On coronavirus (COVID-19) so far [Part I]
[NOTE: I’ve decided this needs to be at least a two-parter, because there’s so much to be said. Here’s Part I.]
I haven’t written too many posts on the new coronavirus (COVID-19) because we know quite little, and much of what we read about it in the MSM probably is incorrect. Nevertheless, it’s what we have to work with right now.
You keep hearing “don’t trust the Chinese on this.” And I agree. But that also means that we can’t trust the people who at least theoretically know the most about it, because they’ve had the largest numbers of cases. And it also sets the scene for cinematic apocalyptic imaginings to rush in, ideas that many in the MSM are only too happy to entertain, the better to raise ratings and to hurt Trump. A twofer.
Prognosticators don’t want to be caught flat-footed if this becomes a much much bigger deal than it already is. People have learned more and more in recent years not to trust governments and bureaus and bureaucrats. So all of that is operating, too.
But here’s what I’ve gleaned so far.
First, some general statements. I’ve read that for infectious diseases, lethality and ease of contagion are ordinarily (not always) somewhat in opposition. That makes sense, because if a disease is quickly and highly lethal, the sufferer will have much less opportunity to be walking around with it in his or her most contagious stages, and therefore will tend to infect fewer people.
That’s why many illnesses that are highly widespread – take the common cold, which is called “common” for a reason – are usually mild (although tell that to the cold sufferer). And yet even such seemingly innocuous illnesses have some lethality, in that (for example) a cold can lead in the susceptible to pneumonia, which is far more likely to kill.
Pneumonia is something we’re all familiar with because, like the common cold, it’s reached a relatively stable rate of infection and, although far less common than the cold, it’s something not especially uncommon. And unlike COVID-19, it’s far from new. But pneumonia can kill, and you might be surprised to learn how often. Pneumonia statistics are as follows:
For US adults, pneumonia is the most common cause of hospital admissions other than women giving birth. About 1 million adults in the US seek care in a hospital due to pneumonia every year, and 50,000 die from this disease.
That’s a death rate of 5%. And not all these people are old or ill to begin with, either (see the link for more), although many are.
I’ve also seen discussions of the 1918 flu in comparison with COVID-19. The 1918 flu was a pandemic, both worldwide and more lethal than ordinary flu (which can also kill). And the death rate in 1918? The truth is that no one really knows what the death rate was in those who contracted the disease. One reason is that in those days, reporting rules were often nonexistent, even in the US. Here’s an account that focuses on the state of Washington, for example (the term “Spanish flu” is used in the excerpt, and although this is a misnomer it was a common term for it):
For several reasons, tracking the progress of the pandemic in the state with much accuracy is impossible. First, influenza was not a disease that had to be reported to state health authorities, at least not during its most virulent phase in the fall of 1918. Voluntary reporting was extremely sporadic, as will be seen. Deaths needed no diagnosis and were faithfully recorded, but overall tallies of the infected must be considered rough estimates, even when impressively specific.
Second, the flu in 1918 and early 1919 came in three distinct waves — a usually mild form in the spring and summer of 1918, followed by the deadly strain in the closing months of that year, and ending with a return of usually (but not always) milder disease in the early months of 1919, not fully tapering off until 1920.
To further frustrate public-health authorities, the Spanish flu killed both directly and by leaving victims vulnerable to secondary infections with bacterial pneumonia, which was often fatal even in the absence of the flu, particularly in the elderly or infirm. This muddled the causality picture. But because the Spanish flu had proven so stunningly contagious and pneumonia was so often found during autopsies of flu victims, the federal Census Bureau decided to use a single category in its mortality statistics for 1918: “deaths from influenza and pneumonia (all forms)” (Mortality Statistics, 1918). As frustrating as it is to epidemiologists and life-insurance actuaries, all statistical studies of the effects of the 1918 pandemic are riddled with uncertainty and approximations.
The difficulties are obvious. And that passage describes the situation in the US, which had relatively good reporting (and probably lower death rates as well) compared to so many other countries:
Although the death toll attributed to the Spanish flu is often estimated at 20 million to 50 million victims worldwide, other estimates run as high as 100 million victims—around 3 percent of the world’s population. The exact numbers are impossible to know due to a lack of medical record-keeping in many places.
What’s more – and what can be confusing – death rates can refer to two different things. The first one is the overall death rate from the disease in the general population, and the second is the death rate from the disease in all people infected with it.
More about the death rate in 1918, which not only is unknowable for sure but seems to have varied widely by country:
Worldwide, an estimate of the mortality of the 1918–1919 pandemic is 50 million deaths, with a range of up to 100 million deaths. Taking the 50 million figure, this was about 2.5% of the world population. By contrast, in the United States, mortality was on the order of 0.5%. Clearly, the rest of the world was struck more severely, on average, than the United States.
So, if 2.5% of the world’s entire population died (and that’s using the lower total death figure of 50 million), we can safely say that the death rate in those infected had to have been way higher. This estimate is that about a quarter of the world’s population contracted the 1918 illness, and the death rate in the entire population from it was 2.8%, which by my calculations would give a death rate in the infected of four times that, which would be somewhere (using 2.5% or 2.8%) between 10 or around 11 per cent. That’s very high, much higher than anything that’s been reported for COVID-19 so far. It seems that the 1918 flu had some highly unusual characteristic for flu, which was that it was both very contagious and unusually lethal. It also happened to have killed a disproportionate number of people in the prime of life rather than just the very old or very young, which does not seem to match the COVID-19 pattern so far either.
Most estimates I’ve seen so far about the death rate in COVID-19 are that it’s around 2.5% of people who are infected (not of the general population). However, there are several possible problems with this. One is that doctors may be missing a large number of mild or even asymptomatic cases, which would make the actual death rate much lower than that. Another is that it’s not just the death rate but the pattern of deaths that’s important. Most of the deaths have occured in the elderly and especially the very elderly. And almost all of them (so far) have been in China. Obviously, the death toll will keep rising, and not just in China, but we don’t know at what rate. We also don’t know whether the geographic pattern will continue, or whether reports that infection rates may be going down in China are true or not.
Italy has more cases than other countries in Europe right now. This is especially mysterious. But it may have something to do with this [emphasis mine]:
More than 3,000 tests for coronavirus have been carried out [in Italy] over the last few days, although authorities are still trying to identity “patient zero” – the person who brought the virus to the region. The first man infected, a researcher at Unilever, came down with symptoms after attending a dinner at which there was a colleague who had recently returned from China, who tested negative for the virus.
“The peak in Italy is partly due to all the tests being done,” said Roberta Siliquini, a former president of Italy’s higher health council. “We have found positive cases in people who probably had few or no symptoms and who may have overcome the virus without even knowing it.”
The Italian government has been criticised for hastily cancelling flights to and from China as, without coherence across Europe, people have been able to fly to other European cities and enter Italy from there.
That’s because Europe has open borders, so if some European countries are letting people in from China, this affects every country in Europe and it’s hard if not impossible to trace whether people have had any contact with anyone who recently came back from China.
I’ll add just one more thing, and then close Part I down, because it’s already way long. Despite rumors and even reports of transmission when people are asymptomatic, there’s no hard evidence of it so far. That doesn’t mean it’s not happening.
WRT pneumonia count: I’ve lost two relations to aspirational pneumonia resulting from neurological issues. Parkinson’s was one cause. We may be an outlier.
Question is whether this is in pneumonia count.
There is a useful interview with Hugh Hewitt interviewing Peter Navarro, the Trump trade advisor.
Well, let’s see – no plan, no urgency. We have a plan. We’ve been moving in Trump time, which is to say as quickly as possible, since January 29 when the President courageously pulled down those flights from China. Let me lay the plan out for you, Hugh. And it’s a four-pronged strategy that we have to deal with. The first thing is on the front lines, the personal protective equipment that we need to have for our health professionals, folks in nursing facilities, things like that. What are that? That’s the gloves, that’s the goggles, that’s Tyvek suits. It’s the masks, the N95 masks. The second thing that we need are treatment options. The third is the vaccine development, and the fourth is the point of care diagnostics. Hugh, we’ve been moving very rapidly on all four fronts. Today, for example, on the personal equipment front, HHS is putting out a half a billion dollar proposal to rapidly get manufacturers of face masks in to get that done. If you look at the treatment options, this is what’s interesting, Hugh. If somebody gets Corona, and they’re moderately to severely infected, there’s, first of all, there’s a drug called Remdesivir. It’s made by Gilead. What we’ve done there are a number of things. First of all, we’ve secured the 4,500 doses that they have. In addition, as a cost of almost $200 million, we’re moving to secure the other 90,000 doses they have in involved material. Now the Chinese have been famously uncooperative, so what we’re doing with that drug is going to clinical trials in Japan as well as in Nebraska, where we have some patients. And we’re hoping that within 60 days, we’ll have an idea whether that drug’s efficacious. Secondly, on the treatment front, and this is really interesting, Hugh, there’s a couple of thousand drugs that have been FDA-approved that we’re going to sequentially and rapidly screen to see if they have any efficacy. And the good news about these, this process is they’re already FDA-approved. So if we find something, we can quickly get that to the American people. As a third treatment, there’s something called monoclonal antibodies. Basically what they do when you inject them as a serum, they strengthen the immune system of a patient, and they slow down the rate of proliferation in the body of the virus. There’s a company called Regeneron, and again, we’re working closely with them on the treatment option. If you move to the vaccine development…
The anti-viral drug, a nucleotide analog that fails replication by the virus, is very effective in the one case it was used. The patient was severely ill with pneumonia and recovered in 24 hours after the drug was used. Obviously that is an anecdote but 90,000 doses will be produced and tested.
There is a dearth of reliable information on this disease. Take the deaths in China- there is no way the Chinese even know that a particular respiratory related death is caused by the novel coronavirus without actually doing the RNA screening for the specific virus. I suspect that 90% of the deaths are due pneumonia related to other causes. If 50,000 people die every year in the US from pneumonia, then imagine that it is 200,000/year in China at a minimum, which means that in the absence of COVID, China would have suffered at least 20-30,000 pneumonia related deaths since the first of the year. COVID related deaths are just noise in the overall death causes in China itself at this point.
This headline linked at Instapundit is scary: you can get infected twice?
https://www.foxnews.com/health/coronavirus-infects-woman-in-japan-for-the-second-time-a-first-in-the-country
I would not go as far as to say “We have nothing to fear but fear itself”. Fear being generated by certain groups does not help the very real situation that may occur.
The info about Italy was great, but closing borders may be necessary.
I think that the US should do more on cutting off travelers from certain countries.
A further wrinkle is that over time a really bad disease can evolve to be less lethal and hence more contagious. The end stage is something like the herpes viruses that a huge proportion of the population has but they never have any symptoms.
JimNorCal:
The article doesn’t say whether she is immuno-compromised, which could be a factor. Nor does it say whether she had tested negative in-between the two positives. There’s a lot of missing information there.
Based on what we’ve seen in the past month, COVID19 does not seem likely to cause a pandemic any more significant than annual flu does, but time will tell. It is also unlikely to disappear from the world soon, may even rise and fall over the next, several years.
As neo writes, it takes just the right combination of lethality, transmission rate and dormancy. Ebola is wickedly lethal, but it’s so lethal folks who contract it barely have any time to infect anyone else before they are incapacitated, which minimizes its spread. I’ve always thought our modern world is very susceptible to something that takes more than one week for symptoms to appear, especially if it can survive for long periods in the air, or on surfaces. Modern humans cover a lot of ground in one week, and many of us encounter a lot of other humans in a typical week. In the West we are probably very susceptible to a pet borne illness, something that uses dogs or cats as carriers.
I’ve always been amazed we’ve avoided something akin to the Spanish Flu pandemic for more than 100 years. The speed of modern travel makes such an outbreak more likely, in my mind. But what I’ve seen regarding COVID19 has me rethinking things. Medical care is MUCH better today than it was 100 years ago, at least in 2nd and 1st world nations, and a much greater percentage of humans live in 2nd and 1st world conditions today. Perhaps if a disease identical to the Spanish Flu broke out today our ability to identify sufferers, minimize the affect of symptoms and communicate across the planet instantaneously would make that disease much less deadly? And, the greatest factor may be the overall health of humanity. What percentage of the world at the turn of the 20th century were well fed, well rested, had access to fresh water, could wash their hands or even bathe regularly? Maybe we’ve had diseases equivalent to Spanish Flu break out once or more in the past 100 years, but our living standards mitigated the spread and lethality? Until now I thought that was hubris, but hygiene, access to good medical care and an immune system in good stead are nothing to sneeze at.
I am generally cautious when it comes to germs as a rule. I don’t dip into the Holy Water, shake hands during the Sign of Peace, nor receive the Cup. Here in our office building I use a tissue to touch door handles leading to the public restroom and wipe things down with my own tissues. To clean my hands I use a paper towel to turn the faucet on and off. About 7 months ago I started buying toiletries that are manufactured in the U.S.A., Canada, Europe and Israel, none made with “imported materials”. I decided to do this when a woman here in Southern California ended up in ICU due to face cream manufactured in Mexico (American product). I’m hopeful that this current scare will ignite a response that brings manufacturing of the things we use on our bodies or ingest (especially our medications) back to our own country. I realize some ingredients (I’m presently taking a supplement that requires an ingredient from Africa, but the manufacturer is here and an AAA rated company) are only available in other parts of the world.Yes, this is costing me more and it’s amazing the number of American labels that I had to discard and bypass.
Sharon W.,
I sometimes wonder if some disease threat could alter the Catholic Mass rituals you mention. I have been at Masses where the wine was not offered due to a particularly rough flu season and I’ve also heard Priests remind people to not shake hands during that point of Mass if they do not feel well.
My wife seems to always sit directly behind a teen with a runny nose who loves to shake hands! We keep hand sanitizer in our car and use it immediately after attending church.
Yesterday we were at St. Monica’s in Santa Monica for Ash Wednesday Mass. The priest announced that for at least a few weeks the Cup will not be offered. (Los Angeles Archdiocese-wide). Because I receive the Eucharist in my hand, I don’t want to touch peoples’ hands prior to Communion.
Sharon, Rufus, when I lived in India I attended a few Catholic masses. At the sign of the Peace, people turned towards each other, palms pressed together, and bowed slightly. No touching. I like that so much better.
I’m certain Neo will address this tidbit in Part 2, since she is usually quite thorough.
My wife (who is an NP) was telling me about research that indicates that in the case of the Influenza Pandemic of 1918/1919, the widespread use of aspirin in developed countries, prescribed to people in very, very large doses, may have been a significant factor in the flu’s lethality.
Fascinating stuff.
Just as their hatred for and frenzied opposition to President Trump has caused the members of the Deep State to rise from their former positions of concealment, and to expose to us their words, their actions, and a hidden shadow government that most of us never really conceived or knew of, the rise of the Corona virus has also exposed something of great significance and consequence that few of us were ever aware of.
And that is that, according to reports, the majority of our pharmaceuticals, our antibiotics—and in the case of antibiotics that percentage is reportedly 80%–the chemicals used in medicine, and the medical equipment we use is manufactured in and is imported from China.
(One Senator was just on Carlson’s show saying that we are dependent on China for something like 150 different drugs.)
How could our political, military, and business leaders let us get into such an obviously vulnerable position?
I note one report today that a Chinese ship, filled with face masks, that was headed for the U.S., has turned around, and is headed back to China–guess they needed these face masks more than we do.
Appreciate the thoughtful and realistic commentary. There is far too much sensationalism and speculation and not enough honest evaluation of the facts.
That said, doesn’t hurt to pick up dry and canned foods and water as a precaution.
The out-sourcing of production of essentials to China is a result of the globalism espoused by the Clintonista Democrats and the Wall Street Journal free trade types, usually GOPers.
This has really turned America into a de facto colony of communist China. The trade imbalance is outrageously massive.
We have truly bought from China the economic rope with which to hang ourselves.
Chinese graduate students are in all our universities, sucking up our research knowledge and taking it home. Plus the notorious Chinese intellectual property theft in all realms.
China is our enemy.
Sure, Russia has nukes, but China is the inexorable danger.
“How could our political, military, and business leaders let us get into such an obviously vulnerable position?” – Snow on Pine
Well, obvious candidates are stupidity, ignorance, misplaced ideological optimism,
but mostly graft, corruption, bribery (all disguised as campaign contributions), and outright treason.
A round-up of some interesting, and some slightly off-the-usual-track, reports.
https://www.washingtonexaminer.com/news/whistleblower-federal-workers-sent-to-remove-americans-from-wuhan-without-proper-coronavirus-protection
(administration not quite as up-to-snuff as they are putting out?)
https://www.jpost.com/HEALTH-SCIENCE/Israeli-scientists-In-three-weeks-we-will-have-coronavirus-vaccine-619101
(But will Iran and the BDS fanatics be willing to take something from the Zionist Satan?)
https://dailycaller.com/2020/02/27/spokeswoman-iranian-hostage-takers-corona-virus/
(karma finally on the job maybe — she was at a major council meeting the day before)
https://dailycaller.com/2020/02/27/california-monitoring-8400-cases-coronavirus/
(but, according to the maps, only a few are confirmed — really?)
To have an idea about how lethal is the virus, the best example we have is the Diamond Princess.
There were 650 infected from more than 3000 tested (the full passage is about 4000). Let’s be aware that that means that 650 people had the virus when they were tested. The real number of infected could be higher: in some cases people kill the virus very quickly. That real number only can be known once there’s a serological test for the virus, and the one for the coronavirus was released only a few days ago, by a German company:
https://www.ostsee-zeitung.de/Mecklenburg/Grevesmuehlen/Euroimmun-aus-Luebeck-bringt-Test-zur-Diagnose-von-Coronavirus-heraus
4 people have died in the Diamond Princess. The total number of peole who are o were infected should be somewhere between 650 and 1000. That’d make a 0.5% to 1% death rate.
But that’s not all. The passage in the Diamond Princess were mostly retired people, in their 60s, 70s and even 80s. A 0.5% to 1% death rate in those cases means that the average one for the general population should be lower, somewhere between 0.1% to 0.2%.
Of course, that’s a very quick calculation with a small sample of people. The numbers will be probably wrong… BUT I think they’re valid enough to give us a clue about the order of magnitude. I’d bet the final death rate will be something like 0.X% or lower. This is a serious crisis, but it’s not the Spanish Flu.
And besides that, it seems to be seasonal. You barely has cases in warm places (only exception: Singapore, but most of cases there were linked to meetings in air-conditioned buildings), and the spring is coming.
So keep your immune system ready (sleep well, healthy food, vitamins, exercise, avoid stress), but don’t worry too much.
Interesting development.
https://theconservativetreehouse.com/2020/02/27/president-trump-considering-defense-production-act-to-expand-domestic-production-of-u-s-medical-needs/#comment-7891895
The linked article has more details, which are kind of scary.
If this virus doesn’t kill a gazillion Americans and thereby topple Trump, CNN and Dems will be very unhappy.
So far I agree with Yann’s analysis. Until the COVID data starts to outpace the standard seasonal flu data, I think cautious watch and wait are in order. The panic in the markets and in general is not justified at this point by the numbers.
@AesopFan
(but, according to the maps, only a few are confirmed — really?
California isn’t monitoring 8400 cases, they are monitoring people who might have come in contact with carriers. Folks returning from trips to South Korea, for instance.
Italy has more cases than other countries in Europe right now. This is especially mysterious.
No mystery — Italy has large numbers of resident Chinese. The largest group is in Milan, where many of the cases are.
The markets see what most politicians do not, and the markets have crashed globally this week.
Nationhood is good, globalism bad!
Fractal Rabbit, above, is correct. The salicylate toxicity hypothesis for the high case mortality in the 1918-1919 influenza epidemic has been around for a while and is certainly respectable. Very high doses of aspirin were used to treat flu victims in many places, doses known now to be toxic. The toxicity of high dose salicylates includes pulmonary edema (fluid in the lungs) which was a feature in many of the deaths. There were official recommendations for aspirin therapy by the U.S. Surgeon General and the U.S. Navy in September 1918 and there was a big spike in deaths from flu in the U.S. beginning shortly thereafter. There were a few physicians at the time who suspected that salicylate toxicity was responsible for some or much of the mortality. Patterns of salicylate use may explain why the mortality was especially high in young adults, very unusual for epidemic disease.
On the aspirin (cure is worse than the disease) situation – there might also have been a lethal spiking of Reyes’ Syndrome, especially if “young adults” includes teenagers, as it is now recommended to not be used for anyone under 19.
http://www.reyessyndrome.org/aspirin.html
In case you are worried about claims by the Left that President Trump is singularly unfit to preside over the corona-crisis:
https://libertyunyielding.com/2020/02/28/when-it-comes-to-public-health-crises-the-lefts-memory-is-short/
Soooo – I’m not sure if that’s a mic drop line or a problem.