This is the latest in our ongoing coverage of the fast-developing coronavirus outbreak originating in Wuhan, China. Our goal is to provide timely and science-based clarity on the situation for those overwhelmed by the many confusing & conflicting reports swirling in the media. If this is the first article of ours you’re reading on the subject, we recommend also reviewing our primer on the coronavirus.
There’s currently a bit of a kerfuffle on Twitter. It’s over an R0 study on ‘2019-ncov’, which is the official designation for the Wuhan coronavirus (as a reminder, R0 is a measure of how contagious a virus is).
The study is creating a stir because it initially reported an R0 of 3.8, but then was swiftly downgraded to 2.5.
First, it’s important to know that an R0 of 2.5 is still very bad. That’s at the top end of previously reported ranges that were in my video alert from yesterday.
This specific Tweet garnered a lot of attention because a Harvard trained epidemiologist used some very inflammatory language:
So who is Dr Ting?
He’s a Harvard trained epidemiologist:
Dr. Ting was reacting to a new study that estimated the coronavirus’ R0 using available data. Here’s the Twitter thread he posted:
Yikes! Pretty alarming.
Before we go on, I need to say that this study cited immediately came out with a retraction/adjustment and has since “downgraded” the R0 to 2.5.
I use quotation marks because whether the number is 2.5 or 3.8, it’s still a concerningly bad number.
Immediately and predictably, an army of people slamming Dr. Ting for being “alarmist” and unhelpful quickly emerged. These are the sorts of gatekeepers who feel it’s their duty, as enlightened souls, to help prevent less intelligent people from overreacting. Or something.
Notably among them was Ferris Jabr, who really took Dr Ting to task:
And who is Ferris?
I have no idea what Jabr’s qualifications are beyond that short bio. I’m guessing a ‘science writer’ has at least some science background??
Okay, with that as context, let’s parse through this. To begin, I completely disagree with the notion that making elevated claims during a pandemic is “unhelpful.”
Why? Because what’s helpful during a pandemic? I would suggest an overabundance of caution and swift reaction by authorities and the general public.
I already think that letting people travel while simply scanning them upon arrival for a fever is criminally negligent. I would vastly prefer a much more reactionary response.[optin-monster-shortcode id=”mnldlgnrbdryk45m4edk”]
People like Jabr fit comfortably within the Overton Window where it’s always polite to downplay risks and act as if the State has things firmly under control. You get invited to a lot more parties if this is your stance.
So, I take the opposite view of Jabr on this. I think overreacting is appropriate when the facts are still fluid and nobody knows truly what’s going on. I happen to think it is Jabr’s stance that is unhelpful and probably harmful. If “panicking” means reacting swiftly on incomplete data, then by all means ‘panic’ when a pandemic comes along. That’s just my view.
Now let’s turn to the study itself. The authors turned around and changed the study’s conclusions very quickly. I’m absolutely not going to fault them for that. We’re still in the very early stages of all this, and everything’s subject to change in an environment like this.
I fully applaud and respect people for changing their opinions and conclusions as more data comes in. That’s the same approach we take here at Peak Prosperity.
Here’s the latest from the study authors:
Comment: having such tight 95% confidence intervals after just downgrading your conclusion by -34% seems a bit precise.
The point stands, though, that they’re are still estimating an R0 of 2.5(!)
That’s NOT a favorable number.
This second, lower R0 estimate of 2.5 is still nearly impossible to contain and a major pandemic risk. We can expect that number to change, possibly radically, as more and better data comes in.
However, I just read the study and I’m pretty certain that the 2.5 number may be too low. Here’s why:
I’ve highlighted the most critical line from the entire study. The entire epidemiological model is built upon a number of assumptions — but the largest of them all is the use of “reported case information” as the primary input.
What are the chances that the Chinese government is reporting the full and accurate case information?
Either for political motives to downplay the severity (which every government would do, but China maybe more than most) or because of faulty case gathering (the PCR labs are swamped, and not every person got swabbed and sent off for testing), the “reported case information” is certain to be minimized vs reality.
In other words, the R0 of 2.5 is a minimum value, not a defined value (which is why I take exception to the confidence interval being so tight…that’s a measure of how confident they are if their data inputs are correct, not a measure of actual confidence that they are right).
So the true confidence interval should be placed around the question “how confident are we that the reported case information is correct?” There my instinct would be to have big, fat error bars mostly to the upside, meaning more cases than reported is the actual reality.
Whether it’s 3.8 or 2.5 or 6.7, the R0 for 2019-ncov is sufficient to cause a pandemic. It spreads easily. My current opinion, which I reserve the right to change when better data comes in, is that the current R0 estimate of 2.5 is too low because of its reliance on officially reported case data.
My advice to you is to begin practicing good hygiene right now. Your best defense against this virus is to not catch it in the first place.
So even in the safety of your own home begin these steps:
- Don’t touch your face.
- Don’t rub your eyes, don’t pick your nose, don’t wipe off your lips.
- Every single time you touch a “nuclear surface,” a doorknob, an oven handle, a railing, a chair armrest, immediately go and wash your hands.
- Practice wearing an N95 mask or its equivalent or better.
By doing these things you will be practicing habits that are useful during any flu season (which is still underway sadly). It takes time to break a lifetime of bad habits of transmitting contaminants to your mucus membranes. So, start them at home and you’ll be better equipped when in public.
When in public, be aware. If someone around you is sneezing or coughing, get away from them. Everybody in public, especially those infected should be wearing a properly fitted face mask. If or when the pandemic arrives where you live, eye protection is needed too. [read here of Chinese MD who traced his own illness to having exposed eyes]
This is all changing very quickly, and having proper information is essential.
Finally, here’s some great advice from Peak Prosperity member Sand-puppy (who has many years of experience in emergency rooms):
Home treatment of febrile Influenza Like Illnesses/Respiratory Infection[This is a very educated group and most are well versed in this.]
During outbreaks of viral illness, the ED will be a mad house. Stay away if possible. Recommend strong attempts at self-treatment at home. Stay out of the hospital unless truly needed.
- Ibuprofen 800 mg(or naproxen) for fever, body aches, headache, chest wall soreness. This is a miraculous drug for the misery of ILI. It also helps to sort out the miserable from the seriously sick (see below).
- If not vomiting repeatedly, you can drink water. “Drink until you pee.” Lots.
- Electrolytes in water if diarrhea is a part of fluid losses.
- If incessant coughing, Nyquil or equivalent.
The hospital ED will be a miserable place during a flu epidemic. Long waits, no pillows or blankets. No snacks. No sympathy from the staff!! Sleeping on the floor of the hallways. Remember that the ED staff is probably sick also.
A few situations where hospital care IS needed.
- Intractable vomiting (>6-8 times) or vomiting with diarrhea. IV fluids and anti-emetics will help when not able to hydrate by mouth.
- Chest pain and shortness of breath with fever, IF associated with fast pulse and low oxygen saturation. Might be pneumonia. Chest x-ray. Supplemental oxygen if oxygen is actually low. Measure pulse rate an oxygen saturation (see below). In children, fast breathing at rest, even after good fever control, points towards pneumonia.
- Severe headache even after big doses of Ibuprofen and hydration. Might be meningitis. Spinal tap needed. IV antibiotics might help. Don’t even think about spinal tap until ibuprofen dose has been in body for 2 hours—everyone with the flu has a terrible headache.
- Urinary symptoms. UTI can give a ILI, especially in children and women.
- Wheezing with cough. May have an asthma-like response to the infection. Albuterol (and maybe steroids) may help. Uncommon.
Equipment list for home treatment of ILI:
- Costco sized bottle of Ibuprofen or Naproxen. (Use the big dose)
- Watch with second handto measure pulse rate and respiratory rate.
- Pulse oximeter,$29 from Walmart or Amazon. This device will save you an ED trip. Recommended! Pic below.
- Big tumblerfor water. Drink and refill often.
- Electrolyte powder(mag and K) in water if have diarrhea.
- Disinfectant wipes.
Your faithful information scout,