According to the WHO, Coronavirus Is WORSE Than the Spanish Flu … Which Killed Tens of Millions of People

Yves here. I don’t like seeming like a scaremonger, but I see way too much evidence that people are not taking coronavirus risk seriously enough. For instance, I have been e-mailing the service that employs my mother’s home health care aides about handwashing every time they come in the door.  I’ve had to send the WHO video to make sure they are actually washing thoroughly enough (unfortunately, my pressing the aides goes over less well than directives from their bosses). And I am certain they are not taking precautions when they are out, like avoiding touching their faces and cleaning handles they touch or grabbing them using a tissue or paper towel. And this place has mainly nurses as managers!

Similarly, in my gym, which has at least 20% medical professionals among its membership, I see zero change in behavior, no greater use of hand sanitizers on the floor (and note the FDA recently challenged Purell’s claims, perhaps in part because hand sanitizers are “mostly useless” as deployed by real people), nor any curiosity as to whether the spray bottles on the floor have stuff in it that will actually kill germs (they are hardly used and the purpose really seems to be wipe sweat off benches and cardio machines. They don’t contain alcohol and even bleach diluted to the level the NIH recommends for wiping down surfaces takes more than ten minutes to kill viruses. 10% bleach is more deadly but also pretty corrosive and thus can’t be used on quite a few surfaces). And no, it’s not as if people are staying home. Exercise classes and games are very well attended.

In other words, it appears that more people need to get the message that the coronavirus is dangerous and they need to take meaningful precautions. This short post might help in conveying that message.

By George Washington, formerly of Washington’s Blog

The World Health Organization (WHO) says that the mortality rate from the Wuhan Coronavirus (formally known as 2019 nCoV) is 3.4% globally.

The Spanish Flu of 1918 – which killed between tens of millions of people – had a lower mortality rate, estimated by the WHO as between 2 and 3%.

But surely, you say, the Coronavirus is not as contagious as the Spanish Flu …

Unfortunately, it’s more contagious.  The Center for Infectious Disease Research and Policy notes:

The novel coronavirus has an R0 of 2.2, meaning each case patient could infect more than 2 other people. If accurate, this makes the 2019 nCoV more infectious than the 1918 influenza pandemic virus, which had an R0 of Based on calculations, the authors of the larger study estimate the novel coronavirus has an R0 of 2.2, meaning each case patient could infect more than 2 other people. If accurate, this makes the 2019 nCoV more infectious than the 1918 influenza pandemic virus, which had an R0 of 1.80 ….

WHO says that the R0 of Coronavirus in China was initially between 2 and 2.5.< But scientists from the Los Alamos National Laboratory said that the R0 for the Coronavirus is actually between 4.7 to 6.6 (although that number drops to between 2.3 and 3 after quarantines and social distancing are implemented).

According to the Director of the US Centers for Disease Control and Prevention, the Director of the National Institute of Allergy and Infectious Diseases and others, Coronavirus can be spread even when people have no symptoms. On the one hand, this is bad news, as it is very hard to screen and locate carriers when they are symptom-free or have only mild, cold or flu-like symptoms.

On the other hand, this means that the real R0 might be much higher than WHO estimates … which would make the mortality rate lower.

If the number of people with Coronavirus is a lot higher than is being reported, that means the mortality is a lot lower … i.e. a smaller percentage of the larger population of people infected have died.  

Indeed, China only tests a portion of those who are really sick, and the United States has tested less than 500 people total for Coronavirus (American doctors have to beg to get their sick patients tested).

So far, WHO has rejected the theory that there are more people who have Coronavirus than reported:

One of the hopes of people watching China’s coronavirus outbreak was that the alarming picture of its lethality is probably exaggerated because a lot of mild cases are likely being missed.

But on [February 25th], a World Health Organization expert suggested that does not appear to be the case. Bruce Aylward, who led an international mission to China to learn about the virus and China’s response, said the specialists did not see evidence that a large number of mild cases of the novel disease called Covid-19 are evading detection.

But one can’t assess whether mild cases are being missed without a widespread testing program.  Especially since many cases are mild, and some cases are wholly asymptomatic.

The bottom line is that we don’t yet have the core data we need to determine how lethal the Coronavirus is.

Our best bet at reaching an accurate estimate is probably to follow what’s happening in South Korea. As of last week, South Korea had already tested 66,652 people for Coronavirus. And it’s testing more than 10,000 new people a day.

South Korea also has a modern healthcare system.

So keeping track of the mortality rate in South Korea will be a good indicator of the real lethality of this virus.

Postscript: Some have claimed that Asians are more vulnerable to Coronavirus than other races.  However, I wrote to the international agency which is claimed to have gathered the data, the European Molecular Biology Laboratory-European Bioinformatics Institute (EMBL-EMI), which sponsors the 1000 Genomes Project. Paul Flicek – Associate Director and Senior Scientist and Head of Genes, Genomes & Variation Services at EMBL-EMI explained to me that the data was hogwash. In any event, given that Italians, Americans and others are dying of the Coronavirus, I don’t know why people keep claiming that Asians are more vulnerable.

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  1. Noel Nospamington

    Is it too early to start blaming the Chinese practice of live animal (wet) markets with stressed wild animals (such as bats & pangolins) and raising waterfowls and pigs in close proximity?

    These have been the breeding grounds for many new diseases including COVID-19, SARS, and numerous influenzas.

    At some point, the world needs to decide that these unsafe animal practices are not worth potentially killing off tens or hundreds of millions of people, and damaging global economies. Pressure is needed on all countries to comply.

    1. rosemerry

      This seems to me a case of victim-blaming. Can you really believe that the huge intensive, antibiotic-driven production of meat-animals in the USA and elsewhere is not a much more likely source of infection and spread of disease? You can see already how unprepared the USA is for even the small exposure to this new virus so far, while China immediately began countering the spread. The effect of the H1N1 flu from Mexico/California in 2009,which was not acted on for months,then spread and killed hundreds of thousands throughout the world.

      1. PlutoniumKun

        Its not victim blaming, its science. As I’ve had to explain regularly to my Chinese friends, there is a reason why so many diseases arise in China and not, for example, equally densely populated India. Indians simply don’t use animals so much in agriculture and have no real equivalent of Chinese wet markets, which have always been the primary worldwide source of new diseases. This is simple scientific fact, not ‘blaming’. When you mix multiple species of live or recently slaughtered animals together in close proximity to people, in hot, unhygienic conditions, you create an ideal breeding ground for new viral or bacterial disease.

        Yes of course diseases can arise in other circumstances especially with over intensive animal farming, but this is still less risky than wet markets simply because having one species together in unhygienic conditions is far less dangerous than having multiple species together, it really is that simple.

        The only good thing from this is that the Chinese government seems to have finally realised this and will act in future, rather than pretending to act as they did in the past (and anyone who has been to a restaurant frequented by upper crust Party officials in China, or Vietnam for that matter), will see exactly why it is that they haven’t acted).

        1. vlade

          Ideed. I believe you used in a conversation few months back “bioweapon factories” and was, unfortunately, shown correct way faster than you expected.

          I’d add that Africa with it’s bushmeat market is in a similar situation (hello HIV, hello Ebola).

        2. The Rev Kev

          Look, I’ve got a long laundry list myself of how screwed up the Chinese government is and how obnoxious their nationalism is but this is different. Lots of people like to bash China because Coronavirus broke out there but as rosemerry pointed out, this could just have likely broken out in the US with their production of meat.

          And when I think about it, the 1919 Flu Pandemic is reckoned to have broken out originally in the United States and not in some place like China a century ago. Would you have equally blamed American practices back then that created the conditions for it to break out? Would you have railed at the US shipping troops to Europe, even though they knew that they had the flu aboard? Because President Wilson was asked about that and he gave the go ahead anyway.

          You have to be fair about such things and identify what caused a particular outbreak of a particular virus without turning it into a bashing session because science. It could have been Africa or South America or Australia but this time it was China. This will not be the last virus that arises that decides it like the taste of our breed.

          1. PlutoniumKun

            I’m sorry, but this is nonsense. The Chinese government have been warned for decades that their wet markets and wild animal farms are a ticking time bomb, both from outside agencies and (the few, brave) civic society groups within China who have been fighting a losing battle against the use of wild animals and the farming of wild creatures for food and chinese medicine. The Chinese government themselves have repeatedly acknowledged the dangers, and have claimed to be cracking down on them, but nothing has happened, precisely because senior Party members wanted it that way.

            And yes, plenty of disease have arisen elsewhere, and I’m perfectly prepared to criticise any government responsible, whether it be the UK allowing cattle to be fed to cattle leading to BSE or battery farming aiding Avian flu or overuse of antibiotics in the Americas leading to deadly hospital infections. But this one is all on the Chinese government.

            1. The Rev Kev

              I agree that this one is all on the Chinese. Just as I say that the 1919 Flu Pandemic was all on Americans. But you have to take the long term view and recognize that viruses can evolve in all sorts of places and arise unexpectedly when you least expect it. Lots of nasty ones in Africa for example.

              But pandemics are the punctuation marks in human history and any criticism of where a particular virus breaks out should be viewed dispassionately. For context, here is a long list that shows that we have been here many times before and will be again down the track-


              1. vlade

                “can evolve in all sorts of places”. Yes. But it can evolve way more in places like wet or bushmeat markets than at your butchers.

                A lot of viruses can incorporate RNA from other viruses. The more RNA you expose a virus to, the more likely it is it will mutate.

              2. MLTPB

                I think a key issue has been no transparency, more so at the beginning, on the part of the CCP.

                To be critical, being specific helps to focus the issues.

                1. xkeyscored

                  True enough, but which countries have been transparent about it? South Korea is perhaps top of the list, and where’s that got them? The USA has been transparently incompetent (crappy CDC test kits etc), and now it’s being incompetently untransparent, with Professor Pence vetting all official mention of the thing. China did share important scientific information early in the outbreak, even if it has manipulated or suppressed other data.
                  No country was prepared to deal with this, and it’s still early days to review it all and decide which policies were best.

          2. Yves Smith Post author

            With all due respect, no.

            What you miss is the species cross contamination issue. US factory farms are all one species: dairy cows. Chickens laying eggs. Etc.

            US factory foods are delivered refrigerated, and often frozen, to stores.

            By contrast, even raising widely ranging species together runs some risk of diseases jumping species. Slaughtering them at room temperature, with all that blood near other lives animals of different species, bears no resemblance to US slaughterhouses.

            Look at the UK, how mad cow disease came out of feeding meal with sheep and cow brains in it to cows. That was not a US practice:


          3. Kasia

            The most likely source for the 1918 Flu pandemic is war torn France, in the port of Étaples-sur-Mer. Other possible sources are Kansas or China. One hypothesis is that the flu was brought to France by Chinese laborers brought over to help the war effort. The flu only had a minor impact on China and this may well be because of the widespread unhygienic Chinese practices, the Chinese population may evolved a much higher tolerance for these types of viruses. A little like the advantage the Spanish had when they invaded the New World and wiped out much of the indigenous population. So in a twisted way, as the global population reaches hard resource limits the Chinese have a Machiavellian interest in keeping up their unhygienic animal practices!

            This theory will be tested by the mortality rates for the coronavirus in places other than China.

            1. rtah100

              Actually, the theory on Spanish Flu is that it originated in Mid West USA, entered the US Army recruitment camps and was brought to France by the “Doughboys” on their way to the Western Front.

              1. Kasia

                It is not “the” theory; it is one of many, which is why I mentioned Kansas in my comment.

      2. Thomas P

        Different problems. China uses practices that make new diseases move from animals to humans, USA promotes antibiotic resistance in old diseases. Both need to stop, but for this particular disease China is to blame. When you get older and need a transplant, but realize you can’t have one because so many bacteria are by then resistant to antibiotics that complex surgery is impossble, then you can blame USA and a bunch of other countries.

        1. xkeyscored

          New antibiotics aren’t that hard to find. I notice reports of promising new candidates perhaps once a month.
          The problem is persuading pharma companies to invest in something we don’t want them to sell in huge amounts, but on the contrary to restrict to patients with severe infections resistant to current drugs.

          1. urdsama

            Do you have a source for this? From what I’ve heard the new antibiotic candidates are running into the same issues as the old ones: infections are much hardier and have developed immunity.

            I find it hard to believe pharma is against it: I seriously can’t believe that if one of the big pharma companies developed a super antibiotic they wouldn’t shout about it from the highest buildings – and then charge a premium for access. Also, they would get huge bragging rights for having figured out how to defeat the “super bugs”.

            1. xkeyscored

              New antibiotics, some with novel targets – I quite often notice things like this:
              A new antibiotic selectively kills Gram-negative pathogens

              Pharma’s reluctance to invest, fewer articles in scientific/popular scientific press, but occasional things like this:

              due to a variety of inherent market failures, the present business model for antibiotics has not adequately responded to the growing demand for innovation

              Many large capital companies have exited the antibiotic space in favour of more profitable therapeutic ventures. Small- and medium-sized enterprises (SMEs) have attempted to fill this void but generally lack the capital and resources to undertake intensive and long-term research and development (R&D).9, 10 Consequently, the low hanging fruit of antibiotic development, such as compound redevelopments and combinations, has been tapped. This leaves behind the complex and expensive task of discovering and developing truly novel mechanisms of action that are effective against the most resistant pathogens.11 Some companies are choosing to focus development efforts on alternatives to antibiotics such as antibodies, probiotics, lysins and bacteriophages.

              Incentivising innovation in antibiotic drug discovery and development: progress, challenges and next steps

        2. Michelle Williamson

          You go Thomas your right on point I like your point of view and agree 100% you couldn’t be more right. Good job!!

      3. Ignacio

        Definitely it is not the case. Both SARS-CoV epidemics 1 and 2 have originated in China and though their origin has been traced to bats, there have been identified not one but some wild species that might be assigned as the intermediate hosts. It is not obvious in the case of SARS CoV1 simply because there are at least three candidates including badgers, racoons and civets. The case for the Pangolin as intermediate host in SARS CoV2 is very strong so as to be considered almost certain. It is so strong that Chinese leadership forbade commerce with wild animals about a week ago. Your flu examples don’t say anything useful about new coronavirus outbreaks. The other recent one, MERS-CoV, is originary from the Arabian Peninsula and the intermediate hosts are camels.

        There is a very strong case for China to stop those non hygienic practices with both farm and wild animals. Very, very strong. No victim blaming here.

        1. xkeyscored

          “The case for the Pangolin as intermediate host in SARS CoV2 is very strong so as to be considered almost certain.”

          Not so, at least as of last week.
          . The researchers said they had found a coronavirus in smuggled pangolins that was a 99% genetic match to the virus circulating in people. But the result did not actually refer to the entire genome. In fact, it related to a specific site known as the receptor-binding domain

          Three similar comparison studies … coronaviruses in frozen cell samples from illegally trafficked pangolins shared between 85.5% and 92.4% of their DNA with the virus found in humans. Two other papers … 90.23%3 and 91.02%4 similar

          So far, the closest match to the human coronavirus has been found in a bat in China’s Yunnan province. A study published on 3 February found that the bat coronavirus shared 96% of its genetic material with the virus that causes COVID-19.

      4. Hatuxka

        The first case had nothing to do with the wet market. Nor with consumption of wild animals. That market, in full holiday season mode was regularly densely packed with people. That is where the virus multiplied. Also, there is solid evidence that the United States is the center of diversity for haplotypes of this particular virus. This points to a US origin of the virus.

        1. Ignacio

          There is solid evidence you don’t present any evidence on any of your assertions. We are in the midst of a pandemic not seen since the Spanish flu and all this stupidity is not just unnecessary but harmful idiocy. Harmful particularly to yourself.

            1. Yves Smith Post author

              No, you are misrepresenting both papers. For instance, the Lancet authors state the infection was brought to the wet market, meaning likely by animals. Numerous experts have traced it to bats, with an intermediate host like pangolin believed to have conveyed it to humans. There is zero that supports your US assertion.

      5. Jude

        No, this is not victim blaming. It is an attempt to begin looking at unsafe practices with animals that cause diseases to jump species—these Chinese markets are firmly implicated in this, but we may also need to look at our practices in America and elsewhere around the world.

    2. c_heale

      If you watch this video, 4 out of the first 5 cases didn’t come from the wet market.

      Sars came from a colony of bats (doesn’t appear to be from a wet market)

      No idea where MERS came from…

      It appears that banning wet markets won’t be sufficient.

      And everyone knows where BSE came from…


        Human-animal interactions and bat coronavirus spillover potential among rural residents in Southern China
        Study conducted in Wuhan, published Sept 2019.

        …”This study found serological evidence for bat-borne coronavirus transmission to people. Direct contact with bats was not identified as a risk factor….

        … However, despite the small sample sizes, this study suggests that there are a substantial number of people in rural Southern China who are exposed to bat-borne viruses, and that exposure likely occurs through the daily or normal practices of rural communities, rather than specific high-risk behaviours (e.g. wild animal hunting).”

      2. bwilli123

        Excellent, if technical video from 27 Feb.
        Speaker is HK Chinese (English speaking) Epidemiologist.

      3. ewmayer

        Re. bats – yah, well, my sister “kindly” shared a video clip from pre-outbreak Chinese TV, a foodie show in which some attractive young female shows the proper technique for pulling the wings off a live bat and then stuffs it in her mouth. Appalling stuff.

    3. eg

      My reading of history tells me that the population with the deepest, most virulent disease reservoirs wins … YMMV

    4. margaret beresford

      Imagine, 500 million infected –50 to 100 million dead (in 1918 that would have been half the population of the entire US). With no viable drug or vaccine treatment…..And this, now, is being touted as a Pandemic because of what exactly or its contagious ….? Nuts, we’re comparing % rates to firm a numbers game that is ridiculous. This is not worse, 50 million to 100 million DIED in 15 MONTHS..There was no way to stem the flow of contagion…period. The Spanish Flu had to terrifyingly run its course…much like the plague did.

      How is 90,000 infected with only 3000 dead after 2 months even a Pandemic, as our entire drug marketers with $ signs in their eyes; begin clawing to be the first with any kind of vaccine or treatment…to reap profits untold..? What is scary are all these closures and stoppages of events necessary for a functioning global economy…..Maybe, just maybe as the newsletter, ‘Wall Street on Parade’ has been warning all who would read —their coverage– of the governmental committees listening to how our financial system may be on-the-ropes again —–with hundreds of trillions of dollars in derivative contracts o/s and investment bankers constantly found to be liars and then fined billions for fraud, etc –‘-that all-hell-just–might happen again as in 2008’….So bring on a pumped up disaster to blame for causing a global downturn —and ‘Bob’s your uncle’—again all monies lost by stupid investment/gambling decisions by banks and corporations will be paid for again by taxpayers/bank/customers….After all, nothing was done to investigate the biggest global fraud crisis in 2008! And that was how long ago–yeah 12 years ago—seems the timing is just about right….

        1. Dwight

          Another possible motive or opportunity in exaggerating the threat could be bringing production back to US in preparation for war with China, and to create jobs to help Trump with re-election.

          But is the threat exaggerated? The numbers game needs to be understood in exponential terms – 15 months is a long time and this is just starting. What happens this autumn? How long did the Spanish Flu take to really explode?

          1. drumlin woodchuckles

            Bringing production back to the US does not have to be done out of “preparation for war with China”. It can be done in “preparation for peaceful long-term survival withOUT China”. And withOUT Free Trade in general.

      1. Ian Ollmann

        Exponential growth is boring at first and terrifying later. All of a sudden it hits the knee in the curve and “everyone” has it, whereas “no one” did before. We are still in the slow ramp up. Despite quarantines, in most of the world the numbers are still climbing. Much like 1918, there are no treatments for the disease. If the numbers knee up, there will not be anywhere near enough hospital space and ventilators to accommodate everyone. It doesn’t matter how compassionate or predatory your healthcare system is if it is simply overwhelmed. Listen to what the epidemiologists are saying. This isn’t going away. It’s going to be with us a long time. A lot of people will get sick.

        In a while, maybe a year or two, you may expect an approved mass produced vaccine. Possibly Merck or someone will come up with a small molecule antiviral that will slow it down enough to give your body time to kick it. Until then, we are going to fight off the virus in the good old fashioned 1918 method of plenty of rest, chicken soup and your bodies’ personal resources.

        I’m personally appalled that my employer hasn’t granted leave for those living with elderly or immuno compromised family members to work from home. I don’t have this particular problem, but some do and their best chance is just not to get sick, at least until some of these treatments come online. Our building with plenty of security door choke points, bull pens, and quirky unhygienic water fountain designs seems particularly suited to spread Coronavirus. The inquest will judge them harshly, I expect. It is all so unnecessary.

    5. SAKMAN

      Nah, its never to early to blame the “other”. The Chinese media is now claiming that the US caused the outbreak.

      1. MLTPB

        It is OK to point out the cause, if it can be demonstrated.

        More about providing evidence than being early or not.

  2. rfdawn

    My only big hospital stay included a limited training in sterile procedure. There are so many shared points of contact in a public gym that I can’t see how germ transfer between sweaty bodies can be prevented. In normal times, people just accept the risks of normal germs, at least I do. These days, I just don’t go there (a gym restricted to denizens of my apartment building). But, apparently, many people still bet on normality.

    1. pretzelattack

      i’m just not going to gyms. i’m exercising outdoors till shape of things to come becomes more distinct.

      1. Wukchumni

        A friend runs a sightseeing tour in Sequoia-Kings Canyon NP and he built it from the ground up and has 4x 15 passenger vans and 4 drivers, along with him doing some when need be. The company has been at for 20 years, and I just looked them up and as per Trip Advisor, they are #1 of 31 Outdoor Activities in Sequoia and Kings Canyon National Park, and almost all 5 star reviews, they do a great job!

        A typical tour takes around 6-8 hours of being cheek by jowl with complete strangers sitting next to you typically (you can book a private tour as well) and I get the feeling this business model is a Dodo and sales will completely tank as the busy summer season comes along.

          1. Monty

            I hope so, but it is unknown whether that will be the case with this virus. “Flu deaths” die down in the summer, but that’s only because the CDC lumps anyone who died whilst having a respiratory infection as a flu death. Lots of people, especially the elderly and infirm, die of pneumonia in the end, especially when its cold and wet. All those people are in the CDC 36k “flu” death tally..

  3. salvo

    well, as for the officially known cases, it has to be assumed that a lot of infections have not been detected yet, here in Germany, doctors are complaining that even most basic protective gear is not available so they have to expose themselves to the danger of getting infected, the testing system does not seem to work as expected either, as the facilities supposed to do them are either overstrained or not functional for whatever reason. People have reported on the mass media that they have tried in vain for days to contact the emergency numbers set up explicitely for such cases. The same seems to be true of Italy, as I read in the media a few days ago. That’s what one should expect from a privitized health system. Anyway, I suppose it is likely the that numbers of infected people is (much) higher, at least here in Europe.

    1. Ignacio

      This is a shame for sanitary authorities and/or managers. I don’t know exactly who is to blame here but it has been known from the very beginning that sanitary personnel is at high risk and this collective has to take special protective measures including masks, gloves etc.In Spain there are currently 193 confirmed cases of which 14 correspond to sanitary workers. By the way, a 4 year old girl has been confirmed as infected. I hope she doesn’t develop COVID-19. (all her family was infected and the source was the father after returning from Italy.

      1. rtah100

        Hola Ignacio! I enjoy reading your comments on this topic. Can I offer you a better translation in English of “sanitary worker”, as “healthcare worker”? The phrase “sanitary worker” does exist but it suggests somebody who deals with drains and effluent (the English notion of “sanitation”) rather than provides healthcare.

        It’s probably true that sanitary workers are high risk as well though!

        1. Ignacio

          Thank you! Fast writing and loose Spanish to English translation in mi mind to blame.

    2. Isotope_C14

      I’m around a lot of doctors here in Berlin, they are being incredibly cavalier about this epidemic/pandemic. They are acting like “this is just a flu” and I’m reasonably certain China wouldn’t shut down their economy for “just a flu”.

      Why is the old saying “Better safe than sorry” no longer a concern for people?

      The cases in Berlin are starting to take off, 3 so far, but it’s going to get much, much larger than that.

  4. clarky90

    A tip of the hat, to Karl Denninger, who I learned the following from….

    The sick room of a covid19 patient should always be at negative pressure. This is especially important in a hospital setting. The air in the sick room (or covid19 wing of the hospital) should be exhausted to the outside, (but well away from other people). This means that virus laden air is not forced back, into the rest of the hospital or house by positive pressure (by conditioned air, blown into the sick room.) This simple tech greatly protects the uninfected from infection by the virus.

    FI, if a covid19 patient is sheltering at home with other, uninfected people in the house; Put the patient in a sick room with an en suite. Have an exhaust fan in their bedroom window which sucks the tainted air out of their room and into the outside. or, better yet, up a chimney (if present).

    Also, in Wuhan, the patient’s door, into the home, would be sealed with tape, and the patient would lower a basket on a rope out their window to get food and supplies. Their rubbish would be double bagged and thrown out the window for collection. This is real quarantining. So simple, practical and medieval!

    Please somebody who has a better grasp of the concept, jump in with a clearer explanation.

    Years ago, people would have open windows and open doors, with a breeze blowing through the sick room, to clear out air born pathogens……bringing in fresh, clean air, which was already partially sterilized by the UV radiation of the sunlight.

    1. Carla

      “FI, if a covid19 patient is sheltering at home with other, uninfected people in the house; Put the patient in a sick room with an en suite.”

      Thank you, clarky90. All of us who live in mansions will comply. In my century-old neighborhood, the houses at most have a lavatory on the first floor, and one bathroom on the second. Many lack the first floor facility.

      1. xkeyscored

        Many lack homes full stop. Will they suddenly be given one in the interest of public health? I doubt it, though I gather there’s plenty of empty ones around.

      2. clarky90

        The old, drafty (good!) rented house, where I live, only has one toilet/bath. However, I am living on my own. Maybe put a chemical/camping toilet in the sick room of a house with multiple residents and no en suite?

        It is 6am in NZ and I just turned on the TV news. A couple more covid19 cases!

        1. clarky90

          I am assuming that our NZ (very good!) health system will be completely over run with Covid 19 patients within weeks. Too few ICUs, respirators, PPEs, pharmaceuticals, healthy health workers…..and so on.

          So, it becomes important for all of us to now, brainstorm how we, our families, our neighbors and our communities, can survive, un-hospitalized, if need be. WAOOO! (We Are On Our Own)

          If I was homeless, I would take a tent and supplies (or my car/van) and head for a remote place in the bush (wilderness), near water and a supply of wood for cooking/heat/company. It would be best (but not necessary) to be part of a small, trusted, sober encampment of other like-minded people. Everybody would have to “be on board” with sheltering in place. ie, not surreptitiously slipping into town, for what ever reason, and inadvertently bringing the virus back with them.

          There would be advantages to tent life, and I have it as a plan “B” for myself. Fresh air, lots of sun, good sleep environment, peace and quiet, the songs of the birds….

  5. PlutoniumKun

    Unfortunately, I think the wrong message is getting out, and most of the blame must lie with the WHO (so many national health authorities take their lead from WHO). They are so intent (or so it seems) on stopping ‘panic’, that they are allowing the voices saying ‘hey, this is just a bad flu’ to dominate. I was looking at a random selection of US and UK TV news reports and I found the casualness quite shocking. Especially business news, which seems to see this as just a big joke, they really do.

    Anecdotally, we’ve had two cases here in Ireland, but I’ve seen little evidence of behaviour changes. To my horror, my gym has changed nothing (its a really nice place, but never with the best hygiene I have to say). The owner of my local yoga centre has started scrubbing everything with chlorine, but (quite rightly) admits that given the close proximity of everyone in the class its probably a bit pointless. I haven’t noticed any significant behavioural change – a little bit of hoarding of tinned foods (mostly sold out in local supermarkets), and thats about it. My attempts to get my apartment management company to do things has been met with a deafening silence (oh, but we already clean everything regularly).

    Italy is completely out of control. Italians are popping up all over the world with the virus, which strongly suggests it is completely endemic now to northern Italy. The figures from much of SE Asia are just not credible. And I’m pretty sure the Chinese government is lying about its cases – despite what WHO says, there is plenty of credible evidence that hospitals all over China are being pressured to re-diagnose cases as ‘viral pneumonia’ or similar (see the ADVChina and Peak Prosperity YT channels for evidence on this).

    Iran, I think, is a catastrophe in the making, there seems little doubt but that the Iranians are suppressing the news of widespread deaths.

    The most disturbing situation I think is in South Korea. They are doing everything right – they are open, transparent, and treating it at a war like level of mobilisation. And they still can’t stop it or keep the mortality rate as low as we’d like.

    The only bright side that I can see is that I think the indirect evidence is mounting that summer weather slows the virus down to manageable levels. So if authorities act quickly enough, a good spring (at least in the northern hemisphere) can buy us time. I suspect at some level this is the Chinese strategy, and why they are willing to maintain the shut down. They think that warm weather will allow them to declare victory and get everything back to work – everyone may be gambling on a vaccine by September.

    1. vlade

      I think SK has (lagging) mortality of about 0.5%. I can’t find timeseries for it, so it’s hard to say what it is with say two weeks lag.

      It’s miles better than Italy or China (never mind Iran), but if you need this level of mobilisation to keep it down to 0.5% (which is five times worse than bad flu epidemics), we’re in for a world of hurt.

      Silver lining, if this goes on for a few more months:
      – CO2 emissions have dropped a lot.
      – air travel may have peaked, as people realise it’s the best way to spread diseases fast around the world
      – long fragile supply chains may be reconsidered
      – pharma stops looking for the latest convenience/fashion drugs and starts looking more seriously at antivirals

      1. c_heale

        What about the second wave of the virus. That should be starting around Autumn/Fall time.

        From what I’ve read there is no chance of a vaccine for at least a year – 18 months. SARS has been around for about 12 years (I knew someone who died from it) and there is no vaccine yet.

        1. Maurice

          Sorry, but this is just plain scare mongering and certainly not comparing apples to apples. If you want to do it properly, you have to take your sample from people who got it long enough ago that all either are recovered or dead, then you are comparing apples to apples. Don’t have that figure though and are not really interested in it either as currently my risk of becoming infected still stands at 0,00%

          1. The Rev Kev

            Just 0,00%? That’s not you, Julian Assange, is it and pranking us from your glass booth?

          2. Yves Smith Post author

            Sorry, but that is not what recovered in this chart means. I provided a link and there is a definition:

            At the moment, 31 patients were discharged from hospitals after making a full recovery from the virus and 22 deaths are reported. In total, over 105 thousand people are tested until now.

            It appears that 14% of the people who get infected get a serious case that requires hospitalization. “Recovered” = left hospital. Now admittedly some people die who never got into a hospital, but obviously they should have been hospitalized.

            14% x 41% = 5.8%.

            Since everyone says South Korea has such great reporting, are you now trying to tell me it isn’t properly presenting cases discharged from hospitals? Or alternatively, that it has far fewer serious cases as a % of people who contract the coronavirus that the rest of the world? The latter could be true but I haven’t seen anyone asserting that. They’ve instead been trying to say South Korea’s levels of care are leading to fewer deaths, but you therefore ought to see much higher levels of recoveries.

        2. vlade

          ok, I agree your metrics is better and makes sense.

          When I apply your metrics to China ex Hubei, this metric is 0.7%. That is 63 deaths and 8,041 recovered.

          Which strongly supports the case PK made, that _with_ sufficient healthcare, the infection is worse than annual flu by high single digits multiples. When the health-system is overrun, the ratio can and will spike substantially, as in Hubei, where the rate is 7.3%.

          1. Yves Smith Post author

            Other sources have agreed that the death rate is 0.7% out of Hubei, but they attribute the low death rate explicitly to the severity of the lockdown.

            Or to borrow an expression from Lambert, ” _with_ sufficient healthcare” is doing an awful lot of work. It appears a significant number of severe cases require putting the patient on a respirator. No hospital has many of them due to space and cost reasons.

            In other words, it looks like the infection level needs to be kept very low for that ” _with_ sufficient healthcare” to be attainable.

            1. vlade

              I did not claim anything about the levels of infection where the health system will or won’t be overrun. Every health system can be overrun, there’s just not enought resources. Some will be faster some slower.

              80 thousand symptomatic infections with 5% requiring ICU care would happily overrun UK’s NHS, which has 6k ICU beds total and not all of them can be used for CV (well, you can, but that’d likely keep your overal mortality the same, just different causes).

              I have, in previous comments, repeatedly said that the 5% of “require ICU” is my worry, as it can easily transform something that’s bad, but manageable, into a disaster.

              That is, actually, why I’m worried about the asymptomatic infections (even if they make the overal infection/mortality rate seem low).

              Ultimately, it matters little whether the mortality rate is 0.6% of 100m infected, or 3% of 20m symptomatic, it’s 600k dead either way. But if you have 20m symptomatic, the ongoing infection is less likely to spread than if you have 80m people who don’t know they are infected but spread the virus.

            2. Wyoming

              And this ‘new’ (I think) information below that we are no longer talking about Covid 19 properly will have a big impact on all these numbers everyone is arguing about.

              That is: there are two strains of the Covid 19 in play not one. The first strain was responsible for the super fast growth of the disease in Wuhan and the 2nd strain is what is mostly running around the world now. They will have different death rate nuimbers and R0 numbers and so on. This will change everything I expect- for better or for worse tbd.


              1. Brooklin Bridge

                I note the following in the list of items on that CNBC site:

                Travel restrictions ‘irrelevant’ if coronavirus becomes a pandemic, top US health official says

                Why then, has China and Italy (to mention just two) implemented lock downs?

                Never mind the fact that it already IS a pandemic. It seems as though Mr. USofAholes Market wants us to squeeze every last drop of infection and spreadablity out of this nightmare. I could easily be missing something.

                1. MLTPB

                  There are people who suggest we focus on mitigation.

                  Are you for containment?

                  Is it possible to have containment AND mitigation at the same time, receiving equal attention and resources?

                  1. Brooklin Bridge

                    I don’t see how we achieve mitigation without limiting travel. My understanding is that mitigation involves isolation. How do we achieve isolation with new potential cases coming in and going out of the country? As to resources, we don’t seem to want to bother with any.

        3. Jason

          And in Singapore (admittedly a best case scenario), there have been 110 total cases. 79 are discharged from hospitals. 33 are still warded of which 7 are in critical condition. No deaths.

          1. charles 2

            Singapore is the only country in SE Asia where I trust the figures, so I follow them closely. What is impressive is that they are still quite successful at contact tracing (12 cases only unresolved out of 110) and the number of clusters is still quite small. Considering they have not closed schools, nor closed borders (300,000 passages a day), that is quite encouraging. My take is that the virus can’t take the heat, so we really should yearn for summer…

        4. Samuel Conner

          For apples to apples, I think one needs to look at end states of all patients infected at the same time; one doesn’t have this and so the ratio evolves as end states are reached. Also, in early stages of an epidemic, incidence is rising and if mortalities occur quicker than recoveries (as appears to be the case in this epidemic), the #died/(#died + #recovered) can be extremely high at first.

          In China, in both Hubei and “all China other than Hubei”, this ratio has been declining day by day since Feb 17 (for Hubei) and Feb 19 (for China ex Hubei), ie since the first day I have been tracking the daily JHU CSSE numbers for the respective regions.

          China ex Hubei is (assuming the reported numbers are accurate), as of late 3/3, at 0.96%, with about 1500 unresolved cases (of 11300 total cases) and almost no new fatalities in recent days. I think this gives a plausible guess at a final ratio of around 0.8% if all future outcomes of the current cases in this region were known. But that was with very aggressive containment measures. One would be justified to wonder whether there is sufficient will to do this in US.

          It would be very helpful, I think, to know whether, or the extent to which, “smoking” is a prior condition that predisposes patients to more severe respiratory complications. China consumes a lot of tobacco products. There appears to be a very high prevalence of smoking in China.

      2. PlutoniumKun

        I did a rough estimate of SK figures assuming around 10 days lag (just a guess), and I came up with just over 1%. The problem they face is that the overall numbers now are manageable in hospitals. What happens when they run out of respirators and isolation wards? I would expect death rates to climb significantly. Also I think early mortality rates are likely to be very dependent on the population cohort hit first – we’ve seen how in Italy it spiked dearly because it seems to have hit a major hospital first. In SK, its mostly older churchgoers, but from what I’ve seen, older right wing xtian South Koreans are a hardy bunch.

        Silver linings – yes, CO2 levels are dropping, and this may even be long term. A lot of older foundries and power stations may not be worth restarting once they go cold. This may fundamentally change the world travel market, especially if the airlines take a serious hit which would stop them from investing in more capacity. I doubt if there is much appetite at government level for supporting big airlines. Boeing is toast, which might fundamentally reduce production capacity. It may even lead to the closure of coal mines and oil/gas fields.

        1. vlade

          Indeed – the manageable-in-hospitals was what I was saying for a long time could drive the mortality – i.e. I was afraid of the 5% of “need ICU” cases, because no nation has enough ICUs to cope. We will see how it works in SK.

        2. CuriosityConcern

          Cruise ships idled by diminished pleasure outings could be retrofitted for social distance friendly ocean passages.

      3. Ignacio

        Estimating mortality is quite complicated. Given the rapid progress of infection the (not accumulated but current) casualties have not to be compared with current confirmed cases but with the number of infected about 7-10 days ago, which is not exactly the same as confirmed one week ago. Even in SK because they have different rules for testing are detecting many more cases than elsewhere, there are almost certainly many undetected infections and there are also some unknown numbers of let’s call them atypical infections.

    2. rtah100

      Can we stop saying that places like Italy and South Korea are out of control? They are not.

      Their governments are not controlling them. That is a big difference. Saying it is out of control breeds fatalism – the WHO mission warned against wasting the time China has bought us to introduce our own strict measures – and exculpates our leaders.

      China shut down Hubei. By that scale, South Korea needs to quarantine nationally, not in one area, because it is small and densely networked. The same with Italy, the quarantine should cover the country north of the Rubicon.

      Our governments have responsibilities and they are choosing to act late and timidly, for misplaced fear of being accused of over-reacting and of sparking market panic. If they lose control of this, people will surely panic anyway so they should react promptly and trust their populations to agree with the measures (which most do, judging by surveys) and sugar the pill by using fiscal measures, for example to compensate workers kept away by sickness or school closures or businesses hit by travel restrictions.

    3. xkeyscored

      The figures from much of SE Asia are just not credible.

      Cambodia still has no new cases, and I think even the Westerdam woman subsequently tested negative, albeit with CDC involvement. There have been odd rumours on social media etc of cases, but they usually turn out to be rubbish. No such rumours from people who would know about these things. IOW, I find this country’s numbers fairly credible.
      Cambodia has significant Chinese and Sino-Khmer communities, meaning why isn’t it here, so it could be that the virus doesn’t like hot weather. Current temperature here, at midnight, 27C / 80F.

    4. Lee

      Dr. Paul Offit and others are saying with something of a dissmissive air that the case fatality rate of Covid-19 will turn out to be no greater than that the seasonal flu. That’s the possibly good news. The bad news is that. if true. and Covid-19 becomes endemic, annual deaths due to respiratory infection will double.

      I’m wondering being a Sanders supporter in the Biden voter age demographic will prove protective.

  6. vlade

    I suspect WHO, they are under a lot of pressure from China, and no support from US/EU as far as I can tell.

    My current suspicion is that the R0 is much higher, but the majority of infected are almost entirely asymptomatic. I’m pretty damn sure Chinese are not testing everyone who sneezes – there’s not enough capacity to do it.

    The high R0 and high asymptomatic would explain how “has no connection to the regions” would show up in unexpected places.

    I’d really like to see some studies on say smoking and the seriousnes of the infection, as smoking is more common in adult (and especially older) males, who seems to have higher incidence of serious cases. I.e. there seems to be lower incidence of children (who are almost none smokers), and females (who tend to smoke less than males) than I’d expect, especially in the very young children cohort who are usually (together with older people) the tails of mortality distribution. For a massie outbreak like what we seen in China, normal mortality pattern would be sort of U shaped when graphed against age (Spanish flu had a hump in the middle, which made it unsusual, and it’s old-age tail was somewhat less than normal flu).

    That said, Korea has relatively high level of male smoking, and relatively few deaths, although I can’t find any data on serious vs mild cases.

    1. Yves Smith Post author

      Please be more precise. The WHO has rejected the notion that there are meaningful #s of people with inconsequentially mild versions of the disease.

      Individuals are not symptomatic during the incubation period, which China has said might be as long as 24 days but everyone is sticking with a 14 day quarantine. I assume that is what you are referring to.

      1. vlade

        Let’s just say that I do not believe WHO on this, as they are under a lot of pressure from Chinese who want to look like they sucessfully contained it. Anecdotal evidence from China is that you had to be _very_ sick to be tested (which makes sense to an extent, as China may have had problems carrying out the required number of tests).

        I’m not saying I won’t eat my hat on this, but say, with flu, it’s estimated that (adjusted for other ilnesses) as many as 60% of flu infections are asymptomatic. A few years back there was a large English study which claimed that up to 75% of people infected with flu (and able to spread the flu virus) were asymptomatic (which, incidentally, makes the flu mortality even less..).

        We do not know enough about CV to say anything with any certainty – TBH, I see the definite pronouncements from WHO on this almost as a proof of the Chinese pressure, because there’s no way that the virus could be understood in six weeks (Ebola is still not understood well, years before and after outbreaks. Different type of virus, but still).

        As I wrote above, large number of asymptomatic infection would explain the “no connection” cases, which otherwise can’t be easily explained, as well as the weird claimed cases of very long incubation period. So that’s my Occam’s razor.

        1. Yves Smith Post author

          As I have repeatedly pointed out, the evidence is that in Hubei that there are easily >2x serious, not mild, infections that are not in the data. That’s based on people saying on Weibo that they desperately needed help and had been turned away by doctors and hospitals.

          Moreover, big # of mild infections would make all of China’s numbers look better. People would be much less freaked out about the coronavirus if the serious cases and deaths were a smaller % of the total.

          In other words, the WHO’s message on this issue is not at all helpful to China.

          1. vlade

            Asymptomatic people would not be mild infections. They would be asymptomatic, so either no sign of infection at all, or so very mild as to be ignored.

            Right now, I have some knee joints/leg muscles pain. Do I have a cold, flu, CV, or just tired for some other reason? I have no idea, but it’s not even a minor annoyance, and if I was in Hubei, I’d rather stay at home (and not show in any statistics) waiting to see if I get worse than walk to a hospital and risk a chance of actually catching something.

            SK test asymptomatics, China doesn’t (because it has enough symptomatic to exhaust its testing capacity).

        2. rd

          China and Korea have done enough testing to come up with a lot of negative tests. This makes WHO’s current interpretation that most COVID-19 cases end up with significant observable symptoms and that there aren’t a lot of undetected cases that just go away without symptoms credible.

          I think it is the long incubation period that throws people for a loop. We are used to getting exposed and then getting sick within a handful of days. Something that takes a week to three weeks to create symptoms does not fit well into our brains’ acclimation to instant feedback on everything. This is more of an information exchange using handwritten letters via US Post than Twitter.

          It is also why there is probably a rising issue lurking in the US because it is taking time to get people who are showing symptoms tested, never mind screening people they may have been in contact with. By the time they are diagnosed, they could have exposed dozens of people.

          1. Yves Smith Post author

            I agree, and I haven’t articulated the point about the impact of the long (sometimes even longer than 14 day) incubation period as well.

            1. Ian Ollmann

              Which I presume is that the quarantine period should be 4 weeks, if it is going to be effective. With two weeks, you are just giving the virus time to be almost full blown before releasing the patient to infect the community.

      2. Ignacio

        I think there is data that indirectly shows how incorrect is WHO’s statement. Just compare countries that have obviously different approach to testing, like South Korea and the ROW. SK was hit by a bad MERS outbreak 5 years ago and probably for this reason they are applying more tests to any person, symptomatic or not, that simply lives or works in the vicinity of people that has shown to develop COVID-19. The fact that SK detects many more cases indicates there are many infected and asymptomatic. This is almost certain IMO. I believe that WHO wants to avoid panic.

        1. Yves Smith Post author

          For the regular flu, you can test positive up to four days before symptoms occur (as in during the incubation period), so I would assume you could also test positive for the coronavirus during the incubation period, which is even longer and therefore the test might pick it up even earlier.

          So the big disparity between SK and everyone else could be identifying cases well before symptoms break out. That does not mean those cases are mild. They have not happened yet.

          And that would also mean a very low apparent death rate by virtue of a high proportion not having gotten to the disease phase.

          1. vlade

            You can test for flu virus (usually by testing exhaled air, alternative is antibodies over certain level, but that is not a reliable test), repeatedly over time, and be asymptotic during the whole infection (i.e. from the first time you tested positive till you test negative later on).

            Studies I linked to above suggest that majority of flu infections are like that, which would for example explain (to some extent) the still unanswered question of the flu virus reservoir.

            1. none

              Sounds like we need some random testing, like every 10000th person whether or not they have any correlates of infection. Or every 1e5’th person or whatever, enough to make the random tests a few percent of the total tests, enough to reveal significant info but not enough to overload the testing system.

          2. Ignacio

            Direct comparison between flu and SARS-CoV2 regarding all aspects from epidemiology to diagnostics and clinical development is not advisable.

            From EU-CDC: Cases with mild symptoms are numerous and able to transmit the infection. Cases with mild symptoms are not always aware of their potential infectivity, and some people with mild symptoms have sought medical care, thereby infecting health care workers;

          3. Ignacio

            Labs scramble to spot hidden coronavirus infections

            Though it is true that by analysing extensively you could detect cases that haven’t yet developed symptoms these will also include many cases that won’t develop symptoms, very mild symptoms or mild symptoms and it is not known when these became infected. About 15-20% are cases need clinical treatment if I recall correctly. So more than 80% go from mild to asymptomatic. It is too soon to know now but it will be analysed retrospectively when good antibody tests are available.

        2. thoughtful person

          Did not that possibility, more asymptomatic cases than other places that were not testing, also show up with the Diamond Princess? Last numbers I find are 20 Feb wikipedia. 3063 tested, 634 positives and 328 asymptomatic.

          It does perhaps seem that there is an effort among those concerned 1st about markets to minimize testing (restrict information), muzzle scientists etc. Same playbook for the climate crisis.

      3. rtah100

        To be precise:
        – WHO rejected the contention there is a large number of unconfirmed mild cases *outside* Hubei
        – WHO confirmed that there are asymptomatic patients, their infectiousness is unclear.

        Here is the transcript re Hubei (from the Aylward press conference at WHO HQ).


        [Bruce Aylward speaking]

        I would say one point, because I know there will be questions, and I’ll stay as long as we need to try and help with any of those, but one of the big questions that we keep hearing about is how much transmission is going on in communities? And you keep hearing the tip of the iceberg, we can’t see this thing, there are millions of people infected, etc. So, we tried to look at those kinds of questions as well. Again, you’re at war here and there’s a huge fog in any war. You’re trying to find those little bits of information that can add up and give you some confidence in what you’re saying.

        We tried to look at where was there sampling of people in the population that might give us a sense of how widely this virus was spreading? And again, this is where it’s great to look at these things in China because the numbers are so big. But you’ve probably heard that there’s something called an influenza like illness surveillance system that runs around the world with many sentinel sites that collect 20 samples every month and we get them analysed. But this happens in multiple places in China, and what you can do is look at those data and they can show you, here’s our data, our sampling, here’s all the flu cases that are coming up, in November, December of last year, they all went back to look.

        Because once we had a COVID-19 test and they went back to test all of these, nobody found it. It wasn’t there. They found lots of flu. But then in January, they did find it, it comes up in the first couple of weeks in January. But outside of Hubei, very rare. One might be positive here or one there, it wasn’t like all of these samples were positive, like there was a lot of it circulating. And then another thing we did was in places that were heavily infected, more and more people were coming to fever clinics and wanted to get tested.


        And in one place, it might have been Guangdong, they had tested 320,000 samples for the COVID virus. 320,000 is going to give you some sense of what’s going on. And when they started the sampling of those, about 0.49% of them were positive, so less than 05%. And in the recent period, it’s something like 0.02%. So, I know everybody has been out there saying, this thing is spreading everywhere and we just can’t see it, tip of the iceberg. But the data that we do have don’t support that. What it supports is sure, there may be a few asymptomatic cases, and that probably is a real issue, but there’s not huge transmission beyond what you can actually see clinically.


        So, in Hubei, retrospective testing of flu cases showed up COVID-19 but in Guangdong large-scale population sampling shows minimal undiagnosed/asymptomatic cases.

        And here is the transcript on asymptomatic cases (from the WHO press conference in China the previous night):

        [Liang Wannian speaking for China National Health Commisson]

        The proportions of mild, severe, and critically ill patients are about 80%,
        13%, and 6%, respectively. Some asymptomatic patients have been found. However,
        whether such cases are patients with asymptomatic infections or carriers whose virus is
        still in the incubation period warrants further study. It is unclear whether the
        asymptomatic carriers can also spread the disease.”

        1. Ignacio

          In Guandong they analysed 320.000 samples for flu and SARS “and when the epidemic started the analysis yielded 0,49% were Covid-positive, which means that out of 113.000,000 living in Guangdong we could extrapolate to about 553.000 infected in the whole province where only 1300 COVID cases have been registered. This is If we assume that sampling for flu is equally efficient for SARS CoV 2 detection (and there is proof it isn’t as there have been described many examples of failure to detect the coronavirus in swabs). Then if the transcription is correct it went down to 0,02% which extrapolates to 22.600 possible cases in the province lately.

          Isn’t this weird?

          1. Ignacio

            If anything this would suggest there are not a few but lots of very mild to asymptomatic cases if i read correctly. Which is very good news in some sense.

          2. Synoia

            Extrapolating anything from the bottom of a “s” curve, a grouth curve, produces inaccurate results.

            An “s” curve is a double exponential curve, but at this stage the exponents are inaccurate. The top of the curve’s exponent remains inaccurate until one has much reliable data. In this case that means accurate infection rates and survivors.

        2. Ignacio

          Thank you for this info rtah100!

          It strikes me that given the fierce quarantine program in China, the incidence of not only SARS CoV2 but Flu, as well as any other respiratory disease, should have diminished by a lot in all China. Given there is such Flu surveillance program to analyse incidence and determine which is the prevailing Flu every year it would have been quite interesting if Mr. Aylward have given more precise data on the results of the surveillance in both Flu and SARS CoV2 instead on loosely leaving a couple of percentage numbers. According to WTO data in the privious season, the incidence of flu was in between 11-20% (20 to 40 times of that apparently seen with SARS-CoV in its Guangdong peak). What about the incidence of Flu after the quarantine?

          1. Ignacio

            OK a quick search in WHO FluNet shows that Flu incidence fell from 36% incidence in China during its January peak (first week of the year) to 5% in the seventh week of 2020 which is quite low compared with incidence above 25% in previous years.

      4. Monty

        Watch this American who lives in Shenzhen, China explain how China got in under control.

        Everything is shut except supermarkets and pharmacies, schools have been closed for 50 days. They were all obliged to install an app that tracks their whereabouts. When you enter a building they test your temperature. Fever = covid19 test, if positive then quarantine. If someone you were near on the app is found to have the virus, they tell you to stay put and come and test you. positive -> quarantine.

        He says pretty soon China will be the safest place to be, because they rose to the challenge and did what had to be done to prevent an unprecedented catastrophe. Hard to argue with that, because they couldn’t even make an app to count a few thousand caucus votes over here!

    2. hcho

      According to Chosun newspaper, there are 52 mid to serious cases. 25 serious cases on breathing apparatus and the rest either have fever above 38.5 c or use oxygen mask.
      So in Korea the number of serious cases is far lower than published rates. I believe this is because the cult members were extensively tested, and these make up over 50% of the infected. I don’t see how this is consistent with WHO’s claim that there are not many undetected cases.

      1. rtah100

        It takes 3 weeks typically from diagnosis to death. It can take longer if you are strong or they throw everything they have got at you (these patients are on invasive ventilation under sedation, possibly even ECMO, i.e. life support – their date of death is fairly arbitrary, just when they stop putting coins in the meter).

        South Korea has done a massive testing exercise. Now we have to wait 3 weeks and see how the cards fall.

        I don’t think the WHO is saying that there are not many undetected (i.e. undiagnosed) cases. Clearly a lot of people have not got an official diagnosis. They are saying that nearly all cases will go on to present frank clinical disease that follows the 80/15/5 pattern of mild, serious, critical. There is no army of people with a cough and nothing more, not in the long run: asymptomatic patients are the exception not the rule.

  7. clarky90

    Thank you to Yves, Lambert and Jerri-Lynn for taking Covid 19 seriously. I am absolutely dismayed at watching our local TV news. Always minimizing, “what abouting”, distracting, soothing….

    It is exponential growth which is very difficult for the human mind to grasp. The feared, hockey stick.

    IMO, the pandemic of the 2020s will be the defining event our lives.

    1. Tom Stone

      I’m taking it very seriously, being immunosuppressed due to Chemo.
      No more gym, no more broker’s meetings, stopped doing volunteer work at the jails after 15 years,Deep cleaned and disinfected my home and vehicle and continue disinfecting doorhandles etc daily. started shopping a times when stores have few customers, nitrile gloves in public and thorough handwashing ,
      Close to a self quarantine until my immune system recovers.
      Unfortunately my Chemo requires a hospital stay of roughly 30 hours and there are four more to go a month apart, the next one tomorrow, my most likely point of exposure.

      1. Brooklin Bridge

        Best of luck with that , Tom. That your exposure happens only once a month is of course vastly better than every day. Fingers crossed!

      2. JTMcPhee

        Are the people who administer your chemo taking adequate precautions to avoid transmission to you and the other people getting chemo treatments? I have several friends and relatives who are doing chemo and as a retired nurse who saw too much cavalier behavior in several settings, I worry that they are maybe in harm’s way.

      3. Old Jake

        Saying a little prayer (agnostic though I may be) for you and all those on chemo or otherwise immuno-challenged in this time. Live long and prosper.

      4. Susan the other

        You just made me wonder if immunosuppression might not be a good thing as a lot of the reports explain how the immune system actually over-reacts and floods the bloodstream with various immune response molecules that do more damage than good. hope so.

        1. rtah100

          There are several papers out there on using immune suppresants for treatment, e.g. chloroquine (malaria drug, has multiple mechanisms of action, including mild immune modulation so often given for long-term autoimmune disorders) and thalidomide (another immune suppressant and also an anti-anxiety medication, one paper said it had very good effects on stabilising patients on non-invasive ventilation, to help them cope and to reduce immune reaction symptoms)

          You may want to take a look at http://www.reddit/com/r/COVID-19 which is the academic research paper subreddit….

  8. The Rev Kev

    I am going with the idea that people need to see something dramatic to convince themselves that this s*** is getting real and I think that I know what it will be. It will be the cancellation of the Tokyo 2020 Olympic Games. Japan has really blown their response and now it is running rife there. A Japanese doctor was estimating on the news tonight that there must be thousands if not tens of thousands of cases right now. And there is still nearly five months until the Summer Games are supposed to start. When – not if – the Games are cancelled then that is the point that people will finally get with the idea that their lives have changed forever. That this is an event on the same level as a World War.

    There is another factor at work and that is how the Coronavirus pandemic will become a litmus test for responsible government. We will find out who has good governance and who does not. South Korea and Singapore are covering themselves with glory because of their rapid response at the moment. China and Iran are lying their faces off as are other countries like Thailand. Trump’s America is doing what a lot of countries are doing and that is a See No Evil, Hear No Evil approach that will totally overwhelm them. The Netherlands seem to be experimenting with a PC approach to handling Coronavirus. We will all see how well our governments perform in a true emergency and what their revealed priorities are.

    1. Thomas P

      Before the Olympics there is Eurovision, which I suspect will be cancelled or turned into a video conference. This should spread awareness in Europe at least. With almost 200 million viewers this is quite a big event.

    2. Ignim Brites

      The illness of one of our setuagenarian presidential candidates might be a wake up call. And it seems not an improbable event as political rallies and campaigns seem ideal for spreading infectious disease. Maybe the elections should be postponed until 2021.

      1. Jane

        Wouldn’t Trump love that, a national emergency that means no elections until a vaccine is available; he’d be demanding it take six years and not six months.

        One thing that the media is clarifying, unlike the manufactured crises porn they so love to hype, real crises are bad for business.

        1. JTMcPhee

          It would not be just Trump. You can bet that the state security apparatus is slavering at the idea that this can be the occasion to impose the kinds of populace controls that populate their wet dreams of dominance for dominance’s sake…

          1. MLTPB

            One case at the European Union offices.

            People from all over at UN sites.

            When elected institutions are infected, what happens?

            1. Ian Olmann

              They go home, deputy assistant file clerk second grade has a few weeks of trying to keep it all together, and then with any luck, the minister gets better, the file clerk collapses and we are in real trouble because the minister has no clerk and nothing can be done.

        2. MLTPB

          I see this morning that it has infected 8% of the parliament of Iran.

          Could thay lead to a political crisis there?

    3. rd

      My expectation is that they will limit the attendance to athletes, coaches, and media and do everything just on TV. They can effectively quarantine and sterilize dorms etc. They could spread everybody out a lot more during the opening and closing ceremonies if there is nobody else in the stands. They could even spread the duration of the games out so that there is less density of people in the dorms at one time.

      1. MLTPB

        There have been soccer pr football games in Europe played behind closed doors, ie empty stadiums.

      2. Dwight

        In Japan, high school baseball Koshien tournament qualifying games will be played without audiences, even players’ families.

  9. VietnamVet

    Automatic Earth posted the following chart: “The Varying Impact of the Coronavirus”.

    This is a couple days old and doesn’t include the USA and the 9 deaths in the Seattle area. With the horrific string of SNAFUs by the Federal Government, I am afraid that this information has not gotten through to the Decision Makers. They are following in lockstep with the Obama Administration’s belief that PR can fix everything. It can’t and won’t stop a pandemic.

    To get the mortality rate down to South Korea’s benchmark lowest of 0.6% (around 6 times more deadly than seasonal flu) everybody in the USA must shelter in place. First world healthcare and drive through testing must be provided. Instead, middle class American cities will be similar to Italy and Japan. The 2.0% mortality rate will kill millions of American. If the public healthcare system breaks down and people avoid testing and getting medical care because they can’t afford it, the mortality rate will be similar to Iran’s 5.5% which is in the high range for the Spanish flu. Hundreds of millions will die across the world. Unless Personnel Protective Equipment
    – PPE are provided for first responders, they will all sooner or later be quarantined like in Kirkland WA. If police, firemen, the military, utility workers, grocery clerks, healthcare workers (all the people that make things work) are not provided the PPE to do their jobs safely, society will disintegrate.

    It is simply incredible that the Elite believe that hording wealth makes them impervious to Pestilence, Famine and War. No bolt-hole is safe in 2020 when their neighbors start dry coughing into the air intakes.

      1. rtah100

        I think we have to handle the SK data with care, many of the early cases are hospital-acquired infection among elderly psychiatric in-patients (never a healthy group, poor diet choices and personal care, no exercise etc.) so many had co-morbidities. Something like 95% of the patients in the facility have the disease! This will skew the numbers.

        The results from the Italian town of “Vo’ Euganeo” where the authorities tested *everybody* will be more revealing.

        But the Chinese actions suggest this is a disease to be rationally afraid of, with a high hospitalisation rate and high infectiousness, overwhelming healthcare systems….

      2. JTMcPhee

        There’s no “simple math” to project any accurate and complete numbers, but in a population of 330,000,000, if the infection rate is 40% and the mortality rate is 3%, my calculator says some 3,960,000 of us USians will die of this disease. I think I did that, though of course all the numbers are just arbitrary at this point.

        The knock-on effects are of course imponderable. Economic disruption, people weakened by the disease then dying from other problems. I would hope that this thing that requires “social distancing” among already atomized people might serve as an impetus to learn to all pull together. Not a given, but who knows, given how Bernie is doing.

        I wonder if he and his advisers have thought out how to message this situation. Would be great if he has some strong message on what a more “socialist” approach could have done, and what needs doing going forward. Really hard to do, of course — can’t be seen as a Casandra or to be undercutting whatever legitimate responses the Imperial government is undertaking.

    1. LawnDart

      My cynicism was shaped by war and honed by public service.

      In the face of this crisis, the elites are still hustling for bucks– “affordable vaccine, anyone?”

      We’ll know that they take it for real as they struggle to further distance themselves, isolate and protect themselves, from the unwashed; when they fire the nanny and watch over their own kids; when they let their faucets drip rather than allow a handyman into their home… You get the picture.

      5.5% still means you will probably survive this pandemic. The pandemic is our reality, but at least we can try to find some good amongst the horror to come: is there a better time to show kindness, warmth and good will towards others? To face the possibility of death with calm, dignity and grace?

      I certainly don’t expect to see that from most, and especially from our “elites”, party members, and the political class in general.

      Back in December, I purchased a piece of DOG, before the virus hit the radar. It’s been
      rather fun watching the dogpile into those shares over the last few weeks. If you look at the historical data, it looks like that b—h has the legs for plenty of run. So worse comes to worse, and I don’t make it to the other side of this virus-thingy, at least my kin can afford to bury me.

    2. Ian Ollmann

      I was with you until society will disintegrate. I feel this is an unnecessarily large leap. I’m more in line with the WAOOO comment earlier. We are on our own. I feel that most citizens are pretty capable of taking care of themselves and getting along with neighbors if they have to. Maybe you have to survive the cold on your own might and constitution — some won’t make it — but I think that in the end we will be okay.

      It isn’t time to start cobbling together your Mad Max mobile and hoarding Go Juice. Though, you can order a cyber truck though if it tickles your fancy. We need to start rotating out the ICEs.

  10. LawnDart

    This virus will probably be around for at least the next few years.

    Considering that anything “public” in the USA has been starved, harvested for revenues, or stripped for assets, it’s hard to see that our public health system will be anything other than overwhelmed.

    You’re on your own, kid.

  11. Jen

    “It is simply incredible that the Elite believe that hording wealth makes them impervious to Pestilence, Famine and War. No bolt-hole is safe in 2020 when their neighbors start dry coughing into the air intakes.”

    It won’t even take that. The Elite are the ones who can afford to go to places where this disease already exists.

    We’ve had our first case reported in my NH town – someone who recently traveled to Italy and brought it back with them. Yesterday, my employer, a “small liberal arts college” (SLAC) reported that this person had attended an event in a nearby town that was sponsored by one of our professional schools, and they were in the process of identifying and contacting those whom the victim had interacted with. Our COVID-19 task force noted, cheerfully, that no SLAC students were among the contacts. Apparently only the undergrads count as students.

    Right now, the biggest concern of the SLAC leadership appears to be whether to proceed with the foreign exchange program next term. Not a peep about what to do about the students who are currently abroad. What happens if some of them bring a little COVID-19 back with them? Dorms are petri dishes for contagion, and most of our undergrads reside in dorms. I’ve seen no evidence to date that the SLAC leadership is thinking seriously, or for that matter at all, about worse case scenarios.

    In my little corner of the SLAC universe, where we teach medical students, we’re already trying to figure out how our teaching programs continue if we have no physicians or residents available to teach. This could actually happen in another week or so. We’re looking at what tasks require humans to do – we have animal research, fly colonies that need to be maintained. What about research MRI units that need to be monitored? If the helium levels get too low in those machines, bad things happen. What happens if we have to cancel classes, and/or exams?

    I really hope that we never get to the point of actually having to deal with any of the worst case scenarios, but better that we put them out there and at least try to plan than get find ourselves in the midst of a worst case scenario saying “what the family blog do we do now?”

    If we have an outbreak on campus, it will very much affect the Elite, as their progeny are the primary occupants of our dorms, and expand out to the [far less well off] employees. Who cleans the dorms? Who serves food in the dining halls? How will these people be protected?

    One other fun note – we self insure. Drugs and cancer treatment have always been the biggest driver of cost, but it won’t take many people ending up in the ICU to change that.

    1. rd

      I think one of the big issues that is going to come to the forefront with this is the lack of safety nets that is forcing a lot of people over 65 to stay in the work force. That is the population with the high morbidity to date. They will be coming to work and circulating with many people, getting infected, and then go off and become a serious case with large demands on the healthcare system (they are covered by Medicare, Medicaid, and VA). Many seniors will not be in a position to shelter in place.

    2. TheHoarseWhisperer

      The kids are going to be (mostly) ok. It’s the Kendall residents that are at peril. DHMC has a total of 369 beds. Biggest hospital between Boston and Montreal…

      on most days, they are full. Market-wise: 100% utilization. Any Tuck graduate would tell you, this is a good thing.

  12. Eustache de Saint Pierre

    I happened to listen to while occasionally looking up at some gruesome vintage photographs, a docu that concentrates on the US end of things during the Spanish flu pandemic, a couple of months before Covid-19 reared it’s ugly head & have just done so again & it’s not for the fainthearted.

    It appears that the same attitudes are somewhat prevalent again, although medically & knowledge wise things are much improved now & the much of what was happening there like shift workers entering a bed after another just got out is probably limited to the very poor parts of today’s world. Hypoxemia appears to have killed many & it was said that once someone turned blue that would be goodbye cruel world for them as they had no ventilator equipment, which I suppose could happen again if a health system was swamped.

    San Francisco fared best & people were shot for not wearing masks but in most other cities the local bosses screwed up big time – Philadelphia I think being the worst & the stories about the troop transportations throughout the US which infected people everywhere they travelled is a pure horror show, while of course that particular little devil had a 2nd wave sting in it’s tail.

    Dr. John Campbell has been complaining about the WHO being reactive rather than proactive for some time & the other day got pretty angry about it. He is though reasonably happy with Boris’s statement & he has done a very good live demo of hand washing & best toilet practice if anyone is interested – in his opinion because the skin is covered with a thin membrane whose name I cannot remember, ordinary soap if used properly will kill any virus droplets. I imagine that the EU might get hit pretty badly due to it’s borders & perhaps it’s lack of a single point of authority.

    Maybe if everybody watched this they might wake up a bit, but of course ” This time it’s different “, which it is but not that much if those in charge don’t get their act together.

  13. Stephen The Tech Critic

    When it comes to estimating mortality, I think it’s helpful to keep in in mind the concept of multiple tiers and required care at each tier. My numbers here are very roughly derived from case report data from a handful of sources. Uncertainties are large here, and I mostly just want to illustrate the point.

    First, we are told that around 80% of cases are “mild”. Mild means that they don’t require hospitalization to recover. That’s “tier zero” as it requires no significant health-care resources. About 20% of cases, require a hospital bed and supplemental oxygen. About 3 in 4 of these cases (15% of total) recover without additional measures, and these “serious” cases make up “tier one”. This implies about 5% of cases need mechanical ventilation. About 3 in 4 of these cases (3.75% of total) will recover without additional measures, and these “severe” cases make up “tier two”. About 1.25% of cases need extreme measures that can only be delivered in highly equipped ICUs. About 3 in 4 of these cases will survive (although they can tie up other hospital resources for many weeks), and these “critical” cases make up “tier three”. Finally, even with all resources brought to bear, some small fraction of cases (like 0.3%???) still die anyway (“tier 4”).

    Like I said, all these numbers are uncertain, but you can see how resource shortages at each tier are likely to impact mortality variance from region-to-region, and how reducing the spread of the disease through containment measures can make a huge impact on the number of lives lost. Of course if the whole point is to keep the hospitals from overflowing, whatever containment measures are necessary are likely to have to remain in place for a long time with such a contagious disease. This means that the knock-on effects of such policies (i.e., a cratering of economic demand in the services) are likely to be more severe. What a nasty trade-off!

    IMO, it may be time for helicopter money in addition to NDMS health-care. And someone should figure out how to accurately test for immunity so that people who are (hopefully) already immune can be recruited rapidly for jobs that are high risk.

    1. samhill

      I’m in Italy, figures compared to those out of China are sadly, worryingly, worse and have been fairly consistent and the sample is pretty big at this point, >40% hospitalised and >10% ICU. See for yourself:

      My unqualified dilettante epidemiologist guess – Two strains? An early oct-jan one and a post jan mutated worse one, Italy late to the game got only the worse? In China the two averaged out the stats? The Italian stats needless to say have me scared sh!tless. Hope it’s some stats anomaly I’m not seeing or understanding, or bad stats out of one or both Italy and China, but I think Italy is straight up with the numbers.

      IMO, it may be time for helicopter money

      Central Bank cutting and QE will have no effect in countries under lockdown, ie forced unemployment and collapsing sales as people can’t shop even if they wanted too. I need to think about this more but seems if there was a Universal Basic Income it might be a real economic bulwark here? At least people can pay the bills.

      1. rtah100

        Again, we have to take the Italian figures carefully.
        – The population is skewed elderly (I am not saying elderly deaths don’t count, I am saying that the different age structure of the population will produce a different CFR from China despite the same virus properties).
        – The early cluster was of hospital transmission, so a lot of people who were already sick in hospital for other reasons have died of it
        – There have only been one or two deaths of “healthy” patients (the 60 year old doctor yesterday for example). Same in South Korea, the one 35 year old who died was a Mongolian health tourist with liver and renal failure in SK for a liver transplant.

        I am not minimising the impact of the virus in S Korea or Italy – we have to take the population we have, so the CFR will be higher – but the terrible dead/recovered ratios we are seeing are an artefact of two high income countries with high quality care which, in normal times, keep alive a lot of frail people, and the excess mortality will be concentrated in these cohorts – very elderly and serious comorbidities (which are strongly correlated anyway).

        The virus enters in the healthcare systems. Many of these people are going to die in this epidemic, of competition for resources if not of coronavirus. You could say that COVID-19 is a disease of weak / dissolute healthcare systems (and by extension governments/polities) and we are going to find out which national bodies can resist it….

        1. samhill

          we are seeing are an artefact of two high income countries with high quality care which, in normal times, keep alive a lot of frail people, and the excess mortality will be concentrated in these cohorts


        2. Dan

          So, in short, the people who have the most severe symptoms are those whose immune systems were already diminished.

      2. MLTPB

        It would seem basic income helps more than work guarantee, if a lot of people have to stay home.

      3. Krystyn Walentka

        Would the fact that it is highly contagious mean we have a more rapid evolution of the virus? Is that why we have these new strains? More contagious=more replication=more genetic diversity=more infected?

        1. MLTPB

          One interesting fact I observe is that now, the thing has travelled around the world and is going back to China, via Italy, Iran and probably elsewhere.

          Would that be the ‘second wave?’

  14. Mark

    Interesting how different countries have reacted. Trump has certainly downplayed this and the US is in stronger denial than many places.

    Even plenty of ‘experts’ have been guilty of down playing this. One does wonder if it is all just wishful thinking. Down playing by numerous means including the ‘low’ 2% death rate. For over 60s it is closer to 10%, how many over 60s do you know?

    I was tracking the exponential growth in China from late January and saying to anybody who would listen, this doesn’t look good. My relevant knowledge was pretty much basic understanding of virus transmission and exponential growth.

    In contrast here in Australia we have been facing shortages of toilet paper and other bulky essentials or long life item as people stockpile, which it then trigger hoarding for fear of scarcity. This is just the tip of the iceberg. If the virus takes hold then keeping the vital parts of the economy functioning is just as important as treating the ill. In worse case scenarios the economic and social disruption is vitally important to control. National leadership is needed if things get bad.

    My elderly father, despite his intelligence, just won’t believe it. He is happily planning their next trip away and repeating the flu is more dangerous…

  15. The Rev Kev

    @ Yves & Lambert. Just a suggestion here. As Coronavirus is not going away anytime soon and will probably bedevil us the next two or three years, perhaps it should be given its own place in “Topics” for ease of access for readers.

    I refuse to call it Corvid-19 as it always, for some reason, it brings up an image of black crows and that is one thing I do not want to think about in connection with pandemics.

      1. The Rev Kev

        Ah, I was looking for that topic among the letter “C” and did not go further down that list. No worries.

  16. Lina

    What I’m wondering about at this stage is if there will be a clear pre-Corona time and post-Corona time…. similar to pre 9-11 and post 9-11 – for me, who lived in NYC and experienced the event up front and personal, it is very obvious in retrospect (I’ll bet this is true for most of the US, too).

    Life was different before 9/11. Will this virus drive the same kind of large scale changes to the world economy, work, culture, etc?

    What do the smart folks here think about this?

    1. Democrita

      Great question. Anecdote: My own boss has been congenitally averse to any working from home. He’s now being overruled by the owner, who is, apparently like many other rich bosses, a total germophobe.

      I would call it a silver lining but my mom has weak lungs and is vulnerable.

    2. MLTPB

      Before 2020, and Post 2020.

      (Mentioned here a while ago)

      It looks that way more and more, each and every day people read about it.

  17. Vichy Chicago

    Companies are worried about the mild cases too. I work for a bank in Chicago with multiple bldgs in the Loop. Starting yesterday they banned travel between Loop bldgs, and in-person meetings of more than 5 people (arbitrary, to be sure). Travel domestic and international was cancelled at the end of January.

    If 20% of staff are out sick things stop happening immediately. In-flight projects to meet regulatory decrees, work to keep an unhappy client onboard, etc.

    1. polecat

      At my wife’s place of employment, a co-worker mentioned that their spouse came to work sporting a mild cough (All the family members having had a bout with the .. ‘flu’. Said spouse (a public employee) was told by their employer (city/county .. not sure which??) to go home, as a precaution. Humm ….

  18. Krystyn Walentka

    I just watched an obese woman come into a Starbucks in Corpus Christi, TX with a young child. This is just south of San Antonio where the infected woman was released by the CDC too early.

    She coughed in her hand three different times while waiting for her order, rubbed the back of her son, grab some straws and lids for her drinks, and grabbed the handle of the as she left.

    These people don’t care and it is making me cynical enough to start not caring if they die.

    1. MLTPB

      I wonder, with human diversity, if there are super cough-ers, super breathers (think a cab or a bus) or super sneezers.

      1. The Historian

        Some people are on medications that make them cough. The first high blood pressure med I was prescribed made me cough all the time. The one that I am on right now is not so bad but I still do have coughing spells.

    2. Krystyn Walentka

      Wow. we are so fked. Maybe not this year but the next.

      So far I have seen THREE people coughing into their OPEN hands before they ordered and then picked up lids and straws with the same hand. And these were deep coughs, phlemmy coughs.

      1. polecat

        Me thinks, that before this thing runs it’s course, many a food franchise will go terminal !
        All the more reason to prepare & cook more of one’s own food, if one has the ability to do such, no?

        … short of acquiring copious amounts of sealed, packaged no-cook foodstuffs that one can dump into a vat of 15% bleachwater, for a good soaking, before consuming !

      2. clarky90

        Movie theaters as well!

        I have been sheltering in place for a couple of weeks now- except for shopping forays for essentials. It takes some getting used to if you are even remotely gregarious! Start practicing now. It is way harder than I imagined. Counter-intuitive

        1. Ian Ollmann

          This will be as easy as falling off a log for me. Shake your hand? It never seemed like a good idea before, and now I can get away with a stoic wave. “How!” Attend your meeting? Rather work on my stuff, thanks. Don’t need your input, or if I do, I’ll ask. Email seems good. Lunch in the building cafeteria with 2000 of my closest friends? You know, I haven’t gotten enough exercise this week, and there are some excellent chow 6 blocks away with 5 other people there and some decent quiet.

          My family are good people. The cat is fluffy. Everyone else seems like a unnecessary liability.

          1. Ian Ollmann

            Oh, and for those of you still on the EV fence, imagine:

            Charge your car with your own private charge cable in your own garage. Nobody has used this charge handle since you used it last. It isn’t like the grubby gas pump handle, which If sterile is only so because it was recently soaked with gasoline. You don’t have to go into the beleaguered minimart to pay in advance, wondering what will be on your credit card when you get it back. You don’t have to play sloppy seconds (or five hundred and seconds) with the automatic card reader on the pump. You don’t have to sit in the EZ lube waiting room with some well used magazines waiting for the oil change. Best of all, the rest of us don’t need to deal with your exhaust!

            There is a whole lot to be gained with the decision to make your current ICE your last.

    3. Lina

      I dont go to coffee shops but my partner does and he finally stopped this week at my insistence (fir this reason, as well as unsanitary baristas)

      He brews a pot at home and uses his yeti mug to go.

      He finally listened to me, lol.

      1. MLTPB

        Even going to the doctor for various reasons can be a difficult decision for a few people.

        1. Lunker Walleye

          First, thanks to Yves and all of the knowledgeable people here who have provided great information and links. Over two weeks ago, when there were only a few known cases in Italy, I told husband that I was not comfortable traveling to Italy in May. Today’s John Hopkins site shows 2502 confirmed cases in Italy. Wowser. A few days ago I e-mailed my gym to ask them if they are taking extra precautions to protect their clientele. They replied with what looked like a boiler plate (non) response. I decided today not to return as yesterday it looked like nothing had changed. Too many snowbirds are returning home and spring break begins soon. One of the instructors said she will be going out of the country next week. The weather is lovely here and it is a wonderful time to walk outdoors. We have a treadmill and some weights and bands at home. Today I had physical therapy and I asked the therapist if we could do sessions on line since I don’t want to go to the clinic. She was agreeable and understood. Best wishes to all who must go to hospitals or clinics for treatment.

          1. Lina

            I am dealing with shoulder impingement and had a cortisone shot. The ortho surgeon said to start PT this week. Heck no. I’m doing my own PT based on what I learned during the last go round and what feels right for my shoulder.

            I stopped using the gym 2 winters ago when my daughter was sick nonstop with upper respiratory infections, bronchitis and pneumonia (multiple times for each)!

            So all that to say: I hear you!

  19. The Wolf


    Sat 2.29.2020 – My brother (40), his wife (38) and two sons (12 and 9) returned to Port Canaveral from a 7-day Caribbean cruise, drives home to a suburb 20 mins north of Charlotte, NC.

    Important Side Note: brother is a severe asthmatic, far more controlled now, but as a child he suffered through numerous hospitalizations, daily medications, breathing treatments etc, and as an adult requires a daily inhaler to control symptoms, with an occasional breathing treatment when needed.

    Mon 3.2.2020 – Brother presents symptoms of sneezing, runny nose, otherwise feels fine, no other family members have presented symptoms, goes to work in his small office with two other adults.

    Tues 3.3.2020 – Brother presents a fever of 102 with coughing and visits his PCP and tests positive for Influenza A, noting that these infections are prolific in his area. He is sent home with Tamiful is NOT tested for COVD-19.

    3.4.2020 – Bringing us to this morning, he is now suffering respiratory distress, coughing and chest pain (from his constant coughing) and is taking breathing treatments and has a fever around 100.

    His PCP advised to contact the local ER and plan a visit if his condition worsened and breathing treatments/inhalers were ineffective. He was left with the impression that testing positive for flu-a meant he could not also be infected with COVD-19 (which could very well be an overly optimistic misinterpretation on his part). After furious googling, I can find no statement to this affect.

    Thus, I share my anecdote to highlight why I am concerned with our (US) approach to dealing with this infection. Unless (and I hope) someone can point me to data that confirms Influenza A and COVD-19 are mutually exclusive, I am absolutely stunned he was not immediately tested for COVD-19, given his recent travel and asthma. Yes, I am aware that the CDC recommends testing only when a patient has both symptoms and has traveled to or been in close proximity to “hot spots” or people from “hot spots” but this seems dangerously inadequate. I know these guidelines will evolve, but come on. I’m not the type to panic, but I just do not understand why he would not be tested. FWIW, he is under a self-imposed quarantine for the next 7 days.

    1. Wukchumni

      Sorry to hear of your travails, its so easy to get sick on a floating mall.

      Maybe a bad time to go on a cruise, but I can get you a 4 day journey from Miami to the Bahamas and back (hopefully) for $110, including open bar.

      We have a paid-for cruise coming up some months away, and not only is it a no go, but our insurance won’t cover Covid-19 it looks like, so we’ll be yet another victim of the virus, financially.

    2. ChrisFromGeorgia

      While I am not shocked or even surprised at your brother’s experience, I am scared.

      My suspicion based on more than a wee bit of evidence (CDC botched testing kits) is we don’t have sufficient test kits out there to properly test for COVID-9, and by the time we do it may be too late for any hopes of containment, even at a local level. In this case he did the right thing and self-quarantined, but how many similar cases including ones from that same cruise ship may be out there, in the wild, so to speak?

      You might try calling the CDC or asking your brother’s PCP if they can have the CDC run a test. Given he was just on a cruise, it should be high risk enough to justify it. Of course there is the “will the insurance cover it?” angle and I am not giving advice, just a thought.

    3. clarky90

      I remember getting fibre optic internet connected to the house. The modem they sent was faulty, AND the optic cable was not live. It was very difficult getting the Help Person to imagine that there could possibly be two problems, both at the same time. We did get there in the end…

      Eric Feigl-Ding
      7h (ago)
      Troubling graph from CDC: High “influenza-like activity” nationwide last week— hmmm… CDC needs to rule out if they are flu or #COVID19. How can we do that? #TESTVIRUSNOW Test tube

    1. MLTPB

      There probably will be more entry bans, large gathering bans before no flying or no public transportation.

      Also, prior to that, probably a declaration that will bring in FEMA. Among the things it could do, I read, is setting up mobile hospitals (a different approach from CCP’s building a brand permanent hospital, that seemed to have impressed a few people. Later, schools ang gyms were converted. Perhaps it was not so easy to build one that it could be repeated even for just a second time, less a third).

    1. Wukchumni

      Aussie, NZ, Singapore and a number of countries use polymer currency, as opposed to paper.

      Which surface would be a better host for the most Covid-19?

      1. MLTPB

        I think it’s copper or brass.

        Time for copper coin money, or gold coins, if the barbarous metal is healthier?

        1. Wukchumni

          In David’s missive below about who gets the treatment, as i’ve mentioned before, those in China in 1949, South Vietnam in 1975 and Iran in 1978, all made their exit via karats, and could it come to that where as our system of digital money crumbles under the relentless assault of the virus (you saw yesterday how little respect Covid-19 had for a Fed rate cut) and only old school money will get ‘r done.

      2. rtah100

        Paper, probably. Several studies show it is a trapping environment for pathogens. Fluids get wicked into the fibres where the pathogens dry out. It represents a lower transmission route when handled briefly than you might think. Don’t chew it!

        Polymer banknotes have no such accidental benefits and probably present pathogens neatly for infection. Similar story with wooden and plastic chopping boards.

        Copper coins are naturally disinfecting.

        1. rtah100

          Sorry, inverted the question when I answered. I am agreeing with Yves, paper is safer than polymer, for the reasons above.

      3. Yves Smith Post author

        My guess is polymer.

        The issue is that the virus can live on flat surfaces for up to 9 days, and I have repeatedly seen glass, metal, wood, and plastic mentioned. I think paper is too porous. It may be dirty as hell (harbors a lot of bacteria) but I am not sure that makes is virus friendly.

  20. David

    Not to depress people further, but the only modern analogy I can think of for what might be required to cope with this epidemic is planning for the aftermath of nuclear war, which major western states did until the 1990s. Yes, the casualties would (very probably) be much smaller, the scenario is completely different, etc. etc. but the key similarity is that it was recognised from the beginning that medical facilities (not just drugs, but personnel and equipment) would be completely inadequate to deal with the number of casualties of a nuclear attack. As a result, it was always assumed (though seldom publicly stated) that a system of triage would be necessary. That meant that if you were probably going to survive anyway, or you probably weren’t going to survive anyway, you would not be given treatment. That treatment would be reserved for those for whom treatment would actually make a difference. The same system is used even in peacetime in mass-casualty incidents for deciding who to treat first.
    All differences duly recognised, I can see the same broad logic having to be applied here. The very old and the very young may simply have to be denied treatment (insofar as there is “treatment”) and resources such as ICU beds targeted on those who would be likely to benefit from them most. I don’t know how far this is technically feasible, but it’s worth pointing out that triage in wartime would have been in a context of emergency government with sweeping powers to direct everything and everybody, and the passing of emergency laws. First Come First Served is surely not a feasible alternative, but enforcing a real system of triage would require the kind of powers probably never seen before in peacetime.

    1. Samuel Conner

      I think that there may be plenty of quasi-conventional tools that could be deployed to help mitigate spread and enable the currently (badly) configured health-care system to cope. High on the list IMO would be ways to incentivize sick workers to stay home.

      Back circa 2008, GWB did a kind of slow-motion “helicopter drop” of money into household income by IIRC temporarily suspending certain payroll deductions. I wonder how difficult it would be to simply inject funds into people’s accounts. It’s a crazy idea by conventional standards, but out-of-box measures are IMO warranted. Widespread precarity is going to deter people both self-quarantining and and from seeking early care.

      I think that DJT is quite capable of running to the left of Biden, who I think has to be, from an R strategic perspective, the presumptive D nominee. It would help him to starting governing to Biden’s left now. And that would help against any other D nominee, even Sanders.

      1. Samuel Conner

        Paying sick people to self-quarantine would seem to be far cheaper than subsequently treating the people they would infect if they reported for work while sick.

        I hope this crisis does not go to waste.

    2. MLTPB

      Will people go to Thailand or Mexico for treatment, if they can make it there, invoking humanitarian status?

    1. MLTPB

      Not everyone needs to, at any time.

      Even in Korea, they cannot test everyone in one day.

      The latest I read is doctors can now order it without more permissions.

      Also recommended, I understand, is for people to call their doctors first.

  21. Brooklin Bridge

    Here in my (northern) nook of Massachusetts, the supermarket shelves are empty of hand sanitizer, but otherwise seem fairly normal. Well stocked with disinfectant wipes and liquids for instance, and no shortages of food stuffs both perishable and non perishable.

    Like many others, I’m a bulls eye for the most severe aspects of covid-19. It wouldn’t be so bad if one just went in their sleep, but going from diseased lungs and lack of oxygen is a grim prospect to say the least.

    1. MLTPB

      New cases announced overnight here in CA.

      A day after many voted in gatherings of various sizes.

      Italy may close cinemas.

  22. Mane

    What happens if/when other countries will place travel restrictions on the USA? The way Trump administration is handling the epidemic seems to me guarantee that the situation will be very soon similar to Italy at the moment. How will the Americans react when tourism to the USA drops and they themselves are not any more welcome to other countries?

    1. MLTPB

      China has already asked people, Americans included, to isolate 14 days, if they have been to Iran or Italy recently.

      I imagine it is up to the competency of each nation to do what it thinks best.

  23. Anon

    Yves, do not go to a public gym. You are as much a prime candidate for contracting the virus as your mother. California health officials have stated that people over 50 y.o. should avoid large gatherings, as that is the age group where the serious cases of Covid-19 are occurring.

    Maintaining strength is important, especially to seniors. Try to use elastic tubing at home to mimic full body workouts. I use the strongest elasticity tubing to do both upper and lower body workouts: lat pulls, bicep/tricep stresses, and squats (while holding onto the door-attached tubing for controlled balance).

    Limiting contact with younger gym users (potential stealth carriers) is essential; but not easy.

    1. Joe Well

      I was thinking the same thing.

      I have already paid up personal training sessions (that were a real financial stretch for me) that I am thinking of forgoing.

      It’s that in a gym, you have to touch so many surfaces that many other people have touched.

      I wonder about using thick workout gloves the entire time?

        1. none

          I’ve heard the main reason to wear a surgical mask is that it stops you from touching your face. I’m not freaking out about CV yet, but might start wearing a mask since enough other people are wearing them for CV, that I can wear one to obstruct face recognition cameras without standing out in the crowd.

    2. Yves Smith Post author

      1. This gym does not have large gatherings except for some classes, which I do not take. The people who do take them interestingly do not then use the weight or stretching area. Nor do I get on the cardio machines, which although closely spaced are not crowded either. Nor is is crowded, evah.

      2. I weight train and stretch (on a fresh towel). I do not get within 2 meters of anyone. I spray alcohol which I let sit for ten seconds plus on everything my hands touch or use a paper towel to grab them (like when moving a weight plate to and from a universal bar, when I’ve sanitized the bar itself). Even then, I also wash my hands a few times to be extra sure. I use paper towels when entering the gym (large lobby) and for the various (few) door handles I encounter.

      I am not not going to the gym. I will shortly not be able to walk at all if I don’t. There are some stretches I do which depend on specialized equipment that I cannot have at home. And I require it for my mental health. Weight training is the best form of exercise for coping with anxiety.

      1. José

        I also go to the gym for weightlifting (twice a week) plus swimming practice three times a week.

        I do not think of stopping for the same reasons: it’s a big help for controlling anxiety and it gives me a great feeling of well being.

        Two questions:

        What’s the best method for drinking water while training at the gym? I usually carry a bottle with me – but I worry that I might catch something every time I open it with my hands during the training session and then drink from it.

        Are swimming pools safer than gyms? Are there any data on how this corona virus can spread in swimming pool water ?

        I’ve looked for reliable information on these topics but could not find it. Any help would be much appreciated. Thanks.

        1. Yves Smith Post author

          I don’t know re pools. They ought to be OK due to chlorine in the pool water. So the other risk factors are the dressing room and shower area.

          I use a whirlpool so I have a similar issue, I need to shower before and after. Fortunately the dressing room is pretty much always deserted in my gym.

          Go off on one side in the dressing room. You need to stay 6 feet away from people.

          Use a paper towel to open and close the locker and touch any handles going in and out. Have several in case it becomes hard to keep track of which side was the hand side v. the handle side.

          To be safe, wash hands after getting dressed. Too easy to touch something incidentally while dressing. This allows you to grab an extra paper towel for touching handles while you exit.

          Similarly, grab or bring a couple of clean paper towels for opening and closing your bottle. My experience is after a couple of uses of a paper towel it gets hard to keep track of which side was which. Or you could get a small cloth towel (if it has a label, you can use that to keep track of which side is which). Cloth and paper also good because viruses like flat surfaces. I think they tend to adhere to fabrics and are less likely to get on you in much of any quantity if you screw up.

          1. José

            Thank you very much for your answers.

            Another possible source of infection is the (plastic) bottle of water itself – that I always buy at the local supermarket. I usually put it under running water at home and then dry it using a paper towel. I think that it’s safer to touch it after that.

      2. Anon

        I find a good, hard weight training session therapeutic, too. My local gym is way too crowded to follow your super-hygenic protocol. Please be cautious. I’ve not seen any Covid-19 patients, but I can imagine the distress it can cause. Be wise.

  24. xkeyscored

    From today’s Times. “Police may only be able to tackle the most serious crimes” looks ominous enough in the UK, where people easily outnumber guns.

    Hospitals have been told to see as many patients as they can via video calls because their beds will be needed to treat coronavirus sufferers, and Professor Whitty said government “should look very seriously” at how many consultations could be done online.

    Police may only be able to tackle the most serious crimes and keep public order because so many officers will be sick, it [Johnson’s ‘plan’] warns. Mr Johnson said the military was ready to “back-fill” civilian roles.

  25. xkeyscored

    From today’s Telegraph, an article tracing the phrase “Keep calm and carry on” back to comments made in 1918 by Sir Arthur Newsholme, Britain’s then senior medical officer, in response to the outbreak of Spanish flu.

    By late 1918, ministers were aware of the horrific potential impact of the virus, which was known to turn its victims’ bodies blue and black before death, and so drafted a memorandum which advised Britons to isolate themselves at home if they were sick, and avoid any public gatherings.

    But the nation was also facing its final stretch of the First World War, which had already claimed hundreds of thousands of British lives, and Sir Arthur worried that telling workers to stay at home could hinder Britain’s war effort. Men and women needed to return to the factories day after day if Germany was to be defeated, officials believed, and so the memorandum was buried. Instead, Sir Arthur told the Royal Society of Medicine that Britain’s “major duty” was to “carry on” largely as normal, “even when risk to health and life is involved”.

    “What’s remarkable is how, although we’ve got all this medical technology today which didn’t exist in 1918, when faced with a fast-moving respiratory virus, we really have to fall back on the tried and tested public health measures from the 19th and early 20th Century,” says Dr Honigsbaum [medical historian and author of The Pandemic Century]. “That’s why you’re seeing messaging that it’s essentially ‘business as usual’.”

    1. MLTPB

      1. Not 19th century., but earlier, if any public gatherings are to be avoided.

      That also puts aside new green deal’s preference of public transportation over cars.

      The new new green deal is walking or horse riding (and donkey). Basically pre 18th century.

      2. A similar situation to WW1 today is found in Syria.

      Will the ‘wise’ Putin be the first to back down?

  26. Wukchumni

    So, the sharing economy is shot, with maybe the exception of brave delivery apps serving shut ins.

    That results in lost income, a surplus of used cars perhaps, and a rash of real estate thrust on the market. (here, about 1 out of 4 residences is an AirBnB)

    Those pesky scooters?

    so gone.

  27. Spurfect One

    There is a reason modern farming techniques were evolved. It was to simply stop the spread of disease. Most safe farming practices screen there animals before they are culled and if they are found to have any viruses they are culled immediately and will never make it to any members of the public. Now think of the wet meat markets all throughout Asia. Wild animals taking from god knows where, all in close proximity to each other, all brutally slaughtered or eaten alive in hot conditions. Is it any wonder novel viruses are always transferring from animals to humans in these regions? It’s only a matter of time before a virus mutates to a highly infectious dangerous one that could wipe out as many as a billion on the planet. Viruses need the infected to pass it along to keep it going, a virus could potentially incubate for much longer periods and could be more fatal, this will reach many people. China needs to fix their ways ASAP.

  28. Jabbawocky

    Can I recommend this source of information.

    I think a few things are clear, whatever people say in this thread and whatever the WHO say:

    There is no massive reservoir of people that carry the disease but don’t get sick. This is a myth.

    The most common course of the disease is 3-4 days incubation followed by viral pneumonia lasting around 10 days on average. Much nastier than the flu.

    Mortality rates of around 1% seem reasonable, higher in vulnerable groups. Yves I think your estimate of 5-6% in S Korea is flawed because it doesn’t take into account how long recovery takes relative to death.

    For contrast where the outbreak has been contained:

    Zhejiang province:

    1213 cases

    119 currently infected

    1 death

    1093 recovered.

    But current mortality rates rely on supply of treatments, drugs, equipment etc not being outstripped by demand. Therefore containment is critical to mortality, even if eventually unsuccessful.

    1. Yves Smith Post author

      I’m not saying that the Korea math is correct, I am just using the data from Korea to counter some awfully cheery looking claims about Korean mortality.

      Re the BMJ, one bit counters what I have read repeatedly: your first get what looks like a pretty normal respiratory flu. In the serious cases, it morphs into viral pneumonia after 5-7 days. That is another reason it is contagious: people wander around with what they think is a normal flu and infect other people with their coughing and sniffling.

  29. none

    I wonder if increased teleconferencing will kill off a lot of what remains of the in-person US workforce, such as in the tech sector. If you’re going to hire remote workers you may as well hire them from low-wage countries.

  30. mrtmbrnmn

    It is difficult to know what is really going on with coronavirus with all the “cover-our-butt” lies, official propagandizing and media scare-mongering. The best result would be the kiss-of-death to the 40-yr-long cursed Globalization scam. Perhaps equally frightening, it has demonstrated that big tech and breathless & hysterical media propaganda can drive the whole world into a frenzy in the space of one or two news cycles. Is it a coincidence that pandemonium and pandemic appear to have the same root?

    Not to be too cynical, but our 21st century war-mongering has killed over 1 million Middle Easterners so far. That could be considered a man-made plague, with no cure in sight nor even a legitimate attempt to find one.

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