I have come to the conclusion that the most dangerous places in the UK are hospitals, especially accident and emergency departments. Many old people who would be safe at home are getting infected in hospital.
I have it on good authority (being married to someone who works in one) that absolutely every effort is being made to ensure that anyone in hospital who can be at home is sent home.
I have no doubt that is true but it remains a fact that hospitals are a dangerous place for both staff and patients.
And this has been true far longer than we've been struggling with the current crisis. Nosocomial infection can kill as many people as are killed by what they went to the hospital for. The less time one has to be in hospital, the safer one is.
I have come to the conclusion that the most dangerous places in the UK are hospitals, especially accident and emergency departments. Many old people who would be safe at home are getting infected in hospital.
I have it on good authority (being married to someone who works in one) that absolutely every effort is being made to ensure that anyone in hospital who can be at home is sent home.
I have no doubt that is true but it remains a fact that hospitals are a dangerous place for both staff and patients.
It's true up to a point. But as I pointed out above, paediatricians are seeing major issues with kids being brought in too late. At my hospital we had a child die of sepsis who probably would have survived but for the late presentation. It is not a simple thing.
The way in which the virus is raging through care homes rather gives a lie to the 'cocooning' strategy.
"Cocooning" works, but (and this is the key point) it relies on not having the bloody virus in the cocoon with you. And also on not having asymptomatic staff shuttle in and out of the care come being disease vectors.
The way in which the virus is raging through care homes rather gives a lie to the 'cocooning' strategy.
"Cocooning" works, but (and this is the key point) it relies on not having the bloody virus in the cocoon with you. And also on not having asymptomatic staff shuttle in and out of the care come being disease vectors.
Yes, I was complaining about the implementation rather than the strategy in itself -- I suppose this is what the arguments about 'many people would have died anyway' amount to in practice - Harald Shipman was ahead of his time.
List of countries with at least 5,000 known COVID-19 cases.
United States - 468,887 (426,262 / 25,928 / 16,697)
Spain - 153,222 (85,610 / 52,165 / 15,447)
Italy - 143,626 (96,877 / 28,470 / 18,279)
Germany - 118,235 (63,221 / 52,407 / 2,607)
France - 117,749 (82,333 / 23,206 / 12,210)
China - 81,907 (1,116 / 77,455 / 3,336) 4.1%
Iran - 66,220 (29,801 / 32,309 / 4,110)
United Kingdom - 65,077 (56,964 / 135 / 7,978)
Turkey - 42,282 (39,232 / 2,142 / 908)
Belgium - 24,983 (17,296 / 5,164 / 2,523)
Switzerland - 24,051 (12,503 / 10,600 / 948)
Netherlands - 21,762 (19,116 / 250 / 2,396)
Canada - 20,765 (14,945 / 5,311 / 509)
Brazil - 18,176 (17,046 / 173 / 957)
Portugal - 13,956 (13,342 / 205 / 409)
Austria - 13,244 (7,709 / 5,240 / 295)
South Korea - 10,450 (3,125 / 7,117 / 208) 2.8%
Russia - 10,131 (9,357 / 698 / 76)
Israel - 9,968 (8,871 / 1,011 / 86)
Sweden - 9,141 (8,143 / 205 / 793)
India - 6,725 (5,863 / 635 / 227)
Ireland - 6,574 (6,286 / 25 / 263)
Norway - 6,219 (6,079 / 32 / 108)
Australia - 6,152 (3,113 / 2,987 / 52)
Chile - 5,972 (4,641 / 1,274 / 57)
Denmark - 5,635 (3,662 / 1,736 / 237)
Poland - 5,575 (5,117 / 284 / 174)
Czechia - 5,569 (5,156 / 301 / 112)
Japan - 5,347 (4,563 / 685 / 99)
Peru - 5,256 (3,680 / 1,438 / 138)
Romania - 5,202 (4,307 / 647 / 248)
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries seventeen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3).
Romania, Japan, and Peru have been added to the list since the last compilation.
Here in South Africa, the lockdown has been extended until the end of April as more testing gets underway. South Africa has 6 000 ventilators collectively in its private and public health care sector, with plans to produce another 10 000 by the end of June. Trying to buy time...
In Italy last I heard they had had 8 dead in prison riots in early days of the lockdown. We have had several prison riots here of varying degrees of seriousness. Don't get me started on the obstructionism with regards to prison chaplaincy.
It's that last one that's concerning. Did the report you came across say whether these 91 individuals were symptomatic, or just infected with the virus.
Is anyone sufficiently up on viruses (virii?) to know if there exist viral diseases where one recovers without immunity as a matter of course? I don't mean one odd individual, I mean people in general, and I don't mean the virus lies low and reactivates, I mean it's really gone and then really reinfects someone, within (say) a single year. And I mean the same freaking virus, not a related one (as with the common cold).
Plural is viruses. *Virii would require a singular *Virius.
[pedant's cap and gown on]
In Latin, virus, meaning poison, venom, ooze or slime, appears to be a second declension neuter noun, even though the nominative ends in -us. Thus, technically speaking, the nominative plural in Latin would be vira, although no occurrences appear to exist in literature.
You would expect neuter nouns ending in -us to be third declension, e.g. opus, corpus. Virus appears to be unique.
Interestingly, the Proto-Celtic cognate of Virus would be *Uiros; this had the sense of water rather than slime, much less venom, and gives us the -wy element in a number of Welsh rivers, and the Afon Gwy (River Wye) itself.
Apparently, some people do not develop antibodies. This is the reason why we need an antibody test to determine whether a recovering patient is protected.
Common colds are caused by any of about 200+ known viruses of which most are rhinoviruses and a handful are coronaviruses. How long one remains immune to a particular coronavirus after infection and recovery is known to vary depending on type of coronavirus (and probably also on the person infected).
It's that last one that's concerning. Did the report you came across say whether these 91 individuals were symptomatic, or just infected with the virus.
There is definitely notno post-infection immunity. That's not how the immune system works. If you clear the virus, you will have some immunity for some time. The question is how long?
For other viruses, immunity usually lasts a matter of years. But it can be less. It can be life-long but is not always. It's very much an unknown at this stage. It's one of the things that is being very carefully looked at. I have not seen any data on this point yet - I will share such links when I see it published. As an example, Polio immunity is known to wane in later life and thus elderly people who had the vaccine as a child can contract it. (It's not a problem in developed countries because polio is all-but irradicated by effective vaccine programs).
This will be important to know going forward. What I have seen is data suggesting that SARS-CoV-2 has a slow mutation rate. That, if confirmed, is very good news for immunity in general and vaccine-development in particular. But mutation rate is not the only factor for long-term immunity. It's a bit technical and basically comes down to T-helper cell involvement but some pathogens produce much better immune memory that others. (Happy to expand on this point if anyone's interested, although my knowledge on this is out of date by a decade or two).
The common cold is made up of a diverse group of viruses. It does include some Coronaviruses but also Rhinoviruses and Adenoviruses. IIRC the Adeno- are the most common but I might have got that wrong. They are a diverse group of viruses but the common factor is the ability to cause the same Upper Respiratory Tract symptoms without (usually) and more significant effects. The point being that the huge variability in viruses and a generally high mutation rate results in us all being vulnerable to catching 'a cold' (coryzal infection) repeatedly.
There's a lot of unknowns at the moment. As noted the 'reinfection' might be nothing of the sort or could be a very rare thing. We just don't know yet.
Common colds are caused by any of about 200+ known viruses of which most are rhinoviruses and a handful are coronaviruses. How long one remains immune to a particular coronavirus after infection and recovery is known to vary depending on type of coronavirus (and probably also on the person infected).
Today's figures were dreadful, particularly for the USA and the UK. It seems likely tomorrow that the USA will overtake Italy as the country which has seen the most deaths and will also see its 20,000th death, following its 500,000th confirmed diagnosis.
The evidence from Italy and Spain is that they have reached the top of the curve, but numbers are declining slowly. A flattened curve is a stretched curve. The curves for both Italy and Spain suggest the decline of numbers, both of diagnoses and deaths, to levels below 50 a day will take significantly longer than the rise to the apex took. Maybe 6 to 8 weeks?
The virus will determine the timetable, but the Trump idea of an economy restart by the beginning of May already looks hopelessly optimistic. The beginning of June starts to look quite optimistic as well, And the prediction models show a second spike if social restraints are lifted early.
This is going to be a long haul. Any risky attempts to speed up economic activity look destined to boomerang, actually make the process longer.
List of countries with at least 5,000 known COVID-19 cases.
United States - 502,876 (456,815 / 27,314 / 18,747)
Spain - 158,273 (86,524 / 55,668 / 16,081)
Italy - 147,577 (98,273 / 30,455 / 18,849)
France - 124,869 (86,740 / 24,932 / 13,197)
Germany - 122,171 (65,522 / 53,913 / 2,736)
China - 81,953 (1,089 / 77,525 / 3,339) 4.1%
United Kingdom - 73,758 (64,456 / 344 / 8,958)
Iran - 68,192 (28,495 / 35,465 / 4,232)
Turkey - 47,029 (43,600 / 2,423 / 1,006)
Belgium - 26,667 (18,080 / 5,568 / 3,019)
Switzerland - 24,551 (12,449 / 11,100 / 1,002)
Netherlands - 23,097 (20,336 / 250 / 2,511)
Canada - 22,148 (15,566 / 6,013 / 569)
Brazil - 19,943 (18,696 / 173 / 1,074)
Portugal - 15,472 (14,804 / 233 / 435)
Austria - 13,560 (7,177 / 6,064 / 319)
Russia - 11,917 (11,028 / 795 / 94)
South Korea - 10,450 (3,125 / 7,117 / 208) 2.8%
Israel - 10,408 (9,130 / 1,183 / 95)
Sweden - 9,685 (8,434 / 381 / 870)
Ireland - 8,089 (7,777 / 25 / 287)
India - 7,600 (6,577 / 774 / 249)
Ecuador - 7,161 (6,496 / 368 / 297)
Chile - 6,501 (4,865 / 1,571 / 65)
Norway - 6,314 (6,169 / 32 / 113)
Australia - 6,238 (3,043 / 3,141 / 54)
Japan - 6,005 (5,221 / 685 / 99)
Poland - 5,955 (5,456 / 318 / 181)
Peru - 5,897 (4,159 / 1,569 / 169)
Denmark - 5,819 (3,799 / 1,773 / 247)
Czechia - 5,732 (5,267 / 346 / 119)
Romania - 5,467 (4,468 / 729 / 270)
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries seventeen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3).
Ecuador has been added to the list since the last compilation with a huge increase of 2,196 diagnosed cases on April 10. For comparison the previous record daily increase in known cases for that country was 515 on April 9. This suggests an increase in testing capabilities rather than a sudden surge of infections.
Excellent clarifications. My working hypothesis is that it is not safe to draw parallels. We need the data.
More than anything else we need complete data.
What does a massive increase in the number of cases tell us? That a lot more people have developed symptoms? A lot more people have been tested (and thus more tested positive)? A bit of both?
What does a massive increase in the number of daily deaths tell us? That a lot more people have died of the disease, or that the disease is being attributed as the cause of death in more cases (e.g. care homes)?
And can somebody please explain Germany? The numbers of deaths per million of population there seem to be lower than those in Italy by a factor of ten. Even accounting for lots of other factors, that's a whole order of magnitude different.
The reason for Germany's low death rates thus far is still in the realm of speculation. The following BMJ article firstly refers to widespread testing from the outset of the outbreak, leading to the inclusion of mild cases in the statistics. It then mentions several other factors, such as early social distancing rules.
Thank you. It probably is too early to tell, and perhaps what seems to be called "exponentional whiplash" ('hey, where did that graph line go?') may come into play as time goes on, nevertheless it seems astounding that those factors alone would make a whole order of magnitude of difference.
(I suppose another part of my niggle in this is that if, as is now being posited, the virus can be airborne, caught off (say) food packaging for hours or days after the surface is contaminated, etc., is massively contagious, etc., how come anything short of complete and total confinement could make such a huge difference. Germans are still shopping).
I don't know about credible, but in France the prospect of aerosols being airborne long enough to be a source of contamination in enclosed environments has certainly been raised, I think by health authorities or government, and leaving shopping for several hours outside before bringing it indoors to reduce the risk of contamination has been posted as official advice.
I don't know about credible, but in France the prospect of aerosols being airborne long enough to be a source of contamination in enclosed environments has certainly been raised, I think by health authorities or government, and leaving shopping for several hours outside before bringing it indoors to reduce the risk of contamination has been posted as official advice.
Thanks for the quick reply. But isn't that idea conflating two things - the virus in the air and the virus on a surface? I haven't read anything to suggest the virus will lift off the surface and become part of an aerosol (used masks aside, perhaps). I thought you leave shopping alone solely so that you don't touch it. But I am very much not a medical person or medical research bod.
The reason for Germany's low death rates thus far is still in the realm of speculation. The following BMJ article firstly refers to widespread testing from the outset of the outbreak, leading to the inclusion of mild cases in the statistics. It then mentions several other factors, such as early social distancing rules.
My son reckons it’s partly because a lot of the early cases in Germany were young, fit people returning from ski trips. So the early death rate was low. Then Germany got to testing very quickly.
Even when I was there in early February they (in Heidelberg) were shielding their bus drivers with a barrier not letting anyone on at the front. The chemist across the road from ‘our’ flat had everyone queuing two metres apart, even then.
The instruction for general social distancing (in Heidelberg) and total school and kindergarten closures also came before I left on the 9th of February.
I suppose another part of my niggle in this is that if, as is now being posited, the virus can be airborne, caught off (say) food packaging for hours or days after the surface is contaminated, etc., is massively contagious, etc., how come anything short of complete and total confinement could make such a huge difference. Germans are still shopping.
I have been handling and emptying shipping boxes with gloves then throwing them in the shed - and washing down all my shopping, door handles and surfaces the shopping has been on - with soapy water, careful not to touch my face until after I’ve washed my hands, ever since the start of this. So are my German friends and family.
Or to put it another way, the UK govt were late, and flirted with herd immunity, before the lockdown. Possibly also, British exceptionalism was hovering, as Boris said, it's an Englishman's inalienable right to go to the pub. Plus, NHS had been shredded by 10 years austerity.
isn't that idea conflating two things - the virus in the air and the virus on a surface?
Sorry, I didn't mean to conflate them, I was listing two examples of contamination vectors that I personally find hard to integrate in the general scheme of things.
Or to put it another way, the UK govt were late, and flirted with herd immunity, before the lockdown. Possibly also, British exceptionalism was hovering, as Boris said, it's an Englishman's inalienable right to go to the pub. Plus, NHS had been shredded by 10 years austerity.
And the US were even later, some states following tRump’s terrible lead - full of denial and false hope.
isn't that idea conflating two things - the virus in the air and the virus on a surface?
Sorry, I didn't mean to conflate them, I was listing two examples of contamination vectors that I personally find hard to integrate in the general scheme of things.
Or to put it another way, the UK govt were late, and flirted with herd immunity, before the lockdown. Possibly also, British exceptionalism was hovering, as Boris said, it's an Englishman's inalienable right to go to the pub. Plus, NHS had been shredded by 10 years austerity.
Who mentioned the UK? I was comparing Germany and Italy. It will be intruguing to see how the UK figures compare over the long term, but I think it's far too soon to be making judgement calls.
Comments
And this has been true far longer than we've been struggling with the current crisis. Nosocomial infection can kill as many people as are killed by what they went to the hospital for. The less time one has to be in hospital, the safer one is.
It's true up to a point. But as I pointed out above, paediatricians are seeing major issues with kids being brought in too late. At my hospital we had a child die of sepsis who probably would have survived but for the late presentation. It is not a simple thing.
AFZ
Conversely, industructobobbin.
"Cocooning" works, but (and this is the key point) it relies on not having the bloody virus in the cocoon with you. And also on not having asymptomatic staff shuttle in and out of the care come being disease vectors.
Yes, I was complaining about the implementation rather than the strategy in itself -- I suppose this is what the arguments about 'many people would have died anyway' amount to in practice - Harald Shipman was ahead of his time.
When we all performed the urchatz
Many times a day
Together but apart.
That Year.
When we marked our doors with Purell.
When we took our meals at a formal distance.
When we drank more wine than was customary.
That Year.
When we prayed for deliverance
From the Plague
And from the Tyrant.
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries seventeen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3).
Romania, Japan, and Peru have been added to the list since the last compilation.
Brilliant!
It's that last one that's concerning. Did the report you came across say whether these 91 individuals were symptomatic, or just infected with the virus.
Back to hydroxychloroquine: don't take it unless you can say torsades de pointes properly and want to experience it.
[pedant's cap and gown on]
In Latin, virus, meaning poison, venom, ooze or slime, appears to be a second declension neuter noun, even though the nominative ends in -us. Thus, technically speaking, the nominative plural in Latin would be vira, although no occurrences appear to exist in literature.
You would expect neuter nouns ending in -us to be third declension, e.g. opus, corpus. Virus appears to be unique.
[pedant's cap and gown off]
There is definitely not no post-infection immunity. That's not how the immune system works. If you clear the virus, you will have some immunity for some time. The question is how long?
For other viruses, immunity usually lasts a matter of years. But it can be less. It can be life-long but is not always. It's very much an unknown at this stage. It's one of the things that is being very carefully looked at. I have not seen any data on this point yet - I will share such links when I see it published. As an example, Polio immunity is known to wane in later life and thus elderly people who had the vaccine as a child can contract it. (It's not a problem in developed countries because polio is all-but irradicated by effective vaccine programs).
This will be important to know going forward. What I have seen is data suggesting that SARS-CoV-2 has a slow mutation rate. That, if confirmed, is very good news for immunity in general and vaccine-development in particular. But mutation rate is not the only factor for long-term immunity. It's a bit technical and basically comes down to T-helper cell involvement but some pathogens produce much better immune memory that others. (Happy to expand on this point if anyone's interested, although my knowledge on this is out of date by a decade or two).
The common cold is made up of a diverse group of viruses. It does include some Coronaviruses but also Rhinoviruses and Adenoviruses. IIRC the Adeno- are the most common but I might have got that wrong. They are a diverse group of viruses but the common factor is the ability to cause the same Upper Respiratory Tract symptoms without (usually) and more significant effects. The point being that the huge variability in viruses and a generally high mutation rate results in us all being vulnerable to catching 'a cold' (coryzal infection) repeatedly.
There's a lot of unknowns at the moment. As noted the 'reinfection' might be nothing of the sort or could be a very rare thing. We just don't know yet.
AFZ
Thank you, forgot rhinoviruses, [headslap]
The evidence from Italy and Spain is that they have reached the top of the curve, but numbers are declining slowly. A flattened curve is a stretched curve. The curves for both Italy and Spain suggest the decline of numbers, both of diagnoses and deaths, to levels below 50 a day will take significantly longer than the rise to the apex took. Maybe 6 to 8 weeks?
The virus will determine the timetable, but the Trump idea of an economy restart by the beginning of May already looks hopelessly optimistic. The beginning of June starts to look quite optimistic as well, And the prediction models show a second spike if social restraints are lifted early.
This is going to be a long haul. Any risky attempts to speed up economic activity look destined to boomerang, actually make the process longer.
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries seventeen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3).
Ecuador has been added to the list since the last compilation with a huge increase of 2,196 diagnosed cases on April 10. For comparison the previous record daily increase in known cases for that country was 515 on April 9. This suggests an increase in testing capabilities rather than a sudden surge of infections.
What does a massive increase in the number of cases tell us? That a lot more people have developed symptoms? A lot more people have been tested (and thus more tested positive)? A bit of both?
What does a massive increase in the number of daily deaths tell us? That a lot more people have died of the disease, or that the disease is being attributed as the cause of death in more cases (e.g. care homes)?
And can somebody please explain Germany? The numbers of deaths per million of population there seem to be lower than those in Italy by a factor of ten. Even accounting for lots of other factors, that's a whole order of magnitude different.
https://www.bmj.com/content/369/bmj.m1395
(I suppose another part of my niggle in this is that if, as is now being posited, the virus can be airborne, caught off (say) food packaging for hours or days after the surface is contaminated, etc., is massively contagious, etc., how come anything short of complete and total confinement could make such a huge difference. Germans are still shopping).
My son reckons it’s partly because a lot of the early cases in Germany were young, fit people returning from ski trips. So the early death rate was low. Then Germany got to testing very quickly.
Even when I was there in early February they (in Heidelberg) were shielding their bus drivers with a barrier not letting anyone on at the front. The chemist across the road from ‘our’ flat had everyone queuing two metres apart, even then.
The instruction for general social distancing (in Heidelberg) and total school and kindergarten closures also came before I left on the 9th of February.
I have been handling and emptying shipping boxes with gloves then throwing them in the shed - and washing down all my shopping, door handles and surfaces the shopping has been on - with soapy water, careful not to touch my face until after I’ve washed my hands, ever since the start of this. So are my German friends and family.
And the US were even later, some states following tRump’s terrible lead - full of denial and false hope.
Who mentioned the UK? I was comparing Germany and Italy. It will be intruguing to see how the UK figures compare over the long term, but I think it's far too soon to be making judgement calls.