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Wuhan coronavirus in Scotland?


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The Guardian article says four are being treated in hospital, three in Edinburgh and one in Glasgow, after showing symptoms after arriving from Wuhan.

https://www.theguardian.com/science/2020/jan/23/increased-likelihood-coronavirus-uk-health-secretary-matt-hancock

I've been following developments on the Flutrackers site for a while, and it's clearly not just going to go away, like SARS. How bad it gets is anyone's guess, but a Chinese expert 'conservatively' guessed that it would be ten times worse than SARS. Most 'suspected' cases turn out to be something else, but the fact that there's a cluster of four is a bit worrying. You wouldn't expect a cluster of four people all to develop flu at the same time, would you?

The official figures coming out of China are just the tip of the iceberg. The testing procedures are lengthy, and the numbers involved are overwhelming. One expert has said that the current 2.5% fatality rate is the same as Spanish flu, which is believed to have killed between 40-50 million (Wikipedia). However, that fatality rate for Wuhan coronavirus is among hospitalised patients who received intensive care. It would be far higher in a situation where the hospitals were no longer admitting patients due to being full, which is already happening.

Against that, we don't know how many mild to moderate cases there are that are never seen by hospitals. Most Chinese can't afford the medical bill that would be incurred, so they just suffer at home. Also, unlike most flus, Spanish flu killed mostly healthy young adults, while the Wuhan virus is killing mainly older people, and those with underlying health problems. The reason healthy young adults succumbed to Spanish flu is because their stronger immune systems caused a 'cytokine storm', similar to an extreme allergic reaction.

Anyway, as it's a winter virus, it'll probably go away in the summer. SARS disappeared in July. Spanish flu had three winter waves, the second being the most deadly, and only infected a few during the summer.

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First cases announced in Europe, today, two in France (Paris and Bordeaux). Both had been to Wuhan. French health minister says to expect more. 

https://www.theguardian.com/science/2020/jan/24/coronavirus-chinese-hospitals-in-chaos-as-lockdown-spreads-to-affect-25m-people

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It's scary. I listened to a report and the concern seems to be whether the virus mutates into something stronger, although, it could also become weaker.  

Keep washing those hands and avoid crowds.

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The experts are 'all at sea' regarding just how transmissible Wuhan coronavirus is. The 'reproductive number' (R0) is a measure of how many people the average infected person will infect with the virus. So, a R0 of 2 means that each infected person will, on average, infect 2 more people.

Estimates vary wildly, and that's partly due to the fact that the virus is in evolutionary flux as it adapts to its new host. The figure will be different for different variants of the virus. Most estimates have it around 2 to 2.5. However, I found this written by an expert from Harvard.

"HOLY MOTHER OF GOD - the new coronavirus is a 3.8!!! How bad is that reproductive R0 value? It is thermonuclear pandemic level bad - never seen an actual virality coefficient outside of Twitter in my entire career. I’m not exaggerating.."

Just one opinion, though.

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Worrying development - the second infection in Germany was transmitted by a Chinese woman who didn't have symptoms. Asymptomatic spreaders have been suggested, but this dimension now looks like a game changer. From The Guardian.

"The first human-to-human transmission of the Wuhan coronavirus in Europe has been reported in Germany, where a man was infected by a colleague who had been in China, fuelling anxieties about the potential ease of international spread.

Experts said it was of particular concern that the Chinese woman who originally had the virus apparently had no symptoms when she transmitted it to her colleague. There have been warnings from inside China that people may be infectious before they start to feel ill.

So far there has been very limited spread from China. A handful of countries have reported cases including France, which has three, and the United States, which has five. This is the first reported European case of transmission from one person to another but it has also occurred in Japan, Vietnam and Taiwan."

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Strange pattern of coronavirus deaths as a proportion of total cases in Hubei province, compared to elsewhere.

Total confirmed cases 20,704 Deaths 427 = 2.06%

Hubei confirmed cases 13,522 Deaths 414 = 3.06%

Other mainland Chinese provinces confirmed cases 6,969 Deaths 11 = 0.16%

Outside mainland China confirmed cases 213 Deaths 2 = 0.94%

Why the huge discrepancy in the number of deaths between Hubei province, where the epidemic originated in Wuhan, and everywhere else? Three possibilities 1) The original virus was more lethal - in Wuhan city, the death rate is about 5% - and it has mutated into a much less lethal strain in regions affected later. 2) The virus is killing late on (latest information is an average of 14 days after symptoms appear), perhaps because of secondary bacterial infections, and there is a much higher proportion of patients in Hubei who have been infected for a longer time. 3) The hospitals in Hubei are swamped, and no longer able to offer the best intensive care.

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10 people confirmed with Wuhan coronavirus on Japanese cruise ship with 3,700 passengers. Can't think of a worse place to be in an outbreak.

 

https://www.japantimes.co.jp/news/2020/02/05/national/science-health/quarantined-japanese-cruise-ship-infected-coronavirus/#.XjoTnWj7SUk

 

Edit 6/2/20 Another 10 passengers confirmed infected with the virus.

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Youtube interview with Imperial College London epidemiologist. He estimates that only 10% of Chinese cases and perhaps 25% of overseas cases are being identified.

https://www.youtube.com/watch?v=ALQTdCYGISw&feature=emb_title

Edited transcript:

Dr. Sabine van Elsland, External Relationships Manager, Imperial College London interviewing Professor Neil Ferguson, director of MRC GIDA, J-IDEA, Imperial College of London. February 5th, 2020. Transcribed from YouTube J-IDEA website.

Good Afternoon. We are here with Professor Neil Ferguson, director of J-IDEA, talking about the current coronavirus outbreak.

Question: Would you be able to give us an update on the current estimate?

Answer:  What we can say about surveillance ongoing in China is we’re probably picking up, if you think of all infections out there being a kind of pyramid, it’s at the top of the pyramid, the most severe infection. We think probably that 10% or less of all infections in China are being detected at the current time. The next tier down, is really what’s being detected overseas. There, we think sensitivity is somewhat higher. But, still we may be only detecting maybe a quarter of all infections at that level. Lots of people will be entering, borders are porous. Countries won’t be detecting every case coming in.

 Question: Would you be able to say anything about forward projections as where the outbreak, the current outbreak is going?

In terms of where we think the current outbreak has got to, in terms of scale, we estimate that maybe up to 50,000 new infections a day are occurring in China, which is obviously much larger than the official case numbers. It’s going up all the time so the forward projections depends on the effectiveness of the control measures. We think the epidemic is roughly doubling in size about every five days at the current time.

QUESTION: There have been few fatalities outside mainland China. Would you be able to explain why that is? Why we see that difference with the fatalities that we see in China?

So, looking at the severity of an epidemic, and looking at how many people might eventually die from it, is very challenging. There were delays, quite often long delays, from when someone is diagnosed, with an infection that may be reported in the media, for instance in Thailand, or Japan, or Hong Kong, and when we finally know what the outcome of that case is. People will persevere, cases will be in intensive care maybe for weeks. We think the delay from when somebody is developing symptoms to when they might die, is as long as 20 days or longer, three weeks or so. So the fact that we haven’t seen many deaths in travellers, we’ve seen two so far for cases detected outside of mainland China, is not terribly reassuring. We wouldn’t have expected to see very many so far, because of those delays in the system. What we are trying to do now is account for those delays and do an accurate estimate of how lethal we think this virus is.

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Third UK case confirmed in Brighton.

 

https://www.theguardian.com/world/2020/feb/06/third-person-in-uk-confirmed-as-having-coronavirus

 

First UK national to get the virus, and he caught it in Singapore, which has only 28 confirmed cases. Strange one.

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Now, a second Brit has caught the virus in Singapore, and has infected five other Brits in France, who will be added to the French total of cases. This is unconnected to the first Brit who caught the virus in Singapore and was diagnosed in Brighton on Thursday.

Singapore is a city of 5.6 million people, and has just 33 'official' diagnosed cases. Apparently, he was at a conference in a hotel attended by 94 foreign visitors.

https://www.theguardian.com/world/2020/feb/08/coronavirus-five-new-cases-in-france-are-british-nationals

Edit: It looks as if the two Brits may have caught it at the same hotel conference. Two South Koreans and a Malaysian who attended the conference are also confirmed. No information regarding whether it's the hotel itself that's the source, or attendees at the conference.

https://www.thestar.com.my/news/regional/2020/02/06/another-south-korean-at-singapore-work-conference-infected-with-coronavirus

Edit 9/2/20 Turns out that the Brit diagnosed in Brighton, after returning from Singapore, is the same person who infected the five people in the French ski chalet.

https://www.bbc.co.uk/news/uk-51425702

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There are no confirmed cases in the whole of Africa, despite the very active involvement of the Chinese there. This could be due to a number of factors, including a lack of testing facilities, no screening at airports, and political motives. The Chinese wouldn't want the negative publicity that confirmed cases would bring. There's already quite a lot of hostility towards them from locals. I found this on Twitter:

https://twitter.com/i/web/status/1225808200739565573

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It's a minefold, Yonza. Thanks for all the detailed updates.  Very worrying. No, I would not like to be on that cruise ship.  I wouldn't like to be on any of those flights home either. Flights seem to be a perfect place for passing on germs. 

Hopefully Storm Ciara may blow a lot of the bugs away – does that happen at all?

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1 hour ago, Pat said:

It's a minefold, Yonza. Thanks for all the detailed updates.  Very worrying. No, I would not like to be on that cruise ship.  I wouldn't like to be on any of those flights home either. Flights seem to be a perfect place for passing on germs. 

Hopefully Storm Ciara may blow a lot of the bugs away – does that happen at all?

Nup, don't think so. Bad weather keeps folk indoors and breathing each others germs. Cruise ships are floating petri dishes. I feel for the ones with inside cabins and no windows. They've still got more than a week of quarantine.

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3 hours ago, samscafeamericain said:

Just to put things in context, 42.9 million people got flu during the 2018-2019 season, 647,000 people were hospitalized and 61,200 died

That's an argument I see a lot, but the UK Department of Health has just declared Wuhan coronavirus to be a 'serious and imminent danger to public health'.

https://www.bbc.co.uk/news/uk-51442314

The experts at Imperial College London say that the doubling time for infections is 5 days, and 50,000 new infections a day are probably occurring in China. Anything could happen, but if nothing changes, a large percentage of the global population could be infected. Spanish flu (1918/19) infected one third of the global population, despite hardly any international travel (apart from troop movements), and a global population density one third of today's. But, it might just disappear, like Sars, or become much milder, like swine flu. No one knows.

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Today's updates

UK cases double from 4 to 8. All in Brighton. 

https://www.theguardian.com/world/2020/feb/10/coronavirus-uk-declares-outbreak-serious-threat-to-health

60 more cases on quarantined cruise ship (now 130 cases), as depression sets in.

https://www.theguardian.com/world/2020/feb/10/coronavirus-60-more-cases-on-cruise-ship-as-depression-sets-in

Brighton GP practice closes after staff member tests positive for the virus.

https://www.bbc.co.uk/news/uk-51447761

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Updates

The WHO has officially named the virus COVID-19, as in COronaVIrus Disease, originating in 2019. 

One of the 5 confirmed cases in Brighton is an A&E worker at Worthing hospital who attended to patients for two days after becoming infected.

Another 39 patients on the Diamond Princess cruise ship have been confirmed as infected with the virus, taking the total known to be infected to 175 from 492 tested. There are 3,700 passengers and crew on the ship, which is in quarantine in Yokohama harbour. Only those showing signs of illness are tested. The Japanese authorities have said that they don't have the capability to test all on board. That's a worrying statement. If such an advanced country as Japan can't cope with 3,700 tests, what chance have less developed countries, when it starts spreading?  Another worrying development is that one of the Japanese health workers who took the on board samples, has also become infected, despite wearing protective gear.

Another cruise ship, the Westerdam, has not been allowed to berth in any of the ports it has tried to visit. That includes Japan, Taiwan, Guam, the Philippines, and now Thailand, because of fears that passengers and crew may have the virus, despite no one on board having been confirmed. Unlike the Diamond Princess, passengers are not quarantined in their cabins, and walk around freely on board. It has been at sea since January 16, and supplies are running low.

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My God. All passengers would need to be tested on the Diamond Princess and what a nightmare for the poor people on the ship no port will accept. 

I was in Clydebank yesterday and the Asian workers at the nail bar were all wearing masks. They were all very busy with customers so not putting anyone off.  We were at the pictures.  I took the hand sanitiser for all of us to use but forgot it was in my bag. 

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14 minutes ago, Pat said:

My God. All passengers would need to be tested on the Diamond Princess and what a nightmare for the poor people on the ship no port will accept. 

I was in Clydebank yesterday and the Asian workers at the nail bar were all wearing masks. They were all very busy with customers so not putting anyone off.  We were at the pictures.  I took the hand sanitiser for all of us to use but forgot it was in my bag. 

Just in, the Westerdam is being allowed to dock in Cambodia. You won't be needing a hand sanitiser for a couple of months yet, I don't think, although it helps against the 'usual suspects', like cold and flu germs.

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The complicated saga of the 'super spreader' who became infected at a hotel conference in Singapore, where 2 South Koreans and a Malaysian were also infected, is becoming clearer. Since he returned to Brighton, two local GPs have become infected, and I naturally assumed that they had been infected in Brighton, after he visited them. Turns out, both of the GPs had been holidaying at the ski resort in France that he visited.

Timeline

20-23 Jan Infected in Singapore

24 Jan Flies to France. 11 people infected. 5 remain in France. 1 returns to Majorca. 5, including the 2 GPs, return to UK.

28 Jan Flies from Geneva to UK. 

6 Feb Quarantined.

 

_110873966_coronavirus_spread_man_640-nc.thumb.png.9b21bc3161a6194873986df1aca26778.png

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Another paper from 5 scientists that estimates a huge R0. Still to be peer reviewed, but peers tend to be ultra conservative, and I really don't see them letting this one pass.

The Novel Coronavirus, 2019-nCoV, is Highly Contagious and More Infectious Than Initially Estimated

Steven Sanche, Yen Ting Lin, Chonggang Xu, Ethan Romero-Severson, Nick Hengartner,  View ORCID ProfileRuian Ke
 
 

Abstract

The novel coronavirus (2019-nCoV) is a recently emerged human pathogen that has spread widely since January 2020. Initially, the basic reproductive number, R0, was estimated to be 2.2 to 2.7. Here we provide a new estimate of this quantity. We collected extensive individual case reports and estimated key epidemiology parameters, including the incubation period. Integrating these estimates and high-resolution real-time human travel and infection data with mathematical models, we estimated that the number of infected individuals during early epidemic double every 2.4 days, and the R0 value is likely to be between 4.7 and 6.6. We further show that quarantine and contact tracing of symptomatic individuals alone may not be effective and early, strong control measures are needed to stop transmission of the virus.

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Updates

First death outside Asia has occurred in France, an elderly Chinese tourist who arrived in France on January 16, and was placed in hospital quarantine on January 25. So, it has been more than a month from infection until his death. This appears to be fairly normal.

Another 67 cases confirmed on the Diamond Princess cruise ship, in Yokohama, bringing the infected total now to 285, with 11 critical. They have now been in quarantine for 12 days, so were either infected before the 12 day period started, and have been incubating it without symptoms, or have become infected since, despite being quarantined. It has recently been claimed that the virus can be transmitted via aerosol. Up until now, it was assumed that it spread in tiny droplets which fell to the ground within about two yards from the source of infection. The difference between an aerosol and a droplet is unclear, but the aerosol particle is basically a much smaller droplet, which can remain suspended in the air, and travel much longer distances. If that happens, then that makes it much more transmissible, and it's conceivable that it might therefore be transmitted via the ventilation system that connects the cabins, particularly the interior cabins without windows. Another possibility is that one or more of the food handlers preparing or delivering their meals is spreading it.

The US government is preparing to fly out the 380 US citizens on board on Sunday, but they would have to be quarantined for a further 14 days at an air base in California, which currently has around 200 people quarantined there. This has understandably dismayed some of the passengers who expressed a preference to finish their quarantine on the ship and make their own way home. However, the US has said that passengers who decline may not be allowed to return to the US 'for some time'.

https://www.theguardian.com/world/2020/feb/15/us-to-evacuate-citizens-from-coronavirus-hit-cruise-ship-diamond-princess

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