中国CDCのCOVID-19の最新情報の要約


2/17に中国のCDCが発表した、COVID-19の最大の症例シリーズの報告のキーとなる知見を、この視点は要約する。
February 24, 2020

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in ChinaSummary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Epidemiologic Characteristics of the COVID-19 Outbreak
Among a total of 72 314 case records (Box), 44 672 were classified as confirmed cases of COVID-19 (62%; diagnosis based on positive viral nucleic acid test result on throat swab samples), 16 186 as suspected cases (22%; diagnosis based on symptoms and exposures only, no test was performed because testing capacity is insufficient to meet current needs), 10 567 as clinically diagnosed cases (15%; this designation is being used in Hubei Province only; in these cases, no test was performed but diagnosis was made based on symptoms, exposures, and presence of lung imaging features consistent with coronavirus pneumonia), and 889 as asymptomatic cases (1%; diagnosis by positive viral nucleic acid test result but lacking typical symptoms including fever, dry cough, and fatigue).1

Box.
Key Findings From the Chinese Center for Disease Control and Prevention Report

72 314 Cases (as of February 11, 2020)

Confirmed cases: 44 672 (62%)

Suspected cases: 16 186 (22%)

Diagnosed cases: 10 567 (15%)

Asymptomatic cases: 889 (1%)

Age distribution (N = 44 672)

≥80 years: 3% (1408 cases)

30-79 years: 87% (38 680 cases)

20-29 years: 8% (3619 cases)

10-19 years: 1% (549 cases)

<10 years: 1% (416 cases)

Spectrum of disease (N = 44 415)

Mild: 81% (36 160 cases)

Severe: 14% (6168 cases)

Critical: 5% (2087 cases)

Case-fatality rate

2.3% (1023 of 44 672 confirmed cases)

14.8% in patients aged ≥80 years (208 of 1408)

8.0% in patients aged 70-79 years (312 of 3918)

49.0% in critical cases (1023 of 2087)

Health care personnel infected

3.8% (1716 of 44 672)

63% in Wuhan (1080 of 1716)

14.8% cases classified as severe or critical (247 of 1668)

5 deaths

Most case patients were 30 to 79 years of age (87%), 1% were aged 9 years or younger, 1% were aged 10 to 19 years, and 3% were age 80 years or older. Most cases were diagnosed in Hubei Province (75%) and most reported Wuhan-related exposures (86%; ie, Wuhan resident or visitor or close contact with Wuhan resident or visitor). Most cases were classified as mild (81%; ie, nonpneumonia and mild pneumonia). However, 14% were severe (ie, dyspnea, respiratory frequency ≥30/min, blood oxygen saturation ≤93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, and/or lung infiltrates >50% within 24 to 48 hours), and 5% were critical (ie, respiratory failure, septic shock, and/or multiple organ dysfunction or failure) (Box).1

The overall case-fatality rate (CFR) was 2.3% (1023 deaths among 44 672 confirmed cases). No deaths occurred in the group aged 9 years and younger, but cases in those aged 70 to 79 years had an 8.0% CFR and cases in those aged 80 years and older had a 14.8% CFR. No deaths were reported among mild and severe cases. The CFR was 49.0% among critical cases. CFR was elevated among those with preexisting comorbid conditions—10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for hypertension, and 5.6% for cancer. Among the 44 672 cases, a total of 1716 were health workers (3.8%), 1080 of whom were in Wuhan (63%). Overall, 14.8% of confirmed cases among health workers were classified as severe or critical and 5 deaths were observed.1

COVID-19 rapidly spread from a single city to the entire country in just 30 days. The sheer speed of both the geographical expansion and the sudden increase in numbers of cases surprised and quickly overwhelmed health and public health services in China, particularly in Wuhan City and Hubei Province. Epidemic curves reflect what may be a mixed outbreak pattern, with early cases suggestive of a continuous common source, potentially zoonotic spillover at Huanan Seafood Wholesale Market, and later cases suggestive of a propagated source as the virus began to be transmitted from person to person (Figure 1).1

 

https://jamanetwork.com/journals/jama/fullarticle/2762130

http://blog.with2.net/link.php/36571(ブログランキングをよろしく)

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岩田健太郎教授に対する批判


歌舞伎町の女王の下記のコメントに賛同します。

「彼はどうしてダイヤモンドプリンセス号で検疫しないといけない、という初動の段階で乗り込まなかったんでしょうか?
感染症学会は会員全員にダイヤモンドプリンセス号に行ってくれというメールをよこしていました。」

【偽善の帝王】上昌広 【偽善の王子】岩田健太郎:コロナウイルスをめぐる医師の報道とのかかわり方について

熱意と行動力と発信力のある岩田健太郎教授なら、臨床疫学調査チームと検疫チームを早期に立ち上げて、厚労省に働きかけをしてくれると思っていました。

しかしながら、マスコミでの発言は、的を外れています。

2/14
https://search.yahoo.co.jp/amp/s/mainichi.jp/articles/20200214/k00/00m/040/374000c.amp%3Fusqp%3Dmq331AQRKAGYAbP_vKSb74vb_gGwASA%253D

以下は引用。

――私たち一般市民が気をつけることはありますか。

特にありません。日本国内の状況は、市民が騒ぐほどのフェーズ(段階)ではありません。普段通りに生活し、外出すればよいと思います。マスクの買い占めや、人の集まる観光地に行かないことに意味はありません。そもそも、マスクを着けること自体に意味がありません。

新型コロナウイルスを放置してはいけませんが、そればかりに気を使うのは不毛です。私に言わせれば、新型コロナウイルスより、毎年3000人が亡くなっている子宮頸(けい)がんの方が深刻です。
引用終わり

2/14の時点では下記のグラフのように、患者は横ばい。

感染症の専門家なら、今の事態を予測できたはずです。

https://hazard.yahoo.co.jp/article/20200207

2/8に、下記の対策会議が開催されていることを岩田健太郎教授はご存知なかったようです。蚊帳の外に置かれていたのでしょうか?

井の中の蛙大海を知らず

新型コロナウイルス感染症への対応に関する拡大対策会議議事録
(文責 森島)
日時:令和2年2月8日(土)
場所:国立感染症研究所 戸山庁舎 共用第一会議室
厚生労働省健康局 結核感染症課、 国立感染症研究所 脇田 隆字 国立国際医療センター 大曲 貴夫、 愛知医科大学 森島 恒雄

記事録には、下記の議論がありました。

疫学的追跡についてであるが、軽症例が多いと接触者追跡が困難である。つまり、封じ込 めを困難にする。日本は今、封じ込め〜感染拡大の間にある。おそらく今後、感染拡大に至ってしまうと思われる。

http://blog.with2.net/link.php/36571(ブログランキングをよろしく)

https://www.jpa-web.org/dcms_media/other/議事録%E3%80%80新型コロナウイルス感染症%E3%80%80拡大対策会議VER2.pdf

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COVID-19;中野晃一教授がNY Timesに論評


Koichi Nakano is a professor of political science at Sophia University, in Tokyo.

中野晃一 Koichi Nakano
@knakano1970
2019年6月刊行『野党が政権に就くとき』(人文書院)、『私物化される国家』(角川新書)、『右傾化する日本政治』(岩波新書) 上智大学国際教養学部教授(政治学) Professor of Political Science, Sophia University


この論評は的を得ている。すごい。共有してください。

TOKYO — The Japanese government’s response to the coronavirus outbreak has been staggeringly incompetent. Why, when so much is at stake for Japan, especially as the host country of the Olympics this summer?

The first infection in Japan was confirmed on Jan. 28. The World Health Organization declared the coronavirus to be “a public health emergency of international concern” on Jan. 30. But it took until Feb. 17 for the Health Ministry of Japan to even inform the public about when, where and how to contact government health care centers in case of a suspected infection. And it was only this Tuesday that the government finally adopted a “basic policy” for responding to the outbreak — which essentially boiled down to asking people to stay home. As of Wednesday, there were 847 confirmed cases of Covid-19 (and six deaths) in or just offshore of Japan.

Medical professionals are running short of face masks, disinfectant and test kits — and Japan is running short of medical professionals who can perform diagnostic tests. Yet so far Prime Minister Shinzo Abe has rejected the opposition’s demand to increase the budget currently under discussion in Parliament, or the Diet, to help tackle the outbreak; he has said it was premature to assume that the existing budget reserve will be insufficient.

And so the Japanese people have been told not to seek testing, nor bother visiting medical institutions unless their symptoms are severe and lasting. Mr. Abe has, in effect, outsourced the government’s containment efforts to the population itself, while the state concentrates limited resources on the severely ill and makes little effort to increase those resources. He might also have been thinking: With no test, there can be no rise in confirmed cases either.

 

http://blog.with2.net/link.php/36571(ブログランキングをよろしく)

 

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クルーズ船の論文が中国から!


2/22中国からクルーズ船に関する論文が出ている!やはり中国の科学レベルは高い!

Estimation of the reproductive number of Novel Coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: A data-driven analysis

Highlights

The novel coronavirus (COVID-19) pneumonia has caused 355 confirmed cases on the Diamond Princess cruise ship as of February 16, 2020.


We estimated that the Maximum-Likelihood (ML) value of reproductivenumber (R0) was 2.28 for COVID-19 outbreak at early stage on the ship.


If R0 value was reduced by 25% and 50%, the estimated total number of cumulative cases would be reduced from 1514 (1384-1656) to 1081 (981-1177) and 758 (697-817) as of February 26, 2020, respectively.

https://www.sciencedirect.com/science/article/pii/S1201971220300916

https://www.medrxiv.org/content/10.1101/2020.02.21.20026070v1

http://blog.with2.net/link.php/36571(ブログランキングをよろしく)

 

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COVID-19感染者は30万人程度か?


中国の科学のレベルは高い!
医療、医学レベルも高い!
日本は明らかに負けている!

論文の出すスピードが素早い!

しかもレベルが高い!

2/21に下記の論文が出ているのを知っていたが、内容を読んでいなかった!

論文によると、日本のコロナウイルス感染者数は、2/29から上海並みの規制をしたとしても、45万人に達すると。

2/22から始めると、15万人!

2/26から始めているので、感染者数は25-30万人程度か。

厚労省はこの論文の存在を知ったため、厳しい対策が昨日から開始されたのであろう。

https://www.medrxiv.org/content/medrxiv/early/2020/02/23/2020.02.21.20026070.full.pdf

CoVID-19 in Japan: What could happen in the future? | medRxiv

Abstract

We adopt a novel statistical time delay dynamic model proposed in our recent work to estimate the evolution of COVID-19. Based on the cumulative number of confirmed cases and cured cases published daily by government, we effectively simulate and predict the outbreak trend of COVID-19 in different regions in China. Meanwhile, the model reveals the growth rate of the epidemic, through which the basic reproductive number is thus estimated to be 3.25 to 3.4. Then, we apply the model to track the spread of COVID-19 in Japan. We find that the trend of the epidemic in Japan is strikingly similar to that in Wuhan, China at the early stage. Therefore there are reasons to draw a serious concern that there could be a rapid outbreak in Japan if no effective control measures are carried out immediately. Finally, we make a prediction of the future trend of COVID-19 in Japan, and suggest an enhancement of control measures as soon as possible, so as to avoid a severe outbreak

We conclude from Figures 10-19 as follows:
1. l2= l1: If Japanese government does not take any action to restrict the behavior of its people, the number of infected people will lose control, and it will increase exponentially.
2. l2 = 0.38: If the measures taken by the Japanese government are insufficient, the number of infected people will remain increasing exponentially.
3. l2 = 0.39: The measures taken by Japanese government are not sufficient, and the number of infected people will have a vibration rise.
4. l2 = 0.40: The measures taken by the Japanese government are not sufficient, and the number of infected people will rise at a slower rate.
5. l2 = 0.41: The Japanese government has taken sufficient measures to eventually control the number of infections, but the number of infections is relatively large. If measures are taken earlier (2020- 02-22), the scale of infection will be about 1.1 million. If measures are taken later (2020-02-29), the scale of infection will be about 1.7 million.
6. l2 = 0.45: The Japanese government has taken sufficient measures, and the number of infected people will eventually be controlled, but the number of infected people will still be large. If measures are taken earlier (2020-02-22), the scale of infection will be about 45 If the measures are taken later (2020-02-29), the scale of infection will be about 1 million.
7. l2 Same as Shanghai: The Japanese government has adopted the same quarantine measures as Shanghai, and the number of infected people will be better controlled, and the number of infected people will be relatively small. If measures are taken earlier (2020-02-22), the scale of infection will be about 150,000, and if measures are taken later (2020-02-29), the scale of infection will be about 450,000.

6 Discussion
As the epidemic develops, some researchers [12] suggest that substantial measures that limit population mobility should be seriously and immediately considered in affected areas, such as cancellation of mass gathering, school closures and work-from-home arrangements. These strategies, based on our model, could drastically increase the isolation number and thus are beneficial for securing containment of the spread of infection. Furthermore, public education on personal prevention (eg, use of face masks and improved personal hygiene) is also crucial for reducing risk of infection among general public.

https://www.medrxiv.org/content/10.1101/2020.02.21.20026070v1

http://blog.with2.net/link.php/36571(ブログランキングをよろしく)

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COVID-19の致死率は高い!


中日新聞の夕刊の記事から計算、

致死率
中国 2715/78064=3.5%
韓国 12/1146=1.0%
イタリア 11/325=3.4%
日本 3/178=1.7%

当初は湖北省以外の中国での致死率は0.5%だから、大したことないと伝えられていたと思うが、上記の数値を見ると、致死率は明らかにインフルエンザによる致死率より高い。油断していた!

http://blog.with2.net/link.php/36571(ブログランキングをよろしく)

 

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発熱5日目に受診したら、重症で手遅れになるのでは!


日本の状況は極々早期の段階、軽症の人は99.99%は感染していない。

→このように断定する根拠、すなわち、あなたはエビデンスを持っているのですか?

情緒に訴えて現状を過小評価することは非科学的だ。失望しました。

押谷仁教授殿!

PCR検査の少なさから判断すると、患者は前回のように押し寄せていない。

自宅で恐れながら待機しているのでしょう。

開業医での感冒様患者の受診者数は例年と比べて減少している?

季節性インフルエンザのピークが過ぎているので、2日間も発熱があれば、新型コロナウイルス 感染症を除外しないといけないので、マスクを適正に着用して、開業医ではなく、感染症病床のある指定病院を受診した方が良いのでは。

保健所に電話で相談しても、自宅待機と言われるだけ。適切な治療の機会を逃す。

2日間の発熱を経験したことがある人なら分かるが、頭痛がして体がえらい。咳痰があればなおさら苦しい。

他の治療可能な疾患を見逃し、治療のタイミングを逸してしまうのではないか?

発熱5日目に受診したら、重症で手遅れになるのではと危惧する。

http://blog.with2.net/link.php/36571(ブログランキングをよろしく)

 

 

 

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