Saturday, February 29, 2020

First death from Covid19 occurs in US; more medical literature explains infectiousness, suggests use of anti-HIV drugs as the most promising clue


Here is the New York Times coverage on the whole issue of quarantines, rationing, effect on small businesses, by Andrew Jacobs and Sheri Fink. 

Stephen Chen writes in Inkstone why Coronavirus SarsCov2 is more contagious than the 2003 virus.  It has a lot to do with the ability of the virus to hook on to a protein called furin, which anti-HIV drugs target.  This has less to do with ACE2, which is less common in healthy people, which SARS inhibits. Losartan has been suggested as a possible medication.  But the most likely result will be the use of some kind of variation of anti-HIV drugs. Trials can’t start soon enough.

  
The United States has incurred its first death, in King County WA.  Details on the patient will be released at 4 PM EST.  Trump announced she was a medically challenged  and in her late 50s. Washington state governor said the patient was male. 
  
 At the press conference, a reporter challenged Trump ("rude question") on whether Fauci had been muzzled (Fauci spoke to that). Azar said that Americans should still go about their daily lives normally. Fauci also said that it was very unlikely that people get the disease a second time, despite scattered media reports of "bi-phasic" positive tests, which apparently may result from the fact that many infectious diseases take a long time to go completely negative. 

Friday, February 28, 2020

COVID19: Are you on your own? Or are we all in this together? This is all crazy (are quarantines worse than the disease for most of us?)



We need to have a straightforward and frank discussion on individual citizen responsibility.
  
It looks more and more like this is a disease that largely spares the strong with few symptoms, maybe none, but focuses on those with other medical problems (or sometimes health care workers who got huge exposures at once), including the elderly (me).
  
Zynep Tukfeki talks about our “civic duty” in Scientific American, Feb. 27.
  

Some of this is pretty simple.  Yes, I got my flu shots.  Yes, it’s not too much to ask to use hand sanitizers properly in public places.  I live alone, so it should not matter much – unless a repair person has to come for service and so that matters then.

I’ve already noted in previous posts that there are problems with people being required or asked to self-isolate because of accidental contact with another case.  This hasn’t been talked about much (as I discussed on the LGBT blog Feb. 25).  There are scattered reports.  The “8400” in Newsome’s announcement were previous travelers;  about 70 people associated with the community acquired case.
    
On Wolf Blitzer today, the question came up, would every American be tested?  No (impossible);  but doctors will test everyone with significant URI.  
         
There was a tweet today about New York State having 700 people under self-isolation, article.   I’ve reported that Virginia has monitored about 270 so far, with no positive tests yet.  Previously I've reported another article that says about 700 are under monitoring in Washington State around Spokane, not sure why so many. 
  
Most of these appear to be people with more known close contact with people who have traveled to affected countries (mainly China).
   
Asking someone never to leave a residence for any reason sounds Draconian.  What if something breaks?  It is very difficult to have to spend so much time on tedious preparations and remain competitive as an individual.  Yes, I’ve got the canned food and will pick up the water soon.
   
One risk could happen with the primaries super Tuesday.  Are the election officers (usually paid little for very long days) suddenly taking on a risk comparable to sudden enlistment in the military?  Hopefully, no one is allowed to work if symptomatic (even a cold), and hopefully no one who was asked to self-isolate would show up to vote.  But in the testing flurry to come, certainly there will be positive tests after the fact.  Mathematically this could catch almost everyone.  There is some point at which this madness must stop – even as more evidence exist that a majority of positive cases, if everyone is tested, will be asymptomatic.

In China, people who were infected have been forced to destroy all their personal belongings. OK, China is Communist, about the we, not the I.  Would that happen here?  What about the few “bi-phasic” or relapse infections that are reported, even after cure.  Are they just artifacts, or reinfections, or incorrect tests?   One imagines the dystopian ending where anyone tainted by the virus is segregated forever.  Or is this the stuff of horror movies.

You can imagine lives being destroyed for nothing. You're still responsible for your own outcome;  you can't sue Communist China. 
  
At some point, you need to look at the medicines, and start trying more interventions (Losartan looks promising).
  
Remember, probably 90% of all people infected will never have symptoms and know it unless they are forced to be tested.  In the United States, as far as I know, we do not have clusters of people with ARDS or on ventliators above what we usually have from everything else.  Most of the casual spread should have occurred before the travel restrictions so there should have been time for more severe cases to show up.  (We do have the two new ones in California, LA Times report today.

I’ll let the reader judge Chris Martenson’s “You’re on your own” video.  Basically, that’s true.  That’s why I don’t want to be isolated for nothing.

One more thing – we really need to think, quickly, about how we will conduct the mass gatherings of elections and primaries and caucuses – and the implications.

I have a (Facebook) friend who predicts martial law will happen, because Trump wants one last chance for chest hair.  Just like China?  BUT, remember, most cases are asymptomatic.
   
(Posted: Friday, February 28, 2020 at 8 PM EST)

Thursday, February 27, 2020

First community-acquired coronavirus case in US in California, as markets reel around a support point; what does home isolation really mean?; 8000+ people under observation in CA




The Los Angeles Times (Taryn Luna)  reports about the new “community spread” case of Novelcorona-virus(sars2) or Covid19 disease, where there was a week delay in getting back the test result of a week.  She had been admitted in serious or critical condition, possibly needing a ventilator. Some hospital workers were asked to self-isolate at home. 
  
Supervision of persons at home or under quarantine normally falls to state health departments.  It’s a little surprising that the state could not get pressure put on the CDC to get a test back sooner.
  
  
Which leads to the next criticism, that the United States is not performing tests quickly as are other countries hit harder.  There was a narrow criteria (foreign travel) and there were problems with the first test kits.  Doctors in five cities are supposed to have access to tests. 
  
Widescale screening will probably lead to a large number of asymptomatic patients, leading to new public health quandaries in the US, where at a constitutional level, excessive use of isolation or quarantine might face legal challenges.
  
Victoria Kim has a different story in the Los Angeles Times about the aggressive contact tracing in South Korea, which is carried out with electronic surveillance like China’s, to an almost unbelievable extent.
  
A tour guide in Japan has had a relapse (or second infection), quite disturbing (AOL news story).
  
I want again to emphasize how disturbing the unpredictable threat of sudden quarantine or forced isolation could be, and it could happen to anyone.  There are things you could do to make your movements in public less traceable (not using electronics, turn off location, pay with cash) if you fear you really would be tracked down under extreme measures.  These situations seem unprecedented in my own adult lifetime, and can lead to dangerous circumstances for persons with poor social capital. 
   
 They can lead to novel moral quandaries that threaten democracy itself.
  
This video from John Campbell in the UK discusses the possibility of transmission by objects, such as elevators buttons in buildings, and sound rather extreme. He does say that persons on home isolation can have food or other items delivered.  Would this be allowed in a high-rise building?

Update:  Gavin Newsome, California governor,. said that about 8400 people are under observation in California.  Apparently this was before the contact tracing for the community case above, but the CNBC story (which rattled markets) was unclear.  There are 33 confirmed cases in California. Virginia has about 110 persons to observe with two outstanding tests. 

Update:  San Francisco Chronicle reports that the 8400 (sounds like "The 4400" sci-fi series!) were returnees from China, implying that the stock traders misunderstood the story.  About 70 people are in home isolation based on contact with the UC Davis patient (which would have happened almost 2 weeks ago, doesn't make a lot of sense) and at at least one college in California 3 rommates are on isolation. Wall Street may have mixed all these stories up (LA times, Colleen Shalby). 

Wednesday, February 26, 2020

Speculation on what disruptions from COVID-19 in the US would really be like, including domestic travel (Trump press conference tonight at 6 PM)


The Trump administration is certainly sending out conflicting tweets and statements, and tonight at 6 OM Trump will have his “press conference”, after the stock markets close.

There is some speculation on CNN this morning that there will soon be “travel restrictions” even within the United States.  Other than the obvious observation that you are grounded if you are quarantined or isolated (or under supervision by a health department) it’s not clear what this would mean.  Would that mean closing off towns or cities?

  
What about apartment or condo buildings?  I covered some of this on the LGBT blog yesterday (in conjunction with discos or bars).  I don’t think that a quarantine or home isolation of one person affects a whole building, and it really doesn’t sound feasible.

What about “risk” for people who work the elections next week?  I think in practice it is very low, but very little has been said.  What happens in November?
  
One question also remains, as to the actual danger from infection.  The case fatality ration drops quickly even within China when you get away from Hunei.  However, in Italy and South Korea, the fatalities are higher (in Italy they may still be the elderly with other conditions) and the explosion in Italy seems explained in part by a hospital fumble when one patient showed up (after a contact with someone from China).
 
 
It does seem likely that the incidence of serious disease and death will go way down, if the asymptomatic cases or low symptoms are counted.  One hopeful sign, on the LGBT blog entry yesterday, is that a number of well-known medications might mitigate symptoms or disease entirely if given early (the blood pressure medication Losartan is one of them).  That could mean a large number of asymptomatic spread and a “survival of the fittest” pattern and a renewal of ethical problems we have forgotten about.

Sunday, February 23, 2020

NIH has encouraged Congress, and states to protect incomes of workers involuntarily quarantined, especially when without symptoms (could really matter soon for Covid-19)


Here’s a couple of questions about home isolation and quarantine.

HHS says that home isolation applies to someone who is already ill.  Quarantine may be applied to someone who was exposed and has not had enough time for symptoms or develop a positive test (as for Covid-19), or how may never develop symptoms but who is kept in isolation to protect others who are medically more vulnerable.
  
The CDC has a similar page, here. 
  
It’s obvious that involuntary confinement, especially for someone without symptoms, can be very costly to the individual.  NIH has a paper, dated 2007, outlining in detail legal inadequacies in the laws to protect workers from job loss or loss of income.  Several countries, such as Singapore, Taiwan, and Canada (since its brush with SARS in 2003) do have some laws.  Several states in the US do have such laws.  However, the United States has not, in recent years, encountered this situation very often, and the current Covid-19 epidemic is likely to cause it.   So far, the quarantines have been applied only to people returning from China or the cruise ship; but in the future we are likely to see that applied for community acquired infection.  Influenza is not usually treated this way because it is well known (although that could change and there was a scare in 2009 with H1N1); Ebola was encountered in 2014 (there was one difficult situation with someone in NYC) but the number or persons was small and with Ebola people are usually very sick. Covid-19 seems to demand this kind of handling because it is novel and unclear;  there is a troubling problem with severe disease to appear after a patient seems to be improving, and there appears indeed to be asymptomatic transmission (JAMA).   
  

There have been scattered reports of hundreds of people under public health supervision when they had been close contacts of someone infected with Covid-19, especially in Washington state.  I am under the impression that isolation of one individual at home, even in an apartment, is far more common can roping off an entire building (as what happened in Hong Kong), but I have not heard definitely what happens in the US.  
    
Anecdotally, these persons (under observation at home) do not seem to become ill, but not many have been tested for asymptomatic infection.  From a practical viewpoint, it sounds like (in otherwise healthy people) very small exposures don’t result in illness and might even lead to “vaccination”.  It is not clear if these individuals were allowed to go to work, or whether they could telecommute.
  
There are other ways people could be affected.  I am retired and run a group of blogs as my tool of political participation, so to speak;  these could be permanently lost if I were involuntarily separated from my electronics (although that sounds a lot more likely with a normal hospitalization with one’s own illness, or even an auto accident).
   
 Many people will think this is a problem for social capital online:  that people should not feel ashamed to do Gofundme's or that Facebook could prod people to run fundaisers for them.  I don't being forced into involuntary social capital (see main blog, Feb. 22). 

Thursday, February 20, 2020

Hospital in Spokane WA takes COVID19 patients because it is specifically equipped; related story about larger than reported numbers of people in US now under health department supervision


A Spokane WA television station reports that Sacred Heart hospital in Spokane (a “Catholic” hospital, and their hospital trade association was at one time a big client at Lewin when I worked for Lewin on simulating hospital Medicare operating margins) will treat five patients infected with COVID19.  
    
The TV station links to another story that reports on 700+ people are under health department supervision (as people under investigation).  Are these people supposed to self-isolate?  They are not part of the CDC outstanding cases, probably because they won’t be tested unless they have symptoms.  They don’t seem to be reported on CDC of Johns Hopkins yet.

  
As noted yesterday on the International Issues blog, it’s probably possible to have a close brush with the virus, develop temporary immunity, and then get a worse case months later if having a larger exposure (Antibody Dependent Enhancement, ADE). SARS behaved this way, as does Dengue (which is not a coronavirus).  It’s starting to look like a very large percentage of people who have community micro exposure to the virus will never have symptoms (maybe a cough for one day that goes away) and develop a minimal antibody response which may not persist.  A vaccine would need to keep the response permanent. This idea could relate to the "superspreader" problem, which sounds like science fiction.  
     
I’ve driven through Spokane once, in 1990.  By the way, if I heard from someone at Lewin who remembers me, that would be great.  It was an interesting job, in retrospect. Odd that their website (at least the home strike page) doesn't have https.  If I worked there now, they would.  
  
Wikipedia
By Jdubman - Own work, CC BY-SA 3.0, Link

Tuesday, February 18, 2020

New push to eliminate Selective Service System is forming quickly, could lead to street protests, probably a documentary film soon


I just got a very long email (or press release) from “World Beyond War” maintaining “US Teens will be impacted by change in military draft law”.

The URL for the email is here  The publication is called “Resistance News” and seems to represent a group called “No Draft”. 
  
I just got this, so I will have to look over the details of HR 5492 which would abolish the Selective System.

This group wants to assist people in not registering for the draft as well as lobbying for repeal. Of course, that implies "resistance" = "breaking the law". CodePink (involved in the Venezuela Embassy protests in 2019 as on News2share) seems heavily involved in the effort. 
  
My first “Do Ask Do Tell” book talks a lot about the old Vietnam era draft and deferment (later lottery).
  
  
Talk about this issue increased after Trump’s nearly triggering a major war with Iran at the start of this year.
  
A film proposal that I just sent to a film pitchfest talks about the idea of a documentary film on this topic.  It’s odd that I got this email the very next day.  Coincidence?
    
I think some of the major documentary film companies will want to bite on this. I will start checking quickly.  I would expect to see it on PBS Independent Lens or something like that.
   
Picture above comes from Dec. 1, 2007, a flag display on the Mall related to repeal of "don't ask don't tell" then.  

Monday, February 17, 2020

Democrats in Virginia Senate help defeat some gun control measures; assault weapons bans are viewed as ill-defined


Democrats in the Virginia Senate helped block Gov. Northam’s legislation today that would have banned sales of certain assault weapons and banned certain silencers. Other bills are still in the Virginia Senate. Brrakkton Booker has a story for NPR.  

A persistent problem with assault weapons bans has been “defining them”.

Ford Fischer (Libertarian Party and News2share) advanced an argument on Facebook this morning that racial profiling in conjunction with stop and frisk could be conceived as a targeted form of gun control, and should be viewed as morally wrong.

Michael Bloomberg has drawn criticism for his statements in the past about helping “black and brown” kids in a way that makes them sound like helpless victims and actually sound racist.
  

This follows the Jan 20, 2020 rally where many gun rights activists showed up and outside the fence marched peacefully with their weapons, without incident, but gun control activists maintained they felt intimidated.
  
By the way, “this” (or the “real”) David Hogg, a conservative (North Carolina), concurred with “that’ David Hogg on Twitter and March for our Lives that something needs to be done about this.

Saturday, February 15, 2020

Former FDA commissioners expects US COVID-19 cases to soar in 2-4 weeks


The concerns of how the COVID-19 virus may trap people even in the US and other western countries who have not been to China but are secondary or tertiary contacts of someone who was there and returned before the travel shutdowns, may be increasing.
    
The Wall Street Journal has an op-ed by Scott Gottlieb Feb 4 “Stop a coronavirus outbreak before it starts”. 
  
The Washington Examiner (a conservative free paper) published an article by Anna Giaritelli Feb. 12 where former FDA commissioner Scott Gottlieb told the Senate that community outbreaks are inevitable in the next two to four weeks, and contact tracing could identity hundreds to thousands more largely mild or asymptomatic cases, posing public health dilemmas.  Testing will become faster, starting first in five cities.  However Gottlieb has also said there would be limits on just who would be tested.
  
Persons taking domestic flights probably expect to be asked if they have been to China or SE Asia recently or are in contact with someone who was. But’s possible to imagine situations that could lead to unexpected detentions, like temperature testing, oversensitivity to normal coughing or sneezing when confined in a plane.   These could be imagined in other venues too.  This is already being talked about in the UK.
  
  
If airlines or other accommodations are required to take on these policies, the public needs to be told immediately.  Some people simply cannot afford to be trapped.
  
As I’ve noted, this could affect primaries in the election season, and various kinds of congregation for volunteer activity.
  
What seems missing also is, what percent of the cases really will be mild and not normally lead to medical attention?
  
There was one incident where a passenger became ill when flying from San Francisco to England (NBCBayarea). 
   
The other passengers were held for 25 minutes.  Persons seated near the passenger will be notified it the passenger tests positive, but it is not clear if those persons have to be followed.


Thursday, February 13, 2020

COVID19: Washington Post discusses the "most cases are mild" thing. That can cut both ways. What about the primaries and Super Tuesday, if we have mini-clusters later from them?



Lenny Bernstein and Carolyn Y. Johnson have an important Washington Post article this morning on the observation that 80% of the reported coronavirus COVID-19 cases are mild.  
  
That could mean that 20% are serious enough to develop pneumonia and possibly ventilators, which would quickly overwhelm any advanced health care system.  But let’s continue.
  
The article maintains that all 14 of the cases (as of the time of writing) are mild.  Actually, the first one in Everett Washington was serious enough to develop pneumonia after about 6 days, although that resolved itself quickly. A couple in San Francisco is reported to have had to be suddenly hospitalized. But another couple in Chicago is reported to have recovered with few real problems.
    
Cases in England and France related to the superspreader seem to be mild, as was the Superspreader’s himself.  An earlier cluster in Germany (which related to pre-symptom transmission from a woman from China) seems to be mild, as was the woman’s.

  
Peak Prosperity (Chris Martenson) reports on the severity of some disease in Japan, and about a disturbing situation in Santa Clara County, CA.

It does sound plausible that very small transmissions don’t usually lead to major illness.  This idea needs to be investigated, now.  That appears to be a possible pattern outside of China. 
   
Most experts feel there will be small clusters in the US within 2-3 weeks.  It could be very damaging to persons who are caught away from home even in the US, as in airline traps. But so far no unusual health screening seems to be happening for people getting on or off domestic flights.
   
In the worst scenarios, this could disrupt election voting in primaries, where many people and workers are congregated.  Have state election officials thought about this?  Should election officers (who essentially volunteer for slave wages for very long hours to "pay their dues")  be forced to self-isolate later just because one person who came to the polling place turned out to be positive?  This is getting undoable. What really may happen Super Tuesday?

So, indeed, some of the scare talk sounds like horror movie scenarios (which AIDS was, with a virus that was not casually transmissible, back in the 80s, and has settled down today).  Or Ebola (we have a vaccine, but it was a threat in 2014).  Or what SARS or conceivably MERS "might have been". 
  
Again, if the underlying reality is that almost all cases in practice turn out to be mild, that changes the discussion.  Then it becomes about the (shocking) morality of “survival of the fittest” thinking. I’m 76 so my time could be up from a lot of things.

Tuesday, February 11, 2020

China's coronavirus pandemic keeps sending out troubling outlier reports, near a tipping point as to how if can affect ordinary life in the US ("COVID-19")


The Barrett Channel (I think from Australia, some of the staff now camping out in Szenshen) has I think the best video this morning on coronavirus, and some of the recent info in the past 24 hours is even more troubling.


I recommend you watch Dr. John Campbell (factual evidence-based analysis) and if you want something a little more alarmist (on the crypto-currency right) watch Peak Prosperity (Chris Martenson, who by the way has said his Wikipedia presence was removed).  Tim Pool has been covering some of the more alarming stories every two days.
  
There are multiple stories that the virus can have as long as a 24-day incubation period.  This is hopefully an outlier and most cases show symptoms in 3-5 days.  

There are also stories (as in a big study) in China that many people have a second wave of pneumonia after first starting to seem better, and relapses after apparent recovery are possible.  I experienced an unusual "flu-corona-like" illness that followed this pattern in California in February 2002, before SARS was known. 
   
There was a story of a “superspreader” who went to Singapore and then to a French ski resort.  He finally had mild symptoms.  Apparently he is in isolation now in the UK with apparent recovery with minimal symptoms.  The secondary cases appear to have mild symptoms, but it is critical that we find out if secondary cases are milder because viral exposure is less.

There is a particularly disturbing story about the evacuation of an apartment building in Hong Kong because two people on distant floors on the same tier rested positive.  Plumbing issues were suspected.  The people may be allowed to return.  But this story sets up a warning for any apartment or high rise condo building (which I live in) anywhere in the world.  ABC reports in this story a new named for the virus, COVID-19.
    
It will be very relevant to know how well the people on the cruise ship do, and how people in the military base quarantine centers in the US do clinically.  We don’t have definite information on this. It sounds like their cases are much milder than in mainland China, again a persistent pattern.
    
Again, it is not practical to quarantine every possible theoretical exposure that you could find by cell phone, facial recognition, airliner seating, credit card use in bars, etc.  At some point this has to stop.  
     
We need to know where that point would be.  A “voluntary quarantine” in a condo unit is still a legally enforceable quarantine, and a person who lives alone without social capital could be in serious trouble.  This whole problem can disintegrate into “survival of the fittest”.
   
  Here is the best map (via Johns Hopkins).

Sunday, February 09, 2020

For some ordinary people, even in the US, Communist China has created a Black Swan




CNN has a rather eye-catching story Sunday morning about ordinary Americans caught in extraordinary circumstances imposed on them indirectly because of recklessness in a Communist country, China.

This is a true Black Swan.

The worst situations right now seem to be the people caught on at least two cruise ships.  But it is true that cruise ships are notorious for having outbreaks, mostly or Norwalk virus.


And on a number of military bases, people who have returned are quarantined for 14 days. 
So far the number of cases in the United States seem to be rising only very slowly.  Most of the tests submitted to CDC so far have come back negative.

The danger could explode quickly, however, in a large city, even in an apartment building or condo, like where I live.  Could you ever quarantine all of Manhattan?  Have we had a single case in the US in a large residential building? What happens then?  
    
We still don’t have a clear idea as to whether in a western country with high living and sanitations standards, people in practice would medically tolerate very small exposures (as would happen in an apartment or office building), simply have very mild symptoms or none at all and make antibodies and become immune.  That is what happens with most viruses.  When they jump from animals, they are more alien and harder to defend against.

Circumstantially, it would seem as though the epidemic is much worse in China because of overcrowding and the very large viral exposures at once.

But we need to get a grip on this quickly.

There is at least a risk of a sudden asset drop in the financial markets that could affect retired people.
   
And there is a risk of disruption on supply parts to fix all kinds of problems with computers, cars, elevators, escalators, etc.    Could an epidemic threaten the delivery of utilities?  It doesn’t seem to have done that in China, however.

Friday, February 07, 2020

Reparations for slavery and police profiling are already happening


The Washington Post reports that reparations for slavery are already being paid, especially by some educational institutions, municipal governments, and even churches, in a story by Thai Jones   

One examples is payments to African Americans targeted by police in Chicago from the 1970s to 1990s.


And some well known people are making something of benefits owed to people based on group membership rather than their own individual histories, such as for Native Americans.   David Hogg recently wrote such a tweet.  And the “Covington Kids” scandal in Jan. 2019 would not have happened had mainstream media and many other peoples not felt a bias toward this kind of thinking, to the point that they overlooked the actual circumstances of the event.
    
I think you could try to target inheritances in some cases. 

Thursday, February 06, 2020

Mitt Romney's explanation of his vote for conviction


Mitt Romney explains fully his vote to convict Trump, for sacrificing national security to promote his own political interests.


He also said that his faith was part of his decision.  Here he explains on Fox News.

Pelosi’s tearing up of Trump’s Manifesto and her outburst this morning were pretty sickening, but then so was Trump’s attack on his enemies as he celebrates his acquittal today.

Tuesday, February 04, 2020

Coronavirus and "social distancing" in the US; the reports of transmission without symptoms may be overblown


CNBC has a story today predicting that there will be a pandemic in the United States but that it will be mostly mild disease.  This creates a community moral problem with a highly contagious disease that still most people survive easily but which has a much higher fatality rate among the vulnerable than usual. 

One question was whether “social distancing” should be enforced, especially with closing of schools and other public gatherings.  I have some earlier posts on this topic here, going back to 2014 with Ebola cases in the US, and earlier with H1N1.  The video below says that decisions like this are usually politically rather than scientifically based.

   
But Science News (Kai Kupferschmidt) reports that review of the case cluster in Germany does not support the idea that the virus was spread before symptoms;  the woman from China, on closer questioning, admitted she had felt some symptoms earlier when she met the businessman.

Update:  Feb. 4

JAMA has been saying that transmission is most likely just before and just after showing symptoms, so some asymptomatic transmission is still regarded as possible. Dr. John Campbell in the UK explains today. 

Sunday, February 02, 2020

How domestic air travel even for ordinary Americans now could be disrupted by novelcoronavirus:


The Associated Press and AOL report that any flight in which it is discovered in flight that someone on the plane had been in China in the past fourteen days, will be diverted to one of a list of larger airports where the person can be detained and screened, and held in isolation for fourteen days.


This could disrupt the travel of any persons domestically in the until Feb. 16, when presumably there should be no such persons on a plane.  However, TSA agents could ask all people when they go through security the question.  Do ask, do tell”, go ahead an use my wordmark.
  
I would hate to see the DHS think it has to hold people unlucky enough to sit next to them.  
   
We’re still trying to get better information on just how serious such an infection is, given the odds. 
  
 Donald J. McNeil discusses the growing pandemic with some candor in the New York Times today,. 


Saturday, February 01, 2020

Physician explains the complicated cycle of symptoms and infectivity of Novel-Coronavirus (from the UK)



I’ll start the month of February with a video from a doctor in the UK, Dr. John Campbell, about new data regarding contagion of the NovelCoronavirus, formerly the Wuhan coronavirus..

  
The doctor examines a chain letter in Germany, where a woman from Wuhan met with a businessman casually.  The woman had no symptoms.  The man had a brief acute illness and seemed recovered after 3 days.  The man still continues to shed virus that could affect others however. 

The woman developed symptoms when returning to China.  Two or three other business contacts of the man have tested positive and apparently as of now none have symptoms. 
  
This has serious implications to the extent that our moral sense requires healthy people not to infect others.  (That makes sense with sexually transmitted diseases like HIV but not normally with ordinary respiratory infections, which people are supposed to get vaccinated for or be able to get over on their own  -- presenteeism, which was how it was when I was working.)

This sort of thing sounds impossible to control.

Will most people have mild symptoms? 

It sounds like some people have mild symptoms at first, start to recover, and then have a second wave when their body tries to get rid of virus-infected cells in the lungs.
  
It’s pretty obvious that HIV-infected people could be at more risk, and the virus has been reported as more likely to infect men, which could become problematic later for the CIS male gay community.
  
Here is a perspective on Jan. 24 in the New England Journal of Medicine.