Coronavirus

[pigou]

Thanks very much, pigou, that helps.

Recent mass media articles on keeping calm during this time suggest some doable actions:  stay physically and mentally healthy, rely only on credible news sources, keep things in perspective (most people with the virus recover), and take breaks from following the news.

I also think the "negative" tests give us meaningful information. The UK tested 20,000 people and came up with just over 200 positive results. That may well include a lot of hypochondriacs who, despite having no risk factors, think their sneezing means they're about to die from the coronavirus. Don't be like those people.

Also, don't be like the government of Italy, which may be about to quarantine a quarter of its population: https://www.washingtonpost.com/world/europe/italy-coronavirus-milan-lombardy-lockdowns/2020/03/07/403fcea2-60b3-11ea-ac50-18701e14e06d_story.html

ROME — Italy's government on Saturday considered dramatically expanding its northern lockdown zone to encompass up to 15 million people — about a quarter of the country's population — in an extraordinary bid to slow the spread of the coronavirus, according to a draft proposal reviewed by The Washington Post. [...]

The measures would at least temporarily transform the nation, locking off much of the northern part of the country, with people allowed to exit or enter Lombardy and 11 northern provinces only for emergency reasons or for essential work that cannot be delayed.

The changes would cut off the daily high-speed rail connections between Milan and Rome, bring an absolute halt to tourism in Venice, and essentially paralyze Italy's economic heartland.

It would also signal that Western democratic nations are willing to drastically restrict freedoms as they contend with major outbreaks.

I just can't grasp the insanity of this action. The Italian government has always been pretty dysfunctional and their economy was going to do poorly no matter what... but it seems like their politicians have decided a show of strength is what they need and they might as well give up on things like employment, growth, and liberalism.

While I'd not generally recommend people take any action beyond basic hygiene... if you lived in one of those areas, I'd absolutely recommend getting out ASAP (and perhaps getting out of Italy entirely). Governments have massive powers when it comes to stopping the outbreak of diseases and the mere existence of such a draft proposal suggests Italy may be considering using them. It's all fun and games until you end up on the wrong side of that.

In the US, for what it's worth, the federal government can deploy the military to enforce a quarantine. Moreover, the standing rules for the use of force would apply and allow the armed forces to use deadly force against anyone trying to leave a quarantine. That's at the complete discretion of the president and not subject to Congressional review or authorization. If you want something to be anxious about, let it be this -- not the virus.

[pgher]

I think the time has come to remember this: All is well! Remain calm!

[Hegemony]

Well, I'm not all that displeased at the Italians setting a quarantine. Some larger effort needs to happen, and that appears to be it. The WHO praised China's success in slowing down the epidemic considerably, and strict quarantines were at the heart of it. To those who would say, "Everyone's going to get it anyway, so quarantines are useless" — they are still useful because they slow the rate of transmission so that hospitals can cope with the surge. Although "only" 1-3.4% of people appear to die from it, as many as 14% of those who contract it need to be hospitalized, and 5% of the total will need to be in intensive care with ventilators and other equipment in limited supply. So unless we slow the rate of transmission appreciably, many people will die simply through lack of available beds and equipment in hospitals. The first line of defense is tracing contact lines. When the transmission gets too wide to make that feasible, slowing social contact is the next and in fact only line of defense, until such day as better treatments and vaccines are developed. It's fine and dandy if people want to elude the quarantine — unless they happen to have the disease. Then their "freedom" spreads it more widely. At the moment in the U.S., infection rates are doubling every 6 days. Coming soon to a crowded venue near you.

[spork]

Taiwan's response to Covid-19

[mamselle]

Thanks for that.

M.

[spork]

Do any of the folks here with medical/biological/public health connections have information on how long the Covid-19 virus remains active (or "alive") on a dry surface that's at room temperature?

[Stockmann]

Well, I'm not all that displeased at the Italians setting a quarantine. Some larger effort needs to happen, and that appears to be it. The WHO praised China's success in slowing down the epidemic considerably, and strict quarantines were at the heart of it. To those who would say, "Everyone's going to get it anyway, so quarantines are useless" — they are still useful because they slow the rate of transmission so that hospitals can cope with the surge. Although "only" 1-3.4% of people appear to die from it, as many as 14% of those who contract it need to be hospitalized, and 5% of the total will need to be in intensive care with ventilators and other equipment in limited supply. So unless we slow the rate of transmission appreciably, many people will die simply through lack of available beds and equipment in hospitals. The first line of defense is tracing contact lines. When the transmission gets too wide to make that feasible, slowing social contact is the next and in fact only line of defense, until such day as better treatments and vaccines are developed. It's fine and dandy if people want to elude the quarantine — unless they happen to have the disease. Then their "freedom" spreads it more widely. At the moment in the U.S., infection rates are doubling every 6 days. Coming soon to a crowded venue near you.

Plus, there's the knock-on effects - if hospitals and the healthcare system generally are overwhelmed, then cancer patients, accident victims, women in labor, etc will not get timely/adequate/any treatment. It's eminently sensible to slow down the spread, even if it had no effect on the final tally of cases. Quarantines and similar measures are pretty much all that's available aside from hygiene.
Plus, the experiences of China and Singapore show that drastic measures are effective against Covid-19. The experiences of countries that did nothing until they faced a full-blown epidemic - Italy (didn't quarantine folks repatriated from China) and Iran (they at first said they didn't believe in quarantines), show that there's a high cost to not taking drastic measures early. The reluctance of many countries to impose any restrictions on people coming from Italy (unlike the much greater willingness to impose restrictions on people coming from China or Iran) quickly spread it across the world, again illustrating the difference between imposing restrictions and doing nothing.
Yes, the economic cost of drastic measures is massive, but there would also be a massive cost to the healthcare system collapsing - and Italian officials are saying that the healthcare system in Lombardy is close to collapse.

[onthefringe]

Do any of the folks here with medical/biological/public health connections have information on how long the Covid-19 virus remains active (or "alive") on a dry surface that's at room temperature?

I am not an immunologist, but I've done some reading in the scientific literature.

I don't think we really know for this particular strain, but we might be able to make predictions based on other coronaviruses. This review looks at surface survival of several respiratory and enteric viruses on fomites (inanimate objects that can transmit infections). They note that a multitude of factors including temperature, humidity, and UV exposure affect viability. Some studies they cite give other coronaviruses survival periods in the range of 3-12 hours (in contrast, some influenza viruses survive up to  several days in similar conditions). But there's evidence of some coronaviruses being able to survive on a non pourous surface for up to a week given the right conditions. This paper suggests some respiratory viruses can survive for a few days.

[namazu]

So, I have tried to look for this, and have not found such an analysis, but shouldn't the Diamond Princess cruise ship fiasco give us a pretty definitive idea of the mortality rates (at least for that demographic)? From my understanding of all the news articles, everyone on the ship ended up getting tested, right? So here's a population in which every case, mild/asymptomatic or not, would be caught. So according to the Johns Hopkins website, there were 705 cases, 5 deaths, and 690 cases not yet resolved. So with at least 5 deaths, that's at least 0.7% mortality rate, and that number can only go up. I guess cruise ship passengers likely skew older, but still, this seems like a pretty obvious case study where we really do know the denominator in the mortality rate equation. I am somewhat surprised that these numbers are not discussed more; I hope that some epidemiologists are closely following this population, as it seems like a very useful source of data.

Russell TW, Hellewell J, Jarvis CI, van Zandvoort K, Abbott S, Ratnayake R, CMMID nCov working group, Flasche S, Eggo R, Edmunds WJ, & Kucharski AJ. Estimating the infection and case fatality ratio for COVID-19 using age-adjusted data from the outbreak on the Diamond Princess cruise ship. Centre for Mathematical Modelling of Infectious Diseases.  Published online 5 March 2020. 

Abstract:

Adjusting for delay from confirmation-to-death, we estimated case and infection fatality ratios (CFR, IFR) for COVID-19 on the Diamond Princess ship as 2.3% (0.75%–5.3%) and 1.2% (0.38–2.7%). Comparing deaths onboard with expected deaths based on naive CFR estimates using China data, we estimate IFR and CFR in China to be 0.5% (95% CI: 0.2–1.2%) and 1.1% (95% CI: 0.3–2.4%) respectively.

Note: CFR = # deaths / # of symptomatic cases; IFR = # deaths / # of infections.

Excerpt from discussion:

The case fatality ratio is challenging to accurately estimate in real time [8], especially for an infection with attributes similar to SARS-CoV-2, which has a delay of almost two weeks between confirmation and death, strong effects of age-dependence and comorbidities on mortality risk, and likely under-reporting of cases in many settings [6]. Using an age-stratified adjustment, we accounted for changes in known outcomes over time. By applying the method to Diamond Princess data, we focus on a setting that is likely to have lower reporting error because large numbers were tested and the test has high sensitivity.

The average age onboard the ship was 58, so our estimates of cCFR cannot directly be applied to a younger population; we therefore scaled our estimates to obtain values for a population equivalent to those in the early China outbreak. There were some limitations to our analysis. Cruise ship passengers may have a different health status to the general population of their home countries, due to health requirements to embark on a multi-week holiday, or differences related to socio-economic status or comborbities. Deaths only occurred in individuals 70 years or older, so we were not able to generate age-specific cCFRs; the fatality risk may also be influenced by differences in healthcare between countries. Because of likely age-specific differences in reporting, we focused on overall cCFR in China, rather than calculating age-specific cCFRs [7].

[spork]

Anyone have details on the air travel situation to Rome from the USA and back? Asking for an acquaintance. She doesn't want to get stuck in Italy or be put in a quarantine upon returning home.

[mamselle]

Anyone have details on the air travel situation to Rome from the USA and back? Asking for an acquaintance. She doesn't want to get stuck in Italy or be put in a quarantine upon returning home.

In past years, (in past presidencies), there might have been a centralized State Department advisory page on this (like the M&IE website I referred someone to on another thread recently).

I haven't looked for it, but that's one place to start.

M.

[science.expat]

The reference to an 'average' in the Russell study makes me nervous as I'd expect the population to be strongly bimodal - generally young staff, generally older travelers.

I think Rome is ok but smart traveller in Australia or its equivalent in the US will list the travel restrictions. Also International SOS.

[Caracal]

Anyone have details on the air travel situation to Rome from the USA and back? Asking for an acquaintance. She doesn't want to get stuck in Italy or be put in a quarantine upon returning home.

I wouldn't go right now. Rome hasn't had a lot of cases, but that could change quickly. The same, of course, could be said for just about anywhere in the US, but I think the danger of getting stuck is real. It also just seems like it be worth it at this point unless there's a really compelling reason to go. Just doesn't seem like a fun time to be a tourist in Italy, if that's the purpose of the trip, lots of stuff might get shut. If she's doing research, similar problems and concerns.

Of course if she has any medical condition or is older, than she definitely shouldn't go and probably should avoid travel in general...

[mamselle]

Anyone have details on the air travel situation to Rome from the USA and back? Asking for an acquaintance. She doesn't want to get stuck in Italy or be put in a quarantine upon returning home.

In past years, (in past presidencies), there might have been a centralized State Department advisory page on this (like the M&IE website I referred someone to on another thread recently).

I haven't looked for it, but that's one place to start.

M.

OK, found it:

Here's the basic site:

   https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html/

Here's the travel map (note: the "Do not travel"/red areas don't say why, so they might not all be contaigion-related):

   https://travelmaps.state.gov/TSGMap/

Here's the site for Italy: restrictions are for the north, although I pointed the cursor on Rome and the pop-up was focused on Rome itself, but the "More Info" link took me here):

   https://it.usembassy.gov/covid-19-information/

M.

[AmLitHist]

A young woman in our town came home from studying abroad in Italy and brought the virus with her.  The train she took home from Chicago is out of service, being cleaned, and all passengers notified, etc.  She and her family got tested and agreed to in-home quarantine. 

Until the dad and younger sister went to a father-daughter dance on Saturday night.  They also stopped at a private pre-dance party on the way there.

Today, two high schools are closed, with others whose students also went to the party and/or dance telling their students to watch for symptoms, etc.

Not too surprisingly, the patient and her family live in one of the richest suburbs.  So, the rest of us slumming in economically-struggling areas are safe. . . .

. . . .EXCEPT.. . . . my campus traditionally has a number of students who work as valets, housekeepers, bar- and waitstaff at the hotel where the dance was held. 

I'll keep my colorful comments about the dad to myself.  (The patient herself has maintained the quarantine, as have her mother and other family members.)  Once again, the rules and common sense apparently only apply to some of us.  Let it have been one of my students who did such a lame-brained stunt, and all hell would be raining down.