outbreak! (ebola, sars, coronavirus, etc)

Ed: NOLA, a mile from a 75 yr old father. It's not my field, despite reading Laurie Garrett for decades. I've just been following the more public epidemiologists and infectious disease Drs, some on the more alarmed side (@DrEricDing et al), some more reserved (Dr. John Campbell is rather calming), joining in on the beatdowns of conspiracy nuts at r/ChinaFlu. If your planning on redditing this pandemic, the saner sort hang at r/COVID19.

Re: hosing my parents with Purell: Had to buy a wiper blade, was surprised to find a big display of the economy size hand-sanitizer at the entrance (no shortages there), and a misplaced box of N95s in the hardware section (they've been scarce). No intention of hoarding/arbitrage, just wanted some boxes (not cases) for the parents. There's a low probability that we'll see lockdowns in the US, though nothing comparable to Wuhan.

mookiproof: Death (mostly in the elderly and those with comorbidities) mostly comes through suffocation as one's lungs fill with fluid. Like SARS, COV SARS-2 responsible for COVID-19 targets the lung's cilia cells, preventing mucus transport, and then the innate immune system (macrophages etc) damages lung tissues with oxidative bursts. Alveoli fill up with mucus, pus, blood, and at some threshold there's not enough oxygen transport for life. ICUs can handle this (oxygen and ventilators), but in Hubei, critical cases rapidly outnumbered critical beds. I suspect few parts of the world overbuild their critical care infrastructure, and the non-COVID-19 cases still need care...

Seems likely the WHO will declare a pandemic in the near future. A "super-spreader" subset of the infected appear to be contagious for weeks before any symptoms, so containment is no longer the game. China's herculean/draconian efforts bought the world around 6 additional weeks to prepare. Police shoving people into quarantine wards isn't good optics (though a sound practice), and much appears to be pointless busy-work (sterilizing the sidewalks), but the extra time potentially will save millions.

There are some 90 antiviral drug trials taking place, a couple labs have already expressed Covid-19 shell proteins (in bacteria) for potential use as vaccines, its been really impressive watching global infectious disease science drop their current projects (for the duration) and tackling this.

I am watching Chernobyl right now and it just reinforces how little faith I have in the people that ultimately make decisions of communication about these things.

I saw people wearing masks in the airport yesterday and thought they were out of their minds tbh.

I am kind of whatever about the masks but will pick up some n95s when I get home home since they are also useful for other things. It is funny to see white people wearing them in public now though.

I would pick up n95s on sight as they have become rare as hens teeth in Australia (P2s here)

NB this is bushfire related, rather than strictly about focus-19. My wife has asthma and I had to send off to China for 3M particulate masks (the irony).

oh yeah, I have asthma and I was also thinking of fire related things and even tear gas (although I don't think they are that useful for that butI have a better non-disposable gas mask).

at the start of the recent chilean protests I was surprised how poorly prepared a lot of our friends (the non-chilean ones) were. the grocery stores were all shut down or on abbreviated schedules +the curfews and people didn't have enough food in their house for a week. We always have enough for a month and that's mostly because I get anxious if I am somewhere where it takes a long time to get certain things in stock. I didn't even bother trying to find n95s here (hawaii) and probably got some of the last few disposable surgical masks in the market last month.

Re: decisions of communication about these things

Australian virologist Ian Mackay posted this response by the "expert risk communication team" of Jody Lanard and Peter Sandman. Recommended reading, mostly geared to other communicators, but salted with some tips on preparation as the response progresses from containment to "social distancing".

Past Time to Tell the Public: It Will Probably Go Pandemic, and We Should All Prepare Now

but to Yerac's point

Every single official we know is having multiple “Oh my God” moments, as new COVID-19 developments occur and new findings emerge. OMG – there is a fair amount of transmission by infected people with mild or subclinical cases! OMG – there is a high viral load early on in nasal and pharyngeal samples! OMG – the Diamond Princess, how can that have been allowed to happen! And on and on.

Officials help each other through those moments. They go home and tell their families and friends, sharing the OMG sensation. And then what do they tell the public? That they understand that “people are concerned” (as if they themselves weren’t alarmed), but “the risk is low and there’s nothing you need to do now.”

people just seem completely unwilling to inconvenience themselves to stop from spreading it when they know they have symptoms. I don't know how it won't get worse.

timely article here on Italian quarantine in the 17th century (though I suspect written before covid-19):

https://www.lrb.co.uk/the-paper/v42/n04/erin-maglaque/inclined-to-putrefaction

I guess I do think it will go pandemic, but I'm not concerned about dying from it.

Neither am I, but I am worried about the older members of my family.

I dunno, some of the fatalities so far seem to be falling outside of the elderly/children/compromised category ... But then, the regular flu takes so many otherwise healthy people out annually, too.


We're traveling to Hawaii in a couple of weeks, honestly a hair nervous. We went to Australia at the peak of swine flu, and one of my kids had only gotten one of the two required shots, and we are pretty sure she came down with a mild case, which was miserable.

I can't be sure but I think I had swine flu too, at any rate it was during the peak of it and I was really sick for like 3 weeks.

I haven't noticed any changes in behavior (no masks, e.g.) at the east Asian shops I frequent, nor any diminution of business.

Huh, I was just reading that so far kids aren't really being hit by this, or if they are they're not being hit harder than a cold, or maybe they get it but don't show symptoms. I don't think they know why yet.

https://www.npr.org/sections/goatsandsoda/2020/02/20/807483553/coronavirus-is-contagious-but-kids-seem-less-vulnerable-so-far

Sounds bad:

https://www.theguardian.com/world/2020/feb/23/world-is-approaching-coronavirus-tipping-point-experts-say

xpost hawaii doesn't even have kits to test, but i guess if you can't test for it, you don't have to report it.

It's shocking there are supposedly no cases that originated on oahu. it's high season and it's been throbbing with asian tourists.

Sifting through the news, my impression is:

The good news is that, even though it can and does kill people, the virulence of this news virus is moderate enough that the fatality rate may be well under 2%, with a large percentage of exposed people remaining asymptomatic.

The bad news is that because it is a novel strain and fairly easily transmitted, it could spread widely and rapidly to pandemic levels and almost everyone will be exposed to it within the next few years. So, the mad rush for a vaccine is totally justified, because 1% of 8 billion people would be 80 million dead worldwide and anything that can reduce the impact is going to save a considerable number of lives.

I expect some of ilx's MDs might be able to draw a much clearer and more accurate picture than I just did, but that is the gist I'm getting from the media.

this is going to help bernie, right?

nah, gotta cancel the election for infection control purposes

old fogies gotta watch out for this, no more baby kissing

i'm just thinking, if we can't get young people to actually vote, maybe there's an alternative

i thought you meant all these sick people in US being unable to afford a diagnosis/healthcare.

one other kinda major unknown is what happens to virus as it mutates (rather quickly) - will it become more or less virulent, or maybe remain status quo in that respect

xpost to Aimless

this guy

Though it is a disturbing & extreme option, we should seriously consider deliberately infecting folks with coronavirus, to spread out the number of critically ill people over time, and to ensure that critical infrastructure remains available to help sick. https://t.co/giIfo8z8v0

— Robin Hanson (@robinhanson) February 14, 2020

That sounds utterly batshit, but I guess I can see his chain of reasoning. If we knew with a very high probability that the vast majority of people in a certain area would contract the illness in a short span of time, it might make sense to start introducing it gradually in advance. But there's a lot of "if"s in that chain of reasoning.

I'm sure he'd be happy to volunteer!

While its better to have a critical case either before or after the peak of the local epidemic, its better still to wait til a vaccine is available. It would be really helpful to have medical staff with immunity before the peak of an infection, but no volunteers are really necessary there. I would allocate vaccines to them, first.

The coronavirus story will also become a health-insurance story in America. This guy went to China, caught the flu, came back, did the responsible thing and reported himself for possible coronavirus — but tested negative and now might have to pay $1,400+. https://t.co/GdDqyODPVw

— Matt Pearce 🦅 (@mattdpearce) February 24, 2020

seems... bad? idk

does he mean tested positive? or the test itself cost 1400??

n/m i read the article now and i'm fucking furious
https://www.miamiherald.com/news/health-care/article240476806.html

cryingeagle.jpg

Azcue got unwelcome news in the form of a notice from his insurance company about a claim for $3,270.

In 2018, President Donald Trump’s administration rolled back Affordable Care Act regulations and allowed so-called “junk plans” in the market. Consumers mistakenly assume that the plans with lower monthly costs will be better than no insurance at all in case of a medical catastrophe, but often the plans aren’t very different from going without insurance altogether.

Hospital officials at Jackson told the Miami Herald that, based on his insurance, Azcue would only be responsible for $1,400 of that bill, but Azcue said he heard from his insurer that he would also have to provide additional documentation: three years of medical records to prove that the flu he got didn’t relate to a pre-existing condition.

these motherfucking jackals, man. they should hang their heads in shame. the adjusters, their bosses, the advertising agencies who accept their business. ruining people's lives and literally pushing people closer to death out of fear of bankruptcy. and our broken healthcare system will probably god forbid make any serious outbreak in the united states absolutely impossible to contain because nobody will be able to afford the goddamn tests.

$1,400, that sounds about right. after all, Aspirin goes for about $10/pill in the US healthcare system, bandages are $25 each, leasing an examination table is $200/hour, then you've got the sanitary paper they put on the table (also $200/hour), and that doesn't even include maintenance fees and taxes.

but let me be clear: we have the greatest healthcare in the world and nothing can be changed, especially not the underlying costs for medical procedures

medicare 4 all those left alive after the ravages of the pandemic

I didn't even know the specifics when I made that last comment about healthcare. But considering people who are shot in mass shootings are basically left on their own I figured the US is just kind of live free or die (hard with a vengeance) about this too.

They've been doing what now? https://www.youtube.com/watch?v=-74AGwwl-oc

seems legit

There's probably an awful epidemic in Iran (despite no reports to WHO) per Dr. Campbell.

Reportedly, Khamenei and conservatives held that reports of disease were liberal party attemps to suppress voter turnout in the 21 February legislative election.

That's my biggest concern, that so many places must be either underreporting or not reporting at all.

where will you be staying in hawaii? last report i saw was that 62 people were self monitoring.

Maui. But I'm not worried about the island, I'm worried about the airplane. Then again, it seems like my immediate family has been traveling so much these days it's probably too late to worry about airplanes.

I'm also going to Maui in a couple weeks, I'm currently more anxious about being away from home for 9 days and being in close quarters with my partner's parents than about coronavirus, but I'm starting to be anxious about coronavirus too!

Can be successfully treated with fresh pineapple, iirc.

oh at least it will be less dense in maui.

I am totally wearing a mask and purelling everything on the plane when I have to fly next ( i have 28 hours of travel time to look forward to).

In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10.

https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

good luck usa