I’m still on “looks bad but not Ebola bad” outside of China, but on a personal level I’m getting a little nervous - I’m supposed to be starting 6 weeks of treatment at Stanford the end of the month, and while intellectually I know the chances of that part of the hospital and what they’re planning for me (chemo/radiation/etc) will be completely uninvolved, my lizard brain starts worrying…and of course my wife is freaking out (she’s nonmedical)
MM MD
Yeah, we went from population of all the states from Virginia to Maine locked down to population of the USA & Canada locked down in about a week and a half.
It’s the difference between the provincial officials in Wuhan (who tried to keep this quiet) and the national officials, who are really mad at the provincial officials for trying to keep this quiet instead ofworking on it earlier.
I mean if that number is legit then this is gonna be fucking super bad. Wont the world economy collapse with 400 million locked down?
Shouldn’t the market be collapsing right now from that report if legit?
Someone needs to tell this guy that actually the flu is way more dangerous and he’s worrying about the wrong things, LDO.
This passed the point of containment several weeks ago. Now it’s just about slowing it down.
You really think Ebola was worse than this? Ebola was never really a serious threat of worldwide pandemic. It’s just not that easily transmissable, and as you yourself posted, it makes people too sick too fast and kills them too fast.
Super anecdotal but my coworkers friends were working in China and happened to be in Taiwan when all of this started. It took them a lot of effort to get back to the US, they’re in quarantine for 2 weeks and to the surprise of no one they said it’s much much much worse than China is reporting.
I would certainly think it wouldn’t be maintaining at all time highs. But I’m a market fish and have learned it’s best to just stay in my lane and stay invested at my chosen AA.
If the stock market was efficient at reacting to risk then there would never be crashes, just gradual declines.
For perspective, the 2014-16 Ebola outbreak killed like 11,000 people. We’re at 630 now, who knows but it could be on track to match that.
It could match that by the end of the month if deaths keep tracking the way they’ve been tracking over the past 2 weeks.
Course not. I think it’s Sars bad, not Mers bad, although the jury is still out - I was just engaging in hyperbole, just like I am about my trip/concerns to Stanford in two weeks. If you have too much time to think about things, your brain starts spinning. More beer is probably the right answer, at least for me.
On a happy note, CNN just posted that the Illinois couple diagnosed with Corona have been discharged to home - be on house arrest for a while, but they are pretty clearly markedly improved.
MM MD
Workers in Shanghia (pop. 25M) will return to work on Monday, the Chinese government has said.
They better be sure of this.
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China. The patient stated that he had seen a health alert from the U.S. Centers for Disease Control and Prevention (CDC) about the novel coronavirus outbreak in China and, because of his symptoms and recent travel, decided to see a health care provider.
Apart from a history of hypertriglyceridemia, the patient was an otherwise healthy nonsmoker. The physical examination revealed a body temperature of 37.2°C, blood pressure of 134/87 mm Hg, pulse of 110 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 96% while the patient was breathing ambient air. Lung auscultation revealed rhonchi, and chest radiography was performed, which was reported as showing no abnormalities (Figure 1). A rapid nucleic acid amplification test (NAAT) for influenza A and B was negative. A nasopharyngeal swab specimen was obtained and sent for detection of viral respiratory pathogens by NAAT; this was reported back within 48 hours as negative for all pathogens tested, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and four common coronavirus strains known to cause illness in humans (HKU1, NL63, 229E, and OC43).
Given the patient’s travel history, the local and state health departments were immediately notified. Together with the urgent care clinician, the Washington Department of Health notified the CDC Emergency Operations Center. Although the patient reported that he had not spent time at the Huanan seafood market and reported no known contact with ill persons during his travel to China, CDC staff concurred with the need to test the patient for 2019-nCoV on the basis of current CDC “persons under investigation” case definitions.8Specimens were collected in accordance with CDC guidance and included serum and nasopharyngeal and oropharyngeal swab specimens. After specimen collection, the patient was discharged to home isolation with active monitoring by the local health department.
On January 20, 2020, the CDC confirmed that the patient’s nasopharyngeal and oropharyngeal swabs tested positive for 2019-nCoV by real-time reverse-transcriptase–polymerase-chain-reaction (rRT-PCR) assay. In coordination with CDC subject-matter experts, state and local health officials, emergency medical services, and hospital leadership and staff, the patient was admitted to an airborne-isolation unit at Providence Regional Medical Center for clinical observation, with health care workers following CDC recommendations for contact, droplet, and airborne precautions with eye protection.
On admission, the patient reported persistent dry cough and a 2-day history of nausea and vomiting; he reported that he had no shortness of breath or chest pain. Vital signs were within normal ranges. On physical examination, the patient was found to have dry mucous membranes. The remainder of the examination was generally unremarkable. After admission, the patient received supportive care, including 2 liters of normal saline and ondansetron for nausea.
On days 2 through 5 of hospitalization (days 6 through 9 of illness), the patient’s vital signs remained largely stable, apart from the development of intermittent fevers accompanied by periods of tachycardia (Figure 2). The patient continued to report a nonproductive cough and appeared fatigued. On the afternoon of hospital day 2, the patient passed a loose bowel movement and reported abdominal discomfort. A second episode of loose stool was reported overnight; a sample of this stool was collected for rRT-PCR testing, along with additional respiratory specimens (nasopharyngeal and oropharyngeal) and serum. The stool and both respiratory specimens later tested positive by rRT-PCR for 2019-nCoV, whereas the serum remained negative.
Treatment during this time was largely supportive. For symptom management, the patient received, as needed, antipyretic therapy consisting of 650 mg of acetaminophen every 4 hours and 600 mg of ibuprofen every 6 hours. He also received 600 mg of guaifenesin for his continued cough and approximately 6 liters of normal saline over the first 6 days of hospitalization.
…
On hospital day 6 (illness day 10), a fourth chest radiograph showed basilar streaky opacities in both lungs, a finding consistent with atypical pneumonia (Figure 5), and rales were noted in both lungs on auscultation. Given the radiographic findings, the decision to administer oxygen supplementation, the patient’s ongoing fevers, the persistent positive 2019-nCoV RNA at multiple sites, and published reports of the development of severe pneumonia3,4 at a period consistent with the development of radiographic pneumonia in this patient, clinicians pursued compassionate use of an investigational antiviral therapy. Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development10,11) was initiated on the evening of day 7, and no adverse events were observed in association with the infusion. Vancomycin was discontinued on the evening of day 7, and cefepime was discontinued on the following day, after serial negative procalcitonin levels and negative nasal PCR testing for methicillin-resistant Staphylococcus aureus .
On hospital day 8 (illness day 12), the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present. His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea. As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the exception of his cough, which is decreasing in severity.
NYT did a good article about the public health response to this case, reprinted in the Seattle Times.
Local public health pretty much did a full-court press on this, going so far as to buy groceries for people:
Those who were ordered to stay in their homes were taken care of. The groceries that the Seattle and King County public-health department delivered to one prospective patient included hair conditioner, blueberries and 2% milk.
Overall, I was encouraged by this article; public health seems to be fairly well prepared and competent. The big question though is what would happen if there were a lot more cases. This response was very resource intensive and would quickly get out of control if they had many more to handle.
If it’s still exponential growth but doubling every four days instead of 3 then only marginally better. But looking at the graph below, going from Feb 1 to Feb 5 the infections roughly doubled (not quite,
17.2k–>30.6k). And those last five data points look more like linear growth than exponential, which would be very very good news indeed. Disregard the last data point on that graph, it seems to always get revised upwards.
If the trend is now linear instead of exponential that’s good news not just because it’s linear growth, but because that’s what you’d expect the graph would look like if it ends like this in a couple of weeks:
If they need more to handle they send you to a military base where they can do it at scale. Then after that they probably setup a camp. The reason you go above and beyond at this early stage is that it can still be stopped right there if you quarantine correctly.