covid19 has probably been circulating the globe for over a year now.
major lag factor to actually catch on to an invisible bug

Harrison Wells said:

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Helpful information from
Juliana Grant, a physician and infectious disease epidemiologist from the Seattle area.

Hi folks,

A number of you have asked me what I think is going to happen with coronavirus (COVID-19) and what we should be doing to prepare. I have a few thoughts about what's likely to happen and what you should do about it. For those of you who don't know me well, I am a preventive medicine physician and infectious disease epidemiologist. I graduated from the CDC's Epidemic Intelligence Service and have over 17 years of experience in the field, most of that with CDC.
Wishing everyone good health,
Juliana

Who should I listen to?
The CDC and your state health department are your best place for information about COVID-19. Be cautious about other sources of information - many of them will not be reliable or accurate.

How bad is this going to be?
It's possible that COVID-19 will be similar to a bad flu year but there are a number of indications that it will be very much like the 1918 Flu Pandemic. To put that in perspective, the 1918 flu did not end civilization as we know it but it was the second-deadliest event of the last 200 years. Expect people you know to die from this.
However, there is one critical difference between COVID-19 and the 1918 flu - the 1918 flu virus hit children and young adults particularly hard. COVID-19 seems to be most severe in older adults. Children and young adults generally have mild infections. We are grateful for this.

What can we expect?
This is not the zombie apocalypse. Core infrastructure (e.g., power, water, supermarkets, internet, government, etc.) will continue to work, perhaps with some minor disruptions.

There will be significant economic disruption: a global recession is very possible and there will probably be significant shortages of some products. The healthcare system will be hit the hardest. The number of people who are likely to get sick is higher than our healthcare systems can handle.

Daily life will be impacted in important ways. Travel is likely to be limited and public gatherings will probably be canceled. Schools will probably be closed. Expect health departments to start issuing these orders in the near future, especially on the West Coast.
The acute pandemic will probably last at least for several months and quite possibly for a year or two.

What can we do?
We can't keep COVID-19 from being a global pandemic but the more we can do to slow the spread of the disease, the less severe the impact will be. With that in mind, here are the things you can do:

Stay calm but take it seriously. This will likely be bad but it's not the apocalypse.
Stay home if you're sick or someone in your house is sick.
Leave medical supplies for healthcare workers. You shouldn't be stockpiling masks or other medical supplies. They are needed in hospitals to keep our healthcare workers healthy.
Wash your hands. Get in the habit of frequently washing your hands thoroughly and covering your cough.
Minimize your exposure. Now that we're seeing community transmission, it's time to start seriously cutting back on your exposure to other people. Depending on your circumstances:
Cancel all non-essential travel (and most of it is non-essential!)
Avoid large-scale gatherings
Work from home if possible
Minimize direct contact with others including hand shakes and hugs
Reduce your trips out of the house. If possible, shop for two weeks of groceries at once or consider having your groceries delivered.
Remember, keep calm and prepare. This is likely to be bad but if we respond calmly and thoughtfully we can handle it.

Feel free to share this email as you see fit.
**************************
Juliana Grant, MD MPH
Public health and epidemiology consultant
juliana@julianagrant.com

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This reads like one of those emails my great aunt would forward to the entire family when that was cool 20 years ago.

I'm hoping to find more very cheap hotel rooms when I go to Ireland in a couple of months.

If this gets me, so be it.

I've lived with type 1 diabetes much longer than I thought I would and I have outlived all of my other family members combined that were diagnosed with the same cancer.

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How bad is this going to be?

It's possible that COVID-19 will be similar to a bad flu year but there are a number of indications that it will be very much like the 1918 Flu Pandemic.

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The healthcare system will be hit the hardest. The number of people who are likely to get sick is higher than our healthcare systems can handle.

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At least we are getting some good info from a qualified epidemiologist.

Tanya 93 said:

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ac04 said:

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i'm not even going to engage with you because your entire strategy in disagreements is to take extreme positions and be intentionally obtuse. you're not capable of rational debate.

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When should everything be shut down?

I get being asked when we cannot leave our homes is a hard question, but when should it occur?
Tonight?
Tomorrow?

Sunday so people can get paid on Friday and shop?

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Never. Shutting down "everything" is not the argument. Limiting mass gatherings is the goal. The reason is exactly what cone mentioned... to modify the R0 of the communities to the point where the spread is no longer at pandemic levels. If that can be accomplished by practicing better hygiene, avoiding places where many people gather as much as possible, then we should probably do that... without being ordered as such by the government. When the government has to order that, its already too late.

Nuclear Scramjet said:

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Oh no no no.

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CDC has had their primer sequences and assay posted for a while now. I'm actually kind of shocked that this wasn't done sooner. PCR takes hours to get optimized if you have the right setup, as I'm sure most research hospitals do. The slowest part is going to be ordering oligos, which can happen in 24 hr turnaround for regular business.

At least that was the case the last time I designed PCR assays more than 7 years ago.

what are you basing this on? I've seen research modeling the genetic mutations etc that says this outbreak comes from late November.

yep epidemiologists overstate this stuff- bc its what they have prepared their whole lives for.
It gives meaning to their careers!!!

"Don't you tell me you know more about an epidemic than me! I'm an epidemiologist!"
"Everyone is gonna die!!! My degree makes me an expert!!"

I am still going to True/False this weekend.

I wash my hands all the time and have sanitizer every time I touch a door, arm rest, or stair railing.

I am not worried about getting coronavirus this weekend.

Sorry. Oligos = primers = short pieces of DNA that are used to increase the amount of DNA/RNA they are intended to detect (amplification). The assay is called polymerase chain reaction (PCR).

It's a pretty basic assay, and can be done on a stove if you're patient. The variety they are using requires detection of fluorescent markers used in the amplification process (and more sophisticated equipment than a stove and agar). It's a reasonably basic assay in modern molecular biology.

k2aggie07 said:

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Source
https://www.julianagrant.com/blog/2020/2/29/coronavirus

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Another short article by her
How is Covid-19 like the 1918 Spanish Flu

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A few folks have asked me how COVID-19 is similar to the 1918 flu. There are two main things I'm considering when I say that.
[ol]

Mortality rate: The early reports of COVID-19 are showing a mortality rate of 1.5-3%, meaning that 1.5-3% of people who are infected die. This is approximately 10-30 times higher than the mortality associated with seasonal flu in the U.S. and in the same general vicinity as 1918 flu.
But (there is always a but), as with interpreting any science, there are some key things to consider. For one, it's possible that there are a large number of people with mild, undiagnosed COVID-19 infection. If this is the case, the actual mortality rate is much lower. For another, most of the data are from China where many people smoke and medical care is probably not as strong as in the U.S. Both of these factors could make COVID-19 mortality rates seen to date higher than what we would see here. A final thing to consider is that the mortality rates for both seasonal flu and the 1918 flu are estimates, so our comparisons are not perfect.

Transmission rate: Early reports indicate that each person with COVID-19 infection gives the virus to more than two other people (on average). This is referred to as the transmission rate. There are other factors to consider, but in general the higher the transmission rate the more cases we will see. We think the transmission rate for seasonal flu is less than two but the 1918 flu transmission rate is about the same as what we're seeing with COVID-19. Again, these are estimates and we don't yet know if they are correct.

[/ol]

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As far as mortality rates go, Covid-19 would probably be much higher if it occurred in 1918.

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Limiting mass gatherings is the goal. The reason is exactly what cone mentioned... to modify the R0 of the communities to the point where the spread is no longer at pandemic levels. If that can be accomplished by practicing better hygiene, avoiding places where many people gather as much as possible, then we should probably do that... without being ordered as such by the government. When the government has to order that, its already too late.

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But even then its a matter of degree - one has to determine the appropriate personal risk levels based on size of the event, possible exposure and contact with others, proximity to the known cases, personal general health, etc

Its times like these when the personal responsibility we so like to tout for others gets tested in ourselves.

OverSeas AG said:

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As I said... there is a ton of commerce between the two countries. It only took Chinese in Iran to go home for Chinese New Year and then return to Iran after it was over to start spreading it.

I guarantee you that other countries that have a lot of commerce (and I mean interchanges of Chinese nationals) with China are also highly impacted, they are just not reporting it yet - for various reasons.

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Congo and other Central African countries.....

B-1 83 said:

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OverSeas AG said:

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As I said... there is a ton of commerce between the two countries. It only took Chinese in Iran to go home for Chinese New Year and then return to Iran after it was over to start spreading it.

I guarantee you that other countries that have a lot of commerce (and I mean interchanges of Chinese nationals) with China are also highly impacted, they are just not reporting it yet - for various reasons.

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Congo and other Central African countries.....

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Do you have a SA trip planned this year?

JP_Losman said:

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yep epidemiologists overstate this stuff- bc its what they have prepared their whole lives for.
It gives meaning to their careers!!!

"Don't you tell me you know more about an epidemic than me! I'm an epidemiologist!"
"Everyone is gonna die!!! My degree makes me an expert!!"

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Next time you need heart surgery, you should hire a plumber. After all, it's just a pump with valves. No difference.

Nuclear Scramjet said:

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Oh no no no.

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I knew those bureaucrats at CDC would impede things. And how many really good reference labs do we have scattered around the country? I am betting the U of Washington Medical Center could have done this faster... and did.

One more death announced in Seattle. They haven't given specifics, but pretty good chance it is another nursing home resident since the death is listed in King County.

https://q13fox.com/2020/03/04/coronavirus-death-toll-climbs-to-10-in-washington-state/

VaultingChemist said:

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k2aggie07 said:

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Source
https://www.julianagrant.com/blog/2020/2/29/coronavirus

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Another short article by her
How is Covid-19 like the 1918 Spanish Flu

Quote:

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A few folks have asked me how COVID-19 is similar to the 1918 flu. There are two main things I'm considering when I say that.
[ol]

Mortality rate: The early reports of COVID-19 are showing a mortality rate of 1.5-3%, meaning that 1.5-3% of people who are infected die. This is approximately 10-30 times higher than the mortality associated with seasonal flu in the U.S. and in the same general vicinity as 1918 flu.
But (there is always a but), as with interpreting any science, there are some key things to consider. For one, it's possible that there are a large number of people with mild, undiagnosed COVID-19 infection. If this is the case, the actual mortality rate is much lower. For another, most of the data are from China where many people smoke and medical care is probably not as strong as in the U.S. Both of these factors could make COVID-19 mortality rates seen to date higher than what we would see here. A final thing to consider is that the mortality rates for both seasonal flu and the 1918 flu are estimates, so our comparisons are not perfect.

Transmission rate: Early reports indicate that each person with COVID-19 infection gives the virus to more than two other people (on average). This is referred to as the transmission rate. There are other factors to consider, but in general the higher the transmission rate the more cases we will see. We think the transmission rate for seasonal flu is less than two but the 1918 flu transmission rate is about the same as what we're seeing with COVID-19. Again, these are estimates and we don't yet know if they are correct.

[/ol]

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As far as mortality rates go, Covid-19 would probably be much higher if it occurred in 1918.

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This is undoubtedly true.

Yes, stop idiotically risky overseas travel, and back off unnecessary public gathering and intermingling for a couple of months and this thing dies off here. It needs hosts and needs opportunities to spread to persist. If we all cut down on public contact with others and take care to be extra hygienic, we can defeat it.

MouthBQ98 said:

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Yes, stop idiotically risky overseas travel, and back off unnecessary public gathering and intermingling for a couple of months and this thing dies off here. It needs hosts and needs opportunities to spread to persist. If we all cut down on public contact with others and take care to be extra hygienic, we can defeat it.

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**** that I have rodeo tickets

Rodeo Houston (while boring after a few times, I know by experience) is probably OK as it will be over before this thing is widespread enough for that event to affect it much. By April, it might be rather more risky to be at a similar event. You might get a bad cold, but hospitalize some old people you interact with.

Rustys-Beef-o-Reeno said:

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MouthBQ98 said:

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Yes, stop idiotically risky overseas travel, and back off unnecessary public gathering and intermingling for a couple of months and this thing dies off here. It needs hosts and needs opportunities to spread to persist. If we all cut down on public contact with others and take care to be extra hygienic, we can defeat it.

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**** that I have rodeo tickets

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This is the reaction I've gotten from everyone I know with rodeo tickets. None I have talked to are considering not going.

Interestingly the worst cases in the US are localized in a nursing home where the infected didnt appear to attend any public gatherings or have unnecessary intermingling.

maybe, but maybe not

2.5 weeks is a long time at the beginning of spread

Unfortunately things are probably going to explode on college campuses in the next few weeks with spring break coming up.

I don't think I was much better at that age... I knew of the swine flu when I was at A&M but that didn't stop us from doing what we wanted. I didn't realize how big that got until years later.

luckily, individuals won't be the ones shutting these gatherings down

unluckily, the people who shut them down won't do it until the deaths pile up and the hospitals are packed

PJYoung said:

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I wonder what this thread will look like May 1 or so. I just had to go to the rodeo, or SXSW, or whatever...now I'm in quarantine.

tysker said:

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Interestingly the worst cases in the US are localized in a nursing home where the infected didnt appear to attend any public gatherings or have unnecessary intermingling.

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Except all it takes is a few idiots to go out when sick.

The person in New Hampshire, who intentionally broke quarantine, and the lawyer in NYC are just two examples.

The NH individual infected at least one person, and exposed an many more at some event. The NYC lawyer has infected 5 others (his family and neighbor) but exposed who knows how many others. His son attended college classes while sick.

VaultingChemist said:

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Quote:

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How bad is this going to be?

It's possible that COVID-19 will be similar to a bad flu year but there are a number of indications that it will be very much like the 1918 Flu Pandemic.

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The healthcare system will be hit the hardest. The number of people who are likely to get sick is higher than our healthcare systems can handle.

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At least we are getting some good info from a qualified epidemiologist.

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Exactly. That's why I brought it here. And thanks to k2aggie07 for providing a source link.