13.February 2020 — Moon of Alabama
“This looks to be a bad, heightened cold — I think that’s a rational way of thinking about it,” – Matthew Frieman, a virologist at the University of Maryland School of Medicine.
The battle against the infections with the novel coronavirus in China continues. China is doing its best to win it.
The declining trend of the number of newly suspected and newly confirmed cases per day is now obvious to everyone.
There was a change in the nomenclature of the illness. The not yet official name of the novel coronavirus is 2019-nCoV or nCoV19. The illness the virus causes is now officially named COVID-19. This is the same difference as between HIV, the virus, and AIDS, the illness the virus causes.
The Chinese government has added a new category of infections to the total number of COVID-19 cases. So far there were two published categories. ‘Suspected cases’, which were people who may have come in contact with the virus and showed flu symptoms, and ‘confirmed cases’ of patients who fell ill and where the virus was found during tests.
Now people who show signs of pneumonia will be added to the confirmed COVID-19 cases even when the tests do not find the nCov19 virus in their body. The same criteria will retroactively apply to the number of dead. People who died while showing signs of pneumonia are now counted as COVID-19 casualties even when their virus tests were negative.
The new method only applies to Hubei Province which has by far the most of all global cases. The move added the 13,332 cases to the total number of cases. (To keep the trend numbers comparable the new addition is not incorporated in the above graphic.)
The change was not well communicated and has caused some serious confusion. Some sources seem to believe that this increases the number of total cases while other sources say that it simply moves people from the ‘suspected cases’ category into a new sub category that runs under ‘confirmed cases’.
The motive for doing this is not clear. The case numbers will now include everyone who show signs of pneumonia but does not test positive for the nCoV19 virus. The new count will thereby include a lot of people who simply have a common flu. That seems to make little sense. [Emph WB]
It is possible that this was done because the authorities do not trust the virus tests to identify all COVID-19 cases. Another reason for the change might be that some who fell sick may have avoided to go to a hospital because they did not have the money to do so. The change removes that motive.
China does not have a universal healthcare system. While 95% of all Chinese do have health insurance it often requires unrestricted co-payments of up to 50% of the cost for hospital care as well as for pharmaceuticals. In mid January the Chinese government announced that it would pay 100% of the costs for all novel coronavirus cases but applied somewhat strict criteria for the recognition of such cases.
Those criteria have now been changed with a ‘clinically diagnosed’ added to the ‘confirmed cases’. The criteria for ‘clinically diagnosed’ is a computerized tomographic (CT) scan that shows signs of pneumonia in the lungs of a patient. This criteria will apply even when the patient shows no other sign of illness and even when the applied virus tests do not find an nCoV19 infection.
This will now allow many people in Hubei with a common flu to fall under the clause of 100% cost absorption by the government.
As XINHUA reports:
WUHAN, Feb. 13 (Xinhua) — China’s Hubei Province, center of the novel coronavirus (COVID-19) outbreak, reported 14,840 new confirmed cases and 242 new deaths on Wednesday, the highest daily increases so far, local health authorities said Thursday.
The Hubei Provincial Health Commission said the number of new cases included 13,332 clinically diagnosed cases, which have been seen as confirmed cases from Thursday.
It brought the total confirmed cases in the hard-hit province to 48,206. The province had a total of 1,310 deaths as of Wednesday.
Clinically diagnosed cases are unique to Hubei statistically. The inclusion of those cases drives the surge in the number of new confirmed cases.
Any suspected cases with pneumonia-related computerized tomography (CT) scan results are counted as clinically diagnosed cases, according to the latest version of the diagnosis and treatment scheme released by the National Health Commission.
The provincial health commission said the diagnosis criteria revision has been made to give those who have been clinically diagnosed the timely standard treatment of confirmed cases to further improve the treatment success rate.
The province also saw 3,441 patients discharged from hospital after recovery as of Wednesday. Among the 33,693 hospitalized patients, 5,647 were still in severe condition and another 1,437 in critical condition.
Financial Times reporter Yuan Yank explains:
Here’s some decoding of China’s coronavirus stats: the methodology is detailed in the national health commission’s guidelines. As of Feb 7, there are 4 categories of cases: suspected, confirmed, clinically diagnosed (only in Hubei) and positive tests (meaning asymptomatic). 1/
2/ These are guidelines for what the provinces have to report to the centre. As for what gets told to the public, that’s another matter. Only today did Hubei start publishing its clinically diagnosed cases. We have yet to see the count of asymptomatic cases.
3/ There’s also a final category of people who’ve been in close contact with coronavirus carriers, which is reported separately. Hubei’s count refers to “cases”, meaning “confirmed” + “clinically diagnosed”. National figs, so far, refer only to “confirmed” cases.
The change in the method to count cases will again increase the infodemic and panic about the illness. But we have to keep in mind that this epidemic is in fact relatively mild. Most people on the younger side who come in contact the virus will never develop any symptoms and for those people who develop the COVID-19 disease the symptoms are not severe at all:
[T]he virus’s destructive potential has overshadowed one encouraging aspect of this outbreak: So far, about 82 percent of the cases — including all 14 in the United States — have been mild, with symptoms that require little or no medical intervention. And that proportion may be an undercount.
“The fact that there are so many mild cases is a real hallmark of this disease and makes it so different from SARS,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security. “It’s also really challenging. Most of our surveillance is oriented around finding people who require medical intervention.”
“This looks to be a bad, heightened cold — I think that’s a rational way of thinking about it,” said Matthew Frieman, a virologist at the University of Maryland School of Medicine.
To keep the numbers from China in perspective one can point at the current statistics the Center for Disease Control and Prevention (CDC) provides for the U.S.:
CDC estimates that so far this season there have been at least 22 million flu illnesses, 210,000 hospitalizations and 12,000 deaths from flu.
COVID-19 is still far from producing such high numbers. It likely never will come near to them as the resources China throws at it are overwhelming.
Twenty thousand additional healthcare workers are now working in Hubei province and more are on their way. The government of Hubei province has shipped 180,000 nucleic acid test kits for the diagnosis of a coronavirus infection to the relevant laboratories. The city of Wuhan alone has 40 labs that can conduct 8,000 to 10,000 tests daily. But some hospitals still report shortages of equipment and the 4% death rate in Hubei is still higher than the national one.
I agree with the conclusion of today’s CAIXIN overview:
Overall, the number of newly diagnosed cases in Hubei Province has decreased, and the newly added “clinical diagnosis” indicators help patients to receive standardized treatment early and further improve the treatment rate. On the 12th, the number of cities with confirmed cases did not increase, and the number of newly-discharged hospitals has reached 1171, which has exceeded the number of new deaths for 14 consecutive days, and the epidemic situation has changed positively.