SARS-CoV2/COVID-19 Update 29 Feb 2020

44 thoughts on “SARS-CoV2/COVID-19 Update 29 Feb 2020”

1. So it begins — The long-term care facility in Kirkland Washington linked to COVID-19 has 108 residents and 180 staff members. So far, 27 residents have symptoms as do 25 staff members, according to Washington officials.

2. In other news, about 530 US citizens died today from ordinary flu/pneumonia.

3. While I am keeping an interested side eye on the situation, I am beginning to come over to Gavin’s side on this ongoing debate on these pages. I am also convinced that supply chain will be by far a bigger issue with covid-19 than direct deaths from the virus itself. The media fanning the flames of panic won’t help.

4. Since we now have proof that the virus has spread to the general population in many areas globally for at least a few weeks (in order to see deaths start), we’ll know who is “right” by April 1 (though there are multiple points of issue–to me the “how deadly is the disease” question is actually far, far less important than the “how do you react in highly uncertain circumstances” one). We have to hope that the ~15% number of “severe cases” is not correct, because the medical system cannot possibly cope with those sorts of numbers.

5. I would say that is fair, Brian and like the flu I think the thing has basically spread out already. When everyone can get outside and open windows in a month or two (at least in the northern climes) I also believe symptoms and deaths will slow, exactly like the flu – from what I am reading, the virus act flu-like. Also, the US is not China or Iran. We typically don’t live in filth and have a pretty advanced medical system for all of its warts, so I don’t expect the death rate to exceed the flu. The bigger problem will be reporting of the deaths, and the media intentionally stirring up panic to sell ads and clicks which is inevitable.

6. – 80.9% of infections are mild (with flu-like symptoms) and can recover at home.

   I get that it’s *not the flu* but it sure doesn’t look like Black Death, either, especially since we’re talking about data from a country with obvious problems providing health care. Maybe there’s a middle ground here, somewhere?

   I also lean towards Gavin’s assessment with the stipulation that the biggest problem will be virtually everyone coming in contact with the disease will exhibit symptoms at least due to lack of immunity.

7. Here’s a link to the Washington state breakout story, with confirmation of Trent’s figures on many of the patients and staff are suspected to have CoVid-19:

   https://www.seattletimes.com/seattle-news/health/coronavirus-death-seattle-washington-state/

8. “80.9% of infections are mild (with flu-like symptoms) and can recover at home.”

   That number is good (sort of) for the average individual, but really really bad for society. Estimates have said that 70-80% of people could be infected, and that seems to match what is seen at the Korean church. One fifth of that is that roughly 15% number. 15% of the US population is like 45 million people. Care to guess how many hospital beds there are in the US? Like 500k. How many ICU beds? Like 95k. (Go ahead and try to get the number of extreme sick down by claiming whatever special attributes about us you like, but you have to get it down not by a factor of 2 or even 10, but by 200 in order to not crush the medical system.)

   That’s why quarantine/lockdown responses are necessary, because even these “don’t worry, it’s just the flu” numbers mean total catastrophe for the medical system. What we have to do is prevent the virus from getting to that high level of penetration of the population.

9. Please read this thread if you’re in the “just the flu” camp:
   https://twitter.com/ChristoPhraser/status/1233738443756384259
   Discussions emphasising ‘COVID19 is more serious than flu’ will probably become moot in the coming days and weeks, and for many people already have, but in case you are engaged in them, I would consider trying to get accurate numbers for flu, and to make some general points. 1/n

   First off, flu mortality is sufficiently low that it is hard to measure, and requires a degree of modelling just to get at. That in itself tells you something. 2/n

   Second, the vast majority of flu cases are not reported or diagnosed, so data are pieced together from various surveillance systems and studies. 3/n

   etc.

10. At this point, the number of test that can be made is irrelevant since there isn’t any sort of specific treatment. It may even be counterproductive. From here on out, it will be vitally important to keep as many people out of and away from hospitals as possible. The last thing we need is for anyone that sneezes to go to the ER to get tested.

    I thought that there might be a small chance that this could be contained. An accurate and widely deployed test would have helped then. Now, all a test will be good for is to collect statistics. If the WHO test had a false negative as high as has been said, it probably contributed to the spread rather than helping to contain it.

    If I was a high up in the CDC, I would probably be getting my C.V. in order. I’m sure they think they have Trump dazzled with double talk. I expect changes.

    Should masks become advisable, they surely can be made from any suitable fabric, like bed sheets or even the better grade paper towels.

11. Brian, only 1/3 of the US population in 1918 contracted the Spanish Flu, and that was a virgin field epidemic too. The reason for only 1/3 was that the thing mutated so fast. Right now we have no idea on how susceptible CoVid-19 is to mutation. Plus there will probably be an effective vaccine in two years +/- 6 months, though that does not include manufacturing and deployment time where my wild-a***d guess is another 6 months.

    IMO predictions in the 50-70% range infection are straight-line ones which rarely happen in the real world.

    Basically we simply can’t know right now what the high end of the infection rate might be. IMO the 1/3 rate of the 1918 Flu is reasonable, but it could easily vary from 1/6 (16.7%) to 40%.

    But even if the total infected American percentage is 16.7% of 336 million Americans, that still comes out to 39.2 million for the US, of whom about 7% will have critical care needs (2.7 million), and we have only 95,000 ICU beds. The 2% lethality rate of the 1918 Flu produced 675,000 fatalities among the 33.75 milllion Americans infected then. Comparable lethality (2%) among a hypothetical 39.2 million American infected by CoVid-19 would produce 784,000 dead Americans.

12. Re 1917. We are not 1917. There were no, none, zero antibiotics then. No steroids. Even no asprin. There were no ventilators. So that same influenza today would be a lot less fatal.

    The population back then was a lot less healthy. No blood pressure pills, no treatment for heart disease. No to poor central heating. People didn’t have hot water heaters. One survey at the beginning of WW2, 1940, half of troops came from homes with out door toilets. Diets were poorer. Many adults had grown up with poor nutrition.

    So the population was frailer.
    No drugs.
    No equipment
    No to little central heating nor hot water.
    Sanitation was worse.

13. On the other end, our time. We have a larger percentage of old people that are seeming fine due
    to modern medicine and wealth, but lets get real. They are hanging on by a steady thread, kept in reasonably fair health by the best we have. Many if not most would of long been dead in 1917 before the Spanish Influenza came along.

    I suspect we have a old population of smokers. We wouldn’t of had that in 1917. I think the 1917 population, plus add smoking, might be what the Chinese population today is like. Many of the old Chinese came up, grew up, survived the Mao hardships, starvation, poor nutrition, no to low health care( except the Bernie Sanders barefoot doctors handing out an asprin for your stomach cancer ). Plus now todays Chinese smoke, a lot. Plus it seems that the health care today in China is way worse than anyplace in the US( Socialist elite heros excepted ).

    So the MSM scare death rates taken from China, err…junk.

14. Thread on Washington state outbreak by Trevor Bedford. Genome analysis suggests hundreds of infected.

    https://twitter.com/trvrb/status/1233970271318503426

15. thread:
    https://twitter.com/DellAnnaLuca/status/1233938781616521216
    Probably the single most important headline this week:
    – After just one week from the outbreak, Northern Italy is already considering expanding its hospital beds capacity because 1 in 11 patients goes in ICU

    The Lombardy equiv. of the minister of Health, 5 days ago:
    “in Lombardy no problem with the number of hospital beds”.
    Today: “the hospital beds [in this hospital] are not enough anymore […] even the ICU beds are saturated […] we’re working on expanding our capacity to react.”

    In Lombardy they’re delaying non-urgent surgeries and are re-hiring retired nurses and doctors.
    Bergamo Lodi & Cremona are out of beds.

    Etc., etc.

    And it’s still relatively early days there. That ~10% number (which will certainly rise as time goes on) is just not sustainable. Again, any sort of quarantine measures that can slow (stopping is impossible now, unfortunately) the spread are absolutely imperative, ASAP, to keep the “number of infected” value as low as possible. And the most common “lots of people in close quarters” facilities are what? Schools. Expect mass closings well before the end of the school year. I wonder what will happen for Easter this year, one of two days when churches are absolutely packed shoulder to shoulder–will people be told to stay home? (The Pope is still sick, btw.)

16. Tom H: “Comparable lethality (2%) among a hypothetical 39.2 million American infected by CoVid-19 would produce 784,000 dead Americans.”

    That would be tragic, of course. On the other hand, something more than 2,800,000 Americans are expected to die this year anyway, even without this particular virus. And it is a reasonable guess that the sets of those Americans who would have died anyway in 2020 and those who would hypothetically die from the virus would have a significant overlap.

    Amidst all the hype and Doomer Porn, something which seems fairly clear is that those susceptible to dying from the new virus are mainly the very old and those whose health is already seriously compromised by a pre-existing condition. We all have to die eventually. The real question is how many “excess” deaths will occur because of the virus?

    If we took a wild guess that about 10% of Tom’s 784,000 estimate would represent those who otherwise would have survived 2020, that would put the “excess” deaths at about 78,000 — or about half the number of Americans who will die violent deaths in traffic accidents in 2020.

17. Hospitals, especially ICU’s are sized for normal times. I’ll bet that in most ICU’s right now there are at most 2-3 empty beds. Especially during flu season. The challenge will soon be to keep the not too sick as far from the hospitals as possible.

18. Hospitals, especially ICU’s are sized for normal times. I’ll bet that in most ICU’s right now there are at most 2-3 empty beds

    In our hospital, the ICU was divided between coronary care, respiratory care and step down. Respiratory care tended to be noisy and subject to more contamination. If I were doing it, I would have an isolation ward for those not on respirators. I would hope that Remdesivir would be used on those close to needing a respirator, as I hope it is as effective as it was in the first Washington state patient.

    We will see if it works out. The Chinese are doing a study but I don’t trust their results.

19. thread:
    https://twitter.com/ScottGottliebMD/status/1233940433081896960
    1/n #COVID19 hits older, vulnerable adults hardest. But there’s also data suggesting some disproportionate impact on younger adults when viewed relative to #flu. We compare hospitalizations by age from this China COVID19 data set to rates in U.S. for flu
    6/n But hospitalization rates by age of COVID19 compared to flu, with all the caveats of confounding factors which are substantial, could suggest middle aged and younger adults get serious illness at disproportionate rate relative to the experience with influenza. This isn’t flu.

    Chinese numbers are complete garbage, of course, so it’s hard to know what conclusions can actually be drawn. It’s possible that their numbers are skewed because they’re mostly just letting older people who show symptoms die, and not letting them be hospitalized (i.e., welding them in their apartments, etc.).

20. “The challenge will soon be to keep the not too sick as far from the hospitals as possible.”
    I think this should be telemedicine’s moment. People, especially in areas with outbreaks, should be required to consult with a doctor remotely before they are able to go to a local facility. That would spread out the burden (i.e., if there is an outbreak in Seattle, doctors there need to be all-hands-on-deck to deal with it, while doctors in, say, Florida, can help out with basic screening remotely), and help to slow the spread by keeping sick and potentially sick people from gathering in the waiting rooms of hospitals, urgent care centers, etc.
    Mostly, of course, the government should have been preparing people a month ago for what to do if (when, if we’re being honest) there are cases in their area. Even now they’re hardly doing anything.

21. Re: Paul’s comment above, “So the population was frailer.
    No drugs.
    No equipment
    No to little central heating nor hot water.
    Sanitation was worse.”

    The population was less frail, stronger, in 1917 because of the latter four points you made. Natural selection was a bigger factor in the earlier 20th century and we’re overall a lot weaker population nowadays.

    tyouth20

22. Stanley & Brian – your posts of Twitter thread links were very helpful.

23. Thankfully, I haven’t had any experience with ICU’s in 25 years. If the layouts are still similar, they simply aren’t compatible with maintaining isolation between patients.

    It would have been nice to have the tools and forewarning to keep it out of nursing homes but that horse left the barn a long time ago.

    My memory from the Ebola outbreak is that the patients ended up where they did because those were the only hospitals with as many as 4 isolation suites.

    I don’t think there is going to be any way to avoid being exposed and dealing with it as well as possible if I get sick. I’ll do what I think makes sense to put it off as long as possible. I made my last Sam’s run for the duration. I won’t be able to avoid grocery stores but I intend to keep it to every other week or less.

    I doubt that the health care system can function if every doctor, nurse and tech that gets it is sidelined for some indefinite time. All the things that keep them busy now aren’t going to stop happening. We’ll all just have to take our chances like it was the 1800’s.

24. The medical establishment is recommending greater than droplet level personal protective equipment in dealing with SARS-CoV2/COVID-19 and airborne treatment room protocols. (See American Academy for Anesthesiologists recommendations below)

    Personal observation — This -appears- to be in reaction to a fomite contamination concern.

    Short form: When someone coughs enough in a room. They can so pollute the atmosphere and surfaces of the room that even a blowing air conditioning vent could stir up virus carrying particulates. The over pressure exhaust through a hepa filter would remove viral particulates from the air and allow the use of PPE-3 verus PPE-4. This is important as PPE-4 is very rare and requires training to use and get out of without contaminating yourself.

    —————-
    American Academy for Anesthesiologists recommends:

    Coronavirus (2019-nCoV)
    Information for Health Care Professionals
    …

    Place patients in an Airborne Infection Isolation Room2
    Health care professionals entering the room should use airborne and contact precautions, including eye protection.
    Personal protective equipment-3 (PPE) to be worn includes:

    o Either an N95 mask, for which one has been fit-tested, or a powered air-purifying respirator (PAPR)4.;
    o A face shield or goggles;
    o A gown;
    o Gloves.
    …
    An Airborne Infection Isolation Room (AIIR) has a negative-pressure relative to the surrounding area. A minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation). Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter before recirculation. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. Facilities should monitor and document the proper negative-pressure function of these rooms. If an AIIR is not available, patients who require hospitalization should be transferred as soon as is feasible to a facility where an AIIR is available.“

    https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus

25. This is one of those nightmare COVID-19 datum’s that can’t wait for an update.

    If this SARS-CoV2 virus isn’t a bio-weapon, it is a by G-d 85% stand in for one.

    See below:

    FluTrackers.com
    @FluTrackers
    ·
    7h
    “The significance of this study is that asymptomatic carriers are found to be highly infectious, & the period of infection may be as long as 3-4 weeks…the higher the viral load in the body, the more infectious it is

    https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus/china-2019-ncov/831003-china-covid-19-cases-outbreak-news-and-information-week-9-february-23-february-29-2020?p=832670&#post832670

26. Joy.

    See:
    ————
    Rice University asks “small group” to self-quarantine due to employee’s possible exposure to coronavirus

    The Houston university said it’s making the move out of an abundance of caution.

    BY MATTHEW WATKINS MARCH 1, 202011:39 AM

    Saying the move was out of an abundance of caution, Rice University on Saturday asked a “small group of students and faculty” to self-quarantine because a university employee might have been exposed to the new coronavirus while traveling overseas.

    The university didn’t disclose who the employee is, where in the university the person works or where the employee traveled — other than to say it was not to a country on the Centers for Disease Control and Prevention’s restricted travel list. The university community was notified of the quarantine in a campus-wide alert late Saturday night.

    https://www.texastribune.org/2020/03/01/rice-university-says-employee-might-have-been-exposed-coronavirus/

27. This is a Chinese government media source, i.e. as trust worthy as the American CDC. COVID-19 causing fibrosis damage to the lungs is very bad news. Do an internet search on the term “Pulmonary fibrosis” to see why.

    https://www.globaltimes.cn/content/1181121.shtml

    Autopsies show severe damage to COVID-19 patients’ lungs and immune system, according to a doctor in Wuhan reached by the Global Times, who called for measures to prevent fibrosis of the lungs at an early stage of the disease.

    “The influence of COVID-19 on the human body is like a combination of SARS and AIDS as it damages both the lungs and immune systems,” Peng Zhiyong, director of the intensive care unit of the Zhongnan Hospital of Wuhan University in Wuhan, told the Global Times on Friday.

    Peng said he had just talked to Liu Liang, a forensic specialist from the Tongji Medical College at Huazhong University of Science and Technology. Liu’s team has reportedly conducted nine autopsies on deceased COVID-19 patients as of February 24.

    “The autopsy results Liu shared inspired me a lot. Based on the results, I think the most important thing now is to take measures at an early stage of the disease to protect patients’ lungs from irreversible fibrosis,” Peng noted.

    If irreversible damage is done, other measures, like those to prevent patients from oxygen deficit, will not be of much use, he said.

    Liu’s team published a paper on an autopsy they conducted in the Journal of Forensic Medicine on Tuesday.

28. There are multiple reports of “Normie Florida Man” making appearances at the Walmarts, SAM’s, Costco’s and Fry’s around the country buying up the entire stock of stores hand sanitizer, bleach, cleaning alcohol, and dry goods like pasta, beans and rice.

    My advice here is drive by stores and look at the parking lots before going in. In fact, you may want to wait a couple of days before hitting stores until the initial wave of panic buying blows over.

    Being in the middle of a mob of panicked shoppers is a lot more immediately dangerous than COVID-19.

29. Trent T: “If this SARS-CoV2 virus isn’t a bio-weapon…”

    Not sure I follow your logic. A virus with a long incubation period that leaves most of those who catch it asymptomatic & unaware they even have a disease would certainly be good at maximizing spread. But that means it is going to spread among your own army, your own population as well as among the enemy. And then even those who get sick are mostly not incapacitated. As a bio-weapon, it really sucks!

    Now, one could imagine that a government which has promised to provide its people with social security & health care it cannot afford might be interested in a virus which targeted the old & sick, as this one appears to do. But wouldn’t it just be easier to adopt something like the English NHS and put all those sick old people on long, long waiting lists for treatment? [For Brian’s benefit, that is called sarcasm].

    A question worth pondering is — How long has this virus existed in the world? Since its symptoms are so similar to influenza (which millions of people catch in any year), it may have been with us for a lot longer than we realize.

30. This is the medical report on the ‘super spreader’ demographic mentioned by Flu trackers —

    Clinical Characteristics of 24 Asymptomatic Infections with COVID-19 Screened among Close Contacts in Nanjing, China https://www.medrxiv.org/content/10.1101/2020.02.20.20025619v2.full.pdf

31. What Gavin said. There are already enough diseases. What you need to make a weapon is a way to direct it. Then you have to be able to protect your own personnel without tipping your hand to potential adversaries. Knowing all the time that it will only last until someone else discovers a cure or vaccine. There isn’t any evidence that I’ve seen that they are any closer to a treatment or prevention than we are.

    After SARS, China had plenty of legitimate reason to research corona viruses. As did we. No need to invoke some dark plot. If it actually came from a lab, incompetence is more than a sufficient cause.

32. First, the number of traffic deaths/year in the US is a little under 40,000, about half the number of COVID-19 deaths projected above, not half that number as indicated in one of the comments above.

    Second, In terms of the seriousness of COVID-19 versus a typical flu: The key thing to look at is not necessarily death rates. I would be more concerned by rate of hospitalization. If hospitalization rates hit 10% or even 5% of infections and you hit 40% of the population getting it, then at the peak of the epidemic the bulk of the population will be effectively without health care, because COVID-19 will have more than used up the capacity of the health care system.

    So the key question to ask is what percentage of cases are serious enough to require hospitalization? The best sources of data for that would probably be South Korea and Singapore because they are testing extensively and proactively which probably metheyns they are

33. First, deaths from motor vehicle accidents are a little under 40,000/year, so the projected number of COVID-19 deaths would be roughly twice the traffic death toll, not half of it as stated above.

    Second, while COVID-19 death rates are worrisome, I’m more concerned with rates of hospitalization. If 5 or 10 percent of the people who get the disease go to the hospital and 40 percent of the population gets it, that means that at the peak of the epidemic, we may be effectively without modern health care because the epidemic will use up all of the medical resources.

    We should have enough data outside China to start estimating hospitalization rates by now. South Korea and Singapore should give us a pretty good indicator. Look at total cases and serious cases for those countries and we can probably get a decent ballpark idea, because both countries are being very proactive in testing, which means they are likely to be catching a high percentage of non-serious cases, Yeah, they’ll miss some non-serious cases, but some of the initially non-serious cases will progress to serious cases. So we can have a pretty good order of magnitude idea of what is coming by looking at South Korean figures and figuring what percentage requires hospitalization.

34. Sorry about the sort of duplicate comments. Computer froze with the message incomplete and apparently unsent, so I went to my iPad and redid it.

35. Chinese medical officials in Wuhan admitted that the reinfection rate of the Coronavirus is at least 14%.

    They Recovered From the Coronavirus. Were They Infected Again?
    https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html?fbclid=IwAR1qYp5ZlAgJcf6c6iwrvopCajV2iJKbwkUHp_EKPW17qNejsjcg_VjuDVY

    And see:
    https://www.reuters.com/article/us-china-health-chengdu/coronavirus-patient-re-hospitalized-in-chinas-chengdu-after-testing-positive-again-idUSKBN20F13C

36. This is a very, Very, VERY worth while video to watch on COVID-19 today (3/1/2020).

    The Last Day To Prepare (Mostly)
    2/29/2020
    https://www.youtube.com/watch?v=QVQC1hAYZBs

    Apparently the SARS-CoV2/COVID-19’s R(0) (arh nought) is between 4.7 and 7. That is, one person gets it, they give it to 5 to seven others.

    Please down load the CDC file mentioned in the video at this link:

    https://stacks.cdc.gov/view/cdc/11425

    Text below from the You tube link posted above:

    Here on leap day 2020 (February 29th) the US records its first coronavirus death on the continent, a 50+ year-old man in Washington State. Cases continue to grow exponentially in South Korea and Italy. Meanwhile, most hospital systems in western countries are woefully unequipped for any large influx of serious respiratory patients.

    After dragging its feet for seeming forever, the CDC “allows” states to begin testing on their own. Finally, and inexplicably.

    Through all of this we’ve been consistently telling you that you need to prepare. Now it’s more or less too late. Already many communities are experiencing runs on basic items of food and water. Any preparing you do from here on out needs to be done ultra-responsibly and without any hoarding.

    From here on out the words are going to be “mitigation” (not containment) and “non-pharmaceutical interventions” or NPIs. That’s a fancy way of saying no large gatherings, no school, and no unnecessary travel or contact.

37. DaleCozort: “First, the number of traffic deaths/year in the US is a little under 40,000, about half the number of COVID-19 deaths projected above, not half that number as indicated in one of the comments above.”

    Dale, thank you for that correction. I was thinking about the total number of accidental deaths annually in the US (167,127 in 2018 according to the CDC), and misremembering that as traffic accident deaths.

    On the hospitalization issue, maybe we should be more open-minded. If this virus is similar to the flu (although Hong Kong data says this virus is less serious with a lower mortality rate), then the hospitals which manage to handle the yearly flu outbreaks resulting in about 60,000 annual deaths may be able to deal with the load.

    If the hospitals get overloaded — and maybe even before the hospitals get overloaded — we might want to think about treatment alternatives. If this virus is as bad as some people think, does it make sense to bring those highly infectious cases into hospitals where there are many other susceptible patients whose health is already compromised because of many different conditions? Might it make more sense to deliver oxygen and any relevant medications to the patient in his own home? If this really is a crisis, then we need to be creative and flexible!

38. If we see mass deaths at that extended-care facility in Washington, the public fallout is going to be really bad. Saying “it’s just the flu / they were all sick old people” ain’t going to cut it.

    The government in Seoul is now asking for people to work from home. AND they are asking for a murder investigation into leaders of the church at the epicenter of the outbreak. This is desperation and flailing about looking for a scapegoat.

    We’ve also started to see the first videos of dead bodies in the streets in Iran, as if they just keeled over dead. So bizarre. The sort of thing that was so freaky in the early days (all the way back in late January, which seems like years ago right now), when only Wuhan was in lockdown. I have absolutely no idea what to make of it, any more than I knew what to make of it then, except that it ain’t “just the flu” we’re dealing with.

39. The most disturbing news today lies in Brian’s post linking the Italian report twitter thread stating that 1/11 of the Tuscany, Italy, victims of CoVid-19 required critical care. That is 9% and tends to confirm the Chinese report of 7% requiring critical care. I say “tends to confirm” because we don’t know how reliable that report may be.

    IMO we can put a low end on the CoVid-19 infection rate of at least equal to that of ordinary influenza, which varies from 5% to 20% among Americans depending on the year. CoVid-19 is clearly more infectious and lethal than ordinary flu, so the low end infectious rate is probably more like 10-20%.

    The US population is currently 331 million so a 10-20% infection rate means 31-62 million Americans will contract it.

    If the proportion of victims needing critical care is 7-9% (8% average) as known statistics indicate, I don’t see how the currently estimated fatality rate can go under 2%. This is ordinary math given that the US has only @ 95,000 intensive care beds. The minimum number of Americans requiring critical care for CoVid-19 would be 2.5 – 5.0 million.

    Even if the proportion of people requiring critical care is halved, that would still be a demand for 1.25 – 2.5 million critical care beds with only 95,000 available.

    This thing will be a disaster even at a low end infectious rate. A 1918 Spanish Flu infectious rate of 33% and critical care rate of 8% of infected would create a demand for 8.8 million intensive care hospital beds, i.e., 93 times the number available.

    Right now the only available data is really grim. More should be forthcoming with in a month, but IMO we won’t know how bad is bad until June.

40. Unfortunately, it now seems inevitable that we will be finding out how serious the virus is, probably within about two weeks out west and in Chicago, based on how fast it progressed from initial community spread to thousands of cases in S Korea and Italy.

    The trick to avoid overloaded hospitals is to (a) Slow spread within a community. A big spread AFTER flu season is more manageable than one in addition to the normal seasonal flu. It also avoids big peaks. (b) Slow geographic spread so medical personnel can shift to overloaded areas. (c) Be ready to mobilize retired medical personnel and people with medical backgrounds who have recently moved into other fields, (d) Mobilize industry to identify and fill bottlenecks in treatment capability. Are there enough oxygen tanks? Hoses? Antibiotics for secondary bacterial infections? Enough people to work with other members of the household of a victim staying at home to train them so they can help without getting infected ? Enough easy to use telepresence setups so medical workers can check on at home patients and transfer them to a hospital if they need intubation?

41. Brian – re your last above about “videos of dead bodies in the streets in Iran.”

    I saw a video in an earlier CoVid-19 article by Trent with a security camera clip showing a masked Chinese guy working with a laptop who fell over in convulsions at his desk. He then went into spasms and quivering on the floor identical to those of a Chinese hospital patient on a gurney in an earlier news video. The masked guy’s spasms ceased after about 30-60 seconds and he became very still on the floor. It was pretty clear that he died on camera. Plus he went from working normally to dead in a minute or two.

    Trent saw the same thing, and told me privately that it looked like a “cytokine storm”, and his opinion was that this explained the videos and photos of people in Wuhan dying on the streets.

42. These are two on-the-ground comments [below] from Washington State from my face book feed that I put a whole hell of a lot of credence in.

    BLUFF — We are likely in the low tens of thousands of COVID-19 infected in Washington state alone, simply based on the air traffic numbers in the month of January 2020.

    And — also based on airline travel numbers for January — likely every major urban area with a Chinatown and every major American university with a Chinese student population has cases of COVID-19 developing right now.

    This should be showing up in the next two weeks as local COVID-19 testing in the USA ramps up to 10,000 tests a day up to reveal the above facts.

    ============
    Living here I can tell you it’s way more than 1000 people just from the differing sickness patterns I’ve seen the very very few times I’ve gone out in public the last month as compared to the last 20 years here. It’s in every western Washington city of any size and note, and the dry cough of doom is prevalent everywhere you go. And that is totally not normal here – we are a drippy sinus region when we get sick due to the year round humidity, pollen and spores.

    I ran the math on SeaTac back when Hubei was locked down and it’s bad…. check their statistics … 9% international travelers at 50m a year… during a high volume time for international travel had us having about ~400k potential vectors fly through each month. Then you weight that for region, and narrow that down a bit… to just Asia and the official January numbers are ~100k Asian travelers in January 2020 …. and yeah… we were mathematically slimed hard by first or second week of January. Which is all I needed to spring into action myself.>/em>

    See this link
    https://www.portseattle.org/page/airport-statistics

43. It sounds like Cytokine Storm is a local phenomenon in China.

    One of the most perplexing questions regarding the current COVID-19 coronavirus epidemic is the discrepancy between the severity of cases observed in the Hubei province of China and those occurring elsewhere in the world. One possible answer is antibody dependent enhancement (ADE) of SARS-CoV-2 due to prior exposure to other coronaviruses. ADE modulates the immune response and can elicit sustained inflammation, lymphopenia, and/or cytokine storm, one or all of which have been documented in severe cases and deaths. ADE also requires prior exposure to similar antigenic epitopes, presumably circulating in local viruses, making it a possible explanation for the observed geographic limitation of severe cases and deaths.

44. Mike, then why are victims dropping dead on the streets in Iran?

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