I am impressed how fast Chinese scientists developed a genetic test distinguish 2019-coronavirus from other kinds of pneumonia. I am old enough to remember biologists flailing around for 4 years to identify the HIV virus and two years more for slow (two week) test.
> I am old enough to remember biologists flailing around for 4 years to identify the HIV virus and two years more for slow (two week) test.
HIV is rather fragile, no? It only spreads in specific bodily fluids and shows very little viral load when dormant.
2019-nCoV spreads in air. That's a significantly hardier virus that produces quite a lot of virus particles that are way easier to detect.
In addition, please remember that molecular biology was just getting started when the AIDS epidemic hit. AIDS (1981) predates PCR (1983). Molecular biology and computing have come a long way in 40 years, and we have a lot more tools at our disposal nowadays.
> I am old enough to remember biologists flailing around for 4 years to identify the HIV virus and two years more for slow (two week) test.
I suspect that part of this comes from the fact that people thought the disease was thought to target gay men. In fact, AIDS was originally called GRID -- Gay-Related Immune Deficiency. There was plenty of (truly awful) folks out there who felt that it was some sort of cosmic justice.
It’s interesting to watch the response to this crisis ricochet around the world. Results come from China, the CDC sequences the virus from the Chicago and Seattle patients and releases them, researchers in Seattle process the merged data through their open source tool[0]. Researchers in China then translate these results to Chinese [1]
Of the initial 41 patients, 13 were admitted to ICU and 6 died(15%). This is the data the news has been missing and shows why China is taking this so seriously.
A 15% mortality rate is huge, but considering that this is a newly identified disease, the actual mortaility rate might be much less. Inventing some numbers, let's say that 3000 people were already infected when the initial 41 patients were identified -- those 41 being the sickest. The other 2959 people either didn't have symptoms or were assumed to have a cold or flu, and they all recovered. Had there been a reliable way to identify the hypothetical 3000 infected people, the mortaility rate would be only 0.2% if 6 had died.
We have 2700 confirmed cases, 80 dead. Some also in the West and we are still talking about these initial 41?
Are we a pre or post internet civilisation?
Honestly 4chan is doing better than this. Reading through their noise is better than the clean data coming out of the officials. For example they have people in pools of blood on the street with people in the bio suits China are using.
Maybe it's obvious people will throw up blood with this new SARS, but the officials aren't mentioning it. Sperm may contain the virus for months. Again obvious, not seeing it on official feeds.
In pretty much zero cases do I believe reading 4chan leads to a better understanding of an event than reading the news does. Coughing up blood is a symptom of pneumonia, which has been reported since the beginning of the outbreak.
Also, how is lifetime of the virus in sperm relevant at all and do you have a source for it? I couldn't find anything online about that and can't think of how it could affect anyone.
> obvious people will throw up blood with this new SARS, but the officials aren't mentioning it
Aren't mentioning it? How can you say that?
The linked article directly addresses this right in the Findings section, where it says, "haemoptysis (two [5%] of 39)".
Wikipedia's definition (https://en.wikipedia.org/wiki/Hemoptysis):
"Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs."
So 5% of (that small sample size of) patients cough up blood.
It would be interesting to see less accurate statistics on the total CURRENT number of cases rather than this OLD NEWS. Cool for whoever published that, but we need more focus on speed of information dissemination, even prioritising it over accurracy, we're moving at pre-Internet pace here or someone is actively hindering the flow of info...
one might assume that those who need to know are in response rooms and have more current information. Im not sure that a minor delay to the general public makes any difference whatsoever on outcomes.
> we need more focus on speed of information dissemination
I'm curious why you think so. This report is very detailed from a medical point of view, if you want current numbers there are other news sites for that. Besides, why do you need the current numbers, so you can panic faster?
My wife just pointed out what might be a spurious anecdote: no Caucasians died during the SARS epidemic in 2003, and none have died so far in response to this novel virus. Is there any data to back this up?
(She was in Beijing during 2003, and saw SARS first hand)
> no Caucasians died during the SARS epidemic in 2003
That's not accurate:
29 March 2003
Dr. Carlo Urbani, an expert on communicable diseases, died today of SARS. Dr. Urbani, worked in public health programs in Cambodia, Laos and Viet Nam. He was based in Hanoi, Viet Nam. Dr. Urbani was 46.
There are a lot of explanations besides Caucasians being less suseptable. Because of monitoring by authorities one could imagine any Caucasians becoming infected are buisness people and wealthy-ish travellers. They would be healthy with few co-morbidities, are identified during initial symptoms (because of screening) and treated at world class facilities and monitored closely (quarantine and research).
This is just one of the populor rumors during the 2003 SARS epidemic, that because no Caucasian died from the virus, the whole epidemic is a well organized biological war against China.
Like the other comments has pointed out, Dr. Carlo Urbarni is a doctor who died from SARS. He's the one who warned the WHO about the new desease.
> 27 (66%) patients had direct exposure to Huanan seafood market (figure 1B https://www.thelancet.com/journals/lancet/article/PIIS0140-6...). Market exposure was similar between the patients with ICU care (nine [69%]) and those with non-ICU care (18 [64%]). The symptom onset date of the first patient identified was Dec 1, 2019. None of his family members developed fever or any respiratory symptoms. No epidemiological link was found between the first patient and later cases.
The idea I think was that the strain originated at the market, from people handling and possibly consuming bats. But, the description above and figure 1B indicates the currently known patient 0 was not exposed to the market.
Also, what is the chance that a random person in the area has exposure to that market in say a week's time. If it is a central place in the city, and depending on the layout and public transportation, 60% weekly exposure to it might not be unusual for an average citizen there.
It maybe be conspiracy at this point but I find it highly suspicious that out of all the markets in the country, this epidemic started just around the corner from China's first (and only?) biosafety level 4 laboratory https://wwwnc.cdc.gov/eid/article/25/5/18-0220_article, which just happened to have been built in response to the 2003 SARS epidemic, and so presumably has been working with those kind of viruses since.
Chinese CDC collected environmental samples from the market and some of them tested positive. So it's a little more than "the market happened to be there", although your point about the first patient identified is valid.
> Thirty-three of the 585 environmental samples collected from the Wuhan's Huanan Seafood Wholesale Market were found
But what’s the chance that sick people would have gone to the market when they were infectious and handled animals, produce, raw meat etc.
Having watched footage of some of the wet market I have no doubt it would be place for germs to spread efficiently. But it is still useful to figure out how the whole thing originated.
Yeah. And the virus is transmittable before that. I think it's part of what makes it insidious. There is a time when people don't feel sick so they travel around and spread it.
> It suggests they had a “most recent common ancestor”—meaning a common source—as early as 1 October.
what the quoted link says,
> The first case symptoms was recently reported to be December 1, 2019 5, although WHO has previously reported this as December 8, 2019 1. The estimate from BEAST is in agreement with these dates, giving a median date of December 2, 2019. This date is also consistent with prior phylogenetic analyses using fixed rates of the evolutionary rate of 2019-nCoV.
> "Suspected patients were isolated using airborne precautions in the designated hospital, Jin Yin-tan Hospital (Wuhan, China), and fit-tested N95 masks and airborne precautions for aerosol-generating procedures were taken.
> This study was approved by the National Health Commission of China and Ethics Commission of Jin Yin-tan Hospital (KY-2020-01.01).
> Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious diseases."
In other words, data from every patient they had is reported in this paper, with or without their consent. That includes radiographic imaging, blood and respiratory specimens, including nasal and pharyngeal swabs, bronchoalveolar lavage fluid, sputum, and/or bronchial aspirates.
In a western country, one of the tenants of medical ethics is that, if you have capacity to consent, you can always refuse to give it. In my country, I would be personally liable for assault if I (invasively) collected these samples from patients _without_ their explicit consent.
It must be a terrifying situation to be in: sick, in respiratory distress, and isolated from your family and friends in a large hospital, surrounded only by presumably somewhat scared looking medical professionals wearing tightly fitting face masks. I just hope that patients were _verbally_ asked if they consented to the collection of bronchoscopy-obtained samples for research and hopefully their diagnosis and management: it is an unpleasant procedure that, like many things in medicine, carries a small but non-zero risk of serious injury or death.
In fairness, the GP is bait too. It's just more thoughtful bait with paragraph breaks. It's basically elegant finger wagging.
Decay of the west bit aside, the parent has a point. Do you freak patients out by getting them to sign things when they are already in quarantine and fearing for their lives? Or do you prioritise research and response?
> Who cares about your morals when there's an epidemic ?
I actually find this to be an interesting ethical dilemma. On one hand, I would probably agree that this specific situation demands a degree of urgency and action such that the rights of an individual should be subjugated, to some extent, to the needs of society as a whole.
On the other hand, if we do accept that there are scenarios where this is a necessary trade-off, who gets to decide which outbreaks qualify? Could someone just invent one to circumvent medical ethics requirements whenever they prove inconvenient?
I guess it's not entirely dissimilar to arguments over limits on freedom of expression in cases where a person's speech can be deemed to cause harm to others (e.g. the canonical yelling fire in a crowded theatre). Where and how do you draw the line?
Serious this sort of thinking is what will kill hundreds of millions of people. We are not dealing with a couple of stubbed toes or hurt feelings here, but a novel deadly virus that is out of control. This is a war situation.
Isolation measures and obtaining information are clearly important; so too is acting ethically, and I would argue that it is _precisely_ these sort of circumstances that should prompt us to consider this. And, owing to selection bias in the cases presented, the death rate of this coronavirus is likely far lower than hyped.
Wow this is the first I've heard of the infection and death rate being 'lower than hyped'.
I do believe it's troubling times for everyone near this virus and we need as much information of the virus as possible. This is going past a regular 'patient confidentiality' line and into a 'prevent a possible disaster from occurring by getting on top of it soon'.
> Wow this is the first I've heard of the infection and death rate being 'lower than hyped'.
GP only said the death rate was lower (which necessarily means the infection rate is higher, not lower, assuming all the deaths used in the reported rate are real deaths associated with the disease of concern.)
"A war situation" is precisely when you need this sort of thinking: the modern ethical framework for medical research with interventions is heavily influenced by "The Nuremberg Code". I don't think we need to describe in detail why people thought that code was necessary.
In most of these cases, it is highly unlikely that any significant number of the patients will withhold their consent: so to not ask it is basically saying "we can't be bothered", there's no obvious scientific basis for such a waiver. When patients are incapacitated there are equivalent frameworks which take their personal circumstances into consideration.
There is nothing to suggest that any patient has withheld consent, just that the requirement to get consent in written form was waived. Given how sick these patients were this is reasonable.
Time is of the essence here. If I was put in the situation these researcher are in I would act first and take the risk of being put on trial later. Real ethics means sometimes you have to do more than just follow rules.
I don't know, Coronaviridae have neither oil nor WMD?
There might be cause for some concern like for any form of disease, but calling it a war is ridiculous and inappropiate to describe the situation. Even a well intentioned reading of the statement leaves much to wish for.
The common cold kills more than 50,000 people a year. 90% of media reports are intentionally worded to dramatize the situation, so I don't think anything warrants this classification with respect to the people deceased.
This reaction is precisely the reason why some might think about restricting information about infections or simliar health hazards to the public.
Nothing indeed; besides China having put 20m+ people on lockdown, 5m having fled the cities possibly carrying the virus, it having already reached Europe, the US and Australia, doctors on the ground reporting over 100k infected, and the fatality count racing past the hundreds. Enjoy your breakfast.
What is terrifying is the thought of treatment of those very patients, and prevention/cure for the rest of the world being held back by selfish concerns like yours. Can’t wait for the new pleghma privacy law!
The concern is not about privacy, but about forced treatment against your will.
That's a big deal, and most countries have strict law in place to stop it happening in most situations. There are some exceptions for people who are unable to make that choice, but this is limited to people who are not conscious, or who have severe learning disability, or who are currently severely mentally ill.
Because bronchoalveolar lavage, one of many procedures used here, is an invasive medical procedure that has no purpose other than to obtain information for diagnosis or scientific research. A small endescope is passed down the trachea, and part of the lung tissue irrigated with fluid, and the fluid (now containing cellular detritis) analysed. It is intensely uncomfortable if performed without sedataion and bronchoscopy is typically performed under heavy sedataion as a result. All of these facts carry risk -- risks which, under international law, the patient has to consent to.
>>> (d) Apprehension and examination of persons reasonably believed to be infected
>>> (1) Regulations prescribed under this section may provide for the apprehension and examination of any individual reasonably believed to be infected with a communicable disease in a qualifying stage and (A) to be moving or about to move from a State to another State; or (B) to be a probable source of infection to individuals who, while infected with such disease in a qualifying stage, will be moving from a State to another State. Such regulations may provide that if upon examination any such individual is found to be infected, he may be detained for such time and in such manner as may be reasonably necessary.
In many cases, the government has various powers like arresting, fining, or jailing people for violating quarantine or entering private property to investigate.
64 comments
[ 4.5 ms ] story [ 167 ms ] threadHIV is rather fragile, no? It only spreads in specific bodily fluids and shows very little viral load when dormant.
2019-nCoV spreads in air. That's a significantly hardier virus that produces quite a lot of virus particles that are way easier to detect.
In addition, please remember that molecular biology was just getting started when the AIDS epidemic hit. AIDS (1981) predates PCR (1983). Molecular biology and computing have come a long way in 40 years, and we have a lot more tools at our disposal nowadays.
I suspect that part of this comes from the fact that people thought the disease was thought to target gay men. In fact, AIDS was originally called GRID -- Gay-Related Immune Deficiency. There was plenty of (truly awful) folks out there who felt that it was some sort of cosmic justice.
The internet is our immune system.
[0] https://twitter.com/nextstrain/status/1221181133884256256?s=...
[1] https://mobile.twitter.com/nextstrain/status/122154827481917...
Are we a pre or post internet civilisation?
Honestly 4chan is doing better than this. Reading through their noise is better than the clean data coming out of the officials. For example they have people in pools of blood on the street with people in the bio suits China are using.
Maybe it's obvious people will throw up blood with this new SARS, but the officials aren't mentioning it. Sperm may contain the virus for months. Again obvious, not seeing it on official feeds.
I managed to guess the correct URL:
https://www.who.int/docs/default-source/coronaviruse/situati...
This says 2741 confirmed cases in China and 2798 globally.
Also, how is lifetime of the virus in sperm relevant at all and do you have a source for it? I couldn't find anything online about that and can't think of how it could affect anyone.
Aren't mentioning it? How can you say that?
The linked article directly addresses this right in the Findings section, where it says, "haemoptysis (two [5%] of 39)".
Wikipedia's definition (https://en.wikipedia.org/wiki/Hemoptysis): "Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs."
So 5% of (that small sample size of) patients cough up blood.
I'm curious why you think so. This report is very detailed from a medical point of view, if you want current numbers there are other news sites for that. Besides, why do you need the current numbers, so you can panic faster?
(She was in Beijing during 2003, and saw SARS first hand)
That's not accurate:
29 March 2003
Dr. Carlo Urbani, an expert on communicable diseases, died today of SARS. Dr. Urbani, worked in public health programs in Cambodia, Laos and Viet Nam. He was based in Hanoi, Viet Nam. Dr. Urbani was 46.
https://www.who.int/csr/sars/urbani/en/
https://en.wikipedia.org/wiki/Carlo_Urbani
Like the other comments has pointed out, Dr. Carlo Urbarni is a doctor who died from SARS. He's the one who warned the WHO about the new desease.
The idea I think was that the strain originated at the market, from people handling and possibly consuming bats. But, the description above and figure 1B indicates the currently known patient 0 was not exposed to the market.
Also, what is the chance that a random person in the area has exposure to that market in say a week's time. If it is a central place in the city, and depending on the layout and public transportation, 60% weekly exposure to it might not be unusual for an average citizen there.
It maybe be conspiracy at this point but I find it highly suspicious that out of all the markets in the country, this epidemic started just around the corner from China's first (and only?) biosafety level 4 laboratory https://wwwnc.cdc.gov/eid/article/25/5/18-0220_article, which just happened to have been built in response to the 2003 SARS epidemic, and so presumably has been working with those kind of viruses since.
http://www.xinhuanet.com/english/2020-01/27/c_138735677.htm
But what’s the chance that sick people would have gone to the market when they were infectious and handled animals, produce, raw meat etc.
Having watched footage of some of the wet market I have no doubt it would be place for germs to spread efficiently. But it is still useful to figure out how the whole thing originated.
Is not impossible and is a question that must be answered. Good point.
https://www.sciencemag.org/news/2020/01/wuhan-seafood-market...
https://news.ycombinator.com/item?id=22157067
> It suggests they had a “most recent common ancestor”—meaning a common source—as early as 1 October.
what the quoted link says,
> The first case symptoms was recently reported to be December 1, 2019 5, although WHO has previously reported this as December 8, 2019 1. The estimate from BEAST is in agreement with these dates, giving a median date of December 2, 2019. This date is also consistent with prior phylogenetic analyses using fixed rates of the evolutionary rate of 2019-nCoV.
> This study was approved by the National Health Commission of China and Ethics Commission of Jin Yin-tan Hospital (KY-2020-01.01).
> Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious diseases."
In other words, data from every patient they had is reported in this paper, with or without their consent. That includes radiographic imaging, blood and respiratory specimens, including nasal and pharyngeal swabs, bronchoalveolar lavage fluid, sputum, and/or bronchial aspirates.
In a western country, one of the tenants of medical ethics is that, if you have capacity to consent, you can always refuse to give it. In my country, I would be personally liable for assault if I (invasively) collected these samples from patients _without_ their explicit consent.
It must be a terrifying situation to be in: sick, in respiratory distress, and isolated from your family and friends in a large hospital, surrounded only by presumably somewhat scared looking medical professionals wearing tightly fitting face masks. I just hope that patients were _verbally_ asked if they consented to the collection of bronchoscopy-obtained samples for research and hopefully their diagnosis and management: it is an unpleasant procedure that, like many things in medicine, carries a small but non-zero risk of serious injury or death.
This kind of bait is not needed on Hacker News. Keep that on reddit or facebook or whatever.
Decay of the west bit aside, the parent has a point. Do you freak patients out by getting them to sign things when they are already in quarantine and fearing for their lives? Or do you prioritise research and response?
related: "Conducting Research in Disease Outbreaks" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669128/
I actually find this to be an interesting ethical dilemma. On one hand, I would probably agree that this specific situation demands a degree of urgency and action such that the rights of an individual should be subjugated, to some extent, to the needs of society as a whole.
On the other hand, if we do accept that there are scenarios where this is a necessary trade-off, who gets to decide which outbreaks qualify? Could someone just invent one to circumvent medical ethics requirements whenever they prove inconvenient?
I guess it's not entirely dissimilar to arguments over limits on freedom of expression in cases where a person's speech can be deemed to cause harm to others (e.g. the canonical yelling fire in a crowded theatre). Where and how do you draw the line?
I do believe it's troubling times for everyone near this virus and we need as much information of the virus as possible. This is going past a regular 'patient confidentiality' line and into a 'prevent a possible disaster from occurring by getting on top of it soon'.
GP only said the death rate was lower (which necessarily means the infection rate is higher, not lower, assuming all the deaths used in the reported rate are real deaths associated with the disease of concern.)
In most of these cases, it is highly unlikely that any significant number of the patients will withhold their consent: so to not ask it is basically saying "we can't be bothered", there's no obvious scientific basis for such a waiver. When patients are incapacitated there are equivalent frameworks which take their personal circumstances into consideration.
Time is of the essence here. If I was put in the situation these researcher are in I would act first and take the risk of being put on trial later. Real ethics means sometimes you have to do more than just follow rules.
There might be cause for some concern like for any form of disease, but calling it a war is ridiculous and inappropiate to describe the situation. Even a well intentioned reading of the statement leaves much to wish for.
The common cold kills more than 50,000 people a year. 90% of media reports are intentionally worded to dramatize the situation, so I don't think anything warrants this classification with respect to the people deceased.
This reaction is precisely the reason why some might think about restricting information about infections or simliar health hazards to the public.
If we are lucky the problem is not as bad as it appears, but so far nothing I have seen suggests this is anything other than very, very serious.
While some might be scared that much that they approve of these measures, I am just glad not to live in China.
That's a big deal, and most countries have strict law in place to stop it happening in most situations. There are some exceptions for people who are unable to make that choice, but this is limited to people who are not conscious, or who have severe learning disability, or who are currently severely mentally ill.
Always? That's just not true.
In the US, the CDC has the power to involuntarily quarantine AND EXAMINE people.
See their page about legal authority: https://www.cdc.gov/quarantine/aboutlawsregulationsquarantin...
Also, one of the relevant laws (https://www.govinfo.gov/content/pkg/USCODE-2011-title42/html...) says this:
>>> (d) Apprehension and examination of persons reasonably believed to be infected
>>> (1) Regulations prescribed under this section may provide for the apprehension and examination of any individual reasonably believed to be infected with a communicable disease in a qualifying stage and (A) to be moving or about to move from a State to another State; or (B) to be a probable source of infection to individuals who, while infected with such disease in a qualifying stage, will be moving from a State to another State. Such regulations may provide that if upon examination any such individual is found to be infected, he may be detained for such time and in such manner as may be reasonably necessary.
Health officials at the state level also have similar powers. Here's a summary of state-level laws: https://www.ncsl.org/research/health/state-quarantine-and-is...
In many cases, the government has various powers like arresting, fining, or jailing people for violating quarantine or entering private property to investigate.