Tag Archives: CDC

Some sanity (and hope) about the Wuhan flu

There is an excellent article in the following link,  https://news.harvard.edu/gazette/story/2020/03/public-urged-to-ramp-up-social-distancing-increase-coronavirus-tests/

Epidemiology Professor Marc Lipsitch, head of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, called the pace of coronavirus testing in the U.S. “utterly inadequate” and “a debacle” that robs public health officials of information crucial to devising an effective response and protecting health care workers. Testing has been so slow that no one knows the extent of the U.S. epidemic, though scientists guess at somewhere between “tens of thousands and hundreds of thousands” of cases.

Let’s say that is true that 100,000 people in the USA have already been infected.  What does that mean?  It means that most people with it aren’t very sick (we don’t have 100K people in ICUs on respirators).  This is the hope anyway

The CDC monopolized testing for Corona virus for a while and then distributed faulty test kits (while you may not like Trump, this isn’t his fault). So we have no way of knowing what’s out there.

That’s information gap #1 — we don’t know how many people are actively infected with the virus

Information gap #2 is even worse, and very likely longer to be corrected.  We don’t know how many people are out there who have fought the infection off and are no longer sick.  This will require a test for the antibodies to the virus they’ve developed (something that doesn’t happen right away during the acute infection although that’s where it begins).  Such information  is not available now, and likely won’t be for a month or two.

Addendum: Not everyone reading this knows what an antibody is so this is in response to a few questions.  Antibodies are proteins made by your body in response to an invading organism (which kill it).  This is why your kids have measles, mumps and rubella vaccines — they give the kids proteins from the viruses (not the whole organism), and your kids react as if infected by the intact virus (which is why they often seem to have the flu after vaccination), producing antibodies to those proteins, so when the real thing comes sneaking around, your kid’s antibodies recognize it and fight it off.  Having an antibody to the Wuhan flu is perfect evidence that you’ve been infected with it (even if the virus is long gone).  They aren’t something you’d have normally.  It isn’t simple to develop and validate a test for anti-Wuhan antibodies which why I think it will be a while before we have a test we can trust.

This will tell us just how much to worry about the virus.  Most reading this are too young  to remember the polio epidemic (which also put people on respirators). https://en.wikipedia.org/wiki/Polio  After antibody tests finally became available it was found that only one out of every one hundred people infected developed paralysis.

 

The Wuhan flu epidemic in China has likely peaked

Could the Wuhan flu epidemic in China be peaking, or am I indulging in wishful thinking because of a son, daughter-in-law and two grandkids living in Hong Kong?  Possibly but here’s why.

The South China Morning post (https://www.scmp.com) keeps a total of the cases of the flu in China and worldwide.  The figures change throughout the day, but they don’t vary too much during the US day (Chinese night).

Looking at the totals in the US evening

From 2 Feb to 3 Feb there were just under 3,000 new cases

From 3 Feb to 4 Feb there were just over 3,000 new cases

From 4 Feb to 5 Feb there just under 4,000 new cases (3891)

From 5 Feb to 6 Feb there were slightly fewer newer case (3789)

From 6 Feb to 7 Feb there were definitely fewer new cases (3143)

 

Even though the totals are horrible — 31,161 cases in China (worldwide 31,482) with 636 worldwide deaths as of 5AM Eastern Standard time  7 Feb (USA), this is the second time in the China epidemic that there have been fewer new cases (and more importantly with a significant reduction from yesterday’s increase). This means we are likely at or over the peak of spreading of the epidemic (although the number of cases will continue to increase).

The number of new cases probably doesn’t contain any false positives, because of the thoroughness of the way they’ve been checked.

Caveat — only those lucky enough to make it into a hospital get checked, and stories I’ve read about how crowded they are and the long waits for care and admission, means that the number of cases are likely much higher.

Note that I include both the Chinese totals, and those worldwide as when the disease spreads worldwide (as it has) the total number of new cases will continue to increase (even if the Chinese new cases drops).

Having flown back and forth to Hong Kong several times, you couldn’t ask for a better way to spread the flu than cooping up 100+ people packed cheek by jowl in the steerage section of a large airplane for 16 – 18 hours.   This is particularly true since we now know asymptomatic people can spread the disease.

A very smart friend asked me ‘Why the excitement since influenza in the USA causes many more deaths each year’.  Well from the Center for Disease Control (CDC) we have the following — https://www.cdc.gov/flu/about/burden/index.htmlhttps://www.cdc.gov/flu/about/burden/index.html

“CDC estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010.”

That’s quite a range (5 fold) for number of illnesses and number of deaths, but the ratio is the same.  So what is the mortality of the flu we have in the USA?  Well 12,000/9,000,000 = .0013 or .13% which is 20 – 30 times less than the current known mortality rate of 2 – 3% for Wuhan flu.

Remember the figures are for symptomatic diagnosed cases.  There may well be many more cases with minimal or no symptoms.  Remember for every case of paralytic poliomyelitis, there were 99 infections where that didn’t happen.  Hopefully soon, we’ll have a way to test for human antibodies to Wuhan flu with specific antibodies (not all antibodies are specific) and we’ll find out the true prevalence of Wuhan flu infection.

Could the Wuhan flu epidemic in China be peaking?

Could the Wuhan flu epidemic in China be peaking, or am I indulging in wishful thinking because of a son, daughter-in-law and two grandkids living in Hong Kong?  Possibly but here’s why.

The South China Morning post (https://www.scmp.com) keeps a total of the cases of the flu in China and worldwide.  The figures change throughout the day, but they don’t vary too much during the US day (Chinese night).

Looking at the totals in the US evening

From 2 Feb to 3 Feb there were just under 3,000 new cases

From 3 Feb to 4 Feb there were just over 3,000 new cases

From 4 Feb to 5 Feb there just under 4,000 new cases (3891)

From 5 Feb to 6 Feb there were slightly fewer newer case (3789)

Addendum 6 Feb (USA) 9:20 PM 7 Feb China  (10:20 AM) — the news is good — the total number of new cases from 6 Feb to 7 Feb in China dropped significantly (967).  Hopefully this is accurate, and not due to some reporting glitch, or suppression of the numbers by directive from above.  If so, the epidemic has peaked, and all people have to do is stay indoors and not infect others.   Let’s hope this holds up.  Tomorrow’s count will be very important.   End Addendum 6 Feb 

Even though the totals are horrible — 28,396 cases worldwide with 566 deaths the morning of 6 Feb (USA), this is the first time in the China epidemic that there have been fewer new cases. This means we may be at the peak of epidemic spreading (although the number of cases will continue to increase).

The number of new cases probably doesn’t contain any false positives, because of the thoroughness of the way they’ve been checked.

Caveat — only those lucky enough to make it into a hospital get checked, and stories I’ve read about how crowded they are and the long waits for care and admission, means that the number of cases are likely much higher.

Note that I include only the Chinese totals, as when the disease spreads worldwide (as it has) the total number of new cases will continue to increase (even if the Chinese new cases drops).

Having flown back and forth to Hong Kong several times, you couldn’t ask for a better way to spread the flu than cooping up 100+ people packed cheek by jowl in the steerage section of a large airplane for 16 – 18 hours.   This is particularly true since we now know asymptomatic people can spread the disease.

A very smart friend asked me ‘Why the excitement since influenza in the USA causes many more deaths each year’.  Well from the Center for Disease Control (CDC) we have the following — https://www.cdc.gov/flu/about/burden/index.htmlhttps://www.cdc.gov/flu/about/burden/index.html

“CDC estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010.”

That’s quite a range (5 fold) for number of illnesses and number of deaths, but the ratio is the same.  So what is the mortality of the flu we have in the USA?  Well 12,000/9,000,000 = .0013 or .13% which is 20 – 30 times less than the current known mortality rate of 2 – 3% for Wuhan flu.

Remember the figures are for symptomatic diagnosed cases.  There may well be many more cases with minimal or no symptoms.  Remember for every case of paralytic poliomyelitis, there were 99 infections where that didn’t happen.  Hopefully soon, we’ll have a way to test for human antibodies to Wuhan flu with specific antibodies (not all antibodies are specific) and we’ll find out the true prevalence of Wuhan flu infection.

What to do about the Wuhan flu

This was published 27 Jan ’20.  Nothing has been altered (other than this).

What to do about the Wuhan flu?  The short answer is to lay in a month or two of dried food and drink, and have plenty of bottled water around.

The long answer depends on whether the new corona virus (called 2019-nCOV) becomes a pandemic and if the (symptomatic) case fatality rate continues at 3.5% (based on 80 deaths in 2,800 cases as of yesterday).

With a son, Chinese daughter in law and two grandchildren living in Hong Kong, I’ve followed the outbreak ever since hearing of it 1 January.

The best and most current source of info about the outbreak is the South China Morning Post — https://www.scmp.com.  It is in English and is not a government mouth piece.

Here’s the bad news

(1) As of a few days ago the virus had been found in 29/31 Chinese provinces.  This means that confining the virus to China is nearly impossible — how do you cut off a billion or so people from the rest of the world?

(2) Here’s more from today

  • Hong Kong University  faculty of medicine dean Gabriel Leung says research shows self-sustaining human-to-human transmission is already happening in all major mainland cities.   Here’s a link
  • https://www.scmp.com/news/hong-kong/health-environment/article/3047813/china-coronavirus-hong-kong-medical-experts-call
  •  Why is this significant?  You have to know how docs operate.  When I wanted information about some issue or disease, I’d call a doc whose opinion and background I respected.  It is likely that Leung made this statement after calling med school deans he personally knew in major mainland cities.

(3) There is no treatment, in the sense of stopping the virus in its tracks.  All we have is supportive care, oxygen rest, medication for fever, bronchodilators.  This is true for the vast majority of viruses.  Remember the joke that modern medical science can cure a cold in 14 days, but otherwise it takes two weeks.

(4) We know that you don’t have to be clinically ill to transmit the disease.  Screening new arrivals for fever is well and good but that won’t totally prevent spread.

(5) Some individuals are what is called ‘superspreaders’ — one individual infected 15 hospital personnel.

(6) I wouldn’t hope for a specific treatment any time soon — look how long it took to get any treatment for AIDS, despite the huge amount of resources devoted to it.

Here is some good news. It is quite possible that there are many more cases out there with people who were either asymptomatic or  just mildly ill.  The classic example is polio, in which for every case with paralysis there were 99 cases with mild GI illness or nothing at all.

This will need to wait until we can test people for antibodies to 2019-nCOV to find out how many people have had it.  This is probably at least a month away

Vaccines (if they can be made) are even more months away.  We’ll just have to hunker down and hope for the best.

Why lay in dried food ?– in a pandemic people will panic and clear out all food they can get their hands on.  There were pictures of empty bins in a Wuhan food market last week.

People are getting serious about it.  From Reuters -“U.S. President Donald Trump offered China whatever help it needed on Monday”.  It would be nice to have some of our people from the Center for Disease Control over there. Hopefully the Chinese won’t be too proud to accept the offer.

Addendum 28 Jan — apparently the US (in the form of the CDC) is begging China to let them help out — sad — why should they have to beg?  Apparently the first overture was 3 weeks ago ! ! ! ! — https://www.scmp.com/news/china/article/3047967/china-coronavirus-washington-asks-beijing-permission-send-health-team

Vaping — don’t do it until we know more

If you have kids, I’d advise them to stop vaping entirely until we know more. Here’s why — granted that there have been ‘only’ several hundred cases of ‘lung injury’ and a few deaths  in a 300+ million population, but in any new illness (AIDs, SARs, Legionnaire’s diseases) only the most severe cases are seen first.  

Addendum 19 Mar — from PNAS – When exposed to high temperatures in a vaping device , vitamin E acetate can release the very toxic gas ketene CH2 = C = O which has been shown (in animal studies, dosage not given) to damage the lungs and impair the central nervous system

This is exactly the way it was with AIDs, the first few cases seroconverting (showing they’d been infected with the virus) had their immune system collapse almost immediately after infection.  As time wore on, we’d see seroconverters who remained healthy for 1 year, 2 years, 5 years, because (for reasons we still don’t understand) they were resistant to the virus or had a stronger immune system.  But eventually they got sick and died as well.

So it is with vaping related lung illness.  How many more cases we’ll see in  more resistant individuals in the coming years isn’t known. Will we have a nation of 30 year olds crippled with chronic lung disease?  Unlike AIDS, SARS or Legionnaire’s disease where there is a single organism, there are thousands of vaping products, and what people are putting into the machines is completely unknown.  Perhaps it’s just one drug.  Perhaps it’s a contaminated drug.  Perhaps its the particular machine.  At this point we don’t know.  It’s just like the early days of the AIDs epidemic — plausible theories abound and reliable data is scarce.  I was practicing medicine when AIDs came out in the late 70s and it was scary as hell, not knowing what was causing it.  At least with this we’re pretty sure it’s the vaping, given the age distribution and the positive histories in all.

We have one excellent example of a genetic condition predisposing to lung disease — alpha1 antitrypsin deficiency predisposes to emphysema and chronic obstructive pulmonary disease  — https://en.wikipedia.org/wiki/Alpha1_antitrypsin.  It would be useful  to see how many of the vaping cases have this deficiency.

This just in – according to the Wall Street Journal 2 hours ago 31 October ’19 ago the CDC says there have been 1,888 cases with 37 deaths.  Hopefully this is NOT the tip of the iceberg  — but probably it is.

Addendum 1 Nov ’19 I wrote this to a niece who has an 18 year old daughter entering college.  She is a teacher in a standard American high school (not in the ghetto, not filthy rich).  If any one has boots on the ground she does. Her response:  “Yes it’s very common in high school” — scary.

Addendum 8 Nov ’19  — The following comment by Peter Shenkin is so important that it belongs in the body of the blog proper —

It’s pretty impressive, but these are early times in the investigation.

If you have kids, I’d advise them to stop vaping entirely until we know more. Here’s why — granted that there have been ‘only’ …

You wrote: “Vaping — don’t do it until we know more”

We now know more; source of the following quote is at the end.

“CDC Announces “Major Breakthrough” that I Recognized and Reported Two Months Ago; Outbreak is Almost Certainly Not Associated with Legal Nicotine Vapes
Minutes ago, the Centers for Disease Control and Prevention (CDC) announced what they called a “major breakthrough” in its investigation of the vaping-associated respiratory illness outbreak. They tested lung tissue samples from 29 case patients and all 29 (100%) were found to contain vitamin E acetate oil.

This finding does represent a major breakthrough for four reasons:

1. The vitamin E acetate oil was detected in the actual lung tissue of the case patients.

2. The vitamin E acetate oil was detected in every single one of the lung tissue samples from these 29 case patients.

3. The samples came from 10 different states, confirming that the outbreak seems to have a common cause, rather than geographic variation.

4. Three of the patients whose lung samples revealed vitamin E acetate had reported using only nicotine-containing products, thus confirming that there is significant under-reporting which may explain why about 11% of the patients do not report vaping THC.”

The above quote is from: https://tobaccoanalysis.blogspot.com/2019/11/cdc-announces-major-breakthrough-that-i.html.

Full disclosure: Michael Siegel, a Public Health and Epidemiology doc who writes this blog, is my first cousin once removed. In another blog entry, he lambasts the FDA for disallowing mint vaping liquids while giving cigarette companies a pass on mint-flavored cigarettes.