The New Neo

I’ve written several posts already, trying to offer the main facts so far as they emerge. But I see so much stuff out there that’s not only obvious fear-mongering, but just plain incorrect.

It’s true that we don’t yet know exactly how this illness works and can come to no firm conclusions. That always takes a while with something that appears novel. But so far there’s been absolutely no indication that this is going to be an illness that’s hugely different and hugely worse than so many that have come down the pike in recent decades. However, you wouldn’t know that from most of the MSM coverage.

If you’re interested in voices that seem more fact-based, you should take a look at this from the New England Journal of Medicine. An excerpt (emphasis mine):

On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively…

A robust research effort is currently under way to develop a vaccine against Covid-19.10 We anticipate that the first candidates will enter phase 1 trials by early spring. Therapy currently consists of supportive care while a variety of investigational approaches are being explored.11 Among these are the antiviral medication lopinavir–ritonavir, interferon-1?, the RNA polymerase inhibitor remdesivir, chloroquine, and a variety of traditional Chinese medicine products.11 Once available, intravenous hyperimmune globulin from recovered persons and monoclonal antibodies may be attractive candidates to study in early intervention. Critical to moving the field forward, even in the context of an outbreak, is ensuring that investigational products are evaluated in scientifically and ethically sound studies.

But that tone is much too sober to serve the twin MSM/left purposes of attracting viewers and hurting Trump economically. However, at least for the moment, something seems to be calming the stock market.

Maybe it’s even the fact that Biden won South Carolina and might have a whisper of a chance of stopping the Bernie runaway locomotive – although I’m not sure why the election of a somewhat-addled mediocrity such as Biden would be soothing. Perhaps the thought is that he will continue business-as-usual and be quite malleable.

The message to take from COVID-19 is that we are too dependent on China. Trump has long been aware of that, although not necessarily because of novel viruses. But let’s just add that to the mix, because novel viruses emerge from China with some regularity. COVID-19 may be the most recent, but it won’t be the last.

For those on this blog of a certain age, you can reminisce (like me) about the Asian flu of 1957 or the Hong Kong flu of 1968:

Asian flu of 1957, also called Asian flu pandemic of 1957, outbreak of influenza that was first identified in February 1957 in East Asia and that subsequently spread to countries worldwide. The 1957 Asian flu was the second major influenza pandemic to occur in the 20th century; it followed the influenza pandemic of 1918–19 (also known as Spanish flu) and preceded the Hong Kong flu pandemic of 1968. The Asian flu outbreak caused an estimated one million to two million deaths worldwide and is generally considered to have been the least severe of the three influenza pandemics of the 20th century.

The 1957 outbreak was caused by a virus known as influenza A subtype H2N2, or Asian flu virus. Research has indicated that this virus was a reassortant (mixed species) strain, originating from strains of avian influenza and human influenza viruses. In the 1960s the human H2N2 strain underwent a series of minor genetic modifications, a process known as antigenic drift. These slight modifications produced periodic epidemics. After 10 years of evolution, the Asian flu virus disappeared, having been replaced through antigenic shift by a new influenza A subtype, H3N2, which gave rise to the Hong Kong flu pandemic.

In the first months of the 1957 Asian flu pandemic, the virus spread throughout China and surrounding regions. By midsummer it had reached the United States, where it appears to have initially infected relatively few people. Several months later, however, numerous cases of infection were reported, especially in young children, the elderly, and pregnant women. This upsurge in cases was the result of a second pandemic wave of illness that struck the Northern Hemisphere in November 1957. At that time the pandemic was also already widespread in the United Kingdom. By December a total of some 3,550 deaths had been reported in England and Wales. The second wave was particularly devastating, and by March 1958 an estimated 69,800 deaths had occurred in the United States.

There certainly was newspaper coverage then, and news filtered down to children – including me. But somehow the country didn’t self-destruct.

[NOTE: Part I can be found here.]

While musing about COVID-19, I wondered whether the virus really is novel. Perhaps it’s been around for a while and just wasn’t causing all that many deaths and therefore wasn’t even noticed until the spike occurred in China. Now that the virus has been recognized and is being tested for, perhaps we’re finding it all over the place (in small quantities so far) because it’s long been all over place and not caused all that much damage.

This seemed an odd thought. But it turns out it’s not so odd after all:

…”[H]as this virus ever entered the population undetected and been spreading?” asks Andrew Pekosz, a biologist at the Johns Hopkins Bloomberg School of Public Health. If in previous instances it induced only mild disease, “it may not have registered a large enough number of cases to get on the public health radar screen.”

Ebola and HIV both turned out to have existed for many years before scientists recognized the diseases those viruses cause. Scientists discovered that by running antibody tests on blood that had been stored long ago.

An antibody test is sorely needed, in order to tease out an answer to that question. It would also help us to learn whether there are a great many mild or even symptomless cases that have gone unrecognized, which would change our perception of the lethality of the virus.

There are two main issues with COVID-19, and we don’t know all that much about either yet: contagiousness and lethality. But the situation of the Diamond Princess cruise passengers offers an opportunity to learn about both under a sort of worst case scenario, which is confinement of healthy with ill passengers in a closed system, and an especially susceptible population because of a high percentage of people of advanced age. So let’s take a look.

The first thing you’ll notice is that the headline blares that the ship started with 10 passengers testing positive for the virus and ended with 700 testing positive within the two weeks of the quarantine. That’s quite a leap. The total number of people on the ship was 3,711. So the final number testing positive represented about 19% of the whole, or a little less than a fifth. Of that number – in the month since the first person from the ship was diagnosed – 6 have died, which is .16% of the whole, and .86% of those who tested positive. Both figures are under 1%. That only represents a months’ time, of course, two weeks of which involved quarantine on the ship. But it’s a fairly low figure, especially considering the advanced ages of so many of the passengers. Time will tell whether there will be any more deaths of people who were on that ship.

A large part of the linked article is about the terrible conditions of confinement and fear on the cruise, and how certain things probably fostered the spread of the disease. It’s missing a clear timeline of when people were tested and whether some of the rise in cases over time represented the fact that only certain people were tested at first (perhaps only the symptomatic?). It’s really unclear from the article, and perhaps the health officials on the ship were the ones who were unclear in communicating exactly how the testing went.

This part is especially interesting:

More than half of the infected people (322) showed no symptoms at all, which suggests that some coronavirus carriers in China could be going undetected.

That’s a fact that indicates less mortality – and even less morbidity – than has commonly been reported.

This article also describes the people who died. The first two were 87 and 84, both with underlying pre–existing health issues. The next two were also people in their 80s, and it’s unclear what their previous health status had been. The fifth person was in her 70s, and the sixth was of as-yet unreported age. This is further indication that advanced age is a big factor, just as it is in pneumonia deaths and deaths from most varieties of flu (although not the 1918 flu, where the majority of deaths were of younger adults ).

One question as yet unanswered is, if you eliminate the asymptomatic passengers, what percentage of the others testing positive had only mild symptoms. But we don’t know; at least I haven’t seen this reported, even though it would be important information. This article, based not on the ship data but on Chinese health officials’ reports, says that 80.9% of cases in China have been mild. However, that probably misses almost all the cases that are asymptomatic, and so it doesn’t tell us much about that phenomenon. Of the 19% of confirmed cases in China that have been considered serious, 2.3% were critical, and all the deaths were in that group.

This is how the death rates for COVID-19 so far (mostly in China) compare to previous novel illnesses that have gotten a lot of publicity:

Overall, however, the COVID-19 fatality rate is far lower than that of past coronavirus epidemics. Based on the ratio of deaths to confirmed cases so far, it appears to be about 2%. Severe acute respiratory syndrome (SARS), by contrast, killed 9.6% of those infected, and Middle East respiratory syndrome (MERS) killed 34.4% of cases.

But on the other hand, those illnesses were seemingly less contagious and therefore more easily contained

The following is encouraging, and it makes sense to me:

Fauci and other experts, however, think the existing fatality rate will drop as more mild cases are counted.

And this article points out something that might be obvious but that’s still important to note: novel threats, even if they’re less dangerous than pre-existing threats, can cause more fear. People are used to the familiar.

As I mentioned in Part I, COVID-19 has been hyped by the press and the Democrats, the better to get clicks and/or sell papers, and to criticize and blame Trump. But there’s another factor, which is the increase in our economic dependence on products and shipments from China. That’s real, and any disruption in the supply chain from China could be very problematic. Ironically for the left, another thing Trump’s been doing for quite a while is trying to lessen our trade connection to China. But don’t sit on a hot stove waiting for the left to praise him for it.