Coronavirus: Facts, Myths and Surprises (March 13th)

(go here for link to latest update)

This is a collection of facts on the ‘novel’ coronavirus, together with some discussion on myths and surprises such as:

the debunking and fact exploring on topic of ‘the coronavirus’.

My first post on the new coronavirus (the real threat level) back in late January speculated there could be as many as 180,000 cases by end of February if the rate of spread could not be constrained. The rate of spread has been constrained (and it was around half of my estimate), but not sufficiently constrained to prevent a pandemic, or suggest the threat has passed. My second post spoke of tipping points that would lead to the pandemic, and it turned out that the outbreak in northern Italy constituted tipping point3, not the false alarm of the Westerdam cruise ship. Still, the tipping point did occur, as sooner or later seemed inevitable it would. We, now as this post is written on Friday 13th of March, have a pandemic.

This post is on general infromation on the virus and what has been learnt so far, and I should be able to provide updates over time to this post, avoiding the need for new posts.

2020 March 13th: State of outbreak (Friday the 13th?)

March 12th

  • The World Health Organisation (Who?) declared a global pandemic
  • USA, UK and Australian Governments all made national addresses
  • US blocks arrivals from Europe
  • Famous diagnosis:
    • Tom Hanks and Rita Wilson
    • UK Health Minister (Nadine Dorries)

March 13th

  • The Australian F1 grand prix was cancelled, which will likely result in the F1 2020 season being cancelled
  • International Tennis was Cancelled until at least April 20 (and likely most of the 2020 season)
  • Famous diagnosis:
    • Pierre Trudeau’s wife
    • Australian Government minister (Peter Dutton)
    • President Trump Declares as State of Emergency

Potential Global Outcomes.

Background

The pattern for a virus such as this is first pass around the globe which will typically take about 18 months. If not contained and eradicated, the virus will remain and continue to spread in cycles that tend to become seasonal.

The first pass of the virus is the main concern, as after that the impact will be significantly less. During following passes, there will be some immunity from previous infections and a significant percentage of those most vulnerable to the virus will no longer be with us. If you can survive the first pass, you are even more likely to survive subsequent passes.

So the ‘pandemic’ is the first pass or first 18 months of the disease. With no cure or vaccine, the disease can continue a problem, but a much smaller problem.

Simple Analysis Worst Case

I have seen scientific based reports that vary between stating between 20 to 50 percent of all people can be expected to contract the virus that causes Covid-19 in the initial pass of the virus around the globe, which will take approximately 18 months. If the 2% mortality figure is used, then that would result in between 30 million and 75 million deaths globally. A lower percentage of the globe than with the ‘Spanish Flu’ of 1918, but quite severe.

UK: A conflicting scenario

UK Prime Minister Boris Johnson stated that as many as 10,000 people in the UK may have been infected, despite there being on 5980 people diagnosed, and 10 deaths. In fact, this suggestion comes from the UKs chief scientific officer so should be taken seriously. If correct, this means over 16 times as many infections as formally diagnosed. The mortality rate compared to those diagnosed is consistent with other data (around 1.6%) but if it is reality that 16x as many people are infected, but show no symptoms so do not present for diagnosis, then the figures from the ‘simplistic worst case’ can be divided by 16, resulting in between 2 million and 5 million deaths over 18 months, which is still horrific, and between 2x 6x worse than the ‘the flu’ (annual, not 18 month, figures here)

China??

At this time, China is claiming to have effectively stopped the spread of the disease in its tracks. There around 5,000 fatalities worldwide at this time. If China could restrict fatalities 5,000 within China, then given China represents around 1/6tb of the world population, the world could restrict fatalities to 60,000. Significantly less than the flu.

But is it real?:

  1. China may have stopped reporting cases accurately
  2. China may have paused the spread for now, rather than actually stopped the spread (still useful but the story may not be over)
  3. The disease may be further through the cycle than diagnosed cases suggest (as per UK figures) making real containment more practical at this stage
  4. Queue the conspiracy theories: China has secret weapons again the virus

The most likely explanation is some combination of 1,2 and 3 above, and for the numbers to be even close to accurate, it seems logical that the data from the UK has to be somewhat realistic on asymptomatic undiagnosed cases.

Summary

See the conclusion of this post for a summary of the range of global outcomes

Mortality Rate & Impact

Mortality rate is the ratio of deaths to people-infected by the virus. The data on deaths has every reason to be accurate.

But in place of ‘people-infected’ we have ‘diagnosed-cases’.

To allow for the worst, we can only assume that most people infected are diagnosed, which would mean the mortality rate of approximately 2% is correct.

However, given we do not know many undiagnosed case there are, the reality is we only know a worst case scenario for mortality rate.

If there were sufficient Covid-19 diagnostic kits, we could (and should) also test people with no symptoms in order to establish a more certain count of those infection. To ensure the ‘diagnosed cases’ does reflect people infected. But there are simply insufficient diagnosis kits to test everyone who should be tested. This has all has happened to quickly. There are rarely enough kits to confirm cases where there is high confidence of infection before testing, let alone more speculative tests.

Reality is, there are three reasons for deaths as a result of Covid-19:

  • Cases where despite best practice medical treatment, patient dies due to Covid-19
  • Cases where an overloaded medical system results in sub-optimal medical care for Covid-19 and patient does not survive
  • Cases where medical system is so overloaded as a result of Covid-19 that medical staff must triage which patients they can treat and which they cannot resulting in deaths due to an overloaded medical system, including deaths unrelated to Covid-19

It is important to remember than Covid-19 patients can require intensive care, or significant care, in far greater numbers than the mortality figure. Data suggesting a 2% mortality rate, also suggest a 20% severe illness rate. It is not just the fatalities that strain the medical system.

The health impact is far more than just those who die. Just as significant is the far larger number who are very seriously ill and the impact of the overall medical system, and financial impact on so many individuals.

Rate of Spread

Only Over 60s?

I have often heard claims that Covid-19 only effects the elderly and those who already have chronic health problems. Note the doctor, Dr. Li Wenliang, who was censored for sounding the early alarm who died, age 31. There are reports that medical workers are vulnerable because they are overworked, even though they may otherwise be, like Dr Weng Liang, young and healthy. The death toll in the this group is 1/4 of the overall death toll, but it is far from ‘no deaths below 60’. Note that while medical workers does include a very overworked group, it does not include people from the below 60s age group who have an existing condition preventing them working. Medical workers in their 20s are amount fatalities. So being below 60 and healthy provides better outcomes, but does not provide immunity. If the death toll in the below 60s age group is 1/4 of the average not just for health care workers, then 3/4 or all deaths are occurring in a group that is just 1/4 of the population (over 60s), making things far more serious for over 60s than 2% – in fact the risk would be as high as 7%.

But being under 60 does not provide immunity to Covid-19.

No Children

I heard an interview with professor Brendan Murphy, chief medical officer where he stated

There have been very few reports of symptomatic infection in children. What we don’t know is whether the children are getting infected, but just do not get symptoms, or whether that it appears children do not show symptoms, and can still spread it, or whether they are not getting infected. The former is probably more likely, but in a way if they are getting infected and they are perfectly well, whilst they might spread it, it also creates a herd immunity

Proffessor Brendan Murphy, Chief Medical Officer of Australia on Insiders (34:45) 15th March

This is consistent with all data from other sources. Again there is very little data on whether asymptomatic people are infected due to the shortage of testing kits, but it seems most likely children do get infected, but very rarely have symptoms.

The Undiagnosed: The Big Hope

The message from ‘No Children’ is that on balance it is seems likely that children do become infected, but almost always remain asymptomatic. If this is the case, it also seems almost certain that this outcome of being asymptomatic does not magically cease at some particular birthday. If children are almost always asymptomatic, then the next age group is probably very often asymptomatic, and so on. In fact since we rarely test people without symptoms, or with symptoms so mild the person could have a very mild ‘cold’, we do not know if there is any age where there result of at least some people having almost no symptoms are all or none at all stops. We do have some people confirmed as having the virus but with no symptoms or extremely mild symptons, but normally, without symptoms, you are not tested.

As children are around 20% of all people, they could easilry represent an additional set of cases, but asymptomatic and undiagnosed. Young adults another group, and in fact some could arise from all age groups. The British Chief Medical Officers assessment of potentially 16x more cases than diagnosed could very well be accurate.

If this additional group of undiagnosed asymptomatic cases at least includes many children and could extend well beyond just children. The larger this group, the lower the actual mortality rate. Further since, this would mean far more people are already infected, the shorter the time before infections reach saturation.

A Changed World

Peoples thoughts on travel, and large crowds are likely to be changed forever as a result of the time in quarantines, with travel bans and crowd bans. How far changed? I will explore more in updates/

Conspiracy Theories.

There are facts that feed conspiracy theories. One of the major research facilities of the world studying viruses just like the ‘novel coronavirus’ is based in Wuhan. Coincidence? Or is that an area where such viruses are present so a logical location? I will add more in this in the coming days.

Coronavirus? (Name)

In my first post on the ‘novel coronavirus‘ back in January I noted the virus did not yet have genuine name. Finally (on Feb 12 I believe) a name was allocated. Not a particularly catchy name for the disease (Covid-19) and even less catch name for the virus (SARS-CoV-2). The result is that in common usage the name ‘Coronavirus’ which describes a whole group of viruses including the common cold and SARS and MERS that all share a common shape even if in some cases not really closely related, has become a name for this specific virus. At least I guess it was never that great a name in its original usage.

Despite ‘coronavirus’ not technically being the name for this outbreak, in common usage, we have to live with the name. Least of the problems right now.

Government Response: The Problems

So far (as at 13 March 2020) I have seen government responses directed at:

  1. delaying the spread of the virus to help prevent medical system overload
  2. boosting the capacity of the medical system to assist with the virus
  3. economic stimuls to minimise impact on the economy

It is point 3 that worries me. Not because it is not needed, but because none of the funds so far have specifically been directed into scientific research and/or data collection and analysis. Just a small percentage of economic measures specifically boosting these industries could produce results that have a far greater impact on not just global economics, but also lives. Yet funding science as opposed to ‘industry’ seems like taboo for many governments.

The End?

How will it all end. As far as we know, the SARS-CoV-2 virus which causes Covid-19 can only survive outside of a host for a 3 days, and inside an infected person until they die or recover, which means less than 3 weeks. So the only way the virus survives beyond around 3 weeks is by new infections, moving from person to person. If it is possible to completely stop new infections, every copy of the virus would die within one month!

Conclusion

China, a country of over 1 billion people claims to have conquered the virus in around 3 months. So it is possible that within another 3 months so has everyone else. Possible, but perhaps not even likely. At this stage a lot depends on that data we do not have: just how many asymptomatic cases go undetected. The higher that number, the lower the actual mortality rate, the further through the pandemic we are, and the less serious all will be in the end.

Lack of data, and even lack of research is worrying. The scope for global impact is an absolute minimum of 3 months of quarantines and isolation before things can start to recover. More likely at least 6 months of quarantines and isolations and at the worst extreme case more than another year.

Deaths could be anywhere from 50,000 globally to as high as 1% of global population: 70 million. That 50,000 is a great target, but around 2 million over the twelve months is a more likely minimum, and even that figure comes at the cost of huge shut downs and disruptions to slow the spread to a rate that avoids medical system collapse.

The slower the spread of cases with symptoms, the less stress on medical infrastructure and the better the outcome.

There could easily be as many as 16x more cases than are diagnosed, and this would be a good thing. The greater the number of cases without symptoms in proportion to those with symptoms, the sooner this will all plateaux and the less fatalities will result. This ratio – how many without symptions – number is the greatest unknown right now.

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