2019 Novel Coronavirus Covid-19 Discussion

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#2416870 12-Feb-2020 20:44

Beccara:

In all honesty if this thing popped up in the middle of winter in Auckland with an R0 of 2-4 I'd expect to see 100-200 cases at least from the first few generations in the community before the 1st person even went to ED.

The work-thru-it culture it just too big in the west, Some middle-management lifestyle block owner get's something from his pig they would infect quite a few brushing it off as just a cold, If we're lucky patient zero would get hit hard and went to ED quickly and we'd see the authorities maybe become aware of it, I certainly doubt we'd lockdown Auckland as fast as China did tho

Yes, if your example occurred, its not much but those cases and the myriad of contact those cases had in the previous two weeks would overwhelm the health system. As it has overwhelmed China's. While Im acutely aware of China frailties, as are the people themselves as they have progressed from reforms in the 70's to massive growth, to trying to stomp out corruption, my beef is that these outbreaks can happen anywhere and they have. Australia, Middle East, Mexico, USA, etc. Its a global issue. Easy travel, big cities, packed subways, and no Im not talking the Eat Fresh variety! :-)

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Beccara

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#2416875 12-Feb-2020 20:51

Yeah, I don't think there's a single city in the world that could handle an outbreak like this any better, To have any hopes of containing it early you need to have so many things go right for you

Most problems are the result of previous solutions...

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tdgeek

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#2416880 12-Feb-2020 20:54

Fred99:

tdgeek:

If you can wait it out, then the 98% survivors, are free of it, and have immunity.

Just commenting on that as it's an assumption that may not turn out to be true as time goes on.

For example a sample IIRC of 90 or so health workers known to have been infected with SARS in China, then tested for presence of antibodies only a year or so later, 10% tested negative. I think that's fairly well accepted - immunity from SARS didn't last long - maybe a few years. This is probably the same for Covid-19. This must be causing concern WRT to difficulty in developing an effective vaccine. It's also critical that the host species as well as any intermediate host are identified, to prevent fresh outbreaks.

Yes, its an assumption, just based on various articles Ive read of SARS. From what Ive picked up, and please correct me if Im wrong, is that colds, common flu, are all mild variants of corona viruses. Stemming from past outbreaks, mutations, etc. Colds and flu we just suck it up, as there is no cure, but vaccines and immunity are a help, and I assume might cause a Covid-19 infection to be one magnitude less for a sufferer. In NZ we may fare better due to flu jabs, immunity, than China and other less developed nations?

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#2416894 12-Feb-2020 21:10

Fred99:

tdgeek:

Genuine question. Are China's efforts to quarantine bad? Are they withholding the makeup of the virus. What I have read is that they have distributed that everywhere. Im not sure what would happen if Auckland had the outbreak, or New York, or LA.

I don't know. I was reasonably confident that China's response was kind of okay a few days ago, as every day goes on, less is adding up in their reporting of cases and their response. It alarms me that they'd reject outside expertise. Some of the "rumours" about inaccurate reporting seem to be being validated by reliable sources.

"Less is adding up" is an understatement. Ask a statistician how likely it is that with a fatality rate of 2% (which is the minimum), there are multiple reports of ZERO - 2 deaths in provinces with 900-1,200 cases reported. I mean there's a fatality in Hong Kong... with only 17 cases :/

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#2416908 12-Feb-2020 21:31

Fred99:

tdgeek:

Genuine question. Are China's efforts to quarantine bad? Are they withholding the makeup of the virus. What I have read is that they have distributed that everywhere. Im not sure what would happen if Auckland had the outbreak, or New York, or LA.

I don't know. I was reasonably confident that China's response was kind of okay a few days ago, as every day goes on, less is adding up in their reporting of cases and their response. It alarms me that they'd reject outside expertise. Some of the "rumours" about inaccurate reporting seem to be being validated by reliable sources. Nobody seems to know - and the people outside China who should know have wildly divergent opinions - yet if China had been more up front and open from the start, my feeling is that (for better or worse) we'd all know a lot more.

Edit: OTOH, if they've got a couple of hundred thousand people on a list based on contact tracing, self isolating at home (thus possibly infecting an entire household), and haven't got the ability to test (even if they could give them all an rRT-PCR - which they can't - anyway the results aren't accurate enough), then it's out of control (even if containment measures are reducing the rate at which it spreads). I think the horse has bolted in China - the Chinese government knows it, and the chance of it not getting established here eventually is very slim.

Re second paragraph, Im not sure what to suggest as if they have so many self isolating, I dont see how its possible to visit and test them all. Theoretically if everyone self isolated, then local contact tracing would be covered. And with Wuhan itself having an 11 million population, I cant see how they or anyone could do any more than self isolation. The longer the Govt can support that, if thats possible logistically, that seems the only way out.

As to here, in NZ, thats up to our government, and AFAIK its still just a casual voluntary thing. VERY early on here, the government policy was, its not here so phase 1 is to keep it out. We haven't done anything to keep it out.

Fred99

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#2416910 12-Feb-2020 21:35

tdgeek:

Yes, its an assumption, just based on various articles Ive read of SARS. From what Ive picked up, and please correct me if Im wrong, is that colds, common flu, are all mild variants of corona viruses. Stemming from past outbreaks, mutations, etc. Colds and flu we just suck it up, as there is no cure, but vaccines and immunity are a help, and I assume might cause a Covid-19 infection to be one magnitude less for a sufferer. In NZ we may fare better due to flu jabs, immunity, than China and other less developed nations?

No, flu is a completely type of virus, different RNA structure (single strand RNA, but segmented negative sense) - the segmented structure means segments from two strains infecting the same cells can recombine to form new variants which adds an extra can or worms in terms of making effective vaccines and is a particular threat in terms of a new lethal strain developing from what's already an endemic infection in humans. The virus causing Covid-19 is also single strand, but not segmented and positive sense, so not related (ie flu didn't descend from coronavirus or vice versa).

So a flu jab or past flu infection won't give any immunity from Covid-19 (but get a shot anyway!).

You know it's possible that having had a cold might give some cross-immunity from Covid-19, but only two of the known virus species causing colds are closely related coronaviruses, and they account for only ~15% of cases of the common cold. But that's maybe not encouraging even if true - how long have we been waiting for a cure or vaccine for the common cold?

It's too early to say whether anywhere will fare better than China - lower smoking rates and access to a good health system will surely help. Really - nobody knows partly because the data from China is incomplete - the total number of cases is unknown, and there's now acceptance that the disease progression sometimes could take much longer from time it was contracted until severe symptoms develop than was thought a few days ago.

There was a very brave woman from Wuhan who got up and spoke and asked some questions at the lecture in Wellington.

I am not an expert in virology/epidemiology/infectious disease. I just get a bit OCD about some things - including this (epidemic) which has fascinated me for a long time.

tdgeek

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#2416913 12-Feb-2020 21:44

Thanks for that. One thing Im finding tough is I read stuff that seems up to speed, example colds and common flu are all mild variants of corona viruses from the past, only to find later its not that accurate. Im sure many lay people who just read media find it even worse. You know what people are like, read something that sounds not too bad, and latch onto that "fact"

Cheers.

Fred99

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#2416916 12-Feb-2020 21:46

tdgeek:

Re second paragraph, Im not sure what to suggest as if they have so many self isolating, I dont see how its possible to visit and test them all. Theoretically if everyone self isolated, then local contact tracing would be covered. And with Wuhan itself having an 11 million population, I cant see how they or anyone could do any more than self isolation. The longer the Govt can support that, if thats possible logistically, that seems the only way out.

As to here, in NZ, thats up to our government, and AFAIK its still just a casual voluntary thing. VERY early on here, the government policy was, its not here so phase 1 is to keep it out. We haven't done anything to keep it out.

If I heard the woman from Wuhan speaking at the lecture in Wellington correctly, she'd been informed by her parents (still there) that they'd changed approach re self isolating, as they'd found that if they sent a "suspected" case home and they turned out to be infected, then the entire household got infected - so they're isolating them together in bulk rather than sending them home. I have some thoughts about that too - I'd personally be considering trying for the "great escape" or avoiding turning up for testing if a bit unwell - rather than be forcefully confined somewhere with probably many infectious people with a potentially fatal disease.

That was just one more bit of anecdotal evidence (she was very believable) to convince me that in Wuhan/Hubei, it's now completely out of control and unstoppable.

Fred99

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#2416929 12-Feb-2020 22:06

tdgeek:

Thanks for that. One thing Im finding tough is I read stuff that seems up to speed, example colds and common flu are all mild variants of corona viruses from the past, only to find later its not that accurate. Im sure many lay people who just read media find it even worse. You know what people are like, read something that sounds not too bad, and latch onto that "fact"

Cheers.

I think they've analysed progressive mutations in the RNA of SARS, MERS, and the Covid-2019 virus (nCoV-2019) and estimated that they evolved from a common ancestor a few hundred years ago.

Flu is different, rather than occasional cross-species jumping, it's constantly jumping between birds, pigs, and humans, and between those of the same species - mutating and recombining the RNA from different strains. The big mystery is why we haven't had a repeat of the 1918-20 pandemic.

It's kind of interesting IMO to compare humans with expected rights to travel etc, vs disease epidemics in livestock and how careful they are. My son went to do some electrical work in a large pig farm the other day - was turned back at the gate because he disclosed when asked that we've got chickens at home. I don't know what the quarantine period is, but if you've got chickens at home, then you can't walk into a piggery - or at least than one.

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#2416931 12-Feb-2020 22:07

Also watched the Otago Lecture. Thanks for the link :)

Found it worthwhile. Some analysis tabled showed that the quarantine action has had an impact, and that (outside the quarantined area) that there was a slow down in cases. Obviously the quarantine only assists those outside, not those inside the infected zone.

Analysis of the cases outside china was also interesting. Conclusion was that mortality rate is likely well below the 2% widely published, but that the demand on Incentive Care Units is extremely heavy. In NZ we have only limited ICU capacity for surges.

NZ's pandemic plan (keep it out; stamp it out; manage it; manage it (post-peak); and recover from it) was mentioned. Was noted that we could be doing more to keep it out, including travel restrictions from countries with more than 5 confirmed cases. I don't see this as being diplomatically plausible at this stage.

The experts expect a way more serious pandemic (than COVID-19) to come in the future, perhaps linked to synthetic biochemistry, and said we should take the opportunity to test out systems by taking this as seriously as possible.

Seasonality of flu will currently working to the southern hemispheres favor, but could work against us it it enters NZ as we are going into winter.

Was a lot of content on PPE from healthcare workers.

Distressed female from Wuhan in the audience and she shared lots of info from family members. Advice was not to trust the numbers from china. Apparently one hospital with around 600 suspected cases had zero test kits, CT scans showing lungs all white, but deaths not logged against COVID-19 as not proven by test... Cases of infection traveling vertically in apartment buildings, Major PPE shortages, Doctors asking for swimming googles to be donated etc.

Was another question from a primary health care worker. Apparently reqests by primary health care operations (think GP's) to have access to the relevant DHB's PPE stockpile have been declined. Concern as the infected will likely present to local GP with cold symptoms, rather than going straight to hospital.

Rikkitic:

If we survive this, I can just imagine all the disaster films about cruise ships from hell sailing in circles while people sicken and run out of supplies and every country they try to dock at sending out warships to drive them away. Will anyone ever book a cruise again?

I assume you are referring to the MS Westerdam.

No suspected cases on board

Japan was it's intended final destination, however they refused it entry. Now Japan, Taiwan, The Philippines, Guam, and Thailand have also refused requests to dock. Currently moored in the gulf of Thailand, trying to work out what to do. Has become a hot potato. I assume Japan didn't want to carry the risk of another infected ship tieing up

Apparently there are concerns about running out of food and other supplies, but I think these are unfounded. I would assume that pritty much any country would allow a fuel and or supply barge to restock the ship at sea.

Of course the passengers will soon get sick of the situation, but having full entertainment & mobility within the ship must be way better that the situation on the diamond princess with people locked down to cabins, and the number of infected climbing by the day.

As you say, this will be a massive blow for the cruise industry.

Fred99

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#2416939 12-Feb-2020 22:32

Scott3:

Was a lot of content on PPE from healthcare workers.

I gather the woman from UNSW was a public health expert - not a virologist/epidemiologist etc. She was very good on that (PPE etc), but not so much on other questions, not able to answer relatively well known things from a Lancet study that she'd posted powerpoint slides from - it seemed as if she hadn't read it.

I got distracted from watching part of it. My sister and husband were messaging me from the US, I didn't know they were there, he's a physics professor and gets around a bit. She was freaking as flew in to LAX and every single worker there had PPE, most of the passengers on the other planes arriving and in the airport had masks - except none of the passengers from Akl did. She'd panicked and tried to buy masks when she got to Pasadena - all sold out. Meanwhile I'm watching an expert tell me that for that intended public use as some are using them overseas, they're probably a waste of time.

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#2416941 12-Feb-2020 22:38

Fred99:

I gather the woman from UNSW was a public health expert - not a virologist/epidemiologist etc. She was very good on that (PPE etc), but not so much on other questions, not able to answer relatively well known things from a Lancet study that she'd posted powerpoint slides from - it seemed as if she hadn't read it.

Biosecurity. Before I looked it up I was surprised that Synthetic Biotech was mentioned - seems a bit niche...

Speakers

Chair: Professor Michael Baker, Director, Health Environment Infection Research Unit, Department of Public Health, University of Otago, Wellington

Michael Baker is a public health physician and infectious disease epidemiologist who is actively involved in tracking emerging infectious diseases and advising on the response.

Professor Raina MacIntyre, Head of the Biosecurity Research Program, Kirby Institute, University of NSW, Sydney

Raina MacIntyre is one of the world’s leading researchers on biosecurity and the public health response to biosecurity threats.

Professor Nick Wilson, Director of BODE3, Department of Public Health, University of Otago, Wellington

Nick Wilson is a public health physician and epidemiologist who is an active researcher on the population impact of pandemic diseases.

Fred99

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#2416943 12-Feb-2020 22:54

Darn it - I missed the part I'd have been most interested in.

Beccara

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#2416944 12-Feb-2020 22:54

Synthetic BioChem is an interesting one along with the DIY BioHacker space. I think a lot of people would be shocked how easy DNA manipulation is today, We're in an age where anyone could write a DNA sequence and have it made for them. Yes we're talking under 10k basepairs but still thats right today over the net

Fred99

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#2416952 12-Feb-2020 23:04

Beccara:

Synthetic BioChem is an interesting one along with the DIY BioHacker space. I think a lot of people would be shocked how easy DNA manipulation is today, We're in an age where anyone could write a DNA sequence and have it made for them. Yes we're talking under 10k basepairs but still thats right today over the net

Yep. I gather relevance to nCoV-2019 is the possibility to write RNA sequence to shortcut vaccine development - ie modify/create something already known to be "safe" in another producible vaccine with snippets of RNA sequences from nCoV-2019 to trigger antigen production in the body.

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