Of course he did. This is Japan, he walker all over people faces, people above his status. Expect demotion or firing, shunning from all government funded positions, Li Wenliang style televised public apology, maybe even legal repercussions.
Doctor Kentaro Iwata is properly effed for speaking up.
Much of the information floating around regarding 2019-ncov has hallmarks of "conspiracy theory" because it is all happening in real time and legitimate media is unwilling to publish anything without confirmation from "official" sources...who in turn are not willing to confirm anything because anecdotal reports and pending peer review journal articles do not meet (understandable) verifiability standards. This unfortunately relegates any news to unnofficial "conspiracy" channels and gives people a dangerous justification for dismissing potentially legitimate reports.
If you've been paying attention for the last month or two, there are hundreds of anecdotal reports and videos all pointing toward the same grave conclusions - not to mention dozens of published (awaiting review) papers at this point and, increasingly, many if not most of the rumors from 1-2 months ago are gradually being confirmed. Look no further than China's unprecedented response to this outbreak - 700 million people are under lockdown and their GDP is effectively shut down.
Frankly, the modern media establishment's standards for proof are too high to adequately cover such a rapidly unfolding catastrophy when the majority of information has to come from unofficial leaks because ground zero is an authoritarian regime which controls what it's citizens can say amongst themselves and to the rest of the world. This epidemic is far worse than westerners currently seem to understand, and if it is not contained, the chaos that will grip the rest of the world will be truly awesome to behold. This is a virus which is at least as deadly as the infamous 1918 flu, likely more virulent (R0 estimates anywhere from 3 to 6+), and there is still no cure, though a paper was published on the 4th with chloroquine as a potential candidate. Plus, based on autoimmune reactions induced by all previously developed viable vaccine candidates for SARS and MERS, there is unlikely to be a vaccine for this coronavirus as well.
As I've been saying for a month now, we should not be panicking, but there's no excuse at this point not to be prepared. WSJ announced 5400 people in California are under quarantine today. 700 people in WA under supervision from authorities. Personally I'm moving to minimize my reliance on the government in the case that this pandemic spreads to the U.S. at large, based on the rank incompetence that we see in government activities on a frequent basis.
Honestly watching so many average people dismiss 2019-ncov has been a fascinating exposé on the potential for centralized information control in free speech societies - if you're a 3 letter agency and you want something to disappear from public consciousness, just preemptively leak the story to "questionable" sources and suddenly the media won't report on it and people will balk at you for posting junk sources. What a world we live in!
The reason traditional media and other authoritative sources are so reluctant to post speculation is to avoid spreading unwarranted panic. Right now, Influenza is a far bigger risk to the average person, and less than half of Americans bother to get vaccinated.
If the vaccine gives me 50% protection from a disease that will leave me bedridden for a week and that disease has a 0.1% chance of killing me, I'll take that vaccine (and I have -- ever year now for the past 20 or so years, ever since I last got the flu).
I can't say whether or not it's working, but I haven't caught the flu since I started getting vaccinated.
.1% is pretty pessimistic on vaccine mortality. There are circumstances where it would be preferable to the alternative, but I don't think there are any /that/ bad.
No, I mean the disease (the flu) has a 0.1% chance of killing me. I wouldn't take the vaccine if the mortality risk was that high (unless I was protecting myself from a disease with a much worse mortality rate)
I wouldn't assume your individual risk profile is equal to the average death rate, which is somewhere around 1 in 1000 to 1 in 2500. It's not a random occurrence when you die from the flu. Certain people have a higher risk profile depending on health, age, and immune system dynamics.
Is a false sense of security better than spreading panic? Shouldn’t the goal be accurate reporting of the science and statistics, done in a way the general public can understand? Why lie to keep people calm when that is certain to push the R0 higher? (It’s increasingly difficult for me to assume good faith when people keep comparing it to the flu, despite clear and overwhelming evidence, in multiple domains!, to the contrary.)
What advice would you have them give? The CDC (and mainstream newssources) already advises commonsense strategies to avoid respiratory illnesses of all types like regular handwashing, don't touch the face, eyes or mouth, stay home when feeling sick, etc.
Preemptive social distancing to slow the spread. This is done by educating the public about the probabilities involved thus increasing fear, increase social distancing and decreasing the r0, maybe even enough to avert the coming pandemic. The downside to this is a short term economic hit, the upside is using the “window of opportunity,” as the WHO calls this interim period, to avert or at least slow the spread. A number of helpful policies might come As the result of public demand for more potent measures. For instance greater travel restrictions like those being enacted in other countries. Also, we could actually test people like they are doing elsewhere. That would allow American patients to receive remdesivir. Right now we aren’t testing, so the first bunch of American cases won’t get proper treatment and some, I think many, will suffer worse outcomes and maybe even death because they won’t be identified at first because there’s “no evidence of spread yet” and regular Americans can’t be PUI yet. I get that it’s a medical ethics issue, but do people really get that? I don’t think they do.
I've followed it closely but the death toll outside of China is really low. Some reports are that this disease binds to specific receptors in the lungs that are especially prominent in Asian males:
"The result indicates that the ACE2 virus receptor expression is concentrated in a small population of type II alveolar cells (AT2). Surprisingly, we found that this population of ACE2-expressing AT2 also highly expressed many other genes that positively regulating viral reproduction and transmission. A comparison between eight individual samples demonstrated that the Asian male one has an extremely large number of ACE2-expressing cells in the lung."
Which is disturbing all the same, but it means the fatality rate will be lower among non-Asians, unless the disease mutates further, which is very possible.
I remember reading something about how something like half of chinese men smoke and that was potentially what was leading to their susceptibility to pneumonia from ncov. would be happy if someone could source that.
Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation.
Women were included only in the second study. Of 302 669 women enrolled in 2004–08, only 3·2% were ever regular smokers, including 0·5% who stopped by choice. Smoking uptake decreased steeply across successive generations of women.
It's worth reading the paper, which calls out its own limitations:
* It is unknown if ACE2 is the only important receptor
* Study doesn't actually count the amount of ACE2 receptors, just the amount of RNA expression (ok, you can probably hand wave this limitation away)
* Study also shows a difference of expression ratio of 1.6% vs 0.4% in males vs females (n=2 vs n=6)
* There was a SINGLE asian male in the data set
Given these limitations of the original paper, at the very least, I would say that you should shy away from definitive statements until stronger evidence appears.
The top comment on biorxiv ran with some of the ideas from the paper, and looked at a more general and larger data set and found no statistically significant difference between Asian and Caucasian lung tissue samples in terms of ACE2 expression when measured in bulk (see https://uploads.disquscdn.com/images/5cb4b2c5e1ae3cf8454e870...)
From that link above, "there are eight and 436 putative Asians and Caucasians, respectively (imputed from the first two principal components" so its comparing a sample size of 8 Asians with a sample size of 436 Caucasians. I'd say the jury is still out on whether there is a racial difference in ACE2 expression, but good call out either way.
Not sure why you're getting down voted - this is all quite correct. The Chinese Government's response in and of itself speaks volumes about what the situation on the ground must be, and completely contradicts their own numbers.
I think the problem with the media though isn't what you're suggesting. We seem to be seeing a simple lack of basic research skills in many media outlets. Being able to go through a lot of real time media sources, separate truth from fiction, and build up a synthesis should be the basic qualification for a journalist these days - and probably would be, except the job no longer pays enough for the people who build up that kind of skill set.
Can't see the chaos though. There is a lot of spare capacity these days.
No, they are not. 700M are under reporting requirements, meaning they need to record entry and exit to some buildings. Actual lockdowns (can't leave your home outside schedule or without permission) affect a much smaller if admittedly still enormous population of around 100M.
If the tests are as unreliable as has been reported (and a lot of rubbish gets reported) then those released passengers travelling around Japan seem like a bit of a risk.
Effective crisis management of this nature requires rehearsal and drilling, even if just an administrative / tabletop exercise. The chaos described is a classic symptom of not doing so.
"Japan lacks an agency like the U.S. Centers for Disease Control and Prevention, charged with applying research to public health ... NIID is focused on basic research."
I'm under the impression the Japanese government received some withering criticism for their bureaucratic mismanaged response to the Tōhoku earthquake and tsunami; I expected they would have revisited their emergency response procedures after that, but I guess not?
Japan has effectively been a corrupt, one party democracy for decades and press freedom has dropped dramatically since Abe’s rise to power/attacks on it.
Imagine if something like Trump administration had been in charge for the same length of time in a culture where popular dissent has been all but quashed, most people were baby boomers, and the government silenced reporters. It’s a recipe for disaster and immune to criticism.
The German Public Broadcaster DW has a short video[1] covering this, including some of Kentaro Iwata's video statement.
The mention that the Japanese government is allowing it's citizens to leave and use public transit seems like a very risky and foolhardy move.
While I'm certainly no expert, and I'd definitely hate to be stuck on that ship - I think Japan could surely have set up some kind of field isolation area in the last few weeks and get passengers off and isolated using proper quarantine protocols.
The statement by Kentaro Iwata makes it clear that nobody with a background in infectious diseases was involved in setting up proper quarantine procedures onboard the ship.
An isolated outbreak on a cruise ship? That should be the bare minimum a country should handle. Note that Japan doesn't have any organization like the CDC- they aren't prepared for anything.
Japan or rather their govt screwed it up. But it's very hard to deal with thousands of sick people, no doubt they had no facility big enough. They should have seen this as an extreme emergency and either used a military base or taken over (renting) a large hotel. These are emergency situations.
And it speaks volumes of politics and power hierarchies in action and under-performing as expected. This could take different but similar bad turns in any of the first world countries too having a less population factor unlike in china but with deadlier virus or catastrophe. I hope we all learn something from this besides pointed fingers. The world we live in is still very fragile and I think we it would be great if we concentrated our collective energies on something constructive in this direction.
Can someone fix this headline? ‘... cruise ship Japan” reads like it is a cruise ship called “Japan” rather then the full headline “... cruise ship Japan quarantined”
A Japanese infectious disease specialist who visited the quarantined Diamond Princess decried "chaotic" and "scary" conditions on the cruise liner that gave the coronavirus more opportunity to spread.
42 comments
[ 3.4 ms ] story [ 103 ms ] threadDoctor Kentaro Iwata is properly effed for speaking up.
If you've been paying attention for the last month or two, there are hundreds of anecdotal reports and videos all pointing toward the same grave conclusions - not to mention dozens of published (awaiting review) papers at this point and, increasingly, many if not most of the rumors from 1-2 months ago are gradually being confirmed. Look no further than China's unprecedented response to this outbreak - 700 million people are under lockdown and their GDP is effectively shut down.
Frankly, the modern media establishment's standards for proof are too high to adequately cover such a rapidly unfolding catastrophy when the majority of information has to come from unofficial leaks because ground zero is an authoritarian regime which controls what it's citizens can say amongst themselves and to the rest of the world. This epidemic is far worse than westerners currently seem to understand, and if it is not contained, the chaos that will grip the rest of the world will be truly awesome to behold. This is a virus which is at least as deadly as the infamous 1918 flu, likely more virulent (R0 estimates anywhere from 3 to 6+), and there is still no cure, though a paper was published on the 4th with chloroquine as a potential candidate. Plus, based on autoimmune reactions induced by all previously developed viable vaccine candidates for SARS and MERS, there is unlikely to be a vaccine for this coronavirus as well.
As I've been saying for a month now, we should not be panicking, but there's no excuse at this point not to be prepared. WSJ announced 5400 people in California are under quarantine today. 700 people in WA under supervision from authorities. Personally I'm moving to minimize my reliance on the government in the case that this pandemic spreads to the U.S. at large, based on the rank incompetence that we see in government activities on a frequent basis.
Honestly watching so many average people dismiss 2019-ncov has been a fascinating exposé on the potential for centralized information control in free speech societies - if you're a 3 letter agency and you want something to disappear from public consciousness, just preemptively leak the story to "questionable" sources and suddenly the media won't report on it and people will balk at you for posting junk sources. What a world we live in!
I was curious about the source for this so I searched and found this: https://www.wsj.com/articles/coronavirus-has-u-s-cities-stre...
It states the 5400 Californians are under "self quarantine", as opposed to the Washington State enforced quarantine of 700.
The reason traditional media and other authoritative sources are so reluctant to post speculation is to avoid spreading unwarranted panic. Right now, Influenza is a far bigger risk to the average person, and less than half of Americans bother to get vaccinated.
I can't say whether or not it's working, but I haven't caught the flu since I started getting vaccinated.
(I edited my previous post to clarify)
What else would should they be telling people?
"The result indicates that the ACE2 virus receptor expression is concentrated in a small population of type II alveolar cells (AT2). Surprisingly, we found that this population of ACE2-expressing AT2 also highly expressed many other genes that positively regulating viral reproduction and transmission. A comparison between eight individual samples demonstrated that the Asian male one has an extremely large number of ACE2-expressing cells in the lung."
Which is disturbing all the same, but it means the fatality rate will be lower among non-Asians, unless the disease mutates further, which is very possible.
https://www.biorxiv.org/content/10.1101/2020.01.26.919985v1
Here are two excerpts I am basing my summary on:
Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation.
Women were included only in the second study. Of 302 669 women enrolled in 2004–08, only 3·2% were ever regular smokers, including 0·5% who stopped by choice. Smoking uptake decreased steeply across successive generations of women.
* It is unknown if ACE2 is the only important receptor * Study doesn't actually count the amount of ACE2 receptors, just the amount of RNA expression (ok, you can probably hand wave this limitation away) * Study also shows a difference of expression ratio of 1.6% vs 0.4% in males vs females (n=2 vs n=6) * There was a SINGLE asian male in the data set
Given these limitations of the original paper, at the very least, I would say that you should shy away from definitive statements until stronger evidence appears.
The top comment on biorxiv ran with some of the ideas from the paper, and looked at a more general and larger data set and found no statistically significant difference between Asian and Caucasian lung tissue samples in terms of ACE2 expression when measured in bulk (see https://uploads.disquscdn.com/images/5cb4b2c5e1ae3cf8454e870...)
That said, it's certainly a cool paper.
From my understanding of statistics and biology this is not significant at all then.
I think the problem with the media though isn't what you're suggesting. We seem to be seeing a simple lack of basic research skills in many media outlets. Being able to go through a lot of real time media sources, separate truth from fiction, and build up a synthesis should be the basic qualification for a journalist these days - and probably would be, except the job no longer pays enough for the people who build up that kind of skill set.
Can't see the chaos though. There is a lot of spare capacity these days.
No, they are not. 700M are under reporting requirements, meaning they need to record entry and exit to some buildings. Actual lockdowns (can't leave your home outside schedule or without permission) affect a much smaller if admittedly still enormous population of around 100M.
"Japan lacks an agency like the U.S. Centers for Disease Control and Prevention, charged with applying research to public health ... NIID is focused on basic research."
Imagine if something like Trump administration had been in charge for the same length of time in a culture where popular dissent has been all but quashed, most people were baby boomers, and the government silenced reporters. It’s a recipe for disaster and immune to criticism.
The mention that the Japanese government is allowing it's citizens to leave and use public transit seems like a very risky and foolhardy move.
While I'm certainly no expert, and I'd definitely hate to be stuck on that ship - I think Japan could surely have set up some kind of field isolation area in the last few weeks and get passengers off and isolated using proper quarantine protocols. The statement by Kentaro Iwata makes it clear that nobody with a background in infectious diseases was involved in setting up proper quarantine procedures onboard the ship.
[1] https://www.youtube.com/watch?v=iPpAsRJJ14E
An isolated outbreak on a cruise ship? That should be the bare minimum a country should handle. Note that Japan doesn't have any organization like the CDC- they aren't prepared for anything.