What is new with the COVID-19 disease?

It has been about two months since the CoV outbreak in Wuhan, China.  We have learned a lot about the disease: the pathogen, transmission, symptoms, etc.  We have witnessed unprecedented efforts to curb the disease in China and around the world.  Well over 100 papers have been published on the subjects, as well as countless media reports.  Here are a few most prominent developments for the past 2 weeks.

1. In China, outside the Hubei province, new confirmed cases have dropped to 0 or close to 0 in most provinces.  The disease, thus, seems to be contained.  There will probably be rebounds here and there in the future, but the trend is established for now.  Zhong Nanshang was quoted as saying that now needs to distinguish between CoV and flu on Feb 23.  This is a backdoor saying we need to switch criteria to declare victory.  Because the drastic efforts currently still employed in China do not and cannot, and it is not even clear if the distinction is possible or doable at the population level.

2. Outside China the disease is spreading after a lull till about Feb 20.  During this time most infections occurred on the Diamond Princess cruise ship.  Now Japan, South Korea, and Italy have seen hundreds of cases.  Most new Japanese cases are linked to the ship, while in Korea linked to an infected patient attending many social events.  These cases complicated the health, social, and economic prospects of 2020, but perhaps it is also an opportunity to drive home the message: don’t panic over it, it will be here for a while, but just needs to be identified and treated properly.

3. There are still unknowns about the disease.  There are directly conflicting reports (scientific and media) in China about whether certain drugs are effective.  Maybe the treated cases have different severity, or we need more cases.  There are recommendations that glucocorticoids should not be used because of their side effects, also based on experience with SARS in 2003.  But many “younger” patients died from an overactive immune response, and some doctors have suggested that glucocorticoids could have saved their lives.  Another issue is virus carriers with no symptoms for a long time, and whether they are infectious.  People getting infected but staying healthy is actually common in most diseases, but it is also hard to say whether one has symptoms or not.  For one thing, we cough even without any infections.  And our body temperature fluctuates; even with a fever, we don’t stay hot all the time.  So a carrier may not realize he is infected or has symptoms.  Furthermore, with the stigma now associated: he gets blamed if he is infected, he gets more blame if he infects others (even though most likely he did not know he was sick), and he gets quarantined if he is confirmed, he has more reasons to lie about symptoms.  Thus, the current data or understanding is still up in the air.

4. Going back to Wuhan.  It has been estimated 5 million people left Wuhan, some carrying the virus outside.  We can now calculate how many of them infected others.  As of Feb 23, 2020, there are about 77000 confirmed cases, Wuhan 46000, Hubei outside of Wuhan 18000, rest of China 13000.  So 31000 cases from those 5 million.  Because there are secondary or tertiary infections, let’s assume 50% of the 31000 cases were directly from Wuhan carriers.  This leads to essentially about 1 in 300 of the people from Wuhan being infected.  Note that 50% is likely an overestimate, so percentage of the infected is likely even lower.  The media reports are filled with infections by people traveling from Wuhan, but absolutely nothing says that the vast, vast majority of those people are free of the virus.  This creates tremendous pressure and discrimination as well as brings about completely unnecessary social and economic costs.  

5. In the case of Wuhan, 46000 cases out of approximately 11 million people, a ratio also not alarming.  Remember, though, they can’t escape, so on the day of lockdown, Jan 23, infections must be much, much lower.  According to media reports, many people couldn’t get to the hospitals, because we know why, and had to stay at home, which led to the whole family eventually getting infected.  And they still couldn’t get to the hospital for many days, leading to a more serious disease.  When they finally got out, it might be too late to save them.  The same thing happens in the whole Hubei province.  In fact, the situation is exactly like that on the Diamond Princess ship: they are all sequestered, nobody escapes, so the virus is fermenting inside, with more and more people getting it. Here lies another reason why the fatality rate in Wuhan and Hubei is much higher than the rest of the country, which is linked to the other, previously blogs-stated reason: the health system was busted because of the panic.  In fairness to Wuhan, no city in the world can handle this.  The silver lining is now the tide is also turning in Wuhan.  With new hospitals built, and more patients getting discharged than admitted, most if not all patients can now get a bed in hospitals.  

With Wuhan and China improving, hopefully the other countries can also contain the smaller outbreaks quickly.  Then we can all come back to a still dangerous 2020.

Note on Feb 27, 2020: This latest article, quoting numerous experts, actually agreed very well with my blogs' arguments since Jan 26, 2020: https://www.yahoo.com/news/coronavirus-may-explode-u-overnight-101725466.html.