2019 - nCoV (novel coronavirus originating in Wuhan, China)

[msmob]

Time to re-visit Sweden's policy .. much vaunted by those pointing to her and saying ' look' ..it's 'working for them' ..



Compare with their neighbours - who are imposing stricter measures ..

[Gator]

Time to re-visit Sweden's policy .. much vaunted by those pointing to her and saying ' look' ..it's 'working for them' ..

Compare with their neighbours - who are imposing stricter measures ..

Stark difference from a visual perspective. 

During the US Civil War, the Union's General Grant was called a "butcher" because of his attrition strategy.  However, Lincoln appointed him commander of US armies because Grant won battles albeit at great loss of life.  And after the war the public twice elected Grant President.

In other words, it is premature to decide the Sweden vs. Scandinavian approach. 

[fathertime]

China did something strange again. For over 3 weeks, they haven't reported more than 7 deaths a day. Some days they reported zero deaths. Today they reported 1290 deaths. Could it be them attempting to raise the number of deaths to decrease the number of accusations that they are lying? Their reputation is taking a hit. Fortunately for them, there's quite a few people out there that would never hold them responsible.

If China wants to update their numbers periodically that makes sense to do.  The increase isn't that great a number.   Since they are used to walking around with facemasks and took draconian measures it is possible that they got a handle on the virus earlier than other nations.   I tend to believe their numbers aren't that far out of whack like many others do.    While politically the US wants to blame and demonize China for the virus, many other nations aren't going to be dragged along with us.  We (The US) want to try to force China to bend to our will and will stop at nothing (Aside from actual war), to force them but we have continued to fail.

Fathertime!

[Gator]

DIFFERENCES BETWEEN SARS AND COVID-19



The SARS epidemic (Severe Acute Respiratory Snydrome) of 2003  had a much higher CFR (case fatality rate) than COVID-19.  It was brought under control in just 8 months with only 8098 total cases worldwide, and 774 deaths.  Can COVID-19 be brought under control in the same amount of time?
 

Similarities

The SARS virus (SARS-CoV) shares several  similarities with COVID-19.  Both are a coronavirus, and  in fact the initial name given to COVID-19 virus was SARS-CoV-2.  The whole genome of SARS-CoV-2 has a "86% similarity" with SARS-CoV.   The primary transmission pathway for both is deemed to be the same, respiratory droplets.   The host cells in the human receptor are also the same. Also, both emerged in China, and both seem to have originated from bats.
 

Containment Techniques for SARS

SARS eventually spread to 26 countries with majority of cases occurring in five (China, Taiwan, Hong Kong, Singapore, and Canada (Toronto).  SARS was effectively "eradicated" by interrupting all human-to-human transmissions.  This involved the following steps:

                     1.  Sydromic surveillance including virtually 100% testing of possible cases. 
                     2.  Prompt isolation of infected persons, mostly in special sections of hospitals ("isolation" is physical separation of infected patients to prevent any contact with uninfected people - complete isolation, not just 6-ft social distancing).
                     3.  Tracing of contacts prior to isolation.
                     4.  Enforced quarantine (more restrictive than US lockdown) of all traceable contacts.  Some quarantined persons were moved from their homes to hotels.  Measures included spot checks by police (Singapore installed video cameras in homes of  all contacts).  Medical observation of close contacts such as family. 
                     5.  For situations where the spread was so great that quarantine of individuals was not feasible, the entire community was quarantined.  The techniques were far more restrictive than US lockdown, e. g.,  police enforcement, mandatory monitoring of body temperature.

In other words the most restrictive mitigation methods now employed by any state in the US would fall short of the measures used in containing SARS.
 

Differences Between the Two Viruses

Although the two viruses share many similarities there are some key differences. 

1.  The originating locales are different.  Wuhan is a large, densely populated metropolitan region.  It is a major transport hub for regional, national and international travel.    Once COVID-19 developed, the opportunity was high for transport to areas around the globe. 

2.  SARS is more symptomatic than COVID-19.  Many  COVID-19 cases exhibit only mild symptoms, and some are asymptomati.  Only about 15-20% require hospitalization, and the percentage will decline as more data is developed for asymptomatic cases.  In contrast, essentially all cases of SARS infections advanced  to severe respiratory problems requiring medical attention if not hospitalization.   

3.  The infectious period is different for the two.  Infected cases of COVID-19 can shed viruses  before becoming symptomatic, and some contagious cases never exhibit symptoms.  In contrast, SARS cases became so ill with respiratory ailments to seek medical attention before the peak period of shedding viruses.

4.  Transmissibility (R₀) appears to be higher for COVID-19,  especially as more data are collected or asymptomatic infections. 

5.  The Case Fatality Rate is different.  SARS is maybe 5-50 times more fatal than COVID-19.  This may be seen as  helpful, yet it encourages more spreading and so many more cases that more total deaths worldwide occur. 

6.  Community spread is far more prevalent with COVID-1

These differences suggest that COVID-19 can not be contained the same as done with SARS.  Because the horse is already out of the barn, a SARS containment approach to COVID-19 seemingly will require the testing of a a large portion of the nation's population, maybe a majority.  And there is the issue of whether US citizens would accept the stringent isolation and quarantine enforcement  methods  used to contain SARS. 
   

[msmob]

STILL suggesting this all 'kicked off' in Wuhan ? .....

[Gator]

STILL suggesting this all 'kicked off' in Wuhan ? .....

What a superfluous comment. 

The substance of my post comparing SARS and COVID-19 does not change.   

You can pursue a theory that the epidemic wave originated from a tiny pebble dropping somewhere else, yet you must admit the fact that the virus made its way to Wuhan where it first made the news by overwhelming the medical care system, becoming a pandemic.   

You know what else does not change regardless of your tiny pebble theory?  The fact remains that a SARS solution will not work for COVID-19.   

Moby, you do anything to pick an argument,  caring little about how we get out of this mess.     

[jone]

In 'Differences between two viruses, paragraph 3 states 'COVID-19 can shed viruses'.   Does that mean that the asymptomatic infected can infect other people?

Nice write-up.

[BillyB]

the virus made its way to Wuhan where it first made the news by overwhelming the medical care system, becoming a pandemic.   
 

I actually trust China when they said it started in Wuhan except for the part in came from a meat market. Doctors from Wuhan were the first to confirm there is a new virus running loose causing the Wuhan pneumonia. No other doctors in China or the world made a claim like that in December.

China has a history of viruses and bacteria accidently escaping laboratories. China is actually good in stopping the spread of escapees but they didn't have the experience to deal with the pathogen of the century and they refused help from WHO, CDC, America and other nations to help prevent the spread in January.

[BC]

In 'Differences between two viruses, paragraph 3 states 'COVID-19 can shed viruses'.   Does that mean that the asymptomatic infected can infect other people?

Nice write-up.

Indeed a good assessment.  Yes, if I understand correctly 'shedding' means that those without symptoms can infect others.  Also for symptomatic cases before symptoms appear.

[Gator]

In 'Differences between two viruses, paragraph 3 states 'COVID-19 can shed viruses'.   Does that mean that the asymptomatic infected can infect other people?

Yes.  "Shedding" is just like a dog shedding hair.  In SARS, only the really sick dogs shed viruses.   In COVID-19,  happy puppies are shedding.     

[Gator]

GOING OUT ON A LIMB


So a vaccine is one year, two years away, assuming a virus is developed. 

And a SARS-type containment strategy will not work in the immediate future given the stealth nature of asymptomatic carriers requiring essentially everyone be tested. 

So the general mood is to reverse the "lockdown" and return to work in a phased approach.  How long will the phased approach take?  Without the advent of a vaccine, this is asking how long before we achieve "herd immunity?"

To estimate the time required, we first need to make some assumptions.

Assumption No. 1  -  Infection gives us  immunity to future exposures and resulting infections.  If not, even more time is required. 

Assumption No. 2  - We need to incorporate in our calculations  how many people become exposed and minimally infected yet do not display the necessary symptoms to have been tested.    We don't know, but some preliminary  studies suggest that for each confirmed positive test, a number of other people were infected without ever being tested.    For the purpose of this exercise, let us assume these fortunate people outnumber positive cases at a 3::1 ratio.

Assumption No. 3 -  What rate of new  cases per day will not exceed our healthcare system capacity?  Today, the US has 30,000 new cases per day, and it seems the healthcare system can care for that number.  The rate will likely increase as we return to work, yet our healthcare system capacity will improve with new developments, therapies, etc.    Let us assume the healthcare system could accommodate 70,000 new  cases  per day.

Assumption No. 4 - What percentage of the population must obtain immunity to prevent significant outbreaks?   I read that the number is about 90%, meaning a vulnerable person has very few people to catch the disease from.


Using basic arithmetic, a population of 330 million will thus achieve herd immunity immunity in about 3 years. That would be 3 years of millions of sick people.  It is also 3 years of restricted life, starting off with restrictive measures envisioned in Trump's Phase One plan, and gradually going to Phase Two, then Phase Three.

Some will argue that with greatly expanded testing, we can isolate the virus from the majority of the population akin to the SARS approach but on a major scale.  This would require isolation of all persons as they become infected and monitored quarantine of their contacts.   I believe without development of "home tests"  it will take years, and meanwhile we will not have reopened the nation. 

[Gator]

I went through this exercise to guide my investing decisions just from a health perspective.

There are other, and more complicated factors, such as the trillions of government spending and lending.   

We have talked about whether the recovery will be a V, U, W or L.   The S & P is down only about 13 percent from 1 January.    I believe the market is too optimistic.  Not that we will retest the lows in a W, but it seems to me we should be on a Nike swoosh.  So the market will back off to the Nike curve and then rise slowly.  The tail is higher than the start.   

Timing?  Recoveries usually take 2 1/2 years to reach the starting point.  We probably can do better than that,  but I see no guaranteed approaches anywhere.   



 

[jone]

The 'Swoosh' may already be at the low point.   Investors are awaiting signs that the death/infection rate - or maybe just the hospital rate - has reached its high point.  The market took a 1200 point jump today on just such an assumption. 

[BillyB]

Using basic arithmetic, a population of 330 million will thus achieve herd immunity immunity in about 3 years. That would be 3 years of millions of sick people.  It is also 3 years of restricted life, starting off with restrictive measures envisioned in Trump's Phase One plan, and gradually going to Phase Two, then Phase Three.

There have been bad news of hundreds of those who have been infected was re-infected. It's too early to tell if they were released due to faulty test results, had sleeper viruses that couldn't be detected and later reactivated, or simply the human body doesn't have immunity against SARS-COV-2. Lots of studies going on right now about it.

Below is a study I found on SARS. Significant levels of antibodies to defeat SARS remain present in the body for 2 years and reduction begins. Conclusion was it is possible for somebody to get re-infected from SARS after a few years.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/

So the general mood is to reverse the "lockdown" and return to work in a phased approach.  How long will the phased approach take? 

My governor gave an interview on CNN recently. Although Washington State seems to have things under control, he said schools will remain closed for the rest of the year. I think he's taking a wait and see approach to see if the virus spikes heavily soon or in Winter so kids will do classes online. Also, he said he will begin phase one after the curve goes down but currently the curve has remained flat. Hopefully it will go down soon because our State economy is paying a heavy price to just to keep a curve flat at it's current level which is not enough for my governor to begin a phase 1. It's costing us trillions at the national level to bring the curve down but hopefully it will go way down and stay there.

I believe without development of "home tests"  it will take years, and meanwhile we will not have reopened the nation. 

We can't trust nations and we can't trust the common man to do their part. Home test kits are only as effective as the people who use them. Some parents will have a kid sick with the flu or cold and send them to school anyway to get them out of the house. Even if a person gets off the drugs to become smart enough to use a test kit, it's no good if they test positive and still go out partying and spreading the virus. In Washington State we had a homeless guy escape quarantine and then steal stuff from a convenience store. There's still too many selfish people out there that don't care about the welfare of others. Whatever plan our governments decide is best to limit the spread, they need to include the idiot factor.

[Gator]

The 'Swoosh' may already be at the low point.   Investors are awaiting signs that the death/infection rate - or maybe just the hospital rate - has reached its high point.  The market took a 1200 point jump today on just such an assumption.

What if the endemic rate as we return to work is not far below this awaited high point?! 

In Florida, we are below the peaks of two weeks ago (on a 3-day average, which IMO is a better way of examining the trends).  However, I still feel hesitation about socializing.      Certainly not ready for "normal" life. 

I learned that my neighbor a HOF baseball player wonders if he had COVID in March.  Was never tested,  but had a rough recovery.  He had earlier interviewed a player who tested positive not long afterwards. 

[Gator]

Laser light lab test shows the need to wear mask. 

RWD is safer than talking with a golf buddy.   


http://www.accuweather.com/en/health-wellness/how-does-sars-cov-2-spread-laser-demonstration-shows-how/723608?utm_medium=push&utm_source=pushly&utm_content=511946&utm_campaign=pushly_trial

[Faux Pas]

Laser light lab test shows the need to wear mask. 

RWD is safer than talking with a golf buddy.   


http://www.accuweather.com/en/health-wellness/how-does-sars-cov-2-spread-laser-demonstration-shows-how/723608?utm_medium=push&utm_source=pushly&utm_content=511946&utm_campaign=pushly_trial

More fear mongering I'm afraid. Definitely it is highly contagious but, this we already know. 2.75 inches before being shown by the light. The trajectory maybe 12 inches total? As each day goes by the less and less I'm trusting the information being shoved down our proverbial throats

[LAman]

  As each day goes by the less and less I'm trusting the information being shoved down our proverbial throats

Would you rather have a shaft shoved up our proverbial arses? ))

[Faux Pas]

Would you rather have a shaft shoved up our proverbial arses? ))

Is there a difference?

[LAman]

Is there a difference?

One is going down...the other is going up!!!

[2tallbill]

[fathertime]

We can't trust nations and we can't trust the common man to do their part.

Even today after all that has been happening, I dealt with numerous people who weren't wearing masks, wanted to shake hands, and were a little closer than I would have preferred.  Based on what I've seen I'd suspect this virus has a ways to go before it runs it's course.  That said, when vegas opens whenever that is, I'll be there, and will be curious to see what measures are taken.

Fathertime! 

[msmob]

So, your President closed the borders and wants the USA to open ..?!

Not at all conflicting...

[fathertime]

So, your President closed the borders and wants the USA to open ..?!

Not at all conflicting...

Yeah mobers, the wall he was trying to build wasn't just to keep people out...it was to keep us locked in. 



Fathertime! 

[Gator]

CHANGES TO MY ASSUMPTIONS CALCULATING HERD IMMUNITY

I just watched CNBC interview of Dr. Scott Gottlieb.  The former FDA commissioner is on top of medical and scientific developments.  He speaks in a measured, careful manner,  yet unlike Dr. Fauci,  he is not shy about using anecdotal data to predict the trajectory of this disease. 

Today, he opined that the US is diagnosing only about 1 out of 10 cases (in NYC maybe a million people have been exposed vs. the 100,000+ with a positive lab test).  That changes my assumption from yesterday that asymptotic cases outnumber positive cases at a 3::1 ratio.   Dr. Gottlieb's observations say it could be 9::1. 

I also assumed the percentage exposure necessary for herd immunity.  Dr. Gottlieb  said he believes the R_o is somewhat above 3.  That would translate to herd  immunity being achieved at a lower percentage than the 90% I assumed yesterday, yet still higher than 67%. 

This new anecdotal info suggests the US can achieve herd immunity in 1 - 1.5 years using back of the envelope math.  This should be calculated using differential equations because some of the variables change over time at a nonlinear rate.  Yet, it is better than the 3 years I estimated yesterday.   

A key assumption is this estimate is "infection gives us  immunity to future exposures."  That has not been proven.