Italy Connections
- Italy Cases Today: 566 new cases and 5 new deaths in Italy, for a total of 1,694 cases.
- Italy Cases Yesterday: 239 new cases and 8 new deaths in Italy.
- Italy Total Cases: Among the 1,577 active cases, 779 (49%) are hospitalized, 140 of which (representing 9% of active cases) are in intensive care. Among the 117 closed cases, 83 (71%) have recovered, 34 (29%) have died.
- Scotland from Italy: 1st case in Scotland (UK) a “resident of the Tayside area and has recently travelled from northern Italy“.
- Iceland from Italy: 1 new case in Iceland: a man in his 60s who arrived from Verona, Italy, yesterday with Icelandair.
- Finland from Italy: 5 new cases in Finland: including an elderly person and a school-aged child, both related to a previous case who had travelled to northern Italy.
- Czech Republic from Italy: First 3 cases in Czech Republic. They had all recently traveled to Northern Italy.
- Algeria from Italy: 1 new case in Algeria: an Italian citizen.
- Netherlands from Italy: 5 new cases in the Netherlands: Three of them visited Lombardy, Italy.
- Mexico from Italy: 1 new case in Mexico: first in Chiapas, a student who had traveled to Italy.
- US from Italy: 1 in Rhode Island: a man in his 40s who had traveled to Italy in mid-February.
- Luxembourg from Italy: 1st case in Luxembourg: a man around the age of 40 who returned from Italy through Charleroi last week with his family.
- Spain from Italy: 25 new cases in Spain. At least one arrived from Italy.
- Switzerland from Italy: 10 new cases in Switzerland, of which 4 in the circle of two children of an Italian family in Graubünden who tested positive last week.
- Norway from Italy: 1 new case in Norway: an employee at the eye department at Ullevål University Hospital in Oslo, as tests were conducted on 4 staff members with symptoms after that, on Feb. 28, Covid-19 infection was confirmed in a staff member who had traveled to Northern Italy, showed symptoms on Sunday but still went to work on Monday and Tuesday.
- Brazil from Italy: 1 new case in Brazil (second in the country): as with the first case, the person was in Italy.
- UK from Italy: 12 new cases in the UK. 6 had traveled to Italy. 2 had traveled to Iran
- Italy Flight Cancellations: American Airlines has announced it is suspending flights to and from Milan, Italy from both New York and Miami from March 1, 2020 until April 25, 2020, citing reduced demand. The announcement comes only hours after the U.S. State Department said it was raising its travel warning to Level 4: Do Not Travel for parts of Italy due to the coronavirus outbreak
Iran Connections
- Iran New Cases: 385 new cases and 11 new deaths in Iran
- Qatar from Iran: 2 new cases in Qatar: they had both been evacuated from Iran
- Bahrain from Iran: 6 new cases in Bahrain: 3 female Bahraini nationals, 2 male Bahraini nationals and 1 male Saudi national, arriving at Bahrain International Airport via indirect flights from Iran.
- Iraq from Iran: 6 new cases in Iraq: 2 in Baghdad, 4 in Sulaimaniya. They had all recently traveled to Iran.
- Lebanon from Iran: 3 new cases in Lebanon, all three had visited Iran.
- Georgia from Iran: 1 new case in Georgia: a Georgian citizen who, having returned from Iran.
- Canada from Iran and Egypt: 5 new cases in Canada. Two traveled to Iran, one to Egypt.
- Travel Bans: Incoming travel from Iran to Australia is banned starting Sunday. Appropriate level of travel advisory to Italy is being considered. But “it’s not possible to further isolate Australia,” said Chief Medical Officer Brendan Murphy, adding that the focus should be on detection and containment instead.
Last Two Days Only
Those Iran and Italy details are from Worldometers for the last two days only.
Licking Madness in Iran
CDC Incompetence
https://twitter.com/kr3at/status/1234345193345867777
Extreme Politicization by VP Pence and Donald Trump Jr
Better Late than Never or Too Late to Matter?
Spotlight US and Canada
Trump has banned travel from Iran.
He needs to immediately ban are travel from Italy and South Korea as well.
Canada has not yet banned travel from Iran.
This is truly crazy.
What are they waiting for?
What’s Happening
- Feb 19: Fed Minutes Highlight Coronavirus Concerns and Uncertainty 8 Times
- Feb 24: Bond Yields Crash and Gold Soars on Pandemic Threat
- Feb 25: CDC Admits Spread of Coronavirus in the US Appears Inevitable
- Feb 25: Lie of the Day: This is Not a Pandemic
- Feb 25: Nearly 50% Odds of “At Least” 3 Rate Cuts by December
- Feb 26: Trump says We are “Very, Very Ready for the Coronavirus, for Anything”
- Feb 27: Useless Act: California Monitors 8,400 People for Coronavirus; 33 Test Positive
- Feb 27: Containment Fails: Coronavirus Tweets of the Day
- Feb 27: Tweets of the Day: Iran’s VP Infected, Japan Closes All Schools
- Feb 28: 5 Mistakes by the CDC and FDA Set Back Virus Testing
- Feb 29: China PMI Contracts to the Weakest on Record
- March 1: Powell Floats “Fed Will Act As Appropriate” Rate Cut Message
- March 1: State of Emergency in Alameda County
- March 1: Florida Governor Declares State of Emergency
- March 2: Global Recession Now Baked in the Cake
Mike “Mish” Shedlock
Comparing Italy and Irans’s deaths to the Death Princess, both have about 13x as many deaths now. It seems likely that they have 13x as many cases, meaning 9,200, that have been around a week or more (it takes awhile to go from infection to death). They also would have additional, more recent cases in Italy and Iran, since their data set is not constrained by the size of a ship. I would guess that both countries probably have more like 25k infections, rather than the reported 2500.
If you apply the same methodology to S. Korea, they are probably catching almost all their cases. I would do the same for the US, but most of their cases are from people repatriated from either Wuhan or the Death Princess, and who were never out in the general population.
There is a lag between community dispersal and confirmation of unknown origin cases. We have to guess, but eight of ten won’t be tested in US, the other two severe would possibly be tested up to two weeks after symptoms (as per a case there I think) . Reality is that you can have had transmission in community going on a month maybe unnoticed – first infection, after one week symptoms, two weeks later a test (or not as seems the case in US). Multiply that by however many initial infections and appply R0 of 10 say within first ten days. Not a joke, right now there could easily be several thousand infected in US… or none.
I broke the world data up based on their average temperature in March, at least, as best i can, since some countries have many sub-climates. I found that countries with an average March temperature of 54 degrees F saw cases grow by 20% a day the last two days, and 27% a day if you exclude S. Korea. Countries with an average March temperature over that had an average case growth of 5% a day.
Note that this is just observational data massaging, and thus is not proof of anything. It can be used to formulate a theory, and that theory can be tested using future data, with this data excluded, but on it’s own it is not proof of anything. The theory I will test, then, with data over the next week is:
Future data should get better because as total cases grow, and travel shrinks, cases resulting form local transmission should vastly outnumber cases imported via foreign travel. Right now that is not necessarily the case in many countries, and what appears to be case growth simply reflects cases from foreign travel.
Have to start somewhere. There are so many variables that I would not know where to do so, but, if you start finding trends then it gives a basis to work with (or against). Clearer data might also be had from same country, towns of similar profile, different climate zone – that would take out some of the variables (cultural for example). My encouragement.
Bear in mind, again, that the WHO mission head found no evidence of widespread asymptomatic spread.
BBC just reported that the WHO is revising CFR upwards to 3.5%.
Asymptomatic though means no cold or flu like symptoms, most (all almost) in US would not be tested for nCov if they presented those.
Here is from money.it from today, on Mattia, who they are trying to save:
“How is it possible that a 38-year-old sporty and healthy man is struggling between life and death because of the coronavirus? This is the question that many are asking about the conditions of Mattia, the thirty-eight year old from Castiglione d’Adda, the first case of Covid-19 in Italy. The man has been hospitalized for a week in extremely serious conditions in the intensive care unit at the Policlinico San Matteo in Pavia; he also infected his wife Valentina, 8 months pregnant and hospitalized at the Sacco in Milan.
Mattia is “sedated, unconscious and intubated because he is not autonomous in breathing”, explained Raffaele Bruno, the doctor from Cosenza who takes care of him.
Although so far the infection has proven to be lethal especially for patients very old and with a compromised clinical picture, unfortunately Covid-19 has also killed many very young and fit people.
An exemplary case is the 34-year-old Chinese “hero” doctor who died of the virus a few weeks after he first raised the alarm for the outbreak of the epidemic. Or, again, the 29-year-old Chinese doctor from Wuhan, who died on February 20 after contracting the virus and twenty days after his hospitalization. His conditions, already serious, worsened over the days, so much so that he needed intensive care.
Dr Bruno, who is following the case of Mattia in the Lodi area, said that “It is impossible to predict the course of the infection because the virus is unknown and unpredictable.” “
I don’t say this to fearmonger, it is simply that it is not explained beyond these people ( and others of similar ages that exist) being in “sub-optimal condition” due to exertion or fatigue etc., which is no explanation at all as far as the average person is concerned.
To clarify, WHO in China went looking for evidence of widespread spread (the “iceberg” that was being referred to). The report, which is worth reading in its entirety, is here:
On the “widespread community transmission” we find the following statements:
“In Wuhan, COVID-19 testing of ILI samples (20 per week) in November and December 2019
and in the first two weeks of January 2020 found no positive results in the 2019 samples, 1
adult positive in the first week of January, and 3 adults positive in the second week of
January; all children tested were negative for COVID-19 although a number were positive for
influenza. In Guangdong, from 1-14 January, only 1 of more than 15000 ILI/SARI samples
tested positive for the COVID-19 virus. In one hospital in Beijing, there were no COVID-19
positive samples among 1910 collected from 28 January 2019 to 13 February 2020. In a
hospital in Shenzhen, 0/40 ILI samples were positive for COVID-19.
Within the fever clinics in Guangdong, the percentage of samples that tested positive for the
COVID-19 virus has decreased over time from a peak of 0.47% positive on 30 January to
0.02% on 16 February. Overall in Guangdong, 0.14% of approximately 320,000 fever clinic were positive”
The other thing that i thought was interesting was that spread is mostly within family units.
“Household transmission
In China, human-to-human transmission of the COVID-19 virus is largely occurring in
families. The Joint Mission received detailed information from the investigation of clusters
and some household transmission studies, which are ongoing in a number of Provinces.
Among 344 clusters involving 1308 cases (out of a total 1836 cases reported) in Guangdong
Province and Sichuan Province, most clusters (78%-85%) have occurred in families.
Household transmission studies are currently underway, but preliminary studies ongoing in Guangdong estimate the secondary attack rate in households ranges from 3-10%.”
I don’t think there is an iceberg of asymptomatic cases either, but I think it is possible that there might be a large background of mild cases and some severe/fatalities that do not appear until testing is done. Looking at it this way with R0 of 10 occuring in ten days from infection, you have 100 people infected for some reason (a couple of superspreaders, a tour group etc) day 1, day 10 you have 1000 people infected and some of the first 100 in hospital, day 20 some severe and fatalities from the first 100, tests find say 10 or 20 of those, plus people from the 1000 start going to hospital, but the number of infected is now 10000, most with only cold or flu symptoms.
So it depends when you test, if you test, and the real dynamic of the epidemic. All of those are missing for us. Eventually when it is understood there is an epidemic, they lock down and test everyone, and at that point nearly everyone is registered, this is what happened in Italy. So there is no iceberg of an epidemic that does not eventually appear in cumulative figures, but there is a period at the start , as in now in the US, where the epidemic has a possibility to expand unnoticed. The less testing there is, the more it has the possibility to expand that way. Lockdown halts it mostly, and then they are counting the true number of cases and picking up the pieces.
So a test in China where this is not background reality will find no iceberg. A test at peak background cases when people are first being hospitalised might find an iceberg. The tests after this will however bring in that background information, and there will be no iceberg distorting the statistics.
As I mentioned once previously, household transmission is to be expected as source of many cases , because once one member is infected, likely will be the rest.
One more case that has attention in Italy, a newborn with nCov, via corriere dela sera:
” In the deluge of coronavirus-infected in the province of Bergamo, the positivity to the swab of a child of a few weeks focuses the attention of a province already very worried. The baby, coming from Alzano Lombardo, in Val Seriana, has been hospitalized since Monday afternoon in the neonatal pathology of Pope John XXIII. He had arrived at the hospital showing typical respiratory symptoms of the syndrome. The health management defines its situation “not particularly compromised”, it breathes alone, without the assistance of machinery. However, underline the Bergamo doctors, on this case “the attention is very high”. “
The short of it is that we don’t know enough about this virus, or who it affects or how exactly it affects.
I don’t use any dasboards here so that is my last post on this thread normally because it is awkward always checking back.
Remember this is a “NOVEL” virus ( and China hasn’t been that forthcoming with its data) so its not like there is a ready made data source or test kit available to determine who is infected and who is not.Toss in that phylo-geneticists say the infected population doubles every 5 to 7 days and there is no way anyone or organization can stay ahead of this virus.
Things we still don’t know. Incubation time, that R naught rate, Case Fatality Rate, Reinfection rate ( if any). Its all estimated from studies over less than two months since the virus was identified and its genome mapped.
It is currently doubling faster than 5-7 days. Looking at the non-China data, it took 20 days to get from 100 to 1,000, which is a doubling time of 6 days. However, it took only 13 days to get from 1,000 to 10,000. That is equivalent to a doubling time of 3.9 days. In recent days the log chart of non-China cases is rising even faster, and it might only take 10 days to get to 100,000, which would be a doubling time of 3 days.
The truth is probably somewhere in between. The early numbers for doubling time of 5-7 days are probably too low because many early cases were undetected. The later numbers may be too high as there may be some catch up going on. As we go forward, the reported numbers will probably be too low again, as cases exceed testing capacity. My best guess is that the doubling time is closer to 4-5 days than to 7.
As China showed, aggressive containment can limit the spread however, and I suspect we will see more of this. For those that question the Chinese numbers, remember that actions speak louder than words. They rushed to build 2 one thousand bed hospitals in 10 days, plus built additional low care facilities in a stadium, exhibition hall, etc. in Wuhan, indicating a sudden, dramatic need.
But, note that they have not build additional hospitals in other parts of the country. Thirteen Chinese provinces reported at least 200 cases as of February 1. Had the spread doubled every 4 days, those would have turned into over 50,000 cases in each province, which would have been impossible to hide, even assuming under-reporting. Had they doubled every 7 days, it would still be at 4,500, which would be straining their capacity in all provinces. The more time that goes by without an urgent need to build more hospitals in other provinces, the more indication we have that their draconian controls actually were effective. Again, actions speak louder than words, and the lack of action, plus some attempts to re-open for business, indicates that the draconian restrictions have been largely successful.
These countries should take a leaf out of the Australian governments book.
The government itself is taking advice from a respected panel of medical experts and not letting political constraints get in the way.
They already stated a couple of weeks ago that the virus can’t be contained.
They have ignored the WHO and have stated that this will be a pandemic. They are also ignoring Chinese statements and statistics.
They are getting prepared for a large amount of cases in April / May.
They have already communicated to the general public to get ready for isolations.
(This has caused supermarket panic buying but it will settle down as people get stocked up).
Under the medical advice they are under no illusions that hospitals and general health facilities will be stretched so will allocate funds to help this along.
My local GP is being briefed with updates.
He already told me weeks ago that Chinese style isolations are not out of the question.
The economy is going to take a hit. The government has communicated this to the general public and told them to be prepared.
Chinese tourism to Australia is worth AUD$16 billion per year. It’s dried up already fir 6 weeks.
There are 200,000 Chinese national foreign students normally in Australian universities.
There are 100,000 still in China awaiting to come back to Australia after the New Year break. They’re barred from reentry.
Massive disruption to the economy. Worth billions.
Not to mention Australia’s raw product exports not getting to China.
Impressive. That sounds like exactly the right course of action. Sadly, while the Northern hemisphere is starting to come out of their flu season, Australia’s is approaching. There is no chance at all that a vaccine can save them.
Its a bit on the late side for finger-pointing RE past bad decisions. We need test kits ASAP so we can get an idea how widespread it is and start slowing the spread by locking down areas and halting/shuttering anything but critical infrastructure and food/supply outlets.
I pointed out many times earlier that this virus is very dangerous. More dangerous than the seasonal flu whose severe infection cases number is dampened by the great proportion of older and weaker people vaccinated each year.
I also concluded from datas earlier that there were a lot of untested bearer spreaders everywhere. They now appear by the hundreds in most countries as testing finally started.
So as of now without containment measures it will spread faster than the seasonal flu.
I must repeat here that it kills at least ten time more patients than the flu and is at least 50 per cent more contagious.
So if that virus would be left alone like the seasonal flu the number of infected persons requiring an hospital bed with medical devices would probably be 15-20 time higher than in the case of the
yearly flu epidemic.
There are no countries having enough hospitals, medical personnel and beds, as would be needed. Wuhan initial lack of medical services has been a warning in that matter.
So containment in order to reduce the speed of infection is an obligation in order to avoid a public health disaster to happen.(the like as in Wuhan where peoples were dying probably by thousands everywhere at the beginning.)
I think that in every country they know that fact. So containment measures and the associated collapse of the service sector everywhere will go on until a remedy is found..
They need to try to slow it, but they can’t slow it forever. If it goes up 10x every 12 days, as it did the last 12, by early April there will be 10 million cases outside of China. The only hope would seem to be that it takes the summer off. Some viruses do, some don’t, and no one knows why.
Would you believe your ears when I tell you that this week 120 pupils( +-12 years old) are going on a so called snowclass to the affected area in North Italy ? Well believe me, they are from 2 schools in Dilbeek(near Brussels), and up till now it looks like they are actually allowed to go …..
Aha. So it disproportionately targets the stupid. On second thought, the pupils are collateral damage of their idiotic teachers, just like some yahoo spreading it by coughing in public. I read, China has the right approach…
Italian numbers should go down, because of the following:
“But according to the Health Ministry, Lombardy has also carried out swab tests on people who are more likely to have come into contact with infected people, even if they have no symptoms themselves.
On Thursday, after insisting that their comprehensive approach to testing was the right one, Lombardy said it would now conform with national and international guidelines and test only people showing symptoms.”
It appears that Mike Pence is now in charge of the Italian response team as well. “If we don’t test, we can’t have a pandemic”
And people still have the nerve of constantly bashing the Chinese. ROFL. They will come out of this looking among the most competent.
What I wish the U.S. government would do that they still have not done is give the public better insight about what response will unfold as major outbreaks of COVID-19 occur within the US. Alex Azar has stated that cordon sanitaire will not be used. Okay, what will be used? Can we expect school closures? Will public transportation be mostly shut? Are U.S. public officials going to keep these plans secret until there are lines outside of hospitals like happened in China?
If they want the public to remain calm, then they should clearly state the government strategy in more detail and give people a reasonable framework to plan from. It is the lack of detail that causes me concern. Look at the testing situation with the CDC. That was a major scandal before anyone in a leadership position would even acknowledge that the US is not yet able to effectively monitor community transmission of cases. Meanwhile, the President keeps emphasizing how few cases there are. Those two facts are inconsistent, and that feeds public concern.
We are rapidly approaching the point where everyone will have to give up trying to contain it. It has been slowed a lot, but enough, I don’t know. It took 20 days to go from 100 to 1,000 cases outside China, and 13 days to go from 1,000 to 10,000. By March 12th I think we will have 100,000 cases outside China, and there is no way they can trace them all. They will continue to quarantine infected people, but move to the next step, encouraging people to stay home, not travel (anywhere), and to avoid public gatherings.
In Spain infected more or less doubled last day, almost all cases are via Italy directly or indirectly. Nigeria was via Italy, Portugal also.
This sort of says how it comes across to me right now:
“avoid public gatherings.”
Not a good year to campaign to become POTUS.
Not sure why you say it’s crazy Mish? It’s all purely human reaction to something that cannot be controlled. We try to brush it aside, or downplay the severity but that won’t help. Just like the Spanish flu of 1918, this thing will end up going around the world a few times for the next couple of years no matter what precautions we will, have, or did take. Based on Kotter’s 8 step model of change we’re very early in the process, maybe step 1. We’ve got a long way to go.
The difference is we can develop a vaccine in a year or so. Not so in 1918.
While the Spanish Flu pandemic lasted about 2 years in total, it killed most of the people it killed in the second wave – which hit about two months after the first wave ended.
All of that happened within about 10 months…
If by chance, this follows the same pattern, “a year or two” won’t be good enough.
I’ve posted this before but google “salicylate Spanish flu”.
TL;DR it wasn’t the virus in the second wave, it was the lethal doses of aspirin handed out by doctors. It’s worthy of consideration because the clinical autopsy findings were very different to what would be expected for flu, and very similar to what might be expected for somebody taking a lethal dose of aspirin twice a day for a week.
That’s a very interesting hypothesis. And I have no doubt that it could be true as often the reaction and urge to “do something” override the need to wait and see – which can lead to unintended consequences. I read the original paper and will continue reading more – thanks!
I always tell people that if aspirin or penicillin had to go through today’s rigorous FDA approval process, they may very well never make it to market.
What is the point of banning travel? It will be throughout the entire population in short order anyway. Does anyone really think their city/area won’t be affected? –Ed: I suppose it could slow the spread.
On the subject of travel, anybody notice that the death rate on the Diamond Princess full, as it is, of old people, is far, far lower than the death rate in Italy?
They test(ed? Are they done yet?) everyone, or near everyone, on Diamond Princess. Up to several times, from what I gather.
In Italy, and even more so most other places like the US, while there may be some purely exploratory, “random” testing, there is a much greater bias towards testing people sufficiently symptomatic that they come into contact with health care systems.
They think the virus was maybe circulating earlier than first case in Italy , plus the Italian fatalities so far are mostly very old people, who succumb faster. Put it this way, the weakest might not survive a week, and due to the number of infections in Italy, there will be a lot of early weak fatalities. That alone gives current 2.5 % CFR. Maybe they are over represented demographically in cases, I don’t know, but not for lack of testing whole community at start of outbreak ( though now they stopped). For Diamond Princess they are older people, but not that that old. A lot of infections there were more recent, so if you use worldometer at waybackmachine, you can see say on 22 feb there were 29 fatalities/serious/critical combined. Currently that figure is up at 43 , with the CFR only set to climb from its current 1 %.
Not a full explanation but it maybe gives some clues for you.
Another possibility is that the Italian strain (which I think they have isolated) is more lethal, but that is completely speculative of my part.
Thanks. I did more reading. Seems like many of the victims were already hospitalised for other things including frailty (elderly) and cancer treatment.
Which probably will not come as a comfort to the families of cancer patients in a certain U.K. hospital, where a cancer ward medic was diagnosed (and symptomatic) yesterday.
Like Diamond Princess, hospitals will become a source of infection probably. It is where infected people go, and those who work with them, all in close contact. Even attempts at isolation of the various patients there are going to be difficult – you build a seperate hospital just fot virus but in a pandemic staff and other patients at a normal hospital will still be turning up with the virus. Pretty much a nightmare scenario I should imagine.
The plan is to slow the spread. Hoping warmer air will slow it and hoping a vaccine can be made widely available before it’s too late.
They’re also trying to slow the spread so hospitals & medical workers aren’t over run with cases.
It kills smokers.
That outcome will be a catastrophe for school funding!
Buying time is essential. That’s was essential. The opportunity windows closed.
More time could inch us towards the summer (which dumped down SARS) and towards a vaccine.
The cost due to restricted (read “no”) international travel would be justified by the time we could have bought.
Apparently The Pope’s tested positive according to the BBC.
Ha, they’ve changed it now, its negative