It's Eric strong from strong medicine.

Today I am talking Corona virus once again with important updates on the diseases spread.

And there's a lot to talk about community transmission now occurring within the U.

S.

Whether it's accurate to call it a pandemic yet.

And, of course, whether it's time to start panicking before any of that, let me first talk about the name because not everyone has heard yet that this virus and this disease have been renamed.

Two and 1/2 weeks ago, there were joint announcements.

In one, the International Committee on Taxonomy of Viruses announced that novel Corona Virus 2019 has been formally renamed SARS cov to in order to highlight its genetic similarity to the original SARS virus.

This made sense to two virologists, but there was some criticism that people might mistakenly link stars Kobe to to the more deadly SARS disease of 2003 caused by the virus now generally known as SARS.

Kobe one.

Meanwhile, the W H O named disease caused by this virus Cove in 19 for Corona Virus Disease 2019.

I personally think they took a confusing name and made it even worse, but I won't talk any more about disease naming conventions today.

That was the topic of my last video about the outbreak.

Let's move on and talk numbers.

The number of cases, the number of fatalities, the case, fatality rates and how many countries were talking about.

As of February 29th confirmed cases in China are up to 8 80,000 while the rest of the world has 7000.

Deaths in China are at around 2900.

The rest the world has seen about 100.

The disease has now been found in over 60 countries, including particularly notable outbreaks in South Korea, Italy and Iran.

The case fatality rate broke open.

19 has remained 2 to 2.5% when considering all cases.

But there are very important predictors of mortality.

First, it's very age dependent.

In the 1st 6 weeks or so, the outbreak, the measured case fatality rate ranged from literally zero among Children under nine to 15%.

Among those 80 on over, with an inflection point between the ages of 60 and 70.

The presence of chronic disease is predictably a risk factor, especially cardiovascular disease, respiratory diseases like COPD and diabetes.

Being male has been identified as a risk factor for death, though it's not yet known if that's an independent risk factor or if it's due to confounding factors like men and China being much more likely to smoke than women.

And there's also important difference in case fatality rate between countries.

For example, the measured 2 to 2.5% overall rates is mostly driven by China, since that's where the vast majority of cases still are.

But outside China, the rate appears to be closer to 1% or even less possible.

Explanations for the difference include China Feeling to identify Moloch cases, which makes their case fatality rate falsely elevated well.

The excess deaths in China is because your health care system is stretched well beyond the capacity to deal with this.

For example, there just aren't enough.

I see you beds and ventilators for the most critically ill there.

So the rate in the U.

S.

And Europe, when the full brunt of the disease hits us, will likely be under two and may even be under one.

But it's too early to say yet with any confidence.

Iran on the other hand has reported 43 deaths among 600 cases.

A remarkable 7% case fatality rates.

This is almost certainly because they've been struggling to identify milder cases rather than because of disease or the virus or somehow different there.

After all, Iran.

It's not really an obvious place for a Corona virus to have spread early on, and still the country was probably particularly unprepared for it.

There have been a few particularly notable stories about the virus has spread.

These include the nightmare quarantine of the cruise ship Diamond Princess off Japan after a handful of passengers tested positive for the virus.

As many as 700 cases have been linked to the ship, and it will be an interesting investigation as to how many of those cases and ultimate deaths.

We're directly caused by the in retrospect, terrible decision to quarantine the passengers on board rather than evacuate them, and due to the reportedly lacks onboard quarantine procedures.

Another important story about the outbreak concerns South Korea, where their local outbreak has been strongly linked to a religious group called the Shin Jeong Gi Church of Jesus, who happened to believe their founder is the literal second coming of Jesus Christ.

This group was particularly prone to facilitating the spread because of the style in which they worship.

They're packed together very closely and frequently.

Shouting during service is spreading respiratory droplets.

Ah, they also reportedly encouraged worshippers to come to service is even when ill.

And both the church's secretive and the church of secretive about membership do the fear of members being ostracised in the community, which makes tracking down case contacts for public health officials much more difficult.

These situations with a Diamond Princess and the Shin Jeong GI Church highlight the divers challenges that exist when trying to contain an epidemic.

And then there is the new story about community transmission here in the U.

S.

There have now been two confirmed cases of Coben 19.

Here in California, you have no relevant travel or known contact history one in Solano County on to 26 1 announced on to 28 just one town away from where I work at Stanford.

We have no idea how they became infected, though, notably in that first case in Solano County.

It's very close to Travis Air Force Base, where some of the evacuees from the Diamond Princess were isolated upon returning to the U.

S.

And from where there were some horrifying stories about staff being untrained and unequipped to be interacting with possible Corona virus cases.

That could be a coincidence, but maybe not.

It certainly seems a little suspicious.

They're also probable Corona virus cases in Oregon and Washington who saw their first krone virus death today on these cases have no obvious source of transmission.

And there's a long term care facility in Washington in which over 50 people have patients, have staff are reporting symptoms over all, these new cases are important for three reasons.

First, this is the first evidence of community transmission in the U.

S.

Where one person from the community who has no contact China or Asia, is transmitted to somebody else.

We're likely at the inflection point where the number of cases are going to start climbing much more quickly.

This won't be predominantly because of a sudden overnight explosion of cases, but rather an artifact of the fact that testing is becoming more widespread.

Community transmission has almost certainly been going on here for several weeks undetected people feeling mildly ill and assuming that they just have a bad cold or the flu.

There are probably dozens, if not hundreds, of Americans walking around with Corona virus.

No, not all are equally contagious.

The second reason is that there is early evidence of potential spread in health care facilities, at least in the Solano County case.

There was a significant delay in the diagnosis in my case because of CDC initially declined UC Davis's request to test the patient for Corona virus.

This led to healthcare workers potentially being exposed.

Combining this with the fact that it's believed that a symptomatic individuals can spread the disease.

It's easy to imagine hospital based spread could have occurred the other patients, which may have happened at the facility in Washington.

Given that we have no vaccines and that the mortality rate is particularly high in the elderly and the chronically ill, the idea of outbreaks occurring in hospitals and nursing homes is really scary.

And the third reason is that the UC Davis case in particular highlighted the potential problem with the CDC, serving as he sold gatekeeper to Corona virus confirmation testing in the United States.

Had UC Davis had access to the test directly, many fewer health care workers would have been potentially exposed.

However, the problem with Cuban 19 testing it's actually a lot more complicated than just We need to be testing more people.

That's kind of a huge rabbit hole that I'm I'm not gonna jump down right at this moment.

And at least as a few days ago, the CDC has approved strategies to increase test availability, so hopefully this will soon not be quite as big a problem.

This brings me to one of the key questions for today has Corona virus or Coben 19.

If you prefer crossed the threshold to becoming a pandemic.

To answer that question, we need to first discuss what is a pandemic.

It actually does not have a universally agreed upon definition, but one definition used by the W.

H O is quote an epidemic occurring worldwide or over a very wide area, crossing international boundaries and usually affecting a large number of people.

This is sufficiently vague for that.

For better or worse, the W H O can apply slightly different standards to different diseases, depending on how they want to message preparedness to the public and how they want to allocate resources.

That's not the W h O.

Being devious, but rather gives them a little flexibility in combating different diseases because not all worldwide outbreaks warrant the equivalent response.

The W.

H.

O director general has recently further clarified that a determination of whether a disease should be classified as a pandemic is based upon its geographical distribution, the severity of the associated disease and the impact it has on society in general.

Almost four weeks ago, in a prior video here on strong medicine, I asserted that Corona virus remained an epidemic and not a pandemic.

At that time.

A few viewers took exception to that.

But my position was consistent with the overwhelming majority of experts was consistent with the fact that about 99% of cases were located in China and that there was no significant outbreak focused in any other country.

Fast forward a month, though things now look very different, while the U.

S.

Has been largely spared so far, at least as far as we know.

With just over 60 known cases, most of whom are Diamond Princess evacuees, there are now 3500 cases in South Korea, 1100 Italy and 600 in Iran, and these numbers are climbing very quickly.

As I said earlier at the time of recording this, there are now about 7000 cases outside of China across more than 60 countries.

By tomorrow, that number could easily be at 8000.

There's even discussion that consideration should be given to canceling the 2020 Olympic Games in Tokyo.

Well, I'm not an epidemiologist.

This feels like to me grown a virus has crossed the pandemic threshold.

For what it's worth, the W, H O and CDC are still saying not a pandemic.

Yet it's being classified as a quote global health emergency.

However, pretty much everyone else is saying that it will become I'm sorry.

Pretty much everyone is saying that it will become a pandemic at some point, if not one already.

Unfortunately, the common wisdom is that this has obviously been a pandemic for a while now, and by common wisdom, I mean what everyone's uncle is saying on Facebook.

So when the W, H.

O.

And the CDC are saying, you know, we're not quite there yet, it's leading to a major credibility problem.

I don't think the credibility problem is completely justified.

But it's nevertheless leading the public to become increasingly skeptical of everything else those institutions air saying.

And that's going to get increasingly dangerous as the number of cases rises.

So why doesn't even matter?

I mean, why do we care what we call it?

Why do we care if it's epidemic a pandemic?

What difference does it make?

Well, once it's labeled a pandemic, the broadest public health goals start to shift a little.

If the disease has spread worldwide, containment within one country or one part of the world has obviously failed.

So travel bands like the US restricting Chinese citizens from visiting here lose their effectiveness.

We aren't there yet, I think, quarantining returning travellers from certain parts of Asia.

That's still appropriate.

But that probably won't be true for too much longer.

So once we give up on containment, what should the focus be?

It becomes mitigation, trying to slow down the spread in order to give time for vaccine development, to give time to study antiviral medications and to prevent a huge surge in the need for I C U beds, a surge which many hospitals are not prepared to handle.

in addition to frequent hand washing mitigation involves something called social distancing.

Social distancing consists of five basic primary measures.

Isolation of sick individuals.

Ah, home quarantine of close contacts of those sick individuals changing work patterns to allow more people to work from home or to spread out shifts so that there are fewer people at work at one time canceling large group events like concerts and sporting events like the Olympics and even closing schools and day care centers in those communities that are hit particularly hard.

Thes five measures, including school closures, have already been put into place in China, Japan, Italy and South Korea to some extent, and they were particularly strict about them in China.

It's not clear that Americans would even allow the degree of infringement on freedom of movement that China enacted, so it's kind of hard to say what affect those Ah, those actions might have here.

But I think we should expect some work in school closures here in the U.

S.

And in the rest of Europe as well.

Now coming up with formal plans for these types of closures, that takes time.

So if your school or your company or your own family doesn't have a plan yet.

They need to start working on one.

It might not become necessary.

Hopefully, it won't become necessary.

But this is not the kind of thing you want to throw together at the last minute.

Whereas the previous containment strategies were primarily the responsibility of public health departments and national governments, mitigation strategies like social distancing and frequent hand washing, these are primarily the responsibility of individuals and local schools and small businesses.

Thes involved a lot of people who don't have the necessary expertise to independently gauge risk or to independently developed a science based response, which is why it will become increasingly important for laypersons to pay attention.

Toe what experts are saying about the pandemic as mentioned before, I know that the CDC and W.

H O have a bit of a credibility gap with the public right now, however, they are still among the most trustworthy sources of information.

In addition to some public health experts, I'm active on Twitter, who I'll be listening in the video comments below.

So as we've crossed into pandemic territory and we have community transmission occurring here in the U.

S.

Is it.

Time to panic.

The short answer is no.

It is not time to panic, but we collectively need to be more concerned than we are or, more accurately, our leaders in to be more concerned than they are.

The United States is woefully under prepared for the Corona virus pandemic.

For one thing, last May, John Bolton as national security advisor, he eliminated the post of senior director for global health, security and bio threats who sat on the National Security Council.

Now that might sound like an esoteric job title, but that person, they were the one in charge of coordinating a national response here in the U.