Friday, February 28, 2020

Coronavirus Update -- February 28, 2020

Case study: The Diamond Princess coronavirus event is being closely monitored and studied by the public health community. Talk about a rare chance to study a "controlled population." Except that children (and younger people in general) would be under-represented in this population it will still provide a wealth of information about the virus. Basic facts:
  • 3,711 passengers and crew
  • 705 cases (as of 6:39 a.m. Central Time, February 29, 2020 -- real-time updates)
  • deaths: 6
  • death rate of 6/705 = 0.85%
We'll also get to see the "incubation period" and how long an outbreak can last:
  • January 20, 2020: index case; 80-y/o male from Hong Kong embarked in Yokohama
  • he sailed on segment, disembarking on January 25, 2020
  • he visited a local Hong Kong hospital, six days later, January 31, 2020;
  • he tested positive on February 1, 2020
  • on the next segment, February 4, 2020: ten passengers were diagnosed with the virus (while in Japanese waters)
The ship remains under quarantine as of February 29, 2020; anchored off Yokohama, Japan. The exact date of quarantine was not stated, but one can probably consider February 4, 2020, as the most likely date.

Of huge concern from the public health angle: the most recent deaths from the Diamond Princess: two deaths two days ago -- almost a month after the first case was diagnosed. However, it is not known when the most recent patient became infected, when that patient first showed symptoms, when that patient was first diagnosed; when that patient was hospitalized; where those two patients were hospitalized; and where they are being treated.

Recent history from the Diamond Princess:
  • February 29: one new case, 70 years old; got off the ship Feb 20, symptoms Feb 28; remains "mild"
  • February 28: one new case, a Japanese woman in her 70s
  • February 27: no new cases actually report on ship (however, see below)
  • February 26: fourteen new cases: nine crew members and five passengers
  • February 25: one new death; a person in their 80s; again, no details
Tracking challenges; double counting: as one scrolls through the list of countries with less than five coronavirus cases, they are "all" evacuees from the Diamond Princess, which underscores the challenge of sorting this out. For example, on February 26, any number of European countries reported one new case and in each incidence, it was an individual in quarantine evacuated from the Diamond Princess.

South Korea: from February 20, 2020:
The Shincheonji religious group in Daegu, attended by the 31st case (a possible "super spreader"), has been shut down after about 10 members tested positive for the virus. About 1,000 members attended worship at the church. 
Case studies for the future:
  • 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
"Super spreaders": imagine the number of super spreaders in this group of 30,000 refugees that Turkey will let stream into the EU this weekend.  No matter how much money public health agencies have, it won't be enough if countries like Turkey are this irresponsible.
Coronavirus Update

The official daily figures for February 28, 2020, should be posted within the next few hours. It looks similar to yesterday with the exception of two new deaths from the Diamond Princess, the cruise ship. It appears that China is running about 50 new deaths/day. Outside of China, the countries with the most new deaths were Iran (8), Italy (4), South Korea (3).

It appears the following countries reported their first cases:
  • Mexico (two new cases; the first cases reported by Mexico)
  • New Zealand
  • Monaco
  • Lituania
  • Iceland
  • Belarus
  • Azerbaijan
The United States reported three new cases bringing the total to 63 cases overall; no coronavirus-related deaths (yet) -- but that's inevitable. Especially now that Mexico has their first cases, and the courts are not supporting the president's policies to protect the southern border.

If Mexico were to lose control of the public health crisis, one can assume Mexicans attempting to leave the country would head north, not south to Guatemala.

Coronavirus is tracked here.

Seasonal Flu
What The Major Networks Are Not Reporting

With regard to seasonal flu, the CDC is much less exact with regard to numbers. As of February 21, 2020:
More than 100 kids have died of the flu so far this season.
Flu deaths up in the new year: CDCFlu deaths are up more than 65% so far in 2020, with the Centers for Disease Control and Prevention reporting that 4,800 people had died and 87,000 people had been hospitalized.
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%;
  • pediatric deaths:
    • 20 new deaths this past week;
    • cumulative for the 2019 - 2020 season: 125
  • the "flu" vaccine is less than 50% effective; reported February 27, 2020, the "flu" vaccine is said to be 45% effective, about average for "flu" vaccines in general;
In the small print of that report:
The overall cumulative hospitalization rate was 52.7 per 100,000 population which is similar to what has been seen during recent previous influenza seasons at this time of year.
Rates in school aged children and young adults are higher than at this time in recent seasons, and rates among children 0-4 years old are now the highest CDC has on record at this point in the season, surpassing rates reported during the second wave of the 2009 H1N1 pandemic.
Note that despite the rates for children being higher than the 2009 H1N1 pandemic there have been no calls to close day care centers, schools, or athletic events, to the best of my knowledge.
The highest rate of hospitalization is among adults aged ≥ 65, followed by children aged 0-4 years and adults aged 50-64 years. 
Coronovirus Statistics
February 28, 2020

Four most important statistics:
  • growth factor: 2%; no change; same as yesterday, 2%
  • daily deaths, change in new deaths, daily, 7 (12%) d/d; yesterday: 21 (57%) d/d; much better;
  • daily deaths, change in total deaths, 65 (2%), d/d; yesterday: 58 (2%) about the same as yesterday;
  • deaths by country: see above; unremarkable;

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