Since I can't, in good conscience, "like" this post, I am posting to say only:
oh. my. god.
And also:
ughhhhh.
I posted this article in the coronavirus thread but I took down the graphs because I thought they would scare people who are mainly looking for information on how to protect themselves and for hope. But since you are all already writing about how Trump has endangered the country by delaying the testing, how far behind we are and what is happening as a result, here is the graph of how the virus is escalating here versus how it progressed in the far east where they actually did something about it.
It shows that the virus in the U.S. is escalating at a steeper curve, as steep as in Italy and Iran versus the way it progressed in China, Hong Kong, and Singapore where authorities quickly began testing tens of thousands and containing the epidemic.
P.S. I don't think it was just bungling that delayed the tests. I have read detailed accounts of the comedy of errors at the CDC that prevented the tests, and there is much information that is missing. I feel there is a good chance that Trump made it clear he didn't want those tests out there. Trump has a way of getting people to do what he wants without putting it in writing.
Thanks, Jeanne. This is important for us to see and understand.
The following is from an email sent to me with the highlights of a discussion that took place this week among the University of California, San Francisco's leading researchers in infectious disease.
University of California, San Francisco
BioHub Panel on COVID-19
March 10, 2020
- Panelists
o Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic.
o Emily Crawford: COVID task force director. Focused on diagnostics
o Cristina Tato: Rapid Response Director. Immunologist.
o Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist.
o Chaz Langelier: UCSF Infectious Disease doc
What’s below are essentially direct quotes from the panelists. Bracketed those few things that are not quotes.
- Top takeaways
o At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US.
o Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.
o How many in the community already have the virus? No one knows.
o We are moving from containment to care.
o We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.
o 40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
o [We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.]
- The fatality rate is in the range of 10X flu.
- This assumes no drug is found effective and made available.
o The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%. [See chart by age Signe found online, attached at bottom.]
o Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
o Definitively, it’s going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year.
- What should we do now? What are you doing for your family?
o Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
o How long does the virus last?
- On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this
- The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based.
o Avoid concerts, movies, crowded places.
o We have cancelled business travel.
o Do the basic hygiene, eg hand washing and avoiding touching face.
o Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing.
o Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
o Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
o We would say “Anyone over 60 stay at home unless it’s critical”. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
o We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in.
o Three routes of infection
- Hand to mouth / face
- Aerosol transmission
- Fecal oral route
- What if someone is sick?
o If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on.
o If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
o There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis.
o If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines.
o Why is the fatality rate much higher for older adults?
- Your immune system declines past age 50
- Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults.
- Risk of pneumonia is higher in older adults.
- What about testing to know if someone has COVID-19?
o Bottom line, there is not enough testing capacity to be broadly useful. Here’s why.
o Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating”.
o A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives.
o The PCR test requires kits with reagents and requires clinical labs to process the kits.
o While the kits are becoming available, the lab capacity is not growing.
o The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation.
o Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon.
o UCSF and UCBerkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified.
o Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.
- Where do you find reliable news?
o The John Hopkins Center for Health Security https://urldefense.proofpoint.com/v2/url?u%3Dhttp-3A__www.centerforhealthsecurity.org_resources_COVID-2D19_%26d%3DDwMGaQ%26c%3DyIH1_-b1hO27QV_BdDph9suDL0Jq0WcgndLmIuQXoms%26r%3DdiC0DwaAS134TtjbAAOBVTQONf_NXRnBOhECEqZDbCk%26m%3D92B19XK2hVQySYUz_5AM41ctAX7tctOhNurK237Gr38%26s%3Do8nMJ-g-78epH0T6Yl8GODz6XabvndO7cQ-p1CPRY_8%26e%3D&source=gmail&ust=1584137654485000&usg=AFQjCNHaOWZH5ABLqxrVLuMAEnG3UrIdu Q">site. Which posts daily updates. You can sign up to receive a daily newsletter on COVID-19 by email.
o The New York Times has the same service and is good on scientific accuracy.
- Observations on China
o Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19.
o While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.
o Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots.
o Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime.
Thank you for this information. Much to digest.
I also am hearing the numbers 12-18 months.
Can't even imagine that impact yet.
I felt a few days ago that a HIV drug might help mitigate the effects of Coronavirus.
Just read China is now testing one.
Also read Ivanka is now "working" from home after being exposed.
Regarding the vision with the bear on its side, I didn’t connect it to the stock market at the time. I just thought it was strange and didn’t quite know what to make of it. The whole thing in my notes from January 23rd this year went as follows:
I saw orange trees - which I understood to be Florida
I saw Uncle Sam running and it looked like he was making chopping motions with his hands (US trying to stop something?)
I saw a bear laying on its side stiff - it looked almost like a stuffed animal (maybe a symbol for Russia?)
re your sense that an HIV drug might help treat COVID-2019 -- I've posted a long response under the "New Wuhan Coronavirus ..." thread.
That same thought about an existing antiviral that might be effective against the coronavirus also keeps coming to my mind, too, and an existing HIV drug certainly fits. My gut feeling is that there will be some effect treatments or preventatives that are discovered along the way.
Thanks for the article and insight. So interesting.
Yes, it just quietly floated into my mind. More than once. It feels like it would help a great deal until we develop a vaccine.