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Thursday, February 27, 2020

How Seriously Will Coronavirus Thin The Herd? What Can You Do About Not Being One Of The Ones Being Thinned?

Two or three weeks ago I explained why coronavirus fear had caused me to cancel a trip to the Dordogne region of France. Yesterday Scott McCartney was on the case for the Wall Street Journal: Smart Travel Planning In The Time Of Coronavirus. He began by asking, "Should you postpone or cancel travel because of coronavirus?" and replied "Yes, no and maybe." For him it's about geography-- a mistake. "For some destinations, the answer is a clear yes; others, a clear no. An increasing number are becoming a maybe, where it’s really a question of how much worry and hassle you want to pack into your trip." The disease is too rapid and virulent for there to be any negative answers, or even maybes. He's downplaying it and that's dangerous.
One threat: If you get the flu while traveling, you could end up quarantined somewhere because the symptoms in early stages are very similar to those of Covid-19.

“I think it’s a good time to assess personal risk tolerance,” says Henry Wu, director of Emory University’s TravelWell Center and assistant professor of infectious diseases at Emory University School of Medicine. “There’s a lot of potential for complications for travelers that may happen even if not high-risk for getting the disease.”

With the virus spreading beyond China to new countries, events and conferences are being canceled, airlines are expanding waivers to change reservations without penalty and more travelers are looking to postpone or cancel trips. The spread of the virus to Italy and South Korea changes travel considerations for many.

Travel does present greater risk because you typically encounter more people when traveling, public health experts say. They add that proper precautions-- frequently washing hands, avoiding touching unwashed hands to the face and liberal use of hand sanitizer-- reduce risk.

How to decide whether to go or not? Here’s a guide to help you make informed decisions:

Some Absolutes

First, if you’re sick, don’t travel. This rule applies all the time, but people routinely ignore it. Don’t do that in this climate unless you want to end up quarantined.

Some countries are or will be scanning passengers for increased body temperature. If you have a fever, you may be detained. Further, airline crews-- not to mention passengers-- are on heightened alert for anyone sneezing or coughing. In the U.S., the Centers for Disease Control and Prevention has recommended flight crews isolate ill passengers. And it’s not negotiable: On an airplane, failure to comply with crew orders is a federal crime.

Second, no matter where you travel internationally, there is increased risk that travel may be disrupted. An outbreak can mean a city is sealed off, flights are canceled and travelers are quarantined. So best to plan ahead for serious disruption, just in case.

Take extra supplies of your medications with you. Take a supply of cold medicine and a thermometer. You might want to take work materials with you that you need after your return in case you end up stuck somewhere. Make sure you have health insurance documentation in case you end up sick. And have someone back home at the ready to help with emergency travel plans if you need to find a way home quickly. A travel agent may be a very good idea.

“As we learn more about the virus, governments can change overnight how they are responding,” says epidemiologist Jennifer Nuzzo of the Johns Hopkins Center for Health Security.

Third, consider whether you have a higher risk of getting sick while traveling. Older people or those with underlying medical conditions may want to ground themselves, experts say.

Dr. Wu advises getting a flu shot before traveling if you haven’t already. It can take a week to become effective, but it’s not too late in the flu season to protect yourself.

Fourth, if you want to consider travel insurance, consider only “cancel for any reason” plans. These policies typically cost about 40% more than standard policies and typically reimburse about 75% of nonrefundable trip costs if you do cancel, says Megan Moncrief, chief marketing officer for Squaremouth, a travel insurance comparison service. That’s a lower payout than other plans, but it’s the only type of travel insurance that will help at this point.

If you have insurance you bought before the outbreak began, it likely will only cover you if you contract the virus. It might cover you if you get sick and your doctor certifies you shouldn’t travel during your planned itinerary. But travel insurance doesn’t cover fear.

“People are just nervous. They aren’t sure what’s going to happen. They simply don’t want to go anymore, don’t feel comfortable going, don’t feel safe going. But those aren’t covered reasons under a standard policy,” Ms. Moncrief says.

Now that the coronavirus outbreak is well known, policies you buy won’t cover it-- it’s a known hazard. It’s the same reason you can’t buy fire insurance as wildfires approach your house.

Some Options

There are some logical ways to make an informed choice about where to go. Use the CDC’s three-level warning system, which is frequently updated and considered reliable.

Level 3 is a high-level warning of serious outbreak and it’s a no-go. The CDC recommends avoiding all nonessential travel. If your destination is Level 3-- mainland China and South Korea, which was added to Level 3 on Tuesday-- the decision is simple.

Level 2 calls for practicing enhanced precautions. You can still go, but a good rule for any travelers nervous about the virus would be to postpone or cancel trips to Level 2 counties-- Italy, Iran and Japan as of Tuesday. Wait for things to resolve.

Level 1 is when a place has been put on watch. Right now, only Hong Kong is listed as Level 1 for coronavirus. But other countries are listed with “apparent community spread”: Singapore, Thailand, Taiwan and Vietnam. The CDC says virus spread isn’t sustained or widespread enough to warrant a travel health notice. But that may be notice enough for you. (Here’s a link to all CDC travel warnings.)

Even without notice, you may find public events canceled and venues closed. And closings to prevent congregating crowds may happen anywhere.

Public health experts say the biggest health risk for domestic travel now is the flu. No part of the U.S. is considered higher risk for coronavirus than any other. But Dr. Nuzzo of Johns Hopkins says she doesn’t believe authorities have a good handle on where the virus is and where it isn’t, including in the U.S., because many countries aren’t testing aggressively.

“I think this virus will turn up everywhere,” she says, because that’s how respiratory viruses tend to spread. She also notes that trying to stop the spread by restricting travel hasn’t worked so far.

Still, Dr. Nuzzo booked a family summer vacation recently to Mexico and plans to go, even though she expects the virus to show up in Mexico. “My risk tolerance is that life needs to go on,” she says.

Flights by themselves aren’t considered higher risk, except that they are crowded situations. Dr. Wu notes there have been no documented or confirmed cases of coronavirus transmission aboard an airplane. The World Health Organization says an airplane cabin by itself isn’t more conducive to spreading infection. But the proximity of passengers does matter.

The WHO says the virus is transmitted by droplets, and only lives on surfaces for short periods, perhaps 30 minutes. Other health groups have questioned that, suggesting it can live much longer on surfaces. If you are concerned, wipe down surfaces you are going to touch on airplanes or other public spaces, such as hotel rooms.

Paper surgical masks are effective at keeping you from spreading disease if you are sick, but not effective at blocking you from ingesting virus. For that, health experts recommend an N95 respirator—a heavy-duty mask.
Americans are not taking this seriously enough, in part because Trump just looks at it through the prism of his own reelection chances and has been foolishly and selfishly playing it down. Tuesday, Australian virologists Ian Mackay and Katherine Arden noted that coronavirus is now showing up in 30 countries outside China and that the rapid spread indicates that "the virus is ahead of our efforts to contain it." They wrote that their post "is based on the assumption that a pandemic will occur at some point and that Wave 1 will impact us, wherever we live, in the coming weeks and months... Planning now and doing something means we can control how well we cope with some of what may be coming."
If we enter into a pandemic, large numbers of people will be sick. Even if that’s just staying home with a fever and bad cough for a week. If COVID-19 is more severe, that will have a greater impact.

And when one family member is sick, one or more others may be involved in their care, removing more people from the workplace. The same effect may result if children being excluded from school. In a worst-case scenario, widespread illness may mean too few workers to drive trucks and trains, buses and taxis, run water treatment, electricity or other government services, teach at schools or staff hospitals. This didn’t happen in Australia during the 2009 H1N1 “swine flu” pandemic. But supply chains may be impacted in a number of ways.

Authorities will try to slow the speed of COVID-19 to prevent hospitals-- which are essential to care for the sickest people-- from being overloaded. Public gatherings-- sports events and concerts-- as well as schools and childcare centres, could be postponed or closed. All of which aims will be to keep people apart, making it harder for the virus to spread quickly. Again, these decisions will differ between places, and may not even have to be made.

...As long as the virus circulates, and as long as you have never been infected, you are susceptible to infection resulting in COVID-19. This will be the case for the rest of your life until you have been infected which should protect you from severe disease. COVID-19 is mostly a mild illness but can cause severe pneumonia in approximately 20% of cases, leading to hospitalization for weeks and in a portion of these cases, to death.

Stay at least 2m away from obviously sick people.
We’re trying to avoid receiving a cough/sneeze in the face, shaking hands, or being in the range of droplet splatter and the “drop zone”
Wash your hands for 20 seconds & more frequently than you do now
Soap and water and then dry, or an alcohol-based hand rub, and air dry
Try not to touch your face.
There is a chance your unwashed fingers will have a virus on them and if you touch/rub your mouth, nose or eyes, you may introduce the virus and accidentally infect yourself. Practice this; get others to call you out when you forget. Make it a game.
While a mask seems like a good idea, and when used by professionals it does protect from infection, it can actually give inexperienced users a false sense of security. There isn’t a lot of good evidence (still!) that shows a mask to reliably prevent infection when worn by the public at large. They are useful to put on a sick person to reduce their spreading of the virus.

If you or a loved one becomes sick, follow the practices of the day. Call ahead before going to a Doctor, fever clinic or hospital and get advice on what to do. Hopefully, this message is already out there and we’ll see it more once transmission of the virus is widespread.

Reducing our risk of running short of food and important goods-- the 2-week list

What we’re looking at here is trying to minimize the impact of any shortages of goods we rely on having at the grocery store or at the end of an online ordering system.

...Below we list things we’ll need to have in case of a more major interruption to supply; a stock that will last 2 weeks. Some of these things will last much longer and include items that may not be a top priority for authorities to keep stocked:
Extra prescription medications, asthma relief inhalers Some of these may be a problem, so talk to your doctor soon.
Over-the-counter anti-fever and pain medications paracetamol and ibuprofen can go a long way to making us feel less sick
Feminine hygiene products
Family pack of toilet paper
In case food shortages limit the variety in your diet
Alcohol-containing hand rub
Household cleaning agents
Bleach, floor cleaner, toilet cleaner, surface cleaning spray, laundry detergent
Tissues, paper towel
Cereals, grains, beans, lentils, pasta
Tinned food – fish, vegetables, fruit
Oil, spices and flavours
Dried fruit and nuts
Ultra-heat treated or powdered milk
Ian is not drinking black coffee, no matter what
Batteries for anything that need batteries
Think about elderly relative’s needs
Their medications, pets, pandemic stash, plans for care
Pet food and care
Dry and tinned food, litter tray liners, medicines, anti-flea drops
Soft drink or candy/chocolate for treats
In a more severe pandemic, supply chain issues may mean fresh food becomes harder to get. So this list is an add-on to the one above, and its items should be the last things to buy if you have a hint of when supplies might slow or stop for a (hopefully short) time.
Bread, wraps
Meat for freezing
Vegetables, fruit
Fuel for your car
To date, looking at data from China (below), most (94%) deaths from COVID-19 have occurred in those aged over 50 years of age, with more than half (51%) in those aged over 70 years. The age group most at risk for death are those aged over 80 years.

Older people with comorbidities have experienced higher proportions of death than those with no comorbidities. Most cases identified in mainland China-- 80.9% of them-- even with the more severe case catching that China has favoured-- have been classified as mild. This is good news although 20% is still a lot of “severe” disease. Mild cases recover in about 2 weeks from the time they showed symptoms, while severe cases can take 3 to 6 weeks to recover.

Because of this, we may see a big impact on our elderly population, both in terms of hospitalisation and death. Residential aged care is likely to suffer and visits to loved ones may be restricted to keep them safe. If you have loved ones in an aged care facility, ask the facility about its plans for keeping their residents safe from flu (a similar situation) and whether they have thought about what they will do if SARS-CoV-2 is spreading widely.

It will be important to check that your parents and grandparents have prepared a Will and have considered an Enduring Power of Attorney in case they are unable to make care-based decisions for themselves. These aren’t fun to organise or think about, but they’re important whether we see a COVID-19 pandemic or not, so just use this as a reminder to get it done.
And when does it become too dangerous to go out to eat in restaurants? Yesterday? Much the way Trevor Noah did last night, but writing for Bloomberg News this morning, Jonathan Bernstein explained that Trump's coronavirus press conference wasn't exactly reassuring to anyone with half a brain. "Yes, he used his usual juvenile nicknames and petty insults for the Democrats he’s going to have to work with. Yes, he blamed the stock market drop on Monday and Tuesday on-- wait for it-- the Democratic debate Tuesday night. Yes, he repeatedly praised himself for solving the problem (setting up a potential 'Mission Accomplished' moment in the likely event the pandemic spreads in the U.S.) and had administration officials praise him as well. All entirely inappropriate and counterproductive. But it was worse than that. He was at times barely coherent even for someone who knew what he was trying to say. I can’t imagine what it was like for the bulk of the nation, folks who only sometimes pay attention to politics but might have tuned in because they want to be reassured that the government is on top of the problem. He must have been almost completely incomprehensible to them, rambling on about how he had recently discovered that the flu can kill lots of people and referring in a totally oblique way to the budget requests he had made to Congress and their reaction. He occasionally said something that sort of made sense, but mostly? Not. Dr. Ezekiel Emanuel’s reaction was what I thought: 'I found most of what he said incoherent.' At no time over the course of the news conference did Trump supply evidence that he had any idea what he was talking about." Yeah... we're all going to die-- although Trump supporters will probably die first; at least there's that.

Sunday, February 09, 2020

In Regard To The Coronavirus, How Unsafe Is Airplane Travel? Will Governments Level With Us?

I'm a fairly intrepid international traveller and I've never thought twice about pandemics when making my travel plans. Until this morning. This morning is when I called my friend Helen, who was putting out summer vacation together in the Dordogne region of France. First off, how cool does this look?

But I told Helen to hold up on reserving the house Sarlat we were planning on. I just got this awful feeling that this coronavirus is way more serious than the public is lead to believe and that by summer, air travel is going to be... well too risky, even just to Europe.

Today the Washington Post reported that both the number of infected people and the number of people dying keeps growing, primarily in Wuhan in central China.
The global death toll from the novel coronavirus reached more than 810 on Sunday, surpassing the 774 fatalities attributed to the outbreak of the SARS coronavirus in 2002 and 2003. Among the dead was the first American, a 60-year-old woman who died Thursday in Wuhan.
Although Wuhan and Hubei province remain ravaged by the disease, Chinese officials say the number of new cases outside Hubei is declining, in a reflection of strict quarantine measures taking effect nationwide.
A World Health Organization-led international team is planning to leave for China on Monday or Tuesday to conduct an investigation of the coronavirus.
Chinese authorities have labeled masks a “strategic resource,” and experts call for most protective masks to be reserved for medical workers amid global shortages.
Hong Kong expanded its quarantine orders to more than 160 people who arrived from the Chinese mainland. People who violate the quarantine face up to six months in jail.
As far as I can tell, infected people in China are being put into what amounts to storage facilities. Oh-- and the Chinese government aren't being very forthcoming about the disease. We don't really know much about anything and I don't trust any of the information China is releasing. The Post reported that "Even as infections overwhelm the afflicted province, the rest of China may be seeing the effects of strict quarantine measures, Chinese health officials said Sunday. In all parts of China excluding Hubei, the daily number of new infections dropped from nearly 900 on Feb. 3 to 509 on Saturday, the officials said." Is it true? I wouldn't count on it.

An international team of experts led by WHO will depart for China on Monday or Tuesday to investigate the outbreak, said the director-general Tedros Adhanom Ghebreyesus.

Medical experts say available data show the disease-- officially named “novel coronavirus pneumonia,” or NCP, by Chinese health officials on Saturday-- is much more contagious than SARS, but the probability of death for those infected is much lower.

Around the world, cases continue to tick up. The number of confirmed infections rose on Sunday to 70 onboard the cruise liner Diamond Princess, which has been anchored and quarantined off the coast of Japan. Only the sick are able to disembark.

One of the evacuees was Rebecca Frasure, her husband Kent Frasure, 42, told The Post by phone on Sunday from the quarantined ship in Yokohama. The couple from Forest Grove, Ore., had traveled to Disneyland in Hong Kong, Vietnam and other destinations before Japanese medical staff boarded the ship with thermometers. Rebecca Frasure, 35, tested positive for the virus on Thursday, her husband said, and was taken by ambulance to a hospital north of Tokyo.

“She is doing pretty good, no fever or cough,” he said, although symptoms can take as many as 14 days after exposure to appear. Frasure said his wife is being evaluated in a stripped-down contagious disease ward with just a bed, TV and calendar on the wall. Doctors step through a sealed antechamber to see her.

It is an alien experience for her, said Frasure, a technician at Intel. She does not speak Japanese and the physicians use electronic devices to translate confusing medical jargon. But Rebecca, who works for a health-care company, has WiFi and keeps in contact with him and family on FaceTime, he said.

The quarantine on the ship, meanwhile, has become claustrophobic. Frasure had a fever earlier, so he has been restricted to his suite. His Nintendo Switch and reporters calling him for comment help pass the time, he said. The ship captain periodically issues updates over a loudspeaker, but media reports often clue in the passengers before then.

“Usually we know what’s happening before it’s announced,” he said.

Singapore’s prime minister, Lee Hsien Loong, urged calm as the city-state reported a spike in the number of cases to a total of 40 and raised its alert level. New cases were also reported in Germany and South Korea.

In Hong Kong, where grocery stores have been emptied as worried residents stock up on supplies, the number of cases rose by three to a total of 29 on Sunday. The city’s health authorities said tests for all 3,600 crew and passengers quarantined for the past four days on a cruise ship, the World Dream, came back negative and everyone aboard was released Sunday afternoon.

China faces a crucial test beginning Monday as laborers from across the country trickle back to work in major cities that have been effectively emptied and shut down since the Lunar New Year in late January.

Officials, concerned about another spike in infections, have tried to delay the return to work. Shanghai is asking companies to dissuade nonlocal employees from returning for several more weeks. In Shenzhen, the iPhone assembler Foxconn has told employees that work is suspended until further notice. Officials in cities ranging from Xian in the north to Tianjin on the east coast have warned travelers from other parts of China that they would be immediately quarantined upon their return.

In a sign that governments are still seeking to prolong closures, state media reported Sunday that the populous Hebei province surrounding Beijing would join a number of other major jurisdictions keeping schools closed until March 1 at the earliest.

At the heart of the epidemic in Wuhan, the situation remains dire.

Officials are rushing to transfer patients into three quarantine facilities with 4,000 beds to alleviate a severe shortage of space inside the city’s overwhelmed hospitals. Hotels and university dorms are being requisitioned and converted into spaces for “centralized quarantine” for patients showing symptoms.

Leishenshan, a second makeshift hospital with 1,600 beds, began accepting patients with severe symptoms beginning Saturday night, state media reported.

Wuhan officials had initially asked all but the most ill patients to stay home in recent weeks due to a shortage of hospital beds, but on Saturday Vice Premier Sun Chunlan, the leader of a central government response group, ordered local officials to “take in everyone that should be taken in” to newly established facilities to quarantine confirmed cases.

But risks remain inside medical facilities. Doctors from Wuhan’s Zhongnan Hospital reported that 41 percent of coronavirus patients at their hospital became infected while inside the hospital by other patients and medical staff. The doctors announced their findings in a paper published by the Journal of the American Medical Association on Friday.

At another hospital, the Wuhan Mental and Health Center, 50 patients and 30 medical staff were infected due to a lack of caution and protective gear, a doctor, Zhao Ping, told China Newsweek magazine.

Hubei deputy governor Cao Guangjing said Saturday that hospitals in the province had only 80 percent of the masks they required.

Two prominent incidents have become symbols for China’s tight grip on information and simmering tensions among its citizens unhappy with Beijing’s response to the virus.

Chen Qiushi, an attorney and citizen journalist, slipped into the Wuhan hot zone on Jan. 24 to interview citizens about the outbreak, The Post reported, garnering worldwide attention for the city of 11 million where little, if any, information has slipped through government censors.

Chen’s family and friends said this weekend he was forcibly detained in an undisclosed location.

Details of his disappearance emerged days after Li Wenliang, the “whistleblower doctor” considered the first to sound the alarm about the disease, died after contracting the virus in Wuhan.

Millions of Chinese tried to surge past censors by amplifying the social media hashtag #WeWantFreedomOfSpeech, and photos of him flooded the Internet as a digital rallying cry.

One month after patients began flooding into area hospitals, many increasingly sick and desperate households say they still cannot secure care and fear time is running out.

Li Lina, a resident in the Hanyang district, beat a gong and shrieked from her high-rise balcony this weekend to beg for help for her and her stricken mother holed up at home. A neighbor filmed her cries and uploaded it to the Internet, where it went viral.

Reached by telephone on Sunday, Li explained that her mother’s condition was steadily worsening but she has not been able to secure a hospital bed since Jan. 29, because city regulations allow only confirmed coronavirus patients to get spots.

Li was finally able to administer a nucleic acid test on Friday; the result returned positive for coronavirus but ambiguous. Doctors gave her mother a second exam and Li is waiting for the result to arrive Tuesday.

“I don’t even know if she’ll hold out that long,” Li said as she tended to her mother, who is too feeble to speak and communicates by ringing a bell. “I feel helpless. I can’t watch my mother die.”

A friend of mine who lives in Hong Kong told me that the city is better equipped than most places, because of previous hibernations in response to SARS and bird flu potential pandemics, to react by being careful without panicking. BUT the government has virtually no credibility. The consequence of that is the city's medics are on strike demanding a total shutdown of the Chinese border.

There were 7,000 medics on strike last week