5591

Friday morning is the infectious disease group meeting, which went from “I don’t have time for that” to “must attend meeting”. Today’s speakers was Dr. Xihong Lin, who discussed exactly how Wuhan addressed the corona virus outbreak. I found it pretty informative, and took some notes for people that might be interested. If the video is publicly available later today, I’ll post it, and I recommend watching it, as it’s pretty sobering.

Notes from Dr. Xihong Lin’s talk on Wuhan’s stategy to combat corona-
Lockdown with traffic ban and home quarantine changed R0 from 3.88 to 1.25, but that’s not enough.
Family to family transmissions still occurred
Infected cases couldn’t seek care because of the traffic ban
Stay at home was hard to enforce because people were allowed to go grocery shopping, which allowed them to infected others
Here, if you’re infected, you will get the people you live with sick, and if you try to get help (go to doctor, go to pharmacy, etc), you can infect everyone along the way

Solution: Centralized Quarantine [Suppression]
Take all people that are sick or presumed sick, and move them out of home/away from family

Test positive -> go to new field hospital
Suspected cases -> go to designated hotels
Have fever -> go to designated hotels
Close contact with confirmed cases -> go to hotel or dorm
If any of these groups go from unconfirmed to confirmed, move to the field hospitals
Move from field hospital -> standard hospital if they need ICU treatment

Timely medical care prevented mild cases from being severe.
For everyone else: Stay at home, government handles grocery delivery.
Free housing for healthcare workers so they are isolated from general population

R0=0.33.

60% of infected cases not ascertained, often asymptomatic, still infectious. [wuhan had a shortage of testing kits as well]
Workers went door to door to find all suspected individuals.
Healthcare workers are by far the most vulnerable group at risk of infection, highlighting the need for the proper protective gear.

Tufts university is preparing dorm rooms to contribute to house people here [preparing for central quarantine, or just off-loading some patients?]

As of March 16, all patients are out of field hospitals
As of March 18, no new cases in Hubei

5592

Yup. China also had the benefit of actually having fever hospitals built for the 2003 SARS epidemic; they mothballed them in case of future emergency.

But all of this was stuff they learned from 2003. Plus, you know, authoritarian government made it easier.

5593

That’s quite a set of measures needed before you stop exponential growth.

5594

I think the sobering thing for me was that they couldn’t get R0 < 1 with the sorts of interventions we’re still failing to do.

I’m in the Q/A period right now and there have been some questions about the R=1.25 period, and if that was calculated correctly given some outliers in the data,etc. It’s a real fundamental question - is it impossible to get the R0<1 without these measures?

We’re still in “SPRING BREAK WOOOOO” period.

The thing is, if you could be this draconian for a few months, you could avoid the 18 month flatten the curve approach, and then go to lots of screening to catch lingering virus in the population.

5595

If it’s so damn infectious, it sounds like huge amounts of Wuhan must have been infected.

5596

So what if by the time we decide to implement the measures needed to get R0 < 1, the number of infected has grown too large to do that? Not enough space by an order of magnitude, etc.

5597

They acted pretty damn fast to lock down the city. Like, one of the chief doctors said “This is out of control, we need to lock down the city” and they did it within 48 hours (driving the R2 down to 1.25, where it wasn’t so damn infectious anymore). Then after a few weeks they saw that wasn’t enough and locked down MOAR.

Acting very quickly is pretty important.

5598

Yeah, but they did it after more than a month of exponential growth at the original R0.

5599

Yeah, but the start of exponential growth still doesn’t produce huge numbers, because the start is still N=1… We’re talking about < 500 people are known infected when they decide to lock down.

This slide still relevant:

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5600

Does Musk think his ventilators can be approved by FDA that quickly without going through FDA approval for patient use?

5601

Anecdotal story about the suburbs of NYC. A drive thru testing site has been opened off the highway in Rockland County. It is staffed by at least 100 people in hazmat gear, and 2 dozen or so state and local police officers. My father attempted to get a test this morning, with zero other cars on line. He was denied, told to go home and make an appointment by phone. The wait time is 2-4 hours via phone. We are fucking doomed by bureaucracy.

5602

It has to be by appointment only, or you’ll have a zillion people trying to get in. I was at a drive-through electronic recycling dumb in NYC a couple years ago. I waited hours to get in, and that’s people who weren’t scared they were going to die.

5603

That… that does not sound good. At all. Are our Western democracies even capable of something like that? And if we don’t have the capacity/will to do so… how bad is this going to get?

That was really troubling to read.

5604

Did they mention what that care consisted of?

5605

Just supportive care. There’s currently no known treatment for the disease, just to try and get people through the symptoms.

5606

One of the big differences between here and Wuhan is that we typically don’t live with as many people in the same house. China (and Italy) are multi-generation big houses, so when one person is infected you infect many more people.

The within-house infection was a big part of why they couldn’t get there R0 < 1, so we might be more effective than their numbers. Fuck me if it’s an experiment I don’t want to run, though.

5607

I mean, clearly people aren’t swarming the site. It was open for two hours before my dad arrived, and again, not a single patient there. It’s either bureaucratic incompetence, or rationing of the tests. Probably both.

5608

I guess it depends on R0, which is hard to estimate given poor testing, asymptomatic (who may/may not infect), etc.

I wouldn’t be surprised if it’s higher than current estimates (given how almost all containment efforts failed; all the extra stuff we’ve learned about how many ways it has of infecting us, no natural immunity…).

5609

I think germany only categorized has killed by covid if they directly die from it and not one of the illness covid cause. So is mostly a glitch of how they capture the data.

5610

The initial message from many sources was “Is just the flu”. After a long hard winter people want to be outside, and we share the same traits than the italians.

Politicians really have litte control over society, …