Coronavirus Crisis: Main Thread

[Wombaticus Rex]

I have laced up some real bummers here in the past six weeks, but for this one, I actually apologize.

Via: http://www.cidrap.umn.edu/news-perspect ... s-shenzhen

Study reveals sharp increase in COVID-19 in kids in Shenzhen

COVID-19 has become endemic to the Chinese city of Shenzhen, and a sharp increase in pediatric infections may indicate that community and intra-family transmissions have become the new mode of spreading the virus, according to a study published yesterday in Emerging Infectious Diseases.

Also, in a research letter published yesterday in the Journal of Infection, researchers described and compared the wide range and changing characteristics of COVID-19 infection on computed tomographic (CT) imaging with clinical manifestations to improve diagnosis.

Shifting characteristics in Shenzhen

Led by researchers at the Third People's Hospital in Shenzhen, the study analyzed clinical and epidemiologic characteristics of the city’s first 365 COVID-19 patients with laboratory-confirmed disease, including 74 clusters of 183 cases. The median patient age was 46 years (range, 1 to 86 years), and the cases were split evenly between males and females.

To investigate the shift of the epidemic, the researchers compared patient characteristics before Jan 24 with those from Jan 25 to Feb 5. "Compared with before Jan 24, the proportion of case-patients without definite exposure was much higher from Jan 25 through Feb 5 (11% vs. 6%; P < 0.001) and increased to 36% (12/33) on both Jan 31 and Feb 5," the authors wrote.

They also reported a sharp increase in the proportion of infected children (2% before Jan 24 to 13% for Jan 25 to Feb 5; P < 0.001), meaning that increased exposure for children and familial transmission could contribute substantially to the epidemic.

The researchers noted that the steep increase could be attributed to the low proportion of children exposed early in the outbreak; early detection for children who had had close contact with people with diagnosed or suspected infection after control measures were implemented; or failure to identify the relatively mild signs and symptoms in children, especially because resources were limited early in the Wuhan outbreak.

The investigators caution that delays from infection to illness onset or onset to confirmation may have biased the comparisons.

After Jan 17, infections increased substantially and peaked Jan 22 to 30. The authors said that the decline since then is probably due to both under-identification of cases of recent onset and delayed identification or reporting.

...

In other research news, pregnant women are not at increased risk of having severe symptoms of COVID-19 infection, according to an analysis of 147 women in Wuhan published Friday by the World Health Organization and China.

The analysis found that only 8% of the women had serious illness, and 1% were critically ill.

This is in contrast to other respiratory infections that easily infect pregnant women and can cause serious illness, with long-lasting consequences for them and their babies. While long-term effects on the babies are unknown, a small study published in February in The Lancet showed that the newborns of women infected with COVID-19 appeared healthy and virus-free after cesarean delivery and isolation from their mothers.

Note that this update comes from the University of Minnesota's CIDRAP news feed, which has evolved into a superior source for straightforward synthesis, especially as major media coverage gets worse.

Here is today's US-centered update and their international summary. Things continue to accelerate, everywhere.

[chump]

https://youtu.be/lUYk-LYrUBg
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[Iamwhomiam]

I believe we'll soon see the number of confirmed cases begin to soar once more testing kits are made available.

It's truly amazing to see how utterly incompetent our US response has been, considering China, once they finally got serious, built a huge modular, state of the art hospital for isolating thousands of patients in four days and planned on building more.

Homeland insecurity, as should always be expected in this free market, pay as you go world.

Is it time for the lamb's blood to be smeared above the door?

[Wombaticus Rex]

considering China, once they finally got serious, built a huge modular, state of the art hospital for isolating thousands of patients in four days and planned on building more.

China leveled a dirt lot and put down a bunch of prefab buildings. There are hundreds of music festivals every summer that involve more work (and more ambition (and better infrastructure)).

That was cheap PR and they deserve zero credit for it. They instituted martial law for hundreds of millions of poor people when it was too late to really contain the virus, give them credit for that -- to the extent they were able to pull it off. Reducing community spread made a big difference in Wuhan -- just like letting rich people leave for vacation homes around the world made a big difference everywhere else.

Anyway. More cheerful thoughts from Lancet:

Via: https://www.thelancet.com/journals/lanc ... 40-6736(20)30521-3/fulltext

The attack rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) calculated by mathematical models, from estimates of the basic reproduction number, R0, of 2–3, suggests that 50–60% of the population should eventually be infected because the population seems to be entirely naive to the new virus. The observed attack rate on board the Diamond Princess cruise ship remained slightly below 20% (705 of 3711 passengers and crew members became infected).

It is of upmost importance to know whether the SARS-CoV-2 outbreak in China is subsiding, as local authorities and the entire international community might wish. With 80 026 COVID-19 cases officially reported from China as of March 2, 2020, the proportion of the population affected remains far from 50%, or even 20%, of China's 1·4 billion people. Has China just experienced a herald wave, to use terminology borrowed from those who study tsunamis, and is the big wave still to come?

Serosurveys can help answer these questions precisely.

To serosurvey the outbreak would involve testing sera of blood samples from the most representative sample of the population at the epicentre of the epidemic, Wuhan. Serology analysis with neutralising antibodies from the 1000 people could allow for the rate of SARS-CoV-2 infections to be estimated with good accuracy. This rate could be extrapolated to the city's entire population and thus inform more precisely whether the provisional attack rate during this period was a few cases per thousand or perhaps affected 1–2% of the population, 20%, or more. Serosurveys should be seen as polls before elections; they can be repeated several times,
week after week, to monitor the epidemic precisely.

There is no reason to wait for the end of the epidemic before doing serosurveys. The results would be tremendously informative to China, first and foremost, and to the entire international community, on the risk of big secondary epidemic waves.

I declare no competing interests.

[identity]

https://coronavirustechhandbook.com/

[Wombaticus Rex]

CIDRAP this evening:

Seattle closing schools leads the local update -- Interesting behavioral detail: 20% of parents kept their kids home at some point this week. That's likely a venn diagram where wealth and distrust overlap; public education is public daycare so I'm sure a lot more parents would have kept their kids at home if they could have. Gotta go to work.

Lots of "community spread" cases getting ID'd now, which is always an indication that there are hundreds more.

The Seattle Times in a separate story reported that affected counties King and Snohomish have 70 cases, including 11 deaths. Total cases rose by 31 since yesterday.

Many Washington state cases are linked to the Life Care long-term care facility outbreak in Kirkland, Washington ... This week Amazon, Facebook, Google, and Microsoft are some of the major Seattle companies to announce work-from-home policies for staff.

...

Today the US Senate approved an $8.3 billion budget package for the coronavirus response, and the bill is expected to be signed by President Trump tomorrow.

The US Department of Health and Human Services (HHS) also said today it intends to buy 500 million N95 respirators over the next 18 months for the Strategic National Stockpile.

The global roundup is also grim. Italy is face to face with ICU overflow now. WHO teams are all over the place now. Tedros is still embarrassing.

At today's media telebriefing, Tedros said trends in South Korea are encouraging, with signs that virus activity may be decreasing and most new cases linked to known clusters.

China today reported 143 new cases, edging its overall total to 80,409, according to the National Health Commission. All but 5 were from Hubei province. The number of people still in serious condition declined by 464 to 5,952. And 31 deaths were reported, all from Hubei province, bumping the fatality total above the 3,000 mark to 3,012.

Tedros said today that of 31 China provinces that were at their highest alert level, 20 have downgraded the risk level, and today alone, 11 moved their level to the lowest level. "There's hope in that," he added.

...

Italy's health ministry today reported 769 new cases and 41 more deaths, lifting its respective totals to 3,858 cases, 148 of them fatal. Though cases have been reported throughout the country, 3,356 are from three hard-hit northern regions: Lombardy, Emilia-Romagna, and Veneto.

In a letter to the European Society of Intensive Care Medicine, a group of Italian doctors from Milan sent a letter to the group, warning others that a high percentage of positive cases are being admitted to intensive care units (ICUs), about 10% of patients. "We wish to convey a strong message. Get ready!" they wrote.

They listed several recommendations, including having a personal protective equipment stocking and restocking protocol in place, increasing ICU capacity, and preparing spaces for cohorting ICU patients, if needed.

Finally, the clinical update is worth reproducing in full:

A study involving 28 COVID-19 patients in Japan has shown that the virus's serial interval—the time between successive cases—is close to or shorter than its median incubation period, suggesting pre-symptomatic transmission may play a key role in the outbreak and case isolation alone might not be as effective as hoped.

Also, a separate study today outlines how Hong Kong protected 413 healthcare workers from infection with the novel coronavirus as they cared for patients without contracting the disease.

Serial interval estimated at 4.0 to 4.6 days

In the Japanese study, published yesterday in the International Journal of Infectious Diseases, investigators calculated that the time from symptom onset in a primary COVID-19 patient to symptom onset in secondary patients, or the serial interval, was 4.0 to 4.6 days.

Led by researchers at Hokkaido University in Sapporo, the study, though small, is important because serial interval enables identification of epidemiologic links between cases and is an important parameter in epidemic transmission models to inform infection control methods.

"When the serial interval is shorter than the incubation period, pre-symptomatic transmission is likely to have taken place and may even occur more frequently than symptomatic transmission," the authors wrote.

The incubation period is the time from exposure to the virus to first symptoms.

Much spread might occur before symptoms

The researchers gathered dates of illness onset of primary patients (infectors) and secondary patients (infectees) from published research articles and case reports. They subjectively ranked the legitimacy of the data, analyzed both the full dataset (28 patients) and a subset of pairs that had highest certainty in reporting (18 patients) and then adjusted for right truncation of the data because the epidemic is still growing.

They estimated the median serial interval at 4.0 days (95% credible interval [CrI], 3.1 to 4.9). When the data was limited to only the most certain pairs, the median serial interval was estimated at 4.6 days (95% CrI, 3.5 to 5.9). "This suggests that a substantial proportion of secondary transmission may occur prior to illness onset," the authors wrote.

They add, "The COVID-19 serial interval is also shorter than the serial interval of severe acute respiratory syndrome (SARS), indicating that calculations made using the SARS serial interval may introduce bias."

Because of the shorter serial interval, "contact tracing methods must compete against the rapid replacement of case generations, and the number of contacts may soon exceed what available healthcare and public health workers are able to handle," they wrote.

Of the 28 infector-infectee pairs, 12 pairs were parts of family clusters.

Protecting healthcare workers against COVID-19

A robust, multifaceted response to the COVID-19 outbreak protected healthcare workers against the virus in a Hong Kong hospital, according to the second study, published today in Infection Control & Hospital Epidemiology.

Led by researchers at Queen Mary Hospital in Hong Kong, the study describes the hospital's infection control response in the first 42 days after a cluster of pneumonia in Wuhan, China, was reported on Dec 31.

The hospital, like other public hospitals in Hong Kong, immediately stepped up its infection control procedures using enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers who had been unprotected against exposure.

Workers were educated about personal protective equipment, infection control, and hand hygiene in staff forums and in-person sessions. When screening identified a patient infected with the coronavirus, he or she was immediately isolated in an airborne isolation room or a ward with at least one meter of space between patients.

Zero infections or deaths in hospital workers

Eleven unprotected healthcare workers out of 413 involved in treating patients with confirmed illness were quarantined for 14 days. No hospital workers were infected, and no hospital-acquired infections were identified after the first 6 weeks of the epidemic. This was despite the health system testing 1,275 patients with suspected infection and treating 42 patients with active, confirmed infection.

"Vigilance in hand hygiene practice, wearing of surgical masks in the hospital, and appropriate use of personal protective equipment in patient care, especially performing aerosol-generating procedures, are the key infection control measures to prevent nosocomial transmission of SARS-CoV-2 (the COVID-19 virus)," the authors wrote.

The investigators also collected air samples from near the mouth of a patient with a moderate viral load. The virus was not detected in any test, and tests of objects in the room detected it only on a window bench, suggesting that environmental transmission may not be as important as person-to-person transmission.

Swift public health response in Hangzhou

Also today, investigators at the First People's Hospital at Zhejiang University School of Medicine published a letter in the same journal crediting public health efforts for rapid containment of the spread of COVID-19 in Hangzhou, China.

The city's COVID-19 cases climbed from an initial 6 on Jan 19 to 169 by Feb 27. In the last week that they studied, the number of new cases decreased sharply, and only 1 case was confirmed from Feb 17 to 20, according to the authors. There were no deaths among the patients.

The researchers used a regression of log–incidence-over-time model to generate a fitted trajectory for daily incidence to prove the effects of the efforts, which began on Jan 23 with the launch of the highest level of emergency public health alert and response to limit people's movements.

On Feb 3, Hangzhou officials said only one family member was allowed to leave the family home and buy essentials outdoors every 2 days. At the same time, authorities implemented a package delivery method that involved no close contact with clients, which many express delivery companies adopted. Officials also urged employees and students to work online and arranged chartered transportation to help migrants return to their workplaces.

On Feb 11, Hangzhou implemented a system consisting of green, yellow, and red codes. People wanting to visit Hangzhou had to submit their travel history and health information online before they could do so. A green code indicated a low risk of infection, while residents with yellow or red codes had to be quarantined for 7 to 14 days and report their health condition daily before their code turned green.

The researchers said that their study shows that these efforts succeeded. "Now this health surveillance system has been applied in most cities in Zhejiang province and then would be promoted to other provinces," they wrote.

So, that works. If you can pull it off.

The United States of America is, at present, highly indisposed to such a radical reorganization of our daily lives. But not uniquely. There is a tremendous amount of distrust -- mutual distrust -- between the rulers and the ruled. Perhaps the way forward is to put ER workers in charge of the coming perpetual emergency utopia?

Something far beyond COVID-19 is beckoning here, the same force that's winking at us from beyond urbanization, centralization and the explosion of our technology. It's behind your screen right now, and it intends to turn us all into something new, something different. We'll only get a little closer in 2020; but it always gets a little closer. That's all it ever needs.

[liminalOyster]

[Wombaticus Rex]

FT gently dunking on the colonies.

Via: Why the US is so vulnerable to coronavirus outbreak

As the number of coronavirus cases mount in the US, experts are warning that the country is unusually vulnerable to the spread of the disease.

There were 149 cases of coronavirus in the US and 10 people had died from the disease, according to the latest bulletin from the CDC, published at noon on Thursday and reflecting the situation on Wednesday afternoon.

Public health officials and academics are concerned that a mix of high numbers of uninsured people, a lack of paid sick leave and a political class that has downplayed the threat could mean it spreads more quickly than in other countries.

While US drugmakers look best set to find treatments and vaccines, some believe that the country could yet find itself one of the worst affected by a global pandemic.

“The US has certain strengths when it comes to innovation and expertise around diseases, but it also has critical vulnerabilities, especially with our health system,” said Lawrence Gostin, professor in public health law at Georgetown University.

Patchy healthcare regime

The spread of coronavirus could be fuelled by patients reluctant to seek care because of the expense of the US healthcare system. Almost 18m Americans did not have insurance in 2018, according to the Kaiser Family Foundation, a healthcare research organisation.

Even those patients with insurance might struggle to pay their contributions to their care — so-called deductibles or co-pays — as almost 29 per cent were classified as “underinsured” in 2018, according to a Commonwealth Fund survey.

America’s Health Insurance Plans, a trade association of insurers, has said it would remove barriers to virus tests for members, including perhaps waiving a patient’s costs or allowing them to seek care anywhere, not just in an assigned network.

More than 800 experts also signed a letter calling for US policymakers to help the uninsured, but so far, no federal assistance plans have been announced.

Soumi Saha, senior director of advocacy at the Premier alliance of 4,000 hospitals, said doctors would prioritise treatments to billing patients. But she also noted that many hospitals also operated on “razor thin” margins. “The truth is no one truly knows how much this will cost,” she added.

Diagnostic kit shortages

The US has suffered from a shortage of diagnostic kits to test who has the virus, meaning many cases may be going undetected. While South Korea has tested more than 130,000 people, the US public health agency has only been able to test hundreds of samples per day.

The Centers for Disease Control and Prevention (CDC), the leading US public health institute, initially only allowed testing at its own laboratories. This delay meant tests were often restricted to the sickest patients, those who had travelled to affected areas, or had contact with a known sufferer. Doctors say this may have delayed the realisation that the disease was being passed around the community in certain areas of the country.

Another reason for the delay was a problem with the initial test that meant they had to be manufactured again. Peter Kyriacopoulos, chief policy officer of the Association of Public Health Laboratories (APHL), said the original test had also tried to detect other viruses, such as Sars, when it worked better when focused on the new virus, called Covid-19.

At first, patients were having to wait for their samples to be sent to the CDC labs but now they can get results from more local public health labs within 24 hours. The APHL estimated that labs could do at least 10,000 tests a day, when they all come online.

The public capacity will also be bolstered by private labs, after the CDC announced last weekend that it would allow them to use verified tests. Both LabCorp and Quest Diagnostics, major testing companies, have launched tests for Covid-19.

Lack of guaranteed sick pay

While 11 states and 25 cities have passed laws forcing companies to provide paid sickness leave, there remains no federal requirement to do so, and campaigners say about 30 per cent of US workers still have no such entitlement.

Experts say this could exacerbate the spread of coronavirus if workers end up going into work while ill and infecting others, for fear of missing out on salary payments. According to an academic study published in 2012, the lack of workplace policies such as paid sick leave led to 5m extra flu-like illnesses during the H1N1 swine flu outbreak of 2009.

Sherry Leiwant, co-president of A Better Balance, which campaigns for stronger workplace protections, said: “Studies show contagion can really be contained with paid sick leave. People cannot stay at home and self-isolate if they are going to risk their jobs by doing so.”

Confused political response

When US cases rose and markets tanked, and Mr Trump felt pressure to respond, he asked Mike Pence, the vice-president with a patchy record on science and medicine, to manage the crisis. The result is that there is little confidence in this US administration’s ability to contain the outbreak in the world’s largest economy, before matters worsen sharply.

The lag in implementing widespread testing for the disease exacerbated fears that Mr Trump and his team were complacent in dealing with the outbreak, or deliberately quashed evidence of domestic spread for political purposes.

Bruce Aylward, assistant director-general at the World Health Organization, said: “There are still different messages coming from the [Trump] administration about how serious this is, right at the time when you need people to be as vigilant as possible. The population is your best surveillance system, and they need to be aware of how serious the problem is.”

Health experts say the spread of the disease in the US will depend heavily on whether officials respond quickly enough to the changing situation, including instituting potentially unpopular policies such as banning gatherings of over a certain number of people.

“Ultimately, the US really comes together around joint threats,” said Mr Aylward. “But they now have a very narrow window of time to do so.”

[Wombaticus Rex]

It's Friday, so it's time for the Weekend Bad News Dump to begin in earnest. Not surprisingly, we've got more variations on the theme of America's spectacular failure -- imagine what's going to come out after 5 pm today?

First up, on the ground observations from LA Times: Chaos at hospitals due to shortage of coronavirus tests

Federal officials said nearly 1 million tests were expected to be available by the end of this week. But in California, one of the country’s hardest-hit regions with 60 cases, the total testing capacity is limited to only 7,400 through the weekend, according to the California Department of Public Health.

...

“Last night I had a patient with clear coronavirus symptoms, but the health department didn’t think he should be tested,” said an emergency room doctor in Downey who spoke on condition of anonymity. “I went from that patient into the next room, where I had an 80-year-old, immune-compromised, diabetic patient. If I’m taking coronavirus in there, it’s mild for me, but it’s deadly for her.”

California has only tested 516 people for COVID-19 to date, far below what is probably needed in a state where Gov. Gavin Newsom declared a state of emergency this week due to the outbreak. Though there are no known instances of community spread of the virus in California, the number of people who have been exposed to the virus appears to be growing daily.

About 1,250 Californians who were possibly exposed to COVID-19 on a cruise ship need to be tested for the virus. There are more than 9,000 people in California who have recently returned from countries experiencing severe outbreaks. Then there are others who may have been exposed within the community, and are now worried about infecting their families.

Renee Schwartz, a 60-year-old North Hills resident, said she was told by her doctors that her sinus infection and breathing problems could probably be COVID-19. But staff at multiple Los Angeles-area hospitals this week told her they don’t test for the virus.

“I said ‘Who does testing? And they said, ‘No idea,’” Schwartz said.

...

In a call with reporters on Tuesday, Dr. Nancy Messonnier evaded a question about whether the narrow testing criteria early in the outbreak was linked to the limited availability in tests and potentially hindered the nation’s response to the outbreak. She also would not name the cause of flaws in the early test kits, saying the investigation is ongoing.

“What we really need to focus on is where we are today,” she said.

Thanks, Nancy. A bigger picture survey from the retards at The Atlantic: The Strongest Evidence Yet That America Is Botching Coronavirus Testing

...

“The CDC got this right with H1N1 and Zika, and produced huge quantities of test kits that went around the country,” Thomas Frieden, the director of the CDC from 2009 to 2017, told us. “I don’t know what went wrong this time.”

Through interviews with dozens of public-health officials and a survey of local data from across the country, The Atlantic could only verify that 1,895 people have been tested for the coronavirus in the United States, about 10 percent of whom have tested positive. And while the American capacity to test for the coronavirus has ramped up significantly over the past few days, local officials can still test only several thousand people a day, not the tens or hundreds of thousands indicated by the White House’s promises.

To arrive at our estimate, we contacted the public-health departments of all 50 states and the District of Columbia. We gathered data on websites, and we corresponded with dozens of state officials. All 50 states and D.C. have made some information available, though the quality and timeliness of the data varied widely. Some states have only committed to releasing their numbers once or three times a week. Most are focused on the number of confirmed cases; only a few have publicized the number of people they are capable of testing.

The Atlantic’s numbers reflect the best available portrait of the country’s testing capacity as of early this morning. These numbers provide an accurate baseline, but they are incomplete. Scattered on state websites, the data available are not useful to citizens or political leaders. State-based tallies lack the reliability of the CDC’s traditional—but now abandoned—method of reporting. Several states—including New Jersey, Texas, and Louisiana—have not shared the number of coronavirus tests they have conducted overall, meaning their number of positive results lacks crucial context.

...

Washington State, the site of the country’s largest outbreak thus far, can test roughly 1,000 people a day. The state health department’s laboratory can test 100 people a day; the rest of the testing is being done at the University of Washington’s Virology Lab. Officials have found 70 positive cases in Washington so far, though a genetic study has estimated that there may be hundreds of untested people who have COVID-19 in the greater Seattle area.

Oregon, situated between the California and Washington hotspots, can test only about 40 people a day. Texas has 16 positive cases, according to media reports, but the health department’s website still lists only three cases. The Texas Tribune has reported that the state can test approximately 30 people a day.

Other states can test even fewer. Hawaii can test fewer than 20 people a day, though it could double that number in an emergency, an official told us. Iowa has supplies to test about 500 patients a day. Arkansas, though not near a current known outbreak, is able to test only four or five patients a day.

On the East Coast, testing capacity varies significantly. New York State has 22 positive cases, including several cases of community transmission in Manhattan and Brooklyn. It can test 100 to 200 people a day. Neighboring New Jersey and Connecticut have not shared any information about how many tests they have run, or about their daily testing capacity.

Pennsylvania can test only about a dozen people a day, and Delaware can test about 50 people, our survey found. An official in Massachusetts, where two of 20 tests have come back positive, said that she did not know the Bay State’s daily capacity, but that its health department “currently [has] an adequate supply of test kits.”

These data come with an important caveat. Currently, most labs require two specimens to test one person. Single-specimen testing capability is being developed, but right now the top-line number of available tests should be cut in half. In other words, “1.5 million tests” should be able to test roughly 750,000 people. Some states, such as Colorado, told us how many specimens they could test a day (160), not how many patients (about 80). Other states shared the number of patients they could test, but not the number of specimens. In this story, we’ve standardized these numbers by dividing any specimen figure by two to give an estimate of the number of patients who can be tested.

[Blue]

It was only a few weeks ago I was mocking those "paranoid nuts" overreacting to this virus. It was all in China. Then it spread in Asia. Still, it was on the other side of the world. Very quickly it was in Europe, now the US. Daily it grows exponentially.

Yeah, some people are panicking too much. The media is milking it and Big Pharma salivates. But that doesn't mean it isn't going to affect millions of people if not by just the virus itself, the economic repercussions.

What bothers me the most right now is that the US is clearly trying to hide the COVID-19's severity here and I don't mean the clown prez and vice prez's absurd statements, but the entire fed response and some state govs. Florida says it won't bother with testing yet they have the largest elderly population in the country where it would be extremely useful. Don't want to hurt the cruise ship, spring break and Disneyworld economies now do we.

Gonna be a lot of very sick or dead elderly and compromised immune system Americans who have not been tested who will go on record as dying of the flu or pneumonia, or some other ailment. It's gonna be a cover up.

ETA some tunes that help me relax during this age of incessant noise.

https://www.youtube.com/watch?v=MwxaxdcYcJc

[Belligerent Savant]

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[brekin]

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Coronavirus: Italy reports biggest daily jump in death toll
https://www.bbc.com/news/world-europe-51777049

Italy’s large elderly population poses a challenge in slowing the number of coronavirus deaths in the worst-affected country in Europe, a health specialist has said.
The virus has killed 79 people in Italy, overwhelmingly aged between 63 and 95 with underlying serious illnesses.
The youngest patient to die was 55 and suffering from chronic disease. A 61-year-old doctor who was not known to have underlying health problems has also died.

[b]The death toll, provided by officials on Tuesday night, marked an increase of 27 in 24 hours. Twenty-three per cent of the Italian population is over 65, making it the oldest in the world after Japan.[/b]
“Italy is a country of old people,” said Prof Massimo Galli, the director of infectious diseases at Sacco hospital in Milan. “The elderly with previous pathologies are notoriously numerous here. I think this could explain why we are seeing more serious cases of coronavirus here, which I repeat, in the vast majority of cases start mildly and cause few problems, especially in young people and certainly in children.“Our life expectancy is among the highest in the world. But unfortunately, in a situation like this, old people are more at risk of a serious outcome.”

The are more than 2,500 people infected in Italy. Health workers have carried out 25,856 swab tests, significantly dwarfing the number undertaken in other European countries.
Those tested include Pope Francis, 83, after he was forced to cancel engagements this week because of a cold. He returned a negative result, Il Messaggero newspaper reported on Tuesday.
The majority of cases – 1,520 – are in the northern Lombardy region, where 10 towns have been under lockdown for more than a week. The virus has spread to more than half of Italy’s 20 regions, including Tuscany, Puglia, Sicily and recently Sardinia.
Authorities say the majority of people who tested positive in other regions were travelling from Lombardy or had been in the north for a few weeks before the outbreak.
Of those infected, 1034 are in hospital – 229 in intensive care – and 1,229 are recovering at home. The number of people who have recovered from the illness has more than doubled to 160.

Researchers at Sacco hospital last week isolated a strain of the virus from an Italian patient, which suggests Covid-19 may have circulated in northern Italy for weeks before it was detected.
Galli said: “It has been claimed that the so-called Italian virus is very different from the Chinese one. These are simply rumours. We are currently mapping out the sequences and only afterwards can we know.“Obviously, since it is an RNA virus, it is expected to be at least a little different from the Chinese one. RNA viruses typically change: between each viral copy and its template there will be a few differences, like a single nucleic acid mutation. But only once we have the sequences can we begin to make comparisons.”

Italy had experienced the coronavirus outbreak despite being one of the first countries that not only closed contact with Wuhan but also all air contact with China, he said.
“Some countries have accused us of taking too drastic measures. Yet even taking drastic measures, proactively, does not seem to have been enough,” Galli said. “What is certain is that we had no way of predicting the outbreak in the so-called red zone or identifying it before sick people appeared.”

Many people could reach Italy from other countries that had not closed direct flights from China, Galli said, adding that “outbreaks that will eventually appear elsewhere in Europe” may not necessarily come from Italy.“Let us remember the case of a person who had travelled from Singapore, of British nationality, who then went to visit friends in France and infected them,” he said. “If such a thing happened in other parts of Europe, it means we might end up with other red zones.”
A doctor in Italy who is recovering from the virus at home told the Guardian she had only mild symptoms. She lives with her parents and brother, all of whom tested negative. She will be tested again on Friday, after two weeks in quarantine.
“In the majority of cases, people heal,” said the doctor, who asked not to be named. “The problem is we don’t have the mechanisms to protect those who are most vulnerable: the elderly or those with serious health problems. But we need to be objective – an increase in new cases doesn’t mean an increase in serious cases.”

[Grizzly]

Maybe some good news?

https://news.ucr.edu/articles/2020/03/02/new-coronavirus-protein-reveals-drug-target
Drugs previously in development for SARS could be effective for COVID-19

New coronavirus protein reveals drug target

UCR is working hard on a cure

The 3D structure of a potential drug target in a newly mapped protein of COVID-19, or coronavirus, has been solved by a team of researchers from the University of California, Riverside, the University of Chicago, the U.S. Department of Energy’s Argonne National Laboratory, and Northwestern University.

The scientists said their findings suggest drugs previously developed to treat the earlier SARS outbreak could now be developed as effective drugs against COVID-19.

The initial genome analysis and design of constructs for protein synthesis were performed by the bioinformatic group of Adam Godzik, a professor of biomedical sciences at the UC Riverside School of Medicine.

The protein Nsp15 from Severe Acute Respiratory Syndrome Coronavirus 2, or SARS-CoV-2, is 89% identical to the protein from the earlier outbreak of SARS-CoV. SARS-CoV-2 is responsible for the current outbreak of COVID-19. Studies published in 2010 on SARS-CoV revealed inhibition of Nsp15 can slow viral replication. This suggests drugs designed to target Nsp15 could be developed as effective drugs against COVID-19.

Adam Godzik
Adam Godzik is a professor of biomedical sciences at UC Riverside. (Sanford Burnham Prebys Medical Discovery Institute)

“While the SARS-CoV-19 virus is very similar to the SARS virus that caused epidemics in 2003, new structures shed light on the small, but potentially important differences between the two viruses that contribute to the different patterns in the spread and severity of the diseases they cause,” Godzik said.

The structure of Nsp15, which will be released to the scientific community on March 4, was solved by the group of Andrzej Joachimiak,a distinguished fellow at the Argonne National Laboratory, University of Chicago professor, and director of the Structural Biology Center at Argonne’s Advanced Photon Source, a Department of Energy Office of Science user facility.

“Nsp15 is conserved among coronaviruses and is essential in their lifecycle and virulence,” Joachimiak said. “Initially, Nsp15 was thought to directly participate in viral replication, but more recently, it was proposed to help the virus replicate possibly by interfering with the host’s immune response.”

Mapping a 3D protein structure of the virus, also called solving the structure, allows scientists to figure out how to interfere in the pathogen’s replication in human cells.

“The Nsp15 protein has been investigated in SARS as a novel target for new drug development, but that never went very far because the SARS epidemic went away, and all new drug development ended,” said Karla Satchell, a professor of microbiology-immunology at Northwestern, who leads the international team of scientists investigating the structure of the SARS CoV-2 virus to understand how to stop it from replicating. “Some inhibitors were identified but never developed into drugs. The inhibitors that were developed for SARS now could be tested against this protein.”

Rapid upsurge and proliferation of SARS-CoV-2 raised questions about how this virus could become so much more transmissible as compared to the SARS and MERS coronaviruses. The scientists are mapping the proteins to address this issue.

Over the past two months, COVID-19 infected more than 80,000 people and caused at least 2,700 deaths. Although currently mainly concentrated in China, the virus is spreading worldwide and has been found in 46 countries. Millions of people are being quarantined, and the epidemic has impacted the world economy. There is no existing drug for this disease, but various treatment options, such as utilizing medicines effective in other viral ailments, are being attempted.

Godzik, Satchell, and Joachimiak — along with the entire center team — will map the structure of some of the 28 proteins in the virus in order to see where drugs can throw a chemical monkey wrench into its machinery. The proteins are folded globular structures with precisely defined functions and their “active sites” can be targeted with chemical compounds.
The first step is to clone and express the genes of the virus proteins and grow them as protein crystals in miniature ice cube-like trays. The consortium includes nine labs across eight institutions that will participate in this effort.

[Wombaticus Rex]

Gonna be a lot of very sick or dead elderly and compromised immune system Americans who have not been tested who will go on record as dying of the flu or pneumonia, or some other ailment. It's gonna be a cover up.

Completely agree, too many key actors have no incentive to tell the truth. Nobody wants to be first to take measures that would reduce tourism or tax income, but it will all be inevitable pretty soon here. Even once the response gets coordinated and serious, though, most of the casualties will be written off on the margins, or -- like the death toll of the US opioid epidemic -- not investigated at all.

Been a hell of a week, as expected. Even with some beers, it's all a lot to take in.

Italy has gone Full Wuhan, and the EU response will be largely shaped by a desperate attempt to contain that from here. That attempt will be increasingly disrupted by the realization there are at least a half-dozen other epicenters going in their midst, especially France and Spain, and possibly even Germany, their economic engine and true ruler. (I also think all four of them may wind up dwarfed by the unknown unknowns of an outbreak in Greece, barely solvent, teetering, and over-run with already "immunocompromised" arab immigrants.)

There's going to be a lot of Reversion To Primary Loyalties in the EU, and that alliance as a whole will be scarred with too-obvious fault lines come 2021 -- and that's the best case scenario, where there's no COVID-20 Second Wave coming through to double the death toll. Said fault lines are already visible, too: "EU fails to persuade France, Germany to lift coronavirus health gear controls," per Reuters. Shit like this is why I've never bought the diversity hype, we are who we are and we all have our people. The rest is just ad campaigns.

Speaking of ad campaigns, pity the PR workers who have to pivot next week from "there's nothing to worry about" to "nothing is under control." Per the Telegraph: "Government is expected to announce there is no hope of stopping the spread of the virus." Per the nerd losers at Vox: "Two or three weeks ago, we were still hoping for containment. We’re really past that. ... The horse is out of the barn." A mastery of folksy idiom is so crucial for a successful career these days.

Horses, out of barns:

In its situation report today, the WHO said that, over the last 24 hours, 17,481 cases, including 335 deaths, have been reported outside China from 88 countries.

Which bring me to the United States of America. I'm honestly surprised that the US response has been even worse than I expected -- my cynicism is a pretty decent baseline for real world predictions, but seldom does my guesswork look so naively optimistic in retrospect. I expected persistent systemic problems after the response got going, but I didn't expect there to be essentially no response for six consecutive weeks. But here we are.

It is encouraging to see big events -- SXSW, comic book conventions -- getting cancelled. In the next week, we'll see a lot of news about outbreak clusters being traced to concerts (and, especially, political rallies) that should have been cancelled, but at least things are improving.

The problem is that things are improving too late to prevent the leading-edge, most-dangerous cascade effect of the nCoV outbreak, which is a wave of cases overwhelming the existing emergency care medical system.

The West Coast is fucked, well and truly. The whole corridor is seeded, has weeks of ongoing community spread, and seems poorly prepared to deal with it, in the face of their ongoing governance and infrastructure problems. Washington state is facing a critical shortage of masks already -- that's kind of a constant throughout the US, but the irony of this oversight transpiring in the backyard of Bill "Global Health" Gates is acute.

Both Italy and South Korea are solid indications of what we can expect from here: a hockey-stick chart of explosive growth in confirmed infections which is only constrained by the limitations on testing. (Just posted some articles quantifying those limitations.)

As a selfish meme, I'm most troubled by the fact Vermontistan is now completely surrounded by confirmed cases, and has only executed 8 tests to date. Like most states, most countries, it's already here. NYC and Mass are both clusters that only seem small due to the lack of a serious response, and the week to come will only offer a glimpse at the true extent of their problems -- but it will become clear those problems are not "contained" in any sense.

It's not just self-interest, either. Vermont, like Maine, has a big elderly population. So does NY, CT and New Jerusalem. Then there's Pennsylvania and Mass, and a huge a streak down the center of the midwest through the Dakotas down to Arkansas. Stated bluntly, all of this is dry tinder, fuel for the fire. And how much of a priority will it really be to run autopsies on bodies from long-term care facilities? Especially when you have to run two samples to verify and that pipeline is full of tests for people who are, currently, still alive?

This brings us back to Blue's point: most of this will just get written off without any attribution.

On the clinical front, there's a lot of creepy news. HK researchers, who have been sober and careful so far (and done a fucking outstanding job containing contagion among their health workers) are currently pegging the CFR at 1.4% -- or, you know, 14x the fatality rate of "Just The Flu, Bro." More troubling is the indications that nCoV does affect children, and may be doing so on a slower timetable than adults. This would imply that schools are basically amplifiers for super-spreaders, such a Satanically devious viral strategy that now I'm wondering about bioweapons, too.

One curious detail of the HK studies: the indictions that aerosol transmission might be less common than expected, per previous coronaviruses (and influenza itself), which would make the focus on keeping surfaces clean even more important.

The investigators also collected air samples from near the mouth of a patient with a moderate viral load. The virus was not detected in any test, and tests of objects in the room detected it only on a window bench, suggesting that environmental transmission may not be as important as person-to-person transmission

Yet that also makes it inevitable that public transportation would be an ongoing vector for infection. So again and again, we come to the same inevitability of marginalized workers and citizens bearing the brunt of social crises. This is not exactly a new song. Homeless victims? Won't be counted, won't matter. Victims in public housing? Won't be counted, won't matter. Time to move on as a nation.

A few green shoots: Newsom swears testing will be free. Kudlow is proposing tax relief -- not for you, of course, for "targeted" corporations. Yet even these limited initiatives will be, at worst, funded by strategic cuts to other threads of the social safety net -- or at best, through new bond issuances.

Most interventions will remain aimed at the "supply" side of the equation. The "demand" side will keep being neglected.

https://coronavirustechhandbook.com/

This reminded me of Vinay Gupta's early wiki work on pandemic response, and sure enough, he's got some provocations up on Ycombinator:

Via: https://news.ycombinator.com/item?id=22489895

A hashtag: #FLUSTARTUP

Come on, there's 8 weeks of fairly-contained virus before the hockey stick goes vertical. Long enough for companies to form or pivot. Key areas:

1) education for kids who will be out of school

2) cheap, low-cost respirators - can CPAP machines be adapted? what about vacuum cleaners - run one as a pressure source, pipes and valves, serve 5 patients. @lucasgonzalez

3) masks designed for prolonged use by entire populations. https://theconversation.com/copper-is-g ... e-it-73103 CU adjustment tabs etc Copper is great at killing superbugs – so why don't hospitals use it? Lack of knowledge and perceived cost issues could be holding back the fight against the superbugs.

4) Apps to coordinate check-ins on elderly relatives - have somebody in quality flu-blocking gear look in on mom, make sure she has her meds etc. #PandemicPostmates. https://en.wikipedia.org/wiki/Fureai_kippu if you want a currency aspect, it works in Japan

5) Everything remote work. Everything.

6) @Uber but what turns up is a Tesla in biodefense mode, with a driver who's taking his temperature four times a day with spare masks and hand sanitizer for passengers. Do this!

7) Same thing, but for grocery deliveries.

Expect supply chain problems. Sharing app for items?

9) Parents are possibly exposed. You need eldercare. You need to get the kids out of the house. Helpers who are immune to flu because they've had it once are ideal for these roles. A "survivor work register" could be really key to lots of jobs.

10) Who's quick-training nurses to do a lot of flu-related stuff that used to need doctors? Who's training former-patients to do a lot of stuff that used to be done by nurses? The longer this goes on, the more probably-immune survivors you have to work in these critical roles.

(Copper is great a killing superbugs but it's also expensive. There is also no shortage of existing corporations in the remote working space.)

WHO is responding obliquely with a R&D roadmap of their own: https://www.who.int/blueprint/priority- ... avirus/en/

And how much of that will matter? Infections double every six days. Are you going to get testing done in six days? Infections double again in twelve days. Are you going to make pitches and fast track financing by then? Eighteen days later, infections have doubled again. Now you've got to work out manufacturing and distribution. Before infections double again, six days after that.

And all that? All that's not even a month.

None of what I've posted here in this thread has been prognostication or prediction or inside information, just napkin math, sad and implacable. None of this ends well, anywhere, for anyone.

In closing, having wasted a lot of time reading up on existing policy and statutes, it's fucking pathetic how ad hoc the whole domestic response has been. These bitches don't even read their own boilerplate copy. Window dressing. Kayfabe.

[Grizzly]

Guess this cancels anything I posted above about good news...and Rex's 'bring it on home' erudite, fate warnings.

Big Banks Call for Wall Street Deregulation to “Fight Coronavirus”
As Naomi Klein laid out in her bestseller “Shock Doctrine,” the wealthy elite use the confusion caused by economic and other disasters to quickly force through pro-free-market legislation.
https://www.mintpressnews.com/big-banks-call-wall-street-deregulation-fight-coronavirus/265558/

As coronavirus panic hits the U.S., a financial lobbying group is attempting to use the crisis to push through the deregulation of its industry. The Bank Policy Institute (BPI), a Washington-based lobbying organization representing many of the nation’s largest banks, released a set of proposals this week, the most important of which recommends that the Federal Reserve lower capital requirements to zero. This would mean banks could lend an unlimited amount without having any assets or wealth to back it up. It also advocated relaxing the so-called “stress tests” that force banks to show that they can withstand economic shocks. This, it claims, would help America fight the COVID-19 virus. The report’s lead author was BPI CEO Greg Baer, former Managing Director of JP Morgan Chase.

The recommendations have been condemned as incoherent and “transparently opportunistic” by Jeremy Krass of the University of Michigan School of Business. “The whole idea of capital requirements and stress-testing banks is to make sure they have enough cushion to absorb losses” in a period of economic crisis, Kress told the Washington Post. Now that the economy has gone into a sudden shock, Wall Street wants those regulations lifted.

The government itself is also trying to force through measures that it dubiously claims would help fight the coronavirus. Earlier this week President Trump called on Congress to enact a large tax cut and pushed Democrats to support it.

These efforts perfectly encapsulate the idea of the “Shock Doctrine” that author Naomi Klein laid out in her 2007 book of the same name. Klein argued that the wealthy elite use the confusion caused by economic and other disasters to quickly force through pro-free-market legislation that would otherwise meet with widespread and coordinated opposition. As she said, “the idea of exploiting crisis and disaster has been the modus operandi of [economist] Milton Friedman’s movement from the very beginning – this fundamentalist form of capitalism has always needed disasters to advance.”

“Some of the most infamous human rights violations of this era, which have tended to be viewed as sadistic acts carried out by antidemocratic regimes, were in fact either committed with the deliberate intent of terrorizing the public or actively harnessed to prepare the ground for the introduction of radical free-market ‘reforms,’” she explained.

Klein cites Hurricane Katrina – where the Bush administration rushed through privatization and charter school bills for New Orleans while residents were reeling from the devastation – as a perfect example. Going further back, Chilean dictator Augusto Pinochet used his coup against President Salvador Allende to turn Chile into a free-market, neoliberal experiment almost overnight, over the protestations of ordinary Chileans, whom he suppressed with overwhelming force.

There are many things to worry about with the corinavirus, but a plunging stock market is not one of them, unless you are one of the minority who owns a large amount of stock https://t.co/lxZC10PxgD

— Dean Baker (@DeanBaker13) March 6, 2020

The stock market is in serious decline amid fears that the coronavirus will disrupt international supply chains; the Dow Jones index plummeted nearly 1,000 points yesterday. Yet, as the Center for Economic Policy Research’s Dean Baker has noted, the stock market is a very poor indicator of the economy’s current and future health. It is, however, a great gauge on how the top one percent are faring. Stocks also tend to surge after natural disasters (like the 2004 Indian Ocean tsunami) or when conservatives win elections (in December, British banks and weapons manufacturers’ share prices jumped after Boris Johnson beat Jeremy Corbyn). This is because corporations, ignoring the devastation, expect big orders to rebuild or to destroy.

News that will cause stocks to go up:
– a minimum wage increase is struck down
– employees are prevented from unionizing
– corporate taxes are reduced
– labor laws are relaxed

The stock market is not the economy, it's an estimate of how much wealth can be extracted from workers.

— Existential Comics (@existentialcoms) January 12, 2020

Today the number of COVID-19 cases worldwide reached 100,000, with 3,461 recorded deaths. In response, the Himalayan nation of Bhutan closed its doors to tourists altogether, Starbucks announced it would no longer allow customers to use their own cups due to concern about contagion, and the world’s smallest country, the Vatican, recorded its first case of coronavirus. In the U.S., 259 people have been infected, and 14 have died.

While emergency funding to combat the virus will be passed today, the American response has not been swift. Workers have not been guaranteed full sick pay while quarantining, leading to a situation where many poorer citizens will have to choose between doing the right thing and going broke. A Miami resident returning from China was presented with a $3,500 bill after reporting his flu-like symptoms to medical staff, leading to fears that a lack of universal healthcare will help the virus spread. Analysts, however, appear more concerned about the health of stock prices than the health of the nation. CNBC’s Rick Santelli suggested infecting the entire population with COVID-19 so nobody would have an excuse to miss work, thus effectively sacrificing the country for the sake of the economy. While there are many economic steps the United States could take to help the situation, deregulating Wall Street might not be the most necessary.

Feature photo | A pedestrian wears a surgical mask on a busy street in mid-town Manhattan, as concerns grow around coronavirus, March 3, 2020, in New York. Bebeto Matthews | AP

Alan MacLeod is a Staff Writer for MintPress News. After completing his PhD in 2017 he published two books: Bad News From Venezuela: Twenty Years of Fake News and Misreporting and Propaganda in the Information Age: Still Manufacturing Consent. He has also contributed to Fairness and Accuracy in Reporting, The Guardian, Salon, The Grayzone, Jacobin Magazine, Common Dreams the American Herald Tribune and The Canary.