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Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

virologydownunder.com

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Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#361

Post by rotexo »

contemporary343 wrote: post #3

The lack of testing and testing capacity in the US is deeply alarming. They’ve only run 500 tests so far and criteria still require the patient to have recently traveled from Hubei! By comparison South Korea is running thousands of tests per day, which is why it is picking up so many cases. Absolutely unforgivable complacency and lack of transparency from CDC. There is almost certainly community spreading in the US t…

I am curious if we will see rapid deployment of one of the rapid point-of-care CRISPR-based detection systems (like https://mammoth.bio/wp-content/uploads/2020/02/A-protocol-fo...)

Probably unlikely, given the understandable emphasis in the medical community on gold-standard diagnostic methods. But if one of these companies can collaborate with the CDC to get their hands on a large number of patient samples for validation, the FDA for quick approval, and a reliable manufacturing partner for scale-up, the possibility exists.

(Edit: spelling and added required collaborators to the list)

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#362

Post by est31 »

jacquesm wrote: post #98
est31 wrote: post #30

> One horrible effect of this continued “stop the pandemic” daydream masquerading as a policy goal: It is driving counter-productive and outrage-inducing measures by many countries against travelers from other countries, even their own citizens back from other countries. But possibly more horrible: The messaging is driving resources toward “stopping,” and away from the main potential benefit of containment – slowing…

The time that border closures would have stopped the spread is past. Those measures are useless now, 25+ countries have the virus within their borders now (and likely, many more without knowing it) so it will spread within those communities unless measure to stop that spreading will be taken. This sucks but if you live in a wealthy country you will likely survive this, it may still impact you economically.

Closing borders might not stop the spread, but it certainly slows it down if there is a major population of sick people in one country, but in the other country the population of sick people is smaller. The numbers of detected and undetected cases are different, but definitely not uncorrelated.

The less people have the disease, the more you can focus onto containment measures. If you detect one case in a country of 30 million, you can test everyone who had contact with that person and maybe even their entire street. However, if there are 10 000 cases in that same country, you suddenly have a problem.

Even if you assume constant spreading rates with an exponential model of patient number increase, where after a period P, the number of cases doubles, then with 10 case, after P you have 20 cases. If you have 100 cases because you left your border open and, say 50 000 people from the country with many cases got in, you'll have 200 cases after period P.

Closing borders is an efficient method to slow down the spread. Of course you need to accompany these cases by within-country measures like China is taking, but you can isolate them to affected regions. What's important though is that you prevent travel in any fashion as much as possible, because the virus doesn't travel by itself, it needs humans to travel for it.

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#363

Post by est31 »

bpfrh wrote: post #75
est31 wrote: post #30

> One horrible effect of this continued “stop the pandemic” daydream masquerading as a policy goal: It is driving counter-productive and outrage-inducing measures by many countries against travelers from other countries, even their own citizens back from other countries. But possibly more horrible: The messaging is driving resources toward “stopping,” and away from the main potential benefit of containment – slowing…

Closing borders isn't easy. Most of the time there are still ways you can cross, so instead of having known routes where you can test and treat accordingly, you have an unknown number of people crossing the border on unknown points and spreading the virus in unknown regions.

The virus doesn't spread because of a natural effect, but because infected people travel and take the virus with them. The speed of the spread is as fast as the fastest method of travel. If we have FTL travel, it travels faster than light. If we have airplanes, it travels as fast as them. So even if you don't watch land borders, shutting down airplane traffic to a country is highly useful: the virus cases are isolated to the border region of your country, and you can focus your attention to that part.

Usually there is already infrastructure to close down land borders for cars and similar. So why not use that infrastructure? Besides stomping out the few cases inside its own borders or preventing travel from affected regions, it's the most useful measure a country can take. After that there are only inside country prevention methods, like curfews, forbidding car usage, etc.

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#364

Post by jacquesm »

emmelaich wrote: post #359
jacquesm wrote: post #269

Earlier quoted context omitted.

Or Iran, for that matter. https://time.com/5789360/iran-coronavirus-death-toll/ 8 dead on 43 cases suggests severe under-reporting of the number of people infected. That in turn suggests that testing is inadequate which may cause the disease to spread further than necessary. The fact that infected Iranians have turned up in Lebanon and Canada is further proof that the number of infections is likely higher than report…

What interests me is the low or zero figures elsewhere. Especially Indonesia; surely they have significant numbers of Chinese travellers?

Latin America and Africa have the temperature going for them but especially Africa has a ton of back-and-forth with China so you can expect there are or will be cases there.

Indonesia is an interesting case especially geographically. Maybe there is some data on how well they did during previous pandemics?

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#365

Post by carbocation »

stallmanite wrote: post #346
carbocation wrote: post #316

Earlier quoted context omitted.

Not sure what you're referring to. I'm thinking of medications like injectables, which may not have a sufficient shelf life to permit getting the full set of supplies all at once. But most of the medications which are life-threatening if withheld (e.g., antiplatelet medications after a stent) can be obtained in bulk with a normal prescription.

I was thinking of Adderall specifically but in the case of Benzodiazepines, withdrawals can be fatal and they’re controlled substances so presumably ineligible for the 3 months prescription.

Yes, I agree; while benzodiazepines are not generally considered life-saving medications, they can be life-threatening (like alcohol) if high tolerance is developed and cessation is abrupt.

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#366

Post by jacquesm »

Engineering-MD wrote: post #300
joak wrote: post #2

In the preparation list, scaling ICU is most needed. A lot of people survived thank to intensive care units. There might not be enough to cope with the peak

So scaling of ICU is already possible to a degree. In most hospitals in case of a major accident (eg terror isn’t attack with many injured) theatres are used as ICUs and all non emergency surgery is stopped. I suspect this will happen in these cases. The main issue is going to be sufficient nursing staffing (ICU requires 1:1 nurse:patient ratio usually).

That trick doesn't work when you're talking about infectious diseases. You need to isolate your patients from each other to avoid re-infection and you need to stop rotating your ICU personnel between units or they themselves will become vectors for infection to people who would otherwise recover or may be mis-diagnosed.

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#367

Post by [deleted] »

nednar wrote: post #61

Well. Infection rate is going down already. Death rate is starting to slow down. Death rate was never higher than a common flu. Healing rate is increasing drastically, many heal without medical needs. So, should we really talk about a pandemic? A flu pandemic? Or has the virus changed in the last few days and I've missed it?

[deleted]

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#368

Post by divbzero »

hajile wrote: post #351
WaltPurvis wrote: post #298

Earlier quoted context omitted.

> the mortality rates aren't all that high (a few percent) That's about the same mortality rate as the pandemic flu of 1918, which wasn't exactly a walk in the park.

We don't actually know mortality. By the numbers, 2,470 deaths, 23,419 recoveries, and 53,105 undecided cases. 10% of all settled cases resulted in death. That is far higher than the 3% of Spanish Flu and reasonably close to SARS. Median time to death is around 12 days which is similar to time to recovery meaning the 10% seems likely to be an accurate metric. https://www.cdc.gov/coronavirus/mers/clinical-features.htm…

Thank you for calling out the actual numbers:

> By the numbers, 2,470 deaths, 23,419 recoveries, and 53,105 undecided cases. 10% of all settled cases resulted in death.

The mistakenly low estimates of mortality rate are likely due to use of the wrong denominator. As Worldometer [1] explains correctly in their summary of Ghani et al. [2]:

> Once an epidemic has ended, it is calculated with the formula: deaths / cases. But while an epidemic is still ongoing, as it is the case with the current novel coronavirus outbreak, this formula is at the very least “naïve” and can be “misleading if, at the time of analysis, the outcome is unknown for a non negligible proportion of patients.”

[1]: https://www.worldometers.info/coronavirus/coronavirus-death-... "Worldometer Coronovirus Mortality Rate"

[2]: https://doi.org/10.1093/aje/kwi230 "American Journal of Epidemiology Volume 162, Issue 5, Pages 479–486"

As the parent calls out, a better estimate of mortality rate for an ongoing epidemic is deaths / settled cases where settled cases is the sum of deaths and recoveries.

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#369

Post by tim333 »

nednar wrote: post #61

Well. Infection rate is going down already. Death rate is starting to slow down. Death rate was never higher than a common flu. Healing rate is increasing drastically, many heal without medical needs. So, should we really talk about a pandemic? A flu pandemic? Or has the virus changed in the last few days and I've missed it?

They got the rates down in Wuhan pretty much by confining everyone to their houses. If they have to so that globally it's not going to be pretty.

Re: Past Time to Tell the Public:It Will Probably Go Pandemic, We Should Prepare Now

#370

Post by irq11 »

senordevnyc wrote: post #360
irq11 wrote: post #348

Earlier quoted context omitted.

It is about as contagious as the flu. Stop fear-mongering. Also, not for nothing: most people don’t get the flu vaccine, despite endless begging on the part of health officials.

It’s much, much deadlier and more likely to put you in the hospital than the flu, though. The trite comparisons to the flu are honestly irresponsible at this point. There’s a reason public health officials all over the world are taking this very seriously.

It is not. You are making up “facts” and need to stop.

This virus disproportionately kills old and sick people. Aside from the fact that over 80% of cases are mild, the death rate in patients under 60 is well under 1%:

https://www.google.com/amp/s/www.bbc.com/news/amp/world-asia...

Even these are based mostly on statistics from Wuhan, where a “confirmed infection” has to be severe to begin with; these rates are going to be overestimates of the real rates.

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