Monthly Archives: February 2020

The global data has two things I’d like to point out. First, the case fatality rate seems to be stabilizing once again after a couple of weeks of steady climb. It will be interesting to see where it lands eventually, but I think 2.5-3.0% seems like a reasonable guess on my part.

Second, it’s pretty clear that we have a climbing incidence again. I will attribute this to China having done significant measures to control spread as well. as the number of cases climbing in Iran, Italy, and South Korea.

Also, remember not to compare these graphs directly to each other. The scales on them are different, although I’ve used the same time x-axis on all of them to help normalize a sense of what individual countries are contributing to the whole global case count.

An interesting feature in both the Iran and Italian data is the 100% fatality spike at the beginning of both outbreaks. This tells me that it is likely that they first identified cases in those countries either as the victims were either close to death or after their deaths. The other possibility is that they hadn’t reported cases initially.

It is still my feeling that Italy and South Korea will be better models of how things might unfold in the US, although both have flaws. South Korea has the benefit of the more acceptance of the common good over the individual as well as the impact of more common mask use by the public, which is a very good way to prevent the spread of respiratory droplets from those who are sick.

Italy is a bit more like our culture in the US, but they clearly made some mistakes about failing to handle their first cases correctly in a health care setting.

Disclaimer: This commentary is my own interpretation and does not represent the analysis by the government or my employer. The data is from the Johns Hopkins University’s Center for Systems Science and Engineering.

It’s time to discuss a couple of other global hot spots and want to focus on religious practices leading to the spread of disease.

South Korea is important because it is an economic and cultural bridge between East and West so it could easily act as a point of spread to other locations around the world.

The country has had only a handful of cases until mid-February. The sudden rise in cases is a good study in the need for social distancing. According to the South Korea Centers for Disease Control (KCDC), 339 out of 556 cases by Feb 23rd were linked to the Shincheonji Church of Jesus, the Temple of the Tabernacle of the Testimony. More cases were among a Catholic group of 39 people in the Andong Diocese who had traveled to the Holy Land. At the time of the KCDC report, 18 of the travelers had tested positive. By February 26, the number was closer to 30 of the travelers. 41 of the churches in the diocese had suspended mass and meetings until March 13th.

On Feb 26th, all 16 dioceses of the Catholic Church in South Korea had decided to suspend public mass, which affects 5.86 million members among 1747 churches and chapels. That has never been done in the church’s 236-year history in the country. Other denominational groups have begun to follow their lead.

The thing that I can’t determine is if they were incubating disease while in Israel. If so, this will be one of the important incidents in global spread because of the importance of Israel in world religion and as a destination for adherents from all parts of the world. It is pretty clear that if they were infectious during their time in the country that we can expect to see many more countries with cases in the next 2-4 weeks.

The situation in Iran is also very eye opening. The outbreak there likely started in Qom, which is one of the holy sites often visited by devout Muslims during the Hajj, which would start on July 28th. In an unprecedented move yesterday, the government of Saudi Arabia has closed all of the holy sites of Islam to foreigners, effectively bringing an end to any plans for the Hajj this year. This had not even been done during the Spanish Flu in 1918.

While that was a very good move on the part of the Saudis, it may be too late to help limit global spread from the Iranian epicenter. Researchers in Canada have modeled the epidemic in Iran using International Air Transport Association (IATA) data. Their conclusions are beyond alarming. “We estimated that 18,300 (95% confidence interval: 3770 –53,470) COVID-19 cases would have had to occur in Iran, assuming an outbreak duration of 1.5months in the country, in order to observe these three internationally exported cases reported at the time of writing…Given the low volumes of air travel to countries with identified cases of COVID-19 with origin in Iran (such as Canada), it is likely that Iran is currently experiencing a COVID-19 epidemic of significant size for such exportations to be occurring.”

I think what can be extrapolated is that if their conclusions are correct, we can expect to see the disease emerging in countries with a high level of air travel to Iran. I’ve copied the table from the report showing the IATA data on air passenger travel from Iran.

A similar analysis was conducted in 2009 related to H1N1 influenza that had originated in Mexico. What was striking to me at the time was the strong correlation between where H1N1 was having large impact in US cities and the amount of air travel to those cities from Mexico.

I know the inevitable questions I’m going to be getting from people is “Should I travel to destination X?” I can clearly answer that question about some countries with a resolute “no,” but to be honest, at some point in the near future, I’m not sure that I would want to do any international travel, and that is coming from someone who loves to travel internationally. I’m not going to make a blanket statement. You need to assess your own acceptance of risk, but I hope you really think a lot about what is important to you as part of your decision.

Finally, I want to encourage everyone who reads this to share it with people in their churches, synagogues, mosques, temples, and other places of worship. Given that these locations are common community gathering spots, it is time to start having conversations about what steps your religious organizations are planning to take should this disease become common in your region.

Disclaimer: This commentary is my own interpretation and does not represent the analysis by the government or my employer. The data is from the Johns Hopkins University’s Center for Systems Science and Engineering.

From February 27, 2020

I needed to find something to latch on for some hope, because frankly, looking at all this data and research is very depressing.

Since China is the furthest along in this, I decided to look at the epidemic curve for the mainland. There is a little hope here. Clearly the number of new cases have dropped recently.

While this is positive, I also temper it with how different society is there than in the West, and I’ve alluded to that before. China as also taken very aggressive measures to control the spread, which might not be as accepted in other countries. Part of the reason for the spread in Italy was the failure to take the proper precautions at a hospital. I’m not surprised though. In my years of experience in hospital infection control, I’ve seen many shortcuts that would likely have produced the same result and have had to investigate the resulting outbreaks.

Coronavirus: inquiry opens into hospitals at centre of Italy outbreak

Disclaimer: This commentary is my own interpretation and does not represent the analysis by the government or my employer. The data is from the Johns Hopkins University’s Center for Systems Science and Engineering.

From February 21, 2020

The good news is we had another day of low incidence of cases. That bad news is that the case fatality rate has been climbing. This could represent that those who have been ill that had not yet succumbed to their illness, In most people, the disease is the most severe on about day 7 of the onset of symptoms. For those that make it to day 11, they are on their way to recovery.

Disclaimer: This commentary is my own interpretation and does not represent the analysis by the government or my employer. The data is from the Johns Hopkins University’s Center for Systems Science and Engineering.

From February 20, 2020

There’s a big drop in new cases today. I’m hopeful about that as well, but will want to see if this continues for a few more days. It could also be a gap in reporting like on 2/5 and 2/7.

Disclaimer: This commentary is my own interpretation and does not represent the analysis by the government or my employer. The data is from the Johns Hopkins University’s Center for Systems Science and Engineering.