Feb 202020
 


Saul Leiter Man with flowers, NY 1950s

 

A few days ago, I was thinking of writing another corona article, focusing on two things: 1) the ease and speed with which the virus spreads -because I think that is hugely underestimated-, and 2) testing. But then the situation with the two cruise ships started going berserk.

I had intended to use the Diamond Princess as a case for the ease and speed of infection, but it became clear quite rapidly that you can’t use the ship to prove any case, other than that people are completely nuts. But we already knew that. And while Dostoyevsky wrote some great books on the topic, it’s not a great framework for a piece on a virus. Unless perhaps if it infects the brain.

Not that I don’t think the ship is still a good example to make the point, but too much plain bonkers stuff has been going on with and around it. The quarantine, the evacuations, the infection numbers, you name it. I’ll get to the testing later, that was/is a whole other chapter.

A problem, if you’re me, with letting an essay simmer for a bit, is that ever more sources start accumulating, until there’s too many to either comprehend or use in an effective way. First thing to do is not to wait another day. Let’s start with 1) The ease and speed with which the virus spreads, aka transmissibility,, and see where we land.

 

1) The ease and speed with which the virus spreads

People continue to have this idea that COVID19 isn’t all that bad, yada yada, an “analysis” crowned by the comparisons to seasonal flu. Which make no more sense then to compare it to bovine flatulence. Stop it.

The way and extent the virus was spreading aboard the Diamond Princess became clear before the evacuation efforts. The US government, and others, were watching it happen, and pulled the plug. What the Japanese were doing and thinking is less clear. It’s sort of fun to see Washington refrain from calling Tokyo on it, best allies and all, but it makes you think at the same time.

So if using the Diamond Princess is not a good example, we need to look elsewhere. This Feb 16 Zero Hedge graph of infections outside China might be a good start. Whether it represents an exponential or a quadratic function is sort of an inside joke by now, but it’s clear enough in either case.

 

 

Even more obvious perhaps is this from the South China Morning Post (SCMP):

Coronavirus Up To 20 Times More Likely Than Sars To Bind To Human Cells

The deadly new coronavirus is up to 20 times more likely to bind to human cell receptors and cause infection than severe acute respiratory syndrome (Sars), a new study by researchers at the University of Texas at Austin has found. The novel coronavirus and Sars share the same functional host-cell receptor, called angiotensin-converting enzyme 2 (ACE2).

The report, published on the website bioRxiv on Saturday, said the new coronavirus had around 10 to 20-fold higher affinity – the degree to which a substance tends to combine with another – for human ACE2 compared with Sars. But the researchers added that further studies were needed to explore the human host-cell receptor’s role in helping the new virus to spread from person to person.

“Compared with SARS-CoV, 2019-nCoV appears to be more readily transmitted from human to human,” the report of the study said. “The high affinity of 2019-nCoV S for human ACE2 may contribute to the apparent ease with which 2019-nCoV can spread from human to human.”

The ACE2 receptor has already been reported as being much more prevalent among Asian people, but please don’t presume the buck stops there. Non-Asians have them as well, and we’re not even sure what role they play, or if fewer of them would protect you from being infected. Allegedly, smokers have more ACE2 enzymes as well. As do older people.

Another transmissibility example is the death of an entire family in Wuhan:

Virus Kills Chinese Film Director and Family in Wuhan

A Chinese film director and his entire family have died from the novel coronavirus in Wuhan, the epicenter of the outbreak. Chang Kai, a film director and an external communications officer at a Hubei Film Studio subsidiary, died in hospital on Feb. 14 from the virus now called COVID-19, according to a statement from the studio. He was 55.


But Chang’s death was not the first in his family—the Chinese media reported that Chang’s father and mother were infected and died one after the other. Chang and his sister, who looked after their parents at home, were both infected with the virus as a result. His sister died just hours later. Chang’s wife is also infected, still alive, and is still battling the virus in an intensive care unit.

But everything above loses most of its meaning compared to the following, also from the South China Morning Post. You might want to sit down for this one.

Until now, ‘accepted knowledge” is that the first death from COVID19 was registered on January 9 2020, a 61-year old man in Wuhan. And that the incubation time for the virus was maximum 14 days – hence the 2-week quarantines everywhere. No more.

The government of Xinxian county, in the city of Xinyang, on Sunday reported that one of its new cases had been confirmed 34 days after the patient returned from a mid-January visit to Wuhan.

He had been sent to hospital with suspected symptoms on January 28, but twice tested negative before testing positive on February 16. A further two people who attended family gatherings with the man in Xinxian were reported as infected, while three were suspected cases or under hospital quarantine.

The county government announced it would extend the home quarantine period from 14 to 21 days for residents who had been to Hubei or had contact with people who had been there.

It also reported a case that was confirmed 94 days after the patient’s contact with a relative from Hubei. The patient had taken care of his father-in-law, who arrived from Wuhan on November 13 and died days later.

The son-in-law continued to stay in the father-in-law’s house until January 31. However, the government statement said the origin of the son-in-law’s infection had yet to be identified. Zhuhai, in the southern Guangdong province, last week reported two cases with incubation periods longer than 14 days. Similar cases have also been reported in Anhui and Shandong provinces.

This potentially pushes back the first known case to November 13 2019 and the first known death to November 13 and change. “Died days later”. Shall we say 4-5 days? That means the first fatality was November 17-18. While incubation time may have been pushed forward to 94 days.

 

 

 

 

2) Testing

The most important term coming out of the coronavirus news, going forward, will be “false negative”. Closely followed by “asymptomatic”. There are tons of stories about people testing negative 2-3-4- times before testing positive. And also tons of stories about people with no symptoms infecting others. It’s all about the things you don’t see.

The Chinese had it about as wrong as can be early on, and knee-jerked into the Party deny and hide mode. They have it right now, though: the only way to keep the virus from spreading is to limit contact between people, even if that may seem to reach extreme proportions. If there is no vaccine, there is no other way. But if it’s just the Chinese that do isolation, that solves nothing.

When I first read that the passengers of the Holland-America Line cruise ship Westerdam had been allowed to leave the ship when it landed in Cambodia a week ago after, I think, 9 days of floating around aimlessly, I thought this was a “Go Forth and Multiply” message for the virus. Second thought was: who’s in charge here? Still wondering about that one.

The Westerdam had 2,257 people on board, 1,455 passengers and 802 crew. They were not allowed to dock anywhere after a man who had gone off board in Hong Kong tested positive. As we speak, some 255 passengers and 747 crew members are still being held on the ship while further testing was conducted. That means 1,200 passengers and 55 crew have left the ship. Cambodia let lots of them fly to Malaysia, and they flew all over from there.

And only then did they discover an 83-year old American woman who had already flown to Malaysia had tested positive. The ship had a lot of Americans (400?) , Canadians and Dutch people on board. Where did they go? Mostly home, of course. And now all those countries are scrambling to locate these people. Even if they do, who have they infected in the meantime? They’ve been in close proximity to others, like on planes.

And, again, who’s in charge? Did the Holland-America people, and the Cambodian government, keep in constant touch with the WHO and the Chinese? Would it have made any difference if they did? Or is it as bad as it seems, a Wild East sort of set-up with everyone fending for themselves?

What are the odds that someone in the Cambodian government now has a new offshore bank account with $10 million in it, in a deal made before the 83-year old American woman tested positive, in exchange for letting the ship dock and making sure the passengers would leave ASAP?

 

Hard as it may seem to imagine, the Diamond Princess may be, and have been, even more of a mess than the Westerdam. Someone said: “it was a mess on board, and the mess is now moving off board”. And now we have the first 2 fatalities from the ship.

Diamond Princess: everyone confined to their cabins, little interaction, but still in the past week numbers of new infections have exploded, with many dozens of new cases every day. So now we have a total of what, 500-600 new infections ever since the US said: enough!

Why were they, why were larger numbers, not discovered earlier? Well… There were 3,711 people on board. 5-6 days ago, 10-12 days after the first positive test, 1,219 had been tested. Which means that after 10+ days of quarantine, less than a third had actually been tested. As of Monday, 2,404 passengers and crew, out of the 3,711, had been tested. That still left 1,300. Many of whom are now gone.

The remaining 61 American passengers on the Diamond Princess who opted not to join the evacuation will not be allowed to return to the US until March 4, according to the American embassy in Tokyo.

Undoubtedly some logic behind the lack of testing until recently will be offered by Tokyo, but you must wonder how many of the 542 new cases of the last four days had been tested at all, and how long some of them had been infected, probably without showing any signs. For instance, the 14 cases on the flights to the US this week were all asymptomatic virus carriers. All of them, according to official channels.

And now we read that Japan has no intentions of quarantining its citizens who were on board the Diamond Princess:

Earlier in the week, the United States evacuated more than 300 nationals on two chartered flights. A State Department official said there were still about 45 US citizens on board the cruise ship as of Thursday. Americans flown back will have to complete another 14 days quarantine, as will returning Hong Kong residents. Disembarked Japanese passengers, however, face no such restrictions, a decision that has sparked concern.

One more thing, then I’ll stop. Zero Hedge a few days ago quoted a Taiwan Times article saying people can be infected multiple times. And be worse off for it. A first infection leaves your immune system ravaged, and combined with the damage caused by the medication taken, can make you helpless against a second attack.

Chinese Doctors Say Wuhan Coronavirus Reinfection Even Deadlier

Doctors working on the front lines of the novel coronavirus (COVID-19) outbreak have told the Taiwan Times that it’s possible to become reinfected by the virus, leading to death from sudden heart failure in some cases. “It’s highly possible to get infected a second time. A few people recovered from the first time by their own immune system, but the meds they use are damaging their heart tissue, and when they get it the second time, the antibody doesn’t help but makes it worse, and they die a sudden death from heart failure.. ”


“The source also said the virus has “outsmarted all of us..” [..] “It can fool the test kit – there were cases that they found, the CT scan shows both lungs are fully infected but the test came back negative four times. The fifth test came back positive.” -Taiwan Times

We will now start to see the economic effects (you haven’t seen anything yet in that regard). More on that later. Rule of thumb: companies have 1-2 weeks of supplies in stock. Just-in-Time. Then they need more delivered. But the Chinese economy is on its last legs. Please don’t think it’s about Apple or some other major company. This is about a million smaller companies and (chain) stores in the west. What was it, 80% of US drugs come from China? Or was that just antibiotics?

There are ways to minimize the damage a virus can do. Mankind as a whole, in the places where the proverbial chain literally is as strong as the weakest link, has not minimized it. Instead it has told the virus: “Go Forth and Multiply”. Prepare accordingly. If we’re lucky, this will die down and pass. But that’s the problem: it’ll happen only if we’re lucky, not because we’ve done all we know we could.

 

 

Feb 052020
 


Max Ernst Inspired hill 1950

 

Hi, it’s me again, with more virus stories. I know you may think it’s enough now, but I do want to do this one. Actually, I haven’t written all that much about it, just two essays, 2019-nCoV and The Party and the Virus, but the topic has become a staple of my daily Debt Rattle news aggregators lately. So much that I find I need to remind myself all the time that it’s been a news item for only two weeks, going back to January 20 or so.

Through those two weeks, I’ve seen a number of studies, simulations, models, of where the virus can be expected to go going forward. And I want to take a look at some of them. I said early on that I didn’t like people talking about the economy as soon as the first people died, but 2 weeks later, given the growth of the epidemic, that doesn’t appear avoidable anymore.

People are starting to wonder what’s going to happen to society at large, and in “the markets” -or what’s left of them after central bank manipulation- if and when the virus remains an issue for an X amount of time. I think I can explain some of the parameters, though I want to make clear predicting what viruses do is, even for virologists, crystal ball material, and I ain’t got one of those.

 

China injected $242.74 billion into the markets via reverse repos on Monday and Tuesday, and stocks seem to have made up for their $445 billion losses on Monday. But what exactly is that optimism based on? Is it that “investors” think the PBOC will have their backs no matter what? Is it the reports of companies like Gilead testing possible solutions, vaccines?

I’m not an expert, but I do know it takes a sophisticated drug company about a year to develop a drug/vaccine for a novel disease, as “WuhanCorona” is. From what I can gather, the Gilead drug (co-)tested by the Chinese is basically an anti-viral developed with Ebola in mind, which may or may not work. Ebola is somewhere related to “WuhanCorona”, in a third cousin twice removed kind of way, but that’s it. HIV drugs could also perhaps work to some extent, but that’s a big question.

So what the optimism in the “markets” is based on, you tell me. Are people so afraid of what might be coming that their minds switch off, are they afraid to get informed, or do they genuinely think it’ll all soon be over? Me, I hope it’ll turn out fine, but I wouldn’t put any money on it. And that’s based on what I’ve been reading.

 

When reporting on the Wuhan situation started for real in the west, let’s say January 20 (that’s just 16 days ago!), there were 291 registered infection cases. There are 27,648 now, and 564 people have died. Those are “official” Chinese numbers, and there are plenty doubts about their accuracy (see today’s stories about Tencent posting 10x higher numbers), but let’s roll with the official ones for the moment. I’m going to hop through time a little, but please bear with me, there is a logic.

First, there’s this from January 28 in the SCMP (South China Morning Post), a major Hong Kong news outlet owned by -very Chinese- Alibaba. Zhong Nanshan is a scientist working for the government. My first reaction when I saw this was: it looks like he’s doing damage control for the CCP.

 

Chinese Experts Say Wuhan Coronavirus Outbreak Will Not Last

One of China’s top experts said the Wuhan coronavirus infection rate could peak in early February. “I estimate that it will reach its peak in around the next week or 10 days, after that there will be no more major increases,” said Zhong Nanshan, the respiratory disease scientist who played the pivotal role in China’s fight against the severe acute respiratory syndrome (Sars) coronavirus epidemic in 2002-03.


[..] Gao Fu, the director of the Chinese Centre for Disease Control and Prevention [said] he was “optimistic” that the outbreak’s “turning point” could arrive by February 8 if current disease control protocol is maintained.

3 days earlier, January 25 (that’s just 11 days ago!), the SCMP ran this piece on the same Zhong Nanshan, which reinforces my image of him a bit more. One might argue that Beijing has become more transparent recently, but the facts remain that for instance the WuhanCorona virus can be traced back to early December if not earlier, and that after the first death on December 9 no testing at all was done in Wuhan for a week.

Just to name a few things. So for a scientist to claim that “Beijing has no secrets to hide” and “has not held back information in reporting the outbreak in Wuhan” is at the very least over the top.

 

China Has Been Transparent About Wuhan Outbreak, Virus Expert Zhong Nanshan Says

Chinese officials have been transparent in handling the Wuhan coronavirus outbreak and the participation of a Hong Kong professor through the process indicates that Beijing has no secrets to hide, said one of the country’s leading experts on communicable diseases. Dr Zhong Nanshan, whose team is advising the leadership on how to handle the crisis, told a news conference in Guangzhou on Tuesday that China had not held back information in reporting the outbreak in Wuhan, which has sickened more than 300 people across the country since early December.

But also on January 25, there was this Zero Hedge piece about British scientist Jonathan Read, who had completely different ideas about the outbreak. Note: both predictions focus on Feb 4.

 

UK Researcher Predicts Over 250,000 Chinese Will Have Coronavirus In Ten Days

[..] in 10 days time, or by February 4, 2020, Read’s model predicts the number of infected people in Wuhan to be greater than 250 thousand (with an prediction interval, 164,602 to 351,396); [..] Read estimates that only 5.1% of infections in Wuhan are identified (as of Jan 24)..


[..] Read’s model alleges that Beijing was woefully late in its response and that recently imposed “travel restrictions from and to Wuhan city are unlikely to be effective in halting transmission across China; with a 99% effective reduction in travel, the size of the epidemic outside of Wuhan may only be reduced by 24.9% on 4 February.”

Very different. Remember his “travel restrictions from and to Wuhan city are unlikely to be effective in halting transmission across China”, it’ll come in handy later. Now, I’ve been posting a few math sequences, Fibonacci and otherwise, and those are way too negative, or at least would seem to be.

Problem with that is, as with many facets of the whole thing, we don’t know. There are simply too many scientists who state that real infection- and fatality numbers are much higher than what Beijing reports. They do that based on models, simulations etc. Not because they want The Party (CCP) to look bad, but because the models tell them.

An example: SCMP reported early Tuesday that the mortality rate for the city of Wuhan has reached 4.9%, while the mortality rate for Hubei province as a whole is 3.1%. They added that the mortality rate is predicted by doctors to drop, because extra medical attention is available etc. But we know that extra attention threatens to be overwhelmed by too many patients, shortages of beds, equipment, test kits, protective clothing etc. Nice try, but…

 

All this just to get to why I started writing this, which is a report published at The Lancet on January 31, from Hong Kong University (HKU). I have cited previously that it estimated 75,815 people had been infected in Wuhan on January 25, a far cry from the 1,300 official number at that point. And yes, I do want to use the discrepancy to cast at least some doubt on the official numbers.

But there’s something else that I would like to focus on. The same report also says that the epidemic -or episode, pandemic- would end “around April” 2020, so between, say, mid-March and mid-May, 6 weeks and 14 weeks from now, if certain conditions are met. And that’s just Wuhan. Add another 2 weeks “across cities in mainland China”.

The full name of the paper by Prof Joseph T. Wu, PhD, Kathy Leung, PhD and Prof Gabriel M. Leung, MD is “Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study”

It says: “We estimated that if there was no reduction in transmissibility, the Wuhan epidemic would peak around April, 2020, and local epidemics across cities in mainland China would lag by 1–2 weeks.”

[..] In this modelling study, we first inferred the basic reproductive number of 2019-nCoV and the outbreak size in Wuhan from Dec 1, 2019, to Jan 25, 2020, on the basis of the number of cases exported from Wuhan to cities outside mainland China. We then estimated the number of cases that had been exported from Wuhan to other cities in mainland China. Finally, we forecasted the spread of 2019-nCoV within and outside mainland China, accounting for the Greater Wuhan region quarantine implemented since Jan 23–24, 2020, and other public health interventions.

Figure 2 summarises our estimates of the basic reproductive number R0 and the outbreak size of 2019-nCoV in Wuhan as of Jan 25, 2020. In our baseline scenario, we estimated that R0 was 2·68 (95% CrI 2·47–2·86) with an epidemic doubling time of 6·4 days (95% CrI 5·8–7·1;).

We estimated that 75 815 individuals (95% CrI 37 304- 130 330) had been infected in Greater Wuhan as of Jan 25, 2020. We also estimated that Chongqing, Beijing, Shanghai, Guangzhou, and Shenzhen, had imported 461 (227–805), 113 (57–193), 98 (49–168), 111 (56–191), and 80 (40–139) infections from Wuhan, respectively.

Beijing, Shanghai, Guangzhou, and Shenzhen were the mainland Chinese cities that together accounted for 53% of all outbound international air travel from China and 69% of international air travel outside Asia, whereas Chongqing is a large metropolis that has a population of 32 million and very high ground traffic volumes with Wuhan. Substantial epidemic take-off in these cities would thus contribute to the spread of 2019-nCoV within and outside mainland China.

 


Figure 2 – Posterior distributions of estimated basic reproductive number and estimated outbreak size in greater Wuhan
NOTE: a zoonosis is an infectious disease that can spread between animals and humans. FOI = force of infection

 

Figure 4 shows the epidemic curves for Wuhan, Chongqing, Beijing, Shanghai, Guangzhou, and Shenzhen with a R0 of 2·68, assuming 0%, 25%, or 50% decrease in transmissibility across all cities, together with 0% or 50% reduction in inter-city mobility after Wuhan was quarantined on Jan 23, 2020.

The epidemics would fade out if transmissibility was reduced by more than 1–1/R0=63%. Our estimates suggested that a 50% reduction in inter-city mobility would have a negligible effect on epidemic dynamics.

We estimated that if there was no reduction in transmissibility, the Wuhan epidemic would peak around April, 2020, and local epidemics across cities in mainland China would lag by 1–2 weeks.

If transmissibility was reduced by 25% in all cities domestically, then both the growth rate and magnitude of local epidemics would be substantially reduced; the epidemic peak would be delayed by about 1 month and its magnitude reduced by about 50%.

A 50% reduction in transmissibility would push the viral reproductive number to about 1·3, in which case the epidemic would grow slowly without peaking during the first half of 2020.

However, our simulation suggested that wholesale quarantine of population movement in Greater Wuhan would have had a negligible effect on the forward trajectories of the epidemic because multiple major Chinese cities had already been seeded with more than dozens of infections each.

The probability that the chain of transmission initiated by an infected case would fade out without causing exponential epidemic growth decreases sharply as R0 increases (eg, <0·2 when R0>2).

As such, given the substantial volume of case importation from Wuhan, local epidemics are probably already growing exponentially in multiple major Chinese cities.

Given that Beijing, Shanghai, Guangzhou, and Shenzhen together accounted for more than 50% of all outbound international air travel in mainland China, other countries would likely be at risk of experiencing 2019-nCoV epidemics during the first half of 2020.

 


Figure 4 – Epidemic forecasts for Wuhan and five other Chinese cities under different scenarios of reduction in transmissibility and inter-city mobility

 

Ergo: reducing mobility is ineffective because too much mobility had already happened prior to the lockdowns. That ship has sailed. Not that one shouldn’t try to limit mobility, but it can’t stop the disease from spreading. The HKU team doesn’t say much about how they would see transmissibility lowered, but that seems to come down to more, and intense, lockdowns.

There’s a cruise ship floating off Yokohama where everyone is ordered to stay in their cabin because of the virus. Think along those lines: ordering people to stay in their homes. Sort of like the Black Death plague in 14th century Europe.

Perhaps there are anti-virals that can lower transmissibility somewhat, but that is by no means sure. The discovery ofasymptomatic transmitters doesn’t help either. You can’t very well test everyone, you test those with symptoms.

Chinese health authorities have identified a number of patients who have become carriers and transmitters of the coronavirus despite showing no outward symptoms of the disease. Li Xingwang, chief infectious diseases expert at Beijing Ditan Hospital, said most of the “dormant” carriers were related to and had caught the virus from patients with symptoms.


“These [carriers] have the virus and can transmit it. The amount of virus correlates to the severity of the illness, which means these patients carry less of the virus and their ability to transmit disease is weaker,” Li said.

 

Lunar New Year holidays have been extended everywhere across China, except in a few rare places. Major cities are under full lockdown. Western companies are scrambling to find alternative suppliers. Just 2 weeks into the epidemic. What happens when the factories stay closed for 6 or 16 more weeks?

Where will Chinese and western stocks be then? Xi Jinping has declared the WuhanCorona virus the number 1 threat. How can he order the factories to re-open before mid-April at the earliest then, when the peak of the epidemic hasn’t even been reached? But at the same time, can he afford to order all production shut for 2-3-4 months?

Thing about such peaks is, you can only see them in the rearview mirror. But you can bet that in 2-3 weeks max, people will solemnly declare the peak is here. Because the existing but especially potential economic damage will be so great. Bur declaring a peak too soon, let alone the end of the epidemic, is too much of a risk.

The way things are going, pretty soon there won’t be any westerners left in China, other than those who wish to stay permanently. Many if not most factories will be closed. No Chinese will be allowed to visit the rest of the world, while Chinese products will not ship there.

The big lockdown has just begun. Because once you start it, you can’t go back until you can prove that everything is safe. And that will in all likelihood take a long time, months. When will absolutely everybody have faith that everything is safe? When nobody falls ill anymore, when nobody can infect other people anymore.

But that’s a long way away. April, May, or later? And that in an economic system built on just-in-time delivery? Chinese oil demand is allegedly down 20% already. How can oil prices not fall if that is true? Since those prices are linked to the US dollar, what will happen with the currency?

There are too many questions that nobody can answer, or even try to. That’s complex systems for you. And I really really hope I’m wrong, but the way out of the lockdown is not clear at all.

The world cannot afford the risk of consciously helping to spread a lethal pandemic. And the only way to prevent it may be the big lockdown. Unless there’s a vaccine. But there isn’t one right now.

Overly alarmist, you say? Let’s hope so.

 

 

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