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.
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This drug Remdesivir was trialled in the treatment of those who fell ill on this particular ship
https://unredacted.co.uk/2020/03/15/experimental-antiviral-drug-saved-a-coronavirus-patient-in-critical-condition/
Excellent article in Science about how the Koreans have managed the epidemic … testing, contact tracing, isolation of those testing positive. My friend Steve Mosher, who for unknown reasons y’all love to hate, who is living in Seoul says they even have text alerts for new cases in your area.
Worth emulating.
w.
“If you get it, you have about a 50/50 chance of showing no symptoms at all.” WE
From the paper “(asymptomatic cases were either self-assessed or tested positive before symptom onset)”.
If I am reading this correctly they are using asymptomatic where perhaps they may mean pre-symptomatic, and given the long latency this seems reasonable.
Fixed Wireless Communications at 60GHz Unique Oxygen Absorption Properties.
“At 60GHz, the extremely high atmospheric absorption level is due primarily to the molecular composition of the atmosphere. Figure 3 illustrates the atmospheric attenuation characteristics for wavelengths from 3 cm to 0.3 mm. For millimeter waves, the primary absorption molecules are H2O, O2, CO2 and O3. Since the presence of O2 is fairly consistent at ground level, its effect on 60GHz radio propagation is easily modeled for margin budgeting purposes. In addition, the high level of attenuation from oxygen absorption makes even the worst weather-related attenuation insignificant, especially on the short paths where 60GHz systems operate. Even extremely heavy rainfall, 25mm/hr (5dB/KM), will make only a very small percentage contribution to aggregate attenuation in the 60GHz oxygen absorption region.”
https://www.rfglobalnet.com/doc/fixed-wireless-communications-at-60ghz-unique-0001
What happens to your body when your oxygen level is low?
“Hypoxemia occurs when levels of oxygen in the blood are lower than normal. If blood oxygen levels are too low, your body may not work properly. … Hypoxemia can cause mild problems such as headaches and shortness of breath. In severe cases, it can interfere with heart and brain function.”
https://my.clevelandclinic.org/health/diseases/17727-hypoxemia
Is 5G involved in the coronavirus outbreak?
“Since our original post on 31st January, ALL our predictions happened exactly as we said they would so we have updated the Article….”
https://australianhiphopdirectory.com/5g/
re: “Is 5G involved in the coronavirus outbreak?”
We went OVER this ground a few weeks back. The effect would be immaterial, non-measurable.
Of course, you’re well out-of-your-depth on this too.
BTW, NO ONE (including myself) could find ANY telecom wireless infrastructure equipment manufactured (yet) for 60 GHz (Q-band). There is some limited ‘demo’ class hardware available (WE discussed THIS too a few weeks back), but to discuss this with you any deeper, jmorpuss, would be both fruitless and futile.
Jim
And what’s your proclaim to fame ?? Please provide links … Without links all your doing is GASLIGHTING
https://wattsupwiththat.com/2020/03/14/the-11-gaslighting-characteristics-of-the-climate-debate/
re: “And what’s your proclaim to fame ??”
Succinctly?
“Time in type.” (If you have done any flying, you’ll know what that answer entails, means.)
BTW, the phrase is “claim to fame”, and its not fame (per se), its experience with the technology. It’s the ability to know what current state-of-the-art is, its having ‘worked’ nearly ALL aspects of wireless (from semiconductor fab to radio/cellular test bed, incl. new product development) for probably more years than you’ve drawn breath.
re: “Without links all your doing is GASLIGHTING”
Moron, find my previous comments, they include links.
BTW, it’s “you’re doing”, not ‘your doing’. Either “you know your s**t”, or “you know you’re s**t”; you want the former, you end up being the latter …
Jim
I think you are full of s**t, I’ve never seen you leave a link you silly old F**t, and remember life is like a mirror , What you put out you get back.
Willis, I shared your piece with friend snd he bounced back this link about Brit epidemic modeling:
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
You can forward this to Willis and have him give his take perhaps?
On Wed, Mar 18, 2020 at 3:58 PM James Brown wrote:
Good to see this data. Kind of debunks the young/old hypothesis. I take his point on proportion, but I would add that auto accidents are not exponentially increasing. If there was more certainty about how it’s spreading, then I think we could relax a bit more. But there’s not, and we’re not.
Assume I have bad luck and the post person delivers some mail to my home that is infected . Will heat kill the virus? If so what temp. and for how long, eg 120 degrees for 10 or more min. John
Just apply Fahrenheit 451 to the mail, total sterilization.
w.
Willis using the diamond princess is a bad idea.
This has to do with the characteristics of R0.
With these virus it appears that infectiousness is not ‘normally” distributed.
think super spreaders. some infected people (think diamond princess) will have R0 1000
https://icjournal.org/Synapse/Data/PDFData/0086IC/ic-48-147.pdf
So the ship is not the perfect natural experiment.
Thanks much for that, Steve. However, you haven’t run the analysis all the way through.
As your link points out, although the average R0 is some given number, in fact the distribution is highly skewed, with many people not passing on any infection, while some “superspreaders” infect many people.
Now, the Imperial College Group has estimated the R0 of coronavirus at 1.5 – 3.5, so I’ll use the midrange. I’ve used the average value of “k” for MERS, SARS, and Ebola, which is 0.12.
With these values, we get the following results for the number of people who infected 0,1,2, etc other people:
As a result, I’m not seeing why the distribution makes much difference. Yes, IF the coronavirus acts like those other viruses, for which we have no evidence but is certainly possible, some 408 people didn’t infect anyone. But on the other hand, nine people infected nine others, six infected ten others, five infected eleven each, and one infected 12 others.
And the average R0 is still whatever it was. Your paper is certainly important in terms of how to fight the virus. But in terms of the overall spread in a closed community, I’m just not seeing how it makes any difference.
I mean, suppose four infected people get on the ship. Each one infects two others. Net is eight people, and the average R0 is 2
Now, suppose three infect nobody, and the other is much more virulent, he infects eight people. And again, the average R0 is 2
Not seeing the difference. Eight people are infected with an average R0 of 2, regardless of the distribution.
Let me add that it assuredly makes a difference in how to FIGHT the virus. As the paper says:
Whis is very valuable information … but it doesn’t change the average R0 one bit. So I can’t see how it invalidates the Diamond Princess experiment.
Thanks again for a fascinating paper.
w.
“Whis is very valuable information … but it doesn’t change the average R0 one bit. So I can’t see how it invalidates the Diamond Princess experiment.”
No superspreader, your R0 will be lower
the reason you dont use the diamond princess to estimate a GLOBAL metric
is that there is no superspreader
SAME REASON why you dont use the patient 31 in Korea to estimate R0
https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.htmlv
Thanks, Steve. You keep talking like there are regular spreaders and A solitary superspreader. That is NOT what your paper said. Look again at the distribution above. There is a range, and the range is continuous from zero-spreaders to superspreaders.
As a result, according to their numbers, there would be no less than 77 (range 61-105) people who infected more than five people (R0>5), and 50 (range 39 – 77) who infected more than 8 people (R0>8). Heck, there are an average of 12 (range 3 – 22) who infected more than 20.
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.
w.
One more look. Again using the figures from you link, we would indeed expect there to be superspreaders. If we look at the max R0 from repeated runs, it has a mean of R0=51 ± 1, a standard deviation of 11, a max R0 of 97, and a minimum R0 of 27. So indeed, we’d absolutely expect to see superspreaders among the Diamond Princess passengers.
w.
One event that might suggest the existence of ‘super spreaders’ was the Biogen meeting in Boston:
“Seventy-seven of the 95 confirmed cases in Massachusetts have been linked to a meeting of executives with Biogen, a company based in Cambridge, next to Boston, that develops therapies for neurological diseases, state officials said.
An additional 12 people who have tested positive for the virus outside Massachusetts have been linked to the Feb. 26-27 meeting, including five in North Carolina, two in Indiana, and one each in New Jersey, Tennessee and Washington, D.C., officials said. Two tested positive in Europe, Biogen spokesman David Caouette said Wednesday.”
This was dated March 11 since then there have been further developments, two attendees at that meeting were at a family party in Princeton and several people at that party have tested positive. This includes four members of one family that have since died of the virus and one other is on life support. That one event seems to have been the source of a major cluster.
Willis, what happened today ? 16 new cases among passengers from the ship ? How long incubation will that be ?
We may still have a lot to learn !
There’s always more to learn … I fear we don’t have enough information about those 16 cases. Were they still in quarantine? How good was the quarantine? Were they interacting with the other passengers?
w.
Well, it’s not so much the death rate or % of possible contagion to other people (which is not that high with 2019-nCoV, about 2-4 people on average get it around the first infected) – it’s the fact that the virus doesn’t respond to any medication, so there is a high chance that the contagion *can* grow to be uncontrollable if left unchecked. Uncontrollable meaning that in a very short time span (possibly under three days) it can overwhelm the medical units and when that happens, the virus will start to put more pressure on the whole infrastructure in other places.
It spreads too covertly, the incubation period is way too long – if it was something like 2-4 days, it would be much easier to monitor and contain. But because it can be as long as two weeks, it can spread too much behind the scenes before first patient starts getting sick. There is also a very long recovery period for the patients who have had it, some staying bed ridden for a month or more.
This hits the infrastructure hard, as well as the whole economy as everything is connected.
There are drugs that are highly effective against this virus.
More detail
https://www.niid.go.jp/niid/en/2019-ncov-e/9407-covid-dp-fe-01.html
‘Based on the number of confirmed cases by onset date, there is clear evidence that substantial transmission of COVID-19 had been occurring prior to implementation of quarantine on the Diamond Princess on 5 February (see also febrile patient visits to the on-board clinic below). The decline in the number of confirmed cases, based on reported onset dates, implies that the quarantine intervention was effective in reducing transmission among passengers. Transmission toward the end of the quarantine period, which is scheduled to end for most passengers on 19 Feb, appears to have occurred mostly among crew or within passenger cabins. It should be noted that due to the nature of the ship, individual isolation of all those aboard was not possible. Sharing of cabins was necessary, and some crew had to continue to perform essential duties for the functioning of the vessel with passengers aboard.
Recent confirmations of asymptomatic cases can be explained by the systematic testing of passengers that began around 14 Feb. Although some of these cases may have been secondary cases within a given cabin, it is difficult to know when transmission occurred. They may have been infected before the quarantine began. Nevertheless, these asymptomatic cases have been disembarked and their cabinmates have been defined as close contacts with their 14-day isolation reset on the day the asymptomatic case was disembarked. The systematic testing of asymptomatic cases was useful in screening these persons before allowing them to disembark.”
Not a “perfect” experiment for determining R0
any more than a Church in Korea is
‘Buncha virus resistant old geezers, I guess …’
The fact that older people are less likely to either get infected or show symptoms from the virus is not surprising at all. In fact it is exactly what I would have expected. It only takes a cursory knowledge of immunology to figure out why this is the case. For non novel viruses, the disparity is even greater.
“Small Italian town of 3,300 people cuts coronavirus cases to zero after authorities forced the WHOLE population to have repeated tests”
https://www.dailymail.co.uk/health/article-8126899/Small-Italian-town-cuts-coronavirus-cases-zero-population-tested.html
“The 3,300 or so citizens of Vo’ Euganeo, just 30 miles (50km) from Venice, were all swabbed for COVID-19 in late February. Anyone who tested positive was immediately quarantined to stem the spread of the disease – even if they weren’t showing symptoms – local media reported.”
And the city isolated itself.
“Two weeks later, mass testing showed the infection rate had dropped by 12 times from three per cent of the population to just 0.25 per cent.”
“Half of those who carried the virus in Vo’ Euganeo had no symptoms, proving that people are capable of spreading the deadly virus without even knowing it. ”
That’s the background. Here is the relevant quote:
The article does not go into how they did the total lockdown, but it is clear that should be the next step. The country-border closures were too late (horse/barn door) to keep out the virus. Now that it is here, we need to isolate any green zones we can find, testing anyone coming in, and doing strict isolation on any positive vectors that are found. It’s like a war. All the other “war on X” was just talk. This one is real, including the devastation.
re: “Two weeks later, mass testing showed the infection rate had dropped by 12 times from three per cent of the population to just 0.25 per cent.”
Alternate interpretation: A ‘whole lot’ of false positives were recorded initially. (Or, later tests were inadequate for purpose.)
Somebody correct me, but if these tests are for antibodies in the blood (to Covid-19) THEN said anti-bodies would still be present in subsequent tests later when additional testing of the same subjects took place.
You raise good questions. What are the false-positive and the false-negative rates for the tests?
What different test kits are being used in different countries? Which test kits are better? Which methods give the quickest results?
https://en.wikipedia.org/wiki/COVID-19_testing
I don’t know what test they used in Italy. For the last 0.25%, “The town isolated these last few cases and has since reopened.”
Another Italian mayor said they couldn’t test “test everyone since it takes 8-9 hours to get a result.”
“Luca Zaia, the governor of the Veneto region told Italian media this week: “We tested everyone, even if the ‘experts’ told us this was a mistake: 3,000 tests. We found 66 positives, who we isolated for 14 days, and after that 6 of them were still positive.”
“The Veneto governor told newspaper Corriere della Sera that the region has the ability to carry out 20-25,000 swabs a day.”
re: “Corriere della Sera that the region has the ability to carry out 20-25,000 swabs a day.”
Yes … need more info; what is their “test protocol”? Is it the same as ours? The Chinese? How did they ‘ramp up’ so fast? Receiving test kits, analysis and technical support from the Chinese? More questions …
The RT-PCR test is for the genome of the virus not for the antibodies to it.
re: “The RT-PCR test is for the genome of the virus …”
This ‘testing’ is a murky area for me, and I’m sure I am not the only who does not know the specifics of the protocol and the ‘lab’ work involved.
OK the viral genome is a strand of RNA, think of it like a sequence of letters (made up of GCAU). Each virus has its own sequence with differences in certain region, if you find a unique sequence you can test for it. This what RT-PCR does, it amplifies that unique region (if present) to give a sufficient sample to test for. The sample preparation and amplification process takes a few hours but the samples have to be sent to a qualified lab and the results transmitted. So early in the process when only the CDC could do the test the turnaround was about 4 days.
Just wondered if we can deduce the pathogenicity of this virus from Willis’s investigations!
It’s a small number, but highly relevant to the cocoon environment.
Anyone got the courage?
Not sure what you’re calling “pathogenicity” …
w.
“At this point at least, it doesn’t appear that we are following the Italian trajectory. However … it’s still early days.”
It’s all about demographics with Italy-
https://www.msn.com/en-au/news/world/why-have-so-many-coronavirus-patients-died-in-italy/ar-BB11qA65
You can’t beat this pandemic by printing money and all staying home. Stop believing Gummint can sole every problem all the time and common sense says you don’t sacrifice the productive majority on the altar of the aged and frail minority-
https://www.msn.com/en-au/news/world/i-dont-know-how-im-going-to-pay-rent-next-month/ar-BB11ocim
https://www.msn.com/en-au/entertainment/celebrity/this-is-so-far-beyond-absurd-today-extra-host-sylvia-jeffreys-slams-panic-shoppers-and-reveals-her-sister-had-to-mail-her-baby-panadol-from-brisbane/ar-BB11pnmO
https://www.msn.com/en-au/lifestyle/familyandrelationships/a-viral-video-of-a-mum-crying-over-sold-out-diapers-at-walmart-reveals-the-devastating-effects-of-bulk-shopping/ar-BB11pOaJ
You don’t produce and distribute stuff or earn incomes doing that then no amount of line credits dumped in your bank account is going to help anyone. That will simply beget massive stagflation as the adept and agile scoop up the available real goods and onsell their surplus at higher prices fighting with each other in supermarkets over the spoils. That’s Econ101 stoopids.
You might want to compare death rate for the virus at different age groups against the average chance of dying at that age also, because 99% of people who die have pre-existing conditions and the gender breakdown of deaths worldwide from the virus also seems to be remarkably similar to the average chance of dying by gender at that age group.
The odds of dying in any given year between the ages of 70-90 range from 2.3% at the low end (70) up to 16% at the high end (90) and you have 1200 people in that age range. So if we say 1000 people from 70-79 with a yearly 3.5% mortality rate and 200 people between 80-89 with a 10% yearly mortality rate.
35+20= 55 deaths per year, so 7 deaths would be the average number of deaths over a 6 week period anyway and people who die from flu related and respiratory illnesses tend to die more in the winter flu season anyway.
https://www.ssa.gov/oact/STATS/table4c6.html
Has anyone actually worked out how many of those people would have died anyway, because looking at it the numbers and gender ratio seem very similar.
Of course, the teenagers were partying through the night, and making out every chance they could get. Versus the seniors who retired to their rooms after the 5 PM dinner to cuddle up with a good book (enlarged print, of course).
Hello mr Eschenbach.
Firstly thankyou for all the informative posts of yours I have read over the last few months. Even your little spat with Zoe Phin brought much amusement.
With regard to the current crisis I have long believed in the benfits of vitamin D in the fight against the flue bug.
While doing a bit of research on the internet……..I know, it appears that Iran’s population is defficient in vitamin D and zinc and the Italian population is defficient in vitamin D and zinc, both these countries have comparitively high mortality rates.
My concern is if people isolate during the summer, they may come out of isolation with vitamin D defficiency due to lack of sunlight.
I am currently trying to run small business in the UK and all my time is being taken up with that, however I am about to visit my 82 year old dad with some home made meals and vitamin D and zinc suppliments.
I would appreciate your response to my comments and once again, thankyou for your posts.
Hello Mr Eschenbach.
Firstly thankyou for all the very informative posts of yours that I have read on this site over the last few months.
Regarding the current crisis, I have long believed in the benefits of vitamin D in fighting of the flue bug. A little bit of research on the internet reveals that there may be a vitamin D and zinc defficiency in the population of Iran and also a zinc defficiency in the elderly population of Italy, both have high mortality rates…….. I know, internet research.
My concern is if there is a correlation, the advice to self isolate indoors during the summer months could well mean many people not getting enough sunlight and coming out of isolation defficient in vitamin D.
I am currently trying to run a small business in the UK and all my effort is taken up with that, however I am just off to visit my 82 year old dad with some home made meals and Vit D and zinc tablets.
I would appeciate your thoughts on my comment above and once again, thankyou.
Hello mr Eschenbach.
Firstly thankyou for all the informative posts of yours I have read over the last few months. Even your little spat with Zoe Phin brought much amusement.
With regard to the current crisis I have long believed in the benfits of vitamin D in the fight against the flue bug.
While doing a bit of research on the internet……..I know. It appears that Iran’s population is defficient in vitamin D and zinc and the north Italian population is defficient in vitamin D and zinc, both these countries have comparitively high mortality rates.
My concern is if people isolate during the summer, they may come out of isolation with vitamin D defficiency due to lack of sunlight.
I am currently trying to run small business in the UK and all my time is being taken up with that, however I am about to visit my 82 year old dad with some home made meals and vitamin D and zinc suppliments.
I would appreciate your response to my comments and once again, thankyou
thank you for substantiate my assertion: http://asiawithout.us/corwel.html
corona is here to judge our characters, not so much resistance to virus infection. for whatever inconvenience it has cause us, it could very well have prepared us for surviving the ultimate knock-out punch — the killer virus.
please just allow all the countries to develop the minimum immunity for future more serious virus attack, and possibly also wake up to what we are doing to the climate, which would not be so kind as our good friend corona.
Just spitballing based on the chart at:
https://docs.google.com/document/d/12YDytbAsZaruGlhFO7eTTgxSH_BuxJtwFmbhqpkPPSk/mobilebasic
and some of the background data at ourworldindata.com…
and if someone else has made this point I apologize for not seeing it….
I can’t speak for this ship, but officers often come from southern or eastern Europe while deck and passenger service crews come from the Phillipines, South America, Indonesia, etc.
Just thinking that if you bash one data set into the other there might be a case to be made that many of the younger cases were among a crew cohort from places with greater malaria exposure and perhaps previously dosed preemptively with antimalaria drugs.
Looking at the malaria deaths by 1000s at risk it’s fascinating the variation between countries that you might think should be similar. Either the reporting is weird, or some governments and some programs are doing a far better job than others.
Hat tip to Steve Mosher, who tweeted a link to this most interesting and detailed analysis of the Diamond Princess.
w.
Maybe the immune system was overreacted cytokine storm Thats maybe the reason that people in age 20,30,40 get so sick .
There should also be some cruise ships with flu outbreaks that could be used for comparison. Flu cases are mostly estimated as well it is not known how many people actually get infected each year.
I think this post has also been mentioned on the Mark Levin radio show — heard while I was a distance from my computer.
Maybe the “missing” cases never cam about because another Rx prevented them? A high blood pressure med or statin? Likely that a significant part of the 50+ crown on the ship were taking similar daily meds for one of these conditions?