H5N1

The new COVID-19 coronavirus and preparing for the next viral pandemic

An excellent perspective from Michael Specter in The New Yorker: The New Coronavirus and Preparing for the Next Viral Pandemic. Excerpt:

These viruses all pose special threats because they are new, which means that humans have no antibodies to defend against them. The 2009 H1N1 epidemic infected at least 1.4 billion people, most of them before vaccines or treatments for the virus were available. And that was in a year when, by most accounts, the W.H.O. moved as expeditiously as it ever has. That strain of influenza killed as many as two hundred thousand people in the world—but it could have been many times worse. 

In 1957, for example, the Asian flu pandemic killed more than a million people. In 1968, the Hong Kong flu pandemic killed between one and four million. Maybe we will also be lucky this year. (It ought to be remembered that, even now, the seasonal flu poses a much greater threat to the health of the average American.) Unless covid-19 proves to be uniquely virulent, it will likely subside within a few months, and the danger it poses will be substantially forgotten, like that of sars, mers, avian influenza, and other zoonotic diseases. But it is too soon to know for certain. 

Scientists are moving with great speed to stop this pandemic. They sequenced the virus in less than two weeks—an essential step in creating diagnostics, drugs, and vaccines, and one that only a few years ago would have taken months. But, even with expedited trials and drug development, it could take a year to create a vaccine. If this virus were to swerve out of control before then, the death rate could soar. 

In addition to the human toll, the economic damage to China—and, eventually, to the rest of the world—would be enormous. Industrial supply chains throughout the world have already been badly disrupted. Travel to and from China has all but stopped, and xenophobic attacks against Asians are rising. Although New York City has not reported a single confirmed case of covid-19, business in Chinatown has reportedly fallen by more than fifty per cent since the epidemic began.  

Not all of this has to happen; we can do a much better job of preparing for these epidemics, just as we no longer wait to have heart attacks before we use our knowledge to limit their risk. Prevention works, and it can work with viral epidemics. For now we can be much more vigilant about improving sanitary conditions and regulating livestock in the kinds of markets where outbreaks are likely to occur. Sufficient and reliable tests for people who may have been exposed must be made readily available. There are scores of similar viruses found in host reservoirs—most notably, bats. Many of those viruses have genetic similarity to this coronavirus, and also to sars and mers. 

The time has come to use the modern tools of molecular and synthetic biology to make drugs and vaccines to protect us from them. We can make DNA vaccines in laboratories and store them as spare parts, just as we do with parts for a phone or a laptop. Why not work on making vaccines that would protect broadly against this entire class of virus, rather than waiting for each one to attack us, and then try to fight back? Today, with the annual flu, we grow most of our vaccines in eggs, just as we have for decades. It’s time to move on. 

At some point, not many years from now, we will have the capacity to instantly sequence viruses and to make and operate diagnostic tests anywhere, not just in a lab. Biology is becoming digital information, and it needn’t be stored only in Cambridge, or Palo Alto, or Paris. It is already possible to transmit and print a DNA sequence using the molecular equivalent of 3-D printers—a process that could enable scientists almost anywhere to construct vaccines. Making this technique readily available should be a national and, in fact, an international priority. 

There are other possible solutions, such as editing the genes of pigs (and bats) to repulse the viruses that can transfer to humans. This kind of ecological intervention would be scientifically difficult, and ethically questionable. But it will inevitably be discussed, so let’s do it rationally. 

Even if this pandemic passes quickly, there will be another one, possibly far more catastrophic, next year, or in ten years’ time, or twenty. All we can know for sure is that if we have any hope of containing it, the time to prepare is now.

An example of bogus news: 'Six COVID-19 cases confirmed in Wilmington, NC'

Earlier today I followed a tweeted link this report:

Via cbtvn.com: BREAKING NEWS: Six coronavirus cases confirmed in Wilmington. Excerpt:

Five Americans and one Chinese have tested positive for coronavirus in Wilmington, North Carolina, authorities have said in a statement. 

According to the statement, five people became ill after coming into contact with a Chinese colleague who was visiting from Shanghai and had recently been in Wuhan, the epicentre of the outbreak.  

Authorities say the Chinese is still not showing symptoms of the virus despite testing positive and that is why border control did not notice. 

The six have been admitted at an undisclosed health facility and are staying in an isolation ward.

Nothing yet on the website of the North Carolina Department of Health and Human Services. And nothing in the North Carolina papers and TV stations I've checked.

Well, what Twitter provided, Twitter could also fact-check, and the report was rapidly debunked. "CBTVN.com" is a fake-news site with a bunch of COVID-19 reports, and no indication at all of who created it.

I'm a bit bemused that anyone with the resources would go to the trouble of creating such a site. It's not as if public confusion about COVID-19 will affect the outcome of the 2020 presidential election, or topple the Xi regime. It's mischief, a nuisance; even combined with other such reports, it seems unlikely to weaken support for government health agencies, the American healthcare system, or WHO.

Then again, I could have said the same about the idiotic tweets a few months ago concerning Ebola-ridden DR Congo migrants slipping across the Rio Grande to spread disease among upstanding white folks. Someone out there is exploring the exciting potential of undermining Western nations' institutions through bots and disinformation. It's certainly cheaper (and perhaps more entertaining) than going to the trouble of fighting a world war.

So if nothing else, it's been a teachable moment, and it's taught me (I hope) to post from a single source only if the source is known and reliable. 

China expands chaotic dragnet in COVID-19 crackdown

Via The New York Times: China Expands Chaotic Dragnet in Coronavirus Crackdown. Excerpt:

China’s leaders expanded a mass roundup of people possibly sickened with the coronavirus on Thursday, widening their dragnet well beyond the epicenter of the outbreak to at least two more cities in what the government has called a “wartime” campaign to stamp out the epidemic.  

But the campaign, first announced last week in the city of Wuhan, already has been marred by chaotic conditions that have isolated vulnerable patients without adequate care and, in some cases, left them alone to die.  

The expansion of the decree to “round up everyone who should be rounded up” in the Wuhan area of central China has deepened the nation’s sense of anxiety. 

In their zeal to execute the edict, officials in Wuhan, a metropolis of 11 million, have haphazardly seized patients who have not yet tested positive for the coronavirus, in some cases herding them onto buses with no protective measures where they risked infection from others, their relatives said.

After that, patients have been sent to makeshift medical facilities that don’t provide the support they need to recover. With little to no dedicated medical staff on hand to help, some patients die. 

One woman was abruptly carted off to a quarantine facility and prohibited from retrieving her supply of heart medication, her daughter-in-law said. A man said he was getting sicker and sicker in his hotel room, but there were no doctors and he was not allowed to leave. 

Another man placed in a makeshift shelter fell into a coma for two days, but his family said they couldn’t get him admitted to a hospital. He died. 

Despite the upheaval, the mass roundup extended beyond Wuhan to include other cities in central Hubei Province that have been hit hard by the outbreak. The state-run CCTV news broadcaster said the expanded area included the cities of Huanggang and Xiaogan.  

A sudden spike in new cases could make the situation worse. Officials in Hubei Province announced on Thursday that they had expanded the criteria for counting new infections to include diagnoses by doctors based on a chest scan and symptoms, rather than a more complicated test. The tally from the outbreak surged as a result, with the province adding nearly 15,000 new cases and 242 new deaths in a single day. 

The surge continued on Friday, though not as markedly, when Hubei officials disclosed about 4,800 new cases and 116 additional deaths.

Singapore confirms 5 new cases of COVID-19; 1 more patient discharged

Via Channel News Asia: Singapore confirms 5 new cases of COVID-19; 1 more patient discharged. Excerpt:

SINGAPORE: Singapore reported five new cases of COVID-19 infection, the Ministry of Health (MOH) said in an update on Saturday (Feb 15). 

Of these, three are linked to the cluster at Grace Assembly of God church; one is linked to the cluster at Seletar Aerospace Heights construction site and the other case is linked to a previous case.  

This brings the total number of novel coronavirus infections in Singapore to 72. 

Singapore's Health Minister Gan Kim Yong had earlier said authorities expect the number of COVID-19 cases to increase in part due to enhanced disease surveillance implemented.  

One more patient has also been discharged from hospital as of Saturday, said MOH. She is Case 24, a 32-year-old Singaporean tour guide who brought 20 tourists from China to health products store Yong Thai Hang.   

The ministry added that to date, a total of 18 cases have fully recovered from the infection and have been discharged from the hospital. 

To cope with anxiety, coronavirus patients do the safety dance

Via Sixth Tone, a very good online news source: To Cope With Anxiety, Coronavirus Patients Do the Safety Dance. Note: "square dancing" in China means "dancing in the public square," not American square dancing. Click or tap through for links and a video.

Videos of masked coronavirus patients square dancing with their doctors in full hazmat suits were widely circulated on Chinese social media this week, shedding light on how patients and medical workers are finding psychological solace amid the ongoing coronavirus epidemic. 

As of Friday, COVID-19 had killed over 1,300 people in China — most of them in the central Hubei province, where the coronavirus outbreak originated — and infected over 60,000 worldwide. 

Given the shortage of mental health professionals, other medical workers have had to think creatively to cope with the sometimes-grim reality. At several of Wuhan’s fangcang — exhibition centers, stadiums, and other public venues that have been converted into temporary “shelter hospitals” — patients have embraced square dancing and tai chi to stay healthy in mind and body.  

“The patients feel heavy-hearted being quarantined at the hospital, so our staff have arranged for them to dance for half an hour after dinner,” said Zhou Junhui, head nurse at Zhongnan Hospital of Wuhan University. “Square dancing cheers them up and improves their immunity, which in turn helps them recover.”

Because of a dire shortage of beds at Wuhan’s overstreched hospitals, over 4,300 patients with relatively mild symptoms have been sent to the city’s seven fangcang. Mental health professionals regularly visit these facilities to offer counseling services, and have set up chat groups, online forums, and hotlines for use by both patients and medical workers who need to unburden themselves.  

But there are still too few of these sorely needed specialists to go around, according to Xiao Jinsong, a senior counselor at Zhongnan Hospital. 

“Psychological services are necessary to prevent post-traumatic stress disorder,” Zhao Xudong, a professor of psychiatry at Tongji University in Shanghai, told Sixth Tone. “Some people cannot bear the lingering impact of their trauma.”  

So-called primitive fears — fear of strange surroundings, closed spaces, the unknown, or death, for example — can consume people’s emotions, said Zhang Chun, director of the Nanjing Psychological Crisis Intervention Center. As a result, Zhang added, they may experience anxiety, general dissatisfaction, or even aggressive behavior.  

To help mitigate such negative emotions, Wuhan’s fangcang have established radio stations, book clubs, and counseling groups for their patients.  

Xu Feng, a pseudonym for a patient at one of the shelter hospitals, described how the coronavirus has torn families apart. Some of those who are admitted may have lost a parent or a spouse to the epidemic, he said — but for the sake of their relatives who are still alive, they must remain strong.  

“To society, we may be just a small part,” he said. “To our families, we may be everything.”

Dr. Tedros on Ebola and COVID-19: 'For too long, the world has operated on a cycle of panic and neglect'

Via WHO, an excerpt from the speech given today by Director General Dr. Tedros Ghebreyesus at the Munich Security Conference.

Yesterday I was in Kinshasa, in the Democratic of the Congo, meeting with the President and other senior ministers to review progress against the Ebola outbreak and work together on a plan to strengthen DRC’s health system so that it never sees another outbreak like this again. I’d like to thank the President for his leadership, and for his vision of a healthier and safer DRC. 

We are finally starting to see the possibility of ending this outbreak, after more than 18 months and the loss of 2,249 lives. In the past week there has been just 1 case of Ebola, compared with 120 cases a week at the peak in April.  

This epidemic stands in stark contrast to the previous Ebola outbreak in the western part of DRC in 2018, an area that is relatively stable and peaceful. That outbreak was controlled in just three months.  

This experience illustrates a key lesson of history: disease and insecurity are old friends. 

It was no coincidence that the 1918 flu pandemic erupted in the middle of the First World War, and killed more people than the First World War itself. It’s no coincidence that the final frontier for eradicating polio is in the most insecure regions of Pakistan and Afghanistan. It’s no coincidence that Ebola has spread in the most insecure region of the DRC. Without peace, health can be an unattainable dream.  

But the opposite can also be true: epidemics have the potential to cause severe political, economic and social instability and insecurity. Health security is therefore not just the health sector’s business. It’s everybody’s business. 

There are three main scenarios in which a coordinated response between the health and security sectors is essential: 

First, high-impact epidemics in situations of conflict and insecurity, such as Ebola. In the last few years, 80% of outbreaks requiring an international response have occurred in countries affected by fragility, conflict and insecurity.  

Second, the emergence of a pathogen with pandemic potential, moving rapidly from country to country and requiring an immediate and large-scale response in countries. 

And third, the deliberate or accidental release of biological agents – a hopefully rare event for which we must nonetheless be prepared. 

The second of these three scenarios is what we are seeing now with the outbreak of COVID-19. Although PHEIC (Public Health Emergency of International Concern) is declared, with 99% of cases in China, this is still very much an emergency for that country. Because in the rest of the world we only have 505 cases and in China we have more than 66,000 cases. 

Let me be clear: it is impossible to predict which direction this epidemic will take. What I can tell you is what encourages us, and what concerns us. 

We are encouraged that the steps China has taken to contain the outbreak at its source appear to have bought the world time, even though those steps have come at greater cost to China itself. But it’s slowing the spread to the rest of the world.  

We’re encouraged that outside China, we have not yet seen widespread community transmission. We’re encouraged that the global research community has come together to identify and accelerate the most urgent research needs for diagnostics, treatments and vaccines. 

We’re encouraged that we have been able to ship diagnostic kits, as well as supplies of masks, gloves, gowns and other personal protective equipment to some of the countries that need it most. 

We’re encouraged that an international team of experts is now on the ground in China, working closely with their Chinese counterparts to understand the outbreak, and to inform the next steps in the global response. 

But we also have concerns. We’re concerned by the continued increase in the number of cases in China.  

We’re concerned by reports from China yesterday of the number of health workers who have been infected or have died.  

We’re concerned by the lack of urgency in funding the response from the international community. 

We’re concerned about the severe disruption in the market for personal protective equipment, which is putting front line health workers and carers at risk. 

We’re concerned about the levels of rumours and misinformation that are hampering the response.  

And most of all, we’re concerned about the potential havoc this virus could wreak in countries with weaker health systems. 

The outbreaks of Ebola and COVID-19 underscore once again the vital importance for all countries to invest in preparedness and not panic. 

Two years ago, WHO and the World Bank founded the Global Preparedness Monitoring Board, an independent body to assess the state of the world’s readiness for a pandemic. My sister Gro Bruntland, the co-chair of the Board, is actually here. 

Last year the board published its first report, which concluded the world remains badly prepared. For too long, the world has operated on a cycle of panic and neglect. We throw money at an outbreak, and when it’s over, we forget about it and do nothing to prevent the next one.  

The world spends billions of dollars preparing for a terrorist attack, but relatively little preparing for the attack of a virus, which could be far more deadly and far more damaging economically, politically and socially.  

This is frankly difficult to understand, and dangerously short-sighted.

COVID-19: WHO Thailand Situation Report – 15 February 2020

Via ReliefWeb, WHO has published Coronavirus disease 2019 (COVID-19) WHO Thailand Situation Report – 15 February 2020. Excerpt:

• Today, 15 February 2020, the Ministry of Public Health of Thailand announced a new laboratory-confirmed COVID-19 novel coronavirus case, the 34th confirmed case in the country so far.  

• The case reported today is that of a 35-year-old health care worker who tended to a COVID-19 patient at a private hospital. According to the Ministry’s report, the health care worker did not wear a mask consistently while looking after the patient. 

• WHO reiterates that health screening and surveillance systems in Thailand – at points of entry into the country as well as nationwide - are robust and capable of tracking suspected cases quickly, allowing health authorities to implement protocols to ensure isolation, contact tracing, testing and treatment of symptoms.  

• Today’s report also indicates the importance of all health care personnel rigorously applying the required infection control measures when caring for suspected cases, including the correct use of appropriate face masks. 

• Meanwhile, two COVID-19 patients, a 70-year-old man and a 30-year-old man, both of whom suffered from serious underlying medical conditions before infection, remain in what authorities describe as a “severe condition.”  

• Additionally, the 30-year-old man is reported to be on extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, which is a technique of providing prolonged cardiac and respiratory support to a person whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion (the passage of blood, a blood substitute or other fluid through the blood vessels or other natural channels in an organ or tissue) to sustain life. 

• The Ministry of Public Health also reports that 130 persons are currently under investigation, while 674 have been treated for symptoms and discharged. (These numbers have been revised downward by the Ministry of Public Health, after duplication of data was discovered.) 

• 138 Thai nationals remain under a 14-day quarantine at Navy guesthouses after having been brought back to their country from Wuhan, China on 4 February. This quarantine period expires in the coming week. A man among this group who tested positive for novel coronavirus after displaying flu-like symptoms on 7 February is said to be doing well.

What went wrong on the Diamond Princess? Why cruise ships are a hotbed for viral outbreaks

Via CBC News: What went wrong on the Diamond Princess? Why cruise ships are a hotbed for viral outbreaks. Excerpt:

The decision to quarantine some 3,700 people on board the Diamond Princess cruise ship in Japan amid an outbreak of coronavirus is unprecedented. But experts say it's also likely doing more harm than good.  

"It would be extremely difficult to end up containing it on a cruise ship, which is sort of like the most obvious place to house people where disease spreads," said Dr. Michael Mina, an epidemiologist and assistant professor at Harvard's School of Public Health.   

"It was really a bad idea from the start."  

The U.S. Centers for Disease Control has recorded hundreds of viral outbreaks on international cruises over the past 25 years, with norovirus being the most common with more than 250 cases. 

"There's always going to be a risk of transmission of a disease when you've got thousands and thousands of people on board from different backgrounds with different medical conditions," said Dr. Robert Quigley, of International SOS, a security and medical travel risk firm.  

"They congregate in public areas and they're in close proximity, because there's only so much cubic space on these cruise ships."

Quigley says because the illness caused by the coronavirus, now known as COVID-19, is extremely contagious, it's no surprise the Diamond Princess saw case numbers rise since the quarantine began on Feb. 4.  

There have been 218 passengers with confirmed cases on the ship, 12 of whom are Canadian, and pressure has mounted to allow them to leave as quarantine efforts failed to contain the outbreak.   

"Some of them are not in quarters that even have windows, let alone balconies, and so it becomes a challenge," he said. "There's so many ways that these people could be further exposed, regardless of the efforts that are being made to keep them in their quarters."   

One key factor with ongoing infections may be the ship's crew, who have been tasked with delivering food and supplies to passengers amid the outbreak. 

At least 10 staff members have already been infected, which Mina says was a "turning point" for him in assessing the effectiveness of the quarantine. 

"Clearly the quarantine is no longer working," he said. "You're just asking for continued transmission and now that we really know that transmission is occurring on the ship, it really drives the whole question of, what's even the point of this quarantine?"

Full spectrum of COVID-19 severity still being depicted – Authors' reply

Via The Lancet: Full spectrum of COVID-19 severity still being depicted – Authors' reply. Excerpt:

Zhou Xu and colleagues point out that mortality, which should be referred correctly and more clearly as case fatality ratio, among the first 41 cases with laboratory-confirmed 2019 novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was misleading in our Article. 

We definitely agree that the case fatality ratio among the first 41 cases cannot represent the case fatality ratio of the full disease spectrum during the outbreak of COVID-19. From the perspective of case detection, the reasons for the inconsistency between the case fatality ratio reported in our Article and data that have become available since publication of our Article were clearly clarified in advance in the comment by Chen Wang and colleagues. 

Patients with the most severe symptoms were paid attention to during the early stages of the outbreak because of limited resources to detect severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection. From the perspective of treatment, even the most up-to-date case fatality ratio is expected to decrease as diagnosis and treatment procedure for patients with pneumonia who are infected with SARS-CoV-2 is improving, potential drugs to treat COVID-19 are being evaluated for efficacy and safety in ongoing clinical trials, and management is becoming more intense, not only for patients with severe infection but also for those with moderate, mild, or even asymptomatic infection. 

Without denying the limitations of our study at the time of publication, we still hope our results provided a useful depiction of clinical features of SARS-CoV-2 infection at the very early stage of the outbreak and during progression of disease. Intense and continuous efforts are indeed needed for medical workers and researchers all over the world to get the full picture of the spectrum of disease severity of COVID-19 and to overcome the huge health challenge.

France: First COVID-19 death outside Asia; US will evacuate citizens from Diamond Princess

From The New York Times: Coronavirus Live Updates: First Death Outside Asia Reported in France. Excerpt:

France announces the first coronavirus death in Europe. 

France’s health minister, Agnès Buzyn, said on Saturday that a 80-year-old Chinese tourist had died of coronavirus on Friday at a hospital in Paris.  

Ms. Buzyn said the man, who was from the Chinese province of Hubei, the center of the outbreak, arrived in France on Jan. 16 and had been hospitalized at the Bichat-Claude Bernard Hospital since Jan. 25.  

“His condition had quickly worsened and he had been in critical condition for several days,” Ms. Buzyn said in a televised statement.

She did not name the patient. The man’s daughter also has the coronavirus and was also hospitalized in Paris, Ms. Buzyn said, adding that she should be discharged soon.

The victim and his daughter were among 11 confirmed cases in France, which also included five British citizens who stayed in a ski chalet in the French Alps. 

A total of nine cases have been confirmed in Britain, and on Saturday the country’s National Health Service said that all but one had been discharged from hospitals. 

The death in France is the fourth from the virus outside of mainland China, where about 1,500 people have died, most of them in Hubei Province. The Philippines, Hong Kong and Japan have each reported one death. 

The U.S. says it will evacuate Americans from the cruise ship quarantined off Japan.

The United States will evacuate Americans from the cruise ship that has been quarantined for more than a week in Japan because of coronavirus infections on board, the United States Embassy in Tokyo told Americans aboard the ship on Saturday. 

American passengers and crew members were told in an email from the embassy that a chartered flight would arrive on Sunday for those who wanted to return to the United States. 

The ship, the Diamond Princess, was placed under quarantine at the city of Yokohama early last week with about 3,700 passengers and crew members aboard, after a man who had disembarked in Hong Kong was diagnosed with the coronavirus. Since then, at least 218 cases have been confirmed aboard the ship. 

There are hundreds of Americans aboard, and at least 40 who were infected with the virus have been taken off the ship for treatment. 

Japan has more confirmed coronavirus cases — the vast majority of them from the ship — than any country outside China, and it reported its first death from the virus on Thursday.