OK. Been putting this off. Coronavirus and what I think you need to know. A thread thats going to just be a brain dump over an unspecified period of time. By me. A microbiologist. But not that kind of microbiologist. (1)
Firstly, its a virus. This is basic stuff and beneath many of you to need to be told, but it means its not a whole living thing on its own. To reproduce it needs to find a host, where it latches on to a cell, injects its own information, and makes more of itself (2)
...think of it as being a bit of genetic code wrapped in stuff. The stuff in this case is a protein mix that sticks up on the outside forming a sort of crown (or 'corona') when you look at it using an electron microscope. Hence, coronavirus. (3)
Now, that corona is quite interesting, its sort of bits of bulbous proteiny stuff that cover the outside. They're called peplomers - and the technical term is glycoprotein, but all that means is protein with some specific sugars stuck on in a specific order. Stay with me... (4)
...those peplomers make specific shapes that stick to other specific shapes on certain cells. If it fits, it sits. Or on other words if you've got a receptor on your cells it can recognise, it'll attach to that and you can get that virus. Thats called host tropism (5)
...usually thats a very specific thing. Sometimes there might be a little mutation in a virus like this whereby it gets into another species by having a different form, and it can jump into a new species. Its not common, but it happens. (6)
...and when it does things start getting 'interesting'. And by 'interesting' I mean in an 'oh shit' sort of way. Because this is a new virus now, something we can't immediately know the behaviour of (7)
And I mean really, we can't entirely know. Yeah, we can make some predictions based on what its cousins do, but we can't know it all. But we can say that as its a new virus, few people will be immune to it, and the risk that it could kill a lot of people is high (8)
Anyway, I'm getting ahead of myself. Coronavirus, its one of a whole family of coronaviruses divided into four genera, which affect a whole range of species. Of which I think we're up to 7 species that humans can get (9)
...so its latched on to a cell and it injects something called the virus particle. That contains its genetic material and enough protection to get it inside. Now its job is to make more of itself... (10)
...and its a beast at doing that. Its an RNA virus, adding its own RNA replicase to the mix of enzymes in the cell. The details aren't important, what you need to know is its a very efficient, fast, reliable takeover bid. Its an extremely efficient virus (11)
So, as I mentioned, its the newest of a family of coronaviruses that infect people. Currently it goes by the unimaginative name 2019-nCoV, and it seems to come originally from bats. Which is why I would like to call it bat-flu, but I'm in a minority. Of, I think, one. (12)
...besides, thats not certain yet, there's also a chance it came from snakes. We don't really know. I'm going to stick with 2019-nCoV. I know. Dull. (13)
...anyway, Coronaviruses. Mostly in humans they cause cold like conditions, leading sometimes to pneumonia or bronchitis. They're not nice, but most aren't that serious. And then came SARS. Thats a coronavirus too (14)
...and SARS causes infection in both the upper and lower respiratory tract. Thankfully it turned out to be not all that infections and relatively easy to contain - which is good because it had a 10% mortality rate. You don't want that spreading among a population (15)
..aside - new viruses in a population that isn't used to them are bad. Really bad. You wouldn't believe how bad they can be. Usually, not always worst when they've passed through a population of people for a long while and then find their way into a new population of people (16)
...want to know how bad? Civilisation ending bad. We can never really know how many people died when Europeans reached the Americas, but various estimates are that between 80% and 95% of the people there died due to the diseases they brought. (17)
...smallpox, measles, and their nasty little cousins destroyed whole cultures before they were know to the settlers. The persecutions that followed were awful, of course, but the images and records we have of native Americans aren't of those civilisations in their prime... (18)
...ecologically the impact of this was the abandonment of settlements, agriculture, technologies, and ecology falling apart - millions of passenger pigeons and vast herds of bison weren't a natural end point, they were symptoms of the harm done (19)
More recently of course you've all heard of Spanish flu, right? Small matter of the single biggest killed since the black death, polishing off 50-100 million people after the first world war? That. Thats the fear. The question is, how likely is a new virus going to be that? (20)
Now, you're hoping I've got insight into how bad this is? A little. But it isn't definitive, because, and I can't stress this enough, we've known about this virus for, like, a month. We don't have all the answers yet. But its astonishing how much we do know. (21)
...for this I'd like to introduce you to @ProMED_mail - the single best collator of reliable news on disease outbreaks that there is. Its invaluable. It has been invaluable for years, and long may it continue. Thus far there are 37 updates about the new virus there (22)
@ProMED_mail ...if you scan through there you'll observe that while we've got the whole genetic sequence, there are many things we haven't got. We haven't got a definitive answer for incubation period, we can only speculate about infective dose or solid data on transmissibility (23)
@ProMED_mail ...so, brass tacks. Its spread by coughs and sneezes. Use. A. Hanky. Don't touch things and then put your fingers to your mouth, stop poking your own eyes. This isn't specific to coronavirus, its solid advice all of the time. (24)
@ProMED_mail ...they aren't the toughest of viruses though. They're likely as not going to die in a few minutes in sunlight. And they're not magically going to survive being washed off your hands with soap and water. But this is why we're seeing places quarantined... (25)
@ProMED_mail ...it isn't in the water, its not in the air, its spread person to person. And not likely further than two or three meters at a time. Want to avoid catching it? Avoid going where it is. Bluntly. And trust measures to stop it spreading, for the moment (26)
@ProMED_mail ...and the death rate? We don't know. Sorry. About 2% of those getting to hospital with it. Thats literally all we know about morbidity for the moment. But thats bad enough (27)
@ProMED_mail ...lastly before I take a break and come back to this later/tomorrow - treatment. There isn't one. Well I mean we can treat peoples symptoms, keep them comfortable and warm and try to give them a chance to get better, but there isn't a cure (28)
@ProMED_mail ...you can't treat a virus with an antibiotic. Thats now how this works. You can however develop vaccines to treat them, and a lot of work is going on around the world make one for this. We're months away from that though, at best. Maybe early next year. (29)
@ProMED_mail I'll go into vaccines next. Later, dudes. (30)
Delving in and out of this today. So hold your horses. Treatments, and vaccines. I probably need to explain what they are. (31)
There isn't an easy 'cure' for this kind of viral disease. You can't take an antibiotic to cure a virus. Why not? Because antibiotics work on bacteria, not viruses. To get why I have to explain very briefly what bacteria and viruses are... (32)
...apologies to any microbiologists reading, I know these are going to be simplifications and that you'll be able to hurl some exceptions at me. (33)
...bacteria are whole cells, whole living things that interact with the environment around them. They grow, some mate, they make more bacteria. Get their waste products to dissolve away and get them food and they'll grow on their own. (34)
...if the place they're growing is on or in you, then they might be just hitching a ride, living alongside you as part of a deal you both benefit from, or they might be making you ill. There are many, many bacteria. They out number us beyond comprehension. (35)
...but they're whole organisms. They have in their cell everything they need to grow and make copies of themselves. And sometimes to wage chemical warfare on each other, and on us. (36)
...so salmonella, anthrax, syphilis, and gazillions of other diseases are caused by bacteria. Things as minor as a little bit of acne all the way to plagues. But because they're whole organisms, they have a weakness (37)
As they grow, taking in nutrients, making more stuff to keep going, we can find chemicals that get in the way. Maybe they interfere with how they make their outer walls. Perhaps they stick to the gubbins that the bacterium used to make it's proteins. Lots of ways this works (38)
...but this basically works because they're a living thing that is very different to us, inside us. Antibiotics attack specific families of bacteria while not killing us. Neat, yeah? (39)
...now as you already know from earlier in the thread, viruses aren't entire, whole cells on their own. They're like pirates, hijacking other organisms cells and using the machinery in there. It's rather rare that there is a specific drug to stop them (40)
Right, my train is pulling in. Later, folks. (41)
Got my shopping. Train back to Cambridge now. So, I hear you ask. Why is it that the doctor might give me an antibiotic when I have a virus? That's because your doc thinks you have what's called a secondary infection. (42)
...your virus has led to you coughing and spluttering and facilitated some physical damage or some nasty wet bits of lung to be all horrid, and a bacterial infection takes hold. (43)
...in that scenario the antibiotic is to help right off the bacterial infection. Which is great. But has no impact onnrj virus at all. What kills the virus off is your own immune system. (44)
...and this is why vaccines are epic. And it's why developing a vaccine for an emergent viral species is so important. Here I've got to say some things about your immune system. Sorry immunologists, the over simplifications here are going to annoy the hell out of you... (45)
...when a new virus you haven't seen before gets in to you and starts doing its viral thing (attacks cells, gets into them, makes more of itself) there's a race going on. Your immune system is going 'who are you, exactly? Because you aren't me!' (46)
...then it's taking all of its capacity to mix up potential antibody combinations until one works. You have an -astonishing- number of potential antibodies. Of little peotein attack molecules whose job is to tag the baddies and call in the test of the immune system to attack (47)
...and this system works best at somewhat elevated temperature. You get a fever, your body goes to war against the invader. And then when you've won something amazing happens - you keep a record that you've won this battle and you keep a record of how (48)
...so if that same virus comes back again you're ready for it and you beat it, usually very quickly. Vaccines take advantage of our capacity to do this, and how they work is amazing (49)
...train pulling in now, more later. (50)
Home again. So, vaccines. Usually they're made of either a dead version of the virus or a bit of protein that looks enough like the virus so your immune system is fooled, or historically out of another virus that looked, to our immune system, just like the baddie (51)
...in fact the word 'vaccine' comes from the Latin word for cow (vaccinus) because it was known that milkmaids didn't get smallpox. The first vaccine used the related cowpox (which causes fleeting infection in humans) to immunise against smallpox (52)
...as yet another aside, this is one of the reasons dairy maids were of interest to many young gentlemen, with their need to be clean and lack of ugly pox scars, they were considered rather sexy (53)
...not to lay it on too thick here but vaccines are MAGNIFICENT. That smallpox thing that destroyed whole cultures? Gone. Eradicated. Vaccinated into extinction. Go science! (54)
...so by priming human immune systems to know what a virus looks like, we can prime it to be ready for that virus and beat it. So we can defeat polio, measles, many strains of flu... It's amazing. It's not universal, some viruses are much harder to find vaccines for (55)
...HIV is a great example. We still haven't got a reliable vaccine, because it's a virus that's much better at playing hide and seek from the immune system than most others. But with the new coronavirus, it will be possible to make a vaccine (56)
So - how that will me made, what research efforts are likely to be going on, and when we'll see a vaccine, that's all for later on. More soon (57)
So. Vaccines. How do you make a new one these days? Well, its both very technical and disarmingly simple. And just right now it's rather political (58)
...not just in terms of governments looking for capacity to make large volumes of vaccine, just in case, and in terms of the World Health Organisation urging a vaccine to be developed, but in terms of the business and research in biotechnology (59)
...there are many labs around the world, lots in academia with associated spin out companies, some entirely private, all wheeling round to develop a vaccine as fast as possible, each with a CEO putting their own spin on why theirs is best (60)
...now there are differences between them, but remember, the point of this thread is to tell you what you need to know. And if I'm honest, what I think you need to know is the overall thrust of how this is being done, not the specifics. Sorry biotech people. (61)
...one thing that I've been impressed with in the Chinese response was that when they acknowledged they had a problem, they isolated and got a dull sequence of the virus published almost immediately. And these days that's HUGE for other researchers (62)
...you all know that DNA encodes how living things are made, right? And that we have DNA, that we copy into RNA and that is used to make proteins? So our DNA code literally defines the sequence of amino acids that make your proteins? (63)
...and thats basically how all life works. Your proteins make the structures of your cells, they're the enzymes that make your chemistry work, they move fatty bits in place to make your cells, they do everything. And they're coded by your DNA. (64)
...your proteins even fold up your other proteins to make sure they're the right shape to do their jobs. Those shapes are really, really important (65)
...now this virus cuts one of these steps out. It doesn't have DNA, it has RNA, which when injected in the cell binds in to the machinery we use for making proteins and takes over. And having studied lots of different viruses, we know what each part of its RNA does (66)
...a 'gene' is a section of DNA or RNA that encodes a particular protein. We know what they all are in this virus and we have structures for most of them, from decades of studying related viruses. (67)
...knowing what shapes they are and where they are, we can predict which of those genes encode things on the outside of the virus. Which ones are therefore visible to your immune system, the ones they can tag with antibodies to attack (68)
...we call those 'antigens'. Ultimately the way most research groups are looking at this is they're modelling those antigens, then making copies of them, to test whether they're sufficiently good at priming the immune system to attack the real virus (69)
...I should think dozens of labs worldwide were looking in to this, perhaps half of them by now will have some solid modelling, and I would be surprised if less than half a dozen have got some antigen synthesis done and are getting in to testing them for immune response (70)
...now while there will be lots of groups looking at this, using a similar idea, which antigens they choose will vary. And they'll all be able to give you good reasons for their choice. (71)
...some are working on the least variable sequences of antigens. Some will be looking at the most exposed. Some will be trying to build this around a mix of antigens. But this is fine detail. What matters is how long this will take and how well it will work. (72)
...bottom line - it has to work and be safe. From now? Next January would be my guess. With enough investment, with enough effort, it could be done faster - but at greater risk. Let's hope we don't come to that though! (73)
Enough for tonight. Someone told me that some students in Honk Kong have been trying to use whisky and honey to prevent the disease. It won't work but it sounds delicious and I'm jonesing for that now. Tomorrow, folk. Maybe antivirals next, depending what's in the news (74)
A little pushed for time this morning, but there's a development I think needs addressing. There are news reports coming from China that this coronavirus is airborne. Firstly, don't panic. Secondly, you need to know what 'airboene' means here (75)
...it doesn't mean that everyone in a town in suddenly exposed to a virus that's on the air. And it doesn't mean that suddenly it's everywhere. (76)
...we'll know more over the next couple of days when solid studies emerge, but what I thinks we're looking at is aerosols from coughing and sneezing. Which we already knew. Aerosols - the lowdown (77)
...when water hits water it creates droplets. Some are big, and fall straight back down, some are small and splash about, and some become airborne. It's a complex mix of charge and motion allows this, but think about getting a spray bottle and squirting it... (78)
...most of the water falls straight down. Some flies further. If you sneeze or cough the same happens. Congratulations, you have created a bioaerosol. You have aerosolised any infection you carry. So for Pete's sake, use a hanky (79)
...now the question is how far any viruses will travel and how much it matters - when microbiologists say that the range is 2-3m they aren't saying that the virus can only go that far, they're saying that's how far it's likely to be infectious (80)
...there are VERY few viruses or bacteria where if you're exposed to one cell or virus particle, you'll get sick. The term you're looking for here is "minimum infective dose". And the further you are from the source, the less likely it is you are to get to that (81)
...you can send viruses for miles this way. But it doesn't mean a sneeze is infective for miles. If someone has been sick in a restaurant after after food poisoning, you can literally draw a heat map around them showing a declining number of infections with distance (82)
...so keep an eye on this news as it develops. But please, it's worth stepping back and thinking about what airborne means here. This news story isn't one to panic about at present. (83)
...so this thread was pitched as "what you need to know about Coronavirus", and if I may, I will continue with the same goal. It's an evolving picture, and keeping up with what is happening has to be worthwhile... (84)
...I haven't dug in to updated stats on infection and deaths today yet, plenty of time for that. Two other things that have happened are more important right now. Firsrly, the end of the extended Chinese New Year break (85)
...now China being China, having a peoblem with disease containment at the time of a big celebratory holiday, they did what only a nation like China can do. They said "it's ok everybody, take some more time off" (86) china-briefing.com/news/china-ext…
Why, I hear you ask? Well China has seen an astonishing change in recent years with a huge expansion of industrial cities and the already massive worldwide Chinese diaspora growing, turning Chinese New Year into the biggest annual mass migration in the world (87)
...so the government said "that's ok folk, have some more time", which means they've had time to look in to transport and containment. It has also meant a bit of a bottleneck in manufacturing, with human resources and supply chains being squeezed (88)
...with stories about protective gear like face masks and gloves running short. Now this is a big moment in the spread of this disease. Have the measures the Chines national and regional governments put in place going to work, or is this when things really kick off? (89)
...you may be expecting this to mean we'll either see loads of new cases by tomorrow or it's all just over hyped. Sorry, it doesn't work that way. The disease has an incubation period, so it'll be a week or two before we know the impact of this. Sorry. (90)
...the other thing you need to be aware of is how other countries are responding to this. It's the point at which people can move in larger numbers and obviously health authorities across the world are responding. (91)
...here in Britain its all sounding rather dramatic. It isn't, at least not yet amyway, but there isn't any way of readying ourselves just in case without it sounding dramatic (92) bbc.co.uk/news/uk-514423…
...so, what does this mean for you, what do you need to know? What you need to know from today's news is that this is when China's containment efforts will be tested. They're cleverly bought themselves time to be ready for this, now we watch to see how it plays out (93)
...while our response here sounds dramatic, its really just scaling up the same 'be aware' narrative. What should you do? Use a tissue to cough or sneeze. Wash. Your. Hands. Talk to your doctor if you feel unwell. And follow the travel advice. The risk you face is still low (94)
Diagnostics. How a case is identified and what you need to know about that and an emerging news story about it. (95)
Like any time you're sick you'll think "I'll be fine in the morning", you go to bed thinking you'll be right as rain in the morning, and you're not. So you go to the doctor, its probably days later. We all do it. How does the doctor determine whether its the new virus? (96)
...sadly doctors don't have magical powers. All they can really do is take a note of tour symptoms and try to work out whats wrong. That can only take you so far though, they can work out you've an infection, its probably a virus, but any more than that needs a proper test (97)
There are lots of ways of identifying different kinds of microbes. Sometimes you don't need to do a test, you can see just by looking. Chicken pox looks like chicken pox. Syphilis lesions can be so obvious that while a test will be done, it isn't really necessary to confirm (98)
...but there are a LOT of viruses with basically the same symptoms. Its a bit like a really bad cold that can develop into pneumonia or bronchitis, you need a specific test to determine whether its the new virus or not (99)
...if its bacteria, like if your doctor wants to confirm the identification of a bacterial infection via a stool sample or a swab, thats sent off normally to be grown in a lab, it takes a couple of days, and the results come back based on what that microbe does (100)
...there are more space age ways of identifying bacterial strains but in most places in the world, most of the time, its done the old fashioned way, by growing it in little biochemical tests. And its good enough. But this isn't a bacterium, its a virus... (101)
...you will remember from earlier on that a virus isn't a whole organism in itself. It won't grow outside of a host cell. You can't just grow it and do biochemistry. So for identifying viruses typically tests using either antibodies or nucleic acids are used. Scary words! (102)
...both have advantages and disadvantages, there aren't any generalisations that never miss here. Antibodies are just like the ones your immune system uses to tag invaders, they're made in labs and you stick something to them that tells you when they've stuck to a target (103)
...you've seen a pregnancy test? Thats an antibody test. Nucleic acid tests are based on finding a specific bit of DNA or RNA that isn't found in anything else. You have to make another bit of DNA or RNA that sticks to that... (104)
...you know how DNA is a double helix? One sequence running one way sticks exactly to a sequence running the other way. Take a bit of that exact sequence on one side, it will only stick specifically to one matching strip of DNA... (105)
...and there are a range of ways of determining if this has happened. Pretty neat, right? If you want some details (and I'll save you from me babbling on about them here) start here en.wikipedia.org/wiki/Nucleic_a…, but here's what you -need- to know... (106)
...both ways of doing this are great. Antibody tests are kind of foolproof but not always as sensitive as you need, and, besides, for brand new pathogens it takes some time to be able to make them. And nucleic acid tests are amazingly sensitive but technically harder (107)
...because they have a step to amplify how much genetic material is there they can even be astonishingly sensitive. But that step can go wrong, it takes a skilled operative to be sure you're getting it right (108)
...the new coronavirus is detected using a nucleic acid. You can't do it just on symptoms, or grow it, and I don't think there's an antibody test sold for it yet (correct me if I'm wrong there). But how to do the nucleic acid test is openly published cdc.gov/coronavirus/20… (109)
...and here is why you need to know - there's chatter coming out of China that maybe a lot of false negative tests have been done. People with the virus tested as negative. You'll find this at Promedmail, or here: caixinglobal.com/2020-02-08/key… (110)
The conspiracy theorists will go nuts with this. Most likely this isn't conspiracy, its cock up to do with scale. I doubt whether any country in the world could reliably scale up the number of people doing such tests without them making mistakes (111)
...you don't just walk into a lab and crack how to do an rtPCR diagnostic on your first morning. With modern kits its much easier than it was, but its not monkey work either. Its not surprising that there may be cases going uncounted because of this (112)
...does it matter? Well solid data is always better. But the quarantine and containment measures being employed aren't only being aimed at the confirmed positive cases. In practical terms, its not that big a deal. Not yet, anyway. (113)
In the interests of sharing more things I think you need to know about Coronavirus but not in any particular order, here goes... (114)
Overnight the figure for the number of confirmed deaths due to 2019-nCoV passed 1000. Promedmail put the figure at 1,013. Almost all in mainland China. In the last 24 hours 108 people died (115)
...and that sounds shocking - the number who died increased relative to the day before. But the number of new cases was 2,479 which is lower than the day before by 19%. Which is, "yaaay!" but only sort of... (116)
...we haven't got good data for the rate of the disease spreading, because the date of testing is after the date of the diseases onset. Be that as it may, a slowing rate of diagnosed cases increasing is positive... (117)
...there are now 376 confirmed cases outside mainland China, 10 new ones in the last 24 hours. But there have not been positive tests in any new countries in that time, not have there been more fatalities outside China (118)
It is of course to be hoped that this isn't a lack of good diagnostics in places the virus has spread to, but, again, tentatively this slower rate of transmission and few fatalities is good news. (119)
Another emerging news story in the last 24 hours has been that the virus may not have originally come from bats (so my favoured name 'bat-flu" may not work), but could have come into humans possibly via. bats or other animals from pangolins. Yes. Pangolins (120)
Pangolins are adorable, harmless, endangered little things used in some traditional Chinese treatments. It is to be hoped that if pangolins are identified a zoonotic reserviour of the virus, perhaps they will be left alone in the future (121)
Lastly (for now), the World Health Organisation (WHO) are of course coordinating the response. This is a big effort. (122) who.int/news-room/even…
We have a name, and dagnammit, it isn't Bat Flu. The official WHO chosen name for the disease caused by the new coronavirus is Covid-19 (123) bbc.co.uk/news/world-asi…
I'm noticing some confusion regarding why the new disease has been called Covid-19 and why the virus is called Sars-CoV-2. And why, in fact, a more catchy name hasn't been chosen. I think it would be helpful if you understood this... (124)
Covid-19 is the disease caused by the virus. It stands for Coronavirus (Covi) disease (d) and the year it was first found (2019). SARS-CoV-2 is the name chosen for the virus to recognise its a Coronavirus related to SARS. Simple really... (125)
Now you might be wondering why have two names? Its not odd, really - think about HIV being the name of a virus, and AIDS being the name of a disease. Covid-19 was chosen, according to a WHO spokesperson, to be easy, simple, fast to say. Fair enough, I guess... (126)
...another thing to to note is these days we're moving away from naming a new disease after an animal vector or a place. MERS (Middle Eastern Respiratory Virus) upset a lot of people. And 'Swine Flu' frightened people needlessly (hence the total cull of all pigs en Egypt) (127)
...its easy to say 'political correctness gone mad!' when its not your home being forever associated with a deadly disease or animals near you targeted by a government. So this is probably for the best. Shame. I did like bat-flu as a name (128)
Waking up to the news this morning, one might have thought that the world was about to end. Parry chief in the region as the centre of the Covid-19 outbreak fired, the death rate doubling overnight. Here is, as ever, what you need to know (129)
...as I understand it (I will wait until this is deciphered on the professional feeds before being 100% certain) we're looking at a reshuffle in how infections are reported. Were previously recording those with the right symptoms in one column, confirmed cases in another (130)
...and only those who has been tested to the high standard of a molecular test, showing they had the viruses generic material in a sample, were confirmed as infected. The suspected pool of infection was recorded too... (131)
...the problem with that is the test is a complex, technical thing for trained staff to do. And they can only do the work as fast as they can. Hence, perhaps, the rather linear rate of growth of the number of cases... (132)
...that's most likely the rate that the tests can be made, shipped and used. The number of cases hasn't doubled over night, but the recording regimen is basically being shifted over one column to reflect this... (133)
...what does this mean for those outside of China? Not a lot. Cases are sporadically appearing in many countries, and for now be aware and be vigilant, but don't worry. If you feel a cold coming in then use a hanky, and wash your hands often. (134)
I'm no expert on Chinese politics and what the sacking is the regional party chief means. My suspicion is it was inevitable based on the way this was handled at the outset. The scale or China's subsequent response has been huge...(135)
...more later when I've had a chance to confirm some other news stories. (136)
...what you need to know about today's news on Covid-19? Nothing really. It continues its slow spread in China but elsewhere it is still sporadic rather than established. (137)
...and the World Health Organisation is actively seeking to combat false information, using the word 'infodemic' to describe this problem. Never let microbiologists and epidemiologists invent new words, we are bad people. (138)
...but otherwise the message remains the same - be vigilant. Wash. Your. Hands. And don't worry unduly. Ain't like it helps. (139)
...there are a couple of stories developing I think you need to be aware with regarding Covid-19. Firstly, with so many who need treatment the Chinese are working on medication, with interesting results (140)
...obviously they're doing computer modelling to narrow the field, but sensibly they're screening known drugs to find which are most useful, and which already known to be safe so they can go straight to human trials... (141)
...they're reporting that chloroquine is quite helpful, that using plasma from people who have for better seems effective (but that's likely to have its own problems), and that there are around 100 potential drugs to test out of a library of tens of thousands (142)
...other than that, it's worth noting that across Europe and the US labs are gearing up for doing more testing, with reports such as this being common. ecdc.europa.eu/en/news-events… (143)
...and, lastly, the WHO is appealing for people to talk in simple, solid factual terms rather than share scare stories. Always good advice (144) news.un.org/en/story/2020/…
...a few more things I think you should know about Covid-19. Sorry. Time marches on, and there is more news that is worthy of your attention if you're staying informed about Coronavirus. (145)
...you may have observed that cruise ships are quite a popular way of certain demographics going on holiday. It's a way of spending a short while visiting multiple different places while otherwise being pampered as if at a resort. And two have attracted global attention (146)
...one of these ships (called Diamond Princess) has docked in Japan and has been quarantined. Understandable, as over 450 people on the ship have the virus, the most recorded infections anywhere outside China (147)
...so keeping people in the ship closely monitored in a ready-made quarantine facility makes sense. But if you've any humanity you'll be hoping for a resolution that doesn't mean everyone on the ship is left to get sick (148)
...hence stories like this. Britain is considering a similar approach. (149) bbc.co.uk/news/amp/world…
...this does mean that the number of known cases in the US will suddenly jump, but this is another instance where how we measure the numbers is the issue. Effective quarantine and monitoring will be important, and the US, UK and similar should be more than capable. (150)
...of more concern is MS Westerdam, another ship that docked in Cambodia. Hundreds of people who may well have since dispersed across the world and who it seems may have been exposed to the virus. (151) theguardian.com/world/2020/feb…
...without wishing to cause alarm, this seems irresponsible. But, as ever, time will tell. (152)
...as the news cycle continues, so does our need to stay informed. To begin with, things continue at a similar pace in China. As of this morning there have been 77,150 recorded cases of Covid-19 (Coronavirus) in China (153)
...that includes 409 new cases in the preceding 24 hours, of which 398 (93.7%) are in Hubei province. That remains by far the highest concentration of infection (154)
...from outside mainland China we are up to 2047 confirmed cases, with a big increase of 353 in the last 24 hours. Those cases are mainly in South Korea (176 people) and Italy (76 people). Iran, with 43 cases is also notable (155)
...globally, 2469 fatalities have been recorded. 26 of them have been outside mainland China. 8 of the 43 cases in Iran have been recorded as fatalities. And yes, these numbers are a bit odd and this needs explaining. I hope I can offer a little insight... (156)
...Covid-19 can kill, but Iran's 8 deaths out of 43 cases looks exceptional. Most likely there are far, far more cases waiting to be properly recorded there. Hence some neighbouring countries (e.g. Turkey and Kuwait) imposing travel restrictions (157)
...looking at a map of where the cases in Iran are, it is to be hoped that measures being taken there to contain the spread of the virus will be effective (158)
...in Italy cases confirmed so far are in a relatively small area. This should make containment possible, and measures taken there so far seem both sensible and proportionate - but, as ever, time will tell. I will continue to update with more as and when. Later. (159)
Well I was rather hoping the coronavirus news might be slowing down. It wasn't likely but it was my hope. But instead things are moving really rather fast. Off to bed to sleep on current news and will update further in the morning. Sleep well, all. (160)
...one thought before bed time though. Be alert, be responsible, but it isn't like panicking will help, no matter the headlines in the morning. (161)
Ok. Things are moving fast. Italy, South Korea, Iran. What you need to know. (163)
Covid-19 has spread in parts of Northern Italy. And because it's the time of year people from other parts of Europe go over there and ski, posh schools have trips for half term. And now, they're home in th UK (164)
...quite reasonably those school kids are being told to self isolate, some schools are closing their doors for a couple of weeks. Reasonable precautions, but it doesn't mean those kids have brought coronavirus back (165)
...this is precautionary and reasonable. But whether it can stop the virus now spreading, with cases being recorded in other parts of Europe (France just reported its first death) is increasingly unlikely. (166)
...cases have been found in multiple states now linked to the outbreak in Iran. That includes Iraq, Oman, Kuwait, Bahrain and Afghanistan. Whether increased vigilance has meant that's a safe catch or whether the infection will then spread there? As ever, time will tell. (167)
...likewise cases reported in Romania, Austria, Switzerland and Algeria having originated in Italy may or may not be safe catches rather than the start of new outbreaks. Wait and see (168)
Now one thing I'm seeing is people are asking if it is a pandemic. And I can say that no, at present, it is not. That isn't seeking to deny the severity of this, it's just that what is happening isn't what a pandemic is, not yet. (169)
...a pandemic is when community acquired infection happen across the world. And yes, the dividing line between multiple outbreaks and a pandemic is a fine one and a matter of judgement... (170)
...but at present we have multiple confirmed community acquired infections in China, Hong Kong, Italy, Iran and South Korea. It's too soon to call it a pandemic. (171)
We will see more stories like this, and the employer is to be commended for taking this precautionary approach. But I worry that here in the UK many people in our gig economy won't be able to afford to take time off in simar circumstances (172)
And the news cycle churns on, demanding facts faster than they can be produced. But, here goes, here is the state of things as I think you need to know them this morning (173)
China is up to 78,497 reported cases of Covid-19, with 433 new cases in the last 24 hours. There were 29 more deaths, of which 26 were in Hubei. There were 6 new cases on Hong Kong... (174)
Outside of China we now have 3,666 confirmed cases, with 738 in the last 24 hours. 449 of those are in South Korea, 131 in Italy, and 44 in Iran. Of the 2800 reported deaths 56 have been outside China... (175)
...reports it is spreading faster outside of China than inside seem absurd, because while the total rise in cases has been higher, that's across the rest of the world. Such scaremongering doesn't help. It has spread, there are more cases, it isn't running rampant (176)
I am currently more concerned about the outbreak in Iran than other locations. The number of deaths is massively out of proportion to the number of recorded cases, and it seems to have reached every region and most provinces (177) bbc.co.uk/news/world-mid…
...and the number of cases in countries bordering Iran, coming from that country, is increasing rapidly. This is a problem. (178)
...indeed Saudi Arabia has responded rapidly and decisively to this. I don't recall anything quite like this before. metro.co.uk/2020/02/27/sau… (179)
...lastly, for now, the impact on cultural and sporting events continues. The Ireland vs. Italy rugby match has been postponed, as has the F1 Chinese Grand Prix, the world indoor athletics chempionship in March has been put back a year (180)
...no decision has been made about the Tokyo Olympics yet, and what UEFA choose to do about the Euro football championships is anyone's guess. As ever, time will tell. (181)
What you need to know today about Covid-19. Oh dear me, where to even begin. Well, let's start with the scary sounding stuff that probably isn't all that frightening... (182)
...there has been a report from Japan of a woman who caught the virus, got better, and caught it again. It's going to happen, but it is likely to be a rare phenomenon. See here for info:rnz.co.nz/news/national/… (183)
...next, we have a potential case of a dog catching it. Now don't get all alarmed by this - it's not yet fully confirmed, and it's not the case that we have any reason to believe a dog can spread the virus (184) scmp.com/news/hong-kong…
...further testing will be needed to work out what the implications of this are. Don't start treating your dog with any greater suspicion than you were already. (185)
One other thing you should note is that how different nations are reacting is diverging quite fast. Switzerland has banned gatherings of more than 1000 people, Greece has cancelled their coming Easter parades (186)
....whereas perhaps it could be argued that the response from the British government is a little more relaxed, with the Cabinet security meeting being scheduled for Monday, after the weekend. (187) independent.co.uk/news/uk/politi…
...and of course likewise leadership decisions in the US government have been criticised by many. This isn't meant to be an overtly political thread, but I will say I'm surprised and disappointed that responses have been a little less determined in some places than others. (188)
...events are once again moving quickly. For those still following this thread, thank you for your patience and I will update more later when I've managed to verify news reports and digest them. In the mean time, keep calm, don't panic. And wash your hands. (189)
Okay. What you need to know about Covid-19 today. First, there's a term that epidemiologists use at times like this. They say "Seek and ye shall find", apparently it's also biblical. What they mean is there's probably more about it than you think. So, why am I saying that? (190)
I'm saying that because increasingly we are seeing community acquired infection across the world. Several US states and the UK have reported their first of these. It is likely that there is more of it around than has yet been detected yet in those places (191)
...which of course means finding a rapid diagnostic test for the virus is ever more important. And in the mean time, epidemiologists are calling for wider serological surveys in places like Wuhan to give us a truer measure of just how many people in the community have it (192)
...remember, health workers and authorities really only get to measure cases that are, well, reported. As yet we don't know what proportion of people get the virus but never feel bad enough to go and get help (193)
...the evidence that this is something we need a measure of comes from the ever widening difference in fatality rates due to this virus in different places, suggesting that locations with very high death rates are under-recording infections. I've seen some numbers (194)
...but I want to give them another check before really forming an opinion. Will do so in the morning and share. In the mean time the advice remains the same - be vigilant, wash your hands, use a hanky, and don't poke your eyes or mouth while out. (195)
Sorry, didn't find time to update yesterday. But that's just as well, as events have continued at a pace. What you need to know about Covid-19 today... (196)
...we now have some evidence that the virus has been spreading in nations like the USA, the UK and other countries with some reported cases but which have not been considered hot spots. This isn't surprising. What is surprising is that it may have been happening for weeks (197)
...we can determine this from mutations in the virus. This isn't as frightening as it sounds! Most mutations don't do much, they're just point changes in genetic code that don't much impact on anything, but they do allow us to make deductions about how the virus spreads (198)
...as ever, we haven't got the full picture yet. But here's a good place to start. Given a little time scientists will continue making this picture clearer. (199) nytimes.com/2020/03/01/hea…
Another thing you should be aware of is that the World Health Organisation continues to update it's guidance. Here is that they're saying about international traffic (200) who.int/ith/2019-nCoV_…
...and here is what the WHO currently say about patient care (201) who.int/emergencies/di…
...and of course the WHO continue to act as a hub for gathering and sharing clinical data. I would urge anyone interested to go and look at the WHO websites and of course at Promedmail. (202)
One other thing I alluded to in Saturday is that the mortality rate reported in different places is widely variable. While there is a widely reported figure of 3.4%, outside mainland China about 1.4% of patients have died, in South Korea it's 0.5%... (203)
...obviously the only thing that can be recorded is, well, reported cases. And population demographics are variable between regions where the virus is to be found. This will be -much- easier to monitor when there is a rapid test available for the virus. (204)
...and that's going to have to be an antibody based test. That's not out there on the market yet, but I note that a prototype of this test has just been published (205): onlinelibrary.wiley.com/doi/abs/10.100…
...to end with (for today) the advice from many governments is evolving rapidly, with regard to how many cases we should expect to see and how much disruption we should anticipate. In a way that's less important than the key message that I will repeat yet again (206)
Wash. Your. Hands. Sneeze and cough into a tissue. Be vigilant and conscious of those around you, and don't panic. This are serious times, but worrying will do you less good than taking the best care you can. (207)
Things have reached a "blink and you'll miss it" stage with regard to how fast Covid-19 news is developing. Please forgive me if I stick to broad strokes in defining what I think you need to know going forward... (208)
...more countries report infections every day and it is now looking very likely that epidemics will occur (are occurring) in many nations. The old 'seek and ye shall find' adage that epidemiologists are so keen on has proven true (209)
...and that's good news. We can hope that now testing is more widespread that controls can be put in place to slow infection. This is particularly true in America and Europe, where as yet (other than in Italy) infections has not reached such high levels (210)
...but in broad terms there were as of this morning 72 countries with infection. 9 in the Western Pacific region, 34 European region, 5 Southeast Asia, 15 Eastern Mediterranean, 6 Americas and 3 African. 30 of those have reported local transmission of the disease (211)
...it is of particular concern that the Eastern Mediterranean has seen rapid spread in the last couple of days. And in Iran the spread has impacted on many aspects of life - it is reported that 8% of their members of parliament have the disease (212)
There is a frightening number being shared by some news sights, a claim.3.4% of confirmed cases have been fatalities. Again, I must stress, this is lily to be much worse than a typical seasonal flu, but the number of people with mild symptoms will be hugely under reported (213)
...confirmed cases divided by total deaths doesn't give you a real fatality rate. I would advise treating such scare stories with a grain of salt. (214)
Lastly (for now) economic damage is kicking in not just in parts of the world with most infections. Where I live (Cambridge, UK) it is startling how few tourists there are. How much of that is Covid-19 and how much is Brexit I can't say. But it's a factor cambridge-news.co.uk/news/cambridge…
More updates to come later. But this can't wait - scammers are making a profit our of coronavirus. Do not be a sucker. Stay informed. Stay safe. (216) actionfraud.police.uk/alert/coronavi…
...now is also the time to contact lawmakers in your country (your MPs, representatives, etc.) and tell them that whatever they're holding back from doing, now is the time to stop holding back. WHO are not messing around with this announcement. (217) independent.co.uk/news/health/co…
...and in "taking no joy in having told you so" news there won't be a vaccine ready this flu season - we have largely it seems failed to delay an outbreak for long enough to allow that to be done. (218) independent.co.uk/news/health/co…
News you need to know about Coronavirus, Covid-19, today. From the WHO. Not so much a shot across the bow at governments not taking things as seriously as they might, more a plea for more action. A short thread they've just tweeted out, with links. (219)
Strange days indeed. What you need to know about Covid-19 (Coronavirus) today. Where to even begin... (220)
...Italy hasn't exactly quarantined a whole region, but the restrictions they have placed are as far a I can recall unprecedented in a modern Western European nation. They are not messing around. (221) cnn.com/2020/03/09/eur…
...the scale of this is extraordinary, as their health workers in severely impacted areas are overwhelmed. They've been pushing hard back against the virus as the number of cases has risen. (222)
...Covid-19 has hit close to home for the French government. (223) france24.com/en/20200309-fr…
...indeed France has joined with other countries like Switzerland in banning large gatherings of people (224) france24.com/en/20200308-fr…
...curiously here in Britain our government has argued that it's too soon for such measures, that their modelling suggests it would be better to wait. I haven't seen their models, but I must say that's one hell of a roll of the dice. (225)
...while in the US the picture is fairly confused - what (if any) national plan may emerge is anyone's guess. By I think the economic measures announced are important (226) cnn.com/2020/03/09/hea…
Well, I said a few days ago that we were entering a blink and you'll miss it phase of news over Covid-19. Events have not slowed down. But here is what I think you need to know today... (227)
...the rate of increase in many countries is increasing. While in China and South Korea efforts to slow the spread of rh disease appear to have started to turn things around, in other countries we are nowhere near that point. And the response to this varies wildly (228)
...while large events continue largely unchecked in the UK and the USA, Denmark has joined France, Switzerland and others in announcing severe restrictions (229)
Norway, Switzerland, the Netherlands and several other nations are showing worrying trends (230)
And now we are using the P word. The WHO says it's a pandemic. What does that mean? It means across the world, the new normal is that this disease is caught locally rather than spread by a few travellers (231) cnbc.com/2020/03/11/who…
It's interesting to observe how different countries are handling things. Often their approach is based on capacities developed for handling other diseases. Nigeria, for example, fears ebola. They are -very- good at quarantining (232) punchng.com/nigeria-record…
...I've tried to keep speculation and my own opinion mainly out of this thread. I hope you won't get too upset if I speculate that in the next few days we will see more restrictions, in more countries. This seems inescapable. (233)
...before signing off for tonight. This is being shared among Italian clinicians. If you believe restriction of large gatherings, closing schools etc. is still disproportionate, please read this. It's truly extraordinary, and very worrying. (234)
The news races on. Some more things you need to know about Coronavirus, Covid-19, today. (235)
Let's start with the science. Various teams around the world have been trying to grow the virus in culture, with some success. This isn't easy with a virus. (236) globalnews.ca/news/6670445/c…
...you can't give a virus food and take waste products away like you can with many bacteria. You have to find a set of host cells you can culture it in, and grow those. But since January people have been managing to do this, and now we're seeing the virus isolated to study (237)
...now, way back I talked about making vaccines. That's been based on working out what proteins the genetic code in this virus made and using that data to work out its surface structures, and in turn making those in the lab to test for use as vaccines (238)
...isolating and studying the virus in this way is valuable for validating that work. This is good news. (239)
And groups around the world are working on this vaccine. It's hazy where they are exactly, because (as I've already covered) they'll be using somewhat different approaches. But the whispers are positive... (240) indiatoday.in/world/story/sc…
...some are even speculating that a prototype vaccine will be ready in weeks or even days. But that will still need extensive safety testing. My estimate of next January at the earliest remains possible. I'm a glass half full kind of guy. (241) sciencebusiness.net/news/good-prog…
Also of note (forgive me for no link, it's a pdf and I know how that irritates some) is a study on stability of the virus in droplets and on surfaces. Our best data shows it is about as tough as SARS was, which does beg the question of exactly why it is more infectious (242)
...and yes, there is considerable speculation there. Probably it's to do with it being infectious before symptoms show, but the impact of 'superspreaders' is being discussed. I'll keep an eye out for news on that, watch this space. (243)
As for the spread of the disease and the impact of that, I'm sure you've seen the news. The WHO sees Europe as the epicentre for the diseases spread now, while China has much to celebrate in how well the disease has now been controlled in Wuhan (244)
...without wishing to play too much into national stereotypes, the severity in Europe is such that in England we have cancelled the football, the French are closing restaurants, the Belgians have closed their pubs and the Italians shutting cafes. (245)
