Just spoke with him again today, he states others he knows at work are sick as well with his respiratory illness. But he describes them as days ( 9-12 )behind his presentation. He is probably patient 0 at his office. He is now complaining of shortness of breath and difficulty of breathing and considering a trip to the ER. Again, he did not travel to china or come into contact with a confirmed case of NcoV. However, he did have direct contact with a family member’s wife who traveled through china on jan 15. He also has a history of flying back from Tahoe via san fran on early am of the 12th. and he developed symptoms around jan 21-23 and has been sick hoarse and with dry cough and now seems be having difficulty breathing I feel he will be dismissed even though , his clinical presentation is clearly not the flu and not a cold. I am including the problem with the CDC… in the below flowchart for clinicians to evaluate a person for the Ncov - you can clearly see he does not meet the criteria. But how do many others that have been diagnosed like the 4 britons at the french ski resort?/ was my brother not at a ski resort? frequented by local nearby high chinese population? I am pretty sure there are more asians in san fran ( 36%) than the french
alps. 
Sorry to taake up so much space, but these above papers are great summaries,
The last, just above paper mentions that infection with 2019-nCoV appears to be initially associated with an increased Th2 response.
This is the best layperson explanation of how to balance Th1/Th2 immune response using OTC supplements, herbs and nutrition that is evidence based.
https://selfhacked.com/blog/supplements-people-th2-dominant/
Also, some people won the genetic lottery when it comes to a highly efficient, capable and balanced immune response to viral infections. These people, even though may show some initial symptoms, might not be shedding large amounts of viral particles in their naso-pharngeal secretions. So there swabs might test false negative initially. This phenomenom was seen in SARS. Also, shedding large numbers of viral particles was a bad sign....those folks tended to have higher mortality. Also, even after symptom resolution and discharge from the hospital some SARS patients shed viral particles up to 80 days after being sent home.Nasopharyngeal shedding of severe acute respiratory syndrome-associated coronavirus is associated with genetic polymorphismshttps://www.ncbi.nlm.nih.gov/pubmed/16652313
That’s a great list Doc. We now know most of it is produced in China but China is closed for business with all major ports shut down. Secondly, domestic Chinese demand has already used most of the global supply of available masks and gloves. We need operating factories there soon to get the rest of the world supplied again. In my own town I have heard that local Chinese have bought up all the available masks and some medications and couriered them back to China! What are the rest of us supposed to do when infection arrives here and those ports are still closed? Is this Xi’s revenge?
Sorry, we can’t supply you?
Another Aussie here, been reading and watching for past month or so now. Located in Top North where the “evacuees” from Wuhan were brought to on the weekend. Trying to get as much info as possible regarding facts and possible scenarios to plan and prepare accordingly. Best wishes.
Mark - I think your assessment is spot on. I too was thinking how the cases might manifest themselves in the US. The CDC protocol for testing says only use for China exposure or indirect exposure to known NCoV person plus primary symptoms. This means most folks going to hospital as new potential cases will not be tested and will likely get misdiagnosed (until a cluster or other anomaly appears). I wonder what cities these might pop up first in. A worldpop risk study says Los Angeles and New York City are the top 2 US travel destinations for Chinese during the lunar new year period (Jan. 10th to Feb. 18th). These cities might have had many potential visits by China residents prior to the beginning of airline restrictions towards late January.
See page 14 in the report - https://www.worldpop.org/resources/docs/china/WorldPop-coronavirus-spread-risk-analysis-v1-25Jan.pdf
This is the second study of this nature, i have read on the topic in 3 days. I always assumed this anyway. And i do not believe in medicating a healthy person or child. So, yeah… It is one thing to get a vaccine when there is imminent risk, but to vax like they do with children now and for illness that do not harm you permanently, is absurd PERIOD.
I just read something about georgia dept of health is working with the cdc in evaulating potential patients via feedback from practitioners… It looks the practitioners are seeing something and speaking with the dept of health… it looks like the CDC will soon change the criteria… Again , slow to move their ass, but this was dumb for CDC to set this criteria. its going to kill a lot of people for the delay… I cant believe these people are real drs running this… really. i am going to apply for a job there. oh yeah. i havent been employeed by big pharma… so i guess that wont happen.
China changes counting scheme to lower Wuhan virus numbers
TAIPEI (Taiwan News) — The daily reports of Wuhan virus infections in Communist China will likely begin to drop as the government has decided to stop counting patients who test positive for the disease but do not exhibit symptoms as "confirmed cases." https://www.taiwannews.com.tw/en/news/3874490 =================================Shanghai, Chongqing also locked down as Wuhan virus spreads
Zhu said that the measures include strict controls over those coming and going and that those who enter must register and have their temperature checked. If someone's body temperature is found to be abnormal, local authorities must be notified, and the person in question will be examined by medical personnel. https://www.taiwannews.com.tw/en/news/3874064 ===================Wuhan, the queue for the hospital. Coronavirus
https://www.youtube.com/watch?v=H0k5l9nHwjEI have been reading a lot lately and trying to piece it all together. In my house we have come to the conclusion that since this virus is now out of the bottle (so to speak) and can’t be put back inside, that we might just accept infection as inevitable sometime in the next 6 to 12 months.
There really is nowhere to run and hide from this kind of illness with such a high infection rate.
What that means in other words is taking precautions but perhaps more importantly, doing the things that will reduce known risk factors. We cannot get younger but we can quit smoking for example.
And we can take steps to reduce hypertension. Since age, smoking and hypertension are listed among the major factors that create the highest risk we will deal with those within our power while just practicing good hygiene.
One thing we decided in our house was to avoid handshaking from now on. It is not such an extreme idea anymore. Maybe we will embrace the Japanese tradition of simply bowing to guests instead. Lol!
This indeed looks promising for targeting the spike protein and viral destruction by the immune system. There is 20 years of experience producing monoclonal Abs in pharmaceutical quantities. US pricing (~10X than elsewhere) is somewhat expensive but a large patient group might allow reasonable pricing. https://www.ncbi.nlm.nih.gov/pubmed/29461857
There is also the issue of patient tolerance. The first time I took a monoclonal with NSAID, I neglected to take a second 4 hour later dose (not suggested) and spiked a 100 fever. One time issue.
I am not often in the car to listen to the radio at 9am on a Monday morning, but this morning I was. And I was actually rather relieved to hear a local NPR station have a “roundtable” discussion about the coronavirus in which the participants were actively critiquing how the media has downplayed the risk and referred to an article in the New York Times that covered the exponential nature of the spread if R0 is over one. Sounded like the article used an R0 of 2.6 but I was pleased to see that this critical information is actually being discussed in mainstream media sources, and I can’t help but think, despite the pushback Chris has received, he is actually influencing things in a direction of more people actually thinking about the data, which is what we want. So three cheers for CM and the crew at PP. I’m so glad you are giving us this “lens” through which we are watching things unfold. Felt the same way about the Crash Course. And I really appreciate watching you update the key points as more data emerges. You are actually doing what you said you would do, and that is base your reporting on the data and that the reporting will change when the data does. That is integrity. And in a world of so much misinformation and misdirection, your integrity speaks volumes about you and remains in tact despite whatever pushback they try to throw at you. Thank you!
Hi nordicjack,
I’m hoping that some of the physicians, nurses, paramedics or others within the PP community will add their better informed perspective on your brother’s situation. Your brother’s symptoms are concerning, whether or not they are related to nCoV.
Here are some of my thoughts from purely a layperson’s perspective:
Here’s the link to the latest CDC Interim 2019 Person Under Investigation (PUI) form that health personnel will need to complete to send to his local/state health dept.: https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf. It may be helpful for you to review and complete your copy of the form with your brother to help ensure you accurately capture key clinical information in terms that comport with clinician’s screening criteria.
The CDC flowchart you provided is not definitive as the CDC states that, “The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain travel or exposure).” (Source)
So the CDC criteria and PUI (“Interim”, now a few weeks old) are to be used as a guide, deferring to state and local health depts., in consultation with local health care providers, to test, identify and confirm cases. My point being that if persistent, you/your brother may be able to make the case for nCoV testing given the recognized high R0 of the virus, potential for person-to-person transmission, and the awareness that the virus is now self-spreading in the US (so your brother could have been infected without having met the Interim PUI travel criteria or exposure to an nCoV confirmed patient). If state and other designated labs are now CDC-authorized to perform tests, it might be a bit easier to get tested, and get results back quicker (for now).
Is the woman (wife of a family member) who traveled to China showing any nCoV symptoms? If not, she could still be asymptomatic, but either way this would be helpful information to provide the health/medical workers. You/he should also include information about any co-morbid health conditions your brother has. Inform them that other workers in his office are showing similar symptoms as your brother.
Very important: CDC/health depts. advise calling ahead before going to any health/medical facility or provider to ensure they are prepared to properly screen the suspected nCOV patient while preventing exposure and possible infection of others. If you are not able to go with him, is there someone else who can go that can help advocate on his behalf? Or can you be linked via phone to the health/medical provider?
Again, I hope other PP members with more appropriate expertise can add their perspective.
Wishing you and your brother well. Hang in there!
As has been stated before, the use of masks is primarily to prevent spreading the illness if you are sick (even if sick and without symptoms) unless you go with with the full sealing ‘gas mask’ type respirator with eye protection. The only step above that is the powered “moon suit” HAZMAT suit. Aerosols can enter through the eyes, ears, nose and mouth, as well as open wounds/scratches, etc.
Due to the reported long survival rate on surfaces (up to 9 days), the best advice it to go inside, close the door and stay there for the next 4 weeks if an epidemic strikes in your area.
While there is a conspiracy thread weaving through these conversations (I’m not completely sold that it’s 100% natural either), the precautions for dealing with biological agents are the same:
Nobody new in, nobody goes out and, if they go out, they stay out.Decontamination in a pandemic (or other mass-casualty scenario) is a major pain. Here's a few sample videos on YouTube to show you why: https://www.youtube.com/watch?v=MlRPIPJ8khI https://www.youtube.com/watch?v=jZnDFFhdI0Y (If you would like others, search for terms like NBC Decontamination training video or CBRN Decon training video. Even DuPont has helpful videos on YT). The good news is that you may be able to reuse some of your PPE (since it is unlikely that you would sue yourself) by washing it in a bleach solution. I don't know if some of the masks would hold up to soaking in 90% isopropyl alcohol and air-drying. I'm not going to get excited about it; I live in one of those backwards Third World places where people sneeze and cough and spit all over the place, public hospitals rarely stock soap or toilet paper for fear that the public will steal them and pride in a job well done is a crap shoot.
There has been a lot of information saying that surgical type masks offer no real protection from the virus. I disagree… Although, they are truly designed to limit the exposure of others from the wearer, they would be somewhat affective if you were to have a conversation with a bank teller or cashier from the ordinary saliva spittle that may spray from one during normal speech. I would not expect it to be helpful in a setting where you were in hospital waiting area and lots of people coughing or a movie theater or bus or airplane with coughing. What i normally due even during flu season , is stay away from anyone coughing ( ie while shopping ) at least 20 feet if possible and not inhale for 30 seconds if some has coughed closer. But the other reason they can offer protection is as reminder to not touch your face… I am pretty well trained to not do this while out in public - but a mask can train someone to be more cognizant of touching or cross contamination of surface touching. So, for basic extra caution for shopping it should fine - to keep peoples spittle from getting on your face in normal conversation, and for learning to avoid facial contact it is purposeful. But by no means would expect to hang out in a room of sick people with this and expect protection unless for just a few moments. Why are you hanging out around a bunch of sick people unless you are health care provider or on public transport? elevators can pose a hazard as well .
Just for reference , i have washed dust masks and surgical masks many times before and they do hold up pretty well if they are decent quality, I have not washed these for sterile purposes , but for air borne contaminants… particulate… from light industrial work and building …
The information you provide is greatly appreciated. I will pass on the information to him and he will be better advised to speak with his clinicians regarding his condition and potential of serious illness or ncov
I hope that anyone who experiences shortness of breath visits the Emergency room/Acute Care as soon as possible. Mayo Clinic shows why Corona viruses are not the first concern:
https://www.mayoclinic.org/symptoms/shortness-of-breath/basics/causes/sym-20050890
You can have a legitimate illness without exposure to the Wuhan strain. Anyone can have a heart attack from reading the news. Please seek help if you are ill.
…is the extended close proximity, and the shared ventilation systems. Their environment forces more contagion, so I don’t think they’re a good representative sampling for those living outside of closely-crowded circumstances.
The cruise ship is a good proxy for people living in densely-populated areas. When you consider that most of the world lives in urban areas, it’s an important reference point.
https://ourworldindata.org/grapher/urban-vs-rural-majority?year=2019
Cruise ship is also a good proxy for any institutional setting: large corporate workplace that shares a company cafeteria, university, prison, military installation, etc.
Country folks forget that the trucks and trains that haul stuff to their towns come from ports in these densely urbanized areas.
I can imagine a liberalization of automated transport rules in the event of a mutation and nationwide lockdown - only robots will be cruising the highways, so it’s safe to introduce the technology. Convenient, yes?