Covid-19 / SARS-Cov-2 Manual for Reasonable Choices

Don’t panic. This is not a manual.

We do not have a manual yet. (Still! 26/12/2020. We still do not understand why some young ones get gravely sick and some very old ones walk off without symptoms). But, still we have a crisis in crisis communication. We do not know enough. You have to think for yourself You have to trust the professional consensus and people working with Cvid patients as well as peer reviewed science – and trust not just someone (on facebook). We do not know who to believe, confused and overwhelmed by the drastic changes in degrees of freedom and uptick in rants and opinions. The data collected so far on how many people are infected and how the epidemic is evolving may be partly unreliable. We may call it a fiasco, ongoing. This post ha been left to itself since about April 2020, and got updated and amended on Christmas 26/12/2020 during the second wave. At the time of the first wave, I cited John Ioannidis, but the famous name now rings some alarm bells:

At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact. JOHN P.A. IOANNIDIS for Statnews https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/ from 17/03/2020 retrieved on 19/03/2020

This sounds still fine for the citation given, not so fine concerning what he stood for later, drifting into the camp of Corona deniers. The few “critical voices” caused a lot of unnecessary ruckus doubting that the crisis is a grave one, giving space to all sorts of conspiracy myths. I denounce any “Querdenken” and “being critical” other than being critical with those Covid-denyers who use wishfu thinking and not science to downplay the crisis. The likes of Wodarg, Schwindelambulanz, Bhakti, Ioannidis & Co and a small minority of professionals fearing for their freedom creating petitions and confusion among laymen. In March this year I was more trying to gather the facts known so far, sounding also a tad too much “critical” but only having a hunch that the governments are downplaying the thing. In the end I was right. All over the world very often the following pattern emerged and emerges, for which we need to hold the authorities accountable:

„At first it is swept under the rug, although the facts had long been clear. And then someone seemed to pull the ripcord in panic. (German original in Der Standard at 21/03/2020 about the spread of Covid-19 from Tyrol to Europe) Erst wurde unter den Tisch gekehrt, obwohl die Fakten längst klar waren. Und dann zog offenbar jemand panisch die Reißleine.“ https://www.derstandard.at/story/2000115989961/apres-ski-mit-boesem-erwachen-in-den-tiroler-bergen

So, why shall you trust me? (good question, still! I would not be so bold now and write a Corona manual, for the beginning it still feels fine). Well, I do not want to sweep anything under the table, on the contrary, I like to look under the table. First, I mainly curate trustworthy links here with due diligence, fact checking and (minor) writing and interpreting – and second, I do not gain anything from being a big mouth – I try to share useful stories, not sensational ones. Cherry picking in a world full of cherry vendors is tricky – I am not a news service, not ad driven, do not earn anything with this site – I do not sell cherries, I want to help people making up their mind.

We write a point in time and history when the author of this got quarantined for a bit longer than a week in Northern Italy (Venice, to be halfway precise) with measures looming in the rest of Europe copying more or less the Italian response to the Covid-19 outbreak, which itself could look at and observe the onset and battle unfolding in Wuhan, China. So, after 3 weeks of daily research and communication with friends and family it could help to share links and themes to keep them ready – because the crisis is far from over. (so true, second wave, hello, lockdowns for Christmas in Germany, Austria, Italy, Great Britain…) We do not know HOW far, yet. (still true, too, even with vaccines on the horizons in January 2021).

See the collection of links and findings as a treasure chest of a curated swarm of concepts and trustful voices, including some of my own conclusions. Please consider these made IMHO (in my humble opinion), not as a directive or scientifically sound and complete account – specially if these expressions may change your own behaviour in an ongoing health crisis. I do not take responsibility for accurate links or procedures, the contents displayed, numbers or methods, but I do take responsibility for my own reasoning, even though I urge you to not trust, but trust your own judgement.

Trying to be a voice of reason in a veritable panic situation is an unthankful job – well, no job at all, and those “Querdenker” or “critical thinkers” like Wodarg, Schwindelambulanz, Bhakti, Ioannidis & Co. do no service to society if they play the danger down. Better safe than sorry – caution rules! That may mean sometimes to play the reminder, prophet and Cassandra (more or less knowingly) it may mean at other moments to find reassurance and hope in some basic fact checking. I am not fallible but nevertheless believe in a reality of results and observations, therefore I try to declutter some of the worst misconceptions I had or which may arise somewhere else, too, for the sake of my own mental health and for the possible benefit of others who read this. Or it might add to their confusion, if I fail.

I am scientifically trained (nice, but that does not make me an expert), but working in games and education now, with 4 years of basic medical training and 4 years in learning scientific procedures in the medical institute for brain research in Vienna – not that my research there had anything to do with virology or epidemiology, directly or indirectly. But I am curious, painstakingly persistent, know how to ask uncomfortable questions and I call my own knowledge into question – all these things might be the basic toolbox of a researcher. In a range of 1-10, where 1 is a no-name facebook rant and 10 the best local heath authorities, scientific board or worldwide WHO experts, I would possibly be a 4 or 5, on a lucky day.  So you can take everything I say as half-true or maybe hitting something. But I doubt that there are certainties out there right now and I would be cautious of anybody saying strongly that they know exactly what they are dealing with.

Silicon Valley lionizes people who rush toward solutions and ignore problems; science is designed to find solutions by identifying those problems. The two approaches are often incompatible. https://www.wired.com/story/an-old-malaria-drug-may-fight-covid-19-and-silicon-valleys-into-it/

YES, wash your hands often and keep the distance to your fellow humans, until it is said to be relatively safe again. That is still valid in 12/2020. Including wearing FF2 mask when being inside, with people in not well ventilated rooms. See below – the main drill has not changed – rather almost been forgotten over the summer.

(My own take on a planetary view of accounting for least two dangerous virus on earth… 12/03/2020 CC BY-NC-SA 4.0) 

#StayTheFUCKhome

Those two things, in summary social distancing and amping up hygiene are the only things which might help significantly slowing down the spread of the new SARS-Cov-2 virus. In any case this would be the manual for all of us for contributing to society’s health on a daily basis. Until we are told to do other things which might work better. But you know this already, if all people in Europe ACCEPT this – including the very social Italian crowd of 60 million people – is doubtful right now.

 

MASKS

Only masks of the standard FFP2 (and better, FFP3 – not better, because they ususally have valves which let the breath out infiltered, helping to spread the virus you might have, well fitting FFP2 are filtering both ways) are certified for use in virus contaminated areas. Most of them are very a bit more difficult to breathe through, and they should could be reserved for health care workers who are exposed to heavy virus loads during their work in confined spaces. If there are enough FFp2 masks available, though, get some. They should cost about 30-50cents, sometimes sold for elevated prices of 4-7EUR. If you are sick, wear masks, but FFP2 or 3 would be great, but they are were rare and sold out often since beginning of March. Later on they become available in department stores and pharmacies. You can wear ANY mouth protection which would catch droplets from cough and sneezing, even scarfs, anything is better than nothing. Just FF2 protects you, too. If your are healthy (how do you know?) than wearing a mask outdoors is like a courtesy as you show that you respect the others, you may me an asymptomatic spreader or actually positive, but you do not know yet and the sickness is not noticeable in the incubation phase (up to 14 days, some say even 21).

 

DETERGENTS & DISINFECTANTS

Soap & water (cold or warm) does help to reduce the pathogens significantly on your skin. It is always a reduction, not killing them to 100% (also in a hospital, which poses a big problem there with growing resistant strains). Washing your hands thoroughly for 30 seconds (sing happy birthday twice) and don’t forget to pry under your fingernails and wash the wrists, too! SARS-Cov-2 (like many other virus, cannot breach the skin, but they stick to it and we bring them onto the mucus of our nose or mouth by touching our face.

Why soap is effective against SARS-Cov-2 by Pall Thordarson / The Guardian https://www.theguardian.com/commentisfree/2020/mar/12/science-soap-kills-coronavirus-alcohol-based-disinfectants

The SARS-Cov-2 virus can remain intact and contagious on surfaces for up to 4 days, studies in a laboratory suggest. On dry surfaces it will degrade quickly within 2-3 hours, but on metal and with humidity in the air, it can last longer.

Coronavirus can persist in air for hours and on surfaces for days: study REUTERS https://www.reuters.com/article/us-health-coronavirus-study-idUSKBN2143QP

It can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05–0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. (see Kampf et. al (2020) “Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents”; Journal of Hospital Infection, 01/2020, Elsevier, https://www.sciencedirect.com/science/article/pii/S0195670120300463 retrieved on 18/02/2020)

CHECK if your household disinfectant about active contents and if it has at least a proven limited viricidal effect. Many disinfectants are mainly aimed at bacteria and are not efficient enough against virus contagion.

Recipe for home made disinfectants by WHO, in German (Rezept Desinfektionsmittel WHO) https://ze.tt/diy-wie-du-desinfektionsmittel-selbst-herstellen-kannst/

 

DON’T TOUCH YOUR FACE (if you have not washed diligently shortly before!)

“Scratching the nose, rubbing your eyes, leaning on your chin and your fingers go next to your mouth — there’s multiple ways we do it,” said Dr. Nancy C. Elder, a professor of family medicine at Oregon Health and Science University in Portland who has studied face touching among doctors and clinic staff members. “Everybody touches their face, and it’s a difficult habit to break.” https://www.nytimes.com/2020/03/02/well/live/coronavirus-spread-transmission-face-touching-hands.html

https://www.ncbi.nlm.nih.gov/pubmed/24808112 exposing 19x per hour in a hospital staff study.

IMHO, we touch our face with our hands about 2x in an hour – 2x in a minute. In waking hours of 16 this this will amount to 36-2.000 times a day! The rate being cited in Steven Soderbergh’s film Contagion (2011), it being 3.500x could not be proven or being verified in studies. But individually it may be high, as people are exposing different habits. Viral pathogens are invading the mucus membrane of the nose, mouth and the moist tissue of the eyes through touch. About 70% of infections are generated by touching surfaces and then touching your face, through hands.

One study involving 249 randomly selected people in public places in the U.S. and Brazil (Dr. Wladimir Alonso, a global health researcher at the National Institutes of Health in Bethesda, in 2012, Nov. 15 in the journal Clinical Infectious Diseases) found they touched their faces an average of 3.6 times per hour. https://www.livescience.com/25086-stop-touching-yourself-flu-researchers-say.html

Another with only 10 subjects (Nicas & Best, 2008) found this mean rate to be 15,7 x/h. https://www.ncbi.nlm.nih.gov/pubmed/18357546

Another one (Kwok et al. 2015) with students showed 23x per hour. https://www.ncbi.nlm.nih.gov/pubmed/25637115

https://www.today.com/health/how-coronavirus-spread-how-stop-touching-your-face-prevent-infection-t175189

The German Infektionsschutz notes to Covid-19 spread that they have not found clear indication so far that surfaces or transmission through hands plays a major role, but it can not be ruled out. https://www.infektionsschutz.de/fileadmin/infektionsschutz.de/Downloads/Merkblatt-Infektionsschutz-Coronavirus.pdf

Surfaces turned out to be a smaller vector of transmission than supposed. Luckily. No frozen food or packages tracked  down to spread the virus in a cluster, as far as I have heard/read…

 

NUMBERS GLOBAL

Numbers and charts convey a reassuring sense of certainty. But in the midst of an evolving crisis, that certainty is too often an illusion. A single, imprecise statistic generated more than a decade ago can suddenly proliferate, inciting panic and senseless hoarding that diverts resources from those who need them most. When experts and journalists uncritically pluck numbers from careless studies and clutch at fluctuating figures, hastily offering them up as beacons, they may do more to confuse than illuminate. https://www.wired.com/story/covid-19-is-nothing-like-the-spanish-flu/

John Hopkins Univ. / Official data in “realtime” of Coronavirus spread worldwide https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html

Well as of 26/12/2020 John Hopkins notes 80,027,056 Mio official infections (positive tests) and 1,753,313 Mio global deaths. Sigh. What a disaster…

An interactive visualization of the exponential spread of COVID-19 / based on data of John Hopkins Univ.: http://www.91-divoc.com/pages/covid-visualization

CSSEGISandData time series of data worldwide of John Hopkins Center of System Science and Engineering on github for further analysis as updated .csv files: https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data/csse_covid_19_time_series

STATISTICS & Math of Covid-19 by Jason Scott Warner (USA) @medium https://medium.com/@Jason_Scott_Warner/the-sober-math-everyone-must-understand-about-the-pandemic-2b0145881993

OVERVIEW and comprehensive read, plowing through the data available, by Thomas Pueyo (USA, online course start-up entrepreneur and MBA), good at diagrams and explaining overall dynamics, linking to a lot of resources, but not citing them thoroughly @medium https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

FLATTENING THE CURVE as a delusion? > it could mean, we are spreading it anyways, but slower > lesson: containment FIRST! https://medium.com/@joschabach/flattening-the-curve-is-a-deadly-delusion-eea324fe9727

Yeah, we did not do containment first, were “sleeping” in summer when numbers were low and so we are getting into a second and maybe third wave…

04/03/2020 About “WRONG” NUMBERS in the USA: A survey by The Atlantic (strangely on medium.com – I did not know that they had their own “channel” on medium, too, posting articles there) https://medium.com/the-atlantic/the-official-coronavirus-numbers-are-wrong-and-everyone-knows-it-7bfb334e0ceb

31/03/2020 Daily News update / SupChina: The only people taking COVID-19 tests are people with a significantly high chance of having COVID-19, thus skewing the numbers higher. The only way to get a clear and accurate count of COVID-19 cases will be to test the entire population at random. In the U.S., that would mean testing people at random in all 50 states, in cities and rural areas, whether they are sick or healthy, and whether they have any reason to believe they have — or at any point have had — COVID-19 or not.

+ Up to 25% of infected people might show no symptoms at all. (New York Times, porous paywall)

+ This long but worthwhile article by Andre Ye dives deep on selection bias in COVID-19 testing. (towardsdatascience.com / medium.com)

+ So does this WSJ op-ed from a week ago. (Wall Street Journal Opinion, paywall)

+ The President of Turkmenistan (the flamboyant dentist-rapper strongman Gurbanguly Berdymukhamedov) banned the word “coronavirus.” The country now has no cases. How about that for statistics?

from the Editors of SupChina (per email).

Experiments with fictive SIR-models homepage: https://www.3blue1brown.com presented by: http://3b1b.co/sir-thanks

MORTALITY / CFR – Case Fatality Rate 

That is a tricky one. (still is, just that the low IFRs spread by “critical thinkers” seem to not hold up in the ongoing contagion scenario, mortality IS high! Still in the ballpark of something like:) The accounts vary a lot, from 0,3% to 6,5% in Italy. The bias to predominantly test people already heavily inflicted seeking medical help may twist the number. Lets hope we stay in the end below 2%. IMHO, the mortality rates only get statistically prominent in big numbers of infections in a country. Up to a thousand officially infected, there might be only a few deaths like in Germany. But if millions get infected the CFR is the base for the grade of horror awaiting, pointing to potentially millions of deaths if we have a billion infected people worldwide. This worst case scenario was put under the rug far too long, IMHO. The mean range in most of the areas might be around 2-3%, but possibly not counting in asymptomatic cases which did not get registered. Therefore the dark number of asymptomatic cases might be the most important variable to assess the CFR in a more profound way. Unluckily or luckily, CFR is driving also politics and a lot of confusion was coming from not having these numbers present in comparison to seasonal influenza (0,1%) or the big pandemic outbreaks in history.

Spanish flu had a CFR = 6-8% or even higher, surely higher than the often cited 2,5% CFR. It seems to be too low under scrutiny, an article in WIRED strongly suggests. (see https://www.wired.com/story/covid-19-is-nothing-like-the-spanish-flu/) So far for reliable numbers on Wikipedia and in media outlets…even the New York Times copied the “classical” findings being collected and interpreted 40 years ago in only ONE study. “The CFR was possibly around 2 percent in the US and some other parts of the developed world, he said, but fatality rates were much higher elsewhere. Johns Hopkins University epidemiologist Jennifer Leigh recently told The Los Angeles Times that the overall fatality rate for Spanish flu may have been closer to 10 percent.” As the author also rightfully notes: “Of course estimates differ; the pandemic in question happened more than a century ago, and we don’t have anything close to complete or accurate records of its casualties. But that does not explain away a glaring mathematical incongruity, nor does it justify an abdication of scholarly responsibility.” For a comparison with Covid-19:”There are many additional reasons not to make blithe comparisons between the current crisis and the 1918 pandemic: stark differences in health care infrastructure and medical technology; the ravages of the first world war; the unusual tendency of the Spanish flu to kill young adults; and the fact that many, if not most, people infected with influenza in 1918 died from secondary bacterial infections (as mass-produced antibiotics did not yet exist) …During the Spanish flu, for instance, it ranged from less than 1 percent in some areas to 90 percent in one Alaskan village. What gets lost in superficial analogies is that, despite some valid and instructive parallels between the two pandemics, there are many more differences. We can’t use half-contrived statistics about a century-old pandemic to predict what will happen today.”

 

DARK NUMBERS vs. TRUE NUMBERS vs. OFFICIAL NUMBERS

There is an elephant in the room, probably explaining a lot of the spread: dark numbers, or asymptomatic cases who stay subclincal and do not develop symptoms (or only very mild ones). How many are these? If we cannot screen for temperature or feeling sore or “sick”, cough, headache or throatache, how shall we contain the virus? It seems to be proven that (unlike SARS) in Covid-19 cases people are already infective without symptoms (but may develop them at a later stage) AND that there is a significant percentage of “asymptomatic cases” which may NEVER develop symptoms but prove to be SARS-Cov-2 positive AND are spreaders. This calls quarantine and screening into question, but social distancing and wearing a mask is still the best way to fight a spread, BECAUSE we do not know who has it (or will get sick soon). I call them (to distinguish from Thomas Pueyo using “true” case) dark cases.

In the Italian study of the first location of the outbreak in Italy, the community of Vò, they are called ‘submerged’ infections. It got conducted by Andrea Crisanti, Direttore della Cattedra dell’Unità Diagnostica di Microbiologia e Virologia dell’Università di Padova. https://www.trialsitenews.com/university-of-padua-vo-study-one-possible-hypothesis-of-how-to-contain-covid-19/ “The percentage of infected people, even if asymptomatic, in the population is very high.” A professor (Professor Sergio Romagnani of the University of Florence) interpreting the study, saying, “The isolation of asymptomatic is essential to be able to control the spread of the virus and the severity of the disease.” In La Republicca Prof. Romagnani (who is a former teacher of Prf. Andrea Crisanti) is quoted to estimate the asymptomatic cases to be 50-75%: “The vast majority of people infected with Covid-19, between 50 and 75%, are completely asymptomatic but represent a formidable source of contagion.” – Italian original: “La grande maggioranza delle persone infettate da Covid-19, tra il 50 e il 75%, è completamente asintomatica ma rappresenta una formidabile fonte di contagio”. https://www.repubblica.it/salute/medicina-e-ricerca/2020/03/16/news/coronavirus_studio_il_50-75_dei_casi_a_vo_sono_asintomatici_e_molto_contagiosi-251474302/

10/03/2020 Andrea Crisanti, the leader of the study in Vò has outlined his learnings and strong suggestions from the data gathered there, the “model of Vò”: https://www.corriere.it/salute/malattie_infettive/20_marzo_10/crisanti-tamponi-massa-zone-focolaio-c-poco-tempo-df2e2036-6239-11ea-9897-5c6f48cf812d.shtml

12/03/2020 Andrea Crisanti interview VVOX https://www.vvox.it/2020/03/12/coronavirus-tamponi-veneto-cosa-succede/

13/03/2020 Andrea Crisanti interview Il Gazettino https://www.ilgazzettino.it/nordest/primopiano/coronavirus_italia_news_virologo_asintomatici_problema_vero_epidemia-5108698.html

How old were the infected people?
“Half of them were elderly people who did not develop serious forms: an unexpected fact, which we are still studying.”

Can the «Venetian model» be exported to other Italian regions?
“The goal is to control the epidemic in the early stages, also to limit the severity of clinical manifestations. I believe that the approach chosen for Vo ‘can be used to close the outbreaks existing in our country – starting from Veneto, Marche, Emilia-Romagna – and then concentrate efforts in Lombardy. But we must hurry, time is not on our side ».

What do you recommend to do in practice?
«Wherever there are outbreaks, carry out mass tests on the population and trace the contacts of the positive (more or less close), then isolate all the infected, even if they are asymptomatic. It takes aggressive action, otherwise the virus will continue to circulate. The alternative is the Chinese way, all closed for 3 months without exception. ”

Is it an economically sustainable program?
“A test (tampon) costs 30 euros, a patient in intensive care from 3 to 5 thousand euros per day.”

How do you assess the situation in Lombardy?
“It is very submerged, it is necessary to make it emerge, find and isolate all the positive and the related contacts, direct and indirect. Costs what you cost: do you need 5 million tampons? They take it. Lombardy has the resources to do it, but drastic measures are needed ».

A less scientific account of this model, here called “Veneto model” for the eyes of the US: https://promarket.org/why-mass-testing-is-crucial-the-us-should-study-the-veneto-model-to-fight-covid-19/

True cases, not yet registered (or staying unregistered) may be about 50x the registered official cases. Harvard Medical School / Massachusetts General Hospital released their estimate (video recording is here: https://externalmediasite.partners.org/…/53a4003de5ab4b4da5…  from the MGH Medical Grand Rounds of 12/03/2020) that the actual cases are 50x greater than the reported cases. So they likely have 75,000 cases in the United States already (15/03/2020 date of Jason Scott Warner’s blog post). The number of reported cases he judges as not that important.

“Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.” Still, Dr. John P.A. Ioannidis, professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center is founding his reasoning of the CFR on the narrow Diamond Princess case and the few cases in comparison in the US, dismissing the work of the Chinese authorities, South Korea or the high CFR in Northern Italy right now (6,5%!) entirely. There are 72.000 people case scenarios here and I suggest he reads that and asks European fellow colleagues for their unfolding data (31.000 cases in Italy as of yet 19/03/2020). https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

“Asymptomatic and mildly symptomatic transmission are a major factor in transmission for Covid-19,” said Dr. William Schaffner, a professor at Vanderbilt University School of Medicine and longtime adviser to the CDC. “They’re going to be the drivers of spread in the community.” A quite US-centered approach to the theme https://edition.cnn.com/2020/03/14/health/coronavirus-asymptomatic-spread/index.html

BILL GATES about asymptomatic cases, February 28, 2020 in New England Journal of Medicine. Yes, THIS Bill Gates. He is a billionaire and funds medical research for years. He has a voice and a weight. https://www.nejm.org/doi/full/10.1056/NEJMp2003762

Study of 126 EVACUEES FROM WUHAN / 2 asymptomatic cases found which got missed by through symptom screening in quarantine, from 18/02/2020 https://www.nejm.org/doi/full/10.1056/NEJMc2001899

DIAMOND PRINCESS Covid-19 cruiseship survey for the ratio of symptomatic vs. asymptomatic cases / Result: 17,9% asymptomatic cases https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180 

JAPANESE STUDY (Nishiura et al. Feb 17/2020 – March 6/2020) of Wuhan evacuees / 30,8% asymptomatic > This ratio is slightly smaller than that of influenza, which was estimated at 56–80% (Hsieh et al., 2014) using similar definitions for symptomatic individuals. This is taken from the .pdf with updates in March. https://www.ijidonline.com/article/S1201-9712(20)30139-9/pdf

The preprint version of this paper from 17.02.2020 shows a higher count still of 41,6% asymptomatic cases: https://www.medrxiv.org/content/10.1101/2020.02.03.20020248v2

R0 / R Naught

Initially, the basic reproductive number, R0, was estimated to be 2.2 to 2.7.

https://en.wikipedia.org/wiki/Basic_reproduction_number

Covid-19 = Influenza??

Sanche et al. 2020 from the Los Alamos National Laboratory, Theoretical Biology and Biophysics, Theoretical Division,

/ R0 more like 4.6 to 6.6 https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1.full.pdf

CHINA Covid-19 NUMBERS (Official numbers from China & studies)

China CDC / Weekly numbers /  http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

China CDC / Large 72.000 cases overview Epidemiology study / asymptomatic cases = 1,2% http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

 72.000 cases China study /JAMA – Journal of American Medical Association / 24.02.2020 https://jamanetwork.com/journals/jama/fullarticle/2762130

MEDRXIV Meta study of 50.000 cases in China / CFR = 4,3% https://www.medrxiv.org/content/10.1101/2020.02.18.20024539v1

CHINA Cultural / Political & Media / Individual accounts

2 Nurses Deng Danjing & Xia Sisi (29) turning critical in Wuhan, one of them died (NYT)

https://www.nytimes.com/interactive/2020/03/13/world/asia/coronavirus-death-life.html

Living with the Corona Virus in China / a Chinese speaking account (in German)

https://www.zeit.de/kultur/2020-03/coronavirus-china-leben-ausnahmezustand

HONG KONG Covid-19 NUMBERS (Officially low numbers, containment)

HONG KONG – memory of SARS and draconian measures keep numbers low

https://www.bloomberg.com/amp/opinion/articles/2020-03-07/coronavirus-sars-lessons-reduce-hong-kong-infection-rate

SOUTH KOREA

The simple 10min Testing kit / 27/02/2020  https://www.asiatechdaily.com/korea-firm-covid-19-testing-kit/

Has South Korea Stabilized Its COVID-19 Outbreak? [Infographic] FORBES 11/03/2020 https://www.forbes.com/sites/niallmccarthy/2020/03/11/has-south-korea-stabilized-its-covid-19-outbreak-infographic/

 

AUSTRIA

Transcription of an interview of Armin Wolf with Tilg Bernhard (Tirol Health official, OEVP) in state run channel ORF https://tvthek.orf.at/transcripts/show/858935

20/03/2020 The Austrian POSTAL SERVICE / POST.at has has abandoned 201 countries (Afghanistan – Cyprus) for package services and 189 countries concerning letters (sending, maybe also receiving?) from TODAY on!! It seems to be no big news yet, but I think it is a unilateral scandal. Additionally, the reason for not accepting parcels going to Italy is blamed on the Italians (they will send it back, answer was). Hermes and Post employees have used this unproven story as an excuse: no liquids are accepted in parcels by the Italian postal service. I cannot find anything like this so far in the Italian channels or at Poste italiana. The truth is, they stopped their service unilaterally having included ITALY in their official black-list (a quite hidden .csv file, not easy to open for everybody), they do not deliver to. So far for “indispensable services” we keep up as a trusted European government strategy…worrying, indeed. We are living in the EU, dammit! https://www.post.at/liefereinschraenkungen-coronavirus.php#

„Erst wurde unter den Tisch gekehrt, obwohl die Fakten längst klar waren. Und dann zog offenbar jemand panisch die Reißleine.“ https://www.derstandard.at/story/2000115989961/apres-ski-mit-boesem-erwachen-in-den-tiroler-bergen

„Am 13. März war schon die Hälfte der damals 750 Corona-Fälle in Norwegen auf Österreich zurückzuführen […] Am 13. März wurde Tirol vom RKI daraufhin als “Risikogebiet” eingeschätzt. Auf die Frage, ob das RKI, angesichts der vielen Fälle, die dortigen Behörden kontaktiert habe, heißt es in Berlin: “Eher nicht.” Keinen Kontakt nach Tirol gab es auch vom Ostalbkreis aus. Dieser liegt in Baden-Württemberg, am 12. März wurden dort zwei Personen positiv getestet, beide hatten zuvor – unabhängig voneinander – in Ischgl geurlaubt.“ https://www.derstandard.at/story/2000115989961/apres-ski-mit-boesem-erwachen-in-den-tiroler-bergen

Vienna: Masks and gloves crisis already after a three days of lockdown https://m.oe24.at/coronavirus/Alarm-im-Wiener-AKH-Wir-haben-einen-Versorgungs-Notstand/422450711

Statistiken fuer Österreich, Fälle und Lockdown https://orf.at/corona/stories/3157533/

Sigh. Austria was high nosed, did not keep up the rigor mask attitude and got the worst numbers in Europe in autumn, following with lockdowns. What could possibly happen, if you are cautious in comparison to careless? Kurz is still confusing the people with measurements, bad communication with the health minister Anschober and inefficient mass testing…and by he way, no, Covid is not brought in over the borders mainly by immigrants, but by tourists. See spread of the Spanish strain to whole Europe after summer…

SARS & animal origin of Covid-19

26/02/2020 Mystery deepens over animal source of coronavirus https://www.nature.com/articles/d41586-020-00548-w

Chinese bat lady / long story:

11/03/2020 How China’s “Bat Woman” Hunted Down Viruses from SARS to the New Coronavirus / Chinese bat lady / long story https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/

17/03/2020 Sciencedaily Study / Origin of virus = natural: https://www.sciencedaily.com/releases/2020/03/200317175442.htm

INFLUENZA (worldwide)

290.000-650.000 deaths PER YEAR are attributed to influenza according to WHO. The CF Rate (CFR – case fatality rate) of influenza is being estimated as ca. 0,1%.

WHO factsheet https://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal)

WHO Influenza monitoring https://www.who.int/influenza/surveillance_monitoring/bod/en/

The Spanish flu had CFR of 6-8% or more (see CFR above).

Wie sich Fehler wiederholen (N-TV) Spanische Grippe und Folgen (in German). https://www.n-tv.de/panorama/Wie-sich-Fehler-wiederholen-article21644456.html

 

ITALY

19/03/2020 The location of the first death in Italy due to the novel coronavirus is the community of Vò (and Codogno) in Lombardy. They were shut off by military and severe quarantine measures and have been kept under strict scrutiny. This allowed also the University of Padua to conduct a study of the spread within a limited population (3.300) with multiple repetitive testing. This study is aiming to understand better the natural history of the virus, the transmission dynamics and categories of risk. https://www.trialsitenews.com/university-of-padua-vo-study-one-possible-hypothesis-of-how-to-contain-covid-19/

13/03/2020 CHINA sends 31 tons of protective gear, plasma of Covid-19 patients, respirators and nine doctors & experts, while EU declines call for help. REUTERS https://www.reuters.com/article/us-health-coronavirus-italy-respirators/china-sends-medical-supplies-experts-to-help-italy-battle-coronavirus-idUSKBN2101IM

 

INFLUENZA (Italy)

Flu deaths in in Italy in the past 11 years (my translation in English from agi.it / Agenzia Italia):

“According to the Istat database on the initial causes of death (i.e. on those diseases that led to death), there were 663 deaths from the flu in 2017, double the 316 recorded in the previous year. In 2015 there were 675, and 272 deaths in 2014. Between 2007 and 2013, flu deaths were respectively: 411, 456, 615, 267, 510, 458 and 417.

Between 2007 and 2017 (the last year on which we have the data), the flu was the initial cause of death for a total of 5,060 deaths, an average of 460 per year.”

 

PNEUMONIA (general & numbers in Italy) 

A “quick” survey and update on pneunomia (ital.: polmonite) cases in general and in Italy. There seem to have been registered ca. 12.000 official deaths related to pneumonia last year in the Istat database in Italy. Roughly 17x as much as deaths by influenza. That is a large and substantial number. Still. it might be important to check, what kinds of pneumonia are prevalent and if they can get diagnosed easily.

Pneumonia – triggered by bacteria, but by virus as well – is a caused in 70-80% of the cases by bacteria already present in a healthy subject – primarily by streptococcus pneumoniae or “pneumococcus”. It is estimated that 30-70 percent of healthy people are carriers of this bacterium which, under normal conditions of immunity, is positioned in the human breathing system without causing problems.

About 80% of severe pathologies caused by pneumococcus in adults / elderly are bacteraemic pneumonia. That means that the bacteria are transgressing the blood barrier and far found in the blood, too. Pneumococcal pneumonia remains the most common form of community pneumonia associated with bacteremia – up to 60% of cases associated with blood infection.

“Since blood culture (the test to check for the presence of bacteria in the blood) in people admitted to hospital with suspicion of pneumonia is not routinely performed, most of these forms can be identified as pneumonia, but are not attributed with certainty to pneumococcus nor defined as bacteraemic, because its presence in the blood is not verified.” (La Repubblica, see below, my translation)

In times of Covid-19 outbreak and the high numbers of mortality in Northern Italy, finding gram-positive or gram-negative bacteria in the blood should be routine and may help to distinguish bacteria pneumonia from Covid-19 ARDS (Acute Respiratory Distress Syndrome). I guess it is still possible that the deaths from Covid-19 in the last 2 weeks are hidden in the current pneumonia statistics – but we can check that in the next two weeks with the official national monitoring numbers.

I guess doctors who have seen and treated both and know the differences very well and could better explain…and its their job to rule out other factors than SARS-Cov-2 as a main factor for a death.

Sources: La Repubblica, 16/02/2020 https://www.repubblica.it/…/polmonite_ospedali_super…/  retrieved on 18/02/2020

“Bacterial Pneumonia”. Lung Disease & Respiratory Health Center. WebMD https://www.webmd.com/lung/pneumonia-types  retrieved on 18/02/2020

 

POLICY 

IMHO, reacting too slow despite examples worldwide will destabilise governments and call those into question who prove to have peformed incompetently in crisis management or chose not to listen to their experts. Trials may be looming or necessary to take responsibility in front of angry citizens and caring for the of people and the world’s spread (including the tumbling stock markets). Containment could have avoided all that (see Hong Kong, Taiwan, Thailand, Singapur). “We did everything we could” and ” It was all a great and very good response” lip-service & propaganda might not be enough.

The problem of a reenforced surveillance state and long-term suppression of citizen right and human rights lingers. In the US and in China there seem to be forces to utilise the crisis to strengthen their power base and crack down on critique under the cloak of prolonged “emergency laws”, IMHO.

Shifting from isolationism to transnational cooperation and coordination in mid-term. https://foreignpolicy.com/2020/03/16/coronavirus-what-works-transparency-testing-coercion/ (Paywall)

HOARDING / STOCKPILING

New South Wales, Australia. Don’t be fooled that this cannot happen in your “ALDI” too, people shop in Berlin in the same chain/brand in a globalised world – and people are people. Here in Venice, Italy, in the red zone, country in lockdown and with No.2 of infected cases worldwide people are overall relaxed and do not shop excessively, nor are important goods missing. I go very much with the comment from the Byron Bay community Board:

“Every man for himself is the right wing, conservative wet dream. Building societies, and communities, and looking after each other is apparently this devil called *socialism* and we should stand against all forms of being kind and compassionate so as not to be snowflakes. Imagine, for all our claimed religious morality, creating a world that literally puts wealth/capital on a pedestal and worships it, rather than the actual people.” 

 

HEARSAY / TO CHECK

15% of the Covid-19 cases are asymptomatic without fever? Interview on Italian TG2 in the journal Medicina33, said by expert Prof. Paolo Palange / Univ. di Roma / Dipartimento sanintá pubblica e malattie infettive https://dspmi.uniroma1.it/node/6658

QUARANTINE LITERATURE

THE PLAGUE (La Peste) – Albert Camus (1947) / about the nature of destiny and the human condition, also about dreadful black death (inspired by historic epidemic Cholera in the Algerian city Oran)

THE DECAMERON – Giovanni Boccaccio (written 1348-1353) / with the background of the black death in Florence in 1348, classic erotic literature

1984. Orson Wells. For when the isolation becomes normal.

The Sleepwalkers from Hermann Broch

“Blindness” by Saramago

Der Zauberberg of Thomas Mann

Death in Venice also Thomas Mann

Earth Abides by George R. Stewart (1949); a melancholy imagining on how society rebuilds itself after the earth has been ravaged by a virus.

The Passage Trilogy. It’s a bit like The Stand, but with Vampires and a truly epic story.

The city of lost things by Paul Auster (or the New York trilogy)

‘The Brief History of the Dead’ by Kevin Brockmeier is short but stunning.

La Pelle – The Skin / Curzio Malaparte (1949) – Naples and the Vatican never forgave him this account…best expression of Italian-American relations and the ending of WWII in Italy I know of

The Eyes of Darkness (1981) Dean Koontz / For the 1989 edition onwards, the novel’s bioweapon was renamed Wuhan-400 (likely due to the end of the Cold War), prompting speculation from some in early 2020 that Koontz had somehow predicted the Coronavirus disease 2019.

Daniel Defoe / A Journal of the Plague Year (1722)

 

QUARANTINE MOVIES & SERIES

Contagion (2011) by Steven Soderbergh

The Plague (1992) with William Hurt / after La Peste by Albert Camus

Westworld / by Jonathan Nolan /  all 3 seasons > the new one is out on Sky, but may hit streaming in April

Last Night (1990)

Mr. Robot /Amazon Prime / all 4 Seasons

Prospect (film sci-fi, 2018) / Amazon Prime

The OA / Netflix / series

Picard / Amazon Prime / Star Trek

The Expanse / Amazon Prime

12 Monkeys / (yes, the series, produced by syfy, I guess you can watch it on Hulu or Amazon)

…to be continued.