Coronavirus - worldwide spread and control

[spinoza577]

1. Lots of people together indoors milling about and talking.
2. Recirculating air maybe through air conditioning systems.
3. Lots of people touching surfaces while eating or drinking.

This would explain spread on cruise ships, airport lounges, aeroplanes. It may apply to supermarkets but without the talking maybe much less.

I thought that in supermarkets people are not staying for a longer time, and the virus would not have a good chance to concentrate.

I wonder though if the Chinese advise to go shopping only every third day might be part of the success. And did they give any permission, like with the beginning characters of the name. And what´s about the workers there?

Another factor that might be even more crucial is a pattern of behaviour in which individuals are in this sort of environment at least once a week - maybe these people, who seem to be overrepresented.

1. Politicians, their advisors and spouses
2. Film and music stars
3. Religious worshippers (Korea)

Edit: This may also explain why the trail from cases coming from China went cold but not for those coming back from Italy, many of whom would be regular socialisers who went to the pub within a week in their prodromal phase.

Apparently only 15% of family will get infected by a case. That does not sound like most respiratory viruses where usually everyone in a household gets it once one has brought it home.

And spouses may differ from other family members in that they tend to sleep in proximity.

 

[TrixieStix]

I am not sure about that. Neutrophilia is not an abnormal condition. It is a normal response to bacterial infection. It may mean that people who show a strong neutrophil response during the illness do badly?

I found the source....

"Among 200 patients hospitalized with COVID-19 in Wuhan, China, factors that increased the risk for developing acute respiratory distress syndrome (ARDS) and for dying include older age, neutrophilia, and higher lactate dehydrogenase and D-dimer levels, according to a JAMA Internal Medicine study."

https://www.jwatch.org/fw116450/2020/03/15/covid-19-new-who-guidance-ards-risk-factors-mass

 

[Andy]

My understanding of what these mean in the context of that pre-print.

"secondary transmission"

So they are looking at transmission of Covid-19 at particular events. The person who turns up at that event infected, and then who spreads it to other people, is the source of primary transmission. Those people now infected, and then who spread it to more people, are the source of secondary transmission.

"case"

Someone infected by Covid-19.

 

[Adrian]

There is another modelling paper that was released yesterday in the lancet looking at interventions in Singapore. I don't think its saying anything different from other modelling papers.

One thing of interest though I'm not sure if it is in this paper is that from what I gather Singapore is not in lockdown but seems to have got some form of control on things,

https://www.thelancet.com/journals/...avirus20&utm_source=twitter&utm_medium=social

 

[Sly Saint]

One thing of interest though I'm not sure if it is in this paper is that from what I gather Singapore is not in lockdown but seems to have got some form of control on things,

Singaporians are very obedient/compliant when it comes to regulations. eg where they can and cannot cross the street, and the whole country is very regulated.

 

[spinoza577]

My understanding of what these mean in the context of that pre-print.

So they are looking at transmission of Covid-19 at particular events. The person who turns up at that event infected, and then who spreads it to other people, is the source of primary transmission. Those people now infected, and then who spread it to more people, are the source of secondary transmission.

This is my understanding as well, thank you for having put your´s, and your words.
"Primary cases" then are the sources of primary transmission, and secondary cases likewise.


This Chinese publication about the very subject of corona cdc.gov/eid/article/26/6/20-0251_article says:

The definition of primary versus secondary cases refers to whether persons traveled from Wuhan (primary) or never left Gansu Province (secondary). The aim of this distinction was to explore potential transmission.

So they are referring specifically to the location where the virus has been caught and don´t look at more small time windows, in this publication.

But in the publication Nishiura et al this specific understanding would not make sense. Here the secondary transmission is simply a transmission after the event they looked at (specifically, a primary transmission in closed enviroments).

 

[Daisymay]

They had a dedicated project for an emergency information app a few years back and never bothered to put it into practice. Why they cannot just twitter goodness knows.

Quite, and think how quickly and effectively political parties were on twitter/internet when it came to electioneering, it can easily be done, so why oh why are they not using these mediums? And of course communicating for those who aren't on twitter/internet, campaigns need to factor in them too, often the most vulnerable, poorest in society.

 

[Andy]

For the first time, all the UK's mobile networks are sending out a government message to their customers with details of the new shutdown measures.

The government has had to work with the operators to get the message sent because an emergency alert system, trialled seven years ago, was never put into practice.

https://www.bbc.co.uk/news/technology-52017451

 

[JaneL]

I can't remember where, but I saw a list last week that listed 'Neutrophilia' as one of the risk factors along with cardiovascular disease, diabetes, etc.

This study (not peer reviewed) found that the neutrophil to lymphocyte ratio predicts severe illness in patients with Covid-19:

Abstract
Background: Severe ill patients with 2019 novel coronavirus (2019-nCoV) infection progressed rapidly to acute respiratory failure. We aimed to select the most useful prognostic factor for severe illness incidence. Methods: The study prospectively included 61 patients with 2019-nCoV infection treated at Beijing Ditan Hospital from January 13, 2020 to January 31, 2020. Prognostic factor of severe illness was selected by the LASSO COX regression analyses, to predict the severe illness probability of 2019-CoV pneumonia. The predictive accuracy was evaluated by concordance index, calibration curve, decision curve and clinical impact curve. Results: The neutrophil-to-lymphocyte ratio (NLR) was identified as the independent risk factor for severe illness in patients with 2019-nCoV infection. The NLR had a c-index of 0.807 (95% confidence interval, 0.676-0.38), the calibration curves fitted well, and the decision curve and clinical impact curve showed that the NLR had superior standardized net benefit. In addition, the incidence of severe illness was 9.1% in age ≥ 50 and NLR < 3.13 patients, and half of patients with age ≥ 50 and NLR ≥ 3.13 would develop severe illness. Based on the risk stratification of NLR with age, the study developed a 2019-nCoV pneumonia management process. Conclusions: The NLR was the early identification of risk factors for 2019-nCoV severe illness. Patients with age ≥ 50 and NLR ≥ 3.13 facilitated severe illness, and they should rapidly access to intensive care unit if necessary.

https://www.medrxiv.org/content/10.1101/2020.02.10.20021584v1

 

[Adrian]

Singaporians are very obedient/compliant when it comes to regulations. eg where they can and cannot cross the street, and the whole country is very regulated.

They are but when I was talking to someone there last week he was talking about traveling on crowded public transport still. Yet the infection rate seems very low and they are linking most of them to imported cases. So yesterday they reported 54 cases with 48 being imported. So I'm wondering what is different about their strategy.

https://www.channelnewsasia.com/new...s-new-cases-imported-travel-covid-19-12567298

 

[Evergreen]

This analysis of 196 covid-19 critical care admissions in England, Wales & N. Ireland was being discussed on the UK news yesterday. You can download it as a pdf from here (click on "report"):

https://www.icnarc.org/About/Latest...-On-196-Patients-Critically-Ill-With-Covid-19

Median age of these ICU-admitted patients (IQR): 64 (52, 73)

70.1% male

Most were previously independent:

Medical history
Dependency prior to admission to acute hospital, n (%)
Able to live without assistance in daily activities 155 (87.1)
Some assistance with daily activities 23 (12.9)
Total assistance with all daily activities 0 (0.0)

As far as I can see, this means that most ICU-admitted UK patients did not have previous severe comorbidities:

Severe comorbidities*, n (%)
Cardiovascular 0 (0.0)
Respiratory 3 (1.6)
Renal 4 (2.1)
Liver 0 (0.0)
Metastatic disease 2 (1.1)
Haematological malignancy 2 (1.1)
Immunocompromise 7 (3.7)

* Cardiovascular: symptoms at rest; Respiratory: shortness of breath with light activity or home ventilation; Renal: RRT for end-stage renal disease; Liver: biopsy-proven cirrhosis, portal hypertension or hepatic encephalopathy; Metastatic disease: distant metastases; Haematological malignancy: acute or chronic leukaemia, multiple myeloma or lymphoma; Immunocompromise: chemotherapy, radiotherapy or daily high dose steroid treatment in previous 6 months, HIV/AIDS or congenital immune deficiency

BMI data is also provided for the ICU-admitted covid-19 patients in UK:
Body mass index, n (%)
<18.5 1 (0.6)
18.5-<25 49 (27.7)
25-<30 56 (31.6)
30-<40 58 (32.8)
40+ 13 (7.3)

It looks like the mean BMI for 64 year olds in the UK is around 28/29:

In 2018, men aged 55 to 64 years had an average body mass index (BMI) of 29 kg/m2 and women aged 65 to 74 years had a BMI of 28.3 kg/m2
https://www.statista.com/statistics/375886/adult-s-body-mass-index-by-gender-and-age-in-england/

Wishing all those in critical care and those looking after them the very best.

 

[Roy S]

There is a twitter thread too.

 

[BurnA]

One thing of interest though I'm not sure if it is in this paper is that from what I gather Singapore is not in lockdown but seems to have got some form of control on things,

Just to share my recent experience of Singapore.

I arrived there early Jan. Before entering the work place, I was asked if I had flown from China or if I had any symptoms of a flu/fever. Everyday I had to fill in the same form. I didn't link this to coronavirus at the time because early Jan nobody was thinking about that in Europe. This was a full two weeks before the first case in Singapore. There was no mention of any social isolation at this time but face masks and sanitizers were in demand.

By the time the first case occurred in Singapore I had left so the following I have heard from colleagues who were there.

Every building registered who was entering /leaving. Temperature was checked twice a day everyday by everyone in work.
Public events and mass gatherings incl religious, were cancelled.
Nobody went out to bars or restaurants and people got their shopping delivered.
Anyone who arrived from China had a 14 day isolation period. Temperature screening was introduced at all entry points to Singapore.

I don't know how things may have changed since because my last update was around end of Feb.
I believe they subsequently cancelled any short term visits to Singapore and residents returning from anywhere in the world had to do a 14 day isolation.

But it seems if you act early and people comply with the common sense measures then that goes a long way.

Singapore have experience of viral outbreaks so they were ready to act and prepared well before the first case.

 

[Sly Saint]

There is a twitter thread too.

Experts cite three major hurdles to following South Korea’s lead, none related to cost or technology.

One is political will. Many governments have hesitated to impose onerous measures in the absence of a crisis-level outbreak.

Another is public will. Social trust is higher in South Korea than in many other countries, particularly Western democracies beset by polarization and populist backlash.

But time poses the greatest challenge. It may be “too late,” Dr. Ki said, for countries deep into epidemics to control outbreaks as quickly or efficiently as South Korea has.

 

[Roy S]

Uh, looks like the U.S. is not quarantining or tracing. Very difficult Trump speech, one of the most unclear, but it sounds like we're actually going to relax restrictions in the coming week. Some states can continue on their restrictions, but interstate travel can continue freely.

I seem to have an ability to sleep through those. It must be a superpower.

Since Fauci was not at that one,

 

[lunarainbows]

I think the tweet might be 'fake news' (others in the thread have questioned it)
also see
Iceland Slows COVID-19 Testing Due to Shortage of Swabs
from yesterday
https://www.icelandreview.com/society/iceland-slows-covid-19-testing-due-to-shortage-of-swabs/

I don’t think it’s fake news: from what I understand, They’ve already tested people; however it was a small sample size so far. They were planning on testing the entire population with the help of the company mentioned in the article, but since there’s been a shortage from that company from the 18th March, it looks like that won’t be going ahead or not as quickly. Their rate of 1% I think, (since the sample size is quite small); is probably not accurate until they test lots more people.

 

[Jonathan Edwards]

I found the source....

"Among 200 patients hospitalized with COVID-19 in Wuhan, China, factors that increased the risk for developing acute respiratory distress syndrome (ARDS) and for dying include older age, neutrophilia, and higher lactate dehydrogenase and D-dimer levels, according to a JAMA Internal Medicine study."

https://www.jwatch.org/fw116450/2020/03/15/covid-19-new-who-guidance-ards-risk-factors-mass

Yes I think that means that neutrophilic is an indicator that the body has already got into a serious systemic reaction phase - similarly LDH and D-dimer. D-dimer is something that appears when fibrinogen starts to clot - a sign of a serious complication called diffuse intravascular coagulation.

 

[Mij]

A women (mid 30's) was interviewed on CNN last night tested positive for COVID19 and recovered. She had Lyme D and deals with underlying autoimmune issues, she recovered without any complications from the virus.

 

[Mij]

I donated my (10) N95 masks to my local walk-in clinic yesterday.

 

[Invisible Woman]

Well, whatever means the govt is using it simply isn't getting through to people.

My husband out walking the dog - at first very quiet - it's a huge area, Anyone who was there kept themselves to themselves. On the route home, he happened to glance back and saw a big group of at least 10 people clustered together - I very much doubt that's a single household.

The a text from my niece who is in an at risk group - she's busily working from home and, looking out her window this morning, the florists across the road is open.