Coronavirus Sars-CoV-2/Covid-19 Megathread

[Monoriu]

Experts on infectious diseases generally say this virus is as contagious as the flu, but with a death rate that is at least 10-20 times higher.  The overall death rate is a bit misleading, because the distribution is uneven.  The bulk of the infections and deaths occur in old people, or people with pre-existing conditions.  So you are 70 years old with diabetes, the chance of dying could be as high as one in five. 

[Sheilbh]

US has first case of "community spread" - the CDC didn't test them for several days because they didn't match the profile:

The US Has Its First 'Community Spread' Coronavirus Case
The patient was admitted to UC Davis Medical Center on February 19 but not diagnosed until the 23rd—raising concerns about testing capabilities and health care workers' exposure to the disease.

During the press conference where President Trump announced that Vice President Mike Pence would be taking charge of domestic efforts to combat SARS-CoV-2, the new coronavirus spreading internationally, the Centers for Disease Control and Prevention also announced that the outbreak had entered a new phase in the US. The agency reported the first patient infected via "community spread"—which is to say, the patient hadn't traveled to places where the virus is common and had no known exposure to anyone with Covid-19. WIRED has learned that the patient has been in a northern California hospital for a week, but went undiagnosed until Sunday.

The CDC specified only that the patient was in California; the California Department of Public Health announced that the patient was a resident of Solano County—which, as other reports have pointed out, is the location of one of the Air Force bases being used for quarantines of people who've returned to the US from countries with the disease.

A microbiologist at UC Davis posted to Twitter on Wednesday evening that his university's hospital had that patient. A letter circulated at UC Davis (signed by David Lubarsky, vice chancellor of human health sciences and CEO of UC Davis Health and Brad Simmons, interim CEO and COO of UC Davis Medical Center) says that the patient has been at the university's medical center since February 19—a full week ago—and was only diagnosed with Covid-19 on Sunday, February 23. The hospital admitted the patient intubated and on a ventilator, and since health care workers suspected a viral infection they implemented "droplet protection," keeping on guard against coming into contact with the stuff that comes up in coughing or sneezing.

That gap between admission and diagnosis raises concerns about health care workers being unknowingly exposed at Davis—a potential problem anywhere. Earlier in February the New York Times reported that more than 1,700 health care workers were infected with the coronavirus in China. Some of them even pleaded for international aid via an article in the journal The Lancet this week. (Worldwide, more than 82,000 people have the disease, and 2,800 have died. The US has 60 known cases.)

The UC Davis memo explains the delay in testing in testing by noting that neither Sacramento County nor the city of Davis' public health agency performs the test. The hospital had to request the CDC do it. "Since the patient did not fit the existing diagnostic criteria for COVID-19, a test was not immediately administered," the memo says. On Sunday the CDC did the test and UC Davis put the patient on more stringent airborne and contact infection control precautions. "Today the CDC confirmed the patient's test was positive."

The UC Davis memo also confirms that the hospital has treated other patients infected with Covid-19 and said that the precautions it had taken with the patient all along probably meant "minimal potential for exposure." Nevertheless, "out of an abundance of caution, in order to assure the health and safety of our employees, we are asking a small number of employees to stay home and monitor their temperature."

Neither the CDC nor UC Davis Health System returned calls requesting comment.

Despite the president's attempts to allay concern today, public health officials have been warning to expect community spread of Covid-19. "We expect we will see community spread in this country," Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said at a press conference on Tuesday.

Now that it's happening, two more concerns become central. Public health workers are beginning to understand that Covid-19 is quite contagious, though the specific mechanisms aren't yet established. "Are we potentially missing people who might be sick? This case kind of proves we may be. It doesn't answer the question of how big the population is," says Nahid Bhadelia, medical director of the Special Pathogens Unit at Boston University's National Emerging Infectious Disease Laboratories.

But figuring out the true size of the infected population will require a leap in US capabilities to actually test for the virus—a technology that has been delayed. As the Washington Post reported Tuesday, while South Korea has performed more than 35,000 tests, the US has done fewer than 500, and only the CDC and a handful of local public health agencies even have the diagnostic system. "Not a lot of places have the ability yet to test for this infection," Bhadelia says. "This case increases the pressure that we need to make that testing more available and closer to the patients' bedsides. It's important for the patient, but also for the healthcare facility, so they can do the correct infection control and other interventions to keep health care workers safe and other patients safe." The key to making that happen: resources, the right protective gear, and more data.

Edit: And in the UK, the government's preparing for a surge in cases:

Ministers preparing for potential big jump in coronavirus cases
Government planning public information campaign amid concerns of an Italy-sized outbreak
Rowena Mason and Haroon Siddique
Wed 26 Feb 2020 20.31 GMT
First published on Wed 26 Feb 2020 14.06 GMT

Ministers are racing to prepare the UK for a potential sudden increase in the spread of the coronavirus, with officials fearing it could take just 72 hours for an outbreak the size of Italy's to take hold.

Amid growing concerns around the world about the pace of the virus's spread, the health secretary, Matt Hancock, said the government would launch a mass public information campaign giving advice on how to react to suspected cases and guard against infection.

Updating MPs in the House of Commons, he cautioned against overreaction, but acknowledged that the government is expecting more cases in the UK.

The rapid expansion of coronavirus cases in Italy – a key destination for British holidaymakers – has caused concern in recent days and officials are stepping up precautions in case a similar scenario happens in Britain.

The decision to step up preparations in the UK came as the World Health Organization said that the number of new cases being officially reported outside China had overtaken the number within the country for the first time. The WHO chief, Tedros Adhanom Ghebreyesus, described the steep rise in new cases around the world as "deeply concerning".

There have been 13 cases of the virus so far in the UK, with no deaths. But Italy saw its confirmed cases rocket from just three on Friday to more than 200 by Monday and its total is now 400, with 12 deaths.

On a day of global efforts to limit the spread of Covid-19:
• The total number of infections in Italy represented a rise of 45% in 24 hours. Italian prosecutors opened an investigation into hospital procedures amid claims that an investigation into a so-called "super-spreader" was initially delayed.
• Austria, Croatia and Switzerland reported their first cases linked to the outbreak in Italy. Greece reported its first ever case, which was also linked to the country. France recorded its second death. South America and Norway reported their first cases.
• Event organisers considered their plans as Italy's rugby match against Ireland in Dublin was called off and questions were raised over the Venice Biennale.
• Around 160 Britons were trapped in a hotel in Tenerife which could stay in lockdown until 10 March.
• 52 further deaths were reported in China, the lowest number in three weeks.
• The WHO warned against using the term "pandemic", which it said falsely indicated that the spread could no longer be contained.

It is understood that the government's public information campaign, due to be launched in the coming days, will broadcast advice about calling 111 if coronavirus is suspected.

A Whitehall source said: "It's as much about winning the battle for public confidence as it is about winning the battle against the disease. There will be social media, stuff on TV, poster campaigns. It will be making sure we can reach as many people as possible.

"It's making sure that people have got the right advice. At the moment it is very much about telling people to ring 111 ... It will be about what people can do to help prevent the spread like handwashing and using tissues."

The government has been publishing more advice to employers, schools, the travel industry and health workers, but there have been complaints about mixed messages from ministers.

They have said there was no need to shut schools unless a new case is confirmed at the premises, but some 40 schools have either closed their doors or sent pupils home, and the oil giant Chevron ordered 300 traders and other staff at its office in Canary Wharf to work from home. The FTSE 100 has also plummeted on fears of the global economic impact.

As well as increasing concern on UK soil, the government was faced with criticism of alleged inaction and pleas for help from Britons who remain in lockdown at a Tenerife hotel.

Speaking in the Commons, Hancock said that while the government was prepared for a pandemic, it was currently in the "contain" phase and its hope was that all its efforts to contain the virus would prevent that coming to pass.

"The public can be assured that we have a clear plan to contain, delay, research and mitigate, and that we are working methodically through each step to keep the public safe," he said. "Overreaction has its costs too, economic and social, and so we have to keep the public safe, but we also need to act in a way that's proportionate."

Amid concerns about the rights of workers told to self-isolate, the health secretary said the guidance to employers included instructions that such employees were entitled to sick leave.

"It's a very important message for employers and for those who can go home and self-isolate as if they were sick because it's for medical reasons," he said.

He said that that 7,132 people in the UK had been tested for coronavirus. Of these, 13 had tested positive, eight of whom have since been discharged from hospital.

But Public Health England (PHE) announced that it was stepping up testing to ascertain "whether there's evidence of infection more widespread than we think there is". PHE said tests for the virus would be carried out at hospitals as well as at 100 surgeries on people who have "severe respiratory symptoms".

Prof Jonathan Ball, professor of molecular virology at the University of Nottingham, said the increased surveillance and testing was welcome.

He said: "Many of us have been worried that the virus might be introduced into the UK under the radar and start to transmit more widely in the community. This concern is borne out by the experiences of other countries such as Italy and Iran that are suffering quite large outbreaks where the source of the virus is unknown."

In parliament, Hancock said the NHS was looking to extend home testing for coronavirus, which has already been piloted in London. "Home testing is the safest place to be tested because then you don't have to go anywhere, and that will allow us to roll out testing to a much larger number of people as well," he said.

[HisMajestyBOB]

In the US, we don't have universal healthcare or universal paid sick leave , so there's no need to prepare. The poor can simply continue working until they drop dead.

And if they die before payday, their company profits just that much more!

[Sheilbh]

I was wondering about this actually - because I'm currently stuck in my flat so using a lot of delivery services 

And I wondered about what happens if we reach a point where this gets serious and there are people who probably should stop work for a while, for their own benefit and others, but might not be able to because they need the income/may not get sick pay - such as my delivery folks.

[Zanza]

Germany's government now says it is epidemic in Germany and everybody knows the infection chains are out of control. The infected went to big public gatherings recently. 

[Richard Hakluyt]

I was wondering about this actually - because I'm currently stuck in my flat so using a lot of delivery services 

And I wondered about what happens if we reach a point where this gets serious and there are people who probably should stop work for a while, for their own benefit and others, but might not be able to because they need the income/may not get sick pay - such as my delivery folks.

The advice is very middle class; centred around people with stable finances, sick pay and jobs that can be done from home. A parcel delivery person in London........almost by definition totally broke and with no employment benefits.........they will continue working till laid low. Another of the hidden costs of eschewing social democracy and the welfare state.

[Razgovory]

It appears that Trump is setting Pence up to take the fall for any failure in the government response.

[Sheilbh]

The advice is very middle class; centred around people with stable finances, sick pay and jobs that can be done from home. A parcel delivery person in London........almost by definition totally broke and with no employment benefits.........they will continue working till laid low. Another of the hidden costs of eschewing social democracy and the welfare state.

And potentially not even eligible for sick pay because they're not a "worker".

[Richard Hakluyt]

They are mostly "self-employed" nowadays yes.

[Richard Hakluyt]

From what I've seen for infection rates/deaths...the common seasonal flu still has it beat.

The statistics you quoted seem to prove the opposite.  The seasonal flu has caused 14K deaths out of 26 million illnesses, or a death rate of 0.05%
COVID-19 on the other hand has caused 2000 deaths out of 75,000 illnesses, or a death rate of 2.6%.

That is on these numbers COVID-19 is about 50 times more deadly then the flu.  If it were to reach the same number of infections as the flu, that would mean over 700,000 deaths.  I would call that pretty catastrophic.

The potential downsides of under-reacting are a MUCH MUCH higher then the downsides of a little media hysteria.

It does seem that maybe as many as 80% of people infected have minimal symptoms. That being so it is possible that the death rate is lower, maybe even below 1%. But it is a two-edged sword; the people with minimal symptoms will make the spread of the virus much easier.

Re media hysteria; I think one of the first things that the authorities need to do is to put out high-quality public service announcements about the virus; try and prevent hysterical misinformation getting out there.

[Sheilbh]

I also think the media's been reasonably responsible so far - if anything the big, slightly hysterical reaction is in the markets. This may not be hysterical but at the minute seems a little disproportionate.

[crazy canuck]

I also think the media's been reasonably responsible so far - if anything the big, slightly hysterical reaction is in the markets. This may not be hysterical but at the minute seems a little disproportionate.

Or just a good excuse for investors to pull out of an over valued market

[Josquius]

I do wonder whether anyone on languish has had it yet and just not realised.

[Syt]

School around the corner from me was locked down for 4 hours yesterday. False alarm. Parents were pissed because there had been little information; school and health departments of the city blame each other.

First confirmed case today: a 72 year old who has been in isolation since the weekend.

Last Tuesday, when the two cases were confirmed in Innsbruck, this guy was seen in an Innsbruck supermarket.

[Tamas]

  Being Austrian, I assume he already has an underground bunker.