Wednesday, February 19, 2020

COVID-19 #14 (Required Parts are Highlighted)

It’s been 5 days since the last class, due to the long weekend. A lot has happened.
Here’s the Reddit thread I mentioned in class. Ostensibly it’s about cooking, but it’s mostly about life in China under quarantine. The comments are just as interesting. Apologies in advance for the language sometimes used. The writer is in Shunde, in Guangdong, about 500 miles south of Wuhan. I have been unable to find a current list of quarantined regions in China; some are imposed at the national level, but most are being imposed by party officials at the very local level.

That’s an educated guess as to the size of the Chinese quarantine, which comes from an analysis by The New York Times. There are many reports that, outside of Hubei, local party officials have some latitude within China’s “grid management system” to make their local quarantine more stringent or more lenient.
This is a cool visualization:

Clearly, Chinese air traffic is way down.
China has fired the bureaucrats in charge of Wuhan (city) and Hubei (its province); essentially a mayor and a governor.
For perspective, 92 kids have died of the flu in the U.S. this winter. Precise numbers are hard to get for seniors (who often die “with the flu rather than “of” the flu), but it’s in the thousands. Do not forget that COVID-19 is mostly about what it might do, not what it has done.
The article I mentioned in class about "China sacrificing a province to save the world" is here.
As of last week, the U.S. has set up 15 quarantine centers around the country. I believe 12 are still empty. About 600 people are in quarantine, although the first group was released last week.
Also, a cruise ship with almost 4K passengers and crew has been quarantined in Tokyo harbor for a few weeks after passengers tested positive. The quarantine has been effective in keeping the infection from spreading into Tokyo, but not from spreading amongst those quarantined.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said the original idea to keep people safely quarantined on the ship wasn't unreasonable. But even with the quarantine process on the ship, virus transmission still occurred.
The Japanese health ministry said Monday that the number of cases confirmed aboard the Diamond Princess had reached 454.
…
"The quarantine process failed," Fauci said. "I'd like to sugarcoat it and try to be diplomatic about it, but it failed. People were getting infected on that ship. Something went awry in the process of the quarantining on that ship. I don't know what it was, but a lot of people got infected on that ship."
This Japanese doctor who went on to the ship explains that the quarantine within the ship has been inadequate. He has worked in areas with Ebola and SARS, and was much more scared inside the ship:

He was asked to leave the ship after pointing out problems. The message here is probably that it’s been so long since anyone tried to execute a quarantine that no one knows how to pull one off.
The U.S. began repatriating people from that ship to quarantine centers on the U.S. mainland over the weekend.
This isn’t too surprising:

 It would put the number of infected at about 500,000. That seems consistent with reports that Chinese hospitals have been refusing admittance to anyone not displaying severe symptoms.
Forecasting is always tough though, and predicting epidemics is especially hard. This article entitled “Disease modelers gaze into their computers to see the future of Covid-19, and it isn’t good” discusses forecasts made by the CDC. Their range currently runs from 550,000 to 4,400,000 infections. It’s by Sharon Begley, an award winning author who I’ve been reading since the 80’s.
Lastly, this piece, entitled “How China’s Incompetence Endangered the World”, appeared over the weekend in Foreign Policy. That is a regular media rather than scholarly outlet, but is a serious one. The author, Laurie Garrett, has won a Pulitzer Prize and two Polk Prizes for reporting on international health issues. You can follow her on Twitter at @Laurie_Garrett.
The Chinese leadership seems to be getting more sensitive to outside criticism. Today they expelled 3 reporters for the The Wall Street Journal in response to a February 3 article entitled “China Is the Real Sick Man of Asia”. I’ve read the article a couple of times now — it won’t ever be required for class — but it’s hard for me to see that it’s saying anything that a lot of other sources on the internet are saying: the epidemic is a big deal, the response from the Chinese government hasn’t been great, there probably will be economic consequences to both, and it’s not at all clear that the Chinese economy is strong from top to bottom to begin with.
Many institutions treat Hong Kong as a separate entity from the rest of China. Today, the CDC issued a warning about traveling to Hong Kong. This is the first place other than China for which such a warning has been issued. Hong Kong currently has somewhat fewer cases than Singapore, so this is probably a statement not so much about the progress of the epidemic, but of the availability of treatment supplies given that Hong Kong’s largest trading partner is China.
The fatality rate seems to be holding in the 2-3% range, still less than SARS or MERS. On the other hand COVID-19 is more easily transmitted. And still, the flu causes a lot more deaths, although its fatality rate is in the 0.15% range. Flu also seems to be much harder to transmit than COVID-19; people get the flu because it is endemic in the population of humans, not because it is transmitted easily. So the long-term threat with COVID-19 is that it becomes endemic. That threat is why we have quarantines.
Statistical evidence has emerged that China’s infection numbers and death numbers are too closely correlated for typical data. This suggests the numbers are being massaged before being released.



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