2019-nCoV or COVID-19

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2019-nCoV or COVID-19

#1  Postby kiore » Jan 25, 2020 1:53 am

I started this thread after going to post in another one on this subject and decided that aside from that one there was room for some more serious discussion on the implications of this new outbreak.
I see people around the web questioning why such a fuss is being made of this when other viral diseases like influenza regularly kill large numbers of people, so far it seems that 2019-nCoV has a relatively low mortality rate. This is assuming that most cases go undiscovered and the current mortality rate of diagnosed cases is around 3% (watch this number for recalculations) and assuming for every diagnosed case there are say 10 more or 100 more even. Why could it be vastly more? Well as this is already the 'cold and flu' season many people assuming they just have a regular mild respiratory disease may have in fact had a mild form of this virus so there is lots of background noise, testing is also not quickly available and those who get sick and recover rapidly are rarely tested.
The reason this such a big deal and it is not just like seasonal influenza is because we know so little about it. Yes we have a genome sequenced in record time leading to testing being available quite rapidly, and yes treatments developed for the SARS outbreak are already being modified and work has already commenced on at least one vaccine. The reality is that just a couple of weeks ago we were not even sure human to human transmission was possible, it is, but we still are unsure of the reproductive rate of the infection is it R0 1 or 2 like Ebola Virus Disease? Or R0 15-18 like a disease such as Measles. We don't know the source although it is presumed to be animal, perhaps bats via a mammal like civet cats (presumed) for SARS or camels as with MERS CoV both Corona Viruses that would appear at this point to be most similar.
I also hear about fears this could 'mutate' and by this I assume people are using this word it the 1950's scifi meaning, mutation is of course likely but not always a bad thing as mutation to less serious form is also possible. From an evolutionary point of view the virus is usually more successful if the host remains alive and mobile so a 'mild' mutation should spread faster and further.
I field queries regularly from people seeking advice on how to protect themselves from this and so far the consensus seems to be that advice for protection against general respiratory viruses: Hand washing etc hold true for this, as far as masks go the standard paper surgical mask is most useful for infected people to protect others, while probably not very useful and possibly harmful if it gives a false sense of security for the uninfected. What are referred to as respirators, that is N95/FFP2 level masks will give better protection however they are frequently worn for too long or incorrectly. I do see some data that any kind of mask may be useful not as filters but as reminders to not touch your mouth.



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Re: 2019-nCoV

#2  Postby Spearthrower » Jan 25, 2020 3:15 am

I do see some data that any kind of mask may be useful not as filters but as reminders to not touch your mouth.


That's something I think is always useful if you've got a virus like a cold, or you're hopping around public transport. Studies show that we touch our faces more than 20 times an hour, making hand to mouth/nose transmission a higher risk than airborne transmission.
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Re: 2019-nCoV

#3  Postby I'm With Stupid » Jan 25, 2020 5:08 am

Am I the only person who thinks that a 3% mortality rate sounds pretty bad? If someone told me there was a 3% chance a plane was going to crash, I wouldn't get on it.
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Re: 2019-nCoV

#4  Postby Spearthrower » Jan 25, 2020 5:26 am

Right, but it's a little thin on data right now. That 3% includes people who got sick prior to being aware that there was any major health concern and may then have reported to hospital late assuming they just had a cold or something minor, plus doctors weren't aware of what they were dealing with. It'll be some time before that number really means much.
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Re: 2019-nCoV

#5  Postby kiore » Jan 25, 2020 5:46 pm

Spearthrower wrote:Right, but it's a little thin on data right now. That 3% includes people who got sick prior to being aware that there was any major health concern and may then have reported to hospital late assuming they just had a cold or something minor, plus doctors weren't aware of what they were dealing with. It'll be some time before that number really means much.


The 3% figure is based on confirmed cases, I am anticipating that the actual number of cases is much higher and as severe illness is more likely to be counted that group is over represented. As we were unsure whether human to human transmission was possible until quite recently and the initial group was made up of those presenting to health facilities with severe illness those with mild and resolving illness will not be in the initial count. I suspect the contact tracing of severe positive cases will start to identify a much larger number of these milder cases, but we are still at very early stages and testing capacity is low with no readily available rapid test. Looking at the first case in Melbourne Australia it seems even some health practitioners are still not aware of this outbreak incredible as that seems. In the case I refer to it seems a traveler recently in Wuhan had presented to a Medical Practitioner wearing a mask and reporting he had been in Wuhan and was now symptomatic.
Victoria's deputy chief health officer Angie Bone said she was concerned that the GP did not link a person coming from Wuhan and a respiratory virus with a possible case of coronavirus, but she was "very glad that the family then brought extra help the following day when he clearly wasn't getting any better."

https://www.abc.net.au/news/2020-01-25/ ... s/11900428
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Re: 2019-nCoV

#6  Postby kiore » Jan 25, 2020 6:17 pm

Perhaps I should also note the naming convention that has caused some confusion. Since 2015 the World Health Organization (WHO/OMS) has adopted a naming convention avoiding previous usage of naming diseases for the discoverer, the initial site/country of discovery or supposed animal reservoirs. https://www.who.int/mediacentre/news/no ... seases/en/
This really helps when you are trying to explain to someone why they may be at risk of Japanese Encephalitis even if not going to Japan for example. The current and I presume temporary naming for this outbreak is 2019 (date identified) n (for novel/new) Corona Virus. I already see it being described as;plague, China Virus and Wuhan Virus. I do wonder whether sales of a famous Mexican beer are suffering fallout from all the headlines.
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Re: 2019-nCoV

#7  Postby newolder » Jan 25, 2020 6:42 pm

Corona with Lyme is off the menu too, I read. :yuk:
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Re: 2019-nCoV

#8  Postby aban57 » Jan 25, 2020 7:13 pm

I read it was transmitted to us by a snake. Is that correct ?
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Re: 2019-nCoV

#9  Postby aufbahrung » Jan 25, 2020 7:29 pm

aban57 wrote:I read it was transmitted to us by a snake. Is that correct ?



https://www.wired.com/story/wuhan-coron ... lu-theory/
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Re: 2019-nCoV

#10  Postby aban57 » Jan 25, 2020 7:54 pm

aufbahrung wrote:
aban57 wrote:I read it was transmitted to us by a snake. Is that correct ?



https://www.wired.com/story/wuhan-coron ... lu-theory/


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Re: 2019-nCoV

#11  Postby kiore » Jan 25, 2020 7:55 pm

aban57 wrote:I read it was transmitted to us by a snake. Is that correct ?


It is far too early to tell for sure as mentioned bats are considered the likely reservoir species for both SARS and MERSCoV which was then transmitted via another mammal, camels in the case of MERSCoV which we know a lot more about. As the seafood market in Wuhan that is the current presumed ground zero also sold mammals and reptiles this muddies the waters considerably.
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Re: 2019-nCoV

#12  Postby Fallible » Jan 25, 2020 8:22 pm

I heard mention of a civet.
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Re: 2019-nCoV

#13  Postby newolder » Jan 25, 2020 8:30 pm

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Re: 2019-nCoV

#14  Postby aban57 » Jan 25, 2020 8:38 pm

Fallible wrote:I heard mention of a civet.


Are you using civet with its French meaning or the English one ? :lol:
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Re: 2019-nCoV

#15  Postby kiore » Jan 25, 2020 8:43 pm

Fallible wrote:I heard mention of a civet.


This was strongly associated with the SARS 2002 outbreak and although not confirmed (despite some claims) as the source a similar virus is known to be present in these mammals so a high level of suspicion is reasonable. They are eaten in this region and were available in the market in Wuhan. The sale and slaughter of the civet had been prohibited following the SARS outbreak it seems those regulations no-longer in place or at least no-longer enforced.
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Re: 2019-nCoV

#16  Postby felltoearth » Jan 26, 2020 3:27 am

Canada has confirmed its first "presumptive" case of the deadly coronavirus in Toronto as the number of infections worldwide surpasses 1,900 cases.

Public health officials announced Saturday afternoon the confirmed case — a man in his 50s who had travelled to Wuhan, China — was found at Toronto's Sunnybrook Health Sciences Centre.

Within a day of arriving, officials say, he became "quite ill," said Dr. Barbara Yaffe, associate chief medical officer of health with the provincial Ministry of Health.

Officials say lab results were received Saturday afternoon. The man is in stable condition.


https://www.cbc.ca/news/canada/toronto/ ... -1.5440760
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Re: 2019-nCoV

#17  Postby Macdoc » Jan 26, 2020 6:47 am

Of course that's my son's onco hospital ... :roll: Superb facility tho. Toronto is better prepared this time.

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Re: 2019-nCoV

#18  Postby Spearthrower » Jan 26, 2020 5:40 pm

kiore wrote:
Spearthrower wrote:Right, but it's a little thin on data right now. That 3% includes people who got sick prior to being aware that there was any major health concern and may then have reported to hospital late assuming they just had a cold or something minor, plus doctors weren't aware of what they were dealing with. It'll be some time before that number really means much.


The 3% figure is based on confirmed cases, I am anticipating that the actual number of cases is much higher and as severe illness is more likely to be counted that group is over represented. As we were unsure whether human to human transmission was possible until quite recently and the initial group was made up of those presenting to health facilities with severe illness those with mild and resolving illness will not be in the initial count. I suspect the contact tracing of severe positive cases will start to identify a much larger number of these milder cases, but we are still at very early stages and testing capacity is low with no readily available rapid test. Looking at the first case in Melbourne Australia it seems even some health practitioners are still not aware of this outbreak incredible as that seems. In the case I refer to it seems a traveler recently in Wuhan had presented to a Medical Practitioner wearing a mask and reporting he had been in Wuhan and was now symptomatic.
Victoria's deputy chief health officer Angie Bone said she was concerned that the GP did not link a person coming from Wuhan and a respiratory virus with a possible case of coronavirus, but she was "very glad that the family then brought extra help the following day when he clearly wasn't getting any better."


https://www.abc.net.au/news/2020-01-25/ ... s/11900428




Also seeing that this is proving to be extra difficult due to being infectious even during incubation.

Please keep us up to date from your more informed basis. With Thailand's infected starting to mount and the government doing their usual incompetent chest-beating, this is starting to look a little worrying.
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Re: 2019-nCoV

#19  Postby kiore » Jan 26, 2020 9:19 pm

I am not sure I am that much more informed on this, I certainly am watching this situation closely and discussing with colleagues.
The media are covering this heavily and I see various claims about the outbreak such as it is adapting to the human host quickly, that the R0 is somewhere between 3 and 4, that it is transmissible prior to any symptoms. All this stuff may be correct but we have moved from little data to a flood of raw data. I suspect that we will get much better transmissiblity data from the cases outside of the outbreak area where there is much less chance of contamination of data by multiple possible sources of transmission. The two cases I have been reading about from Sydney were both symptomatic on day 9 but this a small sample. I had anticipated that there would be many low grade cases which seems to be correct, this will seriously alter both the presumed mortality rate and exaggerate the initial transmission speed due to what will appear to be cases coming out of nowhere if asymptomatic or mildly symptomatic cases can transmit.
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Re: 2019-nCoV

#20  Postby felltoearth » Jan 26, 2020 9:57 pm

Two people in one of my SO’s classes have self quarantined. The father if one of them was in the same flight as the person mentioned in the story I posted.


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