The aggressive and increasingly stringent measures taken in China to contain the “novel coronavirus” sure look like the officialdom is worried, if not panicked about the disease.
Although we and they are suffering from bad data (for instance, shortages of tests and even in places personnel to confirm that suspected cases are the coronavirus and not something else), the facts at hand are not pretty.
World Health Organization increases global risk degree of novel coronavirus from moderate to high. #JaipurToday #NewsUpdates #News #WHO #WorldHealthOrganization #Coronavirus #CoronavirusAlert @WHO pic.twitter.com/Yo70hm3mRH
— Jaipur Today (@TodayJaipur) January 28, 2020
This coronavirus is very contagious. The estimates of the reproduction are between 2.6 and 2.9. By contrast, from a 2014 paper in BMC Infectious Diseases:
We conducted a systematic review to summarize published estimates of R for pandemic or seasonal influenza and for novel influenza viruses (e.g. H5N1). We retained and summarized papers that estimated R for pandemic or seasonal influenza or for human infections with novel influenza viruses.
The search yielded 567 papers. Ninety-one papers were retained, and an additional twenty papers were identified from the references of the retained papers. Twenty-four studies reported 51 R values for the 1918 pandemic. The median R value for 1918 was 1.80 (interquartile range [IQR]: 1.47–2.27). Six studies reported seven 1957 pandemic R values. The median R value for 1957 was 1.65 (IQR: 1.53–1.70). Four studies reported seven 1968 pandemic R values. The median R value for 1968 was 1.80 (IQR: 1.56–1.85). Fifty-seven studies reported 78 2009 pandemic R values. The median R value for 2009 was 1.46 (IQR: 1.30–1.70) and was similar across the two waves of illness: 1.46 for the first wave and 1.48 for the second wave. Twenty-four studies reported 47 seasonal epidemic R values. The median R value for seasonal influenza was 1.28 (IQR: 1.19–1.37). Four studies reported six novel influenza R values. Four out of six R values were <1.
In other words, the reproduction rate is now reported to be meaningfully worse than for the Spanish flu and later flus deemed to reach pandemic levels. This is the reason for the freakout.
— Mr. Tamimi (@tamimi0x01) January 28, 2020
The reproduction rate is, however, lower than for measles, as the Wall Street Journal cheerily points out. The reason is that this is a big pathogen. From Foreign Policy two days ago:
The coronavirus is a physically large virus—in relative terms, at just 125 nanometers with a surface of spike projections, too big to survive or stay suspended in the air for hours or travel more than a few feet. Like influenza, this coronavirus spreads through both direct and indirect contact. Direct contact occurs through the physical transfer of the microorganism among friends and family through close contact with oral secretions. Indirect contact results when an infected person coughs or sneezes, spreading coronavirus droplets on nearby surfaces, including knobs, bedrails, and smartphones.
As with SARS, droplets generated during medical procedures such as bronchoscopy and respiratory treatment may be aerosolized, infecting multiple medical staff and enabling super-spreading. Hand hygiene and personal protective barriers—gowns, gloves, masks, and goggles—reduce droplet transmission. The incubation period, however, is unknown but currently very roughly estimated as between one and 14 days.
Note the potential for contagion from surfaces….just as gyms are disease vectors by virtue of patrons putting their hands on weights and exercise machines. So frequent hand washing, and/or use of gloves, and/or using alcohol wipes on things you touch in high risk settings (check in touchscreens at airport kiosks and those horrible iPad restaurant ordering systems are high risk if you are in an area with cases) are all good precautions.
More bad news on the contagion front….China’s health minister has said he believes the disease can be transmitted during the incubation period and has reaffirmed the one to fourteen day estimate. That means screening people for fever would only be partially effective in containing its spread. The Hill confirms our concerns:
A longtime adviser to the U.S. Centers for Disease Control and Prevention, Dr. William Schaffner, told CNN the new development means “the infection is much more contagious than we originally thought.”
Schaffner called it a game changer and warned current preventative methods won’t be enough to fight off the outbreak since tracking down the contacts a patient had before experience symptoms complicates the situation.
Researchers at the University of Hong Kong, however, said the number of infections could be much higher. On Monday, the university estimated that at least 25,630 people in Wuhan were showing symptoms of the disease and around 44,000 were infected with the disease but not yet showing symptoms.
However, some of those “showing signs of the disease” might have some other bug, and if they do have the coronavirus, it has not yet run its course.
Earlier estimates put the mortality rate even higher, but the 2.2% observed level is not at all good. While it is lower than for SARS (9.6%), it is similar to that of the Spanish flu, which was 2.5%. By contrast, a study published at the Lancet on global mortality from the seasonal flu, which came up with higher figures than other efforts, put the total at 4·0–8·8 per 100,000 for 1999 to 2015 seasonal flus. The mortality rate for the 1957 and 1968 flu pandemics were both about 0.1%.
Will containment work? We don’t know. The disease has already reached all provinces of China. Thailand has the most confirmed cases outside China, now at 14. Germany has identified its first case. The US has 5 confirmed cases and 110 more in 26 states under observation. Japan has identified a victim who had not visited Wuhan.
However, officials are trying to keep the disease within China and limit its spread in China. Some of many examples:
— Bloomberg (@business) January 28, 2020
The northern Chinese city of Tangshan announced that it will suspend all local public transportation services, in an effort to curb the spread of the Wuhan coronavirus https://t.co/Hs9Wr8ZAa5
— CNN International (@cnni) January 28, 2020
Smaller cities in Hubei are taking matter into their own hands:
"No outsiders allowed in."
— Sky News (@SkyNews) January 28, 2020
Even Shanghai is starting to look vacant:
Turkish citizen, who lives in China's Shanghai, records a video from empty streets of the city
A video of @akcay_nuri shows a city once flourished with life, now only ghosts lurking around the streets.
— EHA News (@eha_news) January 28, 2020
This may be web evidence, but I’ve seen panicked buying in Manhattan before blizzards that would only shut the city down for only two days (when Manhattan is full of food), so it’s plausible:
— Robin (@Robin78206324) January 28, 2020
Macau deported visitors from Hubei, the afflicted province. Starbucks in Hubei have closed. Chinese package tours have been canceled, as have cruises with stops in China. Public events such as movies screenings have also been halted, albeit not universally. The State Department has urged Americans to cancel non-essential travel to China.
Yet it isn’t clear that these efforts will do much. From the Financial Times:
Ian Mackay, a virologist at Queensland University in Australia, said it was possible the travel restrictions would simply be a “Band-Aid” solution. “It has never been done before, there is no evidence this will do anything by shutting these people in. There is still the virus there,” he said.
Mr. Market is rattled, as are foreign businesses and governments, most of whom have started evacuating staff from Wuhan. The logic escapes me, since this is a great way to spread the disease, unless they are quarantined for the maximum 14 day incubation period (note several medical journals have estimates shorter incubation period, but it’s not clear they have a better basis for making an assessment than Chinese doctors and scientists who have the most direct experience). From CNN:
As coronavirus cases continue to rise in Wuhan and wider Hubei province, several countries are taking action to repatriate their citizens in the affected areas.
Here are the countries planning or preparing to evacuate citizens:
The US: About 240 Americans being evacuated from Wuhan Wednesday morning local time will arrive in Anchorage, Alaska, before arriving in Ontario, California. About three dozen Wuhan-based US diplomats and their families are also expected to be on board, a US official with knowledge of the matter told CNN.
Japan: Japan is sending a charter flight to Wuhan tonight to retrieve about 200 citizens on Tuesday night local. It will leave Wuhan Wednesday morning and will arrive in Tokyo by midday local time. Roughly 650 Japanese citizens have requested to return to Japan, and the government will send more flights from Wednesday onwards.
Australia: Australia’s health minister said yesterday he was working with the Chinese Foreign Minister to repatriate Australian citizens in Wuhan, including 100 “young Australians.”
India: The Indian government is looking for “possible travel options out of Hubei province” for citizens in Wuhan, said a government spokesperson on Sunday. This comes after reports of 56 Indian students at the Wuhan University School Of Medicine who had been trapped in Wuhan since the lockdown.
South Korea: Four charter planes will evacuate South Korean citizens from Wuhan, said a government spokesperson today. Almost 700 South Korean citizens have applied to take the flight out.
France: A plane will fly French citizens back from Wuhan to France sometime this week, said the French Health Minister on said Sunday. There are around 800 French citizens in Wuhan.
United Kingdom: The UK is “looking at all the options” to help Britons trapped in Wuhan, said the UK Home Secretary after being asked about the possibility of evacuation flights
India, which is not famed for organized official responses, is being impressively transparent about its new measure and has even created a help line. Update: Apologies, I cannot find the official tweet again, and Twitter makes it far too easy to get false positives on efforts to copy embed code, so I had a duplicate of another tweet in this spot. However, I see as of this hour (4:30 PM EST) that India has one confirmed case and over 400 people under observation.
Even later update. I found the tweet after all:
1. We have created #CoronaVirus testing facility in 5 labs and will soon add 5 more;
2. Experts are performing qualitative checks on the airport screening mechanism
3. Have established (+91)11-23978046 as HELPLINE NUMBER: @drharshvardhan on measures taken by Government pic.twitter.com/GQqgWYC9SO
— PIB India (@PIB_India) January 28, 2020
Back to the original post.
The coronavirus will hit all sorts of industries that benefit from Chinese travel, from oil to airlines to hotels, and a hit to Chinese growth and business activity will have knock-on effects. For instance:
— Reuters (@Reuters) January 28, 2020
And finally, the practical advice for staying healthy, aside from hiding at home and ordering in. Bear in mind the risk of infection in the US right now is effectively nada, but this is worth keeping in mind if that changes:
How to protect yourself from Wuhan coronavirus:
– Avoid close contact with anyone showing symptoms of respiratory illness
– Cook food thoroughly
– Wash your hands
– Cover your mouth and nose when you cough or sneeze
– Wear a surgical maskhttps://t.co/agYkeaKKyZ
— CNN International (@cnni) January 28, 2020