BA cancel all flights to and from China due to Coronavirus

[ORAC]

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/public...ciated-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]

Originally Posted by ORAC

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/public...ciated-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]

https://www.bbc.co.uk/news/uk-51374056

Coronavirus: UK tells all Britons to leave China 'if they can'

[EDLB]

Originally Posted by OldnGrounded

, 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]

Originally Posted by EDLB

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.

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

[OldnGrounded]

Originally Posted by EDLB

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/wuha...spitals-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]

Originally Posted by Twitter

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]

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]

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]

Veracity

Originally Posted by OldnGrounded

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.

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..."

[ORAC]

https://employeebenefits.co.uk/catha...e-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, 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 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 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]

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

[FlareArmed2]

Originally Posted by fdr

...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]

Originally Posted by fdr

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]

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]

Originally Posted by Fzz

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]

Originally Posted by fdr

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]

Originally Posted by EDLB

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]

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]

Originally Posted by OldnGrounded

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