[Health] The Infectious Diseases Thread

[Daehawk]

I started having spring and fall allergies around age 43 in 2012. Right now I have a random cough, sneezing, and watery eyes. When I go to town this week I dont know if people will beat me to death or run in fear. Maybe give me the symbol of the cross. Ill hiss at them.

[Kurth]

Thanks for the informative and helpful response, Smoove!

So, if there’s no evidence COVID-19 is going to be orders of magnitude worse than swine flu, and if there’s nothing we can really do about it now anyway because treatment is just supportive care and containment isn’t feasible or realistic, then it’s hard for me to understand why our response (school closings, businesses cancelling travel and meetings, supply chains disrupted, etc) is at all justified or rational. Seems like the “infodemic” (and great work there if you coined that term) is causing more harm than the virus itself.

My sister is an ER doc in Jacksonville, FL. Her take on this is that the media (mainstream and social) is sensationalizing COVID-19 and fueling a panic. She thinks it will definitely be endemic, and we should treat it like we do seasonal flu.

One of my best friends is not a doctor but considers himself an expert on most things (in truth, he’s pretty smart and more often right than wrong). He thinks my sister is crazy and that COVID-19 is the second coming of the 1918 Spanish Flu and is sure to kill millions.

Talking to the two of them in one afternoon makes my head feel like it’s going to explode!

[Kasey Chang]

Correct. All this "abundance of caution" is just driving the hysteria. EVERYBODY is adopting the China model of containment... Shutdown EVERYTHING and treat it as if it's a horrible pandemic. It isn't. Google and Amazon curtailing travel obviously is being picked up by the media as if that is a signal "start panicking now".

But then, human psyche works this way. It's how our survival instinct is tuned... better to be safe than sorry.

Just to put things in perspective...Pertussis (whooping cough) if unvaccinated, has a fatality rate of about 3.7% in developing countries. It's quite a bit lower in the developing countries due to advanced supportive care.

[gameoverman]

i think a lot of responses are motivated by 'cover your ass' and/or politics. If you run a business and insist on travel for your employees, and one of them dies of this virus, where does that leave you in terms of liability? If you are the leader of a country and you take a more calm and laid back approach to this threat, and it turns out it's a bit worse than it seems, where does that leave you in the eyes of the public?

So I think from the lowest levels to the highest levels there are reasons people have for overreacting. Others hype up the threat for the excitement. Remember Y2K? All it takes is some people to talk about this virus, then others hear about it and they want to get in on the discussion, then it goes mainstream, viral you might say, and EVERYONE starts chiming in. That's when it picks up momentum and gets talked up as the next Spanish Flu. After all, there's not much excitement to be had talking about a virus spreading worldwide if the end of the world isn't in play.

[Formix]

I think the isolation tactic is mainly meant to slow the progress. They're trying to prevent too much impact on healthcare at any one time. I feel that they're pretty aware that this spreads easily, and will most likely become endemic, they're just trying to make sure it happens in a manner that's slower and more easily dealt with without considering economic impact, which is how it should be, in my opinion.

[morlac]

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

Was wondering what was taken so long, what with our genermous, international airport and all.

[LawBeefaroni]

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?

I wouldn't say everyone panicked in 2009-2010 but there was similar fear. And irrational responses. Pork was a casualty of ignorance, much like Corona beer. There were rumors of FEMA camps to quarantine the infected (remember back then, everything was a setup for FEMA death camps?). Zombie fear/love was rampant.

[JSHAW]

Israeli scientists are on the cusp of developing the first vaccine against the novel coronavirus, according to Science and Technology Minister Ofir Akunis. If all goes as planned, the vaccine could be ready within a few weeks and available in 90 days, according to a release.

“Congratulations to MIGAL [The Galilee Research Institute] on this exciting breakthrough,” Akunis said. “I am confident there will be further rapid progress, enabling us to provide a needed response to the grave global COVID-19 threat,” Akunis said, referring to the disease caused by the novel coronavirus.

This was taken from The Jerusalem Post website.

I read a few days ago that Israel was close to having a vaccine, not hearing any major cable news reporting on this.

[stimpy]

Went to a concert last Saturday.
Being amongst a crowd didn't really worry me.
After the concert the band came out to do a signing.
I was about 5th in a line of around 200.
The band was friendly as could be, signing multiple items for people and shaking hands.
It was on the way home that it dawned on me that this band travels a lot and shaking hands with them might not have been the best idea.
In addition to them, I only had 4 people ahead of me to worry about. Imagine being number 200 in that line......

[Smoove_B]

So, if there’s no evidence COVID-19 is going to be orders of magnitude worse than swine flu, and if there’s nothing we can really do about it now anyway because treatment is just supportive care and containment isn’t feasible or realistic, then it’s hard for me to understand why our response (school closings, businesses cancelling travel and meetings, supply chains disrupted, etc) is at all justified or rational. Seems like the “infodemic” (and great work there if you coined that term) is causing more harm than the virus itself.

Sadly, I cannot claim Infodemic - but I wish I could because it's a perfect description of what's happening.

The response (cancelling travel, preparing to close schools, preparing to have remote business options) is normal (at least to me). I don't know how many people realize it, but schools already have closure plans in place for influenza. I mean, I hope they do in other states. Every morning in NJ the school nurse checks in with a county or state public health office and reports the number of absences related to "flu-like" symptoms. If the school reaches a certain percent, it's going to be recommended they close down to stop spread. I can't think of a time when that has actually happened, but that policy is already on the books.

I could see a situation where sporting events, concerts and public gatherings would be stopped. Maybe not by a state but because people are going to cancel or not show up. I think that's what's happening with many of the conventions right now. It's a realization that panic is driving decisions right now and that could equate to a loss in money. The supply chain is already disrupted but I don't know what the direct impact will be to the average person. We're not going to run out of food or toilet paper, but there could be issues with some medications and random manufacturing supply elements (plastics). I don't think people will go nuts if they can't get cheap clothes or furniture for 6 weeks, but who knows?

It's also entirely possible that a region that is particularly hard-hit (right now Washington state will be one to watch) might opt for school closures out of an abundance of caution. I would be surprised if we get to Japan's solution of simply closing schools for a month nationwide.

So much of the response is because of the lack of known information. I think it's wise to be prepared (and verify you have plans in place), which includes thinking about/talking about what school or work modifications might mean for you and your family. I was surprised when I asked my 13 year old if she'd heard about it she said the school is filled with people like your friend - end of the world, we're all going to die, etc... hyperbole. That kind of surprised me, but I guess that kind of message spreads quick. Me telling people to wash their hands and engage in social distancing is not nearly as exciting.

[Smoove_B]

For the data folks, figured I'd share this awesome analysis of the demographics of the virus. This information is so important to help figure out what's happening:

Ages:

The vast majority of cases in China — 87% — were in people ages 30 to 79, the China Center for Disease Control reported last month based on data from all 72,314 of those diagnosed with Covid-19 as of Feb. 11. That probably reflects something about biology more than lifestyle, such as being in frequent contact with other people. Teens and people in their 20s also encounter many others, at school and work and on public transit, yet they don’t seem to be contracting the disease at significant rates: Only 8.1% of cases were 20-somethings, 1.2% were teens, and 0.9% were 9 or younger. The World Health Organization mission to China found that 78% of the cases reported as of Feb. 20 were in people ages 30 to 69.

Death, by age:

The death toll skews old even more strongly. Overall, China CDC found, 2.3% of confirmed cases died. But the fatality rate was 14.8% in people 80 or older, likely reflecting the presence of other diseases, a weaker immune system, or simply worse overall health. By contrast, the fatality rate was 1.3% in 50-somethings, 0.4% in 40-somethings, and 0.2% in people 10 to 39.

Gender and susceptibility:

The effect of sex on susceptibility to Covid-19 is less clear than the age effect, but preliminary data suggest men might be more susceptible. China CDC found that 106 men had the disease for every 100 women, while the WHO mission found that men make up 51% of cases.

Gender and fatality:

The effect of sex on susceptibility to Covid-19 is less clear than the age effect, but preliminary data suggest men might be more susceptible. China CDC found that 106 men had the disease for every 100 women, while the WHO mission found that men make up 51% of cases.

Lots of details on how that was all calculated, but an excellent read overall.

[$iljanus]

Me telling people to wash their hands and engage in social distancing is not nearly as exciting.

But with the correct child demographic, putting the word "cooties" in front of your hand washing and social distancing advice can make all the difference!

After reading the demographic report, we should just call it the Boomer flu.

[stessier]

Me telling people to wash their hands and engage in social distancing is not nearly as exciting.

You make up for it during the holidays with all those fun bed time stories about Thanksgiving leftovers allowed to cool on kitchen counters.

[ImLawBoy]

The response (cancelling travel, preparing to close schools, preparing to have remote business options) is normal (at least to me). I don't know how many people realize it, but schools already have closure plans in place for influenza. I mean, I hope they do in other states. Every morning in NJ the school nurse checks in with a county or state public health office and reports the number of absences related to "flu-like" symptoms. If the school reaches a certain percent, it's going to be recommended they close down to stop spread. I can't think of a time when that has actually happened, but that policy is already on the books.

FWIW, schools in the Chicago area to occasionally shut down due to flu outbreaks. I don't know if their procedure is the same as the one you describe, but, there's usually a couple of shutdowns each year.

[Smoove_B]

FWIW, schools in the Chicago area to occasionally shut down due to flu outbreaks. I don't know if their procedure is the same as the one you describe, but, there's usually a couple of shutdowns each year.

Could be my suburban / rural experience vs more metro. I would bet they're doing exactly what I described - school nurse monitoring the population. For major corporations that also have on-site medical staff (kind of rare these days), I have seen similar programs in NJ. But those are voluntary - they're just doing sentinel surveillance based on their size and corporate location. They're great places to get data about how an illness might be spreading through a community.

[ImLawBoy]

I'm really tempted to edit both my original post and your response to fix my glaring typos/grammatical issues.

[Smoove_B]

No worries, I'll distract everyone with some sobering news:

The head of the World Health Organization (WHO) said that public health officials are operating in "uncharted territory" as they combat the spread of the novel coronavirus, which has infected more than 90,000 people across 73 countries and territories as of Monday evening.

We're learning. Bear with us.

[wonderpug]

There isn't anything yet suggesting this is going to be orders of magnitude more fatal than H1N1 or seasonal influenza.

Can you help me understand how you get to this conclusion? That WHO investigation you linked to seems to make this sound quite a bit worse than seasonal flu.

[Smoove_B]

It's a few different things. First, the number of known cases and how it's manifesting (demographics). At ~90K at this point we're looking at a fraction of humans across and entire planet. Yes, 2% of the cases were fatal, but if you go back up and look at the demographic breakdown it gives a clearer picture. The new virus is targeting (for lack of a better word) groups that we would historically expect - people over the age of 60 and people with chronic illness. Our attention should be focused on identifying them and doing whatever we can to help prevent and then mitigate cases. Conversely, this isn't causing high fatalities in younger, healthier adults or children. To me, that would be the end-times indicator. High communicability + highly virulent = doom.

Second, what think we're going to find in the coming weeks is that this really is already far more widely distributed than we realized, i.e. more people actually have it. When that happens and we start re-adjusting the numbers, I expect case fatality rates to drop. With a newly emerging disease I would expect higher risk populations to suffer more - it's the nature of things. We're paying attention to them (as we should) because they're in distress. News reports aren't being written about people with runny-noses or dry coughs; no one cares.

Regarding seasonal flu (and at the risk of sounding like Azar), it might be worse on a case-by-case basis, depending again on those risk factors - like MERS or SARS. But in terms of overall illness severity, it seems to be very similar to influenza.

I think this new editorial from Dr. Fauci and Dr. Lane summarizes it best:

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.

Dr. Fauci, IMHO, is the expert to follow. Whatever he says, I believe 100%.

[morlac]

Yea i'm not buying not as deadly as flu anymore. Even if the mortality rate was exactly the same if it spreads easier than influenza (per above fecal Smooveness) due to being passed by touching wouldn't that make it deadlier?

Smoove, I am also hearing the incubation period maybe double the currently expected 2 weeks. Have you heard anything on that? If that ends up being true and it is easier to pass around than the flu, plus no vaccine than wouldn't it (eventually) be deadlier than the flu?

[Kurth]

I am glad we have a resident OO expert here.

Question on the data coming out of China: Do we know how much testing has been done in CN?

My ER doc sister seems to discount a lot of the data (not that it's false, just leads to incorrect conclusions) on the basis that there has not been enough testing to really take much from the resulting data. She's especially opinionated about the mortality rate and believes we'll look back at the 2% number and shake our heads later on.

I don't know how familiar she really is with the medical system in CN, but she suggests that the Chinese don't use emergency medicine the same way we do in the U.S. They are far more reluctant to visit an ER and usually just stay home, whereas Americans frequently use ER as primary care. Her take is that for every reported case of COVID-19 in CN, there are most certainly legions of people who were infected and never sought care.

[Smoove_B]

I was declared an expert witness once in court. Did not enjoy!

I too have been cautious of the China data from day one, namely because of how they handled the SARS outbreak back in 2003/4, in particular their policy of denial and data obfuscation. I think we're going to find out more about the likely validity of their data overall as more and more countries continue to respond. Italy would be the one to watch next. For the last few weeks my public health guides have been following the response in Singapore as they have the gold standard for surveillance. Unfortunately, when Singapore failed to quickly identify and contain this new virus, I think it was a indicator that the rest of us were likely in trouble. That being said, there are still lessons to learn from Singapore. I'm not really qualified to comment much on global health systems - it's not my area, at least in comparative analysis. It won't surprise me if there aren't bigger lessons to come out of this entire adventure related to how healthcare and public health is structured worldwide, namely how some countries were able to respond better than others.

But yes, I would likely agree there are legions of people in China that have the virus that never received care - because it was something they just handled on their own.

[Smoove_B]

Smoove, I am also hearing the incubation period maybe double the currently expected 2 weeks. Have you heard anything on that? If that ends up being true and it is easier to pass around than the flu, plus no vaccine than wouldn't it (eventually) be deadlier than the flu?

I'm not sure. I think there's been some debate over what could be re-infection vs people testing positive after having been cleared. The story out of San Antonio where the woman was released after 14 days and showing no positive test result only to have her come back and be positive a week later is odd. Was it a faulty test? Two in a row seems unlikely, but if all the kits were bad it's possible. After everything we learned about Ebola a few years ago, nothing surprises me anymore. A 4 week incubation period would be odd (outside of what we normally see), but it's not unheard of.

It could be deadlier than the flu for at-risk populations, yes. And it could be something we're going to see year round instead of in the winter months. Being part of a currently unfolding experiment is fun!

[gilraen]

I'm not sure. I think there's been some debate over what could be re-infection vs people testing positive after having been cleared. The story out of San Antonio where the woman was released after 14 days and showing no positive test result only to have her come back and be positive a week later is odd. Was it a faulty test? Two in a row seems unlikely, but if all the kits were bad it's possible.

My theory was that due to aggressive treatment, her viral load was undetectable at release, but she wasn't fully recovered (at least not enough for her immune system to take over). So once she stopped treatment, the virus came back. It may be a faulty test or it may be that they are not approaching the treatment protocols the right way.

[LawBeefaroni]

So reports are that Northside stores were packed all weekend. Costco ran out of water and toilet paper.

I can only speak to Jewel, where I went Sunday and Whole Foods where the wife went yesterday. WF had some empty shelves (non perishables) and Jewel was crowded.

Corona, sadly, was only discounted a few bucks. I'm thinking when it gets under $8/12pack I'm in.

[ImLawBoy]

So reports are that Northside stores were packed all weekend. Costco ran out of water and toilet paper.

I can only speak to Jewel, where I went Sunday and Whole Foods where the wife went yesterday. WF had some empty shelves (non perishables) and Jewel was crowded.

Corona, sadly, was only discounted a few bucks. I'm thinking when it gets under $8/12pack I'm in.

Mariano's on Webster seemed about typical over the weekend, maybe even less crowded. I didn't even have to wait in line at the checkout.

[LawBeefaroni]

Oh, also Trader Joe's on Lincoln was stupid on Sunday but I think it's always stupid on Sundays.

[Daehawk]

I had to go to town today and I did everything wrong supposedly. I went to many stores. I was pumping gas and rubbed my eye. Sitting at a red light I pulled a handnail until it bled and was raw the rest of the trip. I rubbed my face many many times.

[Kurth]

Corona, sadly, was only discounted a few bucks. I'm thinking when it gets under $8/12pack I'm in.

Are they going to pay you $8 to drink it???

[gameoverman]

There isn't anything yet suggesting this is going to be orders of magnitude more fatal than H1N1 or seasonal influenza.

Can you help me understand how you get to this conclusion? That WHO investigation you linked to seems to make this sound quite a bit worse than seasonal flu.

I can offer the analysis of someone totally unqualified to give an analysis of what a virus can and can't do, just so you get some variety. This virus has been around since the end of December, let's call it Jan 1 for clarity. We are now in March. This virus started in a city of millions of people living in a relatively high population density environment. Let's also agree that the Chinese government is not being 100% truthful in the numbers.

Considering how easy it is to spread, considering the head start the virus had in infecting people before anyone was aware of it, and considering the numbers we do have, does this virus look especially deadly? Not to me. The latest numbers I can find show 92k infected/3100 dead. Now look at how many people worldwide are killed by the regular flu. If you extrapolate the Jan-March numbers to cover the entire year you get 550000/18600. If you double that, to account for under reporting, you get a bit over a million infected, thirty seven thousand dead. Now look at how many people die of the flu every year again. One of those numbers isn't as scary as the other one.

This virus's scary factor lies in 'what ifs'. What if it mutates? What if the economic impact causes a worldwide recession or even a depression? What if people around the world kick off a massive panic? If someone thinks there's going to be a food shortage and they start buying extra food, that means other people will notice less food on the shelves and they'll think there's a shortage and they'll buy extra food, and more people will notice less food on the shelves and THEY'LL start buying extra food...pretty soon the virus is the least of anyone's concerns.

[Daehawk]

Also in my view China stats are skewed because they all smoke and spit like machines.

[LawBeefaroni]

Also in my view China stats are skewed because they all smoke and spit like machines.

You're in Tennessee, right?

[Isgrimnur]

[hitbyambulance]

my mother is 68 years old, a liver-transplant recipient and on immunosuppresants. what extra precautions should she take (other than 'never leave the house')?

[Lorini]

A friend who is a pediatrician believes that corona has been around a lot longer (even here in the states) than realized. There was no diagnosis called coronavirus until recently and the symptoms aren't all that specific at first look. So this pandemic may have been around longer than is being recognized in the press. I think the stock markets are going crazy because everyone knows that China can't be relied upon to tell the truth (especially negative truth) so 'no one knows' what's really going on. The WHO guy said when he went to China he spoke to those in the hospitals and they indicated that the lines to get into the hospital are gone and they think it is calming down now.

I don't understand why people feel the need to buy all this shit? Really? I mean my son came into contact last week with someone who has mild (?!) corona virus symptoms, and my son and his friend are staying home and using Door Dash . I don't like the comparisons to earthquakes et al, because while the grocery store could have a skeleton heavily protected crew, the store will certainly still be there. Also the percent hospitalized doesn't seem to indicate that a catastrophe is going to happen? Why do people love to make problems for themselves? Seems crazy to me.

Sorry just saw this thread!

[Lorini]

my mother is 68 years old, a liver-transplant recipient and on immunosuppresants. what extra precautions should she take (other than 'never leave the house')?

Should talk with her doctor who knows the meds she's on.

[Smoove_B]

IANAD, but I'm not sure there's much more to recommend at this point, other than social distancing. I'd be checking with her doctors to find out what you should do (or her caregivers) to keep her risk levels low above and beyond what they'd already recommend during influenza season and/or for someone on immune system suppression.

[Isgrimnur]

A friend who is a pediatrician believes that corona has been around a lot longer (even here in the states) than realized.

[Anonymous Bosch]

my mother is 68 years old, a liver-transplant recipient and on immunosuppresants. what extra precautions should she take (other than 'never leave the house')?

Nitrile gloves could provide some useful additional protection as long as she's careful never to reuse them.

[Ralph-Wiggum]

https://twitter.com/jessemckinley/statu ... 55365?s=20

Spoiler:

NEW out of Westchester County: "Temple Young Israel in New Rochelle" will "halt all services immediately." Anyone at "who attended services on Feb. 22, and a funeral and a bat mitzvah at the temple on February 23 must self-quarantine until at the very earliest March 8."

My brother lives in the town right next to New Rochelle (pretty much the same town). Fortunately, he and his family go to a different synagogue.