Tag: 2019-nCoV

Wuhan Coronavirus/2019-nCoV Update: February 4th, 2020 (and Some Frank Talk About Proper Risk Communication by Governments During a Potential Pandemic by an Expert)

I can tell that a certain amount of “WuFlu fatigue” has already begun to set in among my readers, according to my WordPress viewer stats. That’s probably to be expected; nobody wants to keep reading bad news.

My Twitter feed, which I had taken such pride in ruthlessly pruning to follow only those people in social VR and virtual worlds, has suddenly become a rather bizarre mix of social VR/virtual worlds and various good, authoritative sources of information about the 2019-nCoV outbreak. (By the way, if you want a credible list of people to follow on Twitter, epidemiologist Dr. Ellie Murray has compiled a curated list of coronavirus experts that you can subscribe to.)

One of the people I am following is a brand new account called simply nCoV2019. There is no biography provided, zero information about who this person is, and there’s no way to learn their background or qualifications, but God damn it, whoever they are, I think they have been BANG. ON. THE. MONEY. lately in their coverage of the Wuhan coronavirus.

One of the things this person did yesterday was share several excerpts of a report from the 2009 H1N1 “swine flu” influenza pandemic about risk communication by governments, and a lot of what they are sharing is directly applicable to the current 2019-nCoV situation.

Here’s a quote from the paper by Dr. Peter M. Sandman and Dr. Jody Lanard, titled Containment as Signal: Swine Flu Risk Miscommunication, from the Peter Sandman Risk Communication website. Please note that the following quoted text is **NOT** about 2019-nCoV, but about the H1N1 influenza virus!

How should they explain the goals and endpoints of containment to their publics?

Many governments doing intense swine flu containment are signaling that the purpose of containment is to prevent local spread of the virus – not just slow it or reduce its impact, but actually prevent it. Many of these governments explicitly tell their people that this is the goal; some just signal it without actually saying so. In all cases, these signals and messages are misleading, since containment will eventually fail.

Thus governments are setting themselves up to be blamed, and setting their people up to be shocked and unprepared for imminent domestic epidemics.

The misleading signals and messages about containment violate a very basic risk communication principle for helping people cope with bad news that is likely to worsen: anticipatory guidance, telling people what to expect.

As I have reported in today’s and previous days’ updates, many infectious disease experts are now openly saying that we can expect a pandemic, as nCoV2019 has tweeted:

The message from many infectious disease experts, such as Dr. Michael Osterholm (which I blogged about here), Dr. Anthony Fauci (which I blogged about here) and Dr. Gregory Poland and Dr. Scott Gottlieb (which I blogged about here) could not be clearer:

Despite our best efforts, we here (in countries outside China) will probably NOT be able to successfully contain the 2019-nCoV virus, because it seems to be so easily transmissible. Eventually, it WILL begin to spread widely around the world.

Here’s another pertinent quote from that 2009 Sandman/Lanard swine flu paper (again, please note that the following quoted text is **NOT** about 2019-nCoV, but about the H1N1 influenza virus):

…we believe the combination of the containment strategy itself and the way that strategy is being communicated has had a huge impact on worldwide public understanding of the novel H1N1 pandemic, especially in the developing world. We think the containment signal has:

– led many publics to expect that swine flu will be prevented from entering or at least from spreading in their country;
– led many publics to believe that swine flu is currently more severe than it actually is (so far);
– led many governments to adopt containment measures that experts consider epidemiologically ineffective and economically harmful;
– led many governments to continue initially sensible containment measures long after they were no longer useful; and
– led many governments to beg the World Health Organization to delay declaring swine flu a pandemic, in part because they did not want to tell their people that swine flu’s continuing spread was unstoppable.

And when the swine flu containment strategy is ultimately abandoned, the risk communication signals sent by that strategy – if uncontradicted by explicit government communications – can lead many publics to become more mistrustful of their government and more alarmed about swine flu.

In other words, if governments and institutions do not do a proper job of risk communication in the face of a potential pandemic, they will only amplify public panic and reduce people’s trust in government, if/when things do become worse.

Peter Sandman has posted the text of an email message he shared with Canadian National Post journalist Sharon Kirkey on January 29th, 2020. (Sharon Kirkey later wrote an article on the coronavirus threat for the National Post, quoting part of what Peter wrote to her.)

I am going to quote Peter’s message at length, because I think it is required reading:

My most fervent risk communication complaint at the moment is the tendency of many top officials in the U.S., Canada, and Europe to overemphasize the fact that the risk of the novel Wuhan coronavirus here and now is tiny – as if that meant that people should (or could!) wait to worry until the risk here and now got bigger. “No reason for alarm,” is bad science as well as bad risk communication. Officials and experts are alarmed already – reason enough for the public to gird up its loins as well.

Worry is about the future. Telling people not to worry about an emerging infectious disease because it isn’t a significant risk here and now is foolish. We want people to worry about measles when there’s very little measles around, so they will take the precaution of vaccinating their children before it’s imminently necessary. We want people to worry about retirement when they’re years away from retiring, so they will start saving now.

Given the real possibility that the coronavirus might start spreading locally in North American cities, now is the right time to worry and prepare, at least emotionally and perhaps logistically as well. There’s not much reason to wear masks against the coronavirus in North America now. Masks may or may not turn out to be useful in the months ahead. In case they do turn out useful, buying them now is provident, not panicky.

Even more importantly, telling people they are foolish to worry about an emerging infectious disease is patronizing and contemptuous – when what is needed is empathy. When confronted with a risk that’s new and scary, people naturally go through what some risk communication professionals call an adjustment reaction. We temporarily overreact – feeling and imagining and even behaving as if this possible future threat were here and now. The adjustment reaction is unavoidable and usually pretty brief. It is also useful, an emotional rehearsal. It helps us prepare for the new normal that may be coming.

Instead of deriding people’s fears about the Wuhan coronavirus, I would advise officials and reporters to focus more on the high likelihood that things will get worse and the not-so-small possibility that they will get much worse. I think there is little need to ameliorate public over-reaction now. The bigger need is to reduce public over-reaction later to predictable bad news that will take people by surprise insofar as they weren’t sufficiently forewarned and didn’t get enough chance to rehearse emotionally. My wife and colleague Jody Lanard M.D. says to tell you that adjustment reactions are “like tabletop exercises for regular people.” Officials should help the public rehearse better, not tell people not to rehearse.

Good Sources of Information on 2019-nCoV

Here is my list of good, credible, authoritative resources to learn more about the Wuhan coronoavirus (more formally known as 2019-nCoV):

If you want a quick, up-to-date overview of the current situation, here are three good places to check:

Sources of Fast-Breaking News on 2019-nCoV (WARNING: News You Read Here May Not Be 100% Credible!)

PLEASE READ: In addition to the sources listed in the previous section, there are other places you can check, which might have reports (including translated links to local social media in China) that have not yet made the mainstream news media. Please keep in mind that the situation in China is chaotic, and that some of the information you find in the sources I list below might be gossip, rumours, hoaxes, conspiracy theories, misinformation, or disinformation! 

Please review the information and videos I posted in my blogpost about How to Spot Fake News, BEFORE using any of these links.

Stay healthy!

Wuhan Coronavirus/2019-nCoV Update: February 3rd, 2020

Waiting room at a Wuhan hospital, January 24, 2020 (source: Agence France-Presse)

As of noon today, there were 17,491 confirmed cases of patients infected with the 2019-nCoV virus, of which 17,308 were in mainland China. Three hundred and sixty-two people have died, including the first death occurring outside China, in the Philippines.

In a CNBC news report, Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID), said that approximately 25% of Chinese patients require intensive care:

Dr. Anthony Fauci of the National Institutes of Health told CNBC on Monday that a quarter of China’s coronavirus cases require intensive treatment.

“About 25% of them have very serious disease, requiring relatively intensive or really intensive care,” said the director of the NIH’s National Institute of Allergy and Infectious Diseases.

Cases of Wuhan Coronavirus Outside China (source: BBC)
2019-nCoV Global Cases (source)

Today, CNBC News interviewed Dr. Gregory Poland of the Mayo Clinic and Dr. Scott Gottlieb, former administrator of the U.S. FDA about how the United States should be responding to the 2019-nCoV outbreak:

Dr. Gottlieb wants the United States to broaden screening for the Wuhan coronavirus, which is currently only being done by the U.S. Centers for Disease Control. Dr. Poland asserts “we’re basically at a pandemic now”, and agrees that we need better point-of-care diagnostics in hospitals.

Testing to officially confirm the presence of the 2019-nCoV virus is also a bottleneck in many other countries, especially China, where the true number of infected patients is probably much higher than the official counts. The New York Times paints a dire picture of the current situation in Wuhan:

As countries race to deal with an outbreak that has begun spreading around the world, inciting panic and disrupting the global economy, the residents of Wuhan are waging a daily battle to survive an illness that has sickened more than 4,100 people and killed 224 in their city alone.

Last month, the government put Wuhan in a virtual lockdown, sealing off the city and banning most public transportation and private cars from its streets in a desperate effort to contain the outbreak. Now, many residents say it is nearly impossible to get the health care they need to treat — or even diagnose — the coronavirus.

Expressing exasperation, doctors say there is a shortage of testing kits and other medical supplies, and it is not clear why more are not available. The ban on transportation means some residents have to walk for hours to get to hospitals — if they are well enough to make the journey. Layers of bureaucracy stand between residents and help. And the long lines outside hospitals for testing and treatment suggest that the outbreak is spreading far beyond the official count of cases.

Ambulances, too, are hard to come by, residents say. In recent days, some say they have called 120, China’s equivalent of the emergency number 911, only to be told that there were already hundreds of people in the queue.

Those who do make it to the hospital say they are squeezed together for hours in waiting rooms, where infections are easily spread. But the shortages have meant that many are ultimately turned away and sent home to self-quarantine, potentially compounding the outbreak by exposing their families.

Good Sources of Information on 2019-nCoV

Here is my list of good, credible, authoritative resources to learn more about the Wuhan coronoavirus (more formally known as 2019-nCoV):

If you want a quick, up-to-date overview of the current situation, here are three good places to check:

Sources of Fast-Breaking News on 2019-nCoV (WARNING: News You Read Here May Not Be 100% Credible!)

PLEASE READ: In addition to the sources listed in the previous section, there are other places you can check, which might have reports (including translated links to local social media in China) that have not yet made the mainstream news media. Please keep in mind that the situation in China is chaotic, and that some of the information you find in the sources I list below might be gossip, rumours, hoaxes, conspiracy theories, misinformation, or disinformation! 

Please review the information and videos I posted in my blogpost about How to Spot Fake News, BEFORE using any of these links.

Stay healthy!

Wuhan Coronavirus/2019-nCoV Update: February 2nd, 2020

Photo by Michael Amadeus on Unsplash

Today, The New York Times reports:

The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world’s leading infectious disease experts.

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease. “But will it be catastrophic? I don’t know.”

…

It is “increasingly unlikely that the virus can be contained,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention who now runs Resolve to Save Lives, a nonprofit devoted to fighting epidemics. “It is therefore likely that it will spread, as flu and other organisms do, but we still don’t know how far, wide or deadly it will be.”

One of the biggest questions about this new virus is how lethal it will be:

The biggest uncertainty now, experts said, is how many people around the world will die. SARS killed about 10 percent of those who got it, and MERS now kills about one of three.

The 1918 “Spanish flu” killed only about 2.5 percent of its victims — but because it infected so many people and medical care was much cruder then, 20 to 50 million died.

By contrast, the highly transmissible H1N1 “swine flu” pandemic of 2009 killed about 285,000, fewer than seasonal flu normally does, and had a relatively low fatality rate, estimated at .02 percent.

The mortality rate for known cases of the Wuhan coronavirus has been running about 2 percent, although that is likely to drop as more tests are done and more mild cases are found.

…

An accurate estimate of the virus’s lethality will not be possible until certain kinds of studies can be done: blood tests to see how many people have antibodies, household studies to learn how often it infects family members, and genetic sequencing to determine whether some strains are more dangerous than others.

Closing borders to highly infectious pathogens never succeeds completely, experts said, because all frontiers are somewhat porous. Nonetheless, closings and rigorous screening may slow the spread, which will buy time for the development of drug treatments and vaccines.

Other important unknowns include who is most at risk, whether coughing or contaminated surfaces are more likely to transmit the virus, how fast the virus can mutate and whether it will fade out when the weather warms.

However, it would appear that some doctors are having some success in treating severe cases of illness caused by the Wuhan coronavirus. Reuters reports that Thai doctors have had some success in treating patients infected with 2019-nCoV using a combination of HIV and influenza drugs:

Thai doctors have seen success in treating severe cases of the new coronavirus with combination of medications for flu and HIV, with initial results showing vast improvement 48 hours after applying the treatment, they said on Sunday.

…

The drug treatment includes a mixture of anti-HIV drugs lopinavir and ritonavir, in combination with flu drug oseltamivir in large doses.

The New York Times article I cited earlier says:

In China, several antiviral drugs are being prescribed. A common combination is pills containing lopinavir and ritonavir with infusions of interferon, a signaling protein that wakes up the immune system.

In the United States, the combination is sold as Kaletra by AbbVie for H.I.V. therapy, and it is relatively expensive. In India, a dozen generic makers produce the drugs at rock-bottom prices for use against H.I.V. in Africa, and their products are W.H.O.-approved.

Another option may be an experimental drug, remdesivir, on which the patent is held by Gilead. The drug has not yet been approved for use against any disease. Nonetheless, there is some evidence that it works against coronaviruses, and Gilead has donated doses to China.

Of course, it is still early days, and a great deal more testing and research needs to be done.

Good Sources of Information on 2019-nCoV

Here is my list of good, credible, authoritative resources to learn more about the Wuhan coronoavirus (more formally known as 2019-nCoV):

If you want a quick, up-to-date overview of the current situation, here are three good places to check:

Sources of Fast-Breaking News on 2019-nCoV (WARNING: News You Read Here May Not Be 100% Credible!)

PLEASE READ: In addition to the sources listed in the previous section, there are other places you can check, which might have reports (including translated links to local social media in China) that have not yet made the mainstream news media. Please keep in mind that the situation in China is chaotic, and that some of the information you find in the sources I list below might be gossip, rumours, hoaxes, conspiracy theories, misinformation, or disinformation! 

Please review the information and videos I posted in my blogpost about How to Spot Fake News, BEFORE using any of these links.

Stay healthy!

Wuhan Coronavirus/2019-nCoV Update: February 1st, 2020

(source: BBC)

Yesterday, I provided information from The New York Times on six key factors about the Wuhan coronavirus/2019-nCoV. Today, I share with you an informative article from Vox, which explains in detail two key concepts that researchers are still trying to nail down in these earliest days of the virus outbreak: the basic reproduction number (R0 or R-naught), and the case fatality rate (CFR).

The Jan. 28th Vox article, titled The 2 key questions that will determine if the coronavirus outbreak becomes a pandemic, states:

Less than four weeks into the outbreak, fear about how bad this could get is spreading faster than the virus. And with good reason.

While the vast majority of cases and deaths are occurring on mainland China, 2019-nCoV has already made its way to at least a dozen other countries, including the US, Germany, and Canada. People are buying face masks. Markets are on edge. Cities and countries are responding with mass quarantines and travel bans. The whole thing feels a lot like the 2011 pandemic film, Contagion.

So how big could the outbreak get? Is this the next pandemic — a disease that spreads globally?

An answer to this question requires knowing the answers to two other questions: How easily does the 2019-nCoV spread from person to person, and how deadly is the virus? At the moment, scientists only have informed guesses, which are likely to solidify in the coming weeks and months. But what we know so far is instructive.

I urge you to click over and read the entire article. Between yesterday’s New York Times article and this one, you will be comfortably up-to-speed on 2019-nCoV.

How Do We Deal With Infectious Diseases?

A 2016 article appearing in the scientific journal Physics Reports, titled Statistical physics of vaccination, provides a handy reference chart outlining all the various ways that humanity has responded to limit the spread of infectious diseases throughout history (this image is hosted on Flickr; please click on the link, or the image below, it to see a high-resolution version):

Summary of commonly used interventions against infectious diseases.
Summary of commonly used interventions against infectious diseases (source)

The authors state:

We note that this list is not exhaustive, and interventions are often used in combination, such as contract tracing and isolation.

The eight tactics used to combat the spread of an infectious disease are:

  • Vaccines: treatments which create an immune memory of the pathogen, so that the immune system can respond more vigorously when challenged with the actual pathogen (please note that, as I reported yesterday, we are probably not going to have a readily-available vaccine for 2019-nCoV for at least a year)
  • Antibiotic drugs and antiviral drugs: treatments which interfere with the life cycle of the bacterium or virus within the body of an infected person (for example, there are some reports that antiviral drugs used to treat HIV are being used to treat some patients)
  • Social distancing: closing schools and businesses, avoiding crowded places, etc.
  • Case isolation: asking people who already contracted the infectious disease to stay home; using negative-pressure rooms in hospitals, etc. (note the key difference between isolation and quarantine, the next point, which is applied to potentially infectious people)
  • Quarantine: isolation of individuals who may have already been exposed to the infectious disease, and therefore potentially infectious themselves (this is what China is doing now in many locations)
  • Barrier precautions: masks, gloves, condoms in the case of sexually-transmitted viruses like HIV, etc.
  • Contact tracing: tracking down the contacts of infected individuals to treat, isolate, or quarantine them (at the moment, most countries are devoting many resources to this)
  • Hygiene: hand washing, hand sanitizer, etc.

Dr. Michael Osterholm: “Once it starts to spread, there really is no stopping it”

Now for some bad news. Dr. Michael Osterholm is an internationally recognized expert in infectious disease epidemiology, who led many investigations into infectious disease outbreaks during his 15 years as state epidemiologist at the Minnesota Department of Health. He is currently the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, and he was interviewed yesterday by the Fox Business News channel (this link is to the 5-minute video, which unfortunately cannot be embedded here).

Dr. Osterholm predicts that this epidemic will likely get a lot worse, given how easily the 2019-nCoV virus seems be transmitted between people. He said in this Fox interview:

It’s acting very much, in terms of transmission, like that of an influenza virus, which means that once it starts to spread, there really is no stopping it, until it decides to stop.

He predicts that hospitals and healthcare systems around the world are going to be overwhelmed with the Wuhan coronavirus in the coming weeks and months, just as those in mainland China are now. Not if, but when.

So, what does all this mean?

Well, referring back to that chart above, we have no vaccine, and we still don’t know how effective existing antiviral treatments will be (although we can expect many scientific research papers to be published as doctors conduct various experiments).

Countries outside China are relying on case isolation and contact tracing to chase down and isolate infected individuals, which may work (although some experts like Dr. Osterholm don’t believe it will be effective enough). Healthcare professionals are using proper hygiene and barrier precautions (personal protective equipment such as masks, gloves, eye protection, etc.) to avoid becoming infected with the virus themselves while treating patients. Many civilians are also starting to use barrier protections when out in public.

That only leaves two approaches which we will begin to see more of in the coming weeks and months: social distancing and quarantine. What this means for you, reading this now, is that you need to prepare yourself and your family for the possibility that you will need to stay in your homes for a period of several weeks, avoiding contact with as many other people as possible, as a wave of illness caused by the Wuhan coronavirus sweeps through your community, forcing schools, businesses, and public transportation and public gathering places like movie theatres and shopping malls to close (as we already seen in Wuhan and many other cities in China). The time to prepare for this is NOW.

I hope that this discussion has convinced you that you do need to start taking this seriously. That means that you need to prepare by stocking up on food and other supplies to last you at least two or three weeks. Start by reviewing the Personal Health Preparedness lists provided by the U.S. Centers for Disease Control and Prevention here.

You will need to have on hand:

  • At least two weeks of food and other supplies (toilet paper, first aid supplies, soap and hand sanitizer, garbage bags, etc.). Hardcore, doomsday preppers would argue that you also need to store enough water for each person to last 2 or 3 weeks, but I think it is unlikely that we are going to lose public utilities in first-world countries, such as electricity, water, and sewer services, during an epidemic/pandemic. If stocking up on water makes you feel less anxious overall, do it.
  • Refills of all your presecription medications, plus a stock of over-the-counter medicines (talk to your doctor and pharmacist about creating an emergency supply of your prescription medication). You might not be able to get out to your pharmacy because of the imposition of social distancing and quarantines to stop the spread of the virus.
  • Power sources (flashlights, extra batteries, car chargers and adapters for your mobile devices, a battery-operated or hand-crank radio if the electricity or Internet do go out, which I still think is unlikely).

Other things that you should do:

  • Sign up for any local alerts from your city, state/province, or federal government (or know where to find the information on the Internet). Find out what plans your employer is making.
  • If you haven’t yet, get your seasonal flu shot. It can’t hurt, and it will help to figure out whether or not you do have 2019-nCoV if/when you do become sick. Many areas now give out the flu shot for free.
  • Watch the following video from the World Health Organization on how wash your hands! (Yes, I’m serious. And stock up on soap. This will also help you avoid catching regular colds and influenza.)

Good Sources of Information on 2019-nCoV

Here is my updated list of good, authoritative resources to learn more about the Wuhan coronoavirus (more formally known as 2019-nCoV):

If you want a quick, up-to-date overview of the current situation, here are three good places to check:

Sources of Fast-Breaking News on 2019-nCoV (WARNING: News You Read Here May Not Be 100% Credible!)

PLEASE READ: In addition to the sources listed in the previous section, there are other places you can check, which might have reports (including translated links to local social media in China) that have not yet made the mainstream news media. Please keep in mind that the situation in China is chaotic, and that some of the information you find in the sources I list below might be gossip, rumours, hoaxes, conspiracy theories, misinformation, or disinformation! 

Please review the information and videos I posted in my blogpost about How to Spot Fake News, BEFORE using any of these links.

Stay healthy!