Pushing back patient zero, possibly good news

China is now saying their outbreak started in November. Which means it's been spreading since then.

Here's an interesting article from the UK in January that I found while looking for someone else.

Patients 'dying in hospital corridors'

Hospital bosses said they had run out of beds as they battle with "very high" rates of flu.

Official figures show the number of hospital admissions from flu has risen by more than 50% in the past week in England, although Public Health England officials said the levels were certainly not "unprecedented".

...

The rest of the UK is also struggling. Waits in Scotland's major A&E units hit their worst levels at the end of December.

The Welsh government has said the health service was facing "significant pressure" and in Northern Ireland the Antrim Area Hospital has had to bring in St John Ambulance volunteers to help with a surge in demand...

Figures from Public Health England show "medium" levels of flu are circulating across the community, but they are causing "very high" rates of admission to hospital.

...
On both measures, flu rates are the highest since 2011, the year after the pandemic when there was a lot of swine flu circulating.

Prime Minister Theresa May insisted the government was still doing enough to support the health service, but blamed flu for the pressures on hospitals.

Officially, the first COVID -19 patient occurred twenty days after this article was written. The WHO would announce officially the existence of a novel coronavirus the next day (12 Jan).

How many of these cases may have been COVID-19 cases? Does the rapid rise of COVID -19 in the UK reflect increased testing and not increased prevelance?

One Oxford study suggests so. Which could mean good news for everyone.

How many US flu cases, deaths prior to 27 Jan were undiagnosed/untested COVID-19 cases?


Another look by Stanford professors of medicine, including an infectious disease expert come to much the same conclusions.

Using the commonly accepted assumptions for rate of doubling (once every three days) working backwards from 1 Jan, they find we should have six million cases already:

"If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death, this is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.”

and



Related to prevalence, they find:

Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

Are we slowly getting a clearer picture as data becomes available?

To be clear, this is still an emergency for the health care system. It is certainly going to strain it. Certain measures are both warranted, and common sense. But is the complete shuttering of large sectors of the world economy warranted? People are becoming increasingly dubious as the numbers get crunched.

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%...

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.
...

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.

I don't know what the answers are, but I suspect the entire global lockdown is unwarranted. South Korea is upheld as a model, and they did not shutdown businesses or lock their citizens down in draconian governmental measures. They targeted their response. But this is also clearly a problem for our healthcare systems.

I mostly post to ask questions, and show that some medical professionals are asking the same questions. If you are in the "we must listen to medical professionals" camp, it's probably worthwhile to note the common doom scenarios are not without professional dissent and detractors. Perhaps we should listen to them, too.

a reply to: RadioRobert

I have seen a lot of these conjecture stories lately.

I highly doubt that covid 19 has been running around for weeks to months before detected (we have people on boards stating October and November in the US which is almost impossible). Otherwise the exponential growth and infection rates would be sky-high by now.

a reply to: infolurker

These are studies by epidemiologists. They aren't random posters on the internet. I think it's worth noting.

If the current models are based on bad assumptions, then of course it would appear to be "impossible" given those models.

a reply to: infolurker

Well, would be sky high if we have been hearing the truth of it from the media and other fear mongers. I have a hard time buying into it myself. 1 case in my county at the moment. He tested positive over a week ago and no other cases here yet.

originally posted by: infolurker
a reply to: RadioRobert

I have seen a lot of these conjecture stories lately.

I highly doubt that covid 19 has been running around for weeks to months before detected (we have people on boards stating October and November in the US which is almost impossible). Otherwise the exponential growth and infection rates would be sky-high by now.

Unless the present values are horses__t...

a reply to: infolurker

I dont know about in the US.. But in early December/late November (not quite sure), I became aware of something "afoot" when trying to get a respirator for general use.

Clearly anecdotal, but I thought it was wierd enough that I looked into it. The things floating around at the time were "rumor," at best, but Ive kept my eye on it since.

a reply to: RadioRobert

Shhh! Don't say good news!

a reply to: RadioRobert

I tried to track back the initial reports in Wuhan at one time, and found that the first mentions were of "isolated cases" of pneumonia in June; then it was "clusters" of pneumonia in September; then an "outbreak" in November/December, and finally the "pandemic" sometime after the first of the year. I don't think it was identified as a coronavirus until December or January though. Since I first searched, there have been so many new stories and reports and studies and so on, that I haven't been able to track it like I did then. But I'm pretty sure those "isolated cases" in June 2019 were the beginning of it.

I posted an article in another thread, which I cannot for the life of me find again, that tracked eight confirmed CoV-19 cases in men who had been in Wuhan and traveled to the USA in December. They concluded that these eight men alone could have led to as many as 10,000 people being infected.

I'm pretty sure my husband and I had the CoV-19 last month. At the time we were sick, the coronavirus was just starting to be talked about. I did not look at the symptoms until after we were over it, but we had all the symptoms. Including the red eyes that was reported yesterday: The sickest all had red eyes, says nurse on front lines of coronavirus pandemic. Well, actually, my husband did. I did not. But my husband was also much sicker than I was. He had a couple rough days.

So all of this (and more) makes me believe that, yes, the CoV-19 has been here much longer than we realized, and that many "flu" diagnoses were actually Coronavirus. Probably since last summer, but didn't start ramping up until the cold set in for the winter.

a reply to: RadioRobert

Technically then it's possible it all did start in the UK.
Maybe , it was deliberately ignored in the first place .
In the UK . On purpose . It was something but it had to be nothing. Desperate you were, said yoda . Or sometimes just that medics , vets , police, sometimes millenial aged idiots doing triage with suspicious little trap a patient factual credibility issues , and an overblown scrubby TV ego sometimes and a crap sense of himour in full knowledge of a serious or deliberate medical compromise being committed with zoonoses , aren't always what they're cracked up to be, and blindly go as if they knew more than everybody just because they work 'for the state' as 'the combined services ' altogether with the written records of silly little ex school Chinese whisperers and wierd interpreters . Or on purpose . No one wants to claim it started here. Love from patient zero , have a lovely life

originally posted by: RadioRobert
a reply to: infolurker

These are studies by epidemiologists. They aren't random posters on the internet. I think it's worth noting.

If the current models are based on bad assumptions, then of course it would appear to be "impossible" given those models.

Undoubtedly there are uncertainties about what fraction of the population is infected vs what fraction is symptomatic enough to be in the hospital. However, if there really are 100 or more times as many infected as are showing up in the hospitals, we should know that very soon by witnessing a natural flattening of the curve, regardless of whether or not social distancing is taking place.

Right now, there are about 65,000 active, diagnosed cases in the US. If there are 100 asymptomatic cases for every diagnosed case, then there would actually be 6,500,000 infected people in the US population right now, or about 4% of the population.

For an uncontrolled epidemic in which the entire population starts out uninfected and nobody has immunity (which is basically what we had in January) the infection rate builds up exponentially until the number of people who have recovered and developed immunity starts being close to the number who remain to be infected. Assuming the epidemic curve is symmetric, the peak infection rate will occur at the time when 1/2 the people who are GOING to be infected actually ARE infected. There is a fairly simple mathematical relationship between the Basic Reproduction Number (R0) and the total number of people who will eventually get infected for this simple epidemic model it is; F = 1 - 1/R0. Currently, R0 is estimated to be about 2.5. Plugging 2.5 into that equation would predict that F = .6, meaning that we should be at peak infections when F/2 or 30% of the population is infected. If we are are at 4% of the population infected right now, then the number of infections would need to grow 7.5 x to reach that point.

The average doubling time for the spread of the disease right now in the US is about 2.38 days. To grow by a factor of 7.5 at the current growth rate would only require about 7 days. If we get to this day next week and the number of cases is still increasing we will know that the ratio of infected to diagnosed is less than 100.

a reply to: RadioRobert

That's even less than my .03% death rate assessment I've been posting lately.

I'm so thrilled to see I had the most accurate estimates out of virtually everyone.

originally posted by: RadioRobert
a reply to: infolurker

These are studies by epidemiologists. They aren't random posters on the internet. I think it's worth noting.

If the current models are based on bad assumptions, then of course it would appear to be "impossible" given those models.

It doesn't take a degree to do some basic math, some critical thinking, and a bit of research.

All we had to do was determine how many infected went unreported to gauge the true death rates.

This is a common cold virus so my very conservative estimate was 100x infected that never got tested and confirmed. They were mild so didn't seek hospital treatment.

These estimates are several multiples beyond my own so just to be conservative again I'll rephrase:

Its less than my .03% estimate last week and potentially much lower than their .01% even. It could actually be as low as .005% death rates.

Watch as we drive this number down. Give it a few more months.

a reply to: RadioRobert

Chinese whispers eh !

a reply to: RadioRobert

I'd like to see them test some of the e-cig lung disease patients from this summer and fall for antibodies.

a reply to: MotherMayEye

Thought occurred to me, too.

If/when we can get widespread testing, it would help relieve the PPE burden for first responders, too (as many may have previous exposure).

a reply to: RadioRobert

Just remember, the Covid-19 virus was just a flu virus.

a reply to: makemap

Right. We have obviously missed many cases (and some deaths by extension).

And we aren't sure which countries (if any) are parsing co-morbidity factors. If you die in Italy, for example, WITH the virus, you are counted as a COVID-19 death. Meaning a cardiac death, or respiratory distress that is possibly due to other factors are being lumped into a pile as long as you have tested positive for COVID-19.

And people are making devastating economic choices for literally billions of people based on this incomplete and/or misleading data.

Also, this.

a reply to: RadioRobert

The decisions are not being made on the basis of fatality rates, but on hospitalization rates.

a reply to: Phage

And if prevalence rates are as high as suggested, those would drop precipitously as well, my little mathematician...

originally posted by: infolurker
a reply to: RadioRobert

I have seen a lot of these conjecture stories lately.

I highly doubt that covid 19 has been running around for weeks to months before detected (we have people on boards stating October and November in the US which is almost impossible). Otherwise the exponential growth and infection rates would be sky-high by now.

Depends on what one considers "conjecture" to be ...
Just because one does not want to believe , does not fill the definition of conjecture.