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In the coronavirus pandemic, we’re making decisions without reliable data

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/



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FIRST OPINION

A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

By JOHN P.A. IOANNIDIS
MARCH 17, 2020

A nurse holds swabs and a test tube to test people for Covid-19 at a drive-through station set up in the parking lot of the Beaumont Hospital in Royal Oak, Mich.PAUL SANCYA/AP

The current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.
At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.
Draconian countermeasures have been adopted in many countries. If the pandemic dissipates — either on its own or because of these measures — short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm?
ADVERTISEMENT

Vaccines or affordable treatments take many months (or even years) to develop and test properly. Given such timelines, the consequences of long-term lockdowns are entirely unknown.

Related:

We know enough now to act decisively against Covid-19. Social distancing is a good place to start

The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.
ADVERTISEMENT

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.
The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.

STAT Reports: STAT’s guide to interpreting clinical trial results

That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.
Could the Covid-19 case fatality rate be that low? No, some say, pointing to the high rate in elderly people. However, even some so-called mild or common-cold-type coronaviruses that have been known for decades can have case fatality rates as high as 8% when they infect elderly people in nursing homes. In fact, such “mild” coronaviruses infect tens of millions of people every year, and account for 3% to 11% of those hospitalized in the U.S. with lower respiratory infections each winter.
These “mild” coronaviruses may be implicated in several thousands of deaths every year worldwide, though the vast majority of them are not documented with precise testing. Instead, they are lost as noise among 60 million deaths from various causes every year.
Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases. In the U.S., for example, so far this season 1,073,976 specimens have been tested and 222,552 (20.7%) have tested positive for influenza. In the same period, the estimated number of influenza-like illnesses is between 36,000,000 and 51,000,000, with an estimated 22,000 to 55,000 flu deaths.
Note the uncertainty about influenza-like illness deaths: a 2.5-fold range, corresponding to tens of thousands of deaths. Every year, some of these deaths are due to influenza and some to other viruses, like common-cold coronaviruses.
In an autopsy series that tested for respiratory viruses in specimens from 57 elderly persons who died during the 2016 to 2017 influenza season, influenza viruses were detected in 18% of the specimens, while any kind of respiratory virus was found in 47%. In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.

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A roundup of STAT’s top stories of the day.

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If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.” If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average. The media coverage would have been less than for an NBA game between the two most indifferent teams.
Some worry that the 68 deaths from Covid-19 in the U.S. as of March 16 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?
The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.
In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns. Unfortunately, we do not know if these measures work. School closures, for example, may reduce transmission rates. But they may also backfire if children socialize anyhow, if school closure leads children to spend more time with susceptible elderly family members, if children at home disrupt their parents ability to work, and more. School closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease.
This has been the perspective behind the different stance of the United Kingdom keeping schools open, at least until as I write this. In the absence of data on the real course of the epidemic, we don’t know whether this perspective was brilliant or catastrophic.
Flattening the curve to avoid overwhelming the health system is conceptually sound — in theory. A visual that has become viral in media and social media shows how flattening the curve reduces the volume of the epidemic that is above the threshold of what the health system can handle at any moment.

Related:

The novel coronavirus is a serious threat. We need to prepare, not overreact

Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated. If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse: Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity.
One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health. Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric. At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.
In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.
The vast majority of this hecatomb would be people with limited life expectancies. That’s in contrast to 1918, when many young people died.
One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.
If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.
John P.A. Ioannidis is professor of medicine and professor of epidemiology and population health, as well as professor by courtesy of biomedical data science at Stanford University School of Medicine, professor by courtesy of statistics at Stanford University School of Humanities and Sciences, and co-director of the Meta-Research Innovation Center at Stanford (METRICS) at Stanford University.

About the Author

John P.A. Ioannidis

jioannid@stanford.edu

@METRICStanford

Tags

CORONAVIRUS
GLOBAL HEALTH
INFECTIOUS DISEASE
PUBLIC HEALTH

Republish this article

DP

MARCH 19, 2020 AT 12:04 PM

“I’m sitting at home after my office closed today and still wondering why my country’s economy is being destroyed by panic.”
“…and the death rate will turn out to be about what the flu is. It seems most likely.”
If you want to know why then read more of the readers comments and you will see why. The contagion factor is excluded from the authors analysis, which makes his theory just as incomplete as the missing data he complains about.
The contagion factor of this virus is far greater than influenza- so if you don’t take measures to slow the spread you get a higher death rate because you can’t treat all the sick at once. Italy versus China is an actual example of what happens- they are already surpassing China’s death rate even though their population pales in comparison (60 million versus 1.35 billion)

Will

MARCH 19, 2020 AT 11:59 AM

In the same article that you use the Diamond Princess cruise ship as a case study for fatality rates, you estimate that 1% of the U.S population might be infected. The Diamond Princess cruise ship saw nearly 25% of the ship’s passengers infected. Perhaps multiple your “lost in the noise” 10,000 influenza-like deaths by 20+.

DP

MARCH 19, 2020 AT 11:50 AM

The author’s choice of influenza and cruise ship results as points of comparison as basis are… just as bad, if not worse, than proceeding with incomplete data.
There is a point to not having the data, but this article is irresponsible and biased against in its assumptions. Stating ‘we don’t know if these measures work’ isn’t completely accurate either, as we see first hand the difference between what happens in some instances as opposed to others (Italy’s death toll will surpass China’s).
For those touting this author’s expertise, know there are others with greater experience indicating otherwise. The author uses 1918 as a reference, so note Frank Macfarlane Burnet (more knowledgeable about influenza than this author ever will be) indicates the actual death toll from influenza was much higher, and that these viruses can mutate and come in multiple waves- the second wave in 1918 was far deadlier.
This author fails to take that into consideration, as well as the contagion factor. Th fact that COVID19’s viral shed factor is 1,000 times greater than influenza, and it’s peak shed is during incubation when many times there are no symptoms (as opposed to influenza, which peaks after it settles into the lungs).

Julian

MARCH 19, 2020 AT 11:49 AM

Why is this article’s main source of data the Diamond Princess when we have a much, much larger data set in South Korea? As of March 15th, South Korea had tested 248,000 people, and confirmed 8,162 cases, and recorded 75 deaths. That represents a case fatality ratio of 0.9%. If governments should base their policy decisions on a range of reasonable possibilities, it seems like the South Korea example, where they have conducted the most testing, should be the benchmark – not the Diamond Princess.

Mike Schwaller

MARCH 19, 2020 AT 11:49 AM

This is misinformation but the premise is right…we really do not know until better data is available.
The author selected the cruise ship as a reasonable system to make his argument, then listed confounding variables that make his points appear credible. These variables were presented like a subordinate clause. There are major epidemiologic flaws in his approach.
He could be right, but he is brave to make his assertions this early in the game based on this cruise ship.
We need draconian measures for at least 1 month until we have better data.
MS

Annie

MARCH 19, 2020 AT 11:47 AM

Thank you for this article. It is the first one I’ve read lately that seems logical and unbiased. We had over 60,000 American deaths during the 2017-18 flu season, and yet confirmed American deaths from this disease are still under 200. I’m sitting at home after my office closed today and still wondering why my country’s economy is being destroyed by panic. It’s just the unknown factor I guess, along with media bias and politics. Hopefully more testing will be done on people who have only experienced mild symptoms, and the death rate will turn out to be about what the flu is. It seems most likely.

Bob

MARCH 19, 2020 AT 11:46 AM

Dr. Ioannidis, if you’re reading this pretty robust conversation:
several comments have alluded to preparedness of the health care system (everyone at our at-capacity university hospital seem to have fingers crossed).
Any idea how your colleagues at Stanford (particulary ER docs, intensivists, ID), as well as nursing, RT, etc (especially as it pertains to staffing) feel about preparedness?

Albert

MARCH 19, 2020 AT 11:31 AM

How about “Let’s do two things at once”?
First, social distancing, knowing that it’s (a) effective at ‘flattening the curve’ and helping health systems to better cope with the inevitable influx of severely ill patients, and (b) temporary, a society-wide acute care response that’s needed until…
Second, better data are collected to determine a more complete epidemiological profile of COVID-19. Especially now that China, South Korea, and others appear to be moving past their respective outbreak peaks, countries can move quickly to randomized serological studies to determine true mortality risk. From there, we can determine how much social distancing protocols can be eased and what pace, how many restrictions (re: travel, telework, retail, public gatherings, etc.) are still needed and for whom, and how much surveillance, public health, and medical capacity are needed to maintain watch for new clustered outbreaks.
It’s not that Team Ioannidis is right and Team Lipsitch is wrong, or vice versa. It’s that they’re both right.

Dom

MARCH 19, 2020 AT 11:25 AM

Love this article… while this seems to be hospitalizing people at an alarming rate, the fear and warnings issued are based on bad data. Hospitals need protected in order to provide standard care beyond just treating this virus but issuing a death rate between 3 and 5% when almost no one has been tested is irresponsible.
I am interested to know how many hospitalizations have occurred in the last 30 days for this virus compared to others to gauge how severe this is.
I tend to want to look at things from a place of intelligence rather than emotion.

Lylia Hoehl

MARCH 19, 2020 AT 11:51 AM

What a waste of time and materials to test everyone. If someone tests negative then comes in contact with the virus, they may then test positive.

OLDER COMMENTS »

Comments are closed.

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In the coronavirus pandemic, we’re making decisions without reliable data

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/



Newsletters

Try STAT Plus

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FIRST OPINION

A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

By JOHN P.A. IOANNIDIS
MARCH 17, 2020

A nurse holds swabs and a test tube to test people for Covid-19 at a drive-through station set up in the parking lot of the Beaumont Hospital in Royal Oak, Mich.PAUL SANCYA/AP

The current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.
At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.
Draconian countermeasures have been adopted in many countries. If the pandemic dissipates — either on its own or because of these measures — short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm?
ADVERTISEMENT

Vaccines or affordable treatments take many months (or even years) to develop and test properly. Given such timelines, the consequences of long-term lockdowns are entirely unknown.

Related:

We know enough now to act decisively against Covid-19. Social distancing is a good place to start

The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.
ADVERTISEMENT

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.
The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.

STAT Reports: STAT’s guide to interpreting clinical trial results

That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.
Could the Covid-19 case fatality rate be that low? No, some say, pointing to the high rate in elderly people. However, even some so-called mild or common-cold-type coronaviruses that have been known for decades can have case fatality rates as high as 8% when they infect elderly people in nursing homes. In fact, such “mild” coronaviruses infect tens of millions of people every year, and account for 3% to 11% of those hospitalized in the U.S. with lower respiratory infections each winter.
These “mild” coronaviruses may be implicated in several thousands of deaths every year worldwide, though the vast majority of them are not documented with precise testing. Instead, they are lost as noise among 60 million deaths from various causes every year.
Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases. In the U.S., for example, so far this season 1,073,976 specimens have been tested and 222,552 (20.7%) have tested positive for influenza. In the same period, the estimated number of influenza-like illnesses is between 36,000,000 and 51,000,000, with an estimated 22,000 to 55,000 flu deaths.
Note the uncertainty about influenza-like illness deaths: a 2.5-fold range, corresponding to tens of thousands of deaths. Every year, some of these deaths are due to influenza and some to other viruses, like common-cold coronaviruses.
In an autopsy series that tested for respiratory viruses in specimens from 57 elderly persons who died during the 2016 to 2017 influenza season, influenza viruses were detected in 18% of the specimens, while any kind of respiratory virus was found in 47%. In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.

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A roundup of STAT’s top stories of the day.

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If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.” If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average. The media coverage would have been less than for an NBA game between the two most indifferent teams.
Some worry that the 68 deaths from Covid-19 in the U.S. as of March 16 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?
The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.
In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns. Unfortunately, we do not know if these measures work. School closures, for example, may reduce transmission rates. But they may also backfire if children socialize anyhow, if school closure leads children to spend more time with susceptible elderly family members, if children at home disrupt their parents ability to work, and more. School closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease.
This has been the perspective behind the different stance of the United Kingdom keeping schools open, at least until as I write this. In the absence of data on the real course of the epidemic, we don’t know whether this perspective was brilliant or catastrophic.
Flattening the curve to avoid overwhelming the health system is conceptually sound — in theory. A visual that has become viral in media and social media shows how flattening the curve reduces the volume of the epidemic that is above the threshold of what the health system can handle at any moment.

Related:

The novel coronavirus is a serious threat. We need to prepare, not overreact

Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated. If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse: Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity.
One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health. Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric. At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.
In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.
The vast majority of this hecatomb would be people with limited life expectancies. That’s in contrast to 1918, when many young people died.
One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.
If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.
John P.A. Ioannidis is professor of medicine and professor of epidemiology and population health, as well as professor by courtesy of biomedical data science at Stanford University School of Medicine, professor by courtesy of statistics at Stanford University School of Humanities and Sciences, and co-director of the Meta-Research Innovation Center at Stanford (METRICS) at Stanford University.

About the Author

John P.A. Ioannidis

jioannid@stanford.edu

@METRICStanford

Tags

CORONAVIRUS
GLOBAL HEALTH
INFECTIOUS DISEASE
PUBLIC HEALTH

Republish this article

DP

MARCH 19, 2020 AT 12:04 PM

“I’m sitting at home after my office closed today and still wondering why my country’s economy is being destroyed by panic.”
“…and the death rate will turn out to be about what the flu is. It seems most likely.”
If you want to know why then read more of the readers comments and you will see why. The contagion factor is excluded from the authors analysis, which makes his theory just as incomplete as the missing data he complains about.
The contagion factor of this virus is far greater than influenza- so if you don’t take measures to slow the spread you get a higher death rate because you can’t treat all the sick at once. Italy versus China is an actual example of what happens- they are already surpassing China’s death rate even though their population pales in comparison (60 million versus 1.35 billion)

Will

MARCH 19, 2020 AT 11:59 AM

In the same article that you use the Diamond Princess cruise ship as a case study for fatality rates, you estimate that 1% of the U.S population might be infected. The Diamond Princess cruise ship saw nearly 25% of the ship’s passengers infected. Perhaps multiple your “lost in the noise” 10,000 influenza-like deaths by 20+.

DP

MARCH 19, 2020 AT 11:50 AM

The author’s choice of influenza and cruise ship results as points of comparison as basis are… just as bad, if not worse, than proceeding with incomplete data.
There is a point to not having the data, but this article is irresponsible and biased against in its assumptions. Stating ‘we don’t know if these measures work’ isn’t completely accurate either, as we see first hand the difference between what happens in some instances as opposed to others (Italy’s death toll will surpass China’s).
For those touting this author’s expertise, know there are others with greater experience indicating otherwise. The author uses 1918 as a reference, so note Frank Macfarlane Burnet (more knowledgeable about influenza than this author ever will be) indicates the actual death toll from influenza was much higher, and that these viruses can mutate and come in multiple waves- the second wave in 1918 was far deadlier.
This author fails to take that into consideration, as well as the contagion factor. Th fact that COVID19’s viral shed factor is 1,000 times greater than influenza, and it’s peak shed is during incubation when many times there are no symptoms (as opposed to influenza, which peaks after it settles into the lungs).

Julian

MARCH 19, 2020 AT 11:49 AM

Why is this article’s main source of data the Diamond Princess when we have a much, much larger data set in South Korea? As of March 15th, South Korea had tested 248,000 people, and confirmed 8,162 cases, and recorded 75 deaths. That represents a case fatality ratio of 0.9%. If governments should base their policy decisions on a range of reasonable possibilities, it seems like the South Korea example, where they have conducted the most testing, should be the benchmark – not the Diamond Princess.

Mike Schwaller

MARCH 19, 2020 AT 11:49 AM

This is misinformation but the premise is right…we really do not know until better data is available.
The author selected the cruise ship as a reasonable system to make his argument, then listed confounding variables that make his points appear credible. These variables were presented like a subordinate clause. There are major epidemiologic flaws in his approach.
He could be right, but he is brave to make his assertions this early in the game based on this cruise ship.
We need draconian measures for at least 1 month until we have better data.
MS

Annie

MARCH 19, 2020 AT 11:47 AM

Thank you for this article. It is the first one I’ve read lately that seems logical and unbiased. We had over 60,000 American deaths during the 2017-18 flu season, and yet confirmed American deaths from this disease are still under 200. I’m sitting at home after my office closed today and still wondering why my country’s economy is being destroyed by panic. It’s just the unknown factor I guess, along with media bias and politics. Hopefully more testing will be done on people who have only experienced mild symptoms, and the death rate will turn out to be about what the flu is. It seems most likely.

Bob

MARCH 19, 2020 AT 11:46 AM

Dr. Ioannidis, if you’re reading this pretty robust conversation:
several comments have alluded to preparedness of the health care system (everyone at our at-capacity university hospital seem to have fingers crossed).
Any idea how your colleagues at Stanford (particulary ER docs, intensivists, ID), as well as nursing, RT, etc (especially as it pertains to staffing) feel about preparedness?

Albert

MARCH 19, 2020 AT 11:31 AM

How about “Let’s do two things at once”?
First, social distancing, knowing that it’s (a) effective at ‘flattening the curve’ and helping health systems to better cope with the inevitable influx of severely ill patients, and (b) temporary, a society-wide acute care response that’s needed until…
Second, better data are collected to determine a more complete epidemiological profile of COVID-19. Especially now that China, South Korea, and others appear to be moving past their respective outbreak peaks, countries can move quickly to randomized serological studies to determine true mortality risk. From there, we can determine how much social distancing protocols can be eased and what pace, how many restrictions (re: travel, telework, retail, public gatherings, etc.) are still needed and for whom, and how much surveillance, public health, and medical capacity are needed to maintain watch for new clustered outbreaks.
It’s not that Team Ioannidis is right and Team Lipsitch is wrong, or vice versa. It’s that they’re both right.

Dom

MARCH 19, 2020 AT 11:25 AM

Love this article… while this seems to be hospitalizing people at an alarming rate, the fear and warnings issued are based on bad data. Hospitals need protected in order to provide standard care beyond just treating this virus but issuing a death rate between 3 and 5% when almost no one has been tested is irresponsible.
I am interested to know how many hospitalizations have occurred in the last 30 days for this virus compared to others to gauge how severe this is.
I tend to want to look at things from a place of intelligence rather than emotion.

Lylia Hoehl

MARCH 19, 2020 AT 11:51 AM

What a waste of time and materials to test everyone. If someone tests negative then comes in contact with the virus, they may then test positive.

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„Am discutat şi cu doamna ministru al Muncii, Violeta Alexandru, este o situaţie în care cei care lucrau acolo au abandonat lucrul, să spun aşa, urmează să facă reîncadrări, sunt ai noştri, sunt instituţionalizaţi şi trebuie şi trataţi, trebuie supravegheaţi şi trebuie şi avut grijă pe partea medicală”, a declarat Nelu Tătaru.

Tătaru, despre situaţia de la căminul de bătrâni din Galaţi: Cei care lucrau acolo au abandonat lucrul

„Am discutat şi cu doamna ministru al Muncii, Violeta Alexandru, este o situaţie în care cei care lucrau acolo au abandonat lucrul, să spun aşa, urmează să facă reîncadrări, sunt ai noştri, sunt instituţionalizaţi şi trebuie şi trataţi, trebuie supravegheaţi şi trebuie şi avut grijă pe partea medicală”, a declarat Nelu Tătaru.

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Viața după Coronavirus – Patru scenarii posibile (I)

Prefectul judeţului Galaţi, Gabriel Avrămescu, a solicitat autorităţilor centrale găsirea unei soluţii legale pentru ca azilul privat de la Galaţi, unde doi bătrâni au murit din cauza coronavirusului, iar alte 26 de persoane, vârstnici şi angajaţi, sunt infectate, să fie preluat de instituţiile statului. Solicitarea vine după ce, potrivit administratorului azilului, în unitate ar mai fi alimente pentru masa bătrânilor doar pentru trei zile.
La rândul său, preşedintele Consiliului Judeţean Galaţi, Costel Fotea, a declarat, marţi, că, dacă se va identifica de către autorităţile centrale calea legală de preluare a azilului, acesta va fi preluat fie de DGASPC, fie de AJPIS.
La solicitarea DSP Galaţi, marţi a fost aprobată detaşarea a 10 asistente şi 12 infiermiere la Căminul de bătrâni „Sf. Ilie” din Galaţi.
Procurorii au început o anchetă după ce mai multe persoane de la Căminul pentru vârstnici s-au infectat cu Covid-19, ei precizând că directorul acestei instituţii a intrat în contact cu o persoană venită dintr-o ţară cu peste 500 cazuri de coronavirus şi nu a luat măsuri pentru prevenirea şi combaterea bolilor, continuându-şi activitatea în cadrul centrului.
Potrivit unui comunicat al Parchetului de pe lângă Judecătoria Galaţi, marţi s-a înregistrat la Parchet dosarul penal nr. 2149/P/2020, în care se fac cercetări pentru zădărnicirea combaterii bolilor.
Anchetatorii au precizat că directorul Căminului pentru persoane vârstnice „Sf. Ilie” din Galaţi, care a intrat în contact cu o persoană reîntoarsă în ţară dintr-un stat aflat pe lista celor cu peste 500 de cazuri confirmate de infecţie cu coronavirus Covid-19, nu a luat toate măsurile legale pentru prevenirea şi combaterea bolilor, continuându-şi activitatea în cadrul centrului, iar acest fapt a dus la infectarea cu coronavirus Covid-19 a mai multor persoane vârstnice din cele 130 cazate în centru.
Un total de 28 de teste pentru coronavirus au ieşit până acum pozitive la centrul de bătrâni din Galaţi, inclusiv ale celor doi bătrâni care au decedat.
Bolnavul 0 care a dus la îmbolnăvirea bătrânilor din azilul privat este femeia care deţine afacerea şi care s-a îmbolnăvit de la soţul ei, care a călătorit în Turcia. Femeia este infectată, internată în spital, iar soţul ei a murit din cauza coronavirusului.

Wearing Masks actually Saves Lives! – Covid 19 Virus Pandemic

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Wearing Masks actually Saves Lives!

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Right Now, People Are Promoting Anti-mask and it’s completely Wrong!

The U.S. Surgeon General and W.H.O. are spreading news, that masks are not effective at preventing COVID-19 spread. Who knows why they are saying this. Maybe this is some kind of fake news, just to be able to get masks to the front line ( Nurses and Doctors fighting the Pandemic). Look it’s only common sense to know that anything that prevents any type of aerial viruses from being transmitted lowers the virality of COVID-19 ¹

U.S. Surgeon General✔@Surgeon_General

So what is the U.S Surgeon General demanding for people to stop buying masks?

Here is a latest post, that they are stating that its not effective in preventing the general public from catching the Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! Here is the Link : http://bit.ly/37Ay6C

World Health Organization Western Pacific✔@WHOWPRO

What the UN is saying is that if you don’t have any type of symptoms such as respiratory symptoms, which include, fever, cough, or runny nose, you do not need to wear a medical mask. When used alone, masks can give you a false feeling of protection and can even be a source of infection when not used correctly . Here is that post : https://bit.ly/2QN3QOp

What we find is that these two are kinda wrong. And we need to get this out. We want the U.S. Surgeon General and The World Health Organization to reverse their decision to stop people from buying masks, and start promoting a universal mask wearing culture, so we can stop the spread faster.

This is actually a fact that Countries that are pro mask wearing have lower infections. Here are some real facts below.

Japan has been always been considered a mask-wearing culture, and because of that , it also has the lowest COVID-19 infection rates

Despite Japan’s large elderly population and early infection, the infection and death rate is one of the lowest in the world. A leading reason for this is Japan’s strong mask-wearing culture lowering the virality of COVID-19 to manageable levels. Japan has only had 1,387 infections, yet being one of the earliest countries to become infected ². Tokyo Metropolitan Police paper towel mask

Here is how the Czech Republic is fighting the fight against the Corona Virus.

Starting on March 18, the Czech Republic made it mandatory to wear a mask while in public. So far there have only been 2,279 COVID-19 confirmed cases, making it one of the lowest infected countries in Europe. ⁶ We should keep a close on the Czech Republic’s future infection rate relative to its neighbors to show the quantifiable impact of mask-wearing. OVERVIEW: Czech campaign #masks4all.

Let’s promote mask-wearing culture to lower COVID-19 infections.

Anything that prevents aerosolized viruses from being transmitted person-to-person will lower COVID-19’s infection rate ⁵.

1. Wear a mask when outside of your home to avoid lingering aerosolized virus droplets³.
2. N95 masks are better than surgical masks, but anything that prevents breathing in moisture partials with viruses helps. ⁴
3. We need hard data that show a direct effect of a strong mask-wearing culture to lower COVID-19 virality. We only have anecdotal research at this point.
4. Going in public without a mask in a pandemic is like riding a motorcycle without a helmet. You don’t look cool. People see you and think you don’t value your life.
5. Promote research that shows the benefits of wearing masks. Research
6. Start promoting universal masks-wearing at the local level. Encourage your neighbors, apartment building, and city government to wear masks.

Our Top Recommendations To Protect You Better

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References

• 1.) Rational use of face masks in the COVID-19 pandemic
• 2.) Coronavirus: How Japan keeps COVID-19 under control
• 3.) Coronavirus can travel twice as far as official ‘safe distance’ and stay in air for 30 minutes, Chinese study finds
• 4.) Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?
• 5.) Association between 2019-nCoV transmission and N95 respirator use
• 6.) Simple DIY masks could help flatten the curve. We should all wear them in public.
• 7.) COVID-19 CORONAVIRUS PANDEMIC

#MasksForAll Community #stopthespread

• Johnathan
• March 31, 2020
• Corona Virus

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Learn more This article is about a current pandemicwhere information can change quickly or be unreliable. The latest page updatesmay not reflect the most up-to-date information.

Map of confirmed cases of COVID-19 per capita (as of 5 April 2020):

1,000+ confirmed cases per million

100–1,000 confirmed cases per million

10–100 confirmed cases per million

1–10 confirmed cases per million

>0–1 confirmed cases per million

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Total confirmed cases of COVID-19 by country and territory (as of 5 April 2020):

100,000+ confirmed cases

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This article documents countries and territories affected by and their responses to the coronavirusresponsible for the ongoing 2019–20 pandemic first detected in Wuhan, Hubei, China. It may not include all the most up-to-date major responses and measures.

Pandemic by country and territory

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2019–20 coronavirus pandemic by country and territory

Countries and territories^[a]Cases^[b]Deaths^[c]Recov.^[d]Ref.2241,249,10767,999256,059^[2]United States^[e]327,2539,30216,735^[7][8]Spain^[f]130,75912,41838,080^[10]Italy^[g]128,94815,88721,815^[13]Germany^[h]98,7651,52423,192^[14][15]China (mainland)^[i]81,6693,32976,964^[16]France^[j]70,4788,07816,183^[18][19]Iran^[k]58,2263,60322,011^[21]United Kingdom^[l]47,8064,932–^[23][24]Turkey27,0695741,042^[25][26]Switzerland21,0377126,415^[27]Belgium19,6911,4473,751^[28]Netherlands^[m]17,8511,766–^[30]Canada15,3982772,613^[31]Austria11,9552042,998^[32][33]Portugal11,27829575^[34]

Ofiţer de intelligence israelian: Oraşul Wuhan ar avea două laboratoare care sunt implicate în dezvoltarea de arme biologice Conform unor rapoarte de intelligence, în Wuhan ar exista nu unul ci două laboratoare

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Epoch Times România

Ofiţer de intelligence israelian: Oraşul Wuhan ar avea două laboratoare care sunt implicate în dezvoltarea de arme biologice
Conform unor rapoarte de intelligence, în Wuhan ar exista nu unul ci două laboratoare implicate în programe biologice militare

. (Photos.com)
A.P.

27.01.2020

Potrivit unui expert israelian în război biologic, epidemia mortală de virus răspândit la nivel mondial ar putea avea originile într-un laborator din Wuhan legat de programul de arme biologice al Chinei arată publicaţia Washington Times.

În această săptămână, Radio Free Asia a redifuzat un raport al unui post local de televiziune din Wuhan transmis iniţial în 2015, care vorbea despre cel mai avansat laborator de cercetare de virologie din China, cunoscut sub numele de Institutul de Virologie Wuhan.

Laboratorul este singura unitate declarată de China acreditată să lucreze cu viruşi letali.

Dany Shoham, fost ofiţer de informaţii militare israeliene care a studiat războiul biologic chinez, a declarat că institutul este legat de programul de arme biologice secret al Beijing-ului.

“Anumite laboratoare din institut au fost probabil angajate, din punct de vedere al cercetării şi dezvoltării, în dezvoltarea de [arme biologice] chineze, cel puţin colateral, dar nu ca centru al războiului biologic propriu zis”, a declarat domnul Shoham pentru The Washington Times.

Operaţiunile cu armele biologice ale Chinei sunt parte dintr-un program dual civil-militar şi sunt „cu siguranţă secrete”, a spus el într-un e-mail.

Shoham are doctoratul în microbiologie medicală. Din 1970 până în 1991 a fost analist senior de informaţii militare israeliene pentru război biologic şi chimic în Orientul Mijlociu şi în întreaga lume, deţinând gradul de locotenent colonel.

China a negat în trecut că deţine arme biologice ofensive. Departamentul de Stat, într-un raport de anul trecut, a declarat că suspectează angajarea regimului comunist chinez în programe secrete de război biologic, conform Washington Post.

Până în prezent, autorităţile chineze au spus că originea coronavirusului care a ucis şi a infectat mii de persoane (conform datelor oficiale) în provincia centrală Hubei nu este cunoscută.

Gao Fu, directorul Centrului chinez pentru controlul şi prevenirea bolilor, a declarat joi, că semnele iniţiale au indicat că virusul provine de la animale sălbatice vândute pe o piaţă de fructe de mare din Wuhan.

Un semn sigur că regimul chinez începe o operaţiune de dezinformare este că, cu câteva săptămâni în urmă, au început să circule pe Internetul chinez zvonuri care susţineau că virusul face parte dintr-o conspiraţie a SUA pentru a răspândi armele biologice. Asemenea campanii de zvonuri sunt – ca de altfel întregul sistem de media socială – sub controlul total al regimului chinez.

Campania de dezinformare ar putea indica faptul că Beijingul pregăteşte un război informaţional pentru a contracara acuzaţii ulterioare că noul virus a scăpat din unul dintre laboratoarele de cercetare civile sau militare din Wuhan.

Institutul Wuhan a studiat coronavirusurile în trecut, inclusiv tulpina care cauzează sindromul respirator sever acut sau SARS, virusul gripal H5N1, encefalita japoneză şi febra dengue. Cercetătorii de la institut au studiat, de asemenea, germenul care provoacă antrax – un agent biologic dezvoltat pe vremuri de Rusia.

„Coronavirusurile (în special SARS) au fost studiate în institut şi se află probabil acolo”, a spus el. „SARS este inclus în programul chinez de război biologic, în general, şi este ţinut în mai multe laboratoare din China”.

Nu se ştie dacă gama de coronavirusuri a institutului este inclusă în programul de arme biologice, dar este posibil, a spus colonelul.

Întrebat dacă este posibil ca virusul Wuhan să se fi scurs, Shoham a spus: „În principiu, infiltrarea externă a virusului ar putea avea loc fie ca scurgere, fie ca o infecţie interioară neobservată a unei persoane care ieşea în mod normal din unitatea respectivă. Acesta ar fi putut fi cazul Institutului de Virologie Wuhan, dar până în prezent nu există dovezi sau indicaţii pentru un astfel de incident.”

După găsirea amprentei genetice a noului coronavirus, ar putea fi posibilă determinarea sau sugerarea originii sau sursei sale.

Shoham, care în prezent lucrează la Centrul de Studii Strategice Begin-Sadat de la Universitatea Bar Ilan din Israel, a declarat că institutul de virologie este singurul sit declarat în China de nivel 4, un statut care indică cele mai stricte standarde de siguranţă pentru a împiedica răspândirea celor mai periculoşi şi exotici germeni patogeni.

Fostul medic israelian cu activitate în intelligence-ul militar a declarat că au existat suspiciuni cu privire la Institutul de Virologie din Wuhan, când un grup de virologi chinezi care lucrau în Canada au trimis în mod necorespunzător probe în China despre unele dintre cele mai mortale virusuri de pe pământ, inclusiv virusul Ebola.

Într-un articol din iulie în jurnalul Institutul pentru Studii şi Analize ale Apărării, Shoham a spus că institutul Wuhan este unul dintre cele patru laboratoare chineze angajate în unele aspecte ale dezvoltării armelor biologice.

El a identificat laboratorul securizat de biosecuritate Wuhan din cadrul institutului ca angajat în cercetări asupra virusurilor cu febra hemoragică Ebola, Nipah şi Crimeea-Congo.

Institutul de virologie Wuhan se află sub egida Academiei Chineze de Ştiinţe. Dar anumite laboratoare din cadrul acestuia „au legătură cu armata sau structuri legate de războiul biologic din cadrul armatei”, a afirmat el.

În 1993, China a declarat o a doua instalaţie, Institutul de Produse Biologice Wuhan, ca una dintre cele opt laboratoare de cercetare în domeniul războiului biologic acoperite de Convenţia asupra armelor biologice (BWC), la care China s-a alăturat în 1985.

Institutul Wuhan de Produse Biologice este un laborator “civil”, dar este legat de armată şi a fost considerat implicat în programul chinez de război biologic, conform declaraţiilor colonelului Shoham.

Vaccinul Chinei împotriva SARS este probabil produs acolo, conform declaraţiilor colonelului israelian. „Aceasta înseamnă că virusul SARS este păstrat acolo, dar nu este un nou coronavirus, cu excepţia cazului în care tulpina iniţială a fost modificată, ceea ce nu este clar că s-a întâmplat şi nu poate fi speculat în acest moment”, a spus el.

Raportul anual al Departamentului de Stat privind respectarea tratatelor militare afirma anul trecut că regimul comunist chinez s-a angajat în activităţi care ar putea susţine războiul biologic.

„Informaţiile indică faptul că Republica Populară Chineză s-a angajat în perioada de raportare în activităţi biologice cu aplicaţii potenţiale cu dublă utilizare, ceea ce ridică îngrijorări cu privire la respectarea de către aceasta a convenţiilor privind războiul biologic, a spus raportul, adăugând că Statele Unite suspectează că Beijingul nu a eliminat programul de război biologic, conform cerinţelor tratatului.

Laboratorul de biosecuritate este situat la aproximativ 30 de km de piaţa de fructe din Hunan despre care unele rapoarte locale susţin că ar fi focarul epidemiei actuale.

Medicul microbiolog Dr. Richard Ebright, de la Universitatea Rutgers, a declarat pentru Daily Mail din Londra că „în acest moment nu există niciun motiv de suspiciune”, că laboratorul din Wuhan ar fi legat de focarul virusului.

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Gov. Newsom issues “Stay at Home” order (Gina Ferazzi/Los Angeles Times)

By ALEX WIGGLESWORTH ,

MARIA L. LA GANGA, RICHARD WINTON, JAMES QUEALLY

MARCH 22, 2020

5:11 AM

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The death toll rose in California this weekend as coronavirus cases spread and residents tried to adjust to extraordinary restrictions on their movement.
Los Angeles County health officials on Saturday confirmed two more coronavirus deaths and 59 new cases, bringing the total confirmed cases in the county to 353.
The individuals who died were both older than 65 with underlying health conditions; one person lived in the Miracle Mile area and the other in Del Rey, public health officials said in a statement.
“Because there are positive cases across the entire county, the public should not think one location is safer than another,” according to the statement.

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The total number of confirmed cases of COVID-19, the illness caused by the virus, in California now stands at more than 1,400, with 27 deaths, but officials have said that the number of cases is a gross underestimation due to the lack of tests for the virus. Testing picked up this week, but healthcare authorities said they still don’t have anything close to a firm estimate of how many people are infected.
About 25,200 tests had been conducted in California, by both commercial and private labs, as of 2 p.m. Friday, the state Department of Public Health said Saturday. Results for more than 12,700 of them were pending.

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A growing number of the cases in California are instances of community transmission, in which the person diagnosed had not recently traveled or been in contact with another confirmed case. Those cases indicate that the virus is spreading locally within communities.

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Community transmission has been identified in California since late February, and since early March, most of the cases in the state have been unrelated to international travel, the state Public Health Department said Saturday. Therefore, the state will no longer collect information about travelers returning to California from countries with confirmed outbreaks of COVID-19, the Public Health Department said.
In Los Angeles County, the median age for the total number of those who have been infected is 47, county Public Health Department Director Dr. Barbara Ferrer said. There are 138 people between the ages of 18 and 65 who have tested positive.
“The risk is spread across everyone,” Ferrer said.
On Saturday, a third Los Angeles police officer tested positive for the coronavirus. The officer, who had recently returned from a vacation out of the country, was “coughing and sweating” during roll call earlier this week in the Central Division, which patrols areas that include downtown L.A., sources told The Times.

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At least 14 Los Angeles Police Department employees have shown symptoms and been tested for the virus, sources said. The other two who tested positive are a sergeant in the Pacific Division, who is hospitalized, and the other is a high-ranking command staffer, the sources said. The LAPD has now set up a plan for first-responder testing, they said.
On Saturday, Long Beach announced that it had recorded three more cases of the virus, for a total of 15.
New cases were also reported in Orange County, which rose from 65 to 78, and Riverside County, which rose from 22 to 28.
In Orange County, a resident of graduate student housing at UC Irvine tested positive for the coronavirus, the school said Saturday.

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The person, who is not a student, had recently returned from an international trip and reported symptoms, Dr. Albert Chang, medical director of the UCI Student Health Center, said in a statement. The person is isolated and in good condition, and the risk of transmission to others on campus is low, the school said.
Big Bear Lake mayor Rick Herrick tested positive for the coronavirus, becoming the first confirmed case in Big Bear Lake and the 10th in San Bernardino County, the city announced Saturday.
Herrick was tested on Thursday and received a positive result late Friday. He is doing well and expected to recover, the city said.
“This is not the announcement that I imagined, but I hope that by going public on what is normally a private, HIPAA-type subject can be a learning moment for our tight-knit community,” Herrick said in a statement.

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He said that he became sick with relatively mild symptoms about a week ago and self-quarantined at his home. He will continue to conduct his mayoral duties from home, he said.
The mayor had limited contact with other city officials, and none are currently symptomatic, the release said. Any members of the public who had contact with the mayor before he self-quarantined can call the San Bernardino County Public Health Department for advice, officials said.
In San Jose, a reserve police officer who tested positive for coronavirus is now in an intensive care unit at a local hospital, while another 20 officers or reserves remain self-quarantined, according to a source. Eleven city firefighters have tested positive, and more than 50 are in self-quarantine.
Intensive care beds at L.A. County’s emergency-room hospitals are already at or near capacity, even as those facilities have doubled the number available for COVID-19 patients in recent days, according to newly released data.

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Fewer than 200 ICU beds were available Wednesday, with most occupied by patients who don’t have the virus, according to the data, which cover the roughly 70 public and private hospitals in Los Angeles County that receive emergency patients.
County health officials have advised doctors to refrain from testing some patients unless a positive result could change how they would be treated.
The guidance, sent to doctors in a letter on Thursday, was prompted by a crush of patients and shortage of test kits, and could make it difficult to ever know precisely how many people in the county contracted the virus.
The health department “is shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” according to the letter. Doctors should test symptomatic patients only when “a diagnostic result will change clinical management or inform public health response.”

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Sweeping orders

Gov. Gavin Newsom on Friday deployed the California National Guard to assist food banks statewide that are serving residents facing food shortages.
Newsom said the short-term deployment will initially assist a food bank warehouse in Sacramento County and will also assess the needs of other counties that have requested assistance with their programs.
The move came a day after he took the extraordinary action of telling most Californians so stay home.
The mandatory order allows residents to continue to visit grocery stores, pharmacies, farmers markets, food banks, convenience stores, takeout and delivery restaurants, banks, gas stations and laundromats. People may also leave their homes to care for a relative or a friend or seek healthcare services.

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Newsom asked Californians to practice social distancing when performing such “necessary activities.”
“We’re going to keep the grocery stores open,” he said. “We’re going to make sure that you’re getting critical medical supplies. You can still take your kids outside, practicing common sense and social distancing. You can still walk your dog.”
On Saturday, after a day of confusion about the reach of Newsom’s historic executive order, the state announced that more stringent sets of mandatory restrictions implemented by some California counties and cities will remain in place.

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Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he strongly supported the move by Newsom, as well as a similar directive by New York Gov. Andrew Cuomo, and urged residents of the two hard-hit states to heed the new orders.
President Trump also praised Newsom and Cuomo, saying, “I applaud them” for “taking very bold steps” to limit activities in their states.
On Saturday, Trump said he is continuing to work with the two governors. “We coordinate very much with them,” he said.

Lives changing

Saturday will be a key test of the governor’s order.

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On Friday, automobile traffic was “pandemic light.” Hiking trails, meanwhile, were filled with cabin-fever sufferers who stayed the requisite six feet apart and smiled a lot more than normal, grateful to be anywhere but home.
The city of El Segundo blocked off parking spots in front of local restaurants, where sit-down service is prohibited, and posted cheerful “Gundo to Go” signs. Masks and latex gloves were the garb of the day for those who ventured out.
At Los Angeles International Airport at 10:30 a.m. Friday, there were twice as many workers as there were travelers at the Air Canada counter in Terminal 6. The LAXit lot looked all but closed. The four zones where travelers wait for Uber and Lyft rides had a total of three cars at 11:15 a.m. There were 13 taxis. And the travelers? Forget about it.
At Griffith Park, dog walkers and exercisers were out in force Friday morning. People did lunges on the grass and push-ups on the picnic tables. A sign flashed “Observatory closed until further notice.”

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Robert Dolan, a 64-year-old Los Feliz resident, said he’d been cooped up at home for nearly a week. But on Friday he decided to resume his regular speed-walking routine.
“I was feeling stuck in the house because of the coronavirus and all that,” he said. “Finally I said today I need to get out of here, because it’s driving me crazy.”
He sat on a stone ledge and watched a robin land on a tree. He listened to the flow of water near his feet.
“It’s better than it usually is,” he said, “because I’ve actually stopped and looked.”

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Additional deaths

Additional deaths were reported Friday across the state. Contra Costa County announced its first death related to the virus: a person in their 70s who had an underlying medical condition and had recently traveled to Europe. The patient died Thursday in an undisclosed hospital.
Riverside County reported its fourth death. Information about the victim wasn’t immediately available.
Santa Clara County announced two additional deaths from COVID-19 on Friday, bringing its total to eight.

CALIFORNIACORONAVIRUS PANDEMIC

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Alex Wigglesworth

Alex Wigglesworth is a staff writer at the Los Angeles Times.

Maria L. La Ganga

Maria L. La Ganga is a Metro reporter for the Los Angeles Times. She has covered six presidential elections and served as bureau chief in San Francisco and Seattle.

Richard Winton

Richard Winton is an investigative crime writer for the Los Angeles Times and part of the team that won the Pulitzer Prize for public service in 2011. Known as @lacrimes on Twitter, during 25 years at The Times he also has been part of the breaking news staff that won Pulitzers in 1998, 2004 and 2016.

James Queally

James Queally writes about crime and policing in Southern California for the Los Angeles Times.

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Bayer preps U.S. donation of malaria med chloroquine to help in COVID-19 fight: report | FiercePharma

https://www.fiercepharma.com/pharma/bayer-preps-u-s-donation-malaria-med-chloroquine-to-help-covid-19-fight-report

Chloroquine isn’t approved to treat patients suffering from novel coronavirus infections, but some early studies have shown promise.

In France, for instance, a professor conducted a small study of the malaria drug in 24 patients with novel coronavirus infections. Only 25% of those who received the medicine tested positive for the virus after 6 days, according to en24. Meanwhile, of those who didn’t receive it, 90% tested positive after that timeframe. The French government now plans to run larger studies.

In a study published last month in Nature, authors wrote that “chloroquine is a cheap and a safe drug that has been used for more than 70 years and, therefore, it is potentially clinically applicable against the 2019-nCoV.”

While there’s certainly more to learn about the potential therapy, chloroquine is just one of several drugs being explored to fight the novel coronavirus pandemic.

RELATED: Coronavirus tracker: What’s on pharma’s drug-repurposing list?; social distancing may last months

Sanofi and Regeneron are studying rheumatoid arthritis med Kevzara in patients with severe COVID-19, while Roche is exploring testing its arthritis med Actemra, NBC News reports. AbbVie is working with authorities on testing HIV meds Kaletra and Aluvia. And Gilead and others are already trialing the company’s investigational Ebola drug remdesivir, with data expected in April.

Besides those efforts, many companies—including Johnson & Johnson, Takeda, Sanofi and Pfizer—are advancing new drugs and vaccines.

As of Wednesday, officials around the world had reported more than 200,000 COVID-19 cases and more than 8,200 deaths.

Coronavirus Update (Live): 206,951 Cases and 8,272 Deaths from COVID-19 Virus Outbreak – Worldometer

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COVID-19

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Medical Library: Immune System

Medical Library: Immune System

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Wikipedia: Epidemia de coronavirus (2019-nCoV)

https://ro.m.wikipedia.org/wiki/Epidemia_de_coronavirus_%282019-nCoV%29

Epidemia de coronavirus (2019-nCoV)

Acest articol sau secțiune este de actualitate.
Informațiile se pot schimba rapid odată cu desfășurarea evenimentelor.Epidemia de coronavirus (COVID-19)BoalaCOVID-19Tulpina de virusCoronavirusul sindromului respirator acut sever 2(SARS-CoV-2)Primul caz1 decembrie 2019OrigineWuhan, Hubei, Republica Populară ChinezăMorți2.801Cazuri confirmate82.187Modifică date / text

Focar

Harta focarului de coronvirus Wuhan 2019-2020, cu număr de cazuri în China, Hong Kong, Macau și Taiwan.

 Suspectate

 Confirmate: 1–9

 Confirmate: 10–99

 Confirmate: 100–999

 Confirmate: ≥1000

Harta focarului de coronvirus Wuhan 2019-2020 (începând cu 24 ianuarie 2020):

 Țara de origine de unde a provenit coronavirusul (China)

 Cazuri confirmate

 Cazuri suspecte raportate pe țară

Epidemia de coronavirus 2019-nCoV, cunoscut și sub denumirea de coronavirus Wuhan, focar de pneumonie chineză sau pneumonie Wuhan (chineză simplificată: 武汉肺炎; chineză tradițională: 武漢肺炎; pinyin: Wǔhàn fèiyán) a început pe 12 decembrie 2019 în centrul orașului Wuhan, China, atunci când a apărut un grup de persoane cu pneumonie de cauză necunoscută, a fost legat în principal de proprietarii de tarabe care lucrau la piața de pește Huanan, care vindeau și animale vii. Ulterior, oamenii de știință chinezi au izolat un nou coronavirus, denumit 2019-nCoV, care s-a dovedit a fi cel puțin 70% similar în secvența genelor SARS-CoV.[1][2] Coronavirusul 2019-nCoV a fost identificat în Wuhan, provincia Hubei, China, după ce oamenii au dezvoltat pneumonie fără să aibă o cauză clară și pentru care vaccinurile sau tratamentele existente nu au fost eficiente. Virusul prezintă dovezi de transmitere de la persoană la persoană, iar rata de transmitere (rata infecției)[3] pare să fi escaladat la jumătatea lunii ianuarie, aceasta reieșind și din alte cazuri decât cele pe care China le-a raportat până acum.[4] Primul caz de coronavirus din România a fost confirmat pe 26 februarie 2020 la un bărbat din județul Gorj.[5]

Perioada de incubație (perioada de la expunere până la apariția simptomelor) este de aproximativ două săptămâni, simptomele includ febră, tuse și dificultăți de respirație și ea poate fi fatală.[6]

Pe 20 ianuarie 2020, premierul chinez Li Keqiang a cerut eforturi decisive și eficiente pentru prevenirea și controlul epidemiei de pneumonie cauzată de un nou coronavirus.[7] Începând cu 24 ianuarie 2020, au avut loc 26 decese, toate în China și există dovezi că se transmite de la om la om. Testele ample au evidențiat peste 2120 de cazuri confirmate, dintre care unii sunt angajați în asistență medicală.[8] De asemenea, au fost semnalate cazuri confirmate în Thailanda, Coreea de Sud, Japonia, Taiwan, Macau, Hong Kong și Statele Unite.

La 23 ianuarie 2020, OMS a decis să nu declare o urgență internațională pentru sănătate.[9] OMS avertizase anterior că este posibil un focar mai larg,[10] există temeri de transmitere ulterioară în timpul sezonului maxim al Anului Nou Chinezesc.[11][12] Creșterea bruscă a focarelor de boală a ridicat întrebări cu privire la traficul de animale sălbatice, răspândirea virusului și incertitudinile legate de virus, indiferent dacă virusul a circulat mai devreme decât se credea anterior, originea și probabilitatea de a fi super-virale, adică un eveniment de răspândire majoră.[13][12][14]

Primele cazuri suspectate au fost raportate la 31 decembrie 2019,[15]primele cazuri de boală simptomatică apărând cu puțin peste trei săptămâni mai devreme la 8 decembrie 2019.[16] Piața a fost închisă la 1 ianuarie 2020 și persoanele care au prezentat semne și simptome ale infecției cu coronavirus erau izolate. Peste 9930 de persoane, care au intrat în contact strâns cu persoane posibil infectate, au fost inițial monitorizate. După dezvoltarea unui test de reacție de polimerizare în lanț de diagnostic specific pentru detectarea infecției, prezența 2019-nCoV a fost confirmată ulterior la 41 de persoane în clusterul din Wuhan,[17] dintre care două au fost ulterior raportate ca fiind un cuplu căsătorit, dintre care unul nu fusese prezenți pe piață și alți trei membri ai aceleiași familii care lucrau la standurile de fructe de mare ale pieței.[18][19] Prima moarte confirmată din cauza infecției cu coronavirus a avut loc la 9 ianuarie 2020.[20]

La 23 ianuarie 2020, centrul Wuhan a fost plasat în carantină, în care au fost suspendate toate mijloacele de transport în comun și din Wuhan. Orașele din apropiere Huanggang, Ezhou, Chibi, Jingzhou și Zhejiang au fost de asemenea plasate în carantină începând cu 24 ianuarie 2020.[21][22]

Context

Epidemiologie

Identificare

Cauze

Diagnostic

Prevenirea

Igiena respiratorie

Cercetări privind vaccinul și terapia

Gestionarea

În cultura populară

Referințe

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Watch “Leonard Cohen Chelsea Hotel #2 Live” on YouTube

I remember you well in the Chelsea Hotel
You were talking so brave and so sweet
Giving me head on the unmade bed
While the limousines wait in the street
Those were the reasons and that was New York
We were running for the money and the flesh
And that was called love for the workers in song
Probably still is for those of them left

Ah but you got away, didn’t you babe
You just turned your back on the crowd
You got away, I never once heard you say
I need you, I don’t need you
I need you, I don’t need you
And all of that jiving around

I remember you well in the Chelsea Hotel
You were famous, your heart was a legend
You told me again you preferred handsome men
But for me you would make an exception
And clenching your fist for the ones like us
Who are oppressed by the figures of beauty
You fixed yourself, you said, “Well never mind,
We are ugly but we have the music”

And you got away, didn’t you babe,
You just turned your back on the crowd
You got away, I never once heard you say,
I need you, I don’t need you
I need you, I don’t need you
And all of that jiving around

I don’t mean to suggest that I loved you the best
I can’t keep track of each fallen robin
I remember you well in the Chelsea Hotel
That’s all, I don’t even think of you that often

Source: LyricFind

Songwriters: Leonard Cohen

Chelsea Hotel #2 lyrics © Sony/ATV Music Publishing LLC, BMG Rights Management

I remember you well in the Chelsea Hotel
You were talking so brave and so sweet
Giving me head on the unmade bed
While the limousines wait in the street
Those were the reasons and that was New York
We were running for the money and the flesh
And that was called love for the workers in song
Probably still is for those of them left

Ah but you got away, didn’t you babe
You just turned your back on the crowd
You got away, I never once heard you say
I need you, I don’t need you
I need you, I don’t need you
And all of that jiving around

I remember you well in the Chelsea Hotel
You were famous, your heart was a legend
You told me again you preferred handsome men
But for me you would make an exception
And clenching your fist for the ones like us
Who are oppressed by the figures of beauty
You fixed yourself, you said, “Well never mind,
We are ugly but we have the music”

And you got away, didn’t you babe,
You just turned your back on the crowd
You got away, I never once heard you say,
I need you, I don’t need you
I need you, I don’t need you
And all of that jiving around

I don’t mean to suggest that I loved you the best
I can’t keep track of each fallen robin
I remember you well in the Chelsea Hotel
That’s all, I don’t even think of you that often

Source: LyricFind

Songwriters: Leonard Cohen

Chelsea Hotel #2 lyrics © Sony/ATV Music Publishing LLC, BMG Rights Management

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