Guest Post by Willis Eschenbach
OK, here are my questions. We had a perfect petri-dish coronavirus disease (COVID-19) experiment with the cruise ship “Diamond Princess”. That’s the cruise ship that ended up in quarantine for a number of weeks after a number of people tested positive for the coronavirus. I got to wondering what the outcome of the experiment was.
So I dug around and found an analysis of the situation, with the catchy title of Estimating the infection and case fatality ratio for COVID-19 using age-adjusted data from the outbreak on the Diamond Princess cruise ship (PDF), so I could see what the outcomes were.
As you might imagine, before they knew it was a problem, the epidemic raged on the ship, with infected crew members cooking and cleaning for the guests, people all eating together, close living quarters, lots of social interaction, and a generally older population. Seems like a perfect situation for an overwhelming majority of the passengers to become infected.
And despite that, some 83% (82.7% – 83.9%) of the passengers never got the disease at all … why?
Let me start by looking at the age distribution of the Diamond Princess, along with the equivalent age distribution for the entire US.
Figure 1. Number of passengers by age group on the Diamond Princess (solid) and expected number of passengers given current US population percentages (hatched).
When as a young man I lived in a port town with cruise ships calling, we used to describe the passengers as “newlyweds and nearlydeads”. Hmmm … through some improbable series of misunderstandings and coincidences, I’m in the orange zone now … but I digress …
In any case, Figure 1 shows the preponderance of … mmm … I’ll call them “folks of a certain distinguished age” on the Diamond Princess. Folks you’d expect to be hit by diseases.
Next, here’s the breakdown of how many people didn’t get the virus, by age group:
Figure 2. Percentage of unaffected passengers on the Diamond Princess. “Whiskers” on the plot show the uncertainty of each percentage.
In addition to the low rate of disease incidence (83% didn’t get it), the curious part of Figure 2 for me is that there’s not a whole lot of difference between young and old passengers in terms of how many didn’t get coronavirus. For example, sixty to sixty-nine-year-old passengers stayed healthier than teenagers. And three-quarters of the oldest group, those over eighty, didn’t get the virus. Go figure. Buncha virus resistant old geezers, I guess …
Next, slightly less than half the passengers (48.6% ± 2.0%) who got the disease showed NO symptoms. If this disease is so dangerous, how come half the people who got it showed no symptoms at all? Here’s the breakdown by age:
Figure 3. Percentage of Diamond Princess passengers who had coronavirus but were symptom-free. There was only one illness among the youngest group, and they were symptom-free. As in Figure 2, the “whiskers” on each bar of the graph show the uncertainty.
Again, a curious distribution. Young and old were more likely to be symptom-free, while people in their 20s, 30s, and 40s were more likely to show symptoms. Who knew?
There were a total of 7 deaths among those on board. All of them were in people over seventy. So even though the generally young were more likely to show symptoms if they had it, it hits old people the hardest.
Finally, according to the study, the age-adjusted infection fatality rate was 1.2% (0.38%–2.7%). Note the wide uncertainty range, due to the small number of deaths.
For me, this is all good news. 83% of the people on the ship didn’t get it, despite perfect conditions for transmission. If you get it, you have about a 50/50 chance of showing no symptoms at all. And the fatality rate is lower than the earlier estimates of 2% or above.
It is particularly valuable to know that about half the cases are asymptomatic. It lets us adjust a mortality rate calculated from observations, since half of the cases are symptom-free and likely unobserved. It also gives a better idea of how many cases there are in a given population.
To close out, I took a look at the current state of play of total coronavirus deaths in a few selected countries. Figure 4 shows that result.
Figure 4. Deaths from coronavirus in four countries. Note that the scale is logarithmic, so an exponential growth rate plots as a straight line. Blue scale on right shows the deaths as a percentage of the total population.
At this point at least, it doesn’t appear that we are following the Italian trajectory. However … it’s still early days.
Finally, a plea for proportion. US coronavirus deaths are currently at 67, we’ll likely see ten times that number, 670 or so, might be a thousand or three … meanwhile, 3,100 people die in US traffic accidents … and that’s not 3,100 once in a decade, or 3,100 per year.
That’s 3,100 dead from auto accidents EACH AND EVERY MONTH … proportion …
My best to all on a day with both sun and rain here, what’s not to like?
w.
As Always: When you comment please quote the exact words you are referring to, so we can all understand who and what you are discussing.
Terminology: Yes, I know that the virus is now called 2019-nCoV, that it stands for 2019 novel CoronaVirus, and that the disease is called Covid-19, and that it stands for COronaVIrus Disease 2019 … so sue me. I write to be understood.
Data: For those interested in getting the data off the web using the computer language R, see the method I used here.
Other Data: A big hat tip to Stephen Mosher for alerting me to this site, where you can model epidemics to your heart’s content … Mosh splits his working time between Seoul and Beijing, he’s in the heart of the epidemic seeing it up close and personal, and he knows more about it than most.
Nice job Willis!!!
In perspective:
CDC estimates that so far this season there have been at least 36 million flu illnesses, 370,000 hospitalizations and 22,000 deaths from flu in the USA alone (10/2019 to present)
In the last 24 hrs approximately 60 people died from influenza related complications. In the next 24 hrs another 50-60 people will die from complications due to Influenza.
Total Corona virus deaths in the US 80 total.
Total Corona virus deaths world wide 7100.
2017/2018 US Flu deaths 86000
2009/2010 H1N1 cases 2 billion plus ( we estimate 1 in 3 people on planet earth were infected with H1N1) fortunately it was a very mild form of swine flu.
Source: CDC weekly flu report : https://www.cdc.gov/flu/weekly/index.htm
Johns Hopkins Corona virus Map : https://coronavirus.jhu.edu/map.html
Willis, the correction is appreciated.
The ratio of passengers to crew is approximately 1:0.7.
With this in mind, the total age group likely skews toward the younger side.
My only point is, it is difficult to establish any statistical inferences with so many unknowns.
In fact, your flawless statistical analysis my paint a false picture of COVID-19 disease spread and death rates.
In a perfect world, a demographically congruent group of people would all interact equally with each other in a confined space.
I didn’t see anyone mention the studies that show two different strains of the virus. Wouldn’t make more sense (taking into account Italy and Spain) that the cruise ship just had the less virulent strain of the virus? Hence less infected, and less serious cases. The cruise ship would be a perfect place for this to occur, only one patient bringing on the strain, whereas in a country like Italy, you have multiple vectors of infection… ??
Excellent analysis! (Excellent reporting, too.)
However, confounding factors:
1) As noted by several here, the population of a cruise ship is skewed from that of the general. The aged will not be the most vulnerable aged – they are people who have had good medical care, and do not live in heavily polluted environments. (The demographic of old + wealthy also has a much lower smoking rate than even the US population as a whole.)
2) The major cruise lines are, after previous very bad experiences, very close to OCD about cleaning. More than a nursing home – more than many hospitals, in fact. (A norovirus outbreak was the worst of those incidents – and is a far nastier thing to get loose. If I hear about a “novel norovirus” – that is when I will fill the shelves and freezer and lock the bunker door.)
3) Also as noted, the younger demographics are the more social with strangers – and also have a shorter social distance. (Us old grumps don’t want to be hugged except by very close relatives. Many of us not even then.)
Was this data taken after everyone cleared the period of incubation?
I get a strange feeling when people compare the absolute number of death by automobile accidents and the absolute number of deaths by COVID-19. That’s not how you determine that automobile accidents are worst than the flu by the absolute the number of deaths. They are not the same death rate!
Someone people even tried to compare the number of death from COVID-19 in the U.S. with the number of death of H1N1 back in 2009, but they failed to mention the number of cases involved.
From the CDC : https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
“From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million)… 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus.”
That’s:
12,469 deaths/60,800,000 cases = .02 % Death rate
Put that into perspective. And from Willis’s article above, “according to the study, the age-adjusted infection fatality rate was 1.2% (0.38%–2.7%)”. Now, if the U.S. gets 60,800,000 cases of COVID-19, God forbids, that’s a possible death count of ABOUT 729,600 at the 1.2% death rate.
Let us not forget that an infection can spread very quickly… exponential anyone?
Cheers,
Chuck
Exactly, it’s like comparing the normal aging of your home to either a spark of fire (but it’s just a little spark!) or some termites (but it’s just a few termites!). Some conditions are chronic and stable–sad facts of life. Others are a sign of something that you’d better get a handle on quick, before they overwhelm your resources.
I had the same curiosity and not 10 minutes ago shared this with some friends.
How about a random group sampling?
The Diamond Princess – a mini-city of 3700
Total cases 696
New cases 0
deaths 7
recovered 456
active 233
serious critical 15
Math-
696 out of 3700 = 18% got the virus
7 out of 696 = 1% of the infected died
More:
https://www.worldometers.info/coronavirus/
You can follow the tally globally and by country.
There have been 182,457 recorded cases.
Active 95,682 Closed 86.775
95,682 Active-Currently Infected Patients
89,519 (94%) in Mild Condition
6,163 (6%) Serious or Critical
86,775 Are closed cases
Cases which had an outcome:
79,617 (92%) Recovered / Discharged
7,158 (8%) Deaths
But missing is any estimate of total people infected as is done with the flu.
Most people infected with the corona never get tested, treated or counted.
They are out there and infectious, with or without symptoms just like people with the flu.
But millions have the flu in the USA alone.
If the cruise ship mortality rate (miraculously) ends up extrapolated to a global scale then we have been witnessing……. something odd?
7,158 deaths divided by 182,457 cases = 3.9%
The point is… the total number of infected is actually much much higher than 182,457. So, the percentage is wrong, and is much much lower than 3.9%.
No you are misled, mistaken and missing the point.
The number of global cases is not 182,457
It is far more and unknown. Likely in the millions world wide.
That 182,457 is only the number who were processed by medical facilities and there can be no mortality rate derived from it.
That’s why the captured populous on the cruise ship is meaningful.
My 21-year-old nieces went on a sold out spring break Caribbean cruise. They left out of Florida on the 8th and returned on the 15th. They had a great time and so far no reports of illness.
Incubation period: 5-15 days.
Hang on, over 700 died in Italy yesterday and you expect less than 4000 deaths in the US?
Italy also reports that 99% of the deaths were people with underlying health conditions and those over 80. Speculation is that this is happening because Italy has a tradition of multi-generational housing that the US does not.
Neil March 22, 2020 at 2:26 am
Neil, I have no idea who “you” is or where said prediction was made … please quote exactly what you’re referring to.
w
Thanks – a very interesting analysis, Willis.
I am hearing that the test (used in Australia at least) has a ~ 30% false positive (I think) error rate. If this had been the case for testing on this ship, can you tell us what the effect would have been on your results?
“Really, Mr. Eschenbach, don’t you think it is misleading to say they were kept together for one full month, when they were under quarratine for half of that month?”
So JTom, I guess you figure the regular crew members working under duress were able to effect the perfect “quarantine”. Really ? All these untrained crew members moving food, plates, forks, knives, cups, glasses etc. according to some ad hoc undefined protocol were doing just as well as trained medical staff. What they did on the ship, and it was probably the best these untrained workers could do, was probably for naught. Trained medical staff are having a hard time establishing effective quarantine. The crew never had a chance to be effective. Personally, I would view their whole time on the ship as “exposure”time
Willis, regarding your 83% non-infected rate/17% infection rate…perhaps an interesting “coincidence”:
Compare to the 2009 H1N1 swine flu pandemic. In the US (https://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm), the CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) from April 12, 2009 to April 10, 2010. The population of the US in 2009 was 306.8 million. 60.8/306.8 x 100% = 19.8% infection rate.
Coincidence?
Drcrinum
One of the survival advantages deriving from genetic diversity is that animals seem to have an inherent natural immunity of something like 10% of the population, even when they have never previously been exposed to a novel pathogen. That is one reason that, when given an antibiotic, one is strongly urged to complete the entire regimen. Some bacteria are more susceptible and are the first to die. One will then start to feel better. However, if the remaining bacteria are not continued to be hammered, they will come back and all will have resistance to the antibiotic.
Curiously, Clyde, some recent studies say taking all the antibiotics kills all of the pathogen except the most resistant … which is left with no competition and takes over immediately as the main form. And that advances resistance rather than discouraging it.
Funny how life works.
w.
My understanding is that a course of antibiotics is supposed to be designed to allow ample time for the immune system to mop up all of the population of the infectious organism.
By the time of the conclusion of a systemic infection, the number and amount of immune cells and antibody protein fragments in the system of the patient is immense.
As an example, at any given time, the population of immune cells in the blood and tissue of a healthy person is some three to 5 trillion cells, a total mass of ten pounds or more…and maybe twice that.
And the compliment system is a collection of chemicals that has a mass of several pounds all by itself.
By way of comparison, the brain is around 3 to 3.5 pounds.
But the response that is ultimately generated by a person with a strong immune system to rid a person of a systemic infection may consist of an ADDITIONAL temporary population of cells, cytokines, and various other immune system molecules, twice as large or more, as the normal population, which itself may have 98% of the total mass within tissues rather than circulating in the blood or lymphatic system.
A normal white cell count for a healthy adult is between 4,000 and 10,000 cells per milliliter.
When an infection is present, a typical value for the WBC count might be 25,000 to 50,000.
And these cells are being produced in prodigious quantity on an ongoing basis at such times.
With the exception of pathogens that have found some way to hide within cells in a dormant form, there is generally zero pathogenic bacteria just hanging around in the blood stream or within tissues. In order to overcome or be in temporary equilibrium with the innate and adaptive immune systems, vast numbers of any pathogenic organism must be present.
Memory cells ensure that there are no stragglers infecting us at the conclusion of an illness.
@Willis – actually, referring back to your earlier excellent post, antibiotic response also follows a Gompertz curve. Take a ten day course – the first couple of days, not much response; days three through eight, most of the critters die; the last two gets enough of the rest that the healthy immune systems cleans them out. (One reason that an MD should evaluate the immune system of each patient before prescribing – a compromised system requires a longer course.)
Willis
Certainly it is possible that a normal regimen of antibiotics will not kill all of the pathogens, and the patient doesn’t fully recover. That is why in particularly problematic infections the physician may follow up with treatment with a different antibiotic. It is a fine line to walk between not giving enough and giving too much.
Inasmuch as toxins are rated with an LD50, the amount of toxin in, say, milligrams per kilogram of body weight that will kill 50% of the subjects, I’ve often wondered why a 100 lb woman will be given the same antibiotic dosage as a 200 lb man. It would seem to me that 1) the woman is given too much, or 2) the man is given too little, or 3) neither gets the optimum dose. I’ve never gotten a satisfactory answer when I’ve asked a physician.
As an aside, I’m going to guess that the susceptibility of people to a pathogen looks something like a normal curve. That is, some on the tail will be extremely susceptible, those on the other tail will be extremely resistant, while most people will fall somewhere in between. That can probably be expected to be the behavior of pathogens exposed to antibiotics as well.
Doses for dogs are typically weight dependent. Likewise, a major reason for reduced dose recommendations for children.
It is also strange that they do not advise everyone to start every course of antibiotics with a double dose, to get the blood level up into the therapeutic range as quickly as possible.
It takes more to perfuse a person than it does to keep blood levels above the therapeutic range once the system is perfused.
Everyone should do their own homework on things like the proper course of time and the best antibiotic to use, unless you think your doctor knows everything and is never wrong.
Was just teaching this in class last week Willis. Basically you need to hammer them initially and keep going for the full course.
You might find this movie I showed interesting.
The “experiment” does not include description of treatments, if any, that were applied.
Late breaking info indicates that a common anti-malarial drug, chloroquine, has potential to prevent and cure 2019-nCoV. See for one example:
https://www.nature.com/articles/s41422-020-0282-0
I doubt the Princess passengers were treated with any anti-virals but cannot say for sure. If they weren’t, and if chloroquine is effective, then predictions of future outcomes from this disease (based on Princess outcomes) may be overly pessimistic.
Thanks, Mike. The article says:
Both of those are great news. Me, I’ve taken a lot of chloroquine in my life … I’ve had malaria four times, and I’ve blocked malaria from developing when it started coming on another four or five times by taking three chlorquine “daily doses” each day for three days.
So if I get the virus, I know what I’m gonna try …
w.
Willis. Chloroquine is a zinc ionophore. Helps the zinc get through the cell wall. Chloroquine is also used in some cancer therapy.
It’s the zinc that does the job inside the cell.
I see claims that zinc + chloroquine is being used in South Korea. Steve Mosher, do you have any info on this?
w.
They most certainly were treated with remdesivir.
At least 14 of the sickest of the Americans taken off that ship got remdesivir.
Hundreds more who have been hard hit by the disease in Washington state alone have got the drug.
All of these were given the drug on a compassionate use basis, IOW not as part of a clinical trial.
All 14 recovered.
I have been giving a heads up on this for over a month, and it is still possible to take advantage of a possible pop in the price of the stock.
The Street seems to hate Gilead, even as it may have the drug that at the present time is the single best hope of putting this episode behind us.
We do not need to get rid of the virus to change the trajectory of the economy, only to find out that there is a drug that will prevent death in most cases of severe illness.
https://www.wsj.com/articles/experimental-drug-helps-some-americans-ride-out-coronavirus-nih-doctor-says-11584094955?mod=business_lead_pos2
I wonder what the long term tolerance would be to taking remdesivir as a seasonal preventative, especially for the elderly. Mechanistically, its mode of prevention and cure seems sound.
Never happen.
As a matter of fact 15 critically ill US passengers were used by Gilead as a first test group for remdesivir treatment. This is likely to have affected total mortality, since they all survived.
2 strains of the “Wuhan” corona-virus are known to be existing side by side. One is more agressive than the other (as discussed in prior WUWT post invoking this virus) & at least one case had simultaneous infection with both known strains.
Which means, to me, that extrapolating from the Original Post cruise ship data to global “Wuhan” corona-virus data has some limitations. If the cruise ship had relatively acceptable consequences & cruise ship exposure involved the less agressive viral strain that doesn’t mean we can deduce similar consequences in situations involving the more agressive viral strain.
Strange numbers out of Germany.
An “interesting” article about the situation inside the Diamond Princess.
https://www.businessinsider.com/seasoned-expert-visit-diamond-princess-ship-scared-terrible-hygiene-2020-2
Thanks, Astrocyte, fascinating. It reinforces my assumption that there was continuing infection despite the ship being quarantined.
w.
It’s good news that controls were inadequate but outcome was not catastrophic.
“Again, a curious distribution. Young and old were more likely to be symptom-free, while people in their 20s, 30s, and 40s were more likely to show symptoms. Who knew?
I did. An age-related decline in the naive T cell compartment fully explains this. Both the lack of symptoms in the young (a robust Type 1 viral response with fever is more common after puberty), and in the elderly where declining age-related proliferative responses in T cells in the host delays viral responses or simply allows the virus to replicate without response (chronic infection, very bad).
See this graphic from my PhD dissertation at UMass Medical School.
https://drive.google.com/file/d/11Xx1V8-pP6nNIwddpuzZagmuSKP57hcI/view?usp=sharing
Proliferation of T-cells is necessary to allow them to multiply to the numbers needed and to differentiate into various forms that both directly attack and kill virus infected cells and to provide vital “Help” to other cellular functions like B-cells to proliferate and become plasma cells that secrete immunoglobulin (antibodies) to neutralize free viral particles in the circulation and in tissues. As we age our telomeres (the ends of our 43 chromosomes in every cell = 96 telomere “ends”) shorten due to steady proliferative erosion, essentially a biological clock on cell division limits. This cell division limit is called the Hayflick Limit.
From this resource:
https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1570&context=gsbs_diss
If you don’t know, T-cell responses are necessary (essential) for defeating a viral infection. Depending on the virus and the route of infection, the B-cel cell humoral (antibody) response may or may not be essential. In respiratory viral infections they usually are to prevent recrudescence. Both B-cells and T-cells must undergo selection for virus specific patterns and then those selected T and B cells must vigorously proliferate to then go fight the virus throught the body, both with antibodies, and with T cells killing infected cells before they can release their virus.
Excellent! Thank you for this.
Joel, thanks as always for your interesting and informative replies.
w.
Also thank you for the link to the full paper. Currently collecting various papers etc. for a blog post – and it’s not easy finding ones that I’m sure aren’t overly biased.
Joel O’Bryan
March 16, 2020 at 9:12 pm
“Both B-cells and T-cells must undergo selection for virus specific patterns and then those selected T and B cells must vigorously proliferate to then go fight the virus throught the body, both with antibodies, and with T cells killing infected cells before they can release their virus.”
————————–
So the efficiency of response depends on “selection for virus specific patterns”,
Which very much tied to the virus and the antibodies fusion on the blood stream.
In the very first stage of a viral infection (respiratory organ),
the chances of such effective response been in time triggered, are very little, as there very little viral penetration of the blood for not saying none, definitely no antibodies (the proper one), so;
The response will be by default, good but not properly efficient,
due to the fact that the “selection for virus specific patterns” will be based on the default, the default immunity setting response, good, the best under this circumstance, but still not the proper one
required… as it will not match for the proper response required.
But as the infection of a population increases, the heard immunity will quickly stabilize and rely in the proper response, as chances of the viral and antibody fusion in the blood will increase considerably,
and subject the immune system to respond by relying in the proper parameters for “”selection for virus specific patterns”, and therefor be far more efficient… and in same time flashing out the “pollution”
from the less efficient response of the first stage.
A heard insulation or isolation, definitely not helping much in such a case, only extending the time of the first stage response, which may be a good response, but not as efficient as the proper one…
Thanks Joel.
Please do not mind of letting me know if you see that my understanding as expressed being wrong.
cheers
Willis,
You said, “Buncha virus resistant old geezers, I guess … ” That is probably more prophetic than you realize. It has been said that “Age is only a number.” The older people who were on the cruise are probably more ambulatory than is typical of their age group, probably more affluent, and therefore has probably had better medical care than average. Inasmuch as comorbidity has been strongly correlated with deaths, we may be able to assume that, on average, those taking the cruise do not have the same level of comorbidities as smoking laborers from Wuhan or northern Italy. A cruise ship doesn’t select as strongly for physical fitness as a skiing holiday, but even a ship, what with stairs and outdoor recreational activities, probably eliminates the least healthy in their age groups. So, it wasn’t a perfect ‘test tube’ for what will happen to the land-locked “geezers” in the US, but it probably provides some insight on who the real high-risk people are.
In any event, I am a little perplexed by the reaction of the Media and political leaders to what is still a relatively small number of deaths in the US. We know very well that the vaccines that target specific strains of flu virus, sometimes completely miss the mark. Apparently, this year, with 20,000+ seasonal flu deaths, is one of them. Yet, in all the decades that we have been hit-or-miss vaccinating, we have never had the panic reaction to an ineffective vaccine that was little better than no vaccine. The Media and the public has just accepted what seemed to be inevitable, tens of thousands of deaths.
There have been objections to the UK response claiming that “herd immunity” will only last a few months, at best. Yet, again comparing to seasonal flues, we know that the flu viruses mutate and that is one reason we have to get vaccinations annually. If “herd immunity” is established, even temporarily, that probably gives the world a year to develop a COVID-19 vaccine. There is a lot regarding this pandemic that just doesn’t seem to add up.
“In any event, I am a little perplexed by the reaction of the Media and political leaders to what is still a relatively small number of deaths in the US.”
ITS NOT ABOUT THE DEATHS
Indeed. The danger is not the viral infection itself but the risk of not having enough capacity in the health care system to provide what would be normal treatment.
Now the main danger to society is the absolutely insane over reaction by politicians which seems likely to trigger another financial crisis which will do far more harm than good.
Now I have to go. France goes into housebound curfew in a few hours , I want to take a last breathe of freedom before the end of the world.
Steven Mosher
March 16, 2020 at 9:51 pm
Yes Steven,
“ITS NOT ABOUT THE DEATHS”
it is about “The projected death blossom” by the gutless and the unworthiness”
It is a very very low profile viral infection, far lower than any common cold flu.
Very very soft and even benign.
In this example that Willis brings here it is very clear.
Actually the rate of infected in that “experiment” is far higher.
Tests do not pick it up due to the fact that such tests do not detect or can not detect outside the incubation period proposition.
Infected ones with the virus in the state of dormancy or hibernation do not test positive.
That how soft and undetected such a viral infection this one is.
The tests used and applied, seems to be on detecting directly the virus… which will be ok with the cases that have just completed the incubation period.
Low capability of detection for general population, due to low window, due to this virus infection being too soft…
As far as I know, the test thus far happens not to be an anticorps test.
When a viral infection gets within a “herd”, it actually means that it consist also as an anticorp “infection” too,
and in such as a kind of viral infection as this one, the anticorps “infection” very much will overrun the virus… as there will not be hibernation or dormancy in case of the anticorps “infection”.
In this case, as put here, Steve, the only thing we may claim as success by this preventing draconian measures imposed globally,
is simply a very little delay in the consideration of the elderly getting the anticorps before the virus…
Steve, there is a full blown anticorps “infection” in the “heard” going on,
and this draconian crazy measures only slowing that one down, when in the same time no much impact at all on the virus… as the virus infection has a very much slower path…
When I said the first time, that this viral infection looks like an implemented natural “vaccination”
I was not joking or being irresponsible.
cheers
You English is not sufficient to make your comments decipherable, unfortunately.
Nicholas McGinley
March 17, 2020 at 4:11 am
Nicholas,
you may be right, but the chances of you being right are less than chances of me been right, when telling you that the problem there or here, happens to be your lack of knowledge in this matter… more than my English not good enough in this case.
So take a breath and let others here like Steven or Willis to respond… if they like to.
Besides,
was not a comment addressed at you, therefor you should have stayed away if the only thing you have to say it happens to be a complaint about my language.
See, easy, you will very much easily understand this reply to you, in consideration of my English,
because you have good enough knowledge in such issues as gossiping or social moaning…
comprende amigos!
Please do not start moaning about my Spanish too now, will you!
cheers
What the SNIP are you babbling about?
Incubation period does NOT mean dormancy or hibernation.
Greg
March 17, 2020 at 10:24 am
Greg,
Thank you for your interest and effort.
But how do you think that dormancy and hibernation has nothing to do with incubation period or not meaning anything there,
when and where actually the length of incubation period tied also very much so to such as.
Any understanding at all of the seasonal period setting of the seasonal flu.
Wait for it, dormancy and hibernation…. oh well that happens to be the clause of softness of a viral infection, the length of dormancy and hibernation in consideration of incubation period… stalled or extended, by the merit of the viral infection been too soft…
The dormancy and hibernation synchronizing of a viral infection, like in the cold flu influenza, with seasons, consist as the softness of such viral infections.
If you ever believed that such seasonal infections went way temporarily because the virus went way, you wrong mate…
The virus still there, dormant or hibernating, till the condition right or ripe to flash out again… very much in proposition of incubation period essentially.
Hope this further supports a further explanation.
Please keep asking, if feel like… 🙂
cheers
Mosher
If it isn’t about the deaths, then what is it about? Virtue signaling? With 20,000+ seasonal flu deaths in the US up to this time, versus 60 COVID-19 deaths, it is obvious that the seasonal flu patients are requiring almost 3 orders of magnitude more bed space and resources than COVID-19. Will the COVID-19 pandemic ever match the seasonal flu? I doubt it unless there is something about its behavior that we don’t know.
I’m not Mosh, but I can tell you what it’s about. It’s about not overwhelming your health care system with too many seriously ill patients … that leads to bad outcomes for everyone, including increased deaths.
w.
Willis
https://www.msn.com/en-us/news/us/some-ask-a-taboo-question-is-america-overreacting-to-coronavirus/ar-BB11gh4K
If we were quickly approaching filling half of the available ICU beds, then I would say that it was time to put the breaks on the transmission. However, we don’t seem to be near there.
A question I have asked before, and haven’t received a good answer for, is “Why in years past when the flu vaccine has missed the target strain(s), we haven’t panicked and instituted lock downs? Why is there no public discussion of the 40,000 US deaths from seasonal flu [as claimed in the link above] as compared to the ~70 COVID-19 deaths?”
I recently saw a graph of the daily infection rates of the so-called Spanish influenza for New York and London. The rise/peak/and decline took place within less than 2 months without the kind of extraordinary disruption of business, education, and social activities that have currently been implemented. The intent is to “flatten the curve.” However, what happened in Wuhan doesn’t look fundamentally different from what happened 100 years ago, without the unprecedented restrictions.
The deaths are bad, the potential deaths are worse, but look what is happening with the economy already and we are still in the going-up phase.
https://unherd.com/2020/03/the-scientific-case-against-herd-immunity/
“Why the Government changed tack on Covid-19”
(The UK govt)
Very clearly written, you should read it. Some quotes:
* “the case fatality rate of COVID-19 is over a hundred and fifty times higher than influenza fatalities in a typical year”
* “Another is that the influenza virus mutates rapidly, […] In comparison, COVID-19 and coronaviruses in general mutate relatively slowly”
* “Another difference is that the influenza virus exhibits clear evidence of seasonality, while evidence shows only a weak relationship for coronaviruses.”
* weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in case counts
* “Finally, there is a lack of evidence that lasting herd immunity to COVID-19 was possible in humans when acquired by infection, and that recovered cases would be prevented from reinfection.”
Thanks, yet again Willis, for another very informative article, this time on the Diamond Princess and the Covid-19 Panic.
“For me, this is all good news. 83% of the people on the ship didn’t get it, despite perfect conditions for transmission. If you get it, you have about a 50/50 chance of showing no symptoms at all. ”
what makes you think its perfect for transmission? folks spend a long time isolated in their rooms.
There are also interesting cases. Like the dude on the bus in china who infected folks at a distance?
Also the call center in Korea.
Not to nit pick but the ship is not exactly a good experiment.
any ways nice work
Next.
I hope people See that sometimes science cannot do controlled experiments. AND STILL
we have some understanding, some knowledge, some things we can rule out.
Steven Mosher March 16, 2020 at 9:30 pm
Thanks, Steve. Someone above posted as follows:
Seems pretty perfect for transmission to me, particularly with the crew cooking meals and cleaning rooms … not to mention that the Diamond Princess has 12 bars and clubs, a theater with live entertainment, various venues that “host events like karaoke, trivia, Japanese storytelling, retro quiz contests and theme dances”, a swimming pool, activities like carpet bowls, beanbag toss, Ping-Pong, egg drop challenge, bingo, golf chipping, basketball free-throw, ukulele, hula, ballroom dance and Bollywood dance lessons, a demonstration by the executive chef, art auctions, spa seminars and shop staff lectures, movies and concerts, and various unhosted get-togethers (LGBT, bible study, veterans and military).
Not to mention a casino, dances, a library, a spa, a Japanese bath, five dining rooms, a buffet, an internet cafe, shops featuring logo apparel, toiletries, jewelry (costume and gemstone), watches, liquor and perfumes.
And you think this is not perfect for transmission? Not sure why. Information from here.
See also this article by a Japanese expert who went on board during the period when it was quarantined … he said the hygiene was terrible and quarantine procedures non-existent.
Best regards, stay healthy, my friend,
w.
Still not seeing any evidence that it is perfect for transmission.
good?
better than most?
based on the experience in Korea the church service appears to have been better.
lets put it this way. 1 lady goes into church and 1000 people get sick
dude goes into work and 50% of the people get sick.
The right question might be what was different about the ship?
The right question might be why is the Diamond princess an exception?.
Thanks, amigo. My very first question above was, why only 17% getting the virus? So I’ve asked the right question.
Next, I can’t find anyone (but you) saying “1 lady goes into church and 1000 people get sick”. I find this:
and this
and this
So near as I can tell, the one woman, “Patient 31”, didn’t GIVE coronavirus to the people in the church—she GOT coronavirus from the people in the church.
Finally, I’m not seeing why a church, where you are for a few hours, would be a better place to spread coronavirus than say the theatre or the bars or the restaurants or the chapel or the whole ship of the Diamond Princess, where they were for a month.
Regards,
w.
PS—I asked somewhere in the thread, I’ve read that in Korea they’re using zinc + chloroquine as a treatment … true?
I think because how close they sit in that particular church, plus apparently being sick is not a valid excuse for nonattendance!
https://www.cnn.com/2020/02/26/asia/shincheonji-south-korea-hnk-intl/index.html
From what I’ve read the zinc+ chloroquine treatment sounds very promising, I’m taking zinc supplement (I’ve found Zicam to be effective with colds). I hope that the US will check this out and if it looks effective adopt it and not the ‘not invented here’ approach that they did with the test (and messed up).
Someone brought it up at the Presidential news conference today so maybe it will get followed up?
https://www.cdc.gov/mmwr/volumes/69/wr/mm6911e2.htm?s_cid=mm6911e2_w
There is another problem with infering R0
from the diamond princess.
R0 estimates can be dominated by superspreaders.
no superspreader ( person with a LARGE viral load)
low r0
Same with SARS and MERS
Thanks, Steve. You keep talking like there are regular spreaders and one single solitary superspreader. That is NOT what your paper said. Look again at the distribution above. According to your link, there is a range of R0 among the individuals, and the range is continuous from zero-spreaders to people with a very high R0.
As a result, according to their numbers in the run I showed above, there would be no less than 48 people who infected more than five people (R0>5), and 21 who infected more than 8 people (R0>8). So the idea that there are no “superspreaders” in a group of that size comes up hard against the claim by the authors of your link that it is a distribution from people that don’t infect anyone at one end to people that infect a whole bunch at the other end of the distribution.
Nor does this change a whole lot in different runs. In the run of the calculations I showed above, there were 48 people with an R0>5. Running the calculations 100 times give us a mean of 43 people with an R0>5, with a maximum of 56 and a minimum of 26.
This is also true for even more infectious people. In this run there were 21 people with an R0>8. Running the calculations 100 times give us a mean of 18 people with an R0>8, with a maximum of 25 and a minimum of 10.
So it is mathematically very, very unlikely that there would be no people with a very high R0 in the group.
Regards, and stay well, my friend,
w.
Steven Mosher
March 16, 2020 at 9:30 pm
Next.
I hope people See that sometimes science cannot do controlled experiments. AND STILL
we have some understanding, some knowledge, some things we can rule out.
————–
Yes Steven,
and this “experiment”, no matter how some will start to water it down,
it shows clearly that there were no any such scary spikes, that required draconian measures to considerably force it down to a degree, so there will be no overwhelming….
The whole thing happened to be too flat, Steven… by it’s own merit… no scary spikes there whatsoever.
Even with no any extra support, the outcome would have being the same, pretty much,
with no any overwhelming of the medical service of the ship.
This experiment, good enough at that point, on ruling out the bases of this global mad panic:
“The overwhelming of the hospitals”… WOW.
cheers
Thank you Willis, excellent analysis and very prescient. So much hysterical conjecture at this point it’s a relief to have an objective examination of the Diamond Princess experience.
Unusual, there isn’t a distribution by sex.
Let us not forget the 500,000 deaths in the US alone, per year, from smoking cigarettes…
Automobile deaths also illustrate an important point. How many more do you think
there would be if there were no restrictions on speed, safety, drink driving, training, road quality etc? Society has learnt how to reduce automobile deaths to a manageable number by enforcing a large number of restrictions (speed limits, traffic lights, road rules, etc) all of which we expect people to learn and be tested on before they get behind a wheel. Car manufacturers are also required to install safety devices like seat belts, brakes etc and test their cars for safety in collisions. Which took decades and significant government intervention before deaths got as low as they currently are.
Now apply the same lesson to COVID-19. Dramatic government intervention now is likely to save a significant number of lives (leading people to ask what all the panic was about). Do nothing and there will be mass casualties, if only because hospitals do not have enough spare capacity to cope with all the additional people requiring treatment.
Dear Willis
May you please do another data presentation against time.
Number of Microbial swabs taken for viral/bacterial infection.
Number of swabs investigated for virus.
Number of swabs investigated for Covid19.
Number of test kits available for Covid19.
Number of testing facilities available.
Number of news items referencing Covid19.
Number of positives for Covid19.
Number of positives for other pathogenic virus or bacteria.
Number of pneumonic deaths.
Could be an interesting graphic
So far no one has responded to my queries as to how the artifacts of tests, publicity and ayailability are accounted for in the outbreak statistics.
Sorry, John, but as far as I know, nobody has that data. At best, we MIGHT find out number of tests, but even that I haven’t seen.
w.
Dear Willis
I have followed your work and know you understand the questions I asked as they are the ones you usually nail first.
Stephen McIntyre’s ‘Starbuck Hypothesis’ comes to mind here. If I was advising the President or the WHO, the first thing I would want to know is the how, where, what, why of the data. Until that is known we are flying by the seat of our pants.
As for cruise ships, I understood many finish their cruise in a freezer as they often choose a ocean voyage as their final farewell.
Thanks for your reply.
I don’t understand the ‘age-adjusted’ fatality rate.
There were 696 infections and 7 deaths. All the deaths were older than 70 years.
But the 70+ year cohort was overrepresented by a factor of three compared to the general population. If the Diamond Princess had had a typical distribution, there would have been 400 70+ people, not 1200. This would adjust the number of deaths downward to 2 or 3. The infection rate would be unaffected because all ages were more or less equally likely to catch the virus.
So we would have 2-3 deaths from 696 infections, a rate about 0.3%, which is not much above the common flu.