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Re: COVID-19 FACTS and INFO ONLY

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Alan_X:
(Hinesy:)
This is a new thread that we'd like to keep to information and factual stuff only. Opinions and arguments and used tissues can go in the other thread....
ta




--- Quote from: aggerdid on March  8, 2020, 10:56:28 pm ---“Underlying health conditions” seems like a very broad umbrella term.

--- End quote ---

Have you read the NHS website?

https://www.nhs.uk/conditions/coronavirus-covid-19/common-questions/

mercury:
Besides social distancing and regular hand sanitation, there are a couple of things you should really know:

1)  Symptoms of COVID-19

90 percent have fever

70 percent have dry coughs (no sputum)

30 percent have malaise, trouble breathing  (this is getting serious, as it means lung cells aplenty are getting infected)

Runny noses were only 4 percent.


2)  Get the test asap when there are symptoms

-  so that you get isolated and cut off from infecting others, especially people living with you, most likely your family and loved ones.

-  China's medical experts have said, more than one time, that early detection significantly improve the chances of recovery

Below is an NY Times interview with Dr. Bruce Aylward, leader of the W.H.O. investigation mission to China, which contains very useful information, including his view on the mortality rate.  A more digestable form of and contains a bit more details than the WHO report.

A crucial point (as have already pointed in this thread I think): 
the danger of COVID-19 is its being highly contagious -- early on when symptoms are not obvious and the patient not having a clue he's already got it, and novel.  There is no cure and our immune system does not recognize it.  Those in critical conditions relies on support measures such as ventilator and ECMO (a heart-lung machine which temporarily takes over the work of the heart and lungs, usually used in heart surgery) to pull them through (keep them alive, basically) until their own immune system figure out the virus and win the battle. 

So, suppose 1/10 of UK population, 6m get infected in a short period of time, and 5%  in severe or critical conditions, it would mean 300,000 patients would require a ventilator or an ECMO (there are not a lot around), not to mention the number of health professionals and other medical supplies needed to look after each patient.  The high mortality rate early on in Wuhan is really because of this:  the health system was overwhelmed.  They did not have enough of everything to look after the massive number of people getting infected and hospitals have to turn away patients (which made the matters worse for the city), until I think, in the second half of Feb, when the rest of the country stablized their own situation and start to send all health resources they can spare, en masse, to the province and the city,  including 40,000 health professionals.

By the way, Dr Aylward and China defines the severeness of the patient conditions as below:

“Mild” was a positive test, fever, cough — maybe even pneumonia, but not needing oxygen.

 “Severe” was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator.

“Critical” was respiratory failure or multi-organ failure.

So mild is not really what you think as something similar to a cold.   

Everyone take care.   I'm from Hong Kong.

***

https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html

Q&A 
Inside China’s All-Out War on the Coronavirus

Dr. Bruce Aylward, of the W.H.O., got a rare glimpse into Beijing’s campaign to stop the epidemic. Here’s what he saw.

By Donald G. McNeil Jr.
•   March 4, 2020  New York Times

As the leader of the World Health Organization team that visited China, Dr. Bruce Aylward feels he has been to the mountaintop — and has seen what’s possible.

During a two-week visit in early February, Dr. Aylward saw how China rapidly suppressed the coronavirus outbreak that had engulfed Wuhan, and was threatening the rest of the country.
New cases in China have dropped to about 200 a day, from more than 3,000 in early February. The numbers may rise again as China’s economy begins to revive. But for now, far more new cases are appearing elsewhere in the world.

China’s counterattack can be replicated, Dr. Aylward said, but it will require speed, money, imagination and political courage.

For countries that act quickly, containment is still possible “because we don’t have a global pandemic — we have outbreaks occurring globally,” he added.

Dr. Aylward, who has 30 years experience in fighting polio, Ebola and other global health emergencies, detailed in an interview with The New York Times how he thinks the campaign against the virus should be run.

This conversation has been edited and condensed.

Q:  Do we know what this virus’s lethality is? We hear some estimates that it’s close to the 1918 Spanish flu, which killed 2.5 percent of its victims, and others that it’s a little worse than the seasonal flu, which kills only 0.1 percent. How many cases are missed affects that.

A:  There’s this big panic in the West over asymptomatic cases. Many people are asymptomatic when tested, but develop symptoms within a day or two.

In Guangdong, they went back and retested 320,000 samples originally taken for influenza surveillance and other screening. Less than 0.5 percent came up positive, which is about the same number as the 1,500 known Covid cases in the province. (Covid-19 is the medical name of the illness caused by the coronavirus.)

There is no evidence that we’re seeing only the tip of a grand iceberg, with nine-tenths of it made up of hidden zombies shedding virus. What we’re seeing is a pyramid: most of it is aboveground.

Once we can test antibodies in a bunch of people, maybe I’ll be saying, “Guess what? Those data didn’t tell us the story.” But the data we have now don’t support it.

Q:  That’s good, if there’s little asymptomatic transmission. But it’s bad in that it implies that the death rates we’ve seen — from 0.7 percent in parts of China to 5.8 percent in Wuhan — are correct, right?

I’ve heard it said that “the mortality rate is not so bad because there are actually way more mild cases.” Sorry — the same number of people that were dying, still die. The real case fatality rate is probably what it is outside Hubei Province, somewhere between 1 and 2 percent.

Q:  What about children? We know they are rarely hospitalized. But do they get infected? Do they infect their families?

We don’t know. That Guangdong survey also turned up almost no one under 20. Kids got flu, but not this. We have to do more studies to see if they get it and aren’t affected, and if they pass it to family members. But I asked dozens of doctors: Have you seen a chain of transmission where a child was the index case? The answer was no.

Q:  Why? There’s a theory that youngsters get the four known mild coronaviruses so often that they’re protected.

That’s still a theory. I couldn’t get enough people to agree to put it in the W.H.O. report.

Q:  Does that imply that closing schools is pointless?

No. That’s still a question mark. If a disease is dangerous, and you see clusters, you have to close schools. We know that causes problems, because as soon as you send kids home, half your work force has to stay home to take care of them. But you don’t take chances with children.

Q:  Are the cases in China really going down?

I know there’s suspicion, but at every testing clinic we went to, people would say, “It’s not like it was three weeks ago.” It peaked at 46,000 people asking for tests a day; when we left, it was 13,000. Hospitals had empty beds.

I didn’t see anything that suggested manipulation of numbers. A rapidly escalating outbreak has plateaued, and come down faster than would have been expected. Back of the envelope, it’s hundreds of thousands of people in China that did not get Covid-19 because of this aggressive response.

Q:  Is the virus infecting almost everyone, as you would expect a novel flu to?

No — 75 to 80 percent of all clusters are in families. You get the odd ones in hospitals or restaurants or prisons, but the vast majority are in families. And only 5 to 15 percent of your close contacts develop disease. So they try to isolate you from your relatives as quickly as possible, and find everyone you had contact with in 48 hours before that.

Q:  You said different cities responded differently. How?

It depended on whether they had zero cases, sporadic ones, clusters or widespread transmission.

First, you have to make sure everyone knows the basics: hand-washing, masks, not shaking hands, what the symptoms are. Then, to find sporadic cases, they do fever checks everywhere, even stopping cars on highways to check everyone.

As soon as you find clusters, you shut schools, theaters, restaurants. Only Wuhan and the cities near it went into total lockdown.

Q:  How did the Chinese reorganize their medical response?

First, they moved 50 percent of all medical care online so people didn’t come in. Have you ever tried to reach your doctor on Friday night? Instead, you contacted one online. If you needed prescriptions like insulin or heart medications, they could prescribe and deliver it.

Q:  But if you thought you had coronavirus?

You would be sent to a fever clinic. They would take your temperature, your symptoms, medical history, ask where you’d traveled, your contact with anyone infected. They’d whip you through a CT scan …

Q:  Wait — “whip you through a CT scan”?

Each machine did maybe 200 a day. Five, 10 minutes a scan. Maybe even partial scans. A typical hospital in the West does one or two an hour. And not X-rays; they could come up normal, but a CT would show the “ground-glass opacities” they were looking for.

(Dr. Aylward was referring to lung abnormalities seen in coronavirus patients.)

Q:  And then?

If you were still a suspect case, you’d get swabbed. But a lot would be told, “You’re not Covid.” People would come in with colds, flu, runny noses. That’s not Covid. If you look at the symptoms, 90 percent have fever, 70 percent have dry coughs, 30 percent have malaise, trouble breathing. Runny noses were only 4 percent.

Q:  The swab was for a PCR test, right? How fast could they do that? Until recently, we were sending all of ours to Atlanta.

They got it down to four hours.

Q:  So people weren’t sent home?

No, they had to wait. You don’t want someone wandering around spreading virus.

Q:  If they were positive, what happened?

They’d be isolated. In Wuhan, in the beginning, it was 15 days from getting sick to hospitalization.
They got it down to two days from symptoms to isolation. That meant a lot fewer infected — you choke off this thing’s ability to find susceptibles.

Q:  What’s the difference between isolation and hospitalization?

With mild symptoms, you go to an isolation center. They were set up in gymnasiums, stadiums — up to 1,000 beds. But if you were severe or critical, you’d go straight to hospitals. Anyone with other illnesses or over age 65 would also go straight to hospitals.

Q:  What were mild, severe and critical? We think of “mild” as like a minor cold.

No. “Mild” was a positive test, fever, cough — maybe even pneumonia, but not needing oxygen. “Severe” was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator.

“Critical” was respiratory failure or multi-organ failure.

Q:  So saying 80 percent of all cases are mild doesn’t mean what we thought.

I’m Canadian. This is the Wayne Gretzky of viruses — people didn’t think it was big enough or fast enough to have the impact it does.

Q:  Hospitals were also separated?

Yes. The best hospitals were designated just for Covid, severe and critical. All elective surgeries were postponed. Patients were moved. Other hospitals were designated just for routine care: women still have to give birth, people still suffer trauma and heart attacks.

They built two new hospitals, and they rebuilt hospitals. If you had a long ward, they’d build a wall at the end with a window, so it was an isolation ward with “dirty” and “clean” zones. You’d go in, gown up, treat patients, and then go out the other way and de-gown. It was like an Ebola treatment unit, but without as much disinfection because it’s not body fluids.

Q:  How good were the severe and critical care?

China is really good at keeping people alive. Its hospitals looked better than some I see here in Switzerland. We’d ask, “How many ventilators do you have?” They’d say “50.” Wow! We’d say, “How many ECMOs?” They’d say “five.” The team member from the Robert Koch Institute said, “Five? In Germany, you get three, maybe. And just in Berlin.”

(ECMOs are extracorporeal membrane oxygenation machines, which oxygenate the blood when the lungs fail.)

Q:  Who paid for all of this?

The government made it clear: testing is free. And if it was Covid-19, when your insurance ended, the state picked up everything.

In the U.S., that’s a barrier to speed. People think: “If I see my doctor, it’s going to cost me $100. If I end up in the I.C.U., what’s it going to cost me?” That’ll kill you. That’s what could wreak havoc. This is where universal health care coverage and security intersect. The U.S. has to think this through.

Q:  What about the nonmedical response?

It was nationwide. There was this tremendous sense of, “We’ve got to help Wuhan,” not “Wuhan got us into this.” Other provinces sent 40,000 medical workers, many of whom volunteered.

In Wuhan, our special train pulled in at night, and it was the saddest thing — the big intercity trains roar right through, with the blinds down.

We got off, and another group did. I said, “Hang on a minute, I thought we were the only ones allowed to get off.” They had these little jackets and a flag — it was a medical team from Guangdong coming in to help.

Q:  How did people in Wuhan eat if they had to stay indoors?

Fifteen million people had to order food online. It was delivered. Yes, there were some screw-ups. But one woman said to me: “Every now and again there’s something missing from a package, but I haven’t lost any weight.”

Q:  Lots of government employees were reassigned?

From all over society. A highway worker might take temperatures, deliver food or become a contact tracer. In one hospital, I met the woman teaching people how to gown up. I asked, “You’re the infection control expert?” No, she was a receptionist. She’d learned.

Q:  How did technology play a role?

They’re managing massive amounts of data, because they’re trying to trace every contact of 70,000 cases. When they closed the schools, really, just the buildings closed. The schooling moved online.
Contact tracers had on-screen forms. If you made a mistake, it flashed yellow. It was idiot-proof.

We went to Sichuan, which is vast but rural. They’d rolled out 5G. We were in the capital, at an emergency center with huge screens. They had a problem understanding one cluster. On one screen,they got the county headquarters. Still didn’t solve it.

So they got the field team. Here’s this poor team leader 500 kilometers away, and he gets a video call on his phone, and it’s the governor.

Q:  What about social media?

They had Weibo and Tencent and WeChat giving out accurate information to all users. You could have Facebook and Twitter and Instagram do that.

Q:  Isn’t all of this impossible in America?

Look, journalists are always saying: “Well, we can’t do this in our country.” There has to be a shift in mind-set to rapid response thinking. Are you just going to throw up your hands? There’s a real moral hazard in that, a judgment call on what you think of your vulnerable populations.

Ask yourself: Can you do the easy stuff? Can you isolate 100 patients? Can you trace 1,000 contacts? If you don’t, this will roar through a community.

Q:  Isn’t it possible only because China is an autocracy?

Journalists also say, “Well, they’re only acting out of fear of the government,” as if it’s some evil fire-breathing regime that eats babies. I talked to lots of people outside the system — in hotels, on trains, in the streets at night.

They’re mobilized, like in a war, and it’s fear of the virus that was driving them. They really saw themselves as on the front lines of protecting the rest of China. And the world.

Q:  China is restarting its economy now. How can it do that without creating a new wave of infections?

It’s a “phased restart.” It means different things in different provinces.

Some are keeping schools closed longer. Some are only letting factories that make things crucial to the supply chain open. For migrant workers who went home — well, Chengdu has 5 million migrant workers.

First, you have to see a doctor and get a certificate that you’re “no risk.” It’s good for three days.
Then you take the train to where you work. If it’s Beijing, you then have to self-quarantine for two weeks. Your temperature is monitored, sometimes by phone, sometimes by physical check.

Q:  What’s going on with the treatment clinical trials?

They’re double-blind trials, so I don’t know the results. We should know more in a couple of weeks.
The biggest challenge was enrolling people. The number of severe patients is dropping, and there’s competition for them. And every ward is run by a team from another province, so you have to negotiate with each one, make sure they’re doing the protocols right.

And there are 200 trials registered — too many. I told them: “You’ve got to prioritize things that have promising antiviral properties.”

Q:  And they’re testing traditional medicines?

Yes, but it’s a few standard formulations. It’s not some guy sitting at the end of the bed cooking up herbs. They think they have some fever-reducing or anti-inflammatory properties. Not antivirals, but it makes people feel better because they’re used to it.

Q:  What did you do to protect yourself?

A heap of hand-sanitizer. We wore masks, because it was government policy. We didn’t meet patients or contacts of patients or go into hospital dirty zones.

And we were socially distant. We sat one per row on the bus. We ate meals in our hotel rooms or else one person per table. In conference rooms, we sat one per table and used microphones or shouted at each other.

That’s why I’m so hoarse. But I was tested, and I know I don’t have Covid.

24∗7:
https://www.bbc.com/sport/51777154

Coronavirus: British sporting events to continue as normal, says Culture Secretary Oliver Dowden

Sporting events in Britain are unlikely to be affected by coronavirus in the immediate future, says Culture Secretary Oliver Dowden.

Governing bodies and broadcasters will meet with government officials later on Monday to discuss the staging of events behind closed doors if the outbreak worsens and mass gatherings are banned.

Dowden told BBC Radio 5 Live: "At this stage we're not in the territory of cancelling or postponing events."

He added fans should not be barred.

"I was at Twickenham [for England v Wales] with the Prime Minister [on Saturday]," he said. "There was a huge crowd of people there. There is no reason why people should not be going to those events. It is very premature to be talking about things like that."

Dowden did add that the advice was based on the current guidance issued by the medical experts.

He added: "That is why I asked the chief medical officer to brief the sporting bodies last week and that is why we will be driven by the advice of the chief medical officer as we continue.

"I do want to emphasise in relation to sporting events, any talk of cancellation is very premature indeed. At the moment there is no evidence to suggest we should be doing that and we don't have any plans to."

However, Andy Holt, the owner of League One side Accrington, said he was concerned about the current situation and that consideration should be given to pausing the football season.

"I think we need to get on top of it," he told BBC Radio Four's Today programme, and added there would be "long-term financial ramifications" for his club if fans contracted the disease.

"I would be considering pausing the season until we know exactly where this is going and get a grip on it.

"I am walking round our club at the weekend and there are 3,000 fans there - I am worried that inviting them altogether at our place is actually putting them in danger."

Three people have died in Britain from the virus so far and 278 people have tested positive as of Sunday.

Italy has ordered all major sporting events throughout the country to be played without fans for one month in a bid to curb Europe's worst coronavirus outbreak, while the upcoming Italy v England Six Nations match in Rome has been postponed.

It was also announced on Sunday that fans will not be allowed to attend this month's Bahrain Grand Prix because of the outbreak.

Within football's Premier League there is a growing expectation that matches may have to be played behind closed doors within the next two weeks, depending on government advice.

Attendees are due to discuss logistics and feasibility as well as contracts and rights considerations.

The Premier League and EFL said pre-match handshakes between both teams and officials will not take place until further notice because of fears over the spread of coronavirus.

The measure came after the government asked the Premier League "to step up its contingency planning".

Several clubs have instructed players not to sign autographs or take selfies with fans.

On Sunday, European football's governing body Uefa told players and officials not to carry out pre-match handshakes in all its competitions until further notice.

IOC steps up coronavirus advice
The International Olympic Committee (IOC) has stepped up its advice to sports federations on how to deal with the coronavirus.

In a letter seen by the BBC, the organisation's sports director Kit McConnell has written to the bodies to offer "further support".

Earlier this week, after an executive board meeting in Lausanne, IOC President Thomas Bach insisted he was confident this summer's Olympics in Tokyo would go ahead as planned.

McConnell tells the federations that the IOC is "committed to the success of Tokyo 2020".

And he says that "all potential solutions should be explored" if athletes are at risk of being prevented from competing in qualifying events.

"Keeping athletes informed remains critical in addressing the ongoing challenges of Covid-19," McConnell writes.

A host of Olympic qualifying events in a range of sports have been cancelled in recent weeks.

And some athletes from countries worst affected by the outbreak - such as China and Korea - have been barred from participating overseas because of travel restrictions or quarantine rules.

"If, despite all efforts, there is a significant risk to the full participation of teams or athletes in any Olympic qualification event... please bring this to our attention as early as possible and we will work with you to find appropriate solutions," McConnell tells the federations.

"In certain circumstances, there may be a need to review the current details of the qualification system.

"Where there may be health regulations or entry restrictions which could impact on athlete participation, all potential solutions should be explored.

"In some circumstances, we have seen permission being granted for exceptional entry for athletes from areas highly impacted by Covid-19 into countries hosting sporting events. We encourage you to explore possible solutions with your NF (national federation) and LOC (local organising committee)."

And in a sign of what athletes can perhaps expect at the Tokyo Games if they go ahead as planned, the international federations are told to work with local health authorities "to organise ongoing health screenings on site, including a temperature check for athletes and entourage upon arrival, pre-competition and during competition, and carry out Covid-19 tests for those individuals arriving from highly affected areas".

McConnell explains that other good practises include providing hand sanitisers and masks throughout the event, reminding athletes and entourage to maintain high levels of personal hygiene, including advice on hand washing and minimising physical contact, with increased medical personnel on site.

Hinesy:
Use this thread for up to date information and factual stuff only please.
ta

Zeb:
https://www.statnews.com/2020/03/06/were-learning-a-lot-about-the-coronavirus-it-will-help-us-assess-risk/

It has been two months since China announced a previously unknown virus had been identified as the cause of a new outbreak in the city of Wuhan. In the weeks since then, the coronavirus — now called SARS-CoV2 — has raced around the globe, igniting major outbreaks in Iran, South Korea, Italy, Japan and now, it seems, Seattle.

There are still many, many questions about this virus and the disease it causes, Covid-19. But in a matter of mere weeks, a number of features of the disease have come into focus, through extraordinarily rapid sharing of research.

“Eight weeks into Covid-19, there’s quite a lot that we are learning,” Maria Van Kerkhove, who heads the World Health Organization’s emerging diseases and zoonoses unit, said in a recent interview. (Zoonoses are diseases that jump to people from animals.)

Kerkhove spoke to STAT after returning to the agency’s headquarters in Geneva after two weeks in China, where she was part of an international mission to learn about China’s response to its outbreak.

You can read the mission’s report (pdf file) on the WHO’s site. But interviews with Kerkhove and others help illuminate some of the most interesting findings. Of note: For now, they pertain to the outbreak in China. Some may change as the virus spreads to locations that use different approaches to try to limit its spread.

People are infectious really early in the course of their disease.

When the world saw a SARS outbreak in 2002-2003, one of the reasons it could be contained was because people were most infectious about seven days after they started to be sick — by which point they were generally already in isolation and their contacts were in quarantine. The same has been true in the case of some other related viruses. But Van Kerkhove said early studies on Covid-19 suggest people who have contracted the coronavirus are emitting, or “shedding,” infectious viruses very early on — in fact sometimes even before they develop symptoms.

“We do know from shedding studies that people can shed in the pre-symptomatic phase,” Van Kerkhove said, adding that while the data are still preliminary “it seems that people shed more in the early phases rather than the late phases of disease.”

If people can infect others before they know they themselves are ill, it makes it much more difficult to break the chains of transmission.

“If you are feeling a little bit unwell and you’re in your early stage of disease, you’re not necessarily in hospital. It takes a few days for you to develop more severe disease and you wouldn’t necessarily seek health care. So it does make sense in terms of what we’re seeing with the epidemiology” of the outbreak, Van Kerkhove said.

People can shed virus for weeks after they have recovered. But that doesn’t mean they are infectious.

There have been a number of studies that suggest Covid-19 patients may shed virus in stool or from their throats for some time after they’ve recovered. That naturally raises concerns about whether they are still infectious.

It’s too soon to draw that conclusion.

Testing for these viruses is based on what’s known as PCR — polymerase chain reaction. It’s a process that looks for tiny snippets of the genetic code of the virus in sputum from a throat or nasal swab, or in stool.

Finding that recovered patients are emitting virus fragments does not mean they are shedding whole viruses capable of infecting others. To determine if they are, scientists need to try to grow viruses from the sputum or stool of recovered Covid-19 patients, Van Kerkhove said.

The report from the WHO mission that traveled to China concluded that viable — i.e. potentially infectious — virus has been isolated from stool in some cases, but it questions whether that means much for spread of a virus that attacks the respiratory tract. Those mainly spread by coughs and sneezes.

Van Kerkhove said researchers should follow recovered patients over time to map out whether and how long they remain infectious, testing them at intervals of seven days, 14 days, and 21 days to see if they can grow virus from their sputum.

Truly asymptomatic Covid-19 infections are probably rare.

An early report on a cluster of cases in Germany caused a huge stir when the authors claimed a woman from China who was asymptomatic had infected several colleagues in Germany when she visited her company’s headquarters there.

It was later revealed the woman had had some symptoms while she was in Germany, but sloughed them off as jet lag. Despite that, the authors continue to describe her as having infected others before she became ill.

People infected with Covid-19 who are truly asymptomatic are rare, Van Kerkhove said. Studies in China estimate that about 1.2% of confirmed cases are asymptomatic. But Van Kerkhove said when the scientists on the WHO mission to China pressed for more detail, it became clear that most of the people who were first described as asymptomatic actually were pre-symptomatic — they’d been detected through contact tracing before their symptoms manifested.

“So, very, very few,” she said. “And [asymptomatic cases are] definitely not a major driver of transmission.”

People probably aren’t being re-infected after recovery.

There has been concern on social media about reports of people getting infected, recovering, and then later developing symptoms again. Some scientists from China have suggested the virus is able to re-infect people after a very short time.

Van Kerkhove said this probably is not what is happening. In fact, it would be unusual if an immune system that had just fought off a viral invader would forget how to recognize it and fend it off within a period of days or a few weeks.

What more likely, Van Kerkhove said is this: In order for hospitalized Covid-19 patients to be released after an infection they have to test negative for the virus twice, in tests conducted 24 hours apart. In some cases, people have had the two negative tests — but then tested positive again later.

Van Kerkhove said those results likely reflect more about the way the tests were conducted than about the status of the patient — how a throat swab was taken, for instance. “I don’t think that they’re actually truly negative and then they get re-infected again. It’s likely that they’re still positive for some time.”

Transmission in China happened among family members and close contacts. True “community spread” was less common.

“This virus is not circulating in the community, even in the highest incidence areas across China,” Van Kerkhove insisted.

What’s the difference between spread among close contacts and community spread, you might wonder? Van Kerkhove said the data the mission saw in China pointed to the virus finding its way into households and transmitting there. One family member gets infected and infects others. The “secondary attack rate” — the percentage of people in a household who got infected after someone brought the virus into the home — was between 3% and 10%.

Van Kerkhove said true community spread involves transmission where people get infected in a movie theater, on the subway, or walking down the street. There’s no way to trace back the source of infection because there’s no connection between the infected person and the person he or she infects. That’s not what the Chinese data show, she said.

Marc Lipsitch, an infectious diseases epidemiologist at the Harvard School of Public Health, found this claim puzzling. “I have reached out to the World Health Organization to understand the basis of some of those statements. My perception is that there is significant community transmission, especially when you aren’t aware that someone is sick, because there’s not enough testing,” he said.

China’s Covid-19 outbreak isn’t driven by spread in hospitals.

The SARS outbreak mainly occurred in hospitals. Sick people who weren’t recognized as cases infected other patients nearby or the health workers looking after them. Large hospital outbreaks have also been a feature of MERS infections.

With this new disease, more than 2,000 health workers have become ill. But Van Kerkhove said it seems like most of them were infected at home — something she acknowledged came as a surprise.

“Given our experience with SARS and MERS, I was expecting that there would be large hospital outbreaks,” she said. “But even among the health care worker infections that have been reported to date, when they went back and did interviews with them and then looked at exposures, it’s likely that most of those exposures were in the community rather than in health care facilities.”

That pattern may not hold. With global supplies stretched thin of of N-95 respirators and other equipment needed to protect health workers, there is a real risk of shortages that could put the front line workers at risk, the WHO has warned.

China’s Covid-19 outbreak isn’t driven by spread in schools.

Children and teens make up a smaller proportion of China’s cases than adults do, accounting for just 2.1% of nearly 45,000 cases reported in a study from the China CDC. The WHO report said that in China, about 2.5% of children and teens who became infected developed severe disease and 0.2% developed critical disease. None of the infected children 9 and younger died; only one teenager succumbed to infection.

South Korea, which is grappling with an explosive outbreak, has likewise seen small numbers of infections in children and teens and no deaths in those age groups. Of 6,284 cases, only 0.7% were under the age of nine; 4.6% were ages 10 to 19. A bigger chunk of the total cases, 29.9%, were ages 20 to 29. Even in that age group, South Korea reported no deaths.

“Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around,” Van Kerkhove said. “And the children tending to have mild disease.”

If that pattern holds true elsewhere, it would question the value of closing schools to slow spread. But that could happen regardless, if teachers fall ill or families are worried about letting their children attend school.

The big unknown: How deadly is this outbreak?

In order to answer that question you need to know how many people have been infected and how many have died. The assumption before the WHO-led team went to China was that there were probably mild cases that hadn’t come to light.

In the report, the team indicated it couldn’t find much evidence of undetected cases. But the only way the world will know for sure is when researchers start testing the blood of people who were not confirmed cases in places where the virus has circulated.

If they find antibodies to the virus in the blood of people who never made the case list, that will change the math. This week the WHO said the case fatality ratio currently looks like 3.4% — which is not a reassuring number.

Researchers have been working feverishly to develop the tests needed to do this kind of research. China has recently licensed a couple of serology tests and Singaporean researchers have developed one as well. More will come on board soon.

Any country or location that has cases should be conducting this type of research, Van Kerkhove said.

“These types of studies should be conducted now,” she said. “This is one of the major things that needs to be done now. And everywhere. Not just in China. In the U.S., in Italy, in Iran — that would give us a better understanding of where this virus is and if we’re truly missing a large number of cases,” she said.

“Until we have population based sero-surveys, we really don’t truly know.”

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