Coronavirus:

The Good:
—So far, there has NOT been an explosion commensurate with the high contagiousness estimates being thrown around last weekend in the informative, non-China cases.
—The vast majority of cases around the world are from travelers picked up by screening measures who are from, or recently traveled to, Wuhan and surrounding area China.
—As of 29 January 2020, there are 165 patients under investigation in the US.  This is a combination of patients picked up in travel screening and those showing up with cold/flu symptoms and a history of travel to China or close contact with someone traveling to China.  Of that 165, ONLY 5 have confirmed disease thus far.  68 have tested negative for novel coronavirus.  92 test results are pending.  So thus far, in the US, even patients with possible exposure AND symptoms are more than 12 times more likely to NOT have novel coronavirus.
—This -implies- to me that even if travelers are getting through in the incubation period, there has NOT yet been worrisome amounts of spread of the virus in the community outside China.  Certainly nothing consistent with the scare headlines, numbers and projections.
—China is catching up to the true prevalence of the disease.  The -vast- majority of detected cases are not “serious” per WHO accounting (read as “not requiring hospitalization”).  Based on results to date, ~80% of patients who get coronavirus get a case that does NOT require hospitalization.  This is consistent with the huge leaps of “new cases” being detected and hyped in China.  Remember—most of those new cases DON’T wind up in the hospital so far!  Many are only being detected because there is now a test for this virus and high index of suspicion (EVERY sniffle is getting tested for this in China right now).
—There are NO confirmed deaths in patients outside of China, in at least 68 such patients identified so far.  If “China is hiding deaths!” were true, we would have at least one, probably several deaths in patients ex-China.  We don’t.  That argues that this is not Ebola.  It’s not the Black Death.  We’re going to be much closer to the flu.

The Bad:
—That said, ~20% of patients in China, per the current numbers, do require hospitalization.  Based on current China numbers, mortality is ~2.2%.
—I EXPECT THAT MORTALITY RATE TO FALL.  China is still very much catching up to the denominator in terms of total number of people with the virus to calculate its actual mortality rate.
—Right now, pencil in “mortality rate of 2.2% and falling”.

—China has, medically speaking, a fuck ton of this running around, and probably all over the country.  The steady drip of cases detected internationally from travel screening suggests widespread exposure in China.  Either that, or getting this virus makes you much more likely to hop on a plane.  I tend to favor “there’s a lot of this on the ground in China right now–so much that a few patients per day with infection are hopping on an airplane.”  Do not be surprised if cases go north of 100,000 in China—again, this is mostly catching up to how far the virus was able to run in China before we knew it was a thing.
—There are confirmed cases in several countries now in patients who did NOT travel to China themselves recently.  They are few and isolated so far.  
—THEY WILL GROW IN NUMBER.  How fast will tell us a LOT more about how far the virus ran globally before we knew about it AND how infectious it really is.
—Again, numbers OUTSIDE of China matter far more than numbers in China right now, and will remain that way for a few more weeks at least.

Commentary on proposed “solutions” so far:
I have seen calls to isolate China entirely.  That’s a tough one, quite frankly.  If we assume the worst case scenario at the moment—this virus is at least as infectious as the flu, and 2.2% mortality turns out to be bang on, -AND WE DO NOTHING-, the back of the envelope plays out like this:

In the 2018-2019 flu season, 44 million people in the US got the virus.  That’s just about 14% of the US population.  If we say coronavirus infects AT LEAST that many GLOBALLY, that’s 14% of 7.8 billion or 1.092 billion cases in the next year.  At 2.2% mortality, that’s 24 million deaths (for comparison, WW2 is estimated to have killed 70-81 million).

So calls to take this seriously are not unreasonable—IF that’s the true severity of the virus.  Big IF is deliberate.

The major problem with this plan is that this virus is running rampant in China.  Isolating China WITHOUT causing major dislocation globally is a challenge, to say the least.  Many supply chains are just in time, with critical replacement parts being made and shipped from China.  Fortunately, food is less of an issue (China’s exports are not enough to cause problems), but prolonged isolation of China will cause SIGNIFICANT global economic problems if China has to be completely cutoff for a few months to let the virus burn itself out (and China is going to take an economic hit from all this disruption no matter what happens—it’s just a question of degree for them right now).  That’s a hit worth taking if it saves 24 million people, for sure.

Ironically, the US trade war with China, having forced some of these supply chains out of China already to avoid tariffs, makes the “isolate China” option a little easier if the coronavirus is at the higher end of contagiousness and mortality estimates.  (deaths from fentanyl overdose globally, and especially in the US, would also take a holiday as a secondary “bonus” from ban hammering China)

The challenge is we don’t know what the actual contagiousness and mortality is right now.  I am optimistic based on the ex-China cases that we are much closer to flu than not.  If it is flu like (0.13% mortality rate in the US in 2018-2019), the human cost of economic dislocation from isolating China to let it burn out is probably worse than cutting China off just for Flu 2.0.  Plus, the virus is already global, as we mentioned.  This is travelers with the disease who got in BEFORE the screening (and may be spreading it in various countries around the world) or are going through during the asymptomatic incubation period.  So the virus is already out of China, and isolation of China may not be enough to stop it right now if it really is as super contagious as the weekend (and current) scare headlines would have you believe.

But, you CAN minimize the chance it gets worse globally and increase the chances of containing it on the beach head in those countries with just a few isolated travelers identified right now.  Restrictions of flights to and from China, as are de facto happening with United and American airlines (for example) cancelling routes or from several countries just outright “nope”-ing those, will help, and control global spread until the true severity is better known for better decision making on how long and hard to isolate China.  

Those are reasonable and conservative options to take, especially if the truth is something like 2 to 5% mortality with significant contagious risk.  I know that my company, at least, has restricted travel to China and anyone coming back will be banned from campus (and forced to “work from home” the poor bastards) for 14 days.  That is also reasonable given the upper bound mortality implied in the current China numbers.  

That said, I think odds are far greater than not that mortality and contagiousness estimates will FALL from current China numbers, and the broad stability in the Ex-China cases is very encouraging for those odds this week—but the situation needs to fully develop.

So, YOUR chances of catching Coronavirus are better than last week by a bit, but still lottery level.  Any sniffle you have at the moment, unless you’ve been to Wuhan lately, is still MUCH, MUCH more likely to be actual cold or flu than this virus.

Maintain droplet precautions like the flu was close by, stalking you.  Maintain baseline health.

As for masks, I did price them out, just to see.  So far, plenty of stock available and cheap.  If it comes to it, there is mixed evidence on a surgical mask versus an N95 respirator type mask—both significantly reduce transmission of flu in controlled clinical studies.  The N95 respirator mask does need to be properly fit to work though, making ease of use (and cost) an advantage of surgical masks.  If you wanted to buy because you tend to worry and would at least feel the big downside was covered if you did, I wouldn’t stop you.  It’s like $8 through Atlantic Medical Supply right now.  On the other hand, if you don’t want to spend even the $8 until signs definitively point to “worse than flu” AND “enough cases that it is LIKELY coming to a town near you”, I wouldn’t argue with you either.  Stockpile a few or not—your call this week.

Actually wearing one right now is a little excessive given the current likely risk you’ll be anywhere close to the virus though.

Ebola Update:
Only 4 new cases this week, all in the same town (Beni), and 3 of the 4 were from known contacts.  If there is no rubber band back to the teens next week, the end may finally, really and truly this time, be in sight for this outbreak.

Until novel coronavirus hits the DRC.  I kid, but not really, because the DRC has that kind of infectious disease luck.

Your chances of catching Ebola this week are equivalent to the chances of Ebola itself catching novel coronavirus.

(no, viruses cannot really catch other viruses)

<Paladin>