Thursday, February 27, 2020

Should we worry about the coronavirus?

As people know, the coronavirus (i.e. SARS-CoV-2/COVID-19) is running rampant in China. It's an epidemic in China, but the question is whether it'll become a pandemic that will hit our shores too.

  1. The coronavirus effectively already is a pandemic (e.g. China, Italy), but it hasn't been officially announced that it is, as far as I'm aware. So what does that mean? At the most basic level the term "pandemic" refers to how widespread a disease is (e.g. sustained transmission). For example, the common cold and the flu are technically pandemics each cold or flu season. However, we don't typically worry about them. So a pandemic alone doesn't necessarily mean it'll be horrible news for humanity, though of course it's not as if a pandemic is a good thing.

  2. We'd have to consider additional factors in order to figure out how bad it'll be for us. For starters, and as I've mentioned in the past, we'd have to consider a disease's infection (i.e. R0) rate and its fatality rate. If these are high enough, and if the disease is also a pandemic, then that's potentially quite disconcerting. These rates are based on the empirical data; more on the data in a moment.

  3. Still, there are limitations. I don't think the coronavirus is going to wipe out humanity. Christians in particular should trust God's sovereignty here.

    Also, at least based on the data so far, I doubt even in a worst case scenario the coronavirus will be as bad as the Spanish flu in 1918 which on most estimates infected about 500 million people (~25% of the world's population at the time) and killed between 50 million to 100 million people (including ~650,000 Americans), making the Spanish influenza one of the deadliest diseases in history.

    For one thing, infectious disease experts have been expecting and warning about an eventual coronavirus to emerge, which it did. Likewise medical care has advanced by leaps and bounds since 1918 (e.g. vastly improved sterilization techniques, hygiene education, antibiotics and antivirals, the very idea of an intensive care unit involving intubation, vents, hemodynamic monitoring, etc.). And we're not coming out of a world war.

  4. That said, most Western medical experts are highly skeptical of the data coming out of China. We don't know how reliable the numbers are. Sure, China has been more trustworthy than in the past, but that's not saying much, I don't think. To be fair, the data from developed nations is likely more reliable (e.g. Japan, S. Korea).

    In addition, though it seems we're prepared, there may be some cracks beneath the surface. A recent concern is what UC Davis reported.

    Also, it wouldn't necessarily take much for our medical facilities to be overwhelmed. We may be well-prepared, but even the most well-prepared place could easily become overwhelmed if enough people in an area need their services. Some places are better than others.

    And in general I don't trust mainstream media, nor international organizations like the WHO (e.g. see here). At best, there are a lot of people out there who don't know what they don't know.

  5. In short, on the one hand, I don't think we should panic about the coronavirus. I don't think it's generally helpful to panic even when something might be worth panicking about.

    On the other hand, I don't think we should have little or no concern about the coronavirus. It's not implausible that the coronavirus becomes overwhelming even for developed nations.

  6. Instead I think we should be realistically prepared.

    One thing I'd think is a good idea is if people buy basic supplies now rather than later. That's because if the coronavirus situation does worsen considerably, then it's possible there will be a supply shortage (e.g. Senator Josh Hawley's remarks).

    I'm referring to items like food and water. If someone has dependents, then make sure their needs are provided for (e.g. diapers for babies, drug prescriptions refilled for the elderly). That sort of thing.

    Likewise basic medical supplies (e.g. adult and infant medications like ibuprofen, cough syrups, hand sanitizers, band-aids, gauze, gloves, injection needles, surgical masks).

    Anyway, no need to panic, but prepare.

  7. I think it'd be best to follow physicians and other relevant experts for news about the coronavirus. For example, consider following Roger Seheult who is a pulmonary and critical care physician (as well as a 7th Day Adventist in Loma Linda, California). Another pulmonologist and critical care physician is Michael Hansen. A person I only recently heard about is the virologist Ian Mackay, but he seems reliable so far. Eric Strong is a hospitalist at Stanford University, though he's quite liberal and sometimes unduly critical of Trump, but I just ignore the politics and focus on the medicine. Amesh Adalja is solid.

13 comments:

  1. The fatality rate among those infected with the Spanish flu was weirdly high, and hopefully (Lord willing) the fatality rate (percent that die of those infected) is much lower with the current coronavirus. I was doing a little googling last night, and it looks like estimates range from 2% to 20% (!) for fatality rate of Spanish flu. Also, those who died were disproportionately young, which doesn't look like death from spinoff effects like secondary infections. There was something weird about that virus that really killed people.

    I am guessing that if COVID-19 gets into the general population and a lot of people come down with it, the biggest effects are going to be economic. To put it no higher, if a lot of people in a particular area are really sick and some are dying, things eventually grind to a halt in that area. Quarantine efforts could worsen these economic effects yet still might be justified to some degree.

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    1. Thanks, Lydia! I agree with everything you said. Very good points.

      (By the way, just updated my post with one or two more things.)

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    2. Not suggesting Lydia doesn't already know this (in fact I trust she does), but just to be clear in general:

      The virus is SARS-CoV-2, while the disease is COVID-19. It's like HIV/AIDS where HIV causes AIDS. So it's possible to be infected with the virus, but not develop the disease. So says the International Committee on the Taxonomy of Viruses (ICTV).

      Of course, it's just a name. Names can be changed. Not a big deal. And in fairness it's a mouthful to say SARS-CoV-2/COVID-19! So I think it's perfectly fine to use shorthand and call it COVID-19. Or even call it something else.

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    3. "Also, those who died were disproportionately young, which doesn't look like death from spinoff effects like secondary infections. There was something weird about that virus that really killed people."

      Michael Oldstone argues the following in his book Viruses, Plagues, & History (revised ed.), pp 321-323. It's an interesting explanation, but I don't know if I'm entirely on board:

      No single gene of the 1918 influenza virus accounts for its high degree of pathogenicity. Therefore, we are forced to conclude that the lethal effect is caused by many viral genes (polygenic). The definition of this profound lethality is that the resurrected 1918 virus is 100 times more lethal than other strains for experimental animals so-infected; it replicates in some instances to produce 39,000 more virus particles than other influenza strains, and it causes severe lung injury in mice and monkeys very similar to that in lungs from humans who died from the 1918–19 influenza virus infection. Further, unlike other influenza viruses, the 1918 resurrected virus is lethal when injected into chick embryos. Although many of its genes may participate in the virulence, both the hemagglutinin and polymerase genes likely play the dominant roles.

      Other clues as to the virulence of the 1918 influenza virus have come from recent studies in monkeys (38). Infection of cynomologous monkeys with a contemporary influenza strain led to mild symptoms and minimal pathology in the lung. In contrast, the revived 1918 influenza virus spread rapidly through their lungs and was lethal. Particularly important was an outcome of 1918 influenza virus infection in which the monkeys’ immune systems went into overdrive causing an increased production of host proteins called cytokines. This immunopathologic effect is called a “cytokine storm.” The implication is that such host-derived molecules, in addition to damage from the virus itself, are responsible for tissue injury and death. Cytokine storms have also been blamed for severe respiratory disorders in humans infected with SARS or Hanta viruses. Several of these cytokines provide signals for the migration of macrophages and polymorphonuclear cells that significantly add to the destruction of the lung by compromising air exchange and breathing.

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    4. ...In rural Southeast Asia, the most densely populated area of the world, hundreds of millions of people live and work in close contact with domesticated pigs and ducks. This is the likely reason for influenza pandemics in China. Epidemics other than the 1918–19 catastrophe have generally killed 50,000 or fewer individuals in that area, although within a year over one million people had been infected with these new strains.

      Three major hypotheses have been formulated to explain antigenic shifts. First, as described above, a new virus can come from a reassortant in which, for example, an avian influenza virus gene substitutes for one of the human influenza virus genes. The genome of human influenza virus group A contains eight RNA segments, and the current wisdom is that the circulating influenza hemagglutinin in humans has been replaced with an avian hemagglutinin. A second explanation for antigenic shifts that yield new epidemic-quality viruses is that strains from other mammals or birds become infectious for humans. A third possibility is that newly emerging viruses have actually remained hidden and unchanged somewhere but suddenly come forth to cause an epidemic, as the Russian H1N1 virus once did. H1N1 first was isolated in 1933, then disappeared when replaced by the Asian H2N2 in 1957. However, twenty years later, the virus reappeared in a H1N1 strain isolated in northern China then spread throughout the world. This influenza virus was identical in all its genes to the one that caused epidemics among humans in the 1950s. Where the virus was for twenty years is not known. Could it have been inactivated in a frozen state, preserved in an animal reservoir, or obscured in some other way? If this is so, will the Spanish influenza virus also return, and what will be the consequences for the human population?

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  2. It is also surreal that Democrats have become so vile and deranged that they—and the accomplice media—are even cheering for a wide-spread infection of Americans. I don't see them as fellow Americans anymore.



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    1. Too bad we can't trade Ilhan Omar for someone like Dalia Al-Aqidi who's grateful to be American. I don't know what Al-Aqidi's chances are at unseating Omar, but I hope Al-Aqidi wins.

      Progressives hate America (e.g. AOC, Ilhan Omar, Rashida Tlaib, Bernie, Warren). They actively work to undermine our nation's foundational principles. Perhaps it's arguable they don't deserve American citizenship. Perhaps we have to reform how citizenship works.

      By the way, I notice the mainstream media is using the coronavirus to attack Trump after Trump's tweet. Granted, Trump's tweet was ill-considered, but it's revealing how the mainstream media is only now changing their narrative about the coronavirus. I think that's because they believe it'll hurt Trump (though I doubt it will). Anyway they've gone from "nothing to worry about!" to "Trumpvirus"!

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    2. I don't see any liberals cheering for a wide spread infection of Americans, though I'm certain that there are always some on the extremes who do (as there always are on both sides of the aisle). Can you point me to any mainstream liberal political leaders who are doing what you claim?

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    3. I've been following the closely, and I don't remember seeing the MSM ever saying that "we have nothing to worry about". Most have been cautionary about the potential for problems if this gets out of hand from the beginning. I haven't seen any change in the narrative - there's always been a concern about what might happen, and concern has only naturally increased as infections have increased.

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    4. So it's important to keep in mind what I did not say. For example, I never said "liberals are cheering for a wide spread infection of Americans". Nor did I ever say "mainstream liberal political leaders" are saying this.

      Rather I said the msm have changed their narrative with regard to the coronavirus and Trump. Perhaps the best recent example is the New York Times which is known to be a liberal paper: "Let’s Call It Trumpvirus: If you’re feeling awful, you know who to blame". Of course, that's manifestly biased, for it's not as if Trump or his administration had anything to do with the coronavirus as a disease. If anything, the NYT might've better termed the coronavirus "commivirus" or "Xivirus" or "Chinavirus" or any number of other names. However I think the msm are attempting to shift the narrative toward blaming Trump.

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    5. By the way, I was assuming you were replying to me, but I realized you might be replying to Alan instead. Anyway hope it's useful info.

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    6. Sorry, I thought it was clear that I was replying to Alan since he said:

      "It is also surreal that Democrats have become so vile and deranged that they—and the accomplice media—are even cheering for a wide-spread infection of Americans."

      That comment makes even less sense given that the Democrats have offered an additional $8.5 billion in additional funding, given the administration only requested an additional $2.5 billion. If they wanted the disease to spread, why the additional funding offer?!

      As for your comment, you said that the media originally said there was nothing to worry about, then started blaming Trump. I asked about this change in the narrative, from going to "nothing to worry about" to "blaming Trump". I am still asking where do you see this change of narrative? I don't ever remember the media saying we have nothing to worry about. Yes, an opinion column attacked Trump (what else is new) but where has the narrative changed? You haven't shown me that.

      As far as blaming Trump, if you read the article and just not the headline, the article is not blaming Trump for the virus (who would logically do that?) but blaming him for his administration's response or lack there of. They cited a number of examples, including the grilling of the acting head of Homeland by Security by Republican Senator John Kennedy. That line of questioning showed that the Secretary was unable to answer a number of very basic questions about pandemic preparation. Trump isn't to blame for the virus (of course) but he 100% owns the preparedness (or lack of) of his administration and it's response. That's on him.

      As far as a changing narrative, only look to the administration and it's allies:

      Lawrence Kudlow (Chief Economic Advisor): "We have contained this"
      Rush Limbaugh: "It looks like the coronavirus is being weaponized as yet another element to bring down Donald Trump," Limbaugh Now, I want to tell you the truth about the coronavirus … I’m dead right on this. The coronavirus is the common cold, folks."
      President Trump: "The Coronavirus is very much under control in the USA"
      President Trump: "Because of all we've done, the risk to the American people remains very low"

      Since those comments two days ago, it is the Trump administration that has changed it's narrative, not the media. And Trump's press conference on Wednesday was not reassuring. The president said, "Well, I don't think it's inevitable. It probably will. It possibly will. It could be at a very small level or it could be at a larger level.There's a chance that it won't spread, too, and there's a chance that it will." He was then promptly contradicted by his experts at that same press conference who stated that the virus will spread - it is "inevitable". Trump also said, "It's a little like the regular flu that we have flu shots for. And we'll essentially have a flu shot for this in a fairly quick manner". This isn't true, it will be at least 12 to 18 months. He then said, "But we have it so well under control. I mean, we really have done a very good job." Again, this isn't something that is "under control" by any means - his own experts again said it is going to spread. The markets obviously didn't take comfort at Trump's press conference either - market futures were trending up before the press conference started, but then turned negative at the conference went on.

      Look, no reasonable person wants Trump to fail, when it comes to this or any other disease, the pathogen wont' care whether we're Republicans or Democrats, all it cares about is that we're good hosts. But Trump has got get his A game going or we're all in trouble.

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    7. "Sorry, I thought it was clear that I was replying to Alan since he said:"

      No problem. It just sounded like you were replying to both of us, but I wasn't sure. Anyway I'll let Alan respond to the comments you've directed at him if he wants.

      "I am still asking where do you see this change of narrative? I don't ever remember the media saying we have nothing to worry about."

      This isn't rocket science. This is obvious stuff you can do on your own. Go to Google, search for a string like "coronavirus", sort by date (e.g. custom range from, say, Nov 2019 till now), read the headlines and articles. You can filter by msm outlets too. If you remain unconvinced, then there's nothing more I can do. If you don't agree, then ignore my comment.

      "Yes, an opinion column attacked Trump (what else is new) but where has the narrative changed? You haven't shown me that."

      1. Not just any opinion column, but an opinion piece from the New York Times which (as I'm sure you know) is quite an influential media source. However, there are others, just Google. Go to Twitter. Search hashtags like #Trumpvirus. Look at leading msm outlets. Again, this is obvious stuff you can do on your own.

      2. Also, I think you're making this a bigger deal than it is. It's not that big of a deal whether the msm has or hasn't attempted to change the narrative with regard to Trump and the coronavirus. Even if it's untrue, it's already obvious to any reasonable person that the msm is anti-Trump and has had many other instances of attempting to push an anti-Trump narrative in general (e.g. Russiagate, impeachment). Trump and the coronavirus would just be one example in a string of examples. If one example isn't true, it hardly affects all the other examples. So just take it or leave it. It doesn't really change the bigger picture about what the msm thinks about Trump and conservatives in general.

      3. Regardless of the past narrative, the present narrative is that we aren't as well prepared for the coronavirus as previously thought, which is evidently Trump's fault. Again, just look at how lit up the msm on Twitter is about this.

      "As far as blaming Trump, if you read the article and just not the headline, the article is not blaming Trump for the virus (who would logically do that?) but blaming him for his administration's response or lack there of."

      Don't be daft. When someone refers to "Trump" they can be referring to his administration as well.

      "As far as a changing narrative, only look to the administration and it's allies:"

      At worst, all this shows is that conservatives and liberals alike have been nonchalant about the coronavirus. But that's something I myself have pointed out in the past. However the difference is that conservatives aren't using it as a reason to attack Trump, whereas liberals are.

      "Trump administration that has changed it's narrative"

      At the risk of stating the obvious, even if (arguendo) that's true, it doesn't mean the msm didn't change their narrative. It's possible for both sides to have changed their narratives.

      "Trump's press conference on Wednesday was not reassuring"

      I originally pointed out Trump's tweet was ill-considered. Likewise I've said to others that Trump should have a better response. Other conservatives have said the same (e.g. see here).

      "He was then promptly contradicted by his experts at that same press conference who stated that the virus will spread"

      Something I've pointed out as well.

      "This isn't true, it will be at least 12 to 18 months"

      Another thing I've pointed out.

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