Coronavirus: Go Forth and Multiply

Yves here. One might argue that Ilari has chosen the most alarming information about the coronavirus and then written a post about it. However, it does appear that some reports contain bad facts that haven’t gotten the attention they warrant.

It is apparent that the Chinese don’t have a good vantage on their own problem. The hospitals are full. Many people who are sick are quarantined at home. And it’s been found that people who have gotten the coronavirus can test negative, even repeatedly, and then test positive (my impression is after they become symptomatic). So even with universal testing, there would still be a great uncertainty as to how many people had contracted the coronavirus.

And on top of that, the Chinese have incentives to misrepresent if coronavirus propagation isn’t slowing.

For a mainstream report that echoes Ilargi’s downbeat take, consider As Wuhan’s desperate and sick beg for help, China shuts them down from the Guardian a few days ago. Key bits:

I got to know [Dr.] Song [in Wuhan] when I was helping a medical supplies donation group. He was not the only one pleading for help via social media – I was contacted by dozens of medical workers, who all described a desperate situation. I also received a lot of pleas for help from patients. They had been waiting in packed hospital lobbies for days, in fear of being left untested, untreated and ultimately dying from what is now officially called Covid-19. Some people had felt ill for almost a week, and in that time, their family members had started to feel ill as well. But they had a long wait to be diagnosed and treated….

On Weibo, one of the biggest social media platforms in China, there is a group of more than 150,000 people – mostly patients and their families – asking for help. Reading through the posts, it’s clear there is a shortage of everything. Many people have to decide whether to prioritise their mother or daughter, grandson or grandfather, wife or husband….

In mid-January, a nurse told me that medical workers in Wuhan had been advised to not wear protective gear to avoid causing panic. Later, Song told me that medical workers had been advised not to appeal for help on public media outlets. Now 1,700 medical workers nationwide have been infected.

Finally, Ambrose Evans-Pritchard of the Telegraph predicted earlier this month, that China could not contain the virus without sacrificing its economy, and it would choose the latter over the former. But China could wind up with a lose/lose. Will enough container ship operators and airlines trust China’s claim that things are getting better, given that they must have figured that China can’t be sure of the truth of the matter and has powerful incentives to downplay a bad trajectory, if that’s the way things appear to be going. So China could free up internal movement yet have foreign transport companies remain leery of resuming service until they have more proof than just the government’s word.

Having said that, Ilargi relies on ZH twice, the second time ZH quoting a supposed story in the Taiwan Times…..which I have been unable to find in multiple Google searches or in searches on the Taiwan Times site proper. The claim it makes isn’t critical to Ilargi’s piece. In the interest of not propagating potential misinformation, I have removed that section, and indicated where it sat with […..].

By Raúl Ilargi Meijer, editor of Automatic Earth. Originally published at Automatic Earth

A few days ago, I was thinking of writing another coronavirus article, focusing on two things: 1) the ease and speed with which the virus spreads -because I think that is hugely underestimated-, and 2) testing. But then the situation with the two cruise ships started going berserk.

I had intended to use the Diamond Princess as a case for the ease and speed of infection, but it became clear quite rapidly that you can’t use the ship to prove any case, other than that people are completely nuts. But we already knew that. And while Dostoyevsky wrote some great books on the topic, it’s not a great framework for a piece on a virus. Unless perhaps if it infects the brain.

Not that I don’t think the ship is still a good example to make the point, but too much plain bonkers stuff has been going on with and around it. The quarantine, the evacuations, the infection numbers, you name it. I’ll get to the testing later, that was/is a whole other chapter.

A problem, if you’re me, with letting an essay simmer for a bit, is that ever more sources start accumulating, until there’s too many to either comprehend or use in an effective way. First thing to do is not to wait another day. Let’s start with 1) The ease and speed with which the virus spreads, aka transmissibility, and see where we land.

1) The ease and speed with which the virus spreads

People continue to have this idea that COVID19 isn’t all that bad, yada yada, an “analysis” crowned by the comparisons to seasonal flu. Which make no more sense then to compare it to bovine flatulence. Stop it.

The way and extent the virus was spreading aboard the Diamond Princess became clear before the evacuation efforts. The US government, and others, were watching it happen, and pulled the plug. What the Japanese were doing and thinking is less clear. It’s sort of fun to see Washington refrain from calling Tokyo on it, best allies and all, but it makes you think at the same time.

So if using the Diamond Princess is not a good example, we need to look elsewhere. This Feb 16 Zero Hedge graph of infections outside China might be a good start. Whether it represents an exponential or a quadratic function is sort of an inside joke by now, but it’s clear enough in either case.

Even more obvious perhaps is this from the South China Morning Post (SCMP):

Coronavirus Up To 20 Times More Likely Than Sars To Bind To Human Cells

The deadly new coronavirus is up to 20 times more likely to bind to human cell receptors and cause infection than severe acute respiratory syndrome (Sars), a new study by researchers at the University of Texas at Austin has found. The novel coronavirus and Sars share the same functional host-cell receptor, called angiotensin-converting enzyme 2 (ACE2).

The report, published on the website bioRxiv on Saturday, said the new coronavirus had around 10 to 20-fold higher affinity – the degree to which a substance tends to combine with another – for human ACE2 compared with Sars. But the researchers added that further studies were needed to explore the human host-cell receptor’s role in helping the new virus to spread from person to person.

“Compared with SARS-CoV, 2019-nCoV appears to be more readily transmitted from human to human,” the report of the study said. “The high affinity of 2019-nCoV S for human ACE2 may contribute to the apparent ease with which 2019-nCoV can spread from human to human.”

The ACE2 receptor has already been reported as being much more prevalent among Asian people, but please don’t presume the buck stops there. Non-Asians have them as well, and we’re not even sure what role they play, or if fewer of them would protect you from being infected. Allegedly, smokers have more ACE2 enzymes as well. As do older people.

Another transmissibility example is the death of an entire family in Wuhan:

Virus Kills Chinese Film Director and Family in Wuhan

A Chinese film director and his entire family have died from the novel coronavirus in Wuhan, the epicenter of the outbreak. Chang Kai, a film director and an external communications officer at a Hubei Film Studio subsidiary, died in hospital on Feb. 14 from the virus now called COVID-19, according to a statement from the studio. He was 55.

But Chang’s death was not the first in his family—the Chinese media reported that Chang’s father and mother were infected and died one after the other. Chang and his sister, who looked after their parents at home, were both infected with the virus as a result. His sister died just hours later. Chang’s wife is also infected, still alive, and is still battling the virus in an intensive care unit.

But everything above loses most of its meaning compared to the following, also from the South China Morning Post. You might want to sit down for this one.

Until now, ‘accepted knowledge” is that the first death from COVID19 was registered on January 9, 2020, a 61-year old man in Wuhan. And that the incubation time for the virus was maximum 14 days – hence the 2-week quarantines everywhere. No more.

The government of Xinxian county, in the city of Xinyang, on Sunday reported that one of its new cases had been confirmed 34 days after the patient returned from a mid-January visit to Wuhan.

He had been sent to hospital with suspected symptoms on January 28, but twice tested negative before testing positive on February 16. A further two people who attended family gatherings with the man in Xinxian were reported as infected, while three were suspected cases or under hospital quarantine.

The county government announced it would extend the home quarantine period from 14 to 21 days for residents who had been to Hubei or had contact with people who had been there.

It also reported a case that was confirmed 94 days after the patient’s contact with a relative from Hubei. The patient had taken care of his father-in-law, who arrived from Wuhan on November 13 and died days later.

The son-in-law continued to stay in the father-in-law’s house until January 31. However, the government statement said the origin of the son-in-law’s infection had yet to be identified. Zhuhai, in the southern Guangdong province, last week reported two cases with incubation periods longer than 14 days. Similar cases have also been reported in Anhui and Shandong provinces.

This potentially pushes back the first known case to November 13, 2019 and the first known death to November 13 and change. “Died days later”. Shall we say 4-5 days? That means the first fatality was November 17-18. While incubation time may have been pushed forward to 94 days.

 

2) Testing

The most important term coming out of the coronavirus news, going forward, will be “false negative”. Closely followed by “asymptomatic”. There are tons of stories about people testing negative 2-3-4- times before testing positive. And also tons of stories about people with no symptoms infecting others. It’s all about the things you don’t see.

The Chinese had it about as wrong as can be early on, and knee-jerked into the Party deny and hide mode. They have it right now, though: the only way to keep the virus from spreading is to limit contact between people, even if that may seem to reach extreme proportions. If there is no vaccine, there is no other way. But if it’s just the Chinese that do isolation, that solves nothing.

When I first read that the passengers of the Holland-America Line cruise ship Westerdam had been allowed to leave the ship when it landed in Cambodia a week ago after, I think, 9 days of floating around aimlessly, I thought this was a “Go Forth and Multiply” message for the virus. Second thought was: who’s in charge here? Still wondering about that one.

The Westerdam had 2,257 people on board, 1,455 passengers and 802 crew. They were not allowed to dock anywhere after a man who had gone off board in Hong Kong tested positive. As we speak, some 255 passengers and 747 crew members are still being held on the ship while further testing was conducted. That means 1,200 passengers and 55 crew have left the ship. Cambodia let lots of them fly to Malaysia, and they flew all over from there.

And only then did they discover an 83-year old American woman who had already flown to Malaysia had tested positive. The ship had a lot of Americans (400?) , Canadians and Dutch people on board. Where did they go? Mostly home, of course. And now all those countries are scrambling to locate these people. Even if they do, who have they infected in the meantime? They’ve been in close proximity to others, like on planes.

And, again, who’s in charge? Did the Holland-America people, and the Cambodian government, keep in constant touch with the WHO and the Chinese? Would it have made any difference if they did? Or is it as bad as it seems, a Wild East sort of set-up with everyone fending for themselves?

What are the odds that someone in the Cambodian government now has a new offshore bank account with $10 million in it, in a deal made before the 83-year old American woman tested positive, in exchange for letting the ship dock and making sure the passengers would leave ASAP?

Hard as it may seem to imagine, the Diamond Princess may be, and have been, even more of a mess than the Westerdam. Someone said: “it was a mess on board, and the mess is now moving off board”. And now we have the first 2 fatalities from the ship.

Diamond Princess: everyone confined to their cabins, little interaction, but still in the past week numbers of new infections have exploded, with many dozens of new cases every day. So now we have a total of what, 500-600 new infections ever since the US said: enough!

Why were they, why were larger numbers, not discovered earlier? Well… There were 3,711 people on board. 5-6 days ago, 10-12 days after the first positive test, 1,219 had been tested. Which means that after 10+ days of quarantine, less than a third had actually been tested. As of Monday, 2,404 passengers and crew, out of the 3,711, had been tested. That still left 1,300. Many of whom are now gone.

The remaining 61 American passengers on the Diamond Princess who opted not to join the evacuation will not be allowed to return to the US until March 4, according to the American embassy in Tokyo.

Undoubtedly some logic behind the lack of testing until recently will be offered by Tokyo, but you must wonder how many of the 542 new cases of the last four days had been tested at all, and how long some of them had been infected, probably without showing any signs. For instance, the 14 cases on the flights to the US this week were all asymptomatic virus carriers. All of them, according to official channels.

And now we read that Japan has no intentions of quarantining its citizens who were on board the Diamond Princess:

Earlier in the week, the United States evacuated more than 300 nationals on two chartered flights. A State Department official said there were still about 45 US citizens on board the cruise ship as of Thursday. Americans flown back will have to complete another 14 days quarantine, as will returning Hong Kong residents. Disembarked Japanese passengers, however, face no such restrictions, a decision that has sparked concern.

[…..]

We will now start to see the economic effects (you haven’t seen anything yet in that regard). More on that later. Rule of thumb: companies have 1-2 weeks of supplies in stock. Just-in-Time. Then they need more delivered. But the Chinese economy is on its last legs. Please don’t think it’s about Apple or some other major company. This is about a million smaller companies and (chain) stores in the west. What was it, 80% of US drugs come from China? Or was that just antibiotics?

There are ways to minimize the damage a virus can do. Mankind as a whole, in the places where the proverbial chain literally is as strong as the weakest link, has not minimized it. Instead it has told the virus: “Go Forth and Multiply”. Prepare accordingly. If we’re lucky, this will die down and pass. But that’s the problem: it’ll happen only if we’re lucky, not because we’ve done all we know we could.

 

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118 comments

  1. Roland

    I notice that quite a bit of ZH’s coronavirus coverage cites Epoch Times, a source which is quite hostile to the PRC government. That’s not to say their information is necessarily false, but Epoch Times is definitely biased.

    Reply
    1. rjs

      i had seen the Taiwan Times story when it came out, and also figured it to be hostile to the PRC government and thus suspect…the fact that they pulled it quickly was confirmation enough for me..

      Reply
    2. RBHoughton

      Indeed, Epoch Times is the organ of the Fa Lun Gong, a Taiwanese quasi-religious group managed in New York. Its given away free here in HK.

      Reply
  2. PlutoniumKun

    A couple of days ago it seemed we might be turning a corner. At least one reputable study indicated that the peak is within a week or two away if not sooner. But now it looks much worse.

    The chaos over the two cruise liners is shameful. Its hard not to see that the Japanese are prioritising the Olympics over everything. In doing so they may have made a bad situation catastrophic. If there is one silver lining, this could be the end of Abe once everything washes out.

    Very bad news from South Korea – there has been a huge rise in cases in Daegu – 156 now.

    I think the big hidden possible problem is the Middle East/Central Asia. Those two deaths in Iran, a country with supposedly only 2 cases, looks particularly ominous. Its still winter there, and wet, perfect conditions for a rapid spread. There is no way the countries of that region can cope, they simply don’t have the resources or administrative capacity.

    Peak Prosperity is an interesting youtube channel, which along with ADVChina, has been discussing this in depth. The worst case scenario is that Covid-19 behaves like dengue – whereby it can be far more dangerous on a second infection – essentially, the existing antibodies can be hijacked to allow easier access to the cell. Its purely speculative now, but if true, it could become endemic and a huge killer over the years – it would be the new TB (or the new Dengue, for those countries still plagued by that disease). This is just speculation now, but credible enough IMO to be a major worry.

    What we’ve seen repeatedly by authorities all over the world is that in the name of suppressing panic they’ve refused to take the reasonable worst case scenario of long gestation periods for the disease and have relied on the efficacy of very new and unproven testing kits. This ‘caution’ may well kill millions.

    Some have noted that stock markets seem remarkably sanguine about this. I think they are still betting on a short sharp impact with no medium to long term effect. They may lose that bet. If SK and Japan have to go into emergency quarantine along with China then the worlds economy in 6 months time will be 2008 all over again, maybe worse.

    Reply
    1. PlutoniumKun

      There is always a bright side – as soon as I posted this I got a banner ad for ‘up to 82% reductions on holiday cruises worldwide’. Lol, as the kids would say.

      Reply
        1. MLTPB

          Some Americans asked to be evacuated soon after the quarantine on that ship.

          They were dismissed by some as showing ‘exceptionalism’

          Reply
    2. Winston Smith

      And what about Africa?
      There is a significant Chinese presence in many countries and there’s no question coronavirus would be a daunting challenge for these countries. The official count is one case reported in Egypt (!).
      As for the stock market, all Mr Market wants to do is to use his “hand” to pleasure himself so I don’t see that a real indicator of what may be.

      Reply
      1. PlutoniumKun

        Africa and India (and maybe Indonesia too) are big unknowns. If they are lucky, and the theory that the virus doesn’t spread very well in hot humid conditions is true, then they may get away relatively lightly. Africans also smoke a lot less than the Chinese, and it does seem that smoking may be a significant contributor to mortality, so again, its possible they could get lucky in this.

        Reply
        1. Scott D

          I don’t think it’s the heat, but rather the higher UV levels from a higher sun angle. UV-C is rather good disinfectant.

          Reply
            1. vlade

              IRC, Singapore is hot a humid. Humid = high water content in the air. Water is a good UVC filter/reflector.

              UVC sterilisation requires low humidity.

              Reply
        2. Code Name D

          I keep wondering if air pollution might be relevant here. If so, that the virus would seem to even target industrial zones.

          Reply
            1. Wukchumni

              For what it’s worth, Pittsburgh had the most deaths from the Spanish Flu of any city in the country on a per capita basis, and it sure looked like many places currently do in China once upon a time with all that pollution constantly in the air above.

              Reply
              1. Susan the other

                I read the statistic about how long it took for the Spanish Flu to wear itself out. Something like 3 or 4 years. Just the epidemic itself. But the effects on its victims could become sub-chronic and kill them slowly. No indication that people caught the SF more than once as we have heard @ Corona19. And nobody really knows where it started – I read one speculation that it first showed up in Iowa among the first recruits to be sent to Europe c. 1917.

                Reply
                1. Wisdom Seeker

                  I just reread “The Great Influenza” by John Barry, and it argues that there were (delayed) reinfections during 1919 pandemic flu. But not quite like what we’re hearing about with today’s coronavirus.

                  In the 1919 pandemic, the first wave in spring 1918 was bad, but didn’t spread too far. Then over the summer the virus mutated and evolved and became much worse. Some people who had been sick in the first wave were sick again, much worse, in 1919-1920. Now, to be fair, there could have been other flu strains circulating, and they didn’t have working RT-PCR DNA testing in 1919. (But then again, we don’t seem to have that either, just yet.)

                  The inability to test reliably for coronavirus is a real problem. Perhaps 2019-nCoV is also a “mutant swarm” and not a single consistent RNA molecule. Or perhaps there’s a different pathogen in play which isn’t being tested for at all, and the coronavirus is merely along for the ride? The Influenza book talks at length about how most researchers in 1919 had a faulty belief that a particular bacterium caused influenza, and wasted a lot of effort trying to make a vaccine or antibody serum against it, before concluding that they were wrong (and then much later identifying the virus).

                  Reply
              2. MLTPB

                Look up Three Funaces of China, Wikipedia.

                Wuhan is one if the three, along with Chonqing and Nanjing, per popular opinion, but slightly different per meteorologists.

                The summer weather there is oppressively humid.

                Not sure where Wuhan is relative to other cities in China wrt winter weather.

                Reply
        3. xkeyscored

          the virus doesn’t spread very well in hot humid conditions
          So far as I can make out, there’s no hard evidence it doesn’t spread in hot conditions, though it does look that way.
          However, there is evidence that it likes humid conditions.

          Reply
          1. MLTPB

            Watch out for the coming furnace summer in Wuhan then though I tend to think of dryness near a furnace. Perhaps they need a better word.

            Reply
            1. xkeyscored

              I was a bit rushed before, but here’s a link. The research was conducted on other coronaviruses before this recent outbreak.
              “Low temperature and high air humidity further increase their lifespan,” says physician Günter Kampf at the Greifswald University Hospital.
              The results were originally bound for a future textbook, but under the circumstances, the authors felt it was best to publish their findings in advance. They think the results might also extend to the COVID-19 virus.
              https://www.sciencealert.com/study-shows-just-how-long-coronaviruses-can-stick-around-on-a-surface
              Full text of original paper:
              https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext
              “The aim of the review was therefore to summarize all available data on the persistence of all coronaviruses including emerging SARS-CoV and MERS-CoV as well as veterinary coronaviruses such as transmissible gastroenteritis virus (TGEV), mouse hepatitis virus (MHV) and canine coronavirus (CCV) on different types of inanimate surfaces and on the efficacy of commonly used biocidal agents used in surface disinfectants against coronaviruses.
              … it was shown at room temperature that HCoV-229E persists better at 50% compared to 30% relative humidity “

              Reply
        4. David

          Not all of Africa is hot and humid, of course. Ethiopia, for example, is high and often dry (19 degrees in Addis as I write this, according to the BBC). And much of the continent is arid. It very much depends where the links with China are. If you believe Wikipedia the largest Chinese communities in Africa are in Ghana and South Africa, which couldn’t be more different as regards climate. It’s late summer in South Africa now, getting towards autumn.

          Reply
    3. Phillip Allen

      A couple of days ago it seemed we might be turning a corner. At least one reputable study indicated that the peak is within a week or two away if not sooner. But now it looks much worse.

      I am reminded of the first decade of the HIV pandemic (a glacial, slow motion thing compared to COVID19), when the unknown vastly outweighed the known. Promising, well-vetted research would be a ‘light at the end of the tunnel’ until, 6-12 months later further research would put out said light. This new creature is fast and frisky enough to to be an uncatchable moving target for a good long while, and could well be Brother Gibson’s fabled Jackpot. [Cue radio announcer’s voice, We’re witnessing history today here, folks!]

      Reply
      1. JBird4049

        That slow moving nature just added to the fun and horror as well as the lack of effort by the federal government to do anything. I think that this also is possibly an aspect of Corvid-19. It can be years before it progresses to AIDS while still being infectious and the symptoms can mimic thing at first.

        Reply
  3. Lambert Strether

    I recall (too lazy to find the link; I think Singapore) that another piece of 19th century advice on COVID-19 is to keep windows open. But it’s hard to do that on a cruise ship. From the CDC, “Guidance for Cruise Ships on Influenza-like Illness (ILI) Management“:

    Commercial maritime travel is characterized by the movement of large numbers of people in closed and semi-closed settings. Like other close-contact environments, these settings can facilitate the transmission of influenza viruses and other respiratory viruses from person to person through droplet spread or potentially through contact with contaminated surfaces.

    This applies to the Chang example as well.

    That said, if I understand what the Japanese government did, they let the Japanese passengers loose in the general population with no quarantine. What did they, do, take the (enormous and notoriously jam-packed) subway home?

    Seems demented… Ilargi’s question — “Who’s in charge here?” is a good one. I suppose the answer is Mr. Market. Some may not find that re-assuring….

    Reply
    1. PlutoniumKun

      I was talking about this recently to a friend who knows Japan much better than me. There is an assumption – in most cases fully justified – that Japan is a very well oiled machine and super competent when dealing with ‘predicted’ disasters, such as earthquakes and volcanic eruptions. However, as is well known (it may be a cliché, but that doesn’t mean its not true), the rigidity of its administrative structures means its response can be very slow and chaotic when an ‘unknown unknown’ hits. Quite simply, if nobody has been identified before hand to be in charge, nobody will take the initiative and do things.

      We saw that with the Fukushima reactor (everything else about the tsunami response was generally very good), and the bungling that led to unnecessary loss of life when JAL 123 crashed, or the Kobe earthquake unexpectedly revealed construction faults in boom years structures.

      My guess is that the Japanese have assumed that viral outbreaks are someone elses problem and simply didn’t prepare for something like this. When nobody is in charge in Japan, and there is no fixed plan, nobody will ever take responsibility. Ultimately, of course, the buck stops with Abe.

      Reply
      1. David

        I think that’s a very fair comment about Japan, and, in my experience, it’s broadly true of most “Confucian” countries. Where respect for procedure and hierarchy is ingrained, people tend not to use initiative but to wait for instructions, and in the absence of instructions to do nothing. Such societies cope extremely well with routine, but much less well with emergencies for which no plans exist. It’s less a question of doing the wrong thing (as might be the case in the West), and more a case of doing nothing at all. If you’ve flown much around Asia you will have encountered the problem in a more banal form: flights are on time, staff are helpful, aircraft are clean and modern, but when flight delays occur, it can be hard to get any sense out of the ground staff.
        Don’t forget also that “responsibility” in Japan means something a bit different from how we see it in the West. After the JAL 123 crash, the chairman of JAL resigned, not because what had gone wrong was in any sense his “fault”, but rather that it was his “responsibility”: senior figures in such organisations know that they will be sacrificed as part of a ritual if something goes wrong. Abe may well be forced to resign if things get much worse, but that will be a ritual act of expiation on behalf of the government as a whole. In a society which proceeds by consensus and takes a long time to reach conclusions, it’s often unclear who, if anybody, is really in charge.

        Reply
        1. MLTPB

          I’d like to see some comparative studies on Chernobyl (communist) Katrina (market), and Japan (Confician) crisis responses.

          Reply
        2. Cuibono

          agree 100% on this. Multiple trips into Narita can confirm it. the further OUT of ordinary one strays the bigger the mess.
          Once we diverted frm Haneda to Narita. it took ground 4 hours to agree to let us off the plane at Narita. by the time we did, all ground transportation was closed.

          Even worse was the cluster$%^ that was the typhoon pre World cup Rugby…passengers stranded at Narita for endless hours and days with no food or water

          Reply
  4. Foy

    The reason why the Diamond Princess hasn’t tested everyone is that the Japanese did not have the capacity to test everyone of the ship, so they have only been testing those who have shown symptoms. Dr John Campbell, an A&E teaching PHD nurse, who has been doing daily updates on youtube for a while suspected this about 10 days ago, before Japan confirmed this recently. Campbell expressed concern that a 1st world country does not have the capacity to do this.

    A Japanese professor of epidemiology, Kentaro Iwata, who had been on the ground with ebola, SARS and cholera patients previously and said he had never been scared then as he knew how to prevent infection , when he was finally allowed on the Diamond Princess a few days ago said he was never so scared before about getting infected as on this ship. There was no infection control on ship, no officer for infection prevention, no green and red zones separating the infected areas. He put up a video about what he saw on the ship, it has been taken down, but reposted by others. Professor Iwata also said in the video Japan has no Centre for Disease Control (CDC). It’s really interesting to hear what he saw on the ship and what he had to say, from someone who knows exactly what he is talking about. He was very worried and and I hate to say ‘scared’ about getting infected himself and subsequently infecting his family, but that was the word he used in the video….

    https://www.youtube.com/watch?v=SjGEGMLs4TE

    Reply
  5. Ignacio

    This is it. Very high infectivity means that you can be infected with a very small load. Then you have a first incubation period for, may be a few days. This could explain why many show no symptoms and many infected are negative by NATs. If you have small localized infection the sampling can easily skip the initial site. The EU CDC recommends sampling in both nose and throat, and the sampling should be as extensive as possible.

    Reply
    1. polecat

      So, as I mentioned several days ago, a contract-for-hire cruise ship comedian essentially escaped hotel quarantine in Cambodia, caught a flight(s) (transfers ??) back to the U.S., whereby he rented a car in Seattle, to complete his exodus back to Eugene, Oregon !!

      So where’s the proper follow-up on this individual e.i. relevant authorities, CDC, State of Oregon, local medical establishment, etc. ?
      So far, I haven’t seen it. And now, it appears that a BC woman returning from Iran has been shown to be positive for Covid19 ! HER whereabouts, at least, are being seriously tracked, to determine who else she may have come in contact with. The fellow from Eugene — All I hear are ..crickets !!

      Reply
      1. Unfinished

        polecat, the complete lack of proper follow-up on this person does not auger well for containment of this virus in the US. The story was initially covered by a number of news outlets in the days just after his return, and then nothing. The nonchalance with which this is being treated is terrifying when one considers the possibility of a super carrier wandering unchecked amongst us.

        Reply
      2. Dirk77

        What is your source? A sister lives in Eugene and she could alert the authorities. They usually don’t have much to do and should get right on it. Thanks.

        Reply
  6. Eustache de Saint Pierre

    He is correct about the small companies right down to those who use the shared container service which is still going strong, of which one fella in England I knew made a small fortune in setting this service up & he was only one of many.

    Even without the obvious mountain of Chinese imports, very many products at least in England in Ireland are not labelled as such, because they either lie or in Ireland were allowed to get around it by simply re-packaging it – although I do know of one once thriving SME & small town employer which is now basically just a distribution centre, who don’t even bother with that.

    It could perhaps if things get really bad lead to an eventual return of home based manufacturing, but at the cost of a massive human tragedy – Nemesis has an often gigantic blunderbuss approach.

    Reply
  7. giantsquid

    “The ACE2 receptor has already been reported as being much more prevalent among Asian people, but please don’t presume the buck stops there. Non-Asians have them as well, and we’re not even sure what role they play, or if fewer of them would protect you from being infected. Allegedly, smokers have more ACE2 enzymes as well. As do older people.”

    I wish that the author had presented a reference for this assertion since an article recently submitted to https://www.medrxiv.org/ suggests that there is no difference in ACE2 gene expression between Asians and Caucasians nor between those under and over 60. It does site differences in ACE2 gene expression levels in the lungs of smokers, former smokers, and non-smokers as well as in the specific cell type ACE2 is expressed in as relates to smoking history.

    https://www.medrxiv.org/content/10.1101/2020.02.05.20020107v2

    “Bulk and single-cell transcriptomics identify tobacco-use disparity in lung gene expression of ACE2, the receptor of 2019-nCov”

    “We didn’t find significant disparities in ACE2 gene expression between racial groups (Asian vs Caucasian), age groups (>60 vs <60) or gender groups (male vs female). However, we observed significantly higher ACE2 gene expression in former smoker's lung compared to non-smoker's lung. Also, we found higher ACE2 gene expression in Asian current smokers compared to non-smokers but not in Caucasian current smokers, which may indicate an existence of gene-smoking interaction. In addition, we found that ACE2 gene is expressed in specific cell types related to smoking history and location. In bronchial epithelium, ACE2 is actively expressed in goblet cells of current smokers and club cells of non-smokers. In alveoli, ACE2 is actively expressed in remodelled AT2 cells of former smokers."

    The author of this manuscript concludes that:

    "Together, this study indicates that smokers especially former smokers may be more susceptible to 2019-nCov and have infection paths different with non-smokers."

    Reply
    1. vlade

      There was an original study which was widely cited. The only problem with it was that it had a sample of 8 (IIRC), which included no white male at all.

      Even the study you cite has problems, as it’s based on lung tissue of lung cancer patients (which can be readily had, unlike hundreds of wide samples of healthy lung etc..)

      So, we’re still in the dark.

      Reply
      1. giantsquid

        Thank you.

        A study posted online on February 18th in a preprint, not yet peer reviewed, suggests that tumorigenesis does not effect ACE2 expression. In any case, it seems there may be a more definitive answer to the question forthcoming.

        https://www.preprints.org/manuscript/202002.0258/v1

        “Asians and other races express similar levels of and share the same genetic
        polymorphisms of the SARS-CoV-2 cell-entry receptor”

        “The recurrent coronavirus outbreaks in China (SARS-CoV and its relative,
        SARS-CoV-2) raise the possibility that Asians are more susceptible to coronavirus.
        Here, we test this possibility with the lung expression of ACE2, which encodes the
        cell-entry receptor of both SARS-CoV and SARS-CoV-2. We show that ACE2
        expression is not affected during tumorigenesis, suggesting that the transcriptome data
        from the more than 1000 lung cancer samples in The Cancer Genome Atlas (TCGA)
        can be used to study ACE2 expression among people without cancer. The expression
        of ACE2 increases with age, but is not associated with sex. Asians show a similar
        ACE2 expression to other races. Furthermore, the frequencies of ACE2 alleles in
        Asians are not significantly deviated from those in other races. These observations
        indicate that individuals of all races need the same level of personal protection against
        SARS-CoV-2.”

        Reply
    1. Susan the other

      makes me wonder a couple of things: are there varieties of Corona19, some more resilient – like bacteria – so that those survivors can start up again; and two, are there less harmful medicines to take as you fight off Corona19 but they take twice as long – so assuming here that the medicines are just as harmful as the disease for some people. Also, they say (not sure who) that you can’t catch the flu if you already have a viral infection – this implies antibodies are the best medicine and the news stories lately include serum (of those recovered) injections that seem to be working…

      Reply
    2. Samuel Conner

      the bit about “antibodies making it worse” got my attention.

      “makes it worse” in what sense? More detail would have been helpful. I hope that what is meant is that the improved immune response (itself a good thing in terms of clearance of the new infection) has undesirable consequences in patients with weakened cardiac function. Given that the locus of the infection and immune response is respiratory, perhaps heightened inflammation produced by the immune response to the reinfection is what leads, in patients with damaged hearts (and perhaps also in healthier patients?) to the heart failure.

      This might also help to make sense of the anecdotal reports of people “dropping in the streets”. From my own anecdotal family history, people with heart failure can decompensate suddenly and quickly collapse.

      I really don’t like wondering what the news means, but it seems likely that they’re going to have to find medications that don’t injure the patients.

      Reply
      1. Pespi

        Antibodies making infection worse is a key part of viral infection. think of the common prescription of steroids for infections

        Reply
    3. Cuibono

      This has been my working hypothesis and explains a lot about the patterns we see so far:
      esp the young versus old hypothesis.

      Dengue for example rarely kills on your first infection. It is subsequent infections that tend to result in DHF.

      Perhaps Wuhan has seen 9 likely indeed ) older waves of these infections. If so, the elderly might have some immunity which rather than conferring protection, leads to more serious outcomes.

      Reply
  8. The Rev Kev

    This is appalling news about how long the incubation period is. But even worse was that tidbit about Japan cutting all those people loose to scatter to all of Japan. Seriously? Lambert’s transport map just put a dirty big underline under it. How many infected people were there? How many surfaces did they touch? Were they in crowds? I think that at this point that Japan can kiss the Olympics goodbye. If somebody gave me free tickets including bed & board and transport I would refuse to go. Abe can commit seppuku at this stage for all the difference that it would make. He had his chance to shine and he blew it.

    While reading Yves’s article, a movie scene flashed in my mind from the film “The Towering Inferno”. It was where Steve McQueen tells Paul Newman “It’s out of control, and it’s coming your way!” I am calling it as being widespread before the end of the year. In fact, I would not be surprised if a few commenters will from time to time post that they have caught Coronavirus and will let everybody know how it goes and what it is like. The worse of it is that neoliberalism has weakened so many governments that they will find it difficult to cope and will keep on trying to find ‘market’ solutions to this problem. Just watch out that to avoid infections in the Presidential elections, that Washington comes up with an app to vote with this November that has been developed by Homeland Security and tested by the Pentagon.

    Reply
    1. MLTPB

      There are also millions who left Wuhan before the lockdown with about a week before the US travel bans. Other nations did the same after that, which BEIJING accused the US of over reacting and spreading fear.

      Many of those millions could be anywhere in the world now.

      Reply
    2. Tony Wright

      And I wonder if that is the case, the app will mysteriously malfunction if the B. Sanders button is pushed by the voter…..Speculation, I know, but these are uncharted waters in so many different ways.

      Reply
  9. ObjectiveFunction

    Sitting in my breezy plague tower in Singapore (where social distance has placidly but noticeably increased), I have opened my Boccaccio for the first time since college:

    From these things and many others like unto them or yet stranger, divers fears and conceits were begotten in those who abode alive, which well nigh all tended to a very barbarous conclusion, namely, to shun and flee from the sick and all that pertained to them, and thus doing, each thought to secure immunity for himself.

    Some there were who conceived that to live moderately and keep oneself from all excess was the best defence against such a danger; wherefore, making up their company, they lived removed from every other and shut themselves up in those houses where none had been sick and where living was best; and there, using very temperately of the most delicate viands and the finest wines and eschewing all incontinence, they abode with music and such other diversions as they might have, never suffering themselves to speak with any nor choosing to hear any news from without of death or sick folk.

    Others, inclining to the contrary opinion, maintained that to carouse and make merry and go about singing and frolicking, and satisfy the appetite in everything possible, and laugh and scoff at whatsoever befell was a very certain remedy for such an ill. That which they said, they put in practice as best they might, going about day and night, now to this tavern, now to that, drinking without stint or measure; and on this wise they did yet more freely in other folk’s houses, so but they scented there aught that liked or tempted them, as they might lightly do, for that every one—as he were to live no longer—had abandoned all care of his possessions, as of himself, wherefore the most part of the houses were become common good and strangers used them, whenas they happened upon them, like as the very owner might have done; and with all this bestial preoccupation, they still shunned the sick to the best of their power.

    In taberna quando sumus (not Orff)

    Penitenzagite!

    Reply
  10. Scott D

    The abbey was amply provisioned. With such precautions the courtiers might bid defiance to contagion. The external world could take care of itself. In the meantime it was folly to grieve, or to think. The prince had provided all the appliances of pleasure. There were buffoons, there were improvisatori, there were ballet-dancers, there were musicians, there was Beauty, there was wine. All these and security were within. Without was the “Red Death.”.

    Reply
  11. OwenFinn

    Unfortunately, the building I work in in Yokohama, The Sky Building, seems to be the main disembarkation point for passengers being bussed off the cruise ship. This afternoon I took the elevator down to the lobby and was shocked to see it crowded with suitcase pushing passengers from the ship. Some stopping into Starbucks for coffee! Outside at street level groups of reporters were crowding around passengers for interviews as they got off the buses. There will be no extra quarantine at all for these people without symptoms(yet) – just suggestions to stay home as much as possible and to avoid crowds. Seems pretty apparent that the government has decided that there is no hope of containment and to let just let the disease run it’s course.

    Reply
  12. vlade

    I’ll repeat part of what I posted at Lamert’s “bad bet” stuff.

    The mortality rate right now, if one looks at official numbers (whatever they are these days) is about 2%.

    But, when one looks at teh WHO study of Chinese patients, the numbers are way worse. 80% of cases are mild, 14% with complication (which I translate as “require hospitalisation”), 5% “serious complications” (which, given it includes things like septic shock, multiple organ failure etc., I class as “requires intensive care”), and 2% mortality (for a total of 101%, so ignore some rounding).

    The problem is that this is 2% mortality when IC and hospital care is available (at least sort of). The 5% requiring intensive care would, in case of epidemics, turn into mortality pretty much straight away. US has 100k IC beds, UK has 5k (yes, you read it right, five thousands, give or take a few), so if you’d have 50% infection rate (ignoring re-infection), say 30m in the UK, you get 1.5m in the UK ALONE. that require intensive care or die. In a country with 5k beds. 300 times less than would really be needed (mind you, not that any nation could have that many beds, even germany has only about 30 beds/100k, so only 167times less than needed).

    So, if the rates are like the WHO puts in, then we’re in for Black Death mk 2000.

    There can be a good spin on this though. Which is if the Chinese are as bad as getting the real data as most people think they are (intentionally or not), if there virus is already out there in Pakistan/Iran/wherever and we’re not seeing massive die-offs, then chances are that the actual infected rate is massively higher than the 70k that we expect. Hence the mortality numbers etc. could be way lower than what we’re presented with.

    The problem is, we don’t know, and we likely won’t know until it’s too late.

    In other news, I was surprised that WHO prioritised the tests/studies of the various retrovirals mentioned in a study that has been linked here a couple of days back, but not the chlorquine that was mentioned in the same study and the study found it effective too. I’d really like to know why is that.

    Reply
    1. MLTPB

      In the UK example, perhaps not all 1.5 m need a bed at the same time.

      And your comment seems to suggest it not so much M4A but the health system of a nation being overwhelmed.

      Reply
      1. vlade

        sure, it won’t need all 1.5m beds, that was for effect. But with 5k beds, it’ll still get overwhelmed quickly. US 100k beds is unevenly distrubuted over geography, so again, I’d expect it to be overwhelmed.

        And yes, IF the virus is as virulent, transmissive etc. as the numbers _seem_ to apply, the system will get overwhelmed – either that, or basically we’ll all self-quarantine for a couple of months, which is not workable either due to our just-in-time food supply system. Having stash helps, but what if there are food riots?

        That’s why I’m actually hoping that the 70k is really just a tip of the iceberg and the real numbers are in hundreds of thousands if not more, so that the real death rate is way lower.

        Reply
        1. Samuel Conner

          It is way too early to guess, but my guess is that you are right. The death rate seems likely to be uncomfortably high in patients who develop significant symptoms, and especially in older patients and patients with prior cardiopulmonary issues. I suspect that the mortality rate among all diagnosed patients is going, when there is more complete data, to come in below 1%, and the rate among all infected might be considerably lower than that.

          Those are hopeful thoughts that are consistent with the very incomplete present state of knowledge.

          But it’s a really really unhappy thought that we have a new endemic virus that kills the elderly.

          Reply
          1. thoughtful person

            Someone wrote recently that the fatality rate would be higher in places like Wuhan where the hospitals are overrun and the levels of care are not as high as normal. Thus fatality rates, so far, outside of Chona have been less.

            As for asymptomatic cases, I think thst is not a hopeful development at all. The rate of infection will skyrocket and likely make up for a lower fatality rate. The flu is something like 0.05%. Imagine covid19 with 1% fatality but infection rates like the flu?

            All speculation at this point. I guess Japan will be a test case.

            Reply
        2. Wukchumni

          We keep around $777 worth of canned & dry food on hand in case of weirdness such as the idea that Cov-19 might have us quarantined for months or other maladies beyond our control. Very little of it gets eaten and is pretty much strictly an insurance policy against hunger.

          When the use-by dates are around a year past, we donate it all to the local food bank, and go out and hit the Jackpot, by buying another $777 worth.

          Reply
          1. MLTPB

            Have you been tracking gold as productive capacity destruction unfolds first in China, Vietnam (one city under lockdown), and now Koear (from prevention to containment), and Japan (not quarantine cruise ship passengers) ?

            Reply
          2. Susan the other

            We do that too because we don’t like to drive in the winter. So in May and June I usually really pig out on sardines. Matiz are especially good.

            Reply
    2. Kevin C. Smith

      Chloroquine is off-patent. Chloroquine actually works well, and is well tolerated, in particular for short courses of treatment.

      The antivirals are patented.
      The makers of antivirals are eager to underwrite studies which might vastly expand their market.

      Question answered?

      Reply
  13. Samuel Conner

    It appears to me that the ZH plot for “World ex China” includes the Diamond Princess, which probably should have been backed out in order to represent the progress of the epidemic in ordinary conditions in the rest of the world.

    Having said that, the dispersal of the cruise ship passengers does look like a complete clusterdam.

    If one is prepared to trust the numbers for “died” and “recovered” coming out of Chinese provinces other than Hubei (with smaller numbers of cases, the reporting may be more complete), the ratio of “died in last day” to “recovered in last day” for China ex Hubei is about 135 and rising. The ratio is also rising in Hubei, but is 10-fold lower. The ratio for “World ex China” is between that of Hubei and Chine ex Hubei, but the numbers at this point are not large (as of last night, from beginning of the epidemic, only 11 died in “World ex China” and only 175 recovered) and the ratio of the daily differences changes a lot from day to day.

    It’s a poor proxy for the inverse of the mortality rate and will change depend on whether new infections (at the respective “look-back times” of the new arrivals at the “end states” of “recovered” and “died”) are accelerating or decelerating. On the plausible assumption that the “died” end state tends to be reached sooner than the “recovered” end state, which would imply that the “died in last day” statistic represents a cohort of patients infected at a later stage of the epidemic than the “identified sick patients recovered in last day” statistic represents, the fact that the ratio is declining in Hubei and in China ex Hubei seems hopeful, as it could indicate that the epidemic is growing less rapidly than exponentially.

    I was feeling mildly hopeful that the mortality rate might prove, with more complete information, to be significantly lower than 1%. And it might be, but with poor containment, that is still an awful lot of casualties.

    Reply
    1. Samuel Conner

      BAD, BAD TYPO:

      ” the ratio of “died in last day” to “recovered in last day” for China ex Hubei is about 135 and rising”

      should be

      ” the ratio of “recovered in last day” to “died in last day” for China ex Hubei is about 135 and rising”

      Reply
      1. Wisdom Seeker

        Between reinfection possibility, tests with high proportions of false negatives, and possible extended incubation times, the notion of “recovered” may be way off. Particularly for mild cases.

        Very hard to trust any of the numbers.

        Reply
    2. Kevin C. Smith

      The epidemic could be growing more slowly, but still exponentially … with the result that we will still get to the same endpoint, just a little more slowly.
      Still, a decelerating growth rate will buy us a little more time.

      Reply
  14. Polar Donkey

    I took my.4 year old to pediatrician yesterday. He was getting a check up. Chatted with doctor. He said his wife is a tour guide for chartered trips to Italy. Business is collapsing. We also talked about the actual covid19 virus. I knew more about it than him. I told him about it doesn’t seem to hit children as bad, but smokers because of ACE-2, older people with diabetes, high blood pressure, other pre-existing conditions can die. If an where doctor who wife’s business is directly affected by the virus doesn’t know much, what does that say about the preparedness of the U.S. Healthcare system as a whole? I have a brother-in-law with a house deep in the country on the Tennessee river, I may be heading for the hills in a month or two.

    Reply
  15. lyman alpha blob

    A small, or maybe not so small, silver lining –

    In Maine, the anti-vaxxers managed to get a referendum on the ballot this year which would overturn a recently passed state law that eliminated almost all exemptions to having children vaccinated. I ran into one of the signature gatherers and it took me a minute after hearing the woman’s spiel to realize she was one of these kooks – the pitch at first sounded fairly reasonable. When I asked her flat out if she were an anti-vaxxer and she wouldn’t say ‘no’, I knew what was up. Maine, like other states, has already seen rises in diseases like measles which had been until recently extremely rare. With the current coronavirus scare and the rush to find an antidote, I would expect this anti-vax referendum to go over like a lead balloon.

    While coronavirus may be around for a while, at least it has made it less likely that children will die of some other extremely preventable disease.

    Reply
    1. xkeyscored

      I’ve been wondering about the anti-vaxxers. Will they push their way to the front of the queue for a shot, or will they mount a huge campaign around the idea it’s all fake, an attempt by big pharma to whatever?

      Reply
    2. Kevin C. Smith

      On the subject of vaccinations, you should all get the Pneumovax-23 to reduce the risk of many forms of bacterial pneumonia; and you should all get the flu vaccine.
      What does this have to do with COVID-19?

      1. If you get COVID-19, and this renders you more susceptible to bacterial pneumonia or the flu, the combined effect of the two superimposed infections will be more likely to cripple or kill you.

      2. Conversely, if you get bacterial pneumonia or the flu, either of those might render you more susceptible to superimposed COVID-19, and guess what: the combined effect of the two superimposed infections will be more likely to cripple or kill you.

      Reply
      1. Frank Dean

        The overall effect of pneumonia vaccine may be problematic.

        The study did not directly examine the reason for the increased incidence of empyema. But the researchers conjectured that the PCV7 vaccine, by eliminating certain types of pneumococcus, is creating opportunity for other bacteria that the vaccine does not target.

        These other serotypes are responsible for less pneumonia overall, but, when they do occur, they may lead to more complicated pneumonias such as empyema.

        https://www.ucdavis.edu/news/pneumonia-cases-decline-incidence-complication-goes

        Reply
  16. Chauncey Gardiner

    Couple of the sites that are tracking the spread of the illness, including the site noted in the graphics from the Guardian in Illargi’s post. Of course they depend on the quality of data input. I myself view the reported data as a representative statistical sample with a high degree of confidence re mortality rates among various demographic segments:

    http://www.centerforhealthsecurity.org/resources/COVID-19/ — Center is at Johns Hopkins

    https://www.worldometers.info/coronavirus/

    Reply
    1. Wisdom Seeker

      The Worldometer site is excellent, thanks for sharing that link!

      Suggest looking at data in 4 tiers, each with a unique contribution:
      1) Hubei Province (impacted health system makes fatality rate much higher, unable to catch all cases). If we don’t slow this down, every city will go Full Hubei at some point.

      2) Diamond Princess (growth rate in closed system is high and/or delayed onset is real).

      3) China outside of Hubei (look at the outcomes for cases with adequate healthcare… best estimate of fatality rates. Ignore confirmed cases due to pressure to suppress numbers, and expect most other countries to suppress as well.)

      4) Rest of World (pandemic threshold reached yet?)

      Reply
  17. IronForge

    Funny thing,

    Has Anyone written in length and detail about the relative successes of Treatment Plans and Recovered Patients?

    I’m curious. The Recovered have been reported to Outnumber and Outpace the Deaths – and Plasma Transfusions from the Recovered have been reported to fare well for the Critical Cases.

    I also heard of claims made by MDs Outside CHN who allegedly treated Patients to Recovery via HIV+AnitViral_Rx and Avyuredic Formularies.

    I haven’t yet come across coverage of Cases where SARS-01_CoV and MERS_CoV related Rx have led to Recovery.

    From the Daily Headcount Data Posted on the Wikipedia Outbreak Coverage, it can be presumed that there should eventually be a Base of the Healthy Recovered who can provide the Plasma in Volume for the Duration.

    I hope Summaries get Published Soon – it would be interesting to see how Treatment Regimen Results are shared and coordinated. For the Long Term Solutions, We simply may have to take Closer Looks at CoVs Out in the Animal Kingdom.

    Best Wishes.

    Reply
    1. Yves Smith Post author

      This is inconsistent with the notion that getting the infection makes you MORE susceptible to reinfection. See the discussion of dengue above.

      Also getting plasma from people is a big deal procedurally. This isn’t an efficient way to protect people.

      And my father had an extremely bad reaction to a gamma globulin treatment, which is a plasma product. Got lesions in his mouth, lost 25% of his body weight, couldn’t sleep. Suicide by gun because he could not take the side effects. So this has risks even if it works.

      Reply
  18. Susan the other

    I think the Chinese government knew well in advance that Corona19 was loose. They had to have been preparing to house an epidemic because they built 2 or more hospitals in lightning speed – using prefab compartments. Manufacturing all that stuff takes time. And when Xi said that everybody had to report on the disease honestly so the world could respond to protect themselves he said dramatically (early January?) that those who fail to respond honestly will be “nailed to a pillar of shame.” It seems believable that China knew the shit would hit the fan 3 months prior to the big splat.

    Reply
    1. Anon

      The rapid construction of pre-fabricated, high-rise, buildings is an art form in China. They have years of experience. Doesn’t mean the CCP wasn’t suppressing knowledge of Covid-19, just that their rapid construction skills are well beyond those seen in the US.

      Reply
      1. rtah100

        Those “hospitals” have the room locks on the outside. They are modular prisons. Plenty in Xinjiang to copy, whether well intentioned or less so.

        The real worry is they are building another NINETEEN in Wuhan. So clearly under control….

        Reply
  19. Samuel Conner

    Re: > “there should eventually be a Base of the Healthy Recovered who can provide the Plasma in Volume for the Duration.”

    And this is one area in which US might be well prepared, since we already have a scaled-up system for purchasing plasma from the precariat /s

    The thought has occurred to me that “recovered” patients would be a good group from which to recruit and, if possible, rapidly train helpers for overburdened medical staff. Given that the appalling failure of containment in the dispersal of possibly infected people reported in this post may make “endemic in much of the world” the end-state of the situation, there will need to be large numbers of already-immune health care workers in future years.

    Reply
    1. KiWeTO

      That would be on the basis that reinfection is not possible, and susceptibility to varying mutant strains is zero (unlike Dengue). We do not know that. A humanity ending apocalyptic outcome is the only way virus survivors would offer to be the caregivers, simply because they would be the only healthy ones left around to give anything.

      The data out of most places is sanitized/restricted to prevent total panic in their societies. We simply do not yet know enough about transmission methods nor infectability nor incubation nor anything. Its’s humanity’s turn to be in the petri dish, real-time.

      As to economic damage versus pandemic containment, it is easy to throw shade on any government’s response. Unfortunately, those decision makers are truly operating in an environment of insufficient or incorrect or suppressed information. Nobody wins there.

      Having China decide that any chest infection in Wuhan = CoViD19 determination, meant that we saw a crazy upshoot in Chinese cases a week ago. However, that was a response to a bureaucratic rule that only the “infected” would receive hospital treatment (which from some horror stories appears to be giving them a bed amidst other “infected” and wishing them good luck). Hothousing future mutant strains perhaps.

      If asymptomatic transmission is true (and so far, empirical evidence points to yes), then no government across the world can get ahead of transmission using quarantine as the primary method to limit virus mobility. Which has worked for SARS. That means the virus would spread faster than any society/government’s response could defend against.

      Korea is now becoming a test example of being too late to limit transmission as their case numbers start showing explosive growth. Where that situation goes from here, who would take bets now? 50 to 100 to 200 to 346 as of this Saturday morning. In 4 days. And those are the known cases.

      As for stock markets still rising or unconcerned… good luck to them stockholders fiddling with their digitally recorded increased wealth in a pandemic era. Akin to having bitcoin without the unlock key.

      Take pleasure in living in the now, for tomorrow may never come. Oh, and keep hands washed frequently and avoid touching the face.

      Reply
  20. xkeyscored

    I still keep reading, even here on Naked Capitalism, about China, China, China.
    Given the recent spate of cases in Iran and South Korea, most of which appear to have been caught in those countries, I think it has definitely become more of a global problem already.

    Reply
  21. DJG

    The problem with asymptomatic people with Covid: La Stampa reports this morning of an outbreak in a small city in Lombardy. The carrier / asymptomatic person is a man who spent a good deal of time in China on business and returned to Italy on 20 January. He didn’t have symptoms till 10 February and has a mild form like the flu.

    Meanwhile, on return, he went out to dinner with friends, including more than once with another man who must be a good friend: The friend is now in intensive care in serious condition.

    The workplace of the “carrier” has been shut down.

    The town is now shuttered till the authorities can determine how far the virus may have spread.

    We all vaguely knew that air travel means that people are moving during incubation periods. Covid is unfortunate proof.

    Reply
  22. Jack

    Who are these “people” who continue to believe the virus isn’t that bad? Provide some evidence. People in Ukraine are attacking vehicles; Lambert says there’s tons of bad info on how to deal with it. To me this is evidence that people are taking this epidemic all too seriously. Maybe it’s being poorly managed; maybe it’s not; this might be the best a confused mankind can do. Roughly 10 weeks after discovery less than 2 percent of new cases are outside mainland China. Is that good news? I think so.

    Sure, the longer it goes on the greater the probability of further geographic expansion. Pissing, moaning and finger pointing ain’t gonna fix it.

    Reply
    1. MLTPB

      I feel that if people in China sense that Xi is putting GDP growth over fighting this, if they sense any hint of what AEP is speculating, it will be fear turned to more than fury.

      He and CCP would go down in history worse than the first Qin emperor, worse than emperor Yang of the Sui dynasty.

      Reply
    2. kareninca

      Most people are not taking this seriously at all. It may turn out that the people in Ukraine have the right degree of concern (but are acting on it in the wrong way).

      We don’t know how many cases there are outside of China. I have the flu right now here in Silicon Valley, and no-one is testing me.

      I don’t see how writing/posting informative articles counts as pissing, moaning or finger pointing.

      Reply
  23. anon in so cal

    Correct me if I’m wrong, but didn’t Cambodia permit the disembarkation of another cruise ship, whose passengers were given red-carpet receptions and allowed to roam free, then fly home, even as one of the passengers subsequently tested positive, afterwards?

    Reply
    1. MLTPB

      That’s one area of concern.

      Also those millions who left Wuhan before lockdown and with approx. 7 days before our travel bans.

      Then, there is the route possibly from Iran to Syria, Turkey, and elsewhere.

      Reply
    2. xkeyscored

      You’re correct, and they didn’t just fly home – Time tracked down one who’s continuing her vacation in Bali.
      Not only did Prime Minister Hun Sen not wear one, assured that the ship was virus-free, his bodyguards ordered people who had donned masks to take them off. The next day, the American ambassador to Cambodia, W. Patrick Murphy, who brought his own family to greet the passengers streaming off the ship, also went maskless.
      https://www.nytimes.com/2020/02/17/world/asia/coronavirus-westerdam-cambodia-hun-sen.html

      US Ambassador to Cambodia, Patrick Murphy said the Cambodian government did the right thing for humanitarian needs by allowing MS Westerdam to be anchored in Sihanoukville and passengers to disembark. “The passengers are really wanting to get home now after quiet an adventure. That’s why we are here to help them achieve,” he added.
      https://www.khmertimeskh.com/50691502/cambodia-does-the-right-thing-for-humanitarian-needs-murphy-says

      And a video of Murphy in Sinoville (local demonymic nickname):
      https://youtu.be/Mk5Bw1VOBeY

      Reply
    1. MLTPB

      I thought after evacuating those in Wuhan, we could have done the same with those onboard Princess Diamond.

      I commented on that a few times. I guess I was the only one, and I dont remember any candidates talking about it in particular, or covid19 in general.

      Reply
  24. kareninca

    I live in Silicon Valley, which of course is an international hub. I go out into the world doing errands nearly every day.

    Right now I have the worst flu I have ever had. The night before last I had the most amazing fever and aches. Last night it was just truly terrible. During the day I have brief periods of okayness. I don’t really care; I’m middle aged; I won’t die of this. But usually I don’t get sick, or if I do I get a mini version of whatever is going around. This is not a mini version. Or if it is, I would hate to know what the regular version is.

    So, of course no-one is testing me for coronavirus. But I could easily have it, per its ability to be spread. I guess that whoever is in charge of getting numbers, isn’t all that highly motivated to get a lot of numbers? Or they don’t have enough test kits?

    Reply
    1. blowncue

      I think it perfectly reasonable to be evaluated for your symptoms as well as monitored, particularly as it seems to be unusually hard hitting. I have asked for any clarity obtainable from my provider for the peace of mind it can provide, in the past, without apology. There is nothing wrong in being a member of “the worried well” if, in the end, your membership is confirmed. The existence of “the worried well” was a part of the HIV epidemic, and it will be in this one as well. I’ve struggled to keep my footing in the face of a reasonable, anxiety-provoking narratives without the benefit of data from which to assess probabilities. While testing might be the sine qua non, diagnosis from clinical presentations isn’t impossible. All the best, from North Carolina.

      Reply
      1. kareninca

        My HMO has a blurb on its website about the coronavirus. They are only testing symptomatic people who have recently traveled in China or who have been around someone who is confirmed to have been infected. If they tested everyone symptomatic who has been around someone who had recently traveled in China, that would be a monstrous number of tests in this part of the country.

        I doubt they would be able to tell by physical exam.

        Really, I’m not worried. I just am noting how little data is being collected.

        Reply
  25. rjs

    the CDC reports 16,000 US deaths and 280,000 hospitalizations from flu this season, while the world is in a panic about 2000 deaths in China

    Reply
    1. MLTPB

      That’s with lockdowns, quarantines, severe movement restrictions, etc.

      The number would be a lot higher without those, and normalize the population of Hubei to the US or to the rest of China.

      Overnight, 101 new cases in Chosen (making the three day total at 174 ), and 13 more in Iran and 16 more in Italy. For the US, the Wiki case stats show 20 new cases. I assume they relate to the evacuees.

      Reply
  26. smoker

    Likely a stupid question, but have there been any Congressional Bills, or Joint Resolutions sponsored to provide the much needed financial safety net – via a Country Sovereign in Its Own Currency – which would definitely be needed in the event of a US Pandemic? A financial safety net which should have been written into law eons ago, let alone since the Anthrax and Ebola episodes.

    Millions in the US cannot even afford one day off. US Employee Law has really not much changed from the days of Dickens’ famous books. So much for that Developed World Enlightenment™.

    Speaking of which (Congressional Bills), where are the Congressional Bills making it a severely punishable crime to sponsor a Bill, or Resolution, with the Unmistakable Stench and Tangible Public Damage of Big Donor Cronyism. There should be an additional Bill against frivolity, solely for the sake of Donor/Identitarian brown nosing for funding and re-election purposes, such as naming Post Offices after people while Congress allows the USPS to be destroyed.

    Reply
  27. rtah100

    I do not believe the Chinese statistics for a moment but I am willing to believe the clinical papers documenting actual case data being published in China, for Wuhan and other areas. These suggest “high” mortality compared to flu in younger age cohorts (0.2% vs 0.02%) but in absolute terns nothing apocalyptic. The picture for older patients, largely seemingly driven by CV, pulmonary and diabetic complications, is disastrous, 20% death rates (it is quite possible the real variable is comorbidity and age is just a correlate of increasing comorbidity prevalence). These patients likely account for the reported serious and critical condition patients and they are probably all going to die under conditions of an overwhelmed health system. The overall case fatality ratio (instantaneous, I.e. Just dividing current deaths into current cases, not properly calculated by dividing deaths into all resolved cases for a defined cohort) is c. 2% by comparison.

    These papers are all of confirmed cases. The great worry with the public health statistics is that reported cases do not equal actual cases, by a magnitude. One of the Imperial College papers suggests 20-fold, I think. We have to assume a million people in Hubei have COVID-19 by now.

    We also have to assume that China is denying a large proportion hospital care, using PCR confirmation as a rationing step to treatment. This is either deliberate, to suppress the figures, or from resource constraints on the testing and/or hospital sides. Deaths of unconfirmed cases are apparently being reported as “pneumonia” not COVID-19.

    If we generously assume that the non hospital population is less sick and even asymptomatic in many cases and that none of them will die, the infection fatality ratio will drop by a magnitude overall to 0.2% for whole population and 2% for comorbidities and 0.02% for the healthy.

    However, this is still enough to swamp a healthcare system. Some of the reports re undertakers suggest the excess deaths are at 6x normal overall and 60% are coming from houses and 40% hospitals. If the unconfirmed cases are 90% of cases and 60% of deaths, it would suggest the instantaneous CFR for unhospitalised cases is 1/6th the rate in hospitals or 0.3%.

    The R0 of the virus appears to be high, 2.5-7 depending on estimates. Worse, asymptomatic people are spreaders and it can aerosolise. Really it is the worst set of properties for a pandemic: It is unstoppable by quarantining individuals, only by a prompt cordon sanitaire around the origin, which did not happen. It has been spreading since at least November. It has a high lethality but not so high to burn out. Nearly everything points to massive pandemic and high deaths from direct illness and failed services.

    The one ray of light is it appears in some epidemiological models to have “over-dispersion”, i.e. A small number of patients are superspreaders (72x more infectious!) and the rest have R<1 and are essentially deadends for it. As a reddit comment put it, we need to play whack-a-mole with superspreaders….

    The fact there is community transmission in Korea and Japan and Iran makes me feel this hope is only of delay, not containment.

    Reply
  28. MLTPB

    And all of the sudden, I see reports that more than 500 cases in China stemmed from prisons. Did not read much on this front up till now, but had always meant to inquire about it.

    Reply

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