Do we Cancel Everything? You still Travelling??

[scianoir 610]

On ‎3‎/‎12‎/‎2020 at 9:34 PM, Andiroto said:

In South Korea is tested a lot. This means that many infections, even mild ones, are recorded. With around 7,500 officially infected people, South Korea only has 54 deaths - significantly less than one percent. The same is expected for Germany, where a differentiated laboratory landscape enables extensive tests. Lothar Wieler, President of the Robert Koch Institute, also mentions mortality around one percent as expected in Germany. In comparison to a flu wave, the statistical death rates of the coronavirus are “five to ten times as high”. But: These rates "are constantly changing because we don't have that many numbers yet."

As a retired doctor, I have been watching the trends in various countries and, I agree, the South Korean figures are possibly the closest we might have to an accurate assessment of the risk. Most other countries, including the one in which I live, really have no idea of the prevalence of this virus in their communities because they are simply not testing enough people. What I would have thought is really needed is a random sample of tests from a very large number of the population to try to get an idea of the prevalence. If that proved that a lot of people had the virus with minimal or no symptoms, it might throw a new light on the mortality rate and perhaps make the figures currently emerging from many countries seem a little less terrifying. Unfortunately, given the apparent shortage of testing kits, I guess that is unlikely to happen so the optimistic side of me (which doesn't frequently emerge these days!) is hoping that the prevalence of the virus in the community, in people with little or no symptoms, is much higher that we realise which would mean that the mortality rate becomes proportionally less.

Keep hoping (and for those of you that believe, praying)

Bill

[Dominique_K 10,147]

Beyond all the data that are used or often abused, I see two elements which are reasons to worry  : 

1/ Numerous governments of various political flavors (left/right, presidential/parlementarian, democratic/tyranny, etc.),  some from countries with a very high level of health research (EU, US, Israel) take the same tough and unheard of confinement measures.

If you have ever been close to top-level decision circles you know that politicians agonize over such harsh decisions, not because they are cowards (some are, most not) but because they need to decide fast knowing they will never have in time a clear picture even with all the specialists around them (the known unknowns and the dreadful unknown unknowns). And that there is a price to pay at the end of the day. And I mean not only losing the next election. I mean having your own people die. You don't feel good.

2/ All the MDs are today on professional networks, continuously exchanging tons of  emails. What I understand is that the mood is rather gloomy, very gloomy on these networks. The lethality of the virus is one thing. The inability of the medical infrastructures (ICU) and staff to respond in real time is worrying. No country can have an ICU infrastructure to respond to one-in-a-century pandemic of this magnitude. This is what confinement is all about. Not stopping the disease - the cure or vaccine are still inexistant -  but to spread  it over several months for the infrastructures to be able to take care of the sick people.

 

 

Edited March 15, 2020 by domkle

[Andiroto 37]

@scianoir 

One should also take into account that the communication possibilities have improved considerably since SARS 2003 and the world can now follow such an event almost in real time! For example, during SARS I had no internet! 
I also hope that we all go through this time relative unscathed and are hopefully better equipped next time against such pandemics worldwide!

[psolk 3,040]

3 hours ago, fluffyflops said:

TB wasnt created from a wet market.

 

TB is estimated to be 6,000 years old I'm pretty sure it didn't start from day 1 at 3,000 deaths per day...  

[Farlis 2,287]

4 hours ago, Nedo68 said:

Germany closes all its borders tomorrow

Incorrect. Only the borders to Austria, Switzerland and France are closed. These are far from all. However Denmark has closed it's border to Germany last week and Poland and the Czech Republic did the same. So as a german citizen you can only get out to the Benelux countries at this point.

[Alan_A 1,650]

4 hours ago, scianoir said:

...a random sample of tests from a very large number of the population to try to get an idea of the prevalence. If that proved that a lot of people had the virus with minimal or no symptoms, it might throw a new light on the mortality rate and perhaps make the figures currently emerging from many countries seem a little less terrifying.

With the caveat that you'd have to test multiple times to account for asymptomatic transmission.  If current estimates hold, the asymptomatic period is 7-14 days.  That's a lot of potential for spread.  So a large number of positives with minimal or no symptoms would, as you say, take the case fatality rate down in the immediate term.  But given what we also know about R-zero and doubling time, it could also point to a much higher level of hospitalizations and fatalities 2-4 weeks out.

[Alan_A 1,650]

Good take here on how exponential growth works:

Quote

There’s an old brain teaser that goes like this: You have a pond of a certain size, and upon that pond, a single lilypad. This particular species of lily pad reproduces once a day, so that on day two, you have two lily pads. On day three, you have four, and so on.

Now the teaser. “If it takes the lily pads 48 days to cover the pond completely, how long will it take for the pond to be covered halfway?”

The answer is 47 days. Moreover, at day 40, you’ll barely know the lily pads are there.

That grim math explains why so many people — including me — are worried about the novel coronavirus, which causes a disease known as covid-19. And why so many other people think we are panicking over nothing.

 

[odourboy 1,289]

2 minutes ago, Alan_A said:

With the caveat that you'd have to test multiple times to account for asymptomatic transmission.  If current estimates hold, the asymptomatic period is 7-14 days.  

That's more dire then what I've read. Symptoms may show as early as 2 dsys. The median incubation period is 5.1 days. 97.5 % show symptoms within 11 days. 

[Alan_A 1,650]

2 minutes ago, odourboy said:

That's more dire then what I've read.

Could well be - the 7-14 day estimate is very broad and it's at least a few days old, which is quite old in the current scheme of things.

Problem is, it's impossible to tell for sure without widespread testing - which except in a few places (South Korea) isn't available.  Right now everyone's trying to extrapolate from available figures - e.g. looking at the growth curve in Italy and trying to project to other populations, such as in the US, which is showing the same rate but about 20 days behind.  But there's a lot we don't know yet.  Which is not reason to be complacent.  It's a case of hope for the best, plan for the worst.

[fluffyflops 1,858]

27 minutes ago, Alan_A said:

Could well be - the 7-14 day estimate is very broad and it's at least a few days old, which is quite old in the current scheme of things.

Problem is, it's impossible to tell for sure without widespread testing - which except in a few places (South Korea) isn't available.  Right now everyone's trying to extrapolate from available figures - e.g. looking at the growth curve in Italy and trying to project to other populations, such as in the US, which is showing the same rate but about 20 days behind.  But there's a lot we don't know yet.  Which is not reason to be complacent.  It's a case of hope for the best, plan for the worst.

We might not have agreed on stuff before, but you definitely seem to know your stuff on this covid virus ill give you that 

[Alan_A 1,650]

10 minutes ago, fluffyflops said:

We might not have agreed on stuff before, but you definitely seem to know your stuff on this covid virus ill give you that 

Thanks!

As I've said before, there's so much misinformation around that I want to do what I can, even with just a minimal background.

I also owe you an apology for an earlier harsh reaction to one of your posts about the wet markets.  You're right to call them out - or at least, as the LA Times pointed out, it's not so much the wet markets themselves as the live animal sales, which is of course the point you're making.  You got it right.

SIV (Simian Immunodeficiency Virus) probably jumped species and became HIV as a result of hunting chimpanzees for the meat trade.

So yes - animal cruelty, and the failure to police that, is at the heart of a lot of this.

 

[Dominique_K 10,147]

A misconception one needs to eradicate from people's mind is that only the old people are at risk. They are at greater risk to die but the virus also attacks adults of any age with devastating and deadly effect.

[charliearon 3,024]

OK, this should answer any questions about flying!

 

[Nedo68 533]

13 minutes ago, domkle said:

A misconception one needs to eradicate from people's mind is that only the old people are at risk. They are at greater risk to die but the virus also attacks adults of any age with devastating and deadly effect.

we are not told everything for good reasons,
but this days you can get very good information directly from the source, like from one Doctor ( Dr Daniele Macchini) from one of the Hotspot in Italy:

'Stop saying it's a bad flu'
He also stressed the virus does not just affect old people,
warning that younger people "end up intubated in intensive care"
or "worse in ECMO (a machine for the worst cases, which extracts
the blood, re-oxygenates it and returns it to the body, waiting
for the organism, hopefully, heal your lungs).

His message was shared just before the Italian government put the entire country on lockdown.

 

 

 

[Alan_A 1,650]

33 minutes ago, domkle said:

A misconception one needs to eradicate from people's mind is that only the old people are at risk. They are at greater risk to die but the virus also attacks adults of any age with devastating and deadly effect.

Quite right. This take is pretty sobering

Quote

 

...Fatality is the wrong yardstick. Catching the virus can mess up your life in many, many more ways than just straight-up killing you. "We are all young"—okay. "Even if we get the bug, we will survive"—fantastic. How about needing four months of physical therapy before you even feel human again. Or getting scar tissue in your lungs and having your activity level restricted for the rest of your life. Not to mention having every chance of catching another bug in hospital, while you're being treated or waiting to get checked with an immune system distracted even by the false alarm of an ordinary flu. No travel for leisure or business is worth this risk.

Now, odds are, you might catch coronavirus and might not even get symptoms. Great. Good for you. Very bad for everyone else, from your own grandparents to the random older person who got on the subway train a stop or two after you got off. You're fine, you're barely even sneezing or coughing, but you're walking around and you kill a couple of old ladies without even knowing it. Is that fair? You tell me.

My personal as well as professional view: we all have a duty to stay put, except for very special reasons, like, you go to work because you work in healthcare, or you have to save a life and bring someone to hospital, or go out to shop for food so you can survive. But when we get to this stage of a pandemic, it's really important not to spread the bug.