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Online Discussion: Tracking new emerging diseases and the next pandemic since 2005; Coronavirus COVID-19 Pandemic Discussion Forum.

China Investigates SARS Like Pneumonia Disease

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Albert View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 8:18am
2 more yesterday in critical condition. Eitherway the hospitalization rate is quite high. Not sure if all 60 required hospitalization at one point, but that's a 3% rate, if the 1,700 estimated cases is accurate. And without treatment for the pneumonia, what would the fatality rate be?

I agree though, without actual numbers and with China suppressing information, who knows what the outcome will be and what numbers we're dealing with.     
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 9:21am
Other things to consider if the estimates are accurate with this nCoV, and it does in fact spread globally:

Coinfections are common with coronaviruses and the flu. What happens during flu season and coinfections with this one?

Is it here to stay forever like other coronaviruses?

Are animals also going to be transmitting it, and which ones? pets?


Would like to take China's word for it that they can contain it and the situation in controllable, but I guess we will know that in the coming days.   
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 9:50am

I've been saying this nCoV is a real close cousin to Sars, or Sars itself. I still say Sars2 and China is splitting hairs in their sequencing, to avoid saying it. A slight variant to Sars.    


Analysis of the genetic code of the new virus shows it is more closely related to Sars than any other human coronavirus.


https://www.bbc.com/news/health-51168333
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 11:32am
First cousin! Alike in so many ways!
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Wow... this thing is exploding. Make note that approx 33 of the new cases are *severe*.

Rapidly spreading: Chinese authorities confirm 136 NEW cases of deadly virus in 2 days

Health officials in Wuhan, China have revealed that 136 new cases of a mysterious new strain of the coronavirus have been diagnosed over just two days, bringing the total in the city to 198.

In a statement detailing the latest escalation in figures for the major viral outbreak, Wuhan Municipal Health Commission said a third person has died from the illness, while two more are in critical condition. A further 33 cases among the newly diagnosed patients are classified as “severe.” All of the patients are being kept in isolation.

https://www.rt.com/news/478669-coronavirus-outbreak-china-wuhan-soars/
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Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth.🖖

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 3:28pm
[I can't get that link to work, Carbon.

Hopefully this will work:]
https://www.who.int/health-topics/coronavirus/laboratory-diagnostics-for-novel-coronavirus
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 3:43pm
[This is the clinical recommendations of the WHO for suspected cases.

It should show us what to expect]


Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected:

Interim Guidance

1 Clinical management of severe acute respiratory infection when novelcoronavirus (nCoV)infection is suspected Interim guidance 12January 2020WHO/nCoV/Clinical/2020.

1 Introduction This is the first edition of this document for novel coronavirus, an adaption of WHO Clinical management of severe acute respiratory infection when MERS-CoVinfection is suspected publication (2019). This document is intended for clinicians taking care of hospitalised adult and paediatric patients with severe acute respiratory infection (SARI) when a nCoV infectionis suspected. It is not meant to replace clinical judgmentor specialist consultation but rather to strengthen clinical management of these patients and provide to up-to-date guidance.   Best practices for SARI including IPC and optimized supportive care for severely ill patients are essential.   This document is organized into the following sections:

1.Triage: recognize and sort patients with SARI

2.   Immediate implementation of appropriate infection prevention and control (IPC)measures

3.Early supportive therapy and monitoring

4.Collection of specimens for laboratory diagnosis

5. Management of hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS)

6.Management of septic shock

7.Prevention of complications

8.Specific anti-nCoV treatments

9.Special considerations for pregnant patients. These symbols are used to flag interventions:

Do: the intervention is beneficial(strong recommendation) OR the intervention is a best practice statement

Don’t: the intervention is known to be harmful.

Consider: the intervention may bebeneficial in selected patients (conditional recommendation) OR be careful when considering this intervention.

This document aims to provide clinicians with updated interim guidance on timely, effective, and safe supportive management of patients with nCoV and SARI, particularly those with critical illness. The recommendations in this document are derived from WHO publications.   1-4   Where WHO guidance is not available, we refer to evidence-based guidelines. Members of a WHO global network of clinicians, and clinicians who have treated SARS, MERS or severe influenza patients have reviewed the recommendations (see Acknowledgements).   

For queries, please email outbreak@who.intwith ‘nCoVclinical question’ in the subject line.

[Technophobe: This is obviously a hasty first draft and (up until now) I have attempted to correct the lack of spaces, paragraphs and punctuation. But I can't keep it up! I'm dyslexic and proof reading is enormously hard for me. So appologies, the rest is in part as it is in the PDF, I just added about 200 spaces between words, so it would all fit on one page,]

Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance 21.

Triage: early recognition of patients with SARI associated with nCoV infection Triage: recognize and sort all patients with SARI at first point of contact with health care system (such as the emergency department). Consider nCOV as a possible etiology of SARI under certain conditions (see Table 1). Triage patients and start emergency treatments based based on disease severity. Remarks: nCoV may present with mild ,moderate, or severe illness; the latter includes severe pneumonia, ARDS, sepsis and septic shock. Early recognition of suspected patients allows for timely initiation of IPC (see Table 2). Early identification of those with severe manifestations (see Table 2) allows for immediate optimized supportive care treatments and safe, rapid admission (or referral)to intensive care unit according to institutional or national protocols. For those with mild illness, hospitalization may not be required unless there is concern for rapid deterioration. All patients discharged home should be instructed to return to hospital if they develop any worsening of illness. Table 1. Definitions of patients with SARI, suspected of nCoV* SARI. An ARI with history of fever or measured temperature ≥38 C° and cough; onset within the last ~10 days; and requiring hospitalization.

5 However, the absence of fever does NOT exclude viral infection.

6 Surveillance case definitions for nCoV*

1. Severe acute respiratory infection (SARI) in a person, with history of fever and cough requiring admission to hospital, with no other etiology that fully explains the clinical presentation

1(clinicians should also be alert to the possibility of atypical presentations in patients who are immunocompromised); AND any of the following: a)A history of travel to Wuhan, Hubei Province China in the 14 days prior to symptomon set; or b) the disease occurs in a healthcare worker who has been working in an environment where patients with severe acute respiratory infections are being cared for, without regard to place of residence or history of travel; or c) the person develops an unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, without regard to place of residence or history of travel, even if another etiology has been identified that fully explains the clinical presentation.

2. A person with acute respiratory illness of any degree of severity who, within 14 days before onset of illness, had any of the following exposures: a) close physical contact 2 with a confirmed case of nCoV infection, while that patient was symptomatic; or b) a healthcare facility in a country where hospital-associated nCoV infections have been reported; *see https://www.who.int/health-topics/coronavirus for latest case definitions 1 Testing should be according to local guidance for management of community-acquired pneumonia. Examples of other etiologies include Streptococcus pneumoniae, Haemophilus influenzae type B, Legionella pneumophila, other recognized primary bacterial pneumonias, influenzaviruses, and respiratory syncytial virus.

2 Close contact’ is defined as:-Health care associated exposure, including providing direct care for nCoVpatients, working with health care workers infected with nCoV, visiting patients or staying in the same close environment of a nCoVpatient. - Working together in close proximity or sharing the same classroom environment with a with nCoVpatient-Traveling together with nCoVpatient in any kind of conveyance-Living in the same household as a nCoVpatientThe epidemiological link may have occurred within a 14-day period before or after the onset of illness in the case under consideration.

Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance3Table 2. Clinical syndromes associated with nCoV infectionUncomplicated illnessPatients with uncomplicated upper respiratory tract viral infection, may havenon-specific symptoms such as fever, cough, sore throat, nasal congestion, malaise, headache, muscle pain or malaise. The elderly and immunosuppressed may present with atypical symptoms. These patients do not have any signs of dehydration, sepsis or shortness of breath. Mild pneumonia Patient with pneumonia and no signs of severe pneumonia.Child with non-severe pneumonia has cough or difficulty breathing + fast breathing: fast breathing(in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40and no signs of severe pneumonia. Severe pneumonia Adolescent or adult: fever or suspected respiratory infection, plus one of respiratory rate >30 breaths/min, severe respiratory distress, or SpO2<90% on room air(adapted from [1]). Child with cough or difficulty in breathing, plus at least one of the following:central cyanosis or SpO2<90%; severe respiratory distress (e.g. grunting, very severe chest indrawing); signs of pneumonia with a general danger sign: inability to breastfeed or drink,lethargy orunconsciousness, or convulsions.Other signs of pneumonia may be present: chest indrawing, fast breathing(in breaths/min):<2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40.2The diagnosis is clinical; chest imaging can exclude complications. Acute Respiratory Distress Syndrome7-9Onset: new or worsening respiratory symptoms within one week of known clinical insult.Chest imaging (radiograph, CT scan, or lung ultrasound):bilateral opacities, not fully explained by effusions, lobar or lung collapse,or nodules. Origin of oedema:respiratory failure not fully explained by cardiac failure or fluid overload. Need objective assessment (e.g. echocardiography) to exclude hydrostatic cause of oedema if no risk factor present.Oxygenation (adults):•Mild ARDS: 200 mmHg < PaO2/FiO2≤300 mmHg (with PEEP or CPAP≥5 cmH2O,7or non-ventilated8)•Moderate ARDS: 100 mmHg < PaO2/FiO2≤200 mmHg with PEEP ≥5 cmH2O,7or non-ventilated8)• Severe ARDS: PaO2/FiO2≤100 mmHg with PEEP ≥5 cmH2O,7or non-ventilated8)• When PaO2is not available, SpO2/FiO2≤315 suggests ARDS(including in non-ventilated patients)Oxygenation (children; note OI = Oxygenation Index and OSI = Oxygenation Index using SpO2):•Bilevel NIV or CPAP ≥5 cmH2Ovia full face mask: PaO2/FiO2≤300 mmHg or SpO2/FiO2≤264• Mild ARDS (invasively ventilated): 4≤OI<8or 5≤OSI<7. 5•Moderate ARDS (invasively ventilated): 8≤OI<16or 7.5≤OSI<12. 3•Severe ARDS (invasively ventilated): OI≥16or OSI≥12.3Sepsis10,11Adults: life-threatening organ dysfunction caused bya dysregulated host response to suspected or proven infection, with organ dysfunction*. Signs of organ dysfunction include: altered mental status, difficult or fast breathing, low oxygen saturation, reduced urine output, fast heart rate, weak pulse, cold extremities or low blood pressure, skin mottling, or laboratory evidence of coagulopathy, thrombocytopenia, acidosis,high lactate orhyperbilirubinemia. Children: suspected or proven infection and ≥2 SIRS criteria, of which one must be abnormal temperature or white blood cell count.Septic shock10,12Adults: persisting hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥65mmHg and serum lactate level >2 mmol/L. Children (based on [12]): any hypotension (SBP <5thcentile or >2SD below normal for age) or 2-3 of the following: altered mental state; tachycardia or bradycardia (HR <90bpm or >160bpm in infants and HR <70 bpm or >150bpm in children); prolonged capillary refill (>2sec) or warm vasodilation with bounding pulses; tachypnea; mottled skin or petechial or purpuric rash; increased lactate; oliguria; hyperthermia or hypothermia. Abbreviations: ARI, acute respiratory infection; BP, blood pressure; bpm, beats/minute; CPAP, continuous positive airway pressure; FiO2, fraction of inspired oxygen; MAP, mean arterial pressure; NIV, noninvasiveventilation; OI, Oxygenation Index; OSI, Oxygenation Index using SpO2; PaO2, partial pressure of oxygen; PEEP, positive end-expiratory pressure; SBP, systolic blood pressure; SD, standard deviation;SIRS, systemic inflammatory response syndrome; SpO2, oxygen saturation. *If altitude is higher than 1000m, then correction factor should be calculated as follows: PaO2/FiO2 x Barometric pressure/760. *The SOFA score ranges from 0 to 24 and includes points related to 6 organ systems: respiratory (hypoxemia defined by low PaO2/FiO2), coagulation(low platelets), liver (high bilirubin), cardiovascular (hypotension), central nervous system (low level of consciousness defined by Glasgow Coma Scale), and renal (low urine output or high creatinine). Sepsis is defined by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score13of ≥2 points. Assume the baseline score is zero if data are not available
Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance42. Immediate implementation of appropriate IPC measuresIPC is a critical and integral part of clinical management of patientsand should be initiated at the point of entry of the patient to hospital (typically the Emergency Department). Standard precautions should always be routinely applied in all areas of health care facilities. Standard precautions include hand hygiene; use of PPE to avoid direct contact with patients’ blood, body fluids, secretions (including respiratory secretions) and non-intact skin. Standard precautions also include prevention of needle-stick or sharps injury; safe waste management; cleaning and disinfection of equipment; and cleaning of the environment.Table 2. How to implement infection prevention and control measuresfor patients with suspected or confirmed nCoV infection14,15At triageGive suspect patient a medical mask and direct patient to separate area, anisolation room if available. Keep at least 1meter distance between suspectedpatientsand other patients. Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow for others. Perform hand hygiene after contact with respiratory secretions Apply droplet precautions Droplet precautions prevent large droplet transmission of respiratory viruses. Use a medical mask if working within 1-2metres of the patient. Place patients in single rooms,or group together those with the same etiological diagnosis. If an etiological diagnosis is notpossible, group patients with similar clinical diagnosis and based on epidemiological risk factors, with a spatial separation. When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), use eye protection (face-mask or goggles), because sprays of secretions may occur. Limit patient movement within the institution and ensure that patients wear medical masks when outside their rooms.Apply contact precautions Droplet and contact precautions prevent direct or indirect transmission from contact with contaminated surfaces or equipment (i.e. contact with contaminatedoxygen tubing/interfaces).Use PPE (medical mask, eye protection, gloves and gown) when entering room and remove PPEwhen leaving.If possible, use either disposableor dedicatedequipment(e.g.stethoscopes,blood pressure cuffsand thermometers). If equipment needs to be shared among patients, clean and disinfectbetween each patient use. Ensure that healthcare workers refrain from touching their eyes, nose,andmouth with potentially contaminated gloved or ungloved hands. Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handlesandlight switches). Ensure adequate room ventilation. Avoid movement of patients or transport. Perform hand hygiene. Apply airborne precautions when performing an aerosol generating procedureEnsure that healthcare workers performing aerosol-generating procedures (i.e. open suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation)use PPE,including gloves, long-sleeved gowns, eye protection,and fit-tested particulaterespirators (N95 orequivalent,or higher level of protection). (The scheduled fit test should not be confused with user seal checkbefore each use.) Whenever possible, use adequately ventilated single rooms when performingaerosol-generating procedures, meaning negative pressure rooms with minimum of 12 air changes per hour or at least 160 litres/second/patient in facilities with natural ventilation. Avoid the presence of unnecessary individuals in the room. Care for the patient in the same type of room after mechanical ventilation commences.   Abbreviations: ARI, acute respiratory infection; PPE, personal protective equipment 3.Early supportive therapy and monitoring Give supplemental oxygen therapy immediatelyto patients with SARIand respiratory distress, hypoxaemia,or shock.Remarks: Initiate oxygen therapy at 5 L/min and titrateflow ratesto reach target SpO2≥90% in non-pregnant adults and SpO2≥92-95 % in pregnant patients.

1,2Children with emergency signs (obstructed or absent breathing, severe respiratory distress, central cyanosis, shock, coma or convulsions) should receive oxygen therapy during resuscitation to target SpO2≥94%; otherwise, the target SpO2is ≥90%.

4 All areas where patients with SARI are cared for should be equipped with pulse oximeters, functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces(nasal cannula, simple face mask, and mask with reservoir bag). Use contact precautions when handling contaminated oxygen interfaces of patients with nCoV infection.Use conservative fluid management in patients with SARI when there is no evidence of shock.Remarks: Patients with SARI should be treated cautiously with intravenous fluids, because aggressive fluid resuscitation may worsen oxygenation, especially in settings where there is limited availability of mechanical ventilation.

16 Give empiric antimicrobials to treat all likely pathogens causing SARI. Give antimicrobials within one hour of initial patient assessmentfor patients with sepsis.   Remarks: Although the patient may be suspected to have nCoV, administer appropriate empiric antimicrobials within ONE hour of identification of sepsis.

17Empiric antibiotic treatment should be based on the clinical diagnosis(community-acquired pneumonia, health care-associated pneumonia [if infection wasacquired in healthcare setting], or sepsis), local epidemiologyand susceptibility data, and treatment guidelines. Empiric therapy includes a neuraminidase inhibitor for treatment of influenza when there is local circulation or other risk factors,including travel history or exposure to animal influenza viruses.18Empiric therapy should be de-escalatedon the basis of microbiology resultsand clinical judgment.Do not routinely give systemic corticosteroids for treatment of viral pneumoniaor ARDS outside ofclinical trialsunless they are indicated for another reason. Remarks: A systematic reviewofobservational studies ofcorticosteroidsadministered to patients with SARS reported no survival benefitand possible harms (avascular necrosis,psychosis, diabetes, and delayedviral clearance).19A systematic review of observational studies in influenza found a higher risk of mortality and secondary infections with corticosteroids; the evidence was judged as very low to low quality due to confounding by indication.

20A subsequent study that addressed this limitation by adjusting for time-varying confounders found no effect on mortality.

21Finally, a recent study of patients receiving corticosteroids for MERS used a similar statistical approach and found no effect of corticosteroids on mortality but delayed lower respiratory
Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance5tract (LRT)clearance of MERS-CoV.22Given lack of effectivenessand possible harm, routine corticosteroids should be avoided unless they are indicated for another reason. See section 6 for the use of corticosteroids in sepsis.Closely monitor patients with SARI for signs of clinical deterioration, such as rapidly progressive respiratory failureand sepsis, and apply supportive care interventions immediately. Remarks: Application of timely, effective,and safe supportive therapies is the cornerstone of therapy for patients that develop severe manifestations of nCoV. Understand the patient’s co-morbid condition(s) to tailor the management of critical illness and appreciate the prognosis. Communicate early with patient and family.Remarks: During intensive care management of SARI, determine which chronic therapies should be continued and which therapies should be stopped temporarily. Communicate proactively with patients and families and provide support and prognostic information. Understand the patient’s values and preferences regarding life-sustaining interventions.

4.Collection of specimens for laboratory diagnosis WHO guidance on specimen collection, processing, and laboratory testing, including related biosafety procedures,is available.23Collect blood cultures for bacteria that cause pneumonia and sepsis, ideally before antimicrobial therapy. DO NOT delay antimicrobial therapy to collect blood cultures.Collect specimens from BOTH the upper respiratory tract (URT; nasopharyngeal and oropharyngeal) ANDlower respiratory tract (LRT; expectorated sputum, endotracheal aspirate,or bronchoalveolar lavage)for nCoV testing by RT-PCR. Clinicians may elect to collect only LRT samples when these are readily available (for example, in mechanically ventilated patients). Serology for diagnostic purposes isrecommended only when RT-PCR is not available.23Remarks: Use appropriate PPE for specimen collection (droplet and contact precautions for URT specimens; airborne precautions for LRT specimens). When collecting URTsamples,use viral swabs (sterile Dacron or rayon, not cotton) and viral transport media. Do not sample the nostrils or tonsils. In a patient with suspected novel coronavirus, especially with pneumonia or severe illness, a single URT sample does not exclude the diagnosis, and additional URT and LRT samples are recommended.

23LRT (vs. URT) samplesare more likely to be positive and for a longer period.23Clinicians may elect to collect only LRT samples when these are readily available (for example, in mechanically ventilated patients). Sputum inductionshould be avoided due to increased risk of increasing aerosol transmission.Remarks: Dual infections with other respiratory viral infectionshave been found in SARS and MERS cases. At this stage we need detailed microbiologic studies in all suspected cases. Both URT and LRT specimens can tested for other respiratory viruses, such as influenza A and B(including zoonotic influenza A), respiratory syncytialvirus, parainfluenza viruses, rhinoviruses, adenoviruses, enteroviruses(e.g. EVD68), human metapneumovirus, and endemic human coronaviruses (i.e.HKU1, OC43, NL63, and 229E). LRT specimens can also be tested for bacterial pathogens, including Legionella pneumophila. In hospitalized patients with confirmed nCoV infection,repeat URT and LRT samples should be collected to demonstrate viral clearance.

Thefrequencyof specimencollectionwill dependonlocalcircumstances but should be atleastevery 2to4 days until there are two consecutive negative results (both URT and LRTsamples if both are collected) in a clinically recovered patientat least 24 hours apart.If local infection control practice requires two negative results before removal of droplet precautions, specimens may be collected as often as daily. 5.Management of hypoxemic respiratory failure and ARDSRecognize severe hypoxemic respiratory failure when a patient with respiratory distress is failing standard oxygen therapy.Remarks: Patients may continue to have increased work of breathing or hypoxemia even when oxygen is delivered via a face mask with reservoir bag (flow rates of 10-15 L/min, which is typically theminimumflow required to maintain bag inflation; FiO20.60-0.95).Hypoxemic respiratory failure in ARDS commonly results from intrapulmonary ventilation-perfusion mismatch or shunt andusually requires mechanical ventilation.High-flow nasal oxygen (HFNO)or non-invasive ventilation (NIV) should onlybe usedin selectedpatients with hypoxemic respiratory failure. The risk of treatment failure is high in patients with MERS treated with NIV, and patients treated with either HFNO or NIV should be closely monitored for clinical deterioration.Remark1: HFNOsystems can deliver 60 L/min of gas flowand FiO2up to 1.0; paediatric circuits generally only handle up to 15 L/min, and many children will require an adult circuit to deliver adequate flow.Compared to standard oxygen therapy, HFNO reduces the need for intubation.24Patients withhypercapnia(exacerbation of obstructive lung disease, cardiogenic pulmonary oedema), hemodynamic instability,multi-organ failure, or abnormal mental statusshould generally not receive HFNO, although emerging data suggest that HFNO may be safe in patients with mild-moderate and non-worsening hypercapnia.25Patients receiving HFNO should be in a monitored setting and cared for by experienced personnelcapable of endotracheal intubationin case the patient acutely deteriorates or does not improveafter a short trial (about 1 hr). Evidence-based guidelines on HFNO do not exist, and reports on HFNOin MERS patients are limited.26


Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance7only be offered in expert centres with a sufficient case volume to maintain expertiseand that can apply the IPC measures required for nCoV patients.48Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis. Use in-line catheters for airway suctioningand clamp endotracheal tube when disconnection isrequired (for example, transfer to a transport ventilator). 6.Management of septic shock Recognize septic shock in adults when infection is suspected or confirmed ANDvasopressors are needed to maintain mean arterial pressure (MAP)≥65 mmHg AND lactate is≥2 mmol/L, in absence of hypovolemia. Recognize septic shock in children with any hypotension (systolic blood pressure [SBP]<5thcentile or >2 SD below normal for age) or 2-3 of the following: altered mental state; tachycardia or bradycardia (HR <90 bpm or >160 bpm in infants and HR <70 bpm or >150 bpm in children); prolonged capillary refill (>2sec) or warm vasodilation with bounding pulses; tachypnea; mottled skin or petechial or purpuric rash; increased lactate; oliguria; hyperthermia or hypothermia.Remarks: In the absence of a lactate measurement, use MAP and clinical signs of perfusion to define shock. Standard care includes early recognitionand the following treatments within 1 hourof recognition:antimicrobial therapyand fluid loadingand vasopressors for hypotension.49Theuse of central venous and arterial catheters should be based on resource availability and individual patient needs.Detailed guidelines are available for the management of septic shock in adults17and children.2,3,12In resuscitation from septic shockin adults, give at least 30 ml/kg of isotonic crystalloid in adults in the first 3 hours. In resuscitation from septic shock in childrenin well-resourced settings, give 20 ml/kg as a rapid bolus and up to 40-60 ml/kg in the first 1 hr.Do not usehypotonic crystalloids,starches,or gelatins for resuscitation.Fluid resuscitation may lead to volume overload, including respiratory failure. If there is no response to fluid loading and signs of volume overload appear (for example,jugular venous distension, crackles on lung auscultation, pulmonary oedemaon imaging,or hepatomegaly in children),then reduce or discontinue fluid administration. This step is particularly important where mechanical ventilation is not available. Alternate fluid regimens are suggested when caring for children in resource-limited settings50Remarks: Crystalloids include normal saline and Ringer’s lactate. Determine need for additionalfluid boluses (250-1000 ml in adults or 10-20 ml/kg in children) based on clinical responseand improvement of perfusion targets. Perfusion targets include MAP (>65 mmHg or age-appropriate targets in children), urine output (>0.5 ml/kg/hr in adults, 1 ml/kg/hr in children), and improvement of skin mottling, capillary refill, level of consciousness, and lactate.Consider dynamic indices of volume responsiveness to guide volume administration beyond initial resuscitationbased on local resources and experience.17These indices include passive leg raises, fluid challengeswithserial stroke volume measurements, or variations in systolicpressure, pulse pressure, inferior vena cava size, or stroke volume in response tochanges inintrathoracic pressure duringmechanical ventilation.Starches are associated with an increased risk of death and acute kidney injury vs. crystalloids. The effects of gelatins are less clear, but they are more expensive than cyrstalloids. 51,52Hypotonic (vs. isotonic) solutions are less effective at increasing intravascular volume. Surviving Sepsis also suggestsalbumin forresuscitation when patients require substantial amounts of crystalloids, but this conditional recommendation is based on low-quality evidence.17Administer vasopressors when shock persists during or after fluid resuscitation. The initial blood pressure target is MAP ≥65 mmHg in adults and age-appropriate targets in children.If central venous catheters are not available, vasopressors can be given through a peripheral IV, butuse a large vein andclosely monitor for signs of extravasation and local tissue necrosis. If extravasation occurs, stop infusion.Vasopressors can also be administered through intraosseous needles.If signs of poor perfusion and cardiac dysfunction persist despite achieving MAP target with fluids and vasopressors, consider an inotropesuch as dobutamine.Remarks: Vasopressors (i.e. norepinephrine, epinephrine, vasopressin,and dopamine) are most safely given through a central venous catheter at a strictly controlled rate, but it is also possible to safely administer them via peripheral vein53and intraosseous needle. Monitor blood pressure frequentlyand titrate the vasopressor to the minimum dose necessary to maintain perfusionand prevent side effects. Norepinephrine is considered first-linein adult patients; epinephrine or vasopressin can be added to achieve the MAP target. Because of the risk of tachyarrhythmia, reservedopamine forselected patients with low risk of tachyarrhythmia or those with bradycardia. In children with cold shock (more common), epinephrine is considered first-line,while norepinephrine is used in patients with warm shock (less common).No RCTshave compared dobutamine to placebo for clinical outcomes.17

Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance87. Prevention of complicationsImplement the following interventions(Table3)to prevent complications associated with critical illness.These interventions are based on Surviving Sepsis17or other guidelines,54-57and are generally limited to feasible recommendations based on high quality evidence.Table

3. Prevention of complicationsAnticipated OutcomeInterventionsReduce days of invasivemechanical ventilation•Use weaning protocols that include daily assessment for readiness to breathe spontaneously. Minimize continuous or intermittent sedation, targeting specific titration endpoints(light sedation unless contraindicated) or with daily interruption of continuous sedative infusionsReduce incidence of ventilator-associated pneumonia• Oral intubation is preferable to nasal intubationin adolescents and adults•Keep patient in semi-recumbent position(head of bed elevation 30-45º)• Use a closedsuctioning system; periodically drain and discard condensate in tubing•Use a new ventilator circuit for each patient; once patient is ventilated, change circuit if it is soiled or damaged but not routinely• Change heat moisture exchanger when it malfunctions, when soiled,or every 5–7 daysReduce incidence of venous thromboembolism•Use pharmacological prophylaxis (low molecular-weight heparin[preferred if available]or heparin 5000 units subcutaneously twice daily) in adolescents and adults without contraindications. For those with contraindications, use mechanical prophylaxis (intermittent pneumatic compression devices).Reduce incidence of catheter-related bloodstream infection•Use a checklist with completion verified by a real-time observer as reminder of each step needed for sterile insertion and as a daily reminder to remove catheter if no longer neededReduce incidence of pressure ulcers•Turn patient every two hoursReduce incidence of stress ulcers and gastrointestinal bleeding• Give early enteral nutrition (within 24–48 hours ofadmission)• Administer histamine-2 receptor blockers or proton-pump inhibitorsin patients with risk factors for GI bleeding. Risk factors for gastrointestinal bleeding include mechanical ventilation for ≥48 hours,coagulopathy, renal replacement therapy, liver disease, multiple comorbidities,and higher organ failure score Reduce incidence of ICU-related weakness• Actively mobilize the patient early in the course of illness when safe to do so8.Specific anti-Novel-CoV treatmentsand clinical researchThere is no current evidence from RCTsto recommend any specific anti-nCoV treatmentfor patients with suspected or confirmed nCoV.Unlicensedtreatmentsshould be administeredonly in the context of ethically-approved clinical trials or the Monitored Emergency Use of Unregistered Interventions Framework (MEURI), withstrict monitoring. https://www.who.int/ethics/publications/infectious-disease-outbreaks/en/Clinical characterization protocols are available, including the SPRINT-SARI https://isaric.tghn.org/sprint-sari/and WHO-ISARIC forms available at https://isaric.tghn.org/protocols/severe-acute-respiratory-infection-data-tools/. Contact oubreak@who.intfor additional questions.9.Special considerations for pregnant patientsPregnant women with suspected or confirmed nCoVshould be treated with supportive therapies as described above,taking into account thephysiologic adaptations ofpregnancy. The use of investigational therapeutic agents outside of a research study should be guided by individual risk-benefit analysis based on potential benefit for mother and safety to fetus, with consultation from anobstetric specialist and ethics committee. Emergency delivery and pregnancy termination decisions are challenging and based on many factors: gestational age, maternal condition, and fetal stability. Consultations with obstetric, neonatal,and intensive care specialists(depending on the condition of the mother) are essential

Source (PDF):   https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf?sfvrsn=bc7da517_2&download=true
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 8:00pm
Hi Albert. Its been a while

You mention Ferguson's estimates. How accurate are they? Is there anywhere I can see the modelling or raw data?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 8:18pm
In my experience. China is known for suppressing outbreaks.

They try to save face and not tarnish China's good name. This is until its too difficult to keep a lid on the situation. They then release the numbers in several batches, which makes the virus look like a rapid spreader. They are full of crap. Their stats are crap. Don't trust China.

Look outside of China to gauge the spread. It will no doubt spread to neighboring areas like Japan. Japan will report it as it happens.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: January 19 2020 at 11:17pm
http://www.thebigwobble.org/2020/01/chinese-mystery-disease-update-no-3-139.html

The Big Wobble is trying to get a grip on this story.
(N-SARS New-Severe Acute Respitory Syndrome ?)

https://www.globaltimes.cn/content/1177345.shtml;

There have been suspected cases in Vietnam and Singapore, and 90 suspected cases have been reported in China's Hong Kong Special Administrative Region.
-
In the early moments of SARS, there was concealment in China. This must not be repeated.

The new epidemic in Wuhan is not as horrible as SARS. We sincerely hope Chinese society can be more successful in preventing and controlling the pneumonia, and move a big step forward in terms of medicine, social management and public opinion compared with 2003.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 3:14am
Hi Cobber.

As I'm here I'll try to answer your question to the Boss. But it might not be all that clear.

Dr. Fergusson (from his comments) has been using mathematical modeling to predict the spread. This is the standard tool for eppidemiologists. The figure of 1700 infected (AT THAT POINT IN TIME!) would have been the top of the curve.

There is a description of the bell curve graph here if you want it:   https://www.investopedia.com/terms/b/bell-curve.asp

I did a Coursera course on mathematical modelling and two on eppidemiology when Rickster (always missed, never forgotten) pointed them out to me. So I have become quite familiar with this system. The first thing you learn in modelling is that all models are wrong. The second is that they are less wrong than the guestimates used by those not using models (sorry Med!) and the more models employed, the closer to accurate you become.

Fergusson, from his comments and wealth of different figures, is clearly using more than one model. I don't know how many different models he used, but the top of my personal bell-curve-of-belief is that he is profoundly accurate. 1700 is the most likely figure. At a rough guess (but still based on his figures) standard deviation would be around ± 400 cases; which would make 1700 most probable and both 190 and 4000 = 4σ (which has odds of thousands-to-one against).

Like Fergusson, I'm extrapolating this from insufficent data. But it is not a complete guess (Think of it as a Mr Spock guess and you are about right.) The increase in cases over the weekend also backs up Fergusson's figures, as does China's reputation for a whitewash.

The one bit of good news is that one of the axioms Fergusson used was that most cases were mild enough to masquerade as a common cold; the deaths (and presumably the critical cases) were among people with co-morbidities (the already sick with something else). So the more accurate Fergusson is - the less deadly the virus.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 3:36am
Ps. I posted a PDF from the WHO about how to treat patients last night. It was full of typographical errors. The draft itself, in its PDF form, had the word "draft" splattered all over it.

I think this is indicative of growing alarm - if not outright panic. If you have time to spare, you use it to look less illiterate than that.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 4:02am
2020/01/20, Health

Chinese Health Officials Report Huge Spike in Cases of New Virus



Chinese health officials in the central city of Wuhan confirmed 136 newcases of a new coronavirus — a huge spike — over the past three days.

The Wuhan Municipal Health Commission says the total number of cases of the virus now exceeds 200, including two new cases in Beijing and one in Shenzhen in southern China. Most of the confirmed cases are described as mild, but three deaths have been reported.

Doctors in Wuhan, China's seventh most populous city, have stepped up screening for suspected cases of pneumonia. They are urging people to be more conscious of their personal hygiene and to cover their mouths when they cough or sneeze.

On Friday the U.S. Centers for Disease Control and Prevention started screening passengers arriving from Wuhan at three airports — San Francisco, Los Angeles, and New York. Airports in Japan, Thailand, South Korea and Singapore are also screening passengers.

Passengers on a flight that arrived Saturday morning in San Francisco said they went through the screening and it was an easy procedure. Their temperature was taken and they filled out a form.

Chinese and U.S. health officials are particularly concerned because many of the 1.4 billion Chinese citizens are expected to travel for the Lunar New Year holiday that starts January 25, both inside China and beyond.

A coronavirus is one of a large family of viruses that can cause illnesses ranging from the common cold to the deadly Severe Acute Respiratory Syndrome. SARS, which also started in China, killed nearly 800 people globally during an outbreak 17 years ago.

Chinese health experts know little about the new strain, dubbed 2019-nCoV, in Wuhan, especially how it is transmitted. They suspect the outbreak started in a Wuhan seafood market, which also sold other animals such as poultry, bats, marmots, and wild game meat, but some patients say they were never there.

Health officials are urging caution but say there is no reason to panic. The World Health Organization is not recommending against travel to China, and China's National Health Commission says the current outbreak is "preventable and controllable."

"According to the latest information received and WHO analysis, there is evidence of limited human-to-human transmission of the virus," the WHO tweeted Sunday. "This is in line with experience with other respiratory illnesses and in particular with other coronavirus outbreaks."

Of the new cases announced this weekend, all involve adults ages 25 to 89. About half are male (78) and half are female (75), according to Minnesota Center for Infectious Disease Research and Policy, which translated the Wuhan commission's statement.

Of the 198 patients confirmed so far, 28 have recovered or been discharged. Of the 170 people still in the hospital, 126 have mild illness, 35 are listed as severe, and 9 are in critical condition. Three deaths have been now reported. Hospitalized patients in Wuhan are isolated at a designated facility.

The number of close contacts under monitoring has risen from 763 to 817, and monitoring is still underway for 90. So far no related cases have been found in contacts.


Source:   https://international.thenewslens.com/article/130259
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 4:25am
Well that was unexpected......

😂😂😂

I mean the Chinese admitting to it.....LMAO
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Loribearme Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 6:19am
There are more cases and countries. News is updating now hourly.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 6:29am
[The reports are flooding in now.]

British tourist fighting for life in Thailand is feared to be first western victim of new Chinese coronavirus as third patient DIES and outbreak spreads to South Korea

    Ash Shorley, 32, is in critical condition in a hospital in Phuket, Thailand
    His lung infection is similar to the Chinese coronavirus, but is not confirmed
    The unnamed novel virus has infected an estimated 1,700 in Wuhan, China
    Authorities revealed the virus has spread to other cities in China this weekend
    The total confirmed cases has tipped 200 and three have died
    Four confirmed cases are outside China in Thailand, Japan, and South Korea

Source and full article:   https://www.dailymail.co.uk/health/article-7906281/SARS-like-virus-spreads-China-nearly-140-new-cases.html

Wuhan virus: Singapore expands temperature screening to all travellers arriving from China

Published
3 hours ago
Updated
7 sec ago

Clement Yong

SINGAPORE - The Ministry of Health (MOH) said on Monday (Jan 20) that it is stepping up precautionary measures against the mysterious Wuhan virus in anticipation of more travellers in the lead-up to the Chinese New Year holidays.

The expanded measures include temperature screening for all travellers arriving from China at Changi Airport and issuing health advisory notices to them from Wednesday.

Previously, only travellers from the Chinese city of Wuhan were screened.

Source and full article:   https://www.straitstimes.com/singapore/health/moh-steps-up-measures-against-wuhan-virus-as-cny-approaches

Masks on, Chinese start holiday travels as alarm mounts over mystery virus

Posted by Reuters | Jan 20, 2020


Source and full article:   https://www.physiciansweekly.com/masks-on-chinese-start/

The new york times has an article (which I can't access) about 5 more people being quarantined.


Source and full article:   https://www.nytimes.com/reuters/2020/01/19/world/asia/19reuters-china-health-pneumonia-zhejiang.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 11:18am
Cheers.
This virus looks to have the jump on us...
Prof Neil Ferguson is the real deal. As he says Chinese new year will be problematic.

The death rate is low. Which is reassuring, but its still early days.
Do we know much about who died and why. Ie ages of people or preexisting conditions?

One thing which is alarming is many reports of 30-40 year olds being hospitalized. Hospitalization of young and fit is very concerning.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 11:48am
VERY! But not so surprising with a new disease.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote KiwiMum Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 12:49pm
Here in NZ the news is stating that China has confirmed human to human transmission.

Quote:The head of a Chinese government expert team says that human-to-human transmission has been confirmed in an outbreak of a new coronavirus.

The news comes as the World Health Organisation plans an emergency committee of experts meeting this week to assess whether the outbreak constitutes an international emergency.

The virus has infected nearly 200 people and a fourth case been reported outside of China.
You can't fix stupid.
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Passengers at the airport who have taken direct flights from Wuhan will need to fill in health forms. Photo: AP
Health & Environment
Hong Kong strengthens detection and response measures against new Wuhan virus as mainland China reveals disease has spread
Health declaration forms will be used at airport and expanded monitoring will cover everyone arriving from Hubei province
Mainland authorities reveal there are five cases in Beijing, one in Shanghai and 14 in Guangdong province, which borders Hong Kong
Topic | China coronavirus outbreak
Victor Ting
Victor Ting

Published: 11:33pm, 20 Jan, 2020

Updated: 12:11am, 21 Jan, 2020


Hong Kong has stepped up detection measures against the new Wuhan pneumonia-like coronavirus, including the use of health declaration forms at the airport and expanded monitoring of local suspected cases to cover those with symptoms and arriving from Hubei province. The latest measures came as Chinese authorities confirmed that another person had died over the weekend from the infection, bringing the death toll to three in Wuhan, and for the first time revealed the virus had spread, with five cases in Beijing, one in Shanghai and 14 in Guangdong province, which borders Hong Kong. The total confirmed cases in mainland China stood at 218. In Hong Kong, seven more suspected infections were reported, taking the total to 106 as of 8am on Monday, according to the Centre for Health Protection. There were no confirmed cases in the city.


The World Health Organisation, meanwhile, said there were indications the severe acute respiratory syndrome-like virus – thought to have originated in a seafood and meat market in Wuhan – could spread through human-to-human transmission. Hong Kong’s health secretary Sophia Chan Siu-chee said Chief Executive Carrie Lam Cheng Yuet-ngor had attended a cross-departmental meeting on Monday morning for the latest reports on the situation, and hammered out three new measures.

“There may be the first confirmed case in Hong Kong at any minute, so we must not let our guard down, and have to be well prepared with the most adequate response in place,” Professor Chan said.
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In a three-pronged package, Chan said all suspected infection cases with fever, pneumonia or respiratory symptoms who had been to Hubei province in the past 14 days had to be reported by all doctors and monitored by the health authorities. Previously, the scope of monitoring only included those who had travelled to Wuhan, centre of the outbreak, visited any mainland hospitals or had direct contact with patients with confirmed infection.
Health chief Sophia Chan, flanked by Constance Chan and Tony Ko, provides an update on the situation on Monday. Photo: Dickson Lee

Director of Health Dr Constance Chan Hon-yee insisted the expanded scope was sufficient despite newly reported cases in Beijing and Shenzhen. “All those patients had visited Wuhan before,” she said. Another key plank of the new strategy was a health declaration form to be filled by passengers who had taken direct flights from Wuhan. The director said they would be asked to declare any symptoms and put down their contact information for follow-up action if necessary. Those reporting symptoms would be taken to public hospitals for further checks and isolation. False declaration could result in the maximum penalty of a HK$5,000 fine and six months in prison.
But she faced a barrage of questions as to why the measure was not extended to visitors arriving by high-speed rail, or other border crossings such as the Lo Wu checkpoint and Hong Kong-Zhuhai-Macau Bridge. “If all passengers at the terminals have to stay in one crowded place and fill in health declaration forms, it may not be ideal for controlling the transmission of the virus,” she said, adding that temperature screening at those terminals was already “operational sufficient and appropriate”.
Questions were asked as to why the measures don’t include the high-speed rail terminus. Photo: K.Y. Cheng
Hospital Authority chief executive Dr Tony Ko Pat-sing said public hospitals would also strengthen their response mechanism. One clinic from each of the seven hospital regional groupings could be made available within 48 hours to treat patients infected with coronavirus. Patients with less urgent appointments would be transferred to other clinics. Currently, 500 isolation wards at public hospitals are available, with more ordinary wards to be converted if necessary. Professor David Hui Shu-cheong, a respiratory medicine expert from Chinese University, believed the measures were reasonable. He said it made sense to draw the line of monitoring at Hubei province where the virus was widely thought to have originated, since there was no apparent evidence of mass transmission in the mainland community yet.
“The health declaration form has great limitations and yields little benefits actually, because many visitors will not honestly report their condition to get in. Some forms may even be filled in bulk by tour guides,” he said. The most effective measure, he said, was rigorous temperature screening at arrival checkpoints, highlighting confirmed cases in Thailand, Japan and South Korea, which were all discovered after temperature checks at airports.

China coronavirus outbreak
Hong Kong health care and hospitals
Victor Ting
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Loribearme Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 2:40pm
A computer model showing the way this virus will spread would be helpful.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 2:50pm
Hard to predict,

with Chinese New Year,

Millions of people on the move,

couldnt have come at a better time.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 2:53pm
BBC News - New China virus: Cases triple as infection spreads to Beijing and Shanghai
https://www.bbc.co.uk/news/world-asia-china-51171035
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Loribearme Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 2:54pm
Don't forget the Superbowl comes on February 2,2020...2-2-2020. can you imagine the crowd all wearing masks and not yelling?   If the virus hits the US in the next six days it's possible for it to spread very fast. Good idea to stock up on food, water, meds, and stay home.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 3:01pm
Anyone who has spent time here knows about influenza’s ability to mutate and reassort with other strains to come up with novel viruses, but I’m not sure how well a coronavirus can adapt to a new host. MERS never really made the jump, while SARS seemed to hit the ground running, so we don’t have any historical precedent to guide us on this one. It’s not an efficient killer yet, but will that change as it moves into a larger population?
It would seem that we’ve entered a whole new chapter in infectious diseases.

"Buy it cheap. Stack it deep"
"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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No mention yet of a super spreaders, a big factor in the sars of old.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 4:33pm
It seems they’re already playing a role.

“... Zhong elaborated that there was at least one case of human-to-human transmission in Wuhan, a city in central China, and two cases in families in the southern Guangdong province that borders Hong Kong. He also said that in one case, a single patient spread the virus to at least 14 medical staff members. He referred to such a patient as a “super-spreader,” according to South China Morning Post, and called these patients key to controlling the outbreak.”

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Mutation rates in RNA viruses are important because these viruses cause a terrible toll in terms of human death and disease. The flu and HIV, for example, are caused by viruses with RNA-based genomes. The high mutation rate means that they can rapidly evolve resistance to new drugs.
https://sciencing.com › rna-mutation...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 5:20pm
If true, that is a phenomenal R0; medical staff should have the best anti-infection protocols of anyone anywhere. That makes measles look hard to catch!

That would also make Fergusson's higher estimates correct. TERRYFYING!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arirish Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 8:19pm
Technophobe said: medical staff should have the best anti-infection protocols of anyone anywhere"

In the west I'm sure this statement would hold up but in a country that even after SARS still sells Civet Cats in their wet markets and rely on home remedies to cure the sick, I'm not so sure!
Buy more ammo!
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Post Options Post Options   Thanks (1) Thanks(1)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: January 20 2020 at 9:35pm
Originally posted by Technophobe Technophobe wrote:


The new york times has an article (which I can't access) about 5 more people being quarantined.


Source and full article:   https://www.nytimes.com/reuters/2020/01/19/world/asia/19reuters-china-health-pneumonia-zhejiang.html


Here you go!

Five Patients Quarantined in China's Zhejiang for Respiratory Illness
By Reuters
Jan. 19, 2020

BEIJING — China's eastern province of Zhejiang on Monday reported that five patients are in quarantine for respiratory illness but the diagnosis is not confirmed yet.

The province has found five people traveling from the city of Wuhan in central China with respiratory symptoms since Jan. 17, Zhejiang province's health commission said in a statement on its website, adding that the patients are in stable condition and their close contacts have been placed under medical observation.

(Reporting by Lusha Zhang and Se Young Lee; Editing by Christian Schmollinger)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 12:12am
We could have a case here in Australia......

Man quarantined at home in Brisbane
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News > World > Asia
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China coronavirus: 14 medical workers infected by single carrier, officials admit
Australia among countries around world to introduce new screening measures as China warns of risk posed by 'super-spreaders'

Adam WithnallAsia Editor @adamwithnall
30 minutes ago
Authorities are taking urgent steps to contain the spread of a new virus in China, after officials admitted that at least 15 health workers who had contact with patients have now themselves been infected.

The Chinese government announced for the first time late on Monday that the novel coronavirus, which causes pneumonia-like symptoms and has led to four deaths, can be spread between humans.


Speaking on state TV, leading health expert Zhong Nanshan said that 14 medical staff had been infected by a single carrier in the city of Wuhan, where the coronavirus is believed to have first transmitted from animals to humans at a seafood market.


Dr Zhong is one of the Chinese government’s top SARS specialists, and his appearance on TV heightened concerns of an outbreak similar to that which spread from China to more than a dozen countries in 2002-3, killing at least 800.

Since China first reported the new virus to the WHO on 31 December, there have been at least 217 confirmed cases and travellers from Wuhan have been isolated in Japan, Thailand, South Korea and - in the latest incident - possibly Australia.

Read more

China confirms human-to-human transmission of deadly virus

Airport checks for deadly coronavirus begin in three US cities

British tourist believed to have contracted coronavirus as cases soar

Some 17 new infections of coronavirus discovered in China

Experts warn mystery Chinese virus could have infected hundreds
Queensland’s health agency said on Tuesday it was testing a man in quarantine after he returned to Sydney from central China with a respiratory illness. The state’s chief medical officer told ABC News the results from a generic test for coronavirus were still being awaited.

In the meantime, Australia said it would be increasing airport screening measures. The country receives a significant number of travellers from China, including three direct flights a week from Wuhan into Sydney, and these flights will be met by border security and biosecurity staff for assessments, the national chief medical officer Brendan Murphy told reporters.

China coronavirus: Cases soar of deadly new flu-like virus
Show all 20
China’s Dr Zhong said catching so-called “super-spreaders” - people in the most virulent stage of illness - was the key to preventing a major SARS-like outbreak.


Banning people with symptoms from leaving Wuhan was the best way to do this, he said. Videos on social media showed health workers in protective clothing screening passengers on board what was described as a domestic flight out of the city.

“At present, there is no special cure for this new coronavirus, [we are] conducting some tests with animals,” Dr Zhong said on TV, according to the South China Morning Post. “We expect the number of infected cases will increase over the Lunar New Year travel period and we need to prevent the emergence of a super-spreader of the virus.”


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President Xi Jinping also gave his first public statement on the crisis on Monday, saying that the virus must be “taken seriously” and “resolutely contained”. “Party committees, governments and relevant departments at all levels should put people's lives and health first,” he said.

In Japan, prime minister Shinzo Abe told a meeting with ministers that the country must “step up our caution levels as the number of patients is continuing to rise in China”.

Japan, South Korea, Hong Kong and other places with extensive travel links to China are also enacting stricter screening measures.

At least three US airports have started screening incoming airline passengers from central China.

Watch more
What are symptoms of new Chinese virus – and where has it spread?
And the UAE, whose Dubai International Airport is one of the busiest in the world and receives direct flights from Wuhan, said measures had been taken to sure all ports of entry were “on standby to handle coronavirus cases”.

Experts said that the scale and urgency of the precautionary measures taken by authorities across the world should give hope that an outbreak like 2002-3 can be avoided.

Gabriel Leung, dean of medicine at the University of Hong Kong, said Chinese authorities in particular have responded much more quickly this time.

Dr Leung, who was heavily involved in the response to SARS, said modeling shows that cases will multiply over the coming weeks but the outbreak will gradually lose momentum as precautionary measures take effect.

He told reporters at a briefing: “Our underlying assumptions are, the force of infection is very different now ... because so many public health measures have been undertaken and so many interventions have been executed.”

What is a coronavirus, and what are the symptoms?
Coronaviruses are a group of virus that cause respiratory infections – diseases ranging from the common cold to SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome).

The novel coronavirus, which was isolated on 7 January, is only the seventh of its kind known to science that can infect humans.

The virus causing the current outbreak is different from those previously identified, Chinese scientists said earlier this month.

Initial symptoms of the novel coronavirus are mainly fever, with some experiencing coughing, tightness of the chest and shortness of breath.

Scans on some patients have shown fluid in the lungs consistent with viral pneumonia. Each of the four cases that has led to deaths involved patients with other underlying health conditions.

Read more about the coronavirus outbreak and the official response here.



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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 2:02am
Banning people form leaving Wuhan......

Horse,Gate,Bolted......

Spring to mind.....

It's to late baby,now it's it late......
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 3:41am
https://www.zerohedge.com/geopolitical/xi-warns-party-officials-anyone-who-covers-coronavirus-will-be-nailed-pillar-shame

Now that the Chinese government has finally confirmed that the coronavirus outbreak that originated in Wuhan can be spread between humans, international investors are grappling with the worst-case scenario: Another global SARS-like outbreak that could leave hundreds dead around the world.

As millions of Chinese prepare to travel for the Chinese New Year holiday on Saturday, deaths are piling up at a steady but alarming rate from the virus, which claimed its sixth victim on Monday, according to the mayor of Wuhan, the central-Chinese city where the virus was initially detected, before spreading to Shanghai, Beijing and elsewhere around the country.
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According to the South China Morning Post, Beijing on Tuesday warned party functionaries not to lie about the spread of the coronavirus, warning that anyone caught withholding information would be severely punished and "nailed on the pillar of shame for eternity."

Chang An Jian, the official social media account of the Central Political and Legal Affairs Commission – Beijing’s top political body responsible for law and order – ran a commentary on Tuesday telling cadres not to forget the painful lessons of Sars and to ensure timely reporting of the current situation.

More than 700 people were killed around the world by the severe acute respiratory syndrome outbreak in 2002-03, which originated in China.

"Anyone who puts the face of politicians before the interests of the people will be the sinner of a millennium to the party and the people," the commentary read.
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In what appears to be a PR stunt meant to calm the public, Beijing said it had appointed Dr Zhong Nanshan, the same doctor who led the fight against SARS 17 years ago, to lead the charge against the virus that originated in Wuhan.

Still, the virus, which was first detected in December before being officially identified earlier this month, appears to be spreading rapidly. Chinese provinces reported a combined 77 new cases of the virus to the National Health Commission on Jan. 20, according to the government.

https://en.wikipedia.org/wiki/High-speed_rail_in_China and
https://en.wikipedia.org/wiki/High-speed_rail_in_China#/media/File:Rail_map_of_China_(high_speed_highlighted).svg
DJ-Wuhan has high speed rail links with Sjanghai, Bejing etc. China also invested in raillinks to Laos, Viet Nam, Russia.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 3:44am
Bloomberg are reporting over 200 cases now. Sorry, I've used up my free article limit, so I can't access the whole thing.

Oh, and yes, Carbon, that horse is long gone, the stable is burnt down and the groom has put the stablemaid up-the-stick.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 3:45am
BBC News - New China virus: Warning against cover-up as number of cases jump
https://www.bbc.co.uk/news/world-asia-china-51185836
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 4:02am
15 health workers who had contact with patients have now themselves been infected. This is pretty serious if it's accurate.

Again remember its from China... They are full of $hit. The only reason why they are coming out now is because the virus has been found in other countries.

China is all about saving face. They are too concerned about not embarrassing China. Its dumb, its the communist system.

The key thing we should focus on is H2H spread outside of China. If its occurring in first world countries then we should be concerned.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 4:06am
Warning against cover-up... LOL

Irony: If low level officials spoke out about a virus, they wouldn't be officials.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 4:09am
6 dead?? Okay this is new
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 4:17am
BBC just confirmed 6 dead.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2020 at 1:31pm
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