[pescetom]

Today's updated figures from Italy: 2706 cases (+20% on yesterday) and 107 dead (+35% on yesterday), a ratio of 3.95%.

A medic told me that from their point of view, the biggest concern is the sheer time people need to stay tubed up in intensive care before recovery.

[Winstonm]

If one were feeling mildly under the weather and could still pass on the virus it would be enough to make it dangerous to all those in this country who don't have paid sick leave and can't afford to miss work, much less go to the doctor.

[pescetom]

Winstonm, on 2020-March-04, 14:07, said:

If one were feeling mildly under the weather and could still pass on the virus it would be enough to make it dangerous to all those in this country who don't have paid sick leave and can't afford to miss work, much less go to the doctor.

Maybe you still have a rosy eyed view of the situation. Here in just the second week of an outbreak many workers are already at home because they are obliged, or no longer have work to go to (given collapse of many industries linked to mobility or China) or must care for their children with the schools closed. Almost nobody dares go to the doctor. It may well be the same in the rest of Europe by the end of the month. Don't know about USA but somehow I doubt it will beat Europe in terms of freely available intensive care, as long as that can cope.

[y66]

From Andrew Harrison, Chief Commercial Officer at my favorite airline:

Quote

Please be assured that Alaska Airlines is closely monitoring the situation, including conducting daily briefings with some of the best medical experts in the nation. Our top priority is always the safety of you and our employees. Check out our blog on the extra steps we are taking to keep our guests safe with additional cleaning and updates to onboard procedures.

At Alaska, we are optimistic about the future and hope you feel that way too. We launched our Peace of Mind policy so that you can take comfort in knowing that any ticket purchased after February 27, 2020 can be changed or canceled without a fee (applies for any travel through February 28, 2021). Today, we launched our biggest fare sale yet with fares starting as low as $20 one way* for travel between March 19, 2020 and May 20, 2020. And, we’ve got great deals to Hawaiʻi, New York and Florida starting at $99 one way.* We hope the combination of these great fares and our Peace of Mind policy will help those who want to travel this spring but are concerned their plans may change.

We understand that everyone is in a different place when it comes to what is best for you and your family. Just recently, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention, said “I just want to echo again that the risk is low—the risk is low. I encourage Americans to go about their life. That includes travel to California, Oregon and the state of Washington.”

In closing, some of you may know that my wife and I are blessed with eight children. We have a family trip to Hawaiʻi planned for spring break this year, and we can’t wait to go! We know things can change, but we are looking forward to our trip together as a family. Hopefully we will see some of you there.

Thank you for being a Mileage Plan™ member.

[Winstonm]

pescetom, on 2020-March-04, 14:29, said:

Maybe you still have a rosy eyed view of the situation. Here in just the second week of an outbreak many workers are already at home because they are obliged, or no longer have work to go to (given collapse of many industries linked to mobility or China) or must care for their children with the schools closed. Almost nobody dares go to the doctor. It may well be the same in the rest of Europe by the end of the month. Don't know about USA but somehow I doubt it will beat Europe in terms of freely available intensive care, as long as that can cope.

Here in the U.S. we have a very sick (psychologically) man in the White House who is claiming the virus isn't dangerous and the risk is exaggerated because it makes him look bad and deflects attention away from him.

[pescetom]

Today's updated figures from Italy: 3296 cases (+18% on yesterday) and 148 dead (+38% on yesterday), 414 recovered for a ratio of 3.98% deaths. 351 in intensive care (10.8% of all cases).

In an interview in 'La Stampa' today a virologist from San Raffaele Hospital in Milan casually announced that the main virus strain circulating in Lombardy is not identical to the original chinese strain: she said it originated in Bavaria. People have been hinting at this for several days but this is the first public confirmation I have seen.

[kenberg]

My thoughts often run in a simple mode, in this case for diagnosis. At https://phpa.health....oronavirus.aspx we see their estimate that it might be 2 to 14 days before symptoms occur. Obviously we cannot all be going off to get tested every three or four days. While out for a morning walk, I got to wondering: Might a person engaging in strenuous activity notice symptoms earlier than a person sitting in from of a tv? One of the symptoms is shortness of breath. I might not notice any shortness of breath while watching Miss Fisher re-runs. Never mind just how far I walk or at what pace, my point is that it took about the same time and the same energy as it did yesterday and as it did last week.
It's critical that the infected realize that they are infected as soon as possible. Pushing yourself a bit every day and noticing any changes in breath might help in self-diagnosis. Also it might not help, I realize that. But we know so little, I would not rule it out.

I should make it clear that I realize that here in Maryland we have three, not three hundred or three thousand or more, or many more, diagnosed cases. I recognize the difference. But we all need to be thinking about this. Keeping the number low is, well, it's obvious how to finish the sentence.

[barmar]

kenberg, on 2020-March-06, 10:33, said:

Might a person engaging in strenuous activity notice symptoms earlier than a person sitting in from of a tv? One of the symptoms is shortness of breath. I might not notice any shortness of breath while watching Miss Fisher re-runs.

But your shortness of breath might just be because of the strenuous exercise. Unless you're in good shape, you expect this.

Being short of breath when you aren't doing anything energetic is an obvious symptom.

Basically, the symptoms of COVID-19 are not much different from a cold or flu: fever, coughing, shortness of breath. I'm not sure how people are expected to distinguish them, so probably lots of people with colds and flu are going to doctors to get tested, and there aren't yet enough test kits.

[Winstonm]

Quote

Business
White House economic adviser Larry Kudlow claims coronavirus is 'contained,' says Americans should 'stay at work'
Brendan Morrow
The WeekMarch 6, 2020, 10:53 AM CST

This is what we have to deal with in the U.S. - BS straight from the top.

[pescetom]

barmar, on 2020-March-06, 10:53, said:

But your shortness of breath might just be because of the strenuous exercise. Unless you're in good shape, you expect this.

Being short of breath when you aren't doing anything energetic is an obvious symptom.

Basically, the symptoms of COVID-19 are not much different from a cold or flu: fever, coughing, shortness of breath. I'm not sure how people are expected to distinguish them, so probably lots of people with colds and flu are going to doctors to get tested, and there aren't yet enough test kits.

Close but not on target, I fear. From local medics and acquaintances (multiple cases within 20 miles of here in last few days) it seems the initial symptoms are fever and sore throat - shortness of breath only comes later and often after a period of several days of apparent remission. And the worst thing for control of the disease is that for all this time until things deteriorate again you may test false negative (this happened in the case nearest to us, and the person was so happy he went dancing the day before he was tubed up) even if they have enough kits to test you.

[pescetom]

Today's updated figures from Italy: 3916 cases (+22% on yesterday) and 197 dead (+33% on yesterday), 523 now healthy for a ratio of 3.3% deaths.

Finally (some) official numbers about who is getting ill and (more) about who is dying. The average age of those infected is 61 (it would be nice to know the actual breakdown by age group and gender). The average age of those dying is 81 (we do have a breakdown by age group here, similar to China) and 73.3% (!) are male. 75% suffered from high blood pressure before the onset of virus, only 16% had one or less chronic illness.

[cherdano]

This is tragic:
https://mobile.twitt...038360680054784

[hrothgar]

cherdano, on 2020-March-07, 06:30, said:

This is tragic:
https://mobile.twitt...038360680054784

What I find tragic is that this stupid virus might take Trump down when children in cages didn't..

[pescetom]

Italian democratic party leader Nicola Zingaretti tested positive today, but luckily for him he is only 54 years old.
Also the first two positive bridge players (in Rome).

Today's Italian statistics: infected 5061 (+29%), deaths 233 (+18%), no longer infected 589 (+13%). Ratio of deaths/cases 4.1%.

[y66]

From The Coronavirus, by the Numbers by James Gorman at NYT:

Quote

Adam Kucharski studies how diseases spread, but he’s not handling viruses in the lab or treating sick people in the hospital. He’s a mathematician at the London School of Hygiene & Tropical Medicine, and he uses math to understand outbreaks of diseases like Ebola, SARS, influenza and now Covid-19. His goal is to design better ways to control outbreaks.

In an eerie coincidence, he wrote a book called “The Rules of Contagion,” before the current outbreak, which has been published in Britain and will be released in September in the United States. In it he talks about the math of contagion involving not only physical diseases, but also ideas, rumors and even financial crises.

In a recent experiment for the 100th anniversary of the 1918 flu, he worked with another mathematician and BBC presenter, Hannah Fry, of University College London, and collaborators at the University of Cambridge, to create a documentary, “Contagion: The BBC Four Pandemic,” using a phone app to track social contacts and map how an infection might spread.

The news of coronavirus epidemics around the world involves a flood of numbers that are a challenge for any nonscientist to digest. I asked Dr. Kucharski to help us navigate some of these numbers, and to tell us which ones we should pay attention to. We talked on the phone and corresponded by email this week. This is an edited version of our back and forth.

We hear a lot about the percentage of sick people who are dying. Is that the case fatality rate?

The case fatality rate measures the risk that someone who develops symptoms will eventually die from the infection.

And how is that rate calculated?

Ideally, we would monitor a large group of people from the point at which they develop symptoms until they later die or recover, then calculate the proportion of all these cases who had died.

So can we just look at the total number of deaths and the current number of cases?

The problem with just dividing the total number of deaths and total number of cases is that it doesn’t account for unreported cases or the delay from illness to death. The delay is crucial: If 100 people arrive at hospital with Covid-19 on a given day, and all are currently still alive, it obviously doesn’t mean that the fatality rate is 0 percent. We need to wait until we know what happens to them eventually.

Any deaths will be people who got sick two to three weeks ago, so it’s not simply deaths at the moment divided by cases at the moment. Plus some cases might be missed: If you have two deaths from two cases, as happened in Iran last month, that most likely means you’ve missed a bunch of cases.

We’ve seen all sorts of numbers for fatality rates. Does the latest estimate of 3.4 percent globally make sense?

Early on, people looked at total current cases and deaths, which, as I said, is a flawed calculation, and concluded that the case fatality rate must be 2 percent based on China data. If you run the same calculation on yesterday’s totals for China, you get an apparent CFR (case fatality rate) of near 4 percent. People are speculating that something is happening with the virus, where it actually is just this statistical illusion that we’ve known about from Day 1. I’d say on best available data, when we adjust for unreported cases and the various delays involved, we’re probably looking at a fatality risk of probably between maybe 0.5 and 2 percent for people with symptoms.

I had a short Twitter thread explaining this (and predicting the rise) a couple of weeks ago:

Adam Kucharski @AdamJKucharski said:

If the number of reported confirmed cases of #COVID19 continues to slow down, the 2% fatality rate people have been quoting will appear to rise. But it will be a statistical illusion. Let me explain why...

What about another number we hear about all the time, R, the reproductive number, or how many people a given patient is likely to infect. Why is it important and what goes into calculating it?

At its simplest, R is the answer to the question: How worried should we be about infection? If R is above one, each case, on average, is giving it to at least one other person. You’re going to see growth.

If it’s less than one, then a group of infected people are generating less infection. From a policy-planning point of view, it gives you a very clear objective. For example, in the Ebola response in 2014, it was a really prominent part of the response. The aim was to get R below one.

That seems very simple and straightforward, but you write that it’s more complicated than it seems. In your book you say that to calculate R you’ve got to know duration, opportunity, transmission probability and susceptibility (the “DOTS”). Let’s take them one by one. What is duration?

How long someone is infectious. If someone is infectious twice as long, then that’s twice as long that they are around to spread infection.

Do we know what the duration is for this coronavirus?

On average, we’d probably be looking at a week or two. Of course, if people get hospitalized, then they’re not in the community spreading infection in the same way.

The second component is opportunity. How do you determine that?

That’s a measure of how many people you come into contact with for every day you’re infectious. With something like flu, you’re not infectious very long but a lot of your interactions could potentially spread it. Whereas with something like HIV, the duration is much longer but the number of sexual partners you have relative to the number of conversations you have is obviously much lower.

And transmission probability?

This is a measure of the chance the infection will get across during an interaction. For example, during a sexual encounter, the virus won’t necessarily get across.

Finally there’s susceptibility. How do you determine that?

Susceptibility measures the chance the person at the other end of the interaction will pick up the infection and become infectious themselves.

Once you’ve got numbers for these four components, what’s the equation to come up with R?

If you multiply them together, you get the reproduction number. So if you scale up or scale down any one of these things, it directly affects the value of R.

How does this knowledge help public health planning?

Generally, susceptibility is the easiest one to reduce if we have things like vaccines. If we don’t, then we have to think about targeting the other aspects of transmission, such as reducing opportunities through social distancing, or probability of transmission during things like handshakes by encouraging hand washing.

What if you’re not in public health, but are thinking about your own personal chances and what your behavior should be?

If you imagine you’ve got a reproduction number of two, each person’s infecting two others, on average. But some situations are more likely to spread infection than others. We’ve found for things like Covid-19, it’s close-knit interactions that seem to be most important.

What we need to think about — and what a lot of our modeling is certainly thinking about — is not just how much transmission is happening, but where is that transmission happening. If you’re going to change your behavior, think how to reduce those risky situations as much as possible.

If you were the average person, what would you pay attention to — in terms of the news and the numbers?

One signal to watch out for is if the first case in an area is a death or a severe case, because that suggests you had a lot of community transmission already. As a back of the envelope calculation, suppose the fatality rate for cases is about 1 percent, which is plausible. If you’ve got a death, then that person probably became ill about three weeks ago. That means you probably had about 100 cases three weeks ago, in reality. In that subsequent three weeks, that number could well have doubled, then doubled, then doubled again. So you’re currently looking at 500 cases, maybe a thousand cases.

I think the other thing that people do need to pay attention to is the risk of severe disease and fatality, particularly in older groups, in the over-70s, over-80s. Over all we’re seeing maybe 1 percent of symptomatic cases are fatal across all ages. There’s still some uncertainty on that, but what’s also important is that 1 percent isn’t evenly distributed. In younger groups, we’re talking perhaps 0.1 percent, which means that when you get into the older groups, you’re potentially talking about 5 percent, 10 percent of cases being fatal.

In thinking about social behavior and thinking about your interactions, the question should be, “How do we stop transmission getting into those groups where the impact could be really severe?”

[pescetom]

y66, on 2020-March-07, 15:06, said:

From The Coronavirus, by the Numbers by James Gorman at NYT:

A lot of good sense here, in particular "We’ve found for things like Covid-19, it’s close-knit interactions that seem to be most important." is relevant for anyone still playing face to face bridge in a club with elderly people, even if it is permitted.

[Winstonm]

The other side of this story:

Quote

Here’s a tweet thread which runs the numbers based on our current understanding of COVID-19.


Liz Specht
@LizSpecht
I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math. 1/n

87.2K
8:03 PM - Mar 6, 2020
Twitter Ads info and privacy
37.8K people are talking about this

The follow-on gut punch: if the states and federal government do not develop and implement a comprehensive plan to mitigate contagion, the U.S. will run out of hospital beds in early May.

That’s in a little over eight weeks.

If we don’t have adequate beds let alone mechanical ventilators and intubation equipment, the mortality rate will jump from an estimated 2-2.3% to at least 5%.

If you don’t read the twitter feed, understand that the writer is an engineer with a Chemical & Biomolecular Engineering degree from Johns Hopkins and her PhD from UCSD - no lightweight assessment.

The risk of coronavirus is not to any one individual but whether or not it systemically overwhelms the healthcare systems, which in turn could create higher mortality for non-virus cases, not to mention the economic damage done.

[barmar]

Winstonm, on 2020-March-08, 08:27, said:

If you don’t read the twitter feed, understand that the writer is an engineer with a Chemical & Biomolecular Engineering degree from Johns Hopkins and her PhD from UCSD - no lightweight assessment.

But is she a "stable genius" with a "hunch"?

[pescetom]

barmar, on 2020-March-08, 15:02, said:

But is she a "stable genius" with a "hunch"?

No need to be a stable genius, just look at Lombardy, wealthiest region of Italy, population 10 million.
Only 16 days after outbreak, 2217 infected in hospital and 399 in intensive care (many in beds liberated by the 227 already dead).
The region is already exporting intensive care cases to surrounding regions and the possibility to increase ICU facilities in short term is limited.
10% of doctors and nurses are quarantined for possible infection, the rest are at the limit and doctors in pension are being sought.
The epidemic numbers have been growing at a steady logarithmic rate which shows no sign of declining despite containment measures.
Even without a hunch it is evident that very soon a large proportion of those who require intensive care (not just from virus) will not receive it.

Today's Italian statistics: infected 7375 (+45%), deaths 366 (+57%), no longer infected 622 (+6%). Ratio of deaths/cases 4.1%.
That's a bigger rise than usual even on a logarithmic scale, no change in criteria or death rate either.

[barmar]

What's surprising me when I hear numbers like that is how slow the increase has been here in the US, especially considering the limited resources that have been applied to the outbreak (e.g. we don't have enough testing kits). How is it that our total cases is still under 200?

This may be why Trump thinks this thing is blown out of proportion.