John Massey’s Coronavirus 101

John Massey is an engineer, not a medical professional. But he is smart, interested and well read, and he has a solidly fact-based worldview from a Hong Kong observation point. So I think his information is worth sharing, not least to avoid unnecessary fears. Bottom line: it’s not the end of the world.

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Infection: By droplets from coughing or sneezing (max. range about 2m) which can hit you in the eyes, nose, mouth and infect you that way; picking up virus from surfaces (fomites, where it can stay alive possibly for weeks) and then touching the mouth, nose, eyes, where the virus enters through the mucous membranes; direct contact with infected people (shaking hands, kissing, whatever); in at least some circumstances (maybe when the disease has progressed in an infected person to infect their lungs) by airborne transmission (aerosols when people breathe out, so much greater range than droplets, and it can spread through ventilation ducts, central air-conditioning systems, etc.) It is at least as easily transmissible as seasonal influenza, maybe more so.

Incubation: Anywhere from 2 to 14 days (and in a few cases seemingly a lot longer), during which people are asymptomatic but already infectious, so disease control becomes really difficult, particularly combined with aerial transmission. In that scenario, trying to trace all ‘close contacts’ of infected people to identify those who might be infected and quarantine them all becomes an impossibility. But still worth doing, because taking some of those people out of circulation for 14 days quarantine will help to reduce the rate of spread of the virus. The problem then becomes – where do you put them all to keep them in quarantine? Home quarantine becomes an option, but then some people will sneak out, abscond, need to get out to buy food and other essential supplies. But all quarantines leak, they always do, but still worth doing to slow down the rate of spread.

Asymptomatic: Some people remain asymptomatic and recover naturally, but are still infectious while they have virus in their bodies.

Mild: Fever, dry cough, sneezing.

Severe: A % of mild cases will progress to severe, when people begin to experience breathing difficulty – if this is going to happen, it seems to happen about 5 days after the first onset of symptoms (but evidently what takes about 5 days in China is happening in a matter of a few hours in Iran, so it looks like the virus has mutated there to become more virulent), when the virus infects the lungs, and people need supplemental oxygen to keep them alive long enough while they recover from the infection.

Critical: A % of severe cases will progress to critical, where people need intensive support like mechanical ventilation to keep them alive.

Death: A % of critical cases will result in death.

Iran: Worryingly, in a lot of informally reported cases, people have suffered permanent damage to the heart muscle – the whatever, the myocardial muscle. The big pump.

Everywhere: In all severe and critical cases everywhere, some people suffer permanent lung damage.

So, imagine two scenarios: Scenario A and Scenario B.

In Scenario A, public hospitals receive new cases at a rate they can cope with and have sufficient resources to provide the necessary level of medical care, while ensuring that medical staff have sufficient personal protective equipment (masks, eye shields, plastic body suits, etc.) to avoid being infected themselves. Scenario A is what has happened in all areas of Mainland China + Hong Kong + Macau except for Hubei Province. In Scenario A, the fatality rate seems to be around 1%, so about 10x the typical fatality rate for seasonal influenza, which is around 0.1%.

In Scenario B, public hospitals are overwhelmed by being presented with so many cases that they do not have the resources to cope, have only enough beds and can only provide the necessary medical support for the more severe cases, and they do not have sufficient PPE for medical personnel, so a % of them also become infected and some die. This is what has happened in Wuhan (where the case fatality rate has been around 5%) and to a lesser extent in the rest of Hubei (where the CFR has been around 3%), and 3.8% of medical personnel have become infected.

When do you have an epidemic? When you have locally self-sustained transmission of the virus, with an R0 > 1. R0 is the average number of people that one infected person can infect. For SARS-CoV-2, it is working out at about 2.8 on the Chinese data, but you need to watch out for ‘super spreaders’, people who have the ability to shed a much greater viral load and infect many more people, and there have been some of those. R0 is not a constant, and if you can get R0 < 1, the epidemic will die out.

Testing: Difficult, because the early symptoms look like seasonal influenza or a bad cold, so there will be far more suspected cases than confirmed cases. The test developed for it is genetic matching from nasal and pharangeal swabs, you need 3 consecutive tests spaced a day apart to avoid false positives and false negatives, and the test is proving to be imperfect – some people who initially test negative go on to infect others, and then test positive later.

Recovery: The criteria that the Chinese are using, which are pretty solid, are 2 consecutive negative tests + no fever for 10 consecutive days + improving lung scans. But worryingly, some people who have recovered and have been discharged have subsequently infected some others, so now China is quarantining all recovered and discharged cases for a further 14 days.

National epidemics:

China: Guangdong, the second most severely affected province, but still a very long way below Hubei, the epidemic has peaked and died down to close to zero, and they have downgraded their health alert from I to II – I think only Guangzhou and Shenzhen are still locked down, Shenzhen hasn't had a single new known infection for days now, and everywhere else everyone is back at work, but schools remain closed – so in Guangdong they have done a super job; well done, people. Hubei, the epidemic is still going strong but seems to be peaking (which it will at some point – all epidemics peak at some point), and they have started to ease some of the controls on people's movements. Wuhan has been much harder hit than anywhere else in the country. Everywhere else in China seems to have peaked and be on the way down.

South Korea: exploding and in very deep shit.

North Korea: reports daily that they still have zero cases. Believe that and you will believe anything. Anecdotal reports that they are burning bodies like crazy.

Japan: exploding, maybe not quite as bad as South Korea, where it is running wild in the armed services and everywhere, but still a very worrying situation.

Italy: starting to explode. They are trying to control it aggressively by locking places down, canceling all of the football matches (you know things are bad in Italy when they cancel the football) and all of the other sensible stuff they can do, but it still looks like they could be in for a bad time, particularly with their aged population.

Iran: officially, not bad – the Ayatollahs are censoring the news, and everything is pretty much OK. Informally, via anecdotal reports from doctors and others in Iran, it is exploding all over the country, and the virus seems to have mutated there into a much more virulent strain; very high numbers of infection, very high deaths. Really bad. Major disaster.

Indonesia: Thinks it has no cases, but then it has no test kits, and no health care system to speak of. They could have a raging epidemic and not know it. That could apply to a lot of African countries too – lots and lots of Chinese people coming and going to various African countries, so it defies belief that none of them have any of it. Ethiopia still has regular commercial flights to China – they must be out of their minds.

USA: The CDC is sensibly on high alert and actively doing what they can to prepare, getting extra equipment, PPE, etc. The biggest risk to the USA is Canada, which is being run by an idiot. Yes, a worse idiot than Trump, if that's possible.

UK and Australia: The governments keep saying they are well prepared, when they are not remotely – if they get an epidemic, they are screwed, they will be straight into Scenario B.

HK: 74 known cases so far with 2 deaths, so already far fewer than Italy. The local epidemic curve, such as it is, has died right down and we are only getting the occasional small trickle, but some people keep doing dumb things like going to church or the local Buddhist centre or having big group dinners. But people are paranoid and panic-stricken, and the atmosphere is anxiety inducing. The known infection rate so far is 0.001% of the population, so I can't take seriously the idea that we have something you could call an epidemic, but we need to stay careful. By this stage in 2003, with the SARS epidemic (which I suppose I now have to call SARS-CoV-1) we had more than 1,000 infected and 50 deaths, and by the time it burned itself out at the start of summer we had 299 deaths. This could be potentially a lot worse, but so far the reality is far better. So far.

The Diamond Princess cruise ship anchored in Yokohama: Don't want to talk about it. Complete shit-show. If you want to read about the whole dreadful debacle, you can Google it. In short, Japan has earned itself widespread international condemnation for the way it has grossly mishandled the whole dreadful mess, and also condemnation from some of its own very experienced infectious disease control specialists.

Vaccines: none yet, and even if they can find one, it will take about 2 years to test, mass-manufacture and vaccinate everyone, so forget that. I don't want to sound gloomy, but no one has yet managed to find a vaccine for SARS or MERS.

Treatments: none yet, but some individual reported successes with some antivirals, and with plasma from blood taken from patients who have recovered, which has antibodies against the virus (this is far from a new idea, and seems to be quite promising). But they all need proper trials, which will take at least months. In the meantime, the best they can do is just keep you alive long enough for your body's immune system to fight off the virus.

Who dies: Mercifully, not kids, not even newborns whose immune systems are not fully developed, and not healthy young people. Most at risk of dying are older people, and/or people with pre-existing health conditions like chronic heart disease, diabetes, hypertension, respiratory illnesses. And more men than women, both because of smoking patterns in China (half of all men smoke, while fewer than 2% of women do) and because women generally have somewhat better disease resistance. If you are over 80 and have some prior health condition (which almost everyone does at that age), you are basically screwed, but then at that age you are not going to be around for a hell of a lot longer anyway. If you are over 70, you have about an 8% chance of dying, but worse if you have one or more of the above health conditions (assuming Scenario A, not Scenario B).

Author: Martin R

Dr. Martin Rundkvist is a Swedish archaeologist, journal editor, skeptic, atheist, lefty liberal, bookworm, boardgamer, geocacher and father of two.

41 thoughts on “John Massey’s Coronavirus 101”

  1. “some people who initially test negative go on to infect others, and then test positive later.”

    How does one know (as the text at least seems to imply) that they weren’t infected between the initial negative and later positive test?

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    1. If you haven’t been following what has been happening in China, you will just have to take their word for it, or do a huge amount of background reading to catch up. They know what they are doing. I am not going to try to explain it all to you, because I don’t wish to write a book on this subject, and am not the right person to do so anyway.

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    2. I can now answer your question easily, without wading through 2 months of what I have learned from following closely everything that has happened in relation to this virus for the past two months (my psychiatrist first alerted me to an anomalous cluster of ‘atypical pneumonia’ cases in Wuhan that had her really worried in late December).

      Just watch this video. If you are not prepared to at least sit through an 11 minute video, please just don’t ask me any more questions. Ever. About anything.

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  2. “The biggest risk to the USA is Canada, which is being run by an idiot. Yes, a worse idiot than Trump, if that’s possible.”

    Presumably you consider him to be an idiot (at least) in the context of the corona virus. If so, why?

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    1. Idiot in general. In this context, he won’t close Canada to travelers from China (for stupid reasons). So infected people can enter freely (health checks on arrival are not effective), then they can just drive across the border into the USA. Or they can infect people in Canada, who can then just drive across the border into the USA.

      Closing the border between Canada and the USA would be a hopeless task, so it is a gaping hole in the USA’s defences intended to keep out potentially infected people.

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      1. It is not as easy to cross the US-Canada border as it was 20 years ago. They check passports, and if you are from a country that is not part of the visa waiver program (which China is not), you need to have a valid visa for the other country to cross the border in either direction. The US has been clamping down on issuing visas to Chinese nationals even before the coronavirus jumped species (one of my collaborators was not able to attend a conference in the US in December because his visa application was flagged for further review).

        This does not mean that the border will actually stop an infected person whose paperwork is in order. But one does not simply drive into the US if one is not a US or Canadian citizen or US permanent resident. (Canada allows US green card holders to enter Canada, but the US does not extend that courtesy to Canadian landed immigrants–they need a visa, or a passport from a country that is part of the visa waiver program.) And US border agents have broad discretion to refuse entry to anyone even if their paperwork is in order.

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      2. I have been misinformed on the first circumstance, then. The second circumstance could still apply though. But it gets a bit paranoid trying to block every single possible link – if Canada had a big self-sustaining epidemic, I assume the USA would exercise its discretion and refuse entry to everyone.

        Such blocks, and quarantines, always leak, but they still serve an important purpose in controlling the flow of people – dealing with an attenuated curve of infections is a lot easier for hospitals to deal with than a very peaky curve. (Imagine a peaky normal distribution, and then squash it down so it gets flatter but lasts longer – the rate of people presenting with symptoms and possibly infected is a lot easier for hospitals with necessarily limited facilities to deal with – Scenario A instead of Scenario B.)

        Scenario B is the bad one that everyone should be trying to avoid – that is when the case fatality rate shoots up, and a lot of people die who could be kept alive long enough to recover in Scenario A.

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      3. Parts of the US-Canada border can be crossed on foot, but these places tend to be a long way from any sizable city. For instance, I expect that much of the border between Alaska and the Yukon Territory isn’t fenced–but these areas are so remote that it is difficult to even get there. There are even a couple of crossings where the border guard is not physically present–but these crossings lead to exclaves (Point Roberts in Washington state and the Northwest Angle in Minnesota) that have no direct land connections to anywhere else in the US. Furthermore, if you are of non-European ancestry and you are crossing the 49th parallel part of the border east of the two crossings that handle Vancouver-Seattle traffic, you are going to stand out.

        In other places, the US-Canada border follows rivers and lakes. This is true of the stretch of border from the Northwest Angle to just downstream of where the Saint Lawrence River crosses 45 degrees latitude, near Watertown in New York (east of which the border runs due east until it intersects the border between Vermont and New Hampshire). Between Thunder Bay and Watertown there are only five border crossings: the bridge at Sault Sainte Marie, a bridge and a tunnel at Detroit/Windsor, and two bridges at Niagara Falls/Hamilton.

        For the record, I have crossed the US-Canada border by land in the following locations: Peace Arch, Pacific (these are the two Vancouver-Seattle crossings), Champlain (serving Montreal-New York City traffic), Highgate Springs, Derby Line (these two serve Montreal-Boston traffic) and Pittsburg (the last is the one border crossing in New Hampshire). Four of those are motorways, so not walkable. The Pacific crossing serves truck traffic (trucks are not allowed to use the Peace Arch crossing), so while it would technically be legal to walk across there, it’s not practical. That leaves Pittsburg, which border crossing is about 20 km north of that town’s village, the northernmost settlement in the state of New Hampshire. You can walk across there, but it would have to be part of a long hike, or something involving coordinating rides in a remote area.

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      4. Sweden, Norway, Finland, and Denmark are all in the Schengen zone, so crossing the borders between Sweden and the neighboring countries (unless you are driving a truck, in which case there may be border checks between Sweden and Norway) is little different from walking across the border between two US states (which I have done). The closest Sweden comes to having a real border is the maritime border with Russia, and that would only come into play if there is ferry service between Sweden and either Saint Petersburg or Kaliningrad. (I do not know whether there is any SE-RU ferry service, as opposed to ferries to Germany, Finland, and Estonia, all of which are in the Schengen zone.)

        Trespassing is very much frowned upon in the US, and depending on the landowner and state, anti-trespassing laws may be enforced with guns. I have seen a sign on a private house with the following words: “Trespassers will be shot. Survivors will be shot again.”

        There is also the sheer size of both the US and Canada. From Boston to Seattle is a distance of about 4000 km by air, and about 5000 km by road. Canada is even bigger than the US..

        The mastermind of the Millennium bomb plot tried to enter the US via the ferry from Victoria, BC, to Port Angeles, WA. He was caught because the customs inspector had a hunch that something wasn’t right, and opened up his car trunk to find the bomb materials. (It is against US law to bring hazardous materials, such as explosives, on a common carrier such as a car ferry.) That was before 9/11, so he would be even less likely to go through today.

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      5. I would be very surprised to see Sweden get an uncontrollable self-sustaining epidemic. I really doubt that will happen.

        It seems possible there might be an outbreak in one or two cities (Malmö seems the most likely, or least unlikely) but that should be controllable, and if controlled, case fatality rate (CFR) would be kept to 0.9%, which is tolerable in societal risk terms.

        But CFR seems to be varying a lot in different countries – in Italy it is currently about 3%, which is close to the whole of Hubei Province at around 3.3%. Why? Only reasons I can think of: (1) very old population, maybe particularly in the towns worst affected, or (2) in the towns worst affected, the hospitals have been overrun with suspected and confirmed cases, so they are in Scenario B. I can’t think of any other reasons. I discount genetics – this is a new disease to all humans, so genes shouldn’t make that much of a difference. But there is some suggestion in the medical literature that ‘double hits’ make a difference; so if a population has previously been hit by some other epidemic, like maybe a particularly bad ‘flu season (and the dominant strain this season is H1N1, so it is particularly bad if people have not been vaccinated) and if there has been a lot of secondary infections of pneumonia, the people previously infected seem more vulnerable to dying from a new infection.

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      6. What I read coming out of those quarantined north Italian towns is that the local authorities are overwhelmed. That sounds right.

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      7. Yes, the vast majority of the Canadian-US border can be crossed on foot or in a kayak. It runs through suburbs, buildings, and ecosystems and is thousands of kilometers long, how could it be otherwise? There are demilitarization agreements going back to 1818 when London and Washington looked at the cost of trying to build war fleets on the Great Lakes (one upstream and one downstream of the Falls!) and decided that it was a silly idea.

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  3. “very experienced infectious disease control specialists”

    A pet peeve are missing hyphens in compound adjectives. Presumably the specialists are not infectious, but rather the disease.

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  4. “Infectious disease specialist” is a standard term. This is the way everyone writes it, and everyone understands what it means, including me. If you have an issue with it, I am not the right person to take that up with. If you want the world to change to satisfy your pet peeve, you have a job on your hands.

    To convey that such a person is infected, you would need to write something like: a very experienced infectious disease specialist who is himself infected. There has been at least one such person in China, and that is the way it has been expressed in multiple media.

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  5. Huh. I just noticed that Malmö in July is like Hong Kong in February in terms of mean temperatures. But much bigger difference in hours of daylight between summer and winter than in Hong Kong, obviously.

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  6. Under appreciated fact – more than half of the doctors and 90% of the nurses who are treating Covid 19 patients in Hubei Province, where the hospitals have been totally overwhelmed, are women.

    So the front line battling the coronavirus in Hubei are mostly women. You might think that at least someone would find that newsworthy, but I guess not.

    A lot of these women have been having their heads shaved, in the interests of hygiene, plus I guess it is just easier not to have to deal with hair washing and drying when they are working very long hours for very extended periods, and easier for donning and removing hazmat suits. Whatever – just easier.

    The medical personnel who treat Covid 19 patients need to wear full hazmat suits, which are in critically short supply. When they need to go to the toilet, they need to ‘de-gown’ safely, which is a process (ask my daughter). And they can’t reuse the same suit – they need to dispose of it properly (another process) and use a new one. So, to avoid that, they are wearing adult diapers, and just pissing in their pants.

    Women, surprise surprise, menstruate. Hygiene products for women are in critically short supply – factories have been diverted onto making masks and other protective gear. So the female medical workers are working in diapers soaked in both urine and menstrual blood, so they are at risk of urinary tract infections.

    3.8% of medical workers in Hubei Province have been infected with the coronavirus, and some of them have died. Chances are the majority of those have been women. Medical workers there have been at heightened risk of infection, and have a higher fatality rate, because: (1) full protective gear has been in short supply, and (2) they have been working such long hours that they have become physically exhausted, which has caused their immune systems to become suppressed; so if they are infected, their immune systems are less able to fight off the infection.

    The necessary medical support for severely and critically ill patients (like supplemental oxygen for severe patients, and mechanical ventilation or similar for critically ill patients), to keep them alive long enough for their immune systems to fight off the infection, has been severely stretched. When that essential medical support cannot be provided, the fatality rate rises from around 0.9% (currently in South Korea I calculate that it is 0.6% so far, so they are doing well, but it is still early days there), which it has been in almost all areas of China outside of Hubei Province, to just under 5%, which is what it has been in Wuhan – ground zero.

    If the numbers coming out of Iran can be believed (which I seriously doubt), I calculate the current fatality rate there to be 10.6%. I suspect but don’t know that the fatalities are probably being accurately reported, as far as they are known, but the total infected cases are being under-reported, either because the Iranian government is suppressing them, or because they just don’t know. Both are possible. That would inflate the fatality rate. Anecdotal reports from doctors in Iran talking to doctors in other countries by email, etc. (at no small personal risk to themselves) is that the fatality rate is running at about 5%. That would suggest (1) the virus is no more virulent in Iran than elsewhere, but (2) the hospitals in Iran are all overwhelmed. Iran already faces severe shortages of essential medical supplies because of international sanctions – essential medical supplies are supposed to be exempt from the sanctions, but the USA has been discouraging international banks from having any financial dealings with Iran, so the problem is that they have no way of paying for the medical supplies that they need. It is a big country, > 83 million people.

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  7. The Coronavirus is said to be at least as infectious as seasonal influenza, probably more so. In a normal ‘flu season, you would expect about 15% of a population to be infected. Someone can correct me if I have got that wrong, but it’s likely to be somewhere around there.

    In Hubei, by far the worst affected province in China, the infection rate is about 1%. In all other provinces it is much lower – the second worst affected per capita is Zhejiang, it’s 0.002%. So what’s going on – Chinese authorities lying, massive cover-up? In Guangdong Province, where I have a reasonable level of confidence on the numbers, the infection rate is o.oo1%. In Hong Kong, very much smaller sample but where I have absolute confidence in the numbers it is 0.001%, same as Guangdong. And in Zhejiang, where the hospitals have not been overrun, there has been…..1 death. Well done, you Zhejiangese. In Guangdong, China’s most populous province with 113.5 million people, there has been 7 deaths. This is in a country with awful air quality in most cities, where 50% of men smoke (and fewer than 2% of women do), and 10% of adults have Type 2 Diabetes – prior conditions known to increase risk of dying in infected people. In Hong Kong, there has been 2 – a 39 year old man with prior chronic heart disease who died of sudden heart failure, and a 70 year old man with an undisclosed prior chronic health condition, cause of death also not disclosed, but probably hypoxia causing multiple organ failure (I’m guessing, but it’s a reasonable guess).

    Among the passengers and crew aboard the Diamond Princess cruise ship anchored in Yokohama, where there was absolutely no effective infectious disease control at all, the infection rate is currently around 20% (and still climbing, among people who have been evacuated from the ship by their own governments). Yikes.

    That is the difference. In a normal ‘flu season, aside from the minority of the population who get vaccinated, there is effectively no government coordinated containment and control. In the Chinese provinces and in Hong Kong, there has been very aggressive containment and control. Plus a highly ‘mobilised’ (worried) population all exercising avoidance behaviours and self-protection like frequent thorough hand washing, and the large majority of the population being very self disciplined and complying with quarantines. It makes a huge difference. If 15% of the whole Chinese population were infected with the coronavirus, and 5% of them died (so more than 50 times the typical fatality rate from seasonal influenza), the country would be on its knees by now, and secondary effects like widespread food shortages would be causing a lot more deaths, and probably an even greater rate of infection. And the national economy would be destroyed. Coronapocalypse.

    As it is, the Chinese economy has taken a big hit, but it can recover quickly once the epidemic is over, which most international ‘experts’ (really dislike that word) are predicting will be by the end of May, but which leading infectious disease specialists in China are predicting will be over by the end of April (I think they are being optimistic, but we’ll see). BUT that will depend on, ironically, China keeping out infection reintroduced into the country from other countries.

    Per capita, the infection rate in South Korea has already shot past all Chinese provinces except Hubei, where infection spread too much before containment measures were implemented, but still only 1% infected – but that was enough for all of the hospitals to be completely overrun by severely ill people. Italy is getting up there, but somewhat more slowly than South Korea because they have locked down towns and are doing what they can to contain infection, but they need to do more. I just don’t believe the numbers from Iran, and they are not doing nearly enough to avoid a national disaster, which will flow over into other countries.

    I am far from confident that the governments of the USA, the UK and Australia (and maybe Canada, but I don’t know – I don’t know enough about Canada and shouldn’t speculate) are prepared to do what is necessary, because they are looking at what has happened in most of China and thinking the risk is really not that bad, and that avoiding impacts on the economy as far as possible is more important (that is certainly what Trump thinks, and he’s wrong). They all think they are sufficiently prepared, and that they have got this covered. I have read all of their national preparedness plans, and I don’t think they have got it covered at all. If that is what they are thinking, they could be making a big mistake.

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  8. Could be ambiguous. I mean, if 15% of the population were infected, and 5% of the 15% infected died, so 0.75% of the total population died. In the case of China that would mean an additional 10.5 million people dead, all in the space of less than two months.

    As it is, the current number of deaths is around 2,800, most of those in Hubei Province.

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  9. If DailyNK is to be believed, there may be no cases in North Korea, but the government is taking action suggesting that there have been cases. For example, they’ve delayed the release of the latest military training cohort by two weeks and have cut back on domestic travel permits, in both cases citing fears about COVID19.

    The Italian infection is ironic. That part of Northern Italy is seriously anti-vax, so odds are not a lot of folks have gotten flu vaccine. Even if we had a COVID19 vaccine, odds are too few would take it for herd immunity.

    COVID19 doesn’t seem to be like the 1918-1919 flu. It is killing the old and more vulnerable. The post-Great War epidemic didn’t change the mortality of children or old people, instead it killed a lot of people in the middle including a lot of young men who had managed to survive the war.

    I wouldn’t worry about Canada all that much. There are only a handful of flights from China to Canada, and they are only from coastal cities like Hong Kong and Shanghai, none from further inland. If I wanted to worry, I’d worry about Californians who seem to be catching COVID19 all on their own, and I don’t think we have a legal way to keep them out.

    P.S. As for crossing the Canadian border, try the Pacific Crest Trail. If you are in good enough shape to hike the Pacific Crest Trail, odds are you aren’t infected. This trail is famous in hiking circles for its wilderness mountain beauty and because there is technically no legal way to cross the US / Canadian border along the way. You can get the US and Canadian wilderness passes at the appropriate ranger stations, but there is no way to wangle to border crossing. Mind you, this doesn’t stop serious hikers.

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    1. I think you are right; California is in trouble. Community transmission is occurring. One guy with symptoms presented himself to a hospital and tested negative, so got sent home. Then presented himself to another hospital and tested positive. So because of that one case, almost 100 hospital staff have been quarantined, and who knows how many members of the public attending those two hospitals could have been infected (not to mention how many people he might have been in contact with during the incubation period when he was asymptomatic but already infectious). The test kits being issued by the CDC are only 70% reliable, which is a major concern – potentially a lot of false negatives.

      So now Canada needs to worry about keeping Americans out, not the other way round.

      It is like the truly ironic situation now with China, where the biggest risk now is reintroduction of infection into China by people coming from other countries. They have already quarantining all travelers to China from South Korea, which is in serious trouble, despite having an excellent healthcare system and doing whatever they can to limit transmission (not assisted by >200,000 doomsday cult people who are all trying to hide from the authorities to avoid being tested, and all out potentially infecting other people).

      Virtually the only external trade that North Korea has is by traders from NK crossing into northern China, which has multiple cases like almost everywhere else in China, so it absolutely beggars belief that there are no cases in NK. There are certain to be.

      The good news is that there are no cases (yet) in Antarctica, so the penguins are OK.

      To try to hammer home points I have already tried to make: this coronavirus is very infectious; there is a huge difference in outcome depending on whether there is effective containment and control, or whether there is not; the fatality rate varies a lot depending on whether hospitals can cope and provide the necessary level of care to severely ill patients, or whether they are overwhelmed with cases and do not have enough beds, properly protected staff, oxygen supplies and equipment to keep people alive or not.

      Don’t be lulled into a sense of false security by thinking that it only kills old people. It is true that the fatality rate rises with age, and THERE HAVE BEEN ZERO FATALITIES IN THE 0 – 9 YEARS OLD AGE GROUP, which has to be really good news. But there have been fatalities in all other age groups. A 20 year old chronic asthmatic should be concerned. A 30 or 40 year old with Type 2 Diabetes should be concerned – the highest % of fatalities has occurred among diabetics, and most countries now have a pretty high percentage of adults who are diabetic, including China and even more so India. But also the Anglophone and European countries as well. And once your healthcare system is overwhelmed, the fatality rate zooms up a lot. There is a huge difference between <1% and possibly as much as 20% fatality rate.

      The other piece of good news I can give is that, like the SARS and MERS coronaviruses, the SARS-CoV-2 coronavirus looks like it is very genetically stable. It is not mutating (despite earlier fears that it might have mutated into a more lethal strain in Iran – that has turned out not to be the case). So, this is really good news because people who have been infected and recovered cannot be reinfected, it should increase the chances of being able to make an effective vaccine, and it shows no sign of mutating into more lethal or even more infectious strains. This is really a piece of good news.

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  10. This is one of the bad side effects.
    https://www.scmp.com/news/china/society/article/3052997/coronavirus-fears-prompt-panic-buying-cities

    “there were no reports of mass panic buying in the US” – oh yes there are. People in the USA have noticed that there has been a big spike in people buying non-perishable foodstuffs from Amazon. The preppers are prepping.

    The Mormons have already prepped. I didn’t know this, but apparently Mormons believe in keeping a year’s supply of non-perishable food stashed away at home at all times.

    In Hong Kong I couldn’t buy toilet paper anywhere, or facial tissues or any other product that could serve the purpose in an emergency, and my family were getting perilously close to a situation which I don’t want to think about – using our hand held shower as a bidet, I suppose, but that would be a very unattractive alternative and require frequent disinfection of the shower cubicle. But thankfully that is over now.

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  11. Comment by someone on Gregory Cochran’s blog that would be amusing if…

    “You will be relieved to know that your man Trump calls the coronavirus a hoax. It’s those dirty no good democrats new hoax. He also says

    “one day like a miracle coronavirus will disappear.”
    “Vice President Pence is really very expert in the field.” (In infectious disease)
    “It’s a little like the regular flu that we have shots for and essentially we will have a flu shot for this in a fairly quick manner.”
    “this is the flu. This is like the flu and this is much different than Ebola.”

    Why we can all sleep easier now.”

    I’m looking forward to the promised miracle. I suppose the bright side is that Trump himself, over 70 and obese, probably diabetic, is in the ‘death zone’. But then that would put Pence in charge, so…but that’s not so bad, because we are informed that Mike Pence is really very expert in infectious disease control. Americans must be feeling hugely reassured.

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    1. The good news is that on the subject of infectious disease, Mike Pence is not incompetent. The bad news is that he is anti-competent; in other words, you can be sure he will do the wrong thing. At least an incompetent administrator will sometimes, by chance, do the right thing.

      When he was governor of Indiana, Pence opposed a needle exchange program on religious grounds, resulting in a substantial HIV outbreak in the state. There is at least one Indiana county where about 1% of residents are HIV positive. This comes on top of the opioid and meth issues that plague much of the rural US.

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  12. For those who haven’t read the WHO’s China mission report, it is clear the WHO believe that transmission is by droplets from coughing or sneezing (which have a maximum range of about 2m) or contact (either direct contact with people, or picking up virus from surfaces on the hands and then transferring it to the mucous membranes in your eyes, nose or mouth by touching your face. They do not believe aerial transmission is happening (which is a biggie, and a relief if they are right), and they think the faecal-oral route is only a slim outside chance.

    So, that points to what the effective personal protective measures are:

    (1) Good hand hygiene and don’t touch your face without washing your hands thoroughly with soap and water first, or by using a hand sanitizer containing at least 70% alcohol (repeat, on your hands, not by drinking it) (sorry, just my little joke) but in which case you need to leave the hand sanitizer on your hands for a little while to give the alcohol time to do its work – actually, it will normally evaporate by itself without the need to rinse it off and dry your hands, so you just let it do that.

    (2) Distancing yourself from people. So no kissing, hugging, shaking hands with people in the street, and giving strangers a pretty wide berth. If you are Muslim, no kissing walls of religious shrines or rubbing your hands on the walls and then on your face. What you really don’t want is someone sneezing or coughing directly into your face. How sick you get with any virus is a function of, inter alia, how much viral load you receive.

    I do recommend reading the WHO’s China report though; it’s only 40 pages in total and not that difficult to get through. The Chinese scientists and doctors now know much more about this coronavirus than anyone else, for what should be self evident reasons, and the report will tell you quite a lot about what they have already figured out – and a lot of stuff that they don’t yet know as well.

    A surprising fact is that they have not yet been able to identify the source of the virus. They are confident that the reservoir animal for the coronavirus is bats, but they have not been able to identify the intermediate animal that enabled the virus to jump into humans, despite trying very hard to do that.

    In 2003, they identified the ‘intermediate’ animal that enabled the SARS coronavirus (also from bats) as palm civets which were being sold as food, and my recollection is that they were able to do that really pretty quickly. And that was then, and this is now.

    So in this case it is really a mystery. One of the problems with that is that, if they don’t know where it came from, they cannot be certain that the source is no longer out there in the community in Wuhan somewhere, and that is a worry. Today’s China Daily quotes Xi Jinping as saying that the epidemic in Wuhan is not yet contained, and that is borne out by the reported daily number of new infections in Hubei Province – they are dropping, but they are still a long way above zero. So, watch this space – that is a mystery they really need to solve if they can.

    The Chinese National People’s Congress Standing Committee has banned the captive breeding of, trading in or consumption of all wild animals with immediate effect, so if as suspected the intermediate source is some live wild animal being sold in markets for food, that should have been removed by now, but until they can get confirmation of the intermediate source, they can’t be certain that they have eliminated it.

    Liked by 1 person

  13. At least six deaths from coronavirus were reported in the Seattle metro area yesterday. Five in King County, where my sister lives, and one in Snohomish County, where my >80 year old mother lives.

    And it looks like if any of us will be traveling this summer, it will be my mother, since a relative has announced plans for a wedding in the Adirondacks (upstate New York) in July.

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  14. One thing that has not yet changed: spam for dubious international conferences in China. I got an e-mail invitation to a conference, sponsored by a group I have not previously heard of, scheduled to take place in Hangzhou in May of this year. The invitation is based on a paper I published two years ago.

    Even if I had the budget for international travel (I don’t) and were familiar with the sponsoring organization, I don’t want to count on things being back to normal in Zhejiang by May. Air travel between the US and China will probably still be disrupted (this may be more on the US than China). And although the conference organizers may have arranged deals with hotels near the conference site, I have even less confidence than usual that the prices on offer will be good prices. I suspect anybody willing and able to risk travel to Hangzhou in the next several months will find good bargains on hotel rooms.

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    1. Cousin E told me today that Hangzhou hasn’t had a new confirmed case in two weeks and that restrictions have therefore been eased in town. He took a long walk around the West Lake to celebrate.

      Liked by 1 person

      1. And still only 1 fatality in Zhejiang.

        Chinese health authorities have predicted that there will be 0 new cases outside of Hubei Province by mid-March. It’s a brave prediction – China now has a problem with back-migrations of people who have been infected in other countries.

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    2. Swap you – I get endlessly spammed for dubious conferences in the USA (because I work for an American parented multinational company with 80,000 employees worldwide, but it seems a lot of Americans are not aware that the rest of the world is not just some small extension of the USA).

      I would like to have $1.00 for every time some company employee writes an email that is only relevant to people in some part of the USA, and then hits the SEND button to the full company address list of 80,000 people. Employees in multiple other countries have given up asking the Americans to quit spamming them all the time, because it just doesn’t seem to sink in with the American staff concerned. Or maybe it’s just easier to send the emails to everyone, and not care that you are cluttering up the IN boxes of tens of thousands of people that you don’t care about.

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  15. I’m tempted to ask how the appalling debacle with coronavirus testing is going in the USA, but I’d better not. Besides, I already know the answer – at a time when both South Korea and China are cranking out hundreds of thousands of tests weekly, so far the USA has managed a total number of tests in the hundreds. And Japan.

    I thought that Japan was actually doing pretty well on containing the spread of the coronavirus, going by the total number of known infections. No. It just turned out that they weren’t doing many tests. This is the country that insists that the 2020 Olympics are going to go ahead in Tokyo (and Hokkaido, which is currently locked down) in July.

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  16. Reading my original post with some embarrassment – the biggest risk to Canada now is the USA; the opposite of what I predicted.

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