A coronavirus update

I'll organize this update in sections:

Pandemic

1. As I've previously noted, for all intents and purposes, the coronavirus is already a pandemic, whether or not major health organizations like the WHO or CDC wish to make it official. There are now over 7000 coronavirus cases outside China in nations as geographically distant as Italy, Iran, and S. Korea and Japan. The US has about 60 cases. And there's even talk that the Summer Olympics in Tokyo beginning in July this year should be canceled.

2. I presume the main reason major health organizations haven't made it official is because if they make it official it would come with changes they don't think are desirable right now. For example, if it's officially labeled a pandemic, then that means containing the coronavirus to one nation (China) has failed, hence travel restrictions and bans would likely take a backseat to other measures, but perhaps the WHO and CDC still wish to prioritize travel restrictions and bans. Perhaps they still believe containment is possible.

3. To be fair, the official definition of a pandemic is itself vague. That's intentional. That in turn is largely because it gives organizations like the WHO and CDC some flexibility in applying the term in different ways in different situations with different diseases.

4. At any rate, the longer the WHO and CDC hold off from calling the coronavirus a pandemic, then the more likely they'll risk losing their credibility with the general public who see and hear all the news about the coronavirus spreading around the world.

Change our mentality

The majority of health care experts are strongly urging the gov't (e.g. CDC) to start changing its mentality from one of containment (e.g. travel bans, quarantines) to one of mitigation (e.g. improve and increase diagnostic testing to better identify the coronavirus in the general population, prioritize developing vaccines and antivirals to treat the coronavirus, implementing social distancing measures like other nations have already done, ensure community medical facilities are well stocked with necessary supplies and personnel). See here for instance.

2. Fortunately, many communities have already taken their own initiative in this regard. Hopefully there will only be more in days ahead, whatever the gov't decides to do or not do.

Fatality rates

1. The worldwide fatality rate for the coronavirus is around 2.5%. However, that's mainly based on the data in China because China makes up nearly 99% of all the cases.

2. If we look only at the data outside China, the fatality rate is about 1%. There are likely various reasons for the difference between China and the rest of the world, but one reason seems to be because China's healthcare system is overwhelmed (e.g. no ICU beds available, no ventilators available). As long as the US (or any other nation) isn't overwhelmed like China, as long as we prepare well, then it's likely our fatality rate will be closer to 1%.

Risk factors

1. Currently it looks like the single biggest risk factor for dying of coronavirus is older age. Those over ~70 would be most at risk.

2. Second seems to be someone with an underlying chronic disease (primarily cardiovascular or respiratory diseases).

Coronavirus around the world

1. Iran has a 7% fatality rate. That's the highest of any nation. However, this figure may be deceptive because most medical experts think that's most likely because Iran has only been able to identify severe coronavirus cases, not mild or moderate cases, so their numbers look worse than they are.

2. South Korea is odd. Arguably the majority of their coronavirus outbreak appears to have been due to a Christian cult which apparently believes their pastor is the literal second coming of Christ. The cult encourages members to come to church despite being sick. The cult is highly secretive with outsiders. As such, it's been very difficult for public health officials to do routine things like track down case contacts.

3. Japan had a cruise ship called the Diamond Princess quarantined off their coast. This has been both a political and medical nightmare to deal with. Apparently lots of fingerpointing in Japan over what was or wasn't happening on the ship. In any case, it's likely Japan's infection and fatality rates are higher than normal because of the poor quarantine and other measures taken (or rather not taken!) on the cruise ship. Look up Dr. Kentaro Iwata who is one of Japan's leading infectious disease experts and who was on board the cruise ship (but told to leave after only one day) describe what a fiasco he saw with his own eyes.

4. Italy has over 1100 cases with 34 deaths at present. The Italian epicenter is apparently the Lombardy region. Tim Challies has an interview with an Italian pastor in the "hot zone".

Coronavirus in the US

1. It's almost certain the coronavirus is already widespread in the US but undetected. That's for several reasons. One is because clinically speaking coronavirus is virtually indistinguishable from the flu. This flu season we're coming out of has been particularly bad too. Many medical facilities have likely sent their patients home without testing them for coronavirus, but just assumed they had the flu.

In addition, depending on the test (e.g. chest CTs, serial RT-PCR assays), our diagnostic tests may not have high sensitivity.

There have been two recent coronavirus cases, both in California, that patients have developed coronavirus with no known travel or other contact with anyone known to have coronavirus. That suggests the coronavirus is in the US but not detected. In fact, one of the two cases occurred near Travis AFB where the coronavirus patients from Japan's Diamond Princess cruise ship were temporarily quarantined on their return to the US. It's plausible the coronavirus has spread from Travis AFB into local communities.

2. There have been coronavirus cases in several other states. We just saw our first death in the US from the coronavirus in Washington state today.

3. Many medical experts are expecting the numbers to climb soon. They think it's quite likely we're near or at the tippping point at which coronavirus infection and fatalities will start climbing. The main reason for that is probably because community diagnostic testing has started becoming more prevalent, not because there's a sudden invasion of coronavirus onto our shores. More medical facilities are now testing for the coronavirus unlike before, even while there are likely hundreds of Americans walking around with undetected coronavirus.

4. Another concern is that healthcare workers have been unknowingly infected with coronavirus and as such are themselves the source of some or many coronavirus transmissions to their patients. UC Davis recently had that very concern, which I noted here.

5. Moreover, as the UC Davis report tells, it's a significant problem if the CDC continues to wish to be the sole gatekeeper for all coronavirus confirmation testing. If UC Davis had been allowed to do the confirmation testing themselves, then it's likely fewer healthcare professionals would have been exposed to the coronavirus. Fortunately, it looks like the CDC realizes this and is moving away from this.

6. Anyway, as I said in one of my previous posts, it's a good idea to prepare. Such as by makings sure there's enough basic supplies as well as basic medical supplies. Also, good hygiene is important. For example, start with regular hand-washing. Hand-washing is underrated. It's surprising how many people don't wash their hands even after, say, going to the restroom. Also, when washing our hands, a majority of people forget to wash their thumbs, in-between their fingers, and/or their wrists. They just wash their palms and fingers. Also, minimize touching our faces. Of course, these sorts of things are good to do in general, with or without coronavirus.