NEW UPDATE: Steve Sailer links to an article about the Italian town where the first death occurred. They tested the whole town--twice. Here's what they concluded--and you'd be excused for freaking out a bit:
A study in Vò, which saw Italy’s first death, points to the danger of asymptomatic carriers
The researchers explained they had tested the inhabitants twice and that the study led to the discovery of the decisive role in the spread of the coronavirus epidemic of asymptomatic people.
When the study began, on 6 March, there were at least 90 infected in Vò. For days now, there have been no new cases.
“We were able to contain the outbreak here, because we identified and eliminated the ‘submerged’ infections and isolated them,” Andrea Crisanti, an infections expert at Imperial College London, who took part in the Vò project, told the Financial Times. “That is what makes the difference.”
The research allowed for the identification of at least six asymptomatic people who tested positive for Covid-19. ‘‘If these people had not been discovered,” said the researchers, they would probably have unknowingly infected other inhabitants.
“The percentage of infected people, even if asymptomatic, in the population is very high,” wrote Sergio Romagnani, professor of clinical immunology at the University of Florence, in a letter to the authorities. “The isolation of asymptomatics is essential to be able to control the spread of the virus and the severity of the disease.”
We've barely scratched the surface here.
First, the good and bad news to start the morning.
The good news has been percolating through the interwebs for the past week or so. Today we're hearing about more positive findings regarding the efficacy of a very common, safe, generic (and so inexpensive) anti-malarial drug known under various names based on "chloroquine." The new findings come from France--a limited clinical trial but run by one of the top infectious disease experts in the world. If this pans out it could be a game changer. South Korea has also been reporting good results from the use of chloroquine or some variant of it.
The bad news, summarized via snippets from Zerohedge, is that Covid-19 continues to spread around the world. Worse, its characteristics may still be emerging with new data, as Italy (in addition to France and Belgium) is now reporting increasing numbers of younger people being severely affected as well:
[T]he total number of cases in Spain has climbed 28% to 17,147. 169 new deaths were reported, raising the country's death toll to 767 ...
As the number of cases explodes in India, PM Modi has halted arrivals of international flights for at least a week beginning on Sunday.
[A]s the virus spreads in Africa, South Africa said its total cases confirmed climbed to 158 on Thursday after reporting its first case of human-to-human transmission within the country.
In Hong Kong, researchers have apparently found samples of the novel coronavirus inside another dog, the second time the pet of a Covid-19 patient was also found to be carrying the virus.
The biggest news overnight was out of Italy, which has been reporting record numbers of newly confirmed cases and deaths, as well as a surprising number of young and healthy people hospitalized in serious condition. Italian PM Giuseppe Conte said Thursday that the government would extend the nation-wide lockdown beyond April 3 because too many Italians are disregarding the orders. The extension comes as Italy faces an alarming milestone: On Thursday, Italy is very likely to officially overtake China as the country with the largest number of deaths from the virus. 475 people lost their lives on Wednesday, the largest daily jump yet, taking the total in Italy to 2978. Officially, China's death toll is 3,231, according to the WHO, though many suspect the real death toll is much, much higher.
As of Thursday morning in New York, Italy has recorded 35,713 cases, along with 2,978 deaths.
Any global pandemic is a scary thing. Last night I got through the chapter in Michael Osterholm's book, Deadliest Enemy: Our War Against Killer Germs (2017) that deals with the SARS outbreak of 2003. Keep that date in mind. In the excerpts below, Osterholm is writing 14 years after SARS first surfaced and was supposedly eradicated.
First of all, what is SARS? It's a coronavirus, a type of virus that causes many respiratory tract infections, including the common cold. The acronym is simply based on the symptoms of the virus that surfaced in 2003: Severe Acute Respiratory Syndrome [SARS]. Covid-19 is more properly known as SARS-CoV-2--meaning it's the second outbreak of a SARS-like coronavirus disease. Covid-19 simply means Corona Virus Disease 2019.
Below are the excerpts from the chapter on coronaviruses, bearing in mind that earlier in his book Osterholm had listed what he considered the top four priorities of public health officials. The first priority was confronting influenza pandemics. The second priority was:
to prevent high-impact regional outbreaks, such as Ebola and coronavirus infections including MERS, and the possible return of SARS and Zika ...
Woops! Not only was that "possible" return of SARS not prevented, but it returned as a global pandemic rather than a high-impact regional outbreak. Bummer. It appears that a version of SARS has taken on the pandemic potential of the influenza virus--what we're witnessing with the emergence of Covid-19. So ...
Osterholm first points out that there was no specific treatment for SARS. All medical personnel could do was to treat the symptoms. SARS was ultimately controlled by isolating those who were infected. Is it any surprise that that's the technique being adopted on a vast scale to try to stop Covid-19, now that this version of SARS has emerged as a global pandemic? There's still no specific treatment for SARS/Covid-19 beyond supportive care at an intensive level (but we'll keep our fingers crossed re chloroquine). :
What eventually stopped the spread was not high-tech medicine, since there wasn't any specific treatment for SARS. Instead it was implementing impeccable infection control, including isolating patients and making healthcare workers wear protective gear, and then intensive follow-up of both healthcare workers and community contacts, with immediate isolation if they showed any early symptoms of SARS. By mid-May, it looked like the outbreak had tapered off, and Ontario lifted its state of emergency. Within days of the proclamation, the hospitals started filling up again with infected patients. Containment efforts went back into a full-court press, and it took another five weeks before SARS was truly under control in Toronto.
Next Osterholm describes a characteristic of SARS that should give us serious pause with regard to Covid-19--'superspreaders':
Perhaps the greatest medical mystery of the SARS outbreak was why some people ... gave the disease to so many people they encountered, even casually, while others who caught it became sick themselves but were hardly infectious at all to others. For reasons we still don't completely understand, certain individuals with coronavirus become "superspreaders."
In the public health-infectious disease world, we worry most about diseases that have high mortality rates and that can be effectively transmitted via the respiratory route--in other words, killer diseases that you can catch just by being in the same air space with an infected person or animal. ...
Superspreaders break the reproductive [R] rate rule. They transmit to many more contacts than other cases with the same infection. What we do know is that superspreaders can make coronavirus infections in humans into a very scary situation. These superspreaders are not obvious; the are not necessarily sicker, immunocompromised, older ...
A possibly related sidenote--on the Diamond Princess cruise ship the age group most likely to exhibit symptoms was ... 20-49. Obviously that's not a random sample, but it should also give pause, even though all deaths were among older people.
Speaking of deaths, while the total deaths from SARS was "only" 916, that was calculated as an 11% mortality rate--a rate that Osterholm considered "terrifying." Anyone who thinks a 1% mortality rate is 'low' is simply wrong. We still don't know what the mortality rate for Covid-19 is, but based on the example of SARS is it any wonder that governments have freaked out when confronted with a global pandemic of a highly contagious form of SARS?
... Globally, the estimated mortality was 916--11 percent of those infected. This is a pretty terrifying mortality rate for an infectious disease with global transmission potential.
... two very different public health-based activities played critical complementary roles in stopping the SARS outbreak: first, elimination of the animal sources in China, and second, effective infection control.
Writing in 2017, 14 years later, Osterholm reported the bad news that we now are confronted with--SARS never really went away, it was lurking in China:
But Dr. Peter Daszak, a disease ecologist ... recently observed, "SARS is alive and well and living in China, and ready for the next outbreak."
Two recent studies support that conclusion. Bats sampled in China and Taiwan were found to be carrying a coronavirus that was genetically almost identical to the SARS virus and that any day could be transmitted to another animal species that has substantial human contact. ... We can't for a moment believe that the SARS virus obituary has been written.
Finally, Osterholm describes the a recurrent problem regarding vaccine development. It's hugely expensive and difficult. Without government support pharmaceutical companies are loathe to invest vast sums with no hope of a return:
The SARS outbreak has left the world one legacy that continues to haunt us today. A number of vaccine research, development, and manufacturing companies stepped forward in the early days of the SARS outbreak in 2003 at the request of the WHO and invested many millions of dollars in SARS vaccine work. I'm not aware that anyone knows exactly how much was invested across the pharmaceutical industry, but it's likely in the hundreds of millions of dollars. ...
When the outbreak was extinguished by the end of the summer of 2003, interest from government agencies and philanthropic organizations to support additional research on a SARS vaccine virtually disappeared. ... The companies were left largely holding the bag for the early SARS vaccince research costs. As we've noted, this corporate "memory" remains a major concern going forward for vaccine-related investment.
When Covid-19 emerged, governments, of course, were painfully aware that there was no vaccine, no specific treatment, and no natural immunity among their populations. The only thing to do was to resort to "social isolation" on an unprecedented scale, and pray for a miracle--like a generic anti-malarial drug that could be stunningly effective against coronaviruses.
M*A*S*H had an episode involving chloroquine near the end of its run. If memory serves, Klinger developed a reaction to primaquine.ReplyDelete
Not really relevant other than it sparked a memory and I remember both medicines' names.
SARS was easily contained, since you only became contagious when you showed symptoms. After the initial SNAFU, especially in Canada, quarantines were implemented.ReplyDelete
The Wuhan Chinese CoronaVirus can be spread, by those that don't show symptoms.
And this report from the LA Times, about the Husband of a victim that did CPR (first death in LA County, and one city over from me) not being tested, since he did not show symptoms, bothers me.
Front page LA Times per my Mother. I have not figured out the LA Times link, but found this:
My guess is the current guidelines on testing will change, as more testing comes online. The number of cases went up by 1000 yesterday in the US, probably because of more testing.
Osterholm's Chapter 10 is: "Gain of Function and Dual Use: The Frankenstein Scenario." It's about modifications to viruses for research purposes. The result can be, may be intended to be, that the virus "gains function." For example, if it only infected animals before it now can infect humans, are is more easily transmitted because it can now attach to receptors more readily, and so on. There are legit reasons for such research, as Osterholm explains, but there are scary scenarios--like if some such virus gets loose, whether by accident or by design. I would not discount that possibility in this case.Delete
In my small city, city offices have been closed. Movie theaters are closed. Restaurants, the ones that stay in business, can do only take out.ReplyDelete
Tomorrow they shut down Uber, Lyft, hairdressers. We are in the middle of a full-fledged panic, and it's getting worse. On top of all this, despite what I'm reading, we don't have accurate data.
We have anecdotes. I tried tracking down your Italy notation. Seems to have come originally from Fortune, but I'm not sure. The article used "may" a number of times. No specific incident was mentioned.
Young people are getting seriously ill from Covid-19? Forgive me, I didn't get the memo that said they were immune from this or any disease. My favorite headline? "21 year old soccer coach dies from coronavirus"...he also had leukemia.
In my town, one of our deranged progressive soccer moms went ballistic when she saw some boys playing basketball. She yelled at them! They told her to go fuck herself! I'm on their side.
Hysteria has become a chronic condition in American life. It's the little girl culture (Greta T). It dominates. It rules. So much "certainty" that I hear about this virus smacks of the "certainty" we get from the global warming crowd or those who say Trump colluded with the Russians: bad data, anecdotes, outright lies.
The cure may be worse than the disease.
"we don't have accurate data. We have anecdotes."Delete
We have history and we have science. The history of the SARS and the science that went with it tells us what to expect from a new outbreak of SARS. Having found out that this new version of a SARS coronavirus had achieved pandemic proportions, and knowing what we already knew about that type of disease, the authorities took the only effective action that was known to be at their disposal. Hopefully chloroquine will change that, but until that's for sure social isolation is the only tool at hand that's known to work.
My recall is, that the social isolation push in the SARS episode was trivial, compared to the current orgy.Delete
When a shrewd guy like Boris tells the Brits, that they're better off just taking their lumps from Covid-19, rather than risk economic collapse, I take him seriously.
I recommend you read my two latest posts, read up on the 1918 flu pandemic, and then reconsider Boris' shrewdness. Personally, I'll stick with Trump's shrewdness.Delete
I am quietly hopeful--almost said exuberant--about chloroquine. Read about it on WUWT a week ago? And today Roy Spencer opined. He noted that where anti-malarial drugs were in use, there is no Covid-19.ReplyDelete
If he's right, Covid-19 should run into a wall in equatorial Africa. It would be great news if some on the shelf, readily available drug put a stop to this pandemic. So, fingers crossed.
On the SARS front, the virus did its damage, the world didn't come to an economic halt. SARS could be a good example of what to expect if we did no more than what they did in terms of precaution.
"Covid-19 should run into a wall in equatorial Africa."ReplyDelete
It hasn't. There are cases all across equatorial Africa. Also in Brazil, another tropical type country. It's true that most of the cases in Africa are in North Africa and South Africa for now, however the equatorial African countries are also those least prepared to get a read on it--testing and so forth.
Re your last paragraph, I can't believe you wrote that. SARS was a regional outbreak and, while extremely lethal, was always confined. 916 people died over 8 months. Covid 19 has already killed 9953 in less than half that time and is far from over--and that's if you believe the China stats. It's a GLOBAL PANDEMIC that continues to spread rapidly.
Perhaps I should rephrase: Spencer says that "Covid-19 is where malaria is not."Delete
And true, Covid-19 has killed 9953 in four months. In that same time period, the flu, in America alone, has killed at least 20,000.
"Spencer says that "Covid-19 is where malaria is not."Delete
Last year reported by WHO was 2017, when malaria killed 400K, 93% in Africa. Apparently they don't take their chloroquine there, so what does that suggest about the spread of Covid-19 to Africa?
Re flu deaths: So to add thousands more--although estimates run into millions if no action taken--is no big deal?
1. This isn't the flu.
2. There are no vaccines.
3. Nobody has any immunity.
I'm as hopeful as anybody that a treatment is soon found. I just want to throw out one concern about chloroquine.Delete
Does a study that shows that 90-x% of patients treated with chloroquine recover prove anything if 90-x% of patients recover anyway?
The way I heard it is that they are totally free of the virus within 6 days. That's re the French trial. That's all I really know. Also that the Koreans have used it.Delete
Grist for the ChiCom Fever mill.
Towards the end is this 'caveat': "Our estimates of sCFR are inevitably affected by under-ascertainment of cases and deaths of COVID-19."
No Shit Sherlock! The reported fact that the Wuhan crematoria was processing 600+ bodies a day, operating three shifts, for most of January as opposed to a "normal" day of 300, over two shifts, and ground was broken for an additional facility that would triple capacity, while the Party attributed less than a thousand fatalities to ChiCom Fever might indicate a 'downward bias for your severity estimate.'
All the numbers submitted by the CCP are crap. Even money says a fat .gov (ours or theirs) grant paid for a 'study' based on aforementioned crap data. Garbage in: garbage out.
As I've said before this scared the living daylights out of an group of people that didn't even blink at intentionally starving 50 million of their own to death. That says a great deal about the seriousness of the situation.
I do not believe in panic. I believe that Trump has been attempting to ameliorate the tendency to panic, even among his own staff, with a "keep calm and carry on" message while trying to develop a rationale plan of action. I have seen nothing to indicate that he does not have a handle on this, as much as can be expected anyway. During the time frame he was supposedly not magically conjuring test kits (our medical supply industry was almost totally offshored in the 1980's) the ChiCom's were passing out mimeographed instructions on how people could manufacture 'homemade' tests. Good luck with that. The test kits supposedly he could have had from overseas reportedly were wrong 48% of the time. Maybe he thought American's deserved better. Early test methods had a 4-5 day turn-around, now I think it's down to 48 hours and supposedly a 8 hour test is coming on line.
He is, I think, trying to be rational and decisive while sifting advice that ranges from do nothing and it will solve itself to hair-on-fire full on martial law all the while staving off endless critiques and out right attacks, not to mention he must always be mindful that his ostensible subordinates and aides are ever ready to disobey or undermine his every effort for the 'resistance'. I don't know that he is doing a great job, but I can't honestly say I could do better. I certainly would have much less patience with the thumb-suckers carping that the National Gov't should not only haul TP to their doorstep, but come in and wipe their derrière as well. I think he believes, truly, that Americans can only bootstrap themselves out of this together. (I would go on with this but I'm already running long but I haven't forgotten your challenge to defend the premise that the Founders foresaw this and left us the 9th and 10th Amendments as tools. I will address that when I can find time (I saw the face you just made ;-).))
If it's an external enemy Trump fights the ship; if it's internal he fights for the ship, under the most adverse conditions that any captain has faced since Lincoln. I can't reasonably expect more.
Sorry about the rant. It looked shorter in the little comment window.Delete
It's OK. I agree with most of it.Delete