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Day 37: COVID-19 Outside of China
South Korea breached the 1,000 mark in cases. The Diamond Princess continues to add cases. Italy is scrambling. And the US is finally admitting what everyone already knows: COVID-19 is coming to your neighborhood at some point and your life is going to be affected in some way more than a shortage of goods manufactured in China. Also, WHO retiring the word “pandemic.” Apparently it was useful as a description of something to be avoided and a worse case than what was currently being dealt with, but as a description of current reality — not so much.
Worldometer summary of the news:
Published in GeneralFebruary 26 (GMT):
- 1 new case in Germany (in North-Rhine Westphalia): a 47 year-old with pre-existing conditions. He had been in contact with an acquaintance who had recently returned from China. He is in critical condition. [source]
- 3 new cases in Spain. They had all recently returned from Italy: [source]
– a 22 year old man in Sevilla (Andalusia) who had visited Italy.
– a 36 year old Italian woman resident in Barcelona (Catalunya) who had travelled to Northern Italy.
– a 24 year old man in Madrid who travelled to Italy.- 3 new cases and 4 new discharged patients in Singapore. [source]
- 1 new case in Canada (Ontario).
- 1st case in Greece: a 38-year-old woman from Thessaloniki who recently returned from a trip to northern Italy. She is now suffering from viral pneumonia but is in good condition. The patient has no existing health problem. [source]
- 14 new cases on the Diamond Princess cruise ship: 9 crew members and 5 passengers. [source]
- UK: About 30 schools have shut for a fortnight after pupils return from half term ski trips to Italy. [source]
- 3 new cases and 1 new death in France: a 60 year old teacher from the Oise region. [source]
- 1 new case in Australia is a former passenger of the Diamond Princess cruise ship. 8 of the 23 cases in Australia had been on the ship. [source]
- 44 new cases and 3 new deaths in Iran. [source] [source]
– Epicenter of the outbreak is the central city of Qom.
– Schools and cultural institutions closed for a week in over 10 provinces as of Tuesday Feb. 25 in order to “prepare schools” which have to be disinfected and sanitized.
– More than 1750 tests performed.
– Iran’s Deputy Health Minister falls ill with coronavirus (video).
– Iranian Government Spokesman Ali Rabiyee cautioned yesterday that “those regional states which have kept the number of their coronavirus-infected patients confidential will be bombarded by media reports about their conditions in the next few days.”- 51 new cases and 1 new death in Italy: a 69-year-old man from the Lodi area who was hospitalized in Emilia Romagna and had existing respiratory problems. The virus has now spread in half of the Italian’s regions: Lombardy: 258 cases and 9 deaths | Veneto: 71 and 2 deaths | Emilia Romagna: 30 and 1 death | Piedmont: 3 | Lazio: 3 | Liguria: 3 | Tuscany: 2 | Sicily: 3 | Marche: 1 | Alto Adige: 1.
- 284 new cases and 1 new death in South Korea: Death of a 73-year-old male [source] [source] [source]
- 14 new cases in Kuwait: a woman coming from Iran, an additional 6 citizens who had traveled to Iran, and other 7 cases when the Kuwaiti Ministry of Health announced that the total had increased to 25 cases. [source] [source] [source]
- 1 new case in Croatia: the brother of the first case, infected after visiting Milan in Italy. [source]
- 3 new cases in Bahrain: Bahraini women who had returned through indirect flights from Iran. Testing was conducted immediately upon their arrival at the Bahrain International Airport in the hall designated for testing. [source]
- 1 new case in Taiwan: a 27-year-old female foreigner with only a slight throat discomfort. She is linked to the clustering incident in a hospital for which 53 people among patients and caregivers have been tested, resulting in 5 confirmed cases, 141 negatives, and 7 awaiting results. [source]
- 1 new death in Japan: an elderly person in Hakodate, Hokkaido. [source]
- 3 new cases in Thailand. Health Minister Anutin urges citizens to avoid traveling abroad if possible. “For the airlines, please reduce promotions,” he said. “Even though tickets are cheap, it could be your last holiday.” Health officials have been prohibited to visit at risk countries, which are: China, Macau, Hong Kong, Taiwan, South Korea, Singapore, Italy, Iran, and Japan. “We are entering a full war with Covid-19” Anutin said. [source] [source]
@Rodin: Do you think having the temperature scans really helps? If one is asymptomatic it would not seem to help. Is this something governments, businesses are doing to, well, look like they’re doing something?
Also @rodin: First much thanks for keeping us up to date on this topic. On the BBC today they had a scientist who feels that we’re doing too much about COVID-19 now that we know how it works. His argument is that this is the new normal (be another flu that we’ll have to factor in for flu season for instance) and we should not be shutting things down, quarantining, etc. We’ll find a vaccine eventually, some people will die but not to worry. What do you think?
Hey, congratulations @rodin for being selected by James Lileks for the post of the week!! Actually it’s this series. So great minds want to know, why isn’t it listed in that special area, @max?
The Worldometer site shows that the death rate continues to fall (down to 8.42% now), and that the number of active cases continues to fall (down to 48,014 now, from a peak of 58,747 on Feb. 17).
I don’t know enough epidemiology to determine whether the decline in active cases is really good news. It seems that the overwhelming majority of the cases continue to be in Hubei province, which appears contained. But if the new outbreaks in other areas follow the trend seen previously in Hubei province, there could be another big ramp-up.
Does anyone have a link to a cite making projections? I imagine that WHO and CDC have projection models, but I haven’t seen them.
I’m wondering about this too.
There were initial reports that the decision was made by Ian Brownlee, Principal Deputy Assistant Secretary, Bureau of Consular Affairs, but
Dr. Williams was hired by the Department of State in 2012 as a GS-15, and since 2017 has been in the Senior Executive Service.
The initial plan was for any returning passengers needing quarantine to be housed at an abandoned school in Costa Mesa, California. However, the city obtained an injunction preventing this. The CDC had no plans detailing how an urban site with no running water, no electricity, and no functioning toilets could be brought into service overnight and safely used to house patients of this kind. The CDC also had no plans for feeding the internees, coordinating with area hospitals for care in isolation of internees who became dangerously ill, coordinating possible 911 responses to the site or proper disposal of the inevitable biohazard waste. A bunch of other stuff, too.
The math is unclear here. As was explained in the HHS briefing Tuesday, the denominator (the total number of cases) is uncertain, but the bigger the denominator, the more total cases, the smaller percentage the known fatalities becomes.The WorldOMeter is not measuring the right death rate. The question everyone has is this: if I get the virus, what are my chances of dying from it. That is answered by dividing the total reported deaths by the total reported cases, not just cases with an outcome.
So: 2771/81,296 = 3.4%
But even that might be an over-estimate, right? For the “regular” flu, we have models to provide a SWAG for the number of people who get the disease but never go to the doctor for whatever reason, right? (Even the number of hospitalizations and deaths involves some amount of guesswork). With this, the 81,296 doesn’t have that built in? or does it?
The BBC scientist is probably right. Containment is not an option and this particular disease was going to be damned difficult to contain. First, because of the contagious, but asymptomatic, period which is generally thought to be two weeks but for which there have been cases of 24-27 days. Second, like other viruses, COVID-19 seems to have a post recovery (again symptom free) contagion period as well. I haven’t read whether they have been able to quantify that any better than the pre-sympton phase. So you don’t put people into quarantine soon enough and then you let them out too soon — and you don’t know what soon enough and too soon are.
Taking temperatures is probably more theatre than therapeutic. People can have temperatures for lots of different reasons. Until there is a field test unit that can sample some bodily fluid and react accurately there is no effective screening of people arriving at airports, borders, or by sea. And people arriving now are already lying about their travel itineraries to avoid the risk of being quarantined. And the “travel to China” screen will become obsolete when the question is really whether they have been traveling to China, Italy, Iran, South Korea, Japan etc.
And then you have the “fomites” issue. I noticed in (I think it was) a WHO article that they need some testing regarding fomites. Fomites are any non biologic surface, e.g. door nobs, faucets, etc. upon which a virus can live. The question is for how long. Imagine that your strategy for avoiding infection is to have groceries and packages delivered to your house. You will not be making contact with the delivery person, but they will be handling the packages. If the delivery person is contagious and sneezes in their delivery vehicle, can the virus persist on the packaging and for how long? How long is important because maybe someone up the packaging chain is ill and not the last person making the delivery.
I don’t think we will be successful in preventing its spread. We need to learn about management strategies.
I disagree. The total number of cases includes thousands of people who haven’t died, some of whom will die. Death is an outcome, as is recovery. The question, “will I die?” refers to an outcome. Using total number of cases, which is not an outcome, with deaths, which is an outcome, is mixing apples and oranges.
Thanks so much! Great explanations!
Absolutely. But there are really no measurements that are all that useful at present. Different geographical locations are experience death rates that vary based on a multiple factors. And then there is the secondary problems that can also lead to death. Current reliance of China for pharmaceutical manufacture means that some number of people are at risk depending on how critical a given medication is to their personal survival. How many deaths are attributable to attrition amongst health care providers who are rendered unavailable to treat various diseases? The impact of the disease will be profound. It has already been so in China, South Korea, Italy etc. It will become more so elsewhere. But predictions are not possible. We do not yet know whether it is seasonal. Singapore, given its equatorial position may be suggestive it is not, but we’ll see.
Baby, can you dig your man?
If you have a Facebook account, you might find this interview interesting to see how regions like Cape Cod that are made up of small towns are sifting through the CDC information and applying it locally. This is an interview with our local infectious diseases specialist who oversees our infectious disease controls at Cape Cod Hospital, Dr. David Pompo, and a Cape Cod Times reporter, Gwen Friss, on the Covid-19.
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This graph from the WHO site shows that new cases outside of China are now not sourced in persons who themselves were exposed in China.
From Boston this evening:
I’ve been guessing this was the case. The Boston area would be an epicenter for this virus because the area hosts so many foreign national students from China.
To give a sense of how many more places have become affected by COVID-19 in the last few days I took a time-sequence data chart from the Johns Hopkins site and simply filled in the cells with red for reported cases (ignoring the count) and green for no reported cases for each individual location appearing on the chart.
The top third of the chart is taken up with Chinese locations that were reporting cases on an before 1/21/20. The green sliver surrounded by red is Tibet which apparently remained virus free until the end of January. The bottom two-thirds are locations outside of mainland China. Remember I am focusing in this chart on confirmed detection of the presence of the virus not on the number of cases. So in the last week COVID-19 was confirmed in 25 new locations.
@susanquinn First I’m hearing about it. 🤷♂️