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Thread: Disease and pandemics thread (because it's science)

  1. #1231
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    Population density, high social interactions (until regulated) and seasonal influx of transients/tourists.

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    Quote Originally Posted by Ken G View Post
    Perhaps that might also help explain why there have been so few cases in Russia, despite proximity to China. Doesn't seem to be true in the US, the worst places are New York and New Orleans, which seem quite different conditions, and New Orleans is generally humid by I don't know about this time of year. But I do have a sense that there is some explanation for why it explodes in some places. Could just be a random Pareto type effect involving superspreaders, causing an illusion that an explanation is required.
    New Orleans just had Mardi Gras celebrations.

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    Quote Originally Posted by Selfsim View Post
    New Orleans just had Mardi Gras celebrations.
    Apparently New Orleans is rising in Corona Virus cases and deaths faster than any other area has. By April 4th the healthcare will be overwhelmed.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Quote Originally Posted by Copernicus View Post
    Since we are throwing out ideas. Notice how most of the worst countries are mediterranean countries France, Spain, Italy, only other really bad one is Iran. Could be the different diet as well. They eat a low inflammatory diet, Russia eats an inflammatory high saturated fat diet very little fruits and vegetables.
    I think that diet is really important for things like diabetes and cancer, which develop over a long period of time, so that small things can really make a big difference, but I really doubt that diet would have much to do with this. Like with colds and influenza, pretty much everyone gets them if exposed, and it's just that some people get really sick either because they have a weak immune system (in the case of older people) or they get a particularly strong exposure. Of course there could be some effects--for example people who eat lots of fruits and vegetables probably tend, on average, to be healthier than those who don't.
    As above, so below

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    Quote Originally Posted by Jens View Post
    Quote Originally Posted by Copernicus
    Since we are throwing out ideas. Notice how most of the worst countries are mediterranean countries France, Spain, Italy, only other really bad one is Iran. Could be the different diet as well. They eat a low inflammatory diet, Russia eats an inflammatory high saturated fat diet very little fruits and vegetables.
    I think that diet is really important for things like diabetes and cancer, which develop over a long period of time, so that small things can really make a big difference, but I really doubt that diet would have much to do with this. Like with colds and influenza, pretty much everyone gets them if exposed, and it's just that some people get really sick either because they have a weak immune system (in the case of older people) or they get a particularly strong exposure. Of course there could be some effects--for example people who eat lots of fruits and vegetables probably tend, on average, to be healthier than those who don't.
    More likely widespread, long term smoking in those countries causes respitory illness/degradation ... and population density then facilitates transmission.
    (Family-centric co-habitation wouldn't help).

  6. #1236
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    Quote Originally Posted by grant hutchison View Post
    A paper, most recent revision today, which suggests coronavirus establishes strong community spread only within a narrow climatic band:


    Grant Hutchison
    Does that really seem right? It is thought to be infectious by touching surfaces and breathing indoors where the climate is controlled and people are proximate. Is that the factor rather than the outdoor climate? Or is that conclusion embedded in the paper?
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by Jens View Post
    I think that diet is really important for things like diabetes and cancer, which develop over a long period of time, so that small things can really make a big difference, but I really doubt that diet would have much to do with this. Like with colds and influenza, pretty much everyone gets them if exposed, and it's just that some people get really sick either because they have a weak immune system (in the case of older people) or they get a particularly strong exposure. Of course there could be some effects--for example people who eat lots of fruits and vegetables probably tend, on average, to be healthier than those who don't.
    The CDC is recommending against ibuprofen or other anti inflammatory drugs. Some diets are anti inflammatory.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Quote Originally Posted by Copernicus View Post
    Since we are throwing out ideas. Notice how most of the worst countries are mediterranean countries France, Spain, Italy, only other really bad one is Iran. Could be the different diet as well. They eat a low inflammatory diet, Russia eats an inflammatory high saturated fat diet very little fruits and vegetables.
    Most of the cases in Italy are in Lombardy, which doesn't really have (no data; my personal impression) the traditional Mediterranean diet. I think population density is probably more significant. Along with the fact that multi-generational families tend to live in close proximity. That, and the high prevalence of smoking, may also contribute to the high percentage of serious illness and death.

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    Quote Originally Posted by Selfsim View Post
    Maybe a bit premature(?) ...
    There are also reports that big populations such as Brazil appear to be only now just starting to get underway with counting cases(?)
    It's a hypothesis which fits with what we already know about droplet transmission of respiratory disease in general and coronavirus in particular, and it's been a reasonable match for data so far. Like all such hypotheses, it may yet be killed by a single fact.

    Quote Originally Posted by Ken G View Post
    Perhaps that might also help explain why there have been so few cases in Russia, despite proximity to China. Doesn't seem to be true in the US, the worst places are New York and New Orleans, which seem quite different conditions, and New Orleans is generally humid by I don't know about this time of year. But I do have a sense that there is some explanation for why it explodes in some places. Could just be a random Pareto type effect involving superspreaders, causing an illusion that an explanation is required.
    The hypothesis is not that epidemic spread can't establish itself, but that it is easier to bring under control outside the particular climatic bands that favour droplet transmission in the outdoors. R0 is lower (but still >1) in climatically unfavourable regions, in other words.

    Quote Originally Posted by profloater View Post
    Does that really seem right? It is thought to be infectious by touching surfaces and breathing indoors where the climate is controlled and people are proximate. Is that the factor rather than the outdoor climate? Or is that conclusion embedded in the paper?
    Well, it seems right to the extent that we know temperature and humidity are relevant factors in other diseases spread by droplet spray, including other coronaviruses--hence, to some extent, the seasonality of seasonal flu, for instance. So droplet spray outdoors is relevant (otherwise we wouldn't have the police breaking up groups of people standing close together in the street).
    So it's all a matter of which factors primarily contribute to keeping R0 above 1. If you have a culture that primarily socializes at close proximity in indoor air-conditioned locations, then maybe not relevant; if you have a culture that gets together for hours around outdoor restaurant tables, maybe more so.

    It's a hypothesis. I posted it here because it passes the tests of "Does it make biological sense?", "Is it testable?" and "Are there at present data to support it?"

    Grant Hutchison

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    Well that’s interesting. In general heated indoor spaces will have lower RH than the colder air coming in, and it certainly seems reasonable that RH is important. Against that I read that some viruses are resistant to dessication, and the high transmission rate we are seeing suggests maybe this is one of them.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by Copernicus View Post
    The CDC is recommending against ibuprofen or other anti inflammatory drugs. Some diets are anti inflammatory.
    I think that might be out of context or over simplified. If you mean the issue is to reduce fever, I think it may be a complicated issue.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    The BBC mentioned a blood group variable. Amongst people in intensive care, group A are over and group O under represented compared with prevalence in the general population. I think that was from chinese data.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by profloater View Post
    I think that might be out of context or over simplified. If you mean the issue is to reduce fever, I think it may be a complicated issue.
    The evidence against non-steroidal anti-inflammatories in COVID-19 is essentially anecdotal--a case series, which is about the lowest level of evidence in medicine. But it sort of makes sense in terms of the up-regulation of ACE-2 receptors (to which coronavirus binds) by NSAIDs. So a specific property of the drugs, rather than a general hazard of vaguely "anti inflammatory" states.

    I haven't been able to find anything from the CDC, but both the European Medicines Agency and the WHO have recently stated that there is currently no good evidence of increased COVID-19 morbidity or mortality from non-steroidal anti inflammatories.

    That said, if you're not already taking NSAIDs for pain control, there's absolutely no reason to take them when you have a fever. Paracetamol/acetaminophen is just as good at lowering your fever and reducing the associated aches and pains, and has far fewer potential side effects. (In fact, I had no idea anyone thought NSAIDs were a good thing to take for a fever until the whole COVID-19 thing kicked off.)

    Grant Hutchison
    Last edited by grant hutchison; 2020-Mar-25 at 02:43 PM.

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    How does aspirin fit in here?
    I never use anything else.

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    Quote Originally Posted by a1call View Post
    How does aspirin fit in here?
    I never use anything else.
    That's very retro of you. I was chided for prescribing aspirin for fever and pain relief back in 1980, because of its unpleasant side effect profile compared to paracetamol/acetaminophen.
    Aspirin is a non-steroidal anti-inflammatory, albeit one with all sorts of other interesting actions, too.

    The UK's National Health Service gives the following advice:
    There is currently no strong evidence that non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or aspirin for pain relief can make coronavirus (COVID-19) worse.
    But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.
    If you have no coronavirus symptoms and regularly take aspirin for pain relief, carry on taking it as usual. If you develop coronavirus symptoms, ask your doctor about changing to paracetamol instead.
    Updated: 20 March 2020
    Grant Hutchison

  16. #1246
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    Is it not the case that fever increases metabolic rate and is an important part of the immune response? So reducing it, unless really too high, is not sensible? Pain relief is a separate issue.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Just thought I'd post a timely reminder on how graphs can be misleading.

    For example, here is a screenshot of the Public Health England Covid-19 tracker

    Screenshot_20200325-151829.png

    To the unobservant person, that doesn't look too bad. The blocks don't appear to be growing very rapidly at all. What's all the fuss about?

    Here is another screenshot of the same page, but squashed into portrait format

    Screenshot_20200325-151813.png

    Oh, that looks more serious! Much steeper growth in block size and a definite rising curve.

    Which one is correct? Both of them. Which one conveys the urgency better? I would say the second one. But is it appropriate to manipulate perceptions like that? (not saying anyone has, but in general) Would it depend on the intended audience?

    Of course even without the graphics, for an infection to go from 373 cases to over 8000 in 15 days is quite alarming, especially to someone who has no experience of the speed of transmission of, say, the flu. Would an outbreak of flu display a similar rapid growth?

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    Quote Originally Posted by profloater View Post
    Is it not the case that fever increases metabolic rate and is an important part of the immune response? So reducing it, unless really too high, is not sensible? Pain relief is a separate issue.
    Evidence is all over the place with regard to the "suppress it / let it ride" schools of thought. We're not even sure if fever is an epiphenomenon, an adaptive response or maladaptive response, or if it ranges across all these classes according to disease and body temperature. Most of the evidence comes from hospital settings, which don't apply to self-medication in the community, and it's vanishingly unlikely that we'll ever see a randomized trial in the community looking at significant morbidity and mortality.
    In the USA in particular, people seem to be keen to check their body temperatures, and this does lead to people medicating themselves or their children in order to "treat a number", rather than in response to symptoms. Which is why, I guess, you can find a lot of on-line information from paediatric hospitals telling people that a bit of fever does no harm.
    But very high temperatures have their own adverse consequences--limiting people's ability to care for themselves, worsening dehydration, causing confusion in the elderly and (rarely) febrile convulsions in children. And these can be moderated with paracetamol.

    Grant Hutchison

  19. #1249
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    Ah. I can see from some papers that it seems good in some cases and bad in others. Some infectious agents do not like the elevated environment but outcomes vary with other ailments such as sepsis. So, good old paracetamol! I can report anecdotally that paracetamol rises to the occasion in severe pain. When my appendix ruptured 16 months ago, it was the worst pain I can remember, (if indeed there is a memory of pain itself as opposed to the circumstances, involuntary shouting) and paracetamol brought it to a tolerable level for the hours while my doctors convinced themselves it was indeed an appendix issue.
    I will just remind that you can overdose Paracetamol and it is important to observe the rules.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Italy is now recording more than twice as many deaths than China; Spain is recording more deaths than China. The statistics from China may be somewhat suspect, but still....
    Cum catapultae proscriptae erunt tum soli proscript catapultas habebunt.

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    From Matador Travel Security

    Latest developments: March 25, 2020

    The US State Department Global Health Advisory remains at its highest level: Level 4 - Do Not Travel. On March 23 the Wall Street Journal reported that “major U.S. airlines are drafting plans for a potential shutdown of virtually all domestic passenger flights.” Industry and federal officials indicated that no final decisions have been made by the carriers, but the coronavirus pandemic “has made the shutdown seem more unavoidable to airline officials, pilot-union leaders and federal transportation officials".

    In the United States, the Centers for Disease Control has advised against gatherings of more than 50 people for the next eight weeks, while White House officials have warned against gatherings of over ten people. Individual states have enforced their own similar restrictions on gatherings, amongst other measures. The New York Times has created this page depicting the states with Shelter in Place and Quarantine Orders in effect.

    In India the government announced a nationwide lockdown from 23.59 (local time) on 24 March, to last for a minimum of 21 days. Under the lockdown, which will be imposed in all 36 states and union territories, all movement outside homes and residences is banned, with the exception of essential services. All shops, commercial establishments and places of worship will be closed, while all public transport services will be suspended. Meanwhile, all hotels, motels and lodges are not permitted to accept new guests.

    China has announced that all international flights into Beijing will be rerouted to one of 12 cities prior to landing in the capital. The Civil Aviation Administration of China stated that all international passenger flights bound for Beijing will be diverted to the following twelve designated first points of entry: Tianjin, Shijiazhuang, Taiyuan, Hohhot, Shanghai Pudong, Jinan, Qingdao, Nanjing, Shenyang, Dalian, Zhengzhou and Xi’an. Passengers on the international flights will be required to go through quarantine inspection and customs clearance formalities at the airports, and then once passed can go onto Beijing.

    The United Arab Emirates (UAE) has suspended all inbound and outbound passenger flights and the transit of airline passengers in the UAE for two weeks effective March 25. Cargo and emergency evacuation flights are exempt.

    Singapore closed its borders to all short-term visitors and many work pass holders, who will no longer be allowed to enter or transit the country from 23.59 (local time) on 23 March. Citizens and permanent residents are exempted from this entry ban. According to the Ministry of Manpower (MOM), only work pass holders providing essential services will be permitted entry. Citizens, permanent residents, permitted work pass holders and their dependents returning to the country will be issued a 14-day Stay-Home Notice (SHN); those returning from Hubei (China) will be isolated. All returning travelers from 09.00 on 27 March will also be required to submit an online health declaration form prior to clearing immigration. Those not exempt from the expanded restrictions should defer all travel to or through Singapore.

    Malaysian Prime Minister Muhyiddin Yassin says a two-week lockdown that began on March 18 will be extended until April 14. There were 172 more cases confirmed on March 25, bringing the total across the country to 1,796.

    In Thailand, confirmed cases of coronavirus rose to 934 on March 25, a day before a state of emergency is due to come into force, giving the government sweeping powers. A health official said a further 107 people had been diagnosed with the infection. Prime Minister Prayuth Chan-ocha, who first took power in a coup in 2014, said emergency rule would begin on Thursday. The decree allows the government to "censor or shut down the media if deemed necessary", among other measures.

    Hong Kong will ban all non-residents from entering the city from midnight local time on Wednesday March 25, as it tries to halt a recent spike in virus infections from people returning from abroad. The order will be in place for at least two weeks. The Macau government has also announced that visitors from mainland China, Hong Kong and Taiwan who have traveled overseas in the past 14 days will be banned from entering. Those who haven’t been abroad will be quarantined for 14 days. Ferry services between Hong Kong and Macau remain suspended.

    The U.S. Canadian border was closed to non-essential traffic effective 11.59 EDT on March 20 until at least 12.00 (local time) on April 21. The closure does not apply to the movement of trade and essential supplies through the border, nor essential workers such as medical workers, accredited diplomats and airline employees. The US and Mexico have implemented similar rules restricting non-essential travel across the border. The rules will allow for essential travel, such as travel for trade purposes, medical reasons, emergency and public health services, or education-related travel.

    The global number of reported infections now stands at 425,493 with 18,963 fatalities. 109,191 people are reported to have recovered, these figures are up 7,280 on yesterday.

    Europe and CIS: Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Channel Islands (Jersey and Guernsey), Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, ​​​​​​​Greenland, Holy See, Hungary, Iceland, Ireland, Italy, Kazakhstan, Kosovo, Kyrgyzstan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Moldova, Monaco, Montenegro , the Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Russia, San Marino, Serbia, Slovenia, Slovakia, Spain, Sweden, Switzerland, Turkey, Ukraine, Uzbekistan and the United Kingdom (including Northern Ireland and Gibraltar).
    Middle East: Afghanistan, Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria and the United Arab Emirates.
    Africa and North Africa: Algeria, Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Chad, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea (new), Eswatini, Ethiopia, Gabon, Gambia, Ghana, Guinea, Kenya, Liberia, Libya (new), Mauritania, Mauritius, Mayotte, Morocco, Namibia, Niger, Nigeria, Rwanda, Senegal, Seychelles, Somalia, South Africa, Sudan, Tanzania, Togo, Tunisia, Zambia and Zimbabwe.
    Asia Pacific and South Asia: Australia, Bangladesh, Bhutan, Brunei, Cambodia, China, East Timor, Fiji, French Polynesia, Guam, Hong Kong, India, Indonesia, Japan, Laos (new), Macau, Malaysia, Maldives, Mongolia, Nepal, New Zealand, Pakistan, Papua New Guinea, the Philippines, Reunion, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, Vanuatu and Vietnam.
    Americas and Caribbean: Antigua and Barbuda, Argentina, Aruba, the Bahamas, Barbados, Belize (new), Bolivia, Brazil, Canada, ​​​​​​​Cayman Islands, Chile, Colombia, Costa Rica, Cuba, Curacao, Dominican Republic, Ecuador, El Salvador, French Guiana, Gaudeloupe, ​​​​​Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Saint Barthelemy, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines​​​​​​​, Suriname, Trinidad & Tobago, Venezuela, the United States and Uruguay.

    Updated figures can be found on Johns Hopkins University's coronavirus tracking map.​​​​​​​

    Resident employees and returning travelers alike should understand exactly what self-quarantine involves by reviewing the national guidelines publicized in their countries. An example of such guidance from the UK's National Health Service can be reviewed by clicking this link.
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  22. #1252
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    Maybe it is just me, or a US/UK thing, but I didn't know what "paracetamol" was. But Google tells me it is acetaminophen (like brand name Tylenol).
    At night the stars put on a show for free (Carole King)

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  23. #1253
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    Quote Originally Posted by Swift View Post
    Maybe it is just me, or a US/UK thing, but I didn't know what "paracetamol" was. But Google tells me it is acetaminophen (like brand name Tylenol).
    Sorry, I forgot the naming difference. We have also several brand names.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by Selfsim View Post
    More likely widespread, long term smoking in those countries causes respitory illness/degradation ... and population density then facilitates transmission.
    (Family-centric co-habitation wouldn't help).
    Apparently ACE2 receptor sites are increased with smoking too. https://www.preprints.org/manuscript/202002.0051/v1
    I would be curious how quick receptor sites are made or how long it takes for receptor sites to go away after stopping smoking or taking NSAIDS, ACE inhibitors, or ARB's. Or are they permanent after being made.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Trust me I have thought of this too. Frontline workers would rather have a controlled dose of infection, rather than continuous exposure taking care of patients for 12 hours without proper PPE. https://abcnews.go.com/Health/immuni...ry?id=69756590
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Quote Originally Posted by Trebuchet View Post
    Italy is now recording more than twice as many deaths than China; Spain is recording more deaths than China. The statistics from China may be somewhat suspect, but still....
    There are quite a few suspect statistics .. even from the John Hopkins site. The various source(s) of the actual data may be of interest. The JH site says:
    The data sources include the World Health Organization, the U.S. Centers for Disease Control and Prevention, the European Center for Disease Prevention and Control, the National Health Commission of the People’s Republic of China, 1point3acres, Worldometers.info,BNO, state and national government health departments, local media reports, and the DXY, one of the world’s largest online communities for physicians, health care professionals, pharmacies and facilities.
    The reported Chinese 'new infections' stats seemed to almost stop around the same time as someone attempted to change the 'Covid-19' designation(?)

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    Quote Originally Posted by Selfsim View Post
    ... someone attempted to change the 'Covid-19' designation(?)
    What does that mean?

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    What does that mean?
    Hard to explain because of the forum rules on politics.

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    May be dodgy reporting .. but a possible super spreader (because of his job)?:
    Prince Charles’ job means he is a COVID-19 ‘super spreader’
    Prince Charles tests positive for the coronavirus, but if there is “anyone who can get good treatment” it’s the Prince and therefore he is unlikely to “drop off the perch because of coronavirus” says Sky News contributor Caleb Bond.

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    Quote Originally Posted by Selfsim View Post
    Hard to explain because of the forum rules on politics.
    Ah, that context was enough.

    Grant Hutchison

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