Why wouldn't the Wuhan scenario play out in my city?
February 7, 2020 10:15 AM   Subscribe

Is this a silly question? I don't really know. I live in a large US city. Could what is happening in Wuhan -- related to the spread and intensity of the coronavirus -- happen here? Why or why not?
posted by nanook to Health & Fitness (20 answers total) 4 users marked this as a favorite
Do you mean specifically with the current novel coronavirus outbreak, or an epidemic in general with similar qualities?
posted by dusty potato at 10:24 AM on February 7

Construct a 645,000-square-foot hospital in 10 days? No way Jose.
posted by humboldt32 at 10:27 AM on February 7 [10 favorites]

I think it is possible that it could spread as quickly and intensely in a US city (definitely not my area of expertise, though). This Lancet article, for example, says "Large cities overseas with close transport links to China could also become outbreak epicentres, unless substantial public health interventions at both the population and personal levels are implemented immediately. Independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions. Preparedness plans and mitigation interventions should be readied for quick deployment globally." U.S. hospitals are preparing.
posted by pinochiette at 10:29 AM on February 7 [2 favorites]

Don't know if this is helpful or not, but since it was also a coronavirus, you might be interested in the Ontario public inquiry into the 2003 SARS outbreak and how it played out in one large North American city (Toronto) vs. another (Vancouver), and recommendations for handling similar public health emergencies in the future:

In Ontario there was a systemic failure to recognize the precautionary principle in health worker safety, and in the identification and diagnosis of a respiratory illness that mimicked the symptoms of other, better-known diseases. Amid this systemic absence of the precautionary principle, it is not surprising that in Ontario, unlike in Vancouver, SARS caused such devastation, infecting 375 people, including 169 health workers, and killing 44, including two nurses and a physician.

There are significant differences in health care delivery in the U.S. relative to Canada, of course, so some of this might be apples-to-oranges, but some of the underlying precautions/responses that are recommended are widely applicable.

Final Report of the SARS Commission

Brief summary in The Lancet

List of recommendations (pdf)

See also:

Learning from SARS: Preparing for the Next Disease Outbreak
posted by mandolin conspiracy at 10:50 AM on February 7 [14 favorites]

Yes, it could absolutely happen here, though it probably wouldn't play out in exactly the same way. I'm going to assume you mean a large epidemic of the Wuhan virus, rather than a novel zoonotic epidemic starting in the US at some point in the future, which the odds of are probably a bit lower, though not zero.

There wouldn't be the same move by the authorities to just sweep everything under the rug at first, but the fact that so many Americans can't afford to go to the doctor, let alone the ER, would probably create a larger reservoir of undiagnosed cases. The fact that you can be infected, not show any symptoms yet, but still be contagious would make it difficult for even the best public health system in the world to stop. The US healthcare system would not be able to shift resources so quickly, because everything is so much more expensive. Building a 645K square foot hospital in the US at all costs north of $300M (could be more than twice that in a large city) - to do it in a week would be tens of billions if it could even be done.

A major issue, in a scenario where the Coronavirus has gone pandemic to the point where there are large epidemics in US cities, would be the supply chain, particularly for medical supplies. A huge portion of the world's medical supply chain runs through China. There's a already a worldwide shortage of surgical masks, for example, because the Chinese are now diverting all of their own production for internal use, some hospitals in the West are already rationing them. In this scenario, the same would probably apply to all sorts of medical supplies and general manufactured goods as China deals with a nationwide outbreak.

I don't think the death toll from the virus itself would be huge - it's highly contagious. but the mortality rate is only about 5%. However you would see huge disruption, most forms of economic activity in the city would stop for weeks or months, and more people might die from poverty, and from other health conditions that they were unable to get treated due to the health system being overwhelmed, than from the virus itself.

I think there would also be huge issues here with rumors and misinformation spreading via social media, and I wouldn't rule out the possibility of violence, either against people of East Asian descent, quarantine centers (this has already happened in Hong Kong), or the authorities in general. Also a high possibility of generalized police violence against minorities they identify as "looters", etc., as happened in New Orleans after Katrina.
posted by strangely stunted trees at 11:25 AM on February 7 [10 favorites]

From mandolin conspiracy's link to List of recommendations, the actual PDF is here and the summary of recommendations is near the bottom.
posted by anadem at 11:36 AM on February 7 [2 favorites]

The pictures used to boast about the “hospital built in 10 days!” turned out to be marketing materials for modular buildings in an entirely different country FWIW.
posted by sideshow at 11:55 AM on February 7 [10 favorites]

Yes, I do mean specifically the Wuhan coronavirus and what the possibility is that we might see an extreme situation play out in US cities.

"...but the mortality rate is only about 5%.." And not to threadsit, but that seems high? And maybe a conservative estimate?
posted by nanook at 12:12 PM on February 7

A mortality rate of 5% is rather high. SARS was about 10% and epidemiologists were losing their shit. However, no one knows what the actual novel coronavirus mortality rate is yet. I've seen estimates ranging from 2-3%; I have not seen 5%.
posted by Automocar at 12:15 PM on February 7 [3 favorites]

There have been fake pictures circulated of the new hospital, probably circulated by the Chinese Government to make it look nicer than it is, but the facility itself is real, or convincing enough to fool credible journalists.

Yeah, the case fatality rate is a very rough estimate now. Here's an article from Caixin that lays out the range - says they've experienced 4.9% in Wuhan city itself, and 2.1% across all of China, but it's also a mainland Chinese source so who knows the accuracy. Caixin says the 4.9% is probably driven by the extent to which the healthcare system became overwhelmed in Wuhan, so I'd say a bit below 5% is as reasonable an estimate to use in a citywide epidemic with a degraded local health system as anything else we know right now.
posted by strangely stunted trees at 12:31 PM on February 7

Construct a 645,000-square-foot hospital in 10 days? No way Jose.

My understanding is that the U.S. National Disaster Medical System is organized differently and that the way it works is that Disaster Medical Assistance Teams (civilian primary care treatment teams) are sent to disaster/epidemic areas and then patients who need more treatment are moved to hospitals with excess capacity out of the disaster area by military transport. There's some excess capacity in the hospital system in general and more would presumably be created by deferring all elective procedures and non-urgent medical care.
posted by Jahaza at 12:42 PM on February 7

And not to threadsit, but that seems high? And maybe a conservative estimate?

5% is high compared to regular flu, but low compared to other pandemic flu. Ten years ago, Swine Flu had a death rate of 10%. Unless you are very young or very old, your chance of dying from Corona are actually low.
posted by DarlingBri at 1:05 PM on February 7 [4 favorites]

Epidemiologist chiming in. Short answer: yes, it can happen here. In epidemiology, there's a subspecialization that focuses on the threat posed by emerging infectious disease. In a nutshell, if one's just learning what to look for in an outbreak context then the precise location is, in many ways, interchangeable (I'm grossly overgeneralizing). We still talk about HIV as an illustrative case study here, since no amount of healthcare infrastructure can accommodate unknown/long latency, especially in the period during which diagnosis is purely via clinical syndrome rather than a rapid, direct test for the causative agent. There's an awful lot of modeling that goes into trying to anticipate how human populations move about and interact, and the factors invovled in those modeling calculations very quickly get complicated and chaotic--like a weather forecast, in which confidence in predictions drops sharply over time.

This isn't to fearmonger, it's just a reflection of how diseases work in populations. Every new outbreak of every emerging disease is the grist for the mill of retrospective understanding.
posted by late afternoon dreaming hotel at 1:24 PM on February 7 [17 favorites]

Construct a 645,000-square-foot hospital in 10 days?

I don't know about the US but Canada could build a proportionally sized facility if we wanted to. It would cost a shit ton of money because we don't have significant construction staff on tap in our military but the build is essentially plugging together modules.

The US has a couple dozen portable surgical hospitals each with 248 beds. They are soft sided with some rigid buildings because they are designed to be air portable but the effect is the same (and the previous Beijing rapid build hospital was abandoned after the crisis which to me implies these hospitals aren't much better than tents anyways at least as far as durability and maintainability goes (IE: not all hospitals are created equally)). It's wizard international propaganda though. They could be deployed to a quarantine area.

Had to imagine the US being able to put an actual quarantine around a significant area though unless it was like Hawaii or something with a natural barrier. If nothing else the coming for our guns crowd would lose their shit.
posted by Mitheral at 2:53 PM on February 7 [3 favorites]

Yeah, I lived through SARS (I didn’t have it) and lost an acquaintance but I feel like the mistakes that were made are largely not repeating. Toronto culture also shifted around coughing; coughing into your sleeve was drilled into everyone and it’s now common among the youth and kids I work with...I’m not sure it’s highly effective or anything but it was interesting to watch. I’m really glad I’m not in cancer treatment right now though. But it definitely can happen here.

To add to your thoughts, this hospital was built afterwards and would hopefully help.
posted by warriorqueen at 4:55 PM on February 7 [1 favorite]

The US has a couple dozen portable surgical hospitals each with 248 beds. They are soft sided with some rigid buildings because they are designed to be air portable but the effect is the same

This gets to the nub of it. The 10-day build Chinese hospital is supposed to support 1000-1500 beds. At a guess the U.S. military has 5000+ beds ready to deploy.

Of course the same is probably true of the Chinese military. I wonder why someone felt the need to build a structure?
posted by Tell Me No Lies at 6:22 PM on February 7

I think the situation in Wuhan is not the same as what would happen in a major US or Western city. From what I’ve read, the most likely way to get the virus is from close contact with an infected person. It may be possible to get it on public transport but its probably more likely to happen in clusters of people living together. Look at how fast it’s spread on the cruise ship. This is because, like norovirus, it spreads when someone sneezes on the salad bar or goes to the bar and eats the snacks provided after using the restroom without washing their hands.

What I’ve read is that the most likely places to pick it up are in food prepared by a sick person, at home with a sick person, or in the hospital or at the doctor with a sick person. So how is Wuhan so bad and the rest of the world isn’t? How is it not just a matter of time before we are all Wuhan?

Something in Wuhan that isn’t the same as in a major US city: we know about it. At first it was just unknown in to everyone in Wuhan. Then it WAS known and nobody took measures to stop it and even actively tried to stop the measures to curb it.

Here in the U.K. we are all on alert. And so are the officials. And in the US and all around Europe. If someone presents symptoms, people ask: have you been to Asia in the last 2 weeks? And if so measures are taken. People are quarantined and tested, in environments where they couldn’t spread the virus easily if they are infected.

If someone is infected, officials track down everyone they came in contact with.

In Wuhan, none of this happened until it was too late. Hospitals let people in and those people infected eachother and the hospital staff and vice versa. Now as they have gotten some help and have more knowledge we are seeing the infection rate slow a bit. It’s still going up but it’s not doubling anymore. A good sign though we aren’t out of the woods at all.

Also, we know more now. We know more about how it spreads, we know more about what symptoms to look out for, and we know more about who might need treatment and when.

I am so devastated for the people of Wuhan. They have suffered so much and likely will continue to. I think it is possible for an outbreak to hit a nation like the US as it has hit Wuhan, particularly if the US descends into more totalitarian madness. But I don’t think that it is going to happen with this particular one.

It’s not going to just go away, either, but I don’t think we are in danger of experiencing what is happening in the Hubei province. I hope!
posted by pazazygeek at 2:47 AM on February 8

I'm of the opinion that we might actually find ourselves in a worse mess, should an out-of-hand scenario start in a US city. I have zero faith that the majority of people would listen to a quarantine request, and I'd imagine that any attempt at forcing a quarantine would lead, very quickly, to civil unrest.

Put it this way. The Chinese KNOW exactly how far their government will go to enforce quarantine. In the US, that level of quarantine is unlikely to even be considered, let alone attempted... and if it was, I suspect that would be an even bigger nightmare than the virus. Especially in a US city, and I suspect some cities would be more... combustible? than others.
posted by stormyteal at 8:37 AM on February 8 [2 favorites]

If you're looking for detailed ongoing coverage in English, Caixin, the website that strangely stunted trees linked upthread, is really good. Some of it requires a subscription, but their page devoted to epidemic updates requires only a registration. There are a number of free-with-registration articles about the coronavirus, including a sad long-form interview with an ER doctor in Wuhan who is preparing a paper about transmission and mortality rates.
posted by Frowner at 8:55 AM on February 8

Just for anybody who comes back to this thread later, I want to say that obviously it turns out I was wrong about the authorities not sweeping it under the rug.
posted by strangely stunted trees at 6:21 PM on March 12

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