Real News: Coronavirus Facts

Hi everyone,

 

I have been watching and observing the spread of NCOV-19 (also known as the Coronavirus) since it sprang up in the Wuhan province of China late last year. Since then, it has exploded onto the world scene. Since I have been tracking this outbreak for some time, I have been able to watch it unfold and have learned a lot about it. This post is for collecting and disseminating that information.

Edit: To be clear because I have seen reports of discrimination – there is absolutely no indication that the virus targets people of Asian descent or is even limited to Asian people. In fact, despite Austin, Texas having no official cases of the virus, an American returning to India brought the infection with them. Go to your favorite Asian food restauraunt, sit next to any Asian person on the train: you are just as safe there as you are anywhere else.

diver

Basic Facts

The Name

Coronavirus: “any of a group of RNA viruses that cause a variety of diseases in humans and other animals.”

2019-nCov: So named because this is an entirely new type of virus i.e. “novel”. It is not a mutation of SARS, but it is of the same class – hence “coronavirus”. It occurred in 2019, hence “2019”.

“Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” – the current full name of the virus.

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Origin

The Wuhan province in central China, sometime around November of last year (2019). Local authorities originally covered it up at least until late December. Dr. Li Wenliang was the first whistleblower but was forced to sign a confessional saying that there was no danger posed by the virus. He later died from complications stemming from it. He was 34.

It is currently believed that the virus stemmed from either consumption of bat meat or pangolin meat as it has several genetic markers that are similar to coronaviruses found in these animals.

There is a conspiracy theory that Chinese nationals caught smuggling samples from a Canadian biolab that studies coronaviruses (the much more lethal MERS) were taking them to a known high-security biolab in Wuhan province. There is no significant evidence to tie these events together.

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Symptoms

(Note: Some people do not exhibit symptoms for up to a week or even ever).

  • Fever of ~103°.
  • Dry, unproductive cough. Unproductive means you do not create phlegm.
  • Sore throat (unconfirmed cases have said it feels like “heartburn” except in your esophagus.
  • Fatigue.
  • Shortness of breath and difficulty breathing.
  • Headache.
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Spread

  • It is spread through saliva and other fluids. Coughing and sneezing are big culprits.
  • Recent evidence points to it being able to stay in the air for up to 30 minutes, survive for days on some surfaces and travel up to 15 feet. Source.
  • Touching a surface that has been contaminated and then touching a part of your body that allows it to enter (face, nose, etc.).

Note that you can catch it by breathing it or through occular transmission – if you get someone’s spit in your eye, you can catch it.

Through genetic tracking, we have determined that the virus spreading through Washington state was most likely introduced in a single event. Source is Trevor Bedford, a scientist studying viruses, evolution and immunity.

New information as of 3/09/2020 @ 2:11 PM. National Institute of Health (NIH) study reflects how long the virus can live on surfaces:

New as of 3/17/2020 @ 11:36 PM: many young people are extreme vectors for this – they have it and never show. That’s why it’s critical that we practice social distancing. Source: Dr. Margaret Stager:

“Twenty somethings are MAJOR vectors for the virus. Current US protocols won’t get them tested but S Korea data shows they are spreading the virus everywhere. It’s time for the healthy young adults to stay home and stop spreading the virus.”

New as of 3/17/2020 @ 11:36 PM: Source

SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A).

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Safety

  • Masks:
    • Masks can protect you if they are fitted properly. They need to make an airtight seal against your face. They must be rated at N95 (filtration). Surgical masks don’t count. The virus is 120–160 nm in diameter, so anything that can filter particles that small will do.
    • Disposable masks must be discarded after every use.
    • Masks must fit tightly over your nose. There is a metal clip at the top; squeeze it to tighten it against your nose.
    • Masks will not protect you from saliva, particulate, etc. that enters your body through your eyes. So be aware that masks are not 100% foolproof. You would need to wear goggles, a face mask, a disposable smock, gloves, etc. to be completely protected in public.

    Touch:

    • Keep track of what you touch things with. I’ve taken to touching elevator buttons with my knuckle. After handling public surfaces (coffee machines, subway poles, etc.) wash your hands with soap and water.
    • Try to avoid shaking hands.

    Social Distancing:

    • Cut back on going out to parties, large events, etc.
    • Stay away from large groups and crowds as much as possible.
    • Quarantine.
    • Web-only meetings, school closures, work from home.
    • Avoiding recreational facilities like gyms, pools, etc.
    • Cancelling large gatherings.
    • Limiting mass transit.
    • Limiting in-person meetings.
    • Minimizing physical contact (no shaking hands, etc.).

These are listed later in this article, but I am repeating them here:

  1. Here is a great summary of what China had to do to cut down their cases and get the event under control.
  2. How South Korea slowed the spread of the coronavirus without locking down cities. Includes drive-through testing centers, public display of people’s movements based on credit card purchases, phone records, etc., good hygiene and more.
  3. Seven steps we can take: Boston Globe, including giving hourly workers paid sick leave and preparing for months, not weeks of mitigation.
diver

Existential Risks

“It’s just the flu, bro”.

I am going to go over the fatality statistics but, to be honest, they’re not what’s most important. Skip to “Knock on Effects” for where it starts getting nasty. Influenza, also known as the flu, has a lethality rate of roughly .01% for ages 0 to 49 years old, climbing to .83% at 65+ years old. This means that if you are an at-risk individual (65+), you have less than a 1 in 100 chance of dying if you catch the flu.

However, Coronavirus has a .2% chance of fatality for 0-39 years old. For 60-69, that climbs to 3.6% (so almost 4 in 100). For 80+, that’s almost 15% – so fifteen out of every one hundred 80 year olds will die if they are infected.

For the Baby Boomer generation, this virus is potentially very deadly. But that’s not to say that it’s a picnic for Gen X, Millenials or Gen Z. From a report where 25 international experts from the World Health Organization (WHO) visited China to find techniques from combating this virus (emphasis mine);

“Most people infected with COVID-19 virus have mild disease and recover. Approximately

80% of laboratory confirmed patients have had mild to moderate disease, which includes

non-pneumonia and pneumonia cases, 13.8% have severe disease (dyspnea, respiratory

frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300, and/or lung

infiltrates >50% of the lung field within 24-48 hours) and 6.1% are critical (respiratory

failure, septic shock, and/or multiple organ dysfunction/failure). Asymptomatic infection

has been reported, but the majority of the relatively rare cases who are asymptomatic on

the date of identification/report went on to develop disease. The proportion of truly

asymptomatic infections is unclear but appears to be relatively rare and does not appear to

be a major driver of transmission. “

For what it’s worth, here are the fatality rates vs. the regular flu:

EDIT: 3/10/2020: 2:04 PM: New death rates from a recent (yet to be peer-reviewed) study on the outbreak in Wuhan (Source):

Regardless of the mortality rates, dying from the disease directly is not the real risk. That dubious trophy belongs to:

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Knock-on Effects

Like climate change, nCOV19 is most lethal to our society because of what it does to the society as a whole, not individuals. The greatest risk is that, despite the low death rate, many cases still require hospitalization. These cases require ICU beds. We don’t have enough. From Mark Manson, a blogger who wrote about this as well;

 

“Roughly 10-15% of people infected need to go to the hospital. Right now, epidemiologists are saying we can expect anywhere from 40-70% of the world population to be infected in the next year. Let’s say that’s an exaggeration and go with a more conservative 30%. In the US, that means roughly 110 million people getting sick. And of those 110 million, 10-15 million or more need a hospital bed.

Yet, the US only has 924,000 hospital beds… in the entire country.”

 

There are only 94, 837 ICU beds in the United States, but this leaked slide from the American Hospital Association is calling for at least 1.9 million ICU admissions and 480,000 deaths,.

 

If we do not take sufficient preventative measures, the case amounts that require ICUs will spike past what our healthcare system can handle and deaths will begin to compile. Even if you are young – if you get this and require a ventilator (to help you breathe because your lungs are filled with mucus), you may not be able to get one and will die. If you are going in for a major surgery or are undergoing treatment, you may not be able to get it and might die. Unless we stretch the infection rate out over time and “flatten the curve” we could be facing disaster.

Marc Lipsitch is an infectious disease epidemiologist and microbiologist at Harvard. From his Twitter:

 

“We looked at the epidemics in Wuhan and Guangzho and their ICU and hospital bed use vs US capacity. Summary: Wuhan’s peak critical case load per capita was equal to the total number of ICU beds per capita in the US — a similar experience to Wuhan would fill our ICU with COVID”

As an example of what it’s like if we fail to do this, I give you this story from an Italian doctor on the front lines.

Excerpt:

“Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.

“Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.

“Someone already to be intubated and go to intensive care. For others it’s too late… Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.”

Another Italian doctor had to choose who to give a ventilator to; a 40 year old or a 60 year old patient. Whoever they chose, the other would die. There are more stories like this; such as the one found in this thread (unverified):

Excerpt:

“3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity”

“4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.”

“6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.”

This can happen here. In fact, here are some charts showing we are on the same path (Source):

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Exponential Increase

Disease’s infectiousness rate is measured in R0, or essentially, how many people one person will infect. The flu’s rate is about 1.3 per person, or, for every person they will infect roughly 1.3 people. That person will infect 1.3 people, and so on.

nCov-19’s rate is estimated at around 2.4. However it could be higher, with several studies averaging out to be around 2.79. That means one carrier will infect 2.4 to 2.79 people, and they will infect 2.4 to 2.79 people themselves. The current estimated incubation period is around 5 days. We do not know if they are contagious during these five days before they start showing symptoms.

This is one potential scenario of what exponential functions look like. On the right, you can see actual case numbers.

Day 0: 1 x 2.4 = 2.4.

Day 5: 2.4 x 2.4 = 5.8

Day 10: 5.8 x 2.4 = ‭13.8

Day 15: ‭13.8 x  2.4 = ‭33.2

Day 20: ‭79.7 x 2.4 = 191

Day 25: 191 x 2.4 = ‭458.4‬

Day 30: ‭458.4‬ x 2.4 = ‭1,100.16‬

Day 35: ‭1,100.16‬ x 2.4 = ‭2,640.38

From Source:

“Italian study found that growth of ICU admissions (data up to march 1) near perfectly fits exponential (R2=0.96) doubling every 2.6 days. I added data points for march 4 and 6 -> trend still holds This is devastatingly fast: ICU capacity will be depleted within 10 days.”

According to this Twitter post from Rachel Donadio, writer for The Atlantic, parts of Italy’s health system is already collapsing as of March 7th:

“The head of the Lombardy’s intensive care crisis unit says the health system is on the brink of collapse, intensive care being set up in hallways. By March 26 they predict ~18,000 #Covid19 cases in Lombardy, of which ~3,000 will need intensive care.”
In the image below (original source lost) – Lombardy is black:

…and the United States is on the same path (Source):

US trajectory as of March 10th, per NYT:

…so is Germany (Source):

According to the models in this Medium post, Washington State will begin to run out of beds sometime around end of March:

…while Germany will begin to run out around early April:

Here is a comparison chart of several different countries:

As per source: Prof. Mark Handley, Professor of Networked Systems and part-time Roboticist at UCL:

Here’s the coronavirus data, overlayed with the dates offset by the amounts shown. One of these countries is not like the rest. Everyone else will be Italy in 9-14 days time. This version includes South Korea. They were on the same growth curve til 7 days ago – ahead of Italy. The measures they adopted then (subject to the lead time in measurements) seem effective – still exponential growth, but similar doubling period to Japan now.

With all this data, we are seeing an increasing amount of 1.3 new cases per day. This is consistent with an R0 of around 2.4 every 5 days (same as increasing 1.2x every 1 day). The case load increases 10x every 16 days. You can watch a video detailing exponential growth of the virus here:

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Advice for Leaders

This is my experience and what I have been practicing/would suggest practicing to those around me. 

 

  1. If you manage people, make it clear to them that they should under no circumstances feel pressured to come into work if they are sick.
  2. I suggest pre-emptively setting up WFH for your employees. If you have a VPN system you should already be stress-testing it to withstand your entire workforce remoting in.
  3. If you have events scheduled, consider postponing them or making them online-only if possible.
  4. Encourage people you know to be informed and to wash their hands. Present calmness to those around you, to help them be calm as well. This is only a disaster if we let it become one.
  5. Be decisive. Give clear go/no-go decisions. 
  6. Be willing to think outside the norm to keep things going or to branch into a new direction that reacts to this problem.
  7. Just because things were done a certain way doesn’t mean you can’t take personal responsibility to change the way they are done.
  8. Do not fall prey to normalcy bias.
    “Normalcy bias, or normality bias, is a tendency for people to believe that things will always function the way they normally have functioned and therefore to underestimate both the likelihood of a disaster and its possible effects.”
  9. Here is a great summary of what China had to do to cut down their cases and get the event under control.
  10. How South Korea slowed the spread of the coronavirus without locking down cities. Includes drive-through testing centers, public display of people’s movements based on credit card purchases, phone records, etc., good hygiene and more.
  11. Seven steps we can take: Boston Globe, including giving hourly workers paid sick leave and preparing for months, not weeks of mitigation.
diver

Risks of Failure

We could see a catastrophic failure of our health systems. If we do not act now to flatten the curve, we will see countless lives lost. Our economy is already heading into a recession. If no one is worried, then you should be worried. If everyone is worried, then you can start to relax.

We will see senseless deaths of hundreds of thousands. Wash your hands and flatten the curve.