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Across the US all-cause mortality is down as as people avoid catching the flu, getting run over, and other risks. But in New York where coronavirus has hit hardest, all-cause mortality is at record highs.
This is nothing like the seasonal flu
For the whole month of March, deaths in New York were twice as high as normal. This includes not just extra coronavirus deaths but all other causes. Deaths were even higher than the number of known coronavirus deaths, leaving cardiologists worried that there may have been an increase in other conditions like heart attacks or strokes, because people were afraid to go to hospital or couldn’t get help in time.
This is an underestimate. The authors expect this number to rise as more paperwork gets completed. It’s still only a small excess in a giant country, but it hints at the scale of the event were no quarantine measures put in place, no flights stopped, and the virus allowed to spread naturally. The current epidemic is stabilizing in New York, but if major action wasn’t taken, this would be the early weeks of a pandemic about to sweep across all fifty states. And this would not be the […]
For doctors or nurses reading — there’s a call to share this widely
An information event on this online SUNDAY April 12 8pm US Eastern time. (Open, free to anyone who wants to listen). That’s 10am Monday morning EST Australia.
This is not the flu. Most of the time apparently it’s not ARDS either. Coronavirus it turns out — is a vascular disease as much as lung disease. In fact in 70-80% of ICU patients putting them on a ventilator straight away may make the situation worse.
Currently patients in ICUs have about a 50:50 chance of making it out alive. The odds are terrible. Doctors have been reporting how people can degenerate suddenly into a life threatening crisis situation. Now, perhaps this explains it. This kind of hypothesis is one of the reasons we really want to crush the curve, now, because we are so underprepared and there is so much to learn. If this is right it will save many lives.
This could solve several mysteries at once
This virus causes heart damage, it raises clotting factors. People seem fine, then they relapse.
One recent paper found people with high levels of D-dimer, a clotting factor, […]
Australia remains the star Lucky Country compared to overseas. Infections are low, deaths are even lower. It’s all so much better than the desperate situation in Europe and the US. These are enviable, fantastically small numbers. Politicians are afraid to say so, lest the population relax, and party too much this Easter and the “unknowns” increase. (Which might well happen).
At the moment, the trend that matters most is the daily new cases of unknown transmission and it is trending down. There is community spread, but social isolation is shrinking it. This is what “Crushing the Curve” looks like. Right now there are still asymptomatic spreaders out there, but they are infecting less than one other person each (Ro < 1), so the infection is on its way to extinguishing itself — assuming we keep up the distancing.
But these great figures are not a reason to let up on social isolation, they’re a reason to go harder. We want to achieve the Golden Holy Grail — no new infections, and business as usual with no lockdowns, no curfews and a zone of freedom.
Australia is the Lucky Country, and doing the right thing
Why is the situation so good […]
Ancient technology wins: Not only are quarantine and isolation measures useful, they’re the best tools we have.
Some people don’t seem to realize that the only reason the daily growth of infections is slowing anywhere, is thanks to drastic quarantine measures or changes in human behaviour. We can see this in graphs from Italy, Spain, Norway, South Korea, Switzerland, Germany, and China, but not in Sweden or Brazil where there’s not much quarantine and not much slowing of growth curves either. In all of the former, the big meaningful actions were followed around 12 days later by an obvious slow down.
Willis Eschenbach, for example, wondered If Lockdowns Worked, but counted subdivisions of any quarantine type action as a measure of the severity when it’s more a measure of the wordsmithiness or indecision of leaders.
To see if major action matters, it’s better to look at the dates that borders, schools and shops were closed. The graphs of daily new cases below show that around 12 days later in so many countries, the growth in cases slows too. The delay is due to both the incubation period of Covid-19 and testing. By the time a lockdown is declared (or […]
NEWS: A group say they have developed five antibodies from the old SARS antibody stocks that with tweaking can now bind well to the SARS-2 novel coronavirus.
An antibody is a long string of molecules that binds only to the exact target (we hope). Wikimedia Bioconjugator
If they get through all the testing phases and ramp up production, in theory, these could be ready for mass use in September (but everything would need to go right). They could be injected into patients and within 20 minutes these antibodies would bind to the virus and stop it entering cells. The protection might last 8 – 10 weeks before someone would need another dose.
This could be a gamechanger, but beware before anyone gets too excited, this is very early days — “protoplasm” days. There are a lot of steps to rush through.This group have searched and evolved the protein with their supercomputer which has a huge library of antibodies. They claim to be certain it binds to the virus — and to exactly the right part of the virus, but they haven’t actually done that yet — they’ll send the antibody to a military secure lab to do that. Then […]
It’s a big natural experiment
Swedish people are still going to schools, restaurants and gyms. Even the cinemas are running. Apparently Sweden is taking the punt that there are many asymptomatic infections out there, despite having no data, and not doing any structured screening to get some either. They are also betting that immunity to this form of coronavirus will last a lot longer than the coronavirus colds where herd immunity is irrelevant one year later.
All recommendations are made by the Public Health Agency. Apparently they are learning from the 1918 influenza spread, and thus successfully “fighting the last war”. Swedish doctors are reportedly not happy about it. Probably because their idea of being doctors is not where you choose which 60 year old mother lives and which one dies, or where the doctors work round the clock and many of them get sick themselves, and some die. Gruelling is not the word.
Gatherings of 50+ people are banned, and the 70+ age group have been told to avoid social contact.
I predict that as the ICU units overflow, or even before, they will move to serious measures like the rest of the world as the inhumanity of the […]
How big should that gap be?
The WHO recommends “3 feet”, the CDC recommends 6 feet, but new research shows they got the model wrong and we might need to be 30 feet apart. Not to mention that the cloud of aerosols can wander suspended for hours. So we may need to be 30 feet and three hours apart.
No wonder churches and places where people sing are such high risk events, and why an astonishing 12,000 health workers are infected with coronavirus in Spain.
They aren’t sure if their new findings have clinical implications, which says a lot about how much we don’t know. The 27 ft distance applies to sneezes, so if the other party isn’t sneezing you might not have to be so far. Lucky sneezing isn’t that common, though the dry cough is. Personal trainers at 27 feet is going to be tricky.
UPDATE: Some readers ask whether one new study is even worth reporting, accusing me of “scare tactics”. I’ve been reading medical papers now for over 20 years, so forgive me if I found the results here so banal that I didn’t mention that this result is barely new, and very well […]
There is a third way — Why are we so fatalistic?
It’s not a choice between Let It Rip and the slow bleed of “Flatten the Curve”. It’s not a choice of health versus money. The third option no one is mentioning is to Crush The Curve: we go hard, fast, and do a major short sharp quarantine. It’s not radical, it’s just textbook epidemiology, it saves more lives and it saves the economy too.
SlowMo, Boris and Trump are still two weeks behind the virus. It’s time to get the Third Option on the table.
Flattening the Curve is a fatalistic slow bleed that must last months. It rescues us from the demolition derby that the Let It Rip disaster is cursing on Italian hospitals, but it’s deadly for the economy. All leaders who are keeping schools open while turning student dorms into triage units are locked into this limited thinking. It’s the Influenza-plan rejigged.
There is another way — (as I’ve been saying) — we stop dithering and acting two-weeks-late, and jump ahead of this inanimate code. We aim for extinction — hunt every infection down, keep most people at home, reduce the spread, then finish by following […]
Get out of the way of this virus.
Could Italy be suffering from a different and nastier strain?
Figures from South Korea and the Diamond Princess may not be a good guide to what’s happening in Italy and Iran. There something seriously different going on there. Death rates are much higher than expected. Three weeks ago, Italy officially had three cases, now a thousand people are dead and 12,000 have the virus. The hospital system is already at the point of being overwhelmed. Reports say that even stroke patients are now missing out on help, the ICU wards are overflowing, and the staff are prioritizing younger people because they have a better chance of survival.
Perhaps Italians hug more and spread more, perhaps it’s worse because they have an older demographic. But perhaps this is a deadlier strain than the one Japan, Hong Kong, Taiwan, Singapore and South Korea appear to be containing. The Italian strain, whatever it is, is from the Iranian strain. Every country that has imported infected passengers from Iran will likely also have the Iranian strain.
Do we really want to follow Iran and Italy?
It’s not impossible — Just stop feeding the virus fresh bodies […]
Fun subject of the day: How Coronavirus kills
No seriously, this is matter-of-fact, youtube-at-its-best, concise, cartoony, and smart.
Think of doctors as Body-Engineers. The problem to solve today Engineer-readers — is how to keep blood supply oxygenated when lungs are highly inflamed, filling with fluid, and the delicate thin membranes of lung tissue can’t cope with the sheer forces of rapid collapse and expansion. As well, if oxygen levels drop, even unconscious patients will breathe involuntarily — out of synch with artificial ventilation machines. The sensation of suffocation creates the urge to breath faster and harder. . The great news is ICU staff are getting much better at keeping people alive when they get ARDS (Acute Respiratory Distress Syndrome) which can happen with other diseases (like Influenza). Seems, the ICUs can keep 84% alive while they wait for the inflammation to subside and the damage to heal. Though the DIY version at home probably won’t be so effective.
Not enough beds
Obviously, this explains my obsessive interest in the percentage needing ICU care and also the Ro (rate of reproduction or spread). With a shortage of ICU beds, slowing the spread makes a life-and-death difference to state the bleeding obvious. […]
Something does not add up
So the virus is on its way. Even though Australia has no known community transmission we are choosing to slow down the spread by actively importing it even though we are surrounded by a moat, and are pretty much self-sustaining. We have thousands of high risk people and the disease that’s coming is largely unknown — today there are reports a Japanese case of a woman medical experts had thought had recovered who tests positive again. Is this a biphasic disease like anthrax? That’ll be fun.
Winter is twelve weeks away for Australians, and we know the coronavirus potentially threatens to overwhelm our medical systems and could be a GDP-type hit on national economies. It’s highly infectious, and between 5 – 17% of current cases outside China require hospitalization, and probably 1 -3% will need intensive care. Inviting the virus to start spreading now will mean it will peak during winter — the worst possible time in Australia.
Australia is one of the easiest countries to protect from this scourge, yet we are obediently following policies of northern hemisphere nations in a different situation. Hmm?
As I keep saying, it’s easier to import a deadly […]
Coronavirus, Covid-19, cases outside China. Source JoDiGraphics
The short not-good news: It’s looking like early exponential growth outside China
The cases outside China have reached 1,500. South Korean cases leap to 156, 204, 340, mostly centred on one church and one hospital. In China, prisoners were discovered to be infected and a 29 year old doctor has died. The first death in Italy is confirmed, cases jump from 4 to 17, and the health minister there has cancelled or closed schools, events and shops in ten towns. The Iranian death toll has risen to 4, and Iraq has closed flights to Iran. Improbably Canada’s ninth case turns out to be a woman who flew from Iran, raising the worrying possibility that the virus is spreading undetected. Lastly, panic is spreading too. There were attacks in Ukraine to stop a bus of evacuees from China for their 14 day quarantine. It was triggered supposed by an email hoax.
Wise people might like to stock up the pantry just in case. As the people in some Italian towns just found out, there may not be a lot of warning.
The extraordinary rise in South Korea:
Four days ago South Korea had […]
In short:
Outside China, 2% of cases have progressed to “severe”. But if the lag is eight days then progression to severe is more like 5%. In China about 1/5th of severe cases are “Critical” If that rate occurs in the West, hospitals will be overwhelmed if just 1% of the population gets infected. In Singapore, the doubling period for confirmed cases is about nine days. Currently the spread is not exponential outside China (most days)
News today: First victim in Europe — an 80 year old Chinese tourist.
Stats: Total cases outside China: 787 Deaths: 4 Severe cases: 18 (2%)
Early days of “outside China” data
The 2% rate of severe cases is an underestimate above. There is an eight day lag from diagnosis to “severe,” and then a longer lag to death. Total cases outside China on Feb 8th was 354. So a more realistic estimate is that about 5% of confirmed cases outside China have now progressed to “severe” (i.e. 18/354).
What does severe mean? It appears “severe” means hospitalized but not necessarily in ICU. In China, the rates issued in a Feb 7 press release were 82% mild, 15% severe, and 3% critical. From […]
Partial post hoc reactive quarantine holds seven planes at London airport– seriously?
Madness. Eight planes have been held up for hours in London airports as they land with people with coughs and colds and try to check suspected cases. By the time people are symptomatic, its too late. Temperature checks may catch the most contagious people but now one person with a unrelated common cold can also cause a major and unnecessary disruption while other infective people can freely fly in and walk straight through.
Asymptomatic people can potentially infect 2 to 3 random people (or 10) who may then also infect 2 – 3 random people each before the Epidemiology SWAT Team realizes and starts testing and tracking. We play an impossible game of catch up in a race to isolate all possible contacts.
HOURS of misery in coronavirus lockdown at Heathrow:
DailyMail UK
Passengers endured hours of misery at Heathrow Airport this morning when up to eight planes were put on lockdown over coronavirus fears after passengers on board complained of symptoms of the deadly virus.
MailOnline understands a British Airways flight from Kuala Lumpur was held up on the tarmac for […]
Global Markets were shaken by the sudden rise in numbers out of China yesterday. But the increase was not a surprise for anyone who has been watching social media and the measures being taken in China. That China is now allowing the WHO in may be an admission that they really do need help. The explanation for the jump is that China changed the definitions. They are also admitting that there may be many cases of people with low grade infections, but also unattributed deaths as well. For days the ratio of cases to deaths was suspiciously 2.1%, 2.1%, 2.1% … Now perhaps it’s a tiny bit closer to the truth.
The tally outside China continues to rise: there now 587 cases, with 3 deaths (1 new one in Japan) and 24 people classified as “serious critical”. These are the key figures to watch. We expected the number of cases that were severe to rise as the five to eight day lag unfolds from the first symptoms to the onset of breathing trouble. So at the moment 4% of cases outside China are headed for hospital intervention, perhaps ICU (does anyone know the definition of “Serious Critical”?). That will keep […]
So Coronavirus is now CoVID-19.
We’ve been walking the cusp of containable versus pandemic for two weeks but the growth of infections outside China is just a bit too fast, a bit too random and the news suggests its easier to spread. At least the number of severe cases outside China is still only 2% of the total. But there’s a lag of a week or two, so that’s likely to rise. If it is even possible to stop, I suspect only the mass closure of borders will do.
World (ex China) Cases: 517 Deaths: 2 Recovered: 54 Severe: 12
Click to enlarge
While Australia and the US and even India have the illusion of stability, the rise in Singapore, and on that ship is hard to ignore. Singapore is doing advanced tracking, yet still it spreads (see the chart, right). The difference between Singapore and Australia may be part luck — one superspreader versus one man who didn’t infect anyone on a whole plane.What matters then, is just how many people are superspreaders? The one ray from Singapore is that 15 people on that list are already listed as recovered. When I say we hope it’s […]
One day ago, the statistics were looking good but there have been a few ominous shifts. Another 26 infections have been recorded, some in a French ski chalet, some in Singapore —at least three of which are hard to explain. These appear to be transmissions outside China, which is what we are hoping to avoid. It’s bad, but could have been a lot worse. Fortunately the Diamond Princess tally hasn’t risen much — standing at 64. Another plus — it’s almost two weeks since one passenger on a Tiger Air flight in Australia flew as he was coming down with symptoms yet the other 157 passengers appear to be OK. Promising.
…
Just 2% of cases so far are severe outside China (but that may grow)
The all important statistics outside of China are starting to accrue — So far there are 355 infections. Of those, 35 have recovered and only eight are marked as severe (see the table below). It’s good news that only 2% are severe, however it’s too soon to know — 90% are still unwell.
The illness appears to be less severe outside China, but a new study reports that this virus often looks benign […]
Infected 34,887 Deaths 724 Recovered 2,076 John Hopkins CSSE
Assuming that these official statistics from China bear a faint connection to reality (in trend, if not number) this may be a sign that the draconian quarantine is starting to work. If real, it is only a slight slowing in the rate of growth, but it’s a good sign — one I have been looking for. It is a barely visible slowing of the rate of change in the cumulative tally of victims. The exponential curve is slowing. Of course, if this takes off in Africa this would be but a pause…
Graph by Worldometers.info
The virus which had been growing at 50% a day two weeks ago, slowed to 20% last week, and 11% today. One week was such a long time ago in exponential land. Last Friday night the tally was 9,700 infected, and 213 deaths. At that point, no nation had cut off flights or refused visas. UPDATED: Saturday.
..
Sadly the brave doctor who tried to warn the world has been taken by the virus. Ominously he was only 34 — presumably with no “underlying disease”. Instead of listening to him, the Communist […]
A fateful decision that led to many deaths
The Samoan Islands, 1896 | Wikimedia
Western Samoa and American Samoa are side by side islands in the Pacific. When the Spanish Flu arrived in 1918, one would instigate a quarantine while the other had a trading community that did not want to stop trade. American Samoa survived the Spanish Flu without a death. Western Samoa kept trading and lost a quarter of the population.
Influenza 1918: the Samoan experience
John Ryan McLane
In 1918 the Samoan archipelago was split between American Samoa (a United States territory) and Western Samoa (previously a German colony but under New Zealand governance from 1914). The 1918 influenza pandemic killed a quarter of Western Samoans, while leaving American Samoa unscathed.
The dangers of ship-borne disease were well known, and exclusion of many diseases, especially plague, had been implemented since the imposition of colonial governance nineteen years before.
On 30 October 1918 the Union Steamship Company’s Talune left Auckland for its run through Polynesia… The new, more lethal influenza variant had arrived in Auckland with the spring, and several crew members were ill.
Western Samoa was a German colony that […]
Ooh. Are these the real figures? Is someone on the inside trying to leak out the truth?
There are claims tonight that a flickering set of figures have appeared that are much higher than the official tolls. These ghostly statistics have appeared three times then switched to the much lower official tally. But each time they grow — almost as if there are two sets of data, one for officials, and one for the public.
Ominously, the flickering death tally was 80 times higher than the official one. The infections were ten times higher. If it’s true the death rate may be far worse than the 2% bandied about.
If they are real, this changes everything. If they are fake, who or what would benefit? A glitch?
From Tyler Durden, ZeroHedge, and the Taiwan Times, h/t David E.
Tencent may have accidentally leaked real data on Wuhan virus deaths
Tencent briefly lists 154,023 infections and 24,589 deaths from Wuhan coronavirus
Taiwan Times
TAIPEI (Taiwan News) — As many experts question the veracity of China’s statistics for the Wuhan coronavirus outbreak, Tencent over the weekend seems to have inadvertently released what is potentially the […]
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