Stephen Flynn

3,044 deaths / 89,072 confirmed cases = 3.4% If we look at cases with known outcomes, then the population would be 3,044 + total recovered of 45,074, this would give us a total population of 48,118. That leaves 40,954 a remaining set of cases for which the outcome is unknown. Deaths of 3,044 / the total population with known outcomes (48,118) gives us 6.3%. If the 89,072 are the “cases,” in the CFR then it seems that using this definition is pointless. To say that the CFR today is 3.4% is useless information. Why? Because it assumes that all in the remaining 40,954 will recover and no deaths will occur. It seems to me that CFR should not be discussed at all, excepting as a future prediction. About half the “cases” have either died or recovered. So far, worldwide the “death rate” is ~6.3%. So why does the media focus on CFR which understates the death rate? I suppose that for every “case” there may be one, or two, or more, who do not make the definition of “case.” If so, then 6% would (if later defined as cases) drop to 2-3% death rate. My take is that CFR ought not be a quantifier for public information, nor even for clinical use, for it has this large “as yet undetermined” component. So why is the CFR even used? Why not “death rate for the population with known outcomes? Your answer implies the reason is that it would be too alarming, and 3.4% looks less alarming than 6.3%. If so, then so much for honesty and transparency.

"Sequence match between Snohomish Co sequence in community case (17M) and January 1st in UScase (35M also Snohomish)" Is the January 1st a clerical error? Is it the 21st? See A confirmed case of novel coronavirus 2019 in Snohomish County was announced January 21, 2020. The patient had recently traveled to Wuhan, China. *Update 2/20/2020* In consultation with state and federal public health authorities, the Snohomish Health District has released the patient from home isolation. The above is from a search summary. I cannot find on Snohd.org’s (Snohomish Health District) announcement but there are several “supposed” links to it, which do not appear to work. https://www.snohd.org/Search?searchPhrase= novel coronavirus 2019 in Snohomish County was announced January 21%2C 2020

With all that has been going around, about him, he may very well be positive for the virus. Time will tell.

A statement from LifeCare Center of Kirkland, at 7:45 EST “Recently, one of our associates and one of our residents were diagnosed with coronavirus (COVID-19) while receiving care in local hospitals. We only have those two confirmed cases at this time. Current residents and associates are being monitored closely. As is normal this time of year, there are various cold and flu-like symptoms being exhibited from residents and associates. The health department has advised us to monitor for an elevated temperature, cough and shortness of breath. We're consulting with the health department and possibly sending patients to a local hospital for formal COVID-19 testing. That testing is not performed in our facility.” https://lcca.com/locations/wa/kirkland/announcement So much for honesty and transparency. What vastly different perspectives....

I'm inclined to not believe this. I suspect it's "false news."

Dr. Niman made a short reference today in one of his posts to faulty CDC test kits which raises the question as to how many cases exist in America, if there are no test kits available. From the article: A faulty CDC coronavirus test delays monitoring of disease’s spread See: https://www.msn.com/en-us/news/us/a-faulty-cdc-coronavirus-test-delays-monitoring-of-diseases-spread/ar-BB10nglx?li=BBnbcA1 Some excerpts: “While South Korea has run more than 35,000 coronavirus tests, the United States has tested only 426 people, not including people who returned on evacuation flights. Only about a dozen state and local laboratories can now run tests outside of the Centers for Disease Control and Prevention in Atlanta because the CDC kits sent out nationwide earlier this month included a faulty component.” “The nation’s public health laboratories, exasperated by the malfunctioning tests in the face of a global public health emergency, have taken the unusual step of appealing to the Food and Drug Administration for permission to develop and use their own tests. In Hawaii, authorities are so alarmed about the lack of testing ability that they requested permission from the CDC to use tests from Japan. A medical director at a hospital laboratory in Boston is developing an in-house test, but is frustrated that his laboratory won’t be able to use it without going through an onerous and time-consuming review process, even if demand surges.”

Apologies for the prior, odd, post, which does not seem editable. First Covid-19 case in Brazil, if confirmed by a second test. “Brazil's Health Ministry said a man has tested positive for the coronavirus on in initial test. If it's confirmed in a second test, it will be the first case in South America.” “First case of COVID-19 in Brazil is registered in the state of São Paulo: 61-year-old patient returned from a trip to Italy on February 21” https://saude.estadao.com.br/noticias/geral,brasil-tem-1-resultado-positivo-para-coronavirus-mas-ainda-falta-teste-para-confirmar-diagnostico,70003210088.amp

Hotel worker, 56, is diagnosed with coronavirus after testing negative EIGHT TIMES in 17 days during quarantine https://www.dailymail.co.uk/news/article-8042535/Woman-diagnosed-coronavirus-testing-negative-EIGHT-TIMES-quarantine.html I wonder if this is a deficiency in tests being able to pick up a positive, meaning it results in a false negative, or is something else going on. It's a bit of an odd article because they do not say just how she was diagnosed. I wonder if it was diagnosed via CT scan which has characteristic patterns called ggo (ground glass opacities) and "crazy paving." Crazy-paving seems a hallmark of COVID-19, but it shows in a number of other chronic and acute diseases

Go to: https://public.tableau.com/profile/kuldeep.ram#!/vizhome/WuhanCoronavirus/CoronavirusTracker Take a peek at the trajectory of COVID-19 cases in South Korea. Hint: It’s parabolic. Then, go to https://flightaware.com/live/ pull the map over to Incheon Airport (S. Korea) then hover cursor over any, of the many flights now heading to the US to see where it’s going. Then ask the question: Might any of those flights from Incheon to America contain infected individuals? Am I wrong in thinking that this is insane?

Translate the page OR click on the bottom bar of the pop-up to see the map. https://coronamap.site/ Note: Using Chrome I can auto-translate the pop-up to English

Huh? I lost 'ya there...

Thank you for posting it, I watched it and appreciated the post. When you see/hear what appeared fairly obvious beforehand (at least to me) there's not really a reason to respond. The way Japan dealt with the PD was/is a mess and Japan will pay a price along with those who were released who used various means of public transportation, some of which can be reasonably expected to infect others. Most here on the board know this. Infection control is an odd subject. Back in 2001 I went to college specifically to become an APIC (American Professionals in Infection Control) Certified infection control specialist. However, I never realized that goal. I found that a person must work a certain number of hours over two years to be able to sit for the APIC Board test but nobody would hire you to work even part time unless you were APIC certified. Where I worked, the largest tertiary hospital in NH, I offered to work weekends for free--as an intern, but that was not accepted. What this meant that anyone who really wanted to get into IC could not. Positions were usually filled, at that time, by people that really had not worked the requisite two years, but were "in the system," so to speak. It went like this: "We need a new IC person, why don't you do it X?" X responds, "But I don't have the two years for APIC's work requirement." The response went like this: "Oh, no problem, you do infection control every day (universal precautions, wear gloves, wash hands, etc.) I'll just vouch for your experience." Lately, and wisely APIC reversed its position and now a person can become APIC certified without the requisite two-year work requirement, which I think has helped a lot in America. So Infection Control, as you can see in Japan, sometimes is not taken seriously. In America it's taken far more seriously and Japan really messed up (my opinion), though not quite as bad as Prime Minister Hun Sen did in Cambodia handing roses to those departing the Westerdam, as well as throwing a party for those aboard--now that's taking IC to a new level. Then as you can see in the video, even when you have a knowledgeable person as Kentaro is, politics can intervene. Additionally, Kentaro is an Infectious disease doctor (professor), he treats disease, he doesn't deal with the science of controlling the spread of disease quite so much. The APIC certification exam is rigorous and I'd bet that he could not pass it. Treating infectious disease and "controlling infection" are really separate things. See apic.org should you care to.

From the top article: "The finding of live virus particles in stool specimens indicates a fecal-oral route for coronavirus, which may be why it’s caused outbreaks on cruise ships with an intensity often seen with gastro-causing norovirus, which also spreads along that pathway." This could be partly true. I wish I could point to an article that I read long ago about noro-virus transmission in a restaurant. The restaurant was linear with three segments, the last separated by an open doorway. A diner vomited near the entrance. I think every other person in the restaurant contracted noro-virus which meant aerosol transmission. However I have not heard of vomiting--has there been any with this virus? Fecal: Consider the case, was it HK, where an upper floor (7th level) seemingly spread NCOV through the sanitary system. I've read other reports of virus being shed in feces. Fecal-oral, aerosol, persistent presence on doorknobs.... 'tis a clever virus.

Community spread all the way from Iran, and how many were infected on the plane, or other modes of transportation including airport switching flights?

Iran reports two coronavirus deaths, becoming 28th country or territory to report infections https://www.abc.net.au/news/2020-02-20/iran-reports-its-first-2-cases-of-the-new-coronavirus/11982254 ” Two Iranians, who tested positive earlier today for new coronavirus, died of respiratory illness," the official told Mehr. Iran's health ministry spokesman Kianush Jahanpur confirmed their death on Twitter. Iranian authorities earlier confirmed the country's first two cases of the virus shortly after reports that preliminary tests had come back positive. ISNA news agency quoted an official in the country's health ministry, Kiyanoush Jahanpour, as saying that over the last two days, "some suspected cases of the new coronavirus were found" and the patients had been put in isolation.”

https://www.eutimes.net/2020/02/covid-19-disaster-9-die-in-iran-of-coronavirus-qom-city-to-be-quarantined-by-military/ Bits from this erratically written (translated from Persian) article: “Last night 2 men from Qom who called the ambulance were already very sick and dying, they were taken to the hospital immediately but the doctors couldn’t do anything to help them as their condition was already way too late for them so they both died." "Since last night until today, new cases have already been discovered in other cities such as Arak and Iran International is reporting that 7 more have died, including a 5-year-old girl.” “As for Qom? The army has been called in to prepare for curfew in Qom…" "They already closed the schools and universities." "As of last night, least 20 more Iranians were hospitalized which are now in a severe condition of pneumonia and thus are suspected of being infected with Coronavirus.”

Recommended https://chp-dashboard.geodata.gov.hk/nia/en.html The red areas with white center dots are “Buildings where confirmed cases have stayed in the past 14 days. For me, this paints a grim future picture for Hong Kong. I found the above link via: https://docs.google.com/spreadsheets/d/1Z7VQ5xlf3BaTx_LBBblsW4hLoGYWnZyog3jqsS9Dbgc/edit#gid=2129369885 Be aware that the tabs at the bottom of the second listed spreadsheet are live. This spreadsheet led me to the above link that I find particularly useful which I have posted at the top.. Hong Kong appears to be using the same software platform that John Hopkins uses. If anyone finds other countries doing as Hong Kong is doing, please post the link. Also, there is a ink showing “List of buildings (in Hong Kong) with confirmed cases of COVID-19 in the past 14 days;” “List of flights/trains/ships taken by confirmed cases…,” and “List of buildings … under mandatory home quarantine …” For this see: https://www.chp.gov.hk/en/features/102465.html

Yes, well done. At the end, "take measures to prevent its spread." I did not see any acknowledgement or denial of cases within NK, did I miss that? It's hard to believe that there is none since there's only a river between China and NK and plenty of cases on the other side.

WHO says 'no indications' of coronavirus cases in North Korea- https://www.reuters.com/article/us-china-health-northkorea-idUSKBN20D04S Yet another article says otherwise: Deadly Outbreak COVID-19 Reportedly Spreads to North Korea https://futurism.com/neoscope/deadly-outbreak-covid-19-north-korea “South Korean newspaper Chosun Ilbo reported today that the deadly coronavirus COVID-19 is spreading in North Korea.” “North Korea hasn’t officially acknowledged any deaths, but experts are suspicious that the reclusive, totalitarian country — which shares a border with China, where the outbreak began — would be able to avoid a local health crisis because of the virus. “There is no way that North Korea is not being impacted by the coronavirus — they are clearly lying as they don’t want to show any weakness or that there is any threat to the regime,” said director of Korean Studies at the Center for National Interest Harry Kazianis, in an interview with Fox News. Several weeks ago, the Wall Street Journal reported that North Korea’s response to the outbreak had been to double down on its isolation, blocking even the hermit kingdom’s close ally China from travel and trade. There’s no question, though, that North Korea is taking the outbreak seriously — albeit with a characteristic brutality. It reportedly executed an official this week, for instance, because he violated its quarantine by visiting a public bath after a trip to China. Other official responses have been — as is also often the case with North Korea — straight-up puzzling. A North Korean state publication claimed this week, for instance, that the common plant root burdock could cure the virus. And South Korean publication Daily NK, which specializes in investigative journalism about North Korea, reported earlier this week that authorities there had made cremation mandatory, nominally to prevent infection after death.”

I'm not at all sure that this will end the fiasco. I suspect it may start the real fiasco as those leaving who test negative who are, in reality, positive create numerous patient zero clusters. The Diamond Princess reminds me of how "Pox parties" during the 1940's and 50's worked. A child become infected with measles, mumps or chicken pox and they'd throw a party specifically to infect all the children who visited to "get it over with." I find it hard to believe that there are any from that ship who have not been exposed to the virus, regardless of whether or not they presently test positive. And some of those leaving will take public transportation home...?

It is what it is, a Coronavirus that arrived in 2019, therefore Covid-19. "No amount of political correctness will cause the outcome to change." Actually, in this case, though I often abhor "PC," systematized naming might actually reduce severity. For instance, the "swine flu," caused a sharp drop in pork consumption, though pork products have nothing to do with the spread of that disease. Many think that China has under-reported cases. Using a name such as the "Wuhan Zombie disease" would likely produce under-reporting by the name alone. The 1918 Spanish Influenza did not start in Spain. In that case, since the first known case was reported at a military base in Kansas, on March 11, 1918, perhaps it should have been named the American Killer disease.... https://www.history.com/news/why-was-it-called-the-spanish-flu https://www.who.int/mediacentre/news/notes/2015/naming-new-diseases/en/

I'll try psk. Perhaps another might correct me if I'm incorrect. I'll ignore Covid-19 and stick with a simpler example, that being HIV. It’s “simpler” to relate to because it has a great amount of history. Imagine that, way back in 1971 a person received a blood infusion with HIV tainted blood. Immediately, from a technical point of view, they were infected. The person, unknowing, goes home and has sex with someone the same day. Does that 2nd person become infected? Not likely, because there is not yet enough replicated virus in the infected person’s body to infect another, yet. At some undefined point, perhaps a week, perhaps a month, the person who got the blood transfusion will become infective to others via sex. A common question that I’ve occasionally fielded is: “How long must I wait after ending a sexual relationship with one person before a test will tell me if I have been infected with HIV?” The answer relates to seroconversion. The definition might be: “Seroconversion is the length of time after infection, that it takes for a person to develop enough specific antibodies to be detected by our current testing methods.” Using HIV as an example, looking back to the 1980’s, to be sure that a person was not HIV positive, that person would have to be tested after six months, as before then there may have not been enough antibodies to detect. Then, in “1990, the Association of State and Territorial Public Health Laboratory Directors reached a consensus recommendation that virtually all seroconversions are complete within twelve weeks of exposure. (1) What happened? Answer: Tests improved. In short, tests that could “pop” a good answer went from taking six months, to four months. Then we must add in newer tests that have been developed that use RNA and/or DNA such as PCR and its variants. Currently CDC says that the above theoretical patient now can expect to know about in 6 weeks with current tests. So, you see, in the case of seroconversion the “time” it took to get a reliable positive result from a test has one from six months to six weeks, simply because tests got better. With Covid-19, an infected person might show (reliably, which is another subject, entirely) seropositivity within a day with some of the tests that are being used and it seems definitely within six or so days, with current tests. So seropositivity is simply the time that a test can detect the infection (usually by looking for an antibody). It is made more complex by many factors such as, “are there any false negatives?” Let’s say 100 infected persons are tested. Tests results indicate 98 are positive, but fail to identify two which, in reality, are positive. Therefore, you have less than desired sensitivity, as the test failed twice. This may not be very important in HIV but may be extremely important with Covid-19 since those two people that went undetected might infect others, creating a self-sustaining community cluster. I hope this helps.

From your article Jon: "He also called for worldwide joint efforts to contain the virus, adding that China had effectively prevented the virus from spreading to other countries." Uh...perhaps he hasn't heard about the lock-down in Vietnam and community spread clusters in Hong Kong, Singapore, and other countries... or, the Diamond Princess

Dr. Niman, If you feel this is too of-topic feel free to remove. Up till recently, I’ve poo-pooed the idea that the origin of Covid-19 might have come from Wuhan’s biolabs. I thought you might look at this article and comment: https://www.zerohedge.com/geopolitical/sudden-militarization-wuhans-p4-lab-raises-new-questions-about-origin-deadly-covid-19 Zerohedge is a strange website with a lot of strange stuff, but occasionally it does have some gems. There have been many bio-lab accidents, near-accidents and intentional release of pathogens (anthrax in letters allegedly mailed by US Army researcher Bruce Ivins resulting in five deaths) around the world, historically, perhaps this is another accident. This article makes me wonder if the origin may have been an accidental release from the biolab in Wuhan. I thought you might comment on the part that I found most interesting, though admittedly over my ability to judge: “A genetic analysis of the spike-protein genes – the exact region that was bio-engineered by the UNC lab in 2015, where Zhengli Shi and Xing-Yi Ge previously isolated a batty coronavirus that targets the ACE2 receptor just like this 2019-nCoV strain of the coronavirus does – indicates an artificial and unnatural origins of the Wuhan Strain’s spike-protein genes when they are compared to the genomes of wild relatives. Instead of appearing similar and homologous to its wild relatives, an important section of the Wuhan Strain’s spike-protein region shares the most genetic similarity with a bio-engineered commercially available gene sequence that’s designed to help with immunotherapy research. It is mathematically possible for this to happen in nature – but only in a ten-thousand bats chained to ten-thousand Petri dishes and given until infinity sense. And so, as the report goes on, a scientist who’s been prolifically involved with studying the molecular interaction of coronaviruses and humanity, spending decades and millions of dollars, and having even helped build a hyper-virulent coronavirus from scratch at UNC – just so happens to be working at the only BSL-4 virology lab in China that also just so happens to be at the epicenter of an outbreak involved a coronavirus that’s escaping zoological classification and whose novel spike-protein region shares more in common with a commercial genetic vector than any of its wild relatives