This will be relatively short due to unexpected time constraints this week.

–Ebola update:  No new cases in the last week.  Only 139 known contacts remain under surveillance, with 99% follow up of contacts.  We are within 3-4 weeks of closing the books on this outbreak, assuming no new cases. 

–Coronavirus:  Again, lots of news, I won’t be able to cover it all.

–In short, spread to more countries, with more cancellations of major cultural and sporting events around the world.  Schools are closed in parts of China, all of South Korea, Japan and Italy seems like it will be closing schools too, at least as of latest updates.

–WHO now estimates case fatality rate of 3.4% or so.  I still think this is high based on available data, even though the US rate is relatively high out of the gate (mostly due to a nursing home full of elderly people with pre-existing conditions being a very healthy chunk of known cases in the US right now).

—South Korea is currently testing 10,000 or so people per day, making it the most comprehensive dataset (and a significant contrast from the CDC, who is losing “adult in the room” status as they continue to find excuses to NOT test cases).  To me, the South Korean data is most reliable and best estimate of CFR by including more mild cases than other datasets.  In short, overall case fatality rate is 0.6% in South Korea right now.  For ages 60-69, ~1%.  Over 70, about 5%.  No deaths in kids, and relatively rare infection -at all- in pediatric age ranges, and thank God for that.  For the age range of most on this list (<60 years old), at least in South Korea, the flu is more dangerous than this virus.  So far, the song remains the same:  Covid-19 is most dangerous to the very elderly, especially with underlying conditions. 

–I stand by my “likely to land between flu and 1-2%” call from previous emails.  And again, testing of more mild cases than is currently happening most places in the world is likely to find a bunch, and continue to push CFR lower.

–That said, because of the incomplete data still, my company, like many others, has restricted all international travel to business essential activities, and requires a vice president’s approval.  We, and I am sure others, have also been getting nudging lectures to “be responsible” in personal travel.  Some large companies are moving to work at home.  I would expect that Seattle will not be the last school system in the US to shut for a bit before all is said and done–again out of abundance of caution.

–Got lots of questions this week on domestic travel and conferences.  My short take:  if being there, in person, at the conference, especially in a state with a lot of cases is truly essential, yeah, go.  Chances you run into someone with coronavirus are still pretty low, and again, data right now says it is not especially dangerous to those on this mailing list.  BUT, take precautions.  Bleach the bejesus out of your airplane seat.  Wash hands frequently.  Assume everyone around you is infectious.  All the stuff we have been talking about.

–For my own part, my wife is still planning on attending a major endocrine conference on the West Coast in a few weeks.  We are both still planning on our milestone birthday trip to Arizona at the end of the month (I’ve been looking forward to it, and coronavirus can go ahead and come get some if it’s in Arizona when I get there).  I am also NOT cancelling Spring Break plans of a cabin in the Tennessee mountains.  But, I absolutely plan on taking the same precautions I am advocating to you on those trips (i.e. lots of bleach wipes for the plane). 

–I would not be traveling internationally though unless I absolutely, unequivocally, HAD to.  To me, that is as much about the risk of being stranded by a quarantine if that country blows up with coronavirus while I’m there, or US international airports I am trying to get back to blows up and quarantine while I’m in transit.

–There is still a testing gap in the US and most nations globally to detect active cases, especially mild but still infectious disease in the community.  You are still a week, maybe two, from the more localized testing becoming available following the FDA ruling this past weekend.  (in fact, there is a giant webcast for US labs tomorrow afternoon for questions and best practices for getting up and going). Most of the testing gap was limited availability of the CDC assay in the early going (less a problem now), bureaucratic rules, and CDC’s restrictions on who to test, which were behind the pace of the outbreak.  And still are, so far as CDC itself goes.

–For example of the testing gap, there is good evidence (summarized here:  https://bedford.io/blog/) that the breakout in Washington has been spreading there for -at least- 5 weeks, and very probably is 570+ people with coronavirus in -just Washington- whether they know it or not.  Possibly up to 1500.

–Most countries reporting cases have a LOT more than they have confirmed, as we have discussed before. 

–Conflicting reports on if China is actually back to work, or just making it look good.  They say they are, but pollution monitoring says they are nowhere near full speed again.  And I still don’t trust their infection numbers completely.

–Yes, the CDC screener at LAX getting coronavirus is a little concerning given apparent transmission despite using a full complement of personal protective gear.  That said, all it takes is a bit of a slip at the wrong time, and you’re exposed.  Or they simply got in their off time, around other people, when they were not wearing their equipment.  Don’t make the panic assumption “OHMYGODITGETSPASTMASKSANDGLOVES” and especially don’t come at me with “see, totally a bioweapon dude.”  Off hours, or poorly timed mental lapse with equipment use, are FAR more likely explanations for how that guy got his case of coronavirus.

–Lastly, continue to remember that the priority for governments around the world is effectiveness of response and containment, and -perception- of effectiveness of response and containment.  If they have to pick one, they -will- pick perception of effectiveness.  That’s often -easier- for them to manage than actual containment of contagious airborne virus.  Keep calm, and carry on.

–Your chances of catching coronavirus are equivalent to the chances you remember that Tulsi Gabbard is still in the running to be the Democratic Presidential nominee.  You might remember, but odds really aren’t good, since the media has been doing its absolute best to ignore her.  But she even has pledged delegates and everything from all the primary voting!  Alright, better analogy.  Your odds of catching coronavirus, or ebola, are equivalent to seeing Tulsi in the Democratic Primary debates coming up–despite the DNC inviting anyone with a pledged delegate to debate previously.

Finally, Love in the Time of Coronavirus:

Thanks to a UK contributor for that one…

Also the winner for “Most Appropriate Meme for This Particular Email Series”

God bless you, Internet.  You just -get- me sometimes.

<Paladin>