Ye gods the scare headlines have been fast and furious this weekend, so figure I would drop a quick update.

What I am -certain- of:
1).  This outbreak started some time ago in China.  Before the mid December date currently projected.  It was not detected because this looks like a bad cold, and with a fever, the flu.  The few cases that first hit hospitals or doctors offices were isolated.  -If- they tested for viruses, and that is a big -if- given what I have been told by Chinese colleagues about how testing is ordered, paid for, and even available in middle of nowhere China, it came back negative for the known viruses.  With just -a- patient here or there, that’s easy to chalk up to weirdness with the test and just treat like it was flu or a bad cold or a viral pneumonia.  Not until a pocket of cases in Wuhan showed up to the hospital in a rush and ruled out for the usual suspects did the novelty of the virus get recognized.  That’s not a surprise.  China being less than forthcoming about human to human transmission is.

2).  There are -at least- 4,000 active cases in China.  Bank on that.  Key point—some, if not many, of them are not sick enough to actually go to the hospital.  Counts are rising in China because now they can (and will) test anyone showing up to a doctor with cold/flu symptoms for this thing. THIS IS NOT AN ACCURATE MEASURE OF HOW EASILY THE VIRUS IS SPREAD.  Much of these “new” cases are just a reflection of new and widespread ability to recognize this virus as being responsible, coupled with a -lot- of people in China with it and spreading it who did not know they had it because it has been circulating in China for months now.

3).  I want to reiterate that case numbers in China, and their change, for the next several weeks will be as much a measure of -prevalence- (number of people infected when the novel coronavirus was running dark under the radar, and was not specifically tested for over the last couple of months) as -incidence-, or the number of actual new cases.  Incidence is a -function- of how many cases are already running around (prevalence) and the true contagiousness of the virus.  NUMBERS IN CHINA RIGHT NOW ARE NOT AN ACCURATE ESTIMATE OF CONTAGIOUSNESS, BECAUSE THEY ARE STILL CATCHING UP TO PREVALENCE.

4).  There are articles out now mentioning the Ro, best thought of as the epidemiological measure of contagiousness.  These are based -on the numbers in China-.  At -best-, they are the upper limit on the true Ro, because again, numbers in China are as much catching up to how many people got infected before the virus was detected as a reflection of actual new infections.  That upper limit is a little above the Spanish flu, but much less than, say, smallpox (Ebola is about half the Spanish flu).  The Ro only tells you approximate contagiousness.  It doesn’t tell you how serious the disease itself is.  The common cold has a pretty rocking Ro too.

5).  The media will take the scariest statistics and suggestions and run with those.  Count on it.  They don’t understand or don’t care to print this nuance and caveat on these numbers they are throwing out.

6).  That said, because there are more patients than suspected in China, because it was under the radar as a cold/flu that wasn’t quite bad enough to cancel travel plans or go to a doctor for a long time in China, this virus is everywhere.

7).  That bears repeating too.  New cases all over the world should be -expected-.  Even worse, there are undoubtedly patients who did not have symptoms to trigger travel screens (even now), but were in the incubation period when they traveled.  They will get sick—all over the globe.  They will spread this virus.  It’s not a question of “if” it goes global.  Rest assured, it already -is- global.  Everyone, including you and me, is absolutely at risk—

BUT….
8).  THE KEY PATIENTS TO WATCH ARE THESE ISOLATED PATIENTS OUTSIDE CHINA.  None of them have died—yet.  But they are few, their contacts are easily traced.  THE BEST DATA ON THE ACTUAL Ro AND SEVERITY, and thus how worried you REALLY should be will be these patients over the next week to 10 days.

9). Your odds of having run into someone carrying this virus are lottery level–this week.  Your odds will “improve” over the coming weeks.  How much depends greatly on those patients outside China, and how many of their known contacts come down with the virus.  How much of a problem that is will also be told by what outcome we see with those outside China patients.

10).  Remember with those videos from inside China showing panic—an already less than trustworthy and corrupt government is closing entire cities and regions as it realizes that the -prevalence- is high because the virus has been running unrecognized for months.  The panic of the average Chinese citizen is understandable.  -Everyone- with cold and flu symptoms there will panic—even though many of them are -still- much more likely to have the actual cold or the actual flu than novel coronavirus.

What I am uncertain of:
1).  How infectious this coronavirus -actually- is.

2).  How severe it is in most patients.  Plague is severe in most patients.  Ebola is severe in everybody who manages to catch it (even though its Ro is low—Ebola is relatively tough to catch).  The flu is really uncomfortable for about 7-10 days in most patients.  But the flu infects a lot of people.  Only a small minority are killed by even the Spanish flu—flu kills a medium sized town’s worth of people in the US every year only because so many people get it, including people very young, very old, pregnant or with other serious underlying problems who are a little more likely to get severe pneumonia if they do catch the flu.  This virus is -much- more likely to be like the flu than like Ebola.  The outcome of the patients OUTSIDE China will be the best indication of where on the spectrum the truth lies.  We’ll know more about them by Friday/Saturday or so.

What you can do in the meantime:
1).  The basics, as always.  Don’t smoke.  Eat clean (and you know what junk food is—favor healthy choices, whenever, wherever).  If you cannot get outside for an hour a day or so, get a Vitamin D3 supplement going—2000 IU per day is plenty in most cases.  Exercise.  Even little things like walking for 30 before or after lunch help.  Maxing out the incline on a treadmill and just -walking- until you can’t is a surprisingly effective workout.  Get 6-8 hours of sleep, religiously.  Keep your baseline health up, and you will make yourself a harder target for any virus.

2).  Standard flu precautions.  -Assume-, right now, like when a couple people in the office call off for flu, that the virus is already around you and spreads like the flu.  What I do, especially when family has cold/flu symptoms, is avoid letting them cough on me as much as possible.  Don’t do “dad mop up” on their leftovers on their plate.  Don’t share utensils.
Most importantly, I wash my hands like I am scrubbing for surgery after touching anything I even remotely suspect might be infectious (and anytime I go to the bathroom).  That’s hot water, with soap, lathering up to my elbows (literally).  It should take at least a minute or you did not do it right.  Good thing to teach elementary and preschool age kids too.

3).  Masks are a little premature.  I promise I will let you know the moment I go to Amazon for one—but we will need to see a bunch of deaths next week in the “outside China” patients and each of them with several contacts now getting sick before I go looking for a mask.

It’s a fluid situation.  Not much is known -for certain- right now.  We will know more by the end of next week.  Don’t let them convince you to panic and run around like your hair is on fire—just yet.

<Paladin>