BA cancel all flights to and from China due to Coronavirus [Archive]

OldnGrounded

29th Jan 2020, 14:41

Not true
https://www.hse.gov.uk/research/rrpdf/rr619.pdf
https://hpspubsrepo.blob.core.windows.net/hps-website/nss/1722/documents/1_tbp-lr-rpe-v3.1.pdf
SWINE FLU: Filtering fact from fiction about face masks - Clinova : Clinova (http://clinova.co.uk/swine-flu-filtering-fact-from-fiction-about-face-masks/)

This may be important enough to clarify, at least for some people in some settings.

Surgical masks are reasonably good protection against droplets (from sneezing, etc.) but they can't protect against airborne virus particles. For one thing, they don't form a seal. They are best used by people who actually have (or might have) transmissible disease, to provide some measure of protection for others.

N95 respirators (the designation indicates that they block at least 95% of 0.3 micron particles) are much more effective than surgical masks in protecting the wearer. However, that's only true when they are properly fitted, which is seldom the case when they are selected and worn by untrained personnel. And if you've ever worn one for very long, you know that they are very uncomfortable.

Most transmission of "airborne" virus disease is actually the result of contact, e.g., touching a contaminated object/person/surface and subsequently touching nose/eyes/mouth.

The lesson from all of this is that, if you are in a situation where the risk of infection is high, you should be masked, gowned, wear goggles, have a properly-fitted respirator and be trained in infection-control practices. Measures less stringent that those might be helpful -- if you're lucky -- but it's foolish to rely upon them if the risk is high.

If you are interested in "official" guidance, the US Centers for Disease Control provide some here:

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource.html

atakacs

29th Jan 2020, 14:45

SWISS (https://www.swiss.com/ch/EN/various/breaking-news) is also stopping flight in/out China

Jackjones1

29th Jan 2020, 15:10

So who will be the lucky airline/charter company to bring the people from Wuhan home to be sent to a quarantine centre ... so this of course would include the crew ...... any volunteers or would they be press ganged?

jafar

29th Jan 2020, 15:16

SWISS is also stopping flight in/out China

Some carriers distribute masks (we know hiw effective these are), some give nothing at all, others simply cancel their flights.
So as a flight or cabin crew, would you go to China if asked by your employer?

airseb

29th Jan 2020, 16:29

The French are flying a military A340 tonight at 23h30.

JanetFlight

29th Jan 2020, 17:01

WonderBus

29th Jan 2020, 17:47

IMHO and i must assume that i can be totally wrong, but maybe not only health issues for this BA cutting-route decision, but as well its a route that could be losing money and no profit at all for the incoming times...my humble 2 cents...

2 aircraft turned round mid flight, going to PKX and PVG, based of govt. advice. The other aircraft going to PKX continued, but returned to LHR with only crew onboard. Both profitable routes for the airline. Fairly hefty revenue loss with the refunds offered.

wiggy

29th Jan 2020, 18:20

2 aircraft turned round mid flight, going to PKX and PVG, based of govt. advice. The other aircraft going to PKX continued, but returned to LHR with only crew onboard. Both profitable routes for the airline. Fairly hefty revenue loss with the refunds offered..

I thought the plan last night was for a PKX and the PVG to continue and then return with the outbound crew and any crew who were on slip? Did that change?

I’m not sure why there are comments about BA crew, quarantine and pay, unless it’s just speculation about what might have happened if BA hadn’t pulled the routes.

22/04

29th Jan 2020, 18:39

Nothing said about Virgin- today at least they continue and VS250 is en-route as I write. Website offers options on changing flights for those booked but doesn’t mention cancelled flights

gpsavd

29th Jan 2020, 20:50

Seems that Lufthansa Group is stopping flights, too.

All Lufthansa, Swiss, Austrian flights to mainland China canceled until Feb 9 at this time, the website says:
www.lufthansa.com/de/de/fluginformationen

Rated De

29th Jan 2020, 21:16

And in news just to hand, Australian education Minister Tehan yesterday claimed person to person transmission was not possible.

Oxymoron? An education minister with no knowledge?

Australia's Qantas have not had time to use the latest crisis to berate staff so they will continue flying until their first crew are in ICU.
A spokesperson of unknown gender pronoun, claimed it was simply a cost of doing business.

JanetFlight

29th Jan 2020, 21:34

Portuguese ACMI HIFLY tomorrow will operate the EU flight bringing some European citizens from Wuhan... Will do stops at Paris and Vietnam... Not sure by now if will use 330, 340 or 380...
https://observador.pt/2020/01/29/coronavirus-primeiro-aviao-fretado-parte-de-beja-para-repatriar-europeus-incluindo-17-portugueses/

Loose rivets

29th Jan 2020, 22:34

OldnGrounded #22 Spot on. Can't say much more.

Most folk know a virus is very small. It used to be called 'Non filterable'. This came from finding unglazed porcelain could filter bacteria, but let the virus pass.

"Most viral infection is via contagious transmission." Odd statement, but in a publication c 20 years ago. But it's the airborne droplets that get you.

Eyes are an open door for virus laden droplets. Tears have an antibiotic on one or more of their seven layers, but no use at all for the virus which will spread over the eye in seconds.

Some people create a storm of droplets when speaking - easily visible in front of a daytime window. Doctor's waiting rooms are often filled with people that think putting a fist in front of their silly faces will protect the world. We could empty a zillion hospital beds if only people would carry a mini-towel and blast into that. It could become de rigueur. In the meantime, masks will protect (some) others.

rudolf

29th Jan 2020, 22:50

This may be important enough to clarify, at least for some people in some settings.

Surgical masks are reasonably good protection against droplets (from sneezing, etc.) but they can't protect against airborne virus particles. For one thing, they don't form a seal. They are best used by people who actually have (or might have) transmissible disease, to provide some measure of protection for others.

N95 respirators (the designation indicates that they block at least 95% of 0.3 micron particles) are much more effective than surgical masks in protecting the wearer. However, that's only true when they are properly fitted, which is seldom the case when they are selected and worn by untrained personnel. And if you've ever worn one for very long, you know that they are very uncomfortable.

Most transmission of "airborne" virus disease is actually the result of contact, e.g., touching a contaminated object/person/surface and subsequently touching nose/eyes/mouth.

The lesson from all of this is that, if you are in a situation where the risk of infection is high, you should be masked, gowned, wear goggles, have a properly-fitted respirator and be trained in infection-control practices. Measures less stringent that those might be helpful -- if you're lucky -- but it's foolish to rely upon them if the risk is high.

If you are interested in "official" guidance, the US Centers for Disease Control provide some here:

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource.html

I can confirm that 6 hours at Shanghai airport and the subsequent 4 hours to Hanoi in an N95 mask was chuffing uncomfortable.

Loose rivets

29th Jan 2020, 22:56

And probably didn't help you at all.

The flight deck air system. Just how much air is mixed with the cabin's air?

rudolf

29th Jan 2020, 23:01

And probably didn't help you at all.

The flight deck air system. Just how much air is mixed with the cabin's air?

More than you think as the virus appears to be droplet spread rather than airborne. Other measure like washing hands regularly, keeping a distance from other people, not touching handrails etc and refraining from touching your face probably help more.

rjtjrt

29th Jan 2020, 23:03

This may be important enough to clarify, at least for some people in some settings.

Surgical masks are reasonably good protection against droplets (from sneezing, etc.) but they can't protect against airborne virus particles. For one thing, they don't form a seal. They are best used by people who actually have (or might have) transmissible disease, to provide some measure of protection for others.

N95 respirators (the designation indicates that they block at least 95% of 0.3 micron particles) are much more effective than surgical masks in protecting the wearer. However, that's only true when they are properly fitted, which is seldom the case when they are selected and worn by untrained personnel. And if you've ever worn one for very long, you know that they are very uncomfortable.

Most transmission of "airborne" virus disease is actually the result of contact, e.g., touching a contaminated object/person/surface and subsequently touching nose/eyes/mouth.

The lesson from all of this is that, if you are in a situation where the risk of infection is high, you should be masked, gowned, wear goggles, have a properly-fitted respirator and be trained in infection-control practices. Measures less stringent that those might be helpful -- if you're lucky -- but it's foolish to rely upon them if the risk is high.

If you are interested in "official" guidance, the US Centers for Disease Control provide some here:

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource.html

Very good info. However wearing a mask has some real value, as it makes it less easy to touch mouth/nose, and if a visor mask, eyes.

fdr

29th Jan 2020, 23:17

And probably didn't help you at all.

An N95 with proper use, with eye protection, and with proper hand de-sanitising, and sterile technique helps the wearer reduce likilhood of contracting the virus. The transfer from surface to hand to face is the most problematic action to intervene with, and to that extent, even a surgical mask acts at least as a reminder to be very careful where you put your hands. Being isolated from potential carriers and limiting contact to surfaces is the most effective manner to avoid transmission.

We have entered a new period of awareness, and the Malindo crews (2 B737s) now having holidays in isolation in China as one pax in each return to PRC had a temperature is the new near term norm. Of course, the passengers are also in isolation, so when you next board an A380, even though symptoms apparently (to be confirmed) post date being contagious, any one of your compatriots may result in you needing lots of good Michener books to read for a while. And that is a good outcome, worse is you may become a statistic thereafter. Not being alarmist, until the airlines have appropriate protocols in place, any travel has the potential to go pear shaped. On your A380 with 549 other SLF, what is the likelihood of someone having a temp on arrival post a 14 hr flight? Suspect it isn't zero.

Current case growth is still sitting around 48% per day, and the reported fatality rate appears low on first look, however, that is when comparing current confirmed cases against fatalities. Compared to previous virus pandemics, that appears quite low, but that is also an aberration from the immediate viewpoint. Past outbreaks are effectively concluded, and total fatalities are compared with total confirmed cases. At present, the figures being considered are of todays confirmed cases, not those of a week ago, so there is around a 4 times higher true fatality rate underlying the problem at this time. That is close to the SARS mortality rate. Approximately 1 in 5 confirmed cases ends up with ICU requirements, and somewhere just under 50% of those cases ends badly at present. These are sobering values, and suggest that taking care in travel is important, care in personal hygiene is necessary, and those that have potentially compromised lung function or immunity need to be very careful.

(stats for the above can be found on the JHU website)

568

29th Jan 2020, 23:37

OldnGrounded

29th Jan 2020, 23:52

Very good info. However wearing a mask has some real value, as it makes it less easy to touch mouth/nose, and if a visor mask, eyes.

Yes, quite right. At least it serves as a reminder, as someone just said here.

OldnGrounded

29th Jan 2020, 23:58

I can confirm that 6 hours at Shanghai airport and the subsequent 4 hours to Hanoi in an N95 mask was chuffing uncomfortable.

Oh, yeah, that was clearly not a fun ten hours. I've never had to wear one for that long and I hope I never need to.

rudolf

30th Jan 2020, 00:12

Oh, yeah, that was clearly not a fun ten hours. I've never had to wear one for that long and I hope I never need to.

I brought replacement filters and intend to wear the mask along with my specs whenever I’m transiting through airports etc. Vietnam has escaped apart from a few isolated cases and Singapore should be low risk now that the travel restrictions are in place.

krismiler

30th Jan 2020, 01:50

Many pax in Changi transit area masked up already, including Qantas cabin crew though not the pilots. In Asia due to air pollution and cultural norms when sick, the wearing of masks in public isn’t unusual at all and it was quite normal to see people walking around wearing them before this crisis hit.

I tried one yesterday for the first time, hot and uncomfortable they also makes your glasses steam up.

jolihokistix

30th Jan 2020, 01:54

https://www.biorxiv.org/content/10.1101/2020.01.26.919985v1.full

Cold Spring Harbor Laboratory. Latest research paper quote:
We further compared the characteristics of the donors and their ACE2 expressing patterns. No association was detected between the ACE2-expressing cell number and the age or smoking status of donors. Of note, the 2 male donors have a higher ACE2-expressing cell ratio than all other 6 female donors (1.66% vs. 0.41% of all cells, P value=0.07, Mann Whitney Test). In addition, the distribution of ACE2 is also more widespread in male donors than females: at least 5 different types of cells in male lung express this receptor, while only 2~4 types of cells in female lung express the receptor. This result is highly consistent with the epidemic investigation showing that most of the confirmed 2019-nCov infected patients were men (30 vs. 11, by Jan 2, 2020).

We also noticed that the only Asian donor (male) has a much higher ACE2-expressing cell ratio than white and African American donors (2.50% vs. 0.47% of all cells). This might explain the observation that the new Coronavirus pandemic and previous SARS-Cov pandemic are concentrated in the Asian area.

fdr

30th Jan 2020, 02:18

As at JAN 29 9PM EST, JHU has indicated:

1. global confirmed cases at 7783, fatalities at 170.
2. All fatalities to date are in China.
3. About 7 days ago, total confirmed cases were roughly 1000.

Not surprising that the Chinese are building dedicated hospitals at record speeds. There is a strong suggestion that the care is a major factor in the outcome. How long does it take to train ICU staff?

https://www.biorxiv.org/content/10.1....919985v1.full (https://www.biorxiv.org/content/10.1101/2020.01.26.919985v1.full)

Cold Spring Harbor Laboratory. Latest research paper quote:
We further compared the characteristics of the donors and their ACE2 expressing patterns. No association was detected between the ACE2-expressing cell number and the age or smoking status of donors. Of note, the 2 male donors have a higher ACE2-expressing cell ratio than all other 6 female donors (1.66% vs. 0.41% of all cells, P value=0.07, Mann Whitney Test). In addition, the distribution of ACE2 is also more widespread in male donors than females: at least 5 different types of cells in male lung express this receptor, while only 2~4 types of cells in female lung express the receptor. This result is highly consistent with the epidemic investigation showing that most of the confirmed 2019-nCov infected patients were men (30 vs. 11, by Jan 2, 2020).

We also noticed that the only Asian donor (male) has a much higher ACE2-expressing cell ratio than white and African American donors (2.50% vs. 0.47% of all cells). This might explain the observation that the new Coronavirus pandemic and previous SARS-Cov pandemic are concentrated in the Asian area.

That is sober reading, and appears in line with the statistical spread to date.

Loose rivets

30th Jan 2020, 02:29

An N95 with proper use, with eye protection,

Sealed eye protection.

and with proper hand de-sanitising,

I've never been too sure about this. Virus laden droplet. I'd imagine the 50 nm entity making its way into the blood stream as one rubbed away.

and sterile technique Time and time again this will save lives, but it takes skilled knowledge and good discipline. Every time I visit a hospital, I seen staff and patients alike making mistake after mistake.

May I ask our posters to look at this site. Kate stares out of that sepia print and tugs at my heartstrings. A very brave young lady - just weeks before my grandfather, who'd survived Flanders, also killed by the flue which opens the throat and lungs to bacteria.

You know the vast numbers in 1918 - 20 If only we'd had the resources we have now. But the issue is, it's not the medicine in the viral stage, but the cunning - and this time around we're seeing plenty of that.

What I don't know is the deaths caused by the ensuing secondary infections. These are usually treatable by antibiotics providing too much damage hasn't been done by the virus. It's not just the sore surfaces letting bugs in, but a modification of the immune system as well. Pneumonia is still a dangerous by-product.

https://heatonhistorygroup.org/2016/10/02/kate-elizabeth-ogg-remembered/

flyerguy

30th Jan 2020, 03:33

BA flights for tomorrow seem to be operating both the Beijing and Shanghai..... at the moment according to BAs ops systems

Diverskii

30th Jan 2020, 07:59

The rest of the cancellations will be going in this morning

Rated De

30th Jan 2020, 08:11

Meanwhile in the antipodes, a connection informs that Australian carrier Qantas last updated crew two days ago.
An email from the "union" supporting the company position says the risk of transmission is low and that it is difficult to spread to person to person...
Thanks to the QF guys sending this...
According to the union..
Today the WHO rolling like swine in excrement will reluctantly likely concede that this meets the criteria for a pandemic.

The virus is not easily transmitted from person to person; unlike SARS.

And meanwhile;

Advice from Flight Operations Management is that pilots should consult their Base Manager if;

they have school age children who would be denied school attendance if they come into contact with persons who have been to China, and/or
they have an underlying medical condition that would be adversely affected by possible exposure.

Your Base Manager will then advise you of your options.

That is some form of representation

scr1

30th Jan 2020, 08:31

Elal is stopping flights till 25 march

https://www.timesofisrael.com/el-al-stops-china-flights-due-to-deadly-virus-outbreak/?utm_source=dlvr.it&utm_medium=twitter

fox niner

30th Jan 2020, 08:44

Everyone is running from/after this virus. The real plague is humanity really.

Diesel_10

30th Jan 2020, 09:14

SYD had the only direct flights into Oz from Wuhan. These are now suspended but on the Arrivals page there are still scheduled flights from Guangzou, Hong Kong, Chengdu and Shanghai.

Surely if they now say there are asymptomatic carriers, shouldn't they be routed through Christmas Island?

Loose rivets

30th Jan 2020, 09:23

When one compares the flu-related death starting at the end of WW1, humanity is doing very well. This is the first 'universal' response since EBOLA. We did well there and are responding well now. It's just the lack of knowledge that's holding people back.

It's been known for decades that viruses enter via the eye and its a short route to the brain-roof of mouth nervous system which is not protected as well as the brain.

The blood-brain barrier (BBB) provides significant protection against microbial invasion of the brain. However, the BBB is not impenetrable, and mechanisms by which viruses breach it are becoming clearer.6 May 2012

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367119/

ACMS

30th Jan 2020, 09:39

Any schools in Australia not allowing kids of crew that have been to HK or China to attend school? Does anyone know?

McDoo

30th Jan 2020, 11:27

I have just disembarked from an internal flight in Thailand. The crew had been ordered to wear surgical masks. Probably 80-90% of the pax were wearing an assortment of masks ranging from basic surgical to almost full on Stormtrooper.

If the cabin had dumped at FL390 and they needed to don the O2, either over the mask or removing it first, how successful.would this have been?

Twitter

30th Jan 2020, 13:54

Well if a couple of hundred pax pose a virus problem - try a cruise ship - 7,000 folks not landing in the old town (for that is what Cittavecchia means) tonight.

Fortunately virus experts from Rome now on board.

Airbubba

30th Jan 2020, 16:53

From the staff clinic today at an airline in Dubai.

https://cimg0.ibsrv.net/gimg/pprune.org-vbulletin/1083x1080/ek_coronavirus_39d44ec52d1a54b703a5d49bc1b8e89459186372.jpg

OldnGrounded

30th Jan 2020, 18:17

From the staff clinic today at an airline in Dubai.

Oh, dear. And, the other day, in Washington State, they transferred their first 2019-ncov patient in an ISOPOD, put him in an isolation ward and sent in a robot to treat him.

https://cimg3.ibsrv.net/gimg/pprune.org-vbulletin/748x369/isopod2_8f1b426857b73c8975171446f4144e721a068bd9.jpg
More than a little bit over the top for an illness that appears, so far, to be serious in relatively few cases and truly dangerous mostly for patients who don't get good supportive care. In any event, the disease appears to have a reproduction number of around three (it's early in the game for analysis) and an average latency period of about nine days. That means it will likely spread fast enough and widely enough that the world won't even come close to having the facilities to provide that level of isolation -- and, if the virus is transmissible before symptoms are evident, there would be no way to even guess which humans to try to isolate.

Loose rivets

30th Jan 2020, 22:48

You land. You go into isolation. You have one positive patient in the group. Now what? A new 14 days? Where would it end?

What kills you?
The second patient, a 69-year-old man, also had acute respiratory distress syndrome.

He was attached to an artificial lung or ECMO (extra-corporeal membrane oxygenation) machine but this wasn't enough.

He died of severe pneumonia and septic shock when his blood pressure collapsed.

Isn't this bacteriological? i.e. a secondary infection. If so, it's a fast transition.

Winemaker

30th Jan 2020, 23:54

From The Economic Times, January 25 (looks like Bloomberg News first):

https://cimg6.ibsrv.net/gimg/pprune.org-vbulletin/630x374/bloom_2_f41a58ecc0f134946d5a03b13ddca0f5f62e00bd.jpg

Airbubba

31st Jan 2020, 00:25

Reuters update:

Pilots, flight attendants demand flights to China stop as virus fear mount worldwideby Reuters
Thursday, 30 January 2020 23:58 GMT(Adds U.S. flight attendant reactions)

By Tracy Rucinski and Laurence Frost

CHICAGO/PARIS Jan 30 (Reuters) - Pilots and flight attendants are demanding airlines stop flights to China as health officials declare a global emergency over the rapidly spreading coronavirus, with American Airlines' pilots filing a lawsuit seeking an immediate halt.

China has reported nearly 10,000 cases and 213 deaths, but the virus has spread to 18 countries often by plane passengers.

The Allied Pilots Association (APA), which represents American Airlines pilots, cited "serious, and in many ways still unknown, health threats posed by the coronavirus" in a lawsuit filed in Texas, where the airline is based.

American said it was taking precautions against the virus but had no immediate comment on the lawsuit. On Wednesday it announced flight cancellations from Los Angeles to Beijing and Shanghai starting next month, but is continuing flights from Dallas.

APA President Eric Ferguson urged pilots assigned to U.S.-China flights to decline the assignment. In a statement, the American Airlines' flight attendants union said they supported the pilots' lawsuit and called on the company and the U.S. government to "err on the side of caution and halt all flights to and from China."

Pilots at United Airlines, the largest U.S. airline to China, concerned for their safety will be allowed to drop their trip without pay, according to a Wednesday memo from their union to members.

United announced on Thursday another 332 U.S.-China flight cancellations between February and March 28, though it will continue operating roundtrip flights from San Francisco to Beijing, Shanghai and Hong Kong.

The American Airlines pilot lawsuit came as an increasing number of airlines stopped their flights to mainland China, including Air France KLM SA, British Airways, Germany's Lufthansa and Virgin Atlantic.

Other major carriers have kept flying to China, but protective masks and shorter layovers designed to reduce exposure have done little to reassure crews.

A U.S. flight attendant who recently landed from one major Chinese city said a big concern is catching the virus and spreading it to families, or getting quarantined while on a layover.

"I didn't understand the gravity of the situation until I went there," she said on condition of anonymity, describing general paranoia on the return flight, with every passenger wearing a mask. "Now I feel like I'm on a 14-day countdown."

Thai Airways is hosing its cabins with disinfectant spray between China flights and allowing crew to wear masks and gloves.

Delta Air Lines is also operating fewer flights and offering food deliveries so crew can stay in their hotels.

Korean Air Lines Co Ltd and Singapore Airlines are sending additional crew to fly each plane straight back, avoiding overnight stays.

The South Korean carrier also said it was loading hazmat suits for flight attendants who might need to take care of suspected coronavirus cases in the air.

Airlines in Asia are seeing a big drop in bookings along with forced cancellations because of the coronavirus outbreak, the head of aircraft lessor Avolon Holdings Ltd said, adding the impact could last for some months.

The outbreak poses the biggest epidemic threat to the airline industry since the 2003 SARS crisis, which led to a 45% plunge in passenger demand in Asia at its peak in April of that year, analysts said.

Air France, which maintained China flights throughout the SARS epidemic, suspended its Beijing and Shanghai flights on Thursday after cabin crews demanded an immediate halt.

"When the staff see that other airlines have stopped flying there, their reaction is 'Why are we still going?'," said Flore Arrighi, president of UNAC, one of the airline's four main flight attendants' unions.

Airbubba

31st Jan 2020, 01:28

U.S. State Department Level 4: Do Not Travel advisory.

https://cimg3.ibsrv.net/gimg/pprune.org-vbulletin/812x654/state_dept__bbe84b439759c3bcb202f2c3cb955d3cb5e00422.jpg

https://t.co/BIIUdavoP0

Airbubba

31st Jan 2020, 01:34

Passenger screening at GMP (Seoul-Gimpo).

https://cimg7.ibsrv.net/gimg/pprune.org-vbulletin/1645x945/epkz6y8waaazzwq_7c4f451c5964881d7f8cc6aaf26521384c92202e.jpg

Airbubba

31st Jan 2020, 02:47

UK evacuation charter flight.

https://cimg2.ibsrv.net/gimg/pprune.org-vbulletin/862x703/uk_evac_a3f3a5a619129d3304fafb0013235577116a9681.jpg

krismiler

31st Jan 2020, 06:35

https://www.youtube.com/watch?v=aQX2dGTA5SE

Rated De

31st Jan 2020, 08:02

Some carriers distribute masks (we know hiw effective these are), some give nothing at all, others simply cancel their flights.
So as a flight or cabin crew, would you go to China if asked by your employer?

Interesting question.
In several European jurisdictions, it is very clear: Management must not knowingly expose crew to hazard.
Airlines would find it very difficult to defend a decision to force a crew member to go if this virus continues to present itself as the real deal.

k.h.p.

31st Jan 2020, 19:47

Very good info. However wearing a mask has some real value, as it makes it less easy to touch mouth/nose, and if a visor mask, eyes.
Health officials in British Columbia, Canada, argued the opposite: as many people are not used to wearing masks, they will frequently adjust/itch/move the mask and increase the likelihood of mouth/nose/eyes and hand contact.

Airbubba

31st Jan 2020, 23:07

Turkish Air Force A400M ready to evacuate citizens from Wuhan.

https://cimg8.ibsrv.net/gimg/pprune.org-vbulletin/900x675/eppf5jjwkac1glo_3db01e527905eb2ba81ce732344fd8123799ac70.jpg

https://cimg5.ibsrv.net/gimg/pprune.org-vbulletin/1024x768/eppszxrxsaejiyd_88252f3ced908007eb6f1d514b7c2eb3aff74bed.jpg

https://www.internethaber.com/turk-vatandaslarini-tahliye-edecek-ucak-cine-ulasti-2079708h.htm

sorvad

1st Feb 2020, 16:54

The R0 and the Case Fatality Rate are completely meaningless at the moment... the R0 because we have absolutely no clue how many have been infected partly because of those with mild illness who haven't presented at Medical care facilities and been tested and also the somewhat doubtful scale of reporting by the Chinese authorities. And the case fatality rate because most are still in the midst of their illness.... look at the statistics ... at the moment out of 11,000 confirmed cases 250ish have died, and 250ish have recovered... this leaves a heck of a
lot of uncertainty about the fate of the others and therefore the validity of
that 2% case fatality rate

sorvad

1st Feb 2020, 17:03

having said that I take a bit of twisted comfort in the fact that in a normal year over 10,000 people per day die of respiratory infectious diseases

OldnGrounded

2nd Feb 2020, 14:01

The speculation, misinformation, scaremongering, etc. surrounding this outbreak are getting seriously out of control, around the world and the Internet, including here on PPRuNe. Everyone should stop spreading unfounded rumors and try to pay attention to the most reliable sources of information, from people who actually have the best-available data and the expertise to evaluate it:

UK Dept. of Health & Social Care Coronavirus Guidance (https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public)

US CDC 2019-nCoV Information (https://www.cdc.gov/coronavirus/2019-ncov/summary.html)

WHO 2019-nCoV Information (https://www.who.int/emergencies/diseases/novel-coronavirus-2019)

OldnGrounded

2nd Feb 2020, 14:05

Paul Joseph Watson is apparently connected to Infowars who said Sandy Hook never happened. Says it all.

Seems to be a certified wacko. His Wikipedia entry (https://en.wikipedia.org/wiki/Paul_Joseph_Watson) begins: "Paul Joseph Watson (born May 24, 1982)[1] (https://en.wikipedia.org/wiki/Paul_Joseph_Watson#cite_note-TDB-1) is an English YouTube personality (https://en.wikipedia.org/wiki/YouTube_personality), radio host, writer and conspiracy theorist (https://en.wikipedia.org/wiki/Conspiracy_theorist)."

Apparently, last spring, he was banned from Facebook and Instagram for "extremism."

JanetFlight

2nd Feb 2020, 14:19

I second OldnGrounded in everything...sometimes Pprune are also suggested even on some aeronautical foruns, meetings, symposiuns, etc, along with avherald, jacdec, etc...tons of normal msm are coming here on a daily basis collecting info about aviation,,,IMHO its not healthy at all if we start falling in the typical conspiracy trends.
Paul Joseph Watson belongs to those illuminated who said Malaysia entered a time portal and its pax are now living along with dinossaurs and mammoths.

OldnGrounded

2nd Feb 2020, 15:52

Of course there are ongoing projects aimed at developing vaccines, and of course they are based upon understanding the genome of the virus. That does not mean that anyone knows the "required makeup" of a vaccine, only that there is data available to point researchers in the right direction.

I don't think my post implied that a vaccine would be ready tomorrow, merely that it is in production, albeit very early stages.

No vaccine is "in production." No vaccine will be "in production" until one is formulated and tested for safety and efficacy, first in cell culture, then in animals and finally in humans.

This article provides solid and sensible information on the issue and is easy to understand:

How Long Will it Take to Develop a Vaccine for Coronavirus? (https://www.healthline.com/health-news/how-long-will-it-take-to-develop-vaccine-for-coronavirus#Faster-vaccine-development)

Note that one company asserts that it will have a vaccine ready for testing in humans within a month. That's a pretty bold claim (you can be pretty certain that it is aimed at investors at least as much as any other audience) and, even if it turns out to be accurate, the testing referred to is a phase one trial. Here (https://www.nih.gov/health-information/nih-clinical-research-trials-you/basics), from the US National Institutes of Health, is a quick overview of the phases of clinical trials:

Clinical trials are conducted in a series of steps called “phases.” Each phase has a different purpose and helps researchers answer different questions.

Phase I trials: Researchers test a drug or treatment in a small group of people (20–80) for the first time. The purpose is to study the drug or treatment to learn about safety and identify side effects.
Phase II trials: The new drug or treatment is given to a larger group of people (100–300) to determine its effectiveness and to further study its safety.
Phase III trials: The new drug or treatment is given to large groups of people (1,000–3,000) to confirm its effectiveness, monitor side effects, compare it with standard or similar treatments, and collect information that will allow the new drug or treatment to be used safely.
Phase IV trials: After a drug is approved by the FDA and made available to the public, researchers track its safety in the general population, seeking more information about a drug or treatment’s benefits, and optimal use.

Edit: A study from Germany that's just making the rounds appears to contradict the WHO observation, from yesterday, that transmission from asymptomatic carriers may be rare.

Letter to the New England Journal:Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany (https://www.nejm.org/doi/full/10.1056/NEJMc2001468?query=featured_home)CNN story with comments by Anthony Fauci (who is definitely the real deal in epidemiology):'There's no doubt': Top US infectious disease doctor says Wuhan coronavirus can spread even when people have no symptoms (https://www.cnn.com/2020/01/31/health/coronavirus-asymptomatic-spread-study/index.html)

SMT Member

3rd Feb 2020, 05:55

If it does indeed spread without the carrier exhibiting any symptoms, why on earth are these evacuation flights taking place? Surely containment is the best defence against further spreading of a virus, yet .gov's around the world are organising evacuation flights. Baffling.

Ron Swanson

3rd Feb 2020, 07:32

marchino61

3rd Feb 2020, 07:52

OldnGrounded

3rd Feb 2020, 15:00

Given the font size you have used on your link I would say this is serious! Cant believe I survived SARS and MARS and swine flue and ebola and BSE just to be killed by the shear size of your font!

That's what happens (often) when text is pasted into vBulletin from other HTML sources, in this case from the source news stories. If you explore the user interface, you will see (actually, you will learn) that font size control is somewhere between very difficult and impossible.

Hope this helps.

OldnGrounded

3rd Feb 2020, 15:08

Originally Posted by SMT Member View Post (https://www.pprune.org/rumours-news/629265-ba-cancel-all-flights-china-due-coronavirus-4.html#post10678188)
If it does indeed spread without the carrier exhibiting any symptoms, why on earth are these evacuation flights taking place? Surely containment is the best defence against further spreading of a virus, yet .gov's around the world are organising evacuation flights. Baffling.

That's why the evacuees are being put in quarantine, I believe.

Well, some evacuees, at some destinations. Per AFP, France flew in a couple of hundred folks from Wuhan, quarantined the 20 showing symptoms of (some) illness upon arrival and told the rest to go home.

Given the number of carriers who have been moving with relative freedom all around the world since the initial outbreak, and the likelihood that each has passed the virus to two or three others (each of whom subsequently . . .), it's probably not possible to effectively prevent widespread epidemics, even a pandemic, with quarantine and isolation measures. The world just doesn't have sufficient facilities or resources.

Fortunately, so far, it appears that the disease in severe in only a minority of patients and the case fatality rate is fairly low, so we may well escape a real catastrophe.

ORAC

3rd Feb 2020, 15:59

OldnGrounded, we don’t know the severity of the virus yet, there is no in depth analysis. But I offer you this from the last update European Centre for Disease Prevention and Control, page 3 of the pdf document. Accepting we don’t know what percentage of cases become severe enough to even be hospitalised.

https://www.ecdc.europa.eu/en/publications-data/risk-assessment-outbreak-acute-respiratory-syndrome-associated-novel-1

“Estimates of severity and case fatality rate should be interpreted with caution at this stage. In a published case series of the first 99 hospitalised cases, 17 (17%) patients developed acute respiratory distress syndrome and, 11 (11%) patients died of multiple organ failure, while the majority of the cases remain hospitalised and final outcomes are as yet unknown [10].”

OldnGrounded

3rd Feb 2020, 17:14

OldnGrounded, we don’t know the severity of the virus yet, there is no in depth analysis. But I offer you this from the last update European Centre for Disease Prevention and Control, page 3 of the pdf document. Accepting
https://www.ecdc.europa.eu/en/publications-data/risk-assessment-outbreak-acute-respiratory-syndrome-associated-novel-1

“Estimates of severity and case fatality rate should be interpreted with caution at this stage. In a published case series of the first 99 hospitalised cases, 17 (17%) patients developed acute respiratory distress syndrome and, 11 (11%) patients died of multiple organ failure, while the majority of the cases remain hospitalised and final outcomes are as yet unknown [10].”

I don't think we can extrapolate much useful information from that data, precisely because, as you say, "we don’t know what percentage of cases become severe enough to even be hospitalised." Based upon all we do know, a reasonable guess would be that there are likely a very large number of cases that never require hospitalization and perhaps an even larger number that are never seen by healthcare providers, which would mean that the cited numbers are substantially higher than those for the disease overall.

Given the speed at which the disease is spreading, we'll probably have a lot more information soon.

For those wanting to keep up on the raw statistics, the Worldometers" site is pretty reliable: https://www.worldometers.info/coronavirus/

ORAC

4th Feb 2020, 13:16

https://www.bbc.co.uk/news/uk-51374056Coronavirus: UK tells all Britons to leave China 'if they can'

EDLB

4th Feb 2020, 19:29

, it's probably not possible to effectively prevent widespread epidemics, even a pandemic, with quarantine and isolation measures. The world just doesn't have sufficient facilities or resources.

Fortunately, so far, it appears that the disease in severe in only a minority of patients and the case fatality rate is fairly low, so we may well escape a real catastrophe.

Currently we (ROW) are about 8-12 weeks behind mainland China. When it is all said and done we likely will have a single digit CFR may be even a bit more. In Germany we have about 30 ICU beds/100k. In the Netherlands or UK about 6-7/100k. That makes only a difference of 2-5 days until you run out of capacity. I hope that we get a vaccine a.s.a.p. That is the only realistic way to stop a 1918/19 rerun.

Twitter

4th Feb 2020, 20:43

OldnGrounded

5th Feb 2020, 01:54

Currently we (ROW) are about 8-12 weeks behind mainland China. When it is all said and done we likely will have a single digit CFR may be even a bit more. In Germany we have about 30 ICU beds/100k. In the Netherlands or UK about 6-7/100k. That makes only a difference of 2-5 days until you run out of capacity. I hope that we get a vaccine a.s.a.p. That is the only realistic way to stop a 1918/19 rerun.

There's no realistic chance of having a vaccine available in time to deal with an outbreak spreading now. If the new development techniques (e.g., using the virus genome to sequence messenger RNA to trigger a "practice" immune response that would later be triggered by the actual virus) work faster than ever before, it would still be at least 30-60 days before vaccine candidates could be ready for the first human tests. Those tests have to proceed in stages and would necessarily take several months. Don't expect anything faster.

If any nation or region experiences numbers of serious cases in the range they've been seeing in Wuhan, treatment facilities and medical staffs will be overwhelmed. The ten-day, 1K-bed hospital in Wuhan isn't close to adequate and today's news photos show workers turning sports stadiums, exhibition halls, etc, into temporary hospitals: https://www.businessinsider.com/wuhan-sports-stadiums-makeshift-coronavirus-hospitals-2020-2. Nowhere are there adequate existing resources to avoid having to do similar things, if that many cases arise.

In the West, our best hope is that, having started surveillance, testing, quarantines, isolation, preventive measures, etc. much earlier than in China, and benefiting from travel restrictions, infection won't spread as rapidly and widely as it did there. The very earliest indicators are somewhat encouraging -- although they are very, very early. At least in our larger urban centers, we also have somewhat better supportive care available for patients who become seriously ill, as long as the volume of cases isn't overwhelming.

OldnGrounded

5th Feb 2020, 02:02

So maybe many more isolation wards should be prepared while there is time - rather safe than sorry...

It would be a good idea to try to prepare, but it should be recognized that turning any random spaces -- including in existing medical facilities -- into effective isolation wards is far from a trivial task. And even if you have the physical plant, you still need trained personnel to care for the patients and for the facilities. If an effort like this is contemplated, the responsible parties should be in high gear already and be provided with plenty of resources.

ATC Watcher

5th Feb 2020, 06:32

Back to the original question : airlines cancelling flights to China : until now most European majors cancelled their flights until Febr 9th , but just learnt that, following El Al more airlines are now considering extending their flights cancellations to China until the end of March . An AF spokesperson said it was not only because of spreading the virus but also by lack of demand. While for those 2 airlines China traffic is relatively marginal , there are some others airlines that this loss of traffic/revenue will hit much harder financially

rog747

5th Feb 2020, 07:27

I have Virgin VS LHR-HKG Mar 4th booked and they will let me cancel with full refund - VS are offering this to all HKG pax until about the end of March, Their China flights are actually all suspended.
But Cathay/CX are not offering pax full refunds but only rebooking and waiving the change fees....I will have total them to task about this cos I want to cancel my HKG-RGN

fdr

5th Feb 2020, 08:15

It would be a good idea to try to prepare, but it should be recognized that turning any random spaces -- including in existing medical facilities -- into effective isolation wards is far from a trivial task. And even if you have the physical plant, you still need trained personnel to care for the patients and for the facilities. If an effort like this is contemplated, the responsible parties should be in high gear already and be provided with plenty of resources.

Getting in front of the curve would seem prudent.

Cases ending in fatality take around 7 days on average to progress to conclusion from first symptoms. Symptoms are observed around 2 days after contracting the virus. Discounting the 2 day lag, then the available data from China in January is suggesting some things.

The case fatality rate stated at the end of January was that the CFR was lower that SARS, Great!. About 2 %, comparing total cases on 30th Jan to fatalities on the 30th January. So, what about the lag? Those that had succumbed by 30th January, contracted the virus around the 23rd January, and so the figures of cases on the earlier date are appropriate to use as the denominator when working out the CFR. ... Those that had died on 30th January, (213) came from a total case catchment on 23rd January (639). Now, before going off the deep end, this is telling us two things, the rate is probably higher than is being touted by WHO, CNN etc, considerably so. It also suggests that there was a lot of missing case data in the dataset, a lot or actual cases were possibly not being recorded at that time. How is that able to be deduced? shift the dates in question to the 4th February, and look back, as for the second chart below. That gives a CFR of 493/7700, or 6.4%, against 213/639, or 33.3%.

The take homes are:

The figures are as good as the data capture and the subsequent analysis that is done;
A 33% CFR would gain even the PRC Govt's attention, but would need to be reduced to avoid panic. Noting that twice as many people are normally admitted to critical care, that would have a high rate of all cases needing assistance. The analysis then would depend on the number of people that are getting symptoms to the extent they need hospital admission, which is a shorter lag than that for fatalities. The official figure is approximately 20% of todays cases are needing hospitalisation, but again, they contracted the virus 2 to 3 days before, and that is a bit more than half the current cases (4 Feb, 20,492 cases, 20% is.... 4098 cases. 2 Feb, 16884 cases, > 4098/16884= 24.3%). That is only about a 20% increase in the likely number of people needing ICU, so perhaps the 100K ICU beds total that exist in the US of A are more than adequate. For China, no wonder they are building new hospitals; they also need to build more funeral homes unfortunately. Every statistic is a family member, a tragedy and a loss to the community.
Missing data is not all bad news, if more cases existed unreported, then the real CFR would be lower, although the spread would be higher. With a contagion that shows a capability to be easily spread, it would be comforting to know that the spread is much higher than reported, as yet there is no sign of real control of the progression in the hard hit communities.
The international cases are still relatively low, and are not progressing quite like Wuhan has to date, but that may all change in the near future. Additional external person to person transmission has occurred in Thailand and in Singapore today, so that will add to the data and trends. Every day takes us closer to the point of global concern, where the fatalities start to occur to external populations that had no association with Wuhan directly. As of today, that has not happened, and it is not impossible that it will not happen, but that is unlikely, the most likely development is a start of fatalities later this week overseas, at which point the concern will be whether the rate is different to the PRC experience. There are various reasons why that may be the case, and that will be the point that the fire handles will be pulled out of self interest or not. To be effective, all the containment and protections need to be put in place before hand, to avoid saturation of the medical services. China may be able to put up a hospital in 10 days, but I doubt that many other places on the planet could do such a feat.
The 3000 pax on the cruise ship in Japan probably would like to have made different choices in their travel plans. Many will not be positive, so far only 10 have been tested positive out of a fair testing %, but, they are all looking at free food and beer for the next couple of weeks from a single source. That is the level of disruption that we can look forward to without timely and reasonable protocols in place.
When you board an RPT aircraft, whether your travel will be disrupted is dependent on everyone else in that tube being asymptomatic. The inconvenience is not as significant as the risk to self and to others from asymptomatic transfer and thereafter spread to those in your neck of the woods.
By this Sunday, the data should indicate how bad this is going to be globally, we know it is tough in China to the local population in the current environment, with existing treatment. By then the international cases would be expected to show local fatalities. More data the better.

https://cimg2.ibsrv.net/gimg/pprune.org-vbulletin/1428x944/screen_shot_2020_02_05_at_4_02_06_pm_70fe83ac975e58ffbe54410 56ded41e037c415b7.png

https://cimg8.ibsrv.net/gimg/pprune.org-vbulletin/1426x946/screen_shot_2020_02_05_at_4_03_22_pm_f5916fdef5b54a1c8fc2f53 06e2bfccf1614bcd3.png

The prior charts are log scale for cases, to allow the data to be read, but they appear alarming as a result of that scale. To keep things in perspective, a normal scale of cases is below, of the same data.

The facts remain the same, it is quite possible that the case numbers out of China are well underreported, or alternatively the CFR is much higher than we want with a readily transmissible virus. Outside of China, transmissibility is entirely up to individuals as to how they behave and how they cope with infection control. Masks have some value, but the transmission from a contaminated surface (a "fomite") to the individual needs the action of the individual to complete as often as not. That is not saying gloves cure the problem, the problem is your own hand touching your face, to which end a mask of any sort at least is a reminder to "...be careful out there, it is a jungle..."

https://cimg5.ibsrv.net/gimg/pprune.org-vbulletin/1424x988/screen_shot_2020_02_05_at_4_50_00_pm_4d3eadb7f4da60233ebcf7c 8551f139992750570.png

ORAC

5th Feb 2020, 11:22

https://employeebenefits.co.uk/cathay-unpaid-leave-coronavirus/

Cathay Pacific asks staff to take unpaid leave due to Coronavirus outbreak

Hong Kong airline Cathay Pacific has asked its staff to take three weeks of unpaid leave (https://employeebenefits.co.uk/pay-strategy/), to help it address the impact of the current Coronavirus outbreak.

The airline has proposed a leave scheme for its 27,000 employees, operating in 79 destinations, following recent drops in demand due to the Coronavirus outbreak. Earlier this week, the carrier also announced plans to cut 30% of the capacity of flights in the next two months, including 90% of flights to mainland China.

Its unpaid leave scheme (https://employeebenefits.co.uk/pay-strategy/) will not be mandatory, but is being actively encouraged, and is projected to run from 1 March until 30 June 2020.

A spokesperson from Cathay Pacific said: “In view of the Novel Coronavirus outbreak, and also a significant drop in market demand, we just announced massive capacity cuts yesterday. Preserving cash (https://employeebenefits.co.uk/pay-strategy/) is the key to protecting our business. We have already been taking multiple measures to achieve this.

“Today, we are appealing to all employees to participate in the special leave scheme, which will take effect from 1 March and last until 30 June. All employees will have the option to take three weeks of unpaid leave in this period.”

ATC Watcher

5th Feb 2020, 11:56

and Delta airlines to suspend all its flights to China from tomorrow ( Febr 6th) to April 30th , Does not look good.

FlareArmed2

5th Feb 2020, 13:36

...So, what about the lag? Those that had succumbed by 30th January, contracted the virus around the 23rd January, and so the figures of cases on the earlier date are appropriate to use as the denominator when working out the CFR. ...

I like your work but I'm not sure that it is valid. The look at total deaths on a certain date and relating them to the cohort number of cases five seven days ago is looking at totals-to-date. This adds in all numbers of patients who died/got ill from all time periods before five seven days ago.

If the hypothesis is that a new case on day x has a %age mortality rate that shows up x+seven days later (and you have reasoned this argument well) then I would suggest a better method would be to look at the daily increase in deaths on a particular date, and relate that to the corresponding daily increase in number of cases from five seven days ago. That might have a completely different outcome.

Fzz

5th Feb 2020, 13:47

Now, before going off the deep end, this is telling us two things, the rate is probably higher than is being touted by WHO, CNN etc, considerably so.

It seems like results for Hubei province are different from those for the rest of the world. If we assume that the time to recovery is similar to the time to death, we can get an idea of the death rate by simply dividing deaths by recovered count. Taking the most recent data for everywhere except Hubei, we get:
deaths: 15, recovered: 459
This gives a death rate of 3%. If there are recovered people who are uncounted because they did not display significant symptoms, then this figure may be too high.

The figures for Hubei are much worse: deaths: 479, recovered: 537. But this may be due to many reasons. First, doctors did not know what to expect at first, so the death rate there may have actually been higher. Second, the medical facilities there are overloaded, reducing quality of care. And then it's likely that due to overload, only severe cases are being treated, so the true recovered number may be much higher than the official number.

So is 3% the true rate, at least when medical facilities are not overloaded? If people are declared to have recovered much faster than the severe cases take to die, then the recovered rate could be inflated and the death rate could be higher than 3%. But equally, if people take longer to be declared to have recovered than the severe cases take to lead to death, then the rate could be lower. I suspect though that 3% is probably roughly in the right ballpark.

Twitter

5th Feb 2020, 14:16

Interesting how this tragedy is being dealt with in media / social media:

There are many articles about the economic impact - that includes Airbus shutting a production line for the duration - and many learned statistical projections. There is not too much sympathy shown for the poor blighters who catch it.

Wouldn't be surprised to read that the slow down suits Boeing just fine, while it gets its act together. Somebody benefits from every war...

EDLB

5th Feb 2020, 14:21

I suspect though that 3% is probably roughly in the right ballpark.

Don’t think it makes much sense to speculate now on an exact CFR number. It will depend on the quality of care. Ebola CFR is around 18% in a modern up to date hospital environment but 67% in the woods. We will learn over time of more effective treatment of nCoV2019. But case numbers and CFR is currently high enough, that it complete overwhelms the capabilities of a modern city. We would currently be able to deal with a few additional 1000 patients in a typical 50 million+ country, but over 10k with tight isolation requirements not so much.

OldnGrounded

5th Feb 2020, 15:11

Getting in front of the curve would seem prudent.

Yup.

Cases ending in fatality take around 7 days on average to progress to conclusion from first symptoms.

Perhaps. We really don't have enough data to know that with much confidence.

Symptoms are observed around 2 days after contracting the virus.

No. Two days is at the low end of the estimated latency (incubation) period, which is thought to range between 2 and 14 days. The earliest estimates of a mean were around 6.4 days. In a 30 January study published in the New England Journal of Medicine -- https://www.nejm.org/doi/full/10.1056/NEJMoa2001316 -- 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. And the time between presumed exposure and onset of symptoms was widely varied.

OldnGrounded

5th Feb 2020, 15:23

Don’t think it makes much sense to speculate now on an exact CFR number. It will depend on the quality of care. Ebola CFR is around 18% in a modern up to date hospital environment but 67% in the woods. We will learn over time of more effective treatment of nCoV2019. But case numbers and CFR is currently high enough, that it complete overwhelms the capabilities of a modern city. We would currently be able to deal with a few additional 1000 patients in a typical 50 million+ country, but over 10k with tight isolation requirements not so much.

As of yesterday's World Health Organization situation report, there were 20,630 confirmed cases, worldwide, and 425 deaths. That's a CFR of 2% and that number has been pretty stable for several days. Since a majority of cases don't require hospitalization and an unknown but likely fairly large percentage are either asymptomatic or result in only mild symptoms, that 20,630 number is probably a significant undercount, which would mean the actual case fatality rate is less than 2%.

That said, EDLB is right: (a) CFR will probably vary based upon the promptness and quality of supportive care; and (b) any nation on this planet that experiences an outbreak on the scale Wuhan is facing will have its healthcare facilities and system massively overwhelmed.

ORAC

5th Feb 2020, 21:24

All UK hospitals ordered to prepare “Coronavirus assessment pods” where people can be assessed and Coronavirus isolation areas.

https://www.bbc.co.uk/news/uk-51392607

flynerd

5th Feb 2020, 22:05

As of yesterday's World Health Organization situation report, there were 20,630 confirmed cases, worldwide, and 425 deaths.

And just this now there is a new report of 594 deaths just in Hubei province..

China's health officials have confirmed the death toll from the coronavirus outbreak in Hubei province has reached 594, with 19,665 cases of infection
source: abc.net.au/news

OldnGrounded

6th Feb 2020, 00:38

And just this now there is a new report of 594 deaths just in Hubei province..

China's health officials have confirmed the death toll from the coronavirus outbreak in Hubei province has reached 594, with 19,665 cases of infection
source: abc.net.au/news

Yes, that appears to be the latest from the Chinese Health Ministry. The one-day increase in Hubei was just under 3,000 new cases and 70 additional deaths. Nothing in those numbers to suggest that the 2% CFR estimate is unreasonable, although we still have no idea how many cases are uncounted.

The WHO 5 February situation report shows a total of 32 new cases outside of China. 13 of those are in Japan, where they have 3,700 people quarantined on a cruise ship and ten of those 13 new cases are passengers from the ship. Latest news from Japan is that 10 more passengers have tested positive for 2o19-nCoV, which is hardly surprising. Only one new ROW death in that WHO report, and that's the case in the Philippines that had previously been reported elsewhere.

fdr

6th Feb 2020, 01:26

OldnGrounded;10680125]

Perhaps. We really don't have enough data to know that with much confidence.

No. Two days is at the low end of the estimated latency (incubation) period, which is thought to range between 2 and 14 days. The earliest estimates of a mean were around 6.4 days. In a 30 January study published in the New England Journal of Medicine -- https://www.nejm.org/doi/full/10.1056/NEJMoa2001316 -- 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. And the time between presumed exposure and onset of symptoms was widely varied.

O'nG

I drank a lot of coffee to put in a 2 day value, and here is the reason why is had some angst.

It takes time for the cases to be identified (the point in question) which is then added to a recorded period from detection to outcome. If the mean is applied, then for fatalities recorded on 30 Jan, (213) these would have come out of a pool of patients identified by the 21st, (326 cases, [JHU]). That results in an excessively high mortality rate, given that there are recovered patients (171 recoveries recorded by 30th January) The time to determination of recovery is not identified, so that may be a valid number, or may be higher or lower than actual cases related to cases as of the 21st January. Using that number however, we get 171+213=384 case outcomes, good and bad, from... 326 cases on 21st January. That all looks fine, except the recovery cases are a subset of total cases as far as I understand, following the general premise that 20% of identified cases need ICU care, and 1/2 of those cases end badly. The truth of that is unknown to the public, it is known to the PRC govt, and presumably WHO, CDC etc.

What is evident is that the CFR being quoted by WHO and the CDC etc is flawed, and significantly under reports the rate. Post an outbreak, such as SARS or EBOLA, then the data compares all known cases against all known outcomes. WHO & CDC methodology of using todays fatalities against todays identified cases neglects every fatality that exists for the cases known today that have not run their course of illness to conclusion, good or bad. Going back only the period from today to the average time for an adverse outcome to develop remains within known data and has a rational meaning at that time. Time from diagnosis to conclusion is a metric that is able to be measured. Guessing future deaths is, a guess.

The data does suggest that there is considerable missing data. (IMHO that is more likely to be good than bad paradoxically, more cases that are undiagnosed would reduce the CFR ratio, and this thing is spreading rather well within China. We still have a cycle or two to go in the rest of the world to see how bad it is going to be, but right now, if the figures are correct, this looks generally like a critical problem for the PRC, and a manageable problem to the rest of the world). From 23 DEC 2019 to 21 JAN 2020, there is a certain progression which is geometric but the rate changes from the 21st January to 28th January the rate accelerates. That may be the effect of the Lunar New Year travel causing a widespread expansion of the base, or it is backfilling of the data that was missing, increased accuracy of the reports as the outbreak is taken seriously. From the 30th to date the case rate has a relatively constant exponent, charts as approximately a straight line on a log scale. The last couple of day there is a possible reduction in that exponent, just a hint. Non PRC cases have remained relatively constant in total numbers, trending away from the PRC progression rate. Recorded fatalities are still increasing with an exponent, but it is considerably lower than the PRC case development rate, the fatality exponent has reduced in the last week, but is still an exponent value.

Within China, case development is still a geometric progression, suggesting that the total cases will continue to spread there significantly. Very roughly, the exponent of case development and fatalities are similar at this time,

Outside of China, the spread is either at a lower rate or is being underreported. fatalities outside China remain very low, and associated to PRC cases or nationals. At the total cases level of the non PRC area today, the Mainland China experience had a number of fatalities recorded. This signal is still not present in the non PRC cases, and that may just be due to environmental differences, (weather: temperature, humidity etc) or other causes. It also may be that the mortalities are being missed as nCoV, and are being classified as Influenza fatalities. All things are possible, but the longer the period before fatalities occur in the non PRC region, the greater the likelihood that there is a difference in the outcomes due to unknown factors.

Right now, there are around 4 fatalities that have not occurred in the non PRC area that are going to be the canary in the cage to how this outbreak is going to develop... If they develop in the next 3 days, the whole globe is going to take a correction. If they don't materialise, then there is a clue towards a cure from ascertaining why this is the case; there is an opportunity to support the PRC with medical support and a better allocation of resources to the combating of the outbreak. In total impact terms, this is a tragedy but it isn't the end of the world as we know it, but it will potentially alter demographics in some places.

https://cimg8.ibsrv.net/gimg/pprune.org-vbulletin/2000x1005/screen_shot_2020_02_06_at_12_49_51_pm_0cdabe24f671098427e583 ee42bd3e46c328c219.png

https://cimg9.ibsrv.net/gimg/pprune.org-vbulletin/2000x889/screen_shot_2020_02_06_at_12_53_53_pm_d2d541dbb59b92a6bf35d6 b1cf454bcc20abbeab.png

Australopithecus

6th Feb 2020, 02:33

OldnGrounded

6th Feb 2020, 04:46

After reading an article today regarding the relative immunity of the young to coronaviruses I realise that whatever CFR is calculated will reflect the total case load, but fatalities will be skewed to the older, more male end of the pool. Older males thus will suffer a CFR quite a bit higher than the raw numbers suggest.

It's not really a matter of immunity. It's unlikely that any group of humans has significant immunity to a novel virus, unless it is very similar to one that has previously infected a population and resulted in a persistent capacity to develop an effective antibody response. And viruses mutate incredibly rapidly, so that isn't something that would be expected in this case. It is certainly true, though, that some cohorts typically suffer more from diseases like this than others. Older people often make up one of the more-susceptible cohorts (and often have preexisting conditions that make any systemic illness more dangerous). That seems to be the case here, and, for whatever as-yet unclear reason, most deaths to date are in males. If these trends continue, Australopithecus' expectation may well turn out to be correct.

Australopithecus

6th Feb 2020, 07:58

Yeah, bad choice of words on my part. I meant the apparent relatively mild symptoms in the young, and very small numbers of complications.

As O'n'G mentions, pre-existing conditions feature in the fatalities. I wonder what fraction of the population is free of those by 65 years of age. That cohort would have lots of ex-smokers too.

“Pre-existing” reminds me that there are tens of millions of uninsured low-income people in the US. I can imagine all too well how that could play out.

ORAC

6th Feb 2020, 10:25

https://www.cnn.com/2020/02/06/us/coronavirus-thursday/index.html

Planeloads of Americans flee growing coronavirus outbreak in Wuhan as 12th case is reported in the US

CNN)Planeloads of Americans fleeing the fast-moving coronavirus outbreak (https://www.cnn.com/specials/asia/wuhan-coronavirus-intl-hnk) in China are arriving at military bases across the United States this week on what could be the final chartered flights.......

Evacuations of Americans from Wuhan started last month after one flight landed at a base in California with nearly 200 Americans aboard. On Wednesday, two more flights out of Wuhan (https://www.cnn.com/2020/02/04/us/us-wuhan-evacuation-flight-coronavirus/index.html) arrived in California carrying a total of 350 passengers.

Both planes landed at Travis Air Force Base (https://www.travis.af.mil/) -- between San Francisco and Sacramento. Of those, 178 passengers from one plane stayed at Travis while the other plane refueled before taking the others to Marine Corps Air Station Miramar (https://www.miramar.marines.mil/) in San Diego.

And two more evacuation flights are scheduled to arrive from Wuhan later this week -- one headed to Lackland Air Force Base in San Antonio, Texas, while the other one is going to Eppley Airfield in Omaha.

This week's flights will likely be the last ones. The State Department does not anticipate chartering any planes after this week, an official said.

About 1,000 Americans live in Wuhan, and priority on chartered flights was given to US citizens at a higher risk of contracting coronavirus (http://www.cnn.com/2020/01/28/asia/wuhan-coronavirus-update-intl-hnk/index.html) if they stay in the city, the State Department has said.......

OldnGrounded

6th Feb 2020, 14:28

About 1,000 Americans live in Wuhan, and priority on chartered flights was given to US citizens at a higher risk of contracting coronavirus (http://www.cnn.com/2020/01/28/asia/wuhan-coronavirus-update-intl-hnk/index.html) if they stay in the city, the State Department has said.......

Judging relative risk of exposure in Wuhan? That has to be an exercise in futility. Maybe they mean those with a greater risk of developing severe cases. It might be possible to take a stab at that -- sort of.

Twitter

6th Feb 2020, 16:48

Must be pretty grim being kept on a ship with an epedemic around.

For those of a statistical bent it might provide some hard data I suppose - 10 became 20 today...

rog747

6th Feb 2020, 17:06

Previously healthy young doctor who whistle blows in China he had warned them of a new virus, and then dies - Hmmmmmn OK...........

Twitter

6th Feb 2020, 18:05

Previously healthy young doctor who whistle blows in China he had warned them of a new virus, and then dies - Hmmmmmn OK...........

Now they are changing the story and saying he is seriously ill. Hope he makes it.

OldnGrounded

6th Feb 2020, 18:27

Now they are changing the story and saying he is seriously ill. Hope he makes it.

South China Morning Post (Hong Kong) reports, as of a few minutes ago, that Li is alive, but in critical condition, per the Wuhan hospital. SCMP is pretty reliable on coronavirus news from the PRC, having better contacts there than most Western news organizations.

https://www.scmp.com/news/china/society/article/3049411/coronavirus-li-wenliang-doctor-who-alerted-authorities-outbreak

WHBM

6th Feb 2020, 18:55

“Pre-existing” reminds me that there are tens of millions of uninsured low-income people in the US. I can imagine all too well how that could play out.
Indeed. I saw an extraordinary complex piece of US protective medical equipment shown as for a victim who had arrived there. I did feel that if they did not have sufficient medical insurance one would not have seen the supplier for dust ..

Winemaker

6th Feb 2020, 19:11

For what is worth, was mucking about with the Chinese numbers and came up with this:

https://cimg0.ibsrv.net/gimg/pprune.org-vbulletin/994x768/plot_160764892d112ffbfd874a5a95e5668f40c1e499.jpg

OldnGrounded

6th Feb 2020, 19:22

Indeed. I saw an extraordinary complex piece of US protective medical equipment shown as for a victim who had arrived there. I did feel that if they did not have sufficient medical insurance one would not have seen the supplier for dust ..

The expensive equipment you saw was likely the ISOPOD they used to transport the first 2019-nCoV case in Washington State:

https://cimg6.ibsrv.net/gimg/pprune.org-vbulletin/299x168/isopod_c2eeeb9b1ad575aedf859d943788bbc712589d30.jpg

Not only did they use the ISOPOD, they put the patient into one of the two beds in their isolation ward and sent in their one and only robot to treat him. As you can probably guess, ISOPODS and high-tech isolation wards are few and far between, no less so in the US than anywhere else in the Western world. Treatment robots are in even shorter supply.

If and when an outbreak even remotely of the scale of what's happening in Wuhan develops here in the US, facilities and personnel will be utterly overwhelmed. There's not enough of anything, anywhere. There may be a very few individuals whose wealth is adequate to avoid the queues and command scarce resources, but merely having good health insurance won't be enough. No one will get what doesn't exist.

As far as access to care, the the law requires hospitals to treat patients who arrive at an emergency room, at least to the extent required to stabilize them, without regard to ability to pay. So, in that setting, it's pretty much a matter of first-come and most critical, first served. Of course, patients who are admitted but don't have good coverage or lots of money (hardly anyone has that much money) will be financially ruined, for years or decades, when the bills arrive.

And many won't be admitted, regardless of coverage, because there won't be adequate space, beds, other facilities, medical staff, lab techs . . .

Seat4A

6th Feb 2020, 19:28

South China Morning Post (Hong Kong) reports, as of a few minutes ago, that Li is alive, but in critical condition, per the Wuhan hospital. SCMP is pretty reliable on coronavirus news from the PRC, having better contacts there than most Western news organizations.

https://www.scmp.com/news/china/society/article/3049411/coronavirus-li-wenliang-doctor-who-alerted-authorities-outbreak

Current headline on SCMP, quoting Wuhan Central Hospital on their Weibo account:

"Coronavirus: Li Wenliang, doctor who alerted public to the outbreak, dies of the disease

Wuhan Central Hospital confirms Li’s death, as commenters on Chinese social media mourn his loss and express anger at his treatment
Li, 34, was one of eight doctors who tried to share information about the coronavirus only to be reprimanded by Wuhan police"

https://www.scmp.com/news/china/society/article/3049411/coronavirus-li-wenliang-doctor-who-alerted-authorities-outbreak

Twitter

6th Feb 2020, 19:34

In respect of wealth / poverty / insurance coverage - whether a patient can afford treatment or not, it is of course in the interests of the whole community to isolate him. Death is a great leveller.

ORAC

6th Feb 2020, 19:50

Two Brazilian air force jets are on their way to China (https://www.theguardian.com/world/china) to rescue a group of about 34 Brazilian citizens from the city at the centre of the coronavirus outbreak. Brazil’s state-run news agency, Agencia Brasil, says the planes are currently in Poland waiting for clearance from Chinese authorities to continue their flight to Wuhan. The delay is reportedly the result of the high number of international repatriation missions trying to fly into the Chinese city.

Once back in Brazil those being evacuated from Wuhan will be placed in quarantine for 18 days at a military base in the city of Anápolis, in Brazil’s midwest. According to the Estado de São Paulo newspaper, Argentina has asked Brazil for help in evacuating 15 of its citizens.

Twitter

6th Feb 2020, 20:09

Very sad. There's a real strain of authoritarian sociopathy built into the Chinese system. Not only their system, of course, but it's very persistent there and has been for a long time.

Not only China hides facts - Iran, Russia... there are more closer to home too.
Who knows how this would have affected the spread if the nipping could have been closer to the bud? Complete scandal.

OldnGrounded

6th Feb 2020, 20:22

Not only China hides facts - Iran, Russia... there are more closer to home too.
Who knows how this would have affected the spread if the nipping could have been closer to the bud? Complete scandal.

Yes, there's a lot more of that than most of us would care to recognize or admit. And not all of it -- not nearly all of it -- is in nations that we think of as "bad guys."

OldnGrounded

6th Feb 2020, 20:33

China grows isolated as airlines cancel more than 50,000 flights amid coronavirus epidemic (https://www.cnbc.com/2020/02/06/coronavirus-china-becomes-increasingly-isolated-as-airlines-pull-out.html)

Published Thu, Feb 6 2020 1:46 PM EST Updated an hour ago

[. . .]
These steps have left China, the world’s second-largest air travel market after the U.S., more isolated. Airlines in dozens of countries — from New Zealand to Finland to the United Arab Emirates — have scaled back service or in the case of U.S. airlines canceled flights altogether to the Chinese mainland and Hong Kong as the coronavirus spreads. This will drive down airlines’ 2020 revenue and deprive other segments of the travel industry, including hotels and retailers, of high-spending tourists.

More (https://www.cnbc.com/2020/02/06/coronavirus-china-becomes-increasingly-isolated-as-airlines-pull-out.html)

Private jet

6th Feb 2020, 20:36

https://cimg4.ibsrv.net/gimg/pprune.org-vbulletin/824x960/83729154_2793180937429247_7478011088559144960_o_9d457e7dfa55 e1fc6caea9c15359e33d425de6bc.jpg

Winemaker

6th Feb 2020, 23:52

Well, maybe the theory is that the burning tobacco will kill any airborne viruses that are accidentally sucked in.

fdr

7th Feb 2020, 01:53

Current headline on SCMP, quoting Wuhan Central Hospital on their Weibo account:

"Coronavirus: Li Wenliang, doctor who alerted public to the outbreak, dies of the disease

Wuhan Central Hospital confirms Li’s death, as commenters on Chinese social media mourn his loss and express anger at his treatment
Li, 34, was one of eight doctors who tried to share information about the coronavirus only to be reprimanded by Wuhan police"

https://www.scmp.com/news/china/society/article/3049411/coronavirus-li-wenliang-doctor-who-alerted-authorities-outbreak

What's the chance that the PRC Govt show some moral backbone and honor his efforts. He will have helped save a lot of lives of his compatriots.

OldnGrounded

7th Feb 2020, 02:20

What's the chance that the PRC Govt show some moral backbone and honor his efforts. He will have helped save a lot of lives of his compatriots.

They may well do that, but I doubt it will because of moral backbone. The Chinese public is furious about the treatment by the authorities of the eight docs who tried to warn about the coronavirus and even state-sponsored media have been openly critical in the past few days. The Chinese government is authoritarian, but that doesn't mean it can ignore public opinion and it knows that perfectly well.

Twitter

7th Feb 2020, 05:16

Meantime 61 positive cases on the Diamond Princess off Yokohama. 1,2,4,10,20,61 was the progression. Isolation is partial at best and although well meant, came late as we now see.

ORAC

7th Feb 2020, 05:30

Must be pretty grim being kept on a ship with an epedemic around. For those of a statistical bent it might provide some hard data I suppose - 10 became 20 today...

https://www.bloomberg.com/news/articles/2020-02-07/cruise-ship-virus-infection-tally-grows-to-biggest-outside-china

Cruise Ship Virus Outbreak Is Biggest Outside China With 61 Sick

Japan confirmed 41 more cases of the new coronavirus aboard a quarantined cruise ship, and denied entry to another vessel as it sought to control the spread of the deadly infection, with thousands now stranded on stricken luxury liners.

The results bring to 61 the tally of infections among 273 passengers and crew so far tested aboard the Diamond Princess, which is being kept in isolation at the port of Yokohama and is the biggest center of infection of any place outside of China.

Japan’s Ministry of Defense said Thursday it would send Self-Defense Forces medical personnel to help out with treatment on the ship, and bring alongside a commercial passenger vessel to act as a temporary base. Health Minister Katsunobu Kato said he was considering testing other elderly and vulnerable people among the roughly 3,700 people aboard.

Foreign Minister Toshimitsu Motegi said one of those infected on the ship was now confirmed to be in serious condition, while Twitter users who said they were aboard the vessel expressed increasing concern.......

Japan has banned a separate cruise ship -- the Westerdam -- from berthing at a port in the country, saying a person on the vessel was suspected to have contracted the virus.

Cruise operator Holland America, part of Carnival Corp., said earlier there were no known cases of the novel coronavirus (https://www.bloomberg.com/news/terminal/Q5AGJOT0G1KX) aboard the Westerdam and the ship was not in quarantine. The vessel is currently off Ishigaki -- one of Japan’s most southerly islands -- and Holland America said it was trying to make alternative plans for its passengers.........

ATC Watcher

7th Feb 2020, 07:56

1,2,4,10,20,61 was the progression that is also the progression what the German (Munich) case a week ago demonstrated : 1 not showing symptoms infecting 2 to 3 others, at this rate the whole ship will be contaminated in a matter of days .
Health Minister Katsunobu Kato said he was considering testing other elderly and vulnerable people
The Chinese Dr that died yesterday was 34...

Twitter

7th Feb 2020, 08:06

Not WHO but who?
9 out of 10 folk questioned in Germany for instance are unconcerned. So were most people in the Far East when it broke out.
Then preparations don’t get made until it’s too late.
Should be possible to stay cool - but think.

Airbubba

7th Feb 2020, 15:23

Some news on today's evacuation flights.

Published 1 hour ago
Last Update 6 mins ago2 planes carrying American coronavirus evacuees held in California, Canada over ‘persons of interest’: sources
By Madeline Farber (https://www.foxnews.com/person/f/madeline-farber) | Fox News (http://www.foxnews.com/)

Two State Department-chartered flights carrying additional American evacuees from Wuhan, China -- the epicenter of the deadly coronavirus (https://www.foxnews.com/category/health/infectious-disease/coronavirus) outbreak -- were held in Vancouver, Canada and Travis Air Force Base in California due to "two persons of interest," one on each plane. The passengers showed symptoms of coronavirus, which include fever, shortness of breath, and a cough, two U.S. officials close to the Centers for Disease Control and Prevention (CDC) told Fox News.

Medical teams in Nebraska and Texas are prepared to receive the passengers, who were set to be held in quarantine for 14 days while they were monitored for possible symptoms.

The latest estimates suggested the plane held in Vancouver was expected to arrive at Marine Corps Air Station Miramar in San Diego, Calif., shortly before 12 p.m. ET, while the other plane was estimated to arrive at its first stop at Lackland Air Force Base in San Antonio around 1:30 p.m. ET. The plane would then leave Lackland for Nebraska to drop off the remaining passengers at Eppley Airfield in Omaha.

On Thursday, an official with the federal department told Fox News that the two flights were likely to be the last State Department-chartered flights (https://www.foxnews.com/health/us-coronavirus-evacuees-texas-nebraska-last-chartered-flights) out of the city.

“At this time, we do not anticipate staging additional flights beyond those planned to depart February 6,” the spokesperson said, adding any U.S. citizens still in China “should attempt to depart by commercial means.”

https://www.foxnews.com/health/american-coronavirus-evacuees-california-canada-symptoms

https://cimg3.ibsrv.net/gimg/pprune.org-vbulletin/1485x997/cks379_3e2fe88fc5e03d746556674003ead6596356389d.jpg
https://cimg7.ibsrv.net/gimg/pprune.org-vbulletin/1865x1002/cks377_62a610ee6543b59cc58b8ecada2075a18ab0d9f1.jpg

ORAC

7th Feb 2020, 15:58

Sky News reporting last British evacuee flight from Wuhan will be arriving in UK on Sunday and evacuees will be accommodated in isolation in Milton Keynes.

ORAC

7th Feb 2020, 20:00

https://www.theguardian.com/world/2020/feb/07/coronavirus-royal-caribbean-cruise-bans-chinese-nationals

Royal Caribbean bans all Chinese nationals from its cruise ships

The US cruise ship company Royal Caribbean has announced that would-be passengers and crew with Chinese passports will be banned from all of its cruise ships – regardless of when they were last in the country at the centre of the coronavirus outbreak (https://www.theguardian.com/world/coronavirus-outbreak).

The measure – which also covers people with Hong Kong and Macau passports – comes amid growing concerns over the fast-spreading virus, which has killed more than 600 people and affected individuals in at least 25 countries. But it was likely to face criticism from Beijing, which has bridled at sweeping travel bans on its citizens, and from human rights activists who have denounced such restrictions as discriminatory........

Twitter

7th Feb 2020, 22:02

FlareArmed2

7th Feb 2020, 23:38

Update for 7 Feb. Total number of cases:

https://cimg5.ibsrv.net/gimg/pprune.org-vbulletin/667x750/200207_ncov_69c0182a4e0659b145e214b60320b75376dcb227.png
"Cases" are number of cases reported in mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Y-axis is plotted as a logarithm, so straight lines on graph show the exponential rate.
Coloured lines on chart are lines of best fit to mainland China data showing the daily increase in number of cases.

The rate of increase each day:

https://cimg7.ibsrv.net/gimg/pprune.org-vbulletin/943x530/200207_ncov_rate_5519151069bba2d46a517455ed7632873d6c3b52.pn g
"Daily change" for mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Coloured lines on chart are linear lines of best fit.
Lines extending beyond data points are extrapolated and therefore not data-based but are speculative.

The rate of increase each day is trending downwards which is good. In the last few days the rest of the world (ROW) trend has gone upwards due to newly discovered cases eg on cruise ships. As the ROW has much lower overall numbers the data for ROW tends to bounce around a bit, so this might be factor rather than any long-term change. The linear trend is still strongly downwards.

Overall the trend for mainland China matches the trend for the ROW pretty closely, with the total numbers in the ROW being about 1% of the mainland China numbers. If there is under reporting in either series it is either (1) too small to notice or (2) both series under-report by the same proportional amount.

The reduction in daily increase is significant. For example, had the initial trend of 50% per day increase continued to today, there would be about 320,000 cases in China and about 3,200 cases in the ROW, whereas the actual numbers today are about a tenth of that. So major strides have been made to contain the spread of nCoV so far.

fdr

8th Feb 2020, 00:29

For what is worth, was mucking about with the Chinese numbers and came up with this:

https://cimg0.ibsrv.net/gimg/pprune.org-vbulletin/994x768/plot_160764892d112ffbfd874a5a95e5668f40c1e499.jpg

The concern with all of the information provided to date is that as you indicate, there is a cubic fit to the data.... with a fair match, (R2 in high .99.... ). This is a virus, which in the absence of limiting constraints has an exponential function for case growth. The curve for a quadratic looks like an exponential function over the first few values of x, thereafter they diverge, quite rapidly. A cubic function, (your example fit of abX^3+cdx^2+k) will have two curves combined, and may approximate an exponential function, at early values of x, and then will diverge as well from exponential functions.

So far, the provided data doesn't fit an exponential growth, and that is curious. Either there are constraints to the growth that do a remarkable job of matching a quadratic or cubic function, (at least over part of the growth in numbers) or the data ain't the full monty. Being of generous mind, I choose to assume that there are other constraints involved, such as interventions etc, that are altering the course of the cases. That isn't necessarily being naiive, there is a fair chance that the breakout from Hubei gave anomalous growth rates in cases, and intervention by various countries to control the spread. If the numbers have however been back driven, then that will become identifiable in due course assuming that the data of the rest of the world can maintain integrity.

Fatalities in this outbreak have taken some time to occur, actually much longer than was assumed first up. WHO/CDC are not reporting that time at present, but the cases that have been looked at show a progression that takes between 7 days and 14 days from contagion to death. That increases the mis-match in the CFR methodology, however, the reported fatalities are not following a consistent progression compared to reported cases for the early to mid January data (slip fatalities at the end of January forward by 10 days, and they are almost equivalent to the number of cases reported at the earlier time, when the fatal cases were exposed to the virus, yet 10 days later in the data, this is not the case).

ORAC

8th Feb 2020, 08:20

Deadliest day for coronavirus as mainland China records 86 fatalities

https://medicalxpress.com/news/2020-02-coronavirus-infected-staff-wuhan-hospital.html

New coronavirus infected 40 staff in single Wuhan hospital: study

Forty health care workers were infected with the novel coronavirus by patients at a single Wuhan hospital in January, a new study has found, underscoring the risks to those at the frontlines of the growing epidemic.

One patient who was admitted to the surgical department was presumed to have infected 10 health care workers (https://medicalxpress.com/tags/health+care+workers/), according to the paper that was authored by doctors at the Zhongnan Hospital of Wuhan University and published in the Journal of the American Medical Association (JAMA) on Friday.

Seventeen patients who were hospitalized for other reasons also became infected by the coronavirus. A total of 138 patients got the virus in a period spanning January 1 to January 28, with hospital-associated transmission accounting for 41 percent of all cases.........

Of the 40 infected health (https://medicalxpress.com/tags/health/) care workers in the JAMA study, 31 worked on general wards, seven in the emergency department (https://medicalxpress.com/tags/emergency+department/), and two in the ICU.

The example of the patient presumed to have infected 10 health workers (https://medicalxpress.com/tags/health+workers/) highlighted the high level of danger within hospitals during the first phase of the epidemic, even though overall it is currently estimated that each patient infects on average 2.2 others.

"If true, then this confirms that some patients (https://medicalxpress.com/tags/patients/) are likely to be far more infectious than others, and this poses further difficulties in managing their cases," said Michael Head, a global health expert at the University of Southampton said in a comment to the UK's Science Media Centre.......

Seat4A

8th Feb 2020, 16:03

Some interesting images and sources. (His audience is SLF, but he gets a lot of attention nonetheless.)

"Coronavirus - Rescue Flights and Impact to Aviation" - Feb 8, 2020

https://www.youtube.com/watch?v=_hXwyTppCg8

OldnGrounded

8th Feb 2020, 17:52

[. . .]
Forty health care workers were infected with the novel coronavirus by patients at a single Wuhan hospital in January, a new study has found, underscoring the risks to those at the frontlines of the growing epidemic.

One patient who was admitted to the surgical department was presumed to have infected 10 health care workers (https://medicalxpress.com/tags/health+care+workers/), according to the paper that was authored by doctors at the Zhongnan Hospital of Wuhan University and published in the Journal of the American Medical Association (JAMA) on Friday.

Seventeen patients who were hospitalized for other reasons also became infected by the coronavirus. A total of 138 patients got the virus in a period spanning January 1 to January 28, with hospital-associated transmission accounting for 41 percent of all cases.........

[. . .]

The example of the patient presumed to have infected 10 health workers (https://medicalxpress.com/tags/health+workers/) highlighted the high level of danger within hospitals during the first phase of the epidemic, even though overall it is currently estimated that each patient infects on average 2.2 others.

This isn't surprising or unusual in the context of other outbreaks of novel infectious diseases. The 2019-nCoV virus was only identified in Wuhan in early January. By that time, any number of transmissions by carriers -- symptomatic and asymptomatic -- to others would have occurred, probably more in-hospital than in most other places. And it takes time (often longer than it should) for hospitals and other providers and public health authorities to ramp up infection control measures.

It would be more surprising if there had not been a burst of hospital-acquired cases.

"If true, then this confirms that some patients (https://medicalxpress.com/tags/patients/) are likely to be far more infectious than others, and this poses further difficulties in managing their cases," said Michael Head, a global health expert at the University of Southampton said in a comment to the UK's Science Media Centre.......

Also typical of infectious viral diseases. Different patients, and patients at different stages of incubation and symptomatic illness, shed virus particles at varying rates and quantities. Since it really isn't possible in clinical settings to determine who might be "more infectious than others," the same isolation and infection control measures really apply to all cases, so the "further difficulties" comment doesn't make much sense. There might be additional risk in some cases, but usually no one knows that in real time.

jugofpropwash

8th Feb 2020, 18:07

Fatalities in this outbreak have taken some time to occur, actually much longer than was assumed first up. WHO/CDC are not reporting that time at present, but the cases that have been looked at show a progression that takes between 7 days and 14 days from contagion to death. That increases the mis-match in the CFR methodology, however, the reported fatalities are not following a consistent progression compared to reported cases for the early to mid January data (slip fatalities at the end of January forward by 10 days, and they are almost equivalent to the number of cases reported at the earlier time, when the fatal cases were exposed to the virus, yet 10 days later in the data, this is not the case).

Actually, it makes some sense. If many of the early exposures were to other hospital patients, then those people were probably sick to begin with, and the virus only added to their other issues. I've also read some reports that most victims are male - I wonder if that relates to the smoking rates in China? (I've seen various numbers, but apparently somewhere around 50 percent of the men but few women smoke.) Areas of China also have a lot of pollution - if the virus affects the lungs, then surely pollution and smoking aren't going to help.

OldnGrounded

8th Feb 2020, 19:15

've also read some reports that most victims are male - I wonder if that relates to the smoking rates in China? (I've seen various numbers, but apparently somewhere around 50 percent of the men but few women smoke.) Areas of China also have a lot of pollution - if the virus affects the lungs, then surely pollution and smoking aren't going to help.

According to the China National Health Commission press conference last Tuesday, two-thirds of coronavirus fatalities in that country had at that point been male, 80% were over 60 years of age and 75% had underlying diseases -- cardiovascular disease, diabetes, etc.

The Worldometers site -- https://www.worldometers.info/coronavirus/ -- is doing a good job of keeping a summary of reliable information from the various authorities around the world up to date and easily accessible.

Your information on rates of cigarette smoking and China appears to be accurate: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546632/

fdr

9th Feb 2020, 00:30

On Saturday the first fatalities of foreigners were reported, one a US citizen, and the other Japanese. Both fatalities occurred in China.
It is not clear in the data which set of cases these occurred from, but presumably they were from the Chinese data set. These fatalities were 60 Y/O and mid 60's. The Japanese citizen was admitted into hospital in Wuhan around 16 January with suspected viral pneumonia.

The time from contact to fatality is quite long in a number of cases, considering the Japanese national and Dr Li, total time is anywhere between 40 days to 23 days with a lot of variability. The first fatalities that were attributed to NCoV were also around 40 days after the first assumed contagion in the wet market. If that is correct, then the foreign fatalities, offshore of PRC will take further time to occur, and these first two foreign national fatalities are part of the Chinese morbidity cohort, and do not indicate as yet a commencement of fatalities resulting from the spread of the virus external to China. The external fatalities may commence at a later date, anywhere from another 10 days or more from now showing a similar development to Chinese events. That is the long end of the timeline, there is more likelihood that the spread external to Chia occurred earlier than currently reported, through the many asymptomatic travellers who then were embedded in day to day activity without awareness of their status. Medical resources in China are under stress treating their caseload, and that could well impact adversely the outcome within the Chinese medical system. If the spread is minimised externally, that stress may be avoided globally. 2020 is off to a lousy start.

However... since the beginning of Feb, total cases are showing a much lower rate of growth, currently running nearly a constant increase per day, which indicates that some controls are effective, or reporting is incorrect. fatalities are still trending up in rate but as stated previously, there is a lag in the fatalities and unless medical intervention becomes more effective, short term increase in rate of fatalities per day would continue until reaching the lag time for the current rate of case reporting.

FlareArmed2

9th Feb 2020, 06:08

Update for 8 Feb. Total number of cases:

https://cimg6.ibsrv.net/gimg/pprune.org-vbulletin/667x750/200208_ncov_3237a3628e49fe126be3b3ac2b830537cf42c8aa.png
"Cases" are number of cases reported in mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Y-axis is plotted as a logarithm, so straight lines on graph show the exponential rate.
Coloured lines on chart are lines of best fit to mainland China data showing the daily increase in number of cases.

The rate of increase each day:

https://cimg7.ibsrv.net/gimg/pprune.org-vbulletin/943x530/200208_ncov_rate_43ed5a9f45de076cd4bc06083d21f9f126bf5fca.pn g
"Daily change" for mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Coloured lines on chart are linear lines of best fit.
Lines extending beyond data points are extrapolated and therefore not data-based but are speculative.

The rate of increase each day is trending downwards which is good. Overall the trend for mainland China matches the trend for the ROW pretty closely, with the total numbers in the ROW being about 1% of the mainland China numbers. If there is under reporting in either series it is either (1) too small to notice or (2) both series under-report by the same proportional amount.

The reduction in daily increase is significant. For example, had the initial trend of 50% per day increase continued to today, there would be about 485,000 cases in China and about 4,800 cases in the ROW, whereas the actual numbers today are about a tenth of that. So major strides have been made to contain the spread of nCoV so far.

Will we get to zero growth on or about 12 Feb? I've been doing these graphs for a while now and the extrapolation on the daily change graph has consistently crossed the zero line on 12 Feb (graph on 7 Feb (https://www.pprune.org/rumours-news/629265-ba-cancel-all-flights-china-due-coronavirus-post10682277.html#post10682277), 6 Feb (https://www.pprune.org/rumours-news/629494-ncov-its-effect-aviation.html#post10681376), 3 Feb (https://www.pprune.org/passengers-slf-self-loading-freight/629057-cdc-begins-passenger-funneling-re-2019-ncov-4.html#post10679298)). Today I read this article (https://www.msn.com/en-us/news/world/virus-outbreak-in-wuhan-may-peak-with-more-than-5-25-infected/ar-BBZNlpO) which says in part:

Trends in reported cases in Wuhan so far broadly support the mathematical modeling (https://cmmid.github.io/ncov/wuhan_early_dynamics/index.html) the London School of Hygiene & Tropical Medicine is using to predict the epidemic’s transmission dynamics.“Assuming current trends continue, we’re still projecting a mid-to-late-February peak” in Wuhan, said Adam Kucharski (https://www.lshtm.ac.uk/aboutus/people/kucharski.adam), an associate professor of infectious disease epidemiology, in an email Sunday. “There’s a lot of uncertainty, so I’m cautious about picking out a single value for the peak, but it’s possible based on current data we might see a peak prevalence over 5%.”

...based their modeling on a range of assumptions about the 2019-nCoV virus. These include an incubation of 5.2 days, a delay from the onset of symptoms to confirmation of infection of 6.1 days, and the risk of infection among the 10 million people who have been identified as more vulnerable in Wuhan.

Based on that, a prevalence of 5% equates to about 500,000 cumulative infections.

When they mention 5% prevalence they are talking about all those infected, not just those that are so sick they report to hospital and get tested (which is what the John Hopkins data uses). What is interesting is that their modelling also shows a "mid to late-Feb peak" which means my guesswork of 12 Feb is at least ballpark. They would know much better than me, of course, so I make no claims that I am more right; quite the opposite, extrapolation is speculative, I say that in the footnotes below the graph.

So for the sake of all our aviation careers, perhaps the "end of the beginning" is in sight...

ORAC

9th Feb 2020, 07:44

How accurate are those figures being reported from Wuhan?

https://twitter.com/badiucao/status/1226226906724364288?s=21

ORAC

9th Feb 2020, 13:42

https://www.straitstimes.com/singapore/coronavirus-singapore-confirms-3-more-coronavirus-cases-including-71-year-old-grandfather

3 new coronavirus cases in Singapore

SINGAPORE - A 71-year-old grandfather and a Bangladeshi worker are among three new coronavirus cases confirmed here on Sunday (Feb 9), said the Ministry of Health (MOH). The third case is a 54-year-old Singaporean man who works at Resorts World Sentosa.

All three have no currently known links to previous cases or recent travel history to China.

The total number of people infected here (https://www.straitstimes.com/singapore/health/novel-coronavirus-cases-in-singapore) has grown to 43. Six are now in critical condition and in the intensive care unit, up from four previously, said MOH in its latest update......

ORAC

9th Feb 2020, 13:49

Regardless, total ban on all Chinese passengers remains in force.

https://www.phillyvoice.com/four-passengers-royal-caribbean-cruise-ship-nj-coronavirus/

Four passengers on Royal Caribbean cruise ship in NJ cleared of coronavirus

Four Royal Caribbean passengers who were hospitalized and tested for coronavirus have been cleared of the illness after results came back negative, New Jersey Gov. Phil Murphy said in a statement on Saturday. "After the evaluation at the hospital, the Center for Disease Control permitted the four individuals who arrived Friday via a cruise ship to be discharged," Murphy said.......

Royal Caribbean announced on Saturday evening (https://www.royalcaribbean.com/cruise-ships/anthem-of-the-seas-updates) that the Anthem of the Seas cruise ship, which is still docked in Bayonne, will now set sail on Monday for its next cruise and return to New Jersey next Saturday.......

ORAC

9th Feb 2020, 14:29

https://www.thenews.com.pk/latest/611396-six-new-coronavirus-cases-found-on-japan-cruise-ship

Six new coronavirus cases found on Japan cruise ship

TOKYO:: Six more people on a cruise ship off Japan are found to have the new coronavirus, the government said on Sunday, bringing the number who have tested positive on board to 70.

Test results are still coming in as passengers on the Diamond Princess face a two-week quarantine against the virus, which has killed hundreds of people, most of them in China. Japanese authorities had earlier tested 279 people on board the cruise ship, finding 64 of them were infected with the coronavirus.

The Diamond Princess was quarantined after a former passenger who disembarked in Hong Kong last month was diagnosed with the virus.

There were more than 3,700 passengers and crew on the ship when it arrived off Japan's coast last week. Dozens have been taken to hospital and around 3,600 people, many of them elderly, were still on board on Sunday. It was not clear whether Japanese authorities would conduct tests on all of them.

The ship docked in Yokohama on Sunday to resupply for a quarantine that could last until February 19. Local reports said Japan's health authorities brought urgently needed drugs and other medical supplies to some 500 people. About 100 said they had a fever or felt unwell, according to the reports......

Television footage has shown a Japanese flag hung on a balcony with the message: "Drug shortage is serious."

davidjohnson6

9th Feb 2020, 16:46

Has there been any effect on sales of air tickets in the last week for itineraries which do not involve mainland China / Hong Kong or pax connecting to these destinationd ? If demand has been affected, is it just Japan, Singapore and Thailand or has demand been affected more widely ?

apaletta

9th Feb 2020, 18:08

Sounds reasonable. Just wondering when/if others wilk follow? Gulf carriers? US carriers?

I believe Delta and AA have.

JanetFlight

9th Feb 2020, 23:56

Pardon me the sligthly OffTopic (this is a very recent study published by recognized and credited medical Journal JAMA) says that maybe according new studies and experiences, there is a great probability that almost / a great percentage of Wuhan cases were infected at the hospital and not at the common city places...very interesting read.
Some says could be a ton of cases where a lot of people were only normal flu, but with the "Hysteria/Fear - pardon me the expression" went to the hospital with a normal flu thinking they had the Corona (but not), and really got it after arriving there...if this is true could start to make things flow in another way of thinking....weird but indeed very plausible.

https://edition.cnn.com/2020/02/08/health/coronavirus-hospital-infections-frieden/index.html

CurtainTwitcher

10th Feb 2020, 02:48

Reporter's Notebook: Life and death in a Wuhan coronavirus ICU (https://www.straitstimes.com/asia/east-asia/reporters-notebook-life-and-death-in-a-wuhan-coronavirus-icu)An important article from the Straight Times interviewing Dr Peng Zhiyong, director of acute medicine at the Wuhan University South Central Hospital. Note, the clinical criteria for diagnosis was very restrictive until the 18th of January (requirement for a positive test) before being relaxed, this will have a significant bearing on the data on confirmed cases.

The number of patients in the interview also matches the JAMA publication Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China (https://jamanetwork.com/journals/jama/fullarticle/2761044) which appeared recently.

ORAC

10th Feb 2020, 06:41

https://www.nytimes.com/2020/02/10/world/asia/coronavirus-china.html

Coronavirus cases on a cruise ship in Japan nearly double, surpassing 130.

An additional 66 cases of the new coronavirus have been confirmed on a cruise ship quarantined in Yokohama, Japan, raising the total number to 136, the ship’s captain told passengers on Monday.......

Passengers have grown increasingly fearful that the quarantine is putting them in jeopardy. The Japanese authorities have tested a few hundred people for the coronavirus who were believed to be at particular risk, but as the number of cases has risen, some passengers have pressed for everyone on board to be screened. For days, Japanese officials have said they do not have the capacity to test all 3,700 people on board. But on Sunday, the health minister, Katsunobu Kato, said his ministry needed to consider whether it could do so, while noting the challenges of carrying out such a large screening.

China records most deaths from the virus in a single day.

Ninety-seven people died from the coronavirus on Sunday, a new daily record since the new coronavirus was first detected in December, as the death toll rose to 908, China’s National Health Commission said on Monday.......

Twitter

10th Feb 2020, 08:34

On the Diamond Princess, the previous daily trend:
1,2,4,10,20,41,61 - yesterday 70, today 136.

Good luck to all there.

ORAC

10th Feb 2020, 09:37

Reportedly in Brighton, whether the people previously self-isolating or others is not clear.

https://www.bbc.co.uk/news/uk-51442314

https://www.theargus.co.uk/news/18223614.coronavirus-brighton-four-new-cases-confirmed/

Coronavirus: Four more people diagnosed in UK

The number of people infected by the coronavirus in the UK has doubled to eight - after four more patients in England tested positive for the virus.....

Confirming the four new cases on Monday, chief medical officer for England Prof Chris Whitty said they were all "known contacts of a previously confirmed UK case, and the virus was passed on in France". He added that they have been transferred to specialist NHS centres at Guy's and St Thomas' and the Royal Free hospitals in London..........

It comes as the government announced new powers to keep people in quarantine to stop the spread of the virus. In order to do this the Department of Health has described the coronavirus as a "serious and imminent threat" to public health"......

The BBC's political correspondent Iain Watson said the new measures were announced because a passenger on the first UK flight from Wuhan, who is currently being held in quarantine on the Wirral, "is threatening to abscond". "Currently the regulations are not strong enough to stop him leaving before the 14-day period is up so they brought in these new regulations to try and compel him to stay put," he said.

Twitter

10th Feb 2020, 12:47

ORAC

10th Feb 2020, 13:43

Then again, he didn’t have any symptoms when he infected the others in the ski chalet before flying home to the UK either.......

https://www.manchestereveningnews.co.uk/news/uk-news/easyjet-statement-coronavirus-passenger-appeal-17720950

Easyjet warns passengers after coronavirus 'super spreader' flies to UK

Budget airliner EasyJet is urging passengers who travelled on a flight from Geneva to London Gatwick to speak to health officials - after a fellow passenger was later found to have coronavirus. The British man, who became infected at a work conference in Singapore appears, to be linked to 11 other confirmed cases in England and Europe, prompting fears he is a 'super spreader' of the potentially deadly virus.

An easyJet spokeswoman said: "EasyJet has been notified by the public health authority that a customer who had recently travelled on one of its flights has since been diagnosed with the coronavirus. Public Health England is contacting all passengers who were seated in the vicinity of the customer on flight EZS8481 from Geneva to London Gatwick on 28 January to provide guidance in line with procedures. As the customer was not experiencing any symptoms, the risk to others on board the flight is very low.

"We remain in contact with the public health authorities and are following their guidance. The health and well-being of our passengers and crew is the airline's highest priority.”.....

JanetFlight

10th Feb 2020, 13:46

Reports now, that a pax from GVA to LGW on EZS 8481 28.Jan has since proved positive for the disease.
Company contacting all pax seated in his area. Not quite sure how that works with Easy seating arrangements. Perhaps they will contact all of them.
And as a few days have passed, more folk will have been in contact with pax - and crew.
Problem in Europe is that we are operating with no precautions - until something happens.

And now what are we going to do... To ban and forbidding all easyJet flts into our airports as we did with some Chinese airlines, to not allow incoming flts from Geneva or even Gatwick...!?
Perhaps we shall close entire Europe too...

ORAC

10th Feb 2020, 13:49

https://www.theargus.co.uk/news/18223764.coronavirus-brighton-live-updates-four-new-cases/

Patients of a Brighton GP who tested positive for coronavirus are being urgently traced. Her surgery was closed this morning, almost two weeks after she returned from skiing holiday with the man at the centre of the Brighton cases.

A deep clean is currently taking place at County Oak Medical Centre after it was confirmed a member of staff has coronavirus..........

ORAC

10th Feb 2020, 14:10

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/

Imperial College London - Report 4: Severity of 2019-novel coronavirus (nCoV)

Summary Report 4

We present case fatality ratio (CFR) estimates for three strata of 2019-nCoV infections.

For cases detected in Hubei, we estimate the CFR to be 18% (95% credible interval: 11%-81%).

For cases detected in travellers outside mainland China, we obtain central estimates of the CFR in the range 1.2-5.6% depending on the statistical methods, with substantial uncertainty around these central values.

Using estimates of underlying infection prevalence in Wuhan at the end of January derived from testing of passengers on repatriation flights to Japan and Germany, we adjusted the estimates of CFR from either the early epidemic in Hubei Province, or from cases reported outside mainland China, to obtain estimates of the overall CFR in all infections (asymptomatic or symptomatic) of approximately 1% (95% confidence interval 0.5%-4%).

It is important to note that the differences in these estimates does not reflect underlying differences in disease severity between countries. CFRs seen in individual countries will vary depending on the sensitivity of different surveillance systems to detect cases of differing levels of severity and the clinical care offered to severely ill cases.

All CFR estimates should be viewed cautiously at the current time as the sensitivity of surveillance of both deaths and cases in mainland China is unclear. Furthermore, all estimates rely on limited data on the typical time intervals from symptom onset to death or recovery which influences the CFR estimates.

ORAC

10th Feb 2020, 15:05

So much for the quarantine.......

https://www.independent.co.uk/news/world/asia/coronavirus-incubation-period-symptoms-china-sars-length-days-time-a9326591.html

Coronavirus could have incubation period of 24 days — 10 days longer than previously thought

Medical researchers in China have found the incubation period for coronavirus (https://www.independent.co.uk/topic/coronavirus) ranges up to 24 days — 10 days longer than experts previously thought. The research was co-authored by Dr Zhong Nanshan, who discovered the SARS coronavirus in 2003 and has been appointed as a leading advisor in managing the current coronavirus crisis.

Current advice from health organisations and ministries say the virus’ incubation period is as long as 14 days, based on the incubation period of previous MERS viruses. Public Health England (https://www.independent.co.uk/topic/public-health-england) and the Department of Health and Social Care has urged anyone travelling from specific countries, including China, to quarantine themselves at home for 14 days.

The findings, which have not yet been peer reviewed, were published on Sunday and titled ‘Clinical characteristics of 2019 novel coronavirus infection in China (https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1)’.

Researchers extracted data from 1,099 coronavirus patients from 522 hospitals in 31 provinces in China. They found only 1.18 per cent of patients “had a direct contact with wildlife”. The majority of the patients had contracted the virus from being in contact with people from Wuhan (https://www.independent.co.uk/topic/wuhan), where the centre of the outbreak is.

More than 80 percent of patients developed lymphopenia, which is a state where a specific white blood cell that is part of the body’s first-line defence against diseases is reduced. Lymphopenia is commonly caused by infections and the flu, and usually recovers on its own after the patient recovers.

The 55 patients observed in the study were admitted into the intensive care unit, some with severe pneumonia as a result of the virus. Of those patients, 15 died.

The research concluded that the virus “spreads rapidly by human-to-human transmission” and its severity “predict poor clinical outcomes”.........

https://twitter.com/williamyang120/status/1226784315133980672?s=21

Rood

10th Feb 2020, 15:23

Would be interesting if anyone has access to historical flight data to know what the tailcode for that Easyjet flight was and see where else that aircraft flew in the past two weeks.

Also nobody has mentioned how he got to Geneva. Am guessing an Emirates flight via Dubai but are those crew and passengers being contacted?

Twitter

10th Feb 2020, 15:37

Also nobody has mentioned how he got to Geneva. Am guessing an Emirates flight via Dubai but are those crew and passengers being contacted?

Was connected with the French skiing chalet case. Incubation period is leading to lag in recognition and lag in taking precautions, as well as difficulty in follow up. It’s a bugger.

ORAC

10th Feb 2020, 16:17

Brighton A&E sets up dedicated area for patients

A seperate area has been set up at accident and emergency to deal with potential coronavirus cases.

The Royal Sussex County Hospital has set up a dedicated pod to deal with possible cases of the disease. Signs direct those possibly contaminated to use the special entrance rather then enter the main A&E department.

https://cimg1.ibsrv.net/gimg/pprune.org-vbulletin/620x992/image_760868912bea3c84b3cc9129bfc9164988c99dbe.jpeg

ORAC

10th Feb 2020, 17:11

Flights

British Airways has extended the suspension of flights serving Chinese cities amid concerns over the spread of coronavirus.

On Monday the airline said flights to and from Beijing and Shanghai had been cancelled until March 31.

In a statement, BA said: “We are contacting customers on cancelled flights so we can discuss their travel options, including rebooking onto other carriers where possible, full refunds or booking with BA for a later date of travel. Safety is at the heart of everything we do and we will keep the situation under review.”

Virgin Atlantic extended the suspension of its flights to mainland China last week. The airline said flights on its Heathrow-Shanghai route would not be in operation until March 28.

OldnGrounded

10th Feb 2020, 19:36

Longtimer

10th Feb 2020, 23:21

On the Diamond Princess, the previous daily trend:
1,2,4,10,20,41,61 - yesterday 70, today 136.

Good luck to all there.
Just remmber, despite the tight quarters, there are over 3500 other folks on the ship so the rate of infection is still under 3%.

Winemaker

10th Feb 2020, 23:56

Just remmber, despite the tight quarters, there are over 3500 other folks on the ship so the rate of infection is still under 3%.

Tight quarters indeed, and that can really be the problem. The service crew are living four to a room and eat buffet style. Those same people are preparing and delivering food to the passengers. With an incubation period of five or six days I suspect it's too late to prevent spread. If tomorrow's number is 200 cases the cat is long out of the bag.... Does the 14 day quarantine clock reset each time there is a new case?

FlareArmed2

11th Feb 2020, 02:41

Update for 10 Feb. Total number of cases:

https://cimg0.ibsrv.net/gimg/pprune.org-vbulletin/667x750/200210_ncov_0033ac3cf96ce7be423704660f7697721fc801b2.png
"Cases" are number of cases reported in mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Y-axis is plotted as a logarithm, so straight lines on graph show the exponential rate.
Coloured lines on chart are lines of best fit to mainland China data showing the daily increase in number of cases.

The rate of increase each day:

https://cimg2.ibsrv.net/gimg/pprune.org-vbulletin/943x530/200210_ncov_rate_a24e244225c32970c683aee4e35d99af14872752.pn g
"Daily change" for mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Coloured lines on chart are linear lines of best fit.
Lines extending beyond data points are extrapolated and therefore not data-based but are speculative.

The rate of increase each day is trending downwards which is good. The recent rate of increase (since 2 Feb) in mainland China has dropped from 16% (based on data to 6 Feb (http://www.pprune.org/rumours-news/629494-ncov-its-effect-aviation.html#post10681376)) to 12% (based on data to 10 Feb). Overall the trend for mainland China matches the trend for the ROW pretty closely, with the total numbers in the ROW being about 1% of the mainland China numbers. If there is under reporting in either series it is either (1) too small to notice or (2) both series under-report by the same proportional amount.

The reduction in daily increase is significant. For example, had the initial trend of 50% per day increase continued to today, there would be about 1,087,000 cases in China and about 10,800 cases in the ROW, whereas the actual numbers today are a fraction of that. So major strides have been made to contain the spread of nCoV so far.

Will we get to zero growth on or about 12 Feb? I've been doing these graphs for a while now and the extrapolation on the daily change graph has consistently crossed the zero line on 12 Feb (graph on 8 Feb (https://www.pprune.org/rumours-news/629265-ba-cancel-all-flights-china-due-coronavirus-8.html#post10683067), 7 Feb (https://www.pprune.org/rumours-news/629265-ba-cancel-all-flights-china-due-coronavirus-post10682277.html#post10682277), 6 Feb (https://www.pprune.org/rumours-news/629494-ncov-its-effect-aviation.html#post10681376), 3 Feb (https://www.pprune.org/passengers-slf-self-loading-freight/629057-cdc-begins-passenger-funneling-re-2019-ncov-4.html#post10679298)). We could be surprised by a new surge in numbers but I remain optimistic that growth will reach zero sometime in February, and hopefully soon.

fdr

11th Feb 2020, 03:05

Update for 10 Feb. Total number of cases:

https://cimg0.ibsrv.net/gimg/pprune.org-vbulletin/667x750/200210_ncov_0033ac3cf96ce7be423704660f7697721fc801b2.png
"Cases" are number of cases reported in mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Y-axis is plotted as a logarithm, so straight lines on graph show the exponential rate.
Coloured lines on chart are lines of best fit to mainland China data showing the daily increase in number of cases.

The rate of increase each day:

https://cimg2.ibsrv.net/gimg/pprune.org-vbulletin/943x530/200210_ncov_rate_a24e244225c32970c683aee4e35d99af14872752.pn g
"Daily change" for mainland China (M. China) and rest of the world (ROW), from John Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Coloured lines on chart are linear lines of best fit.
Lines extending beyond data points are extrapolated and therefore not data-based but are speculative.

The rate of increase each day is trending downwards which is good.

The reduction in daily increase is significant.

Will we get to zero growth on or about 12 Feb? I've been doing these graphs for a while now and the extrapolation on the daily change graph has consistently crossed the zero line on 12 Feb (graph on 8 Feb (https://www.pprune.org/rumours-news/629265-ba-cancel-all-flights-china-due-coronavirus-8.html#post10683067), 7 Feb (https://www.pprune.org/rumours-news/629265-ba-cancel-all-flights-china-due-coronavirus-post10682277.html#post10682277), 6 Feb (https://www.pprune.org/rumours-news/629494-ncov-its-effect-aviation.html#post10681376), 3 Feb (https://www.pprune.org/passengers-slf-self-loading-freight/629057-cdc-begins-passenger-funneling-re-2019-ncov-4.html#post10679298)). We could be surprised by a new surge in numbers but I remain optimistic that growth will reach zero sometime in February, and hopefully soon.

You are referring to the differential, which is the rate of change of the numbers of cases, not the additional numbers of cases. Once this goes into a negative territory, the case numbers will still continue to increase, the increase will just not be exponential or accelerating, and that is definitely good news, it indicates that some form of mitigation is occurring, which may be isolation, weather change, infection control discipline, under reporting of numbers, but the "rate" of change is altering in a desirable direction. To get the case numbers to peak, the additional cases on a daily basis have to drop to zero, which is well off in the future. So far, the virus has been playing fair, it hasn't altered it's behaviour greatly, so if the collective knowledge and skills of the medical fraternity come up with effective protocols, and the great majority of us the unwashed masses adhere to those protocols, then this can be curtailed.

We appear to be surprised as always that the medical system ends up being involved in the transmission of these viruses; they are a natural focus for people with infection, and the understanding that the patient has a new form of infection takes a finite time to ascertain. In the absence of information, then infections arise.

FlareArmed2

11th Feb 2020, 04:12

If, and I stress if this change of definition turns out to be correct, then the official Chines figures are cannot be considered reliable to tracking the progress in their population...

I get figures from John Hopkins (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6), they in turn get their data from a wide variety of sources not just the Chinese government. They have a blog here (https://systems.jhu.edu/research/public-health/ncov/) for those that wish to deep dive.

At the end of the day I don't really know how accurate anything on the internet is. I can point out that the trajectory of data in mainland China matches the rest of the world. If there is a significant diversion between the two then I think the idea that some numbers don't add up would be a supportable hypothesis; but I don't see that right now. But that's just me, you might have another take on it. I honestly don't know.

ORAC

11th Feb 2020, 06:26

Beijing reports 5 new confirmed cases of novel coronavirus infection - Xinhua | English.news.cn (http://www.xinhuanet.com/english/2020-02/11/c_138773781.htm)

Beijing reports 5 new confirmed cases of novel coronavirus infection

BEIJING, Feb. 11 (Xinhua) -- Beijing reported five new confirmed cases of the novel coronavirus on Monday, bringing the number of infections in the capital to 342, the Beijing Municipal Health Commission said Tuesday. The new confirmed infected patients have been sent to designated medical institutions for treatment, the commission said.

By the end of Monday, a total of 342 infections have been reported in Beijing. Among them, 48 patients have been discharged from hospital after recovery and there were three deaths. Statistics showed the infections are scattered in 15 of the 16 districts of Beijing except Pinggu District. Among the confirmed cases, 25 were from outside the capital.

Beijing has rolled out a series of measures to curb the spread of the novel coronavirus. Beijing subway and bus operators increased the frequency of buses and subway trains, limited passenger numbers during rush hours and enhanced disinfection as the extended New Year holiday ended and more employees returned to work.

Residential communities are also required to enhance anti-virus measures.

ORAC

11th Feb 2020, 06:38

Twitter

11th Feb 2020, 08:58

https://www.theargus.co.uk/news/18225378.brighton-coronavirus-it-spiralling-control/

Brighton coronavirus: 'It is spiralling out of control'

Health bosses have let coronavirus “spiral out of control” by “intentionally hiding” information.

That is according to furious Professor Samer Bagaeen, a leading figure on Brighton and Hove (https://www.theargus.co.uk/news/by_location/brighton_hove_news/) City Council’s Health board. He was speaking as the fifth case of the killer virus was diagnosed in Brighton (https://www.theargus.co.uk/sport/albion/)........

So we may gain a sense of proportion - this local outbreak was caused by one bloke visiting a pub. The principle is the same but the extent not - yet.

Meantime unfortunate black humour by the BBC today:

https://cimg2.ibsrv.net/gimg/pprune.org-vbulletin/716x213/0ef695b6_ec77_4355_8b0a_a08dea263a36_2dd55011a25386b75b34c20 ba88a9a4df95f2842.jpeg

ORAC

11th Feb 2020, 09:14

So we may gain a sense of proportion - this local outbreak was caused by one bloke visiting a pub. The principle is the same but the extent not - yet.
Unfortunately not true.

Two of those who were with him in the ski chalet were local Brighton GPs (doctors) who returned to work on their return. The clinic of of one, County Oak, has been closed and disinfected as other staff have been identified as infected and the NHS is trying to trace the patients they have seen since their return.

A medical student from Sussex University, who has doing training at the clinic, has been taken from the university campus accommodation in an ambulance and is now in isolation. A Bevendean primary school teacher who was in close contact of one of those identified as infected has been placed in isolation and the parents told they can keep their children at home.

And so it spreads.

https://www.theargus.co.uk/news/18223764.coronavirus-brighton-live-updates-four-new-cases/

Twitter

11th Feb 2020, 09:38

Thanks for that correction ORAC. Here is the source of the pub story:

https://www.dailymail.co.uk/news/article-7984385/Hundreds-people-tested-coronavirus-French-Alps.html

Diesel_10

11th Feb 2020, 09:39

Steve Walsh identified as the Superspreader in this case.

Apparently 'Fully Recovered' according to the Evening Standard.....which goes on to say he never experienced any symptoms ????

So he's apparently miraculously cured from what exactly? Poor journalism or is this virus more sinister than we thought??

ORAC

11th Feb 2020, 10:23

Which is the problem, carriers can be totally asymptomatic as they spread the infection without being detected and diagnosed.

For a bit of history......

https://en.wikipedia.org/wiki/Mary_Mallon

galacticosh

11th Feb 2020, 12:09

There are now Chinese Airlines flying internal European routes after arriving from China on at least 1 pairing I know of. Maybe it’s been going on for a while but it’s the first I’ve heard of it. BA stopping flying is good but these guys aren’t.

ORAC

11th Feb 2020, 12:50

If there was absolutely one place you didn’t want one of those two GPs to visit........

https://www.theargus.co.uk/news/18223764.coronavirus-brighton-live-updates-four-new-cases/

Nursing home sealed off

A nursing home is closed to visitors after a GP with coronavirus attended last week. Two Brighton doctors have been diagnosed with coronavirus since the outbreak in the city.

A spokeswoman for Patcham Nursing Home in Brighton confirmed they had stopped allowing visitors.........

Twitter

11th Feb 2020, 15:30

So now it is called Covid-19.
Better than Novi-chok.

ORAC

11th Feb 2020, 16:03

https://www.businessinsider.com/westerdam-cruise-ship-denied-entry-five-ports-thailand-no-coronavirus-2020-2

'Floating around the ocean': A Westerdam cruise ship has been turned away by 5 countries despite no passengers testing positive for coronavirus

On Tuesday, Thailand became the fifth country to deny entry to the Westerdam luxury liner amid coronavirus fears.

The luxury liner departed Hong Kong on February 1 and set sail on a 14-day cruise to Taiwan and Japan. Although Westerdam operator, Holland America Line, says none of its 1,455 guests and 802 crew members have coronavirus, the ship has already been turned away by Taiwan, Japan, the Philippines, and the US territory of Guam.

The World Health Organization said Thai officials may board the ship to investigate the passengers' health conditions before deciding whether they should be "allowed to eventually disembark in Thailand."

Some passengers are growing extremely concerned after being stranded at sea, while others are trying to keep their spirits up.......

Longtimer

11th Feb 2020, 18:39

Interesting perspective:
https://cimg0.ibsrv.net/gimg/pprune.org-vbulletin/792x781/epidemics_6ceb1adca129840dedb13f7f11ebc8ff6b9c84db.jpg

ORAC

11th Feb 2020, 19:40

Quite... draconian, in their use of the latest government powers.......

https://www.theargus.co.uk/news/18227689.fresh-suspected-coronavirus-case-nurses-mill-view-hospital-held-quarantine/

Coronavirus Brighton: Nurses at Mill View Hospital held in quarantine

Nurses are being held in quarantine after treating a patient with a new suspected case of coronavirus, a source has told The Argus.

Two nurses treating a woman at The Haven in Mill View hospital, Hove, are being kept in a room next door to the patient, the source said. It is understood the patient had recently returned from Hong Kong.

The two nurses at the psychiatric hospital have been held there since 8.30pm yesterday evening, the Argus was told. They have not been allowed to leave, and one of the nurses is said to be pregnant.

It comes after five people were confirmed to have the virus in the city.........

Sussex Partnership NHS trust initially refused to comment. But just before 8pm, a spokesman for the trust said: "As is the case across the NHS, if we identify any individual displaying some of the symptoms consistent with coronavirus we will take proportionate, timely action in line with Public Health England guidance."......

Twitter

12th Feb 2020, 06:10

ORAC

12th Feb 2020, 06:17

It’s gone a bit quiet concerning the Diamond Princess at Yokohama. Media are still publishing the figure of infected folk from 2 days back. (originally reported as 136 - now as 135 cases). This could be good news. Let’s hope so.

https://www.japantimes.co.jp/news/2020/02/12/national/science-health/40-new-coronavirus-cases-cruise-ship-quarantined-japan/

Japan confirms 40 new coronavirus cases linked to cruise ship quarantined off Yokohama

Thirty-nine more passengers and crew members on the Diamond Princess cruise ship and one quarantine officer have tested positive for the new coronavirus, health minister Katsunobu Kato said Wednesday morning. The new cases bring the total linked to the ship to 175.

“Out of 53 new test results, 39 people were found positive,” he told reporters, referring to the figure for passengers. He added that: “At this point, we have confirmed that four people, among those who are hospitalized, are in a serious condition, either on a ventilator or in an intensive care unit.”.......

Twitter

12th Feb 2020, 07:17

Good source ORAC. Just seen it on NHK news too...

Twitter

12th Feb 2020, 14:07

However the crew - over 1,000 of them, is reported to be worried - no private rooms and claiming unsuitable protection.

ORAC

12th Feb 2020, 18:10

First case in London confirmedThe Guardian has confirmed that a coronavirus case has been diagnosed in London. The victim is understood to be a woman and is on her way to hospital, a source said.

Referring to the diagnosis in London that emerged less than an hour ago (https://www.theguardian.com/world/live/2020/feb/12/coronavirus-live-updates-deaths-infections-symptoms-transmission-wuhan-china-cruise-ship-quarantine-cases-latest-update-news?page=with:block-5e4442368f086a28115aa987#block-5e4442368f086a28115aa987), the chief medical officer, Prof Chris Whitty, has said:

One further patient in England has tested positive for novel coronavirus (COVID-19), bringing the total number of cases in the UK to nine. This virus was passed on in China (https://www.theguardian.com/world/china) and the patient has now been transferred to a specialist NHS centre at Guy’s and St Thomas’ in London.

OldnGrounded

12th Feb 2020, 19:55

slats11

12th Feb 2020, 20:56

https://www.scmp.com/week-asia/health-environment/article/3050308/coronavirus-some-people-may-succumb-says-singapore

50 cases
8 critical – with no discernible pattern among these 8
Population told to prepare that some may not survive

Singapore is probably the place to watch now. They appear to be completely transparent re this.

Chinese data is complete rubbish. They are too many rumours they have been under-reporting, and they changed their definition of the disease just as their leader promised the cases would start to fall.

We have been here before with China and Coronavirus
https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome
China was the only country in the world with meaningful numbers (over 100 cases) to report mortality less than 10% - everyone else was 2-3 x higher.

Currently 99% of the global data is from China. I wouldn't make any predictions based on that.

Winemaker

12th Feb 2020, 23:24

Strange numbers from the Johns Hopkins site today, a huge jump of Chinese cases, from 44.7k yesterday to 59.6k today. Previous increases were in the 1k to 2k range.

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

etudiant

13th Feb 2020, 03:33

fdr

13th Feb 2020, 03:56

Strange numbers from the John Hopkins site today, a huge jump of Chinese cases, from 44.7k yesterday to 59.6k today. Previous increases were in the 1k to 2k range.

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

It may be:

an improvement of the testing,
a further outbreak such as from delayed symptoms
a correction in underreporting of existing cases. That could be the result of the testing turnaround time, or the real figures being washed back into the data.

The death rate spike is of concern, and may be from re-categorisation of COD.

Not good news though for PRC at the very least. The rest of the world still lags in fatalities arising which may well indicate co factors exist.

The concern of the extended incubation period out to 24 days or so is a major complication on the face of it, however, that does not logically tie in with the general progression of illness from the virus. If the 24 days was the case from the get go, then the growth rate would have been explosive, at any level of infectiousness. The recent cases show multiple contacts occur resulting in spread, Each person appears to get about 3 others infected, per day (very roughly, it has been lower and higher). One person doing that for 24 days before any symptoms is going to give a major jump in numbers, even if they are not contagious for a couple of days, the breakout is very large.

Day 1: 1, Day 2: 1, Day 3: 4, Day 4:10, ... Day 24: 1,594,289

So assuming 24 days incubation prior to symptoms of any kind, and an initial period of 48 hours from contact to being infectious, then the progression would be 1.6M infections prior to first symptom appearing. Thereafter, the progression of symptoms would be around 59K (roughly todays number of cases) 18 days after first symptoms noted. The outbreak first symptoms were on or about 8th December. If the infection was 24 days prior, then the cases on 26 Dec would be around the 59K level, 30 days later, around 25 Jan 2020 we would have symptoms from 3.3 Billion people. That didn't happen, so there is a fair possibility that the 24 day incubation case is a shorter incubation from an unknown source. If indeed it was 24 days, then right now, we have all on this planet been infected... and essentially it is unfortunate to be immuno-compromised, and it'll sort itself out in the wash. That is merely based on 3 contacts per day per person, which is well below the level of contacts that the average adult has in any day. Each progression is unique but within a statistical spread, so that can be added to the equation as a Monte Carlo input.

It is possible to have a single delayed progression, all things are possible, but on average, the incubation period is going to be in the 4-12 day period, with the 24 day being an anomaly or a later contraction of the virus than presumed.

OTOH, if the great mass of the planet has already got the virus, then it has a lower adverse outcome than the seasonal flu does.

The recent increase in numbers should be considered in context, the Wuhan jump is in a region under major stress on resources, that affects accuracy and control and outcome mitigation efforts. Japan gets to add the cases of the cruise ships that are great concentrators of bugs on a good day. They also permit control of the development to an extent and provide isolation from the greater population.

rog747

13th Feb 2020, 04:37

The HAL cruise ship Westerdam is now allowed to dock in Cambodia (and disembark the pax)

BA canx's one of their 2 daily HKG's

The Cunard liner Queen Mary canx's all Far East port calls including Singapore, and she is now heading for Freemantle (Perth) on 18 Feb - 2 weeks at sea after she left Colombo!

Singapore is a worry - I really think the lid should now be closed...Latest travel advisory for all non-essential travel from more countries.

edit - Latest
BA 034 isolated on runway LHR 06.18 hours today
Currently sitting on BA 034, arrived one hour ago from KUL.
Passenger declared illness to crew.
Awaiting arrival of Port Authority Doctor.
LHR Fire Brigade in Hazmat gear outside the plane

CurtainTwitcher

13th Feb 2020, 06:04

FDR, the incubation period is a probability distribution, with the bulk of patients in the earlier portion of the period, it seems the first seven days or so. 100% will be positive within the 24 day window. This is perhaps why there are super spreaders, infectious, but asymptomatic for close to the full 24 days, but they are rare.

There was a WHO presser about a week ago, and the rates stated were 82% mild, 15% severe, 3% critical. The death rate in severe/critical was about 20%. This accords reasonably with the Diamond Cruise ship figures, as well as Singapore who seem to have quite clean data. The Straits Times has been covering this well.Coronavirus: 3 new cases in Singapore - 2 from Grace Assembly of God church, 1 from DBS (https://www.straitstimes.com/singapore/health/coronavirus-3-new-cases-in-singapore-2-from-grace-assembly-of-god-church-1-from-dbs)SINGAPORE - There are three more confirmed cases of the coronavirus infection here, bringing the total number of those who have been infected to 50.

Two of the new cases announced on Wednesday (Feb 12) are Singaporeans with no travel history to China. Both went to Grace Assembly of God church's sites in Tanglin and Bukit Batok.

The third is a Singaporean, also with no recent travel history to China. He works for DBS Bank at Marina Bay Financial Centre (MBFC), which had earlier asked some of its staff to work from home.

So far, 15 patients have recovered, while 35 are still in hospital.

Eight are now in critical condition, said Health Minister Gan Kim Yong at a press conference on Wednesday.

Mr Gan, who co-chairs a multi-ministry task force, said: "While most infected patients will recover, some may become seriously ill and a small number may succumb to the infection ultimately. We have to be prepared for the worst."

Link to the WHO presser, 7th Feb, the rates are discussed from 18:25

https://youtu.be/CQtuKNM5gCg

Twitter

13th Feb 2020, 08:04

Meantime on the ship, another 44 confirmed cases puts the total to 218.
The daily increase appears to have stabilised around 40 in a semi controlled environment (pax kept to rooms - crew not).
It should be noted, however that people who have been diagnosed are being removed from the vessel on a daily basis.
Latest news is that elderly people are to be evacuated - also those weakened by other illnesses.
Quarantine period scheduled to end next Wednesday - one week ahead.

Paul852

13th Feb 2020, 10:04

China was the only country in the world with meaningful numbers (over 100 cases) to report mortality less than 10% - everyone else was 2-3 x higher.Yes, but in the case of Hong Kong the mortality rate due to SARS (as opposed to with SARS - big difference) was much lower than the headline 300 figure normally reported.

Essentially, there was a panic overreaction by the HK medical establishment that meant patients were given huge doses of steroids. The HK "experts" are, of course, not proud of this, so it doesn't get talked about now. But it did slip out at the time and was reported in the South China Morning Post on 9 May 2003.

Professor Yuen Kwok-Yung, one of HK's "experts", said that SARS wasn't generally what killed otherwise healthy people then - it was due to the large doses of steroids, thereby turning their immune system off and causing them to die from whichever bug next passed by and which their body no long had a defence against. Many more people survived this "treatment" but were maimed for life. The HK Government has spent several hundred million HK$ in compensation and ongoing support to those unfortunates.

Contemporaneous screenshot of the article on the SCMP's website here: https://ibb.co/LhFDCwW

Details of the HK Government cock-up compensation fund here: https://www.swd.gov.hk/en/index/site...ub_trustfundf/ (https://www.swd.gov.hk/en/index/site_pubsvc/page_medical/sub_trustfundf/)

Winemaker

13th Feb 2020, 13:53

JanetFlight

13th Feb 2020, 18:32

Interesting...Airlines more exposed to Corona.

https://www.bloomberg.com/news/articles/2020-02-10/these-airlines-are-most-exposed-to-china-s-virus-outbreak-chart?fbclid=IwAR23PhxbgAGE6PQnBt03hppWVU0SsHBWYcutxl-iq1EePpeYZE8zC7k6CUU

Twitter

13th Feb 2020, 19:43

With new cases constantly showing up, how can the quarantine be ended? Seems like it would have to reset each time a new case appears; 14 days with no new cases...

In the context of a closed vessel, all personnel would need to be planned into teams and allocated fixed areas. Contact (in the service context) could only be made by each team, with a proportional segment of the passengers.
Also, crew members should only have contact amongst their own team.
In this way each new case would not affect the quarantine timing of the whole contingent and tracking is simplified. This might well be the way the service is being organised already but probably not the way the crew messing is organised.
The elderly pax to be evacuated are defined as being over 80 by the way.

FlareArmed2

14th Feb 2020, 00:50

Update for 14 Feb. Total number of cases:

https://cimg6.ibsrv.net/gimg/pprune.org-vbulletin/667x750/200214_ncov_3d0c0a3003055eaa442bc6e7bab3dbc257542c9c.png
"Cases" are number of cases reported in mainland China (M. China) and rest of the world (ROW), from Johns Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Y-axis is plotted as a logarithm, so straight lines on graph show the exponential rate.
Coloured lines on chart are lines of best fit to mainland China data showing the daily increase in number of cases.

The rate of increase each day:

https://cimg8.ibsrv.net/gimg/pprune.org-vbulletin/943x530/200214_ncov_rate_8d80a55956475271bddf3e8affa0841244b89b22.pn g
"Daily change" for mainland China (M. China) and rest of the world (ROW), from Johns Hopkins University (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
Coloured lines on chart are linear lines of best fit.
Lines extending beyond data points are extrapolated and therefore not data-based but are speculative.

What a difference a few days of bad data makes! Despite the increase in reported numbers, due to a change in diagnosis, the rate of increase is still tracking 12% per day since 2 Feb. I've said this in many previous posts: "Overall the trend for mainland China matches the trend for the ROW pretty closely, with the total numbers in the ROW being about 1% of the mainland China numbers. If there is under reporting in either series it is either (1) too small to notice or (2) both series under-report by the same proportional amount". I also said this: "We could be surprised by a new surge in numbers...". Well now we have had a significant change to reporting indicating that the Chinese data was under-reported. The Chinese data was levelling off but now it has continued its upward movement.

FlareArmed2

14th Feb 2020, 01:13

This article (https://news.yahoo.com/coronavirus-sharp-increase-deaths-cases-164234063.html) sums up the new numbers and their effect on data analysis pretty well:

Just about everyone who's been following China's official coronavirus numbers has been able to see that they have been incomplete. Government officials know this too. There's no way they've accounted for everybody infected. How could they?

But at least we had what appeared to be a trend. We could observe the pattern to try and estimate the trajectory of outbreak. Now that's gone too.

You can understand why it has been decided that people who have virus symptoms, plus a CT scan showing chest infection, are now being counted in the "definitely infected" column. However, this has thrown the trend mapping into chaos.

Over the past 24 hours in Hubei alone, nearly 15,000 people were moved into the infected column. This would have sent shockwaves around the world, but actually, if you consider Wednesday's cases by the old definition, the rate could well mean another day of decline: a completely different picture.

So now, we're scratching our heads: do we start looking at the pattern all over again from Thursday onwards? This has also left many wondering what the real death rate must have been over recent weeks and the extent to which we should be treating the overall figures seriously anyway...

https://cimg3.ibsrv.net/gimg/pprune.org-vbulletin/800x400/1581646382_8f4121ea7d83e81a9d8d9db452ac0b09fba68398.png

Australopithecus

14th Feb 2020, 01:30

OldnGrounded

14th Feb 2020, 02:07

On today’s data we are back to an additional 4000 cases. If yesterday’s spike is factored in, the additional case numbers average out to around 4000/day for the last ten days or so. Which is itself an oversimplification. Why would the case numbers grow linearly?

Apologies if this is repetitive, but I didn't see it addressed here, so . . .

It appears that the big jump in reported cases in China is a result of a change in the diagnostic protocol. As we know, they have been hopelessly backlogged trying to verify diagnoses with RT-PCR tests (the only way to do so accurately and quickly). So, now, they are simply judging (assuming, really) that patients showing signs of pneumonia on chest scans are coronavirus cases. Most probably are (there, at this time) and treatment is the same whatever virus may be causing the illness, so it makes good clinical sense to do this. That said, it makes the diagnoses rather less certain and created this big jump, since all those patients who had been through radiology but not been verified by PCR are suddenly "confirmed" cases.

fdr

14th Feb 2020, 03:47

I get figures from John Hopkins (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6), they in turn get their data from a wide variety of sources not just the Chinese government. They have a blog here (https://systems.jhu.edu/research/public-health/ncov/) for those that wish to deep dive.

At the end of the day I don't really know how accurate anything on the internet is. I can point out that the trajectory of data in mainland China matches the rest of the world. If there is a significant diversion between the two then I think the idea that some numbers don't add up would be a supportable hypothesis; but I don't see that right now. But that's just me, you might have another take on it. I honestly don't know.

https://cimg4.ibsrv.net/gimg/pprune.org-vbulletin/976x1064/screen_shot_2020_02_14_at_12_00_26_pm_9ae9b6f23b81006f8f8c4f c248acf1c05cd27b18.png

The "S" be silent?

There is possibly fair skepticism on the numbers that came out of China, which doesn't mean any intent to be deceptive, it is just as likely to be from the problems of responding to the new virus, establishing exactly what is and what isn't a case, and appropriately categorising the data of non COVID-19 (WuFlu) cases against the background cases of similar conditions, flu, pneumonia etc. For scale, the figures on seasonal flu deaths is bad enough, but the deaths from pneumonia alone are over 50,000 PA in the USA, so sorting out the signal from the noise is always problematic until there are reliable tests in place. The recent Chinese numbers reflecting the change in categorisation doesn't mean the situation is deteriorating, it puts the data in better perspective.

A curiosity with this virus so far is that the outcomes are quite variable. The latest information suggests that many more cases exist, yet the rate overall is not increasing that greatly for the adverse outcomes. That is cold comfort for the recently departed, but it puts in context the significance of the outbreak. The fatality ratio is going to be lower against actual infected cases when this is washed out, and it will quite probably be higher than the seasonal flu, but it is not going to change the world, other than an excessive response that shuts down activity globally which may have a greater adverse effect than WuFlu itself.

The adverse outcomes appear to impact those that are immune compromised already, and if that is really the case, then the most effective response to the virus is to identify those that are at risk, and maintain isolation for them from the potential spread of the disease, as, effectively we are at risk of bombing our own global systems into the stone age to stop something that has already been let out of the bag. If the spread is already outside of the containment lines, it is time to point defend, and that currently is a doable procedure. If a belated half hearted attempt to quarantine the global public remains the focus, then we are unlikely to be successful, and that action will take resources away from those that are in greatest peril from adverse outcomes. That same group at most risk are already under risk of similar outcomes from other causation agents.

WuFlu is like a forest fire that set up lots of undetected hot spots throughout the forest. The resources can be focused on the points of critical effect, the building in the forest, or we can attempt to tamp out each new hotspot, but we are behind the spread, and the spots are not showing up easily. Our current response is to pull out every tree in the forest, not sure that is now the correct response any longer. With infinite resources, sure, fill your boots, but when we have limitations, then the best solution may be to protect those that are readily identifiable as being at risk.

This virus doesn't affect the great majority of the cases at present. A risk of a half hearted response is that the virus doesn't spread rapidly through the available population, and all we do is slow it down, and then we are effectively giving it an opportunity to have more time active in the community overall, and allow it therefore more opportunity to evolve. As it changes slightly at every replication cycle, there is as much likelihood that it becomes more problematic over cycles than becomes benign. Right now, it is relatively benign to the vast majority of cases. I'm not suggesting terminating personal discipline in infection control, I am suggesting that the cat is out of the bag, and the rational defence is to protect those that the virus has greatest impact on. To do so would lessen the economic impact that this outbreak has which has all the hallmarks of a bad day out at present. Those at most risk can be protected without affecting trade and commerce at all, and that would be a rational position to consider. The current global response is heading over a cliff, and adding economic collapse to the equation hardly improves the survival rate of those at risk already.

slats11

14th Feb 2020, 07:37

Essentially, there was a panic overreaction by the HK medical establishment that meant patients were given huge doses of steroids. The HK "experts" are, of course, not proud of this, so it doesn't get talked about now. But it did slip out at the time and was reported in the South China Morning Post on 9 May 2003.

Sure, HK tried marinating their critical patients with steroids, and that didn't work. No argument.
But Singapore and Toronto didn't marinate, and their mortality was much closer to HK than mainland China.
China was very much the statistical outlier in the SARS dataset, not HK.

Its hard to work out what is happening with all the changing data.
With a dramatic increase in the number of cases in Hubei, the Hubei mortality has decreased from to 3% (in Hubei) and 4.5% (Wuhan city) to about 2.5%
Meanwhile, the mortality outside Hubei is slowly drifting up (from 0.16% to o.38% to 0.47% to 0.52%).

Overall, it may be that these figures are going to converge at about 2% mortality (compared to 0.1% for a bad 'flu season, and perhaps 2.5% for the 1918 "Spanish 'flu").

Australopithecus

14th Feb 2020, 08:13

All of the numbers and assumptions that make sense indicate that 2% is about right. But we are still in the early stages, and once health care systems get overwhelmed then the fatality rate should increase.

I expect that this year's death rate from the flu will be much lower than typical because COVID-19 is going to cull the people most at risk from the flu first.

Has anyone heard any results from the trials of remdesivir? (The Gilead anti-viral fast tracked into clinical trials on coronavirus patients)

fdr

14th Feb 2020, 08:38

Its hard to work out what is happening with all the changing data.

Overall, it may be that these figures are going to converge at about 2% mortality (compared to 0.1% for a bad 'flu season, and perhaps 2.5% for the 1918 "Spanish 'flu").

The data has suggested from early on that there was a likely greater transmission into the populace than was being recorded as cases. The asymptomatic numbers at least in China appear to be multiple times the identified cases, and that would lead to an expectation that the cases that result in.fatalities is a lower percentage of all actual infections. The latest Japanese fatality falls into the high risk category of age and health for pneumonia, so doesn't give much in the way of new data. The Singapore cases would appear to be most likely to result in some information on risk factors external to the Chinese experience; Singapore is reporting that no discernible patten exists as yet on their critical cases, which is at variance to the reports ex China.

Singapore is an affluent and society, with a population of 74.3% Chinese, 13.4% Malay, 9% Indian, and 3% other races. 25% of the population is over 55 years old. Underneath the headlines of prosperity, there is a considerable disparity between the affluent and the poor in the country, but healthcare is available as is education. The details on the critical cases in Singapore will be telling if they become available.

slats11

14th Feb 2020, 09:46

Agreed. Singapore has world class healthcare and are very likely to be transparent with the data.

8 critical / 50 cases with “no discernible pattern” who was critical and “some likely not to survive” was very sobering yesterday.
7 critical / 58 cases today.

reading behind the lines, it seems they are expecting some non-survivors even with plenty of ICU capacity.

If the numbers increase significantly and the system gets overwhelmed, then it could be like Wuhan.

I am struck that China is critical of international quarantine measures, while China internally has employed extreme measures not seen for 500 years (and even with Black Plague, the quarantining of cities was obviously on a much smaller scale).

Paul852

14th Feb 2020, 10:04

Singapore is an affluent and society, with a population of 74.3% Chinese, 13.4% Malay, 9% Indian, and 3% other races. 25% of the population is over 55 years old. Underneath the headlines of prosperity, there is a considerable disparity between the affluent and the poor in the country, but healthcare is available as is education. The details on the critical cases in Singapore will be telling if they become available.That racial mix is of citizens and permanent residents. It doesn't include the so called "non-residents" who currently constitute about 30% of the people actually living there. Those ~1.7M people are of a quite different racial mix: a load (maybe 300K) of Indonesian and Filipino domestic servants for a start, plus a lot of ethnic Europeans, Indian labourers, etc.

fdr

14th Feb 2020, 10:54

That racial mix is of citizens and permanent residents. It doesn't include the so called "non-residents" who currently constitute about 30% of the people actually living there. Those ~1.7M people are of a quite different racial mix: a load (maybe 300K) of Indonesian and Filipino domestic servants for a start, plus a lot of ethnic Europeans, Indian labourers, etc.

Quite so, with about a further 350,000 people per day crossing the causeway to/from JB, and another 50-100,000 crossing at Tuas total. Screening has been implemented for all travellers, to whatever extent that is effective. Interestingly, while Indonesia has been quiet on the subject, screening is being conducted in JKT and in BLI so they are being active.

Compton3fox

14th Feb 2020, 11:45

ORAC

14th Feb 2020, 11:51

You can see wh6 they are flying in thousands of army medics. I wonder how mn6 more they have in reserve.

https://www.bbc.co.uk/news/world-asia-china-51501005

Coronavirus: New China figures highlight toll on medical staff

Chinese officials have given figures for health workers infected with coronavirus, amid concerns about shortages of protective equipment. Six health workers have died and 1,716 have been infected since the outbreak, they said.......

Zeng Yixin, vice minister of China's National Health Commission, said 1,102 medical workers had been infected in Wuhan, where the outbreak began, and another 400 in other parts of Hubei province. He said the number of infections among staff was increasing.

“The duties of medical workers at the front are indeed extremely heavy; their working and resting circumstances are limited, the psychological pressures are great, and the risk of infection is high," Mr Zeng said, quoted by Reuters.

Local authorities have struggled to provide protective equipment such as respiratory masks, goggles and protective suits in hospitals in the area.

One doctor told AFP news agency that he and 16 colleagues were showing possible symptoms of the virus. Another medical worker said she and more than 100 other staff at her hospital had been quarantined (https://edition.cnn.com/2020/02/13/asia/coronavirus-health-care-workers-infected-intl-hnk/index.html). A further 30 had been confirmed to have been infected there out of a staff of 500 she told CNN.......

SOPS

14th Feb 2020, 12:43

I don’t normally prescribe to conspiracy stuff.. but I’m starting to wonder if this thing popped out of a lab somewhere.

fdr

14th Feb 2020, 12:47

There is an interesting sidebar at this time on immune responses vs sleep, logically presented on youtube, on medcram.com, update 17. https://www.youtube.com/watch?v=wlbM6VVkVZM

The presentation makes a good case to sleep behaviour that would cause variations in the outcome from an infection. The variables may be applicable to some of the cases that have been seen so far, making a case that a good nights sleep is desirable. Worth a coffee break to watch and draw your own conclusions. The conclusion that could be drawn from the referenced studies is that an outbreak would have a more adverse outcome in a group that work activity results in poor quality of sleep and a level of sleep deprivation. A hard working workforce would be at risk, say countries that have a concentration on time at work, poor rest conditions and limited time in rest. That may sound like every airline pilot in the world, but the studies make cases that suggest the airline FDL's are beneficial.

gpn01

14th Feb 2020, 12:51

Unsurprising really but quite worrying that eight flights in total have been reported https://www.dailymail.co.uk/health/article-8004013/Coronavirus-chaos-Heathrow-EIGHT-planes-lockdown-runway.html

jimmievegas

14th Feb 2020, 13:14

Is there anything from a reputable source?

gpn01

14th Feb 2020, 13:33

Daily Mail not reputable enough these days ? :-)

Magplug

14th Feb 2020, 13:57

"Put on lockdown".... "Quarantined on the runway"...... All very dramatic hot air that the Daily Mail relies on to sell newspapers. Shame that they don't indulge in some quality journalism.

Perhaps they mean "Port Health were advised of illness on board by the arriving crew as they are required to do under UK law".... Nowhere near enough fear/drama in that line.

nonsense

14th Feb 2020, 15:24

On today’s data we are back to an additional 4000 cases. If yesterday’s spike is factored in, the additional case numbers average out to around 4000/day for the last ten days or so. Which is itself an oversimplification. Why would the case numbers grow linearly?

Most drugs have a half life in the body; a period over which the concentration halves as the drug is metabolised and/or eliminated.
Yet we're surely all familiar with drink driving advice that the rate of elimination of alcohol from the body is roughly constant at about 0.01%BAC per hour, regardless of how drunk you are.
Why might this be? Why would alcohol level fall linearly?

The answer to both your question and mine is of course that the factor being measured has hit some sort of maximum capacity. Ethanol metabolism has a limited capacity regardless of blood alcohol level.

Confirmed diagnosis rates are quite possibly also limited by the capacity to test and diagnose. If you've got more probable cases than you can test, then you're probably getting a very high rate of confirmed cases, with total confirmed numbers more representative of your capacity to test, not the actual rate of infection.

And indeed the recent spike in reported infections was apparently about a broadening of the diagnostic criteria to capture more actual infections at the cost of certainty by RNA testing that none were false positives.

Australopithecus

14th Feb 2020, 16:16

Yes, I understand that. It was more of a rhetorical question, because the Chinese have already stated that they can only perform 8000 tests/day, that results take two days and that there are many false negatives. Even many of the CDC test kits are faulty (as per their report on 13/2. Given those realities China had no option but to rely on clinical signs for a diagnosis and a more accurate data set.

etudiant

14th Feb 2020, 16:22

I don’t normally prescribe to conspiracy stuff.. but I’m starting to wonder if this thing popped out of a lab somewhere.

Doubt that would make a difference. After the SARS experience, China along with every major country has had corona viruses in their bio labs for study, so an escape from sloppy handling in their Wuhan lab is not implausible.
However, given the slow incubation period and the relatively modest 2+% fatality rate, this is in no wise a weaponized virus, rather it may have been a research study item.
Fwiw, the best estimates are that it started with a single infection, whether from an animal or from an accidental release, sometime in late November 2019. Since then, it has been transmitted from person to person.
See: https://nextstrain.org/ncov

The inept response of the political leaders in the affected area allowed the virus to spread.

OldnGrounded

14th Feb 2020, 16:31

I don’t normally prescribe to conspiracy stuff.. but I’m starting to wonder if this thing popped out of a lab somewhere.

All available evidence, and the history of coronaviruses jumping to humans, indicate that it popped out of an exotic animal market.

OldnGrounded

14th Feb 2020, 16:44

After the SARS experience, China along with every major country has had corona viruses in their bio labs for study, so an escape from sloppy handling in their Wuhan lab is not implausible.

Actually, that's very unlikely. Remember that the virus in the outbreak was unidentified until researchers sequenced the genome for the first time. Unless you believe that Chinese researchers had been working with what came to be called 2019-nCoV but not sharing with fellow researchers around the world with whom they are in regular and routine contact, there's no reason to think it has been seen before this outbreak. That sort of secrecy is pretty much limited to biowarfare research and, as you point out, this coronavirus, or any of its known relatives, would make a really poor weapon.

Of course, the virus is now being grown in cell cultures in any number of labs, so escape is definitely possible. But the people who do this work are skilled and careful.

The inept response of the political leaders in the affected area allowed the virus to spread.

Government response certainly didn't help, but the combination of transmissibility and latency period probably means that the outbreak was unstoppable by the time anyone really understood what was happening.

Peter H

14th Feb 2020, 17:01

Anybody have information on any link between 2019-nCoV and "cytokine storms"? I'd sort of assumed there would be,
but the high average age of the fatalities suggest not.

https://www.scripps.edu/news-and-events/press-room/2014/20140227oldstonerosen.html
A cytokine storm is an overproduction of immune cells and their activating compounds (cytokines), which, in a flu infection, is often
associated with a surge of activated immune cells into the lungs. The resulting lung inflammation and fluid buildup can lead to
respiratory distress and can be contaminated by a secondary bacterial pneumonia—often enhancing the mortality in patients.

This little-understood phenomenon is thought to occur in at least several types of infections and autoimmune conditions, but it
appears to be particularly relevant in outbreaks of new flu variants. Cytokine storm is now seen as a likely major cause of mortality
in the 1918-20 “Spanish flu”—which killed more than 50 million people worldwide—and the H1N1 “swine flu” and H5N1“bird flu” of
recent years. In these epidemics, the patients most likely to die were relatively young adults with apparently strong immune
reactions to the infection—whereas ordinary seasonal flu epidemics disproportionately affect the very young and the elderly.

OldnGrounded

14th Feb 2020, 17:45

Anybody have information on any link between 2019-nCoV and "cytokine storms"? I'd sort of assumed there would be,
but the high average age of the fatalities suggest not.

Your assumption was on-target. Most investigation to date indicates cytokine storms developing in many/most COVID-19 (WHO's new official name for the disease caused by 2019-nCoV) cases that become fatal.

Knowing that may not be all that useful in a clinical sense, because there aren't really any good, established ways to deal with cytokine storms.

I don't think the fact that the fatalities are typically in older patients argues against the relationship. Remember, cytokine storms are explosive but ineffective immune responses that develop in later-stage illness.

A Google search for "coronavirus cytokine storm" will return many of the most useful results. This Lancet brief and the papers cited in it is a good place to start and has been widely cited in the short time since publication: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30305-6/fulltext

etudiant

14th Feb 2020, 17:45

[QUOTE=Peter H;10687677]Anybody have information on any link between 2019-nCoV and "cytokine storms"? I'd sort of assumed there would be,
but the high average age of the fatalities suggest not.

Chinese doctors suggest that the cytokine storm is a consequence of oxygen starvation and consequent cell death in the lungs. Essentially, the body's clean up ,squad working overtime, if I understand it correctly.
Their focus is to ensure adequate oxygenation of the patient, even by forced oxygen ventilation, with the hope that eventually the victim recovers. Absent a drug option, this kind of supportive treatment is all that is available.
Hence the efforts to use the blood plasma of recovered patients as well as experimental drugs such as remdesivir, we are groping in the dark.

OldnGrounded

14th Feb 2020, 21:51

Their focus is to ensure adequate oxygenation of the patient, even by forced oxygen ventilation, with the hope that eventually the victim recovers.

I wonder how many mechanical ventilators are available per 100K population. I couldn't find a number for China in a quick search but the median for the US, per a National Institutes of Health study about a decade ago, was under 20.

mickjoebill

14th Feb 2020, 23:48

[QUOTE=etudiant;10687703][QUOTE=Peter H;10687677]

Chinese doctors suggest that the cytokine storm is a consequence of oxygen starvation and consequent cell death in the lungs. Essentially, the body's clean up ,squad working overtime, if I understand it correctly.
Their focus is to ensure adequate oxygenation of the patient, even by forced oxygen ventilation, with the hope that eventually the victim recovers. Absent a drug option, this kind of supportive treatment is all that is available.
.../QUOTE]

What equipment are well financed “preppers” gathering?

Cylinders of 02?

mjb

FlareArmed2

15th Feb 2020, 00:13

Excellent article (https://wattsupwiththat.com/2020/02/14/wuhan-coronavirus-wuwt-update/) on current state of COVID-19, symptoms, course of infection, mortality, treatment (this is brand new), and possible vaccination. Not paywalled.

Australopithecus

15th Feb 2020, 01:30

Excellent article. Shame about the source.

etudiant

15th Feb 2020, 02:11

I wonder how many mechanical ventilators are available per 100K population. I couldn't find a number for China in a quick search but the median for the US, per a National Institutes of Health study about a decade ago, was under 20.

That is perhaps the least of our worries if the virus is not arrested.
There is no large scale domestic production capacity for even basics such as face masks or medications, much less a surge potential or a national stockpile. Most of that supply is now sourced from lower cost areas such as China or India.
So the US and Europe would be no better off than China in terms of dealing with this outbreak if it continues to build. Thus far, we have the reported number of victims still rising on a weekly doubling pace outside of China. That is very troubling.
At this rate, we are headed for a very different and less well connected world.

up_down_n_out

15th Feb 2020, 03:14

Shame about the source.

WHY?

As a community, WUWT is reasonably free from conspiracy theories.

Excellent article.

fdr

15th Feb 2020, 03:38

Interesting statistics:

ACE2 expression has a relationship to the SARS CoV2 corona virus causing Covid-19.
A significant positive correlation exists between ACE2 and smoking.
PRC Doctor smoking stats are similar to the overall smoking stats for the general PRC population.

Reference:

[1] Cai, G. Tobacco-Use Disparity in Gene Expression of ACE2, the Receptor of 2019-nCov. Preprints 2020, 2020020051 (doi: 10.20944/preprints202002.0051.v1).

[2] Haga S, Yamamoto N, Nakai-Murakami C, Osawa Y, Tokunaga K, Sata T, Yamamoto N, Sasazuki T, Ishizaka Y (2008) Modulation of TNF-alpha-converting enzyme by the spike protein of SARS-CoV and ACE2 induces TNF-alpha production and facilitates viral entry. Proc Natl Acad Sci USA 105:7809–7814

[3] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. https://doi.org/10.1016/S0140-6736(20)30183-5

[4] Jia HP, Look DC, Tan P, Shi L, Hickey M, Gakhar L, Chappell MC, Wohlford-Lenane C, McCray PB Jr (2009) Ectodomain shedding of angiotensin converting enzyme 2 in human airway epithelia. Am J Physiol Lung Cell Mol Physiol 297:L84–L96

[5] Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, Huan Y, Yang P, Zhang Y, Deng W et al (2005) A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med 11:875–879

[6] Oakes, J. M., Fuchs, R. M., Gardner, J. D., Lazartigues, E., & Yue, X. (2018). Nicotine and the renin-angiotensin system. American journal of physiology. Regulatory, integrative and comparative physiology, 315(5), R895–R906. https://doi.org/10.1152/ajpregu.00099.2018

[7] Parascandola, M., & Xiao, L. (2019). Tobacco and the lung cancer epidemic in China. Translational lung cancer research, 8(Suppl 1), S21–S30. https://doi.org/10.21037/tlcr.2019.03.12

[8] Smith, D. R., Zhao, I., & Wang, L. (2012). Tobacco smoking among doctors in mainland China: a study from Shandong province and review of the literature. Tobacco induced diseases, 10(1), 14. https://doi.org/10.1186/1617-9625-10-14

[9] Yao, T., Ong, M., Lee, A., Jiang, Y., & Mao, Z. (2009). Smoking knowledge, attitudes, behavior, and associated factors among Chinese male surgeons. World journal of surgery, 33(5), 910–917. https://doi.org/10.1007/s00268-009-9938-0

[10] Yilin, Z., Yandong, N., Faguang, J., (2015) Role of angiotensin-converting enzyme (ACE) and ACE2 in a rat model of smoke inhalation induced acute respiratory distress syndrome. NCBI. Burns. 2015 Nov;41(7):1468-77. doi: 10.1016/j.burns.2015.04.010. Epub 2015 May 14

Chart 2

https://cimg1.ibsrv.net/gimg/pprune.org-vbulletin/1964x1440/screen_shot_2020_02_15_at_11_55_46_am_0dc52f2bd5b49dc2d50578 bec7fe7ddbfc045be7.png

Prevalence of smoking for males in the Asia Pacific region in 2016

https://cimg8.ibsrv.net/gimg/pprune.org-vbulletin/1388x1302/screen_shot_2020_02_15_at_12_36_56_pm_722844d7062b1e6698c81b 953516e45f4c4b0f9e.png

ZFT

15th Feb 2020, 04:35

Daily Mail not reputable enough these days ? :-)

1st laugh of the day

Australopithecus

15th Feb 2020, 06:36

WHY?

Excellent article.

Do I have to draw you a map? It's a climate change denial website. Run by an ex-T.V. weatherman with an apparent idealogical axe to grind. And as such would be overlooked by the majority of thinking people. That’s why I wrote “shame about the source”.

Twitter

15th Feb 2020, 07:53

1523 people dead from Covic-19 in China as of Friday. 143 died during the day.

300 odd US pax to be evacuated from the Diamond Princess at Yokohama. 67 fresh cases there yesterday and 286 total now (CNN)

Second doctor in Japan tested positive. A man in Japan positive - had been on a trip to Hawaii but not to China.

Peter H

15th Feb 2020, 11:23

etudiant

15th Feb 2020, 13:24

Thanks to all who replied about cytokine storms.

I asked because I vaguely remember a SARS related article that talked about the use drugs to dampen this misplaced immune response.
In particular the repurposing of already-approved off-the-shelf drugs. Although I've seen mention of -- often new -- anti-virals I've not seen
mention of anti-immune-response ones. (Maybe because it's so old-hat that it's not worth mentioning.)

PS Re the query about the origin of the virus, I've seen suggestions that the virus may have originated in bats (cf Elboa?).
As a thread search for bats was unsuccessful, here's a quickly-chosen ref:
https://www.businessinsider.com/wuhan-coronavirus-sars-bats-animals-to-humans-2020-1?r=US&IR=T

For more than you want to know, see Flutrackers.com. It provides links to most aspects of the outbreak, including links to the health measures attempted as well as the virus research.

The virus is very transmissible, as evidenced by a case in China where 2 families were infected in a restaurant simply by sitting next to a third family which had an asymptomatic but infected member.
If China does not manage to control this outbreak despite measures akin to martial law, a pandemic is probable, because society in other countries is less rigorously controlled.

Superpilot

15th Feb 2020, 13:36

In addition to the last comment, here in England and more so in London specifically the hospitals can't cope on a good day because of the Tory decimation of public services. Any epedimic here will be the end of rule of law.

OldnGrounded

15th Feb 2020, 16:55

That is perhaps the least of our worries if the virus is not arrested.
There is no large scale domestic production capacity for even basics such as face masks or medications, much less a surge potential or a national stockpile. Most of that supply is now sourced from lower cost areas such as China or India.
So the US and Europe would be no better off than China in terms of dealing with this outbreak if it continues to build. Thus far, we have the reported number of victims still rising on a weekly doubling pace outside of China. That is very troubling.
At this rate, we are headed for a very different and less well connected world.

Yes, yes, all true. If you read my post again and note what I was responding to, you'll see that I was pointing out -- perhaps not in sufficiently clear and simple terms -- that the cited Chinese clinical practice of ventilating patients in advanced respiratory distress simply isn't going to be possible -- in China or anywhere else.

And I have made it clear, in this thread, that I doubt any nation is capable of adequately addressing an outbreak on the scale of the one China is dealing with.

Drc40

15th Feb 2020, 17:43

Do I have to draw you a map? It's a climate change denial website. Run by an ex-T.V. weatherman with an apparent idealogical axe to grind. And as such would be overlooked by the majority of thinking people. That’s why I wrote “shame about the source”.

That’s too bad because the article content is beyond excellent. Had to let my Dr wife read it (she spent a great deal of her early career in labs) to get a firm grip on the gist. Regardless, the writer is obviously another doctor or scientist who has extrapolated some telling specifics. The biggest news is the testing revelation so we get a much better picture of the overall impact. The coming days should see exponential numbers being reported but mainly due to better testing, not further spreading.

peter we

15th Feb 2020, 17:48

Your assumption was on-target. Most investigation to date indicates cytokine storms developing in many/most COVID-19 (WHO's new official name for the disease caused by 2019-nCoV) cases that become fatal.

Knowing that may not be all that useful in a clinical sense, because there aren't really any good, established ways to deal with cytokine storms.

I don't think the fact that the fatalities are typically in older patients argues against the relationship. Remember, cytokine storms are explosive but ineffective immune responses that develop in later-stage illness.

A Google search for "coronavirus cytokine storm" will return many of the most useful results. This Lancet brief and the papers cited in it is a good place to start and has been widely cited in the short time since publication: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30305-6/fulltext

This might help
https://www.nationalgeographic.com/science/2020/02/here-is-what-coronavirus-does-to-the-body/

ATC Watcher

15th Feb 2020, 18:00

The virus is very transmissible, as evidenced by a case in China where 2 families were infected in a restaurant simply by sitting next to a third family which had an asymptomatic but infected member.
Well not surprising if you are in a traditional Chinese family restaurant whee everyone shares the food from a single pot and picks up food bits with its own sticks on that pot..This is their culture. So I guess it is a bit more than just sitting around the same table...
The real fear is if that virus gets to Africa, where physical contacts, handshakes and eating and sharing food using fingers is common place and cultural in rural areas. Also in Many African Sates have a very basic medical infrastructure.

OldnGrounded

15th Feb 2020, 19:02

The biggest news is the testing revelation so we get a much better picture of the overall impact.

The only revelation related to testing is that China has decided to accept "clinical diagnosis" -- basically assessment of symptoms plus radiological findings from chest scans -- as confirming the disease for practical purposes under current conditions. That decision was made because they can't come close to keeping up with RT-PCR testing.

This practice is almost certainly correctly identifying most of the many new cases it's adding to the total, but it is also undoubtedly erroneously including other viral respiratory infections, since symptoms and radiological findings are more or less identical for the various viral infections.

Edit: Also, of course, clinical diagnosis won't find any asymptomatic carriers. But few of those individuals are probably being found in Hubei, anyway, given the size of the outbreak and the fact that they can't keep up with nucleic acid testing even for already-ill patients.

By the way, since this is PPRuNe, does anyone have a summary of overall flight cancellations at this point?

ORAC

15th Feb 2020, 19:48

https://www.thesun.co.uk/news/10972005/elderly-woman-on-coronavirus-cruise-diagnosed-after-being-cleared-to-leave-to-leave-the-ship/

Elderly woman on coronavirus cruise diagnosed AFTER being cleared to leave the ship

AN 83-year-old US passenger aboard the luxury cruise ship Westerdam has been diagnosed with coronavirus a day AFTER she disembarked along with 2,200 other passengers and crew including 600 Americans.

Cambodia allowed the stricken ship to disembark in the port city of Sihanoukville on Friday after it was turned away by five other ports. Cambodian Prime Minister Hun Sen, who has been skeptical of the severity of the virus, personally distributed roses and shook hands with the Westerdam’s passengers (https://www.the-sun.com/news/403216/coronavirus-cruise-passengers-disembark-virus-ship-cambodia/) as they disembarked........

Malaysia’s health ministry reported that the infected woman and her husband were among 145 passengers that flew to Malaysia on February 14. She was found with symptoms when she landed in Kuala Lumpur and was sent to a specialist designated hospital. She has been placed in isolation and is in a stable condition......

jugofpropwash

15th Feb 2020, 21:28

Interesting statistics:

A significant positive correlation exists between ACE2 and smoking.

I wondered about that. I'd assume that the air pollution in China isn't helping, either. If you've already got damaged lungs....

etudiant

15th Feb 2020, 23:07

Well not surprising if you are in a traditional Chinese family restaurant whee everyone shares the food from a single pot and picks up food bits with its own sticks on that pot..This is their culture. So I guess it is a bit more than just sitting around the same table...
The real fear is if that virus gets to Africa, where physical contacts, handshakes and eating and sharing food using fingers is common place and cultural in rural areas. Also in Many African Sates have a very basic medical infrastructure.

Except that this was three separate tables, just adjacent, no food sharing, so presumably aerosol transmission.

JanetFlight

15th Feb 2020, 23:58

Except that this was three separate tables, just adjacent, no food sharing, so presumably aerosol transmission.

How can you be so sure about that regarding those details such as 3 separate tables ..?
You been there or just a newspaper reading like any mortal here?
(forgive me the little irony... I respect your point)

OldnGrounded

16th Feb 2020, 00:04

Except that this was three separate tables, just adjacent, no food sharing, so presumably aerosol transmission.

Indeed. I think we can know enough about the transmissibility of this virus, simply by observing the development of the outbreak in Wuhan and, on a smaller scale, the transmission among pax on the cruise ship now docked in Yokohama, to be pretty sure that close contact is not required. Depending upon the material and the specific virus (and temperature, etc.) various coronaviruses are known to survive on inanimate surfaces for periods between a few hours and 28 days. There's no reason to expect 2019-nCoV to be less persistent.

Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents (https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext#sec3.1)

JanetFlight

16th Feb 2020, 00:08

Recent update numbers in BNO few minutes ago...

@BNODesk

UPDATE: China's National Health Commission reports 166 new cases and 3 new deaths outside Hubei province since yesterday.

Crisis averted... Maybe

slats11

16th Feb 2020, 00:28

There has been a lot of talk about inaccurate test results.

NAAT (nucleic acid amplification tests) for resp infections generally have very good accuracy per se. NAAT has been a major advance over earlier techniques. There is no reason to believe NAAT will be any different for this virus.

https://www.ncbi.nlm.nih.gov/pubmed/21073292
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2227-x

BUT, a big problem is adequate sample collection.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/
Respiratory virus detection is highly dependent on the type of sample collected, the time of collection after the onset of clinical symptoms, the age of the patient, and the transport and storage of the sample prior to testing (48 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/#B48), 49 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/#B49)). Several different upper respiratory tract specimens are applicable for testing, including nasopharyngeal (NP) washes, NP aspirates, and NP swabs placed in virus transport media (48 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/#B48), 49 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/#B49)). There are limited data that support the use of combined nose-throat swabs for influenza A virus testing by NAAT (14 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/#B14)). Detection of 12 respiratory viruses using a NAAT panel was significantly less sensitive with oropharyngeal swab specimens (54.2%) than with either nasopharyngeal swabs (73.3%) or nasopharyngeal wash specimens (84.9%) (33 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/#B33)). This may be due to the substantially lower viral loads in the oropharynx than in the nasopharynx (23 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185851/#B23)).
The more accurate sampling techniques are more likely to induce aerosolization of respiratory secretions (coughing, sneezing) and hence pose greater risk to the tester. Threat swabs are very poor (possibly no better than a coin toss), but are quick and easy and less dangerous to the tester. Nasopharyngeal washings are the opposite in every regard.
Imagine an environment where an entire province has been isolated for the greater good, where there is a sense of being abandoned, where the state has failed to provide sufficient PPE, where health care workers (who have their own families to look after) are getting infected.
Now imagine what tests are being done.

The technology per se is probably good. But like everything else, testing breaks down when the system itself starts to break down.