Coronavirus Update

—In the past week, there has been no exponential take off in new cases outside of China.  In short, although many travelers have been found with coronavirus, their known contacts, by and large are NOT getting coronavirus from them.  Nor are their healthcare providers.

—Of 191 patients currently outside of China with confirmed coronavirus, only 50 do NOT have travel history to China, and caught it from someone else who did go to China.  This suggests an Ro MUCH lower than the dire estimates off the China numbers.

—In the US, only 2 (at most 3) patients out of 11 have caught coronavirus without traveling to China first.  The UK is 1 from China, who probably infected the 1 who did not go to China (that’s both of their cases).  Among countries with large-ish numbers of cases so far, Japan, Korea, and Germany are the only ones running about 50/50 or better China travel to no China travel cases.  Thailand is 4:1 travel to China vs no travel to China respectively (25 total cases) and Singapore 5:1 (24 total cases).  Again, consistent with lower end Ro.

—Some better epidemiological modeling is coming out, and peer reviewed.  The best I have read so far currently estimates a Ro of 1.4-3.8 (under 1, the epidemic is doomed to die out—what you want to see is an Ro falling).  That includes China numbers, and at face value.  That same paper also suggests, as current case numbers do, that super-infection events (where one patient infects a whole lot of other people at once) are likely rare to non-existent, and the epidemic is chugging along because it’s in a lot of people already, some of whom are infecting a few other people themselves at a time.

—If that last sentence is true, then keeping the airplane travel ban in place will go far to contain the spread of the virus globally.  If you keep the numbers of simultaneous patient zeroes down, you can hold the beach head pretty well.

—In the United States, 206 patients with symptoms and travel or known exposure history have tested negative for coronavirus versus 11 testing positive.  So currently, patients WITH a reason to possibly have coronavirus AND symptoms are still 18.7 times MORE LIKLEY to have something OTHER than novel coronavirus.  Yes, that number trending up this week is also consistent with a lower end Ro/contagiousness.

—The difference in the mortality rate between patients OUTSIDE of China (where only one patient in the Philippines has died) and INSIDE of China (based on official Chinese numbers) is now statistically significant.  That is to say, there are 19 chances out of 20 that the mortality rates are truly different between patients INSIDE China and OUTSIDE China.  The mortality rate OUTSIDE China is much less than the mortality rate inside China.  The most likely explanation of this is far more rampant disease inside China and the “severe disease” attack rate.  After all, most of the patients outside China are themselves also Chinese, so genetics doesn’t explain it, and there is no magic bullet drug that other places have and China does not.

–However, there probably IS a treatment difference between cases inside China, and those outside, and that is probably driving the big difference in reported mortality. 

—Why?  The “severe disease” rate in China is currently at about 13% of cases, down a bit from last week, based on official WHO numbers.  ALL of those severe disease patients need to be hospitalized.  I think the China death rate may be significantly higher than outside China because the Chinese hospital system is overwhelmed by the sheer number of cases in the affected geographic zones, and does not have enough ICU/hospital beds for everyone.

—I will pause to let you recover from the shocking, –shocking– suggestion that a communist system may be under-resourced.

—But it does explain the crash build of a 1,000 bed facility in Wuhan with mostly droplet isolation and ICU beds.  It would also explain any fudging of numbers China is actually doing—because their government, already tyrannical and corrupt, does not want to let its people know it screwed up and its healthcare system cannot handle this emergency because of lack of availability of appropriate care.  So the Tencent “leak” of much higher numbers for China in terms of deaths and numbers of confirmed infected, and internet rumors of Chinese doctors claiming they are being leaned on to classify coronavirus pneumonia as something else and denying hospital admissions to some cases, possible.  Are they true?  Who knows?  Doesn’t matter, as the outside China cases continue to be the more relevant ones for measuring the risk to the rest of the world.  But it is worth noting that an overwhelmed system would both explain the death discrepancy AND motive for China to undersell the scope of their current problem, especially domestically.  If they have to admit that higher mortality is because when crisis hit, their all powerful, highly repressive government was NOT prepared, that would threaten the party’s legitimacy.  China’s Communist Party also -desperately- needs to avoid major economic disruption to maintain legitimacy too, another motive to undersell a bit at least and complain about travel and border restrictions.  Again, those restrictions will be a fine balance though.  Prolonged or complete economic isolation of China will have global human consequences eventually.  For example, fun fact, 97% of all antibiotics in the US have mission critical components made in China.  And that’s not the only critical supply chain that China plays an outsize role.  China produces 71% of all rare earth elements–which anything electronic needs.

—Anyways, outside China, where patients are mostly in singles or small groups, the hospitals can accommodate the “severe” cases without getting overwhelmed–at least right now.  No good data on how many outside China cases are “severe”, but we can assume something in the order of 10-20%.  

—This again argues FOR at least temporary extension of travel measures–at least until the supply chain pain starts and begins to threaten lives itself.  Once that happens… tough call.  But the difference in inside/outside mortality suggests the key to controlling the virus’ mortality may come down to having enough beds for everyone who needs them.  That means -total- cases in the area need to be minimized.  If it continues to be a trickle of cases outside China that the local healthcare systems can swallow, humanity wins.  If China travels freely, globally, with as many cases on the ground as they seem to have, you have an increasingly unacceptable risk that enough patient zeros (and the few per zero they may infect each) will be around locally with severe disease to start overwhelming the hospital system.

—Thailand and Singapore, in my opinion, are the highest risk for this right now based on number of existing and new cases (25 total in Thailand, 6 new today; 24 in Singapore, also 6 new today).  That said, I think they have plenty of current beds to handle the trickle of cases coming their way at the moment.

—Continue to watch the Outside China numbers as more informative for contagiousness and seriousness of the threat.

Your chances of catching coronavirus remain slightly elevated again this week (the world is still adding new cases every day), but still very much lottery level.

Ebola:
6 new cases, but only 5 come from known transmission chains.  So the Ebola portion of this is likely to roll on for at least a little while longer.  The geographical range has shrunk considerably, and it still feels very much like we are in the late innings on this one.  Contact tracing percentages are up to the low 90s—insufficient for a quick win, but trending in the right direction.  Finally. That said, there are still security issues, especially at health checkpoints within the DRC, and with the world now way more focused on coronavirus, a rebound is still possible. 

Your chances of catching Ebola this week are equivalent to the chances that coronavirus successfully develops its own vaccine–against humanity.

<Paladin>