2019 Novel Coronavirus (COVID-19) Update

Topics discussed in this interview:
0:00 Introduction

0:58 Background on several coronavirus papers being published in JAMA

2:51 What is the latest information about the infections in China?

6:04 What is R0?

7:55 How does R0 relate to the case fatality rate?

9:44 Where are we at with cases in the United States?

13:30 Asymptomatic transmission and incubation period

18:13 Signs and symptoms

18:57 Is transmission only through respiratory droplets?

20:18 Anything emerging other than symptomatic treatment?

24:11 Are the cases in Wuhan worse than the cases in the rest of the China and the world?

25:58 What do we know about COVID-19 and children?

27:45 Any concerns about maternal fetal transmission?

29:50 Do we need to be concerned about transmission through blood transfusions?

31:26 Any more information about where COVID-19 came from?

33:15 What will the next 2 weeks look like in China and around the world?

#Coronavirus #COVID19

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[DanMars]

What's the death rate for people who are not given oxygen at all? That's an important figure for understanding how this will impact most communities.

[DanMars]

Look at the percentage of patients who have been given oxygen or ICU care ... it's somewhere between 25-50% of the confirmed cases. Once oxygen resources aren't available in an area, this gets really bad. Compare the number dead to the number recovered ... it's about 1:3. While some may say "but these are people who are in a hospital, " I'll say that it's totally wrong to assume that only the people who need to be in the hospital are in the hospital in Wuhan. These are people who have access to oxygen. People who haven't gone to the hospital out of fear, or finances, or lines, or because they couldn't leave their family ... they don't have oxygen. I'd guess that the mortality rate is much higher outside of the hospitals in Wuhan.

[vernearase]

The numerator and denominators are both increasing at geometric rates, but the numerator reflects a fatality from an infection pool which existed two to four weeks in the past. The infection pool size at _that_ time is the denominator which _should_ be used, since newly infected patients won't experience fatalities for another two weeks or more in the future.

Additionally, we're talking about reported infections and fatalities of an incredibly overstressed healthcare system.

There are insufficient test kits to test everyone, and if there is no positive PCR test a patient is _not_ included in the official infection pool. Additionally, if that infected patient expires without being the in the official infection pool, his death is not included in the nCoV fatality pool and he is simply cremated without ever knowing (officially) if he was nCoV infected.

Reports are circulating that families have gone to four or five hospitals only to be told to go home and self-quarantine because there aren't enough test kits, and only those who are officially infected can be admitted. Crematoria in the hardest hit areas appear to be running 24x7 vs. their normal four hours per day. While the Chinese government is being much more transparent in their handling of nCoV, they will seize every opportunity to exclude patients from the official nCoV counts, so many will just exist as faceless statistics which reduces the rapidly escalating counts and helps control panic, and keeps the party leadership looking less guilty of gross negligence in their handling of the situation.

The real critical point will be when a locally administered fast antibody test is developed, since that will yield a positive result much more quickly. Recovered patients will still require PCR tests to determine when the patient stops shedding virus particles, but PCR test will only then be needed for the truly infected patients rather than for general screening where (hopefully) most tests come back negative.

[brynduffy]

Jesus! "R-ought"? Really? You don't know this term is "R-naught"?
What are you doing to make sure that there is oxygen generators not being bought up by Asia from US suppliers? About 15% of patients need oxygen and may need ventilator support/ICU care. That should scare your pants off.

[alicemorton]

How long can a single room on a hospital ward remain vacant, after being terminally cleaned after being occupied with this virus?

[cynthiachiu]

Thanks for the interview! We hear conflicting info on the media. It’s good to have reliable information from the medical and research world!

[steveneeply]

It's all about having access to a ventilator and nursing care.

[oreilly]

The main stream media is the metaphorical equivalent of a sewer running directly through your living room.

[geaca]

Dr. Li Wenliang, who has died at age 34 of the new corona virus, said that an older woman when she infected him did NOT have a fever, she only had a loss of appetite. She went to the hospital for acute angle-closure glaucoma and he treated her. She developed a fever THE NEXT DAY at noon. She unwittingly infected people of her family as well.


(translated from Chinese language)

"Obviously there are people from person to person. Around January 8th, I admitted myself to such patients. At that time, a patient in our ophthalmology department was admitted to the hospital with acute angle-closure glaucoma, and her appetite was poor on that day, but her temperature was normal. At first, we didn't think about it elsewhere. Later, her glaucoma had normal IOP, and she still had poor appetite the next day. She had a fever at noon. A CT scan of her lungs suggested that she had “viral pneumonia”. All other indicators were consistent. Unexplained criteria for pneumonia."

... The family who took care of her that night also had a fever, and her other daughter also had a fever, which was obvious from person to person.

Caixin Reporter: Is your own infection related to this patient?

Li Wenliang: At the beginning, the patient did not have fever, and I took care to prevent it (?). As a result, the day the patient turned away, I started to cough, and the next day began to have fever. At this time, I started to wear a N95 mask for protection. On January 12, I checked the respiratory tract virus and performed a CT scan. I was highly suspected to be New Crown Virus pneumonia and was hospitalized. Colleagues in the same department also had infections a day or two later, and my parents had symptoms and were hospitalized one after another three or four days after me. Later, I experienced a worsening of my condition, and now I am taking antibiotics, antivirals, globulin, and oxygen.

[alineageofdragons]

False number game, 565 deaths and 1, 376 recovered, for a total of 1941. So, to do the PROPER math it should be 565 divided by 1941, which is 29%. Therefore the death rate is actually almost THIRTY PERCENT.

[pretzel_cat]

So “transmissible” means being “replication competent” and is not the same thing as being “pcr identifiable”.

Good to know from an authoritative source. Hoping for some reports and/or studies on both pre- and post- symptomatic viral replication competence. I noticed that the German article said that high viral levels identified via pcr in a post-symptomatic patient hadn’t yet been shown to be viable at time of publication.

[juddbiggs]

When you talk of the death rate of 2 %, it is impossible to understand what you are talking about. 2 % of what...2% of the number newly infected, confirmed ..what??? ..Patients take longer to die than to recover, so recoveries will appear to go up. Newly infected occur faster than recovery so your death rate is an invalid statistic. A valid statistic of the death rate would be to pick a time of a number of confirmed cases and wait until all of those particular patients either recover or die. Then you can do a death rate. You can compare the same approach later to see if the death rate has gone up or down. It currently appears the number of critical or dead compared to confirmed is maybe 19% with more than 20% of critical having died. Only when you compare the total dead vs the total recovered can you make a valid estimate of the death rate. It currently looks like the actual death rate of those infected is above 10%. Thumbs down to your reliable information. Time will tell if containment and treatment will be effective.

[zune]

Outstanding interview, impressive. Excellent work

[williambolton]

The fact that Event 201 Pandemic Exercise just concluded prior to the coronavirus epidemic/pandemic is just a coincidence, right?

[Collabadvantage]

In Australia we are being told that we cannot contract COVID 19 from children. Did your studies support the idea that teachers cannot get the virus from pupils and grandparents and vulnerable younger people cannot contract COVID19 from children. Do your studies indicate this is the case? If it doesn't could you indicate the studies that show we cannot get COVID19 from children.

[williambolton]

Why did my comment about the R0 being reported by some as 8.04 get deleted?

[MarkProffitt]

It's spreading in Thailand & Singapore, both are warm all the time. Is that an indication of the infection rate in warmer weather? If so does that mean it could be much worse in Europe or North America?

[mvvagner]

Listening to Fauci explain how travel restrictions are almost pointless is very cringe. Travel restrictions serve a very valid and important role in gaining control of outbreaks. It's the first and one of the most important tools we have during a pandemic situation.

[xiao-rongpeng]

Great to have updates from this highly respected scientific journal! Truth help everyone to stay rational!

[Gumarko]

Very informative interview. Thank you, Dr. Fauci. NIH and the country are indeed fortunate to have your expertise and experience during this pandemic.