Sindre writes:

Hello, new listener from Norway here. Just want to link you guys some very good visualization of European CDC data. The page is updated on a day to day basis. Thought you guys would like it.



https://ourworldindata.org/coronavirus

Marc writes:

TWIV, please please read this, we must stop the government for needlessly collapsing the entire global economy:



—

Thanks,

Marc Garrett

Chief Operating Officer

Quality King Distributors, Inc

Long Island

Eric writes:

Was listening this week to the special edition. Very informative.



On the topic of respirators, a key constraint on respirators is the need for beds that are attended to by nurses and other hospital staff. Need a certain number of nurses and ancillary staff per bed, and they all need protective gear — e.g., masks, visors. Difficult to scale up this ICU bed capacity in the short-run even if the respirators are available.



Eric



Ema writes:

Hi Guys,



Love your show! Greatly needed in this time of chaos. I am 36 year old triathlete who lives in lower Manhattan. Since Manhattan is a ticking time bomb, over the weekend, I relocated to the country to my family’s pool house. Anyways, I’ll quarantine myself in here for 3 weeks and I have everything I need to survive without contacting anyone. The pool house is about 50 feet from the main house, where elderly relatives live. However my relative comes to a tool shed attached to the back of the pool house to clean the pool. He avoids the patio that leads to the pool house since I exercise every morning on that patio. He stays a good 10 feet away from that patio. However if I exercise when they aren’t around, could my sweat droplets somehow linger in the air and infect him an hour or two later if he passes by? I might be overreacting but it would make me feel better if I knew that sweat droplets can’t linger in the air or travel in the wind for hours.



Weird question. Weird times.



Keep up the good work!

Ema



Kristen writes:



Do we know the “dose” or how many SARS COV2 virions it takes to induce covid-19? I’m also wondering if the 3 log reduction that is typically used to determine antimicrobial efficacy is sufficient. In other words, how clean is clean?



I saw a report in the media that a dog in Hong Kong, now deceased, had tested positive. Is this just an isolated incident? What is known about potential risks to feline or canine companion animals?



Kristen



Amy writes:



Hi Professor Racaniello,



I was your student last year and I want to say THANK YOU SO MUCH for everything you taught me in virology. It is definitely (and has now proven to be) one of the most important and useful courses I have taken in my lifetime. I even share my class notes with my brother so he can learn more about viruses too. I am now back home in Vancouver, Canada, where people have also jumped on the toilet paper hogging bandwagon. At Costco, the toilet paper even has its own aisle. This bewilders me because the last resource Canada lacks is paper? My mom is now ordering bidets to avoid this frenzy.



So I got a text that was circulating this morning about how anti-inflammatories (Advil, ibuprofen) are worsening coronavirus symptoms and how people should take Tylenol instead (full text image below). Apparently France’s health ministry and other sources posted about this as well. Ireland’s Health Service Executive posted this information to dispel the false information: https://www.hse.ie/eng/services/news/media/pressrel/advice-about-anti-inflammatory-medication-and-covid-19.html



I was hoping you and your team on the podcast could address this and explain how anti-inflammatory drugs can treat symptoms of the virus. Is it even possible for it to worsen the symptoms? Prior to this, there have been numerous reports of people feeling better and then suddenly feeling worse than before, so it could just be that some of these people took anti-inflammatory drugs during this time (correlation does not mean causation)?



Thank you,

Amy



Abbie writes:



As a lay-person (as in non-scientist or medical), I’m wondering what new materials you recommend beyond the CDC and WHO websites? Obviously I will/have followed up on the sources you all quoted in your podcast.



My background as a librarian makes me hungry for data, but it isn’t too wise. Of course, we’re looking at authoritative sources.



Either way, thanks.



Abbie



Ken writes:



https://www.technologyreview.com/s/615330/best-worst-coronavirus-dashboards/

William writes:



Dear TWIVsters,

Thanks very much for keeping your updates going during the current series of epidemics. Here are some resources I’ve discovered that other listeners might find useful:

Dr Muge Cevik at the University of St Andrews in Scotland has produced a useful summary of research papers produced during the outbreak – “only scientifically sound research articles included” – https://twitter.com/mugecevik/status/1236372854171750400?s=20

Behrooz Hassani-Mahmooei at Monash University in Australia produces and updates a number of useful country-specific charts such as the one below:

Sam Abbott and others at the London School of Hygiene and Tropical Medicine publish real-time information on patterns of transmission, including charts of the inferred reproduction number in selected countries, such as this one:



Nextstrain publishes real-time genomic analysis based on sequences deposited in GisAid, such as the one below. Trevor Bedford, one of the co-founders of Nextstrain, has used the information to explore chains in transmission in the US, and was one of the first to highlight the cryptic outbreak in the Seattle area, recently highlighted in Nature. He would make a great guest on a future episode.

All the best, and keep up the good work.

William Lees

Birkbeck College, London



Glenn writes:



Vincent and TWIV et al. ,



Thanks all for keeping these updates coming….



Just saw this today on the serial interval calculation of covid-19 which might help explain some of the reactive faux pas we’ve seen….



https://www.ijidonline.com/article/S1201-9712(20)30119-3/fulltext

And this maybe be old news already but these seem to be some firm numbers from

China



https://www.nejm.org/doi/full/10.1056/NEJMoa2002032?query=featured_home

Rebekah writes:



Dear TWIV



I have been a loyal listener for many years. After completing my master’s degree in public health, I really missed the hard core science classes from my undergrad and started taking classes on Coursera, including Vincent’s virology class, which is how I learned about TWIV. Since then, I have continued my at-home learning by taking courses in things like epigenetics and listening to TWIV, while working in scientific editing. I cannot tell you all how grateful I am to be able to continue learning by listening to TWIV. I like to tell people that I liked ebola before it was cool. Now I can say that about coronaviruses. One day, maybe I’ll go back for that PhD.



Anyway, just wanted to say thanks for what you do and send you this cool website that has infographics of the world’s pandemics. You may have already seen it, but it would be a fun weekly pick.



Thanks!

Rebekah



—

Rebekah Butterfield

Washington Scientific Editing

https://www.washingtonscientificediting.com

Ben writes:



Hi TWiV team,



Came across this post https://twitter.com/andreamatranga/status/1239774862572277760?s=21, which is a translation of an article written in Italian by Prof Andrea Crisanti from Imperial College and the University of Padua. Contained in the post are the two original Italian articles if Vincent wants to exercise his Italian!



It suggests that up to 90% of infections are asymptomatic, which has big implications for the number of people currently infected, and disease modelling.



I was at a conference in Australia in early February when Prof Crisanti was evacuated by the Italian government to help deal with the unfolding situation there. I think that was the first time it clicked to me that this was bigger than I could have anticipated…



Keep the information coming, hearing from those in the know is so important in these trying times.



From what I feel is a significantly under-prepared South Australia,

Ben



Eric writes:



Hi TWIVers, thank you for following the COVID-19 outbreak in your podcast. I’ve been listening for many years and appreciate all you do, during and between outbreaks. The situation in the greater Seattle area is getting a bit more unsettled. There appears to be substantial low level transmission in the counties around Seattle already, but the scale is not known due to very limited testing. Schools are still open, but many are half empty as parents keep their kids home. Trevor Bedford at UW has done a nice analysis of the very limited data we have so far. He has written up his modeling at https://bedford.io/blog/ncov-cryptic-transmission/. I think his post is very well written and approachable and would encourage you to discuss it on your next episode if you record it soon. Always looking forward to your next episode!

Eric



Gregory writes:



Dear TWiV Team,



I just wanted to send you this link to a Scientific American article all about Shi Zhengli’s work on bat coronaviruses, in case you did not see it already.



https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/?fbclid=IwAR0ZFPmkgMfZEQPd3RPYTlaeAuQadQTTF8qbtvHXW1ogrtPJMa1gAqYijEk

I mentioned this in a previous email, but it must be said again; your collective discourse around the SARS-CoV-2 pandemic has been absolutely wonderful and your interviews with Ralph Baric on 01/26 and now most recently on 03/13 have been invaluable!

Simply stated, to have access to a group of level-headed experts in the field of virology in general, but specifically during the throes of SARS-CoV2 is in itself a real gift, but the added bonus of listening to you all discuss this pandemic with Dr. Baric is just out of this world enlightening. As a thank you I have donated the money I would have spent during a hording mania bulk-buy of toilet paper to your Patreon.



I will not bore you with the details, but will only say that your conversation with Dr. Baric back on 01/26 and his words about SARS-CoV-2 acquiring a community based spread being a “barometer for higher level of concern” are probably the only reason that I was able to figure out when to leave Rome, Italy so that I could get home well before the country sadly saw the outbreak swell and the whole of Italy go into lockdown.



My heart goes out to all the healthcare workers on the frontlines of this pandemic and hopefully with some humility, handwashing, and social distancing we can weather this pandemic to a relatively positive conclusion.



In any event, may your hands all be washed thoroughly and your bathroom cabinets runneth over with toilet paper!



Kindest Regards,



Greg



Gerry writes:



Good day team TwiV,

Does research by Dr. Lydia Bourouiba, MIT, increase the recommended 1 to 2 meters minimum safe distance from someone with COVID-19?

Dr. Bourouiba’s website Understanding the Fluid Dynamics of Disease Transmission is found at https://lbourouiba.mit.edu/

Thanks so much for your excellent podcast,

Gerry

Michael writes:

I’m wondering what your take on this potential therapy is? Will it work? Does it make sense?

https://www.defenseone.com/technology/2020/03/us-military-scientists-hope-have-coronavirus-therapeutic-summer/163659/

Love your show, it’s 70 degrees F, humidity 64% and partly cloudy here in Broward County, Florida.

Michael



Curtis writes:



Greetings and salutations!



Long time listener, first time writer here on an overcast 7 degree C day in St. Louis, MO. First of all, thank you very much for this podcast as it scratches the science itch of this community pharmacist. I’m writing to make you aware, if you aren’t already, of this interesting study currently undergoing peer review for a DNA-based vaccine that was developed in a few hours by scientists at Inovio Pharmaceuticals. Inovio is in collaboration with the Wistar Institute and the lab of Dr David Weiner. I recall you all discussing this company and it’s electroporation method for delivering DNA vaccines a few years back. I find this relevant in regards to your recent discussion on the vaccine development timeline and I believe this is a “new” approach to vaccine development which warrants further discussion. The rapidity of vaccine development of this platform is unmatched by previous efforts and I hope to see this technology advance as it appears to be a paradigm shift in the vaccine world. I hope you can read and discuss as some point while I know you are all extremely busy. Thank you for your time!



Respectfully,

Curtis Willingham, PharmD

https://www.researchsquare.com/article/rs-16261/v1

Justin writes:



Coronavirus haplotypes

https://academic.oup.com/nsr/advance-article/doi/10.1093/nsr/nwaa036/5775463

https://www.linkedin.com/posts/andrea-love-phd_coronavirus-sarscov2-research-activity-6641360901280669696-urFn

Also I was supposed to be going to Japan and I was going to surprise Vincent with some cherry blossom festival pictures but it doesn’t look like that may happen right now.



Jason writes:



I am writing from Sagamihara in Japan. A friend of mine who works at CDC recommended your podcast to me and I have found it quite informative and have recommended it to other people.



Anyways, I am now listening to the newest podcast where someone mentioned data from Hong Kong saying other diseases have decreased this season. I wanted to pass on this article from the Japan Times. I just googled and found this specific article but I recall a few weeks ago this going around twitter and such.



https://www.japantimes.co.jp/news/2020/02/21/national/influenza-wave-drastically-wanes-japan-amid-spread-coronavirus/

Thank you again for the informative podcast.



Jason



Trudy writes:



Thank you for the daily TWiVs! A friend just sent this to me and I thought it was cute. Might want to mention on TWiV if you approve.



It’s a coloring book for kids regarding the pandemic. Click on the English PDF.



https://www.mindheart.co/descargables?fbclid=IwAR0wECTdgANvbGIrahJpCoxtTDLMUjJYVFdEn3hKSfUdVfn1cb7-31_LMzo

Chaim writes:



Hi TWiV,



I work upstairs from Barney Graham’s coronavirus lab here at the Vaccine Research Center, NIH, that is developing the SARS-CoV2 vaccine going into phase 1 trials. As Vincent said, it is an mRNA vaccine, being produced in collaboration with Moderna. It has, in fact, been through a preclinical study in mice that confirmed immunogenicity. In total, it will be about 60 days from the publication of the first viral genomes to the start of a phase 1 trial, slashing the previous record of ~6 months for a DNA-based Zika vaccine. As Vincent frequently notes in other contexts, the only reason they were able to do this so quickly is that they have spent the last ~10 years studying other coronaviruses, especially MERS.



Thanks for everything,

Chaim



James writes:



Hi TWiV Team,

Thanks for your podcast! I was a former Medical lead for GSK vaccines, and wanted to comment on the discussion regarding COVID-19 vaccine development. In all cases of the current SARS-CoV-2 vaccine efforts, nonclinical studies would absolutely have to be performed in advance of any Phase 1 human testing. FDA and other global regulatory agencies (EMEA; TGA; etc.) would absolutely require this data before permitting human study.

Nonclinical testing has evolved considerably and the timelines to data are far shorter than anything we could do in humans. As you correctly stated, these nonclinical tests primarily enable evaluation of immunogenicity, safety and in cases where there are animal models for the disease, potential efficacy. Neutralization is also considered in some animal models. However, they are only directional as to how they can be translated into human potential. I have heard vaccine colleagues state, “We have cured every disease known to mice”, and there is a grain of truth in the inability to consistently extrapolate animal data to humans.

The targeting of current COVID-19 vaccine candidates are also aided by DNA sequencing of the virus as well as homology of SARS-CoV-2 with SARS. The initial DNA vaccine efforts were based upon that homology in seeking targets which would be potentially efficacious. The latest vaccines are based upon the DNA sequence and suspected targets which would enable neutralization. The timelines required to develop prophylactic or therapeutic vaccines are lengthy, but as noted, an 18 month timeline to a potential candidate is extremely impressive. Based upon my continued contacts in vaccinology, there are some brilliant minds working tirelessly to find a solution for the benefit of humanity. Have faith!

James

James P. Tursi, M.D.

Executive Vice President – Head of Research & Development

Chief Medical Officer

Antares Pharma, Inc.



Dennis writes:



My name is Dennis and I live in Florida (southern), and am 60 yrs of age. I was recently diagnosed with high blood pressure, and also found out I have coronary heart disease. I quit smoking a year ago, but still booze it up each evening with scotch.



Will I be better off getting this and surviving, or should I try not to get it and live to fight another day? I work in close contact with the general public (general?) By the way, I have enough rice and beans to feed a small foriegn country, and I know how to hunker down. Thanks for your concise expert knowledge on virus, and all. You guys are the best!



Dennis



Chris writes:



Hello hosts,

it’s a beautiful 48f and sunny here is Stony Brook Long Island today. First off I want to thank you all for the excellent work you have been doing in relaying accurate and sensible information pertaining to the coronavirus, as I have been seeing A LOT of fake news surrounding the topic, and it’s nice to have such an accurate source to keep me rational (that alone worth my monthly donation). Today I am writing because I have some questions concerning RNA viruses that I was hoping the team could shed some light on.



First, while doing my own experiments looking at cell expression of RNA all the methodologies requires that we keep things as cold as possible and have to maintain all samples in a -80 freezer as RNA breaks down quickly. So I was wondering how do RNA viruses persist in the environment? I know they have capsids and many of them have envelopes and such but even so how does this alone maintain the RNA quality? Do RNA viruses tend to persist in the environment for shorter periods of time than DNA viruses, and if so what the max time (or in general) an RNA virus can remain stable?



Second question is how much mutation of the viral genome takes place outside of the host? By this I mean, is there any mutation occurring in the virus after it has been shed from the host. For example, if I were to cough on my desk would a virus change over the course of a few days? I know there is no replication going on during this, but could environmental factors damage parts of the virus genome to the point where the virus would be slightly different but still transmissible, thus creating more genetic variability?



Lastly and on a less serious note, how long until someone looks at the ability of lime juice to be used for disinfecting surfaces contaminated with the coronavirus so they can publish a paper with the title “Corona and a lime:Impacts of lime extracts on viral longevity in the environment “.

Once again thanks for everything.

Warm regards,

Chris



PS. Vincent(and possibly all of TWIV) you should consider doing an AMA (ask me anything) on reddit, with all the confusion surrounding coronavirus you could help clear up a lot of misconceptions and bring new people to TWIV. just let your listeners know prior to doing it so we can help bring attention to it.



Karen writes:



Good day ya’ll!



I sent a tweet about inaccurate information floating around social media (from people I know) and a need for a fast response team to help swat it all down 🙂 and Alan Dove replied that today would be an all letters podcast and I should send the “main crap” in an email.



Here goes. It’s like those anti vax posts that have eeentsy bits of truth mixed in and sounds sorta half way right and confuses people who don’t have lots of experience and education on the topic. I know enough to know its “wrong” but not enough to knock it down efficiently–though I did get my closer friends to delete their facebook posts that shared it.



It’s 59 Fahrenheit and sunny here in Hannover, Germany. (I’m an American living abroad for a bit so most of my friends are posting from the states)



Thanks!

Karen



Sylvia writes:



hello TWIVers,



I’m sure you are getting lots of questions on COVID-19, but unless I missed it, these two have not been addressed:



1. The use of simple face masks (i.e. dust masks) by healthy people has been downplayed in preventing disease, however the use of these masks IS encouraged by people who are sick. In fact, clinics and hospitals had these masks available for a person to wear if he or she was coughing, well prior to COVID-19.



I’m not sure why the reverse is not true. If I’m healthy and a person next to me is coughing and *isn’t* wearing a mask, why wouldn’t a simple face mask on me at least reduce (not eliminate of course) the risk of infection due to the prevention of large globules from landing near my mouth and nose?



2. The N95 and N100 masks are widely used and endorsed for health care workers to prevent the spread of COVID-19 as well as other viruses with airborne transmission.



All well and good. However the frequent admonishment to “wash your hands” clearly acknowledges the role played by mucus membrane transmission (presumably eyes and nose). I see little attention paid to eye protection, and it seems to me that a person wearing only an N95 / N100 mask in an environment with airborne particles still has the mucus membranes of the eyes unprotected. The standard eye protection (unless in a PAPR suit) is glasses or goggles, none of which would be much of an impediment to viruses swirling around in the air that might land on an open eye.



Am I misunderstanding the mechanism of mucus membrane transmission and can you comment on this?



Paramedic in Seattle area

Not freaked out, just fascinated and want to learn more! 🙂



Sylvia



Anonymous writes:



Hi all – Thanks for the great episode with Ralph Baric. How do asymptomatic people spread the virus, if they are not yet coughing or producing mucus? I am a journalist as well as a listener, so no need to obscure my name. It is cold and sunny in Toronto, and I spotted the year’s first robin on a walk this morning.



David writes:

Hi All at Twiv

Thanks for all of the Coronavirus information you are putting out. Great and well balanced and a must listen too podcast for me each week.

I’m a senior NHS doctor specialising in the diagnosis and management of infectious diseases in the UK (Clinical Microbiologist).

I know that there is a strong push for schools to close in order to help reduce the spread of SARS2 but I think there is a difficult balance to strike here. Many health care workers are young and have young families. Closing schools will put a horrendous pressure on staff stuck between providing care for patients or having to be at home to look after children. Now I know the response will be “children usually have two parents” but in my experience many healthcare workers’ partners are also healthcare workers… I think we spend so much time at work that we only get to meet other healthcare workers much of the time! I’m married to a Physiotherapist!! This is something that many outside of healthcare may not be aware of.

I wonder if Governments should give serious consideration to state provided child care (using school resources?) to provide care for healthcare workers’ children so the medical workforce can be maintained as much as possible. After all increase numbers of patients with decreased numbers of staff is not going to end well.

What are your thoughts about trying to maintain a healthcare workforce?

Keep up the good work and stay healthy (and wash your hands!) 🙂

David

Cary writes:



Hi

I’m a virologist, but not an epidemiologist. Wondering why not put full efforts into protecting at risk populations as opposed to whats happening now? Significant economic downturns kill people too.



Thanks

Cary



Cornelis writes:



Dear Twiv-Team

Thank you for your educational podcast which keeps me informed while training.

I’m currently a med student from Germany with an education as a medical technical assistant. Currently we have sunny weather with mild 16°C (62.6 °F), no clouds and nearly no wind and many corona cases and neither toilet paper, noodles nor flour in stores.



Your podcast was mentioned to us by our Virologists in many lectures. I started listening actively and frequently when SARS-Cov 2-cases started coming up in Wuhan.



Currently measures are implemented (e.g. closing stores, bars, schools and universities, Drive thru testing facilities) and further restrictions might come soon.

I have two questions for you. Please excuse me if they were answered in episodes before:

1. Is is possible that not only ICUs and other patient facilities are overflooded by patients but also that limited testing capacity is also causing problems.

From lab reports that came to my eyes, every sample is tested separately by R>T-qPCR with E-Gen as a target.

I my opinion, you could implement screening-diagnostics by pooling samples and performing RT-qPCR on pools to sort out negative patients.

This would speed up the process and throughput since many tests come back negative and then test positive for sesasonal flu.

2. I was wondering about the spike-Protein (Furin cleavage site). What went through my mind is that maybe the Virus acquired this spike whilst being oscillating between humans and livestock or other animals.

Thank you for your great work and effort to keep everyone informed and sorry for my bad English.

Stay healthy

Cornelis



Chris writes:



I started listening to your Ep. 586, and you discussed several China-related items

and speculated (poorly) about Chinese monitoring, who goes to wet-markets, translations,

data and statistics. I cringed every time you and your panel regurgitated another

xenophobic “theory.” Perhaps you should invite a Chinese graduate student or professor (someone who is at least familiar with who goes to China’s wet-markets, or who has read about what happened about the doctor from wuhan who circulated the uncorroborated SARS report. He did go back to work) to be on your panel. It would strengthen your podcast.



Love the science. I’m a computer scientist/engineer, so glad you explain virology in terms I can understand.



sincerely,



-chris



Janet writes:



Dear TWIV team,



I’ve been avidly listening to your brilliant podcast for the past 4+ years particularly whilst doing long experiments during my PhD on TB immunology. I am an ID physician and have since returned to clinical work, but have been listening to you whenever I get a moment and very much wanted to get your take on the coronovirus drama as it unfolds. Thanks so much for your coverage of the SARS-CoV2 pandemic – it has been truly excellent. I just wanted to write in response to the discussion on your last episode re differentiating deaths from Covid-19 vs Covid-19+bacterial superinfection – this is usually quite easy to determine clinically as the patient often takes a turn for the worse clinically with new fevers/resp deterioration and radiological signs on CXR/CT chest (bacterial pneumonia looks quite different to viral pneumonia). Also, I would always put this down quite clearly on the death certificate (ie cause of death would be resp failure 2ary to bacterial pneumonia 2ary to flu for example). I have often thought that your podcast would be even more awesome than it currently is if you sometimes included a clinician (eg an ID doc) particularly in circumstances when the topic involves a lot of clinical issues. Just a suggestion.



One other thing – in regards to covid19 – I have been wondering whether given the mortality and morbidity is almost entirely borne in the over-60’s maybe one strategy to slow down the epidemic would be to home-isolate older people and let the infection run its course in the younger population? This preserves the majority of the workforce and means children can continue to go to school. Older people are likely to be able to tolerate home ‘isolation’ better than younger ones (maybe?), especially as it would be for their own self interest. Then, the oldies could be ‘released’ once a certain level of herd immunity is reached. This strategy would help slow down the risk of overwhelming ICU/ventilator beds. Older people could be supported at home by having people deliver groceries etc to them and even visit them at home (you could screen the people doing home visits with throat swabs to ensure they are not infected) or via skype/zoom telehealth type check ups, and have stringent infection control/screening of staff in nursing homes. Probably a mad idea, but I cant help wondering whether targeting the population at risk might be an easier strategy than trying to contain spread amongst children/young people which seems to be an almost futile task when there is mild/asymptomatic transmission and also considering the impact on society of trying to make people work from home/close schools etc – thoughts?



Best,

Janet



Comensally writes:



Hi TWIV,



I started listening to you back when you were one of the only podcast results for Coronavirus, and I’ve been sending you to all my friends as a great way to obsess over the pandemic for hours but in a calm and reasonable way.



I have been noticing that most of the coverage online and in the news, even from very scientific sources, has been tracking the progress of the pandemic via total cases per country. This made to me sense early on when any individual case was news, but it seems like at this point it’s more useful to look at cases by population – Italy’s situation looks a lot worse compared to China when you look at cases per million people.

Is there a good reason to keep looking at total cases in preference to cases per million?



Thanks,



Commensally



Andrew writes:



Hello TWIV,



Just discovered and really enjoying your podcast as I’ve been looking for opinions on COVID19 that comes from actual experts.



I’m in Japan, and I note that they’ve had a lot of trouble performing enough PCR tests, which hints that there could be a lot more community transmission than reported. My prefecture (Iwate, 1.2 million people) has so far performed 20 tests in total, which probably explains why no cases have been found here. I also note that the USA CDC seems to have had a variety of problems getting enough tests done.



However, South Korea seems to be able to perform a lot of testing, including their brilliant drive through testing.



What makes PCR testing so difficult to do en masse? Why has South Korea been able to ramp up their abilities so quickly?



In Japan you can only be tested if you have had a fever for 4 days. But there have been cases where this (and even a pneumonia diagnosis) have not been enough to qualify for a test.



For example:

https://www3.nhk.or.jp/nhkworld/en/news/videos/20200306151420233/

I am concerned that if only the most serious cases are tested, then community transmission of mild cases will be completely missed, and so containment will not be possible at all. Instead we will just be counting deaths and wondering what happened after the fact.



I note that one benefit from the Diamond Princess debacle is data about mild cases of COVID19. For example, here is a case reported in the CDC of 2 people who had nothing more than a sore throat (no fever) but tested positive:

https://wwwnc.cdc.gov/eid/article/26/6/20-0452_article

3 out of 5 members of my family have had short fevers / sickness this week, and we are certain the infection we have came from a kindergarten. We have heard other kids are also similarly unwell. We are simply staying at home and avoiding people as a precaution, but if this was COVID19 being passed around in our community, it would be worrying because the authorities will probably only find out when it is too late – i.e. a death.



Thanks!



— Andrew



Joakim writes:



Hello Vincent and the rest of TwiV!



I’m Joakim, a new listener from Sweden who was brought here recently because of my worries about the ongoing covid-19-pandemic. I’m really loving the show so far, though of course I wish I would have found it through better circumstances.



I don’t know how much you’re able to follow the situation in Europe at the moment, but it’s looking worse and worse by the day. Europe is running out of materials for testing kits and most countries seem as of yet unwilling to impose the same kind of strict social distancing measures we have seen in China, South Korea and most recently in Italy.



My own country’s health authority for example have so far only recommended people with cold-like symptoms to stay at home and banned all events with over 500+ people attending. For reference, at the moment I’m writing this Sweden have had 500 reported cases and one death, but it has now also been confirmed that we have cases of untraceable local spread of the virus so the true extent of the spread is currently unknown.



This is all worrying in itself of course. However, what really made me worry was reading this blogpost titled “Coronavirus: Why You Must Act Now” by Thomas Pueyo.



Link: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca



In it, Pueyo argues that all countries affected by the epidemic must act as swiftly as possible by imposing the same kind of social distancing measures as Italy (for example: creating locked down areas with restrictions regarding when you can leave your home, closure of all educational establishments, closure of all pubs, all sport events cancelled, limited access to hospital visits for friends and family etc) or preferably even stricter “Wuhan-style” measures. If they don’t do this, he says, a country will face an exponential growth of cases and eventually a completely overwhelmed healthcare system, possibly leading to a fatality rate of 4 % among those infected, instead of a fatality rate of less than 1 % which a normal-functioning health system would face when dealing with the same disease.



What do you guys think about these claims? Do you think measures such as these, imposed ASAP, is necessary to prevent the rest of Europe and the United States from ending up like the current situation in Northern Italy or even worse? Do you think there is any realistic chance that we could even impose such measures or would they be too unthinkable to even consider in our countries? If they can’t be, do we potentially face a scenario where 70-80 % of the population could get infected and 3-4 % of all those people might die as a result of this pandemic?



Take care,

and with all my heart I wish your country the best of luck in this awful crisis



Joakim



Jonas writes:



Guten Abend TWiV-Team,



I stumbled across your great podcast some time ago and want to thank you for the valuable information.



I am writing to you from the Lower Rhine region in Germany. We have 8°C (46°F) outside temperature, occasional rain and at Sunday 8.3.2020 9:45 p.m. (CET) ~1040 confirmed cases of COVID19. The federal state I live in (North Rhine-Westphalia) is so far the most affected in Germany. One of the epicenters of the epidemic in Germany is the town of Heinsberg which is about an hour’s drive from where I live. In Heinsberg an infected couple had taken part in a traditional carnival celebration and infected in this way many people. On the one hand, the infection has spread rapidly in Heinsberg and on the other hand guests of this celebration, who are not inhabitants of Heinsberg, have spread the virus in other parts of the country. For example: Last week in the have COVID-19. She had been infected in Heinsberg.



Last week there were some panic buying and flour, noodles, toilet paper etc. were partly bought empty. By the weekend the situation has calmed down considerably. Now that the number of cases has increased significantly, I am curious to see what the public mood will be on Monday.



Testing for the virus, if you go by the news, seems to be pretty chaotic at the moment. I think this is partly because we have a rather federal system, similar to the US.



I’d like to ask you some questions about hygiene measures in a company:



I work in a company with about 200 employees and two weeks ago I asked my superiors what our contingency plans are in case COVID-19 spreads.

There wasn’t really any.



I suggested based partly on the information from your Podcast:



• Disinfectant dispenser in every work or social room where there is no wash basin.

• Hygiene training for every employee

• Flu shots via the company doctor for anyone who does not yet have the vaccination. (To avoid unnecessary panic due to normal flu infections).

• Strictly sending home everyone with cold symptoms

• Paying the cleaning company extra hours so that really all handrails, light switches, door handles, keyboards etc are disinfected at the end of the shift.



Are these appropriate suggestions or unnecessary scaremongering?

Do you have anything to add to that or is that enough?



If these are good proposals, I would like to do more this week to

ensure that all of them are implemented.



And one more question out of curiosity about the popular topic of

surgical masks:



If there were no shortage of these masks, wouldn’t it be a good idea if everyone wore one? I know that the mask mainly protects other people from my viruses and not necessarily me, but if everyone wears one, don’t we achieve some kind of „herd immunity“?



Many thanks for your valuable work and best regards from Germany,



Jonas