Coronavirus -- Global Health -- Public Health -- Fascinating -- February 29, 2020

February 29, 2020: the daily statistics won't be out for about eight hours, but right now the big news is in the US. Data, as of 2:17 p.m. Central Time, February 29, 2020:

• US: five new cases (now at 68), and the first death, an individual in Washington state with minimal additional details.
• China holding steady at around 50 new deaths each day;
• South Korea with a whopping 813 new cases, far more than what China even had (433), today;
• despite that huge increase in new cases, South Korea is reporting only one new death (one can expect new deaths to come over the next few days)
• Italy: with about half as many new cases (239) as China; considering the difference in population, that's very, very alarming for Italy; in addition, eight new deaths in Italy compared to just that one new death in South Korea;
• Iran: statistics almost identical with Iran; total cases almost doubled overnight; 43 total deaths; 9 new deaths;
• Diamond Princess: no new cases; no new deaths;

I keep looking for a historical precedent. It's very possible the 1918 influenza pandemic is the best historical model. See "1918 "Spanish" influenza" link below. The takeaways:

• a pandemic will be declared within six month; and, 
• the pandemic will burn itself out before a vaccine is widely available

One definition of a pandemic:

• when an epidemic spreads throughout the world

What is the CDC's definition of "seasonal flu epidemic"? Re-posting from yesterday:

From the CDC, week 8, ending February 22, 2020:

• overall cumulative hospitalization rate for the season increased to 53/100,000
• the percentage of deaths attributed to pneumonia and influenza is 6.9%, which is below the epidemic threshold of 7.3%

My hunch: "this" will be called an epidemic a lot more quickly than "they call it" for "seasonal flu." It is very likely, it will be called a pandemic before "epidemic" criteria are met.

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Viruses, Flu, Corona, and All That Jazz

New links:

• Genome sequence of the SARS-associated coronavirus, Science, May 30, 2003.
• Origin and evolution of the 1918 "Spanish" influenza virus hemagglutinin gene, National Institutes of Health, February 16, 1999.
• Genes that made 1918 flu lethal isolated, ScienceDaily, December 31, 2008.

Re-posting from February 2, 2020:

A reader called me out -- and rightly so -- on my flippant remarks regarding coronavirus. So, where do we stand on this issue? Here are a few links:

• Relax! Coronavirus is less dangerous than the "flu," says epidemic expert -- CCN
• High flu activity spreads across US as virus claims fourteen (14) more children -- ABC News
• Worried about coronavirus? In the US, "flu" is a bigger threat -- NPR
• US on track for one of the worst flu seasons in decades -- CNN
• Weekly US Influenza surveillance report (FluView) -- CDC
• Coronavirus is scary, but the flu is deadlier, more widespread -- USA Today
• Genomic characterisation and epidemiology of 2019 novel coronavirus (2019-nCoV): implications for virus origins and receptor binding -- The Lancet

Case studies for the future, from an earlier post:

• South Korea: will be incredibly interesting from many aspects; 
• South Korea may indeed be "the model" for the US;
• Italy: could be the model for the EU;
  
• Iran: third world country; method of containment: trucks driving down city streets spraying germicides;
• Russia: a fairly closed society;
• Turkey; complete and total disregard for possible consequences; institutes policies to ensure "inevitability" that coronavirus spreads;

Re-posting, from February 25, 2020:

Is this a bio experiment gone awry in Wuhan?

The Chinese physician who first called attention to this died? Is he the only physician that has died of Covid-19? Exactly what were the circumstances of his death? How many other physicians have died? I haven't heard of any others.

How did a "country physician" come up with the cause of this brand new infectious disease, seemingly overnight? Explanations for most unexplained cases like this are preceded by four articles in the Lancet, two articles in The New England Journal of Medicine, and a breakthrough article in Nature. But in this case, no research articles, but simply a "country doctor" discovering the cause. And then he's dead; within days. Shoot, the incubation period is two weeks. Jeffrey Epstein did not hang himself.

Many, many more questions. The questions fall into two categories. The first category is for Sherlock Holmes to answer: where/how/why/when did the virus appear. I think there is enough circumstantial evidence for Sherlock to start working some theories. In fact, my hunch is that Sherlock Holmes would have already sorted this out. It's too bad Richard Feynman is no longer with us. He, too, would have it figured out. Algore, the inventor of the internet and discoverer of global warming -- I'm surprised we haven't heard from him.

The second category, the public health angle, which is now the "only" medical angle: if you were "king/queen for a day" and could institute your plan to control this infectious disease how/what would you do? What policies would you dictate? 

US lab, from wiki:

Rocky Mountain Laboratories (RML) is part of the NIH Intramural Research Program and is located in Hamilton, Montana.

Operated by the National Institute of Allergy and Infectious Diseases, RML conducts research on maximum containment pathogens such as Ebola as well as research on prions and intracellular pathogens such as Coxiella burnetti and Francisella tularensis.

RML operates one of the few Biosafety level 4 laboratories in the United States, as well as Biosafety level 3 and ABSL3/4 laboratories.

In February 2020, electron microscope images of Novel Coronovirus strain COVID-19 were collected at RML.

From globalbiodefense:

The National Institute of Allergy and Infectious Diseases’ Rocky Mountain Laboratories (RML) has produced images of the novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV), the causative pathogen of Coronavirus Disease (COVID-19), on its scanning and transmission electron microscopes this week.

Note that the images do not look much different from MERS-CoV (Middle East respiratory syndrome coronavirus, which emerged in 2012) or the original SARS-CoV (severe acute respiratory syndrome coronavirus, which emerged in 2002).

That is not surprising: The spikes on the surface of coronaviruses give this virus family its name – corona, which is Latin for “crown,” and most any coronavirus will have a crown-like appearance.

RML investigator Emmie de Wit, Ph.D., provided the virus samples as part of her studies. Microscopist Elizabeth Fischer produced the images, and the RML visual medical arts office digitally colorized the images.

More links:

• rate of transmission compared to "SARS - 1";