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Day 55: COVID-19 Pandemic
156 countries and territories now reporting COVID-19 cases. One case is now reported on Reunion Island. You may recall my mentioning that a crowd showed up at the port demanding that an arriving cruise ship have passengers screened before letting them disembark for their onshore excursions. Police controlled the crowd and permitted the passengers to load on to buses to begin their tour. The crowd pelted both the police and buses with rocks. No doubt the participants in that public display are now feeling justified. Of course, whether the source of contagion was the cruise ship or one of the many daily flights to Reunion will likely never be known.
In the screen grab above I want to direct your attention to Switzerland. The cases per million of population in Switzerland is 256.2. Only Italy at 349.9 is higher. Switzerland had less than 10 cases on February 28.
The stealth nature of the virus causing COVID-19 is key to the rapid spread of contagion. Although many viruses have asymptomatic contagion periods, the virus that causes COVID-19 has a much longer one ~14 days (with outliers at 27 days). This permits people without symptoms to spread the virus unknowingly for a very long time. And some of the spreaders will never know it because they will never become ill themselves. This is not unique to this virus, various flu viruses also occupy hosts without causing illness. A 2014 study of H1N1 influenza in Taiwanese school children estimated that between 56-80% of the subjects were infected without ever becoming ill (Hsieh Y, Tsai C, Lin C, et al. Asymptomatic ratio for seasonal H1N1 influenza infection among schoolchildren in Taiwan. BMC Infect Dis 2014;14: 80. doi: 10.1186/1471-2334-14-80.) A new un-peer reviewed draft study of Japanese nationals repatriated from Wuhan, China using similar methodology to the 2014 study estimates about a third of infected persons will not become ill. So within any given population some number will never be infected, another cohort will be infected without becoming ill, others will have mild illnesses and recover, fewer will become severely ill and recover, and some number will become ill and either have lasting effects (still unquantified) or die.
Given there is so much more to be known and the capacity of health care may be challenged, people are freaking out. Craig Medred, an Alaskan freelance reporter, has written about the response to the COVID-19 threat in Alaska. Those of us who have consumed various “reality” shows about rugged Alaskan individualists can be forgiven for believing that Alaska would be the last place you would find a freak out in progress. But as Medred reports, urban dwellers in Anchorage and Fairbanks have more in common with urban dwellers in the lower 48 than they do with the forest-dwellers that commute via float plane.
Worldometer news updates can be found here. I encourage you to examine the entire page today. You’ll not only get anecdotes like the Hawaii case (below) but also timeline and other information about the disease generally. You will also note that the news has gotten so great in volume that archiving is already in process.
– 2 new cases in Hawaii (on Maui and Oahu). Details have emerged regarding the latest 2 cases in Kauai: a couple who had traveled from Indiana arriving in Maui on March 2. Shortly after their arrival, one of the visitors developed a fever, shortness of breath and cough and went to an urgent care facility. On March 7, the second visitor also developed symptoms and went to urgent care. A day later, both of the visitors flew to Kauai, staying at the Kauai Marriott, and on March 9, one of the visitors visited again an urgent care facility. Finally, on March 12, the two informed health care workers that they had close contact with an individual who had tested positive for coronavirus. 2 health care workers in Maui and 1 in Kauai are now in self-isolation because they were not wearing protective equipment [source]
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
Oregon has had its first death.
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I am seeing reports out of France and The Netherlands that half of critical cases are for people under 60/under 50 respectively. That seems different. Oddly, reporting from countries shows that the ratio of serious/active cases varies wildly. That seems like the most important number to get a handle on.
The CDC’s situation report updated yesterday (March 14) includes the below paragraph. Prepare to be exposed.
What May Happen
More cases of COVID-19 are likely to be identified in the United States in the coming days, including more instances of community spread. CDC expects that widespread transmission of COVID-19 in the United States will occur. In the coming months, most of the U.S. population will be exposed to this virus.
More at https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html
Italy numbers now updated. 3,579 new cases (17% increase), 368 deaths, 154 more critical/serious.
I am concerned that American emergency rooms are not working with up-to-date information on fever indicators. According to this Wall Street Journal article dated January 17, 2020:
I was in the Cape Cod Hospital emergency room about that time, about a week before I saw that article. I had a terrific doctor, but I said to both him and the nurse that a 99 degree temperature was high for me. My normal temperature is 97.5. As things turned out, I did have some type of viral infection that caused gastritis.
But it has been bothering me that so much of the Covid-19 monitoring has revolved around an elevated temperature. I sincerely hope that the ERs across the country have updated their temperature criterion.
I am reading inconsistent reports for what temperature elevation is required before it is an indication of COVID-19. I have read that early testing criteria had a fairly low “fever” triggering the testing, while more recently I have been reading “high” fever. At this point I have no clue.
Latest emergency medicine guidance is that since fever is only present in 44% of patients at initial presentation, but increases to 90% during hospital admission, fever is not required to make the diagnosis.
Oregon also has the lowest number of hospital beds per capita in the country: 1.6 per thousand. Sixty six hundred beds, many already in use. It won’t take much to overwhelm the system.
Consider that the French killed off many of their elderly a few summers back
https://en.wikipedia.org/wiki/2003_European_heat_wave#France
and then kept up the seasonal geezer cull
https://www.bbc.com/news/world-europe-49628275
Kozak, thank you for sharing that. I’ve sent it to family across the Pacific. Where they are, the government has been complacent and is only responding now.
I remember this. Socialism’s finest hour.
In the Friday presser with Trump, the lady doctor (forgot her name) said the reason the CDC didn’t use the Korean test was that it had 4% false positive. That is true and knowing that Korea has tested 100,000 people, with 8000 diagnosed it might be that half of their cases are false. The US test is supposed to better, 1%-2%. If we test 1M people that will be a lot of false positives. This might be one reason to add conditions to getting a test.
Britain is considering quarantining their entire population of people who are over 70 years old, “for months”.
I am nearly 71. I am going in to work tomorrow. Most of my department will be working remotely, and my boss gave me the choice to go in, or take vacation (I have more than enough hours available). I prefer to work, and take my chances.
@Rodin, I appreciate your daily report, but when certain countries of interest dropped off your abbreviated chart I began checking Worldometer to get the full chart. Last night, it had been hacked to show Vatican City at the top with 89,204,500 new deaths. Just thought you should know, if you didn’t already, that the site is being tampered with.
what is happening in Washington state, especially Seattle? Most deaths in US, 40.
It will be interesting what happens in Switzerland. The Swiss have an excellent healthcare system.
Singapore also has an excellent healthcare system. I think one reason you don’t see Singapore on the list above is its proximity to the equator, which means always hot and humid.
Remember SARS in 2003?
SARS is one type of corona virus
So 4000 people didn’t get sick and were quarantined. Not exactly a big harm. (and I doubt it was this large because there were probably multiple tests, Unlikely to get a second false positive in the same patient.)
Instead we lost 6 weeks getting this under control and lost the ability to contain it.
Alternately we start by using the Korean test until we develop the more accurate test.
Again, you don’t lose a crucial 6 weeks of containment.
Sometimes, a pandemic is just a panic, with a dem in the middle of it.
From the National Review, and not intended as rhetorical questions:
“We don’t have to rely on (positive!) national stereotypes to grasp the size of the threat, of course. We Americans can do the elementary math ourselves. If tens of millions of Americans get a disease with a 1 percent fatality rate, it would be a national catastrophe.”
I don’t think the threat is being over-hyped, except, of course, that everything on the MSM (especially) is over-hyped. The message I hear Dr. Fauci offering is that this is both truly dangerous and we can do something about it. Though I have to say, it is very strange for me to be in the midst of a crisis in which the best thing I can do for people is NOT show up!
https://m.jpost.com/Breaking-News/Intern-at-Ichilov-contracts-coronavirus-as-Israeli-cases-spike-to-250-621142
Notably, in burying the lede, we see that a person who was symptomatic first drew a negative test and then only later tested positive.
I’ve always found it odd that we’re so precise about what temperature is “normal”. Not 98° or 99°, but 98.6°. Then I realized that 98.6° Fahrenheit is exactly 37° Celsius. All this time we’ve been conforming to the metric standard!
Seriously though, this does make me wonder. We have one of those instant forehead thermometers and I’ve always just assumed it reads slightly cool since it always shows our temperature at about 97.5°. Maybe it’s accurate after all and the in-ear thermometers are reading too high.
Isn’t that what happened in San Antonio with the woman who tested negative, went to a shopping mall, then tested positive?
Does a regular flu shot help at all against COVID-19? Or are the antibodies wholly unique?
Re: “normal” temperature – I determined long ago that my “normal” is not 98.6. It hovers more around 96. For me, 98.6 is indeed a low – grade fever.
Maybe two or three decades ago, a government agency was created (don’t remember if federal or state) that controlled how many beds, medical facilities, etc. could be built, etc. Similarly, this agency controlled who was allowed to set up some of the new medical equipment, like CAT scan machines, etc. The government’s rationale was that under – utilized beds and expensive medical equipment drove up the cost of health care for all of us. They fully intended to reduce the number of hospital beds, and limit the availability of some types of equipment, to ensure more efficient use. This economic theory is closely linked to the concept that we only need one type of deodorant. Thus the number of beds in reserve, and the supply of more expensive equipment to diagnose and treat, were (are) kept well below where the market would have provided them. And here we are.
Along with not recalling whether this was a federal or state agency, I don’t remember more about the dates, or if it is still in effect. I do remember that it became an issue when a local hospital wanted to expand, back in that time frame, whatever the time frame is/was. Can somebody help me remember? In my searches for the answer, I find references to a similar, apparently current situation in Michigan.
Ha ha. I’ve always wondered about that.
The Hundred Years War will never end. :-)
I think it does not. We got it anyway–mainly to improve our odds of being in good health if we come across the coronavirus.
I remember that argument. It never made a lot of sense to me. It’s a good reminder of how much to trust the judgment of those government people who are looking out for our welfare.
A flu shot would help in a lot of ways, but mostly just keeping you from getting the flu, which will keep your strength up to battle the Covid-19 assault. Pneumonia is always a complication threat with the flu. Covid-19 is pneumonia. That’s why the doctors are so insistent about the flu shots for people. They will offer a bit of protection.
In Massachusetts officials announced a month ago that although we were in a very bad flu season, the vaccine cocktail had matched perfectly the mix of flu bugs in Massachusetts this year. This year the vaccine makers got the strains right for our state. That was excellent news. I’m not sure what strains are going around the rest of the country.
My sense is that there are a lot of active bugs out there right now. It’s the crazy warm winter we’ve had. That’s why the test accuracy has been argued about from the day people started using it. In a bad bug season like this one, think of the other viruses and bacteria swirling around a patient as the noise while the doctors are looking for the precise Covid-19 signal. The only tests they have available to them are unfortunately picking up some of the noise.
The healthier the population is as a whole, the easier the diagnosis process is and the better able people will be to fight off the coronavirus. Good health is the best defense.
What a shame we have not done a better job promoting flu shots. I read in WSJ that only about 50 percent of us got them this year.
I want to emphasize this point. So I’m repeating it here.
Please please please, get one if you haven’t already. It is not too late to get a flu shot.
I didn’t. When I tried to explain to my doctor why I was reluctant and when my doctor continued to misrepresent my reservations back at me, I decided it wasn’t worth arguing about and just went without.
Somewhere, a couple of days ago, I read on YouTube about a study showing that the flu shot increased your chance of getting generic coronavirus disease by 1.36 times. This wasn’t about COVID-19, because we don’t have those data, but about all coronaviruses lumped together. I remember being puzzled by that way of expressing the effect, but I now can’t find the video. Actually, I found the channel, but not the place where this was said. After seeing it I had asked Mrs R if she had her flu shot this year, and then told her about this. I’m pretty sure I didn’t imagine that part, but I wish I could find it again because I have some questions about it.