Coronavirus (COVID-19) Outbreak – Page 1

24 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – downgraded to 1 (this could be upgraded with some unexpected development, but the information emerging out of especially Korea, Italy and the middle-east is very concerning which confirms rapid and widespread transmission, including in well developed countries, with the clear suggestion of high mortality rate.)

This is a scale that can move daily depending on latest developments. Extreme pessimism of 1 would entail confirmation that the virulence of the virus is such that infections result in a mortality rate of 1% or greater (10x the virulence of severe flu) even under optimal conditions, continued indications of very high transmissibility (a reasonable proportion of infected individuals infect several people), and a lack of effective treatment and/or prevention (vaccination). An increase in optimism would necessitate clear evidence that outbreaks outside of China were being contained, evidence supportive of a virulence attenuation resulting in a mortality rate of below 1%, or strong indications of successful therapeutic treatments that can be administered widely and rapidly.

WHO Situation Report 34 for 23 February (released at 6am 24 February Brisbane, Australia, time)

China: 77,042 confirmed cases (650 new); 2,445 deaths (97 new)

Rest of the World: 1,769 confirmed cases (367 new); 17 deaths (6 new)

From China ending midnight 23 Feb: 409 new cases (Total 77,150)*; 150 new deaths (Total NYA). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

* The way the Chinese Government data has been collated has changed several times and I find it confusing, which may just be the intention. As suggested in earlier reports, the political imperative in China has changed to the point where one must assume that these figures are compromised and will likely be managed to meet the narrative that the CCP chooses. In the future I may cease to report these, quoting only the figures reported by the WHO, and with greater attention moving towards reporting from other countries where there is greater confidence in the reported data.

The vice governor of the People’s Bank of China (PBOC) continued the party line which has been pushed for several weeks now that the impact of the outbreak on their economy will be “short-lived and will not change the country’s sound economic fundamentals” suggesting that they may attempt to manage a return to work while enforcing heavy-handed social controls to handle disquiet if mortalities mount. Quarantine controls are being lifted gradually in Wuhan and nearby cities.

The most concerning international news of the day centred on South Korea where confirmed cases continue to surge. As of midday 161 additional confirmed cases lifted the total number of infections to 763 and there were 2 more deaths. Concerningly Bloomberg reported officials as stating that 37,000 people had been identified with symptoms! And the entire city of Deagu will be tested for infection which is on the one hand impressive, and on the other hand alarming to say the least. It will be interesting to see what proportion of the population test positive. The South Korean Government has raised the alert level to the maximum meaning that it can restrict air travel and impose stricter measures on foreigners entering the country. There have been 7 deaths recorded.

Prior to daybreak in Italy the total of confirmed cases had risen to over 150, according the Wall Street Journal, with 11 northern towns in lockdown which is being tightly enforced by police.

Iran confirmed 8 deaths related to coronavirus, 43 confirmed cases and over 785 people showing symptoms. Israel has recorded its first coronavirus case, a passenger from a cruise ship in Japan (name not supplied by WSJ), but they are also tracking down people who came into contact with a South Korean tour group in which 9 tested positive on returning home. Throughout the middle-east restrictions on travel are being introduced.

Margaret Harris, a spokeswoman for the WHO said “We’re seeing some cases that don’t have a clear epidemiological link” as infections emerging in people who haven’t traveled to China or come in contact with confirmed cases showing “it’s not clear how the virus is spreading”.

It would be surprising if the WHO did not declare pandemic status in the next 24-48 hours. It will be interesting to observe over the next few days the actions of attendees of the G-20 meeting that occurred at the weekend.

23 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2 (with a very strong downward bias because my concerns are being realised in Japan, Korea and Italy, and with growing concerns about Iran and other most developing nations, and with more suggestions that the mortality rate is around >2%)

WHO Situation Report 32 for 21 February (released at 6am 22 February Brisbane, Australia, time)

China: 76,297 confirmed cases (397 new); 2,348 deaths (109 new)

Rest of the World: 1,402 confirmed cases (202 new); 11 deaths (3 new)

From China ending midnight 20 Feb: NYA new cases (Total NYA)*; NY new deaths (Total NYA). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

* The Chinese Government data has again changed with regards to how they count new and total cases. As suggested in earlier reports, the political imperative in China has changed to the point where one must assume that these figures are compromised and will likely be managed to meet the narrative that the CCP chooses.

Concerningly, but consistent with my very earliest comments, it does appear that the incubation period for some people is considerably longer than the one to two weeks that most quarantine procedures presume. A 70 year old man in Hubei took 27 days to exhibit symptoms. This, together with transmission by asymptomatic cases, only serves to highlight the difficulty in developing effective biosecurity procedures.

The pandemic potential of the virus is becoming clearer by the day with now sharp jumps in the number of confirmed cases throughout the rest of the world, and growing concern for developing countries where the majority of cases known are people who have died or who have been found to be infected when reaching other more developed countries. The WHO is rightly beginning to speak about their concern for the impact of the pandemic in Africa and other developing regions lacking health infrastructure to respond.

Sadly I expect to reduce my optimism factor in the next few days if the virulence of the virus in confirmed in the cases outside of China.

The total number of cases in South Korea continues to climb reaching 433 cases on Saturday. Half the total number of cases are related to one church in the city of Deagu. Samsung Electronics closed a factory in Gumi, close to Deagu, when one employee was found to be infected. It expects to reopen on 25 February. On national television South Korean Prime Minister Chung Syekyun advised people to cease attending large gatherings.

The number of cases in Japan is now over 100 with nearly all new cases for several days a consequence of transmission within Japan. Most of the new cases are unrelated to each other.

The emerging concern in Europe is in Italy where within the space of a few days the number of confirmed infections has risen sharply to 70, with most infections across the north of the country (the majority in Lombardy, 12 or more in Veneto, 1 in Turin and a suspected case in Umbria). There is no apparent relationship between the sites of these clusters. At the weekend a Carnevale was observed throughout Italy. However, in Codogno in Lombardy, the site of one of the clusters (including a 38 year old man in intensive care, his pregnant wife and another man), as well as several other nearby towns, the streets were deserted as people were encouraged to stay in doors and minimise social contact. These towns, numbering at least 10, were quarantined by the Italian Government and schools and businesses have all been ordered to close, except for pharmacies and supermarkets. The Government has ordered police to ensure that nobody leaves any of these towns and the armed forces have been placed on standby to assist the police if necessary. Two Italians have died from the coronavirus thus far.

22 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2 (but with a downward bias because my concerns are being realised in Japan and Korea, and with more suggestions that the mortality rate is around >2%)

WHO Situation Report 31 for 20 February (released at 6am 21 February Brisbane, Australia, time)

China: 75,569 confirmed cases (894 new); 2,239 deaths (118 new)

Rest of the World: 1,200 confirmed cases (127 new); 8 deaths (0 new)

From China ending midnight 20 Feb: 889 new cases (Total NYA)*; 118 new deaths (Total NYA). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

* The Chinese Government data has again changed with regards to how they count new and total cases.

Events in South Korea continue to develop with a total number of 346 cases, over the double the number from yesterday. Half the total number of cases are related to one church and 40% of those who attended services with the first known infected person are yet to be contacted. One person in Korea has now died from the infection.

The number of cases in Japan is now approaching 100, with it not possible to identify the original source of infection in any of the cases. Most of the new cases are unrelated to each other. One woman who was infected showed symptoms on 12 February, but went to work at a junior high school, and was hospitalised on 19 February. The school will be closed for two days from 25 February.

Now 6 Australians from the Diamond Princess have tested positive for coronavirus.

21 February

WHO Situation Report 31 for 20 February (released at 6am 21 February Brisbane, Australia, time)

China: 74,675 confirmed cases (399 new); 2,121 deaths (115 new)

Rest of the World: 1,073 confirmed cases (149 new); 8 deaths (5 new)

From China ending midnight 20 Feb: 889 new cases (Total NYA)*; 118 new deaths (Total NYA). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

* The Chinese Government data has again changed with regards to how they count new and total cases.

Events in South Korea continue to develop with 52 new cases, of which 39 were linked to that one church, bringing the total to 156. “Special care zones” have been designated in the worst affected areas which presumably enables special quarantine procedures to be implemented.

The Australians from the Diamond Princess have lended in Australia with 2 passengers testing positive for coronavirus.

20 February

WHO Situation Report 30 for 19 February (released at 6am 20 February Brisbane, Australia, time)

China: 74,280 confirmed cases (1,752 new); 2,006 deaths (136 new)

Rest of the World: 924 confirmed cases (120 new); 3 deaths (0 new)

From China ending midnight 20 Feb: NYA new cases (Total 56,303)*; 114 new deaths (Total 2,118). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

* The Chinese Government data has again changed with regards to how they count new and total cases.

Events in South Korea continue to develop with 20 new cases bringing the total to 51 yesterday, and now another 32 cases reported today bringing the total to 83. The Guardian – in its Live Coronavirus coverage – has thoroughly detailed the events around “Patient 31” who refused to be tested for the virus after a traffic accident, but presenting with a fever, on 6 February. Her symptoms worsened and was finally tested for the virus on 17 February and found to be positive. The 61 year old woman was a member of a church community, and so far 15 people that attended the same church on 9 and/or 16 February have tested positive (and today it was revealed more have tested positive). One other person who was in contact with the woman at a hospital was found to be infected. The source of “patient 31s” infection is unknown.

At this stage these events are still being considered “super spreader” events, but given the small numbers of cases that have been thoroughly studied, there is likely to be a growing suspicion amongst epidemiologists that such events are not rare with this virus, and in a worst case outcome, might prove to be common or even typical.

Meanwhile more information on events on the ground in Wuhan. Inspectors in protective suites are going door to door to identify all infected residents according to Associate Press reports. Wang Zhonglin, the new Communist Party secretary for the city, said that if a single new case was found after Wednesday then the district leaders would be held accountable.

One final word of caution. While it is perhaps understandable that even senior health officials are highlighting the high odds of minimal impact for any individual contracting the infection – e.g. 4/5 people will at worst be only mildly unwell, and discussion of 8/9 UK citizens with the virus having recovered and nearly half of the 35 cases in Thailand recovered – the impact on broader populations should not be underestimated.

It is increasingly clear that this virus is highly transmissible. In all countries that are open, with two-way travel across borders, there are likely to already be many more infected individuals than are currently known within all such countries across the globe. Across broad populations, within developed or developing countries, the mortality rate as yet is largely unknown. In China the case fatality rate is 2.3%, but on the one hand this does not account for those that were asymptomatic and lost the infection, and on the other does not account for those that are yet to die. The WHO has quoted several mathematical studies which suggest that the mortality rate across broad populations may be between 0.3% and 1%, but the numbers of cases used to make such calculations are so small that there has to be a wide degree of uncertainty (or wide confidence limits – one earlier study I quoted mentioned a range from 0.5% to 4%). Every fraction of a percent below 2% represents fewer lives that will be lost. Even so it is already clear that this will be the worst acute global pandemic in living memory.

19 February

WHO Situation Report 29 for 18 February (released at 6am 19 February Brisbane, Australia, time)

China: 72,528 confirmed cases (1,901 new); 1,870 deaths (98 new)

Rest of the World: 804 confirmed cases (157 new); 3 deaths (0 new)

From China ending midnight 18 Feb: 1,700 new cases (Total 74,185); 136 new deaths (Total 2,004). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

South Korea, another well developed nation near to China and with likely strong flows of people between the two countries, is now reporting more cases without travel to China or contact with anybody who has been in China.

WHO Director-General Tedros Adhanom Ghebreyesus praised China for its rapid and strong response to the outbreak and said that the measures implemented in Wuhan slowed the spread of the outbreak to China by a few days, and to the rest of the world by a few weeks.

There is discussion in the press about the measures that are now being taken in Wuhan to identify anybody who is unwell – artificial intelligence and questioning staff where medicines or supplies are bought by unwell people – and it appears that the ill people are being collected. It is an abrupt departure from what was occurring early when seriously ill people were being turned away by overwhelmed medical facilities, as in the very sad story of the Chinese film director Chang Kai who passed away caring for his parents and sister who also died.

Je suis Chinois!

18 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 28 for 17 February (released at 6am 18 February Brisbane, Australia, time)

China: 70,635 confirmed cases (2,051 new)*; 1,772 deaths (106 new)

Rest of the World: 794 confirmed cases (157 new); 3 deaths (0 new)

* The WHO is now reporting clinically-diagnosed as well as lab-confirmed infections inline with Chinese reporting.

From China ending midnight 17 Feb: 1,886 new cases (Total 72,436); 98 new deaths (Total 1,868). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

17 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 27 for 16 February (released at 6am 17 February Brisbane, Australia, time)

China: 51,857 lab-confirmed cases (1,278 new)*; 1,666 deaths (142 new)

Rest of the World: 683 lab-confirmed cases (157 new); 3 deaths (1 new)

* The Chinese authority’s figures are different to these as they began to include clinically diagnosed cases. The WHO will not change their reporting until they assess whether this is appropriate.

From China ending midnight 16 Feb: 2,048 new cases (Total 70,548); ??? new deaths (Total 1,770). These figures are released on Bloomberg weekdays as the data are released by the Chinese Government.

This is more talk today, including on Bloomberg, about Chinese citizens not placing a great deal of faith in the accuracy of the CCP’s reporting of data from the outbreak. Also from the same source there is significant quarantine measures already in place as far away as Beijing where people are being prevented from entering districts unless they live there. Of course the measures in place in Wuhan are extreme – no private cars are allowed on the roads.

The Japan Times has detailed the recent surge in Japan of cases with no recent travel history to China. Tomorrow I will begin to follow the situation in Japan more closely and have a specific report.

16 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 26 for 15 February (released at 6am 16 February Brisbane, Australia, time)

China: 50,580 lab-confirmed cases (1,527 new)*; 1,524 deaths (121 new)

Rest of the World: 526 lab-confirmed cases (21 new); 2 deaths (1 new)

* The Chinese authority’s figures are different to these as they began to include clinically diagnosed cases. The WHO will not change their reporting until they assess whether this is appropriate.

Just some quick comments as it is the weekend. With regards the fall off in the number of new cases in China, I would suggest to keep in mind two things: 1) as I said previously, the political pressure now on the Communist Party is such that internal political considerations would be outweighing any need to be seen to be doing the right thing internationally in reporting to the WHO (remember China’s official statistics on economic and other measures have always been treated with scepticism, even historically be senior party officials in quiet moments); and 2) just think about the extreme measures that have been taken in Wuhan and elsewhere in China, and how the people throughout China have responded on their own (deserting shops from Shenzhen to Beijing), to produce an impact in slowing the spread and human consequence of this outbreak. I am not sure whether similar measures will be able to be enacted in developed countries when the outbreak is seen to be pandemic.

15 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 25 for 14 February (released at 6am 15 February Brisbane, Australia, time)

China: 48,548 lab-confirmed cases (1,998 new)*; 1,381 deaths (121 new)**

Rest of the World: 505 lab-confirmed cases (58 new); 2 deaths (1 new)

* The Chinese authority’s figures yesterday were different to these as they began to include clinically diagnosed cases. The WHO will not change their reporting until they assess whether this is appropriate.

** The Chinese authority adjusted this figure downward yesterday (so in yesterday’s report where I pondered whether it was a typo on Bloomberg, sorry Bloomie!)

Over recent days I had a running battle on “The Conversation” with some bloggers – who could well be 20 year old political science majors sitting in the office of the Prime Minister and Cabinet – about how to communicate to Australian people about this outbreak. One article was by an Infectious Disease expert in Brisbane, and in my comment to him I encouraged the scientists to keep fighting the good fight to see the science – and thus the public good – win out over political self interest.

That has occurred today with the publication of this article in The Guardian – Things are changing so quickly: will Australia cope with the coronavirus if the worst happens.

It was a great article and gratifying to see that the scientists are absolutely fighting the good fight. It is not so difficult for me anymore – I do not have to worry about continuing a career and winning research funding (much of it from the Government). And I do not have to be concerned about my employer (often a university) that is concerned to protect its flows of revenues. I can say what I really think without fear of punitive career-altering repercussions. So well done everyone! It was an excellent start to getting the communication strategy right…

14 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 24 for 13 February (released at 6am 14 February Brisbane, Australia, time)

China: 46,550 cases (1,820 new)*; 1,368 deaths (254 new)

Rest of the World: 447 cases (6 new); 1 death (0 new)

* The Chinese authorities figures yesterday were different to these as they began to include clinically diagnosed cases. The WHO will not change their reporting until they assess whether this is appropriate.

Because the WHO is compiling the data globally the Chinese Government data is more recent and I will include that here also:

From China ending midnight 13 Feb: 5,090 new cases (Total 63,851); 121 new deaths (Total 1,380) – I suspect this is an error and it is meant to be 1,490??

I get these figures from Bloomberg television when they are released at around midday Brisbane time. Bear in mind that politics will play a part in how data are treated and publicly released. It is the case in all countries, though the degree of effect varies.

There are news reports that people on the Diamond Princess that are yet to test positive to the coronavirus, either having been tested and received a negative result, or those that have not exhibited symptoms and/or have been in recent contact with somebody who tested positive, will be permitted to leave the ship. It is not clear what will be the process – whether these people will continue to be held in quarantine somewhere in a facility where the quarantine can be better managed.

Prof Ian Mackay is in the press and on The Conversation stating that he thinks airborne transmission through airconditioning is unlikely, and the reason for new cases being found amongst the group is because of prior exposure – which essentially fits with what I said in my first reports (with regards the prolonged incubation period and asymptomatic spread). I posed some questions for Prof Mackay on The Conversation, and he was (understandably given the situation) vague in some areas. Fair enough – everybody involved in the response must be under significant pressure. But one hopes that the science wins out over the politics.

The most significant finding of the past 24 hours is the 80 year Japanese woman that died without any indication whatsoever for how she contracted the virus. She was being treated for another condition and infection by coronavirus was only detected post mortem. Her son-in-law, a taxi driver, has also tested positive. Unfortunately, this is a situation that likely will be played out in a myriad of scenarios going forward.

It will be a political decision on how the economic impacts from measures that could be enacted to slow the spread of the virus will be counterbalanced by the benefit to society of that slowing. Unsurprisingly I would sacrifice economic activity for the chance to save more lives. Perhaps our leaders should have some focus groups and do some testing on social media to tell them what they should do…

13 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 23 for 12 February (released at 6am 13 February Brisbane, Australia, time)

China: 44,730 (2,022 new); 8,204 severe (871 new); 1,114 deaths (97 new)

Rest of the World: 441 (46 new); 1 death (0 new)

Because the WHO is compiling the data globally the Chinese Government data is more recent and I will include that here also:

From China ending midnight 12 Feb: 14,840 new cases (13,332 from clinical diagnosis) and 195 deaths (total 1,310)

I get these figures from Bloomberg television when they are released at around 8am Brisbane time. Bear in mind that politics will play a part in how data are treated and publicly released. It is the case in all countries, though the degree of effect varies.

Note China is saying it has changed its diagnostic methodology, in response to press yesterday discussing false negatives, resulting in a large surge in cases.

At the same time, there is increasing discussion in the western press of a large-scale propaganda scheme running in China promoting the party’s response. Given the undoubted enormous impact on the Chinese economy, one has to wonder what the CCP has in mind to keep the economy afloat, whether they might just decide that they will take the hit to their population like most developing countries will do and use propaganda to disguise the true impacts to society.

The positive cases on the Diamond Princess continue to mount. Another 44 positive cases announced today bringing the total of positive cases to 218 (including one quarantine worker) out of a total 713 tested to this point. The sample group is obviously positively biased as those exhibiting symptoms, and those exposed to them, are being prioritised for testing. Yesterday it was reported that 4 were severe in intensive care or on a respirator. It should be obvious to any observer that these observations are concerning, but at the same time I would assume that the passengers were over-represented by elderly passengers.

12 February

I have now started a “petition” on Change.org entitled “Je suis Chinois” (I know nothing about change.org – I am hoping it is apolitical.) My petition is an expression of sympathy and solidarity with the people of China as the first peoples to suffer from this outbreak. Ultimately it is an expression of solidarity and of the coming together of all peoples – a united humanity.

Je suis Chinois

From now on I will only provide a very brief analysis of the ongoing outbreak on this page. Those that wish to gain continued access to my views and recommendations will need to sign the petition and provide an email address, thereby showing that you are for a united humanity free from xenophobia and prejudice.

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 22 for 11 February (released at 6am 12 February Brisbane, Australia, time)

China: 42,708 (2,484 new); 7,333 (849 new); 1,017 deaths (108 new)

Rest of the World: 395 (76 new); 1 death (0 new)

Because the WHO is compiling the data globally the Chinese Government data is more recent and I will include that here also:

Deaths in China in previous 24 hrs: 97 (bringing total to 1,113)

Note that my optimism scale has not changed, but I think that the community scale is starting to decrease because more experts are being reported in the press with their severe concerns.

For example, The Guardian has an exclusive (?) reporting the views of the chair of public health medicine in Hong Kong – on transit to the WHO expert meeting in Geneva on the coronavirus outbreak – Prof. Gabriel Leung which mirror my comments made here over the last 2 weeks.

Believe me I find no satisfaction in experts now expressing the same views – to anybody with a background in studying disease in any populations this was all fairly straight-forward to analyse.

People outside of Wuhan may be confused by the concern. You need to imagine it like an enormous tsunami, like the one in the Indian Ocean a few years ago. There has been an event that has triggered a chain of consequences – for a tsunami it is often an undersea earthquake – in this case it was a virus “jumping” species, to humans. Because we have no previous exposure to the virus it is highly virulent to us. Like a tsunami emanates outward from the epicentre, so too has this virus. At the moment we in most countries are at the stage where the sea is calm, but we know that it will arrive soon. Scientists from China and all around the world will be working feverishly to try to develop some tools – medicines, vaccines, procedures to minimise spread – to mitigate the impacts. Everybody needs to remain calm but be alert and be prepared, in your mind and in what you do.

In future emails or restricted access reports I will give more detail on the outbreak and my recommendations for individuals and families to manage the risks.

At this stage I want to say something important. My first draft of the petition was a little different to the one I ran with. Originally I was going to include more detail about my friend, Dr Shi Zhengli, the scientist leading the virology research group in Wuhan that identified the coronavirus and is working away for all of our benefit right now. Given political events in China – which I admit I am largely naive to – I felt it was probably better to not closely link my campaign with Zhengli. But I did not want these things unsaid so here is what I was going to include in the campaign.

I am for a united humanity!

Are you?

Now I have a friend who not only lives in Wuhan, but she is the head scientist leading the virological research team working on the outbreak.

I first met Dr Shi Zhengli over 22 years ago when I visited the laboratory where she was studying for her PhD with the brilliant and legendary aquatic invertebrate virologist, Jean-Robert (JR) Bonami, in Montpellier in southern France.

I had finished my PhD 18 months earlier, and I was visiting JR in the hope that I might be able to organise to do a postdoc with him in France. It took 2 years but I finally won a fellowship from the CNRS (the French equivalent of the CSIRO) to spend a year in JR’s laboratory learning from him and his team.

Indeed Bonami was brilliant. The techniques that he had developed were simplicity in themselves – just like brilliant Italian food – simple, good quality products used to perfection! – but you had to learn it directly to get them under your belt.

In between time I visited Zhengli briefly in 2000 at her laboratory in Wuhan.

Zhengli had finished her PhD research when I spent a year in Montpellier in 2001, but she visited periodically through the year and for a while we lived in a flat next to her. And Zhengli was amongst the multicultural group of foreign postdocs, from China, India and Sicily, whose friendship was so important to us during this period.

I admired Zhengli deeply for her extremely strong work ethic and her commitment to her research and career. Like all of the PhD students and postdocs I knew from developing and lesser-developed countries, she made very real personal sacrifices to develop her skills to benefit her country, for certain, and for the whole of humanity.

Zhengli was more than a colleague, though; she was a friend. Zhengli has an enormous heart and is a wonderful mother and a very authentic and caring friend. That was vital for a period in my life when they were rare.

Living in France, without being able to speak the language, was incredibly isolating for my wife and I. As a mixed couple we felt comfortable because we saw many African-French mixed couples and families. However, even though French colleagues were very keen to make full use of my English writing skills to help them publish their work in high ranking journals, they would not talk to me at all at other times and in group settings I sat alone feeling very much in the dark. I tried to learn French, but I just could not pick it up quick enough while working full time on my research to have any sort of social interaction with my French colleagues.

Virtually all of the foreign students and postdocs I knew were miserable, some bordering on clinical depression.

When Zhengli was there, I had a friend with whom I could talk. And I soon knew that she was a special person.

11 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

WHO Situation Report 21 for 10 February (released at 6am 11 February Brisbane, Australia, time)

China: 40,235 (3,073 new); 6484 (296 new); 909 deaths (97 new)

Rest of the World: 329 (12 new); 1 death (0 new)

Because the WHO is compiling the data globally the Chinese Government data is more recent and I will include that here also:

Deaths in China in previous 24 hrs: 1,021

Significant developments over the last 24 hours:

another 66 people that were on the Diamond Princess in quarantine in Yokohama have tested positive bringing the total of cases to 136 (the total on-board population was around 3,700)
the WHO Situation Report 21 states that around 50% of confirmed cases in Singapore, of a total of 43, were cases “with possible or confirmed transmission outside of China”
UK has declared the coronavirus outbreak a serious and imminent threat to public health, meaning that people with coronavirus can be forcibly quarantined and will not be free to leave, and can be forcibly sent into isolation if they pose a threat to public health.

Those people on the Diamond Princess complaining about their conditions need to accept that quarantine is not about the people held in quarantine, it is about protecting the broad population, as the UK directive makes clear. Perhaps they should be grateful that if they do contract the infection then they are in about as favourable a position as one can be given it will be detected early and they will receive excellent treatment within a sophisticated and well resourced medical environment. Other people should be so fortunate!

We remain in a wait and see situation but everybody should be taking this threat very, very seriously.

I asked my 11 year old son yesterday whether the children at his school were talking about the outbreak. He said that initially there were jokes in the school grounds, but now nobody has said anything for days. I asked if he thought that was because they were not worried – he said he thought it was the opposite. He said he thinks that the parents are not talking about it so that is making the children more scared.

I can understand in some ways why the parents are not talking about it with children, because the Government is not talking about it, probably for political reasons (concerned about impacts on opinion polls coming after the bushfires, and concerned about the impacts on the economy which would also impact on views of the Government).

It is time these people realised that anxiety builds in people when they sense a threat. (Jo Hockey might think it is OK to abrogate leadership to the Facebook masses which lead the politicians via them picking up on trends through focus groups – as he said on 7.30 recently – but unsurprisingly what people need most is real Leadership, with an intentional capital “L”.) Not talking about scary things only amplifies that anxiety because people assume that the threat is very serious (anyway) if they are not being told about it. And they have no information on which to confront those fears.

I understand that it is a very challenging situation to handle. But, as usual, prioritising political self interest will always result in inferior outcomes for the people. And I am concerned for the psychological damage being done to the young who sense the anxiety within society at present.

Finally, and I place this last because on the one hand the range of estimates is so wide to make the work very preliminary (as the authors note), and because those likely to see the glass half full will jump on the low range of estimates (as has been reported in the press today), while others more inclined to the see the glass half empty may be frightened by the high range of the estimates. The Imperial College London, the WHO Collaborating Centre for Infectious Disease Modelling, has produced their latest research providing case fatality ratio (CFR) for three categories of coronavirus infection from this outbreak.

“For cases detected in Hubei, we estimate the CFR to be 18% (95% credible interval: 11%-81%). For cases detected in travellers outside mainland China, we obtain central estimates of the CFR in the range 1.2-5.6% depending on the statistical methods, with substantial uncertainty around these central values. Using estimates of underlying infection prevalence in Wuhan at the end of January derived from testing of passengers on repatriation flights to Japan and Germany, we adjusted the estimates of CFR from either the early epidemic in Hubei Province, or from cases reported outside mainland China, to obtain estimates of the overall CFR in all infections (asymptomatic or symptomatic) of approximately 1% (95% confidence interval 0.5%-4%).”

The authors qualify these results with the following statements:

“All CFR estimates should be viewed cautiously at the current time as the sensitivity of surveillance of both deaths and cases in mainland China is unclear. Furthermore, all estimates rely on limited data on the typical time intervals from symptom onset to death or recovery which influences the CFR estimates.”

Those figures are concerning to say the least – I do not believe that I need to unpack these data any further.

Today I am going to discuss likely actions by Governments, likely economic impacts and discuss any reasons for optimism.

Likely Actions by Governments

Authorities in all countries will have been drawing up plans for many years on how to deal with this type of event. This represents the most serious challenge to that planning.

Presently every developed country will be asking themselves these questions:

what is our capacity to test everybody displaying flu-like symptoms and at what point do we start and at what point do we stop (and devote resources elsewhere)
at what point will we stop large public gatherings (sports events, conferences, concerts)
at what point will we close schools
at what point will we stop public transport and encourage employers to ask employees to work from home
how will we ensure that we can continue vital services such as health, water, electricity
at what point do we close the borders completely to all non-citizens or residents

As I said in my original post, being in the southern hemisphere – heading into the seasonal flu period – and our proximity and links to the original outbreak area – will mean that there will be greater pressure on our authorities to act decisively. They will be balancing up the impacts on society – the damage of scaring people when it is clear just how concerned authorities really are about this outbreak versus the significant benefits to slowing the spread of the virus within Australia. They will also be balancing things in relation to impacts on the Australian economy which is incredibly vulnerable (I have been talking on MacroEdgo and in earlier blogging activities for the previous 12 years about those vulnerabilities.)

I expect that this outbreak will take over a year to clear – we may well be living with it for several years if none of the current anti-viral drugs are effective and if there are challenges to developing and producing a vaccine.

Economic Impacts

Bad… very bad… under virtually all reasonable scenarios from where we are now.

I expect that central banks will try absolutely extraordinary actions (as opposed to the already “extraordinary” actions that we have become desensitised to over the last decade). The problem will be how to safeguard the economy by creating activity when most activity runs counter to the best way to reduce the spread of the virus. We hardly want more people out and about shopping, or even working together. As I said above, I believe most workplaces will need to either put people on paid leave or working from home.

Any stimulus to create activity will need to be activity that does not require people to come together. Thank goodness for electronic communication, if our networks hold up.

In the developing world, I wonder what might happen. It might be that they have no choice but accept the mortality rate as it is while their people go about their business relatively normally. As I said in my original report, these people need to work in order to eat. A 2% mortality rate is not such a huge departure from their normal life experience unlike those lucky enough to live on “islands of prosperity”.

This might even end up being the case amongst blue collar workers in China, though I suspect that nobody is going to want to take delivery of products out of factories where there has been no biosecurity efforts. So who will they produce for?

The realities of an inequitable world!

Reasons for Optimism?

At this stage I have not seen any data or anecdotal evidence that I would trust which increases my optimism. What is being said about a levelling off in case numbers in Wuhan and the relatively few deaths in the rest of China thus far does not provide a lot of comfort – the political situation in China now decreases the incentives for accurate reporting of any data which would suggest a worsening of the situation. In any case I would imagine that diagnostic capacity in China and definitely Hubei would be fully stretched (as I discussed in my initial report).

For me all eyes are now on what happens in countries where we can have more trust on the reporting of the outbreak (based not just on incentives to report accurately – or less inaccurately – but on capacity to do so). How quickly will it spread and how virulent is it really. There are no good indications on either of these points pointing to a more optimistic outcome, unfortunately, not yet anyhow.

Will any of the antiviral drugs currently available or in late stage development be effective? Will a vaccine be relatively straight-forward to develop, manufacture and administer?

I am certainly not qualified to estimate about pharmaceutical responses, but I am guessing that even experts within these fields will have a great degree of uncertainty around their views.

Eventually humanity will emerge from this event. We will never be the same, as I made clear in my initial report. That is sad.

We will all suffer loss. We already have. But humanity will go on. Even if the mortality rate turns out to be greater than 2%, the majority of people infected will survive the infection even if we (they) need to endure its spread for several years.

Nobody is immune and viruses do not discriminate. Our elderly and young are more at risk.

Let us hope that humanity can get its act together after this event.

I am for a united humanity!

Are you?

10 February

China: 37,251 cases (2,657 new); 6,188 severe (87 new); 812 deaths (89 new)

Rest of the World: 307 cases (19 new); 1 death (0 new)

More elites are out in the press this morning trying to tame down concerns. The problem being that arguments are only superficially attractive and most people with any sort of common sense will see through them. Let’s examine the comments by AstraZeneca’s Pascal Soriot who said that the H1N1 swine flu outbreak “was” worse. He quoted that around 60,000,000 were infected in that outbreak. Now, as I have said continuously, the mortality rate of the new coronavirus will not be known for quite a while but 2% seems to be the most commonly quoted figure at this stage (but it could settle higher – towards 10% like the other coronavirus outbreak SARS – or lower towards 0.1% like flu). Of course at this stage more people died from H1N1, but that outbreak is fully resolved (having occurred a decade ago!), and the current outbreak is far from resolved. But if H1N1 produced a mortality rate of 2% it would have killed 1.2 million of the 60 million cases quoted by Mr Soriot instead of 18,000. (A Wikipedia page suggests that the true number of mortalities due to H1N1 was between 175-500K, but it also suggested that the true number of cases was between 11-20% of the global population or 0.7-1.4 Billion people!)

Everyone hopes that the new coronavirus is not as transmissible as the flu, but the truth is we do not know yet, and recent observations (discussed below) are concerning.
I leave it to others to decide whether in these situations it is best to minimise the perception of risk on the basis that it is better for society. I am not a psychologist. But as I said to someone recently, if you were on the Titanic would you have been pleased with your decision to listen to the ship’s captain and get another drink at the bar instead of managing your risk by heading towards the lifeboat station.

Now that that is out of the way, and any shallow, casual observers that cannot read past 2 paragraphs have drifted off, I will state my full opinion.

Containment has clearly failed. The case studies discussed in yesterday’s report (the 5 French people contracting the virus after contact with a UK citizen that visited Singapore, as well as the number of cases and the history of the Diamond Princess) suggests to me that there is no chance that the disease will be contained. Almost immediately when I finished typing that sentence Bloomberg just discussed the infected UK citizen – apparently he attended a conference in Singapore and then holidayed at a French ski resort in the alps where he infected people from Spain, France and the UK. At this stage they are referring to such incidents as revolving around “super-spreaders” – let’s hope they really are unusual, but given that we are only just seeing a few cases in developed countries which at this stage have the capacity to fully examine these case studies, it is all too early to know.

Sadly, I expect many more cases in Australia, and increasingly there will be cases where people can not identify from where they contracted the infection. This will become increasingly apparent over the next few weeks as people fall ill (as discussed in yesterday’s report, the challenge is that the time to fall seriously ill seems to be quite extended). This will be the reality throughout all developed countries.

As I discussed in my very first report, the developing countries will be totally overwhelmed to respond and will do their best to encourage individuals and families to enact basic biosecurity protocols. The growth in the numbers of infected people and mortalities directly due to the virus will probably never be accurately known in those countries.

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

(If there is any future indication that UK citizen “super-spreader” is not atypical, then that would definitely result in a further fall in optimism. Future indication that the mortality rate is less than 2%, or promising drug treatments and/or vaccine development would significantly increase optimism.)

In the next few days I will put together my thoughts on what are likely actions by Governments, what are my thoughts on economic impacts, and discuss any factors for optimism.

I am for a united humanity!

Are you?

9 February

WHO situation report 19 (for 8 Feb 2020) – www.who.int

China : 34,598 cases (3,401 new); 6,101 severe (1,280 new); 723 deaths (86 new)
Rest of World: 288 cases (18 new); 1 death

The fact that there have been so few deaths outside of Hubei is not a cause for comfort, yet. At this stage I believe it is accurate to say that nobody that has not been to Wuhan has died to this point of the outbreak.

While this could be interpreted to suggest that detected cases have a better chance of survival when health facilities are not overloaded, it may equally suggest that this virus takes some considerable time to cause fatality, and combined with a prolonged incubation period with asymptomatic transmission, this is a combination which will make this virus exceptionally difficult to control. All eyes are now on the mortality figures for other Chinese states to see how things progress.

I am closely following the case study of the passengers on the Diamond Princess which is quarantined off Yokohama. From what I have managed to gather in the press, the first (known) infected passenger disembarked in Hong Kong before the cruise ship continued it’s schedule. According to the schedule at “Crew Center” the previous stop in Hong Kong preceding this was 25 January and the passenger later became ill and was diagnosed as being infected. I have not seen it stated where that gentleman boarded – possibly it was a round trip in which case he would have been aboard for 12 days (from 13 January) stopping in at Keelung (Taiwan), Osaka (Japan), Toba (Japan), Yokohama (Japan) and Kagoshima (Japan).

After this first known infected passenger disembarked at Hong Kong the Diamond Princess stopped at Chan May (Vietnam), Halong Bay (Vietnam), Keelung (Taiwan), and Okinawa (Japan) before arriving at Yokohama (Japan).

Testing has revealed that 64 people that were on board the vessel at Yokohama were infected perhaps as much as 26 days after the first known infected person first boarded the vessel. However, there has been no information provided on what attempts have been made to contact others that disembarked the cruise at any time over those 26 days to encourage them to be tested for the virus. What is more, it is impossible to know how many local people at those ports became infected by contact with people infected from the vessel.

This one case study reveals just how difficult it will be to contain this virus. There would be many, many other scenarios which have been played out.

For instance, in France 5 people were infected after contact with a UK citizen who recently returned from Singapore according to the Wall Street Journal.

All of this suggests that attempts to limit the virus to people who have been infected in China have failed, further increasing the probability of a global pandemic.

The Diamond Princess case study will also be very interesting for another reason. It will give a very clear indication of the pathogenicity of the virus in patients treated in optimal conditions with many diagnosed prior to the onset of illness and in a country with a sophisticated health system that has not yet been stretched by a high number of cases.
If the number of infected people who succumb to the virus under these conditions suggests a mortality rate of 2% (as of 8 Feb, n=64) or higher then we face a very, very challenging situation to say the least.

I will continue to pay very, very close attention to developments with that particular case study.

Of course as the virus spreads it is unlikely that many infected people will be (fortunate to be?) diagnosed early. But it will show what is possible to achieve in protecting populations in ideal situations.

My optimism/pessimism level – from 10 to 1 in decreasing optimism – is at 2

(The number of cases found on the Diamond Princess and the new cases in France decreased my optimism level from 3 previously)

In an upcoming report I will begin to discuss implications for how we will live in our societies until the coronavirus outbreak passes, and what we can all do in an attempt to manage the risk of infection for ourselves and our loved ones.

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24 February

23 February

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19 February

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9 February

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