[Health] The Infectious Diseases Thread

[LawBeefaroni]

Good news, everybody! You can keep the toothbrush moustache!

[msduncan]

So we've all been lectured at this point by Facebook friends who talk about how the flu kills xxxx number of people each year and that nobody is talking about that. Of course they also say this is public media induced panic over the coronavirus. All of these arguments seem logical, however I'm having a bit of difficulty rationalizing a few things in my mind that I hope the OO Hive might have suggestions about:

-- If this is no worse than a flu, why has there been a drastic and overwhelming response to it by the Chinese authorities?
-- Once it started spreading beyond China's borders, why has there been the same sort of response from other nations, such as setting up quarantine centers on military bases here in the US?

Is this because it's deadlier than is being reported? Is it because it's more virulent than is being reported?

I realize that any disease like this could become far more deadly if health systems are overrun. Very quickly our first world health system could more resemble a third world one if a ton of people start coming down with it all at once -- shortages in support drugs, shortages in antivirals, shortages in caregivers, beds and healthcare workers. Is this the reason for the very strong reaction by authorities? Most of the people I know joke about the coronovirus. The general public isn't panicking (yet). All of these actions are being taken by governments, so the whole argument about this being public hysteria doesn't jive for me.

Thoughts?

[Smoove_B]

-- If this is no worse than a flu, why has there been a drastic and overwhelming response to it by the Chinese authorities?

Because they're an authoritarian regime. No other nation on our planet can or would respond to a disease outbreak like China. They're able to do things that simply wouldn't work here. People are already balking at the idea of working from home, cancelling sporting events or concerts and shutting down schools. That's not up for discussion in China.

Once it started spreading beyond China's borders, why has there been the same sort of response from other nations, such as setting up quarantine centers on military bases here in the US? Is this because it's deadlier than is being reported? Is it because it's more virulent than is being reported?

Because this is protocol. What I think is getting lost in the mix is that this is the first time in our history that we've been able to follow a disease emergence from origin to where we are now. Other than annual influenza, we have no other recent point of reference on this scale. Sure, we had H1N1 and SARS, but both of those were partially retrospective - discovering the outbreak long after it started. We've been in on this one since the beginning and so we're now relying on plans and protocols that were put into place in the early 2000s imagining a scenario like what we're experiencing now.

The other thing that keeps getting lost is that we have absolutely no idea the exact number of people that have this variant cornovirus right now. We know ~81,000 have been diagnosed, but that is likely a fraction of the people with it. Calculating a death rate from what we know is useful, but it's only a snapshot of a point in time. Until we can get a better handle on how many people actually have this (which will help to identify how easily it spreads) the best we can do is follow protocols.

The real story (for us in the United States) will be happening in Northern California over the next week. Not only in trying to figure out how the person diagnosed with the virus was exposed, but then also monitoring all the medical staff to see if they come down with the illness as well. I strongly suspect that the patient had contact with someone that traveled but was asymptomatic. I also suspect there are going to be a number of medical staff that are subsequently diagnosed with it as well.

In truth, so much of what's about to happen will come down to (1) what part of the United States you live in and (2) what your local public health system has done to prepare. As mentioned earlier, unfortunately public health practice is not uniform nation-wide and I fear our neighbors in more rural areas are going to be hit the hardest. Not necessarily with the disease itself but the rippling impacts that would result from multiple outbreaks occurring across the United States all at the same time.

[Cortilian]

I am not a DR but the death rate for the flu is something like 0.0143% (14.3 per 100k in 2017). Coronovirus has a death rate of 3%. It is 209 times more deadly than the regular flu. It's a lot worse than the flu.

Edited to find out my statistic of 14.3 per 100k includes pneumonia. I can't find a stat that has flu only.

[Smoove_B]

I am not a DR but the death rate for the flu is something like 0.0143% (14.3 per 100k in 2017). Coronovirus has a death rate of 3%. It is 209 times more deadly than the regular flu. It's a lot worse than the flu.

I feel like I've repeated this half a dozen times. Focusing in on the death rate without understanding how it's calculated is a problem. The reason is that the death rate is a proportion calculated by looking at the people diagnosed with the disease. We have absolutely no idea how many people actually have it; we only know the death rate for those diagnosed. This isn't to say we shouldn't be concerned, but given the nature of this disease it is *highly* likely there are a significant number of people carrying this virus that are asymptomatic or mildly ill. If we could somehow add their numbers to the denominator in the death rate calculation, the overall % would go down.

Right now all signs are pointing to increased risk for elders and those with chronic health conditions. If healthy people in their 20s start dropping dead, I will be the first one to raise the alarms.

[LawBeefaroni]

So we've all been lectured at this point by Facebook friends who talk about how the flu kills xxxx number of people each year and that nobody is talking about that. Of course they also say this is public media induced panic over the coronavirus. All of these arguments seem logical, however I'm having a bit of difficulty rationalizing a few things in my mind that I hope the OO Hive might have suggestions about:

-- If this is no worse than a flu, why has there been a drastic and overwhelming response to it by the Chinese authorities?
-- Once it started spreading beyond China's borders, why has there been the same sort of response from other nations, such as setting up quarantine centers on military bases here in the US?

Is this because it's deadlier than is being reported? Is it because it's more virulent than is being reported?

It is worse than the flu in terms of what we know about the fatalities to infected ratio. The flu Facebook thing is more about how we need to keep some perspective but if the infection rate of Covid-19 reaches that of the flu it will be far worse.

It's like how you might pack bear spray on a camping trip and someone tells you you have a greater chance of being struck by lightning than attacked by a bear.

[msduncan]

Thanks. My daughter has real anxiety about this thing, which I'm trying to calm.

[Combustible Lemur]

I was thinking last night about 2% and worse than the flu 0.1%. What we need are some overly strained metaphors for perspective.

If my high-school was 100% infected.
68 dead.

So yeah, strained. But damn 2% scales real fast to something very ugly.

Excuse me while I go rub elbows with thousands of teenagers in a closed box.

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[LawBeefaroni]

It's probably a side effect of the test. You can test "sero-positive" for a virus but no longer have the illness. Similar to how a vaccine will make the person test sero-positive for the stuff it protects against. We don't know how China tests though.

The test would not cause someone to test positive for the illness after the disease has ended, no. I'm not sure if the question is whether or not it's unusual for this disease or any disease. For this disease? No one knows. For any disease, not common, but not impossible. Just look at how much we learned about Ebola (check Siljanus' signature) and how long the virus circulates after recovery.

Doesn't sound like a side effect of the test.

The woman was discharged from the hospital on Feb. 1 and tested negative for the virus five days later, though she still had a cough that went away a week later.

But on Feb. 21, she returned to the doctor because of a sore throat and chest pain — and tested positive again on Wednesday, according to AFP.

...

“Once you have the infection, it could remain dormant and with minimal symptoms, and then you can get an exacerbation if it finds its way into the lungs,” Professor Philip Tierno of the New York University School of Medicine told Reuters.

He said much remains unknown about COVID-19.

“I’m not certain that this is not bi-phasic, like anthrax,” he said [speculated wildly], meaning the illness might recur after appearing to go away.

[gilraen]

It's probably a side effect of the test. You can test "sero-positive" for a virus but no longer have the illness. Similar to how a vaccine will make the person test sero-positive for the stuff it protects against. We don't know how China tests though.

"Seropositive" test means you have antibodies to a specific virus. It does not mean you have any viral load remaining, since it's not testing for the actual virus.

[Kraken]

In non-COVID news (which seems like a derail), I got my second Shingrix vaccine this morning. Hoping it doesn't kick me in the arm the way the first one did. Besides bad muscle pain, I had a bit of fever, chills, fatigue, and nausea for a couple of days. Anecdotally, the second shot is said to be better-tolerated. So whatever else is going around, I should at least be safe from shingles now.

[Blackhawk]

Good news, everybody! You can keep the toothbrush moustache!

And just last week I started the transition from a Fu Mancu + goatee to a hulihee. Damn.

Spoiler:

Yes, really.

I did spring for a couple of $15 7-gallon water jugs, by the way.

[Max Peck]

Good news, everybody! You can keep the toothbrush moustache!

IIRC, that's by design since that style of moustache came into vogue in WWI because it was compatible with gas masks.

[gilraen]

In more non-COVID news, 'tis the season for mumps outbreaks.

-Keystone ski resort in Colorado

-San Diego State University

-Temple University in Philly - while it's only 3 people so far, they had a major outbreak a year ago, so they get to see if any lessons were learned from that.

[Daehawk]

ugh I dont need that. I only had the mumps on one side back in the 90s. Which means I can still get them on the other I think. I remember the entire time I had them I worried about my balls. I moved so gingerly. Dont want mumps to fall. Also I could not eat anything with any twang to it..no mustard or vinegar or anything. I laughed and said suuuuure and ate some mustard...bout had my head and face implode. That damn well hurt.

[gilraen]

ugh I dont need that. I only had the mumps on one side back in the 90s. Which means I can still get them on the other I think.

No...that's really not how it works.

[Daehawk]

ugh I dont need that. I only had the mumps on one side back in the 90s. Which means I can still get them on the other I think.

No...that's really not how it works.

Ive worried all this time over nothing?

[Kasey Chang]

I don't know either.

Reading on the CDC website says they are using RT-PCR, which basically measures a specific amount of RNA by combining it with DNA and look for specific DNA markers, as a test kit for COVID-19 to be used with a specific type of lab tester. It's not something that's as simple as take-home pregnancy test kit.

And I seem to recall something about the first sets CDC sent to the WHO may be inaccurate, necessitating a recall and redo.

We really have no idea what method Chinese is doing to verify COVID-19.

[$iljanus]

I don't know either.

Reading on the CDC website says they are using RT-PCR, which basically measures a specific amount of RNA by combining it with DNA and look for specific DNA markers, as a test kit for COVID-19 to be used with a specific type of lab tester. It's not something that's as simple as take-home pregnancy test kit.

And I seem to recall something about the first sets CDC sent to the WHO may be inaccurate, necessitating a recall and redo.

We really have no idea what method Chinese is doing to verify COVID-19.

"rRT-PCR". Sorry, from someone who has performed both RT-PCR and rRT-PCR (r=real time) it's a pet peeve of mine. rRT-PCR is quantitative meaning it's used to measure amounts of a gene of interest and I assume that if you have x copy number of whatever marker they're screening for then it's counted as a positive result. I wonder what reagent was unreliable in the initial batch of kits?

Carry on!

[Blackhawk]

ugh I dont need that. I only had the mumps on one side back in the 90s. Which means I can still get them on the other I think.

No...that's really not how it works.

Ive worried all this time over nothing?

There aren't separate viruses for Left Mumps and Right Mumps.

[noxiousdog]

ugh I dont need that. I only had the mumps on one side back in the 90s. Which means I can still get them on the other I think.

No...that's really not how it works.

Ive worried all this time over nothing?

There aren't separate viruses for Left Mumps and Right Mumps.

What about munumanumps?


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[LawBeefaroni]

ugh I dont need that. I only had the mumps on one side back in the 90s. Which means I can still get them on the other I think.

No...that's really not how it works.

Ive worried all this time over nothing?

There aren't separate viruses for Left Mumps and Right Mumps.

Of course there aren't. How silly.

There's just Fore Mumps and Aft Mumps.

[$iljanus]

ugh I dont need that. I only had the mumps on one side back in the 90s. Which means I can still get them on the other I think.

No...that's really not how it works.

Ive worried all this time over nothing?

There aren't separate viruses for Left Mumps and Right Mumps.

Also known as Liberal/Conservative Mumps

[Isgrimnur]

It’s the Whig mumps you have to look out for.

[Blackhawk]

What about munumanumps?

[Ralph-Wiggum]

I wonder what reagent was unreliable in the initial batch of kits?

The dNTPs. It's always the dNTPs.

[$iljanus]

I wonder what reagent was unreliable in the initial batch of kits?

The dNTPs. It's always the dNTPs.

LOL! Always aliquot your dNTPs to avoid multiple freeze-thaws!

[gameoverman]

So we've all been lectured at this point by Facebook friends who talk about how the flu kills xxxx number of people each year and that nobody is talking about that...

Thoughts?

My opinion is that it's not wise to underestimate the power of an angry public. In the case of China's response, the leaders there don't want the people to have any kind of rallying point for protest. Protests like that might lead to a change in leadership. So they are willing to do whatever it takes to shut this epidemic down and quiet the people. Also, don't assume health and medical treatment are the same everywhere. Chinese leaders know what kind of conditions they have in that country, so it might be that they are doing what is needed in that country to stop this virus. That doesn't mean the same actions will be required everywhere else. It's not a case of 'if China is doing it then we should'...unless conditions in the two countries are very similar.

If I was a leader I would do everything I could to stop the spread. I would not want to go down in history as the leader who did nothing and hundreds or thousands of their people died. Even if the experts tell you it's just a fancy flu, what's the upside to looking like you can't be bothered to do anything? Consider the political impact. What if I as leader do nothing and this just happens to be the ONE time this new kind of virus does some real damage. Now the people hate me, and by extension my political party. I won't be re-elected and the opposing party sweeps the next elections. On the other hand, if you do your best to limit the spread and it turns out the virus was no big deal, the people will still be impressed by your decisive action. And if the people are mad about actions like quarantines, it's a piece of cake to redirect that anger towards China.

[Holman]

I definitely picked the wrong week to try rereading The Stand.

[Blackhawk]

So, I just had a 'family meeting' with Michelle and the kids.

I wanted to discuss the virus, what it meant, and what to expect if things got bad (closings, etc.) I filled them in on the preparations I had made (the ability to skip a shopping trip, for instance.) I let them know why closings and cancellations might be necessary, even if they weren't at much risk. I also told them that it was most likely that none of that would happen, that this was just being prepared, not being afraid (I compared it to the possibility of getting a flat tire. You don't stop driving because you might have one, you just make sure you have a spare and a jack.)

I also discussed with them what it would be like if they got it (somewhere between a light cold and the flu, but likely not all that much of a risk to any of us.) Sure enough, they'd heard otherwise and were scared. The word going around the schools is that the virus is going to be widespread, and that it is guaranteed death. And this is a high school.

Moral of the story: Talk to your kids. If my kids are hearing that the world is about to end, yours probably are, too.

[Holman]

So, I just had a 'family meeting' with Michelle and the kids.

I wanted to discuss the virus, what it meant, and what to expect if things got bad (closings, etc.) I filled them in on the preparations I had made (the ability to skip a shopping trip, for instance.) I let them know why closings and cancellations might be necessary, even if they weren't at much risk. I also told them that it was most likely that none of that would happen, that this was just being prepared, not being afraid (I compared it to the possibility of getting a flat tire. You don't stop driving because you might have one, you just make sure you have a spare and a jack.)

I also discussed with them what it would be like if they got it (somewhere between a light cold and the flu, but likely not all that much of a risk to any of us.) Sure enough, they'd heard otherwise and were scared. The word going around the schools is that the virus is going to be widespread, and that it is guaranteed death. And this is a high school.

Moral of the story: Talk to your kids. If my kids are hearing that the world is about to end, yours probably are, too.

+1

My household is a little different, as we live with my in-laws. MIL is 80, and FIL is 90 with an already compromised immune system (plus dementia, which makes self-protection difficult for him).

I'm trying to figure out what this means for us.

If cases appear in Philadelphia, we might need to keep the kids home from school even before the school district takes any action.

[hitbyambulance]

but it'll go away when it gets warmer out.

[Smoove_B]

The word going around the schools is that the virus is going to be widespread, and that it is guaranteed death. And this is a high school.Moral of the story: Talk to your kids. If my kids are hearing that the world is about to end, yours probably are, too.

Good on you, being all parental and smart.

I'm trying to figure out what this means for us

I'd get in touch with the school ASAP and at least ask about their contingency plans. Make sure you explain the status of your in-laws (age, health) as the driving concern and that you're really interested in remote education options (if applicable). Generally the recommendation for your in-laws would likely be to engage in social distancing (i.e. hiding indoors), but with people coming in and out and their need for care that's really not viable. I'd also likely check in with their healthcare providers to see if they have any specific guidance.

[Daehawk]

All Ive learned today is the workers who came into contact with the quarantined folk were not trained and had no protective gear so it will be like The Stand and infect us all and that the DOW dropped 1200 points and they all clapped at the closing bell. Never understood the clapping on a bad day. Yay we lost billions..good job us.

[Kurth]

Anecdotally, I hit Costco today to stock up the basement freezer (and the wine rack). This was at 1:30 in the afternoon, and the place was mobbed. One of the checkers commented that their average receipt today was over $200. They said that is really, really high.

Also, I'm starting to get the sneaking sense that the Disney cruise we have planned for March 20 (San Diego to Cabo San Lucas) may not happen. Bummer.

[msduncan]

So..... the Pope might have it.

[Smoove_B]

It's like a scene from a movie, via the AP:

There was no word from the Vatican about the nature of his illness, but the pope was seen coughing and blowing his nose during the Ash Wednesday Mass.

...

Francis has had a busy schedule lately, including his public general audience on Wednesday and the Ash Wednesday service later in the day in a Roman basilica.

During the audience, Francis made a point to shake hands with the faithful in the front row, kissed a baby during his popemobile spin through St. Peter’s Square and greeted visiting bishops at the end. The prelates, however, appeared to be refraining from kissing his ring or embracing him, as they normally would do.

[Holman]

It's like a scene from a movie, via the AP:

There was no word from the Vatican about the nature of his illness, but the pope was seen coughing and blowing his nose during the Ash Wednesday Mass.

...

Francis has had a busy schedule lately, including his public general audience on Wednesday and the Ash Wednesday service later in the day in a Roman basilica.

During the audience, Francis made a point to shake hands with the faithful in the front row, kissed a baby during his popemobile spin through St. Peter’s Square and greeted visiting bishops at the end. The prelates, however, appeared to be refraining from kissing his ring or embracing him, as they normally would do.

This kind of heavy-handed irony seems totally appropriate to the current era.

Did he sneeze in the communion wine? That's all that's missing.

[gameoverman]

They need to add a decontamination module to the Popemobile. Every time he goes in or out he gets a quick spray. He's mingling with so many people there are probably a dozen different types of bugs on him at any given moment. Coronavirus will have to fight its way onto him, like troops storming a beach.

[Jeff V]

They need to add a decontamination module to the Popemobile. Every time he goes in or out he gets a quick spray. He's mingling with so many people there are probably a dozen different types of bugs on him at any given moment. Coronavirus will have to fight its way onto him, like troops storming a beach.

Pfft. If the pope can't count on divine protection, his god might as well not exist.