Mutating Corona Virus

[BazzaS]

1. Range 2-14 days is not “incubation period is 14 days” that you keep banging on about, any more than it’d be accurate to say “incubation period is 2 days”.

 

Not only do I understand range, median, mode and mean, but distribution (e.g. normal distribution), and standard deviation too ..... having mentioned these previously.

Search enough of my previous posts and you’ll see part of my work involves such.

is part of your work explaining to people not only the statistics.... but as importantly : their limitations.....

 

2) I still don’t believe there are 3 authorised labs holding smallpox stocks. Which 3 labs? (You may find that it was always 2 authorised labs, even if it was stock transferred from one to a different one in the USSR, only ever 2 at any one time), but still waiting on you clarifying which 3 so I can see if that is the explanation for your mistaken belief.

 

You might want to read Kanatjan Alibekov’s (Anglicized : Ken Alibek) book ‘Biohazard’.

 

3) The smallpox vaccine target didn’t mutate and that was one of the key features in its eradication.

It didn’t mutate over centuries.

Seems little point in me repeating it yet again, so this is my last try on that point.

Edited January 27, 2020 by BazzaS

[BazzaS]

If we can’t agree on the incubation period, what are you thoughts on “Ro” for 2019-CoV (or R0), which I’d prefer to write as R(subscript-0) if I was able....

 

a) what would you estimate it to be?

 

I’ve seen estimates of between 1.4-2.5 (the WHO report factoring in 4th generation cases, from Jan 23rd),

 

1.4-3.8 from other analyses from the same date, although Fisman from Toronto (who did much of the modelling around SARS) cites a paper noting “the volume of observed exported cases in countries outside China suggested a much larger underlying epidemic than had been reported at that time, and this epidemic may have begun a month prior to the recognition of
the market-associated outbreak, consistent with the reported timing of
viral emergence based on phylogenetic analyses”

Fisman believes there is “a SARS-compatible generation time of 6-10 days” (so, again, not 14 days!), stating that he believes the transmission dynamics are similar to SARS :  “ It is the average R0 that determines whether, and how, the disease
can be controlled.  By analogy with SARS and MERS, with which nCoV
seems to share many characteristics, the spread of this virus should
be controllable.”

 

Do you agree:

a) “superspreaders may widen the Ro range seen” (there are suggestion one hospitalised case generated 14 secondary cases), and

b) the outbreak can be controlled by measures to bring Ro (targeting both standard spreaders and accepting the challenge of “superspreaders”) down to below 1?

 

Happy to consider your expert epidemiological opinion based on current knowledge of the statistics currently available (& accepting that the information gets refined over time!)

 

Ohh, and that still isn’t an incubation period of 14 days, if the generation time is 10 days  (dependant on when / if infectivity occurs prior to symptoms, are you suggesting that that interval is 4+ days??)

Edited January 27, 2020 by BazzaS

[BazzaS]

Ahh well. No actual answers then.

Fair enough, I can’t persuade you.

 

Time will tell.

[BazzaS]

“Same chap” as in Prof Ferguson from Imperial, or as in Dr Carrington (who has returned to St George’s but used to head up the PHE [PHLS in those days!] Virology Service in Bristol) along with Matt Donati and Peter Muir)

 

You’ve quoted them both, recently.

Edited January 27, 2020 by BazzaS

[BazzaS]

1 hour ago, hightail said:

Meanwhile the December figures for our 'ordinary' annual flu don't make particularly pretty reading but nobody has triggered panic mode.

......

 

Prescribers may now prescribe and pharmacists may now supply antiviral medicines for the prophylaxis and treatment of influenza at NHS expense.”

 

No need for panic mode (for flu)

 

We have a vaccine.

 

We have a widely available testing system to differentiate FluA and B from the other respiratory viruses with similar presentations.
 

We have treatments (oseltamivir, and zanamivit) and the testing means to determine if the FluA is an H3 or H1 (helping predict when to use zanamivir because of the higher risk of oseltamivir resistance via the H275Y mutation that is seen more commonly with H1N1 over H3 strains)

 

More interventions / treatments : less panic.

[BazzaS]

Up to people to decide if they want to put trust in what I post, HB, not based on me claiming to be a virologist (I’m not claiming to be one btw!). I could claim to be John Oxford, or Nick Phin (I’m not either of them), but how would I prove it?. So, I’ll TRY to persuade people by using the resources I have access to, what I’ve posted here, and what I’ve posted about ‘flu in the past.

 

I had difficulty persuading someone back then, too.

 

I posted then about the likelihood of the change in UK vaccine schedule (again, based on a resource I had access to). 3 months later : that change became public policy. Perhaps that track record might persuade some.

[BazzaS]

10 minutes ago, BazzaS said:

No need for panic mode (for flu) (and I explained why ......

 

10 minutes ago, BazzaS said:

1 minute ago, tobyjugg2 said:

I thought hightail made a couple of excellent points there:

 

Not least that there are far more people dying every year from 'ordinary' flu strains but we aren't panicking about it

 

 

We have a vaccine.

 

We have a widely available testing system to differentiate FluA and B from the other respiratory viruses with similar presentations.
 

We have treatments (oseltamivir, and zanamivit) and the testing means to determine if the FluA is an H3 or H1 (helping predict when to use zanamivir because of the higher risk of oseltamivir resistance via the H275Y mutation that is seen more commonly with H1N1 over H3 strains)

 

More interventions / treatments : less panic.

 

Sadly my explanation hasn’t helped (or, at least hasn’t helped my main sceptic).

OK, I’m done here.

[BazzaS]

Must resist, can’t resist.

 

It is about panic, and reasons to panic (or not).

 

I wasn’t ignoring hightails point (& I’ve found them a reasoned and reasonable contributor)

 

But if one is looking for factors where people should be more or less worried: I’ve laid them out.

 

What will happen? Hopefully 2019-nCoV won’t kill more than ‘flu (SARS didn’t!). SARS did kill many healthcare professionals in Toronto though, including those who knew the risks, and still turned up to work.

 

What will happen? Hopefully 2019-nCoV won’t kill more than ‘flu (SARS didn’t!), but only time will tell.

 

Really done now. Bait all you want, I’m turning notifications off. 

[BazzaS]

In case this hasn’t been posted (Lets just say I may not be seeing some contributors messages, nor their posts even if I dip back into this thread):

 

For the benefit of those who want info “from the horses mouth”

 

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200127-sitrep-7-2019--ncov.pdf

 

“Current estimates of the incubation period of the virus range from 2-10 days, and these estimates will be refined as more data become available. Understanding the time when infected patients may transmit the virus to others is critical for control efforts. Detailed epidemiological information from more people infected is needed to determine the infectious period of 2019- nCoV, in particular whether transmission can occur from asymptomatic individuals or during the incubation period.“

Sitrep 8 has been issued by WHO, but doesn’t update on the epidemiological info of incubation and transmissibility periods, but does update on the case /country numbers.

 

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200128-sitrep-8-ncov-cleared.pdf?sfvrsn=8b671ce5_2

 

As ever, they are careful to state that this is “current best knowledge”, and subject to change as more knowledge / data becomes available.

 

[BazzaS]

Trying to persuade people I know what I'm talking about, will just have to be my pet project, but not my Priority. 10 (or more) useful cites might help establish my bona fides - but I suspect still won't persuade all.

 

Latest WHO Sitrep: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200204-sitrep-15-ncov.pdf?sfvrsn=88fe8ad6_2

1 death outside China (in the Philippines). That page summarizes the cases by region, including Europe, and confirms the UK's 2 cases.

 

There is now a candidate treatment : remdesivir.

 

South Korea is now derogating from the case finding definition of 

a) travel to China in the preceeding 14 days, or

b) contact with a confirmed case

South Korea is now aiming to test anyone with compatible symptoms regardless of travel / exposure history.

 

Expect hospitals to have a room (ideally NOT in A&E!) to redirect possible cases into (to phone 111, to have them screened for the case definition).

 

I'll try to update (to reach my 10 or so useful cites), but this is for people to make their own minds up : I'm unlikely to enter into protracted debate - as I said, it isn't my priority.

 

 

 

[BazzaS]

19 hours ago, BazzaS said:

Expect hospitals to have a room (ideally NOT in A&E!) to redirect possible cases into (to phone 111, to have them screened for the case definition).

posted 2 am 5/2/20 or thereabouts. Then, some 17 hours later......

 

Coronavirus: NHS orders 'assessment pods' in England hospitals https://www.bbc.co.uk/news/uk-51392607

from BBC News, 19.20 5/2/20

 

lucky guess by me, eh?

 

Incidentally, that BBC News page uses a “stock photo” of a healthcare worker using a surgical mask. Shame then that the picture used doesn’t show the correct PPE for 2019-nCoV..........

[BazzaS]

Case definition updated (change in symptoms) but also a much larger change in geographical areas

 

The initial advice had only covered mainland China, but now also includes:  
■   Thailand
■   Japan
■   Republic of Korea 
■   Taiwan 
■   Singapore
■   Malaysia
■   Hong Kong
■   Macau 

 

presumably because:

Coronavirus: Third UK patient 'caught coronavirus in Singapore' https://www.bbc.co.uk/news/uk-51398039

 

 

 

[BazzaS]

On 27/01/2020 at 14:39, BazzaS said:

 

Do you agree:

a) “superspreaders may widen the Ro range seen” (there are suggestion one hospitalised case generated 14 secondary cases), and

b) the outbreak can be controlled by measures to bring Ro (targeting both standard spreaders and accepting the challenge of “superspreaders”) down to below 1?

reports of a 4th UK case (and both that person and the UK-nationals in France confirmed with  Coronavirus) having acquired it from the “3rd UK case” (who was a returnee from Singapore).

 

Suggestions that that 3rd Uk case may be a “super-spreader) (as was seen with SARS)

 

BBC News has just reported that the government has just announced:

Coronavirus 'imminent threat' to public health https://www.bbc.co.uk/news/uk-51442314

Expect that to mean that quarantine can be enforced (it takes a change in the law, probably by Statutory Instrument) to add 2019-nCoV to the list of diseases a “proper officer” can detain a person against their will.

It has benefits for those affected to.

Expect that where someone doesn’t have friends or family to go shopping for them, or would suffer financially from being isolated / ‘self-isolated’, that there is a more formal mechanism for them to receive support. 

 

[BazzaS]

I don’t see all the posts on this thread, so don’t know if there is a context in which HB is posting / replying, but it is always a pleasure to respond to HB.

 

The issue the experts raise in that article is that passengers aren’t being offered the opportunity to “disembark and go into quarantine”.

‘Preventing travellers disembarking and travelling without restriction’ has been permissible for a long time : the phrase ‘quarantine’ arises from the 40 days people were quarantined from vessels approaching Venice in the 14th Century.

https://www.cdc.gov/quarantine/historyquarantine.html
 

What you would wish to avoid is “importing new susceptibles”.

 

Cruise lines have established policies for these situations : norovirus outbreaks are a problem for cruise, lines based on similar transmission dynamics (large droplet spread contaminating shared areas), with control measures including enhanced environmental cleaning and restricting passenger cases to their cabins.

 

Crew are a different story, as they live in much higher density cabins. My expectation is that affected crew will be ‘cohorted’ in an “infected crew cabin”.

Air conditioning shouldn’t be an issue, as the virus isn’t spread by ‘aerosol’ (like flu), but by droplet.

Plumbing would be more of a concern (as it was with SARS)

https://www.who.int/mediacentre/news/releases/2003/pr70/en/
 

until more is known of Covid-2019’s transmission and infect I ITU.

Sampling for those meeting the case definition initially included urine and stools samples. This was never realistically going to happen for the majority of those meeting the case definition (as few will be admitted to hospital, and if seen in A&E and not needing admission they’ll be sent home ASAP)

For those admitted, the stool and urine would have had to be collected & sent in the period before the initial test result came back : negative & there would be no need, positive (and needing to be in hospital)  and they’d be whisked off to one of the specialist units.....

 

Perhaps in recognition of this, the initial test set no longer includes stool and urine.

 

For the confirmed positives (9 so far....) the reference lab advises on ongoing sampling : they say “we’ll tell you what to send and when”, so it isn’t clear if they are asking for stool and / or urine, and if so, when ; either from the specialist units, or the recovered cases (at home).

Edited February 18, 2020 by BazzaS

[BazzaS]

Current case contact tracing looks at environmental contamination, so not “someone sneezes on a bus, person the other end of the bus catches it” (‘aerosol’, like ‘flu), but instead, for a plane :

 

contact for > 15 mins, within a 2m distance.

That is based on the stats (isn’t it always?), and “having to draw a line somewhere”

it doesn’t mean you suddenly start being at risk at 2.00m from 2.01m, nor “can’t catch it at 14 mins 59 seconds”.

That is for the “well”, who would then be asked to self-isolate, and only screened if they develop symptoms.....

Edited February 18, 2020 by BazzaS

[BazzaS]

My advice to a traveller : don’t wear a surgical or FFP2 mask. Wear an FFP3 mask ONLY if you know how to put it on and take it off AND know it fits you correctly (you’ve been “fit tested”), otherwise you are “making yourself feel safer” rather than “making yourself safer”.

 

Much more use is using hand sanitizer and / or washing your hands before touching your mouth, nose, or face, or eating.

To prevent you infecting others : “Catch it, Bin it, Kill it”

https://www.gov.uk/government/news/coronavirus-public-information-campaign-launched-across-the-uk

[BazzaS]

It already is epidemic.

perhaps he meant the next stage ... pandemic.

 

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html

 

media existing to sell newspapers / advertising space / looking to get viewer numbers ... who’d have thought it.

 

The media has a responsibility to give decent advice : appropriate concern rather than generating panic.

[BazzaS]

Delivery people don’t have to be at any more risk than the general public.

 

Even if someone is self-isolated : order online. Pay online.

delivery driver drops off on doorstep. Walks away.

self-isolated person (wearing a surgical mask*), opens door, moves shopping into their home, closes door, never touches the environment of outside their front door.

delivery driver washes their hands / uses alcohol gel sanitizer.

 

* FFP3 mask (fit-tested, correctly donned and doffed) protects uninfected person from the environment. Surgical mask protects (large droplet) environment from infected person.

Edited February 28, 2020 by BazzaS

[BazzaS]

FFP3 masks : only useful if used correctly by people who have been “fit - tested” - some people the masks just don’t fit well enough.

 

The problem then is that people think they are being protected by the mask, but aren’t.

[BazzaS]

The “proper officer” will have power over individuals (if the virus added to the list of organisms such as MDR-TB / diseases which they already have powers over those infected)

The Civil Contingencies Act gives broad powers over groups / areas.

 

I suspect the new legislation is mostly codifying, perhaps with some new powers to defer / suspend some statutory limits (such as class sizes - has been suggested by the BBC)

“There are few details about what the measures could involve - but school class sizes in England is one area which would be addressed. They would be permitted to rise above statutory limits, in the event of widespread teacher absences.”

 

https://www.bbc.co.uk/news/uk-51684624

 

[BazzaS]

8 hours ago, PIXeL_92 said:

I flew to Sweden on Thursday last week by Saturday morning I had a sore throat, chesty cough and occasionally very slight shortness of breath (put this down to blocked nose and having to breath through mouth.) It has started to wear off, should I have really gone to the doctors in case ?

 

In case of what?

 

In case it was "what you normally get when you fly" : if you normally get that and there isn't anything different to normal, why are you worried about what is normal for you?.

 

In case it was a cold? Would you normally go to the doctors with a cold?

 

In case it was the current coronavirus people are panicking over?.

https://www.nhs.uk/conditions/coronavirus-covid-19/

https://111.nhs.uk/covid-19

 

In case *something else*: what *something else*?

 

 

So, if you think you have an ordinary cold, do what you normally do. I'd hope you don't go to the doctors with a cold unless there is something *out of the ordinary* or your doctor has previously told you "come to the surgery if ........" and you meet what they've advised.

 

If you think you might have Covid-19, just as HB has pointed out, going to the GP or the hospital is *just the wrong thing to do* (unless you need an ambulance to take you to A&E urgently, because you are that ill, in which case dial 999/112 for an ambulance, but tell them [or get whoever is calling for you if you are that unwell, to tell them] where you've traveled).

 

It is important to take simple precautions, and not ignore the risk this current virus poses, but at the same time : don't over react.

Think you have a cold or flu? : "Catch it. Bin it. Kill it."

Want to avoid catching covid-19, a cold, or flu: wash your hands. Wash them if contaminated. wash them before eating or touching your mouth or face.

This has been a BazzaS public service announcement on behalf of common sense, everywhere.

Edited March 3, 2020 by BazzaS

[BazzaS]

9 hours ago, honeybee13 said:

Easyjet have started cancelling flights. OH was due to travel from Gatwick to Montpellier and it's been called off.

 

Likely cancelled for commercial reasons (people cancelling their travelling plans, not enough pax to make the flight commercially viable).

There is no current FCO advisory against travel to Montpellier, although it seems sensible to limit non-essential travel.

 

In general terms (so, anyone, not just HB or her hubby!)

Able to work from home just as effectively as office? Why aren't you working from home already? :)

Able to work from home more (and still be as effective, or almost as effective)? Do so. "Sell it" to your employer as "I'll be less likely to get ill, so it can fit in with your resilience plan ......."

Is it essential you travel abroad? Put off non-essential travel : but if you have already booked? Follow the FCO advice.....

[BazzaS]

6 hours ago, unclebulgaria67 said:

 

plenty of soap and hot water for at least 20 seconds.

 

 

Correct.

 

6 hours ago, unclebulgaria67 said:

 

And don't just clean your hands, you have to wash up to your elbows.

 

wrong (unless of course you are using your elbows to eat with, or using them to touch your face..... but that’s pretty tricky)

Or, if you are scrubbing up in operating theatre, then yes, to elbows 

 

 

Spend the 20 seconds washing your hands.

if you wash up to your elbows you might be wasting 10 of those 20 seconds on upper forearms that don’t matter.

[BazzaS]

On 17/03/2020 at 16:13, honeybee13 said:

That's excellent, CJ.

 

On a more sombre note, I've just seen on Twitter that cynical thieves are posing as coronavirus testers at people's homes. Please pass this on so people aren't caught out.

 

 

“Ohh good, I need testing, I’ve got the worst cold I’ve ever had.

No you can’t come in, but I’ll happily cough on you on my doorstep!” .... and watch them run away!

[BazzaS]

13 hours ago, hightail said:

I’m no fan of Boris either but I have to grudgingly admit he seems to have got his act together.  

love him or hate him, he had (at least, as Mayor of London) an ability to get good advice, and listen to it.