2019 Novel Coronavirus Covid-19 Discussion

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#2417279 13-Feb-2020 12:29

Fred99:

There is a reported case from China of a Chinese tourist who visited Bali on Jan 22, then returned to Shanghai on the 28th, then began showing symptoms 8 days after returning to China. (Jakarta Post article).

He had flown from Wuhan - so probably already had the infection before he travelled.

If the article is correct (big ?) then he wasn't diagnosed in Shanghai but in Huainan, he probably wasn't able to return to Hubei/Wuhan. With incubation period of 2-10 days or 2-14 days (WHO and US CDC) or possibly 2-24 days (preview paper from China awaiting peer review), then that gives an idea of how complex contact tracing etc for just one confirmed case can be, and once there are many confirmed cases and growing, then the task becomes effectively impossible.

I met 10 people who met 10 people who met 10 people and so on.

People are wearing masks so they don't catch it, perhaps the tactic is to treat every person as a carrier, so that the mask and other hygiene practices in China are there to keep a potential infection within that person. Not to allow cinemas to open etc obviously, but to enforce everyone to wear a mask for protection outwards and inwards. Break the cycle. Possibly gloves as well, and no face touching. Are disinfectants any use? If a person had it, and got a little sick, then recovered, all at home, are they still a carrier?

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Fred99

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#2417281 13-Feb-2020 12:30

kobiak:

There should be official statement and if leave needs to be taken - this should become sick leave.

14 day quarantine period and 5 day statutory sick leave entitlement, but a high proportion of the NZ workforce "casualised", then there's an obvious problem.

Beccara

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#2417292 13-Feb-2020 12:44

Yeah doing that and you'll spike unemployment, You'd be getting people on casual contracts effectively fired for daring to take a holiday.

In other news WHO's daily shows only 42 new cases with 40 of them happening on cruise ships and 2 more in Germany and starting to get some numbers on asymptomatic numbers:

Most problems are the result of previous solutions...

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kobiak

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#2417299 13-Feb-2020 12:51

Fred99:

kobiak:

There should be official statement and if leave needs to be taken - this should become sick leave.

14 day quarantine period and 5 day statutory sick leave entitlement, but a high proportion of the NZ workforce "casualised", then there's an obvious problem.

I could not care less for the short term high unemployment (government needs to step up and support) vs pandemic in the small community like AKL/NZ... what will cause major problems long term?

and I mentioned, this should apply for these who recently got or on the arrival from overseas with a high chance of been contaminated

But that's me, panic maniac :)

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Beccara

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#2417304 13-Feb-2020 12:57

Yeah that is a panic response, You'd be doing more damage than the virus. Current global measures are working and there's still more options left before "quarantine everyone coming off the plane"

Fred99

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#2417318 13-Feb-2020 13:25

The official death toll from Hubei region increased by 243 yesterday - and diagnosed cases increased by over 13,000 to over 48,000 for that region alone.

I can't find the China total except on BNO which reports only 377 new confirmed cases and 3 deaths.

The method of diagnosis / confirming cases seems to have changed for Hubei. That could actually also apply for the death total - seems they've included "clinical diagnosis" to "confirmed by rRT-PCR" there, so presumably a death from pneumonia but not yet (or maybe not ever) confirmed by the RNA test may explain the sudden large increase.

With the deepening of understanding of new coronavirus pneumonia and the accumulation of experience in diagnosis and treatment, in view of the characteristics of the epidemic in Hubei Province, the General Office of the National Health and Health Commission and the Office of the State Administration of Traditional Chinese Medicine issued the "Diagnosis and Treatment Plan for Pneumonia of New Coronavirus (Version) "adds" clinical diagnosis "to the case diagnosis classification in Hubei Province, so that patients can receive standardized treatment according to confirmed cases as early as possible to further improve the success rate of treatment. According to the plan, Hubei Province has recently conducted investigations on suspected cases and revised the diagnosis results, and newly diagnosed patients were diagnosed according to the new diagnosis classification. In order to be consistent with the classification of case diagnosis issued by other provinces across the country, starting today, Hubei Province will include the number of clinically diagnosed cases into the number of confirmed cases for publication.

Beccara

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#2417319 13-Feb-2020 13:29

WHO SitRep's show Hubei with 33366 confirmed cases total, 11295 suspected and 1068 deaths, China overall has 1114 deaths with 97 new deaths and 2022 new confirmed cases today

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200212-sitrep-23-ncov.pdf?sfvrsn=41e9fb78_2

wellygary

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#2417325 13-Feb-2020 13:34

Beccara:

In other news WHO's daily shows only 42 new cases with 40 of them happening on cruise ships and 2 more in Germany and starting to get some numbers on asymptomatic numbers:

OK is quite clear that the numbers coming out of China are to be read with a pretty big lump of Salt

So today we have an additional 14,840 cases, including 13,332 “clinically diagnosed” cases ...

So under the old reporting that's a growth of 1500, so continuing an overall decline, but its not clear what "clinically diagnosed" cases are ??

Fred99

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#2417328 13-Feb-2020 13:38

Beccara:

WHO SitRep's show Hubei with 33366 confirmed cases total, 11295 suspected and 1068 deaths, China overall has 1114 deaths with 97 new deaths and 2022 new confirmed cases today

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200212-sitrep-23-ncov.pdf?sfvrsn=41e9fb78_2

That's a day out. Total deaths are over 1350, total "confirmed" cases now almost 60,000 in China - but note change to include clinically diagnosed cases - at least in Hubei region - (but probably not - or not yet - for the rest of China?).

I think it's a good move to include clinically diagnosed, there are cases with ie lung opacities and other symptoms highly indicative of Covid-19 who test negative. If it's deep in the lungs, it's hard to get a sample - you probably wouldn't want to routinely do an invasive procedure (bronchoscope etc) because of risk of (secondary) infection.

It does stuff up the figures though for anyone tracking. For the Hubei region, they're including the number "clinically diagnosed" in the totals - so the data is there if you want it. But that does not mean it's right - if they're happy to use clinical diagnosis, there may be a temptation to not bother with rRT-PCR as well - especially if patient management would be the same in any case.

Fred99

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#2417349 13-Feb-2020 13:49

wellygary:

OK is quite clear that the numbers coming out of China are to be read with a pretty big lump of Salt

So today we have an additional 14,840 cases, including 13,332 “clinically diagnosed” cases ...

So under the old reporting that's a growth of 1500, so continuing an overall decline, but its not clear what "clinically diagnosed" cases are ??

There's a note about the title of the report/guideline on the new procedure in the official release from the Hubei region Health Commission statement.

I haven't looked for it, but probably safe to assume that hasn't really changed, so:

There are three clinical criteria and one epidemiological, the patient meets either all 3 clinical criteria, or two clinical criteria and the one epidemiological:

Clinical:

Fever
Radiological (lung opacity by x-ray or ideally chest CT)
Blood (leukopenia etc)

Epidemiological

From Wuhan or had contact with infected person (that's probably changed I guess)

I think it's a good move. If the treatment is going to be the same either way and a patient is sick, then you don't want to wait for a path lab to come up with results - and especially when "false negative" is a significant risk and especially when there's zero risk to the patient from the treatment.

wellygary

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#2417354 13-Feb-2020 13:56

Fred99:

I think it's a good move. If the treatment is going to be the same either way and a patient is sick, then you don't want to wait for a path lab to come up with results - and especially when "false negative" is a significant risk and especially when there's zero risk to the patient from the treatment.

From a treatment standpoint that's totally understandable, but from a reporting POV what's to ensure they keep the regular seasonal flu cases out of the stats??..

mattwnz

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#2417355 13-Feb-2020 13:57

Fred99:

There is a reported case from China of a Chinese tourist who visited Bali on Jan 22, then returned to Shanghai on the 28th, then began showing symptoms 8 days after returning to China. (Jakarta Post article).

He had flown from Wuhan - so probably already had the infection before he travelled.

If the article is correct (big ?) then he wasn't diagnosed in Shanghai but in Huainan, he probably wasn't able to return to Hubei/Wuhan. With incubation period of 2-10 days or 2-14 days (WHO and US CDC) or possibly 2-24 days (preview paper from China awaiting peer review), then that gives an idea of how complex contact tracing etc for just one confirmed case can be, and once there are many confirmed cases and growing, then the task becomes effectively impossible.

This is the problem, and unless there is a total travel ban from people coming in from China, I can't see how it can be contained. I was reading that if it becomes widespread , 60% of the population could end up getting it, and leading to 24 million deaths which is based on a similar percentage to the spanish flu in 1918, where in this case, approx 2% of people who get it die. The demand on the health system will also be huge.

MikeB4

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#2417372 13-Feb-2020 13:58

Statistics on this don't count for me(not sure if that is a pun or not) this this scares the pants off me.

Fred99

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#2417374 13-Feb-2020 13:59

wellygary:

From a treatment standpoint that's totally understandable, but from a reporting POV what's to ensure they keep the regular seasonal flu cases out of the stats??..

Probably only luck - unless they've changed and CT/X-ray has to be included.

Edit: - ...and restrospectively, unlike Covid-19 for now, they could do blood test to determine if they patient has seasonal flu.

tdgeek

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#2417384 13-Feb-2020 14:04

mattwnz:

Fred99:

There is a reported case from China of a Chinese tourist who visited Bali on Jan 22, then returned to Shanghai on the 28th, then began showing symptoms 8 days after returning to China. (Jakarta Post article).

He had flown from Wuhan - so probably already had the infection before he travelled.

If the article is correct (big ?) then he wasn't diagnosed in Shanghai but in Huainan, he probably wasn't able to return to Hubei/Wuhan. With incubation period of 2-10 days or 2-14 days (WHO and US CDC) or possibly 2-24 days (preview paper from China awaiting peer review), then that gives an idea of how complex contact tracing etc for just one confirmed case can be, and once there are many confirmed cases and growing, then the task becomes effectively impossible.

This is the problem, and unless there is a total travel ban from people coming in from China, I can't see how it can be contained. I was reading that if it becomes widespread , 60% of the population could end up getting it, and leading to 24 million deaths which is based on a similar percentage to the spanish flu in 1918, where in this case, approx 2% of people who get it die. The demand on the health system will also be huge.

I agree re the travel ban. The talk is all about China but the expected growth in China isn't affecting anyone else. Unless there is relatively free travel from China to NZ, which there is. Keep It Out here isn't working, as we provide a pathway and we hope.

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