The question is 2 out of how many tests? If this page https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html is to be believed, only about a dozen tests were done over the past two days because it was 445 tested on Wednesday and we have 2 hits.
To the best of my knowledge (and not trying my to incite panic), there are only 200 test kits in the entire state of CA. The official numbers are meaningless given the inability to actually test. Why do you believe the US will be able to quarantine the entire Bay Area?
There are no concentrations of flu and respiratory problems according to hospital case managers. Clusters aren’t likely to stay hidden for very long, even without kits. I don’t think the goal is to quarantine entire regions, just to slow it down by limiting groups of people in affected areas.
On the question of use of tests, and detection in individuals much less clusters, this note is from /r/AskNYC this evening:
Hello,
Just giving a heads up to what I and my doctor both considered a very fucked up situation. I just spent a week in Japan, a country at high risk for COVID-19. I wore a mask and essentially tried to stay away from most touristy places (not my first time there), but trains and stations are still packed with people, so there's really not much you can do.
On arriving back to America (3 days ago), I developed a 102F fever, coughing, and aches. I went to a local hospital in Brooklyn's ER. I informed them of my travel, they provided me a mask, and redirected me to a private room and followed infection protocols (full face covers, gloves, aprons, etc.). I had a chest x-ray and testing for flu/cold/pneumonia/and about 25 other viruses. They all came back negative.
At this point, the hospital called the CDC requesting permission to perform the COVID-19 testing. The CDC denied the request on the ground that I did not have the most life-threatening symptoms: chest pain and shortness of breath. According to everything I read it's very likely not to have these symptoms if you're in your 30's and relatively healthy.
And... that was that. They discharged me, said I don't have Corona virus, since they didn't test me for it, and said I can ride the subway, return to work, do whatever I want.
Of course my doctor disagreed. She said I should treat myself as if I am infected. My partner is currently staying in a nearby hotel since we live in a studio apartment. I've performed a self-quarantine for 14 days. Fortunately I can work from home and my partner can deliver me groceries if I run out.
But I don't think that many people are aware of the fact that they're actively not testing people for COVID-19, even people who have travel history to high-risk places.
Do I still have symptoms? Yes, Fever is current 101.6 (as of a couple hours ago), aches, and a cough that is persistent. I'm taking Tylenol and drinking a lot of water.
Do I just have the flu? Well, not according to my screens I don't.
Is this real? It's as real as I said it is. I returned from Japan. I'm sick. The symptoms are similar to COVID19 and I was refused testing.
You can believe whatever you want, I don't care.
A channel NY1 reporter reached out to connect with the individual, so perhaps if validated, it won’t “stay hidden very long”. And to your point, it’s not a cluster. But how would you have a cluster if each given patient is handled this way?
The individual case is less interesting than the protocol.
You'd want to make a list of all contacts of the last days to test and quarantine those as well if they show symptoms of any kind. At least that's what other countries do.
Based on what exactly? This thing seems to surprise us daily with its ability to spread undetected. And the US is woefully unprepared to administer tests. I fully expect the numbers to sharply rise right along with our ability to test over the next few weeks.
You mean if everyone took this seriously. Which is obviously a lot more difficult. It would probably not be possible to get everyone to agree that the sky is blue or 2+2=4.
There was a point in time where a single city could have made that difference. Then there was a point in time where single province could have made that difference. Then a country. Now none of this matters anymore but it is still an interesting question: was the virus known and detected at a point in time where it could have been contained?
From the long incubation time my gut feeling is that it probably couldn't have been. International airtravel speeds things up, it also didn't make a difference in 1918 when intercontinental traffic was by boat. Lindbergh didn't make his flight until 1927.
They showed a strong unwillingness to declare the high state of emergency from the start, which dragged the numbers 30 fold through delayed action. They were the one institution with the moral authority to drive prevention (incentivising testing, the closure of air travel, etc). People act as if the only possible responses are complete inaction or panic. This is terribly misguided. Had the WHO declared high alert a month ago, it would have meant a whole month to take it all in, plan, condition your touch-your-face reflexes, rethink your lifestyle, etc. Maybe they didn't want to be the boy who cried wolf after SARS, MERS and H1N1 were declared global outbreaks and ended up not being full-blown pandemics. But now what? Is the watchdog scared to watch? They act as if Chinese numbers are trustworthy, and I can only guess that it's half political reasons, half delusion. The CCP has a history of under/misreporting catastrophe that should be factored in, at the very least as a warning label. With a mostly mild disease that spreads like wildfire there's bound to be huge visibility biases which were not taken into account, and then you end up with things like Italy where they don't even know how it spread.
Instead there's a discourse vacuum where people seem to decide what's going to happen more on the basis of pre-existing narratives than reality. Examples; People mistrust the US believed it's all exaggerated to hurt China, for a while some "journalists" wrote more about racism and stigma than the actual ongoing development, politicians kept ringing the everything's OK alarm, and finally, mindless optimists are the worst.
The Chinese government decided to establish an economy-crippling quarantine on January 23rd with only 1000 confirmed cases. Something was awry. And in the following week all the warning sings have been available (the quick spread, reports of CCP measures and life in Wuhan, research papers about the spread, incubation, etc). But for a month now the WHO refused to read the writing on the wall, only god knows why.
We now know with certainty Chinese numbers are more trustworthy than US (and half of EU) ones on the sole basis Chinese are actually TESTING people, while CDC refuses any due diligence.
> We now know with certainty Chinese numbers are more trustworthy than US (and half of EU) ones on the sole basis Chinese are actually TESTING people, while CDC refuses any due diligence.
That just means the upper bound of the potential quality of the Chinese numbers is better, not that the actual quality of the numbers is better. Just because they are gathering more information doesn't mean they are publicly reporting it accurately.
That is, the Chinese potentially internally have more complete data, because they are doing more surveillance. That doesn't mean that the numbers they are reporting are more trustworthy.
But back to the discussion about the WHO, their bland attitude is greatly to blame for the inaction of the CDC, and the rest of the world.
As a case study, for some days half of all confirmed cases outside of China were in the Diamond Princess, and the proportion held until very recently with 1000+ cases worldwide (sans China). Why? Sampling bias. Even arguing that a cruise is more virus-friendly cannot possibly account for a single ship holding half of the world's cases. And then came about Iran and Italy, with no clear path of spread. It's hurtfully evident that there are so many more cases and there's a huge visibility issue, and the WHO delaying measures aggravates the matter dramatically.
The US is shown has having "local transmission". "Community transmission" is defined as "the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through routine screening of sentinel samples".
Maybe this is just a terminology issue... "spreading freely in communities" could refer to "community transmission" defined above.
Given the incubation time, the virus has been spreading in the community for at least 1-2 weeks. Not a US citizen and don’t really understand how things work there, but you’d think it’s time for a response at scale to have any chance of containment. From a distance, it seems politics is interfering with this.
The smart thing to do at this point would be to abandon the fool's hope that this will be contained in the US, stop trying to track cases and spread, and just work on shoring up the heath care system for when it's inevitably going to be overrun. Trying to keep it contained now is like putting up a truckload of sandbags to stop a tidal wave.
If it wasn't possible to be reinfected, I'd say the wise thing to do would be to get yourself infected now, while you can still get a respirator in the hospital.
That assumes you can't get it twice, which we don't know yet. It also assumes there are no long-term effects, and there are already reports of lung fibrosis. You're better off delaying it as long as possible. Work from home if you can, and try to avoid non-essential travel while people work on better treatments.
Long duration shedding even after recovery is a more likely explanation than than re-infection. But even that's not good news if someone is contagious after they've recovered.
https://twitter.com/mlipsitch/status/1231662145156374528
Slowing the spread via containment so the health system can be shored up seems sensible to me.
Possibly those weeks could make a difference; I'd imagine vaccine development is highly parallelised relative to a normal year, and there may be something in the next 6 months. 4 weeks in that scenario could be huge.
It doesn't sound like a vaccine is going to save the day here[1].
> Marks said a real late-stage trial to test a vaccine is likely “months away.” One concern is that some previous coronavirus vaccines have caused worsening of the disease, not improvement.
> “We have to make sure that as we proceed with development, we’re not creating problems,” Marks said. It might be realistic, he said, for studies of vaccines to begin by the summer, although that timeline is still aggressive.
>...Trying to keep it contained now is like putting up a truckload of sandbags to stop a tidal wave.
I don't think this is true, and since we still don't know enough about true fatality rates outside of China (yet) it seems foolish to be fatalistic at this stage about containment. There's no "shoring up the [US] health care system". We can't build hospitals out of thin air (China's attempt notwithstanding), and we can't apparate more medical devices, whose supply chains are broken because of our dependence on China. Limiting infections - especially in higher risk demographics - seems critical at this point.
>If it wasn't possible to be reinfected, I'd say the wise thing to do would be to get yourself infected now, while you can still get a respirator in the hospital.
Uhhh no. This would needlessly stress the existing infrastructure. If you're young and healthy, don't soak up resources that should be used to care for at-risk populations. WFH and wash your hands.
> We can't build hospitals out of thin air (China's attempt notwithstanding), and we can't apparate more medical devices, whose supply chains are broken because of our dependence on China.
Seems like a lot of “we can’t” assertions. If any country started seeing ~1M deaths per month or something, I bet they’d somehow figure out a way to do it.
Sure. It would take a WWII-level mobilization to do so, and some very hard trolley_problem.jpg choices about what to do. Even then I'm still skeptical. Let's take medical devices, for example. So we could, temporarily, nationalize a PCB fab in the US to make the circuit boards ... but do we even have the gerber files? Do we have the human capital to QA a new process? How long for tooling on the rest of the mechanicals?
I hope that, deep in the Pentagon, someone is asking these questions. Not necessarily because of COVID-19, but just in general.
> Limiting infections - especially in higher risk demographics - seems critical at this point.
We've already failed at this - it's in the community, cases are popping up with no known contact with an infected person. Asymptomatic cases are contagious for several days, and in a large chunk of patients it presents as a common cold that they won't go to the hospital for, and even if they could there isn't enough capacity to do the necessary testing. Game over.
It's closer to the cold than the flu, so like the cold people have been reported to have been infected after having had it, then not had it, then to have it once more. Though, at this point it's not known if it was dormant or through new infection.
> Off-Topic: Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon. Videos of pratfalls or disasters, or cute animal pictures. If they'd cover it on TV news, it's probably off-topic.
Again, this is an unprecedent event. Nothing in recorded history has had the potential ramifications for society that this virus does, short perhaps of the black plague of the middle ages. This virus will test civilization.
Will it? Obviously it could be due to all the precautions, but thus far no children 0-9 have died from the virus. The data shows mostly older people, and apparently those already ill. Thus far, that isn't to be compared with black plague because it had a much worse impact.
It already does. Stock markets are crashing. The tourism industry worldwide will take a hit. Olympic games may be canceled. Concerts and conventions are also canceled. If this thing keeps spreading cafes and restaurants will start loosing clients by the dozens, companies will have to rely heavily on remote working and who knows what other economic implications will ensue.
Sorry, that is not my definition of "testing civilization". Everything you mentioned is luxuries, or has workarounds (e.g. conference call instead of physical meeting).
Wake me up when there is a water, food, or housing shortage or significant amount of population infected and dying because of a global disease.
Was discussing this with colleagues recently. The last big global event was the GFC, and before that WW2. Suspect the impact of COVID-19 will be closer to WW2 than the GFC, but truly hope I'm wrong. We are living through an interesting time, which is never fun.
Chinese sources report up to 15% critical infection rate requiring life support. There are less than 100k ICU beds in the U.S. Consider the spread rate and do the math. It won't be long before hospitals are overwhelmed and businesses start to shut down to quarantine. When that happens, which stores will stay open to provide food? How will they be restocked if supply chains are disrupted? Weeks ago CNBC reported 80-90% of China's GDP was shut down. How long will your home reserves of food last when restaurants and stores close and truckers stop delivering goods? This outbreak could last for months and it's just starting.
This isn't just FUD for FUD's sake. People need to wake up to the severity of this virus and prep now. Even if it turns out to be mild at this point this is a risk to greater society because of disruption.
Chinese sources report that, outside of Hubei, the outbreak is over and everyone's getting back to work. Even in Hubei, and even in Wuhan itself, essential goods are and consistently have been available.
It seems hopeless... to even try and reply to the doomers with some sense of rationality.
It’s human nature to get excited in a way about the end of times. Like the preacher on the sidewalk in NYC holding a sign, except now everyone can get away with it and maybe they’re not crazy?!
A couple hundred cases per day (and decreasing) of a virus which will be significantly less deadly than an average flu season.
My family and I are heading to Disney World. Hopefully the lines will be shorter than average.
Which sources are you going to believe? Medical researchers potentially trying to warn the world, or sources aligned with the repeatedly demonstrated goal of the CCP to minimize this event by censoring and removing information, and providing misleading information, like a case rate when hospitals are turning people away and tests aren't being conducted?
Look at China's absurd response. There has never been a point in history where so many people were placed in lockdown by a single government. Over the flu???
I have a broad distrust of any information produced by the Chinese government. So I am suspicious of their claim that the outbreak is contained, yes - but I'm equally suspicious of their claims about infection rates, their claims about what actions the government is taking, and the implicit assumption that the actions they claim to be taking are necessary or warranted.
What I distrust a lot more is uncorroborated reports of divergent numbers, because there are just so many ways they could be wrong. For example, I saw one source claiming ironclad proof infection rates are 3x higher than reported - because a document they posted showed the number of positive coronavirus tests run in a day, and it was higher than the number of new cases reported that day. (And I'm extending the very generous assumption that the document was real, but how would anyone know if it wasn't?)
I’ve seen reports of 80% mild, 15% hospital (mainly oxygen and managing secondary infections) and 5% critical care (ICU, some intubations). But, yes, even 5% could overrun hospital resources.
Is it really unprecedented? I mean, Ebola emerged not too long ago...
Also, keep in mind CDC estimates between 16k-41k have died from the flu in the US alone for the 2019-2020 flu season (dont have a link handy but just Google: CDC 2019 flu deaths). It may be that coronavirus has a higher fatality rate than the flu, but it doesnt have the body count of the flu. I think most of the fear is from it being new and unknown, but I personally have more fear of flu or salmonella poisoning than coronavirus. For instance, I will never eat shrimp from a cafeteria after grtting food poisoning twice. (Sleeping on a bathroom floor so you can easily vomit in the toilet is not fun or comfortable).
> Again, this is an unprecedent event. Nothing in recorded history has had the potential ramifications for society that this virus does, short perhaps of the black plague of the middle ages. This virus will test civilization.
There’ve been the SARS in 2002-2003 which infected 8000 people and killed 600 ones in 28 countries. It has had such a negligible impact on civilization that most people don’t even remember it.
This is an unprecedented global geopolitical event that is already reshaping politics. The market is down some 15% in 3 days. The Chinese Century has been pushed back for decades as the us and other governments realize the danger of excessive offshoring. Manufacturing may return to the U.S. Iran is crippled and blaming the virus on the U.S. Borders the world over are closing and will continue to close and you may see a rise in pro immigration control sentiment.
Nothing is arguably more appropriate for HN right now than this. The time to keep your head in the sand and go about daily life blissfully has long passed. Now is the time to brace for as the CDC put it severe disruptions. If the virus continues to spread as it has in Italy, China, Iran, it will affect every one of us.
> The Chinese Century has been pushed back for decades as the us and other government's realize the danger of excessive offshoring.
Remains to be seen. I think they have pulled off an enormous feat in slowing the virus as they have. Maybe China comes out of this relatively better than some other nations. The cone of uncertainty is a mile wide.
That's a fair point, the rate of increase in cases in China is now lower than the rate of increase in some countries. At the same time, I think that any numbers should be taken with a large grain of salt, both on the up and the downside. Not all countries test suspected cases in large quantities, reporting is inconsistent between countries and over time from single countries. Some countries are still in 'head in the sand' mode and asymptomatic spreading could translate in many more cases than are registered.
The ratios of cases:deceased and recovered:deceased are converging, which at least reduces the error bars around some of the more important numerical parameters of this particular virus.
The most important thing to realize is that R0 is not a hard attribute of the virus but something that we have some control over. By reducing R0 through the application of best practices we can stretch the onset of the peak and hence reduce the number of fatalities and the number of people that end up in a critical condition.
Some examples of best practices:
- good personal hygiene, in other words: wash your hands
- don't travel if you don't have to
- don't touch your face all the time (very hard, subconscious)
- if you think you have 'a' bug don't go to work and stay indoors until you've been tested (call the doctor, they should have a protocol)
- avoid crowds
The next few weeks will be crucial and will have an enormous effect on how we (collectively) will look back at this in a few months time.
I feel super sorry for everybody living in countries that do not have free healthcare, the virus will have a disproportional effect on people of different wealth status but in countries without free healthcare that effect will be vastly amplified.
Why would you feel sorry for everyone living in countries without free healthcare? As you mentioned wealth status would allow the wealthier to get care plus the fear of the spread will provide emergency funding to the poor (only for this). Plus can take supplies from global market by overpaying reducing supplies to other countries.
I feel sorry for smaller nations who rely on bigger countries for medical supplies/medicine as supplies reduce and become a national issue.
- coronavirus have been shown to reappear in recovered patients in China (prob due to the unsanitary conditions in cities)
- they have welded people in their homes. How would they have tested these folks?
- 800 million people are under quarantine. Again, how do they test all these people? Plus it’s been shown that family members locked in a tight space transmit the disease to each other. And the entire family dies off.
You're on the right track, though I don't think the welding was common. Chinese neighborhoods are under a type of lockdown where there are some 4 taxis per 10-50k people that are designated for goods and extreme emergency cases. One of the many ways the government makes the numbers look smaller.
They are playing straight out of the old Soviet playbook. Their party is literally an incarnation of the CCCP. Do not treat this country as you would a democratic first world nation - it's culture is nothing of the sort, for better or worse.
Yes, absolutely. It is history in the making at a level that rarely happens, and that - unfortunately - makes you realize at a deep level why 'may you live in interesting times' is considered a curse, not a blessing. This will likely affect just about everybody on HN, their families, work environment and even you.
It's been spreading since November 2019, initially news of it was muzzled by China and then they didn't know or didn't have tests for it in other countries.
So it's going to popup everywhere. Any town with an international airport or university with international students will be flooded with cases in a month. Absolutely no-one has immunity since it's never existed before and since everyone feels entitled to still go to work or shop while very sick, it will spread like wildfire.
Also remember there are millions upon millions in the USA without any kind of insurance or easy access to healthcare.
Not to mention that political leadership and one corner of the media is throwing chaff in the air and blaming the Democrats and mainstream media for sensationalizing the virus. Trust, which is absolutely key to having the population take action, has been eroded.
Right now it is all about slowing down the onset of the eventual peak. Any delaying action will give healthcare systems in countries that are really working on preparations (and they all should be) time to get more capacity in place. The sooner that peak hits the harder it will be, the more people will die.
There are only 4 countries outside of China which have at least 100 confirmed COVID cases.
There are only 3 countries outside of China which have had at least 10 COVID deaths.
The story at this point has been blown massively out of proportion relative to a typical flu season. How many more people died last week from flu-related complications than died of COVID?
It’s wise to take precautions, but it should be done rationally. IMO, I think prophecies of WWIII level calamity should be flagged, as it’s not healthy discussion but more like gruesome fan fiction.
Ebola is a perfect example of an extremely hard to spread infection that stands zero chance of ever propagating in the US.
Only in areas where it’s common to have close contact with infected during their dying days while they are vomiting and hemorrhage blood can Ebola spread with an R0 approaching even 1.5.
Yeah, I think Ebola is a pretty strong argument against using R0 for public consumption. Ebola has never spread in the presence of a functioning health system, and even without a functioning health system outbreaks have been localized - a metric showing it's as contagious as the common cold is not measuring the common-sense definition of "contagious".
In other thread, people commented that "it's becoming real" because now we have TWO cases in US among the population over 300M. The current economic damage is at least $50M/death due to COVID-19 virus! I'm not sure if this is the most dangerous disease but its certainly most expensive diseases the world has seen so far. So yes, the hype is real.
The hype is hype. The reactions to the hype are certainly real, and obviously extremely overblown. It will be easier to see this by April 1 than it is to foresee it on March 1.
In the moment, when reactions are snowballing, it's hard to be the one who doesn't cancel an event. And then of course there will be the people who claim next month that all the economic fallout was worth it because a pandemic never materialized.
Personally, I think it's not terrible to have a good solid Stress Test for "Disease X", but it's also very much nothing to worry about. Hopefully the over-reaction this time doesn't lead to an under-reaction if it's ever truly needed.
The problem with R0=2 is that its exponential. Nor saying at all people should panic, Singapore shows it can be contained, but using 《100 as a yardstick for severity is not very useful. Germany will be 》100 in today and 》1000 a few days later, they already have up contact tracing on two clusters and it seems every local mayor gets to decide if schools stay open.
That's because the US CDC produced defective test kits and hasn't done enough testing. A tiny nation like SK has tested 30k people while the US has only tested 450+(and each kit costs a patient $3k while it's free or cheap in other countries).
The scientific facts are simple and clear. R0 is between 2 and 3, fatality rate is around 1%.
Even if it's not containable, actions should be taken to buy us more time before an effective vaccine is produced.
On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%. In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity.
If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%.
This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.
Once the hospitals are overloaded, fatality would be way higher. In China, fatality rate in the epicenter Hubei province is more than 4%, while it's less than 1% for the rest of the provinces.
If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%.
Well sure, if one assumes that, you can easily make yourself feel better. But is there a specific reason to believe this? The widespread contact tracing and testing in SK, Singapore, and Italy are not comforting. If there was a huge number of asymptomatic cases, wouldn’t they be finding them?
The point is that the fatality rate depends on the denominator chosen.
Choosing a denominator of only people with COVID who go on to develop pneumonia, results in a rate of 2%.
Choosing a denominator of all people with laboratory confirmed cases of COVID, results in a rate of 1.4%.
Clearly a denominator of “everyone who was infected with COVID” is larger than the denominator of “everyone with a laboratory confirmed case”.
The question is, how much larger? The number of reports of asymptomatic and mild cases which are asked not to go to a hospital are specific reasons why the true fatality rate is less than 1.4% and may be considerably less than 1%.
The number of reports of asymptomatic and mild cases which are asked not to go to a hospital are specific reasons why the true fatality rate is less than 1.4% and may be considerably less than 1%
Total speculation. There is no reliable data on how many uncounted people there are. I've been watching your comments on here for days and it's clear you want this to be overblown, as we all do, but you're intentionally twisting the uncertainty in the evidence and data to try and downplay things. Things could turn out to be worse than we think, not better. Look at the death rates in Italy and Iran. Not to mention how high hospitalization rates could overwhelm our medical infrastructure and push the mortality rate even higher.
In short, unless you're a working expert in a relevant field, there's exactly zero reason to listen to you. I'll continue to listen to what health officials are saying, and watch what they're doing. And when I do that, it's pretty clear that you and others like you who claim this is overblown and no big deal are almost certainly wrong.
> I've been watching your comments on here for days and it's clear you want this to be overblown, as we all do, but you're intentionally twisting the uncertainty in the evidence and data to try and downplay things.
Agreed. There are a few users on here who are almost 'hysterically' downplaying things and it's fascinating. I imagine these are the types of people who would get busy rearranging deck chairs as the Titanic went down, so to speak.
98 comments
[ 3.2 ms ] story [ 180 ms ] threadNo longer true: CDC Confirms Possible Instance of Community Spread of COVID-19 in U.S.
https://www.cdc.gov/media/releases/2020/s0226-Covid-19-sprea...
Testing it should be free (based on symptoms) if US wants to stop the disease from spreading.
Hello,
Just giving a heads up to what I and my doctor both considered a very fucked up situation. I just spent a week in Japan, a country at high risk for COVID-19. I wore a mask and essentially tried to stay away from most touristy places (not my first time there), but trains and stations are still packed with people, so there's really not much you can do.
On arriving back to America (3 days ago), I developed a 102F fever, coughing, and aches. I went to a local hospital in Brooklyn's ER. I informed them of my travel, they provided me a mask, and redirected me to a private room and followed infection protocols (full face covers, gloves, aprons, etc.). I had a chest x-ray and testing for flu/cold/pneumonia/and about 25 other viruses. They all came back negative.
At this point, the hospital called the CDC requesting permission to perform the COVID-19 testing. The CDC denied the request on the ground that I did not have the most life-threatening symptoms: chest pain and shortness of breath. According to everything I read it's very likely not to have these symptoms if you're in your 30's and relatively healthy.
And... that was that. They discharged me, said I don't have Corona virus, since they didn't test me for it, and said I can ride the subway, return to work, do whatever I want.
Of course my doctor disagreed. She said I should treat myself as if I am infected. My partner is currently staying in a nearby hotel since we live in a studio apartment. I've performed a self-quarantine for 14 days. Fortunately I can work from home and my partner can deliver me groceries if I run out.
But I don't think that many people are aware of the fact that they're actively not testing people for COVID-19, even people who have travel history to high-risk places.
Do I still have symptoms? Yes, Fever is current 101.6 (as of a couple hours ago), aches, and a cough that is persistent. I'm taking Tylenol and drinking a lot of water.
Do I just have the flu? Well, not according to my screens I don't.
Is this real? It's as real as I said it is. I returned from Japan. I'm sick. The symptoms are similar to COVID19 and I was refused testing.
You can believe whatever you want, I don't care.
A channel NY1 reporter reached out to connect with the individual, so perhaps if validated, it won’t “stay hidden very long”. And to your point, it’s not a cluster. But how would you have a cluster if each given patient is handled this way?
The individual case is less interesting than the protocol.
EDIT: Now reported by media: https://abc7ny.com/5974999/
That’s 7.0 miles from where I am, so of course I’m concerned.
The Santa Clara County health department
You mean if everyone took this seriously. Which is obviously a lot more difficult. It would probably not be possible to get everyone to agree that the sky is blue or 2+2=4.
From the long incubation time my gut feeling is that it probably couldn't have been. International airtravel speeds things up, it also didn't make a difference in 1918 when intercontinental traffic was by boat. Lindbergh didn't make his flight until 1927.
Instead there's a discourse vacuum where people seem to decide what's going to happen more on the basis of pre-existing narratives than reality. Examples; People mistrust the US believed it's all exaggerated to hurt China, for a while some "journalists" wrote more about racism and stigma than the actual ongoing development, politicians kept ringing the everything's OK alarm, and finally, mindless optimists are the worst.
The Chinese government decided to establish an economy-crippling quarantine on January 23rd with only 1000 confirmed cases. Something was awry. And in the following week all the warning sings have been available (the quick spread, reports of CCP measures and life in Wuhan, research papers about the spread, incubation, etc). But for a month now the WHO refused to read the writing on the wall, only god knows why.
That just means the upper bound of the potential quality of the Chinese numbers is better, not that the actual quality of the numbers is better. Just because they are gathering more information doesn't mean they are publicly reporting it accurately.
That is, the Chinese potentially internally have more complete data, because they are doing more surveillance. That doesn't mean that the numbers they are reporting are more trustworthy.
As a case study, for some days half of all confirmed cases outside of China were in the Diamond Princess, and the proportion held until very recently with 1000+ cases worldwide (sans China). Why? Sampling bias. Even arguing that a cruise is more virus-friendly cannot possibly account for a single ship holding half of the world's cases. And then came about Iran and Italy, with no clear path of spread. It's hurtfully evident that there are so many more cases and there's a huge visibility issue, and the WHO delaying measures aggravates the matter dramatically.
The US is shown has having "local transmission". "Community transmission" is defined as "the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through routine screening of sentinel samples".
Maybe this is just a terminology issue... "spreading freely in communities" could refer to "community transmission" defined above.
Second community acquired infection and it's in the heart of the valley.
If it wasn't possible to be reinfected, I'd say the wise thing to do would be to get yourself infected now, while you can still get a respirator in the hospital.
I'm assuming you can get it twice, based on recent news[1], that's why I said:
> If it wasn't possible to be reinfected
[1] https://thehill.com/changing-america/well-being/prevention-c...
Long duration shedding even after recovery is a more likely explanation than than re-infection. But even that's not good news if someone is contagious after they've recovered. https://twitter.com/mlipsitch/status/1231662145156374528
Possibly those weeks could make a difference; I'd imagine vaccine development is highly parallelised relative to a normal year, and there may be something in the next 6 months. 4 weeks in that scenario could be huge.
> Marks said a real late-stage trial to test a vaccine is likely “months away.” One concern is that some previous coronavirus vaccines have caused worsening of the disease, not improvement.
> “We have to make sure that as we proceed with development, we’re not creating problems,” Marks said. It might be realistic, he said, for studies of vaccines to begin by the summer, although that timeline is still aggressive.
[1] https://www.statnews.com/2020/02/26/coronavirus-vaccines-are...
I don't think this is true, and since we still don't know enough about true fatality rates outside of China (yet) it seems foolish to be fatalistic at this stage about containment. There's no "shoring up the [US] health care system". We can't build hospitals out of thin air (China's attempt notwithstanding), and we can't apparate more medical devices, whose supply chains are broken because of our dependence on China. Limiting infections - especially in higher risk demographics - seems critical at this point.
>If it wasn't possible to be reinfected, I'd say the wise thing to do would be to get yourself infected now, while you can still get a respirator in the hospital.
Uhhh no. This would needlessly stress the existing infrastructure. If you're young and healthy, don't soak up resources that should be used to care for at-risk populations. WFH and wash your hands.
Seems like a lot of “we can’t” assertions. If any country started seeing ~1M deaths per month or something, I bet they’d somehow figure out a way to do it.
I hope that, deep in the Pentagon, someone is asking these questions. Not necessarily because of COVID-19, but just in general.
We've already failed at this - it's in the community, cases are popping up with no known contact with an infected person. Asymptomatic cases are contagious for several days, and in a large chunk of patients it presents as a common cold that they won't go to the hospital for, and even if they could there isn't enough capacity to do the necessary testing. Game over.
> Off-Topic: Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon. Videos of pratfalls or disasters, or cute animal pictures. If they'd cover it on TV news, it's probably off-topic.
[1]: https://news.ycombinator.com/newsguidelines.html
Again, this is an unprecedent event. Nothing in recorded history has had the potential ramifications for society that this virus does, short perhaps of the black plague of the middle ages. This virus will test civilization.
Wake me up when there is a water, food, or housing shortage or significant amount of population infected and dying because of a global disease.
This isn't just FUD for FUD's sake. People need to wake up to the severity of this virus and prep now. Even if it turns out to be mild at this point this is a risk to greater society because of disruption.
It’s human nature to get excited in a way about the end of times. Like the preacher on the sidewalk in NYC holding a sign, except now everyone can get away with it and maybe they’re not crazy?!
A couple hundred cases per day (and decreasing) of a virus which will be significantly less deadly than an average flu season.
My family and I are heading to Disney World. Hopefully the lines will be shorter than average.
Look at China's absurd response. There has never been a point in history where so many people were placed in lockdown by a single government. Over the flu???
What I distrust a lot more is uncorroborated reports of divergent numbers, because there are just so many ways they could be wrong. For example, I saw one source claiming ironclad proof infection rates are 3x higher than reported - because a document they posted showed the number of positive coronavirus tests run in a day, and it was higher than the number of new cases reported that day. (And I'm extending the very generous assumption that the document was real, but how would anyone know if it wasn't?)
Also, keep in mind CDC estimates between 16k-41k have died from the flu in the US alone for the 2019-2020 flu season (dont have a link handy but just Google: CDC 2019 flu deaths). It may be that coronavirus has a higher fatality rate than the flu, but it doesnt have the body count of the flu. I think most of the fear is from it being new and unknown, but I personally have more fear of flu or salmonella poisoning than coronavirus. For instance, I will never eat shrimp from a cafeteria after grtting food poisoning twice. (Sleeping on a bathroom floor so you can easily vomit in the toilet is not fun or comfortable).
The disease may not be unprecedented, but the response to it certainly has been.
There’ve been the SARS in 2002-2003 which infected 8000 people and killed 600 ones in 28 countries. It has had such a negligible impact on civilization that most people don’t even remember it.
Nothing is arguably more appropriate for HN right now than this. The time to keep your head in the sand and go about daily life blissfully has long passed. Now is the time to brace for as the CDC put it severe disruptions. If the virus continues to spread as it has in Italy, China, Iran, it will affect every one of us.
Remains to be seen. I think they have pulled off an enormous feat in slowing the virus as they have. Maybe China comes out of this relatively better than some other nations. The cone of uncertainty is a mile wide.
The ratios of cases:deceased and recovered:deceased are converging, which at least reduces the error bars around some of the more important numerical parameters of this particular virus.
The most important thing to realize is that R0 is not a hard attribute of the virus but something that we have some control over. By reducing R0 through the application of best practices we can stretch the onset of the peak and hence reduce the number of fatalities and the number of people that end up in a critical condition.
Some examples of best practices:
- good personal hygiene, in other words: wash your hands
- don't travel if you don't have to
- don't touch your face all the time (very hard, subconscious)
- if you think you have 'a' bug don't go to work and stay indoors until you've been tested (call the doctor, they should have a protocol)
- avoid crowds
The next few weeks will be crucial and will have an enormous effect on how we (collectively) will look back at this in a few months time.
I feel super sorry for everybody living in countries that do not have free healthcare, the virus will have a disproportional effect on people of different wealth status but in countries without free healthcare that effect will be vastly amplified.
I feel sorry for smaller nations who rely on bigger countries for medical supplies/medicine as supplies reduce and become a national issue.
- coronavirus have been shown to reappear in recovered patients in China (prob due to the unsanitary conditions in cities)
- they have welded people in their homes. How would they have tested these folks?
- 800 million people are under quarantine. Again, how do they test all these people? Plus it’s been shown that family members locked in a tight space transmit the disease to each other. And the entire family dies off.
They are playing straight out of the old Soviet playbook. Their party is literally an incarnation of the CCCP. Do not treat this country as you would a democratic first world nation - it's culture is nothing of the sort, for better or worse.
Technology is going to be critical getting through this.
Schools will be shutdown; many people are going to have to work from home, possibly for extended periods of time.
Most people get their information from websites and social media.
Most of the manufacturing for medical supplies and equipment is in China.
Many tech companies of going to be hurt; COVID-19 may be the tech story of 2020.
So it's going to popup everywhere. Any town with an international airport or university with international students will be flooded with cases in a month. Absolutely no-one has immunity since it's never existed before and since everyone feels entitled to still go to work or shop while very sick, it will spread like wildfire.
Also remember there are millions upon millions in the USA without any kind of insurance or easy access to healthcare.
There are only 3 countries outside of China which have had at least 10 COVID deaths.
The story at this point has been blown massively out of proportion relative to a typical flu season. How many more people died last week from flu-related complications than died of COVID?
It’s wise to take precautions, but it should be done rationally. IMO, I think prophecies of WWIII level calamity should be flagged, as it’s not healthy discussion but more like gruesome fan fiction.
Only in areas where it’s common to have close contact with infected during their dying days while they are vomiting and hemorrhage blood can Ebola spread with an R0 approaching even 1.5.
In the moment, when reactions are snowballing, it's hard to be the one who doesn't cancel an event. And then of course there will be the people who claim next month that all the economic fallout was worth it because a pandemic never materialized.
Personally, I think it's not terrible to have a good solid Stress Test for "Disease X", but it's also very much nothing to worry about. Hopefully the over-reaction this time doesn't lead to an under-reaction if it's ever truly needed.
The scientific facts are simple and clear. R0 is between 2 and 3, fatality rate is around 1%.
Even if it's not containable, actions should be taken to buy us more time before an effective vaccine is produced.
If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%.
This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.
— New England Journal of Medicine, Feb 28, 2020
https://www.nejm.org/doi/full/10.1056/NEJMe2002387?query=rec...
Well sure, if one assumes that, you can easily make yourself feel better. But is there a specific reason to believe this? The widespread contact tracing and testing in SK, Singapore, and Italy are not comforting. If there was a huge number of asymptomatic cases, wouldn’t they be finding them?
Choosing a denominator of only people with COVID who go on to develop pneumonia, results in a rate of 2%.
Choosing a denominator of all people with laboratory confirmed cases of COVID, results in a rate of 1.4%.
Clearly a denominator of “everyone who was infected with COVID” is larger than the denominator of “everyone with a laboratory confirmed case”.
The question is, how much larger? The number of reports of asymptomatic and mild cases which are asked not to go to a hospital are specific reasons why the true fatality rate is less than 1.4% and may be considerably less than 1%.
Total speculation. There is no reliable data on how many uncounted people there are. I've been watching your comments on here for days and it's clear you want this to be overblown, as we all do, but you're intentionally twisting the uncertainty in the evidence and data to try and downplay things. Things could turn out to be worse than we think, not better. Look at the death rates in Italy and Iran. Not to mention how high hospitalization rates could overwhelm our medical infrastructure and push the mortality rate even higher.
In short, unless you're a working expert in a relevant field, there's exactly zero reason to listen to you. I'll continue to listen to what health officials are saying, and watch what they're doing. And when I do that, it's pretty clear that you and others like you who claim this is overblown and no big deal are almost certainly wrong.
Agreed. There are a few users on here who are almost 'hysterically' downplaying things and it's fascinating. I imagine these are the types of people who would get busy rearranging deck chairs as the Titanic went down, so to speak.
FYI, the italicized portion was a quote from the New England Journal of Medicine from a working expert in a relevant field.