Morning Roundup:
Sources: The NBA has sent a memo to its franchises explaining that, due to coronavirus outbreak, teams should be preparing to play games without fans in attendance and identifying “essential staff” present for these games -- should it be necessary.
Shams Charania Shams Charania (@ShamsCharania) March 7, 2020
They’re pulling asymptomatic nurses off of quarantine early so the can take care of patients.
Link
Ms. Shepler said that after quarantining some workers who were exposed to coronavirus patients, the hospital determined that the extent of the quarantine was unrealistic because it left shortages in a needed work force. They brought nurses back who were asymptomatic — an approach deemed reasonable by the C.D.C., she said — and are testing them twice a shift. They are also required to wear masks while treating patients.
LINK
eBay is banning the sale of a number of items related to the novel coronavirus outbreak after rising prices raised concerns about price gouging.
The online auction giant says that "effective immediately" it will "block new listings and start to remove listings" that offer "masks including N95/N100 and surgical masks." Hand sanitizers and disinfecting wipes will also be banned.
Random Commentary:
Look at the AIPAC conference news I posted yesterday where there were two infected at the conference, and about 2/3 of Congress attended the conference.
Now extrapolate average age of a Congresscritter against COVID fatality statistics by age group, since we're seeing COVID rip through Iranian elected officials like a hot knife through butter:
#coronavirus strikes the Iranian parliament again, killing another Iranian official. Fatemeh Rahbar died today of #COVID?19. She was a newly elected member of Parliament, she had also served as an MP in the past. She is the first female official to be killed by #coronavirus.
Contract job offers are going out for nurses (from another forum):
Nurse i know just sent me a text with a job offer they tried to get her to do a contract on
Kirkland,WA $5160 a week for Coronavirus response assignment 8-13 week agreement
LINK
Liz Specht
@LizSpecht
I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math.
Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate.
We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.
We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.
As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population.
What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted.
The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).
Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients).
By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)
If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.
If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.
As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now.
Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).
There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.)
As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.
One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.
How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China.
Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor.
Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.
HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.
We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going.
Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.
Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.
I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.
Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.
But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”.
These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.
And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?
Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.
One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.
Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.
But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.
That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.
This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.
That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there. /end
From ARFCOM:
"Well at least this answers the age old question whether the gov would tell us if an asteroid was approaching."
Standford U cancels classes.
STANFORD, Calif. (KRON) Stanford University has canceled all in-class courses for the remainder of the winter quarter due to coronavirus concerns, the university announced Friday.
For the final two weeks of the winter quarter, classes will not meet in person but will move to online formats.
Large group events will also be canceled or adjusted.
The university says it is actively monitoring the local and global health situation and is taking precautionary measures in an effort to help limit the spread of COVID-19.
People related to Iran are wondering what's going on with DHS/Immigration at US ports of entry on twitter:
My mom’s friend just came back from Iran. At LAX she asked if she needed to be tested for corona virus. They asked her if she had a fever. She said no. So they let her pass through. Hearing many other similar stories about people coming from Iran.
Arash Karami Arash Karami (@thekarami) March 6, 2020
TOP. MEN.
Nevermind that up to maybe 40% of COVID cases may be asymptomatic. We've only known this datapoint since what, a month or more ago?
COIVID survival rates on various surfaces (
LINK
At "Normal" Temp 68-86°F (20-30°C)
Aluminum - 2-8 hours
Metals - 5 days
Wood - 4 days
Paper - 3 hour to 5 days depending on initial load/amount of virions
Glass - 4 days to 5 days
Plastics - 4 - 9 days (longer the higher the viral load/contamination)
Silicone Rubber - 5 Days
Latex Gloves - 8 hours
Disposable Gown (Tyvek) - 1 hour to 2 Days depending on initial level of contamination
Ceramics - 5 days
Teflon - 5 days
...
Here are the best disinfectants (in order of paper above)
3log₁₀ is 99.9%, 4log₁₀ is 99.99%, 5 log₁₀ is 99.999%, etc.
Ethanol 4.0 log₁₀ to > 5.9 log₁₀ after 30 seconds 70% to 95% respectively (other biologicals survive longer with 90%+ alcohol, NOT nCoV-19)
2-Propanol > 3.3 log₁₀ in 30 seconds
BZK/Benzalkonium chloride 0 - 4.0 log₁₀ after 10 Minutes
Sodium Hypochlorate (Bleach) - 0.21% (2100 ppm concentration) > 4.0 log₁₀ after 30 seconds
Sodium Hypochlorate (Bleach) - <=0.01% (<100 ppm concentration) 0.3 - 2.8 log₁₀ 10 Minutes
Formaldehyde - above 0.7% concentration > 3.0 log₁₀ in 10 Minutes
Glutardialdehyde - 0.5% to 2.5% > 4.0 log₁₀ after 2-5 Minutes
Povidone iodine > 4.0 log₁₀ after 15 seconds
Kent County, WA has just purchased a brand new Econolodge hotel and converted it for use as a quarantine hospital via painting over the sign.
LINK
Americans buy more ammo
Alex Horsman, the marketing manager at Ammo.com, said of the surge, "We know certain things impact ammo sales, mostly political events or economic instability when people feel their rights may end up infringed, but this is our first experience with a virus leading to such a boost in sales." Horsman continued, "But it makes sense. A lot of our customers like to be prepared. And for many of them, it's not just facemasks and TheraFlu. It's knowing that no matter what happens, they can keep themselves and their families safe."
When it comes to actual sales, Ammo.com's increase varied among calibers and brands. Calibers that saw the largest increase include:
40 cal (S&W) ammo: 410%
223 ammo: 194%
7.62x39 ammo: 114%
9mm ammo: 101%
12 gauge shotgun shells: 95%
5.56x45 ammo: 69%
380 ACP (Auto) ammo: 43%
45 Auto (ACP) ammo: 35%
308 Winchester ammo: 32%
22 Long Rifle (LR) ammo: 29%
Top sales increases in brands went to MBI ammo with a 179% increase and Federal ammo at 176%. Other significant growth included:
Fiocchi ammo: 122%
Remington ammo: 116%
Winchester ammo: 107%
PMC ammo: 101%
Tula ammo: 90%
Hornady ammo: 79%
Wolf ammo: 79%
Sellier & Bellot ammo: 20%
Sales also varied by state, with North Carolina and Georgia coming in with the largest increase (179% and 169% respectively). These were closely followed by Pennsylvania (140%) and Texas (128%). Other states that saw a big boom are:
Florida: 76%
Illinois: 67%
New York: 48%
Ohio: 40%
Can China's COVID-19 strategy work elsewhere?
Kai Kupferschmidt, Jon Cohen
Science 06 Mar 2020:
Vol. 367, Issue 6482, pp. 1061-1062
DOI: 10.1126/science.367.6482.1061
Chinese hospitals overflowing with COVID-19 patients a few weeks ago now have empty beds. Trials of experimental drugs can't find enough eligible patients. And the number of new cases reported each day in China is dropping precipitously.
These are some of the startling observations in a report released on 28 February by a team of 12 Chinese and 13 foreign scientists who toured five cities in China to study the state of the COVID-19 epidemic and the effectiveness of the country's response. Even some on the team, organized jointly by the World Health Organization (WHO) and the Chinese government, say they were surprised. “I thought there was no way those numbers could be real,” says epidemiologist Tim Eckmanns of the Robert Koch Institute in Berlin.
But the report is unequivocal. “China's bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic,” it says. To Bruce Aylward, a Canadian WHO epidemiologist who led the mission and briefed journalists in Beijing and Geneva last week, the effort was a huge success. “Hundreds of thousands of people in China did not get COVID-19 because of this aggressive response,” he says.
Aylward and other members of the task force say the rest of the world should learn from China. But critics say the report failed to acknowledge the human rights costs of the most severe measures imposed by China's authoritarian government: massive lockdowns and electronic surveillance of millions of people. “I think there are very good reasons for countries to hesitate using these kinds of extreme measures,” says Lawrence Gostin, a global health law scholar at Georgetown University. Many also worry that a resurgence of the disease will occur after the country lifts some of its strictest control measures and restarts its economy, which has taken a huge hit.
The report comes at a critical time in what many epidemiologists now consider a nascent pandemic. The number of affected countries is rising rapidly—it stood at 72 as Science went to press, according to WHO. Alarmingly, in many of these countries, the virus has quickly gained a foothold and started to spread in communities.
But cases have plummeted in China. On 10 February, the first day of the mission, the country reported 2478 new cases. Two weeks later, when the foreign experts packed their bags, the daily number of new cases had dropped to 409. (On 3 March it had dropped further to 129 new cases, compared with 1848 in the rest of the world.) China's epidemic appears to have peaked in late January, according to the report.
Members of the team traveled to Beijing, Shenzhen, Guangzhou, Chengdu, and the hardest hit city, Wuhan. They visited hospitals, laboratories, companies, live animal markets, train stations, and local government offices. “Everywhere you went, anyone you spoke to, there was a sense of responsibility and collective action—and there's a war footing to get things done,” Aylward says.
As part of the effort, Chinese scientists have compiled a massive data set that gives the best available picture of the disease. The mission report says about 80% of infected people had mild to moderate disease, marked by fever and a dry cough; 13.8% had severe symptoms; and 6.1% had life-threatening episodes of respiratory failure, septic shock, or organ failure. The case fatality rate was highest for people over age 80 (21.9%), and people who had heart disease, diabetes, or hypertension, but 3.8% overall. Children made up a mere 2.4% of the cases, and almost none was severely ill. People with mild and moderate illness took 2 weeks on average to recover.
The report highlights how China achieved what many public health experts thought was impossible: containing the spread of a widely circulating respiratory virus. “China has rolled out perhaps the most ambitious, agile, and aggressive disease containment effort in history,” the report notes. The most dramatic—and controversial—measure was the lockdown of Wuhan and nearby cities in Hubei province, putting at least 50 million people under a mandatory quarantine since 23 January. That has “effectively prevented further exportation of infected individuals to the rest of the country,” the report concludes. Most of China did not face such severe measures: People were asked, but not required, to quarantine themselves if they felt ill, and neighborhood leaders monitored their movements.
Chinese authorities also built two dedicated hospitals in Wuhan in about 1 week, sent health care workers from all over China to Hubei, and launched an unprecedented effort to trace contacts of confirmed cases. In Wuhan alone, more than 1800 teams traced tens of thousands of contacts. Aggressive “social distancing” measures implemented in the entire country included canceling sporting events and shuttering theaters, schools, and businesses. Anyone who went outdoors had to wear a mask.
Two widely used mobile phone apps, AliPay and WeChat—which in recent years have replaced cash in China—have helped enforce the restrictions, because they allow the government to keep track of people's movements and even stop people with confirmed infections from traveling. “Every person has sort of a traffic light system,” says mission member Gabriel Leung, dean of the Li Ka Shing Faculty of Medicine at the University of Hong Kong. Color codes on mobile phone screens—in which green, yellow, or red designate a person's health status—let guards at train stations and other checkpoints know who to let through.
“As a consequence of all of these measures, public life is very reduced,” the report notes. But the measures did work. In the end, infected people rarely spread the virus to anyone except members of their own household, Leung says. Once all the people living together were exposed, the virus had nowhere else to go and chains of transmission ended. “That's how the epidemic truly came under control,” Leung says.
It's debatable how much of this could be done elsewhere. “China is unique in that it has a political system that can gain public compliance with extreme measures,” Gostin says. The country also has an extraordinary ability to do labor-intensive, large-scale projects quickly, says Jeremy Konyndyk, a senior policy fellow at the Center for Global Development: “No one else in the world really can do what China just did.”
Nor should they, says lawyer Alexandra Phelan, a China specialist at Georgetown's Center for Global Health Science and Security. “There are plenty of things that would work to stop an outbreak that we would consider abhorrent in a just and free society,” Phelan says.
The report urges China “to more clearly communicate key data and developments internationally.” But it is mum on the coercive nature of China's control measures and the toll they have exacted. “The one thing that's completely glossed over is the whole human rights dimension,” says Devi Sridhar, a global public health specialist at the University of Edinburgh. Instead, the report praises the “deep commitment of the Chinese people to collective action in the face of this common threat.”
“To me, as somebody who has spent a lot of time in China, it comes across as incredibly naﶥ—and if not naﶥ, then willfully blind to some of the approaches being taken,” Phelan says. Singapore and Hong Kong may be better examples to follow, Konyndyk says: “There has been a similar degree of rigor and discipline but applied in a much less draconian manner.” Jennifer Nuzzo of the Johns Hopkins University Bloomberg School of Public Health also wonders what effects China's strategy had on, for instance, the treatment of cancer or HIV patients, whose care may have been interrupted. “I think it's important when evaluating the impact of these approaches to consider secondary, tertiary consequences,” she says.
And the benefit may be short-lived. “There's no question they suppressed the outbreak,” says Mike Osterholm, head of the Center for Infectious Disease Research and Policy at the University of Minnesota, Twin Cities. Reducing the peak number of cases buys a health system time to deal with later ones, public health experts say. But once the restrictions are lifted, “It'll come roaring right back,” Osterholm predicts.
Aylward and the other visiting scientists on the team were well aware of the “reality of different political systems,” he says, but they spoke with hundreds of people around the country and “everyone agreed with the approach.” He hopes China's successes so far will encourage other countries to act quickly. “We're getting new reports daily of new outbreaks in new areas, and people have a sense of, ‘Oh, we can't do anything,’” Aylward says. “Well, sorry. There are really practical things you can do to be ready to be able to respond to this, and that's where the focus will need to be.”
#BREAKING. @US_EUCOM can confirm its first U.S. military #COVID19 case in Naples, Italy. Official updates will continue to be provided. @USNavyEurope
— U.S European Command (@US_EUCOM) March 7, 2020