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[elbows]

All this of course.

And/but if you click through that voice recording the see the replies, there’s a clp of a very crowded hospital (which may well be full of over-cautious folk) with three covered corpses in the corridor. Three dead on the floor (if true) suggests a genuinely overwhelmed system.

Would China accept international aid?

A lot of my tone was due to the 100,000 people figure. Whereas terrible scenes at hospitals can easily be created by the sorts of numbers we've already got official word of, hundreds or thousands, we dont need tens or hundreds of thousands to cause such distressing scenes. Even without serious panic adding to hospital attendee numbers its possible to imagine such scenes, so add the panic layer on top and it would be more surprising if we hadnt seen such scenes. And even at the best of times it really doesnt take much unexpected swing in number of patients for hospitals to reach breaking point.

 

[Rimbaud]

Certainly seems to be the case, total lack of concrete info. Especially in light of your post above... just surprised me a bit.

Nanjing chatter seems pretty normal looking at my wechat moments/talking to friends. People concerned of course, but nothing beyond that yet.

Most of my contacts in China are from Guangdong and Chongqing - Chongqing is pretty close to Wuhan (in that Wuhan is the next really major city along the Yangtze, and Hubei borders the wider municipality) and Guangdong is apparently the province with the second most cases. So this seems to be like 80-90% of my Wechat moments recently.

 

[SheilaNaGig]

Exactly as you say elbows .

Complacency and familiarity/contempt for caution will no doubt play a part in any full on catastrophic pandemic. So too will circumstance and coinciding events, such as for instance Chinese New Year (or the Olympics, Kumbh Mela, Hajj...)

The more often stuff like this happens and we get away with it globally, the more likely it is that folks will become more complacent about the next one.

 

[elbows]

The more often stuff like this happens and we get away with it globally, the more likely it is that folks will become more complacent about the next one.

Depends on the folks in question. There is a very much decreased risk of complacency within key disease related disciplines and responders these days, much greater international networks of information sharing and research, protocols, legally-backed response mechanisms etc. Detection and surveillance and analysis of novel emerging diseases is so much better, and every new bullet that has been dodged has been treated not with complacency, but with a sense of what should be improved in our responses next time around.

Likewise, I believe the nature and scale of transport shutdown in relation to Wuhan might be utterly without precedent. But maybe there is an example I have overlooked.

Away from the specialist response sphere, complacency is an inevitable part of the human psychology and coping strategies for retaining sanity and a sense of normality in abnormal times. In much the same way that life goes on in war zones, with horrific abnormal levels of terror co-existing with the day to day.

 

[elbows]

Now when it comes to China, complacency and failures, the most obvious direction in which to finger point is the wild animal markets. SARS raised the flag on this, but there were cultural, political and economic reasons why the entire practice wasnt completely banned. Same story with MERS and certain middle eastern countries, MERS is linked to camels but there are cultural reasons why mass camel slaughter was not considered a viable response.

 

[Yossarian]

"Disease expert gets infected through eyeballs" isn't a story that inspires optimism.

Chinese expert thinks he contracted coronavirus through his eyeballs

Peking University respiratory specialist Wang Guangfa contracted illness after visiting the city and believes lack of eye protection may have been the cause.

amp.scmp.com

 

[cupid_stunt]

This articles goes into detail about how the officials in Wuhan deliberately downplayed the virus, medical staff were banned from speaking publicly about it, police admitting they had arrested people for spreading “rumours”, doctors in the city told not to report cases, etc., etc.

Weeks before lockdown, Wuhan authorities used 'refrigerating strategy’ to downplay coronavirus

New evidence is emerging that officials in Wuhan deliberately downplayed the virus, even after notifying the WHO in late December about ‘a cluster of cases of pneumonia of unknown cause.’

www.theglobeandmail.com

 

[SheilaNaGig]

Replying to elbows

Setting aside the market forces etc (such as in the actual markets) that cause complacency and failings, people who really understand what could happen will not be complacent and will - as you say - be better able and more likely to take all necessary measures to get ahead of an infection. But can you imagine what would happen if some kind of deadly respiratory virus gets a toehold while people are gathering for the Hajj or for the Kumbh Mela. It would be impossible to persuade people not to travel, and they gather in huge numbers, in close proximity. And then they all go home again.

The Chinese government, because of their powers, have been able to shut down entire cities and transport routes, but would the same be possible in India? The Kumbh Mela is so loose and baggy, and so huge, that I doubt it could be effectively shut down if some virus were detected in, say, the preceding fortnight.

If something (like with this present coronvirus) has a fairly long and asymptomatic incubation period, just the European festival season could enable it to get a toehold. A respiratory virus with a significant risk of cytokine storms in the young and healthy could travel in those youngsters while they're immunologically on the back foot as a result of lack of sleep and booze/drug comedowns, taking it from the festivals back to the cities.

If someone went to Hajj and didn't get MERS - or did and didn't really struggle with it, or did struggle or even died of it but no one in their village realised it was a big deal - are they more likely to be more dismissive of concerns another time? Does that make the next time more problematic? The Hajj cough is a regular and growing concern, with a significant uptick of TB and pneumonia amongst pilgrims every year. It's not hard to imagine some kind of URTI taking evolutionary advantage of such a gathering, and it would be too late to contain it by the time everyone went home.

These are exactly the questions epidemiologists are asking, of course. But not everyone has the same kind of overview or perspective that is being seen on this thread. How many people around the world even know about the Hajj cough, or about Kumbh Mela. Crowds gathering for the funeral procession of Suleimani, or the Hong Kong protests, or the Sardines gatherings in Italy, any of these could kick off a deadly virus. Would people forgo the gathering if there was a vague rumour of an URTI going round?

I'm not trying to be a doomsayer here; I really really hope that SARS and MERS and Ebola and this current problem will make us all think carefully about the implications in the future. But I can't shake this feeling...

 

[cupid_stunt]

I guess it's probably only a matter of time.

There was some modelling done last year, that suggested a serious coronavirus pandemic could kill 65 million people across the world in just 18 months.

A scientist at Johns Hopkins last year modelled what would happen if a deadly coronavirus reached a pandemic scale. His simulated scenario predicted that 65 million people could die within 18 months.

Health experts issued an ominous warning about a coronavirus pandemic 3 months ago. The virus in their simulation killed 65 million people.

The virus in the simulation was a fictional one called CAPS, but it bears some similarities to the Wuhan coronavirus.

www.businessinsider.com.au

 

[SheilaNaGig]

We get these models over and over again, and so far we've been lucky.

Finger's crossed for the future.

But none of that takes away from the real horror of what it's like for those caught up in the local events.

 

[Reno]

We get these models over and over again, and so far we've been lucky.

Finger's crossed for the future.

But none of that takes away from the real horror of what it's like for those caught up in the local events.

We haven't been lucky. AIDS is thought to have killed 25 million people by now. The flu pandemic, which killed 500 million, was only a century ago.

 

[elbows]

Replying to elbows
But can you imagine what would happen if some kind of deadly respiratory virus gets a toehold while people are gathering for the Hajj or for the Kumbh Mela. It would be impossible to persuade people not to travel, and they gather in huge numbers, in close proximity. And then they all go home again.

The Chinese government, because of their powers, have been able to shut down entire cities and transport routes, but would the same be possible in India? The Kumbh Mela is so loose and baggy, and so huge, that I doubt it could be effectively shut down if some virus were detected in, say, the preceding fortnight.

I dont think about things that much from quite the angle of those or other comments you made there (and some others I didnt quote). I'll try to explain why, hopefully briefly because my stance relies on a bunch of points I already made earlier.

I think I dont think about it in the same way as you mostly because I think the effectiveness with which a particular infection can spread between people is the biggest factor. Human behaviour is a good deal less relevant if the disease has a certain inherent potential, we are unlikely to stop it whether few mistakes are made or many. The dramatic lockdowns imposed by China will do nothing other than alter the timing a little, if this coronavirus turns out to develop efficient human to human spread.

Thats not to say I am dismissing your angles, planners of certain things certainly need to consider that stuff and mass gatherings are a vector that always deserves attention. But when it comes to me sitting around wondering whether this current outbreak will ever be contained or not, I dont place that much emphasis on the actions of people in the weeks ahead. The characteristics of the virus will turn out to be the big difference maker, and under the worst scenarios a lot of the human response will really be in the service of the psychology of feeling a bit better about your circumstances if you feel somewhat empowered to take matters into your own hands, to have some degree of control over your fate. But the narrative of humans battling to control a situation is not always where the real action is, under certain scenarios the reality is that we are relatively powerless and humans are not in the driving seat at all.

 

[elbows]

We haven't been lucky. AIDS is thought to have killed 25 million people by now. The flu pandemic, which killed 500 million, was only a century ago.

Estimates for the 1918 influenza pandemic are more like 50-100 million. And there have been four subsequent flu pandemics since then (1957,1968,1977,2009), none of which had as many estimated casualties but all of which took their own toll in ways no less worthy of reporting.

 

[Reno]

Estimates for the 1918 influenza pandemic are more like 50-100 million. And there have been four subsequent flu pandemics since then (1957,1968,1977,2009), none of which had as many estimated casualties but all of which took their own toll in ways no less worthy of reporting.

That's still nothing to be sneezed at.

 

[elbows]

"Disease expert gets infected through eyeballs" isn't a story that inspires optimism.

Yeah, eye protection is part of the standard template for infection prevention in healthcare workers, and indeed as expected it is present in the WHO interim guidance on infection prevention and control during health care when novel coronavirus infection is suspected.

• Use eye/facial protection (i.e. goggles or a face shield);

• Refrain from touching eyes, nose or mouth with potentially contaminated hands;

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected

Interim guidance

www.who.int

 

[elbows]

Would China accept international aid?

I forgot to respond to this earlier.

At this stage its more of a question of directing national assets to the affected areas. The systems were clearly overwhelmed at the local level, and now they have taken control away from local government and have brought in hundreds of military medical personnel.

International research, investigation etc will be part of things, but in terms of international aid, if things got so bad that China used up all of its own capacity and required such support, I would tend to think that things would also be looking bad internationally, and that countries might need to hang on to their own resources to tackle their own outbreaks.

 

[SheilaNaGig]

We haven't been lucky. AIDS is thought to have killed 25 million people by now. The flu pandemic, which killed 500 million, was only a century ago.

Sorry.

I forget how pedantic and complete one needs to be on Urban. These things were certainly in my mind when I was typing but were not part of the point I was trying to make. So I apologise for not being more complete and thorough.



Disclaimers:

Setting aside the global flu epidemic that followed WW1 (which gives us a pretty good idea of how devastating these thing can be) but focussing on the modern much more connected world that we currently live in.... then my post.


The ongoing awfulness of HIV/AIDS, which has become a chronic health issue around the world and clearly demonstrates how viruses can take hold and decimate populations, gives us a pretty good idea of what might happen; but I'm thinking specifically of the recent apparent increase of sudden outbreaks that need immediate containment. Hopefully we've learned important lessons from HIV/AIDS about what NOT to do, however.... then my post.


So I'm saying

Notwithstanding our earlier experiences of how infection can take hold (for instance HIV/AIDS and the 1918 flu pandemic), I wonder how much we've actually learned in respect to the ways the modern world is more connected and gatherings are so fucking huge. We've been lucky this century but it feels like we're on borrowed time.






ETA

Also, various reiterations of the plague.

 

[SheilaNaGig]

To clarify (and then I'm going to step back I think).

My wider concern isn't about this particular virus (hopefully it goes without saying that I am hugely worried about the reality for those affected); my wider concern is a sense that it's a harbinger of things to come, I feel like the writing is on the wall in a more general sense.

Maybe that's down to the general doomy end-times feeling that seems to be so prevalent.

There's a great deal more I'd add to a general discussion but I get so fed up with getting bogged down in specifics and detail when I want to make larger points. So yeah. I'll step back now.

 

[weltweit]

..
There's a great deal more I'd add to a general discussion but I get so fed up with getting bogged down in specifics and detail when I want to make larger points. So yeah. I'll step back now.

Well I would like if you did make your larger points because it will add to the discussion and I think would be welcomed.

 

[elbows]

To clarify (and then I'm going to step back I think).

My wider concern isn't about this particular virus (hopefully it goes without saying that I am hugely worried about the reality for those affected); my wider concern is a sense that it's a harbinger of things to come, I feel like the writing is on the wall in a more general sense.

Maybe that's down to the general doomy end-times feeling that seems to be so prevalent.

There's a great deal more I'd add to a general discussion but I get so fed up with getting bogged down in specifics and detail when I want to make larger points. So yeah. I'll step back now.

Funnily enough it was a tendency towards apocalyptic thinking and catastrophising that caused me to become clued up about respiratory diseases and novel virii crossing species barriers in the first place. It was back in the days of initial concern about H5N1 bird flu, and the medias coverage of the subject was not enough for me, and quacks were using it to pedal bullshit, so I decided to get clued up. It didnt end up feeling all that useful at the time, since H5N1 remained limited, but its been an enormously useful foundation when subsequent outbreaks of respiratory illnesses have occurred.

At least it is useful for my own ability to convey information and tackle misperceptions. For me personally it was also of help in terms of my own psychology and coming to terms with things. But this is a personal thing that relies on my own personality type and existing attitudes towards things. So I dont really feel I can preach on this side of things, just because I am comfortable with the realities and risks of life and the seeming inevitability of certain things (albeit even if the question is when not if, the when still makes a huge difference and is a key area where sense of doom can pollute rational conclusions via a sense of immediacy that turns out to be false). Right now I am able to consider the full spectrum of possibilities with this outbreak, ranging from containment to pandemic, without a sense of doom turbo-charging one of these possibilities and making them seem inevitable. I wont always get it right either, the balance between accepting our fate and lack of control over everything, without giving in to a useless fatalism, seems easy at times but very difficult at others, and errors on this front can sneak up on me.

 

[elbows]

There's a great deal more I'd add to a general discussion but I get so fed up with getting bogged down in specifics and detail when I want to make larger points. So yeah. I'll step back now.

I'd be much happier if everyone spoke up with whatever levels of discussion they want to have on this subject.

Obviously I mostly operate on a tedious level of detail, as well as trying to paint quite broad pictures. This invariably means I will use other peoples comments to launch some of my own points. I dont want this to shut anyone else down, but I know it can be draining to have to respond to picky detail all the time, so I understand if you dont want to be subjected to that all the time. If you are anything like me then energy levels will vary in terms of how much you can be arsed with it, so I suppose I'm just saying please do on the occasions when you feel up for it!

 

[weltweit]

I don't have any deep or large points to make about this particular outbreak, I do think in many ways we are lucky that it is in China where the authorities can clamp down on movement in a way that might have been unthinkable in Europe.

However with it being in China we also don't have free flowing information to know just how serious it is.

What would have happened if this outbreak had occured in cologne?

 

[Supine]

What would have happened if this outbreak had occured in cologne?

They have a plan - Influenza discussed here:

https://www.rki.de/DE/Content/InfAZ...tific_part_summary.pdf?__blob=publicationFile

 

[weltweit]

They have a plan - Influenza discussed here:

https://www.rki.de/DE/Content/InfAZ...tific_part_summary.pdf?__blob=publicationFile

TLDR .. tricky to read on a phone!

 

[Supine]

TLDR .. tricky to read on a phone!

We don't need to know what the plan is. But it's good to know there is one

 

[Humberto]

I'd be much happier if everyone spoke up with whatever levels of discussion they want to have on this subject.

Obviously I mostly operate on a tedious level of detail, as well as trying to paint quite broad pictures. This invariably means I will use other peoples comments to launch some of my own points. I dont want this to shut anyone else down, but I know it can be draining to have to respond to picky detail all the time, so I understand if you dont want to be subjected to that all the time. If you are anything like me then energy levels will vary in terms of how much you can be arsed with it, so I suppose I'm just saying please do on the occasions when you feel up for it!

It's been very good, informative and balanced.

 

[elbows]

However with it being in China we also don't have free flowing information to know just how serious it is.

I dont expect the information picture to be that much different compared to if it had happened anywhere else really. It could have been, if they had decided to try to suppress the whole thing, but thats not whats happened by the end of last year and now even their propaganda has gone in the 'call it a massive threat' direction.

In the initial weeks, yes. But this year I think the scientific community are getting the data they would expect, when they would want it.

And when it comes to numbers, no country would be able to detect every case, so the difference between confirmed cases and estimated cases would also happen elsewhere, its not merely a state information control phenomena.

My stance on this could always change if more coverups or distortions emerge. But my main point is that both the nature of disease detection, the need to use other methods like estimates and modelling, and the tendencies of states to careful control public health information, with the resulting impacts on public confidence in the information, are phenomenon that tend to crop up everywhere, they are not unique to China. Its just easier for these subjects to readily be discussed when it comes to China because there is all the other political baggage with their system and modes of control and suppression that means we are already used to talking about China in these terms, there is no taboo to us going there, its a theme that springs readily to mind. As such it is ripe to use as an example of ingrained media bias, and I probably will do this sometime, especially since I already read a New York Times article that was blatant in its lazy framing and nationalistic bias.

What would have happened if this outbreak had occured in cologne?

Too many variables to have a good stab at that. Much would come down not to the politics of the country or the transport logicstics, but to medical good fortune and alertness towards novel disease outbreak possibilities during the initial wave of infections.

Also it isnt random that China is often the source of new things that came from animals. The conditions have been ripe there for such things to happen, so from time to time they do happen. This also means that in theory the Chinese are at least more alert to the potential of novel diseases coming via these animal-human vectors, so when you get an outbreak of a viral pneumonia there with some unexpected characteristics, coronavirus is going to be much higher up the list of theoretical possibilities to urgently investigate than it would be in Cologne.

 

[elbows]

It's been very good, informative and balanced.

Thanks. In many areas of life I am pretty much a useless lump so on the rare occasions I think I can be useful I may rather attempt to overcompensate!

 

[Supine]

Thanks. In many areas of life I am pretty much a useless lump so on the rare occasions I think I can be useful I may rather attempt to overcompensate!

Keep it up. Good work.

 

[weltweit]

I read an interesting article on the BBC about how China can build a hospital in 6 days. Partly it's because the hospital will be prefabricated but also it is because of the massive resources they are able to throw at it.

Apparently this won't be the first time, during the last epidemic they built a hospital in 6 days, after the emergency it was discarded.