[Health] The Infectious Diseases Thread

[Daehawk]

2009 air traffic was 2.5 billion
2019 air traffic was 4.9 billion

200 years ago this would have probably been just China and only a small area. 1000 years ago it definitely would have been just China. Or any origin place.

[gilraen]

2009 air traffic was 2.5 billion
2019 air traffic was 4.9 billion

200 years ago this would have probably been just China and only a small area. 1000 years ago it definitely would have been just China. Or any origin place.

In the mid-14th century, the Black Plague started in China. It spread through all of Europe, Asia and North Africa and killed 25 million people.

[Smoove_B]

Second Washington state patient has died; first case in NY State (Manhattan) has been confirmed:

New York Gov. Andrew M. Cuomo (D) confirmed the state’s first case of coronavirus Sunday night, announcing that a woman in her late 30s contracted the virus after traveling to Iran.

Late 30s is...odd. I guess we'll find out more about how she was identified and what her symptoms are. The man that died in Washington state was in his 50s and with underlying health conditions.

[Smoove_B]

I'm pretty sure it will be coming here.

Based on what I'm learning in the last 24 hours, I'll be amazed if it's not already there.

Hey, look at that -- Helllloooo Tallahassee, come on down - you're next:

Two people in Florida have tested positive for the coronavirus, Gov. Ron DeSantis announced Sunday night, the first two cases of the virus in the state.

The two patients are from Hillsborough and Manatee counties, according to the governor, who directed Surgeon General Scott Rivkees. to declare a public health emergency.

[Daehawk]

Man if it spreads through those older folks in FL ..ugh. Lotta open real estate to be sold. Scary for them.

[Anonymous Bosch]

If bodies begin dropping on the streets as a result of their inherently unhealthy and deplorable living conditions, it's liable to get ugly in a serious hurry. What say you, Smoove? What would the appropriate response be?

It's an interesting observation and thought. I can't say I've seen anything specific related to the issue though in planning/tabletops or otherwise formally discussed. That could be because 90% of my experience is in suburban/rural environments, not major metro areas.

At a most basic level, I'm guessing it'll be something that will serve to overwhelm first responders (police/fire/EMT) that are going to need to show up and then get these individuals into treatment centers. My guess is that if there are random people dropping on the streets we're at the point where medical tents and temporary facilities have been set up.

Like everything else now, it's going to be a matter of scale. One homeless person dropping? The system can handle that. A dozen? Problems.

More realistically, next up will be the worried-well that start overwhelming local physicians and then the ER.

In related news...

Could the coronavirus hit California’s homeless population? Health officials are worried:

SACRAMENTO — When a Solano County woman came down with a suspected viral infection and needed treatment, doctors chose to take her to one of the busiest hospitals in Sacramento, not realizing she would become the first person in the nation to be diagnosed with the novel coronavirus without a known cause.

The hospital, UC Davis Medical Center, has an emergency room that’s often filled with homeless patients, their immune systems battered from living in encampments along the capital city’s riverbanks and sidewalks.

The potential for an outbreak among that unsheltered population — both in Sacramento and across California — is beginning to concern some public health officials as the coronavirus spreads.

On Thursday, a student at UC Davis’ main campus, about 30 miles from the hospital, was isolated after exhibiting mild symptoms of the virus. On Friday, a second case of unknown origin was diagnosed in Santa Clara County. And on Saturday, a man died of the coronavirus in Washington state, the first fatality in the U.S.

“I was thinking about it when I was in the … shower [on Thursday] morning, literally,” said Peter Beilenson, director of health services for Sacramento County, where preparations for a potential local outbreak began almost immediately after the Solano County woman was diagnosed. “We’ve been checking on the schools and on the nursing homes and on healthcare facilities, etc., and so I was thinking, ‘What about the homeless?’”

Beilenson and others said homeless people present unique risks and challenges for outbreaks of infectious diseases. Though the number of coronavirus cases remains at only a few dozen in the United States, homeless people, in particular, for multiple reasons could be vulnerable to both a quick spread of the illness and to more severe cases.

People living outdoors often do so in close quarters and lack the ability to maintain basic hygiene, including precautions such as hand washing. They may also face more danger from serious infection because of existing illnesses or frequent use of drugs or alcohol — factors with the potential to make a case of COVID-19 more severe.

[hitbyambulance]

also, as a city bus rider:

https://www.seattletimes.com/seattle-ne ... ronavirus/

Sound Transit officials also recommend riders distance themselves from other passengers as needed to avoid spreading the virus.

“It’s not rude to get up and move if you need to,” officials wrote in a Sound Transit news release.

[LawBeefaroni]

also, as a city bus rider:

https://www.seattletimes.com/seattle-ne ... ronavirus/

Sound Transit officials also recommend riders distance themselves from other passengers as needed to avoid spreading the virus.

“It’s not rude to get up and move if you need to,” officials wrote in a Sound Transit news release.

It may not be rude but it is probably impossible during rush hour.

[RMC]

So, some of the clinicians I have talked to back in the day recommended this product.
Emergen-C

Usually buy on Amazon, and have it shipped. It is out of stock for the normal flavors, you can get Tropical and Cocunut pineapple of something. Anyway, I have taken this stuff for two years or so. I figure for a few bucks a month, if it helps great if not, at least I think it helps. But with the sudden out of stock status, I wonder if everyone else is looking for that awesome counter punch to Flu/Coronavirus...

[LawBeefaroni]

On the other hand, the ones who have mentioned it to me call it BS. But they've said if you can spare the extra cash for it and fell it works, go for it.

This article is middle of the road.

Seems like daily vitamins would handle your C and zinc requirements.

[Blackhawk]

I've read up on it, too, and everything current I've seen says that vitamin C does nothing, while zinc might result in a minor reduction of the duration of a cold (one day shorter on the average) when taken in lozenge or syrup form within a day of noticing symptoms, although those large doses can have side effects. The vitamin C thing seems to be a holdover from a flawed experiment in WWII that convinced GIs that it was a cold/flu panacea. After the war they brought that belief home to their proto-boomer families and it has been accepted as fact ever since despite not ever having been backed up by science.

Vitamin C for colds, along with the '8 glasses of water per day' thing are myths that are so baked into the culture that some doctors still recommend them despite the lack of any actual fact to back them up. It's just something they've accepted as fact since day one. (in fact, I'd add "don't drink caffeine if you need to hydrate" to that list.)

The best way to lessen a cold is to stay healthy. Especially sleeping well and exercising. The best way avoid it is still hygiene.

[Kasey Chang]

Vitamin C was one of Linus Pauling's crazy ideas that never bore fruit.

https://www.vox.com/2015/1/15/7547741/v ... th-pauling

[RMC]

Man you guys are killing my ability to live in my own world of ignorance. Sigh. I still am going to take it, just to prevent scurvy. Okay?

[Jaymon]

There's no other nation on the planet that can (or would) respond to an outbreak like China. We're going to run into huge problems here in the U.S. asking for voluntary cooperation, guaranteed.

Just imagine in your head, if government tried to put a US city or a state under quarantine. First causalities are Washington, so lets start there.
Quarantine the entire PNW section of the state. Block all the mountain passes, block the southern roads at the river, close the border to Canada, close the airports, close the harbors.

Now imagine, in your head, if americans with guns would ever stand for such a thing. the people inside the state would likely react violently to being "put into prison" and the people outside the state would likely react by forming wandering bands of militia to help contain to quarantine.

It would get extraordinarily ugly extremely quickly, and many deaths related to hotsilities, rather than sickness.
And also it would be supremely useless. As you can see by how well the Chinese quarantine prevented worldwide spread.

[RMC]

There's no other nation on the planet that can (or would) respond to an outbreak like China. We're going to run into huge problems here in the U.S. asking for voluntary cooperation, guaranteed.

Just imagine in your head, if government tried to put a US city or a state under quarantine. First causalities are Washington, so lets start there.
Quarantine the entire PNW section of the state. Block all the mountain passes, block the southern roads at the river, close the border to Canada, close the airports, close the harbors.

Now imagine, in your head, if americans with guns would ever stand for such a thing. the people inside the state would likely react violently to being "put into prison" and the people outside the state would likely react by forming wandering bands of militia to help contain to quarantine.

It would get extraordinarily ugly extremely quickly, and many deaths related to hotsilities, rather than sickness.
And also it would be supremely useless. As you can see by how well the Chinese quarantine prevented worldwide spread.

I think that is a dim view of people with guns. But if we blocked everything and didn't provide care, then yes I can see that happening. But really we need to make sure people understand what happens when you get it. If you have co-morbitities or are very young, or older, then you need to be vigilant and ready to get the help you need. But even most of hte cases in China are not dying, they are not even in the hospitals. They need people to care for them, and they need to take care of themselves. With all that said, the outbreak in Washington is in a nursing home, and I think they are up to five deaths, and like 50+ showing symptoms, if the news report I read is to be belived. So this is spreading fast, and in a population that is one of the most at risk, older with co-morbidities.

[LordMortis]

So everyone everywhere is like. Don't touch your face, don't touch your face, don't touch your face. You know what I do all day long, every day? Touch my face. It's an affectation and there's no way I'm ever getting rid of it. If I try, I start to feel my face getting itchy or my nose getting tickled.

[YellowKing]

Our hospital is making contingency plans so that up to 1/4 of the workforce can work from home if need be. Isolation rooms are ready to go - I think we have 50+ on campus. I've been here when they've prepped for previous outbreaks (SARS, ebola, etc) and I've always felt very confident that they're on top of things. Fortunately our leadership is very forward-thinking so we are typically ahead of the curve when things start going south.

[Isgrimnur]

[Archinerd]

I just had an argument with a co-worker.

Are ears part of the face?

[LordMortis]

image

I don't code but that's me and when it's not me I'm constantly brushing, wiping, scratching, playing...something and it's only gotten much worse since my last cigarette, some 3+ years ago.

[gameoverman]

I just had an argument with a co-worker.

Are ears part of the face?

Pro: ears are an opening to your body, similar to mouth and nostrils
Con:ears do not contain body fluids similar to saliva or mucus
Pro:ears have wax
Con:the virus may get stuck trying to pass through the wax like a dinosaur in the tarpits

[morlac]

uggh, So we had a meeting about some layoffs this morning. Knew they were coming and it was due to a couple big projects that fizzled but then we went right into a Coronvirus discussion and what it would mean to our business (national IT, mostly infrastructure deployments). We all agreed it would not be good as network refreshes could easily be delayed for months/years. More layoffs would definitely be coming. 3 hours later we learn our biggest partner (Giant US telecom) has frozen all travel, all face to face client meetings, and all trade shows even if it is in your home city. That's going to make it extremely difficult to produce and close new deals. I would imagine a full work stoppage is the next step meaning no deploying on current contracts and no incoming billable revenue. This shit is going to hurt and hurt bad.

[gilraen]

So everyone everywhere is like. Don't touch your face, don't touch your face, don't touch your face. You know what I do all day long, every day? Touch my face.

Yep, same here.

[Zaxxon]

uggh, So we had a meeting about some layoffs this morning. Knew they were coming and it was due to a couple big projects that fizzled but then we went right into a Coronvirus discussion and what it would mean to our business (national IT, mostly infrastructure deployments). We all agreed it would not be good as network refreshes could easily be delayed for months/years. More layoffs would definitely be coming. 3 hours later we learn our biggest partner (Giant US telecom) has frozen all travel, all face to face client meetings, and all trade shows even if it is in your home city. That's going to make it extremely difficult to produce and close new deals. I would imagine a full work stoppage is the next step meaning no deploying on current contracts and no incoming billable revenue. This shit is going to hurt and hurt bad.

Bummer. Best of luck!

[Kasey Chang]

WHO update says China (only) saw 206 new cases in the past 24 hours... while outside of China saw 1598 new cases in 24 hours, but it's mainly from new discoveries in Korea, Italy, and Iran, each reported over 400 new cases in a day (Italy reported 561)

[gameoverman]

uggh, So we had a meeting about some layoffs this morning. Knew they were coming and it was due to a couple big projects that fizzled but then we went right into a Coronvirus discussion and what it would mean to our business (national IT, mostly infrastructure deployments). We all agreed it would not be good as network refreshes could easily be delayed for months/years. More layoffs would definitely be coming. 3 hours later we learn our biggest partner (Giant US telecom) has frozen all travel, all face to face client meetings, and all trade shows even if it is in your home city. That's going to make it extremely difficult to produce and close new deals. I would imagine a full work stoppage is the next step meaning no deploying on current contracts and no incoming billable revenue. This shit is going to hurt and hurt bad.

This kind of thing is why I think ultimately the real damage this virus does is going to be economic. And there hasn't even been a panic yet. Having to deal with a public scared of a new health threat and a tanking economy is going to be one heck of a challenge for any leader.

[Kasey Chang]

This is ridiculous... Amazon Prime Now! has diet coke back in stock, but ran out of instant noodles. That's right, instant noodles. It used to be 12 for $2.70 (it should be like 5 or 6 for $1 at dollar stores). it's now 0.45 for a single serving. At this rate, I'm gonna rent a car and make a dash to my local dollar store, if they have anything worthwhile left.

Prime now! has a delivery squeeze. Normally I order in the early afternoon and get stuff in the evening. Now, I order in the afternoon and it won't be delivered for 24 hours, and that's with a $5 surcharge. In fact, there's a banner across the app front page that "delivery availability may be impacted by heavy demand" or something like that. Argh.

[Daehawk]

Chinese businesses in NYC hurting bad.

[Kasey Chang]

Chinese businesses in NYC hurting bad.

Same here in San Francisco. Visually it ain't that different, but one can feel it's a bit less than usual, and Pelosi was in town last week along with our Mayor trying to allay fears... when the power went out.

https://www.kron4.com/news/bay-area/san ... rus-fears/

[Jeff V]

A friend of mine who is in Chicago's Chinatown a lot said Chinese New Years was practically deserted this year. His wife nixed his idea of taking a picture of himself in a mostly empty restaurant while hoisting a Corona beer.

[em2nought]

Unfortunately for me I too touch my face all the time, somebody has to. LOL

[Kurth]

A question for Smoove: I recently was made aware of the numbers related to swine flu. I was shocked: 285K hospitalized in the U.S. and 12K died (as of March 2010).

Yet, I was aware of swine flu back then, but I can’t remember a single disruption to every day life. Certainly no mass panic, no states of emergency, no mass quarantines or cancellations of meetings.

So what are we to make of the reaction to COVID-19? It seems like it’s one of two things: (1) it has the potential to be much worse than swine flu - like deaths in the six or seven figures, or (2) the reaction is not rational.

What’s your take?

[Victoria Raverna]

Swine flu's mortality rate is less than 0.1%, right?

So far COVID-19's mortality rate is around 2% but maybe actually less since we only compare them to the confirmed cases. Still it is at least 10 times the mortality rate of swine flu. So if it infected as many people as the 2009 swine flu, it'll kill more than 120K in US.

[Smoove_B]

I like questions!

What you're noticing is a key observation - something about the entirety of a disease outbreak (that started in 2009 and ended in 2010) vs trying to understand what's happening while we're in the early stages of a new one. This is why people freaking out over case fatality rates is problematic - because we really have no idea how widespread this is yet. The numbers for the H1N1 outbreak also include cases that were identified long after the outbreak ended. We're going to be be tallying numbers for this outbreak for months after it's over, in a similar way.

I wouldn't say there was mass panic in 2009, no - you're correct there. We are in a different world now (and have been for some time), so the ability to share/spread/broadcast information is magnitudes larger. I had lecture this evening and my students were asking me questions that started with, "I heard..." or "Someone told me..." - all stuff I've seen circulating on social media over the last week or so. The word for 2020 will be Infodemic, count on it.

To go back to the details of H1N1, it turned out to be about as transmissible as seasonal influenza. The risk for H1N1 was a little weird in that there was a slight increase and for hospitalizations and deaths for people under the age of 65 and the theory was (or maybe still is) people over the age of 65 had already been exposed as children to this virus (or a close cousin); younger folks had never seen it before so without immune system memory/reference, they were at slightly higher risks for complications. Either way, the overall risks were similar - with age and health status being highly influential on outcome. But to refocus it was about as transmissible as Influenza *and* there was a quick vaccine available. In short, there was something people could do.

Contrast that with this novel coronavirus where we've been repeatedly told there's no cure and treatments are basically mitigating symptoms. It remains to be see how easily transmissible this is, but the numbers so far suggest it's easier to transmit than influenza and in addition to droplets (coughing, sneezing) there is evidence that the virus is present in feces and therefore possibly spread through direct contact.

There isn't anything yet suggesting this is going to be orders of magnitude more fatal than H1N1 or seasonal influenza. It's scary how fast it's ripping around the globe,but my guess is that we're going to discover it's been in locations for longer than we realized and there are lots of asymptomatic or mild-illness people that had been spreading it around. I've also seen some respected scientists saying they believe it will likely become endemic (i.e. ever present in our population) long after this pandemic ends.

What will be key is to figure out what the risk factors are and how we protect the people then that need it the most. I would bet we're at least 16-18 months from seeing a vaccine (12 is the lowest guess, but I'd be amazed if that happened). We don't have any type of cornoavirus vaccines, so unlike H1N1, we're starting from scratch - and in the throes of an outbreak of a new one. Had we come up with one for SARS or MERS, this might be a whole different story (in terms of how we could respond).

[RMC]

Swine flu's mortality rate is less than 0.1%, right?

So far COVID-19's mortality rate is around 2% but maybe actually less since we only compare them to the confirmed cases. Still it is at least 10 times the mortality rate of swine flu. So if it infected as many people as the 2009 swine flu, it'll kill more than 120K in US.

That assumes that the mortality rates are correct. Some of the stories I have read, have questioned that number. Not that I am in any position to do that, but I certainly hope that the mortality rate is wrong.

[Jeff V]

Mortality is also skewed towards the old and infirm. From what I can tell, however, it hasn't yet come up against dbt's shotgun defense.

[Victoria Raverna]

Swine flu's mortality rate is less than 0.1%, right?

So far COVID-19's mortality rate is around 2% but maybe actually less since we only compare them to the confirmed cases. Still it is at least 10 times the mortality rate of swine flu. So if it infected as many people as the 2009 swine flu, it'll kill more than 120K in US.

That assumes that the mortality rates are correct. Some of the stories I have read, have questioned that number. Not that I am in any position to do that, but I certainly hope that the mortality rate is wrong.

Which is why I only use 10 times not 20 times. But you're right, iti possible in the end, the mortality rate turned out to be under 0.1%, but right now, the number is closer to 2%.

[Daehawk]

2 cases in Georgia now. Husband and wife. No ages given. Says one of them returned from Italy and gave it to the other.

https://www.wrcbtv.com/story/41843032/w ... d-in-state

[Moat_Man]

Here an updated interactive map from Johns Hopkins with confirmed, recovered, existing and deaths.

https://gisanddata.maps.arcgis.com/apps ... 7b48e9ecf6

[em2nought]

Random thoughts:

If this whole scare fizzles it has me thinking that a fake pandemic would be an interesting way for a totalitarian regime to sell their gold high and then buy stocks for a bargain while the blood is still in the streets. It could be the biggest most impressive heist ever.

and: Italians really seem to get around.