Wuhan Coronavirus: Megathread - Got too big

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Some interesting and hopefully useful info. Bottom lines up front - we're looking pretty good on handling this virus, but Africa is just fucked, like they are in everything else.



Be Prepared but Don't Panic: Health Departments Respond to Coronavirus

State and local governments have adapted plans for other pandemics and are putting them into action. They're hoping for better coordination and more funding from the feds. Officials insist that they’re up to the challenge.
ALAN GREENBLATT, SENIOR STAFF WRITER | MARCH 2, 2020 | ANALYSIS


Over the course of her career in public health, Dawn Emerick has dealt with hurricanes in Florida and wildfires in Oregon. Now, just over three weeks into her job as metro health director for San Antonio, Emerick is dealing nonstop with the coronavirus.

“From day one, I’ve been dealing with this emergency,” she says. “I haven’t met all of my staff yet.”
San Antonio is coping with six active cases of coronavirus, having received travelers returning from Wuhan, China, and passengers from the Diamond Princess cruise ship. Dozens more are being monitored under quarantine, although many are set to be released on Monday.

Emerick may be stressed, but she’s not worried. San Antonio is well-equipped, with large numbers of hospitals, robust fire and emergency management agencies and a strong military presence.

The U.S. public health system as a whole, after all, has largely held up to many of the most dire global outbreaks in recent years, including SARS, Zika, H1N1 and Ebola.

In San Antonio, the health department has longstanding emergency response plans it’s adapting and putting into action. “The disease, the specific coronavirus, is different, but your response to respiratory disease is the same,” Emerick says. “We’re not going to deviate from that.”

Around the country, state and local health departments are implementing their plans for dealing with disease outbreaks. Following guidance from the federal Centers for Disease Control and Prevention (CDC), they’re issuing health and hygiene instructions to the public, while stepping up their coordination with other agencies and other levels of government, as well as their immediate neighbors.

“The health department prepares for this sort of thing all year round,” Laura Curran, the county executive in Nassau County, N.Y., said at a news conference last week. “We have a Medical Reserve Corps of volunteers, medical professionals — a thousand of them — who are ready for any kind of situation that needs their attention.”

The Medical Reserve Corps program, which began in the wake of the 2001 terrorist attacks, now has 839 units around the country, with 175,000 volunteers on tap.

Still, while health departments know the drill, they also acknowledge they now face a challenge that, at this point, remains unknowable in terms of its ultimate scope.

“If this is a baseball game, we’re in batting practice now,” says Jeffrey Duchin, the top public health officer for Seattle and King County, Wash. “The game hasn’t started yet.”

Duchin spoke prior to the death of two men in King County over the weekend, the first known deaths from the coronavirus in the U.S. A review of two infection cases in the county suggests that the virus may have been present in the state for several weeks. On Saturday, Washington Gov. Jay Inslee issued an emergency proclamation, “directing state agencies to use all resources necessary to prepare for and respond to the outbreak,” according to a news release.

Failing the Prevention Test

Everyone knows the saying that an ounce of prevention is worth a pound of cure. That’s an approach rarely put into practice when it comes to public health.

Most medical dollars are devoted to individual treatment and care. Less than 3 percent of U.S. health-care spending is devoted to public health.

Those dollars aren’t all distributed evenly. The American health system is highly fragmented. Not every community has the resources of a San Antonio or Seattle. The amount of dollars and personnel devoted to public health varies widely from state to state and, of course, within states at the city and county levels. That makes a uniformly robust response to a new threat impossible.

“This will spread within the weakest links of our public health systems,” says Ali Khan, dean of the University of Nebraska College of Public Health. “This virus is going to exploit all of the inequities and variabilities within our health system.”

Federal spending on public health programs such as hospital preparedness has declined over the past decade. More than 55,000 jobs were cut at local health departments between 2008 and 2017, according to the Trust for America’s Health.

Despite all that, Khan notes that the CDC’s public health emergency preparedness level — a set of measures looking at system capabilities and planning — has increased since 2013, rising from 5.9 to 6.7 on a scale of 10.

“The national preparedness level has gone up,” says Khan, a former director of the CDC’s Office of Public Health Preparedness and Response. “But the point is, it’s still low.”

Strains on the System

State and local governments are still largely gearing up, holding internal coordination meetings and spreading the word to the public about prevention measures such as washing hands and surfaces. “One technology development that has had an adverse impact is the amount of disinformation out there,” says Bill Hazel, a former Virginia health secretary.

Some local health departments are already tracing contacts of people who may have been exposed to the virus. That alone can be a massive task. A student who had traveled to Wuhan showed up at a hospital in Lawrence, Kan., with signs of respiratory illness. The state health department traced his contacts and was ready to notify 403 people. “We had a phone bank. We were ready to go,” Kansas Health Secretary Lee Norman told The Kansas City Star.

It turned out to be a false alarm, but Norman noted that the state had to wait five days to get test results back from the CDC. The number of test kits are limited — the state of California only has about 200, Gov. Gavin Newsom said at a news conference on Thursday — and states are having to wait on the CDC for results.

Officials in Rhode Island are alerting about 40 people who had contact with a man who had traveled to Italy and is now the state’s first positive case. “We are not seeing widespread community transmission in Rhode Island, and that means the general level of risk for Rhode Islanders is still low,” Department of Health Director Nicole Alexander-Scott said Sunday.

There are other challenges. The lack of testing capacity is only one shortfall. Supply chains are bound to be disrupted — particularly with China being such a major manufacturer of prescription drugs.

With most of the initial patients in self-isolation at home, doctors and nurses are having to make house calls. That takes time. And, when patients have to be transported, emergency personnel will need protective gear.
“Depending on the numbers involved, the health-care system could be overwhelmed quickly,” Hazel says.
That’s why containment is so important. Many health experts believe it’s inevitable that the coronavirus will be transmitted locally in the U.S. But every day before that happens is a day closer to developing a vaccine, while also allowing hospitals more time to procure masks and ventilators.

“The piece that’s coming more into focus now is the need to prepare for a potential large outbreak,” says Duchin, the Seattle-King County health officer. “We definitely need to prepare for many more people needing health care.”

The Politicized Federal Response

State and local health officials insist that they’re up to the challenge. Emergency operations centers are being activated to allow for coordinated response. Pandemic flu plans are being reviewed, adapted and implemented.

“We are gearing up for a big outreach message which is to prepare, don’t panic,” says Emerick, the San Antonio health official. “We do see a lot of folks who are getting very nervous about what’s going on.”

States, cities and counties are putting their plans to work, but so far they’re doing so in the absence of federal financial support. “The federal government needs to step in and support this on-the-ground effort with money,” says Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents health officers in the 30 largest cities. “The public health system is going to respond, but they’re going to need to backfill dollars that are spent.”

President Trump has called for a $2.5 billion package to respond to the coronavirus, while Charles Schumer, the Democratic leader in the Senate, wants $8.5 billion. Presumably, the final number will fall somewhere in between.
But it will take some time for that money to flow down to the local level. After Congress passed a $1.1 billion package to combat Zika in 2016, it took 233 days for that money to reach local governments, Juliano says.

So far, politicians in Washington haven’t been able to put aside their political differences to act with a sense of urgency.

Trump has accused Democrats and the media of overhyping the coronavirus for political purposes. Appearing at the Conservative Political Action Conference on Friday, acting White House Chief of Staff Mick Mulvaney said the media is exaggerating the threat because “they think this will bring down the president. That’s what this is all about.” He also noted, however, that schools might be closed and public transit disrupted by the virus.

Elizabeth Warren, a Democratic senator and presidential candidate, has introduced a bill that would shift all the funding from Trump’s border wall to the coronavirus fight. On Friday, a group of House Republicans walked out of a coronavirus briefing after Connecticut Democratic Rep. Rosa DeLauro made remarks lambasting the administration’s response. Inslee, the Democratic governor of Washington, took to Twitter to criticize the administration for not sticking to the science.

“The public health response depends on people trusting in the system and trusting in government,” Juliano says. “It’s very difficult for folks on the ground when there’s not a consistent message from the federal government, or there’s a local message that’s different from the federal messaging.”

Prior to Trump enlisting Pence to run the administration’s response and communications, the White House and federal health agencies had issued contradictory statements. All the bickering and partisanship hasn’t helped to foster a sense of credibility or public trust in government.

Khan says that the administration has finally taken steps that should have been taken weeks ago. “At long last, we have an established leadership structure for the nation,” he says. “We now have a czar and we have a brilliant scientist who is now the response leader," referring to Deborah Birx, an AIDS expert and global health ambassador who was just named as coronavirus response coordinator.

Some critics of the administration have complained about having Pence, rather than a doctor or scientist out front. Appearing on CNN Sunday, Pence said that the risk of infection to the average American remains low. “This weekend, more than 15,000 testing kits have been released,” Pence said. “Also, the FDA has approved a testing regimen that state and local officials can be using.”

Khan says that the main thing is to have someone clearly in charge. “Having the vice president as czar, whatever you think of his scientific acumen — his job isn’t a scientific job,” says Khan, the author of a 2016 book, The Next Pandemic. “It’s a political job, making sure the interagency response works.”

But he warned that the threat posed by the coronavirus should not be taken lightly.

“I’m not somebody who dismisses this as just another respiratory infection,” Khan says. “This is not a disease to discount — especially if you love your grandparents. This disease looks quite mild for young people, but as you start getting 50 or older, and especially if you have some additional illnesses, this becomes quite deadly.”





Preparing for the coronavirus and other epidemics in Africa
Patricia GeliFriday, February 28, 2020


The outbreak of the novel coronavirus (COVID-19) emanating from China has created worldwide alarm, and now, as two cases of COVID-19 have been confirmed in Africa, global policymakers must look to Africa’s readiness to handle a potential coronavirus outbreak.

ECONOMIC IMPACTS COULD BE HUGE

In our increasingly interconnected world, what happens in China’s economy impacts the world at large, and Africa in particular. As in the rest of the world, Africa’s economic growth numbers will be revised downward as the coronavirus further compounds already prevailing global headwinds.


The Economist Intelligence Unit estimates that the coronavirus could take 0.5 to 1 percent off China’s GDP growth. Given its lowered output, Chinese demand for Africa’s exports, including minerals, petroleum products, and other raw materials, will be reduced. Petroleum exporters like Angola and Nigeria, and mineral exporters like the Democratic Republic of the Congo (DRC) and South Africa could face reduced sales

Africa’s importers who depend on China as a principal source of goods will also be affected.

HOW CAN AFRICA PREPARE TO COMBAT A CORONAVIRUS OUTBREAK?

If China is challenged, one can imagine how devastating the impact could be on Africa’s weak health systems. The 2014-2016 Ebola outbreak in West Africa was a wake-up call, but Africa is still working to implement solutions and strategies to prevent such a devasting epidemic again.

Recommendations include:

Harmonize and coordinate cross-continental efforts for disease prevention and control. Indeed, in 2017, Africa’s heads of states accelerated the establishment of the Africa Centres for Disease Control and Prevention (Africa CDC) under the auspices of the African Union. Along with the European Centre for Disease Control and Prevention, Africa CDC is the first public health institute mandated to harmonize infectious disease surveillance and control among a group of independent countries.

In line with the International Health Regulations (2005), the Africa CDC’s mandate includes disease surveillance, prevention, and response measures intended to shift the focus from quarantine and embargoes at borders to containment at the source. It aims to increase the emphasis on preparedness by supporting countries to establish the necessary core capacities in surveillance and response. Already, Africa CDC is responding to the COVID-19 threat: It has activated its Emergency Operations Center and, in collaboration with member states and partners, trained laboratory personnel across 27 countries and distributed test kits, provided infection prevention and control training for 22 countries, and conducted Training-of-Trainers events on points-of-entry surveillance with 18 countries. It continues to coordinate effectively with the World Health Organization.

Partner with outside CDCs to build public health infrastructure and strengthen health systems. A successful Africa CDC requires more than the establishment of a central office in Addis Ababa, Ethiopia. It also entails building up Africa CDC’s five “regional collaborating centers” (in Egypt, Gabon, Kenya, Nigeria, and Zambia), and expanding the continent’s network of National Public Health Institutes that currently exist with varying functionality in some 20 countries. Additional needs include building surveillance systems (even in remote areas), streamlining communication, establishing high-quality laboratory systems, and better equipping public health emergency teams, among others. The close partnerships with more established and experienced CDCs in China, Europe, and the U.S. can offer best practices and strategies for dealing with crises.

Building trust is key. Just as trust in financial institutions is important to avert financial crises triggered by bank runs, so is trust in public health institutions for avoiding arbitrary border controls and trade disruptions due to real or perceived risks of disease. There are different dimensions of trust when managing health crises—that between the public and the public health institutions, and among different institutions within the health sector.

However, building trust takes time. For example, in the case of trust between public health institutions such as laboratories, samples will need to be transferred across countries as was the case during the West Africa Ebola crisis when samples were moved from Guinea to Pasteur Institute in Paris. Within the guild of microbiologists, the prestige and ranking order of laboratories in different countries is almost universally recognized, and to a large extent builds on previous scientific discoveries and publications. This affects whether a country’s laboratory becomes the first choice for receipt of difficult or dangerous samples from other countries.

A major milestone since the establishment of Africa CDC is its creation of the Regional Integrated Surveillance and Laboratory Networks (RISLNET). The RISLNET platform will link Africa’s existing public health assets and build trust in these, thus ensuring that they are put to their most efficient use. Additionally, developing a repository of science-based information, and effective communications will also help build trust in the Africa CDC as the continent’s “mouthpiece” on epidemics.

As Africa becomes increasingly populous and interconnected with the African Continental Free Trade Agreement, Africa CDC will be ever more faced with complex, multidimensional health challenges that require monitoring disease risks, analyzing threats, and mounting a swift and calculated response anywhere on the continent. The establishment of Africa CDC is a huge step in the right direction. All 55 AU member states contribute financially to the AU Commission, which has committed 0.5 percent of the AU’s operational budget annually for the Africa CDC, emphasizing the strong ownership. Continued investments in health systems strengthening will be key in safeguarding the remarkable progress made toward the AU’s Agenda 2063—a prosperous, peaceful, and integrated continent. (JS - Africa's just fucked.)

No it isn't. In China, with their primo health care, the death rate seems to be 3.6 percent for people in their 60s. Even at 80+ it's less than 15 percent.

Trust you meant "primo" as sarcasm. 🙂 This has shown Chinese health care to be utterly inadequate.
 
How much longer to go before this officially becomes deadlier than the flu?
Depends by what metric, but the CDC currently estimates flu deaths at 18K-46K this year *so far* with 310K-560K hospitalizations

So that should give you an idea at least for absolute numbers
 
No it’s not more deadly than the flu even though the flu is 0.1% in the US?
You said death sentence.

And I think the death rate will be adjusted down by quite a lot in the end because it's starting to seem like it's been out infecting people for probably 2 months longer than earlier thought, so the number of mild cases is probably significantly higher.
 
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Hey look, the DOW spiked back up almost 1,300 points--making it the single largest one-day gain since 2009--now that people are starting to chill out about this, again.
 
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Hey look, the DOW spiked back up almost 1,300 points--making it the single largest one-day gain since 2009--now that people are starting to chill out about this, again.
Also there is the fact that Biden won Carolina and showed that Bernie just isn't gonna get handed the Nomination.
 
You said death sentence.

And I think the death rate will be adjusted down by quite a lot in the end because it's starting to seem like it's been out infecting people for probably 2 months longer than earlier thought, so the number of mild cases is probably significantly higher.
It’s pretty bad for those who are elderly, I think that nursing home is going to get rocked. I hope you’re right the death rate will come down but China’s been lying through their teeth about all of this so we won’t know for some time until the US, Italy, South Korea, etc gets through a few months of this.

I think a lot of mild cases went untested but they also probably missed some deaths so who knows.
 
View attachment 1170035

Hey look, the DOW spiked back up almost 1,300 points--making it the single largest one-day gain since 2009--now that people are starting to chill out about this, again.
that's called the dead cat bounce. the only thing that's going to keep things afloat is rate cuts and liquidity injection, which japan and china are already on top of. at worst, expect negative interest rates (🌙 !!!) in at most 24 months from the Fed in a last-ditch attempt to keep money in the market during an undeniable recession. i would be highly surprised if the Fed doesn't go negative, unless someone manages to succeed their way to the top instead of failing their way to the top of a bureaucracy.
 
What's the difference between ethanol (>70%) and soap (NaOH?), then? In the context of keeping your hands clean from both bacteria and viruses.
Ethanol disrupts membranes of bacteria and capsids (the shell) of viruses.
soap helps to dislodge stuff. What actually does most of the cleaning is the physical rubbing of hands to help the foam and water lift stuff off.
So a lab bench you can squirt with a mist of ethanol way easier than scrubbing with soap, it evaporates (or gets passed through a flame and burnt off) and there you go, everything is dead. but for hands, soapy water is probably better. Just look up how to wash your hands properly - there will be loads of clips online.
So soap doesn't actually have an effect on the membranes of either bacteria or viruses? A contact effect only happens with ethanol?
No soap does have a contact effect, it’s a detergent and detergent will disrupt a lipid membrane. It’s just that ethanol nukes stuff, whereas the amount of soap and strength of detergent you’d need to do that on skin would lead to skin damage after a while. Your hand soap you use is formulated differently to a strong ‘grease cutting’ detergent like washing up/dish liquid. You’ll notice if you do dishes by hand a lot you get very dry skin - that’s the grease and lipids and sebum that protects your skin getting stripped out. Really strong lab detergents exist (basically concentrated SDS) and they’re awful for your skin.
Warm water and soap is the best thing, but out and about we don’t have that and 70% sanitiser does just fine

Alright so since Otterly got this one from the biological perspective let me explain the chemical basis.

For people with no knowledge of biochemistry EtOH and NaOH may look similar. But note that while Na is an element (sodium) Et is an organic compound (Ethane), EtOH is actually CH3CH2OH when written as elements.

Now, as you can see, that's a substantially bigger molecule. This has multiple effects.

NaOH: well quite simply, NaOH is a strong polar molecule so it's quick to attach itself to whatever it can find. But it doesn't have that many electrons so the bond is typically not that stable. This is why it basically serves to stick to whatever you want out while its water that actually pulls it away from your skin. It's like covering everything in oil so it slips away but on a molecular level.

EtOH: however is much larger and has more electrons to maintain the bonds it creates. Furthermore, having two carbons and an oxigen for a chain, it has enough of an angle to rotate carrying a lot more power behind said rotation (not weight but charge, but really, the effect is the same) so basically it's like attaching a ball and chain which also has a mind of its own to the virus. This is why it "nukes" stuff. While NaOH just gently covers everything and awaits for a force to pull it off EtOH just grabs while it can and janks the shit out of it wildly like a madman.

So. Warm water and soap is still a combo that achieves pretty much everything correctly. And it also carries away the particles so it has a lot more aplications. But if you want something dead, EtOH kills most things pretty well. In this situation, as Otterly and everyone else that knows what they're talking about said, the best is to use warm water and soap normally, and carry ethanol to disinfect if needed (such as a wound or to clean your hands on the go).

As for why the water gotta be warm it's just because it disolves things better while warm because temperature is essentially a measure of the speed the particles in the water carry. Cold water also cleans but not as well.
 
National health care system and access to private for those who can afford it.
The Saudi Royal Family does get a lot of their care outside the country; one of the floors at UPMC in Pittsburgh had the signs labeled in Arabic (along with the normal English) for their benefit.
 
You dont need both. If you have access to soap and water use that. Out and about use sanitiser. I keep a little bottle in my handbag and use it after touching stuff like handrails, trolley handles, PIN pads etc. When I come in from being out its shoes off, then wash my hands.
If this thing makes people wash their hands more then it’ll have at least one positive effect (along with taking out anyone who thinks licking a shrine is a good idea, people who think bushmeat is great and the entire Iranian leadership...)

yeah I agree about it Iran. I know a fair few Iranians and they’re all good people. Their leadership however....
A silly question no doubt, but I'd rather be sure: shops and drug stores around me are pretty much out of sanitizers and other alcohol-based cosmetic products, but I can still get rubbing alcohol (70%) with an addition of camphor oil. Would that work in a pinch?
 
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There are ways to jury-rig something like that very, very quickly. They’re trying to cover up the emissions from cremation so outsiders don’t notice, not because they give a fuck about pollution. They don’t. Just appearances.

Let me explain. Let me try to summarize that post I made earlier with all the spoopy sciency links.

This virus first causes a little flu.

Then, you get bilateral pneumonia in both lungs, with ground-glass opacities touching the lung edges.

Then, it sneakily infects your heart muscle with myocarditis, and your myoglobin from your heart breaks off into your bloodstream and gives you rhabdo, which gives you acute kidney failure requiring dialysis.

It also starts clumping up lumps of virus, bacteria, and dissolved tissues in your bloodstream, forming clots that can give you a heart attack or stroke.

Meanwhile, it’s infecting your blood vessels and giving you vasculitis, in your brain and other vital organs.

As if that wasn’t bad enough, this thing may have a symbiotic relationship with prevotella bacteria in your gut, combining with it like Voltron and then colonizing your gut bacteria.

Every time you defecate, you shit out lumps of virus/bacteria symbiote, which contaminate sewage and bodies of water.

When you die, your whole body becomes hazmat and must be incinerated immediately to prevent environmental contamination, otherwise, the virus may live alongside its bacterial colony as an anaerobic waterborne disease, or it may even attack and feast on other bacteria in water and in sewage, persisting in it for weeks, months, years, who the fuck knows?


Wuhan is fucked. The whole city will have to be torn down. It’s no longer habitable anymore.

This is a sci-fi pathogen like nothing we’ve ever seen. I’ve never even heard of a virus that acts as both a bacteriophage and something that attacks human tissues at the same time.
Didn't it come out that the source map for the SO2 spike around Wuhan was a computer model rather than live data?
 
Yeah about that
View attachment 1170035

Hey look, the DOW spiked back up almost 1,300 points--making it the single largest one-day gain since 2009--now that people are starting to chill out about this, again.
I would love to have a positive to say about thus but the Fed announced immediate interest rate cuts.
The bank of Japan frantically prints 500billion to buy Chinese bonds. We'll see how long this can go on. I hope it does go on and it doesn't crash.
 
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