Down the planes now!! Every American self-quarantine for 2 weeks. It went up 100 today! We need to stop this now. How dumb can we be to keep circulating this thing throughout the country?! Stop traveling. I'm gonna get it. In my state which (officially) has no community spread (probably unlikely at this point), someone is going to come here on an airplane from Seattle or LA and infect me. Down the planes now! We don't need it here! But unfortunately, I predict cases of "community spread" (i.e. AIRPLANES!!!) will start appearing here in WI in a few days. The day that person in North Carolina who got it in Washington State and then flew back should have been the last day of flights. And now I've been sick for a week and getting worse and it just seems like everyone is snuffling their noses and coughing. I really think about 50% of the country is going to get this if we're not smart NOW!
26
Because the Chinese Gov did not believe or give credence to the early cases .. The Proverbial Cow is now out of the Barn for the rest of the world...
Left to his own "innate medical judgement" Trump would do the same. I think he should visit Wuhan and assist them.
37
This is precisely why Trump should be dismissed for his desire to keep the nation ignorant of the dangers. Who is telling him to stay quiet? Why does he control scientific facts which he hates with a political man? We are now just in the beginning of trouble and still largely calm and capable of learning how to prevent getting sick and this very aptly focuses the readers on the dangers before they may be widespread. We can't take care of ourselves and others being stupid and unaware. This article likely saved many older people's lives because now they will receive more protection.
12
Keep in mind that about 20% of COVID-19 patients require ventilator support, costing around $1500 per day with a median stay of around 15 days (for all cases). If you have the misfortune of having a serious case requiring extracorporeal membrane oxygenation (ECMO), the mean total hospital cost is $213,246.
https://www.researchgate.net/publication/7800750_Daily_cost_of_an_intensive_care_unit_day_The_contribution_of_mechanical_ventilation
https://academic.oup.com/ejcts/article/37/2/339/774991
36
I'm not an expert in the field, but I did work in a hospital laboratory while I was in college, during the H1N1 pandemic. Eventually, doctors in our hospital stopped testing people because it just wasn't very deadly. I think it's better to look at this coronavirus through that lens just for everyone's own sanity; there are definitely thousands of uncounted cases in the US, but if they're all going to get better without treatment, what's the use in testing and freaking people out?
36
Donald J. Trump's "hunches" about anything that matters should be quarantined by the media.
86
Too smart!
This virus is over blown. We are going to wreck our economy over it? Go and live your life. This is all silly.
29
When I received an email circulating around the Internet with recommendation by noted pathologist and molecular virologist James Robb, MD, ( he was the first to demonstrate the number of genes this virus contained) I concluded there are 2 BIG differences between the flu and the COVID19:
1) Coronavirus survives on surfaces for 10 days to two weeks. The flu virus survives only 24 hours on hard surfaces.
We are still learning about COVID19 but it is safe to assume this virus can last 1000% longer on surfaces than flu viruses.
2) The coronavirus particles travel only about six feet (1.8 meters) and fall out of the air rather quickly. By contrast the flu droplets 1-4 microns in diameter remain suspended in the air for very long periods.
These two differences taken together means that the only reason to wear a mask is to prevent you from touching your nose or mouth (wear glasses to prevent you from touching your eyes. Unless someone sneezes directly on you the chance is you will get infected from your hands rather than breathing the virus. By the way if someone infected with COVID19 sneezes directly on you the mask will not do much good anyway.
This it the reason you should clean your hands and avoid using your fingers on electrical switches doorknobs, fuel pumps or any other surface touched by many people. Use wipes to clean the shopping cart and keep bottles of disinfectant in your car and by each door to your house.
I forget did I say wash your hands for 20 seconds?
56
Are medical equipment manufacturers ramping up production and distribution of ventilators? Come on, guys--we've had two months to get ready for this thing.
Has the medical infrastructure been following the lead of the "What, me worry?" Alfred E. Neumann Presidency? God help us.
15
A question I haven't seen answered: the test kits coming along the pike are geared toward diagnosing active infections. Test is called the "...(CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel."
Is there a test yet which picks up the presence of antibodies for those who have had an unrecognized coronavirus infection, recovered and proceeded with their lives?
Are any such tests developed? If that group is not in some way enumerated, it seems to my statistically challenged brain that all estimates will be off.
23
Personally I find it very frustrating how all parties are bantering about this infection. The medical professionals we see on TV. The media’s blizzard of scary stories. And the administrations various interpretations of what’s happening.
Two weeks I came down with what I thought was maybe this virus, so I stayed home and watched and read. And worried: I’m 72 but in good health essentially. But as I felt worse and worse I started thinking: do I have my affairs in order? And then on one show on one day, another expert appeared and simply said: if you don’t have a temperature of at least 101, if you don’t feel ache. And if when you take deep breaths it comes easy with now rattling the you don’t have this virus.
It turns out I didn’t, as I’m over whatever it was. All of which made me realize how useless “news reporting” is in this era of marketing for money and our insane internecine political warfare. And it has to stop for all our sakes.
22
Have ANY children died from Coronavirus?
Supposedly in China 80% of deaths were 65 or older and 75% had preexisting conditions.
I hope the US publishes the ages of those who have died.
6
Russia reports 13 cases nationwide. This means either they've lost control and are keeping the numbers secret, or nobody is bothering (or are unable) to test, and the numbers are simply not known. Either way, expect a disaster.
12
If the same virus had popped up before anybody could write anything online and make it instantly available for everybody to get paranoid about, would we be seeing the same overreaction and panic that we are seeing now? A panic that has no basis on data.
7
Statistically, the "the number of deaths divided by the total number of confirmed cases," which the article defines as the case fatality rate, will always be too low if the virus is spreading. For example, if five people got sick yesterday and all five of them died today, the case fatality rate should be 100%. But if five more people also got sick today, the total deaths (5) divided by the total cases (10) would equal 50%, even if they're all going to die tomorrow. (Apologies for using the most morbid possible example).
One way to account for this is to compare the number of deaths to the number of new cases from x days ago, with x being the average number of days between case confirmation and death.
7
Another key indicator interests me much more, but I have a hard time to find any numbers on it: the hospitalisation rate.
At the moment, it seems health system are the bottleneck: countries are trying to slow down the propagation to be able to provide care to everybody.
Early on, I read the number for China of 14% require hospital care + 5% intensive care.
Any new info by now, and more importantly: how does that rate compare to the seasonal flu ?
Thanks for your great coverage of the situation.
17
It might be important to know the percentage death rate, but what really matters is how many people become critically ill from this virus. It is the illness rate that will affect communities and hospitals and economies,
The reality is we don’t know the true death rate from seasonal flu. We only know deaths of people known to have tested positive for flu as a percentage of people who were tested for flu. Many people have mild flu and are not tested or treated — so the Covid19 mortality figures we currently have seem to be methodologically comparable to those of seasonal flu,
7
I understand the case fatality rate and the infection fatality rate are based on two entirely different set of parameters which is one of the key reasons why the predicted death rate varies greatly.
What I don't understand is why this president feels the need to comment on something so serious, technical and scientific based with "his opinion" instead of deferring the conversation to the experts in the field of epidemiology.
But then, this is a president who does not believe in science, does not believe what scientists and doctors at the WHO have been saying and predicting based on how this virus has performed and spread in other countries, and does not believe what the media has been reporting.
I'm waiting for this president to come out and present his "opinion" that the percent death rate number "is way under 1 percent" in the form of a big chart and black Sharpie markers.
His "leadership" does little to comfort nor ensure a sense of safety by downplaying this virus and by not having enough medical testing kits, masks, or other necessities in order to control and diagnose this virus.
This Administration has been woefully underprepared across the board to effectively deal with this health crisis. But then, when has this Administration ever been proactive about anything that relies on and requires scientific and medical experts?
29
Why don’t we look to a country who have done wide testing to get a more accurate sense of infection fatality rate? South Korea with their weeks’ of testing (n>150,000) has a fatality rate of ~0.6%. This is why I’m not panicking. Is this overly optimistic?
17
Will this come back next year as well? I got a text message from my GP that they will be doing triage from over the phone until the epidemic is over. My first thought was 3 years for some reason. I mean what happens next winter? And the winter after? How we treat animals/ nature collectively freaks me out - it’s so depressing. One bat or pangolins reaction to us might kill millions and brings a global recession. We openly see how capitalism destroys the planet and I wonder if we will ever learn or change. Positive side we are finally not blindly traveling all over the world burning fossil fuels etc. I think the psyche of Greta and all of the abused animals caused a rift in the universe as one last plea. I also think corona meaning crown is wild reminding us nature is the ultimate prevailer.
8
Massive testing is the answer, but Trump doesn’t want to know. He doesn’t want the American people to know. He doesn’t want to cancel his hate-rallies.
14
Humanity gets a wake up call every now and then. Now is one of those times. When troubles like this strike, it's not just the economy at risk, it is society itself. We framework around Capitalism, but it's not much help when a serious new disease arrives. The inadequacy of profiteering pales when real problems arise. Climate Change is in the same category, but the Ignoramus -in-Chief calls it a hoax. Sadly, the hoax is on us for allowing such an outrage, a con that slows us down from dealing with the trouble. Not enough test kits, really? First the planet, then people, then profits. Any other priority threaten our very existence.
9
There seems to be total and complete lack of information of high risk populations such as newborns, infants and pregnant women. Coronavirus may be fatal in the elderly with health risks but what is more risky than being pregnant or a newborn? What are the statistics for them and their recovery? Are there any health risks to newborns or infants under the age of 1? The more information the Trump administration withholds the hard it becomes to make intelligent decisions.
4
Many thanks for an informative and nuanced article.
10
It would be very important to determine the mortality based upon decades. If you get the virus and you are over ninety what is the percentage of death? If you get the virus and you are over eighty what is the percentage of death? And so on with the last group being under ten. This would be a far more meaningful way of determining how lethal this virus really is.
5
We actually have a pretty good laboratory for the COVID-19 death rate: the Diamond Princess cruise ship. Everyone on the ship was tested repeatedly, and we know how many died. Slightly over 700 were infected, and seven have died. That is roughly a 1% first-world fatality rate. Unfortunately, reporting on this stopped several days ago.
One percent is pretty high if millions of people are infected.
19
I wonder if the reason the diamond princess death rate is lower than expected is because they had a lower dose of virus. They were trying infection control, maybe it worked, sort of. It motivates me to be washing my hands 16 times per day when at work and slosh 1000 ppm bleach water every where I touch in my car and house. Be nice to yourselves and those in quarantine please. I’m worried about losing my elders. Sure wish we had a president that cared.
13
I heard that some doctors were experimenting with drugs developed to combat HIV and ebola, also Tamiflu. So how successful have these experiments been? And is there enough supply of these drugs to treat many people? Also, as far as I can tell--I may be entirely wrong--if you die, you don't die of the Covid-19 virus itself. You die of opportunistic pneumonia, that sets in after Covid-19 has damaged your bronchial tubes--and your lungs? I think that's how many flu deaths take place. So does it help if you have been vaccinated for pneumonia?
5
Epidemiologists are rational players in this matter and prudent rationale thought and action are what we need. Fearful, knee-jerk responses while tempting are really counter-productive. The Times and other Media outlets need to consider this in the headlines that they generate on the virus story. Just as for Trump this should not be a time for politics, it should not be a time for media marketing.
4
How deadly is the Coronavirus? That depends if the Trump administration can get its act together in time to save American lives. I wouldn't count on it.
5
I am not optimistic about the ability of people who refise to understand what a “margin of error,” is in polling data tobe able to get this.
1
How lucky is the United States that in the midst of a Pandemic you have a President who is a Professor of Pandemonium ..
11
S. Korea has tested many thousands of people. Based on reports in the news and from family members who live in Korea the number of people tested exceeds 200,000. And based on the number of deaths caused by COVID19, the death rate is less than 1%. Any meaning in these numbers?
4
Thank you NYT for your attention to science and to facts. This is what we all need right now. Keep up the good work.
8
I’d like to know what kills the virus. Alcohol? Bleach? Steam? Microwaves? Heat?
Is it too soon to have studied this?
2
Probably the best summary article regarding testing is from the C.B.C.:
"'We're just lost': Why the U.S. still lags on COVID-19 testing"
https://www.cbc.ca/news/world/we-re-just-lost-why-the-u-s-still-lags-on-covid-19-testing-1.5488886
I will skip summarizing the article or quoting excerpts. If the subject interests you, I'd recommend reading and evaluating it for yourself. There's enough second and third-hand stuff going around without me adding to the fog.
1
The denominator in the calculation is the key. While established diseases with regular patterns use the entire population as the denominator. So far, the Covid-19 only uses those diagnosed. While this is a good predictor of the outcome of a diagnosed infection, it does not predict for the general population.
The current data says that this is a very serious infection and if you become infected the probability of death is in the 3 to 4% range.
If the Chinese were to use the total population of Wuhan or all of China the probability is much lower - perhaps on track with Influenza.
We must remember that: "Fear is the mind-killer" and our fear will cause us to do really stupid things.
3
Good thing our government and health departments all agree on what to do to protect the public!
(not!)
3
Here in King County, Washington, where most of the US coronavirus death have occurred, it's hard to know just how worried to be. It does seem that unless your health is already compromised, you're still more likely to die in a car accident going to a public event that from catching a virus while you're there. But I don't want to be stupidly cavalier, either. I much appreciate level-headed coverage such as this article.
4
The Case fatality rate in China outside Hubei is around 0.86% right now. Perhaps more importantly the number of new confirmed cases each day is in the low double digits, and the number of new deaths averages less than one per day. This means that the CFR is becoming flat and approaching a limit under present conditions. You can see a graph of this here:
https://drive.google.com/file/d/1KVUpukK2-UxH0zVE-fAsiEGBJcKLEnmG/view?usp=sharing
2
I am a permanent critic of the NYT. But this time I thank them for trying to report as best they can on the facts involving this mysterious virus, and especially the fatality rate that is far lower than Health organizations announce..... but do so because they must report even with unclear and incomplete data. But in truth, it appears that Covid19 is closer to a global economic disruptor than to the Black Plague. The trick is going to be how best to not allow what may be necessary to crash an economy. Scaring people to death never helps.
It has been well reported (except by the NY TImes, I guess) that testing for the coronavirus has been very thorough in South Korea and the death rate computed as a result of that extensive testing is .6%.
Why this info is NOT being provided by The NY Times is astonishing to me.
3
It seems in this case, those who thought Trump was making a fool of himself to second-guess the head of the WHO were themselves playing the fool. Humbled by Trump, they could thank him for this humility exercise....
1
Why are we not seeing comparisons to the Polio epidemics?
I haven't seen Polio references mentioned in the coverage of Covid-19.
I was involved in the Salk trials and recall the 1950's infections very clearly.
5
Some under reported intel about C-19. It is a 2 stage affliction. Seems that it really is a "cold" to start with. Then in a few cases it migrates to the lungs and becomes serious. That makes statistical analysis of the numbers infected more or less impossible. You would have to start with EVERY case of respiratory illness, screen out the allergy sufferers. Screen out the people who have a cold, Screen out the people who have the "flu" and those that are LEFT would be the C-19 patients.OR you would have to test EVERY person with upper respiratory symptoms of any kind. Needless to say this will NEVER happen. So we are left with only knowing the number of C-19 cases because A, they become serious, or B, they get caught in a targeted screening net. Targeted nets will get you an unrealistically high number of positives. That is why we have these crazy percentages of "serious and fatal" cases.
1
A useful follow-up article could focus on the rate of expansion of the denominator: estimates of prevalence of COVID-19 cases in locations and over time periods. For example, during the first six months of 2020, what percent of the total population of New York City will be infected or will have recovered from infection?
Are there reasonable scenarios where the case prevalence would be lower than 100%, maybe 50% or 20%? What would have to be true about the virus, and about our public health strategies, and about public responses to those strategies?
3
It's not just the immediate death rate that counts but also the long-term impacts of anyone who has been seriously ill with this virus. We are getting reports from other countries that survivors who were seriously ill have permanent lung damage(fibrosis). This is a real concern as the quality of life and medical costs for survivors who were seriously ill may be greatly impacted.
As well, there are indications that one can catch the virus again, especially if it mutates. What will be the numbers of fatalities(or serious illness) for those who catch it again?
10
How much is the cost of the coronavirus test? I ask that thinking in poor countries.
4
It's worth knowing the risks for hospitalization and death by age, gender, co-morbidities, and level of available healthcare. Those matter once you have the illness, but are largely out of your control at that point. They can still prove useful for planning as well as a baseline to compare various outpatient and inpatient therapies. They can also be followed to see if there are changes to those rates over time or by locale.
Many of us would find it even more important to know our risk to get infected in the first place and what factors influence that. Certainly it will vary by local changes in disease prevalence. Individual factors like social habits and faithfulness to known mitigation measures likely matter, too.
But what's maddening is that to gain these understandings you have to do comprehensive testing for the disease in the first place, and we're weeks behind when every day matters.
7
@Michael Tyndall Not true. The sort of testing (sampling is a better word) required to answer the questions raised in this article can be done on anyone of us for years to come (those that die now are being tested post mortem).
The testing to see if you have it now is different but even then is not that relevant: first, they test you for the regular flu. Second, if you don't have the regular flu but have all the symptoms, they just assume you have this and treat you (meaning quarantine you) accordingly
1
I've heard stories from at least three European countries. While self isolation is always recommended, few qualify for a test for covid as a precaution. So the number of positive cases is probably much higher.
1
I don't understand why scientists have not said why warmer weather (how warm?) will reduce the number of people who catch Covid-19. Surely the survival of the virus can be tested in a laboratory under different degrees of temperature and humidity? Instead of us all anxiously waiting to see what the weather will do?
11
@Frances Grimble I haven't seen any reports that the virus is affected by the weather. The hope is that with warmer weather people will open windows and get outside where disease transmission drops.
2
@Frances Grimble
Although the exact cause of reduced flu cases as summer approaches (in the northern hemisphere) is not fully understood, there are two main theories:
1. people spend less time indoors in constant close contact when the weather is warm, so less transmission;
2. the flu runs its natural course, people contract it and gain immunity - so there is "herd immunity"
The actual outdoor, ambient temperature and level of humidity may or may not have a significant effect on the survival of the virus outside the body.
3
@Frances Grimble
Excellent point . . .
And if it is spreading in Iran, Israel, and Egypt, while Saudi Arabia closed down Mecca, what temperature does it need to reach?
3
The death rate is a very misleading statistic for an individual to attribute any meaning to. Thus far, many of the serious cases and fatalities seem to be patients with comorbid conditions. If we truly want to help people understand their risk of having a bad case of the disease, then we need to create a risk model with many variables (covariates).
Right now we have very little data. We know that the possible key variables thus far are: country, age and overall health, with the last two being correlated to some extent. That's all we have. Let's stop talking about death rate, because it's only helpful to epidemiologists, and misleading to the public.
5
i have an extended family of caregivers and first responders including doctors, nurses, police officers and teachers. I volunteer at a shelter and am a retired clinician. The people who will suffer the most are the elderly, the immune-compromised, the severely ill, the homeless, and the front- line workers who are constantly exposed to the virus. There is an integrity which everyone can maintain that will keep the majority of us alive. Stay calm. Do not hoard. Take practical precautions. Don’t waste time calling your doctor to help you make a decision about a trip. Instead, go to the CDC website and do your own research. Be responsible and responsive towards others. And stop panicking. I come from a very giving family and I’m fortunate most are healthy. As they provide necessary services, the public has a responsibility to act with kindness and calmness. Please.
92
@GGram What's so bad about panicking?
I am interested in the test methods used in each of the reporting countries. What concerns me are false positives and false negatives. I also wonder if an effective test has existed in these countries, and when this testing was started. We in the USA are now making test kit. Are these kits different from other.countries? I ask these questions because "confirmed cases are subject to the effectiveness of the test used.
2
Amid all the one off reports of new cases and events, this article was a great attempt to work through the epidemiology.
I would be interested in more expert analysis on future projections based on emerging evidence. Is this going to become endemic? If endemic, will earlier infection provide immunity? Would the death rate decrease as higher proportions of the population have recovered from infection? Given knowledge of corona viruses, over what time period could mutation be expected? Does mutation generally move in the direction of greater or lesser transmisability and mortality? Then the whole societal implication piece moving forward. Do corona viruses "Just go away"?
9
@GR
Yes, SARS 1.0 just "went away". It didnt have a large enough host population to sustain itself, and it disappeared in 2003 MERS did not go away, but its very rare. Thankfully COVID is much, much less deadly than those two.
As far as mutations - All viruses mutate slightly with transmission. Coronaviruses mutate less than a virus like influenza.
Most mutations dont change the virus enough to make it "different" though, and are more like genetic fingerprints. The virus itself acts the same.
When a virus does mutate enough to change the way it works, its generally selected for less deadly and easier spread. There are plenty of coronaviruses out there that give humans mild annoying symptoms, and are very easily spread. These are colds. But maybe thousands of years ago, what we consider annoying colds were deadly to ancient humans, but a combination of immunity and mutations selected for those coronavirus colds to be less virulent.
COVID is interesting because its more like a bad flu (It is *not* a flu though, and has a hgher death rate than seasonal flus) fortununately it is nowhere near as deadly as the other novel coronaviruses like SARS and MERS. We'd be in major trouble if it was.
17
@raix one extra reason why mers and sars were contained was that they were too deadly too fast. They were "too good" for their own survival.
2
I would expect that the proportion of people dying in an ICU would be pretty high. To date, in this country especially, we have only looked at the mortality among people highly likely to be very seriously sick. Unsurprisingly, the mortality rate looks high. Denominator effect, as the exhibits in this article illustrate.
My prediction, as someone who doesn't even play an epidemiologist on TV, is that we are going to see many, many more cases diagnosed as testing becomes more widespread. This will freak people out. But it will be accompanied by a rapidly declining mortality rate because we will be testing many more people with mild symptoms.
We don't monitor the spread of our usual seasonal flu one patient at a time, one death at a time. At most, we show it as being prevalent in state A, less so in state B. Once we get a better handle on the mortality rate of this strain, we'll get our reaction more in line with its real risk.
7
An important statistic that is missing is what is the case fatality rate for healthy people with no preexisting conditions under 50. If we knew this more clearly then we could more appropriately more resources to those more at risk. People are not receiving critical care right now as hospitals are overwhelmed with non-critical care of covid-19. Better triage is needed. Most people just need to be told to self-quarantine at home. The current response in most countries is not only tanking the economy but using limited resources inefficiently. The second order effects must also be considered more such as the effect on the overall health care system. The average case fatality rate is not important when it varies from 0.1 to 15 percent according to various articles.
8
I implicitly understand the higher mortality rates for people over 60, like myself, and those with pre-existing health issues like high blood pressure or respiratory problems. So why did that young doctor in Wuhan die, with access to excellent healthcare and medical facilities? It suggests there are at least two strains of this floating around, one you get over and one you don't.
23
@raven55 Health care workers are considered at higher risk. The question is : why? On theory is that being around the virus, not just once, but repeatedly and frequently, overwhelms their immune system. In other words , it isn’t just exposure but also frequency and intensity that may be crucial variables. .
15
@raven55 The most likely reason the doctor you mention succumbed was the viral load he was exposed to. While he was in a lower risk age group, the risk at his age is not non existent. In the original group of ~45k in Wubei, the average CFR was 7% for people with comorbidities, but still 0.9% for people without. Lower risk does not mean no risk especially if you are exposed over and over again.
21
@raven55 The doctor was also a whistleblower in China.
5
"If there were a magical way to test everyone in the world for the disease, we would know exactly how many people have the infection."
I agree that the mortality rate is hard to estimate, but it does not need a magical way to test everyone. There are well known statistical processes to sample the population, and epidemiologists are quite familiar with them. The problem really is that the relevant agencies have been caught unawares and do not have a sufficient number of test kits to do meaningful estimates at this time.
16
I am 89, and other than the ordinary depreciating effects of age, I am in decent condition. Yet, I wonder. I don't want to have suffered the cruelties of promoting my good health to now die of some aberrant and unknown virus. I want treatment if it is warranted, on the basis that it's remedial, without the notion of age entering in. Why is it that age stands last in the line? We actually have lots to offer - experience equates to wisdom, and some of it is valuable. Why toss it aside? The youth does waste its time.
91
@Dave L thank you for sharing your honest feelings above, Dave. I may be just slightly over half your age, but I’m old enough to know every life at risk from this virus is valuable and worth fighting for. Stay strong. Keep healthy. I’ll be thinking of you and your words, each and every day.
47
@Dave L
Everybody dies of something, and at 89 it can be anything. (I'm 72.) "Aberrant and unknown virus"? Maybe good old-fashioned flu or some pneumonia would be better? Or just an everyday heart attack, perhaps....
6
@Dave L - Agreed, with respect, we need you. Please be safe and avoid public gatherings while we figure this out.
6
Even if you get a mild case, pneumonia can effect you for a while; and considering ARDS requires a ventilator, I suspect the death rate will rise in the US from lower income people who are worried about paying for their medical bills
13
@Ian I suspect this is your hope so you can jump on the blame Republicans bandwagon
I'm disturbed by the dismissive tone of so many people who point out that many of the dead were people with underlying health problems. (This is the same line that was used to refuse to attribute so many deaths in Puerto Rico to the aftereffects of the hurricane.) If a person is able to live, and maybe even to thrive, in normal circumstances, despite some health problems, but succumbs to this virus, he or she is as much a casualty as anyone else.
148
@Terry
Actually Terry, your admirable for your stance on the older people, but actually, I view the information regarding those with underlying problems as very useful information for them and the families to take the utmost precautions to care for them so they don't get the virus in the first place. I'm an older guy in the 16% category being over 65, and I found the information extremely helpful so now I will reduce my contacts and become very mindful of frequent cleaning to avoid illness myself. But it is good you care.
26
@Terry realistically speaking we can’t grind civilization to a halt if otherwise healthy people arent at risk. This article is I hope the first stage by which the public realizes we have WAY overblown this. We can’t eliminate bad things in this life. We can however reduce them to background levels. We have people dying and suffering from so many other more lethal problems.
4
I still feel like we are not getting enough information about the demographic make up of the people who are unfortunately succumbing to this disease. Sure they tend to be older but what are their underlying health conditions?
9
@Robert according to the Chinese data, heart disease, cancer and diabetes. I noticed some studies appear to have weird data. I have to credit the Chinese workers ability to care for so many and can’t imagine how hard it was to collect good data.
6
This was a very welcome article. In your next writing you could follow up with ethnic differences such as you outlined due to genetic differences in immune systems.
I'm in the 11% risk category so you also helped me to know I should seek medical care early in any future respiratory symptoms onset. The sooner the better to increase survival possibilities.
This kind of information, blunt, despite Trump, will save many lives, not panic people.
29
I correct; I'm in the 16% risk category.
1
@PATRICK
Uh, Check that. I'm in the 16% category. You know; full moon!
1
Thank you so much for the article. I'm over 65 so I know to be a little more careful about contacts and cleanliness. It was useful information.
17
Dangerous as it may be to suggest but one scenario that must be watched for is that certain powers will suppress the response to COVID-!9 intentionally or unintentionally resulting in the significant reduction in the number of elderly population who require Medicare and Social Security coverage by the government. An abundance of caution is called for early on.
19
@Ed Pancoast I find this implausible. But if it's true then I don't care if I'm one of the fatalities because I have no desire to live in your scenario.
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@Ed Pancoast If this is the case (“Certain powers will suppress the response....”) then these “Certain powers” will have become the “death panels” that were bandied about during the adoption of the Affordable Care Act, aka Obama Care. They will have become the thing that they falsely claimed to stop affordable health care. Disgusting.
I saw a comment speaking about immunity. I was researching this yesterday. Generally coronaviruses do not inspire long term immunity. If you catch one of the strains that circulate and cause colds, you'll usually only be immune for about 4 months. Of course we don't know what the story is with this new one.
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@Dan But then do vaccinations, such as those for flu, confirm immunity for only 4 months?
What does seem pretty clear is that the new virus has likely been here in the US for quite some time. The lack of testing kits, a federal government that seems more interested in pretending and the overall similarity to the flu have conspired to allow this disease a substantial foothold and I suspect it is fairly widespread.
Whatever the proper response at this time might be, not taking into account that this is already prevalent may alleviate some of the fear while reminding people of the value of science and more importantly, competency in government.
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The coronavirus seems to be more deadly than the flu — so far. The new coronavirus seems to be more contagious than most strains of the flu, and roughly as contagious as strains that appear in pandemic flu seasons. Each person with the coronavirus appears to infect 2.2 other people on average. By comparison, the figure for the seasonal flu is roughly 1.3.
On average, seasonal flu strains kill about 0.1 percent of people who become infected. The 1918 flu had an unusually high fatality rate, around 2 percent. Because it was so contagious, that flu killed tens of millions of people.
Early estimates of the coronavirus death rate from Wuhan, China, the epicenter of the outbreak, have been around 2 percent. But a recent report on 1,099 cases from many parts of China, published recently in The New England Journal of Medicine, found a lower rate: 1.4 percent. The coronavirus death rate maybe even lower, if as most experts suspect there are many mild or symptom-free cases that have not been detected.
Now the WHO' is reporting that the mortality rate is 3.4 %. Even a few weeks ago the WHO was reporting that the mortality rate was 2% and the WHO also claimed that the seasonal flu kills more people.
COVID -19 is a new disease, even the experts do not know a lot of things. What we know so far is that the coronavirus is more contagious and deadlier than the seasonal flu and we have to take this epidemic seriously.
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Why the concern about asymptomatic carriers in calculating death rates? The knowable numbers ( X% of symptomatic people that will die and Y% of symptomatic patients will need a hospital bed) allows us to gauge our response.
It is also the "right" number for comparative purposes:
-2% of the people with flu symptoms in 1918/1919 died
-0.1% of people with flu symptoms in 2018/2019 died
We don't know how may people would have tested "positive" for flu in 2018/2019 or 1918/1919.
There are only two reasons to care about how many asymptomatic carriers there are
1) political - it makes Covid-19 look less dangerous (and blunts the public response and tolerance to disruption associated with fighting the disease.
2) public health - it helps to model the number of carriers that can spread the disease and determines how we can protect each other.
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@ugh You asked a question as if asymptomatic carriers aren’t important data points. You answered it demonstrating why they are important. Thanks for clarifying the importance of a denominator in epidemiology.
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@ugh Your thinking is completely backwards, and there are many reasons to care about asymptomatic rates beyond those two you mistakenly say are the *only* reasons. Most people's personal concern is: am I likely to get a mild infection or severe or fatal, so the rate of asymptomatic cases is of paramount interest, and also allows us to project the possible deaths/hospitalizations under a full-population pandemic.
In balancing the amount of harm and disruption we'd choose to tolerate from containment measures, the fraction of asymptomatic carriers is very important. Economic harm can also cause deaths, there are physical and mental tolls to isolation; if a large fraction are likely to experience nothing from an unchecked pandemic, then that would lean towards responding to it like flu, i.e. less invasive disruptions and more toward normal activities.
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@ugh Exactly. It would blunt the public response. We call that “perspective.”
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The WHO is likely high a bit as they are strictly looking at known cases and known deaths. They do not, and will never know the total number of cases because many young people will have very light symptoms. A better estimate that is not very precise is about 0.5% to 2%. There was data from a group of healthcare workers where 1700 became ill with the virus and 6 died. That is 0.35 % which is probably the rate for normally healthy people. It appears to be much higher for the elderly and smokers.
No matter what you think the number is, it is serious. The normal rate for a flu is 0.1%. That means the likely rate of death for the corona virus is 5 to 20 times higher, and if WHO is correct 35 times higher. Even at the lowest number it is still a very serious event. It does not appear that anything can be done short of closing down everything. I do not believe the owners will do that.
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@Chris Also, the rate of spread means lots of people get sick at the same time, straining and even overwhelming our capacity to deal with it, as well as imperilling the economy through absenteeism.
The mortality rate by age and by 'underlying' health conditions... all are clearly Smokers.
The only under age 10 smokers are second hand or as occurs in very impoverished areas, child smoking. Those over 80 who have survived smoking related deaths will have smoking caused health conditions. Asthma, COPD, Cardiovascular, Pulmonary, etc etc.
Men tend to smoke more than women and the older generations more than younger generations.
When it has passed, the number of deaths will be almost exclusively Smokers...
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@MichaelT There are plenty with asthma, and heart disease that are not smokers.
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@MichaelT That might make you feel better, but it is, in fact, just something you made up.
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@MichaelT Your statements are inaccurate, as many non-smokers have died from this disease.
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The question that comes to mind is, is China providing correct number for deaths out of infected because they have the highest number of infected? Bear in mind, considering that wildlife market was also origin for SARS virus(I think), there is going to be some downplaying going on for the current Coronavirus? That's what I think, but who knows.
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With statistics indicating that the number of people who have contracted the virus worldwide has reached the tens of thousands, and the number of actual deaths remaining quite low, percentage-wise, would it not be helpful for statisticians to do some number-crunching and profiling to give the public some idea of which subsets of the population are more at risk than others? Reports by accredited health officials saying that this virus is putting the elderly and those with multiple, chronic health conditions the most at risk remain frustratingly rare in the news - if what they're saying is true, shouldn't they be shouting it from the rooftops? I'd also like to see a piece in the NYT looking back at the last two epidemic scares, SARS and H1N1, and telling us about the true results. In Canada, a population of 37 million plus, we currently have 54 confirmed & presumptive cases - do the math, you'll see how many zeroes AFTER the decimal point that works out to. Same goes for the US. Wash your hands frequently, sneeze into your elbow, and calm down.
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@Lorraine Buy some kleenex and sneeze into them. The 'coughing' into your elbow has come about because the majority of people do not carry kleenex with them anylonger. Better yet, if you have an illness where you are coughing or sneezing you should wear a filtration mask so you don't send particulate matter into the general population.
have we ANY guidance at all--even from 1918 re:
1. when will they sound the all clear--after everyone has died? Will that sufficiently reduce the prospect of coming into contact with an infected person?
2. Do recovered pts have any immunity to re-infection? otherwise the problem's MUCH WORSE
3. I continue to remember/know that every year, in US, a considerable number of pts die of the ordinary influenza.
Never do we take such extreme precautions against transmission as now being used ''the "ebola suits".
Why is this different from ordinary flu? MUCH more contagious? MUCH more lethal?
So far I think NO to both. Any better info?
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@Mike
The disease is too young to accurately determine how contagious it is. Scientists have used transmission models to estimate an RO factor of anything from slightly less than the flu to about 3 times more than the flu.
As to deaths, even if it's "just" 1%, that would make it 10 times deadlier than the seasonal flu, which has a historical mortality rate of about 0.1% for all cases, not just clinical ones. This year's flu is mild so far with a mortality rate of about 0.05%.
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@Mike Sorry, Mike, I didn't see your comment before I put in my two cents' worth. New CNN headline says that the US now has 377 cases - that is LITERALLY one in a million. Think about that folks - you have a better chance of being struck by lightning (1 in 700,000) than catching coronavirus.
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@Mike The flu hasn't gone away and is still sending people to ICUs all over the country. This virus would send several times as many people to ICUs as does the flu even if were exactly as bad as the flu because nobody has any immunity to it, while everyone has some immunity to the flu. There are anti-viral drugs that treat the flu, but there are none yet for this virus. This means there won't be enough ventilators, or ventilator nurses, to go around so the flu and pneumonia of every cause will become more deadly than it is now. The faster it comes, the more people will die from this problem. So they're attempting to slow it down.
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Reading about the 1918 flu epidemic on Wikipedia underscores how little we can predict the course of the current pathogen. That flu was first identified in late autumn of 2017. A second, much more deadly wave, appeared in August of 2018, about 9 months later, peaking in October. Those who recovered from the first wave were immune to the second. Although many are predicting the pandemic will resolve with warmer weather in the Northern hemisphere, that simply was not the case in 2018. We could be in for very long ordeal.
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Something I haven’t seen discussed is how this will affect different socio economic groups in the US. We know that certain populations have higher rates of obesity, smoking (believed to be a factor in China), heart disease, diabetes, and other chronic conditions. These same populations often have limited access to medical care—in some places there are no easily accessible hospitals. And of course we have our “greatest health care on Earth,” which is to say 27.9m non elderly people are uninsured in the US. These people are also less likely to have job security, paid sick leave, etc.
To think that the crisis won’t be worse in those areas is short sighted. Unfortunately, there is also a confluence between these communities and a likelihood to believe this is all liberal alarmism—making it less likely that communities will prepare or inform citizens. Just think about the people who are likely to stay home despite hurricane warnings out of antipathy towards government and expertise rather than economic or physical limitations.
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Something I haven’t seen discussed is how this will affect different socio economic groups in the US. We know that certain populations have higher rates of obesity, smoking (believed to be a factor in China), heart disease, diabetes, and other chronic conditions. These same populations often have limited access to medical care—in some places there are no easily accessible hospitals. And of course we have our “greatest health care on Earth,” which is to say 27.9m non elderly people are uninsured in the US. These people are also less likely to have job security, paid sick leave, etc.
To think that the crisis won’t be worse in those areas is short sighted. Unfortunately, there is also a confluence between these communities and a likelihood to believe this is all liberal alarmism—making it less likely that communities will prepare or inform citizens. Just think about the people who are likely to stay home despite hurricane warnings out of antipathy towards government and expertise rather than economic or physical limitations.
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I'm a family medicine doctor on the East Coast, in a fairly rural area. There's more we don't know than we do, but these are the assumptions we're working with:
1) The asymptomatic period after infection is anywhere from 2-14 days. Flu and cold's incubation period is around 1-4 days. Most viruses can be spread during this period, although less virulently than during the symptomatic phase. If coronavirus's incubation period is on the longer end of that estimate, this infection will be extremely difficult to control.
2) Many people who get COVID-19 won't experience severe symptoms, or even any symptoms, but can still spread it. The normal coronavirus -- which causes colds -- lives for several hours outside the body if it's cold. No direct contact may be required to get the virus. Handling a doorknob, or touching a handrail while visiting a family member in the hospital, could cause infection.
3) Test kits are limited. Doctors like me must ask permission from the CDC to run these tests on patients. We can't identify carriers who aren't very ill, but if everyone with cold symptoms in March self-quarantines there will be not be enough healthcare workers.
4) Unlike the flu, there are no vaccines or antivirals to help improve survival and slow spread. The flu vaccine alone reduces infection rate by 50% and the death rate by 90%. Tamiflu may reduce symptom length. We have nothing like that for COVID-19.
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@Lauren
One should add to Lauren's list two more differences between the flu and Coronaviruses:
5) Flu survives on hard surfaces up to 24 hours Coronaviruses up to 9 days
https://www.medicalnewstoday.com/articles/coronaviruses-how-long-can-they-survive-on-surfaces#How-long-do-coronaviruses-persist?
While COVID-19 is new and we are still learning it may be safe to assume coronaviruses may last on surfaces up to 900% more than flu viruses.
6) The coronaviruses droplets are big and generally fall within 6 feet. Not so with flu droplets. The new study found clear evidence that influenza patients breathe the virus out through their mouths and noses in tiny particles that can stay suspended in the air for minutes or hours.
The main reason to wear a mask is to prevent your hands from touching your mouth or nose (that we do all the time without thinking) and ...glasses not to touch your eyes.
Conclusion wash your hands for 20 seconds.
Colbert suggested singing "Happy birthday to you" twice. I tested "hey ho nobody home" it also takes 10 seconds. We can have some interesting musical bathroom experiences.
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@Lauren There is more, better and more coherent information in your comment than is being released by our federal government. Please keep commenting and give us straight, reliable information.
And please, stay healthy and stay blessed.
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@Lauren Will Tamiflu work on COVID-19?
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of course, without comprehensive testing, which means testing all people presenting with appropriate symptoms -- a standard that we currently lack (at least, outside china) -- we cannot know the actual mortality rate.
and, despite graphic titled "examples of how death rates can vary", it's important to note that we *do* have enough clinical data to suggest how death rates vary by age, which appears to be the critical morbidity dimension.
apparently it's somewhere around 1 in 5.
i've seen "COVID", "covid" and "Covid" (in this report) used in the press.
the style preferred by the CDC is "COVID".
I can't wait to hear Trump's opinion on the stock market drop. "I don't think it dropped more than 13 percent. That's fake news. I think it's more like it rose 13." That's how you handle a crisis folks!
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@Sean Morrow
The article suggests he may be right.
Nah...not possible. Especially since the whole thing is his fault!
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Thank you for this non judgemental presentation of current information concerning this disease . lots more to be learned of course as it runs its course , but last year 80 thousand died in the US of seasonal Flu . Does anyone think we will see similar
numbers from this virus ?
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@PFS Jr. @PFS J it’s not just a matter of how many people will die. 10% of those infected need critical care. Many need ventilators. In some areas, only very large hospitals or university hospitals have this kind of equipment. In China death rates increased when people could not get hospitals beds. I can’t recall the stat but bc of price pressures of private insurance most hospital beds are filled to capacity. The CDC estimates we have 1% of the masks required. Once the hospitals fill with covid 19 patients other sick people may be turned away. This was also seen in China.
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@PFS Jr. We don't know yet if this virus will become permanently established in the U.S. We don't know how effective a vaccine or anti-viral drugs will be. But assuming that the disease becomes established and it maintains a .5% infection fatality rate, then yea maybe we see 400,000 deaths per year from this. Every year people get older and develop underlying conditions so the overall effect would be to shave a few years off everyones life expectancy.
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@PFS Jr. Yes, I expect US deaths to end up being between 80,000 and 1,800,000 (1918 flu US flu deaths scaled to current population). It could end up being 20,000,000 but I doubt it. This time. It’s just my hunch that the Big One is still out there.
The risk is exacerbated by the lack of information and the lack of dissemination of information.
We know that the primary risk is that the virus spreads rapidly, there is little herd immunity, and the health system can be overwhelmed, leaving critically ill patients with no place to go. Even though most people who get the virus will not become critically ill - or even noticeably ill - the number who do can rise more rapidly than a community can accommodate. If there are 5 ventilators and 10 people who need them, 5 people are very likely to die.
But also, there are a lot of questions, that people in health care have not been able to answer.
Who gets assigned to care for the critically ill? Are they expected to self-quarantine after a certain number of shifts? Are hospitals equipped with enough mask and safety equipment? -(easy answer: no.)
Who is likely to see patients with undiagnosed illness and put themselves and others at risk by aiding the spread? The first person to sound the alarm was an ophthalmologist, not a respiratory critical care physician.
The questions we all ask are the ones that a well coordinated, well staffed government epidemiology response team would have planned for.
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@Cathy And are elderly patients likely to be untreated because of sentiments that I hear from non-medical people, that so what if elderly people die, because they matter less than younger people? I'm 65--a vulnerable age, but my father lived into his mid 80s and my mother lived into her mid-90s. I'm healthy and I'd like those extra decades instead of dying now.
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