Agvet12 said:

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Agreed, even if he only "infects" 3 ppl (that's the aggressive Rnaught being used right?). He's been in contact with over 100... so the potential to be infected and spread is what's terrifying. Now imagine it's flight attendants catching this and flying it over their next stops for 15 days before they show signs and are hospitalized

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Agvet12 said:

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Agreed, even if he only "infects" 3 ppl (that's the aggressive Rnaught being used right?). He's been in contact with over 100... so the potential to be infected and spread is what's terrifying. Now imagine it's flight attendants catching this and flying it over their next stops for 15 days before they show signs and are hospitalized

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Bobcat06 said:

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After googling

ASM = America Society of Microbiome

BSL3 = Biohazard Severity Level 3

Is that right?

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k2aggie07 said:

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Saw a post on reddit from a supposed person working with WHO and CDC. Said their estimates of R0 are 3ish. They also said confirmed case lags behind the real number by 7-10 days due to Chinese bureaucracy to name something as confirmed. And, China records only final cause of death in co-morbidity cases, so if you had a heart issue and caught nCoV and died of heart failure, cause of death is heart failure, not nCoV. Same if you're waiting for confirmation and die - gets recorded to neither.

Somewhat encouraging they also said the estimate for incubation period is mean 4.8 days now, close to sars at ~5.

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titan said:

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[ Edit: this was reply to mpl35 post]

That sounds very serious. The translation is that they should be taking more precautions but they are not upgrading it so the people can waive safety regulations and continue to work on patients.

The blasted air-travel is the main big weakness. If that could be shut down flat somehow everywhere it would be easier to arrest and slow the spread instead of having it pop up wherever Chinese have traveled from the Wuhan zone.

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titan said:

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foleyt said:

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Still, AT Wuhan.

Any that has gone there, or been with one that did in the past month, including our diplomats - needs to be considered high-risk until determined otherwise.

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What items comprise `fomites' -- that is, and, what kind of contact is the transmission?

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VaultingChemist said:

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Quote:

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What items comprise `fomites' -- that is, and, what kind of contact is the transmission?

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Skin, hair, clothing, cash, bedding, door knobs, faucet handles, etc.

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fullback44 said:

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I'm afraid this virus could go nuts... I hope they aren't telling us everything and it's not as bad as some of these sites make it out to be ... China is thinning the herd... seems to me that's what's up, terrible if true

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titan said:

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VaultingChemist said:

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Quote:

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What items comprise `fomites' -- that is, and, what kind of contact is the transmission?

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Skin, hair, clothing, cash, bedding, door knobs, faucet handles, etc.

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And the way it enters the body is mouth, nose, or eyes? A mucous place, not just through a thigh - correct?

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titan said:

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fullback44 said:

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I'm afraid this virus could go nuts... I hope they aren't telling us everything and it's not as bad as some of these sites make it out to be ... China is thinning the herd... seems to me that's what's up, terrible if true

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China's problem is a gender imbalance as much as numbers. It would make more sense to "thin" only on one side for them. Wars are good for that because tend to be mostly men, if that is what they needed. Viruses are too indiscriminate.

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VaultingChemist said:

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titan said:

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fullback44 said:

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I'm afraid this virus could go nuts... I hope they aren't telling us everything and it's not as bad as some of these sites make it out to be ... China is thinning the herd... seems to me that's what's up, terrible if true

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China's problem is a gender imbalance as much as numbers. It would make more sense to "thin" only on one side for them. Wars are good for that because tend to be mostly men, if that is what they needed. Viruses are too indiscriminate.

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But this virus seems to infect more men than women by about a factor of four.

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JJMt said:

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Asymptomatic transmission may be rare.

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200201-sitrep-12-ncov.pdf?sfvrsn=273c5d35_2

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The main driver of transmission, based on currently available data, is symptomatic cases. WHO is aware of possible transmission of 2019-nCoV from infected people before they developed symptoms. Detailed exposure histories are being taken to better understand the pre-clinical phase of infection and how transmission may have occurred in these few instances. Asymptomatic infection may be rare, and transmission from an asymptomatic person is very rare with other coronaviruses, as we have seen with Middle East Respiratory Syndrome coronavirus. Thus, transmission from asymptomatic cases is likely not a major driver of transmission. Persons who are symptomatic will spread the virus more readily through coughing and sneezing.

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JJMt said:

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I'm not sure I understand; can you explain further?

I don't necessarily trust the WHO, but what incentive would they have to make that statement if they know or think that they'll have to change it soon?

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aezmvp said:

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JJMt said:

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I'm not sure I understand; can you explain further?

I don't necessarily trust the WHO, but what incentive would they have to make that statement if they know or think that they'll have to change it soon?

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To prevent panic and calm markets and traders. If you look at several of the recent moves it's clear they've been more worried about the economic impact and not the health impact.

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JJMt said:

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Other positive signs are the continuing low contagion and death rates outside of China.

Of concern, though, is the length of time that it takes for confirmed cases to be classified as "recovered". I don't think that any outside of China have been so classified yet.

Also, it's not clear what it takes for a case to be classified as "recovered"; does that mean no more symptoms, does it mean some period of time with multiple tests coming back negative, or does it mean something else?

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Fenrir said:

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First US infection was reported 2 weeks ago. According to the hysteria about exponential infection rates earlier in this thread it's clear many were expecting a much larger spread by this point.

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1) What is the incubation period? Why do I keep hearing 14 days? Is this scary?

The incubation period so far shows a period of 2-7 days with a 95% confidence interval, with median cases at 4.8 days. [url=https://www.biorxiv.org/content/10.1101/2020.01.25.919787v1][1][/url]The 14 day limit is the current maximum theorized incubation period from a Zhejiang case study. The exact maximum is difficult to know because this is based on patient survey and contact reconstruction and prone to error, but 14 days is the "safe" upper bound so far. This figure is similar to the ~5 day incubation for SARS. [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322923/][2][/url] There is no need to panic about this as it's very normal viral behavior.

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2) But what about asymptomatic transmission? Is this worth worrying over?

So to be clear, so far over 95% of patients in most studies do eventually display symptoms. [url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext][3][/url] However, transmission during the asymptomatic incubation stage above has also been confirmed by local and international studies. I believe the US decision to vastly heighten travel restrictions on China last night was largely due to this German confirmation. Ironically US CDC previously did not believe Chinese warnings this was happening.

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4) What is the R0? Is it 2? 5? 12? What does this mean for the viral evolution?
Since popular media (Contagion, Pandemic) really brought the concept of R0 into public focus, there's a lot of confusion about this simplification of statistical methods. Put simply, R0 is a variable used in theoretical epidemiology analysis, derived from the data through various mathematical methods. It is not an intrinsic property of the virus, nor is it set in stone - R0 will change as properties of the outbreak, and our containment efforts, adjust it. There's a good further discussion of R0 here, but generally, without understanding the underlying methods that led to the calculation of a specific R0, you shouldn't overly focus on this number, nor compare it or make conclusions based purely on it.
As best as our models can tell, the R0 of the virus was well above 2-3 in the beginning, where it was infecting people in Wuhan through the Seafood market and across many vectors before broad awareness. This was from Dec of last year to maybe early January. Since increasing awareness and containment factors, the R(t) has likely declined to below 2, and optimistically will head below 1.

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5) Why is the official case count so low? Why do I keep hearing larger numbers of infected? Is there a government cover-up?
The official "confirmed cases" number is not meant to be a "live" count of the # of infected or even identified infected individuals, and the professional community understands this. This number is exactly what it says on the tin, eg, this is the official number we have been able to test and confirm to our satisfaction. In our current fast-response information-driven society, we are used to having access to immediate, live data, and we expect such. The fact we have any confirmation at all at this point is actually a miracle. Back in the days of SARS, no accurate testing existed for many months after the outbreak, so ALL numbers were estimates!
Now due to Chinese bureaucracy and how the confirmations work in China, lack of supplies and personnel when Wuhan hospitals were overwhelmed last week, and difficulty producing the test kits, there is a lag time of up to 12 days to someone being suspected and able to be tested in Wuhan. I think this week they're working hard on bringing that lag down, and the lag is a lot shorter in other provinces due to still-functioning logistics, but it's still about 5 days at least in almost all of China, due to the multiple bureaucratic checks they force it to go through before it's deemed "confirmed enough". There's a trade-off between accuracy (yes, they wouldn't want to make an embarrassing mistake misdiagnosing or mistaking identity) and speed.
In the rest of the world, the delay can be very fast, ~1 day response to 3 or 4 days as well, depending on the country's infrastructure and availability of test kits/proximity to CDC center that's stocking it.
So really the way to think about the number of confirmed cases in China is, this is the number of cases that we can confirm from about 7-10 days ago. This is how we're roughly working with the data. I think most laypeople are just assuming this is a "live" number which is just not the case, it takes time from patient intake to screening to testing to confirmation to double checking.

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6) What about deaths? Have a lot of people died? Why is the official death rate so low? Is there a cover-up?
It is true that the death rate reported by China is heavily misleading. But this is NOT due to an active cover-up. There are 2 main structural reasons:
[ol]

This is primarily due to the structural method of how China records deaths on their certificate. It is established policy/practice in China to record the final cause of death, rather than all existing conditions and overlapping factors.

[/ol]For example, if a (say 85 yo) patient in the US with diabetes and an existing heart condition gets nCoV, is admitted in the hospital, is confirmed with nCoV, then dies of heart failure, he is recorded as dying of nCoV AND heart failure with other complications. However if the same patient dies in China, he would only be recorded of dying by heart failure.
This is a well-known issue with China and co-morbid diseases. I don't agree with it, I wouldn't do it, but I don't run China. But this is not a new method they made up to try to hide deaths here, it's just the way it's done. This has led to jokes in the epidemiology community that "it's impossible to die of flu in China", because they basically don't record any deaths where the patient has flu. See here this recent article from the Global Times, which is one of China's state-sponsored newspapers.
This is not something even China is really trying to hide. They just tell us, sorry, our doctors just do things this way, we have no interest in changing it.
2) The other reason is, right now if a patient is awaiting test results (turnaround can be 3-5 days in China still), and passes away in the meantime, they are not recorded as nCoV. I guess this I can understand, I think similar policies in US, we don't like to go back and edit death certificates because it's a huge hassle.
Ok so - definitely, the death count is too low. We all agree there. But before you freak out, there's a bright spot. We CAN also put an upper bound with a fair amount of certainty on the general death rate. How? Because there have been enough cases reported globally already, and enough data from the patients OUTSIDE of China, that we can tell the death rate is NOT anywhere near 10% with a strong degree of certainty (many patients have recovered, and are just awaiting the viral test all-clear before they can be discharged. Most other patients are in stable and recovering condition).

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