CharonY

No doubt. Folks in the midst of it will only have limited capacity to correctly categorize each death, though I believe that Italy has one of the higher post-mortem tests. In Wuhan for quite some time they counted suspected cases as confirmed ones after using MRI, as they were running low on test capacities and/or wanted to have faster reporting. Everyone involved knows that data is imperfect and will remain for quite some time in most countries.

A few things, the coverage varies a lot between different countries also the case when folks are being tested. Considering that a lot of outbreaks are actually localized rather than nation-wide (depending on size of the country). One thing to look at that sometimes is helpful is how many tests come back negative. Italy also does some post-mortem testing, which other countries don't for example. So roughly 15% of all tests currently administered still come back positive. Contrast that with South Korea where less than 2% of all cases come back positive. The "real" fatality rate is probably lower than the 2-3% reported for the simple reason that many asymptomatic folks will remain unknown. What we start doing now is testing for antibodies that will detect "invisible" infections. Some preliminary local data has been provided for Germany for example (in Gangelt, one of the hotspots of infections) and the death rate there when accounting for undetected cases was closer to 0.4%. In other words the observed crude death rate is also a factor of tests being administered as well as the other factors Stranger mentioned. And of course there is also a matter of definition, as some calculate it based on symptomatic cases exclusively, i.e. case fatality. This basically would only count the likelihood of dying after developing symptoms (a couple of countries including China have waffled a bit in terms of what to report as a case). Again, it would be silly to assume that the world would have reacted differently if China had reported a few percentage points higher or lower. With regard to testing, the reporting was a bit all over the place. Typically two or more tests are administered and initially Italy for example listed counted each test but I think they switched to individuals at some point. That caused a bit confusion to calculate test coverage and makes some data not comparable. Other Countries (such as Germany or US) either did not publish a totals list or referred to individual states (which may or may not have reported). With regard to reporting, I know I got test numbers from Wuhan (via the provincial reporting)a while back but I do not know enough Chinese to effectively dig out data. There was a report in the province in Guangdong which showed about 320,000 tests at the end of February (or 2820 tests per million people). It does look that only from 66 countries we can get convenient national data (although again, they may be different in terms of what is being reported). The correction of death rates on the other hand does look more like an attempt at transparency rather than obfuscation. Most countries will under report deaths unless they do post-mortem testing in all suspicious cases. And countries with limited capabilities will obviously under report more. To be clear, China is definitely not a source that can be trusted with the same level as many other countries. While there is no evidence of systematic data manipulation they could, in theory reduce overall positive as well as death numbers, thus keeping the ratios constant (again, no evidence that they did). But, and this is the important bit, even if they did, and even if they are in a worse shape than they seem to be, it is no freaking excuse for the other countries to not at least create emergency plans and scenarios the moment China started reporting on the outbreak. Cases outside of China (including US) were already been reported leading up to February but without evidence of community spread. So why wasn't there more contact tracing or any kind of travel screening (as shown in other countries shutting down borders is not even necessary). I am repeating myself here, but it is not about whether China is a reliable partner or not. It is about why folks did not act even with the available information (regardless whether they were 100% accurate or not, as you will never get perfect data in a novel outbreak). Infectious disease experts have been making some noise early on and the CDC has made all the right statements come February. And then there is the gaping lack of action until Italy was hit and Europe was starting to get nervous. I suspect much of it is because often Europe looks toward the US in these situation as especially Germany is often unwilling to take lead. Germany produces a lot of the components for the tests and has decent capacity of PPE production and I think I got a notification sometime around March where only then they were asked to increase their production. I.e. folks did not think that they needed the surplus (which is why the first weeks in Germany there was an abysmal rate of tests until they managed to ramp it up). There was a whole lot that could be done and it is perhaps no surprise that countries with with SARS experience responded better. What the rest of the world needs to understand is that infectious diseases will be with us and regardless where you live, there is always a chance for deadly outbreaks. The tendency to think that if something happens elsewhere will never impact us or that where we live is clean and disease-free is an illusion. I am expecting that this situation is a teachable moment for countries that ignored the pandemics and epidemics that have been less consequential for them, but am dismayed that some countries (including China and the US) are instead playing the blame game, as if diseases would care about any of that. There is some evidence that higher viral loads correlate with worse outcomes. Studies are limited, but I can dig them out if you want.

Macron is getting some flak from it, but at least he is referring to a scientist whose data may not be great but has otherwise a good reputation. If Fauci was pushing it and Trump being in support, it would probably also look different. Folks outside of Brazil have pretty much given up on Bolsonaro. He has not the same impact on the Western world so they do not bother roasting him, I suppose.

I think evidence is clear that children are carriers ( but often under tested) what is unclear is whether they are spreaders. Data is lacking here.

Oh sure, the studies do not really support the claims. What I meant is that it is not strong enough to outright dismiss it, either. I.e. I think it is to early to scrap it, but I suspect better data will come form some of trials with other therapeutics which are randomized and have actual controls.

Oh yeah, I think that is the follow-up to a follow-up (the second by Molina study showed no beneficial effects). But critically, the study was more set up like a case or observational study rather than a efficacy test. At this point the data looks inconclusive to me.

I am not talking about whether China might or might not have been forthright or who is more or less honest. That is not terribly productive in itself, and I am mostly concerned about facts we know or which are missing. What I am saying is that if there was a cover-up, it does not appear to had any functional consequences. Therefore there was no reason to not to heed the warnings. Or conversely, stating that folks were taken by surprise due to China hiding the infection is ridiculous, given the massive lockdown on the 23rd of January and the inaction of e.g. the US between then and March. If they hid something, and the something does not change our knowledge on the infection, why would it matter? It would then all be a discussion about who is bad and who is not, and not about whether the information is reliable and useful. And that is a very dangerous stance, because you are essentially saying we should throw out all the data from China as they are all wrong. Luckily (or sadly) by now we also have data in other countries that a very similar picture, pretty much invalidating that assumption. And here is the other thing, we are science oriented forum, so data is king. If we look at that dispassionately we (so far) do not find strong evidence of any meaningful manipulation (aside the points I mentioned before, which are not really hidden). So I am asking, what is the benefit of just assuming things with evidence, other than becoming more vulnerable to manipulation and spin? There is already the narrative that the one pushing the responsibility to WHO and China rather than acknowledging failures in own responses. Because from the latter we can learn and improve, but the former will keep us in blissful ignorance (until the next outbreak hits). Let me be clear, there are two major narratives, mostly pushed by the US at this point. One is that the inability of China (or willingness) to report on the original clusters of pneumonia up to the end of December has cost the world time to react. The issue with that is even after that only few countries started to implement measures whereas the US and others have done little until March. And there are emerging reports that intelligence services have notified folks of these clusters of infections almost as soon as the Chinese CDC, and drew their own conclusions (but apparently not resulting in any reactions from the administration) And even in March before the lockdown, folks were not asked at airports regarding their travels. So that does not line up. Associated with that is that folks could have closed borders earlier. The issue with that one, is I believe that either in the US or Canada more infections were coming from Europe than from China.Which is why the big world-wide waves started actually way later than anticipated (as China was shutting down). The second is that China is hiding some big secret, which, for some reasons, does not change epidemiological data in any relevant way. So not only it is not clear what is missing, it also fails to show any impact (at least on the scientific side of things). But again, it does not impact folks to learn about the virus, nor to implement meaningful measures, as you insinuated earlier (how can it if it does not change the meaning or interpretation of the published data?). If one does not take responsibility to ones own failures (in China's case free distribution and discussion of information, in the US' case acting on actually available information and in many other countries learning from timely and effective responses in other countries), these issues will crop up again. And there is not guarantee that the next one will not have an origin in, say, North America.

It is a big unknown. Antibody testing is going to be the next stage for better understanding of epidemiological coverage.

That is nonsense. Plenty of folks took it seriously, their pandemic responses teams activated early January. China shut down whole provinces and tanking their economy and risking unrest. That alone was a strong signal (and WHO raised their warning levels at the same time). I mean seriously, what would have been a warning sign if not that? Obviously China (as well as other countries hit by SARS) took it seriously at the latest toward the end of January (again, there was an unprecedented shutdown). Other countries, including US and Europe did not react until late February to March. Folks such as the RKI in Germany have acknowledged that they should have done more contact tracing, for example. In addition it is a weird cover up that managed to create perfectly predictive data. So far transmission rates, lethality, effects of age and comorbidity all seem to line up with data all over the world so either they new the correct numbers and fudged it to much or they covered up something that had no impact on our undersanding. In that case if something was covered up, what would it even theoretically be? Everything that happened in China is now happening elsewhere with the same intensity (or worse, depending on the response). So what is being covered up that so well matches all observations so far? I do not expect the Chinese government to be forthright, but it is silly to assume that this causing in poor responses elsewhere as, again everything that came out of China so far was shown to be fairly predictive. In addition to all that, there was also data coming out from countries that started early testing, so by February we also had range of strategies on display, including total lockdown (China), enhanced contact tracing eventually followed by testing (e.g. Taiwan, Singapore, Vietnam, South Korea). Well, or nothing.

There is a difference between let's conduct a trial to see if it works vs. "just ask your doctor to take it. I think it works." One is following procedure and creating scientific evidence. The other one is pushing gut feeling.

The suppression of free speech by the Chinese government is definitely wrong. However, I am skeptical regarding large-scale misinformation for several reasons. The biggest one is that one strictly follows the data, everything we learned from China so far largely lines up with models with data from other countries. For example, if they were covering up deaths, by now we would see an unexplained shift in fatality rates outside China, but that does not seem to be the case. They did change the reporting several times, including not counting asymptomatic cases as infected, but it kind of makes sense from a clinical viewpoint, as they isolated all cases but treated symptomatic and asymptomatic cases differently (and moved the former to the latter category once symptoms manifested, it is an inelegant way to avoid double counting). But all it did was to increase the published death rate. So if there is huge cover-up of sorts, it is unclear what they hid, as at least on the scientific side of things regarding the virus nothing has fundamentally changed in our understanding.

The issue there is that the WHO cannot force countries to run their health system in a specific way. Even a single country might report things differently in each province/state/ prefecture. Taiwan had a task force from the SARS days that spring into action. South Korea quickly assembled one. Likewise Singapore. One could have emulated them (or not weakened ones own pandemic response team, for example).

Ultimately we don't know yet. It is atypical to many other respiratory diseases, but a working hypothesis is that it is because children do not mount cytokine storms. Another one is that symptoms are amplified by accumulated lung injuries/damages and that younger folks just have healthier lungs.

Exactly. Children are likely asymptomatic carriers and generally live with folks that are older...

Well from what I have seen the US has been heavily pushing the anti-Chinese narrative and China has responded in kind. Both are crap, but I am not sure whether the saying actually fits well here.

No, not the messing up things. I was more referring to the narrative that they deliberately hid things knowingly. I.e. they knew that they had a spreading disease on their hands and decided to suppress that. The USA also messed things up, but after having all the information that China at that point didn't have. So even without the expectation that the US would have reacted better under the same circumstances, I certainly expect them (or anyone else) to react better with the knowledge at hand. To make the wrong steps based on structural issues in a situation with incomplete information is different from choosing to take the wrong steps when presented with all the information. That is perhaps also a part of it. As long as medical professionals have to work within a system that has strong political influence, it is somewhat expected to have slower reaction times and more mismanagement. The US used to be (much) better in that regard.

I would agree with the the fact that China should not engage in public mudslinging and I am more than dismayed on their attempt to create a new narrative. I do think their failures were structural ones where medical advice was not shielded from political meddling combined with secrecy creating a recipe for disaster that could have ended far worse. That being said, there is at least some level of plausible deniability based on a mix of incompetence, awful reporting structure and error of judgement in an somewhat unknown situation. The US has none of these excuses. And at least the machinery started moving once they were past that point. According to NYtimes reports apparently the Chinese CDC really got memos regarding clusters of unexplained cases of pneumonia by Dec. 30 on 31st a team was dispatched to Wuhan, concurrent with notification of the WHO. The cases that were circulating were only then finally entered into a system that was part of a pandemic warning system (around Jan 3rd). The initial assessment before they were certain that a new disease was in circulation was finished by the 19th and on the 23rd the province was shut down. In-between (on the 12th) Chinese researchers released the full sequence of the virus. So somewhere around that point, the world knew what was coming. While responses have been slow and halting in many parts outside Asia, the US was one of the few Western countries who were still in active denial deep into the process with some first moves being done sometime in March, way after Italy was hit badly. With regard to the WHO, not sure what they could have done much better. When they raised alarm regarding SARS they were criticized for damaging the economy. In the link above there is a report on the payment status March 31st. And from it it looks like that in their balance 31-Dec-19 was 71mill and only 29 was collected leaving 41 mill as outstanding from their previous balance. Maybe they have paid it since then. China has an outstanding bill for 2020 but paid for 2019. From a quick look it appears that only few countries had outstanding bills for that year (most in the Middle East, from the looks of it). But again, the commitment does not seem an arbitrary pledge, rather it appears to be something that is based on agreement of its member states.

No, if one is infected but e.g. with such a low amount that the body did not build up memory, a vaccine that triggers a stronger response can be beneficial. However, a person that has been exposed to sufficient viruses and/or vaccine would mount a faster and stronger response once the virus pops up again and thereby have a higher likelihood to clear the virus before it actually manages to go into hiding.

And even with the missteps and structural issues in China, at least they had the excuse that it was a new disease that they had to identify and develop a diagnostic tool against. Once they decided to move, it was incredibly fast (the scientific side of things) and perhaps needlessly harsh. But a few months in, seeing all that is happening and virtually no response is something else entirely. As I have stated before, the CDC is usually on top of these things and if they were the ones handling it without interference, I would think that if the outbreak was in the US, the outcome would have been better. Yet seeing what the current administration has done (or rather not done), I am not so sure.

It is quite a bit more complex than that but it would require a lengthier explanation. Simply put is that while adaptive (as well as innate) responses can clear infections, obviously. However, at the same time pathogens have mechanisms that can delay or evade responses. Viruses replicate intracellularly, so once they managed to get into cells, they can remain hidden until the cells produces viral particles. There are also various strategies that keep those particles hidden from the host for longer. Simply speaking, if there are only few particles around who are not slipping into cells yet the immune system can clear them. But it is essentially a race between how well the virus hides and replicates vs the immune system finding viruses and infected cells.

That is my assumption as well. There is currently a concerted effort to blame China and WHO for all the mismanagement that happened in the US.

The membership fees are calculated based on wealth and population of the country (I do not know the exact formula, though). I.e. it is a share that the nations agreed on and where the USA decides to break the agreement for PR reasons. It should be noted that the USA has not paid its last membership fees, either (whereas China apparently has). https://www.who.int/about/finances-accountability/funding/assessed-contributions/en/ It does seem that Trump is indeed running the US like one of his companies. And that is not a good thing.

Oh I am sure he just needs to blame it on Obama and he is golden.

No, evolution in the technical sense does not apply here (evolution is a process describing gene pool changes within a population over generations). The adaptive response needs the target from the virus (or something identical you synthesize using the genetic code of the virus) .

I am not sure what you mean here. Perhaps some clarifications (in case that is the issue). An antigen is basically any substance to which antibodies can bind to. Once antibodies bind to the foreign substance they can eliminated following a number of pathways. An artificial antigen would essentially be the same protein (or parts of it, technically you just need a good epitope) but synthesized in vitro, rather than taking a virus and take fragments of it. However, the structure and sequence would identical to the real thing (for the biding site) in order to work.