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This was at panel at University of California San Francisco. Very disheartening to read. If this is for real we are in for some major difficulties. Notes from UCSF Expert panel - March 10 Published on March 12, 2020 Dr. Jordan Shlain, M.D.Follow Like66 Comment5 Share0 University of California, San Francisco BioHub Panel on COVID-19 March 10, 2020 Panelists Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic. Emily Crawford: COVID task force director. Focused on diagnostics Cristina Tato: Rapid Response Director. Immunologist. Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist. Chaz Langelier: UCSF Infectious Disease doc What’s below are essentially direct quotes from the panelists. I bracketed the few things that are not quotes. Top takeaways At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US. Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed. How many in the community already have the virus? No one knows. We are moving from containment to care. We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different. 40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population. [We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.] The fatality rate is in the range of 10X flu. This assumes no drug is found effective and made available. The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%. [See chart by age Signe found online, attached at bottom.] Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did I can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year. What should we do now? What are you doing for your family? Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset). How long does the virus last? On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based. Avoid concerts, movies, crowded places. We have cancelled business travel. Do the basic hygiene, eg hand washing and avoiding touching face. Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing. Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous. Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous. We would say “Anyone over 60 stay at home unless it’s critical”. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines. We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in. Three routes of infection Hand to mouth / face Aerosol transmission Fecal oral route What if someone is sick? If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on. If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER. There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis. If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use" of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines. [More I found online.] Why is the fatality rate much higher for older adults? Your immune system declines past age 50 Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults. Risk of pneumonia is higher in older adults. What about testing to know if someone has COVID-19? Bottom line, there is not enough testing capacity to be broadly useful. Here’s why. Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish "COVID-19 from flu or from the other dozen respiratory bugs that are circulating”. A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives. The PCR test requires kits with reagents and requires clinical labs to process the kits. While the kits are becoming available, the lab capacity is not growing. The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation. Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon. UCSF and UCBerkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified. Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger. How well is society preparing for the impact? Local hospitals are adding capacity as we speak. UCSF’s Parnassus campus has erected “triage tents” in a parking lot. They have converted a ward to “negative pressure” which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility. If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected. School closures are one the biggest societal impacts. We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects. If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services. Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found. What will we do to handle behavior changes that can last for months? Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed. Kids home due to school closures [Dr. DeRisi had to leave the meeting for a call with the governor’s office. When he returned we asked what the call covered.] The epidemiological models the state is using to track and trigger action. The state is planning at what point they will take certain actions. ie what will trigger an order to cease any gatherings of over 1000 people. Where do you find reliable news? The John Hopkins Center for Health Security site. Which posts daily updates. The site says you can sign up to receive a daily newsletter on COVID-19 by email. [I tried and the page times out due to high demand. After three more tries I was successful in registering for the newsletter.] The New York Times is good on scientific accuracy. Observations on China Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19. While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent. Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots. Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime. Every few years there seems another: SARS, Ebola, MERS, H1N1, COVID-19. Growing strains of antibiotic resistant bacteria. Are we in the twilight of a century of medicine’s great triumph over infectious disease? "We’ve been in a back and forth battle against viruses for a million years." But it would sure help if every country would shut down their wet markets. As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa. See article on Wired magazine on sequencing of virus from Cambodia

https://news.yahoo.com/california-declares-state-emergency-contain-011556575.html

I really worry about senior citizens residences...my moms place has been locked down because of the regular flu before...but it still spread because the workers were bringing meds and meals to the residents. I don’t know how that can helped. I’ve stocked her up with some easy to heat meals so she can say no to them bringing her food if she wants to...but I don’t have a fix for the giving her meds part. I remember you Happygirl! You’re a writer! I read Joys Journey and Joys Legacy a couple of times. Welcome back!

Why.......?

People in my area are finally doing something...likely because of the UC student who is being quarantined. I was at Costco this morning at 9 when it opened to pick up some things....first thing I noticed was the young couple getting out with full masks with the small respirators on them. I saw them throughout the store with the shopping cart and a flatbed loaded with water, cleaning supplies, food, tp, etc. Also saw a couple of neighbors with hydrogen peroxide, rubbing alcohol and lots of shelf stable goods. Then the groups of Asian students with shopping carts full of cases of water bottles and shelf stable foods. By 9:30 the store was overflowing...much more than the usual Saturday crowd. I was trying to get a temporal thermometer and Costco ran out of them last week. Going to hit up some other stores to see if I can find one.

Welcome back Peg!

Awww! That’s sad....but Lori should know we’d love her to come back.

I thought it was confirmed airborne and aerosol? This is an article on the BBC China(translated from Chinese) that says it’s an aerosol. It even suggests putting the seat down when flushing.... I thought this was why there are so many videos of them basically fogging the streets? https://translate.google.com/translate?depth=2&nv=1&rurl=translate.google.com&sl=auto&sp=nmt4&tl=en&u=https://www.bbc.com/zhongwen/simp/amp/world-51427216%3F__twitter_impression%3Dtrue&xid=17259,15700022,15700043,15700186,15700191,15700259,15700271,15700302

Newly diagnosed coronavirus patient being treated at UC Davis Medical Center By Anne Ternus-Bellamy The UC Davis Medical Center is treating a patient who may be the first person in the country to have contracted the novel coronavirus (COVID-19) from community exposure. The California Department of Public Health reported Wednesday the individual is a resident of Solano County who had no known exposure to the virus through travel or close contact with a known infected individual. An email sent out Wednesday by two UC Davis officials said the patient arrived at the medical center in Sacramento last Wednesday but was only tested for the virus on Sunday despite a request made by med center officials that the Centers for Disease Control and Prevention conduct a test when the patient was admitted. “Today the CDC confirmed the patient’s test was positive,” said the email from David Lubarsky, vice-chancellor of human health services, and Brad Simmons, interim CEO of UC Davis Medical Center. “This is not the first COVID-19 patient we have treated, and because of the precautions we have had in place since this patient’s arrival, we believe there has been minimal potential for exposure here at UC Davis Medical Center,” the email said. Nevertheless, a small number of medical center employees have been asked to stay home and monitor their temperatures. Lubarsky and Simmons said the patient was transferred to UC Davis from “another Northern California hospital” on Wednesday, Feb 19. “When the patient arrived, the patient had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” the email said. “Since the patient arrived with a suspected viral infection, our care teams have been taking the proper infection prevention precautions during the patient’s stay. “Upon admission, our team asked public health officials if this case could be COVID-19. We requested COVID-19 testing by the CDC, since neither Sacramento County nor (the California Department of Public Health) is doing testing for coronavirus at this time. Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered,” said the email, which added that, “UC Davis Health does not control the testing process.” On Sunday, the CDC ordered COVID-19 testing of the patient and the patient was put on airborne precautions and strict contact precautions. The positive test results were announced on Wednesday. “We are proud of our health care workers who have been working to care for this patient and are committed to saving this patient’s life,” the email said. “Just as when a health care worker has a small chance of exposure to other illnesses, such as TB or pertussis, we are following standard CDC protocols for determination of exposure and surveillance. So, out of an abundance of caution, in order to assure the health and safety of our employees, we are asking a small number of employees to stay home and monitor their temperature. “We are handling this in the same way we manage other diseases that require airborne precautions and monitoring. We are in constant communication with the state health department and the CDC and Sacramento County Public Health about the optimal management of this patient and possible employee exposures,” the email said. “As we regularly handle patients with infectious diseases, we have robust infection control protocols in place to handle this patient and others with more frequently seen infectious diseases. In this case, we are dedicated to providing the best care possible for this patient and continuing to protect the health of our employees who care for them.” The CDC announced on Wednesday that a case of novel coronavirus of “unknown origin” — without a relevant travel history or exposure to another known patient — had been diagnosed in a patient in Northern California but did not indicate what city or county the case was in. In a press released issued Wednesday evening, the state Department of Public Health revealed the individual was from Solano County. “The health risk from novel coronavirus to the general public remains low at this time,” the release said. “While COVID-19 has a high transmission rate, it has a low mortality rate. From the international data we have, of those who have tested positive for COVID-19, approximately 80 percent do not exhibit symptoms that would require hospitalization. There have been no confirmed deaths related to COVID-19 in the United States to date. California is carefully assessing the situation as it evolves.” “Keeping Californians safe and healthy is our number one priority,” said State Public Health Officer Dr. Sonia Angell. “This has been an evolving situation, which California has been monitoring and responding to since COVID-19 cases first emerged in China last year. This is a new virus, and while we are still learning about it, there is a lot we already know. “We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California. That’s why California has been working closely with federal and local partners, including health care providers and hospitals, since the outbreak was first reported in China — and we are already responding.” This would be the first known instance of person-to-person transmission in the general public in the United States, according to Angell. Previously known instances of person-to-person transmission in the United States include one instance in Chicago, Ill., and one in San Benito County. Both cases were after close, prolonged interaction with a family member who returned from Wuhan, China, and had tested positive for COVID-19, the disease caused by novel coronavirus. As of Wednesday, including this case, California has had seven travel-related cases, one close contact case and now one community transmission

So for those of us who live in closer quarters...think small back yard with six foot fence but neighbors on two sides and back part of fence backs up to a church parking lot....if the virus is airborne would it be safe to go into a backyard if a quarantine was to happen? I want to be able to continue to garden and am thinking that because we have such a small inside space the yard might be necessary for sanity’s sake.... On one side is a couple our age who are rarely out in their yard and the other side is a single disabled man who I also don’t see outside often... Any thoughts?

Ambergris, do you know if the confirmed ones in the US are from the ship?

https://ottawacitizen.com/news/local-news/canadians-being-told-to-prepare-for-a-possible-novel-coronavirus-pandemic

San Francisco declared a state of emergency today (they say to get emergency funds) after the CDC announcement that Americans should prepare for “significant disruptions’ in their lives... https://www.cdc.gov/media/releases/2020/a0225-cdc-telebriefing-covid-19.html https://abc7.com/health/coronavirus-cdc-warns-americans-to-prepare-for-significant-disruption/5966697/ https://www.sfchronicle.com/bayarea/article/SF-mayor-London-Breed-declares-state-of-emergency-15083811.php

https://www.statnews.com/2020/02/24/who-tells-countries-prepare-coronavirus-pandemic-too-soon-to-make-call/ But...they won’t use the term ‘pandemic’.

That was on my local news. A little too close for comfort.

Why we prepare ahead of time.

Whoa. I sure hope they don’t reuse them for years now.

I saw it. It was a video of him trying to catch his tail? He is such a beautiful dog!

Here is a screenshot and pictures on the Facebook page of one of the passengers who was evacuated to Travis. In the comments she says that the first round of evacuees are not in the same building but nearby.

https://www.usatoday.com/story/travel/cruises/2020/02/17/coronavirus-official-explains-diamond-princess-cruise-quarantine-fail/4785290002/

Dee, is Hawaii keeping people from flying in?

Not understanding this...at all...here I thought they weren’t allowing anyone on the flight who tested positive. *Saw another article saying their last test results didn’t come in until they were on the plane and none of them were showing symptoms. https://www.nbcbayarea.com/news/local/east-bay/evacuees-from-cruise-ship-with-coronavirus-outbreak-coming-to-travis-air-force-base/2235223/ 14 Evacuees Positive for Coronavirs Allowed on Flight to Travis AFB According to the U.S. Department of State, 14 of the evacuees aboard flights headed from a quarantined cruise ship in Japan to Travis Air Force Base in Fairfield have tested positive for the coronavirus. They are among 340 passengers shuttled to two charter jets from the Diamond Princess cruise ship in 14 buses. The flights are expected to arrive Sunday night.

So the nurse who helped take care of the 80 year old woman with the virus that died in Japan has the virus. The woman was in that particular hospital for 6 days. How is it getting to the caregivers when you would assume they would be taking extreme care? https://www3.nhk.or.jp/nhkworld/en/news/20200217_32/ Authorities in Kanagawa Prefecture, near Tokyo, say a nurse at a hospital in Sagamihara City has the new coronavirus. They say Sagamihara Chuo Hospital is where a woman in her 80s, who was confirmed to have the virus after her death last week, was being treated earlier this month. In a news conference on Monday, prefectural and city officials said the female nurse in her 40s took care of the patient. They say the elderly patient, a resident of the prefecture, was in the hospital from February 1 to 6. She died later at a different hospital. She was reportedly treated at a total of three hospitals. The officials said a total of 61 people came into close contact with the patient. They said the results of virus tests on 43 of them were available as of Monday morning, and that the nurse was the only one who tested positive. She reportedly developed a fever and sought treatment on Friday. She visited another medical institution on Saturday, and had diarrhea that night. The officials said the nurse had not worked since Saturday. They said she no longer has a fever, but will be hospitalized later on Monday. Sagamihara Chuo Hospital says it has stopped treating outpatients. It says visits to inpatients will be suspended.

This doesn’t make a lot of sense to me. They clean the money...put it back into circulation....then the first infected person touches it...and it’s re-infected all over again? https://www.bloomberg.com/news/articles/2020-02-15/china-quarantines-cash-to-sanitize-old-bank-notes-from-virus The government cut off the transfer and allocation of old bank notes across provinces, and between cities most affected by the deadly outbreak, according to Fan Yifei, People’s Bank of China’s deputy governor. The central bank also ramped up measures to sanitize old money to reduce contagion risks and added 600 billion yuan ($85.9 billion) of new cash for Hubei, the epicenter of the coronavirus, he said. “Money from key virus-hit areas will be sanitized with ultraviolet rays or heated and locked up for at least 14 days, before it is distributed again,” Fan said at a press conference on Saturday. Money circulated in less riskier areas is subject to a week of quarantine and commercial lenders have been asked to separate cash from hospitals and food markets, he said.

https://www.egypttoday.com/Article/1/81641/Egypt-announces-first-Coronavirus-infection