COVID-19: What we Know so Far

Sometime in November a species cross-over event occurred, likely involving the following chain: bat → pangolin → human. Snakes have been ruled out as an unlikely candidate.

Animal reservoirs and transmission chains.

Early on Chinese authorities suppressed news of the infection, but in January this changed as the epicenter, Wuhan, was placed under lock down and many precautions were taken through the rest of China. A Japanese YouTuber shows what life is like 200 miles outside of Wuhan as of mid-March 2020.

Overall the virus is something very new to us. It enjoys a level of transmission similar to the common cold and a lethality closer to the SARS epidemic of 2003 and 2004.

Though the coronavirus differs greatly from the flu, we might most closely compare it to the 1918 Spanish flu, which infected nearly half of the Earth and claimed 20-50 million lives (most of them healthy, young adults).

Status in the USA and Elsewhere

At the time of writing this (2020-03-16) there are probably around 100,000 active cases in America, with three to ten times that amount likely to emerge over the coming weeks.

The risk to the general public will become greater in the coming weeks, and states will need to close shops, bars, gyms, and put tighter restrictions in place in order to prevent hospitals from being overwhelmed in the Summer.

If distancing measures are taken, the disease may be dragged out for several years and even stopped. The resulting economic and social fallout is a subject of great controversy. In China the measures taken are so extreme, as to even stop COVID-19.

Despite the delayed response of the USA to the coronavirus threat, officials are now taking matters more seriously with more decisive actions.

The UK remains lackadaisical in their approach, while Canada, continental Europe, and the US keep each other in check, but less tightly than China, Korea, Taiwan, Singapore, or Australia (which are being more proactive).

It is not clear how “herd immunity” would apply here, in the UK’s terms. The virus is clearly dangerous and ahead of the curve; we should not preclude the containment strategy, which seems to work well in China.

Vaccine and Treatments

A vaccine could be up to a decade away. Other less pestilent coronaviruses which cause variants of the common cold have eluded vaccination, and the virus is evolving rapidly (for one with a proofreader mechanism).

Currently there are 519 unique variants, with two major strains. Similar to how flu shots can’t protect against all infections (there are too many “types” or “strains” of flu going around), genetic variety may also be a problem in vaccinating coronaviruses.

Evolution of the novel coronavirus: https://www.gisaid.org/epiflu-applications/next-hcov-19-app/

Medicines and Vitamins

Treatments are already being investigated. An anti-arthritic drug may alleviate the deadly lung inflammation in severe cases. Additionally, the Folding@Home project identified over 20 more drug candidates. It is not clear these would be ready before the vaccine, but potentially.

As for dietary choices and supplements, it is important to note “boosting” the immune system is not the only goal. Some illnesses attack the young and healthy and use their immune system against them.

The primary recommendations have been an adequate amount of Zinc, Vitamin C and D, omega 3s (plant-based ALA is fine), garlic, and mushrooms (common white, Crimini, Almond, and wild).

Studies have shown mushrooms in particular to modulate “over-reactive” immune systems, lessening auto-immune diseases, and potentially alleviating the exact kind of “cytokine storm” seen in the lungs of COVID-19 patients.

Spanish flu of 1918: Young, Healthy Victims

Besides the black plague of Medieval Europe, the 1918 H1N1 influenza pandemic is the only other event in recorded history to compare with the coronavirus outbreak.

This strain differed from the common flu not only in its intensity but also in its target. A virus which evolved in the trenches of World War I, this was a foe which targeted and struck down young, healthy people in their prime.

The “W-curve” which shows how relatively few old people died during the pandemic.

Midway through the 1918 professional hockey finals, both teams became afflicted and the series was called off. Over half of the men (who were athletic and an average age of 29 years) were taken to the hospital. Less than four days later hockey’s toughest defensivemen, Joe Hall, was dead, a fever of 105 and lungs full of mucous. Hamby Shore, a player for Ottawa, also succumbed to the disease. Manager George Kennedy was also affected and he never fully recovered; his lungs were significantly weakened and he died less than a year later.


Announcement of Cancellation in The Globe

Certain strains of the coronavirus may begin to take on this characteristic, of targeting the young and healthy. Virus evolution is not discriminatory; if it can make young people sick and infect medical staff this way, there is a chance of it proliferating, as it did in the trench warfare of WWI.

This is certainly a concerning trend to keep an eye out for; a more virulent and deadly disease is more likely to cause widespread panic and economic disruption.

An article reporting unusual coronavirus trends in younger populations.

The prevalence in the wild and fatality rate of the two strains is not currently known.

It is also possible both strains are similar, and differences in testing and reporting account for perceived discrepancies. Italy also reports a significant number of ICU patients in the 30-49 age range. And when hospitals become overloaded, the old ICU rate becomes the new mortality rate. So far the youngest death in Italy is 39.

Germany seems to have a particularly mild version of the illness, with nearly 10,000 cases but only two listed as in serious or ICU condition and “only” 20 deaths so far.

As the virus evolves, it is possible new dominant strains will take seed and cause greater disruptions. In the 1918 outbreak, it seemed to come in three waves with the second being the deadliest, and immunity from the first wave seeming to protect individuals against the second and third.

We have already seen the potential supply chain disruptions that short-term panic can cause, even when supply is at normal capacity. The panic from a more deadly virus (that targets younger people) could be significantly worse, as could the death toll.

Three “waves” of the 1918 flu.

Strategies Used During the 1918 Outbreak

One of the things we noticed from the 1918 outbreak was the effect of school closings. It is not clear whether this still applies today: if most kids are sent to a daycare or group babysitter the spread of disease may be the same. Compared with 100 years ago, most children spent their time off school helping their family garden vegetables and tend to the house.

Australia has ordered students to remain in school but to stay 1 meter apart from one another and take other precautions. It is not clear how practical this is, but it may be better than the daycare alternative. The school would also need to be cleansed with bleach fairly regularly, and students would need to be extra sensible and cautious.

St. Louis closed schools and cancelled parades, Philadelphia did not.

“Social Distancing”

Social distancing keeps old people safe. When adopted mildly, it slows the spread of disease but when taken to to the extreme, it can actually stop it in its tracks and leave only 5-20% of people to become infected.

You can see the different “regimes” here, with animations showing how things work: https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

Difficulties and What to Expect

Expect more countries to close bars, restaurants, gyms, schools, casinos, churches and other places of gathering. In extreme cases only grocery stores and pharmacies may remain open, with permission to leave house only being granted twice per week. Homeless shelters may experience a heightened crisis during this pandemic.

School closings, slowdowns, closures at the border, and store curfews might have far-reaching, cascading consequences on the economy and supply chain. While we don’t expect any immediate, terrible shortages or famines, we may find ourselves with less of or completely without some of the products and technologies of daily life which depend on international trade.

Based on the bond markets we were already heading for a slight recession, but the pandemic is likely to bring it on sooner and harder. Starting the economy back up may be a months- or years-long process as well, China is having a hard time restarting.

It is possible the virus will cause greater harm, time will tell.

Other Concerns

The coronavirus has been observed to be contagious at a distance of up to 4.5 m or 16 feet. While it has trouble surviving on rough materials (fabrics, wood) as well as copper, it can survive up to 9 days on plastics and steel. It does best indoors (22–25°C, humidity 40–50%), and has troubles at higher temperatures and humidity (e.g., 38°C, humidity >95%).

It has been reported some patients test positive for the virus up to 47 days, much longer than the commonly assumed 2 week period.

Patients who fall ill, like any form of pneumonia, may suffer a permanent 20-30% loss in lung function upon recovery.

The virus attaches to a receptor found in other areas of the body, including the kidneys, testes, and brain. Effects here are atypical, but a few cases of encephalopathy and kidney failure have already been reported.

Fact checks

Ohio Governor stirs panic, claims 100,000 cases in Ohio

False

This is based on the assumption that “community spread means 1% are infected”. A John Hopkins professor rather estimates 50,000 – 500,000 cases nation-wide as of early March 2020.

While I sympathize with the governor’s desire to cause concern and preparedness in the public, the data simply do not support his claim. We would expect hundreds or thousands of suspicious pneumonia-related deaths in Ohio alone if this were true.

The US is a few (precious) weeks behind Italy, whose official tally of 25,000 infections is probably a slight under-estimate, and which represents a smaller population base than the 320 million in the US.

We know now, just the fact of community spread, says that at least 1 percent, at the very least, 1 percent of our population is carrying this virus in Ohio today.

Governor Acton

NYC has only 3,000 ICU beds so if even 0.5% of the population was affected, the hospitals would be feeling incredible strain. They aren’t. Yet. Neither is Ohio.

Community spread is occurring in NYC and Ohio, and the Governor is mistaken.

Estimates range from 10-20% of cases being severe, and potentially requiring hospitalization.

People without Symptoms can be Contagious

True

Up to 15-20% of people in Italy report showing no symptoms. Scary if they can avoid even a slight fever or cough.

Hong Kong Dog becomes Infected

Mostly True

The dog did contract it from his owner, but the dog did not show symptoms and isn’t thought to be contagious. More research is needed here.

See: https://qz.com/1818227/the-who-says-that-dogs-cats-and-other-pets-can-get-coronavirus/

Catching the Virus a Second Time

Mostly True

This is confirmed, but again more research is needed. Perhaps a few of us are unlucky to catch both of the two “main strains” of the virus? Perhaps it changes all the time like the common cold and you can keep catching it? Time will show how true this is.

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