The first patient was confirmed after having been intubated for >= 4 days. On average it takes 9 days from infection to ARDS, which requires intubation, according to a Lancet study. She was confirmed 5 days ago (on Feb 23rd). So she could be infected 9 + 4 + 5 = ~18 days ago.
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.
Because the US is doing nearly zero surveillance testing, we don't know what we don't know.
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 don't think community transfer is a "maybe". If two people have been infected without any link to known cases, there must be at least one single person that links known cases to the two new infections. That can't really be debated. And what are the chances there is only one? And they only infected two more people, won't infect anyone else, and those two people didn't infect anyone before being quarantined? I think this thing is in the wild now.
It seems the odds are high there is more than 1 because if there is only one there would be something in common between these two recent community cases. But from what I’ve seen there’s nothing linking these two together which means there are at least two distinct groups in California at the moment in which community infections are happening.
> we're only testing people returning from China or from the cruise ship
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.
Like why didn't they send people who had a few years ago dealt with Ebola. It's not like we didn't have people who went over there to help or people who treated infected people stateside --granted Ebola transmission is different but you still need PPE, but people know the protocol in practice, not just reading about how to wear PPE.
The CDC is targetting routine bedside testing of COVID19 like we have for flu. It will take "months". Surveillance testing is enhanced by this. Recently an attempt to broaden testing ran into issues, now resolved. I expect test numbers to increase sharply. Monitoring those who are most likely vectors makes sense.
What is the CDC actually doing? Presumably they've deployed a team to Santa Clara to deploy test kits, review hospital admissions and help construct isolation units? Or hopefully soon?
Is there a site tracking the response of CDC and public health departments to this emerging pandemic?
According to this reddit post the CDC won't even test you unless you're so sick that you need hospitalization even if you were in a country with an outbreak AND have flu symptoms:
The CDC had issues with quality control on the test kits that must be distributed before labs outside of CDC Atlanta can begin doing their own testing.
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.
Apparently the CDC has screwed up the “test kit” in numerous ways.
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.
South Korea tested on the order of 10,000 people today alone and found roughly 300 positive cases. The USA has managed to test around 500 in the past two months.
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?
> The plan was always to expand testing, but you need a working test kit first.
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!
Why can't the CDC make a working test kit? After China, every other country seems to have been able to do it in like 2-3 days after a few cases were discovered.
Isnt this a good thing? Isnt the fact that 8% of the bay area is not dying an indication the diamond princess cmr is more accurate than iran or wuhan, which is to say this is a normal seasonal virus?
It's getting real now. Wash you hands, and avoid touching your face. Plan to spend less time in close proximity to others.
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.
Countries that are heavily affected right now primarily have open borders with China (still!!?) - japan, South Korea, Italy, Iran, with tons of Chinese workers going back and forth
" It's getting real now. Wash you hands, and avoid touching your face. Plan to spend less time in close proximity to others."
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.
The virus isn't truly airborne. The respiratory droplets can be carried in the air short distances, but direct infection from that is extremely unlikely outside of someone literally sneezing in your face.
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.
Droplets contaminated public surfaces like door handles, elevator buttons, etc, and one person normally touches his/her face hundreds of times per day.
Because there are other vectors of contact besides breathing. Since we can't stop breathing, we can at least minimize infection through other vectors, even if they represent less likely avenues of infection.
Not sure why you are getting downvoted. There are many unknowns with this and if you see what is happening in China to disinfect, they clearly believe it is airborne.
I am suspicious that a lot of people in the Bay Area have mild cases of COVID-19. I also see no reason to believe that the total number of cases isn’t a couple of orders of magnitude higher than reported, making the overall fatality rate quite low.
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.
I share your concern. Perhaps it is because of heightened awareness, but I don't recall any previous winter where so many people were sneezing and coughing at the office as there were this past week. No hacking rib crackers, just lots of muffled throat clearing.
Are we the slowly boiling frogs?
I have flu right now and so does the rest of my family (got tested). We all had flu shots but I guess they aren't very effective this year. The illness has been very mild but that's likely because of the shot.
Last I heard the number of 'mild' cases was very low, and low enough to not make it a talking point as far as diminishing the seriousness of the situation.
> I also see no reason to believe that the total number of cases isn’t a couple of orders of magnitude higher than reported, making the overall fatality rate quite low.
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.
As I recall, the passengers in question were all tested, but a lot of those tests were administered long before the last time those passengers could have been exposed. I see no a priori reason to believe that the number of cases is accurate.
I've suspected the same in SoCal. DW and I have been feeling kind of bleh over the past few days, and as of today both of our families haven't been feeling great either. It could be something else too, but I wouldn't be surprised either way.
Not in the news yet but there is an admission at kaiser San Jose of a potential covid-19 patient. Have all the symptoms, traveled and tested negative for flu!!
What is the rumor? There are many people working in hospitals that know a thing or two but aren't in a position to share it outside the workplace. I'd rather the facts be allowed out rather than covered up... it's more responsible and will keep people from getting killed.
My wife is an ER nurse. (West Coast but not California) Kind of wondering if I’m going to have to isolate myself from her just in case. She’s almost surely going to be coming into contact with patients soon.
Even young and middle-age people have a 0.2% mortality rate, which at the US statistical value of life (~$10M) works out to $20,000. (And if you're a well-paid software developer, you can probable 5x that.) Whatever you would do to avoid losing $20k-$100k, you should probably do to avoid getting Covid-19 (modulo questions about how long immunity lasts).
Drawing things out so that you're not sick at the same time if possible seems like a win for both of you, and for the health care system in general. The slower it goes, the less health care providers get slammed with too many people to cope with.
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.
Yeah I think the issue is that you can be contagious without being symptomatic. I don’t want it on my conscience that I may end up infecting others, even though I personally will probably be fine.
It’s about smoothing the curve so the healthcare system can absorb the influx of patients. If the healthcare system is overwhelmed then it’s a problem.
This is exactly what's happening in Italy. The majority of people are asymptomatic or only have mild symptoms, but smaller hospitals are nearing full capacity and thus are redirecting patients to other hospitals. ICU beds cannot all be reserved to covid patients, there are regular patients as well. All the restrictive measures put in place should help contain the spread and avoid overwhelming the healthcare system.
You would still want to slow the spread as much as possible to ease the load on hospitals and make sure you can take care of as many of the serious cases as you can.
Yeah but this is the United States where we've rolled up and stowed away all the social safety nets should one lose their job which is going to start happening soon if this economic disruption continues. In short, bad economy equates to lost lives. So it really isn't a question of economy over lives.
Readit News
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.
https://www.wired.com/story/community-spread-coronavirus/
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
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.
https://www.washingtonpost.com/world/2020/02/28/coronavirus-...
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.
https://www.nytimes.com/2020/02/27/us/politics/coronavirus-u...
https://sanfrancisco.cbslocal.com/2020/02/27/gov-newsom-coro...
https://abcnews.go.com/Politics/cdc-moves-rapidly-expand-cov...
Is there a site tracking the response of CDC and public health departments to this emerging pandemic?
https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_stor...
So it seems what the CDC is doing is trying to minimize the number of confirmed cases to make things look better.
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.
https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html
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.
https://www.theverge.com/2020/2/24/21147157/coronavirus-lab-...
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.
https://www.propublica.org/article/cdc-coronavirus-covid-19-...
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.
https://www.propublica.org/article/cdc-coronavirus-covid-19-...
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?
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!
Dead Comment
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:
https://www.theguardian.com/world/2020/feb/22/coronavirus-as...
Deleted Comment
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....
Deleted Comment
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.
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.
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.
It seems to already be spreading in Bay Area with 2nd case of unknown origins..
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.
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.
Edit: spelling
Here's an article from the WSJ about how using serum from recovered measles patients prevented an outbreak decades before the vaccine was developed.
https://www.wsj.com/articles/how-a-boys-blood-stopped-an-out...
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.
https://blogs.scientificamerican.com/observations/preparing-...
Deleted Comment
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