On coronavirus (COVID-19) so far: Part II
[NOTE: Part I can be found here.]
While musing about COVID-19, I wondered whether the virus really is novel. Perhaps it’s been around for a while and just wasn’t causing all that many deaths and therefore wasn’t even noticed until the spike occurred in China. Now that the virus has been recognized and is being tested for, perhaps we’re finding it all over the place (in small quantities so far) because it’s long been all over place and not caused all that much damage.
This seemed an odd thought. But it turns out it’s not so odd after all:
…”[H]as this virus ever entered the population undetected and been spreading?” asks Andrew Pekosz, a biologist at the Johns Hopkins Bloomberg School of Public Health. If in previous instances it induced only mild disease, “it may not have registered a large enough number of cases to get on the public health radar screen.”
Ebola and HIV both turned out to have existed for many years before scientists recognized the diseases those viruses cause. Scientists discovered that by running antibody tests on blood that had been stored long ago.
An antibody test is sorely needed, in order to tease out an answer to that question. It would also help us to learn whether there are a great many mild or even symptomless cases that have gone unrecognized, which would change our perception of the lethality of the virus.
There are two main issues with COVID-19, and we don’t know all that much about either yet: contagiousness and lethality. But the situation of the Diamond Princess cruise passengers offers an opportunity to learn about both under a sort of worst case scenario, which is confinement of healthy with ill passengers in a closed system, and an especially susceptible population because of a high percentage of people of advanced age. So let’s take a look.
The first thing you’ll notice is that the headline blares that the ship started with 10 passengers testing positive for the virus and ended with 700 testing positive within the two weeks of the quarantine. That’s quite a leap. The total number of people on the ship was 3,711. So the final number testing positive represented about 19% of the whole, or a little less than a fifth. Of that number – in the month since the first person from the ship was diagnosed – 6 have died, which is .16% of the whole, and .86% of those who tested positive. Both figures are under 1%. That only represents a months’ time, of course, two weeks of which involved quarantine on the ship. But it’s a fairly low figure, especially considering the advanced ages of so many of the passengers. Time will tell whether there will be any more deaths of people who were on that ship.
A large part of the linked article is about the terrible conditions of confinement and fear on the cruise, and how certain things probably fostered the spread of the disease. It’s missing a clear timeline of when people were tested and whether some of the rise in cases over time represented the fact that only certain people were tested at first (perhaps only the symptomatic?). It’s really unclear from the article, and perhaps the health officials on the ship were the ones who were unclear in communicating exactly how the testing went.
This part is especially interesting:
More than half of the infected people (322) showed no symptoms at all, which suggests that some coronavirus carriers in China could be going undetected.
That’s a fact that indicates less mortality – and even less morbidity – than has commonly been reported.
This article also describes the people who died. The first two were 87 and 84, both with underlying pre–existing health issues. The next two were also people in their 80s, and it’s unclear what their previous health status had been. The fifth person was in her 70s, and the sixth was of as-yet unreported age. This is further indication that advanced age is a big factor, just as it is in pneumonia deaths and deaths from most varieties of flu (although not the 1918 flu, where the majority of deaths were of younger adults ).
One question as yet unanswered is, if you eliminate the asymptomatic passengers, what percentage of the others testing positive had only mild symptoms. But we don’t know; at least I haven’t seen this reported, even though it would be important information. This article, based not on the ship data but on Chinese health officials’ reports, says that 80.9% of cases in China have been mild. However, that probably misses almost all the cases that are asymptomatic, and so it doesn’t tell us much about that phenomenon. Of the 19% of confirmed cases in China that have been considered serious, 2.3% were critical, and all the deaths were in that group.
This is how the death rates for COVID-19 so far (mostly in China) compare to previous novel illnesses that have gotten a lot of publicity:
Overall, however, the COVID-19 fatality rate is far lower than that of past coronavirus epidemics. Based on the ratio of deaths to confirmed cases so far, it appears to be about 2%. Severe acute respiratory syndrome (SARS), by contrast, killed 9.6% of those infected, and Middle East respiratory syndrome (MERS) killed 34.4% of cases.
But on the other hand, those illnesses were seemingly less contagious and therefore more easily contained
The following is encouraging, and it makes sense to me:
Fauci and other experts, however, think the existing fatality rate will drop as more mild cases are counted.
And this article points out something that might be obvious but that’s still important to note: novel threats, even if they’re less dangerous than pre-existing threats, can cause more fear. People are used to the familiar.
As I mentioned in Part I, COVID-19 has been hyped by the press and the Democrats, the better to get clicks and/or sell papers, and to criticize and blame Trump. But there’s another factor, which is the increase in our economic dependence on products and shipments from China. That’s real, and any disruption in the supply chain from China could be very problematic. Ironically for the left, another thing Trump’s been doing for quite a while is trying to lessen our trade connection to China. But don’t sit on a hot stove waiting for the left to praise him for it.
Earlier Fox News had a 67 year old man from the cruise ship on from his quarantine in Nebraska and he had some good insight. Going by memory but I think he and his wife tested positive and both had very mild symptoms but they tested positive at different times he even said he would have gone to work the next day if were home and none of this was going on.
He was remarkably good natured about the whole ordeal.
Also Dr Fauci was very good at the press conference this morning. He was very clarifying in his comments. Of course I’m sure they will be ignored because they don’t fit the ‘we’re all gonna die and it’s Trump’s fault narrative’.
“(…although not the 1918 flu, where the majority of deaths were of younger adults)…
I appreciate your work on your two articles…thank you for your research!
I do wonder about this statement, though. Given the average length of life in that period of time, were the “younger adults” the old people of the population? Length of life now is commonly in the 70s and 80s range – wasn’t it much shorter pre-1920? And now I’m realizing how much I don’t know about what caused those shorter lives…lack of medical care? hard work just wearing out bodies? lack of sanitation?
No electricity. Outhouses.
I’m _so_ glad I live now!!
Length of life now is commonly in the 70s and 80s range – wasn’t it much shorter pre-1920?
Up until the last 40 years or so, improvements in life expectancy at birth have predominantly a function of reductions in infant and early childhood mortality and the sources of reductions in mortality rates have been improvements in sanitation and nutrition much more than improvements in medicine and surgery. The life expectancy of people who live to an age where they might marry did improve, but the improvements were much less pronounced. (Taking the medians, my own great-great grandparents were born around 1838, married around age 24, and typically lived an additional 48 years).
Now they are saying the person that died here in the Puget Sound area was a man in his late fifties with underlying health issues who if I understand their confusing press conference (which interrupted my attempt at watching golf to escape this stuff) was a resident in a nursing home and a nurse at that facility also has the virus.
Art Deco,
I seem to remember seeing somewhere that if you removed deaths of children under a year or two that life expectancy went up markedly even in Revolutionary War times. It was as you said the infant mortality rate that dragged it down.
So far it sounds like 97% of us who live in first world countries, regardless of age, have no reason to panic.
“Up until the last 40 years or so, improvements in life expectancy at birth have predominantly a function of reductions in infant and early childhood mortality and the sources of reductions in mortality rates have been improvements in sanitation and nutrition much more than improvements in medicine and surgery.”
Agree with Griffin and ArtDeco. I’ve read (a long time ago, fuzzy memories) that life expectancy was not bad if you made it past infancy. So many failed to make it to, say, age 5 that it dragged down the averages. If you look up historical people like Ben Franklin, they lived to ages that seem in the normal range today.
How sure are we that we have a “new” coronavirus? Many, many of us have the same mild illness each year and are told with a blithe shrug that “It’s just a virus”, without any virus blood tests ever done on anyone.
Guess What?!!
Dr. Fauci, the infection guru at NIH wrote earlier this year in JAMA: “Human coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs—severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus —emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, novel coronavirus was recognized in Wuhan, China, and has caused serious illness and death. Four HCoVs are endemic globally and account for 10% to 30% of upper respiratory tract infections in adults.”
This all needs to be worked out, sorted out. How many people actually caught SARS and MERS coronaviruses? Not that many! And those were really bad boys. Where’d they go?
MSM hysteria is unhelpful, just ignorant reporters talking thru their hats.
What is useful about COVID-19 and also about Syrians in Turkey is the critical importance of maintaining nations with borders and walls to keep bad stuff out and parenthetically keeping manufacturing assets in, not outsourcing them to communist enemies. No Schengen open borders BS! Trump is a reasonable man of reason.
I am starting to wonder why health departments and organizations are continuing to behave as though they are tracing Ebola contacts, rather than monitoring something that is easily transmitted by casual social contact by people who don’t seem to be – and often may never be – ill.
I don’t know whether they are having difficulty changing gears to deal with a virus that causes a high percentage of mild or asymptomatic cases or if they think they’re preventing panic by this approach, or what.
In 2018, 80,000 people in the US died from flu. Something like between 70 and 85 percent of those deaths have occurred in people 65 years and older.
And we don’t freak it that much about flu.
I do, because I have an 86 year old aunt I love and don’t want her to catch it.
(BTW, they’re “flu-related” deaths because it’s not so much the flu as secondary infections )
And about “average life expectancy”:
Drives me nuts when people think if during some period the average life expectancy was X years, that anyone who reached that age was “old.” No…. As had been mentioned, infant and cold mortality really bright down the average life expectancy. If you have two people, one a newborn and one who is sixty, and the newborn does, the average life expectancy of those two people is thirty years. Of people made it past the agree of five, they had a very good chance of making it to adulthood. In adulthood, however, came more dangers: for women it was childbirth and for men, it was war. And, barring any sort of dealt epidemic, like the Black Death, once you got forty, your odds of making into your seventies were probably better than they are today. (Stress and poor nutrition are killing a lot of people in the sixties.)
It’s also not that cancer didn’t happen a hundred years ago — it’s that people died of polio and small pox and diptheria and measles, etc. before they had a chance to develop cancer. The primary cause of death a hundred years ago — for EVERYONE under seventy — was infection.
Thanks a lot for these articles Neo. I’ve now caught up on parts 1 & 2 and the Aspirin Aside. They’re very much appreciated.
Since this started making the news a little while back, my main source has been Instapundit. But viruses are one of his triggers, for lack of a better term. And while he is not panicking, there’s definitely an edge of mounting concern from him and a majority of his regular comment makers. So, its been very hard to sort through the real news and info from the panic stuff.
The biggest question I have is, why is China reacting the way it is to such an outbreak? Is it because most outbreaks tend to be more deadly in the first stages? Or at least they seem that way because the doctors only see the more serious cases?
Why hamstring your country’s economy for this virus?
Regarding Fauci, he has really impressed me. I loved one of his press conferences not to long ago where he stressed why this virus worries some doctors: Influenza is predictable. And this novel virus, by definition, is new. And its too early to predict anything about it.
The health authorities should be well aware what they are doing tracing people is useless. They need to be *seen* to be doing something by the easily panicked though.
I’m not convinced the Democrats are wise attacking Trump on this. If it does blow over without much fuss they will make him look wise and statesman like, which isn’t a natural look for him. If it does turn out to be serious, it’s still unlikely to worse in the US than outside, so how much blame will stick to him? The only downside is if he panics too.
Fractal Rabbit:
Here’s my guess about why China’s coming down so hard on this. The first reason is that the death toll in China really is frightening and they needed to clamp down, and hard (which they have, although there was a delay before they realized). The second is that social media in China and around the world was almost immediately fanning the flames of fear. And the third is that these days their entire economy depends heavily on exports, to a much greater extent than in the past.
This article has some data on the underlying health conditions of Chinese COVID-19 patients who die. 10.5% of patients with underlying heart disease die; diabetics, 7.3%, while chronic respiratory disease, high blood pressure, and cancer come in more or less at 6%.
https://www.msn.com/en-us/health/medical/coronavirus-patients-with-heart-disease-have-a-10-25-chance-of-dying-heres-the-mortality-rate-for-patients-with-various-underlying-health-problems/ar-BB10zo0J
For people with none of the above, it’s .9%.
I wonder if the declining rate of infections in China is related to the greatly improved air quality caused by shutting down Chinese factories.
I hope a lesson from all this will be for American drug supplies to be sourced more often here in the US. Being dependent on China when there’s an epidemic, or at all, is worrisome.
SueK:
The majority of deaths in 1918 were of young adults who were considered young adults at the time.
Just to take one article that goes into it:
A great many of the dead were young soldiers in the military.
SueK:
Also please see this post.
KyndyllG on February 29, 2020 at 6:40 pm said:
I am starting to wonder why health departments and organizations are continuing to behave as though they are tracing Ebola contacts,…
I don’t know whether they are having difficulty changing gears …
* * *
Most institutions are always fighting the last war.
However, the doctors may be aware of that now, and will start shifting to a more effective mode.
“Regarding Fauci, he has really impressed me. I loved one of his press conferences not to long ago where he stressed why this virus worries some doctors: Influenza is predictable. And this novel virus, by definition, is new. And its too early to predict anything about it.’ – Fractal Rabbit
My father was stationed at Ft Devens for a period, but it would have been some 10 years or so after the epidemic.
I wonder if the reason for the high death rate in younger adults was influenced by the military population – because the close living situation of soldiers might make it easily more transmissible and might shift the statistics. But I expect that’s one of the questions that will never be answered. Statistics can only tell you so much.
675,000…that number looked familiar. Isn’t that very close to the number killed during the Civil War? And about 60 years apart. I wonder if there is a separate count of soldiers that died…and were they considered part of the deaths counted in WWI? So many young men died within that period of time.
I’ve seen it mentioned many times that the number of young men killed in WWII had an effect on the culture of the USA in the years that followed, but I’ve never seen anything about the same phenomenon in WWI – and now plus this epidemic.
Kinda makes me wonder about the possible similarities between the roaring ’20s and the ’60s.
Catching up on some old news, and a pertinent observation.
https://legalinsurrection.com/2020/02/wuhan-virus-watch-cdc-director-says-rod-rosensteins-sister-misspoke-about-coronavirus-risk/
AND
Check this out, excerpted from Twitter. This is new news at one of the other forums where I lurk.
“The team at the @seattleflustudy have sequenced the genome the #COVID19 community case reported yesterday from Snohomish County, WA, and have posted the sequence publicly to http://gisaid.org. There are some enormous implications here. / This case, WA2, is on a branch in the evolutionary tree that descends directly from WA1, the first reported case in the USA sampled Jan 19, also from Snohomish County / This strongly suggests that there has been cryptic transmission in Washington State for the past 6 weeks. / I believe we’re facing an already substantial outbreak in Washington State that was not detected until now due to narrow case definition requiring direct travel to China.”
While the organization posting this news politely sidesteps the issue, someone else tweets: “We only started testing for SARS-CoV2 a few days ago, unless they were known to have traveled to China, or known to have been in contact with someone who tested positive. Irresponsible CDC…”
My sources, online and personal, agree the number of new infections in China are getting lower each day. From triple digit to recent values like 52, 43 and latest 35.
Plus the new cases are all pretty much in the Wuhan area not Beijing, not Shanghai. The spread (inside China) is being curbed.
New outbreaks have flared in S Korea, Japan, Italy and Iran. West coast US may be next in the headlines. But I’m holding off on buying CostCo’s “year’s worth of canned foods” product. I’m now tending to the viewpoint that things will stabilize
My prediction is that this disease will join the rest of the “world as we know it is ending” stories and it will be all but forgotten in a year or two.
If early signs are accurate that this virus cascades out of control in the lungs of an unusually high percentage of susceptible people (compared to ordinary flu), then clamping down as much as possible on quarantine is not a bad idea. That’s not because we can keep the virus from burning through the global population, because we almost certainly can’t, but because even a pretty good medical system can be badly strained by having too many acute cases of anything at one time. More people will recover if the severe cases can be spread out over time.
That’s one reason Ebola, a really dangerous infection, kills many more in a 3d world country than a 1st world one. It’s also why the 1918 flu was particularly devastating in some isolated villages: the lack of basic supportive medical care combined with the fragile web of healthy adults needed to keep life and limb together just in terms of making sure everyone had heat and calories and clean water.
Does anybody here remember the “Asian Flu” of 1957?
The Asian Flu came from China (surprise!), and according to the CDC, killed 117,000 in the USA.
The world did not come to the end in 1957.
This is an excellent post. Great information. Really helpful.
Thanks for your efforts, Neo.
KyndyllG,
Not completely surprising as WA1 took public transit home (about 40 miles) after flying into SeaTac. I believe he was asymptomatic at that time only becoming symptomatic several days later. Not sure they would have been able track all potential contacts even with better testing.
Local press coverage has succeeded in panicking the public as I don’t think I’ve ever seen a local Costco parking lot completely full and passed two in that condition while out-and-about today.
Fractal Rabbit,
I switched off Drudge two years ago due to all his sensationalist click-bait. I switched on to Instapundit. I like Glenn and company’s humor and phlegmatic style but lately his obsession with viruses is deja vu all over again. I’ve noticed something similar going on over at Daily Wire, a growing tendency towards the sensational. Methinks that they are being advised by the same marketing firm.
Brian Morgan,
I’m not sure that Glenn Reynolds is being intentionally sensational or is be advised to act that way, unlike many others. Over the years, viruses have always been one of his hot buttons. He was a bit over the top back in 2014 with the Ebola outbreak.
But this time, he’s way, way over the top. The comments, the links to dodgy sources. Somebody over there called it Panic Porn, and I don’t think they’re wrong.
And it’s all counterproductive anyway. Be prepared. Don’t panic. The #PanicDon’tPanic mixed messages are sending some of the regular readers into a tizzy, though they all swear “It’s not panic!”And the calmer voices are getting labeled as trolls. It’s crazy to watch it happen so fast.
I’ve been watching financial news which is almost in panic mode over the virus. Only one analyst referred to the general reaction as a text-book panic.
So last Fri. evening my wife and I went to the first Lenten dinner of the season and got there a little late. It is a fish and pasta dinner put on by the local Italian fishermen. I thought maybe it wouldn’t be too crowded because of the corona-virus, but it was slammed. We had to wait an hour in the lobby to get in. A thousand people in a large room who clearly were not very worried about contagion.
______
A doctor claimed this morning that the U.S. still does not have a definitive test for the virus. There is a reagent required for a RT-PCR test, but our reagent supply is tainted and we’re struggling to obtain the pure stuff.
RT = reverse transcription which is how the virus RNA is converted to DNA which can then be amplified via PCR. There is also a “Real Time” PCR and the two different RT’s can be combined. Here is a Wikipedia’s attempt to resolve the confusing alphabet soup. The whole page has a ton of info.
The words Real Time suggest something fast, but all of the techniques require either 30 or 40 – 50 temperature cycles in a thermal cycler. Does anybody know how long that takes? Supposedly these techniques are relatively commonplace these days, which is partly why it is puzzling that we don’t have clean reagents available.