can be beneficial, but often it needs to be more structured. Without this structure, non-FtF communication is just FtF without the nuances.

how many GVCs do you have where people are connecting from their desk or rooms on different floors of the same building? It happens a lot. Can’t be that bad.

It's not that it's impossible to communicate through GVC, but most people interact very differently with those they only know through a screen vs. those they've met in person.

Hopefully it encourages innovation in the space. 17 years after Skype came out we'd still all rather prefer to be in the same physical room than a laggy, compressed, low quality virtual call.

To be fair, video quality is usually great in developed regions where ISP's do not intentionally slow down internet speed via bandwidth throttling.

Maybe I just haven't been exposed to it, but in my opinion I have pretty good speeds (100 down / 50 up) and still experience stuttering on both ends. I've tried enterprise solutions (like WebEx) at a Fortune 50 with a >1Tbps fiber connection and still encountered problems. I think the problem is just that...video conferencing is a hard problem, and there is more innovation that needs to be done until we can feel comfortable replacing physical interactions with it.

One exciting prospect is the advent of AR/VR, where instead of streaming 30 1080x720 frames a second, we can stream 60 virtual character positions a second (a la multiplayer FPSs like CS:GO) that operate as stand ins for real bodies / faces. I think games such as VRChat will have a real impact on the enterprise teleconferencing space once the proper market is targeted: replace the childish characters with more "indifferent" avatars, add in some "business casual" background environments, etc.

This pandemic will likely play out over a months to years timescale, so it very well might alter patterns like this.

I heard this, too, and I wonder if any companies will extend this travel ban to local transit. I work in Seattle, and I ride a ferry and a bus to get to the office. The Seattle ferry, especially at rush hour is a crowded and not-incredibly-santiary experience, as are the city busses. How long before MSFT/GOOG/AMZN/etc. are asking people not to ride the ferries? Or busses?

> Amazon recently announced that all non essential work travel is cancelled. Friend who works there said they are taking it very seriously - any "essential" travel must be approved from the highest levels.

Same at Toyota. At least for international travel.

The company I work for has canceled travel to "affected regions" period -- no exceptions for "essential" travel. But it hasn't cancelled business travel elsewhere (e.g. the US, Canada, South America) . . . yet. I can only imagine in a week or two that will be the next step.

Same at the Megacorp I work at and a lot of other places. I’m in the South and my closing is doing it globally with a 14 day self-quarantine if you went to China, South Korea, and Italy.

Same here. All travel must be approved by the CEO

As we are several decades into an equally serious—or perhaps a far greater—catastrophe with globally rising temperatures—in part to blame by human activities that are now hindered because of this new immediate emergency.

I love that it took a global virus outbreak for these companies to take these actions that they should have taken long since in an effort against the climate disaster.

I don't know where to begin with this opinion and commentary so I'll just say how I feel.

Finding solace of potential human loss of life through a lens of reduced carbon footprint is tonedeaf to those who have lost loved ones to this disaster, and furthermore alienates an enriching dialogue between climate deniers by providing a scapegoat to keep heads in sand.

"Look at those climate cry babies, celebrating loss of life"

The numbers don’t really add up though since the climate disaster is causing few orders of magnitude more deaths then the corona virus outbreak.

I find it great that companies and governments are taking actions to reduce harm (like I said, I love it), but these actions should have been taken long ago to prevent a far greater harm being caused by another disaster.

First posted this on another article before seeing this one.

Not much information in this article, but given they only just reported new cases that makes me wonder if this person didn’t come to a hospital until they were in severe condition - probably because they had no idea it was coronavirus and were thinking “it’s the flu, it’ll pass.” If so it likely means many more cases in the community than we currently know about.

The fact that symptoms are mild in the vast majority of cases and there have now been a couple severe cases positively identified basically guarantees that we have widespread community transmission at this point.

Even among people with health insurance, the costs of visits combined with the likelihood of being told "it's viral, just wait it out" mean that many people simply won't bother with going to get a diagnosis from a doctor.

And it's not even just disincentives, right? If I feel bad but not deathly ill, I don't want to go to the doctor in the first place; I want to lie in bed, where I have Youtube and crackers and there's nobody around to infect.

Surely there are a number of people with severe pneumonia all over the US right now. Maybe they just started testing them for coronavirus.

That's correct - until very recently, severe pneumonia with no known link to coronavirus cases didn't meet the testing criteria.

a lot of people will walk about with pneumonia [of various origins] and its no big deal to them until they just suddenly pass out or cant walk 2 steps without taking a knee

Personally, I believe most people should just accept that they are going to get COVID-19. It's going to get spread around, and it's not containable. You're likely going to get it. That's the bad news, but the good news is that we have immune systems and we know how to take care of each other and ourselves. Yes it's going to kill some people, no it is highly probably not going to kill you. People will be sick and going on with their lives and doing their jobs.

It feels like we're teetering on the verge of hysteria, but a little acceptance about the situation would go a long way.

There are steps that can be taken now at the community and country level that will drastically lessen the impact of the virus. That is to heavily promote social distancing.

Social distancing will flatten the epidemic curve, which means that hospitals will be less likely to be overwhelmed. It will cause economic pain so it will be anything but easy. Mitigating that economic pain would be an absolutely good use of government stimulus.

So let’s say there is no political will to be proactive with social distancing. Then we enter reactive mode - schools And offices close when a cluster is detected. Perhaps a larger scale quarantine must be enacted by the government (aka martial law). The economic pain is worse, and the end result is more deaths and an overwhelmed hospital system. Plus Wuhan style images of hospitals in major Anerican cities flooding the media.

This misses all the secondary effects an uncontained global pandemic would have, which would be wide-ranging. A sudden and prolonged 10% drop in global productivity could be a nightmare scenario.

Having said that, I'm not panicking either, and I think it's still too early to assume it's going to be fully uncontained -- hell, once the weather starts warming it could all change dramatically. (But then again, I have the advantage of living in a first-world developed nation with strong health care; the massive numbers of people living in 2nd- and 3rd-world countries have a lot more reason to be concerned I think.) But the concerns here go well beyond the simple individual experience of contracting the illness.

The secondary effects could go far beyond productivity losses.

If the health care system gets overwhelmed as we've seen in China (and as it already nearly does in the US every year due to seasonal flu), then even those 15%-20% (according to current estimates) with severe symptoms that could have been saved had the health care system not been overwhelmed are likely to die.

Also, people with other life threatening illnesses that could have been kept alive may die when the health care system gets overwhelmed.

Here[1] is a recent post from a doctor expressing his concerns:

"The hospital beds are most of the time at full capacity. Usually I had to send on Friday 30% of my patients home to make place for the new ones that were coming over the weekend, and this without any major epidemic. The reserves of protective gear are low. A lot of doctors and nurses don’t want to work in these conditions and most probably won’t show up at work anymore after they see how many people are going to die ( especially if young ones are also gonna start dying left and right ). We don’t have enough personnel. We don’t have enough beds. We don’t have enough machines. I expect that the CFR will be around 10%."

[1] - https://old.reddit.com/r/Coronavirus/comments/fbbr3b/r0_betw...

I think the experiences of places like Singapore and Vietnam indicate containment is possible and we shouldn't give up yet. I wish the US would do more testing and quarantine those who have it. (Singapore has gone down from 56 active cases to 32, Vietnam from 16 to zero in spite of being a major travel hub for China and next to China respectively).

I agree about avoiding hysteria, but IF "most" people got the virus...

Let's take "most" people to be 50% of the population. The Seattle Metro area had ~3.9 million people in 2017. The virus death rate is currently estimated at 2%.

So just accepting that 3.9m * 0.5 * 0.02 = 39,000 people will die in the the Seattle area alone seems a bit extreme

Saying that the death rate is 2% is extremely dishonest since it ignores one of the most important factors: age. For most people reading this you're off by an entire decimal.

That's only "dishonest" if your only concern is to estimate your own probability of dying and you are a young person. However, if you're trying to estimate the proportion of (confirmed) infected people that will die, it's a pretty good guess.

There are 86k confirmed cases globally. That’s 0.001%

Why would you think most people will get it?

The number of cases per day outside of China is still growing exponentially:


Until that changes it’s a fair assumption that a lot more people will get it

If you look at the log graph on that link it’s clear it won’t get 50000x more severe unless the course drastically changes.

Looks like doubling every 5-6 days. So a million cases in 35-40 days if trend continues?

“The train appears to be over a mile away from where I’m standing. Why would you think it would hit me?”

Because it's spreading exponentially and its incubation period is up to 1 month. You should watch the CDC press conference given a few days ago[0]. Officials are not talking in terms of "if", they're talking in terms of "when."

0. https://www.youtube.com/watch?v=KNV8HYI126U

One person has died in the US. It's not time to panic. I expected more logical comments here.

The concern is people have not been taking this seriously for the past two months. This has resulted in the US being on the back foot and only acting in a reactive manner. The CDC has fallen flat on its face and now state public health departments need to try to pick up the slack. I hope they do.

Other countries are already trying to slow down spread via cancellation of events and closures of schools. The same needs to happen here so that our hospital system has a chance to cope. The real danger is what happens when the 19% of people who get infected that require some level of hospital care can’t get it. The death rates will then rise considerably. Those are preventable deaths if we slow this down.

There needs to be clear and fact based communication from authorities every day about the current situation and what the public can do to play their part. People panic when information is hidden from them, they aren’t stupid they will see what’s going on. They need to know that all the correct things are being done.

> The concern is people have not been taking this seriously for the past two months. This has resulted in the US being on the back foot and only acting in a reactive manner. The CDC has fallen flat on its face and now state public health departments need to try to pick up the slack. I hope they do.

Oh please. There's likely absolutely nothing the CDC could have done to prevent it from entering and spreading within the US, given the nature of the virus. What would have been an ideal situation in your mind, have the CDC order a complete halt to domestic/international travel early January?

Over the last 3 years the CDC funding for participation in international epidemic detection and management programs was cut by 80%. In addition the several most senior positions responsible for pandemic preparation and response were cut. The budget proposed just a few weeks ago again included significant cuts in CDC funding, so the governments eye has not been on the ball for quite some time.

Having said that you’re right that the CDC and health systems in general have mainly and advisory and coordination, rather than a direct role in preventing the spread of a disease. However they need to have the funding, focus and senior representation in order to do that quickly and effectively.

What differences in behaviour would you have expected to see in the CDC if their budget wasn't cut? I'm not seeing it. This thing spreads too fast to meaningfully stop it, China, Korea, Singapore, Japan, are all examples of this

Understanding the disease quickly and slowing down the spread of the disease is incredibly valuable work. Knowing more about it lets us prepare more effectively. If we can reduce the rate at which it spreads, that gives us more the time to prepare for it by training staff and building up stockpiles. Also even if the number of cases ultimately stays the same, if they are spread out over a longer period that means the number of patients needing care at any one time can be dramatically lower, reducing the strain on the health care system and allowing more resources to be devoted to the care of each patient.

The CDC, or some agency in each country anyway, has four roles in this I think.

The first is as part of international monitoring, research and co-ordination efforts. Pandemics are by definition international phenomena and the countries they are most likely to start in are the ones with weak governments or health care infrastructure. This is the first line of defence.

The second line of defence is advice and information, supporting other government institutions and agencies in co-ordinating their resources. Medical expertise is needed to support border control, diplomatic efforts, internal transit networks, government policy, law enforcement, logistics, the list is endless. These all have a role to play in limiting the transmission of the disease and preparing for the eventuality that is reaches populations. They all need expert advice and that advice needs to be prepared in advance and consistent.

Thirdly if the disease does take a grip, co-ordinating local and regional medical resources and efforts. Collecting data from health care networks to track the disease and direct resources where they are needed most, and ensure those resources are used in the most effective and efficient way possible.

Finally, research. This is a long term commitment to developing new equipment, treatments and techniques. This, and all the previous functions operate at the national or even really international level and can't effectively be progressed by fragmented regional or local health care systems. If it's not the CDC it needs to be somebody.

Care to explain what "on the ball" would realistically look like for this specific situation we are in right now? Because everyone else seems to be avoiding the question.

If you're genuinely interested go read how other countries such as Singapore have been handling it. For example Singapore has done a thorough job of testing, tracing, and quarantining individuals and it's slowed the spread dramatically there. They've also been communicating opening and honestly with the public so that the public knows what is happening, knows the right things are being done, and knows what their role is to play.

The CDC used to have a unit in China coordinating with local health care experts to identify and manage epidemics and new diseases. This was cut a few years ago.

Also there used to be a CDC expert on the National Security Council until 2018. Of course you can bring in an advisor as needed, but that’s not the same as having someone you know, and that knows you and how you work, and knows the resources and capabilities you have right there on staff in the NSC.

On the ball would be treating the CDC and pandemic response as national defence, not charity welfare.

"There's likely absolutely nothing the CDC could have done to prevent it from entering and spreading within the US"

The point isn't to prevent it from entering and spreading within the US, but to slow down its spread to give the medical community more time to study it and develop treatments and vaccines, and for the US health care system to prepare by increasing capacity, equipment, training, and staffing.

Sadly, little preparation has been happening because people haven't been taking it seriously, and have been squandering the advanced warnings we've gotten from China.

Something else to consider is that a slowly spreading disease is much easier to manage than a fast-spreading, uncontrolled outbreak. The latter leads to an overwhelmed health care system and many more unnecessary deaths.

In developed countries that have done lots of testing the ratio of infections to deaths is about 50 or 100 to 1. This death implies that there are a lot of undetected infections.

When is it time to start freaking out? I have a friend who may be starting to unhinge a little bit. Whereas I have some sort of stoic “this is completely out of my control and will happen or it won’t” response that is probably not that much more rational.

It’s never time to freak out. That leads to poor decisions. It is time to take this seriously. Beyond personal hygiene, plan on how you’ll deal with school closures if you’re a parent (and ensure your school has a remote study curriculum in place.) Consider if you get it, it could be fairly benign — so you want to think about your role in reducing the spread to more vulnerable populations. WFH if possible.

Preparedness begins in the household, to the community, to the state. We should all do what we can to spread the impact of this and prevent a strain on resources.

When is the point at which freaking out will help?

I think the “truth” is likely somewhere in the middle: Be cautious and take precautions like washing your hands, avoiding huge crowds, and having some extra supplies on hand, but don’t panic. It’s not completely out of our control but completely freaking out and melting down won’t help anything.

Never. However the time to take it seriously as something that has already transmitted throughout communities in the US, has passed, and you should do that starting now.

If you're healthy and under the age of 50, the most you need to be doing is stocking up on two weeks of shelf-stable food for riding it out.

No one should be freaking out but we should all be preparing by stocking up on essentials to stay home as much as possible for a month or two.

If you are under 60 years old, the lethality of Covid19 is only 2-3x that of the regular flu. Why are people spreading these types of news and commenting on them like it's the end of days? We may yet see a severe pandemic in our time but I don't see anything indicating this would be it, especially not since lethality goes down with spread. The biggest concern so far people should have regarding this virus is what it's going to do to your portfolio seeing as the supply chain of half the companies in the world seems to be disrupted in the coming months.

> If you are under 60 years old, the lethality of Covid19 is only 2-3x that of the regular flu.

That does not pass the smell test. According to the CDC, in the 2017-2018 flu season, there were an estimated people 14.4 million cases of the flu for people 18-49 years old, of which 2,803 died. That's a fatality rate of 0.02%.

The latest fatality rates coming out China show a 0.2% to 0.4% CFR for that age group. Which is 10-20x higher.

It seems like you reached the 2-3x lethality factor by comparing against the flu's overall CFR of 0.1%, which includes a lot of elderly people.

[1] https://www.cdc.gov/flu/about/burden/2017-2018.htm

[2] https://www.worldometers.info/coronavirus/coronavirus-age-se...

I think you're correct, so I apologize.

many people have beloved family members who are older than 60. even if you are young, the symptomatic infection can be very severe and disabling for a week or two. it's also extremely contagious.

> especially not since lethality goes down with spread

there is no guarantee of this

How is any of this different from seasonal flu? It's also potentially lethal for the older population and can also knock you out for a week or two. I'm not disputing that flu viruses are bad, I'm just pointing out that the mass hysteria that seems to be brewing is not based in facts.

Well, even if it's only as bad as the flu, what we're talking about is "remember that thing that kills hundreds of thousands every year? We're now going to double that number for the foreseeable future". Unless of course we manage to stop it from spreading further (which seems unlikely at this point but possibly worth trying anyway.)

it's much, much deadlier and more contagious than the flu, there is hardly any research into treatment, no vaccine and no herd immunity. if this gets into serious exponential takeoff, which seems increasingly likely, we're talking about potentially millions of deaths. even if you're at low risk of death, you probably know a few people that aren't.

Because the flu is simply much less lethal than this.

I don't know how you can rationalize "this was so bad that China cut off half the supply chains in the world" with "its just a flu bruh"

Except, for people who are older or have health problems, who might also read HN you mean ?

I have chronic Bronchitis and Asthma and am on biological drugs witch lower my immune system.

Had pneumonia last year, wasn't fun.

Somehow my portfolio is not high on my list of concerns.

I sympathize with your health concerns, but all things considered it's not much more of a threat than (unfortunately) seasonal flue is every year. And your point is exactly what I'm saying, in terms of health profile you are an outlier, but the hysteria visible online makes a reader think that this pandemic is somehow going to wipe out a majority of humanity.

According to Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases (NIAID), 15-20% of people infected require hospitalization. If this becomes widespread, it will overwhelm the US healthcare system. If that happens, anyone who needs urgent care for any reason, has fewer resources available to help them.

We have no idea what's happening[1] so maybe paranoia is a reasonable default?

[1] https://www.nytimes.com/2020/02/27/us/politics/us-coronaviru...

Meta point but when NYT introduced their paywall they said access would be free during emergencies. Certainly this qualifies.

For others confused like me, this isn't one of the cases reported last Friday that were reported as 'doing well.' Seems this is part of a collection of new cases that weren't reported to the public (and still aren't).

The article leaves more questions than it answers:

> A person in Washington state infected with coronavirus has died, according to the Seattle and King County Department of Health.

Was this one of the reported cases on Friday, or yet another new one?

Unfortunately, I suspect we've already moved past the point of worrying about individual cases.

It was not one of the reported cases on Friday, the person that died was a 19 year old male.

Hmm, the president just said that it was a 50 year old woman that died. But the Seattle Times stated that that woman was at home resting comfortably. We'll probably know more after the 1 pm press conference by King County health officials.

I think I’m going to start working from home.

It’s way past time for that. Meaning I agree with you.


Trump just said in his press conference that the deceased was almost 60 years old.

I'm not going to stop saying this. This looks very dangerous and we should take very precaution possible to slow transmission. All nonessential travel should be avoided, don't touch your face, wash your hands. Slowing this virus down makes everything so much better.

[1] Estimate that the case to fatality ratio is between 5-8%. The transmission rate is between 2 and 3. Both of these numbers are similar to the earlier SARS outbreak in the early 2000s.

[2] The death rate in Wuhan is significantly higher than that outside. We want to buy time so our healthcare facilities can handle the volume of patients.

Take precautions everyone! This may not seriously affect you but you can help prevent the spread to people you love.

[1] https://www.mdpi.com/2077-0383/9/2/523

[2] https://www.medrxiv.org/content/10.1101/2020.02.17.20023630v...

[1] Estimate that the case to fatality ratio is between 5-8%. The transmission rate is between 2 and 3. Both of these numbers are similar to the earlier SARS outbreak in the early 2000s.

That's 2-3 times higher than most estimates that I've seen.

> This looks very dangerous, fatality ratio is between 5-8%.

We're better than this at HN. There are stats on the mortality rates, and given you are younger than 50 there is a less than 0.4% mortality rate.

Furthermore, recent autopsies have shown this is a virus that hits the lungs more than anything else. China with it's incredible pollution, might have skewed mortality rates that are higher than we may expect in Europe/US.

Yes, we should do all we can to prevent the spread. The biggest risk is health facilities not being able to handle the amount of patients. This is very contagious. So please don't spread panic, more people going to the ICU without case doesn't help

> given you are younger than 50 there is a less than 0.4% mortality rate

Please let's stop making assumptions about who is over/under 50 and implications about how un/important their lives are. This has come up too often already, and it's leading to flamewars.

0.4% is number of deaths / number of cases. Problem is that not all cases have recovered and there will be more deaths among them.

But yes, main takeaways, don't panic, slow down spread as much as possible (aka wash your hands)

Presumably there are also many cases that are mild and will never be tested or reported.

The fact that only a few deaths occurred on the cruise ship is pretty reassuring. Practically everyone on board would have been older and thus more at risk, yet there were only four deaths out of 600+ cases, IIRC.

> We're better than this at HN. There are stats on the mortality rates, and given you are younger than 50 there is a less than 0.4% mortality rate.

Generally speaking, people younger than 50 probably know someone older than 50 and might even be in daily contact with them. You know, parents, grandparents, uncles and all that. I'm not afraid of dying from the coronavirus, I'm afraid of being an infection vector for someone else higher at risk.

> more people going to the ICU without case doesn't help

In a sane healthcare system, this would actually help. Because ideally, we'd have cheap, easily accessible tests for the coronavirus and people could get tested in a safe environment without fear of spreading or catching it.

But alas, it seems we're more comfortable with turning away potential coronavirus patients and letting them spread it on their own. Especially because people don't have the option to self-quarantine.

Oh so we don't care about anyone over the age of 50 now? Almost no one reading this thread is going to be in the patient populations that are going to die. I'm here to say this is going to kill the people you love, who are elderly. Also, smoking looks like it exacerbates the problems but the worst factor is age and immunosuppression; 1-2% of the US is immunosuppressed at any time.

I'm advocating that you take precautions by not touching your face, washing your hands, and avoiding public places. Stocking up on food so you can avoid the grocery store later is a great idea. Avoiding people when you don't feel well and self quarantining are also great ideas.

HN has plenty of readers over 50. Age diversity, from high school students to people who post about their programming jobs in the 1960s, is one of the best things about HN.

I get that you feel strongly about coronavirus and are trying to be helpful, but these comments are starting to become repetitive, so if you'd pull back a bit, we'd be grateful. Repetition is the enemy of curiosity, which this site exists for.

I understand, I appreciate your feedback :)


Why are you asking?

There has been speculation I've overheard that the virus is particularly deadly to Asian people.

Seems like a bogus theory to me, but I suspect that was the reason for the question.

Largely plays into the "escaped bioweapon" theory.

This is a great example of how misinformation spreads.

All of the speculation comes from a single non peer reviewed paper, which had literally one data point. That paper was posted to a preprint server where scientists could comment on it. And the first comment was somebody doing a quick followup study with 100x more data, which found no significant difference.

Source: https://www.biorxiv.org/content/10.1101/2020.01.26.919985v1

What you're saying isn't entirely untrue, but there has also been at least one other paper from about 10 years ago floating around which, following SARS, looked at genetic markers for ACE2 receptors and found that they are significantly overrepresented in Han Chinese and Japanese genes. So there is still some credibility to the speculation.

this preprint needs a pass with occams chainsaw to get rid of some loaded terms that verbally modify the data

there is a basis for the recombinant selection of specificity to histocompatability type [in simple terms that can mean race]

I have a gut feeling it would be impossible to contain or manage the media if this virus or any other pathogen was killing only those of asian heritage so we would know if it actually was happening.

There is no indication any one particular ethnic group is hit harder at this time as there is no adequate comparison between the asian and other than asian people

Are we forbidden to even ask this?

this is one of the problems with research or any sort of policy. we all have different physical properties but we all have a human consciousness in common.

So some people may have different constituative expression of particular properties such as a cellular receptor protien [eg ACE2] and this information could be used to predict the degree of deleterious effect a virus may have for any one person.

with that being said, there is no need to suspect this is a bioweapon, as a serial passaging of mutable pathogens will begin to create a selective effect [naturally of its own ].

ordinarily communicability is the direction of drift as lethality or debilitating morbidity inhibits communicability [in the simplest scenario]

a bioweapon cant be quite so communicable to everyone that has ACE2 receptors as it must be strategically controlled so its lethel effect will only go so far.

I’m afraid you’re responding to the wrong comment. I do not suspect a bioweapon and agree with your points. I was just angry that people assume racists intent when asking simple question as this.

Yeah this weekend is going a whirlwind, let's see what the President Trumps remarks are today.

“Pence tells me no new cases or deaths, so it’s a hoax”

We need to shut down mass transit (trains, planes) and shut down group events including elementary school (which is almost like a bioweapon in terms of its ability to exchange viruses).

Honestly, we should probably all start working remotely as well until this is better understood.

We need to slow the transmission of the virus.

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