Guest Post by Wim Röst
Abstract
Nearly all the deadly infections of the corona virus are localized in the centre of the epidemic in and near Wuhan in the province of Hubei, China. This analysis leads to two main types of contamination: 1) breathing in the virus after a nearby contaminated person coughs or sneezes and 2) contracting the virus via the fecal-oral route, due to poor hygiene, that is not washing your hands. Of these two methods, the first is very dangerous. From the point of view of epidemics, the second form is potentially as dangerous as the first one. But for most individuals that are treated well the consequence of being contaminated seems to be no more deadly than a normal flu. Even so, the danger for whole populations and even for whole continents remains huge: every infected individual, who is not properly treated, can lead to a huge and dangerous epidemic.
Introduction
There is a large difference in fatality for people infected in Wuhan and the surrounding area and for people that are infected outside the province of Hubei. Nearly all deadly cases can be traced back to contamination in Wuhan, Hubei. This observation requires an explanation.
Becoming infected in Wuhan is more dangerous than becoming infected elsewhere
Outside Mainland China, the disease has resulted in death only in Hong Kong and the Philippines. Both victims traveled from Wuhan in the province of Hubei where they were infected.*
Outside of the province of Hubei (the origin of the epidemic) contamination by the virus seems to be much less deadly for individuals that were contaminated. Outside the province of Hubei there are only 14 deaths, out of a total of 563** deaths. Nearly all of that small number of deaths, in the rest of Mainland China, seem to have been infected in or near Wuhan, Hubei.
This leads to the simple conclusion that individuals that have been infected in Wuhan are at greater risk than people that are infected outside Wuhan.
The question is: why?
Types of infections
From tuberculosis we know that there are two main types: the so called ‘open tbc’ and ‘closed tbc’. Open tbc (lungs involved) is very contaminating and the consequences are far more severe.
For the Wuhan coronavirus various ways of contamination are proposed ***:
- Spread from person to person through respiratory droplets emitted by coughing or sneezing.
- Airborne – meaning: the virus is able to travel across a large room.
- The fecal-oral route. Viruses from a diarrhea can be transmitted by hands or other means to the respiratory system of the infected person.
This analysis leads to the conclusion that a fourth one should be added:
4. The fecal-manual route. A first infection in the digestive system of the first person is transmitted by ‘shaking hands’ with secondary persons that may transmit the infection to their own digestive system, causing a primary reaction like diarrhea.
Origin and spread of infections of the new corona virus
In the city of Wuhan which is the origin of the epidemic 55% of the first contaminations are proven to come from a market. In first instance the digestive systems of one or more customers of the market must have been infected by eating contaminated food, causing a diarrhea.
If the virus is first infecting the intestines of a patient the body probably has more time to activate its defense system after which a person gets protection by antibodies, constraining the severity of the contamination: “Reports point to mildly symptomatic but infectious cases of 2019-nCoV [2019 Novel Coronavirus], which were not a feature of SARS.”
Probably by the fecal-oral route, the respiratory system of one or more of the first victims, must have been reached in a second case, resulting in severe respiratory problems and in many deadly further cases.
In Wuhan contamination by respiratory droplets has been directly infecting the lungs of other victims nearby, resulting in many deaths for Wuhan and nearby. When large quantities of viruses are directly transmitted from lung to lung a totally unprepared and unprotected body gets a big problem from the very first moment: a viral load of up to 108 copies per milliliter is mentioned – 100 million viruses per milliliter.
Besides the above route the virus is transmitted via the fecal-manual route by seemingly healthy people whose digestive system has been infected but who are not aware of the type of infection or not even of becoming ill. People that are infected through the digestive route may or may not develop sickness symptoms like a diarrhea. These people themselves could not have or show problems in their respiratory system but they are still able to contaminate other people. For example, by simply shaking hands with other people with a hand with slight traces of the virus. The danger of a less than perfect hygiene (which is rather common) and more especially the hygiene in squat latrines has been mentioned in this informative article.
The fecal-manual route of contamination probably has been the case in most of the illness cases in the rest of Mainland China and in most of the secondary cases in foreign countries where corona infected people from China, not having respiratory problems, traveled to. The infection by an infected guest in the factory in Germany probably was transmitted by ‘just shaking hands’, which is what people in firms are used to doing when they meet each other.
Consequences
If the above analysis is correct, in case of sickness, two types of contamination must be distinguished:
- by the fecal-manual route
- by the respiratory route
The last one is by far the most dangerous for the individual because it directly affects the fragile lung system even before the slightest resistance in the body could have been built up. Both varieties however are very contagious and can spread the virus to many people which means that both varieties have more or less the same potential in creating a dangerous epidemic.
After recognizing the ‘dangerous’ and the ‘less dangerous’ variant different ways can be followed. The ‘respiratory group’ needs 100% isolation. For the other group 100% strict hygienic prevention measures should be enough to prevent further spreading. A ‘contactless period’ is needed but further complications for the infected person are much less probable which facilitates treatment and recovery.
The Big Danger
By seemingly healthy people the disease can travel to other locations and can be spread by persons that are not showing symptoms of the disease. The spread of this highly infectious disease might already have taken place to less equipped countries. In poor countries further containing of the very contagious disease will be more difficult than in China or in other more developed countries.
New possibilities for killing the epidemic?
The fact that people develop resistance against the disease by slight infections of the digestive system possibly opens up new ways to fight the epidemic. But it is not easy to imagine how this could happen without self-contamination of the lung system of some individuals or without transmitting considerable quantities of the virus to the people in the environment – things that happen during the uncontrolled spread of the virus.
Conclusions
From the geographical spread of confirmed cases of the corona virus the difference between two main types of contamination is inferred.
First there is, for individuals, the less dangerous contamination that only affects the digestive system of a patient. The patient himself often develops less severe symptoms but is still able to contaminate many other people by fecal-manual transmission.
Second there is the very dangerous variant in which the respiratory system is affected.
In case of ‘lung to lung’ transmission of infections the natural defense system of infected people does not have enough time to develop natural resistance against the disease. Very soon the patient is very ill and highly contagious in the most dangerous way. It is the contamination of the respiratory system that causes most deaths.
Outside Wuhan/Hubei contamination by the fecal-manual route probably is the most common way of becoming infected. This type of infection is less problematic in its direct effects because usually only the digestive system is involved. For the affected individual the contamination usually has less severe consequences but from the point of view of contaminating other people a high risk remains. Strict hygiene is needed.
Distinguishing the two forms of contamination, eases treatment decisions. Distinguishing the two forms of transmission leads to better and more efficient policies in fighting and constraining the epidemic.
Disclaimer: The author is a geographer, not a medical specialist nor an epidemiologist. Geographical data have lead to the above analysis which may be right or may be wrong but if right this analysis will have many advantages for policies regarding the epidemic. Many lives could be saved – which has been the reason to publish this not perfect and not complete analysis.
With regards to commenting, please adhere to the rules known for this site: quote and react, not personal.
In commenting, please be reminded you are on an international website: for foreigners it is difficult to understand abbreviations.
About the author: Wim Röst studied human geography in Utrecht, the Netherlands. The above is his personal view. He is not connected to firms or foundations nor is he funded by government(s).
Andy May was so kind to read the original text and improve the English where necessary. Thanks Andy!
A 44-year-old man who traveled from Wuhan, China, the center of the outbreak, died in the Philippines, officials said.
Hong Kong confirmed its first death from the novel coronavirus on February 4, 2020, after a 39-year-old man died after travelling to Wuhan, the capital of the central Chinese province of Hubei. (Italic added)
**Current map of Coronavirus 2019 cases in China
Earlier numbers in more detail (2/6/2020)
Mainland China 28,085 Total Deaths 563
Province of Hubei (inclusive the city of Wuhan):
Confirmed: 19,665 (70% of total Mainland China confirmed)
Deaths: 549 (97% of total Mainland China deaths)
Mainland China exclusive the province of Hubei:
Mainland China 28,085 – 19,665 = 8,420 = 30% of total China Mainland
Total Deaths 565 – 549 = 16 – 2 (outside of Mainland China) = 14 = 2.5% of total China Mainland
Hubei:
The province of Hubei has 70% of total confirmed cases and 97.5% of total deaths
To compare: the rest of Mainland China has 30% of all cases and only 2.5% of all deaths.
Many confirmed cases, no deaths: for example, the province of Zhejiang, Mainland China
Confirmed: 954 (3.4% of total of Mainland China)
Deaths: 0 (0 % of total Mainland China deaths)
***CNN: February 5 coronavirus news
6:49 a.m. ET, February 5, 2020
Cruise infections raise questions about how Wuhan coronavirus spreads
From CNN’s Joshua Berlinger in Hong Kong
The novel coronavirus is thought to spread from person to person through respiratory droplets emitted by coughing or sneezing.
There’s currently no evidence that the virus is airborne — meaning, for instance, it doesn’t travel across a large room.
Still unknown: An important factor yet to be determined, however, is whether the virus spreads via the fecal-oral route, according to Dr. John Nicholls, a clinical professor in pathology at the University of Hong Kong.
Coronavirus cruise: Norovirus — a contagious stomach bug that causes vomiting and diarrhea — and severe acute respiratory syndrome (SARS) both spread by the fecal-oral route. Norovirus is also notorious for infecting cruise passengers.
Viruses like norovirus spread so quickly on cruises because “you’ve got so many people in a crowded area and people are sharing areas, touching places,” Nicholls said.
Questions raised: The infection of at least 10 people aboard a cruise ship now quarantined in Japan is raising questions about whether the Wuhan coronavirus can spread the same way.
Recent news: There is now an American death and a Japanese one from this virus: https://www.washingtonpost.com/world/asia_pacific/coronavirus-china-live-updates/2020/02/08/4fcbd584-49f5-11ea-9164-d3154ad8a5cd_story.html
Some good research here: Corona Virus Fakery And The Link To 5G Testing | https://www.vigiliae.org/virus-link-to-5g/
Diane
“Some good research here?”
That is typical, worst fake info.
As a general rule learned from experience it is very difficult to describe the actual behaviour of an epidemic such as this within the first few weeks. We are certainly in those first few weeks as far as the statistical observation of the Wuhan coronavirus outbreak. There are many different theories that may explain the lower death rate outside of Wuhan and no one can claim to know the real answer but let me just add one more which is consistent with what we know of deaths from respiratory viruses such as influenza and corona viruses. The typical pattern is an infection beginning with dry cough, fever and lots of respiratory secretions in the upper airways for corona virus. It looks like a common cold. Death typically occurs when an individual develops widespread inflammation in the lungs which causes difficulty exchanging oxygen and CO2 and which appears clinically indistinguishable from acute respiratory distress syndrome (ARDS). This is a widespread lung injury which will lead to death in many who develop it but most individuals will recover without this complication.
We don’t know why certain people are more prone to ARDS than others but this is an illness that can affect young previously healthy people. Certainly older and more debilitated individuals are at higher risk of death but ARDS is the likeliest cause of death in young fit people with these viruses.
With that background it is important to recognize that the development of ARDS and eventual respiratory death typically develop over several days to weeks. The application of modern critical care with supplemental oxygen, non-invasive ventilatory support, and mechanical ventilation can support those with the most severe lung injury for weeks before they ultimately recover or die. This means that the outcomes for many of the most severely affected by this new corona virus are not known to date. We are in the very early upswing part of the epidemic curve and it is far too early to see all of the outcomes that will occur. There will be more recorded outcomes, and more deaths per infected individual in those areas where the infections occurred earliest in the epidemic (i.e. Wuhan). Where the epidemic spread is more recent there will not be many individuals who have been ill long enough to die from ARDS. If this is at least a partial explanation for the variable death rates, and I believe it must be, then the final death rate will likely be above the 2% reported overall and this would explain a death rate closer to 5% in Wuhan so far. The rate in Wuhan could also increase because their epidemic is not yet mature and I wouldn’t be surprised at numbers as high as 7%.
The possibility that the rates of severe illness and death are much higher is also supported by reports that 14-16% of those known to be infected are classed as critically ill. I would expect a substantial number of those classed as such will die ultimately even with modern health care supports but, if cases continue to rise rapidly, the ability to provide such support will be severely stretched and death rates may trend even higher.
As many others have mentioned another phenomenon that may reduce the death rate would be the finding of many more minimally symptomatic people who don’t present to medical care thus increasing the number of mildly affected individuals. This would be a very welcome and not surprising finding but it would also substantially increase the pool of individuals capable of spreading the virus and make containment more difficult.
Finally it is important to recognize that these numbers are based on the reported statistics coming from a country whose health care services are likely extremely stretched and where the ability to accurately find and report every case and death should be at least partly suspect. Is there under-reporting of cases and deaths due to logistical issues – quite possibly. Are there political and civil reasons to want to diminish the perceived severity of the epidemic – most probably. None of this is meant to be a critique of the Chinese government response to this epidemic. This is a huge disruption to normal social systems and would be a severe test of any national government. China deserves all of the support and sympathy the world can offer. We are all in this together.
Thank you for all of this information.
The daily rise in severe cases since the 27th and the percentage rise in % of the total of severe cases the day before, all numbers for whole China as I noticed them are as follows:
461
976 112%
1239 40%
1370 11%
1527 11%
1795 18%
2110 18%
2296 9%
2788 21%
3219 15%
3859 20%
4821 25%
6101 26%
The rise in % of the previous day remains strong.
Do you perhaps have any information about the percentage of severe cases outside of Hubei?
According to what I have read about all cases outside of China nearly none of those cases showed severe symptoms and I presume this is also the case for ‘the rest of China’ given the low numer of deaths outside of Hubei, a number which is not quickly rising either.
Inverse reasoning leads to the conclusion that there can only be a low percentage of severe (lungs involved) cases outside of Hubei but confirmation or disconfirmation by official numbers is lacking.
There are reports of severe cases and two deaths outside of China. All of what I know about this epidemic is from published statistics. There are very few cases relatively and most of those cases are “young” in their evolution so it is not surprising there are few severe outcomes outside of China so far. I have no first hand knowledge and take all of the reports with some skepticism (a sound scientific perspective) The very unfortunate outbreak on a ship docked in Japan will be very interesting to follow as it is a closed population and should give some very helpful clues on infectivity (reproduction rate), pathogenicity as shown by severity of illness and death rate, and what measures are effective to control spread. I continue to hear various experts state whether the current control measures are sufficient, deficient or over the top but I don’t trust any of those judgments as sound at this time and only the passage of time will allow a better understanding.
However bad this epidemic is or becomes, I suspect, as is typical of most modern epidemics, that the worst effects will not be from the infection but from all of the various reactions to and the fear generated by the epidemic. China faces very real risks of economic harm, civil disruption and collapse of civil order in some jurisdictions and I suspect their very aggressive response is in large part driven by the need to avoid that. Again this is not a critique of China. The same type of thinking is prevalent in democracies where the perception of the voter as to how well a politician protects and improves ones own circumstance is key to the politicians fortunes.
I should have mentioned that for cases outside Hubei but in China I am only aware of the differential death rate where, near the Center of the epidemic it approaches 5% and outside of that region 2%. As stressed above the rates don’t just reflect the actual severity of the infection in different regions/populations but also the maturity of the epidemic in any region. The longer individuals have been infected the more severe outcomes and deaths will be recorded as there is a large lag time between infection and ultimate death.
Andy Pattullo: “there is a large lag time between infection and ultimate death”
WR: is there any indication about the average time lag between infection and ultimate death?
The cruise ship in Japan took the sick man on board the 20th of January:
“The checks began after an 80-year-old Hong Kong man who had been on the ship last month fell ill with the virus. He boarded the luxury cruise liner in Yokohama on 20 January and disembarked in Hong Kong on 25 January.”
https://www.bbc.com/news/world-asia-51409800
To know the lag time one needs to know when someone is first infected and then when they become maximally symptomatic or die. The earliest anyone on the ship could have been infected by the index case is when that man boarded but the infections could have taken place anywhere between that date and when he disembarked on the 25th. That helps to narrow things down but then there are likely several secondary transmissions from others who were infected by the index case so it becomes murky. The ship may work as a closed system that gives some more insights into this and other questions. I have posted elsewhere the statistics regionally for deaths in China that clearly show a rising rate the more established the epidemic is and this is likely a function of that lag time.
With influenza and modern medical care it is not at all uncommon for a person who dies of ARDS to do so many weeks after first becoming symptomatic. Some will linger on ventilation for months. It is also worth noting of that among those most severely affected, having ARDS, most do survive but many have markedly damaged lungs for life and substantially reduce exercise tolerance.
Andy Patullo: “I have posted elsewhere the statistics regionally for deaths in China that clearly show a rising rate the more established the epidemic is”
WR: Could you give us a link to those statistics? Or post them here as well?
Check the following link for daily statistics. I posted it in another comment but it may be in moderation.
https://www.worldometers.info/coronavirus/
A superb source of information. Recommended to everyone.
Thank you very much!
Following is a useful link for updated statistics:
https://www.worldometers.info/coronavirus/
From the above source as of February 9, 2020 17:55 GMT there were a total of 37612 cases, 6198 of those in severe condition, 815 deaths and 2990 recovered. This means of those identified as being infected 18.6 percent ((6198 + 815)/3762) have either been made severely ill or died. Of those with a reported final outcome (death or recovery) 21.4% (815/(815+2990)) have died. THIS DOES NOT MEAN the actual death rate will be any where near that high – it may all be due to the limitations of the reporting to date and the lack of counting mild or asymptomatic cases.
However the phenomenon of increasing death rates with age of the epidemic may well explain the following death rates: Wuhan 4.8%, Hubei province 3.1%, other provinces 0.16%, all of China 2.1%.
Two observations:
1. Regarding the slowing rate of new cases: If new cases were increasing, in just Hubei Province, at the rate they were increasing a week ago, which was around an 18-20% increase per day, we would now be seeing around 50,000 to 60,000 confirmed cases in Hubei and a daily increase of around 10,000 cases. In another week, there would be nearly 200,000 cases and a daily increase of 40,000 cases.
Does anyone seriously believe that the testing resources of Hubei Province would not be completely overwhelmed in another week if that were the case? I doubt it. So the question then becomes, at what point will they, or more to the point, did they, become overwhelmed? Hubei cases were going up at an exponential rate of 19% per day until they leveled off at about 2500 cases per day (numbers are approximations). Is 2500 the upper limit of cases that can be diagnosed per day with existing medical resources? I don’t know, but I would bet it’s somewhere less than 40,000. In other words, the cases could still be increasing exponentially but are just not being diagnosed by official testing. And if that’s the case, they could also be dying without being diagnosed.
Add to that the report that the Shanghai health commission has claimed that the virus is now found in aerosol form. Whether that report is true or not, I have no idea, but if the virus is present in aerosol form it will be tough to stop. That would also explain how people seem to contract it so quickly, as in one person contaminating four or five family members all at once, or so many people returning from Wuhan to their home countries carrying the virus even though they left China when the confirmed cases were quite low.
2. Regarding the low number of deaths in virtually all other provinces, including zero deaths in a province with over 1,000 cases and almost 200 recoveries: Officials routinely get “disappeared”, or at least severely penalized, in China for revealing information the central government does not approve of. Reportedly, nearly half the population of Wuhan left the city for other parts of China during the Lunar New Year, so the virus was almost certainly carried throughout China in respiratory form by those travelers, especially since every mode of mass transport would have been overcrowded at that time. A far more reasonable speculation, which is what the article above is also, is that deaths are occurring throughout China but are being vastly underreported. That could also be the case for confirmed cases in other provinces. China’s economy was already fragile due to several circumstances. The last thing its leadership wants now is a pandemic and the officials of every province are no doubt aware of that fact and could be behaving accordingly.
“The last thing its leadership wants now is a pandemic and the officials of every province are no doubt aware of that fact and could be behaving accordingly.”
“The last thing its leadership wants now is the world learning there is a pandemic and the officials of every province are no doubt aware of that fact and could be misbehaving accordingly.”
“The infection by an infected guest in the factory in Germany probably was transmitted by ‘just shaking hands’, which is what people in firms are used to doing when they meet each other.”
There is a lot to be said for the Indian custom of greeting others by holding one’s hands together in a prayerful position and saying namaste.
Namaste (nah-mah-stay) originates in Hindu religious practice. The word comes from Sanskrit, the classical language of religious texts in Hinduism and it means “I bow to you,” and is used as a greeting.
A fundamental of infection control for all of these respiratory viruses is the use of effective hand washing/sanitizing after contact with anyone who might be an infectious source. It is likely with many of these viruses that skin to skin contact with secondary contamination of wet membranes (eyes, nose and mount) by contaminated hands is an important if not the most important means of transmission. Once that is understood then the issue of fomites (inanimate objects/surfaces that may be temporarily contaminated by touch) becomes a concern. These viruses may persist and remain infections for at least a brief period of time on surfaces once contaminated. I am reminded of photos during the SARS epidemic of Asian riders on transit wearing masks to avoid droplet spread from sneezing coughing individuals but in the photo they are holding on to bars and handles on the transit which have almost certainly just been held by many other riders. This is not meant to scare but just to emphasize that regular hand washing/sanitizing and avoiding unnecessary touch of hands to eyes/nose and mouth when out in public paces is a key measure in reducing risk of infection. These cautions are useful anytime colds, flus or other respiratory viruses are circulating in a community. Perhaps one additional benefit of masks is that they may prevent you touching your nose and mouth frequently.
Here’s some low-quality data and worst case math, but it is an interesting look at the other end of medical care:
https://twitter.com/anilvohra69/status/1226321939297267714 says:
However, the source is not very credible, and others have found fewer crematoria. An estimate of the normal daily deaths is under 250, which doesn’t jibe well with 49 crematoria.
It’s probably substantially lower than that but who knows? There is also something odd going on with SO2 emissions around Wuhan. Some people are claiming that levels are way above normal in the past few days and speculate that it is due to burning medical wastes and/or bodies. Don’t know who to believe.
Here’s a different, more personal look at Wuhan crematoria, see https://www.theepochtimes.com/exclusive-funeral-homes-in-coronavirus-ground-zero-cremating-dozens-of-bodies-a-day_3228938.html
On Feb. 1, Chinese health authorities announced mandatory cremation for people who died from the coronavirus.
The official at the first-mentioned funeral home said that about 60 percent of the bodies come from private homes, while 38 percent are transported from hospitals. Most of the corpses coming from homes are people who died from the new coronavirus, he said.
People who died at home from the virus are unlikely to have been officially diagnosed with the illness—given that diagnoses are issued at hospitals—and therefore do not count toward the official death toll.
Of the 127 bodies received by the crematorium on Feb. 3, eight were diagnosed with the virus, while 48 were suspected of having the illness, based on their death certificates, the official said. It is unclear what was specified as the cause of death for the remaining 71 bodies.
…
Stretched to the Limit
The senior official at the first-mentioned funeral home said his staff of around 110 people has been stretched to the limit, working round the clock to transport bodies from hospitals and private homes and cremate them.
“We transport the bodies 24 hours a day,” he said. “Now every single male employee is involved [in this task]. As long as they can still move, they will work.”
The facility’s 11 furnaces are cremating bodies nonstop every day, he said.
The official said that at this rate, he would need 40 to 50 additional staff to keep up with the workload, adding that current staff have not taken a day off since Lunar New Year’s Eve on Jan. 25.
“I’m on the brink of collapse,” the official said.
“We are exhausted and can’t get any rest,” he added. “Now I would feel grateful if I can sleep for two or three hours a day.”
The official added that he’s been in touch with the Hankou Funeral Home, whose “workload is even heavier than mine.”
That facility, located in downtown Wuhan, is officially designated by authorities to cremate bodies of coronavirus victims from downtown Wuhan hospitals.
Wim Röst,
An interesting and reasoned transmission vectors vs mortality hypothesis, given the uncertainty of real infection and mortality data available. Thank You (!), for posting here. Having survived a persistent bout of intestinal ‘flu’ that transitioned into a severe pneumonia in February 2019, I have a visceral appreciation of these types of viral infections.
Thank you, J Mac. I hope you recovered completely and I can imagine that you follow the discussions with special interest.
Death toll since Januar 21
https://drive.google.com/file/d/11mtC3BqAS4qJUMhTfSrLrITCXnDnFbXO/view
Day by day source: French newspapers
Thanks. Good graphic.
Wim Röst
An interesting ‘detail’: the quadratic fit’s behavior since Feb 1
day | num | diff | x² | x
.1 | 259 | 46 | 2.11 | -4.82
.2 | 304 | 45 | 2.12 | -4.84
.3 | 362 | 58 | 2.17 | -5.45
.4 | 427 | 65 | 2.25 | -6.43
.5 | 492 | 65 | 2.29 | -7.04
.6 | 565 | 73 | 2.34 | -7.67
.7 | 636 | 71 | 2.34 | -7.80
.8 | 724 | 88 | 2.38 | -8.41
.9 | 813 | 89 | 2.42 | -8.99
10 | 910 | 97 | 2.46 | -9.66
The death toll’s quadratic coefficient is growing.
No wonder!
You will like the graphics and lots of other information on https://www.worldometers.info/coronavirus/
(link provided by Andy Pattullo)
Thx, very interesting stuff.
We feel very affected by the terrible fate that affects all these people – yes: especially those who are alive, if you can call it ‘living’ at all.
Rgds
J.-P. D. in Germany
My take:
Parasites never entirety eliminate their host
Virus’s gradually lose their ability to infect as they reproduce – unless there is a secondary mutation which is purely over to chance
To overcome resistance in hosts built in response to past infections they reinvent themselves on a regular basis after an outbreak. This is why there is no universal vaccine and infections occur on a ~ annual basis
Authorities hardly ever over-state casualties during an emergency
There are probably a number of viral infections circulating in China right now e.g. the common cold. Therefore health centres get flooded.
My predictions (% chance):
Real infection numbers in China at time of this post: 10 x that being reported
Global pandemic and fatalities of the scale of Spanish Flu: 3%
That China can contain the outbreak: 20%
That it spreads to Nth India and is not controlled there 80 %
That the outbreak has a significant impact on the world economy 80 %
That the outbreak causes a global recession 40 %
I could go on but this is enough
Some thoughts.
The medical services in China have at this point been overwhelmed, so if the figures are inaccurate, its more likely due to reporting protocols breaking down than malice. In any event the ‘Official Figures’ out of China have to be taken with a large dose of salt at this time ?
Viruses have, from my limited knowledge of the subject, a fondness for different parts of the body. This one likes to be settled in the lower respiratory tract, hence its potential to turn nasty. No doubt viruses that enter by the mouth (faecal manual) lose a number of their millions of friends down to the decidedly hostile bag of hydrochloric acid we call a stomach. But it remains the case that once in the mouth they have access to the mucosa and a trip down the trachea.
Still holding my breath, but a little over 2 weeks since the brown stuff went into the fan, there’s yet to be hundreds of cases popping up in western countries. So by the end of the coming week we should know if a bullet has been dodged ?
As others have pointed out, the apparent lack of cases in Latin America, and Africa, are probably cause for concern that the nCOV virus could get a start in areas where the medical system is poor to non existent. If it does, no doubt the virus will back for a potential sequel in the West next winter. :O
Good essay! Note that corona 2019-nCov is a RNA virus. RNA viruses mutate at a relatively high rate compared to DNA viruses. The more human 2019-nCov pass through they higher the probability of it changing to a less infectious disease or a more infectiuous disease.
Influenza viruses are RNA viruses with a very high mutation rate. The 1917 Spanish Flu started as a rather mild flu, believed to have started in US training camps. By the time it got to Europe and then back it mutated into the most deadly flu virus in recorded history.
It is my understanding that communal eating is the standard in the culture. Everyone eating out of the same bowls with their own chop sticks. Remember this took off during Chinese New Year where it is expected that one visits their parents with many familial banquets. https://www.chinahighlights.com/travelguide/chinese-food/eating-and-drinking-in-china.htm
I think this is BINGO:
There is another indication that cases in the Rest of China are less severe than in Hubei. Both Hubei and the Rest of China have more or less the same number of recovery’s*:
Hubei 1480
Rest of China 1444
It has been argued that Hubei has more deadly cases because the epidemics started earlier in Hubei. But if the severity of cases would be equal everywhere, recovery’s in Hubei also should be higher than in the rest of China: more people should have been dismissed from the hospital: because they became earlier sick and because there are more cases of sickness in Hubei, nearly three times as much. But the number of dismissed patients is NOT higher in Hubei.
Assuming that deadly cases and recovery’s follow the same time path the ratio in deadly cases Hubei/Rest of China indicates the number of recovery’s to expect for the Rest of China.
The ratio of deadly cases of Hubei vs. the Rest of China is 780 vs. 34: the number of deadly cases is 23 times as high as in the rest of China. So the number of recovery’s should have been 23 times as high as the number of recovery’s in the rest of China. But they are NOT.
Recovery’s in the Rest of China are nearly equal, indicating that the seriousness of infection in the Rest of China could be 23 times lower (!) than in Hubei.
Besides the above, some Hubei infected people travelled to the Rest of China possibly wearing the more deadly type of contamination (lung to lung) as happens in Hubei, raising the death toll in the Rest of China, which would even diminish the severity of the Rest of China contaminations.
* Source of the data 9th of February 2020: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
I assume that data is from Chinese authorities. If so, it means nothing.
It may be better than nothing, but not much better.
Ric I have seen all of your comments, also on earlier threads on this topic on WUWT. I also had a look at the latest thread on Joannenova (see the link of Roger Knights below).
And I had another look at the numbers, searching for the number of recovery’s in western countries. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
That number for recovery in western countries up to now is very low. Infections started later which could have delayed recovery. I suppose all officially recovered people in western countries have to be tested well which possibly was not the case in [Mainland] China.
I have not seen many recent messages about the further development of corona sickness cases in Western countries. Those developments could tell us more about the developments to expect.
If numbers of the WHO / China can not be trusted, the analysis given in this post is only valuable in case WHO / China divided all numbers by the same factor X.
If the WHO/China numbers are totally unreliable in the way that they don’t reflect the actual (geographical and medical) situation in China the conclusions drawn in this post were not based on correct data and probably could not be drawn. All judgement relies on trustworthy data.
I also reread the valuable information that Andy Pattullo has given in his comments. I can recommend everyone to read his comments carefully. He commented also here: Andy Pattullo January 25, 2020 at 6:57 am
China “broadens her definition of confirmed cases”. As a consequence the number of new cases for Hubei alone rose by 14,840 extra from 1638 extra the previous day.
The WHO added “this kind of tweaked definition is “normal,” according to CNN.
The number for extra deaths for Hubei in one day doubled from 97 the previous to 196 for today according to the data on John Hopkins’ https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
WR: I have got the bad feeling that many numbers about this epidemic will be revised / updated in the coming days.
CNN: “Yesterday Chinese officials broadened their definition of what constitutes a confirmed coronavirus case, to include “clinically diagnosed cases” — i.e. people diagnosed on the basis of their symptoms rather than testing positive.
This has led to a huge spike in the number of cases reported – 14,840 in just one day. But this kind of tweaked definition is “normal,” said the World Health Organization.”
https://edition.cnn.com/asia/live-news/coronavirus-outbreak-02-13-20-intl-hnk/index.html
WHO has chosen for a consequent reporting of only laboratory tested confirmed cases. Only in this way numbers of the past can be compared to recent numbers. In their daily reports they write for example: “Globally 49 053 laboratory-confirmed (2056 new)”
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200214-sitrep-25-covid-19.pdf?sfvrsn=61dda7d_2
Other daily reports (every report contains more valuable information): https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
Included just as a reference:
Total flu cases worldwide 2019/2020
380 000 000
In Hospital
4 000 000
Dead (complications releated to flu or ILI (Influenza like illness))
200 000
Which disease are you most likely to contract nCOV or Flu??
The PPE for flu also works for nCOV
https://www.cdc.gov/flu/weekly/index.htm
From some of the SerpentAZ video, R0 may be between 2.5 and 4.something, IIRC. The Case Fatality Ratio may be much higher than influenza. Let’s see if exponential growth keeps up for a couple months or if people can get the R0 below 1.
The fecal route is also how Michael Mann publishes.
Here’s the latest (2/10 in Australia) JoNova thread on the topic:
http://joannenova.com.au/2020/02/corona-virus-darkness-in-china-the-west-waits-while-reports-come-that-a-mild-illness-may-progress-badly/
Epidemic suppression APP ? – Perhaps someone is already working on this, and I know it is a globalist wet dream, however the development of a personal proximity app which can log time, date and duration of all personal interactions with other people (or their smartphone to be precise) with automated infection danger alert could be a hugely beneficial tool in epidemic suppression assuming people can (a) self report and (b) self quarantine
The comment below is an extensive one which also is published on the next thread on WUWT on this subject by Rud Istvan: https://wattsupwiththat.com/2020/02/10/wuhan-coronavirus-a-wuwt-scientific-commentary/
In this thread a reaction has been asked on the study https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1 “Clinical characteristics of 2019 novel coronavirus infection in China”. In this reaction is referred to this post which is the reason to repeat the comment below. It might be that interesting reactions follow on Rud Istvan’s thread.
First of all, I myself would be interested in the conclusions of Andy Pattullo on this study. He is an expert in this field and he knows better than a layman as me how to weigh all the medical info in the study.
Second: this is a very long comment that I will also copy to yesterday’s thread. It might contain important or at least interesting thoughts/conclusions.
Some elements I picked up from the study which is about 1099 hospitalized patients from 552 hospitals in 31 provinces through January 29th, 2020.
– “4 out of 62 stool specimens (6.5%) tested positive to 2019-nCoV, and another four patients in a separate cohort who tested positive to rectal swabs had the 2019-nCoV being detected in the gastrointestinal tract, saliva or urine”.
WR: Because this study is about hospitalized patients, the big unknown is how many people have been infected but did not show any symptoms or did only show very slight symptoms. Most of them will not have been hospitalized. But they probably played a role in the transmission of the virus.
The 6.5% of researched stool specimens of hospitalized persons that tested positive for the virus is an indication that the digestive system plays a role. The study: “Collectively, fomite transmission might have played a role in the rapid transmission of 2019-nCoV, and hence hygiene protection should take into account the transmission via gastrointestinal secretions.”
The important role of the gastrointestinal secretions in the transmission is clear. But there is no clarity about the role of gastrointestinal secretions resulting in natural resistance (the development of antibodies) in only slight or very slight infected persons. Which could be an important field of research.
– “Our findings were consistent with the national official statistics, reporting the mortality of 2.01% in China out of 28,018 cases as of February 6th, 2020 [11,23].”
– “The fatality rate was lower (0.88%) when incorporating additional pilot data from Guangdong province (N=603) where effective prevention has been undertaken (unpublished data).”
WR: Effective prevention could have played a role in the low death rate for the Rest of Mainland China compared with Hubei. The yesterday suggested low rate of lung to lung transmissions for those areas is another possibility https://wattsupwiththat.com/2020/02/08/the-corona-epidemic-a-dangerous-and-a-less-danerous-form/.
An indication for the possible importance of the lung to lung contaminations in creating severe cases can be found in a study that found out that “of more than 1,000 cluster cases, 83% were identified as family clusters.” Cluster cases generally refer to “more than two infected cases within a limited space”. (Source: https://edition.cnn.com/asia/live-news/coronavirus-outbreak-02-11-20-intl-hnk/index.html Most cluster cases are spread among families, China officials say. From journalist Alex Lin in Hong Kong)
The paper concludes:
“ – In summary, 2019-nCoV elicits a rapid spread of outbreak with human-to-human transmission, with a median incubation period of 3 days and a relatively low fatality rate.”
– Absence of fever and radiologic abnormality occurs in a substantial proportion of patients on initial presentation while diarrhea is uncommon.
– The disease severity is an independent predictor of poor outcome.
– Stringent and timely epidemiological measures are crucial to curb the rapid spread.”
WR: Elsewhere the study concluded: “These findings will inform the mass public, clinicians and policy makers the true transmissability of 2019-nCoV which has resulted in a major social panic.”
The high transmissibility is probably a main factor in the ‘major social panic’. The overwhelming growth of the number of patients in a short time and the lack of medical possibilities puts a high pressure on the whole society. Prevention in the spread of the epidemic plays the central role to control the what is called here ‘major social panic’.
Understanding the way of transmission in less severe cases (!) might play a main role in the development of the right policies to win the fight against this epidemic.
Possibly such a research could also lead to finding medical ways to stimulate healthy people to create antibodies without the medical risk of developing and later spreading the sickness. One of today’s commenters MarkW February 11, 2020 at 7:51 am told: “My dad was a doctor and of the 5 kids, none of us missed a single day of school due to illness. I always thought that this was because dad brought home micro-doses of whatever was going around on his clothes every day.”
If so, those micro doses if given to healthy people in a non-risky way (through the digestive system?) might lead to a way to fight effectively this epidemic. Specialists should research whether this could be an option.
One of today’s commenters, John Sheperd February 10, 2020 at 11:38 am guessed that in China only one out of ten Chineses people will go to a doctor in case of sickness. Doing research in this group that does not visit a doctor might help in finding out the real spread of the virus and might also help in finding the best way to end this epidemic.
CDC: We Absolutely Assume The Reported Cases in China Are An Underestimate.
https://www.youtube.com/watch?v=QEtvhMgauq80:57
As additional cases of the coronavirus epidemic are confirmed in the U.S., Dr. Anne Schuchat, Principal Deputy Director of the Centers for Disease Control and Prevention (CDC) provides an update on the CDC’s ongoing response on Tuesday, February 11.
Schuchat addresses the possibility that the epidemic could be highly underestimated
A doubling of the total number of deaths?
https://www.bbc.com/news/world-asia-china-51482994
BBC: What is the new diagnosis method?
The province – which accounts for more than 80% of overall Chinese infections – now includes “clinically diagnosed cases” in the number of confirmed cases.
This means it includes those showing symptoms, and having a CT scan showing an infected lung, rather than relying only on the standard nucleic acid tests.
Of the 242 new deaths in Wuhan, 135 are such “clinically diagnosed” cases.
That means, even without the new definition, the number of deaths in Hubei on Wednesday was 107 – a new high for the province.
WR: this indicates that the number of deaths for Hubei probably has to be doubled. At least.
“Of the 242 new deaths in Wuhan, 135 are such “clinically diagnosed” cases.”
INCORRECT NUMBER OF DEATHS REPORTED – CORRECTION
The in the last comment noticed doubling of the number of deaths for February 13 has been corrected. The new number now is “116 new deaths (including 8 clinically diagnosed)”.
“The National Health Commission of China, in its February 14 official report, deducted 108 previously reported deaths and 1,043 previously reported cases from the total in Hubei Province due to “repeated statistics.” We have updated the daily (Feb. 12 and Feb. 13) and cumulative totals accordingly.”
Source: https://www.worldometers.info/coronavirus/#feb-14
The complete numbers for Hubei according to the same source:
Report from Hubei province for February 13:
4,823 new cases (including 3,095 clinically diagnosed)
116 new deaths (including 8 clinically diagnosed).
51,986 cumulative total cases (including 15,384 clinically diagnosed)
36,719 currently hospitalized, of which:
– 27,081 (73.8%) in mild condition
– 7,953 (21.7%) serious
– 1,685 (4.6%) critical
690 new hospital discharges (including 214 clinically diagnosed)
166,818 close contacts have been tracked
77,685 people are undergoing medical observation
Moving this here:
You propose different routes if infection as the primary reason for different CFR. Fair enough. But that is just one of many possibilities to account for apparent discrepencies you note.
I can imagine for example that this population in Wuhan has perhaps had other Corona virus epidemics in the distant past and it is the sequential infection that leads to serious illness like happens wirh Dengue.
That would explain geographical differences as well as age differences.
A similar expalnation was made for the Spanish Flu