2020 CoronaVirus Outbreak - That began in Wuhan, China and is spreading - Page 4
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  1. #46
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    It seems to be harder on smokers.
    Michael Caine on Jaws: The Revenge:

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    An old friend of mine I used to play basketball with, who now plays professionally in China, posted this on FB the other day.
    óó

    Some more/new info about CORONAVIRUS. Share to raise awareness.

    CLSA Conference call with Coronavirus expert
    Overnight in Asia, we hosted a call with professor John Nicholls a clinical professor in pathology at the University of Hong Kong and expert on coronaviruses. He was a key member of the research team at the University of Hong Kong which isolated and characterized the novel SARS coronavirus in 2003. Heís been studying coronaviruses for 25 years (full bio here). The recording of the call can be found on our website HERE. Below are my notes transcribing the call. The first 30m are worth listening to.

    Quick summary: look at the fatality rate outside of Wuhan - itís below 1%. The correct comparison is not SARS or MERS but a bad cold which kills people who already have other health issues. This virus will burn itself out in May when temperatures rise. Wash your hands.

    My notes from the call below:

    Q&A Session with Professor Nicholls:

    What is the actual scale of the outbreak? How much larger is it compared to the official ďconfirmedĒ cases?

    People are saying a 2.2 to 2.4% fatality rate total. However recent information is very worthy - if you look at the cases outside of China the mortality rate is <1%. [Only 2 fatalities outside of mainland China]. 2 potential reasons 1) either chinaís healthcare isnít as good Ė thatís probably not the case 2) What is probably right is that just as with SARS thereís probably much stricter guidelines in mainland China for a case to be considered positive. So the 20,000 cases in China is probably only the severe cases; the folks that actually went to the hospital and got tested. The Chinese healthcare system is very overwhelmed with all the tests going through. So my thinking is this is actually not as severe a disease as is being suggested. The fatality rate is probably only 0.8%-1%. Thereís a vast underreporting of cases in China. Compared to Sars and Mers we are talking about a coronavirus that has a mortality rate of 8 to 10 times less deadly to Sars to Mers. So a correct comparison is not Sars or Mers but a severe cold. Basically this is a severe form of the cold.

    You mentioned a shortage of testing kit can you talk more about that?

    There are two ways to detect a virus. 1) Through the genetic material Ė DNA or RNA or 2) to detect the protein of the virus. The rapid tests used in a doctorsí labs look at the protein. The problem with that is that you need an antibody to pick it up. And it takes 8-12 weeks to make commercial antibodies. So right now for the diagnostics tests they are using PCR which give you a turnaround in 1-2 hours. But then you need to run a machine and run 96 runs in 1 hour but then you have to a batch of samples so thereís another delay of 5-6 hours for patient presentation. So that will lead to some problems you canít turnaround in 5-10m which is what you want when a patient shows up to the emergency room. Because right now you also have influenza going around so what you want is to be able to rule out influenza so you can treat the patients correctly for coronavirus. So that may be why they missed some of the earlier cases.

    Your colleague at HK university estimated that the size of the infected population on Jan 25th was 75K with a doubling time of 6.4 days. So by feb first we would have 150k infected. How accurate do you think these models are and how accurate have they been in the past?

    Those figures did not take into account restriction on travel, quarantine etcÖ These reports are likely on the high side. This is not taking into account social distancing. Historically these models have not been all that accurate.

    When do you think this thing will peak?
    Three things the virus does not like 1) sunlight 2) temperature and 3) humidity. To make you guys really worried. A coronavirus can survive on a stainless steel surface for 36 hours. It hangs around for quite a bit.

    Sunlight will cut the virus ability to grow in half so the half-life will be 2.5 minutes and in the dark itís about 13m to 20m. Sunlight is really good at killing viruses. Thatís why I believe that Australia and the southern hemisphere will not see any great infections rates because they have lots of sunlight and they are in the middle of summer. And Wuhan and Beijing is still cold which is why thereís high infection rates.

    In regards to temperature, the virus can remain intact at 4 degrees or 10 degrees for a longer period of time. But at 30 degrees then you get inactivation. And High humidity the virus doesnít like it either. Thatís why I think Sars stopped around May and June in 2003 Ė thatís when thereís more sunlight and more humidity. The environment is a crucial factor. The environment will be unfavourable for growth around May. The evidence is to look at the common cold Ė itís always during winter. So the natural environment will not be favourable in Asia in about May.

    The second factor is that of personal contact. With Sars once it was discovered that the virus was spread through the fecal oral route there was much less emphasis on the masks and far more emphasis on disinfection and washing hands. HK has far more cleanliness (than China) and they are very aware of social hygiene. And other countries will be more aware of the social hygiene (than China). So in those countries you should see less outbreaks and spreading. A couple days ago the fecal-oral route of transmission was confirmed in Shenzhen. In China, most of the latrines are open- thereís more chance of phermites (?) being spread. But in other countries the sanitations systems tends to closed. My personal view is that this will be a bad cold and it will all be over by May.

    People talk about the vaccine and this is the big problem that people get from movies. Where in the movie they come out with a vaccine and then three days later itís all over the world and everybody is saved. In reality this does not happen because for a vaccine you need to go through clinical trials Ė is it safe and will it work. The last thing you want to do is rush a vaccine too early. If you get any severe reactions, then the anti-vaxxer will just say ďI told you soĒ. You are talking about a working vaccine in 1 to 2 years. With SARS, in 6 months the virus was all gone and it pretty much never came back. SARS pretty much found a sweet spot of the perfect environment to develop and hasnít come back. So no pharmaceutical company will spend millions and millions to develop a vaccine for something which may never come back. Itís Hollywood to think that vaccines will save the world. The social conditions are what will control the virus Ė the cleaning of hands, isolating sick people etcÖ

    What do we know about the transmission rate? Itís been estimated around 2.2 to 2.68. What percent of the patients are transmitting while being asymptomatic?

    This is a big problem when you talk about asymptomatic that means you have a good diagnostic test- where you can say they are asymptomatic (which we donít have with this virus).

    We actually looked at this with MERS where people were saying it had a high fatality. We went to Camel abattoirs and took serums from the abattoir workers and found that quite a few had low infections with no symptoms. This is what should have been done at the initial stages at the seafood market. But to do that you need a good diagnostic test. A good diagnostic test is necessary to determine to the transmission rate. Now we have normal human airways and we can now look at how long it takes the virus to replicate in that environment. And that will be very useful to determine those who are asymptomatic carriers.

    Any sense of whether the estimates of the reproductive number the Ro of 2.5 or 2.7. Do you think that is high or low. What does that mean?

    Measles was about 10-15 and influenza is just below 2. I think itís about 2.2 as itís being transmitted within the community.

    Have we seen any super spreaders? We saw that with Sars and Mers.

    Thereís talk about that but the epidemiologists are still overwhelmed so no clear answer. But I donít think there are any super spreaders.

    What is the percentage of people transmitting the virus while being asymptomatic?

    Unlike SARS, patients were symptomatic at about day 5, some of these cases may be asymptomatic until about day 7. Thatís based on the first publications. Asymptomatic is probably the first 5 days.

    Thereís a paper published looking a familial cluster with a boy who was shedding the virus and he was asymptomatic.

    Thatís something about kids and we saw this with Sars. Very few kids had very severe disease. We are trying to determine if this is a virus which we call low (unintelligible) kind of inducer or high (unintelligible) kind of inducer. SARS is high [unintelligible] kind of inducer. This means that when it infects the lower part of the lung, the body develops a very severe reaction against it and leads to lots of inflation and scarring. In SARS what we found is that after the first 10 to 15 days it wasnít the virus killing the patients it was the bodyís reaction.

    We are doing testing on this now. Is this virus in the MERS or SARS kind picture or is this the other type of virus which is a milder coronavirus like the NL63 or the 229. I think this will be a mild (unintelligible) kind inducer.

    Case fatality is about 2.5% or so? Do you expect this to change over time? And are you seeing any difference among the young population and older population in terms or mortality rate?

    SARS went really for people in their 30 or 50 years. And MERS on the other hand basically is if you have co-morbidity Ė try and find somebody in the middle east who does not smoke or does not have high blood pressure etc... The data coming out of China seems to indicate that itís those with the co-morbidity are most at risk. For the seasonal influenza thatís also what we find. Itís the people with the co-morbidity that have the increase mortality rate. Having said that thereís a guy in the Philippines who died in his mid-30.

    I think this looks more like the seasonal influenza where those who die have to co-morbidity. Now that we have better case control definitions outside of mainland China, we will get a true assessment of the fatality rate. I would now put it at about 0.8% to 1%. When you look at all the death reports Ė separate out the deaths from mainland China and outside China.

    Mortality rate in China Ė is much higher? Why?

    Its related to the environment. In the high income countries you donít have as high a population density, higher level of environment control and hygiene. In Indonesia Ė itís unlikely to spread much as itís very hot and humid. Would this virus move to Africa? I think thatís unlikely Ė too hot thereís not a lot of travel there.. Europe Ė possibility higher transmission but environmental care is higher.

    At this stage itís a really bad cold which can cause problems in people. People are talking about the ďlethal virusĒ but seasonal influenza can cause deaths in elderly but we donít call that ďthe lethal influenzaĒ

    Thereís news reports that antivirals are being used and that itís working what are your thoughts on that?

    With SARS it didnít seem to work at all with the commercially available antivirals. But there seems to be good effects with the case in Washington with the Gilead agent. And it sounds like China will be using it.

    Interferon works and it has quite a bit of benefit.

    The problem with the antivirals Ė because the virus has different ways of replicating within the cell, finding a nice common target has been difficult. But the Gilead agent appears to me to be very promising. We now have the virus growing in our labs/cultures so can now test it to see what will work and not work.

    Would the opening of the hospitals in China change anything?
    What we found with SARS in HK was that a contributing factor to the spread was the overwhelming of the HK healthcare system. Hospitals and doctors were overwhelmed. When China built these Wuhan hospitals Ė itís to take the work load off the staff which is likely exhausted.

    In HK with SARS we found quite a lot of infection of healthcare workers as they are close and doing invasive procedures. But this time around there is not much evidence of the healthcare workers getting sick or dying (but maybe China is not reporting it) so this may suggest that I think it is not being spread by close aerosol contact but more by the fecal-oral route or with droplets. So it will not be as contagious within hospitals. So getting the two hospitals built it will take a lot of the work load off the other hospitals so it should be a big benefit.

    The recovery rate now higher than the deaths rate? Thoughts on that?
    What we found is that in HK with SARS we didnít know how long to treat a patient for. Now in China they are using the SARS model but treating patients for shorter time periods so that they donít get the secondary problems that they did with Sars. Getting actual data on recovery from the mainland is still a bit of a challenge.

    Iíd consider a patient recovered if heís been discharged. The problem is that with SARS, there were quite a bit of people where the steroid were very beneficial to treat the acute stage and we didnít know how long the virus would live for so we kept them on the steroids for a long period of time and they came out with all sorts of secondary problems due to the immunosuppression.

    I havenít seen any data on the quality of life of those who have been discharged.

    Evidence of E-coli?
    Secondary infection are most likely the cause of deaths of the patients in the Philippines and HK.

    What does it mean for a patient to have recovered?
    That means the patient has been discharged from the hospital. Thatís the criteria for Hong Kong. But thereís no good data or guidelines on this.

    What is the probability that this will be contained and eradicated or will it be endemic in the human population?
    If it is like SARS it will not be endemic. It most likely will be a hit and run just like SARS. People talk about mutation but what we found with SARS was that there was no mutation and we have been tracking MERS and we have not seen any severe mutation. This is unlike the common coronavirus which when they replicate they donít have a Ēspell checkĒ so they mutate. So if this virus follows the same path as SARS or MERS it wonít mutate. This will not be endemic. I think it will burn itself out in about 6 months.

    Does mortality rate or fatality rate typically increase over time? That was apparently the case with SARS.
    With SARS we didnít know how long the virus was alive for. So with SARS in the later stages people were not dying of SARS but of the complications of SARS which is why the mortality rate increased. But now people are much more aware of the dangers of over immunosuppression. So the death rate shouldnít be more severe. Especially with the new hospitals being established which should take some of the workload off of the healthcare workers from Wuhan.

    If we look at the serious cases being reported itís about 13% of the total cases being reported. If we assume a 50% mortality rate for the severe cases than we are looking at a mortality rate of 5-6%. Is that a fair assumption?
    In Hubei, the milder cases are not making it to the hospital. Because they are so overwhelmed that milder cases are being sent away. So thatís why itís important not to look at the mortality rate in Wuhan but to look at the mortality rate in Shanghai or Shenzhen or outside of Wuhan. Itís very important to dissect it out.

    Would it be too early to make conclusion outside of Wuhan? Itís still really early days outside of Wuhan? Are we making assumption with very little data and very early data?
    Thatís all the data we have to work with. When you are dealing with an epidemic at the early stages Ė thereís such a variable. But now for political reason people are far more aware of the virus so it wonít be as epidemic as it was early on. Thereís far more awareness and controlled environment and changes in social behaviour. Which Iím not sure is taken into account in the models. So it should spread far less outside of Wuhan.

  3. #48
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    Helped a colleague w some math and he did a good read on the virus and numbers

    https://www.epsilontheory.com/body-count/#.XkHHKUrR8zU

    Sent from my SM-N950U using Tapatalk

  4. #49
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    IDK, hard to believe anything the Chinese government says. Could be 500,000 people infected already. Hopefully, not.

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    RE: http://www.vhlinks.com/vbforums/thre...=1#post2307806

    Where's the Q&A "Is the Cornoavirus bio-engineered virus?"
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  6. #51
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    Quote Originally Posted by PrideofPasadena View Post
    IDK, hard to believe anything the Chinese government says. Could be 500,000 people infected already. Hopefully, not.
    Mathematically the official china data is near impossible

    Sent from my SM-N950U using Tapatalk

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  8. #52
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    China failed to try and contain this for weeks or even a month.

    Hopefully quicker reaction plus warmer weather setting in might help to limit this somewhat.
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    I just know that anytime you convert sports arenas into makeshift hospitals, it isn't good.
    If I don't respond to you it means I have you on ignore, which means you are a douchenozzle.

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    ☩ ☩ ☩

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    Quote Originally Posted by Dave's Dreidel View Post
    I just know that anytime you convert sports arenas into makeshift hospitals, it isn't good.
    Fuck the Chicom Government.

    I feel bad for the people there though.
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    Quote Originally Posted by fudd View Post
    47 do you work in medical field?
    I can't answer that since we have an asshole member here that likes to save that information to troll us with.

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    Yummy.

    Bat curry continues to fly off the shelves in Indonesian markets despite links to coronavirus, as traders boast 'it is always sold out' and defy orders to take it off the menu

    https://www.dailymail.co.uk/news/art...rus-fears.html
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    I just threw up a little in my mouth.

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    Hubei reports nearly 15,000 new COVID-19 cases with new method of diagnosis

    https://www.channelnewsasia.com/news...ethod-12429726
    "The VH Universe is built on a wall that separates CVH from SVH. Tell either side there's no wall, you've bought a war. Or a slaughter." Lt. Joshi - LAPD

 

 

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