Long summary from an Estonian virologist Irja Lutsar
https://www.etis.ee/CV/Irja_Lutsar/est?tabId=CV_ENG , using Google translate. Just for comparison, nothing else (she is not a tinfoil hat person).
I put together this week's thoughts on the coronavirus. The keyword for this week is Italy, for me, many things that are going on there are incomprehensible. Don't get too deep into absolute numbers, they change in real time. Sorry it is too long.
02.03-08.03 week with coronavirus
About the spread and infection of the virus
1. Within a week, the virus spread significantly beyond China. Infections have been found in 100 countries. In recent days, 3500-4000 infections have been added, of which only 100-150 are registered in China. 3500-4000 cases were registered in China during the peak period of the outbreak.
2. 86% of cases are mild and the rest serious or critical. Children are still ill but relatively mild.
3. In China, the epidemic seems to be under control, with a peak period of about 4 weeks with rising and falling morbidity. Models also say that 60% of infections occur within 4 weeks and 90% within six weeks
4. It is important to note that, despite the very stringent quarantine measures, some 80,000 people (1 633 cases per 1 million) were infected in Hubei Province with a population of 60 million, with a mortality rate of 4.9%. What part of the super-angel in quarantine was, and what we will never know at the natural cost of the disease. At the same time, we do not know how much concentration of patients in institutions (hospitals, schools, etc.) caused secondary illness.
5. After China, South Korea, Italy and Iran have the highest numbers of infected, each with more than 5,000. All three countries have epidemic centers with significantly more cases than other regions. In Italy mainly Lombardy (capital Milan), Veneto (capital Venice) and Emila Romagna (capital Bologna), in South Korea around Daegu and in Iran around Tehran. Infections have been found in other areas.
6. Italy is the country with the highest morbidity in Europe. 11 cities in northern Italy have been subject to quarantine since 24 February. Since March 8, there has been strict quarantine throughout Northern Italy. If the models are right, the situation in Italy can be expected around March 20.
7. There is still no definitive answer to the question of whether the incubation period is ill because the information is contradictory. In my best understanding, a person can only be infected if he or she has the virus. An article was published in JAMA in which a person from Wuhan allegedly infected persons in contact with him on January 10. His PCR turned positive on January 28, being negative on January 26, while positive and contact PCRs became positive. This series raises many questions. Wasn't this a subsequent infection and not by a Wuhan patient.
8. The infection has not yet reached the poorest countries in the world - Africa and South America
From mortality
9. Global mortality 3.4%, of which China 3.7% and the rest of the world 1.9%.
10. The outbreak mortality in Italy is similar to that in China, 3.9%. It is incomprehensibly large and exceptional outside of China. Italy also has a very high number of critically ill patients compared to other countries. Italian officials explain Italy's high mortality rate with an aging population; the average age of the deceased is 81.2 years.
11. Although mortality rates are similar in Italy and China, it is important to note that in Italy, 83% of the dead were> 70 years old and 48%> 80 years old while none were <60 years old. The corresponding figures for China are 51%, 20% and 19%. In Italy, mortality has fallen in recent weeks, probably as a result of widespread testing and the recording of mild cases.
12. While China and Italy have high mortality rates, this is not the case worldwide. Excluding China and Italy in mortality, we get a mortality rate of 1.4%.
13. There are countries with very low mortality (South Korea 0.6%) or no mortality. Singapore, for example, where the onset of morbidity started to be less pronounced than in China. Or Germany (a relatively new outbreak), where 939 cases have been registered to date, of which 9 are in critical condition. There are no deaths in the Nordic countries either. Incidence and mortality rates are also low in Japan.
Positive experience of other countries in managing the epidemic
14. Singapore and Taiwan have learned to deal well with the epidemic. Both countries did not impose quarantine or extreme restrictions. However, they introduced the so-called. health declarations. All entrants filled them in by plane or at the border, declarations were checked before entry and only suspicious cases were dealt with. Only cases requiring hospitalization for medical purposes were admitted to the hospital. Others were in home treatment / quarantine and their contacts in home quarantine. Compliance with quarantine was strictly controlled. Singapore has a population of 5 million and currently has 138 cases and 0 deaths. 23.9 million people in Taiwan and 45 cases. Both countries are close to China, but probably with little land transport. Similar paths have been taken by Canada, which suffered a great deal during the outbreak of SARS.
15. The British suggested that they prepare and focus their resources on treating the seriously ill and commit less to keeping the disease out of the country. This is then a move into the second phase of the epidemic. You probably have to be ready for both.
Coronaviruses and other respiratory diseases
16. Comparison with seasonal influenza. According to the CDC, there are an estimated 32 million people in the United States affected by seasonal flu this year, with 300,000 hospitalized and 18,000 dead. Coronavirus worldwide numbers are 106,000 and 3,200, respectively. But with the flu there is hope that when spring comes it will disappear. Many hope the same will happen with the coronavirus.
Coronavirus in Estonia
17. Last week, 10 infections were identified in Estonia, 9 of which came from a holiday in northern Italy. Everyone is infected with mild disease symptoms. Currently, the local spread of the disease has not been described in Estonia. Incidence in Estonia per 7.6 / 1 million persons. At the same time, the incidence of influenza is 798 cases / 1 million. In the current situation, canceling events and closing schools seems disproportionate, but the situation needs constant monitoring.
Coronavirus collateral injury and science
18. The damage to the economy is enormous and will sooner or later affect us all. Stock markets are falling, car sales in China have fallen by 92%, drug shortages may arise as raw materials for many drugs come from China. Northern Italy is the backbone of Italian industry and economy. It has already been decided to support those affected by the outbreak. The economy is also likely to be under review and there may be support for the survival of local businesses.
19. Political opposition between countries is not out of the question.
20. The vaccine and medicines are not yet available. Studies are ongoing, but from a drug perspective, it has already been suggested that clinical trials on drugs in China may not be complete due to rapidly declining numbers of patients in China. Europe does not stand out in investing in science. There are about 20 different vaccines in the studies, with no one active in the EU, except the UK has withdrawn from the EU.
21. The European Union has then announced grant rounds where you can apply for money for coronavirus research. There is also an opportunity for Estonian researchers.
