This chart shows the daily case growth outside of Hubei. On January 31, it stopped growing altogether. If this holds, it means China's quarantine worked and they have contained the coronavirus outside of Hubei.
This next chart shows cases in Wuhan (blue) and the rest of Hubei (orange). It is not as encouraging:
I don't want to extrapolate off this small set, but the very initial takeaway is that there is a small window for stopping the spread of coronavirus. The good news is it can be stopped with "crude" measures such as quarantining cities, but the bad news is this requires a powerful and competent government. The bad news is Wuhan and Hubei could be in bad shape even with quarantine measures. Huanggang (which borders Wuhan) is now under full lockdown. Caixin: Reporters’ Notebook: There Shouldn’t Be a Second Wuhan
Among them, Wuhan has 2,639 confirmed cases, of which 159 people have died. Huanggang has confirmed 573 cases, of which 12 have died. However, Huanggang’s situation may be much worse than its numbers suggest, as the city may have more than 1,000 cases when taking into account suspected but unconfirmed infections as of Wednesday, according to Governor Wang.Too many sanguine reports on the coronavirus fail to appreciate how quickly logistics break down in a pandemic. Short of a major pandemic that hits everywhere simultaneously, the biggest risk from the coronavirus is a disruption in the economy. Leaving aside all the debt and fragility created by governments and central banks, global and national supply chains are also fragile. Just-in-time inventory is highly efficient because the great coordination between companies makes the global and national economy function like a single body. However, if one important part of the supply chain goes down or there is a great demand shock somewhere, it causes a shock to the entire system. It looks like China has a handle on the virus outside of Hubei, but if they lose one more major city to the coronavirus, the demand shock will be incredible. Imagine a nation that lacks the manufacturing base of China or its logistics system, how would that nation respond to a similar outbreak?
Many patients are simply waiting for the tests needed to confirm whether their symptoms come from the new virus, but resources are either prioritized for Wuhan, or still in transit. Traffic lockdowns and logistics blockages are among the factors that leading to near-total exhaustion of medical supplies in cities like Huanggang.
Back to the good news. This next chart also shows the case growth slowing in all of China, inclusive of Hubei province.
These charts (save the first) came from: 新型肺炎(2019-nCoV)非湖北新增病例首次下降,拐点还会远吗? (New pneumonia (2019-nCoV) non-Hubei new cases drop for the first time, Is the inflection point far away?)
Decrease in new cases is one of the signs of the turning point in the epidemic, New cases have declined in Hubei non-Wuhan and non-Hubei provinces. Xiaobian expects within three days, new diagnoses nationwide will also decline.Some experts are more cautious and expect a peak in cases in Wuhan and Hubei may not arrive until late February or March. 武汉肺炎的拐点可能要拖到二月下旬?
One thing to worry about is, new cases in Wuhan increased sharply on the 31st, the possibility of a second wave of outbreaks cannot be ruled out.
Two outcomes: Will the inflection point of new cases be delayed until the end of March?I've heard many people in the U.S. compare the coronavirus to the flu. The article plainly states why this is wrong:
Combining all the data and information I know, I think there are two endings to the epidemic:
1: If the three-generation infectious index is low and the severity of the disease is reduced, coupled with the concerted efforts of the people across the country to isolate, prevent, and prevent most of the transmission routes, the highest point of new cases will appear inflection point in mid-late February.
2: If the three-generation infectious index and the level of disease remain high, coupled with factors such as the return of employees to work in the market in early February after the year, the disease will erupt at the end of February and may spread across the globe. In the end, the inflection point of the new cases will be delayed until the end of March if nothing unexpected happens. If so, the actual number of people infected will exceed one million, or even higher. Of course, the counted number will be much lower than this number.
4. Wuhan Pneumonia and Influenza Viruses Can't Be EqualedThere's also concern it could be transmitted back to animals:
Recently, some people have suggested that the flu kills thousands in the United States every year and tens of thousands of lives in China. Therefore, it is believed that there are currently 10,000 cases of infection in 2019-nCoV, and the death of two hundred people is a piece of cake. Don't forget that the genes of influenza viruses are relatively stable and regular, and we have vaccines that can cause tens of thousands of deaths each year without additional isolation and precautions (case fatality rate is about 0.1%).
If a new virus, all of our human bodies do not have any immunity, and a mortality rate of 3% (current forecast of the virus by Lancet Jan 2020) , assuming that 10% of Chinese people are infected and 1.4 billion Chinese people will have More than 4 million deaths. The resulting social unrest and economic losses will be a huge disaster. This is why the WHO and other countries around the world are so anxious about this issue.
5. The possibility of infection and transmission of Wuhan pneumonia cannot be ruled out in pets and other animalsGoing back to my post yesterday, Coronavirus Spreading as Fast in China as Outside, that showed the case growth was the same inside and outside of China. If China has gotten a handle on the coronavirus inside China, concern will quickly shift outside of China where other governments have been late to declare emergencies or take similarly strong measures.
There may be many unknown possibilities that really determine the next step. Some people recently emphasized that pets and other animals will not infect and spread 2019-nCoV. In the absence of evidence, no possibility of transmission can be ruled out. There are currently no reports of pets getting sick from 2019-nCoV. But several coronaviruses have been found to infect animals and in some cases make them sick. Therefore, the U.S. Centers for Disease Control and Prevention recommends avoiding contact with pets and wearing a mask if you are sick. Researchers reported in the 2003 issue of Nature that cats may be infected with the SARS virus and spread it to other cats in the same cage, but they did not show any symptoms.
To summarize: Wuhan and Hubei are not out of the woods. These remain the areas of highest concern. Case growth outside of Hubei may peak in the coming days. China outside of Hubei may breathe a sign of relief as early as next week. While China is starting to look good, the rest of the world remains a concern. Case growth through January 31 was growing at the same pace inside and outside of China. Even if China has success, it is unknown if foreign governments have or will be able to match China's response. Even if they stop an outbreak, the economic impact could be substantial. Still, the turn in Chinese data is a reason for cautious optimism, at least for China.
Finally, here is a good thread from Erik Townsend which explains why we need to take the data with a big grain of salt, but comes to similar conclusion that ex-China is more important now.
1/THREAD
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
PREDICTION: #2019nCoV infection rate will fall off prior exponential trajectory being tracked by @chrismartenson and @biancoresearch creating a sense of relief that the crisis probably isn't as bad as it first looked.
This thread details why that will be a FALSE SIGNAL
2/The exponential progression in which the case count was increasing by 25% to 40% PER DAY may CONTINUE, but REPORTED case count from China will be much lower.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
REASON: IF the REAL case count continues to grow on prior trajectory, China medical facilities will turn most new.....
3/...cases away. Facilities are overwhelmed and can't handle new cases. This will create the APPEARANCE of the situation improving and make prior exponential growth projections look WRONG.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
In reality, all it means is the situation in China is so bad the data are useless.
4/ The solution is for observers to start focusing exclusively on ex-China data, where reporting is more trustworthy.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
This will allow careful monitoring of case and death toll trajectory independent of Chinese government distortion. Much cleaner data, but moe importantly,...
5/...This approach will also eliminate distortions caused by prior flaws in Chinese reporting. And perhaps even more importantly, this overcomes "But there have been no deaths outside China" objection.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
We need to start tracking the EX-China dataset as a new, cleaner source...
6/...of data for measuring what this epidemic will mean to the rest of the world, ex-China.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
BUT we haven't yet gotten past the "inflection point in the knee curve". Ex-china death toll won't be relevant until it starts to grow to meaningful values on its own.
7/So, we're about to enter a "data blackout" period. Chinese data will rapidly decay to zero statistical value because it will be so distorted by systems being overwhelmed in China that the data becomes useless. Meanwhile, ex-China data set isn't yet big enough to be meaningful.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
8/ So what do we do? Answer is start focusing primarily on ex-China data. For a while that will mean looking at a very small case count and trivially small death toll, and feeling tempted to think "No big deal".
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
What is ABSOLUTELY CRITICAL is that we measure it in terms...
9/...of EXPONENTIAL TRAJECTORY, not in terms of how significant the early values are.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
Example, suppose you see reports of death tolls that grow from 1 to 2 to 4. Human nature is to think those are very small numbers and nothing to worry about. BUT...
10/...to a trained eye, 1..2..4 is a SCARY set because it shows a 100% per period exponential trajectory. A trained observer knows than in just a few more periods, the figures will be 8,192... 16,384... 32,768... 65,536...
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
The point is focus on the exponential trajectory.
11/ The key is to ANTICIPATE that China data are about to become meaningless, and that ex-China data are EXPECTED to stay small in absolute terms for another few weeks.
— Erik Townsend 🛢️ (@ErikSTownsend) February 1, 2020
During this "data blackout" we need to focus on trajectory, not magnitude of ex-China data values.
END THREAD
Finally, here's my projection for case growth assuming the January 31 growth rate holds. If there is no change, there will be 1 billion infections outside of China by March 20.
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