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There is *already* historical (1918 flu/H1N1) evidence that non-pharmaceutical interventions (NPI's) like cancelling large gatherings/events, asking ppl to work from home, closing schools, can slow spread. Also more recent evidence: China, Hong Kong. seattletimes.com/seattle-news/h…
1918
H1N1
Modeling studies consistently show that, to be effective, school closure to limit community-wide transmission requires an early trigger, such as before 1-2% of the population is infected. ncbi.nlm.nih.gov/pmc/articles/P…
In Hong Kong, leader Carrie Lam said her government will raise its response level to emergency, the highest one, and close primary and secondary schools for two more weeks on top of next week’s Lunar New Year holiday. They will reopen Feb. 17
apnews.com/b2810cebad305f…
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COVID19
@V2019N
Infectious Disease Doctor: What Does (And Doesn't) Scare Me About The Coronavirus

1) Our health care system does not have “surge” capacity. This is especially true during flu season, when many hospitals run at nearly full capacity. wbur.org/commonhealth/2…
2. Here in the U.S., testing for the new coronavirus was initially sharply limited. While the logjam on testing should end soon, it's probably too late to prevent extensive community transmission.
3. The people at greatest risk for severe or fatal coronavirus illness are already our most vulnerable patients. Estimates from China suggest the mortality rate among those older than 80 is 15%.
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COVID19
@V2019N
thread @ScottGottliebMD on @FaceTheNation

"What we need to do now is make a real concerted effort to get a therapeutic. We know when this started, but we don't know when this is going to end. And what's going to end it is our technology."

cbsnews.com/news/transcrip…
(Need) A treatment or a vaccine (to stop #COVID19). But a therapeutic- a treatment is going to be more likely to be available in the fall. A vaccine is a much longer way off...going to have to depend on our science...
"...right now, probably hundreds or low thousands of cases. (US) It's a big country 330 million people, so anyone's individual risk is still very low... we need to get those cases diagnosed & identified so can start getting people quarantined & into treatment & prevent spread"
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COVID19
@V2019N
WHO China joint mission #COVIDー19
COVID-19 is transmitted via droplets and fomites during close unprotected contact between an infector and infectee.

who.int/docs/default-s…
Not major drivers of transmission:
-airborne spread not been reported
(can be envisaged if certain aerosol-generating procedures are conducted in health care facilities)
-fecal shedding demonstrated from some patients, & viable virus identified in limited # case reports.
Household transmission studies underway, prelim studies ongoing in Guangdong est secondary attack rate in households ranges from 3-10%.
As COVID-19 is a newly identified pathogen, no known pre-existing immunity in humans. Everyone is assumed to be susceptible
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Dr. Theresa Tam
@CPHO_Canada
1/8 March 15: there are 313 #COVID19 cases in 🇨🇦, with 10 provinces now reporting a case. With the recent rapid⬆️in cases, Canada’s window to #FlattentheCurve is closing. The time for all Cdns to act is now. #doyourpart
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Allen Cheng
@peripatetical
A brief thread about what might be coming up in Australia to control #COVID19. I'll emphasise that what interventions are likely to work depend very much on the situation at the time, and not all are being considered in the near future, or even at all.
Some principles are that interventions should be proportionate to the risk, reasonable and the least restrictive option, considers equity and burden, and evidence based. This obviously is difficult with uncertain parameters and imperfect surveillance.
Most of these have been considered in the context of influenza, but there are some key differences with COVID. The incubation period is much longer (6-7 days vs 1-2 days). Probably less pre-symptomatic transmission than flu. Kids don't seem to get severe disease.
Read 21 tweets
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Nicholas A. Christakis
@NAChristakis
Let's talk about school closures re COVID-19. It's a tough topic, scientifically and pragmatically. It's hard to estimate the benefits precisely. And closing schools can have costs, such as health care workers having to stay home, kids missing subsidized lunches, etc. 1/
Yet studies show that school closures are one of the most beneficial 'non-pharmaceutical interventions' (NPI) that can be employed, more effective even than reactive quarantines or banning of public gatherings. Partly, the reason is that *parents* also stay home as a result. 2/
An inventive 2007 study by @HowardMarkel et al in @JAMA_current examined impact of school closures and other NPI, and their precise timing, in the 1918 influenza pandemic, looking at 43 major USA cities. jamanetwork.com/journals/jama/… 3/
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Matthew Bennett
@matthewbennett
Van 10 muertos por Coronavirus en Corea del Sur. 977 casos en total.
El ministro británico dice que los que vuelven del norte de Italia con algún síntoma deberían aislarse en sus casas durante dos semanas.
Echenique (Podemos) carga contra los medios por el Coronavirus, dice que está todo controlado.
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Tom Inglesby
@T_Inglesby
Cases are appearing in greater numbers in countries outside China and a number aren't linked to travelers. For example, dramatic
increase in cases in Rep of Korea today – 433 cases diagnosed, thousands more getting tested. apple.news/AENW3sEMBQeGAN… 2/x
Cases also in # of places in Iran, + new cluster in Italy, w/ other countries already
w cases unexplained by travel. Public health authorities call this “community
transmission”. So concerning because it means COVID spreading in ways that not
likely to be stopped 3/x
For most part countries still not testing widely for
community transmission, focusing predominantly on
returned travelers from China. So we do
not have clear sense where COVID is circulating. Can't say
w/ confidence that any given country has no community transmission. 4/x
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DocRock1007 🇺🇸
@DocRock1007
...to San Francisco. apnews.com/cc77e92054c495…
2. Roads in and out of #Wuhan (even small side roads) being barricaded with piles of dirt/rocks to block all traffic in or out.
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