Wednesday, February 26, 2020

COVID-19 # 17 (Required Parts are Highlighted)

The CDC has updated its warning levels. So has the State Department (updates are highlighted in purple):
Country
State Department
Center for Disease Control and Prevention
China
4
3
Hong Kong and Macau
2
1
Japan
2
2
South Korea
2
3
Italy
2
2
Iran
4
2

If you’d told me at the beginning of the semester I’d have to research this stuff, I wouldn’t have believed you. The new thing I’ve found out is that State Department levels go from 1 to 4, and 1 is no travel risk at all. The CDC’s levels go from 1 to 3, and 1 is used for places with some risk (the CDC is part of the Department of Health and Human Services, not the Department of State).Anyway, I color coded these so that the bad ones are in green, the worse ones in yellow, and the worst ones in red.
The International Olympic Committee is considering cancelling the Tokyo Olympics this summer. They are going to watch how the epidemic evolved until late May, and then make a decision.
There’s new research out on quarantine effectiveness.
  • Effective and interesting: the travel ban inside Wuhan slowed down the epidemic’s growth in other cities, but only by about 3 days.
  • Effective: closing entertainment venues
  • Effective: banning public gatherings
  • Effective: closing public transportation within cities
  • Ineffective: banning public non-air transportation between cities
No idea why they did not look at air travel.
I missed this from a few days back. Iran was not expected to be one of the first places an outbreak would spread from China:
Uh oh.
Add Brazil to the list. The infection has now gotten to all continents. Johns Hopkins has a dashboard on the outbreak, putting a map and numbers in an easy to find location. The problem with getting a case in Brazil is that Carnival season (similar to our Mardi Gras) ended yesterday. It is believed that an annual public pot luck dinner (basically a tailgate party) in Wuhan in mid January, attended by about 40K people, was a significant factor in the outbreak.
An interesting feature that you can pick up from the Johns Hopkins dashboard is the extent to which the healthcare system in Hubei was overwhelmed. It is not a fatality rate, but another thing that we look at is the ratio of deaths to recoveries (basically, patients who died in care divided by those who were in care and checked out of the hospital). In Hubei it’s 12%. The next hardest hit province in China is neighboring Henan, and there it’s 2%. In rich Guangdong, it’s under 1%. But, distance is a problem: Heilongjiang, which is about as far as you can get from Hubei, doesn’t have much of an epidemic but it’s 5% rate suggests they’re not prepared for what’s coming.
The WHO is supported by countries that donate in proportion to their GDP. China is its second largest donor. There has been suspicion that the WHO will go lightly on China to preserve their funding. On Monday, the WHO announced that they do not think there are a significant number of undiagnosed cases in Hubei. Outside experts are not so sure. Either:
  • The WHO is right, but fewer cases means the fatality rate is worse than estimated, but also that the risk of further spread is low, or
  • The WHO is wrong, and the fatality rate is lower, but the risk of further spread is higher.
Outbreaks in Iran and Italy point towards the latter. Also, WHO representatives at press conferences on Monday did not wear face masks, but on Tuesday they did. Interesting. But Julia Belluz noted this important point from those press conferences: [the] “Main driver is not widespread community transmission” but rather transmission within households. She also linked to this chart from the WHO's press releases:

 This does tend to support the WHO's position that the virus peaked in Wuhan a few weeks back, but that their ability to diagnose the illness was lagging behind by 10-15 days. It's also telling that they were getting thousands of onsets of symptoms each day before they really started testing at all. The whole article is interesting, especially for its comparisons to the SARS and MERS outbreaks.
OK. And here’s some Twelve Monkeys sh*t. Most cases in South Korea are linked to the Shincheonji Church of Jesus. This is widely regarded as a cult: members are not allowed to tell other family members they have joined. This church’s eschatology is that all its members will attain eternal life through a rapture like event when the church reaches a certain size (about where it is now). Think about this:
A senior health official in Daegu — the city that lies at the center of South Korea's coronavirus outbreak — confessed to being a follower of a controversial doomsday church cult after testing positive for the virus.
The unnamed official leads the Infection Preventive Medicine Department in the city …
Excuse my implied language, but WTF. For its part, the Church’s public position is now that they know they are part of the problem, they are cooperating fully with authorities; in particular, services have been shut down.
On a related note, Iran’s conflicts with the rest of the Moslem world are mostly because they practice the Shia sect rather than the predominant Sunni sect. Shia is known for being more apocalyptic than Sunni, and Iran’s leaders over the last 40 years have repeatedly stressed eschatological points as motivating their political actions. Is it PC in America in 2020 to note that an outbreak might be hard to fight in a place that already suspects we’re in the end times? As evidence of this note that religious shrines have not been closed in Iran, nor have public religious gatherings been discouraged. And then there was this:
At a news conference that was televised live on state-run channels, the country’s deputy health minister, Iraj Harirchi, was quick to deny accusations that there was a cover-up of deaths due to COVID-19, the disease caused by the coronavirus. He characterized the outbreak as a “national problem,” and said that it was “not the time for political confrontations.”
But the deputy health minister himself was confirmed as someone infected with the virus on February 25—one day after he appeared beside government spokesperson Ali Rabiei at a press briefing, sweating heavily.
Iran currently has a higher fatality rate amongst reported cases than Wuhan ever had. And there’s new research arguing that for Iran to display the numbers it has publicly released, there must currently be 4-50K infections there (that’s a 95% confidence interval). Today, 6 new countries neighboring Iran announced a total of 61 cases.
On the other hand, this might make you rethink whether the U.S. policy of maximum sanctions pressure on Iran was a good idea. There’s probably a screenplay in that story …
Obviously, there’s always finger pointing when something like this happens. Dali Yang has an op-ed in The Washington Post arguing that, while China has made big improvements in disease reporting since the SARS outbreak in 2003, they failed monumentally this time around. Most of the blame is placed with local officials in Wuhan and Hubei.
I pointed out in a required blog post last week that you need to have a very strong filter when you read news that a U.S. president ever cut funding for anything. Here’s why:
The tweeter is a fellow at the Center for Global Development. The CGD is one of the most influential DC area think tanks. It’s not particularly political, but it’s fairly obviously in line with Democratic and/or progressive positions.







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