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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
I’ve been seeing this too. I’m wondering too if we haven’t somehow screwed up the human immune system, but I still say with every fiber in my being that a flu shot is the best defense against this bug at this moment in human history.
I’m a reclusive person by nature. This year, I resolved to get out more and meet more people. Maybe next year.
“Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, cautioned that the public shouldn’t view the government’s response as a failure, because that could create distrust of future public health measures.
“There is a real danger in the public believing they had failed,” Adalja said. “This is a respiratory spread virus with efficient community spread and as such it’s not containable. It is not as if the containment failed, it was never going to be successful.””
Containment was never going to happen.
People: We needed to implement the containment strategies of XXXX.
Reality: XXXX also develops a number of cases in line with everyone else.
People: We need more pointless health security theater!
This couple from Indiana sounds almost “Typhoid Mary”ish. Close contact with a COVID-19 person and (1) they go on their vaca, (2) upon getting off plane they have the COVID-19 symptoms but DON’T tell the health people about their close contact, (3) they get on another plane, (4) they again get COVID-19 symptoms and finally fess up the health authorities. Sheesh – and I thought people from the Midwest were saner that the coastal types. Hmmm – are they by any chance academics? Finally, @Rodin, I’m throwing out this completely (and probably wacky) idea: Could being on an airplane with its forced air push the virus deeper into a person’s lungs therefore helping them to get sick and spread the virus around? It seems like the spreading of most cases are air travel related but I assume its just our modern way. Again, thanks so much for keeping us informed and also introducing me to the Worldometer. Stay healthy @Rodin!
Our good neighbors to the north:
Maybe we need a wall between us and a country that would elect Trudeau.
update:
Ooops. The above tweet and comment was supposed to follow this:
I linked the study here. They were investigating virus interference, the potential for a vaccine, in this case flu vaccine, to increase the likelihood of catching a different virus. A summary of the findings:
TANSTAAFL.
That sounds like just human nature. Wishful thinking can stubbornly override cold hard logic. They probably assumed the symptoms indicated a more common and milder condition. Then they refused to report themselves because they believed it would be much ado about nothing, unnecessarily interrupting their lives.
I know people who justifiably distrust the news media and continue to believe the common flu is a greater threat than COV-19. There are still many conflicting reports, as can be expected with any new disease before extensive testing.
Subsequent to the 2013 Avian Flu outbreak in China US officials reviewed our national pandemic response plan. Their conclusions were in part that in the event of an outbreak in the US with 30% of people infected and a 0.24 to 0.5% case fatality rate that between 35,000 to 60,500 additional ventilators, supplies, and the people trained to used them will be needed to prevent death due to shortages.
We don’t know how many people will eventually be infected. Hopefully, it will be a great deal less than the above scenario.
A bit of good news is that the growth of numbers of infected people in the US dropped a bit over the weekend leading me to think that perhaps measures being taken to slow down the virus are taking effect.
Ah, that was it. Thanks.
Hmmm:
This isn’t the first time this has been a concern:
Salicylates and Pandemic Influenza Mortality, 1918–1919 Pharmacology, Pathology, and Historic Evidence
There are many reports from this epidemic of people on the “really sick” end of the spectrum reporting that they are having so much trouble breathing that they feel like they are “drowning.”
Could some of the differences in death rate be explained by local preferences in what OTC meds to take for fever?
Thanks for this info.
I supposed you are right @aaronmiller. They wanted to go on their Hawaiian vacation and they just assumed, a number of times, that everything was ok or no big deal. Still if I get a fever at this point I’m self-isolating and certainly not getting a plane. I suppose this also means that human nature will kill us all for sure.
YES!
Emphasis added
That is interesting. It will take a lot of research to pin down. I say that because I just had a case of gastritis which was discovered through an endoscopy to be only inflammation caused by some unknown virus or bacteria. I, as did the ER doctor, thought I had ulcers.
It’s too expensive to culture tissue for everything. Labs look for only specific possible pathogens. The gastroenterologist who performed my endoscopy biopsied the lining to my stomach and ordered a test only for H. pylori, which is the bacteria that usually causes ulcers. The test came back negative.
But before we got the test results and immediately after the endoscopy, my gastroenterologist told me to take the anti-inflammatory Ibuprofen. I laughed at him. “You’re not serious? Isn’t that what caused the problem in the first place?” “Nope. You don’t have ulcers and you don’t have cancer. You have an inflammation, and the best drug for that is Ibuprofen.” I went home and took two. My gosh, in twenty minutes I felt like a different person.
Everything I’ve read says Covid-19 is causing lungs to be inflamed. That suggests to me that Ibuprofen would help.
There’s so much we will have learned by the time this is over.
With your doctor’s caveats in mind, NSAIDs can be great short term. Long term, maybe not so much.
Long term, Boswellia seems to modulate the inflammatory process in a way less likely to interfere with repair. It tends to take a week or two to ramp up, though.
I remember reading something similar. Can’t remember where.
One other reason for getting the flu shot is, if people report having a flu-like illness but have had the shot, it helps the people collecting disease surveillance data to rule out which type of virus was responsible for the illness. Helpful research data.
That was quick:
If you want a very good discussion of the immune responses in question, an overview of this epidemic, plus a deep but not too technical epidemiology rabbit hole plus lifestyle recommendations for managing your health, click here.
Perhaps not the greatest data. In a typical year the vaccine is about 50% effective, give or take. Meaning that there’s a decent chance that a person who got the vaccine and has cold-like or mild flu-like or few to no symptoms actually does have the flu.
The goals of the flu vaccine campaign include keeping from overwhelming the hospitals (where have I heard that before. . .) and keeping people at work and keeping kids in school. Useful research data depends more on actually testing people for flu infections and as we’re seeing with COVID-19, it’s not enough to test the symptomatic people.