[Health] The Infectious Diseases Thread

[Smoove_B]

Insert Samuel L Jackson joke here:

Snakes -- the Chinese krait and the Chinese cobra -- may be the original source of the newly discovered coronavirus that has triggered an outbreak of a deadly infectious respiratory illness in China this winter.

That's...interesting.

[$iljanus]

Insert Samuel L Jackson joke here:

Snakes -- the Chinese krait and the Chinese cobra -- may be the original source of the newly discovered coronavirus that has triggered an outbreak of a deadly infectious respiratory illness in China this winter.

That's...interesting.

Heh, I would never have thought that a reptile would be a possible source. I'd be curious to see the genetic data as this awakens my curiosity as a former scientist. Off to the internet!

From a cursory search it seems that reptiles host a wide variety of viruses. I guess with a few shifts in the DNA and a couple of base pair changes all sorts of mischief can arise.

I guess China needs to hold a Wacking Day!

[gilraen]

Calling it a "respiratory infection" is actually an important distinction here. Snakes can catch all kinds of viruses, are very prone to pheumonia...but they cannot catch or transmit influenza viruses.

[$iljanus]

So there is a theory that the coronavirus which can originate in bats, the source of all sorts of viruses that can kill us off, were fed on by snakes which then became the new host. The tricky question is how the virus adapted to their new cold blooded host if this is the case.

Other than the potential of causing deaths, viruses are fascinating to ponder.

[Smoove_B]

Snakes can catch all kinds of viruses, are very prone to pheumonia...but they cannot catch or transmit influenza viruses.

It is insanely interesting (to me) and also quite frightening. When I had "boots on the ground" during the 1999 West Nile Virus emergence on the East Coast, we were initially focusing in on the birds (crows mainly) that were dying. But as we started to learn more and additional sampling was conducted, they found WNV in hundreds of animal species - including snakes and alligators. They weren't transmitting the virus to people, but the idea that there was a virus being spread by mosquitoes that could somehow survive in so many different animal species and still manage to cause harm to humans was crazy.

It really could also be something like I said earlier - snake viscera that's being hosed down drains or into gutters every day and that process is atomizing blood and viral particles that random people are breathing in.

Also, this is how the world ends for us, I'm convinced. Random viral genomic combination that delivers a knockout punch. We'd been watching birds and pigs, but maybe it was the snakes we should have been concerned about the most. I wonder if there are any global mythologies about how evil snakes are? I should look into that.

EDIT: Let me just check my email...

**Information in this document is not for public dissemination or public posting**

Well...ok. I'll update what I can when I can. It is not time for our viewers to crack each other’s heads open and feast on the goo inside. There's nothing really new in the document (that I can see), I guess they just don't want us sharing it.

[Smoove_B]

Not great news:

Of all the alarming aspects of the rapidly spreading new virus out Wuhan, China, this is perhaps the most alarming: A single patient has infected 14 health care workers. That's what's called a "super spreader," and disease detectives are hot on that patient's trail. It's one element to stopping the spread of this coronavirus that's killed 17 people and infected more than 500 in five different countries, including the United States.

Look, I'm not saying China is lying about the number of cases and deaths, but I'm beginning to think this is much, much bigger than they're letting on.

Of note:

The presence of a super spreader in Wuhan indicates that the virus can spread with some ease, said Michael Osterholm, an epidemiologist and professor at the University of Minnesota School of Public Health.

He calls them "super shedders," since they shed the virus -- for example, in sneezes or coughs -- in larger quantities than most other people.
"You only need one super shedder to say, 'This dog is going to hunt,' " he said. "It really does speak to the potential for this virus to be transmitted."

He added that there are probably more super spreaders -- or shedders -- of the Wuhan coronavirus than this one patient.
"If we have one super shedder, that tells us we're going to have more super shedders," he said. "If there's one, there will be more."

[Hrothgar]

I can't tell if this article is just click bait or trying to accuse China of something without accusing them.

China built a lab to study SARS and Ebola in Wuhan - and US biosafety experts warned in 2017 that a virus could 'escape' the facility that's become key in fighting the outbreak

[Dogstar]

Totally normal to lock down 35 million people for 800 cases with a low mortality rate, right?

As someone who used to study emergency management, my mind boggles at the effort and cost that has to go into securing a population total more than double the size of New York, Chicago, and Los Angeles combined.

https://www.nytimes.com/2020/01/24/worl ... virus.html

[Smoove_B]

I can't tell if this article is just click bait or trying to accuse China of something without accusing them.[/url]

It does seem like they're trying to imply something, yes. However, I've seen nothing official suggesting anything they are implying. Is it possible? I guess. But so far (based on the information shared) all signs still seem to point to the so called "wet market" as the origin.

Totally normal to lock down 35 million people for 800 cases with a low mortality rate, right?

Normal in the sense that on paper, it's what should happen. In practice, it's never been attempted on a scale that's being reported. I suspect we're going t learn this started much earlier than the day(s) it hit international media and/or this new virus has a much longer incubation period and/or window of time where people are shedding the virus but perhaps not visibly ill. The first one is a logistical issue and represents bad public health. The second one is much more problematic for the overall etiology of the illness and what it will mean for global distribution.

Of the case data I've seen so far, the age ranges for deaths go from 10-81, though the overwhelming majority seem to be people 55+ and allegedly with existing health conditions. This follows what you'd expect for the emergence of a completely new virus - elders are the weakest and their immune systems (despite having 50+ years of data stored) have never seen this virus before.

Still not time to panic. I'd be amazed if we don't identify more suspected and possibly actual cases in the U.S. over the next 3 days.

[LawBeefaroni]

Totally normal to lock down 35 million people for 800 cases with a low mortality rate, right?

Normal in the sense that on paper, it's what should happen. In practice, it's never been attempted on a scale that's being reported.

It's cooled down Hong Kong though. Seems like that might be enough motivation to finally enact paper standards.

[Roman]

/Terrible humor alert/

Patient Zero caught on video

[Dogstar]

Normal in the sense that on paper, it's what should happen. In practice, it's never been attempted on a scale that's being reported. I suspect we're going t learn this started much earlier than the day(s) it hit international media and/or this new virus has a much longer incubation period and/or window of time where people are shedding the virus but perhaps not visibly ill. The first one is a logistical issue and represents bad public health. The second one is much more problematic for the overall etiology of the illness and what it will mean for global distribution.

I get that on paper, it's what should happen. But the expenditure of resources -- time, people, equipment and money -- would make it cost-prohibitive to do unless you're really concerned, or just have an infinite supply of resources to burn. Or do you think China just approaches cost-benefit analysis differently than we do when it comes to infection control?

As to incubation, one source (I'll try to run it down as I've been reading a fair bit) had an epidemiologist opining about a 14-day incubation period.

[Smoove_B]

I get that on paper, it's what should happen. But the expenditure of resources -- time, people, equipment and money -- would make it cost-prohibitive to do unless you're really concerned, or just have an infinite supply of resources to burn. Or do you think China just approaches cost-benefit analysis differently than we do when it comes to infection control?

All unknown. Assuming we're collectively given access to the data, these are the kinds of things we can calculate after it's over. How much did it all cost, is there evidence it had a measurable impact in slowing down or stopping transmission? I can tell you NJ has similar plans - again on paper - to deal with a pandemic influenza outbreak. In theory forced quarantine could be called, but that would be long after the state would ask for voluntary self-quarantine along with closing public gathering spaces, schools and asking private business to consider the same. I am not capable of performing any type of critical analysis on China's ability to respond to this; that's not my wheelhouse (international outbreak control). Given what they've done for other outbreaks (destruction of 1+ million pigs, hundreds of thousands of chickens, etc...) they certainly do not mess around.

As to incubation, one source (I'll try to run it down as I've been reading a fair bit) had an epidemiologist opining about a 14-day incubation period.

Yes, I've seen similar things. For reference, SARS has an incubation period of 2-7 days. If this is potentially double, that is going to dramatically increase the risk of spreading like wildfire. Evidence (randomly showing up far outside Wuhan) certainly suggests the longer incubation period.

[Kurth]

I haven’t been paying close attention to this corona virus outbreak, but now I may have to. I’m supposed to attend a trade show in Vegas the first week of February. Specifically, it’s a fashion/footwear sourcing show where most (or all) of the vendors are from China. How concerned should I be? Should I consider skipping it?

As a possibly relevant aside, I just started some medication which has a side effect that it’s supposed to make it more difficult to fight off infections.

[LawBeefaroni]

I get that on paper, it's what should happen. But the expenditure of resources -- time, people, equipment and money -- would make it cost-prohibitive to do unless you're really concerned, or just have an infinite supply of resources to burn. Or do you think China just approaches cost-benefit analysis differently than we do when it comes to infection control?

All unknown.

Like I mentioned, don't underestimate Hong Kong. They had thousands protesting in the street a few days ago and from what I understand there are very few out today. There were lots of New Year protests planned. I'm sure that wasn't overlooked when doing the cost-benefit-risk analysis.

[Kraken]

I can't tell if this article is just click bait or trying to accuse China of something without accusing them.

China built a lab to study SARS and Ebola in Wuhan - and US biosafety experts warned in 2017 that a virus could 'escape' the facility that's become key in fighting the outbreak

The Daily Mail is not a reputable news source, to put it politely.

[Smoove_B]

I haven’t been paying close attention to this corona virus outbreak, but now I may have to. I’m supposed to attend a trade show in Vegas the first week of February. Specifically, it’s a fashion/footwear sourcing show where most (or all) of the vendors are from China. How concerned should I be? Should I consider skipping it?

As a possibly relevant aside, I just started some medication which has a side effect that it’s supposed to make it more difficult to fight off infections.

Still too early to say, though it sounds like an aggressive response. Any type of air travel and contact with crowds is going to put you at increased risk of infection. I'd check with your doctor over that alone (not risk for this outbreak specifically) - the idea that you'd be on this new med and engaging in an increased risk scenario.

[Smoove_B]

Like I mentioned, don't underestimate Hong Kong. They had thousands protesting in the street a few days ago and from what I understand there are very few out today. There were lots of New Year protests planned. I'm sure that wasn't overlooked when doing the cost-benefit-risk analysis.

You're watching Hong Kong, I'm watching your neighborhood.

EDIT: CDC currently monitoring 63 other potential cases in 22 states.

[Isgrimnur]

Do we know about the semen yet?

[Isgrimnur]

Pig Progress: Porcine Respiratory Coronavirus (PRCv)

It does not appear to cross the placenta but has been found in the semen for up to 6 days post infection in boars.

[Smoove_B]

Do we know about the semen yet?

I would not be worried about semen at this time, but I will continue to monitor the situation.

[LawBeefaroni]

Like I mentioned, don't underestimate Hong Kong. They had thousands protesting in the street a few days ago and from what I understand there are very few out today. There were lots of New Year protests planned. I'm sure that wasn't overlooked when doing the cost-benefit-risk analysis.

You're watching Hong Kong, I'm watching your neighborhood.

EDIT: CDC currently monitoring 63 other potential cases in 22 states.

Yeah we got a brief from the CDC at work. The timeline is a bit disturbing (to me, a non-clinician, at least).

All I can say is that I'm glad it's Friday, and that I have a full larder at home.

[Smoove_B]

A professional I have tremendous respect for in the public health arena (global health in particular) has observed that China is using the SARS protocol for screening people and that protocol relies on the presence of fever (SARS is close to 100% of infected presenting with fever). However, the data she's seen so far suggests only about ~40% of the people infected with this new virus have a fever meaning a significant number of people with the virus could be slipping through screening.

[Isgrimnur]

Which raises the question of what, if any, reliable screening method exists.

[Paingod]

The spread is impressive. Y'all had discussed the Chinese response being good on paper, and I'd agree. NPR said something this morning about 800+ cases with 30+ fatalities - and additional cities in lockdown. Reports say 8 cities are now locked down, but I wouldn't be surprised if there were more soon. That's a huge kick in the economy, but better than losing 3% of their population if the illness were to rage out of control.

Never been happier to do the majority of my work through a computer and have minimal interaction with real people. I'm not in any kind of panic state, but I like my diminished risk.

I had heard some story about a woman who escaped quarantine by faking being healthy - taking whatever she could to bring her fever under control and passing security - and then flying to France, where she bragged about it. Can you imagine having been trapped in a plane with her, and then thinking about everyone you may have come into contact with.

I feel like Madagascar should get busy with closing its port.

[LawBeefaroni]

Which raises the question of what, if any, reliable screening method exists.

Well, we are working on a travel ban for Nigerians and pregnant women so it's all good.

[Isgrimnur]

Which raises the question of what, if any, reliable screening method exists.

Well, we are working on a travel ban for Nigerians and pregnant women so it's all good.

Don't forget Sudan, Tanzania, Eritrea, Belarus, Myanmar and Kyrgyzstan.

[Smoove_B]

Yup. At this point it's going to be a manpower issue. They need investigators (like what I used to do) out in the field conducting shoe-leather epidemiology. Transportation hubs also need skilled investigators to ask questions and red-flag people based on known localities of concern and high-risk communities. Waving laser thermometers at people might look good but if ~60% of the infected people aren't febrile, it's pointless. I mean, they can start grabbing people that are coughing and have a runny nose, but I'm guessing they're going to be overwhelmed in a holding area.

[MHS]

I'm feeling not so great about the 25+ planes and however many dozens of hotels I'll be on in the next 4 months, with my immunosuppressed self. Aside from the things I already do (wipe down every surface of my plane seat with clorox wipes, do the obvious hotel hot spots like door handles, remotes, light swtiches, etc., and wear protective masks in crowds at the airports/on the plane/on shuttles), is there anything else I should be doing? The whole Meal/MHS family isn't happy about this one. Meal has the lungs of a 90 year old, so one bad respiratory infection could kill him, and our daughter and I are both immunosuppressed (her because of lupus, me because of my kidney transplant.) I'm not one to be nervous easily, but I'm a bit nervous.

[Paingod]

I'm guessing they're going to be overwhelmed in a holding area.

See also: clumping people with the common cold or another simpler illness along side those who have the coronavirus. How well does it work if you're in the midst of one illness when another starts breaking down the walls?

[Smoove_B]

Ugh, the individual in question is now apologizing saying she misread the data. Not sure if it's a translation issue or not, but she's saying fever might be reliable; it's not nearly as bad as the originally interpreted. I think she's a bit rattled, which is understandable.

[LawBeefaroni]

I'm feeling not so great about the 25+ planes and however many dozens of hotels I'll be on in the next 4 months, with my immunosuppressed self. Aside from the things I already do (wipe down every surface of my plane seat with clorox wipes, do the obvious hotel hot spots like door handles, remotes, light swtiches, etc., and wear protective masks in crowds at the airports/on the plane/on shuttles), is there anything else I should be doing? The whole Meal/MHS family isn't happy about this one. Meal has the lungs of a 90 year old, so one bad respiratory infection could kill him, and our daughter and I are both immunosuppressed (her because of lupus, me because of my kidney transplant.) I'm not one to be nervous easily, but I'm a bit nervous.

I can't give you any practical advice but stylistically, black masks are the coolest. I wish I knew about them the last time I stocked up.

[Smoove_B]

I'm not one to be nervous easily, but I'm a bit nervous.

Hand hygiene is paramount. Having those masks is also helpful, just make sure you're changing them "as often as necessary". There's no magic number, but they're notoriously worn for far too long by the general public. They're really good at protecting people from splatter. But when you wear them all the time the moisture from your exhaled breath compromises the fabric and can allow viral particles through.

Honestly, being hyper-aware of your hands and what you're touching is arguably the most important thing. Sanitizing wipes and hand sanitizers are good but personally I'd be a little hesitant on over using them because of the microbial disruption they cause (i.e. killing off the good microbes as well as the bad). Handwashing is always ideal but I can appreciate the idea of going into an airport bathroom to disinfect your hands as being counter-intuitive.

I wouldn't be more nervous about this. I would just continue to maintain vigilance and awareness. Hand hygiene!

[MHS]

I can't give you any practical advice but stylistically, black masks are the coolest. I wish I knew about them the last time I stocked up.

Those look better than what I currently use (although mine are cuter, they have flowers and stars). Thanks for the recommendation!

I wouldn't be more nervous about this. I would just continue to maintain vigilance and awareness. Hand hygiene!

Thanks for the reassurance. We'll be hand hygiene zealots!

[Smoove_B]

These meme speaks to my soul.

[Isgrimnur]

[sic]-k

[LawBeefaroni]

[sic]-k

Los Angeles plague? How about the Spanish freaking flu?

[stessier]

Is there a decade where you couldn't make a list like that?

[Blackhawk]

The Trump impeachment thread, the global warming thread, this thread.

I'm starting to feel bad for mocking the preppers.

[LawBeefaroni]

The doomsday clock just moved to 100 seconds to midnight. Closest it's ever been to EOtW IIRC.