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  • Podcast

    What The 1918 Spanish Flu Can Tell Us About The Coronavirus

    The world's readiness for a true pandemic is woefully lacking
    by Adam Taggart

    Tuesday, January 28, 2020, 8:13 PM

Given the continued spread of the Wuhan coronavirus, we urgently reached out to John Barry, author of the award-winning New York Times best-seller The Great Influenza: The Epic Story of the Deadliest Plague in History.

Two years ago, we interviewed John about the expected implications should a pandemic of similar scale break out in today world. Little did we realize at the time how quickly his insights would prove relevant.

John was the only non-scientist to serve on the US government’s Infectious Disease Board of Experts and has served on advisory boards for MIT’s Center for Engineering System Fundamentals and the Johns Hopkins Bloomberg School of Public Health. He has consulted on influenza preparedness and response to national security entities, the George W. Bush and Obama White Houses, state governments, and the private sector.

John remains quite concerned at how the world’s readiness for a pandemic is woefully lacking, exacerbated by the hyper-connectedness of our modern society (i.e., the ease and speed with with people can travel):

An often-overlooked part of the damage a virulent pandemic can do is its impact on supply chains and the economy.

If you’ve got 20 to 30% of your air traffic controllers sick at the same time, what’s that going to do to your economy?

Most of the power plants in the United States are still coal powered. They get their coal, most of them, from Wyoming. You see these enormous trains – that’s a highly skilled position, the engineers who move those trains which are a mile and a half long. Suppose they’re out. You’re not going to have power in many of the power plants.

These are things that we don’t automatically think of as relating to a pandemic. Even a mild one that makes a lot of people sick without killing them will wreak an economic impact.

In terms of the health care system, practically all of the antibiotics are imported. If you interrupt those supply chains then you start getting people dying from diseases that are unrelated to influenza that they would otherwise survive. We had a small example of that with saline solutions bags which were produced in Puerto Rico. Because of the hurricane, Puerto Rico was no longer producing them; so we had tremendous shortages in those bages after the hurricane. Other suppliers worldwide have picked up the slack, so that’s not a problem today.

But in a pandemic, you’re going to have supply chain issues like that simultaneously all over the world. So you’re not going to be able to call on any reserve, anywhere, because everybody’s going to be in the same situation whether you talk about hypodermic needles or plastic gloves — any of that stuff. The supply chain issues in a moderate pandemic are a real problem. If you’ve got a severe pandemic, the hospitals can’t cope. There are many fewer hospital beds per capita than there used to be because everything has gotten more efficient. In this past year’s bad influenza season, many, many hospitals around the country were so overwhelmed they all but closed their emergency rooms and weren’t talking any more patients for any reason.

There’s just no slack in the system. What efficiency does is eliminate as much as possible what’s considered waste, but that waste is slack. And when you have a surge in something, you need that slack to take care of the surge. If I were grading generously I would give us a D in terms of overall preparedness. If we had a universal influenza vaccine, maybe we’d be relatively okay, but we don’t.

And while good data is scarce in these early days, what we do know so far about the coronavirus does not encourage him. If the virus is indeed as contagious as suspected, he sees no hope of containing it before it becomes widespread:

Understanding the incubation period is very, very important.

The critical question is: Can you infect someone else when you’ve been infected but don’t have any symptoms?

The Chinese have made statements that they think that’s the case. If that’s in fact true, then there’s no chance of controlling this.

Exacerbating things, when facing an influenza pandemic, you have to sustain anything that you’re doing to be successfully preventive. And that’s extremely difficult for a public health official to get the public to do; sustaining the right behavior.

Unless you get in the habit of washing your hands all the time — and do it constantly, three, four, five days after you start doing it — you’re going to get tired of it. But that kind of behaviour has to be sustained to be effective.

I guess I’m a pessimist when it comes to changing human behaviour, even something as simple as handwashing — and good luck trying to prevent people from touching their mouth or eyes.

Even the “good” masks, like N95 respirators, have to be fitted almost perfectly for them to be effective. And they’re uncomfortable.

So for those who get sick, just stay home. It’s that simple. That runs counter to American culture; you’re supposed to tough it out — you’re sick, you go into work. But in this case, that’s not useful. Employers should emphasize that to their employees: If you’re sick, stay home.

Click the play button below to listen to Chris’ interview with John Barry (43m:34s).

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Transcript

Chris Martenson: Welcome, everyone, to this Featured Voices podcast of Peak Prosperity.com. I'm your host, Chris Martenson, and it is Monday, January 27, 2020.

This podcast we are going to explore the current coronavirus outbreak here in January 2020, first identified as a case that came out on December 8th, just barely a month and a half ago in 2019. I'm of the opinion that is a pandemic quality bug, and we need to look at, and look at it very closely. I'm also of the opinion that the US press has been doing a reasonably expectedly poor job of keeping people informed about this.

And you're really going to want to listen to this podcast because we're going to be talking again with John Barry who literally wrote the book on the Spanish flu. Okay, a book. But a really, really great one. In fact, it’s an award-winning New York Times best selling book called The Great Influenza: the Epoch Story of the Deadliest Plague in History. And let’s hope it remains the deadliest plague in history.

Now, as a I said, we first interviewed John Barry back in July of 2018 where he warned us then of the inevitability of a future pandemic. It was only a matter of time, he said. Well, it seems maybe that time has arrived. And so we're going to be talking with him again today to discover what he knows about this particular virus.

John Barry was the only non-scientist to serve on the US governments’ infectious disease board of experts. He served on advisory boards for MIT Center for Engineering System Fundamentals and The Johns Hopkins Bloomberg School of Public Health. He has consulted extensively on influenza preparedness and response to national security entities, the George W. Bush and Obama White Houses, state governments, and the private sector.

His verdict, back in 2018, was this: It was that the risk of a massively fatal worldwide pandemic, just like the 1918 Spanish flu, was remote but very real. And that any future pandemic would be heightened by the hyper-connectedness of our modern society. That is, the ease and speed of which people can travel around.

John, welcome back to the program.

John Barry: I'm not sure – considering the subject matter, I'm not sure it’s a pleasure. But…

Chris Martenson: Yeah. We're kind of sorry to have you back on, too. But here we are. And let’s start right at the beginning, John. I'm sure you’ve been glued to the news and emerging data, just as we have. What’s your take on this Wuhan coronavirus, which, I guess, goes by the technical name of 2019-NCOV, or NCOV. Does this have the characteristics of that pandemic you were warning us about?

John Barry: It certainly looks like a pandemic. You know, I don't know what it would take the World Health Organization to declare such an event, but, you know, it’s pretty close. I'm sure they’re thinking about it.

Chris Martenson: Well, they haven't declared it, but, you know, as we run down the checklist, I was looking at the WHOs own checklist as they take us through a pandemic table and..

John Barry: It’s pretty close. I mean, it actually probably fits all their criteria.

Chris Martenson: I think to get to phase five all we're missing is a sustained outbreak at the community level in a region other than China, I guess. That’s the step we're looking for, I would guess. But we have the cross-species jump. We have human to human transmission, multigenerational, meaning it’s hopped from human to human to human.

The things that are concerning us, and I’d love to get your take on this, is it appears to have a latency period, that is, people can be affected. It’s going through an incubation period, and it takes time – five to seven days before they get sick, just as a normal flu before you express symptoms – but it looks like they may be infective during that period of time. What’s your take on that?

John Barry: Well, the incubation period is very, very important. Flu is shorter than that. Flu can be as little as one day. And if you have a long incubation period, then you have a possibility of contact tracing and isolating individuals and so forth. If it’s a short incubation period, that’s impossible, as with influenza.

The question of whether you can infect someone else when you’ve been infected but don’t have any symptoms, I know the Chinese have made statements that they think that’s the case. I was talking to a friend of mine who is probably the premier worldwide expert on pandemics and a scientist and has been in touch with all sorts of folks worldwide, and he’s not convinced. He wants more data before he’s ready to say that. And that’s pretty important.

If that’s the case, then there's no possibility of containing this, I don’t think.

Chris Martenson: And let’s, before we go on to really dive in to this one, I would just like to – let’s take a tour back: the Spanish flu which your book was about. If you could, just take people through that story because I think there's some really instructive parallels.

So first, what similarities do you see, if any, between the Spanish flu and this new coronavirus?

John Barry: Well, I mean, let’s talk about what isn’t similar. And at this point, the case mortality is very unclear on this outbreak, and that’s pretty crucial. You know, also, just how many people are going to turn out to be susceptible, that’s not clear.

But as far as 1918, the virus, of course, comes from animals. All influenza viruses have a natural reservoir in birds. They go from birds to other mammals. It spread pretty – there's dispute over when it entered the human population. Some people think as early as 1915 or so. Some people think as late as a couple months before the pandemic erupted in the spring of 1918, although that was the first wave. And then there was a lethal second wave, and then there was a third wave. That was in the fall of 1918. Third wave came in the spring of 1919, which was lethal by any standard except the second wave.

In total, it killed between 50 and 100 million people. If you adjust for population, that would be equivalent to 225 to 450 million people today, most of them dying within 14 weeks. So at this point, the coronavirus, while certainly potentially quite serious, doesn’t look anything like that in terms of mortality.

So, again, one on hand, I take it very seriously. I think public health officials should take it very seriously, and they are, but it is not looking like the 1918 influenza pandemic. Fortunately.

Chris Martenson: Fortunately. Absolutely. But I want to talk then about those waves that came through. Were those due to the Spanish flu virus mutating and becoming more lethal as it progressed around?

John Barry: It’s not really clear. I mean, you know, there are a lot of disagreement over that. If you look at all the pandemics that we know about in any detail came in waves. That’s ’57, ’68, 2009, 1890, 1889 and 1890-91. And in the first wave, it was sort of hit or miss. There were a lot of cities that were entirely skipped. For example, Los Angeles didn’t record a single influenza death in the spring of 1918. There were other cities like Louisville where it was probably as bad or conceivably even worse than in the second wave.

So the virus was distributing itself. And the same could be said worldwide by just – use the Los Angeles and Louisville examples.

If the virus entered the population in 1915, you would think they would be much difference between spring and fall 1918 as to its ability to infect humans. If you think it entered the population much closer to the outbreak that was recognized, then you think maybe the virus was getting better at adapting to humans. It’s not clear.

I'm not a biologist, but my knowledge of the epidemiology makes me lean toward that latter point, that latter. The spring wave was also much less lethal. There certainly were deaths, and in Louisville it did look a lot like the fall. But in most places, it was not particularly virulent. You had medical journal articles by scientists saying that the symptoms all look like influenza, but it’s not lethal as ordinary seasonal influenza, therefore it probably is not influenza.

They were published in late June 1918 and, of course, a couple months later you had scientists saying well, this looks like influenza, but it’s so much more lethal than anything we're familiar with. It’s probably not influenza, maybe a new disease. It wasn’t a new disease; it was just a very, very virulent influenza virus.

Chris Martenson: Now, part of that virulence has to do with something called herd immunity. Can you explain why it is such a – number one on my pandemic checklist, and number one on the WHO checklist, of course, is: Is this a brand-new cross species jump? In this case, the new coronavirus, from what I’ve read – I haven’t seen the sequencing – it apparently has bat coronavirus and maybe some snake too. So it definitely was somehow crossing species.

And then it made the jump to humans. Can you connect that to herd immunity for us, please?

John Barry: Well, I mean, herd immunity, by definition, is when so many people or whatever it could be, a herd of animals with some of the pathogen – when so many people have been exposed to it and have developed natural immunity or have been vaccinated, that the pathogen cannot get a foothold.

That happens in measles, largely, and we have a very good – very good – vaccine against measles. And if people are vaccinated the disease doesn’t have a chance of entering the population and continuing to propagate. If you do not have – I mean, that’s another of the very, very, very important questions about this virus. Will people develop natural immunity and, along with that, can you make a good vaccine?

If in fact you can develop a natural immunity, chances are pretty likely that you’ll be able to make a good vaccine. But they have identified the sequence, as you’ve already talked about, and they are working on vaccines. So, we will see, and we will hope.

Chris Martenson: So John, how long would it take to develop a vaccine at scale? I assume there would be some you’d have to test a variety of them. You find one, it feels good. How long would it take to get that up and running? Is that a days, weeks, or months kind of a thing?

John Barry: Well, certainly months in the best case. You know, with this virus, I don’t really know. I'm much more familiar with what it takes with a pandemic influenza virus when in a best case you're talking about six to eight months. That’s when everything goes right. And then you can have enough – that includes the production of large quantities of vaccine.

But we have an infrastructure that’s set up for pandemic influenza vaccines. I'm not sure what kind of infrastructure is available for this. I imagine it could be adapted pretty quickly, but the exact timing I don't know.

Chris Martenson: And the idea being that we know how to grow the virus for the standard, say, avian flus, the HN series, but this coronavirus is new. Have we faced a coronavirus at this scale before?

John Barry: Well, excuse me, they are able to grow this in the laboratory. That’s pretty important. It’s not so much growing the avian influenza virus, although that can be a problem, particularly since sometimes you were growing viruses in eggs and they’re bird viruses, so they were grown eggs. You weren’t producing any – it’s more the factory type infrastructure that I was talking about in terms of producing large volumes of vaccine.

You're obviously very up on this yourself. You may know something I don’t. But my understanding is they are able to grow the virus. They don’t anticipate a problem there. The question is will the vaccine work. I don't know the answer to that.

Chris Martenson: Right. So there would be some testing. And then once we’ve got something that feels good we’d rush that out to production assuming…

John Barry: Right. And depending on how virulent this virus is, that would have a lot to do with how many steps they compress or maybe even skip. You know, if this turned into, and there is no sign that it is, so I don’t want to scare people, but if this did turn into a lethal virus, my guess is that the FDA would allow some skipping of steps, or at least skimming through them, let’s say, rapidly.

Normally, when you have a new drug that’s being produced for humans, then there's a very, very long testing process. Pandemic influenza vaccines can skip a lot of that because they’re considered basically improvements on existing technologies and vaccines that are well known. This would be different.

Chris Martenson: Again, because we haven’t faced a coronavirus before?

John Barry: Well, we have faced coronaviruses. We have, SARS was a coronavirus. MERS, Middle East Respiratory Syndrome is a coronavirus. Both of them were pretty lethal with about 40 percent case mortality. However, they were able to be controlled. You know, the common cold – coronaviruses cause a lot of common colds. So, they’re not all lethal.

The difference between SARS and this seems to be – and MERS also – SARS, you were not really infectious until you were really sick. So you were not walking around going to supermarkets or in subway cars when you were infectious with SARS. Upwards of 90 percent of the transmission between people occurred at hospital settings, particularly with healthcare workers treating patients. And MERS is similar.

In this instance, it doesn’t seem to be the case.

 

Chris Martenson: I’d heard, as well, that SARS had super-spreaders, people who were really good at spreading it, and they accounted for a big chunk of the overall other infections that occurred. And this one seems to be more like, hmm, I don't know if they’re super spreaders here too, but it seems more like everybody’s pretty capable of spreading it. Which brings us to this concept of the R naught, the R-0.

John, I mean, I’ve seen things all over the place. It certainly looks north of 1. I’ve seen some papers that have tried to estimate at 2.5. I don’t have a good handle on this because I got to confess here: I don’t trust the Chinese statistics that are coming out. So, it’s very hard, I think, to model and R naught without having some solid actual data around how many people have been infected.

John Barry: My friend whom I was speaking with last night about this, actually, and who, as I said earlier, he’s one of the people everyone in the world turns to when something like this happens, told me, to the best of his knowledge, the R naught is between 2.5 and 3.5, which is very high.

Now, what that means is one person will infect between 2.5 and 3.5 people. To give you a sense of comparison, ordinary seasonal influenza, according to multiple studies, the median number for these multiple studies was 1.28. So this is roughly double that. And the 1918 pandemic, again, multiple studies the median figure was 1.8. So, this is well north of that.

However, this is what I talked about earlier, things like the incubation period and how it spreads are very, very important. SARS initially had an R naught around 3.0. But we’ve eradicated. That’s because an incubation period and the fact that isolation and so forth could work for SARS. And it wasn’t that easy to catch SARS. You needed pretty close contact. This case, this instance, it does not seem to require close contact.

I don’t know what the incubation period is. I know you said five to seven days. You may well be right. But I don't know what it is. If that is the case, that’s a good thing because that’s fairly long, much longer than influenza.

So the R naught is important, but it’s not everything.

Chris Martenson: John, why would a long incubation period make it better? I would have thought that would have made it worse.

John Barry: Because it gives you time to trace contacts and isolate them.

Chris Martenson: Alright. But…

John Barry: If the incubation period is one or two days, like influenza, or three days for that matter, but as early, as little as one day, you have no opportunity to contact someone, isolate them and prevent them from spreading the disease. The longer the – well, you can reason that out yourself as to why incubation period matters.

Chris Martenson: Well, it does. But I was taking kind of the other side of that which is if I go to flight tracker right now, I can see hundreds of planes coming from and to China.

John Barry: I got you. Yeah. Well, that’s true. I mean, it’s going to spread around the world, as it has already. But once that – this is why airport screening is not going to be useful. If someone is asymptomatic when they get off the plane, I don’t care how accurate those temperature things you shoot at the people’s forehead are.

I happen to go to Hong Kong during an outbreak when they were doing that stuff. And actually, someone else who’s an assistant secretary of HHS in charge for emergency preparedness made sure that no American airports did that because it was pointless for bird flu. It was not going to catch anything. First, those things aren’t necessarily accurate. And second, asymptomatic individual - you know, you develop the disease, incubation, all that stuff that you’re talking to me about.

But you're correct in the sense that a longer incubation period means it’s going to spread around the world. Absolutely right. But the upside of that is it does give you an opportunity, once people are identified, of tracing their contacts.

The killer is, if in fact it’s true, that they can spread the disease before they are symptomatic, before they realize they’re sick themselves, then there's no chance of controlling this. And we are going to have to get used to it.

Chris Martenson: And here’s where it gets a little tricky because I don’t quite know how to assess the statistics. But of the statistics I have, so far, it’s pointing to around a three percent case fatality rate. Honestly, I wouldn’t stake anything on that; could be higher; could be lower. I just don’t know.

John Barry: I mean, this is a good conversation we're having. I don’t know how good it is for your podcast, but I'm curious where you got that?

Chris Martenson: So that was coming out of China, and it’s looking at their official statistics at this point in time. And it’s backfitting. So, knowing that the cycle of this is about 15 to 17 days from first exposure to either death or recovery, factoring out the new cases, and then dividing into the actual number of people who died – and again, I don’t think we’ve got complete statistics – but of those numbers, gets you around three percent right now. And it’s very sloppy work, and we don’t know because, as you know, not until all is said and done can you divide proper numbers from each other.

But beyond that, we have lots of stories coming out of China that people were dying of pneumonia, being buried or cremated before any testing had been done. So, it could have been normal pneumonia, could have been totally unrelated, could have been related. We don’t know.

So I'm not real sure that we have good statistics yet at all, but that sort of where it was pointing to early on. And, of course, totally not hinging anything on that number at this point yet.

John Barry: Well, if you remember, in 2009 with H1N1, the initial numbers sounded scary, but we had no idea how many people were actually getting sick. We only had an idea of how many people were dying. And even it turned out that Mexico was overstating the number of dead from the disease.

The only study that I'm familiar with on this so far, but it may a few days out of date, was about 15 percent of hospitalized patients died, which is a little more than double influenza. So we have no idea how many people are actually sick, which is what you're getting at.

You know, there may be 50 times the number walking around who had been infected and cough once or sneeze once, and that’s the end of the disease, in which case that so-called three percent case mortality would drop precipitously. And let us hope that’s the case.

But as you say, we don’t know. And on something like that, the Chinese don’t know. They’re not the most trustworthy in terms of numbers. You're absolutely correct, but this is such a moving target. They did put somebody in charge a couple of days ago who’s pretty transparent and has a very good reputation. So, we’ll see.

Chris Martenson: Listen, I know that the number of infected are much higher than the official statistics, which as of this morning even was 2,070. I think it made it up to 2,800 on the last release. But even at 2,070, Wuhan is a city of 11 million people. There's about 49,000 hospital beds. I know that the Chinese…

John Barry: Five million people left before they closed.

Chris Martenson: Yes. That happened. But the Chinese were saying, oh, there's 2,000 cases identified, so far. But this had completely swamped their hospital system. I know they have a little bit of a culture towards rushing to the hospital when they have a first sniffle. But it still seemed like the system got overwhelmed. And you don’t do that with a seriousb complication rate of ten percent on 2,000 case. Two hundred hospital beds does not swamp a 49,000-bed hospital system.

So I'm pretty sure that the infection rate is – I got to be honest – I'm just wait – please. Don’t hold me to anything – ten times higher than the stated case? Because A, they didn’t have the ability to test because they had to ramp up their test kit ability. B, I'm not sure they could take tests in every case. C, as you mentioned, people got sick but never even went to the hospital or bounced off and didn’t go back and got better all on their own. So we still don’t know.

But based on what you’ve been reading and hearing so far and also, I trust what people do more than what they say. The Chinese government has taken extraordinary steps. They’ve asked all nonessential businesses to close in ShangHai b for about a week. That’s 24 million people there. They put a level I emergency on Beijing; no transport, ground transport, in or out. Those feel like the kinds of steps you take when you have to, not as a precaution . What do you think about that?

John Barry: Well, I agree with you. Now, that’s a short answer. Shortest answer I’ll probably ever give you.

Chris Martenson: So given that, I want to turn now and I want to ask: What should China be doing? Are they doing the right things in order to control a pandemic? You’ve already said the cat’s out of the bag. If it has the incubation period we think it has, forget about it. This thing’s going around the world.

So given that, what steps should any culture or country be taking in light of that?

John Barry: Educating the public as to what kind of personal measures they can take, which are chiefly hand washing for this disease and for most coronaviruses.

I'm hesitating because I was part of a group, early after bird flu surfaced, that our government started talking about what they call nonpharmaceutical interventions. What do you do when you don’t have drugs that work? Public health measures. And I was part of the initial group which made certain recommendations along those lines.

I think they are all you can do. But by the same token, I think their effectiveness will be pretty limited. And they involve staying away from crowds, social distancing, all the obvious stuff, and washing your hands.

You know, masks are not very useful, in my view. There's some people who think they are: I'm not one of them. If someone is sick, then a surgical mask on that person will be effective in protecting people around them. Not a hundred percent, but it will significantly help.

But if you're a healthy person walking around in a crowd, then it’s unlikely that a surgical mask is going to do you significant good.

What are called N 95, which are actually respirators, they’re useful. By the same token, they are very – they have to be fitted almost perfectly for them to be effective, and they’re uncomfortable.

In New Orleans after Katina, there was a study of professionals who went into houses where there was concerns about toxic-mold. And it turns out 60 percent of these professionals did not put the M95s on properly. So even N95s I have some questions about.

Again, the surgical masks I don’t think are useful. But they don’t do any harm. And other than that, hope for a vaccine.

Chris Martenson: But a great point though that the surgical mask does an excellent job if it’s on somebody who is sick. I want to reinforce this point for people. This coronavirus, as far as I understand it, spreads by droplets. It’s not airborne. It’s not little viruses wandering around with wings trying to find you. If somebody sneezes, coughs, they eject particles. If you could see these particles in a really bright beam of light, sunbeam, you know, you would see that they float around for a while, and then they drift, and they settle.

If you could prevent them from coming out and going out and drifting around and settling, that’d be great. So that’s what the surgical mask does for somebody who is sick. And everybody who thinks they’re sick or are sick I think is a – if this goes forward and turns into a worldwide travelling sort of thing and we’ve got to get used to it, it really will become important for people who are sick to never go out in public without wearing a mask as a point of courtesy and public health and just being a reasonable human being, I think.

John, does that make sense?

John Barry: Yes, it does. And the other thing is, incidentally, influenza is spread primarily by aerosols, which is the smaller virus floating around in the air. I mean, it’s also spread by larger droplets. But the virus itself, you know, aerosol transmission is certainly important in influenza.

The other thing is just stay home if you’re sick. It’s that simple. Which runs counter to, certainly in our culture, you're supposed to tough it out. You’re sick, you go into work. In this case, that is not useful. Employers should emphasize that to their employees. If you're sick, stay home.

Chris Martenson: Well, we’ve already seen the prophylactic closing of large gatherings. Some festivals and things have gotten closes. But as well, the state of Mongolia this morning completely closed its border with China. So that’s the first border closing I’ve heard of. And they also closed all their schools. Hong Kong has closed schools for two weeks.

So that’s another thing people should be aware of is one of the ways that you fight something like this is you basically limit large gatherings. And if that means you close schools and stop festivals and maybe even – I think China even close 70,000 movie theatres. So they’re just basically, as fast as they can, making sure that they are limiting large assemblages of people. Hard to do in a city anyway because that is a large assemblage of people. But I think that’s what people need to be aware of here is that those are the kinds of steps that do get taken as necessary steps, precautions here.

John Barry: Right. And school closings is a very common step and in a severe influenza outbreak that would be recommended. Kids tend to be so-called “super spreaders” largely because, partly because they’re young enough, they’re rubbing their nose and mucus is all over the place. But also, because, given their age, they haven’t been exposed to a lot of influenza, so they’re more susceptible than an adult who has probably seen quite a few influenza viruses.

There's actually a study that inoculating children against pneumonia cut pneumonia rates – and I'm talking about bacterial pneumonia – cut pneumonia rates in their grandparents in the 90 percent range. So that can be important. But it all depends, of course, on the disease and how it’s transmitted and so forth and so on.

And there are still a lot of unknowns with this coronavirus. You are obviously very well informed.

Chris Martenson: Thanks. I’ve just been reading like as much as I can. John, I have another question here about mutations and the risk of mutation and what might happen with that. So it sounds bad. You know, oh my gosh, the virus has mutated. They all, I guess, mutate to some extent.

But I guess my question is around are those mutations always unfavourable? Can they also be favourable? And if so, what’s the balance? Like do they tend to be favourable versus unfavourable, and how’s that factor into this?

John Barry: Well, they’re random, of course. The ones that are going to be more successful are going to be the ones that allow it to adapt to the human population since they are animal viruses. But that doesn’t necessarily mean lividity [PH] [00:35:21]. Obviously, if a virus kills it’s host it cannot propagate.

So, for example, a lot of the very dangerous bird flu viruses in birds don’t make the bird sick. Some are highly pathogenic. But a lot of them that would be dangerous to humans don’t make a bird sick at all because the virus coexists. Hopefully, that would be the case with pathogens that infect humans.

Again, a coronavirus is an RNA virus. All RNA viruses mutate like crazy. But measle is also an RNA virus. And one exposure gives you lifetime immunity often.

The reason is that the parts of the measles virus that are immunogenic can’t change or the virus can’t function. All other parts of thee virus change but that particular stuff, the RA of the virus, the part that the immune system happens to recognize, if that changes the virus won’t function.

And that’s actually why influenza vaccines have not been particularly successful because they target an area of the virus that can mutate without affecting the ability of the virus to function. There are new strategies out on influenza vaccines which will probably be successful. There's enough work done to make it look like it’s very likely they will succeed, which will target what is called conserved portions of the virus. And these are parts of the virus that cannot change, or the virus won’t work.

So the mutation rate for all these viruses is extraordinarily rapid. But you asked the right questions, the direction and so forth, whether it becomes worse or better. Random.

Chris Martenson: Thank you so much. That really added a lot to what I know. And this idea that obviously something that makes the virus more successful, that is it spreads more rapidly, that mutation will be favoured. But if that also at the same time made it less lethal that’d be great because it’s actually probably running around and acting like an immunizing agent rather than a lethal agent I guess, if I understood that correctly.

John Barry: You did.

Chris Martenson: Excellent. So what is it that you think people should be doing, if anything, at this point in time? Should they be just alert and watching this? Should they be – one of the things I’ve advised people is to begin good hygiene practices.

John, my background, I did a lot of cell biological work, and so I learned pretty early on as a grad student that if you touch something that’s not sterile, you’ve just contaminated weeks’ worth of work, potentially. So, I learned the habits of good sterile protocol.

But I got to honest, I touch my own face all the time. And so one of the things I’ve advised people is to begin at home just practicing what it means to have good sterile protocol. Which means don’t touch your face. I’ve read somewhere that people touch their face on average two thousand times a day. So, let’s see if we can just drop that to as close to zero as possible at home in the comfort and safety of it before you go out in public and say, well, you know what, Chris, when I go out in public that’s when I’ll be cautious and careful. I think good habits, you gotta start them early and practice them.

But beyond that, I don’t know what to tell people except wash your hands, and that seems to be one of the best things you can do. Especially if you’re in public and you touch a common escalator handrail, I would then at that point consider, especially in the airport, I would consider my hands to be as if they were covered with axle grease. I'm not going to do anything with them until I get into the bathroom and wash them good.

John Barry: Or a doorknob. Or pick up somebody else’s pencil. Anything. I guess I'm a pessimist when it comes to changing human behaviour, whether it’s as simple as handwashing – I think you can probably get people to wash their hands a lot more often. In terms of touching your face, good luck.

Going back to the 2009 pandemic that sort of wasn’t, I mean, technically it was – once I get into that because I have a lot to say about 2009. But the reason I bring it up that the Mexican government recommended wearing masks on public transit and gave them out for free at entrances to bus stops and so forth. And usage peaked at 67 percent, and four days later it was in the 20 percent range, 27 percent, something like that.

My point is that when you're facing something like an influenza pandemic, and I'm not sure about the coronavirus, but you have to sustain anything that you're doing. And that is extremely difficult for a public health official to get the public to do. Sustaining is.

Unless you get in the habit of washing your hands all the time, and do it constantly, three, four, five days after you start doing it, you're going to get tired of it. But that kind of behaviour has to be sustained for it to be effective.

Chris Martenson: Great point. And this last 2019 flu season was pretty bad by the numbers. I think the last numbers I saw were closing in on a million people hospitalized and some 80,000 deaths. It was pretty high worldwide.

John Barry: Not 2019. Wasn’t that 2018?

Chris Martenson: Yeah, that might have been.

John Barry: Actually, CDC, and I just looked at this this morning, has revised those numbers. They originally said 79,000 deaths. It’s now a little bit better than that at 61,000. That is a lot of people. That’s in the United States. And that’s seasonal influenza.

And that’s something that had we taken that disease seriously for decades I think we would probably have a universal vaccine by now. But research money did not go to influenza even though it was killing thousands of Americans a year.

If you go back to West Nile virus in 2000, West Nile was actually getting more money than influenza. In West Niles worst year it did not kill 300 Americans. And in influenza’s best year it killed at least 3,000 Americans. And yet, West Nile was getting more research dollars. Made no sense.

Then bird flu came along and scared everybody and influenza started to get attention.

Chris Martenson: I was bringing that up because I think we're still sort of launching into the typical flu season anyway, so we’ve got that. And it’s going to be easy for people to confuse catching what we call ordinary flu which you just pointed out is pretty dangerous all on its own. And, as yet, there may still be the possibility that we get this coronavirus coming through.

And I guess all we can do now is just watch and wait and get more data. I'm still troubled by the seemingly Draconian actions that the Chinese government is taking in terms of – I don't know if you’ve seen, but around Wubai – it’s a pretty big city, and they’ve just got dump trucks dumping sand, dirt, piles of rocks, logs, whatever they can to just block roads. It looks really sort of haphazard emergency. And the Chinese are fairly thoughtful people who are capable of big construction projects.

So just the nature of that made me question if they knew something that we didn’t. But other than that, I don’t have a lot of – it’s just trying to read the tea leaves here.

John Barry: Chinese social media suggests the Chinese population shares your concerns.

Chris Martenson: [Laughs] Yeah. Well, thank you so much for sharing your expertise here, and I hope we can touch base again. I hope we don’t need to, but if we do, I’d love to tap back in.

We’ve been talking with John Barry, author of The Great Influenza: The Epoch Story of the Deadliest Plague in History. John, is there any other book that you’ve got going on or any other thing you’d like people to know about?

John Barry: It’s not the only book that I’ve written. You can go to johnmbarry.com. I managed to cause some trouble in some other areas. In New Orleans, after – another book I had written on, actually, a Mississippi River flood in 1927 called Rising Tide, that ended up after Katrina – those people thought I knew something about floods. I ended up on the reform post Katrina levee board and managed to sue 97 oil companies to create a little bit of attention in Louisiana.

So, that’s kind of interesting. If anybody is interested in environmental stuff, you could go to my website, johnmbarry.com and check out some of that. And of course, I’ve written other books, as well.

Chris Martenson: Well, good. We’ll direct people to that, of course. And thank you so much for your time today and for writing the books. And I hope you’re well, and we’ll be in touch someday.

John Barry: Okay. You too. Thank you.

Chris Martenson: Thanks.

John Barry: Bye-bye.

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48 Comments

  • Wed, Jan 29, 2020 - 1:27am

    #1
    Sparky1

    Sparky1

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    Public Health Alert: Dr. Lueng, HKU Dean/Chair PH's dire forecast of global 2019-nCoV epidemic [video, summary1 of 3]

    Sparky1 note: This video presentation marks a significant shift in the narrative to-date regarding the 2019-nCoV, representing a call to action from a credible messenger to acknowledge and mitigate the pending global epidemic--if possible. The video is about 30 minutes long and well worth viewing.  I've summarized the content as an assist, into three posts on this thread for readability. I put the introduction and study findings in this first post; recommendations and study model in the second post; and further discussion in the third post.

    [h/t "ReadyMom" on Flutrackers]

    1/27/20 Presentation by Dr. Gabriel Leung, Dean and Chair of Public Health Medicine, Hong Kong University

    http://https//youtu.be/CwXMPsbxFfo

    [Sparky1 Summary 1 of 3]

    Introduction:  Dr. Leung presented results of a study which had just been completed the evening before and released to WHO head quarters and HK officials earlier that morning (1/27/20). He stated that the WHO Director General and the "top team" in infection control were arriving 1/27 or 1/28 in Beijing to meet Chinese officials.

    This video is the English version of a news conference to alert governments, health  professionals and the public regarding the study's dire findings. Dr. Leung noted that the study models and findings are consistent with those of 3-4 other epidemiologist teams globally. Dr. Leung stressed that this was not a prediction, but a forecast to prompt action to increase preparedness. In discussing his recommendations, he noted that the question is not if/whether to proceed to prevent the global epidemic, but how to proceed in ways that are feasible, implementable and enforceable.

    Study findings and conclusions [my summary gleaned from video presentation]:
    * the 2019-nCoV is on the verge of becoming a global epidemic
    * "self-sustaining" human-to-human spread is already present in all major Chinese cities
    * quarantine is not ineffective, but it may not be enough to substantially change the course of this epidemic in the other major city clusters in China
    * 2019-nCoV may be imported/exported to other cities/countries initially by infected Wuhan travelers; thereafter 2019-nCoV infection within these cities and city clusters, and outside mainland China may be established through "seeding" local epidemics, which in turn, become self-sustaining/perpetuating

    * 5 major cities in China connected to the Wuhan travel hub account for 53% of all international travel in the country and 70% of all international travel to Asia originating from China
    * population size and traffic volume/travel intensity were positively associated with increase of 2019-nCoV spread
    * the largest Chinese city cluster peak of 2019-nCoV is expected in April/May 2020--about 2 weeks after Wuhan peak, which has not yet occurred
    * other large city clusters in China are expected to peak thereafter in waves about every 2 weeks

    [Summary continued in 2nd post, this thread]

     

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  • Wed, Jan 29, 2020 - 1:32am

    #2
    Sparky1

    Sparky1

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    Public Health Alert: Dr. Lueng, HKU Dean/Chair PH's dire forecast of global 2019-nCoV epidemic [video, summary2 of 3]

    1/27/20 Presentation by Dr. Gabriel Leung, Dean and Chair of Public Health Medicine, Hong Kong University

    http://https//youtu.be/CwXMPsbxFfo

    [Sparky 1 Summary 2 of 3, continued]

    Recommendations for increased preparedness [to mitigate 2019-nCoV global epidemic]
    * Substantial, draconian measures limiting population mobility should be taken immediately
    * Cancellation of all mass gatherings, school closures, and instituting work-from-home arrangements
    * Should containment fail and local transmission of 2019-nCoV is established, mitigation measures during previous major public health outbreaks (e.g., SARS, MERS or pandemic flu) could serve as a useful reference
    * Regions within the closed travel links with major Chinese ports' preparedness plans should be readied for deployment on short notice

    Study model:
    Model took a one-day (1/25/20) snapshot of number of 2019-nCoV confirmed cases in Wuhan (N=25,630; R0 = 2.13 (range 1.92-2.31)) vs. number of infections (including pre/a-symptomatic) in Wuhan (N =43,590; R0=6.2 (5.4-7.4, i.e., doubling every 6.2 days). The study assumed up to 2-week lag time between infection-->incubation-->symptom onset-->confirmation. Clinical outcomes such as admission to hospital/treatment, recovery OR death were not estimated or projected in this study. Taking into consideration the one-day number of Wuhan confirmed cases vs. number of infections, RO and travel patterns, they forecast the spread of the 2019-nCoV epidemic to 5 major cities/city clusters in China over time, the impact of mobility quarantine on the epidemic spread, and the potential impact of initial 1/25/20 Wuhan 2019-nCoV "exports" and spread to other destinations and ports outside of China.

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  • Wed, Jan 29, 2020 - 1:41am

    #3
    Sparky1

    Sparky1

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    Public Health Alert: Dr. Lueng, HKU Dean/Chair PH's dire forecast of global 2019-nCoV epidemic [video, summary 3 of 3]

    1/27/20 Presentation by Dr. Gabriel Leung, Dean and Chair of Public Health Medicine, Hong Kong University

    http://https//youtu.be/CwXMPsbxFfo

    [Sparky1 Summary 3 of 3]

    Dr. Leung cited several problems with the lack of reliable, available data regarding 2019-nCoV. A key unknown at present is whether the those with no/mild symptoms are infective and, if so, to what extent are they infective to others. (Viral shedding used as a proxy for infectivity.) The "severity profile" of the virus in unknown. He hopes that the infectivity of the virus is "to scale" with the symptoms, i.e., that asymptomatic/mild symptoms result in lower viral shedding as an indicator of lower infectivity. If so, he feels that will give us a "better fighting chance" to control the epidemic. But at present, we don't know so we must prepare for the possible outcome that even asymptomatic individuals are just as infective as those with symptoms.

    He noted that current 2019-nCoV practice is impeded due to incomplete, inconsistent, biased data collection/reporting and "best guess" assumptions based on SARS and MERS experience--which may/may not apply to 2019-nCoV. Dr. Leung is advocating for research that includes an extensive sample of individuals along the case severity spectrum (e.g., from general public with no symptoms, close contacts w/confirmed infected, those w/mild symptoms, those with severe symptoms, and outcomes of recovery or death). He cited other challenges in securing reliable, timely and actionable data, including human resources, quality control in collecting samples, laboratory supplies, and laboratory availability and capacity.

    Dr. Leung acknowledged that health and medical care professionals and facilities are already operating at peak capacity. However, he stressed the necessity of implementing greater crowd and infection control measures in hospital waiting rooms in particular to prevent the possibility of "super spreaders" from infecting others visiting/working in these settings.

    When asked by a reporter, "What happens when there are too many cases to count?" Dr. Leung responded that he was revisiting paper a he co-authored with a Harvard colleague and published in the Lancet 8-10 years ago about "what to do if the numbers become absolutely overwhelming."

    [h/t "ReadyMom" on Flutrackers]

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  • Wed, Jan 29, 2020 - 3:41am

    #4
    Andy_S

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    THIS IS a LOW-FATALITY VIRUS

    I have been looking at the best info on this for a week. Yes - it is highly infectious. So it spreads easily. But outside of China this is a low-fatality illness. All international cases so far prove this. Highly infectious but low-fatality.

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  • Wed, Jan 29, 2020 - 5:05am

    Timon Vinke

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    To early to tell

    I hope what you say is true, but in my opinion it is too early to tell.

    The reason why is that the international infected haven't been reported as recovered either. They are still under treatment.

    On top of that the death percentage is somewhere around/below 3% of infected. Currently the number of international infected stands at 87. Based on those numbers we would "only" expect 2-3 deaths internationally. Having none yet could simply be because they/we are lucky so far.

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  • Wed, Jan 29, 2020 - 5:37am

    #6
    Andy_S

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    EVIDENCE THAT it's a LOW FATALITY VIRUS

    Outside China, at least. Here is some proof for you-

    Current status of outside-china patients. from China_Flu

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  • Wed, Jan 29, 2020 - 5:44am

    #7

    Snydeman

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    And, that May be...

    Perhaps that is because these patients are receiving top-notch treatment from dedicated teams in hospitals which are not being overwhelmed with cases. You can’t isolate the recovery possibility from the context in which it is occurring. How high will fatality be if thousands of cases begin rolling in and our medical systems get overwhelmed, as is happening in China? My guess is fatalities rise.

    And, not to be coy, but why would draconian measures be taken all across China if this was not an uncommonly high fatality illness?

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  • Wed, Jan 29, 2020 - 5:49am

    BBQ MD

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    Fatality rate vs severity

    While the fatality rate seems to be "only" 3%, those are still odds I don't want to play. Also something to consider is the overwhelming of health care resources. As Sandpuppy has noted, most hospitals and ICU's are at capacity already.  If this thing causes just 10% to require ICU admission, those people would add to the fatality rate.

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  • Wed, Jan 29, 2020 - 5:57am

    #9

    Quercus bicolor

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    International cases disproportionately among the young?

    Perhaps the international case are disproportionately among the young (college students traveling back to campus, etc.). In China, the death rate among the young is very low.

    Also, perhaps the vigilance around this is bringing milder cases to the attention of authorities while they are slipping through the cracks in China, especially in overwhelmed Wuhan.  That would suggest that China's death rate is from the subsample of severe cases while internationally it is among a broader cross-section of severe, moderate and mild cases.

    Of course there is a silver lining in that - the death rate among the general public will be much lower after considering mild cases which theoretically result in immunity.  Of course, this is barring mutations that make the virus more deadly among a broader cross-section of the population.  Such a mutation is likely enough to be concerned about.

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  • Wed, Jan 29, 2020 - 6:26am

    Timon Vinke

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    Thank you for your work!

    Appreciate you pulling all those cases together.

    It does make me hopeful that it won't be as severe, but I stand by my previous point about the numbers. There are too few international cases known to make a reliable calculation of international fatality rate vs Chinese fatality rate.

    FYI
    Both Germany and France now stand at 4 infected identified.

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  • Wed, Jan 29, 2020 - 7:30am

    #11
    Andy_S

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    OVERWHELMED HOSPITALS MAKE it WORSE

    For sure you are right. If any nation gets overwhelmed like China, then more will die. But so long as cases just trickle in - in other countries - the death rate should stay low.

    Sadly, China is the real "basket case" here. Imagine this going on and on for months.....

     

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  • Wed, Jan 29, 2020 - 7:40am

    Bleep

    Bleep

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    Age and Coronavirus

    It doesn’t look like this podcast was uploaded to ITunes.  Coronaviruses are more deadly as one gets older, so there is a possibility that this is related to the difference in fatalities inside and outside of China.

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  • Wed, Jan 29, 2020 - 7:50am

    #13

    George Karpouzis

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    Very low death rate in China outside of Wuhan

    All the other provinces are reporting very low death rates as well

    encouraging signs

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  • Wed, Jan 29, 2020 - 7:56am

    #14
    Andy_S

    Andy_S

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    YES - IT is ENCOURAGING

    Thankyou, George.

    But the fear itself could keep China in a downward spiral for months. The global economy may get shaky.

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  • Wed, Jan 29, 2020 - 7:59am

    #15

    dcm

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    The Problem is

    It is very likely to mutate and it’s anyone’s guess  Great interview Chris   Great questions

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  • Wed, Jan 29, 2020 - 8:37am

    #16
    BobbyJoe

    BobbyJoe

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    Some Assumptions

    To followup on Syndeman's comment:

    "How high will fatality be if thousands of cases begin rolling in and our
    medical systems get overwhelmed, as is happening in China? My guess is fatalities rise."

    Assume the following:

    - 1/3rd of U.S. population gets infected, say 100 million.
    - 3/4th self treat at home with bed rest and OTC medicines and survive.
    - 1/4th have a severe reaction and require hospitalization (intensive care), say 25 million.
    - With hospitalization a person with a severe reaction will survive; without hospitalization a person with a severe reaction will die.

    The total number of hospitals beds in the U.S is approximately 930,000.
    The total number of ICU beds is approximately 80,000.

    From a national perspective, 25 million people in need of 80,000 ICU beds.

    From a personal risk perspective there are many factors to consider.
    Can anyone have a severe reaction, or does it depend on age, underlying health,
    ancestral genetics etc...? Are there regional differences in the ratio of population
    to available ICU beds? Will large numbers of temporary ICU beds be quickly brought on line? And most importantly, what is the temporal production rate of new severe cases versus turnover of the available ICU beds?

    Until someone does that analysis I am going to assume the following:

    If I get infected I have a 25% chance of having a severe reaction.

    At the time of my infection my regional hospital system is overwhelmed and I
    am sent home with a hope and a prayer. Without hospital treatment I have a 100% chance of death.

    Therefore if I get infected I consider my chance of dying as 25% not 3% or 4%.
    I aim not to get infected.

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  • Wed, Jan 29, 2020 - 8:37am

    George Karpouzis

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    Posts: 184

    Ongoing story

    the economic ripple effects will definitely be felt. In terms of “immediate emergency” for us in the states I think we can take a breather. Half of China is on full blown lockdown mode which will slow the spread. US cases are reported at 5 for several days now which is fantastic. One by one airlines are suspending flights from China. US is going to ban soon.

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  • Wed, Jan 29, 2020 - 8:40am

    #18
    schmidtma01

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    WHO Press Conference

    Is anyone else watching the WHO Press Conference on coronavirus? Maybe I'm just cynical, but the fact that it seems designed to be such a Pro-China Infomercial makes me less confident that they're providing truly accurate scientific information.

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  • Wed, Jan 29, 2020 - 8:59am

    #19
    borderpatrol

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    First world countries will be good for now

    I'm on board with Andy S. I doesn't look like it will be too bad unless it mutates, only time will tell on that one. What most people don't know is that the Spanish flu was different due to it's response called the cytokine storm. The cytokine storm affected major organ function cause it had a plugging affect on major organs. This particular virus doesn't seem to have that affect. Most people that have a healthy response to flu viruses shouldn't have too much of a problem with this one.

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  • Wed, Jan 29, 2020 - 9:12am

    #20
    borderpatrol

    borderpatrol

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    Just supportive care for viruses, no treatment per se

    I work in an medical ICU and flu pneumonia's is one of our patient populations. It's just supportive care for viral infections, i.e. resp support, renal support, hydration, tube feeds etc. I don't think I've never seen a death from the flu in a normal healthy patient. All that have died have some other underlying factor that caused them to have a poor response to their viral infection. One of the most overlook factors is morbid obesity, for some reason it causes an ARD's response. Others that are highly susceptible are ones that are transplant and auto-immune patient's due to their immune suppression meds.

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  • Wed, Jan 29, 2020 - 9:27am

    #21
    Andy_S

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    Re: VERY INFECTIOUS but LOW FATALITY

    The stats posted above on the international cases did not originate with me. Someone else did the work.

    But one question remains. What if First-World countries get swamped too?

    Then I think the death rate may go up to 3%

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  • Wed, Jan 29, 2020 - 9:39am

    #22

    sand_puppy

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    Stop! You are scaring me. (Response to learning about pandemic potential)

    I've puzzled over the resentment and rejection I have seen as I put the "this is a serious pandemic" viewpoint out to family, friends and coworkers using a low key, just the facts tone.  Some are angry at me.  Some roll their eye (rejection of the viewpoint and contempt for the speaker).  I was surprised.

    They are mad when I point out that every appliance in their home and garage was made in China and that China is the manufacturing center of much of the globe.  China is the major global steel maker.

    They do not want this to be true and actively are defending against it.

    "I am not going to sh*t my pants over this."

    "You are spreading negativity."

    "I refuse to live in fear."  (Don't scare me with this information.)

    "I choose to live in the present moment."

    "God (and my angels) will keep me safe.  That is all I need to know."

    "We got over MERS and SARS and we will get over this."

    "The markets are fine.  Look, they are up again today."

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  • Wed, Jan 29, 2020 - 9:48am

    #23

    sand_puppy

    Status: Platinum Member

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    Posts: 2296

    Agree BobbyJoe: Fatality rate depends on 1) disease, 2) patient and the 3) State of the Medical System

    Very very good point (post #12)

    If I get infected I have a 25% chance of having a severe reaction.

    At the time of my infection my regional hospital system is overwhelmed and I am sent home with a hope and a prayer. [With a severe infection, and] without hospital treatment I have a 100% chance of death.

    Therefore if I get infected I consider my chance of dying as 25% not 3% or 4%.

    A severe infection in the setting of no ICU beds might become a 20%-25% fatality situation.

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  • Wed, Jan 29, 2020 - 10:00am

    greendoc

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    Even with ICU care, initial fatality in Wuhan appears to be 15%

    I posted in the pandemic prep thread already. The second article article offers a glimmer of hope this might be the worst for asian males, and others might be less at risk for cytokine storm/sepsis.  Check the other thread for how to make Knotweed tincture, other herbs that may be effective ARBs for inhibiting coronovirus infection.

     

    Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), anemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα
    Note: Interleukins IL-2, IL-7, TNF-alpha, IP-10 chemokine, Granulocyte colony stimulating factor (GCSF). Monocyte chemoattractant protein-1 (MCP1), Macrophage Inflammatory Protein 1A
    Anti-inflammatory: IL-10.
    LSS: those who died exhibited higher levels of pro-inflammatory molecules (which normally do increase as this part of a normal immune response to infection) but these levels indicate presence of an immune overreaction/cytokine storm.  More research needed to understand mechanisms behind this (genetic studies that my indicate presence of known or new mutations that up regulate/exaggerate inflammatory immune response relative to those without mutations).
    Other salient points:
    However, few patients with 2019-nCoV infection had prominent upper respiratory tract signs and symptoms (eg, rhinorrhoea, sneezing, or sore throat), indicating that the target cells might be located in the lower airway. Furthermore, 2019-nCoV patients rarely developed intestinal signs and symptoms (eg, diarrhoea), whereas about 20–25% of patients with MERS-CoV or SARS-CoV infection had diarrhoea.
    I must say I am very impressed with the quality of the papers published in the past few days concerning novel CoV.  True, they are not peer reviewed, in order to get the information out in a timely manner..  Papers like this would normally take a year or more to get researched, written, reviewed and published.  Believe it our not, these are excellent in their clarity, oftentimes papers from China are difficult o parse, more from an English as second language situation than purposeful obfuscation. These researchers are likely working in extremely difficult conditions. I applaud their efforts, apparent transparency and the fact so far the key papers are free and available in their entirety online.

    https://www.biorxiv.org/content/10.1101/2020.01.26.919985v1.full

    Just published two days ago by Chinese researchers investigating the pathogenicity of  2019-nCov.

    Severe infection by 2019-nCov could result in acute respiratory distress syndrome (ARDS) and sepsis, causing death in approximately 15% of infected individuals1,2.

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  • Wed, Jan 29, 2020 - 10:02am

    George Karpouzis

    Status: Silver Member

    Joined: Feb 17 2009

    Posts: 184

    1+

    Stop you are scaring me- response

    I had similar reactions from people but I could care less. I shared some reports from here to my office mates which of course have been ignored.

    If this spreads to our area and becomes an issue they will be so unprepared. Don’t ask me To bail you out then I’m looking after my people

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  • Wed, Jan 29, 2020 - 10:05am

    #26

    AKGrannyWGrit

    Status: Silver Member

    Joined: Feb 06 2011

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    Sandpuppy

    At any given time approximately how many ICU beds are realistically available?  I would suppose many are already in use for regular gravely ill patients.  Heart attacks, accidents, end of life, violence, allergic reactions and so on.  Can’t fathom there are a bunch of beds waiting for flu or Pandemic patients.

    Just wondering.

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  • Wed, Jan 29, 2020 - 10:08am

    #27
    Andy_S

    Andy_S

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    Joined: Jan 27 2020

    Posts: 61

    CANNOT JUDGE FATALITY RATE by FIRST 41 PATIENTS

    Those 41 you refer to ALL HAD PNEUMONIA. That's why they were in hospital. They were the most obvious severe cases!

    This is why the international patients are more insightful. Not such a "biased" sample.

    And the international patients are now largely "stable" or "recovered". (See above).

    Mind you - they do have good care in place.

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  • Wed, Jan 29, 2020 - 10:36am

    BBQ MD

    BBQ MD

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    ICU availability

    I can't answer for Sandpuppy or for current conditions, but 6 years ago I was working at 3 hospitals in North Texas as an anesthesiologist and we were lucky to have 2-3 beds available at any given time.  Often we'd have to let a patient sit in the PACU for 12-24 hours while they got a bed available in the ICU.  I'd suspect not much has changed.

    My concern is that since hospitals are often running at capacity (more efficient? more profitable?) it wouldn't take much to overwhelm their ability to take on casualties from a pandemic.  Couple that with staff calling in sick and it would't be a pretty picture.

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  • Wed, Jan 29, 2020 - 10:36am

    signalfire

    signalfire

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    ICU bed and respirator availability

    My husband just died in November from heart failure and he was in the 'ICU' for several days before he was transferred back to the general population rooms and put on a a short term of hospice - it wasn't worth finding a regular hospice spot for him because he didn't have long. Since I spent a lot of time in the ICU and have hospital experience otherwise, I can tell you 'not much' in the way of empty rooms and adequate staffing, especially during the winter normal flu season. It looked like a warehouse for terminally ill patients.

    I encourage anyone who is thinking of going to a hospital if they feel unwell to first open up that hospital's website on line, search under 'careers' and look at how many nursing and other technical staff openings they have. I don't care which hospital you look at, they will have dozens of unfilled spots.

    Learn to take care of yourself at home, stock up on flu medications, alcohol, Lysol, gloves - depending on whether you live alone or not - masks to protect others in the household, easy to prepare and consume food. You may be MUCH BETTER OFF staying at home than exposing yourself to the germ soup that is a hospital, and an understaffed overwhelmed hospital at that. Oh, by the way, even the biggest city hospitals only have a few respirators, and they'll be used by the sickest and/or most politically advantageous (board members and sick staff) patients. Unless you think someone else will get taken off a respirator to give you access to it. People in China are starting to spit on (!) hospital personnel saying 'if you won't treat me, I'll make you sick too' - and they're being polite. In the US, all these types of people have guns.

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  • Wed, Jan 29, 2020 - 10:48am

    signalfire

    signalfire

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    Oh, it gets better.../s/

    I was working as a medical transcriptionist in the medical records dept which is usually situated a long ways away from the patient care area (usually a dungeon of a basement somewhere); when I was hired by Kaiser Permanente in Portland, OR in January of 2010, I was required to sign a document that 'in the event of extraordinary circumstances' meaning anything from a terrorist attack to a pandemic, that I would be reassigned to any needed position for the duration.  Moving patients around from a room to the xray or lab, sure... but one wonders if they think a typist would be any good at intubating grandpa, or whatever, fill in the blank.  A sane doc or  nurse once the pandemic really gets going is going to go home, self isolate, and not bring it home to their family. Most professionals are sane, and not Mother Teresa. I have no idea who the hell China thinks is going to magically appear to staff those 1000 bed hospitals they're building in five days flat. (And why don't they just use their ghost cities?)  If this gets going one iota more than it is currently, they're not going to need hospitals, they're going to need crematoriums. The population load I'm seeing in those photographs of business as usual in China are mind boggling. Megacities are death traps.  So glad I moved to rural Tennessee a few years ago...

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  • Wed, Jan 29, 2020 - 11:14am

    #31
    Time2help

    Time2help

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    Re: Stop! You are scaring me...

    Suspect that few actually believe (feel?) that something like a pandemic virus, economic collapse, war, etc. could/would happen to them (directly). Psychological defense mechanism? Add in some Media fed Stockholm Syndrome (daddy will take care of you) and you've got a pretty effective mental bulwark against any reality that might spook the herd.

    So what will it ultimately take to break the spell of "it couldn't happen"?

    For many the answer is:

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  • Wed, Jan 29, 2020 - 11:23am

    VeganDB12

    VeganDB12

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    Joined: Jul 18 2008

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    Medical staff in an emergency. In defense of the Mother Theresas (docs, nurses, clerks, security, all professionals retired and working who may help out)

    It has been my experience that will people WILL step up to the plate in a public health emergency(though some will call in understandably and rightly)  As we saw with Ebola, a bigger risk to staffing could be illness among first line providers.  There ARE a few saints out there and many who place their safety in danger every day on the job as you know. Not only doctors and nurses.  For many health care workers the prospect of getting injured or sick is normal to them. And many do, even though it isn't discussed much with the public.

    It may not be enough but they are out there.  I have seen it. (edited for punctuation)

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  • Wed, Jan 29, 2020 - 11:29am

    #33
    BobbyJoe

    BobbyJoe

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    What are your chances and no good deed goes unpunished

    The real issue is conditional probability.
    What are the chances of having a severe reaction requiring
    hospitalzation if one is young and healthy or just plain old?
    Male vs. female. A 20yr old vs a 60year old vs a 75yr old? With and without
    health issues? In assessing risk one can not use the probability that applies to the total
    population.  One must use the probability that applies to the sub-population to which one belongs. Is that data even available? Where do you stand along the spectrum of age and health? If infected what is your probability of having a severe reaction?
    What are the chances of a 58 year male, a C5 quadraplegic, of NOT needing hospitalization if infected? Zero.  There is a 100% chance that my brother will require hospitalization because a C5 quad has only the diaphragm to expand the lungs; the rib muscles are paralyzed and there is difficulty bringing up mucus, even from a common cold. If infected, my brother probably won't survive, because an ICU bed will probably
    be unavailable for him.
    And here is the irony and it is one hell of a kicker. People on this list and the loved ones we warn will, hopefully, take precautions to avoid catching the virus.  We will stay away from crowds,  wear PPE when out, wash our hands etc...  And if we slip up and get infected it will probably be in the middle  of an outbreak when the hospitals are overwhelmed and when we, the prudent, are turned away.  It is the uninformed, the people who wander about in public, oblivious to the danger, people who don't wash their hands, who don't sneeze into their elbows who will be the first infected and if they have a severe reaction, it will be they who will be the first in line for an ICU bed. If their numbers exceed the number of ICU beds, then those of us infected late and who need hospitalization will be out of luck.

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  • Wed, Jan 29, 2020 - 11:38am

    #34

    thc0655

    Status: Platinum Member

    Joined: Apr 27 2010

    Posts: 1945

    3+

    China is busy on the internet correcting fake news

    Did PeakProsperity get something from the Chinese authorities?

    https://gab.com/StevenKeaton/posts/103566586502612802

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  • Wed, Jan 29, 2020 - 11:40am

    mntnhousepermi

    mntnhousepermi

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    Joined: Feb 19 2016

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    dont have to tincture it

    I take alot of knotweed, and you dont need to tincture it, as a matter of fact Buhner says that it is best to just take the powder, and cheaper.  People take the tincture for convenience, but then that expense can keep people from taking enough.  A pound of the powdered knotweed is under $30.  I mix mine, and the other powdered herbs, cordyceps mushroom powder, etc... with some protein shake mix twice a day, for the third time a day I either mix with water, have some encapsulated ( so you can put the powder into capsules, or buy that way) or if realy busy, take the tincture. That is for the knotweed.

     

    There are 2 herbs I take specifically for cytokine remodulation, and those I tinctured at home,  salvia miltiorrhiza and scutellaria baicalensis .

    But, I take herbs for Lyme disease, so not the same as his recommendations for a corona virus, although both use knotweed

    To see his corona virus recommends, this is from his facebook page:

    "....

    Corona virus treatment. I have an analysis of how corona viruses infect tissues, what tissues they infect, and the herbs that are useful to interrupt that process, as well as the herbs useful to shut down the cytokine cascade they create on pages 52-55 of Herbal Antivirals. It is useful reading in that it can inform treatment from a knowledgeable place (there are also some suggestions, not often used by medical professionals, for specific pharmaceuticals that have been found to be useful). Here is a sample protocol. Please note it is rather more extensive than the ones i normally suggest, this is because the particular corona virus that is now spreading world wide is exceptionally potent in its impacts. Again, this is only a suggested protocol, but all the herbs are specific in one way or another for this virus. A number of the herbs are strongly antiviral for corona viruses. In general, I would only begin using these formulations IF there is good reason to believe that the virus is entering your area. The formulations are preventative as well as specific for acute infections, the only alteration is the dosage. Three tincture formulations and one tea.

    Core tincture formulation: Baikal skullcap (3 parts), japanese knotweed root (2 parts), kudzu (2 parts), licorice (1 part), decocted elder leaf tincture (1 part). Note, the berry will do i guess but it is about 1/3 as effective as the decocted leaf (which no one sells, you have to make it yourself). Dosage: 1 tsp 3x day, 6x if active infection.

    Immune system, cellular protection, cytokine interruption tincture formulation, supportive for core tincture activity: Cordyceps (3 parts), Dong Quai (2 parts), rhodiola (1 part), astragalus (1 part). Dosage: same as above.

    Cellular protection, cytokine interruption, spleen/lymph support tincture formulation: Dan Shen (3 parts), red root (2 parts), cinnamon (1 part). same dosage as above.

    With active infection: very strong boneset tea, to 6x day.

    I have used this with other corona virus infections, including SARS, it works well.

    ..."

     

     

     

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  • Wed, Jan 29, 2020 - 1:24pm

    #36
    Mike from Jersey

    Mike from Jersey

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    Joined: Jan 22 2018

    Posts: 37

    7+

    Update from my own far east travel

    I just got back rom China and this is an update on what I saw.

    I flew back from China. I left China via Kunming International Airport in southwest China. When I arrived at the Kunming airport, there were two guards at the door. They were nice enough, but they would not let me enter unless they took my forehead temperature with a handheld thermometer. Thankfully, everything was fine.

    I then flew from Kunming to Seoul, South Korea for my connecting flight. Most people on the flight (and in the Seoul-Incheon airport were wearing masks) included some with true respirator masks. I could see no scanning of incoming passengers at Seoul at all. That doesn't mean that there was no monitoring since I know that Hong Kong airport has technology to automatically monitor the temperature of arrivals even though it is not apparent to passengers.

    After about a five hour delay, I boarded for the overnight flight to JFK airport in New York. Again, most - but not all of the passengers (including myself) wore masks. I felt that was especially important since airplane air is re-circulated. Additionally, there were some people coughing on the flight. Not a lot, but it was noticeable under the circumstances.

    Upon arriving at JFK, there was no health monitoring that I could see. Again, that doesn't mean that there was no monitoring since I know that Hong Kong airport has technology to automatically monitor the temperature of arrivals. In any event, there was no obvious monitoring.

    I was asked by a customs agent in New York - where I had flown in from? I told them that I had come from China and I was asked about the conditions there. I told them what I had seen. But I got the impression that the customs agent knew little about the situation other than as reported on the news. I may be wrong about that, but that was the impression that I was left with.

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  • Wed, Jan 29, 2020 - 1:38pm

    #37

    thc0655

    Status: Platinum Member

    Joined: Apr 27 2010

    Posts: 1945

    5+

    It’s not just medical personnel and facilities you have to think about

    Don’t forget police and firefighters. Both occupational groups are required by conscience and departmental policies to show up for work, *especially* in the worst of crises. So not many will stay home as a precaution (at least not until it truly becomes apocalyptic). That means they will come to work sick, as they *usually* do, and especially for police will be exposed daily to whatever communicable disease is ravaging the community. You can be absolutely sure the police department will *not* encourage employees with flu symptoms to stay home. So, even assuming 100% nobility and devotion to duty, police in particular will start falling ill and staying home when they literally can’t drag themselves out of bed. Not only that, many hospital personnel will surreptitiously move seriously sick police and firefighters to the front of the line for things like ICU beds and new vaccines out of gratitude for their service and hoping to expedite their return to duty for the sake of the public.

    Police response times will start getting longer and longer, even for the most serious calls like “burglary in progress” or “man with a gun.” Imagine waiting 20-30 minutes or more for police and ambulance response to a robbery in which the victim was shot in the chest. Calls to 9-1-1 may start getting busy signals, especially in big cities where police can’t even keep up on a “normal” day.

    The worst will come when the criminal underclass (that 5% of the population that engages in crime daily as a lifestyle choice) gets wind that police are understaffed and response times are much longer than usual. They will be emboldened and a crime wave will result in the midst of the the larger pandemic crisis, even in “safe” communities.

    As you’re running out for elderberries and N95 masks, you might want to consider stopping in at the local gun store, especially if you live in a state that has a 3-10 day wait before picking up a firearm you bought. It’s too late to get serious training, but untrained but armed people save lives every day. It’s better than nothing. If you live in places like NJ, Chicago, Australia or the U.K., disregard that advice and do what you usually do when faced with the threat of violent crime. Maybe just do more and more of it as the risk gets higher and higher.

    ”Happy Hunger Games! And may the odds be ever in your favor.”

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  • Wed, Jan 29, 2020 - 1:44pm

    #38
    HaikuJr

    HaikuJr

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    Joined: Jan 29 2020

    Posts: 5

    4+

    Amaterasu

    A full moon cycles
    People says we have scary virus
    The pheasant sleeps

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  • Wed, Jan 29, 2020 - 1:59pm

    Kgluong

    Kgluong

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    Kgluong said:

    99 inflected. 11 dead. Full hospital care.

    Pdf report.

     

    https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620302117.pdf

     

     

     

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  • Wed, Jan 29, 2020 - 2:09pm

    Barbara

    Status: Member

    Joined: Dec 15 2009

    Posts: 141

    2+

    Response to talking about virus locally

    I've got mostly reasonable responses.  Not panic, but what might we do questions.  Perhaps it's because the local small town college has 6 students back on campus from China and they decided NOT to quarantine for the incubation period.  Because it's so close, it's been a bit easier to discuss.  We have an insider monitoring to let us know at once if one of them gets sick.
    In the larger, nearby university city, I also hear it discussed both as the question how serious is this and then as the what should I do now, with no cases locally.

    We do have suspected carriers locally and a know case about 100 mi away.  People seem to be waiting 2 weeks to see if there are secondary cases.  Medical facilities are asking 1) have you traveled and 2) are you sick? if so how.  It's too bad we don't systematically segregate emergency rooms into sick areas and injured areas.  Nothing like breaking a bone and catching something from the emergency room.
    Of course in a major epidemic, even if you did try to separate out those with symptoms, people would just lie to stay out of the quarantine area.

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  • Wed, Jan 29, 2020 - 2:41pm

    thc0655

    Status: Platinum Member

    Joined: Apr 27 2010

    Posts: 1945

    3+

    Coincidence?

    The corona expert is cited as posting the following:

    “has unusual middle segment never seen before in any coronavirus. 4) Not from recent mixing. 5) That mystery middle segment encodes protein responsible for entry into host cells.— Dr. Eric Feigl-Ding (@DrEricDing) January 28, 2020
    https://twitter.com/DrEricDing/status/1222010300859371522 

    At the same time, zero hedge has an unbelievable mind blowing report of how a Chinese corona virus expert was hired to study specifically that same DNA segment after being hired to study the very narrow area of  “bats to research the molecular mechanism that allows Ebola and SARS-associated coronaviruses to lie dormant for a long time without causing diseases.”  at a brand new P4 facility about 20 miles away from the alleged “source” of the virus.  I normally dont believe most of what is posted in ZeroHedge but this is seemingly black and white, and shows the actual job posting notice from the  Virology Institute located a few subway stops away from the bat soup that non-experts instantly blamed for creating the unusual new virus.

    This is serious information.  Either this is CIA planted information to attack China, or it means what the deductive logic implies.  It will be very interesting to see if the bat corona virus researcher in Wuhan gets suicided, unfortunate accident or simply disappears without explanation.

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  • Wed, Jan 29, 2020 - 3:26pm

    #42

    sand_puppy

    Status: Platinum Member

    Joined: Apr 13 2011

    Posts: 2296

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    Interpreting "The Percentage That Die"

    I am sure that many already understand this, but I'll point it out again.

    When someone say X number out of Y number of patients died giving a fatality rate of Z%.   The denominator Y, the population group studied, has to be defined clearly.

    Is the denominator Y people who:

    -were slightly sick, but not sick enough to seek medical care. (Yeah, I coughed twice....)

    -sick enough to go to the doctors office with a symptoms complex suggestive of this disease and were diagnosed clinically.

    -sick enough to go to the doctors office and had clinical and lab confirmation of etiologic  agent.

    -sick (or scared) enough to check into the emergency department.

    -sick enough to be admitted to the hospital.

    -sick enough to be admitted to the ICU.

    -sick enough to be transferred to the regional tertiary care hospital specializing in that disease.

    The excellent Lancet article is this last group--people from a tertiary care hospital specializing in the disease.

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  • Wed, Jan 29, 2020 - 3:59pm

    Quercus bicolor

    Status: Silver Member

    Joined: Mar 19 2008

    Posts: 334

    death rate in subgroups

    There was very little information on this in the article, but I was able to determine:

    age 60+: 7 deaths / 37 patients = 19%
    age 59-: 4 deaths 62 patient, 6.5%

    57 patients were still hospitalized on Jan 25, the data cutoff date, so more deaths are possible.

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  • Wed, Jan 29, 2020 - 8:15pm

    #44
    borderpatrol

    borderpatrol

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    Posts: 62

    1+

    ICU beds are limited

    The medical ICU I work has only a capacity of 20 beds. We can float patients to other units but it is very limited. We were at max capacity when H1N1 it, like movies about pandemics and the numbers of sick were not that bad. There is no cushion if numbers were worse. Still, most of our patients HAD other health problems. So if you are not immune suppressed or morbidly obese don’t worry about being in the ICU, you’re not gonna be there. Your bigger worries will be how other worldly functions will go on without a hitch.

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  • Wed, Jan 29, 2020 - 9:02pm

    #45
    Little Pond

    Little Pond

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    Joined: Jun 09 2018

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    Thank you

    I want to thank John Barry for taking the time to speak about this, and also thank Adam for taking the time to interview him. I LOVED The Great Influenza. I learned so much not just about flu but about the whole arc of medical science in US history. I tried to get everyone I knew to read it. They were mostly just strangely uninterested. Weirdos.

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  • Wed, Jan 29, 2020 - 9:21pm

    Alex Earle

    Status: Member

    Joined: Jun 14 2015

    Posts: 13

    Alex Earle said:

    Jesus.

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  • Wed, Jan 29, 2020 - 9:37pm

    Alex Earle

    Status: Member

    Joined: Jun 14 2015

    Posts: 13

    Alex Earle said:

    I did have the passing thought that perhaps I should find someone infected and get the process started before access to all the ICU beds is gone.

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  • Mon, Mar 23, 2020 - 8:18am

    CountryDog

    CountryDog

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    Joined: Mar 22 2020

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    CountryDog said:

    I'm 72 years old with breathing issues from radiation therapy 7 years ago.  I am self-isolating on a rural farm.  If I get the Coronavirus I do not think I  will survive, hospital or not.  If there are no respirators there is little chance of survival for a person like me.  I am prepared to meet the Lord, and that brings me the most comfort and security I could want.

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