This is important, because lots of internet commentators are just going with the most alarming possible statements: 28 day incubation periods, people can get infected twice, airborne transmission, asymptomatic transmission. These assertions are all based on outlier cases, sometimes even single cases, observed during the fog of war. Even if these accounts are correct, they aren't the typical case, which is what actually matters for policy and prevention.
The typical case has been well-known for months: most people get fevers, the incubation period is usually a few days, and most transmission is from symptomatic cases and via droplets. The WHO has collected stats from tens of thousands of cases and they've been straightforwardly pointing in this direction the entire time.
There definitely is a serious problem, but misinformation helps nobody, even if its spreaders are well-meaning. For example, I've seen a lot of people take the inflated statements ("28 day incubation period!!") to mean that stopping the spread is completely impossible, while we have seen by example that it isn't.
If the theory is correct, the L type is more aggressive and may be causing explosive outbreaks as in Wuhan, while the S type is less aggressive but harder to block from transmission. Interestingly, the S type is the ancestor. It would be interesting to see what is more prevalent in the outbreaks of South Korea, Italy and Iran.
yes its about time we start looking at the very real phenomenon of co-circulation of strains and co-infection.
The model of one virus in circulation is simple for providing an explanation of how things work at a basic level but the real picture is somewhat more interactive.
I don't share your optimism. The virus has been able to successfully evade e.g. testing people's temperatures in airports. It doesn't really matter if there are asymtomatic carriers or not, it doesn't matter whether people eventually get a high fever. What matters is whether people with non-specific/mild symptoms (a dry cough) can pass on the infection. And the answer is emphatically yes.
Bypassing airport temperature tests is an incredibly low bar because it rarely catches other diseases.
Anecdotally, I've travelled multiple times with people who have had fevers and entered countries with routine temperature screening and haven't been stopped.
Human body temperature is also so variable that a small fever is masked by the margin of error.
You don't need to catch everyone. You just need to bring R0 to below 1. If R0 is a little over 2 in the first place you just need to catch a little over 50% of the infected with all your actions (in addition to temperature checking) to eventually control the epidemic. The better you do the sooner you get it under control.
Not quite... You'd need to catch a bit over half of all cases _before they passed on the virus to anyone else at all_ to bring R0 below 1 in this fashion.
It's a low bar for many of the common and less deadly illnesses that we are used to. But relative to the mortality rate, it's more notable. People with SARS tended to get too sick to even go to the airport.
I challenge HN's readers to devise ways to defeat a forehead thermometer. IF we had a hackathon around this idea, how long until somebody devises a method of communication via forehead thermometer reading manipulation?
Smear some alcohol on your forehead before the check, the phase change as it evaporates will drastically decrease the local temperature where it's applied.
As long as airlines (and hotels, resorts, etc) don't let you reschedule for free or cancel for a full refund if you are sick people will keep flying sick.
The same as as long as people don't get unlimited paid sick days and protection from being fired, they will keep going to work sick.
These things need to be legislated if we want to reduce deaths and lost productivity from infections diseases (including the yearly flu)
Yes, I always cancel thousands of dollars worth of travel plans when I start coming down with something. I also always check my temperature right before entering an airport, so I can be sure to cancel my plans.
> The WHO has collected stats from tens of thousands of cases...
This part is inaccurate. The WHO's best quality data set is South Korea, which is only a few thousand cases (the vast majority of which are still in the early stages of the illness). The data quality in places like Iran, China, and even the USA are TERRIBLE and should not be used to draw any conclusions.
Additionally, the R0 is clearly different in different climates, so places like Singapore, Thailand, Vietnam, Malaysia, should not be used to infer infectivity in colder climates like Korea, Taiwan, Japan, Europe, and America.
A great source for facts is the TWIV podcast - twiv.tv. They are experts in Virology and infectious disease control.
> most people get fevers
This is a bit misleading when the WHO says 3.4% of people die, and 5-10% require intensive case and mechanical ventilation. According to the CDC, the flu kills 0.05% of the 32 million people infected in the US annually. A 100X increase is devastating for healthcare systems. The systemic problems occur when masses of older people require more ICU beds and ventilators than are available, which then drives the mortality even higher.
We should be tremendously thankful that children do not seem to be impacted. If it weren't so, the level of panic and economic damage would be significantly higher. Schools would already be closed and a HUGE portion of the workforce would be unable to work.
> ...stopping the spread is completely impossible, while we have seen by example that it isn't.
Given the global spread and the lack of testing in most non-first-world countries, most experts agree that the disease will not be contained and will become endemic. Think about North Korea, Mongolia, or Nepal - the fact that they are not reporting cases, should not be interpreted as evidence that no cases exist.
The recommended WHO strategy is to SLOW the spread of the virus with a balanced strategy of containment and mitigation. The goal is to buy us enough time to develop and deploy a vaccine.
I've noticed a trend in the discussion of Covid-19 when talking to people. They tend to either under estimate it; "it's just the flu", or they over estimate it; "This is going to be really bad, time to buy all toilet paper".
There's a lot of confusing mixed messages, not even from just random people, but from the WHO and different governments. They say they are fully prepared and it can be contained yet doctors and health advisors are saying that's just not true. I think there's a bit of play here between the negative effects from the virus, versus the perceived negative effects from panic (I suspect the economy plays a role in government's responses far more than people think).
So to me it seems there is a bit of a management or reaction to an over reaction. Yet, in face of a pandemic, being worried is probably sensible because it will lead you prepare and be conscious of good hygiene practises. Telling people everything is okay in the face of possible emergency or possible disaster is not good.
Are there people out there over reacting and over reaching with their analysis of this? Sure. But that doesn't mean there's nothing worth reacting over. This is a serious health issue, and calling it 'just the flu' could be considered reckless in my opinion.
The worry and panic can be viewed as the social mass fever. Possibly a dangerous symptom if it gets out of hand, but actually a strategy to fight the virus.
IMO part of this is that at every step there are a number of scenarios that could occur (from "bad flu" to "1918 all over again"). As we get more information and see this unfold, we can update our scenarios based on new information. However, I haven't seen too much reporting that lays it out in this way.
This leads to some people drawing conclusions like "wow I was lied to, they said it wasn't bad and would be contained to China," which isn't entirely true.
Doubling rate in confirmed cases is closer to 4 days than 3 unless you include only the last week or so. A doubling rate of 6 days in the medium term has also been estimated. This will obviously delay the time to reach one million cases. However, confirmed cases are a lower bound for the total number of cases, as cases only get confirmed when evaluated by healthcare personnel. It is not credible that Iran and Italy have 3000 cases each, when lots of tourists returning from there have been diagnosed. Did they just randomly bump into one of the 3000 in a country of millions?
Uncertainties aside, the model of exponential growth is sound. Disease spread follows exponential growth until it hits an inflection point, either due to running out of viable hosts or due to quarantines and other countermeasures reducing the transmission rate per infected below 1. China forcibly caused this inflection on February 4th, by essentially stopping their economy through strict quarantines.
A doubling rate of 4 days yields 1 million infected globally on the 29th of March, and that's what we'll get unless the transmission rate somehow falls before then. Plenty of assumptions in that statement though.
I honestly have no idea! Can you link to his analysis, I haven't seen it.
Regardless, I'm no expert on this matter, and it would be nice if people stated this more often than defer to which ever thing they heard as being correct, which I think is what people are doing when they say it's 'just a flu'.
Ideally we should prepare for the worst of possible outcomes, hope for the best of possible outcomes, and expect the actual outcome to be in the middle. Those possible outcomes change as more information gets released.
There’s also a lot of politics involved. Fox News pundits are insisting the escalating seriousness of the coverage is a plot to make Trump look bad, and shouting about how influenza kills way more people, and it’s no big deal.
It's amusing because when Trump instituted the travel ban early, it was Fox which was playing up the threat and all other news channels which were playing it down. Then a month later, they switched positions. This nonsense is why we have international organizations like the WHO, which are made of actual experts rather than pundits.
To me it seems WHO was downplaying it the whole time. First lie is China will be able to contain it and now they don't even call it a pandemic. Also R0 is much higher then for flu.
I really hope the new idea about transmissability is true but if it is I don't get why China treats it as they do. Wuhan is locked for 40+ days.
I can't trust WHO now related to Covid-19, especially after what happened to stock. Of course they have to lie more if that avoids "panic". Truth is underrated in our civilization at the moment.
> I can't trust WHO now related to Covid-19, especially after what happened to stock.
The stock market is an indicator of investor confidence. How investors feel about a particular event is not necessarily accurate, and has basically no direct relation to the WHO.
Also, even a perfectly successful way of containing Covid-19 would depress stock values [against a benchmark of the virus not existing] if it involved containment actions such as isolating significant numbers of people and cancelling events and flights.
Well, the conventional wisdom, as it were, was that R0 is much higher than with influenza, but here the WHO appears to contradict that. I don’t see what’s gained by just repeating the conventional wisdom.
Could not find the exact reference, but here are some other bullshit from that time:
https://www.globaltimes.cn/content/1178015.shtml
That "transparency" and "openness" were quoted a lot but it was not the case at all. Many chinese doctors and journalists were shut down.
A month ago I took a lot of flak for saying that China's numbers were probably faithfully reported, as accurately as their logistics permitted. This was a claim that literally nobody could make anywhere on the Western internet without being downvoted to hell and called a shill. Everybody agreed that all numbers were completely made up, because somebody was able to fit a quadratic curve through 3 of their data points.
I still can't say China's data was real without being called a shill, but it's getting increasingly obvious that this was the case. China's numbers line up perfectly with what visiting WHO observers saw (as stated in their latest report), their hospital occupancy, their rate of exported cases, economic activity in the country, and the day to day experience of hundreds of millions of actual human beings. Anybody who still says it's all fake is just jacking off on nationalism.
There is definitely opaqueness and one needs to know how to read the data. For example China does not report people who test positive but do not develop pneumonia. The criteria for classification is clearly listed in the national guideline but is easy to escape notice because the daily report is terse and does not reference the definitions. It may not be a big deal in terms of assessing mortality (WHO explained the percentage of asympotamaic cases that test positive is small), but it can make a significant difference when assessing risk for a particular region. If a region reports zero case but there is actually a postive test, the risk outlook is quite different even though the report is technically correct.
But it would be unfortunate to then disregard all Chinese data. That would be like throwing out the baby with bath water. If we don't study their experience we will be bound to repeat their mistakes. Fortunately this does not appear to be the case with medical professionals and scientists, judging from the volume of peer reviewed publications coming out of China.
Are you agreeing with me that people shouldn't do that? Or are you saying that calling out people that do that is the real problem?
I'm outnumbered 100:1 here by users that flood almost all of these threads and never say anything actually correct, following blind nationalistic instinct.
There's more than one "the real problem". Moderating one doesn't preclude moderating others.
Lashing out with phrases like "jacking off on nationalism" is flamebait and therefore against the site guidelines. You need to follow the rules regardless of how outnumbered you are, or how wrong others are or you feel they are. I know the experience and I know it's frustrating, but that's the way it is when you're representing a contrarian view. When someone possesses a truth that others don't, they need to hold themselves to a higher standard, because if you sink to a degraded level in presenting that truth, you end up discrediting it, which harms the minority cause you're trying to serve, and harms other people by driving them further from the truth.
Well said. I don't get why people are so optimistic and keep trusting the WHO, given they have downplayed the situation multiple times, and that China was doing a brilliant job to contain the Wuhan Corona Virus.
Look at the spread of the corona virus in South Korea and Italy now. Then look at Hong Kong and Taiwan, whose people don't trust China for even a bit.
The first thing China did was to detain whistle blowers. One of them died from this virus. What they did was to conceal the outbreak, not tackling it.
China’s authorities, nor the WHO, never claimed that China could contain the virus.
China’s goal with the Wuhan lockdown, then Hubei, then all of China, was to slow down the spread of the virus. In order to give themselves, and humanity, a chance to fight it. And to understand it, and devise a cure or vaccine for it.
The escape of the virus was inevitable. This was a known fact. To believe otherwise is naive.
The only thing you can buy with the lockdown, is time.
And to make matters worse, the governments of the world, flew all their citizens out of Wuhan and China. Then, they screwed up the decontamination and quarantine process. The incompetence of the American CDC shipped out faulty test kits all over the world. Then they released someone infected into San Antonio, before their quarantine was over, and before the positive test results came back. Then, news came out that the flight attendants and pilots flying the chartered planes, weren’t even properly protected from airborne transmissions of the virus. Then, the Princess cruise ship quarantine was a disaster, which is entirely the fault of the Western governments.
So now, the responsibility of the spread of the virus outside of China, lays in the respective governments, and their inability to monitor and contain it. So the blame goes all around. It really is illogical to blame the China government for a virus that arose out of nature.
It feels like all of the reporting I've seen from experts (not just mainstream news outlets which are admittedly terrible)has indicated Covid-19's R0 is worse than influenza.
It would have been awfully nice if The WHO tossed us a citation on their claim that this is not the case. It was hard to read the entire piece with that unsupported claim hanging so heavily.
And the containment claim...again...would have loved for them to argue the case, because it is exceedingly easy to argue against the case.
For seasonal flu, you could think of it as being very low, because most people already have immunity. It's already endemic, so there isn't room for exponential growth.
For a new flu (like the 2008 swine flu) it is extremely high, which is why people barely did anything to contain it back then -- it was just impossible.
The problem is that “worse” can mean anything. It can be marginally worse without being a serious cause of concern or it can be really really bad.
That’s the beauty of journalism: being flexible with the truth. You can print end of the world headlines with the clean conscience that since it is technically worse, you are not pushing fake news. But that may still be a massively over exaggerated and misleading headline.
And I think that is what happening. I don’t see many people claiming it is no worse than the flu. I see people claiming it is marginally worse than the flu.
R0 is not the only factor in the spread of the disease. R0 is measure of how contagious a disease is, the average number of infections from each case. But other factors matter for the spread and for possibility of containment. For example, the incubation period matters for how fast it spreads, and asymptomatic transmission matters for can be contained.
"With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19."
It sounds like the big difference is that most of spread from COVID-19 is when people are sick. With lots of testing, can detect who is sick and isolate them. It also sounds like most of the spread is with close contacts and unlike flu, it is possible to map contacts and isolate them.
"We don’t even talk about containment for seasonal flu – it's just not possible. But it is possible for COVID-19. We don't do contact tracing for seasonal flu – but countries should do it for COVID-19, because it will prevent infections and save lives. Containment is possible."
Keep in mind that almost 20% of the Diamond Princess cruise ship's passengers and crew (700+ of 3711) were infected with the coronavirus. However its infection rate compares with the seasonal flu (which is a much less dangerous illness overall), it clearly has the potential to infect a large number of people in the coming months.
Given that there are probably very few places that are worse for a disease outbreak than a cruise ship where everyone eats and drinks all day and touches everything and uses the same toilets I'll actually take the 20% as an encouraging number.
Yeah, but as soon as they were aware of a single case on board, everyone single person on the ship was informed, told to stay in their room, and became paranoid about further transmission. I don't know if we'll have similar levels of obedience in the rest of the world.
This isn't an accurate representation of how the number got to 700. The numbers were low when the ship docked. I recall in the single digits. Everyone was put on cabin quarantine, though people could leave their rooms for a window of time each day. It was quarantine and they were testing symptomatic people. I was watching mostly HK and Taiwanese news sources on it multiple times every day.
That makes me very skeptical of the WHO claim that asymptomatic spread isn't a problem.
This is true. Do you think under those conditions, the ship would have symptomatic employees serving food or sharing bunks with asymptomatic employees? That really goes against the idea of quarantine, so I'd like to see evidence of that instead of assuming it.
Isn’t a cruise ship a special case because it’s all self contained and there is almost no way to avoid contact with other infected people?
Unless they had access to disposable Kevlar jumpsuits, masks, gloves and disinfectant, they’d be hard pressed to slow its spread in cramped conditions.
The way ship HVAC systems are designed, it helps limit costs while simultaneously increasing infections from anything that's airborne.
In regard to Diamond Princess though, there were no safety protocols that were followed, so we don't know if it was the ship or the failure to follow pathogen related protocols.
As this and all other reports indicate, it can become aerosolized in certain invasive hospital procedures, which involve sticking stuff into people's lungs. This holds for a lot of diseases, we've known that for decades, and it doesn't have anything to do with how spread occurs in public.
IIRC, the crew was largely responsible for spreading the virus.
Not that I'm faulting them. They simply were neither trained nor equipped to do a specialized job that was essentially forced on them - operating a quarantine facility.
Then we saw China locked down all major city themselves. Now you tell me it's fine not to ban flights from China?
And they also keep mentioning it's not a big deal. Obviously they don't want to hurt Chinese economy. I won't trust anything they say, as their interest is China government's interest, not people's health.
Hindsight. At the time, nobody had travel restrictions. Were they all influenced by China? No, with the then current information travel or trade restrictions didn’t make sense.
This is the same lazy argument as with the 737 MAX - why wasn’t it immediately grounded? Well, you can’t just shut down the world at any sign of trouble. You have to make an informed judgement call with the information you have at the time. Sometimes, ex post, it will turn out to have been the wrong call. Doesn’t mean you need to revise or impugn the decision procedure.
> On 23 January 2020, the central government of the People's Republic of China imposed a lockdown in Wuhan and other cities in Hubei province in an effort to quarantine the epicentre of an outbreak of coronavirus disease 2019 (COVID-19)
What do you mean nobody had travel restrictions? The report from WHO date was on 30 January 2020, when they saw this and yet suggest not to put any restrictions?
Imagine if Israel had taken the opportunity to lock-down West Bank in the name of health, specifically prevention of novel coronavirus.
My artificial example is perhaps not accurate on its face, but I hope you can see the principle. WHO was trying to prevent unnecessary border restrictions in the world, until such time as they became justified for health reasons. In China that was already the case.
Many of the footage are before the Jan 30 WHO announcement, like the many body moving in front of hospital.
WHO probably already know what's really happening there, but still given wrong advice, so that many countries, like Korean, Japan follow the instruction by WHO, not imposing the restriction on China. And now people in these countries are suffering from the misinformation provided by WHO.
Another evidence WHO is controlled by China, that is when Taiwanese people want to join WHO to get latest update about the virus and help from the world, Chinese government doesn't want this to happen.
So basically Taiwan was excluded from the global health system for long time because that.
I am from Taiwan, I don't feel surprise at all that WHO is controlled by China, as they have shown it that way long time ago on the issue of excluding people from Taiwan. So that's obviously political over people's health in the world.
The 737 Max is actually a great analogy, but you and I come to different conclusions. The FAA shot themselves in the foot by not grounding the Max after the second crash. They were previously so trusted that their standards were the default for other countries. The widespread trust made it easier and faster for American planes to go to market. That trust took decades to build up and will not be easily restored.
It's interesting that the notes regarding transmission efficiency are not present in the similar speach given on the 4th of March (as opposed to the article link, which is the 3rd of March).
I'm not sure what to make of it. It might be pure paranoia on my part - but it is an interesting change in the welcome statements that are otherwise generally similar.
Then how come we see cases where there were no symptomatic patients nearby? Like this CDC screener, no cases where known in the entire state when the person contracted the disease and it happened weeks ago:
And this is not the first such case in USA. So either there are a ton of symptomatic Covid-19 patients in USA right now who are just thought to have the flu, or Covid-19 can spread just fine from asymptomatic people and that was how it spread to the well protected CDC personnel in the airport. And if an expert who follows all hygiene standards and wearing gloves and N95 respirators got it from an asymptomatic person, imagine how many other people at the Airport must have gotten it as well? And how many persons the carrier infected after arriving in USA?
I am all but certain that the statement "We can contain it" is a lie at this point, I don't see how anyone can believe that. At least not without aggressively doing complete lockdowns of large communities before we even confirm cases, but I feel it is too late even for that now.
1. I would not trust anything coming out of WHO at this point. Even Germany called it a pandemic, yet they are not willing to call it such (perhaps due to political influence/pressure, or just incompetence). This looks more like a 'panic containment' type of statement than the truth.
2. The R0 of seasonal flu, is about 1.5, Covid-19 has a R0 between 2.6 and 3.5*. (yet to be determined), which is much more contagious than normal flu. This article has no mention of it, hence has no credibility. By any account of any data, Covid-19 looks to be 2x more efficient to spread as the normal flu.
3. The major cases from the Diamond Princess, the cult in South Korea, and the Eldery Care facility in Seatle, are an indication that the virus is very easily spread in close quarters. That's not a normal flu type of virality, it is much worse.
4. We have many cases where people still tested positive even after 14 days of quarantine, hence it is not going to be easy to contain. But we don't know yet if a person is still contagious after testing positive after 14 days. No mention to this as well.
TLDR: Don't panic, yet 3.4% of people are going to die, or 10-15% of your parents/grandparents will perish earlier due to this virus.
I am sorry, but that's war-zone like statistics.... and this should be treat as such. (it needs a true war like mobilization to be combated, and talks like this to minimize the impact are just irresponsible).
The fatality rate may be 3.4% and the r0 may be 2.6 to 3.4 but it is unlikely that both are true at the same time.
It depends on your assumption of undiagnosed cases. We don’t know how many of those there are.
But suppose you assume that all the diagnosed cases are all the cases (impossible but for the sake of the statistical argument). That is to say we tested 100% of the sick people.
If that were true the fatality rate would shoot up to the high end of the estimate and the r0 would plummet. It hardly spread at all, but if a patient gets it, it is more fatal.
On the other hand assume that almost everyone has it but we only tested a tiny fraction. Now the r0 sky rockets and the fatality rate plummets.
Put another way, there is a trade off between the two and it is unlikely to be on the upper end of the estimates for both.
What this author is saying is that it hardly spreads at all but the fatality rate is high. I.e we tested many of the cases.
Pretty sure the fatality rate is based on the number of patients who present themselves to a doctor. I've seen estimates of influenza fatality rate of 0.2%, which corresponds with the ~61000 deaths over ~20700000 medical visits for the 2017-2018 influenza season documented here: https://www.cdc.gov/flu/about/burden/2017-2018.htm
The fatality rate would obviously decline with a larger denominator which includes total infected. But so would the rate for influenza. It still seems to remain the case that this virus is ~10x deadlier than the flu, unless it has a far greater r0. The possibility of variants (type-S and type-L) mentioned elsethread makes things more complicated, though.
> Pretty sure the fatality rate is based on the number of patients who present themselves to a doctor.
In an ideal world that would be true, however we know that in early Wuhan they were mostly only testing people who were already hospitalized with "pneumonia symptoms" due to having limited kits and staff. Pneumonia symptoms how the most serious cases advance after going through flu symptoms. I read one analysis of the Wuhan data that showed 91% of everyone they tested had pneumonia. This changed later but a lot of the stats we're looking at are from papers with data only through the end of Jan.
Almost every country has different criteria for testing a patient and you can't become a "case" until you have a positive test. The U.S. has changed testing policy three times in the last week.
> Pretty sure the fatality rate is based on the number of patients who present themselves to a doctor.
I don’t think this is right. I believe it’s based on an estimate. Your own numbers bear me out. The flu death rate is estimated to be around 0.1% and we can come to that number by a division here:
“ The overall burden of influenza for the 2017-2018 season was an estimated 45 million influenza illnesses, 21 million influenza-associated medical visits, 810,000 influenza-related hospitalizations, and 61,000 influenza-associated deaths”
Actually 21 million or 45 million does not make much difference. There will be still order of magnitude between influenza and covid-19 (CFR 0.2% vs 3.4%, and mind you, 3.4% is an early estimate and subject to change in the situation where new cases are still coming in and people are still dying, if you observed then CFR for covid-19 was around 2% when it was rapidly growing in China and did rise to current level when the new cases started to slow down; many people warned that it will be much higher actually but these people were hushed down; you have to use your own analytical mind to choose what is more closer to the truth).
Also, WHO just raised the death rate to 3.4% from the previous value of 2.3% ... [1]
Add to this, the fact that that the outbreak is still expanding, and new cases tend to drive this number downwards. But if we consider only the "closed" cases (recovered/dead), the current number is more like 6% [2].
And it could be worse from the previous experience with SARS [3]:
>> Finally, we shall remember that while the 2003 SARS epidemic was still ongoing, the World Health Organization (WHO) reported a fatality rate of 4% (or as low as 3%), whereas the final case fatality rate ended up being 9.6%.
Of course, this number could also go down, if there's a big number of unreported mild cases.... so the conclusion is that we only know that we have no idea... and that it does indeed sound like this is aimed to reduce panic (which is also a good thing).
For [2] I believe this page is making a good work at aggregating the data, and they have been linking their sources for the stuff they add, and for [3] in particular, they do link to WHO ([4][5]), but also summarize information from other sources.
It's clear the WHO message is trying to present the bad news in the best possible light. The sentences about transmissibility are very obviously constructed extremely carefully. However, I do take away from the report that Governments should get serious about containing this, because the experience of China shows that this is possible, whereas with the flu it's known to be impossible.
I think that is the right message at the moment. Simply acquiescing to some undetermined percentage of the elderly and random people of all ages dying is not a good strategy, and I think that is what he is trying to communicate.
Something that confuses me is, why would governments minimize the risk and not take necessary steps to slow the virus? It seems obvious that the short-term economic gains resulting from such an approach are vastly outweighed by the negative consequences of an extended and prolonged outbreak. I'm missing something.
It is possible that people in relevant positions are clueless cowards or calculating psychopaths.
My initial impression leans towards the first option.
Taking measures needs courage. You have to take very disruptive steps in the environment where popular opinion still calls it not worse than flu and before that you have to be smarter than popular opinion.
>
The [class a] bonds default if pandemic-related deaths reach 2,500 in a single nation with an additional 20 or more deaths confirmed in an overseas country, according to the bank's prospectus.
>
The [class b] bonds pay 11.5% annually, but reach default after 250 deaths. The bonds' payout rate scales with the number of additional countries that experience than 20 confirmed deaths.
Well? Why are they dragging their feet? Even the official numbers have seen more than 2.5k die in China and more than 20 in Iran. The only question now is whether this is incompetence or maliciousness.
I don’t see it. Pandemics are objectively defined. The bonds’ principal pays for relief in the event of a pandemic, meaning a venal WHO would lean towards categorising non-pandemics as pandemics.
"First, COVID-19 does not transmit as efficiently as influenza, from the data we have so far."
Ok let's look at the data he summarizes in the next sentences:
"With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19. Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days."
That's 1% of reported cases. But evidence shows there are many more unreported cases, and these cases tend to be asymptomatic, or very mild. Peer-reviewed research has estimated there are 11x to 38x more cases than detected:
These 3 studies are all the studies I know of that try to estimate the rate of underascertainment. I did not cherry-pick these to make a point.
Anyway, this suggests the vast majority of cases might be, in fact, just like influenza: asymptomatic or very mild. And there are no reason to believe they are not major drivers of transmission.
"Some countries are looking for cases of COVID-19 using surveillance systems for influenza and other respiratory diseases. Countries such as China, Ghana, Singapore and elsewhere have found very few cases of COVID-19 among such samples – or no cases at all."
China: the only reason they find so few new cases in March (only 100-200 new cases per day) is not because COVID-19 is less contagious than the flu, but because they implemented extreme response measures including the complete shutdown and isolation of whole cities, cancellation of public events, closing all schools nationwide, prohibition of attendance at work, etc. So of course COVID-19 is spreading slower than the influenza. If China implemented these measures during influenza season, they would likely drastically reduce the number of influenza cases.
Singapore: COVID-19 has, so far, been contained (less than 110 cases country-wide) with strict isolation procedures for patients. I am not sure this is evidence that COVID-19 is less contagious than influenza.
Ghana: it is not even a country rated "high risk" by https://www.thelancet.com/journals/lancet/article/PIIS0140-6... but just "moderate risk". And there are no known cases of COVID-19. So in my opinion, it is insufficient evidence to suggest COVID-19 is less contagious than the flu.
"The only way to be sure is by looking for COVID-19 antibodies in large numbers of people, and several countries are now doing those studies. This will give us further insight into the extent of infection in populations over time."
That's the only statement from the WHO Director-General that makes sense: we need more evidence to be sure we can correctly quantify COVID-19's contagiousness.
TLDR: "Since February 28, an increasing number of newly diagnosed confirmed and presumptive COVID-19 cases have been in patients with neither a relevant travel history nor clear epidemiologic links to other confirmed COVID-19 patients. However, despite intensive follow-up, no sustained person-to-person transmission of symptomatic SARS-CoV-2 was observed in the United States among the close contacts of the first 10 persons with diagnosed travel-related COVID-19."
They tracked the first 10 people in the US with travel-related confirmed COVID-19, and followed up with 445 people who had close contact with them.
Over 14 days, 54 of those 445 people developed new or worsening symptoms and were tested for COVID-19.
Of the 54 people, only 2 tested positive for COVID-19. Both were household members of originally infected people.
"Both persons with confirmed secondary transmission had close contact with the respective source patient before COVID-19 was confirmed and were isolated from the source patient after the patient’s COVID-19 diagnosis."
"No other close contacts who were tested for SARS-CoV-2 had a positive test, including the five household members who were continuously exposed during the period of isolation of their household member with confirmed COVID-19. An additional 146 persons exposed to the two patients with secondary COVID-19 transmission underwent 14 days of active monitoring. Among these, 18 (12%) developed symptoms compatible with COVID-19 and were considered PUIs. All tested negative, and no further symptomatic COVID-19 cases (representing tertiary transmission) have been identified."
So... what? These people are picking up something that looks like COVID-19, but isn't? The COVID-19 tests are missing something like 90% of the people who have it? Or what?
> These people are picking up something that looks like COVID-19, but isn't
> The COVID-19 tests are missing something like 90% of the people who have it
As far as I know (I'm not an expert) either of those are possibilities, and it's too early to know for sure.
Edit: This comment mentions the possibility of there being 2 types of the virus that spread at different rates: https://news.ycombinator.com/item?id=22489599 Maybe the 10 people monitored in the US had the less contagious version? There are a lot of unanswered questions right now.
It's flu season. The symptoms of mild Covid-19 which were sufficient reason for the CDC to test close contacts of infected people are also basically just the symptoms of the flu or a cold or probably any number of other things.
"To summarize, COVID-19 spreads less efficiently than flu, transmission does not appear to be driven by people who are not sick, it causes more severe illness than flu, there are not yet any vaccines or therapeutics, and it can be contained – which is why we must do everything we can to contain it. That’s why WHO recommends a comprehensive approach."
Ah, so there aren't hordes of asymptomatic carriers out there, which is both good and bad (the death rate really is high)
The confusing thing is that the Diamond Princess data points in the other direction: more asymptomatic cases, and a significantly lower case fatality rate, than the WHO numbers.
The WHO says they haven't found many asymptomatic cases (despite looking), but apparently lots of the cruise ship cases were. The WHO estimates a mortality rate over 3%, but much less 3% of the Diamond Princess infected died.
I don't know how to reconcile these other than to suppose the virus has mutated (possible) or the asymptomatic cases were false positives (maybe?) or some demographic factor on the cruise ship was different.
One way to reconcile the numbers is that the asymptomatic cases are less infectious. It seems like asymptomatic transmission is rare. This does make sense since this virus is transmitted by droplets from coughing and sneezing and mild cases cough and sneeze less.
Perhaps a cruise ship demographic factor was fewer pre-existing health issues than we'd see in a randomly chosen age cohort of similar size?
Co-morbidity of other diseases and COVID-19 seems to correlate with higher case mortality rates. This would predict higher case mortality in assisted living homes, which has been found in the Washington state cluster.
The WHO seemed to be relying on Chinese flu surveillance data, which is basically useless - even the figures it produces for flu infections are implausible and probably wrong. Between this and their other comments it might be best to treat anything the WHO says as just Chinese propaganda at this point.
Just a reminder that this is coming from an organization that
1. Receives part of it's funding from China
2. Has been using China's clearly manufactured numbers since day 1
3. Has yet to officially call this a pandemic though it has met the criteria for weeks ($425MM in pandemic bonds would default) [0]
4. Is led by a man (the very director being quoted) who was accused by the NYT of covering up no less than 3 cholera epidemics in his home country of Ethiopia. [1]
So you're telling me China shut down it's entire economy [2] and put 700MM people under lockdown and/or travel restrictions because of something about as dangerous as the common flu? Note that the Chinese economy is still not back online - don't believe me? Check real time pollution maps for yourself. The air is still cleaner than it has been in decades.
The WHO and CDC are lying to you. You can verify all of this for yourself.
Hell, 8% of Iranian parliament members are infected. Look at the chaos gripping Iran, Italy, and SK. This is not the flu and I'm astounded that not only are official organizations misleading the public to this degree, but people are buying it en masse.
Finally, after a mass petition, a number of journals released all 2019ncov literature from paywall. You can find estimates for mortality and R0 from many sources, and I don't think I've seen a single one below 2. The Spanish Flu of 1918 was at 2. Of course take these with a grain of salt as they may be oversampling severe cases, but they all point to the same grave conclusions, and you can read them yourself. Do not rely on these agencies to digest this information for you when you have unprecedented access to the same information.
> The WHO and CDC are lying to you. You can verify all of this for yourself.
In a case like this, where you're basically saying that two massive government organizations are broken, and one of which is an international organization which is _designed_ to transcend national borders (and thus includes different member countries, including China), the burden of proof lies with the person making the claim.
As a general response: of course the WHO is going to use China's numbers. If you don't establish some baseline for reporting then what are you going to do? Guess? The WHO does not have people to drop into China and start testing everyone. If China is under-reporting numbers then that's a great shame the world needs to deal with, but in typical situations involving bad data, you exclude the bad data entirely. Are we to exclude all of the numbers reported by China? Multiply by a scale factor to adjust? Pick a random number?
There are many problems in the world and the WHO is not free of problems. Every director of every organization has some random set of things people don't like about them. In cases like this, again, it's important to provide evidence to support your claims (even if that's just basic links to overviews by reputable sources). From there, people can make informed decisions and judgement calls. I don't particularly think you're lying or telling the truth, I just think that not making evidence backed decisions is dangerous, especially in times like these.
Regarding your #3: Wouldn't WHO gain that $425MM if they triggered the default on those bonds?
> If certain criteria are met, the bonds' principal is transferred to the World Bank's Pandemic Emergency Financing Facility (PEF) to fund containment and relief efforts.
To me, that seems like quite the incentive to declare this a pandemic. If doing so would unlock that funding.
But, there's details. Just declaring "pandemic" isn't enough. The bonds have numerical thresholds that must be met. (e.g. 20 deaths in 2 or countries).
They have clearly been met. Read the article. People stand to lose money in default conditions. The question is who?
As I posted elsewhere, the first class of bonds default after 2500 deaths in one country and at least 20 in another. China and Iran have long met that condition. So what's going on?
I find your point 3 confusingly worded: the trigger conditions for the pandemic bonds are specific and essentially transparent, but have not yet been met. They are independent of any statement the WHO may or may not make about whether a particular outbreak can reasonably be called a "pandemic". This independence should be unsurprising, because investors want some kind of "clarity" about what it is they are investing in.
Whether or not the trigger conditions are too stringent for the bonds to be useful in dealing with the targeted crises, and whether or not the additional "clarity" provided by having well-defined trigger conditions is sufficient to manage risk for investors, are both separate concerns.
Point #3 on the Bonds doesn't seem relevant. From the Bloomberg article you linked:
> Funds can only be released from the PEF for non-flu epidemics 12 weeks after the "start of the event," according to a World Bank document. The novel coronavirus strains were first reported on in late December, leaving funds locked up until late March.
"To summarize, COVID-19 spreads less efficiently than flu, transmission does not appear to be driven by people who are not sick, it causes more severe illness than flu, there are not yet any vaccines or therapeutics, and it can be contained – which is why we must do everything we can to contain it. "
Interesting... i wonder what the data is to back up that assertion?
Another interesting tidbit in there was that very few cases (1%) appear to be totally asymptomatic, and that most infections apparently start showing some symptoms after a couple days. So there are a few assertions in total that seem to depart from what was previously understood, at least through mass and social media.
> i wonder what the data is to back up that assertion?
The data is the tens of thousands of cases the WHO has stats on. You can read any of their reports, they've been saying the same thing for months. The main sources contradicting them are random internet commentators.
They've not been saying that for months, that's completely absurd. The disease started spreading in November at the earliest. Just a month ago very little was known about its transmission rate and lethality; estimates from reputable sources ranged from 1 to 20%.
The highest estimated r0 in a non-peer reviewed paper that I've seen is 6.6.
himinlomax may be referring to individual cases like the one involving a cult in South Korea where one lady was confirmed to have infected approximately 70 people
I didn't talk about reports, I said "estimates." And yes, early estimates included the perfectly reasonable though eventually disproven hypothesis that it could turn out to be as deadly as MERS (SARS was not that deadly).
> Another interesting tidbit in there was that very few cases (1%) appear to be totally asymptomatic
I believe this was based on mass testing in China well into the lockdown period, so it's a reason to be optimistic but may not be they case in other parts of the world, particularly during the early outbreak phase. Even more complicated because they now know there are multiple strains.
Are you actually receiving conflicting data, or just conflicting reports about data? It's not clear to me how data itself can "conflict." As a made-up example, if you keep seeing alternating cases where one person had symptoms and another person didn't, that's not "conflicting data." That's just data showing that 50% of people have symptoms.
Well said. There can be conflicting reports but never conflicting realities. That said, sometimes our apparent data is being filtered by different factors, or even altered, across different reports.
There are a lot of things that make calculating a straightforward percentage hard:
- not all cases detected
- deaths are a laggy indicator
- recoveries are an extremely laggy indicator
- impact of demographics, healthcare quality
- sizes of effects of all 4 previous things depends on the country and the time
This has led to internet commentators coming up with wild numbers, ranging from 0.1% to 20%. At the risk of sounding like a spoilsport, I suggest we all defer to the expert numbers (2-3%), because the experts are perfectly aware of all 5 effects I mentioned, and more, and have already tried their best to correct for them, using better data than we have.
That's just them reporting the number of deaths/confirmed cases it's not an attempt at estimating the actual mortality rate among the general population.
All Countries except for South Korea are NOT counting the mild or asymptomatic cases. When you look at the SK numbers, 5,621 confirmed cases and 35 deaths. That puts the death rate at 0.6% (same as severe influenza season).
Even if COVID-19 fatality rate is _lower_ than the regular flu, if it infects people faster to the point where those very few severe cases cannot get the help they need because of health services being overwhelmed then it will potentially be resulting in a lot more deaths than the flu.
I don't understand people downplaying this by saying it's only as bad as the flu. The flu is really fucking bad!
Before widespread flu vaccination, it killed 50 million people in just one outbreak (Spanish flu). That's more than have been killed by HIV/AIDS combined in history. And we have no vaccine against COVID-19.
Even nowadays, it still kills tens of thousands of people every year.
To be fair. Seasonal flu usually induces secondary sickness (bacterial pneumonia) that causes mortality in the elderly and very young population.
Spanish flu wiped out the young and elderly but also the middle aged directly with things like cytokine storms. Something we are not seeing with Covid 19.
Correct. Note that there were multiple waves of the Spanish Flu. First wave was fairly mild and hit the young and elderly. Second wave hit the middle aged and wiped out a chunk of the population.
The third wave was slightly worse than the first but much less deadly than the second - I couldn't find much detail about it when I last tried.
Several theories on why it turned out this way, none of them relevant to the current situation though.
SK looks like a good back of the envelope proxy for the first world.
Id also add... I’m not sure why we, worried internet lay people, really care so much about “the percent”. (Not accusing you of this, just having a thought after your comment).
The final rates being quoted are global averages. They are basically meaningless if you’re trying to assess how worried and prepared you, as an individual, should be.
Age and access to care (in addition to counting mild cases) seems to be a huge predictor here of severity and outcome. So any given country or community is going have different demographics and health infrastructure compositions that impact the mortality rate reported.
What I really want is a calculator that tells me based on age, pre existing conditions, country, etc what my (or my older loved ones) chances are so I know how to react appropriately.
Recovery takes more time compared to dying. So areas where it's been present for less time are going to show a different proportion even if it's evolving the same way.
Right. You can see that here: [1] The "Deaths" line and the "Recovered" line add up to maybe 60% of the "Confirmed" line. The difference is the people who are sick, but alive.
> Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days.
They came up with this number by testing people who didn't have symptoms but were in some contact with someone who had the virus. The big question is how much the lockdown affected this, but there doesn't appear to be large swaths of asymptomatic people.
They tested everyone on the Diamond Princess and seemed to find a lot of asymptomatic cases. I don't know how to reconcile this, but there it is. The mortality rate was worse than seasonal flu but not 3%, either.
Mutation would do it, so would demographic differences, level of treatment, who knows. Data out of South Korea indicate a similar CFR as the cruise ship.
What do you mean by "was"? Because as far as I'm aware, 690 of the 706 confirmed diamond princess cases have not concluded (neither dead nor recovered).
Thanks. I misinterpreted that to put emphasis on the "reported" part. Your explanation of how they arrived at it would definitely reduce the possible size of unsurveyed carriers.
The other replies to parent do a much better job explaining how "just looking at the data" is misleading.
Death/recovery probably isn’t a useful stat at this point, as most sufferers haven’t had it long enough to recover, so death is the only early exit stage.
At the very least, you need deaths/(deaths+recoveries) to calculate the mortality rate.
That is, deaths / (total cases); as other comments note, the problem is that computing "total cases" as just deaths+recovered might not be right if one outpaces the other, and if there are a bunch of cases we don't know about because we're not testing. (E.g., are we only seeing severe cases as they send people to the hospital?)
On January 23rd, 2020. Tedros Adhanom Ghebreyesus declines to declare China virus outbreak as a global health emergency. As we all know, the Coronavirus is not treatable at the moment. The number of infected and deaths has risen more than ten times (infected from 800 - close to 10,000) within only 5 days. Part of it is related to Tedros Adhanom Ghebreyesus under estimated the coronavirus. We strongly think Tedros Adhanom Ghebreyesus is not fit for his role as WHO Director General. We call for the Immediate Resignation of Tedros Adhanom Ghebreyesus.
A lot of us are really disappointed, we believe WHO is supposed to be political neutral. Without any investigation, Tedros Adhanom Ghebreyesus solely believes on the death and infected numbers that the Chinese government provided with them.
On the other hand, Taiwan should not be excluded from WHO for any political reasons. Their technologies are far more advanced than some of the countries on the “selected WHO list”.
The typical case has been well-known for months: most people get fevers, the incubation period is usually a few days, and most transmission is from symptomatic cases and via droplets. The WHO has collected stats from tens of thousands of cases and they've been straightforwardly pointing in this direction the entire time.
There definitely is a serious problem, but misinformation helps nobody, even if its spreaders are well-meaning. For example, I've seen a lot of people take the inflated statements ("28 day incubation period!!") to mean that stopping the spread is completely impossible, while we have seen by example that it isn't.