> "If we had the ability to test earlier, I'm sure we would have identified patients earlier," he [a Washington State health official] said.
This is a pattern playing out with striking regularity:
1. Local authorities can't test for themselves.
2. CDC adjudicates testing requests, rejects many (most) of them.
3. People likely infected with COVID-19 are sent back home, to infect others.
Consider this case, posted to HN today:
This pattern of apparently deliberate suppression of information can only fan the flames of what looks like a rapidly escalating problem.
Isn't this exactly how the situation got so bad in Wuhan in the first place? Authorities not releasing information and preparing fast enough because it can make them look bad. China was able to limit the spread somewhat because they took the drastic step of cordoning off Hubei, shutting down all travel. If there was a big outbreak in WA, do you think the US, as a democracy, could shutdown all airports, roads and rail at the state border?
This is why the WA governor called a state of emergency. With that action, the state level government gains some pretty un-Democratic powers, such as mobilizing the National Guard for martial actions. I think that it would take them a while, and not be perfect, but eventually they could shut down most external transportation.
There's an alternative explanation: that the CDC massively dropped the ball on making enough test kits available.
The CDC comes off looking pretty bad regardless of whether it's deceit or incompetence, but they're pretty different things.
Hanlon's Razor (https://en.wikipedia.org/wiki/Hanlon%27s_razor) would tell us which to prefer, although it's not always right.
You know how, when you really need to something accomplished without delay, you pursue two paths in parallel, so that by the time phase 1 comes to a close, you've got things ready for phase 2? Well, maybe the CDC doesn't.
Obviously they do on some level because they did develop kits (which had problems, which delayed them). But it's one thing to give lip service to getting started on stuff you're going to need in the near future, and it's another thing to commit to it and follow through with it and make sure it happens.
Also, I'm sure they were super busy and had other priorities, but lack of testing means the country is flying blind, so this should have made the short list of priorities.
Either way, the CDC has been intentionally handicapped by the Trump administration who specifically and intentionally reduced their ability to respond to crises like this one.
I certainly do not blame the CDC for their issues this time around, they are generally an incredible organization employing truly top minds and very high tech. If there is blame to go around here, it is with those who think that science is fake and that no money needs to be spent on community healthcare or prevention.
- Patient 0 falls ill on December 1, 2019.
- Patient 1 falls ill on December 8.
- 8 total cases by December 18.
- 45 cases by January 16, 2020.
- 121 cases by January 18.
- 1,287 cases by January 24.
- 11,791 cases by January 31.
- 24,324 cases by February 4.
- 44,653 cases by February 11.
- 70,548 cases by February 16.
- 79,251 cases by today.
Right now, South Korea and Italy are basically where China was in late January and the US and most of the rest of the world reporting their first infections are where China was in mid January. The next few weeks are not going to be pleasant.
It's important to note that the Hubei lockdown started on January 23, and China is only recently seeing new cases plateau as a result. It's hard to imagine what the stats would be had they not taken such aggressive action to contain the spread, but we may find out given that the US, Europe, and most of the rest of the world seems to be taking a wait and see approach as opposed to prompt action.
And the most of the accumulated cases are from Hubei. I agree the quarantine seems to be effective.
I really, really hope I’m just going insane and nothing will happen.
>80% of cases are mild symptoms. A mild cold. Under 50 has a fatality rate of less than 0.5%. Almost all fatalities are over 70 or people who are already severely ill. You are about 25x more likely to die of the seasonal flu at this point.
This is media hysteria in a post fact world where all information from all sources is equally valid. Everyone is trying to be heard to make their case.
If you are 70+ or severely ill this IS pretty bad because, unlike the flu, their is literally no defense. If you don’t fit that profile it’s just a bunch of FUD.
You don’t self isolate for yourself, you do it for all the people you can spread it to.
The 34 year old Chinese doctor who spoke up about the virus died.
I’m checking reddit r/COVID19, which is a science based discussion forum with cited academic papers and flaired scientists. It started turning into a prepper forum but I think the mods are shutting that down pretty quickly. I go there for my news.
Are you sure that's accurate? I'm not disputing that as viral load increases, so do symptoms, and ability to infect others.
However, I'm finding it hard to model a scenario in which a virus is already replicating in one's system and external exposure to comparitively infinitesimal amounts of the same virus has an impact. Do you have any actual evidence to present which backs up your claims?
Who really knows, but there are genetic diversity effects in other diseases. We also know that being exposed to a tiny initial viral load has a better prognosis with many diseases than a massive one (including with past SARS).
Doctors could be facing a "quadruple whammy"-- a disproportionate share of the worst strains (because they're meeting the most ill patients; exposure to greater viral loads; exposure to many patients with many slight variants of the disease; and sleep deprivation and overwork causing minor immune suppression.
But in the end, this is all speculation.
Here's the full text of the post:
Recently there have been several tragic deaths of young doctors in Wuhan from covid19, including the 29-year-old Dr. Xia Sisi, the 29-year-old Dr. Peng Yin Hua, the 42-year-old Dr. Huang Wenjun, and of course the 34-year-old Dr. Li Wenliang. This is at some odds with general population data showing that deaths of covid19 tend to be highly concentrated in the elderly. It could be a statistical anomaly, but it does seem like death rates may be higher in young doctors than would be expected in the population.
As an explanation, many of the most upvoted comments on these posts suggest that their immune systems might be suppressed due to overwork, poor sleep, and stress. To me, this seems to be an extremely unlikely explanation for many reasons, including the fact that doctors don't seem to die at relatively higher rates of other infectious illnesses such as influenza.
However, some people have mentioned higher viral load as a possibility, which seemed more likely. I did some research and I found this 2005 study on the role of viral load in SARS (which is, of course, very similar to covid19): https://wwwnc.cdc.gov/eid/article/11/12/pdfs/04-0949.pdf
The study looked at an outbreak of sars in a particular housing area in Hong Kong. They found that people who had closer contact with the index patient had a higher nasopharyngeal viral load on admission as measured by RT-PCR. Crucially, they also found that people in this area were also the most likely to die. Some quotes:
"The median nasopharyngeal viral load in E block patients (5.09 log10 copies/mL) was much higher than in non-E block patients (0 log10 copies/mL) on admission (p<0.001)... The overall case death rate among the 79 patients was 24.1%. The highest rate was in block E, which accounted for 79% of all deaths, while the death rate in patients living in E7 (the same block as the index patient) was 70% (7 patients). This rate is significantly higher than in other units (p = 0.001 by χ2 test). The index patient was one of the few patients from E7 who survived the disease."
"Severity of illness did not differ between block E patients and non-E block patients when they were first seen at the hospital, despite higher viral load in block E patients. However, the death rate was higher in block E. We have previously demonstrated that patients with high initial and peak viral loads in nasopharyngeal samples were more likely to show a less favorable disease course and lower survival rate (8,18). Patients living in E7 who had highest nasopharyngeal viral loads explains why their death rate was higher than for those living in other units. The dilution effect resulted in a decreased viral load as the disease spread to other units and in a lower death rate."
This data corroborates the viral load theory. It's not perfect evidence, but the theory also makes basic physiologic sense. A higher viral load on initial infection means that the virus will be able to do more damage and suppress the host's immune system further (lymphopenia) before the host can mount an immune response against the virus.
Hospital workers are likely to be exposed to especially high viral loads of covid19. People who are hospitalized with covid19 infections are likely to cough more and require close contact for procedures such as IV placement and intubation. It is hard to know for sure, but healthcare transmission risk may have been especially high in the early stages of the epidemic in Wuhan, when people were not as aware of the high mortality rates of this disease.
If viral load upon initial infection correlates with disease severity, this may also help to explain why some local clusters seem to have more severe disease, such as the family who all died of the disease. For some reason, people in these clusters may have been exposed to an especially high viral load. Ideally, we could measure the viral load of infected people with RT-PCR to test this, although it's hard enough to get basic yes/no tests for covid19 at this point.
The viral load theory is not rock solid. It may not explain a large percentage of the variance in disease severity - certainly age seems to be a larger factor. But to me, it is clearly the leading theory why a disproportionate number of young doctors without apparent pre-existing health problems have died of covid19 in Wuhan.
Healthcare workers putting themselves at risk to care for the sick during this pandemic are heroes. It is an urgent priority to have sufficient PPE available to our healthcare staff. We also need to have adequate space available to allow for the adequate distancing of staff and possibly infected patients. The viral load theory suggests that PPE and distancing are not only important for preventing healthcare workers from getting the illness but also decreasing the likelihood that they will die of the illness if they are infected.
It's worth noting this is only a hypothesis. Yes, in general, across viral illnesses, people have a worse course of disease with high viral load. Whether that's a primary cause of differences in prognosis-- who knows. It would help explain why medical practitioners seem to do so badly.
Another factor beyond just viral load is viral diversity. People that are exposed to high viral loads also tend to be exposed to a genetically diverse population of viruses with a range of virulence and there's more likely to be virus that is particularly adapted to grow in that person and virulent. Also, there is almost certainly genetic variance in 2019-nCoV virulence and lethality, and the nastier strains are probably more concentrated in hospitals.
The governor just declared a state of emergency and authorized use of the national guard:
Also, rather ironically, Costco is headquartered there.
EDIT: Costco was founded there, but current hq is a few miles away in Issaquah.
What does this mean? That everyone who could have got exposed are already sick? Or that two weeks have passed with no more new flu-like illnesses?
I think pretty much everyone expects additional positive cases. The statement is so vague, with no definitions of when, where or by what metric they mean "expected".
There has been significant misinformation around coronavirus, especially from US gov't officials - although not so much at the state level yet, from what I can tell.
Whoever is doing the 'expecting' on how there will be no future positive cases (whatever that means...I give it a couple hours/days before news breaks of an additional positive case near this location) is either intentionally misleading people, or the quote was taken out of context, or something.
I would certainly expect 'additional positive cases' to appear.
Communication also was handled pretty poorly on all levels (central government, local government, and media). Strong measures (likely necessary) were not communicated properly ("do not panic" followed by restrictive measures), and the news are basically happy to provide sensationalist headlines ("coronavirus nightmare", "war bulletin", etc.).
Lastly, the incompetent PM (he is: he's only there because he was "honest") blaming the hospital where the crisis started. This might be true (personally I think not, it is a failure in the chain of command as far as I can see), but you don't come out with these statements. What example are you giving to the country, the citizens, and everywhere in the world? That you don't even know how things are run in the country you are serving as part of the executive branch.
Also the experts (I do not use quotes, they are, or at least should be) providing explanations for the general public often coming up with contradictory statements (because of the various unknowns surrounding this virus and its behavior outside China). And the general public, which is unequipped to understand, gets even more confused.
This also led to the mass hysteria from the last weekend, with people raiding pharmacies and supermarkets. And the press from abroad (in Spain and at least in Colombia, from what I've seen) sensationalized that even more, up to the point that an acquaintance of mine (Colombian) got a worried phone call from her father because he was worried she'd starve.
"Professional"? Not by any means.
The US has and is handling it the best.
The administration shut down travel earlier than any other country.
There are much fewer cases than other countries even though we have a larger population, economic trade, and travel.
There was already a travel ban from Iran to the US. This morning they just banned travel if you've ever been in Iran, so they don't come through Canada.
Maybe Canada should shut down flights from Iran.
> You don't have confirmed cases if you don't test.
There's appropriate testing. You and some media outlets are just fear mongering.
There's less testing overall because there's less risk because the US government quarantined it so well.
Other countries did and have not. Yes there have been some blunders, but that's human.
I don't think blanket statements politicizing the situation helps.
Can you elaborate on that? Up to now everything shows that US government did not quarantine it very well, the chances for early testing and isolation of early cases were missed because of too restricted testing, and now we're getting severe patients who did not have any travel history, so they've been infected somewhere on US soil a week or two ago from sources who haven't been identified (possibly because they themselves have only mild symptoms and don't need hospitalization) and presumably have infected others. These "surprise patients" are evidence that community spread in USA has started some time ago already.
From what I see, countries like Singapore and South Korea are some examples of implementing somewhat effective quarantine measures, and USA has quarantined it much worse than other countries, it's just that it's been hidden due to lack of testing and the time delay of severe symptoms, so we're just starting to see the consequences of that.
Currently compared to every other country on Earth, we have quarantined it the best.
Even if you assume there are some undetected cases in the US (which is likely), it's still not even close.
It WILL spread across America, it's just a matter of time.
You are speculating that the CDC will not be able to handle it.
Take a step back and calm down. Maybe evaluate where you get your news and why they are trying to fear monger.
The number of cases in the US is wrong. We know it's wrong because if it was right, we wouldn't have cases stemming from unknown sources.
> Currently compared to every other country on Earth, we have quarantined it the best.
No. We've put our collective heads in the sand, and hidden from testing any significant number of people.
> It WILL spread across America, it's just a matter of time.
This is the outcome of a bad quarantine.
> You are speculating that the CDC will not be able to handle it.
The CDC has already mishandled it. They created red tape making the criteria for administering testing very narrow. They coerced medical establishments to only use their test kits, rather than being able to pick from known working kits proven elsewhere in the world. Then, the kits they issued were flawed, and they forbade medical professionals from administering them. They have literally done nothing right yet. Have you seen their official webpage on Covid-19? It doesn't even describe the common chain of symptoms; instead it has multiple bullet points about Covid-19 Stigma... You get better and more complete information from reddit.
We know they are from other countries that weren't able to get their quarantine under control. Iran and South Korea. Flights from SK were banned this Saturday morning. Flights from Iran were already banned, but now those coming from Canada and other countries that have been in Iran can no longer enter either.
> This is the outcome of a bad quarantine.
So you agree that case numbers matter and the US has dealt with it the best so far, because it's spread across the world much more prevalent than here.
> You get better and more complete information from reddit.
Your reaction makes a lot of sense now.
> We know they are from other countries that weren't able to get their quarantine under control. Iran and South Korea. Flights from SK were banned this Saturday morning. Flights from Iran were already banned, but now those coming from Canada and other countries that have been in Iran can no longer enter either.
No shit Sherlock. Unknown sources, as in none of the people that we suspected of being exposed could've come into contact with people who later tested positive.
> > This is the outcome of a bad quarantine.
> So you agree that case numbers matter and the US has dealt with it the best so far, because it's spread across the world much more prevalent than here.
I'm really not sure why you think "bad quarantine = we're #1!", but no, there are many other countries that did a better job of the US, and now it's likely a good number of us will die from it.
> > You get better and more complete information from reddit.
> Your reaction makes a lot of sense now.
Yes, I'm wholly willing to vet sources by the quality of the information they provide, and the CDC is putting out platitudes and vague happy-go-lucky information, while a number of informal channels are putting out the highest quality information available.
Check out: https://www.reddit.com/r/COVID19/comments/fakavo/compilation...
Compare it to:
I know at this point you're just trolling, but this really isn't the right place for it.
You're very misinformed and you seem to have angst against the administration for little reason.
Get off the internet and stop trying to scare people. Go stock up on germ-x and spend time with your family. Stop politicizing a very serious situation, it's dangerous and tacky.
Before you edited your comment, you said that half of the links linked to the CDC. The other half linked elsewhere, where useful information was to be had.
> You're very misinformed and you seem to have angst against the administration for little reason.
Gee thanks, nice to see you aren't above personal attacks. Having been a Marine for nearly a decade, I have quite a lot of experience with the US government.
> Get off the internet and stop trying to scare people. Go stock up on germ-x and spend time with your family. Stop politicizing a very serious situation, it's dangerous and tacky.
> Good night.
Truly a poet.
Press conferences held by US leadership seem to indicate that they're not well prepared for an actual crisis, but are prepared to play politics with one. This does not bode well.
Care to elaborate what you had issue with?
We already have people testing positive who have not travelled overseas and have not come into contact with known carriers. The CDC has labeled those cases as community acquired cases. That means we KNOW that we don't have accurate numbers, and we KNOW that there are more people sick than our data suggests. It also means that some population of carriers are both not in quarantine, and are activity transmitting to others.
So the quarantine in the US has failed, and we have no idea how badly. Paranoia is warranted at this point.
No one ever suggested it was never going to spread in America. The quarantine was to TRY to prevent it from getting here, but you can only do so much.
Once it is here we will treat it. There are plenty procedures in place since 9/11 to handle these things properly.
The longer we held the quarantine the more time we had to prepare. We've done really well thanks to the early travel bans that the media was against.
> Paranoia is warranted at this point.
Stop fear mongering.
In an earlier post you wrote, "There's less testing overall because there's less risk because the US government quarantined it so well." If the US government did so well at quarantine that they didn't need to do any surveillance testing, how is it now spreading outside of quarantine? Your statement is an assertion that the government has stopped it from spreading, by the logic that they wouldn't need to test outside of quarantine. So yeah, you did suggest it.
> Once it is here we will treat it. There are plenty procedures in place since 9/11 to handle these things properly.
There is no treatment that is known to work. There are four or five that are, or are approaching, clinical trials. The one that looks most promising to me is being used in a trial in Wuhan.
> The longer we held the quarantine the more time we had to prepare. We've done really well thanks to the early travel bans that the media was against.
We have no idea when the quarantine broke. We just know we've had several cases of people in hospitals who were sick and had no clue who they got it from. It could have been a single carrier, or they could be representing a thousand people who are just beginning to develop flu-like symptoms... We just don't know. Not enough data.
> > Paranoia is warranted at this point.
> Stop fear mongering.
I will monger fear when I think it's necessary; an illness that doubles the number of infected every 6 days, has no cure or treatment, has a death rate higher than swine flu, and takes a median of 4.5 days to even show symptoms scares the hell out of me, and it should scare the hell out of you too. And if you think the government "has this under control", you've obviously never worked for them. I did for nearly a decade, and they take months to get their heads out of their asses.
You might have the best of intentions, but you're not really helping anyone.
The US appears to be mirroring China's missteps quite well, and we all know how things turned out there. Unfounded optimism is as dangerous as fearmongering.
Waiting for a negative, or declaring that only those that may have traveled or contacted someone who was in china is test worthy is foolhardy. This thing dies after 9+ days in the environment, if we reduce exposure of those who may be infected; It is possible we can wait this out.
Companies without work from home policies should revisit them immediately. Forcing someone who is under the weather or feeling off to come into your office is risking your whole company site.
Also tell your co-workers to go home when they are sick! An office is not an ambulatory pneumonia wing of the local hospital. Sick people should be home!
I don't know if the hysteria is warranted or not, but at this point I'm convinced that it doesn't make for good HN discussions. People who want to discuss every development of this epidemic can find tons of places to do that already, including a plethora of subreddits focusing on various aspects of it.
It seems politics are forced to take the same kind of exceptional measures as in other countries for fear of being accused of not being responsible.
I won't mention the other topic, but it's the second time i've found HN lacking scientific rigor the same way the general public does. I guess it's the downside of being more popular..
Now it is true that old and fragile people should be worried about coronavirus, but judging from death rates, it doesn't seem more deadly than the flu. So why put fear in the whole population ?
also, most people only experience nothing more than a cold symptoms. Which means most people actually have an immune system able to fight this virus quite efficiently.
according to https://www.worldometers.info/coronavirus/
coronavirus has 3k deaths over 86k, which is 3%. Or if you take the other metrics, which is 40k recovered, that's 3/43 around 7% death. still way lower than the flu.
as for my remark about immune system, my point is that the vast majority of people experience very mild symptoms. Which means that their body was perfectly able to fight back and produce the antibody, just like against the other flus.
Perhaps you're missing the part of the article that says:
>There are also two confirmed cases associated with the nursing facility.
I'm not trying to say they definitely have it, but it's foolish to brush this aside as "probably just the flu" when they appear to have been exposed to the virus.
edit: I now see you said 3 weeks ago, so that may not be helpful.
Our "patient zero" was a dev who came into work for a day with a cough.
If you're sick, please stay home.
I have never worked at a company where one could call in sick without consequences. My last employer (which was evil) had a policy of five sick days per year, and more than two days consecutively needed a doctors note.
Also, there was recently a death from Coronavirus in Seattle, and there has been community transmission in the nearby neighborhood of Mill Creek.
So, what evidence do you have that that "these folks probably have the flu"? At best you are dismissing concerns, at worst you are making things worse by trying to convince people not to take this seriously.
So no, I don't think it's statistically more likely that ill patients around a highly contagious disease randomly picked up something else.
Statistics based on bad data (which we know is bad at this point) is analogous to guessing, and when guessing it's best to guess with the more cautious point of view. Is it still more likely, at this point in time, that a person with flu-like symptoms has flu? Probably.
Given the transmission rate from Chinese data (also bad data, but not as bad as ours), the US likely has more flu carriers than Covid-19 carriers. But how much more likely? No one knows, and no one can know, until we get a reasonable sample population tested.
Now is the time to be vigilant. I’d rather have too many people thinking they have this and self isolating/getting tested than too few.
An update, ten days later: 26 people (nearly a quarter of the 120 residents of this facility) have died in the past three weeks. Most of those who died have already positive for the SARS-CoV-2 coronavirus. Post-mortem tests are still pending for a handful of the earlier cases.
More than half of the surviving residents have also tested positive for coronavirus so far. Most of them are serious cases and are currently hospitalized. More than a third of the staff have COVID-19 symptoms and are awaiting test results.
And two people have confirmed cases and are currently hospitalized.
immunity to flu lasts a few years
Useless in a clinical setting, of course, but highly useful for epidemiology